Dr. P.Karpagam Kiruba Rajeswari, M.B;B.S, D.C.P.

,
Blood Bank Medical Officer,
MAPIMS.
Composition of blood
Composition of blood
 Oxygen supply to tissues ( bound to Hb present in RBCs.)

 Supply of nutrients  glucose, amino acids, and fatty acids (dissolved in the
blood or bound to plasma proteins.

 Removal of waste  carbon dioxide, urea, and lactic acid.

 Immunological functions  circulation of white blood cells, detection of

foreign material by antibodies.

 Coagulation mechanism  to stop bleeding.

 Transport of hormones.

 Regulation of body pH.

 Regulation of core body temperature

 Process that takes place in the laboratory to
ensure that donated blood, or blood
products, are safe before they are used in
blood transfusions and other medical
procedures.

 Includes typing the blood for transfusion and

testing for infectious diseases.
 A  blood bank is a
bank of
blood or blood
components,
gathered
as a result of blood
donation, stored
and preserved for
later use in blood
transfusion.
 Differences in human blood types – d/t presence/absence of certain
CARBOHYDRATE molecules –> ANTIGENS & ANTIBODIES.

 Antigens  Surface of RBCs.

 Antibodies  Blood plasma.

 The blood group you belong to depends on what you have inherited from your
parents.

 > 22 major blood group systems named after specific antigens on the RBC
membrane. Clinically most important  ABO & Rh.
 Others – Lewis, Kell, Kidd, Duffy, MN, I, P, Lutheran, Diego, Cartwright, Xg,
Dombrock, Colton, Se, Chido/Rogers, Hh, Kx, Ge etc.

 Mixing incompatible blood groups  clumping/agglutination – dangerous for

individuals BLOOD GROUPING – VERY IMPORTANT!!!
 Many people – have an
ANTIGEN  Rh factor
on RBC surface.

 If Rh factor – present
 Rh POSITIVE &
absent  Rh
NEGATIVE.
ABO - incidence Rh incidence

O group - 40 % Rh positive - 95%

B group - 33 % Rh negative - < 5 %

A group - 22 %

AB group - 5%
 Rare but harmless  Bleeding from the
donor is stopped at the
 Include first sign of the
syncope/fainting, reaction.
tetany, nausea and
vomiting, hematoma  Managed according to
and convulsions. the reaction.

 Cardiac arrest –
extremely rare.
 HIV

 Hepatitis B

 Hepatitis C

ELISA
 Syphilis 

VDRL

 Malaria 

PERIPHERAL SMEAR
 To detect red cell antibodies  Tests involve testing patients’
other than anti-A & anti-B. & donors’ sera against 2-3
reagent RBCs – screening cells.
 UNEXPECTED ANTIBODIES. Group O cells are used.

 Present in only 0.3-2.0% of the  Two specially selected group

population. OR1R1 & OR2R2 red cells
carrying clinically significant &
 Higher in women d/t pregnancy. commonly encountered
antigens – Rh, Kell, Duffy, Kidd,
 Unexpected Antibodies MNSs, P and Lewis are used.
1. Shortens survival of transfused
red cells.  If panel – not available – fresh
2. Hemolytic TRs pooled cells of 2 – 3 group O
3. Hemolytic ds. Of newborn. blood – used.
 Blood is collected as whole blood

 Blood can be stored as whole blood

as packed red blood cells (PRBC's)
in which about 70% of the plasma
has been removed.
This is done by light centrifugation
 The platelet rich plasma
can then be expressed
off, leaving packed
red blood cells (PRBCs).

 The plasma can be

centrifuged heavily a second
time to separate the
platelet rich plasma.
 The supernatant plasma is expressed into a third bag
and stored as fresh frozen plasma (FFP). Remaining
platelet rich plasma is utilized as a platelet pack
 Blood Storage
component temperature Shelf life

Whole blood + 4°C 35 days

Packed red blood cells + 4°C 35 days

Fresh frozen plasma - 30 ° C 1 year

Platelet concentrates + 22 ° C 5 days

 Upon request for whole blood or its
components – cross matching – done to
ensure compatibility between the donor and
the recepient.
 Major cross – match  Recepient’s serum x
Donor’s red cells
 Minor cross – match  Donor’s serum x
Recepient’s red cells
Blood is issued from the blood bank along with the
following:
1. Compatibility form.
2. Certified to be tested for infectious diseases
mentioned earlier.
3. Transfusion reaction form to be returned to the blood
bank after transfusion duly filled in.

 The appropriate product is brought to the ward for

transfusion
 IMMUNE MEDIATED NON-IMMUNE MEDIATED

ACUTE DELAYED
( ONSET WITHIN < 24 HRS.) (ONSET WITHIN DAYS/MONTHS)
 ACUTE DELAYED

 Hemolytic  Hemolytic

 Febrile non hemolytic  PRIMARY ALLOIMMUNIZ

ATION
 Allergic
 Post – transfusion purpura
 Anaphylactic
 Graft vs host disease
 TRALI
 Immunomodulation
 D/t transfusion of incompatible
red cells in a pt. already
immunized by previous
transfusion.
 D/t incompatibility of Rh & other
blood group systems.
 Few days after transfusion  Ab
conc. increases  Delayed
hemolytic reactions.
 3.
No rn. at the time of transfusion.
 Delayed signs & symptoms  Fall
in Hb, rise in bilirubin mild
jaundice, Renal failure  very rare.
 Management:
1. Transfusion with compatible blood
if required.
2. When RBC antibodies – identified
by the blood bank – patients
should be informed – couselled to
provide the info when hospitalized
elsewhere.
Pt. should carry a transfusion alert
card.
 ACUTE DELAYED
 Bacterial contamination  Transfusion associated
infections
 Circulatory overload 1. Hepatitis B & C
 2. HIV 1 & 2
Physical/Chemical damage
to RBCs 3. Syphilis
4. Malaria
 HYPERKALEMIA
 Iron overload
 CLERICAL ERRORS TECHNICAL ERRORS
 Incorrect labelling of blood  Error in blood grouping & cross
bag/recepient’s sample. matching

 Improper method of cross –

 Confusion in the identity of the matching.
patient during sample
collection/ transfusion.  Weak antibodies not detected by
routine tests.
 Improper identification of
 Destruction of recepient’s red cells by
patient’s blood sample by blood
donor antibodies.
bank technician.
 Incorrect intepretation of test results.
 Wrong blood issued.
 In both – Initial event 
binding of the patient
antibody to the antigen on
the surface of transfused
incompatible red calls 
Ag – Ab complexes

INTAVASCULAR HEMOLYSIS EXTRAVASCULAR HEMOLYSIS

Ag – Ab complexes Ag – Ab complexes

Activate complement No complement activation

Red cell hemolysis No RBC lysis in the

intravascular circulation
Hemoglobin and stroma of
red cells – liberated in the No release of Hb and red cell
circulation stroma
 Fever + or – chills
 Pain at infusion site
 Chest pain / flank pain
 Respiratory distress
 Oozing from IV line
site
 Anaesthetized pt. 
oozing from surgical
site, hypotension,
pink/red urine d/t
hemoglobinuria.
 Oliguria
 Anuria
 Shock
 Dryness and flushing of  Abdominal cramps
skin
 Hemoglobinuria
 Severe hypotension
 Shock
 Fever & chills
 Renal failure
 Muscular pain
 DIC
 Vomiting
 Treatment depends on the amount of
incompatible/contaminated/hemolyse
d blood transfused,the specificity of
the offending antibody and the
clinical severity of the reaction.

 Inform the patient’s physician

 Stop the transfusion –
disconnect the entire infusion
set from the needle.
 With a new infusion set keep
the IV line open with Normal
saline drip.
 Check blood bag label,cross-
matching report and confirm
that the patient receieved the
correct unit of
blood/component.
immediately.
 Notify blood bank.
 Post-transfusion fresh blood
sample ( 10 ml in plain tube and 2
ml in EDTA) taken from another
vein – sent to the blood bank
with blood bag,transfusion set &
transfusion reaction report.
 First voided urine – sent to the
lab to check for free Hemoglobin.
 Ensure that there was no clerical
error – check patient’s identity,
donor blood & relevant papers.
 Compare colour of pre – and post –
transfusion blood specimens.
1. Pink/red colour => free Hb d/t red
cell destruction.
2. Yellow/brown colour => increased
bilirubin.
 Colour of blood in bag
 Purple colour/clots in the blood bag
but no colour change in the
segments – d/t bacterial
contamination.
 Colour change in both bag and
tubing => hemolysis.
 Check for any error in ABO & Rh
typing – Pre- and post-transfusion
blood samples ,blood from the
bag/segments.
 DCT on the patient’s blood to
check for any antibody ( IgG)
coating on the red cells in case of
incompatibility.
 Bacteriological smear and culture
of donor’s blood – to rule out
bacterial contamination.
 LABORATORY TESTS

NEGATIVE POSITIVE

1. Repeat cross match – both pre and post

No Hemolytic reaction transfusion samples against sample of blood
from the bag/segment.

2. Screen for irregular antibodies in both pre and

post transfusion samples and sample of blood
from the bag/segment.

3. If irregular antibodies detected – identify the

antibodies in the recepient and the
corresponding antigens on the donor’s red cells