AN INTRODUCTION TO BLOOD

GROUP AND CROSSMATCH

Abdullah Ahmed Meshi, BMSc., MT, (CLS).

Chief of Blood Bank
Member of International Society of Blood Transfusion
Member of British Blood Transfusion Society
King Fahd Central Hospital
Jazan, KSA, 2003
 INTRODUCTION
• HISTORY OF BLOOD GROUPS.

• BLOOD GROUP SEROLOGY.

• BLOOD GROUP SYSTEMS.

• COMPATIBLITY TEST.

• SELECTION OF APPROPRIATE UNIT FOR

TRANSFUSION.
 HISTORY OF BLOOD GROUPS

• Karl Landsteiner discovered the 1st human blood

group system, ABO in 1900.

• Karl Landsteiner and his student A. Wiener

discovered the 2nd most important blood group
system, Rh system in 1939.
 BLOOD GROUP SEROLOGY

• Antigen (Ag)
– Any substance recognized as foreign by the body which
stimulates the immune system to mount a response
against it.
• Antibody (Ab)
– A protective protein produced by the immune system as
a result of stimulation by a foreign protein.
• Immunoglobulin (Ig)
– An antibody molecule synthesized by plasma cells in
response to an antigen.
Antigens on Red Blood cells

Antigen (Ag)

RBC RBC
Antigen – Antibody Reaction
Immunoglobulin (Antibody)
Immunoglobulin (Antibody)
 Blood Group Systems

• ABO system
• Rh system
• Other systems:
– Kell system
– Lewis system
– MNSs system
– Duffy system
– Kidd system
– Lutheran system
 ABO Blood Group System
• Two Ag (A and B) make all four blood
groups.

RBC with A Ag RBC with B Ag

only only

A group B group
 ABO Blood Group System

• Two Ag (A and B) make all four blood groups.

RBC with RBC without

A and B Ag A and B Ag

AB group O group
 ABO Blood Group System

• Two antibodies are (naturally) developed in this

system.
• Type A individual develop anti-B antibodies.
• Type B individual develop anti-A antibodies.
• Type AB individual develop NO antibodies.
• Type O individual develop anti-A and anti-B
antibodies.
 ABO Blood Group System

Antibody (Ab) Antigen (Ag) on

Blood Group
in Plasma RBCs

A Anti-B A Ag

B Anti-A B Ag

AB No Ab A & B Ag

Anti-A &
O No Ag
Anti-B
 Rh Blood Group System
• Five antigens are present (D, C, c, E, and e).
• No (Naturally) developed antibodies in this
system, but developed as an immune response.
• D Ag is the most significant Ag in Transfusion
practice.
• If D Ag present on RBC, it is called (Rh Positive).
• If D Ag is not present on RBC, it is called (Rh
Negative).
• If Rh Neg patient receive Rh Pos RBCs, 50-75%
he/she will form Anti-D.
Combination Between ABO & Rh System

D Ag absence D Ag Present ABO Group

A Rh Neg A Rh Pos A

B Rh Neg B Rh Pos B

AB Rh Neg AB Rh Pos AB

O Rh Neg O Rh Pos O
 Other Blood Group System
Antigen Present Blood Group system
Lea & Leb Lewis system
M, N, S, & s MNSs system
K, k, Kpa, Kpb,Jsa & Jsb Kell system
Fya & Fyb Duffy system
Jka & Jkb Kidd system
Lua & Lub Lutheran system
Blood Grouping Technique
Blood Grouping Technique
 Compatibility Testing

• Compatibility testing is consist of:

– Review of patient’s past transfusion history and
records.
– ABO and Rh typing of recipient and donor.
– Antibody screening of recipient and donor.
– The crossmatch test.
• Crossmatch test is only part of compatibility test.
 Crossmatch Test
• XM is an in-vitro procedure to determine serologic
compatibility between the donor’s RBC and the recipient’s
serum.

• 1 drop of 3-5% donor RBC suspension in NS + 2 drops of

recipient serum.

• There are two main functions of XM test:

– Final check of ABO compatibility between donor and patient.
– Detects most antibodies in patient’s serum directed against
antigens on the donor cells.
 Causes of Incompatible Crossmatch

1. Incorrect ABO grouping of the patient or donor.

2. An alloantibody in the patient’s serum reacting with the
corresponding antigen on donor RBCs.
3. An autoantibody in the patient’s serum reacting with the
corresponding antigen on donor RBCs.
4. Prior coating of the donor RBCs with Ab/C resulting in
a positive antihuman globulin test (AGT).
5. Abnormalities in the patient’s serum.
6. Contamination in the test system.
 Antibody Identification Test

Donor Rh Rh-hr Kell MNSs Duffy Kidd Lewis Lutheran P1 Xg Test Methods
w a b a b a b a b a b a b a
# ID# D C E c e C V K k Kp Kp Js Js M N S s Fy Fy Jk Jk Le Le Lu Lu P1 Xg # IS 37 AHGCCC
1 r'r DL0176 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + 0 + + 0 0 + 0 + 0 0 1 0 0 0 2+
2 R1R1W DW0410 + + 0 0 + + 0 0 + + + 0 + + 0 + + + 0 + 0 0 + 0 + + + 2 0 4+ 4+
3 R1R1 DC0331 + + 0 0 + 0 0 0 + 0 + 0 + + + 0 + + 0 0 + + 0 0 + 0 + 3 0 4+ 4+
4 R2R2 DE1143 + 0 + + 0 0 0 0 + 0 + + + + 0 0 + 0 0 + 0 0 0 0 + + 0 4 0 4+ 4+
5 r"r DM0187 0 0 + + + 0 0 0 + 0 + 0 + + + 0 + + + + + 0 + 0 + 0 0 5 0 0 0 2+
6 rrK DK0425 0 0 0 + + 0 0 + + 0 + 0 + + + + + + + + + 0 + 0 + + + 6 0 0 0 2+
7 rr DN1081 0 0 0 + + 0 0 0 + 0 + 0 + + 0 + + 0 + + 0 + 0 0 + + + 7 0 0 0 2+
8 rr DN1082 0 0 0 + + 0 0 0 + 0 + 0 + + + + + 0 + 0 + 0 + 0 + + + 8 0 0 0 2+
9 rr DN1085 0 0 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 + + 0 + 0 + + + 9 0 0 0 2+
10 R0r DT0231 + 0 0 + + 0 + 0 + 0 + 0 + 0 + 0 + 0 0 + + 0 0 0 + + 0 10 0 4+ 4+
11 R1r DH0127 + + 0 + + 0 0 + + 0 + 0 + + + + 0 0 + 0 + 0 + 0 + + 0 11 0 4+ 4+
PC Autocontrol PC 0 0 0 2+

Patient 0 + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 0 + + 0 + 0 + + 0
w a b a b a b a b a b a b a
D C E c e C V K k Kp Kp Js Js M N S s Fy Fy Jk Jk Le Le Lu Lu P1 Xg
Selection of Appropriate Unit for Transfusion

• Selection of whole blood for transfusion.

• Selection of RBCs for transfusion.

• Selection of platelet and fresh frozen

plasma for transfusion.
Selection of Whole Blood for Transfusion
With Approval of Patient
Alternatives 1st Choice
Consultant Group
------ O Neg O Pos O Pos
O Pos ------ O Neg O Neg
------ A Neg A Pos A Pos
A Pos ------ A Neg A Neg
------ B Neg B Pos B Pos
B Pos ------ B Neg B Neg
------ AB Neg AB Pos AB Pos
AB Pos ------ AB Neg AB Neg
 Selection of RBCs
With Approval Patient
Alternatives 1st Choice
of Consultant Group
------ O Neg O Pos O Pos
O Pos ------ O Neg O Neg
------ A Neg, O Pos, O Neg A Pos A Pos
A Pos, O Pos O Neg A Neg A Neg
------ B Neg, O Pos, O Neg B Pos B Pos
B Pos, O Pos O Neg B Neg B Neg
------ AB Neg, O Pos, O Neg, A AB Pos AB Pos
Pos, A Neg, B Pos, B Neg
AB Pos, A Pos, O Neg, A Neg, B Neg AB Neg AB Neg
B Pos, O Pos
Selection of Platelets and Fresh Frozen Plasma

Alternatives 1st Choice Patient Group

A, B, AB O O

AB A A

AB B B

AB AB AB
 ‫شكراً لكم‬
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