HISTORY
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1900- Landsteiner -Blood GroupsA, B, and O
1902- Sturli and DeCastello - AB
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1940- Landsteiner and Wiener-
Rh typing
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Over 250 different antigens categorizedMore than 25 major discrete systems are
now known
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Progression
Blood groups
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Anticoagulants? ABO
Plastic bags
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? Rh
? Many other!!!
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TransfusionApheresis
Medicine
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World Health Organization data for Southeast AsiaRequirement ?
16 mil ion units per year
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Gap ?
6
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mil ionunits
Col ection - about 9.4
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mil ion units annual y
Aggarwal S, Sharma V. Attitudes and problems related to voluntary blood donation in India: A short
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communication. Ann Trop Med Public Health 2012;5:50-2Every three seconds someone needs blood!
One out of every 10 people entering a hospital
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needs blood !
A country needs- 20?25 donors per
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1000 inhabitants.
In developed countries
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50 per 1,000 peopledonate blood
In India eight per 1,000
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do so
? About 112.5 million blood donations are collected
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yearly worldwide.? More than half of these are collected in high-income
countries, home to 19% of the world's population.
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Blood donation rate (per 1000 people)? High-income countries- 33.1
? Middle-income countries- 11.7
? Low-income countries-4.6
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? Data reported to WHO shows significant
increases of voluntary unpaid blood donations
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in low- and middle-income countriesBlood cannot be manufactured
It can only come from generous donors.
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Facts about donors? Common reasons cited by people who don't
give blood
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"Never thought
"I don't like
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about it"needles."
What is the solution?
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Retention donorsDonor satisfaction
Donating blood is a safe process
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Sterile disposable blood bags are
used.
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The entire process, from the timeyou arrive to the time you leave,
takes about an hour.
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Donated blood is tested for HIV,
hepatitis B and C, syphilis and
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malaria.Blood cannot be manufactured in
factories, and someone has to donate.
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Action neededv Conduct more blood donation camps.
v Enlist dedicated donors.
v Conduct donor education / awareness programs.
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Social media plays a role too!!
They donate regularly too !!
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Right blood
to the right patient
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at the right time!
Rational Use of Blood
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? Right product? Right dose
? Right time
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? Right reasons
Criteria for donor
selection
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Conditions for donation of Blood
(1)General ?
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(3)Weight > 45 kgonce in three months
(4)Normal
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good health
Temperature
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(2)Age groupPulse
18 to 65 years
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Blood pressure
e) Hemoglobin more than 12.5 g/dl
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f) The donor should be free from
acute respiratory diseases
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skin diseases at the site of phlebotomydisease transmissible by blood transfusion
i) The arms and forearms of the donor should be free from
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skin punctures or scars indicative of professional blood
donors or addiction of self injected narcotics.
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Additional criteria- (Deferral)Conditions
Period of Deferment
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1) Abortion
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6 Months2) Accident ? major
6 Months
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3) Accident ? minor
4 Weeks
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4) Acupuncture6 Months
5) Alcoholism
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24 hours after intake
6) Al ergy
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Til symptom free7) Anemia
Til treated
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8) Aspirin
3 days
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9) AsthmaTil acute attack subsides
10)Blood Donation (previous)
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3 months
11)Blood Transfusion
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6 monthsConditions
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Period of Defermentl2) Common Cold
Til symptom free
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13) Contraceptive
No deferral
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14) Child Birth6 months
15) Ear Piercing
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6 months
16) Fracture
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6 months17) Hepatitis
12 months
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18) Immunization
15 days
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19) Immunoglobulin12 months
20) Infectious Mononucleosis
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24 months
21) Hepatitis Vaccination
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6 months after thelast dose
Conditions
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Period of Deferment
21)Lactation
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12 months after delivery22)Malaria
3 months after treatment
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23)Menstruation
Temporary
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24)Pregnancy12 months
25)Rabies vaccination
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1 year after vaccination
26)Surgery ? major
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12 months27)Surgery ? minor
3 months
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28)Tattooing
6 months
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29)Toxoplasmosis12 months
30)Tuberculosis
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Til completely treated
31)Typhoid
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12 months after recovery32)Vaccination ? Kil ed Vaccine
48 hours
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33)Vaccination ? Live Vaccine
3 weeks
No person shal donate blood suffering from any of the
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disease mentioned below,
a) Cancer
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b) Heart diseasec) Abnormal bleeding tendencies
d) Unexplained weight loss
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e) Diabetes ? control ed on Insulin
f) Hepatitis infection
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g) Chronic nephritish) Signs and symptoms, suggestive of AIDS
i) Liver disease
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j) Tuberculosis
k) Polycythemia vera
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l) Asthmam) Epilepsy
n) Leprosy
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o) Schizophrenia
p) Endocrine disorders
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QUESTIONNAIRE FOR MEDICAL HISTORY? (Ask fol owing question from the donor in
? Do you get up every night to urinate ?
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privacy)
? Have you had sugar in the urine ?
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? HAVE YOU HAD ANY OF THE FOLLOWINGILLNESS?
? Have you had /suspected you had a
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venereal disease ?
? Hepatitis
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? Did you ever have painful, swol en? Malaria
joints/rheumatism ?
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? Asthma
? Have you ever been told you have
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? Al ergic to Medication/Chemicals ?anemia ?
? Significant infections or diseases of the skin
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? Subjects to diziness, fainting, twitching,
?
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spel s/fits ?? Do you bruise easily ?
? Do you have neuralgia or neuritis ?
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? Do you perspire excessively ?
? Do you have numbness/tingling in your
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? Do you faint easily ?fingers/toes ?
? Have you ever been knocked unconscious ?
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? Does cold/hot weather bother you
? Do you have light headedness/dizziness ?
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excessively ?? Have you been jaundiced (Yel ow eyes and
? Do you have a chronic cough ?
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skin) ?
? Have you ever coughed up blood ?
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? Have you lost weight ?? Do your gums bleed frequently ?
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Types of blood bags &anticoagulants used in
Blood Bank
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Blood Storage
? Acid Citrate Dextrose (ACD)
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? Citrate Phosphate Dextrose (CPD)? Citrate-phosphate-double dextrose (CP2D)
? Citrate-phosphate-dextrose-adenine (CPDA1)
SINGLE BAG-WHOLE BLOOD
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DOUBLE BAG-PRBC & PLASMA
TRIPLE BAG-PRBC & FFP & PLATELETS
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Quadruple bag- +Cryoprecipitate
What are Components?
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1. Cellular components: RBCs,
platelets, granulocytes
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2. Non cellular components: FFP,Cryoprecipitate, Cryo poor plasma
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Why Components?? Better shelf life
? Whole blood has shelf life of 35days
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? Shelf life of components: PRBC 42days
FFP 1year
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RDP 5daysWhy Components?(Contd..)
? Whole blood can be used only for one patient.
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? Components:? PRBC can be used for anemia and thalassemia.
? FFP for coagulopathy
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? Platelet concentrate for thrombocytopenia.
Principle of component preparation:
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? Principle: different components of whole blood have
different specific gravities and require different centrifugal
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force to separate from one another.Specific gravities of Components:
1.030
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1.035
1.090
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1.093Different components that can be
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prepared:1. Packed RBC(PRBC)
2. RBC with Additive solution(ADSOL)
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3. Leucoreduced RBC
4. Platelet concentrates: random donor platelets(RDP)
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5. Granulocyte concentrates6. Fresh frozen plasma(FFP)
7. Cryoprecipitate
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8. Single donor plasma(SDP)
9. Cryo poor plasma(CPP)
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Preparation of Packed RBC:Whole blood bags are kept at room
temperature after donation
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Bags are put in centrifuge cups and
balanced by soft weights
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Balanced centrifuge cups are to placeddiagonal y in refrigerated centrifuge
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Centrifuge should be run at speed of1800rpm with 9 acceleration and 6
deceleration for 10mins
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Using plasma expresser, platelet rich
plasma(4/5th Plasma) is separated into
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another satel ite bag to retain RBC inmother bag.
RBC Components:
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1. PRBC: RBCs are separated from plasma by plasma
expresser and kept at 2-40C. Shelf life is 35days.
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2. RBC with Additive: SAGM? Requires quadruple or penta bags.
? Shelf life is 42days when stored at 2-40C.
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? It contains Saline, Adenine, Glucose and Mannitol
Clinical indications of PRBC
transfusion: BCSH
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? Surgery/Critical care: <7g/dl
? Cardiovascular disease: <8g/dl
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? Chronic anemia: Hb maintained >8g/dl to preventsymptoms
Clinical response of PRBC
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transfusion:
? Each unit of PRBC,
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i. In a 70kg adult will cause increase of 1g/dl of Hb and 3%HCT
ii. In a child, 3g/dl of Hb and 6% HCT
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Long term storage
? Cryopreservation of red blood cells is done
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to store rare units for up to 10 years.
? The cells are incubated in a glycerol solution
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which acts as a cryoprotectantPlatelet Concentrate:
? Random donor platelets(RDP) are prepared from whole
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blood unit by centrifugation.
? Ideally from 450ml unit of whole blood kept at room
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temperature and within 6 to 8 hours of collection.Storage of Platelet Concentrate:
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Temperature:20-24 degreesAgitation
? Exchange of gases
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? Maintenance of pH
? Decreased formation of aggregates
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Clinical response of Plateletconcentrate:
? 1 unit of RDP causes an increment of 5000 to
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10000/mm3 in a 70kg adult.
Fresh frozen plasma:
? Prepared from a single unit of whole blood and frozen
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rapidly within 6-8hrs
? Contain all coagulation factors
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? Rapidly frozen within 1 hour of separation? Used as FFP until 1year if stored below -300C.
FFP Transfusion:
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? Dosage of FFP: 15ml/kg body weight
? Compatibility testing is not necessary before transfusion.
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? Donor plasma should not contain ABO antibodies thatinteract with recipient's red cells.
Cryoprecipitate:
? Precipitated proteins of plasma rich in Factor VIII,
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Fibrinogen and Fibronectin.
? Stored at -300C for 1year.
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Component StorageExpiration
Whole Blood 2-6 0 C
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35-42 days
PRBC
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2-6 0 C35-42 days
Platelets
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20-24 0 C
5 days
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FFP<-18 0 C
12 months
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PRETRANFUSION TESTING
? BLOOD GROUPING
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? CROSS- MATCHINGQ. What determines a blood
group?
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A. The antigens on the red cell
surface.
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What are the antigens?
Group A
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Group B
Group AB
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Group OWe have antibodies to the antigens we don't have!
Group A
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Group B
Group AB
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Cell grouping Serum grouping
Group A
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Group B
Group AB
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Group OThis is very important during
blood transfusion
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Anti-A antibodies lyse type A red cel s
Anti-B antibodies lyse type B red cel s
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CROSSMATCHpatient
donor
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AHG
serum
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red cellsCross-matching
? Major Cross-match: Recipient serum is tested
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against donor packed cells
? Minor Cross-match: Recipient red cells are
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tested against donor serum