Week 1: Introduction To Immunohematology PDF

1 introduction to immunohematology immunohematology blood group antigens and antibodies HLA antigens and antibodies pretransfusion testing identification of unexpected alloantibodies immune hemolysis autoantibodies drugs blood collection blood components cryopreservation of blood transfusion-transmi...

1 introduction to immunohematology immunohematology blood group antigens and antibodies HLA antigens and antibodies pretransfusion testing identification of unexpected alloantibodies immune hemolysis autoantibodies drugs blood collection blood components cryopreservation of blood transfusion-transmitted viruses tissue banking and organ transplantation blood transfusion practice safety quality assessment records blood inventory management; and blood usage review bloodbank It is one of the major divisions in hospital laboratory that provides safe blood to patients by performing blood screening, grouping and compatibility testing Early development 1492 Pope Innocent VII Recipient of the first blood transfusion recorded in history Jean Baptiste Denis Practiced animal-to-human transfusion 1829 James Blundell Successfully transfused human blood to women suffering from postpartum hemorrhage Early development Jean Baptiste Denis Practiced animal-to-human transfusion Discovery of Blood Groups 1901 Karl Landsteiner Discovered the ABO blood group and explained the serious reactions that occur in humans as a result of incompatible transfusion 1902 Alfred von Descatello and Adriano Sturlie Discovered blood type AB 1911 von Dungern/Dungren and Hirszfeld Discovered subgroups of A 1940 Karl landsteiner and alex wiener Discovered the Rh blood group Blood transfusion Edward E. Lindemann First to succeed in coming up with appropriate device for performing transfusion; carried out vein-to-vein transfusion of blood by using multiple syringes and a special skin cannula for puncturing the vein through the skin Unger Designed syringe-valve apparatus for practical blood transfusion Blood Preservation and Storage 1869 Braxton Hicks Recommended the use of sodium phosphate as anticoagulant for blood transfusion 1914 Albert Hustin Reported the use of sodium citrate as an anticoagulant solution for blood transfusion 1915 Richard Lewisohn Determined the minimum amount of citrate used for anticoagulation and demonstrated its nontoxicity in small amounts 1915 Richard Weil Found that citrated blood could be refrigerated for several days before use 1916 Rous and Turner Introduced a citrate- dextrose solution for the preservation of blood 1943 Loutit and Mollison Introduced the formula for the preservative acid-citrate-dextrose (ACD) 1957 Gibson Introduced an improved preservative solution, citrate-phosphatedextrose (CPD), which was less acidic and eventually replaced ACD 1978 US FDA Approved the use of adenine for blood preservation Advent of Blood Banks 1921 Percy Oliver Established the first blood donor service 1935 Mayo Clinic First true predecessor of modern blood bank Advent of Blood Banks Bernard Fantus First to coin the phrase "blood bank" for the operation because blood could be stored and saved for future use Federico Duran-Jorda Organized a highly successful mobile blood bank 1941 Charles Drew Appointed as the first director of the American Red Cross His pioneer work during the World War Il is the development of techniques in blood transfusion and blood preservation leading to the establishment of wide system of blood banks Blood Fractionation and Apheresis 1951 Edwin Cohn Developed the first cell separator Fractionation method that yielded albumin, fibrinogen and immunoglobulins 1960s A. Solomon and J.L. Fahey Used centrifugation technology to separate whole blood into plasma and red blood cells to perform the first reported therapeutic plasmapheresis procedure Blood Collection 1952 Carl Walter and William Murphy Described a system in which the blood was collected into a collapsible bag of polyvinyl resin Compatibility Testing 1907 Weil and Ottenberg First attempt of crossmatch procedure; major and minor crossmatch began 1950s Antibody screen began 1976 AABB made the minor crossmatch unnecessary 1980s Abbreviated, or immediate-spin, crossmatch was implemented in the absence of antibodies in the current antibody screen or the patient's past record 1990s Blood banking community proposed elimination of in vitro crossmatch under certain defined circumstances and the adoption of the computer crossmatch Modern Era 1971 Peter Perlmann and Eva Engvall Invented ELISA 1985 Dr. Yves Lapierre Developed Gel Technology 1 BASIC GENETICS Genetics Study of transmission of inherited characteristic Important in the study of antigen inheritance and inherited disorders Normal number of human chromosomes consists of 46 in each nucleated cells (22 autosomal pairs and 1 pair of sex chromosomes) Autosomal genes: genes expressed with equal frequency in males and females, on non-sex chromosome Sex-linked genes: genes carried on the X chromosome Gene locus segment of DNA arranged along the chromosome at a specific position alleles Gene at a specific locus that differs in their nucleotide sequence alternate forms of a gene at a given locus Polymorphic: Having two or more possible alleles at a locus Allelic: Term to describe one of two or more different genes that may occupy a specific locus on a chromosome Antithetical: Opposite form of a gene, different allele; opposite antigens encoded at the same locus Genotype: Total genetic composition of an individual, representing maternally and paternally derived genes Phenotype: Detectable or expressed characteristics of genes Dominant: Onlv one allele must be inherited for it to be expressed: gene product always present Recessive: in Gene that, in the presence of the dominant gene, is not expressed; same allele must be inherited for it to be expressed Codominant: Term used to describe a pair of genes in which neither is dominant over the other; that is they are both expressed Mendelian Genetics: Genes occur in pairs; one gene is passed from parent to offspring Law of Independent Segregation Two members of single gene pair passed from one generation to the next in separate genes Law of Independent Assortment Traits inherited from different chromosomes expressed separately and discretely Inheritance Patterns The inheritance of blood group antigens can be predicted using a Punnett square Punnet squares useful for understanding inheritance of blood groups and ramifications of heterozygosity or homozygosity Homozygous: Individual inherits identical alleles at the same gene locus from both parents Heterozygous: Individual inherits different alleles at the same gene locus from each parent Dosage effect Agglutination reactions are generally stronger for homozygous cells and slightly weaker for heterozygous cells. Presence of homozygous genotype can express itself with more antigen than the heterozygous genotype Which among the following cells.. 1. is/are homozygous for jkB? 2. is/are heterozygous for Fya? 3. show/s dosage for S? 4. shall react the strongest with anti-C? 5. shall react the weakest with anti-N? Cell Jka Jkb C c Fya Fyb M N S s 1 + 0 0 + 0 + 0 + + 0 2 + + + + + + + + + + 3 0 + + 0 + 0 + 0 0 + Position effect Cis: Genes are inherited on the same chromosome Trans: Genes are inherited on separate chromosomes; genes inherited in transposition can weaken the trait's expression Linkage genes: Genes that are close together on a chromosome and inherited as one unit Haplotypes: Set of genes inherited via one of the two parental gametes of Amorphs: Genes that do not produce a detectable trait ISBT System CHROMOSOME # ISBT System CHROMOSOME # 001 ABO 9 012 Xg X 002 MNS 4 013 Scianna 1 003 P or P.Pk 22 014 Dombrock 12 004 Rh 1 005 Lutheran 19 015 Colton 7 006 Kell 7 016 LandsteinerWiener 19 007 Lewis 19 017 Chido/Rodgers 6 008 Duffy 1 018 H 19 009 Kidd 18 019 KX X 010 Diego 17 020 Gerbich 2 011 Cartwright 7 021 Cromer 1 ISBT System CHROMOSOME # ISBT System CHROMOSOME # 022 KNOPS 1 033 Lan 2 023 Indian 11 034 Vel 1 024 OK 19 035 HRF/CD59 11 025 Raph 15 036 Augustine 6 026 John Milton Hagen 15 037 Kanno 20 027 I 6 038 SID 17 028 Globoside 3 039 CTL2 19 029 Gill 9 040 PEL 13 030 RHAG 6 041 MAM 19 031 FORS 9 042 EMM 4 032 jr 4 043 ABCC1 16 RELATIONSHIP (PARENTAGE) TESTING Testing of genetic markers that are inherited to determine the presence or absence of a biological relationship Genetic Systems Used in Parentage Testing RBC antigens: ABO, Rh, MNSs, Kell, Duffy, and Kidd RBC Enzymes and Serum Proteins Immunoglobulin Allotypes Human Leukocyte Antigens (HLA) DNA Polymorphisms Polymerase Chain Reaction (PCR) Restriction Fragment Length Polymorphism (RFLP) Mismatch used when the bands between the child and the alleged father do not match; a minimum of two mismatches is required before an opinion of nonpaternity (or nonmaternity) is rendered interpretation of results: Parentage testing works on the principle of excluding falsely accused individuals using statistics W value (Likelihood of paternity/Probability of paternity) must be at least 95% to suggest paternity Types of Exclusion: 1. direct exclusion occurs when a marker is detected in the child and is absent in the mother and the alleged father or when the alleged father's phenotype demonstrates two markers and the child has neither one of them. 2. indirect exclusion occurs when a single marker is detected in the child and a different single marker is detected in the alleged father.