INTRO I 2 25

the Joint Commission (JC) standards

federal-level

state in which it resides

Clinical Laboratory'

state, CLIA, and CAP

Clinical Laboratory Improvement Amendments

a facility that tests any human sample for the purpose of diagnosis, prevention, treatment, or monitoring of disease

personnel license and a facility license

TJC, CAP, AABB, CMS / CLIA

hospital and lab healthcare organizations

association for the advancement of blood and biotherapies

Centers for Medicare and Medicaid services

study of immune response to blood (ex. Blood transfusion & other immune responses related to blood / blood group antigens)

1. transfusion medicine - GIVING blood
2. donor center - TAKING blood

protect the patient receiving blood produces and protects the donor who gives blood

blood banking

quality management

1. unit of blood / blood component is compatible with pt
2. no intentional adverse reactions towards transfused blood

1. blood typing (ABO & Rh)
2. antibody screening (ABS)
3. crossmatching (xmatch / xmat) of blood

1. whole blood (WB)
2. Red blood cells (RBCs)

provides both plasma for volume & RBCs for oxygen-carrying capacity to vital organs (brain, liver, heart, etc)

O2-carrying capacity to vital organs (brain, liver, heart)

RBCs

hemoglobin-oxygen dissociation curve

blood is stored for a longer time, decreased 2-3 DPG, means INCREASE in affinity (O2 wants to stay on the RBC not to target)

shows RBC affinity to oxygen and its ability to release oxygen to vital organs

plasma (plsm)
platelets (plts)
cryoprecipitate (cryo)

provides all coagulation factors (non-cellular elements e.g., factor I-XIII)

platelets provide clotting capacity via cellular elements ; helps form scab at wound

provides factor VIII & fibrinogen, used for specific factor replacement or 'fibrin glue' to stop oozing blood

donor safety is priority

FDA, CAP, & AABB

repeat donors

liquid form (can be frozen)

altruistic reasons (not for cash) ; humanitarian reasons

Jun - Aug. ; nov-jan (vacations / holidays)

1600s (using sheep's blood)

1818

1900 (by Landsteiner)

1916

1939 (by Levine)

Christian science groups / Jehovah's witness

Red cells, white cells, plasma, platelets

red cell fractions, white cell fractions, plasma fractions, and platelet fractions

hemoglobin based blood substitutes, interferons / interleukins, albumin, globulins, clotting factors, wound healing factors

1. giving pt erythropoietin
2. giving pt vitamins (vitamin K)
3. using harmonic scalpel
4. intraoperative blood salvage system
5. artificial hemoglobin

hormone that creates RBCs

help blood clot

cuts and cauterizes at the same time (to prevent too much bleeding)

recovers blood from operating table, washes it, and returns the cleaned blood to the pt

mimics human hemoglobin (still being studied)

pharmaceutical drugs

needs a written prescription for transfusion

The FDA, for the protection of the consumer

can cause a severe adverse effect on the pt

hemolytic (intravascular / extravascular)
non-hemolytic (allergies, febrile, circulatory overload)

in blood refrigerator (1-6C); time frame dependent on anticoagulant

21 days

35 days

42 days

room temp (20-24C) for 5 days

less than 18C for up to 1 year

in blood fridge (1-6C) for up to 5 days

surfaces of RBCs and platelets

36 human blood group resulting in 379 different antigens

346 RBC antigens and 33 platelet antigens

27 antigens

pt can develop and ab to RBC ag

cause subsequent transfusion reactions by attacking the transfused cells and destroying them

1. autosomal dominant
2. autosomal recessive
3. sex-linked (dom / rec)
4. codominant

2 genes are equally expressed when both are present

states genotype frequencies in a population remain constant or in equilibrium from generation to generation unless specific influences are introduced

studies population genetics; permits estimation of gene frequencies from phenotype frequencies observed in population

p2+2pq+q2=1

p = gene frequency of dominant allele

q = gene frequency of recessive allele

1. population studied must be large
2. mating must be random
3. mutations must not occur in parents or offspring
4. no migration, differential fertility, or mortality groups of genotypes studied

physical attribute you can 'see'

using specific ag antisera with RBC

anti-A, anti-B, anti-A,B

anti-D, anti-C, anti-c, anti-E, anti-e

not a physical attribute you can 'see'

by the detection of the molecular make-up of the blood group antigens; analysis / probe for a single nucleotide polymorphism (SNP)

large Ig (pentamer)
does not pass placenta
readily binds to complement
reacts at RT or lower

IgM

small Ig (monomer)
single Y shaped Ig
passes placenta
only certain types bind complement

37C or at AHG test phase of antibody detection testing / ABS

IgG3 > IgG1 > IgG2 > IgG4

IgG (80%)

as a dimer / trimer containing J chain that joins monomers together

in mucosal secretions

protect the underlying epithelium from bacterial / viral penetration

no

pt may have anti-IgA that can cause severe transfusion reaction if transfused with plasma-containing products

purple, red, pink

EDTA (K2 EDTA or K3 EDTA)

dried form coated along sides of plastic specimen tube

liquid form found in glass specimen tubes

anticoagulant binds Ca in the blood and prevents clotting

common in hematology, but can be used in BB for RBC antigen typing only

NO anticoagulant / additives ; just plain glass or plastic

yes

spin specimen for 5 mins

antibody detection and identification

blood typing (if purple top is not available)

K2 EDTA

1. antisera
2. red cell reagent
3. antiglobulin reagents
4. potentiators / enhancement media
5. lectins

possess Abs of known specificity

RBCs that posses ags of known specificity

detects IgG and complement on RBCs

reagent used to increase Ab uptake to corresponding ag or enhance RBC agglutination

plant extracts that react to specific human RBC ags

1. review package inserts
2. adhere to package insert instruction for use
3. adhere to manufacturer's restrictions and precautions

used with pt sera to identify pt Abs that are present

used as positive and negative controls

saline media

potentiator media OR saline media

to enhance reactivity to RBCs

to react at the AHG phase of testing

none known at this time

usually an immune response
produced by multiple B cell lines
broader specificity due to mixture of Abs to multiple epitopes

produced by single B cell line
specificity directed at single epitope
identical Ab molecules

1. unlimited production
2. no human source
3. IgM antibody
4. no contaminating Ab(s)
5. standardized reagents
6. little to no variation between batches
7. limited used to phenotype DAT+ RBCs

animal source Ab usually obtained through hybridoma technology

so direct agglutination occurs in shorter time

1. 22% albumin (bovine)
2. low ionic strength solution (LISS)
3. polyethylene glycol (PEG)

decreases zeta potential by buffering &
allows ab-coated cells to come close together

decreases zeta potential & increases ab uptake
serum / cell ratio very important

removes water (concentrates ab)
uses specific AHG with IgG (or else false +)
do not read agglutination microscopically (or else false +)

DUVIAGSS
Dolichos biflorus, ulex europaeus, vicia graminea, iberus amara, arachis hypogae, glycine soga, salvia sclarea, salvia horminum

A1

H

N

M

T

differentiates polyagg

Tn

differentiates polyagg

0, 1, 2, etc

strength of reactions may also be associated with the titer of antibody or the affinity of the ab

non-immune hemagglutination reactions

single clump of agglutination with no free cells

3-4 individual clumps with few free cells

many large clumps with many free cells

fine granular appearance, but definite small clumps per low power field

2-3 cells sticking together per low power field, uneven distribution; visually no agg

all cells are free

hemolysis (partial or total) must be interpreted as positive