Rh Negative Pregnant Women and the RhoGAM Shot

"I'm Rh negative an had to get a shot while pregnant, why?"

Rh-negative Mothers and the Importance of Rh Immune Globulin Shots

Rh-negative blood type is a relatively rare blood type, present in only about 15% of the global population. In cases where an Rh-negative mother is pregnant with an Rh-positive baby, there is a risk of Rh incompatibility that can potentially lead to serious health complications for both the mother and the baby.

Rh incompatibility occurs when an Rh-negative mother is exposed to Rh-positive blood from her baby, either during pregnancy or delivery. This exposure can cause the mother's immune system to produce antibodies against the Rh factor, which can potentially lead to hemolytic disease of the fetus and newborn (HDFN) in subsequent pregnancies.

HDFN is a condition where the mother's antibodies attack and destroy the baby's red blood cells, leading to anemia, jaundice, brain damage, and even death in severe cases. To prevent Rh incompatibility and HDFN, Rh-negative mothers are recommended to receive an Rh immune globulin shot, also known as RhIg or RhoGAM, during and after pregnancy.

Rh immune globulin is a blood product that contains antibodies against the Rh factor. When given to an Rh-negative mother, RhIg can prevent her immune system from producing antibodies against the Rh factor, thereby preventing Rh incompatibility and HDN in future pregnancies.

RhIg is typically given to Rh-negative mothers at around 28 weeks of pregnancy, and again within 72 hours after delivery if the baby is Rh-positive. RhIg may also be given after any procedure that may cause mixing of maternal and fetal blood, such as amniocentesis or miscarriage.

While RhIg is generally safe and effective, like any medication, it may cause side effects in some individuals, such as pain or swelling at the injection site, fever, or allergic reactions. It is important for Rh-negative mothers to discuss the risks and benefits of RhIg with their healthcare provider and to report any side effects or adverse reactions.

Anti-D Antibody Titers

If a mother has Anti-D antibodies, it means that she has been previously sensitized to the Rh factor (D antigen), either through a previous pregnancy, blood transfusion, or other exposure to Rh-positive blood. This can potentially lead to hemolytic disease of the fetus and newborn (HDFN) in future pregnancies.

To monitor the risk of HDFN and the severity of the mother's Anti-D antibodies, healthcare providers typically perform antibody titers during pregnancy. Antibody titers are blood tests that measure the concentration and potency of the mother's Anti-D antibodies.

The results of antibody titers can help healthcare providers to determine the risk of HDN and the appropriate course of treatment. For example, if the mother's antibody titers are low, it may indicate a lower risk of HDN and close monitoring may be sufficient. If the mother's antibody titers are high, it may indicate a higher risk of HDN, and additional interventions, such as early delivery or intrauterine blood transfusions or even exchange transfusions after deliver, may be necessary.

In addition to monitoring the mother's antibody titers, healthcare providers may also monitor the baby's well-being through regular ultrasounds, amniocentesis, or other diagnostic tests to detect any signs of anemia, hydrops, or other complications.

Intrauterine Transfusions for HDFN

Intrauterine transfusion (IUT) is a medical procedure in which blood is transfused directly into the fetal bloodstream while the fetus is still in the uterus. This procedure is typically performed to treat severe cases of hemolytic disease of the fetus and newborn (HDFN) caused by Rh incompatibility between the mother and fetus.

During IUT, a needle is inserted into the fetus's abdomen or umbilical cord under ultrasound guidance, and blood is transfused through the needle into the fetal circulation. The blood used for the transfusion is typically Rh-negative and free of any antibodies that could further exacerbate the HDFN.

IUT is typically performed when the fetus is between 18 and 34 weeks gestation, depending on the severity of the HDFN and the availability of specialized medical facilities. The procedure is typically performed in a specialized center by a team of experienced healthcare providers, including maternal-fetal medicine specialists, neonatologists, and transfusion medicine specialists.

IUT carries some risks, including infection, bleeding, and premature labor. However, when performed by experienced healthcare providers, the risk of complications is relatively low, and the benefits of preventing severe HDFN and its associated complications may outweigh the risks.

Exchange Transfusion for HDFN

An exchange transfusion is a medical procedure that may be used to treat severe cases of hemolytic disease of the fetus and newborn (HDFN) caused by Rh incompatibility between the mother and fetus. During this procedure, a newborn's blood is gradually replaced with Rh-negative donor blood in order to remove the Rh-positive red blood cells that have been attacked by the mother's antibodies.

The procedure involves placing catheters into the baby's umbilical vessels or other blood vessels, and gradually removing small amounts of the baby's blood and replacing it with donor blood.

The goal of the exchange transfusion is to reduce the levels of bilirubin, a yellow pigment that can build up in the baby's blood and cause jaundice, as well as to remove the Rh-positive red blood cells that have been attacked by the mother's antibodies.

Exchange transfusion may be necessary when the baby's bilirubin levels are very high, or when the baby is showing signs of severe anemia, such as low oxygen levels, fast heartbeat, or lethargy. The procedure can help to prevent or treat the complications associated with severe HDN, such as brain damage or organ failure.

Kleihauer-Betke Test

The Kleihauer-Betke (KB) test is a laboratory test used to quantify the amount of fetal-maternal hemorrhage (FMH) that has occurred in a pregnant woman. FMH is the mixing of fetal and maternal blood that can occur during pregnancy, childbirth, or after an invasive procedure, or trauma.

The KB test involves staining a maternal blood sample with a special stain, which specifically stains fetal red blood cells. The stained cells are then examined under a microscope to determine the percentage of fetal cells in the maternal blood sample. The results of the KB test can help determine the appropriate dose of Rh immune globulin (RhIg) that an Rh-negative mother should receive after a potentially sensitizing event, such as childbirth or miscarriage.

The KB test is especially important for Rh-negative mothers because if a significant amount of fetal blood enters the maternal circulation, it can trigger the production of antibodies against the Rh factor. This can cause hemolytic disease of the fetus and newborn (HDFN) in future pregnancies if the next baby is Rh-positive. 

This test is often proceeded by a "Fetal Bleed Screen" which is a more rapid test to determine if mom and baby's blood have mixed. The Fetal Bleed Screen looks for the presence of RhD positive red blood cells within the blood of the Rh negative mother. This test is read microscopically to determine whether it is positive or negative. If positive, a Kleihauer-Betke test is performed to determine if the standard dose of ONE vial of RhIG will cover the bleed, or if more vials are necessary. One vial of RhIG can protect against 30mL of RhD whole blood. 

COVID: Convalescent Plasma

What is Convalescent Plasma?

Convalescent plasma is a blood product that is obtained from individuals who have recovered from a particular infection, such as COVID-19. The plasma is collected through a process called plasmapheresis, which separates the plasma from the other components of the blood, such as red and white blood cells.

The plasma of recovered individuals contains antibodies that the body produced in response to the infection. These antibodies can potentially help fight the same infection in other individuals who are currently ill. Convalescent plasma therapy involves transfusing the plasma from recovered individuals into the bloodstream of patients who are currently suffering from the same infection, in the hope that the antibodies in the plasma will help boost their immune response and aid in their recovery.

COVID-19 Convalescent Plasma

 The COVID-19 pandemic has brought about unprecedented challenges to the healthcare industry, prompting researchers to look for innovative ways to fight the virus. One of the strategies that emerged was the use of convalescent plasma therapy, which involves using blood plasma from people who have recovered from COVID-19 to treat others who are still infected. Convalescent plasma therapy has been used in the past to treat other infectious diseases, including SARS and Ebola, but its effectiveness in treating COVID-19 was still under investigation.

The use of convalescent plasma as a treatment for COVID-19 was initially considered a promising approach, and it was authorized for emergency use in the United States by the Food and Drug Administration (FDA) in August 2020. However, subsequent studies and clinical trials have yielded mixed results on the effectiveness of convalescent plasma in treating COVID-19.

Convalescent plasma therapy served as a bridge between the early days of the pandemic, when no treatments were available, and the development of vaccines and monoclonal antibody therapy. When the pandemic first began, the world was not yet equipped with the tools and knowledge to fight the virus effectively. As a result, many people became severely ill or died, and hospitals were overwhelmed with patients. Convalescent plasma therapy provided an option to treat COVID-19 patients who were critically ill, with no other effective treatments available.

The use of convalescent plasma therapy was not without its challenges, however. The collection of plasma from recovered COVID-19 patients was difficult, and not all patients were eligible to receive the therapy due to various factors such as blood type compatibility and the timing of the illness. Additionally, the effectiveness of convalescent plasma therapy was not fully established, and the treatment was not widely available in all regions.

Some studies have suggested that convalescent plasma may have a modest benefit in reducing mortality rates and improving clinical outcomes in certain patient populations, such as those who receive plasma with high levels of antibodies early in the course of their illness. However, other studies have not found significant benefits from convalescent plasma therapy.

In February 2021, the National Institutes of Health (NIH) released updated guidelines on the use of convalescent plasma for COVID-19 treatment, stating that there was insufficient evidence to recommend either for or against its use. The guidelines noted that the available data were limited, and further research was needed to better understand the potential benefits and risks of convalescent plasma therapy.

Despite these challenges, the use of convalescent plasma therapy provided valuable insights into the treatment of COVID-19 and paved the way for the development of vaccines and monoclonal antibody therapy. Vaccines have proven to be the most effective way to prevent COVID-19, while monoclonal antibody therapy provides a targeted treatment for those who become infected with the virus.

How was the blood supply affected by COVID?

Blood Donation Decline Due To COVID 

The COVID-19 pandemic has had a significant impact on blood donation worldwide. Blood donation centers and blood banks have seen a significant decline in the number of blood donations as a result of the pandemic, which has led to a shortage of blood products. In the early months of the pandemic, blood donation centers and blood drives were canceled or postponed due to lockdowns and social distancing guidelines, resulting in a sharp decline in blood donations. According to the American Red Cross, they experienced a significant decline in blood donations in March and April 2020, resulting in a shortage of nearly 200,000 blood products.

Reasons for Blood Donation Decline

One of the main reasons for the decline in blood donation is the fear of contracting COVID-19. Many people are afraid to leave their homes and go to blood donation centers or blood drives, as they are concerned about exposure to the virus. Blood donation centers have responded to this concern by implementing strict safety protocols, including enhanced cleaning and disinfection, social distancing, and the use of personal protective equipment (PPE) such as masks and gloves.

Another factor contributing to the decline in blood donation is the cancellation of blood drives and events due to social distancing guidelines and lockdown measures. Many organizations that typically host blood drives, such as schools, churches, and community centers, have been closed or have limited capacity, making it difficult to organize blood drives.

The impact of the COVID-19 pandemic on blood donation has been felt worldwide. The World Health Organization (WHO) has reported that many countries are experiencing blood shortages, which could have serious implications for patients who rely on blood transfusions for life-saving treatments.

Despite the challenges posed by the pandemic, blood donation remains a critical need. Patients undergoing surgery, receiving cancer treatments, or suffering from traumatic injuries still require blood transfusions to survive. Blood donation centers are taking extra precautions to ensure the safety of donors and staff, and are urging healthy individuals to consider donating blood if they are able.

To encourage blood donation during the pandemic, many blood donation centers have implemented new measures, such as online registration and appointment scheduling, to reduce wait times and minimize the risk of exposure to the virus. Additionally, many centers are offering incentives to donors, such as gift cards or discounts on merchandise.

Another reason for blood shortages is that many elective surgeries and procedures were postponed or canceled due to the pandemic. This reduced the demand for blood products in some areas. However, some regions experienced an increase in demand for blood products as a result of COVID-19 patients requiring blood transfusions due to complications from the virus.

Furthermore, there were disruptions to the global supply chain for blood products due to travel restrictions and border closures. This affected the availability of certain blood products in some regions.

The pandemic also created challenges for blood collection and processing. Blood donation centers and blood banks had to implement additional safety measures to protect donors and staff, such as enhanced cleaning and disinfection, social distancing, and the use of personal protective equipment. These measures reduced the number of donors that could be accommodated at any given time, which led to longer wait times and reduced blood collection capacity.

Many hospitals were struggling to maintain par levels of inventory. Shortages were so bad, some hospitals were splitting units of platelets, even Red Blood Cells in half to provide half doses of product so that individuals in need could get SOMETHING, rather than nothing. 

Many long time donors were lost to follow up during the pandemic, and have not returned. 

While the blood supply has increased, there are still strains on the supply, especially O negative blood, in 2023. 

Liver Issues and Transfusions

The Liver

How Can Liver Issues Cause Transfusion Need?

The liver plays a critical role in many important bodily functions, including detoxification, protein synthesis, and the production of bile. In certain medical situations, such as liver failure or drug overdose, the liver may become overwhelmed and unable to perform these functions adequately.

Liver issues can have a significant impact on the body's ability to clot blood, leading to an increased risk of bleeding. The liver is responsible for producing several clotting factors that are essential for the coagulation cascade, including factors II, V, VII, IX, X, and fibrinogen. In liver disease, the liver may not be able to produce enough of these clotting factors, leading to impaired blood clotting and an increased risk of bleeding, and thus a need for transfusion (potentially both plasma and Red Cells)

Patients with liver disease may experience bleeding from various sites, including the gastrointestinal tract, nose, gums, and skin. The severity of bleeding can vary, from minor bleeding to life-threatening hemorrhages. Additionally, liver disease can also lead to the development of portal hypertension, a condition where high blood pressure develops in the portal vein, leading to the formation of varices in the digestive tract that are prone to bleeding.

When patients with liver disease experience bleeding, they may require transfusions of blood products to replace the clotting factors that are deficient in their blood. Fresh frozen plasma (FFP) is a blood product that contains all of the clotting factors and is often used to replace deficient clotting factors in liver disease patients. In severe cases, patients may require transfusions of packed red blood cells to replace blood lost due to bleeding.

Esophageal Varices

Esophageal varices are swollen and fragile veins in the esophagus that can rupture and cause severe bleeding in patients with liver failure. Liver failure can result from various chronic liver diseases such as cirrhosis, hepatitis B or C, or alcohol abuse. When the liver is damaged, it can lead to an increased pressure in the veins that carry blood from the digestive organs to the liver (portal veins). This increased pressure can cause the veins in the esophagus to become enlarged and fragile, leading to the risk of bleeding.

Esophageal varices bleeding is a medical emergency and requires urgent medical attention. Patients may experience symptoms such as vomiting blood, black or tarry stools, low blood pressure, rapid heart rate, or confusion. Treatment typically involves stabilizing the patient's condition with fluids and blood transfusions, then endoscopic procedures such as band ligation or sclerotherapy to stop the bleeding and prevent future episodes.

In addition to treating the bleeding, it is important to address the underlying liver disease to prevent further damage to the liver and the development of additional varices. This may involve lifestyle changes such as avoiding alcohol and certain medications, as well as medical interventions such as antiviral therapies, immunosuppressants, or liver transplant in some cases.

Alcoholic Liver Disease

In advanced stages of alcoholic liver disease, the liver becomes severely damaged and is unable to perform its normal functions, including producing clotting factors that help the blood to clot, as mentioned This can lead to a condition called coagulopathy, where the blood is unable to clot properly.

Transfusions of blood or blood products may be necessary in patients with alcoholic liver disease who have coagulopathy to help prevent bleeding complications. For example, if a patient with alcoholic liver disease requires a surgical procedure or has a bleeding episode, transfusions of clotting factors or platelets may be needed to help stop the bleeding.

In addition, patients with alcoholic liver disease may develop anemia, which is a decrease in the number of red blood cells in the body. Anemia can cause fatigue, shortness of breath, and other symptoms. Transfusions of red blood cells may be necessary to help correct anemia in these patients.

It's important to note that while transfusions can be life-saving in some cases, they are not a cure for alcoholic liver disease. The underlying condition needs to be addressed through lifestyle changes, such as stopping alcohol consumption and improving nutrition, and in some cases, medical treatment may be necessary to manage complications of the disease.

Kidney Disease and Transfusions

Kidney disease is a serious health condition that affects millions of people worldwide. It is a condition that occurs when the kidneys are unable to function properly, resulting in a buildup of toxins and waste products in the blood. This can lead to various complications, including anemia, bleeding, and the need for transfusions.

Why Would Patients With Kidney Disease Needs Transfusions?

Anemia: Kidneys play a vital role in producing a hormone called erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells. In kidney failure, the kidneys may not produce enough EPO, resulting in anemia. Transfusions can be given to increase the number of red blood cells in the body and improve oxygen delivery to tissues.

Bleeding: People with kidney failure may be at a higher risk of bleeding due to the effects of uremia (accumulation of waste products in the blood), medications used to treat kidney failure, and other factors. In cases of severe bleeding, transfusions may be necessary to replace lost blood and prevent complications.

Uremia caused by Kidney Failure can contribute to bleeding in several ways:

• Platelet dysfunction: Uremia can impair the function of platelets, which are small blood cells that play a crucial role in blood clotting. Platelets help to form a plug at the site of an injury and prevent excessive bleeding. In uremia, platelets may not function properly, leading to a higher risk of bleeding.
  
  
• Vascular abnormalities: Uremia can cause changes in the walls of blood vessels, making them more fragile and prone to bleeding. These changes can include thickening, stiffening, and weakening of the vessel walls.
  
  
• Coagulation abnormalities: Uremia can also affect the coagulation system, which is responsible for forming blood clots. In some cases, uremia can cause an imbalance in the coagulation system, leading to an increased risk of bleeding.
  
  
• Medications: People with kidney disease may need to take medications to manage their condition, such as anticoagulants or antiplatelet drugs. These medications can increase the risk of bleeding, particularly if kidney function is impaired and the drugs are not cleared from the body efficiently.

Surgery: People with kidney failure may require surgery for various reasons, such as placement of a dialysis access or kidney transplant. Transfusions may be necessary during surgery to replace blood loss.

EPO Supplementation 

EPO supplementation can help increase the number of red blood cells in the body and improve oxygen delivery to tissues. EPO can be administered by injection under the skin or directly into a vein. The dosage and frequency of EPO supplementation may vary depending on the severity of anemia, the underlying cause of kidney failure, and other factors.

It is important to note that EPO supplementation can have potential risks and side effects, such as high blood pressure, blood clots, and an increased risk of certain types of cancer. Therefore, the decision to supplement with EPO should be made after careful consideration of the benefits and risks, and alternative treatments should be explored when possible.

In addition to EPO supplementation, other treatments for anemia in kidney failure patients may include iron supplements, vitamin B12 and folic acid supplements, blood transfusions, and medication adjustments to manage underlying conditions.

Massive Transfusion Protocol

Massive transfusion protocol (MTP) is a critical medical intervention used in emergency situations to save the lives of patients with severe bleeding. This protocol is a set of guidelines developed by healthcare professionals that facilitate the rapid administration of large quantities of blood products, including red blood cells, plasma, and platelets. Studies have shown that early implementation of MTPs can improve patient survival rates and decrease the incidence of complications such as multiple organ failure, sepsis, and respiratory distress syndrome. By providing blood products in a targeted and timely manner, MTPs can help to replenish the patient's blood volume, restore normal clotting function, and improve tissue oxygenation.

We will discuss what MTP is, how it works, and why it is essential in emergency medical situations. We will also provide some insights on how MTP is initiated and what factors influence its success.

What is Massive Transfusion Protocol?

Massive Transfusion Protocol (MTP) is a pre-established set of procedures and guidelines for the administration of large volumes of blood products in trauma patients who have sustained significant blood loss. MTP is initiated in patients who have lost over 50% of their total blood volume, typically as a result of a severe injury or surgical procedure.

The goal of MTP is to rapidly replace the lost blood volume and maintain appropriate levels of oxygen delivery to the body's vital organs, including the brain, heart, and lungs.

How Does The Massive Transfusion Protocol Work?

MTP is a coordinated effort involving healthcare professionals from different specialties, including emergency medicine, critical care, hematology, transfusion medicine, and pharmacy. The protocol is typically initiated by the trauma team leader, who assesses the patient's condition and determines whether MTP is necessary.

Once the decision to activate MTP has been made, blood bank staff prepares and delivers a predetermined amount of blood products, including red blood cells, plasma, and platelets, to the patient's bedside. The blood products are then administered based on the patient's specific needs, as determined by laboratory tests and ongoing clinical assessments. MTPs are most successful when a 1:1 ratio of Red Blood Cells and Plasma is followed. So, for example, each MTP cooler may contain 6 RBCs and 6 units of plasma. Platelets and cryoprecipitate may also be prepared at specific intervals. 

Factors Influencing the Success of MTP

The success of MTP is influenced by several factors, including timely activation, appropriate selection of blood products, and effective monitoring of the patient's response to transfusion. The early initiation of MTP is critical, as it ensures that the patient receives blood products promptly, which can improve survival rates.

Another essential factor in the success of MTP is the selection of appropriate blood products. Red blood cells are typically administered first, followed by plasma and platelets in a predetermined ratio (usually 1:1). This approach ensures that the patient receives the necessary clotting factors to stop the bleeding.

Finally, effective monitoring of the patient's response to transfusion is essential. The patient's vital signs, laboratory values, and overall clinical condition must be continuously assessed to ensure that the transfusions are providing the intended benefit.

Why is MTP Important?

MTP is critical in emergency medical situations, as it can save the lives of patients with severe bleeding. Without MTP, patients who have lost significant amounts of blood may not receive the necessary blood products in a timely fashion, leading to poor outcomes and high mortality rates.

MTP has been shown to improve survival rates in trauma patients with severe bleeding, reducing the risk of death from bleeding by up to 70%. Additionally, MTP has been associated with a reduction in hospital length of stay and ICU admissions, leading to lower healthcare costs.

What are the negatives of activating an MTP?

While MTP can be life-saving, it is not without complications. Some potential complications of MTP include:

• Transfusion reactions: Blood transfusions can trigger immune reactions in the recipient, leading to symptoms such as fever, chills, itching, hives, and difficulty breathing. These reactions can be mild to life-threatening.
  
  
• Fluid overload: Rapid transfusion of large amounts of blood products can lead to fluid overload, which can cause edema, shortness of breath, and heart failure.
  
  
• Coagulopathy: Patients who have lost a large amount of blood may also have impaired blood clotting function, which can be exacerbated by transfusions. This can lead to bleeding complications and make it difficult to control bleeding.

• Hypothermia: Blood products that are stored at cold temperatures can cause hypothermia when rapidly infused into a patient. Hypothermia can cause a variety of complications, including cardiac arrhythmias and impaired coagulation function.

• Transmission of infectious diseases: While blood products are tested for infectious diseases, there is still a risk of transmission of viruses, bacteria, or other pathogens.

• Cost: MTP can be expensive due to the large amount of blood products used, which can strain healthcare budgets and resources.
  
  
• Blood Wastage: Ocassionally, MTPs might be activated inappropriately, and thus blood products, especially thawed FFP, might be wasted. MTPs must only be called in true exsanguination emergencies. 

Ionized Calcium and MTPs

Ionized Calcium is the free calcium within ones serum that is not bound to other proteins or molecules.

During a massive transfusion, ionized calcium levels can become depleted due to a number of factors.

One of the main reasons for this is that blood products, such as stored red blood cells and plasma, have low levels of ionized calcium. When large volumes of these products are transfused into a patient, it can cause a dilutional effect, reducing the concentration of ionized calcium in the bloodstream.

In addition, the citrate anticoagulant that is added to blood products to prevent clotting can also chelate (bind) calcium ions in the blood, further depleting ionized calcium levels. Citrate works by binding to calcium ions, which is necessary to prevent clotting in the blood bag during storage. When blood products are transfused, citrate is rapidly metabolized by the liver, leading to the release of ionized calcium into the bloodstream.

The rapid infusion of large volumes of blood products can also cause an increase in acidity in the blood (metabolic acidosis), which can further reduce the levels of ionized calcium. This occurs because acidosis can cause an increase in the binding of calcium to proteins and other molecules in the blood, reducing the amount of free ionized calcium.

Overall, the depletion of ionized calcium during massive transfusion can lead to a variety of complications, including impaired blood clotting function, cardiac arrhythmias, and muscle cramps. To prevent or manage these complications, healthcare providers may administer calcium supplements, such as calcium gluconate or calcium chloride, during and after transfusion to help restore ionized calcium levels to normal. 

How Do You Administer Blood Rapidly for an MTP?

Many systems will use the Belmont Rapid Infuser System. The Belmont Rapid Infuser is a medical device used to rapidly and efficiently administer large volumes of fluids, including blood products, to patients in emergency situations. It is a type of fluid warmer that can warm fluids to body temperature as they are being infused into the patient.

The Belmont Rapid Infuser works by using a disposable cassette system that incorporates a heating element and a pump. The cassette is filled with the fluid to be infused, such as blood products, and is then placed into the Belmont device. The device warms the fluid to body temperature and then rapidly infuses it into the patient using a high-pressure pump.

The device can infuse up to 1 liter of fluid in less than one minute, making it particularly useful in situations where patients require large volumes of fluids or blood products quickly, such as during massive transfusions for trauma or surgery.

The Belmont Rapid Infuser is designed to minimize the risk of air embolism, which can occur when air enters the patient's bloodstream during infusion. The device is equipped with air detection sensors that can automatically stop the infusion if air is detected in the tubing.

Synthetic or Artificial Blood?

Artificial blood is a fascinating concept that has been explored by scientists for decades. The idea of being able to create a synthetic alternative to human blood could revolutionize medicine and save countless lives. However, despite years of research, artificial blood is not currently viable. In this article, we will explore the reasons why.

What is Artificial Blood?

Artificial blood, also known as blood substitute, is a laboratory-created substance designed to mimic the oxygen-carrying capabilities of human blood. The goal of artificial blood is to provide a safe and readily available alternative to traditional blood transfusions.

There are two main types of artificial blood: hemoglobin-based oxygen carriers (HBOCs) and perfluorocarbon-based oxygen carriers (PFCs). HBOCs are made by purifying and isolating hemoglobin from human or animal blood and then chemically modifying it to increase its stability and oxygen-carrying capacity. PFCs are synthetic compounds that can dissolve and transport oxygen, much like hemoglobin in human blood.

Why is Artificial Blood Not Currently Viable?

Despite years of research and development, artificial blood is not currently viable for use in humans. There are several reasons for this:

•     Lack of Long-Term Safety Data

One of the main challenges with artificial blood is the lack of long-term safety data. While early clinical trials have shown promising results, there have been concerns about potential side effects, including increased risk of heart attack, stroke, and blood clotting.

•     Difficulty Regulating Oxygen Delivery

Another challenge with artificial blood is the difficulty in regulating oxygen delivery. Human blood has a sophisticated mechanism for regulating oxygen delivery to tissues and organs, which is not yet replicable in artificial blood. This means that artificial blood could potentially cause oxygen toxicity, leading to tissue damage and other adverse effects.

•     Cost and Production Challenges

Producing artificial blood on a large scale is also challenging and expensive. Current methods require specialized equipment and highly trained personnel, which makes it difficult to produce and distribute artificial blood in large quantities.

•     Lack of Efficacy Compared to Traditional Blood

Finally, artificial blood has not been shown to be as effective as traditional blood transfusions. Studies have shown that artificial blood products do not deliver oxygen as efficiently as human blood and may not provide the same benefits to patients.

• Short Shelf Life

Another challenge in developing artificial blood is ensuring that it has a long shelf life. Natural blood must be refrigerated and used within a certain time frame to prevent bacterial growth and other complications. Unfortunately, many synthetic blood products have a short shelf life, making them impractical for use in emergency situations.

• Potential for Side Effects

Like any medical intervention, synthetic blood products have the potential to cause side effects. Some researchers have expressed concern about the safety of artificial blood, particularly with regard to the potential for immune reactions and other adverse effects.

 For the time being, it looks like we will still need to rely on the kindness of strangers to donate their time AND blood to help others!

Directed Donation

Blood donation is a critical process that helps to save millions of lives worldwide. Blood transfusions are required by patients undergoing medical treatment, surgeries, and other medical procedures. Directed blood donation is a type of blood donation where a donor gives blood for a specific individual, usually a friend or family member, who needs a transfusion. In this article, we'll discuss what directed blood donation is, how it works, and why it's important.

What is Directed Blood Donation?

Directed blood donation is a process where a donor gives blood that is reserved for a specific recipient. The blood is collected and tested in the same way as regular blood donations, but it is designated for the specific recipient. The donor and recipient must have compatible blood types, and the donor's blood must meet the requirements for transfusion to ensure that the recipient receives the correct blood type.

How Does Directed Blood Donation Work?

Directed blood donation is a process that involves several steps. First, the donor must be identified and screened to ensure that they are eligible to donate blood. They must also have a compatible blood type with the recipient. Once the donor is identified and screened, the blood is collected and tested for infections and other health conditions.

The collected blood is then labeled and stored specifically for the recipient. The recipient must also undergo screening to ensure that they are healthy enough to receive the transfusion. Once the blood and the recipient are deemed suitable, the transfusion can take place.

Why is Directed Blood Donation Important?

Directed blood donation can be crucial for individuals who require regular transfusions or have rare blood types. In some cases, regular blood donations may not meet the specific requirements of the recipient, and directed donation may be necessary. It can also be essential for patients who have developed antibodies that react to most donated blood, making it difficult to find a suitable match.

Moreover, directed blood donation can offer emotional support to the recipient and their family, as it allows them to have a sense of control over their treatment process. It can also give the donor a sense of satisfaction, as they can see the direct impact of their donation on someone they know and care about.

Is Directed Donation Recommended?

Directed donation is not advised in most cases because it may not provide any additional benefit compared to regular blood donations. Regular blood donations go through extensive testing and processing to ensure they are safe for transfusion to anyone who needs them, regardless of whether they are directed donations or not.

In addition, directed donation can be problematic if the donor's blood is not a good match for the recipient, or if the donor is unable to donate for any reason. This can lead to delays in transfusion and can potentially cause harm to the recipient if they are in urgent need of blood.

Furthermore, some experts argue that directed donation may create a false sense of security among recipients and their families, leading them to believe that directed donation is safer or more effective than regular blood donations. In reality, regular blood donations are the safest and most effective way to ensure a sufficient blood supply for patients in need.

How do I start the process of Directed Donation?

Contact the Blood Bank at the hospital in which the recipient patient will be receiving the possible transfusion. A Blood Bank / Transfusion Medicine Pathologist (A medical doctor) will initiate the beginning stages of the Directed Donation consult and get the ball rolling on the entire process.  Where you donate will be up to what the Blood Bank allows and has set up. Some hospital Blood Banks have their own donation center. Others will allow donors to donate at a local Blood Center and have them ship the blood to the hospital after donation.

What happens to the donated blood if the recipient doesn't need it? 

It will expire on shelf. Directed Donation blood cannot be given to anyone else except for the intended recipient. 

Sickle Cell Disease and Tranfusions

Sickled Cells on a blood smear

What is Sickle Cell Disease

Sickle cell disease (SCD) is a genetic blood disorder that affects millions of people worldwide. It causes red blood cells to become sickle-shaped and stiff, which can block blood flow to various organs and tissues, leading to severe pain, organ damage, and even death.

Sickle cell disease is most common in people of African descent, but it also affects people of Hispanic, Middle Eastern, and Mediterranean descent. There is no cure for sickle cell disease, but treatments can help manage symptoms and reduce complications.  Transfusion therapy can help manage the complications of SCD, but it also poses risks, and its use needs to be carefully considered.

Understanding Sickle Cell Disease and its Complications

SCD is caused by a mutation in the HBB gene that affects the production of hemoglobin, the protein that carries oxygen in red blood cells. Instead of the normal round shape, the hemoglobin molecules in people with SCD form stiff, sickle-shaped structures. These sickle cells can get stuck in small blood vessels, leading to inflammation, tissue damage, and severe pain, particularly in the bones, chest, and abdomen. Repeated episodes of pain can lead to organ damage and increase the risk of infections, stroke, and other complications.

Transfusion therapy for Sickle Cell Disease

Transfusion therapy can help manage the complications of SCD by providing healthy red blood cells that can improve oxygen delivery and prevent sickling. The goals of transfusion therapy for SCD include reducing the frequency and severity of pain episodes, preventing or treating strokes, and reducing the risk of acute chest syndrome, a potentially life-threatening complication that can occur when sickle cells block blood vessels in the lungs.

However, transfusion therapy also carries risks, including the development of alloantibodies, iron overload, and infections. Alloantibodies are antibodies produced by the immune system in response to foreign red blood cells from donors. In SCD patients who receive frequent transfusions, alloantibodies can accumulate and make it difficult to find compatible blood for transfusion. Iron overload can occur when the body absorbs too much iron from the transfused blood, leading to organ damage, particularly in the heart and liver. Finally, chronic transfusions can increase the risk of infections and other transfusion related sequela. 

Transfusion needs in SCD patients

The decision to transfuse SCD patients depends on various factors, including the severity of their symptoms, the presence of complications, and their overall health. In general, SCD patients with a hemoglobin level below 6 g/dL or with evidence of tissue damage or organ dysfunction may benefit from transfusion therapy. However, transfusions should be used judiciously and tailored to the individual patient's needs to minimize the risks of complications.

Rh and Kell Antigen Screening

SCD patients require Rh and Kell antigen screening before receiving transfusions. Rh and Kell antigens are present on the surface of red blood cells and can cause alloimmunization, which is the production of antibodies against these antigens. As many SCD patient's are chronically transfused, they are at a higher risk of developing alloantibodies, the most common being antibodies in the Rh system such as D,C, or E and also Kell. If SCD patients with Rh or Kell antibodies receive blood containing these antigens, their immune system will attack the donor red blood cells, leading to a severe transfusion reaction. Therefore, SCD patients require Rh and Kell antigen-negative blood to avoid these complications.

HgbS Negative Blood

SCD patients also require blood that is tested to be HgbS negative. HgbS is the abnormal hemoglobin that causes sickling of red blood cells in SCD patients. If SCD patients receive blood containing HgbS, their red blood cells will still sickle, and they will not benefit from the transfusion. Therefore, SCD patients require blood that is tested to be HgbS negative.

Transfusions and Sickle Cell Trait

Individuals with sickle cell trait typically do not require blood transfusions. Sickle cell trait is a genetic condition where a person inherits one normal hemoglobin gene and one abnormal hemoglobin gene. While individuals with sickle cell trait may have some symptoms related to the abnormal hemoglobin gene, these symptoms are usually mild and do not require blood transfusions.

What is a Type and Screen?

A type and screen is a blood test that is used to determine a person's blood type and screen for antibodies in their blood that may react with transfused blood. The test is typically performed before a person receives a blood transfusion, surgery, or other medical procedure that may require a blood transfusion.

Blood Type

During a type and screen, a sample of blood is collected from the person and sent to a laboratory for analysis. The blood is first tested to determine the person's blood type, which is based on the presence or absence of certain antigens on the surface of the red blood cells. There are four major blood types: A, B, AB, and O.

Additionally, The Rh factor is a protein that is found on the surface of red blood cells. Specifically, the Rh factor refers to a group of antigens known as the Rhesus antigens, with the most important of these antigens being the D antigen. People who have the D antigen are considered Rh positive (Rh+), while those who do not have the D antigen are considered Rh negative (Rh-).

The D antigen is determined by an individual's genetics. The gene that controls the D antigen is located on chromosome 1. If an individual inherits the dominant D gene from one or both parents, they will be Rh positive. If they inherit two recessive d genes, they will be Rh negative.

Most people (about 85%) are Rh positive, while the remaining 15% are Rh negative. Rh factor is important in pregnancy because if a woman who is Rh negative becomes pregnant with a fetus who is Rh positive, there is a risk that the woman's immune system may produce antibodies against the Rh factor of the fetus, which can lead to complications in future pregnancies. To prevent this, Rh-negative women who become pregnant with an Rh-positive fetus may be given a medication called Rh immune globulin (RhoGAM). RhoGAM works by blocking the woman's immune system from producing antibodies against the D antigen of the fetus.

Antibody Screen 

The blood is also screened for antibodies that may react with transfused blood. Alloantibodies are antibodies produced by an individual's immune system in response to exposure to foreign antigens from transfused blood. In other words, alloantibodies are antibodies that are directed against antigens that are not present on a person's own red blood cells. These antibodies can develop when a person is exposed to red blood cells that have different blood group antigens than their own.

Alloantibodies

Alloantibodies can cause serious complications during blood transfusions. When a person receives a transfusion of blood that contains foreign antigens, their immune system can produce alloantibodies against those antigens. If the person receives another transfusion with incompatible blood in the future, their immune system can recognize the foreign antigens and initiate an immune response, resulting in a transfusion reaction. The A and B antigens are the most commonly known antigens on a persons Red Blood Cells that are used for compatibility. This is where we get the blood types A, B, O, and AB. However there are DOZENS more known antigen systems on Red Blood Cells. It is not routine for labs to screen for these antigens on a patient due to time and cost, but if they create an alloantibody they will then need tested for these antigens that they create an antibody towards.

Alloantibodies may also be made during the stages of pregnancy. Alloimmunization in pregnancy occurs when a woman's immune system produces antibodies against foreign blood group antigens present in the blood of her developing fetus. This can occur when the mother has a different blood type from the fetus, and the fetus inherits blood group antigens from the father that are foreign to the mother.

If the mother is Rh-negative and the fetus is Rh-positive, for example, the mother's immune system may produce Rh antibodies that can cross the placenta and attack the fetal red blood cells. This can result in hemolytic disease of the newborn (HDN), a condition in which the fetus or newborn experiences the destruction of red blood cells and can lead to anemia, jaundice, and other serious complications.

Alloantibodies are often detected through a blood test called an antibody screen, which is performed prior to a blood transfusion to ensure that the donor blood is compatible with the recipient's blood type. If alloantibodies are detected, the transfusion process must be carefully managed to avoid a transfusion reaction. In some cases, it may be necessary to use blood from a special donor source or to perform additional testing to identify compatible blood products.

Crossmatch

You may hear the term Type and Cross, which is a bit of a misnomer. A crossmatch is a test performed using the Type and Screen specimen. A crossmatch involves mixing a sample of the recipient's blood serum with a sample of the donor's red blood cells and observing whether there is agglutination (clumping) of the cells. If the recipient's antibodies react with the donor's cells, this indicates that the blood is incompatible and a transfusion could result in a severe transfusion reaction.

There are two main types of crossmatches: the immediate spin crossmatch and the full crossmatch. The immediate spin crossmatch involves mixing the donor's cells with the recipient's serum and observing for agglutination at room temperature. The full crossmatch is a more comprehensive test that involves incubating the donor's cells with the recipient's serum at 37°C to mimic the conditions inside the body and observing for agglutination.

Patient's with a proven history of a negative antibody screen may be eligible for an "Electronic Crossmatch" in which the laboratory information system scans the unit of blood through the patient's history and agrees that the unit is "electronically" compatible based on the correct choice of Blood Type and negative antibody history. This saves time and efficiency for the lab worker and the patient as no physical testing needs to be performed. Patient's with blood typing issues or antibodies are not eligible for electronic crossmatch.

The crossmatch is a critical step in ensuring safe blood transfusion and is performed for every blood product that is transfused to a patient. If an incompatible crossmatch is detected, the transfusion must be halted immediately, and alternative compatible blood products must be obtained.