[PHYSIO]LEC_008_BLOOD_TYPE_TRANSFUSION_AND_TRANSPLANTATION.pdf

(008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 OUTLINE A. O-A-B Blood Types...

(008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 OUTLINE A. O-A-B Blood Types Relative Frequencies of the I. BLOOD TYPING Different Blood Types. A. O-A-B Blood Types The prevalence of the different blood types B. Antigenicity causes immune reactions of among one group of person studies was Blood approximately: C. Agglutinins Origin of Agglutinins in the Plasma Titer of the Agglutinins at Different Ages Agglutination Process in Transfusion Reactions Acute Hemolysis Occurs in some It is obvious from these percentages that the O Transfusion Reactions and A genes occur frequently, whereas the B D. Blood Typing Procedures gene occurs unfrequently. Forward Grouping Reverse Grouping B. Antigenicity Causes Immune Reactions of E. RH Blood Types Blood RH Antigens The blood of different people have different RH Immune Response antigenic and immune properties so that Erythroblastosis Fetalis antibodies in the plasma of one blood type II. TRANSFUSION will react with antigens on the surfaces of the A. Transfusion Reactions Resulting from RBCs of another blood type. Mismatched Blood Types B. Blood Transfusion Two particular types of antigen that are III. TRANSPLANTATION OF TISSUES AND more likely to cause blood transfusion ORGANS reaction than others: A. Transplantation of Cellular Tissues a. A-O-B System B. Attempts to Overcome Immune b. RH. System Reactions in Transplanted Tissue IV. TEST YOURSELF V. REFERENCES I. BLOOD TYPING Before giving a transfusion to a person, it is necessary to determine the blood type of the recipient’s blood and the blood type of the donor blood so that the bloods can be appropriately matched. This process is called Blood Typing and Blood Matching/Crossmatching Figure 1.0 Antigen A and B RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 Figure 2.0 Antigens and Antibodies in Blood Types These “ABO” carbohydrate structures have a common oligosaccharide foundation called the “O” antigen Figure 4.0 Antigens and Antibodies Type “A” adds N-acetylgalactosamine Antigens (isoantigens or Type “B” adds galactose (D-Galactose) agglutinogens) - found on the surface of RBC; Type “AB” both have galactose (D- they are called Agglutinogens Galactose) and N-acetylgalactosamine because they are capable of sugar attached. causing RBC agglutination which causes most blood transfusion reactions. Antibodies (isoantibodies or agglutinins) - found in plasma Figure 3.0 Carbohydrates in antigen structures RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 C. Agglutinins Agglutinins corresponds to the Antigen or Agglutinogen that is NOT present in the RBC (Refer to Table 1) ⚫ Type A- contains Type A agglutinogen and anti-B agglutinins ⚫ Type B- contains Type A agglutinogen and anti-B agglutinins ⚫ Type O- no agglutinogen and but contains both anti-A and anti-B agglutinins ⚫ Type AB- contains both Type A and B agglutinogen but not agglutinins ORIGIN OF AGGLUTININS IN THE PLASMA The agglutinins are gamma globulins (Immunoglobulins), and they are produced by the same bone marrow & Figure 5.0 Different Blood Types lymph gland cells that produce antibodies Blood Genotype Agglutinogens Agglutinins to any other antigens. Type A AO/AA A Anti-B Most of them are IgM and IgG B BO/BB B Anti-A immunoglobulin molecules. AB AB A and B None O OO none Anti-A - ABO Aggutinins are IgM and they and anti- are reactive at room temperature B - Rh Agglutinins are IgG and they react at 37oC and are capable of Table 1. This table shows the different ABO Blood Types crossing the placenta. and their corresponding Agglutinogens and Agglutinins. When only Type A agglutinogen is present at the surface of the RBC, the blood type is Type A. When only Type B agglutinogen is present, the blood type is Type B. When both type A and Type B are present, the blood type is Type AB. When neither A nor B Agglutinogen is present, the blood type is Type O. Figure 6.0 IgM and IgG Molecules RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 TITER OF THE AGGLUTININS AT Because of the way these agglutinogens are DIFFERENT AGES inherited, people may have neither of them on their cells, they may have one, or they may have both simultaneously. Figure 7.0 Average Titers of Anti-A and Anti-B Agglutinins in the plasma of people with different blood types At birth, the quantity of agglutinins in the plasma is almost zero but 2 to 8 months after birth, an infant begins to produce Figure 9.0 Inheritance of Agglutinogens agglutinins. AGGLUTINATION PROCESS IN Type A and B antigens enter the body in TRANSFUSION REACTIONS food, in bacteria, and in other ways, and these substances initiate the When bloods are mismatched so that anti- development of the anti-A and anti-B A or anti-B plasma agglutinins are mixed agglutinins with RBCs that contain A or B agglutinogens, respectively, the RBCs A maximum titer is usually reached at 8 agglutinate as a result of the agglutinins to 10 years of age. This titer gradually attaching themselves to the RBCs. declines throughout the remaining years of life. Figure 8.0 Blood Types with their Genotypes Figure 10.0 Transfusion Reactions RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 Serum is plasma after coagulation factors This binding causes the cells to clump, which have been removed; liquid portion of is the process of “agglutination.” clotted blood Then these clumps plug small blood vessels throughout the circulatory system. ACUTE HEMOLYSIS OCCURS IN SOME TRANSFUSION REACTIONS Sometimes, when recipient and donor bloods are mismatched, immediate hemolysis of RBCs occurs in the circulating blood. Figure 12.0 RBC, WBC and Plasma To determine the ABO “group” or “type” of an individual requires characterizing both the Figure 11.0 Lysis in RBC A and B antigen expression of the patient’s red blood cells (“FORWARD TYPING”) and In this case, the antibodies cause lysis of the the presence of anti-A and anti-B antibodies RBCs by activating the complement system, in their plasma (“REVERSE TYPING”). which releases proteolytic enzymes (the lytic complex) that rupture the cell membranes. Forward typing is performed with monoclonal typing sera, whereas reverse typing is performed with commercial D. Blood Typing Procedures preparations of type A and B erythrocytes. BLOOD TYPING Procedures: process of Forward grouping/ Cell grouping/Direct identifying a person’s specific blood type by Typing serologic testing of blood samples Red blood cells are tested for A and B Terminologies antigens using known commercially prepared anti-A & anti-B sera. Blood: made up of RBC, WBC & platelets in a liquid called plasma. Plasma is the liquid component of blood after all of the cells and platelets are removed, liquid portion of unclotted blood RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 Figure 13.0 Test for Antigen A and B Figure 15. Blood Typing Sera for Forward Typing. Anti-A (Blue), Anti-B (Yellow) Reverse grouping/Serum grouping/Indirect Typing Serum is tested for anti-A & anti-B antibodies using known A & B red cells. NOT ideal for newborns because antibodies are still NOT developed Figure 14.0 Results of the Test for Antigens. If there is agglutination in both anti-A and anti-B, the blood type is AB. If there is only agglutination in anti-B, the blood type is Type B. If there is only agglutination in anti-A, the blood type is A. If there is NO agglutination for both anti-A and anti-B, the blood type is O. RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 Figure 16. Test for Antibodies A and B Figure 19.0 Reverse (Serum Grouping) Figure 17. Results of the Test for Antibodies Landsteiner’s Law a. If an agglutination is present on RBC membrane, the corresponding agglutin must be absent in the plasma b. If an agglutinogen is absent on the RBC membrane, then the corresponding agglutinin must be present in the plasma Figure 18. Forward (Cell Grouping) RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 ANTIGENS - It refers only to presence or absence of antigen D on the RBC surfaces, that termed “D-positive” and “D-negative” ANTIBODY - Produced through exposure to D Antigen by transfusion or pregnancy Figure 22. RH Blood Group System Figure 20. Karl Landsteiner discovered the ABO and Rh Rh Antigens - “Rh-Positive” & “Rh- Blood Groups and is the first one to perform Forward and Negative” People Reverse Typing 6 common types of Rh antigens (Rh factor.) Designations: C, D, E, c, d, e. Type D antigen - widely prevalent in the population and considerably more antigenic than the other Rh antigens. - Anyone who has this type of antigen is said to be Rh positive, whereas a person who does not have type D antigen is said to be Figure 21. Landsteiner’s Law Rh negative. E. RH Blood Types - 85 % of all white people are Rh positive and 15 %, Rh negative. - 2nd most important blood group next to - In American blacks, the percentage of Rh- ABO positives is about 95 %, whereas in African - primary cause of Hemolytic Disease of the blacks, it is virtually 100% Fetus and Newborn (HDFN) - Major difference between Rh and O-A-B Characteristics of Rh Transfusion system: Reactions: ⚫ O-A-B system- the transfusion reactions develop spontaneously, ⚫ If an Rh-negative person has never before ⚫ Rh system- the person must first be been exposed to Rh-positive blood, massively exposed to an Rh antigen, transfusion of Rh-positive blood into that before enough agglutinins to cause a person will likely cause no immediate significant transfusion reaction will reaction. develop. ⚫ However, anti-Rh antibodies can develop in sufficient quantities during the next 2 to 4 weeks to cause agglutination of the transfused cells that are still circulating in the blood. RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 ⚫ These cells are then hemolyzed by the When the mother is Rh negative and the tissue macrophage system. Thus, a father is Rh positive, the fetus can inherit delayed transfusion reaction occurs, the Rh factor of the father. This makes the although it is usually mild. fetus Rh positive too. ⚫ Upon subsequent transfusion of Rh- Problem can arise when the fetus blood positive blood into the same person, has the Rh factor (Rh positive) and the who is now already immunized against mother’s blood does not. the Rh factor, the transfusion reaction is A mother who is Rh negative may develop greatly enhanced and can be immediate antibodies to an Rh positive baby, when a and as severe as a transfusion reaction small amount of baby’s blood mixes with the caused by mismatched type A or B mother’s blood at birth blood. In response to fetal Rh antigens, the mother will produce anti RH antibodies RH IMMUNE RESPONSE The mother’s anti Rh antibodies may cross Formation of Anti-Rh Agglutinins. the placenta and attacks and damages fetal RBCs in the next pregnancy. When RBCs containing Rh factor are Such an attacks breaks down the fetus RBC’s injected into a person whose blood does creating hemolytic anemia and it can become not contain the Rh factor - that is, into an severe enough to cause serious illness, brain Rh-negative person ---- anti-Rh damage and even death in the fetus/newborn agglutinins develop slowly, reaching maximum concentration of agglutinins about 2 to 4 months later. Effect of the Mother’s Antibodies on the Fetus. This immune response occurs to a much greater extent in some people than in - After anti-Rh antibodies have formed in the others. With multiple exposures to the Rh mother, they diffuse slowly through the factor, an Rh-negative person eventually placental membrane into the fetus’s blood. becomes strongly “sensitized” to Rh factor. - There they cause agglutination of the fetus’s blood. The agglutinated RBCs subsequently hemolyze, releasing hemoglobin into the blood. - The fetus’s macrophages then convert the hemoglobin into bilirubin, which causes the baby’s skin to become yellow (jaundiced). - The antibodies can also attack and damage other cells of the body. Figure 23. Formation of Anti-RH Agglutinins RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 cause of death, many children who barely o Erythroblastosis Fetalis survive the anemia exhibit permanent (“Hemolytic Disease of the Newborn”) mental impairment or damage to motor areas of the brain because of deposition - is a disease of the fetus and newborn and precipitation of bilirubin and then child characterized by agglutination and destruction of the brain’s neuronal cells, phagocytosis of the fetus’s RBCs. “Kernicterus” An Rh-negative mother having her first Rh-positive child usually does not Treatment of Neonates with develop sufficient anti-Rh agglutinins to Erythroblastosis Fetalis cause any harm. However, about 3% of second Rh- One treatment is to replace the neonate’s positive babies exhibit some signs of blood with Rh-negative blood. About 400 erythroblastosis fetalis; about 10% of third milliliters of Rh-negative blood are infused babies exhibit the disease; and the over a period of 1.5 or more hours while the incidence rises progressively with neonate’s own Rh-positive blood is being subsequent pregnancies. removed. Clinical Picture of Erythroblastosis This procedure may be repeated several times during the first few weeks of life, mainly The jaundiced, erythroblastotic newborn to keep the bilirubin level low and thereby baby is usually anemic at birth, and the prevent kernicterus. anti-Rh agglutinins from the mother usually circulate in the infant’s blood for another 1 to 2 months after birth, By the time these transfused Rh-negative destroying more and more RBCs. cells are replaced with the infant’s own Rh- positive cells, a process that requires 6 or The hematopoietic tissues of the infant more weeks, the anti-Rh agglutinins that had attempt to replace the hemolyzed RBCs. come from the mother will have been The liver and spleen become greatly destroyed. enlarged (hepatosplenomegaly) and produce RBCs in the same manner that they normally do during the middle of Prevention of Erythroblastosis Fetalis gestation. The D antigen of the Rh blood group system Because of the rapid production of RBCs, is the primary culprit in causing immunization many early forms of RBCs, including of an Rh (-) mother to an Rh (+) fetus. many nucleated blastic forms,are passed from the baby’s bone marrow into the In the 1970s, a dramatic reduction in the circulatory system, it is called incidence of E.F. was achieved with the dev'l “Erythroblastosis” due to the presence of of Rh immunoglobulin globin, an anti-D these nucleated blastic RBCs antibody that is administered to the expectant (Erythroblasts) mother starting at 28 to 30 weeks of gestation. Although the severe anemia of The anti-D antibody (Rhogam) is administered erythroblastosis fetalis is usually the to Rh (-) women who deliver Rh (+) babies to RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 prevent sensitization of the mothers to the D such as by transfusion of blood antigen. This step greatly reduces the risk of containing the Rh antigen, before developing large amounts of D antibodies enough agglutinins to cause a during the second pregnancy. significant transfusion reaction will develop. The mechanism by which Rh immunoglobulin globin prevents II. TRANSFUSION sensitization of the D antigen is not completely understood, but one effect of A. Transfusion Reactions Resulting from the anti-D antibody is to inhibit antigen- Mismatched Blood Types induced B lymphocyte antibody production in the expectant mother. If donor blood of one blood type is transfused into a recipient who has another blood type, a transfusion reaction is likely to occur in which The administered anti-D antibody also the RBCs of the donor blood are agglutinated. attaches to D-antigen sites on Rh positive fetal RBCs that may cross the placenta and enter the circulation of the expectant mother, thereby interfering with the immune response to the D antigen Figure 24. RhoGAM prevents RH-negative The major difference between the O-A-B system and the Rh system is the following: Figure 25. Transfusion Reaction In the O-A-B system, the plasma agglutinins responsible for causing All transfusion reactions eventually cause transfusion reactions develop either immediate hemolysis resulting from spontaneously; whereas, hemolysins or later hemolysis resulting from phagocytosis of agglutinated cells. In the Rh system, spontaneous agglutinins almost never occur. The hemoglobin released from the RBCs is Instead, the person must first be then converted by the phagocytes into massively exposed to an Rh antigen, bilirubin and later excreted in the bile by the RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 liver. The concentration of bilirubin in the body fluids often rises high enough to cause jaundice. However, if liver function is normal, the bile pigment will be excreted into the intestines by way of the liver bile, so jaundice usually does not appear (unless more than 400 ml of blood are hemolyzed in less than a day) B. Blood Transfusion To avoid transfusion reactions, it is best to transfuse only matching blood types; that is, a type B+ recipient should ideally receive blood only from a type B+ donor and so on.... In emergency situations, when acute hemorrhage threatens the patient’s life, there may not be time for cross matching to identify blood type. In these cases, blood from a universal donor - an individual with type O− blood may be transfused. Blood from a universal donor, an individual with type O− blood may be transfused in emergency situations: TYPE O do not display A or B antigens. Thus, anti-A or anti-B antibodies that might be circulating in the patient’s blood plasma will not encounter any Figure 26. Blood Type O as Universal Donor and Blood erythrocyte surface antigens on the Type AB+ as Universal Recepient donated blood and therefore will not be provoked into a response Group A can receive blood from type A and type O Blood type AB+ is known as the Group B can receive blood from type B and type O Group AB can receive blood from type A and type B universal recipient. This patient can and type AB and type O theoretically receive any type of blood, Group O can receive blood from type O because the patient’s own blood— having both A and B antigens on the erythrocyte surface—does not produce anti-A or anti-B antibodies. RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 Group A can donate blood to blood type A and type AB substances from the hemolyzing blood that Group B can donate blood to blood type B and type AB Group AB can donate blood to blood type AB cause powerful renal vasoconstriction. Group O can donate blood to blood type A and type Band type AB and type O 2. loss of circulating RBCs in the recipient, along with production of toxic substances from the hemolyzed cells and from the Rh negative can donate and receive blood only from Rh immune reaction, often cause circulatory (-) shock. The arterial blood pressure falls very Rh positive can donate and receive blood only from Rh (+) low, and renal blood flow and urine output decrease. 3. If the total amount of free hemoglobin released into the circulating blood is greater than the quantity that can bind with “haptoglobin” (a plasma protein that binds small amounts of hemoglobin), much of the excess leaks through the glomerular membranes into the kidney tubules. If this amount is still slight, it can be reabsorbed through the tubular epithelium into the blood and will cause no harm; if it is great, then only a small percentage is reabsorbed. Yet water continues to be reabsorbed, causing the tubular hemoglobin concentration to rise so high that the hemoglobin precipitates and blocks many of the kidney tubules. Thus, renal vasoconstriction, circulatory shock, and renal tubular blockage together cause acute renal shutdown. If the shutdown is complete and fails to resolve, the patient dies within a Figure 27.0 Guide for Blood Transfusion week to 12 days, unless he or she is treated with an artificial kidney. ACUTE KIDNEY FAILURE AFTER TRANSFUSION REACTION III. TRANSPLANTATION OF TISSUES AND ORGANS One of the most lethal effects of transfusion reactions is kidney failure, which can begin A transplant of a tissue or whole organ within a few minutes to a few hours and from one part of the same animal to continue until the person dies of acute renal another part is called an autograft failure. From one identical twin to another, an isograft CAUSES: From one human being to another or from any animal to another animal of 1. the antigen-antibody reaction of the the same species, an allograft transfusion reaction releases toxic RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 From a non-human animal to a human Development of significant immunity against being or from an animal of one species any of these antigens can cause graft to one of another species, a xenograft rejection The HLA antigens occur on the white blood A. Transplantation of Cellular Tissues cells & other tissue cells. Therefore, tissue typing for these antigens is done on the In the case of autografts and isografts, cells membranes of lymphocytes that have been in the transplant contain virtually the same separated from the person’s blood. types of antigens as in the tissues of the The lymphocytes are mixed with appropriate recipient and will almost always continue to antisera and complement; after incubation, live normally and indefinitely if an adequate the cells are tested for membrane damage, blood supply is provided. usually by testing the rate of transmembrane uptake by the lymphocytic cells of a special At the other extreme, immune reactions dye. almost always occur in xenografts, causing death of the cells in the graft within The best success has been with tissue-type 1 day to 5 weeks after transplantation unless matches between siblings and between some specific therapy is used to prevent the parent and child. The match in identical immune reactions. twins is exact, so transplants between identical twins are almost never rejected With proper “matching”: because of immune reactions. a. Kidney allografts- successful for at least 5-15 yrs b. Liver and heart allograft- successful Prevention of Graft Rejection by for 1-5 yrs Suppressing the Immune System If the immune system were completely B. Attempts to Overcome Immune Reactions suppressed, graft rejection would not occur. in Transplanted Tissue In a person who has serious depression of Tissue Typing—The Human Leukocyte the immune system, grafts can be Antigen Complex of Antigens successful without the use of significant therapy to prevent rejection. Human leukocyte antigen (HLA) antigens- the most important antigen complex for However, in the normal person, even with causing graft rejection. It is found in all the best possible tissue typing, allografts nucleated cells; located at short arm of seldom resist rejection for more than a few Chromosome 6. days or weeks without use of specific therapy to suppress the immune system. Six of these antigens are present on the tissue cell membranes of each person, but Furthermore, because the T cells are mainly there are about 150 different HLA antigens the portion of the immune system important to choose from, representing more than a for killing grafted cells, their suppression is trillion possible combinations. much more important than suppression of plasma antibodies. RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 b. Type B c. Type AB d. Type O Some of the therapeutic agents that have 4. What are the possible ABO phenotypes of been used for this purpose include the the offspring from the mating of a group A to following: a group B individual? a. O, A, B 1. Glucocorticoid hormones from adrenal b. A, B cortex glands which inhibit genes that code c. A, B, AB for several cytokines, especially interleukin-2 d. O, A, B, AB (IL-2). IL-2 is an essential factor that induces Tcell proliferation and antibody formation. 5. The immunodominant sugar 2. Drugs that have a toxic effect on the (carbohydrate) responsible for blood group A lymphoid system and, therefore, block specificity is? formation of antibodies and T cells, ex. Drug, a. L-fucose Azathioprine b. N-acetyl-D-galactosamine 3. Cyclosporine and tacrolimus, which c. D-galactose inhibit formation of T-helper cells and are d. Uridine diphosphate-N-acetyl-D- especially efficacious in blocking the T-cell galactose rejection reaction. 4. Immunosuppressive antibody therapy, 6. Rh antibodies are primarily of which anti-lymphocyte or IL-2 receptor antibodies. immunoglobulin? a. IgA b. IgM IV. TEST YOURSELF c. IgG 1.Transfusion reactions occurs mainly due to d. IgD ABO incompatibility. Erythroblastosis fetalis mainly occurs during the 1st pregnancy. 7. Rh antibodies reacts best at what a. Only the 1st statement is true temperature (oC)? b. Only the 2nd statement is true a. 34oC c. Both are true b. 37oC d. Both are false c. 30 oC d. 24oC 2. A B+ patient was rushed in the hospital with a life threatening hemorrhage. There is 8. A patient has the following ABO typing no available B+ blood from the Blood Bank. results: What will you do? Anti-A Anti-B A1 cells B Cells a. Transfuse with O+ blood 4+ 4+ 0 0 b. Transfuse with O- blood (Agglutination) (Agglutination) (No (No c. Transfuse with B- blood Agg.) Agg.) d. Transfuse with A+ blood This patient’s blood type is a. O 3. During Forward Typing, the blood does b. A not agglutinate with both anti-A or anti-B. c. AB What is the blood type of the patient? d. Not able to be determined with the a. Type A information given RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (008) BLOOD TYPES, BLOOD TRANSFUSION, TISSUE AND ORGAN TRANSPLANTATION DR. MA. EILEEN OPENA PASCUA | 11/05/2020 9. The emergency room requests six units of packed RBCS for a trauma patient prior to collection of the patient’s specimen. The most appropriate course of action is: a. Release group O RBCS to ER b. Refuse release of blood units until you get a patient sample c. Indicate necessity for signed physician waiver for incomplete pre- transfusion testing d. Release group AB RBCs to ER e. A and C 10. Rh antibodies have been associated with which of the following clinical condition? a. Erythroblastosis fetalis b. Thrombocytopenia c. Hemophilia A d. Acute Lymphocytic Leukemia Answers: 1.A 2.B. 3. D.4.D 5.B 6.C 7.B 8.C 9.E 10.A V. REFERENCES Hall, J. E. 1. (2016). Guyton and Hall textbook of medical physiology (13th edition.). Philadelphia, PA: Elsevier Harmening, D. (2012). Modern Blood Banking & Transfusion Practices (Sixth Edition). RED – PDF/BOOK; BLUE – AUDIO; BLACK - PPT PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L