Immunohematology

Blood Group Antibodies

y Immunoglobulins and Antigen Binding

Immunoglobulin (Ig)s are protein molecules that are produced in response to antigenic stimulation and that demonstrate specific antibody activity. The specificity of an antibody is determined by the hypervariable or complementarity-determining regions of an Ig molecule. Amino acid sequence heterogeneity in the hypervariable regions, which allows for variation in the configuration of the peptide chains in the variable loops, determines the combining specificity for each antibody. The combining site of an antibody, where it is in physical contact with an antigenic determinant or epitope, is called the paratope. Binding involves formation of multiple noncovalent bonds between the antigen and amino acids of the paratope. The attractive forces between antigen and antibody, which include electrostatic and van der Waals forces, hydrogen bonds, and hydrophobic interactions, become significant when the distance between the interacting groups is small. As a result, the better the physical fit between epitope and paratope, the higher is the overall binding energy and the greater is the affinity of the resulting reaction between antibody and antigen. y Blood Group Antibodies and Autoantibodies

Blood group antibodies are usually classified as : 1. Alloantibody, which reacts with a foreign antigen (not present on the patient s own erythrocytes) Alloantibodies can be divided into : - Natural antibody (occurs naturally, unknown stimulus, appears regularly in the serum of person who lacks the corresponding antigens, may be produced in a small subset of individuals) - Immune antibody (result of immunization to foreign RBC antigen, exposure through blood transfusion or pregnancy) 2. Autoantibody, which reacts with an antigen on the patient s own cells. y The Complement System and Blood Banking

Complement is important in immunohematology testing. It is involved in destruction of autologous RBC by autoantibody and also sensitization and destruction of transfused RBC by alloantibodies. y Role Of Complement In RBC Destruction

RBC antibody complexes usually activate complement by the classical pathway. However, the mode of destruction and the extent of RBC hemolysis depend primarily on the class of Ig involved and the activity of an individual s reticuloendothelial (RE) system. RBC destruction is divided into 2 kinds : 1. Intravascular Hemolysis : Binding of antibodies directed against antigen Activation of complement (terminal membrane-attack complex polymerized to form pores in the RBC membrane ECF enters cell swelling burst by osmotic lysis; IgM, IgG). 2. Extravascular Hemolysis : Mainly occured by IgG. Removes complement coated RBC.

Reference : Henry s Clinical Diagnosis 22th edition.