Z Transfusion Tehann

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An Ab that can agglutinate RBCs (bind RBCs in a visible clump in a test tube) if such RBCs show the specific corresponding Ag on their membranes

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Agglutinin

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An Ab that can hemolyze RBCs (lyse RBCs thus causing the presence of a pink supernatant after centrifugation in a test tube) if such RBCs show the specific corresponding Ag on their membranes

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Hemolysin

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Complete Ab

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An antibody that can coat AND directly agglutinate RBCs

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Incomplete Ab

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An antibody that can coat but CANNOT agglutinate RBCs

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“warm” antibody

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An antibody which, in vitro, reacts best at 37 ºC

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“cold” antibody

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An antibody which, in vitro, reacts best at 4 ºC to 10 ºC

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The “thermal amplitude” of so-called antibodies is variable in vivo

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cold much more then warm

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which blood groups
a sustained high concentration of IgM with some formation of IgG after days or weeks is typical of a primary response while only a transient rise in IgM and a sustained IgG increase are typical of a secondary response

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all blood Group Antigens except ABO

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“Coombs’ serum” aka

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Antihuman globulin serum

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Antihuman globulin serum aka

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“Coombs’ serum”

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goal of
Direct Coombs’ test

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To detect Ig (Ab) bound to the membrane of the patient’s RBCs

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Direct Coombs’ test
wrt false positive

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Ab present “accidentally” on the patient’s RBCs (Ab transiently acquired through the transfusion of plasma or of other component, maternal Ab circulating in neonatal plasma

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autocontrol
phases

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1 detection of "cold" Ab's mostly IgM

2 some “warm” antibodies mixture of Ab's and IgG

3 add antihuman globulin which allows detection of MOST warm Ab's

3

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goal of
Indirect Coombs’ test

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To detect, in the patient’s serum, Ig (Ab) directed against an Ag seen on RBC membranes

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Procedure
Direct Coombs’ test

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Wash the patient’s RBCs with saline then add antihuman globulin serum

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An “auto-control” is similar to the

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DAT

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procedure for
Indirect Coombs’ test

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Like the auto test but
Mix “commercial” suspension(s) of RBCs with serum from patient at room T º

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It is the most commonly performed test in the transfusion service besides the tests to determine ABO Group and Rh Type

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INDIRECT ANTIGLOBULIN TEST

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The test serves as the basis for antibody screens and panel work-ups

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INDIRECT ANTIGLOBULIN TEST

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Elution

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removing and/or detaching an antibody from the RBC membrane

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Elution
why used

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The antibody is then tested against RBCs with known antigens on their membrane

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ELUTION TECHNIQUES

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Heat, freeze-thaw and chemical methods

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PRACTICAL APPLICATIONS OF THE DAT
allo or auto

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Usually this test screens for auto-antibodies

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PRACTICAL APPLICATIONSOF THE IAT
allo or auto

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Screens most usually for allo-antibodies

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Hemolytic disease of the newborn

Patients with auto-immune disease

what test to run

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PRACTICAL APPLICATIONS OF THE DAT

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If no (further) transfusions are necessary: the ????? may be practically useless

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DAT

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PRACTICAL APPLICATIONSOF THE IAT
main uses

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Crossmatch: IAT-like test involving the patient’s serum and RBCs from a unit that is likely to be transfused to the patient

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Immediate Spin Crossmatch
what is it

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If the “screen” is negative, the crossmatch is done through phase I only, and is called Immediate Spin Crossmatch

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“Warm” auto-antibodies
which type

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Usually incomplete Ab (mostly IgG

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70% of all auto-antibodies
warm or cold

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warm

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30% of all auto-antibodies

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“Cold

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“Cold” auto-antibodies
what type

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Usually complete Ab (mostly IgM

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CHROMOSOMAL LOCALIZATION OF BLOOD GROUP GENES
ABO

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9

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CHROMOSOMAL LOCALIZATION OF BLOOD GROUP GENES
Rh

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1

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CHROMOSOMAL LOCALIZATION OF BLOOD GROUP GENES
Kell

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7

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CHROMOSOMAL LOCALIZATION OF BLOOD GROUP GENES
Kidd

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18

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CHROMOSOMAL LOCALIZATION OF BLOOD GROUP GENES
Duffy

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1

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CHROMOSOMAL LOCALIZATION OF BLOOD GROUP GENES
MNS

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4

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H antigen only

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type O

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name the ABO
terminal sugar units

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H A B

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is a weak A antigen

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A2

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which is more common A1 or A2

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A1 80 to 20

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What is the Bombay phenotype

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Absence of H

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The symbol used for the phenotype

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Oh

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The Bombay phenotype
Ab's

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Anti-A Anti-B Anti-A,B
Anti-H

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THE RHESUS SYSTEM
letters

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Dd
Cc
Ee

note, there is no d, it correspods to nothing

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Weak D: Historically wrt Tx

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Treated as D positive (“Rh pos”) donor
Treated as D negative (“Rh neg”) recipient

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THE RHESUS SYSTEM
wrt single vs 3 genes

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Wiener system : single gene R

Fisher-Race system: three genes CDE

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KELL SYSTEM
the most important being

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K (ex-Kell) and k (ex-Cellano)

Alloantibodies to K are commonly seen Bc k is much more common
KK=1% kk=91%

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KIDD SYSTEM
antigens

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Jka or Kidd (a) and Jkb or Kidd (b)

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KIDD SYSTEM
antibodies

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Both anti-Jka and anti-Jkb are seen commonly

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DUFFY SYSTEM
antigens

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Several antigens, most important:
Fya or Duffy(a) and Fyb or Duffy(b)

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MNS System
antigens

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Several antigens, most important:
M and N
S and s

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Many clinical situations are associated with auto-antibodies, among which ??????? is the most frequent

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auto-anti-D

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Lymphocytes/HLA
which chromasome

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6

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Class I antigens: Expressed by

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all lymphocytes and many other cells

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Class II antigens: Expressed by

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B-cells and activated T-cells

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HLA testing is important in

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Transplantation (bone marrow, kidney)
Paternity testing
Transfusion medicine (platelets)

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Transfusion of granulocytes
considerations

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Must be HLA-matched
Must be irradiated

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HPA: Human platelet antigen
groups

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5 groups (I-V)

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HPA: Human platelet antigen: current classification
most important system

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HPA I (two alleles: HPA Ia and HPA Ib)

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HPA: Human platelet antigen: current classification
when clinically significant

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N.A.I.T.P. (neonatal allo-immune thrombocytopenia)

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Additional surrogate tests:

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RPR or other for syphilis
ALT (SGPT

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Storage lesion of erythrocytes with ???? (reversible, and less significant when Additive Solutions are used)

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potassium “leakage”

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Storage lesion of platelets due to ?????

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low pH, to insufficient mechanical or manual agitation, or to variations in temperature

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PLT unit (shelf life

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5 days

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RBC unit in AS (shelf life of

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42 days

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FFP unit (shelf life of

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1 year

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Contraindications to transfuse erythrocytes

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If anemia can be treated pharmacologically

If the patient has moderately to severely decompensated congestive heart failure

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Indications for RBC filtering

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Prevention of:
Febrile Non-Hemolytic Transfusion Reactions (FNHTR)
Allo-immunization to HLA
CMV transmission or reactivation
HTLV (not HIV) transmission

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indications of Irradiated RBC products

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prevention of Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)

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Contraindications to transfuse platelets

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Idiopathic Thrombocytopenic Purpura
Thrombotic Thrombocytopenic Purpura
Heparin-Induced Thrombocytopenia / Thrombosis Syndrome
Uremia

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Washed platelets:
Indicated to prevent

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IgA - anti IgA reactions

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Irradiated platelets
why

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Indicated to prevent TA-GVHD

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“Matched platelets”:

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HLA-matching
HPA-matching
Cross-matching

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TRANSFUSING GRANULOCYTES
when

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Granulocyte (neutrophil) count < 500

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FFP contains
what factors

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all factors

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“Cryo” contains
what factors

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I, VIII/vWF, XIII