Immunohema

• Allogenic donation


  Blood is taken from an individual of the same species as the recipient
• Autologous donation


  Blood given to the recipient coming from the recipient itself
• Apheresis


  Process wherein blood is withdrawn from the donor and separated into its components, with one or more components retained and the remaining constituents recombined and returned to the individual
• Donor screening assesses


  • If the donation of approximately 450 ml of blood would be harmful for the donor
  • If the blood drawn from the donor could potentially transmit a disease to the recipient
• Donor requirements


  • Identification card (ID) for photographic identification
  • Donor Registration Information- full name, date and time of donation, address, telephone, sex, age, and date of birth
  • Consent form- donor must sign a consent form giving permission to draw blood and perform required laboratory testing
  • Two types of tubes (red and lavender-stoppered) should be filled with blood of the donor, to be used for donor testing
  • General appearance - appears healthy
  • Age at least 17 years old written consent from guardian if the donor is minor
  • Weight not less than 50 kgs or 110 lbs
  • Hematocrit not less than 38%
  • Hemoglobin 12.5 g/dL
  • Temperature not greater than 37.5 deg C or 99.5 deg F
  • Systolic blood pressure of not greater than 180mmHg
  • Diastolic blood pressure of not greater than 100 mmHg
  • Pulse rate, 50-100 bpm; if prospective donor is an athlete with high exercise tolerance, a lower pulse rate may be accepted
• Formula to calculate amount of anticoagulant to remove for a donor weighing less than 50 kg


  1. Allowable amount of blood to be drawn in mL= donors weight in lbs x450 mL / 110 lbs

  2. Amount of anticoagulant needed= allowable amount to be collected x14 / 100

  3. Amount of anticoagulant to remove= 63 mL- anticoagulant needed
• Permanent donor deferrals


  • Viral hepatitis after 11th birthday
  • Positive test for hepatitis B surface antgen
  • Repeat reactive test for anti-HBC on one more than one reaction
  • Clinical or laboratory evidence of HCV, HTLV or HIV infection
  • Behavioral risk factors for HIV infection according to current FDA guidelines
  • History of Babesiosis or Chagas disease
  • Stigma of parenteral drug use
  • Injection of nonprescription drugs
  • Risk of vCJD according to current FDA guidelines
  • Donors who have taken Tegison or etretinate (these drugs are teratogenic)
  • Donors who have leukemia or lymphoma
• 1 year donor deferrals

  • Mucous membrane exposure to blood
  • Nonsterile skin with an individual with a confirmed positive test for HBsAg
  • Sexual contact with an individual with viral hepatitis
  • Sexual contact with individual with HIV infection or at higher risk for HIV infection
  • Incarceration in correctional institution for longer than 72 consecutive hours
  • History of Syphilis or Gonorrhea
  • If rabies vaccination has been given following a bite of a rabid animal, the donor must be deferred for 1 year after the bite
  • Recipient of hepatitis B immune globulin (HBIg)
• 1 month donor deferrals

  • Recipients of live attenuated for German measles (rubella) or chicken pox
  • Donors who have ingested Accutane or proscar- defer for 1 month from time of last dose
• 2 week donor deferrals


  • Recipients of live attenuated or bacterial vaccines (measles or rubeola, mumps, polio (oral), typhoid or yellow fever; small pox vaccine
• No donor deferrals


  • Recipients of toxoids or killed or synthetic viral, bacterial or rickettsial vaccines especially if donor is symptom-free (e.g. vaccines for anthrax, cholera, diptheria, influenza, paratyphoid, pertussis, plague, polio (injection, salk), rocky mountain spotted fever, tetanus, typhoid and typhus)
  • A previous history of tuberculosis that has been successfully treated and is no longer active need not disqualify a donor
  • Recipients of recombinant type growth hormone
• Other donor deferrals


  • Previous donations= defer for 8 weeks; if the donor has participated in pheresis donation, defer for at least 48 hours
  • Pregnancy=defer for 6 weeks
  • Recipient of blood transfusion or tissue transplant=defer for 12 months
  • Malaria Confirmed diagnosis- defer for 3 years after becoming asymptomatic
  • Travel to or residence in an endemic area as defined by the CDC-defer according to FDA
  • Male patients who took up dutasteride or AVODART are deferred for at least 6 months since the drug is teratogenic
  • Soriatane carries deferral of 3 years
  • Donors who have taken aspirin and aspirin-containing compounds are deferred for 3 days
• Blood collection procedures


  • Positive identification of the patient, the blood specimen and the blood unit for transfusion
  • Use aseptic technique- iodine compound or chlorhexidrine gluconate and isopropyl alcohol (if donor is allergic to iodine)
  • Scrub site at least 4cm (or 1.5 inches) in all directions for 30 seconds
  • Apply tourniquet or blood pressure cuffs (40-60mmHg)
  • 16g is the gauge number of needle often used for bleeding/donation
  • Position the blood-drawing unit at 20 degree angle
  • Instruct the donor to open and close his or her hand every 10-12 seconds during the collection procedure
  • Mix the unit of bag periodically (1 to 2 times per minute or every 30 to 45 seconds)
  • Units requiring more than 8 minutes may NOT be suitable for preparation of platelet concentrates, fresh frozen plasma or cryoprecipitate
  • A unit containing 450-495 mL should weight 425-520g plus the weight of the container with its anticoagulant
  • After blood is collected, it is stored between 1-6 degree Celsius. If the unit is to be used as source of platelet, it should be stored at room temperature (20-24 degree Celsius)
  • Blood collected must be processed for component within 6-8 hours of collection
  • Labeling and coding of blood bags(FDA)
• Color coding of blood bags

  • ABO Blood group shall be printed in black
  • Rh positive= black print on white background; Rh negative= white print on black background
  • A= YELLOW
  • B= PINK
  • AB= WHITE
  • O= BLUE
• Additional color labels (FDA 1985, optional)

  • TAN= Hold for further testing
  • GREEN= For autologous use only
  • GRAY= Not for transfusion
  • ORANGE= For emergency use only
  • PURPLE= Irradiated
  • RED= Biohazard
• Management of adverse donor reactions

  • Fainting and vasovagal reactions: Remove tourniquet and withdraw needle, Apply cold compress o the donor's forehead or back of the neck, Raise donor's legs above the level of head, Loosen tight clothing and secure airway, Administer aromatic spirit of ammonia by inhalation and the donor must respond by coughing, Monitor the vital signs
  • Hyperventilation: Talk to the patient to disrupt his or her increased breathing pattern, Have the donor breathe into a paper bag
  • Nausea and vomiting: Instruct the patient to breath slowly and deeply. Instruct the donor to turn his or her head to one side, Provide an emesis basin and clean towels
  • Cardiogenic or hypovolemic shock: Characterized by increase in pulse rate
  • Hematoma: Remove the tourniquet and needle from donors arm, Apply pressure with sterile gauze pads for 7-10 minutes, Apply ice to the area for 5 minutes
• Post donation care


  • Raise arm and apply pressure on the puncture site after the collection
  • Rest after blood collection, reclining for few minutes, then sit upright and allow to walk
  • Instruct the donor to drink lots of water, refrain from smoking and avoid strenuous works
• Tests performed on donor's blood

  • ABO/ Rh: ABO grouping must include both forward typing (using anti-A and anti-B) and reverse typing (using reagent A and B cells), Rh typing should be determined using anti-D reagent. Negative result should be followed by Weak D testing
  • Antibody Screen: Detects for unexpected antibodies against RBC antigens, Often accomplished by pooling four donor sera and then testing it with screening reagent red cells
  • HBsAg and Anti-HBc: Detects for hepatitis B infection; most commonly employed method for detection is ELISA
  • Anti-HCV: 90% of post transfusion hepatitis is caused by non-A, non-B hepatitis and 10% by hepatitis B, Anti-HCV is now used for the assessment of hepatitis C infection among donors
  • Anti-HIV 1/2: Procedures indicate testing for anti-HIV 1 and 2- if initial screening test is negative, the unit is suitable for transfusion; if it is positive, the test must be repeated in duplicate- and if any one of the duplicate tests is reactive, the unit must be discarded, ELISA serves as the screening test, Confirmation test for HIV include Western blot
  • Anti-HTLV I/II: HTLV-I virus or the human T-cell lymphotrophic virus type 1 is causative agent of adult T-cell leukemia and has been associated with neurologic disorder, HTLV-II is similar to type I and is prevalent in intravenous drug users, Enzyme immunoassays serve as screening test, Confirmatory test include Western blot, RIPA and NAT
  • Serologic test for syphilis: Spirochetes cannot live in blood stored for 72-96 hours at 1 -6 degree Celsius- which would make platelets the only component capable of transmitting the infection, Still part of the test since donors positive for syphilis are considered high risk individuals, Screening test include rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) which detect for reagin or antibody directed toward cardiolipin particles, Confirmatory test for syphilis is the FTA-ABS or the Fluorescent treponemal antibody absorption test
• Autologous donation


  The safest blood a person can receive is his own
• Advantage of autologous donation


  • Safer since there is no risk of disease transmission, transfusion reactions or alloimmunization to WBCs, RBCs, platelet or plasma proteins
• Types of autologous donation

  • Preoperative collection (predeposit)
  • Acute normovolemic hemodilution
  • Intraoperative collection
  • Postoperative collection
• Preoperative collection (predeposit)


  Removal and storage of blood or blood components from a donor-patient before an elective procedure, for reinfusion during or after the procedure
• Potential problems of predeposit autologous transfusion

  • Presurgical anemia and hypovolemia
  • Clerical identification errors
  • Outdating of liquid stored blood
  • Homologous blood transfused instead of autologous
  • Patient-donor unable to donate (poor veins, pre-existing medical condition)
  • Inadequate length of time to collect suitable number of units
• Proper procedure in transfusing blood

  1. Positive identification of the patient, patients blood specimen prior to transfusion, as well as the blood unit for transfusion

  2. Clerical check at the bedside by the nurse

  3. Sample must be collected within 3 days of scheduled transfusion

  4. Stoppered or sealed sample of donors blood must be stored at 1-6 deg C for at least 7 days post transfusion
• Venous access


  Should be established before a blood component is issued. The selection of location and type of access depends on the volume, timing and expected duration of transfusion therapy. Peripheral access with an 18-gauge needle or catheter is typically sufficient. Central venous access is desirable for high-volume administration or long-term therapy.
• Intravenous infusion device


  Should be set before the blood is issued. Only isotonic saline or 5% albumin should be used as intravenous solutions to dilute blood components. Do not use 5% Dextrose solution in water (D5W) since it is hypotonic and can cause hemolysis of RBCs. Do not use Ringers solution since it contains calcium which can initiate coagulation. No medication must be added or administered in the same line with blood components.
• Filtering blood components


  All components must be filtered to remove clots. Clot-screen filters are used to remove gross clots and cellular debris.
• Monitoring patient vital signs

  Pulse rate, respiratory rate, blood pressure and temperature must be monitored during the transfusion to detect signs of transfusion reaction.
• Blood warming


  Cold blood can cause hypothermia in patient, which can lead to cardiac arrhythmia and hemorrhage. Blood warmers should be set at 37 deg C. Blood must not be warmed above 38 deg C. Automatic temperature control is set to alarm when blood is warmed over 42 deg C. Never use water bath or microwave to warm the blood.
• Acute normovolemic hemodilution


  Blood is collected before a surgical procedure and simultaneously replaced with a comparable volume of crystalloid or colloid solution. Blood collected during hemodilution can be saved and retransfused as fresh whole blood
• Rate and length of transfusion

  Blood components are infused slowly for the first 10-15 minutes (approximately 2 ml/ minute for the first 15 minutes) while the patient is observed for signs of transfusion reaction. Subsequently, the administration rate may be increased. It is desirable to complete a red cell transfusion within 2 hours and a platelet or plasma transfusion within 30-60 minutes. Any transfusion should be completed within 4 hours of initiation.
• At least 70% of the transfused red cells remain in the recipients circulation 24 hours after transfusion.
• Reissue of blood unit


  Blood can be reissued after returning from the ward if the following conditions are met: The closure must not have been entered in anyway, the blood must have been kept between 1-10 deg C on a continuous basis, the pilot tube or sealed segment of the donor tube must still be attached to the container, the blood should not be away from the blood bank for more than 30 minutes, records must be available that verify all inspection criteria.
• Emergency transfusion


  If patients ABO and Rh group is unknown, group O Rh negative red cells must be given.
• Massive transfusion


  Is defined as the administration of enough blood or components within less than 24 hours to constitute a volume replacement (that is, in adults 8-10 units; in infants= slightly more than half a unit).
• Adverse effects of massive transfusion

  • Citrate toxicity and Hypocalcemia
  • Hypothermia
  • 2,3 DPG depletion
  • Depletion of coagulation factors and platelets
  • Accumulation of biochemical and microaggregates
• Neonatal RBC transfusion


  Less than 7 days old to reduce the risk of hyperkalemia and to maximize 2,3 DPG. O negative or compatible with mother and infant. CMV- negative or leukocyte-reduced. Hemoglobin S negative for hypoxic or acidotic newborns. Dose: 10 mL/kg over 2-3 hours.
• Exchange transfusion


  Exchange transfusion of a newborn infant is used in the treatment of both anemia and hyperbilirubinemia that characterizes HDN. In exchange transfusion, small amounts of blood are removed from the baby and replaced with donor blood.
• Purpose of exchange transfusion

  • To remove antibody-coated red cells with compatible donor cells
  • To remove bilirubin in order to prevent kernicterus
  • To remove circulating maternal antibody in baby's plasma
  • To suppress erythropoiesis (production of incompatible RBCs)
• Indications of exchange transfusion


  • Greater than 0.5 mg/dL/Hr rise in bilirubin, or
  • A rise of 10 mg/dL in the first 24 hours