Immunohematology and Blood Banking: Principles and Practice

ISBN-13: 9789811584374 / Angielski / Miękka / 2021

Pritam Singh Ajmani

Opis

The book covers the basics of genetics and immunology, technical aspects of blood banking and transfusion.It offers a concise, and practical approach for different blood tests and guidelines on the best ways to take donor history, screen donors, store blood components, ensure safety, and anticipate the potentially adverse effects of blood transfusion, components and its management at the bedside. Different chapters include important topics such as collection, storage and transportation of blood, introduction to blood transfusion, blood group serology, discovery of blood groups, donor selection, interview, and its preparation, and storage, pretransfusion testing, transfusion therapy, clinical considerations, and safety, quality assurance, and data management developed specifically for medical technologists and resident doctors. The book also goes beyond preoperative patient blood management, with detailed accounts of coagulation disorder management and the administration of coagulation products and platelet concentrates. The book also defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This book offers a succinct and user-friendly resource with key points, boxes, tables & charts and is a quick reference guide for pathology and transfusion medicine residents and doctors in blood centers and hospitals dealing with regulatory aspects, transfusion safety, production and storage and donor care.

Spis treści

CHAPTER 1

INTRODUCTION TO BLOOD TRANSFUSION

Blood volume

The compatibility test

Definitions of blood product

Indication of blood grouping

Discovery of human blood groups

Hemagglutination reaction

Blood group systems (international society of blood transfusion (ISBT) 2008

Selection of donor for organ donation

Blood test measures antibodies to HLA

Percent reactive antibody (PRA)  

Types of donor for organ transplant

Change of blood group

Bibliography

CHAPTER 2

 BLOOD GROUP & IMMUNOLOGY

Discovery of Blood group

Immunological reaction

Principles of Immunohematology

The ABO antigens

Mendel's First Law of Inheritance

Autosomal chromosome

Genotypes table

What do co-dominant genes mean?

ABO antibodies

 

Antibody characteristics of IgG & IgM

Immunological reaction in blood banking

Stages of immunological reaction

Factors affecting the antigen-antibody reaction

The basic blood group system ABO

Comparison of ABO and Rh (D) groups

Blood groups with natural & immune antibodies

Subgroups of ABO blood group system

Bombay blood group

Plant agglutinins for ABO blood group

Human Leukocyte antigen (HLA)

Anti-human serum (Coomb’s antisera)

Bovine albumin

Rh Antigen

Classification of Rh antigens

Fisher-Race

Wiener

Rosenfield

Identification of Rh antigens

Translating from Weiner to Fisher-Race

Rh antibodies

Rh Blood group & Rh Incompatibility

Variations of the D phenotype

Partial D

Weak D

Laboratory diagnosis of weak D & partial D

Other blood group systems

 

Blood groups with natural & immune antibodies

Lutheran blood group

Miscellaneous blood groups (Human Leukocyte antigen)

Universal recipient

Universal Donor

Extremely rare blood group

 Bibliography

CHAPTER 3

 DONOR BLOOD COLLECTION

Donor consenting process

Essential issues in consent

Ownership of the donation

Donor rights

Ethical issues of donor screening

Signature of the donor

Donor interview

Essentials criteria for blood donors

Criteria for rejecting donors

Donor pre-transfusion evaluation

Guide lines before taking the blood from donor

Donor session records registration & donor identification

Formula for blood to be drawn                             

Blood Donor questionaries’ form

Consent letter from the donor

Whole blood donation

Blood anticoagulation

Blood flow & completion of donation

Blood volume monitoring

Invention of blood bags

Red cell anticoagulant & preservation

Citrate-phosphate-dextrose-adenine (CPDA-1)

Saline –adenine-glucose- mannitol (SAGM)

Types of blood bags

Anticoagulant used in blood bags

Identification of collected blood

Post donation instructions

Management of syncope fainting or vasovagal attack of donor

Donor care after a blood donation

Blood collection record sheet

Bibliography

CHAPTER 4

BLOOD STORAGE AND TRANSPORTATION

Transportation of blood after collection

Storage and transport conditions

Features of a blood transport container

Characteristics of coolant packs used in transportation of blood

Temperature control of transport container

Blood disposal log

Storage of blood

Blood bank refrigerator(s)

Blood plasma freezer(s)

Platelet agitator(s) with built in incubators

Temperature recording devices & alarms

Handling of Blood components

Cold room for preservation of blood

Organization in storage

Changes in stored blood

CPDA-1

Storage of donor  red cell units considerations

Bibliography

CHAPTER 5

TRANSFUSION OF BLOOD AND BLOOD COMPONENTS

Reasons for blood transfusion

Transfusion trigger

Transfusion target

Blood components   for transfusion

Whole blood

Inappropriate indications for the use of packed red blood cells

Packed red blood cells (pRBC)

Life span of transfused packed red blood cells (pRBC)

 Types of aphaeretic red cell concentrate available for treatment of anemia

Transfusion of packed red blood cells (pRBC) in acute anemia

False high Htc in cases of acute hemorrhage

Transfusion regimen for Thalassaemia major

Transfusion of pRBC in patients undergoing chemotherapy

Transfusion of pRBC in thrombocytopenia

Transfusion of pRBCs in chronic anemia

Transfusion of pRBC in sickle cell disease

Indication for auto transfusion

Transfusion of pRBC in bone marrow transplantation

Transfusion of pRBC in neonates

Leukoreduction Indications

Indications for irradiation of pRBC

Side effect of irradiated pRBC

Washed pRBC

Indications of frozen red cells

Fresh Frozen Plasma (FFP)   

Indications

Different types of plasma

Difference between Fresh Frozen Plasma and Plasma Frozen

Properties of different types of plasma

Storage time for preservation of FFP & cryoprecipitate

Plasma thawing equipment

Humate- P antihaemophilic

Advantages of Prothrombin complex concentrate (PCC) over FFP

Side effect of Humate-P

Composition of Prothrombin complex concentrate

Cryoprecipitate

Desmopressin (DDAVP) Indication

Human Fibrin Glue (HFG)

Platelets

Indication of platelets transfusion

Contraindications

Types of platelets

Compatibility

Platelet swirling phenomenon                                                 

Platelet agitator with built in incubator

Medicine & transfusion options

Bibliography

CHAPTER 6

BLOOD COMPONENT PREPERATION

General principles of component preparation

Laboratory procedures in blood component preparation

Preparation of fresh frozen plasma & packed red cells

Chart showing shelf life of blood components

Additive solutions

Preparation of cryoprecipitate

Reconstitution of cryoprecipitate for transfusion

Cryodepleted plasma ("cryosupernatant")

Preparation of platelet rich plasma (PRP)

Preparation of platelet concentrates

Preparation of pRBC

Bibliography

CHAPTER 7

BLOOD TEST IN IMMUNOHEMATOLOGY & BLOOD BANKING

Preparation of reagent cells for blood grouping

Usage of Coomb’s control cells

Preparation of Coomb’s control cells

Reporting of hemagglutination reaction

Procedure of diluting anti –D

Methods of determination of ABO blood grouping

Forward grouping

Reverse grouping

Preparation of Red cell suspension

Indirect antiglobulin test (Du Testing)

Rh (D) Grouping

Pre -transfusion testing (Compatibility testing)

Collection of blood specimen

Blood sample handling and processing

ABO & Rh grouping sera

Sources of errors in ABO grouping

Pitfalls in slide method

Report of reverse grouping & probable blood group

Advantages of tube method

Tube test for forward & reverse grouping

Results of forward & reverse grouping

Rouleaux formation & true agglutination

Causes of variable reaction

Micro plate technique method for ABO grouping

Column or Gel method for ABO groupingng

Cord blood of Infant

Testing for A ₁ and A₂ sub groups

Anti-D sera

Rh (D) grouping methods

Advantages of tube method

Matched results of forward & reverse grouping

Sources of errors in Rh (D) grouping

Saline Agglutination test for Rh Procedure

Direct coomb’s (DAT)

Causes of positive direct Coomb’s (Antiglobulin) test

 

Indirect antiglobin (Coomb’s) test

Indications of the indirect antiglobin test

Causes of false positive indirect antiglobin test (IAT)

Causes of false negative indirect antiglobin test (IAT)

Compatibility testing

Causes of false negative direct antiglobin (DAT) test

Differences between direct & indirect antiglobulin test

Application of Indirect antiglobulin test (IAT) in immunohematology

Application of Direct antiglobulin test (DAT) in immunohematology

Weak expression of the RhD antigen (Du)

Slide technique for antigen (Du)

Anti-human serum (Coomb’s antisera)

Bovine Albumin

Blood Group Compatibility

Compatibility testing or cross matching

Sources of errors in cross matching

 

False negative reactions

False positive reactions

Emergency cross match procedure

Goals of antibody screen                                                    

Elution of antibodies

Indications of elution of antibodies

Titration of anti – D

Prozone phenomenon

Ant globulin (comb’s) cross match

Bibliography

CHAPTER 8

HEMOLYTIC DISEASE OF THE NEW BORN

Who is affected by hemolytic disease of the newborn?

 

Why is hemolytic disease of the newborn a serious concern?

 

Signs & symptoms of hemolytic disease of the newborn

 

Acid Elution test

Laboratory diagnosis of HDN-Rh

Maternal blood and Rh typing and antibody- D titer

Middle cerebral artery blood flow measurements

Cell-free fetal DNA screening

Specimen collection for HDN

 

Cell-free fetal DNA screening

Test for Feto – Maternal hemorrhage

 Kleihauer-Betke test

Flow cytometry

Calculating RhIG Dosage                                                                            

Routine Rh (D) prophylaxis guidelines

Hemolytic disease of the newborn caused by ABO incompatibility

Prevention of hemolytic disease of the newborn

Treatment for hemolytic disease of the newborn

Intrauterine Fetal Blood Transfusion for Rh Disease

The compatibility test in case of exchange transfusion

Procedure

Prognosis after intrauterine transfusion through umbilical cord

Risks of intrauterine Transfusion

Neonatal transfusion exchange transfusion Indications and aims

Criteria for performing exchange transfusion

Component and procedure specifications

Monitor infants after exchange transfusion

Laboratory complications of exchange transfusion

The choice of blood group for exchange transfusion

Single volume exchange

Double volume exchange

Consideration of other transfusion issues

Transfusion of other blood components in neonates

Platelet transfusion in neonate

Clinical situations to trigger for platelet transfusion

Platelet compatibility

Transfusion of FFP to neonates

 Blood and blood component specification & recommendations for: fetuses, neonates, infants and children’s

Bibliography

CHAPTER 9

HISTORY OF BLOOD TRANSFUSION

Bibliography

CHAPTER 10

MASSIVE BLOOD TRANSFUSION

Trauma Transfusion – order for uncrossed blood components

Massive blood transfusion (MBT)

Massive blood transfusion definition

Pathophysiology of MBT

Causes of Massive Blood transfusion in women

Types of Obstetric hemorrhage

Massive blood transfusion in battle field injury (trauma induced)

Clinical signs & symptoms of volume of blood loss

Signs & symptoms of inadequate oxygen delivery

Methods for volume status assessment in trauma, predictor of massive bleeding

Assessment of blood consumption (ABC) score 

Clinical criteria at the time of admission

Clinical criteria for trauma or non-trauma patient’s  

Laboratory criteria

Assesment of blood consumption (ABC) score

Focused assessment with sonography for trauma (FAST)

Indications for the eFAST exams

Clinical criteria admission

Laboratory criteria for massive transfusion protocol

The Abbreviated Injury Scale (AIS)

Acute coagulopathy of trauma

Different causes of coagulopathy in massive blood loss

Problems due to massive blood transfusion

Effect of dilution

Effect of Hypothermia

Effect of acidosis

Hypocalcaemia

Hyperkalemia

Transfusion-associated hyperkalemic cardiac arrest

Hypomagnesaemia

Adult respiratory distress syndrome (ARDS)

Massive transfusion protocol

Steps in the massive hemorrhage protocol

Two categories of immediate life-threats in trauma

Occult shock in trauma resuscitation

Shock Index (SI)

Resuscitation targets

How to give MTP

Management of intravascular volume loss

Management of loss of blood components

Management of massive blood loss by Pharmacological support

Factor VIIa

Factor Eight inhibitor by pass activity (FEIBA)

Tranexamic Acid (TXA)(Beriplex)

Whole blood or blood component in obstetric hemorrhage

Assessment of volume status in trauma

Limitations of massive transfusion protocols

Measures for control of massive bleeding

Vascular access in trauma resuscitation

IV solutions & Medications

Point-of-care testing

Monitoring

Recommended laboratory test

Massive blood loss in battle field injury

Types of battle field injury

Evacuation & levels of care

Field hospital 

Type of death in battle field injury

Golden Hour Container for collection & transportation

Treatment of war wounded patients

Detection of blood group at the war site by Eldon card

Management of Battlefield blood transfusion

Buddy transfusion

Bibliography

CHAPTER 11

AUTOLOGOUS BLOOD TRANSFUSION

History of Autologous blood transfusion

Types of Autologous blood transfusion (ABT)

Pre-operative blood donation (POBD)

Acute normo-volumic hemodilution (ANH)

Intraoperative salvage (ICS)

Criteria for autologous donors

Time for pre - operative blood donation

Indication of autologous blood transfusion

Contraindication of autologous blood transfusion

Advantages of autologous blood transfusion

Preoperative blood collection (POBD)

Number of autologous blood donations

Perioperative collection acute normovolemic hemodilution (ANH)

Advantages of ANH

ANH complications

Intraoperative cell salvage (ICS)

Intraoperative cell salvage (ICS) contraindication

Postoperative cell salvage (PCS)

Characteristics of processed intra & post-operative blood by cell saver

Complications of intra & post-operative blood salvaging

Complications of autologous blood transfusion

Reasons of decreasing autologous blood transfusion

Bibliography

CHAPTER 12

BLOOD MANAGEMENT

Definition                           

Advantage of Patient Blood Management

Why does patient blood management matter?

Patient benefit 

Use of strict transfusion triggers

Sustainability of the blood supply

The three pillars of Patient Blood Management

Patient cantered decision

Managing anemia

Optimizing coagulation

Practical implementation of Patient Blood Management (PBM)

Advantages of blood conservative programme

Bibliography

CHAPTER 13

BLOOD BANK PROTOCOLS

Blood bank requisition form

Blood delivery slip

Blood bag receiver slip

Identification of the patient

Specimen collection & labeling of the tube

Cord blood specimen

Expiration of the compatibility blood specimen

Causes for specimen rejection

Transport of blood

Transfusion & test requests

Test results and product availability

Request for delivery of blood

Administration of O group blood policy

Testing protocol

Common blood bank orders

Turnaround times for supply of blood

Other important information

Blood specimen collection and processing

Blood administration

Ten golden rules for transfusion

Guide for administration of blood & blood components

Chart for vital parameters check

Monitoring and observation

Outcomes of blood transfusion

Reaction details 

Recommended procedure for documentation

Bibliography

CHAPTER 14

BLOOD BANK INVENTORY

Blood bank inventory

Monitoring wastage

Management

Reasons for laboratory initiated quarantine

Non-conforming products

 

Managing products with short expiry dates

Emergency release of blood without cross matching

Maximum surgical blood order schedules

Monthly denominator reporting form

Chart showing availability of stock

Daily inventory of blood stock in quarantine

Documentation of inventory traceability and the blood service

Why data should be collected

Blood stocks management scheme (BSMS)

Demand of blood components

The number & reasons for transfusion

Whole blood collection management

Approaches to demand forecasting

Daily hospital component requirement

Hospital weekly variation against present inventory

Contingency and disaster planning

 Blood integrated blood shortage plan benchmarking

Bibliography

CHAPTER   15

TRANSFUSION REACTIONS

Definition of Transfusion Reactions

Reporting information

Submission date of form

Patient’s information

Current status at the time of reporting

Transfusion products detail information

Reaction information

Reactions vital signs

Patient’s signs & symptoms at the time of reaction

Suspected adverse reaction

Diagnostics – Check box and/or enter values.

Treatment and clinical course

Outcome of transfusion reaction

Interpretation of transfusion report by Blood Bank Officer

Classification & types of transfusion reactions

Fatal- Acute hemolytic reaction (ABO incompatibility)

Non -fatal acute hemolytic reaction (ABO incompatibility)

Febrile non-hemolytic reactions (WBC or cytokine induced)

Allergic reactions minor (urticarial)

Allergic reactions (fatal) Anaphylaxis

Transfusion-related acute lung injury (Trali)

Hemolytic transfusion reaction

Transfusion related acute gut injury (TRAGI)

Circulatory overload 

Non-immunological hemolysis (heat, cold, osmotic, mechanical)

Reaction to bacterial contamination

Electrolyte imbalance (calcium, potassium, magnesium)

Chemical effects citrate

Coagulopathy with massive blood transfusion

Hypotensive transfusion reaction

Delayed immunological mechanisms

Delayed hemolytic reactions

 Alloimmunisation (RBC hemolysis & Platelet refractoriness)

GvHD

Post-transfusion purpura   

Trim 

Delayed non-immunological mechanisms

Alloimmunization RBC hemolysis & Platelet refractoriness

Delayed hemolysis

Transfusional hemosiderosis

Transfusion transmitted infections

Infections: Viruses, Bacteria, Parasite, Contaminant

Isoimmmune major transfusion reactions

Hypotensive transfusion reaction

Thrombophlebitis

Septic phlebitis

Air embolism

Effect of vaso- active substances

Pyrogenes-bacterial & endogenous

Effect of cold blood

Others

Management of suspected transfusion reactions

Investigation of transfusion reaction

Bibliography

O autorze

Dr. Pritam Singh Ajmani, M.D. Pathology and Microbiology, Professor, Department of Pathology, R.D. Gardi medical college, Ujjain, India