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1. Explain blood typing and how it is used to avoid adverse reactions following blood
transfusions. Include information about antigens and antibodies, as well as the concept

of universal donors and universal recipients.

Before explaining blood typing, I’d like to make the concept of antigen and antibody

crystal clear. An antigen is a particle or a molecule (usually a glycoprotein or lipoprotein)

that when it enters the human body, the body’s immune system (WBCs) starts making

antibodies against it. These antibodies are proteins, that help the body to fight off foreign

invaders. They bind to antigens and form an antigen-antibody complex. This process is also

termed as the antigen-antibody reaction.

Human red blood cells have different molecular surface markers embedded in their cell

membranes. Table 1 describes all the surface markers that are actually the antigens that

determine the blood group of a person.

When a person has a certain antigen, the body makes antibodies against all other antigens

foreign to the body. For example, if a person has antigen A, his body makes antibodies

against antigen B, to protect itself against antigen B as it is foreign to the body. Table 2

describes all other scenarios.

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Table 1

ABO Blood Group System

Antigen on the RBC membrane Blood Group

A A

B B

A and B AB

No Antigen O

Rh Antigen Positive

No Rh Antigen Negative

Rh Antigen Positive

No Rh Antigen Negative

Rh Blood Group System

Rh Antigen Rh Antigen

No Rh Antigen No Rh Antigen

Table 2

Antigen on the RBC Membrane Antibody synthesized

A Anti-B

B Anti-A

A and B No antibody

No Antigen Anti-A and Anti-B

Rh Antigen No Antibody

No Rh Antigen Rh Antibodies produced on exposure

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With the above tables in mind, we can go through a few scenarios of blood transfusion

and understand the concepts regarding adverse reactions of transfusion.

• If blood group A receives blood group B, we know that the person with blood group A

has antibodies against B, so it will cause an antigen-antibody reaction, also described as a

transfusion reaction.

• A similar scenario occurs if blood group B receives blood group A.

• If blood group O receives any of the blood groups A, B or AB, it will result in a

transfusion reaction because blood group O has antibodies against both A and B antigens.

• If an Rh-negative blood group receives Rh-Positive blood, it will produce Rh

Antibodies, which can cause a transfusion reaction. Such exposure of Rh Positive blood to Rh-

negative mothers can even be harmful to future pregnancies.

In order to avoid these adverse reactions, we determine the blood groups of the recipient

and the donor before transfusion by a process called blood typing. We take antibodies A, B, and

Rh on a glass slide and mix a few drops of the blood in each antibody solution. The clumping of

blood mixed with a certain antibody indicates the presence of the same antigen in the blood.

Now that we have understood different scenarios of transfusion reactions and how blood

groups are determined, we will describe the normal compatible donors and recipients for each

blood group in table 3.

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Table 3

Blood Group Donate To Receive From

A+ A+ AB+ A+ A- O+ O-

B+ B+ AB+ B+ B- O+ O-

AB+ AB+ Everyone

O+ O+ A+ B+ AB+ O+ O-

A- A+ A- AB+ AB- A- O-

B- B+ B- AB+ AB- B- O-

AB- AB+ AB- AB- A- B- O-

O- Everyone O-

In table 3, we can see that blood group AB+ can receive blood from every other blood

group. The reason is that it has no antibody, so no antigen-

antibody reaction will occur to cause any transfusion reaction. This is why the blood

group AB+ is called Universal Recipient. We can also see in table 3

that blood group O- can be donated to any other blood group. The reason is that it has no antigen,

so no antigen-antibody reaction takes place to cause any transfusion reaction. This is

why blood group O- is called Universal Donor.