BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

62
BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST

Transcript of BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

Page 1: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

BYDR. FATMA ALQAHTANI

CONSULTANT HAEMATOLOGIST

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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

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Blood DonationBlood Donation1 2

3 4

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5 6

7 8

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9 10

11 12

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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.

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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

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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

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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.

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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

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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

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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

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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

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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

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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.

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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.

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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

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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.

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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.

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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

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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

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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

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Page 41: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

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

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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

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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

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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

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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

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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

Page 56: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

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

Page 57: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

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.

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Page 59: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

• 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.

Page 60: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

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

Page 61: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

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

Page 62: BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST.

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.