Transfusions and Transfusion Reactions

In the late 17th century etching above, a physician and his assistant demonstrate direct dog to human blood transfusion while simultaneously bleeding the human to remove "bad spirits" from the blood. Such a high percentage of blood transfusions between humans were unsuccessful that most European countries quickly banned the practice. Unfortunately, transfusion failures lead to the somewhat inane concept that some persons had "superior" blood. It was not until the dawn of the 20th Century that Austrian pathologist Karl Landsteiner postulated a "4 group compatability theory," A, B, AB and O. The Nobel Prize winning Landsteiner later discovered that Rh factor was also present in 85% of humans.

Blood Groups and Transfusions (Table 17-3,17-4,17-5,Fig.17-2,pp.424-428) General considerations in selection of donor blood: 1) neither donor nor recipient cells are destroyed by antibodies 2) donor blood should not stimulate antibody production by the recipient 3) avoid transmission of blood-borne disease (malaria, jaundice, STD, hepatitis and related antigens) There are at least 17 groups, containing a total in excess of 100 specific erythrocyte antigens that are recognized as having some potential for immunization and could potentially lead to transfusion reactions in humans. Generally, transfusions are clinically acceptable if the 2 major antigen groups, ABO and Rh, are compatible. Cells carrying antigens will react with serum containing corresponding antibodies. This causes large numbers of cells to clump (agglutinate) and lyse. ABO Group: (pp.525-527) The body produces antibodies against antigens not present in the blood. The antigenic stimulus is equivocal; antibody and antigen production may be genetically linked. Those with A antigens (Type A) produce antibodies against B antigens. Those with B antigens (Type B) produce antibodies against A antigens. Those with A and B antigens (Type AB) produce no anti-A-B-O antibodies. Those carrying neither A nor B antigens (Type O) produce anti-A and Anti-B antibodies. Rh Group: (pp.527-528) Rh positive indicates the presence of the most antigenic Rh factor, "D antigen." Rh negative indicates the absence of "D antigen." The body produces antibodies against the foreign antigen. Isoimmunization occurs with transfusion of Rh-positive blood to an Rh-negative recipient or transplacental transfer of Rh-positive cells of the fetus into an Rh-negative mother. Example: A Type A blood donor (contains antigen A and anti-B antibody): You could transfuse it to a person with Type A blood You could transfuse it to a person with Type AB blood You could not transfuse it to a person with Type O blood You could not transfuse it to a person with type B blood A Type A plasma donor (contains anti-B antibody but no antigen): You could transfuse it to a person with Type A blood You could transfuse it to a person with Type AB blood (some risk) You could transfuse it to a person with Type O blood You could transfuse it to a person with Type B blood (some risk)