Blood type
A blood type (also known as a blood group) is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens can stem from one allele (or an alternative version of a gene) and collectively form a blood group system.[1]
Blood types are inherited and represent contributions from both parents of an individual. As of December 2023,[update] a total of 45
Blood group systems
A complete blood type would describe each of the 45 blood groups, and an individual's blood type is one of many possible combinations of blood-group antigens.
Some blood types are associated with inheritance of other diseases; for example, the
ABO blood group system
The ABO blood group system involves two antigens and two antibodies found in human blood. The two antigens are antigen A and antigen B. The two antibodies are antibody A and antibody B. The antigens are present on the red blood cells and the antibodies in the serum. Regarding the antigen property of the blood all human beings can be classified into four groups, those with antigen A (group A), those with antigen B (group B), those with both antigen A and B (group AB) and those with neither antigen (group O). The antibodies present together with the antigens are found as follows:[citation needed]
- Antigen A with antibody B
- Antigen B with antibody A
- Antigen AB with neither antibody A nor B
- Antigen null (group O) with both antibody A and B
There is an agglutination reaction between similar antigen and antibody (for example, antigen A agglutinates the antibody A and antigen B agglutinates the antibody B). Thus, transfusion can be considered safe as long as the serum of the recipient does not contain antibodies for the blood cell antigens of the donor.[citation needed]
The ABO system is the most important blood-group system in human-blood transfusion. The associated anti-A and anti-B antibodies are usually
Phenotype | Genotype |
---|---|
A | IAIA or IAi |
B | IBIB or IBi |
AB | IAIB |
O | ii |
Rh blood group system
The Rh system (Rh meaning Rhesus) is the second most significant blood-group system in human-blood transfusion with currently 50 antigens. The most significant Rh antigen is the D antigen, because it is the most likely to provoke an immune system response of the five main Rh antigens. It is common for D-negative individuals not to have any anti-D IgG or IgM antibodies, because anti-D antibodies are not usually produced by sensitization against environmental substances. However, D-negative individuals can produce IgG anti-D antibodies following a sensitizing event: possibly a fetomaternal transfusion of blood from a fetus in pregnancy or occasionally a blood transfusion with D positive RBCs.[14] Rh disease can develop in these cases.[15] Rh negative blood types are much less common in Asian populations (0.3%) than they are in European populations (15%).[16]
The presence or absence of the Rh(D) antigen is signified by the + or − sign, so that, for example, the A− group is ABO type A and does not have the Rh (D) antigen.[citation needed]
ABO and Rh distribution by country
As with many other genetic traits, the distribution of ABO and Rh blood groups varies significantly between populations.[citation needed][17] While theories are still debated in the scientific community as to why blood types vary geographically and why they emerged in the first place, evidence suggests that the evolution of blood types may be driven by genetic selection for those types whose antigens confer resistance to particular diseases in certain regions – such as the prevalence of blood type O in malaria-endemic countries where individuals of blood type O exhibit the highest rates of survival.[18]
Other blood group systems
As of December 2022[update], 42 blood-group systems have been identified by the International Society for Blood Transfusion in addition to the ABO and Rh systems.[3] Thus, in addition to the ABO antigens and Rh antigens, many other antigens are expressed on the RBC surface membrane. For example, an individual can be AB, D positive, and at the same time M and N positive (MNS system), K positive (Kell system), Lea or Leb negative (Lewis system), and so on, being positive or negative for each blood group system antigen. Many of the blood group systems were named after the patients in whom the corresponding antibodies were initially encountered. Blood group systems other than ABO and Rh pose a potential, yet relatively low, risk of complications upon mixing of blood from different people.[19]
Following is a comparison of clinically relevant characteristics of antibodies against the main human blood group systems:[20]
ABO | Rh | Kell | Duffy | Kidd | |
---|---|---|---|---|---|
Naturally occurring | Yes | No | No | No | No |
Most common in immediate hemolytic transfusion reactions | A | Yes | Fya | Jka | |
Most common in delayed hemolytic transfusion reactions | E, D, C | Jka | |||
Most common in hemolytic disease of the newborn | Yes | D, C | Yes | ||
Commonly produce intravascular hemolysis | Yes | Yes |
Clinical significance
Blood transfusion
Transfusion medicine is a specialized branch of hematology that is concerned with the study of blood groups, along with the work of a blood bank to provide a transfusion service for blood and other blood products. Across the world, blood products must be prescribed by a medical doctor (licensed physician or surgeon) in a similar way as medicines.[citation needed]
Much of the routine work of a
Patients should ideally receive their own blood or type-specific blood products to minimize the chance of a
The blood group may be included on
Rare blood types can cause supply problems for
Hemolytic disease of the newborn (HDN)
A pregnant woman may carry a fetus with a blood type which is different from her own. Typically, this is an issue if a Rh- mother has a child with a Rh+ father, and the fetus ends up being Rh+ like the father.[27] In those cases, the mother can make IgG blood group antibodies. This can happen if some of the fetus' blood cells pass into the mother's blood circulation (e.g. a small fetomaternal hemorrhage at the time of childbirth or obstetric intervention), or sometimes after a therapeutic blood transfusion. This can cause Rh disease or other forms of hemolytic disease of the newborn (HDN) in the current pregnancy and/or subsequent pregnancies. Sometimes this is lethal for the fetus; in these cases it is called hydrops fetalis.[28] If a pregnant woman is known to have anti-D antibodies, the Rh blood type of a fetus can be tested by analysis of fetal DNA in maternal plasma to assess the risk to the fetus of Rh disease.[29] One of the major advances of twentieth century medicine was to prevent this disease by stopping the formation of Anti-D antibodies by D negative mothers with an injectable medication called Rho(D) immune globulin.[30][31] Antibodies associated with some blood groups can cause severe HDN, others can only cause mild HDN and others are not known to cause HDN.[28]
Blood products
To provide maximum benefit from each blood donation and to extend shelf-life,
Units of packed red cells are made by removing as much of the plasma as possible from whole blood units.
Red blood cell compatibility
- Blood group AB individuals have both A and B antigens on the surface of their RBCs, and their blood plasma does not contain any antibodies against either A or B antigen. Therefore, an individual with type AB blood can receive blood from any group (with AB being preferable), but cannot donate blood to any group other than AB. They are known as universal recipients.
- Blood group A individuals have the A antigen on the surface of their RBCs, and blood serum containing IgMantibodies against the B antigen. Therefore, a group A individual can receive blood only from individuals of groups A or O (with A being preferable), and can donate blood to individuals with type A or AB.
- Blood group B individuals have the B antigen on the surface of their RBCs, and blood serum containing IgM antibodies against the A antigen. Therefore, a group B individual can receive blood only from individuals of groups B or O (with B being preferable), and can donate blood to individuals with type B or AB.
- Blood group O (or blood group zero in some countries) individuals do not have either A or B antigens on the surface of their RBCs, and their blood serum contains IgM anti-A and anti-B antibodies. Therefore, a group O individual can receive blood only from a group O individual, but can donate blood to individuals of any ABO blood group (i.e., A, B, O or AB). If a patient needs an urgent blood transfusion, and if the time taken to process the recipient's blood would cause a detrimental delay, O negative blood can be issued. Because it is compatible with anyone, O negative blood is often overused and consequently is always in short supply.[32] According to the American Association of Blood Banks and the British Chief Medical Officer's National Blood Transfusion Committee, the use of group O RhD negative red cells should be restricted to persons with O negative blood, women who might be pregnant, and emergency cases in which blood-group testing is genuinely impracticable.[32]
Recipient[1] | Donor[1] | |||||||
---|---|---|---|---|---|---|---|---|
O− | O+ | A− | A+ | B− | B+ | AB− | AB+ | |
O− | ||||||||
O+ | ||||||||
A− | ||||||||
A+ | ||||||||
B− | ||||||||
B+ | ||||||||
AB− | ||||||||
AB+ |
Table note
1. Assumes absence of atypical antibodies that would cause an incompatibility between donor and recipient blood, as is usual for blood selected by cross matching.
An Rh D-negative patient who does not have any anti-D antibodies (never being previously sensitized to D-positive RBCs) can receive a transfusion of D-positive blood once, but this would cause sensitization to the D antigen, and a female patient would become at risk for hemolytic disease of the newborn. If a D-negative patient has developed anti-D antibodies, a subsequent exposure to D-positive blood would lead to a potentially dangerous transfusion reaction. Rh D-positive blood should never be given to D-negative women of child-bearing age or to patients with D antibodies, so blood banks must conserve Rh-negative blood for these patients. In extreme circumstances, such as for a major bleed when stocks of D-negative blood units are very low at the blood bank, D-positive blood might be given to D-negative females above child-bearing age or to Rh-negative males, providing that they did not have anti-D antibodies, to conserve D-negative blood stock in the blood bank. The converse is not true; Rh D-positive patients do not react to D negative blood.
This same matching is done for other antigens of the Rh system as C, c, E and e and for other blood group systems with a known risk for immunization such as the Kell system in particular for females of child-bearing age or patients with known need for many transfusions.
Plasma compatibility
Blood plasma compatibility is the inverse of red blood cell compatibility.[35] Type AB plasma carries neither anti-A nor anti-B antibodies and can be transfused to individuals of any blood group; but type AB patients can only receive type AB plasma. Type O carries both antibodies, so individuals of blood group O can receive plasma from any blood group, but type O plasma can be used only by type O recipients.
Recipient | Donor | |||
---|---|---|---|---|
O | A | B | AB | |
O | ||||
A | ||||
B | ||||
AB |
Table note
1. Assuming absence of strong atypical antibodies in donor plasma
Rh D antibodies are uncommon, so generally neither D negative nor D positive blood contain anti-D antibodies. If a potential donor is found to have anti-D antibodies or any strong atypical blood group antibody by antibody screening in the blood bank, they would not be accepted as a donor (or in some blood banks the blood would be drawn but the product would need to be appropriately labeled); therefore, donor blood plasma issued by a blood bank can be selected to be free of D antibodies and free of other atypical antibodies, and such donor plasma issued from a blood bank would be suitable for a recipient who may be D positive or D negative, as long as blood plasma and the recipient are ABO compatible.[citation needed]
Universal donors and universal recipients
In transfusions of packed red blood cells, individuals with type O Rh D negative blood are often called universal donors. Those with type AB Rh D positive blood are called universal recipients. However, these terms are only generally true with respect to possible reactions of the recipient's anti-A and anti-B antibodies to transfused red blood cells, and also possible sensitization to Rh D antigens. One exception is individuals with
Blood donors with exceptionally strong anti-A, anti-B or any atypical blood group antibody may be excluded from blood donation. In general, while the plasma fraction of a blood transfusion may carry donor antibodies not found in the recipient, a significant reaction is unlikely because of dilution.
Additionally, red blood cell surface antigens other than A, B and Rh D, might cause adverse reactions and sensitization, if they can bind to the corresponding antibodies to generate an immune response. Transfusions are further complicated because platelets and white blood cells (WBCs) have their own systems of surface antigens, and sensitization to platelet or WBC antigens can occur as a result of transfusion.
For transfusions of
Blood typing
Typically, blood type tests are performed through addition of a blood sample to a solution containing antibodies corresponding to each antigen. The presence of an antigen on the surface of the blood cells is indicated by agglutination.
Blood group genotyping
In addition to the current practice of serologic testing of blood types, the progress in molecular diagnostics allows the increasing use of blood group genotyping. In contrast to serologic tests reporting a direct blood type phenotype, genotyping allows the prediction of a phenotype based on the knowledge of the molecular basis of the currently known antigens. This allows a more detailed determination of the blood type and therefore a better match for transfusion, which can be crucial in particular for patients with needs for many transfusions to prevent allo-immunization.[39][40]
History
Blood types were first discovered by an Austrian physician, Karl Landsteiner, working at the Pathological-Anatomical Institute of the University of Vienna (now Medical University of Vienna). In 1900, he found that blood sera from different persons would clump together (agglutinate) when mixed in test tubes, and not only that, some human blood also agglutinated with animal blood.[41] He wrote a two-sentence footnote:
The serum of healthy human beings not only agglutinates animal red cells, but also often those of human origin, from other individuals. It remains to be seen whether this appearance is related to inborn differences between individuals or it is the result of some damage of bacterial kind.[42]
This was the first evidence that blood variation exists in humans. The next year, in 1901, he made a definitive observation that blood serum of an individual would agglutinate with only those of certain individuals. Based on this he classified human bloods into three groups, namely group A, group B, and group C. He defined that group A blood agglutinates with group B, but never with its own type. Similarly, group B blood agglutinates with group A. Group C blood is different in that it agglutinates with both A and B.[43] This was the discovery of blood groups for which Landsteiner was awarded the Nobel Prize in Physiology or Medicine in 1930. (C was later renamed to O after the German Ohne, meaning without, or zero, or null.[44]) Another group (later named AB) was discovered a year later by Landsteiner's students Adriano Sturli and Alfred von Decastello without designating the name (simply referring it to as "no particular type").[45][46] Thus, after Landsteiner, three blood types were initially recognised, namely A, B, and C.[46]
Czech serologist Jan Janský was the first to recognise and designate four blood types in 1907 that he published in a local journal,[47] using the Roman numerical I, II, III, and IV (corresponding to modern O, A, B, and AB respectively).[48] Unknown to Janský, an American physician William L. Moss introduced almost identical classification in 1910;[49] but his I and IV corresponding Janský's IV and I.[50] Moss came across Janský's paper as his was being printed, mentioned it in a footnote.[46] Thus the existence of two systems immediately created confusion and potential danger in medical practice. Moss's system was adopted in Britain, France, and the US, while Janský's was preferred in most other European countries and some parts of the US. It was reported that "The practically universal use of the Moss classification at that time was completely and purposely cast aside. Therefore in place of bringing order out of chaos, chaos was increased in the larger cities."[51] To resolve the confusion, the American Association of Immunologists, the Society of American Bacteriologists, and the Association of Pathologists and Bacteriologists made a joint recommendation in 1921 that the Jansky classification be adopted based on priority.[52] But it was not followed particularly where Moss's system had been used.[53]
In 1927, Landsteiner, who had moved to the
In 1928 the Permanent Commission on Biological Standardization adopted Landsteiner's proposal and stated:
The Commission learns with satisfaction that, on the initiative of the Health Organization of the League of Nations, the nomenclature proposed by von Dungern and Hirszfeld for the classification of blood groups has been generally accepted, and recommends that this nomenclature shall be adopted for international use as follows: 0 A B AB. To facilitate the change from the nomenclature hitherto employed the following is suggested:
- Jansky ....0(I) A(II) B(III) AB(IV)
- Moss ... O(IV) A(II) B(III) AB(I)[56]
This classification became widely accepted and after the early 1950s it was universally followed.[57]
Hirszfeld and Dungern discovered the inheritance of blood types as
Society and culture
A popular
See also
References
- ISBN 0-13-981176-1.
- ^ Cox, David. "A new understanding of how your blood type influences your health" (2024). New Scientist, 27 January 2024, Issue 3475 (https://www.newscientist.com/article/mg26134751-500-a-new-understanding-of-how-your-blood-type-influences-your-health/).
- ^ a b c d "Red Cell Immunogenetics and Blood Group Terminology". International Society of Blood Transfusion. 2023. Archived from the original on 7 October 2022. Retrieved 25 April 2023.
- ^ Dean 2005, The ABO blood group "... A number of illnesses may alter a person's ABO phenotype ..."
- S2CID 38436810.
- S2CID 6018274.
- S2CID 1150239.
- PMID 13477267.
- PMID 778616.
- PMID 16001361.
The different geographic distributions of α thalassemia, G6PD deficiency, ovalocytosis, and the Duffy-negative blood group are further examples of the general principle that different populations have evolved different genetic variants to protect against malaria
- ^ "Position statement: Red blood cell transfusion in newborn infants". Canadian Pediatric Society. April 14, 2014. Archived from the original on 19 May 2018.
- ^ S2CID 57677644
- ^ "Your blood – a textbook about blood and blood donation" (PDF). p. 63. Archived from the original (PDF) on June 26, 2008. Retrieved 2008-07-15.
- ISBN 0-07-111203-0.
- S2CID 1997656.
- ^ "Rh血型的由來". Hospital.kingnet.com.tw. Archived from the original on 2009-12-11. Retrieved 2010-08-01.
- PMID 35136827.
- PMID 17502454.
- PMID 20660321.
- OCLC 895712380.
- ^ Possible Risks of Blood Product Transfusions Archived 2009-11-05 at the Wayback Machine from American Cancer Society. Last Medical Review: 03/08/2008. Last Revised: 01/13/2009
- ^ 7 adverse reactions to transfusion Archived 2015-11-07 at the Wayback Machine Pathology Department at University of Michigan. Version July 2004, Revised 11/5/08
- from the original on 2023-03-12. Retrieved 2023-06-18.
- PMID 21348250.
- PMID 10439320.
- ^ Bruce, MG (May 2002). "BCF – Members – Chairman's Annual Report". The Blood Care Foundation. Archived from the original on April 10, 2008. Retrieved 2008-07-15.
As Rhesus Negative blood is rare amongst local nationals, this Agreement will be of particular value to Rhesus Negative expatriates and travellers
- ^ Freeborn, Donna. "Hemolytic Disease of the Newborn (HDN)". University of Rochester Medical Center. Archived from the original on 19 September 2016. Retrieved 30 November 2020.
- ^ ISBN 978-0-19-262826-8.
- S2CID 23230655.
- ^ "Use of Anti-D Immunoglobulin for Rh Prophylaxis". Royal College of Obstetricians and Gynaecologists. May 2002. Archived from the original on December 30, 2008.
- NICE. May 2002. Archivedfrom the original on 2022-02-05. Retrieved 2022-02-11.
- ^ ABIM Foundation, American Association of Blood Banks, archived from the originalon 24 September 2014, retrieved 25 July 2014, which cites
- The Chief Medical Officer's National Blood Transfusion Committee (c. 2008). "The appropriate use of group O RhD negative red cells" (PDF). National Health Service. Archived from the original (PDF) on 9 August 2014. Retrieved 25 July 2014.
- ^ "RBC compatibility table". American National Red Cross. December 2006. Archived from the original on 2008-09-13. Retrieved 2008-07-15.
- ^ Blood types and compatibility Archived 2010-04-19 at the Wayback Machine bloodbook.com
- ^ "Blood Component ABO Compatibility Chart Red Blood Cells and Plasma". Blood Bank Labsite. University of Michigan. Archived from the original on 16 June 2019. Retrieved 16 December 2014.
- ^ "Plasma Compatibility". Matching Blood Groups. Australian Red Cross. Archived from the original on 7 May 2020. Retrieved 19 June 2020.
- ISBN 0-07-020291-5.
- ^ "Universal acceptor and donor groups". Webmd.com. 2008-06-12. Archived from the original on 2010-07-22. Retrieved 2010-08-01.
- S2CID 6896382.
- PMID 19016734.
- ^ Landsteiner K (1900). "Zur Kenntnis der antifermentativen, lytischen und agglutinierenden Wirkungen des Blutserums und der Lymphe". Zentralblatt für Bakteriologie, Parasitenkunde und Infektionskrankheiten. 27: 357–362.
- (PDF) from the original on 2018-08-30. Retrieved 2018-06-01.
- S2CID 40158397. Originally published in German in Wiener Klinische Wochenschrift, 46, 1132–1134.
- PMID 23514954.
- ^ Von Decastello, A.; Sturli, A. (1902). "Concerning isoagglutinins in serum of healthy and sick humans". Munchener Medizinische Wochenschrift. 26: 1090–1095.
- ^ PMID 381816.
- ^ Janský J. (1907). "Haematologické studie u psychotiků". Sborník Klinický (in Czech). 8: 85–139.
- from the original on 2022-02-15. Retrieved 2022-02-11.
- ^ Moss W.L. (1910). "Studies on isoagglutinins and isohemolysins". Bulletin of the Johns Hopkins Hospital. 21: 63–70.
- PMID 381816.
- from the original on 2022-02-15. Retrieved 2022-02-15.
- from the original on 2021-08-30. Retrieved 2021-08-30.
- ISSN 0031-9333.
- ^ from the original on 2021-08-30. Retrieved 2021-08-30.
- S2CID 57677644.
- PMC 2176232.
- S2CID 23291031.
- from the original on 2022-02-15. Retrieved 2022-02-11.
- S2CID 87597493.
- S2CID 88119106.
- PMID 21006651.
- ^ a b "Despite scientific debunking, in Japan you are what your blood type is". MediResource Inc. Associated Press. 2009-02-01. Archived from the original on September 28, 2011. Retrieved 2011-08-13.
- ^ Nuwer, Rachel. "You are what you bleed: In Japan and other east Asian countries some believe blood type dictates personality". Scientific American. Archived from the original on 10 January 2012. Retrieved 16 Feb 2011.
Further reading
- Dean, Laura (2005). Blood Groups and Red Cell Antigens, a guide to the differences in our blood types that complicate blood transfusions and pregnancy. Bethesda MD: ISBN 1-932811-05-2. NBK2261.
- Mollison PL, Engelfriet CP, Contreras M (1997). Blood Transfusion in Clinical Medicine (10th ed.). Oxford UK: Blackwell Science. ISBN 0-86542-881-6.
External links
- BGMUT Blood Group Antigen Gene Mutation Database at NIHhas details of genes and proteins, and variations thereof, that are responsible for blood types
- Online Mendelian Inheritance in Man (OMIM): ABO Glycosyltransferase; ABO - 110300
- Online Mendelian Inheritance in Man (OMIM): Rhesus Blood Group, D Antigen; RHD - 111680
- "Blood group test". Gentest.ch GmbH. Archived from the original on 2017-03-24. Retrieved 2017-03-23.
- "Blood Facts – Rare Traits". LifeShare Blood Centers. Archived from the original on September 26, 2006. Retrieved September 15, 2006.
- "Modern Human Variation: Distribution of Blood Types". Dr. Dennis O'Neil, Behavioral Sciences Department, Palomar College, San Marcos, California. 2001-06-06. Archived from the original on 2001-06-06. Retrieved November 23, 2006.
- "Racial and Ethnic Distribution of ABO Blood Types – BloodBook.com, Blood Information for Life". bloodbook.com. Archived from the original on 2010-03-04. Retrieved September 15, 2006.
- "Molecular Genetic Basis of ABO". Retrieved July 31, 2008.