Application in transfusion medicine

BASIC CONCEPTS IN IMMUNOLOGY

M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
RVIN JOHN T. SERVILLON, RMT, MSMT
Can anyone donate blood to everyone?
 Immune System
Primary role: protect self from non-self materials/objects/organism

Immunity
1. Natural (Non-specific)
2. Adaptive (Specific)

Main process in immunity:

1. Antigen recognition
2. Immune Response
3. Antigen Elimination and memory
 Immune System
Primary role: protect self from non-self materials/objects/organism

Determinant of identifying self

vs non-self: Antigens

Antigens are markers that

tell your body that
something is foreign

Found in intra and extra

cellular surfaces of all
organisms including
microorganisms
Antigens are recognized by Immune Cells
Non-specific Immunity – Phagocytes
Specific immunity – Lymphocytes (T and B cells)
Effector Mechanisms of T-cell and B-cells
Products of immune response:
• Surviving Memory T-cells and B-cells
• Antibodies
Immunology in transfusion medicine

•Red Blood Cells, WBCs, Platelets Serum/ Plasma

• Antigens • Antibodies
Red Blood Cell Antigens
ANTIGENS
IMMUNOGEN: IMMUNOGENECITY
IMMUNOGEN: IMMUNOGENECITY
 FACTORS AFFECTING IMMUNE RESPONSE

Antigen Factors Host Factors

• Size • Nutritional status
• Complexity • Hormones
• Conformation • Genetics
• Charge • Age
• Accessibility
• Race
• Solubility
• Exercise level
• Digestibility
• Disease
• Chemical composition
• Injury
 Landsteiner’s Rule

Individuals DO NOT
make allo-antibodies
against antigens they
have
 ANTIBODIES
Naturally occurring • commonly: IgM (cold agglutinnins)
• When found in serum in individuals without • React with ABH, Hh, Ii, Le, MN and P
prior exposure to a certain RBC antigen • Aka isoagglutinnins
• Usually produced due to exposure to antigens
similar to RBC Ags from the environment (ex.
Bacteria)
Immune • Commonly IgG: (reacts at 37C)
• Antibody acquired after exposure to RBC • Usually encountered: Rh, Kell, Duffy,
antigens Kidd and Ss
§ Possible exposure:
§ Transfusion
§ Pregnancy
§ Transplantation
 ANTIBODIES

Antibodies Remarks
G Significant
Clinically significant (react at 37C)
Subclasses (cross placenta and activate complement)
M Significant (cold reacting)
A Significant
Associated with anaphylaxis among IgA deficient individuals
E Sometimes significant: hypersensitivity reaction
D No significance
• Example:
• Rh – usually IgG1 and IgG3
• Anti Jka – usually IgG3
Blood Group Blood Group Immunogenicity
Antigen System (%)
D (Rho) Rh 50 Relative Immunogenicity
K Kell 5 of Blood Group antigens
C (hr’) Rh 2.05
E (rh’’) Rh 1.69
k Kell 1.5
e (hr’’) Rh 0.56
Fya Duffy 0.23
C (rh’) Rh 0.11
Jka Kidd 0.07
S MNSs 0.04
Jkb Kidd 0.03
S MNSs 0.03
 THE ROLE OF COMPLEMENT

Normal Immune Activities Pathogenic Immune Activities

• Kill pathogens • Anaphylaxis
• Mediate inflammation • Intravascular hemolysis of transfused cells
• Maintain solubility of immune • Leukocyte mobilization in TRALI
complexes • Activation of platelets
• Opsonin

Samples: stored up to 48 hours in 1-6oC or frozen to -50C to prevent complement inactivation

Clinical significance of Antibodies
• Transfusion Reactions
• Pregnancy – Hemolytic Disease of the Newborn
Goal in Immunohematology:
• Match antigens between donor and recipient
• Avoid alloimmunization (development of antibodies to Red Cell
Antigens)

• Test: antigens and antibodies

 Application in transfusion medicine

APPLICATION OF IMMUNOLOGY-
HEMAGGLUTINATION TESTING
M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
RVIN JOHN T. SERVILLON, RMT, MSMT
 HEMAGGLUTINATION

M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
Immunology in Transfusion Medicine
M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
Immunology in Transfusion Medicine
M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
Immunology in Transfusion Medicine
M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
Immunology in Transfusion Medicine
M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
Immunology in Transfusion Medicine
“ZONE PHENOMENON”
GRADING OF
AGGLUTINATION
GEL TECHNOLOGY

M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
Immunology in Transfusion Medicine
 Application in transfusion medicine

APPLICATION OF IMMUNOLOGY-
HEMAGGLUTINATION TESTING
M E D I C A L L A B O R A T O R Y S C I E N C E

IMMUNOHEMATOLOGY
RVIN JOHN T. SERVILLON, RMT, MSMT