IJCPD

Priyam R Velani et al 10.5005/jp-journals-10005-1493

ORIGINAL ARTICLE

Determination of ABO Blood Groups and Rh Typing from

Dry Salivary Samples
1
Priyam R Velani, 2Preetam Shah, 3Laxmi Lakade

Source of support: Nil

ABSTRACT
Conflict of interest: None
Introduction: A unique blood group is a characteristic every
individual possesses. Blood group antigens like A, B, D, H,
etc., are found to be present on the cell surfaces of red blood
INTRODUCTION
cells (RBCs). Besides blood, these are also secreted in various
body secretions like semen, sweat, amniotic fluid, and saliva. Forensics in the recent past has gained a lot of impor-
Blood grouping has several applications in forensic sciences tance and coverage. The ever-challenging crime scene
and is also a major part of routine medical investigations. Pres-
investigations are greatly being benefitted with the use
ence of these antigens in saliva is dependent on the secretor
status of an individual. Saliva samples at the crime scene of ultramodern technologies and inventions. The main
are very crucial, as they help in deoxyribonucleic acid typing, aim of every investigation is to establish the identity of
sex determination, bite mark analysis, and blood grouping. the culprit from the various suspects. Forensic dentists
Dried salivary samples are often obtained in more number of play a major role in several such investigations and prove
cases as compared with the wet form, due to the variable time
to be a major aid in solving crimes. Forensic odontology
lapse between the occurrence of the crime and the start of the
investigation. Blood grouping from these samples proves to is a major branch of forensic sciences. Blood at the crime
be very efficient. Thus, the present study aims at evaluating scene proves to be a huge benefit for the investigator.
the accuracy of ABO blood group determination and Rh typing However, in some medico-legal cases like those involv-
from dried salivary samples. Also, the study would establish ing child abuse, rape, robbery, and murders, blood may
the use of saliva as a noninvasive technique in routine blood
examinations, especially in children who have needle phobia.
be absent at the scene, but other biological evidences
may be present and obtainable. These mainly include
Materials and methods: Blood grouping and Rh typing were
fingerprints, hair samples, semen, and saliva. In many
performed on the dry salivary samples obtained from the 47
subjects using the absorption–inhibition technique. This was such cases, saliva may be obtained in a dry or wet form
then compared with the results obtained using extraction from human bite marks, cigarette ends, envelope flap
socket blood and evaluated. openings, dental appliances, food items, plastic casings,
Results: The present study showed a 100% positive cor- etc. Dried salivary samples are often obtained in more
relation for ABO blood grouping, but a mere 14.81% positive number of cases as compared with the wet form, due
correlation for Rh typing between the dried salivary samples to the variable time lapse between the occurrence of the
and the extraction socket blood. crime and the start of the investigation. Thus, the dried
Conclusion: Dried salivary samples can thus be put to salivary samples which are more significant can be put
immense use in several areas of forensic investigations. It to great use in finding out the culprit.
could also help in developing alternate methods for routine
The blood group of an individual, once established
blood investigations in children and adults.
at birth, remains constant throughout one’s life. Hence,
Keywords: ABO blood group, Absorption–inhibition method, blood groups can be successfully used for establishing
Dried salivary samples, Rh typing.
the identity of an individual and in narrowing down the
How to cite this article: Velani PR, Shah P, Lakade L. Deter- suspect pool. Blood groups are basically antigenic deter-
mination of ABO Blood Groups and Rh Typing from Dry Salivary
minants present on the surface of RBCs. Landsteiner was
Samples. Int J Clin Pediatr Dent 2018;11(2):100-104.
the first to describe the ABO grouping of blood. Following
this, several other blood group types like Rh, P, Kell, MN,
1
Postgraduate Student, 2Professor, 3Associate Professor Lewis, Kidd, Diego, etc., were put forth. However, only
1-3
the ABO and Rh groups are in practice for clinical and
Department of Pedodontics, Bharati Vidyapeeth Deemed
University Dental College and Hospital, Pune, Maharashtra forensic use. Other blood groups are of less importance
India because the antigens are weak and the corresponding
Corresponding Author: Priyam R Velani, Postgraduate Student antibodies are not normally present and appear only after
Department of Pedodontics, Bharati Vidyapeeth Deemed multiple transfusions.1
University Dental College and Hospital, Pune, Maharashtra, India Besides blood, the blood group antigens are also secreted
Phone: +919970644709, e-mail: [email protected]
in various other body secretions, such as saliva, semen,

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Determination of ABO Blood Groups and Rh Typing from Dry Salivary Samples

Fig. 1: Collection of saliva sample using gauze piece Fig. 2: Collection of blood using disposable pipette

gastric juice, nasal secretions, vaginal secretions, sweat, tear, Children with systemic diseases and those with mental
urine, etc., from which blood groups can be determined.2 disabilities were excluded from the study. An informed
However, the presence of blood group substances in various consent was obtained from the parents of all the subjects
body secretions depends on whether the individual is a participating in the study.
secretor or a nonsecretor, which can be determined by the
presence of Lewis antigen.3 In some medico-legal cases like Collection of Samples
those involving child abuse, rape, robbery, and murders,
Before the extraction procedure, a small piece of gauze
blood may be absent at the scene, but saliva in some form
was given to each child, who was then asked to wet it
may be procured. This greatly helps in determining the
with his/her own saliva (Fig. 1). Soon thereafter, the saliva
blood group of a victim or a suspect. In such cases, saliva
sample was collected, and the extraction was carried out.
may be obtained in dry forms from bite marks, cigarette
A volume of 1 mL of socket blood was collected using a
ends, envelope flaps, dental appliances, etc.4
dropper inside an ethylenediaminetetraacetic acid bulb
In recent years, many new techniques have been intro-
(Fig. 2). After the collection of these samples (Fig. 3), the
duced and many investigations have shown up to 100%
wet gauze pieces were allowed to dry at room tempera-
accuracy in detecting ABO blood groups from saliva.
ture. Once they dried up, they were taken in a collection
There are mainly two methods for detecting ABO blood
tube, diluted with 3 to 4 mL of distilled water and allowed
group substances from saliva.5
to rest overnight. The blood samples were immediately
1. Absorption–inhibition method
taken to the lab for blood grouping.
2. Absorption–elution method
Blood grouping and Rh typing from socket blood
The absorption–inhibition method is the easier and
were done using the slide agglutination method. Before
simpler of the two.
Moreover, establishing the use of saliva in blood
grouping could also further help establish the use of saliva
as a noninvasive technique in routine blood examination,
especially in children Thus, the present study aims at
evaluating the accuracy of ABO blood group determina-
tion and Rh typing from dried salivary samples.

MATERIALS AND METHODS

The study was conducted in the Department of Pediatric
and Preventive Dentistry, Bharati Vidyapeeth Deemed
University Dental College and Hospital, Pune, after
approval of the ethical committee. Healthy children
between the age group of 6 and 15 years whose teeth were
indicated for extraction either due to physiologic mobility
or for orthodontic purposes were chosen for the study. Fig. 3: Saliva and blood samples in vacuum collection tubes

International Journal of Clinical Pediatric Dentistry, March-April 2018;11(2):100-104 101

Priyam R Velani et al

Fig. 4: Anti A, Anti D, and Anti B antisera Fig. 5: Adding of antisera to the respective test tubes

carrying out blood grouping and Rh typing from the transfer it to a 12 × 75 mm tube. Centrifuge for at least
dried salivary samples, the presence of amylase activity 5 minutes. The denatured saliva after cooling was taken in
was checked for each dried sample using commercially four test tubes. A, B, D, and H antisera in the dilution of
available alpha amylase reagents. Only, once the posi- 1:10 was added to each test tube, and the test tubes were
tive amylase activity was determined, were the samples respectively labeled (Figs 4 and 5). A singe drop from the
considered fit for blood grouping and Rh typing. salivary sample was added to both the test tubes, thor-
To determine if a person is a secretor, the principle oughly shaken and incubated at 37° for 10 minutes. After
of Agglutination Inhibition is utilized. It works through 10 minutes, a single drop of freshly prepared pooled RBC
two processes. of known group (Fig. 6) was added to the respective test
1. Antibody Neutralization: Saliva is mixed with com- tube, shaken well, and further incubated for 15 minutes
mercial antisera and allowed to incubate briefly. If the at 37°. The samples were then checked for the presence
patient is a secretor, the blood group antigens in the or absence of agglutination (Fig. 7). All the results were
saliva will react with and neutralize the antibodies in compared with that obtained from socket blood and the
the commercial antiserum. It is necessary, however, to results were statistically analyzed.
dilute the commercial antiserum so that its antibody
titer more closely matches the antigen level in the Interpretation
saliva. • Agglutination in all of the patient test tubes indicates
2. Agglutination Inhibition: When commercial RBCs a negative result for secretor status.
of the appropriate blood group are added to the test • If any one of the patient test tubes is not agglutinated,
mixture, there should be no free antibody to agglutinate this indicates a positive test for secretor status, and the
them if the patient is a secretor, because the antibodies tube showing the nonagglutination should indicate
have already reacted with the blood group antigens in the ABO and Rh type.
the saliva. The reaction will be negative for agglutina-
tion, but is interpreted as positive for secretor status.
If the patient is a nonsecretor, there will be no blood
group antigens in the saliva; the antibodies in the antise-
rum will not be neutralized and will be free to react when
the test cells are added. Therefore, agglutination is a nega-
tive test for secretor status. Hence, for our samples, the
presence of agglutination means a negative test, and the
absence of agglutination is interpreted as a positive result.

Procedure
In order to denature the saliva, the diluted salivary
sample is placed in a boiling water bath for 10 minutes.
This inactivates enzymes that might otherwise destroy
blood group substances. Allow to cool briefly and then Fig. 6: Blood containing tube for collection of fresh RBCs

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Determination of ABO Blood Groups and Rh Typing from Dry Salivary Samples

DISCUSSION
Blood group of an individual, once established at birth,
remains constant throughout one’s life. Hence, blood
groups can be successfully used for establishing the iden-
tity of an individual and in narrowing down the suspect
pool. Indirect blood grouping from saliva has been very
important in catching criminals in many a crime scene.
Apart from forensics, it has several other applications too.
Pawan Motghare et al4 in their study used the absorp-
tion–inhibition method for blood grouping and found
around 83% secretors among the subjects. ABO blood
grouping from saliva yielded around 85% positive cor-
relation to the blood samples. In a study conducted by
Emberibe et al,6 they studied 176 subjects for the presence
Fig. 7: Checking for the presence or absence of agglutination
of ABH antigen in saliva using the absorption–inhibition
method and their results showed 84.90% secretors. The
RESULTS present study showed a higher percentage of secretors as
In this study, 47 subjects were studied for the determi- well as a 100% correlation between the ABO blood grouping
from dried salivary samples and extraction socket blood.
nation of ABO blood groups and Rh typing from dried
The literature available on the presence of Rh antigen
salivary samples and correlating the outcome with the
in body secretions is very scanty and inconclusive.
blood samples obtained from the extraction sockets. Out
Wiener and Forer,7 claimed that saliva is free of Rh sub-
of these, three samples were discarded owing to contami-
stance. Levin and Ketzin,8 also failed to prove otherwise.
nation of the blood.
However, Boorman and Dodd9 were the first to have
The samples showed that 100% of the subjects were
claimed the demonstration of a small amount of Rh
secretors. Moreover, ABO Blood groups determined from
substance in Rh-positive individuals. In a series of 51 Rh-
the dried salivary samples showed a 100% correlation positive subjects, they reported evidence of secretion in
with the blood groups determined from the extraction 37 instances. They observed that the concentration of the
socket blood. Among the samples tested for ABO blood Rh-specific substance in saliva is less as compared with
grouping, 7 samples showed blood group A, 7 showed the tissues.10 In the present study as well, Rh activity did
blood group B, 16 showed blood group AB, and 14 not yield significant positive results.
showed blood group O (Table 1). For positive Rh typing, Since, there is a lack of significant research wherein
however, only a meager 14.81% positive correlation was both ABO blood grouping and Rh typing have been
obtained between the dried salivary samples and the attempted together from dried salivary sample, the
extraction socket blood, wherein only four dried salivary present study was undertaken to co-relate the presence
samples tested positive as compared with 27 extraction of A, B, H, and D antigens in the dried salivary samples
socket blood samples (Table 2). with that obtained from the blood. There are several other

Table 1: Correlation of ABO blood grouping between dried salivary samples and extraction socket blood
Dried salivary sample Extraction socket blood Dried salivary Extraction socket
Blood group type (number of samples) (number of samples) samples (%) blood (%)
Blood group A 7 7 15.9 15.9
Blood group B 7 7 15.9 15.9
Blood group AB 16 16 36.3 36.3
Blood group O 14 14 31.8 31.8

Table 2: Correlation of Rh typing between dried salivary samples and extraction socket blood
Dried salivary sample Extraction socket blood Dried salivary Extraction socket
Rh typing (number of samples) (number of samples) samples (%) blood (%)
Positive Rh activity 4 27 9.09 61.3
Negative Rh activity 40 17 90.91 38.7

International Journal of Clinical Pediatric Dentistry, March-April 2018;11(2):100-104 103

Priyam R Velani et al

applications for blood grouping from saliva. If a suitable 2. Neiders ME, Standish SM. Blood group determinations
and consistent method can be established, it could further in forensic dentistry. Dent Clin North Am 1977 Jan;21(1):
99-111.
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3. Dacie JV, Lewis SM. The human red cell blood groups and
routine blood examinations, especially in children who the identification of the blood group antigen and antibodies.
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ulcer, ovarian cysts, and even squamous cell carcinoma.12 fluids. Int J Legal Med 1972;70(4):214-222.
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source for ABO blood grouping; however, for the detec- saliva of Calabar Municipality residents. East Afr Med J 1992
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needs to be developed. 7. Wiener AS, Forer S. A human serum containing four distinct
isoagglutinins. Proc Soc Exp Riol 1941;47:215-218.
8. Levine P, Burnham L, Katzin EM, Vogel P. The role of isoim-
CONCLUSION munization in the pathogenesis of erythroblastosis fetalis. Am
ABO blood grouping from dried salivary samples can J Obstet Gynec 1941;42:165.
9. Boorman KE, Dodd BE, Mollison PL. The clinical significance of
thus be put to immense use in several areas of forensic
the Rh factor. Br Med J 1943:1, 2, 535, 569
investigations. It could also help in developing alternate 10. Roy MN, Chatterjea JB. Observations on the presence of
methods for routine blood investigations in children and Rh substances in body fluids. J Indian Med Assoc 1961 Jul
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sensitive approach needs to be devised and put to use. 11. Van Loghem JJ Jr, Dorfmeier H, Van Der Hart M. Two A
antigens with abnormal serologic properties. Vox Sang. 1957
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