Blood Bank Issues

7/30/2019 Blood Bank Issues

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Compatibility Testing for BloodTransfusion

RIH Department of

Anesthesiology


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Blood Bank Issues

How muchONeg Blood

Is OK? What are our

transfusion policies ?

Why does ittake so much

time?

Whats new?


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ISBT = International Societyof Blood Transfusion

Recognizes the Presence of MultipleAntigens on the Surfaces of

Red Blood Cells that defineBlood Group Systems


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2011YTCartwright 2010DIDiego

3009JKKidd6008FYDuffy3007LELewis21006KELKell18005LULutheran 47004RHRh

1003P1P37002MNSMNSs4001ABOABO

BLOOD GROUP SYSTEMS

ANTIGENSISBT NUMBERISBT SYMBOLCONVENTIONAL NAME

*

*


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BLOOD GROUP SYSTEMS

ANTIGENSISBT NUMBERISBT SYMBOLCONVENTIONAL NAME

- -- -- -2

5107119

33531

026JMHJMH025RAPHRaph024OKOk 023INIndian

022KNKnops021CROMERCromer020GEGerbich019XKKx018HHh 017CH/RGChido/Rogers

016LWLandsteiner-Wiener015COColton014DODombrock013SCScianna012XG0Xg


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Population Distribution ofMajor Blood Groups

O Rh pos 38%O Rh neg 7%

A Rh pos 34%A Rh neg 6%B Rh pos 9%B Rh neg 2%

AB Rh pos 3%AB Rh neg 1%


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Why do we care?

Compatibility testing is done to avoida hemolytic transfusion reaction

If the Host or Recipient recognizesthe donor RBC surface antigens as foreign,the host will mount an immune response

to the donor RBCs


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Major Blood Groups

ABO


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ABO blood group antigenspresent on red blood cells

and IgM antibodiespresent in the serum
http://en.wikipedia.org/wiki/Image:ABO_blood_type.svg


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Why do we have Anti-A or Anti-B

Antibodies???

They are not present in the newborn

They develop in the first years of life

Exposure to plant, bacterial, viral

antigens provokes this response


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Why do we have Anti-A or Anti-B

Antibodies???

Viruses transmitted from the

respiratory tracts of humans to otherhumans drag along various antigensincluding ABO blood group antigens.

Prime the newborns immune system.Reduces transmissibility of viruses

within a population.


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Major Blood Groups

Rhesus

47 Antigens make up theRhesus Blood Group

The most significant is the

D antigen


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There is no naturally occurringAnti D

Production of Anti D in the

RH negative recipientrequires previous exposure

to the D antigen

(in utero or by transfusion)


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If red cells are administered

to an ABO- or D-incompatible recipient,the recipient will mount an

antibody response to the foreign

RBC surface antigens

IgM is polyvalentand fixes complement


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Intravascular Clumping of Donor RBCs


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Intravascular hemolysis of donor RBCs


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Clumps and extruded RBC stroma

result in organ dysfunctionand possible death

Incidence 1:38,000 1:70,000Mortality 1:30


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Other Blood Groups

No naturally occurring antibodiesImmune response requires

previous exposureWeaker titers of univalent antibodies


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Donor RBCs coated with host antibodies

Stiffer RBC membraneSusceptible to attack by

splenic macrophages


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But no

intravascular clumping


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Bits of Donor RBC membrane

lost traversing splenic sinusoids(extravascular hemolysis)

SpherocytesDecreased RBC survival

Delayed anemiaPriming for worse reaction


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Donor

Questionnaire:Medical history

Lifestyle

Finger stick:Checking Hct


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Donor

Needs a Hct of 0.38A drop of donor blood is placed into a

test tube containing a

CuSo4 solutionCuSo4 solution has a SG of 1.053

RBC with Hct > 0.38 sink to

the bottom of the test tube


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Donor

Side sample (20cc) collected for testing:Blood group and Infection

The bag is anticoagulated

The unit is labeled with a lot#

like any druge.g. LH59321


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DIFFERENT LEVELS OF COMPATIBILITYTESTING

Landsteiner,

1899Lifespan, 2008


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COMPATIBILITY TESTING

The purpose of pre-transfusioncompatibility testing is to PREVENThemolytic transfusion reaction

Clerical and technical components

Samples must be labeled at the bedside

Two methods of ID required:

Name, SSN, MR#, DOB

The phlebotomist must sign the tube


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Lab checks:

Identity

Record of previous specimenRecord of previous ABO-Rh type

History of abnormalities



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Processing the specimen:

ABO Group determined (forward andreverse)

D typing determinedAntibody screen will be performed

ABO/Rh identical or compatible blood willbe made available


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Front or forward type using monoclonal anti-A and anti-B (commercial)

The sample is diluted to Hct 0.08, the

commercial antibodies added & the testtube is centrifuged

The RBCs are then examined for clumping

(gross observation, gel suspension)

ABO TYPING


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Anti A Anti B Anti A Anti B

Anti A Anti B Anti A Anti B

A B

OAB


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ABO TYPING

Back or reverse type with A and B cells

Commercially available A and B cells are added to

two tubes of plasma

AB B A O

A B A BA BA B


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How do we know whether or not the host (orrecipient) has antibodies to minor bloodgroup antigens?

Add commercial RBCs with known important

minor antigens on their surface to host (orrecipient) plasma and centrifuge. Thenincubate at body temperature for 15-30minutes

Then add rabbit antiglobulin


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If recipient antibodies have coatedcommercial RBC surfaces


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Rabbit antiglobulin will bind to the

Antibodies and the RBCs will clump


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ANTIBODY SCREENING

Detection of unexpected clinically significantantibodies against the minor blood groupsystem antigens

Also called the indirect Coombs test or the indirectantiglobulin test

Positive in between 0 - 8% of samples dependingon the population


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2011YTCartwright2010DIDiego3009JKKidd6008FYDuffy3007LELewis21006KELKell18005LULutheran47004RHRh1003P1P37002MNSMNSs

*

Possibly significant minor blood groups


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SCREENING TEST RESULTS

A negative antibody screen allows bloodto be dispensed using an immediate spinX-match or an electronic X-match, eitherof which confirms ABO compatibility

A positive antibody screen requires a fullantiglobulin phase X-match


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POSITIVE ANTIBODY SCREEN

Can some or all of the antibodies beidentified?

Identify red cells which lack theseantigen(s)


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Why does it

take so muchtime?


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Why does it take so long?

Sample collection

Specimen transport

Specimen centrifugation 15

Testing 25


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How muchONeg Blood

Is OK?


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Past data from Vietnam war era

Minimal auto antibodies in universal

donor bloodPer Dr. Sweeney > 80 units before

anti-A and anti-B cause problems

How much ONeg?


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What are ourtransfusion policies ?


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Policies

Consent: Covered in surgicalconsent

Prescription: Needs to be orderedCollection: Label blood at bedside

Name, MR #, other

Sign and date


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Policies

Administration:

Inspect bag

Verify ABO RhMatch IDs

If no access to name bracelet use

Innovian to match IDs2 licensed personnel & 2 signatures

Normal saline only


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Whats new?


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Whats new?

2007 Nature Biotechnology

USA, Denmark, France, Sweden

Convert blood types A, B, and AB

to O, using bacterial glycosidase

enzymes to cleave the antigens

from the RBC surface.

Need D negative cells


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Red blood cell compatibility table

AB+AB-B+B-A+A-O+O-

AB+AB-B+B-A+A-O+O-DonorRecipient
http://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svg


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Plasmacompatibility table

O

B

A

AB

AB

BAO

DonorRecipient
http://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svghttp://en.wikipedia.org/wiki/Image:Yes_check.svg

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Blood Bank Issues