Chapter 22: Blood Banking I. Introduction II. Blood donation A.

Allogeneic (for another person), autologous (for later transfusion to the donor) or directed (designated for a particular recipient) B. FDA - criteria for acceptability of blood donors C. Single blood donations 450 mL of whole blood 1. Processed into components of RBCs, plasma and platelets 2. Apheresis- process of removing whole blood separating a portion and returning rest to donor a. Less effect on blood volume so greater amount can be collected from one donor 3. Leukocyte components that include granulocytes, nonnuclear cells and hematopoietic progenitor cells collected only by apheresis III. Donor Testing A. Tested fro markers of infectious diseases that may be transmitted by transfusion B. Transfusion transmitted disease tested fro in donor blood are HIV, hepatitis B, hepatitis C, syphilis, and human T cell lymphoma leukemia virus types I and II C. Reduce rate of serious transfusion transmitted disease has come from exclusion of donors with risk factors IV. Characteristics of donated blood - changes that affect post transfusion efficacy A. Stored RBCs lose 2,3 diphosphoglycerate and leak potassium. They also age B. Labile coagulation factors V and VIII are gradually lost from plasma C. Platelets - expressions of activation markers, degranulation and apoptosis like events D. Leukocytes in stored RBCs and platelets undergo activation during storage which can result in release of cytokines and other biologic response modifiers 1. Pyrogenic cytokines (IL 1 and TNF) - febrile reactions 2. Chemokines (IL 8) function of c circulating leukocyte populations and cause impaired immune and inflammatory responses 3. Lipid mediators similar to platelet activating factor may prime neutrophils to respond briskly to secondary inflammatory stimuli V. Blood group serology and pretransfusion testing A. Formation of antibodies 1. Immune responses that cause antibodies to form against cellular antigens with rejection of the transfused cells a. Antibodies in the ABO system are naturally occurring. Usually form in first months of life as result of exposure to environmental bacterial antigens i. Anti A and anti-B are IgM an IgG, fix complement and cause rapid intravascular hemolysis b. Antibodies to most other blood groups (Rh system) are made in response to previous exposure (previous transfusion or pregnancy) i. Antibodies usually IgG, do not fix complement and cause extravascular hemolysis 2. Autoantibodies - antibodies to patients own RBCs may occur and cause hemolysis such as autoimmune hemolytic anemia (AIHA)

a. Autoantibodies may be secondary to certain diseases such a SLE or chronic lymphocytic leukemia b. Can be benign and not cause cell destruction c. Usually react with epitopes common to all blood donors B. Detection of antibodies 1. Necessary to detect RBC antibodies to provide compatible blood. Tests based on agglutination (clumping of RBCs caused by crosslinking of cells by antibodies). Abs in the ABO system and other IgM antibodies can directly agglutinate RBCs. Most IgG antibodies required secondary antibody, anti IgG (antihuman globulin, Coombs serum) for detection by agglutination a. RBCs coated with IgG in circulation (AIHA or during hemolytic transfusion reaction) - detected by direct antiglobulin test (DAT) also known as the Coombs test b. Circulating antibodies in plasma ay be detected by indirect coombs test. Test RBCs are incubated with serum, excess unbound IgG washed away and RBCs are tested for bound antibody with antiglobulin serum c. Temp dependent. Detection of most IgG RBC antibodies requires testing at 37 degrees Celsius d. Not all RBC Abs clinically significant 2. Testing for RBC antibodies useful in diagnosis of some anemias a. DAT detects IgG on surface of RBCs in warm AIHA b. DAT performed with anti-complement serum and detect complement activation products on RBC surface, usually positive in cold hemagglutinin disease c. Some drug induced hemolytic anemias have positive DAT d. RBC autoantibodies may be found in autoimmune diseases such as a systemic lupus erythematous C. Pretransfusion testing 1. Routine pretransfusion testing consists of ABO typing (testing for A and B antigens and the corresponding anti A or anti B in the serum; Rh typing (testing for Rh (D) antigen) and screening for other RBC antibodies a. Screening is an indirect coombs test using RBCs for 2 or 3 group O selected donors of known phenotype that are positive for the most common clinically significant RBC antigens b. If ABO type is inconclusive or if antibody screen is positive, further resting is required c. RBC antibodies identified using panels of typed donor cells. When an antibody is identified, donor units are typed to find ones that re negative for that specificity 2. Final check is the cross match. Serological cross matching involves incubating the donors RBCs with the recipients serum, checking for agglutination and performing an antiglobulin test. The most important purpose is to detect ABO incompatibility. If the patient has a negative antibody screen, it is possible to perform an electronic cross match using a computer to verify ABO compatibility 3. In emergencies, group O RBCs can usually be given safely

a. Group O Rh negative RBCs are often selected to avoid sensitization to Rh(D) b. Group O Rh positive RBCs may be used if there is no risk of alter hemolytic disease of newborn