Please help with understanding a blood transfusion cross reaction issue

Editorial Team / Admin · Aug 3, 2013

I was always taught RABs attack DANs (recipient antibodies attack donor antigens). So, whatever a patient has floating around in their bloodstream (antibodies) attacks whatever happens to be attached to the donor's blood cells (antigens). So, where will you find more antibodies- in the bloodstream of the recipient or in the transfusion? Based on volume, the patient's bloodstream will have more.

However, thanks to type and crossmatching, someone should never get blood that is not their type or at least compatible with their type in an emergent situation. Because type O blood has no antigens attached to the cells, they are considered a universal donor. This is why if someone is so desperately in need of a transfusion and doesn't have time for type and crossmatching they will be given type O- blood. That type has no antibodies (of the "major" type- there are other antibodies besides ABO and Rh-/+). Conversely, because they have no antibodies to attack donor antigens, type AB is considered the universal recipient- they can receive A, B, AB, or O blood. Still, giving someone blood of a type other than their own outside of immediate threat to life is not wise- while a smaller volume and thus smaller amount, the antibodies in the donated blood can attack the antigens on the recipient's cells.

Here's an explanation from the American Cancer Society that may be a little easier to understand than something written in "medicalese."

http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/bloodproductdonationandtransfusion/blood-product-donation-and-transfusion-what-transfusion-involves

KelRN215, BSN, RN · Aug 3, 2013

Donor blood is treated (leukocyte reduced and irradiated), for one and it's separated into its components. Typically when we're talking about "blood transfusions", we're talking about packed red blood cells. Antibodies are in the plasma.

So, type O is the universal donor because there are no antigens on the surface of the RBCs for the donor antibodies to attack. This applies to PRBCs. Type O isn't the universal donor for plasma because it has anti-A and anti-B antibodies in the plasma.

If you give type O blood to a type A recipient, they have anti-B antibodies circulating in the plasma. The O blood type has no antigens so there is nothing to react against. If you did the reverse, a type O recipient has anti-A and anti-B antibodies and would attack the A antigen on the surface of the PRBCs.

pmabraham, BSN, RN · Aug 3, 2013

Good day:

The research I need to do is when there's a bad blood transfusion; and given there is a bad blood transfusion, why would the recipient's blood cause more of a problem than the donor's.

So I cannot base any answer on the bad transfusion not happening in the first place; that part is a given.

On a side note, from what I've been researching, while O is the universal donor, O still have A and B anti-bodies which if the recipient has type A or B blood, there might be a small amount of agglutination based on volume. It will not be complete cross linking as the antigens matter more (from what I've read), but there might be some.

What I've not been able to determine is that if you already have a bad blood transfusion (the given), why would the recipients blood matter more than the donor in terms of the threat.

Sweet_Wild_Rose, if I understand your answer, then it is a volume issue; one of the things I've been thinking.

KelRN215, I might have to presume this is whole blood which includes plasma.

Thank you.

KelRN215, BSN, RN · Aug 3, 2013

Good day:
The research I need to do is when there's a bad blood transfusion; and given there is a bad blood transfusion, why would the recipient's blood cause more of a problem than the donor's.
So I cannot base any answer on the bad transfusion not happening in the first place; that part is a given.
On a side note, from what I've been researching, while O is the universal donor, O still have A and B anti-bodies which if the recipient has type A or B blood, there might be a small amount of agglutination based on volume. It will not be complete cross linking as the antigens matter more (from what I've read), but there might be some.
What I've not been able to determine is that if you already have a bad blood transfusion (the given), why would the recipients blood matter more than the donor in terms of the threat.
Sweet_Wild_Rose, if I understand your answer, then it is a volume issue; one of the things I've been thinking.
KelRN215, I might have to presume this is whole blood which includes plasma.
Thank you.

In practice, we don't transfuse whole blood.

pmabraham, BSN, RN · Aug 3, 2013

Good day, KelRN215:

The research deals with a what if, not what's done in practice, real life, or otherwise.

Thank you.

Esme12, ASN, BSN, RN · Aug 3, 2013

it is simple........ the body does not "recognize" the donor blood as belonging...you might find this helpful......;http://www.pathology.med.umich.edu/bloodbank/manual/bbch_7/

MendedHeart · Aug 3, 2013

The O.P is referring to Autologous blood transfusion reaction and agglutination.

http://www.ncbi.nlm.nih.gov/m/pubmed/9563411/

Check this article out. There may be more out there, I didn't look further.

MassED, BSN, RN · Aug 3, 2013

Transfusion reaction - hemolytic: MedlinePlus Medical Encyclopedia

also check out that website.

"Your immune system can usually tell its own blood cells from blood cells from another person. If other blood cells enter your body, your immune system may make antibodies against them. These antibodies will work to destroy the blood cells that your immune system does not recognize."

That is why blood is crossed and matched. "Blood transfusion between compatible groups (such as O+ to O+) usually causes no problem. Blood transfusion between incompatible groups (such as A+ to O-) causes an immune response."

here's another link for antibody identification:

RBC Antibody Identification: The Test

pmabraham, BSN, RN · Aug 3, 2013

Thank you everyone!