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Blood group incompatibility occurs when a person receives blood containing antigens that their immune system recognises as foreign. The most important systems involved are ABO and Rh, which determine compatibility during blood transfusion and pregnancy. In ABO incompatibility, naturally occurring antibodies can rapidly attack incompatible red blood cells, potentially causing an acute haemolytic transfusion reaction. Symptoms may include fever, chills, back pain, breathing difficulty, low blood pressure, dark urine, or discomfort at the infusion site.

Rh incompatibility is particularly significant during pregnancy. An Rh-negative mother carrying an Rh-positive fetus may become sensitised to the D antigen. In subsequent pregnancies, maternal anti-D antibodies can cross the placenta and destroy fetal red blood cells, resulting in haemolytic disease of the fetus and newborn. Preventive anti-D immunoglobulin can significantly reduce this risk.

Before transfusion, blood grouping, antibody screening, and crossmatching are performed to identify compatible blood and minimise adverse reactions. If incompatibility is suspected during transfusion, the transfusion should be stopped immediately and the patient assessed promptly. Management depends on the severity and cause and may include supportive care, laboratory monitoring, fluid therapy, and treatment of complications. Careful compatibility testing remains essential for safe transfusion practice.