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Blood group incompatibility occurs when a person receives blood containing incompatible red blood cell antigens, causing the immune system to attack the transfused cells. This reaction most commonly involves the ABO and Rh blood group systems, although incompatibility can also arise from other blood group antigens. Careful blood typing and crossmatching before every transfusion are essential to prevent these potentially life-threatening events.

When incompatible blood is transfused, antibodies rapidly bind to foreign red blood cells, leading to haemolysis, inflammation, and impaired circulation. Symptoms may develop within minutes or hours and include fever, chills, back pain, chest discomfort, shortness of breath, low blood pressure, dark urine, and anxiety. In severe cases, blood group incompatibility can cause acute kidney injury, disseminated intravascular coagulation (DIC), shock, or even death if treatment is delayed.

Diagnosis involves reviewing transfusion records, repeating blood group testing, performing a direct antiglobulin (Coombs) test, and evaluating blood and urine samples for evidence of haemolysis. Immediate management includes stopping the transfusion, maintaining intravenous fluids, supporting blood pressure, and treating complications as they arise.

Strict identification procedures, accurate laboratory testing, and adherence to transfusion safety protocols greatly reduce the risk of blood group incompatibility. Ongoing staff training, patient verification, and careful monitoring during transfusion are critical for ensuring safe blood administration and protecting patient health.