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Guyton chapter = 35
Blood Types; Transfusion; Tissue and Organ Transplantation
When neither A nor B agglutinogen is present, the blood is type O. When only type A agglutinogen is present, the blood is type A. When only type B agglutinogen is present, the blood is type B. When both A and B agglutinogens are present, the blood is type AB.
Agglutinins/antibodies
When type A agglutinogen is not present in a persons red blood cells, antibodies known as anti-A agglutinins develop in the plasma. Also, when type B agglutinogen is not present in the red blood cells, antibodies known as anti-B agglutinins develop in the plasma.
Average titers of anti-A and anti-B agglutinins in the plasma of people with different blood types.
The agglutinins are gamma globulins (antibodies) and they are produced by plasma cells Most of them are IgM and IgG immunoglobulin molecules. agglutinin formation occurs almost entirely after birth when type A and/or B antigens enter the body in food, in bacteria, and in other ways.
Landsteiners law
The reciprocal relationship between antigens on the red blood cells and antibodies in the serum is known as Landsteiners law It states that:
If an agglutinogen is present in the red cells of a blood, the corresponding agglutinin must be absent from the plasma. If an agglutinogen is absent in the red cells of a blood, the corresponding agglutinin must be present in the plasma
There are six common types of Rh antigens, each of which is called an Rh factor. These types are designated C,D, E, c, d, and e
A person who has a C antigen does not have the c antigen, but the person missing the C antigen always has the c antigen. The same is true for the D-d and E-e antigens. D Ag: Anyone who has this type of antigen is said to be Rh positive, whereas a person who does not have type D antigen is said to be Rh negative. 85 % people are Rh +ve
it is on the basis of presence or absence of antigens on red cells blood is grouped for purpose of transfusion
- Blood spot on weapon, clothing or some other site - To solve the issue of Disputed paternity and maternity
- Peptic ulcer is common in blood group O - Carcinoma stomach is more common in blood group A
Erythroblastosis fetalis is a disease of the fetus and newborn child characterized by of the fetuss red blood cells
The mother is Rh-negative, the father is Rh- positive and the baby is Rh-positive
Jaundice Kernicterus (deposition of unconjugated bilirubin in the brain) can occur. It can lead to mental retardation and cerebral palsy Hemolytic Anemia Nucleated Erythroblast are present in the peripheral blood Hydrops fetalis (fetus is swollen) Abortion may occur Enlarged spleen and liver
2. phototherapy
UV-rays convert unconjugated bilirubin (lipid soluble) into water soluble form which is excreted in urine.
within 24 48 hours of delivery & these neutralize RBCs of baby in mothers circulation. This prevents the mothers sensitization by babys RBCs.
In contrast to ABO system, in Rh system Anti Rh antibodies are not present naturally. These are produced when an Rh- person is transfused with Rh+ blood Such transfusion can be done one time. Not more than once! Such first Rh+ transfusion sensitizes the RhPerson. Second Rh+ transfusion will cause hemolysis
It is very less common than Rh incompatibility Reason: The antibodies in ABO system are of Ig M type, which being five times larger than Ig G antibodies, cannot cross the placenta.
Red blood cells of the donor blood are agglutinated. The plasma portion of the donor blood immediately becomes diluted by all the plasma of the recipient Hb bilirubin jaundice
These are the result of antibodies in the recipient's plasma directed against antigens on the donor's RBCs. This results in rapid intravascular hemolysis of the donor RBCs. ABO incompatibility due to clerical error is the most frequent cause. immunoglobulin M (IgM) typically result in severe, potentially fatal complement-mediated intravascular hemolysis
1. 2. 3. 4. 5. 6. 7. 8. 9.
Fever Chills Flushing Nausea Burning at the intravenous (IV) line site Chest tightness Restlessness and Apprehension Back pain Difficulty in breathing, increase in heart rate, fall in B.P., circulatory Shock 10. No urine production (oliguria) due to acute renal shut down
Acute Kidney Shutdown After mis-matched Transfusion One of the most lethal effects of transfusion reactions is kidney failure. The kidney shutdown seems to result from three causes:
1. 2. 3. Renal vasoconstriction Circulatory shock Obstruction of renal tubules
2.Circulatory Shock
1. Renal Vaso constriction
1. Renal vasoconstriction
2. Circulatory shock