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Detection of blood group is important particularly in the blood transfusion. Blood formed by Plasma and blood cells. Blood cells are including red cell (erythrocytes), white cells and platelet.
Every day about five million new red cells continuously produced by the bone marrow and released into the blood stream to replace the old red cells. Red blood cells (RBC) are surrounded by antigens which are normally proteins, and therefore the antibodies present in the plasma bind to the antigens on the surface of the erythrocytes. Red blood cell antigens are divided into a few subgroups the most important are ABO blood group system and Rh blood group system.
The ABO is the first important blood group system was discovered by Karl Landsteiner in 1901. The number of international society of blood transfusion (ISBT) is (001), and placed on chromosome 9q34.1-q34.2.
Compatibility of blood group in the blood transfusion is very important, misunderstanding of blood typing or any error in the diagnoses blood group type may causes death. ABO blood group is divided in to four type group A, B, AB and O. The group of blood determine by present Antigen, for example group A present the antigen-A in RBC. In the serum of blood group the A can be found the group B- antibody. Exactly same blood group B the cells contain B- antigen and the serum contain anti-A, blood group AB the cell contain antigen A and B, in case of blood group AB the plasma contain no any antibody. The blood group-O initially the blood group zero because on the red blood cells they are no antigen but there are anti-A and anti-B antibodies. (George Garratty. et al. 2002)
After ABO blood the Rh blood group system is became the second important group system, was found in 1939 by Landsteiner and wiener. It is more complex than other blood group. For first time termed by Rhesus but was wrong because there not associated with human blood. Rh blood group indicates the positivity or negativity of human blood groups. The ISBT of Rh blood group is (004), and found on the chromosome 1p34-36. (
The blood group antigen composed to sugar or protein, characterised by present of oligosaccharide. The antigens of ABO blood group system is most important in transfusion medicine, antigen it is an enzyme protein found on the component of red blood cells (RBCs) membrane and determine the type of blood group. The specific enzymes generated by blood group gene, that enzyme performed on the precursor (carbohydrate chain) substance on the RBCs membrane and then change the enzyme into antigen. Antigen attached to oligosaccharide chain and the chain binds to protein and lipids on the surface of red cells, H gene produce the enzyme, it is act on the precursor substance and then changes specificity of precursor into H substance by attaching to single molecule of sugar. The precursor substance not change with out the H gene therefore the H substance can not be produce. H gene can be homozygote HH or heterozygote Hh. If the H substance becomes the substrate for enzymes A and B therefore the A and B antigen cannot be produce. Lack of antigen A, B and H, is calling the Bombay phenotype Oh. People with Oh group normally produce anti-H, and anti A, B. Anti A, B clinically important. People without the A and B antigens are healthy. The activity of enzyme of subgroup A1 gene is stronger than the enzyme of subgroup A2 gene. The enzyme of A1 gene easily can change the H substance. Thus the antigen of A2 is lower and the H is higher than A1. Also there are other types of subgroup such as group A3 is called mixed-field and Ax have very low antigen on the surface of their RBC.
The Antigens of Rh blood group system, the Rh blood group system is important because of their antigen, it is highly immunogenic antigen. The numbers of antigens are 49 antigens; the most important are D, C, E, c and e antigens. Two Rh genes found by DNA examination, D and CE gene at the chromosome one. The D gene responsible to produce the D antigen and CE gene produce one of the CE, Ce, cE or ce
The antibodies of ABO blood group system are found in the serum of healthy adult. IgM is the main class of antibody in the ABO blood group system they can be produced by recombinant method, of IgM, IgG and IgA. Anti-A and anti-B antibodies are mixing of IgM and IgG. Because of present IgM in the serums usually cause agglutination of red blood cell in the room temperature and antibodies react with antigens at optimal temperature. The reaction of Anti-A and anti-B are active at temperature 37oC, an increase the level IgG component. These antibodies are produce in age between 3-6 month and increased until arrive to age 5-10 years old after that gradually decrease as the age increase. These antibodies known as natural antibodies and difficult to identified in the old age. The Antibodies A and B activated of their production by blood transfusion that is causes the antibodies become immune IgG.
Neutralization of all IgA and IgM Antibodies with blood group substance, but the activation of IgG antibodies are remains at low concentration. The concentrations
all antibodies are decrease by heating, the activation of IgM antibodies reduce completely, IgG antibodies become weak and the IgA Antibodies become very stable. The agglutination of IgG with group A or B cells in saline is very slow but IgA and IgM antibodies agglutinated strong concentration by saline test. These antibodies may lead to haemolytic red blood cell, if group A transfused to blood group O or B and if blood group B transfused to blood group A or O this known as ABO incompatible blood transfusion this cause the life threatening. Only blood group of O can be given to blood group A and B, group O is universal blood compatible with any other type blood. Also Anti-A and B can lead to haemolytic disease in infant
Antibodies of the ABO system are clinically important in transfusion science because of two main reasons; anti-A and anti-B present in older people while the antigen is absent. And acute intravascular haemolytic transfusion reaction occurs because of ABO antibodies.
The Rh blood group system antibodies are natural immune, naturally produces of anti-D, anti-C, anti-E and anti-C. The antibodies present in the IgM and IgG form (Neil D and Marion E, 2000).
Anti-D produced by fresh frozen plasma, may have a small amount of red cell membrane red cell stimulated by transfusion or pregnancy. Because of D antigens have high immunogenicity and Anti-D in the most common in Rh antibody this is IgG antibodies does not cause agglutination the red blood cell, also is not attached to complement and also haemolytic disease occur in newborn and causes transfusion reaction and destroyed red cell.
RH antibodies are specific and found in autoimmune haemolytic anaemia for example anti-e, anti-C+e, anti-c, anti-c+E. Rh blood group antibodies are not bind to complement antigen. Anti-D most frequently seen as D-immunogenicity and occasionally combine with anti-C or anti-E
Incompatibility of Rh is called Rh disease that is serious condition among the pregnant female if they have Rh-negative blood type but shows the Rh-positive blood cells. Rh incompatibility could happen when the pregnant mother with Rh-negative but shows the Rh-positive baby red cells and feto-maternal haemorrhage flow blood from the placenta within pregnant, abortion and delivery. The blood banks used blood group O Rh negative this known as (universal blood group) use for emergency condition. The main reasons for Rh incompatibility is contact the Rh-negative female with Rh-positive foetus blood within pregnancy or delivery. As a results leaking the blood from the foetus blood circulation to maternal circulation.
The majority of Rh antibodies potential causes of Haemolytic disease of foetus and newborn (HDFNB) may occur because of blood group antibodies (IgG) in pregnant mother pass through the placenta into the foetus and then start the immunity and damaging the red blood cell of foetus, IgG clinically is most important mainly (IgG1 and IgG3). No any other types of antibody pass through the placenta. Antigen-negative blood gave to patients with Rh sensitization history, whether antibody is demonstrable or not. IgG neonatal red cells are breakdown by macrophages in the spleen and causes anaemia
Sever HDFNB can causes the death of foetus about the 17th week of pregnancy if the baby deliver and alive as consequences jaundice. Rh-antibodies (RH1, RH4, and KEL1) are associated with HDFNB