title: Risks of hemolysis due to anti-A and anti-B caused by the transfusion of blood or blood components containing ABO-incompatible plasma.
abstract: BACKGROUND
  The increasing use of fresh blood group O whole blood in acute trauma medicine makes it important to reevaluate the issue of hemolytic reactions related to the transfusion of ABO-incompatible plasma.
  
  
  METHODS
  This review summarizes and evaluates published articles and case reports concerning hemolytic reactions in connection with the transfusion of group O whole blood or blood products to nongroup O recipients.
  
  
  RESULTS
  In 1945-1986, 15 nonmilitary publications reported hemolytic transfusion reactions with group O blood/blood products. All patients recovered except for two fatalities. Late in World War II and during the Korean and Vietnam wars and onward in Iraq and Afghanistan only "low anti-A, anti-B titer" group O whole blood has been used as universal blood. In spite of a large number of units transfused, there are no reports of hemolytic reactions. Twenty-five publications report hemolytic reactions after transfusion of group O platelets to nongroup O recipients. In all patients but one, the titer of the implicated A- or B-antibody was >100 (saline) or >400 (antiglobulin) and all cases with an infused volume of incompatible plasma <200 mL were related to anti-A or anti-B antiglobulin titers >1000.
  
  
  CONCLUSIONS
  In emergency lifesaving resuscitation, the risk of hemolytic transfusion reactions from transfusion of group O blood to nongroup O recipients constitutes risk that is outweighed by the benefits. A low titer of anti-A/B will minimize the risk for a hemolytic reaction, particularly if the screening is repeated after an immunization episode, e.g., blood transfusion, vaccination, or pregnancy.
authors.affiliation: Department of Transfusion Medicine, Örebro University Hospital, Örebro, Sweden. berseus@telia.com
authors.forename: Olle
authors.initials: O
authors.lastname: Berséus
authors.forename: Kjell
authors.initials: K
authors.lastname: Boman
authors.forename: Shawn C
authors.initials: SC
authors.lastname: Nessen
authors.forename: Lars A
authors.initials: LA
authors.lastname: Westerberg
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000401:mortality*; D001787:Blood Group Incompatibility / Q000276:immunology / Q000401:mortality*; D006461:Hemolysis / Q000276:immunology; D006801:Humans; D010949:Plasma / Q000276:immunology; D012307:Risk Factors; D014947:Wounds and Injuries / Q000401:mortality*
chemical_list: D000017:ABO Blood-Group System