Never Event: Incompatability of Blood Types In Transfusions

Picture-2511Blood transfusions are the process of transferring a blood component (usually plasma or red blood cells) from one person (the donor) into the circulatory system of another person (the recipient) through an intravenous (IV) line.  Whole blood is made up of blood components (plasma, red blood cells, white blood cells, and platelets), and whole-blood transfusions are rarely given.  Blood transfusion therapy is often used to treat massive blood loss or blood disease.

One major concern during blood transfusions is blood type compatibility.  The donor and recipient blood types should be checked and cross-matched to ensure that the recipient’s immune system will not attack the donor blood.  There are four main blood types: A, B, AB, and O.  Blood is also classified by its Rh factor, either Rh positive or Rh negative (indicating the presence or absence or a specific antigen, which could trigger an immune system response).  For example, a person with type A blood is either A positive or A negative.

If your blood type is . . .

Type

You Can Give Blood To

You Can Receive Blood From

A+

A+  AB+

A+  A-  O+  O-

O+

O+  A+  B+  AB+

O+  O-

B+

B+  AB+

B+  B-  O+  O-

AB+

AB+

Everyone

A-

A+  A-  AB+  AB-

A-  O-

O-

Everyone

O-

B-

B+  B-  AB+  AB-

B-  O-

AB-

AB+  AB-

AB-  A-  B-  O-

Although uncommon, blood transfusion reactions are possible.  Symptoms of reactions include: chills, fever, nausea, rash, itching, pink-colored urine, and difficulty breathing.  Major transfusion reactions include acute hemolytic reaction (see below), transfusion-associated adult respiratory distress syndrome (difficulty breathing during the transfusion or within six hours following transfusion), and febrile transfusion reactions (fever occurring within 24 hours of transfusion). Medical error is the main cause of transfusion-related deaths, including bypassing safeguards, similar patient names, and verbal or faxed communications.

The most serious type of transfusion reaction is acute immune hemolytic reaction, where the donor and recipient blood types do not match, causing the recipient’s antibodies to attack the donor blood, causing the red blood cells to break open and release harmful substances into the bloodstream.  This can result in kidney damage requiring dialysis and even death if the transfusion is not stopped when the reaction begins.  The main cause of acute immune hemolytic reaction is human error, especially during emergency situations.

At the very least, nursing home patients should know their blood type and alert the facility as to their blood type so if a blood transfusion is required, the appropriate blood type can be relayed to the medical providers.

Resources:

American Red Cross – Blood Type Compatibility Table

Mayo Clinic Internal Medicine Concise Textbook – Habermann, Ghosh.  Informa Healthcare (2007).

American Cancer Society – Possible Risks of Blood Product Transfusions

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