Q.1. List various complications of blood transfusion. Add a note on delayed complications of blood transfusion? Ans.

Complications Of Blood Transfusion Despite the best diligence of everyone involved in blood transfusion from "vein to vein," indeed from pre-blood donation to post-transfusion, transfusion is not risk free. Clinicians must exercise judgment to determine that the expected benefits of transfusion outweigh the risks. Complications, transfusion reactions, and adverse events range from mild to lifethreatening. They may involve immune or non-immune mechanisms and occur within minutes to days or weeks after transfusion. A summary of the left menu items is listed below to assist in navigating through Complications: Clinical Presentation Signs and symptoms related to transfusion reactions range from none to many and may involve multiple body organs and systems. Types Complications can be grouped in many ways. They are commonly arranged in two large categories according to when signs and symptoms appear (immediate or delayed), as well as a third "catch-all" category of miscellaneous other complications. Investigation The laboratory investigation can range from minimal to extensive and is dictated by the symptoms and severity of the reaction. Immediate steps to take are discussed in this section. Treatment The immediate treatment of the patient is of utmost importance. The physician manages the course of treatment according to the symptoms.

Prevention Many complications of transfusion can be prevented by the diligent application of quality management principles and practice guidelines to all aspects of the vein-tovein process, i.e., from blood collection to transfusion. Documentation & Reporting Reporting suspected transfusion reactions to the attending physician and the laboratory is one of the first steps to determining the cause and initiating treatment. As well, there are national reporting requirements for blood suppliers to report serious adverse events of transfusion to Health Canada. Hospital blood transfusion services are encouraged to voluntarily report to their blood supplier, any case in which it is important to remove other components from the same donor(s) from circulation and/or defer the donor to prevent similar reactions in other recipients. The Transfusion Transmitted Injuries Section of Health Canada's Health Care Acquired Infections Division has established a national surveillance system for transfusion-transmitted injuries called the Transfusion Transmitted Injuries Surveillance System (TTISS).

Q.2 How would you investigate hemolytic disease of new born? Add a note on its prevention. ? Ans. Hemolytic Disease of the Newborn Hemolytic Disease of the Newborn is also called erythroblastosis fetalis. This condition occurs when there is an incompatibility between the blood types of the mother and baby.

"hemolytic" means breaking down of red blood cells "erythroblastosis" refers to making of immature red blood cells "fetalis" refers to fetus

The mother's immune system sees the baby's Rh positive red blood cells as "foreign." Just as when bacteria invade the body, the immune system responds by developing antibodies to fight and destroy these foreign cells. The mother's immune system then keeps the antibodies in case the foreign cells appear again, even in a future pregnancy. The mother is now "Rh sensitized." Although it is not as common, a similar problem of incompatibility may happen between the blood types (A, B, O, AB) of the mother and baby in the following situations:

Mother's Blood Type O Baby's Blood Type A or B

A B

B A

In a first pregnancy, Rh sensitization is not likely. Usually it only becomes a problem in a future pregnancy with another Rh positive baby. During that pregnancy, the mother's antibodies cross the placenta to fight the Rh positive cells in the baby's body. As the antibodies destroy the red blood cells, the baby can become sick. This is called erythroblastosis fetalis during pregnancy. In the newborn, the condition is called hemolytic disease of the newborn. Who is affected by hemolytic disease of the newborn? Babies affected by HDN are usually in a mother's second or higher pregnancy, after she has become sensitized with a first baby. HDN due to Rh incompatibility is

about three times more likely in Caucasian babies than African-American babies. Why is hemolytic disease of the newborn a concern? When the mother's antibodies attack the red blood cells, they are broken down and destroyed (hemolysis). This makes the baby anemic. Anemia is dangerous because it limits the ability of the blood to carry oxygen to the baby's organs and tissues. As a result:

The baby's body responds to the hemolysis by trying to make more red blood cells very quickly in the bone marrow and the liver and spleen. This causes these organs to get bigger. The new red blood cells, called erythroblasts, are often immature and are not able to do the work of mature red blood cells. As the red blood cells break down, a substance called bilirubin is formed. Babies are not easily able to get rid of the bilirubin and it can build up in the blood and other tissues and fluids of the baby's body. This is called hyperbilirubinemia. Because bilirubin has a pigment or coloring, it causes a yellowing of the baby's skin and tissues. This is called jaundice.

Complications of hemolytic disease of the newborn can range from mild to severe. The following are some of the problems that can result: During pregnancy:

Mild anemia, hyperbilirubinemia, and The placenta helps rid some of the bilirubin, but not all.

jaundice

severe anemia with enlargement of the liver and spleen When these organs and the bone marrow cannot compensate for the fast destruction of red blood cells, severe anemia results and other organs are affected. hydrops details This occurs as the baby's organs are unable to handle the anemia. The heart begins to fail and large amounts of fluid build up in the baby's tissues and organs. A fetus with hydrops is at great risk of being stillborn.

After birth:

severe hyperbilirubinemia and jaundice: The baby's liver is unable to handle the large amount of bilirubin that results from red blood cell breakdown. The baby's liver is enlarged and anemia continues. kernicterus Kernicterus is the most severe form of hyperbilirubinemia and results from the buildup of bilirubin in the brain. This can cause seizures, brain damage, deafness, and death.

Q.3 Discuss various safety measures to be followed in a blood bank to avoid accidents

PRINCIPLE
Human red blood cells possessing the D(Rho) antigen will agglutinate in the presence of antibody directed towards the antigen Agglutination of red blood cells with Anti D(Rho) (IgM) reagent is a positive test result and indicates the presence of D (Rho) antigen .No should be further tested for D (Presence of weak/ partial Ds) by performing the D test procedure using incomplete AntiD (Rho) of IgG class, as described later.

NOTE
1. In vitro diagnostic reagent for laboratory and professional use only .Not for medicinal use. 2. Anti D (Rho)(IgM) reagent is not from human source, hence contamination due to HBsAg and HIV IS practically excluded. 3. The reagent contains sodium azide 0.1% as preservative. Avoid contact with skin and mucosa On disposal flush with large quantities of water. 4. Extreme turbidity may indicate microbial contamination or denaturation of protein due to thermal damage. Such reagent should be discarded.

SAMPLE COLLECTION AND PREPARATION

No special preparation of the patient is required prior to sample collection by approved techniques. Samples should be stored at 28Cif not tested immediately. Do not use heamolysed sample. Anticoagulated blood using various anticoagulants should be tested within the below mentioned time period: EDTA or Heparin 2 days Sodium citrate or sodium oxalate 14 days ACD or CPD 28 days

ADDITIONAL MATERIAL REQUIRED FOR SLIDE AND TUBE TESTS

Glass slides (60x85mm),test tubes (12x75mm), Pasteur pipettes, isotonic saline, Centrifuge, Timer, Mixing sticks, ERYCLONE Anti Human Globulin (Coombs) reagent, ERYCLONE AntiD(IgG)or RHOFINAL AntiD (IgM+ IgG).

TEST PROCEDURE
Bring reagent and samples to room temperature before testing.

Slide Test
1 place one drop of AntiD (Rho)(IgM) reagent on a clean glass slide. 2. Pipette one equal drop of whole on the slide. 3. Mix well with a mixing stick uniformly over an area of approximately 2.5 cm. 4. Rock the slide gently, back and forth. 5. Observe for agglutination macroscopically at two minutes.

Immediate Spin Tube Test

1. Prepare a 5% suspension of red cells to be tested in isotonic saline. 2. Place one drop of reagent AntiD (Rho)IgM)into correspondingly labeled test tube. 3. Pipette into the test tube one drop of the 5% cell suspension and mix well. 4. Centrifuge for 1 minute at 1000 RPM (125g)OR 20 SECONDS AT 3400 RPM (1000g) 5. Gently resuspend the cell button, observing for agglutination macroscopically.

Du TEST PROCEDURE
1. Prepare a 5% suspension of the red cells to be tested in isotonic saline. 2. Place one drop of any incomplete AntiD (Rho)IgM class )reagent such as ERYCLONE AntiD (Rho) IgM ) into a labeled test tube. 3. Add to test tube one drop of the 5% cell suspension and mix well. Incubate at 37C for 15 minutes. 4. Wash the contents of the tube thoroughly, at least three time, with isotonic saline and decant completely after the last wash. 5. Add two drop of ERYCLONE Anti Human Globulin reagent and mix well. 6. Centrifuge for 2minute at 1000 RPM(125g) or 20 seconds at 3400 RPM (1000 g). 7. Very gently, resuspend the cell button, observing for agglutination macroscopically.