2. BLOOD GROUP
THE TERM BLOOD GROUP-Applied to genetically determined
antigen which can be detected on red cell surface.
TYPES OF BLOOD GROUP SYSTEM
1.ABO BLOOD GROUP SYSTEM
2.THE RHESUS SYSTEM
3. GENETICS OF ABO BLOOD GROUP SYSTEM
OLIGOSACCHRIDE
(PRECURSOR)
H SUBSTANCE
A GENE -
TRANSFERASE
A
ANTIGEN+SOME
H ANTIGEN
A BLD
GROUP
B
ANTIGEN+SOME
H ANTIGEN
B BLD
GROUP
H ANTIGEN
O BLD
GROUP
NO CHANGE IN
PRECURSOR
NOT
SUITABLE
SUBSTRATE
FOR A,B,O
GENE
NOA,B,H
ANTIGEN
BOMBAY
BLD
GROUP
CHROMOSOME 9
4. Karl Landsteiner’s Law- If a particular
antigen(Ag)is present on red blood cells
corresponding antibody must be absent
in the serum.
If a particular antigen is absent in the
RBCs,the corresponding antibody must
be present in the serum
5. THE ABO ANTIGEN & CORRESPONDING ANTIBODY
GROUP ANTIGEN ON CELLS ANTIBODIES IN SERUM
A A AntiB
B B AntiA
AB A&B NONE
O NONE AntiA&AntiB
6. BOMBAY BLOOD GROUP-
•DISCOVERED BY BHENDE IN 1952
•PHENOTYPE IS Oh
•GENOTYPE IS hh,THAT IS HOMOZYGOUS FOR “h” gene
•H SUBSTANCE WILL NOT BE PRESENT.
•RED CELLS ARE DEVOID OF A,B,H ANTIGEN
•SERUM CONTAINS ANTI A,ANTIB, ANTIAB , ANTI H
•H ANTIGEN IS COMMON TO ALL ABO BLOOD GROUP
7. BOMBAY BLOOD IS INCOMPATIBLE WITH ALL ABO DONORS.
•THIS PERSON APPEAR TO BE O GROUP DURING FORWAD TYPING
•HOWEVER TRANSFUSING NORMAL GROUP O(WITH HIGHEST CONCENTRATION
OF H ANTIGEN)WOULD CAUSE IMMEDIATE CELL LYSIS BY THE POTENT
ANTI H OF BOMBAY GROUP. SO ONLY BLOOD FROM ANOTHER BOMBAY
INDIVIDUAL CAN BE TRANSFUSED .
8. BOMBAY BLOOD GROUP DETECTED BY REVERSE TYPING
CONFIRMATION OF BOMBAY BLOOD GROUP
ADDITION OF ANTI H LECTIN-NO AGGLUTINATION IN BOMBAY GROUP
OTHER GROUP -AGGLUTINATION.
9. RH BLOOD GROUP
THE ANTIGEN OF RHESUS RBC WAS CALLED RH FACTOR
PEOPLE WHO HAVE THIS RH FACTOR ARE CALLED RH+VE(HAVE D ANTIGEN)
WHO DO NOT HAVE THE ANTIGEN ARE CALLED RH-VE
10. RH ANTIGEN
RH D ANTIGENS ARE PRESENT ONLY ON RBCS,FULLY DEVELOPED IN EARLY
FOETAL LIFE AND REMAIN SO THROUGHOUT LIFE.
CLINICALLY IMPORTANT AS IT IS HIGHLY ANTIGENIC.
12. BLOOD GROUPING
1.CELL GROUPING-(FORWARD TYPING)
THE UNKNOWN TEST CELLS ARE ANTIGEN TYPED AGAINST
POTENT & SPECIFIC ANTI-A &ANTI-B
2.SERUM GROUPING-(REVERSE TYPING)
THE UNKNOWN SERUM IS TESTED AGAINST KNOWN
GROUP A& GROUP B CELLS.
13. PROCEDURE-
1.SLIDE OR TILE METHOD
2.TUBE METHOD
3.MICROPLATE METHOD
4.I D MICROTYPING SYSTEM
5.AUTOMATED OR SEMIAUTOMATIC
INSTRUMENTATION.
14. SLIDE OR TILE METHOD-
USED ONLY FOR EMERGENCY,ESPECIALLY IN OUTDOOR CAMPS
IT IS INSENSITIVE ,NOT RELIABLE FOR WEAK ANTIGEN
IN FORWARD TYPING & LOW TITRE ANTIBODIES IN REVERSE TYPING
THERE IS DRYING EFFECT.
15. PROCEDURE-
88
8 Drops NS
+
2Drop Bld
DD
A B
C D
A&B - 1 DROP DILUTED BLOOD+ 1DROP RESPECTIVE ANTISERUM
C-1 DR0P DILUTED BLOOD+1 DROP NORMAL SALINE
D- 1DROP WHOLE BLOOD+ 1 DROP ANTI D
WATCH GLASS
TILE
16. TUBE METHOD
EASY TO PERFORM
SENSITIVE TEST (DETECTS WEAKER Ag &Ab DUE TO
CENTRIFUGATION)
NO DRYING EFFECT
IMMEDIATE SPIN TECHNIQUE
SALINE ROOM TEMPERATURE
17. MICRO PLATE METHOD
• Ideal for testing large number of blood samples
• Saves time
• Micro plates are polystyrene plates having 96 small wells,
each of which can hold 200 to 300 microlitres of reagent.
18. ID MICROTYPING SYSTEM(DIAMED/BIOVIEW)
Microtubes in the form of cards, filled with buffered dextran gel
are used which maybe natural or impregnated with antisera.
With negative reaction, the red cell pass through gel, upon
centrifugation where as in positive reaction the agglutinated
red cells are trapped on the top of the gel or suspended
within it.
19. HAEMOLYTIC DISEASE OF NEW BORN
HDN IS A SYNDROME ASSOCIATED WITH HEMOLYSIS IN FOETUS
EITHER IN UTERO & OR AFTER DELIVERY WITH CONSEQUENT
HYPERBILIRUBINEMIA,WHILE IT IS COMMONLY DUE TO IMMUNE
DESTRUCTION OF THE RED CELLS OF THE FOETUS AS A RESULT OF
MATERNAL IgG ANTIBODIES WHICH TRANSMIT THROUGHT PLACENTA.
20. CLASSIFICATION OF HDN
•ABO HEMOLYTIC DISEASE DUE TO ANTI A& ANTI B
•Rh(D) HEMOLYTIC DISEASE DUE TO ANTI D
•HDN DUE TO OTHER Rh ANTIBODIES ANTI C,ANTI E,ANTI c, ANTI e
•HDN DUE TO ANTIBODIES AGAINST ANTIGENS IN OTHER BLOOD
GROUP SYSTEM ie. ANTI K, ANTI k,ANTI FY, ANTI JK,ANTIM,ANTI N,
ANTIS,ANTI s.
21. R h INCOMPATIBILITY
LESS COMMON
MORE SEVERE
(ERYTHRO BLASTOSIS FOETALIS)
LESS COMMON IN FIRST PREGNANCY
ABO INCOMPATIBILITY
MORE COMMON
LESS SEVERE
COMMONLY SEEN IN FIRST
PREGNANCY
22.
23. Rh INCOMPATIBILITY
FIRST PREGNANCY Rh +VE RED CELLS OF THE BABY CROSS PLACENTA
INTO MOTHER WHO FORM ANTIBODIES AGAINST Rh +VE CELLS,
IN SUBSEQUENT PREGNANCY ANTIBODIES FROM THE MOTHER
CROSS PLACENTA,COAT FOETAL RED CELLS RESULTING IN HEMOLYSIS
24. GENESIS OF ANTIBODY FORMATION
Exposure of maternal blood to Rh+ve blood can occur in the following ways
1.TRANSPLACENTAL HAEMORRHAGE –CROSS OVER CAN OCCUR DURING
PREGNANCY
DELIVERY
ABORTION
TRAUMA
2.TRANSFUSION OF Rh INCOMPATIBLE BLOOD OR BLOOD PRODUCTS.
25. FOETAL RBC + MATERNAL IgG
HAEMOLYSIS OF FETAL RBC
ANEMIA UNCONJUGATED
BILIRUBINAEMIA
Bilirubin
excreted via
materal
circulation
before birth
Accerelated
erythropoiesis
CCF
HYDROPS FETALIS
OR STILL BIRTH
JAUNDICE AFTER BIRTH
(Neonatal liver deficient in
Glucuronyl transferase)
KERNICTERUS
26.
27. ABO INCOMPATIBILITY
•IF MOTHER IS GROUP O & FOETUS IS GROUP A OR B
•COMMONLY OCCURS IN FIRST PREGNANCY
•TEND TO BE LESS SEVERE & MAJORITY DO NOT
REQUIRE TREATMENT
•DCT ON CORD BLOOD IS WEAK OR -VE
28. CRITERIA FOR DONOR SELECTION
THE DONOR SHOULD BE IN GOOD HEALTH
AGE-18 TO 60 YRS
WEIGHT -45KG CAN GIVE 350ML
55KG CAN GIVE 450ML
BLOOD PRESSURE -SYSTOLIC BETWEEN 100-160MM Hg
DIASTOLIC 60 TO 100 MM WITHOUT MEDICATION.
PULSE-60 TO 100 BEATS/MIN,REGULAR
29. TEMPERATURE-SHOULD NOT EXCEED37.5C
HB-MORE THAN 12.5GM/DL
SKIN AT SITE OF VENIPUNCTURE –FREE FROM DISEASE
FREE FROM SKIN PUNCTURE OR SCARS INDICATIVE OF
PROFESSIONAL DONORS.
,
30. DONOR DEFERRAL (TEMPORARY)
CONDITION PERIOD
1.ABORTION 6MONTH
2.H/O BLOOD TRANSFUSION 6MONTH
3.ALCOHOLISM TILL INTOXICATED
4.MINOR SURGERY 3MONTH
5.MAJOR SURGERY 6MONTH
6.TYPHOID 6MTH AFTER RECOVERY
7.H/O MALARIA &DULY TREATED 3MTH(ENDEMIC)
3YR(NON ENDEMIC)
8.TATTOO 6MONTH
9.ACUTE NEPHRITIS 6MTH AFTER RECOVERY
31. CONDITION PEROID
10.BREAST FEEDING 6MONTH AFTER DELIVERY
11.IMMUNISATION 24HRS AFTER SYMPTOM FREE
12.RABIES VACCINATION 1YR AFTER BITE.
13.H/O HEPATITIS IN FAMILY
OR CLOSE CONTACT 6MONTH
32. REASONS FOR PERMANENT DEFERRAL
CANCER
HEART DISEASE
ABNORMAL BLEEDING TENDENCY
UNEXPLAINED WEIGHT LOSS
DM CONTROLLED ON INSULIN &ORAL DRUGS
LIVER DISEASE
HEPATITIS B INFECTION
CHRONIC NEPHRITIS
SIGNS &SYMPTOMS S/O AIDS
34. ADVERSE DONOR REACTION
1.DIFFICULTY WITH BLOOD FLOW- May be due to
- spasm of the vein
-Reduced cuff pressure
- occlusion of lumen of the needle by vein wall
or by the valve within the vein
GIVE REASSURANCE TO THE DONOR
CHECK CUFF PRESSURE
2.HAEMATOMA- STOP DONATION,REASSURE DONOR
PLACE STERILE GAUZE OR COTTON OVER HEMATOMA
&APPLY FIRM PREESURE UNTILL THE VENEPUNCTURE SITE
STOPS OOZING BLOOD
APPLY SOME ANTI INFLAMMTORYCREAM &PRESSURE
BANDAGE FOR 24HRS.
35. 3.MILD &MODERTE VASOVAGAL SYNDROME-
Sweating,anxiety ,rapid thready pulse,
Pallor,diziness,cold skin with fall of BP
Loss of consciousness(fainting) with
Slow &low volume pulse
Nausea&vomitting
MILD
MODERATE
STOP DONATION
RAISE THE LEGS OF DONOR &LOWER THE HEAD
LOOSEN TIGHT CLOTHING
ENSURE ADEQUATE AIRWAYS
IF DONOR VOMITS TURN HIS/HER HEAD TO ONE SIDE
TO AVOID ASPIRATION OF VOMITUS.
36. HYPERVENTILATION –OR DEEP BREATHING RESULTS IN LOWERING
OF CO2 WHICH MAY LEAD TO MUSCLE SPASM
OR TWITCHING OR TINGLING SENSATION.
THE DONOR SHOULD BE ASKED TO BREATH QUICKLY &
SLOWLY &IF THIS FAILS TO RELEIVE THE SPASM,ASK HIM
TO BREATH INTO A PAPER BAG WHICH WILL BRING PROMPT
RELIEF.
37. CONVULSION-UNCOMMON IF IT OCCURS
PREVENT THE DONOR FROM INJURING HIMSELF
KEEP TONGUE DEPRESSOR BETWEEN TEETH TO PREVENT
DONOR FROM BITING TONGUE
ENSURE ADEQATE AIRWAY
PUT SCREEN TO MAINTAIN PRIVACY.
CHECK THE PULSE FREQUENTLY
LOOSEN TIGHT CLOTHING.
IF CONVULSIONS LAST MORE THAN 5 MINUTES,PHYSICIAN
SHOULD BE CALLED.
DONOR AFTER RECOVERY SHOULD BE GIVEN FULL
REASSURNCE &ADVICED TACTFULLY NOT TO DONATE BLOOD
AGAIN.
38. ACCIDENTAL PUNCTURE OF THE ARTERY-
VERY RARE IN WHICH THERE IS VERY FAST FLOW OF BRIGHT RED BLOOD.
IF IT OCCURS IT IS IMPORTANT
-TO STOP DONATION IMMEDIATELY
APPLY HARD PRESSURE TO PUNCTURE SITE &RAISE THE LIMB ABOVE
THE HEART LEVEL.
THE PRESSURE SHOULD BE APPLIED FOR A MINIMUM OF 15-20 MINUTES.
GIVE REASSURANCE TO THE DONOR &RECORD THE FINDINGS IN DONOR
CARD.
39. PRESERVATION& STORAGE OF BLOOD
CITRATE PHOSPHATE DEXTROSE ADENINE(CPDA-1)14ML/1OOML
SHELF LIFE = 35DAYS
40. ADDITIVE SYSTEM LIKE SAGM = SALINE, ADENINE
GLUCOSE, MANNITOL
A NUTRITIVE SOLUTION IN AN ATTACHED
SATELLITE BAG WILL EXTEND THE RED CELL
STORAGE TO 42 DAYS
41. FUNCTION OF VARIOUS CHEMICALS USED IN ANTICOAGULANT
PRESERATIVE SOLUTION
CITRATE- IT ACTS BY CHEALATING CALCIUM
ONE OF THE MAIN INGREDIENTS USED FOR STORAGE OF BLOOD
DEXTROSE- PROLONGS THE SURVIVAL OF RED CELLS CONSIDERABLY
-METABOLISM OF STORED RED CELLS
CITRIC ACID- PREVENTS THE CARMALIZATION OF GLUCOSE IN
CITRATE DEXTROSE SOLUTION DURING AUTOCLAVING
ADENINE-
PHOSPHATE
INCREASED ATP PRODUCTION RESULT IN
INCREASED POST TRANSFUSION SURVIVAL TO 35 DAYS
BUFFER
42. ANTIGLOBULIN TEST (COOMBS TEST)
DISCOVERED BY COOMBS,MOURANT&RACE FOR DETECTING
NONAGGLUTINATING (INCOMPLETE)ANTIBODIES IN SERUM.
DAT = DIRECT ANTIGLOBULIN TEST (DCT), ICT = INDIRECT
ANTIGLOBULIN TEST (ICT)
43. DIRECT ANTIGLOBULIN TEST(DCT)
USED IN DIAGNOSIS OF HAEMOLYTIC DISEASES OF NEW BORN
DIAGNOSIS OF AUTOIMMUNE HAEMOLYTIC ANEMIA
INVESTIGATION OF DRUG INDUCED RED CELL SENSITIZATION
INVESTIGATION OF HAEMOLYTIC TRANSFUSION REACTION
USED TO DETECT IN VIVO SENSITIZATION(COATING) OF RED CELLS WITH
IMMUNE ANTIBODY(IgG)
44.
45. DCT is used to detect IgG antibodies bound to the surface of RBC.
A Blood sample is taken & RBC are washed removing the patients own plasma
and then incubated with anti human globulin(COOMBS REAGENT, IgM antibodies
against IgG antibodies).
If this produces agglutination of RBCs, the DCT is positive.,a visual indication that
Antibodies &or complement proteins are bound to the surface of RBC
46. INDIRECT ANTIGLOBULIN TEST(IAT)
USED TO DETECT THE PRESENCE OF INCOMPLETE ANTIBODIES
IN THE SERUM
- USED IN COMPATIBILITY TESTING
-SCREENING&IDENTIFICATION OF UNEXPECTED AB IN SERUM
-DETECTION OF RED CELL ANTIGEN USING SPECIFIC ANTIBODY.
47. 1)Test Serum is incubated with Rh
positive RBC (O group)
2)If IgG antibody is present in serum,
it will attach to the surface of RBC
3)Then coombs serum is added (IgM
antibodies)
4)Agglutination will take place if IgG
coated RBC are present.
48.
49.
50. COMPATIBILITY TESTING (PRETRANSFUSION TESTING)
Refers to set of procedures required before blood is issued as been compatible
THE PURPOSE OF PRETRANSFUSION TESTING IS TO SELECT BLOOD & ITS COMPONENT
THAT WILL HAVE
•ACCEPTABLE SURVIVAL WHEN TRANSFUSED
•AND WILL NOT CAUSE DESTRUCTION OF RECIPIENTS RED CELLS
51. CROSS MATCHING
The term compatibility test & cross matching are sometimes used interchangeably
A CROSS MATCH IS ONLY PART OF COMPATIBILITY TEST
COMPATIBILITY TEST CONSISTS OF FOLLOWING
1. Review of patients past blood bank history and records
2. ABO & Rh typing of recipients & donor
3. Antibody screening of recipients & donor serum
4. Cross match
52. CROSS MATCHING
IT IS THE FINAL CHECK OF ABO COMPATIBILITY BETWEEN
DONOR &PATIENT
IT MAY DETECT THE PRESENCE OF AN ANTIBODY IN THE PATIENT
SERUM THAT WILL REACT WITH AN ANTIGEN ON DONOR RED CELLS
WHICH WAS NOT DETECTED IN ANTIBODY SCREENING BECAUSE OF
THE ABSENCE OF CORRESPONDING ANTIGEN IN THE SCREENING CELLS
CARRIED OUT TO ENSURE THAT THERE ARE NO ANTIBODIES
PRESENT IN THE PATIENT SERUM THAT WILL REACT WITH
DONOR CELLS WHEN TRANSFUSED.
53. CROSS MATCHING
MAJOR CROSS MATCH
DONOR’S RED CELL
+
PATIENT’S SERUM
MINOR CROSS MATCH
PATIENT’S CELL
+
DONOR’S PLASMA
55. ALBUMIN & LISS (Low ionic strength saline)
CAN BE USED WITH AHG TO INCREASE
THE SENSITIVITY
Albumin media reduces the electrostatic
repulsion of the cells & allows them to
come close together.
61. BLOOD COMPONENT & ITS USE
PACKED RED CELL- STORED AT+1 TO+6 ° C
APPROXIMATELY 35 DAYS DEPENDING ON
ANTICOAGULANT IN BLOOD BAG.
INDICATION -1.SEVERE ANEMIA (WHOLE BLOOD TRANSFUSION MAY
CAUSE CIRCULATORY OVERLOAD)
2.HAEMOLYTIC ANEMIA
3.REFRACTORY ANEMIA-eg . APLASTICANEMIA,HYPOPLASTIC
ANEMIA,ANEMIA OF CHRONIC RENAL FAILURE,CARCINOMA
LEUKAEMIA etc.
62. PLATELET CONCENTRATE- STORED AT+ 20 TO +24°C WITH CONTINOUS
GENTLE AGITATION CAN BE KEPT FOR 3 TO5 DAYS.
INDICATION-1.ITP
2.LEUKAEMIA
3.THROMBOCYTOPENIA DUE TO IMMUNE DESTRUCTION
4.HYPOPLASTIC ANEMIA
5.DIC
6.DENGUE
7.THROMBOCYTOPENIA.
63. FRESH FROZEN PLASMA- CAN BE STORED AT -18 or <-18 ° C FOR ONE YEAR
INDICATION -1.FACTOR V DEFICIENCY
2.REPLACEMENT OF COAGULATION FACTORS IN DIC
3.FACTOR II,VII,IX&X DEFICIENCY
4.HAEMOPHILIA A,B&VON WILLEBRANDS DISEASE WHEN
CRYOPRECIPITATE IS NOT AVAILABLE.
GRANULOCYTE CONCENTRATE- STORED AT ROOM TEMPERATURE FOR 24
HOURS
INDICATION –1.BONE MARROW DEPRESSION
2.NEUTROPENIA
3.SEPTICEMIA IN INFANTS.
64. CRYOPRECIPITATE– STORED AT -18 or <-18 ° C OR BELOW FOR ONE YEAR
INDICATION –HIGHLY EFFECTIVE IN TREATMENT OF HAEMOPHILIA A
VON WILLIBRANDS DISEASE
65. MAIN DISEASE TRANSMITTED THROUGH BLOOD
VIRAL-
HEPATITIS B VIRUS(HBV)
NON A, NON B HEPATITIS(NANB)/HEPATITIS C VIRUS (HCV)
HEPATITIS G(HGV)
HUMN IMMUNODEFICIENCY VIRUS (HIV)
EPSTEIN BARR VIRUS (EBV)
CYTOMEGALO VIRUS (CMV)
HUMAN T LYMPHOTROPIC (HTLV-1&HTLV-2)
BACTERIAL-
SYPHILIS
BRUCELLA
PARASITIC-
MALARIA
TOXOPLASMA
MICROFILARIA
67. 2.DELAYED REACTION.
IMMUNOLOGICAL CASUES- Haemolysis
Graft vs Host disease
post transfusion purpura
NON IMMUNOLOGICAL CASUES- Hepatitis mostly B &C
AIDS
Iron overload
Malarial infection
Syphilis
viral infections
68. 1.HAEMOLYTIC TRANSFUSION REACTION
DUE TO ABO INCOMPATIBILITY& Rh INCOMPATIBILITY
IMMEDIATE- A VERY SERIOUS COMPLICATION
DONOR RED CELLS ARE DESTROYED (INTRAVASCULAR) BY THE
RECIPIENTSBLOOD CONTAINING PREFORMED IgM ANTIBODIES
OCCURES DUE TO INCORRECT LABELLING,
WRONG IDENTIFICATION OF PATIENTS,
ERROR IN BLOOD GROUPING,
FAILURE TO DETECT WEAK ANTIBODIES
69. CLINICAL PICTURE – IMMEDIATE ,USUALLY WITHIN MINUTES
AFTER STARTING TRANSFUSION.
-SENSATION OF HEAT&PAIN ALONG THE
TRANSFUSED VEIN ,FACIAL FLUSH,
FEVER,RIGORS,SEVERE PAIN IN LOINS,
FEELING OF CONSTRICTION IN CHEST,
THE PATIENT DEVELOP HYPOTENSION,SHOCK
ULTIMATELY ENDING IN DEATH
INTRAVASCULAR HAEMOLYSIS RESULTS IN HAEMOGLOBINURIA,
ACUTE RENAL FAILURE WITH OLIGURIA.
MANAGEMENT –STOP TRANSFUSION,RESTORING BLOOD VOLUME
70. DELAYED - DUE TO EXTRAVASCULAR DESTRUCTION OF RED CELL
MILD REACTION OCCURS 4 DAYS TO 2 WEEKS AFTER TRANSFUSION.
PATIENT DEVELOPS FEVER, ANEMIA,JAUNDICE.
2.FEVER- MOST COMMON (90%)
STARTS DURING OR SHORTLY AFTER TRANSFUSION
CAN BE PREVENTED BY TRANSFUSION OF LEUCOCYTE POOR BLOOD
ie. BLOOD FROM WHICH BUFFY COAT HAS BEEN REMOVED
71. 3.ANAPHYLAXIS- OCCURS DUE TO TRANSFUSION OF BLOOD IN A
IgA DEFICIENT PATIENT
IT IS IMMEDIATE TYPE HYPERSENSITIVITY REACTION
MANIFEST AS FLUSHING,NAUSEA,VOMITTING,RESPIRATORY
DISTRESS,URTICARIA,HYPOTENSION &SHOCK.
4.CIRCULATORY OVER LOAD-FOLLOWING TRANSFUSION THERE IS INCREASE
IN BLOOD VOLUME&VENOUS PRESSURE ESPECIALLY
IN ELDERLY&PREGNANT WOMEN , CARDIAC FUNCTION
IS AFFECTED AND MAY RESULT IN ACUTE PULMONARY
OEDEMA.MANAGED BY STOPPING TRANSFUSION& GIVE
IV DIURETICS LIKE LASIX.
72. 5.URTICARIA –
OCCURS BECAUSE OF THE PRESENCE OF SENSITISING ANTIBODIES IN THE
RECIPIENT WHICH REACTS WITH EXOGENOUS ANTIGEN
PRESENT IN THE PLASMA OF DONOR .COMMON IN PATIENTS WHO SUFFER
FROM ATOPIC DISEASES eg. Asthma, Hay Fever
73. 6.GRAFT VERSUS HOST DISEASE (GVHD)-
RARE COMPLICATION.
SEEN IN CONDITIONS IN WHICH THE IMMUNE SYSTEM IS DEPRESSED.
OCCURS IF DONOR LYMPHOCYTES GET ENGRAFTED & MULTIPLY IN PATIENTS WITH
IMMUNODEFICIENCY.
SYMPTOMS –FEVER, RASH,DIARRHOEA, SUPERINFECTION.
PREVENTION- Patients who are severely immunosuppressed should receive
Leucocyte free blood or irradiated blood components.
74. 7.TRANSFUSION RELATED ACUTE LUNG INJURY- (TRALI)
IS CHARACTERISED BY DEVELOPMENT OF ACUTE RESPIRATORY DISTRESS
WITH HYPOXEMIA WITH IN 6 HRS AFTER COMPLETION OF A BLOOD TRSANSFUSION
IT HAS BEEN ASSOCIATED WITH ALL TYPES OF BLOOD PRODUCTS.
XRAY SHOWED EVIDENCE OF BILATERAL PULOMNARY INFILTRATE.
MAJORITY OF PATIENTS RECOVER QUICKLY.
ANTIBODIES TO WHITE BLOOD CELL ANTIGEN ARE RESPONSIBLE FOR TRALI
75. INVESTIGTION OF A TRANSFUSION REACTION
A)SAMPLES NEEDED 1.POST TRANSFUSION BLOOD & URINE SAMPLE FROM THE
PATIENT.
2.PRE TRANSFUSION BLOOD SAMPLE IF AVAILABLE.
3.PATIENTS ORGINAL CROSS MATCH SPECIMEN(always
keep this for 48 hr
4.THE DONOR PILOT TUBE IS ALSO KEPT FOR 48 HRS.
5.RECORD THE FINDING.
76. The patient’s pretransfusion and post Transfusion plasma from EDTA sample is
examined for evidence of free haemoglobin or increased bilirubin.
Pink or red discolouration in post transfusion plasma indicates the presence of free
haemoglobin due to red cell destruction.
Yellow or brown discolouration of the sample drawn six to eight hours after
transfusion indicates increased bilirubin.
DAT test is done on pre and post transfusion sample
-A positive DAT indicates the presence of recipient antibodies on the surface of
donor red cells.
Check the plasma haptoglobulin level of pre and post tranfsuion sample of the
recipient – a decrease in plasma haptoglobulin usually seen in intravascular
haemolysis
LABORATORY INVESTIGATION
77. INSPECT THE POST TRANSFUSION URINE SAMPLE FOR PRESENCE OF HAEMOLYSIS
CENTRIFUGE THE SPECIMEN TO SEE IF THE RED COLOUR
STAYS IN THE SUPERNATANT(HAEMOGLOBINURIA)
GOES TO THE BOTTOM IN THE SEDIMENT(HAEMATURIA)
BLOOD SAMPLE SHOULD BE CHECKED FOR HAEMOLYSIS
REGROUP &RETYPE DONOR BLOOD WITH THE NEW PATIENT SPECIMEN.
DO GRAM staining and CULTURE of donors blood to rule out any evidence
of bacterial infection
78. INTERPRETATION OF LAB FINDINGS-
1)No evidence of haemolysis in post transfusion sample-
NO RED/PINK PLASMA
NO INCREASE IN BILIRUBIN
DCT IS NEGATIVE
NO HAEMOGLOBINURIA
If nothing abnormal ,indicates that no acute haemolytic reaction.
2) If any finding is +ve or clinical findings strongly suggest a haemolytic reaction, the
following investigation
a) Repeat the cross match ,testing both pre and post transfusion
sample
b)Repeat antibody screening and identification of patients pre and
post transfusion sample
