Special Feature
A Model Curriculum for Blood Banking in
a Medical Technology Program
Charles H. Wallas, MD; Patricia A. Beckjord, MT(ASCP)SBB; Katherine B. Carlson,
MT(ASCP)SBB; Richard J. Davey, MD; Katherine A. Davis, MT(ASCP)SBB; Richard S.
Eisenstaedt, MD; Patricia L. Prewitt, MT(ASCP)SBB; and Marcus B. Simpson, Jr, MD
T
he following material concerning a model curriculum
for the blood bank portion of medical technology training arose from ideas of the Committee on Education of the
American Association of Blood Banks. Guidelines for lecture topics and objectives, laboratory exercises and objectives, and a reading list are given. The document is not
designed as an all-inclusive complete guide for study for
a registry examination. A time of six to eight weeks is the
suggested appropriate length for the blood bank rotation.
We hope that the information will prove useful to instructors in medical technology programs.
Suggested Areas of Study
Weighted by Importance
I. History
II. Basic Immunology and Genetics
1%
10%
III. Blood Group Systems
20%
IV. Serologic Testing
30%
V. Transfusion Practice
VI. Preparation, Storage, and Use of Blood
Components
VII. Administrative Functions and Medical
Legal Considerations
20%
9%
10%
From the American Association of Blood Banks Committee on Education, Arlington,
VA 22209.
176
LABORATORY MEDICINE • VOL. 18, NO. 3, MARCH 1987
Suggested Lecture Topics
I.
History (1%)
History of blood transfusion
II. Basic Immunology (10%)
Basic immunology
The complement system
Antigen/antibody characteristics and reactions
III. Blood Group Systems and Their Genetics (20%)
ABO blood group system and discrepancies
Rh blood group system and discrepancies
Lewis and I systems
MNSs and P systems
Kell and Kidd systems
Duffy and Lutheran systems
Other blood group systems
IV. Serologic Testing (30%)
Anti-human globulin testing
Detection of red cell antibodies
Identification of red cell antibodies
Special procedures, including enzymes, neutralization, lectins
Adsorptions and elutions
Microtechniques
Problem solving, ie, ABO discrepancies, Rh typing
problems
Phenotyping
Cold agglutinins
HLA system, tissue typing, paternity testing
Transfusion Practice (20%)
Coagulation pathways and hemostasis
Fresh-frozen plasma, cryoprecipitate, factor VIII,
platelets
Function of cellular components of blood
RBC components: whole blood, packed cells, washed
cells, frozen cells
Hemolytic anemia
Autoimmune hemolytic anemia, hemolytic disease
of the newborn
Administration and function of blood products
Emergency transfusion
Complications of blood transfusion
Immunological and metabolic
Hepatitis and other infections
Preparation and Storage (9%)
Donor recruitment and assurance programs
Phlebotomy and donor reactions
Component preparation and processing
Apheresis
Storage and shipment of blood
Inventory control
Administrative Functions and Medical-Legal Considerations (10%)
Quality control, recordkeeping, blood bank inspections
Medical-legal aspects of blood banking
Lecture Goals and Objectives
History
A. List major contributors to the advancement of blood
banking and outline their accomplishments.
Basic Immunology
A. Immunology
1. Explain the biochemical nature of immunoglobulins and their interaction with red cell
antigens.
2. Draw the classic and alternate pathway of complement activation and discuss the effect of
complement attachment on red blood cells.
3. Describe the kinetics of antigen/antibody reactions.
Blood Group Systems and Their Genetics
A. Genetics
1. Discuss the basic principles of human genetics
and apply them to blood groups.
B. Review the genetics of the following major blood
groups: ABO, Rh, Kell, Duffy, Lewis, MNSs, and
Kidd.
C. Summarize the biochemical nature and expected
pattern of reactivity of antibodies to the blood
groups listed in III-B.
D. Review the incidence of antigens found in the blood
groups listed in III-B.
Serologic Testing (30%)
A. Pretransfusion testing
1. Discuss the serologic principles involved in ABO
grouping, Rh typing, and irregular antibody
detection.
2. Compare the differences between a direct antiglobulin test and an indirect antiglobulin test.
3. Describe the procedure for a routine antibody
panel.
4. Relate a serologic method for compatibility
testing.
B. Special Techniques
1. Summarize the principle and methodology of
the following techniques:
a.
b.
c.
d.
e.
enzymes
neutralizations
lectins
absorptions
elutions
2. Explain methods and reasons to phenotype cells.
3. Illustrate concepts and methods of microtechniques.
C. Miscellaneous Techniques
1. Discuss basic principles of the HLA system.
2. Relate the use of HLA typing in paternity testing.
V. Transfusion Practice
A. Coagulation and Hemostasis
1. Diagram the coagulation sequence.
2. List indications for albumin, fresh-frozen
plasma, cryoprecipitate, factor VIII concentrate.
3. Define the function of the following cells: platelets, white cells, red cells.
B. Immune Hemolytic Anemias
1. Compare the serologic and clinical characteristics of immune hemolytic anemias, such as
warm autoimmune hemolytic anemia and cold
agglutinin disease.
C. Hemolytic Disease of the Newborn
1. Describe the pathophysiology and clinical consequences of hemolytic disease of the newborn.
2. Discuss treatment and prevention of hemolytic
disease of the newborn.
D. Transfusion Therapy
1. List indications for use of the following blood
components:
a. whole blood
b. red blood cells
LABORATORY MEDICINE • VOL. 18, NO. 3, MARCH 1987 1 7 7
c. fresh-frozen plasma
d. cryoprecipitate
e. platelet concentrates
f. leukocyte-poor red cells
g. washed red cells
h. frozen deglycerolized red cells
2. List the laboratory tests commonly performed
for a transfusion reaction workup and explain
the significance of each one.
II. Transfusion Practice
Hemolytic disease of the newborn
Fetal cell stains
Transfusion reaction workup
III. Preparation, Storage, and Use of Blood Components
Donor screening and phlebotomy
Donor blood processing
Component preparation
Red blood cell freezing
Attend a blood drive. Take part in donor screening
and perform donor phlebotomy under supervision.
Platelet concentrate pooling
Visit apheresis laboratory
Visit HLA laboratory
3. Review diseases that can be transmitted through
blood transfusion.
VI. Preparation and Storage
A. Collection
1. Give examples of incentives for donor recruitment and types of blood assurance programs.
IV. Administrative Functions
2. Review proper phlebotomy technique and
handling of donor reactions.
B. Blood Components
1. Summarize the preparation, storage, and shipping requirements for the following components:
a.
b.
c.
d.
e.
f.
g.
h.
i.
whole blood
red blood cells
fresh-frozen plasma
cryoprecipitate
platelet concentrate
leukocyte-poor blood
washed red blood cells
frozen deglycerolized red blood cells
apheresis products
Quality control of reagents and equipment
Recordkeeping
Goals and Objectives for Laboratory Exercises
I.
Serologic Testing
A. Perform routine ABO typing with 100% accuracy.
B. Recognize commonly encountered ABO discrepancies, such as an A2 with anti-A^
C. Perform routine Rh typing with 100% accuracy.
D. Recognize Rh typing discrepancies, such as a positive Rh control.
E. Perform direct and indirect antiglobulin tests and
compatibility testing with 100% accuracy.
VII. Administrative Functions and Medical-Legal Considerations
F. Identify simple, uncomplicated alloantibodies, such
as anti-D, anti-K, or anti-Fya, with 100% accuracy.
A. Discuss quality control and recordkeeping requirements of the Food and Drug Administration
and the American Association of Blood Banks.
G. Perform special techniques, such as cold panels,
warm and cold absorptions, antigen typing, and
enzyme panels, with 80% accuracy.
B. Outline medical-legal considerations in blood
banking, such as patient/donor informed consent.
Suggested Processes for Laboratory Exercises
I.
Serologic Testing
Basic techniques (3% to 5% cell suspensions, grading
reactions, serumxell ratio)
ABO grouping and discrepancies
Rh typing and discrepancies
Direct and indirect antiglobulin tests
Basic and multiple antibody identification
Pretransfusion and compatibility testing
Incompatible crossmatches
Enzymes, lectins, neutralizations
Absorptions and elutions
Titers
Genotypes
Paternity testing (case studies)
Cold agglutinins
Autoantibodies
Visit a reference laboratory
1 7 8 LABORATORY MEDICINE • VOL. 18, NO. 3, MARCH 1987
II. Transfusion Practice
A. Perform testing and accurately determine eligibility for Rh immune globulin and appropriate
dosage.
B. Perform and properly evaluate results of transfusion reaction workups.
III. Preparation, Storage and Use of Blood Components
A. Perform successfully the following donor procedures:
1. pulse
2. temperature
3. finger stick
4. hematocrit
5. blood pressure
B. Successfully perform a routine donor phlebotomy.
C. Demonstrate the preparation, processing, and
proper storage of the following blood components:
1. red blood cells
2. platelet concentrates
3. fresh-frozen plasma
4. cryoprecipitate
IV. Administrative Functions
A. Perform quality control on reagents and equipment.
B. Demonstrate accurate recordkeeping.
Acquired Immune Hemolytic Anemia, Petz LD, Garratty G, 1980, New York.
An Introduction to Immunohematology, Bryant N, 1976, WB Saunders Co,
Philadelphia.
Blood Component Therapy, A Physician's Handbook, AABB, 4th ed, 1983 Arlington, Va.
Blood Groups in Man, Race RR, Sanger R, 6th ed, 1975, Blackwell Scientific,
Oxford.
Blood Transfusion in Clinical Medicine, Mollison PL, 7th ed, 1983, Blackwell
Scientific, Oxford.
Circular of Information for the Use of Human Blood and Blood Components,
Arlington, Va, AABB, American Red Cross, Council of Community Blood Centers, October 1984.
Clinical Practice of Blood Transfusion, Petz L, Swisher S, 1981, Churchill Livingstone, New York.
Serology and Genetics of the Rh System, Issitt PD, 1979, Montgomery Scientific
Publications.
Standards for Blood Banks and Transfusion Services, AABB, 11th ed, 1984,
Arlington, Va.
Technical Manual, AABB, 9th ed, 1985, Arlington, Va.
The ABO and Rh Systems, Ortho Diagnostics, Inc, 1969, Raritan, NJ.
Suggested Reading List
Books
Journal
A Seminar on Perinatal Blood Banking, AABB, 1978, Washington, DC.
Transfusion
:
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