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BLOOD BANKING REVIEW NOTES

By Jedidiah Calunsag

INTRODUCTION
1. History
a. Gregor Mendel- law of independent __________ states that factors for different characteristics
are inherited independent of each other
b. 1492 - __________ died due to transfusion from 3 human donors (A.22)
c. 1869 - __________ recommended sodium phosphate (nontoxic anticoag)
d. 1892 - __________ first successful human transfusion
e. 1901 - __________ discovered the ABO blood groups
f. __________ - vein-to-vein transfusion of blood
g. 1914 – __________ sodium citrate
h. 1915 - __________ determined the minimum amount of citrate needed for anticoagulation
(A.22)
i. 1916 - __________introduced a citrate-dextrose solution for the preservation of blood
j. 1943 - __________of England introduced the formula for the preservative acid-citrate-dextrose
(ACD). (A.22)

2. Genetics

a. Humans have __________ pairs of autosomes and __________ set of sex chromosomes,
females (XX) and males (XY), giving a total of 46 chromosomes in diploid cells (s.2019)
b. Blood group system are usually expressed as __________
c. ________/secondary/second order - occurs when a genetic marker is _______ in the child but
should have been transmitted by the alleged father

In this type of inheritance, the father carries the trait on his X chromosome. He has no sons with the trait
because he passed his Y chromosome to his sons; however, all his daughters will express the trait.
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant - THIS IS THE ANSWER!
D. X-linked recessive

3. Generative Cell Cycle

a. Go (Gap) – No division and resting phase
b. G1 – RNA and Protein prod
c. S (synthesis) - __________ replication
d. G2 - RNA and Protein production Continuation
e. M (mitosis) - Cell division

4. Mitosis
[Link] - resting stage and chromatin is uncondensed/ A cell that is not actively dividing
b. Prophase - 1st stage and chromatin is visible
c. Metaphase - Chromosome move to the equator attached to microtubules
i. __________ - A photomicrograph of a single cell in the metaphase stage of mitosis that
is arranged to show the chromosomes in descending order of size.
d. Anaphase - Sister chromatids separate
e. Telophase - chromosome at the pole of cell, cell divides

Meiosis in cell division is limited to the ova and sperm producing four gametes containing what complement
of DNA?
A. 1N
B. 2N
C. 3N
D. 4N

MAJOR BLOOD GROUP SYSTEM

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ISBT – International Society of Blood Transfusion - The first three numbers represent the ______ (A.22) and
the remaining three the antigenic specificity.

ISBT 001:ABO Blood Group System

[Link] Landsteiner
[Link]
[Link] blood group with __________ occurring antibody w/o prior exposure
[Link] compatibility = __________ to pre transfusion testing
A. Wrong ABO transfusion = leading cause of death in hemolytic transfusion rxn reported by FDA
B. TRALI - is now considered the leading cause of transfusion-associated fatalities, surpassing ABO
incompatibility and bacterial contamination
C. Most fatal transfusion reaction
D. naturally Occurring Ab: IgM, IgG, and IgA
5. Formation of ABH Antigens
a.H and Se Genes -
[Link] genes -
6. Amorph - does not produce __________ Ag

7.
Gene Glycosyl Transferase Immunodominant sugar Antigen
H L-fucosyl transferase L-fucose H
A N-acetylgalactosaminyl Transferase N-acetyl-D-galactosamine A
B D-galactosyl transferase D-galactose B
AB Both A and B Both A and B AB

8. Greatest Amount of H to least

9. ABO BLOOD GROUPS
Blood Group Surface Ag Plasma Ab
O None Anti A & Anti B
A A Anti B
B B Anti A
AB A and B None

10. Highest Incidence to Lowest:

Blood Type Anti Anti B Anti A1 Anti H Known Known B Known Autocontrol
A A1 O
A2
Ag: A,H
Anti B
Anti A1
A1
Ag: A, A1, H
Anti B
A1 w/Anti H

Ag: A, A1, few or no

H
Anti B
Anti H
B

Ag: B, H
Anti A1 and A

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Bm

Ag: H
Secretion: B,H
Anti A
O
Ag: H
Anti A
Anti B
H null/Bombay

Ag: (-)
Ab: Anti A,B, H
AB

Ag: A, B, H
Antibody: (-)
Group O
Newborn/Elder
Hypogamma
Agamma
Immunosuppressive
drug

Ag: H
Ab: (-)
Grp A w/Acquired B

Ag: A, few B, H

Anti B
AB with
High protein
Plasma expander
Cold or RT reacting
AutoAb

Ag: ABH
Ab: (-)

[Link] Grouping
blood typing is PHENOTYPING
Phenotype - Physical expression of genotype. Example: Genotype "AO" but the phenotype is "A"

[Link] Typing
[Link] commercial __________ anti-sera of known specificity
[Link] __________ on RBC surface
[Link]
[Link] A Dye = (a.22)
[Link] B Dye = (a.22)
[Link] D Dye =

Blood Group Known Anti A Known Anti B

A 4+ 0
B 0 4+
AB 3+ 3+
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O 0 0

[Link] Typing
[Link] __________
[Link] the presence of __________
[Link] __________ red cell suspension
iv. Rh control: Patient cells in saline or 6% albumin – Used if patient is typed as AB+ in slide typing.

Blood Group Known A cell Known B cell

A 0 4+
B 4+ 0
AB 0 0
O 4+ 4+

[Link] Forward and reverse are done in __________

d. Common sources of Technical Errors Resulting in ABO Discrepancies
o Incorrect or inadequate __________ of blood specimens, test tubes, or slides
o __________ suspension either too heavy or too light
o Clerical errors or incorrect recording of results
o __________ during centrifugation
o mix-up in samples

[Link] Subgroups
A. A Subgroup
i.A1 = reacts w/Anti A & Anti A1
ii.A2 = reacts w/Anti A but not Anti A1
iii.A2 and A2B individuals __________ in their serum. Therefore, they can be ___________ with A1 donors
[Link] A1 – naturally occurring IgM.
[Link] A1 or A1B – __________
vi. _________ for Antibody screening
Blood group Ag present Anti A Anti – A1 lectin
A1
A2
Can be transfused with:
-A1 and A2 won't have equal reaction with Anti H
-A1 and A2 will have positive reaction with Anti A,B

[Link] phenotype (Oh/Hnull)

[Link] in Bombay India
[Link] O has no __________
[Link] H/O – __________
Forward Typing Reverse Typing
Phenotype Anti A Anti B Anti H/ Known A Known B Known O
O
Oh

C. Bm and Bel
i. ____________________ - NO agglutination w/Anti B and Anti AB but has B in saliva
ii. __________ – No agglutination w/Anti B and Anti AB, secretors have H but no B in saliva

[Link] TYPING DISCREPANCIES

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[Link] incompat
[Link]

[Link] I - ANTIBODY WEAK OR ABSENT -REVERSE TYPING PROBLEM - more common discrepancy

[Link]: too young and too old (4to 6months)

ii. agammaglobulinemia- no antibody
iii. hypogammaglobulinemia
iv. immunosuppressive drugs
v. Transplanted bone marrow ptx receiving therapy, changing RBC blood type
vi. Ab diluted

[Link] II -ANTIGEN WEAK OR ABSENT – FORWARD TYPING

i. Subgroups of A and B-Rem:Lectins
ii. BGSS (blood group soluble substance)

iii. Leukemia(Translocation at chrom 9-ABO Genes) & Hodgkins (weakens ABH Ag)

iv. Antibodies to Low incidence antigens

v. Acquired B phenomenon

vi. Chimerism – mixed cell population in a single individual

[Link] Chimerism twins from O mother and B father, anastomosis
2. dispermy – two sperm in one egg
[Link] – BM, transplant, Blood transfusion of O to A or B, Fetal maternal bleeding, ,exchange
transfusion

[Link] III -PROTEIN AND PLASMA ABNORMALITIES ROULEAUX/PSEUDOAGGLUTININ

[Link] Ab Reaction (Between Forward and Reverse)

[Link]
ii. Autoantibodies -warm reacting autoantibodies  Agglutinate at Room temp at Autocontrol
iii. increased globulin content and fibrinogen
iv. Plasma expanders (Dextran and polyvinylpyrrolidone)-masyado viscous
v. Wharton’s Jelly

[Link] IV - MISCELLANEOUS PROBLEMS -Unexpected Antigen Reaction ([Link] and reverse)

i. Polyagglutination

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ii. Cold Reactive Antibody
iii. Unexpected ABO isoagglutinins (eg.A2B)
iv. Antibodies against Acriflavine
v. Non allo ABO Ab (eg. Anti I)
vi. Has one ABO group due to transfusion or marrow/stem cell transplant
vii. Cis-AB: Both AB gene from ONE parent + O gene from the other

[Link]
ocondition wherein RBC agglutinates with ABO compatible blood due to altered membrane component
[Link]
i. T-polyagglutination - organisms with __________minidase/sialidase
1.__________
2.__________ virus
3. [Link]
4. [Link]

ii. TK-Polyagglutination - organisms with Endo-B-__________

1.__________
2. Serratia marcesens

iii. Acquired B Phenomenon -organisms with __________

1. __________
2. [Link]

iv. Th- Polyagglutination - sialidase

[Link] aquaticum
[Link]

v. VA-Polyagglutination
[Link] agglutinated by Arachis hypogaea and Dolichous biflorus
b. Mixed-field agglunation by Helix Pomatia

[Link] microbial associated Polyagglutination

[Link]-Polyagglutination – Acquired B Phenomenon

[Link] POLYAGGLUTINATION
[Link] – Cazal Autosomal Dominance
[Link] expression of Sda Ag that are polyagglutinable

ii. HEMPAS – Hereditary Erythroblastic Multinuclearity w/Positive Acidified Serum Test

[Link] at 20oC or lysed at 37oC by complement fixing IgM

2. Elevated i, normal I, and depressed H

Blood Group Characteristics

Naturally occurring
Clinically Significant
Warm antibodies
Cold Antibodies
Enhanced by enzyme treatment
Destroyed by Enzymes
Show Dosage effect

ISBT 002: MNSs

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MN – Landsteiner and Levine
S – Walsh and Montgomery
[Link]: Chromosome __________
[Link] developed at __________
[Link] __________ effect
[Link] Antigen = Glycophorin__________
[Link] by __________

[Link] M
[Link] better with (M+N-)
[Link] best at __________ and reacts at RBCs exposed to__________ solutions instead of freshly
collected M+ RBCs.

[Link] N - Seen in __________patients who were dialyzed on equipment sterilized with __________
[Link] Antigen = Glycophorin _________
[Link] Association
[Link](Glycophorin A) =receptor for __________  __________
[Link] and GPB = __________receptor  leading to infection

ISBT 003: P
1. Landsteiner and Levine in 1927
2.__________ by enzyme.

[Link] Tja = ____________________

Antigen Phenotype Antigen Present Antibodies Others
P+ P1 © P1,P,Pk None Deteriorate rapidly upon storage
P- P2 © P, Pk Anti P1 (IgM)
p® None Anti PP1PK Anti PP1Pk was originally called Anti Tja (IgM and
IgG)
P1K ® P, Pk Anti P Anti P = naturally occurring AlloAb (IgG) –
P2K ® Pk Anti P, anti P1
© - common ® - rare
[Link] P1
[Link] in P1- patient with __________.
b. fascioliasis (bovine liver fluke) and bird handlers.

[Link] Tja -potent hemolysin -__________abortion

[Link] P
a. cold reactive IgG autoAb __________
[Link] hemolysin:
[Link] RBCs in __________ temp
[Link] warmed to __________, cause lysis via complement
[Link] by Donath Landsteiner test

[Link] Associations
a.__________ = receptor for shiga toxin (shigella dysentery) and [Link] assoc HUS (hemolytic Uremic
syndrome)
b.__________ = receptor of human parvovirus B19

RH Blood Group (ISBT 004)

oSynthesize in CHROMOSOME _____
1.“rhesus monkey RBCs”
[Link] by Levine and Stetson
3. Order of Immunogenicity:
[Link] Genetic Inheritance Theory
[Link] Race

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[Link] of pairs of Linked Gene
ii.3 alleles -They postulated that the antigens of the system were produced by three closely linked sets of
alleles

[Link] theory
[Link] of Multiple Allelomorphic genes occuring at __________chromosomal loci

[Link] SYSTEM NOMENCLATURE

Gene Shorthand Wiener Fisher-Race Wiener Blood Rosenfield
Designation Agglutinogen Antigens Factors (numerical)
Rho Ro Rho Dce
Rh1 R1 Rh1 DCe Rh0__________’hr’’ 1, ___,___,-4,5
Rh2 R2 Rh2 DcE Rh0__________’rh’’ 1,-2,3,__,__
Rhz Rz Rhz DCE Rh0rh’rh’’ 1,2,3,-4,-5
rh r rh ce hr’hr” -1,-2,-3,4,5
rh' r' rh' Ce rh’hr” -1,2,-3,-4,5
rh" r" rh" cE hr’rh’’ -1,-2,3,4,-5
rhy ry rhy CE rh’rh’’ -1,2,3,-4,-5

Numeric Fisher-race ISBT

Rh1 D 004001
Rh2 C 004002
Rh3 E 004003
Rh4 c 004004
Rh5 e 004005
Rh6 ce 004006
Rh7 Ce 004007

GENETICS
[Link] weak D – few [Link] D.
b.C trans – Position effect
[Link] D (D mosaic) – one or more parts of D antigen is missing
[Link] for Weak D/Partial D: Indirect Antiglobulin Test

RARE/ UNUSUAL PHENOTYPES

[Link] Null c. G
b.D Antigen only d. F

6. Hemolytic Disease of the Fetus and Newborn (HDFN)

[Link] testing Fetal blood – __________
b. Occurs when mother is __________ and the Fetus is __________ ` c. HDFN is nearly always limited to A
or B infants of group __________ mothers (A.22) with potent anti-A,B
oA mother’s first baby has HDFN due to D antigen. What is the most probable cause? (S.2019)
A. Very strong antigenic stimulation during pregnancy
B. Presence of naturally occurring D Ag in the mother’s blood
C. Leakage of fetal cells to the mother’s circulation
D. Transfusion of Rh positive blood to the mother

ISBT 005: Lutheran

[Link]: Lu (a-b+) > Lu (a+b+)> Lu (a+b-), > Lu(a-b-)
[Link] Lub = IgM,IgA, IgG
[Link] only after __________or transfusion.
[Link] transfusion __________
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ISBT 006: Kell

[Link] developed at birth
2.K Antigen is __________ to D Antigen in immunogenicity.
3.K (kell)<k (cellano)

High Incidence Low Incidence

K - cellano K - kell
Kpb Kpa
Jsb Jsa

[Link] K – IgG__________ is seen with Anti K titer as low as 64

[Link] Phenotype
a. __________ Kell system.
[Link] anemia, poikilocytosis, neurologic , and muscular abnormalities (Duchene).
c. Granulomatous disease (CGD)

ISBT 007: Lewis

[Link] synthesized by RBC, but from plasma __________ by RBC membrane.
[Link] resistant
3. Frequency
[Link]
[Link] after birth
[Link] 10 days
d.>6 years

Genes Ag in Secretions RBC Phenotype

Le, Se, A/B/H ABH, ABH

Le

lele, Se, A/B/H ABH ABH

Le

Le, sese, A/B/H ABH

Le

lele,sese, A/B/H ABH

Le,sese,hh,A/B Le

Le,Se,hh,A/B ABH A,B (parabombay)

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Le

[Link] Association
[Link] – receptor for __________
[Link] (a-b-) – increased __________ to Candida and uropathogenic [Link]
c.__________ marker for reed sternberg cell
5. Anti Lewis can be neutralized using:
6. __________ Cause HTR but not HDFN

ISBT 008: Duffy

[Link] receptors: proinflammatory (DARC – Duffy Antigen Receptor for Chemokines)
[Link] (a-b-)- resistant to __________
[Link] - Anti Fya and Fyb –[Link] delayed __________

ISBT 009: Kidd

[Link] very immunogenic
[Link] denatured by enzyme
[Link] (a-b-) – resist __________
[Link] like Org: [Link], [Link], and Micrococcus
[Link] – (IgG)
[Link] __________ reputation in blood bank.
[Link] to __________

ISBT 027 Ii
[Link] high prevalence
[Link]
[Link] –
[Link] “i"
2. IT - did not demonstrate classical I or i specificity, They concluded that the agglutinin recognizes a
__________ state of i into I

PHENOTYPE STRENGTH OF REACTIVITY WITH

Anti-I Anti-i Anti-IT
Adult I Strong Weak
Cord Weak Strong
Adult i Weak Strong

[Link] enhance
[Link] I– Benign Autoagglutinin at 4oC (30-32oC) in all sera
[Link] Association
[Link] I= __________ -
[Link] i __________
[Link] i Antigen =
I. diseases with shortened marrow time
[Link] (Hereditary Erthroblastic Multinuclearity Positive Acidified Serum Test
[Link] i phenotype = Congenital __________in__________Asians__________.

ISBT 010: Diego

[Link] of band 3 which is __________Exchange for HCO3 and Cl-
[Link] for __________

ISBT 011: The YT (Cartwright) -Link to RBC __________

ISBT 012: Xg -higher in __________
ISBT 013: Scianna -Gene product is ERMAP (Erythroid membrane [Link]) –
ISBT 014: Dombrock -carried on a __________-ADPribosyltransferase 4 (ART4)

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ISBT 015: Colton -carried aquaporin__________
ISBT 016: Landsteiner-Wiener (LW) -Anti LW – reacts strong with __________
ISBT 017: Chido Rodgers (CH/RG) -Not intrinsic to RBC membrane but on the __________
ISBT 018: Hh
ISBT 019: Xk
ISBT 020:Gerbich (GE)
[Link] by glycophorin__________
[Link] to net negative__________of__________RBC
ISBT 021: Cromer -Carried by __________
ISBT 022: Knops (KN)
[Link] on __________

__________Phenotype – Knops null Kn(a-b-)

ISBT 023: Indian (IN)

[Link] on RBCs of 4% of Indians, 11% of __________, and 12% of Arabs
[Link] by __________2.Extremely rare: In(a-b-): __________

ISBT 024: Ok (OK) -Carried by __________

ISBT 025: Raph
1.MER2 (Monoclonal and Eleanor Roosevelt) – lab where Ab was prod.
[Link] on __________

ISBT 026: John Milton Hagen (JMH) - Ab seen __________years__________above

ISBT 029: Gill (GIL) -located on transported Aquaporin__________
ISBT 030: RH Assoc. Glycoprotein (RHAG)

System # Name Blood Group System

001 ABO
002 MNS
003 P1PK
004 RHD
004 RHCE
005 LU
006 KEL
007 Lewis
008 FY
009 JK
010 DI
011 YT
012 XG
013 SC
014 DO
015 CO
016 LW
017 Ch/Rg
018 H
019 XK
020 GE
021 CROM

022 KN

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023 IN

024 OK

025 RAPH

026 JMH

027 I

028 GLOB

029 GIL

030 RHAG

031 FORS

032 JR

033 LAN

034 Vel

035 CD59

036 AUG

037 KANNO

038 SID

039 CTL2

040 PEL

041 MAM

042 EMM

043 ABCC1

044 Er
GATA1,
Transcription Factors
KLF1
[Link]

BLOOD BANKING TECHNIQUE

Blood bank procedures should be reviewed __________ by authorized individual (A.22*)

DONOR SCREENING: LIST OF DEFERRAL

[Link]
a.__________
b. __________hormone from Pituitary gland
c. __________ from cows

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2. 3 years__________ of malaria and leishmanial endemic places for 5 yrs

3. 12 months/1 yr
[Link] received a blood __________
b. Hepatitis B Immune Globulin
[Link] __________
d. sexual contact with:
i.__________ patient or at risk
ii.__________
e. Traveled to places endemic for malaria

4. 6 months __________ from Dengue or Chikungunya infection

5. 16 weeks/4months - __________ red cell unit apheresis

6. 8 weeks/2mon/ 56 days - Whole blood donation interval
7. 6 weeks - termination of __________
8. 4-weeks -Infrequent plasma apheresis
9. 2 weeks -__________ for yellow fever, measles (rubeola), mumps, oral polio, typhoid
10. <48 hrs (A.22)- apheresis donation

DONOR SCREENING- PHYSICAL EXAM

National Voluntary Blood Services Program (NVBSP)

Weight
Pulse rate
Blood pressure
Hemoglobin
Temp

Autologous Donation
[Link] who donates blood for his or her own use referred to as “__________”
[Link]
a.__________ blood loss
[Link] with __________blood type
[Link] with multiple __________

[Link]
[Link] age
b. Minimum Hb: __________/g/dL
c. Minimum Hct: __________%
d. Same BP and PR for Allogeneic donors
[Link]’s __________ should not elevate or indicate any sign of infection

Donor Screening Tests

[Link] and Rh
[Link]
3. Hepatitis C Ab (Anti HCV)/ HCV Ag
[Link] 1 and HIV 2 Ab (Anti HIV 1 and Anti HIV 2) antigen (HIV 1 and HIV 2 Ag)
5. Serologic Test for Syphilis

QBC System for Malaria/The Acridine Orange Stained Capillary Tube

[Link] __________ than traditional thick and thin smear

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2. Tube precoated with __________  Microhematocrit Centrifugation  1 to 2mm near to the top of RBC
column where the parasites are concentrated  Smear  __________ microscope

CHEMICALS IN ANTICOAGULANT SOLUTIONS

[Link]
[Link] sodium phosphate – maintains:
a.
b.
[Link] –substrate for __________ prod
[Link] – Production of ATP
[Link] Rejuvenation: _________
[Link] phosphate, inosine, pyruvate, and adenine
[Link] __________
[Link] is Rejuvenated __________ days after the outdate/expiration

CENTRIFUGATION
[Link] spin:
[Link] spin:
a.5000g for 5 min =
b.5000g for 7min = Cryoprecip, Leukocyte poor RBC, cell free plasma

Note: RBCs are prepared from whole blood by centrifugation or __________

STORAGE
[Link] temp - Platelet from platelet rotators flatbed agitators
2.1oC to 6oC -PRBs and WB
[Link]: -18oC or lower -FFP and Cryoprecipitate
[Link]: -65oC -40% glycerolized RBC
5.-80oC - Tissue bank

RBC STORAGE LESIONS

[Link]:
[Link]:

BLOOD COMPONENTS
[Link] Blood
[Link]: __________
b.1 unit = inc __________ Hb and __________% Hct
[Link] Viable After 24hrs = __________
d. Use
[Link] blood loss
ii. Neonatal exchange transfusion
iii if Ptx has cold agglutinin, then warm the RBCs to 37 oC first before transfusion

2. PRBC
a.250mL - Removal: 200 to 250mL plasma
[Link] Preparations
[Link] system -Shell life: __________
[Link] system – Shelf life: same expiration date as original WB
[Link] bag w/additive: Can extend up to __________ days
[Link] (AS-1) (A.22)
[Link] (AS-5)
[Link] (AS-3)
CORRECTION! Optisol is AS-5 and Nutricel is AS-3
[Link] of RBC – should not exceed 70% to 80%
[Link]

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i. Anemia
[Link] Hb and HCT

3. Deglycerolized RBC
A unit of RBCs may be frozen within 6 days of collection.
[Link] w/in __________hrs  Cells warm mixed w/glycerol  freeze at __________
[Link] Agents
[Link] – penetrating agent
[Link] starch (HES) – nonpenetrating agent

[Link] life: __________.

[Link] of Deglycerolization:
[Link] at 37oC
[Link] washings in saline starting at __________to __________ containing glucose.
1. final soln: __________% NaCl and __________% Dextrose
f.1 unit deglycerolized = 180mL of cells
[Link]: 1oC to 6oC
[Link] be transfused w/in __________ hours of deglycerolization
[Link]
i. Autologous donation
ii. PNH
iii.__________ Deficiency

[Link] RBC
[Link] life: 24hrs after opened.
b.1o to 6oC
[Link] Hb and HCT same as unwashed
[Link]
[Link] most WBCs
iii. Febrile nonhemolytic transfusion reactions

[Link] Cell
[Link] Immediately before transfusion
b.__________
[Link] life: __________ days from the date of irradiation or the original outdate of the unit, whichever is
sooner
[Link]
[Link]
[Link] w/chemotherapy or radiotherapy
 Irradiated RBCs,
 platelets, and
 granulocytes
iii.__________-birth-weight neonates
[Link] deficiency immune sys

[Link] Reduced RBC

Leukocyte-reduced RBCs should be prepared within 6 hours of collection, but must be given within 24
hours, if prepared using an open system.
[Link]: Washing, thawed, deglycerolized, and frozen
-Methods for removing Leukocyte from RBC
 Prestorage filtration
 Bedside filtration
 Poststorage filtration
 Buffy coat removal is not a VIABLE method

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b.__________ of WBC removed and 70% of original RBCs are left.
[Link] life: 24 hours
d. Use
[Link] mass
[Link] Feb and Allerg rx.
[Link]
[Link] and HTLV
[Link] __________ trans

[Link] donor granulocyte concentrate

[Link] by apheresis (leukapheresis) or freshly drawn donor unit
[Link]: >1.0 x1010)
[Link]-600mL
[Link] life: 12-24hr at RT __________ agitation
e. Half life: 6hrs
[Link]
[Link]
[Link] deficient unresponsive to Antbiotic for 48hr
[Link] patient

[Link]
[Link] heavy/hard spin – get the plasma): w/in 6hours of Collection using double bag collection
[Link]:-18oC__________c.Shelf life: 1yr
if stored at -65oC: __________
[Link] __________ Coag factors
e. Use
[Link] failure with Vit. K def.
[Link]
[Link] who received massive transfusion.
iv. For ptx taking warfarin – it reverse the effect of warfarin

[Link]
a.__________ portion of the plasma
[Link] thawed bet.1oC to 6oC  centrifuged  removed supernatant  immediately freeze at -18oC
[Link] life: 1 year
[Link]:
[Link]:
i.__________units of Factor VIII
ii.50% Von willebrand
iii.__________ mg of Fibrinogen
iv.25% Factor XIII
[Link]
[Link] within __________ hours or within __________hrs of pooling
[Link]
i.Hemophilia__________
[Link] XIII def.
[Link]
[Link] willebrand dse

[Link] Conc
[Link] within 6hrs after blood collection
i. __________ spin then __________ spin
[Link] rich plasma: __________ of plasma
[Link] life: 3 to 5 days w/agitation at RT and pH ≥__________

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i. agitation has been shown to facilitate __________ transfer into the platelet bag
[Link] platelet shelf life:
[Link] seal transfused within __________
f.1 Unit = 5k to 7k/uL in a 165lbs person.
[Link]
[Link]
[Link] PLT
[Link]
[Link] thrombocytopenic purpura
[Link] who received massiv Trans

[Link] donor PLT conc. -Contain at least __________x 1010__________

[Link] Donor PLT conc
[Link] at least __________ x 1011
iiUse when there is not enough random PLT.
[Link] useful in immunologically __________ ptx when given as HLA match w/recipient

[Link] storage lesion

[Link]
2. Morphology scores change from _________to ________
3. Degranulation of B-thromboglobulin and platelet factor 4
4. Platelet activation markers: P-selectin or CD64
5. Platelet aggregation

[Link] immune globulin

[Link] Anti-D (Rho)
b.1mL
[Link] life: Fetomaternal hemorrhage
Tests that quantitate RBC (including Fetal
[Link] HDN
cells)
e. Admin: w/in 72hrs ______ delivery
[Link] betke
[Link] reference
b. Enzyme-linked Antiglobulin Test
[Link] for administering
c. Flow cytometry (S.2019)
[Link] must be
[Link] must have
[Link] must be
[Link] on the cord blood must be

[Link] Betke
[Link] cells
[Link]

14. Synthetic Volume Expanders

[Link] Categories: Crystalloid and Colloid
[Link]: Ringer’s lactate and 7.5% normal isotonic
[Link] – NaCl only
ii. Ringer’s Lactate – NaCl, K+, Ca2+, and Lactate ions
iii. useful in burn patients
c. Colloid: Albumin, Dextran, and HES
d. Both are free from viral transmission
e. Comparisons
CHARACTERISTICS CRYSTALLOID COLLOID
Intravascular Retension
Peripheral Edema
Pulmonary Edema
Easily excreted
Allergic Reaction
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Cost

APHERESIS
[Link] word “aphaeresis” means “taking__________
[Link]: __________
[Link] Methods
[Link] Flow Centrifugation 
[Link] Flow Centrifugation 
[Link] consideration - ECV (extracorporeal blood volume) should be less than __________of Total
Blood Vol__________
[Link] of Apheresis:
[Link] of apheresis
[Link] -Irradiated for GVHD
[Link]
[Link]:
1.__________PLT ct and pH > 6.2__________
[Link] (A.22): __________
[Link]: __________
4. Plasma loss exceeding 1,000mL (from plasmapheresis) is REJECTED

[Link]/TPE –Therapeutic Plasma Exchange

[Link] of monoclonal and Polyclonal Ab
[Link] should not be __________

[Link] (Red Cell Exchange)

i.__________cell disease__________ – most common Tx  reduced up to 30%

[Link] APHERESIS /Peripheral Blood Stem Cells/Hematopoetic Progenitor cell

[Link] is used: __________
iidaily injections__________
[Link] express __________

[Link]
[Link] __________
ii.1ml = 1mg iron

[Link] -For __________

[Link]/Selective Adsorption
A. Protein A
[Link]
[Link] B
[Link] acetate

ADVERSE EFFECTS OF APHERESIS

[Link] Toxicity

[Link] Reactions: malaise mediated by vagus nerve

[Link], Allergic Reactions, Air Embolism

4. Protein Interaction

[Link]: cardiac arrest and arrhythmia, pulmonary edema

DONATION FREQUENCY
APHERESIS COMPONENT COLLECTED FREQUENCY OF DONATION
2RBC 16 weeks
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Plasma (frequent) Every 2 days (no more than two times in 7 days)
Plasma (infrequent) Every 4 weeks (no more than 13x/year)
Platelet, single aphresis unit Every 2 days (no more than 2x in 7 days; no more
than 24x in 12 months)
Platelet, double or triple apheresis unit Every 7 days
Granulocytes Every 2 days

ANTIGLOBULIN TESTING
[Link] determine the possibility of immunizing the patient with an Rh Ag from the donor
2. To test unexpected Ab from patient towards the donor’s Ag
3. Determining the patient’s correct __________ is the most critical pretransfusion serologic test

4. DIRECT ANTIGLOBULIN TESTING

[Link] for in vivo coating of RBCs w/Ab or complement
[Link]
[Link]
[Link] and drug-induced hemolytic anemia
[Link]
[Link]:
[Link] = 3-5%
[Link] RBCs from EDTA
[Link] to remove unbound AHG
[Link] at RT
v. centrifuge
[Link]
[Link] for Agglutination (+)
[Link] Negative: Confirmed __________

[Link] (+) D.O.S

[Link] __________
[Link]
iii.__________centrifugation

[Link] (-)
[Link]
[Link] __________ RBCs (most common cause)
iii.__________ testing after specimen collection

[Link] ANTIGLOBULIN TESTING

[Link] patient serum in vitro coating of RBC by Ab or complement
[Link]: Crossmatching
[Link] Crossmatch: Donor cells + Patient’s Serum
b. minor crossmatch: Donor serum + Patient’s RBC
c. Three Phases
[Link] spin in saline at room temp
ii. Incubation at 37oC w/enhancement medium
iii. AHG phase
d. Process:
[Link] + DR  spin at RT LISS  Inc.37oC 15 to 30min  Centri  NSS 3x  AHG  mix and centri 30 sec
 Read

[Link]:
[Link] RBC + Ptx Serum
[Link] __________
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f. Enhancement Media/Potentiators
i.22% or 30% Albumin
[Link] Glycol and Polybrene
[Link] /Low Ionic Strength Soln Media (0.2% NaCl)
[Link] – decrease zeta potential
[Link]/Antihuman Globulin
[Link] to determine if RBCs are coated with antibody or complement or both
[Link] AHG
3. Monospecifi AHG

[Link] OF AGGLUTINATION REACTION

4+ __________ aggregate with clear background

3+ Several __________ clumps with clear to cloudy
background
2+ many __________ size clumps with clear to
cloudy background
1+ many __________ clumps with reddish
background
W __________ clumps barely readable as
agglutinate
0 no agglutination
M mixed field
H Hemolysis
P partial hemolysis

ANTIBODY SCREENING
[Link] __________ antibodies
[Link] importance: Immune alloantibodies which are produced in response:
[Link]
[Link]
[Link]
D. naturally occurring (IgM) by exposure to pollen, bacteria, or fungus.
[Link] acquired Antibodies: Plasma transfusion, Intravenous immunoglobulin
4. RBC REAGENTS
[Link] group O individuals
b.2-5% RBC suspension
[Link] cells – have a unique combinations of antigens
[Link] Prepared Screen cells –superior than crossmatch in compatibility testing

[Link] METHOD
[Link] – traditional method
[Link] serum + RBC w/_______ Antigen  immediate spin (though not required) incubation phase
 AHG phase
[Link] check for Hemolysis  Centrifuge
[Link] check for agglutination  tube is tilted or rolled

[Link] Method – ptx serum + Screen cells

i. Applications
[Link] and reverse type
2. Rh type
3. DAT
4. Ab screen
[Link]
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[Link] Agglutinate
[Link]
v. Disadvantage: Need for __________equipment

7. Solid Phase Adherence – ptx serum + Ag coated microtiter

[Link] – Diffuse pattern

ii. No sensitization – Pellet at the bottom
[Link] –_____ sample size
[Link] – Special equipment

[Link] Magnetized Technology (EMT)

[Link] serum + Screen cells with ____________ polymer beads  magnets
[Link] – diffuse pattern
3. Not sensitized – pellet at the bottom

9. In _____ Hemolysis - Anti Lea, Anti Leb,Anti PP1Pk and Anti Vel
10. __________- Anti Sda and Lutheran Ab
11. _____negative screen cells – _____% no clinically significant Ab
12. Antibody screening tests can’t detect low _________Antigen
[Link] Short Incubation = _____sensitized RBCs
[Link] Long Incubation = Bound Ab will __________from RBC
15. _______Transfusion = Mixed-field agglutination

ADDITIONAL TECHNIQUES FOR RESOLVING ANTIBODY IDENTIFICATION

1. Neutralization - substance in the body and in nature have antigenic structure similar to RBC. These
substances can be used to neutralize Ab to be separated and confirmed
ANTIBODY SOURCE OF NEUTRALIZING SUBSTANCE
Anti-P1
Anti-Lewis
Anti-chido
Anti-rodgers
Anti-Sda
Anti-I

PROVIDING COMPATIBLE BLOOD PRODUCTS

[Link] by the frequency of Ag in the population
[Link] know the number of Units to Ag-Type = # of units requested /Frequency of Ag negative individuals

SUGGESTED ABO GROUP SELECTION ORDER FOR TRANSFUSION OF RBC

RECIPIENT 1ST CHOICE 2ND CHOICE 3RD CHOICE 4TH CHOICE
AB AB
A A
B B
O O

BLOOD ADMINISTRATION
1.__________ – first step
[Link] ptx arm band to the bedside label
[Link] clerical check is done at the patient’s __________
4. All components must be filtered
[Link] slow transfusion:
6. Total Transfusion duration:

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7. Check for Vital signs:
8. Reactions possible causes
[Link] w/back pain
b. Anaphylaxis, hives, or pruritus
c. Congestive heart failure
d. Fever alone
e. Jaundice and decreasing HCT
f. hyperventilation - Discontinue the donation and provide a paper bag for the donor to breathe into in
order to increase the carbon dioxide in the donor’s air.
9. Requires blood warming
[Link] Transfusion

TRANSFUSION REACTIONS

ACUTE IMMUNOLOGIC
Name Cause Tx/Pre transfusion Others
Prep
[Link] incompat ABO incompat (NONE) intravascular hemolysis
signs: Fever, chills, and
Hemoglobinuria
Severe: DIC and Renal failure

[Link] WBCs or PLT vs. HLA I Ag Most common

Febrile -Antipyretic increase __________C temp
[Link] reaction soluble proteins vs. Ab Antihistamine 2nd most common
To IgA

4. Anaphylactic IgG anti-IgA from IgA Epinephrine and (NONE)

deficient steroids

5. TRALI Anti HLA/Anti HNA or vs. High dose steroids respiratory distress
Transfusion- WBC ® -hypoxemia
Related-Acute -pulmonary edema
Lung Injury -fever and hypotension

ACUTE NONIMMUNOLOGIC
Name Cause Tx/Pre Transfusion prep Others

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[Link] contam [Link] check for blood bag -__________ red facial
Pseudomonas common discoloration (A.22), flushing
isolate clots, hemolysis, or gas -high fever
Citrobacter freundii -
[Link]

Verax Pan genera

detection (PGD) assay
has been FDA approved
for both single-donor
platelets and random-
donor platelets for
bacteria screening
-pH and Glucose can no
longer be used as
screening accd to FDA

[Link] Overload __________ transfusion Diuretics and digitalis Increase systolic BP

Seen ptx with cardiac or
pulmonary dse
[Link] Mechanical (NONE) (NONE)
Bacteria

Small bore
Hypotonic soln

DELAYED IMMUNOLOGIC
Name Cause Tx/Pre Transfusion prep Others
[Link] -extravascular
Rh, MNS, Kell, Kidd, and -days to months
Duffy -fever and jaundice
unexpected drop in
__________ or
__________
[Link] Lymphocytes vs. Irradiated blood
Immunocompromised
host
[Link] transfusion Ab vs. Platelet (NONE) pregnant
purpura

DELAYED NONIMMUNOLOGIC
[Link] toxicity
[Link]
[Link]
[Link] overload

INVESTIGATING TRANSFUSION

[Link] – __________ cause of HTR

[Link]-transfusion – check __________ and hemolysis and compared to pre transfusion
[Link] on post transfusion EDTA specimen.

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BLOOD BANK SOFTWARE APPLICATION
[Link]’s password should be KEPT __________
2. Lab Results’ signatories:

References
[Link] Blood Banking Transfusion Practices by Harmening
[Link] Hubbard
[Link] pathology
[Link]’s 18th – 23rd ed.
5. Postgraduate Haematolog by Anthony R. Green
6. Human Blood Groups By Geoff Daniels

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