blood group incompatibility


Summary: An antigenic mismatch between donor and recipient blood. Antibodies present in the recipient's serum may be directed against antigens in the donor product. Such a mismatch may result in a transfusion reaction in which, for example, donor blood is hemolyzed. (From Saunders Dictionary & Encyclopedia of Laboratory Medicine and Technology, 1984).

Top Publications

  1. Strait R, Hicks W, Barasa N, Mahler A, Khodoun M, Köhl J, et al. MHC class I-specific antibody binding to nonhematopoietic cells drives complement activation to induce transfusion-related acute lung injury in mice. J Exp Med. 2011;208:2525-44 pubmed publisher
    ..These observations have important implications for the prevention and treatment of TRALI. ..
  2. Moon H, Yun Y, Hur M, Park J, Lee H, Chang S, et al. [An experience of ABO-incompatible kidney transplantation using plasmapheresis and anti-CD20 monoclonal antibody]. Korean J Lab Med. 2009;29:585-8 pubmed publisher
    ..The kidney transplantation was successful without any sign of hyperacute or acute rejection. ..
  3. Josephson C, Castillejo M, Grima K, Hillyer C. ABO-mismatched platelet transfusions: strategies to mitigate patient exposure to naturally occurring hemolytic antibodies. Transfus Apher Sci. 2010;42:83-8 pubmed publisher
    ..The progress in this European strategy may serve the US to stimulate a re-examination of its practices and policies for the advancement of platelet transfusion safety. ..
  4. Stewart Z, Locke J, Montgomery R, Singer A, Cameron A, Segev D. ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis. Liver Transpl. 2009;15:883-93 pubmed publisher
    ..Liver Transpl 15:883-893, 2009. (c) 2009 AASLD. ..
  5. Miller S, Kim H, Weiner D, Wager C, Gallagher D, Styles L, et al. Red blood cell alloimmunization in sickle cell disease: prevalence in 2010. Transfusion. 2013;53:704-9 pubmed publisher
  6. Heddle N, Fung M, Hervig T, Szczepiorkowski Z, Torretta L, Arnold E, et al. Challenges and opportunities to prevent transfusion errors: a Qualitative Evaluation for Safer Transfusion (QUEST). Transfusion. 2012;52:1687-95 pubmed publisher
    ..Areas of further research to improve safety of blood administration were identified. ..
  7. Uchida J, Machida Y, Iwai T, Kuwabara N, Iguchi T, Naganuma T, et al. Clinical outcome of ABO-incompatible living unrelated donor kidney transplantation. Urol Int. 2011;86:307-14 pubmed publisher
    ..Recent significant improvements in outcomes indicate that it has become a viable treatment option, given the lack of available donor organs. ..
  8. Reyes M, Illoh O. Hyperhemolytic transfusion reaction attributable to anti-Fy3 in a patient with sickle cell disease. Immunohematology. 2008;24:45-51 pubmed
    ..To the best of our knowledge, this is the first published case of hyperhemolysis in sickle cell disease attributable to anti-Fy3. ..
  9. Fidler M, Gloor J, Lager D, Larson T, Griffin M, Textor S, et al. Histologic findings of antibody-mediated rejection in ABO blood-group-incompatible living-donor kidney transplantation. Am J Transplant. 2004;4:101-7 pubmed
    ..Glomerular thrombi appear early in AMR and may appear prior to graft dysfunction. ..

More Information


  1. Heffron T, Welch D, Pillen T, Asolati M, Smallwood G, Hagedorn P, et al. Successful ABO-incompatible pediatric liver transplantation utilizing standard immunosuppression with selective postoperative plasmapheresis. Liver Transpl. 2006;12:972-8 pubmed
    ..In conclusion, our outcomes may support the concept of using ABO-I grafts in a more elective setting associated with split and living donor liver transplants. ..
  2. Yang Y, Xu C, Chen Y, Lu M, Cai C, Li H, et al. [ABO-incompatible liver transplantation for liver failure]. Zhonghua Yi Xue Za Zhi. 2007;87:2833-6 pubmed
    ..ABO-incompatible OLT is an acceptable option to cure liver failure in emergency. Intensive perioperative supervision is essential to improve the effect of ABO-incompatible OLT. ..
  3. Ishida H, Koyama I, Sawada T, Utsumi K, Murakami T, Sannomiya A, et al. Anti-AB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation. Transplantation. 2000;70:681-5 pubmed
  4. Urbani L, Mazzoni A, Bianco I, Grazzini T, De Simone P, Catalano G, et al. The role of immunomodulation in ABO-incompatible adult liver transplant recipients. J Clin Apher. 2008;23:55-62 pubmed publisher
    ..Continued patient enrollment will allow validation of these preliminary observations or the opportunity to devise newer AMR-avoidance policies. ..
  5. Nakamura Y, Matsuno N, Iwamoto H, Yokoyama T, Kuzuoka K, Kihara Y, et al. Successful case of adult ABO-incompatible liver transplantation: beneficial effects of intrahepatic artery infusion therapy: a case report. Transplant Proc. 2004;36:2269-73 pubmed
    ..The patient has now survived for 120 days after transplantation with normal liver function. Beneficial effect of intrahepatic artery infusion with PGE1 seems to be useful in adult ABO-incompatible liver transplantation. ..
  6. Hessner M, Pircon R, Johnson S, Luhm R. Prenatal genotyping of the Duffy blood group system by allele-specific polymerase chain reaction. Prenat Diagn. 1999;19:41-5 pubmed
    ..This assay is particularly useful for rapid genotyping of fetal amniotic cells to identify pregnancies at risk for HDN due to maternal fetal incompatibilities within the Duffy blood group system. ..
  7. Westhoff C. Molecular testing for transfusion medicine. Curr Opin Hematol. 2006;13:471-5 pubmed
    ..This will enable electronic selection of units antigen matched to recipients at multiple blood group loci, potentially eliminating alloimmunization and significantly improving transfusion outcomes. ..
  8. Egawa H, Teramukai S, Haga H, Tanabe M, Fukushima M, Shimazu M. Present status of ABO-incompatible living donor liver transplantation in Japan. Hepatology. 2008;47:143-52 pubmed
    ..ABO-incompatible LDLT is a standard practice in children, and local infusion and rituximab prophylaxis are promising in adults. ..
  9. Gloor J, Lager D, Fidler M, Grande J, Moore S, Winters J, et al. A Comparison of splenectomy versus intensive posttransplant antidonor blood group antibody monitoring without splenectomy in ABO-incompatible kidney transplantation. Transplantation. 2005;80:1572-7 pubmed
    ..The use of intensive posttransplant monitoring may help prevent antibody-mediated graft damage. ..
  10. Iwamoto H, Hama K, Nakamura Y, Osamu K, Yokoyama T, Kihara Y, et al. Biliary complications after 52 adult living donor liver transplantations: a single-center experience. Transplant Proc. 2008;40:2539-41 pubmed publisher
    ..In our series of ABO-incompatible patients undergoing ALDLT, those who developed hepatic artery thrombosis exhibited a high incidence of biliary complications. ..
  11. Arndt P, Garratty G, Daniels G, Green C, Wilkes A, Hunt P, et al. Late onset neonatal anaemia due to maternal anti-Ge: possible association with destruction of eythroid progenitors. Transfus Med. 2005;15:125-32 pubmed
    ..We suggest that babies born to mothers with anti-Ge should have their haemoglobin concentrations monitored for signs of anaemia for several weeks after birth. Functional assays may prove useful. ..
  12. Busquets J, Castellote J, Torras J, Fabregat J, Ramos E, Llado L, et al. Liver transplantation across Rh blood group barriers increases the risk of biliary complications. J Gastrointest Surg. 2007;11:458-63 pubmed
    ..6(1.1-6.4); P=0.02] and cold ischemia time longer than 430 min [RR=1.8(1-3.2); P=0.02] were risk factors for presenting BC. Liver transplantation using Rh graft-host nonidentical blood groups leads to a greater incidence of BC. ..
  13. Wagner F, Frohmajer A, Flegel W. RHD positive haplotypes in D negative Europeans. BMC Genet. 2001;2:10 pubmed
    ..The number of characterized RHD positive antigen D negative and Del alleles was more than doubled and their population frequencies in Europe were defined. ..
  14. Toki D, Ishida H, Setoguchi K, Shimizu T, Omoto K, Shirakawa H, et al. Acute antibody-mediated rejection in living ABO-incompatible kidney transplantation: long-term impact and risk factors. Am J Transplant. 2009;9:567-77 pubmed publisher
  15. Kozaki K, Egawa H, Kasahara M, Oike F, Yoshizawa A, Fukatsu A, et al. Therapeutic strategy and the role of apheresis therapy for ABO incompatible living donor liver transplantation. Ther Apher Dial. 2005;9:285-91 pubmed
    ..In this article, we describe our therapeutic strategy and the role of apheresis around ABO-incompatible LDLT. ..
  16. Winters J, Gloor J, Pineda A, Stegall M, Moore S. Plasma exchange conditioning for ABO-incompatible renal transplantation. J Clin Apher. 2004;19:79-85 pubmed
    ..Controlled clinical trials are needed to identify the optimum conditioning for ABO-incompatible renal transplants. ..
  17. Josephson C, Mullis N, Van Demark C, Hillyer C. Significant numbers of apheresis-derived group O platelet units have "high-titer" anti-A/A,B: implications for transfusion policy. Transfusion. 2004;44:805-8 pubmed
    ..Based on these data, a policy was instituted to test anti-A/A,B titers in O SDPs prior to "out-of-group" transfusion. ..
  18. Stegall M, Dean P, Gloor J. ABO-incompatible kidney transplantation. Transplantation. 2004;78:635-40 pubmed
    ..Here we review the therapeutic options for patients whose only living kidney donor is ABO incompatible, with a specific emphasis on the rationale for and the current outcomes of ABO incompatible living donor kidney transplantation. ..
  19. Janatpour K, Kalmin N, Jensen H, Holland P. Clinical outcomes of ABO-incompatible RBC transfusions. Am J Clin Pathol. 2008;129:276-81 pubmed publisher
    ..Prompt recognition and discontinuation of the transfusion are critical because transfusing less ABO-incompatible blood may minimize signs and symptoms and may prevent death. ..
  20. Galili U. Xenotransplantation and ABO incompatible transplantation: the similarities they share. Transfus Apher Sci. 2006;35:45-58 pubmed
    ..Such tolerance is perpetuated indefinitely by the subsequent transplantation of the organ expressing the incompatible blood group antigen. ..
  21. Skogsberg U, Breimer M, Friman S, Mjornstedt L, Molne J, Olausson M, et al. Successful ABO-incompatible liver transplantation using A2 donors. Transplant Proc. 2006;38:2667-70 pubmed
    ..There was no hyperacute rejection or increased rate of rejections. Anti-A/B titer changes seem to not play a significant role in the monitoring of A(2) to O liver transplantation. ..
  22. Squires A, Nasef N, Lin Y, Callum J, Khadawardi E, Drolet C, et al. Hemolytic disease of the newborn caused by anti-Wright (anti-Wra): case report and review of literature. Neonatal Netw. 2012;31:69-80 pubmed publisher
    ..When hemolysis in a newborn is suspected in the absence of major blood group incompatibility or commonly detected maternal red cell antibodies, a direct antiglobulin test should be performed...
  23. Treml A, King K. Red blood cell alloimmunization: lessons from sickle cell disease. Transfusion. 2013;53:692-5 pubmed publisher
  24. Takeda K, Tanaka K, Morioka D, Kumamoto T, Endo I, Togo S, et al. Pathogenesis in ABO incompatible liver transplantation: a clinicohistological evaluation of four patients. Clin Transplant. 2010;24:747-51 pubmed publisher
    ..This study showed that the early-stage AMR resulted from the antigen-antibody reaction of ABO-blood-group antigens, while the late-stage AMR may have been caused by an infection. ..
  25. Agrawal R, Khakurel S, Hada R, Shrestha D, Baral A. Acute intradialytic complications in end stage renal disease on maintenance hemodialysis. JNMA J Nepal Med Assoc. 2012;52:118-21 pubmed
    ..8%), nausea/vomiting were 20 episodes (1.4%), muscle cramps were 12 episodes (0.8%), hypoglycemia were 6 episodes 5(0.4%). The frequency of intradialytic complications is low and many of them are not life threatening. ..
  26. Meny G, Flickinger C, Marcucci C. The American Rare Donor Program. J Crit Care. 2013;28:110.e9-110.e18 pubmed publisher
    ..Remarkably, a significant number of physicians, both in the United States and abroad, remain unaware of the unique and critical services that the ARDP provides to critical care specialists and their patients. ..
  27. Joyce A, Quantock K, Banh R, Liew Y. Hemolytic transfusion reaction attributable to anti-Dia. Immunohematology. 2017;33:6-8 pubmed
  28. Ushigome H, Koshino K, Sakai K, Suzuki T, Nobori S, Matsuyama M, et al. Rare spontaneous remission of hepatic artery aneurysm following ABO incompatible living donor liver transplantation: a case report. Transplant Proc. 2011;43:2424-7 pubmed publisher
    ..This relatively rare case revealed a hepatic artery aneurysm that spontaneously regressed after ABO incompatible LDLT. ..
  29. Capocasale E, Iaria M, Sassi M, Dalle Valle R, Mazzoni M, Sianesi M, et al. [Kidney transplantation from an ABO-incompatible living donor]. Ann Ital Chir. 2011;82:283-7 pubmed
    ..Despite the ABO-incompatible kidney transplant widespread use, the best desensitization protocol, the upper baseline and perioperative isoagglutinin titer limit and the most accurate isoagglutinin measurement assay are still to define. ..
  30. Delaney M, Dinwiddie S, Nester T, Aubuchon J. The immunohematologic and patient safety benefits of a centralized transfusion database. Transfusion. 2013;53:771-6 pubmed publisher
    ..The CTS-D provides a universal transfusion record that improves patient safety. As health care systems are enlarged, centralization of the transfusion component of the medical record should be considered. ..
  31. Li B, Jiang Y, Yuan F, Ye H. Exchange transfusion of least incompatible blood for severe hemolytic disease of the newborn due to anti-Rh17. Transfus Med. 2010;20:66-9 pubmed publisher
    ..The result suggesting that the least incompatible blood is an alternative choice for exchange transfusion in severe HDN due to anti-Rh17 in case that Rh17 antigen-negative blood is unavailable. ..
  32. Hendrickson J, Hod E, Spitalnik S, Hillyer C, Zimring J. Storage of murine red blood cells enhances alloantibody responses to an erythroid-specific model antigen. Transfusion. 2010;50:642-8 pubmed publisher
    ..Length of storage of RBCs may represent a previously unappreciated variable in whether or not a transfusion recipient becomes alloimmunized. ..
  33. Nikolis N, Boctor F, Heaton W, Martone J. Should we be screening for anti-Js(a)?. Immunohematology. 2011;27:104-6 pubmed
    ..The clinical significance of anti-Js(a) is apparent with previous literature, and our conclusion is that additional studies should be performed to determine whether Js(a) should be included in current antibody screening cells. ..
  34. Yoshida M, Matsuda H, Hasegawa Y, Yoshinaga Y, Asai K, Kawashima A, et al. Accumulation of fetal IgG in immunoglobulin injection into the fetal abdominal cavity is proven. Fetal Diagn Ther. 2011;29:229-32 pubmed publisher
    ..In this study, we examined the effect of immunoglobulin injection on fetal hemodynamics by retrospectively measuring the concentrations of several igg subclasses in stored umbilical cord blood sera collected during fetal therapy...
  35. Shao C, Wang B, Ye S, Zhang W, Xu H, Zhuang N, et al. DEL RBC transfusion should be avoided in particular blood recipient in East Asia due to allosensitization and ineffectiveness. J Zhejiang Univ Sci B. 2012;13:913-8 pubmed publisher
    ..In addition, anti-D positive recipients should also avoid DEL red cell transfusion due to the delayed hemolytic transfusion reaction (DHTR). ..
  36. Dahl D, Hahn A, Koenecke C, Heuft H, Dammann E, Stadler M, et al. Prolonged isolated red blood cell transfusion requirement after allogeneic blood stem cell transplantation: identification of patients at risk. Transfusion. 2010;50:649-55 pubmed publisher
    ..2, p = 0.01), younger age (OR = 0.1, p = 0.02), and matched related HCT (OR = 0.4, p = 0.02) remained independent protective factors. PRTR could serve as a trigger for a standardized screening for DRCC, PRCA, and AIHA after HCT. ..
  37. Inaba K, Branco B, Rhee P, Holcomb J, Blackbourne L, Shulman I, et al. Impact of ABO-identical vs ABO-compatible nonidentical plasma transfusion in trauma patients. Arch Surg. 2010;145:899-906 pubmed publisher
    ..There is a stepwise increase in the complication rate as exposure increases. Further prospective evaluation of the impact of limiting factor replacement to ABO-identical plasma only is warranted. ..
  38. Palmer D, O Toole J, Montreuil T, Scalia V, Goldman M. Evaluation of particle gel immunoassays for the detection of severe immunoglobulin A deficiency and anti-human immunoglobulin A antibodies. Transfusion. 2012;52:1792-8 pubmed publisher
    ..Implementation of these tests would make it possible to supply appropriate products from IgA SD donors to prevent anaphylactic transfusion reactions in patients. ..
  39. Matsuda H, Yoshida M, Wakamatsu H, Furuya K. Fetal intraperitoneal injection of immunoglobulin diminishes alloimmune hemolysis. J Perinatol. 2011;31:289-92 pubmed publisher
    ..The immunoglobulin may have functioned as a neutralizing antibody causing the anemia to improve. ..
  40. Grujić J, Gulan Z, Budakov Z. [Importance of haemovigilance and reports on transfusion reaction in blood component therapy]. Med Pregl. 2012;65:50-3 pubmed
  41. Steinberg D. Compatible-incompatible live donor kidney exchanges. Transplantation. 2011;91:257-60 pubmed publisher
    ..Despite their utilitarian value transplant ethicists have condemned this type of organ exchange as morally inappropriate. An opposing analysis concludes that these exchanges are examples of moral excellence that should be encouraged. ..
  42. Takeda A, Ohtsuka Y, Horike K, Inaguma D, Goto N, Watarai Y, et al. A case of tacrolimus-associated thrombotic microangiopathy after ABO-blood-type-incompatible renal transplantation. Clin Transplant. 2011;25 Suppl 23:15-8 pubmed publisher
    ..Although we gave priority to anti-AMR treatment, adequate dose adjustment of tacrolimus after tacrolimus nephrotoxicity was diagnosed from graft biopsy could correct allograft dysfunction. ..
  43. Bagnis C, Chiaroni J, Bailly P. Elimination of blood group antigens: hope and reality. Br J Haematol. 2011;152:392-400 pubmed publisher
    ..This 'fact of life' has given impetus to a 30-year-old quest to achieve interchangeability of blood products between donors and recipients by eliminating blood group antigens. ..
  44. Boctor F. Overt immediate hemolytic transfusion reaction attributable to anti-Wr(a). Immunohematology. 2008;24:113-5 pubmed
    ..This report describes an acute overt hemolytic transfusion reaction in a patient whose serum contained anti-Wr(a) and who received a Wr(a+) RBC component. ..
  45. Okumi M, Toki D, Nozaki T, Shimizu T, Shirakawa H, Omoto K, et al. ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management. Am J Transplant. 2016;16:886-96 pubmed publisher
    ..Graft survival was almost identical over the past decade, regardless of ABO-incompatibility. Currently, ABO-ILKT is an acceptable treatment for patients with end-stage renal disease. ..
  46. Rose M, West L. Accommodation: does it apply to human leukocyte antigens?. Transplantation. 2012;93:244-6 pubmed publisher
    ..Further research is needed to define mechanisms of both resistance and susceptibility to antibody-mediated injury and to predict under which circumstances allograft accommodation may occur. ..
  47. Iwanaga S, Sakaguchi T, Nakanishi K, Furukuwa M, Ishizeki K, Kogawa K, et al. Passenger lymphocyte syndrome with hemophagocytic syndrome after peripheral blood stem-cell transplantation from an HLA-matched full biological sibling: case report. Transfus Apher Sci. 2012;47:355-8 pubmed publisher
    ..This hemolysis may have been due to PLS with HPS. Therefore, measurement of antibodies may provide a useful hallmark of immune hemolysis. ..
  48. Win N, Needs M, Rahman S, Gold P, Ward S. An unusual case of an acute hemolytic transfusion reaction caused by an autoanti-I. Immunohematology. 2011;27:101-3 pubmed
    ..This case highlights the potential hazard of transfusing units of blood immediately upon removal from the blood refrigerator, especially into neonates and children of small stature. ..
  49. Everitt M, Donaldson A, Casper T, Stehlik J, Hawkins J, Tani L, et al. Effect of ABO-incompatible listing on infant heart transplant waitlist outcomes: analysis of the United Network for Organ Sharing (UNOS) database. J Heart Lung Transplant. 2009;28:1254-60 pubmed publisher
    ..Consideration should be given to altering the allocation system to one that gives less preference toward blood group compatibility in hopes of improving organ use and reducing waitlist mortality. ..
  50. Urschel S, Ryan L, M Larsen I, Biffis K, Dijke I, West L. Development of B-cell memory in early childhood and the impact on antigen-specific tolerance after heart transplantation. J Heart Lung Transplant. 2016;35:491-9 pubmed publisher
    ..Memory B cells may be quantified to assess eligibility for ABO-incompatible transplant and represent a potential therapeutic target to extend the benefits of the immature immune system to older age groups. ..
  51. Yokoyama T, Konno O, Kihara Y, Nakamura Y, Iwamoto H, Kawachi S. Clinical Outcomes and Results of Pathological Findings of 1-year Protocol Biopsy in Recipients of ABO-Incompatible Living Donor Kidney Transplantants. Transplant Proc. 2016;48:831-5 pubmed publisher
    ..Managing chronic pathological changes and arteriolar hyalinosis prophylaxis after ABOi LDKT may result in more successful outcomes. ..
  52. Wiersum Osselton J, van Tilborgh de Jong A, Zijlker Jansen P, van de Watering L, Brand A, van der Bom J, et al. Variation between hospitals in rates of reported transfusion reactions: is a high reporting rate an indicator of safer transfusion?. Vox Sang. 2013;104:127-34 pubmed publisher
    ..The data do not support that hospitals with a higher rate of transfusion reaction reports are safer. ..
  53. Matteocci A, Pierelli L. Red blood cell alloimmunization in sickle cell disease and in thalassaemia: current status, future perspectives and potential role of molecular typing. Vox Sang. 2014;106:197-208 pubmed publisher
    ..Molecular RBC antigenic matching extended to other blood group systems is an innovative strategy to ensure a better quality and effectiveness of transfusion therapy. ..