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Introduction ⬇

Human blood is grouped according to the presence or absence of specific blood group antigens (ABO). These antigens, found on the surface of red blood cells, can induce the body to produce antibodies. More than 300 distinct antigens have been identified. Compatibility of the ABO group is the foundation for all other pretransfusion testing.

All blood donors and potential blood recipients must be tested for blood type to prevent transfusion with incompatible blood products. Specifically linked sugars determine the antigenic activities named A and B. One sugar, N-acetylgalactosamine, gives the molecule A activity; another sugar, galactose, determines B activity. The backbone molecule, without galactose or N-acetylgalactosamine, has antigenic activity termed H. This H substance, as well as H gene activity, is essential for the function of the ABO antigens. Table 8.14 lists the blood groups and their ABO antigens; Table 8.15 shows the relationship between blood antigens and antibodies.

In general, patients are transfused with blood of their own ABO group because antibodies against the other blood antigens may be present in their blood serum. These antibodies are designated anti-A or anti-B, depending on the antigen they act against. Under normal conditions, a person’s blood serum does not contain the antibody specifically able to destroy its antigen. For example, a person with antigen A will not have anti-A antibodies in the serum; however, anti-B antibodies may be present. Therefore, antigen and antibody testing is necessary to confirm ABO grouping.

Clinical Alert

  1. A transfusion reaction can be extremely serious and potentially fatal. Therefore, the blood group must be determined in vitro before any blood is transfused to an individual. Before blood administration, two qualified healthcare professionals must check the recipient’s blood group and type with the donor group and type to ensure compatibility.

  2. A blood group change or suppression may be induced by cancer, leukemia, infection, or bone marrow transplant.

Normal Findings ⬆ ⬇

Procedure ⬆ ⬇

  1. Collect a 7-mL venous clotted blood sample in a red-topped tube. Observe standard precautions.

  2. Do not use serum-separating tubes (SSTs) (cell barrier tube).

  3. Label the specimen with the following information:

    1. Patient’s full first and last names

    2. Patient’s healthcare record number

    3. Date and time of specimen collection

    4. Initials (if collected by laboratory personnel) or signature (if collected by nonlaboratory personnel) of phlebotomist

    5. Possibly a unique blood bank number (found on special blood bank identification band)

  4. Attach a special blood bank band, at the recipient’s bedside, at the time of specimen collection. The blood bank band must remain attached to the patient’s wrist throughout the transfusion period. The same band may be used throughout one hospital admission as long as the information printed on the band is legible and the band is still securely attached to the patient’s wrist.

Interventions ⬆

Pretest Patient Care

  1. Explain test purpose and procedure. The following are conditions that at some point may require transfusion:

    1. Malignant tumors (leukemias)

    2. Cardiac surgical procedures

    3. Surgical hip procedures

    4. Anemias

    5. Certain obstetric or gynecologic procedures or complications

    6. Bone and joint diseases

    7. Lung disease

    8. Kidney disease or genitourinary system surgical procedures

    9. Massive trauma

    10. Liver disease

    11. Certain blood dyscrasias

  2. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Inform patient of blood group and explain its meaning. Rh type (see next section) may have implications for the pregnant woman and fetus.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.