INTRO 1 IMHM

• Packed RBC (PRBC)


  Derived from whole blood, with plasma removed
• Unit Outcomes


  • Understand the mission and vision of OLFU
  • Know the history of Immunohematology and Blood Transfusion Practices
  • Recall the basic concepts of Genetics
• Topic Outline for Immunohematology

  • Introduction to IMH
  • Review of Immunology
  • ABO and H Blood Group System
  • Rh blood group system
  • Other Blood Group System
  • Donor Selection
  • Component Preparation and Component Therapy
  • Antihuman Globulin Test
  • Compatibility Testing
  • Transfusion Reactions and Transfusion Transmitted Diseases
  • Blood Group Associated Diseases
  • Miscellaneous Topics
• Immunohematology


  Study of immunologic properties & reactions of all blood components
• Blood banking


  Study of immunologic principles applied in blood group specific antigens & antibodies, including blood typing, crossmatching, Coombs test, detection and measurement of Ab titers, screening of donors, and bleeding techniques
• Hemotherapy


  Selection, preparation and infusion of blood or its derivatives or components for an individual
• Antibodies will only react with corresponding antigen
• If the blood donor is not compatible to the recipient it will cause hemolytic transfusion reaction
• ABO-RH typing (Forward typing)

  1. Slide method

  2. Tube method
• Direct Antiglobulin test (DAT)/ Indirect Antiglobulin Test (IAT) HHG test


  Need to know if the red cell is coated with immunoglobulins
• If the blood does not match, it can still be transfused but need to measure Ab titers
• Blood Group System


  • ABO
  • Rh
  • Lewis, P, I and I, Kell, Duffy, Kidd, Lutheran
  • Diego, Cartwright, XG, Sciana, Dombrock, Colton, Chido/Rodgers, Gerbich, Cromer, Knops, Indian, JMH, etc.
• There is a blood group system coming from plasma, platelets and leukocytes that will cause agglutination
• The "A", "B" "AB" "O" blood groups are the most predominant and implicated with the most dangerous and severe reaction which is hemolytic transfusion reaction
• Compatibility testing


  1. Mix patient's serum and donor's red cells

  2. Check for reaction
• Blood Type Specific Component


  Matching the patient's blood type with the donor's blood type
• Pharaoh's Blood Bath - Historical use of blood transfusions by aristocrats and in literature
• First human blood transfusion, all 4 died due to clotting and lack of appropriate device


  1492
• Overcoming clotting and appropriate device

  1. 1869: Braxton Hicks introduced Na phosphate as anticoagulant

  2. 1914: Hustin introduced Na citrate as anticoagulant

  3. 1915: Lewisohn determined the minimum amount of citrate needed as anticoagulant and demonstrated its non toxicity in small amounts

  4. 1916: Rous and Turner introduced a citrate-dextrose solution for the preservation of blood
• Loutit & Mollison introduce the formula for the preservative Acid Citrate Dextrose


  1943
• Gibson introduced an improved preservative solution, Citrate Phosphate-Dextrose, which is less acidic and replaced ACD as standard preservative for blood storage


  1957
• Edward Lindemann: first to successfully carry vein to vein transfusion using multiple syringe & special cannula in puncturing the vein through the skin
• Unger: designed a syringe-valve apparatus that transfuses blood from donor to patient by an unassisted physician
• Rare Blood type- "AB-"
• Karl Landsteiner discovered the ABO blood groups (A,B,O) and explained the serious reactions of incompatible transfusion


  1901
• Von Des Catello discovered the 4th group (AB)


  1902
• Karl Landsteiner and Weiner discovered the Rh blood group system


  1940
• Dr. Charles Drew appointed as the director of the 1st American Red Cross Blood Bank & his program becomes the model of the National Volunteer Blood Donor Program of the American Red Cross

  Feb. 1941
• Approved Anticoagulant Preservative Solutions

  • Acid citrate-dextrose (ACD)
  • Citrate-phosphate dextrose (CPD)
  • Citrate-phosphate-double-dextrose (CP2D)
  • Citrate-phosphate-dextrose-adenine (CPDA-1)
• Citrate


  Chelates calcium; prevents clotting
• Monobasic sodium phosphate


  Maintains pH during storage; necessary for maintenance of adequate levels of 2,3-DPG
• Dextrose


  Substrate for ATP production (cellular energy)
• Adenine


  Production of ATP (extends shelf-life from 21 to 35 days)
• Blood collected from the donor is transfused to the patient
• CPDA-1 has the longest shelf life of 35 days
• Normal blood pH is 7.2-7.4
• Additive Solutions (AS)


  Solutions added to RBCs after removal of plasma, with or without platelets, to extend shelf-life to 42 days and allow for more plasma and platelet harvesting
• Additive Solutions


  • Adsol (AS-1)
  • Nutricel (AS-3)
  • Optisol (AS-5)
• Gene


  Biological unit of inheritance
• Dominant gene


  Always expressed as antigen regardless of whether it is in homozygous or heterozygous state