ABO incompatibility describes an immune reaction that occurs in the body if two blood samples of different, incompatible ABO types are mixed together.

A, B, and O are the three major blood types. The types are defined by molecules on the surface of the blood cells. In people of different blood types, these molecules act as antigens -- immune-response triggers.

Each person has a combination of two of these surface molecules. Type O refers to a lack of any molecule. So, the resulting types are type A (AA or AO molecules), type B (BB or BO molecules), type AB, or type O.

People of a given type form antibodies against other types. When exposed to another type of blood, a breakdown reaction occurs. This is most relevant when a patient needs a blood transfusion or transplant. The blood types must be matched to avoid a reaction based on ABO incompatibility.

For example, a patient with type A blood will react against type B or type AB blood. Similarly, a patient with type B blood will react against type A or type AB blood, and patients with type O blood will react against type A, type B, or type AB blood.

Because type O signifies a lack of any surface molecules, type O blood does not cause an immune response. This is why type O blood cells can be given to patients of any blood type, and people with type O blood are called "universal donors." However, people with type O can only receive type O.

Since antibodies are present in the blood plasma -- the liquid portion of the blood -- plasma transfusions as well as whole blood transfusions must be matched to avoid causing an immune reaction.

The following are symptoms of transfusion reactions:

• fever
• blood in urine
• back pain
• feeling of "impending doom"
• jaundice

• laboratory testing of patient's blood and transfused blood shows incompatibility
• complete blood count (CBC) shows damaged red blood cells, may also show mild anemia
• bilirubin level is elevated

Treatment involves supportive care with intravenous fluids, antihistamines, steroids, and blood pressure support if necessary.

This can be a very serious problem which can even result in death. If supportive care is successful, a full recovery is likely.

• kidney failure
• low blood pressure requiring intensive support
• death

Call your health care provider if you have recently had a blood transfusion or transplant and you experience the symptoms listed above.

Careful cross-matching of blood type prior to transfusion or transplant can prevent this problem.