A big concern with blood safety revolves around infectious disease transmission. Today, with our advances in testing the risk of acquiring HIV/AIDS from a blood transfusion is 1 in 2 million transfusions. Hepatitis C(HCV) is also a concern with a risk of 1 in 2 million transfusions. The biggest transfusion transmitted risk is bacterial transmission from Staphylococcus sp. with a risk of 1 in 500,000 in RBCs and 1 in 50,000 for platelets. Prevention of Transfusion Transmitted Disease is accomplished using a detailed Donor History Questionnaire (DHQ) and Infectious Disease Testing.
Infectious Disease Tesing is required on all transfused Blood products and they are the following:
Hepatitis B surface Antigen (HBsAg)
antibody to Hepatitis B core (anti-HBc)
antibody to Hepatitis C (anti-HCV)
Hepatitis C RNA (HCV RNA) - Nucleic acid testing (NAT)
antibody to HIV-1/2 (anti-HIV-1/2)
HIV-1 RNA (NAT)
antibodies to HTLV-I/II (anti-HTLV-I/II)
West Nile virus RNA (WNV RNA) (NAT)
serologic test for syphilis
Platelets are also tested for bacterial contamination
NAT is able to amplify and detect genetic sequences of a virus, so that those infected with these viruses are detected earlier (some within 10 days after exposure) to prevent transmission.
Monday, May 16, 2011
Saturday, May 14, 2011
ABO Blood Group
The ABO Blood Group System was discovered in 1900 by Landsteiner and is the most important Blood Group System.
There are 4 different ABO Blood Types: A, B, AB, and O
The gene for the H antigen is locared on Chromosome 19 and encodes for L-fucosyltransferase.
This enzyme places Fucose onto precursor chains on the RBC and on precursor chains in secretions (urine, saliva, plasma, etc).
The genes for the A and B antigens is locared on Chromosome 9 and there are two co-dominant alleles, A and B.
The B allele encodes for D-galactosyltransferase
The A allele encodes for N-acetylgalactosaminyl transferase
These enzymes added a sugar onto the Fucose that was added by the H gene.
ABO type of a person is determined by these sugars on the RBC
A - N-acetylgalactosamine
B - D-galactose
AB - both N-acetylgalactosamine and D-galactose
O - no sugar is added
The ABO blood group system is unique as it is the only one that the body will form antibodies to the antigens. For example, if you are an A you will have antibodies to B. This is why the blood group system is so important. If you were to transfuse B RBCs to an A person, they would destroy them and cause catastrophic problems for the body that may include death. The Blood Banks most important test is to determine the ABO type of recipients and blood donors to ensure that this does not happen.
ABO typing consists of performing an antigen typing of the RBCs (look for the A and/or B antigen) and the reverse typing (look for anti-A and/or anti-B in the plasma). This is how a person's ABO blood type is determined.
ABO type ABO Antigen Typing ABO reverse typing
A A antigen present anti-B present
B B antigen present anti-A present
AB A and B antigen present No ABO antibodies present
O No A or B antigens present anti-A & anti-B present
There are 4 different ABO Blood Types: A, B, AB, and O
The gene for the H antigen is locared on Chromosome 19 and encodes for L-fucosyltransferase.
This enzyme places Fucose onto precursor chains on the RBC and on precursor chains in secretions (urine, saliva, plasma, etc).
The genes for the A and B antigens is locared on Chromosome 9 and there are two co-dominant alleles, A and B.
The B allele encodes for D-galactosyltransferase
The A allele encodes for N-acetylgalactosaminyl transferase
These enzymes added a sugar onto the Fucose that was added by the H gene.
ABO type of a person is determined by these sugars on the RBC
A - N-acetylgalactosamine
B - D-galactose
AB - both N-acetylgalactosamine and D-galactose
O - no sugar is added
The ABO blood group system is unique as it is the only one that the body will form antibodies to the antigens. For example, if you are an A you will have antibodies to B. This is why the blood group system is so important. If you were to transfuse B RBCs to an A person, they would destroy them and cause catastrophic problems for the body that may include death. The Blood Banks most important test is to determine the ABO type of recipients and blood donors to ensure that this does not happen.
ABO typing consists of performing an antigen typing of the RBCs (look for the A and/or B antigen) and the reverse typing (look for anti-A and/or anti-B in the plasma). This is how a person's ABO blood type is determined.
ABO type ABO Antigen Typing ABO reverse typing
A A antigen present anti-B present
B B antigen present anti-A present
AB A and B antigen present No ABO antibodies present
O No A or B antigens present anti-A & anti-B present
Picture of the reagents for ABO typing.
Friday, May 13, 2011
Blood Components
Whole Blood:
Contains all blood elements plus anticoagulant-preservative
Contains all blood elements plus anticoagulant-preservative
Used to increase oxygen carrying capacity and volume expansion in massively bleeding patients.
Storage: 1-6° C for up to 35 days
Red Blood Cells (RBCs):
Prepared from whole blood after removal of plasma or collected using an apheresis machine(2 unit).
Used to increase oxygen carrying capacity
Storage: 1-6°C for up to 42 days
Fresh Frozen Plasma (FFP):
Prepared from whole blood or using an apheresis machine.
Used to treat patients with multiple coagulation factor deficiency who are bleeding or who will be undergoing an invasive procedure.
Fresh Frozen Plasma (FFP):
Prepared from whole blood or using an apheresis machine.
Used to treat patients with multiple coagulation factor deficiency who are bleeding or who will be undergoing an invasive procedure.
Contains maximum levels of labile (Factor V and VIII) and no labile clotting factors.
Storage: Frozen <-18°C for up to 12 months
Storage: Frozen <-18°C for up to 12 months
Thawed at 30-37°C and stored at 1-6°C for up to 24 hours
Platelets:
Prepared from whole blood (not <20°C) within 4 hrs or by using an apheresis machine.
Used of thrombocytopenia in bleeding patients (<50,000/ml)
Storage: 20-24°C with agitation for up to 5 days
Cryoprecipitate:
Prepared from the insoluble portion of FFP when it is hawed at 1-6°C, and is refrozen within 1 hr of preparation.
Used to treat fibrinogen deficiency or Factor XIII deficiency.
Contains High levels of fibrinogen, Factor VIII and XIII and is suspended in 15ml of plasma
Storage: Frozen <-18°C for up to 12 months
Thawed at 20-24°C for up to 6 hours
Granulocytes:
Prepared from whole blood or apheresis (mostly apheresis).
Can be harvested in buffy coats (UK)
Used when patient has an infection, neutropenia, a failure to respond to antibiotics, myeloid hypoplasia, and a reasonable chance of recovery.
Transfuse as soon as possible after collection
Storage: 20-24°C with no agitation for up to 24 hours
Thursday, May 12, 2011
Governing Bodies
The Blood Bank is a high regulated industry that is monitored and inspected by many different organizations.
Regulatory Agencies:
These agencies enforce Federal Law and can shut down a hospital or lab if these regulations are violated.
Food & Drug Administration (FDA)
Provide Code of Federal Regulations (CFR) that are rules written and enforced by the Federal Government
Provide current Good Manufacturing Practices (cGMP) which gives guidance on production of drugs and biologics to ensure safety, purity, and potency.
The FDA can inspect any facility unannounced.
Centers for Medicare & Medicaid Services (CMS)
Provide CMS regulations for the protection of patients and donors, which includes Civil Rights and Privacy Laws related to health care and research.
Accrediting Agencies:
These agencies set standards that must be met by the hospital or lab to attain and maintain accreditation. These agencies do routine unannounced inspections of accreditated facilities.
Joint Commission on Accreditation Of Healthcare Organizations (JCAHO)
College of American Pathologists (CAP)
Advancing Transfusion and Cellular Therapies Worldwide (AABB)
Laboratory Specific Laws:
Clinical Laboratory Improvement Act of 1988 (CLIA '88), in 1988 the Congress decided that their needed to regulate all the labs in the US. Explanation of CLIA '88 .
Other agencies that regulate the Blood Bank:
Occupational Health & Safety Administration (OSHA)
Provides and enforces regulations to provide safe and healthful working conditions.
They require employers to provide safety training of personnel, personal protective equipment (PPE), vaccinations, and follow-up care for any exposures to hazardous material.
Department of Transportation (DOT)
U.S. Department of Transportation Pipeline and Hazardous Materials Safety Administration (PHMSA) provides a guidance document to ensure safe shipping of blood products.
Nuclear Regulatory Commission (NRC) regulates how nuclear material is used in the U.S. and how it is protected from misuse. Hospitals, Blood Banks, and Donor Centers having access to radioactive material for manipulation of Blood Products must follow these regulations.
Regulatory Agencies:
These agencies enforce Federal Law and can shut down a hospital or lab if these regulations are violated.
Food & Drug Administration (FDA)
Provide Code of Federal Regulations (CFR) that are rules written and enforced by the Federal Government
Provide current Good Manufacturing Practices (cGMP) which gives guidance on production of drugs and biologics to ensure safety, purity, and potency.
The FDA can inspect any facility unannounced.
Centers for Medicare & Medicaid Services (CMS)
Provide CMS regulations for the protection of patients and donors, which includes Civil Rights and Privacy Laws related to health care and research.
Accrediting Agencies:
These agencies set standards that must be met by the hospital or lab to attain and maintain accreditation. These agencies do routine unannounced inspections of accreditated facilities.
Joint Commission on Accreditation Of Healthcare Organizations (JCAHO)
College of American Pathologists (CAP)
Advancing Transfusion and Cellular Therapies Worldwide (AABB)
Laboratory Specific Laws:
Clinical Laboratory Improvement Act of 1988 (CLIA '88), in 1988 the Congress decided that their needed to regulate all the labs in the US. Explanation of CLIA '88 .
Other agencies that regulate the Blood Bank:
Occupational Health & Safety Administration (OSHA)
Provides and enforces regulations to provide safe and healthful working conditions.
They require employers to provide safety training of personnel, personal protective equipment (PPE), vaccinations, and follow-up care for any exposures to hazardous material.
Department of Transportation (DOT)
U.S. Department of Transportation Pipeline and Hazardous Materials Safety Administration (PHMSA) provides a guidance document to ensure safe shipping of blood products.
Nuclear Regulatory Commission (NRC) regulates how nuclear material is used in the U.S. and how it is protected from misuse. Hospitals, Blood Banks, and Donor Centers having access to radioactive material for manipulation of Blood Products must follow these regulations.
Tuesday, May 10, 2011
Blood Donor Selection - Physical Exam
Not just anyone can be a Blood Donor. There is a specific process that must be followed to ensure a safe donation for the donor and a safe product for the recipient. The following are the physical requirements for allogeneic donation.
Physical Exam:
Appear to be in Good Health
Weight: > 110 lbs (to ensure donor can tolerate donating 500ml of blood)
Temperature: < 37.5 C or 99.5 F (to ensure there is not an underlying infection)
Pulse: 50-100 beats per minute (<50 is acceptablefor athletes) (to ensure no underlying cardiac problem that donor cannot tolerate blood donation)
Blood Pressure: <180/100 mm Hg (to ensure no underlying cardiac problem that donor cannot tolerate blood donation)
Hemoglobin: > 12.5 g/dL or Hematocrit >38% or Specific Gravity with Copper Sulfate >1.053
Venipuncture site must be free of skin lesions (to prevent contamination of blood donation or identify drug use)
If a donor does not meet these criteria they will deferred from the current donation but can attempt again at a later time.
Physical Exam:
Appear to be in Good Health
Weight: > 110 lbs (to ensure donor can tolerate donating 500ml of blood)
Temperature: < 37.5 C or 99.5 F (to ensure there is not an underlying infection)
Pulse: 50-100 beats per minute (<50 is acceptablefor athletes) (to ensure no underlying cardiac problem that donor cannot tolerate blood donation)
Blood Pressure: <180/100 mm Hg (to ensure no underlying cardiac problem that donor cannot tolerate blood donation)
Hemoglobin: > 12.5 g/dL or Hematocrit >38% or Specific Gravity with Copper Sulfate >1.053
Venipuncture site must be free of skin lesions (to prevent contamination of blood donation or identify drug use)
If a donor does not meet these criteria they will deferred from the current donation but can attempt again at a later time.
Monday, May 9, 2011
The Blood Bank
The Blood Bank is a special part of the lab that not only performs laboratory tests, but distributes much needed blood products to our patients. I feel rewarded each and every day that I can help save a life through my efforts. Blood donation is essential to our job and relies on the volunteer donation of others. I have spent the last 14 years of my life studying and working in a very busy Blood Bank and have learned so much as a Specialist in Blood Banking.
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