Immunohematology & Transfusion Medicine

Immunohematology and Transfusion Medicine

• Immunohematology studies antigens and their corresponding antibodies.
• Transfusion medicine deals with blood transfusion.
• Blood banking involves donor selection, blood collection, preparation, and storage.

History of Transfusion Medicine

• 1492: Pope Innocent VII had the first recorded blood transfusion, but it was unsuccessful.
• 1901: Karl Landsteiner discovered the ABO blood group system and explained incompatible transfusion reactions.
• Edward E. Lindemann carried out vein-to-vein transfusions using multiple syringes.
• Loutit and Mollison introduced acid-citrate dextrose (ACD).
• Gibson introduced citrate phosphate dextrose (CPD).
• Dr. Yves Lapierre developed the gel test.
• Dr. Charles Drew (1957) developed techniques for blood transfusion and preservation.
• Hustin (1914) was the first to use citrate.
• Gregor Mendel is known as the father of genetics.
• Ludwig Hektoen performed crossmatching.
• Reuben Ottenberg performed the first blood transfusion using blood typing and crossmatching.

Genetics

• Humans have 23 pairs of chromosomes (46 total) in diploid cells.
• 22 pairs are autosomes, and 1 set is sex chromosomes (XX for female, XY for male).

Laws of Genetics

• The first law (Law of Independent Segregation) refers to the transmission of a trait in a predictable fashion from one generation to the next.
• The second law (Law of Independent Assortment) demonstrates that blood group antigens inherited on different chromosomes are expressed separately and discretely.
• The third law (Law of Dominance) is not specified in content.

Terminology

• Genes are basic units of heredity; segments of DNA that encode a particular protein.
• Chromosomes are structures within the nucleus that contain DNA.
• Locus is the site of a gene on a chromosome.
• Alleles are alternate forms of a gene at a given locus.
• Homozygous means having identical genes at a locus on each chromosome.
• Dosage refers to the stronger agglutination when a red cell antigen is expressed from homozygous genes.
• Heterozygous means having different genes at a locus on each chromosome.
• AB Codominance is a state in which the allele at each locus expresses its characteristic effect equally in the heterozygote.
• Genotype is the actual genetic makeup, determined by family studies or molecular typing. A patient's genotype is NOT determined in routine blood bank testing.
• Phenotype is the observable expression of inherited traits, determined by hemagglutination of red cell antigens using specific antisera.
• Amorph describes a gene that does not express a detectable product.
• Dominant refers to a gene that is expressed even in a heterozygous state.
• Recessive refers to a gene that is expressed only in a homozygous state.
• X-linked refers to genes carried on the x-chromosome.

Types of Mutation

• Point mutation is the simplest type, where only one nucleotide in the DNA sequence is changed (substitution, insertion, deletion).
• Missense mutation results in a change in a codon, which alters the amino acid in the corresponding peptide.
• Nonsense mutation results when a point change in one of the nucleotides of a DNA sequence causes one of the three possible stop codons to be formed.

Chromosomal Location of Major Blood Group Systems

• Rh, Duffy are on chromosome 1.
• MNSS is on chromosome 4.
• Kell is on chromosome 7.
• ABO is on chromosome 9.
• Kidd is on chromosome 18.
• H, Lewis, Lutheran are on chromosome 19.
• P1 is on chromosome 22.

ABO Blood Group System

• Discovered by Karl Landsteiner in 1901.
• The first major blood group to be discovered.
• The most clinically significant blood group system in transfusion and transplantation therapy.

Landsteiner's Law

• The antigen on the RBC determines the blood group.
• The corresponding antibody is never found in the individual's serum
• The opposite antibody is always present in the individual's serum.

Blood Group Phenotypes and Frequencies

• Group A can have genotypes AO or AA, has A, H antigens and anti-B antibodies.
• Group B can have genotypes BO or BB, has B, H antigens and anti-A antibodies.
• Group AB has genotype AB, has A, B, H antigens and no antibodies.
• Group O has genotype 0, has H antigen and both anti-A and anti-B antibodies.
• ABO Blood Type Frequencies are O>A>B>AB.

Antigens

• Expressed as early as the 37th day of fetal life.
• ABO genes code not for the antigens themselves, but for the production of glycosyltransferase that adds immunodominant sugars to the Basic Precursor substance.
• The H gene (on chromosome 19) encodes a-2-L-fucosyltransferase, which adds L-fucose (the immunodominant sugar).

Comparison of Type 1 and Type 2 Chains

• Type 1 chains have a Beta 1, 3 linkage and originate in the plasma.
• Type 2 chains have a Beta 1,4 linkage and are synthesized in erythrocytic precursors.
• H, A, B, Se and Lewis control Type 1 chains while H, A, and B control Type 2 chains.
• Both chain types result in the expression of H, A, and B antigens.

Comparison of ABH antigens on RBCs with A, B, and H Soluble Substances

• RBC antigens can be glycolipids, or glycosphingolipids.
• Soluble substances are glycoproteins.
• RBC antigens are synthesized only on type 2 precursor chains.
• Secreted substances are primarily synthesized on type 1 precursor chains.
• Type 2 chain refers to a beta 1–4 linkage in which the number one carbon of the galactose is attached to the number four carbon of the N-acetylglucosamine sugar of the precursor substance.
• The enzyme produced by the H (FUT1) gene (alpha-2-L-fucosyltransferase) acts primarily on type 2 chains, which are prevalent on the RBC membrane.
• The enzyme produced by the Se (FUT2) gene (alpha-2-L-fucosyltransferase) acts on type 1 chains on secretory tissues.

Subgroups of A

• A1 have branched A antigens and 2 million A antigens per adult red cells, and react (+) with Anti-A and (+) with Anti-A1 lectin.
• A2 have linear A antigens and 500,000 A antigens per adult red cells and react (+) with Anti-A and (-) with Anti-A1 lectin

Weak Subgroups of A

• A3 Mixed-field reaction with Anti-A and most Anti-A, B
• Ax Weak agglutination with anti-AB only
• Aend Less than or equal to 10% red cells show very weak mixed agglutination
• Am No agglutination with Anti-A, and Anti-AB, secretors demonstrate quantities of A substance in saliva

Fluids in Which A, B, and H substances Can Be Detected in Secretors

• Saliva
• Tears
• Urine
• Digestive juices
• Bile Milk
• Amniotic fluid
• Pathological fluids pleural, pericardial, ovarian cyst

Genes and Secretion Antigens

• The genes affecting secretion are HH, AO, SeSe, and H,A
• The present antigens are H,A

ABH Substance in the Saliva of Secretors

• In group O both A and B are None, H is increased
• In group A A is increased, B is none, H is present
• In group B A is none, B is increased, H is present
• In group AB both A and B is present, H present

Bombay Phenotype

• The allele H is very rare and does not produce the L-fucose necessary for the formation of H structure
• The genotype is hh or H null

Types of Bombay Phenotype

• Bombay is designated as Oh
• ParaBombay is designated as Ah, Bh, Abh
• H gene is absent from Bombay, but present but weak in Para
• The first Bombay were reported in India by Mumbai, 1952
• A and B antigens are demonstrated on RBC, but not antigen H

Characteristics of Bombay Phenotype

• Bombay shows no agglutination with H lectin
• A non-secretor
• Absence of a-2-L-fucosyltransferase on red and blood
• A recessive mode of inheritance
• The erythro of Bombay will not react with the H lectins

AHB Soluble Substitutes

• Found in the secretion of secretor the CSF
• Absent on the non-individials

ABO antibodies

• Antibodies aren't normally present because they develop 3-6 months after birth -If identified, it's a maternal IgG
• For type A, the Ab is created with IgM
• With Antibody, it will react with room temperature
• It is naturally occurring, Cannot cross placenta

AB (IgG)

• No none
• It create's anti- Ab IgG
• It Immuno Ab, and can cross placenta.

Slide method

• Use a rapid or bedside typing
• Use with a direct
• Limited to one minute

False Positives

• Must read within a minute.
• Subject to repeat, and may positive from drying up a mixture

Tube Method

• This is routine typing
• Direct Indirect
• Reactions and interpretation in 3 minutes, with enhanced reaction

Regents

• Known Red Cell Suspension
• Detects for Unknow Anti bodies
• 2-3% vv is being prepared
• Diluent Used: NSS 0.85 isotonic salt solutions
• You see a blood Ab

Positive Results in Blood Typing

• Hemmagulation
• RBCs are formed
• Lacttice is important

Nemolysis

• Red cell of destroy
• Red color

Agglutination

• all cells are combined into one
• several Large aggregates
• Clear supernatant
• medium sized

Clear

• supernarnt
• Few isolated aggregates
• Turbid and reddish supernatant
• Few solated cells.

Princicple

• -Detect unknown antigens with antisera prepare
• Use a red cell suppension

Regents

• Anti a Antisera, used as a detector Anti-B Anti-ab

Lectins

• They are plant extracts for blood.

• they bind to CHO portion

• Dolicos biflorus Aggluntation or Abcells

• Urex Aeurpaenus, Aggunation or Abcells

• Vica Gramma, N.

Preectins

• Same with ectins, but from SNAIL Source
• Anti A snail source

Abo Reverse grouping

• Detect Ab with a RBC's

Group Discrepancy

• Anti 4 A Anti B cell

• ---pt P group

• enhanced wrak ness

###Chimerism

• Presnece of two cell populations
• Artidicial blood/ transfusion

###Resoluton

• ENHANCE
• serum, reagent @Room T

Group 2

• 4 2 02 0
  • Pt Group
• Forward grouping due to ---Weak antigen ---Low antien
• -Anti to incidence antigeny
• Exes Group
• Gasrt and Cancer
• Acuaried

acquired B

• Bacteria
• Prte vulgaris
• Modify-N
• Into-D

Accruired A

• E coli
• intestional construction, resolution

PX: Anti anatiB acell bc

• Reaction from a B
• Causes a non anti a allution reaction when
• ---Ant A

Solution

• wash 1, a lectin

D

• most clinically, -

WEakD

• WEak expressiom
• Antgbulin
• mech:
• gwnetics express

RH

• Rh
• ---Loated
• Rh
• ---conisder,exstive
• D
• Inhertenc, is codominice
• Reg express
• Rh: Cromosomes: Responsible.Absence
• Rhce; Reponsibel , Absence
• Reag; Responsible. formation

R: Nomenculture

-R

WEINER Rh

• Rh

• A numeric numbers/RH

• 00200c

rh Genotype

R

• R
• R
• O

004

Rh

A

• D
• **ANTIGENE RH:
• Weal devloping Hdfs

###Antibodies

• mostly, 1861
• 156; can cross placenta 005
• Enhancement with High Low
• 7 and Lisser for indentific

Procedure

• Label two - Anti D + Control
• +1-2
• Mix a -Centringe Gently the Suspored. Add I and S to Negative spint and reac

1. Results

• agglution and is positive
• absence and negative
• anti-HGT and specimen -11 and regent

Viewboxrh

• RH Testing
• Provides Heats +5

HDFN/NEWBORN

• Destryciton of cell -Fetal Also +E Patenogenesis is: Lack, Baby and baby posseses all
• Antigen must be well at Birth

Vitero hdfn's clinic features

• Hydrox
• the - threat to fetal and cardiac

Neontal Perodm

• Bilribin

###B1/B2

• b2

ANTI that use hfdm

• d

• -Comp AHO/HDFN

• ab/ Rh

• natural, "A"

• affected

• absent mild

• WEak postive

Transplace

• escape + circulation.
• Wok of gestation

R Rosette test

• D rosette

• indicator "10 M =Give -Negative Give

Rh

• conenttrated

• ---Act Supplessanent

• Standard mother

The moth

Not

ADMIN

• 300UG of Anti-D and protect 30ml
• min dose - so ml wb.

Other Method

• Flow proide, - volub

###R

• Rbc

• Rh is done

-+all Rh = recive

• +and Rh- 3 month.

Deterimnant

• X

• For descimais = ROUND d, ADD 1

Estimate code

0

• Perentage of A + B Avg M volument "Calulate " - mL w"bl
• =Divide mm by mL

Re, Re

• when

• • is

• at max

• • at C

• AH is

• The transfusice must - the

RH - AB

• ---- to to correce
• Mother - sample

selecte

• all (-) for affiniding ABG Feresh, CmV< and Hebs

###Exchange Removal Sample mother

• All

Transfusion

• T and RBC

• Sample

• O()

• ---fresh a/u

Recontisuted Whole

Transusions in-

Exmaple

• Reds -group + plamsa
• Reaches or storeed +Ic +DC.

Overview of immunohematology and transfusion medicine. Includes the history of blood transfusions, blood banking, and the discovery of the ABO blood group system. Key figures like Karl Landsteiner and Charles Drew are also mentioned.