MILA AMOR V.

REYES, MD, FPSP

ANATOMIC AND CLINICAL PATHOLOGIST
IMMUNOHEMATOLOGY

defines the immunologic properties and reactions of all
blood components and constituents

encompasses the performance of laboratory exams,
evaluation of results and reactions, and additional
procedures as required for the study of the pathogenesis,
diagnosis, prevention and management of immunization
(sensitization) associated with transfusion, pregnancy,
and organ transplantation

TRANSFUSION MEDICINE

represents a section of clinical pathology that involves the
transfusion of blood, its components, and its derivatives

BLOOD GROUP SYSTEM

1. ABO SystemA Ags(A
1
-80%, A
2
-20%), B Ags; anti-A, -B,
-A,B Abs (usually IgM)
serum should contain anti-A or -B Abs to those A or B Ags
that the RBCs lack


ROUTINE ABO GROUPING
Forward ABO
grouping
Patient's RBC against
known antisera
Reverse ABO
grouping
Patient's serum
against known RBCs
Interpretation
Anti-A Anti-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 until the
age of 2 years
they do not have the appropriate Abs, production of these
Abs is triggered soon after birth by exposure through
ingestion or inhalation of antigenic substances in nature
(e.g., bacterial polysaccharides, plant pollens) with the
same characteristics as the A and B Ags"naturally
occurring Abs
detectable levels of ABO agglutinins 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 genesexpression of A and B Ags depends on the
presence of H gene (HH/Hh, hh)
H geneexpression of H Ag depends on the presence
of Se gene in the secretory glands and Z gene on the
RBC membrane
Se genesSeSe/Sese "secretors" (80% of the
population); soluble H, A, or B substances may be
detected in their saliva and other secretory fluids
sese"nonsecretors" (20%)



Z geneallows the expression of H gene on the
erythrocyte membrane (ZZ/Zz, zz)
"Bombay phenotype
(1)classic (Oh) phenotypeabsence of H gene (hh),
inherited ABO genes cannot be expressed on the RBC
or in the secretions, anti-A, -B, -H Abs are present in
serum
(2)Hz phenotyperare, absence of Z gene (zz), may
express A, B, or H substances in the secretions,
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
Rh
O
rh
rh
hr
hr
D
C
E
c
E
Rh1
Rh2
Rh3
Rh4
Rh5


Rh typing is performed to established the presence or
absence of the D Agmost immunogenic Ag (exposure to
this Ag in Rh(-) persons is highly likely to result in
formation of an alloAb)

ROUTINE Rh TYPING
Anti-Rh Interpretation
+ Rh positive

-
Perform weak D test (D
u
)add AHG:
+ Rh positive
- Rh negative


individuals do not consistently have anti-D Ab when they
lack the D Ag
anti-Rh is formed only following exposure to Rh Ag during
pregnancy and transfusion
anti-Rh usually IgGcrosses the placenta
Rh(+) can receive both Rh(+) and Rh(-) blood; Rh(-) must
receive only Rh(-) blood
in urgent situations, an Rh(-) may receive Rh(+) blood, if
Rh(-) blood is unavailable; however, the patient 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 Reactions with Anti-
LW
a
LW
b

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 Reactions with
Anti-
Le
a
Le
b

Le (a+b-) + -
Le (a-b+) - +
Le (a-b-) - -
Le (a+b+) + +


5. I and i System

The I and i ANTIGENS
Phenotype Relative Ag Strength Incidence
I i
i
adult
Weakest Strongest Rare
i
cord
Weak Strong All newborns
I
int
Strong Weak Rare adults
I Strongest Weakest Almost all
adults


6. P System

PHENOTYPES AND ASSOCIATED ANTIGENS IN THE P SYSTEM
Phenotype Antigens produced
P
1
P
1
, P
P
2
P
P
1
k
--
P
2
k
P
1
, P
k

P P
k



7. MNSs System
Phenotyp
e

Reactions with Anti-
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+
+
+
-
-
+
+



+
+
-
-
-



-
+
+
-
-



+
+
-
-
+
PHENOTYPES OF THE MNSs SYSTEM


8. Lutheran System


Phenotype Reactions
with Anti-
Lu
a
Lu
b
Lu (a+b-)
Lu (a+b+)
Lu (a-b+)
Lu (a-b-)
+
+
-
-
-
+
+
-
PHENOTYPES OF THE LUTHERAN SYSTEM


9. Kell System


Phenotype Reactions with Anti-
K k Kp
a
Kp
b
Js
a
Js
b
K+k-
K+k+
K-k+
Kp (a+b-)
Kp (a+b+)
Kp (a-b+)
Js (a+b-)
Js (a+b+)
Js (a-b+)
K
o
+
+
-






-
-
+
+






-



+
+
-



-



-
+
+



-






+
+
-
-






-
+
+
-
PHENOTYPES OF THE KELL SYSTEM


10. Duffy System


Phenotype Reactions with Anti-
Fy
a
Fy
b
Fy (a+b-)
Fy (a+b+)
Fy (a-b+)
Fy (a-b-)
+
+
-
-
-
+
+
-
PHENOTYPES OF THE DUFFY SYSTEM


11. Kidd System


Phenotype Reactions with Anti- Jk
a
Jk
b
Jk
ab
Jk (a+b-)
Jk (a+b+)
Jk (a-b+)
Jk (a-b-)
+
+
-
-
-
+
+
-
+
+
+
-
PHENOTYPES OF THE KIDD SYSTEM
IMMUNOHEMATOLOGY TESTS AND
PROCEDURES

tests performed by the BB involve the detection of surface
Ags on blood cells or Abs to blood cells, most commonly
RBCs
antibodies detected may be:
1. Alloantibodiesdirected against antigens absent from the
patients own RBCs (usually stimulated by previous exposure
to foreign antigens)
2. Autoantibodiesdirected against antigens present on the
patients own RBCs
surface Ags on RBCs are identified when agglutination
occurs following mixture of patient's RBCs with known
reagent antisera containing Abs
Hemagglutinationsingle most important reaction in the
BB, end-point of almost all test systems designed to detect
erythrocyte Ags and Abs



Factors affecting hemagglutination:
temperatureoptimum temperature for IgM 24C or
4C; IgG 37C
pH6.5 to 7.0 optimal for most blood group Abs
time of incubationblood group Abs are usually
detectable using incubations between 15 and 60 mins
Ag density and accessibilitytype, number, and
location of Ags
Ab concentrationability of Ab to cause agglutination
depends on the minimum number of Ab molecules
attached/RBC
centrifugationAb-sensitized RBCs physically are
brought closer together (supply centrifugal force)



enhancement media
low ionic strength solutions (LISS)
polyethylene glycol (PEG)
proteolytic enzymes (reduce negative charges)
albumin (reduce negative charges)
Polycationspolybrene, protamine (supply cations)
AHGAbs to human globulin or complement
components act as bridges between erythrocytes already
sensitized with Ab or C
non-specific aggregation
Roleaux formationhigh concentrations of serum proteins
(e.g., Multiple myeloma, Waldenstrom's
macgroglobulinemia, Hyperviscosity syndromes)




x Grading of reactions
+ hemolysisusually indicates a potent antibody capable
of fixing complement in vitro
+ agglutinationobserved and graded according to the
strength of the reaction

Grade Meaning Score
H
4+
3+
2+
1+
+
-
Hemolysis, presence of free Hb
One solid aggregate
Several medium to large aggregates
Many small to medium aggregates with a clear background
Many small aggregates with a turbid background
Few small aggregates, many unagglutinated RBCs
Absence of aggregates
10
10
8
5
3
2
0


all negative reactions when required by the procedure,
should be read under a microscope and recorded

Grade Meantime Score
+
m
-
mf

R

Presence of microscopic aggregates
Absence of aggregates
Presence of minor population of aggregates (aka,
mixed field agglutination)
Rouleaux, appearing like stacks of coins, disappears
with addition of saline

1
0
ANTIBODY SCREENING

detects unexpected Abs in the patient's serum directed
against RBC Ags
patient'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 agglutination of the cellsproteolytic enzymes,
albumin, polycations
incubation of the mixture at 37C is performed to help
detect Abs reactive in vivo followed by indirect Coomb's test



no agglutination or hemolysisabsence of any significant
RBC Abs
false(-) reactions occur:
Ab is present in titers below the level of sensitivity 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, P
1
Abs



Naturally occurring Abspresent even if no previous
exposure to foreign RBCs has occurred, e.g., anti-A, anti-B,
anti-Le, anti-P
1
, anti-M
Immune Absoccur only after antigenic stimulation of the
immune system following exposure to foreign RBC Ags via
transfusion or pregnancy, e.g., anti-Rh, anti-K, anti-Jk, anti-
Fy, anti-S, anti-s

TYPE AND SCREEN

ordered when transfusion may be required at some time
during the following 48 to 72 hours, but immediate
transfusion is not anticipated, or when the probability of
transfusion is remote
includes ABO and Rh (D) typing, and Ab screen of patient's
blood
If Ab screen is (-)BB stores the specimen and awaits
further word from the patient's physician about the need
for transfusion
If Ab screen is (+)BB will notify the physician, and if
the possibility of transfusion remains, Ab identification
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 patient
with an RBC Ab
includes ABO and Rh typing, Ab screen (and identification,
if necessary)
units of blood are tested for compatibility with the patient's
serumcrossmatching

ANTI-HUMAN GLOBULIN TEST (COOMBS' TEST)

principle: specific AHG Abs act as a bridge that induces
agglutination of erythrocytes coated with human Ig or
complement
direct AGTused to detect Abs bound to erythrocytes in
vivo
indirect AGTused to detect the reaction of patient, donor
or reagent erythrocytes and appropriate serum or
commercially prepared antisera, in vitro after an appropriate
incubation period



AHGproduced by hyperimmunizing animals, usually
rabbits, with purified Ig or C to produce high-titered, high-
avidity, IgG Abs
applications of DAT:
investigation of HTR
investigation of HDN
investigation of autoAbs
Abs induced by medication
applications of IAT
detection and identification 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 identification is important
check of previous recordsABO typing, Rh typing, Ab
screening and identification of the patient
ABO and Rh typingdonors and recipients
Ab screening and identificationto demonstrate clinically
significant Abs in the patient's serum using reagent RBCs
or screening cells; includes incubation at 37C followed by
IAT




crossmatching
major crossmatchPSDR
minor crossmatchPRDS (rarely done)
Includes saline phase (room temperature), 37C
incubation (usually with albumin as enhancement
medium), followed by IAT
presence of hemolysis or agglutination
INCOMPATIBLE
absence of hemolysis or agglutinationCOMPATIBLE
abbreviated crossmatch"immediate spin" crossmatch (10-
15 mins)
designed to detect ABO incompatibility
performed only if the patient's Ab screening is negative,
with no known history of previous clinically significant
Abs



crossmatching in emergencies
if ABO and Rh type of the patient are not knownO(-)
PRBC are released
if ABO and Rh type of the patient are known (blood
specimen is available and there is time to perform ABO
and Rh typing)type-specific blood are released
physician signs a release form stating that the clinical
situation warrants the release of uncrossmatched blood
continue Ab screen and crossmatch, if Ab screen is (+),
or crossmatch is incompatiblephysician is notified



BB may provide a group-specific (same blood group as
the patient's), or group-compatible (not the exact blood
group, but the donor RBCs are compatible with the patients
serum) blood
Type Ouniversal donor
Type ABuniversal recipient

Recipient Donor
A
B
AB
O
A,O
B,O
AB, A, B, O
O
PRENATAL SCREENING
includes ABO and Rh typing, and Ab screen to detect fetuses at
risk for HDN
HDNAb 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 destructionjaundice
only Abs of the IgG class cross the placenta and enter fetal
blood
severity of the disease varies, depending on the reactivity of the
Ab and Ag involved, and Ab titer
Rh systemfirst newborn usually not affected, most
common because D Ag is so immunogenic
ABO system first newborn usually affected
other blood group system sIgG Abs of the Duffy, Kidd,
and Kell



Treatment: Exchange Transfusionremoves unbound
IgG Ab, excess bilirubin, Ab-coated RBC
blood used should be ABO-compatible 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) therapyusually given
postpartum to Rh(-) mother with Rh(+) fetus within 72 hours
after delivery, in order to prevent her from forming Rh Abs
postpartum screening for the presence of significant fetal-
maternal hemorrhage is necessary
Qualitative testsdemonstrate the presence of fetal cells in
the maternal circulation
Rosette test (detects the presence of D Ag on the
circulating RBCs which signifies that D(+) fetal cells have
leaked into the maternal blood
Quantitative testsdetermine the quantity of fetal RBCs
present
Acid elution test (Kleihauer-Betke method)
demonstrates fetal Hb
Flow cytometry


BLOOD COLLECTION

Basic Qualifications of the Potential Donor
appears to be in good health
age: 18 years old; <18 may donate with written permission from
their legal guardian
body weight: 110 lbs to remove 450 mL of blood collected in 63
mL of anticoagulant; those <110 lbs may donate if volume of
blood donated is decreased in proportion to their weight, and if
volume of anticoagulant is decreased accordingly
unexplained weight loss of >10 lbs is a reason for deferral
temperature: not > 37.5C
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%, respectively



Deferrals
Permanent
high-risk history for AIDS:
1. men who have had sex with another man any time
since 1977
2. hemophiliacs
3. IV drug abusers, either past or present
4. persons who have engaged in sex for money or drugs
any time since 1977
confirmed (+) laboratory test for AIDS; symptoms of AIDS
history of viral hepatitis after age 11
donor implicated in a post-transfusion hepatitis or AIDS
case




confirmed (+) test for: HBs Ag, anti-HBc, HCV Ab, HTLV-
1/2
malignant solid tumors except basal cell CA of skin, CIS
of cervix, hematologic malignancies
chemotherapeutic agents administered for malignancy
chronic cardiopulmonary, liver, or renal disease
serious abnormal bleeding tendencies
those who have taken etretinate for psoriasis



Temporary
active disease under treatment: cold, cough, flu,
tuberculosis, Sy, infections
curable diseases of the heart, lung, kidney, liver, and GIT
treatment with antibiotics
for 3 years: immigrant coming from an area considered
endemic for malaria, 3 years after departure; those who
have had a diagnosis of malaria, 3 years after becoming
asymptomatic
for 1 year: after hepatitis B Ig administration, therapeutic
rabies vaccination, rape victims, healthcare workers with
percutaneous exposure to blood or body fluids, close
contact with viral hepatitis, tattoo, sexual contact with a
prostitute or persons in a high-risk group for AIDS,
incarceration in jail for > 72 consecutive hours,
transfusion of blood components, travel to areas endemic
for malaria




for 2 months: recent blood donation
for 6 weeks: following delivery of a baby
for 1 month: rubella vaccination, after cessation of
isotretinoin for acne treatment, after cessation of
finasteride for NPH
for 2 weeks: after vaccination with OPV, measles, mumps
or yellow fever, after the immune reaction to smallpox
vaccination
for 48 hours: after hemapheresis

TESTING OF DONOR BLOOD
ABO and Rh typing, Ab screening (history of transfusion
or pregnancy)
Required screening test for infectious diseases (DOH)
HIV 1/2 Ab tests
HBs Ag test
HCV Ab test
Serologic test for Sy
Detection of malarial parasite

HEMAPHERESIS
whole blood is removed from a person, anticoagulated,
and separated into components; the desired components
are retained, and the unwanted portions remaining are
returned to the donor
can be used to obtain components intended for
transfusion (platelet, granulocytes, plasma)Apheresis
Donations (plateletpheresis, granulocytapheresis,
plasmapheresis)
can be used to remove pathologic elements, cells
(cytapheresis), or dissolved plasma factors circulating in
the bloodTherapeutic 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
patient directly solicits blood from family and friends, based
on the false assumption 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
confidentiality has been surrendered in this system,
because the donor's identity is known by the recipient
one main advantage: positive psychological benefit to
patients and donors

MASSIVE TRANSFUSIONS
amount of blood transfused > patient'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 patient's own blood for transfusion, reduces many
of the risks related to blood transfusion, but the risks of
volume overload, bacterial contamination, and mislabeling
of the unit may also occur
indications
patients with multiple RBC alloAbs, leukocyte Abs
patients with IgA deficiency
patients with reactions to plasma proteins
patients refractory to platelet transfusions
as an alternative to homologous transfusionyoung
females, religious sects, blood in short supply



Forms of autologous blood transfusion:
1. Preoperative depositmost widely used
units of whole blood are donated by the patient before
an elective surgery that will likely require transfusion
patients with sepsis, significant anemia, and severe
medical conditions are excluded
Hb and Hct should not be < 11 g/dL and < 33%,
respectively
should not be more frequent than every 3 days, final
donation 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 preoperative hemodilution
involves removal of 1 or more units of whole blood
immediately before surgery with crystalloid or colloid
replacement, blood is then reinfused during or after the
procedure
performed if the anticipated blood loss is 1L or 20% of
the patient's blood volume
patients with sepsis, significant anemia, and severe
medical conditions are excluded
preoperative Hb should be > 12 g/dL
surgical bleeding occurs at a lower Hctamount of
RBC loss is less
donated blood is fresh and contains viable platelets,
adequate levels of CFs and protein



3. Intraoperative blood salvage
blood from the surgical field is collected, processed
(filtered and washed), and returned to the patient
during or after 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. Postoperative blood salvage
drainage tube is placed in the surgical site and
postoperative bleeding is salvaged, processed, and
reinfused
collected blood is dilute, partially hemolyzed and
defibrinated and may contain high concentrations of
cytokines
blood is discarded if transfusion has not begun within
6 hours

BLOOD COMPONENTS FOR TRANSFUSION
CELLULAR BLOOD
PRODUCTS
CONTENTS STORAGE USE POSSIBLE HAZARDS
WHOLE BLOOD
(WB)

FRESH WB (FWB)
*Must be transfused
within 24 hours
Volume= 500 mL
Contains RBCs, plasma, anti-
coagulant, little to no platelet
activity, no viable granulocytes,
diminished F VIII and V levels
1-6
o
C
ACD= 14 days
CPD= 21 days
CDPA
I
= 35 days
CDPA
2
= 42 days
If platelets are to
be harvested:
20-24C within 6
hours post-
donation
RBC replacement and volume
expansion with CFs e.g.,
massive, transfusion, heavy
surgical bleeding, burn
patients

*1 unit raises the Hb by 10 g/L
(1 g/dL)
Viral transmission, RBC
incompatibility causing
hemolysis, bacterial
contamination, febrile reactions,
volume overload, citrate toxicity,
allergic response, GVHD
PACKED RBC
(PRBC)




*RBC with additive
solution (adenine-
saline)
Volume= 250 mL
Contains RBCs, small amount of
plasma, anticoagulant, little or no
platelet activity, granulocyte
activity, or CFs
Volume= 340 mL
Same as WB




I -6C
42 days
RBC replacement for
increased oxygen-carrying
capacity, symptomatic
anemia, and preoperatively

Can be used like WB or
PRBC

Same as WB

PLATELETS
*Maybe from a single
donor
(plateletpheresis) or
pooled from several
donors
Volume= 50 -60 mL
Contains platelets, WBCs, fresh
plasma, anticoagulant

20-24C
5 days with
agitation

Thrombocytopenia
Thrombasthenia

*1 unit raises the platelet
count by 10,000/uL
Viral transmission, bacterial
contamination, febrile reactions,
volume overload, allergic
response, GVHD
FRESH FROZEN
PLASMA (FFP)
VOLUME= 250 mL
Contains fresh plasma, all CFs,
anticoagulant
-18 to -30C
1 year

*After thawing
store at 1-6C up
to 24 hours
Replacement of CFs in
multiple factor deficiencies,
undefined factor deficiencies,
TTP
Viral transmission, allergic
reactions, volume overload,
hemolysis
CRYOPRECIPITATE

*Cold insoluble
portion of plasma
after FFP has been
thawed between 1-
6C

15 mL
Contains F VIII, XIII, I, fibronectin,
vWF

-18 to -30C
I year


*After thawing
store at RT up to
4hours

Replacement of F VIII, XIII, I,
vWF deficiency

Viral transmission, allergic
reactions

BLOOD COMPONENTS FOR TRANSFUSION
CELLULAR BLOOD
PRODUCTS
CONTENTS STORAGE USE POSSIBLE HAZARDS
CRYOSUPERNATE
*Residual plasma
refrozen after
removal of
cryoprecipitate

200 mL
Contains fresh plasma, all CFs
except FVIIl, anticoagulant

-18 to -30C
I year

*After thawing
store at I-6C up
to 24 hours

Replacement of CF
deficiencies except FVIII

Viral transmission, allergic
reactions

GRANULOCYTE
CONCENTRATE

*Collected by
apheresis

250 mL
Contains fresh, viable granulocytes
and other leukocytes, plasma,
anticoagulant
May contain platelets, RBCs

20-24C
24 hours

Severe neutropenia with
active infection and no
response to antibiotics,
congenital granulo- cyte
dysfunction

Febrile, nonhemolytic reactions,
viral transmission, pulmonary
reactions, hemolysis,

Leukocyte-reduced
RBC s

350 mL
Contains RBCs, some WBC s and
platelets

1.Washed-RBC
*RBC washed with
compatible
solution to reduce
WBCs
1-6C
24 hours
2. Filtered-RBC
*leukocyte-
reduction
filters
20-24C
6 hours
3. Frozen deglyce-
rolized RBCs
-65C or colder
10 years
*1-6'C
24 hours after
wash
4. Irradiated RBC
*y-irradiated blood
with viable WBCs

Prevention of
1. febrile transfusion and
allergic reactions due to
WBCs or plasma proteins
2. formation of HLA Abs in
multiply transfused
patients
3. anaphylactic reactions in
IgA deficiency
4. risk of CMV and other
WBC associated viral
infections


Same as washed and filtered
RBC, also useful for rare
blood, autotransfusion





Prevention of TAGVHD, in
congenital T-cell immunodefi-
ciencies, BMT recipients,
fetuses and premature infants

ALTERNATIVES TO BLOOD
TRANSFUSION
Surgical Blood Conservation Methods
improved surgical hemostasis
reduced diagnostic blood loss
autologous transfusion
Pharmacological Interventions
stimulate blood replacementr-hEPO ,
thrombopoietin, GM-CSF, G-CSF, M-CSF, IL-1, IL-2, IL-
3, IL-6, IL-11
serve as blood substitute or oxygen carrier
perflourocarbons
Hb solutions and encapsulated Hb




reduced blood loss
DDAVP or desmopressin acetateincreases plasma
level of F VIII and vWF
topical agents e.g., fibrin glue, fibrin gel
agents that preserve platelet function e.g., dipyridamole,
prostacyclin, heparin
antifibrinolytic agents e.g., -aminocaproic acid,
tranexamic acid, aprotinin



Key Points:
1. Most blood bank tests are performed to find compatible
blood for transfusion and involve testing for RBC Ags
and Abs.
2. Proper labeling of the blood specimen for blood bank
testing is of paramount importance in ensuring a safe
transfusion, as is proper identification of the recipient at
the time of transfusion.
3. The presence of an Ab to an RBC Ag in a patient's
serum complicates the procurement of compatible blood
for transfusion. Additional time must be allowed prior to
the anticipated transfusion.



4. The ABO blood group is the most important RBC Ag
system clinically. Multiple tests in the pretransfusion
work-up are performed to ensure the ABO compatibility
of blood components, because transfusion of ABO
incompatible 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 compatible 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 patient's
serum.
7. During pregnancy, maternal IgG Ab to RBC Ags can cross
the placenta into the fetal circulation and cause hemolysis
of fetal RBCs bearing the Ag (HDN). Prenatal screening is
performed by the blood bank to identify fetuses at risk for
this disease.




THANK YOU AND GOOD PM.