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The risks of ABO-mediated acute immune hemolytic transfusion reactions continue to bedevil modern transfusion services. Of particular concern, the incidence of transfusion fatalities has not changed over time, in stark comparison to the fall in risks of infectious diseases. This article reviews the approaches employed to combat aspects of ABO transfusion errors. The advantages of a universal group O donor pool are considered, and some innovative approaches for achieving this goal, including enzymatic modification of the red cell membrane, the epitope masking through the use of polyethylene glycol, are described. The impact of a group O blood supply on transfusion practices, and on costs to healthcare system, are considered.
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