BVMLT -304 BLOOD BANKING

UNIT-1

 INTRODUCTION

Blood bank: : A place where blood is collected from donors, typed, separated into components, stored,
and prepared for transfusion to recipients. A blood bank may be a separate free-standing facility or part of
a larger laboratory in a hospital.

Separation of blood: Typically, each donated unit of blood (whole blood) is separated into multiple
components, such as red blood cells, plasma and platelets. Each component is generally transfused to a
different individual, each with different needs.

An increasingly common blood bank procedure is apheresis, or the process of removing a specific
component of the blood, such as platelets, and returning the remaining components, such as red blood
cells and plasma, to the donor. This process allows more of one particular part of the blood to be collected
than could be separated from a unit of whole blood. Apheresis is also performed to collect plasma (the
liquid part of the blood) and granulocytes (white blood cells).

 BLOOD GROUPING

 a method in which blood is characterized by the presence or absence of particular antgens on the surface 
of red blood cells. The antigens can be recognised by their reaction to specific antibodies which causes ag
glutination to occur. Two well-known blood groupings are the abo blood group and rhesus blood
group systems.

ROULEAUX BLOOD

The stacking of cells (rouleaux formation) facilitates the rate of red cell sedimentation, a phenomenon
that may be seen on a peripheral smear. The appearance of rouleaux may be artificially caused by a poor
preparation of the smear or by viewing the slide in a thickened area. When rouleaux formation is truly
present, it is caused by an increase in cathodal proteins, such as immunoglobulins and fibrinogen.
Although myeloma and macroglobulinemias are first considered by hematologists, other causes occur
more frequently, such as acute and chronic infections, connective tissue diseases, and chronic liver
disease.
  DEFINITIONS AND CLASSIFICATION OF AGGLUTINATION REACTIONS
Agglutination is defined as the formation of clumps of cells or inert particles by specific antibodies to
surface antigenic components (direct agglutination) or to antigenic components adsorbed or chemically
coupled to red cells or inert particles (passive hemagglutination and passive agglutination, respectively).
Erythrocytes are also agglutinated by non antibody substances such as plant proteins, viruses, salts of
heavy metals, inorganic colloidal acids and bases, and basic proteins (protamines, histones).
Agglutination inhibition or hemagglutination inhibition refers to the inhibition of these reactions by
soluble antigen which reacts with the combining sites of the antibodies and thereby prevents their binding
to and agglutination of the particles.

REVERSE GROUPING
In ABO grouping, the testing of the patient’s serum or plasma against, at minimum, A1 and B reagent
RBCs (the process is also known as “serum grouping” or the slang term “back typing“). The
interpretation of this part of the ABO test is usually simple: Reactions against the A1 cells only shows
that the person has anti-A and is therefore blood group B, for example. The blood group identified by the
reverse grouping should be the same as that identified by the “forward” (or “cell“) grouping; if not,
an ABO discrepancy is present.

SERUM GROUPING.

The currently favored term for the process of confirming a person's ABO type by checking the antibodies
in their serum (or plasma). ... However, the red cell type must be confirmed by the person's ABO
antibody profile, so we test the patients serum or plasma against both group A and group B red blood
cells.

 ANTIBODY- STRUCTURE, CLASSES AND FUNCTIONS

Antibody (Ab) also know as Immunoglobulin (Ig) is the large Y shaped protein produced by the body’s
immune system when it detects harmful substances, called antigens like bacteria and viruses. The
production of antibodies is a major function of the immune system and is carried out by a type of white
blood cell called a B cell (B lymphocyte), differentiated B cells called plasma cells. The produced
antibodies bind to specific antigens express in external factors and cancer cells.
STRUCTURE OF ANTIBODY

Antibodies are heavy (~150 kDa) globular plasma proteins. The basic structure of all antibodies are same.

There are four polypeptide chains: two identical heavy chains and two identical light chains connected by
disulfide bonds. Light Chain (L) consists polypeptides of about 22,000 Da and Heavy Chain (H) consists
larger polypeptides of around 50,000 Da or more. There are five types of Ig heavy chain (in mammal)
denoted by the Greek letters: α, δ, ε, γ, and μ. There are two types of Ig light chain (in mammal), which
are called lambda (λ) and kappa (κ).

 CLASSES/TYPES OF ANTIBODY

Serum containing antigen-specific antibodies is called antiserum. The 5 types – IgG, IgM, IgA, IgD, IgE
– (isotypes) are classified according to the type of heavy chain constant region, and are distributed and
function differently in the body.
 FUNCTIONS OF ANTIBODY

1. IgG provides long term protection because it persists for months and years after the prescence of
the antigen that has triggered their production.
2. IgG protect against bacteris, viruses, neutralise bacterial toxins, trigger compliment protein
systems and bind antigens to enhance the effectiveness of phagocytosis.
3. Main function of IgA is to bind antigens on microbes before they invade tissues. It aggregates the
antigens and keeps them in the secretions so when the secretion is expelled, so is the antigen.
4. IgA are also first defense for mucosal surfaces such as the intestines, nose, and lungs.
5. IgM is involved in the ABO blood group antigens on the surface of RBCs.
6. IgM enhance ingestions of cells by phagocytosis.
7. IgE bind to mast cells and basophils wich participate in the immune response.
8. Some scientists think that IgE’s purpose is to stop parasites.
9. IgD is present on the surface of B cells and plays a role in the induction of antibody production.

HEMAGGLUTINATION
Hemagglutination is used for the diagnosis of some enveloped viruses such as influenza viruses. This
method relies on the specific feature of some enveloped viruses that can adsorb to red blood cells (RBCs).
Specifically, hemagglutinin5 (HA), an envelope glycoprotein of some enveloped viruses, imparts this
property.

 DIAGNOSIS
Hemagglutination can be used to diagnose syndromes that are caused by the absence of a component
carrying blood group antigens (null phenotypes). For example, an absence of the Rh proteins
causes stomatocytosis and compensated hemolytic anemia (Rh syndrome), and an absence of Xk protein
causes the McLeod syndrome.

BLOOD TYPING       
Blood typing is a method to tell what type of blood you have. Blood typing is done so you can safely
donate your blood or receive a blood transfusion. It is also done to see if you have a substance called Rh
factor on the surface of your red blood cells.

Your blood type is based on whether or not certain proteins are on your red blood cells. These proteins
are called antigens. Your blood type (or blood group) depends on what types your parents passed down to
you.

Blood is often grouped according to the ABO blood typing system. The 4 major blood types are:

 Type A
 Type B

 Type AB

 Type O

HOW THE TEST IS PERFORMED

A blood sample is needed. The test to determine your blood group is called ABO typing. Your blood
sample is mixed with antibodies against type A and B blood. Then, the sample is checked to see whether
or not the blood cells stick together. If blood cells stick together, it means the blood reacted with one of
the antibodies.
The second step is called back typing. The liquid part of your blood without cells (serum) is mixed with
blood that is known to be type A and type B. People with type A blood have anti-B antibodies. People
with type B blood have anti-A antibodies. Type O blood contains both types of antibodies.

The 2 steps above can accurately determine your blood type.

Rh typing uses a method similar to ABO typing. When blood typing is done to see if you have Rh factor
on the surface of your red blood cells, the results will be one of these:

 Rh+ (positive), if you have this cell surface protein

 Rh- (negative), if you do not have this cell surface protein

RH FACTOR is a blood protein that plays a critical role in some pregnancies. People without Rh factor
are known as Rh negative, while people with the Rh factor are Rh positive. If a woman who is Rh
negative is pregnant with a fetus who is Rh positive, her body will make antibodies against the fetus's
blood. This can cause Rh disease, also known as hemolytic disease of the newborn, in the baby. In severe
cases, Rh disease leads to brain damage and even death. Since 1968, a vaccine has existed to prevent the
mother's body from making anti-bodies against the fetus's blood.

 HEMOLYTIC DISEASE OF THE NEWBORN (HDN)

Hemolytic disease of the newborn (HDN) is a blood problem in newborn babies. It occurs when your
baby's red blood cells break down at a fast rate. It’s also called erythroblastosis fetalis. 
 Hemolytic means breaking down of red blood cells.
 Erythroblastosis means making immature red blood cells.
 Fetalis means fetus.
 CAUSES HDN IN A NEWBORN

All people have a blood type (A, B, AB, or O). Everyone also has an Rh factor (positive or negative).
There can be a problem if a mother and baby have a different blood type and Rh factor.
HDN happens most often when an Rh negative mother has a baby with an Rh positive father. If the baby's
Rh factor is positive, like his or her father's, this can be an issue if the baby's red blood cells cross to the
Rh negative mother.

SYMPTOMS OF HDN IN A NEWBORN

Symptoms can occur a bit differently in each pregnancy and child.

During pregnancy, you won't notice any symptoms. But your healthcare provider may see the following
during a prenatal test:

 A yellow coloring of amniotic fluid. This color may be because of bilirubin. This is a substance that
forms as blood cells break down.
 Your baby may have a big liver, spleen, or heart. There may also be extra fluid in his or her stomach,
lungs, or scalp. These are signs of hydrops fetalis. This condition causes severe swelling (edema).

DIAGNOSES

HDN can cause symptoms similar to those caused by other conditions. To make a diagnosis, your child’s
healthcare provider will look for blood types that cannot work together. Sometimes, this diagnosis is
made during pregnancy. It will be based on results from the following tests:
 Blood test. Testing is done to look for for Rh positive antibodies in your blood.
 Ultrasound. This test can show enlarged organs or fluid buildup in your baby.
 Amniocentesis. This test is done to check the amount of bilirubin in the amniotic fluid. In this test, a
needle is put into your abdominal and uterine wall. It goes through to the amniotic sac. The needle takes a
sample of amniotic fluid.
 Percutaneous umbilical cord blood sampling. This test is also called fetal blood sampling. In this test, a
blood sample is taken from your baby’s umbilical cord. Your child’s healthcare provider will check this
blood for antibodies, bilirubin, and anemia. This is done to check if your baby needs an intrauterine blood
transfusion.

HDN TREATMENT

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how
severe the condition is.

During pregnancy, treatment for HDN may include the following.

Monitoring

A healthcare provider will check your baby’s blood flow with an ultrasound.

Intrauterine blood transfusion

This test puts red blood cells into your baby's circulation. In this test, a needle is placed through your
uterus. It goes into your baby’s abdominal cavity to a vein in the umbilical cord. Your baby may need
sedative medicine to keep him or her from moving. You may need to have more than 1 transfusion.

Early delivery

If your baby gets certain complications, he or she may need to be born early. Your healthcare provider
may induce labor may once your baby has mature lungs. This can keep HDN from getting worse.  

After birth, treatment may include the following.

Blood transfusions

This may be done if your baby has severe anemia.

Intravenous fluids

This may be done if your baby has low blood pressure.

Phototherapy

In this test, your baby is put under a special light. This helps your baby get rid of extra bilirubin.

Help with breathing

Your baby may need oxygen, a substance in the lungs that helps keep the tiny air sacs open (surfactant),
or a mechanical breathing machine to breathe better.

Exchange transfusion

This test removes your baby’s blood that has a high bilirubin level. It replaces it with fresh blood that has
a normal bilirubin level. This raises your baby’s red blood cell count. It also lowers his or her bilirubin
level. In this test, your baby will alternate giving and getting small amounts of blood

UNIT 2

BLOOD DONATION AND TRANSFUSION

 A blood transfusion is a way of adding blood to your body after an illness or injury. If your body is
missing one or more of the components that make up healthy blood, a transfusion can help supply what
your body is missing.

Depending on how much blood you need, a transfusion can take between 1 and 4 hours. About 5 million
Americans need a blood transfusion every year, and the procedure is usually safe.

 During a transfusion, you receive whole blood or parts of blood such as

 Red blood cells - cells that carry oxygen to and from tissues and organs
 Platelets - cells that form clots to control bleeding
 Plasma - the liquid part of the blood that helps clotting. You may need it if you have been badly burned,
have liver failure or a severe infection.
Most blood transfusions go very smoothly. Some infectious agents, such as HIV, can survive in blood and
infect the person receiving the blood transfusion. To keep blood safe, blood banks carefully screen
donated blood. The risk of catching a virus from a blood transfusion is low.

Sometimes it is possible to have a transfusion of your own blood. During surgery, you may need a blood
transfusion because of blood loss. If you are having a surgery that you're able to schedule months in
advance, your doctor may ask whether you would like to use your own blood, instead of donated blood. If
so, you will need to have blood drawn one or more times before the surgery. A blood bank will store your
blood for your use.

ADVERSE REACTION DURING A TRANSFUSION

To minimize the chance of an adverse reaction during a transfusion, health care practitioners take
several precautions. Before starting the transfusion, usually a few hours or even a few days beforehand,
the patient is cross-matched with the donor blood (not done for transfusions of plasma or platelets).

After double-checking labels on the bags of blood that are about to be given to ensure the units are
intended for that recipient, the health care practitioner gives the blood to the recipient slowly, generally
over 1 to 4 hours for each unit of blood. Because most adverse reactions occur during the first 15
minutes of the transfusion, the recipient is closely observed at first. After that, a nurse checks on the
recipient periodically and must stop the transfusion if an adverse reaction occurs.
Most transfusions are safe and successful. However, mild reactions occur occasionally, and, rarely,
severe and even fatal reactions may occur.

The most common reactions, which occur in 1 to 2% of transfusions, are

 Fever
 Allergic reactions

The most serious reactions are

 Fluid overload
 Lung injury
 Destruction of red blood cells due to a mismatch between the donor's and recipient's blood type

Rare reactions include
 Graft-versus-host disease (whereby transfused cells attack the cells of the person receiving a
transfusion)
 Infections
 Complications of massive transfusion (poor blood clotting, low body temperature, and low
calcium and potassium levels)

Fever

Fever may be caused by a reaction to the transfused white blood cells or to chemicals (cytokines)
released by the transfused white blood cells. For this reason, most hospitals in the United States remove
white blood cells from the transfused blood after it is collected.

In addition to an increase in temperature, the person has chills and sometimes headache or back pain.
Allergic reactions

Symptoms of an allergic reaction include itching, a widespread rash, swelling, dizziness, and headache.
Less common symptoms are breathing difficulties, wheezing, and airway obstruction. Rarely, an
allergic reaction is severe enough to cause low blood pressure and shock.
Fluid overload

Transfusion recipients can receive more fluid than their body can easily handle. Too much fluid may
cause swelling throughout the body or difficulty breathing. This complication is the most common
cause of transfusion-related death. Recipients who have heart disease are most vulnerable, so their
transfusions are given more slowly and they are monitored closely. People who receive too much fluid
are given a diuretic.

Lung injury

Another very rare reaction, called transfusion-related acute lung injury (TRALI), is caused by
antibodies in the donor's plasma. This reaction may cause serious breathing difficulties. This
complication is the second most common cause of transfusion-related death. It occurs in 1 in 5,000 to 1
in 10,000 cases, but many cases are mild and so may not be diagnosed.
Destruction of red blood cells

Despite careful typing and cross-matching of blood, mismatches due to subtle differences between
donor and recipient blood (and, very rarely, errors) can still occur. When such a mismatch occurs, the
recipient's body destroys the transfused red blood cells (a hemolytic reaction) shortly after the
transfusion.

 TRANSPORTATION & STORING OF BLOOD & BLOOD COMPONENTS

The ‘Blood cold Chain’ is the systematic process for safe storage & transportation of  blood & blood
components so that they are kept at the correct temperature at all times from blood collection from a
donor to administration of blood to a patient  in need of transfusion. 

WHOLE BLOOD AND RED CELLS

Red cells & whole blood must always be stored at a temperature between +2 degree C to +6 degree C in a
blood bank refrigerator. Blood bank refrigerators have in built temperature monitoring and alarm devices
and a cooling fan to ensure even distribution of cold air through out the equipment .Maintenance of above
storage temp is essential to maintain the oxygen carrying ability of blood.  The upper limit of 6 degree C
is essential to minimize the growth of any bacterial contamination in the  unit of blood.
 
Below 2 degree C  red cells  become haemolysed.  So they must never be allowed to freeze. Haemolysed
cells if transfused can cause renal failure & fatal bleeding problems.
 
Depending on the type of blood bag used the shelf life ranges from 35- 42 days.

FRESH FROZEN PLASMA(FFP)

Fresh Frozen Plasma  ( plasma separated from a unit of blood within 6-8 hrs of donation and rapidly
frozen) is stored in Blood Transfusion centre at -40 degree C or colder .It has a shelf life of one year.  If
not stored at this temp the coagulation factors as Factor VIII and Factor V deteriorate and the amount is
greatly reduced thereby defeating the purpose for which it is to be administered.
 
FFP  needs to be  thawed before transfusion. in the blood centre in a plasma thawing bath. at 30 degree C
- 37degree C which  takes about 30-45 minutes   FFP should be transported in a blood transport box in
which the temperature is maintained   between +2 degree C to 6 degree C. Once thawed FFP should be
infused within 30 minutes.
 
CRYOPRECIPITATE
Cryoprecipitate is the cold insoluble portion of plasma remaining after FFP has been thawed and contains
Factor VIII ,Von Willebrand factor, factor XIII and fibrinogen. For preparation of cryoprecipitate  plasma
is separated from a unit of blood within 6-8 hrs of donation and rapidly frozen within30 minutes, plasma
is then thawed slowly at below+ 4 degree C  to obtain maximum yield of cryoprecipitate It is finally is
 stored in Blood Transfusion centre at -40 degree C or colder . it has a shelf life of one year..  The volume
of cryoprecipitate  is 25-30 ml.

cryoprecipitate needs to be s thawed at 30 degree to 37 degree C  in a water  bath for about 15-30
minutes

 
PLATELETS – PLATELET RICH PLASMA (PRP)/PLATELET CONCENTRATE (PC)

APHERESED, SINGLE  DONOR PLATELETS (SDP)

Platelet are prepared by manual as well as automated methods and then stored at 22 degree C -24 degree
C in platelet agitator cum incubator to maintain platelet  function of preventing spontaneous bleeding or
stop bleeding in those patients with established thrombocytopenia or hypo plastic anemia or bone marrow
failure. Whole blood for  separation of platelets  should be kept at 20-24 degree C  before processing as
lower temperatures affect platelet function and its separation..

INSPECTION OF  BLOOD BAGS PRIOR TO ISSUE/ADMINISTRATION        

Blood bags should be inspected for deterioration/damage during storage before blood is  issued from the
blood centre and before transfusion at the bed side. Any discoloration or signs of leakage is a warning
sign of bacterial contamination that can cause fatal reaction if transfused therefore it is important to check
each bag for signs as shown in the figure below.

 BLOOD TRANSFUSION PROCEDURE

Blood transfusions are typically performed in a hospital, doctor's office, or other medical facility.

During a blood transfusion, an intravenous (IV) line is placed in a vein in your arm.

Blood or blood components that are stored in a plastic bag are delivered through the IV into your
bloodstream.

The procedure typically takes one to four hours.

Tell your doctor or nurse immediately if you experience any of the following symptoms during your
transfusion:

 Shortness of breath

 Fever or chills

 Pain at the infusion site

 Unusual itching

 A sense of uneasiness

Before a Blood Transfusion

You won't need to change your diet or limit any activities before receiving a blood transfusion.

Let your doctor know if you've had a transfusion in the past that caused an adverse reaction.

After a Blood Transfusion

After the procedure, you may develop bruising where the needle was inserted.

You may need more blood testing to check how your body is responding to the transfusion.

Blood Transfusion Risks

Blood transfusions are considered safe, but certain complications can happen during or after the
procedure. These include:

 Allergic reaction (anaphylaxis)

 Fever

 Lung injury

 Acute immune hemolytic reaction (occurs when the body suddenly attacks donor red blood cells)

 Delayed hemolytic reaction (occurs when the body gradually attacks donor red blood cells)

 Bloodborne infections such as HIV, hepatitis B, or hepatitis C

 Iron overload (too much iron in the blood)

 Graft-versus-host disease (occurs when donor white blood cells attack the recipient's bone marrow)
CRITERIA TO DONATE BLOOD

There are several parameters that determine the eligibility of an individual to donate blood. Guidelines
laid down by the Ministry of Health, Government of India have to be followed by blood banks and
organizations conducting blood donation camps

 Overall health- The donor must be fit and healthy, and should not be suffering from
transmittable diseases.
 Age and weight- The donor must be 18–65 years old and should weigh a minimum of 50 kg.
 Pulse rate- Between 50 and 100 without irregularities.
 Hemoglobin level- A minimum of 12.5 g/dL.
 Blood pressure- Diastolic: 50–100 mm Hg, Systolic: 100–180 mm Hg.
 Body temperature- Should be normal, with an oral temperature not exceeding 37.5 °C.
 The time period between successive blood donations should be more than 3 months.
Individuals under certain conditions are deemed ineligible to donate blood:

 A person who has been tested HIV positive.

 Individuals suffering from ailments like cardiac arrest, hypertension, blood pressure, cancer, epilepsy,
kidney ailments and diabetes.
 A person who has undergone ear/body piercing or tattoo in the past 6 months.
 Individuals who have undergone immunization in the past 1 month.
 Individuals treated for rabies or received Hepatitis B vaccine in the past 6 months.
 A person who has consumed alcohol in the past 24 hours.
 Women who are pregnant or breastfeeding.
 Individuals who have undergone major dental procedures or general surgeries in the past 1 month.
 Women who have had miscarriage in the past 6 months.
 Individuals who have had fits, tuberculosis, asthma and allergic disorders in the past.

SCREENING FOR INFECTIOUS AGENTS

At each donation, the following mandatory tests are performed:

 Hepatitis B – HBsAg
 Human immunodeficiency virus – anti-HIV 1 and 2 and HIV NAT (nucleic acid testing)
 Hepatitis C – anti-HCV and HCV NAT
 Human T-cell lymphotropic virus – anti-HTLV I and II
 Syphilis – syphilis antibodies.

Some donations are tested for cytomegalovirus (CMV) antibodies to provide CMV negative blood for
patients with certain types of impaired immunity.

Additional tests, performed in special circumstances, include:

  Malarial antibodies
 West Nile Virus antibodies
 Trypanosoma cruzi antibodies.

INFUSION RATE 

An infusion rate of 17mL/min allows an entire unit of blood to be transfused in 30 minutes. The usual
recommended time period ranges between 1.5 and 2 hours per unit.

UNIT 3

BLOOD DONATION TYPES:

Volunteer Donations

The standard or most common type of blood donation in which an individual donates one pint, which
goes to any patient in need.

Autologous Donations

Blood drawn from an individual prior to elective, non-urgent surgery during which loss of a lot of blood
is expected. The donated units are stored for up to 42 days and given back to the same individual when
and if a need for transfusion arises. This is very useful for patients with rare blood types who can be very
hard to support from the regular blood supply. Autologous donors must be healthy enough to donate
safely, so this is rarely an option for seriously ill patients.

Obtaining the blood

There are two main methods of obtaining blood from a donor. The most frequent is to simply take the
blood from a vein as whole blood. This blood is typically separated into parts, usually red blood
cells and plasma,

The other method is to draw blood from the donor, separate it using a centrifuge or a filter, store the
desired part, and return the rest to the donor. This process is called apheresis, and it is often done with a
machine specifically designed for this purpose. This process is especially common
for plasma and platelets.

SITE PREPARATION AND DRAWING BLOOD

The blood is drawn from a large arm vein close to the skin, usually the median cubital vein on the inside
of the elbow. The skin over the blood vessel is cleaned with an antiseptic such
as iodine or chlorhexidine to prevent skin bacteria from contaminating the collected blood and also to
prevent infections where the needle pierced the donor's skin.
 A large needle (16 to 17 gauge) is used to minimize shearing forces that may physically damage red
blood cells as they flow through the needle. A tourniquet is sometimes wrapped around the upper arm to
increase the pressure of the blood in the arm veins and speed up the process. The donor may also be
prompted to hold an object and squeeze it repeatedly to increase the blood flow through the vein.

APHERESIS

An apheresis blood donation is the process of blood collected via a special machine to separate it during
the donation, so that only certain parts of the blood are collected and the remainder returned to the donor.
This allows more of a single component, such as red blood cells or platelets, to be collected in one sitting.

BLOOD BANK

A blood bank is a place where blood is collected and stored before it is used for transfusions. Blood
banking takes place in the lab. This is to make sure thet donated blood and blood products are safe before
they are used. Blood banking also determines the blood type. The blood is also tested for infectious
diseases.

BLOOD DONORS

Volunteer blood donors must meet certain criteria. These include:

 Must be at least 16 years of age, or the minimum age set by state law   
 Must be in good health
 Must weigh at least 110 pounds
 Must pass the physical and health history exam given before donation
Some states let people younger than 16 or 17 years to donate blood, with parental consent.

TESTS ARE DONE IN BLOOD BANK

Certain standard tests are done in the lab once blood is donated. These include:

 Typing. This is blood type. Blood can be A, B, AB, or O.

 Rh typing. This can be Rh positive or Rh negative.
 Screening for any unexpected red blood cell antibodies. These antibodies may cause problems in the
person getting the blood
 Screening for current or past infections. The list includes:
o Hepatitis viruses B and C
o HIV
o Human T-lymphotropic viruses (HTLV) I and II
o Syphilis
o West Nile virus
o Chagas disease 
Blood cells are treated with radiation. This kills any T-lymphocytes in the donated blood. T-lymphocytes
can cause a reaction when transfused. They can also cause graft-versus-host problems. This is a rare
complication of a blood transfusion.

 ROLE OF THE HOSPITAL BLOOD BANK

Quality in transfusion practice must apply to the hospital blood bank or equivalent, because it plays a vital
role in ensuring that the correct blood component is supplied for the patient.

The laboratory aspect of the transfusion process is carried out in different ways across the countries of the
EU. In some settings a local hospital blood bank manages the blood component inventory and the clinical
blood transfusion laboratory services. Elsewhere, the blood establishment provides compatible blood
directly to hospitals.

The hospital blood bank is responsible for:

 Rapid response to urgent requests for blood components

 Checking pre-transfusion samples and requests
 Assessing of immunological compatibility between donor and patient
 Selecting of suitable blood component for each clinical condition
 Safe delivery and handling of blood components
 Inventory and stock management
 Interactions with the blood establishment.

1. Blood Is Fluid Connective Tissue

Blood is composed of 55% plasma and 45% “formed elements,” including red blood cells, white blood
cells, and platelets. Because of these living cells suspended in the plasma, blood is considered a fluid
connective tissue (not a fluid). It is the only fluid tissue in the body.

2. Blood Provides the Body's Cells with Oxygen and Removes Carbon Dioxide
Blood absorbs oxygen from air in the lungs. It transports the oxygen to cells throughout the body, and it
removes waste carbon dioxide from the cells. In the lungs, the carbon dioxide moves from the blood to
the air and is exhaled.
3. Blood Transports Nutrients and Hormones

Blood plays a large role in digestion and endocrine system functions. Digested nutrients are absorbed into
the bloodstream through capillaries in the villi that line the small intestine. These nutrients include
glucose, amino acids, vitamins, minerals, and fatty acids. Blood also transports some hormones secreted
by endocrine system glands to target organs and tissues.

4. Blood Regulates Body Temperature

Blood absorbs and distributes heat throughout the body. It helps to maintain homeostasis through the
release or conservation of warmth. Blood vessels expand and contract when they react to outside
organisms, such as bacteria, and to internal hormone and chemical changes. These actions move blood
and heat closer to or farther from the skin surface, where heat is lost.

 BACTERIAL CONTAMINATION

BACTERIAL CONTAMINATION of donated blood is defined as the presence of bacteria in

the blood or blood components which are collected and/or processed for transfusion [1]. A ready to be
transfused blood should be free from microbial contaminants including bacteria 

causes

Blood components may be contaminated by:(1)

 Bacteria from the donor’s skin during the collection procedure

 Unrecognised bacteraemia in the donor
 Contamination from the environment
  Contamination during the preparation of components
 Contamination of ports during the thawing of frozen products in a water bath

Both gram-positive and gram-negative organisms have been implicated in transfusion transmitted
bacterial infection with serious morbidity and mortality occurring most frequently with gram-negative
bacteria.(1)

UNIT 4

ANTICOGULANT USE IN BLOOD BANK BAGS

CPD
citrate phosphate dextrose 
(CPD) a solution containing citric acid, sodium citrate, monobasic sodium
phosphate, and dextrose that is the primary ANTICOAGULANT used for preservation of whole blood or red 
blood cells for up to 21 days. The official USP name is anticoagulant citrate phosphate dextrose solution.

citrate phosphate dextrose adenine (CPDA1) 
an ANTICOAGULANT solution, containing citric acid, sodium citrate, monobasic sodium
phosphate, dextrose, and adenine, used for the preservation of whole blood and red blood cells for up to 3
5 days; it extends red cell survival by providing adenine needed for the maintenance of red cell ATP level
s. The official USP name is anticoagulant citrate phosphate dextrose adenine solution.

CPDA-1

 Citrate phosphate dextrose-adenine 1. A medium which supplies ATP, and extends the shelf life of packe
d red cells destined for transfusion to 35 days with a higher ATP level than earlier-generation red cell pres
ervation media.

SAGM

Additive solution containing combinations of Saline, Adenine, Glucose and Manitol (SAGM) provides
extended shelf life of RBC up to 42 days with increased functional viability. ... Reduced density of red
blood cell concentrate on addition of SAGM solution allows better flow property of Red blood cell and
better transfusion.
ACD (Acid Citrate Dextrose) Solution A and ACD (Acid Citrate Dextrose) Solution B are
anticoagulants for whole blood and also act as acidifying agents to platelet poor plasma.

METHOD AND MEANS FOR SEPARATION OF BLOOD COMPONENTS

In a method of separating different density fluid components, a fluid sample is placed in a first flexible
container. The container and its contents are then spun at high speed while controlling the shape of the
container so that its side walls spread apart and its bottom flattens to give the container and its contents a
relatively small aspect ratio whereby different density components of the fluid contents travel minimum
distances while separating in the container to achieve a density distribution in the container, with the
densest components of the fluid distal to the spin axis being distributed over a relatively large area surface
constituted by the container bottom

COMPATIBILITY TESTING

performed to determine if a particular unit of blood can be transfused safely into a certain patient. This
includes ABO-Rh blood typing (see above), antibody screening (for unexpected red blood cell antibodies
that could cause problem in the recipient), and cross-matching

ABO BLOOD TYPES

Two antigens on blood cells (A and B) determine a person’s ABO blood type (either A, B, AB, or O). In
the United States, the most common blood type is O, followed closely by type A.

 If you have type O blood, you can only get type O red blood cell transfusions. But you can give
your red blood cells to people with type A, B, AB, or O blood, which is why you are sometimes
called a universal donor. (Universal donor blood cells are typically only used in emergencies. For
example, if a person is bleeding severely and nearing death, there may no time for testing. In
everyday practice, people in the US are almost always given the exact same type of red blood
cells that they have.)

 If you have type A blood, you cannot get either type B or AB red blood cells.

 If you have type B blood, you cannot get type A or AB red blood cells.

 If you have type AB blood, you can get transfusions of O, A, B, or AB red blood cells.

HEMOLYTIC TRANSFUSION REACTION

A hemolytic transfusion reaction is a serious complication that can occur after a blood transfusion. The
reaction occurs when the red blood cells that were given during the transfusion are destroyed by the
person's immune system. When red blood cells are destroyed, the process is called hemolysis.

There are other types of allergic transfusion reactions that do not cause hemolysis.

Causes
Blood is classified into four different types: A, B, AB, and O.

Another way blood cells may be classified is by Rh factors. People who have Rh factors in their blood are
called "Rh positive." People without these factors are called "Rh negative." Rh negative people form
antibodies against Rh factor if they receive Rh positive blood.

There are also other factors to identify blood cells, in addition to ABO and Rh.

Your immune system can usually tell its own blood cells from those of another person. If you receive
blood that is not compatible with your blood, your body produces antibodies to destroy the donor's blood
cells. This process causes the transfusion reaction. Blood that you receive in a transfusion must be
compatible with your own blood. This means that your body does not have antibodies against the blood
you receive.

Blood Bank Technician: Job Description

Blood bank technicians, also called phlebotomy technicians, work in a lab under the guidance of a
medical or clinical laboratory technologist or manager. Technicians collect, label and prepare blood,
plasma and other components for transfusions. In addition, blood bank technicians consistently interact
with the public, conducting interviews and testing samples to screen potential donors

Blood Bank Technician: Duties

Blood bank technicians properly store blood draws and maintain documentation and records. Technicians
work with patients, making them comfortable during the procedure and monitoring vital signs.
Technicians also need to be thoroughly versed in OSHA regulations.

IMMUNE TRANSFUSION
 Immune-mediated transfusion reactions occur when incompatible blood products are transfused into a
patient's circulation, triggering a response from the patient's immune system.

In general, the formation of this and other immune responses occur in three stages:

 the immune system detects foreign material (antigen)

 the immune system processes the antigen

 the immune system mounts a response to remove the antigen from the body

The immune response varies tremendously, depending on the individual (the health of his or her immune
system and genetic factors) and the antigen (how common it is and how "provocative" it is to the immune
system).

CROSS-MATCHING 
Cross Matching is a procedure performed prior to a blood transfusion to determine whether donor blood
is compatible (or incompatible) with recipient blood. 

Principle

Cross-matching will detect incompatibilities between the donor and recipient that will not be evident on
blood typing. There are two types of cross-matches: Major cross-match and Minor cross-match.

PROCEDURE

1. Prepare donor and recipient blood samples:

For Major crossmatch : Donor’s red cell and recipient serum or plasma
For Minor crossmatch : Recipient red cells and donor’s serum or plasma
2. Prepare 3 – 5% cell suspensions of red cells.

3. Major Crossmatch:
Label a test tube. Add two drops of the patient serum and one drop of the appropriate donor cell
suspension.

4. Minor Crossmatch:
Label a test tube. Add two drops of the appropriate donor serum and one drop of the patient cell
suspension.

5. Mix the tubes and incubate at 37°C for about 45 minutes.

6. Add two drops of AHG (Antihuman globulin) and mix well.

7. Centrifuge for 1 minute at 1500 rpm

8. Read macroscopically and microscopically and record the results

Quality Control
Quality control (QC) is required testing to ensure that products or processes are meeting standards. QC
testing is performed on blood products to measure the quality of the component manufacturing process.
Platelet count and pH in apheresis and whole blood-derived platelets, fibrinogen and factor VIII level in
cryoprecipitate, and residual white blood cell count after leukocyte reduction of platelets or red cells are
just a few of the QC measures evaluated by blood banks. If products fail minimum QC standards, blood
banks must assess the issue and intervene to ensure that the products are being properly prepared. 

Steps for managing suspected transfusion reactions

Upon recognising a transfusion reaction, you should:

1. Stop the transfusion immediately

2. Check and monitor vital signs
3. Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required)
4. Check the right pack has been given to the right patient
5. Notify your Medical Officer and Transfusion Service Provider

After the transfusion is terminated (except for some types of mild reaction), you may be required by the
Transfusion Service Provider to send freshly collected blood and urine samples along with the blood pack
and IV line.

MINOR CROSSMATCH

Minor Crossmatch. In contrast to the “major” crossmatch (recipient serum vs. donor red blood cells), the
“minor” crossmatch is designed to test opposite compatibility: The donor's serum/plasma with the
recipient's red cells.

 MAJOR CROSS MATCHING

Compatibility testing concerning RBCs. MeSH. D001788. In transfusion medicine, cross-
matching or cross matching (part of series of steps in blood compatibility tests) is testing before a blood
transfusion to determine if the donor's blood is compatible with the blood of an intended recipient.

BLOOD COMPONENT MUST BE COLLECTED BY APHAERESIS

PLATELETS are essential for blood clotting. Platelet transfusions are routinely needed to support
patients undergoing cancer therapy, open-heart surgery, organ transplantation, and for patients with
bleeding disorders. Platelets have a very short shelf-life and must be transfused within five days of
collection. 

RED BLOOD CELLS (RBCs) carry oxygen to all parts of the body. Red cell transfusions are most
needed after significant blood loss due to trauma, surgery, or to treat anemia. A single red blood cell
donation can be made every 8 weeks;

PLASMA is the liquid portion of the blood containing critical clotting factors. Plasma is used to treat
patients with coagulation factor deficiencies, such as patients with liver failure, and those patients with
certain bleeding disorders. Plasma donations can be made every 4 weeks. Type AB donors are in high
demand because they are “universal” plasma donors. Their plasma can be used to treat all patients.

FFP and Cryoprecipitate (often just called ‘cryo’) are both blood components made from plasma. Plasma
is the yellow liquid that carries red cells, white cells and platelets within the blood vessels around the
body. It contains vital proteins known as clotting factors

THE PRIMARY INDICATION FOR RED CELL

The primary purpose for a red blood cell transfusion is to increase the oxygen-carrying capacity of
the blood. Therefore, red blood cell transfusion is indicated in patients with anemia who have evidence
of impaired oxygen delivery