Unit 4 Blood Bank & Immunolgy 1.0.ppt

Blood Bank Transfusion medicine/Immunohematology 5.1.3 1  Objectives 1. Basic definitions 1.1 Define some basic definition 2. Types of transfusion 2.1 List the different types of transfusions 3. Storage...

Blood Bank Transfusion medicine/Immunohematology 5.1.3 1  Objectives 1. Basic definitions 1.1 Define some basic definition 2. Types of transfusion 2.1 List the different types of transfusions 3. Storage 3.1 Describe on how to store different blood products 4. Blood group 4.1 Define blood type 4.2 List the 2 most common blood group 4.3 Describe the ABO group and Rh group 4.4 List other blood groups 2  Objectives 5. Donor 5.1 Define the criteria and type of universal donor 6. Cross match 6.1 Define cross matching 7. Hemolytic Disease of the Fetus and Newborn (HDFN) 7.1 Describe Hemolytic disease of the fetus and newborn (HDFN) 8. Antibody titer 8.1 Describe antibody titer 9. Canadian Blood Service (CBS) requisitions 9.1 List the requirements that must be on CBS requisitions 3  Objectives 10. Specimen rejection 10.1 List the conditions in which a specimen will be rejected 11. Blood Conservation 11.1 List some blood alternatives 4 Definitions Agglutination – agglutination or clumping because of an interaction between antigens and antibodies. Antibody – A natural immune substance that reacts with and destroys specific antigens entering the body Antigen – A substance that promotes the production of antibodies 5 Agglutination 6  Antibody Screen – a test done to screen a patient’s blood for antibodies Blood Bank – The area of the lab that processes products for transfusion. Also referred to as immunohematology. Cross Match – compatibility testing. Testing the blood cells of a donor with the serum from the recipient for observation of clumping 7  Plasma – The liquid portion of the blood. This is used to treat burn victims. Packed Cells ( Red blood cell mass) – Red cells that are separated from whole blood. This is used in the majority of blood transfusions Serology – The study of the reaction of antigens and antibodies. 8  Transfusion Reaction – An abnormal reaction by a patient to a blood transfusion. Reactions may be heat at the site of transfusion, a rash, lower back pain, anxiety, kidney failure, clotting or death. Whole blood – The entire contents of a unit of blood. Autologous transfusion – patients bank their own blood to be transfused. 9 Types of transfusions Whole blood – rarely done Packed Cells – most common Plasma – for burn victims Platelets White blood cells Blood factors – usually factor VIII or IX for coagulation patients 10 Blood donations 11 Storage of blood products Packed cells – stored in the fridge (1-6°C) and good for up to 42 days Plasma – stored in the freezer (- 18°C) and good for up to one year Platelets – stored at RT (20- 24°C)on a rocker , and good for up to 5 days 12 Platelets Donor blood is passed through a filter and then allowed to rest for 1 hour. The bags are radiated in order to kill the WBCs because the WBCs have antigens. The platelets are separated from the RBCs and stored at RT on a rocker. They are kept in constant motion to prevent the platelets from sticking together 13  Blood Types ( Groups ) A blood type (also known as a blood group) is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. 14  ABO Blood Group Group O no antigen A & B antibody Group A A antigen B antibody Group B B antigen A antibody Group AB A & B antigen No antibodies 15 ABO Blood Group 16 Blood antigens & antibodies 17 18  RH Blood Group Determines the presence or absence of D antigen. RH positive – has D antigen (85% of pop) RH negative – absence of D antigen (15% of pop) Subgroup is called RH Du – a weak D antigen. ( most common in black women) Rh testing is very important in pregnant women to prevent RH antibody production. 19 Rh antigen (D) RH positive RH negative 20 % of population Group O + 37.4% Group O - 6.6% Group A + 35.7% Group A - 6.3% Group B + 8.5% Group B - 1.5% Group AB + 3.4% Group AB - 0.6% 21 Other blood groups Kell Duffy Kidd Lewis Lutheran MN Various related RH systems 22  The most NB test done in blood bank is ABO and RH testing. Donor blood is tested to determine the type and RH and compatibility tests are done on the recipient's blood. If no clumping occurs the patient may be given the donated blood Group O is the universal donor 23 Universal Donor Group O - universal donor for red cells Over 45 years, male and female receive group O RH positive Under 45 years, females receive group O RH negative Group AB – universal donor for plasma and platelets 24 Cross matching/ Type and Screen Cross matching is a procedure performed prior to transfusion of blood or blood products to detect any serological incompatibilities in the blood of donor and recipient. Before a donor’s blood is transfused into a recipient, there should be no antigens or antibodies in both, that would react with each other resulting in transfusion reaction. Cross matching is designed to prevent such transfusion reactions which may occur after transfusion. 25 Cross matching/ Type and Screen Commercially prepared red blood cells and antibodies are used to determine specific antigens and antibodies of donor and recipient blood in order to detect incompatibilities. Donor’s RBCs are mixed with recipient's plasma. This is incubated at 37° and then reacted with Coombs serum (an antiglobulin). If no agglutination occurs the donor’s blood is compatible with the recipient’s blood. 26 Cross Match Blood drawn in an appropriate EDTA tube as requested on the requisition. Collected for transfusions, not diagnostic testing 27 Hemolytic Disease of the Fetus and Newborn (HDFN) Hemolytic Disease of the Fetus and Newborn (HDFN) is a set of pathophysiological consequences that occur before and/or after birth resulting from the destruction of fetal red blood cells by maternal antibody that reacts with an antigen or antigens inherited from the father. 28  At one time anti­D was the most common antibody implicated in severe HDFN. However there are other antibodies associated with HDFN anti­K anti­c anti­E 29  ABO HDFN is the most common form of the disease, most frequently associated with anti ­A,B in group O mothers who give birth to group A infants. Although, ABO incompatibility is a common event, the disease is usually mild and often subclinical. 30 HDFN ( Anti D) What Happens In the first pregnancy, Rh positive fetal red cells enter the maternal circulation during the pregnancy and/or at delivery. The mother has a primary immune response in which mainly IgM antibody are produced. Thus the first infant is rarely affected 31 HDFN ( Anti D) What Happens In the second pregnancy, if the fetus is again D ­positive, when fetal cells enter the mother, they cause a secondary immune response in which higher levels of IgG anti ­D are produced. Depending on the antibody titer, the second child may suffer mild to severe HDN. 32 HDFN ( Anti D) What Happens If a third or fourth pregnancy results in positive infants, these infants (by also bleeding into the mother) cause the production of even higher titers of IgG anti­- D and offspring will be more severely affected, perhaps dying in utero or soon after birth. 33 Rhig Rh Immune Globulin All RH neg mothers are given Rhig injections. This is to prevent Hemolytic Disease of the Fetus and Newborn (HDFN) It is given at 28 weeks 34  Antibody Titre An antibody titer is a type of blood test that determines the presence and level (titer) of antibodies in the blood. This test is carried out to investigate if there is an immune reaction triggered by foreign invaders (antigens) in the body. The test is performed to determine if a person was infected by any pathogen in the past. The test is also done to check the degree and extent of an immune reaction against the body’s own cells. Determines the strength of antibodies. 35  Antibody Titre This is done with a series of dilutions The weakest dilution that shows antigen/antibody reaction ( clumping) is considered the antibody titre 36 Antibody Titre 37 Antibody Panel When a donor is found to have an abnormal antibody, further testing is done with various antigens to determine the type of antibody 38 Antibody Panel 39 CBS requisitions must include the following: Patient’s last and first name A PHIN # or other identifier Facility name Patient location Facility medical record # ( if available) Patient/s DOB Treatment order 40 CBS requisitions must include the following: Name of ordering physician Intended date and time of transfusion Diagnosis and reason for transfusion Priority Special handling requirements Transfusion history 41 Complete the req with the following after collection Phlebotomist’s printed name, initials & classification Date & time of collection Facility name where specimen is collected Facility name where blood product is to be sent If errors are made it must be crossed out with a single line & initialed – no white out 42 Confirm ID of patient In hospital the identification must be attached to the patient – no band – no blood. Out patients must confirm ID with their health card. 43 Specimen Labels Must be written in front of the patient Indelible ink must be used for handwritten labels Must include: Patients first and last name PHIN Date and time of collection Initials of phlebotomist & name of facility 44 CBS specimens will be rejected if: Grossly hemolyzed Appears contaminated with IV fluid Grossly contaminated with blood on the outside of the tube Not collected in an EDTA tube Letters or numbers are overwritten making them illegible 45  Error in the collection date Specimen is over labelled Specimen information has been corrected & the correct information does not clearly identify that the specimen was collected from the same patient Specimen label has been altered with white out Specimen is not labelled with indelible ink Specimens should be stored at 1° to 8° 46 Blood Conservation Alternatives to blood transfusion exist and recommended when appropriate Appropriate avoidance of blood transfusions can improve patient outcomes Provides improved management of a precious resource 47 Examples of alternatives Erythropoietin – e.g. Eprex Iron supplements Autologous Blood – patients donate their own blood prior to surgery Intra – operative blood technique – filter and return blood to a patient during surgery 48 Issuing Blood Products Only authorized personal who have been trained in the issuing process shall issue blood, blood components or plasma protein products. Usually, a MLT has this responsibility. However, in rare circumstances a MLA maybe required to fulfill this role due to severe shortages of MLT. ( examples rural or remote areas) 49 Issuing Blood Products Procedure. 1)Blood or blood components can only be issued prior to the patient being transfused. Informed consent is obtained by the physician /authorized practitioner. 2)At the time of issue, there shall be final verification of the patient information and the blood, blood components information. 3)If the information does not agree, blood, or blood components shall not be issued. 4)A record keeping system shall ensure a copy of all information relating to the patient and the transfused blood will become part of the patient record 50 Issuing Blood Products 5) The record keeping system shall have the following; - Facililiate the traceability of the blood, blood component from the source ( the donor or the facility) - Recheck the records applying to blood or blood components - Investigate adverse reaction demonstrated by the patient. 6) Visual inspection shall be performed before issuing all blood or blood components. 51 Immunology /Serology 52  Objectives 1. Serology 1.1 Define serology 1.2 Describe the basic principle in serology testing 2. Serology test 2.1 List some serology tests 53  Serology is involved with testing antigen- antibody reactions. Most testing involves an agglutination reaction. 54 The Principle of Serologic Testing 1.Patient has a disease 2. Produces a specific antibody 3. Test patient’s serum with a known antigen ( reagent) and look for a reaction Pos reaction = the patient has the antibody and therefore has the disease Neg reaction = the patient does not have the antibody and therefore does not have the disease 55 Serology/ Immunology tests Aids Antibody ANA ( antinuclear antibody) – for SLE ASO Titre ( antistreptolysin O) – strep infections. Antistreptolysin O is an antibody produced by Strep A Rubella HIA ( hemagglutination- inhibition antigen) Mono test – for infectious mononucleosis - The mono test determines the presence of antibodies produced by the Epstein Barr virus. 56 More Serology/ immunology tests Rheumatoid factor ( RF) – rheumatoid arthritis RPR – rapid plasma reagin – syphilis VDRL – venereal disease research laboratory – syphilis CRP – C reactive protein- arthritis Allergy tests Complement tests ( examples: C3, C4) Antibody tests ( example IgM, IgG antibodies) 57