The AB0 System and Gallstones

Today's medicine is inconceivable without the knowledge of the blood types. This discovery belongs to Karl Landsteiner, Austrian biologist and physician, and was made at the beginning of the 20th century. In recognition of this achievement, Landsteiner was awarded the Nobel Prize in Physiology or Medicine.



Landsteiner was not the first to suspect immunological differences in people and especially their blood cells. First attempt to blood transfusion was performed in 1628, soon after the circulation of blood was discovered by the English physician William Harvey. Before 20th century and Landsteiner's scientific work successful blood transfusions have occurred seldom and without any reasonable explanation. Physicians were not able to handle with even minimal blood losses. The maternal mortality of postpartum hemorrhage was extremely high.

When Landsteiner started his work on blood types system, it was already known that in most cases blood of two people under contact agglutinates. He correctly suggested differences between blood cells' antigens and also antibodies contained in the serum. That statement gave him possibility to systematize the blood types, creating the ABC-system. Nowadays it is well known that blood, labeled as A, contains antigens A and antibodies ß; respectively blood type B contains antigens B and antibodies a. The situation with blood groups AB and 0 was not cleared by the time of Landsteiner's discovery. Blood type 0 was labeled by the Austrian physician as C and was correctly remarked as not containing A and B antigens but positive for a and ß antibodies. The characteristics of blood group AB are completely reverse. It was also discovered that the contact between antigen A and antibody a, and antigen B and antibody ß leads to agglutination.

Applying the AB0-system, as it is known now, is the most important part of performing blood transfusion. Rh-compatibility should also be taken into consideration.

Gallstone pancreatitis is potentially life threatening so appropriate and timely surgery may be required.

If there is any suspicion that patient's pancreatitis is caused by gallstones the conventional treatment includes full recovery from the inflammation and investigation performed by biliary tract radiology - oral cholecystography and intravenous cholaniography. Still, all of these tests that rely on excretion of media by the liver are notoriously unreliable in the acute stages of pancreatitis.

Next step is to register the patient on the waiting list for elective surgery. The procedure will be performed in 6-8 weeks and its goal is to confirm or deny existence of gallstones by operative cholangiogram. That way of treatment carries the risk of patient's worsening before he finally comes to billiary tract surgery. However it is unnecessary and even harmful to operate on acute pancreatitis if the diagnosis gallstones is not confirmed. After all if the surgeon decides he can practice a policy of early surgical intervention, even within the first 24-48 hours after the patient's admission. The advantage to classical approach of deferred surgery is avoiding people running into risks while on the waiting list.