Summarize the following text to main points and sub-points and make detailed explain for them:

ations 
unless doctor instructs otherwise. 
2.11.1 Causes of Increased ESRs: 
1. All types of anemia except sickle cell. 
2. Macrocytosis. 
3. Elevated fifbrinogen. 
 
53 
 
4.ERYTHROCYTE SEDIMENTATION RATE (ESR)           
ﺩ.
ﻓﺮﺍﺱ
 
ﺣﻤﻴﺪ
 
ﻋﺒﺪ
 
ﺍﻟﺎﺋﻤﺔ
 
ﺗﻘﻨﻲ
 
ﻃﺒﻲ
 
ﺍﺧﺘﺼﺎﺹ
 
ﺣﺴﻴﻦ
 
ﻧﻌﻴﻢ
 
ﺭﺷﻚ
 
ﺑﺎﻳﻮﻟﻮﺟﻲ
 
ﺍﻗﺪﻡ
 
ﻓﺎﻃﻤﺔ
 
ﻧﻌﻴﻢ
 
ﻋﺎﺟﻞ
 
4. Excess plasma immunoglobulins – Multiple Myeloma. 
5. Acute and chronic inflammatory conditions and infections. 
 
 Including: 
1. HIV, Tuberculosis, Acute viral hepatitis, Arthritis, Bacterial 
endocarditis, Pelvic Inflammatory Disease, Ruptured Ectopic 
pregnancy, Systemic lupus erythematosus. 
2. African trypanosomiasis 
3. Visceral leishmaniassis 
4. Lymphoma, Hodgkins, disease, and some tumors 
5. Some drugs including oral contraceptives 
6. African trypanosomiasis. 
7. Visceral leishmaniassis. 
8. Lymphoma, Hodgkin’s disease, and some tumors. 
9. Some drugs including oral contrceptives. 
2.11.2 Causes of Decreased ESRs 
1. Polycythemia. 
2. Microcytosis. 
3. Spherocytosiss. 
4. Poikilocytosis. 
5. Newborns. 
6. Dehydration. 
7. Dengue Hemorrhagic fever. 
 
 
 
 
 
 
54 
 
5.ABO BLOOD GROUP SYSTEM 
ﺩ.ﺳﻬﺎﺩ ﺭﺿﺎ ﻣﺘﻌﺐ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺳﺮﻯ ﻋﻠﻲ ﻋﺒﺪﺍﻟﺮﺯﺍﻕ
 
2.12 Introduction  
The ABO system is the most important of all blood groups in 
transfusion practice. It is the only blood group system in which 
individuals have antibodies in their serum to antigens absent from their 
RBCs. This occurs without any exposure to RBCs through transfusion or 
pregnancy. Due to the presence of these antibodies, transfusion of an 
incompatible ABO type may result in immediate lysis of donor RBCs. 
This produces a very severe, if not fatal, transfusion reaction in the 
patient . Blood transfusion is a life-saving procedure in all cases of severe 
blood loss and life-threatening anemia. 
2.13 Inheritance of the ABO Blood Groups 
A blood type (also called a blood group) is a classification of blood 
based on the presence or absence of inherited antigenic substances on the 
surface of red blood cells (RBCs). An individual inherits one ABO gene 
from each parent and these two genes determine which ABO antigens are 
present on the RBC membrane. The inheritance of ABO genes, therefore, 
follows simple Mendelian genetics. ABO, like most other blood group 
systems, is codominant in expression. The O gene is considered an 
amorph, as no detectable antigen is produced in response to the 
inheritance of this gene. The designations group A, B, AB, and O refers 
to phenotypes, whereas AA, BO, and OO denote genotypes. An 
individual who has the phenotype A (or B) can have the genotype AA or 
AO (or BB or BO). In the case of an O individual, the genotype will be 
00, and that of the AB will be AB as shown in Table (2-5). 
 
 
 
 
55 
 
5.ABO BLOOD GROUP SYSTEM 
ﺩ.ﺳﻬﺎﺩ ﺭﺿﺎ ﻣﺘﻌﺐ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺳﺮﻯ ﻋﻠﻲ ﻋﺒﺪﺍﻟﺮﺯﺍﻕ
 
Table (2-5): ABO genotypes inherited from parents 
ABO genotype in the 
offspring 
ABO alleles inherited from the mother 
A 
B 
O 
ABO alleles 
inherited from 
the father 
A 
A 
AB 
A 
B 
AB 
B 
B 
O 
A 
B 
O 
Blood is characterized into different blood groups, based on the 
presence or absence of these antigens or agglutinogens. The frequency of 
ABO blood groups is outlined in Table (2-6). O Group is the most 
common and AB is the rarest. However, frequencies of ABO groups 
differ between populations and ethnic groups. 
 
 
 
 
 
2.14 ABO Antigens: 
The ABO blood group is characterized by two glycolipid antigens, 
called A and B – depending on whether the RBCs have none, only one or 
both antigens, blood groups are distinguished as type O, type A, type B, 
or type AB. A and B antigens are not fully developed at birth. As a result, 
reactions of newborn RBCs with ABO reagent antisera are frequently 
weaker than reactions with adult cells. The expression of A and B 
antigens on the RBCs is fully developed by 2 to 4 years of age and 
remains constant throughout life. 
 
 
Table (2-6): Frequency of ABO Blood Groups 
Blood Group 
Frequency 
O 
45% 
A 
40% 
B 
11% 
AB 
4% 
 
56 
 
5.ABO BLOOD GROUP SYSTEM 
ﺩ.ﺳﻬﺎﺩ ﺭﺿﺎ ﻣﺘﻌﺐ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺳﺮﻯ ﻋﻠﻲ ﻋﺒﺪﺍﻟﺮﺯﺍﻕ
 
2.15 ABO Antibodies: 
• Individuals normally produce antibodies directed against the A 
and/or B antigen(s) absent from their RBCs. These antibodies have 
been described as naturally occurring because they are produced 
without any previous exposure to RBCs as shown in table (2-6).  
• The ABO antibodies are predominantly IgM, and they activate 
complement and react at room temperature or colder. 
• The production of ABO antibodies is initiated at birth, but titers are 
too low for detection until the individual is 3-6 months of age. 
Results of serum ABO testing before 3 to 6 months of age cannot 
be considered valid because some or all of the antibodies present 
may be IgG maternal antibodies that have crossed the placenta. As 
a result, it is logical to perform only forward grouping (testing of 
RBC Ag) on cord blood from newborn infants. 
• Serum from group O individuals contains not only anti-A & anti-B 
but also anti-A, B which reacts with A & B cells. Anti-A, B is not a 
combination of anti-A & anti-B but is a separate "cross-reacting" 
antibody that is usually IgG in nature. 
• Both immunoglobulin classes of ABO antibodies (IgM & IgG) 
react preferentially at room temperature (20-24°C) or below and 
activate complement at 37°C. 
 
 
 
 
 
57 
 
5.ABO BLOOD GROUP SYSTEM 
ﺩ.ﺳﻬﺎﺩ ﺭﺿﺎ ﻣﺘﻌﺐ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺳﺮﻯ ﻋﻠﻲ ﻋﺒﺪﺍﻟﺮﺯﺍﻕ
 
Table (2-7): ABO antigens and antibodies 
 
Group A 
Group B 
Group AB 
Group O 
Red blood cell 
type 
 
 
 
 
Antibodies in 
plasma 
Anti B 
Anti A 
None 
Anti A and B 
Antigens in 
red blood cell 
A antigen 
B antigen  
A and B  
antigen 
None 
 
2.16 ABO blood group   
The A, B, and O alleles Human blood type is determined by co-
dominant alleles. An allele is one of several different forms of genetic 
information that is present in DNA at a specific location on a specific 
chromosome. There are three different alleles for human blood type, 
known as IA, IB, and i. For simplicity, can call these alleles A (for IA), B 
(for IB), and O (for i) . 
Each of us has two ABO blood type alleles, because each inherit 
one blood type allele from our biological mother and one from our 
biological father. A description of the pair of alleles in our DNA is called 
the genotype. Since there are three different alleles, there are a total of six 
different genotypes at the human ABO genetic locus. The different 
possible genotypes are AA, AO, BB, BO, AB, and OO. 
There are 4 main blood groups A, B, AB and O. blood group is 
determined by the genes inherit from parents as shown in figure (2-16). 
 
 
58 
 
5.ABO BLOOD GROUP SYSTEM 
ﺩ.ﺳﻬﺎﺩ ﺭﺿﺎ ﻣﺘﻌﺐ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺳﺮﻯ ﻋﻠﻲ ﻋﺒﺪﺍﻟﺮﺯﺍﻕ
 
1. Blood group A  
- Approximately 40% of the population is group A.  
- Have A antigens present on the surface of red blood cells. 
- These individuals form B antibodies in blood plasma which 
circulate at all times. 
2. Blood group B 
- Approximately 11% of the population is group B.  
- Have B antigens present on the surface of red blood cells. 
- These individuals form A antibodies in blood plasma which 
circulate at all times. 
3. Blood group AB 
- Approximately 4% of the population is group AB. 
- Have both A & B antigens present on the surface of red 
blood cells. 
- These individuals do not have antibodies.  
- Blood group AB is called the “universal recipient” because 
it has no anti-bodies in the plasma. 
4. Blood group O 
- Approximately 45% of the population is group O. 
- Have neither B nor A antigens present on the surface of red 
blood cells. 
- These individuals form A & B antibodies in blood plasma 
which circulate at all times. 
- Blood group O is called a “universal donor” because it has 
no antigens on the surface of RBC as shown in table (2-8) 
and figure (2-17). 
 
 
 
59 
 
5.ABO BLOOD GROUP SYSTEM 
ﺩ.ﺳﻬﺎﺩ ﺭﺿﺎ ﻣﺘﻌﺐ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺳﺮﻯ ﻋﻠﻲ ﻋﺒﺪﺍﻟﺮﺯﺍﻕ
 
Figure (2-16): A diagram showing the antigen types and antibodies present in the 
different blood groups. 
 
 
 
 
 
 
Figure (2-17): diagram of how different blood types may donate 
Table(2-8): Illustrate the ABO compatibility 
35% Chance of mismatch 
Recipient blood group 
Donor blood group 
O 
A 
B 
AB 
O 
A 
 
 
B 
AB 
 
Compatible : Patient survive
,
Incompatible : Potentially fatal
 
 
60 
 
5.ABO BLOOD GROUP SYSTEM 
ﺩ.ﺳﻬﺎﺩ ﺭﺿﺎ ﻣﺘﻌﺐ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺳﺮﻯ ﻋﻠﻲ ﻋﺒﺪﺍﻟﺮﺯﺍﻕ
 
2.17 Routine ABO Testing: 
2.17.1 Agglutination 
ABO antibodies can cause rapid intravascular hemolysis if the 
wrong ABO group is transfused; this can result in the patient dying. If 
someone receives blood of the wrong type, the worst problem is the 
reaction of the recipient's antibodies to the donor's RBCs, when the body 
encounters a foreign antigen, agglutination occurs. 
Agglutination is the clumping of RBCs due to the binding of antibodies 
(part of the immune system) to antigens and causes blockage of blood 
vessels and eventually death as shown

Summary :