The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [280]
Table 8.8 Blood group compatibility
People with the blood group AB have red cells with A and B surface antigens, but they do not have any anti-A or anti-B immunoglobulin M (IgM) antibodies in their serum. Therefore, they are able to receive blood from any group, but can only donate to other people from group AB.
People with group O red cells do not have either A or B surface antigens but they do have anti-A and anti-B IgM antibodies in their serum. They are only able to receive blood from group O, but can donate to A, B, O and AB groups.
People with group A red cells have type A surface antigens, and they have anti-B IgM antibodies in their serum. They are only able to receive blood from groups A or O and can only donate blood to people from A and AB groups.
People with group B red cells have type B surface antigens and they have anti-A IgM antibodies in their serum. They are therefore only able to receive blood from groups B or O and can only donate blood to people from B and AB groups.
In addition to the ABO system, the rhesus (Rh) system was discovered in 1940; again, these are surface antigens and they are another essential system used in transfusion therapy (Mollison et al. 1997). The Rh D antigen is the most immunogenic of the Rh antigens (Porth 2005). However, many other red cell antigens exist and exposure to them may stimulate the development of corresponding antibodies (McClelland 2007).
Related theory
Blood group incompatibility
The transfusion of ABO incompatible red cells can lead to intravascular haemolysis where the recipient’s IgM antibodies bind to the corresponding surface antigens of the transfused cells (McClelland 2007). Complement activation results in lysis of the transfused cells and the haemoglobin that is released precipitates renal failure, with the fragments of the lysed cells activating the clotting pathways, which in turn leads to the development of disseminated intravascular coagulation (DIC) (Mollison et al. 1997). Transfusion of rhesus-positive cells to a rhesus-negative individual will result in immunization and the appearance of anti-D antibodies (Hoffbrand et al. 2006). However, on any subsequent exposure extravascular haemolysis occurs when rhesus antibody-coated red cells are destroyed by macrophages in the liver and spleen (McClelland 2007).
A patient’s rhesus status is of particular importance in pregnancy as haemolytic disease of the newborn (HDN) can occur when the mother is rhesus negative and the developing foetus is rhesus positive as exposure to foetal blood can stimulate anti-D activation in the mother, which in turn can cross the placenta, causing haemolysis (McClelland 2007).
Blood groups in haemopoietic stem cell transplantation
The human leucocyte antigen (HLA) is used to determine compatibility for organ transplantation, including bone marrow and peripheral blood stem cells. However, because ABO blood groups and HLA tissue types are determined genetically, it is not uncommon to find a suitable HLA donor who is ABO and/or rhesus incompatible with the recipient. In such circumstances, major transfusion reactions can be avoided by red cell and/or plasma depletion of the donor cells in the laboratory before reinfusion (Mollison et al. 1997). Occasionally, if the recipient has a very high titre of anti-A or anti-B lytic antibody and the donor marrow or peripheral blood stem cells are blood group A, B or AB, then plasmapheresis of the recipient may be performed to lower the titre of this antibody to safe limits. This is necessary because it is not possible to remove all the red cells from the donor product and those remaining may cause a major transfusion reaction in this situation (Mollison et al. 1997).
Evidence-based approaches
The transfusion of blood components is a complex multi-step process involving personnel from diverse backgrounds with differing levels of knowledge