Compatibility Testing/Pre-Transfusion Testing

Compatibility Testing

• series of testing procedures and processes with the ultimate objective of ensuring the best possible results of a blood transfusion

• specimen collected either in _ or _

• testing should be performed in samples less than _

• after testing, pre-transfusion samples must be stored for - days at - degrees celcius

• review of patient's blood bank records is very important (ABO & Rh, antibody screening results)

• 3 steps: _

• series of testing procedures and processes with the ultimate objective of ensuring the best possible results of a blood transfusion

• specimen collected either in EDTA or PLAIN

• testing should be performed in samples less than 72 HOURS

• after testing, pre-transfusion samples must be stored for 7 days at 2-8 degrees celcius

• review of patient's blood bank records is very important (ABO & Rh, antibody screening results)

• 3 steps: ABO and RH TYPE, ANTIBODY SCREENING and IDENTIFICATION, CROSSMATCH

SEROLOGIC CROSSMATCH

• consists of mixing recipient plasma with cells directly obtained from donor unit

• Types:

→_

• centrifuge test mixture at room temperature

• detects IgM antibodies in patient serum that is reacting to donor RBCs

→_

• principle used is based on IAT

• detects IgG antibodies in patient serum that is reacting to donor RBCs

→IMMEDIATE SPIN CROSSMATCH

• centrifuge test mixture at room temperature

• detects IgM antibodies in patient serum that is reacting to donor RBCs

→ANTIGLOBULIN CROSSMATCH

• principle used is based on IAT

• detects IgG antibodies in patient serum that is reacting to donor RBCs

ANTIBODY SCREENING

• Purpose:

• Specimen:

• Reagent:

• Phases:

• Purpose: detects unexpected antibodies present in 0.2-2% of general population (auto/alloantibodies)

• Specimen: patient serum/plasma

• Reagent: 3 vials (screening cells)

• Phases: IS, 37C incubation, AHG

ANTIBODY IDENTIFICATION

• Purpose:

• Specimen:

• Reagent:

• Phases:

• Purpose: additional testing to identify the reacting antibody and determine the clinical significance

• Specimen: patient serum/plasma

• Reagent: 11 vials (panel cells)

• Phases: IS, 37C incubation, AHG

Antibodies detected at IS (cold-reacting)

• Lewis

• Anti-I

• Anti-P

• M

• ABO

• N

Antibodies detected at 37C/AHG (warmreacting)

• Kell

• Kidd

• Duffy

• S

• U

• Rh

Special Antibody Identification Techniques

• hemagglutination inhibition

• serum adsorption

• elution

• ZZAP

Hemagglutination Inhibition

• inhibit reactivity by mixing serum with a specific soluble antigen source

Soluble antigen and source

• ABH, Lea, Leb - _

• P1 - _

• Sda - _

• I - _

• Ch-Rg - _

Soluble antigen and source

• ABH, Lea, Leb - saliva from secretor

• P1 - hydatid cysts, pigeon eggs

• Sda - human / guinea pig urine

• I - human milk

• Ch-Rg - human plasma (+) Ch-Rg

Adsorb serum antibodies with autologous cells or selected allogeneic cells

Serum Adsorption

Elution

• remove and recover antibody from surface of red cells

Reagents: _

→gentle heating at 45C

• chloroquine diphosphate

• EDTA-glycine acid

→heating at 56C

• organic solvents, glycine acid solution (pH3)

Combination of DTT and enzymes destroys coating of IgG autoantibodies

ZZAP

BLOOD DONATION

→Sizes of blood bags and amount of anticoagulant

• 350 mL - _

• 450 mL - _

• 500 mL - _

• 350 mL - 49 mL

• 450 mL - 63 mL

• 500 mL - 70 mL

BLOOD DONATION

• anticoagulant required per mL of blood: _

• maximum allowable amount of blood that can be extracted: _

• needle size and length: _

• blood bag material: _

• antiseptic: _

• anticoagulant required per mL of blood: 0.14 mL

• maximum allowable amount of blood that can be extracted: 10.5 mL/kg

• needle size and length: 16 grams/ 1 - 1.5 inch

• blood bag material: plasticized polyvinyl chlorite

• antiseptic: 70% ethanol and povidone-iodine

DONOR REACTIONS

Mild Reactions

→syncope/fainting, nausea/vomiting, hyperventilation, twitching, muscle spasm

→needed actions:

• remove tourniquet and withdraw needle

• place cold compress on donor's forehead

• raise donor's leg above level of head

• loosen tight clothing and secure airway

• monitor vital signs

DONOR REACTIONS

Moderate Reactions

→loss of consciousness, low pulse rate, hyperventilation, systolic pressure 60 mmHg

→Needed actions:

• check vital signs frequently

• administer 95% oxygen and 5% CO2

DONOR REACTIONS

Severe Reactions

• convulsions, hyperventilation

• needed actions: _

• call for help immediately

• restrain donor to prevent injury to self and others

• ensure adequate airway

BLOOD DONOR

• chronic alcoholism, severe allergic reaction, severe asthma, anemia, angioplasty, angina pectoris, autoimmune disease/SLE, brain surgery, bronchiectasis, brucellosis, cancer

• Chagas disease, colitis/IBS. convulsions/seizures, epilepsy, coronary heart disease, unexplained weight loss of >5kg within 6 months

• family history of CJD, recipients of human CJD, recipients of human GH and dura mater grafts, DM uncontrolled and on insulin, embolism, emphysema, encephalitis

• filariasis, complete gastrectomy, genital warts, genital herpes, gonorrhea, HBsAg positive, malignant disease, chronic nephritis, Paget's disease, polycythemia

• prolonged bleeding, psychiatric disorder, psoriasis, Q fever, Reynaud's phenomenon, pheumatic fever, sarcoidosis, schistosomiasis, STI

Permanent

BLOOD DONOR

• taking prohibited drugs, HSV infection, hypertension (>160/100), hypotension (<90/60)

• undetermined jaundice, risky sexual behaviour, syphilis

Indefinite

BLOOD DONOR

• acute nephritis - after recovery

5 years

BLOOD DONOR

• after treatment for malarial infection

3 years

BLOOD DONOR

• after recovery from TB (completed theraphy + two negative sputum exam)

2 years

BLOOD DONOR

• abortion/miscarriage (with dilation/curettage), moderate allergic reaction, appendectomy, biopsy, recipient of blood transfusion, body piercing, dental surgery

• fracture with surgical intervention, incarceration in jail, obstructive jaundice, poliomyelitis after recovering

• tatooing, thyroidectomy'tonsillectomy, cholecystectomy, cosmetic procedures (facial cleaning, botox injection, dermabrasian)

1 year

BLOOD DONOR

• after childbirth

9 months

BLOOD DONOR

• glandular fever, hepatitis A - after liver function tests have normalized, hydatid disease

• travel to area endemic with malaria, osteomyelitis after recovery, peritonitis, pneumothorax, spticemia, tetanus infection, toxoplasmosis

6 months

BLOOD DONOR

• fever of unknown origin

4 months

BLOOD DONOR

• after recovery from mild concussion, duodenal ulcer currently on treatmnet, active gout, leptospirosis

• lung abscess, peptic ulcerm phlebitis, salmonella food poisonin, thrombophlebitis

3 months

BLOOD DONOR

• abortion/miscarriage (without dilation and curettage), measles (rubeola), meningitis after recovery

6 weeks

BLOOD DONOR

• acute bronchitis, after recovery from chickenpox, after contact with person infected with chickenpox

• -after recovery from dengue infection

• dental extraction with abscess

• infectious diarrhea, diptheria, amoebic dysentery, gastroenteritis, herpes zoster/shingles, influenza, mumps after recovery, pancreatitis after recovery, rubella, scarlet fever

• stye, sore eyes, tonsilitis, household contact for someone who has typhoid infection

4 weeks

BLOOD DONOR

• candidiasis after treatment

• cellulitis

• common cold

• laryngitis

• TB skin test/PPD

• URTI

1 week

BLOOD DONOR

• dental extraction - uncomplicated

3 days

BLOOD DONOR

• alcohol intake

1 day

DEFERRAL due to intake of DRUGS

• _ - NSAIDS for platelet donation

• _ - single dose aspirin

• _ - chronic intake of aspirin

• _ - mass drug administration for filariasis and schistosomiasis

• _ - acne medication (retinoids, isotretinoin), antibiotics, fungal medication, propecia

• _ - IV glutathione (cosmetic use)

• _ - anticonvulsant, beta-blockers, digitalis, tegison, psychosis drugs

• 1 day - NSAIDS for platelet donation

• 3 days - single dose aspirin

• 3 weeks - chronic intake of aspirin

• 2 weeks - mass drug administration for filariasis and schistosomiasis

• 4 weeks- acne medication (retinoids, isotretinoin), antibiotics, fungal medication, propecia

• 1 year - IV glutathione (cosmetic use)

• permanent - anticonvulsant, beta-blockers, digitalis, tegison, psychosis drugs

Informed Consent

• donor must be informed of the following before blood donation

→risk of procedure

→serologic tests performed: (5)

• HIV → anti-HIV 1/2

• HBV → HBsAg

• HCV → anti-HCV

• Malaria → lateral flow assay/thick & thin blood smear

• Syphilis → RPR or VDRL

Donor records

• must be retained by blood collection facility and ensure confidentiality of donor records

• minimum retention time: _

5 - 10 years

Qualifications of Potential Blood Donor

• minimum age: _

• body weight: _

• temperature: _

• pulse rate: _

• blood pressure: _

• hemoglobin: _

• hematocrit: _

• minimum age: 18 years old

• body weight: 50 kg/110 lbs

• temperature: should not exceed 37.5 degrees celcius / 99.5 degrees fahrenheit

• pulse rate: 50 - 100 bpm

• blood pressure: systolic - 90 to 160 mmHg, diastolic - 60 to 100 mmHg

• hemoglobin: > or equal to 12.5 g/dL

• hematocrit: > or equal to 38%

Interval in between whole blood donations

every 3 months

Autologous Blood Donation

• Required Hgb :

• Required Hct: _

• Last donation must occur _ before scheduled surgery

• _ is a cause of defferal

• Transfusing facility must retest ABO and Rh type

• Required Hgb : > or equal to 11 g/dL

• Required Hct: > or equal to 33%

• Last donation must occur 72 HOURS before scheduled surgery

• BACTEREMIA is a cause of defferal

• Transfusing facility must retest ABO and Rh type

Uses an automated cell separator device whose centrifugal force separates blood into components based on differences in cellular density

Apheresis donation

Plateletpheresis

• Frequency: _

• Platelet count must be more than _ for frequent donors

• Frequency: twice per week (48 hour-interval)

• Platelet count must be more than 150,000/ul for frequent donors

Plasmapheresis

• Frequency:

• serial donors must be tested for _ and _

• Frequency: once in 4 weeks

• serial donors must be tested for plasma protein levels and immunoglobulin levels

Leukopheresis

• Frequency:

• _ are administered on donors to increase cell yield

• Frequency: twice per week

• HES, corticosteroids, growth factors are administered on donors to increase cell yield

Double RBC pheresis

• Frequency:

• Hct required:

• Males weight:

• Males height:

• Females weight:

• Females height:

• Frequency: once in 16 weeks

• Hct required: more than or equal 40%

• Males weight: > or equal 130 lbs

• Males height: > or equal to 5’1

• Females weight: > or equal to 150 lbs

• Females height: > or equal to 5’5