Chapter 12: Respiratory care, CPR and blood transfusion
Skip chapter table of contents and go to main content
Anatomy and physiology
ABO and Rh D blood groups
In 1901, Karl Landsteiner discovered that human blood groups existed and identified the ABO system; this marked the start of safe blood transfusion (Bishop [22]). There are four principal blood groups: A, B, AB and O. Each group relates to the presence or absence of surface antigens on the red blood cells and antibodies in the serum, and these antigens and antibodies dictate ABO compatibility (Table 12.21). A key recommendation of the 2017 Serious Hazards of Transfusion (SHOT) report was that all staff involved in the transfusion process, both laboratory and clinical, must have an understanding of the A, B, O and Rh D blood groups so that incompatibility will be recognized (Bolton‐Maggs [27]). However, there are many more blood groups than the ones mentioned in this chapter.
Table 12.21 Red cell compatibility
| Group | Antigens | Immunoglobulin M antibodies | Compatible donor for |
Compatible recipient of |
|---|---|---|---|---|
| A | A | Anti‐B | A and AB | A and O |
| B | B | Anti‐A | B and AB | B and O |
| AB | A and B | None | AB | A, B, AB and O |
| O | No A or B | Anti‐A and Anti‐B | A, B, AB and O | O |
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 people in the A, B, AB and O 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 the 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 the B and AB groups.
In addition to the ABO system, the Rh blood group was discovered in 1940; again, Rh blood group antigens are surface antigens and they are another essential system used in transfusion therapy and safety (Klein and Anstee [127]). The Rh D antigen is the most immunogenic of the Rh antigens (Porth [222]). Approximately 85% of Caucasians have the D antigen and are therefore Rh positive, whereas approximately 15% lack the D antigen and are Rh negative (Daniels [54]). Several hundred red cell transfusion‐related antigens have now been identified. Antibody production can happen after contact with ‘non‐self’ blood antigens, usually due to transfusion or pregnancy (Zwaginga and van Ham [296]).
