CLINICAL BLOOD TRANSFUSION

Dr Ojo
Department of Heamatology and Blood
Transfusion
OOU
 Introduction
• Blood Transfusion deals with the collection and
provision of safe blood and blood products.
• Indications for blood transfusion.
• Properly filled requisition form.
• Properly labelled samples for grouping and
crossmatching.
• Select donor for transfusion.
• Issue of donor blood unit.
• Transfusion of blood unit
Properly filled requisition form
 Selection of donor blood
• ABO- for whole blood or packed red cell:
Recipient Donor blood group
blood 1st choice Alternative
group

A A O
B B O
AB AB A,B,O
 Selection of donor blood…
• For Rh D:
Rh D +ve is given to Rh D +ve recipient.
Rh D -ve is given to Rh D –ve/ +ve recipient.
• Antibody screening/ identification- patient
plasma is screened for irregular/ unexpected
antibodies.
• Crossmatching/ compatibility testing: To detect
presence of clinically significant unexpected
antibodies
 Major- recipient plasma & donor red cell
 Minor- donor plasma & recipient red cell
 Crossmatching/ compatibility testing
• Major crossmatch tests the possibility of antibodies in
the recipient that may destroy donor cells.
• Minor crossmatch test the possibility of antibody in
the donor blood that can destroy recipient cells.  
• Procedure
 One drop of 5% red blood cell suspension in saline is
mixed with two drops of serum at room temperature,
370C, 370C with Albumin, and AHG.
 Auto crossmatch is also carried out to rule out
autoantibodies.
• Compatibility label is attached to blood bag showing
recipient name, Hospital no, ward, blood group,
donor’s no, date of expiry, date of compatibility test
 Issue of donor blood unit
• Before issue of blood unit check information on
the blood bag, request form and compatibility
label for discrepancies
• Inspect blood bag for:
 Evidence of haemolysis-pink discolouration of
plasma.
 Large clots in plasma
 Black or purple discolouration of red cells
indicating bacterial contamination
 Leakage
 Transfusion of blood unit
• Physician should carry out similar inspection of
blood bag and compatibility label.
• Transfusion should commence within 30mins of
removing the blood bag from the refrigerator.
• Transfusion orders.
• Connect the blood line (giving set with filter in use)
and set flow rate
• Observation:
 Observe the patient and monitor vital signs at the
beginning and periodically.
 Check for continuity of flow at determined rate.
• Watch for blood to finish and clip the line. 
• Investigate adverse blood reactions, if there are.
 ANTIGLOBULIN TEST
• Formerly referred to as Coomb’s Test
• It is a procedure used to detect the presence of
antibody attached to the red blood cell or in a
serum sample.
• The reagent used is the Antihuman globulin
(AHG), which is an antibody against human
globulin.
• It is produced by injecting human serum into
rabbits, sheep or goats and using the resultant
serum containing antibodies).
 ANTIGLOBULIN TEST...
• The procedure is particularly useful when
antibodies are incomplete and AHG is
required to further act as bridge between the
red blood cells to which antibodies are already
attached, but which are kept apart by zeta
potential created by negative charges.
• Other means of enhancing agglutination
include the use of bovine albumin or low ionic
strength saline (LISS).
 ANTIGLOBULIN TEST...
• There are 2ways of carrying out Antiglobulin :
 Direct Antiglobulin Test (DAT) and the Indirect
Antiglobulin Test (IAT).
• DAT detects antibodies bound in vivo to red
cells. E.g AIHA,HDN and blood transfusion
reaction.
 ANTIGLOBULIN TEST...
• In IAT, antibodies are usually in the serum.
 Red blood cells are incubated in the patient’s serum at
370C for 30 to 60 minutes.
 This is to allow the antibodies in serum to attach to the
red blood cells.
 The mixture is then washed at least three times in saline
to remove excess antibodies.
 AHG is then added and examined under the microscope
for agglutination.
 An IAT can be performed between the cells and serum of
the same individual when used as control in blood
crossmatching or antenatal testing for Anti D.
• Controls (Positive and Negative) should be introduced to
identify contamination