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INTRODUCTION

  • Routine Blood Donation

  • Blood Groups

  • Blood Banking Procedures

  • Preoperative Blood Setup

  • Emergency Transfusions

  • Basic Principles of Blood Component Therapy

    • Red Cell Transfusions

    • Platelet Transfusions

    • Plasma Transfusion

    • Granulocyte Transfusions

  • Modified Blood Components

    • Irradiation

    • Leukoreduction

    • Washing

  • Transfusion Procedure

  • Transfusion Reactions

    • Managing Suspected Transfusion Reactions

    • Specific Transfusion Reactions

  • Transfusion-Transmitted Infections

    • Hepatitis

    • HIV

    • CMV

    • HTLV-I, -II

    • COVID-19 (SARS-CoV-2)

    • Bacteria, Parasites, and Other Viruses

  • Apheresis

  • COVID-19 Convalescent Plasma

ROUTINE BLOOD DONATION

Voluntary blood donation provides all blood products that are transfused in the United States. Donors usually are >18 yr old, are in good health and afebrile, and weigh >110 lb (50 kg). Donors are usually limited to one unit every 8 wk and six donations per year. A variety of medical conditions and behaviors may temporarily or indefinitely exclude a donor from donating blood; these deferrals are intended to reduce the risk of transfusion-transmitted infections. Donor blood testing includes ABO/Rh type, antibody screen, HIV-1 and -2, HBV, HCV, Zika virus, HTLV-I and -II, and Treponema pallidum (syphilis). As of June 2020, the Red Cross began testing donated blood for COVID-19 antibodies. Donors who test positive for COVID-19 antibodies may be invited to donate convalescent plasma.

BLOOD GROUPS

Table 16-1 gives information on the major blood groups and their relative occurrences. For RBC units, type O is the “universal donor,” and AB is the “universal recipient.” For plasma units, type AB is the “universal donor” because it lacks both anti-A and anti-B, while type O is the “universal recipient.”

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Table 16-1 Blood Groups and Selecting ABO/Rh Types for Transfusion

Type (ABO/Rh)

Population Frequency

Can Receive RBCs Froma

Can Receive Plasma From

O

45%

O

O, A, B, AB

A

40%

A, O

A, AB

B

11%

B, O

B, AB

AB

4%

AB, A, B, O

AB

Rh-positive

85%

Rh-positive or -negative

Rh-negative

15%

Rh-negative

aFirst choice is always the identical blood type; other acceptable combinations are shown. An attempt is also made to match Rh status of donor and recipient; Rh− can be given to an Rh+ recipient safely, but Rh− recipients should receive Rh− only to prevent alloimmunization.

BLOOD BANKING PROCEDURES

Type and Screen (T&S): The blood bank tests the patient’s ABO and Rh type and screens for antibodies. If an alloantibody (an antibody formed in response to pregnancy, transfusion, or transplantation targeted against a blood group antigen that is not present on the person’s red blood cells) is found that would make crossmatching challenging, the ordering physician usually is notified. If the decision to transfuse is made before the specimen expires (typically 72 hr after collection), the T&S order may be changed to a T&C.

Type and Cross (T&C): The blood bank performs a T&S on the patient’s specimen and matches specific ...

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