Rumah Sakit Columbia Asia - Medan

Analysis of Pretransfusion Testing in

Blood Component Transfusion

Rosita Juwita Sembiring

 Pre transfusion testing

American Society of Hematology (ASH)

1. ABO group and Rh type
2. Antibody screening, antibodies identification
3. Cross match major
Coombs reagent 37 derjad celcius

Australian
1. ABO group and Rh type
2. Antibodies screening
3. Cross match major/ auto control

British
1. ABO group and Rh type
2. Antibodies screening
3. Cross match major/ AC
IAT
 BDRS RS COLUMBIA ASIA MEDAN

Pre transfusion testing:

1.ABO group and Rh type

2.Antibodies screening
3.Cross major and minor
4.Coombs test/ IAT

5. Direct antiglobulin test (DAT)

IgG
C3b, C3d
Control
II. Pemakaian Darah di RSCAM Inpatient dan Outpatient
PEMAKAIAN DARAH DI RSCAM
12000

10000

8000

In Patient
6000
Out Patient
TOTAL

4000

2000

0
2011 2012 2013 2014 2015
III. Pemakaian Komponen Darah di RSCAM Inpatient dan Outpatient
PEMAKAIAN KOMPONEN DARAH 2011 PEMAKAIAN KOMPONEN DARAH 2012
1% 2% 0%
1% 1%
7% 4% 7%
Whole Blood Whole Blood

Packet Red Cell Packet Red Cell

Thrombo 28% Thrombo

24%
Fresh Frozen Plasma Fresh Frozen Plasm

Cryoprecipitate Cryoprecipitate
62% Trombosit Apheresis 5% 55% Trombosit Apheres
3% Plasmapheresis Plasmapheresis

PEMAKAIAN KOMPONEN DARAH

2013
1% 0%
5% 4%
Whole Blood
Packet Red Cell
21%
Thrombo
Fresh Frozen Plasma
2% Cryoprecipitate

67% Trombosit Apheresis

Plasmapheresis
III. Pemakaian Komponen Darah di RSCAM Inpatient dan Outpatient

PEMAKAIAN KOMPONEN DARAH PEMAKAIAN KOMPONEN DARAH

2014 2015

2%
0% 0%
1% 2%
4% 3% 3%
Whole Blood Whole Blood
20% Packet Red Cell 22% Packet Red Cell
Thrombo Thrombo
Fresh Frozen Plasma Fresh Frozen Plasma
2%
Cryoprecipitate 1% Cryoprecipitate
Trombosit Apheresis Trombosit Apheresis
70% 70%
Plasmapheresis Plasmapheresis
Robert Royston Amos Coombs
1921-2006
 Pre transfusion testing incompatibilty

2011 2012 2013 2014 2015

13 cases 18 cases 50 cases 19 cases 6 cases

 Incompatability Test

25 cases
CM major CM minor Ab Coombs IAT
screening test

9 12 13 17 16

Antibodies identification: Kell

Luth
 When should a DAT be performed

All transfusion reaction (esp. hemolytic)

At hemolytic anemia's
At NHD
At any suspect of drug related hemolysis
Indirect antibodies test
Classification of the Immune Hemolytic Anemia's

1. Auto Immune Hemolytic Anemia (AIHA)

2. Drug related hemolytic Anemia
3. Immune hemolytic anemia due to allo antibodies
 Auto Immune Hemolytic Anemia (AIHA)

AIHA due to warm auto antibody (WAIHA)

Idiopathic
Secundary due to
Lymphoma
Systemic lupus erythematodes (SLE)
Carcinoma
Drugs and medication
 AIHA

AIHA due to warm auto antibody (WAIHA)

48-70 % of all cases
In the DAT approx. 40 % IgG
approx. 56 % IgG + C3d
approx. 0 – 14 % C3d
Ig subtyp IgG1 and IgG3, very rare IgM
Eluate IgG Antibody
Often without any specificity, sometimes Rh, Kell Wrb specificity
 Case

Female, 24 years old

Diagnostic: SLE, AIHA

HGB: 3,8 gr %, Blood grouping A, Rh positive
Coombs test ++++
Indirect coombs test +++
Antibodies screening +++/+++/+++
Antibodies identification: Kell K, Kp , Js
Lut b
Cross major/ minor : 9 donors +++/+++
Donor antibodies screening : 6 donors -/-/-
 cases
15 blood donors with titer 1: 100 with A cells and B cells
Cross match major/minor O blood grouping +++/++++
Only 2 blood donors with cross match major and
minor are negative

Transfusion PRC 500 cc O blood grouping titer 1: 100

Filter RC
Blood warmer

Post transfusion PRC : HGB 7 gr % , out patient

 AIHA

AIHA due to cold antibodies (CAIHA)

Idiopathic
Secondary due to
Lymphoma
Mycoplasma Pneumoniae
Infectious Mononucleosis
 AIHA

AIHA due to cold antibodies (CAIHA)

16-32 % of all cases
in the DAT appr. 91 - 98 % C3d strong positive
Ig Subtype IgM
Elution is not reactive
 CASES

Male 73 years
HGB: 8,6 gr%, planning for surgery cause by Abcess in abdomen
Blood groupin O Rh +
CM major (-)
minor +++
Direct coombs test +++
IAT (-)
Antibodies screening -/-/-

DAT:
IgG: negative
C3bC3d: ++++
Control: negative

Anti I 1: 4000, anti i 1:4000

Diagnostic: AIHA cold type

 CASE

Treatment:
Transfusion of PRC 1 bag
Blood warmer
Warm blanket
 AIHA Drug related hemolytic anemia

Male, 36 years
Severe anemia, consumption of phenobarbital caused
by Epilepsi.
HGB: 3 gr %
Blood grouping O C D e
Coombs test : ++++
IAT : +++
Antibodies screening : S1 +++
S2 +++
S3 +++
 cases

Diagnostic: AIHA drug related hemolytic anemia

Treatment:
Transfusion with blood group O Cde low titer
Dexamethasone 10 amp in Pyggy bag naCl 0,9 %
Before and after transfusion.
Dexametasone 8 mg tid

Post Transfusion 4 bag : HGB 8 gr % out patient

 cases

Rh + 500 donors

Rh + 100 donors Ce : 44 %
CcEe : 13 %
CcE : 11 %
CE : 9
Cce : 8%
C : 5%
cE : 4%
Cc : 3%
CEe : 2%
Ee : 1%
 CASES

ABO hemolytic disease of new born

Mother blood group O/Rh+ CEe

Neonate blood group B/Rh + Cee
Antibodies screening -/-/-
Coombs test direct ++
IAT +++

Cross match major/ minor with B blood group

Father : +++/+
Donor I : -/+++
Donor II : +++/-
 CASES

ABO hemolytic disease of new born

Cross match major/ minor with B blood group

Father : +++/+
Donor I : -/+++
Donor II : +++/-
Donor III : +++/-
Donor IV : +++/-
 CASES

Cross match major/minor with O blood group 1:100

with A cell and B cell
Donor 1 : ++/++
Donor 2 : -/+
Donor 3 : +/++
Donor 4 : +++/+++
Donor 5 : +++/+++
Donor 6 : +/++
Donor 7 : +/++
Donor 8 : -/+
Donor 9 : +/++
Donor 10 : +/++
Donor 11 : +++/++
Donor 12 : +/+
Donor 13 : -/-
 CASES

ABO hemolytic disease of new born

HGB: 8,3 gr%, Bilirubine 21 mg/dl

PRC Transfusion with O 1:100 CM negative

Day 1 : 30 cc
Day 2: 30 cc

Post transfusion:
HGB: 16,2 gr%
Bilirubine 5 mg/dl
Out patient
 Neonate blood grouping

ABO blood grouping

Rh type
DAT
Control

Kell blood group: 36 patients and donors

1 patient K positive in new born
 Rules to live by

Don’t panic
•Follow routine procedures
•Be consistent and systematic
•Document all tests and results
•Never hesitate to ask for help
•Identify and use your resources
•Consider what is “safest” for the patient!
Thank you