Portland Community College | Portland, Oregon

This is a continuation of MLT 241. Commonly encountered blood group systems will be reviewed and principles applied to antibody detection and identification. Blood bank test procedures, interpretation, and sources of error will be covered. Donor selection criteria, anticoagulants, indications and contraindications for transfusing various blood components, transfusion reactions and investigation of reactions will be discussed. Automated technology will be introduced, with an emphasis on gel testing.

Upon successful completion of the course students should be able to:

1. Employ appropriate and effective decision-making skills regarding advanced blood bank and blood transfusions. 
2. Demonstrate commonly utilized procedures and interpret results within a blood bank laboratory.
3. Recognize normal/abnormal test results and correlate data with appropriate pathologic conditions to accurately advise health care providers.
4. Adapt immunohematology laboratory techniques and procedures when errors and discrepancies in results are obtained to effect resolution in a professional and timely manner.

The class is presented by means of lecture/discussion, audio-visual presentations, handouts, demonstrations, web based instructional media and other educationally sound practices. Comprehensive lab work requires demonstration of competency to receive a satisfactory grade. A laboratory manual is provided. The laboratory exercises provide an opportunity for students to employ the testing principles and methodologies discussed and allow for discussion, application and correlation of the concepts presented.  The student is expected to perform all laboratory procedures according to the criteria established by the department. 

Assessment methods may include written and practical examinations, homework assignments and discussion activities. Student knowledge application, laboratory performance, problem solving skills, punctuality and attendance, participation, and communication skills is assessed in each laboratory exercise utilizing an evaluation rubric that includes cognitive, psychomotor and affective learning domains.  

Course Themes:

·         Blood Groups

o    Clinically significant non-ABO blood groups: their inheritance, genotypes, phenotypes, and antibody production and identification

o    Differentiate low-incident and high-incident antigens and their relation to antibody frequency when  selecting blood for transfusion

·         Testing Methods, Principles, and Sources of Error

o    The antihuman globulin test, antibody screen, antibody identification, and cross-match

o    Blood bank reagents, their limitations and expected results

·         Hemolytic Disease of the Newborn

o    Common blood groups involved in Hemolytic Disease of the Newborn

o    The process of RBC sensitization

o    Isolation and identification of antibodies associated with HDN

o    Test results associated with ABO and Rh hemolytic disease

o    Criteria for exchange transfusions and the blood bank tests involved

o    Anti-Rh treatment and criteria for administration

·         Component Therapy

o    Criteria used for acceptability of blood donors

o    Anticoagulants and preservatives used in blood collection for transfusion purposes and their outdating

o    General methods of production, tests involved, clinical indications for administration, and shelf life for components: whole blood, packed red cells, platelets, leukocyte-poor red cells, deglycerolized red cells, fresh frozen plasma, irradiated red cells (or platelets) and cryoprecipitate

o    Types of transfusion reactions, their clinical symptoms, and laboratory methods for investigation

• Gel Testing

  • Reagent selection, cell suspensions, equipment use, interpretation of results and sources of error

Skills:

Knowledge and Application (Cognitive Skills):

·      Cognitive processes

o  Explain immunohematology theory supporting test principles

o  Integrate knowledge and make informed judgments about immunohematology test results  in the clinical setting

o  Formulate a clear, answerable question

o  Predict expected results

o  Follow written protocols and verbal instructions

·      Analysis skills

o  Collect and organize data in a systematic fashion

o  Present data in an appropriate form

o  Assess the validity of the data (including integrity and significance)

o  Recognize errors

o  Draw appropriate conclusions based on the results

·      Safety skills

o  Recognize safety equipment and laboratory safety measures

·      Troubleshooting and problem solving

o  Recognize errors or discrepancies in results during lab procedures

·      Select corrective actions for problem solving Communication skills

o  Discuss and present lab results or findings in the laboratory

·      Interpersonal and citizenry skills

o  Work effectively in teams or groups so that the task, results, and analysis may be shared

o  Effectively manage time and tasks allowing concurrent and/or overlapping tasks to be done simultaneously, by individuals and/or within a group

Performance (Psychomotor Skills):

• Utilize safety measures and equipment

o    Utilize adequate personal protective equipment, sharp container, fume hood and other safety devices

• Proper collection and processing of peripheral blood samples for blood bank testing
• Use a serofuge in the performance of the tube methodology, including
  • Correctly balance the serofuge
  • Properly handle, clean, and store the serofuge
  • Apply correct speed and time settings for the appropriate procedure
  • Operate serofuge head correctly during cell washing procedures
• Use of a water bath in the performance of weak D typing
  • Select the correct temperature for the procedure
  • Properly handle, clean, and store the water bath
• Proper performance of antibody testing

o  Perform and interpret the antibody screen test using the appropriate reagents and controls

o  Properly record results using appropriate notation

• Proper performance of antibody identification testing, including

o  Perform and interpret the antibody identification panel using the appropriate equipment, reagents, and controls

o  Properly record results using appropriate notation

• Proper performance of cross match testing

o  Perform and interpret the cross match using the appropriate equipment, reagents, and controls

o  Properly record results using appropriate notation

• Proper performance of acid elution testing

o  Perform an acid elution using the appropriate equipment and reagents

• Proper performance of antibody titer

o  Perform and interpret the antibody titer using the appropriate equipment and reagents

o  Properly record results using appropriate notation

• Proper performance of tests using gel technology
  • Perform and interpret ABO, Rh, DAT and the antibody screen using the appropriate gel card (reagents) and equipment

Professional (Affective) Skills:

• Demonstrate interest, enthusiasm, and willingness to learn as seen through active participation.
• Show initiative and motivation as demonstrated by independence in performing routine procedures, preparation before class, decreased need for supervision, willingness to go beyond the required assignments, and recognition of opportunities to improve quality and productivity of work.
• Adapt to stressful and/or new situations by maintaining composure and flexibility without compromising individual integrity.
• Exhibit teamwork through cooperation, courtesy, respect, and sensitivity towards others.
• Convey a professional attitude as shown by an appropriate level of confidence and a positive outlook toward work and other people.
• Demonstrate integrity as shown by the admission and documentation of errors, recognition of the potential danger of short cuts, and the maintenance of patient and co-worker confidentiality.
• Act responsibly and reliably as measured by punctuality, attendance, dependability, and quality of work. 
• Respond favorably to supervision and feedback.
• Persevere until task is completed satisfactorily.