Table of Contents
CHAPTER 1
INTRODUCTION TO BLOOD TRANSFUSION
Blood volume
The compatibility test
Definitions of blood product
Indication of blood grouping
Discovery of human blood groups
Hemagglutination reaction
Blood group systems (international society of blood transfusion (ISBT) 2008
Selection of donor for organ donation
Blood test measures antibodies to HLA
Percent reactive antibody (PRA)
Types of donor for organ transplant
Change of blood group
Bibliography
CHAPTER 2
BLOOD GROUP & IMMUNOLOGY
Discovery of Blood group
Immunological reaction
Principles of Immunohematology
The ABO antigens
Mendel's First Law of Inheritance
Autosomal chromosome
Genotypes table
What do co-dominant genes mean?
ABO antibodies
Antibody characteristics of IgG & IgM
Immunological reaction in blood banking
Stages of immunological reaction
Factors affecting the antigen-antibody reaction
The basic blood group system ABO
Comparison of ABO and Rh (D) groups
Blood groups with natural & immune antibodies
Subgroups of ABO blood group system
Bombay blood group
Plant agglutinins for ABO blood group
Human Leukocyte antigen (HLA)
Anti-human serum (Coomb’s antisera)
Bovine albumin
Rh Antigen
Classification of Rh antigens
Fisher-Race
Wiener
Rosenfield
Identification of Rh antigens
Translating from Weiner to Fisher-Race
Rh antibodies
Rh Blood group & Rh Incompatibility
Variations of the D phenotype
Partial D
Weak D
Laboratory diagnosis of weak D & partial D
Other blood group systems
Blood groups with natural & immune antibodies
Lutheran blood group
Miscellaneous blood groups (Human Leukocyte antigen)
Universal recipient
Universal Donor
Extremely rare blood group
Bibliography
CHAPTER 3
DONOR BLOOD COLLECTION
Donor consenting process
Essential issues in consent
Ownership of the donation
Donor rights
Ethical issues of donor screening
Signature of the donor
Donor interview
Essentials criteria for blood donors
Criteria for rejecting donors
Donor pre-transfusion evaluation
Guide lines before taking the blood from donor
Donor session records registration & donor identification
Formula for blood to be drawn
Blood Donor questionaries’ form
Consent letter from the donor
Whole blood donation
Blood anticoagulation
Blood flow & completion of donation
Blood volume monitoring
Invention of blood bags
Red cell anticoagulant & preservation
Citrate-phosphate-dextrose-adenine (CPDA-1)
Saline –adenine-glucose- mannitol (SAGM)
Types of blood bags
Anticoagulant used in blood bags
Identification of collected blood
Post donation instructions
Management of syncope fainting or vasovagal attack of donor
Donor care after a blood donation
Blood collection record sheet
Bibliography
CHAPTER 4
BLOOD STORAGE AND TRANSPORTATION
Transportation of blood after collection
Storage and transport conditions
Features of a blood transport container
Characteristics of coolant packs used in transportation of blood
Temperature control of transport container
Blood disposal log
Storage of blood
Blood bank refrigerator(s)
Blood plasma freezer(s)
Platelet agitator(s) with built in incubators
Temperature recording devices & alarms
Handling of Blood components
Cold room for preservation of blood
Organization in storage
Changes in stored blood
CPDA-1
Storage of donor red cell units considerations
Bibliography
CHAPTER 5
TRANSFUSION OF BLOOD AND BLOOD COMPONENTS
Reasons for blood transfusion
Transfusion trigger
Transfusion target
Blood components for transfusion
Whole blood
Inappropriate indications for the use of packed red blood cells
Packed red blood cells (pRBC)
Life span of transfused packed red blood cells (pRBC)
Types of aphaeretic red cell concentrate available for treatment of anemia
Transfusion of packed red blood cells (pRBC) in acute anemia
False high Htc in cases of acute hemorrhage
Transfusion regimen for Thalassaemia major
Transfusion of pRBC in patients undergoing chemotherapy
Transfusion of pRBC in thrombocytopenia
Transfusion of pRBCs in chronic anemia
Transfusion of pRBC in sickle cell disease
Indication for auto transfusion
Transfusion of pRBC in bone marrow transplantation
Transfusion of pRBC in neonates
Leukoreduction Indications
Indications for irradiation of pRBC
Side effect of irradiated pRBC
Washed pRBC
Indications of frozen red cells
Fresh Frozen Plasma (FFP)
Indications
Different types of plasma
Difference between Fresh Frozen Plasma and Plasma Frozen
Properties of different types of plasma
Storage time for preservation of FFP & cryoprecipitate
Plasma thawing equipment
Humate- P antihaemophilic
Advantages of Prothrombin complex concentrate (PCC) over FFP
Side effect of Humate-P
Composition of Prothrombin complex concentrate
Cryoprecipitate
Desmopressin (DDAVP) Indication
Human Fibrin Glue (HFG)
Platelets
Indication of platelets transfusion
Contraindications
Types of platelets
Compatibility
Platelet swirling phenomenon
Platelet agitator with built in incubator
Medicine & transfusion options
Bibliography
CHAPTER 6
BLOOD COMPONENT PREPERATION
General principles of component preparation
Laboratory procedures in blood component preparation
Preparation of fresh frozen plasma & packed red cells
Chart showing shelf life of blood components
Additive solutions
Preparation of cryoprecipitate
Reconstitution of cryoprecipitate for transfusion
Cryodepleted plasma ("cryosupernatant")
Preparation of platelet rich plasma (PRP)
Preparation of platelet concentrates
Preparation of pRBC
Bibliography
CHAPTER 7
BLOOD TEST IN IMMUNOHEMATOLOGY & BLOOD BANKING
Preparation of reagent cells for blood grouping
Usage of Coomb’s control cells
Preparation of Coomb’s control cells
Reporting of hemagglutination reaction
Procedure of diluting anti –D
Methods of determination of ABO blood grouping
Forward grouping
Reverse grouping
Preparation of Red cell suspension
Indirect antiglobulin test (Du Testing)
Rh (D) Grouping
Pre -transfusion testing (Compatibility testing)
Collection of blood specimen
Blood sample handling and processing
ABO & Rh grouping sera
Sources of errors in ABO grouping
Pitfalls in slide method
Report of reverse grouping & probable blood group
Advantages of tube method
Tube test for forward & reverse grouping
Results of forward & reverse grouping
Rouleaux formation & true agglutination
Causes of variable reaction
Micro plate technique method for ABO grouping
Column or Gel method for ABO groupingng
Cord blood of Infant
Testing for A 1 and A2 sub groups
Anti-D sera
Rh (D) grouping methods
Advantages of tube method
Matched results of forward & reverse grouping
Sources of errors in Rh (D) grouping
Saline Agglutination test for Rh Procedure
Direct coomb’s (DAT)
Causes of positive direct Coomb’s (Antiglobulin) test
Indirect antiglobin (Coomb’s) test
Indications of the indirect antiglobin test
Causes of false positive indirect antiglobin test (IAT)
Causes of false negative indirect antiglobin test (IAT)
Compatibility testing
Causes of false negative direct antiglobin (DAT) test
Differences between direct & indirect antiglobulin test
Application of Indirect antiglobulin test (IAT) in immunohematology
Application of Direct antiglobulin test (DAT) in immunohematology
Weak expression of the RhD antigen (Du)
Slide technique for antigen (Du)
Anti-human serum (Coomb’s antisera)
Bovine Albumin
Blood Group Compatibility
Compatibility testing or cross matching
Sources of errors in cross matching
False negative reactions
False positive reactions
Emergency cross match procedure
Goals of antibody screen
Elution of antibodies
Indications of elution of antibodies
Titration of anti – D
Prozone phenomenon
Ant globulin (comb’s) cross match
Bibliography
CHAPTER 8
HEMOLYTIC DISEASE OF THE NEW BORN
Who is affected by hemolytic disease of the newborn?
Why is hemolytic disease of the newborn a serious concern?
Signs & symptoms of hemolytic disease of the newborn
Acid Elution test
Laboratory diagnosis of HDN-Rh
Maternal blood and Rh typing and antibody- D titer
Middle cerebral artery blood flow measurements
Cell-free fetal DNA screening
Specimen collection for HDN
Cell-free fetal DNA screening
Test for Feto – Maternal hemorrhage
Kleihauer-Betke test
Flow cytometry
Calculating RhIG Dosage
Routine Rh (D) prophylaxis guidelines
Hemolytic disease of the newborn caused by ABO incompatibility
Prevention of hemolytic disease of the newborn
Treatment for hemolytic disease of the newborn
Intrauterine Fetal Blood Transfusion for Rh Disease
The compatibility test in case of exchange transfusion
Procedure
Prognosis after intrauterine transfusion through umbilical cord
Risks of intrauterine Transfusion
Neonatal transfusion exchange transfusion Indications and aims
Criteria for performing exchange transfusion
Component and procedure specifications
Monitor infants after exchange transfusion
Laboratory complications of exchange transfusion
The choice of blood group for exchange transfusion
Single volume exchange
Double volume exchange
Consideration of other transfusion issues
Transfusion of other blood components in neonates
Platelet transfusion in neonate
Clinical situations to trigger for platelet transfusion
Platelet compatibility
Transfusion of FFP to neonates
Blood and blood component specification & recommendations for: fetuses, neonates, infants and children’s
Bibliography
CHAPTER 9
HISTORY OF BLOOD TRANSFUSION
Bibliography
CHAPTER 10
MASSIVE BLOOD TRANSFUSION
Trauma Transfusion – order for uncrossed blood components
Massive blood transfusion (MBT)
Massive blood transfusion definition
Pathophysiology of MBT
Causes of Massive Blood transfusion in women
Types of Obstetric hemorrhage
Massive blood transfusion in battle field injury (trauma induced)
Clinical signs & symptoms of volume of blood loss
Signs & symptoms of inadequate oxygen delivery
Methods for volume status assessment in trauma, predictor of massive bleeding
Assessment of blood consumption (ABC) score
Clinical criteria at the time of admission
Clinical criteria for trauma or non-trauma patient’s
Laboratory criteria
Assesment of blood consumption (ABC) score
Focused assessment with sonography for trauma (FAST)
Indications for the eFAST exams
Clinical criteria admission
Laboratory criteria for massive transfusion prool
The Abbreviated Injury Scale (AIS)
Acute coagulopathy of trauma
Different causes of coagulopathy in massive blood loss
Problems due to massive blood transfusion
Effect of dilution
Effect of Hypothermia
Effect of acidosis
Hypocalcaemia
Hyperkalemia
Transfusion-associated hyperkalemic cardiac arrest
Hypomagnesaemia
Adult respiratory distress syndrome (ARDS)
Massive transfusion prool
Steps in the massive hemorrhage prool
Two categories of immediate life-threats in trauma
Occult shock in trauma resuscitation
Shock Index (SI)
Resuscitation targets
How to give MTP
Management of intravascular volume loss
Management of loss of blood components
Management of massive blood loss by Pharmacological support
Factor VIIa
Factor Eight inhibitor by pass activity (FEIBA)
Tranexamic Acid (TXA)(Beriplex)
Whole blood or blood component in obstetric hemorrhage
Assessment of volume status in trauma
Limitations of massive transfusion prools
Measures for control of massive bleeding
Vascular access in trauma resuscitation
IV solutions & Medications
Point-of-care testing
Monitoring
Recommended laboratory test
Massive blood loss in battle field injury
Types of battle field injury
Evacuation & levels of care
Field hospital
Type of death in battle field injury
Golden Hour Container for collection & transportation
Treatment of war wounded patients
Detection of blood group at the war site by Eldon card
Management of Battlefield blood transfusion
Buddy transfusion
Bibliography
CHAPTER 11
AUTOLOGOUS BLOOD TRANSFUSION
History of Autologous blood transfusion
Types of Autologous blood transfusion (ABT)
Pre-operative blood donation (POBD)
Acute normo-volumic hemodilution (ANH)
Intraoperative salvage (ICS)
Criteria for autologous donors
Time for pre - operative blood donation
Indication of autologous blood transfusion
Contraindication of autologous blood transfusion
Advantages of autologous blood transfusion
Preoperative blood collection (POBD)
Number of autologous blood donations
Perioperative collection acute normovolemic hemodilution (ANH)
Advantages of ANH
ANH complications
Intraoperative cell salvage (ICS)
Intraoperative cell salvage (ICS) contraindication
Postoperative cell salvage (PCS)
Characteristics of processed intra & post-operative blood by cell saver
Complications of intra & post-operative blood salvaging
Complications of autologous blood transfusion
Reasons of decreasing autologous blood transfusion
Bibliography
CHAPTER 12
BLOOD MANAGEMENT
Definition
Advantage of Patient Blood Management
Why does patient blood management matter?
Patient benefit
Use of strict transfusion triggers
Sustainability of the blood supply
The three pillars of Patient Blood Management
Patient cantered decision
Managing anemia
Optimizing coagulation
Practical implementation of Patient Blood Management (PBM)
Advantages of blood conservative programme
Bibliography
CHAPTER 13
BLOOD BANK PROTOCOLS
Blood bank requisition form
Blood delivery slip
Blood bag receiver slip
Identification of the patient
Specimen collection & labeling of the tube
Cord blood specimen
Expiration of the compatibility blood specimen
Causes for specimen rejection
Transport of blood
Transfusion & test requests
Test results and product availability
Request for delivery of blood
Administration of O group blood policy
Testing prool
Common blood bank orders
Turnaround times for supply of blood
Other important information
Blood specimen collection and processing
Blood administration
Ten golden rules for transfusion
Guide for administration of blood & blood components
Chart for vital parameters check
Monitoring and observation
Outcomes of blood transfusion
Reaction details
Recommended procedure for documentation
Bibliography
CHAPTER 14
BLOOD BANK INVENTORY
Blood bank inventory
Monitoring wastage
Management
Reasons for laboratory initiated quarantine
Non-conforming products
Managing products with short expiry dates
Emergency release of blood without cross matching
Maximum surgical blood order schedules
Monthly denominator reporting form
Chart showing availability of sk
Daily inventory of blood sk in quarantine
Documentation of inventory traceability and the blood service
Why data should be collected
Blood sks management scheme (BSMS)
Demand of blood components
The number & reasons for transfusion
Whole blood collection management
Approaches to demand forecasting
Daily hospital component requirement
Hospital weekly variation against present inventory
Contingency and disaster planning
Blood integrated blood shortage plan benchmarking
Bibliography
CHAPTER 15
TRANSFUSION REACTIONS
Definition of Transfusion Reactions
Reporting information
Submission date of form
Patient’s information
Current status at the time of reporting
Transfusion products detail information
Reaction information
Reactions vital signs
Patient’s signs & symptoms at the time of reaction
Suspected adverse reaction
Diagnostics – Check box and/or enter values.
Treatment and clinical course
Outcome of transfusion reaction
Interpretation of transfusion report by Blood Bank Officer
Classification & types of transfusion reactions
Fatal- Acute hemolytic reaction (ABO incompatibility)
Non -fatal acute hemolytic reaction (ABO incompatibility)
Febrile non-hemolytic reactions (WBC or cytokine induced)
Allergic reactions minor (urticarial)
Allergic reactions (fatal) Anaphylaxis
Transfusion-related acute lung injury (Trali)
Hemolytic transfusion reaction
Transfusion related acute gut injury (TRAGI)
Circulatory overload
Non-immunological hemolysis (heat, cold, osmotic, mechanical)
Reaction to bacterial contamination
Electrolyte imbalance (calcium, potassium, magnesium)
Chemical effects citrate
Coagulopathy with massive blood transfusion
Hypotensive transfusion reaction
Delayed immunological mechanisms
Delayed hemolytic reactions
Alloimmunisation (RBC hemolysis & Platelet refractoriness)
GvHD
Post-transfusion purpura
Trim
Delayed non-immunological mechanisms
Alloimmunization RBC hemolysis & Platelet refractoriness
Delayed hemolysis
Transfusional hemosiderosis
Transfusion transmitted infections
Infections: Viruses, Bacteria, Parasite, Contaminant
Isoimmmune major transfusion reactions
Hypotensive transfusion reaction
Thrombophlebitis
Septic phlebitis
Air embolism
Effect of vaso- active substances
Pyrogenes-bacterial & endogenous
Effect of cold blood
Others
Management of suspected transfusion reactions
Investigation of transfusion reaction
Bibliography
