Essential Guide to Blood Groups

Geoff Daniels, Consultant Clinical Scientist and Head of Diagnostics, IBGRL, Bristol Institute for Transfusion Services, NHS Blood and Transplant, Bristol, UK

Imelda Bromilow, Scientific Consultant, Liverpool, UK

Abbreviations, xx

1 An introduction to blood groups

What is a blood group?

Blood group antibodies

Clinical importance of blood groups

Biological importance of blood groups

Blood group systems

Blood group terminology and classification

2 Techniques used in blood grouping

Factors affecting antigen–antibody reactions

Temperature

Time and ionic strength

Stages of haemagglutination reactions

Direct agglutination

Indirect agglutination

Elution techniques

Automation of test procedures

Flow cytometry

Molecular blood group genotyping

3 The ABO blood groups

Introduction

ABO antigens, antibodies, and inheritance

A1 and A2

Antigen, phenotype, and gene frequencies

ABO antibodies

Importance of the ABO system to transfusion and transplantation medicine

Biochemical nature of the ABO antigens

Biosynthesis of the ABO antigens and ABO molecular genetics

H, the precursor of A and B

ABH secretion

H-deficient red cells

Further complexities

Acquired changes

Associations with disease and functional aspects

4 The Rh blood group system

Introduction – Rh, not rhesus

Haplotypes, genotypes, and phenotypes

Biochemistry and molecular genetics

D antigen (RH1)

C, c, E, and e antigens (RH2, RH4, RH3, RH5)

Other Rh antigens

Rh-deficient phenotypes – Rhnull and Rhmod

Putative function of the Rh proteins and RhAG

5 Other blood groups

The Kell system

The Duffy system

The Kidd system

The MNS system

The Diego system

The Lewis system

Some other blood group systems

Antigens that do not belong to a blood group system

6 Clinical significance of blood group antibodies

Antibody production and structure

Factors affecting the clinical significance of antibodies

Haemolytic transfusion reactions (HTR)

Haemolytic disease of the fetus and newborn (HDFN)

Autoantibodies

Tests to assess the potential significance of an antibody

Decision-making for transfusion

7 Blood grouping from DNA

Fetal blood grouping

Blood group typing of patients and donors

Next generation sequencing

The future of blood group serology

8 Quality assurance in immunohaematology

Achieving total quality

Frequency and specificity of control material

Quality requirements for safe transfusion practice

Checklist of critical control points

Laboratory errors, root cause analysis (RCA) and corrective and preventative action (CAPA)

9 Trouble-shooting and problem-solving in the reference laboratory

ABO grouping

Rh grouping

Problems in antibody screening, identification, and cross-matching

10 Frequently asked questions

Recommended reading

Index

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