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August 3, 2016
REPORTING: ABO INCOMPATIBILITY (CORRELATION WITH CARBOHYDRATE STUCTURE)

Audrey Andres, M.D.

• H or group O antigen – the immediate biosynthetic precursor

TOPIC OUTLINE of both A and B antigens
I. ABO BLOOD GROUP SYSTEM • A & B antigens are formed by the addition of a disaccharide to
A. Overview the terminal sugar of the H antigen catalyzed by a specific
B. Importance enzyme coded by A & B genes
C. Genetics
D. Biochemical Structure
E. The ABO Blood Groups
II. KEY TERMS FROM THE GROUP REPORTS

ABO BLOOD GROUP SYSTEM

A. OVERVIEW
• most important blood group system in human blood transfusion
• discovered by Karl Landsteiner who identified the O, A, and B
blood types in 1900
• Classified as histo-blood group antigens: can be found on many
tissues and body fluids, including RBCs, platelets, and endothelial
cells
• consists of two antigens: A and B BLOOD IMMUNODOMINANT ENZYME
• four phenotypes: groups A, B, AB, and O TYPE SUGAR
• A & B - autosomal codominant A N-acetylgalactosamine N-acetylgalactosaminyltransferase
• O phenotype - autosomal recessive B D-galactose D-galactosyltransferase

B. IMPORTANCE FEW H antigen

MANY H antigen
• Transfusion Medicine sites sites
- ABO compatibility between donor cell and patient serum is
the essential foundation of pretransfusion testing
- It is the only system with expected antibodies (ABO
antibodies are naturally-occurring) Most of the H antigen sites in a Group A individual have been
- ABO antibodies (IgM or IgG) can readily activate complement converted to the A antigen
system which can lead to life-threatening transfusion • Amount of H antigen from greatest to least:
reactions O>A 2 >B>A 2 B>A 1 >A 1 B
• Organ Transplantation Q: Why do group O individuals have more H antigen than other groups?
A: The O antigen is a silent allele. It does not alter the structure of the H
C. GENETICS substance; therefore, it has more H antigen sites.
• Genes at three separate loci control the occurrence and location of
ABO antigens E. THE ABO BLOOD GROUPS
• H and ABO genes - control the presence or absence of A, B, and H • Landsteiner’s Rule: normal, healthy individuals possess ABO
antigens antibodies to the ABO antigen absent from their RBCs
• H gene - controls the presence or absence of the ABH antigens on BLOOD ANTIGEN/S ANTIBODIES IN GENOTYPES
the RBC membrane GROUP ON RBCS SERUM
• Se gene - indirectly controls the presence or absence of the ABH A A Anti-B AA or AO
antigens in secretions (body fluids like plasma, saliva, synovial
fluid, etc.) B B Anti-A BB or BO
- consists of 2 alleles: Se and se AB A and B Neither AB
Secretors (80% of population) - individuals with Se allele O Neither Anti-A and Anti-B OO
(either SeSe or Sese)
• H and Se genes - control the expression of Blood Group • Possible Blood Group Genotypes:
Substances (soluble A, B, and H antigens that can be found in the
secretions) Parent Allele A B O

ANTIGEN GENOTYPE A AA AB AO
H HH, Hh
B AB BB BO
A HH or Hh and A/A, A/B, or A/O
B HH or Hh and B/A, B/B, or B/O O AO BO OO
D. BIOCHEMICAL STRUCTURE
• ABO antigens are carbohydrate antigens.

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3.01 Reporting: ABO Incompatibility (Correlation with
Carbohydrate Structure)
• BOMBAY Phenotype REVIEW QUESTIONS
- very rare null phenotype characterized by an absence of 1. In determining the phenotype of ABO system:
TITLEonOF
all ABH antigens RBCsLECTURE (NOTE: ALL CAPS) a. O is dominant over A
- classic Bombay phenotype (Oh): neither AB nor H b. B is dominant over A
antigens are present on RBCs or in secretions; has Anti-A, c. O is recessive
Anti-B, and Anti-H antibodies d. all of the above
- can only receive Bombay blood type during blood
transfusions 2. The reactivity of blood group A is determined by the presence of
which of the following immunodominant sugar?
KEY TERMS FROM THE GROUP REPORTS a. Fucose
• Immunosuppression - the dampening of the immune b. D-galactose
response by a normal immune system to antigenic stimulation, c. N-acetyl-D-galactosamine
either deliberately, or as an adverse effect of a therapeutic d. N-acetyl-glucosamine
agent
Ex of immunosuppressive drugs: Tacrolimus, Cyclosporine, 3. The mating of parents of which two ABO phenotypes can
Cyclophosphomide, Prednisone, Azathioprine potentially produce offspring with ALL of the common four blood
• Accommodation - the survival of an organ graft in the types?
presence of anti-graft antibodies and complement a. AB and O
• Immune Tolerance - a state of unresponsiveness of the b. AB and A
immune system to substances or tissue that have the capacity c. AB and AB
to elicit an immune response d. A and B
• Kidney Transplant
- HLA Typing 4. Bombay phenotype (Oh) individuals may have antibodies with all
3 criteria: the following specificities EXCEPT:
a. Antibodies will not react a. anti-A
b. N graft histology b. anti-B
c. Renal function similar to the compatible donor c. anti-O
- Antibody measurement d. anti-H
- Antibody depletion e. anti-A,B
• Heart Transplantation in Infants
- Immune system of an infant is not yet fully-developed 5. Which of the following statements is TRUE regarding Hemolytic
(naturally-occurring antibodies aren’t produced yet) Disease of the Fetus/Newborn (HDFN) caused by ABO antibodies?
therefore there is less probability of complications to a. Hemolysis is typically severe in ABO HDFN.
occur after heart transplantation. b. ABO HDFN rarely occurs during the first pregnancy.
- Surveillance procedures after heart transplantation: c. ABO HDFN is most common with O mothers and A babies
a. Histopathologic d. ABO HDFN occurs less commonly than Rh HDFN
b. Immunohistochemical
c. Coronary angiography 6. Which of the following is the 3rd most potent cause of HDN?
• Hemolytic Disease of the Newborn a. Rh
- Causes: Rh (most potent), ABO (2nd most potent, most b. Kidd
common) Kell (3rd most potent) c. Lutheran
Other unexpected antibodies: MNS, Duffy, Kidd d. Kell
- Factors: gravidity, gender, birth weight, blood group
- Test for Alloimmune Hemolytic Disease: Direct 7. The gene that controls the presence of absence of ABH antigens in the
antiglobulin test secretions:
• ABO Incompatibilities related to pregnancy a. H gene
- No means for prevention b. ABO gene
- Also called Erythroblastosis fetalis c. Both ABO and H genes
a. ABO d. Se gene
- IgM-mediated
- Group O mother; Group A, B, or AB child REFERENCES
- Occurs even on 1st exposure • Audio recording of Dr Andres’ lecture
b. Rh Isoimmunization • Dr. Andres’ power point presentation
- IgG-mediated • Henry’s Clinical Diagnosis and Management by Laboratory Methods
- Triggered by 0.1 ml exposure to Rh pos blood (23rd Ed)
- Affects the 2nd Rh pos child TRANSERS’ MESSAGE
- Rh neg mother; Rh pos child (Rh pos father)
- Administration of Rhesus immunoglobulin (Rh
Ig) to Rh (D) negative women during
pregnancy and shortly after the birth of D
positive infants has reduced the incidence of
Rh D hemolytic disease
• Treatment for blood transfusion reactions
- Antihistamines, steroids, IV fluid, vasopressors

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