This document discusses blood types and blood transfusions. It covers the discovery of the main blood types (A, B, AB, and O) and the antigens and antibodies associated with each type. It explains that type O negative blood is the universal donor type as it lacks antigens, while type AB positive blood is the universal recipient type. It also discusses Rh factor and the importance of matching blood types to avoid transfusion reactions. It provides details on components of blood that are transfused and potential complications, such as acute and delayed hemolytic reactions, allergic reactions, transfusion-related lung injury, and others.

1. BLOOD TRANSFUSIONS
Matching and Transfusing

2. ABO
 Karl Landsteiner identified the O, A, and
B blood types in 1900.
 Alfred von Decastello and Adriano Sturli
discovered the fourth type, AB, in 1902.
 Antigen – marker expressed on the call
wall
 Antibodies – used by the immune
system to neutralize pathogens

3. ABO
 Type A blood has type A antigen expressed on
its surface.
 Type B has type B antigen expressed on its
surface.
 Type AB has type A & B antigen expressed on
its surface.
 Type O (sometimes referred to as type zero
outside North America) has no antigen
expressed on its surface.
 Depending on the blood type different
antibodies (anti-A, anti-B, or anti-A & anti b)
will be present in the blood.
– Type A: anti-B antibodies
– Type B: anti-A antibodies
– Type AB: no antibodies
– Type O: anti A & anti B antibodies

4. RHESE FACTOR
 Discovered in 1937 by Karl Landsteiner and
Alexander S. Wiener.
 Rh positive indicates that the type D antigen is
expressed.
 Rh negative indicates that the type D antigen is
not expressed.
 You need to be exposed to antigen D (Rh +) to
develop antibodies (i.e. mother-fetus)
 Furthermore, many other antibodies exists and
many be tested for in unique clinical situations.

5. ABO +/-
TYPE ANTIGEN ANTIBODIES
A + A & D Anti-B antibodies
A - A Anti-B antibodies
B + B & D Anti-A antibodies
B - B Anti-A antibodies
AB + A, B & D No antibodies
AB - A & B No antibodies
O + Zero Anti-A and Anti B antibodies
O - Zero Anti-A and Anti B antibodies
Therefore, PRBC must be matched to prevent a hemolytic reaction.

6. ABO +/- Blood Transfusions:
• AB+ is the universal recipient
because the RBC expresses the A,
B and D antigen. Therefore, any
type of blood can be transfer
without an antibody reaction.
• O- is the universal donor. Type O
or type ‘zero’ has no A, B or D
antigens expressed on its surface.
Therefore, when transfused it
won’t create an antibody reaction.
• Rh (+) recipients may receive a
type specific Rh (-) transfusion (A+
received A-).
• However, Rh (-) recipients may
not receive a Rh (+) transfusion. D
antibodies will develop causing a
transfusion reaction.

7. BLOOD TRANSFUSIONS
 Initially, whole blood was transfused.
 Modern transfusion medicine developed component
therapy.
 Whole blood is broken down into different products (PRBC
/ FFP / PLT / CRYO / ALB / ect).
 Whole blood used in military trauma centers.
 Massive Transfusion Protocol attempts to mimic whole
blood (ratio of PRBC:FFP:PLT)

8. PRBC
 ABO Rh specific
 Improve oxygen delivery (VO2)
 Replace lost volume (↑ Hgb & HCT)
 Cold (4C)
 Leukocyte reduced (reduces
transfusion reactions)
 Contains citrate
 Storage: 35 days
 K+↑ and 2,3 DGP ↓ with age
 Limited ATP stores
 Shape changes during storage (oval
shaped)

9. TRANSUSION REACTIONS
 Acute Hemolytic Transfusion Reaction (AHTR)
Delayed Hemolytic Transfusion Reaction (DHTR)
 Febrile Non-hemolytic Reaction
 Allergic Reaction
 Anaphylaxis
 Transfusion Related Acute Lung Injury
 Acute Non Hemolytic Reaction
!! DANGER !!

10. TRANSUSION REACTIONS
Acute Hemolytic Transfusion
Reaction:
• ABO incompatibility (40% lab
error / 60% bedside error)
• Fever, chills, chest pain,
shock, bleeding, death
• Rapid onset (antibody
mediated)

11. TRANSFUSION REACTIONS
Delayed Hemolytic
Transfusion Reaction:
• Seen in patients with multiple
previous transfusion or pregnancy.
• Antibodies develop to other antigens
(not A, B or O).
• Develops days to weeks after the
transfusion.

12. TRANSFUSION REACTIONS
Allergic Reaction  Anaphylaxis:
• Allergic reactions are common in
transfusion recipients (1-3%).
• Reaction to the donor proteins, leukocytes
and antigens.
• Anaphylaxis (rare): severe life threating
allergic reaction.

13. TRANSFUSION REACTIONS
Transfusion Related Acute Lung Injury:
• Transfusion of inflammatory cytokines,
active lipids, and/or antibodies.
• Immune and inflammatory response in
the patient’s lungs (diffusing problems).
• Respiratory distress (secondary ARDS)
• Sick patient + transfusion = TRALI

14. TRANSFUSION REACTIONS
Acute Non-Hemolytic Reaction:
Delayed onset (<1 hour)
Leukocyte mediated
 Cooled donor leukocytes less active.
Leukocytes become more active as they
warm up.

15. TRANSFUSION COMPLICATIONS
 Transfusion associated sepsis
Fluid Overload
Metabolic Effects:
• Hyperkalemia (especially in patient with acidosis and renal
failure)
• Citrate Toxicity: ↓Ca+ and metabolic alkalosis
 Hypothermia
• Associated with poor outcomes
• Warm blood when possible

16. Thank You!