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A.D.A.M. Medical Encyclopedia.

ABO incompatibility

Last reviewed: June 5, 2012.

A, B, and O are the three major blood types. The types are based on small substances (molecules) on the surface of the blood cells.

When people who have one blood type receive blood from someone with a different blood type, it may cause their immune system to react. This is called ABO incompatibility.

Causes, incidence, and risk factors

The different blood types are:

  • Type A
  • Type B
  • Type AB
  • Type O

People who have one blood type may form proteins (antibodies) that cause their immune system to react against one or more of the other blood types.

Being exposed to another type of blood can cause a reaction. This is important when a patient needs to receive blood (transfusion) or have an organ transplant. The blood types must be matched to avoid an ABO incompatibility reaction.

For example:

  • A patient with type A blood will react against type B or type AB blood.
  • A patient with type B blood will react against type A or type AB blood.
  • A patient with type O blood will react against type A, type B, or type AB blood.
  • A patient with type AB blood will NOT react against type A, type B, or type AB blood.

Type O blood does not cause an immune response when it is received by people with type A, type B, or type AB blood. This is why type O blood cells can be given to patients of any blood type. People with type O blood are called "universal donors." However, people with type O can only receive type O blood.

Both blood and plasma transfusions must be matched to avoid an immune reaction. Before anyone receives blood, both the blood and the person receiving it are tested carefully to avoid a reaction. Usually a reaction occurs because of a clerical error. 

Symptoms

The following are symptoms of ABO incompatible transfusion reactions:

Signs and tests

The health care provider will perform a physical exam. Blood tests will usually show:

Urine tests show the presence of hemoglobin

Treatment

Treatment may include:

  • Drugs used to treat allergic reactions (antihistamines)
  • Drugs used to treat swelling and allergies (steroids)
  • Fluids given through a vein (intravenously)
  • Medicines to raise blood pressure if it drops too low

Expectations (prognosis)

ABO incompatibility can be a very serious problem that can even result in death. With the right treatment, a full recovery is likely.

Complications

  • Kidney failure
  • Low blood pressure needing intensive care
  • Death

Calling your health care provider

Call your health care provider if you have recently had a blood transfusion or transplant and you have symptoms of ABO incompatibility.

Prevention

Careful testing of donor and patient blood types before transfusion or transplant can prevent this problem.

References

  1. Goodnough L. Transfusion medicine. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 180.

Review Date: 6/5/2012.

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Single versus double volume exchange transfusion in jaundiced newborn infantsSingle versus double volume exchange transfusion in jaundiced newborn infants
    Extremely high levels of bilirubin (severe jaundice) can lead to brain damage. Severe jaundice in newborns can occur as a result of a variety of causes including rhesus hemolytic disease, ABO incompatibility, atypical antibodies etc. Removal of blood from the affected infant and replacing with fresh blood from the blood bank (exchange transfusion) is used as a treatment for severe jaundice in newborn infants. The affected infant's blood is removed in small portions and equal volume of blood is replaced during exchange transfusion. Traditionally twice the blood volume of baby is removed and the replaced with fresh blood. Exchange transfusion has been shown to reduce brain damage in severely jaundiced babies; however, exchange transfusion is associated with serious adverse events including death. It is likely that the complications of exchange transfusion would increase with amount of blood exchanged. This review was undertaken to examine if single volume (removal of blood equivalent to the blood volume of the baby) is as effective as double volume (removal of twice blood volume of the baby) in reducing the brain damage and bilirubin levels in newborn infants with severe jaundice. Only one randomised trial fulfilled the criteria for inclusion in the analysis. This study compared single and double volume exchange transfusion in jaundice due to ABO hemolytic jaundice. The study found no significant difference in bilirubin levels following exchange. This study did not look at any long term neurodevelopmental outcome (brain damage). Based on the available data, there is insufficient evidence to support or refute the use of single volume exchange transfusion as opposed to double volume exchange transfusion in jaundiced newborns.
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Figures

  • Jaundice infant.
    Antibodies.

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