Mulyanto Basuki - patelkijateng.org...20th Century Blood Banking 1901 AB Group discovered 1907 Importance of crossmatching blood between donor & recipient 1914 Sodium Citrate proposed

Mulyanto Basuki

1818

Partnering to protect

Precious Life

1818

Partnering to protect

Precious Life

“Good Partner is Essential”

1818• A history

• Ortho Clinical Diagnostics

• Immunohematology

• Technique and Technology

• Transfusion Medicine

• Screening Antibody

• DAT/DCT

• Identification

• Product

The Agenda

19th Century Blood Banking

1818 James Blundell, Obstetrician

First successful human to human

transfusion…

Only 10 documented

transfusions, 5 were

successful, the others…not so

sucessful…

20th Century Blood Banking

1901 AB Group discovered

1907Importance of crossmatching

blood between donor & recipient

1914Sodium Citrate proposed as

anticoagulant

1936First Blood Bank:

Barcelona, Spanish Civil War

1940 Levine, Rh blood Group System

Ortho Clinical Diagnostics



Clinical Chemistry

VITROS® 250/350

VITROS® 4600

Immunoassay

VITROS® ECi/ECiQ

VITROS® 3600


Integrated System

VITROS® 5600

Laboratory Automation SystemenGen®


Immunohematology / Blood Bank

ORTHOTM Workstation ORTHO AutoVue ® Innova



ORTHOTM Workstation ORTHO VisionTM



ORTHOTM Workstation ORTHO VisionTM MAX

Immunohematology

● Part of hematology

● Antigen – Antibody

● Antigen : Carbohydrate on the surface of Red Blood Cells

● Antibodi : Complex protein moleculs produced in response to antigen.

Natural : Anti-A Antibody, Anti-B antibody.

Unexpected : anti-D

Causes of transfusion reactions

Immunohematology

√ Slide

√ Tabung

√ CAT ( Gel Tes ???? )

Technique and Technology

√ Slide

√ Tabung

√ CAT ( Gel Tes ???? )


• Slide & Tiles

√ T


• Tube

CAT (


• Tube


• Microplate

CAT ( Gel Tes ???? )


• Microplate


• CAT ( Gel Tes ? )


• CAT ( Gel Tes ? )

Glass beads dan gel act a sieve


So, What does our past tell us ?

• What we are detecting hasn‟t changed…

• As our knowledge increase, and the technology

improves, our testing becomes better. We have

various methods available to us…but there is a

need to standardise our testing method…

• To improve patient safety and the service provided

by laboratories, we need to be up to date with our

skills and testing procedures…errors need to be

reduced…

Transfusion Medicine

Global Trends Continuing need for safe and effective blood supply:

Demand for safe and effective blood supply

Increasing aging population

Growing requirement for operational effectiveness:

Work loads increasing

Economic pressures

Challenges1. Increased demand for better laboratory services

• Workload (multi-tasking), Staffing

2. Increased focus on medical errors and frequency of “near misses”

3. Errors due to result transcription

• Manually record results on file cards, Manually enter into LIS

4. Increased regulatory pressures

UK‟s haemovigilance program (SHOT- Serious Hazards Of

Transfusion) has been monitoring errors related to

transfusion medicine since 1996. In 2011, 98.4% of all NHS

hospitals participated in the program.

“Human error remains the most common cause of Serious Adverse Events. Transfusion teams should be encouraged to consider strategies to minimise the effects of human error by focusing on root causes such as distraction, tiredness and over-familiarity with repetitive tasks.” 2011 SHoT report

Error in the Laboratory


Benefite using latest technology

Patients :

Safer blood- errors reduced when testing for compatible units.

Laboratory :

Increased safety

Increased capacity- able to do more with less resources.

Improvements in the quality of results

Compliance to best practices

Hospital / Institution :

Enhances the service levels and the reputation of the hospital

as a modern facility, with the latest technology for testing.


• Reagent red cells used to detect presence/absence ofunexpected antibody in serum/plasma

• Unexpected antibodies• Red blood cell antibodies other than „expected‟ Anti A or Anti B.

• These antibodies are not naturally occurring and are called irregular

antibodies.

• They occur due to immunization either by

- Transfusion / Pregnancy / Transplantation

• Clinically significant antibodies against Rh and other minorblood group system antigens.• Prevent transfusion reaction (acute or delayed)

• Effective transfusion (RBC survival)

• A Key Process in pre-transfusion compatibility testing in bothdonors and recipients

Screening Antibody


Screening Antibody

• As per literature, the clinical significant unexpected antibodies

can be classified into 3 groups based on their clinical

significance.

• Group 1 : Most clinically significant antibodies : D, C, c, E, e, K, k.

• Group 2 : Fya, Fyb, Jka, Jkb, S, s, Cw, M

• Group 3 : P1, N, Lea, Leb, Lua, Lub, Kpa, Kpb, Jsa, Jsb, Coa, Cob, Dia

• Detection and monitoring of pregnant patiens at risk ofdelivering infants with HDN

• Investigation of potential hemolytic transfusion reactions andimmune hemolytic anemia

• Important for future treatment to know the antibody specificityor specificities


• Once immunized, more chance to develop more antibodies

• Antibody Screen used to detect antibodies • 2-3 cells are typical

• Additional cells cells may be used for specific antigens (Mia, Dia )

Screening Antibody


Transfusion – Development of Antibody, Primary response

IgM antibody


Transfusion – Development of Antibody, Secondary response

IgG antibody


Pregnancy – Primary Immune Response

Slow response. Predominantly IgM, large in size, cannot cross

placenta. Normally 1st Baby is safe

FMH during pregnancy

Or delivery

Fetal RBC Leak


Pregnancy – Primary Immune Response

IgM

( First exposure of Rh –ve

women to Rh +ve RBCs )

• Slow ( several weeks )

• Weak

• Predominantly IgM antibodies which do not cross the

placenta


Fraction of FMH

during

pregnancy

Instant response. Predominantly IgG, small in size, may cross placenta. Cause HDN

Pregnancy – Secondary Immune Response


Pregnancy – Secondary Immune Response

• Rapid ( 1 day )

• Strong

• Predom. IgG antibodies which cross the placenta

IgG

( Second exposure of Rh –

ve women to fraction of ml

of Rh +ve RBCs)


Blood Group Antibodies :

• IgM - A, B, H

I

M, N

Lea, Leb

P1

• IgG - Rh

Kell IgG can cross placenta

Duffy Identified in AHG phase

Kidd Reacts at 37◦C

Ss

IgM - Immediate spin phase

Reacts at Room temperature

cannot cross placenta


Antibody Screening – Recommendations :

Ref : Guidelines for pre-transfusion testing, 4th Edition, 2002


Antibody Screening – Local Regulation :


Antibody Screening – Local Reagulation :


Have you seen this ??

• A patient‟s serum sample was cross matched with three donorcells matching for the ABORh group

• All were compatible

• Yet the patient showed mild transfusion reaction after transfusion

• Cause ??

• The XM units probably did not have the homozygous

expression of antigen against the unexpected Ab in the

patient !



DAT* / DCT :

• Direct Antiglobulin test/ Direct Coombs Test.

• Detects antibody bound to the patients red cells

• Aid in detection/diagnosis• AIHA (Autoimmune haemolytic anemia)• HDN (Haemolytic Disease of the Newborn)• Transfusion Reactions

• Detect in vivo RBC sensitization • Immunoglobulins: IgG, IgA, IgM• Complement: C3d

* Previously called Direct Coombs Test


• Although not always performed in routine pretransfusion testing, a positiveDAT can offer valuable information

• If the patient has been transfused, the patient may have an alloantibody coating the transfused cells

• If the patient has NOT been transfused, the patient may have an autoantibody coating their own cells

DAT* / DCT : What can the DAT / DCT tell us ?

• Reagent red cells used to identify of antibody against RBC Antigen

• Used as a Follow-up test to positive screening antibody Pos

• An important component in the compability testing

• Reagent Red Blood Cells used to detect antibodies

• 10 - 11 cells are typical

Identification Antibody


* American society of Hematology


Immunohematology Products

Products

Traditional Reagents

Column

Agglutination

Technology

Automation

Traditional Reagents

Column

Agglutination

Technology

Automation

Products

Immunohematology Products

Antisera

• Anti-A, Anti-B, Anti-AB, Anti-D

• Anti-M, Anti-N, Anti-S, Anti-s, Anti-Lea, Anti Leb

RBC Reagents

• Blood Grouping ( Reverse Testing )

• Screening Antibody

• Identification Antibody

Products

● Column Agglutination Testing

● Glass Bead VS Gel ?

● Ortho Clinical Diagnostics = Glass Beads

● Inkubasi

Glass Beads : 10 menit VS Gel : 15 menit

● Centrifugasi


Products

Cassettes




● Inkubasi


● Centrifugasi


Products

Cassettes




● Incubation :

Glass Beads : 10 minutes VS Gel : 15 minutes

● Centrifugation :

Glass Beads : 5 minutes VS Gel : 10 minutes

● Blood Grouping

No Incubation required

Products

Cassettes

• 6 Columns, Glass beads

• Antisera

• Objective

• Standardize

• More saver

• Error : minimize

• Manual and Automatic

Products

Cassettes

Products

Reagent Red Blood Cells – Screening AntibodyOrtho Pooled Screening Cells ( 1 Panel )

• 0.8 % and 3 % Suspension

• Group O, HLA Negative, R1r or R2r, Homozygous for Jka, Fya

• Recommended for donor screening only

Surgiscreen ( 3 Panel )

• 0,8 % and 3 %

Products

Reagent Red Blood Cells – Screening Antibody

Selectogen ( 2 Panel )

• 0.8 % and 3 %

• Group O, HLA Negative, Only one cell Kell Posistive, Cell I : R1R1 (CDe

Phenotype ) or R1wR1, Cell II : R2R2 ( cDE Phenotype) , Homozygous for Jka,

Fya

Products

Reagent Red Blood Cells – Screening AntibodySurgiscreen ( 3 Panel )

• 0,8 % and 3 %

• Group O, HLA Negative, One Cell bu NOT ALL 3 Kell Posistive, Cell I : R1R1

(CDe Phenotype ) or R1wR1, Cell II : R2R2 ( cDE Phenotype) , Cell III : rr,

Homozygous for Jka, Jkb , Fya ,Fyb , S, M, Additional Ag ( ie. Mia )

ORTHOTM Workstation

• 2 in 1

• < 11 kG ( 10,89 )

• Integrated : Incubator dan Centrifuge

• Time :

– Cassettes Centrifugation : 5 Minutes ( 2’ : 793 RPM ; 3’ : 1508 RPM )

– Cassette Incubation : 10 MInutes

• Capacity

– Centrifuge : 10 Cassettes

– Incubator : 20 Cassettes ( @ 10 Cassettes )

• 150 VA

• T X P X L = 220 mm X 575 mm X 325 mm

Products

ORTHOTM Workstation

Products

ORTHOTM Workstation

Products

ORTHOTM Workstation

● Blood Grouping

● Crossmatch

● Screening Antibody

● Identification Antibody

● Direct comb test ( Poly and Mono )

● Rhesus phenotyping

Glass Beads :

Products

[email protected]

[email protected]

08158888940 / 085218888940

http://orthoplus.orthoclinical.com

www.transfusionnews.com

www.orthoondemand.com

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Mulyanto Basuki - patelkijateng.org...20th Century Blood Banking 1901 AB Group discovered 1907 Importance of crossmatching blood between donor & recipient 1914 Sodium Citrate proposed

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