Marcela Contreras and Geoff Daniels

Introduction, 207

The red cell membrane and chemistry of blood group antigens, 207 Antigens, 209

The biological significance of blood group antigens, 210 Antibodies, 210

Biochemistry of immunoglobulins, 211 Biological and physical properties of immunoglobulins, 213 Blood group antibodies, 213

Naturally occurring and immune antibodies, 213 Cold and warm antibodies, 213

IgM and IgG antibodies, 214 Monoclonal antibodies, 214 Lectins, 214 Complement, 214

The opsonization phase of the complement sequence, 215 The lytic phase of the complement sequence , 216 Clinical significance of red cell antibodies, 217 Blood group antigen-antibody reactions, 217 First stage of agglutination: combination of antibody with antigen, 217 Second, or 'visual', stage of agglutination, 218

The use of enzyme-treated red cells, 219 Detection of red cell antigen-antibody reactions, 219

Principles of agglutination techniques, 219 Microcolumn tests (gel and beads), 222 Microplate techniques, 222 Automated techniques, 222 Blood grouping reagents, 223 Antibody screening and identification, 223 Molecular techniques for blood grouping, 223 Selected bibliography, 224

Introduction

The primary purpose of transfusion medicine is to provide 'safe' blood when the clinician requires it. However, blood groups and immunohaematological problems of blood transfusion and transplantation are extremely interesting in their own right and their solutions have much to offer to haematology in general.

Blood group serology or immunohaematology includes the study of antigenic molecules present on the various cellular and soluble components of whole blood, together with study of the antibodies and lectins that recognize them and their interactions. However, in practice, the term blood group serology generally is restricted to red cell surface antigens and their interactions with specific antibodies. In this narrower sense, the complexities of HLA, granulocyte, platelet and plasma protein determinants do not normally fall within the blood group serologist's realm, even though all are likewise genetically polymorphic and play a role in blood transfusion.

The narrower definition of blood group serology encompasses the following: (i) the determination of the phenotype of red cells with antibodies and reagents of known specificity, (ii) the search for and identification of antibodies with red cells of known phenotype; and (iii) compatibility testing of patients' sera against cell samples from donor units of the same ABO and RhD groups. At present, more than 2 million units of red cells are transfused to patients each year in the UK alone.

The aim of this chapter is to provide an introduction to blood group serology and to include aspects of immunology and biochemistry that contribute to our understanding of blood group antigens, antibodies and antigen-antibody reactions.

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