Blood types • Blood types is the common of normal antigens signs, which are combined on immunologic and genetic bases There are • erythrocytes • leukocytes and • serum blood types Model of erythrocyte membranes with embedded molecules of different blood group systems. Such systems currently known 25 (AB0, Rh, Cromer, Diego, Duffy, MNS, Lewis, etc.), and they include more than 300 different antigens
History of the discovery of blood groups • In 1900, the Austrian physician Karl Landsteiner published the results of studies, which showed that all people have three blood types. Prague, Jan Jansky doctor found that people are not 3, and 4 blood groups and gave them refer to Roman numerals: I, II, III, IV.
Agglutination • Agglutination ( Latin agglutinatio - adhesive) - this process is irreversible agglutination of red blood cells under the influence of antibodies. It is usually accompanied by hemolysis . The same happens in the bloodstream transfusion of incompatible blood .Agglutination of red blood cells is the result of antigen-antibody reaction . In the erythrocyte membrane are complexes with antigenic properties. These antigenic complexes called agglutinogens . They interact with specific antibodies dissolved in plasma - agglutinins . Normally, blood is no agglutinins in their own erythrocytes.
Attention! • The blood of every human individual contains a set of specific erythrocyte agglutinogens. Everyone has only her characteristic set of antigens.In practice, now we take into account basically two antigenic systems - a AB0 and CDE.
Under this system, human erythrocytes are divided according to the antigenic structure into four groups:without antigen (now known that this antigen H)antigens A, B, AB.Plasma under natural antibodies are conventionally denoted: αβ; β; α and missing.Thus, people are distinguished combination of antigens and antibodies in the system AB0: • 0(І)αβ ; • А(ІІ)β ; • В(ІІІ)α; • АВ(ІV).
Plasma Plasma Plasma Plasma ABO Blood Groups
Average Percents • Type O—46% • Type A—40% • Type B—10% • Type AB—4%
Determination of blood in the system AB0 by standard serum • On clean white plane after their entries for glass, apply a standard serum first, second and third blood group two series. In each of drops of standard serum angle net of glass, make ten times smaller amount of blood, and after 2-3 minutes add one drop of saline. With the advent of agglutination observed within 5 minutes. Install blood type. In the case of four blood groups, conduct additional determination of standard serum group.
Determination of blood in the system AB0 by monoclonal antibodies • Pure white plane for glass divided into 4 sections: anti-A, anti-B, anti-D and control. Put in the relevant sector 1 drop of monoclonal antibodies anti-A, anti-B, anti-D and the control saline NaCl. Angle of glass make ten times smaller amount of blood in two drops of monoclonal antibodies. Observation of the reaction on the plate shaking for 2.5 minutes. В(ІІІ)α, Rh+
System СDЕ (rhesus) At present, there are 6 major Rh antigens . For its designation in Europe adopted the nomenclature of Fisher-Race. According to him, the antigens are indicated by letters : • D, C, E, d, c, e. Sometimes used Wiener nomenclature under which antigens are indicated: Rh0; rh '; rh "; Hr0; hr'; hr". Often the two nomenclatures used simultaneously. Thus the symbols of the signs are in brackets: • Rh0 (D); rh '( C ); rh "( E ); Hr0 (d); hr' (c); hr" (e). Antigen Rh0 (D) - the main antigen of the Rh-system. It is found in red blood cells 85 % of people. • Based on the presence of erythrocyte antigen Rh0 (D) isolated Rh- positive blood. Human blood, red blood cells are devoid of this antigen relate to Rh-positive group.
System СDЕ (rhesus) • Antigen Rh0 (D) are unevenly distributed among the various races. In European populations, people with Rh-negative blood type make up 15%, Mongoloid race - about 0.5%. • The main six of Rh antigens may often occur in combination : CDE - 15,85%; Cde- 53, 2 %: cDE- 14 , 58 %, cde - 12,36%. • Natural antibodies to the Rh blood group system is not there. They can only be acquired , immune . • They are formed under special pregnancy when there is ingestion of Rh negative women through the vessels of the placenta of Rh positive fetal red blood cells .
Mechanism of Rh-conflict in pregnancy • They can only be acquired , immune (during pregnancy when there is ingestion of Rh (-) women through the vessels of the placenta Rh (+) erythrocytes of the fetus).Mechanism of Rh conflict in pregnancy: immune antibodies formed in the body of Rh -negative women pregnant Rh-positive fetus, have the ability to cross the placenta into the body of the fetus, its cause hemolysis of erythrocytes. During labor in the blood of a newborn baby comes many antibodies and developed hemolytic disease.Antibodies can get newborn and mother's milk .
Leukocytes blood types • 1. Common antigens of leukocytes (HLA system) • 2. Antigensof granulocytes. • 3. Antigensof lymphocytes.
Leukocytes blood types • First data for leukocyte group received the French explorer Dausset in 1954 of open leukocyte antigen entered the science called «Mac». • Now there are more than 40 antigens of leukocytes, which are divided into three antigenic systems: • 1. Total leukocyte antigens. • 2. Antigens granulocytes. • 3. Antigens lymphocytes.
Common leukocyte antigens (system HLA-human leucocyteantigene). • According to WHO recommendations using letter- numeric designation for antigens, whose existence is confirmed by a number of laboratories in parallel investigated antigens. • Genetically HLA- antigens are 4 subtypes (A , B, C, D), each of which combines allelic antigens. The most studied is A and B. For example HLA-A1, HLA-A2, HLA-A3, HLA-A5, HLA-A7, HLA-A8. • For the first subspecies amount of antigen is 19 , the second-20. • HLA antigens are also found in addition to leukocytes in the cells of various organs and tissues ( skin, liver, kidney , spleen , etc.). • Mismatch of donor and recipient antigens after these reactions accompanied by the development of tissue incompatibility. Therefore, the installation of these antigens are used for tissue typing when choosing a transplant donor HLA- like phenotype.
Antigens granulocytes • This system antigens characteristic only for cells of myeloid series, as in the bone marrow and blood . • 3 known granulocyte antigens : NA- 1 , NA- 2 ; NB- 1, that can be divided into 3 blood group antigen in this system. • Established that antibodies against granulocyte antigens cause short-term reduction in the number of neutrophils in the newborn. • If you do not take into account the total leukocyte antigens and antigens of granulocytes , you can post transfusion reactions due to the fact that in the plasma of the recipient will be antibodies against antigens and as a result of their interaction allocated pyrogenic substances .
Lymphocyte antigens • Lymphocyte antigens unique to cells of lymphoid tissue. • Known until one antigen of the group, which is designated LYD1. It occurs in people with a frequency of about 36%. The value of this group antigens in transfusiology and transplantology is not fully understood.
Serum group • The highest value among most whey proteins have genetic heterogeneity of immunoglobulins. • We know of two immunoglobulin Gm i Inv. The system has more than 20 Gm antigen levels , like 20 blood group Gm ( 1) and Gm ( 2 ), etc. , and the system has a 3 Inv antigens, ie 3 blood types : Inv ( 1 ), Inv ( 2 ), Inv (3). • Alpha -1 globulin . In the area of alpha -1- globulin polymorphism observed large . Among them, 17 were found phenotypes of the system. • Alpha -2- globulins . In this section distinguish polymorphisms , including ceruloplasmin . • There are 4 types of ceruloplasmin (Cp): Cp A; Cp AB; Cp B i Cp BC. Most commonly found group Cp B. In this group of Europeans found 99 %, and negroid - in 94 % of cases. • Beta globulins . These include transferrin (Tf). It easily enters the compound of iron. The specified property provides the performance of important physiological functions - transport of iron to the bone marrow , where it is used for blood . • There are the following groups : TfC, TfD.
Transfusionofblood • We must transfused only blood of one groop with recipient!!! • Before the transfusion we must do the test on individual blood compatibility • in AB0 system • in DCE system • Biological test
The test of the compatibility AB0 system • The test of the compatibility AB0 system aimed at the detection of antibodies in the blood of the recipient to the donor's red blood cells . • Sterile syringes collected from the vein of the recipient 1-3 ml of blood and carry it in a test tube containing a solution of citric acid - sodium. The tube is centrifuged . After, pipette the serum of the recipient and shall put 2 drops on a plate. These drops of serum added to 10 times less of donor‘s blood. Shaking the plate 5 min. , And then add 1-2 drops of 0.9 % solution of NaCl. The appearance of agglutination indicate that this blood can not be transfused . • Blood donor and recipient are not compatible in the system AB0.
Test of Rh compatibility aimed at detecting anti-erythrocyte Rh antibodies. • In a petri dish put the serum of the recipient. Add 10 times less of donor‘s blood. The mixture was stirred and heated in a water bath (temperature 45 ° C) for 10 min. The presence of agglutination indicating that blood incompatibility Rh factor.
The biological sample • Recipient pour 10-15 ml of blood, then stop the infusion and monitor its condition. If no violations of life, then after 3-5 minutes pour 10-15 ml of blood and re-infusion is stopped. Watch 5 minutes. Such manipulation is carried out for the third time. If the health of the recipient is not observed any violations of health, the blood can be transfused. Otherwise, stop the transfusion
Physiological effects of transfused blood • 1.Stimulating - stimulates the functions of various body systems and metabolic processes. • 2. Hematopoietic - enhances blood. • 3. Immunologic - strengthens the body's defenses by introducing antibodies. • 4. Nutrients effect - with blood enters nutrients.
Groups substitutes are: • 1. Hemodynamic - to normalize hemodynamic. • 2. Detoxification- for the treatment of poisoning. • 3. Preparations for parenteral nutrition: • • protein hydrolysates; • • solutions of amino acids; • • drugs fat emulsion.
Groups substitutes are: • 4. Regulators of water and salt, and acid-base balance: • • saline; • • osmo diuretic. • 5. Blood substitutes with the function of carrying oxygen. • 6. Blood substitutes complex action.