BLOOD BANKING
THE ABO BLOOD GROUP SYSTEM
 Most important of all blood groups in transfusion
practice. It is the only blood group system in which
individuals have antibodies in their serum to
antigens that are absent from their RBCs
Forward grouping (front type)
 Defined as using known sources of
commercial antisera (anti-A, anti-B) to detect
antigens on an individual’s RBCs.
 The procedure is based on the principle of
agglutination (clumping of red blood cells as
a result
of antibodies binding to antigenic sites of
adjacent red cells).
There are two types of cross matches:
Reverse grouping (back type)
 Defined as detecting ABO antibodies in the
patient’s serum by using known reagent
RBCs, namely A1 and B cells.
THE RH BLOOD GROUP SYSTEM
 The term Rh refers to a specific red blood cell
(RBC) antigen (D) and to a complex blood
group system currently composed of over 50
different antigenic specificities.
 Rh system antigens are very immunogenic.
 Antigens -Lack corresponding naturally
occurring antibodies (when present they are
the result of sensitization caused by receipt of
D-positive RBCs from another person
 Antibodies - Individuals who lack the antigen
may be exposed to it through transfusion or
pregnancy
CROSS MATCHING
 Procedure performed prior to transfusion of
blood or blood products to detect any
serological incompatibilities in the blood of
donor and recipient.
 based on the principle of serological detection
of any clinically significant irregular/unexpected
antibodies in either donor or recipient’s blood.
1. Major Cross Match: It involves testing the donor’s
red cells with recipient’s serum to determine the
presence of any antibody which may cause
hemolysis or agglutination of donor red cells. This is
more important than minor cross match.
2. Minor Cross Match: It involves testing of donor’s
plasma with recipient’s red cells to determine the
presence of any antibody which may cause
hemolysis or agglutination of recipient’s red cells.
Type Donor’s Recipient’s
Major Cross Match Red Cells Serum/Plasma
Minor Cross Match Serum/Plasma Red Cells
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Detects 7. Centrifuge at 1500 rpm for 1 minute.

Antibody of 8. Observe macroscopically and microscopically for
Method of Cross Match Type agglutination.
Saline Cross Match IgM 9. If macroscopic agglutination is not observed,
transfer a small amount onto a glass slide and
Albumin Cross Match IgG examine for microscopic agglutination. Rouleaux is
not an indication of incompatibility.
Anti-Human Globulin (AHG) Cross
Match IgG

Major Cross Match

1. Prepare donor and recipient’s blood
sample: Donor’s red cells and recipient’s
serum/plasma.
2. Prepare 3-5% saline cell suspension of red cells.
3. Label a test tube.
4. Add two drops of recipient’s serum and one drop of
donor cell suspension.
5. Mix and incubate the tubes at 37 degree Celsius for
about 60 minutes.
6. Decant the serum completely and wash the cells
three times in saline.
RESULTS
7. Add two drops of Anti-human Globulin (AHG) and
mix. Allow to stand at room temperature for 5
minutes.  Compatible donor and recipient blood should
show no agglutination in both major and minor
8. Centrifuge at 1500 rpm for 1 minute. cross match. Blood which shows incompatibility
9. Observe macroscopically and microscopically for in major cross match should never be transfused,
agglutination. because the large plasma volume of the recipient
10. If macroscopic agglutination is not observed, blood containing antibodies can destroy the
transfer a small amount onto a glass slide and donor’s red cells easily.
examine for microscopic agglutination. Rouleaux is  The minor incompatibility is less
not an indication of incompatibility. important because the donor’s serum which
contains the antibodies is diluted in the recipient’s
own plasma, making the antibodies very dilute
and ineffective.

PHLEBOTOMY
 Act of drawing or removing blood from the
circulatory system through a cut (incision) or
puncture in order to obtain a sample for analysis
and diagnosis.

Minor Cross Match

1. Prepare donor and recipient’s blood
sample: Recipient’s red cells and donor’s
serum/plasma.
2. Label a test tube.
3. Add two drops of donor’s serum and one drop of
recipient’s cell suspension.
4. Mix and incubate the tubes at 37 degree Celsius for
about 60 minutes.
5. Decant the serum completely and wash the cells
three times in saline.
6. Add two drops of Anti-human Globulin (AHG) and
mix. Allow to stand at room temperature for 5
minutes.

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STEPS:

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Instructions After Phlebotomy

 Leave the pressure bandage on your needle site for 3 to 6 hours after your procedure.
 Avoid lifting or carrying heavy objects for several hours.
 Drink more liquids than usual for 1 to 2 days after your procedure. At least 8 to 10 (8-ounce) glasses each day.
 Avoid alcohol and drinks with caffeine for one day after your procedure.
 Avoid strenuous exercise (such as jogging) for 1 day after your procedure.

Post-Phlebotomy Care after Blood Donation (Based on WHO Guidelines on drawing blood)

 Ask the donor to remain in the chair and relax for a few minutes.

 Apply a bandage to the site; if it is bleeding, apply further pressure.

 Ask the donor to sit up slowly.

 Before the donor leaves the donation room, ensure that the person can stand up without dizziness and without a
drop in blood pressure.

 Instruct the donor not to drive.

 It also includes all instructions after phlebotomy as stated above.

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DONOR SCREENING
 encompasses the medical history requirements for the donor, the (mini) physical examination, and serologic
testing of the donor blood.
 designed to answer two questions: (1) Will a donation of approximately 450 mL of whole blood at this time be
harmful to the donor? (2) Could blood drawn from this donor at this time potentially transmit a disease to the
recipient?

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PHYSICAL EXAMINATION
1. General appearance: The donor center
representative should observe the prospective
donor for presence of excessive anxiety, drug or
alcohol influence, or nervousness.
2. Weight: Standards mandates a maximum of 10.5
mL of blood/kg of donor weight for whole blood
collection inclusive of pilot tubes for testing. If the
donor weighs less than 100 pounds, the amount of
blood collected must be
proportionately reduced as well as that of the
anticoagulant. The following formulas can be used
to calculate the adjusted volume of blood to be
collected and anticoagulant to be used.
Volume to collect = (donor’s weight in kg/50) × 450
mL
Volume to collect/450 × 63 mL = reduced volume
of anticoagulant
63 mL – above calculated volume = amount of
solution to be removed
3. Temperature: Standards mandates the donor
temperature must be less than or equal to 37.5°C
or 99.5°F.28 Donors are asked not to drink coffee
or hot beverages while waiting to donate, as this
may sometimes affect their temperature. Oral
temperatures that are lower than normal are not
cause for deferral.
REFERENCES
• Harmening, Modern Blood Blanking and Transfusion Medicine
• McCall, Phlebotomy Essentials, 5th edition
• https://www.ncbi.nlm.nih.gov/books/NBK138665/
4. Pulse: The donor’s pulse should be between 50
and 100 bpm. Often, a donor who is athletic will
have a pulse
less than 50 bpm, which is not cause for deferral.
The pulse should be counted for at least 15
seconds.
5. Blood pressure: A potential donor’s systolic
blood pressure should be less than or equal to 180
mm Hg and the diastolic less than or equal to 100
mm Hg. Blood pressure readings above these
levels should be evaluated by a blood bank
physician.
6. Hemoglobin: The donor’s hemoglobin level
should be greater than or equal to 12.5 g/dL and
the hematocrit level
greater than or equal to 38% for allogeneic
donation. For autologous donation, the
hemoglobin and hematocrit level should be greater
than or equal to 11 g/dL and 33%, respectively.1
The methods used for measuring hemoglobin
include copper sulfate or point-of-care instruments
using spectrophotometric methodology. A
hematocrit or packed cell volume can be
determined manually by centrifugation. The blood
is usually acquired via a finger stick.
7. Skin lesions: Prior to donation, the donor’s arms
should be inspected for skin lesions. Evidence of
skin lesions
(e.g., multiple puncture marks) is cause for
indefinite deferral. Skin disorders that are not
cause for deferral include poison ivy and other
rashes; these, however, should not be present in
the area of the venipuncture site and may need to
be evaluated by a blood bank physician.
At each donation, the following mandatory tests are
performed:
1. Hepatitis B – HBsAg.
2. Human immunodeficiency virus – anti-HIV 1 and
2 and HIV NAT (nucleic acid testing)
3. Hepatitis C – anti-HCV and HCV NAT.
4. Human T-cell lymphotropic virus – anti-HTLV I
and II.
5. Syphilis – syphilis antibodies.
6. Malaria