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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 riskfree. 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 life-

threatening. 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 throughComplications:

Clinical Presentation

Signs and symptoms related to transfusion reactions range from none to many andmay involve multiple body organs and systems.

Types

Complications can be grouped in many ways. They are commonly arranged in twolarge 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 arediscussed 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.

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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-to-vein process, i.e., from blood collection to transfusion.

Documentation & Reporting

Reporting suspected transfusion reactions to the attending physician and thelaboratory is one of the first steps to determining the cause and initiating treatment.

As well, there are national reporting requirements for blood suppliers to reportserious 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) fromcirculation and/or defer the donor to prevent similar reactions in other recipients.

The Transfusion Transmitted Injuries Section of Health Canada's Health CareAcquired Infections Division has established a national surveillance system for

transfusion-transmitted injuries called the Transfusion Transmitted InjuriesSurveillance System (TTISS).

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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 themother 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 bydeveloping 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 A B

Baby's Blood Type A or B B A

In a first pregnancy, Rh sensitization is not likely. Usually it only becomes aproblem 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 thenewborn, 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

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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 becauseit 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 redblood 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 maturered 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 calledhyperbilirubinemia. Because bilirubin has a pigment or coloring, it causes ayellowing 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 jaundiceThe placenta helps rid some of the bilirubin, but not all.

severe anemia with enlargement of the liver and spleenWhen these organs and the bone marrow cannot compensate for the fast

destruction of red blood cells, severe anemia results and other organs areaffected.

hydrops detailsThis 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 andorgans. A fetus with hydrops is at great risk of being stillborn.

After birth:

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severe hyperbilirubinemia and jaundice: The baby's liver is unable to handlethe large amount of bilirubin that results from red blood cell breakdown. Thebaby's liver is enlarged and anemia continues.

kernicterusKernicterus is the most severe form of hyperbilirubinemia and results fromthe buildup of bilirubin in the brain. This can cause seizures, brain damage,deafness, and death.

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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 ofantibody 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.

NOTE1. 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 PREPARATIONNo 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 daysACD or CPD 28 days

ADDITIONAL MATERIAL REQUIRED FOR SLIDE AND TUBETESTSGlass 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 PROCEDUREBring reagent and samples to room temperature before testing.

Slide Test1 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.

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