BYDR. SHIHAB ALMASHHADANI

CONSULTANT HAEMATOLOGIST

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Blood DonationBlood Donation

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Significance of Certain Blood Group Antibodies

Clinical Significance

Blood Group SystemAntibodyRelative Frequency in Antibody ScreeningHTRHDN

ABOAnti-A

Anti-B

All group B and O

All group A and O

Yes

Yes

Yes

Yes

RhesusAnti-D

Anti-c

Anti-E

Anti-C

Anti-e

Common

Common

Common

Common

Common

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

KellAnti-K

Anti-k

Common

Rare

Yes

Yes

Yes

Yes

KiddAnti-Jka

Anti-Jkb

Common

Rare

Yes

Yes

Yes

Yes

DuffyAnti-Fya

Anti-Fya

Common

Rare

Yes

Yes

Yes

Yes

MNAnti-M

Anti-N

Common

Rare

Occasional

Rare

Occasional

Rare

SsUAnti-S

Anti-s

Uncommon

Rare

Yes

Yes

Yes

Yes

LewisAnti-Lea

Anti-Leb

Common

Uncommon

Yes

No

No

No

PAnti-P1UncommonRare No

LiAnti-lUncommon No No

HRT = hemolytic transfusion reaction, HDN = hemolytic disease of the newborn.

Antibody specificities related to the mechanism of immune haemolytic destruction.

Blood group system

Intravascular haemolysis

Extra vascular haemolysis

ABO,HA,B,H

RH All

KellKK, k, Kpa, Kpb, Jsa, Jsb

KiddJkaJka, JKb, Jk3

Duffy Fya, Fyb

MNS M,S,s,U

LutheranLUb

LewisLea

CartwrightYta

ColtonCoa, Cob

DombrockDoa, Dob

Glycosyltransfereases produced by genes encoding

for antigens within the ABO, H, and Lewis blood group system.

GeneAlleleTransferaseFUT1H

H

α-2-L-fucosyltransferase

None

AAα-3-N-acetyl-D-galactosaminyltransferase

BBα-3-D-galactosyltransferase

OONone

FUT2Se

se

α-2-L-fucosyltransferase

None

FUT3Le

le

α-3/4-L-fucosyltransferase

None

ABO blood group system

Blood groupSubgroupAntigens on red cells

Antibodies in plasma

AA1

A2

A + A1

A

Anti-B

(Anti- A1)*

B-BAnti-A, Anti- A1

ABA1B

A2B

A + A1 + B

A + B

None

(Anti- A1)*

O-(H)†Anti-A

Anti- A1

Anti-B

Anti-A,B†

* Anti- A1 found in 1-2% of A2 subjects and 25-30% of A2B subjects.

† The amount of H antigen is influenced by the ABO group; O cells contain most H and A1B cells least. Anit-H may be found in occasional A1 and A1B subject (see text).

† Crossreactivity with both A and B cells.

The “Front Type" determines which antigens ("flags") in the ABO blood group system are on the patient's Red Blood Cells as follows:

A antigen only Type A B antigen only Type B A and B antigens Type AB Neither A or B Type O

The “Back Type" identifies the isohaemagglutinin (Naturally Occurring Antibody) in the patient's serum and should correspond to the antigens found on the Red Blood Cells as follows:

Anti-B Type A Anti-A Type B Anti-A and anti-B Type O Neither anti-A or anti-B Type AB

In addition, RBCs are Rh typed and identified as "D“ positive or

negative

ABO Grouping------------------------------------------ Reactions of

-------------------------------------Cells with Serum

with------------------------------------- Anti-A Anti-B A Cells

B CellsBlood Group (forward grouping) (reverse

grouping)----------------------------------------------- 0 0 0 + + A + 0 0 + B 0 + + 0 AB + + 0 0

The most common Rh phenotypes with possible genotypes and frequencies in an English population (accounting for >99% of all Rh genotypes in this

population)53

Reaction with anti-Phenotype/most probable genotypePossible genotypesFrequency DCcEe

+++-+DCe/dce/R1DCe/dce/R1r

DCe/Dce/R1RO

DCe/dCe/R0r’

32.68

2.16

0.05

++--+DCe/DCe/R1R1DCe/DCe/R1R1

DCe/dCe/R1r’

17.68

0.82

--+-+dce/dce rrdce/dce rr15.10

-++-+Cde/cde r’rCde/cde r’r0.76

--+++cdE/cde r”rcdE/cde r”r0.92

+++++DCe/DcE R1R2DCe/DcE R1R2

DCe/dcE R1 R”

DcE/dCe R2 r’

DCE/cde Rzr

Dce/DCE RoRz

Dce/dCE RoRy

11.87

1.00

0.28

0.19

0.01

<0.01

+-++dCe/DCE R2rDcE/dce R2r

DcE/Dce R2R0

Dce/dcE Ror”

10.97

0.73

0.06

+-+-+Dce/cdeR0r

Dce/Dce R0R0

2.00

0.07

+-++-DcE/DcE R2R2DcE/DcE R2R2

DcE/dcE R2r”

1.99

0.34

The Rh haplotypes in order of frequency (Fisher nomenclature) in caucasians and the corresponding short notations

FisherShort notations Approximate frequency (%)CDeR1 41

Cder 39

cDER214

cD3 RO3

CwDeR1w1

cdEr”1

Cde r’1

CDE Rz Rare

CdERy Rare

ABO group and Rh type Screening for blood-group antibodies Serologic test for syphilis Serologic tests for human retroviruses including:

HIV-1 antibodyHIV-2 antibodyHIV p24 antigenHTLV I antibodies

Serologic tests for hepatitis including: Hepatitis B core antibody (HBcAb) Hepatitis B surface antigen (HBsAg) Hepatitis C antibody

It determines compatibility between patient serum and donor red blood cells.

A full crossmatch procedure takes about 45 minutes to complete and cannot be shortened.

Units are refrigerated until used. A unit of blood MUST be properly labeled and

the label MUST be checked before use.

PREPARATION

Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.

Maslak, P. ASH Image Bank 2005;2005:101277

Figure 1. Packed red cells may contain enough leukocytes and platelets to result in alloimmunization

Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.

Maslak, P. ASH Image Bank 2005;2005:101278

Figure 1. Platelet blood components may be stored for 5 days at room temperature without loss of function or viability

Predeposited: Blood is collected in the weeks prior elective surgery

Haemodilution:Blood is collected immediately before surgery to be reinfused at the end of the operation

Salvage:Heavy blood loss during operation is collected to be reinfused

Choice of ABO group for blood products for administration to neonates and infants

younger than age 4 monthsInfants ABO Group

ABO group of blood product to be transfused

Red cells Platelets FFP*

OOOO

AA or O†AA or AB

BB or O†B† or A or OB or AB

ABAB or A or B or O†

AB† or AAB

FFP, fresh plasma.

* Only babies and infants who are blood group O should receive group O FFP because of anti-A and anti-B antibodies, whereas group AB FFP contains no naturally occurring antibodies. †Group O products must be checked for high-titre anti-A and anti-B before being given to recipients that are not group O. This is particularly important for platelets because of the relatively large volumes of plasma.

•†Group B or AB platelets may not be available.

Immediate Transfusion Reactions• Hemolytic Reactions• Allergic Reactions• Febrile Reactions• Transfusion related acute lung injury (TRALI) • Bacterial Contamination• Circulatory Overload • Citrate toxicity• Air embolism• Alloimmunization:

• RBCs• Platelets

Delayed Transfusion Reactions

• Graft Versus Host Disease (GVHD)• Transfusion-associated graft versus host disease

(TAGVHD)

• Post-transfusion purpura • Haemosiderosis• H.D.N.

Delayed Transfusion Reactions (Cont…)

Transmitted Diseases Hepatitis B Hepatitis C Human Immunodeficiency Virus (HIV) Human T-lymphocytotrophic Virus (HTLV-1) Cytomegalovirus (CMV) Kaposi’s sarcoma and human herpes virus-8 (KS & HHV-8) Malaria Leishmaniasis Others:

Babesiosis.Lyme disease.Chagas' diseaseCreutzfeldt-Jakob Disease (CJD)Toxoplasmosis

Evidence of Haemolysis Examine patient’s plasma and urine for haemoglobin and its derivaties.

Blood film may show spherocytosis Evidence of incompatibility

Clerical checks. An identification error will indicate the type incompatibility.

If no evidence of clerical error, proceed as follows: Repeat ABO and Rh D groups of patient and donor unit and

screen for antibodies. Use patient’s pre-and post-transfusion samples Repeat compatibility tests, using patient’s pre-and post -

transfusion serum Direct antiglobulin test on post-transfusion red cells may

indicate antibody and/or complement Evidence of bacterial infection of donor blood

Gram stain and culture donor blood.