2. Blood bank
• Blood bank comes under the jurisdiction of drug controller and has to
comply strictly with their rules and regulations
• Blood – whole human blood, drawn from donor and mixed with an
anticoagulant
• Blood components- drug prepared ,obtained, derived or separated
from a unit of blood drawn from a donor
• Blood products- drug manufactured or obtained from pooled plasma
or blood by fractionation , drawn from donor
5. Types of donor
1. Volountary donor
2. Replacement donors
3. Professional donors
4. Autologous donor
6. Donor registration
1. Date of donation
2. Name of donor
3. Father ‘s or husband’s name
4. Age
5. Sex
6. Occupation
7. Address and telephone number of both residents and place of work
8. Blood group if known
9. Date of last donation
10. Previous donor reaction if any
11. Previous rejection from donation and its reason
12. Marital status
7.
8.
9. Physical Examination
General appearance
Donor should be in good health,mentally alert, physically fit
Age
Should be between 18_60- 1st time, 65y second time
Weight
A donor can give 8ml per kg body weight
45Kg ---- 350ml blood + pilot sample for processing
>/=55kg----450 ml blood + pilot sample
Blood pressure
SBP --- 100_ 140mmHg
DBP--- 60_90 mm of Hg
10. Pulse
60_100 per minute and regular
Temperature
Should not exceed 37.5° C
• Shall not be fasting,last meal taken atleast 4hrs prior to donation
Donor skin
Skin at venepuncture area should be free of any lesion Or scar of needle pricks
Indicative of addition to narcotics or frequent blood donation (as in case of
professional donors)
Systemic examination
Clinically heart ,lung, and abdomen should be normal
11. Laboratory Examination
Methods
1. Specific gravity method using CuSO4 solution (Specific gravity 1053)
2. Sahli’s Method
3. Cyanometheamoglobin method using spectrophotometer or
photoelectric calorimeter
12. Equipments and materials
A) Blood containers
B) sphygmomanometer, weighing scale,
thermometer, blood weighing balance,
clipper or sealer, artery forceps, plastic
sterile disposable syringes with needle
C)Sterile cotton swab and band-aid/
bandage
D)Methylated spirit,tincture of iodine,
Chlorhexidine hydrochloride
E)Emergency drugs and other items
18. • Drink more fluids than usual for next 4hrs
• Don’t smoke for half an hour
• Don’t remain hungry
• Bleeding from phlebotomy – raise the arm
Apply pressure
20. Management
• Nature and treatment of all adverse reaction should be registered on donor’s record.
1. General
• Remove the tourniquet and withdraw the needle at first sign of reaction during phlebotomy
• If possible remove the donor where he can be attended to privacy
2. Fainting
• Place him/her on back and raise leg above head
• Loosen tight clothing
• Administer inhalation of aromatic spirit of ammonia
3.Nausea and vomiting
• Make him as comfortable as possible
• Turn the head to side to avoid aspirations of vomiting
21. 3.
4.Twiching or muscular spasm
• Asked to breathe into a Paper bag
5. True convulsions
• prevent donor from injuring himself
• Place toung blade
• Adequate airway
6. Hematoma
• Remove the tourniquet
• Withdraw needle
• Place 3 or 4 sterile gauze and apply digital pressure for 7-10 mins with
donor’s arm held above the heart level
• Apply ice to the area for 5 mins
22. Storage and Preservation
Temperature
• Blood should preserve temperature of 2-6°C
Why low temperature?
1. Reduce the rate of glycolysis
2. Minimize the proliferation of bacteria
3. Reduce the Rate of diffusion of electrolytes
23. Anticoagulant solutions
Acid citrate dextrose (ACD)
• Citrate- anticoagulant -chelating calcium
• Dextrose- increase the post transfusion survival of red cell
• Citric acid – prevents carmalization of glucose during autoclave . it
give an optimal pH
24. Citrate phosphate Dextrose solution
• By adding phosphate to ACD solution the post transfusion survival rate of red
cell could be increased
Modified CPD Solution – CPDA-1
• CPD Solution supplemented with Adenine will have more glucose concentration
than the normal
CPDA-2
• In CPDA -2 the amount of Dextrose and Adenine increased
• It’s better than CPDA due to the amount
25. Acid citrate
dextrose
Citrate
phosphate
Dextrose
CPD with
Adenine
Survival of red cells
24 h after
transfusion
70% stored blood
for 21 days
80% stored blood
for 21 days
80.5+/_6.5% after
35 days of storage
pH 5-5.1 5.6-5.8 5.6- 5.8
2,3 DPG At the end of one
week most of 2,3
DPG is lost
Still appreciable,
after 2 weeks may
be at very low level
Loss slightly rapid
.Adequate levels
maintained for 12-
14 days
26. Additive solution for preservation of red cell
CPD SAG and CPD SAGM
• Hogman and Hogman et al introduced the SAG solution ( saline with
Adenine and glucose)
• CPD-SAGM- contains mannitol it will reduce lysis due to SAG
• CPD ADSOL SYSTEM
• Much common with CPD SAGM
• Contains higher concentration of glucose ,Adenine, mannitol
• Red cell survival in this case is 42 days or even possibly 49 days
27. Physical changes and biochemical changes in
stored blood
Physical changes
1. Change in shape of red cell from discoid to spherical
2. Loss of red cell membrane lipids
3. Increase in cell rigidity
4. Increase in osmotic fragility
29. White cell changes
• Granulocyte:-
24 hr of collection nonfunctional
still have antigenic properties
• Few viable lymphocyte may be found even after 3 weeks of storage
Platelet within 48 h lose their hemostatic function in whole blood at 4°C
Coagulation factors factor 5 and 8 loss their coagulation activity
30. Pre transfusion
testing and
selection of
blood
Antibody screening of
recipient’s serum for
commonly
encountered
antibodies
Checking of recipients
previous record. (H/o blood
transfusion)
Identification of recipients
blood sample
Selection of ABO and Rh
compatible donor blood free
from irregular Antibody and
transfusion transmitted
infectious diseases
Cross matching for
donor recipient
compatibility
Proper labeling
donor blood
before issue
ABO and Rh
grouping of
recipient
31. Immunohematolgy
• Antigen
• Complex protein or polysaccharide, if introduced to an individual
whose tissue do not possess that particular substance capable of
producing antibody specific to it. MW- 40000 M.W
• Antibody
• Protein known as immunoglobulin in plasma
• IgA, IgG IgM IgD Ig E
32. • Sensitization –combination of antigen and antibody without agglutination
• Agglutination- clumping of red cells
• Inhibition –soluble forms of blood group substances have the effect of
neutralising the reaction of corresponding antibody
• Precipitation- antigen antibody reaction forms precipitate
• Hemolysis- antigen antibody reaction activate complement and causes
destruction of red cells
• Compliment fixation – binding of complement by antigen antibody aggregation
33. ABO BLOOD GROUP SYSTEM
• Landsteiner discovered ABO blood groups and classified .
• Corresponding to Antigens A and B , naturally occurring antibodies
anti A and anti B are also there in plasma of individuals whose red
cell lack Corresponding antigen
• According to the presence of Antigens or agglutinogens A and B four
groups are there A,B,O and AB
34. Antibodies of ABO system
• Antibodies are naturally occurring mostly IgM
• IgG mostly in O group
• Anti A or anti B are usually not produced in
infants upto the age of 3-6 months( maternal
origin antibody)
• Sreum grouping of newborn is thus not
recommended
35.
36.
37.
38.
39. Secretor status
• Ability to secrete A B and H gene is determined by secretor gene
(heterozygous or homozygous)
Blood group Substance secreted
O H
A A and H
B B and H
AB A , B and H
Oh Nil
40. ABH Antigens
• A,B,and H are present not only on the red cells but are widely
distributed throughout the body tissues except in the central nervous
system
• These are present on glycoprotiens or glycolipids
RBC- glycoprotiens and glycolipids
Plasma- glycolipids
Body serous and mucus secretions – glycoprotiens
Endothelial and epithelial cells- glycolipids and glycoproteins
41. • Classification of A subgroup is
based on
1. Degree of agglutination by anti A ,
anti A1, and anti AB
2. Degree of H reactivity on red cells
3. Presence or absence of anti A1
4. Presence of A and H substance in
saliva of secretors
42. Bombay (oh) blood group
• Rare blood group
• Homozygous hh condition
• The A and B gene specified transferase enzyme cannot act directly on
precursor substance
• Bombay group cells have no A, B, and H antigens
43.
44. ABO typing technique
• Performed using manufacturers’ directions. Three basic techniques
are there
1. Slide test
2. Tube sedimentation
3. Spin tube
47. • Mix the cells and reagent
using clean stick. Spread
each mixture evenly on
slide over an area of
15mm diameter
• Rock rotate the slide or
plate and leave the test
for 2mins at room
temperature. Then rock
again and look for
agglutination
48. Tube testing recommended
• Easy to perform
• Tubes can be
centrifuged to
enhance the
reactions
• Can detect weeker
antigen or
antibody
49.
50. Rh antigen
• Levin and stetson discovered Rh antigen
• Later Fisher and Race discovered four additional antigens in Rh system-D,
C, E ,c and e
• Protein with an active phospholipid component
• Unlike ABO, Rh antigen only present on Red blood cells
• 2nd most important after ABO in the cross matching
53. Other blood group
• Lewis blood group system
• MNS blood group system
• P blood group system
• Kell system
• Duffy system
• Kidd blood group system
• Lutheran blood group system
54. Cross match (compatibility test)
• Done to ensure that the Particular unit of blood may be safely
transfused to a patient
• Two types
1. major cross matching
2. minor cross matching
55. Principle
• Major Cross matching is done to detect serological incompatibility
between donor cells and patient’s serum
• Minor cross matching is done to detect serological incompatibility
between patient’s cell and Donor’s serum
57. • Saline techniques for IgM
• Designed to detect IgM
antibodies that react optimally
at 22°C or lower
• Also detect major ABO
grouping error
• Inadequate Clinically
significant IgG are not detected
• Two methods based on mix
and incubate
1. Spin method
2. Sedimentation method
• Compatibility test for IgG
antibodies
1. IAT is the most important
test and widely used.
2. Enzyme technique
3. Albumin technique
4. Low ionic strength solution
technique
59. Anti globulin test (coomb’s test)
• Coombs discovered this test to detect the non agglutinating
(incomplete) blood group antibodies
• Anti globulin test used to detect RBC sensitized with IgG auto
antibodies, IgG allo antibodies and complement components
• Coombs serum or AHG – prepared by immunising animals usually
rabbit with whole human serum or with specific fraction of human
globulin
60. Anti globulin( anti IgG)
• Anti IgG is the only essential
antiglobulin antibody in AHG
serum
• Clinically significant
alloantibodies are IgG
Since IgA always found with IgG or
IgM
IgM allo antibodies are always
complement binding.
Anti complement antibodies
• To detect complement binding
significant antibodies of Kidd,
kell and Duffy systems
• To enhance reactions of
complement binding antibodies
• To detect IgM which invariably
bind to the complement
61. Principles of
antiglobulin test
• Washed red cells which are coated
with immune antibodies
(commonly IgG)and complement
components will show
agglutination with broad spectrum
AHG reagents
• In vitro Sensitization by IAT
• In vivo Sensitization by DAT
62. DAT
• Diagnosis of hemolytic disease of
new born
• Diagnosis of autoimmune
hemolytic anemia
• Investigation of drug induced red
cell Sensitization
• Investigation of hemolytic
transfusion reactions
63. IAT
• Compatibility testing
• Screening and detection of
unexpected antibodies in
serum
• Detection of red cells not
detected by other
techniques
64. Choice of ABO blood group
• Same blood group that of patient is preferred
• If antibody anti A1 is active in A2 or A2B group patient at 30°C or strongly active at
RT then A2 is preferred
• Very rarely anti H1 may be present at A1 group and is active at temperature above
30°C. In such cases A1 blood group is preferred
• Bombay blood group should be given Oh only
• A1 individual with acquired B like antigen are given A1 Blood only
• If same ABO group type is not available transfusion PRBC of different ABO group
provided they are compatible
65. Patients blood
group
First choice Second choice
A O None
A2 with anti A1 O None
A1 with anti H1 None None
B O None
A1B A or B O
A1B with anti H1(O) A1 or B None
A2B A or B O
A2B with anti A1 A2 or B O
Alternative
blood
66. Choice of blood in Rh system
• Same Rh group should be used
If Rh (D) negative blood is not available
If Rh (D) positive blood
can be given
Blood is compatible
Anti Rh(D) antibodies
have not been
detected at any time
in patients serum
67. Priorities for Rh negative blood in short supply
• Patients who already have Rh antibodies, blood lacking
corresponding antigen is selected
• Rh negative woman who have not passed child bearing age
• Infants suffering from HDN
68. Choice blood in other group systems
Irregular antibodies of other systems
active at 37°C
No
Yes
Possible to identify specificity of
irregular antibodies
Blood lacking
corresponding antigen is
selected for transfusion
Patient’s serum should
be cross matched with
several units of ABO
and Rh to find
compatible blood
Not
Possi
ble
• Patient’s relative especially
siblings may be compatible
70. Disease transmitted through blood and their
screening
Viral
• Hepatitis B and C
• HIV 1 and 2
• EBV
• CMV
Protozoal
• Malaria
• Toxoplasmosis
Bacterial
• Syphilis
• Brucella
71. Method Sensitivity Test for
HBV • RIA
• RPHA
• ELISA
• Moderate
• Moderate
• High
• HBS Ag
• HBS Ag
• HBS Ag
HIV • ELISA
• LA
• High
• Moderate
HIV Ab
HCV ELISA • High Ab of HCV
72. Test Sensitivity Test for
Syphilis • VDRL
• RPR
Moderate
sensitivity
And nonspecific
serological test
Ab to spirochate
Malaria • Thick and thin
leishman stain
for MP
• Antibody
screening test
• High
Parasite
Ab to MP
CMV • LA
• EIA
Moderate
High
Ab to CMV
73.
74.
75.
76.
77.
78.
79.
80.
81. Reference
• Saran, R. and Makroo, R., 2003. Transfusion Medicine. New
Delhi: Directorate General of Health Services, Ministry of
Health and Family Welfare, Govt. of India, p.Collection of
blood and processing.
• Saran, R. and Makroo, R., 2003. Transfusion Medicine. New
Delhi: Directorate General of Health Services, Ministry of
Health and Family Welfare, Govt. of India, pp.12-20.
• Saran, R. and Makroo, R., 2003. Transfusion Medicine. New
Delhi: Directorate General of Health Services, Ministry of
Health and Family Welfare, Govt. of India, pp.23-25, 31-34.
• Saran, R. and Makroo, R., 2003. Transfusion Medicine. New
Delhi: Directorate General of Health Services, Ministry of
Health and Family Welfare, Govt. of India, pp.38-49.
82. • Saran, R. and Makroo, R., 2003. Transfusion Medicine. New
Delhi: Directorate General of Health Services, Ministry of Health
and Family Welfare, Govt. of India, pp.56-62.
• Saran, R. and Makroo, 2003. Transfusion Medicine. New Delhi:
Directorate General of Health Services, Ministry of Health and
Family Welfare, Govt. of India, pp.86-91.
• Saran, R. and Makroo, R., 2003. Transfusion Medicine. New
Delhi: Directorate General of Health Services, Ministry of Health
and Family Welfare, Govt. of India, pp.125-135.
• Saran, R. and Makroo, R., 2003. Transfusion Medicine. New
Delhi: Directorate General of Health Services, Ministry of Health
and Family Welfare, Govt. of India, pp.143-145
