{"id":1460,"date":"2020-08-07T00:26:04","date_gmt":"2020-08-07T00:26:04","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/medical-genetics\/polymorphisms\/blood-groups-abo-blood-groups\/"},"modified":"2021-01-21T22:55:30","modified_gmt":"2021-01-21T21:55:30","slug":"blood-groups-abo-blood-groups","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/medical-genetics\/polymorphisms\/blood-groups-abo-blood-groups\/","title":{"rendered":"Blood Groups: ABO blood groups"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><div class=\"intro\">Blood groups are made\/classified based on the <strong>antigens<\/strong> present on the surface of the red blood cells.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Antigens are molecules that elicit the formation and release of antibodies from the immune system. The reaction between the antibodies and the antigens leads to <strong>agglutination<\/strong> i.e. the cells clump together.<\/li><li>Blood group systems can be <strong>ABO, Rhesus factor, Lewis, Duffy,<\/strong> etc. Here we will discuss the <strong>ABO system<\/strong> which is classifying the blood based on the <strong>carbohydrate antigens<\/strong> on the surface of the red blood cells.<\/div><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">It is important to remember that the ABO blood group gene is a polymorphic one<em>.<\/em>&nbsp;This is because it has more than two alleles (three) in the general population.<\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h2 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Genetics and Inheritance of the ABO blood group system<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">As mentioned above, the ABO gene has three alleles in the population:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>The <strong>I<\/strong><sup><strong>A<\/strong>&nbsp;<\/sup>allele that codes for the &#8216;A&#8217; antigen<\/li><li>The<strong> I<\/strong><sup><strong>B<\/strong>&nbsp;<\/sup> allele that codes for the &#8216;B&#8217; antigen<\/li><li>The <strong>i<\/strong> allele that doesn&#8217;t code for any antigen<\/li><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">It is important to note that the <strong>I<\/strong><sup><strong>A<\/strong>&nbsp;<\/sup>and <strong>I<\/strong><sup><strong>B<\/strong>&nbsp;<\/sup>alleles are <strong>codominant<\/strong> and both of them are <strong>dominant<\/strong> to the <strong>i<\/strong> allele which is recessive<em>(details on dominance and codominance are discussed in the Transmission Genetics: Mendelian Genetics: Introduction and important terms course).&nbsp;<\/em>Fortunately (or otherwise), this is not the end of the story.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>ABO gene<\/strong> is under <strong>recessive epistasis<\/strong> from the <strong>H gene<\/strong><em>(details on recessive epistasis are discussed in the Transmission Genetics: Mendelian Genetics: Epistasis course).&nbsp;<\/em>This means that expression of the ABO gene is dependent on the expression of the H gene i.e. if the H gene is expressed, the ABO gene will be expressed and vice versa. The H gene is non-polymorphic and has two alleles; a dominant <strong>H<\/strong> and a recessive <strong>h<\/strong>. Out of the two&nbsp; H alleles present in a person, one of them must be dominant. It can be heterozygous or homozygous dominant<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To better explain my above point, I&#8217;ll give a series of examples and a table.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A person has an <strong>I<sup>A<\/sup>I<sup>B<\/sup>Hh <\/strong>genotype. Their blood type will be AB because the A and B alleles are codominant so both of them will be expressed and the H gene is expressed as well, albeit heterozygously. If this person had <strong>I<sup>A<\/sup>I<sup>B<\/sup>hh,&nbsp;<\/strong>they would not have the AB blood type because the H gene is not expressed at all, both alleles are recessive. <strong>Remember that the expression of the H gene is required for the expression of the ABO gene.<\/strong> To summarise, I will give a table below;<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"pure-table\"><thead><tr><th>Blood group<\/th><th>Possible genotypes<\/th><\/tr><\/thead><tbody><tr><td>A<\/td><td><strong>I<sup>A<\/sup>I<sup>A<\/sup>H_<\/strong> or <strong>I<sup>A<\/sup>iH_ <\/strong><em>(remember that the i allele is recessive to both A and B and that one of the H alleles have to be dominant for the ABO gene to be expressed at all)<\/em><\/td><\/tr><tr><td>B<\/td><td><strong>I<sup>B<\/sup>I<sup>B<\/sup>H_<\/strong> or <strong>I<sup>B<\/sup>iH_<\/strong><\/td><\/tr><tr><td>AB<\/td><td><strong>I<sup>A<\/sup>I<sup>B<\/sup>H_<\/strong><\/td><\/tr><tr><td>O<\/td><td><strong>iiH_ <\/strong><em>(because no dominant ABO allele is present, the recessive one will be expressed)<\/em><\/td><\/tr><tr><td>Bombay<\/td><td><strong>__hh<\/strong> <em>(this is when the H gene is not expressed at all. In this case, no matter what the ABO alleles are\/were, they would not be expressed at all)<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The sign &#8216;_&#8217; means that no matter what allele is there, the result will be the same.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Physiology of the ABO blood group system<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Antigens of the ABO blood group system<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">I will make this super easy by going step by step.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">First, we start with a red blood cell with no ABO antigens on it. If the <strong>H gene<\/strong> is present<strong>(genotype is H_)<\/strong>, an enzyme will code for the <strong>H antigen<\/strong> to be expressed on the surface of the red blood cell. If the h gene is not present, the H antigen is not expressed on the cell. The latter is the case of the <strong>Bombay<\/strong> blood group. Keep in mind that this <strong>H antigen<\/strong> is a precursor for the expression of other ABO blood groups as the A and B antigens are made from the H antigen. This is why the Bombay red blood cell cannot express any of the ABO antigens(because it lacks the H antigen).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the H gene is expressed and the first H antigen molecule is on the red blood cell, we have three options<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>&nbsp;If the I allele is not present i.e genotype is <strong>iiH_, <\/strong>this will not code for any enzymes and the cell stays this way. This is the<strong> O <\/strong>blood group. The red blood cells will only have H antigens on their surface.<\/li><li>&nbsp;If the I<sup>A<\/sup> allele is present i.e genotype is <strong>I<sup>A<\/sup>I<sup>A<\/sup>H_<\/strong> or <strong>I<sup>A<\/sup>iH_,<\/strong> the&nbsp;I<sup>A <\/sup>allele codes for an enzyme that changes some of the H antigens to A antigens. This is the<strong> A&nbsp;<\/strong>blood group. The red blood cells will have the new A antigen and some H antigen on their surface(not all the H antigens will be changed to the A antigen)<\/li><li>&nbsp;If the I<sup>B<\/sup> allele is present i.e genotype is <strong>I<sup>B<\/sup>I<sup>B<\/sup>H_<\/strong> or <strong>I<sup>B<\/sup>iH_, <\/strong>the I<sup>B <\/sup>allele codes for an enzyme that changes some of the H antigens to B antigens. This is the<strong> B&nbsp;<\/strong>blood group. The red blood cells will have the new B antigen and some H antigen on their surface(not all the H antigens will be changed to the B antigen)<\/li><li>&nbsp;If both the I<sup>A&nbsp;<\/sup>and the I<sup>B<\/sup> allele is present i.e genotype is <strong>I<sup>A<\/sup>I<sup>B<\/sup>H_<\/strong><strong>,<\/strong> the&nbsp;I<sup>A <\/sup>allele codes for an enzyme that changes some of the H antigens to A antigens&nbsp;and the&nbsp;I<sup>B <\/sup>allele codes for an enzyme that changes some of the H antigens to B antigens.&nbsp;This is the<strong> AB&nbsp;<\/strong>blood group. The red blood cells will have the new A and B antigens and some H antigen on their surface(not all the H antigens will be changed to the A and B antigen)<\/li><\/ol>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Antibodies of the ABO blood group system<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Now that we have discussed the <strong>antigens<\/strong> of the ABO blood group system, let us discuss the <strong>antibodies<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As mentioned previously, the antibodies are produced when the antigens activate the immune system, specifically the adaptive immune system. It&#8217;s very easy to understand if you think about it logically, it makes no sense for our bodies to produce antibodies that can attack our own red blood cells. Therefore a person with blood type A who expresses both A and H antigens on their red blood cell will not have anti-A and anti-H antibodies but will have anti-B. This causes problems in blood transfusions that we will discuss soon. I will make a table to simplify and summarize it<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"pure-table\"><thead><tr><th>Blood group<\/th><th>Antibodies present in serum<\/th><\/tr><\/thead><tbody><tr><td>A<\/td><td>Anti-B<\/td><\/tr><tr><td>B<\/td><td>Anti-A<\/td><\/tr><tr><td>AB<\/td><td>None<em>(the AB red blood cell has A, B and H antigens so it will have no antibodies)<\/em><\/td><\/tr><tr><td>O<\/td><td>Anti-A and Anti-B<\/td><\/tr><tr><td>Bombay<\/td><td>Anti-A, Anti-B and Anti-H<em>(the Bombay red blood cell lacks A, B and H antigens so it will have all the antibodies)<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><a href=\"https:\/\/meddists.com\/wp-content\/uploads\/2020\/03\/695px-Bedside_card.jpg\" target=\"_blank\" title=\"Blood Groups: ABO blood groups\"><img decoding=\"async\" src=\"https:\/\/meddists.com\/wp-content\/uploads\/2020\/03\/695px-Bedside_card-600x517.jpg\" alt=\"\" class=\"wp-image-27120\"\/><\/a><figcaption><strong>A picture of the bedside blood typing card. It is fast and results can be seen in less than 10 minutes. Blood is taken from the finger of the patient (by pricking with a small needle) and dropped onto the card. The card contains Anti-A, Anti-B, and Anti-D antibodies as seen above. After a few minutes, agglutination is observed in the Anti- and Anti-D areas but none in Anti-B. This is because the antibodies reacted with the antigens on the red blood cells to cause agglutination. Therefore the blood type of this patient is A+. <em>Details on D antigen are discussed in the next lesson<\/em><\/strong>.<b> This type of agglutination is what happens in a much larger scale in the body if the donor and recipient are not matched properly. This agglutination can lead to blood clots, multiple organ failure and eventually, death<\/b>(Credit: Apers0n at English Wikipedia, CC BY 2.0)<\/figcaption><\/figure><\/div>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Formation of plasma antibodies<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">For the immune system to produce antibodies, it has to have encountered the antigen before. This is the basics of vaccines.<em> Details are discussed in the Immunology of Third Year and are therefore not included in the Genetics curriculum<\/em>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These antibodies(the ones discussed in the table above) are fully formed by the first year of life. You may wonder, how do we have antibodies for antigens that we have never experienced by e.g blood transfusion? This is because of the interaction of the immune system with bacteria eg. normal flora of the gut and other non-pathogenic environmental antigens.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">With this in mind, it must be noted that there is no such thing as a <strong>universal donor<\/strong> and a <strong>universal recipient<\/strong>. This is because there are other factors that determine the compatibility of blood transfusion such as the Rhesus factor. So an AB+ can only give to another AB+. Blood transfusion should only happen between red blood cells as transfusion of whole blood containing plasma can cause adverse immune reactions because of other plasma proteins.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h2 class=\"wp-block-heading\" class=\"wp-block-heading\">Genetics and Inheritance of the ABO blood group system<\/h2><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Physiology of the ABO blood group system<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Antigens of the ABO blood group system<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Antibodies of the ABO blood group system<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Formation of plasma antibodies<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>It is important to remember that the ABO blood group gene is a polymorphic one.&nbsp;This is because it has more than two alleles (three) in the general population. Genetics and Inheritance of the ABO blood group system As mentioned above, the ABO gene has three alleles in the population: The IA&nbsp;allele that codes for the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1448,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1460","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Blood Groups: ABO blood groups &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/pre-clinical\/medical-genetics\/polymorphisms\/blood-groups-abo-blood-groups\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/medical-genetics\\\/polymorphisms\\\/blood-groups-abo-blood-groups\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/medical-genetics\\\/polymorphisms\\\/blood-groups-abo-blood-groups\\\/\",\"name\":\"Blood Groups: ABO blood groups &#8211; 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