Blood is a bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and

transports metabolic waste

products away from those same cells.

In vertebrates, it is composed of blood cells suspended in blood plasma. Plasma, which constitutes 55% of blood fluid, is mostly water (92% by
volume),[1] and contains dissipated proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being the main medium for excretory product
transportation), and blood cells themselves. Albumin is the main protein in plasma, and it functions to regulate the colloidal osmotic pressure of
blood. The blood cells are mainly red blood cells (also called RBCs or erythrocytes) and white blood cells, including leukocytes and platelets. The
most abundant cells in vertebrate blood are red blood cells. These contain hemoglobin, an iron-containing protein, which facilitates transportation of
oxygen by reversibly binding to this respiratory gas and greatly increasing its solubility in blood. In contrast, carbon dioxide is almost entirely
transported extracellularly dissolved in plasma as bicarbonate ion.

Vertebrate blood is bright red when its hemoglobin is oxygenated. Some animals, such as crustaceans and mollusks, use hemocyanin to carry
oxygen, instead of hemoglobin. Insects and some mollusks use a fluid called hemolymph instead of blood, the difference being that hemolymph is
not contained in a closed circulatory system. In most insects, this "blood" does not contain oxygen-carrying molecules such as hemoglobin because
their bodies are small enough for their tracheal system to suffice for supplying oxygen.

Jawed vertebrates have an adaptive immune system, based largely on white blood cells. White blood cells help to resist infections and parasites.
Platelets are important in the clotting of blood. Arthropods, using hemolymph, have hemocytes as part of their immune system.

Blood is circulated around the body through blood vessels by the pumping action of the heart. In animals with lungs, arterial blood carries oxygen
from inhaled air to the tissues of the body, and venous blood carries carbon dioxide, a waste product of metabolism produced by cells, from the
tissues to the lungs to be exhaled.

Medical terms related to blood often begin with hemo- or hemato- (also spelled haemo- and haemato-) from the Greek word αἷμα (haima) for
"blood". In terms of anatomy and histology, blood is considered a specialized form of connective tissue, given its origin in the bones and the
presence of potential molecular fibers in the form of fibrinogen.

Functions

Blood performs many important functions within the body including:

 Supply of oxygen to tissues (bound to hemoglobin, which is carried in red cells)

 Supply of nutrients such as glucose, amino acids, and fatty acids (dissolved in the blood or bound to plasma proteins (e.g., blood lipids))
 Removal of waste such as carbon dioxide, urea, and lactic acid
 Immunological functions, including circulation of white blood cells, and detection of foreign material by antibodies
 Coagulation, which is one part of the body's self-repair mechanism (blood clotting after an open wound in order to stop bleeding)
 Messenger functions, including the transport of hormones and the signaling of tissue damage
 Regulation of body pH
 Regulation of core body temperature
 Hydraulic functions

Constituents of human blood

Blood accounts for 7% of the human body weight,[2][3] with an average density of approximately 1060 kg/m3, very close to pure water's density of
1000 kg/m3.[4] The average adult has a blood volume of roughly 5 liters (1.3 gal),[3] which is composed of plasma and several kinds of cells. These
blood cells (which are also called corpuscles or "formed elements") consist of erythrocytes (red blood cells, RBCs), leukocytes (white blood cells),
and thrombocytes (platelets). By volume, the red blood cells constitute about 45% of whole blood, the plasma about 54.3%, and white cells about
0.7%.

Whole blood (plasma and cells) exhibits non-Newtonian fluid dynamics; its flow properties are adapted to flow effectively through tiny capillary blood
vessels with less resistance than plasma by itself. In addition, if all human hemoglobin were free in the plasma rather than being contained in RBCs,
the circulatory fluid would be too viscous for the cardiovascular system to function effectively.

Cells

One microliter of blood contains:

  4.7 to 6.1 million (male), 4.2 to 5.4 million (female) erythrocytes:[5] Red blood cells contain the blood's hemoglobin and distribute
oxygen. Mature red blood cells lack a nucleus and organelles in mammals. The red blood cells (together with endothelial vessel cells and
other cells) are also marked by glycoproteins that define the different blood types. The proportion of blood occupied by red blood cells is
referred to as the hematocrit, and is normally about 45%. The combined surface area of all red blood cells of the human body would be
roughly 2,000 times as great as the body's exterior surface.[6]

 4,000–11,000 leukocytes:[7] White blood cells are part of the body's immune system; they destroy and remove old or aberrant cells and
cellular debris, as well as attack infectious agents (pathogens) and foreign substances. The cancer of leukocytes is called leukemia.

 200,000–500,000 thrombocytes:[7] Also called platelets, thrombocytes are responsible for blood clotting (coagulation). They change
fibrinogen into fibrin. This fibrin creates a mesh onto which red blood cells collect and clot, which then stops more blood from leaving the
body and also helps to prevent bacteria from entering the body.

Constitution of normal blood

Parameter Value
45 ± 7 (38–52%) for males
Hematocrit
42 ± 5 (37–47%) for females
pH 7.35–7.45
base excess −3 to +3
PO2 10–13 kPa (80–100 mm Hg)
PCO2 4.8–5.8 kPa (35–45 mm Hg)
HCO3− 21–27 mM
Oxygenated: 98–99%
Oxygen saturation
Deoxygenated: 75%

Plasma

About 55% of blood is blood plasma, a fluid that is the blood's liquid medium, which by itself is straw-yellow in color. The blood plasma volume totals
of 2.7–3.0 liters (2.8–3.2 quarts) in an average human. It is essentially an aqueous solution containing 92% water, 8% blood plasma proteins, and
trace amounts of other materials. Plasma circulates dissolved nutrients, such as glucose, amino acids, and fatty acids (dissolved in the blood or
bound to plasma proteins), and removes waste products, such as carbon dioxide, urea, and lactic acid.

Other important components include:

 Serum albumin
 Blood-clotting factors (to facilitate coagulation)
 Immunoglobulins (antibodies)
 lipoprotein particles
 Various other proteins
 Various electrolytes (mainly sodium and chloride)

The term serum refers to plasma from which the clotting proteins have been removed. Most of the proteins remaining are albumin and
immunoglobulins.

Narrow range of pH values

See also: Acid-base homeostasis

Blood pH is regulated to stay within the narrow range of 7.35 to 7.45, making it slightly basic.[8][9] Blood that has a pH below 7.35 is too acidic,
whereas blood pH above 7.45 is too basic. Blood pH, partial pressure of oxygen (pO2), partial pressure of carbon dioxide (pCO2), and HCO3− are
carefully regulated by a number of homeostatic mechanisms, which exert their influence principally through the respiratory system and the urinary
system in order to control the acid-base balance and respiration. An arterial blood gas test will measure these. Plasma also circulates hormones
transmitting their messages to various tissues. The list of normal reference ranges for various blood electrolytes is extensive.

Blood in non-human vertebrates

Human blood is typical of that of mammals, although the precise details concerning cell numbers, size, protein structure, and so on, vary somewhat
between species. In non-mammalian vertebrates, however, there are some key differences:[10]

 Red blood cells of non-mammalian vertebrates are flattened and ovoid in form, and retain their cell nuclei
  There is considerable variation in the types and proportions of white blood cells; for example, acidophils are generally more common than
in humans
 Platelets are unique to mammals; in other vertebrates, small nucleated, spindle cells are responsible for blood clotting instead

Physiology

Cardiovascular system

Blood is circulated around the body through blood vessels by the pumping action of the heart. In humans, blood is pumped from the strong left
ventricle of the heart through arteries to peripheral tissues and returns to the right atrium of the heart through veins. It then enters the right ventricle
and is pumped through the pulmonary artery to the lungs and returns to the left atrium through the pulmonary veins. Blood then enters the left
ventricle to be circulated again. Arterial blood carries oxygen from inhaled air to all of the cells of the body, and venous blood carries carbon dioxide,
a waste product of metabolism by cells, to the lungs to be exhaled. However, one exception includes pulmonary arteries, which contain the most
deoxygenated blood in the body, while the pulmonary veins contain oxygenated blood.

Additional return flow may be generated by the movement of skeletal muscles, which can compress veins and push blood through the valves in veins
toward the right atrium.

The blood circulation was famously described by William Harvey in 1628.[11]

Production and degradation of blood cells

In vertebrates, the various cells of blood are made in the bone marrow in a process called hematopoiesis, which includes erythropoiesis, the
production of red blood cells; and myelopoiesis, the production of white blood cells and platelets. During childhood, almost every human bone
produces red blood cells; as adults, red blood cell production is limited to the larger bones: the bodies of the vertebrae, the breastbone (sternum), the
ribcage, the pelvic bones, and the bones of the upper arms and legs. In addition, during childhood, the thymus gland, found in the mediastinum, is an
important source of lymphocytes.[12] The proteinaceous component of blood (including clotting proteins) is produced predominantly by the liver, while
hormones are produced by the endocrine glands and the watery fraction is regulated by the hypothalamus and maintained by the kidney.

Healthy erythrocytes have a plasma life of about 120 days before they are degraded by the spleen, and the Kupffer cells in the liver. The liver also
clears some proteins, lipids, and amino acids. The kidney actively secretes waste products into the urine.

Oxygen transport

About 98.5% of the oxygen in a sample of arterial blood in a healthy human breathing air at sea-level pressure is chemically combined with the Hgb.
About 1.5% is physically dissolved in the other blood liquids and not connected to Hgb. The hemoglobin molecule is the primary transporter of
oxygen in mammals and many other species (for exceptions, see below). Hemoglobin has an oxygen binding capacity of between 1.36 and 1.37 mL
O2 per gram Hemoglobin,[13] which increases the total blood oxygen capacity seventyfold,[14] compared to if oxygen solely was carried by its solubility
of 0.03 mL O2 per liter blood per mmHg partial pressure of oxygen (approximately 100 mmHg in arteries).[14]

With the exception of pulmonary and umbilical arteries and their corresponding veins, arteries carry oxygenated blood away from the heart and
deliver it to the body via arterioles and capillaries, where the oxygen is consumed; afterwards, venules, and veins carry deoxygenated blood back to
the heart.

Under normal conditions in adult humans at rest; hemoglobin in blood leaving the lungs is about 98–99% saturated with oxygen, achieving an
oxygen delivery of between 950 - 1150 mL/min[15] to the body. In a healthy adult at rest, oxygen consumption is approximately 200 - 250 mL/min,[15]
and deoxygenated blood returning to the lungs is still approximately 75%[16][17] (70 to 78%)[15] saturated. Increased oxygen consumption during
sustained exercise reduces the oxygen saturation of venous blood, which can reach less than 15% in a trained athlete; although breathing rate and
blood flow increase to compensate, oxygen saturation in arterial blood can drop to 95% or less under these conditions.[18] Oxygen saturation this low
is considered dangerous in an individual at rest (for instance, during surgery under anesthesia). Sustained hypoxia (oxygenation of less than 90%),
is dangerous to health, and severe hypoxia (saturations of less than 30%) may be rapidly fatal.[19]

A fetus, receiving oxygen via the placenta, is exposed to much lower oxygen pressures (about 21% of the level found in an adult's lungs), and, so,
fetuses produce another form of hemoglobin with a much higher affinity for oxygen (hemoglobin F) in order to function under these conditions.[20]

Carbon dioxide transport

CO2 is carried in blood in three different ways. (The exact percentages vary depending whether it is arterial or venous blood). Most of it (about 70%
to 80%) is converted to bicarbonate ions HCO−
3 by the enzyme carbonic anhydrase in the red blood cells,[21] by the reaction CO2 + H2O → H2CO3 → H+ + HCO−
3 5% – 10% is dissolved in the plasma,[21] and 5% – 10% is bound to hemoglobin as carbamino compounds.[21]
Hemoglobin, the main oxygen-carrying molecule in red blood cells, carries both oxygen and carbon dioxide. However, the CO2 bound to hemoglobin
does not bind to the same site as oxygen. Instead, it combines with the N-terminal groups on the four globin chains. However, because of allosteric
effects on the hemoglobin molecule, the binding of CO2 decreases the amount of oxygen that is bound for a given partial pressure of oxygen. The
decreased binding to carbon dioxide in the blood due to increased oxygen levels is known as the Haldane effect, and is important in the transport of
carbon dioxide from the tissues to the lungs. A rise in the partial pressure of CO2 or a lower pH will cause offloading of oxygen from hemoglobin,
which is known as the Bohr effect.

Transport of hydrogen ions

Some oxyhemoglobin loses oxygen and becomes deoxyhemoglobin. Deoxyhemoglobin binds most of the hydrogen ions as it has a much greater
affinity for more hydrogen than does oxyhemoglobin.

Lymphatic system

In mammals, blood is in equilibrium with lymph, which is continuously formed in tissues from blood by capillary ultrafiltration. Lymph is collected by a
system of small lymphatic vessels and directed to the thoracic duct, which drains into the left subclavian vein where lymph rejoins the systemic blood
circulation.

Thermoregulation

Blood circulation transports heat throughout the body, and adjustments to this flow are an important part of thermoregulation. Increasing blood flow
to the surface (e.g., during warm weather or strenuous exercise) causes warmer skin, resulting in faster heat loss. In contrast, when the external
temperature is low, blood flow to the extremities and surface of the skin is reduced and to prevent heat loss and is circulated to the important organs
of the body, preferentially.

Hydraulic functions

The restriction of blood flow can also be used in specialized tissues to cause engorgement, resulting in an erection of that tissue; examples are the
erectile tissue in the penis and clitoris.

Another example of a hydraulic function is the jumping spider, in which blood forced into the legs under pressure causes them to straighten for a
powerful jump, without the need for bulky muscular legs.[22]

Invertebrates

In insects, the blood (more properly called hemolymph) is not involved in the transport of oxygen. (Openings called tracheae allow oxygen from the
air to diffuse directly to the tissues). Insect blood moves nutrients to the tissues and removes waste products in an open system.

Other invertebrates use respiratory proteins to increase the oxygen-carrying capacity. Hemoglobin is the most common respiratory protein found in
nature. Hemocyanin (blue) contains copper and is found in crustaceans and mollusks. It is thought that tunicates (sea squirts) might use vanabins
(proteins containing vanadium) for respiratory pigment (bright-green, blue, or orange).

In many invertebrates, these oxygen-carrying proteins are freely soluble in the blood; in vertebrates they are contained in specialized red blood cells,
allowing for a higher concentration of respiratory pigments without increasing viscosity or damaging blood filtering organs like the kidneys.

Giant tube worms have unusual hemoglobins that allow them to live in extraordinary environments. These hemoglobins also carry sulfides normally
fatal in other animals.

Color

The coloring matter of blood (hemochrome) is largely due to the protein in the blood responsible for oxygen transport. Different groups of organisms
use different proteins.

Hemoglobin

Hemoglobin is the principal determinant of the color of blood in vertebrates. Each molecule has four heme groups, and their interaction with various
molecules alters the exact color. In vertebrates and other hemoglobin-using creatures, arterial blood and capillary blood are bright red, as oxygen
imparts a strong red color to the heme group. Deoxygenated blood is a darker shade of red; this is present in veins, and can be seen during blood
donation and when venous blood samples are taken. This is because the spectrum of light absorbed by hemoglobin differs between the oxygenated
and deoxygenated states.[23]
Blood in carbon monoxide poisoning is bright red, because carbon monoxide causes the formation of carboxyhemoglobin. In cyanide poisoning, the
body cannot utilize oxygen, so the venous blood remains oxygenated, increasing the redness. There are some conditions affecting the heme groups
present in hemoglobin that can make the skin appear blue—a symptom called cyanosis. If the heme is oxidized, methaemoglobin, which is more
brownish and cannot transport oxygen, is formed. In the rare condition sulfhemoglobinemia, arterial hemoglobin is partially oxygenated, and appears
dark red with a bluish hue.

Veins close to the surface of the skin appear blue for a variety of reasons. However, the factors that contribute to this alteration of color perception
are related to the light-scattering properties of the skin and the processing of visual input by the visual cortex, rather than the actual color of the
venous blood.[24]

Skinks in the genus Prasinohaema have green blood due to a buildup of the waste product biliverdin.[25]

Hemocyanin

The blood of most mollusks – including cephalopods and gastropods – as well as some arthropods, such as horseshoe crabs, is blue, as it contains
the copper-containing protein hemocyanin at concentrations of about 50 grams per liter.[26] Hemocyanin is colorless when deoxygenated and dark
blue when oxygenated. The blood in the circulation of these creatures, which generally live in cold environments with low oxygen tensions, is grey-
white to pale yellow,[26] and it turns dark blue when exposed to the oxygen in the air, as seen when they bleed.[26] This is due to change in color of
hemocyanin when it is oxidized.[26] Hemocyanin carries oxygen in extracellular fluid, which is in contrast to the intracellular oxygen transport in
mammals by hemoglobin in RBCs.[26]

Chlorocruorin

The blood of most annelid worms and some marine polychaetes use chlorocruorin to transport oxygen. It is green in color in dilute solutions.[27]

Hemerythrin

Hemerythrin is used for oxygen transport in the marine invertebrates sipunculids, priapulids, brachiopods, and the annelid worm, magelona.
Hemerythrin is violet-pink when oxygenated.[27]

Hemovanadin

The blood of some species of ascidians and tunicates, also known as sea squirts, contains proteins called vanabins. These proteins are based on
vanadium, and give the creatures a concentration of vanadium in their bodies 100 times higher than the surrounding sea water. It is not clear
whether these vanabins actually carry oxygen. When exposed to oxygen, however, vanabins turn a mustard yellow.

Pathology

General medical disorders

 Disorders of volume
o Injury can cause blood loss through bleeding.[28] A healthy adult can lose almost 20% of blood volume (1 L) before the first
symptom, restlessness, begins, and 40% of volume (2 L) before shock sets in. Thrombocytes are important for blood coagulation
and the formation of blood clots, which can stop bleeding. Trauma to the internal organs or bones can cause internal bleeding,
which can sometimes be severe.
o Dehydration can reduce the blood volume by reducing the water content of the blood. This would rarely result in shock (apart
from the very severe cases) but may result in orthostatic hypotension and fainting.
 Disorders of circulation
o Shock is the ineffective perfusion of tissues, and can be caused by a variety of conditions including blood loss, infection, poor
cardiac output.
o Atherosclerosis reduces the flow of blood through arteries, because atheroma lines arteries and narrows them. Atheroma tends
to increase with age, and its progression can be compounded by many causes including smoking, high blood pressure, excess
circulating lipids (hyperlipidemia), and diabetes mellitus.
o Coagulation can form a thrombosis, which can obstruct vessels.
 o Problems with blood composition, the pumping action of the heart, or narrowing of blood vessels can have many consequences
including hypoxia (lack of oxygen) of the tissues supplied. The term ischemia refers to tissue that is inadequately perfused with
blood, and infarction refers to tissue death (necrosis), which can occur when the blood supply has been blocked (or is very
inadequate)

Hematological disorders

 Anemia
o Insufficient red cell mass (anemia) can be the result of bleeding, blood disorders like thalassemia, or nutritional deficiencies; and
may require blood transfusion. Several countries have blood banks to fill the demand for transfusable blood. A person receiving a
blood transfusion must have a blood type compatible with that of the donor.
o Sickle-cell anemia

 Disorders of cell proliferation

o Leukemia is a group of cancers of the blood-forming tissues and cells.
o Non-cancerous overproduction of red cells (polycythemia vera) or platelets (essential thrombocytosis) may be premalignant.
o Myelodysplastic syndromes involve ineffective production of one or more cell lines.

 Disorders of coagulation
o Hemophilia is a genetic illness that causes dysfunction in one of the blood's clotting mechanisms. This can allow otherwise
inconsequential wounds to be life-threatening, but more commonly results in hemarthrosis, or bleeding into joint spaces, which
can be crippling.
o Ineffective or insufficient platelets can also result in coagulopathy (bleeding disorders).
o Hypercoagulable state (thrombophilia) results from defects in regulation of platelet or clotting factor function, and can cause
thrombosis.

 Infectious disorders of blood

o Blood is an important vector of infection. HIV, the virus that causes AIDS, is transmitted through contact with blood, semen or
other body secretions of an infected person. Hepatitis B and C are transmitted primarily through blood contact. Owing to blood-
borne infections, bloodstained objects are treated as a biohazard.
o Bacterial infection of the blood is bacteremia or sepsis. Viral Infection is viremia. Malaria and trypanosomiasis are blood-borne
parasitic infections.

Carbon monoxide poisoning

Substances other than oxygen can bind to hemoglobin; in some cases this can cause irreversible damage to the body. Carbon monoxide, for
example, is extremely dangerous when carried to the blood via the lungs by inhalation, because carbon monoxide irreversibly binds to hemoglobin to
form carboxyhemoglobin, so that less hemoglobin is free to bind oxygen, and fewer oxygen molecules can be transported throughout the blood. This
can cause suffocation insidiously. A fire burning in an enclosed room with poor ventilation presents a very dangerous hazard, since it can create a
build-up of carbon monoxide in the air. Some carbon monoxide binds to hemoglobin when smoking tobacco.[citation needed]

Medical treatments

Blood products

Blood for transfusion is obtained from human donors by blood donation and stored in a blood bank. There are many different blood types in humans,
the ABO blood group system, and the Rhesus blood group system being the most important. Transfusion of blood of an incompatible blood group
may cause severe, often fatal, complications, so crossmatching is done to ensure that a compatible blood product is transfused.

Other blood products administered intravenously are platelets, blood plasma, cryoprecipitate, and specific coagulation factor concentrates.

Intravenous administration

Many forms of medication (from antibiotics to chemotherapy) are administered intravenously, as they are not readily or adequately absorbed by the
digestive tract.

After severe acute blood loss, liquid preparations, generically known as plasma expanders, can be given intravenously, either solutions of salts
(NaCl, KCl, CaCl2 etc.) at physiological concentrations, or colloidal solutions, such as dextrans, human serum albumin, or fresh frozen plasma. In
these emergency situations, a plasma expander is a more effective life-saving procedure than a blood transfusion, because the metabolism of
transfused red blood cells does not restart immediately after a transfusion.
Bloodletting

In modern evidence-based medicine, bloodletting is used in management of a few rare diseases, including hemochromatosis and polycythemia.
However, bloodletting and leeching were common unvalidated interventions used until the 19th century, as many diseases were incorrectly thought
to be due to an excess of blood, according to Hippocratic medicine.

History

According to the Oxford English Dictionary, the word "blood" dates to the oldest English, circa 1000 AD. The word is derived from Middle English,
which is derived from the Old English word blôd, which is akin to the Old High German word bluot, meaning blood. The modern German word is
(das) Blut.

Classical Greek medicine

In classical Greek medicine, blood was associated with air, with Springtime, and with a merry and gluttonous (sanguine) personality. It was also
believed to be produced exclusively by the liver.

Hippocratic medicine

In Hippocratic medicine, blood was considered to be one of the four humors, the others being phlegm, yellow bile, and black bile.

Human blood group systems

[Link]

Thirty-three major blood group systems (including the AB and Rh systems) were recognised by the International Society of Blood Transfusion
(ISBT) in October 2012.[1] In addition to the ABO antigens and Rhesus antigens, many other antigens are expressed on the red blood cell surface
membrane. For example, an individual can be AB RhD positive, and at the same time M and N positive (MNS system), K positive (Kell system), and
Lea or Leb positive (Lewis system). Many of the blood group systems were named after the patients in whom the corresponding antibodies were
initially encountered.

The ISBT definition of a blood group system is where one or more antigens are "controlled at a single gene locus or by two or more very closely
linked homologous genes with little or no observable recombination between them".[2]

Blood grouping postulates

Blood is composed of cells suspended in a liquid like substance. The liquid portion is the plasma. Suspended in the plasma are three types of cells:

 Red cells carry oxygen

 White cells fight infection
 Platelets stop bleeding in injuries
The most common type of grouping is the ABO (either uppercase or lowercase) grouping. The varieties of glycoprotein coating on red blood cells
divides blood into four groups:

 A (A oligosaccharide is present)
 B (B oligosaccharide is present)
 AB (A and B oligosaccharides are present)
 O (neither A nor B, only their precursor H oligosaccharide present)

There are subtypes under this grouping (listed as A1, A2, A1B or A2B…) some of which are quite rare. Apart from this there is a protein which plays
an important part in the grouping of blood. This is called the Rh factor. If this is present, the particular blood type is called positive. If it is absent, it is
called negative. Thus we have the following broad categories:[3]

 A1 Negative (A1 -ve)

 A1 Positive (A1 +ve)
 A1B Negative (A1B -ve)
 A1B Positive (A1B +ve)
 A2 Negative (A2 -ve)
 A2 Positive (A2 +ve)
 A2B Negative (A2B -ve)
 A2B Positive (A2B +ve)
 B Negative (B -ve)
 B Positive (B +ve)
 B1 Positive (B1 +ve)
 O Negative (O -ve)
 O Positive (O +ve)

Rare blood types

In the "ABO" system, all blood belongs to one of four major groups: A+/-, B+/-, AB+/-, or O+/-. But there are more than two hundred minor blood
groups that can complicate blood transfusions. These are known as rare blood types. Whereas common blood types are expressed in a letter or two,
with maybe a plus or a minus, a smaller number of people express their blood type in an extensive series of letters in addition to their 'AB-' type
designation.

Blood group systems

ISBT System
System name Epitope or carrier, notes Chromosome
№[1] symbol

Carbohydrate (N-Acetylgalactosamine, galactose). A, B and H antigens mainly elicit IgM

001 ABO ABO antibody reactions, although anti-H is very rare, see the Hh antigen system (Bombay 9
phenotype, ISBT #18).

002 MNS MNS GPA / GPB (glycophorins A and B). Main antigens M, N, S, s. 4

003 P P Glycolipid. Three antigens: P1, P, and Pk 22

Protein. C, c, D, E, e antigens (there is no "d" antigen; lowercase "d" indicates the absence
004 Rh (Rhesus) RH 1
of D).

005 Lutheran LU Protein (member of the immunoglobulin superfamily). Set of 21 antigens. 19

Glycoprotein. K1 can cause hemolytic disease of the newborn (anti-Kell), which can be
006 Kell KEL 7
severe.

Carbohydrate (fucose residue). Main antigens Lea and Leb - associated with tissue ABH
007 Lewis LE 19
antigen secretion.

008 Duffy FY Protein (chemokine receptor). Main antigens Fya and Fyb. Individuals lacking Duffy antigens 1
 ISBT System
System name Epitope or carrier, notes Chromosome
№[1] symbol

altogether are immune to malaria caused by Plasmodium vivax and Plasmodium knowlesi.

009 Kidd JK Protein (urea transporter). Main antigens Jka and Jkb. 18

Glycoprotein (band 3, AE 1, or anion exchange). Positive blood is found only among East
010 Diego DI 17
Asians and Native Americans.

011 Yt or Cartwright YT Protein (AChE, acetylcholinesterase). 7

012 XG XG Glycoprotein. X

013 Scianna SC Glycoprotein. 1

014 Dombrock DO Glycoprotein (fixed to cell membrane by GPI, or glycosyl-phosphatidyl-inositol). 12

015 Colton CO Aquaporin 1. Main antigens Co(a) and Co(b). 7

016 Landsteiner-Wiener LW Protein (member of the immunoglobulin superfamily). 19

017 Chido/Rodgers CH\ C4A C4B (complement fractions). 6

018 Hh/Bombay H Carbohydrate (fucose residue). 19

019 Kx XK Glycoprotein. X

020 Gerbich GE GPC / GPD (Glycophorins C and D). 2

Glycoprotein (DAF or CD55, regulates complement fractions C3 and C5, attached to the
021 Cromer CROM 1
membrane by GPI).

022 Knops KN Glycoprotein (CR1 or CD35, immune complex receptor). 1

023 Indian IN Glycoprotein (CD44 adhesion function?). 11

024 Ok OK Glycoprotein (CD147). 19

025 Raph RAPH Transmembrane glycoprotein. 11

026 JMH JMH Protein (fixed to cell membrane by GPI). Also known as Semaphorin 7A or CD108. 6

027 Ii I Branched (I) / unbranched (i) polysaccharide. 6

028 Globoside GLOB Glycolipid. Antigen P. 3

029 GIL GIL Aquaporin 3. 9

Rh-associated
030 RHAg Rh-associated glycoprotein. 6
glycoprotein

031 Forssman FORS Globoside alpha-1,3-N-acetylgalactosaminyltransferase 1 (GBGT1) 9

033 Langereis[4] LAN ABCB6. Porphyrin transporter 2

032 Junior[4] JR ABCG2. Multi-drug transporter protein

Plasma compatibility

Recipients can receive plasma of the same blood group, but otherwise the donor-recipient compatibility for blood plasma is the converse of that of
RBCs:[citation needed] plasma extracted from type AB blood can be transfused to individuals of any blood group; individuals of blood group O can receive
plasma from any blood group; and type O plasma can be used only by type O recipients.
 Plasma compatibility table[25]

Donor[1]
Recipient
O A B AB

AB

Table note
1. Assumes absence of strong atypical antibodies in donor plasma

Rh D antibodies are uncommon, so generally neither D negative nor D positive blood contain anti-D antibodies. If a potential donor is found to have
anti-D antibodies or any strong atypical blood group antibody by antibody screening in the blood bank, they would not be accepted as a donor (or in
some blood banks the blood would be drawn but the product would need to be appropriately labeled); therefore, donor blood plasma issued by a
blood bank can be selected to be free of D antibodies and free of other atypical antibodies, and such donor plasma issued from a blood bank would
be suitable for a recipient who may be D positive or D negative, as long as blood plasma and the recipient are ABO compatible.[citation needed]

Red blood cell compatibility

 Blood group AB individuals have both A and B antigens on the surface of their RBCs, and their blood plasma does not contain any
antibodies against either A or B antigen. Therefore, an individual with type AB blood can receive blood from any group (with AB being
preferable), but cannot donate blood to any group other than AB. They are known as universal recipients.
 Blood group A individuals have the A antigen on the surface of their RBCs, and blood serum containing IgM antibodies against the B
antigen. Therefore, a group A individual can receive blood only from individuals of groups A or O (with A being preferable), and can donate
blood to individuals with type A or AB.
 Blood group B individuals have the B antigen on the surface of their RBCs, and blood serum containing IgM antibodies against the A
antigen. Therefore, a group B individual can receive blood only from individuals of groups B or O (with B being preferable), and can donate
blood to individuals with type B or AB.
 Blood group O (or blood group zero in some countries) individuals do not have either A or B antigens on the surface of their RBCs, and
their blood serum contains IgM anti-A and anti-B antibodies against the A and B blood group antigens. Therefore, a group O individual can
receive blood only from a group O individual, but can donate blood to individuals of any ABO blood group (i.e., A, B, O or AB). If a patient
in a hospital situation were to need a blood transfusion in an emergency, and if the time taken to process the recipient's blood would cause
a detrimental delay, O Negative blood can be issued. They are known as universal donors.

Red blood cell compatibility table[24][25]

Donor[1]
Recipient[1]
O− O+ A− A+ B− B+ AB− AB+
O−
O+
A−
A+
B−
B+
AB−
AB+
A person with blood type hh (also known as h/h, Oh, "Bombay phenotype", H antigen deficiency) can only receive blood transfusions of blood type
hh because they produce anti-H (just like people with blood type O produce anti-A and anti-B). It is recessive, so the person's parents may be
carriers with Hh genes.
It is extremely rare: only 1 per million in Europe, 1 per 10,000 in India, and 1 per 8,000 in Taiwan (compare to 1 in 25 for rare blood type AB). It is
thought that only those with ancestry from India have the hh phenotype.

The H antigen was discovered in Mumbai (then known as Bombay) and a paper was published in 1952. It is the building block for the antigens of the
ABO blood group. A person with hh genes does not make H antigens, and therefore does not make A or B antigens either. That's why they produce
anti-H, anti-A, and anti-B and have an acute hemolytic transfusion reaction when receiving even type O blood - because type O blood has H
antigens.

Unfortunately, usual blood typing will misidentify hh blood as type O, because the current tests only look for A and B groupings.

There are at least 46 different antigens, with A, B, and Rh being the best known; incompatibility with other antigens (such as H) is extremely rare,
though the proportions vary among different populations.

[I am a layperson when it comes to biology and medicine, but I do have extensive science background. The information above is from my reading of
the 3 websites below and my own accumulated knowledge from interest in blood transfusions.]

Source: [Link]
[Link]
[Link]

Blood mystery solved: Two new blood types identified

February 23, 2012
University of Vermont
You probably know your blood type: A, B, AB or O. You may even know if you're Rhesus positive or negative. But how about the Langereis blood
type? Or the Junior blood type? Positive or negative? Most people have never even heard of these. Yet this knowledge could be "a matter of life and
death." While blood transfusion problems due to Langereis and Junior blood types are rare worldwide, several ethnic populations are at risk.

You probably know your blood type: A, B, AB or O. You may even know if you're Rhesus positive or negative. But how about the Langereis blood
type? Or the Junior blood type? Positive or negative? Most people have never even heard of these.

Yet this knowledge could be "a matter of life and death," says University of Vermont biologist Bryan Ballif.

While blood transfusion problems due to Langereis and Junior blood types are rare worldwide, several ethnic populations are at risk, Ballif notes.
"More than 50,000 Japanese are thought to be Junior negative and may encounter blood transfusion problems or mother-fetus incompatibility," he
writes.

But the molecular basis of these two blood types has remained a mystery -- until now.

In the February issue of Nature Genetics, Ballif and his colleagues report on their discovery of two proteins on red blood cells responsible for these
lesser-known blood types.

Ballif identified the two molecules as specialized transport proteins named ABCB6 and ABCG2.

"Only 30 proteins have previously been identified as responsible for a basic blood type," Ballif notes, "but the count now reaches 32."

The last new blood group proteins to be discovered were nearly a decade ago, Ballif says, "so it's pretty remarkable to have two identified this year."

Both of the newly identified proteins are also associated with anticancer drug resistance, so the findings may also have implications for improved
treatment of breast and other cancers.

As part of the international effort, Ballif, assistant professor in the biology department, used a mass spectrometer at UVM funded by the Vermont
Genetics Network. With this machine, he analyzed proteins purified by his longtime collaborator, Lionel Arnaud at the French National Institute for
Blood Transfusion in Paris, France.
Ballif and Arnaud, in turn, relied on antibodies to Langereis and Junior blood antigens developed by Yoshihiko Tani at the Japanese Red Cross
Osaka Blood Center and Toru Miyasaki at the Japanese Red Cross Hokkaido Blood Center.

After the protein identification in Vermont, the work returned to France. There Arnaud and his team conducted cellular and genetic tests confirming
that these proteins were responsible for the Langereis and Junior blood types. "He was able to test the gene sequence," Ballif says, "and, sure
enough, we found mutations in this particular gene for all the people in our sample who have these problems."

Transfusion troubles

Beyond the ABO blood type and the Rhesus (Rh) blood type, the International Blood Transfusion Society recognizes twenty-eight additional blood
types with names like Duffy, Kidd, Diego and Lutheran. But Langereis and Junior have not been on this list. Although the antigens for the Junior and
Langereis (or Lan) blood types were identified decades ago in pregnant women having difficulties carrying babies with incompatible blood types, the
genetic basis of these antigens has been unknown until now.

Therefore, "very few people learn if they are Langereis or Junior positive or negative," Ballif says.

"Transfusion support of individuals with an anti-Lan antibody is highly challenging," the research team wrote in Nature Genetics, "partly because of
the scarcity of compatible blood donors but mainly because of the lack of reliable reagents for blood screening." And Junior-negative blood donors
are extremely rare too. That may soon change.

With the findings from this new research, health care professionals will now be able to more rapidly and confidently screen for these novel blood
group proteins, Ballif wrote in a recent news article. "This will leave them better prepared to have blood ready when blood transfusions or other tissue
donations are required," he notes.

"Now that we know these proteins, it will become a routine test," he says.

A better match

This science may be especially important to organ transplant patients. "As we get better and better at transplants, we do everything we can to make
a good match," Ballif says. But sometimes a tissue or organ transplant, that looked like a good match, doesn't work -- and the donated tissue is
rejected, which can lead to many problems or death.

"We don't always know why there is rejection," Ballif says, "but it may have to do with these proteins."

The rejection of donated tissue or blood is caused by the way the immune system distinguishes self from not-self. "If our own blood cells don't have
these proteins, they're not familiar to our immune system," Ballif says, so the new blood doesn't "look like self" to the complex cellular defenses of
the immune system. "They'll develop antibodies against it," Ballif says, and try to kill off the perceived invaders. In short, the body starts to attack
itself.

"Then you may be out of luck," says Ballif, who notes that in addition to certain Japanese populations, European Gypsies are also at higher risk for
not carrying the Langereis and Junior blood type proteins.

"There are people in the United States who have these challenges too," he says, "but it's more rare."

Other proteins

Ballif and his international colleagues are not done with their search. "We're following up on more unknown blood types," he says. "There are
probably on the order of 10 to 15 more of these unknown blood type systems -- where we know there is a problem but we don't know what the
protein is that is causing the problem."

Although these other blood systems are very rare, "if you're that one individual, and you need a transfusion," Ballif says, "there's nothing more
important for you to know."

Story Source:

The above story is based on materials provided by University of Vermont. The original article was written by Joshua E. Brown. Note: Materials may
be edited for content and length.
Journal Reference:

1. Virginie Helias, Carole Saison, Bryan A Ballif, Thierry Peyrard, Junko Takahashi, Hideo Takahashi, Mitsunobu Tanaka, Jean-Charles
Deybach, Hervé Puy, Maude Le Gall, Camille Sureau, Bach-Nga Pham, Pierre-Yves Le Pennec, Yoshihiko Tani, Jean-Pierre Cartron,
Lionel Arnaud. ABCB6 is dispensable for erythropoiesis and specifies the new blood group system Langereis. Nature Genetics,
2012; 44 (2): 170 DOI: 10.1038/ng.1069

[Link]