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Immunohematology (Blood Banking) (Lecture) > Chapter 6: The ABO Blood Group System (P) > Flashcards

Chapter 6: The ABO Blood Group System (P) Flashcards

1
Q

What is the most important blood grp system among all blood grps in transfusion practice?

A

The ABO system

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2
Q

What is the characteristic of ABO blood grp system?

A

It is the only blood grp system in w/c people have Abs in their serum to Ags that are absent from their RBCs

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3
Q

What is the result since Abs are present in the ABO blood grp system?

A

Due to these Abs, transfusion of incompatible ABO type may result in immediate lysis of donor’s RBCs

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4
Q

What is the leading cause of death that is still present until today?

A

Transfusion of wrong ABO grps w/c results in hemolytic transfusion rxn fatalities reported by FDA

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5
Q

What are the processes or principles present under routine ABO testing?

A

1) Forward grouping

2) Reverse grouping

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6
Q

What is the principle of forward grouping?

A

The pt’s RBCs w/ commercial antisera

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7
Q

What is the principle of reverse grouping?

A

The pt’s serum w/ commercial RBCs

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8
Q

What are the routine rgnts used for ABO testing (in forward typing)?

A

1) Anti-A
2) Anti-B
3) Anti-D
4) Rh Control

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9
Q

What are the routine rgnts used for ABO testing (in reverse typing)?

A

1) A1 cells
2) B cells
3) A2 cells: also available but not routinely used

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10
Q

*What are the concepts for routine ABO testing?

A

1) Ags are present on the RBCs

2) Abs are present in the pt’s plasma / serum

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11
Q

Answer the ff questions w/ regards to ABO frequencies in the given blood grp:

1) What is the frequency of ABO for white individuals?
2) What is the frequency of ABO for black individuals?

Given blood grp: O

A

1) 45%

2) 50%

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12
Q

Answer the ff questions w/ regards to ABO frequencies in the given blood grp:

1) What is the frequency of ABO for white individuals?
2) What is the frequency of ABO for black individuals?

Given blood grp: A

A

1) 40%

2) 26%

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13
Q

Answer the ff questions w/ regards to ABO frequencies in the given blood grp:

1) What is the frequency of ABO for white individuals?
2) What is the frequency of ABO for black individuals?

Given blood grp: B

A

1) 11%

2) 20%

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14
Q

Answer the ff questions w/ regards to ABO frequencies in the given blood grp:

1) What is the frequency of ABO for white individuals?
2) What is the frequency of ABO for black individuals?

Given blood grp: AB

A

1) 4%

2) 4%

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15
Q

What is the relationship bet forward and reverse typing?

A

Forward typing is inversely related to reverse typing

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16
Q

Is reverse typing performed in infants? Why or why not?

A

No, because they do not have ABO Abs at birth

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17
Q

Since reverse typing is not performed to infants, what is only performed?

A

Forward typing

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18
Q

In reverse typing for infants, what is the sx used?

A

Cord blood

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19
Q

Most Abs present in the cord blood serum are from whom?

A

From the mother (maternal)

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20
Q

Reciprocal ABO Abs are what?

A

These are naturally occurring Abs

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21
Q

*When are reciprocal ABO Abs fully developed?

A

These are fully developed at 3 - 6 mos after birth

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22
Q

*Postulated role of bacteria

A
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23
Q

*What is the predominant Ig present in ABO Abs?

A

IgM (pentamer)

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24
Q

What is the main Ig present in anti-A (from a B person) and anti-B (from an A person)?

A

IgM

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25
Q

Even if IgM is mainly present in anti-A and anti-B, what is the other Ig present in small quantities in anti-A and anti-B?

A

Small quantities of IgG

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26
Q

*What are the Abs produced by O persons?

A

1) Anti-A
2) Anti-B
3) Anti-A,B

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27
Q

What Ig is anti-A,B?

A

IgG

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28
Q

True or False

Anti-A,B is a combination of anti-A and anti-B

A

False, because anti-A,B is not a combination of anti-A and anti-B

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29
Q

*What is the characteristic of anti-A,B?

A

It is a separate “cross-reacting” Ab

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30
Q

*What are the fxns of ABO Abs?

A

1) To activate complement

2) To produce strong direct agglutination rxns

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31
Q

*At what temp are ABO Abs present (or stable?)?

A

Room temp (22 DC) or colder

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32
Q

*What are the characteristics of the rgnts used in routine ABO testing?

A

1) Rgnt anti-A is used
2) Rgnt anti-B is used
3) Rgnt anti-A,B is used
4) Can be monoclonal antisera
5) Can be polyclonal antisera
6) Considered in routine blood bank testing

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33
Q

Is rgnt anti-A,B routinely used? Why or why not?

A

It is not routinely used because commercial, monoclonal anti-A and anti-B can detect most weak A and B Ags

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34
Q

What is the contribution of the work of Bernstein?

A

It is the 1st to demonstrate inheritance of ABO gene - one from both parents

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35
Q

When is the work of Bernstein presented?

A

1924

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36
Q

*What are the characteristics of inheritance by Mendelian genetics?

A

1) Codominant expression
2) O gene is considered an amorph
3) O phenotype can only be produced by 2 O genes (OO)
4) Phenotype vs Genotype

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37
Q

Why is O gene considered an amorph?

A

Because there is no detectable Ag produced by the inheritance of this gene

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38
Q

What is the corresponding phenotype of the given genotype?

Given genotype: A1A1

A

A1

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39
Q

What is the corresponding phenotype of the given genotype?

Given genotype: A1A2

A

A1

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40
Q

What is the corresponding phenotype of the given genotype?

Given genotype: A1O

A

A1

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41
Q

What is the corresponding phenotype of the given genotype?

Given genotype: A2A2

A

A2

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42
Q

What is the corresponding phenotype of the given genotype?

Given genotype: A2O

A

A2

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43
Q

What is the corresponding phenotype of the given genotype?

Given genotype: A1B

A

A1B

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44
Q

What is the corresponding phenotype of the given genotype?

Given genotype: A2B

A

A2B

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45
Q

What is the corresponding phenotype of the given genotype?

Given genotype: OO

A

O

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46
Q

What is the corresponding phenotype of the given genotype?

Given genotype: BB

A

B

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47
Q

What is the corresponding phenotype of the given genotype?

Given genotype: BO

A

B

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48
Q

ABH Ag formation results from what?

A

It results from the interaction of genes at 3 separate loci (ABO, Hh, and Se)

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49
Q

*What is the characteristic of the genes that interact w/c results to ABH Ag formation?

A

These genes do not code for production of Ags but rather to produce sp glycosyltransferases that add sugars to a basic precursor substance

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50
Q

What is the characteristic of H Ag?

A

It is the precursor structure on w/c the A and B Ags are made

51
Q

Where are H and Se genes present?

A

These are present on chromosome 19

52
Q

What is the relationship bet H and Se genes?

A

These are closely linked

53
Q

Se gene are inherited to form what?

A

To form the ABO Ags in secretions

54
Q

*At what age grp are A, B, and H Ags produced?

A

In fetal and adult life

55
Q

What is the percentage of Ags present in the RBCs of newborns in comparison to those found on adult RBCs?

A

25 - 50% of Ags of those that are found in adult RBCs

56
Q

What is the result since RBCs of newborns carry 25 - 50% of Ags to those found on adult RBCs?

A

Newborn rxns in the forward typing are weaker than those in adults

57
Q

When are ABO Ags fully expressed?

A

These are fully expressed at 2 - 4 yrs of age

58
Q

Are ABO Abs present until 3 - 6 mos?

A

No, these are not present until 3 - 6 mos

59
Q

Immunodominant sugars confer what?

A

These confer blood grp specificity

60
Q

What is the immunodominant sugar present to the given gene and Ag?

Given gene and Ag: H

A

L-fucose

61
Q

What is the immunodominant sugar present to the given gene and Ag?

Given gene and Ag: A

A

N-acetyl-D-galactosamine

62
Q

What is the immunodominant sugar present to the given gene and Ag?

Given gene and Ag: B

A

D-galactose

63
Q

Where is ABO gene located?

A

It is located on chromosome 9

64
Q

What is the composition of ABO gene?

A

It consists of 7 exons

65
Q

*What is present at the ABO locus?

A

Diversity

66
Q

What are integral parts of the membranes of various cells?

A

ABH Ags

67
Q

Where can ABH-soluble Ags be found?

A

These can be found in all body secretions

68
Q

*ABH-soluble Ags w/c are present in secretions is dependent on what?

A

These are dependent on ABO and secretor genes inherited

69
Q

*Are nonsecretors possible to be dependent on ABO and secretor genes inherited?

A

Yes

70
Q

What are ABO subgrps?

A

These are phenotypes that show weaker variable serological reactivity w/ the commonly used human polyclonal anti-A, anti-B, and anti-A,B rgnts

71
Q

What type of rgnts are used routinely for ABO subgrps?

A

Monoclonal typing rgnts

72
Q

Who 1st described A subgrps?

A

von Dungen

73
Q

When are A subgrps 1st described?

A

1911

74
Q

What are the A subgrps?

A

1) A1 subgrp

2) A2 subgrp

75
Q

At what aspects are A1 and A2 different?

A

1) Quantitative

2) Qualitative

76
Q

Which is more generally common bet A subgrps and B subgrps?

A

A subgrps generally are more common > B subgrps

77
Q

*What is present among A subgrps?

A

Differences in conversion of H precursor substance

78
Q

*What are present at the ABO locus?

A

Effects of polymorphism

79
Q

*What is the result if forward grping rgnt anti-A is used?

A

It strongly agglutinates both A1 and A2 phenotypes

80
Q

What are the fxns of anti-A1 lectin rgnt (in connection w/ A subgrps)?

A

1) It is used in the differentiation of A1 and A2 phenotypes

2) It agglutinates A1 (or A1B) cells but does not agglutinate A2 (or A2B cells)

81
Q

What are the exs of lectins used in BB?

A

1) Dolichos biflorus
2) Bandeiraea simplicifolia
3) Ulex europaeus

82
Q

What is the fxn of Dolichos biflorus?

A

It agglutinates A1 or A1B

83
Q

What is the fxn of Bandeiraea simplicifolia?

A

It agglutinates B cells

84
Q

What is the fxn of Ulex europaeus?

A

It agglutinates O cells (H specificity) and other ABO blood grps depending on the amt of H Ag available

85
Q

*Do the concentration of H Ag vary among blood grps?

A

Yes

86
Q

What is occasionally found in the serum?

A

Anti-H

87
Q

*What are the characteristics of H Ag?

A

1) It is a naturally occurring IgM cold agglutinin that reacts best below room temp
2) It can produce possible problems in Ab screening procedures
3) It can be detected via the use of anti-H lectin

88
Q

*What is the frequency of appearance of subgrps weaker than A2?

A

These occur infrequently

89
Q

*How are weak A subgrps most often recognized?

A

These are most often recognized through an ABO discrepancy (unexpected rxns in the forward and reverse grping)

90
Q

*varying expression of 4 characteristics

A
91
Q

Weak A subgrps can be distinguished as what?

A

1) A3
2) Ax
3) Aend
4) Am
5) Ay
6) Ael

92
Q

What are the characteristics of weak B subgrps?

A

1) These are very rare and less frequent > A subgrps
2) These are usually recognized by variations in the strength of the rxn using anti-B and anti-A,B antisera
3) These are the result of alternate alleles at the B locus

93
Q

*How many criteria are used for differentiation of weak B phenotypes?

A

5

94
Q

What can be used to characterize B subgrps as weak B subgrps?

A

Serologic techniques

95
Q

*What are the ff categories of B subgrps w/c are considered as weak B subgrps?

A

1) B3
2) Bx
3) Bm
4) Bel

96
Q

The Bombay phenotype is denoted as what?

A

Oh

97
Q

Who 1st reported the Bombay phenotype?

A

Bhende

98
Q

When did Bhende 1st reported the Bombay phenotype?

A

1952

99
Q

When did Bhende 1st reported the Bombay phenotype?

A

In Bombay, India

100
Q

What is the characteristic of hh genotype?

A

It is a very rare genotype

101
Q

How can genotype hh be produced?

A

Via the inheritance of a double dose of the h gene

102
Q

What are the characteristics of the Bombay phenotype?

A

1) It has no H Ag made
2) ABO genes can’t be expressed
3) ABH genes can’t be formed
4) RBCs are devoid of normal ABH Ags
5) It fails to react w/ anti-A, anti-B, and anti-H
6) It is an IgM Ab

103
Q

If only anti-A and anti-B antisera are used in RBC testing, the Bombay would phenotype as what blood grp?

A

O blood grp

104
Q

Where is anti-H occasionally found?

A

In the serum of A1 and A1B individuals

105
Q

The Bombay anti-H can often be potent and reacts strongly at what temp?

A

37 DC

106
Q

What are the fxns of the Bombay phenotype?

A

1) It can bind complement

2) It can cause RBC lysis

107
Q

True or False

Considerations for transfusions for Bombay phenotype must be present

A

True

108
Q

Who is/are the pt/s that can donate blood to a pt w/ Bombay phenotype?

A

Blood w/ Bombay phenotype is the only blood that is compatible

109
Q

Why should only a Bombay (donor) can donate blood to another Bombay (recipient)?

A

Because underlying molecular defect of the Bombay phenotype may be present

110
Q

What are the characteristics of Para-Bombay phenotypes?

A

1) These are rare phenotypes
2) RBCs are completely devoid of H Ags or
3) Small amts of H Ag are present

111
Q

*True or False

ABH Ags and leukemias are associated

A

True

112
Q

Leukemias that are associated w/ ABH Ags demonstrates what?

A

Hypogammaglobulinemia

113
Q

Provide an ex of leukemia w/c is associated w/ ABH Ags

A

Chronic lymphocytic leukemia (or Chronic lymphoid leukemia) (CLL)

114
Q

*What are the diseases that can be present in ABH Ags and Abs in disease?

A

1) Other leukemias w/ chromosome 9 translocations
2) Any hemolytic disease inducing stress hematopoiesis (ex. thalassemia)
3) Acquired B phenomenon in grp A1 individuals

115
Q

What are the causes of the occurrence of unexpected rxns in the forward and reverse grping?

A

1) Problems w/ the pt’s serum
2) Problems w/ the pt’s RCs
3) Problems w/ both the serum and cells

116
Q

What is affected if problems w/ the pt’s serum (as cause of occurrence of unexpected rxns in the forward and reverse grping) are present?

A

Reverse grping

117
Q

What is affected if problems w/ the pt’s RCs (as cause of occurrence of unexpected rxns in the forward and reverse grping) are present?

A

Forward grping

118
Q

What is affected if problems w/ both the pt’s serum and cells (as cause of occurrence of unexpected rxns in the forward and reverse grping) are present?

A

Forward and reverse grping

119
Q

What is the characteristic of ABO discrepancies?

A

These can appear as extra (+) or weak / missing rxns

120
Q

What must be done to ABO discrepancies if these are present prior to reporting a pt or donor’s ABO grp?

A

These must be resolved

121
Q

What are the resolutions that can be done to common grp II discrepancies?

A

1) Enhancing weakly reacting Ags w/ room temp incubation
2) Pretreatment of RBCs w/ enzymes
3) In connection to acquired B Ag

122
Q

What are the diff categories of ABO discrepancies?

A

1) Grp I discrepancies
2) Grp II discrepancies
3) Grp III discrepancies
4) Grp IV discrepancies

123
Q

What are the resolutions for common grp III discrepancies?

A

1) In connection to effects of rouleaux

2) In connection to effects of Wharton’s jelly

124
Q

What are the resolutions for common grp IV discrepancies?

A

1) In terms for consideration of cold autoAbs
2) The pt’s RBCs can be tested w/ Dolichos biflorus to confirm the presence of an ABO subgrp
3) Unexpected alloAbs in the pt’s serum other than ABO isoagglutinins may cause a discrepancy in the reverse grping

Immunohematology (Blood Banking) (Lecture) (10 decks)

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