[2] CHAPTER I LESSON 2 Flashcards
- studies Ag-Ab reactions and analogous phenomena as they relate to the pathogenesis and clinical manifestations of blood disorders
IMMUNOHEMATOLOGY
Major blood groups:
A. B. AB. O. Rh
is also a type of organ transplantation
Blood
TRALI -
transfusion-related acute lung injury
TACO -
transfusion-appropriated circirculatory overload
TTI –
transfusion transmissible infections
- refers to the process of collecting, separating, and storing blood
BLOOD BANKING
First time a blood transfusion was recorded in history.
Pope Innocent VII (1492)
Sodium phosphate
Braxton Hicks (1869)
ABO blood groups
Karl Landsteiner (1902)
Explained results of incompatible trasfusions
Karl Landsteiner (1902)
Vein to vein transfusion
Edward E. Lindemann
Syringe-valve apparatus
Unger
Sodium citrate as an anticoagulant
Hustin (1914)
Minimum amount of citrate needed for anticoagulation
Lewisohn (1915)
Dev of preservative solutions to enhance the metabolism of the rbc
Lewisohn (1915)
Citrate dextrose solution for the preservation of blood
Rous and Turner
Techniques in blood transfusion and blood preservation
Dr. Charles Drew
Journal of Clinical Investigation
July 1947
Introduced an improved preservatice solution called citrate-phosphate-dextrose (CPD)
Gibson (1957)
Frequent transfusions and the massive use of blood resulted in new problems
Component Therapy
Introduced the formula for the preservative acid-citrate-dextrose
Loutit and Mollison
The amount of whole blood in a unit has been
450 mL +/- 10% of blood (1 pint)
More recently.
500 mL +/-10% of BLOOD
For a 110 lb (50 kg) donor, a maximum of (?) can be collected
525 mL
Total blood volume for most adults:
10 to 12 pints
Donors can replenish the fluid lost from the donation of
1 pint in 24 hours.
The donor’s red cells are replaced within (?) after donation.
1 to 2 months
A volunteer donor can donate blood every
8 weeks
Units of the whole blood can be separated into three components:
Packed red blood cells, platelets, and plasma
The plasma can be converted by(?) to a clotting factor concentrate that is rich in (?)
cryoprecipitation
antihemophilic factor
(?) can donate given that the blood type is rare by decreasing the anticoagulant in proportion to the blood donated
Ex. (?)
<50 kg
Autologous donation
A unit of whole blood-prepared RBCs may be stored for (?), depending on the anticoagulant-preservative solution.
21 to 42 days
STORAGE TIME OF ACP AND CPD
21 days
contains information on the risks of infectious diseases transmitted by blood transfusion, including the symptoms and sign of AIDS, is given to each prospective donor to read
Educational Materials
Step 1:
Educational Materials
Step 2:
The Donor Health History Questionnaire
Step 3:
The Abbreviated Physical Examination
A uniform (?), designed to ask questions that protect the health of both the donor and the recipient, is given to every donor.
The Donor Health History Questionnaire
is used to identify donors who have been exposed to diseases that can be transmitted in blood.
The Donor Health History Questionnaire
The abbreviated physical examination for donors includes
blood pressure, pulse, and temperature readings; hemoglobin or hematocrit level; and the inspection of the arms for skin lesions.
AABB
Step 1: Educational Materials
pamphlet
Step 1: Educational Materials
“An Important Message to All Blood Donors”
Step 1: Educational Materials
variant Creutzfeldt-Jakob
Step 2: The Donor Health History Questionnaire
West Nile fever
Step 2: The Donor Health History Questionnaire
Malaria
Step 2: The Donor Health History Questionnaire
Babeslosis
Step 2: The Donor Health History Questionnaire
Chaga’s disease
Step 2: The Donor Health History Questionnaire
Current Donor Screening Tests for Infectious Diseases
The donation process, especially (?), has been carefully modified over time to allow for the rejection of donors who may transmit transfusion-associated disease to recipients.
steps 1 and 2
The (?) is safer than it has ever been because of the donation process and extensive laboratory screening (testing) of blood.
nation’s blood supply
The use of (?), licensed by the Food and Drug Administration (FDA) since 2002, is one reason for the increased safety of the blood supply.
nucleic acid amplification testing (NAT)
Syphilis
1950’s
Hepatitis B surface antigen (HBsAg)
1971
Hepatitis B core antibody (anti-HBc)
1986
Hepatitis C virus antibody (anti-HCV)
1990
Human immunodeficiency virus antibodies (anti- HIV-1/2)
1992
Human T cell lymphotropic virus antibody (anti-HTLV-I/II)
1997
Human immunodeficiency virus (HIV-1) (NAT)*, **
1999
Hepatitis C Virus (HCV) (NAT) **
1999
West Nile Virus (NAT)
2004
Trypanosoma cruzi antibody (anti-T. cruzi)
2007
Hepatitis B virus (HBV) NAT
2009
Babesia microti antibody and NAT (recommended)
2012
Zika virus NAT
2016
1 Anti-HIV-1 testing implemented in
1985
2 Anti-HTLV testing implemented in
1988
diseases - US
12
diseases - pH
4
: Increased safety for the blood supply
NAT
licensced by DOST
NAT
MORE SENSITIVE
NAT
Three areas of RBC biology are crucial for normal erythrocyte
survival function:
- Normal chemical composition and structure of the RBC membrane
- Hemoglobin structure and function
- RBC metabolism
RBC’s- days in the circulation
• Represents a semipermeable lipid bilayer supported by a meshlike protein cytoskeleton structure.
RBC MEMBRANE
- main lipid component of the membrane, arranged
in a bilayer structure comprising the framework in which globular proteins traverse and move.
Phospholipids
Semi-permeable
Integral and Peripheral proteins
some cpt readily passes thruprovided that No there are channel proteins
Semi-permeable
inner -
hydrophobic
outer -
hydrophilic
ribosome:
golgi:
packaging
central dogma:
transc-transl
The biochemical composition of the RBC membrane is
approximately
52% protein, 40% lipid, and 8% carbohydrate
: The loss of RBC membrane is exemplified by the formation of spherocytes and bite cells.
Deformability
: The RBC membrane is freely permeable to water and anions.
Permeability
The RBC membrane is relatively impermeable to cations such as
sodium and potassium
The erythrocyte intracellular-to- extracellular ratios for Na+ and K+ are (?), respectively
1:12 and 25:1
Intracellular
Potassium
cells are called (?), since it leaks out during rupture ex. in cases of muscle wasting
“bag of K+”
Test conducted for emergency cases
K
STAT test
K
Rupture of cells - release of
K
Lethal injection
o first convicted criminal is
o main component is
Leo Echegaray
potassium
for marathon runners, banana is given to relax the muscles
(high in K)
K
may lead to cardiac arrest (serum-potassium)
K
Goal of Blood preservation: To provide (?) for patients requiring blood transfusion.
viable and functional blood components
2 criteria used to evaluate new preservation solutions and
storage contalners:
An average (?) of more than 75%
Red cell integrity be maintained throughout the shelf-
life of the stored RBC’
24-hour post transfusion RBC survival
120 days
To maintain optimum viability, blood is stored in the liquid state between
1oC and 6oC
The loss of RBC viability has been correlated with the
“lesion of storage”
RBC Storage Lesion
% Viable Cells
Decreased
Glucose
Decreased
ATP
Decreased
Lactic Acid
Increased
pH
Decreased
2,3-Diphosphoglyceric Acid
Decreased
Oxygen Dissociation Curve
Shift to the
Left
Plasma K+
Increased
Plasma hemoglobin
Increased
Adenine supplemented blood can be stored at (?) for (?); other anticoagulants are approved for (?).
1 to 6 degrees Celsius
35 days
21 days
Chemicals in Anticoagulant solutions:
- Citrate
- Monobasic sodium phosphate
- Dextrose
- Adenine
- chelates calcium; prevents clotting
- Citrate
- maintains pH during storage
- Monobasic sodium phosphate
- Substrate for ATP production
- Dextrose
- Production of ATP
- Adenine
21 STORAGE TIME (DAYS)
Acid Citrate-Dextrose (formula A)*
Citrate-phosphate dextrose
Citrate-phosphate-double dextrose
35 STORAGE TIME (DAYS)
Citrate-phosphate-dextrose-adenine
*ACD-A is used for
apheresis components