Immunohematology

Front 1

Blood bank

Back 1

-Activities that lead to the preparation of suitable blood and blood products for transfusion
-Activities include blood typing,antigen and antibody detection, compatibility testing

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major blood products

Back 2

1. Whole Blood-400-450 ml
2. Packed Cells
3. Fresh Frozen Plasma (FFP)-giving coagulation factors
4. Platelets-
5. Cryoprecipitate- used mostly for fibrinogen deficiency
6. Factors

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Most transfusion errors are due to

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1. errors in pt ID during collection or labeling
2. errors in ID of pt during confusion

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specimen labeling

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1. name
2. medical record #
3. date/time
4. signature of phlebotomist
5. requisitions (order) should have the same thing

Front 5

specimen requirements

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1. lavender or red top
2. Specimens may be used for testing for 7 days if the patient is not pregnant or has not been transfused (can be good for 14 days).
3. If the patient is pregnant, has been recently transfused or has previously known antibodies the specimen may be used for 3 days

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Type and screen and other tests

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1. ABO and RH type (Group/Rh)
2. Antibody Screen(Indirect Antiglobulin Testing) (if AB is positive it is just a screen so need to do a...)
3.... AB identification
4. Direct Antiglobulin testing- to see if there and RBCs in vivo
5. Compatibility testing (crossmatch)

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ABO typing

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1. Forward typing- detection of antigens on the pts red cells
(A type means you have the A antigen on your red cells)
2. Reverse typing- detection of naturally occurring antibodies in the pts serum
(look at chart)

Front 8

ABO blood type

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-Presence or absence of two antigens, A and B defines the four blood groups.
-Determined by the ABH genes-demonstrate Mendelian genetics
-A and B antigens are co-dominant to each other-if an individual inherits both A and B gene both antigens will be expressed in essentially equal numbers.

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RH typing

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-detection of the presence or absence of the D antigen on the pts RBC
-Rh + --> D antigen is present, 85% of pop
-Rh - -> absence of D antigen, 15% of pop
-if it is an emergency can switch to Rh + blood, try not to in young people and pregnant

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AB screen

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-aka Coombs test or Indiretn Antiglobulin test
-pts serum is tested with red cells with known antigens present to determine clinically significant ABs
-these ABs are not naturally occuring
-in Vitro

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Pre-transfusion testing

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-test to determine whether the pt has clinically significant ABs

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prenatal testing

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-performed to determine whether or not the mother has developed ABs that may be harmful for the fetus

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AB identification

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-if AB screen is positive, AB ID must be performed
-pts serum is tested with a panel (usually 12) of cells to determine specificity

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Direct Antiglobulin test (DAT)

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-determine if pts RBC's are coated w/complement or IgG ABs
-In vivo: determination of AB newly forming; complement coating of red cells; drug induced

Front 15

administration of blood products

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-anything with a red cell in it needs to be cross match
-O = universal donor
-AB = universal recipient
(chart)

Front 16

administration of plasma products

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-plasma cells do not contain red cells
-focus on donors ABs reacting w/antigens on recipients red cells
-AB = universal donor
-O = universal recipient
(chart)

Front 17

antibody titer for prenatal testing

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-titer the AB to see what level it is at
-if titer is the same, the baby is not making ABs
-can result in hemolytic disease

Front 18

Rhogam administration

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-1st dose-given approximately at 28 weeks gestation
-within 82 hrs if delivery, given to an Rh - mother who delivers an RH positive baby
(if father and mom are Rh - dont need to get the shot)

Front 19

Rh immune globulin dosage

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-if qualitative test is neg. - 1 vial
-if qualitative test is positive, a Kleihurere-Betke (quantitative) test must be performed to determine the amt. to be givrn

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Hemolytic disease of the Newborn

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-this occurs when maternal ABs (IgG) cross the placenta and cause red cell destruction to the fetus
-test that need to be performed: Hgb and Hct; bilirubin, reticulocyte count

Front 21

Whole Blood

Back 21

RBC products:
1. packed red cells
2. leukocyte reduced RBCs (less transfusion rxns)
3. frozen rbc's
4. deglycerolized rbc's-for rare cases
Plasma Products:
1. FFP
2. Cryoprecipitate
3. Platelets

Front 22

Factors

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1. Factor VIII concentrates
2. Factor IX concentrates
3. RH immune Globulin
4. Albumin

Front 23

factors to consider before transfusion

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1. weight benefits to risks
2. ask whether there are alternative txs available before transfusion of blood products
3. lab results are not determining factor-pts condition needs to be considered

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PRBC's and LRB's

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-vol is ~ 250cc
-ABO & RH compatible
-filter should be considered if pt has had adverse (allergic) rxn to products containing WBC's
-pts at risk for alloimmunization to WBC or to HLA antigens

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transfusion conderations

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-1 unit of RBC increases Heme by 1-1.5 mg/dl and hematocrit by 3-5%
-indicated to inc RBc mass, improve O2 carrying capacity in symptomatic pts

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Washed RBC's

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-to remove plasma
-washed with saline
-indicated for pts with adverse rxn to plasma
-IgA deficient pts

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frozen RBCs

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-storage for 10 yrs
-indicated for pts with rare blood types
-indicated for pts with ABs against common allergies

Front 28

fresh frozen plasma

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-vol ~ 200-250 cc
-contains coagulation factors
-must be ABO compatible
-indications:
1. replace coag factors, 2. liver disease, 3. overdose of oral anticoagulants

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platelets

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-Suspended in plasma
-Platelet concentrates- platelets that are harvested off the whole unit of blood that was donated
(Volume approximately 50cc)
-Pheresis- platelet suspended in plasma
(Volume approximately 250cc)
-contraindicated to give in pts with TTP and ITP

Front 30

cryoprecipitate

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-vol 15 ml
-contains factor VIII, fibrinogen
-should be ABO compatible
-indications: Von WIlebrands; fibrin glue used in topical surgery

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factor components

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-prepared by recombinant tech to reduce the risk of viral transmission
-factor VIII --> indicated for hemophilia A
-factor IX --> indicated for hemophilia B

Front 32

Tranfusion rxns ssx

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1. Fever with or without chills
2. Shaking chills
3. Pain at the infusion site,in the 4. chest,or abdomen
4. Change in Blood pressure
5. Respiratory distress
6. Skin changes
7. Nausea,vomiting
8. Dark urine

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acute hemolytic transfusion rxn

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-occurs b/t 10-15 ml of blood, giving wrong blood type
-occurs during transfusion or shortly afterwards
-includes:
1. Hemolytic
2. Febrile non-hemolytic
3. Allergic
4. Anaphylactic
5. Bacterial contamination
6. Circulatory overload

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acute hemolytic transfusion rxn
most commonly due to

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-human/clerical errors- transfusion of ABO incompatible blood
-prevention: Clerical checks verified, patient identification, blood unit identification, observe patient closely

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febrile non-hemolytic

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-due to leukocyte &/or platelet ABs (allergic type rxn)
-ssx: rise in temp >1 degree C that can not be explained by any other factor
-prevention: pre-medicate pt, transfere leukocyte-reduced products

Front 36

allergic rxns/ uticaria

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-caused by an allergic rxn to plasma proteins
-ssx: hives, itching
-prevention: admin anti-histamines

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anaphylactic rxns

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-caused by Anti-IgA deficient pts
-ssx: anaphylactic shock
-prevention: wash blood cells before administration

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When you are infusing blood the only thing EVER to go in with the unit of blood is...

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SALINE!
anything else will cause clots in the bag or hemolysis!

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Bacterial contamination

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-caused by RBC's &/or platelets that are contaminated (if unit looks brown, question it; some women on OCs have pltelets that look green)
-ssx: high fever, shock, DIC
-can be deadly

Front 40

circulatory overload

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-body not able to handle excess vol of fluids
-in elderly, CHF pts, and anyone who is given massive transfusion
-ssx: coughing, diffculty breathing, cyanosis
-prevention: transfuse smaller vol at a slower rate

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delayed transfusion rxn

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-occurs within days, wks, months or yrs
-includes: hemolytic, graft vs. host, disease transmission

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delayed hemolytic transfusion rxn

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-ABs in pts serum have dec to undetectable levels
-ssx: dec in H & H, positive DAT
-prevention: obtain previous hx of pt before transfusion; maintain updated accurate records

Front 43

graft vs. host

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-occurs when immunologically competent lymphocytes are transfused into a immunologically incompetent pt
-donor lymphocytes recognized the recipient as foreign and attack the recipient
-usually fatal
-prevention: irradiation of all bl products

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disease transmission

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1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. HIV
5. CMV

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steps when a transfusion rxn is suspected

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1. Stop transfusion
2 .Keep IV line open,run saline
3. Re-check all labels, forms patient ID
4. Call Blood Bank
-notify ssx
-draw post-transfusion blood sample, urine specimen, send al tags, remaining blood in bag
-order transfusion rxn w/u