Blood Group Geneties wa037 ‘© Theblood grouping system that we follow (A, Bsystem) was sivenby Landsteiner. Hgeneis present in Chromosome 19 A,B,andO= Chromosome 9 Rhgene=Chromosome | Hgeneis going tobe the fucosyltransferase (©. Itmakes an H substance and is added to blood group like fucosyltransterase. © Ifitadds the fucosyl molecule to N-acetyl galactosamine, itmakes the Ablood group. ‘©. Ifitadds the fucosyl molecule to Galactose, itmakes the B blood group. © If it is added to both N-acetyl galactosamine and Galactose, itwill bean AB blood group. © If it is not added to any of them, it makes the O blood group. ‘© The maximum conversion is happening in AB, And in the O blood group, no conversion i happening. ‘© So,maximum H substance=O © LeastH substance= AB Testing:- ‘© For testing of H substance, Ulex leetin = arerequired. ‘+ Maximum i substance =O and Least H substance AB, © O>A2>B>A2B>AI>AIB anti-H antibodies Refer Table 63.1 ‘* Ineach of these groups, H antigen iscommon, If all of them have H antigen, none of them will have antibodies. Bombay Blood group/Bhende ETAL, ‘© It was identified by a group of scientists called Bhende ET AL. © Bombay Blood group is when a person doesn't have A antigen, B antigen, orany other antigen. (© Bomnay blood group does not have A,B,H antigen. Inturn ithasantiA, antiBandantiHantibodies * AB=Universal recipient ‘© 0=Universal Donor (Noantigen) ‘© Safest blood group for transfusion in emergency =O. ‘© Safest plasma for transfusion in emergency=AB. Lewis Blood Group ‘© Lewis Antigenare there ‘© Igmantibodies are present. © Team GlobalNet [Link] ——]| BLOOD BANKING AND TRANSFUSION MEDICINE PART-1 401 ‘© RBC does not synthesize Lewis Antigen. ‘+ Itisadsotbed from plasma. Kell blood group ‘+ Kell phenotype deficiency isknownas Mcleod phenotype. ‘* Mcleod phenotype is also referred to as Neuro/acanthosi syndrome ‘© Acanthocytes are Red blood cells with spikes ces, "38% pega Duffy Antigen ‘+ Itis under the contol of the ARC gene. ‘+ TERBC has Dufly Antigen, itis used for Plasmodium vivax andPlasmodiumknowles «1fpatients have Dufly antigen negative, andknowlesicannotenter + This means there will be protection against Plasmodium vivax and knowles Plasmodium vivax, Pantigen And 1Antigen ‘© Pantigen: Parvovirus and warm AIHA ‘© Lantigen: Cold AIHA oma RhAntigen © Chromosome 1 ‘+ C.D, EGenes. Dantigenis very common, ‘+ Thisis given aspositive or negative, Saliva, sweat, semen Present in Not present IgM Antibody: IgG ‘+ Rhageancross the placenta, Telegram : @teamglobalchat Q +© Team GlobalNet Q [Link] Blood grouping methods ans Geleard © Slidemethod © Tubemethod r ee mney + ELISA + Automated Color ofantisera = Mnemonic-BYG © Blue-AntiA © Yellow -AntiB ‘© Gray-AntiD- Rhantigen +/- Bo 1 ete epee tea a a © Hehasantigen * Ifyougetaline ontop Positive blood group © So when sboty A wil te mde 10, ttn wil | its ple Nene om) Nope Blood donation Blood Groups & blood typing > Age 18-65560% sohtOW TO READ YOURRESLITS + Blood donation day= 1st October (voluntary blood donation day) o-rosmive @ ») © 4555kg=350ml blood 49 mlanticougulan') A POSTIVE o> $Skg= 450ml blood (63 mlanticoagulant) eS ‘© Females can also donate blood but not in the bleeding Broan phase of the menstrual cycle. enccarwe © Machine! Ae-rostve a0 Gm © Biomixer nwo 8 OOS invalid, Iwillnot be reliable sample to evaluate. LISA plate sos — Itdisplays weight. > Ithasan auto clamp, which means it will automatically lose the tube as soon as the set limit isachieved. > Iisneeded for mixing the blood withanticoagulants, © Hemoglobin> 12.5 gm ‘© Total wellsare 12x8=96 Wells (PYQs) 402 Telegram : @teamglobalchat‘© Needle 18-19 gaugeneedle ‘* Witha needle, amicroporefilter(170 microns) is attached. ‘© The first 15-30 ml blood goes in litle bag, known as PDB - redonation bag. Usedbecause- © So,all contaminated blood is collected separately. ‘© These initially contaminated blood willbe used for testing for transfusion transmission infections. ‘© Now; the blood will go to the Mother bag, which will have Wholeblood. ‘* Next, the blood is spit into three components. All these three bags arereferred toas component bags. (© Packedred blood cells, © Platelet-richplasma © Freshfiozenplasma ‘* From the mother bag, two tubes go: TAB bag - Top And B ottom bag, ‘© When all thetubings are on the top -TAT bag -top & top bag, © WBC causestwo problems. > They release Cytokines (Interleukin), which will lead tofever. > They ean pose a risk for CMV transmission, — So, itis required to filterthe WBC out. (© Therefore, the filter is present in a center known as Leucoreduced RBC. © Team GlobalNet [Link] Q ‘© All these bags are known as Penta bags - pediatric blood transfusion, ‘© Tipsto identify platelets from plasma bags © Platelets baghasswirling > When the bag is tumed upside down, the platelets start ‘moving inasnaky type of movement. Preservatives Anticoagulants onans ‘© 350ml blood - 49 ml of anticoagulants are added, and in 450 ‘mlblood -63 ml of anticoagulants isadded Acid citrate dextrose (ACD) Citrate phosphate dextrose (CPD) Citrate phosphate dextrose Adenine (CPD-A) Citrate phosphate Saline adenine glucose mannitol (CP SAGM) ‘trate isacalcium chelator © Removeall calciumandclot formation will not be there Phosphate actsasa buifer Dextrose or glucose is added for Some nutrition tothe eel. Adenine is added to give some energy tocells (ATP) ‘Mannitol isadded to prevent lysis of rbe's When ACD or CPD is used, blood can be kept for 3 weeks or 2 days. © CPD-A-5 weeks oF 35 days 6 Thisis the most commonly used anticoagulant ‘+ CPSAGM-6weeks or42days © Not commonly used because this bagis expensive = Noe © Mnemonic - Number of letters including (-) is the ‘number of weeks the blood will last ifan anticoagulant is added ‘© Allthese time limit is for only red blood cell component Platelet agitators 403 Telegram : @teamglobalchat‘© Ifthe machine is working, then the shelf life of platelets rich plasma is proper 5 days and if it stops it comes to only I-day shelflite (AIMS). ‘© Ifthe fresh frozen plasma melts or thawing oceurs, then the shelflife sone day. ‘Summary Whole blood / PRBC 2-6 degree aid celsius (acp/cpp) 35d (CPDA) 42d(SAGM) Platelets rich plasma 20-24 degree S days with agitation Random Donor platelets (1 RDP = ‘5000 - 10000/ mm* platelets) Single donor platelets (collected from a single person) (1 SDP =30k -0k/ mm’ platelets) Fresh frozen plasma ‘© Poor in factor 5 and factor 8 Less than - 30 dogrees celsius |-year Cryoprecipitate ‘= Ithas factor 8, VWF factor 1, factor 13, Washed RBC ‘© Itisgiven incase of isolated IgA deficiency (PYQ) Sercening for TTI (Transfusion Transmitted Infection) ‘© Forindia, we test for five things which include © HIV-Type land? © HBV © HCV © Malaria © Syphilis ‘© These tests are mandatory, and without testing, giving blood © Team GlobalNet [Link] Q *Ifitis platele-rich plasma (PRP) Fresh frozen plasma (FFP)- within 20mins, it should be transfused. © FFP should be thawed/melted before giving it to the patient © Needle-18-19 gauge © Microporefiltersize- 170 MICRONS Massive Blood Transfusion (MBT) Whatever the blood volume ofthe patient, if that is replaced by more than one time of that volume within 24 hours, itis calleda massive blood transfusion, * 0r50percent ofthe total blood volume is replaced in 4 hours The ratio of RBC:PRP: FFP = [Link]; this is because if too ‘much blood is added, the blood gets diluted too much, called Because of these bicarbonates, an element of _metabolic alkalosis will happen, * Citrate toxicity due to foo much citrate anticoagulant ‘o- The function of ciate is calcium chelation - citrate pulls, apart allealeium © Hypocaleemia > This will eause tingling and numbness in the patient, ‘There is so much lysis in the blood, causing hyperkalemia meaning RBC lysis © Potassium level increase © hypocalcemia © These patients can get Dilutional coagulopathy because the factors get diluted when so many blood products are given. (© Due to it, patients can have bleeding, one of the most common causes of death, © Initial hyperglycemia followed by hypoglycemia © SAGM (saline, adenine, glucose, mannitol) is going inthe patient, elevating the glucose spike ofthe patient. © As soon as the glucose spikes, the insulin will eome up, and the patient's glucose level will decrease. ‘Transfusion Reactions © Itcancitherbe immediate or delayed. + Immediate ‘© occurring within 24 hours. © allergies/ anaphylaxis isamedical offense © Febrilenon-hemolytic transfusion reaction (FNHTR) © Febrile hemolytic transfusion reaction (FHTR) ‘Transfusion Protocols rset Hemolytic-some kind of mismatch © WITHIN 30MINS after removal from the refrigerator = Mostcommonly occur due to clerical error. ‘© RBC-shouldbe completed within4 hours ‘+ Minorblood group problem. 404 Telegram : @teamglobalchat> RBC lysis will occur ‘Type IT hypersensitivity reaction © Delayed-after24hours ‘© [Link]-antibody mismatch © Patient willalsocome with fever Febrilenon-hemolytic transfusion reaction (FNHTR) ‘© Patient will have a fever and no hemolysis is happening, ‘© This will occur due to massive eytokine release. © FromWBC © How topreventit? © Remove white blood cells from RBC > Leucoreduced RBCis given tothe patient + WBCilteris reduced by filter ‘Transfusion Related Acute Lung Injury (TRALD, © Ihishappening within 6hours © Misrelatedto (© ARD (Acute Adult Respiratory Distress Syndrome) (© Hyaline membranes forming inthe lungs ‘© In TRALI, the patient will have non-cardiogenic pulmonary Edema(NCPE) ‘© Thisisan immune mechanism ‘© Anfi-HLA antibody in the donor, which will react with the HLAantigen ofthe recipient. (© The antibody is present in plasma; therefore, itis the Donor plasma thatis ereating a problem > Maximally associated with fresh frozen plasma TRALIVs. TACO + Transfusion Related Acute Lung injury (TRALI) ‘Associated withant-HL Antibody + Transfusion-asociated eiculatry overload (TACO) © Thisoccurs due o Preexisting comorbidities Ses. + congestive hear failure + Pregnancy inthe 3rd trimester + Parameters to differentiatebetweenthe wo © Blood pressure(BP) © Jugular venous pressure JVP) © Betype natriureticpeptide (BNP) + nTRALI © BPwillbe ow sometimes © Alltheseparameters willbe normalallthe time + ntaco © [Link] BNPareelevated + TACO cancomeasadelayed disorder Delayed Transfusion Reactions Delayed Hemolytic Transfusion Reaction ‘¢ Mismatch of minor blood groups like Kell, Duffy, Lewis, ete, 405 © Team GlobalNet [Link] Post Transfusion Purpu ‘© Anti-plateletantibodiesare forming, (© Happensafter 7-10 days These antibodies are against the GP 3a receptors GVHD ‘© Transfusion-associated Graft versushost disease (GvHD) © Mechanism (© Donor and recipient, and there is an immunity discrepancy between the two, > Donor-immunocompetent — Recipient Immunocompromised © Donors willattack the poor recipient © Organs damaged © SILorgans > Skin = Rash — Intestine = Diarrhoea > Liver = Jaundice Prevention © Itradiated blood is given by @ procedure known as y radiation > Immunocompetent T cellsare removed Infections ‘(Theres @ risk ofinfection due to blood contamination RBC-2-6 degree celsius PRP-20-24 degree celsius «© FEP-<.30degree celsius ‘© Max risk of contamination is with PRP because they are at quite a high temperature of 20 -24 degree Celsius © Yersinia enterocolitica infection can be seen ‘© Eccolt infection, and Pseudomonas can also be seen. What todo when a transfusion reaction oceurs? 1. Stop the blood transfusion 2. Threesamplesaretobecollected 4. Blood > One blood sample willcomeinan EDTA vial + Used for BG/CM (blood grouping - eross matching) > One blood sample in plain red vial * Biochemical test is done to find out about the hemolysis part of it b. Urine > Test for hemoglobinurea/ Hemolysis Autologous Blood Transfusion © Recent update in the Robin's 10 the edition Telegram : @teamglobalchat© Q Team GlobalNet [Link] ‘© Autologous- giving blood tomyself + Platelevplasma Apheresis Machine © NoriskofHIV, HBS or HCV + Theblood isseparatedinto © Noriskofallerpies orinfection o RBC © Noriskof GVHD or PIP 6 Platelets © Fresh fozen plasma Preoperative autologous blood donation (PAD) + Separated because whatever componentis needed is kept, © Mosteommon + And then the other parts of the blood are returned to the + Bloodiscollected way before electivesurgery donor. 6 Eg Platelet Apheresis- blood bank has kept theplatelets Acute Normovolemic Hemodilution (ANH) © Plasma Apheresis - Plasma was taken to procure Anesthesia ke baad (Mnemonic) antibodies. © Given anesthesia, and before surgery, one unit of blood is taken. MCQ ©The blood is replaced with Normovolemic samples like crystalloid or colloid (artificial blood). Q. Diagnose the blood group. Cettsalvage ‘* Blood from the surgical drain is filtered co Tissue, debris, and fats are removed o get pureblood ‘© Very expensiveand complex process y Apheresis Machine [Link] ra © v v Control Trion) [Link] is seperated into ‘components by 9 centrifuge 1 apositive 3. Needed components are collected inta storie bags b. Bpositive 4. Unused components are ©. ABpositive returned tothe donor 4. Opositive Controlis clean Anti-A and Anti-D have Agglutination, and anti-B does not; fs thus, itis A positive Q. Name the technique of blood grouping as shown in the image below. 406 Telegram : @teamglobalchat© Team GlobalNet www. [Link] a, ELISA forblood grouping ([Link] the images with he correct option? », Golcard for blood grouping 4. Slidetest forblood grouping Tube test for blood grouping © Total 96wells- 12x8 [Name the technique of blood grouping as shown in the image below. vee b. Biomixer ©. Geleard | j J 4. Crossmatch U ([Link] the images with the correct option, ELISA forblood grouping 1. Geleard for blood grouping . Slide test for blood grouping Tubetest forblood grouping, b, c. 4 Q. Diagnose the blood group. r a. Penta transfusion b, Leukoreduced RBC 5 c. Plateletagitator a. TAB ©. TAT | J j © Tubingattopand bottom. ([Link] the images with the correct option? a. Apositive b. Bpositive ©. ABpositive 4. Opositi ‘© Mnemonic~TOP- POsitive, NEeche- Negative. 407 Telegram : @teamglobalchat© Team GlobalNet [Link] a Penta transfusion a. Kell », Leukoreduced RBC b, Dullyantigen c. Platelet agitator cc. Rhsystem 4. TAB 4. Lewis system ©. TAT + Image-Spur/Acanthocytes Q. Which cells agglutinate most strongly with Ulex europaeus * Neuro-acanthosis syndrome - also known as Mcleod lectin? phenotype-Kellsystemofblood group a. Oand az b, AtandA2 ©. OandAlB d. Band 2B Max H substanee-O>A2>B>A2B>AIB Q. The following peripheral smear finding is noted in a patient suffering from involuntary movements, including jerking motions, particularly ofthe arms and legs. Muscle tensing in the face and throat is also noted. On doing genetic analysis, which ofthe following blood group system dysfunction best ‘correlates withthe condition mentioned above? 59s” eicae pege 408 Telegram : @teamglobalchat€ Q Team GlobalNet www. [Link] Table 3.1 Red blood cell type . . a . . « l¢ . * ve . i. 2 . 'e oo” . NZ ME HE yet =e eo > et 409 Telegram : @teamglobalchat@agae see © Q F Te GlobalNet Eines ow [Link] . + *) CROSS WORD PUZZLES @ ee SS Crossword Puzzle Across 2, lisunder the control ofthe DARC gene 5. Itwasidentifiedby a group of scientists called Bhende FT AL Down 1. Kell phenotype deficiency is known as? 3. Meleod phenotype is also referred to as 4 Universal recipient TTTITtTt titi ELT TIT TTI TTT) CITT TTT 410 Telegram : @teamglobalchatTeam GlobalNet Q [Link] BLOOD BANKING & TRANSFUSION 4 64 | MEDICINE PART-2 @ Anticoagulant Added Vacuatiners ‘oa020 1, EDTAVacutainers © Contain powder form of EDTA (nat the Higuid form) + Dipotassium EDTA(K2 EDTA )isthebestofEDTA Q. Most preferreanticoagulantin Purple vacuaineris # Thecolorsinelude a. KDEDTA b. K3EDTA s s ©. No2EDTA a | s s d. Anyotthe above oy om) Sm Kiet ss ete © White © Royalblue © Pink © Pusple/Lavender © Tan ‘© Mnemonic: WHITE princess belonging toa ROYAL family needs a sun TAN and her favorite colors are PINK and PURPLE. ‘+ Thotestsin Purple include routine tests ° CBC 2. Heparin Vacutainers cmos. © Peripheral smear These aregreen containers © Reticulocyte count © ESR(Wintrobe) (2 Heparin) © HbAle Lake sreen DarkGreen ‘© Thetestsin Pinkinclude (anam nepate) © Crossmatching forblood bank ‘© Thetestsin Royal blue include fo Tests or trace elements (Cu,[Link].) © Thetestsin Whiteinelude ©. Plasma for polymerization chain reaction (PCR) ‘© Thetestsin Taninclude — SS © ForLeadincases ofead poisoning =~ times(EDTA-E for EIGHT) & [Link] ofthe followinghave EDTA asanticoagulant one OFT i, 1. Lavender top vial su000 GAs 2. Pink top vial 3. White top vial © Light green 4, Tantop val > Contains Lithium heparin (Light for Lithium) a2 © Dark green’ b. 123 ~ Contains Sodium heparin 41 + Telegram : @teamglobalchatThese are used for © Osmotic fragility testing ‘©. Immunophenotyping(CD markers) © Blood gas(ABG) Q. Most referred anticoagulant in green vacutaineris? ons a. K2EDTA b, 4 Pi K3EDTA Meparin Sodium fluoride ints to Remember Heparin vacutainers are not used for peripheral smear as it ‘makes the background of thesmear dark blue Heparin too) hits eyes) Jue Bockground of smeor ‘Platelet clumping takes place and yields inappropriate results ‘¢ Heparin inhibits enzymes (Shouldn't be used for PCR, only * White EDTA vial is used) Grey Top Vacutiners os © Team GlobalNet [Link] © Gray top for Glucose estimators FBS PPBS RBS GIT Note: For HbA le, as it estimates glycated hemoglobin rather than glucose alone, Purple/lavender vial is used, Anticoagulant used is Potassium Oxalate ‘Additive is Sodium fluoride (NaF) (© Added to inhibit Enolase which ultimately inhibits slycolysis. ‘Afler sample collection, itshould be inverted for 8-10 times. [Link] preferredanticoagulantin gray containers K2EDTA NaF Potassium Oxalate Heparin 4. Light Blue Top Vacutainer oniaa7 reyTop ———+ + Anticoagulant used is Trisodum irate 3.2% Trisodium Citrate is present oss Articoag:K oxalate = © Inverted for3-4 times AN fio oa) Wey + Asltenethet-eaitie a | os | Coagulation tudies(PT,aPT1) ola 7 > ESR (Westergr) 412 Telegram : @teamglobalchat‘ToRemember ‘© ESR(Wintrobe): Purple Vial (EDTA) ‘+ ESR(Westergren): Lightblue Vial (Trisodium citrate) ‘© Automated ESR: Black vial (Trisodium citrate) ‘© For platelet function test, Citrate, Theophylline, Adenosine and Dipytidamole are additionally addedto Light blue vial 5. Black Top Vacutainer mt: oe ‘© Anticoagulantis Trisodium Citrate ‘© Used for Automated ESR test © Team GlobalNet [Link] 3. Bright Yellow Vacutainer © Contains Acid citratedextrose(ACD) ‘© Used for HLA typing and Paternity testing 4. Orange Vacutainer + Contains Thrombin based activator gel Congulating Vacutainers twrrst © Clotting times sminsonly + Used to separate serum (Serum separator tubes) Inverted for Stimes «Prefered forhormone profil lesslike © Serum T3,14,TSH Q. Which of the following Vacutainers reduces the clotting time © HCG toSminutes cozaee ©. Prolactin,LH,FSH, Testosterone @Lightblue © KET Green © LET c. Orange + Inverted for5.6times white + Coagulaingvacutanersare ‘Order of Blood Collection 2216 fst :seum L// © Mnemonic: Stop Light is Red Stay Green Light says Go O © Samples are put into the tubes in the following order if all eo 4 "ale tubesare involved "acacia Ye er ema ©. Sterile-forcultures (Light Yellow) ISS ted a © Lightbiue- fr coagulation studies Dea ©. Red-forserum profiles testing co. Serum separating tubes (Yellow) -for serum profiles © Green-forABG 1. Red Vacutainer wi936 0. Lavender-Routinetests (CBC) + Cloting times 60 mins © Gray=for Glucose © Clotactivatorisadded + Gelisnotadded 2. Golden Yellow Vacutainer * Cloting timeis 30 mins * Clotacivatorisadded © Golisaddedtha! makes clot faster 413 Telegram : @teamglobalchatTeam 2 PREVIOUS YEAR QUESTIONS © GlobalNet [Link] [Link] a platelet poor plasma sample, calcium and tissue thromboplastin is added. This is used to assess which of the following pathway? (AIIMS 2017) A. Extrinsic B. Intrinsic C. Firinolytic D. Common Q Investigation to distinguish between pregnancy acquired hemophilia and upusanticoagulant? "-(JIPMER 2019) A. Factor assay B. ARVVTtest C. VWFassay [Link] Q. True for Von-Willebrand disease? (FMGE -Jun-2018) A. Normal PTT Decreased platelets "Normal PT B. C D. Normal BT Q Which among the following laboratory investigation i best to reveal bleeding in disseminated intravascular coagulation? (AIIMS- May -2018) Increased PT IncreasedaPTT Decreased fibrinogen ). Increased FDPs pos> 414 Telegram : @teamglobalchatGaga8 ee © a ress eG Team GlobalNet [Link] + *2 CROSS WORD PUZZLES a Crossword Puzzle Across 2. Iisunder theeontrol ofthe DARC gene 5. Itwasidentifiedby a group of scientists called Bhende ETAL Down 1, Kell phenotype deficiency is known as? 3. Meleod phenotype is also referred to as 4) Universal recipient ITTTITTIT ti tt ELLTITTITTtT ra CITTTT TT 415 + Telegram : @teamglobalchat +