Immunohema Transfusion Med

IMMUNOHEMATOLOGY &
TRANSFUSION MEDICINE

Mila Amor V. Reyes, MD, FPSP
Anatomic and Clinical Pathologist
IMMUNOHEMATOLOGY

•  defines the immunologic proper6es and reac6ons of all blood
components and cons6tuents
•  encompasses the performance of laboratory exams, evalua6on

of results and reac6ons, and addi6onal procedures as required
for the study of the pathogenesis, diagnosis, preven6on and
management of immuniza6on (sensi6za6on) associated with
transfusion, pregnancy, and organ transplanta6on
TRANSFUSION MEDICINE
•  represents a sec6on of clinical pathology that involves the
transfusion of blood, its components, and its deriva6ves
BLOOD GROUP SYSTEM

1.  ABO System—A Ags(A1-‐80%, A2-‐20%), B Ags; an6-‐A, -‐B, -‐A,B
Abs (usually IgM)
•  serum should contain an6-‐A or -‐B Abs to those A or B Ags that
the RBCs lack
ROUTINE ABO GROUPING
Forward ABO grouping Reverse ABO grouping InterpretaHon
PaHent's RBC against PaHent's serum against
known anHsera known RBCs
An6-‐A An6-‐B A cells B cells
+ -‐ -‐ + A
-‐ + + -‐ B
+ + -‐ -‐ AB
-‐ -‐ + + O
•  infants are more difficult to ABO group accurately because these
Ags may not be fully expressed on the RBCs un6l the age of 2
years
•  they do not have the appropriate Abs, produc6on of these Abs is
triggered soon aTer birth by exposure through inges6on or
inhala6on of an6genic substances in nature (e.g., bacterial
polysaccharides, plant pollens) with the same characteris6cs as
the A and B Ags—"naturally occurring Abs“
•  detectable levels of ABO agglu6nins in humans usually develop
by about 3 to 6 months of age
•  several sets of genes control the expression of the ABO blood
group Ags:
–  ABO genes—expression of A and B Ags depends on the
presence of H gene (HH/Hh, hh)
–  H gene—expression of H Ag depends on the presence of Se
gene in the secretory glands and Z gene on the RBC
membrane
–  Se genes—SeSe/Sese "secretors" (80% of the popula6on);
soluble H, A, or B substances may be detected in their saliva
and other secretory fluids
–  sese—"nonsecretors" (20%)
–  Z gene—allows the expression of H gene on the erythrocyte
membrane (ZZ/Zz, zz)
–  "Bombay phenotype“
(1)classic (Oh) phenotype—absence of H gene (hh), inherited
ABO genes cannot be expressed on the RBC or in the
secre6ons, an6-‐A, -‐B, -‐H Abs are present in serum
(2)Hz phenotype—rare, absence of Z gene (zz), may express A,
B, or H substances in the secre6ons, depending on the Se
and ABO genes inherited
2.  Rh system
COMPARISON OF WIENER, FISHER-‐RACE, AND ROSENFIELD NOMENCLATURES FOR

ANTIGENS OF THE Rh BLOOD GROUP SYSTEM
WIENER FISHER-‐RACE ROSENFIELD
RhO D Rh1
rh’ C Rh2
rh’’ E Rh3
hr’ c Rh4
hr” E Rh5
•  Rh typing is performed to established the presence or absence
of the D Ag—most immunogenic Ag (exposure to this Ag in
Rh(-‐) persons is highly likely to result in forma6on of an alloAb)
ROUTINE Rh TYPING

AnH-‐Rh InterpretaHon
+ Rh posi6ve

-‐
Perform weak D test (Du)—add AHG:
+ Rh posi6ve
-‐ Rh nega6ve
•  individuals do not consistently have an6-‐D Ab when they lack
the D Ag
•  an6-‐Rh is formed only following exposure to Rh Ag during
pregnancy and transfusion
•  an6-‐Rh usually IgG—crosses the placenta
•  Rh(+) can receive both Rh(+) and Rh(-‐) blood; Rh(-‐) must receive
only Rh(-‐) blood
•  in urgent situa6ons, an Rh(-‐) may receive Rh(+) blood, if Rh(-‐)
blood is unavailable; however, the pa6ent may become
alloimmunized to the D Ag and risk problems with pregnancy or
transfusion in the future
3.  LW System (Landsteiner and Weiner)
RELATIONSHIP of OLD AND NEW NOMENCLATURE

Old Phenotype New Phenotype ReacHons with AnH-‐
LWa LWb
LW1 LW (a+b-‐) or LW (a+b+) + +/-‐

LW2 LW (a-‐b-‐) or LW (a+b+) +/-‐ +/-‐
LW3 LW (a-‐b+) -‐ +
LW4 LW (a-‐b-‐) -‐ -‐
4.  Lewis System
PHENOTYPES OF THE LEWIS SYSTEM

Phenotype ReacHons with AnH-‐ Lea Leb
Le (a+b-‐) + -‐
Le (a-‐b+) -‐ +
Le (a-‐b-‐) -‐ -‐
Le (a+b+) + +
5.  I and i System
The I and i ANTIGENS

Phenotype RelaHve Ag Strength Incidence
I i
iadult Weakest Strongest Rare
icord Weak Strong All newborns
Iint Strong Weak Rare adults
I Strongest Weakest Almost all adults

6.  P System
PHENOTYPES AND ASSOCIATED ANTIGENS IN THE P SYSTEM
Phenotype AnHgens produced

P1 P1, P
P2 P
P1k -‐-‐
P2k P1, Pk
P Pk
7.  MNSs System
PHENOTYPES OF THE MNSs SYSTEM

Phenotype ReacHons with AnH-‐
M N S s U
M+N-‐ + -‐
M+N+ + +
M-‐N+ -‐ +
S+s-‐U+ + -‐ +
S+s+U+ + + +
S-‐s+U-‐ -‐ + -‐
S-‐s-‐U-‐ -‐ -‐ -‐
S-‐s-‐U+ -‐ -‐ +
8.  Lutheran System
PHENOTYPES OF THE LUTHERAN SYSTEM

Phenotype ReacHons with Lua Lub
AnH-‐
Lu (a+b-‐) + -‐
Lu (a+b+) + +
Lu (a-‐b+) -‐ +
Lu (a-‐b-‐) -‐ -‐
9.  Kell System

PHENOTYPES OF THE KELL SYSTEM
Phenotype ReacHons with AnH-‐
K k Kpa Kpb Jsa Jsb
K+k-‐ + -‐
K+k+ + +
K-‐k+ -‐ +
Kp (a+b-‐) + -‐
Kp (a+b+) + +
Kp (a-‐b+) -‐ +
Js (a+b-‐) + -‐
Js (a+b+) + +
Js (a-‐b+) -‐ +
Ko -‐ -‐ -‐ -‐ -‐ -‐

10.  Duffy System
PHENOTYPES OF THE DUFFY SYSTEM

Phenotype ReacHons with AnH-‐ Fya Fyb
Fy (a+b-‐) + -‐
Fy (a+b+) + +
Fy (a-‐b+) -‐ +
Fy (a-‐b-‐) -‐ -‐

11.  Kidd System
PHENOTYPES OF THE KIDD SYSTEM

Phenotype ReacHons with AnH-‐ Jka Jkb Jkab
Jk (a+b-‐) + -‐ +
Jk (a+b+) + + +
Jk (a-‐b+) -‐ + +
Jk (a-‐b-‐) -‐ -‐ -‐
IMMUNOHEMATOLOGY TESTS AND PROCEDURES

•  tests performed by the BB involve the detec6on of surface Ags
on blood cells or Abs to blood cells, most commonly RBCs
•  an6bodies detected may be:
1.  Alloan6bodies—directed against an6gens absent from the pa6ent’s
own RBCs (usually s6mulated by previous exposure to foreign
an6gens)
2.  Autoan6bodies—directed against an6gens present on the pa6ent’s
own RBCs
•  surface Ags on RBCs are iden6fied when agglu6na6on occurs
following mixture of pa6ent's RBCs with known reagent
an6sera containing Abs
•  HemaggluHnaHon—single most important reac6on in the BB,
end-‐point of almost all test systems designed to detect
erythrocyte Ags and Abs
•  Factors affec6ng hemagglu6na6on:
–  temperature—op6mum temperature for IgM 24°C or 4°C;
IgG 37°C
–  pH—6.5 to 7.0 op6mal for most blood group Abs
–  6me of incuba6on—blood group Abs are usually detectable
using incuba6ons between 15 and 60 mins
–  Ag density and accessibility—type, number, and loca6on of
Ags
–  Ab concentra6on—ability of Ab to cause agglu6na6on
depends on the minimum number of Ab molecules aqached/
RBC
–  centrifuga6on—Ab-‐sensi6zed RBCs physically are brought
closer together (supply centrifugal force)
–  enhancement media
•  low ionic strength solu6ons (LISS)
•  polyethylene glycol (PEG)
•  proteoly6c enzymes (reduce nega6ve charges)
•  albumin (reduce nega6ve charges)
•  Polyca6ons—polybrene, protamine (supply ca6ons)
–  AHG—Abs to human globulin or complement components act
as bridges between erythrocytes already sensi6zed with Ab or
C
–  non-‐specific aggrega6on
•  Roleaux forma6on—high concentra6ons of serum proteins (e.g.,
Mul6ple myeloma, Waldenstrom's macgroglobulinemia,
Hyperviscosity syndromes)
x Grading of reac6ons
+ hemolysis—usually indicates a potent an6body capable of
fixing complement in vitro
+ agglu6na6on—observed and graded according to the
strength of the reac6on

Grade Meaning Score
H Hemolysis, presence of free Hb 10

4+ One solid aggregate 10
3+ Several medium to large aggregates 8
2+ Many small to medium aggregates with a clear background 5
1+ Many small aggregates with a turbid background 3
+ Few small aggregates, many unagglu6nated RBCs 2
-‐ Absence of aggregates 0
–  all nega6ve reac6ons when required by the procedure,
should be read under a microscope and recorded
Grade MeanHme Score

+m Presence of microscopic aggregates 1
-‐ Absence of aggregates 0
mf Presence of minor popula6on of aggregates (aka, mixed
field agglu6na6on)
R Rouleaux, appearing like stacks of coins, disappears with
addi6on of saline

ANTIBODY SCREENING
•  detects unexpected Abs in the pa6ent's serum directed against

RBC Ags
•  pa6ent's serum is tested against reagent RBCs, which express all
major, clinically significant RBC Ags on their surface
•  reagents are added to the RBC-‐serum mixture to enhance any
agglu6na6on of the cells—proteoly6c enzymes, albumin,
polyca6ons
•  incuba6on of the mixture at 37°C is performed to help detect
Abs reac6ve in vivo followed by indirect Coomb's test
•  no agglu6na6on or hemolysis—absence of any significant RBC
Abs
•  false(-‐) reac6ons occur:
–  Ab is present in 6ters below the level of sensi6vity of the Ab
screen
–  Ab directed against an uncommon RBC Ag not present on the
reagent RBCs

ANTIBODY IDENTIFICATION
•  performed if Ab screen is (+)

•  panel of reagent RBCs with a variety of well-‐characterized Ags
expressed on their surface
•  most common clinically significant RBC Abs: ABO, Rh, Kell,
Duffy, Kidd, and MNSs Abs
•  RBC Abs less commonly of clinical importance: I and i, Lewis,
Lutheran, P1 Abs
•  “Naturally occurring” Abs—present even if no previous exposure
to foreign RBCs has occurred, e.g., an6-‐A, an6-‐B, an6-‐Le, an6-‐P1,
an6-‐M
•  Immune Abs—occur only aTer an6genic s6mula6on of the
immune system following exposure to foreign RBC Ags via
transfusion or pregnancy, e.g., an6-‐Rh, an6-‐K, an6-‐Jk, an6-‐Fy,
an6-‐S, an6-‐s
TYPE AND SCREEN
•  ordered when transfusion may be required at some 6me during
the following 48 to 72 hours, but immediate transfusion is not
an6cipated, or when the probability of transfusion is remote
•  includes ABO and Rh (D) typing, and Ab screen of pa6ent's blood
–  If Ab screen is (-‐)—BB stores the specimen and awaits further
word from the pa6ent's physician about the need for
transfusion
–  If Ab screen is (+)—BB will no6fy the physician, and if the
possibility of transfusion remains, Ab iden6fica6on is
performed
TYPE AND CROSSMATCH
•  ordered when transfusion is certain or likely in the near future,
or if any possibility of transfusion exists in a pa6ent with an RBC
Ab
•  includes ABO and Rh typing, Ab screen (and iden6fica6on, if
necessary)
•  units of blood are tested for compa6bility with the pa6ent's
serum—crossmatching
ANTI-‐HUMAN GLOBULIN TEST (COOMBS' TEST)
•  principle: specific AHG Abs act as a bridge that induces

agglu6na6on of erythrocytes coated with human Ig or
complement
•  direct AGT—used to detect Abs bound to erythrocytes in vivo
•  indirect AGT—used to detect the reac6on of pa6ent, donor or
reagent erythrocytes and appropriate serum or commercially
prepared an6sera, in vitro aTer an appropriate incuba6on period
•  AHG—produced by hyperimmunizing animals, usually rabbits,
with purified Ig or C to produce high-‐6tered, high-‐avidity, IgG Abs
•  applica6ons of DAT:
–  inves6ga6on of HTR
–  inves6ga6on of HDN
–  inves6ga6on of autoAbs
–  Abs induced by medica6on
•  applica6ons of IAT
–  detec6on and iden6fica6on of erythrocyte Abs in sera
–  typing of erythrocyte Ags
–  crossmatching
COMPATIBILITY TESTING
•  process composed of many procedures designed to provide the
safest blood product possible for the recipient of a transfusion
•  accurate donor and recipient iden6fica6on is important
•  check of previous records—ABO typing, Rh typing, Ab
screening and iden6fica6on of the pa6ent
•  ABO and Rh typing—donors and recipients
•  Ab screening and iden6fica6on—to demonstrate clinically
significant Abs in the pa6ent's serum using reagent RBCs or
screening cells; includes incuba6on at 37°C followed by IAT

•  crossmatching
–  major crossmatch—PSDR
–  minor crossmatch—PRDS (rarely done)
–  Includes saline phase (room temperature), 37°C incuba6on
(usually with albumin as enhancement medium), followed by
IAT
–  presence of hemolysis or agglu6na6on—INCOMPATIBLE
–  absence of hemolysis or agglu6na6on—COMPATIBLE
•  abbreviated crossmatch—"immediate spin" crossmatch (10-‐15
mins)
–  designed to detect ABO incompa6bility
–  performed only if the pa6ent's Ab screening is nega6ve, with
no known history of previous clinically significant Abs
•  crossmatching in emergencies
–  if ABO and Rh type of the pa6ent are not known—”O”(-‐)
PRBC are released
–  if ABO and Rh type of the pa6ent are known (blood specimen
is available and there is 6me to perform ABO and Rh typing)
—type-‐specific blood are released
–  physician signs a release form sta6ng that the clinical
situa6on warrants the release of uncrossmatched blood
–  con6nue Ab screen and crossmatch, if Ab screen is (+), or
crossmatch is incompa6ble—physician is no6fied
•  BB may provide a group-‐specific (same blood group as the
pa6ent's), or group-‐compaHble (not the exact blood group, but
the donor RBCs are compa6ble with the pa6ents serum) blood
•  Type “O”—universal donor
•  Type “AB”—universal recipient
Recipient Donor
A A,O
B B,O
AB AB, A, B, O
O O
PRENATAL SCREENING
•  includes ABO and Rh typing, and Ab screen to detect fetuses at risk
for HDN
•  HDN—Ab present in the mother's blood (to an RBC Ag on the
newborn's RBC inherited from the father) crosses the placenta and
enters the blood of the fetus, binds to the Ag present on the fetal
RBCs, causing premature RBC destruc6on—jaundice
•  only Abs of the IgG class cross the placenta and enter fetal blood
•  severity of the disease varies, depending on the reac6vity of the Ab
and Ag involved, and Ab 6ter
–  Rh system—first newborn usually not affected, most common
because D Ag is so immunogenic
–  ABO system —first newborn usually affected
–  other blood group system s—IgG Abs of the Duffy, Kidd, and Kell
•  Treatment: Exchange Transfusion—removes unbound IgG
Ab, excess bilirubin, Ab-‐coated RBC
–  blood used should be ABO-‐compa6ble FWB (<l week) and
close to body temperature
–  usually mother's serum is used in the crossmatch: if the
baby and mother are not of the same ABO blood group,
“O” blood should be transfused
–  if the mother's serum is not available, the baby's serum
and eluate of the baby's RBC (if DAT+) can be used for
crossmatching
EVALUATION OF Rh IMMUNE GLOBULIN THERAPY
•  Rh immune globulin (Rhogam) therapy—usually given postpartum to

Rh(-‐) mother with Rh(+) fetus within 72 hours aTer delivery, in order
to prevent her from forming Rh Abs
•  postpartum screening for the presence of significant fetal-‐maternal
hemorrhage is necessary
–  Qualita6ve tests—demonstrate the presence of fetal cells in the
maternal circula6on
•  Roseqe test (detects the presence of D Ag on the circula6ng
RBCs which signifies that D(+) fetal cells have leaked into the
maternal blood
–  Quan6ta6ve tests—determine the quan6ty of fetal RBCs present
•  Acid elu6on test (Kleihauer-‐Betke method)—demonstrates
fetal Hb
•  Flow cytometry
BLOOD COLLECTION

Basic Qualifica6ons of the Poten6al Donor
•  appears to be in good health
•  age: 18 years old; <18 may donate with wriqen permission from their
legal guardian
•  body weight: 110 lbs to remove 450 mL of blood collected in 63 mL of
an6coagulant; those <110 lbs may donate if volume of blood donated
is decreased in propor6on to their weight, and if volume of
an6coagulant is decreased accordingly
•  unexplained weight loss of >10 lbs is a reason for deferral
•  temperature: not > 37.5°C
•  pulse: 50-‐100 beats/minute, regular rhythm
•  blood pressure: systolic not > 180 mmHg, diastolic not > 100 mmHg
•  minimum Hb and Hct: 12.5 g/dL and 38%, respec6vely
•  Deferrals
–  Permanent
•  high-‐risk history for AIDS:
1.  men who have had sex with another man any 6me since
1977
2.  hemophiliacs
3.  IV drug abusers, either past or present
4.  persons who have engaged in sex for money or drugs any
6me since 1977
•  confirmed (+) laboratory test for AIDS; symptoms of AIDS
•  history of viral hepa66s aTer age 11
•  donor implicated in a post-‐transfusion hepa66s or AIDS case
•  confirmed (+) test for: HBs Ag, an6-‐HBc, HCV Ab, HTLV-‐1/2
•  malignant solid tumors except basal cell CA of skin, CIS of
cervix, hematologic malignancies
•  chemotherapeu6c agents administered for malignancy
•  chronic cardiopulmonary, liver, or renal disease
•  serious abnormal bleeding tendencies
•  those who have taken etre6nate for psoriasis
–  Temporary
•  ac6ve disease under treatment: cold, cough, flu, tuberculosis,
Sy, infec6ons
•  curable diseases of the heart, lung, kidney, liver, and GIT
•  treatment with an6bio6cs
•  for 3 years: immigrant coming from an area considered
endemic for malaria, 3 years aTer departure; those who have
had a diagnosis of malaria, 3 years aTer becoming
asymptoma6c
•  for 1 year: aTer hepa66s B Ig administra6on, therapeu6c
rabies vaccina6on, rape vic6ms, healthcare workers with
percutaneous exposure to blood or body fluids, close contact
with viral hepa66s, taqoo, sexual contact with a pros6tute or
persons in a high-‐risk group for AIDS, incarcera6on in jail for >
72 consecu6ve hours, transfusion of blood components, travel
to areas endemic for malaria
•  for 2 months: recent blood dona6on
•  for 6 weeks: following delivery of a baby
•  for 1 month: rubella vaccina6on, aTer cessa6on of isotre6noin
for acne treatment, aTer cessa6on of finasteride for NPH
•  for 2 weeks: aTer vaccina6on with OPV, measles, mumps or
yellow fever, aTer the immune reac6on to smallpox
vaccina6on
•  for 48 hours: aTer hemapheresis
TESTING OF DONOR BLOOD
•  ABO and Rh typing, Ab screening (history of transfusion or
pregnancy)
•  Required screening test for infec6ous diseases (DOH)
–  HIV 1/2 Ab tests
–  HBs Ag test
–  HCV Ab test
–  Serologic test for Sy
–  Detec6on of malarial parasite
HEMAPHERESIS
•  whole blood is removed from a person, an6coagulated, and
separated into components; the desired components are
retained, and the unwanted por6ons remaining are returned to
the donor
•  can be used to obtain components intended for transfusion
(platelet, granulocytes, plasma)—Apheresis DonaHons
(plateletpheresis, granulocytapheresis, plasmapheresis)
•  can be used to remove pathologic elements, cells
(cytapheresis), or dissolved plasma factors circula6ng in the
blood—TherapeuHc Hemapheresis (e.g., PV, leukemia,
thrombocytosis, sicke cell anemia, hyperviscosity syndrome,
MM, MG, Goodpasture syndrome, TTP, MS, RPGN, and
autoimmune diseases)
•  hemapheresis machines used cell/plasma separators that
separate components by centrifugal force, or some used special
membrane technology that allow plasma but not cellular
elements to pass through the membrane
DIRECTED TRANSFUSIONS
•  pa6ent directly solicits blood from family and friends, based on
the false assump6on that blood donated by family and friends is
safer than that from the regular volunteer donor
•  directed donor is under more pressure to donate than the
anonymous donor
•  confiden6ality has been surrendered in this system, because the
donor's iden6ty is known by the recipient
•  one main advantage: posi6ve psychological benefit to pa6ents
and donors
MASSIVE TRANSFUSIONS
•  amount of blood transfused > pa6ent's blood volume within 24
hours
•  give 10 units of platelets and 2 units of FFP with each 10 units
of PRBC transfused
•  for very rapid infusion of whole blood, Ca gluconate infusion
might be considered to overcome citrate toxicity
•  blood warmer should be used to prevent hypothermia
AUTOLOGOUS BLOOD TRANSFUSION
•  use of pa6ent's own blood for transfusion, reduces many of the
risks related to blood transfusion, but the risks of volume
overload, bacterial contamina6on, and mislabeling of the unit
may also occur
•  indica6ons
–  pa6ents with mul6ple RBC alloAbs, leukocyte Abs
–  pa6ents with IgA deficiency
–  pa6ents with reac6ons to plasma proteins
–  pa6ents refractory to platelet transfusions
–  as an alterna6ve to homologous transfusion—young
females, religious sects, blood in short supply
•  Forms of autologous blood transfusion:
1.  Preopera6ve deposit—most widely used
–  units of whole blood are donated by the pa6ent before an
elec6ve surgery that will likely require transfusion
–  pa6ents with sepsis, significant anemia, and severe medical
condi6ons are excluded
–  Hb and Hct should not be < 11 g/dL and < 33%, respec6vely
–  should not be more frequent than every 3 days, final
dona6on must be completed at least 3 days before the
scheduled procedure (this allows the donor's plasma
volume to return to normal before surgery), oral iron therapy
is recommended
2.  Immediate preopera6ve hemodilu6on
–  involves removal of 1 or more units of whole blood
immediately before surgery with crystalloid or colloid
replacement, blood is then reinfused during or aTer the
procedure
–  performed if the an6cipated blood loss is 1L or 20% of the
pa6ent's blood volume
–  pa6ents with sepsis, significant anemia, and severe medical
condi6ons are excluded
–  preopera6ve Hb should be > 12 g/dL
–  surgical bleeding occurs at a lower Hct—amount of RBC loss
is less
–  donated blood is fresh and contains viable platelets,
adequate levels of CFs and protein
3.  Intraopera6ve blood salvage
–  blood from the surgical field is collected, processed (filtered
and washed), and returned to the pa6ent during or aTer
surgery
–  surgical field must be free from tumor cells, bacteria, and
other contaminants
–  blood is discarded if transfusion has not begun within 6
hours
4.  Postopera6ve blood salvage
–  drainage tube is placed in the surgical site and
postopera6ve bleeding is salvaged, processed, and
reinfused
–  collected blood is dilute, par6ally hemolyzed and
defibrinated and may contain high concentra6ons of
cytokines
–  blood is discarded if transfusion has not begun within 6
hours
BLOOD COMPONENTS FOR TRANSFUSION
CELLULAR BLOOD CONTENTS STORAGE USE POSSIBLE HAZARDS
PRODUCTS
WHOLE BLOOD (WB) Volume= 500 mL 1-‐6oC RBC replacement and volume Viral transmission, RBC
Contains RBCs, plasma, an6-‐ ACD= 14 days expansion with CFs e.g., massive, incompa6bility causing hemolysis,
FRESH WB (FWB) coagulant, liqle to no platelet CPD= 21 days transfusion, heavy surgical bacterial contamina6on, febrile
*Must be transfused ac6vity, no viable granulocytes, CDPAI= 35 days bleeding, burn pa6ents reac6ons, volume overload, citrate
within 24 hours diminished F VIII and V levels CDPA2= 42 days toxicity, allergic response, GVHD
If platelets are to be *1 unit raises the Hb by 10 g/L
harvested: (1 g/dL)
20-‐24°C within 6
hours post-‐dona6on
PACKED RBC (PRBC) Volume= 250 mL Same as WB RBC replacement for increased Same as WB
Contains RBCs, small amount of oxygen-‐carrying capacity,
plasma, an6coagulant, liqle or no symptoma6c anemia, and
platelet ac6vity, granulocyte ac6vity, preopera6vely
or CFs
*RBC with addi6ve Volume= 340 mL I -‐6°C Can be used like WB or PRBC
solu6on (adenine-‐ 42 days
saline)
PLATELETS Volume= 50 -‐60 mL 20-‐24°C Thrombocytopenia Viral transmission, bacterial
*Maybe from a single Contains platelets, WBCs, fresh 5 days with Thrombasthenia contamina6on, febrile reac6ons,
donor plasma, an6coagulant agita6on volume overload, allergic
(plateletpheresis) or *1 unit raises the platelet count response, GVHD
pooled from several by 10,000/uL
donors
FRESH FROZEN VOLUME= 250 mL -‐18 to -‐30°C Replacement of CFs in mul6ple Viral transmission, allergic
PLASMA (FFP) Contains fresh plasma, all CFs, 1 year factor deficiencies, undefined reac6ons, volume overload,
an6coagulant factor deficiencies, TTP hemolysis
*ATer thawing store
at 1-‐6°C up to 24
hours
CRYOPRECIPITATE 15 mL -‐18 to -‐30°C Replacement of F VIII, XIII, I, vWF Viral transmission, allergic reac6ons
Contains F VIII, XIII, I, fibronec6n, I year deficiency
*Cold insoluble por6on vWF
of plasma aTer FFP has
been thawed between *ATer thawing store
…BLOOD COMPONENTS FOR TRANSFUSION
CELLULAR BLOOD CONTENTS STORAGE USE POSSIBLE HAZARDS
PRODUCTS
CRYOSUPERNATE 200 mL -‐18 to -‐30°C Replacement of CF deficiencies Viral transmission, allergic reac6ons
*Residual plasma Contains fresh plasma, all CFs I year except FVIII
refrozen aTer removal except FVIIl, an6coagulant
of cryoprecipitate *ATer thawing store
at I-‐6°C up to 24
hours

GRANULOCYTE 250 mL 20-‐24°C Severe neutropenia with ac6ve Febrile, nonhemoly6c reac6ons,
CONCENTRATE Contains fresh, viable granulocytes 24 hours infec6on and no response to viral transmission, pulmonary
and other leukocytes, plasma, an6bio6cs, congenital granulo-‐ reac6ons, hemolysis,
*Collected by apheresis an6coagulant cyte dysfunc6on
May contain platelets, RBCs

Leukocyte-‐reduced 350 mL 1.Washed-‐RBC *RBC Preven6on of
RBC s Contains RBCs, some WBC s and washed with 1.  febrile transfusion and
platelets compa6ble solu6on allergic reac6ons due to
to reduce WBCs WBCs or plasma proteins
1-‐6°C 2.  forma6on of HLA Abs in
24 hours mul6ply transfused pa6ents
2. Filtered-‐RBC 3.  anaphylac6c reac6ons in IgA
*leukocyte-‐ deficiency
reduc6on 4.  risk of CMV and other WBC
filters associated viral infec6ons
20-‐24°C
6 hours
3. Frozen deglyce-‐ Same as washed and filtered
rolized RBCs RBC, also useful for rare blood,
-‐65°C or colder autotransfusion
10 years
*1-‐6'C
24 hours aTer wash
4. Irradiated RBC *y-‐
irradiated blood Preven6on of TAGVHD, in
with viable WBCs congenital T-‐cell immunodefi-‐
ciencies, BMT recipients, fetuses
ALTERNATIVES TO BLOOD TRANSFUSION
•  Surgical Blood Conserva6on Methods
–  improved surgical hemostasis
–  reduced diagnos6c blood loss
–  autologous transfusion
•  Pharmacological Interven6ons
–  s6mulate blood replacement—r-‐hEPO , thrombopoie6n,
GM-‐CSF, G-‐CSF, M-‐CSF, IL-‐1, IL-‐2, IL-‐3, IL-‐6, IL-‐11
–  serve as blood subs6tute or oxygen carrier
•  perflourocarbons
•  Hb solu6ons and encapsulated Hb
–  reduced blood loss
•  DDAVP or desmopressin acetate—increases plasma level of F
VIII and vWF
•  topical agents e.g., fibrin glue, fibrin gel
•  agents that preserve platelet func6on e.g., dipyridamole,
prostacyclin, heparin
•  an6fibrinoly6c agents e.g., €-‐aminocaproic acid, tranexamic
acid, apro6nin

Key Points:
1.  Most blood bank tests are performed to find compa6ble
blood for transfusion and involve tes6ng for RBC Ags and
Abs.
2.  Proper labeling of the blood specimen for blood bank tes6ng
is of paramount importance in ensuring a safe transfusion, as
is proper iden6fica6on of the recipient at the 6me of
transfusion.
3.  The presence of an Ab to an RBC Ag in a pa6ent's serum
complicates the procurement of compa6ble blood for
transfusion. Addi6onal 6me must be allowed prior to the
an6cipated transfusion.

4.  The ABO blood group is the most important RBC Ag system
clinically. Mul6ple tests in the pretransfusion work-‐up are
performed to ensure the ABO compa6bility of blood
components, because transfusion of ABO incompa6ble
units may be life-‐threatening.
5.  The D Ag in the Rh blood group is one of the most
immunogenic RBC Ags in humans. Therefore, units of blood
compa6ble with the recipient's Rh (D) type are issued
whenever possible.
6.  The direct Coombs' test detects IgG Ab and/or C3
complement fragments on the surface of RBCs. The indirect
Coombs' test detects RBC Ab in the pa6ent's serum.
7.  During pregnancy, maternal IgG Ab to RBC Ags can cross
the placenta into the fetal circula6on and cause hemolysis
of fetal RBCs bearing the Ag (HDN). Prenatal screening is
performed by the blood bank to iden6fy fetuses at risk for
this disease.

THANK YOU AND GOOD PM.

Immunohema Transfusion Med

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• encompasses the performance of laboratory exams, evalua6on

COMPARISON OF WIENER, FISHER-­‐RACE, AND ROSENFIELD NOMENCLATURES FOR

WIENER FISHER-­‐RACE ROSENFIELD

ROUTINE Rh TYPING

Perform weak D test (Du)—add AHG:

RELATIONSHIP of OLD AND NEW NOMENCLATURE

LW1 LW (a+b-­‐) or LW (a+b+) + +/-­‐

PHENOTYPES OF THE LEWIS SYSTEM

The I and i ANTIGENS

iadult Weakest Strongest Rare

icord Weak Strong All newborns

Iint Strong Weak Rare adults

I Strongest Weakest Almost all adults

PHENOTYPES AND ASSOCIATED ANTIGENS IN THE P SYSTEM

Phenotype AnHgens produced

PHENOTYPES OF THE MNSs SYSTEM

PHENOTYPES OF THE LUTHERAN SYSTEM

10. Duﬀy System

PHENOTYPES OF THE DUFFY SYSTEM

11. Kidd System

PHENOTYPES OF THE KIDD SYSTEM

H Hemolysis, presence of free Hb 10

Grade MeanHme Score

• detects unexpected Abs in the pa6ent's serum directed against

• performed if Ab screen is (+)

• principle: speciﬁc AHG Abs act as a bridge that induces

• Rh immune globulin (Rhogam) therapy—usually given postpartum to

THANK YOU AND GOOD PM.

Das könnte Ihnen auch gefallen

•  encompasses the performance of laboratory exams, evalua6on

COMPARISON OF WIENER, FISHER-‐RACE, AND ROSENFIELD NOMENCLATURES FOR

WIENER FISHER-‐RACE ROSENFIELD

LW1 LW (a+b-‐) or LW (a+b+) + +/-‐

10.  Duﬀy System

11.  Kidd System

•  detects unexpected Abs in the pa6ent's serum directed against

•  performed if Ab screen is (+)

•  principle: speciﬁc AHG Abs act as a bridge that induces

•  Rh immune globulin (Rhogam) therapy—usually given postpartum to