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Direct Coombs Test (DAT) Indirect Coombs Test (IAT)

■ Detect antibodies or complement ■ Detects antibodies in the Serum.
on surface of Red blood cells.
■ PS + O cells + AHG (Positive =
■ PR + AHG (Positive = Agglutination) Agglutination)
■ Uses: ■ Uses:

BLOOD BANK – Autoimmune hemolysis

■ Warm (IgG)
– Pre transfusion testing
■ Crossmatching
■ Cold (IgM) – Pre natal antibody screen
Kyle Mirah Sumayao, RMT, DTA, PHIV(TTI),MSMLS
– Drug induced Hemolysis ■ IgG antibodies that can cross
– Alloimmune Hemolysis the placenta.

■ Hemolytic disease of the

newborn
■ Alloimmune haemolytic
transfusion reaction

Blood Group Systems

■ 32 human blood groups systems are now recognized by the International Society of
Blood Transfusion (ISBT)

ABO AND RH
■ The most important of these:
– ABO blood group System
– Rh blood group System

Discovery of ABO Blood Types Inheritance

■ Blood types are inherited genetic traits (like eye color, hair color, etc)

■ ABO blood types were discovered in

1900 by Dr. Karl Landsteiner at the A A B
University of Vienna. B
B A
B
A A B
A
B B A
A
■ He wondered why some patients died A B B B
as a result of blood transfusions and A B A
A A B B B A B
others did not.

TYPE A TYPE B TYPE AB TYPE O

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Carbohydrate portion of the antigen is illustrated

INHERITANCE OF ABO BLOOD GROUP N-acetylglucosamine

L - fucose

■ Theory of inheritance was first described by Bernstein in 1924. He demonstrated

that an individual inherits one ABO gene from each parent and that genes determine
ABO antigens are present on the RBC membrane.
■ Inheritance simple follow Mendelian genetics. A
A A N-acetyl-D-galactosamine
■ The O gene is considered an amorph because it has no detectable antigen produced A
in response to the inheritance.

B B
B
B B D - galactose

Carbohydrate portion of the antigen is illustrated

N-acetylglucosamine
Alleles in the ABO System
a-2-L-fucosyltransferase

Allele
A
A
A a-3-N-acetylgalactosaminyltransferase O
A

A
B
B
B B
B B a-3-D-galactosyltransferase

Blood Group Antigen on Genotype Antigens and Antibodies

(Phenotype) Blood Cells ■ The antigens you have on your blood cells are recognized by your immune system as
SELF antigens
A B AA / AO ■ If foreign antigens are discovered in your body, antibodies (immunoglobulins) will
made by B cells of the immune system

B A BB / BO
■ Antigen + Antibodies = Agglutination (clumping of particles)

AB AB AA / AB / BB

O - OO
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Phenotyoe Antibodies A B AB O
Rh Antigen (D Antigen)
A ANTI – B 0 + + 0
■ Named for the Rhesus macaque in which earlier studies were done.

B ANTI – A + O + 0
Genotype Phenotype Antigens on
AB NONE 0 0 0 0 Blood Cells
RR Rh+ Agglutination
O ANTI – A AND + + + 0 Rr Rh + Agglutination
ANTI – B
rr Rh - No
Type AB – Universal Recipient Agglutination
Type O – Universal Donor

Bombay Phenotype (Oh)

■ hh genotype
■ No H antigens formed; therefore no A or B antigens formed
■ Phenotypes as blood group O
■ Anti-A, Anti-B, Anti-AB and Anti-H present in the serum
■ Can only be transfused with blood from another Bombay.

Para-Bombay Phenotype
■ Rare phenotypes in which the RBCs are commonly devoid of H antigens or have
small amounts of H antigen present.
■ RBCs of these individuals express weak forms of A and B antigens, which are
primarily detected by adsorption and elution studies.

Categories of ABO Discrepancies

pg 136 