Is “O” group Red Blood Cells, a batter choice for transfusion in newborn/neonates irrespective of their ABO group because ABO group is under developed at this age? I am working on this topic and so many time I come across the weaker expression of A and B antigen on neonate RBCs. can anybody has some experience to share with me
The underdevelopment of the ABO antigens in neonates is irrelevant when it comes to neonatal transfusion and transfusion of the infants own blood group should not be a problem as long as it is antigen negative for any IgG class blood group antibodies the mother may have. This includes IgG anti-A , IgG anti-B and or IgG anti-A,B which most pregnant women have (unless they are group AB of course).
The ABO antibodies from the maternal plasma /serum would have to be neutralised before cross matching a unit of blood which is the babies group but ABO incompatible with the mother. These tests can be 'haphazard, unsuccessful, time consuming and difficult to validate so for convenience and clinical safety, group O is selected routinely.
Also, even though the laboratory cross match may indicate compatibility, there is no easy way to estimate if the infant has passively acquired IgG maternal ABO antibodies.
So it is easier in practice to give group O but there is no reason why the infant should not receive their own blood group if it is compatible with the mother eg Mum is group A and so is baby - infant can receive group A.
The maturity of the ABO antigens in the infant is of no consequence - as always with blood transfusion, it is the antibodies which cause the problem
Dear Linda Hoyland,
Thanks for valuable feed . In my opinion
It is OK when Baby and Mom is of B group but when baby and Mom is A group, I encounter incidence after transfusion of A1 group in neonatal period; after three years baby blood group is A2 and serum has anti A1 irregular antibodies. So, I prefer O group instead of Identical group.
It is interesting to have A1 antibody developed in A2 infant after transfusion but how significant it is for clinical management with this irregular antibody? I have hear about it but never experienced a case over 31 years. The blood type distribution in your population should also be considered. If your population has a high percentage of O type blood the surely using O type pack cell can save a lot of cost.
Dear Teng ,
Hello ,
well feed ,
Blood group distribution in our area was phenotypes A, B, AB and O as 22.7%, 37.5%, 9% and 30.8% respectively. A2 and A2B were 8.0% and 8.6% respectively while in cord blood samples incidence of A2 and A2B were 18.6% and 20.2% respectively. I have reported a dorzon of cases where anti A1 is present in A2 cases and in two there is hemolytic transfusion reaction.
Thanks
Personally I have never experienced any case due to Anti-A1 induced acute hemolysis in A2 recipient. It seems this is a case in your area then O type PRBC may be safer practice since 31% of your population is type O. The issue is how significant is the acute hemolytic response between A1/A2? If it is a mild hemolysis then does is worth to do O type blood. At least I know B type infants have no such concern, right?
I agree with Teng.
In 38 years of transfusion experience I have never encountered a case of haemolysis due to anti-A1
Dear Linda,
May be you have never encountered a case of hydrolysis due to anti-A1 but I have reported these reaction in my 36 yrs career after that we are reporting and transfusing A1 & A2 and A1B &A2B identical blood regularly.
thanks for interaction .
Dear Sharma:
Being a student, may I ask if testing neonate with Anti-A2 in Forward Blood grouping may benefit you in avoiding transfusion of A1 blood to A2 Recipient?
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