TYPE & SCREEN

What does the Blood Bank

Do with That Tube?
 Blood group Antigens
• Markers on various red cell
structures
• Detected by serologic techniques
• Antigens organized into 26 blood
group systems that segregate
independently
• Multiple alleles within each system
• Complete red cell phenotypes are
highly individualized
The Nature of Red Cell
Antigens
• Proteins & sugars on surface of
RBC vary slightly in different
individuals
• Protein antigen direct product of
gene
• Carbohydrate antigen indirect
product of the defining gene
• Encoded transferase enzymes
attaches an immunodominant sugar to
a cell membrane component
The Nature of Red Cell
Antigens
• Packed on the surface innumerable
antigens
• Type A cell has 1 x 106 A antigen sites
• 800,000 MN antigen sites
• 150,000 SsU antigen sites
• 20,000 Rh antigen sites
• Hundreds of additional known antigen
sites
• Number of antigens no clinical
correlation
• 800,000 MN sites vs 4000 Kell sites
Recognition of Blood
Groups
• Recognition begins with
discovery of an antibody
• Likely that after a century of
blood group research all of the
major human blood group
systems have been discovered
ABO Testing
ABO Testing

• Front Type

• PT RBCs  Anti-A or Anti-B Abs

• Back Type

• A or B RBCs  PT Serum/Plasma
 Table 3-1. Reaction of
O, A, B, and AB Groups
Cell Grouping Serum Grouping
Blood
Group Anti-A Anti-B A Cells B Cells

O 0 0 4+ 4+

A 4+ 0 0 4+

B 0 4+ 4+ 0

AB 4+ 4+ 0 0
 Table 2-3. ABO Blood Group
Antigens and Antibodies

Blood Group ABO Antigen ABO Antibody

A A Anti-B
B B Anti-A
O None Anti-A and Anti-B
AB A and B None
 Table 2-2. Frequency (%) of ABO
Blood Groups in the United States

Phenotype Whites Blacks Hispanics Asians

O 45 49 56 43

A 40 27 28 27

B 10 20 12 25

AB 5 4 4 5
Blood Group Antibodies
Blood Group Antibodies
IgG IgM
• Binds with Ag @ 37° • Binds with antigen
• Fc portion carries at ambient
macrophage temperature or
receptor colder
• 2 Fab sites • 10 Fab sites
• Monomer requires • Polymer allows
high concentration complement
to activate activation to C9
complement, only • Intravascular
to C3 hemolysis if
reactive at 37°
• Amplifies
extravascular
hemolysis
 Antihuman Globulin
(AHG) Reagents
• Polyclonal • Polyspecific
• Multiple cell • Contains both
lines with anti-IgG and anti-
different complement
specificities • Monospecific
• Monoclonal • Contains either
• Single Antibody anti-IgG or anti-
specificity complement
Direct Antiglobulin Test
(DAT)
• Detects antibody bound to RBCs in
vivo
• Diagnostic test
• Performed only when clinical
evidence suggests
• Autoimmune hemolytic anemia
• Hemolytic disease of the newborn
• Hemolytic transfusion reaction
• Monospecific reagents used to
specify immunoglobulin
• One-step test
 Indirect Antiglobulin
Test (IAT)
• Detects free antibody in serum
• Method for pretransfusion antibody
detection
• AHG reagent must contain anti-IgG
• Two step test – Ag/Ab binding occurs
in vitro
• Other applications: antibody
identification, extended antigen
typing, weak D test
 Selection of Donor ABO
Type
• From the perspective of reactions to
blood transfusion caused by Ag-Ab
reactions, only antibodies matter
• Antigens on donor red cells are of no
immediate consequence in the
absence of antibody
• Therefore ABO blood group system is
of particular clinical importance
 Blood Group Immunizations:
Most Common Specificities

• Rh
• Kell
• Duffy
• Kidd
• MNSs
Blood Group Immunization:
Determining Factors
• Immunogenic potential of antigen
• Rh and Kell most potent
• Dose of antigen
• Amount and frequency of exposure
• Immunocompetence of recipient
• Diagnosis: 20% non-responder rate
• Immunization occurs in
approximately 1% of transfusions
and 5% of transfused patients
 Rh Typing

• D antigen is potent immunogen

• 50% Rh - given 1 unit of Rh+ make
anti-D
• However, 30% are non-responders
despite repeated Rh+ transfusions
• Anti-D may cause serious
reactions with Rh+ transfusion
• Most dangerous of all blood
group antibodies in severe HDN
 Other Blood Donor Antigens

• K antigen of the Kell blood group

system 2nd to Rh in potential to
provoke antibody response
• 5% K- given one unit of K+ blood make
anti-K
• But frequency of K is only 9% in whites
and lower in Black and Hispanic
individuals
• Some services attempt donor
selection Rh (c and E), Kidd (Jka),
and some others
 Compatibility Tests

• ABO Type
• Rh Type
• Antibody Detection (Screen)
• Antibody Identification
• Crossmatch
• Saline
• Coombs
 Crossmatch

• Immediate Spin Crossmatch

• Usual
• Room Temperature
• Full Crossmatch
• Antibody Screen Positive
• Prior History Antibodies
• Room Temperature
• 37°
• AHG (Coombs)
 Table 31-11 ABO and Rh (D)
Compatibility in Blood Transfusion

Blood Type of Donor

Blood Type of
Recipient O A B AB D- D+

O Yes No No No
A S Yes No No
B S No Yes No
AB S S S Yes
D- Yes E
D+ Yes
S=Substitute as packed red blood cells or wash to eliminate
Yes
antibodies. E = Only under extreme emergency conditions,
especially if the recipient is a young female.
 Table 31-12 Probability of
Safe Blood Transfusion
Compatibility
Procedure
Individual (%) Cumulative (%)
None 64.4 64.4
ABO grouping 35.0 99.4
Rh typing 0.4 99.8
Antibody screening 0.14 99.94
Crossmatching 0.01 99.95

Autotransfusion 100 100

 Table 31-8 Approximate Time Required for
Preparing for a Blood Transfusion
PROCEDURES Time in Minutes
1. Collecting the blood 10
2. ABO and Rh Typing 10
3. ABO and Rh Typing plus Antibody 45
Screening
4. Typing, Antibody Screening, and 60
crossmatching
5. Antibody Identification, additional 60+ (up to several days)
6. Fresh-frozen plasma thawing 20
7. Cryoprecipitate thawing 20
8. Washing erythrocytes 45
9. Thawing and washing of frozen 60
erythrocytes