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IMMUNOHEMATOLOGY AND TRANSFUSION MEDICINE

PREPARED BY: AN MARGARETE T. TAN, RMT, MSMT

Immunohematology
Division of hematology concerned with immune, or antigen-antibody reactions, and
with related changes in the blood
Transfusion Medicine
Branch of medicine that is concerned with transfusion of blood and blood components
I.
1492

Historical Perspectives in Blood Bank


Pope Leo Innocent VII
First reported blood transfusion; blood from three young men
1667-1829 No Blood Transfusion done at this period
1829 James Blundell : successful transfusion in woman with post-partum hemorrhage
Search for a nontoxic anticoagulant
1869 Braxton Hicks sodium phosphate
1901 Karl Landsteiner : discovery of ABO blood groups (A, B, O)
1902 von Descatello & Sturle : discovery of blood group AB
Edward E. Lindemann : multiple syringes and a special cannula for puncturing the vein through
the skin
Unger : syringe valve apparatus
1914 Hustin : sodium citrate as anticoagulant
1915 Lewisohn : determined the minimum amount needed
Development of preservative solutions to enhance the metabolism of RBC
Rous and Turner : citrate-dextrose solution
1930 function of dextrose was understood
1940 Weiner and Landsteiner : Rh blood group system
1941 Dr. Charles Drew : techniques in blood transfusion and blood preservation
Feb, Appointed director of the first American Red Cross at Presbyterian Hospital
1943 Loutit & Mollison : formula for acid-citrate-dextrose (ACD)
1947 Blood banks were established; transfusion became common
Led to the discovery of numerous blood group systems
1957 Gibson : citrate-phosphate-dextrose (CPD);
CPD replaced ACD as standard preservative for blood storage
Frequent transfusions resulted in new problems
Component Therapy was introduced
2002 Use of Nucleic Acid testing (NAT)
Current Status
According to the AABB: American Association of Blood Banks
19 million volunteer donors in 2008
One in three people will need blood at some point
450mL 10% of blood 500mL 10% of blood are collected
AC: preservative ratio from 63mL to 70mL
10 screening tests for infectious diseases:
Syphilis, HBsAg, anti-HBc, anti-HCV, anti-HIV1/2, anti-HTLV1/2, (HIV-1, HCV, West Nile,
Trypanosoma cruzi antibody using NAT)

IMMUNOHEMATOLOGY AND TRANSFUSION MEDICINE

PREPARED BY: AN MARGARETE T. TAN, RMT, MSMT

I.

Review of Genetics and Immunology


Gene - Basic unit of inheritance
- hold the information to build and maintain an organism's cells and pass genetic traits to
offspring
- Made up of 2 polynucleotide chains wrapped each other to form a helix
Role of Genetics
1. Testing for inherited diseases
2. Search for new genetic markers
3. Determining legal outcomes
4. Development of advanced treatment options with the advent of gene therapy
Gregor Mendel
- Used sweet pea plants to study physical traits and inheritance
- elementen- now known as genes
- Observed flower color, seed color and shape
First law of inheritance: Law of Independent Segregation
- Individual traits are inherited separately from each other
Second Law of inheritance: Law of Independent Assortment
- Gene for different traits are inherited separately from each other
Terminologies:
1. Chromosomes
- organized structure of DNA and protein that is found in cells
- 46 total: 23 homologous pairs
- 22 autosomes + 1 sex chromosome X or Y (XX female; XY male)
2. Locus - Specific location or position of a gene on a chromosome
3. Allele - 1 of 2 or more diff gene occupying a space locus in chromosome
4. Amorph - silent gene; unable to produce detectable antigen on red cell surface
5. Homozygous both alleles are the same; pair of identical genes
6. Heterozygous alleles are different; pair of different genes
7. Antithetical- used to describe a pair (and occasionally more than a pair) of antigens that are
coded by different alleles of a single gene.
- Term used to describe allelic antigens and means opposite.
- If an individual is heterozygous there will be one copy of each on opposite chromosomes
- M is then said to be antithetical to antigen N; Kell Cellano, Ii, MNSs
8. Phenotype - the assortment of antigens actually detectable on an individual's red cell.
9. Genotype - cannot be determined with certainty and can only be accomplished through family
studies; controls what antigens may be expressed on the cell
10. Dominant gene present; trait will be expressed
11. Recessive trait will not be expressed unless present in a double dose
12. Codominant - pair of genes neither are dominant than the other; both expressed
RBC Antigen and Antibody reactions
1. Antigen / Agglutinogen found on the RBC surface
2. Antibody / Agglutinin glycoproteins produced by plasma cells in response to antigen
Dynamics of Antigen- Antibody Reactions
- Attractive forces vary in strength with changes in pH, ionic strength, temperature and
nature of solvent.
2

IMMUNOHEMATOLOGY AND TRANSFUSION MEDICINE

PREPARED BY: AN MARGARETE T. TAN, RMT, MSMT

- Blood group antigens and antibodies bind until dynamic equilibrium is reached.
- Represented by bell shaped curve based on concentration. (Zone of Equivalence)
Prozone: excess of unbound immunoglobulin; antibody excess
Postzone: surplus of antigen; excess antigen
Zone of equivalence: optimum reaction occurs
1. Agglutination / Hemagglutination
RBCs have antigens which combine with antibodies present in serum (either patient or reagent).
Antibody bridges form with antigens on adjacent cells resulting in agglutination.
2. Hemolysis caused by antibody binding, activation of complement which results in destruction of
RBC membrane.
TWO stages involved
1. First stage is sensitization, attachment of an antibody to corresponding antigen on RBC
membrane.
2. Second stage is lattice formation, bridges form between sensitized cells.
a. IgG have 2 antigen binding sites, one binds to antigen on one cell, the other binds to
antigen on adjacent cell.
b. IgM has 5 antigen binding sites and can bind to several antigen sites on different cells.
Lattice formation will result in hemagglutination.
Zeta Potential Theory: RBC surface has sialic acid molecules
In saline, cations are attracted to negative red cell surface forming a repelling cloud around the
cell; Electric repulsion
Potentiator: enhance antigen and antibody reactions (ex. LISS)
Lectins/Prolectins: Antibody-like substance derived from plant extract
Lectin specificity
Anti-A1
Anti-B
Anti-H
Anti-M
Anti-N
Prolectin specificity
Anti-A1
Anti-A2
Anti-B
Anti-H

Plant source
Dolichos biflorus
Banderaea simplicifolia
Ulex europaeus
Iberis amara; I. umbellata, I. semperivens
Madura aurantiaca
Vicia graminea; Bauhinia variegate; B. candicans
Snail source
Helix pomatia; H. aspersa, Cepaea nemoralis
Euphrada periomphala; Bradybaenafruticum spp.
Salmo irideus
Eel