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    Add as FriendBLOOD GROUPING AND TRANSFUSION THERAPY

    by: jai

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    1 : BLOOD GROUPING AND TRANSFUSION THERAPY Dr.JAISANKAR.P. PG in General Medicine. Madurai Medical College.
    2 : BLOOD GROUPS
    3 : More than 100 blood groups composed of more than 500 antigens. Introduced by Landsteiner in 1900
    4 : ABO SYSTEM First and the most important system. Groups - A, B, AB and O. A and B antigens are found on the RBC membrane either as Glycosphingolipis or as Glycoprotiens. They are also found on other blood cells, all body fluids except CSF and on intestinal epithelium, urothelium & vascular endothelium.
    5 : Genes for A & B - on Chr 9. Co- Dominant inheritance. H substance - the immediate precursor to which A and B antigens are added. H + N Acetyl Galactosamine ? A antigen. H + Galactose ? B antigen Lack of H substance ? Bombay Phenotype (Oh)
    6 : WHY ABO MATCHING ? All individuals produce antibodies against the ABO antigen that they lack. Group A ? Anti B antibodies. Group B ? Anti A antibodies. Group AB ? No Anti A/Anti B antibodies. (universal recipients) Group O ? No antigens. Both antibodies + (universal donors)
    7 : Group Oh (Bombay) ? Anti H antibodies so, compatible only with another Oh. A and B antigens are secreted by the RBCs into the plasma. Non secretors are susceptible to infections with, - Candida albicans, - Neisseria meningitidis, - Pneumococcus, - H. influenza.
    8 : RHESUS SYSTEM 2nd most important. Involves 45 antigens. D, E, e, C, c are common. various combinations DcE, Dce etc resuls in various phenotypes. D antigen present in 85% ? Rh +ve absent in 15 % ? Rh -ve
    9 : D antigen is a potent Alloantigen. Exposure of Rh -ve individuals to even small quantities of Rh +ve cells ? Anti D alloantibody ? severe HTR and HDN. Rh null phenotype occurs when red cells do not express Rh antigens. Anti D antibodies are IgG ? cross placenta ?HDN
    10 : Clinical significance 1. prophylactic Rh immune globulin is to be administered to Rh(D)-negative mothers during pregnancy and at delivery if the infant is Rh(D) positive 2. Rh discordance can lead to severe transfusion reactions.
    11 : LEWIS SYSTEM Carbohydrate antigen. Chr 19. Groups Lea, Leb MCC of incompatibility during pre transfusion screening. IgM antibodies ? do not cross placenta. Lewis antigens are not integral part of RBC membrane. They are synthesized in plasma and adsorbed onto the membrane.
    12 : Clinical significance 1. Transfused red cells always absorb Lewis antigens from the plasma of the transfusion recipient; hence, within several days of the transfusion, the phenotype of the circulating transfused red cells is the same as the patient's red cell phenotype 2. The cell envelop of H. pylori expresses Le x and Le y This finding may be helpful in treating H. pylori infection in future.
    13 : KELL SYSTEM Protein antigens. Chr 7. Principal antigens are K and k. 98% of the population are K-k+
    14 : Clinical significance 1. Kell antigens are the second most immunogenic after Rh. 2. absence of Kell antigens - acanthocytosis - shortened RBC survival McLeod - - muscular dystrophies phenotype.
    15 : DUFFY SYSTEM Protein antigens. Chr 1 six antigens, Fy a, Fy b, Fy3, Fy4, Fy5 and Fy6, Fya and Fyb are Co dominant.
    16 : Clinical significance 1. Both Fya and Fyb serves as receptors for Plasmodium vivax. 2. Antibodies to both are IgG. can cross placenta. Anti Fya has caused HDN.
    17 : I SYSTEM I and i are Oligosaccharide antigens that differ only in branching. Clinical significance some patients with cold agglutinin disease due to IMN, mycoplasma or lymphomas can produce anti I antibodies that can destroy RBCs.
    18 : P SYSTEM Carbohydrate antigens. Chr 22. Single antigen P1. Anti-P1 is usually IgM.
    19 : Clinical significance 1. in some patients suffering from syphilis and viral infections, Paroxysmal Cold Hemoglobinuria occurs due to production of anti P1 antibodies that binds to RBCs in the cold and fixes compliment in warm temperature. Donath Landsteiner Antibodies. 2. P antigens also serves as receptor for - Parvo virus B19 - E coli.
    20 : MNS SYSTEM Protein antigens. Chr 4. Major antigens are M, N, S and s. They are attached to the RBC membrane via Glycophorin A and B. Clinical significance anti S and anti s are IgG antibodies. Can lead to severe HDN similar to RH.
    21 : OTHER MAJOR GROUPS Lutheran Kidd Diego Scianna Dombrock Colton Landsteiner Wiener Chido Rogers Cromer Knops Gerbich Yt Kx Xg
    22 : BLOOD TRANSFUSION
    23 : Donor selection Good health and feeling well. Age 17 - 60 yrs. Weight at least 45 kg. Hb at least 12.5 g/dl. Temp not more than 99.5 oF BP - 110/60 to 160/90 mm Hg. No h/o high risk behaviour eg: IV drug abuse Informed consent.
    24 : Blood donation Draws 450 - 500 ml of blood into a PVC bag containing citrate based anticoagulant. Tests done on collected blood - ABO grouping and Rh typing - Red cell antibody screen - Tests for HIV 1 & 2, HBsAg, anti HBc, Anti HCV, anti HTLV I & II , and VDRL. These tests are performed on pools of 16 to 24 donor specimens.
    25 : Blood Typing Forward typing detects the ABO and Rh groups. Reverse typing detects iso-agglutinins in sera that correlate with the ABO and Rh type.
    26 : Blood Screening Identifies antibodies directed against other antigens. Done by mixing donor’s sera with type ‘O ‘ RBCs which contains the major antigens of most blood groups and is of a known extended phenotype.
    27 : Blood Cross matching Done when there is high probability that the recipient will require multiple PRBC transfusions. Serological cross matching Donor’s RBCs + Recipient’s plasma if Agglutination ? Incompatible Electronic Cross matching
    28 :
    29 : Whole blood Indicated for acute, massive blood loss Contain approximately 450-500 mL donated blood + 70 mL of a citrate-based anticoagulant-preservative solution Stored at 4oC with citrate-phosphate-dextrose-adenine (CPDA-1) solution has a 35-day shelf life and a hematocrit of approximately 35 percent.
    30 : Upon storing, - platelets disintegrate. - coagulation factors disintegrate. - Red cell 2,3 DPG levels come down. - spheroechinocytosis - ? ATP - Lactic acidosis
    31 :
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    33 :
    34 : Glycerolized Red Blood Cells stored frozen at -65°C or lower for up to 10 years Glycerol is removed by washing before transfusion This approach is indicated for prolonged storage of rare red cells for patients with antibodies to red cells with rare red cell antigen phenotypes
    35 : Leukocyte-Reduced Red Blood Cells Indicated for - patients with a history of multiple febrile non hemolytic transfusion reactions, - for patients who are frequent transfusion candidates, - for prevention of cytomegalovirus infection in immuno compromised Adsorption filters enable the removal of 99.9 percent of donor leukocytes Cell washing Centrifugation techniques
    36 : Washed Red Blood Cells They are indicated only for patients who have had severe allergic reactions associated with transfusion or those with immunoglobulin deficiency Washing of red cells may be used to remove excess potassium from older units. prepared by centrifugation with saline to remove almost all plasma and cytokines.
    37 : Irradiated Whole Blood/RBCs To reduce the possibility of transfusion-related graft-versus-host disease. RBCs are exposed to a standard dose of ionizing (gamma) radiation to render viable lymphocytes incapable inducing reaction. In premature newborns and highly immuno- compromised patients
    38 : Mild functional impairment manifested by significant leakage of potassium and accumulation of plasma hemoglobin has been demonstrated subsequent to gamma irradiation Watch for conduction disturbances / arrhythmias Shelf life 28 days
    39 : Attempting to achieve normal BP in the setting of active bleeding through extensive fluid therapy is associated with disruption of haemostatic mechanisms, dilution of clotting factors, increased blood loss and decreased survival. If in emergency ? O - ve blood can be transfused while waiting for the cross matched blood.
    40 : EXCHANGE TRANSFUSION Indications - In neonates when hyperbilirubinemia does not respond to photo therapy - DIC Irradiated fresh red cells ( < I wk old ) are used.
    41 : PLATELET TRANSFUSION
    42 : HARVESTING PLATELETS 450 - 500 ml whole blood @ room temp with in 8 hrs slow centrifugation PRBC PRP fast centrifugation FFP RDP (in 50 - 60 ml plasma)
    43 : One unit Random Donor Platelet contain 5.5 × 1010 platelets Platelets can alternatively harvested from the Buffy coat. Such PC contain fewer WBCs as contaminants.
    44 : Platelet Apheresis  The technique of selectively extracting platelets from the donor and returning the remaining components back to his circulation. Yields Single Donor Platelets (SDP) - equal to six units of RD platelets 3 × 1011 platelets in 300 ml plasma - contains fewer WBCs than RDP. - shelf life of 5 days.
    45 : TRANSFUSION OF PLASMA AND COMMERCIAL PROTEIN CONCENTRATES
    46 : FRESH FROZEN PLASMA Prepared from citrated whole blood by centrifugation and freezing within 8 hrs of collection. stored at -18°C or below for up to 1 year. On storage - minimal loss of activity of the labile coagulation factors V and VIII.
    47 : Indications - in patients who are bleeding or having an invasive procedure and who are deficient in multiple coagulation factors or in a single factor for which there is no specific factor concentrate available. - for reversal of warfarin effect. - for replacement of clotting factors during massive transfusion - for plasmapheresis
    48 : Each unit of FFP ? 200 ml of plasma Must be ABO compatible A dose of 10 to 15 ml/kg would constitute approximately 25 to 30% replacement therapy for coagulation factors. Factor VIII levels ? reduced to 1/3rd in 40 days Factor V levels ? reduced to 1/3rd in 20 days Other factors are relatively stable.
    49 : CRYOPRECIPITATE Is an extract of FFP that is enriched in high-molecular-weight plasma proteins. prepared by thawing 1 unit of FFP at 1° to 6°C. The precipitated HMW protiens ( rich in Fibrinogen, Fa VII, vWF and Fa XIII ) is frozen with 15 ml of plasma.
    50 : Each unit contains 80 - 120 units of Fa VIII and 150 mg of fibrinogen. used in - correction of hypofibrinogenemia in pts with - DIC - prolonged cardio pulmonary bypass. - Hemophilia A. - Fibrin Glue
    51 : ALBUMIN Prepared from pooled plasma by Cold Ethanol (Cohn) Fractionation 95% pure. Heat treated to eliminate the risk of transmission of viral hepatitis and HIV. Available as 4%, 5% and 25%.
    52 : COAGULATION FACTOR CONCENTRATES FACTOR VIII - those derived from plasma can be used to treat both Hemophilia A and vWD. Recombinant Fa VIII concentrates does not contain vWF. PROTHROMBIN COMPLEX CONCENTRATES - contains variable quantities of Vit K dependent clotting factors II, VII, IX, X.
    53 : ANTI THROMBIN III - In anti thrombin-deficient patients with thrombosis or in situations with a high risk of thrombosis.
    54 : INTRAVENOUS IMMUNE GLOBULINS Nonspecific IVIG preparations contain a broad spectrum of antibodies naturally present in the donor population Available as 3 to 12% protein solutions or powders that have to be reconstituted. Slow administration to reduve adverse reactions.
    55 : Indications - prophylaxis of infections in patients with primary immunodeficiencies. - prophylaxis of infection in patients with B-cell CLL. - prevention of infections after BMT
    56 : In treatment of Kawasaki disease ITP Pediatric HIV co infections Guillain - Barre syndrome, Dermatomyositis, Red cell aplasia due to parvovirus B19 infection Adverse effects - renal failure and thrombotic events
    57 : INTRAMUSCULAR IMMUNOGLOBULINS Prepared from pooled plasma by cold ethanol fractionation. Available as 16.5% protein solutions, containing approximately 95% IgG and small amounts of IgA and IgM. Specific IMIg Rh immune globulin, hepatitis B immune globulin, Varicella zoster immune globulin.
    58 : Adverse Effects of Transfusion Immunologic - Alloimmunization - Hemolytic transfusion reactions - Febrile transfusion reactions - Transfusion-related acute lung injury - Allergic transfusion reactions - Post transfusion purpura - Graft-versus-host disease
    59 : Non immunologic - Volume overload - Hypothermia - Hyperkalemia - Pulmonary micro embolization - Transfusion hemosiderosis
    60 : Infectious Hepatitis: B, C Human immunodeficiency virus -1/-2 HTLV -I/-II Cytomegalovirus Epstein-Barr virus Bacterial contamination Syphilis Parasites: malaria, Babesia, trypanosomes
    61 : MANAGEMENT OF TRANSFUSION REACTIONS Discontinue the transfusion immediately A post transfusion blood sample and the discontinued bag of blood should be sent to the blood bank for investigation. Hydration with NS must be begun immediately to prevent renal failure Mannitol or furosemide may be used to maintain urine output of min 100 ml/hr. Anti Histamines and Cortico steroids. Dopamine if hypotension develops. Coagulopathy if develops may require specific management
    62 : REFERENCE
    63 : THANK YOU
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