What is the significance of ABO (Blood Group) incompatibility?

From the Guidelines

ABO incompatibility is a significant concern in transfusion medicine, as it can lead to hemolysis, particularly in patients receiving platelet transfusions, and efforts should be made to provide ABO-compatible products whenever possible, as stated in the American Society of Clinical Oncology clinical practice guideline update 1. The significance of ABO incompatibility lies in its potential to cause hemolysis, especially in certain patient populations, such as children, who may be at higher risk due to the presence of incompatible plasma in platelet transfusions 1.

• Key points to consider:
  • ABO incompatibility can occur when a patient receives a platelet transfusion with incompatible plasma, such as an O donor to an A or B blood type recipient 1.
  • The risk of clinically significant hemolysis is generally low in adult recipients, but it can be a concern in certain situations, such as in patients with cancer who require multiple platelet transfusions 1.
  • Providing ABO-compatible platelet products can help minimize the risk of hemolysis, and plasma can be replaced partially with a crystalloid platelet additive solution to reduce the amount of plasma that might be infused to plasma-incompatible recipients 1.
  • Alloimmunization should be suspected in patients who are refractory to platelet transfusions, and antibody studies should be performed to confirm a diagnosis of alloimmunity, as approximately 90% of patients who are alloimmunized will have alloantibody to HLA antigens 1. In clinical practice, the use of ABO-compatible platelet products is recommended to minimize the risk of hemolysis, particularly in high-risk patients, such as those with cancer or those requiring multiple transfusions 1.

From the Research

Significance of ABO Incompatibility

• ABO incompatibility can lead to severe acute hemolytic reactions, particularly in the setting of red cell transfusion 2, 3.
• The ABO blood group is the most clinically significant blood group due to preformed immunoglobulin M (IgM) and IgG antibodies to ABO blood group antigens (isohemagglutinins) in everyone except group AB individuals 3.
• ABO incompatibility can cause hemolysis in various settings, including:
  • Red blood cell transfusion 2, 3, 4
  • Hematopoietic and solid organ transplantation 3, 5
  • Hemolytic disease of the newborn 3
  • Intravenous immunoglobulin infusion 3
  • Platelet transfusion 6

Consequences of ABO Incompatibility

• More than 50 ml of ABO-incompatible blood transfusion can cause a severe acute hemolytic reaction 2.
• ABO-incompatible blood transfusion can lead to disseminated intravascular coagulation and acute kidney injury 4.
• Platelet transfusion with major ABO incompatibility can cause adverse reactions or platelet refractoriness 6.
• Minor ABO-incompatible platelet transfusion can cause hemolytic transfusion reaction (HTR) 6.

Prevention and Management of ABO Incompatibility

• Establishing a management system of blood transfusion in hospitals, including a hospital transfusion committee and a responsible medical doctor, can help prevent ABO-incompatible transfusion 2.
• Employing specialists in blood banking in large hospitals can also help prevent ABO-incompatible transfusion 2.
• Plasma exchange therapy and continuous hemodiafiltration can be effective treatments for ABO-incompatible blood transfusion 4.
• Forced alkaline hydration with mannitol diuresis in conjunction with red cell reduced buffy coat bone marrow can help prevent hemolysis in ABO-incompatible bone marrow transplantation 5.