selection of blood products. please help

[trisram]

can anyone give me some information of give me a link for instructions on selecting the ABO RH of blood products like plasma and red cells for all the different ABO RH type patients? Like O+, O-, AB+, etc... Thank you for your time

Edited November 21, 2009 by trisram

[adiescast]

Here is the table we use for red cells:

Patient type (Unit types underneath in order of preference)

O Positive

1. O Positive

2. O Negative

O Negative

1. O Negative

2. O Positive (emergency)

A Positive

1. A Positive

2. A Negative

3. O Positive

4. O Negative

A Negative

1. A Negative

2. O Negative

3. A Positive (emergency)

4. O Positive (emergency)

B Positive

1. B Positive

2. B Negative

3. O Positive

4. O Negative

B Negative

1. B Negative

2. O Negative

3. B Positive (emergency)

4. O Positive (emergency)

AB Positive

1. AB Positive

2. AB Negative

3. A Positive

4. B Positive

5. O Positive

6. A Negative

7. B Negative

8. O Negative

AB Negative

1. AB Negative

2. A Negative

3. B Negative

4. O Negative

5. AB Positive (emergency)

6. A Positive (emergency)

7. B Positive (emergency)

8. O Positive (emergency)

Here is the table we use for plasma products:

Patient type = Unit type

O = O, A, B, AB

A = A, AB

B = B, AB

AB = AB

Hope this helps!

Edited November 24, 2009 by adiescast
Table format was not accepted.

[Malcolm Needs ☆]

I would agree entirely with that, except in cases of a stem cell transplant, where it depends on the blood groups of the donor and the recipient, and the length of time after the transplant.

You also have to be a bit careful with patients of small stature (particularly neonates).

[adiescast]

Yes, of course, this list is only for routine products under "normal" circumstances.

[Malcolm Needs ☆]

I thought it probably was, but it's worthwhile being on the safe side for the less experienced amongst us.

[rajendraksaini]

A patient is diagnosed carcinoma his Blood-group was A Rh -POsitive But after some time when he got multiple Blood-transfusions .He came for another Blood -transfusion to Blood -bank His Blood group is showing AB Rh Positive during Blood group how it is possible? Please explaine it

[Malcolm Needs ☆]

A patient is diagnosed carcinoma his Blood-group was A Rh -POsitive But after some time when he got multiple Blood-transfusions .He came for another Blood -transfusion to Blood -bank His Blood group is showing AB Rh Positive during Blood group how it is possible? Please explaine it

Hi rajendraksaini,

There are at the very least two possible explanations for this phenomenon.

Firstly, there is the chance that your patient may be suffering from a concomitant bacterial infection, causing the acquired-B phenotype. In such a case, the bacterial deacetylases convert N-acteylgalactosamine (the dominant sugar residue for the A antigen) to galactosamine, which resembles galactose (the dominant sugar residue for the B antigen) closely enough for the cells to be agglutinated by some anti-B reagents. This can usually, but not always be corrected by lowering the pH of the antibody. Your antibody supplier should already have done this for you though.

The second possibility, particularly as your patient has carcinoma, is that a variant clone of cells are producing the galactosyl transferase that results in the formation of the B antigen, and what you are detecting is a small number of "genuine" group B cells. This galactosyl transferase is usually "silent" in group A individuals.

As I say, there could well be other explanations, but these are two to be going on with!

:):)

[RR1]

A patient is diagnosed carcinoma his Blood-group was A Rh -POsitive But after some time when he got multiple Blood-transfusions .He came for another Blood -transfusion to Blood -bank His Blood group is showing AB Rh Positive during Blood group how it is possible? Please explaine it

Hi rajendraksaini, are performing a forward and reverse group? also do you run a reagent control antisera with the test?

[jcdayaz]

I would agree entirely with that, except in cases of a stem cell transplant, where it depends on the blood groups of the donor and the recipient, and the length of time after the transplant.

You also have to be a bit careful with patients of small stature (particularly neonates).

Absolutely!!

I have never been more scared/excited than the time we were ordered to transfuse 4 A Pos units to an O Pos patient.! The patient was O Pos and was about to receive a bone marrow transplant that was type A. The goal was to reduce the Anti-A1 titer in his system just prior to transplant to increase the chance of him not "rejecting" the bone marrow. The 4 A pos units were transfused to this O pos person while he was on dialysis...(good thing). IT WORKED. Positive outcome.

We had a chart/graph that showed us how many days/weeks after such a blood type change to start switching the types of products we issued. It was very useful. I wish I still had a copy of it.....

[Mabel Adams]

Wow, couldn't they infuse A substance instead of red cells or something else less scary?

[Yanxia]

Hi rajendraksaini,

The second possibility, particularly as your patient has carcinoma, is that a variant clone of cells are producing the galactosyl transferase that results in the formation of the B antigen, and what you are detecting is a small number of "genuine" group B cells. This galactosyl transferase is usually "silent" in group A individuals.

:):)

Do you mean the carcinoma restrain the B antigens?

[Malcolm Needs ☆]

Do you mean the carcinoma restrain the B antigens?

Hi shily,

Cell lines, such as erythroblastic cell lines, are subject to many spontaneous changes to the base pairs making up the active genes, purely because there are so many opportunities during mitosis for "mistakes" to be made.

Usually, your own immune system will identify these as being non-self, and will destroy them quite quickly, before the clone can establish itself. In cases of cancer (of all types) a clone of cells has "gone wild", but the person's own immune system does not recognise this clone as non-self, and the clone becomes established.

The same can occur for blood groups on the red cells (or, in this case, the genes encoding the transferase enzymes), and a clone of cells producing the "B transferase" (or, more likely, "B-like transferase") can become established, and group B cells (or group B-like cells) can, very rarely, be detected in the circulation of a group A patient.

Much more commonly, group O cells are seen in the circulation of a group A concer patient (without them having had a group O transfusion).

:)

[Yanxia]

Malcolm it sounds newly to me, can you give me a piece of paper about it, thanks in advance.

[Malcolm Needs ☆]

I certainly will try shily/Yanxia, but I am actually off work until next week, and so it may take a few days.

[jcdayaz]

I certainly will try shily/Yanxia, but I am actually off work until next week, and so it may take a few days.

Malcolm,

Surely you work/study in your sleep!!

Your knowledge is impressive and I must admit a bit intimidating. Thank you for your input on the "issues" I have posted.

[Malcolm Needs ☆]

Malcolm,

Surely you work/study in your sleep!!

Your knowledge is impressive and I must admit a bit intimidating. Thank you for your input on the "issues" I have posted.

Thanks, but no!

I just enjoy my work.

Don't feel intimidated; I am one of the very lucky, very few for whom it's more of a hobby than work.

:D:D

[Malcolm Needs ☆]

Malcolm it sounds newly to me, can you give me a piece of paper about it, thanks in advance.

Hi,

It is spoken about in Geoff Daniels' book, Human Blood Groups, 2nd edition, Blackwell Science, 2002, Chapter 2, Section 2.11 Overlapping specificities of A- and B-transferases: B(A) and A( phenotypes, pages 41-42.

In relation to the A-transferase bringing about group B red cells, the two references he cites are;

Navaratnam N, Findlay JBC, Keen JN, Watkins WM. Purification, properties and partial amino acid sequence of the blood-group-A-gene-associated alpha-3-N-acetylgalactosaminyltransferase from human gut mucosal tissue. Biochem J 1990; 271: 93-98.

and

Yates AD, Watkins WM. The biosynthesis of blood group B determinants by the blood group A gene-specified alpha-3-N-acetyl-D-galactosaminyltransferase. Biochem Biophys Res Commun 1982; 109: 958-965.

I should say that, although I have read Geoff's book (indeed, I reviewed it for the BBTS) I have read neither of these cited papers.

:)

[Yanxia]

Thanks, Malcolm. I have read this book, and not the reference essay(I can't get them) , probably because my English level limitation, I can't get this kind of information like "the carcinoma restrain the B antigens".

[Yanxia]

Sorry , my last post is incorrect. I want to say I can't get the message that disease can make A person have B cells in their circulation( except B-like in sepsis).

I think the group O cells in group A or B or AB cancer patients is because antigen weaken not "grow wild".

Edited December 12, 2009 by shily

[Malcolm Needs ☆]

Sorry , my last post is incorrect. I want to say I can't get the message that disease can make A person have B cells in their circulation( except B-like in sepsis).

I think the group O cells in group A or B or AB cancer patients is because antigen weaken not "grow wild".

Hi shily, I'll try to explain what I mean.

Everyone, including you and me, has a small number of "rogue cell clones" that spring up in the body from time to time (not just blood cells, but all types of cells). These "rogue cell clones" are usually recognised by your body's immune system as being "non-self" or, more accurately, "non-normal self", and they are destroyed.

When a malignancy forms, what is actually happening is that one of these clones of "not-normal self" cells is not recognised as "different from normal" by your body's immune system, and the clone is "allowed" to grow. The trouble is, it grows wild and takes over other clones of "self" within your body. It becomes cancerous.

Similarly, the cells that produce a group A transferase enzyme often mutate to produce the group B (or B-like) transferase, but are "regocnised" by your body's immune system as "not-normal self" and are destroyed.

In a malignant state, your immune system is already working at sub-optimal levels, and allowing "not-normal self" clones to proliferate (the cancer cells). In such a state, occasionally, the mutated cells producing a B (or B-like) transferase in a group A person can also proliferate, and apparent group B red cells can be seen in the circulation of a group A individual.

What it is, is that a common situation (a very small rogue clone of cells, that would normally be destoyed by the body's own immune system) gets out of control, and what is normally a "silent" clone of cells (i.e. not normally seen) proliferates and becomes noticable.

[Yanxia]

Thank you Malcolm for your patience and kind heart. I understand what you mean . I try to find it in the book you mentioned before, but I am failure, would you provide the original text to me, thank you very much.

[Malcolm Needs ☆]

Thank you Malcolm for your patience and kind heart. I understand what you mean . I try to find it in the book you mentioned before, but I am failure, would you provide the original text to me, thank you very much.

Hi shily,

I will try to do this for you, but I am off sick from work at the moment, so it may take a little bit of time.

Best wishes,

Malcolm

:D:D

[Malcolm Needs ☆]

Hi shily,

I will try to do this for you, but I am off sick from work at the moment, so it may take a little bit of time.

Best wishes,

Malcolm

:D:D

Sorry shily, but it may take a little longer than even I thought. My doctor has signed me off sick for another week.

I will try to do as you ask as soon as possible.

Malcolm

[AMcCord]

Very nice explanation Malcolm. I'll save it for my students.

[Yanxia]

Hi shily,

I will try to do this for you, but I am off sick from work at the moment, so it may take a little bit of time.

Best wishes,

Malcolm

:D:D

Malcolm, have a good rest!

I learn lot of things from your posts, thank you and I wish you will become healthy quickly.