Module 5: The Blood

Lesson 6: Blood Typing

Nhóm Máu

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Mỗi bài học (lesson) bao gồm 4 phần chính: Thuật ngữ, Luyện Đọc, Luyện Nghe, và Bàn Luận.
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Dưới đây là danh sách những thuật ngữ Y khoa của module The Blood.
Khái quát được số lượng thuật ngữ sẽ xuất hiện trong bài đọc và nghe sẽ giúp bạn thoải mái tiêu thụ nội dung hơn. Sau khi hoàn thành nội dung đọc và nghe, bạn hãy quay lại đây và luyện tập (practice) để quen dần các thuật ngữ này. Đừng ép bản thân phải nhớ các thuật ngữ này vội vì bạn sẽ gặp và ôn lại danh sách này trong những bài học (lesson) khác của cùng một module.

Medical Terminology: The Blood

ABO blood group
blood-type classification based on the presence or absence of A and B glycoproteins on the erythrocyte membrane surface
agglutination
clustering of cells into masses linked by antibodies
agranular leukocytes
leukocytes with few granules in their cytoplasm; specifically, monocytes, lymphocytes, and NK cells
albumin
most abundant plasma protein, accounting for most of the osmotic pressure of plasma
anemia
deficiency of red blood cells or hemoglobin
antibodies
(also, immunoglobulins or gamma globulins) antigen-specific proteins produced by specialized B lymphocytes that protect the body by binding to foreign objects such as bacteria and viruses
anticoagulant
substance such as heparin that opposes coagulation
antithrombin
anticoagulant that inactivates factor X and opposes the conversion of prothrombin (factor II) into thrombin in the common pathway
B lymphocytes
(also, B cells) lymphocytes that defend the body against specific pathogens and thereby provide specific immunity
basophils
granulocytes that stain with a basic (alkaline) stain and store histamine and heparin
bilirubin
yellowish bile pigment produced when iron is removed from heme and is further broken down into waste products
biliverdin
green bile pigment produced when the non-iron portion of heme is degraded into a waste product; converted to bilirubin in the liver
blood
liquid connective tissue composed of formed elements—erythrocytes, leukocytes, and platelets—and a fluid extracellular matrix called plasma; component of the cardiovascular system
bone marrow biopsy
diagnostic test of a sample of red bone marrow
bone marrow transplant
treatment in which a donor’s healthy bone marrow with its stem cells replaces diseased or damaged bone marrow of a patient
bruise
localized bleeding under the skin due to damaged blood vessels
buffy coat
thin, pale layer of leukocytes and platelets that separates the erythrocytes from the plasma in a sample of centrifuged blood
carbaminohemoglobin
compound of carbon dioxide and hemoglobin, and one of the ways in which carbon dioxide is carried in the blood
clotting factors
group of 12 identified substances active in coagulation
coagulation
formation of a blood clot; part of the process of hemostasis
colony-stimulating factors (CSFs)
glycoproteins that trigger the proliferation and differentiation of myeloblasts into granular leukocytes (basophils, neutrophils, and eosinophils)
common pathway
final coagulation pathway activated either by the intrinsic or the extrinsic pathway, and ending in the formation of a blood clot
cross matching
blood test for identification of blood type using antibodies and small samples of blood
cytokines
class of proteins that act as autocrine or paracrine signaling molecules; in the cardiovascular system, they stimulate the proliferation of progenitor cells and help to stimulate both nonspecific and specific resistance to disease
defensins
antimicrobial proteins released from neutrophils and macrophages that create openings in the plasma membranes to kill cells
deoxyhemoglobin
molecule of hemoglobin without an oxygen molecule bound to it
diapedesis
(also, emigration) process by which leukocytes squeeze through adjacent cells in a blood vessel wall to enter tissues
embolus
thrombus that has broken free from the blood vessel wall and entered the circulation
emigration
(also, diapedesis) process by which leukocytes squeeze through adjacent cells in a blood vessel wall to enter tissues
eosinophils
granulocytes that stain with eosin; they release antihistamines and are especially active against parasitic worms
erythrocyte
(also, red blood cell) mature myeloid blood cell that is composed mostly of hemoglobin and functions primarily in the transportation of oxygen and carbon dioxide
erythropoietin (EPO)
glycoprotein that triggers the bone marrow to produce RBCs; secreted by the kidney in response to low oxygen levels
extrinsic pathway
initial coagulation pathway that begins with tissue damage and results in the activation of the common pathway
ferritin
protein-containing storage form of iron found in the bone marrow, liver, and spleen
fibrin
insoluble, filamentous protein that forms the structure of a blood clot
fibrinogen
plasma protein produced in the liver and involved in blood clotting
fibrinolysis
gradual degradation of a blood clot
formed elements
cellular components of blood; that is, erythrocytes, leukocytes, and platelets
globin
heme-containing globular protein that is a constituent of hemoglobin
globulins
heterogeneous group of plasma proteins that includes transport proteins, clotting factors, immune proteins, and others
granular leukocytes
leukocytes with abundant granules in their cytoplasm; specifically, neutrophils, eosinophils, and basophils
hematocrit
(also, packed cell volume) volume percentage of erythrocytes in a sample of centrifuged blood
hematopoietic stem cell
type of pluripotent stem cell that gives rise to the formed elements of blood (hemocytoblast)
heme
red, iron-containing pigment to which oxygen binds in hemoglobin
hemocytoblast
hematopoietic stem cell that gives rise to the formed elements of blood
hemoglobin
oxygen-carrying compound in erythrocytes
hemolysis
destruction (lysis) of erythrocytes and the release of their hemoglobin into circulation
hemolytic disease of the newborn (HDN)
(also, erythroblastosis fetalis) disorder causing agglutination and hemolysis in an Rh+ fetus or newborn of an Rh− person
hemophilia
genetic disorder characterized by inadequate synthesis of clotting factors
hemopoiesis
production of the formed elements of blood
hemopoietic growth factors
chemical signals including erythropoietin, thrombopoietin, colony-stimulating factors, and interleukins that regulate the differentiation and proliferation of particular blood progenitor cells
hemorrhage
excessive bleeding
hemosiderin
protein-containing storage form of iron found in the bone marrow, liver, and spleen
hemostasis
physiological process by which bleeding ceases
heparin
short-acting anticoagulant stored in mast cells and released when tissues are injured, opposes prothrombin
hypoxemia
below-normal level of oxygen saturation of blood (typically <95 percent)
immunoglobulins
(also, antibodies or gamma globulins) antigen-specific proteins produced by specialized B lymphocytes that protect the body by binding to foreign objects such as bacteria and viruses
interleukins
signaling molecules that may function in hemopoiesis, inflammation, and specific immune responses
intrinsic pathway
initial coagulation pathway that begins with vascular damage or contact with foreign substances, and results in the activation of the common pathway
jaundice
yellowing of the skin or whites of the eyes due to excess bilirubin in the blood
leukemia
cancer involving leukocytes
leukocyte
(also, white blood cell) colorless, nucleated blood cell, the chief function of which is to protect the body from disease
leukocytosis
excessive leukocyte proliferation
leukopenia
below-normal production of leukocytes
lymphocytes
agranular leukocytes of the lymphoid stem cell line, many of which function in specific immunity
lymphoid stem cells
type of hematopoietic stem cells that gives rise to lymphocytes, including various T cells, B cells, and NK cells, all of which function in immunity
lymphoma
form of cancer in which masses of malignant T and/or B lymphocytes collect in lymph nodes, the spleen, the liver, and other tissues
lysozyme
digestive enzyme with bactericidal properties
macrophage
phagocytic cell of the myeloid lineage; a matured monocyte
megakaryocyte
bone marrow cell that produces platelets
memory cell
type of B or T lymphocyte that forms after exposure to a pathogen
monocytes
agranular leukocytes of the myeloid stem cell line that circulate in the bloodstream; tissue monocytes are macrophages
myeloid stem cells
type of hematopoietic stem cell that gives rise to some formed elements, including erythrocytes, megakaryocytes that produce platelets, and a myeloblast lineage that gives rise to monocytes and three forms of granular leukocytes (neutrophils, eosinophils, and basophils)
natural killer (NK) cells
cytotoxic lymphocytes capable of recognizing cells that do not express “self” proteins on their plasma membrane or that contain foreign or abnormal markers; provide generalized, nonspecific immunity
neutrophils
granulocytes that stain with a neutral dye and are the most numerous of the leukocytes; especially active against bacteria
oxyhemoglobin
molecule of hemoglobin to which oxygen is bound
packed cell volume (PCV)
(also, hematocrit) volume percentage of erythrocytes present in a sample of centrifuged blood
plasma
in blood, the liquid extracellular matrix composed mostly of water that circulates the formed elements and dissolved materials throughout the cardiovascular system
plasmin
blood protein active in fibrinolysis
platelet plug
accumulation and adhesion of platelets at the site of blood vessel injury
platelets
(also, thrombocytes) one of the formed elements of blood that consists of cell fragments broken off from megakaryocytes
pluripotent stem cell
stem cell that derives from totipotent stem cells and is capable of differentiating into many, but not all, cell types
polycythemia
elevated level of hemoglobin, whether adaptive or pathological
polymorphonuclear
having a lobed nucleus, as seen in some leukocytes
positive chemotaxis
process in which a cell is attracted to move in the direction of chemical stimuli
red blood cells (RBCs)
(also, erythrocytes) one of the formed elements of blood that transports oxygen
reticulocyte
immature erythrocyte that may still contain fragments of organelles
Rh blood group
blood-type classification based on the presence or absence of the antigen Rh on the erythrocyte membrane surface
serum
blood plasma that does not contain clotting factors
sickle cell disease
(also, sickle cell anemia) inherited blood disorder in which hemoglobin molecules are malformed, leading to the breakdown of RBCs that take on a characteristic sickle shape
T lymphocytes
(also, T cells) lymphocytes that provide cellular-level immunity by physically attacking foreign or diseased cells
thalassemia
inherited blood disorder in which maturation of RBCs does not proceed normally, leading to abnormal formation of hemoglobin and the destruction of RBCs
thrombin
enzyme essential for the final steps in formation of a fibrin clot
thrombocytes
platelets, one of the formed elements of blood that consists of cell fragments broken off from megakaryocytes
thrombocytopenia
condition in which there are too few platelets, resulting in abnormal bleeding (hemophilia)
thrombocytosis
condition in which there are too many platelets, resulting in abnormal clotting (thrombosis)
thrombopoietin
hormone secreted by the liver and kidneys that prompts the development of megakaryocytes into thrombocytes (platelets)
thrombosis
excessive clot formation
thrombus
aggregation of fibrin, platelets, and erythrocytes in an intact artery or vein
tissue factor
protein thromboplastin, which initiates the extrinsic pathway when released in response to tissue damage
totipotent stem cell
embryonic stem cell that is capable of differentiating into any and all cells of the body; enabling the full development of an organism
transferrin
plasma protein that binds reversibly to iron and distributes it throughout the body
universal donor
individual with type O− blood
universal recipient
individual with type AB+ blood
vascular spasm
initial step in hemostasis, in which the smooth muscle in the walls of the ruptured or damaged blood vessel contracts
white blood cells (WBCs)
(also, leukocytes) one of the formed elements of blood that provides defense against disease agents and foreign materials
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Dưới đây là các bài văn nằm ở bên trái. Ở bên phải là các bài luyện tập (practice) để đánh giá khả năng đọc hiểu của bạn. Sẽ khó khăn trong thời gian đầu nếu vốn từ vựng của bạn còn hạn chế, đặc biệt là từ vựng Y khoa. Hãy kiên nhẫn và đọc nhiều nhất có kể, lượng kiến thức tích tụ dần sẽ giúp bạn đọc thoải mái hơn.
Blood transfusions in humans were risky procedures until the discovery of the major human blood groups by Karl Landsteiner, an Austrian biologist and physician, in 1900. Until that point, physicians did not understand that death sometimes followed blood transfusions, when the type of donor blood infused into the patient was incompatible with the patient’s own blood. Blood groups are determined by the presence or absence of specific marker molecules on the plasma membranes of erythrocytes. With their discovery, it became possible for the first time to match patient-donor blood types and prevent transfusion reactions and deaths.
Antigens are substances that may trigger a defensive response from leukocytes of the immune system if the body does not recognize the antigen as belonging to “self.” (Seek more content for additional information on immunity.) Here, we will focus on the role of immunity in blood transfusion reactions. With RBCs in particular, you may see the antigens referred to as isoantigens or agglutinogens (surface antigens) and the antibodies referred to as isoantibodies or agglutinins. In this chapter, we will use the more common terms antigens and antibodies.

Antigens are generally large proteins, but may include other classes of organic molecules, including carbohydrates, lipids, and nucleic acids. Following an infusion of incompatible blood, erythrocytes with foreign antigens appear in the bloodstream and trigger an immune response. Proteins called antibodies (immunoglobulins), which are produced by certain B lymphocytes called plasma cells, attach to the antigens on the plasma membranes of the infused erythrocytes and cause them to adhere to one another.

  • Because the arms of the Y-shaped antibodies attach randomly to more than one nonself erythrocyte surface, they form clumps of erythrocytes. This process is called agglutination.
  • The clumps of erythrocytes block small blood vessels throughout the body, depriving tissues of oxygen and nutrients.
  • As the erythrocyte clumps are degraded, in a process called hemolysis, their hemoglobin is released into the bloodstream. This hemoglobin travels to the kidneys, which are responsible for filtration of the blood. However, the load of hemoglobin released can easily overwhelm the kidney’s capacity to clear it, and the patient can quickly develop kidney failure.

More than 50 antigens have been identified on erythrocyte membranes, but the most significant in terms of their potential harm to patients are classified in two groups: the ABO blood group and the Rh blood group.
Although the ABO blood group name consists of three letters, ABO blood typing designates the presence or absence of just two antigens, A and B. Both are glycoproteins. People whose erythrocytes have A antigens on their erythrocyte membrane surfaces are designated blood type A, and those whose erythrocytes have B antigens are blood type B. People can also have both A and B antigens on their erythrocytes, in which case they are blood type AB. People with neither A nor B antigens are designated blood type O. ABO blood types are genetically determined.

The body must be exposed to a foreign antigen before an antibody can be produced. ABO blood group antigens are found in foods and microbes throughout nature. Thus, the human immune system is exposed to A and B antigens at an early age and antibodies are formed naturally. Individuals with type A blood—without any prior exposure to incompatible blood—have naturally-formed antibodies to the B antigen circulating in their blood plasma. These antibodies, referred to as anti-B antibodies, will cause agglutination and hemolysis if they ever encounter erythrocytes with B antigens. Similarly, an individual with type B blood has naturally-formed anti-A antibodies. Individuals with type AB blood, which has both antigens, do not have naturally-formed antibodies to either of these. People with type O blood lack antigens A and B on their erythrocytes, but both anti-A and anti-B antibodies circulate in their blood plasma.
The Rh blood group is classified according to the presence or absence of a second erythrocyte antigen identified as Rh. (It was first discovered in a type of primate known as a rhesus macaque, which is often used in research, because its blood is similar to that of humans.) Although dozens of Rh antigens have been identified, only one, designated D, is clinically important. Those who have the Rh D antigen present on their erythrocytes—about 85 percent of Americans—are described as Rh positive (Rh+) and those who lack it are Rh negative (Rh−). Note that the Rh group is distinct from the ABO group, so any individual, no matter their ABO blood type, may have or lack this Rh antigen. When identifying a patient’s blood type, the Rh group is designated by adding the word positive or negative to the ABO type. For example, A positive (A+) means ABO group A blood with the Rh antigen present, and AB negative (AB−) means ABO group AB blood without the Rh antigen.

Table 1 summarizes the distribution of the ABO and Rh blood types within the United States.

In contrast to the ABO group antibodies, which are preformed, antibodies to the Rh antigen are produced only in Rh− individuals after exposure to the antigen. This process, called sensitization, occurs following a transfusion with Rh-incompatible blood or, more commonly, with the birth of an Rh+ baby to an Rh− person. Problems are rare in a first pregnancy, since the baby’s Rh+ cells rarely cross the placenta (the organ of gas and nutrient exchange between the fetus and the pregnant person). However, during or immediately after birth, the Rh− parent can be exposed to the baby’s Rh+ cells (Figure 1). Research has shown that this occurs in about 13−14 percent of such pregnancies. After exposure, the immune system of the person who has given birth begins to generate anti-Rh antibodies. If the same person should then become pregnant with another Rh+ baby, the Rh antibodies they have produced can cross the placenta into the fetal bloodstream and destroy the fetal RBCs. This condition, known as hemolytic disease of the newborn (HDN) or erythroblastosis fetalis, may cause anemia in mild cases, but the agglutination and hemolysis can be so severe that without treatment the fetus may die in the womb or shortly after birth.

A drug known as RhoGAM, short for Rh immune globulin, can temporarily prevent the development of Rh antibodies in the Rh− parent, thereby averting this potentially serious disease for the fetus. RhoGAM antibodies destroy any fetal Rh+ erythrocytes that may cross the placental barrier. RhoGAM is normally administered to Rh− pregnant people during weeks 26−28 of pregnancy and within 72 hours following birth. It has proven remarkably effective in decreasing the incidence of HDN. Earlier we noted that the incidence of HDN in an Rh+ subsequent pregnancy to an Rh− person is about 13–14 percent without preventive treatment. Since the introduction of RhoGAM in 1968, the incidence has dropped to about 0.1 percent in the United States.
Clinicians are able to determine a patient’s blood type quickly and easily using commercially prepared antibodies. An unknown blood sample is allocated into separate wells. Into one well a small amount of anti-A antibody is added, and to another a small amount of anti-B antibody. If the antigen is present, the antibodies will cause visible agglutination of the cells (Figure 2). The blood should also be tested for Rh antibodies.
To avoid transfusion reactions, it is best to transfuse only matching blood types; that is, a type B+ recipient should ideally receive blood only from a type B+ donor and so on. That said, in emergency situations, when acute hemorrhage threatens the patient’s life, there may not be time for cross matching to identify blood type. In these cases, blood from a universal donor—an individual with type O− blood—may be transfused. Recall that type O erythrocytes do not display A or B antigens. Thus, anti-A or anti-B antibodies that might be circulating in the patient’s blood plasma will not encounter any erythrocyte surface antigens on the donated blood and therefore will not be provoked into a response. One problem with this designation of universal donor is if the O− individual had prior exposure to Rh antigen, Rh antibodies may be present in the donated blood. Also, introducing type O blood into an individual with type A, B, or AB blood will nevertheless introduce antibodies against both A and B antigens, as these are always circulating in the type O blood plasma. This may cause problems for the recipient, but because the volume of blood transfused is much lower than the volume of the patient’s own blood, the adverse effects of the relatively few infused plasma antibodies are typically limited. Rh factor also plays a role. If Rh− individuals receiving blood have had prior exposure to Rh antigen, antibodies for this antigen may be present in the blood and trigger agglutination to some degree. Although it is always preferable to cross match a patient’s blood before transfusing, in a true life-threatening emergency situation, this is not always possible, and these procedures may be implemented.

A patient with blood type AB+ is known as the universal recipient. This patient can theoretically receive any type of blood, because the patient’s own blood—having both A and B antigens on the erythrocyte surface—does not produce anti-A or anti-B antibodies. In addition, an Rh+ patient can receive both Rh+ and Rh− blood. However, keep in mind that the donor’s blood will contain circulating antibodies, again with possible negative implications. Figure 3 summarizes the blood types and compatibilities.

At the scene of multiple-vehicle accidents, military engagements, and natural or human-caused disasters, many victims may suffer simultaneously from acute hemorrhage, yet type O blood may not be immediately available. In these circumstances, medics may at least try to replace some of the volume of blood that has been lost. This is done by intravenous administration of a saline solution that provides fluids and electrolytes in proportions equivalent to those of normal blood plasma. Research is ongoing to develop a safe and effective artificial blood that would carry out the oxygen-carrying function of blood without the RBCs, enabling transfusions in the field without concern for incompatibility. These blood substitutes normally contain hemoglobin- as well as perfluorocarbon-based oxygen carriers.

OpenStax. (2022). Anatomy and Physiology 2e. Rice University. Retrieved June 15, 2023. ISBN-13: 978-1-711494-06-7 (Hardcover) ISBN-13: 978-1-711494-05-0 (Paperback) ISBN-13: 978-1-951693-42-8 (Digital). License: Attribution 4.0 International (CC BY 4.0). Access for free at openstax.org.

Blood TypeAsianBlack non-HispanicHispanicNorth American IndianWhite non-Hispanic
A+27.324.028.731.333.0
A−0.51.92.43.86.8
B+25.018.49.27.09.1
B−0.41.30.70.91.8
AB+7.04.02.32.23.4
AB−0.10.30.20.30.7
O+39.046.652.650.037.2
O−0.73.63.94.78.0

The first exposure of an Rh− person to Rh+ erythrocytes during pregnancy induces sensitization. Anti-Rh antibodies begin to circulate in the pregnant person’s bloodstream. A second exposure occurs with a subsequent pregnancy with an Rh+ fetus in the uterus. During that subsequent pregnancy, the pregnant person’s anti-Rh antibodies may cross the placenta and enter the fetal bloodstream, causing agglutination and hemolysis of fetal erythrocytes.

This sample of a commercially produced “bedside” card enables quick typing of both a recipient’s and donor’s blood before transfusion. The card contains three reaction sites or wells. One is coated with an anti-A antibody, one with an anti-B antibody, and one with an anti-D antibody (tests for the presence of Rh factor D). Mixing a drop of blood and saline into each well enables the blood to interact with a preparation of type-specific antibodies, also called anti-seras. Agglutination of RBCs in a given site indicates a positive identification of the blood antigens, in this case A and Rh antigens for blood type A+. For the purpose of transfusion, the donor’s and recipient’s blood types must match.

This chart summarizes the characteristics of the blood types in the ABO blood group. See the text for more on the concept of a universal donor or recipient.

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Script:
  1. Antigens are nonself molecules, usually large proteins, which provoke an immune response.
  2. In transfusion reactions, antibodies attach to antigens on the surfaces of erythrocytes and cause agglutination and hemolysis.
  3. ABO blood group antigens are designated A and B.
  4. People with type A blood have A antigens on their erythrocytes, whereas those with type B blood have B antigens.
  5. Those with AB blood have both A and B antigens, and those with type O blood have neither A nor B antigens.
  6. The blood plasma contains preformed antibodies against the antigens not present on a person’s erythrocytes.
  7. A second group of blood antigens is the Rh group, the most important of which is Rh D.
  8. People with Rh− blood do not have this antigen on their erythrocytes, whereas those who are Rh+ do.
  9. About 85 percent of Americans are Rh+.
  10. When a person who is Rh− becomes pregnant with an Rh+ fetus, their body may begin to produce anti-Rh antibodies.
  11. If the person subsequently becomes pregnant with a second Rh+ fetus and is not treated preventively with RhoGAM, the fetus will be at risk for an antigen-antibody reaction, including agglutination and hemolysis.
  12. This is known as hemolytic disease of the newborn.
  13. Cross matching to determine blood type is necessary before transfusing blood, unless the patient is experiencing hemorrhage that is an immediate threat to life, in which case type O− blood may be transfused.
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