Transcript BLOOD TRANSFUSION.9.12.2013

BY
DR. FATMA AL-QAHTANI
CONSULTANT HAEMATOLOGIST
1
3
Blood Donation
4
2
5
6
7
8
9
10
11
12
Antibody specificities related to the mechanism of immune
haemolytic destruction.
Blood group Intravascular
system
haemolysis
ABO,H
Extra vascular haemolysis
A,B,H
RH
All
Kell
K
K, k, Kpa, Kpb, Jsa, Jsb
Kidd
Jka
Jka, JKb, Jk3
Duffy
Fya, Fyb
MNS
M,S,s,U
Lutheran
LUb
Lewis
Lea
Cartwright
Yta
Colton
Coa, Cob
Dombrock
Doa, Dob
Glycosyltransfereases produced by genes encoding for
antigens within the ABO, H, and Lewis blood group
system.
Gene
Allele
Transferase
FUT1
H
H
α-2-L-fucosyltransferase
None
A
A
α-3-N-acetyl-D-galactosaminyltransferase
B
B
α-3-D-galactosyltransferase
O
O
None
FUT2
Se
se
α-2-L-fucosyltransferase
None
FUT3
Le
le
α-3/4-L-fucosyltransferase
None
ABO blood group system
Blood group
Subgroup
Antigens on red
cells
Antibodies in
plasma
A
A1
A2
A + A1
A
Anti-B
(Anti- A1)*
B
-
B
Anti-A, Anti- A1
AB
A1B
A2 B
A + A1 + B
A+B
None
(Anti- A1)*
O
-
(H)†
Anti-A
Anti- A1
Anti-B
Anti-A,B†
* Anti- A1 found in 1-2% of A2 subjects and 25-30% of A2B subjects.
† The amount of H antigen is influenced by the ABO group; O cells contain most H
and A1B cells least. Anit-H may be found in occasional A1 and A1B subject (see
text).
† Crossreactivity with both A and B cells.
The “Front Type" determines which antigens ("flags")
in the ABO blood group system are on the patient's Red
Blood Cells as follows:
A antigen only
B antigen only
A and B antigens
Neither A or B
Type A
Type B
Type AB
Type O
The “Back Type" identifies the isohaemagglutinin
(Naturally Occurring Antibody) in the patient's serum and should
correspond to the antigens found on the Red Blood Cells as follows:
Anti-B
Anti-A
Anti-A and anti-B
Neither anti-A or anti-B
Type A
Type B
Type O
Type AB
In addition, RBCs are Rh typed and identified as "D“ positive or
negative
ABO Grouping
-----------------------------------------Reactions of
------------------------------------Cells with
Serum with
------------------------------------Anti-A
Anti-B
A Cells B Cells
Blood Group
(forward grouping) (reverse grouping)
----------------------------------------------0
0
0
+
+
A
+
0
0
+
B
0
+
+
0
AB
+
+
0
0
The most common Rh phenotypes with possible genotypes and frequencies in an English
population (accounting for >99% of all Rh genotypes in this population) 53
Reaction with anti-
Phenotype/most
probable genotype
Possible genotypes
Frequency
DCe/dce/R1
DCe/dce/R1r
DCe/Dce/R1RO
DCe/dCe/R0r’
32.68
2.16
0.05
+
DCe/DCe/R1R1
DCe/DCe/R1R1
DCe/dCe/R1r’
17.68
0.82
-
+
dce/dce rr
dce/dce rr
15.10
+
-
+
Cde/cde r’r
Cde/cde r’r
0.76
-
+
+
+
cdE/cde r”r
cdE/cde r”r
0.92
+
+
+
+
+
DCe/DcE R1R2
DCe/DcE R1R2
DCe/dcE R1 R”
DcE/dCe R2 r’
DCE/cde Rzr
Dce/DCE RoRz
Dce/dCE RoRy
11.87
1.00
0.28
0.19
0.01
<0.01
+
-
+
+
dCe/DCE R2r
DcE/dce R2r
DcE/Dce R2R0
Dce/dcE Ror”
10.97
0.73
0.06
+
-
+
Dce/cdeR0r
Dce/Dce R0R0
2.00
0.07
+
-
DcE/DcE R2R2
DcE/dcE R2r”
1.99
0.34
D
C
c
E
e
+
+
+
-
+
+
+
-
-
-
-
+
-
+
-
+
+
+
-
DcE/DcE R2R2
The Rh haplotypes in order of frequency (Fisher nomenclature) in
caucasians and the corresponding short notations
Fisher
Short notations
Approximate frequency (%)
CDe
R1
41
Cde
r
39
cDE
R2
14
cD3
RO
3
CwDe
R1w
1
cdE
r”
1
Cde
r’
1
CDE
Rz
Rare
CdE
Ry
Rare




ABO group and Rh type
Screening for blood-group antibodies
Serologic test for syphilis
Serologic tests for human retroviruses including:
 HIV-1 antibody
 HIV-2 antibody
 HIV p24 antigen
 HTLV I antibodies

Serologic tests for hepatitis including:
 Hepatitis B core antibody (HBcAb)
 Hepatitis B surface antigen (HBsAg)
 Hepatitis C antibody

It determines compatibility between patient
serum and donor red blood cells.

A full crossmatch procedure takes about 45
minutes to complete and cannot be shortened.
Units are refrigerated until used.
A unit of blood MUST be properly labeled and
the label MUST be checked before use.


PREPARATION



Predeposited:
Blood is collected in the weeks prior elective
surgery
Haemodilution:
Blood is collected immediately before surgery to
be reinfused at the end of the operation
Salvage:
Heavy blood loss during operation is collected to
be reinfused
Choice of ABO group for blood products for administration
to neonates and infants younger than age 4 months
Infants ABO
Group
ABO group of blood product to be transfused
Red cells
Platelets
FFP*
O
O
O
O
A
A or O†
A
A or AB
B
B or O†
B† or A or O
B or AB
AB
AB or A or B or
O†
AB† or A
AB
FFP, fresh plasma.
* Only babies and infants who are blood group O should receive group O FFP
because of anti-A and anti-B antibodies, whereas group AB FFP contains no
naturally occurring antibodies. †Group O products must be checked for high-titre
anti-A and anti-B before being given to recipients that are not group O. This is
particularly important for platelets because of the relatively large volumes of
plasma.
•†Group B or AB platelets may not be available.
Immediate Transfusion Reactions
•
•
•
•
•
•
•
•
•
Hemolytic Reactions
Allergic Reactions
Febrile Reactions
Transfusion related acute lung injury (TRALI)
Bacterial Contamination
Circulatory Overload
Citrate toxicity
Air embolism
Alloimmunization:
• RBCs
• Platelets
Delayed Transfusion Reactions
• Graft Versus Host Disease (GVHD)
• Transfusion-associated graft versus host disease
(TAGVHD)
• Post-transfusion purpura
• Haemosiderosis
• H.D.N.
Delayed Transfusion Reactions (Cont…)
Transmitted Diseases









Hepatitis B
Hepatitis C
Human Immunodeficiency Virus (HIV)
Human T-lymphocytotrophic Virus (HTLV-1)
Cytomegalovirus (CMV)
Kaposi’s sarcoma and human herpes virus-8 (KS & HHV-8)
Malaria
Leishmaniasis
Others:
 Babesiosis.
 Lyme disease.
 Chagas' disease
 Creutzfeldt-Jakob Disease (CJD)
 Toxoplasmosis

Evidence of Haemolysis
Examine patient’s plasma and urine for haemoglobin and its derivaties.
Blood film may show spherocytosis

Evidence of incompatibility



Clerical checks. An identification error will indicate the type
incompatibility.
If no evidence of clerical error, proceed as follows:
Repeat ABO and Rh D groups of patient and donor unit and
screen for antibodies.
Use patient’s pre-and post-transfusion samples
Repeat compatibility tests, using patient’s pre-and post -transfusion
serum
Direct antiglobulin test on post-transfusion red cells may indicate
antibody and/or complement
Evidence of bacterial infection of donor blood
Gram stain and culture donor blood.
THANK YOU