Blood Banking
Deals with the study of immunologic principles applied in blood group antigens and antibodies.
Deals with mechanisms of blood typing & crossmatching (compatibility test and coomb’s test)
Detection and measurement of anti body, screening of donors, bleeding techniques Different Tests:
1. ABO typing & RH typing 2. Compatibility/ Crossmatching
3. Coomb’s Test/ Anti Human Globulin Test 4. Detection & Identification
- Antibody screening
- Unexpected antibody and identify 5. Screening of donors
6. Blood components preparation - transfused ABO typing Anti- A Anti- B RH typing Anti- D Major Blood Group
Type O Type A Type B Type AB
Methods to determine Blood Group- done simultaneously
1. Cell typing (direct typing or forward typing)- determines the antigen(surface of RBC) 2 ways:
a) Slide method- 1 drop of red cell, 1 drop of anti A within 2 mins must interpret result: agglutination; over 2 mins= false positive result cause dry na yung mixture
b) Tube method- prepare different red cell suspension; 2-5% red cell suspension wash it 3x with NSS (normal saline solution) to remove anti bodies.
- Applicator: stick mix (within 2 minutes, you have to determine the result) - Done in immunology / serology
*Agglutination – most conspicuous reaction Uses of commerically prepared anti sera:
Anti A- blue because added “thymol blue” Anti B- yellow because added “acriflavine”
Anti AB- colorless; no dye added PLAIN SERUM IS COLOR YELLOW Antigen= red cell antibody = serum
Reagents are expensive so can prepare own anti sera Source of anti A is derived from serum of Group B Source of anti B is derived from serum of Group A Source of anti AB is derived from serum of Group O
Red Cells Anti- A Anti- B Anti- AB Blood Group
A (antigen A) + - + A
B (antigen B) - + + B
AB (antigen AB) + + + AB
O (none) - - - O
*where there is agglutination with the anti sera, yun yung blood group
* other hospitals only use anti A and Anti B; Anti AB is only for confirmation of results * O- most common 45%,A- 40%, B- 10% and AB- 5%
2. Serum Grouping- detect the presence/ absence of anti body by using red cells of known specificity
5% A cells- A antigen 5% B cells- B antigen 5% AB cells- AB antigen 5% O cells- none at all Serum 5% A cells (A antigen) 5% B cells (B antgen) 5% AB cells (AB antigen) 5% O cells (none) Blood Group A ( anti B) - + + - A B ( anti A) + - + - B AB ( none) - - - - AB O ( anti A; Anti B) + + + - O
*where there is no agglutination, yun yung blood group
Blood type Can receive from Can give to
A A, O (packed red blood cells) A & AB B B, O (packed red blood cells) B & AB
AB A, B, AB, O (packed red blood
cells)
AB only
O O (whole blood or packed) A, B, AB, O (PRBC)
PRBC- removed the plasma where anti A and B are present; RBC- has no antigen Different Blood Group Systems
1. ABO- most common 2. Rh- most common 3. MNSs 4. Kidd 5. Kell 6. Duffy 7. P 8. I 9. Lutheran 10. Lewis 11. Xg
Rh blood group system- absence/ presence of D antigen Different antigens and their anti sera:
1. D antigen = anti D 2. C antigen = anti C 3. E antigen = anti E 4. c antigen = anti c 5. e antigen = anti e
*anti sera are imported so expensive; hospitals only keep anti D *if +, the antigen is present, if - the antigen is absent
*(Rh +) antigen D is present, (Rh-) antigen D is absent
* if Rh-, not necessarily na sayo na ang anti D. It is only developed when exposed to Rh+ immune antibodies= not present but can be developed unlike in ABO, naturally occurring siya
Compatibility/ Crossmatching- series of procedure designed to ensure the safety of blood for transfusion
PURPOSE:
*person with multiple transfusions is prone to transfusion reaction so must check compatibility
1. Ensure maximum benefit to the recipient 2. Prevent transfusion reactions due to antibodies SPECIMENS:
- Fresh, not in activated serum, less than 48 hrs old.
- Serum/ plasma may be used but serum is preferred over plasma. Plasma causes clots na napagkakaalaman na agglutination
- Blood samples should not be taken from intravenous tubing lines
- Both donor and recipient samples must be stored only for a minimum of 7 days * clerical error (wrong label of specimen of patient)= most fatal error. It occurs more often than technical error so must always ask name. Shouldn’t rely on the paper list...
TYPES OF CROSSMATCH
- Major Crossmatch (PSDR) patient serum donor red cell
= refers to testing the patients serum against 5% red cell suspension of the donor red cell
= to detect whether there are anti bodies in the patient’s serum that can destroy transfused red cells
- Minor Crossmatch (DSPR) donor serum patient red cell
= refers to testing the donor’s serum against 5% red cell suspension on patient’s red cell
= to detect whether there are anti bodies in the donor’s serum that can cause red cells adverse (transfusion) reaction to the recipient
Broad Spectrum compatibility Test- most used method of choice Coomb’s Test aka Anti Human Globulin test
- Used to detect incomplete anti bodies or non- agglutinating anti bodies Non agglutinating = IgG ; agglutinating = IgM
- Most useful and universally applied tests employed in blood banks and immunohematology
2 METHODS:
- Diagnosis of haemolytic disease of the newborn - Investigation of transfusion reaction
- Diagnosis of auto immune haemolytic anemia
2. Indirect antiglobulin- in vitro sensitization (outside the body)??? - Compatibility testing
- Investigation of transfusion reactions
- Detection and identification pf unexpected anti bodies - Red cell antigen phenotyping
BLOOD DONOR SCREENING
- Procedure is done to decrease risk of blood transmissible diseases by careful examination of the potential donors
- Examples of diseases: HIV, Hepatitic DIVIDED INTO 3 PARTS
1. Registration - REGISTRATION FORM: NAME DATE OF BIRTH AGE SEX CIVIL STATUS ADDRESS
OCCUPATION (if pilot or driver, can’t go back to work at once) 2. Medical History
3. Physical Examination
- CRITERIA FOR POTENTIAL BLOOD DONOR 1. Age: 18-60 years old
2. Weight: 110 lbs. (50kg) can donate 450 mL of blood but if underweight can also donate but less than 450 mL
3. Pulse Rate: 50- 100 beats/ min (can’t shortcut and count 30 secs then x2) 4. Blood Pressure: 90-160 mmHg (systolic)
60-100 mmHg (diastolic) 5. Hemoglobin: 125g/L (12.5g/dL)
6. Hematocrit: 38% TYPES OF DONORS:
1. Volunteer Donor- donates without compensation
- R.A 7719 National Blood Services Act of 1994: advocates voluntary donation of blood in the Philippines
2. Paid, Professional, Commercial Donor- people who sell their blood - Before it was Php 45 per pack
- Use iodine to screen to prevent professional donors
3. Replacement Donor- replaces blood for a particular purpose for replacing the unit of blood used by the patient. It depends upon the ruling of the hospital 1 is to 2. 1 unit used replace with 2 units.
4. Directed Donor- donors who give blood for a particular patient 5. Autologous Donor- gives blood for himself
- Case to case basis for surgical procedure - If unused can give to other patient
- Not for anemic patients or those with iron deficiency
COMPONENT THERAPY- transfusion of the specific component needed by the recipient - May defer the donor permanently if positive for HIV _____________________ Blood Components
- refers to products separated from a single unit of whole blood
- To prepare different blood components, need REFRIGERATED CENTRIFUGE 1. Whole Blood
- Easy to prepare cause its blood taken from donor after screening tests - Contains all cellular components like [RBC, WBC, platelet, anti coagulant]
whole blood parts INDICATIONS:
*to replace the loss of both RBC and plasma volume in actively bleeding patients (massive bleeding) bawal PRBC
2. Packed Red Blood Cells aka Red Cell Concentrate - Prepared by sedimentation or centrification - Tangal na yung plasma
INDICATIONS:
*increase oxygen carrying capacity in patients with acute and chronic anemia *for patients who cannot tolerate sudden increase in blood volume; congestive heart failure
3. Granulocyte Concentrate & Leukocyte Concentrate (crossmatched) Indications:
*severe neutropenia (decreased white blood cells) *Septicemia or bacterial contamination
*myeloid hypoplasia of bone marrow 4. Platelet concentrate
*severe thrombocytopenia (decrease in platelet count) -one unit 5000-10000 per microliter
* Disseminated intravascular coagulation *massive transfusion
5. Fresh Frozen Plasma Indications:
*to treat multiple coagulation deficiencies in patients with liver failure, vitamin K deficiency, massive transfusion and DIC (Disseminated Intravascular Coagulation) 6. Plasma – Removed RBC | type Specific na dapat
-has small amount of factors V & VIII (coagulation factors) Indications:
*treatment of stable coagulation deficiency esp. Factor XI *source of plasma for patients undergoing plasma exchange 7. Cryoprecipitate
- also called factor VIII
- contains at least 80 units of factor VIII - 50% of the Von Willebrand factor -20% of factor XIII
- 200mg of fibrinogen as well as fibronectin INDICATIONS
*Von Willebrand’s disease * Hemophilia A
* Fibrinogen deficiency *Factor XIII deficiency
