Safe, Effective Transfusion

 1901Landsteiner discovers ABO  1907Ludvig Heldon suggests crossmatching  Rh blood group system discovered  1941 Red Cross begins National Donor Drives  1947 ABO and Syphillis testing on each unit  1957 AABB forms its committee on Inspection and accreditation  1961Platelet concentrates recognized in reducing mortality in hemorrhage

 1970US Blood banks move to all volunteer donors  1971Hepatitis B testing of donated blood begins  1983Additives extend shelf live to 42 days  1985HIV testing begins for all donated blood  2002Hepatitis C virus testing begins

 The in vitro testing of the recipient's plasma and the donor cells  This is known as the ‘Major ‘Crossmatch  We used to do the ‘minor ‘crossmatch until 1960  Development of Enhancement media like albumin and AHG, plus knowledge of the blood group systems established the procedures, temps and incubation times

 Correct Patient identification  Correct Sample drawn  Established time the recipient must be drawn before transfusion AABB established 3 days if they have had previous transfusions or pregnancy in the proceeding 3 months or if history is uncertain If no transfusion or pregnancy than we can draw up to 10 days before transfusion All samples are kept for up to 7 days after transfusion

 History, History, History, this is an actual requirement of AABB  Type checks are required of all blood bank units  Pre-Transfusion testing ABO, Rh, Reverse type Antibody screen including an auto control Crossmatch, can be immediate spin or electronic  Labeling the unit, issuing the unit, nurse identification and checking of all the information on the floor before transfusion begins

Antibody Screen Clinical Significant Antibodies Current or Historical sample AHG Crossmatch required No Clinical Antibodies Detected IS or Electronic Crossmatch acceptable

 Nurse must present with the order for transfusion  Both will look for : Name, DOB, Medical record number ABO, Rh type Recipient Blood Bank Armband number Donor Number Donor ABO, Rh Type, Any additional typing if needed or specific labeling as in ‘leukocyte poor’ Expiration date Visual inspection

 Antibody attaches to a specific antigen on the surface of the red cell  Complement is activated  Additional components are activated, including cytokines  Organ failure (e.g. renal) and shock occur  IgM binds compliment and can cause the worst damage, (i.e. ABO)  IgG antibodies affect the activation of phagocytosis  The titer of the antibody plays a role in the amount of antibody/antigen reaction

 TRALI or Transfusion-Related Acute Lung Injury caused by leukocyte-reactive antibodies. FFP and Platelet concentrates are more apt to be involved in this reaction  GVHD rare but serious/ It occurs when donor lymphocytes are transfused to a severely immunocompromised individual  PTP antibody to a platelet antigen is the cause of this reaction  TACO Transfusion-associated Circulatory overload, cardiac and pulmonary compromised individuals more prone to this.

 Re-identification of recipient and the unit, if discrepancy is found, document and report to physician  A post- reaction blood sample is taken and checked for ABO, Rh and antibody screen  Pre-Transfusion sample is retested at the same time checking for any discrepancies  DAT performed and if positive, further testing required  Repeat the crossmatch  Report all findings to medical director and physician  Chemical tests done include haptoglobin, bilirubin. Hgb & Hct, Coagulation and gram stain if suspected contamination.  All done with High-priority

 This is a condition where maternal antibody crosses the placental barrier and sensitizes the fetal red blood cells  The fetus then destroys the cells  The destruction of cells produces a clinical condition ranging from anemia to death.  Initial sensitization of the mother probably best occurs at birth due to fetal- maternal hemorrhage

 ABO Usually mild with elevations of jaundice and bilirubin  Rh HDN  More severe, may need exchange transfusion  Can cause death Any antibody that is IgG has the potential of crossing the placental barrier The titer of the Antibody will be the predictor of the severity of the disease

 This is a concentrated Anti-D prepared from pools of human plasma  This product is administered at 28 weeks and again within 72 hours after delivery  There has to be confirmation on the Cord Blood that there is Rh antigen on the babies’ cells  If there is a large fetal-maternal bleed (more than the 30 ml of blood) then a Kleihauer-Betke stain is done to determine amount of RhoGam that should be given. This stain is a quantitative test to determine quantity of bleed  Flow cytometry is a more accurate method  For exchange transfusion, must be crossmatched with maternal plasma

 Fetal cells per 1000 count  4 / 1000 =.004 x 10 = percentage of fetal cells

 Bring your QC worksheet with enough room to add another day of QC  Review the procedures you have done for waived testing  You will be working independently, try to think the processes through on your own. I want to see if you have the concepts down without peer help.  If you have any questions please bring them to me, don’t share what you see.