TechnicalManual

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TechnicalManual

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1 7 T H E D I T I O N

E d i t e d b y

John D. Roback, MD, PhDEmory University Hospital

Atlanta, GA

Brenda J. Grossman, MD, MPHWashington University School of Medicine

St. Louis, MO

Teresa Harris, MT(ASCP)SBB, CM, CQIA, CQA(ASQ)American Red Cross

Washington, DC

Christopher D. Hillyer, MDNew York Blood Center

New York, NY

Mention of specific products or equipment by contributors to this AABB publication does not represent an endorsement of such products by the AABB nor does it necessarily indicate a preference for those products over other similar competitive products. Any forms and/or procedures in this book are examples. AABB does not imply or guarantee that the materials meet federal, state, or other applicable requirements. It is incumbent on the reader who intends to use any information, forms, policies, or procedures contained in this publication to evaluate such materials for use in light of particular circumstances associated with his or her institution.

AABB authors are requested to comply with a conflict of interest policy that includes disclosure of relationships with commercial firms. A copy of the policy is located at http://www.aabb.org.

Efforts are made to have publications of the AABB consistent in regard to acceptable practices. However, for several reasons, they may not be. First, as new developments in the practice of blood banking occur, changes may be recommended to the Standards for Blood Banks and Transfusion Services. It is not possible, however, to revise each publication at the time such a change is adopted. Thus, it is essential that the most recent edition of the Standards be consulted as a reference in regard to current acceptable practices. Second, the views expressed in this publication represent the opinions of authors. The publication of this book does not constitute an endorsement by the AABB of any view expressed herein, and the AABB expressly disclaims any liability arising from any inaccuracy or misstatement.

Copyright © 2011 by AABB. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the Publisher.

AABB ISBN No. 978-1-56395-315-68101 Glenbrook Road Printed in the United StatesBethesda, Maryland 20814-2749

Cataloging-in-Publication Data

Technical manual / editor, John D. Roback—17th ed.p. ; cm.

Including bibliographic references and index.ISBN 978-1-56395-315-61. Blood Banks—Handbooks, manuals, etc. I. Roback, John D. II. AABB.[DNLM: 1. Blood Banks-laboratory manuals. 2. Blood Transfusion-laboratory manuals. WH 25 T2548 2011] RM172.T43 2011615’.39—dc23DNLM/DLC

Technical ManualAuthors

Colleen A. Aronson, MT(ASCP)SBBJames P. AuBuchon, MDJamie Blietz, MBA, CAE

Robert A. Bray, PhDStella T. Chou, MD

Laura Cooling, MD, MSGeoff Daniels, PhD, FRCPathRobertson D. Davenport, MD

Janice Davis-Sproul, MAS, MT(ASCP)SBBKatharine A. Downes, MD

Anne F. Eder, MD, PhDWilliam P. FitzGerald, LTC USA (Ret)

Susan A. Galel, MDHoward M. Gebel, PhDN. Rebecca Haley, MD

Betsy W. Jett, MT(ASCP), CQA(ASQ)CQM/OECassandra D. Josephson, MD

Jana Julleis, MBA, MT(ASCP)SBBDiane M. Kadidlo, MT(ASCP)SBB

Ram Kakaiya, MD, MBBSMelanie S. Kennedy, MDPatricia M. Kopko, MDThomas A. Lane, MD

Regina M. Leger, MSQA, MT(ASCP)SBB, CMQ/OE(ASQ)

Jill Leonard, MT(AMT)Sandy L. Liles, MT(ASCP)SBB

William B. Lockwood, PhD, MDChristine Lomas-Francis, MSc, FIBMS

Catherine A. Mazzei, MDJeffrey McCullough, MDJanice G. McFarland, MDDavid H. McKenna, MDJohn D. McMannis, PhD

Tania L. Motschman, MS, MT(ASCP)SBB, CQA(ASQ)

Theresa Nester, MDMarilyn S. Pollack, PhDMark A. Popovsky, MD

Glenn Ramsey, MDDonna M. Regan, MT(ASCP)SBB

Rita A. Reik, MDIra A. Shulman, MD

Bonnie L. S. Sink, BSN, RN, HP(ASCP)James W. Smith, MD, PhDSteven L. Spitalnik, MD

Simon Stanworth, MD, DPhilRuth D. Sylvester, Lt Col, USAF (Ret), MS,

MT(ASCP)SBBAlan Tinmouth, MD, FRCPC, MSc

Christopher A. Tormey, MDLance D. Trainor, MD

Phyllis S. Walker, MS, MT(ASCP)SBBJonathan H. Waters, MD

Connie M. Westhoff, PhD, MT(ASCP)SBBSusan L. Wilkinson, EdD, MS, MT(ASCP)SBB,

CQA(ASQ)James C. Zimring, MD, PhD

AcknowledgmentsH E 1 7 T H E D I T I O N O F the TechnicalManual was the work of many dedicated

individuals. In addition to the chapter au-thors, I would like to thank my three associateeditors: Brenda Grossman, Teresa Harris, andChris Hillyer. Their efforts and long hours inrevising and rewriting chapters during the re-view process made my job immeasurably easi-er. Teresa, in particular, took the lead in revis-ing the methods sections, a job she iseminently more qualified to undertake than I.If you enjoy the content of the 17th edition, allcredit should go to the associate editors andthe authors. Laurie Munk, Jennifer Boyer, JayPennington, and their colleagues are an un-matched publication resource. Their knowl-edge of transfusion medicine is encyclopedic,matched only by their grammatical acumen. Ifthe text reads well, it is due to their efforts.Should you find problems with the 17th edi-tion, however, the blame resides with me.

We would also like to acknowledge themembers of the following committees andprogram units for their expert review of chap-ters, methods, and appendices for the 17thedition of the Technical Manual.

REVI EW IN G COMMI TTEES

AABB Cellular Therapies SectionAABB Interorganizational Task Force on

Domestic Disasters and Acts of TerrorismCellular Therapies Standards Program Unit

Cellular Therapies Accreditation Program UnitClinical Transfusion Medicine CommitteeCircular of Information Task ForceDonor Center Accreditation Program UnitDonor History Task ForceImmunohematology Reference Laboratories

Standards Program UnitImmunohematology Reference Laboratories

Accreditation Program UnitInformation Systems CommitteeMolecular Testing Accreditation Program UnitPerioperative Accreditation Program UnitPerioperative Standards Program UnitQuality Management Standards Subcommit-

teeQuality Systems Accreditation SubcommitteeRelationship Testing Standards Program UnitTissue CommitteeTransfusion Services Accreditation Program

UnitTransfusion Transmitted Diseases Committee

Finally, we would like to thank the editors,authors, and program unit members of the16th and earlier editions of the Technical Man-ual for selected tables, figures, methods, andwritten sections of the chapters that could notbe improved upon, and thus were used againin the 17th edition.

John D. Roback, MD, PhDChief Editor

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ix

Preface

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H E E D I T O R S A R E pleased to present the17th edition of the Technical Manual. This

is the second edition to use the revised format,which includes listing authorship for eachchapter. In preparing the 17th edition, wecarefully considered the comments receivedafter publication of the 16th edition, both fromreaders and from authors. Many believed thatthe new format was successful in bringing thenecessary levels of expertise to the preparationof each chapter. However, they also suggesteda number of changes that have now beenincorporated into the present edition. Forexample, Chapter 10 was expanded throughthe addition of several pages of basic andapplied immunology as a primer for laterimmunohematology chapters. A section onhemovigilance was added to Chapter 27 inkeeping with AABB’s expanding commitmentto this important quality and safety activity.Another significant change was the inclusionof several “Key Points” at the end of each chap-ter, which should be useful for both studentsand experienced readers alike.

We believe that with the revised format amodest amount of author rotation is benefi-cial. Thus, for the 17th edition we recruitednew authors for three chapters; additionalauthorship changes were also made for fiveother chapters. These changes should help tokeep the text of the 17th edition fresh whilealso maintaining continuity with earlier edi-tions.

One aspect of the Technical Manual thathas not changed is the commitment of theAABB and the editors to extensive, multi-lay-ered technical review. Each chapter wasreviewed and revised at least twice by an edi-tor. The chapters were also submitted to sub-

ject matter-appropriate committees fordetailed content review (see list in Acknowl-edgments). All chapters were then subjected toadditional regulatory, AABB standards, legal,and editorial review prior to publication.Finally, as noted above, many highly knowl-edgeable readers functioned as an ad hoc“post-publication” review committee for the16th edition by bringing errors and omissionsto the editors’ notice. We have carefully con-sidered each of the issues that was raised andwhere appropriate included revised text in the17th edition. Because the field of blood bank-ing, transfusion medicine, and cellular therapyis complex, detail-oriented, and continues toevolve, we once again invite all readers to con-tact us if they should find omissions, errors,and inconsistencies in the 17th edition, or ifthey would like to suggest ways to improve thenext edition of the Technical Manual. We valueyour opinions and look to the readership forassistance in keeping this valuable resource upto date with our dynamically evolving field.

It is important for readers to realize that,in the opinions of the chapter authors and theeditors, the methods chosen for inclusion inthe 17th edition represent best technical prac-tices. However, these methods are not the onlyapproaches that fulfill the requirements ofAABB Standards; readers may choose to useother approaches. Furthermore, should youfind that any method or statement in the Tech-nical Manual is in conflict with the Standards,the authority of the Standards supersedes thatof the Technical Manual.

John D. Roback, MD, PhDChief Editor

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xi

Contents

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Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Q U A L I T Y I S S U E S

1. Quality Management Systems: Theory and Practice . . . . . . . . . . 1

Tania L. Motschman, MS, MT(ASCP)SBB, CQA(ASQ); Betsy W. Jett, MT(ASCP), CQA(ASQ)CQM/OE; and Susan L. Wilkinson, EdD, MS, MT(ASCP)SBB, CQA(ASQ)

Quality Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Practical Application of Quality Management Principles . . . . . . . . . . . . . . . . . .4Appendix 1-1. Glossary of Commonly Used Quality Terms . . . . . . . . . . . . . . . 32Appendix 1-2 Code of Federal Regulations Quality-Related References . . . . 34Appendix 1-3. Statistical Tables for Binomial Distribution Used to

Determine Adequate Sample Size and Level of Confidence for Validation of Pass/Fail Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Appendix 1-4. Suggested Quality Control Performance Intervals for Equipment and Reagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

2. Facilities, Work Environment, and Safety. . . . . . . . . . . . . . . . . . . 41

Betsy W. Jett, MT(ASCP), CQA(ASQ)CQM/OE;Susan L. Wilkinson, EdD, MS, MT(ASCP)SBB, CQA(ASQ); andTania L. Motschman, MS, MT(ASCP)SBB, CQA(ASQ)

Facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Safety Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Fire Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Electrical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Chemical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Radiation Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Shipping Hazardous Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66General Waste Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Appendix 2-1. Safety Regulations and Recommendations Applicable to

Health-Care Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

xii � A A B B T E C H N I C A L M A N U A L

Appendix 2-2. General Guidelines for Safe Work Practices, Personal Protective Equipment, and Engineering Controls . . . . . . . . . . . . . . . . . . . . . 73

Appendix 2-3. Biosafety Level 2 Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Appendix 2-4. Sample List of Hazardous Chemicals that May Be

Encountered in the Blood Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Appendix 2-5. Specific Chemical Categories and How to Work Safely

with Them . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Appendix 2-6. Incidental Spill Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Appendix 2-7. Managing Hazardous Chemical Spills. . . . . . . . . . . . . . . . . . . . . 85

3. Regulatory Issues in Blood Banking . . . . . . . . . . . . . . . . . . . . . . . . 87

Glenn Ramsey, MD

Federal Laws and Regulations for Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Biological Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Licensure and Registration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89FDA Inspections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90Blood-Related Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Hematopoietic Progenitor Cells as Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Managing Recalls and Withdrawals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Medical Laboratory Laws and Regulations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Hospital Regulations and Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96State and Local Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

4. Disaster Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Jamie Blietz, MBA, CAE; William P. FitzGerald, LTC USA (Ret); and Ruth D. Sylvester, Lt Col, USAF (Ret), MS, MT(ASCP)SBB

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Business Operations Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Working with Emergency Management Agencies. . . . . . . . . . . . . . . . . . . . . . . 120Regulatory Considerations in Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Testing the Disaster Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Summary of Lessons Learned from Recent Disasters . . . . . . . . . . . . . . . . . . . 125Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Appendix 4-1. Internet Resources Related to State and Local

Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136Appendix 4-2. General Internet Resources for Disaster Management . . . . . 136

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5. Allogeneic and Autologous Blood Donor Selection . . . . . . . . . 137

Anne F. Eder, MD, PhD

Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138Selection of Allogeneic Donors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

Table of Contents � xiii

Possible Measures of the Effectiveness of the Donor Interview . . . . . . . . . . 147Blood-Center-Defined Donor Eligibility Criteria . . . . . . . . . . . . . . . . . . . . . . . 148Abbreviated Donor History Questionnaire for Frequent Donors . . . . . . . . 152Postdonation Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152Recipient-Specific “Designated” or “Directed” Blood Donation . . . . . . . . . 153Appendix 5-1. Requirements for Allogeneic and Autologous

Donor Qualification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Appendix 5-2. The Donor History Questionnaire and Corresponding

Regulations and Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Appendix 5-3. Full-Length Donor History Questionnaire . . . . . . . . . . . . . . . 180Appendix 5-4. Medication Deferral List for the Donor History

Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184Appendix 5-5. Blood Donor Educational Materials: Making Your

Blood Donation Safe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

6. Whole Blood Collection and Component Processing atBlood Collection Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Ram Kakaiya, MD, MBBS; Colleen A. Aronson, MT(ASCP)SBB; and Jana Julleis, MBA, MT(ASCP)SBB

Whole Blood Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Blood Component Preparation and Processing . . . . . . . . . . . . . . . . . . . . . . . . 198Descriptions of Major Blood Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Blood Component Modification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207Quarantine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213Labeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214ISBT 128 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216Quality Control of Blood Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

7. Blood Component Collection by Apheresis . . . . . . . . . . . . . . . . 227

James W. Smith, MD, PhD

Component Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227Instruments and Systems for Donor Apheresis Collections. . . . . . . . . . . . . . 233

8. Infectious Disease Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Susan A. Galel, MD

Historical Overview of Blood Donor Screening . . . . . . . . . . . . . . . . . . . . . . . . 239Donor Screening Tests: General Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Residual Infectious Risks of Transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251Screening for Specific Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254Pathogen Reduction Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264

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9. Storage, Monitoring, Pretransfusion Processing, andDistribution of Blood Components . . . . . . . . . . . . . . . . . . . . . 271

William B. Lockwood, PhD, MD; Jill Leonard, MT(AMT); and Sandy L. Liles, MT(ASCP)SBB

Blood and Blood Component Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272Prestorage Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279Poststorage Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279Inspection, Shipping, Receiving into Inventory, Disposition, and Issue . . . 284

B L O O D G R O U P S

10. Molecular Biology and Immunology in Transfusion Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293

James C. Zimring, MD, PhD, and Steven L. Spitalnik, MD

Nucleic Acid Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293Protein Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307Basic Immunologic Principles Underlying Transfusion Medicine . . . . . . . . 313

11. Blood Group Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

Christine Lomas-Francis, MSc, FIBMS

Fundamental Principles of Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328Inheritance of Genetic Traits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337Population Genetics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348Relationship Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351Blood Group Gene Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353Chimerism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356Blood Group Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357

12. ABO, H, and Lewis Blood Groups and Structurally Related Antigens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363

Laura Cooling, MD, MS

ABO System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363The H System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373The Lewis System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376I and i Antigens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378P Blood Groups/GLOB Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381

13. The Rh System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389

Stella T. Chou, MD, and Connie M. Westhoff, PhD, MT(ASCP)SBB

Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390RH Genes and Rh Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393Antigens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394RH Genotyping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Table of Contents � xv

Rhnull Syndrome and RhAG Blood Group System . . . . . . . . . . . . . . . . . . . . . . . 404Rh Structure and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404Rh Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405Technical Considerations for Rh Typing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405

14. Other Blood Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

Geoff Daniels, PhD, FRCPath

The MNS System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411The Lutheran System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417The Kell and Kx Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418The Duffy System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421The Kidd System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423The Diego System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425The Yt System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426The Xg System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426The Scianna System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427The Dombrock System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427The Colton System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428The Landsteiner-Wiener System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429The Chido/Rodgers System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429The Gerbich System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429The Cromer System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430The Knops System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430The Indian System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431The Ok System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431The Raph System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432The John Milton Hagen System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432The GILl System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432The RHAG System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432Antigens That Do Not Belong to a Blood Group System . . . . . . . . . . . . . . . . 432

A N T I G E N A N D A N T I B O D Y T E S T I N G

15. Pretransfusion Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437

Katharine A. Downes, MD, and Ira A. Shulman, MD

Requests for Transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437Identification of Recipients and Labeling of Blood Samples . . . . . . . . . . . . 438Sample Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441Serologic Testing Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442Pretransfusion Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445Tubeless Methods for Pretransfusion Testing. . . . . . . . . . . . . . . . . . . . . . . . . . 449Comparison of Current Testing Results with Previous Records . . . . . . . . . . 450Donor RBC Unit Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451Donor RBC Unit Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451

xvi � A A B B T E C H N I C A L M A N U A L

Compatibility Testing or Crossmatch (Serologic or Computer/Electronic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452

Interpretation of Antibody Screening and Crossmatch Results . . . . . . . . . . . 453Pretransfusion Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455Availability of Compatible Blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455Labeling of Blood and Blood Components with the Recipient’s

Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455Special Clinical Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457

16. Identification of Antibodies to Red Cell Antigens . . . . . . . . . . . 463

Phyllis S. Walker, MS, MT(ASCP)SBB

Significance of Alloantibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463Preanalytical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464Analytical Phase of Antibody Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464Postanalytical Considerations: Selecting Blood for Transfusion . . . . . . . . . . 490

17. The Positive Direct Antiglobulin Test and Immune-Mediated Hemolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497

Regina M. Leger, MSQA, MT(ASCP)SBB, CMQ/OE(ASQ)

The Direct Antiglobulin Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497Autoimmune Hemolytic Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501Drug-Induced Immune Hemolytic Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512Appendix 17-1. Drugs Associated with a Positive DAT and/or

Immune Hemolytic Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519

18. Platelet and Granulocyte Antigens and Antibodies . . . . . . . . . 523

Janice G. McFarland, MD

Platelet Antigens and Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523Granulocyte Antigens and Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539

19. The HLA System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547

Howard M. Gebel, PhD; Marilyn S. Pollack, PhD; andRobert A. Bray, PhD

Genetics of the Major Histocompatibility Complex . . . . . . . . . . . . . . . . . . . . . 548Biochemistry, Tissue Distribution, and Structure. . . . . . . . . . . . . . . . . . . . . . . 552Detection of HLA Antigens and Alleles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557Crossmatching and Detection of HLA Antibodies . . . . . . . . . . . . . . . . . . . . . . 559The HLA System and Transfusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 560HLA Testing and Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562Other Clinically Significant Aspects of HLA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566

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C L I N I C A L C O N S I D E R A T I O N S I NT R A N S F U S I O N P R A C T I C E

20. Hemotherapy Decisions and Their Outcomes . . . . . . . . . . . . . 571

Theresa Nester, MD, and James P. AuBuchon, MD

Red Cell Transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571Platelet Transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579Plasma Transfusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589Cryoprecipitated AHF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 594Granulocytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 595Plasma Derivatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597

21. Administration of Blood Components . . . . . . . . . . . . . . . . . . . . 617

Bonnie L. S. Sink, BSN, RN, HP(ASCP)

Events and Considerations Before Dispensing the Component . . . . . . . . . . 617Dispensing and Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621Events and Considerations Before Component Administration. . . . . . . . . . 622Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 624Unique Transfusion Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 626Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627

22. Perinatal Issues in Transfusion Practice . . . . . . . . . . . . . . . . . . . 631

Melanie S. Kennedy, MD

Hemolytic Disease of the Fetus and Newborn . . . . . . . . . . . . . . . . . . . . . . . . . 631Rh Immune Globulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636ABO Hemolytic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639Immune Thrombocytopenia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639

23. Neonatal and Pediatric Transfusion Practice . . . . . . . . . . . . . . 645

Cassandra D. Josephson, MD

Transfusion in Infants Less than 4 Months of Age . . . . . . . . . . . . . . . . . . . . . . 645Transfusion in Older Infants (More than 4 Months of Age) and

Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 660Prevention of Adverse Effects of Transfusion in Neonates and

Older Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 663

24. Patient Blood Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671

Jonathan H. Waters, MD

Behavioral Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671Preoperative Anemia Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673Perioperative Autotransfusion Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 674

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25. Transfusion Support for Hematopoietic Stem Cell Transplant Recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 687

Christopher A. Tormey, MD

ABO and Non-ABO Red Cell Antigen Incompatible Transplantation. . . . . . 688Blood Component Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 692HSCT Recipients with HLA and/or Platelet Antibodies . . . . . . . . . . . . . . . . . . 698Neutropenic Patients with Infection Unresponsive to Antimicrobial

Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 699Special Processing of Blood Components for the Recipients of HSCT . . . . . 699Other Practical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700

26. Therapeutic Apheresis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707

Robertson D. Davenport, MD

Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707Modalities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 708Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 709Anticoagulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717Replacement Fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717Adverse Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 718Vascular Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 720Patient Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722

27. Noninfectious Complications of Blood Transfusion . . . . . . . . 727

Catherine A. Mazzei, MD; Mark A. Popovsky, MD; andPatricia M. Kopko, MD

Hemovigilance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727Recognition and Evaluation of a Suspected Transfusion Reaction . . . . . . . 728Acute or Immediate Transfusion Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 737Delayed Transfusion Reactions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 751Fatality Reporting Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 757

28. Approaches to Blood Utilization Auditing . . . . . . . . . . . . . . . . . 763

Alan Tinmouth, MD, FRCPC, MSc, and Simon Stanworth, MD, DPhil

Rationale for Monitoring Blood Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . 764Types of Transfusion Audits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 764Interventions to Change Transfusion Practice. . . . . . . . . . . . . . . . . . . . . . . . . . 769Effectiveness of Monitoring and Interventions to Change

Transfusion Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 770Selecting an Audit Process to Monitor Transfusions . . . . . . . . . . . . . . . . . . . . 770Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 772Appendix 28-1. Example of a Transfusion Order Form . . . . . . . . . . . . . . . . . 776

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T R A N S P L A N T A T I O N

29. Collecting and Processing Marrow Products for Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 779

Janice Davis-Sproul, MAS, MT(ASCP)SBB; N. Rebecca Haley, MD; and John D. McMannis, PhD

Diseases Treated with Hematopoietic Cell Transplantation . . . . . . . . . . . . . 780Autologous Hematopoietic Cell Transplantation. . . . . . . . . . . . . . . . . . . . . . . 780Allogeneic Hematopoietic Cell Transplantation . . . . . . . . . . . . . . . . . . . . . . . 780Unrelated Donor Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 782Histocompatibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 782Graft-vs-Host Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783Donor Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783Marrow Harvest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 784Collection Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 784Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785CD34 Antigen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785Processing of HPC(M) Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785Red Cell Incompatibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 787Short- and Long-Term Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 790Transportation and Shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792Thawing and Infusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792Evaluation and Quality Control of Hematopoietic Products . . . . . . . . . . . . . 792Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 794Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 794

30. Hematopoietic Progenitor Cells Collected by Apheresis. . . . . 801

Thomas A. Lane, MD, and John D. McMannis, PhD

Biology of HPC Mobilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 802Clinical Mobilization Regimens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 802Preparation and Administration of HPC(A). . . . . . . . . . . . . . . . . . . . . . . . . . . . 808Clinical Use of HPC(A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 809Clinical Transplantation Outcomes of HPC(A) vs HPC(M) Grafts . . . . . . . . 813Selection of an HPC(A) or HPC(M) Graft vs an HPC(C) Graft . . . . . . . . . . . . 814

31. Umbilical Cord Blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 823

David H. McKenna, MD; Diane M. Kadidlo, MT(ASCP)SBB; Jeffrey McCullough, MD; and Donna M. Regan, MT(ASCP)SBB

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 823Donor-Related Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 824Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 827Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 829Shipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 832Receipt of UCB for Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 833Thawing and Washing of UCB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 834

xx � A A B B T E C H N I C A L M A N U A L

Infusion of UCB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 835Regulations and Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 837Novel UCB-Derived Cellular Therapies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 839

32. Human Tissue Allografts and the Hospital Transfusion Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 849

Lance D. Trainor, MD, and Rita A. Reik, MD

Tissue Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 849Regulations and Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 853Hospital Tissue Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 854Responsibility for Hospital-Based Tissue Services . . . . . . . . . . . . . . . . . . . . . . 854

M E T H O D S

Methods Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 863

1. General Laboratory Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 865

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 865Method 1-1. Shipping Hazardous Materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . 865Method 1-1-1. Monitoring Temperature During Shipment of Blood . . . . . . 868Method 1-2. Treating Incompletely Clotted Specimens . . . . . . . . . . . . . . . . . 868Method 1-3. Solution Preparation Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . 869Method 1-4. Serum Dilution Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 871Method 1-5. Dilution of Percentage Solutions Procedure. . . . . . . . . . . . . . . . 872Method 1-6. Preparing a 3% Red Cell Suspension . . . . . . . . . . . . . . . . . . . . . . 872Method 1-7. Preparing and Using Phosphate Buffer . . . . . . . . . . . . . . . . . . . . 873Method 1-8. Reading and Grading Tube Agglutination . . . . . . . . . . . . . . . . . . 873

2. Red Cell Typing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 875

Method 2-1. Determining ABO Group of Red Cells—Slide Test . . . . . . . . . . 875Method 2-2. Determining ABO Group of Red Cells and Serum—

Tube Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 876Method 2-3. Determining ABO Group of Red Cells and Serum—

Microplate Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877Method 2-4. Initial Investigation of ABO Grouping Discrepancies

Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 878Method 2-5. Detecting Weak A and B Antigens and Antibodies by

Cold Temperature Enhancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879Method 2-6. Confirming Weak A and B Antigens Using Enzyme-

Treated Red Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879Method 2-7. Confirming Weak A or B Subgroup by Adsorption and

Elution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 880Method 2-8. Testing Saliva for A, B, H, Lea, and Leb Antigens . . . . . . . . . . . . . 881Method 2-9. Confirming Anti-A1 in an A2 or Weak A Subgroup. . . . . . . . . . . 883Method 2-10. Resolving ABO Discrepancies Caused by Unexpected

Alloantibodies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 884

Table of Contents � xxi

Method 2-11. Determining Serum Group Without Centrifugation . . . . . . . 884Method 2-12. Determining Rh (D) Type—Slide Test . . . . . . . . . . . . . . . . . . . . 885Method 2-13. Determining Rh (D) Type—Tube Test. . . . . . . . . . . . . . . . . . . . 885Method 2-14. Determining Rh (D) Type—Microplate Test . . . . . . . . . . . . . . 886Method 2-15. Testing for Weak D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 887Method 2-16. Preparing and Using Lectins . . . . . . . . . . . . . . . . . . . . . . . . . . . . 888Method 2-17. Removing Autoantibody by Warm Saline Washes . . . . . . . . . 889Method 2-18. Using Sulfhydryl Reagents to Disperse Autoagglutination . . 890Method 2-19. Using Gentle Heat Elution to Test Red Cells with a

Positive DAT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 890Method 2-20. Dissociating IgG by Chloroquine for Antigen Testing of

Red Cells with a Positive DAT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 891Method 2-21. Using Acid Glycine/EDTA to Remove Antibodies from

Red Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 892Method 2-22. Separating Transfused from Autologous Red Cells by

Simple Centrifugation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 893Method 2-23. Separating Transfused from Autologous Red Cells in

Patients with Hemoglobin S Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 894

3. Antibody Detection, Identification, and Compatibility Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 897

Method 3-1. Using Immediate-Spin Compatibility Testing to Demonstrate ABO Incompatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 897

Method 3-2. Detecting Antibodies to Red Cell Antigens—Indirect Antiglobulin Tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 898

Method 3-2-1. Saline Indirect Antiglobulin Test Procedure . . . . . . . . . . . . . 898Method 3-2-2. Albumin or LISS-Additive Indirect Antiglobulin

Test Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 899Method 3-2-3. LISS Indirect Antiglobulin Test Procedure . . . . . . . . . . . . . . . 899Method 3-2-4. PEG Indirect Antiglobulin Test Procedure . . . . . . . . . . . . . . . 899Method 3-3. Prewarming Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 900Method 3-4. Detecting Antibodies in the Presence of Rouleaux—

Saline Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 901Method 3-5. Enzyme Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 902Method 3-5-1. Preparing Ficin Enzyme Stock, 1% w/v . . . . . . . . . . . . . . . . . . 902Method 3-5-2. Preparing Papain Enzyme Stock, 1% w/v . . . . . . . . . . . . . . . . 902Method 3-5-3. Standardizing Enzyme Procedures. . . . . . . . . . . . . . . . . . . . . . 903Method 3-5-4. Evaluating Enzyme-Treated Red Cells. . . . . . . . . . . . . . . . . . . 903Method 3-5-5. One-Stage Enzyme Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . 904Method 3-5-6. Two-Stage Enzyme Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . 905Method 3-6. Performing a Direct Antiglobulin Test. . . . . . . . . . . . . . . . . . . . . 905Method 3-7. Antibody Titration Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 907Method 3-8. Using Sulfhydryl Reagents to Distinguish IgM from

IgG Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 909Method 3-9. Using Plasma Inhibition to Distinguish Anti-Ch and

-Rg from Other Antibodies with Similar Characteristics . . . . . . . . . . . . . . 911Method 3-10. Treating Red Cells Using DTT or AET . . . . . . . . . . . . . . . . . . . . 912Method 3-11. Neutralizing Anti-Sda with Urine . . . . . . . . . . . . . . . . . . . . . . . . 913

xxii � A A B B T E C H N I C A L M A N U A L

Method 3-12. Adsorption Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 914Method 3-13. Using the American Rare Donor Program. . . . . . . . . . . . . . . . . 914

4. Investigation of a Positive DAT . . . . . . . . . . . . . . . . . . . . . . . . . . . 917

Eluates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 917Method 4-1. Cold-Acid Elution Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 917Method 4-2. Glycine-HCl/EDTA Elution Procedure. . . . . . . . . . . . . . . . . . . . . 918Method 4-3. Heat Elution Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 919Method 4-4. Lui Freeze-Thaw Elution Procedure . . . . . . . . . . . . . . . . . . . . . . . 919Immune Hemolytic Anemia Serum/Plasma Methods . . . . . . . . . . . . . . . . . . . 920Method 4-5. Cold Autoadsorption Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . 920Method 4-6. Determining the Specificity of Cold-Reactive Autoagglutinins . 921Method 4-7. Cold Agglutinin Titer Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . 923Method 4-8. Adsorbing Warm-Reactive Autoantibodies Using

Autologous Red Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 924Method 4-9. Adsorbing Warm-Reactive Autoantibodies Using

Allogeneic Red Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 925Method 4-10. Polyethylene Glycol Adsorption Procedure . . . . . . . . . . . . . . . 927Method 4-11. Performing the Donath-Landsteiner Test . . . . . . . . . . . . . . . . . 928Method 4-12. Detecting Drug Antibodies by Testing Drug-Treated

Red Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 929Method 4-13. Detecting Drug Antibodies by Testing in the Presence

of Drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 930

5. Hemolytic Disease of the Fetus and Newborn. . . . . . . . . . . . . . 933

Method 5-1. Testing for Fetomaternal Hemorrhage—The Rosette Test . . . 933Method 5-2. Testing for fetomaternal hemorrhage—Modified

Kleihauer-Betke Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 934Method 5-3. Using Antibody Titration Studies to Assist in Early

Detection of Hemolytic Disease of the Fetus and Newborn . . . . . . . . . . . 935

6. Blood Collection, Component Preparation, and Storage . . . . 939

Method 6-1. Screening Donors for Anemia—Copper Sulfate Method . . . . . 939Method 6-2. Preparing the Donor’s Arm for Blood Collection . . . . . . . . . . . . 940Method 6-3. Collecting Blood and Samples for Processing and

Compatibility Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 941Method 6-4. Preparing Red Blood Cells from Whole Blood . . . . . . . . . . . . . . 944Method 6-5. Preparing Prestorage Red Blood Cells Leukocytes

Reduced from Whole Blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 945Method 6-6. Rejuvenating Red Blood Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 946Method 6-7. Using High-Concentration Glycerol to Cryopreserve

Red Cells—Meryman Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 947Method 6-8. Using High-Concentration Glycerol to Cryopreserve

Red Cells—Valeri Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 949Method 6-9. Checking the Adequacy of Deglycerolization of

Red Blood Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 952Method 6-10. Preparing Fresh Frozen Plasma from Whole Blood . . . . . . . . 953

Table of Contents � xxiii

Method 6-11. Preparing Cryoprecipitated AHF from Whole Blood . . . . . . . 953Method 6-12. Thawing and Pooling Cryoprecipitated AHF . . . . . . . . . . . . . . 954Method 6-13. Preparing Platelets from Whole Blood . . . . . . . . . . . . . . . . . . . 955Method 6-14. Removing Plasma from Platelets (Volume Reduction) . . . . . 957

7. Transplantation of Cells and Tissue. . . . . . . . . . . . . . . . . . . . . . . 959

Method 7-1. Infusing Cryopreserved Hematopoietic Cells . . . . . . . . . . . . . . 959Method 7-2. Processing Umbilical Cord Blood. . . . . . . . . . . . . . . . . . . . . . . . . 960Method 7-3. Investigating Adverse Events and Infections Following

Tissue Allograft Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 961

8. Quality Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 965

Method 8-1. Validating Copper Sulfate Solution . . . . . . . . . . . . . . . . . . . . . . . 965Method 8-2. Standardizing and Calibrating Thermometers . . . . . . . . . . . . . 965Method 8-2-1. Checking Liquid-in-Glass Laboratory Thermometers . . . . . 966Method 8-2-2. Checking Electronic Oral Thermometers . . . . . . . . . . . . . . . . 967Method 8-3. Testing Blood Storage Equipment Alarms . . . . . . . . . . . . . . . . . 967Method 8-3-1. Testing Refrigerator Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 967Method 8-3-2. Testing Freezer Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 969Method 8-4. Calibrating Centrifuges for Platelet Separation. . . . . . . . . . . . . 970Method 8-5. Calibrating a Serologic Centrifuge . . . . . . . . . . . . . . . . . . . . . . . . 972Method 8-6. Testing Automatic Cell Washers . . . . . . . . . . . . . . . . . . . . . . . . . . 974Method 8-7. Monitoring Cell Counts of Apheresis Components . . . . . . . . . 975Method 8-8. Counting Residual White Cells in Leukocyte-Reduced

Blood and Components—Manual Method. . . . . . . . . . . . . . . . . . . . . . . . . . 975

A P P E N D I C E S

Appendix 1. Normal Values in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 979Appendix 2. Selected Normal Values in Children. . . . . . . . . . . . . . . . . . . . . . . 980Appendix 3. Typical Normal Values in Tests of Hemostasis and

Coagulation (Adults) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 982Appendix 4. Coagulation Factor Values in Platelet Concentrates. . . . . . . . . 982Appendix 5. Approximate Normal Values for Red Cell, Plasma, and

Blood Volumes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 983Appendix 6. Blood Group Antigens Assigned to Systems . . . . . . . . . . . . . . . . 984Appendix 7. Examples of Gene, Antigen, and Phenotype Symbols in

Conventional and International Society of Blood Transfusion Terminology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 989

Appendix 8. Examples of Correct and Incorrect Terminology. . . . . . . . . . . . 989Appendix 9. Distribution of ABO/Rh Phenotypes by Race or Ethnicity . . . 990Appendix 10. Example of a Maximum Surgical Blood Order Schedule . . . . 991Appendix 11. Directory of Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 992Appendix 12. Resources for Safety Information . . . . . . . . . . . . . . . . . . . . . . . . 994

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997

997

�I

Index

�

Page numbers in italics referto figures or tables

A

A antigen, 364-366, 367, 368, 374ABO antibodies

anti-A and anti-B, 364, 365, 369, 879anti-A1, 367, 369, 373, 883-884anti-A,B, 369

ABO compatibility, 447, 451of Cryoprecipitated AHF, 447, 625, 657, 695of Granulocytes, 233, 447, 597, 625, 658in hemolytic transfusion reactions, 737-738of HPC transplants, 372, 688-691, 695, 787-

790of organ transplants, 563, 564, 860of plasma products, 447, 451, 625, 656-657,

693, 695of platelet components, 447, 523-524, 584-

586after HSCT transplantation, 693-694, 695in hemolytic transfusion reactions, 740in nonemergency settings, 625in pediatric patients, 656, 663

of Red Blood Cells, 447, 451, 575-576, 625, 694, 695, 740

of tissue transplants, 853of Whole Blood, 447, 575-576

ABO discrepancies, 370-373, 878-881, 883-884, 888-890

ABO hemolytic disease of the fetus and newborn, 639

ABO system, 363-373acquired B phenotype, 368-369, 370B(A) and A(B) phenotypes, 368, 370biochemistry of, 364-365, 366, 374in development and aging, 365, 372genetics of, 339, 348, 354, 365-367, 989nomenclature for, 354, 984, 989phenotypes of, 363, 989, 990on platelets, 523-524soluble, 881-883subgroups of, 365-368, 370, 372, 880-881,

883-884

ABO testingof blood components, 216, 229, 286, 369-

370, 451with cold autoagglutinins, 372, 373, 509-510comparison with previous records, 450-451discrepancies in, 370-373, 878-881, 883-

884, 888-890hemolysis in, 369for HPC transplantation, 691interpretation of, 364, 368microplate test for, 877-878for organ transplantation, 860in pediatric recipients, 457, 634, 648-650,

661in prenatal studies, 632reagents for, 370of recipients, 369-370, 445on saliva, 881-883slide test for, 875-876in transfusion reaction evaluation, 735tube test for, 876-877for weak antigens or antibodies, 879-881,

884A(B) phenotype, 368, 370ABTI antigen, 433Accidents, 47, 48Accreditation, 95, 96, 854ACE (angiotensin-converting enzyme)

inhibitors, 623, 719, 731, 743, 744Acid elution, 501Acid-elution stain (Kleihauer-Betke), 637-638,

934-935Acid glycine/EDTA, 892-893Acidosis, 681Acitretin, 151, 184Acquired B phenotype, 368-369, 370Activated partial thromboplastin time (aPTT),

589, 681, 750, 981, 982Activated protein C, 603Acute lung injury, 745Additive solutions, 188, 192, 201, 277, 651-652Additives, in serologic testing, 448-449, 899-

900Adenosine triphosphate, intracellular, 794Adhesion-blocking agents, 805-806

998 � A A B B T E C H N I C A L M A N U A L

Adsorption, 478-479, 914allogeneic, 505-507, 925-926autologous cold, 489, 510, 920-921autologous warm, 505, 924-925and elution, 480, 880-881polyethylene glycol procedure, 927

Adverse reactionsto apheresis, 229, 230, 718-720, 722in donors, 20, 22, 196-197to HPC infusions, 792, 808-809, 836-837to HPC mobilization regimens, 803, 804-

805to IVIG, 601-602management of, 20-22, 23related to medical devices, 91related to tissue allografts, 858-859, 961-963See also Transfusion reactions;

Transfusion-transmitted diseasesAET (2-aminoethylisothiouronium bromide),

373, 476, 478, 912-913Affinity constant (Ko), 443Age

of blood samples, 441-442, 482, 488of donors, 141, 160effect on ABO antigens and antibodies, 365,

372Agglutination

in antiglobulin testing, 444-445assays utilizing, 307-309interpreting and grading reactions, 445,

873-874mixed-field, 353, 370, 371principles of, 442, 444spontaneous

in ABO discrepancies, 370, 372, 373dispersing with sulfhydryl reagents, 504,

510, 890removing with warm saline washes, 889in Rh testing, 406

Agitators, 39Agreements, 6-7, 9-10, 116AHG serum, 444AIDS (acquired immunodeficiency

syndrome), 139, 170, 175, 240AIHA. See Autoimmune hemolytic anemiaAir embolism, 678, 731, 751Alanine aminotransferase, 979Alarm systems, 37, 272, 276, 967-969Albumin, bovine (reagent), 448, 488, 899Albumin solutions (colloid), 598, 654, 717, 718Aldehyde dehydrogenase (ALDH), 786, 793Aliquoting components, 282-284, 650-651Alleles, 334-335

defined, 328

frequencies of, 350terminology for, 357-359

Allergic reactionsto apheresis, 718in HSCT patients, 700to latex, 47-48, 188, 189-190to transfusions, 729-730, 742-745

Alloantibodies, 463. See also Antibodies, red cell

Allogeneic adsorption, 505-507, 925-926Allogeneic HPC transplantation, 780, 782

clinical outcomes of, 813-814definition of, 687, 779of HPC, Apheresis, 811-812of HPC, Marrow

donor eligibility for, 783-784preparative regimens for, 688processing marrow for, 785-786, 788,

790storage of products for, 790

selection of graft for, 812-814See also Hematopoietic stem cell

transplantationAllografts, 850. See also Tissue transplantationAlloimmunization

in hemolytic disease of the fetus and newborn, 631-632

HLA, 524, 525-526, 560-561, 587, 698-699, 732

to platelet-specific antigens, 532-533, 587, 639-640, 698, 755

prevention of, 402-403, 528red cell, 732in sickle cell disease, 402-403, 451, 662See also Antibodies

α1-Antitrypsin, 603α-Methyldopa, 514α1-Proteinase inhibitor, 603AMD3100, 805-806, 807American Rare Donor Program, 492, 914-9152-aminoethylisothiouronium bromide (AET),

373, 476, 478, 912-913Amniocentesis, 634Amniotic fluid analysis, 634, 635Amotosalen/UV-treated plasma, 206Ana, 429, 987Anaphylactic reactions, 730, 743-744

in apheresis, 718differential diagnosis of, 743, 745-746laboratory evaluation of, 736

Anaphylactoid reactions, 743Anemia

acute, 571-574chronic, 574-575

I N D E X � 999

in delayed transfusion reactions, 751in HPC transplantation, 692-693in infants, 646, 652-653iron deficiency, 673-674preoperative, 673-674RBC transfusions in, 571-579screening donors for, 142, 144-145, 161signs and symptoms of, 571-572See Hemolytic disease of the fetus and

newborn; Hemolytic anemiaAneuploidy, 341-342Angioedema, 743Angiotensin-converting enzyme (ACE)

inhibitors, 623, 719, 731, 743, 744Ankylosing spondylitis, 566Anti-HBc, 255Anti-HCV, 256Anti-HIV-1, 2, 254Anti-HTLV-I, II, 257Anti-IgA, 736, 743-744, 745Antibiotics, in donors, 151, 164Antibodies

drug-induced, 464, 512-515, 535-538, 587, 929-931

to Factor VIII, 599granulocyte, 539-540HLA, 732

detection of, 525-526, 559in HPC transplant recipients, 698-699in platelet refractoriness, 524, 525-528,

560-561, 587in TRALI, 561, 746, 747in transfusion reactions, 561, 562, 742

naturally occurring, 463, 464platelet

autoantibodies, 534-535detecting, 533-534, 535, 536, 537, 538drug-induced, 535-538, 587in HPC transplantation, 689platelet-specific, 532-534, 587, 639-640,

698, 755to reagent components, 370, 372, 487-488red cell. See Antibodies, red cellstructure of, 317-319See also Autoantibodies

Antibodies, red cell in ABO discrepancies, 884associated with HDFN, 412-413, 420, 485-

486, 632, 633associated with hemolytic transfusion

reactions, 412-413, 485-486, 752with autoantibodies, 504-507clinical significance of, 412-413, 448, 463-

464, 485-486, 490

defined, 463detection of. See Antibody detectiondisease associations with, 464distinguishing IgG and IgM, 909-911dosage effect of, 335, 467, 481effect of DTT on, 485-486effect of enzymes on, 485-486equilibrium constant of, 443to high-prevalence antigens, 464, 465-466,

484, 486-487, 635-636high-titer and low avidity characteristics,

481low-affinity, 508-509to low-prevalence antigens, 487multiple, 483-484naturally occuring, 463, 464nonhemolytic, 322-323phenotyping with, 472-473reactions with antigens, 442-445in selection of units, 451-452, 490-493serologic reactivity of, 443, 485-487in sickle cell disease, 402-403, 451, 662in tissue transplant patients, 853See also specific blood groups

Antibody-dependent cellular cytotoxicity, 491Antibody detection, 448-450

with autoantibodies, 504-507, 510in blood components, 229by ELISA, 310frequency of testing, 490of granulocyte antibodies, 540of HLA antibodies, 525-526, 559interpreting results of, 453, 454, 455methods for, 448-450, 898-900in pediatric recipients, 457, 648-650, 661of platelet antibodies, 533-534, 535, 536,

537, 538in positive DAT evaluation, 500in prenatal evaluations, 632-633prewarming technique for, 900-901reagents for, 449-450, 466-467with rouleaux present, 901-902solid-phase assays for, 310specimen requirements for, 441-442in transfusion reaction evaluation, 735

Antibody identification, 463-493anomalous reactions in, 488of antibodies to high-prevalence antigens,

464, 465-466, 484, 486-487of antibodies to low-prevalence antigens, 487with antibodies to reagent components,

487-488with autoantibodies, 504-507

1000 � A A B B T E C H N I C A L M A N U A L

autologous control in, 471-472, 474-475, 488-490

exclusion (“rule-out”) in, 470frequency of testing, 490immunohematology reference labs for, 490interpreting results of, 469with multiple antibodies, 479, 481, 483-484with no discernible specificity, 482-483positive and negative reactions in, 469-470with positive DAT, 472, 475, 487, 488-490preanalytical considerations for, 464, 465-

466in prenatal evaluations, 633probability values in, 470-471procedures for

adsorption, 478-479, 914, 920-921, 924-927

alteration of pH, 477combined adsorption-elution, 480, 880-

881dispersing autoagglutination, 510, 890distinguishing IgM from IgG, 909-911elution, 479-480enzymes, 473, 476, 902-905flowchart for, 474-475identification panels, 467, 468, 469-471inactivation of antigens, 476, 477-478,

912-913increased incubation time, 476increased serum-to-cell ratio, 476inhibition techniques, 477, 911-912LISS and PEG, 473, 899-900phenotyping, 472-473prewarming, 900-901selected cells in, 470temperature reduction, 476, 879titration studies, 480-481, 633, 907-909,

935-937reagents for, 466-469and selection of blood, 349, 451-452, 490-493specimen requirements for, 463-464, 466in transfusion reaction evaluation, 735variations in antigen expression in, 481-482

Antibody screen. See Antibody detectionAntibody specificity prediction method, 527Anticoagulant medications, 152, 590, 591Anticoagulant-preservative solutions, 188,

191, 216, 277, 827Anticoagulants, in apheresis, 717Antifibrinolytic agents, 588Antigen-matching, 402-403, 451, 662, 717Antigen-presenting cells, 313, 314Antigens

acquired, 368-369, 370

antithetical, 334of blood group collections, 432-433of blood group systems, 357-359, 984-989chromosomal location of, 354-356granulocyte, 539-540high-prevalence, 433, 484, 486-487, 492-493HLA, 524, 547-548, 552-555inactivation of, 476, 477-478, 912-913low-prevalence, 433-434, 487methods for detecting, 307-313platelet-specific, 310, 528-534terminology for, 357-359, 984-989variations in expression of, 481-482See also specific blood groups

Antiglobulin test, 444-445in crossmatching, 452-453direct, 444, 497-501indirect, 444-445reagents for, 444, 467, 469sources of error in, 446-447use of IgG-coated cells, 448

Antihistamines, 619, 744, 745Antiplatelet agents, 151, 152, 166, 184, 229, 581Antipyretics, 619, 742Antithrombin, 602-603AnWj, 431Apheresis

complications of, 229, 718-720, 722component collection by, 227-236

adverse donor reactions in, 229, 230donation requirements for, 142, 160,

162, 166, 168Granulocytes, 228, 232-233, 235-236instrumentation for, 39, 228, 233-236multicomponent donations, 231-232Plasma, 228, 230-231, 233-234Platelets, 228-230, 234quality control of, 975Red Blood Cells, 228, 231-232, 235

defined, 707records of, 230, 232See also HPC, Apheresis; Therapeutic

apheresisApheresis Granulocytes. See GranulocytesApheresis Platelets. See Platelets, ApheresisaPTT (activated partial thromboplastin time),

589, 681, 750, 981, 982Arterial puncture, in donors, 197Aspirin, 152, 166, 229, 581Assessments

blood utilization, 24-25, 763-772competency, 7-8external, 25internal, 23-24

I N D E X � 1001

proficiency testing, 25, 96quality indicators, 24in quality management, 13, 23-25risk, 104-105, 108

Aua/Aub, 354, 417, 985Audits, transfusion, 24, 672, 763-772

concurrent, 765, 766, 769, 770-771, 771prospective, 765, 765-766, 767-768, 770, 771retrospective, 765, 767-768, 769, 771-772, 772

Auto control. See Autologous controlAutoadsorption. See AdsorptionAutoagglutination

in ABO discrepancies, 370, 372, 373dispersing with sulfhydryl reagents, 504,

510, 890removing with warm saline washes, 889in Rh testing, 406

Autoantibodieswith alloantibodies, 489-490, 504-507, 510cold, 489

ABO discrepancies with, 372, 373, 509-510, 884

adsorption of, 489, 510, 920-921in cold agglutinin syndrome, 380, 509-

510determining specificity of, 921-923in mixed AIHA, 380, 511in paroxysmal cold hemoglobinuria, 511removing with warm saline washes, 889in Rh testing, 406, 509titration of, 923use of sulfhydryl reagents with, 510, 890in warm autoimmune hemolytic

anemia, 502, 504defined, 463disease associations with, 464drug-induced, 514-515, 929-931low-affinity, 508-509in phenotyping problems, 472-473platelet, 534-535warm

adsorption of, 505-506, 924-927disease associations with, 464mimicking alloantibodies, 506-507in mixed-type AIHA, 511Rh testing with, 406transfusion with, 507-508, 578in warm autoimmune hemolytic

anemia, 502, 503, 504-508Autoclaving biohazardous waste, 58Autografts, 850, 859-860Autoimmune hemolytic anemia, 501-512

classification of, 502cold agglutinin syndrome, 509-510

DAT-negative, 508-509mixed-type, 380, 511paroxysmal cold hemoglobinuria, 511-512serologic findings in, 503transfusion in, 507-508, 511, 578warm, 502, 503, 504-508

Autoimmune neutropenia, 540Autoimmune thrombocytopenia, 150, 534-

535, 588, 641Autologous adsorption

cold, 489, 510, 920-921warm, 505, 924-925

Autologous bloodcollection of

by blood recovery, 674, 676-678by normovolemic hemodilution, 678-

679by preoperative blood donation, 674

donor selection for, 154-155, 160-162infectious disease testing of, 250-251labeling, 216for rare phenotypes, 493separation from transfused cells, 472, 893-

895Autologous control

in antibody identification, 471-472, 474-475positive, 475, 488-490in pretransfusion testing, 449, 454

Autologous HPC transplantation.clinical outcomes of, 813definition of, 687, 779engraftment speed in, 810of HPC, Apheresis, 802-804, 809-811of HPC, Marrow, 780

donor eligibility for, 783processing marrow for, 785storage of products for, 790-791tumor purging in, 787, 810-811

See also Hematopoietic stem cell transplantation

Automated testing systems, 450Autosomal inheritance

codominant, 338, 340dominant, 337, 339recessive, 338-339, 341

Autotransfusion, perioperative, 674, 676-679blood recovery, 674, 676-678normovolemic hemodilution, 678-679preoperative autologous donation, 674

B

B antigen, 364-366, 368, 374B-cell receptor, 315B cells, 314, 315-316

1002 � A A B B T E C H N I C A L M A N U A L

Babesiosis, 138, 140, 177, 260-261BacT/ALERT culture system, 258Bacterial contamination, 257-259

of HPCs, 793, 809inspecting components for, 202, 257-259,

284-285, 736during phlebotomy, 193-194, 258of Platelets, 258-259, 276reactive donor screening for, 249of Red Blood Cells, 259of tissue allografts, 853, 858, 859in transfusion-associated sepsis, 731, 736, 741

Band 3 glycoprotein, 425B(A) phenotype, 368, 370Be The Match Registry, 782, 785, 794Benchmarking, 672Bennett-Goodspeed (Bg) antigens, 434, 552-

553, 562Bilirubin

in HDFN, 632, 634, 636hyperbilirubinemia, exchange transfusion

for, 653, 654normal values for, 979, 980

Bioassays, for radiation monitoring, 64-65Biocontamination control system, 43Biohazardous waste, 57-58, 116-117Biological product deviations, 20, 22, 93, 94Biological products, regulations for, 88-89Biological response modifiers (BRMs), 746Biological safety cabinets, 52, 53-54Bioluminescence assays, 794Biosafety, 50-58

biological safety cabinets for, 52, 53-54biosafety levels, 51, 77Bloodborne Pathogens Standard, 50decontamination for, 52, 55in donor room, 56emergency response plan for, 56-57engineering controls for, 51-52, 53-54, 55hazard identification and communication

for, 51in laboratory, 55personal protective equipment for, 55safe work practices for, 55-56shipping hazardous materials, 865-867Standard Precautions, 50-51storage of biohazards, 55, 57training for, 51waste management, 57-58

Biovigilance, 32, 727-728. See also Hemovigilance

Bleedingacute, transfusion for, 571-574microvascular, 750

Bleeding disorders. See CoagulopathyBleeding time, 589, 982Blood administration, 617-627

baseline assessment of recipient in, 621blood warmers for, 38, 619-620, 647, 658, 751delays in starting transfusion, 622delivering blood to patient area, 621-622emergency equipment for, 620-621emergency release, 214, 287-288, 457-458,

577-578, 627errors in, 622-623, 734, 739, 740filters for, 623-624, 625, 659identification procedures in, 622-623infusion pumps for, 620, 658infusion rates for, 624, 625, 659infusion sets for, 623-624, 659IV solutions for, 624medical history in, 618medical order for, 618-619, 622, 776-777monitoring patient during, 624, 626in neonates, 658-659out-of-hospital, 627patient education in, 618postadministration events, 626premedications for, 619pressure devices for, 620recipient consent in, 617-618starting the transfusion, 624for surgery and trauma, 627syringe infusion pumps for, 620transfusion reaction in, 626, 728, 734venous access for, 619, 654, 658

Blood cells, specific gravity of, 195Blood clots, in RBCs, 202Blood collection, 187-197

adverse donor reactions in, 20, 22, 196-197anticoagulant-preservatives for, 188, 191,

216, 277, 827autologous, 674, 676-679blood containers for, 188, 189-190, 192, 198,

827of blood samples, 194, 438-441, 455, 673,

940-943of components by apheresis, 227-236, 975in disaster planning, 107-109disinfecting venipuncture site for, 193-194,

258, 940-941donation intervals for, 160, 166-167donor and component identification in,

192donor care after, 196equipment quality control, 39fatalities related to, 20, 197phlebotomy in, 187, 192-194, 940-943

I N D E X � 1003

process of, 194safety of, 43, 56of umbilical cord blood, 827-829vein selection in, 192-193volume collected, 160, 194-195

Blood component selectionABO/Rh compatibility in, 447, 451, 575-576,

584-586, 625, 695after non-group-specific transfusions, 288-

289, 458-459with clinically significant antibodies, 349,

451-452, 490-493for exchange transfusions, 654for HPC transplantation, 685, 698for intrauterine transfusions, 635-636for massive transfusions, 458of platelet components, 447, 526-528, 584-

586, 656rare types, 492-493of red cell components, 447, 451-452, 575-

576in urgent situations, 288, 458in warm autoimmune hemolytic anemia,

507-508Blood components

administration of. See Blood administrationaliquoting, 282-284, 650-651appearance of, 202, 284, 621, 622, 736bacterial contamination of, 257-259, 284-

285, 736, 741CMV-reduced-risk, 250, 597, 635, 663, 699-

700cryopreservation of, 208-210, 947-952density of, 195disposition of, 286expiration of, 215-216, 272, 273-275, 622identification of, 192, 455, 457, 621, 622-623inspection of, 284-285, 457, 621, 622, 736intraoperative sequestration of, 679irradiated, 210-211, 280, 664, 755issuing, 287-288, 455, 457, 621-622labeling, 188, 214-216, 221, 286-287, 455, 457leukocyte reduction of, 207-208, 279, 576,

577, 663-664nonconforming, 284-285, 286ordering, 437-438, 455, 618, 776-777pooling, 211-212, 280-282, 954-955preparation and processing of, 198-201,

279-284, 944-958product quality in, 199quality control testing, 217-221, 221quarantine of, 213-214, 247-250, 284-285rare, 492-493receiving into inventory, 285-286

records of, 457rejuvenation of, 213, 284, 946-947retrieval of prior donations, 247, 248-249,

250return and reissue of, 289, 622selection of. See Blood component

selectionstorage of, 272-279, 575testing

ABO and Rh, 216, 286, 451infectious disease, 216, 239-263phenotyping, 216, 451, 491-492

transporting, 198-199, 272, 285, 621volume-reduction of, 212-213, 282, 586,

656, 664, 957-958washed, 280, 664, 700See also specific components

Blood containers, 188, 189-190, 198for aliquots, 650-651latex-free, 188, 189-190for umbilical cord blood, 827

Blood donation. See Blood collection; DonorsBlood exposure, 47, 55, 169Blood group systems

clinical significance of antibodies in, 412-413, 485-486

genetics of, 327-359chimerism, 356-357gene mapping, 353, 354-356, 356inheritance patterns, 337-348population genetics, 348-351principles of, 328-336relationship testing, 351-353

terminology for, 357-359, 984-989See also specific blood groups

Blood losssigns and symptoms of, 572in surgery, 674, 675, 677transfusion for, 571-574

Blood management. See Patient blood management

Blood order schedules, 286, 991Blood pressure

of donors, 161low (hypotension)

during apheresis, 719associated with ACE inhibitors, 623, 719,

731, 743, 744deliberate, 679-680in recipients, 738, 744

Blood pressure cuffs, 39Blood recovery, 674, 676-678Blood samples

age of, 441-442, 482, 488

1004 � A A B B T E C H N I C A L M A N U A L

from arterial or central lines, 673collection of, 194, 438-441, 455, 673, 940-943hemolyzed, 441incompletely clotted, 441, 868-869from infusion lines, 441labeling, 438-439, 441, 618, 867lipemic, 441packaging, 865-867for PCR, 297, 300for pretransfusion testing, 441-442, 464,

466, 618retention and storage of, 442transportation and shipment of, 66, 865-

867Blood spills, 56-57Blood transfusions. See TransfusionsBlood utilization, 763-772

interventions for change in transfusion practice, 764, 765, 769-770

rationale for, 764selecting audits, 770-772types of audits, 764-769See also Patient blood management

Blood volume, 646, 983Blood warmers, 38, 619-620, 647, 658, 741,

751Bloodborne Pathogens Standard, 50Bloodless medicine, 671Bombay (Oh) phenotype, 365, 373, 375Bonds, chemical, 443-444Bone grafts, 169, 851Bone marrow. See HPC, Marrow (HPC-M)Brain natriuretic peptide, 748Bruising, in donors, 197Buffy-coat enrichment of marrow, 786Buffy-coat method of platelet preparation,

199, 200, 202, 956

C

C/c antigens and antibodies, 401-403phenotypes, 395prevalence of, 391, 392

14C-serotonin release assay, 538C1-esterase inhibitor deficiency, 593Calcium, 627, 718, 732, 749Calibration, equipment, 10, 11

cell washers, 974-975centrifuges, 865, 970-973defined, 32thermometers, 965-967

Cancer, in blood donors, 148-149, 177Cardiac surgery

platelet transfusions in, 580, 581red cell transfusions in, 573-574

Caridian apheresis systems, 228, 234, 235Carriers, of traits, 333, 342-343Cash reserves, 111Catheters

for apheresis, 720for neonates, 654, 658for normovolemic hemodilution, 679for transfusions, 619

Cause-and-effect diagrams, 27CCI (corrected platelet count increment), 525,

583, 587-588CD4+ T-cells, 314-315CD34 cells, 785

analysis and enumeration of, 793, 803-804enrichment of, 786-787, 839

Cell counters, 39Cell counts, 792-793, 975Cell division, 330, 332, 333Cell enrichment, for HPC transplantation,

786-787, 839Cell salvage syndrome, 677-678Cell washers, 37, 786, 974-975Center for Biologics Evaluation and Research

(CBER)inspections by, 90regulation of biological products, 88-89regulation of blood-related devices, 91reporting fatalities to, 20, 756, 757

Center for Devices and Radiological Health (CDRH), 88, 91

Centers for Medicare and Medicaid Services (CMS), 89-90, 93-94, 96

Central nervous system demyelinating disorders, 713

Centrifugationapheresis separation by, 708-709in component preparation, 200, 279in separating autologous cells, 893-894

Centrifugesfor apheresis, 708-709calibrating, 865, 970-973for platelet separation, 970-971QC performance intervals for, 37, 39serologic, 972

Centromere, 329, 330Cephalosporins, 514, 515, 929ceRT, 398, 399ceSL, 398, 399cGMP (current good manufacturing

practices), 1, 7, 8, 20, 271cGTP (current good tissue practices), 8, 20, 837Ch1/Ch2, 355, 429, 477, 911-912, 987Chagas disease, 138, 140, 176, 260Change control, 32

I N D E X � 1005

Chartspedigree, 337, 338process flow, 27, 28run and control, 24, 32

Check cells, 448Chemical bonds, 443-444Chemical safety, 58-63

chemical categories, 59, 80-81chemicals found in blood banks, 78-79engineering controls for, 61hazard identification and communication,

60-61hazardous vapors, 62, 63personal protective equipment for, 61safe work practices for, 61, 80-81spills, 62, 82-86training for, 58-60waste disposal, 62-63

Chemiluminescence assays, 491Chemotherapy, 802-804, 806Chiasma, 344Chido/Rodgers system, 429

antigens and antibodies, 355, 413, 429, 987plasma inhibition studies, 429, 477, 911-912

Chikungunya virus, 261Chimerism, 356-357, 370, 561-562Chloroquine diphosphate, 478, 891-892Chromatin, 328Chromosomes, 328-330, 331

autosomes, 329homologous, 328-329locations of blood group genes, 353, 354-

356, 356sex, 329X chromosome inactivation, 332-334

Chronic granulomatous disease, 421, 597Circular of Information for the Use of Human

Blood and Blood Components, 215Circular of Information for the Use of Cellular

Therapy Products, 93, 959Circulatory overload, transfusion-associated,

731, 746, 747-748Cirrhosis, 590Cis product antigens, 347, 401Citrate toxicity, 718, 732, 749CJD. See Creutzfeldt-Jakob diseaseClean rooms, 42-43Cleaning and decontamination, 52, 55, 57-58Clinical Laboratory Improvement

Amendments (CLIA), 93-94, 96Clocks, 38Clopidogrel, 151, 184, 229Clotting factors. See Coagulation factorsCMV (cytomegalovirus), 250

in neonates, 663preventing with leukocyte reduction, 250,

663, 699-700transmitted through transplantation, 784

CMV-reduced-risk products, 250, 597, 635, 663, 699-700

Coa/Cob, 355, 413, 428-429, 987Coagulation

monitoring hemostasis, 589-592, 681in neonates, 656normal test values for, 981, 982

Coagulation factorsconcentrates, 171, 176, 598-600in Cryoprecipitated AHF, 206, 278, 594half-lives of, 592, 593in neonates, 656normal values for, 982in Plasma, 204, 205, 206, 278in platelet components, 202, 203, 982replacement of, 596

Coagulopathyin apheresis, 719-720in blood donors, 149-150, 176, 177diagnosis of, 589-592in hemolytic transfusion reactions, 738in massive transfusion, 749-751plasma transfusions for, 589-593

Code of Federal Regulations (CFR), 1, 34, 87, 89Codominant inheritance, 338, 340Cold-acid elutions, 917-918Cold agglutinin syndrome, 509-510

antibody detection in, 510serologic findings in, 503, 509-510specificity of autoantibodies in, 380, 464,

510titration studies in, 923

Cold autoadsorption, 510, 920-921Cold autoantibodies, 489

ABO discrepancies with, 372, 373, 509-510, 884

adsorption of, 489, 510, 920-921in cold agglutinin syndrome, 380, 509-510determining specificity of, 921-923in mixed AIHA, 380, 511in paroxysmal cold hemoglobinuria, 511removing with warm saline washes, 889in Rh testing, 406, 509titration of, 923use of sulfhydryl reagents with, 510, 890in warm autoimmune hemolytic anemia,

502, 504Cold-reactive alloantibodies, 372, 373, 443Cold stress. See HypothermiaCollections, blood group, 432-433

1006 � A A B B T E C H N I C A L M A N U A L

Colloid solutions, 572, 598Colony-forming cell assays, 793-794Colton system, 355, 413, 428-429, 987Column agglutination technology, 450Communications, emergency plans for, 111-

116, 120Compartment syndrome, 149Compatibility testing. See Pretransfusion testingCompetency assessments, 7-8Competitive ELISA, 311-312Complement

in acute transfusion reactions, 737-738in autoimmune hemolytic anemia, 509in positive DATs, 497, 503role in immunity, 319-321

Complement receptor-1, 430-431Complications. See Adverse reactionsComplotype, 550Computer crossmatch, 453Computer systems

alternative systems for, 20, 118backup of, 18, 19, 118in disaster plan, 118management of, 19-20security of, 19validation of, 15

Concurrent audits, 765, 766, 769, 770-771, 771Confidential unit exclusion, 153Confidentiality of information, 19, 962Consent

for apheresis, 230for blood donation, 141-142for cord blood donation, 825-826for transfusion, 617-618

Contacts list, in disaster planning, 111-112Containers

for aliquoting components, 650-651for blood collection, 188, 189-190, 198, 827for shipping

dry shippers, 792, 833-834labeling, 867quality control intervals for, 39temperature of, 198-199, 272, 832-834,

856, 868validation of, 198-199, 285

Contaminationfungal, 793, 853, 858, 859between specimens, in PCR, 300See also Bacterial contamination

Continuity of Operations Plan, 108-120Continuous-flow centrifuges, 708-709Contraceptives, oral, in blood donors, 149Contracts, 6-7, 9-10, 116Control charts, 24, 32

Control process, 3Controls

autologous, 449, 454, 471-472, 474-475, 488-490

IgG-coated cells, 448for Rh typing reagents, 405-406

Copper sulfatequality control of, 39, 965in screening donors for anemia, 144-145,

939-940Cord blood

ABO/Rh typing on, 634, 637antigen expression on, 481, 482DAT testing on, 499, 634See also HPC, Cord (HPC-C)

Cordocentesis, 635, 641Corneal transplants, 852-853Corrected platelet count increment (CCI), 525,

583, 587-588Corrective action, 26Corticosteroids, 207, 232, 619Cost collection, 432-433Crawford phenotype, 398, 399Creutzfeldt-Jakob disease (CJD), 262

and plasma derivatives, 598screening donors for, 138, 140, 178transmission through transplantation, 853,

859Crohn disease, 717Cromer system, 355, 413, 430, 988“Cross-out” method, 470Cross-reactive groups, 554Crossing-over, gene, 344-346, 551-552Crossmatch-to-transfusion ratios, 453Crossmatching, 452-455

antiglobulin test in, 452-453computer, 453HLA (lymphocyte), 559, 563, 587immediate-spin, 452, 897-898“in-vivo,” 491, 578interpretation of results, 453, 454, 455in pediatric recipients, 457, 648-649platelet components, 229, 527-528, 561, 587in transfusion reaction evaluation, 735

Cryoprecipitate-reduced plasma, 204, 220, 275, 717, 718

Cryoprecipitated AHF, 206-207ABO compatibility of, 447, 625, 657, 695coagulation factors in, 206, 278, 594dose of, 594expiration of, 212, 275, 278in HSCT transplantation, 697-698indications for, 594-595infusion rates for, 625

I N D E X � 1007

for pediatric patients, 652, 657-658, 663pooled, 212, 281-282, 594, 954-955preparation of, 206-207, 278, 953-954quality control of, 220storage of, 206, 212, 275, 278thawing, 280, 954-955transfusion of, 594-595transportation and shipping of, 285“wet” and “dry,” 206

Cryopreservationagents for, 208, 209, 210, 791of HPCs, 790-791, 808, 831-832of platelet components, 209-210of Red Blood Cells, 208-209, 947-952of tissue allografts, 851

Crystalloids, 572, 598, 718Csa/Csb, 432-433Culture assays, hematopoietic, 793-794Cultures, microbial, 285, 736, 793Current good manufacturing practice (cCMP),

1, 7, 8, 20, 271Current good tissue practice (cGTP), 8, 20, 837Customers, 6-7, 12Cytapheresis, 714-715Cytomegalovirus, 250

in neonates, 663preventing with leukocyte reduction, 250,

663, 699-700transmitted through transplantation, 784

Cytomegalovirus (CMV)-reduced-risk products, 250, 597, 635, 663, 699-700

D

D antigen, 394, 396-401antibody to (anti-D)

in HDFN, 632and partial D, 400-401passively acquired, 638-639in tissue transplantation, 853titrations of, 633, 935-937and weak D, 400

clinical considerations for, 400-401D and D-like epitopes on RHCE, 398, 399D-negative, 393, 394, 398D-positive, 396-398Del, 397, 400elevated D (deletion phenotypes), 398in neonates, 634partial D, 396, 397, 400-401, 407in recipients, 400, 445, 447-448weak D, 396-397

in donors, 400, 451in prenatal patients, 637in recipients, 400, 445, 447-448

DAT. See Direct antiglobulin testDAT-negative autoimmune hemolytic

anemia, 508-509Decontamination procedures, 52-53, 57-58Deep vein thrombosis, in donors, 197Deferasirox, 756-757Deferiprone, 756, 757Deferoxamine, 756Deferrals. See Donor deferralsDeglycerolization, 209, 218, 280, 948-949, 951,

952Del, 397, 400Delayed transfusion reactions, 751-757

hemolytic, 321, 662, 732, 751-753management of, 732-733serologic, 752

Dendritic cells, 840Dengue virus, 261Density, of blood cells and components, 195Derivatives, plasma, 262-263, 597-603Design output, 3, 32Designated donations, 153Dexamethasone, 595Dha, 429, 987DHAR, 398, 399Dia/Dib, 354, 412, 426, 986DIC (disseminated intravascular coagulation),

738, 739-740Diego system, 348, 354, 412, 425-426, 986Digitonin acid elutions, 501Dilution

of percentage solutions, 872of serum, 871-872

2,3-Diphosphoglycerate (2,3-DPG), 276, 575, 648

Diploid, defined, 330Direct antiglobulin test (DAT), 497-501

false positive/negative results in, 446-447, 499

method for, 498, 905-906positive test

after HPC transplantation, 500, 788in antibody identification, 472, 475, 487,

488-490causes of, 497-498in cold agglutinin syndrome, 503drug-induced, 500, 512-516, 519-522elution with, 500-501, 890-891, 917-920evaluation of, 499-501medical history in, 499-500in mixed-type AIHA, 503, 511in neonates, 634in paroxysmal cold hemoglobinuria,

503, 511

1008 � A A B B T E C H N I C A L M A N U A L

red cell testing with, 891-892in warm autoimmune hemolytic anemia,

502, 503in pretransfusion testing, 444, 449principles of, 498-499reagents for, 444, 498-499specimens for, 498in transfusion reaction evaluation, 498, 735

Directed donations, 153-154, 162Disaster management, 103-131

for blood and transfusion services, 106-108business operations planning in, 108-120Continuity of Operations Plan in, 108-120cycle of, 103-104emergency management agencies in, 105-

106, 120-122internet resources for, 136lessons learned from recent disasters, 125,

126-131planning team in, 108regulatory issues in, 122-124risk assessment in, 104-105testing disaster plans, 124-125

Disinfectantsto clean work surfaces, 52, 55for venipuncture, 193-194, 258

Disposalof biohazardous waste, 57, 116-117of chemical waste, 62-63of radioactive waste, 66

Disposition of blood components, 286Disseminated intravascular coagulation (DIC),

738, 739-740Dithiothreitol (DTT)

in differentiating IgG from IgM, 909-911to disperse autoagglutination, 373, 510, 890for inactivating blood group antigens, 476,

478, 485-486, 912-913Diversion pouches, 188, 258DMSO (dimethylsulfoxide), 210, 791, 792, 808,

836DNA, 294-295, 300DNA-based assays

for genotyping, 306-307, 334in antibody identification, 473of fetus, 403, 633, 640in relationship testing, 352of Rh system, 403-404

for HLA antigens, 557-558, 565for infectious diseases, 245-246methods for, 296-307for platelet antigens, 534in pretransfusion testing, 450

Doa/Dob, 355, 412, 427-428, 987

Documents, 13, 16-19. See also RecordsDolichos biflorus lectin, 367, 373, 889, 898Dombrock system, 355, 412, 427-428, 987DOMR, 427Donath-Landsteiner test, 384, 511, 928Donor deferrals

for bleeding conditions or blood diseases, 149-150, 177

blood donation intervals for, 166-167, 168, 228-229, 231

for blood exposure, 169for blood transfusions, 168for bone, skin or dura mater grafts, 169, 177for cancer, 148-149, 177for clotting factor concentrates, 171, 175developing criteria for, 138, 146-147, 148-152during disasters, 107for drugs taken by donor, 151-152, 164-165,

166, 175, 184, 229for heart and lung conditions, 150-151, 177for hemoglobin/hematocrit, 142, 144-145for incarceration, 173for infectious diseases, 140, 170-178for needlesticks, 169for piercings, 172for pregnancy, 166rates of, 143-144for reactive infectious screening tests, 247,

248-249records of, 137requirements for, 160-162, 164-178for sexual contacts, 170-171, 175for tattoos, 172for transplants, 168for travel outside the US or Canada, 173-

174, 178for vaccinations or shots, 167-168, 184

Donor History Questionnaire, 145-147, 180-183

abbreviated, 152effectiveness of, 147-148historical perspective of, 138-140regulations and standards for, 163-178screening for infectious diseases in, 138-

140Donor lymphocyte infusion (DLI), 783Donor room, 56Donor testing

ABO and Rh, 369-370, 398, 400, 451for blood group antigens, 451-452, 491-492for cord blood donation, 826-827for HPC transplantation, 783, 784weak D, 400, 887-888See also Infectious disease screening

I N D E X � 1009

Donorsadverse reactions in, 20, 22, 196-197age of, 141, 160of apheresis RBCs, 160, 162, 168, 231autologous, 154-155, 160-162, 250-251, 674with bleeding conditions or blood diseases,

149-150, 176, 177with cancer, 148-149, 177consent of, 141-142, 230, 825-826designated or directed, 153-154, 162disabled, 142donation intervals for, 160, 166-167, 168,

228-229, 231donor history questionnaire for, 145-147,

152, 163-178, 180-183educational materials for, 141-142, 165,

185-186effect of disasters on, 108, 123family members as, 492-493frequent or repeat, 152general health of, 164hearing- or vision-impaired, 141with heart and lung conditions, 150-151,

177for hematopoietic transplantation, 782,

783-784hemoglobin/hematocrit in, 142, 144-145,

161, 939-940for HLA-matched platelets, 560-561identification of, 140-141, 192leukapheresis, 160, 166on medications, 151-152, 164-165, 166, 184,

229non-English-speaking, 141-142notification of abnormal test results, 247phlebotomy of, 192-194, 940-943physical examination of, 142, 144-145, 160-

162plasmapheresis, 160, 166, 230plateletpheresis, 160, 162, 166, 228-229postdonation instructions for, 152-153postphlebotomy care of, 196preparing for blood collection, 940-941qualification requirements for, 160-178with reactive screening tests, 246-250records of, 140-141registration of, 140-141selection of, 137-155sexual contacts of, 170-171, 175, 178of tissue allografts, 849-850of umbilical cord blood, 824-827weight of, 142, 194, 230

L-dopa, 514Dopamine hydrochloric acid, 739

Doppler ultrasonography, 634Dosage effect, 335, 467, 481Dosimeters, 64, 211DOYA, 427, 9872,3-DPG (2,3-diphosphoglycerate), 276, 575,

648Drug-dependent platelet antibodies, 535-538,

587Drug-induced immune hemolytic anemia,

512-516antibodies in, 464, 512-515classification of, 512-515drugs associated with, 519-522laboratory investigation of, 515-516, 929-

931mechanisms of, 512

Drugsadministered for leukapheresis, 232-233antiplatelet agents, 151, 152, 166, 184, 229,

581to assist coagulation function, 681intravenous use of, 170, 171platelet antibodies induced by, 535-538, 587in positive DAT, 500, 512-516, 519-522for preinfusion of HPCs, 809-810pretransfusion medications, 619, 742, 745regulations regarding, 87-88removal of, in apheresis, 720taken by donors, 151-152, 164-165, 166,

184, 229Dry ice, 285, 867Dry shippers, 792, 833-834DSLK, 356, 404, 432, 988DTT (dithiothreitol)

in differentiating IgG from IgM, 909-911to disperse autoagglutination, 373, 510, 890for inactivating blood group antigens, 476,

478, 485-486, 912-913Duclos, 356, 404, 432, 988Duffy system, 421-423

antibodies, 412, 423, 989antigens, 354, 421-423, 986Duffy glycoprotein, 422, 423and malaria, 423phenotypes and genotypes, 422, 989

Dura mater transplants, 177Dutasteride, 151, 184Dysfibrinogenemias, 594

E

E/e antigens and antibodies, 401-403phenotypes, 395prevalence of, 391, 392

E-mail, 113

1010 � A A B B T E C H N I C A L M A N U A L

Earlobe punctures, 144ECMO (extracorporeal membrane

oxygenation), 659-660Education

for disaster training, 124donor, 141-142, 165, 185-186patient, 618for umbilical cord blood donation, 824-825

Electrical safety, 49-50Electricity, emergency systems, 117ELISA (enzyme-linked immunosorbent assay),

310-312, 538Elutions, 479-480, 500-501

in autoimmune hemolytic anemias, 502, 503methods for, 501, 917-920

acid elution, 501cold-acid, 917-918combined with adsorption, 480, 880-

881digitonin-acid, 501gentle-heat, 890-891glycine-HCl/EDTA, 918-919heat, 501, 919Lui freeze thaw, 501, 919-920

Embolism, air, 678, 731, 751Emergency Communications Plan, 111-116Emergency equipment, 620-621Emergency exits, 49Emergency management. See Disaster

managementEmergency Management Agencies, 105-106,

114-115, 120-122Emergency operations center, 120-121Emergency release of blood, 214, 287-288, 457-

458, 577-578, 627Emergency response plans, 45

for biohazards, 56-57for chemical spills, 62for electrical emergency, 50for fires, 49for radiation safety, 66

Emergency showers, 61Employees. See PersonnelEna, 417End-product test and inspection, 32Engineering controls

for biosafety, 51-52, 53-54, 55for chemical safety, 61for electrical safety, 50for fire prevention, 49general guidelines for, 45, 75for radiation safety, 65

Engraftment, in HPC transplantation, 794, 810, 811

Enhancement media, 469, 488. See also specific reagents

Enzyme-linked immunosorbent assay (ELISA), 310-312, 538

Enzymesin antibody identification, 449, 473, 476,

485-486to confirm weak A and B antigens, 879-880evaluating treated red cells, 903-904ficin preparation, 902one-stage procedure, 904-905papain preparation, 902-903standardization of procedures with, 903two-stage procedure, 905

EPO (erythropoietin)in HPC transplantation, 692-693in newborns and infants, 646-647for preoperative anemia, 673

Equilibrium constant (Ko), 443Equipment

for apheresis, 228, 233-236, 708-709, 720critical, 10decontamination of, 52emergency, 620-621management of, 10-11, 13personal protective, 45, 55, 73-74quality control of

alarm systems, 37, 967-969automatic cell washers, 974-975centrifuge calibration, 970-973performance intervals for, 37-39temperature monitoring systems, 272, 276thermometers, 38, 965-967

for transfusions, 619-621validation of, 15

Era/Erb, 433Ergonomics, 43-44Errors

in ABO and Rh typing, 372, 406companion, 734fatalities due to, 622-623, 739identification, 622-623, 734, 735, 739, 740quarantine release, 251, 255sources of, in antiglobulin test, 446-447wrong blood in tube, 450-451, 455, 740

Erythroblastosis fetalis. See Hemolytic disease of the fetus and newborn

Erythropoiesis, 646-647, 692Erythropoietin (EPO), recombinant

in HPC transplantation, 692-693in newborns and infants, 646-647for preoperative anemia, 673

Ethnic groups, differences inin ABO system, 990

I N D E X � 1011

in antibody identification, 464, 465-466, 486-487

in Duffy system, 421-422in Kell system, 419-420in Kidd system, 424in Lutheran system, 417in MNS system, 414in Rh system, 391, 392, 394, 397, 398

Etretinate, 151, 184Exchange transfusions, 653-655

for acute hemolytic transfusion reactions, 740blood warmer for, 647component choice for, 654for hyperbilirubinemia, 653intrauterine, 636techniques for, 654-655vascular access for, 654volume of, 654

Exclusionin antibody identification, 470in relationship testing, 352-353

Executive management, 5Expiration, of components, 215-216, 273-275,

622Exposure Control Plan, 50, 51Extracorporeal membrane oxygenation

(ECMO), 659-660Extracorporeal photochemotherapy, 716Eye washes, 75

F

Face shields, 74Facilities

alternate, during disasters, 110clean rooms in, 42-43design and workflow of, 42ergonomic design of, 43-44housekeeping in, 42identification of, 215licensure and registration of, 89-90mobile sites, 43quality management of, 5-6, 7, 12regulatory agencies for, 41-42, 71-72restricted areas in, 43safety program of, 7, 12, 44-67

Factor VIIa, recombinant (rFVIIa), 599, 600, 697, 751

Factor VIIIantibodies to, 599concentrates, 596, 598-599in Cryoprecipitated AHF, 206, 594

Factor IX complex concentrate, 599Factor IX concentrates, 596, 599Failure modes and effects analysis, 29

Failures, active and latent, 27False-positive/-negative results

in antiglobulin testing, 446-447in Rh testing, 406-407

Family support plans, 119Family trees, 337, 338Fatalities

during apheresis, 720of blood donors, 20, 197due to identification errors, 622-623, 739due to transfusions, 20, 739, 756, 757of employees, 47related to medical devices, 91reporting, 20, 47, 91, 197, 756, 757

Fatigue, in donors, 197Fc receptors, 319, 320FDA. See Food and Drug AdministrationFebrile nonhemolytic transfusion reactions,

729, 741-742HLA antibodies in, 561, 742in HPC transplant patients, 701prevention of, 619, 742

Feldene, 151, 184, 229Fenwal apheresis systems, 228, 233, 234, 235Fetal and neonatal alloimmune

thrombocytopenia, 639-641Fetal hemoglobin (hemoglobin F), 979Fetomaternal hemorrhage, 637-638, 933-935Fetus

genotyping, 403, 633, 640transfusions in, 635-636See also Hemolytic disease of the fetus and

newbornFever

in HSCT patients, 701transfusion-associated, 561, 729, 741-742,

751FFP. See Fresh Frozen PlasmaFibrin clots, 372Fibrin degradation products, 982Fibrinogen

abnormalities of, 594in Cryoprecipitated AHF, 206, 594normal values for, 982

Ficin, 473, 902. See also EnzymesFilters

leukocyte-reduction, 208, 279, 623-624, 625microaggregate, 623, 659standard in-line, 623, 625, 659

Filtration devices, for apheresis, 709Finasteride, 151, 184Fingerstick samples, 144Fire safety, 48-49First aid, 47, 48

1012 � A A B B T E C H N I C A L M A N U A L

Fish-bone diagrams, 27Flow cytometry, 312-313

in CD34 analysis and enumeration, 793in fluorescence-activated cell sorting, 787in HLA antibody testing, 559, 563to measure residual leukocytes, 208in platelet antibody detection, 533-534,

536, 537in red cell survival studies, 491

Fluids, replacement, in apheresis, 593, 717-718

Fluorescence-activated cell sorting, 787Fluorescent methods for nucleic acid analysis,

304-306FMH (fetomaternal hemorrhage), 637-638,

933-935Focal segmental glomerulosclerosis, 713-714Food and Drug Administration (FDA)

inspections by, 90-91regulations of

for biological products, 88-89cGMP and cGTP, 1, 7, 8, 20, 271, 837for donor eligibility, 138, 163-178for drugs, 87-88for emergencies, 122for HPCs, 91-92, 837-838for licensure and registration, 89-90for medical devices, 88, 91for recalls and withdrawals, 93for tissues, 853-854, 855

reporting adverse events to, 20, 22, 91, 859reporting fatalities to, 20, 91, 197, 756, 757variances to requirements, 11

Forensic testing, 565Forms, 17-18. See also Documents; RecordsFreeze-thaw elutions, 501, 919-920Freezers, 37, 272, 969Freezing

cryoprotective agents for, 208, 209, 210, 791Fresh Frozen Plasma, 203, 953hematopoietic progenitor cells, 790-791,

808, 831-832Platelets, 209-210Red Blood Cells, 208-209, 947-952

Frequency, gene and allele, 349, 350-351Fresenius AS104 apheresis system, 228, 235Fresh Frozen Plasma (FFP), 203-204

ABO compatibility of, 447, 625, 656-657, 695aliquoting, 656coagulation factors in, 204, 278collection by apheresis, 230-231expiration of, 203, 204, 274-275, 278“jumbo units,” 281leukocyte content of, 577

leukocytes-reduced, 204, 208in massive transfusion, 750for pediatric patients, 652, 656-657, 663preparation of, 199, 203, 276, 278, 953quality control of, 220as replacement fluid in apheresis, 593, 717,

718storage of, 203-204, 274-275thawing, 279-280transfusion of, 593, 625transportation and shipping of, 285volume of, 204

Fuel, in disaster plan, 117-118Fume hoods, 61Fungal contamination

of HPCs, 793of tissue allografts, 853, 858, 859

Fy antigens, 354, 421-423, 986

G

G antigen, 401G-CSF (granulocyte colony-stimulating factor)

for HPC mobilization, 804-805, 806, 811in leukapheresis, 207, 232-233, 596side effects of, 804-805

G6PD deficiency, 741Ge2/Ge3/Ge4, 355, 413, 429-430, 987GEAT, 429GEIS, 429, 987Gene locus, 328Genes, 328-330

of blood group systems, 331, 353, 354-356, 356, 989

frequencies, 350-351of major histocompatibility complex, 548-

552mapping, 353, 354-356, 356mutation of, 335nucleic acid structure in, 294-295position effect, 347-348silent or amorphic, 339, 341suppressor or modifier, 347-348syntenic, 345

Geneticsalleles, 334-335cell division, 330, 332, 333chimerism, 356-357crossing-over, 344-346, 551-552gene interaction, 347-348genes and chromosomes, 328-330, 331genotype and phenotype, 334, 336inheritance patterns, 337-348linkage, 344-346linkage disequilibrium, 346-347, 552

I N D E X � 1013

of major histocompatibility complex, 548-552

Mendel's laws, 343-344polymorphism, 335-336population genetics, 348-351position effect, 347relationship testing, 351-353X chromosome inactivation, 332-334See also specific blood groups

Genotypedefined, 334DNA-based typing, 306-307, 334

in antibody identification, 473of fetus, 403, 633, 640in relationship testing, 352of Rh system, 403-404

frequencies of, 350-351nomenclature for, 357-359and phenotypes, 307, 336

GEPL, 429, 987Gerbich system, 355, 413, 421, 429-430, 987GETI, 429, 987GIL antigen, 356, 432, 988Gill system, 356, 413, 432, 988Globoside collection, 355, 381, 382, 383, 413,

988Gloves, 73-74

and latex allergy, 47-48use in donor room, 56, 193

Glycerolization of red cells, 208-209, 947-951Glycine-HCl/EDTA, 478, 892-893, 918-919GM-CSF (granulocyte-macrophage colony-

stimulating factor), 804, 805GMP (good manufacturing practice), 1, 7, 8,

20, 271Goggles, safety, 74Gonorrhea, in donors, 172Grading test results, 445, 873-874Graft failure, 787Graft-vs-host disease (GVHD)

acute and chronic, 783efficacy of photopheresis in, 715-716and graft-vs-leukemia effect, 782, 783in HPC transplantation, 697-698, 780, 782,

783transfusion-associated, 733, 753-754

HLA system in, 527, 561-562in HPC transplant patients, 700in neonates, 647treatment and prevention of, 526-527,

754Graft-vs-leukemia (tumor) effect, 782, 783, 813Gram weight, 39Gram’s stain, 736

Granulocyte colony-stimulating factor (G-CSF)

for HPC mobilization, 804-805, 806, 811in leukapheresis, 207, 232-233, 596side effects of, 804-805

Granulocyte-macrophage colony-stimulating factor (GM-CSF), 804, 805

Granulocytes, 207ABO compatibility of, 233, 447, 597, 658antigens and antibodies, 539-540, 746apheresis collection of, 207, 228, 232-233,

278CMV-reduced risk, 597dose of, 658expiration of, 274, 279HLA-matched, 597increasing yields of, 232-233, 595, 597indications for, 595, 597, 658, 663infusion of, 233, 625, 699irradiation of, 233, 274, 597laboratory testing of, 233, 286preparation of, from whole blood, 207quality control of, 221storage of, 207, 233, 274, 279, 597transportation and shipping of, 285

Growth factors, recombinant, 207, 232-233, 804-805, 806

Growth hormone, in donors, 151, 184GTP (good tissue practice), 8, 20, 837GVHD. See Graft-vs-host diseaseGVL (graft-vs-leukemia) effect, 782, 783, 813Gya, 355, 427, 987

H

H system, 373-376alloanti-H, 375, 413autoanti-H, 375autoanti-IH, 375, 922biochemistry and genetics of, 355, 373, 374Bombay phenotype, 365, 373, 375H antigen, 364, 365, 373, 987Para-Bombay phenotype, 375saliva testing for soluble antigens, 881-883transfusion practice for, 375-376

Haemonetics apheresis systems, 228, 233, 234, 235-236

Hand washing, 75Haploid, defined, 332Haplotype

ancestral, 552, 565-566defined, 346of HLA system, 550, 551, 552of Rh system, 390, 392

1014 � A A B B T E C H N I C A L M A N U A L

Haptoglobin, 979Hardy-Weinberg equilibrium, 350-351Hazardous areas of facilities, 43Hazardous materials

biohazards, 50-58chemicals, 58-63classification of, 866-867identification and communication of, 45

for biosafety, 51for chemical safety, 60-61for electrical safety, 50for fire safety, 49

radioactive, 63-66safety plan for, 44-45shipping, 66, 865-867waste management of, 57-58, 67

HBsAg (hepatitis B surface antigen), 139, 239, 255-256

HBV. See Hepatitis B virusHCT/Ps (human cells, tissue, and cellular and

tissue-based products)biological product deviations of, 22infectious disease testing on donors of, 251,

783, 784, 850regulation of, 91-93, 837-838See also Hematopoietic stem cell

transplantation; Tissue transplantationHCV. See Hepatitis C virusHDFN. See Hemolytic disease of the fetus and

newbornHealth history questionnaires. See Donor

history questionnaireHeart disease, in blood donors, 150-151, 177Heart/lung transplants, 564-565Heart transplants, 564-565Heat elutions, 501, 890-891, 919Heating blocks, 38Hematocrit

in blood donors, 142, 144-145, 161of blood in exchange transfusions, 281, 654in neonates, 659normal values for, 979preparing RBCs with known hematocrit,

281of red cell components, 201as transfusion threshold, 573-574, 692

Hematologic disorders, in blood donors, 149-150

Hematoma, in donors, 197Hematopoietic cultures, 793Hematopoietic growth factors, 207, 232-233,

804-805, 806Hematopoietic progenitor cells. See HPC

entries

Hematopoietic stem cell transplantation (HSCT)

ABO incompatible, 688-691, 787-790bidirectional, 688, 690, 695clinical outcomes and complications of,

690-691major, 688, 689, 695, 788, 789, 790minor, 688, 689-690, 695, 788, 789, 790processing in, 788, 790

ABO typing discrepancies in, 372adverse reactions to, 792, 808-809, 836-837allogeneic, 687-688, 779, 780, 782, 783, 811-

812autologous, 687, 779, 780, 783, 809-811chimerism in, 370clinical outcomes for, 813-814and CMV, 699-700, 784collection of products for, 784-785, 827-829conditioning regimens for, 688, 780cryopreservation of products in, 790-791,

808, 831-832diseases treated with, 780, 781-782donors for, 782, 783-784, 824-827evaluation and QC of products in, 792-794,

831graft failure and relapse in, 787graft-vs-host disease after, 700, 780, 782,

783, 813-814history of, in blood donors, 168and HLA antibodies, 698-699HLA matching in, 563, 782irradiation of products in, 699mobilization of HPCs in, 802-807neutropenia in, 699non-ABO red cell incompatible, 691and platelet antibodies, 698positive DAT after, 500processing products in, 785-786, 788, 790,

808regulation of, 91-93, 794, 837-838sources of cells for, 687-688, 780, 812-814standardization of care in, 701standards for, 691-692, 794, 838storage of products in, 790-792, 808, 831-

832syngeneic, 779, 782, 811-812thawing and infusion of products in, 792,

808-809, 834-837, 959-960transfusion reactions after, 700-701transfusion support for, 685, 692-698, 785transportation and shipping products, 792,

832-833xenogeneic, 779

Hemizygous, defined, 340

I N D E X � 1015

Hemochromatosis, in blood donors, 150HemoCue, 145Hemodilution, normovolemic, 678-679Hemoglobin

in blood donors, 142, 144-145, 161, 939-940in infants, 646, 652-653, 659, 980normal values for, 979, 980physiology of, 569-571in Red Blood Cells, 201as transfusion threshold, 573-574, 577, 652-

653, 671-672, 692Hemoglobin A2, 979Hemoglobin F, 979Hemoglobin S, 635, 656, 894-895Hemoglobin substitutes, 578-579Hemoglobinometers, 39Hemoglobinopathies, in children, 661-663. See

also Sickle cell diseaseHemolysis

in ABO testing, 369in antiglobulin tests, 445extravascular, 321, 502, 738in hemolytic disease of the fetus and

newborn, 632intravascular, 321-322, 502, 737-738nonimmune, 620, 720, 731, 740-741passenger lymphocyte, 788in patient samples, 441, 735See also Hemolytic entries

Hemolytic anemiaautoimmune, 501-512

classification of, 502cold agglutinin syndrome, 509-510DAT-negative, 508-509mixed-type, 380, 511paroxysmal cold hemoglobinuria, 511-

512serologic findings in, 503transfusion in, 507-508, 511, 578warm, 502, 503, 504-509

drug-induced immune, 512-516hemolytic transfusion reactions, 737-740,

751-753positive DAT in, 497, 499See also Hemolytic disease of the fetus and

newbornHemolytic disease of the fetus and newborn

(HDFN), 631-636ABO, 639alloimmunization in, 631-632antibodies associated with, 412-413, 420,

485-486, 632, 633antibody titers in, 480, 633, 907-909, 935-

937

blood selection in, 635-636diagnosis and management of, 632-636elutions in, 500hemolysis in, 632pathophysiology of, 631preventing, 636-639Rh testing in, 407, 632, 634, 637

Hemolytic transfusion reactionsacute, 729, 737-740

antibodies associated with, 412-413, 485-486

clinical evaluation and management of, 728, 734

due to misidentification errors, 622-623elutions in, 500HLA antibodies in, 562

delayed, 321, 662, 732, 751-753intravascular hemolysis in, 321-322nonimmune, 731, 740-741

Hemolytic uremic syndrome, 713Hemophilia

in blood donors, 149, 171factor replacement for, 596, 598-599

Hemorrhagefetomaternal, 637-638, 933-935intracranial, 640-641transfusion for, 571-574

Hemostasisduring massive transfusion, 749-751monitoring, 589-592, 681in neonates, 65normal test values for, 981, 982

Hemostatic agents, 676Hemovigilance, 22, 727-728Heparin, 152, 536-538, 717, 739, 869Heparin-induced thrombocytopenia, 536-538,

588Hepatitis B immune globulin, 47, 151, 184Hepatitis B surface antigen (HBsAg), 139, 239,

255-256Hepatitis B virus, 255-256

employee exposure to, 47nucleic acid testing for, 246, 256prevalence and incidence of, 139prophylaxis for, 46-47reactive donor screening tests for, 247, 248,

249residual transfusion risk of, 251-253, 255screening donors for, 138-139, 171, 176,

239, 244, 255-256transmission through transplantation, 850,

853, 859Hepatitis C virus, 256

employee exposure to, 47

1016 � A A B B T E C H N I C A L M A N U A L

nucleic acid testing for, 245-246, 256prevalence and incidence of, 139reactive donor screening tests for, 247, 248,

249residual transfusion risk of, 251-253, 256screening donors for, 138-139, 171, 176,

244, 256transmission through transplantation, 850,

853, 859Hereditary hemochromatosis, 150, 548Heredity, genetics of. See GeneticsHES (hydroxyethyl starch), 232, 790, 791Heterozygous, defined, 334High-prevalence antigens

901 series, 433antibodies to, 484, 486-487, 635-636blood selection for, 492-493

High-titer, low-avidity antibodies, 481Histocompatibility. See HLA systemHIT (heparin-induced thrombocytopenia),

536-538, 588HIV. See Human immunodeficiency virusHives, 729, 742-743, 744HLA alleles, 555-556HLA antibodies

detection of, 525-526, 559in HPC transplant recipients, 698-699management of, 732in platelet refractoriness, 524, 525-528, 560-

561, 587in TRALI, 561, 736, 746, 747in transfusion reactions, 561, 562, 742

HLA antigensBg, 434, 552-553, 562Class I and Class II, 547, 552-554, 556-557configuration of, 553-554cross-reactive groups, 554detection of, 557-559nomenclature for, 554permissive, 527on platelets, 524“public,” 555“splits,” 554

HLA-B27, 566HLA Matchmaker program, 560-561HLA system

biochemistry, tissue distribution and structure of, 552-557

biologic function of, 556and chimerism, 561-562disease associations with, 565-566genetics of, 548-552in graft-vs-host disease, 527, 561-562importance of, 547-548

HLA typingcellular assays for, 559crossmatching, 559, 563, 587in diagnosis of TA-GVHD, 753, 754in diagnosis of TRALI, 736DNA-based assays for, 557-558, 565in forensic testing, 565of Granulocytes, 597in HSCT, 698lymphotoxicity assays for, 558-559of Platelets, 526-527, 560-561, 587in relationship testing, 565in transplantation, 562-565, 698-699, 782

HNA (human neutrophil antigen), 539-540Homolog, defined, 340Homozygous, defined, 334Hook effect, 312HPA (human platelet antigen), 529-532

in fetal and neonatal alloimmune thrombocytopenia, 532, 639-640

in posttransfusion purpura, 532-533, 755HPC, Apheresis [HPC(A)], 801-814

allogeneic, 811-812, 813-814autologous, 809-811, 813bacterial contamination of, 809clinical use of, 809-812cryopreservation and storage of, 808discontinuing collection of, 803-804and graft-vs-host disease, 813-814mobilization of, 802-807poor mobilizers of, 806-807processing, 808regulations regarding, 91-93syngeneic, 811-812thawing and infusion of, 808-809transplantation outcomes of, 813-814tumor contamination of, 810-811venous access for collection of, 812vs HPC-M and HPC-C grafts, 812-814

HPC, Cord [HPC(C)], 823-840in cell expansion, 839collection of

ex-utero, 828-829in-utero, 827-828

consent for collection of, 825-826cryopreservation of, 829, 831-832donor recruitment for, 824-825donor testing, 826-827health history and medical evaluation for,

826in immunotherapy, 839-840infusion of, 835-837labeling, 833, 834nonhematopoietic progenitor cells in, 840

I N D E X � 1017

processing, 829-832, 960-961quality control of, 831receipt of, for transplantation, 833-834regulations and standards for, 91-93, 837-

838shipping, 832-833storing, 831-832testing, 832thawing and washing, 834-835UCB banks, 824, 837-838vs HPC-A or HPC-M grafts, 814, 824

HPC, Marrow [HPC(M)], 779-794allogeneic, 780, 782, 783-784autologous, 780, 783, 813bioluminescence assays on, 794buffy-coat preparations, 786CD34 antigen on, 785, 786, 793cell counts of, 792-793cell enrichment, 786-787clinical considerations for, 785collection targets for, 784-785colony-forming cell assays for, 793-794cryopreservation of, 790-791cytoplasmic aldehyde dehydrogenase in, 793diseases treated with, 780, 781-782donor databases for, 782donor eligibility for, 783-784engraftment of, 794evaluation and quality control of, 792-794and graft-vs-host disease, 780, 782, 783,

813-814harvesting, 784, 812histocompatibility of, 782infectious disease testing of, 783, 784, 791microbial cultures of, 793mononuclear preparations, 786processing, 785-787, 788, 790red cell incompatibilities using, 787-790red cell reduction in, 790regulations for, 91-93, 794standards for, 794storing, 790-792T-cell reduction of, 787thawing and infusion of, 792transfusions for donors of, 785transplantation outcomes using, 813-814transportation and shipping, 792tumor cell detection in, 794tumor cell purging in, 787untested or infectious products, 791-792viability assays of, 793vs HPC-A or HPC-C grafts, 812-814

HSCT. See Hematopoietic stem cell transplantation

HTLV. See Human T-cell lymphotropic virusHuman immunodeficiency virus (HIV), 254-

255donor exposure to, 170-171, 175educating donors about, 141, 185-186employee exposure to, 47nucleic acid testing for, 245-246, 254prevalence and incidence of, 139reactive donor screening tests for, 247, 248,

249reporting new cases of, 859residual transfusion risks for, 251-253, 254screening donors for, 138, 139, 140, 240,

244, 254-255transmission through transplantation, 850,

853, 859Human neutrophil antigen (HNA), 539-540Human platelet antigen (HPA), 529-532

in fetal and neonatal alloimmune thrombocytopenia, 532, 639-640

in HPC transplantation, 698in posttransfusion purpura, 532-533, 755

Human resources, 7-9, 12, 119Human T-cell lymphotropic virus (HTLV),

256-257reactive donor screening tests for, 248,

249screening donors for, 138, 244, 257transmission through transplantation, 850,

859Human urea transporter 11, 425Hy antigen, 355, 427, 428, 987Hydatid cyst fluid, 383, 477Hydrops fetalis, 631Hydroxyethyl starch (HES), 232, 790, 791Hygiene, in disaster planning, 117Hyperbilirubinemia, 653, 654Hypercholesterolemia, 716Hyperhemolytic syndrome, 662Hyperkalemia, 627, 749Hyperviscosity, 712-713Hypocalcemia, 627, 718, 732, 749Hypogammaglobulinemia, 372, 601, 720Hypoglycemia, 654Hypokalemia, 749Hypomagnesemia, 718Hypotension

in apheresis, 719associated with ACE inhibitors, 623 , 719,

731, 743, 744deliberate, 679-680in transfusion recipients, 738, 744

Hypothermia, 619-620, 647, 732, 751Hypovolemia, 572, 598, 719

1018 � A A B B T E C H N I C A L M A N U A L

I

I and i antigens and antibodies, 378-381anti-I, 379-380, 413, 922anti-i, 380, 922anti-IH, 380in cold agglutinin syndrome, 380, 464, 510disease associations with, 380, 464genetics of, 355, 378-379ISBT nomenclature for, 988phenotypes, 378transfusion practice with, 380-381

IAT (indirect antiglobulin test), 444-445, 446-447, 898-900

Identificationof blood components

labeling, 214-216, 221, 455, 457prior to administration, 622-623prior to issue, 621

of donors, 140-141, 192of equipment, 11errors in, 622-623, 734, 735, 739, 740of personnel, 19of persons issuing blood, 287, 457of phlebotomists, 441of problems and solutions, 26-29of recipients, 287, 437, 438-441, 457, 618,

621, 622-623of umbilical cord blood, 834

Ig. See Immunoglobulin entriesImmediate-spin crossmatch, 452, 897-898Immune thrombocytopenia (ITP), 150, 534-

535, 588, 641Immunity

afferent, 313-317antibodies in, 317-319antigen processing and presentation in,

313, 314CD4+ T-cell activation in, 314-315complement in, 319-321efferent, 317-323extravascular and intravascular hemolysis

in, 321-322Fc receptors in, 319, 320helper T cells in, 316-317immune diversity in, 315-316in infants, 647plasma cell generation of antibodies in, 315

Immunoglobulin(s), 317-319, 979, 981. See also specific immunoglobulins

Immunoglobulin A, 318, 319antibodies to, 736, 743-744, 745deficiency of, 743-744, 745normal values for, 979, 981

Immunoglobulin D, 979

Immunoglobulin E, 318, 319, 979Immunoglobulin G, 318, 319

in autoimmune hemolytic anemias, 503dissociation of, by chloroquine, 891-892distinguishing from IgM, 909-911in infants, 647normal values for, 979, 981serologic reactivity of, 443, 485-486subgroups of, 318, 319

Immunoglobulin G-coated cells (check cells), 448

Immunoglobulin M, 318in autoimmune hemolytic anemias, 503cold-reactive autoagglutinins, 509-510, 511,

920-923dispersing autoagglutination caused by,

373, 510, 890distinguishing from IgG, 909-911in infants, 647in intravascular hemolysis, 321-322normal values for, 979, 981serologic reactivity of, 443, 485-486in warm autoimmune hemolytic anemia,

504Immunoglobulin products, 598, 600-602Immunohematology reference laboratories,

490Immunomagnetic cell separation, 787Immunomodulation, transfusion-related

(TRIM), 576Immunotherapy, 839-840In-vivo testing, 491, 578Ina/Inb, 355, 413, 431, 988Incarceration, history of, 173Incidence, defined, 349Incident Command System, 121-122Incinerators, hospital/medical/infectious

waste, 57-58Incubation

temperatures for, 476, 865times for, 444, 476

Incubators, platelet, 37, 272Independent assortment, 344Independent segregation, 343-344Indian system, 355, 413, 431, 988Indirect antiglobulin test (IAT), 444-445, 446-

447, 898-900Infants. See Neonates; Pediatric patientsInfectious disease screening, 239-265

in apheresis donors, 229approaches to, 241of autologous donations, 250-251for Babesia, 260-261for bacterial contamination, 257-259

I N D E X � 1019

for chikungunya virus, 261for cord blood donation, 826for dengue virus, 261in HCT/P donors, 251, 783, 784, 791in health history assessment, 138-140for hepatitis B virus, 255-256for hepatitis C virus, 256historical overview of, 138-140, 239-241,

242-243for human immunodeficiency virus, 254-

255for human T-cell lymphotropic virus, 256-

257for immunocompromised recipients, 250international variations in, 251logistics of, 241, 245for malaria, 261nucleic acid testing, 245-246for parvovirus B19, 262-263for prions, 262reactive test results in, 246-250residual infectious risks of transfusion, 251-

254serologic testing, 245for syphilis, 257in tissue transplantation, 850for Trypanosoma cruzi, 260in US blood banks, 244for West Nile virus, 259

Infectious diseasessafety precautions for, 50-58transfusion-transmitted, 254-263transmitted by plasma derivatives, 262-263transmitted by tissue transplantation, 853,

858-859See also Infectious disease screening

Infectious substanceslabeling, 867shipping, 865-867waste, 57-58

INFI, 431, 988Inflammatory bowel disease, 716-717Information management, 13, 19-20Infusion, of HPCs, 792, 808-809, 835-837, 959-

960Infusion pumps, 620, 658Infusion rates, 624, 625, 659Infusion sets, 623-624, 659Inheritance patterns, 337-348

aneuploidy, 341-342autosomal codominant, 338, 340autosomal dominant, 337, 339autosomal recessive, 338-339, 341crossing-over, 344-346, 551-552

gene interaction, 347-348linkage, 344-346linkage disequilibrium, 346-347, 552of major histocompatibility complex, 550-

552Mendel’s laws for, 343-344pedigrees, 337, 338position effect, 347-348sex-linked, 339-341, 342-343

Inhibition tests, 477, 881-883, 911-912Inhibitors, in PCR, 297, 299INJA, 431, 988Injuries, 47, 48, 52, 91INR (international normalized ratio), 589, 590,

591, 592Inspections

of components, 202before administration, 622before release, 284-285, 457, 621receiving into inventory, 284-285in transfusion reaction evaluation, 736

external assessments, 25FDA, 90-91of incoming supplies, 10of tissue grafts, 855-856

Insulin, bovine, in donors, 151, 184Insurance, 111Integrins, 532Internal event report, 20, 21International Normalized Ratio (INR), 589,

590, 591, 592Intracranial hemorrhage, 640-641Intrauterine transfusions, 635-636Intravenous immune globulin (IVIG), 600-602

ABO discrepancies with, 372adverse effects of, 601-602in antibody identification problems, 464applications of, 601-602for fetal and neonatal immune

thrombocytopenia, 640in HDFN, 636in platelet refractoriness, 588positive DAT with, 500

Inventory, 108-109, 122-123, 286Iron chelation therapy, 756-757Iron overload, 662, 733, 756-757Iron, supplemental, 145, 673-674Irradiated products, 210-211, 280

expiration of, 273, 274, 280Granulocytes, 233, 274, 597in HPC transplantation, 699, 785indications for, 526-527, 754, 755for intrauterine transfusions, 635for pediatric patients, 664

1020 � A A B B T E C H N I C A L M A N U A L

platelet components, 211, 274, 526-527potassium leak in, 648quality control of, 211, 280Red Blood Cells, 211, 273storage of, 273, 274ultraviolet B, 528, 560Whole Blood, 273

Irradiators, blood, 38, 64, 65, 210-211, 280ISBT (International Society of Blood

Transfusion)128 barcode labeling, 214, 216, 221nomenclature

for platelet antigens, 530-531for red cell antigens, 357-359, 984-989

Ishikawa diagrams, 27Isografts, 850Isohemagglutinins, 364Isotretinoin, 151, 184Issuing blood, 287

delivering blood to patient area, 621-622identification of recipient and component

before, 455, 457, 621policies and procedures for, 455, 457, 621-

622reissue, 289, 622from transfusion service, 287in urgent situations, 214, 287-288, 457-458,

577-578, 627ITP (immune thrombocytopenia), 150, 534-

535, 588, 641IV solutions, 624IVIG. See Intravenous immune globulin

J

Jehovah’s Witnesses, 671Jka/Jkb/Jk3 antigens and antibodies, 354, 412,

423-425, 986, 989Joa, 355, 427, 428, 987Job descriptions, 7John Milton Hagen system, 355, 413, 432, 988Jsa/Jsb, 354, 420, 985“Just-in-time” systems, 116

K

K/k antigens and antibodies, 354, 412, 418-420, 985, 989

Karyotype, 329KCAM, 431, 988Kell system, 418-421

allele frequencies in, 350-351antibodies of, 412, 420, 989antigens of, 354, 419-420, 985, 989association with Gerbich, 421

biochemistry and genes of, 354, 418-419, 989functional aspects of, 421in HDFN, 420, 632, 633Kmod, 412, 420null phenotype (Ko), 412, 420phenotypes of, 419, 989position effect in, 347

Kernicterus, 632, 636, 653Kidd system, 423-425

antibodies in, 412, 424-425antigens in, 354, 423-424, 986, 989in delayed transfusion reactions, 752genetics of, 354, 989inheritance patterns of, 340Kidd glycoprotein, 424, 425phenotypes of, 424, 989in transfusion reactions, 424-425

Kidney transplantation, 563-564Kleihauer-Betke acid-elution test, 637-638,

934-935Kmod, 421Kna/Knb, 355, 430-431, 988Knops system, 355, 413, 430-431, 988Kpa/Kpb/Kpc, 354, 418, 419, 985, 989Ku (KEL5), 421Kx system, 333-334, 343, 355, 413, 421, 987

L

Labelsfor aliquots, 651for biohazardous materials, 51, 867for blood components, 188, 214-216, 221,

286-287, 455, 457for blood samples, 438-439, 441, 618control of, 17for hazardous chemicals, 60ISBT 128 system for, 214, 216, 221for pooled components, 212, 281for reagents, 865for shipments, 833, 866-867for umbilical cord blood, 834

Laboratories, regulations for, 93-94, 96Laboratory coats, 73Landsteiner-Wiener blood group, 355, 389-

390, 413, 429, 987Latex allergies, 47-48, 188, 189-190Law of Independent Assortment, 344Law of Independent Segregation, 343-344LDL apheresis, 716Lea/Leb, 354, 376-378, 412, 986, 989Leadership, organizational, 5-6, 12, 112LEAN, process improvement, 29Lectins

Dolichos biflorus, 367, 373, 888, 889

I N D E X � 1021

preparation and use of, 888-889Ulex europaeus, 367, 373, 888, 889

Leishmaniasis, 173Leukapheresis

collection of Granulocytes by, 207, 235-236donation intervals for, 160, 166-167indications for, 714-715instrumentation for, 228, 235-236

Leukemiacytapheresis for, 714-715and G-CSF, 805HPC transplantation for, 812, 813-814platelet transfusions in, 579

Leukocyte-reduced components, 576for children, 663-664expiration of, 273, 274Fresh Frozen Plasma, 204, 208leukocyte content in, 576, 577platelet components, 208, 211, 229, 528,

956-957prestorage filtration, 207-208, 279, 945-946,

956-957to prevent CMV infection, 250, 663, 699-700quality control of, 218, 975-977Red Blood Cells, 201, 207-208, 218, 273, 576,

945-946to reduce alloimmunization, 528, 560, 587,

662to reduce febrile nonhemolytic transfusion

reactions, 701, 742to reduce incidence of PTP, 755storage of, 273, 274

Leukocyte reduction filters, 208, 279, 623-624, 625

Leukocytesin components, 577normal values for, 979, 980residual, 207-208, 576, 975-977

Lewis substance, 477Lewis system, 376-378

antibodies of, 377-378, 412antigens of, 354, 374, 376, 986, 989biochemistry and synthesis of, 374, 376disease associations with, 378expression in children, 377genetics of, 354, 376-377phenotypes of, 376-377, 989saliva testing for, 477, 881-883transfusion practice with, 378

Licensure, of facilities, 89-90Liley graphs, 634, 635Linkage, 344-346Linkage disequilibrium, 346-347, 552Lipemic samples, 441

Liquid nitrogenfor shipping, 792, 833for storage, 791, 832

Liquid Plasma, 204, 275LISS

antibodies to ingredients in, 488to enhance antigen-antibody reactions,

443, 448-449, 473, 899and serum to red cell proportions, 443, 449

Liver, transplantation of, 564-565LKE (Luke) antigen, 381, 384Logistics, in disaster plan, 116Look-back, 247, 248-249, 250, 859Low-prevalence antigens, 433-434, 487Low-volume units, 194-195, 201Lsa, 429, 987Lu antigens and antibodies. See Lutheran

systemLui freeze thaw elution, 501, 920-921Luke (LKE) antigen, 381, 384Lung conditions, in blood donors, 150-151,

177Lung injury. See Transfusion-related acute

lung injuryLung transplants, 564-565Lutheran system, 417-418

antibodies of, 412, 418antigens of, 354, 417-418, 985genetics of, 339, 341, 346, 347-348, 354

LWa/LWb, 355, 389, 429, 987Lymphocyte crossmatching, 559Lymphocytes

natural killer cells, 839passenger, 788T regulatory cells, 839-840

Lymphocytotoxicity assays, 525-526, 557, 558-559

Lyonization, 332-334

M

M antigen and antibodies, 354, 411, 412, 414-416, 989

Magnesium, 718MAIGA (monoclonal antibody immobilization

of granulocyte antigens), 540MAIPA (monoclonal antibody immobilization

of platelet antigens), 534Major histocompatibility complex, 547

in antigen processing and presentation, 313, 314

Class I, II, III molecules in, 552-554genetics of, 548-552

Malaria, 261and Duffy glycoprotein, 423

1022 � A A B B T E C H N I C A L M A N U A L

and HLA type, 566screening donors for, 138, 140, 173, 176, 261

Markers, defined, 327Market withdrawals, 859Marrow. See HPC, Marrow (HPC-M)Masks, 74Massive transfusions

complications of, 748-751air embolism, 751citrate toxicity, 749coagulopathy, 749-751hyper- and hypokalemia, 749hypothermia, 751

component replacement in, 750-751defined, 288, 458Factor VIIa, recombinant, in, 751pretransfusion testing in, 288, 458

Material safety data sheets, 60, 61Materials management, 9-10, 12Maximum surgical blood order schedules, 286,

991MCA-PSV (middle cerebral artery peak systolic

velocity), 634McCa/McCb, 355, 430-431, 988McLeod phenotype, 333-334, 343, 421McLeod syndrome, 343, 4212-ME (2-mercaptoethanol), 478, 510, 890Mechanical hemolysis, 720, 741Media, working with, 114, 115-116Medical devices, regulations for, 88, 91Medical history

in antibody identification, 464in blood donor selection, 145-147, 163-178for cord blood donation, 826in evaluation of positive DAT, 499-500of recipients, 618

Medical waste, 57-58Medications. See DrugsMeiosis, 330, 332Membrane attack complex, 320-321Mendel’s laws, 343-344Mental health assistance, during disasters,

120MER2 antigen, 4322-mercaptoethanol (2-ME), 478, 510, 890Mesenchymal stem cells, 840Message mapping, 115Messenger RNA, 295Metabolic abnormalities, in infants, 647-648,

654Methemoglobin, 979α-Methyldopa, 514Methylene blue-treated plasma, 205-206, 264Microaggregate filters, 623, 659

Microarray assays, 306, 312, 557-558, 559Microfluorimetry, 208Microhematocrit centrifuges, 39Microhematocrit, spun, 145Microlymphocytotoxicity tests, 525-526, 557,

558-559Microplate test

for ABO group, 877-878for Rh type, 886-887

Microvascular bleeding, 750Military service, donors in, 174Mitosis, 330, 332Mixed-field agglutination, 353, 370, 371,

433Mixed leukocyte culture (MLC), 559Mixed passive hemagglutination assay, 533Mixed-type autoimmune hemolytic anemia,

380, 503, 511MNS system, 411, 414-417

antibodies of, 412, 416-417, 477antigens of, 354, 414, 416, 984, 989effect of enzymes on, 414genetics of, 354, 414, 416, 989glycoproteins of, 414, 415, 416linkage disequilibrium in, 346-347linkage in, 346nomenclature for, 984, 989phenotypes of, 414, 989S–s–U– phenotype, 416

Mobile blood collection, 43, 198Mobilization regimens of HPCs

adhesion-blocking agents and cytokines, 805-806

chemotherapy, 802-804combined growth factor and

chemotherapy, 806hematopoietic growth factors, 804-805poor mobilizers, 806-807

Molecular typing. See DNA-based assaysMonoclonal antibody immobilization of

granulocyte antigens (MAIGA), 540Monoclonal antibody-specific immobilization

of platelet antigens (MAIPA), 534Monoclonal reagents, 370, 398, 399, 406Monocyte monolayer assay, 490-491Mononuclear cell enrichment, 786Mortality. See FatalitiesMozobil (AMD3100), 805-806, 807Multiple sclerosis, 713Multiplex nucleic acid amplification, 304Multipotent stem cells, 840Mur antigen, 417Mutations, genetic, 335Myeloma, IgM, 712-713

I N D E X � 1023

N

N antigen and antibodies, 354, 412, 414-416, 989

Nageotte hemocytometry, 208Narcolepsy, 566NAT. See Nucleic acid testingNational Disaster Medical System, 106National Incident Management System, 106National Marrow Donor Program, 782National Response Framework, 106Natural killer (NK) cells, 839Near-miss events, 26, 32Needlesticks, 52, 169Neonatal alloimmune neutropenia, 540Neonatal alloimmune thrombocytopenia, 532,

639-641Neonates (less than 4 months of age), 645-660

ABO and Rh typing in, 372, 457, 634, 637ABO antigens and antibodies in, 365, 372,

648-649alloimmune thrombocytopenia in, 532,

639-641anemia in, 646antibody screening in, 457antigen variations in, 481, 482autologous blood donation in, 155blood volume in, 646, 983compatibility testing in, 457, 648-650direct antiglobulin testing in, 634ECMO in, 659-660erythropoietic response in, 646-647hemoglobin in, 646, 652-653hypothermia in, 647immunologic status of, 647Lewis antigens in, 377metabolic problems in, 647-648neutropenia in, 540, 597normal laboratory values in, 980-981plasma volume in, 983polycythemia in, 659red cell volume in, 983size of, 645-646transfusion-associated graft-vs-host

disease in, 647transfusions in, 648-660

administration of, 658-659aliquots for, 282-284, 650-651of Cryoprecipitated AHF, 652, 657-658exchange, 636, 653-655of Fresh Frozen Plasma, 652, 656-657of Granulocytes, 658indications for, 648, 649, 652-655of platelet components, 655-656of Red Blood Cells, 648-655

safety of additive solutions in, 651-652vascular access for, 619, 654, 658volumes for, 652

See also Hemolytic disease of the fetus and newborn

Nerve injury, in donors, 197Neutralization techniques, 477, 913-914Neutropenia

autoimmune, 540granulocyte transfusions for, 595, 597, 663in HPC transplant patients, 699neonatal alloimmune, 540

Neutrophil antigens and antibodies, 539-540, 746

Nomenclaturefor blood group systems, 354-356, 357-359,

984-989for granulocyte antigens, 539for HLA system, 554, 555of platelet antigens, 530-531of Rh system, 390-393

Nonimmune hemolysis, 620, 720, 731, 740-741Nonconformances

biological product deviations, 20, 22, 93, 94classification of, 22, 23internal event reports, 20, 21management of, 13, 20-22

Normovolemic hemodilution, 678-679Notifications

to donors, of reactive screening tests, 247to recipients, of reactive donor tests, 247

Nucleated cell counts, 792-793Nucleic acid analysis, 293-307

detection of amplification products in, 304-306

for genotyping, 306-307, 334in antibody identification, 473of fetus, 403, 633, 640in relationship testing, 352of Rh system, 403-404

in HLA typing, 557-558, 565hybridization-based methods in, 295-296for infectious diseases, 245-246isolation of nucleic acids in, 295nucleic acid sequence-based amplification

in, 302, 303for platelet antigens, 534polymerase chain reaction in, 296-305in pretransfusion testing, 450in relationship testing, 352of single nucleotide polymorphisms, 306-

307transcription-mediated amplification in,

302, 303

1024 � A A B B T E C H N I C A L M A N U A L

Nucleic acid sequence-based amplification (NASBA), 302, 303

Nucleic acid testing (NAT), 245-246in HBV testing, 256in HCV testing, 256in HIV testing, 254in West Nile virus testing, 259

Nucleic acids, structure of, 294-295Nutritional supplements, 151

O

O alleles, 367Oh (Bombay) phenotype, 365, 373, 375Ok system, 355, 413, 431, 988Oka, 355, 431, 988Ola, 356, 404, 432, 988Oligonucleotide probes, 557-558Orders, physician

auditing, 763-772pretransfusion, 455, 618-619routine surgical blood orders, 286, 991sample form for, 776-777verifying prior to transfusion, 622

Organ transplantationABO compatibility in, 563, 564, 860heart, 564-565heart/lung, 564-565history of, in blood donors, 168HLA testing in, 563-565kidney, 563-564liver, 564-565lung, 564-565paired donor exchange, 564positive DAT after, 500procurement of organs for, 860rejection of, 714transfusion support for, 860

Organizationsfor biological product regulation, 88-89for blood-related device regulation, 91directory of, 992-993for drug regulation, 87-88for emergency management, 105-106, 122-

124, 136for inspections, 90-91for licensure and registration, 89-90for managing recalls and withdrawals, 93,

94for medical laboratory regulation, 93-94, 96for quality system regulation, 1-2for regulation of HPCs, 91-93for safety, 41-42, 71-72, 994-995structure of, 5-6, 12See also specific organizations

Orientation program, 7, 124Outpatients, 439

P

P antigen, 381-382, 384P blood groups, 381-384

antibodies of, 382-384, 412antigens of, 354, 381, 382, 985autoanti-P, 384biochemistry of, 381-382disease associations with, 384, 464, 512genetics of, 354molecular biology of, 382phenotypes of, 381transfusion practice with, 384

P1 antigen, 381P1 substance, 383, 477P1PK, 354, 381, 412Packaging biological materials, 865-867PAD (preoperative autologous donation), 674Paired donor exchange, 564Pall eBDS system, 258Panel reactive antibody (PRA), 526, 559, 560,

564Panels, red cell, 467, 468, 469-471Papain, 473, 902-903. See also EnzymesPara-Bombay phenotype, 375Parentage testing, 351-353, 565Pareto analysis, 28Paroxysmal cold hemoglobinuria (PCH), 384,

466, 503, 511-512Partial D, 396, 397, 400-401, 407Partial thromboplastin time (PTT), 589, 681,

750, 981, 982Parvovirus B19, 248, 262-263Passenger lymphocyte hemolysis, 788Paternity testing. See Relationship testingPathogen reduction and inactivation

methods, 205-206, 253, 263, 264, 597-598Patient blood management, 671-681

acidosis in, 681auditing in, 24-25, 672, 763-772benchmarking in, 672blood draws in, 673deliberate hypotension in, 679-680drug therapies in, 681hemostatic agents in, 676perioperative autotransfusion in, 674, 676-

679, 680point-of-care monitoring in, 681positioning in, 680in preoperative anemia, 673-674quality assurance measurement in, 672-673routine surgical blood orders in, 286, 991

I N D E X � 1025

single-unit transfusions in, 672surgical techniques for minimizing blood

loss, 675temperature regulation in, 680-681transfusion thresholds in, 671-672

PCR. See Polymerase chain reactionPEDI-PAK system, 650, 651Pediatric patients (older than 4 months of age)

ABO and Rh typing in, 372, 661ABO antigens and antibodies in, 365, 372antibody screening in, 661autologous blood donation in, 155compatibility testing in, 661cytomegalovirus prevention in, 663Lewis antigens in, 377normal laboratory values in, 980-981transfusions in, 660-663

aliquoting for small volumes, 282-284, 650-651

of CMV-reduced-risk components, 663of Cryoprecipitated AHF, 652, 657, 663of Fresh Frozen Plasma, 652, 657, 663of Granulocytes, 658, 663of irradiated components, 664of leukocyte-reduced components, 663-

664of platelet components, 652, 655, 663, 664of Red Blood Cells, 652, 660-663with sickle cell disease, 661-662syringe infusion pumps for, 620with thalassemia, 662-663vascular access for, 619of volume-reduced components, 664of washed components, 664

See also NeonatesPedigrees, 337, 338Peer review, 24, 763-772PEG (polyethylene glycol)

in antibody detection/identification, 449, 473, 899-900

use in adsorption, 927Penicillin, 513-514, 515, 929Peripheral blood progenitor cells. See HPC,

Apheresis (HPC-A)Personal protective equipment, 45, 73-74

for biosafety, 55for chemical safety, 61gloves, 47-48, 56, 73-74

Personnelaccidents and injuries in, 47, 48, 52blood exposure in, 47, 55competency assessment of, 7-8disaster plans for, 118-120essential, 119

hepatitis prophylaxis for, 46-47identification of, 19latex allergies in, 47-48medical first aid and follow-up for, 47orientation program for, 7protective equipment for, 45, 55, 73-74records, 19, 47safety monitoring programs for, 47selection of, 7staffing plan, 8-9, 118-120, 123training. See Training

PF4 ELISA, 538PF24. See Plasma Frozen Within 24 Hours

After PhlebotomypH, 443, 477, 482pH meters, 38Phenotype

calculations for, 349, 492-493defined, 334distribution by ethnicity, 990and genetic mutations, 335and genotypes, 307, 335-336nomenclature for, 357-359, 989prevalence of, 349rare, 465-466, 492-493typing for

autologous red cells, 472-473donor units, 491-492solid-phase assays for, 309-310

See also specific blood groupsPhenotype-matching, 402-403, 451, 662,

717Phlebotomy

adverse reactions to, 196-197care of donors after, 196for collection of blood samples, 194, 441,

940-943of donors, 192-194, 940-943only as needed, 673See also Blood collection

Phosphate buffer, 873Photopheresis, 715-716Physical assessment

of donors, 142, 144-145of recipients, 621

Physiologic anemia of infancy, 646Piercings, 172Piperacillin, 513-514Pipettes, recalibration of, 38Pk antigen, 381, 382, 384PlA1 (HPA-1) antigen, 529, 639Plasma

ABO compatibility of, 447, 625, 656-657, 693, 695

1026 � A A B B T E C H N I C A L M A N U A L

aliquoting, 656biochemical changes in storage of, 276, 278coagulation factors in, 204, 205, 206, 278collection by apheresis, 228, 230-231, 275collection by sequestration, 679expiration of, 203, 204, 274-275, 278“jumbo units,” 281leukocyte-reduced, 204pathogen-inactivated, 205-206, 264for pediatric patients, 652, 656-657, 663preparation of, 200, 203, 276, 278, 953for pretransfusion testing, 441, 463-464, 468quality control of, 220as replacement fluid in apheresis, 593, 706,

717, 718storage of, 203-204, 274-275thawing, 279-280transportation and shipping of, 285volume of, normal value, 983See also specific plasma components;

Plasma transfusionPlasma Cryoprecipitate Reduced, 204, 220,

275, 717, 718Plasma D-dimers, 982Plasma derivatives

α-antitrypsin, 603activated protein C, 603albumin, 598antithrombin, 602-603clotting factor concentrates, 598-599Factor IX complex concentrate, 599Factor VIIa, 600intravenous immune globulin, 600-602screening for parvovirus B19 in, 262-263

Plasma exchange. See Therapeutic plasma exchange

Plasma Frozen Within 24 Hours After Phlebotomy, 204

coagulation factors in, 205, 593preparation of, 199, 278storage and expiration of, 275, 278

Plasma, Liquid, 204, 275Plasma, Recovered (for manufacture), 205, 275Plasma, solvent/detergent-treated, 206, 264Plasma, Source, 230-231Plasma, Thawed, 204, 205, 275, 278, 593Plasma transfusions, 589-593

alternatives to, 679dose and timing of, 592-593in HPC transplantation, 697infusion rate for, 625in massive transfusion, 750in pediatric patients, 656-657, 663types of, 593

Plasmapheresisdonation intervals for, 160, 166-167, 230instrumentation for, 228, 233-234manual, 230, 708plasma transfusion in, 593red cell losses in, 230therapeutic plasma exchange

adverse effects of, 718-720in hemolytic disease of the fetus and

newborn, 636indications for, 709-714instrumentation for, 708-709volume exchange in, 708

Platelet agonists, 151, 152, 166, 184, 229, 581Platelet antigens and antibodies, 523-538

ABO antigens on platelets, 523-524autoantibodies, 534-535detecting, 533-534, 535, 536, 537, 538drug-induced antibodies, 535-538, 587HLA antigens, 524, 560-561in HPC transplantation, 698platelet-specific antigens, 528-534, 639-

640, 698, 755Platelet counts

corrected platelet count increment, 525, 583, 587-588

normal values for, 979, 980in plateletpheresis donors, 162, 229posttransfusion platelet recovery, 525, 583as transfusion threshold, 579-580, 655, 663, 694

Platelet disorders, 580-581. See also Thrombocytopenia

Platelet factor 4 (PF4), 538Platelet function, 681, 750Platelet gel, 282, 588-589Platelet incubators, 37, 272Platelet PGD test, 258-259Platelet-rich plasma (PRP), 199, 200, 202, 588-

589, 956Platelet transfusions, 579-589

ABO compatibility of, 447, 523-524, 584-586after HSCT transplantation, 693-694, 695in hemolytic transfusion reactions, 740in nonemergency settings, 625in pediatric patients, 656, 663

alternatives to, 679contraindications to, 588dosage of, 581-583, 656, 696-697in HPC transplantation, 693-697indications for, 580-581, 655-656infusion rates for, 625in massive transfusion, 750in pediatric patients, 640-641, 652, 655-656,

663

I N D E X � 1027

prophylactic vs. therapeutic, 579, 694refractoriness to, 524-528

ABO compatibility in, 523-524antibody specificity prediction method

for, 527causes of, 525-526HLA antibodies in, 524, 525-528, 560-

561, 587, 732HLA matched platelets for, 526-527, 560-

561managing, 587-588platelet crossmatching for, 527-258, 561,

587preventing alloimmunization in, 528

Rh matching, 586thresholds for, 579-580, 655, 663, 694, 696unit type and age, 583-584

Plateletpheresis, 228-230donation intervals for, 160, 166-167, 228-229donor selection and monitoring in, 160,

162, 166, 228-229instrumentation for, 228, 234records of, 230therapeutic, 715yields from, 680

Platelets (whole-blood-derived), 202-203agitation of, 272aspirin-free, 152bacterial contamination of, 258-259, 276,

284-285biochemical changes during storage, 276,

583-584coagulation factors in, 202, 203, 982collection by sequestration, 679compared to Apheresis Platelets, 584cryopreservation of, 210donors of, 152expiration of, 211, 274, 281, 282, 284inspection of, 289irradiated, 211, 274, 528Leukocytes Reduced, 208, 211, 274, 284,

528, 577, 956-957pathogen reduction for, 264pooled, 211-212, 274, 281preparation of, 200-201, 202, 955-957quality control of, 219return and reissue of, 289storage of, 202-203, 272, 274transportation and shipping, 203, 285volume-reduced, 212-213, 282, 586, 656,

664, 957-958washed, 280, 664

Platelets, Apheresisagitation of, 272

aliquoting, 283-284bacterial contamination of, 258-259, 276,

284-285biochemical changes during storage, 276,

583-584collection of, 228-229compared to whole-blood-derived

Platelets, 584crossmatching, 527-528, 561, 587cryopreservation of, 209-210, 220donors of, 152, 160, 162, 228-229expiration of, 274, 282HLA-matched, 526-527, 560-561, 587inspection of, 289irradiated, 211, 274, 526-527, 528laboratory testing of, 229leukocyte content of, 577Leukocytes Reduced, 229, 274, 528, 577pathogen reduction for, 264quality control of, 219, 220return and reissue of, 289storage of, 272, 274transportation and shipping of, 285volume-reduced, 212-213, 282, 586, 656,

957-958washed, 280, 664

Plerixafor, 805-806, 807Point-of-care testing, 681Policies, 11, 16, 17-18Polyagglutination, 370-371, 406, 888Polycythemia, 659Polyethylene glycol. See PEGPolymerase chain reaction (PCR), 296-302

in genotyping, 334, 633in HLA typing, 557-558oligonucleotide probes, 557-558in platelet typing, 534problems with, 297, 299-300real-time, 304-306reverse transcriptase, 300-302sequence-based typing, 558sequence-specific primers, 534, 557, 558

Polymorphism, 335-336, 351-352Pooled components, 211-212, 280-282

Cryoprecipitated AHF, 212, 281-282, 594, 954-955

expiration of, 274, 281-282labeling, 212Platelets, 211-212, 274, 281Reconstituted Red Cells, 281

Population genetics, 348-351Position effect, 347-348Positioning, surgical, 680Posterior subcapsular cataract, 207

1028 � A A B B T E C H N I C A L M A N U A L

Posttransfusion platelet recovery (PPR), 525, 583

Posttransfusion purpura (PTP), 532-533, 733, 754-756

Postzone effect, 308, 309Potassium, 276, 627, 647-648, 749PPE. See Personal protective equipmentPr antibodies, 510, 922PRA (panel reactive antibody), 526, 559, 560, 564Preadmission testing, 439Pregnancy

autologous blood donation during, 155in blood donors, 166in patient history, 441-442, 464See also Prenatal studies

Premature Infants in Need of Transfusion (PINT) study, 652-653

Premedicationfor HPC infusions, 809-810for transfusions, 619, 742, 745

Prenatal studiesamniotic fluid analysis, 634antibody titration, 480, 633, 907-909, 935-

937in fetal and neonatal immune

thrombocytopenia, 640-641fetal genotyping, 403, 633serologic and molecular testing, 487, 632-634

Preoperative autologous donation (PAD), 674PrepaCyte-CB, 831Preservatives

anticoagulant-preservative solutions, 188, 191, 216, 277, 827

reagent, antibodies to, 488Press, working with, 114, 115-116Pressure devices, 620Pretransfusion testing, 437-459

AABB standards for, 438ABO and Rh typing in, 445, 447-448after non-group-specific transfusions, 288-

289, 458antibody detection in, 448-450, 453-455with autoantibodies, 504-505, 509-510autologous control in, 449and blood availability, 455blood samples for, 438-442, 618in cold agglutinin syndrome, 509-510comparison with previous records, 450-

451crossmatching, 452-455donor testing in, 451identification of recipients in, 438-441interpretation of results, 453-455in massive transfusions, 288, 458

orders for, 455, 456, 618-619in pediatric recipients, 457, 648-650, 661requests for transfusion, 437-438, 455, 456,

618, 776-777selection of units in, 447, 451-452serologic testing, principles of, 442-445steps in, 438tubeless methods for, 449-450turnaround times for, 619in urgent situations, 288, 457-458

Prevalence, of phenotypes, 349Preventive action, 26Prewarming technique, 489, 900-901Primed lymphocyte typing (PLT), 559Primers, PCR, 299-302Prions, 262, 858Probability values, in antibody identification,

470-471Proband, 337Problem identification and resolution,

26-29Procedures, 11, 17-18, 22, 88-89Process capability, 32Process control, 3, 32Process flow charts, 27, 28Process improvement, 13, 25-29Process management, 3-4, 11, 13, 14-16Processes, 11, 14, 17-18Production, principles of, 4Proficiency testing, 25, 96Propositus, 337Prospective audits, 765, 765-766, 767-768, 770,

771Protein analysis, 307-313

agglutination-based methods for, 307-309enzyme-linked immunosorbent assay for,

310-312flow cytometry for, 312-313protein microarrays for, 312solid-phase assays for, 309-310Western blotting for, 312

Protein C, 603, 982Protein microarrays, 312Protein S, 982Proteolytic enzymes. See EnzymesProthrombin Complex Concentrate (PCC),

590, 599Prothrombin time (PT), 589-590, 593, 681, 750,

981Prozone effect, 308, 443PRP (platelet-rich plasma), 199, 200, 202, 588-

589, 956Pseudoautosomal, defined, 341Pseudogenes, 548

I N D E X � 1029

PT (prothrombin time), 589-590, 593, 681, 750PTP (posttransfusion purpura), 532-533, 733,

754-756PTT (partial thromboplastin time), 589, 681,

750, 981, 982Public antigens, 555Pulmonary disease, in blood donors, 150-151,

177Pulmonary edema, 719, 747, 748Pulse, of donor, 161Pumps, infusion, 620, 658Pure red cell aplasia (PRCA), 689, 691

Q

Quad packs, 650Qualification

defined, 32of personnel, 7of suppliers, 9, 855, 856

Quality assurance, 1, 2, 33Quality control, 15-16

of apheresis components, 975of blood components, 217-221, 221

apheresis RBCs, 231-232leukocyte-reduced components, 975-

977Red Blood Cells, Deglycerolized, 952

of copper sulfate solution, 39, 965defined, 2, 33of equipment

automatic cell washers, 974-975centrifuge calibration, 970-973freezer alarms, 37, 969refrigerator alarms, 37, 967-969temperature monitoring systems, 272,

276thermometers, 38, 965-967

of HPCs, 792-794, 831performance intervals for, 37-39records of, 16unacceptable results for, 16

Quality improvement, 3, 125Quality indicators, 24, 33Quality management systems, 1-30

components of, 12-13customer focus, 6-7, 12documents and records, 13, 16-19equipment management, 10-11, 13facilities, work environment and safety, 7,

12human resources, 7-9, 12information management, 13, 19-20management of nonconforming events, 13,

20-22, 23

monitoring and assessment, 13, 23-25organization and leadership, 5-6, 12process improvement, 13, 25-29process management, 11, 13, 14-16quality concepts, 2-4regulation of, 1-2, 34suppliers and materials management, 9-10,

12terminology of, 32-33

Quality oversight, 5-6, 8Quality planning, 2-3, 4Quality System Essentials, 2Quarantine

of collected blood, 213-214of nonconforming products, 284-285, 286of repeatedly reactive units, 247, 248-249,

250of tissue allografts, 961-962

Quarantine release errors, 251, 255

R

Radiation safety, 63-66Radios, 113Raph system, 355, 413, 432, 988Rare Donor Program, 492, 914-915RBCs. See Red Blood CellsRd antigen, 354, 427, 986Reagents

for ABO testing, 370antibodies to components of, 370, 372, 487-

488antiglobulin, 444, 467, 469, 498-499bovine albumin, 448, 899chloroquine diphosphate, 478, 891-892contamination of, 406DTT (dithiothreitol), 476for elutions, 501, 917-920enhancement media, 469, 488enzymes, 449, 473, 476, 478, 902-905glycine-HCl/EDTA, 478, 892-893labeling, 865LISS (low-ionic-strength saline), 448-449,

473, 899monoclonal, 370, 398, 399, 406PEG (polyethylene glycol), 449, 473, 899-

900for phenotyping, 491-492preparation of, 865, 869-871, 873, 888-889,

902-903quality control intervals for, 39red cells, 448, 466-467for Rh testing, 398, 399, 405-406sulfhydryl, 478, 890, 909-911, 912-913ZZAP, 476, 478

1030 � A A B B T E C H N I C A L M A N U A L

Real-time PCR (polymerase chain reaction), 304-306

Recalls, 93, 94, 859Recipients

ABO and Rh testing in, 369-370, 400, 445, 447-448

antibody detection in, 448-450consent of, 617-618crossmatching in, 452-455disclosure of adverse outcomes to, 859education of, 618identification of, 287, 437, 438-441, 457,

621, 622-623immunocompromised, 250medical history of, 464monitoring during transfusions, 624-625phenotyping, 402-403, 472-473records of, 450-451, 736tracing (look-back), 247, 248-249, 250, 859of unknown identity, 439, 441weak D in, 400, 445, 447-448

Recombinant human erythropoietin (rHuEPO)

in HPC transplantation, 692-693in newborns and infants, 646-647for preoperative anemia, 673

Recombination, 345Reconstituted Red Blood Cells, 201, 281Records

altering, 18-19apheresis, 230, 232blood component, 457checking before blood release, 286-287,

457, 621-622comparing testing results to, 450-451confidentiality of, 19donor, 140-141electronic, 18-19, 118management of, 13, 16, 18-19personnel, 19, 47protection of, during disasters, 110-111,

118, 124quality control, 16storage of, 19of tissue allografts, 857-858, 961-962transfusion, 457, 626of transfusion complications, 736

Recovered Plasma, 205, 275Red Blood Cell transfusion, 571-579

ABO/Rh compatibility of, 447, 451, 575-576, 625, 694, 695

alternatives to, 674-679in autoimmune hemolytic anemias, 507-

508, 511, 578

in emergency release, 214, 287-288, 457-458, 577-578, 627

in exchange transfusion, 653-655hemoglobin targets in, 577in HPC transplantation, 692-693, 785of incompatible units, 578indications for, 571-579, 643, 644, 652-655infusion rates for, 625, 659intrauterine, 635-636in massive transfusion, 288, 458, 748-751non-group-specific, 288-289, 458-459in pediatric patients, 648-655, 660-663in red cell exchange, 717-718

Red Blood Cells aliquoting, 283, 650-651bacterial contamination of, 259biochemical changes of storage in, 276, 277,

575cryopreservation of, 208-209, 947-952expiration of, 201, 273-274hemoglobin/hematocrit of, 201inspecting, 202irradiated, 211, 273leukocyte content of, 577low-volume or undercollected units, 194-

195, 201pathogen reduction of, 264phenotyping, 491-492, 662preparation of, 199-200, 944-945quality control of, 217-218rare, 492-493reconstituted, 201, 281rejuvenated, 213, 273, 274, 284, 946-947return and reissue of, 289storage of, 273-274, 276, 482substitutes for, 578-579survival studies of, 491, 578, 735-736transportation and shipping of, 285washed, 218, 273, 280, 577, 664

Red Blood Cells, Apheresis, 231-232collection of, 228, 235donation requirements for, 160, 162, 168, 231quality control of, 218, 231-232records of, 232storage and expiration of, 273

Red Blood Cells, Deglycerolizedexpiration of, 273, 280leukocyte content of, 577preparation of, 209, 280, 948-949, 951quality control of, 218, 952rejuvenated, 274storage of, 273

Red Blood Cells, Frozencryoprotective agents for, 208, 209

I N D E X � 1031

expiration of, 273preparation of, 208-209, 947-952rejuvenated, 274, 284storage of, 273, 948thawing and deglycerolizing, 280, 948-949,

951transportation and shipping, 285

Red Blood Cells Leukocytes Reduced, 576leukocyte content of, 201, 576, 577preparing, 945-946prestorage filtration, 207-208quality control of, 218storage and expiration of, 273

Red cell depletion, 790, 829, 830Red cell exchange, 708, 714, 715, 717-718, 740Red cell losses, in apheresis, 230Red cell sedimentation, 790Red cell substitutes, 578-579Red cells

normal values for, 979preparation of 3% suspension, 872-873separating autologous and transfused, 893-

895volume of, normal value, 983

Reference laboratories, 490Refractoriness to platelets, 524-528

ABO compatibility in, 523-524antibody specificity prediction method for,

527causes of, 525-526HLA antibodies in, 524, 525-528, 560-561,

587, 732HLA matched platelets for, 526-527, 560-561managing, 587-588platelet crossmatching for, 527-528, 561,

587preventing alloimmunization in, 528

Refrigerators, 37, 272, 967-968Regulatory issues, 87-96

for biological products, 88-89for blood-related devices, 88, 91for donor eligibility, 137-138, 163-178for drugs, 87-88for emergencies, 122-124FDA inspections, 90-91hospital regulations and accreditation, 95,

96for HPCs, 91-93, 794, 837-838licensure and registration, 89-90medical laboratory laws and regulations,

93-94, 96for quality systems, 1-2, 34for radioactive materials, 64recalls and withdrawals, 93, 94

for safety, 41-42, 64, 71-72for shipping hazardous materials, 866-867state and local regulations, 96for tissue, 853-854

Reissuing blood products, 289, 622Rejuvenated RBCs, 213, 273, 274, 284, 946-947Rejuvesol, 284Relationship testing, 351-353, 565Relative risk, 566Releasate, 282Remedial action, 26Renal failure, 713, 738Reports

of adverse events related to tissue grafts, 858, 859, 961-962, 963

facility quality, 26-27of fatalities, 20, 47, 91, 197, 756, 757of injuries, 47internal event, 20, 21

Requests for transfusion, 437-438, 455, 456, 618, 776-777

Requirement, defined, 33Respiratory distress

in therapeutic apheresis, 718-719in TRALI, 745-747

Restricted work areas, 43Restriction fragment length polymorphism

analysis (RFLP), 304Reticulocyte counts, 979Retrospective audits, 765, 767-768, 769, 771-

772, 772Retrovirus Epidemiologic Donor Study, 147Reverse transcriptase PCR, 300-302RFLP (restriction fragment length

polymorphism analysis), 304Rg1/Rg2, 355, 429, 477, 911-912, 987Rh Immune Globulin, 636-639

after non-group-specific transfusions, 289antepartum administration of, 634, 636-638in antibody identification problems, 464development of, 390dosage for, 637-638in platelet transfusions, 586positive DAT after, 500postpartum administration of, 637-638serology and mechanism of, 638-639

Rh system, 389-407antibodies of, 405, 412, 492, 507antigens of, 354, 390, 391, 394-403

C/c and E/e, 401-403D antigen, 394, 396-401G antigen, 401prevalence of, 391-392

clinical considerations for, 400-401

1032 � A A B B T E C H N I C A L M A N U A L

in component selection, 451, 492, 586ethnic differences in, 391, 392, 394, 397, 398genes and proteins of, 354, 393-394, 397,

989genotypes, 394, 395haplotypes in, 390, 392history of, 389-390in HPC transplantation, 698, 789nonerythroid Rh glycoproteins, 404-405phenotypes, 394, 395, 989RhAG, 356, 404, 413, 432, 988terminology for, 390-393, 985, 989

Rh testingof apheresis components, 229with autoagglutinins, 406, 509of blood components, 286, 451for C, c, E, e antigens, 395comparison with previous records, 450-451controls for, 405-406of cord blood, 634for D antigen, 398-401, 403-404discrepancies in, 400, 407, 509of donors, 398, 400, 451false-positive/-negative results in, 406-407in HDFN, 407, 632, 634, 637in multitransfused patients, 403in pediatric patients, 407, 457, 634, 648-650,

661phenotyping, 395, 492in prenatal evaluation, 632reagents for, 398, 399, 405-406of recipients, 400, 445, 447-448for sickle cell patients, 401-402, 404slide test for, 885in transfusion reaction evaluation, 735tube test for, 885-886for weak D, 400, 403-404, 445, 447-448, 637,

887-888RhAG system, 356, 404, 413, 432, 988RhBG, 404-405RhCE, 393-394, 405RhCG, 404-405RhD, 393-394, 405Rheopheresis, 709Rhmod, 348Rhnull, 348, 404Risk assessment of hazards, 104-105, 108Risk, relative, 566RNA (ribonucleic acid), 295RNA microarray hybridization, 306Rodgers blood group. See Chido/RodgersRoot causes, of problems, 27-28Rosette test, 637, 933-935Rouleaux

in ABO discrepancies, 370, 372in antibody detection/identification, 445,

488in Rh typing, 406saline replacement technique for, 373, 488,

901-902“Rule-out” method, 470Run charts, 24

S

S/s antigens and antibodies, 354, 414, 989Safe work practices

for biosafety, 55-56for chemical safety, 61, 80-81for electrical safety, 50for fire prevention, 49general guidelines for, 45, 75for radiation safety, 65-66

Safety goggles, 74Safety program, 44-67

accidents and injuries in, 47, 48, 52biosafety in, 50-58, 77chemical safety in, 58-63, 78-86in disaster management, 110electrical safety in, 49-50emergency response plan in, 45employee health services in, 46-48engineering controls in, 45, 75fire prevention in, 48-49first aid and follow-up in, 47hazard identification and communication

in, 45hepatitis prophylaxis in, 46-47latex allergies in, 47-48management controls in, 45, 46personal protective equipment in, 45, 73-74quality management of, 7, 12radiation safety in, 63-66regulations and recommendations for, 41-

42, 71-72resources for information, 994-995safe work practices in, 45, 75safety officers in, 44, 58, 64safety plan in, 44shipping hazardous materials in, 66, 865-

867training in, 45, 46waste management in, 67

Saline replacement technique, 373, 488, 901-902

SalivaLewis substance in, 477, 881-883testing for ABH antigens, 881-883

Samples, blood. See Blood samples

I N D E X � 1033

Sandwich ELISA, 310-311SC1/SC2/SC3, 354, 412, 427, 986SCAN (SC7), 427, 986SCER (SC6), 427, 986Scianna system, 354, 412, 427, 986Scoring reactions, 445SD (solvent/detergent-treated) plasma, 206, 264Sda antigen, 433

agglutination pattern of antibody, 433, 445neutralization of, 433, 477, 913-914

Secretorsgenetics of, 373, 374, 375, 376-377linkage with Lutheran group, 346saliva testing for, 881-883

Security, 110Segments, of RBCs, 201-202Selective absorption, 709, 716-717Sensitization, 442-443Sepax Cord Blood Processing System, 830-831Sepsis

neonatal, 597, 658transfusion-associated, 731, 736, 741

Sequence-based typing (SBT), 558Sequence-specific oligonucleotide probes

(SSOP), 557-558Sequence-specific primers (SSP), 534, 557, 558Serologic testing principles, 442-442Serotonin release assay (SRA), 538Serum

dilution procedure, 871-872for pretransfusion testing, 441, 463-464, 466proteins of, in typing discrepancies, 370,

373, 406ratio to cells, in antibody identification, 476

Services, critical, 4, 9Sewage disposal, in disaster plan, 118Sex-linked inheritance, 339-343Sexual contacts, of blood donors, 170-171, 175,

178Sharps injuries, 52Shelter, emergency, 119-120Shipments

container temperature during, 198-199, 272, 832-834, 856, 868

containers for, 39, 272, 285, 792, 832-833, 867

of frozen products, 285, 792, 833of hazardous materials, 66, 865-867of HPCs, 792, 832-833labeling, 833, 867packaging with dry ice, 285, 867of samples, 66, 865-867

Shock, 738Showers, emergency, 61

Sickle cell diseasealloimmunization in, 402-403, 451, 662in blood donors, 150delayed transfusion reactions in, 662, 753genotyping for, 404in pediatric patients, 661-662red cell exchange in, 715, 717separation of transfused from autologous

cells in, 472, 894transfusion in, 402-403, 451, 661-662

Side effects. See Adverse reactionsSigns, safety, 49, 51, 60, 61Silent mutations, 335Single nucleotide polymorphisms, 306-307Six Sigma, 29Skin appearance, in donors, 142, 161Skin grafts, 169, 844, 851-852Sl1/Sl2/Sl3, 355, 430-431, 988Slide test

for ABO group, 875-876for Rh type, 885

Small intestine transplants, 564-565Sodium citrate, 717, 718, 732, 749Solid-phase red cell adherence (SPRCA)

for detection of HLA antibodies, 559for detection of platelet antibodies,

533for phenotyping red cells, 309-310for platelet crossmatching, 528for pretransfusion testing, 449-450

Soluble antigensABH, 881-883Chido/Rodgers substance, 478, 911-912HLA, 553Lewis, 477, 881-883P1 substance, 477Sda substance, 433, 477, 913-914testing for, 881-883

Solutionsadditive, 188, 192, 201, 277, 651-652anticoagulant-preservative, 188, 191, 216,

277, 827dilution of, 872IV, 624phosphate buffer, 873preparation of, 865, 869-871, 873

Solvent/detergent-treated plasma (SD plasma), 206, 264

Source Plasma, 230-231Specific gravity, of blood cells and

components, 195Specification, defined, 33Spills

blood, 56-57

1034 � A A B B T E C H N I C A L M A N U A L

chemical, 62, 82-86radioactive, 66

“Splits,” 554Spokespersons, 115SPRCA. See Solid-phase red cell adherenceSRA (serotonin release assay), 538SSOP (sequence-specific oligonucleotide

probes), 557-558SSP (sequence-specific primer), 534, 557, 558Staffing, 8-9, 118-120, 123Standard operating procedures. See

ProceduresStandard Precautions, 50-51, 55Standards

for biosafety, 50-51for component quality control, 217-221for donor eligibility, 137-138, 163-178for HPC transplantation, 691-692, 794, 838for performance improvement, 26for pretransfusion testing, 438for quality management, 1- 2for tissue transplantation, 854

Staphylococcal protein A absorption, 716STAR (SC5), 427, 986Statistical tables for binomial distribution, 35-

36Stem cells, 840. See also HPC entriesSterile connection devices, 38, 192, 193, 211,

650Storage

of biohazardous material, 55, 57of blood components, 272-279

biochemical changes in, 276-279, 575, 583-584

Cryoprecipitated AHF, 206, 212, 275, 278Granulocytes, 207, 233, 274, 279, 597Plasma, 203-204, 274-275Platelets, 202-203, 274Red Blood Cell components, 273-274,

575, 948red cell antigen deterioration with, 482Whole Blood, 198, 273

of blood samples, 442in disaster plan, 116equipment for, 272, 276of hazardous chemicals, 61of HPCs, 790-792, 808, 831-832liquid nitrogen, 791, 832of records, 19temperature for, 272, 273-275, 276, 865of tissue grafts, 857, 859-860

Storage lesionof platelets, 276, 583-584of red cells, 276, 277, 575

STR (short tandem repeat) analysis, 352Stromal cells, 840Subgroups of ABO system, 365-366, 367-368

in ABO discrepancies, 370, 372testing for, 373, 879-881, 883

Sulfhydryl reagents, 478to alter blood group antigens, 476, 478, 912-

913applications for, 478in dispersing autoagglutination, 510, 890to distinguish IgM from IgG, 909-911

Suppliersmanagement of, 9-10, 12of tissues for transplantation, 854, 855, 856,

962-963Supplies, critical, 9-10Surgery

acidosis in, 681blood administration in, 627blood loss in, 674, 675, 677blood recovery in, 674, 676-678component sequestration in, 679deliberate hypotension in, 679-680drugs to assist coagulation function in, 681hemostatic agents for, 676normovolemic hemodilution in, 678-679operating room take-backs, 672-673point-of-care testing in, 681positioning in, 680preoperative anemia, 673-674preoperative autologous donation for, 674routine blood orders for, 286, 991temperature regulation in, 680-681transfusion benchmarks for, 672transfusion thresholds following, 573-574

Survey meters, for radiation monitoring, 65Survival studies of red cells, 491, 578, 735-736Syngeneic HPC transplantation, 779, 782, 811-

812Syntenic genes, 345Syphilis, 172, 244, 248, 249, 257, 850Syringe aliquoting devices, 283, 284, 650-651Syringe infusion pumps, 620, 658

T

T activation, 370-371T-cell receptors, 314T-cell reduction (depletion), 787T cells

CD4+, 314-315helper, 316-317in immunity, 314-316regulatory, 839-840

I N D E X � 1035

TA-GVHD. See Transfusion-associated graft-vs-host disease

TACO (transfusion-associated circulatory overload), 731, 746, 747-748

Tattoos, 172Tca/Tcb/Tcc, 355, 430, 988Telephones, in disaster plan, 112-113, 118Temperature

of antibody reactivity, 443, 476, 485-486of collected whole blood, 198for component storage, 272-276, 865of donor, 161incubation, 476, 865monitoring systems for, 272, 276, 868in recipients, 621regulation of, during surgery, 680-681during shipments, 198-199, 272, 285, 832-

834, 856, 868Teratogens, 151Terminology

for blood group systems, 354-356, 357-359, 984-989

of quality systems, 32-33for Rh system, 390-393

Test resultson component labels, 216grading, 445, 873-874

Text messaging, 113Thalassemia, 662-663Thawed Plasma, 204, 205, 275, 278, 593Thawing

Cryoprecipitated AHF, 280, 954-955devices for, 38Fresh Frozen Plasma, 279-280Frozen RBCs, 280, 948-949, 951HPCs, 792, 808, 834-835

Therapeutic apheresis, 707-722adverse effects of, 718-720, 722anticoagulation in, 717cytapheresis, 714-715indications for, 709-717modalities of, 708-709patient evaluation in, 721, 722photopheresis, 715-716principles of, 707-708replacement fluids in, 593, 717-718rheopheresis, 709selective absorption, 716-717therapeutic plasma exchange, 709-714vascular access in, 720, 722

Therapeutic plasma exchange (TPE)adverse effects of, 718-720in hemolytic disease of the fetus and

newborn, 636

indications for, 709-714instrumentation for, 708-709volume exchange in, 708

Thermal amplitude studies, 491, 509Thermometers, 38, 272, 965-967Thrombin, 282, 595Thrombin time, normal value, 982Thrombocytopathy, 580-581Thrombocytopenia

after HPC transplantation, 693-697drug-induced, 535-538, 587fetal and neonatal alloimmune, 532, 639-

641heparin-induced, 536-538, 588immune, 150, 534-535, 588, 641management of, 585in pediatric patients, 532, 639-641, 655-656in plasmapheresis, 720platelet transfusions in, 579-589posttransfusion purpura, 532-533, 733, 754-

756thrombotic thrombocytopenic purpura,

588, 713, 717, 718Thrombocytosis, 715Thromboelastograph analysis, 592Thrombophilia, in blood donors, 149Thrombosis, in blood donors, 149, 197Thrombotic thrombocytopenic purpura

(TTP), 588, 713, 717, 718Ticlopidine, 151, 184, 229Time, incubation, 444, 476Timers, 38Tissue

collecting, 859infectious disease testing of, 850processing, 850-851quarantine of, 961-962recall of, 859receipt, inspection and testing of, 855-856regulations and standards for, 91-93, 853-

854standard operating procedures for, 855storage of, 857, 859-860suppliers of, 854, 855, 856, 962-963traceability and records of, 857-858, 961-

962transporting, 856See also Tissue transplantation

Tissue antigens. See HLA antigensTissue banks and distributors, 853Tissue transplantation, 849-860

ABO compatibility in, 853adverse events in, 858-859, 961-963antibody development after, 853

1036 � A A B B T E C H N I C A L M A N U A L

of autografts, 859-860background of, 850clinical uses for, 851-853disease transmission through, 853history of, in blood donors, 168, 177hospital-based service for, 854-855look-back investigations in, 859organ transplantation, 860oversight of, 854-855regulations and standards for, 91-93, 853-

854standard operating procedures for, 855types of grafts for, 850

Titration of antibodies, 480-481cold agglutinins, 923maternal antibodies, 480, 633, 935-937methods for, 907-909, 935-937

Traceability, of tissue allografts, 857-858Training

for biosafety, 51for chemical safety, 58-59for disasters, 119, 122, 124-125for electrical safety, 49FDA cGMP and cGTP, 8for fire safety, 48for general safety, 45, 46for new employees, 7-8for radiation safety, 65

Traits, 337. See also Inheritance patternsTRALI. See Transfusion-related acute lung

injuryTrans position, 347Transcription-mediated amplification (TMA),

302, 303Transfusion-associated circulatory overload

(TACO), 731, 746, 747-748Transfusion-associated graft-vs-host disease

(TA-GVHD), 733, 753-754HLA system in, 527, 561-562in HPC transplant patients, 700in neonates, 647treatment and prevention of, 526-527, 754

Transfusion-associated sepsis, 731, 736, 741Transfusion committee, 24-25Transfusion reactions, 727-757

acute, 737-751biovigilance programs in monitoring, 727-728categories of, 729-733clinical evaluation and management of,

728, 734delayed, 751-757in HSCT patients, 700-701laboratory investigation of, 734-736recognizing, 626, 728

records of, 736reporting, 20, 22signs and symptoms of, 728, 729-733

Transfusion-related acute lung injury (TRALI), 730, 745-747

differential diagnosis of, 745-746, 748HLA antibodies in, 561, 746laboratory evaluation of, 736neutrophil antibodies in, 540, 746

Transfusion-related immunomodulation (TRIM), 576

Transfusion thresholdsin pediatric patients, 652-653for platelet transfusions, 579-580, 655, 663,

694, 696for red cell transfusions, 573-574, 652-653,

671-672, 692Transfusion-transmitted diseases, 254-263

by Babesia, 260-261bacteria, 257-259, 731, 741chikungunya virus, 261dengue virus, 261hepatitis B virus, 255-256hepatitis C virus, 256human immunodeficiency virus, 254-255human T-cell lymphotropic virus, 256-257malaria, 261parvovirus B19, 262-263prions, 262safety precautions for, 50-58syphilis, 257by Trypanosoma cruzi, 260West Nile virus, 259

Transfusionsadministration procedures for. See Blood

administrationalternatives to, 674-679auditing, 24-25, 672, 763-772chimerism after, 561-562consent for, 617-618of Cryoprecipitated AHF, 594-595, 657-658during disasters, 107-108documentation of, 626exchange, 636, 653-655fatalities due to, 20, 739, 756, 757of Granulocytes, 233, 595, 597, 658and HLA system, 560-562in HPC transplantation, 692-698, 785intrauterine, 635-636massive, 288, 458, 748-751in medical history, 168, 441-442, 464, 488-

489, 499non-group-specific, 288-289, 458-459in operating room and trauma, 627

I N D E X � 1037

in organ transplantation, 860out-of-hospital, 627in pediatric patients, 645-664of Plasma, 589-593, 656-657of plasma derivatives, 597-603of platelet components, 579-589, 655-656of Red Blood Cells, 571-579, 648-655requests for, 437-438, 455, 456, 618, 776-777selection of components for, 447, 451-452single-unit, 672in urgent situations, 287-288, 457-458, 577-

578, 627of Whole Blood, 575

Transmissible spongiform encephalopathy, 262Transplantation. See Hematopoietic stem cell

transplantation; Organ transplantation; Tissue transplantation

Transplantation antigens. See HLA antigensTransportation

of blood components, 198-199, 272, 621containers for, 39, 272, 285, 792, 867in disaster plan, 116of hazardous materials, 66, 856-867of HPCs, 792, 832-833labeling requirements, 833, 867monitoring temperatures during, 198-199,

272, 833-834, 856, 868packaging with dry ice, 285, 867of samples, 66, 865-867of tissue, 856

Trauma, blood administration in, 627Travel, by blood donors, 173-174, 178, 261Treponema pallidum, 257Trypanosoma cruzi, 260

reactive donor screening for, 248, 249, 250screening donors for, 244, 260

Tube testfor ABO group, 876for Rh type, 885-886

Tumor cell detection, 794Tumor purging, 787, 810-811Two-unit red cell collection, 160, 162, 168, 228,

231-232Type and crossmatch, 455, 456Type and hold, 455, 456Type and screen, 455, 456

U

U antigen, 412, 416Ulcerative colitis, 717Ulex europaeus lectin, 367, 373, 888-889Ultrasonography, 634Ultraviolet B irradiation, 528, 560Umbilical cord blood. See HPC, Cord (HPC-C)

Uniforms, 73Urea transporter-11, 425Urgent release of blood, 287-288, 457-458,

577-578, 627Urine

examinations of, in transfusion reactions, 735

neutralization of Sda, 433, 477, 913-914Urticaria (hives), 729, 742-743, 744Utilities, in disaster plan, 117-118Utilization of blood. See Blood utilization

V

Vaccines, 47, 151, 167-168, 184Validation

of computer systems, 15definition of, 33of equipment, 15of processes, 14of shipping containers, 198-199, 272, 285statistical tables for, 35-36of test methods, 14validation plans, 14-15

Vapors, hazardous, 62, 63Variant Creutzfeldt-Jakob disease (vCJD)

and plasma derivatives, 598screening donors for, 138, 140, 173, 174, 262

Vascular accessfor apheresis, 720, 722for HPC, Apheresis collection, 812in pediatric patients, 619, 654, 658for transfusions, 619

Vasovagal reactions, 150, 196-197, 719, 743Vector-borne diseases, 259-261Vel antigen, 433Venipuncture, 161, 192-194, 940-943Verification, defined, 33Viability assays for HPCs, 793View boxes, 38Virus inactivation, 263, 264, 597-598Viruses

donor screening for, 254-257, 259, 261transmitted by tissue transplants, 850, 858,

859transmitted by transfusion, 254-257, 259

Viscosity, plasma, 712-713, 979Vital signs, 621, 626Vitamin K, 590VLAN (KEL25), 420, 985Volume of blood

administered in intrauterine transfusions, 636

administered in neonatal transfusions, 652in exchange transfusions, 654

1038 � A A B B T E C H N I C A L M A N U A L

normal values for, 983in pediatric patients, 646, 983in whole blood collections, 160, 194-195, 216

Volume of plasma, 983Volume of red cells, 983Volume overload. See Transfusion-associated

circulatory overloadVolume-reduction

of platelets, 212-213, 282, 586, 656, 664, 957-958

of umbilical cord blood, 829von Willebrand disease, 149, 594-595, 596,

657-658von Willebrand factor (vWF), 594VONG (KEL28), 420, 985

W

Warfarin, 152, 590, 591Warm autoantibodies, 489-490

adsorption of, 506-507, 924-927alloantibodies with, 504-507disease associations with, 464mimicking alloantibodies, 506-507in mixed-type autoimmune hemolytic

anemia, 511in phenotyping problems, 472-473Rh testing with, 406transfusion with, 507-508in warm autoimmune hemolytic anemia,

502, 503, 504-508Warm autoimmune hemolytic anemia

(WAIHA), 502, 504-509adsorption testing in, 505-507autoantibody specificity in, 507blood selection in, 507-508

Warm-reactive alloantibodies, 443Warmers, blood, 38, 619-620, 647, 658, 741,

751Washed components, 280

HPC, Cord, 834-835for HPC transplant patients, 700for pediatric patients, 648, 664Platelets, 280, 664Red Blood Cells, 218, 273, 280, 577, 664Rejuvenated Red Blood Cells, 213, 274

Waste management, 67biohazardous, 57-58chemical, 62-63disposal, 57radioactive, 66treating, 57-58

Water supply, in disaster plan, 117Waterbaths, 38WB. See Whole Blood

Wb (GE5), 429, 987Weak D, 396-397

in donors, 400, 451in prenatal patients, 637in recipients, 400, 445, 447-448testing for, 400, 445, 447-448, 887-888

Weight, donor, 142, 194, 230WESa/WESb, 430, 988West Nile virus, 259

nucleic acid testing for, 246, 259reactive donor screening for, 248, 249, 250screening donors for, 138, 244, 259

Western blotting, 312White cells, 979, 980Whole Blood (WB), 201

ABO compatibility of, 447, 575-576biochemical changes during storage, 276, 277donation intervals for, 160, 166-167expiration of, 273hematocrit of, 201indications for, 575irradiated, 273leukocyte content of, 577processing, 199-200quality control of, 217reconstituted, 201, 281storage of, 273transportation of, 198-199, 285volume collected, 160

Wipe tests, 65Withdrawals, 93, 94Wka (K17), 420, 989Work environment. See FacilitiesWork instructions, 17Wra/Wrb, 348, 354, 412, 426, 986Wristbands, patient, 439Wrong blood in tube, 450-451, 455, 740

X

X chromosome inactivation, 332-334Xenogeneic HPC transplantation, 779Xenografts, 850Xg system, 426-427

antibodies in, 412, 427genes and antigens in, 354, 426-427, 986inheritance pattern of, 333, 341-342

XK gene, 333, 343, 355, 421

Y-Z

Yka, 355, 430-431, 988Yt system, 354, 412, 426, 986Zygosity, 481. See also Dosage effectZZAP, 476, 478, 510

Glossary ofAbbreviations

AATB American Association of Tissue BanksACD acid-citrate-dextroseACE angiotensin-converting enzymeACOG American College of Obstetricians and

GynecologistsADP adenosine diphosphateAET 2-aminoethylisothiouroniumAHF antihemophilic factorAHG antihuman globulinAHTR acute hemolytic transfusion reactionAIDS acquired immune deficiency syndromeAIHA autoimmune hemolytic anemiaALDH aldehyde dehydrogenaseALT alanine aminotransferaseAML acute myelogenous leukemiaAMR antibody-mediated rejectionANH acute normovolemic hemodilutionAORN Association of periOperative Registered

NursesAPC antigen-presenting cellaPTT activated partial thromboplastin timeARDP American Rare Donor ProgramAS additive solutionASFA American Society for ApheresisASHI American Society for Histocompatibility

and ImmunogeneticsATP adenosine triphosphateBCR B-cell receptorBLA biologics license applicationBPD biological product deviationBSA bovine serum albumin or body surface

areaBSC biological safety cabinetBSL-1 Biosafety Level 1CAP College of American PathologistsCAS cold agglutinin syndromeCBER Center for Biologics Evaluation and

Research

CCI corrected count incrementCD clusters of differentiationCDC Centers for Disease Control and

PreventioncDNA complementary deoxyribonucleic acidCDRH Center for Devices and Radiological

HealthCFR Code of Federal RegulationsCFU colony-forming unitCGD chronic granulomatous diseasecGMP current good manufacturing practicecGTP current good tissue practicecGy centiGrayCI confidence intervalCIDP chronic inflammatory demyelinating

polyneuropathyCJD Creutzfeldt-Jakob diseaseCLIA Clinical Laboratory Improvement

AmendmentsCLSI Clinical and Laboratory Standards

InstituteCML chronic myelogenous leukemiaCMS Centers for Medicare and Medicaid

ServicesCMV cytomegalovirusCNS central nervous systemCP2D citrate-phosphate-dextrose-dextroseCPD citrate-phosphate-dextroseCPDA-1 citrate-phosphate-dextrose-adenine-1CR complement receptorCREG cross-reactive groupCRYO cryoprecipitate (Cryoprecipitated AHF)C/T crossmatch/transfusionCV coefficient of variationDAF decay-accelerating factorDAT direct antiglobulin testDDAVP deamino-D-arginine vasopressinDHQ donor history questionnaireDHTR delayed hemolytic transfusion reaction

DIC disseminated intravascular coagulationDMSO dimethylsulfoxideDNA deoxyribonucleic acidDOT (US) Department of Transportation2,3-DPG 2,3-diphosphoglycerateDRG diagnosis-related groupDSTR delayed serologic transfusion reactionDTT dithiothreitolEACA epsilon aminocaproic acidEBAA Eye Bank Association of AmericaECMO extracorporeal membrane oxygenationECV extracorporeal volumeEDTA ethylenediaminetetraacetic acidEIA enzyme immunoassayELBW extremely low birthweightELISA enzyme-linked immunosorbent assayEMAs emergency management agenciesEPO erythropoietinFACT Foundation for the Accreditation of

Cellular TherapyFcR Fc gamma receptorFDA Food and Drug AdministrationFFP Fresh Frozen PlasmaFMH fetomaternal hemorrhageFNAIT fetal/neonatal alloimmune

thrombocytopeniaFNHTR febrile nonhemolytic transfusion

reactionFTA-ABS fluorescent treponemal antibody

absorption testG-CSF granulocyte colony-stimulating factorGalNAc N-acetylgalactosamineGM-CSF granulocyte-macrophage colony-

stimulating factorGMP good manufacturing practiceGPIa glycoprotein IaGPA glycophorin AGPB glycophorin BGPC glycophorin CGPD glycophorin DGTP good tissue practiceGVHD graft-vs-host diseaseGy GrayHAV hepatitis A virusHAZMAT hazardous materialHb hemoglobinHBc hepatitis B core antigen

HBsAg hepatitis B surface antigenHBV hepatitis B virusHct hematocritHCT/Ps human cells, tissues, and cellular and

tissue-based productsHCV hepatitis C virusHDFN hemolytic disease of the fetus and

newbornHES hydroxyethyl starchHHS (US) Department of Health and Human

ServicesHIT heparin-induced thrombocytopeniaHIV human immunodeficiency virusHNA human neutrophil antigenHPA human platelet antigenHPC hematopoietic progenitor cellHPC(A) HPCs from apheresis (HPC, Apheresis)HPC(C) HPCs from cord blood (HPC, Cord

Blood)HPC(M) HPCs from marrow (HPC, Marrow)HSC hematopoietic stem cellHSCT hematopoietic stem cell transplantationHTLV-I human T-cell lymphotropic virus, type IHTR hemolytic transfusion reactionHUS hemolytic uremic syndromeIAT indirect antiglobulin testIATA International Air Transport AssociationICAM-1 intercellular adhesion molecule-1ID indentification or individual donationIg immunoglobulinIL-1α interleukin-1 alphaIL-1β interleukin-1 betaIL-2 interleukin-2IM intramuscularIND investigational new drugINR international normalized ratioIRL immunohematology reference

laboratoryIS immediate spinISBT International Society of Blood

TransfusionISO International Organization for

StandardizationITP immune thrombocytopeniaIU international unitIV intravenousIVIG intravenous immune globulinLDH lactate dehydrogenase

LDL low-density lipoproteinLISS low-ionic-strength salineLN2 liquid nitrogenLR leukocyte-reducedMAC membrane attack complex2-ME 2-mercaptoethanolMF mixed fieldMHC major histocompatibility complexMNC mononuclear cellMoAb monoclonal antibodyMPHA mixed passive hemagglutination assaymRNA messenger ribonucleic acidMSDS material safety data sheetMSM males who have sex with other malesNAIT neonatal alloimmune thrombocytopeniaNAN neonatal alloimmune neutropeniaNAT nucleic acid testingNHLBI National Heart, Lung, and Blood

InstituteNIH National Institutes of HealthNIPA nonimmunologic protein adsorptionNK natural killerNMDP National Marrow Donor ProgramNRC Nuclear Regulatory CommissionNRF National Response FrameworkOSHA Occupational Safety and Health

Administrationp probabilityPAD preoperative autologous (blood)

donationPBS phosphate-buffered salinePCH paroxysmal cold hemoglobinuriaPCR polymerase chain reactionPEG polyethylene glycolPF24 Plasma Frozen Within 24 Hours After

PhlebotomyPPE personal protective equipmentPRA panel-reactive antibodyPRCA pure red cell aplasiaPRP platelet-rich plasmaPRT pathogen reduction technologyPT prothrombin time or proficiency testingPTP posttransfusion purpuraPTT partial thromboplastin timePVC polyvinyl chlorideQA quality assessment or quality assurance

QC quality controlQSE Quality System EssentialRBCs Red Blood Cells (blood donor unit)RFLP restriction fragment length

polymorphismrFVIIa recombinant Factor VIIaRh Rhesus factorRHAG Rh-associated glycoproteinRhIG Rh Immune GlobulinRIBA recombinant immunoblot assayRIPA radioimmunoprecipitation assayRNA ribonucleic acidRPR rapid plasma reagin (serologic test for

syphilis)RT room temperature or reverse

transcriptaseSCF stem cell factorSD standard deviation or solvent/detergentSNP single nucleotide polymorphismSOP standard operating procedureSPRCA solid-phase red cell adherenceTA transfusion-associatedTACO transfusion-associated circulatory

overloadTCR T-cell receptorTMA transcription-mediated amplificationTNCs total nucleated cellsTNF-α tumor necrosis factor alphaTPE therapeutic plasma exchangeTPO thrombopoietinTRALI transfusion-related acute lung injuryTSE transmissible spongiform

encephalopathyTTP thrombotic thrombocytopenic purpuraUCB umbilical cord bloodUDP uridine diphosphateUNOS United Network for Organ SharingUSC United States CodevCJD variant Creutzfeldt-Jakob diseaseVLBW very low birthweightvWD von Willebrand diseasevWF von Willebrand factorWAIHA warm autoimmune hemolytic anemiaWB whole blood or Western blotWBC white blood cellWHO World Health OrganizationWNV West Nile virus