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Blood type suitable for everyone. Universal donor: which blood type is suitable for everyone

IN medical practice There are cases when the patient loses a critical amount of blood (more than 30% of the total volume), and then there may be a need for blood transfusion from a donor.

The procedure is carried out taking into account group and Rh factor compatibility. Failure to comply with this condition leads to agglutination (gluing of red blood cells), leading to the fact that the recipient falls into state of shock, which can be fatal.

AB0 system

The group is determined according to a common scheme, which identifies a set of agglutinogens (antigens) located on the surface of red blood cells. When foreign antigens enter the body, the immune system begins to produce special antibodies. Based on the presence or absence of these proteins, the classification of blood groups is based - AB0.

The discovery of the phenomenon of agglutination made it possible to significantly reduce the incidence of fatal outcome as a result of blood transfusion. A person in need of blood transfusion (recipient), by receiving the group of which he himself is a carrier, avoids death.

Blood group compatibility

At the same time, scientists discovered that there is one blood group, the owner of which can be considered a universal donor. It contains no agglutinogens that can promote blood clotting, so theoretically it can be transfused to any patient. It is designated as the first (I) or (0).

However, a person with such a blood group is a “bad” recipient, since it contains antibodies that make blood transfusion from a donor with a group different from his own impossible.

People with the first blood group make up the largest category of inhabitants of the Earth - they are about 50%.

Let's list the compatibility for the remaining groups:

The second (II) or (A) contains agglutinogen A. For this reason, it can be transfused to those who have it - these are the owners of II (A) and IV (AB).
The third (III) or (B) is suitable for those who have agglutinogen B - III (B) and IV (AB).
The fourth (IV) can only be transferred to someone who has the same one - since they contain both antigens A and B. For the same reason, a person with this group is an ideal recipient, that is, he can accept blood from any donor.

Blood group determination

The process takes place in laboratory conditions, and consists in determining the presence or absence of red blood cell agglutination. A few drops of blood are added to serums that contain α, β, α and β antibodies. Then the reaction of red blood cell clumping is assessed:

if there is no reaction, then this is group I (0);
if clumping is present in sera that contain α and α+β, – II (A);
if agglutination is observed in sera with antibodies β and α+β, – III (B);
red blood cells stuck together in all three sera - this is IV (AB).

Rh factor compatibility

In addition, there is a division based on the Rh factor (RH) (referred to as D antigen). If it is on the surface of red blood cells, then they say that the person is Rh positive (RH+), and approximately 85% of the world's population are its owners. When the antigen is absent, the person is Rh negative (RH-), and the remaining 15% of the population are carriers.

If a person has RH-, blood transfusions with RH+ are contraindicated. Otherwise, a conflict will arise that can lead to post-transfusion shock with a fatal outcome. At the same time, a negative Rh factor does not cause any harm to a recipient with a positive RH. Thus, group I (0) with RH- is universal.

However, in modern medical practice, it is customary to use blood that matches the group and Rh for transfusion in order to avoid complications. The use of the first group is carried out only in extreme cases when the lack of blood transfusion will lead to the death of the patient. The same goes for RH – in emergency conditions Transfusion from a Rh negative donor is allowed.

Compatibility Determination

Before blood transfusion, tests are performed to determine group and rhesus compatibility:

The recipient's blood serum is mixed with a drop of donor blood. After 5 minutes, the presence or absence of agglutination is assessed. If it is missing, such blood can be used.
The Rh factor is determined in a similar way, but is added Chemical substance, in the presence of which a reaction is possible. Evaluation is also carried out by the presence or absence of red blood cell clumping.

Because other secondary group systems exist, the risk of transfusion complications remains. In order to minimize them, a biological test is carried out. The recipient receives 10–15 ml of donor blood, after which the patient is monitored. This procedure is carried out three times. If a person begins to experience lower back pain, increased heart rate, shortness of breath, or fever, a transfusion is not performed.

Why know your blood type

This is important for several reasons:

in case of an emergency when a transfusion is required, and identifying a group on site is difficult;
in the same case when a person acts as a donor;
during pregnancy, when there may be a conflict in the group or Rhesus of the mother and fetus, which threatens miscarriages, stillbirth, and hemolytic disease of the newborn.

Emergency transfusion does not cancel the compatibility tests between the recipient's serum and donor blood, which were described above.

As a conclusion, it is worth noting that knowing the answer to the question which group is suitable for all people is of practical importance in medical practice - in the case of emergency blood transfusion. This includes the first, or according to the AB0 system - zero blood group. A prerequisite also must be a negative Rh factor, which, when transfused, does not cause red blood cells to stick together in the blood of people with a positive Rh factor.

In the case of a planned procedure, the condition of blood group and Rh compatibility must be met. In accordance with medical protocols, always perform laboratory tests that will eliminate the risk of complications.

There are often cases when, with large blood loss, the patient needs to undergo a transfusion of liquid connective tissue from a donor. In practice it is common to use biological material, matching the group and Rh factor. However, some people's blood is considered universal, and in a critical situation, its transfusion can save the patient's life. There are also individuals who can be transfused with liquid connective tissue of any group. They are considered universal recipients.

Why is blood group compatibility important?

Transfusion of fluid connective tissue is a serious medical procedure. It must be carried out in accordance with certain conditions. As a rule, blood transfusion is indicated for seriously ill patients, people who have complications after surgical intervention etc.

Before carrying out a transfusion, it is important to select a donor whose blood is compatible with the recipient’s biomaterial group. There are four of them: I (O), II (A), III (B) and IV (AB). Each of them also has a negative or positive Rh factor. If the compatibility conditions are not met during blood transfusion, an agglutination reaction occurs. It involves the gluing of red blood cells with their subsequent destruction.

The consequences of such a transfusion are extremely dangerous:

hematopoietic function is impaired;
malfunctions occur in the functioning of most organs and systems;
metabolic processes slow down.

The natural result is post-transfusion shock (manifested by fever, vomiting, shortness of breath, rapid pulse), which can be fatal.

Rh factor compatibility. Its meaning during transfusion

During transfusion, not only the blood type, but also the Rh factor should be taken into account. It is a protein present on the membranes of red blood cells. The overwhelming majority of the Earth's inhabitants (85%) have it, the remaining 15% do not. Accordingly, the former have a positive Rh factor, the latter - negative. When giving blood transfusions, they should not be mixed.

Thus, a patient who has a negative Rh factor should not receive liquid connective tissue whose red blood cells contain this protein. If this rule not to comply, the recipient’s immune system will begin a powerful fight against foreign substances. As a result, the Rh factor will be destroyed. If the situation repeats, the red blood cells will begin to stick together, thereby causing serious complications.

The Rh factor remains unchanged throughout life. In this regard, people who do not have it need to pay special attention during blood transfusion. Women who have a negative Rh factor should notify their doctor and obstetrician-gynecologist about this upon pregnancy. A note containing this information is entered into the outpatient card.

Universal recipient

Give your blood, i.e. Anyone can be a donor for people in need. But when transfusing, it is important to consider the compatibility of the biomaterial.

At the beginning of the 19th century, a scientist from Austria suggested, and soon proved, that the process of gluing red blood cells (agglutination) is a sign of activity immune system, caused by the presence in the blood of 2 reacting substances (agglutinogens) and 2 that can interact with them (agglutinins). The first were given the designations A and B, the second - a and b. Blood is incompatible if substances of the same name come into contact: A and a, B and b. Thus, the liquid connective tissue of each person must contain agglutinogens that do not stick together with agglutinins.

Each blood group has its own characteristics. Special attention deserves IV (AB). The red blood cells contained in it contain both A and B agglutinogens, but plasma does not contain agglutinins, which contribute to the gluing of red blood cells during donor blood transfusion. People with group IV are considered universal recipients. The transfusion process rarely causes complications in them.

A universal recipient is a person who can receive a blood transfusion from any donor. In this case, an agglutination reaction will not occur. But meanwhile, blood of group IV is allowed to be transfused only to people with it.

Universal donor

In practice, doctors select a donor who best suits the recipient. Blood transfusions are of the same type. But this is not always possible. In a critical situation, the patient may be transfused with group I blood. Its peculiarity is the absence of agglutinogens, but at the same time there are a and b in the plasma, making its owner a universal donor. During transfusion, red blood cells will also not stick together.

This feature is taken into account when transfusion of a small amount of connective tissue. If a large volume needs to be transfused, only the same group is taken, just as a universal recipient cannot accept a lot of donor blood from a different group.

Finally

Blood transfusion is medical procedure that can save lives seriously ill patients. Some people are universal blood recipients or donors. In the first case, they can take liquid connective tissue any group. In the second, their blood is transfused to all people. Thus, universal donors and recipients have special groups of connective tissue.

In medical practice, there are cases when a patient experiences severe and profuse blood loss. In this case, there is a need for transfusion (transfusion) from another person. Before the procedure, many tests are carried out to determine the possibility of matching the group and Rh factor. Transfusion of incompatible blood in complicated cases can be fatal. It is generally accepted that those with the first blood group are universal donors. Many modern doctors argue that this compatibility is conditional and there is no blood suitable for everyone.

Blood group refers to a description of the individual antigenic characteristics of red blood cells. This classification was first made by an Austrian scientist at the beginning of the 20th century, and at the same time the concept was voiced - incompatibility. Thanks to this discovery, many lives were saved, because transfusion of the wrong material leads to disastrous consequences. In practice, there are 4 blood groups:

0 (I) first (zero) – it does not contain antigens, but contains α and β antibodies. Due to the absence of foreign particles (antigens), this group is applicable for transfusion to all people. A donor with group 0 (I) is considered to be universal;
A (II) second - contains antigen A and antibodies to agglutinogen B. This blood it is permissible to transfuse to patients with a group that does not contain antigen B (I and II);
In (III) the third - has antigen B and antibodies to agglutinogen A. This blood can be used in relation to recipients (recipient) with I and III group mi, that is, not containing antigen A;
AB (IV) fourth - has antigens A and B, but does not have antibodies. Holders of this group can serve as a donor only for patients with similar blood. Recipients with the fourth blood group are universal, since they do not have antibodies.

If antigens of incompatible groups enter the body during transfusion, the process of gluing of foreign red blood cells is activated. As a result, the blood circulation process is disrupted. Oxygen stops flowing into the required volume to organs and tissues, subsequently blood clotting occurs. Such a violation could lead to serious complications, even death. In this regard, it is very important to take into account the compatibility of the blood of the donor and recipient.

Also, when transfusing, the Rh factor must be taken into account - a special protein located on the membrane of red blood cells. The term is applied to the Rhesus factor D antigen. The designation Rh+ is used for a positive Rh factor (D antigen present), Rh- for a negative Rh factor (does not have the D antigen) and is indicated after the blood type designation. The difference between blood group and Rh factor is that immunization against Rh is relevant only in case of transfusion or placental exposure during pregnancy.

Universal donors and recipients

In the case of transfusion of red blood cells (the main component of the material for transfusion), people with group 0 and negative Rh D are considered universal donors. Representatives of AB (IV) and positive Rhesus D are recognized as universal recipients. These statements are true only in terms of the interaction of foreign particles of the recipient A and B for transfusion of red blood cells and reactive sensitivity to foreign Rhesus cells D. People with the HH system (Bombay phenotype) are an exception; it is permissible for them to receive material for transfusion only from HH donors, since they have antibodies against the H antigen present in red blood cells.

People with antigens A and B or atypical antibodies are excluded from the list of donors. Antibody A and B reactions are not always taken into account. The reason is that a small amount of plasma containing foreign particles is transfused. For example, when transfusion of 0 and D Rh- blood to a recipient with A and D Rh+, immune reactions will not occur between the recipient's B antibodies and red blood cells.

It is worth noting that a small volume of plasma in the donor material used for transfusion contains antibodies A, which can react with foreign particles on the membrane of red cells, but dangerous reaction will not happen, since the effect will be weakened.

Surface antigen erythrocytes, with the exception of A, B and Rhesus D, are capable of causing harmful effects if they begin to interact with the corresponding antibodies to activate defensive reaction. The transfusion process is complicated by the fact that platelets and leukocytes have independent systems of surface foreign particles and sensitization may occur after transfusion ( increased sensitivity) to foreign cells. Plasma of group 0, with antibodies A and B, can only be used for recipients of group 0, since antibodies react aggressively to antigens of the contacted group. AB plasma transfusion can be performed in patients of any AB0 group.

In conditions modern medicine the recipient is transfused with blood strictly compatible with his group and Rh factor. The use of a universal one is resorted to only in cases where the risk is justified. The cause may be an emergency situation and the risk of death. If there is no blood available the desired group and Rh factor, then doctors use a universal one.

Blood transfusion is a serious procedure that must be performed according to certain rules. First of all we're talking about about compatibility. Most often, donation is necessary to help seriously ill people. These may be the most various diseases blood, complex operations or other complications that require transfusion.

Donation has been around for quite some time, so this moment This procedure is not new and is common among all departments in medicine. The very concept of group compatibility appeared more than a hundred years ago. This was explained by the fact that specific proteins were found in the plasma and in the membrane of erythrocytes. Thus, three blood groups were identified, which today are called the ABO system.

Why is there no compatibility?

Quite often, the recipient is not suitable for blood of one group or another. Unfortunately or fortunately, there is no universal group, so you have to constantly select a donor according to certain criteria. If there is a mismatch, an agglutination reaction may occur, which is characterized by gluing of the donor’s red blood cells and the recipient’s plasma.

For correct selection a special scheme is used to determine compatibility or lack thereof. It can also be noted that a donor with the first blood group is universal, since a recipient with the fourth is also suitable for everyone. In addition, there is also incompatibility regarding the Rh factor. In medical practice, positive and negative Rh factors are known.

If you take donor blood the second group for a recipient with a positive Rh from a donor with the second only with a negative one - then this will already be incompatibility, since in this case it is necessary to focus not only on the group itself. Ignoring such information is very dangerous, because after the shock the recipient may die. The plasma and all its components of each person are individual in the number of antigens, which can also be determined by different systems.

Transfusion rules

In order for the transfusion to be successful, it is necessary to follow certain rules of thumb, regarding the selection of groups and, accordingly, the donor:

take into account the compatibility of the blood groups of the recipient and the donor according to the AB0 system;
determine positive or negative Rh factor;
conduct a special test for individual compatibility;
carry out a biological test.

Such preliminary checks of the donor and recipient groups must be carried out without fail, since they can provoke shock or even death in the recipient.

How to correctly determine the blood type for transfusion?

To determine this indicator, a special serum is used. If some antibodies are present in the serum that correspond to antigens from red blood cells. In this case, red blood cells form small clusters. Depending on the group, red blood cells agglutinate with a certain type serum. For example:

serum test for groups B(III) and AB(IV) contains anti-B antibodies;
serum for groups A(II) and AB(IV) contains anti-A antibodies;
As for groups such as 0(I), they do not agglutinate with any test serum.

“Not” compatibility of mother and child groups

If a woman with a negative Rh factor is pregnant with a positive one, then incompatibility may occur. In this case, the universal blood group does not help, because the selection of the Rh factor becomes more important. Such contact occurs only at the birth of a child, and during the second pregnancy a miscarriage or premature birth dead baby. If the newborn survives, then he is diagnosed with hemolytic disease.

Fortunately, today there is a special substance that is administered to the mother and, accordingly, blocks the formation of antibodies. Therefore, such a hemolytic disease is already almost on the verge of complete extinction. In this case, donation may no longer be needed at all.

Testing groups for compatibility for transfusion

There is a fairly common way to determine a suitable donor. To do this, take up to 5 ml of blood from a vein, place it in a special machine with a centrifuge, and add a drop of special serum. After this, a few more drops of the recipient’s blood are added there and the actions taking place are observed for five minutes. You also need to add one drop of isotonic sodium chloride solution.

If no agglutination occurred during the entire reaction time, then compatibility of the selected blood groups is observed. Thus, the donor can donate blood in the required quantity. There is also a known control method for checking transfusion compatibility. To do this, the recipient is injected with a few milliliters of blood for three minutes; if everything goes well and no side effects are observed, then a little more can be added. As a rule, such a procedure is carried out as a control, when the recipient is provided with a donor as a permanent or disposable transfusion. There is a certain table of such a scheme according to which they do a control check and only after that do the transfusion.

Registration of blood transfusion

After the transfusion is completed, a record of the identified group, Rh factor and other possible indications is recorded in the recipient’s and donor’s cards. If the donor is suitable, then with his consent, data for further transfusion is taken, since the first compatibility has already been successfully identified. In the future, periodic monitoring should be established for both patients, especially if the donor has entered into a contract with this center. This is quite widely practiced today, because it is sometimes very difficult to find a suitable donor with a rare group.

There is nothing dangerous in registering for help in this way, because in this way you help the sick and slightly rejuvenate your body. It has long been proven that periodic blood donation helps renew our body, thereby stimulating hematopoietic cells to work actively.

The fact that life is closely connected with blood, that a person dies from great blood loss, was not in doubt in the most ancient times. Even such qualities as courage, strength and endurance were associated with blood, so in ancient times they drank blood to acquire them.

History of blood transfusion [show]

The idea of replacing lost or old, “sick” blood with young and healthy blood arose back in the 14th-15th centuries. There was great faith in blood transfusions. Thus, the head of the Catholic Church, Pope Innocent VIII, being decrepit and weak, decided to undergo a blood transfusion, although this decision was in complete contradiction with the teachings of the church. The blood transfusion of Innocent VIII was performed in 1492 from two young men. The result was unsuccessful: the patient died from “decrepancy and weakness,” and the young man died from an embolism.

If we remember that the anatomical and physiological foundations of blood circulation were described by Harvey only in 1728, it becomes clear that before that blood transfusion practically could not be carried out.

In 1666, Lower published the results of experiments on blood transfusions in animals. These results were so convincing that the court physician of Louis XIV Denis and the surgeon Emerets in 1667 repeated Lower's experiments on dogs and transfused the blood of a lamb to a seriously ill patient. Despite the imperfect technique, the patient recovered. Encouraged by this success, Denis and Emerets gave a transfusion of lamb blood to a second patient. This time the patient died.

At the trial, the French Academy of Sciences acted as an arbiter, whose representatives did not consider it possible to accuse Denis and Emerets of using an insufficiently studied method, since this would slow down the development of the blood transfusion problem. However, the arbitrators did not recognize the actions of Denis and Emerenz as correct and considered it necessary to limit practical use blood transfusions, since this would hand over into the hands of various charlatans, of whom there were so many among doctors, extremely dangerous method. The method was recognized as promising, but requiring special permission from the academy in each particular case. This wise decision did not close the possibility of further experimental study of the method, but it did pose significant obstacles to the practical solution to the problem of blood transfusion.

In 1679, Märklin, and in 1682, Ettenmüller, reported the results of their observations, according to which, when the blood of two individuals is mixed, agglutination sometimes occurs, which indicates incompatibility of the blood. Despite the lack of understanding of this phenomenon, in 1820 Blundel (England) successfully performed a human-to-human blood transfusion.

In the 19th century About 600 blood transfusions have already been performed, but most of the patients died during the transfusion. Therefore, it is not without reason that the German surgeon R. Volkmann ironically noted in 1870 that three rams are needed for blood transfusion - one that gives the blood, a second that allows it to be transfused, and a third that dares to do so. The reason for many deaths there was blood group incompatibility.

A big obstacle to blood transfusion was its rapid clotting. Therefore, Bischoff in 1835 proposed transfusion of defibrinated blood. However, after transfusion of such blood, many serious complications arose, so the method was not widespread.

In 1880, G. Gayem published works on the study of the causes of death from blood loss. The author introduced the concept of relative and absolute anemia and proved that in case of absolute anemia, only a blood transfusion can save an animal from death. Thus, blood transfusion received scientific justification.

However, agglutination and blood clotting continued to hinder the use of blood transfusions. These obstacles were eliminated after the discovery of blood groups by K. Landsteiner and J. Jansky (1901-1907) and the proposal of V. A. Yurevich, M. M. Rosengart and Gusten (1914) to use sodium citrate to prevent blood clotting. In 1921, the classification of blood groups by Ya. Jansky was adopted as international.

In Russia, the first works on blood transfusion appeared in 1830 (S. F. Khotovitsky). In 1832, Wolff successfully transfused blood to a patient for the first time. A large number of works followed on the problem of blood transfusion (N. Spassky, X. X. Salomon, I. V. Buyalsky, A. M. Filomafitsky, V. Sutugin, N. Rautenberg, S. P. Kolomnin, etc.). The works of scientists covered the issues of indications, contraindications and techniques of blood transfusion; devices were proposed for its implementation, etc.

In 1848, A. M. Filomafitsky first studied the mechanism of action of transfused blood, and he also manufactured a special apparatus for blood transfusion. I.M. Sechenov established in experiments that blood transfusion has not only a replacing, but also a stimulating effect. V. Sutugin already in 1865 published the results of experiments on dogs with the transfusion of defibrinated and preserved blood at a temperature of O°C, i.e., for the first time he raised and resolved the question of the possibility of blood preservation.

After civil war Interest in blood transfusion has awakened in our country. S.P. Fedorov began to develop issues of blood transfusion. In 1919, his student A. N. Shamov performed the first blood transfusion taking into account group affiliation, and in 1925, another of his students N. N. Elansky published a monograph on blood transfusion.

In 1926, A. A. Bogdanov organized the Central Institute of Blood Transfusion in Moscow. Since then, a wide network of republican, regional and district blood transfusion stations and rooms has begun to develop in the country. A. A. Bogomolets, S. I. Spasokukotsky, M. P. Konchalovsky and others played a major role in the development of the problem of blood transfusion in the USSR. Soviet scientists were the first in the world to develop new methods of transfusiology; transfusion of fibrinolysis - cadaveric (V.N. Shamov, 1929; S.S. Yudin, 1930), placental (M.S. Malinovsky, 1934) and recycled blood (S.I. Spasokukotsky, 1935). At the Leningrad Institute of Blood Transfusion, N. G. Kartashevsky and A. N. Filatov (1932, 1934) developed methods for transfusion of red blood cells and native plasma. During the Great Patriotic War the organized blood transfusion service saved the lives of many wounded.

Nowadays, medicine as a whole cannot be imagined without blood transfusions. New methods of blood transfusion, blood preservation (freezing at ultra-low (-196°C) temperatures), long-term storage at a temperature of -70°C (for several years) have been developed, many blood products and blood substitutes have been created, and methods for using blood components have been introduced ( dry plasma, antihemophilic plasma, antistaphylococcal plasma, erythrocyte mass) and plasma substitutes (polyvinol, gelatinol, aminosol, etc.) in order to limit the transfusion of fresh and canned blood and for other indicators. Artificial blood - perftoran - has been created.

Blood type is determined by a set of antigens that are contained in blood cells (erythrocytes, leukocytes, platelets) and plasma proteins of a given individual.

To date, more than 300 different antigens have been discovered in human blood, forming several dozen antigenic systems. However, the concept of blood groups, which is used in clinical practice, includes only erythrocyte antigens of the AB0 system and the Rh factor, since they are the most active and are the most common cause incompatibility during blood transfusions.

Each blood group is characterized by certain antigens (agglutinogens) and agglutinins. In practice, there are two agglutinogens in erythrocytes (they are designated by the letters A and B) and two agglutinins in plasma - alpha (α) and beta (β).

Antigens (agglutinogens A and B) are found in red blood cells and in all tissues of the body, excluding the brain. Practical significance have agglutinogens located on the surface shaped elements blood - antibodies combine with them, causing agglutination and hemolysis. Antigen 0 is a weak antigen in red blood cells and does not produce an agglutination reaction
Agglutinins (α β) - blood plasma proteins; they are also found in lymph, exudate and transudate. They specifically bind to blood antigens of the same name. In human blood serum there are no antibodies (agglutinins) against antigens (agglutinogens) that are present in his own red blood cells, and vice versa.

Different ratios of agglutinins and agglutinogens made it possible to divide the blood of all people into 4 main groups: I (0), II (A), III (B) and IV (AB). The ratio of agglutinogens and agglutinins in the four groups, and hence the compatibility of blood during transfusion, is presented in the following table:

The full designations of blood groups are as follows:

Group I - 0(I) α β
Group II - A(II)β
Group III - B(III)α
IV group - AB(IV)0

The doctrine of blood groups is of great importance for blood transfusion, since failure to comply with group compatibility entails severe complications which could result in death. This is explained by the fact that donor red blood cells can stick together into lumps that clog small vessels and interfere with blood circulation. The gluing of red blood cells - agglutination - occurs if the donor's red blood cells contain a gluing substance - agglutinogen, and the recipient's blood plasma contains a gluing substance - agglutinin. Bonding will occur when substances of the same name meet: if agglutinogen A meets agglutinin α, and agglutinogen B meets agglutinin β.

The study of blood groups made it possible to develop rules for blood transfusion. Persons giving blood are called donors, and persons receiving it are called recipients. When transfusing blood, the compatibility of blood groups is strictly taken into account.

For many years we adhered to the so-called. Otenberg's law, according to which only erythrocytes of transfused donor blood (and not erythrocytes of the recipient) agglutinate, given that agglutinins in donor blood are diluted in the recipient's blood and are not able to agglutinate his erythrocytes. This circumstance allowed the transfusion of blood from another group, the serum of which did not agglutinate the recipient’s red blood cells, along with blood from the same group.

In practice, the following scheme was used: a recipient of group 0(I) is allowed to transfuse only donor blood of group 0(I), recipients of group A(II) - donor blood of groups A(II) and 0(I), recipients of group B (III) - donor blood of groups B (III) and 0(I), recipients of group AB (IV) - donor blood of all four groups. Those. any recipient could be injected with blood of group I (0), since its red blood cells do not contain agglutinogens and do not stick together, therefore persons with blood group I were called universal donors, but they themselves could only be injected with blood of group I. Blood from a group IV donor can be transfused only to persons of this group, but they themselves can be transfused with blood from all four groups. People with blood group IV were called universal recipients.

In recent years, it has been proven that there are several subgroups of agglutinogens. Of the subgroups of agglutinogen A, the most important are A 1 and A 2 (as well as A 1 B and A 2 B). A 1 is a strong antigen, it is found in approximately 88% of people with A (II) blood group. If red blood cells contain A 1 antigen, the agglutination reaction occurs quickly and is pronounced. A 2 is a weak antigen, its specific gravity is approximately 12%; The agglutination reaction is weak and difficult to notice. Antigens of other subgroups (A 3, A 4, A 0, A x, A z, etc.) are also weak, they are found very rarely, their practical significance is negligible.

Agglutinogen B also has several subgroups (B 1, B 2, B 3), their difference is only quantitative and in practice they are not taken into account.

Antigens A 1 and A 3 differ in their antigenic structure Therefore, in plasma, along with natural agglutinins, there are also antibodies (extraagglutinins) α 1, which react only with the A 1 antigen, and α 2 - only with the A 2 antigen (Table).

Table. ABO blood group factors

Abbreviated designation blood types	Frequency (%)	Antigens (agglutinogens)	Agglutinins
			natural	possible
			natural	immune	extra-agglutinins
I(0)	38	0	α β	α β	-
II (A)	42	A 1 A 2 (A 3 A 4 A 0)	β	β	α 2 α 1
III (B)	14	B (B 1 B 2 B 3)	α	α	-
IV (AB)	6	A 1 B A 2 B	-	-	α 2 α 1

Extraagglutinin α 1 is more often found in individuals with blood subgroup A 2 (1-2%) and A 2 B (26%). Extraagglutinins are complete, strictly cold antibodies, so at temperatures of 37°C and above they lose activity. This can cause difficulties and errors when determining the blood group using a cross-sectional method, and sometimes requires individual selection of blood. Occasionally, extraagglutinins in the recipient remain active at 37°C, destroying transfused red blood cells.

When transfusing blood, it may happen that the same-type blood of the donor and recipient turns out to be incompatible. For example, if the recipient’s blood group is A 1 (II)βα 2, and the donor’s is A 2 (II)β, then agglutination occurs during blood transfusion, since the recipient’s α 2 extraagglutinins react with the donor agglutinogen A 2.

In addition, during the life of an individual, immune agglutinins α and β (anti-A and anti-B antibodies) may appear as a result of various sensitizations. They can cause an increase in the total titer of agglutinins to 1:512 or more. In such cases, the agglutinins of the transfused blood are not sufficiently diluted in the recipient's blood. For example, immunization with the A antigen of a female donor can occur during pregnancy (if the child inherits the A antigen from the father), intravenous or intramuscular injections foreign blood or plasma, vaccines and serums. When blood is transfused from a donor who has anti-A immune antibodies into recipients with blood group A or AB, hemolytic complications are possible. In this case, immune antibodies from donor blood, unlike natural antibodies, do not bind to plasma antigen A, but combine with the recipient’s red blood cells, causing their hemolysis. (Therefore, it is increasingly possible to transfuse blood, guided by the classical law of Otenberg.) In these cases, they write on the bottle of blood: “Transfuse only to your group.”

Currently, only single-type blood is allowed to be transfused to patients. (If the recipient has blood type A 2 B(IV)α 1 - approximately 26% of people with the fourth blood group - only group B(III) transfusion is possible.) Only in emergency situations When the patient’s life is in danger, transfusion of individually compatible blood of group 0(I) is permissible, but no more than two bottles (500 ml). Children can only receive blood transfusions of the same type.

Rh factor (Rh) discovered in 1940 by K. Landsteiner and A. Wiener. This is a strong antigen that is inherited.

The Rh factor is found in erythrocytes, as well as in leukocytes, platelets, different organs and tissue fluids, amniotic fluid. If blood with a positive Rh factor enters a person with Rh negative blood (there is no Rh factor), then specific antibodies are formed - anti-Rh agglutinins; they can form in an Rh-negative pregnant woman from an Rh-positive fetus. In this regard, a child or an Rh-negative person may die if he is repeatedly transfused with Rh-positive blood. In Rh-negative women pregnant with an Rh-positive fetus, the first blood transfusion can be fatal.

In recent years, it has been proven that the distribution of people into Rh-positive (approximately 85%) and Rh-negative (approximately 15%) is very arbitrary. Six antigens of the Rh-Hr system (D, C, E, d, c, e) are of practical importance during blood transfusion. The first three antigens are varieties of the Rh factor - D(Rh 0), C(rh′), E(rh″). The most antigenic and the most common cause of isoserological conflicts during blood transfusions and pregnancy is the D(Rh0) antigen, the weakest is E(rh″). Therefore, during blood transfusion, it is necessary to prevent the introduction of the D(Rh 0) antigen with donor blood to recipients who do not have this antigen. From this point of view, Rh status in recipients is determined by the presence of the D(Rh 0) antigen, and other antigens of the Rh-Hr system are not taken into account.

If donors' Rh status is determined according to the same principle as that of recipients, then it turns out that in 2-3% of cases, Rh-negative donor blood contains the C(rh′) and E(rh″) antigens in its erythrocytes. In this regard, the group of donors with Rh-negative blood should include only persons whose erythrocytes do not contain antigens D(Rh 0), C(rh′) and E(rh″). This circumstance has essential, since a person in whose erythrocytes the C(rh′) or E(rh″) antigens are found, being a donor, belongs to the Rh-positive group, but, being a recipient, should be considered Rh-negative, because antigen 0 is absent.

Thus, in the blood of an individual there may be one type of Rh factor or a combination of several types, with each type of Rh factor causing the formation specific antibodies.

Red blood cells also contain antigens of the Hr-Hr 0, rh′, rh″ system, which cause the formation of specific antibodies, but their antigenic properties are weaker than those of the Rh factor. The most common cause of immunization is the rh′(c) antigen, the least antigenic are rh″(e) and Hr 0 (d). All persons with Rh-negative blood are also Hr-positive if they have the rh′(c) antigen. The presence of the Hr antigen makes it necessary to warn against transfusions of Rh-negative blood to recipients with Rh-positive blood or without determining the patient’s Rh status at all, since immunization or a post-transfusion complication for the rh′(c) antigen can be caused if the patient turns out to be Hr-negative.

According to modern concepts (Fischer, Race), the Rh system is essentially a complex of six antigens of the Rh-Hr systems linked in one pair of chromosomes. A person may have antigens from both systems (Rh and Hr) or from only one system (Rh or Hr), but there are no people who do not have one of these two antigenic systems. Currently, 27 combinations of antigen types are known.

Before blood transfusion, it is imperative to establish the Rh affiliation of the donor and recipient and conduct a test for Rh compatibility. When transfusing blood, you should strictly adhere to the principle of using blood of the same Rh factor.

About 80% of people have I and II blood groups, 15% have III and 5% have IV blood groups. Anyone can donate their blood for transfusion, i.e., be a donor healthy man. Donation benefits not only patients, for whom blood transfusions sometimes save their lives, but also the donor himself. Taking a small amount of blood from a person (200-250 ml) enhances the activity of the hematopoietic organs.

Additionally:

Order of the Ministry of Health of the Russian Federation dated November 25, 2002 N 363 “On approval of the Instructions for the use of blood components”
Principles infusion therapy(see Solutions for infusion therapy, solutions for correction of BCC deficiency, Whole blood, Blood plasma)

In some diseases and significant blood loss, it becomes necessary to transfuse blood from a healthy person to the patient. But you can’t get a blood transfusion from just anyone. If the blood of two people is incompatible, then the red blood cells of the transfused blood stick together in the body of the person to whom it was transfused, which can lead to death. Human red blood cells contain two substances that have been called adhesive substances - agglutinogens A and B; There are two agglutinins in plasma: agglutinins. A and β. Gluing of red blood cells (agglutination) occurs only when substances of the same name meet: A with a and B with β. In the blood of each person there are no combinations that lead to adhesion; they arise only when incompatible blood is transfused. Based on the presence of certain adhesive and adhesive substances, four blood groups have been identified in people (Table 25).

As can be seen from table. 25, adding blood I group to any other is not accompanied by gluing of red blood cells, i.e. it is quite possible. The vertical bar in the table shows that blood I groups can be poured into people with I, II, III and IV blood groups, blood Group III - groups III and IV, and group IV blood - only IV group. Horizontal lines make it possible to determine which blood groups can be transfused to a person with a certain blood group. For example, a person with I blood type can only give blood transfusions I groups, and into the blood IV group, you can add blood of any group, although in the latter case those present in erythrocytes IV groups both agglutinogens A and B are found with agglutinins of the same name A and β plasma I, II and III groups and, it would seem, agglutination should occur.

But the fact is that a small amount of transfused (donor) blood is usually taken, and it, along with its agglutinins, is diluted with the own blood of the person receiving the blood ( recipient), to such an extent that it loses the ability to glue the recipient’s red blood cells. At the same time, the donor's red blood cells as whole cells cannot be diluted during transfusion and stick together in case of incompatibility. Therefore, when transfusing blood, the agglutinogens of the donor's blood and the agglutinins of the recipient are first taken into account.

About 80% of people have I and II blood types, 15% - III and 5% - IV blood group. Every healthy person can donate their blood for transfusion, i.e., be a donor. Donation benefits not only patients, for whom blood transfusions sometimes save their lives, but also the donor himself. Taking blood from a person (200-250 ml) enhances the activity of the hematopoietic organs.

For thousands of years, people were not aware of the true purpose of blood, but on a subconscious level they understood that the red liquid flowing through the veins was of particular value. It was used in various religious rituals, and bloodletting was performed on seriously ill patients. Today virtually everything is known about her. Modern knowledge was given to doctors unique world red blood cells, platelets, leukocytes, antigen (Rh factor) and other substances flowing in the blood, by which the doctor can determine the state of health. However, why are they different among humanity and what blood group can be safely transfused to all people.

She is the source of life. A continuous flow of living energy supplies every cell of the body with everything necessary substances. Flow of the internal environment – complex mechanism, for the study of which humanity needed its entire history. A lot is known about her, but not enough to close this interesting question forever. In some Asian countries, for example, there is still a tradition where you must know the blood type of your passion before the wedding.

There is also a legend according to which only one flowed in the veins of the first people - the first group. And only later, with the development of civilization, the rest appeared. There are special diets, food for each blood group, and they use it to learn the fate and character of a person. In a word, blood is not only a source of energy for the body, but a broad, multifaceted concept.

Until the second half of the last century, enough was known about it, but the Rh factor was discovered only in 1940, by finding a new antigen in human red blood cells. Subsequently, it was found that the Rh factor and blood type do not change throughout life. It was also noted that according to the laws of genetics, the properties of blood are transmitted hereditarily. As already noted, people were treated with bloodletting, but not in every case such medical assistance ended with recovery. Many people died, and the cause of death could not be determined until the beginning of the 20th century. Later, numerous studies provided a clue, and at the very beginning of the last century, the scientist K. Landsteiner substantiated the concept of groups.

Discovery of global significance

Using the method of scientific research, he proved what directions there are. People can only have 3 (subsequently, J. Jansky from the Czech Republic added a 4 group to the table). Blood plasma contains agglutinins (α and β), erythrocytes - (A and B). Of proteins A and α or B and β, only one of them can be contained. Accordingly, we can designate a diagram where:

α and β - (0);
A and β - (A);
α and B - (B);
A and B - (AB).

Antigen “D” is directly positioned with the concept of Rh factor. Its presence or absence is directly related to such in medical terms, as “positive or negative Rh factor.” The unique identifiers of human blood are: Rh compatibility and blood group compatibility.

For the discovery K. Landsteiner received Nobel Prize and read the report, what concept he developed. In his opinion, the discovery of new proteins in cells will continue until scientists are convinced that there are no two people on the planet that are antigenically similar, with the exception of twins. In the forties of the last century, the Rh factor was discovered. It was found in the red blood cells of rhesus monkeys. Almost a quarter of the world's population is negative. The rest are positive. It (Rh with any value) does not affect the blood group and the owner of, say, the 4th can live with a positive or negative Rh.

What you need to know about blood

However, even if she fits the group and all the rules are followed, patients experienced complications. They could have been called different reasons, but the main one turned out to be a discrepancy in the signs of the reso factor. If a fluid with Rh+ was transfused to someone with Rh-, antibodies to the antigen were formed in the patient’s blood and, during a secondary procedure, the same blood fluid reacted by destroying or “sticking together” the red blood cells of the donor person.

And then they came to the conclusion that not only she could be incompatible. It can only be transfused Rh+ to Rh+. This condition Mandatory for both Rh factor negative and Rh factor positive, donor and patient. Today, a large number of other antigens have been discovered that are built into erythrocytes and form more than a dozen antigenic structures.

Transfusion is often the last step to save a person when he needs urgent help. To comply with all the rules, a compatibility test was introduced. Minimize risks when therapeutic procedure possible using compatibility checks. The internal environment of the other group may turn out to be incompatible, and then a sad outcome is likely.

Before the procedure, a test is prescribed and performed to document the blood type and Rh factor.

Carrying out a mandatory test will allow us to determine: to confirm the ABO compatibility of the donor and the patient, to confirm antibodies in the patient’s serum, which will be positioned against the antibodies of the human donor’s erythrocytes. An identity test regarding the Rh factor can be carried out: a test with 33 percent polyglucin, a test with ten percent gelatin.

Serial data

More often than other methods, a test with polyglucin is used. It is practiced when assistance with transfusion is needed. To get the result, achieve the reaction in a centrifuge tube for five minutes without heating. In the second example, when using a sample with 10 percent gelatin, combine: a drop of donor red blood cells, two drops of 10% heated to liquefy percent solution gelatin, two drops of patient serum and 8 ml of saline solution.

After short manipulations, you get final result- whether the donor’s blood turned out to be incompatible with the patient’s blood. They also practice biological testing. In general, it is aimed at eliminating any force majeure circumstances due to the presence of a large number of secondary group systems. To minimize risks at the beginning of blood transfusion, another sample is tested - biological.

There are only four main groups. It can be assumed that they fall into the category of compatible and incompatible concepts, that is, one group can suit everyone. Blood can be transfused from one person to another, based on a set of medical rules.

First group. Suitable for everyone. People with group 1 are considered universal donors.
Second. Compatible with 2nd and 4th.
Third. Suitable for persons with 3rd and 4th grade.
Fourth. Can be used for transfusion to people with a similar group. It suits only them.

However, for such recipients, if they require help, any blood will do.

An important factor is heredity

Basic rules, and what kind of blood the child will have relative to the group of the parents.

Will always remain constant: Rh factor, blood type.
Blood type does not depend on gender.
Taking into account the laws of genetics, blood type can be inherited.

Inheritance, or what kind of blood a baby may have, is indicated by the framework of genetic rules. If the father and mother are carriers of the first group, then the newborn will inherit it. If the second, we can confidently say that the offspring will have the first or second. If the third, the baby’s veins will begin to flow from the first or third group. A mother and father with AB (IV) will not have a baby with group zero.

In addition to blood fluid, human tissue also has specificity. From this we can conclude that tissue compatibility and blood transfusion are interconnected. To prevent tissue or organ rejection during transplantation, doctors first determine the biological compatibility of the donor and the patient, at the level of tissue compatibility of the organs.

As well as manipulating the internal environment, histocompatibility and blood transfusion play a large role in medicine. However, this meaning was important in the recent past. Today, universal ones have been developed: artificial leather, bones. They circumvent the problem of tissue rejection during transplantation. Therefore, tissue compatibility and blood transfusion are an issue that is gradually fading into the background in medicine.

Blood transfusion can be compared to an organ transplant, so many compatibility tests are performed before the procedure. Nowadays, blood that is strictly suitable for such parameters as group and Rh factor is used for transfusion. Using incompatible blood in large volumes can result in the death of the patient.

It is believed that the first one suits everyone. According to modern doctors, this compatibility is very conditional and as such universal group blood does not exist.

A little history

Attempts at blood transfusion began several centuries ago. In those days, they did not yet know about possible blood incompatibility. Therefore, many transfusions ended unsuccessfully, and one could only hope for a lucky break. And only at the beginning of the last century one of the most important discoveries in hematology was made. In 1900, after numerous studies, an immunologist from Austria, K. Landsteiner, discovered that all people can be divided by blood into three types (A, B, C) and, in this regard, proposed his own transfusion scheme. A little later, his student described the fourth group. In 1940, Landsteiner made another discovery - the Rh factor. Thus, it became possible to avoid incompatibility and save many human lives.

However, there are cases when a transfusion is urgently needed, and there is no time or opportunity to look for a suitable donor, for example, this was the case at the front during the war. Therefore, doctors have always been interested in the question of which blood group is universal.

What is universality based on?

Until the mid-20th century, it was assumed that group I was universal. It was considered compatible with any other, so its carrier could, on occasion, be used as a universal donor.

Indeed, cases of its incompatibility with others during transfusion were observed quite rarely. However for a long time failed transfusions were not taken into account.

Compatibility was based on the fact that some combinations produce flakes, while others do not. Coagulation occurs as a result of red blood cells sticking together, which in medicine is called agglutination. It was because of the clumping of red cells and the formation of blood clots that the death of patients occurred.

The division of blood into groups is based on the presence or absence of antigens (A and B) and antibodies (α and β) in it.

There are various proteins on the surface of red blood cells, and their composition is determined genetically. The molecules by which a group is determined are called antigens. In carriers of the first group, this antigen is completely absent. In people with the second, red cells contain antigen A, in the third - B, in the fourth - both A and B. At the same time, the plasma contains antibodies against foreign antigens. Against antigen A - agglutinin α and against antigen B - agglutinin β. The first group has antibodies of both types (α and β). The second has only β antibodies. People whose group is third have agglutinin α in their plasma. People with fourth level have no antibodies in their blood at all.

Only single-type blood can be used for transfusion

If the donor has an antigen of the same name as the recipient's plasma antibodies, then red blood cells will stick together as a result of the attack of agglutinins on the foreign element. The coagulation process begins, blockage of blood vessels occurs, the supply of oxygen stops, and death is possible.

Since there are no antigens in group I blood, when it is transfused to a person from any other blood, red blood cells do not stick together. For this reason, it was believed that it suits everyone.

Finally

Today, the recipient receives blood from a donor strictly with the same group and Rh factor. The use of the so-called universal blood can only be justified in in case of emergency and when transfused in limited quantities, when there is a question of saving a life, and the required one is not currently in stock.

In addition, medical scientists have found that there are many more types of blood. Therefore, the topic of compatibility is much broader and continues to be the subject of study.

The very first successful blood transfusion was recorded in the mid-17th century in France. Then the man's life was saved thanks to the lamb. But at that time, doctors had no idea about such a concept as blood type and, of course, they could not know which blood type suits everyone, so it is safe to say that the young man was simply lucky.

Only at the beginning of the 20th century, after numerous studies, the Austrian biophysicist Karl Landsteiner determined the principle of dividing human blood into 4 types, and also introduced the concept of “incompatibility”. Humanity owes millions of saved lives to him.

So, there are 4 main groups, they are usually designated as follows:

0 (I) - first (zero)
A (II) - second
B (III) - third
AB (IV) - fourth

What's inside?

Red blood cells (erythrocytes) are studded with various protein molecules. The set of such molecules is genetically programmed and individual for everyone. Among them are those that influence the formation of human blood. These molecules are called antigens. Their combinations are different.

So, people with group II (A) have antigen A, carriers III (B) have B, IV (AB) have both antigens, and those belonging to group I (0) do not have them at all. The opposite situation is observed in blood serum: it contains so-called agglutinins to “foreign” antigens (α and β).

Gluing of blood cells will not occur in the absence of the same antigens and agglutinins. But when a “foreign” element enters, agglutinins immediately attack it and provoke the gluing of foreign red blood cells. The result can be fatal - oxygen stops flowing, small vessels become clogged, and after some time the blood begins to clot.

About 40-50% of people are carriers of the first group. Owners of the second – 30-40%. The third - 10-20%, the least number of people with the fourth - only 5%.

Transfusion compatibility

To avoid the danger of coagulation, Landsteiner proposed transfusing recipients with the first group with the same donor blood. Thus, , due to the lack of antigens, it is universal, and its owners are considered universal donors.

People with group IV are called universal recipients: they are allowed to receive any blood. Those with group II or III can receive a similar transfusion, as well as the first. It is important to remember about the Rh factor. People can only be given blood that matches their Rhesus test.

Blood rhesus is an antigen that is found on the surface of red blood cells. It was also discovered by Karl Landsteiner and his colleague A. Weiner. About 85% of Europeans are Rh positive. The remaining 15% (7% among Africans) are Rh negative.

How does positive and negative Rh factor affect health?

It is also worth noting that today scientists distinguish more than 250 types of blood, which are combined into 25 systems. Therefore, the issue of compatibility continues to be the subject of research, and will be reviewed more than once.