Types of Blood Transfusions

Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. The type of blood transfusion you need depends on your situation. For example, if you have an illness that stops your body from properly making a part of your blood, you may need only that part to treat the illness.

Red Blood Cell Transfusions

Red blood cells are the most commonly transfused part of the blood. These cells carry oxygen from the lungs to your body's organs and tissues. They also help your body get rid of carbon dioxide and other waste products. You may need a transfusion of red blood cells if you've lost blood due to an injury or surgery. You also may need this type of transfusion if you have severe anemia (uh-NEE-me-uh) due to disease or blood loss. Anemia is a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't have enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that gives blood its red color. This protein carries oxygen from the lungs to the rest of the body.

Platelets and Clotting Factor Transfusions

Platelets and clotting factors help stop bleeding, including internal bleeding that you can't see. Some illnesses may cause your body to not make enough platelets or clotting factors. You may need regular transfusions of these parts of your blood to stay healthy. For example, if you have hemophilia (heem-o-FILL-ee-ah), you may need a special clotting factor to replace the clotting factor you're lacking. Hemophilia is a rare, inherited bleeding disorder in which your blood doesn't clot normally. If you have hemophilia, you may bleed for a longer time than others after an injury or accident. You also may bleed internally, especially in the joints (knees, ankles, and elbows).

Plasma Transfusions
Plasma is the liquid part of your blood. It's mainly water, but also contains proteins, clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium, and more. If you have been badly burned or have liver failure or a severe infection, you may need a plasma transfusion

Blood Groups, Blood Typing and Blood Transfusions

The discovery of blood groups

Experiments with blood transfusions, the transfer of blood or blood components into a person's blood stream, have been carried out for hundreds of years. Many patients have died and it was not until 1901, when the Austrian Karl Landsteiner discovered human blood groups, that blood transfusions became safer. Mixing blood from two individuals can lead to blood clumping or agglutination. The clumped red cells can crack and cause toxic reactions. This can have fatal consequences. Karl Landsteiner discovered that blood clumping was an immunological reaction which occurs when the receiver of a blood transfusion has antibodies against the donor blood cells. Karl Landsteiner's work made it possible to determine blood groups and thus paved the way for blood transfusions to be carried out safely. For this discovery he was awarded the Nobel Prize in Physiology or Medicine in 1930.

What is blood made up of?

An adult human has about 46 liters of blood circulating in the body. Among other things, blood transports oxygen to various parts of the body. Blood consists of several types of cells floating around in a fluid called plasma. The red blood cells contain hemoglobin, a protein that binds oxygen. Red blood cells transport oxygen to, and remove carbon dioxide from, the body tissues.

The white blood cells fight infection. The platelets help the blood to clot, if you get a wound for example. The plasma contains salts and various kinds of proteins.

What are the different blood groups?

The differences in human blood are due to the presence or absence of certain protein molecules called antigens and antibodies. The antigens are located on the surface of the red blood cells and the antibodies are in the blood plasma. Individuals have different types and combinations of these molecules. The blood group you belong to depends on what you have inherited from your parents. There are more than 20 genetically determined blood group systems known today, but the AB0 and Rh systems are the most important ones used for blood transfusions. Not all blood groups are compatible with each other. Mixing incompatible blood groups leads to blood clumping or agglutination, which is dangerous for individuals. Nobel Laureate Karl Landsteiner was involved in the discovery of both the AB0 and Rh blood groups.

AB0 blood grouping system

According to the AB0 blood group system there are four different kinds of blood groups: A, B, AB or 0 (null).

Blood group A If you belong to the blood group A, you have A antigens on the surface of your red blood cells and B antibodies in your blood plasma.

Blood group B If you belong to the blood group B, you have B antigens on the surface of your red blood cells and A antibodies in your blood plasma. Blood group AB If you belong to the blood group AB, you have both A and B antigens on the surface of your red blood cells and no A or B antibodies at all in your blood plasma. Blood group 0 If you belong to the blood group 0 (null), you have neither A or B antigens on the surface of your red blood cells but you have both A and B antibodies in your blood plasma.

Rh factor blood grouping system

Many people also have a so called Rh factor on the red blood cell's surface. This is also an antigen and those who have it are called Rh+. Those who haven't are called Rh-. A person with Rh- blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance). But a person with Rh-blood can develop Rh antibodies in the blood plasma if he or she receives blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh- blood without any problems.

Blood group notation

According to above blood grouping systems, you can belong to either of following 8 blood groups:

A Rh+ A Rh-

B Rh+ B Rh-

AB Rh+ AB Rh-

0 Rh+ 0 Rh-

Do you know which blood group you belong to?

Blood typing how do you find out to which blood group someone belongs?

1. You mix the blood with three different reagents including either of the three different antibodies, A, B or Rh antibodies. 2. Then you take a look at what has happened. In which mixtures has agglutination occurred? The agglutination indicates that the blood has reacted with a certain antibody and therefore is not compatible with blood containing that kind of antibody. If the blood does not agglutinate, it indicates that the blood does not have the antigens binding the special antibody in the reagent. 3. If you know which antigens are in the person's blood, it's easy to figure out which blood group he or she belongs to!

A person with A+ blood receives B+ blood. The B antibodies (yellow) in the A+ blood attack the foreign red blood cells by binding to them. The B antibodies in the A+ blood bind the antigens in the B+ blood and agglutination occurs. This is dangerous because the agglutinated red blood cells break after a while and their contents leak out and become toxic.

What happens when blood clumps or agglutinates?

For a blood transfusion to be successful, AB0 and Rh blood groups must be compatible between the donor blood and the patient blood. If they are not, the red blood cells from the donated blood will clump or agglutinate. The agglutinated red cells can clog blood vessels and stop the circulation of the blood to various parts of the body. The agglutinated red blood cells also crack and its contents leak out in the body. The red blood cells contain hemoglobin which becomes toxic when outside the cell. This can have fatal consequences for the patient. The A antigen and the A antibodies can bind to each other in the same way that the B antigens can bind to the B antibodies. This is what would happen if, for instance, a B blood person receives blood from an A blood person. The red blood cells will be linked together, like bunches of grapes, by the antibodies. As mentioned earlier, this clumping could lead to death.

Blood transfusions who can receive blood from whom?

Of course you can always give A blood to persons with blood group A, B blood to a person with blood group B and so on. But in some cases you can receive blood with another type of blood group, or donate blood to a person with another kind of blood group. The transfusion will work if a person who is going to receive blood has a blood group that doesn't have any antibodies against the donor blood's antigens. But if a person who is going to receive blood has antibodies matching the donor blood's antigens, the red blood cells in thedonated blood will clump.

People with blood group 0 Rh - are called "universal donors" and people with blood group AB Rh+ are called "universal receivers." Rh+ blood can never be given to someone with Rh - blood, but the other way around works. For example, 0 Rh+ blood can not be given to someone with the blood type AB Rh -.

Blood Group

Antigens

Antibodies

Can give blood to

Can receive blood from

AB Rh+

A, B and Rh

None

AB Rh+

AB Rh+ AB Rh A Rh+ A Rh B Rh+ B Rh 0 Rh+ 0 Rh AB Rh A Rh B Rh 0 Rh A Rh+ A Rh 0 Rh+ 0 Rh A Rh 0 Rh -

AB Rh

A and B

None AB Rh (Can develop AB Rh+ Rh antibodies)

A Rh+

A and Rh

A Rh+ AB Rh+

A Rh

B A Rh (Can develop A Rh+ Rh antibodies) AB Rh AB Rh+ A B Rh+ AB Rh+

B Rh+

B and Rh

B Rh+ B Rh 0 Rh+ 0 RhB Rh 0 Rh -

B Rh

A B Rh(Can develop B Rh+ Rh antibodies) AB RhAB Rh+ A and B 0 Rh+ A Rh+ B Rh+ AB Rh+

0 Rh+

Rh

0 Rh+ 0 Rh -

0 Rh

None

A and B (Can

AB Rh+

0 Rh

develop Rh antibodies)

AB Rh A Rh+ A Rh B Rh+ B Rh 0 Rh+ 0 Rh -

What Is a Blood Transfusion?

A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Blood transfusions are done to replace blood lost during surgery or due to a serious injury. A transfusion also may be done if your body can't make blood properly because of an illness. During a blood transfusion, a small needle is used to insert an IV line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours, depending on how much blood you need. Blood transfusions are very common. Each year, almost 5 million Americans need a blood transfusion. Most blood transfusions go well. Mild complications can occur. Very rarely, serious problems develop.

Important Information About Blood

The heart pumps blood through a network of arteries and veins throughout the body. Blood has many vital jobs. It carries oxygen and other nutrients to your body's organs and tissues. Having a healthy supply of blood is important to your overall health. Blood is made up of various parts, including red blood cells, white blood cells, platelets (PLATE-lets), and plasma. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. Blood Types Every person has one of the following blood types: A, B, AB, or O. Also, every person's blood is either Rhpositive or Rh-negative. So, if you have type A blood, it's either A positive or A negative. The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who have this blood type are called universal donors. Type O blood is used for emergencies when there's no time to test a person's blood type. People who have type AB blood are called universal recipients. This means they can get any type of blood. If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you should only get Rh-negative blood. Rh-negative blood is used for emergencies when there's no time to test a person's Rh type. Blood Banks Blood banks collect, test, and store blood. They carefully screen all donated blood for possible infectious agents, such as viruses, that could make you sick. (For more information, see "What Are the Risks of a Blood Transfusion?") Blood bank staff also screen each blood donation to find out whether it's type A, B, AB, or O and whether it's Rhpositive or Rh-negative. Getting a blood type that doesn't work with your own blood type will make you very sick. That's why blood banks are very careful when they test the blood.

To prepare blood for a transfusion, some blood banks remove white blood cells. This process is called white cell or leukocyte (LU-ko-site) reduction. Although rare, some people are allergic to white blood cells in donated blood. Removing these cells makes allergic reactions less likely. Not all transfusions use blood donated from a stranger. If you're going to have surgery, you may need a blood transfusion because of blood loss during the operation. If it's surgery that you're able to schedule months in advance, your doctor may ask whether you would like to use your own blood, rather than donated blood. If you choose to use your own blood, you will need to have blood drawn one or more times prior to the surgery. A blood bank will store your blood for your use.

Alternatives to Blood Transfusions

Researchers are trying to find ways to make blood. There's currently no man-made alternative to human blood. However, researchers have developed medicines that may help do the job of some blood parts. For example, some people who have kidney problems can now take a medicine called erythropoietin that helps their bodies make more red blood cells. This means they may need fewer blood transfusions. Surgeons try to reduce the amount of blood lost during surgery so that fewer patients need blood transfusions. Sometimes they can collect and reuse the blood for the patient.

What Are the Risks of a Blood Transfusion?

Most blood transfusions go very smoothly. However, mild problems and, very rarely, serious problems can occur.

Allergic Reactions
Some people have allergic reactions to the blood given during transfusions. This can happen even when the blood given is the right blood type. Allergic reactions can be mild or severe. Symptoms can include: Anxiety Chest and/or back pain Trouble breathing Fever, chills, flushing, and clammy skin A quick pulse or low blood pressure Nausea (feeling sick to the stomach)

A nurse or doctor will stop the transfusion at the first signs of an allergic reaction. The health care team determines how mild or severe the reaction is, what treatments are needed, and whether the transfusion can safely be restarted.

Viruses and Infectious Diseases

Some infectious agents, such as HIV, can survive in blood and infect the person receiving the blood transfusion. To keep blood safe, blood banks carefully screen donated blood. The risk of catching a virus from a blood transfusion is very low. HIV. Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient. Hepatitis B and C. The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million. If you receive blood during a transfusion that contains hepatitis, you'll likely develop the virus. Variant Creutzfeldt-Jakob disease (vCJD). This disease is the human version of Mad Cow Disease. It's a very rare, yet fatal brain disorder. There is a possible risk of getting vCJD from a blood transfusion, although the risk is very low. Because of this, people who may have been exposed to vCJD aren't eligible blood donors.

Fever
You may get a sudden fever during or within a day of your blood transfusion. This is usually your body's normal response to white blood cells in the donated blood. Over-the-counter fever medicine usually will treat the fever.

Some blood banks remove white blood cells from whole blood or different parts of the blood. This makes it less likely that you will have a reaction after the transfusion.

Iron Overload
Getting many blood transfusions can cause too much iron to build up in your blood (iron overload). People who have a blood disorder like thalassemia, which requires multiple transfusions, are at risk for iron overload. Iron overload can damage your liver, heart, and other parts of your body. If you have iron overload, you may need iron chelation (ke-LAY-shun) therapy. For this therapy, medicine is given through an injection or as a pill to remove the extra iron from your body.

Lung Injury
Although it's unlikely, blood transfusions can damage your lungs, making it hard to breathe. This usually occurs within about 6 hours of the procedure. Most patients recover. However, 5 to 25 percent of patients who develop lung injuries die from the injuries. These people usually were very ill before the transfusion. Doctors aren't completely sure why blood transfusions damage the lungs. Antibodies (proteins) that are more likely to be found in the plasma of women who have been pregnant may disrupt the normal way that lung cells work. Because of this risk, hospitals are starting to use men's and women's plasma differently.

Acute Immune Hemolytic Reaction

Acute immune hemolytic reaction is very serious, but also very rare. It occurs if the blood type you get during a transfusion doesn't match or work with your blood type. Your body attacks the new red blood cells, which then produce substances that harm your kidneys. The symptoms include chills, fever, nausea, pain in the chest or back, and dark urine. The doctor will stop the transfusion at the first sign of this reaction.

Delayed Hemolytic Reaction

This is a much slower version of acute immune hemolytic reaction. Your body destroys red blood cells so slowly that the problem can go unnoticed until your red blood cell level is very low. Both acute and delayed hemolytic reactions are most common in patients who have had a previous transfusion.

Graft-Versus-Host Disease
Graft-versus-host disease (GVHD) is a condition in which white blood cells in the new blood attack your tissues. GVHD usually is fatal. People who have weakened immune systems are the most likely to get GVHD. Symptoms start within a month of the blood transfusion. They include fever, rash, and diarrhea. To protect against GVHD, people who have weakened immune systems should receive blood that has been treated so the white blood cells can't cause GVHD.

What To Expect After a Blood Transfusion

After a blood transfusion, your vital signs are checked (such as your temperature, blood pressure, and heart rate). The intravenous (IV) line is taken out. You may have some bruising or soreness for a few days at the site where the IV was inserted. You may need blood tests that show how your body is reacting to the transfusion. Your doctor will let you know about signs and symptoms to watch for and report.

What To Expect During a Blood Transfusion

Blood transfusions take place in either a doctor's office or a hospital. Sometimes they're done at a person's home, but this is less common. Blood transfusions also are done during surgery and in emergency rooms. A needle is used to insert an intravenous (IV) line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours. The time depends on how much blood you need and what part of the blood you receive. During the blood transfusion, a nurse carefully watches you, especially for the first 15 minutes. This is when allergic reactions are most likely to occur. The nurse continues to watch you during the rest of the procedure as well.

What To Expect Before a Blood Transfusion

Before a blood transfusion, a technician tests your blood to find out what blood type you have (that is, A, B, AB, or O and Rh-positive or Rh-negative). He or she pricks your finger with a needle to get a few drops of blood or draws blood from one of your veins. The blood type used in your transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. Some people have allergic reactions even when the blood given does work with their own blood type. To prevent this, your doctor may prescribe a medicine to stop allergic reactions. (For more information, see "What Are the Risks of a Blood Transfusion?") If you have allergies or have had an allergic reaction during a past transfusion, your doctor will make every effort to make sure you're safe. Most people don't need to change their diets or activities before or after a blood transfusion. Your doctor will let you know whether you need to make any lifestyle changes prior to the procedure.

Name of Blood Group

ABO antigens present on the red cell surface

ABO antibodies present in the plasma

Type O Type A Type B Type AB

nil A antigen B antigen A and B antigens

anti-A and anti-B anti-B anti-A nil

Are they Compatible?

When a transfusion is given, it is preferable for patients to receive blood and plasma of the same ABO and RhD group. However if the required blood type is unavailable, a patient may be given a product of an alternative but compatible group as shown below.

Blood Compatibility Patient Type Compatible Red Cell Types Compatible Plasma Types (FFP & Cryoprecipitate) A, AB B, AB O, A, B, AB AB RhD Positive RhD Negative

A B O AB

A, O B, O O AB, A, B, O RhD Positive RhD Negative

RhD Positive

RhD Negative

RhD Negative

RhD Positive RhD Negative

For information about compatible platelet products click here. Note that Group O RhD Negative (O negative) red cells have neither ABO nor RhD antigens on their surface. O RhD Negative red cells are issued in emergency situations where life saving transfusion is required prior to completion of a crossmatch. Both RCH and RWH blood banks maintain a reserve of 5 emergency O RhD Negative red cells. (Click here for further information on emergency blood release). Group O is often referred to as the universal red cell donor. Group AB individuals have neither anti-A nor anti-B antibodies in their plasma. Group AB plasma can therefore be given to patients of any ABO blood group and is often referred to as the universal plasma donor.

Avoiding ABO Incompatible Transfusions

Most ABO incompatible transfusions occur as a result of improper patient identification at the time of collection of the pre-transfusion sample or administration of the blood product. The pre-transfusion check is carried out at the bedside by 2 members of clinical staff to ensure the right blood is transfused to the right patient. Positive patient identification prior to blood sample collection and labelling the specimen tube at the bedside is critical for accurate sample collection