Immunohematology, Transfusion Medicine, Hemostasis, and Cellular Therapy-A Case Study Approach 3rd Edition Mark T. Friedman

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Immunohematology,
Transfusion Medicine,
Hemostasis, and Cellular
Therapy
A Case Study Approach

Mark T. Friedman
Kamille A. West
Peyman Bizargity
Kyle Annen
H. Deniz Gur
Timothy Hilbert
Third Edition
123
Immunohematology, Transfusion Medicine,
Hemostasis, and Cellular Therapy
Mark T. Friedman • Kamille A. West
Peyman Bizargity • Kyle Annen
H. Deniz Gur • Timothy Hilbert
Immunohematology,
Transfusion Medicine,
Hemostasis, and Cellular
Therapy
A Case Study Approach
Third Edition
Mark T. Friedman Kamille A. West
Department of Pathology Department of Transfusion Medicine
NYU Lagone Health National Institutes of Health Clinical Center
Mineola, NY, USA Bethesda, MD, USA
Peyman Bizargity Kyle Annen

Department of Pediatrics Department of Pathology
Northwell Health System Children’s Hospital Colorado
Great Neck, NY, USA Aurora, CO, USA
H. Deniz Gur Timothy Hilbert

Department of Pathology Department of Pathology
Northwell Health System NYU Langone Health
Greenvale, NY, USA New York, NY, USA
ISBN 978-3-031-14637-4 ISBN 978-3-031-14638-1 (eBook)

https://doi.org/10.1007/978-3-031-14638-1
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2016, 2018, 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
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transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
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claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
The authors proudly dedicate this workbook
to those who have tirelessly invested their
professional careers and lives working to
advance the science, knowledge, and
practice of blood banking,
immunohematology, transfusion medicine,
and cellular therapy: to those who
pioneered, to those who continue to discover
and build on the foundations, and to those
who will inherit the wisdom to become the
innovators and educators of tomorrow…
Preface
Pretransfusion testing, including ABO/Rh typing, identification of unexpected anti-

bodies, and compatibility testing, is an important measure in the provision of blood
that may be transfused to the patient in the safest possible manner. This brief intro-
duction is not intended to give the trainee a detailed instruction on solving immuno-
hematology cases; rather, it is intended to give an overview on how to approach the
immunohematology problems of this workbook. The authors of this workbook pre-
sume that the reader has had at least basic instruction in immunohematology before
engaging in these cases.
Although one may be tempted to jump right to the antibody panel after noting a
positive antibody screen in the presented cases, it is recommended to review the
clinical history for important clues that may be helpful in solving the case. For
example, a history of prior transfusions suggests that the patient could have made
clinically significant alloantibodies (i.e., warm-reactive immunoglobulin [Ig]G allo-
antibodies capable of causing hemolytic transfusion reactions or hemolytic disease
of the fetus or newborn). Alternatively, the use of phrases such as “routine clinic
visit” may suggest that the patient is clinically stable despite significant anemia. In
these practice cases, as in the real medical world, obtaining clinical history is an
important step not to be overlooked, though in some of these cases (as sometimes
occurring in actual practice), scant history is provided.
After reviewing the medical history, the next step is to interpret the ABO/Rh typ-
ing results. In most cases, this will be straightforward, though one should be alert to
any discrepancy in the forward and reverse typing results. For example, noting a
positive result with the A1 cell in the back type may be the result of anti-A1 antibody
in an individual of A2 blood type or the result of a cold allo- or autoantibody.
Next, one should review the antibody screen. It should be noted that in this work-
book, we present a two-cell screen in either standard tube or gel (column agglutina-
tion) method. Although typically the antibody screen is interpreted simply as
positive or negative, limited additional information can be gleaned by noting differ-
ences in reactions between the two cells (i.e., whether only one cell or both cells is/
are reacting) or differences in the testing phases (i.e., if tube method is used, differ-
ences in reactions between 37 °C vs. antihuman globulin [AHG] phase).
vii
viii Preface
Additionally, the antigen profiles of the antibody screen cells are listed in the
beginning of the book, which may also provide useful information when ruling out
antibodies.
After review of the clinical history, ABO/Rh typing, and antibody screen, one is
ready to move on to the antibody panels (Fig. 1) if performed in the case. Although
traditionally one is taught to interpret the antibody panels through a process of cross-
ing out antigens, it is prudent to first take a moment to get a “landscape” view of the
panel reactions. That is, one should look to see whether there are reactions at cold
temperatures (i.e., 4 °C, room temperature [RT], immediate spin [IS]) or warm tem-
peratures (37 °C, IgG), whether there are many cells that are positive (perhaps all
cells are positive as in a panagglutinin reaction) or only few, and whether the autocon-
trol is positive or negative. Such consideration may help to narrow the possible speci-
ficities of the present antibodies. In that light, for example, if reactions are only
evident at 4 °C in the panel, then warm-reactive antibodies (such as anti-D, -K, -Jka,
etc.) can promptly be excluded. Finally, after this initial review, one should then move
on to the methodical exclusion of antibody specificities. This is traditionally taught as
“crossing out” antigens in which the reactions are negative with attention toward dos-
age (i.e., homozygous vs. heterozygous antigen expression). Figure 2 demonstrates
crossing out with respect to negative reactions, dosage, and the patient’s RBC antigen
phenotype. The effect of enzyme treatment (e.g., papain or ficin) may also be of value
as antibody reactivity to some antigens may be enhanced or destroyed. Ultimately,
after consideration of all of the clinical information and antibody identification test-
ing, the identity of the antibody or antibodies may be determined so that the most
compatible blood can be provided for the patient in case transfusion is necessary.
In the end, these cases are not necessarily meant to be difficult (though they do
tend to become more challenging as one progresses through the workbook) but are
selected based on principle to introduce the practical concepts of and methods used
in immunohematology antibody identification. Once the learner has grasped these
basic techniques, he/she can apply them to more interesting cases that may be pre-
sented to them within the actual clinical practice of the transfusion service. Certainly,
the intent of this workbook is not to be an end-all but merely a gateway for further
learning.
Finally, a number of the cases are designed to engage the learner in other aspects
encompassing blood banking and transfusion medicine, including coagulation, ther-
apeutic apheresis, granulocyte transfusion, massive transfusion, factor concentrates,
transfusion complications, laboratory administration, patient blood management,
and the approach to the bloodless patient. Furthermore, an entirely new section has
been added which is devoted to donor collection and hematopoietic stem cell
transplantation.
Mineola, NY, USA Mark T. Friedman

Bethesda, MD, USA Kamille A. West
Great Neck, NY, USA Peyman Bizargity
Aurora, CO, USA Kyle Annen
Greenvale, NY, USA H. Deniz Gur
New York, NY, USA Timothy Hilbert
Preface
Fig. 1 Guide to the antibody panel

ix
x
Fig. 2 Guide to antibody panel rule out

Preface
Authors’ Note
This case-based immunohematology workbook, now in its third edition, has been
developed over many years and was created in response to the need to teach learners
in the practical art of interpreting red cell antibody studies. The authors proudly
introduce this updated edition with an enhanced title, reflecting the expanded scope
of topics that are covered. Indeed, this workbook is one of the most comprehensive
collections of case studies of its kind. New cases, including a second part covering
donor collections and hematopoietic stem cell therapy, have been added along with
enhanced information, figures, tables, and references. New additions also include
keywords of covered case topics, a scale rating based on topic content difficulty, and
a brief online abstract introducing each case. Tables of key figures and tables as well
as formulas used throughout the workbook are also included for quick reference.
Although there have been many textbook resources, both in print and online, which
have been published for learning facts about blood banking and transfusion medi-
cine, there are few available resources for studying and practicing immunohematol-
ogy cases. The cases presented in this workbook are based on realistic clinical
scenarios that one may encounter in the blood bank or hematology/coagulation
laboratory, transfusion service, or donor collection facility. Thus, this workbook is
an excellent companion to reference texts for the practical application of learned
immunohematology techniques to case-based studies in the identification of red cell
antibodies and in the clinical management of patient transfusions as well as patients
who undergo therapeutic apheresis, present with coagulation disorders, or who have
donor collection-related issues. Learners will appreciate that while this workbook
covers major topics, finer, often overlooked, details are explained, such as the sig-
nificance of the anticoagulants used for blood bank and coagulation test samples. In
addition, for those interested readers, the workbook delves into some esoteric top-
ics, such as the Matuhasi-Ogata phenomenon, coagulation testing nonparallelism,
clot waveform analysis, and the application of unusual snake venoms in coagulation
testing. Educators, too, will find this workbook to be a valuable resource among
their collection of teaching tools. The questions accompanying each case are pre-
sented in an open-ended format rather than in the traditional single-best-answer
multiple-choice format; though some may prefer the latter format for convenience,
xi
xii Authors’ Note
it is wise to remember that patients do not come with multiple-choice answers.

Furthermore, the open-ended style encourages learners to engage in further reading
and discussion of the subject matter. Over the years, many trainees in clinical pathol-
ogy and hematology have benefitted from the use of this type of workbook problem-
solving learning, both in the preparation for their board certification exams and for
their careers, and since the publication of the first edition, the workbook has achieved
international acclaim.
On a final note, although the information contained herein is current to date of
this publication, readers should always be conscientious of updates, especially with
regard to regulatory guidance documents and policies that are referenced in a few of
the chapters.
Kyle Annen
Peyman Bizargity
Mark T. Friedman
H. Deniz Gur
Timothy Hilbert
Kamille A. West
About the Book
Acknowledgement of Prior Contributors
Sandra Gilmore, Mount Sinai Health System, New York, NY (1st edition).
Jeffrey Jhang, Mount Sinai Health System, New York, NY (2nd edition).
Laboratory Normal Values
Laboratory test Reference range

White blood cells (WBC) 3.8–9.8 K/μL
Hemoglobin (Hgb) 12.5–17.0 g/dL
Hematocrit (Hct) 34.0–46.0%
Mean corpuscular volume (MCV) 80.0–99.0 fL
Mean corpuscular hemoglobin (MCH) 24.8–30.2 pg
Mean corpuscular hemoglobin concentration 31.0–34.0 g/dL
(MCHC)
Platelets 150–450 K/μL (150,000–450,000/μL)
Reticulocyte count 0.5–1.5%
Haptoglobin 30–200 mg/dL
Lactate dehydrogenase (LDH) 300–600 U/L
Total bilirubin 0.2–1.3 mg/dL
Blood urea nitrogen (BUN) 5–20 mg/dL
Creatinine 0.6–1.3 mg/dL
Alanine aminotransferase (ALT) 7–55 U/L
Aspartate aminotransferase (AST) 8–60 U/L
Prothrombin time (PT) 11.0–14.0 s
International normalized ratio (INR) 0.8–1.2
Activated partial thromboplastin time (aPTT) 26.0–38.0 s
Thrombin time (TT) 15.0–19.0 s
Fibrinogen 200–550 mg/dL
xiii
xiv About the Book
Laboratory test Reference range

Urinalysis Color/turbidity Yellow/clear
Red blood cells (RBCs) 0–3/high power field
White blood cells 0–3/high power field
Urine hemoglobin Negative
Urine myoglobin Negative
Red Blood Cell (RBC) Antigen Frequencies
Frequency (%)
Blood group system Antigen Caucasian African American Asian
Rh D 85 92 99
C 68 27 93
c 80 96 47
E 29 22 39
e 98 98 96
Kell K 9 2 –
k >99 >99 –
Duffy Fya 66 10 99
Fyb 83 23 18.5
Kidd Jka 77 92 73
Jkb 74 49 76
MNS M 78 74 –
N 72 75 –
S 55 31 –
s 89 93 –
Key Figures and Tables by Chapter
Chapter # Figure/Table Description

2 Table 2.3 Fisher-Race and modified Wiener terminology for Rh
haplotypes
3 Figure 3.1 Peripheral blood smear: Red blood cell rouleaux
formation
6 Table 6.2 List of coagulation tests
19 Table 19.6 Anticipated reactions with patient RBCs
Table 19.7 Anticipated reactions with eluate and adsorbed plasma
23 Figure 23.1 Peripheral blood smear: Red blood cell clumping
Figure 23.2 Gel column agglutination
27 Figure 27.1 Red blood cell membrane glycophorin A and B
structures
About the Book xv
Chapter # Figure/Table Description

31 Figure 31.1 Peripheral blood smear: Reticulocytes
35 Figure 35.2 Peripheral blood smear: Schistocytes
Table 35.3 PLASMIC scoring system for severe ADAMTS13
deficiency
36 Figure 36.1 Peripheral blood smear: Thrombocytopenia
37 Table 37.2 Anticoagulants and reversal agents
39 Table 39.1 Transfusion medicine proficiency survey worksheet
44 Table 44.8 Effects of enzymes/chemicals on antibody reactions
46 Figure 46.1 Kleihauer-Betke test smear
Table 46.5 Content of anticoagulant-preservative solutions
49 Figure 49.1 Peripheral blood smear: Acanthocytes
50 Figure 50.1 Donath-Landsteiner test
51 Figure 51.1 Peripheral blood smear: Pseudothrombocytopenia
52 Figure 52.2 Thromboelastography parameters
Figure 52.3 Fibrinolytic system
Table 52.2 Thromboelastography parameters
Table 52.3 Thromboelastography tracing patterns
53 Figure 53.1 Peripheral blood smear: Babesiosis
54 Table 54.2 Duquesnoy grading system
Table 54.3 Solid-phase assay for human leukocyte antigen
antibody testing
56 Table 56.2 Classification of von Willebrand disease types
58 Figure 58.1 Thromboelastography tracings
59 Figure 59.1 Peripheral blood smear: Hyperleukocytosis
66 Table 66.4 Lectin reactions in polyagglutination
69 Table 69.2 4T scoring system for heparin-induced
thrombocytopenia
71 Table 71.1 Approximate coagulation factor half-lives
72 Figure 72.1 Peripheral blood smear, normal
Table 72.3 Dilute Russell viper venom time algorithm
73 Figure 73.1 Coagulation cascade
75 Figure 75.5 Platelet light transmission aggregometry agonist
tracings
Table 75.2 Platelet light transmission aggregometry patterns
76 Figure 76.1 Peripheral blood smear: Hypochromic microcytic
anemia
79 Table 79.2 Antiplatelet medications
80 Figure 80.1 Factor VIII: Coagulant activity level assay results
81 Figure 81.3 Clot waveform analysis, activated partial
thromboplastin time
Figure 81.4 Clot waveform analysis, prothrombin time
82 Figure 82.1 Peripheral blood smear: Microcytic anemia, target cells
83 Figure 83.2 Peripheral blood smear: Schistocytes
94 Table 94.5 Hematopoietic stem cell sources
xvi About the Book
Formulas by Chapter
Chapter Formula
# Formula description Comments
1, 10 Antigen-negative RBC Number of RBC units to screen = Number RBC units
units needed/(1 − population frequency of RBC antigen)
For multiple antigens (e.g., E- and K-antigen negative
RBCs), multiply the frequencies of the negative phenotypes
for each antigen
7 Hardy-Weinberg p2 + 2pq + q2 = 1
p and q represent gene frequencies
15 Cryo dose Cryo units = Desired fibrinogen level increase (mg/
dL) × Plasma volume
(mL) × (1 dL/100 mL) × (1 unit/250 mg)
Each individual cryo unit averages 250 mg of fibrinogen
37 INR INR = [Patient PT (s)/Geometric mean normal range PT
(s)]ISI
46, 84 TBV Adult TBV (mL) = Weight (kg) × 70 mL/kg
Use 85 mL/kg for full-term neonates and 100 mL/kg for
premature neonates; use 60 mL/kg to adjust for obesity;
RBC volume (mL) = TBV (mL) × [Hct (%)/100]; Plasma
volume (mL) = TBV (mL) × (1 − [Hct (%)/100])
46 RhIg dose RhIg dose = [% Fetal cells KB test × Maternal TBV
(mL)]/30 mL
Each RhIg dose covers 30 mL fetal blood; if decimal ≥0.5,
round up and add 1 dose, otherwise round down and add 1
dose
Neonatal exchange Vi (mL) = Vf (mL) × Cf (%)/Ci (%); Plasma volume to use
transfusion volume (mL) = Vf − Vi
Reconstituted WB Cf: Final concentration (hematocrit; 50%); Ci: Initial
volume concentration (hematocrit; 70% for a citrate-phosphate-
dextrose-adenine (CPDA) unit and 60% for an additive
solution unit); Vf: Final volume (reconstituted whole blood
volume; typically, twice the neonatal total blood volume);
Vi: Initial volume (red blood cell product volume to use)
54 BSA BSA (m2) = √ [Weight (kg) × Height (cm)]/3600
CCI CCI = [(Post − Pretransfusion platelet count [k/μL]) × BSA
(m2)]/Number of transfused platelets (×1011)
Use 3.0 for number of transfused platelets since each
apheresis platelet unit contains a minimum of 3.0 × 1011
platelets; CCI ≤ 7500 indicates immune platelet
refractoriness (for one-hour posttransfusion count)
About the Book xvii
Chapter Formula
# Formula description Comments
55 FVIII concentrate dose FVIII dose (IU) = Weight (kg) × Desired FVIII level
increase (IU/kg) × 0.5 (Reciprocal of observed recovery
[IU/kg per IU/dL])
FIX concentrate dose FIX dose (IU) = Weight (kg) × Desired FIX level increase
(IU/kg) × 1.3 (Reciprocal of observed recovery [IU/kg per
IU/dL])
Use 1.4 IU/kg per IU/dL for children <12 years
58 Thromboelastography % Platelet inhibition = 100 − {[MA(AA or
platelet mapping ADP) − Activator MA]/[MA(CK) − Activator MA] × 100}
inhibition
67 ANC ANC = Total WBCs × % (Segmented + Band neutrophils)
69 Fall in platelets [(Starting platelet count − Post-fall platelet count)/Starting
(heparin-induced platelet count] × 100
thrombocytopenia)
76 RBC indices MCH MCH (pg) = [Hgb (g/dL)/RBC count (106/μL)] × 10
MCHC MCHC (g/dL) = [Hgb (g/dL)/Hct (%)] × 100
MCV MCV (fL) = [Hct (%)/RBC count (106/μL)] × 10
BMI BMI = Weight (kg)/[Height (m)]2
Healthy BMI = 18.5–24.9 kg/m2
Ganzoni Total iron dose (mg) = [Weight (kg) × (Target − Current
Hgb [g/dL])] × 2.4 + Iron stores (mg)
Iron stores may be estimated at 10 mL/kg
89 Actual platelet yield Platelet yield = Platelet count (platelets/mL) × Product
(apheresis platelets) volume (mL)
91 Volume of blood to Volume of collection = [Donor weight
collect from underweight (kg)/50 kg] × 450 mL
donor (<50 kg)
Volume of CPDA-1 to Volume CPDA-1 to remove = 63 mL − [Collection volume
remove from donor (mL) × 0.14]
collection bag (low The ratio of CPDA-1 to WB in a 450 mL donor collection
volume collection) bag is 14 mL/100 mL (0.14); 450 mL donor collection bags
contain 63 mL of CPDA-1
93 CD34+ collection yield Expected CD34+ (×106/kg) = Peripheral blood CD34+
cells (cells/μL) × Volume of blood processed (L) × [(CE
%/100)/Mass (kg)]
AA arachidonic acid, ADP adenosine diphosphate, ANC absolute neutrophil count, BSA body sur-
face area, BMI body mass index, CCI corrected count increment, CE collection efficiency, CPDA-1
citrate-phosphate-dextrose-adenine, Cryo cryoprecipitate, F factor; Hct hematocrit, Hgb hemoglo-
bin, INR International normalized ratio, ISI International sensitivity index, KB Kleihauer-Betke,
MA maximum amplitude, MCH mean corpuscular hemoglobin, MCHC mean corpuscular hemo-
globin concentration, MCV mean corpuscular volume, PT prothrombin time, RBC red blood cell,
RhIg Rh immune globulin, TBV total blood volume, WB whole blood, WBCs white blood cells
xviii
Screen Cell (SC) Antigen Profiles
Rh-hr Kell Duffy Kidd Lewis MNS P Lutheran

w
Rh-hr D C E c e f C V K k Kpa Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb M N S s Pl Lua Lub
SC1 R1R1 + + 0 0 + 0 0 0 0 + 0 + 0 + + 0 + + + 0 + + + + + 0 +
SC2 R2R2 + 0 + + 0 0 0 0 + + 0 + + 0 + + + 0 0 + + + + + + 0 +
About the Book
Contents
Part I Case Studies in Transfusion Medicine, Immunohematology,

Therapeutic Apheresis, and Hemostasis
1
Basic Antibody Identification: It’s All Greek to Me...�� 3
Mark T. Friedman, Kamille A. West, Peyman Bizargity, Kyle Annen,
H. Deniz Gur, and Timothy Hilbert
2 Rhesus Pieces�� 9
3 The ABC’s of ABO Discrepancy �� 15
4 Crossmatch Crisscross�� 21
5 Cold Case�� 29
6 I “PiTTy” Thee�� 35
7 Buried Treasure�� 43
8 I Can See Clearly Now…�� 51
xix
xx Contents
9
You Really “Oughta” Get This… �� 57
10 What the Kell!�� 67
11 EeeeeK!!!�� 75
12 Are You Kidding?�� 83
13 Oh! Are You My Type?�� 93
14 Hey,
How Did That Antibody Get There?�� 101
15 Don’t
“Cryo” for FFP, Marge and Tina�� 109
16 Radioactive �� 113
17 Je
Ne Sais Pas �� 119
18 Wo Rho, No!�� 129
19 G-Force �� 137
20 Hide and Seek�� 147
21 Reaction Infraction�� 155
Contents xxi
22 What’s This Junk? �� 163

23 Chiller�� 169
24 The Platelet Transfusion�� 179
25 Just Another Autoantibody �� 185
26 I Got You Baby �� 193
27 You
Got that Right… �� 199
28 The
Case of Low Platelets �� 205
29 Dial
M for Maternal Antibody�� 213
30 Decisions, Decisions!�� 221
31 Bad Medicine�� 229
32 All Washed Up�� 235
33 The Red Pee�� 243
34 Emergency!�� 257
xxii Contents
35 Absolutely Necessary!�� 263

36 Cruising
for a Bruising�� 271
37 Head Shot!�� 279
38 Carpe Diem! �� 285
39 Proficiency Deficiency�� 291
40 Six
Degrees of Separation�� 295
41 Eltromplostim What?�� 299
42 L’inspecteur�� 303
43 Chairman
of the Board�� 307
44 Enzymatic Fanatic�� 313
45 Stop the Hemolysis!�� 323
46 To
KB or Not to KB, That Is the Question�� 331
47 Fuggedaboutit�� 339
Contents xxiii
48 Gene Genius�� 349

49 In the Clouds�� 359
50 Hot and Cold�� 369
51 Baby Fate�� 377
52 Thromboelastography,
My Dear Doctor�� 383
53 Malus Sanguis! �� 393
54 Do the Math!�� 403
55 Eight Is Enough!�� 411
56 It’s So “Vonderful”�� 415
57 Of Wind and Water�� 421
58 Thromboelastography,
My Dear Doctor Revisited �� 431
59 Serendipity, C’est La Vie �� 437
60 Omakase
Medicine. Caveat Emptor! Don’t Trim the Facts�� 443
xxiv Contents
61 Oops! Something Went Wrong… �� 447

62 It’s Complicated �� 453
63 The
Perils of Transfusing the Sickle Cell Patient�� 465
64 Passengers and Hitchhikers�� 475
65 How “Dara” You! �� 485
66 Polly Wants a Cracker!�� 495
67 Golden Grans �� 503
68 Spoiled Rotten! �� 509
69 “HIT”
Me with Your Best Shot! �� 517
70 Holy
Cow! (“I’m Bloodless”)�� 523
71 Identity Crisis �� 529
72 Wolf Bite�� 535
Contents xxv
73 The X Files�� 545

74 Heavy Metal�� 553
75 Aggregation Aggravation�� 561
76 IDA? IDK.�� 571
77 Clots of Love �� 579
78 Tragic! �� 585
79 Snakes
and a Plane! �� 591
80 Unparalleled Experience �� 599
81 Coagulation
Testing: Looking Beyond the PT and aPTT�� 605
82 KB Conundrum�� 613
83 Gem City Fallout�� 621
84 Prime Time �� 629
xxvi Contents
Part II Cases Studies in Blood Donor Collection and Cellular Therapy

85 Total Recall �� 637
86 The Young and Restless �� 641
87 Of
Broken Vows and Mad Cows �� 647
88 The
“ART” of “PEP” Talk: All “PrEP”-Ped and Ready�� 651
89 Don’t
Lean on Me, Just Show Me the Money �� 655
90 Some Nerve!�� 661
91 A Family Affair�� 665
92 Liquid Gold�� 671
93 “STEM” Education�� 679
94 Mix and Match �� 685
95 “CAR T”-esian Thinking�� 693
Index�� 699
Abbreviations
α Alpha angle (thromboelastography)

A Activator (thromboelastography)
AA Arachidonic acid
AABB Association for the Advancement of
Blood & Biotherapies (formerly,
American Association of
Blood Banks)
AAV Antineutrophil cytoplasmic antibody
(ANCA)-associated vasculitis
ABC Assessment of Blood
Consumption (score)
ACD/I Anemia of chronic disease/
inflammation
ACD-A Anticoagulant citrate dextrose
solution A
ACE Angiotensin-converting enzyme
ACT Activated clotting time
ADAMTS13 A disintegrin and metalloproteinase
with a thrombospondin type 1 motif,
member 13
ADP Adenosine diphosphate
AFIA Arrayed fluorescence assay
AGE Agarose gel electrophoresis
AHG Antihuman globulin
aHUS Atypical hemolytic uremic syndrome
AI Antibody index (units)
AIDS Acquired immune deficiency
syndrome
AIHA Autoimmune hemolytic anemia
ALL Acute lymphoblastic leukemia
ALT Alanine aminotransferase
xxvii
xxviii Abbreviations
AML Acute myeloid leukemia

ANC Absolute neutrophil count
ANCA Antineutrophil cytoplasmic antibody
Anti-HBcAg Antibodies to hepatitis B core antigen
APC Activated protein C
APLA Antiphospholipid antibodies
APS Antiphospholipid syndrome
aPTT Activated partial thromboplastin time
ARB Angiotensin receptor blocker
ARDS Acute respiratory distress syndrome
ART Antiretroviral therapy
ARU Aspirin Reaction Units (VerifyNow™)
AS Additive solution (AS-1, AS-3,
AS-5, AS-7)
ASFA American Society for Apheresis
AST Aspartate aminotransferase
AT Antithrombin
BAT Bleeding Assessment Tool (ISTH)
BCSH British Committee for Standards in
Haematology
BMP Basic metabolic panel
BNP Brain natriuretic peptide
BPDR Biological Product Deviation Report
BSE Bovine spongiform encephalopathy
BU Bethesda unit
BUN Blood urea nitrogen
BURC Blood utilization review committee
C3b, C3d, C4b Complement components 3b, 3d, 4b
CABG Coronary artery bypass graft
CAD Coronary artery disease
cAMP Cyclic adenosine monophosphate
cANCA Cytoplasmic antineutrophil antibodies
CAP College of American Pathologists
CAPS Catastrophic antiphospholipid
syndrome
CAR Chimeric antigen receptor
(CAR T-cell)
CBC Cell blood count
CBER Center for Biologics Evaluation and
Research
CC Coombs control/check cells
CCI Corrected count increment
CCP COVID convalescent plasma
CD3, CD19, CD20, CD36, CD38, CD47 Cluster of differentiation 3, 19, 20,
36, 38, 47
Abbreviations xxix
CDC Centers for Disease Control and

Prevention
CDP Cryodepleted plasma
CE Collection efficiency
CFR Code of Federal Regulations
CGD Chronic granulomatous disease
cGMP Cyclic guanosine monophosphate
cGMPs Current good manufacturing practices
CHF Congestive heart failure
CIRP Cesium Irradiator Replacement Project
CJD Creutzfeldt-Jakob disease
CK Citrated kaolin (thromboelastography)
CKD Chronic kidney disease
CLIA Clinical Laboratory Improvement
Amendments
CLL Chronic lymphocytic leukemia
CLSI Clinical and Laboratory Standards
Institute
CML Chronic myeloid leukemia
CMS Centers for Medicare & Medicaid
Services
CMV Cytomegalovirus
CNS Central nervous system
COPD Chronic obstructive pulmonary disease
COX Cyclooxygenase
CPAP Continuous positive airway pressure
CPB Cardiopulmonary bypass
CPDA Citrate-phosphate-dextrose-adenine
CPOE Computer physician order entry
CREG Cross-reactive group
CRP C-reactive protein
CRRT Continuous renal replacement therapy
Cryo Cryoprecipitate
CS Cold storage
C-section Cesarean section
CT Computed tomography
cTPE Centrifugal therapeutic plasma
exchange
CWA Clot waveform analysis
CXCR4, CXCR12 CXC chemokine receptor 4, 12
CZE Capillary zone electrophoresis
D10W 10% dextrose in water
D5W 5% dextrose in water
DAH Diffuse alveolar hemorrhage
DAPT Dual antiplatelet therapy
xxx Abbreviations
DAT Direct antiglobulin test

DC Derivative curve
D-D D-dimer
DDAVP Desmopressin acetate (arginine
vasopressin)
DDBD Directed-donor blood donation
DFO Deferoxamine
DFP Deferiprone
DFX Deferasirox
DHHQ Donor health history questionnaire
DHTR Delayed hemolytic transfusion
reaction
DIC Disseminated intravascular
coagulation
DIHA Drug-induced hemolytic anemia
D-L Donath-Landsteiner
DLBCL Diffuse large B-cell lymphoma
DNA Deoxyribonucleic acid
dNTPs Deoxynucleoside triphosphates
DOAC Direct oral anticoagulant
DOB Date of birth
DRVVT Dilute Russell viper venom time
DS Down syndrome
DTI Direct thrombin inhibitor
DTT Dithiothreitol
DVT Deep venous thrombosis
EAP Expanded Access Protocol
ECG Electrocardiogram
ECLT Euglobulin clot lysis time
ECMO Extracorporeal membrane oxygenation
ECT Ecarin clotting time
ED Emergency Department
EDTA Ethylenediaminetetraacetic acid
EEG Electroencephalogram
EGA EDTA glycine acid
EGFR Estimated glomerular filtration rate
ELISA Enzyme-linked immunosorbent assay
EMR Electronic medical record
ESR Erythrocyte sedimentation rate
EUA Emergency Use Authorization
F Factor
FCR Fraction cells remaining
FDA Food and Drug Administration
(United States)
FDP Fibrin degradation products
Abbreviations xxxi
FFP Fresh frozen plasma

FiO2 Fraction of inspired oxygen
FISH Fluorescence in situ hybridization
FLEV Functional fibrinogen level (viscoelas-
tic testing)
FMH Fetal-maternal hemorrhage
FNAIT Fetal and neonatal alloimmune
thrombocytopenia
FNHTR Febrile nonhemolytic transfusion
reaction
FVIII:C Factor VIII coagulant
FVL Factor V Leiden
FXaI Factor Xa inhibitor
G#P# Gravida #, Para #
G6PD Glucose-6-phosphate dehydrogenase
GBM Glomerular basement membrane
G-CSF Granulocyte colony-stimulating factor
GERD Gastroesophageal reflux disease
GI Gastrointestinal
GN Glomerulonephritis
GP Glycoprotein
GPA, GPB Glycophorin A, B
GVHD Graft-versus-host-disease
HAART Highly active antiretroviral therapy
HBOC Hemoglobin oxygen carrier
HBV Hepatitis B virus
HCG [Beta]-Human chorionic gonadotropin
Hct Hematocrit
HCV Hepatitis C virus
HD Hospital day
HDFN Hemolytic disease of the
fetus/newborn
HDL High-density lipoprotein
HELLP Hemolysis, elevated liver enzymes,
low platelets (syndrome)
HEMPAS Hereditary erythroblastic multinucle-
arity with positive acidified serum
Hgb Hemoglobin
HIT Heparin-induced thrombocytopenia
HIV Human immunodeficiency virus
HLA Human leukocyte antigen
HLC Hyperleukocytosis
HNA Human neutrophil antibody
HPA Human platelet antigen
HPC Human progenitor cell
xxxii Abbreviations
HPFH Hereditary persistence of fetal

hemoglobin
HPLC High-performance liquid
chromatography
HSC Hematopoietic stem cell
HSCT Hematopoietic stem cell transplant
HSP Henoch-Schönlein purpura
HTLA High titer/low avidity
HU Hydroxyurea
HUS Hemolytic uremic syndrome
IAT Indirect antiglobulin test
ICH Intracranial hemorrhage
IDA Iron deficiency anemia
IEF Isoelectric focusing
IFE Immunofix electrophoresis
IgA, G, M Immunoglobulin A, G, M
IL Interleukin
IND Investigational New Drug
INR International normalized ratio
IOM Institute of Medicine
IQCP Individualized quality control plan
IRB Institutional Review Board
IS Immediate spin
ISI International Sensitivity Index
ISN/RPS International Society of Nephrology/
Renal Pathology Society
ISO International Organization of
Standardization
ISTH International Society on Haemostasis
and Thrombosis
IT Information technology
ITP Idiopathic (immune) thrombocytope-
nic purpura
IU International units
IV Intravenous
IVIG Intravenous immunoglobulin
JAK2 Janus kinase 2
K Kinetic time (thromboelastography)
K2, K3 EDTA Dipotassium, tripotassium ethylenedi-
aminetetraacetic acid
KB Kleihauer-Betke
L&D Labor and delivery
LAC Lupus anticoagulant
LAH Left atrial hypertension
LBCL Large B-cell lymphoma
Abbreviations xxxiii
LCA Leukocytapheresis
LC-MS Liquid chromatography-mass
spectrometry
LDH Lactate dehydrogenase
LDL Low-density lipoprotein
LIS Laboratory information system
LISS Low ionic strength solution
LMWH Low molecular weight heparin
LN Lupus nephritis
LTOWB Low-titer group O whole blood
LVAD Left ventricular assist device
LVDS Large volume, delayed sampling
LY30 Lysis (clot lysis at
30 min—thromboelastography)
m Microscopic
MA Maximum amplitude
(thromboelastography)
MACE Modified antigen-capture enzyme-
linked immunosorbent assay
MAHA Microangiopathic hemolytic anemia
MAIPA Monoclonal antibody immobilization
of platelet antigens
MCA Middle cerebral artery
MCH Mean corpuscular hemoglobin
MCHC Mean corpuscular hemoglobin
concentration
MCL Mantle cell lymphoma
MCV Mean corpuscular volume
MDS Myelodysplastic syndrome
MERS Middle Eastern respiratory syndrome
mf Mixed field
MFI Mean fluorescence intensity
MICU Medical intensive care unit
MPI Mycoplasma pneumoniae infection
MPO Myeloperoxidase
MPS Massively parallel sequencing
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
MRN Medical record number
MSC Marrow stem cells
MSM Men who have sex with men
MTHFR Methylenetetrahydrofolate reductase
MTP Massive transfusion protocol
mTPE Membrane therapeutic plasma
exchange
xxxiv Abbreviations
NAAT Nucleic acid amplification test

NEC Necrotizing enterocolitis
NGS Next generation sequencing
NHSN National Healthcare Safety Network
NICU Neonatal intensive care unit
NIH National Institutes of Health
NMB New methylene blue
NO Nitric oxide
NPP Normal pooled plasma
NSAID Nonsteroidal anti-inflammatory drug
NT Not tested
OD Optical density
ORS Office of Radiological Security (ORS)
PA Physician assistant
PABD Preoperative autologous blood
donation
PAI-1 Plasminogen activator inhibitor-1
pANCA Perinuclear antineutrophil cytoplasmic
antibody
PaO2 Partial pressure of arterial oxygen
PAS Platelet additive solution
PBM Patient blood management
PBSC Peripheral blood stem cells
PCC Prothrombin complex concentrate
PCH Paroxysmal cold hemoglobinuria
PCR (AS) Polymerase chain reaction
(allele-specific)
PEG Polyethylene glycol
PEP Post-exposure prophylaxis
PF4 Platelet factor 4
PFA Platelet function analyzer
PFC Perfluorocarbon
pHUS Pneumococcal-associated hemolytic
uremic syndrome
PI Pathogen inactivation
PICU Pediatric intensive care unit
PL Phospholipid
PLS Passenger lymphocyte syndrome
PLTA Platelet light transmission
aggregometry
PMN Polymorphonuclear (leukocyte)
PNH Paroxysmal nocturnal hemoglobinuria
PR Pathogen reduction
PR-3 Proteinase-3
PRA Panel reactive antibody
Abbreviations xxxv
PRCA Pure red cell aplasia

Pre-B ALL B-cell precursor acute lymphoblastic
leukemia
PrEP Pre-exposure prophylaxis
PRP Platelet-rich plasma
PrT Proficiency test
PRU P2Y12 Reaction Units (VerifyNow™)
PT Prothrombin time
PTP Posttransfusion purpura
QC Quality control
R Reaction time (thromboelastography)
R/R Relapsed or refractory
RBC Red blood cell
RCA Root cause analysis
RCo Ristocetin cofactor
RDW-CV Red cell distribution width-coefficient
of variation
RESt Rabbit erythrocyte stroma
RhAG Rh-associated glycoprotein
RhIg Rh immune globulin
RIPA Ristocetin-induced platelet
agglutination
RLS Restless leg syndrome
RPGN Rapidly progressive
glomerulonephritis
RT Room temperature
S Strong
S/Co Signal to cutoff
SARS Severe acute respiratory syndrome
SARS-CoV-2 Severe acute respiratory syndrome-
coronavirus-2 (coronavirus disease
2019, COVID-19)
SC1, 2 Screen cell 1, 2
SCD Sickle cell disease
SCT Silica clotting time
scuPA Single chain urokinase-type plasmino-
gen activator
S-D Solvent-detergent (plasma)
SDF-1 Stromal-derived factor-1
Se Secretor
SEER Sonic estimation of elasticity via
resonance
SICU Surgical intensive care unit
SLE Systemic lupus erythematosus
SNP Single nucleotide polymorphism
xxxvi Abbreviations
SOP Standard operating procedure

SPRCA Solid-phase red cell adherence
SRA Serotonin release assay
STEC Shiga toxin Escherichia coli
TACO Transfusion-associated circulatory
overload
TAD Transfusion-associated dyspnea
TAFI Thrombin activatable fibrinolytic
inhibitor
TA-GVHD Transfusion-associated graft-versus-
host disease
TANEC Transfusion-associated necrotizing
enterocolitis
TASH Trauma-Associated Severe
Hemorrhage (score)
TBV Total blood volume
TCD Transcranial Doppler
TDT Transmissible disease test
TEE Transesophageal echocardiogram
TGT Thrombin generation test
TIBC Total iron binding capacity
TJC The Joint Commission
TMA Thrombotic microangiopathy
tPA Tissue plasminogen activator
TPE Therapeutic plasma exchange
TPO-RA Thrombopoietin receptor agonist
TRAGI Transfusion-related acute gut injury
TRALI Transfusion-related acute lung injury
TRIM Transfusion-related
immunomodulation
Tryp Trypsin
TSAT Transferrin saturation
TSO Transfusion safety officer
TT Thrombin time
TTP Thrombotic thrombocytopenic purpura
TXA Tranexamic acid
TXA2 Thromboxane A2
TXT Textarin
UCBSC Umbilical cord blood stem cells
UFH Unfractionated heparin
uPA Urokinase-type plasminogen activator
UVA, B Ultraviolet A, B radiation
vCJD Variant Creutzfeldt-Jakob disease
VET Viscoelastic testing
VKA Vitamin K antagonist
Abbreviations xxxvii
VLBW Very low birth weight

VTE Venous thromboembolism
VVR Vasovagal reaction
VWD/F von Willebrand disease/factor
VWF:Ag/CB von Willebrand factor antigen/
collagen binding
VWFpp von Willebrand factor propeptide
W Weak
WAIHA Warm autoimmune hemolytic anemia
WB Whole blood
WBC White blood cell
WBIT Wrong blood in tube
WHO World Health Organization
Part I
Case Studies in Transfusion Medicine,
Immunohematology, Therapeutic
Apheresis, and Hemostasis
Blood Banking, Immunohematology, Transfusion Medicine

Bloodless Medicine, Patient Blood Management
Coagulation, Hematology
Factor Concentrate
Hemovigilance, Transfusion Reactions
Laboratory Accreditation, Administration, Regulation
Massive Transfusion Protocol
Maternal-Fetal Medicine
Molecular Genotyping
Proficiency Testing
Therapeutic Apheresis
Chapter 1
Basic Antibody Identification: It’s All
Greek to Me...

M. T. Friedman (*)
Department of Pathology, NYU Lagone Health, Mineola, NY, USA
e-mail: mark.friedman@nyulangone.org
K. A. West
Department of Transfusion Medicine, National Institutes of Health Clinical Center,
Bethesda, MD, USA
e-mail: kamille.west@nih.gov
P. Bizargity
Department of Pediatrics, Northwell Health System, Great Neck, NY, USA
e-mail: pbizargity@northwell.edu
K. Annen
Department of Pathology, Children’s Hospital Colorado, Aurora, CO, USA
e-mail: Kyle.Annen@childrenscolorado.org
H. D. Gur
Department of Pathology, Northwell Health System, Greenvale, NY, USA
e-mail: hgur@northwell.edu
T. Hilbert
Department of Pathology, NYU Langone Health, New York, NY, USA
e-mail: timothy.hilbert@nyulangone.org
© The Author(s), under exclusive license to Springer Nature 3

Switzerland AG 2023
M. T. Friedman et al., Immunohematology, Transfusion Medicine, Hemostasis,
and Cellular Therapy, https://doi.org/10.1007/978-3-031-14638-1_1
4 M. T. Friedman et al.
Clinical History
A 52-year-old man with a history of hypertension, type 2 diabetes mellitus, and

three-vessel coronary artery disease is admitted to the hospital for a coronary artery
bypass graft (CABG) surgery. A dipotassium ethylenediaminetetraacetic acid (K2
EDTA) anticoagulant sample is submitted to the blood bank for type and screen
(Table 1.1) along with an order for four units of red blood cells (RBCs). No transfu-
sion history is given. Further, immunohematology testing is performed (Table 1.2).
Table 1.1 ABO/Rh/antibody screen

ABO/Rh (tube method)
Patient RBCs (forward type) Patient plasma (reverse type)
Anti-A Anti-B Anti-D A1 cells B cells
0 0 3+ 4+ 4+
Antibody screen (tube LISS method)
37 °C AHG CC
SC1 0 0 2+
SC2 3+ 4+ NT
AHG antihuman globulin, CC check cells, LISS low-ionic strength solution, RBCs red blood cells,
SC screen cell, Reaction scale = 0 (no reaction) to 4+ (strong reaction), NT not tested
1
Table 1.2 Tube panel (LISS)

Test results: IAT/
Rh-hr Kell Duffy Kidd Lewis MNS P Lutheran Tube LISS
Cell # Rh-hr D C E c e f Cw V K k Kpa Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb M N S s Pl Lua Lub 37 °C AHG CC
1 R1WR1 + + 0 0 + 0 + 0 0 + 0 + 0 + 0 + + + 0 + 0 + + + + 0 + 0 0 2+
2 R1R1 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 + + + + + 0 0 + 0 0 2+
3 R2R2 + 0 + + 0 0 0 0 0 + 0 + 0 + 0 + + 0 0 0 + 0 + + +S 0 + 3+ 4+ NT
4 R0r + 0 0 + + + 0 + 0 + 0 + 0 + 0 0 + 0 0 0 + + + + + 0 + 0 0 2+
5 r′r 0 + 0 + + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + 0 + + 0 + 0 0 2+
6 r"r 0 0 + + + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + + +w 0 + 3+ 4+ NT
7 rr 0 0 0 + + + 0 0 + + 0 + 0 + 0 + + + 0 0 + 0 + + +S 0 + 0 0 2+
Basic Antibody Identification: It’s All Greek to Me...
8 rr 0 0 0 + + + 0 0 0 + 0 + 0 + + + 0 + + 0 + + + 0 +S 0 + 0 0 2+
9 rr 0 0 0 + + + 0 0 0 + + + 0 + 0 + + 0 0 + 0 + 0 + 0 0 + 0 0 2+
10 rr 0 0 0 + + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + +w 0 + 0 0 2+
11 R1R1 + + 0 0 + 0 0 0 0 + 0 + 0 + 0 + + 0 0 + + 0 + 0 + 0 + 0 0 2+
Patient cell 0 0 2+
AHG antihuman globulin, CC check cells, IAT indirect antiglobulin test, LISS low-ionic strength solution, Reaction scale = 0 (no reaction) to 4+ (strong reac-
tion), S strong, W weak, NT not tested
5
Questions
1. What is the patient’s ABO/Rh blood type?

2. What antibodies did you identify?
3. Are the antibodies clinically significant? Why or why not?
4. How many RBC units would you need to screen in order to find four compatible
(i.e., negative for the corresponding antigen) units as requested? (Refer to the
Table of RBC antigen frequencies, using antigen frequencies listed under
Caucasian population).
5. What is the significance of the type and screen sample anticoagulant (K2 EDTA)?
Answers
1. What is the patient’s ABO/Rh blood type? The patient is group O, Rh-positive
blood type. Forward or front typing of the patient’s sample (i.e., using reagent
anti-A and anti-B sera to detect A and B antigens on the RBCs) shows that the
patient is group O type (i.e., neither A nor B antigens are detected). Back or
reverse typing of the sample confirms that patient is group O since both anti-A
and anti-B isoantibodies are detected in the plasma of the patient. Testing with
reagent anti-D serum shows that the Rh(D) antigen is present on the patient’s
RBCs; therefore, the patient is Rh(D)-positive.
2. What antibodies did you identify? Anti-E alloantibody is present; Rh(E) anti-
gen (Rh3) is a part of the Rh blood group system. Although the “rule of three”
applies in the identification of antibodies, for simplicity of working up the cases
in this workbook, the learner will find that the rule cannot be consistently applied.
The “rule of three” states that at least three antigen-positive and three antigen-
negative RBCs that react and do not react, respectively, are necessary to achieve
a statistically significant p value (or probability value) of 0.05 to rule-in or rule-
out an antibody. This standard approach, based on Fisher’s exact method, is nec-
essary to minimize the risk of a false-negative (i.e., failure to identify an
alloantibody that is present) or a false-positive (identification of an alloantibody
that is not present) result [1]. In this case, however, only two of the panel cells
are Rh(E)-antigen positive, and so a third cell technically should be tested; in
actual practice, blood banks utilize secondary antibody panel kits for such addi-
tional testing as needed.
3. Are the antibodies clinically significant? Why or why not? Anti-E is a clini-
cally significant alloantibody since it is immunoglobulin (Ig)G, is warm tem-
perature reactive (i.e., 37 °C), and is capable of causing delayed hemolytic
transfusion reactions (DHTRs) as well as hemolytic disease of the fetus/newborn
(HDFN). In general, clinically significant antibodies are warm-reacting, immune
1 Basic Antibody Identification: It’s All Greek to Me... 7
IgG antibodies, while cold-reacting IgM antibodies are generally not considered
to be clinically significant. Antibodies to the following blood group antigens are
usually IgG:
Rh, Kell, Duffy, Kidd, and Ss. Antibodies to the following blood group anti-
gens are usually IgM: Lewis, MN, and P1.
4. How many RBC units would you need to screen in order to find four com-
patible (i.e., negative for the corresponding antigen) units as requested?
Since approximately 29% of the Caucasian population carries the Rh(E) antigen
(see Table of RBC antigen frequencies) on their RBCs, 71% do not carry it. The
chances of finding a compatible donor RBC unit for the patient with an anti-E
antibody are about 7 out of 10 units. A total of four RBC units were requested
for the patient. Dividing 4 by 0.71 (i.e., 4/0.71), we find that 5.6 or, essentially,
six RBC units need to be screened in order to find four Rh(E)-antigen-negative,
compatible RBC units for the patient. However, one must also keep in mind that
because the patient’s blood type is O-positive, as noted above in question 1, only
group O units may be screened for this patient. In terms of prevalence, group O
is 45% in the Caucasian population (while group A is 40%, group B is 11%, and
group AB is 4%).
5. What is the significance of the type and screen sample anticoagulant (K2
EDTA)? While both K2 EDTA and tripotassium (K3) EDTA samples may be
used for laboratory testing, the former is referred to throughout the cases in this
workbook and generally more commonly used in routine blood bank testing [2,
3]. Typically, these anticoagulants are spray-dried onto the sides of the tube. By
convention, although both pink top and lavender top tubes contain EDTA, pink
top tubes are used in the United States to differentiate blood bank samples from
lavender top tube hematology samples. Serum samples (i.e., clotted sample in a
plain [nonserum separator] red top tube) are less commonly used for routine
blood bank testing nowadays. However, traditionally serum testing was pre-
ferred in order not to miss complement-dependent antibodies, such as those of
Kidd and Kell specificity [4].
References
1. Er LS, Bailey DJ. Identification of antibodies to red cell antigens. In: Cohn CS, Delaney M,
Johnson ST, Katz LM, editors. Technical manual. 20th ed. Bethesda: AABB; 2020. p. 389–425.
2. Leathem S, Zantek ND, Kemper M, Korte L, Langeberg A, Sandler SG. Equivalence of spray-
dried K2EDTA, spray-dried K3EDTA, and liquid K3EDTA anticoagulated blood samples for
routine blood center or transfusion service testing. Immunohematology. 2003;19(4):117–21.
3. Goossens W, Van Duppen V, Verwilghen RL. K2- or K3-EDTA: the anticoagulant of choice in
routine haematology? Clin Lab Haematol. 1991;13(3):291–5.
4. Grey C. Addition of fresh serum to plasma to aid in enhancement of complement-dependent
antibodies. Immunohematology. 2019;35(3):102–4.
Further Reading
Arinsburg SA. Antibody identification. In: Shaz BH, Hillyer CD, Gil MR, editors. Transfusion
medicine and hemostasis. 3rd ed. Dordrecht: Elsevier Science; 2018. p. 117–25.
Dean L. Blood groups and red cell antigens. National Center for Biotechnology Information
(NCBI), National Library of Medicine, National Institutes of Health, Bethesda, MD
20892-6510. Bethesda: National Center for Biotechnology Information (US); 2005.
Er LS, Bailey DJ. Identification of antibodies to red cell antigens. In: Cohn CS, Delaney M,
Johnson ST, Katz LM, editors. Technical manual. 20th ed. Bethesda: AABB; 2020. p. 389–425.
Chapter 2
Rhesus Pieces

M. T. Friedman (*)
Department of Pathology, NYU Lagone Health, Mineola, NY, USA
e-mail: mark.friedman@nyulangone.org
K. A. West
Department of Transfusion Medicine, National Institutes of Health Clinical Center,
Bethesda, MD, USA
e-mail: kamille.west@nih.gov
P. Bizargity
Department of Pediatrics, Northwell Health System, Great Neck, NY, USA
e-mail: pbizargity@northwell.edu
K. Annen
Department of Pathology, Children’s Hospital Colorado, Aurora, CO, USA
e-mail: Kyle.Annen@childrenscolorado.org
H. D. Gur
Department of Pathology, Northwell Health System, Greenvale, NY, USA
e-mail: hgur@northwell.edu
T. Hilbert
Department of Pathology, NYU Langone Health, New York, NY, USA
e-mail: timothy.hilbert@nyulangone.org
© The Author(s), under exclusive license to Springer Nature 9

Switzerland AG 2023
M. T. Friedman et al., Immunohematology, Transfusion Medicine, Hemostasis,
and Cellular Therapy, https://doi.org/10.1007/978-3-031-14638-1_2
Clinical History
A 25-year-old woman, gravida 2, para 1 (G2P1), at 37 weeks of pregnancy, who has

not had any complications throughout the pregnancy, presents for a routine prenatal
clinic visit. A type and screen sample (dipotassium ethylenediaminetetraacetic acid
[K2 EDTA] anticoagulant) is submitted to the blood bank (Table 2.1). Further,
immunohematology testing is performed (Table 2.2).
Table 2.1 ABO/Rh/antibody screen

ABO/Rh (tube method)
Patient RBCs (forward type) Patient plasma (reverse type)
Anti-A Anti-B Anti-D A1 cells B cells
4+ 0 0 0 4+
Antibody screen (tube LISS method)
37 °C AHG CC
SC1 1+ 2+ NT
SC2 1+ 2+ NT
AHG antihuman globulin, CC check cells, LISS low-ionic strength solution, RBCs red blood cells,
SC screen cell, Reaction scale = 0 (no reaction) to 4+ (strong reaction), NT not tested
Another random document with
no related content on Scribd:
“We beseech Thee to ‖ hear us Good Lord ‖ Grant us Thy Peace ‖ Have Mercy Upon
us.”
The desk was given by the Laymen’s Club.
The Choir
Architecture. The Choir (10) may best be surveyed from the eastern end of the
Crossing. (Visitors not admitted to Choir during service time except by permission.)
The half-round arches and other features exhibit a late Romanesque style with
Byzantine influence, which is not inappropriate to the eastern end of the Cathedral,
and which will relatively become a local detail as the prevailing Gothic style of the
whole Cathedral develops.[20] The interior facing is of Frontenac stone. Numerous
symbols from the Revelation of St. John the Divine will appear as the description of
the Choir and its environs proceeds. The first to attract attention is the broad course
of red jasper from South Dakota seen at the base of the piers of the great Choir
arch. This foundation course, which appears in the Ambulatory (12-12-12) running
entirely around the Choir, recalls St. John’s description of the Heavenly City: “And
the foundations of the wall of the city were garnished with all manner of precious
stones. The first foundation was of jasper” (Rev. xxi. 19). The green moulding above
the jasper is Pennsylvania serpentine. The floor of the Choir has three principal
levels. From the Crossing 5 steps lead to the Choir proper, which contains the stalls
for the clergy and choristers and which occupies the first two bays. An ascent of six
more steps leads to the second level which may be designated as the Presbytery.
Upon it are the two thrones hereafter mentioned and the altar rail, the latter a step
higher.[21] In the Sanctuary within the altar rail, 4 steps lead to the third level upon
which stands the Altar with its 3 white steps.[22] Around the Sanctuary stand eight
Great Columns described hereafter. The principal donor to the building of the Choir
was the late Hon. Levi Parsons Morton (Vice-President of the United States 1889-
93, Governor of the State of New York 1895-96) who, after the Great Columns were
erected, gave $600,000 toward the completion of the fabric and the installation of
the Altar, Reredos, Organ, Choir Stalls, Bishop’s Throne, and some other
furnishings. This sum was generously supplemented by Mrs. Morton. The ornate
Altar Rail of English oak is inscribed:
“To the Glory of God ‖ and in loving memory of ‖ Anna Livingston Morton ‖ May 18,
1846-August 14, 1918 ‖ Given by her daughter ‖ Edith Morton Eustis 1920.”
The Parapet at the entrance to the Choir is designed to represent outstanding

characters of 20 centuries of the Christian Era. It is in two sections, one on each
side of the steps leading from the Crossing to the Choir, each section being 18½
feet long and 4 feet high. It is built mainly of Champville (France) marble, in
modified French Gothic style. The twelve marble columns, alternately green, red
and yellow, are of Alps Green from Italy, Rouge de Rance from Italy, and Numidian
from Africa, respectively. The figures, from right to left, are as follows (authorities
differing slightly as to some of the dates given): (1) St. Paul (died A. D. 66) with
sword symbolizing his decapitation; (2) St. Justin Martyr (100-165) with axe and
block; (3) St. Clement of Alexandria (150-220) holding cross in left hand; (4) St.
Athanasius (296-373) pouring baptismal water from a sea-shell, referring to a
playful incident of his boyhood which led to his calling; (5) St. Augustine of Hippo
(354-430) with miter, pen and tablet; (6) St. Benedict (480-543) in habit of
Benedictine monk pointing to scroll; (7) St. Gregory the Great (550-604) with slave
child in broken shackles, referring to his intercession for pagan children in the slave
market; (8) Charles Martel (688-741) with crown, battle-axe and pennant; (9)
Charlemagne (742-814) with crown, scepter and orb; (10) Alfred the Great (849-
901) crowned, with sword by side, holding three burnt cakes on book;[23] (11)
Godfrey of Bouillon (1061-1100) crowned, with Crusader’s sword and shield; (12)
St. Bernard (1091-1153) in monk’s habit, holding aloft a cross in his right hand and
clasping a book in his left; (13) St. Francis of Assisi (1182-1226) in Franciscan
monk’s garb, contemplating a cross in left hand, and preaching to birds[24] in tree;
(14) John Wyckliffe (1325-1384) with book and staff; (15) Columbus (1435-1506)
lifting the veil from the globe, symbolizing the age of discovery; (16) Archbishop
Cranmer (1489-1556) with right hand thrust voluntarily into the flame, symbolizing
his martyrdom; (17) Shakespeare (1564-1616) standing amidst growing laurels; (18)
Washington (1732-1799) in civilian attire as President; (19) Lincoln (1809-1865)
standing by a burial cross delivering his Gettysburg Address; (20) uncarved block.
The basis for selecting the figures was the representative character of the nineteen
men selected in conjunction with their contribution to the development of Christian
civilization. The Parapet was designed by Messrs. Cram & Ferguson, and the
figures, modelled by Ferrari, were carved by John Evans & Co., of Boston. The
Parapet bears the following inscription:
“To the Glory of God and in Memory of ‖ Richard Delafield, ‖ Brigadier-General, Chief of
Engineers, ‖ Brevet Major-General, United States Army. ‖ Born September 1, 1798, Died
November 5, 1873, ‖ This Parapet is Erected by his Children, ‖ Albert, Juliet Covington
and Emma Delafield. ‖ Righteousness Exalteth a Nation: But ‖ Sin is a Reproach to any
People.”
The Pavements of the Ambulatory and Choir, designed by Mr. C. Grant LaFarge in
Romanesque and Byzantine motives, are related in their symbolism. The colors in
the Ambulatory are reddish, or earthy; while those in the three ascents of the Choir
progress through increasingly rich designs of greens and whites (hope and purity)
to greens, whites and blues (hope, purity and heaven) until they reach the pure
white steps of the Altar. The risers of the steps leading from the Crossing to the
Choir proper are of yellow Numidian marble and the treads of green Pennsylvania
marble. The pavement of the Choir is richly inlaid with Numidian, Swiss and other
marbles and Grueby Faience tiles. The steps to the Presbytery are of marble from
Hauteville, France. In the center of the floor of the Presbytery is a magnificent
mosaic rug of tiles and marbles, 32½ feet long and 10 feet wide, with smaller
patterns at the ends. In the center is an oval of black Belgian marble surrounded by
violet marble from Italy, while Grueby tiles of many colors, and Grecian, red
Numidian and other marbles form the rest of the design. The pavement of the
Sanctuary, within the communion rail, in addition to its rich designs of tiles and
marbles, contains, immediately in front of the steps to the Altar, a red tile
surrounded by a square brass border, inscribed:
“Whoever shall have prayed at this spot will have pressed with his feet a tile from the
ancient Church of St. John the Divine at Ephesus, built by the Emperor Justinian in the
year DXL over the traditional site of St. John’s grave.”
The tile was presented to the Cathedral by Bishop Kinsman of Delaware, its
authenticity being attested by Prof. George Weber of Smyrna, who procured it from
the ruins on the hill of Ayassolouk and who, in his lifetime, was a leading authority
on Ephesian archaeology.
The Eagle Lectern of bronze at the north side of the Choir steps is a replica of an
ancient lectern found near St. Albans Cathedral, England, in a lake into which it had
been cast when that structure was destroyed in the Saxon invasion. The eagle,
standing on a globe, is the symbol of St. John in his capacity as an Evangelist.
Around the lectern are the figures of the four Evangelists: St. Matthew with open
book, St. Mark with closed book and pen, St. Luke with open book in one hand and
pen in other, and St. John with chalice. Below are their respective symbols (p. 44).
The lectern was made by the Gorham Co. It bears the following inscription, the
initials at the end being those of the donor, Mary Gertrude Edson Aldrich:
“In Memoriam ‖ Horatio Potter ‖ Bishop of New York ‖ 1854-1887 ‖ M. G. E. A.”

THE BISHOP’S THRONE, CHOIR STALLS AND DEAN’S STALL
The Choir Stalls, rising in four tiers on either side of the Choir proper, are of
carved American oak. The canopies are after studies of those in the Chapel of
Henry VII in Westminster Abbey used as the Chapel of the Knights of the Order of
the Bath. The finials of the stalls are figures of great musicians and composers of
church music, as follows:
East.
Left. Right.
Bortniansky Mendelssohn
Handel Haydn
Bach Purcell
Tallis Palestrina
Pope Gregory St. Cecelia
Asaph King David
West.
The figures, modeled by Mr. Otto Jahnsen, are represented in the costumes of
their day; and the features of all but those of David and his chief musician Asaph
are from portraits.
The high canopied stall nearest the Crossing on the south side of the Choir is the
Dean’s Stall.[25] It was designed in the office of Messrs. Cram & Ferguson and is a
very skillful blending of styles to harmonize with the Jacobean canopies of the Choir
Stalls and the Flamboyant note in the stalls themselves. It has many interesting
details of carving, notably the three panels depicting the Good Shepherd (front),
Learning (east side), and Charity (west side). On the back of the stall is inscribed:
“In the Name of the ‖ Father Son & Holy Ghost ‖ This Stall is Dedicated by ‖ The Head
Mistresses Association ‖ to the Memory of ‖ Agnes Irwin ‖ 1841-1914 ‖ Holding fast the
faithful word as she ‖ had been taught herself being not dis- ‖ obedient unto the heavenly
vision ‖ Head Mistress of the Agnes Irwin School 1867-1894 ‖ First Dean of Radcliffe
College 1894-1909 ‖ First President of the ‖ Head Mistresses Association ‖ 1911-1914.”
In the Presbytery, on the south side, is the lofty Bishop’s Throne of carved oak,
while opposite to it is one with a little lower canopy for the use of a bishop other
than the Diocesan.
On one of the Choir Stalls is inscribed:
“These Stalls are Erected to ‖ the Glory of God ‖ and in Loving Memory of ‖ Susan
Watts Street ‖ 1818-1893 ‖ By her Daughter ‖ Anna L. Morton.”
On a tablet in the Choir is inscribed:
“The Stalls ‖ of the Sanctuary ‖ and the Choir ‖ are Erected to ‖ the Glory of God ‖ and
in Memory of ‖ Susan Watts Street ‖ 1818-1893 ‖ By her Daughter ‖ Anna Livingston ‖
Morton.”
The stalls and the cathedra of the Diocesan were made by the John Barber Co.,
of Philadelphia, and the corresponding Bishop’s throne on the north side by Messrs.
Irving & Casson, of Boston.
The Organ, seen in the upper arches on either side of the Choir, contains 7,000
pipes and a chime, connected by electric wires with the console located in the
gallery on the south choir screen. The console has four manuals and two octaves of
pedals, 106 speaking stops, 31 couplers, and 33 pistons. The organist, invisible to
the congregation, can see the choir and clergy either directly or by means of
mirrors. A Gothic tablet in the south Ambulatory is inscribed:
“This Organ ‖ is Dedicated ‖ to the Praise of ‖ the Blessed Trinity ‖ and ‖ in Loving
Memory of ‖ Lena Kearny Morton ‖ 1875-1904 ‖ By her Parents ‖ Levi Parsons Morton ‖
and ‖ Anna Livingston Morton.”
The organ was built by the Ernest M. Skinner Co., of Boston. (See also Choir
School, page 106).
The Cathedral Flag which hangs above the choir stalls on the north side of the
Choir opposite the American flag, bears upon a purple field a white Latin cross, on
the crossing of which is a shield displaying the arms of the Cathedral. The shield is
divided by radial lines into three parts: In the upper left-hand part (as viewed) are
the arms of the city of New York, in the upper right-hand part the arms of the state;
and at the bottom the seven candlesticks and seven stars of the Book of Revelation
(ii. 1) symbolizing the seven churches and seven spirits of the churches founded by
St. John the Divine in Asia Minor. The Cathedral flag and the American flag were
given by Mrs. J. Herman Aldrich. The American flag which is sometimes carried in
the procession and which was first used in the victory celebration in 1918, was
given by Mrs. William Iselin. (See page 6).
The High Altar is of white Vermont marble. The beautiful Gothic Reredos is of
pierre de Lens, quarried in the vicinity of the city of that name in the north of France
which was so terribly ravaged in the late war. In the center is a majestic figure of
Christ. On His left, (in order from center to spectator’s right) are Isaiah, Jeremiah,
Ezekiel and Moses, representing the Old Testament; and on His right (in order from
center to spectator’s left) are St. John, St. James, St. Peter and John the Baptist,
representing the New Testament. The scale of the Cathedral may be judged from
the size of the figure of our Saviour, which is seven feet high. Those of Moses and
John the Baptist are 6 feet 10 inches high. In smaller niches on the front and sides
are 16 angels holding various emblems—palm, sword, shield, swinging lamp,
crown, trumpet, etc. Under the pedestals of the statues are clusters of grapes,
symbolizing Him who gave His body and blood for man. The statue of Christ was
made by Sig. Leo Lentelli under the direction of Mr. Carl Bitter. The other figures
were made by Mr. Otto Jahnsen. The great rectangular panel in the lower part of
the Reredos is filled with a rare Spanish embroidery in arabesque design, 200 years
old. The Altar and Reredos were built by the Barr, Thaw & Fraser Co. Upon the Altar
is the following inscription:
“To the Glory of God ‖ and in Memory of ‖ Anna Livingston ‖ Morton ‖ 1846-1918.”
THE HIGH ALTAR
The Credence Table, at the right (south) side of the High Altar, is supported by a
shaft composed of three stones from the ruins of the ancient Abbey of Bury St.
Edmunds, England, in which the Barons met on November 20, 1214, and swore
before the altar to secure from King John the liberties which they embodied in
Magna Charta. These relics are of Caen stone, and may be recognized by their
gray color. They were given to the Cathedral in 1922, with the consent of the Abbey
authorities, by the Marquis of Bristol through Dr. Raphael Constantian of New York.
Near the shaft is the following inscription:
“The Adjoining Shaft ‖ Was Once a Part of ‖ the High Altar of the ‖ Abbey of Bury St.
Edmunds ‖ Upon Which on ‖ November 20, 1214, ‖ the Barons Swore Fealty ‖ to Each
Other in Wresting ‖ the Great Charter ‖ from King John. ‖ It is Placed Here ‖ as a Symbol
of ‖ the Community of ‖ Political Tradition, ‖ Laws and Liberties, ‖ Which is the Inheritance
‖ of the English Speaking ‖ Commonwealths ‖ Throughout the World.”
Credence Table with Shaft made of Magna

Charta Stones
The Eight Great Columns standing in a semicircle around the Sanctuary and
forming seven interspaces opposite the seven Chapels of Tongues, are among the
marvels of the Cathedral. They are approached in size only by those in St. Isaac’s
Cathedral, Petrograd. The shafts of light gray granite from Bear Island, near Vinal
Haven on the coast of Maine, were quarried as monoliths and turned on a special
lathe which cost $50,000. When the first two were subjected to the pressure of
polishing they broke, and the contractor then obtained permission to make the
shafts in two pieces. The lower stone in each shaft is 38 feet high and weighs 90
tons, and the upper stone is 17 feet high and weighs 40 tons, the total height
between base and capital being 55 feet and the weight 130 tons. The octagonal
capitals of pierre de Lens by Mr. Post represent singing angels. The columns were
given as memorials of the men whose names are carved on the bases seen in the
Ambulatory (south to north:) “Alonzo Potter,[26] Bishop of Pennsylvania, 1800-
1865;” “Colonel Richard Tylden Auchmuty, U. S. V., 1831-1893;” “Harry Manigault
Morris, 1817-1892;” “Eugene Augustus Hoffman, 1829-1902;” “John Jacob Astor,
1763-1848;” “John Divine Jones, 1814-1895;” “Josiah Mason Fiske, 1823-1892;”
and “Joseph Lawrence, 1788-1872.” Each column cost $25,000, not including the
expense of erection. They were made by Mr. John Pierce of Vinal Haven, Me.
The Clerestory Windows of the Choir, nine in number, of which seven are above
the entrances to the seven Chapels of Tongues, are designed to depict the Book of
Revelation of St. John the Divine. Seven of them are in place. They are of painted
mosaic glass made by Messrs. James Powell & Sons of Whitefriars, London,
according to the methods used in the thirteenth century and cost $10,000 and
upwards apiece. Each window is of three lights with rose window at the top, and is
28 feet high and 17 feet wide. The seven windows above the entrances to the
Seven Chapels of Tongues (north to south) are designed to symbolize in their
circular lights the messages to the seven churches in Asia mentioned in the Book of
Revelation (i. 11), in the order there named: Ephesus, Smyrna, Pergamos, Thyatira,
Sardis, Philadelphia and Laodicea. They are connected by the inscriptions in their
lower borders which read consecutively as follows:
“Grace be unto you and Peace from Him ‖ Which is and Which was and Which is to
come ‖ From the Seven Spirits which are before His throne ‖ Jesus Christ the Faithful
Witness ‖ The First Begotten of the Dead ‖ The Prince of the Kings of the Earth. ‖ To Him
be Glory and Dominion for ever and ever” (Rev. i. 4-6).
These windows, which are of surpassing charm to the unaided eye, flash out with
extraordinary brilliancy of color and affecting beauty of composition and execution,
particularly those called “Christ Reigning in Glory” and “the Woman in the Sun,”
when examined with long distance glasses (apply to Verger), although the less
brilliant windows contain subtle details well worth studying, as, for instance, the
symbolisms of the elements held by the angels in the window above the Chapel of
St. Boniface. Individually, from north to south:
St. John and the Seven Churches are the subject of the window above the Chapel of
St. Ansgarius. In the upper part of the central light, St. John between two praying
angels is depicted in the character of Apostle, beardless, and holding the
sacramental cup—the young St. John, symbolical of love and high ideals and the
feeling which filled all his writings; while in the lower part he appears as the aged
exile on the Isle of Patmos, sitting with book in lap and pen in hand, listening to the
angel behind him who commands him to write (Rev. i. 11). In the side lights are the
angels of the seven churches (i. 11), bearing on scrolls their names: (Upper left)
Ephesus; (lower left) Smyrna and Pergamos; (upper right) Thyatira and Sardis;
(lower right) Philadelphia and Laodicea. In the circular light at the top are the name
“Ephesus” and a shield bearing the seven candles mentioned in the message to the
church of Ephesus (ii. 1). In the lower border of the three lights runs the inscription:
“Grace be ‖ unto you and Peace ‖ from Him.” The window was given by Mrs. E. C.
Ludlow Johnson in memory of Gabriel Ludlow.
The Natural Elements upon which the vials of the wrath of God were poured (Rev.
xvi. 2-17) are the principal subject of the window above the Chapel of St. Boniface.
In the lower part of the left side light is an angel holding between his hands the
earth (green foliage); in the middle light three angels respectively holding the air
(invisible), the sun (yellow glow), and the sea (green waves); and in the right side
light an angel holding the rivers and fountains (blue currents). In the upper part of
the middle light is the Lamb that was slain (v. 12) between the four beasts (iv. 7)
which are in the side lights—on the left, the lion and the beast with the face of a
man; and on the right, the ox and the eagle.[27] In the circular light at the top are the
word “Smyrna” and a shield bearing the crown of life mentioned in the message to
the church in Smyrna (ii. 10). In the bottom border is the inscription: “Which is and ‖
Which was and Which ‖ is to come.” A tablet in the Ambulatory reads as follows:
“The Clerestory Window Above ‖ the Chapel of Saint Boniface ‖ is Dedicated ‖ to the
Glory of God ‖ and ‖ in Loving Memory of ‖ Annie Allen Wallace ‖ February 14, 1853-
August 25, 1890.”[28]
The Seven Angels with Trumpets (Rev. viii. 2) are the main subject of the window
above the Chapel of St. Columba. Three of them are in the lower part of the middle
light and two in each of the side lights. In the upper part of the middle light is the
mighty angel of the cloud, overarched by the rainbow, standing upon the sea, and
holding aloft in his left hand the little open book (x. 1, 2). In the upper part of the left
side light is the angel with the seal of the living God (vii. 2) and in the right side light
the angel with the golden censer (viii. 3). In the middle of the side lights are four
angels (two left and two right) blowing the four winds of the earth (vii. 1). In the
circular light at the top are the name “Pergamos” and a shield bearing the sharp
two-edged sword of Him who sent the message to the church in Pergamos (ii. 12)
between the Greek letters ΙΗϹ and ΧΡϹ (Jesus Christ.)[29] In the bottom border are
the words: “From the seven ‖ Spirits which are before ‖ His throne.” A tablet in the
Ambulatory reads as follows:
“The Clerestory Window Above the ‖ Chapel of Saint Columba‖ is Erected ‖ to the Glory
of God ‖ and ‖ in Loving Memory ‖ of ‖ 1797 John Williams Leeds 1873 ‖ 1800 Eliza Leeds
1885 ‖ Emily Irene Hardenbergh 1899 ‖ By Their Daughter and Sister ‖ Josephine Eliza
Leeds ‖A. D. 1915.”
Christ Reigning in Glory, as described in the first chapter of the Book of

Revelation, is the principal subject of the great central window above the Chapel of
St. Saviour. In the central light is the Son of Man, with up-raised hands, vested as
King and Priest, wearing a royal crown, a crimson mantle and a golden pallium. He
stands in the midst of the seven candlesticks (i. 13), holds in his right hand the
seven stars (i. 16, 20), and is surrounded by winged seraphim. Beneath him a
rainbow (iv. 3) over-arches the sea of glass (iv. 6). In the side lights are the four
principal archangels: St. Michael (left, above,) is depicted in armor as the Prince of
the Celestial Armies, while the balance in his left hand, supposed to contain the
souls of the dead, symbolizes his character as Guardian Angel of Departed Spirits.
St. Raphael, below him, with pilgrim’s staff, is represented as the friendly traveller,
recalling Milton’s “affable archangel.” St. Gabriel (right, above,) appears as Angel of
the Annunciation, as indicated by the lilies (symbol of purity) in his right hand; and
below him is St. Uriel, as Angel of Light, holding the sun.[30] In the circular window
at the top are two angels holding the morning star mentioned in the message to the
church in Thyatira (ii. 28), but the name “Thyatira” is lacking. In the border at the
bottom of the three lights are the words: “Jesus Christ ‖ the Faithful ‖ Witness.” The
window was given by Mrs. Whitelaw Reid. A tablet in the Ambulatory reads:
“The East Window ‖ is Erected in Memory of ‖ Whitelaw Reid ‖ October 27, 1837-
December 15, 1912.”
The Seven Last Plagues (Rev. xv. 1) are the principal subject of the window above
the entrance to the Chapel of St. Martin of Tours. These are represented in the
lower part of the window by seven angels holding the seven vials containing the
plagues, three in the central light and two in each of the side lights. In the upper part
of the middle light is an angel holding aloft in his right hand the everlasting Gospel
(xiv. 6) in the form of a scroll bearing (obscurely) the symbols of the four
Evangelists. In the upper part of the left side light is the angel with the measuring
rod (xi. 1), and in the right side light is the angel standing in the sun (not to be
confused with the woman in the sun mentioned in the next window,) calling the
fowls of the air to the supper of the great God (xix. 17). In the circular light at the top
are the name “Sardis” and a shield bearing a white dove in the midst of the seven
stars (the seven Spirits of God,) mentioned in the message to the church in Sardis
(iii. 1). In the border at the bottom of the three lights are the words: “The First ‖
Begotten of ‖ the Dead.” A tablet in the Ambulatory reads:
“The Clerestory Window Above ‖ the Chapel of St. Martin of Tours ‖ is Erected to the
Glory of God ‖ and in Loving Memory of ‖ Sophia R. C. Furniss ‖ and ‖ Mary B. Hubber ‖
by ‖ Margaret E. Zimmerman ‖ nee Furniss ‖ Blessed are the peace-makers for they ‖
shall be called the children of God.”
The Woman in the Sun is the title of the window above the entrance to the Chapel
of St. Ambrose. In the central light is the woman clothed with the sun and wearing
the crown of twelve stars (Rev. xii. 1). She is surrounded by a dazzling radiance of
flaming rays. Above her, a cloud of glory is carrying her Child up to the throne of
God (xii. 5). In the left side light, above, is the angel proclaiming the fall of Babylon
(xiv. 8), and below, symbolizing that wicked city, the woman in scarlet holding the
golden cup of abominations and seated on the beast from the bottomless pit (xvii. 4,
18). In the right side light, above, is the angel with the sharp sickle and the clusters
of the vine (xiv. 18), and below, the angel with the keys to the bottomless pit and the
chain to bind the dragon (xx. 1). The whole window symbolizes the triumph of Christ
over the forces of evil. In the circular light at the top are the name “Philadelphia” and
a shield upon which, between six D’s, is the key of David mentioned in the message
to the church in Philadelphia (iii. 7). In the border at the bottom are the words: “The
Prince ‖ of the Kings of ‖ the Earth.” A tablet in the Ambulatory is inscribed:
“The Clerestory Window Above ‖ the Chapel of Saint Ambrose ‖ is Erected to ‖ the Glory
of God ‖ and in Loving Memory of ‖ Morgan Lewis Livingston ‖ 1800-1869 ‖ and ‖
Catharine Manning Livingston ‖ 1810-1886 ‖ By Their Daughter ‖ Julia Livingston ‖ 1916.”
The Heavenly City is the principal subject of the window above the entrance to the
Chapel of St. James. In the lower part of the middle light is the angel showing to St.
John the Heavenly City (Rev. xxi. 10 et seq.) and in the upper part is a glorified
figure symbolizing the holy city, new Jerusalem, coming down from God out of
heaven prepared as a bride adorned for her husband (xxi. 2). Beneath this figure in
the upper part is the pure river of water of life, and on either side of it is the tree of
life whose leaves are for the healing of the nations (xxii. 1-2). In the lower part of the
left-hand light is the angel with the Alpha, and in the corresponding part of the right-
hand light is the angel with the Omega (xxii. 13); while above each of them is a
beckoning angel saying “Come” (xxii. 17). In the circular light at the top are the
name of the church of Laodicea and the word “Amen”—the latter being the name of
the sender of the message to the Laodiceans (iii. 14) and the word with which the
Book of Revelation and the Bible end (xxii. 21). In the bottom border of the three
lights is the inscription: “To Him be Glory ‖ and Dominion for ‖ Ever and Ever.” The
window was given in memory of Mary C. and Dr. John D. Ogden by their children
Francis L. Ogden, Margaret Ogden, Mrs. Gardiner Sherman and Mrs. Francis C.
McNutt.
The Ambulatory
The Ambulatory (12-12-12) is a passage about 20 feet wide leading entirely
around the Choir and giving access to the seven Chapels of Tongues, the Sacristy,
and other environments of the Choir. Some of the features have already been
described. The symbolism of the earthly life in the pavement, before mentioned (p.
51), is noticeable in the large areas of clay-red tiles with borders of grassy green
serpentine and green marble from Pennsylvania. The beautifully colored
wainscoting between the great pillars is of Grecian marble from the island of Scyrus.
The Ambulatory is entered through elaborately wrought steel gateways, 30 feet
high, in the archways on either side of the great arch of the Choir. The gates, made
by Messrs. Warren & Wetmore, were presented by the Cathedral League and the
Diocesan Auxiliary. In the south Ambulatory gateway is a white marble tablet,
showing in relief two angels and two portrait medallions of Mr. and Mrs. Levi P.
Morton, and bearing the following inscription:
“To the Glory of God ‖ and ‖ in Enduring Memory of ‖ Levi Parsons Morton ‖ 1824-1920
‖ Vice-President of the United States ‖ Governor of the State of New York ‖ and ‖ of His
Wife ‖ Anna Livingston Morton ‖ 1846-1918 ‖ Whose Gifts Made Possible the ‖ Building
and the Furnishing of ‖ the Choir of this Cathedral ‖ Yea saith the Spirit that They ‖ May
Rest from Their Labours ‖ and Their Works do Follow Them.”
THE FOUNDER’S TOMB
The Founder’s Tomb, containing the remains of Bishop Horatio Potter, sixth Bishop
of New York,[31] in the Ambulatory between the fourth and fifth great pillars opposite
the entrance to St. Saviour’s Chapel, is a beautiful example of an “altar tomb” such
as are seen in many English churches. Its position, immediately behind the High
Altar, is that traditionally reserved for the Founder of a cathedral. It is designed in
the English Gothic style of the 15th century after studies of the tomb of Edward the
Confessor in Westminster Abbey. The sarcophagus, the recumbent figure of the
Bishop and the figures of the five ornamental niches of the front are of Indiana
limestone. The figures, from left to right, are those of (1) Edward the Confessor, with
crown, scepter and orb; (2) St. Remigius, with cup and scourge; (3) St. John the
Divine, with pen, book and eagle; (4) St. Isidore, with miter, pallium and crozier; and
(5) St. Theodosius of the Eastern Church, wearing a coronet with cross, holding a
staff and reading from a scroll. Above the niches is a decorative moulding of oak
leaves and acorns[32] with little squirrels at the ends. On the edge of the slab on
which the Bishop’s figure rests is inscribed:
“Horatio Potter, D.D., D.C.L., Oxon. ‖ Sixth Bishop of New York, Founder of this
Cathedral. Died 2d Jany. 1887, Aged 85 Yrs.”
On the rear of the sarcophagus is inscribed “St. John’s Day ✠ Anno Domini
1921,” the day on which the Bishop’s remains were transferred from Poughkeepsie
to this tomb. Above the tomb, reaching to a height of 15 feet above the pavement, is
a canopy of American oak with richly carved frieze and cresting, supported on
corbels springing from the great granite columns on either side. A narrow stairway
behind the columns and the tomb leads to a landing which permits a closer view of
the figure of Bishop Potter. The architect was Mr. Thomas Nash of New York and
the sculptor of the figures was Mr. Isidore Konti of Yonkers, N. Y.
The Brownell Memorial Tablet on the wall of the bay at the entrance to the Chapel
of St. Ansgarius reads as follows:
“In Memory of ‖ The Right Reverend ‖ Thomas Church Brownell, S.T.D., LL.D. ‖ Born
1779 Died 1865 ‖ Third Bishop of Connecticut 1819-1865 ‖ Presiding Bishop 1852-1865 ‖
and ‖ in Grateful Remembrance of the Foundation of ‖ the Bishop Brownell Memorial Fund
for the ‖ Endowment of the Cathedral by His Daughter ‖ Frances Johnston Holland.”
The Choir Boys’ Stone on one of the piers of the Ambulatory near the Chapel of
St. Ansgarius, is the bust of a boy of the class of 1911, carved by Mr. William Scott.
It represents the choir boys’ contribution to the building of the Cathedral.
The Seven Chapels of Tongues

The seven Chapels of Tongues, built around the Choir on lines converging toward
the Sanctuary and deriving their name from the fact that they were intended for
services of the church in the languages of the principal ethnological groups or
regions of the world, are one of the noblest conceptions of the Cathedral. In early
Gothic churches, the fundamental idea of the apse with radiating chapels was
Christ in the company of his Saints. Here, in the great cosmopolitan Diocese of New
York, this idea has appropriately been carried a step further in these chapels to
include the idea of all the nations of the earth gathered around the Altar of the
Saviour of Mankind. They recall the cry of the multitude in Jerusalem at Pentecost:
“How hear we every man in our own tongue wherein we were born ... the wonderful
works of God” (Acts ii. 8, 11). Among the interesting services held in these chapels
are those in the eastern (St. Saviour’s) chapel for the Japanese and Chinese in
their languages and for colored people in English. The spirit fostered by these
chapels is occasionally reflected in great congregations, entirely of Italians, entirely
of negroes, or predominantly of some other race, at services held in the main part of
the Cathedral filling it to its utmost capacity.[33] Services in English are held in one
or more of the chapels every day of the year, and oftentimes weddings and
baptisms are held in them. As a group, the seven Chapels of Tongues eloquently
express the catholic and democratic spirit of the Cathedral of St. John the Divine
referred to on page 14. They may be visited in order either from south to north or
north to south; but by beginning on the south side they will be seen in the order in
which they were observed on the exterior (p. 31), and by looking through the
archways of the Choir to the opposite side of the Ambulatory, glimpses may be had
of the tapestries and the clerestory windows in the order in which they have been
described. The chapels are all separate gifts and are memorials of the persons
mentioned under their respective headings following:
The Chapel of St. James
St. James, the Apostle, after whom this chapel is named, was the son of
Zebedee and was a Galilean fisherman. He is sometimes called St. James the
Great to distinguish him from another Apostle called St. James the Less. He was a
brother of St. John the Divine. He went almost everywhere with the Lord. After the
ascension, he preached a while in Judea and then in Spain. After his mission there,
he was beheaded by the Jews, and, according to tradition, his body was
miraculously transported back to Spain, where his relics are said to rest at
Compostella. Spanish historians chronicle 38 instances in which he is believed to
have descended from heaven and in shining white armor led the Spanish armies
against the Moors. Under the Spanish equivalent of his name, St. Iago or Santiago,
he became the patron saint of Spain and his name was adopted as the Spanish
war-cry. His shrine at Compostella was one of the most popular for pilgrimages in
the Middle Ages, and it was said that two visits to Compostella equaled one to
Rome. St. James is usually represented in the dress of a pilgrim with a peculiar
staff. His Memorial Day is July 25.
The Chapel of St. James (13 on plan), designed by Mr. Henry Vaughan, is in pure
English Gothic Architecture of the 14th century; 66 feet long and 39 wide, with a
sort of transept on the north side 15 feet wide; seats 250 persons, and cost about
$200,000. Its interior walls are of Bedford, Ind., limestone. On the front of the Altar
of gray Knoxville, Tenn. marble, is sculptured DaVinci’s Last Supper. The central
feature of the limestone Reredos is a relief representing the Transfiguration, after
Raphael. In four niches, two on either side of the Transfiguration, are statues of the
four Evangelists with their appropriate emblems at their feet (left to right:) St.
Matthew with winged man; St. Mark with lion; St. Luke with ox; and St. John with
eagle. Beneath the Transfiguration is a smaller sculpture of the Nativity, with an
alleluia angel on each side. On four escutcheons, two on each side of the Nativity,
are emblems of the condemnation and crucifixion (left to right:) (1) Crown of thorns
and spear (John xix. 2, 5, 34); (2) pillar to which Christ was bound for scourging,
cord, knotted scourge (John xix. 1) and sponge on reed (John xix. 29); (3) ladder,
sponge on reed and spear; and (4) hammer, pincers, coat, and three dice (Mark xv.
24). Beautifully carved canopies surmounted by six adoring angels crown the
Reredos. The stained glass East Window, by C. E. Kempe & Co. of London above
the Reredos, depicts in its three lights (left to right) St. Lawrence, St. James and St.
Vincent. In two walled-up panels of the window, one on each side of the glass, are
statues of St. Peter with keys (left) and St. Paul with sword (right). The Saint James
Window in the middle bay of the south aisle portrays in its four lights scenes in the
life of the patron saint of Spain (see page 71) and other subjects, as follows,
reading from left to right: Bottom, (1) Coat-of-arms of St. John and the words,
“James, servant of God;” (2) St. James preaching to the natives of Spain; (3) St.
James before the judge, forgiving his accuser and giving him his blessing, “Peace
be with thee;” (4) Coat-of-arms of King Ramira I of Spain, and the words (to be read
with those first quoted), “And of the Lord Jesus Christ.” Middle, (1) “Unto his shrine
the mighty and the lowly fared on pilgrimage;” (2) “St. James, the radiant knight,
upon a great white horse;” (3) “Before the banner of his name the Moorish warriors
fled;” (4) “At Compostella still men serve Santiago’s shrine.” Top, (1) angel with ΙϹ-
ΧϹ symbol; (2) “They bore his body to a ship that sailed for Spain;” (3) “Over his
tomb they built a chapel passing fair;” (4) Angel with Ichthus symbol.[34] In the
tracery at the extreme top is a representation of the Crucifixion. The window was
given by Bishop Potter’s daughters and was designed and made by Mr. Henry
Wynd Young, glass-painter, of New York City. In niches of the walls of the chapel
are the following statues and symbols: East Wall, St. Augustine of England with
crozier (left) and St. Gregory the Great (who sent him to England) with papal tiara
and papal cross (right) West Wall, end of main aisle, above, Christ between his
kinsmen St. James the Great (left) and St. James the Less (right); and at end of
south aisle, the Venerable Bede. On four escutcheons, two on each side of the west
door, are: (1) A floriated cross (emblematic of the flowering or productiveness of the
Christian religion); (2) the monogram ihc (representing the first two and last letters,
uncial form, of the Greek word for Jesus[35]); (3) the Greek cross form of the chi rho
monogram (first two Greek letters of the name Christ); and (4) the Alpha and
Omega, the first and last letters of the Greek alphabet, (Rev. i. 8). North Wall, statue
of William of Wykeham. In the upper part of the north wall is the gallery of the organ,
which is independent of the great organ of the Cathedral. Choir Stalls near the Altar
are a distinctive feature of this chapel. Two clustered columns divide the south aisle
into three bays in the middle one of which is Bishop Potter’s Tomb, of Siena marble.
On the tomb is a recumbent figure of the Bishop in Serevezza marble, by Mr. James
E. Frazer. The Bishop is represented in his episcopal robes, and the execution is so
fine that even the texture of the lawn sleeves is apparent. On the front of the tomb is
inscribed:
“Henry Codman Potter ‖ MDCCCLXXXIII Assistant Bishop of New York MDCCCLXXXVII

‖ Bishop of New York ‖ MDCCCLXXXVII-MCMVIII ‖ Upholder of Righteousness and Truth
‖ Soldier and Servant of Jesus Christ.”
THE SANCTUARY OF THE CHAPEL OF ST. JAMES
On the rear:
“He laboured that this Cathedral Church ‖ Should rise to the Glory of God and as ‖ A
witness to the Life of our Lord and Master Jesus ‖ Christ that here the prayers of the
children ‖ of many lands should rise to that ‖ Father in whom alone all men are brothers ‖
Whose service is perfect freedom.”
Around the edge of the top slab:
“I saw the Holy City coming down from God out of Heaven ‖ and I heard a great voice
saying ‖ Behold the tabernacle of God is with men and he will dwell with them ‖ and they
shall be his people.”
On the west wall is inscribed:
“The Chapel of St. James ‖ Consecrated ‖ May 2, 1916 ‖ To the Worship of ‖ Almighty
God ‖ And in Loving Memory of ‖ Henry Codman Potter ‖ Bishop of New York ‖ Born May
25, 1834 ‖ Died July 21, 1908 ‖ The Gift of His Wife ‖ Elizabeth Scriven Potter ‖ Born
September 30, 1848 ‖ Died March 4, 1909.”
Story of the Blind Woman. A beautiful and touching incident occurred in the Chapel
of St. James a few years ago. One day, a woman who was blind, deaf, and could
make only a few hardly articulate sounds, but who was cultured and could read by
touch, visited the Cathedral with another woman. The Verger, the late Charles F.
Barnard, first led her the full length of the Cathedral in order that she might
comprehend its size. Then the general features of the edifice were communicated
by her friend by the touch of their hands. The wood and stone carvings, however,
she read with her own fingers. When she came to the Chapel of St. James, she
wished to feel of Bishop Potter’s features as reproduced in the effigy on his tomb,
but on account of the delicacy of the marble, visitors are not allowed to touch it. The
blind woman, however, produced from her bag a pair of thin white gloves, and by
signs asked if she might feel of the statue if she put them on. The Verger assenting,
she ran her fingers deftly over the Bishop’s countenance, felt of the signet ring on
his finger, etc., and then, satisfied, proceeded to the Altar. Here she knelt down and
began to feel of the relief representing DaVinci’s Last Supper. As soon as she
recognized the work, she threw up her hands in ecstasy and exclaimed in broken
accents, the best she could utter, “Vinci! Vinci!” The venerable Verger, in relating
this incident, said that he was moved to tears by the spectacle of the blind woman,
kneeling before the Altar, with up-raised hands, “seeing” the Cathedral through the
sense of touch. One may well ask, if this blind woman could see so much spiritual
beauty in the Cathedral without eyes, how much more ought those to see who have
the blessed gift of sight.
The Chapel of St. Ambrose
St. Ambrose, or Ambrogio, the namesake of this chapel, was born in Treves
about 340, the son of a Roman Prefect in Gaul (now France). While in his cradle
one day, a swarm of bees settled upon him, clustering around his mouth, but doing
him no harm. A similar thing having happened to Plato, it was considered an omen
of future greatness. He studied law at Rome, became a magistrate in upper Italy
with court at Milan, and by his wisdom and gentleness won such popular esteem
that when called upon to settle of succession of the bishopric of Milan between the
Arians and Catholics he himself was chosen by both parties to be Bishop of that
see. He was one of the most celebrated fathers of the church. His most distinctive
symbol is the bee-hive, although two human bones, the scourge, the crozier, the
mitre, etc. are sometimes used. The Memorial Day for St Ambrose is kept on April
4.
The Chapel of St. Ambrose (14 on plan), designed by Messrs. Carrere &
Hastings, is in modern Renaissance Architecture. It is about 50 feet long and 27
wide, seats 100 persons and cost over $150,000. The floor is inlaid with grey Siena
and red Verona marbles, bordered with cream colored Cenere marble. The walls
are lined with Rosato marble. On the under side of the marble archway at the
entrance are reliefs representing the Three Persons of the Trinity with angels, as
follows: (Left) the Father in human form[36], with triangular nimbus, holding the
globe of sovereignty; angel with lute; angel with lily; (top) the Holy Ghost in form of
the dove; angel with trumpet; angel praying; and (right) the Son in form of the
Paschal Lamb. The false perspective of the side walls is similar to that in the
Sacristy of the Cathedral of Siena. In the spandrels of the false arches of the left-
hand wall (as one faces the Altar) are figures in relief (reading from entrance toward
Altar) of: Moses and the prophets Isaiah, Jeremiah and Ezekiel; and on the
opposite wall, in same order, St. Matthew with cherub, St. Mark with lion, St. Luke
with ox, and St. John with eagle. The ceiling is of white marble carved in low relief.
From the ceiling hang four silver lamps, one an antique Italian lamp and the others
copied from it. On the front of the Altar of alabaster are three golden ornaments,
representing the Paschal Lamb (Christ) between two angels swinging censers, the
latter symbolizing the prayers of all saints (Rev. viii. 3). The Reredos, not copied
from any one European prototype but inspired by many examples found in the
transitional and early Renaissance period in Italy, is of carved wood overlaid with
gold leaf. The lower part consists of a triptych, covered by an elaborate canopy and
flanked by niches in which are statues of St. Francis (left) and St. Ambrose (right).
In niches at the left of the canopy are figures (left to right) of a kneeling angel, St.
Benedict with crozier, St. Agnes in female apparel, and Dante in red gown and
hood; and at the right (same order) Fra Angelico, Galileo with globe, Savonarola,
and kneeling angel. Upon the cross of the canopy is a dove, symbolizing God the
Holy Ghost; above that is the all-seeing eye in a triangle within a sun-burst,
symbolizing God the Father; and on the top-most spire is the figure of God the Son,
holding a cross and pronouncing a benediction. The Apse Windows, one on each
side of the Altar, transmit a soft amber light which gives a peculiar charm to this
chapel. Each has a border of Italian Renaissance tracery, within which is a field of
many small panes of leaded glass. In the left window these panes are ornamented
with repeated designs representing the chalice with emerging serpent and the eagle
(symbols of St. John), flowers, and the chi-rho monogram. In the upper part are the
seven stars and candlesticks from the Cathedral seal, and the legend, “Sigil.
Eccles. Cath. S. Johan;” and in the lower part the words, “For God is the King of all
the Earth. Sing ye Praises with Understanding.” In the right window the panes are
ornamented with repetitions of the bee-hive, mitre and scourges (symbols of St.
Ambrose), the cross and wreath, flowers, and the ΙϹ-ΧϹ and IHS symbols. Near the
middle is a small fragment of brown glass, marked with an “R”, from Rheims
Cathedral. In the upper part is the coat-of-arms of St. Ambrose—the bee-hive, mitre
and croziers—with the legend, “Sigil. Sanct. Ambrosii,” and in the lower part are the
words, “God is our Refuge and Strength, a Very Present Help in Trouble.” The
windows were made by Mr. Henry Wynd Young, glass-painter, under the
supervision of Messrs. Godwin & Sullivant, architects, of New York. Along the side
walls are Stalls and Wainscoting of dark Italian walnut, inlaid with pear-wood in
designs including the star of the east, chalice, Latin cross, patriarchal cross, and
Bishop’s mitre. Inlaid in the top border of the wainscoting is this inscription:
(Left) “Holy, Holy, Holy, Lord God of Hosts. Heaven and earth are ‖ full of thy glory. Glory
be to Thee, O Lord Most High. ‖ Blessed is he that cometh in the name of the Lord.
Hosannah in the Highest. ‖ (Right) O Lamb of God, that takest away the sins of the world,
grant us thy peace. ‖ Glory be to God on high, and on earth peace, good will towards men.
‖ Thou only, O Christ, with the Holy Ghost, art most high in the Glory of God the Father.”
The wrought iron Italian Screen at the entrance to the chapel is best seen from
the inside. Upon the finials at either end are angels blowing trumpets, and the
space between them is divided by seven tall candlesticks into eight spaces, in
which are bronze groups representing scenes in the life of St. Ambrose (left to
right:) (1) His youth; (2) settling the succession of the bishopric of Milan; (3) his
baptism; (4) nuns and (5) monks, listening to the preaching of St. Ambrose, who
stands between them facing the Altar; (6) the public penance before St. Ambrose of
Emperor Theodosius who caused the massacre of the Thessalonians; (7) laying the
corner-stone of the Church of St. Ambrogio in Milan; and (8) his death. Beneath the
figure of St. Ambrose who stands between the nuns and monks is a bee-hive with
crossed croziers. The screen was designed by Mr. Thomas Hastings and was made
by Messrs. E. F. Caldwell & Co., of New York. On the south wall is inscribed:
“To the ‖ Glory of God ‖ and in ‖ Loving Memory ‖ of ‖ Augustus Whiting ‖ Sarah Swan
Whiting ‖ Jane Whiting ‖ Amelia Whiting Davis ‖ Augustus Whiting, Jr., ‖ Natica Rives
Burden ‖ This Chapel ‖ has been Erected by ‖ Sara Whiting Rives.”
The Chapel of St. Martin of Tours
St. Martin, after whom this chapel is named, born in 316, in his young manhood
was a Roman soldier in Gaul. One wintry day, (according to the traditional story
related by Ruskin in his “Bible of Amiens,”) when Martin was riding forth from the
city of Amiens, he saw a beggar shivering by the roadside; whereupon he divided
his cloak with his sword and gave one half to the beggar. That night in a vision he
saw Christ wearing the half cloak and surrounded by angels. And Christ said to the
angels: “Know ye who hath thus arrayed me? My servant Martin, though yet
unbaptized, hath done this.” After this, Martin was baptized; but he remained a
soldier for 17 years. Then, after several years of religious works, he was made
Bishop of Tours. It is related that one day, when going to church in his full robes, he
practically repeated the charitable act beforementioned by giving his stole to a
ragged beggar; and when St. Martin was at the altar, elevating the Host, a globe of
light appeared above him and angels descended and hung chains of gold and
jewels (not of earth) on his bare arms. Sweet, serene and dearly beloved, he was

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Immunohematology, Transfusion

Medicine, Hemostasis, and Cellular

Immunohematology, Transfusion Medicine, Hemostasis, and

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Pretransfusion testing, including ABO/Rh typing, identification of unexpected anti-

Mineola, NY, USA Mark T. Friedman

Fig. 1 Guide to the antibody panel

Fig. 2 Guide to antibody panel rule out

it is wise to remember that patients do not come with multiple-choice answers.

Acknowledgement of Prior Contributors

Laboratory Normal Values

Laboratory test Reference range

Laboratory test Reference range

Red Blood Cell (RBC) Antigen Frequencies

Key Figures and Tables by Chapter

Chapter # Figure/Table Description

Chapter # Figure/Table Description

Screen Cell (SC) Antigen Profiles

Rh-hr Kell Duffy Kidd Lewis MNS P Lutheran

Part I Case Studies in Transfusion Medicine, Immunohematology,

22 What’s This Junk? ���������������������������������������������������������������������������������� 163

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Part II Cases Studies in Blood Donor Collection and Cellular Therapy

α Alpha angle (thromboelastography)

AML Acute myeloid leukemia

CDC Centers for Disease Control and

DAT Direct antiglobulin test

FFP Fresh frozen plasma

HPFH Hereditary persistence of fetal

NAAT Nucleic acid amplification test

PRCA Pure red cell aplasia

SOP Standard operating procedure

VLBW Very low birth weight

Blood Banking, Immunohematology, Transfusion Medicine

Mark T. Friedman, Kamille A. West, Peyman Bizargity, Kyle Annen,

© The Author(s), under exclusive license to Springer Nature 3

A 52-year-old man with a history of hypertension, type 2 diabetes mellitus, and

Table 1.1 ABO/Rh/antibody screen

Table 1.2 Tube panel (LISS)

1. What is the patient’s ABO/Rh blood type?

Mark T. Friedman, Kamille A. West, Peyman Bizargity, Kyle Annen,

© The Author(s), under exclusive license to Springer Nature 9

A 25-year-old woman, gravida 2, para 1 (G2P1), at 37 weeks of pregnancy, who has

Table 2.1 ABO/Rh/antibody screen

The desk was given by the Laymen’s Club.

The Parapet at the entrance to the Choir is designed to represent outstanding

“In Memoriam ‖ Horatio Potter ‖ Bishop of New York ‖ 1854-1887 ‖ M. G. E. A.”

Mineola, NY, USA Mark T. Friedman

Acknowledgement of Prior Contributors

Laboratory Normal Values

Red Blood Cell (RBC) Antigen Frequencies

Key Figures and Tables by Chapter

Screen Cell (SC) Antigen Profiles

Part I Case Studies in Transfusion Medicine, Immunohematology,

22 What’s This Junk? �� 163

35 Absolutely Necessary!�� 263

61 Oops! Something Went Wrong… �� 447

Part II Cases Studies in Blood Donor Collection and Cellular Therapy