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Transfusion pathology Kristine Krafts, M.D. September 24, 2007
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
intro Rh ABO products other groups indications testing dangers
Transfusion Pathology Outline ,[object Object],[object Object]
[object Object],intro Rh ABO products other groups indications testing dangers
[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
[object Object],[object Object],[object Object],[object Object],[object Object],Red Cell Antigens intro Rh ABO products other groups indications testing dangers
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
What are the antigens? ,[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Type A intro Rh ABO products other groups indications testing dangers What are the antigens? Type B Type AB Type O
How do you make the antigens? ,[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
H antigen A antigen B antigen intro Rh ABO products other groups indications testing dangers
What are the genes? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*  almost! intro Rh ABO products other groups indications testing dangers
O None OO AB A and B AB B BO BB AO AA Genotype B A A Blood type Antigens intro Rh ABO products other groups indications testing dangers
How common is each blood type? 42% O 6% AB 12% B 40% A Percent of population Blood type intro Rh ABO products other groups indications testing dangers
So What? ,[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Type A intro Rh ABO products other groups indications testing dangers So what? Type B Type AB Type O
anti-A  anti-B none anti-A anti-B Antibodies O None OO AB A and B AB B BO BB AO AA Genotype B A A Blood type Antigens intro Rh ABO products other groups indications testing dangers
Compatible blood types *   type  O  = universal d O nor! O O AB B A Recipient blood type AB, A, B, or O B or O A or O * Donor blood type intro Rh ABO products other groups indications testing dangers
O AB A B
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
What are the antigens? ,[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Rh - none dd Rh + Dd DD Genotype D Rh + D Blood type Antigens intro Rh ABO products other groups indications testing dangers
What are the antibodies? ,[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Don’t tell me there are more systems. ,[object Object],[object Object],[object Object],*   Not quite: a sh*tload is defined as more than 42. intro Rh ABO products other groups indications testing dangers
 
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
What do you mean, products? ,[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
What are the products? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma BLOOD PRODUCTS
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma BLOOD PRODUCTS
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma BLOOD PRODUCTS
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets BLOOD PRODUCTS Fresh Frozen Plasma
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma VIII Cryoprecipitate BLOOD PRODUCTS IX Albumin IgG
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Whole Blood Use: massive hemorrhage RBC WBC platelets plasma Contents:  INDICATIONS
Whole Blood Red Cells Use: low hemoglobin RBC a few WBC a few platelets a little plasma Contents:  INDICATIONS
Whole Blood Red Cells Granulocytes Use: sepsis in neutropenic patients neutrophils Contents:  INDICATIONS
Whole Blood Red Cells Granulocytes Platelet-rich plasma INDICATIONS
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Use: bleeding due to thrombocytopenia platelets Contents:  INDICATIONS
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma Use: bleeding due to multiple factor deficiencies (e.g., DIC) Plasma  (including ALL  coagulation factors) Contents:  INDICATIONS
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma Cryoprecipitate Uses: low fibrinogen, vW disease, hemophilia A fibrinogen von Willebrand factor VIII Contents:  INDICATIONS
Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma Cryoprecipitate INDICATIONS A bunch of other stuff Use: rarely used
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
 
patient  red cells (type A) FORWARD  TYPE anti-A antibodies AHG Forward typing is done using both anti-A and anti-B antibodies!
patient serum (with anti-B Ab) AHG reagent  red cells (type B) REVERSE  TYPE Reverse typing is done using both type A and type B reagent cells!
patient serum AHG donor red cells CROSSMATCH
patient serum AHG reagent RBC number 1 patient serum AHG reagent RBC number 2 ANTIBODY  SCREEN no agglutination (negative test) agglutination (positive test)
Transfusion Pathology Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What can go wrong? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Acute Hemolytic Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
 
Delayed Hemolytic Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Non-Hemolytic Transfusion Reactions ,[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Circulatory Overload ,[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Iron Overload ,[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
Infections ,[object Object],[object Object],[object Object],[object Object],[object Object],intro Rh ABO products other groups indications testing dangers
What’s the risk of getting an infection? One in 50,000 Hepatitis C One in a million Bacterial infection One in 100,000 HTLV One in 100,000 Hepatitis B One in 2 million HIV One in a million Other infections Risk Bug intro Rh ABO products other groups indications testing dangers
What’s the risk of other complications? One in 100 (severe: one in 20,000) Allergic reaction One in 4,000 (fatal: one in 4 million) Delayed hemolysis One in 3,000 Circulatory overload One in 200 Febrile reaction One in 20,000  (fatal: one in 600,000) Acute hemolysis Risk Complication intro Rh ABO products other groups indications testing dangers

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Transfusion Pathology

  • 1. Transfusion pathology Kristine Krafts, M.D. September 24, 2007
  • 2.
  • 3. intro Rh ABO products other groups indications testing dangers
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10. Type A intro Rh ABO products other groups indications testing dangers What are the antigens? Type B Type AB Type O
  • 11.
  • 12. H antigen A antigen B antigen intro Rh ABO products other groups indications testing dangers
  • 13.
  • 14. O None OO AB A and B AB B BO BB AO AA Genotype B A A Blood type Antigens intro Rh ABO products other groups indications testing dangers
  • 15. How common is each blood type? 42% O 6% AB 12% B 40% A Percent of population Blood type intro Rh ABO products other groups indications testing dangers
  • 16.
  • 17. Type A intro Rh ABO products other groups indications testing dangers So what? Type B Type AB Type O
  • 18. anti-A anti-B none anti-A anti-B Antibodies O None OO AB A and B AB B BO BB AO AA Genotype B A A Blood type Antigens intro Rh ABO products other groups indications testing dangers
  • 19. Compatible blood types * type O = universal d O nor! O O AB B A Recipient blood type AB, A, B, or O B or O A or O * Donor blood type intro Rh ABO products other groups indications testing dangers
  • 20. O AB A B
  • 21.
  • 22.
  • 23. Rh - none dd Rh + Dd DD Genotype D Rh + D Blood type Antigens intro Rh ABO products other groups indications testing dangers
  • 24.
  • 25.
  • 26.
  • 27.  
  • 28.
  • 29.
  • 30.
  • 31. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma BLOOD PRODUCTS
  • 32. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma BLOOD PRODUCTS
  • 33. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma BLOOD PRODUCTS
  • 34. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets BLOOD PRODUCTS Fresh Frozen Plasma
  • 35. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma VIII Cryoprecipitate BLOOD PRODUCTS IX Albumin IgG
  • 36.
  • 37. Whole Blood Use: massive hemorrhage RBC WBC platelets plasma Contents: INDICATIONS
  • 38. Whole Blood Red Cells Use: low hemoglobin RBC a few WBC a few platelets a little plasma Contents: INDICATIONS
  • 39. Whole Blood Red Cells Granulocytes Use: sepsis in neutropenic patients neutrophils Contents: INDICATIONS
  • 40. Whole Blood Red Cells Granulocytes Platelet-rich plasma INDICATIONS
  • 41. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Use: bleeding due to thrombocytopenia platelets Contents: INDICATIONS
  • 42. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma Use: bleeding due to multiple factor deficiencies (e.g., DIC) Plasma (including ALL coagulation factors) Contents: INDICATIONS
  • 43. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma Cryoprecipitate Uses: low fibrinogen, vW disease, hemophilia A fibrinogen von Willebrand factor VIII Contents: INDICATIONS
  • 44. Whole Blood Red Cells Granulocytes Platelet-Rich Plasma Platelets Fresh Frozen Plasma Cryoprecipitate INDICATIONS A bunch of other stuff Use: rarely used
  • 45.
  • 46.  
  • 47. patient red cells (type A) FORWARD TYPE anti-A antibodies AHG Forward typing is done using both anti-A and anti-B antibodies!
  • 48. patient serum (with anti-B Ab) AHG reagent red cells (type B) REVERSE TYPE Reverse typing is done using both type A and type B reagent cells!
  • 49. patient serum AHG donor red cells CROSSMATCH
  • 50. patient serum AHG reagent RBC number 1 patient serum AHG reagent RBC number 2 ANTIBODY SCREEN no agglutination (negative test) agglutination (positive test)
  • 51.
  • 52.
  • 53.
  • 54.  
  • 55.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60. What’s the risk of getting an infection? One in 50,000 Hepatitis C One in a million Bacterial infection One in 100,000 HTLV One in 100,000 Hepatitis B One in 2 million HIV One in a million Other infections Risk Bug intro Rh ABO products other groups indications testing dangers
  • 61. What’s the risk of other complications? One in 100 (severe: one in 20,000) Allergic reaction One in 4,000 (fatal: one in 4 million) Delayed hemolysis One in 3,000 Circulatory overload One in 200 Febrile reaction One in 20,000 (fatal: one in 600,000) Acute hemolysis Risk Complication intro Rh ABO products other groups indications testing dangers