Mastering red blood cell compatibility

Learn about the decision-making process behind choosing a red blood cell (RBC) product that is compatible with your patient's blood type.

Anna Wonnerth, MD
Anna Wonnerth, MD
20th Jan 2019 • 3m read

In this video, from our Transfusion Medicine Essentials course, you'll learn about the decision-making process behind choosing a red blood cell (RBC) product that is compatible with your patient's blood type.

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Video Transcript

[00:00:00] In this lesson, I want to help you to easily and quickly answer the question—what blood product is compatible with my patient's blood group? This will help you determine what products you can transfuse your patient. So, how does red blood cell compatibility work? The underlying question you should ask is—will my patient have antibodies against the donor's red blood cell antigens that can cause hemolysis?

[00:00:30] Let's go forward step by step. Who can you transfuse with blood group A? Remember, you want to avoid interactions between the A antigen on the donor RBC and anti-A in the patient's plasma. So, the answer is you can transfuse A blood to all patients with no anti-A in their plasma. Let's take a look at our table from before. That strikes out group B and group O. Again, who can receive

[00:01:00] blood group A donor blood? Patients with blood group A or AB. The same applies for blood from group B donors. We cannot give it to individuals who have anti-B in their plasma, so do not give it to patients with blood group A or group O. So, only give type B blood to patients with group B or AB. And RBC units of blood group AB, who can receive those? Well, now we have to

[00:01:30] avoid anti-A and anti-B antibodies. Let's have a look. Group A is a no-go, group B is a no-go, and also group O is a no-go, that leaves only group AB. So, AB donor blood can only be given to patients with group AB blood. And finally, blood group O. There is no A antigen or B antigen on the red blood cells. So, even if there are antibodies in the recipient's plasma,

[00:02:00] they won't have anything to bind to on these RBCs. So, you can give group O blood to patients of all ABO blood groups: O, A, B, and AB. For this reason, group O is the universal donor blood group for red blood cells and is used in life-threatening emergencies when there is no time to wait for blood typing. Rhesus D compatibility is also important when transfusing red blood cells. In general, transfused RBCs

[00:02:30] should be identical to the rhesus D status of the patient. So, a rhesus D positive patient should receive rhesus D positive blood and the rhesus D negative patient should receive rhesus D negative blood. However, due to a general shortage of D negative blood product, it is sometimes necessary to give D positive products to D negative patients. This is okay in selected and strictly indicated cases since there is no immediate risk

[00:03:00] of an adverse transfusion reaction. Remember, the patient won't have antibodies to rhesus D antigen until after they’re first exposed to it. If anti-D production is induced that way, the patient will need D negative blood products the next time though. However, in girls or women who are rhesus D negative and who may become pregnant in the future, it is important that rhesus D negative blood products are used in order to avoid immunization and the potential

[00:03:30] development of hemolytic disease of the fetus and newborn in future pregnancies. We will discuss this in more detail in a later chapter. If it is absolutely unavoidable to give D positive products to D negative women, you should provide your patient with anti-D immunoglobulin prophylaxis after the transfusion to prevent immunization.

Contratulations! Now you know how to choose the right RBC transfusion for your patient and how to avoid life-threatening

[00:04:00] hemolytic transfusion reactions as well as harmful immunization.

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