PH 156 Blood Banking and Serology (Part 1) August 2, 2013

Prof. Teresita de Guzman Elysse, Janel, Angel, Jester

OUTLINE o Medical history

I. Definition of Terms o Physical Health
II. History o Possible contact with transfusion-transmissible
III. Rules of Donation infectious diseases including:
IV. Apheresis/Blood Components History of sexual behaviour
V. Blood Compatibility Testing: Blood Typing and Cross- Drug use
matching Travel to areas with endemic diseases (e.g.
VI. Blood Processing, Preservation, and Storage Malaria in Palawan)
VII. Transfusion Reaction/Risks A photo ID is required for all donors
VIII. Immunohematology Potential donor must:
** She didnt strictly follow the outline kasi may part 2 pa raw o Be in good health and feeling well on the day of
donation
DEFINITION OF TERMS o Be on no prescribed medication that would cause the
donor problems when donating or those that would
Blood banking
affect the recipient
o also known as transfusion medicine
o Have a haemoglobin level which meets the
o The process of collecting (donation), testing,
established USFDA standard
processing, and storing blood for later use
o Wait 56 days before giving another donation of whole
(transfusion)
blood
o A cornerstone of emergency and surgical medicine
Donors must meet these criteria to ensure their safety and
o Dependent on the clinical lab for ensuring the safe
also the security of the recipients
use of blood and its components
Rules of eligibility have been established by the USFDA,
HISTORY
but some banks may have different criteria
1667 Jean-Baptiste Denis (France) Donors must be:
o Direct human blood transfusion o 17 years old
o Using human blood to treat disease and trauma although some states permit younger people to
40 years later William Harvey donate if they have parental consent
o discovered the circulatory system o In good health
1900s Richard Lewisohn o Weigh at least 110 pounds
o Discovered that when sodium citrate is added to if <110 lbs, must adjust the amount of blood
freshly drawn blood, it will not clot/coagulate and anticoagulant in bag
1937 o Pass a physical examination and health history exam
o First true blood bank was opened by Chicagos Cook prior to donation
County Hospital Physical exam includes:
1947 - American Association of Blood Banks (AABB) Blood pressure measurement
o Organized to support and encourage continued Pulse rate
blood research Body temperature
o Promote exchange of information Test for anemia (Hb determination)
o Develop standards of practice for blood banks. To protect the health of both donor and recipient, potential
1948 American National Red Cross exposure to transfusion-transmissible disease is asked:
o Operating a full scale blood program to collect and o Viruses: HIV, Hepa B & C, Human T-Lymphotropic
distribute blood to patients in need Virus (HTLV) I & II
1953 o Parasites: Malaria, Babesiosis, Chagas Disease
o Plastic blood bag was introduced by Fenwal Co. Certain people are not permitted to donate:
o Blood bags were approved by FDA in 1963 o Anyone who has ever used illegal IV drugs
Before, blood bottles were used but they were o Men who have had sex with men since 1977
prone to breakage o Hemophiliacs
Blood bag use in the Philippines started in the o Anyone with a positive HIV test
1970s to 1980s o Men and women who have ever taken money, drugs,
Dr. Charles Drew or other payments for sex since 1977
o Pioneer in plasma preservation and a major th
o Anyone who has had hepatitis since 11 birthday
contributor to the advancement of blood banking in o Anyone who has had babesiosis or Chagas disease
the US
o Anyone who has taken Tegison for psoriasis
o Helped supply thousands of units of plasma for WW2
victims o Anyone with Creutzfeldt-Jakob Disease (CJD) or
who has an immediate family member with CJD
BLOOD DONATION RULES o Anyone who has spent time in the UK between 1980-
Whole blood is collected from healthy donors who are 1996 that adds up to 3 months or more
required to meet strict criteria:

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 o Anyone who, from 1980 to present, spent time in
Europe that adds up to 5 years or more
o Anyone who received blood transfusion in the UK
between 1980 and present
o Some travel or health problems may require a
temporary deferral or may be ineligible to donate
like individuals on human growth hormone
(HGH) or bovine insulin from the UK must be
deferred indefinitely
All donors are required to complete a health
questionnaire and blood safety form during a confidential
interview by a donor center healthcare worker each time
they come in to donate blood
Frequently Asked Questions (FAQs)
Why the year 1977?
Because HIV was discovered in 1982 and people
who were exposed in the last 5 years (incubation
period) were included
Why the year 1980?
There was an outbreak of Bovine Spongiform
Encephalitis (BSE) & other prion diseases that year
Why on the 11th birthday?
May be because nearing puberty so baka maging
sexually active na
Difference between Hemophilia A and B?
A - deficit in Factor 8
B deficit in Factor 9
Why are individuals taking HGH and Bovine Insulin
not allowed to donate?
Higher risk of carrying CJD if you have received
pituitary derived HGH injects [Redcross, 2013]
Bovine insulin Possible transmission of variant CJD
from cattle to humans [Redcross, 2013]
AUTOLOGOUS DONATION
Donation when a person donation his/her own blood for
personal use
o Since the blood is not to be used for anyone else,
units positive for infectious agents and with irregular
blood group antibodies are still acceptable
o But units positive for hepatitis (HBsAg) and HIV are
still not allowed into the blood bank
Three Ways to Make Use of Patients Own Blood aside
from Predeposit
1. Hemodilution
o Patients blood is collected prior to surgery and
replaced with plasma
o Any bleeding during surgery will lose fewer RBCs
o The previously collected higher hematocrit blood will
be given back after surgery
2. Cell Saver
o Collection and reinfusion of blood lost during and
immediately after surgery [United Blood Services]
Blood from surgical field is recovered, mixed with
saline and anticoagulant, centrifuged and washed
Resulting RBCs are then reinfused into patient
o Reduces the need for allogeneic blood
transfusion[United Blood Services]
o Surgical field should not be contaminated with
bacteria or malignant cells
o Done during the war
3. Wound Drainage
o Blood is collected from cavities
such as joint space into which bleeding has
occurred
o Then returned thru filter
which removes big items like thrombi and tissue
fragments but not the inflammatory chemical
mediators or cytokines
DIRECTED DONATION
o Occurs when a potential recipient of blood or its products
specifically designate certain people as donors
Additional Problems
Confidentiality of the donor is difficult to maintain
Donor may not want to answer the exclusionary question
of the blood safety form and health questionnaire properly
The procedure is not cost-effective
There are contraindications such as:
o An increased risk for transfusion-associated graft
versus host diseases (TAGVHD)
o Alloimmunization of potential recipients of transplants
o Increased risk for hemolytic disease of the newborn
(HDN) in mothers receiving blood from fathers
There is a small but significant risk for TAGVHD in
persons receiving blood from relatives
o Due to similar genetic make up
TAGVHD is fatal with no effective treatment
Thus, all units of blood collected by directed donation
typically undergoes gamma irradiation
o To destroy any WBCs that could cause TAGVHD
o Significantly adds to the cost of blood processing
o Units must be discarded if not used within 24hrs
** AlloSy- same species but different individuals
** Xeno - different species
PROTECTING THE BLOOD SUPPLY
Certain tests must be performed in a blood bank lab on all
donated blood
ABO blood group and Rh status determinations as well as
several screens to ensure the safety of the blood
Screening is conducted for
o Unexpected RBC antibodies that could cause
reactions
In the recipients such as those made as result
of previous transfusion or pregnancy
o Bacterial contamination in units of platelets
important in Dengue cases
o Current and past transmissible infections; each unit
of donated blood is tested for
Hepa B and C
HIV 1 and 2
HTLV I and II
Syphilis
West Nile Virus
BLOOD TYPES AND CROSS MATCHING
Blood compatibility test must be done (except in life or
death situations)
Type includes a front type and a back type
Note that there are more than 100 blood groups (kell,
duffy, MN) but only the major ones are discussed
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 Front Type LACKING the corresponding antigen are cross-matched
The front type determines which antigens (flags) in the with the patient
ABO blood group system are on the patients RBC o If may nahanap na corresponding antigen, then
Using known sources of commercial anti-sera (AbBy) automatically denied na ang transfusion kasi there
o Anti-A blue will be a reaction
o Anti-B yellow o Note that 1 unit of blood = 1 pint = 473.18 mL
The physician should be notified
Table 1 ABO Grouping (Front Type) Antibody identification can be complicated and take more
Antigen on RBC Blood Type than a day to complete
A only A
B only B Cross Matching
Both A and B AB One part of pre-transfusion testing
Neither A nor B O*
** Not to say that Type O doesnt have any surface antigen. It 1. Major PSDR
has H antigens! o Donors RBC is cross matched with patients serum
Basic antigen on RBC surface 2. Minor DSPR
Dagdagan lang ng sugars kaya nagkakaroon ng types o Patients RBC is cross matched with donors serum
A, B, and AB o Minor because there are very few donors antibodies
** There are more blood type A individuals than blood type B (that can destroy) with respect to recipients RBCs
individuals
Hemolytic Disease of the Newborn (HDN)
Figure 1 Different Sugar Combinations per Blood Type Also called Hemolytic Disease of the Fetus and Newborn
(HDFN) or Erythroblastosis fetalis
RH incompatibility with the mother
Destruction of the RBCs of the fetus and neonate by
antibodies produced by the mother
The mother can be stimulated to form the antibodies by
previous pregnancy or transfusion
IgG that was supposed to combat pathogens now attack
the fetal RBC antigens that were inherited from the father

1. Major: Rh- mother, Rh+ father, Rh+ fetus

Back Type
Or reverse grouping
Detecting isohemagglutinins
antibodies) in the patients serum
Using known reagent RBCs (namely A1 and B cells)
st
o 1 Pregnancy: breakage of vessels (fetal RBC leaks
into mothers body) recognized as foreign
production of antibodies
o Subsequent pregnancy:Antibodies formed from
previous pregnancy attacks fetal RBC
Baby appears BLUE cyanotic baby
o RhoGAM or Rh-IG (Rh-immunoglobulins)
antibodies against D antigens
2. Minor (ABO incompatibility)
(naturally occurring
o Mother is type O and the baby is A, B, or AB
o Rh or (D), ABO antigens are most immunogenic

Table 2 ABO Grouping (Back Type) BLOOD GROUP SYSTEMS

Isohemagglutinins Blood Type ** She skipped all the slides about this so all information found
Anti A B here were lifted from Harmenings Modern Blood Banking and
Anti B A Transfusion Practices
Both anti A and anti B O ** We included it na rin in case lang pero medyo nice to
Neither anti A nor anti B AB know na rin siya

** Horror Autotoxicus immunity is directed against foreign ABO System

materials but not against the constituents of ones own body
** During fetal development genes are switched on or off
depending on blood type
For example, baby is type A
Anti-A gene is switched off (not expressed)
** RBCs are also identified as Rh or D positive or negative
Screening for Alloantibodies
A screen looks for unexpected RBC antibodies which may
form following pregnancy or prior transfusion
If screen is positive, the antibody is identified and 2 units
Only blood group system in which individuals have
antibodies to antigens that are absent from their RBCs
Occurs without any exposure to RBCs through
transfusion or pregnancy (naturally occurring)
Antibodies
o believed to be acquired from exposure to bacteria,
pollen particles, and other substances in nature
Which are chemically similar to A and B
antigens
o Predominantly IgM

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 o Produces strong direct agglutination reactions Figure 2 Summary of ABO Antigens and Antibodies
So if wrong group is transfused, rapid Present in Each Blood Type
intravascular hemolysis can occur
Can lead to death
o Inheritance follows Mendelian genetics
o A locus on each chromosome 9 is occupied by an
A, B, or O gene.
O gene is considered an amorph
no detectable antigen is produced in
response to the inheritance of this gene
Considered an autosomal recessive trait
inheritance of two O genes
Antigens
o The genes do not code for the production of antigens
Produce specific glycosyltransferases that
add sugars to basic precursor substances.
o H antigen
The precursor structure on which A and B
antigens are made
Not part of the ABO system, but can influence
A and B antigen expression
Found on chromosome 19
Must be inherited to form the ABO antigens on Karagdagang Kaalaman
the RBCs Australia Antigen (Au Ag)
Genes also known as Hepatitis B surface antigen (HBsAg)
o H gene 1967 : Dr. Baruch Samuel Blumberg discovered this
Encodes for transfer of L-fucose on precursor antigen in an Australian Aboriginal with jaundice
substance on RBC surface (along with Dr. Harvey Alter)
In O blood no production of active transferase Discovery allowed for the development of a reliable
so H antigen is unmodified blood screening test for hepatitis B
Bombay blood type lacks H antigen on RBC 1969: Dr. Blumberg also invented the HBV vaccine
surface and have anti-H in serum (hh genotype) (along with Dr. Iriving Millman)
o A gene Bombay Blood Type
Encodes for transfer of N-acetyl-D- First case - detected in Mumbai (called Bombay then)
galactosamine (GalNac) sugar on H antigen Patient thought to be an O type but developed
o B gene haemolytic transfusion reaction so they investigated
Encodes for transfer of D-galactose (Gal) sugar Bombay presents as O type in a routine ABO
to H antigen testing because we only use anti-A and anti-B sera
Bombay has neither A nor B antigens so akala, O
Rh System However, it is different from O-type in that it also
Refers to specific Rh or D antigen does not have H antigens
Second most important blood group system Bombay blood type can DONATE TO ANY ABO
o Very immun0genic BLOOD GROUP but it can only receive from fellow
1. Rh positive Bombay blood types
o Possess D antigen
2. Rh negative
o Lacks D antigen References:
http://hospitals.unitedbloodservices.org/perioperative-blood-
salvage.html
Other Blood Systems http://www.redcrossblood.org/donating-blood/eligibility-
Relatively insignificant requirements/eligibility-criteria-alphabetical-listing
International Society of Blood Transfusion (ISBT) http://www.hepb.org/about/blumberg.htm
Classification http://www.thinkfoundation.org/kc_bombay_blood_groups.htm
Harmenings Modern Blood Banking and Transfusion Practices
P Group
o P1Pk (ISBT #003)
o Globoside (028)
o Related (209)
MNS (002) System, Lutheran (005), Kell (006), Lewis
(007) System, Duffy (008), Kidd (009)
Diego (010), Yt (011), Xg (012), Scianna (013),
Dombrock (014), Calton (015), Landsteiner-Wiener (016)
Chido-Rodgers (017), Kx (019), Gerbich (020), Knops
(022), Indian (023), Ok (024)
Raph (025), John Milton Hagen (026), I (027) Antigen, Gill
(029), RH-Associated Glycoprotein (030)
#DoMimicry :P
*** Extremely nice to know things :P

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