2. LEARNING
OBJECTIVES
1. Short history
2. Explain the ABO and Rh system (revisit)
3. Describe the various blood products for
transfusion. List the common indication for blood
transfusion.
4. Explain the techniques used in blood group
serology
5. Describe the cross-matching and pre-transfusion
tests.
6. Explain the processes and procedures for blood
banking
2
3. BLOOD
• Blood is considered as river
of life, fluid of life, fluid of
growth, fluid of health.
• Average human has 5 liters
of blood i.e., 8% of total
body weight.
• It is a transporting fluid.
• It carries vital substances to
all parts of body.
blood and blood transfusions
4. OVERVIEW
• It is a procedure in which a
patient receives a blood product
through an intravenous line.
• It is the introduction of blood
components into the venous
circulation.
• Process of transferring blood-
based products from one person
into the circulatory system of
another.
5. HISTORY OF
BLOOD
TRANSFUSIO
N
• Prof. Karl Landsteiner
discovered that blood clumping
was an immunological reaction
• Karl Landsteiner's work made
it possible to determine blood
types
• For this discovery he was
awarded the Nobel Prize in
Physiology or Medicine in 1930.
6. The first historical attempt at blood transfusion was
described by the Stefano Infessura, 15th-century
chronicler .
1492, as Pope Innocent VIII sank into a coma, the
blood of three boys was infused into the dying pontiff
(through the mouth, as the concept of circulation and
methods for intravenous access did not exist at that
time)
The boys were ten years old and had been
promised a ducat each. However, not only did
the pope die, but so did the three children.
6
HISTORY
7. • The first fully-documented human blood
transfusion was administered by Dr. Jean-
Baptiste Denis, eminent physician to King
Louis XIV of France, on June 15, 1667. He
transfused the blood of a sheep into a 15-
year-old boy, who recovered.
7
8. • In 1818, Dr. James Blundell, a British
obstetrician,
• - first successful blood transfusion of
human blood, for the treatment of
postpartum hemorrhage.
• He used the patient’s husband as a
donor, and extracted four ounces of
blood from his arm to transfuse into his
wife.
• During the years 1825 and 1830, 10
transfusions, five of which were
beneficial, and published his results. -
He also invented many instruments for
the transfusion of blood.
8
9. • The first blood
transfusion using blood that
had been stored and cooled
was performed on January 1,
1916. Oswald Hope
Robertson, a medical
researcher and U.S. Army
officer
• He built an ice chest from
two ammunition cases, took
22 units of blood to a
casualty-clearing station and
used them to resuscitate
Canadian soldiers judged too
deep in shock for surgery.
Eleven of the 20 recipients
survived. 9
15. 15
PACKED RED CELLS
• In Malaysia, all the packed cells are
leucocytes-reduced. (LPRBC). This is a
component derived form whole blood and
removal of plasma and buffy coat, and
subsequent re-suspension of red cells in
an appropriate nutrient solution.
• Volume 400-450mls
• The haematocrit is 0.65-0.75. Each unit
requires a minimum of 45 g of
haemoglobin at the end of processing.
• Indications: Replacement for blood loss
• The therapy of anaemia. (rapidly increase
the delivery of oxygen to the tissues. )
16. PLATELETS
16
A component derived from fresh whole
blood which contains platelet content in a
therapeutically effective form.
Contains 45-85 x 109 (on average 70x
10(9)) in 50 to 60 ml suspension medium.
Indications: severe thrombocytopenia with
clinically significant hemorrhage
attributable to platelet deficit.
Storage: 20-24 Celcius.
AGITATE CONTINOUSLY!
17. FRESH FROZEN
PLASMA
17
Prepared from whole blood using hard-spin centrifugation within 18
hours of collection.
Contains: albumin, immunoglobulin and coagulation factors.
Reduced factor V and VIII, fibrinogen.
Storage : Last 3 months if temperature is between 18-25 Celcius
Last for 36 months at below -25 Celcius
Indications: patients with coagulation disorders esp. with multiple
coagulation factors deficiency.
Also treatment of Thrombotic thrombocytopenic purpura.
NOT TO BE USED IN :
• Volume correction
• Situations where there is an availability of coagulation factor specific is available e.g. Hemophilia.
18. CRYOPRECIPITATE
18
Prepared from fresh frozen plasma after “hard spin”.
Volume is abt 40 ml.
Contains: cryoglobulin fraction of plasma, factor VIII,
von willebrand factor (vWF), fibrinogen, fibronectin.
Storage : Last 3 months if temperature is between 18-
25 Celcius
Last for 36 months at below -25 Celcius
Indications:
Factor VIII deficiency state (if
factor specific material is not
available)
Complex deficiency states:
Disseminated intravascular
vascular coagulation.
Fibrinogen defects
19. Blood Transfusion Form
1. Demography of patient is
very important
2. The signatory is
responsible for the
contents and accuracy of
the information
3. The blood and blood
products required can be
chosen in the blue box by
ticking in the respective
boxes.
19
21. Test tubes
•Forward grouping and reverse
grouping is necessary.
•Tile method is not sensitive.
•Tile is never used for compatibility
testing.
Techniques
21
22. TECHNIQUES
• Gel method is a new innovation in
blood bank.
• Uses less blood than tube.
• The results are “imprinted “ on the
card and lasts longer.
• Useful in cases of audit or enquiry.
22
23. PRE-
TRANSFUSI
ON TESTS
FOR
TRANSFUSI
ON
TRANSMITT
ED TESTS
• There are two types of tests: infectious diseases and serological
• Infectious tests differ from country to country:
• Tests for infectious diseases: (Malaysia)
• HIV-1 and HIV-2
• Hepatitis B
• Hepatitis C
• Syphilis
• Source PDN.
• Tests for infectious diseases: (UK)
• Antibody HIV 1 & 2 in addition to HIV antigen
• Hepatitis B
• Hepatitis C
• HTLV (pooled sample)
• Syphilis
• HCV genome direction/ NAT testing
• Source Prof Marcela Contreras, ABC of transfusion
23
24. • Note the incubation period for
hepatitis B.
• What is the incubation period
for HIV?
24
29. ANTIBODY
SCREENING/
GROUP,
SCREEN AND
HOLD/ GROUP
AND SCREEN/
GSH
PATIENTS'
SERUM VS 3
TUBES OF
RED CELL
REAGENTS
WITH KNOWN
ANTIGENS
1. Antibody screening is mandatory for all requests for transfusion.
2. In laboratories that carry out antibody screening by tube method, the
following phases shall be performed at, Room temperature, 37°C and Anti
Human Globulin (AHG).
3. In laboratories that use other standard methods (e.g. column
agglutination technology) manufacturer’s recommendations shall be
followed.
4. The red cell reagents used shall consist of at least two group O red
cells, (not pooled), and shall express all of the following antigens: C, c, D, E,
e, M, N, S, s, K, k, Fya, Fyb, Jka, Jkb. Where possible, one of the red cell
reagents should be of the R1R1 phenotype (CDe phenotype) and another of
R2R2 phenotype (cDE phenotype). Additional red cell antigens may be
considered to reflect the antigenic profile of the local population.
29
30. ANTIBODY SCREENING
Reagents are 2 or 3 red cells which are group O red cells.
These antigens shall express the following antigens : C, c, D, E,
e, M,N,S, s, K,k, Fya, Fyb, Jka, Jkb
C Fya
M
N
D
Jkb
Y
Y Y
Y
Patient serum sample
30
The aim is to detect any
possible antibody which
is present in patient’s
serum.
32. HISTORY
ABO AND RH
BLOOD PRODUCTS
TECHNIQUES
PRE-TRANSFUSION
COMPLICATIONS
LABORATORY INX
BLOOD BANKS
Antibody identification
1. If the antibody screening is positive, then the next step is antibody
identification.
2. A panel of 12 red cells are used to identify the suspected antibody
in the patient’s serum.
32
33. HISTORY
ABO AND RH
BLOOD PRODUCTS
TECHNIQUES
PRE-TRANSFUSION
COMPLICATIONS
LABORATORY INX
BLOOD BANKS
Pretransfusion testing in newborn less than 4
months of age.
1. Samples from mother and neonates are required.
2. ABO and Rh determined. For the neonate, only forward
grouping is determined, because the corresponding antibody
is weak or absent.
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35. Crossmatched blood that has not been issued shall be released into
general stock after 48 hours.
The decision to use the most compatible blood shall be arrived at after
taking into consideration.
The potential risks of adverse
reactions, and
the potential risks of harm to the
patient owing to delay in transfusion
arising from searching for fully
compatible blood.
Where fully compatible blood is not available, and the patient needs
urgent transfusion, the hospital blood bank shall discuss with the
clinician in charge of the patient for the issue of the most compatible
blood.
When a clinically significant red cell antibody is identified, every effort
shall be made to provide blood that is antigen negative (with respect to
the identified antibody).
crossmatching using tube method, the following phases shall be
performed at:
Room temperature, 37° C, and AHG .
Red cell unit selected for crossmatching shall be of the same ABO and
RhD type as that of the patient.
36.
37. CROSS-MATCH
TRANSFUSION RATIO
A quality indicator
Crossmatch to transfusion ratio (C/T ratio) = number of
units cross matched/number of units transfused. A ratio of
2.5 and below is considered indicative of
significant/efficient blood usage.
References: Zewdie, K., Genetu, A., Mekonnen, Y. et al. Efficiency of blood utilization in elective surgical patients. BMC Health Serv Res 19, 804
(2019). https://doi.org/10.1186/s12913-019-4584-1
