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Blood Typing PowerPoint Presentation

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Description : ABO workup, RBC transfusion

Tags : bloodbank, pathology

Published on : May 18, 2021 | Views : 2356 | Downloads : 9

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Slide 1-

RBC Transfusion Randa Obid, MS4 George Washington University SMHS Class of 2021 Path 321
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Objectives Explain the importance of pretransfusion compatibility testing including ABO and Rh D typing antibody screening and red cell cross-match Explain when it is appropriate to transfuse red blood cells band plasma impatience Identify which blood products (RBC& FFP) individuals are allowed to donate and receive
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The Process of Blood Transfusion Collect & prepare Administer (bedside) Product Patient Process
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Blood Type: Review https://next.amboss.com/us/article/2M0TLg#Ya001dd39ca05d4f779cc7485a7816b93
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DO NOT need to be antigenically identical to recipient's RBCs DO NEED to lack antigens that could provoke significant hemolysis Type O donor ⇨ Type A recipient ✅ BUT Type A donor ≠ Type O recipient ❌ Accomplished via pretransfusion testing Any RBC unit released to the patient must be crossmatched EXCEPTION: EMERGENCY RELEASE BLOOD Transfused RBC Units:
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Pretransfusion testing Involves: Blood typing: ABO and Rh testing of recipient blood Forward Type - identifies ABO antigens present on RBC surface Reverse Type - identifies antibodies to A & B antigens in plasma RBC antibody screening: ABO, D (Rh), Kell (K) Duffy (Fy), Kidd (Jk) Compatibility testing: cross-matching recipient plasma w/ donor RBCs (indirect Coombs test)
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Pretransfusion testing process https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1319340/figure/fb1-12/?report=objectonly
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Forward type Determines presence of A, B, and/or RhD antigens on patient's RBCs Tests the recipients RBC w/ reagent: 1) anti-A₁ 2) anti-B Method: 1 drop recipient red cells + 1 drop anti-A₁ in one tube + 1 drop of anti-B in a 2nd tube Centrifuged briefly Resultant Red Cell button is gently re-suspended & observed for agglutination
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Forward Type: Agglutination Grading https://www.uptodate.com/contents/pretransfusion-testing-for-red-blood-cell-transfusion#H1 Grade of agglutination generally correlated with concentration of anti-RBC antibody Complete resuspension Complete lack of restriction
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Reverse type Tests recipient’s serum w/ reagent red cells ⇨ determines what antibodies present in patient's serum Control group for “forward type” Group A: + anti- B but not anti-A in serum Group B: + anti-A but not anti B Group O: both anti- A & anti-B present Group AB: should not have either anti-A or anti-B Method: 2 drops of recipient serum + 1 drop of reagent A₁ RBC in one tube + 1 drop reagent B RBC in 2nd tube Centrifugation & resuspension ⇨ assess for agglutination
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Interpretation https://professionaleducation.blood.ca/en/pre-transfusion-testing
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ABO Typing: Discrepancies When RBC "forward-type" is inconsistent w/ plasma "reverse- type" MUST be resolved before ABO-group specific blood is issued for transfusion In Emergencies: type O RBCs and type AB plasma should be selected for transfusion
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ABO Forward and Reverse Typing Discrepancies Causes: MCC: Pt who belongs to a subgroup of A and has formed anti-A1 (+++ reactivity on Reverse typing) ~20% of group A and group AB patients are A2 and A2B respectively 2/2 to massive transfusion waning antibody titers in the setting of an underlying medical condition that impairs antibody production ABO-incompatible hematopoietic cell transplant
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Rh Typing: RhD Rh group: >45 antigens; Only test most immunogenic form ⇨ RhD Method: 1 drop of recipient RBCs + 1 drop of anti-D, centrifuged, resuspended RBCs agglutinated by anti-D ⇨ RH + (express D antigen) Can receive RhD (+) or RhD-(-) RBCs NO agglutination ⇨ Rh - Females of childbearing potential are generally restricted to receive only RhD-negative
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Antibody detection tests Used to detect presence of unique/non-ABO blood group antibodies that are present in the recipient’s serum that might react with antigens on transfused RBCs and cause hemolysis. Especially: Kell, Duffy, Kid. If antibody is found => must be identified via Ab identification panel
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ABO-Incompatible reactions Acute hemolytic transfusion reaction (AHTR): typically due to incompatible RBC transfusion Largely results from CLINICAL ERROR (mislabeled specimens, incorrect blood product administration, etc) Occurs in about 1 in 40,000 transfusions Up to 47% of cases of ABO incompatible mistransfusion had no adverse effect Less than 10% of ABO incompatible transfusions cause death
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1319340/
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References Ah-Moye, D., Davies, C., Goody, J., Hayward, P., & Frewin, R. (2014). Introduction to haematology and transfusion science. Metabolic and clinical aspects, 497. Murphy, M. F., Roberts, D. J., & Yazer, M. H. (Eds.). (2017). Practical transfusion medicine. John Wiley & Sons. Petrides, M., Stack, G., Cooling, L., & Maes, L. Y. (2001). Practical guide to transfusion medicine (pp. 136-137). Bethesda, Maryland: AABB press. Roback, J. D., Grossman, B., Harris, T. H. C., & Smith, J. (2011). Technical Manual of the American Assoc of Blood Banks. Tech. Man. Am. Assoc Blood Banks. Mukhtar F, Pelletier JPR. Acute hemolytic transfusion reaction (AHTR). PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/transfusionmedacutehemolytic.html. Accessed May 11th, 2021. Yazer, M. H. (2006). The blood bank “black box” debunked: pretransfusion testing explained. Cmaj, 174(1), 29-32.