Unit #5F – Clinical Unit #5F – Clinical Laboratory Testing – Laboratory Testing –

Basic Basic ImmunohematologyImmunohematology

Cecile Sanders, M.Ed., Cecile Sanders, M.Ed., MLS(ASCP)MLS(ASCP)

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Immunohematology = Blood BankingImmunohematology = Blood Banking In blood banking, technologists and In blood banking, technologists and

technicians must determine blood technicians must determine blood groups (types) and other red blood groups (types) and other red blood cell antigens before blood cell antigens before blood transfusions may be given.transfusions may be given.

Blood grouping is also used in organ Blood grouping is also used in organ transplantation, questions of transplantation, questions of paternity, forensic investigations, paternity, forensic investigations, and genetic studies.and genetic studies.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Units or “pints” of blood are Units or “pints” of blood are

“banked” for use in transfusions to “banked” for use in transfusions to patients that need blood either patients that need blood either because of a blood loss (accident or because of a blood loss (accident or surgery, etc.) or because the patient surgery, etc.) or because the patient is unable to make his own blood is unable to make his own blood (anemia or leukemia, etc.).(anemia or leukemia, etc.).

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Blood from donors is collected in a Blood from donors is collected in a

plastic bag and stored in a special plastic bag and stored in a special refrigerator until used or until the refrigerator until used or until the blood expires, usually in 42 days.blood expires, usually in 42 days.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Most hospitals obtain donor blood Most hospitals obtain donor blood

from processing centers, such as the from processing centers, such as the American Red Cross. In Austin, the American Red Cross. In Austin, the donor collection and processing donor collection and processing center is the Blood and Tissue Center center is the Blood and Tissue Center of Central Texas, 4300 N Lamar Blvd, of Central Texas, 4300 N Lamar Blvd, Austin, TX (512) 206-1266 Austin, TX (512) 206-1266

PLEASE DONATE BLOOD IF YOU CAN!PLEASE DONATE BLOOD IF YOU CAN!

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Donated blood can be separated into Donated blood can be separated into

several components, depending on the several components, depending on the needs of the medical community.needs of the medical community.

Blood may be left as “whole blood” or Blood may be left as “whole blood” or separated into red cells, platelets, and separated into red cells, platelets, and plasma. In this way, several patients can plasma. In this way, several patients can benefit from one unit of donor blood.benefit from one unit of donor blood.

Visit Visit http://www.pbs.org/wnet/redgold/basics/blhttp://www.pbs.org/wnet/redgold/basics/bloodcollection.htmloodcollection.html for more information on blood processing for more information on blood processing and storage.and storage.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology The ABO SystemThe ABO System

– Group O = 45%Group O = 45%– Group A = 41%Group A = 41%– Group B = 10%Group B = 10%– Group AB = 4%Group AB = 4%

ABO grouping is based on the presence of ABO grouping is based on the presence of absence of blood group antigens on red absence of blood group antigens on red blood cells. (Review “antigens” and blood cells. (Review “antigens” and “antibodies” in Unit#5C under Basic “antibodies” in Unit#5C under Basic Serology/Immunology, if needed)Serology/Immunology, if needed)

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Group A individuals have A antigens Group A individuals have A antigens

on their red cells.on their red cells. Group B individuals have B antigens Group B individuals have B antigens

on their red cells.on their red cells. Group AB individuals have A AND B Group AB individuals have A AND B

antigens on their red cells.antigens on their red cells. Group O individuals have NEITHER A Group O individuals have NEITHER A

NOR B antigens on their red cells.NOR B antigens on their red cells.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Red cell antigens are identified by Red cell antigens are identified by

mixing a person’s red blood cells mixing a person’s red blood cells with typing serum (Anti-A and Anti-B) with typing serum (Anti-A and Anti-B) and looking for agglutination. This is and looking for agglutination. This is called forward or direct grouping or called forward or direct grouping or typing.typing.

If a person’s red blood cells If a person’s red blood cells agglutinate (clump) when mixed with agglutinate (clump) when mixed with a typing serum, they have that a typing serum, they have that antigen on their red blood cells.antigen on their red blood cells.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Anti-A and Anti-B serums are Anti-A and Anti-B serums are

purchased like this:purchased like this:

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Forward or direct Forward or direct

blood groupingblood grouping

Anti-A Anti-A SerumSerum

Anti-B Anti-B SerumSerum

Blood Blood GroupGroup

Agglutination (+)Agglutination (+) No agglutination (-)No agglutination (-) AA

No agglutination (-)No agglutination (-) Agglutination (+)Agglutination (+) BBAgglutination (+)Agglutination (+) Agglutination (+)Agglutination (+) ABAB

No agglutination (-)No agglutination (-) No agglutination(-)No agglutination(-) OO

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Pictures of ABO Blood Pictures of ABO Blood

Grouping/TypingGrouping/Typing

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Humans have naturally occurring Humans have naturally occurring

antibodies in their plasma or serum antibodies in their plasma or serum against blood antigens they do NOT against blood antigens they do NOT have.have.

For example: Group A individuals For example: Group A individuals have Anti-B antibodies; Group B have Anti-B antibodies; Group B individuals have Anti-A antibodies.individuals have Anti-A antibodies.

Detection of these antibodies is Detection of these antibodies is called reverse or indirect grouping or called reverse or indirect grouping or typing.typing.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Reverse or indirect Reverse or indirect

blood grouping:blood grouping:

Blood Blood GroupGroup

Anti-A AbsAnti-A Abs Anti-B AbsAnti-B Abs

AA NoNo YesYes

BB YesYes NoNo

ABAB NoNo NoNo

OO YesYes YesYes

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Blood Group Blood Group

Antigens and Antigens and Antibodies Antibodies SummarySummary

Blood Blood GroupGroup Anti-A SerumAnti-A Serum Anti-B SerumAnti-B Serum A AbsA Abs B AbsB Abs

AA ++ -- NoNo YesYes

BB -- ++ YesYes NoNo

ABAB ++ ++ NoNo NoNo

OO -- -- YesYes YesYes

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Group O packed red blood cells are Group O packed red blood cells are

sometimes referred to as the sometimes referred to as the “Universal Donor”. In an emergency, “Universal Donor”. In an emergency, it can be given to any blood type it can be given to any blood type because the red cells do not have because the red cells do not have antigens against which the patient’s antigens against which the patient’s plasma antibodies might react. plasma antibodies might react. Because the blood is “packed”, it Because the blood is “packed”, it does not have plasma antibodies.does not have plasma antibodies.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Group AB is sometimes referred to as Group AB is sometimes referred to as

the “Universal Recipient”. In an the “Universal Recipient”. In an emergency, these patients can emergency, these patients can receive any blood type because they receive any blood type because they do not have any plasma antibodies to do not have any plasma antibodies to react against A or B antigens.react against A or B antigens.

However, it is always best to give the However, it is always best to give the patient group or type specific blood.patient group or type specific blood.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Rh is another antigen that individuals Rh is another antigen that individuals

may have on their red blood cells. may have on their red blood cells. Another name for Rh factor is D Another name for Rh factor is D

antigen.antigen. If a person has the Rh factor (D If a person has the Rh factor (D

antigen) on their red blood cells, they antigen) on their red blood cells, they are called Rh positive. are called Rh positive.

If a person does NOT have the Rh If a person does NOT have the Rh factor (D antigen) on their red blood factor (D antigen) on their red blood cells, they are called Rh negative.cells, they are called Rh negative.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology When a person is blood grouped or When a person is blood grouped or

typed, Rh is always determined, in typed, Rh is always determined, in addition to ABO grouping.addition to ABO grouping.

Rh (D) grouping/typing is also Rh (D) grouping/typing is also performed using anti-serum (anti-D), performed using anti-serum (anti-D), which is mixed with patient’s blood. which is mixed with patient’s blood. If there is agglutination, the person is If there is agglutination, the person is called Rh positive; if there is NO called Rh positive; if there is NO agglutination, the person is called Rh agglutination, the person is called Rh negative.negative.

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematologyABO and RhABO and Rh

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology Try your hand at working in a Blood Bank! Try your hand at working in a Blood Bank!

Play the “Blood Typing Game” at this Play the “Blood Typing Game” at this website:website:

http://nobelprize.org/educational_games/mehttp://nobelprize.org/educational_games/medicine/landsteiner/index.htmldicine/landsteiner/index.html(Hint: Use the syringe to draw blood from (Hint: Use the syringe to draw blood from

patients’ arms; then move the syringe patients’ arms; then move the syringe over the blood typing reagents to add it to over the blood typing reagents to add it to the tubes. Once you decide on the correct the tubes. Once you decide on the correct blood type, click on the right bag of blood blood type, click on the right bag of blood and move it to the IV pole to start the and move it to the IV pole to start the transfusion.)transfusion.)

Unit #5F – Clinical Laboratory Unit #5F – Clinical Laboratory Testing - Basic Testing - Basic

ImmunohematologyImmunohematology ResourcesResources

– Basic Clinical Laboratory TechniquesBasic Clinical Laboratory Techniques, , Estridge and Reynolds, Thomson/Delmar Estridge and Reynolds, Thomson/Delmar Learning, Fifth Edition, 2008Learning, Fifth Edition, 2008

– http://nobelprize.org/educational_gameshttp://nobelprize.org/educational_games/medicine/landsteiner/index.html/medicine/landsteiner/index.html

– http://http://www.pbs.org/wnet/redgold/basics/bloodwww.pbs.org/wnet/redgold/basics/bloodcollection.htmlcollection.html