ABO RH INCOMPATIBILITY IN SELECTED COUPLES IN LAGOS ISLAND

ABSTRACT

A series of glycoprotein and glycolipids on red blood cell surface constitute blood group antigens. These are the ABO (A, B, AB and O) and Rh blood groups which are the most important blood groups despite the long list of several other blood groups discovered so far.  The ABO and Rh blood groip varies worldwide and are not found in equal numbers. Therefore, the aim of this study was to determine the frequency of ABO Rh blood group between couples on Lagos island Lagos Nigeria using the church gathering. Two hundred pairs of couples were selected for this study and were tested for ABO Rh blood group using the tile method.  The result showed that the frequency of ABO Rh incompatibility between couples was 14% out 200 samples used i.e M (O Rhd+ve) and F (A Rh d- ve) = 1%, M (O Rh d +ve) and F (B Rh d- ve) = 4%, M (A Rh d + ve) and F (O Rh d- ve) = 1%, M (B Rh d +ve) and F (O Rh d – ve) = 2% and M(O Rh d + ve) and F (O Rh d – ve) = 6%.   It is imperative for couples to be aware of their ABO Rh blood group for the safety of their unborn children because Rh incompatibility between mother and fetus can be detrimental to health status of fetus

TABLE OF CONTENTS

Title page                                                                                                                    i

Certification                                                                                                                ii

Dedication                                                                                                                  iii

Acknowledgements                                                                                                    iv

Table of contents                                                                                                        v

List of Figures                                                                                                             viii

List of Tables                                                                                                              ix

Abstract                                                                                                                      x

Chapter One

1.0       Introduction                                                                                                    1

1.1       Background of the Study                                                                               1

1.1.1    Historical Perspective of ABO Rh Blood Groups                                          1

1.1.2    The Rh Blood Groups System                                                                        2

1.1.3    Fundamental Principle ABO Rh Blood Group                                              3

1.2       Statement of the Problem                                                                               4

1.3       Justifications for  the study                                                                            4

1.4       Aims and Objectives                                                                                       4

Chapter Two

2.0       Literature Review                                                                                           5

2.1       ABO Blood Grouping                                                                                                5

2.1.1      The Genetics of the Rhesus Blood Group System                                         7

2.2       The Molecular Basis of the Rhesus Alleles                                                     9

2.2.1    D Negative Phenotype                                                                                    9

2.2.2    The Molecular Basis of D Antigen Variants                                                   10

2.2.3    Partial D                                                                                                          10

2.2.4    Weak D                                                                                                           11

2.2.5    Del                                                                                                                  11

2.2.6    The C/c and E/e antigens                                                                                11

2.3       Anti-D In Patients                                                                                          12

2.3.1    Pregnant Women and Anti-D Prophylaxis                                                     13

2.3.2    Prenatal Diagnosis                                                                                          13

2.3.3    Having a Child and Anti-D Antibodies                                                         14

2.4       ABO Rh  Incompatibility in Couples                                                                         14

Chapter Three

Materials and Methods                                                                                               23

3.1       Materials                                                                                                         23

3.1.1    Experimental Design                                                                                       23

3.2       Sample Collection                                                                                           24

3.1.3    ABO and RH Blood Group Determination                                                   24

Chapter Four

4.0       Results                                                                                                            28

4.1       Result showing the Frequency of Abo Rhesus incompatibility

between Couples                                                                                             28

4.2       The Frequency of ABO Rhesus incompatibility between Couples (1)           30

4.3       The Frequency of ABO Rhesus incompatibility between Couples (2)           31

4.4       The Frequency of ABO Rhesus incompatibility between Couples (3)           32

4.5       The Frequency of ABO Rhesus incompatibility between Couples (4)           33

Chapter  Five

5.0       Discussion                                                                                           34

Chapter Six

6.0       Conclusion and Recommendation                                                      36

6.1       Conclusion                                                                                          36

6.2       Recommendation                                                                                36

References                                                                                          37

LIST OF FIGURES

Figure 1:          Blood Group Determination                                                                           26

Figure 2:          Blood Group Determination showing Agglutination                                     27

Figure 3:          The Frequency of ABO Rhesus incompatibility between Couples (1)           30

Figure 4:          The Frequency of ABO Rhesus incompatibility between Couples (2)           31

Figure 5:          The Frequency of ABO Rhesus incompatibility between Couples (3)           32

Figure 6:          The Frequency of ABO Rhesus incompatibility between Couples (4)           33

LIST OF TABLES

Table 1:           Matings and Pregnancies Classified with Respect to the ABO

Blood Group System                                                                                      16

Table 2:           The Compatible and Incompatible Rh Blood Group between Couples         19

Table 3:           Result showing the Frequency of ABO Rhesus Incompatibility

between Couples                                                                                             29

CHAPTER ONE

1.0. INTRODUCTION

1.1       Background of the Study

1.1.1    Historical Perspective of ABO Rh Blood Groups 

A blood type is a classification of blood of inherited antigenic substances on the surface of red blood cells (RBCs) (Yipp, 2002). These antigens may be proteins, carbohydrate, glycoprotein or glycolipids, depending on the blood group system. Blood types are inherited and represent contributions from both patient.

Blood grouping system in clinical practice is important because an antigen may in certain circumstances react with its corresponding antibody and cause harmful clinical effects like haemolytic transfusion reactions and haemolytic disease or newborns (Roy et al., 1983 and Bhatiael el, 1986), what is being called incompatibility.

A total of 33 human blood group system are now recognized by the international society of blood transfusion (ISBT) (ISBT, 2012). The two most important ones are ABO and RhD antigen they determine someone’s blood type (A, B, AB and O, with +, - or Null denoting the RhD status) (ISBT, 2012).  

Experiments with blood transfusions have been carried out for hundreds of years.  Many patients have died and it was not until 1901, when the Austrian Karl Landsteiner discovered human blood groups, that blood transfusion became safer. He found out that mixing two incompatible blood sample from two  individuals can lead to blood clumping or agglutination. Karl Landsteiner discovered that blood agglutination or clumping was an immunological reaction which occurs when the receiver of a blood transfusion has antibiotics against the donor blood cells (Leisky et al., 2000).

1.1.2    The Rh Blood Groups System

The Rh factor is one of thirty-three current human blood group systems. It is the most important blood group systems after ABO.  At present, the Rh blood group system consist of 50  defined blood group antigens, among which the five antigens D, C, c, E and e are the most important.  The commonly used terms Rh factor, Rh positive and Rh negative refer to the D antigen besides its role in blood transfusion, the Rh blood group system, specifically the D antigen is used to determine the risk of haemolytic disease of the new born (enythroblastosis fetalis) as prevention is the best approach to management of this condition (Howard et al., 1998).

If  the Rh antigen is lacking,  the blood is called Rh negative, if the antigen is present it is called Rh positive.  In 1939, Philips Levine and Rufus Stetson published in a first case report the clinical consequences of non-recognized Rh factor, haemolytic transfusion, reaction and haemolytic disease of the newborn in its most severe form (Landsteiner and Wiener, 1941). It was recognized that the serum of the reported human agglutinated with red cells of about 80% of the people. No name was given to this agglutinin when described for the first time.

In 1941, Karl and Wiener reported a serum that also reacted with about 85% of different human red blood cells (Landsteiner and Wiener, 1941). The serum was produced by immunizing rabbits with red blood cells from Rhesus monkeys.  The antigen that induced this immunization was designated by them as Rh factor is indicated that rhesus blood had been used for the production of the serum (Landsteiner and Weiner, 1941).

The clinical significance of this highly immunizing D antigen is seen in the instance where the mother is Rh-negative and the father is Rh-positive, the fetus can inherit the Rh factor from the positive too. Problems can arise when the fetus’s blood has the Rh factor and the mother’s blood does not

1.1.3    Fundamental Principle ABO Rh Blood Group

The central principle of the ABO system is that antigens- in this instance sugars physically exposed on the exterior of red blood cells differ between individuals who have immunological tolerance only toward what occurs in their own bodies (Yipp, 2002).   As a result many humans express  Isoantibodies- antibodies  against isoantigens. Iso antibodies may be present against A and /or B antigens in people who do not themselves have the same antigen in their own blood. These antibodies act as haemogglutinins, which cause blood alls to clump and break apart if they carry the foreign antigen. This harsh response, though an adaptive reaction useful against infection can cause death when large amount of such cells are encountered after a blood transfusion.

 Because A and B antigens are chemically modified from a precursor form that is also present in type O individuals, people with type A and B antigens can accept blood from type O individuals.

1.2       Statement of the Problem

The major reason for this work is that in previous study not much has been composed on the ABO incompatibility among couples intend to find out how much this has affected the society as a result of incompatibility among selected couples.

1.3       Justifications for  the study

This research work is important to the society because when couples are aware of these ABO blood group it helps them pressure for future pregnancy since incompatibility poses a serious threat to the foetus in the aspect of spontaneous abortion and haemolytic  disease of the new born

1.4       Aims and Objectives

The aim of this research work is to determine the frequency of ABO Rh incompatibility in selected couples in Lagos-Inland.

The objective is to:

i.                  determine the genic and phenotypic frequency between couples.

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