1. BY DR. SHIHAB ALMASHHADANI CONSULTANT HAEMATOLOGIST

6. 1 2 34 Blood Donation

7. 56 78

8. 910 1112

18. Significance of Certain Blood Group Antibodies Clinical Significance Blood Group System AntibodyRelative Frequency in Antibody ScreeningHTRHDN ABOAnti-A Anti-B All group B and O All group A and O Yes RhesusAnti-D Anti-c Anti-E Anti-C Anti-e Common Yes KellAnti-K Anti-k Common Rare Yes KiddAnti-Jk a Anti-Jk b Common Rare Yes DuffyAnti-Fy a Common Rare Yes MNAnti-M Anti-N Common Rare Occasional Rare Occasional Rare SsUAnti-S Anti-s Uncommon Rare Yes LewisAnti-Le a Anti-Le b Common Uncommon Yes No PAnti-P1UncommonRareNo LiAnti-lUncommonNo HRT = hemolytic transfusion reaction, HDN = hemolytic disease of the newborn.

19. 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, Kp a, Kp b, Js a, Js b KiddJk a Jk a, JK b, Jk 3 Duffy Fy a, Fy b MNS M,S,s,U LutheranLU b LewisLe a CartwrightYt a ColtonCo a, Co b DombrockDo a, Do b

20. Glycosyltransfereases produced by genes encoding for antigens within the ABO, H, and Lewis blood group system. GeneAlleleTransferase FUT1HHHH 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

25. ABO blood group system Blood groupSubgroupAntigens on red cells Antibodies in plasma AA1A2A1A2 A + A 1 A Anti-B (Anti- A 1 )* B-BAnti-A, Anti- A 1 ABA1BA2BA1BA2B A + A 1 + B A + B None (Anti- A 1 )* O-(H)†Anti-A Anti- A 1 Anti-B Anti-A,B† * Anti- A 1 found in 1-2% of A 2 subjects and 25-30% of A 2 B subjects. † The amount of H antigen is influenced by the ABO group; O cells contain most H and A 1 B cells least. Anit-H may be found in occasional A 1 and A 1 B subject (see text). † Crossreactivity with both A and B cells.

26. 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

28. 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

29. ABO Grouping ------------------------------------------ Reactions of ------------------------------------- Cells with Serum with ------------------------------------- Anti-A Anti-B A Cells B Cells Blood Group (forward grouping) (reverse grouping) ----------------------------------------------- 0 0 0 + + A + 0 0 + B 0 + +0 AB + + 0 0

33. 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 genotype Possible genotypesFrequency DCcEe +++-+DCe/dce/R 1 DCe/dce/R 1 r DCe/Dce/R 1 R O DCe/dCe/R 0 r’ 32.68 2.16 0.05 ++--+DCe/DCe/R 1 R 1 DCe/dCe/R 1 r’ 17.68 0.82 --+-+dce/dce rr 15.10 -++-+Cde/cde r’r 0.76 --+++cdE/cde r”r 0.92 +++++DCe/DcE R 1 R 2 DCe/dcE R 1 R” DcE/dCe R 2 r’ DCE/cde R z r Dce/DCE R o R z Dce/dCE R o R y 11.87 1.00 0.28 0.19 0.01 <0.01 +-++dCe/DCE R 2 rDcE/dce R 2 r DcE/Dce R 2 R 0 Dce/dcE R o r” 10.97 0.73 0.06 +-+-+Dce/cdeR 0 r Dce/Dce R 0 R 0 2.00 0.07 +-++-DcE/DcE R 2 R 2 DcE/dcE R 2 r” 1.99 0.34

34. The Rh haplotypes in order of frequency (Fisher nomenclature) in caucasians and the corresponding short notations FisherShort notationsApproximate frequency (%) CDeR1R1 41 Cder 39 cDER2R2 14 cD3RORO 3 C w DeR 1w 1 cdEr”1 Cder’1 CDERzRz Rare CdERyRy Rare

35.  ABO group and Rh type  Screening for blood-group antibodies  Serologic test for syphilis  Serologic tests for human retroviruses including:  HIV-1 antibody  HIV-2 antibody  HIV p24 antigen  HTLV I antibodies  Serologic tests for hepatitis including:  Hepatitis B core antibody (HBcAb)  Hepatitis B surface antigen (HBsAg)  Hepatitis C antibody

36.  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.

37. PREPARATION

44. 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

47. 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

53.  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

54. Choice of ABO group for blood products for administration to neonates and infants younger than age 4 months Infants ABO Group ABO group of blood product to be transfused Red cellsPlateletsFFP* 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.

56. 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

57. Delayed Transfusion Reactions Graft Versus Host Disease (GVHD) Transfusion-associated graft versus host disease (TAGVHD) Post-transfusion purpura Haemosiderosis H.D.N.

58. 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' disease  Creutzfeldt-Jakob Disease (CJD)  Toxoplasmosis

59.  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.