ImmunoHema

• Immunohematology is the study of RBC antigens and antibodies associated with blood transfusion.
• The first recorded blood transfusion in history was performed in 1492 by Pope Innocent VII, who transfused blood from one person to another via the mouth.
• Storage lesion of blood GDAPP iHAP Decrease GLUCOSE Increase PLASMA HEMOGLOBIN Decrease 2,3 DPG Increase in LACTIC ACID Decrease ATP Increase PLASMA AMMONIUM Decrease pH Increase PLASMA POTASSIUM Decrease PLASMA SODIUM
• The first successful blood transfusion among animals was performed in 1666 by Richard Lower, who transfused blood from one dog to another dog.
• The first fully documented human blood transfusion was performed in 1667 by Jean-Baptiste Denys, who performed the first animal to human transfusion.
• The first successful human to human transfusion was performed in 1829 by James Blundell, who extracted 4 ounces of blood from the arm of the patient’s husband using a syringe.
• Braxton Hicks attempted to find nontoxic anticoagulants in 1869 and suggested sodium phosphate.
• Karl Landsteiner discovered the ABO blood group and the serious blood transfusion reactions due to the ABO system in 1901.
• Edward E. Lindemann was the first person who succeeded by carrying out a vein to vein blood transfusion by using multiple syringes and a special cannula for puncturing the vein through the skin in 1914.
• Hustin reported the use of sodium citrate and glucose as a diluent and anticoagulant solution for transfusion in 1914.
• Lewisohn determined the minimum amount of the nontoxic citrate needed for anticoagulant and transfusion in 1915.
• Rous and Turner introduced the dextrose-citrate solution for the preservation of blood in 1916.
• REJUVESOL is approved for CPD, CPDA-1 and CPD/AS-1.
• RBCs restored in a liquid state can be rejuvenated at outdated or up to 3 days after outdate, depending on RBC preservative being used.
• Red blood cells frozen rejuvenated which were collected and stored in CPD or CPD-A1 may be stored FROZEN up to 10 years.
• During World War II, Dr. Charles Drew worked on developing techniques in blood transfusion and establishing a widespread system of blood banks.
• 75% of cells that have been transfused should remain viable within 24 hours.
• RBC rejuvenation is used in rare blood types.
• Blood should be maintained at a temperature of 1-10°C ice or other cooling devices should not be physically in contact with the blood unit to prevent hemolysis.
• At least 70% of the red cells must remain viable at the end of the permitted storage period.
• Contamination should be suspected if the red cell mass is purple discoloration, hemolyzed, or clotted.
• The ONLY ANTICOAGULANT that can be used with rejuvenating solution is CPD.
• REJUVESOL is the only FDA approved rejuvenation solution in the US.
• REJUVENATING SOLUTION restored the ATP and 2,3 DPG; can revive the dead RBCs as long as it is not expired in more than 3 days.
• ONLY RBC prepared from 450ml collections can be rejuvenated.
• All units of blood should be inspected daily and prior to issue.
• After expiration of blood, for example 35 days, it depletes the ATP and 2,3 DPG and RBC rejuvenation is used to revive the dead RBCs.
• Blood banks were established in many major cities in the US in 1947.
• Spectrin is a protein that gives strength to RBC.
• Deformability: Refers to the cells’ ability to adapt their shape to the dynamically changing flow condition and minimize the resistance of the flow through small blood vessels.
• RBC cannot pass through the small blood vessels if the membrane deformability is lost.
• Low red blood cell deformability prevents the RBC from passing through the small blood vessels.
• The red blood cell membrane: A semipermeable lipid bilayer with a mesh-like protein cytoskeleton structure.
• Integral membrane proteins: Extend from the outer surface and span the entire membrane to the inner cytoplasmic side of the RBC.
• The deformability of RBC starts to decrease when there is a loss of ATP (source of energy of cells) and when the ATP loses, the phosphorylation of spectrin will decrease.
• Blood passes through the apheresis machine which separates the cells from the blood.
• Apheresis machine: A device which receives blood removed from a patient or donor's body and separates it into its various components: plasma, platelets, white blood cells and red blood cells.
• 75% post-transfusion survival of RBCs is necessary for successful transfusion.
• Permeability: The red blood cell membrane is freely permeable to water and anions, but impermeable to cations (sodium and potassium) thus maintaining RBC volume and water homeostasis.
• High red blood cell deformability enables the RBC to pass through the small blood vessels.