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CLINICAL PATHOLOGY: BLOOD BANKS

3 blood products:
Goal of red blood cell transfusion = improve O2 in blood
Platelets = increase platelet count -> increase coagulation of blood
Plasma = everything else -> improve coagulation
Blood type of general population
O 45%
A 40%
B 10%
AB 5%
Rh+ (Rh-D) - 85%
Rh- (Rh-d) 15%
Enzymes on surface of RBC (blood type)
A enzyme N-additive glucosamine (NAG)
B enzyme galactosamine (GAL)
O non-functional protein = does not add sugar to anything
To have kids with all 4 blood types, parents have to have AO and BO
Rh
Rh-DD, Rh-Dd, Rh-dd
Hardy-Weinberg equation: p^2+2pq+q^2; p+q=1
Predict whats out there
Effect of Rh on mother-baby
During pregnancy, some blood from baby could get into placenta
and mom makes anti-D
Affects subsequent pregnancies when baby is Rh+, anti-D
destroys babys RBCs
Give Rhogam during pregnancy and after delivery to keep moms
immune system from making anti-D
When to give Rh+ blood to someone Rh Trauma
Male = Rh+
Female = Rh In trauma, can lose red cells but concentration of hemoglobin
remains the same until refill up tank (ex: saline)
Transplant
Make Ag to foreign Ab so would require immunosuppressants which
also prevent making anti-D
1 unit of blood = 500mL = L
Normal blood volume = 6 units (?)
Transfusion
1. Add anti-coagulant = citrate
a. Binds to Ca2+ so Ca2+ does not flow loosely in blood
b. All clotting factors are Ca2+-dependent (serine proteases)
2. Run through filter to remove white cells (reduce risk of CMV infection)
a. Neonates = neurologic problems

b. Immunosuppressed
3. Centrifuge = bottom red cells, top plasma
a. 1 bag RBC, 1 bag plasma
4. Add AdSol (citrate, dextrose, phosphate, mannitol) as preservative for RBC
a. AdSol 1 and 5 have mannitol
b. Adsol 3 has no mannitol
c. Too much mannitol can cause brainstem/uncal herniation in little kids
5. Some plasma proteins remain in centrifuged RBC so need to:
a. Wash blood to remove things in plasma for patients who are deficient
i. Some people are IgA deficient = anaphylactic shock
ii. RBC can leak K+ as they get older = myocardium to fail
b. Irradiate RBC to prevent Graft vs Host Disease (kids or
immunosuppressed)
Raise hemoglobin in adult by 1 glde
Platelet transfusion raises 20k platelets
Plasma transfusion generally adds clotting factors and reduce INR
Cryoprecipitate concentrated fibrinogen, factor V, VIII, XIII (XIII = cross-links
fibrin strands and helps shrink to strengthen clot)
Transfusion transmitted diseases (risk of infections)
1 in 2 million
Organ transplant
Similar to blood groups with exception:
Can give out of group is donor has subtype A2 if titer of Ab is low
enough
Stronger immunosuppressants
O can get O or A2
AB can get A, B, O
Bone marrow transplant must have 10/10 match
Kidney should have at least 9/10 match
Cross-match = mix donor and patient red cells
Agglutination = incompatible (positive cross-match)
No agglutination = compatible (negative cross-match)
Autoimmune hemolytic anemia = antibodies attack own red cells =
incompatible no matter what
Try to find blood that is absorbed