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AN INTRODUCTION TO AN INTRODUCTION TO BLOOD GROUP AND BLOOD GROUP AND
CROSSMATCHCROSSMATCH
Abdullah Ahmed Meshi, BMSc., MT, (CLS).Abdullah Ahmed Meshi, BMSc., MT, (CLS).
Chief of Blood BankChief of Blood Bank
Member of International Society of Blood Member of International Society of Blood TransfusionTransfusion
Member of British Blood Transfusion SocietyMember of British Blood Transfusion Society
King Fahd Central HospitalKing Fahd Central Hospital
Jazan, KSA, 2003Jazan, KSA, 2003
INTRODUCTIONINTRODUCTION
• HISTORY OF BLOOD GROUPS.HISTORY OF BLOOD GROUPS.
• BLOOD GROUP SEROLOGY.BLOOD GROUP SEROLOGY.
• BLOOD GROUP SYSTEMS.BLOOD GROUP SYSTEMS.
• COMPATIBLITY TEST.COMPATIBLITY TEST.
• SELECTION OF APPROPRIATE UNIT FOR SELECTION OF APPROPRIATE UNIT FOR TRANSFUSION.TRANSFUSION.
HISTORY OF BLOOD GROUPSHISTORY OF BLOOD GROUPS
• Karl Landsteiner discovered the 1Karl Landsteiner discovered the 1stst human blood human blood group system, ABO in 1900.group system, ABO in 1900.
• Karl Landsteiner and his student A. Wiener Karl Landsteiner and his student A. Wiener discovered the 2discovered the 2ndnd most important blood group most important blood group system, Rh system in 1939.system, Rh system in 1939.
BLOOD GROUP SEROLOGYBLOOD GROUP SEROLOGY
• Antigen (Ag)Antigen (Ag)– Any substance recognized as foreign by the body which Any substance recognized as foreign by the body which
stimulates the immune system to mount a response stimulates the immune system to mount a response against it.against it.
• Antibody (Ab)Antibody (Ab)– A protective protein produced by the immune system as A protective protein produced by the immune system as
a result of stimulation by a foreign protein.a result of stimulation by a foreign protein.
• Immunoglobulin (Ig)Immunoglobulin (Ig)– An antibody molecule synthesized by plasma cells in An antibody molecule synthesized by plasma cells in
response to an antigen.response to an antigen.
Antigens on Red Blood cellsAntigens on Red Blood cells
RBC RBC
Antigen (Ag)
Antigen – Antibody ReactionAntigen – Antibody Reaction
Immunoglobulin (Antibody)Immunoglobulin (Antibody)
Immunoglobulin (Antibody)Immunoglobulin (Antibody)
Blood Group SystemsBlood Group Systems
• ABO system• Rh system• Other systems:
– Kell system– Lewis system– MNSs system– Duffy system– Kidd system– Lutheran system
ABO Blood Group System
• Two Ag (A and B) make all four blood groups.
RBC with A Ag only
RBC with B Ag only
A group B group
ABO Blood Group SystemABO Blood Group System
• Two Ag (A and B) make all four blood groups.Two Ag (A and B) make all four blood groups.
RBC with A and B Ag
RBC without A and B Ag
AB group O group
ABO Blood Group SystemABO Blood Group System
• Two antibodies are (naturally) developed in this system.
• Type A individual develop anti-B antibodies.
• Type B individual develop anti-A antibodies.
• Type AB individual develop NO antibodies.
• Type O individual develop anti-A and anti-B antibodies.
Antigen (Ag) on RBCs
Antibody (Ab) in Plasma
Blood Group
A AgAnti-BA
B AgAnti-AB
A & B AgNo AbAB
No AgAnti-A &
Anti-BO
ABO Blood Group SystemABO Blood Group System
Rh Blood Group SystemRh Blood Group System• Five antigens are present (D, C, c, E, and e).Five antigens are present (D, C, c, E, and e).• No (No (NaturallyNaturally) developed antibodies in this ) developed antibodies in this
system, but developed as an system, but developed as an immune responseimmune response. . • DD AgAg is the most significant Ag in Transfusion is the most significant Ag in Transfusion
practice.practice.• If If DD AgAg present on RBC, it is called ( present on RBC, it is called (Rh PositiveRh Positive).).• If D If D AgAg is not present on RBC, it is called ( is not present on RBC, it is called (Rh Rh
NegativeNegative). ). • If If Rh NegRh Neg patient receive patient receive Rh PosRh Pos RBCs, 50-75% RBCs, 50-75%
he/she will form Anti-D. he/she will form Anti-D.
Combination Between ABO & Rh SystemCombination Between ABO & Rh System
ABO GroupD Ag PresentD Ag absence
AA Rh PosA Rh Neg
BB Rh PosB Rh Neg
ABAB Rh PosAB Rh Neg
OO Rh PosO Rh Neg
Other Blood Group SystemOther Blood Group System
Blood Group systemAntigen Present
Lewis systemLea & Leb
MNSs systemM, N, S, & s
Kell systemK, k, Kpa, Kpb,Jsa & Jsb
Duffy systemFya & Fyb
Kidd systemJka & Jkb
Lutheran systemLua & Lub
Blood Grouping TechniqueBlood Grouping Technique
Blood Grouping TechniqueBlood Grouping Technique
Compatibility TestingCompatibility Testing
• Compatibility testing is consist of:– Review of patient’s past transfusion history and
records.
– ABO and Rh typing of recipient and donor.
– Antibody screening of recipient and donor.
– The crossmatch test.
• Crossmatch test is only part of compatibility test.
Crossmatch TestCrossmatch Test
• XM is an in-vitro procedure to determine serologic XM is an in-vitro procedure to determine serologic compatibility between the donor’s RBC and the recipient’s compatibility between the donor’s RBC and the recipient’s serum.serum.
• 1 drop of 3-5% donor RBC suspension in NS + 2 drops of 1 drop of 3-5% donor RBC suspension in NS + 2 drops of recipient serum.recipient serum.
• There are two main functions of XM test:There are two main functions of XM test:– Final check of ABO compatibility between donor and patient.Final check of ABO compatibility between donor and patient.– Detects most antibodies in patient’s serum directed against Detects most antibodies in patient’s serum directed against
antigens on the donor cells.antigens on the donor cells.
1.1. Incorrect ABO grouping of the patient or donor.Incorrect ABO grouping of the patient or donor.
2.2. An alloantibody in the patient’s serum reacting with the An alloantibody in the patient’s serum reacting with the corresponding antigen on donor RBCs.corresponding antigen on donor RBCs.
3.3. An autoantibody in the patient’s serum reacting with the An autoantibody in the patient’s serum reacting with the corresponding antigen on donor RBCs.corresponding antigen on donor RBCs.
4.4. Prior coating of the donor RBCs with Ab/C resulting in Prior coating of the donor RBCs with Ab/C resulting in a positive antihuman globulin test (AGT).a positive antihuman globulin test (AGT).
5.5. Abnormalities in the patient’s serum.Abnormalities in the patient’s serum.
6.6. Contamination in the test system.Contamination in the test system.
Causes of Incompatible Crossmatch Causes of Incompatible Crossmatch
P1 Xg
D C E c e CwV K k Kpa Kpb Jsa Jsb
M N S s Fya Fyb Jka Jkb Lea Leb Lua LubP1 Xga
# IS 37 AHGCCC
1 r'r DL0176 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + 0 + + 0 0 + 0 + 0 0 1 0 0 0 2+
2 R1R1W DW0410 + + 0 0 + + 0 0 + + + 0 + + 0 + + + 0 + 0 0 + 0 + + + 2 0 4+ 4+
3 R1R1 DC0331 + + 0 0 + 0 0 0 + 0 + 0 + + + 0 + + 0 0 + + 0 0 + 0 + 3 0 4+ 4+
4 R2R2 DE1143 + 0 + + 0 0 0 0 + 0 + + + + 0 0 + 0 0 + 0 0 0 0 + + 0 4 0 4+ 4+
5 r"r DM0187 0 0 + + + 0 0 0 + 0 + 0 + + + 0 + + + + + 0 + 0 + 0 0 5 0 0 0 2+
6 rrK DK0425 0 0 0 + + 0 0 + + 0 + 0 + + + + + + + + + 0 + 0 + + + 6 0 0 0 2+
7 rr DN1081 0 0 0 + + 0 0 0 + 0 + 0 + + 0 + + 0 + + 0 + 0 0 + + + 7 0 0 0 2+
8 rr DN1082 0 0 0 + + 0 0 0 + 0 + 0 + + + + + 0 + 0 + 0 + 0 + + + 8 0 0 0 2+
9 rr DN1085 0 0 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 + + 0 + 0 + + + 9 0 0 0 2+
10 R0r DT0231 + 0 0 + + 0 + 0 + 0 + 0 + 0 + 0 + 0 0 + + 0 0 0 + + 0 10 0 4+ 4+
11 R1r DH0127 + + 0 + + 0 0 + + 0 + 0 + + + + 0 0 + 0 + 0 + 0 + + 0 11 0 4+ 4+PC Autocontrol PC 0 0 0 2+
Patient 0 + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 0 + + 0 + 0 + + 0
D C E c e CwV K k Kpa Kpb Jsa Jsb
M N S s Fya Fyb Jka Jkb Lea Leb Lua LubP1 Xga
Donor Rh
ID##
Kell Test MethodsLutheranMNSs Duffy Kidd LewisRh-hr
Antibody Identification TestAntibody Identification Test
Selection of Appropriate Unit for TransfusionSelection of Appropriate Unit for Transfusion
• Selection of whole blood for transfusion.
• Selection of RBCs for transfusion.
• Selection of platelet and fresh frozen plasma for transfusion.
Selection of Whole Blood for TransfusionSelection of Whole Blood for Transfusion
Patient Patient GroupGroup
11stst Choice ChoiceAlternativesAlternativesWith Approval of With Approval of
ConsultantConsultant
O PosO PosO PosO PosO NegO Neg------------
O NegO NegO NegO Neg------------O PosO Pos
A PosA PosA PosA PosA NegA Neg------ ------
A NegA NegA NegA Neg------------A PosA Pos
B PosB PosB PosB PosB NegB Neg------------
B NegB NegB NegB Neg------------B PosB Pos
AB PosAB PosAB PosAB PosAB NegAB Neg------------
AB NegAB NegAB NegAB Neg------------AB PosAB Pos
Selection of RBCsSelection of RBCs
Patient Patient GroupGroup
11stst Choice ChoiceAlternativesAlternativesWith Approval With Approval of Consultantof Consultant
O PosO PosO PosO PosO NegO Neg------------
O NegO NegO NegO Neg------------O PosO Pos
A PosA PosA PosA PosA Neg, O Pos, O NegA Neg, O Pos, O Neg------ ------
A NegA NegA NegA NegO NegO NegA Pos, O PosA Pos, O Pos
B PosB PosB PosB PosB Neg, O Pos, O NegB Neg, O Pos, O Neg------------
B NegB NegB NegB NegO NegO NegB Pos, O PosB Pos, O Pos
AB PosAB PosAB PosAB PosAB Neg, O Pos, O Neg, A AB Neg, O Pos, O Neg, A Pos, A Neg, B Pos, B NegPos, A Neg, B Pos, B Neg
------------
AB NegAB NegAB NegAB NegO Neg, A Neg, B NegO Neg, A Neg, B NegAB Pos, A Pos, AB Pos, A Pos, B Pos, O PosB Pos, O Pos
Selection of Platelets and Fresh Frozen Plasma Selection of Platelets and Fresh Frozen Plasma
Patient GroupPatient Group11stst Choice ChoiceAlternativesAlternatives
O O O O A, B, ABA, B, AB
A A A A ABAB
B B B B ABAB
ABABABABABAB
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