Escolar Documentos
Profissional Documentos
Cultura Documentos
Pre-Transfusion Tests
Genetic Control of the ABO Blood Group Antigens
GENES PRESENT
TRANSFERASE PRODUCED
HH or Hh
Fucosyltransferase
HH or Hh and A
Fucosyltransferase, Nacetylgalactosaminyltransferase
HH or Hh and B
Fucosyltransferase, D-galactosyltransferase
HH or Hh and A plus B
Fucosyltransferase, Nacetylgalactosaminyltransferase
D-galactosyltransferase
hh, or hh and any other
None, or N-acetylgalactosaminyltransferase and/or
gene (A and/or B)
D-galactosyltransferase
TERMINAL SUGAR
RBC PHENOTYPE
Fucose
O
Fucose, N-acetylgalactosamine A
Fucose, galactose
Fucose, Nacetylgalactosamine, Dgalactose
None
ABO Group
A
B
AB
Subgroups A or B
B
AB
Bombay
Exclusion of paternity
Criminal investigations
ABO GROUP
A
B
AB
O
Recipients ABO
Blood Group
A
B
AB
O
Acceptable ABO
Blood Group of
Donor Plasma
A, AB
B, AB
AB
O, A, B, AB
Antibody Screen
Compatible
for
Transfusion
Antibody Crossmatch
Screen
+
Antibody screen
with antigen on
screening cells
but not on donor
cells
Antibody reacts
with a low
incidence antigen
Donor cells have a
positive DAT
Technical error repeat
Antibody reacts
with an antigen
on donor cells
and screening
cells
Possibly
(phenotyped
donor to
confirm
compatibiltiy)
Blood Components
Blood: 6% -8% of body weight
Plasma
Components
Relative
Function
Amounts
Plasma Portion (50%-60% of total volume):
1. Water
91% - 92%
Solvent
of plasma
volume
2. Plasma proteins
7% - 8%
Defense, clotting,
(albumin, globulins,
lipid transport, roles
fibrinogen, etc.)
in ECF volume, etc.
3. Ions, sugars, lipids,
1% - 2%
Roles in ECF
amino acids,
volume, pH, etc.
hormones, vitamins,
dissolved gases
Cellular Portion (40% - 50% of total volume):
1. Red blood cells
4,800,000 Oxygen, carbon
5,400,000
dioxide transport
per milliliter
2. White blood cells:
Phagocytosis
3,000 Neutrophils
6,750
Immunity
1,000 Lymphocytes
2,700
Phagocytosis
150 - 720
Monocytes
(macrophages)
Roles in
100 - 360
Eosinophils
inflammatory
response, immunity
25 - 90
Basophils
Roles in
inflammatory
response, immunity
3. Platelets
250,000 Roles in clotting
300,000
Principle 1:
The cause of the deficiency should be identified.
Coombs/Antiglobulin Test
Principle 2:
Only the deficient component should be replaced.
DAT Use
Diagnosis of:
Transfusion reactions
IAT Use
Antibody screening
Phenotyping
Cross-matching
Blood Components
Oxygen Carrying Components
Leukocyte-poor blood
Cryoprecipitate
Stored plasma
rainwater@mymelody.com || 1st semester, AY 2011-2012
Principle 3:
The blood product should be as safe as possible.
Blood Constituent
Red cells
White cells
Platelets
Plasma proteins
Other
Volume: 500 mL
Quality Control:
1. Donor Hemoglobin 12.5 g/dL
2. Volume = 450 mL + 10%
Clinical Indications:
WB 1. Active bleeding with at least one of the following:
a. Loss of over 15% blood volume
b. Hgb less than 9 g/dL
c. Blood pressure decrease over 20 mm Hg
and/or less than 90 mm Hg systolic
WB 2. Pre-operative patients with expected blood loss
of more than 25% blood volume
Volume: 250 mL
Shelf life:
1. CPDA 1 (close system) = 35 days
2. CPDA 1 (open system) = 24 hours
Quality Control:
1. Volume of red cells (4 per month) > 170 mL
2. Hct (4 per month)< 70%(mean); never > 80%
Clinical Indications:
R1
Hgb less than 8 gm/dL or Hct less than 24% (if not due
to treatable cause)
R2
Pre-operative patients with:
a. Hgb less than 8 g/dL or Hct less than 24%
b. Major bloodletting operation and Hgb less
than 10/dL or Hct less than 30%
c. Signs of inadequate oxygen-carrying
capacity (symptomatic anemia)
R3
Symptomatic anemia regardless of Hgb level
(dyspnea, syncope, postural hypotension,
tachycardia, chest pains, TIA)
R4
Hgb less than 10 g/dL or Hct less than 30% in patients
with COPD, CAD, hemoglobinopathy, sepsis, aortic
stenosis and cerebral infarct
R5
Blood loss of less than 10% blood volume
Volume: 180 mL
Prepared by filtration
Volume: 225 ml
6
Shelf life:
1. CPDA-1 (close system) = 35 days
2. CPDA-1 (open system) = 24 hours
Quality Control:
1. Red cell recovery (4/month) depends upon
2. Leukocyte count (4/month) procedure in
the specific lab.
Clinical Indications: Same as PRBCs
Volume: 50 mL
Shelf life:
1. CPDA- 1 (close system) = 5 days
2. CPDA-1 (open system) = 24 hours
Quality Control:
1. pH (4 per month) = never < 6.0
2. Platelet count (4 per month) = 5.5 X 1010
(75% or more)
3. Plasma volume (4 per month) = 45 65 mL
Clinical Indications:
P-1
Prophylactic administration with count 20,000 and
not due to TTP, ITP, HUS
P-2
Active bleeding with count 50,000
P-3
Platelet count 50,000 and patient to undergo
invasive procedure within 8 hours
P-4
Platelet count 100,000 if surgery in on critical area
(e.g. eye, brain, etc.)
P-5
Massive transfusion with diffuse microvascular
bleeding and no time to obtain platelet count
Leuko-Reduced Platelets (LRPs) Prepared by Filtration
10
Volume: 50 ml
6
Shelf life:
1. CPDA-1 (close system) = 5 days
2. CPDA-1 (open system) = 24 hours
Quality Control:
1. Platelet recovery (4/month) depends upon
2. Leukocyte count (4/month) procedure in
the specific lab.
Clinical Indications: Same as PC
Cytapheresis
* 8 manual donors or one automated donor
Pheresed Platelets
Composition:
11
Platelets (>3 X 10 /unit); RBCs; WBCs; plasma
Volume: 300 ml
Quality Control:
1. pH (4/month) = not < 6.0
2. Platelet count (4/month) = 3 X 1011 (mean)
Clinical Indications: Same as PC
Volume: 200-250 ml
Uses:
1. Provide all coagulation factors in deficiency
states
2. Plasma expander
Cryoprecipitate (CP)
Volume: 15-20 ml
Uses:
1. Provide fibrinogen, Factors VIII and XIII and
Willebrand Factor in deficiency states, e.g.
Hemophilia A, Willebrands Disease
2. Topical Fibrin glue
Recommendations
RBC Products
A representative post-transfusion
Hemoglobin and Hematocrit determination
could be made at least after 24 hours
Platelet Concentrate