blood groups and transfusions. blood loss body is only able to compensate for minor losses –...
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Blood Groups and Transfusions
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Blood Loss
• Body is only able to compensate for minor losses– 15-30% cause weakness– >30% body goes into shock• Can be fatal
• Transfusions used to replace lost blood
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Blood Components• Whole blood– Contains both the RBCs and plasma from the donor
• Packed RBCs– Removal of the plasma from the RBCs
• Plasma (FFP)– Removed and frozen from RBCs
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Blood Components• Donated blood relies on the honesty of the
donor (questionnaire) and lab testing to ensure it is safe to transfuse
• Many hemophiliacs in the early 1980’s were infected with HIV from transfusions
• MOST major diseases can be tested at the donation lab (red cross)
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Human Blood Groups
• Plasma membrane on RBC contains antigens–Protein, genetically determined
–Used by body to identify “self”
–Antibodies recognize “foreign” antigens• Attack cells that are not “self”• Causes cells to agglutinate (clump)
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Human Blood Groups• Blood transfused of wrong “type” can be fatal
(transfusion reaction)
• Type is based on the antigens on the RBC– ~30 antigens on RBC’s
• ABO antigens & Rh cause most severe reactions
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ABO Blood Groups• Based on two antigens, Type A or Type B
• Each person inherits one allele from each parent– Co-dominant – both alleles show
• Type O is absence of BOTH antigens
A type A blood type may be AA or AOA type B blood type may be BB or BO
A type AB person inherited one of each
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Human Blood Groups
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ABO Blood Groups• Most immune responses require “sensitization”– Recognition of “foreign” antigens– Antibodies are produced after sensitization
• ABO blood groups do not work this way!– Antibodies to “foreign” ABO types are produced
during infancy.– Antibodies are made to “non-self” antigens• A type A person makes antibodies to B antigens
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Rh Blood Groups• First identified in Rheus monkeys
• Made up of 8 antigens – Collectively called “D”
• Most Americans are Rh positive– They have ONE or more of the 8 antigens
• The Rh system must be sensitized before antibodies are made
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Rh Blood Groups
• Rh negative form antibodies after exposed to Rh positive blood– Can occur because of transfusion– Can occur during pregnancy of a Rh negative mother with
a Rh positive baby
• Transfusion reactions to Rh do not occur to the first exposure– The second exposure will result in attack on the
RBC’s (hemolysis)
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Rh Blood Groups
• Mothers are tested during pregnancy to determine Rh type
• Rh negative mothers are given RhoGAM after delivery– Prevents FUTURE reactions between Mom and Baby– Untreated results in hemolytic disease of the
newborn• Mom’s antibodies attack baby’s cells
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Blood Typing
• Blood drawn to test ABO and Rh type• Centrifuged to separate into cells and plasma– CELLS have ANTIGENS– PLASMA has ANTIBODIES
• Incorrect blood typing that results in transfusions can be fatal
• Testing is done in a two step process to ensure correct types
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Blood Typing• Forward Typing– Patient’s RBCs are mixed with a known solution
containing anitbodies • Antisera A or Antisera B
– Blood cells will agglutinate if the ANTIGEN is present on the person’s RBCs
– Clumping with Antisera A means that Antigen A is present (type A)• Clumping with Antisera B means Type B• Clumping with BOTH, Type AB
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Blood Typing• Reverse Typing– The patient’s serum/plasma is tested using
KNOWN types of RBCs.– A drop of cells are added to the serum – A person who is type A will have antibodies to type B cells– A Type A person will agglutinate with Type B cells.
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Blood Type Frequencies
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Blood Typing• Rh is tested “forward” style using the patient’s cells• The patient’s cells are mixed with “Anti-D”
antiserum• Clumping with the Anti-D means the patient is Rh
positive.
• Both ABO/Rh testing is done in phases– At room temperature – And at 37°C
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Blood Typing• Blood typing is typically done in a test tube or in
a more recent procedure using a gel apparatus • Forward and reverse typing allows for
discrepancies to be found
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Cross Matching
• More than ABO/Rh matter in transfusions– ~30 antigens on the RBC– ABO/Rh are the MOST severe causes
• Blood from donor is mixed with patient plasma/serum to check for a potential reaction
• If no reaction occurs the unit is compatible and can be transfused
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Cross Matching
• EVERY unit of blood MUST be cross matched
• If there is a reaction in the test tube, further investigation and testing must be done before the patient can be transfused– Involves testing for the MOST common antigens– Like a giant puzzle, you must eliminate each one
• If the lab cannot determine the cause of the reaction, the blood is sent to a blood center