This document discusses medical applications of blood group systems. It covers blood transfusions, identification of disease susceptibility, blood compatibility, blood incompatibility, blood banking, whole blood and blood components, transfusion reactions, and clinical implications such as paternity disputes and criminal cases. It provides details on various anticoagulant solutions, storage of whole blood and components, and separation of components through centrifugation. It also summarizes immediate and delayed transfusion reactions.

1. Medical applications of blood
group systems
MB 344: IMMUNOLOGY II

3. CLINICAL IMPLICATIONS
Blood Transfusions
Medico-legal cases-
 1. Paternity disputes
 2. Criminal cases
Identification of susceptibility towards diseases
1. Prevention of HDN due to Rh incompatibility

4. BLOOD COMPATIBILITY
Impossible to obtain perfectly matched blood for transfusion.
Routinely used system- ABO& Rh.
Other antigens are too weakto be of importance.
Choice of donor:
1. Recipient’s plasma should not contain antibodies against donor’s RBCs
2. Donor’s plasma should not contain antibody that will damage the
recipient’s red cells.
3. Donor’s red cells should not have any antigen lacking in the recipient.

5. BLOOD INCOMPATIBILITY
Rh incompatibility-

7. BLOOD BANKING
MB 344: IMMUNOLOGY II

8. NEEDOF BLOODBANK-
• STORE VIABLE AND FUNCTIONAL BLOOD AS WELL AS BLOOD COMPONENTS
• PREVENT PHYSICAL CHANGES IN BLOOD & BLOOD COMPONENTS
• MINIMISE CONTAMINATION IN BLOOD & BLOOD COMPONENTS

9. ANTICOAGULANT SOLUTIONS-
• ACD- ACIDCITRATE DEXTROSE
TEMPERATURE- 2-6°C FOR 21 DAYS.
CITRATE - ANTICOAGULANT BY CHELATING CALCIUM.
DEXTROSE – INCREASES POST-TRANSFUSION SURVIVAL OF RED CELLS.
CITRIC ACID – PREVENTS CARAMELIZATION OF GLUCOSE DURING AUTOCLAVE.

10. • CPD– CITRATE PHOSPHATE DEXTROSE
PHOSPHATE CAN INCREASE THE POST-TRANSFUSION SURVIVAL RATE OF RBC.
• HEPARIN – PREVENTS COAGULATION BY INACTIVATING THROMBIN AFTER
COMPLEXING WITH ANTI-THROMBIN III AND THROMBIN.
• EDTA – ACTS AS CHELATING AGENT AND BINDS CALCIUM IONS.

11. WHOLE BLOOD & BLOOD
COMPONENTS:
• Whole blood is one unit of donor blood which is collected in a suitable anticoagulant-
preservative solution.
• Blood components are constituents separated from whole blood by differential
centrifugation or by apheresis.

13. WHOLE BLOOD
• Total volume = 400 ml (350 ml of blood + 49 ml of anticoagulant).
• Storage temperature = 2-6°C (in refrigerator)
• Shelf life = 35 days (in CPDA-1).

14. BLOOD COMPONENTS
• Separation of blood components is achieved using centrifugation.
• Separation is carried out in double or triple bags with closed internal
tubings.
• Blood should be processed for component within 6 hours of collection.

19. PACKED RED CELLS
• Prepared by removing most of the plasma from one unit of whole blood.
• It is done by either allowing whole blood to sediment overnight in a refrigerator at 2-6°C or by
spinning whole blood in a refrigerated centrifuge.
• Supernatant plasma is separated from red cells in a closed system.
• Red cells and small amount of plasma are left behind in the primary blood bag.

20. RED CELLS IN ADDITIVE SOLUTION-
• Commonly used additive solution contains Saline,Adenine, Glucose & Mannitol.
• Whole Blood is collected in primary collection bag which contained CPDA-1 and centrifuged.
• Maximum amount of plasma is removed and transferred to one satellite bag.
• Additive solution from second satellite bag is then transferred into the primary collection bag.

21. LEUKOCYTE-POOR RED CELLS-
• Obtained by passing blood through a special leukocyte-depletion filter.
• Should contain less than 5 X 106
white cells per bag.
• Cannot prevent graft-versus-host disease.

22. IRRADIATED RED CELLS-
• Gamma irradiation inhibits donor lymphocyte replication.
• Gamma-irradiated red cells can prevent graft-versus-host
disease in susceptible individuals.

23. WASHED RED CELLS-
• Packed red cells are washed with normal saline to
remove plasma proteins,WBCs and platelets.

24. FROZEN RED CELLS-
• Frozen red blood cells can be stored for up to 10 years.
• Donor red cells with rare blood groups can be stored frozen.
• Cryoprotective agent such as glycerol is added during freezing and thawing.
• Virtually free from lymphocytes, platelets and plasma.

25. PLATELETS-
• It can be obtained by differential centrifugation of one unit of whole
blood or by Plateletpheresis.
• Donor pheresis is a procedure in which the donor is connected to an
automated cell separator machine which withdraws whole blood,
retains desired component and returns back the remainder of the
blood to the donor.

26. PLATELET CONCENTRATE-
• Obtained by differential centrifugation of one unit of whole blood within 6 hours of donation
and before refrigeration.
• One unit of whole blood is centrifuged at low speed to obtain platelet-rich plasma or PRP.
• PRP is then transferred to attached satellite bag and centrifuged at high speed.
• Platelet aggregates at the bottom and platelet-poor plasma (PPP) remains at the top.
• Most of the PPP is returned to the primary collection bag.

27. PLATELET CONCENTRATE-
• Transfusion of one unit of platelet concentrate will raise the platelet count in the recipient by about
5000/ microlitres.
• Usual adult dose is 4 to 6 units or 1 unit/10 kg of body weight.
• These units are collected from different donors and are pooled into one bag before transfusion.
• It is preferable to transfuse platelet concentrate of same or compatible ABO group and similar Rh
group.
• Platelet concentrate can be stored at 20 to 24°C with continuous agitation for 3 to 5 days.

28. PLATELETPHERESIS-
• The donor is connected to blood cell separator machine through which whole blood is
collected in an anticoagulant solution.
• Then, platelets are separated and retained.
• The remaining blood components are returned back to the donor.
• Large number of platelets can be obtained from a single donor.

29. GRANULOCYTE CONCENTRATE-
• Rarely used.
• It can be obtained by leukapheresis or by differential centrifugation.
• Leukapheresis is preferred.
• Administration of Corticosteroids to the donor may enhance leukapheresis by providing
more granulocytes.

30. PLASMA COMPONENTS-
• Obtained either by centrifugation of whole blood or by
plasmapheresis.

31. FRESH FROZEN PLASMA-
• Plasma is separated and transferred to the attached satellite bag.
• Rapidly frozen at -25°C or lower temperature.
• Must be performed within 6 hours of collection.
• Can be stored for 1 year at temperature below -25 ° C.
• When required for transfusion, it is thawed between 30 and 37 ° C and then stored in blood
bank refrigerator at 2 to 6°C.
• Should be transfused within 2 hours of thawing.

32. CRYOPRECIPITATE-
• Prepared by slowly thawing one unit of FFP at 4 to 6°C.
• Plasma and a white precipitate are obtained.
• After centrifugation, most of the supernatant plasma is removed leaving behind sediment of
cryoprecipitate which is suspended in 10 to 20 ml of plasma.
• The unit is then refrozen at -25°C or colder temperature.
• It can be stored for 1 year at this temperature.
• When required for transfusion, it is thawed between 30 and 37°C and then stored in blood bank
refrigerator at 2 to 6°C till transfusion.

33. TRANSFUSION REACTIONS
MB 344: IMMUNOLOGY II

34. TRANSFUSION REACTION-
• ANY UNTOWARDREACTION THAT OCCURS AS A CONSEQUENCE OF INFUSION
OF BLOOD OR CELL THERAPY PRODUCTS.
• IMMEDIATE
• DELAYED

35. IMMEDIATE
IMMUNOLOGICAL-
•FEBRILE NON-HAEMOLYTIC TRANSFUSION REACTIONS
•HAEMOLYTIC TRANSFUSION REACTIONS
•ALLERGIC REACTIONS
•ANAPHYLACTIC REACTIONS
•TRANSFUSION-ASSOCIATED LUNG INJURY
NON-IMMUNOLOGICAL-
•CIRCULATORY OVERLOAD
•BACTERIAL CONTAMINATION OF DONOR BLOOD UNIT

36. DELAYED-
IMMUNOLOGICAL-
•HAEMOLYTIC TRANSFUSION REACTIONS
•POST-TRANSFUSION PURPURA
•GRAFT-VERSUS-HOST DISEASE
NON-IMMUNOLOGICAL-
•TRANSMISSION OF INFECTIOUS ORGANISMS
•IRON OVERLOAD

37. Thank YouThank You
Presented by- Bishwarup S.
References-
1. Kuby immunology/ 6th ed. / Thomas J. Kindt,
Richard A. Goldsby, Barbara A. Osborne.
2. Banaji N. Ananthanarayan and Paniker's Textbook of
Microbiology/ 10th
ed./ Indian J Med Microbiol
2013;31:423.
3. Saran RK. Transfusion medicine technical manual.
DGHS/ 2nd ed./ India: Ministry of Health and Family
Welfare; 2003.