Can You Die from Receiving the Wrong Blood Type?
Blood types are a system of classification of blood based on the presence of specific antigens based on the surface of red blood cells (erythrocytes). Antigen is a molecule (usually protein, peptide or glycan) that the immune system recognises through binding to antibodies or specific antigen receptors present on the effector cells of the immune system. Binding of the antigen is the first step in initiating an immune response.
The two systems to classify blood types are the AB0 system and the Rh system. In the ABO system, blood can be type A, B, AB, or 0 (zero), depending on whether the A and/or B antigens are present. This means that:
- If someone's blood type is A, they have the A antigen and 0 antigen.
- If someone's blood type is B, they have the B antigen and 0 antigen.
- If someone's blood type is AB, they have both A and B antigens.
- If someone's blood type is 0, they don't have A or B antigens, and have two 0 alleles.
In the Rh system, blood is classified as either Rh-positive or Rh-negative, depending on the presence of the Rh antigen [1, 2]. In clinical practice, both systems must be used together.
Consequently, if someone's blood type is AB+, for example, they have the A antigen, the B antigen and the Rh antigen on the surface of their blood cells.
The molecular basis of the blood groups lies in the genes that encode glycotransferase enzymes. These molecules help transfer sugar molecules in cells. In red blood cells, glycotransferases attach a sugar molecule onto an oligosaccharide chain on the surface of the cell and create the A or B antigens [3]. Contrastingly, the Rh antigens are protein molecules which are expressed (present) on the surface of the red blood cells [4].
Can you die from receiving a wrong blood type?
Blood transfusion is a life-saving procedure, where a patient receives blood from a donor. It is very important that the correct blood type is transfused. Receiving a transfusion of the wrong blood type can lead to serious complications, which can be life-threatening.
The immune system is trained to distinguish between self and non-self antigens. This is a complex process, however, here is a brief explanation:
- Self antigens are present on cells, and their presence indicates that a cell is healthy. The immune system cells observe the presence of these antigens, and kill cells that don't present them. An example of this is a cancerous cell.
- The effector cells of the immune system initiate a response when they notice foreign (non-self) antigens. This is how the body responds to bacterial or viral infection - by recognising antigens. Additionally, this is also how a vaccine works - we introduce an antigen to the body which the immune system will be trained to respond to.
AB0-incompatible acute reaction
When a transfusion of the wrong blood type is administered, the immune system will recognise the non-compatible antigens, and initiate a response. This is called AB0-incompatible acute reaction, and leads to multiple complications.
The most common symptoms are in fever, chills, chest pain and back pain. However, in severe cases, shock and kidney failure manifest [5, 6]. These are the symptoms that may be deadly.
The most severe form of this is called an acute haemolytic reaction. It involves the immune system destroying blood cells. This is one of the most significant causes of death following a mismatched transfusion. Fatalities have occurred as a consequence from ABO-incompatible acute hemolytic transfusion reactions, especially with group 0 recipients receiving group A or B red cells. Misidentification of patient or units is a significant cause of such deaths [5].
Fortunately, the increased oversight in healthcare institutions resulted in a decrease in incidence of mismateched transfusions. This involves strict adherence to protocols for patient identification and blood typing, as well as careful cross-matching of blood units. Technological solutions, such as electronic systems for cross-checking patient and blood unit information, can also help reduce the risk of errors [7, 8]. However, they can still happen in rare cases. To treat an AB0-incompatible reaction, these steps are taken:
- The blood transfusion is immediately stopped if a reaction is suspected. The intravenous access is maintained by an infusion of normal saline [9].
- The patient is resuscitated with fluids and oxygen to maintain vital signs.
- In some cases, drugs that increase urine output (diuretics) are administered in order to speed up excretion of the destroyed blood cells and toxic by-products of the immune system reaction [9].
- In severe cases, dialysis may be needed to support the patient's kidney function during detoxificaiton.
- If there's a risk of clotting, patients may receive a transfusion of plasma or platelets, or drugs to manage clotting (such as bloodthinners) [5].
Overall, the goals of the therapy are to support the patient's body to resolve the incompatible reaction. However, the largest emphasis must always be on ensuring that the correct blood type is transfused.
Rh incompatibility: When mother and baby have different blood types
Blood type is inherited. Therefore, in some rare cases it may happen that a pregnant woman with Rh-negative blood carries a baby with a Rh-positive blood.
This can lead to complications, especially in cases where intervention is late. These complications may result in brain damage to the baby, fluid buildup in the baby's body, and issues with development. In extreme cases, it can even result in the death of the baby [10].
Treating the Rh incompatibility
The management of Rh incompatibility relies on close monitoring. In mild cases, intervention during pregnancy is not even needed. After birth the baby can be treated after birth with a series of blood transfusions, hydrating fluids, electrolytes, and phototherapy, which involves keeping the baby near fluorescent lights to help reduce the bilirubin (a waste product of cell metabolism) in their blood [10].
Intervention during pregnancy involves an injection of Rh immune globulins (RhIg) during the first trimester, or while having any bleeding during the pregnancy. These injections contain antibodies to the Rh factor [10].
Summary
Receiving a blood transfusion with a wrong blood type can be deadly due to a serious reaction of the immune system. However, this can be resolved with appropriate management. It is important that healthcare institutions adhere to the strict guidelines on handling blood products so that an incompatible transfusion does not happen.