Transfusion and Immunity

2 parts of Immunity

Innate

Adaptive

What does innate immunity consist of?

-Inflammation

-Phagocytosis

-Cellular components

Signs of Inflammation

pain

heat

redness

swelling

Cells involved in Phagocytosis

Neutrophils

Monocytes

Cellular components

-Neutral Kill cells (NK)

-Interferons

-Complement

parts of adaptive immunity

Cell mediated

Humoral

Cell mediated consists of

T cells from thymus

What are the T cells?

Memory Cells

Effector Cells

Humoral consist of

B cells from the bone marrow

What are the B cells?

Immunoglobulins (M, G, E, A, D)

Which immunoglobulin is the biggest?

IgM

Which immunoglobulin reacts to helminth/allergens?

IgE

Which immunoglobulin is the most common?

IgG

What is the difference between B cells and T cells?

-B cells sees antigen, attached, and attacks it

-T cells reacts to its assigned antigen

What lives on the surface of RBCs?

Antigens

What do pt develop to the antigens they dont have?

Antibodies

What can occur if we give a pt blood products they cannot have?

Debilitating reactions during blood transfusions which defeats the purpose of transfusion medicine

Blood group antigens

Specific surface markers in an individual animal that is genetically determined

What are the blood group Antigens?

DEA

AB System

DEA

Dog Erythrocyte Antigen

What blood cell is designated as positive or negative for specific antigens?

Erythrocytes

Major blood groups

DEA 1

DEA 3

DEA 4

DEA 5

DEA 7

Which blood group is most clinically significant?

DEA 1

DEA 7

50% of dogs are what blood group?

DEA 1+

Concept of "First one's free"

if a pt has no history of blood transfusion, we can give which ever blood group because they can tolerate it (they have no antigens for other groups)

AB System Major blood Groups

A

B

AB

Majority of US cats are what blood type?

A

What blood type is some purebreds or populations in Australia?

B

Alloantibodies

naturally occurring antibodies in cats for antigen they dont have

Type B have ___________________ Anti A antibodies

STRONG

Type A have _______________ anti B antibodies

WEAK

For cats, what must be done for blood type testing?

ALWAYS TYPE AND CROSSMATCH

3 Ways of blood typing

-Tube Method

-Card agglutination

-Immunochromatographic Assay

Tube Method

-Centrifuged at 1000g for 10 min

-plasma removed, RBC washed in saline, respun and suspended

-antisera added to tubes and incubated for 15 min

-respun for 15 sec and examines

Antisera

consists of antibodies specific for each possible blood type of a given species

What blood tubes are used for a tube method testing?

EDTA, Heparin, or acid citrate dextrose

Tube method blood tubes are examined for

hemolysis or agglutination

Card agglutination test

-3 wells on the card

-1 drop of EDTA whole blood and 1 drop of phosphate

What is the EDTA and Phosphate mixture?

buffered saline are mixed with a lyophilized reagent within each well

Card agglutination in dogs

DEA 1+ well has monoclonal antibody that forms an antiserum which will cause agglutination if DEA 1+ blood

Card Agglutination test in Cats

A well has anti A monoclonal antibodies, and B well has anti B monoclonal antibodies

Which well is an auto agglutination screen?

3rd well

Steps to Immunochromatographic Assay

-1 drop of EDTA whole blood in a well with a provided diluent

-Dilution travels up paper strip until the control

-the blood has the antigen, antibody will react and change the strips color

-control strip should also change color, once the sample has wicked to the control, test can be read

What is Immunochromatographic Assay

-control band detects separate antigen on RBCs

-Paper strip is impregnated with monoclonal antibody for specific species

Why is crossmatching necessary?

to make sure the blood product we are giving to the patient is compatible

Major Crossmatch

-always should be done but especially in patients that have naturally occurring antibodies

-Blood from Donor, Plasma from recipient

Minor Crossmatches

-considered less important

-Blood from recipient, plasma from donor

Can we transfuse Positive reaction?

NO

Can we transfuse negative reaction?

YES

After types and crossmatched what occurs next?

the pt is ready to receive transfusion of a blood product

Prepping for transfusion

-prepeping whole blood or if plasma it needs to be thaw

-Admin set should have filter for blood

-Baseline vitals should be taken

-transfuse

At what rate is blood transfuse?

2.5-10mL/kg/hr over 4 hours

if emergent what can do with the blood product?

can be bolused (slammed)

Monitoring during transfusion

every 15-30 minutes for the first hour, then every hour until transfusion is complete

Post transfusion

-flush admin line with 0.9% NaCl at same rate of infusion

-Check PCV/TP immediately after transfusion

Top 3 products

whole blood

packed RBC

fresh frozen plasma

Other blood products

Cryoprecipitate (typically used during Sx)