BLOOD GROUPS BLOOD PRODUCTS BLOOD TRANSFUION REACTIONS BY

BLOOD GROUPS BLOOD PRODUCTS BLOOD TRANSFUION REACTIONS BY DR. SHIHAB ALMASHHADANI CONSULTANT HAEMATOLOGIST

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Blood Groups

Clinically important blood group systems

The ABO blood group system

Structure of ABO blood group antigens

The Rh system genotypes

Significance of Certain Blood Group Antibodies Clinical Significance Blood Group System Antibody Relative Frequency in Antibody Screening HTR HDN ABO Anti-A Anti-B All group B and O All group A and O Yes Yes Rhesus Anti-D Anti-c Anti-E Anti-C Anti-e Common Common Yes Yes Yes Kell Anti-K Anti-k Common Rare Yes Yes Kidd Anti-Jka Anti-Jkb Common Rare Yes Yes Duffy Anti-Fya Common Rare Yes Yes MN Anti-M Anti-N Common Rare Occasional Rare Ss. U Anti-S Anti-s Uncommon Rare Yes Yes Lewis Anti-Lea Anti-Leb Common Uncommon Yes No No No P Anti-P 1 Uncommon Rare No Li Anti-l Uncommon No No

Antibody specificities related to the mechanism of immune haemolytic destruction. Blood group Intravascular system haemolysis ABO, H Extra vascular haemolysis A, B, H RH All Kell K K, k, Kpa, Kpb, Jsa, Jsb Kidd Jka, JKb, Jk 3 Duffy Fya, Fyb MNS M, S, s, U Lutheran LUb Lewis Lea Cartwright Yta Colton Coa, Cob Dombrock Doa, Dob

Glycosyltransfereases produced by genes encoding for antigens within the ABO, H, and Lewis blood group system. Gene Allele Transferase FUT 1 H H α-2 -L-fucosyltransferase None A A α-3 -N-acetyl-D-galactosaminyltransferase B B α-3 -D-galactosyltransferase O O None FUT 2 Se se α-2 -L-fucosyltransferase None FUT 3 Le le α-3/4 -L-fucosyltransferase None

ABO Blood Group

ABO Blood Groups Inheritance

ABO Blood Groups

ABO blood group system Blood group Subgroup Antigens on red cells Antibodies in plasma A A 1 A 2 A + A 1 A Anti-B (Anti- A 1)* B - B Anti-A, Anti- A 1 AB A 1 B A 2 B 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.

BLOOD TRANSFUSION Blood Compatibility Testing (Crossmatch) 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 B antigen only A and B antigens Neither A or B Type A Type B Type AB Type O

The antiglobulin test for antibody or complement

BLOOD TRANSFUSION Blood Compatibility Testing (Crossmatch) 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 Anti-A and anti-B Neither anti-A or anti-B Type A Type B Type O Type AB In addition, RBCs are Rh typed and identified as "D“ positive or negative

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

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 genotypes Frequency DCe/dce/R 1 r DCe/Dce/R 1 RO DCe/d. Ce/R 0 r’ 32. 68 2. 16 0. 05 + DCe/DCe/R 1 R 1 DCe/d. Ce/R 1 r’ 17. 68 0. 82 - + dce/dce rr 15. 10 + - + Cde/cde r’r 0. 76 - + + + cd. E/cde r”r 0. 92 + + + DCe/Dc. E R 1 R 2 DCe/dc. E R 1 R” Dc. E/d. Ce R 2 r’ DCE/cde Rzr Dce/DCE Ro. Rz Dce/d. CE Ro. Ry 11. 87 1. 00 0. 28 0. 19 0. 01 <0. 01 + - + + d. Ce/DCE R 2 r Dc. E/dce R 2 r Dc. E/Dce R 2 R 0 Dce/dc. E Ror” 10. 97 0. 73 0. 06 + - + Dce/cde. R 0 r Dce/Dce R 0 R 0 2. 00 0. 07 + - Dc. E/Dc. E R 2 R 2 Dc. E/dc. E R 2 r” 1. 99 0. 34 D C c E e + + + - - - - + - + + + - Dc. E/Dc. E R 2 R 2

The Rh haplotypes in order of frequency (Fisher nomenclature) in caucasians and the corresponding short notations Fisher Short notations Approximate frequency (%) CDe R 1 41 Cde r 39 c. DE R 2 14 c. D 3 RO 3 Cw. De R 1 w 1 cd. E r” 1 Cde r’ 1 CDE Rz Rare Cd. E Ry Rare

BLOOD TRANSFUSION Mandatory Tests on All Units of Blood § § ABO group and Rh type Screening for blood-group antibodies Serologic test for syphilis Serologic tests for human retroviruses including: Ø HIV-1 antibody Ø HIV-2 antibody Ø HIV p 24 antigen Ø HTLV I antibodies § Serologic tests for hepatitis including: Ø Hepatitis B core antibody (HBc. Ab) Ø Hepatitis B surface antigen (HBs. Ag) Ø Hepatitis C antibody

BLOOD TRANSFUSION Type And Cross match § 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. § §

BLOOD COMPONENTS PREPARATION

BLOOD COMPONENTS PREPARATION (Cont…)

Figure 1. Packed red cells may contain enough leukocytes and platelets to result in alloimmunization Maslak, P. ASH Image Bank 2005; 2005: 101277 Copyright © 2005 American Society of Hematology. Copyright restrictions may apply.

Figure 1. Platelet blood components may be stored for 5 days at room temperature without loss of function or viability Maslak, P. ASH Image Bank 2005; 2005: 101278 Copyright © 2005 American Society of Hematology. Copyright restrictions may apply.

AUTOLOGUS BLOOD TRANSFUSION 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

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 cells Platelets FFP* O O A A or O† A A or AB B B or O† B† or A or O B or AB AB AB or A or B or O† AB† or A AB 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.

Complications of Blood Transfusion 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

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

BLOOD TRANSFUSION 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: Ø Babesiosis. Ø Lyme disease. Ø Chagas' disease Ø Creutzfeldt-Jakob Disease (CJD) Ø Toxoplasmosis

Investigation of a Haemolytic Transfusion Reaction § Evidence of Haemolysis Examine patient’s plasma and urine for haemoglobin and its derivaties. Blood film may show spherocytosis § Evidence of incompatibility Ø Ø § 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.