BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.
-
Upload
morris-mckenzie -
Category
Documents
-
view
230 -
download
3
Transcript of BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.
BYDR. FATMA ALQAHTANI
CONSULTANT HAEMATOLOGIST
Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.
Maslak, P. ASH Image Bank 2002;2002:100434
Figure 1. A standard blood cell separator used in harvesting components from the peripheral blood
Blood DonationBlood Donation1 2
3 4
5 6
7 8
9 10
11 12
Significance of Certain Blood Group Antibodies
Clinical Significance
Blood Group SystemAntibodyRelative Frequency in Antibody ScreeningHTRHDN
ABOAnti-A
Anti-B
All group B and O
All group A and O
Yes
Yes
Yes
Yes
RhesusAnti-D
Anti-c
Anti-E
Anti-C
Anti-e
Common
Common
Common
Common
Common
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
KellAnti-K
Anti-k
Common
Rare
Yes
Yes
Yes
Yes
KiddAnti-Jka
Anti-Jkb
Common
Rare
Yes
Yes
Yes
Yes
DuffyAnti-Fya
Anti-Fya
Common
Rare
Yes
Yes
Yes
Yes
MNAnti-M
Anti-N
Common
Rare
Occasional
Rare
Occasional
Rare
SsUAnti-S
Anti-s
Uncommon
Rare
Yes
Yes
Yes
Yes
LewisAnti-Lea
Anti-Leb
Common
Uncommon
Yes
No
No
No
PAnti-P1UncommonRare No
LiAnti-lUncommon No No
HRT = hemolytic transfusion reaction, HDN = hemolytic disease of the newborn.
Antibody specificities related to the mechanism of immune haemolytic destruction.
Blood group system
Intravascular haemolysis
Extra vascular haemolysis
ABO,HA,B,H
RH All
KellKK, k, Kpa, Kpb, Jsa, Jsb
KiddJkaJka, JKb, Jk3
Duffy Fya, Fyb
MNS M,S,s,U
LutheranLUb
LewisLea
CartwrightYta
ColtonCoa, Cob
DombrockDoa, Dob
Glycosyltransfereases produced by genes encoding
for antigens within the ABO, H, and Lewis blood group system.
GeneAlleleTransferaseFUT1H
H
α-2-L-fucosyltransferase
None
AAα-3-N-acetyl-D-galactosaminyltransferase
BBα-3-D-galactosyltransferase
OONone
FUT2Se
se
α-2-L-fucosyltransferase
None
FUT3Le
le
α-3/4-L-fucosyltransferase
None
ABO blood group system
Blood groupSubgroupAntigens on red cells
Antibodies in plasma
AA1
A2
A + A1
A
Anti-B
(Anti- A1)*
B-BAnti-A, Anti- A1
ABA1B
A2B
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 Type A B antigen only Type B A and B antigens Type AB Neither A or B 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 Type A Anti-A Type B Anti-A and anti-B Type O Neither anti-A or anti-B 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 CellsBlood 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 genotypePossible genotypesFrequency DCcEe
+++-+DCe/dce/R1DCe/dce/R1r
DCe/Dce/R1RO
DCe/dCe/R0r’
32.68
2.16
0.05
++--+DCe/DCe/R1R1DCe/DCe/R1R1
DCe/dCe/R1r’
17.68
0.82
--+-+dce/dce rrdce/dce rr15.10
-++-+Cde/cde r’rCde/cde r’r0.76
--+++cdE/cde r”rcdE/cde r”r0.92
+++++DCe/DcE R1R2DCe/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 R2rDcE/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 R2R2DcE/DcE R2R2
DcE/dcE R2r”
1.99
0.34
The Rh haplotypes in order of frequency (Fisher nomenclature) in caucasians and the corresponding short notations
FisherShort notations Approximate frequency (%)CDeR1 41
Cder 39
cDER214
cD3 RO3
CwDeR1w1
cdEr”1
Cde r’1
CDE Rz Rare
CdERy Rare
Signs and Symptoms of Blood Loss
Volume Lost
mL% of Total Blood Volume Clinical Signs
50010None; occasionally vasovagal syncope in blood donors.
100020At rest there may be no clinical evidence of volume loss; a slight postural drop in BP may be seen; tachycardia with exercise.
1500 30Resting supine blood pressure and pulse may be normal; neck veins flat when supine; postural hypotension
200040Central venous pressure, cardiac output, systolic blood pressure below normal even when supine and at rest; air hunger, cold clammy skin; tachycardia.
250050Signs of shock, tachycardia, hypotension, oliguria, drowsiness, or coma.
To be Completed Before Blood or Blood Products can be Transfused:
Determination of the blood type with a crossmatch. Screening for antibodies that may produce adverse
effects if transfused. Screening for possible infectious agents that could be
transmitted with transfusion.
ABO group and Rh type Screening for blood-group antibodies Serologic test for syphilis Serologic tests for human retroviruses including:
HIV-1 antibodyHIV-2 antibodyHIV p24 antigenHTLV 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.
Every unit cross matched is removed from the general inventory and reserved for the patient for 72 hours.
Units which are crosshatched unnecessarily will deplete Blood Bank inventories and can result in blood shortages.
Blood shortages can result in cancellation of elective surgical procedures.
Blood will ordinarily not be released for transfusion until compatibility testing is completed.
However, under emergency conditions, blood products may be released without a crosshatch if the patient is in danger of dying if transfusion is delayed.
In such cases, if the patient's blood type is not known, then group O Rh negative (O Neg) blood can be released without compatibility testing.
In cases in which the patient's blood type is reliably known, then type-specific blood or RBCs of the same ABO and Rh group may be released.
Trisodium Citrate (Dihydrate) 2.2 g Citric Acid (Monohydrate) 0.8 g Dextrose 2.5 g Water to 100 ml
67.5 ml of this solution (pH 5.0 – 5.1) are mixed with 450 ml of Blood
Store Red Blood Cells 21 days at 1 – 6 0 C
Trisodium Citrate (Dihydrate) 26.3 g Citric Acid (Monohydrate) 3.27 g Sodium Dihydrogen Phosphate (Monohydrate) 2.22 g Dextrose 25.5 g Water to 1000 ml
63 ml of this solution (pH 5.0 – 5.1) are mixed with 450 ml of Blood
Store Red Blood Cells for 28 days at 1 – 6 0 CStore Platelets for 3days at 20 – 24 0 C
63ml Anticoagulant Citrate Phosphate Dextrose Adenine Solution USP for collection of 450ml of blood
Each 63ml contains: • 188 mg Citric Acid (anhydrous) USP• 1.66 g Sodium Citrate (anhydrate) USP• 140 mg Monobasic Sodium Phosphate (monohydrate) USP
• 2.01 g Dextrose (monohydrate) USP• 17.3 mg Adenine USP Store Red Blood Cells 35 days at 1 – 6 0 C Store Platelets 5 days at 20 – 24 0 C
63ml Anticoagulant Citrate Phosphate Dextrose Solution USP for collection of 450ml of blood
Each 63ml contains: • 188 mg Citric Acid (anhydrous) USP• 1.66 g Sodium Citrate (anhydrate) USP• 140 mg Monobasic Sodium Phosphate (monohydrate) USP
• 1.61 g Dextrose (monohydrate) USP 15 mEq Sodium Added
Store Red Blood Cells 42 days at 1 – 6 0 C Store Platelets 5 days at 20 – 24 0 C
Platelet concentrate
FFP for clinical use
FFP for fractionation
Cryprecipitate
Cryosupernatant
Plasma-reduced bloodRed cells in OAS
Whole blood
Platelet-rich plasma
Red cell concentrate
Diagrammatic representation of the preparation of components from whole blood. Items in boxes represent final components. (FFP = Fresh Frozen Plasma).
Fresh Plasma
Optimal additive
solution (OAS)
2nd centrifugation
1st centrifugation
Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.
Maslak, P. ASH Image Bank 2005;2005:101277
Figure 1. Packed red cells may contain enough leukocytes and platelets to result in alloimmunization
Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.
Maslak, P. ASH Image Bank 2005;2005:101278
Figure 1. Platelet blood components may be stored for 5 days at room temperature without loss of function or viability
Summary of blood component valuesComponenComponentt
Indication Indication for usefor use
Component Component rise (In rise (In patient with patient with 5000 ml blood 5000 ml blood volume)volume)
ApproximApproximate ate volumevolume
ContentsContentsAmount of Amount of active active substance per substance per transfused transfused unitunit
Whole Whole bloodblood
Decreased red Decreased red cell mass and cell mass and blood volumeblood volume
1-2%1-2% hematocrithematocrit450450 mlmlRed cells, plasma, white Red cells, plasma, white blood cells, platelets blood cells, platelets and fragments, stable and fragments, stable coagulation factorscoagulation factors
230ml red cells 230ml red cells 60 g 60 g hemoglobin hemoglobin 300 ml plasma300 ml plasma
Red cellsRed cellsDecreased red Decreased red cell masscell mass
2-3%2-3% hematocrithematocrit230-250230-250 mlmlRed cells, some plasma, Red cells, some plasma, white blood cells and white blood cells and platelets or their platelets or their degradation productsdegradation products
200200 ml red cellsml red cells
Leukocyte Leukocyte poor bloodpoor blood
Decreased red Decreased red cell mass, cell mass, febrile febrile reactions from reactions from leukoagglutinileukoagglutiniss
2-3%2-3% hematocrithematocrit200-250200-250 mlmlRed cells, some plasma, Red cells, some plasma, white blood cellswhite blood cells
185185 ml red cellsml red cells
Frozen red Frozen red cellscells
Decreased red Decreased red cell mass, cell mass, febrile or febrile or anaphylactic anaphylactic reactions, rare reactions, rare bloodblood
2-3%2-3% hematocrithematocrit200200 mlmlRed cells; no plasma, Red cells; no plasma, minimal white blood minimal white blood cells and plateletscells and platelets
169-190169-190 ml red ml red cellscells
Summary of blood component valuesComponeComponentnt
Indication for Indication for useuse
Component Component rise (In rise (In patient with patient with 5000 ml 5000 ml blood blood volume)volume)
ApproximatApproximate volumee volume
ContentsContentsAmount of Amount of active active substance per substance per transfused transfused unitunit
PlateletsPlateletsBleeding caused Bleeding caused by by thrombocytopethrombocytopeniania
50005000 platelets/platelets/µµll
1-2%1-2% factor factor VIIIVIII
2%2% stable stable factorsfactors
50-7050-70 mlmlPlatelets, few white Platelets, few white blood cells, some blood cells, some plasma, stable plasma, stable coagulation factors coagulation factors (100%), labile (100%), labile coagulation factors coagulation factors (100% on day 1, 60-70% (100% on day 1, 60-70% on day 3)on day 3)
5.5X105.5X101010 or or more plateletsmore platelets
1-21-2 ml red ml red blood cellsblood cells
4040 units factor units factor VIIIVIII
Fresh Fresh frozen frozen plasmaplasma
Various Various coagulation coagulation diisordersdiisorders
8%8% factor VIII factor VIII 8% stable 8% stable factorsfactors
220-250220-250 mlmlAll coagulatin factorsAll coagulatin factors175-250175-250 units units coagulation coagulation factorsfactors
400400 mg mg fibrinogenfibrinogen
CryopreciCryoprecipitatepitate
Hemophilia A Hemophilia A and von and von WillebrandWillebrand’’s s disese, disese, fibrinogen fibrinogen deficiencydeficiency
2-3%2-3% factor factor VIII rise from VIII rise from each bageach bag
10-2510-25 mlmlVon WillebrandVon Willebrand’’s factor, s factor, coagulation factorscoagulation factors
250250 mg mg fibrinogenfibrinogen
80-10080-100 units units Factors VIIIFactors VIII
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 monthsInfants ABO Group
ABO group of blood product to be transfused
Red cells Platelets FFP*
OOOO
AA or O†AA or AB
BB or O†B† or A or OB or AB
ABAB or A or B or O†
AB† or AAB
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.
• Hemolytic Reactions• Allergic Reactions• Febrile Reactions• Transfusion related acute lung injury (TRALI) • Bacterial Contamination• Circulatory Overload • Citrate toxicity• Air embolism• Alloimmunization:
• RBCs• Platelets
Delayed Reactions • Graft Versus Host Disease (GVHD)• Transfusion-associated graft versus host disease (TAGVHD)
• Post-transfusion purpura • Haemosiderosis• H.D.N.
Types of transfusion reaction
Acute transfusion reactionsDelayed transfusion reactions
Acute haemolytic reactionDelayed haemolytic reaction
Anaphylaxis Transfusion transmitted infection
Bacterial contamination of blood product
Transfusion-associated graft versus host disease
Transfusion-associated acute lung injury
Posttransfusion purpura
Acute fluid overloadIron overload
Allergic reactionImmunosuppression
Febrile nonhaemolytic transfusion reaction
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' diseaseCreutzfeldt-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.