Abolarin A. T, FMCPath Lecturer/Consultant Haematologist ...
BY DR. SHIHAB ALMASHHADANI CONSULTANT HAEMATOLOGIST.
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Transcript of BY DR. SHIHAB ALMASHHADANI CONSULTANT HAEMATOLOGIST.
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BYDR. SHIHAB ALMASHHADANI
CONSULTANT HAEMATOLOGIST
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3 4
Blood DonationBlood Donation
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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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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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PREPARATION
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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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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
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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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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
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Delayed Transfusion Reactions
• Graft Versus Host Disease (GVHD)• Transfusion-associated graft versus host disease
(TAGVHD)
• Post-transfusion purpura • Haemosiderosis• H.D.N.
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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' diseaseCreutzfeldt-Jakob Disease (CJD)Toxoplasmosis
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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.