Compatibility? Compatibility for what? What’s the need for it when it’s the same blood type?

Compatibility? Compatibility for what? What’s the need for it when it’s the same blood type?!

Peace and blessings be upon you.

As you’ve read, that statement is utterly catastrophic.

There’s this person working in a blood bank (and, of course, as we’ve agreed, a place operating this way cannot be called a blood bank). This individual dispenses at least two units of red blood cells or three units daily to different patients. They determine the blood type for the patient (assuming they’re even doing that correctly) and, based on the blood type they identify, immediately issue a matching unit. For example, if the blood type is AB positive, they grab an AB positive unit and give it to the patient.

When a colleague asked them, “Why do you issue blood based only on the blood type without performing compatibility testing?” their catastrophic response was:
“Compatibility? Compatibility for what? What’s the need for it when it’s the same blood type?”

Now, this person:

• Might know what they’re doing is wrong or might not know, mistakenly thinking it’s okay.
• But, in all cases, this person clearly lacks integrity:
  • If they don’t know: How can they work in a field directly tied to people’s lives without first learning properly?
  • If they do know: This is a massive problem, and such behavior deserves the harshest punishment possible.

If someone new to this field hears this catastrophic statement—“Compatibility? Compatibility for what? What’s the need for it when it’s the same blood type?”—then let me clarify:

This is absolutely the worst thing one could say, and here’s why:

When we determine a patient’s blood type, we:

1. Perform forward grouping: We identify the key antigens present on the red blood cells (e.g., A, B, AB, and D antigens).
2. Perform reverse grouping: We identify the key antibodies in the plasma (e.g., anti-A, anti-B, and anti-AB).

Based on the results of both the forward and reverse grouping, we determine the patient’s blood type.

But is it enough to simply identify the blood type and issue a matching unit of red blood cells?
The answer is absolutely not!

Here’s why:

1. Red blood cells have many other antigens besides the primary ones (A, B, AB, and D)—for example, K antigen.
2. Plasma might contain antibodies other than the primary ones, such as anti-K.

Let’s break it down further with examples:

Example 1:

• Suppose we have a patient whose red blood cells lack the K antigen.
• If we transfuse red blood cells from a donor who has the K antigen, the patient’s body will likely form anti-K antibodies against the K antigen they’ve just been exposed to.
• In most cases, this newly formed antibody won’t immediately cause problems for the transfused red blood cells.

But what happens if the same patient requires another transfusion later?

• If compatibility testing is ignored again and they are given red blood cells with the K antigen, the previously formed anti-K antibodies can attack the transfused cells, leading to a hemolytic reaction.

Consequences of such a reaction may include:

1. A drop in hemoglobin levels.
2. An increase in free hemoglobin in the plasma.
3. Elevated bilirubin levels.
4. Other complications from hemolysis, which can be severe for most patients.

For certain patients with underlying health conditions, such reactions could escalate to severe complications and even result in death.

Example 2 (Even More Critical):

Let’s apply the above scenario to a female patient:

1. If her red blood cells lack the K antigen, and she receives a unit of red blood cells with the K antigen, her body forms anti-K antibodies.
2. Suppose another transfusion occurs later, and red blood cells with the K antigen are transfused again, relying solely on blood type compatibility.

Now, let’s introduce pregnancy into the scenario:

• If this woman becomes pregnant and her baby’s red blood cells carry the K antigen, her anti-K antibodies can cross the placenta and attack the baby’s red blood cells.

Potential complications for the fetus or newborn:

• Severe anemia, possibly leading to death.
• Accumulation of fluid in the baby’s organs, potentially causing organ failure.
• Other complications, both in utero and after birth.

Final Notes:

These are just a few examples of what could happen when blood is transfused without compatibility testing (which, by the way, should be the bare minimum in blood banking).

This is why we must remain vigilant and educate everyone working in blood transfusion services about these issues. We need to spread awareness and emphasize that such critical tasks cannot be treated with negligence or irresponsibility.