HISTORY OF IMMUNOHEMATOLOGY AND BLOOD PRESERVATION

Blood banking

Encompasses activities, procedures, and tests done to ensure blood for transfusion is properly collected, preserved, stored, and dispensed for later use in blood transfusion

TRANSFUSION MEDICINE

A branch of medicine that is concerned with the transfusion of blood and blood components. It also deals with the proper selection, utilization, and removal of blood and blood components in the treatment or prevention of disease

BLOOD TRANSFUSION

Taking blood or blood components from one individual and inserting them into the circulatory system of another donor in cases of massive blood loss due to trauma, surgery, shock, and where the cell producing mechanism fails

Autologous transfusion:

refer to those transfusions in which the blood donor and transfusions are the same

Allogenic transfusion

refer to blood transfused to a man other than the donor

COMPONENT THERAPYis the one that gives arise whenever we perform blood typing ng mga positive and negative.

Transfusion of specific blood components needed by the patient or recipient

Rh antigen

is the one that gives arise whenever we perform blood typing ng mga positive and negative.

Hippocrates

believe that disease are caused by the imbalance of the 4 humors: phlegm, blood, yellow bile and black bile

Pope Innocent VII

first time a blood transfusion was recorded in history from three young men

De Motu Cordis (Exercitatio Anatomica de motu cordis et sanguinis in animalibus)

In 1628, William Harvey published a book that described the human circulation system. What is the name of the book?

Richard Lower

transfused blood from one dog to another

Samuel Pepys

"bad blood" might be mended by "borrowing blood from a better body"

Lower and Jean Baptiste Denis

sheep to human transfusion. Unsucessful, banned.

Blundell’s Impellor

"double-walled funnel"

Gesellius’ Method

the donor's back was lanced multiple times and capillary blood was extracted using suction cups

Lewisohn’s method of transfusion of citrated blood

transfusion of citrated blood

James Aveling Transfusion Set

2 silver cannulae is inserted in the recipient and donor and connected by rubber tubing with a compressible bulb in the middle to promote and sustain flow

Edward Lindemann

Came up with an appropriate design for performing blood transfusion. He carried out vein to vein transfusion of blood using multiple syringes and a special cannula for puncturing the vein through the skin.

time-consuming, complicated procedure, requires many skilled assistant.

disadvantage of edward lindemann’s design

16 gauge

gauge used for blood donation

Unger

syringe valve apparatus

Dr. Philip syng physick

father of American surgery, first to perform human to human transfusion

John Henry Leacock

transfusion of blood in extreme cases of hemorrhage

James Blundell

transfused human blood to women suffering from postpartum hemorrhage

Karl Landsteiner;

discovered ABO blood type

Adriano Sturli and Alfred Von Decastellol

discovered AB blood type

Albert Hustin

reported the use of sodium citrate as an anticoagulant solution for transfusions

Richard Lewisohn

determined the minimum amount of citrate needed for anticoagulation and demonstrated its nontoxicity in small amounts

Rous and Turner

introduced a citrate dextrose solution for the preservation of blood

John Loutit and Patrick Mollison

introduced the formula for the preservative acid-citrate dextrose (ACD)

Gibson

citrate-phosphate dextrose (CPD)

Male: 5-6 liters

Female: 4-5 liters

How many liters of blood does a male and female person have?

450-500 mL of blood

amount of blood a normal person can donate

10.5 mL/kg

"AABB standard: volume of whole blood collected including an amount for samples shall be "____of donor weight."

63-70 mL

amount of anticoagulant used during blood collection

2 months;

A person can donate blood every.

• AABB: ___

• DOH: ___

Iron storage

Reference of AABB for blood donation

Lifespan of the RBC (120 days)

Reference of DOH for blood donation

24-48 hours; 3 weeks; within minutes

Body recovers the blood very quickly:

- Blood plasma volume - within ______

- Red Blood Cells - in about ____

Platelets & White Blood Cells - ____

blood preservation

Its goal is to provide viable and functional blood components for patients requiring blood transfusion, viability of RBC is a measure of in vivo survival following transfusion

75%

Expected post transfusion RBC survival after 24hrs of transfusion

liquid state; 1C to 6C

To maintain optimum viability blood containing RBC's is stored in the ____ between _____ for a specific number of days (shelf-life), as determined by the preservative solutions

refrigeration

easiest way to preserve blood is through ____

20C to 24C

Platelet concentrates should be stored at_____

radioisotopes, specifically Chromium 51

To detect the percentage of the viabilty, we should use____

Lactic acid, Plasma K, Plasma Hgb

Sino lang ang increase for RBC storage lesion?

21, 21, 35, 21

Storage time for:

• ACD

• CPD

• CPDA-1

• CP2D

Citrate (sodium citrate / citric acid)

- prevents caramelization of glucose during sterilization of solution at high heat

- binds calcium so blood does not clot

Sodium phosphate

- maintains pH storage; necessary for maintenance of adequate levels of 2,3-DPG

Dextrose

- substrate for energy production

Adenine

- production of ATP (extends shelf-life from 21 days to 35 days)

ACD (ACID CITRATE DEXTROSE)

- Most of 2,3-DPG is lost as early as first week due to low pH

- Preserves blood for only 21 days

- Developed by Loutit and Mollison in 1943

CPD (CITRATE-PHOSPHATE-DEXTROSE)

- Superior for preserving organic phosphate (higher pH)

- RBCs become low in 2,3-DPG by the second week

PDA-1 (CITRATE-PHOSPHATE DEXTROSE-ADENINE)

- August 1978 FDA approved the addition of adenine in CPD

- Increase ADP, driving glycolysis to the production of ATP

- Contain 0.25M of adenine plus 25% glucose

- Storage: 1-6c

CP2D (CITRATE-PHOSPHATE-DOUBLE DEXTROSE)

- 100% more glucose than CPD

- 60% more glucose than CPDA-1

Increase glucose to lengthened the storage of blood

- Same with CPD, 2,3-DPG lost in second week

Additive solution

These are preserving solutions (aka adenine saline solutions)

50-60%

Additive solutions Reduce hematocrits from around 70-85% to around ____

Beutler

Additive solution was developed in 1970 by:

Benefits of additive solutions

- Extends shelf-life of RBCs up to 42 days by adding nutrients

- Allows for the harvesting of more plasma and platelets from the unit

- Produces an RBC concentrate of lower viscosity that is easier to infuse

ADSOL by Baxter Healthcare (AS-1)

- Contains saline, adenine, glucose, and mannitol (SAGM)

- CPD (citrate-phosphate-dextrose): primary anticoagulant

NUTRICEL by Pall Corporation (AS-3)

- Contains saline, adenine, and glucose (SAG)

- CP2D (citrate-phosphate-double dextrose): primary anticoagulan

OPTISOL by Terumo Corporation (AS-5)

- Contains saline, adenine, glucose, and mannitol (SAGM) to retard hemolysis

- CPD (citrate-phosphate-dextrose): primary anticoagulant

RBC freezing

This is done Mainly for autologous units and storage of rare blood types

-65C

Storage temp for rbc freezing

Packed RBC→ Addition of glycerol→ Vigorous shaking→ Storage: -65C

Process of freezing

Glycerol

Cryoprotectant for RBC freezing

20% w/v; 40% w/v

Two types of glycerol concentration:

1. Low glycerol concentration: ___

2. High glycerol concentration: ____

-80 C and -196C

Initial freezing temperature for high and low glycerol

-65C; -120C

Maximum storage temperature for high and low glycerol

RBC REJUVENATION

• Process by which ATP and 2,3-DPG levels are restored or enhanced by metabolic alterations

phosphate, inosine, glucose, pyruvate, and adenine (PIGPA)

Initial rejuvenation solution contains

Incubating an RBC unit at 37C for 1 hour→ Addition with 50mL of the rejuvenating solution→ RBCs stored in liquid state can be rejuvenated at outdate or up to 3 days after outdate→The RBCs are washed during the post-freezing deglycerolization process to remove non-metabolized rejuvenation solution materials and deleterious amounts of extracellular potassium

Process of rejuvenation:

Phosphate, Inosine, Pyruvate, and adenine (PIPA)

PIGPA is not approved, therefore we use ___