Compatibility Testing For Blood Transfusion
Compatibility Testing For Blood Transfusion
Compatibility Testing For Blood Transfusion
Whats new?
Recognizes the Presence of Multiple Antigens on the Surfaces of Red Blood Cells that define Blood Group Systems
BLOOD GROUP SYSTEMS CONVENTIONAL NAME ISBT SYMBOL ISBT NUMBER ANTIGENS
*ABO MNSs
001 002 003 004 005 006 007 008 009 010 011
4 37 1 47 18 21 3 6 3 2 2
BLOOD GROUP SYSTEMS CONVENTIONAL NAME ISBT SYMBOL ISBT NUMBER ANTIGENS
012 013 014 015 016 017 018 019 020 021 022 023 024 025 026
1 3 5 3 3 9 1 1 7 10 5 2
----
O O A A B B AB AB
38% 7% 34% 6% 9% 2% 3% 1%
Why do we care?
Compatibility testing is done to avoid a hemolytic transfusion reaction If the Host or Recipient recognizes the donor RBC surface antigens as foreign, the host will mount an immune response to the donor RBCs
ABO
ABO blood group antigens present on red blood cells and IgM antibodies present in the serum
Why do we have Anti-A or Anti-B Antibodies??? They are not present in the newborn They develop in the first years of life Exposure to plant, bacterial, viral antigens provokes this response
Why do we have Anti-A or Anti-B Antibodies??? Viruses transmitted from the respiratory tracts of humans to other humans drag along various antigens including ABO blood group antigens. Prime the newborns immune system. Reduces transmissibility of viruses within a population.
Rhesus
47 Antigens make up the Rhesus Blood Group The most significant is the D antigen
There is no naturally occurring Anti D Production of Anti D in the RH negative recipient requires previous exposure to the D antigen (in utero or by transfusion)
If red cells are administered to an ABO- or D-incompatible recipient, the recipient will mount an antibody response to the foreign RBC surface antigens IgM is polyvalent and fixes complement
Clumps and extruded RBC stroma result in organ dysfunction and possible death Incidence 1:38,000 1:70,000 Mortality 1:30
Other Blood Groups No naturally occurring antibodies Immune response requires previous exposure Weaker titers of univalent antibodies
Bits of Donor RBC membrane lost traversing splenic sinusoids (extravascular hemolysis) Spherocytes Decreased RBC survival Delayed anemia Priming for worse reaction
Donor
Donor Needs a Hct of 0.38 A drop of donor blood is placed into a test tube containing a CuSo4 solution CuSo4 solution has a SG of 1.053 RBC with Hct > 0.38 sink to the bottom of the test tube
Donor Side sample (20cc) collected for testing: Blood group and Infection The bag is anticoagulated
The unit is labeled with a lot# like any drug e.g. LH59321
Landsteiner, 1899
Lifespan, 2008
COMPATIBILITY TESTING
The purpose of pre-transfusion compatibility testing is to PREVENT hemolytic transfusion reaction Clerical and technical components
Samples must be labeled at the bedside Two methods of ID required: Name, SSN, MR#, DOB The phlebotomist must sign the tube
COMPATIBILITY TESTING
Lab checks: Identity Record of previous specimen Record of previous ABO-Rh type History of abnormalities
COMPATIBILITY TESTING
Processing the specimen:
ABO Group determined (forward and reverse) D typing determined Antibody screen will be performed ABO/Rh identical or compatible blood will be made available
ABO TYPING
Front or forward type using monoclonal antiA and anti-B (commercial) The sample is diluted to Hct 0.08, the commercial antibodies added & the test tube is centrifuged The RBCs are then examined for clumping (gross observation, gel suspension)
Anti A
Anti B
Anti A
Anti B
Anti A
Anti B
Anti A
Anti B
AB
ABO TYPING
Back or reverse type with A and B cells
Commercially available A and B cells are added to two tubes of plasma AB
A B A
B
B A
A
B A
O
B
How do we know whether or not the host (or recipient) has antibodies to minor blood group antigens? Add commercial RBCs with known important minor antigens on their surface to host (or recipient) plasma and centrifuge. Then incubate at body temperature for 15-30 minutes Then add rabbit antiglobulin
Rabbit antiglobulin will bind to the Antibodies and the RBCs will clump
ANTIBODY SCREENING
Detection of unexpected clinically significant antibodies against the minor blood group system antigens Also called the indirect Coombs test or the indirect antiglobulin test Positive in between 0 - 8% of samples depending on the population
MNS P1 RH LU KEL LE FY JK DI YT
002 003 004 005 006 007 008 009 010 011
37 1 47 18 21 3 6 3 2 2
POSITIVE ANTIBODY SCREEN Can some or all of the antibodies be identified? Identify red cells which lack these antigen(s)
15 25
Policies
Consent: Covered in surgical consent Prescription: Needs to be ordered Collection: Label blood at bedside Name, MR #, other Sign and date
Policies
Administration: Inspect bag Verify ABO Rh Match IDs If no access to name bracelet use Innovian to match IDs 2 licensed personnel & 2 signatures Normal saline only
Whats new?
Whats new?
2007 Nature Biotechnology USA, Denmark, France, Sweden Convert blood types A, B, and AB to O, using bacterial glycosidase enzymes to cleave the antigens from the RBC surface. Need D negative cells
Red blood cell compatibility table Recipient OO+ AA+ BB+ Donor
O- O+ A- A+ B- B+ AB- AB+
ABAB+
O A B A B
AB
A B O