In absence of cross-matching, there is a possibility of missing the antigens on donor cells, but in clinical practice, they are of less importance. Antibody screening increases this safety margin up to 99.94%, and an additional cross-match further increases the compatibility to 99.95%. ABO-Rh typing alone results in a 99.8% chance of a compatible transfusion.
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(b) Blood may be ordered without full set of investigations. Many scientific articles disputed the relevance of preoperative arrangement of blood in surgeries where blood loss is not anticipated to be significant. There are controversies regarding the best method for procurement of blood during elective and emergency situations: (a) It can be done by routinely asking for grouping and cross-matching in elective surgical patients. Blood group O increases the severity of infection in Vibrio cholerae strains (O1 El Tor and O139). Protection against falciparum malaria can be achieved with group O by reducing rosette formation. A positive correlation has been shown between blood group A with chronic hepatitis-B infection and pancreatic cancer and blood group B with ovarian cancer. Preliminary studies suggested an association of ABO system with malignancies. Significant association of ABO groups with the prevalence of preeclampsia has been reported, where AB group was found to be associated with an increased risk of 2.1-folds. A higher risk of cerebral venous thrombosis has been reported in non-O groups. Increased association of myocardial infarction, ischemic stroke, and venous thromboembolism is seen with blood groups A and AB possibly through functional ABO glycol transferases modulation of thrombosis. They exert major quantitative effects on plasma levels of von Willebrand factor and factor VIII. The ABO blood groups have a profound influence on haemostasis. Nevertheless, the clinical function of the null phenotypes of these blood groups still remains to be elucidated. Similarly, Knops blood group antigen has been associated with complement receptor 1 and Cromer system with decay acceleration factor. The null phenotype of the system, however, shows no immune system abnormalities when compared with mice except for a blunted neutrophil response on exposure to bacterial lipopolysaccharide. The proposed function of other antigens are mostly receptor/ligand signaling, enzymatic activity, and glycocalyx formation.
The remaining 23 are characterized by the protein sequence of the RBC membrane protein, five major proteins (DI, Rh, RhAG, MNS, GE, and CO) among them are expressed at higher levels and function as membrane transporters, whereas the functional importance of rest of 17 antigens is unknown. Of the 33 blood group system antigens, five are defined by their carbohydrate structures (ABO, H, P1Pk, I, GLOB) two are obtained from the plasma (LE, CH⁄RG). Later, Jan Jansky described classification of human blood groups of four types. His obituary lists an immense contribution of more than 346 publications. He was awarded Noble Prize in 1930 for this discovery. His extensive research on serology based on simple but strong scientific reasoning led to identification of major blood groups such as O, A, and B types, compatibility testing, and subsequent transfusion practices. Karl Landsteiner has been credited for the discovery of ABO blood group system in 1900. Over a period of time, our understanding on blood groups has evolved to encompass not only transfusion-related problems but also specific disease association with RBC surface antigens. “Blood type” refers to a specific pattern of reaction to testing antisera within a given system.
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The term “blood group” refers to the entire blood group system comprising red blood cell (RBC) antigens whose specificity is controlled by a series of genes which can be allelic or linked very closely on the same chromosome.