BLOOD GROUPS &

TRANFUSION
By

Dr.H.Gusbakti, MSc,PKK,AIFM,
Professor of Physiology
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HISTORICAL

19th CENTURY: Boer War

Massive deaths of people:

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Many infections
Severe blood loss

Attempts to transfuse blood began.

They had confusing results.
Some people recovered fully.
Others died.
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WHY? WHY? WHY?

Either all should die
Or all should live.
Why this difference?
This question haunted a
researcher called Karl
Landsteiner.
He worked hard to find out
why.

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KARL LANDSTEINER, NOBEL

LAUREATE, 1930.

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KARL LANDSTEINER

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Wondered about this phenomenon.

Studied this extensively.
Discovered Blood Groups and types
single handedly.
Framed the Landsteiners Law in
1904.
Continued to research on Blood
groups and types till his death in
1943.
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LANDSTEINERS LAW
1.If an agglutinogen is present in
the red cells of a blood, the
corresponding agglutinin must
be absent from the plasma.
2. If an agglutinogen is absent in
the red cells of a blood, the
corresponding agglutinin must
be present in its plasma.
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LANDSTEINERS LAW:
APPLICABILITY

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The first law is applicable to all

groups and types of blood.
It is a logical conclusion.
The second part is a fact, but not
necessarily true always.
It is a fact for ABO Blood groups.
The Rh, M,N and other groups or
types do not follow the second
part of the Landsteiners Law.
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ABO BLOOD GROUPS

The most common type of
blood grouping in use.

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AGGLUTINOGENS

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Also called antigens.

These agglutinogens are present
on the outer surface of the
Erythrocyte membranes.
They are antigenic and have
epitopes or antigenic determinants,
which are glycoproteins.
In ABO groups, three types of
agglutinogens can be present.
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AGGLUTINOGENS (Contd)

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Some individuals will have

Erythrocytes with an agglutinogen
called as A.
Others have one called B
The third type of agglutinogen is non
antigenic and it is called H
H doesnt cause production of
antibodies.
So those having H antigen are called
O group individuals.

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A AND B, INDIVIDUALS

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Those having the A agglutinogen

on their erythrocytes are called
A blood group people.
Those having the B agglutinogen
are called the B blood group
people.

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AB & O INDIVIDUALS

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Some have both the A and B

agglutinogens on their
erythrocytes and they are called
AB type.
Others have neither A nor B
agglutinogens. They have the
non antigenic H on their RBCs
and are called O group people.
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AGGLUTININS

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The antibodies to the agglutinogens

are called Agglutinins.
These are present naturally in ABO
groups.
They are always present in the
plasma of the individual.
There are two types of agglutinins
in the ABO blood system:
Anti A or : Alpha
Anti B or : Beta
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AGGLUTININS (Contd)

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The A group people have the Beta or

anti B agglutinin in their plasma.
Similarly the B group people have the
Alpha or Anti-A agglutinin in their
plasma.
The AB group of people have no
agglutinins in their plasma.
The O group people have both Alpha
and Beta types of agglutinins in their
plasma.
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ABO BLOOD GROUPS

GROUP AGGLUTINOGEN/S AGGLUTININ/S
ON RBC
IN PLASMA
A

AB

Both A & B

None

Neither A nor B

Both and

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ABO BLOOD GROUP TEST

Why test?
To determine the blood
groups.
How is the test done?
The erythrocytes of the
patient are exposed to the two
different types of anti sera.

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ABO BLOOD GROUP TEST

Antisera are solutions containing the

respective agglutinins.
Anti A agglutinin is present in Antisera A
Anti sera B contains Beta agglutinin or
anti B agglutinin.
In this test the patients erythrocytes are
exposed separately to both these
antisera.
Agglutination is seen in one or more of
the solutions.

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AGGLUTINATION

Agglutination or clumping is seen

whenever the respective agglutinogens
and agglutinins are mixed.
Agglutinogen A + Agglutinin = Agglutination.
Agglutinogen B + Agglutinin = Agglutination.
Both agglutinogens + Both antisera = Agglutination.
No agglutinogens = No agglutination.

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ABO BLOOD GROUP TEST

If there is agglutination with antisera
A, the blood group of the individual will
be A.
If there is agglutination with antisera
B, the blood group of the individual is
B.
If there is agglutination with both the
antisera, then the blood group is AB.
If there is no agglutination with either
of the two antisera, then the person is
of the group O.
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ABO BLOOD GROUP TEST

By doing this test we can

determine the blood group of
individuals.
Knowing ones blood group helps
us in times of need. If a patient is
of Group A, he can receive blood as
transfusion from group A or group
O individuals. He cannot receive it
from Group B or Group AB people.

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ABO BLOOD GROUP TEST

Why?
Because the agglutinogens in
the donors blood can
agglutinate with the
agglutinin in the recipients
blood and cause hemolysis.
This is called transfusion
mismatch and can be fatal.

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UNIVERSAL DONOR &

RECEPIENTS

The blood group O can be given to

any other of the ABO group
persons and so is called the
Universal Donor
The blood group AB persons lack
agglutinins and so can receive
blood from any of the ABO group
persons. So this AB group is called
as the Universal Recipient

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DONATIONS

A Blood group person can donate

blood to A and AB groups.
B Blood group person can donate
blood to B and AB groups.
AB Blood group person can
donate blood only to AB group.
O blood group person can donate
blood to O, A, B and AB groups.

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ABO BLOOD GROUP TEST:

SUMMARY
RED
CELLS
A

ANTISERA
ALPHA
AGGLUTINATIO
N

ANTISERA
BETA
NO
AGGLUTINATIO
N

NO AGG.

AB

AGGLUTINATIO
N
NO
AGGLUTINATIO

AGGLUTINATIO
N
AGGLUTINATIO
N
NO
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AGGLUTINATIO

O
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CROSS MATCHING
This is a test done just
before the blood is
transfused.
It helps rule out other group
mismatches.
It has two parts: Major &
Minor cross matching.

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MAJOR CROSS MATCHING

The effects of the recipients

serum agglutinins on the
donors erythrocytes.
This is called major because
about 300 ml of the Blood cells
of the donor are sent into the
circulation of the recipient.
Donors Erythrocytes+
Recipients plasma= ?

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MINOR CROSS MATCHING

The Effect of the donors serum

agglutinins on the recipients
erythrocytes.
This is called minor because these
agglutinins get diluted by the
larger volume of the recipients
plasma.
Donors Serum + Recipients
Erythrocytes

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PERCENTAGE OF BLOOD
GROUPS

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PERCENTAGE OF BLOOD
GROUPS

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Rh TYPING:
INTRODUCTION

It is the second most important

typing of blood.
These blood groups were originally
discovered in Rhesus monkeys
Rh is another type of
agglutinogen.
It is also present on the outer
surface of the erythrocytes.

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Rh Positive and Negative

people

People who have the Rh

agglutinogen on their RBC
membranes are called Rh Positive.
Those who do not have the Rh
agglutinogen are called Rh Negative
people.
Rh-ve people do not NATURALLY
carry the corresponding Anti-Rh
antibody.

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DISTRIBUTION OF Rh
TYPES

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DISTRIBUTION OF Rh
TYPES

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Rh or D Agglutinins

Anti-D agglutinins or antibodies do not

occur naturally.
They are produced by the Immune
systems as and when it is exposed to
the D antigens.
So these Anti D agglutinins are found
only in some of the Rh Negative
people.
Those who have been exposed to the
Rh or D antigen

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Exposure to Antigens:
How?

The Rh+ve people will never

manufacture Anti D antibodies.
Only Rh ve individuals can develop
these Agglutinins.
When these Rh-ve people receive
Rh+ve blood by mistake, they get
exposed to the antigen.
Then they will develop the
antibody.

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Exposure to Antigens:
How?

In case of an Rh-ve woman, if

she is married to an Rh+ve man,
she can conceive an Rh+ve
child.
In this case, the D antigen
present on the erythrocytes of
the fetus does not go into the
maternal circulation throughout
the pregnancy (due to the FetoPlacental barrier)
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Exposure to Antigens:
How?

During the delivery of the baby,

some blood of the fetus spills over
into the maternal circulation.
The maternal circulation is
exposed to the D antigens from
the fetal erythrocytes.
The maternal circulation slowly
develops Anti D antibodies.
The first child is however spared.

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ERYTHROBLASTOSIS FETALIS

The second child in such a woman, if

also Rh+ve, can develop a disease
called as Erythroblastosis fetalis.
This is due to the Anti D antibodies
developed in the mother.
These antibodies traverse through
the placenta, enter the fetal
circulation and cause agglutination
of the erythrocytes of the fetus.

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PATHOPHYSIOLOGY OF
ERYTHROBLASTOSIS FETALIS
MATERNAL
CIRCULATION
Anti-D
Antibodies

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P
L
A
C
E
N
T
A

FETAL
CIRCULATION

Agglutination of RBCs
Hemolysis

Hemoglobin in Plasma
Blocks Renal
Tubules

Bilirubin

Jaundice
Renal Failure

Kernicterus
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NORMAL

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JAUNDICED

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ERYTHROBLASTOSIS FETALIS or
ICTERUS GRAVIS NEONATORUM

Rh+ve children of an Rh-ve mother

If it is of severe nature, bilirubin
may enter te brain to cause
kernicterus
The fetus may become groosly
edematous (swollen).
This is called Hydrops fetalis
Such fetuses may die in utero or
hours after preterm or term birth

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ERYTHROBLASTOSIS:
PREVENTION

All pregnant women to be tested

for Rh.
If any are Rh-ve, their husbands
also to be tested for Rh.
The first babys blood to be
tested for Rh.
If Rh+ve, then the mother to be
given Rhogam injection within 24
hrs after delivery.
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TREATMENT OF
ERYTHROBLASTOSIS

EXCHANGE TRANSFUSION.
The entire blood of the fetus is
replaced by O Rh-ve blood.
This is done in small installments.
Once it is done, slowly the baby
will recover, as erythropoiesis
occurs while these O ve cells die.

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EXCHANGE TRANSFUSION

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AFTER SUCCESSFUL THERAPY

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USES OF BLOOD GROUPS

CLINICAL:

MEDICOLEGAL:

For transfusion of blood

To prevent Erythroblastosis fetalis
Determination of suspected parentage
Can say whether one could or could
not have been the father of a child.
DNA fingerprinting is more specific.

GENETIC STUDIES: EPIDEMIOLOGY.

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INCOMPATIBLE
TRANSFUSIONS CAUSE
MILD REACTIONS SUCH AS:
Chills and rigors
Fever
Inapparent Hemolysis.
Post transfusion Jaundice.
Severe transfusion reactions.
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SEVERE TRANSFUSION
REACTIONS

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Violent Backaches.
Tightness in the chest.
Jaundice.
Oliguria.
Renal Shutdown/Failure.
Anuria
Death
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Blood
Transfusion

OLEH
PROF.Dr.H.GUSBAKTI,MSc,PKK,AIFM
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Communication
between
clinicians and
the Blood Bank
is vital!
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Role of the
Clinician
Ensure that the right
blood gets to the right
patient at the right time
Follow the correct
procedures for the
ordering, collection and
administration of blood/
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Complete the blood

request
form
Order blood in
advance,
if possible
Provide clear
information on blood
products being
requested, #units
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Compatibility
The clinician should;
1.complete all required
details on the blood
request form
2. accurately label blood
sample tubes
3. check the identity of
the patient, the product
and the documentation
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Safe Transfusions
Depends on avoiding
incompatibility between the
donors red cells and the
antibodies in the patients
plasma
Severe acute hemolytic
transfusion reactions are
nearly always caused by
transfusing red cells that are
incompatible with the patients
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2 Main Reasons
for Transfusing
Blood
Restore or maintain
bodys
oxygen-carrying
capacity
Maintain the volume of
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Storing Blood
The storage
temperature for
blood is +2C and
+8C
Red cells or whole
blood must never be
allowed
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Plasma

Fresh frozen plasma (FFP)

plasma that has been
separated from a unit of
whole blood within 6-8
hours of donation,
maintained at a
temperature of -20C or
lower
(given to a patient to
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For plasma volume

replacement crystalloids
and colloids are
recommended.
(FFP should be given
only when these are
unavailable, and as a
life-saving procedure)
Plasma contains water,
electrolytes, clotting
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Factors VIII and V deteriorate

if plasma
is not stored at -20C or
less
Other clotting factors stable
at refrigerator
temperatures.
Plasma must be frozen solid
at all times
There is no lower limit for
storage of frozen plasma.
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Transporting
Temperature must be
maintained at negative
20 degrees Centigrade
or lower

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Thawing
Before use, fresh frozen
plasma must be thawed in
water which is between
30C and 37C (Use a
thermometer)
Do not heat to more than
37C. (destroys clotting
factors and proteins)
While thawing, put inside
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After Thawing
Store in refrigerator at
+2C and +8C.
Infuse within 30
minutes if not,
transfuse within 24
hours.
Unused thawed unit,
should be discarded,
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Warming Blood
No evidence that
warming blood is
beneficial to the
patient when infusion
is slow
Cold blood can cause
spasm in the vein used
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On average, it takes
30 minutes for a unit
of blood to reach 10
degrees Centigrade

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Blood should be warmed in

a blood warmer with visible
thermometer and audible
warning alarm.
Should not be warmed in a
bowl of hot water as this
could lead to hemolysis of
red cells and liberation of K+
which could be lifethreatening
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Warmed blood is most commonly required

in:

Large volume rapid

transfusions
Adults: infusion of
greater than
50ml/kg/hour
Children: greater than
15ml/kg/hour
Exchange transfusion in
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If ambient temperature is
greater than +25C or if
there is a chance that the
blood will not be
transfused immediately,
blood should be placed in
a refrigerator or should
be issued in a cold box or
insulated carrier that will
keep the temperature
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PLATELET
CONCENTRATES

Must be kept at a temperature

of 20C to 24C on a platelet
agitator to maintain platelet
function
Storage life is restricted to 3
or 5 days (risk of bacterial
proliferation)
Platelets held at lower
temperature lose blood
clotting capability
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Time Limits for Infusion

Blood/
blood product

Start infusion

Complete infusion

Whole blood/
within 30 min. of within 4 hour
red cells
removing pack
(less in high
from
ambient temp)
refrigerator
Platelet
immediately within 20 min
concentrates
FFP

within 30 min

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within 20 min

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There is a risk of bacterial

proliferation or loss of
function in blood products
once they have been removed
from the correct storage
conditions
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CHECK THE
PATIENTS IDENTITY
AND THE BLOOD
PRODUCT BEFORE
TRANSFUSION

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IDENTITY
CHECKLIST
Ask patient
to identify himself by
family name, given name, date of
birth and other information
If unconscious, ask a relative or a
second member of staff to state
patients identity
Check patients identity and gender
against:
identity wristband or label
medical notes
Check that details on compatibility
label attached to blood pack exactly
match details on patients
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documentation and identity

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RECORDING OF TRANSFUSION
Consent from patient and/or relatives
Reason for transfusion
Signature of the prescribing clinician
Pre-transfusion checks of :
patients identity, blood pack,
compatibility label
signature of the person performing
the check
Transfusion
type and volume of component,
donation number,
blood group, time at which
transfusion commenced,
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signature of person administering the

BLOOD CHECKLIST

1. No discrepancies between ABO

and Rh group on: blood pack,
compatibility label
2. No discrepancies between
unique donation number on: blood
pack, compatibility label
3. Check expiry date on blood pack.
4. Examine pack before
transfusion. Do not administer if
pack is damaged or there is any
evidence of deterioration.
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Monitoring the
Transfused Patient

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Monitor
the patient
at the

Before starting
the infusion
As soon
as
the
infusion
is
following stages:
started
15 min after starting the
infusion
at least every hour during
the infusion
on completion of the
infusion
carefully
ESPECIALLY during
4Monitor
hrs after
completing
the
the first 15 minutes to detect early
transfusion
signs & symptoms of adverse effects
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At each stage, record the following

Patients
general
infoin
the patients
chart:
appearance
Temperature
Pulse rate
Blood pressure
Respiratory rate
Fluid balance
Oral and IV fluid
intake
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PHARMACEUTICALS &
BLOOD
PRODUCTS
No meds
and
infusion

solutions other than normal

saline should be added to
any blood component .
They may contain additives
such as calcium which can
cause citrated blood to
clot.
Dextrose solution
Last(5%)
word of adv
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RECORD

Time transfusion is
started
Time the transfusion
is completed
Volume & type of all
products
transfused
Unique donation no of
all
products
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