IMHM321 Week 2 Lecture - History of Immunohematology and Blood Preservation PDF

Blood Banking (Immunohematology) IMHM321 LECTURE COURSE OBJECTIVES: 1.Explain the principles and procedures in Immunohematology, collection, processing, preservation, storage, distribution of blood, its components and derivatives. 2.Perform the techniques of blood grouping and compatibili...

Blood Banking (Immunohematology) IMHM321 LECTURE COURSE OBJECTIVES: 1.Explain the principles and procedures in Immunohematology, collection, processing, preservation, storage, distribution of blood, its components and derivatives. 2.Perform the techniques of blood grouping and compatibility testing and other methods of Immunohematology accurately. 3.Explain the concepts in the operation and organization of the Blood Bank. 4.Demonstrate quality assurance in the performance of Immunohematology tests. 5.Apply their knowledge of immunohematological concepts to real-life situations through case studies and review of published researches.  DEFINITION OF TERMS ❖ BLOOD BANKING Encompasses activities, procedures, and tests done to ensure blood for transfusion is properly COLLECTED, PRESERVED, STORED, AND DISPENSED for later use in blood transfusion ❖ TRANSFUSION MEDICINE A branch of medicine that is concerned with the transfusion of blood and blood components. It also deals with the proper selection, utilization, and removal of blood and blood components in the treatment or prevention of disease BLOOD TRANSFUSION taking blood or blood components from one individual and inserting them into the circulatory system of another done in cases of massive blood loss due to trauma, surgery, shock, and where the cell producing mechanism fails Two types of blood transfusion ✓ Autologous transfusion: refer to those transfusions in which the blood donor and transfusion are the same (rare phenotypes, rare blood types) ✓ Allogenic transfusion: refer to blood transfused to someone other than the donor ❖ COMPONENT THERAPY transfusion of SPECIFIC BLOOD COMPONENTS needed by the patient or recipient  HISTORY OF BLOOD TRANSFUSION ❖Since the beginning of human history; prehistoric man → draw on caves showing individuals bleeding from wound ❖Romans and Egyptians bath from it for spiritual and physical restoration ❖Romans drank from the fallen gladiators blood for the belief that vitality and strength will be transferred to them ❖Blood has been the central theme in ancient rituals ❖In the middle age- people drank blood for the tonic rejuvenation and for the cure of various diseases ❖Hippocrates- they believe that disease are caused by the imbalance of the 4 humors: phlegm, blood, yellow bile and black bile ❖After being banned for more than 150 years, blood transfusion has been revived during the 18th century ❖18th century – blood was the most popular treatment for various diseases. Blood letting was very popular even without the proper knowledge about blood circulation  History of blood transfusion ▪ 1492 - first time a blood transfusion was recorded in history. * Blood was taken from three young men * Pope Innocent VII  History of blood transfusion ▪1628 – William Harvey * De Motu Cordis Exercitatio Anatomica de motu cordis et sanguinis in animalibus History of blood transfusion ▪1666 – Richard Lower * Transfused blood from one dog to another  History of blood transfusion ▪In 1666, Samuel Pepys to speculate on the potential benefits of human transfusion, stating that “bad blood” might be mended by “borrowing” blood “from a better body  History of blood transfusion ▪June 15, 1667 – Lower and Jean Baptiste Denis * Both performed sheep to human transfusion * Unsuccessful, banned  History of blood transfusion ❖BLUNDELL’S IMPELLOR consisted of a double-walled funnel in which the outer compartment was filled with warm water. The donor blood flowed into the funnel, was sucked into a syringe, and was forced along tubing into a cannula inserted into the patient’s vein by means of two oppositely acting spring valves below the funnel History of blood transfusion Blundell’s “Impellor”  Blundell’s “Graviator” History of blood transfusion ❖GESELLIUS’ METHOD the donor’s back was lanced multiple times and capillary blood extracted using suction cups Medical and nursing staff administering transfusion, Bellevue Hospital, 1876. The first photograph of blood transfusion James Aveling transfusion set  History of blood transfusion ❖James Aveling transfusion set 2 silver cannulae is inserted in the recipient and donor and connected by rubber tubing with a compressible bulb in the middle to promote and sustain flow ❖Edward Lindemann came up with an appropriate design for performing blood transfusion. He carried out vein to vein transfusion of blood by using multiple syringes and a special cannula for puncturing the vein through the skin. Disadvantage: time-consuming,complicated procedure, requires many skilled assistant. ❖Unger designed his syringe valve apparatus that made transfusion from donor to patient even simpler without physician assistant History of blood transfusion ❖Dr. Philip Syng Physick Father of American Surgery First to perform human to human transfusion ❖1816 – John Henry Leacock “The transfusion of Blood in extreme cases of haemorrhage” ❖1829 James Blundell of England successfully transfused human blood to women suffering from postpartum hemorrhage History of the ABO blood group system 1901 – Karl Landsteiner, discovered ABO blood type Adriano Sturli and Alfred Von Decastello/Descatello – AB blood type Lewisohn’s method of transfusion of citrated blood Blood is collected in a graduated flask and is promptly transfused to the patient. Modified from Lewisohn: The citrate method of blood transfusion after ten years History of anticoagulant preservative solutions ▪1869 – Attempts to find a nontoxic anticoagulant began ▪Braxton Hicks recommended sodium phosphate ▪1901 – Discovery of ABO Blood group by Karl Landsteiner ▪1914 – Albert Hustin reported the use of sodium citrate as an anticoagulant solution for transfusions ▪1915 – Richard Lewisohn determined the minimum amount of citrate needed for anticoagulation and demonstrated its nontoxicity in small amounts. History of anticoagulant preservative solutions ▪1916 - Rous and Turner introduced a citrate-dextrose solution for the preservation of blood. ▪1943 - John Loutit and Patrick Mollison of England introduced the formula for the preservative acid-citrate dextrose (ACD) ▪1957 - Gibson introduced an improved preservative solution, citrate-phosphate- dextrose (CPD)  Fact sheet A person has 5 - 6 liters of blood in their body  450-500 ml of blood – amount of blood a normal person can donate AABB standard - volume of whole blood collected including an amount for samples shall be “10.5 mL/kg of donor weight.” This means that for a 110-lb donor (50 kgs), a maximum volume of 525 mL can be collected.  63-70 ml – amount of anticoagulant used during blood collection (7:1) A person can donate blood every: AABB → 2 months/8 weeks/56 days DOH → 3 months Body recovers the Blood very quickly: Blood plasma volume– within 24 - 48 hours Red Blood Cells – in about 3 weeks Platelets & White Blood Cells – within minutes BLOOD PRESERVATION BLOOD PRESERVATION ❖ Goal of blood preservation is to provide viable and functional blood components for patients requiring blood transfusion, viability of RBC is a measure of in-vivo survival following transfusion ❖ Expected post transfusion RBC survival after 24hrs of transfusion is 75% ❖ 75% of cells that have been transfused should remain viable after 24 hours; this criteria is used to evaluate preservative solutions and storage containers ❖ To maintain optimum viability blood containing RBC’s is stored in the liquid state between 10C to 60C for a specific number of days (shelf-life), as determined by the preservative solutions ❖ Loss of RBC viability has been correlated with the lesion storage, which is associated with various biochemical changes RBC storage lesions (Biochemical changes during storage): Characteristic Change observed % Viable cells Decreased Glucose Decreased ATP Decreased Lactic acid Increased pH Decreased 2,3 DPG/BPG Decreased Oxygen dissociation curve Shift to the Left Plasma K Increased Plasma Hgb Increased ANTICOAGULANT PRESERVATIVE SOLUTIONS CHEMICALS IN ANTICOAGULANT PRESERVATIVE SOLUTIONS ❖Citrate (sodium citrate/citric acid) prevents caramelization of glucose during sterilization of solution at high heat binds calcium so blood does not clot ❖Sodium phosphate maintains pH storage; necessary for maintenance of adequate levels of 2,3-DPG ❖Dextrose Substrate for energy production ❖Adenine Production of ATP (extends shelf-life from 21 to 35 days)  ACD ANTICOAGULANT PRESERVATIVE SOLUTIONS (ACID CITRATE DEXTROSE) ▪Most of 2,3-DPG is lost as early as first week, due to low pH ▪Preserves blood for only 21 days ▪Developed by: Loutit and Mollison in 1943  CPD ANTICOAGULANT PRESERVATIVE SOLUTIONS (CITRATE-PHOSPHATE- DEXTROSE) ▪Superior for preserving Organic Phosphate: Higher pH ▪RBCs become low in 2,3-DPG by the second week ▪Shelf-life: 21 days  CPDA-1 ANTICOAGULANT PRESERVATIVE SOLUTIONS (CITRATE-PHOSPHATE- DEXTROSE-ADENINE) ▪August 1978 FDA approved the addition of adenine in CPD ▪Increase ADP, driving glycolysis to the production of ATP ▪Contain 0.25 M of adenine plus 25% glucose ▪Storage: 1-6 C ▪Shelf-life: 35days  CP2D ANTICOAGULANT PRESERVATIVE SOLUTIONS (CITRATE-PHOSPHATE- double DEXTROSE) ▪100% more glucose than CPD ▪60% more glucose than CPDA-1 ▪Increase glucose to lengthened the storage of blood ▪Same with CPD, 2,3-DPG lost in second week ▪Shelf-life: 21 days Additive solutions ❖These are preserving solutions (aka adenine saline solutions) ❖Added to the RBC after the removal of plasma (removal of the plasma component during the preparation of RBC concentrates removed much of the nutrients needed to maintain RBC’s during storage) ❖Reduce hematocrits from around 70-85% to around 50-60% ❖Developed because of the reason of removing plasma in whole blood ❖Developed by: Beutler in 1970 ❖Implementation of specific solution by: Lovric in 1980’s in Australia and Hogman in Sweden Benefits of additive solutions ❖Benefits of additive solutions: Extends shelf life of RBCs up to 42 days by adding nutrients Allows for the harvesting of more plasma and platelets from the unit Produces an RBC concentrate of lower viscosity that is easier to infuse Additive solutions Additive solutions ADSOL (AS-1) ▪Manufactured by: (Baxter Healthcare) ▪Contain SAGM to retard Hemolysis ▪SAGM: Saline, Adenine, Glucose and Mannitol ▪CPD (Citrate-Phosphate-Dextrose) – used as the primary anticoagulant ▪Shelf-life: 42 days Additive solutions NUTRICEL (AS-3) ▪Manufactured by: (Pall Corporation, manufactured initially by the Cutter Biological and subsequently by Medsep Corporation) ▪Contain SAG in addition to sodium phosphate, sodium citrate and citric acid ▪SAG: Saline, Adenine and Glucose ▪CP2D (Citrate-Phosphate double-Dextrose) – used as the primary anticoagulant ▪Shelf-life: 42 days Additive solutions OPTISOL (AS-5) ▪Manufactured by: (Terumo Corporation) ▪Contain SAGM to retard Hemolysis ▪SAGM: Saline, Adenine, Glucose and Mannitol ▪CPD (Citrate-Phosphate-Dextrose) – used as the primary anticoagulant ▪Shelf-life: 42 days Freezing And Rejuvenation ▪RBC freezing is mainly for autologous units and the storage of rare blood types ▪Autologous transfusion allows individuals to donate blood for their own (autologous) use in meeting their needs for blood transfusion Frozen packed RBC Process of freezing Packed RBC Vigorous shaking Addition of Glycerol Storage: -65 C 2 types of Glycerol Concentration ▪1. Low Glycerol Concentration ▪20% w/v ▪2. High Glycerol Concentration ▪40% w/v ▪Most of Blood banks used high concentration glycerol 2 types of Glycerol Concentration REJUVENATING SOLUTIONS ❖Process by which ATP and 2,3-DPG levels are restored or enhanced by metabolic alterations ❖Initial rejuvenation solution contains: (PIGPA) Phosphate Inosine Glucose Pyruvate Adenine REJUVENATING SOLUTIONS REJUVESOL ▪Manufactured by: enCyte Systems, Inc. ▪Contains the same biochemicals as the original PIPA solution ▪approved for use with CPD, CPDA-1, and CPD/AS-1 RBCs. Process of Rejuvenation RBCs stored in the liquid incubating an RBC unit state can be at 37C for 1 hour. rejuvenated at outdate or up to 3 days after outdate Addition with 50 mL of The RBCs are washed during the post- the rejuvenating freezing deglycerolization solution process to remove nonmetabolized rejuvenation solution materials and deleterious amounts of extracellular potassium. REJUVENATING SOLUTIONS REJUVESOL ❖Disadvantage of Rejuvesol: Expensive and time-consuming; therefore, it is not used often but is invaluable for preserving selected autologous and rare units of blood for later use. END ☺