Blood Banking

 Deals with the study of immunologic principles applied in blood group antigens and
antibodies.
 Deals with mechanisms of blood typing & crossmatching (compatibility test and coomb’s
test)
 Detection and measurement of anti body, screening of donors, bleeding techniques

Different Tests:

1. ABO typing & RH typing

2. Compatibility/ Crossmatching
3. Coomb’s Test/ Anti Human Globulin Test
4. Detection & Identification
- Antibody screening
- Unexpected antibody and identify
5. Screening of donors
6. Blood components preparation
- transfused

ABO typing

 Anti- A
 Anti- B

RH typing

 Anti- D

Major Blood Group

 Type O
 Type A
 Type B
 Type AB

Methods to determine Blood Group- done simultaneously

1. Cell typing (direct typing or forward typing)- determines the antigen(surface of RBC)

2 ways:

a) Slide method- 1 drop of red cell, 1 drop of anti A within 2 mins must interpret result:
agglutination; over 2 mins= false positive result cause dry na yung mixture
 b) Tube method- prepare different red cell suspension; 2-5% red cell suspension wash
it 3x with NSS (normal saline solution) to remove anti bodies.
- Applicator: stick mix (within 2 minutes, you have to determine the result)
- Done in immunology / serology
*Agglutination – most conspicuous reaction

Uses of commerically prepared anti sera:

Anti A- blue because added “thymol blue”

Anti B- yellow because added “acriflavine”
Anti AB- colorless; no dye added PLAIN SERUM IS COLOR YELLOW
Antigen= red cell antibody = serum

Reagents are expensive so can prepare own anti sera

Source of anti A is derived from serum of Group B

Source of anti B is derived from serum of Group A
Source of anti AB is derived from serum of Group O

Red Cells Anti- A Anti- B Anti- AB Blood Group

A (antigen A) + - + A
B (antigen B) - + + B
AB (antigen AB) + + + AB
O (none) - - - O

*where there is agglutination with the anti sera, yun yung blood group
* other hospitals only use anti A and Anti B; Anti AB is only for confirmation of results
* O- most common 45%,A- 40%, B- 10% and AB- 5%

2. Serum Grouping- detect the presence/ absence of anti body by using red cells of known
specificity

5% A cells- A antigen
5% B cells- B antigen
5% AB cells- AB antigen
5% O cells- none at all

Serum 5% A cells (A 5% B cells (B 5% AB cells 5% O cells Blood Group

antigen) antgen) (AB antigen) (none)
A ( anti B) - + + - A
B ( anti A) + - + - B
AB ( none) - - - - AB
O ( anti A; + + + - O
Anti B)
 *where there is no agglutination, yun yung blood group

Blood type Can receive from Can give to

A A, O (packed red blood cells) A & AB
B B, O (packed red blood cells) B & AB
AB A, B, AB, O (packed red blood AB only
cells)
O O (whole blood or packed) A, B, AB, O (PRBC)

PRBC- removed the plasma where anti A and B are present; RBC- has no antigen

Different Blood Group Systems

1. ABO- most common

2. Rh- most common
3. MNSs
4. Kidd
5. Kell
6. Duffy
7. P
8. I
9. Lutheran
10. Lewis
11. Xg
 Rh blood group system- absence/ presence of D antigen

Different antigens and their anti sera:

1. D antigen = anti D
2. C antigen = anti C
3. E antigen = anti E
4. c antigen = anti c
5. e antigen = anti e

*anti sera are imported so expensive; hospitals only keep anti D

*if +, the antigen is present, if - the antigen is absent

*(Rh +) antigen D is present, (Rh-) antigen D is absent
* if Rh-, not necessarily na sayo na ang anti D. It is only developed when exposed to Rh+
 immune antibodies= not present but can be developed unlike in ABO, naturally occurring
siya
 Antigen D is the most important and primary antigen in Rh. it is also immunogenic??
Compatibility/ Crossmatching- series of procedure designed to ensure the safety of blood for
transfusion

PURPOSE:

*person with multiple transfusions is prone to transfusion reaction so must check

compatibility

1. Ensure maximum benefit to the recipient

2. Prevent transfusion reactions due to antibodies

SPECIMENS:

- Fresh, not in activated serum, less than 48 hrs old.

- Serum/ plasma may be used but serum is preferred over plasma. Plasma causes
clots na napagkakaalaman na agglutination
- Blood samples should not be taken from intravenous tubing lines
- Both donor and recipient samples must be stored only for a minimum of 7 days
* clerical error (wrong label of specimen of patient)= most fatal error. It occurs more
often than technical error so must always ask name. Shouldn’t rely on the paper
list.....

TYPES OF CROSSMATCH

- Major Crossmatch (PSDR) patient serum donor red cell

= refers to testing the patients serum against 5% red cell suspension of the donor
red cell
= to detect whether there are anti bodies in the patient’s serum that can destroy
transfused red cells
- Minor Crossmatch (DSPR) donor serum patient red cell
= refers to testing the donor’s serum against 5% red cell suspension on patient’s red
cell
= to detect whether there are anti bodies in the donor’s serum that can cause red
cells adverse (transfusion) reaction to the recipient

Broad Spectrum compatibility Test- most used method of choice

Coomb’s Test aka Anti Human Globulin test

- Used to detect incomplete anti bodies or non- agglutinating anti bodies

Non agglutinating = IgG ; agglutinating = IgM
- Most useful and universally applied tests employed in blood banks and
immunohematology

2 METHODS:

1. Direct antiglobulin- in vivo sensitization (inside the body)

 - Diagnosis of haemolytic disease of the newborn
- Investigation of transfusion reaction
- Diagnosis of auto immune haemolytic anemia

2. Indirect antiglobulin- in vitro sensitization (outside the body)???

- Compatibility testing
- Investigation of transfusion reactions
- Detection and identification pf unexpected anti bodies
- Red cell antigen phenotyping

BLOOD DONOR SCREENING

- Procedure is done to decrease risk of blood transmissible diseases by careful

examination of the potential donors
- Examples of diseases: HIV, Hepatitic

DIVIDED INTO 3 PARTS

1. Registration
- REGISTRATION FORM:
NAME
DATE OF BIRTH
AGE
SEX
CIVIL STATUS
ADDRESS
OCCUPATION (if pilot or driver, can’t go back to work at once)
2. Medical History
3. Physical Examination
- CRITERIA FOR POTENTIAL BLOOD DONOR
1. Age: 18-60 years old
2. Weight: 110 lbs. (50kg) can donate 450 mL of blood but if underweight can also
donate but less than 450 mL
3. Pulse Rate: 50- 100 beats/ min (can’t shortcut and count 30 secs then x2)
4. Blood Pressure: 90-160 mmHg (systolic)
60-100 mmHg (diastolic)
5. Hemoglobin: 125g/L (12.5g/dL)
6. Hematocrit: 38%

TYPES OF DONORS:

1. Volunteer Donor- donates without compensation

- R.A 7719 National Blood Services Act of 1994: advocates voluntary donation of
blood in the Philippines
2. Paid, Professional, Commercial Donor- people who sell their blood
- Before it was Php 45 per pack
 - Use iodine to screen to prevent professional donors
3. Replacement Donor- replaces blood for a particular purpose for replacing the unit of
blood used by the patient. It depends upon the ruling of the hospital 1 is to 2. 1 unit
used replace with 2 units.
4. Directed Donor- donors who give blood for a particular patient
5. Autologous Donor- gives blood for himself
- Case to case basis for surgical procedure
- If unused can give to other patient
- Not for anemic patients or those with iron deficiency

COMPONENT THERAPY- transfusion of the specific component needed by the recipient

- May defer the donor permanently if positive for HIV _____________________

Blood Components

- refers to products separated from a single unit of whole blood

- To prepare different blood components, need REFRIGERATED CENTRIFUGE

1. Whole Blood
- Easy to prepare cause its blood taken from donor after screening tests
- Contains all cellular components like [RBC, WBC, platelet, anti coagulant]
whole blood parts
INDICATIONS:
*to replace the loss of both RBC and plasma volume in actively bleeding patients
(massive bleeding) bawal PRBC

2. Packed Red Blood Cells aka Red Cell Concentrate

- Prepared by sedimentation or centrification
- Tangal na yung plasma

INDICATIONS:

*increase oxygen carrying capacity in patients with acute and chronic anemia

*for patients who cannot tolerate sudden increase in blood volume; congestive
heart failure

3. Granulocyte Concentrate & Leukocyte Concentrate (crossmatched)

Indications:
*severe neutropenia (decreased white blood cells)
*Septicemia or bacterial contamination
*myeloid hypoplasia of bone marrow

4. Platelet concentrate
Indications:
 *severe thrombocytopenia (decrease in platelet count)
-one unit 5000-10000 per microliter

* Disseminated intravascular coagulation

*massive transfusion

5. Fresh Frozen Plasma

Indications:
*to treat multiple coagulation deficiencies in patients with liver failure, vitamin K
deficiency, massive transfusion and DIC (Disseminated Intravascular Coagulation)

6. Plasma – Removed RBC | type Specific na dapat

-has small amount of factors V & VIII (coagulation factors)
Indications:
*treatment of stable coagulation deficiency esp. Factor XI
*source of plasma for patients undergoing plasma exchange

7. Cryoprecipitate
- also called factor VIII
- contains at least 80 units of factor VIII
- 50% of the Von Willebrand factor
-20% of factor XIII
- 200mg of fibrinogen as well as fibronectin

INDICATIONS
*Von Willebrand’s disease
* Hemophilia A
* Fibrinogen deficiency
*Factor XIII deficiency