Blood transfusion and haematopoietic stem cell transplantation

maisie_oj
Mind Map by , created over 6 years ago

Blood Science Mind Map on Blood transfusion and haematopoietic stem cell transplantation, created by maisie_oj on 05/01/2013.

86
1
0
Tags
maisie_oj
Created by maisie_oj over 6 years ago
Bone marrow failure syndromes
maisie_oj
Haemostasis (part 2: secondary haemostasis)
maisie_oj
Haematopoietic System Malignancies 2
maisie_oj
Camera Angles
saradevine97
Art & Design in Context
Chloe Scott
Cell adaptations
maisie_oj
Acute Inflammation
maisie_oj
Rheumatoid Arthritis
maisie_oj
Haemopoietic System Malignancies
maisie_oj
Haemostasis (part 1: primary haemostasis)
maisie_oj
Blood transfusion and haematopoietic stem cell transplantation
1 History of blood transfusions
1.1 First recroded use in 17th Century - between animals; and animals to humans
1.1.1 Unsuccessful - as many died (rejection of transfusion)
1.1.2 1901: Blood groups first identified by Karl Landsteiner (A, B, AB, O system)
1.1.2.1 1940's: Rhesus groups identified
1.1.2.1.1 Storage was a problem (due to lack of anticoagulants etc.)
1.1.2.1.1.1 Anticoagulants and dextorse increase shelf life
1.1.2.1.1.1.1 1922: First blood bank
1.1.2.1.1.1.1.1 1946: National blood service
1.2 Other milestones/achievements
1.2.1 Fractionation of blood
1.2.1.1 Clotting factors
1.2.1.2 Anti-D (to prevent Rhesus haemolysis in newborns)
1.2.1.3 Human albumin (for restoring blood volume, without adding cells)
1.2.1.4 Cell separators (1968)
1.2.1.4.1 Freezing blood for long term storage (in glycerol)
1.2.1.4.1.1 Autologous blood transfusion
1.2.1.4.1.1.1 Removing a patient's blood prior to surgery, then using to transfuse during blood loss)
1.2.1.4.1.2 Useful for transfusion of rare groups
2 Blood groups
2.1 23 blood group systems
2.1.1 e.g. ABO, Rh, Kell, MNS, Duffy
2.1.1.1 Each is a series of antigens - determined by single gene locus or closely linked loci)
2.1.1.1.1 400 antigens to date
2.2 ABO system
2.2.1 Most important grouping system
2.2.2 RBCs can express either; A, B, no (O) or both (AB) antigens
2.2.2.1 Plasma contains naturally occuring Ab's to these antigens
2.2.2.1.1 Present without previous exposure to the blood group antigen
2.2.2.1.1.1 Only blood grouping system to do this
2.2.2.1.1.1.1 All others generate Ab's after an initial exposure
2.2.2.1.2 These Ab's are IgM (pentamer Ig units)
2.2.2.1.2.1 Capable of activating the MAC directly
2.2.2.1.2.1.1 Others (e.g. IgG) can only activate C3/4 of the complement cascade
2.2.3 Genotypes -> phenotypes
2.2.3.1 Genotypes
2.2.3.1.1 AA
2.2.3.1.1.1 BB
2.2.3.1.1.1.1 AB
2.2.3.1.1.1.1.1 OO
2.2.3.1.1.1.1.1.1 AO
2.2.3.1.1.1.1.1.1.1 BO
2.2.3.1.2 Phenotypes
2.2.3.1.2.1 A
2.2.3.1.2.1.1 B
2.2.3.1.2.1.1.1 AB (universal recipient)
2.2.3.1.2.1.1.1.1 O (Universal donor)
2.2.3.1.2.1.1.1.1.1 A
2.2.3.1.2.1.1.1.1.1.1 B
2.2.3.1.2.2 Associated natural Ab's
2.2.3.1.2.2.1 Anti-B
2.2.3.1.2.2.1.1 Anti-A
2.2.3.1.2.2.1.1.1 None
2.2.3.1.2.2.1.1.1.1 Anti-A and Anti-B
2.2.3.1.2.2.1.1.1.1.1 Anti-B
2.2.3.1.2.2.1.1.1.1.1.1 Anti-A
2.2.4 Ethnic differences
2.2.4.1 Caucasian (44% O; 34% A; AB = rarest)
2.2.4.2 Black (49% O; 19% A; 19% B; AB= rarest)
2.2.4.3 Oriental (43% O; 27% A; 25% B; AB = rarest)
2.2.4.4 Indian (22% O; 22% A; 40% B; 15% AB)
2.2.4.5 Australian aborigne (44% O; 56% A)
2.3 Rh group
2.3.1 Second most important group system
2.3.2 Found in 83% caucasians (Rh(D)+)
2.3.3 Highly immunogenic
2.3.3.1 1mL of RBCs will generate Ab response
2.3.3.1.1 Following an Rh(D)+ mismatched transfusion there is 90% chance of Anti-D Ab formation
2.3.3.1.1.1 Rh(D) not the only antigen - 45 Rh antigens known (commonest = D, C, c, E and e)
3 Blood groups = RBC antigens
3.1 Maybe expressed soley on RBCs (e.g. Rh)
3.2 Or shared between RBCs and tissue (e.g. MNS)
3.3 Some are protein alone (e.g. Rh)
3.4 Some are glycoproteins (e.g. ABO)
3.4.1 Sugar moiety which determines A, B, or O group (modification determined by allele expressed)
3.5 Lacking an antigen may be beneficial sometimes
3.5.1 Duffy blood group (Fy)
3.5.1.1 Glycoproteins Fy(a) and Fy(b)
3.5.1.1.1 Cell receptor acts as malarial entry receptor
3.5.1.2 Duffy negative individuals are protected from malaria
3.6 Function of blood groups
3.6.1 Convinient in transfusion - aids selection of appropriate blood
3.6.2 But, they are functional proteins
3.6.2.1 e.g. Band 3 protein forms; Diego and Wr
3.6.2.1.1 Form an RBC anion channel protein (transport Cl(-) and HCO3(-)
3.6.2.2 e.g. Rh proteins control RBC lipid asymmetry
4 Antibodies and their relevance to transfusion
4.1 Immunoglobins (Ig's)
4.1.1 IgG, IgA, IgM, IgE, IgD
4.1.1.1 IgM's are a large molecule (x5 Ig's together in pentamer form) - activate the complement cascade better than IgG
4.1.1.1.1 IgG single Ig molecule - activates the complement cascade
4.1.1.1.1.1 IgG can cross the placenta, whilst IgM cannot (IgG can cause foetal problems when raised against foetal Rh(D)
4.1.1.1.1.1.1 Anti-D neutralising Ab's can be given (= Rhogam)
4.1.1.2 Ab's made by B lymphocytes
4.1.1.2.1 Alloantibodies -> Ab's against foreign molecules
4.1.1.2.1.1 Autoantibodies -> Ab's against self molecules
4.1.1.2.1.1.1 Both auto-and alloantibodies encountered in transfusion
4.2 Ab's against blood groups (ABO)
4.2.1 People who are blood group A have anti-B Ab's
4.2.1.1 People who are blood group B, have anti-A Ab's
4.2.1.1.1 These Ab's are present without an initial exposure to the offending blood type
4.2.1.1.1.1 How?
4.2.1.1.1.1.1 Naturally occuring Ab's vs. immune Ab's
4.2.1.1.1.1.1.1 Naturally occurring Ab's
4.2.1.1.1.1.1.1.1 Not present at birth
4.2.1.1.1.1.1.1.2 Appear by 3-6 months of life
4.2.1.1.1.1.1.1.3 Where do they come from?
4.2.1.1.1.1.1.1.3.1 Exposure to bacterial and food proteins stimulate their production
4.2.1.1.1.1.1.1.3.1.1 If sterile environment -> no anti-A or anti-B Ab's produced
4.2.1.1.1.1.1.1.4 Most naturally occurring Ab's are cold Ab's
4.2.1.1.1.1.1.1.4.1 Cold Ab's
4.2.1.1.1.1.1.1.4.1.1 Warm Ab's
4.2.1.1.1.1.1.1.4.1.1.1 Immune Ab's are warm
4.2.1.1.1.1.1.1.4.1.1.1.1 Produced in response to sensitisation to blood group antigen
4.2.1.1.1.1.1.1.4.1.1.1.1.1 Work at body temperature (37*C)
4.2.1.1.1.1.1.1.4.1.1.1.1.1.1 Potentially dangerous
4.2.1.1.1.1.1.1.4.1.1.1.1.1.1.1 Subtle RBC destruction by the reticuloendothelial system (RES), spleen etc.
4.2.1.1.1.1.1.1.4.1.1.1.1.1.1.1.1 Extravascular haemolysis
4.2.1.1.1.1.1.1.4.1.1.1.1.2 E.g. Anti-D in rhesus disease (aka haemolytic disease of newborn)
4.2.1.1.1.1.1.1.4.1.1.1.1.3 E.g. mismatched transfusion
4.2.1.1.1.1.1.1.4.1.1.1.2 All IgG Ab's
4.2.1.1.1.1.1.1.4.1.2 Usually IgM
4.2.1.1.1.1.1.1.4.1.3 Work better at 0-4*C (many don't work at 37*C)
4.2.1.1.1.1.1.1.4.1.3.1 Most naturally occuring Ab's are cold Ab's
4.2.1.1.1.1.1.1.4.1.3.1.1 BUT.... anti-A and anti-B have a wider thermal range and are active at 37*C
4.2.1.1.1.1.1.1.4.1.3.1.1.1 Cause (when mismated transfusion)
4.2.1.1.1.1.1.1.4.1.3.1.1.1.1 Activation of the complement cascade
4.2.1.1.1.1.1.1.4.1.3.1.1.1.1.1 RBC lysis
4.2.1.1.1.1.1.1.4.1.3.1.1.1.1.1.1 Dramatic intravascular haemolysis
4.2.1.1.1.1.1.1.4.1.3.1.1.2 Ab's that are not activated >30*C are of no clinical significance
4.2.1.1.1.1.1.2 Immune Ab's
4.2.1.1.1.1.1.2.1 Are warm Ab's
4.2.1.1.1.1.1.2.1.1 ->
5 Blood collection and processing
5.1 UK blood source
5.1.1 Homologous blood (from donors)
5.1.1.1 Aged 17-70yrs
5.1.1.2 Max = 2 donors per year
5.1.2 Standar interview with tick box questionaire to determine fitness
5.1.2.1 Ask about transfusion-transmitted diseases (HIV, HBV etc.)
5.1.3 Copper sulfate test (drop of blood -> tests for anaemia)
5.2 The blood itself
5.2.1 450mL of whole blood collected into 63mL anticoagulant
5.2.2 Sterile, closed system
5.2.3 RBCs, plasma and platelets separated (by centrifugation)
5.2.4 WBCs removed (leukodepletion)
5.2.5 Labelled
5.2.6 ABO and Rh groups checked
5.2.7 Shelf-life = 5 weeks
5.3 Processing
5.3.1 Whole blood
5.3.1.1 Cellular components
5.3.1.1.1 RBCs, WBCs and platelets
5.3.1.2 Plasma
5.3.1.2.1 Plamsa for clinical use
5.3.1.2.1.1 Fresh frozen plasma
5.3.1.2.1.2 Cryoprecipitate / cryroprecipitate depleted plasma
5.3.1.2.1.3 Single donor plasma
5.3.1.2.2 Fractionation for plasma products
5.3.1.2.2.1 Clotting factors (VIII and IX)
5.3.1.2.2.2 Ig's (specific and non-specific)
6 Compatability testing
6.1 Ag test
6.1.1 Direct Ag test
6.1.1.1 Detects Ab's bound to RBCs
6.1.1.1.1 Wash patients RBCs (from a collection)
6.1.1.1.1.1 Add anti-human globulin (Ab against human Ab)
6.1.1.1.1.1.1 Watch for agglutination (Anti-human Ab binds to Ab's on RBCs and causes aggregation)
6.1.1.1.1.1.1.1 Positive in: Haemolytic disease of the newborn; autoimmune haemolytic anaemia and haemolytic transfusion reaction
6.1.2 Indirect Ag test
6.1.2.1 Detects Ab's in patients serum
6.1.2.1.1 Test (control) RBCs are incubated in patient's serum
6.1.2.1.1.1 Anti-human globulin added
6.1.2.1.1.1.1 Watch for agglutination of test cells
6.1.2.1.1.1.1.1 Detects anti-RBC Ag's in patient's serum
6.1.2.1.1.1.1.1.1 Positive in: alloantibodies in patient's serum
6.1.2.1.1.1.1.1.1.1 Important because it excludes incompatibility

Media attachments