Immunohema

• Immunohematology


  Studies antigen-antibody reactions (with regards to blood) and analogous phenomena as they relate to the pathogenesis and clinical manifestations of blood disorders
• Antigen


  Foreign substance that enters the body
• Antibody


  Substances produced by the immune system in response to an antigen
• Blood Banking


  The process of collecting, separating, and storing blood
• Blood is a biological specimen and considered as a drug that can cause adverse reactions
• Adverse reactions


  • Transfusion Related Acute Lung Injury (TRALI)
  • Transfusion Associated Circulatory Overload (TACO)
• First recorded blood transfusion, given to Pope Innocent VII


  1492
• The first attempt at blood transfusion was not successful, all 4 people died, and clotting was the main obstacle to overcome
• Challenges in early blood transfusions


  • Finding a nontoxic coagulant
  • Developing devices for performing transfusion
  • Developing preservative solutions to enhance RBC metabolism
• Braxton Hicks used sodium phosphate, the first example of blood preservation research


  1869
• Karl Landsteiner discovered ABO blood groups, improving the quality of blood transfusion


  1901
• Developments in blood transfusion

  • Edward E. Lindemann - vein to vein transfusion
  • Unger - designed syringe-valve apparatus
  • Hustin - used sodium citrate as an anticoagulant
  • Lewisohn - determined minimum citrate concentration needed for anticoagulation
• Hustin used sodium citrate as an anticoagulant, but it could lead to citrate toxicity


  1914
• Lewisohn determined the minimum concentration of citrate needed for anticoagulation


  1915
• Developments in blood preservation

  • Rous and Turner - introduced citrate-dextrose solution
  • Dr. Charles Drew - developed techniques in blood transfusion and blood banking
• Dr. Drew appointed as Director of the first American Red Cross blood bank

  February 1941
• Loutit and Mollison introduced the acid-citrate-dextrose (ACD) formula


  1943
• Journal of Clinical Investigation published records of blood preservation

  July 1947
• Gibson introduced the citrate-phosphate-dextrose (CPD) preservative solution, which replaced ACD


  1957
• CPD


  Less acidic than ACD and became the standard preservative for blood storage, but had issues with circulatory overload
• Issues with frequent blood transfusions and massive blood use

  • New problems emerged
  • Component therapy developed to provide specific blood components needed by patients
• The standard unit of whole blood is 450mL +/- 10%, with 63-70mL of anticoagulant
• More recently, 500mL +/- 10% of blood is collected, with a maximum of 525mL for a 110lb donor
• The total blood volume for most adults is 10-12 pints
• Donors can replenish the fluid lost from donating 1 pint within 24 hours, and their red cells are replaced within 1-2 months
• In the Philippines, the referral period for blood donation is 3 months/12 weeks
• A volunteer donor can donate blood every 8 weeks
• Whole blood can be separated into 3 components: FFT/plasma, cryoprecipitate, and platelets
• Plasma can be converted to a clotting factor concentrate rich in antihemophilic factor
• Whole blood-prepared RBCs may be stored for 21-42 days, depending on the anticoagulant-preservative solution
• The donation process


  1. Educational materials provided

  2. Donor health history questionnaire

  3. Abbreviated physical examination
• Screening tests for infectious diseases

  • Syphilis
  • Hepatitis B surface antigen (HBsAg)
  • Hepatitis B core antibody (anti-HBc)
  • Hepatitis C virus antibody (anti-HCV)
  • HIV antibodies (anti-HIV-1/2)
  • Human T-cell lymphotropic virus antibody (anti-HTLV-I/II)
  • Human Immunodeficiency virus (HIV-1) (NAT*)
  • Hepatitis C virus (HCV) (NAT*)
  • West Nile Virus (NAT*)
  • Trypanosoma cruzi antibody (anti-T. cruzi)
• Hepatitis C is the most common cause of hepatitis disease
• RBC biology and preservation

  • Normal chemical composition and structure of the RBC membrane
  • Hemoglobin structure and function
  • RBC metabolism
• RBC membrane


  A semipermeable lipid bilayer supported by a meshlike protein cytoskeleton structure
• Phospholipids


  Main lipid component of the RBC membrane
• RBC membrane proteins


  • Ankyrin and spectrin - give RBCs flexibility to pass through small capillaries
• The biochemical composition of the RBC membrane is approximately 52% protein, 40% lipid, and 8% carbohydrate
• RBC membrane deformability issues

  • Spherocytes
  • Bite cells
• Bite cells


  Permanent indentation in the RBC membrane caused by the removal of a portion of the membrane, an effect of Heinz bodies (denatured hemoglobin)