The value of blood groups over the AVO system system. Antigenic blood systems

Analysis on ABO antibodies - generalization study aimed at identifying alpha beta-isohemaggluutinin - natural IgG antibodies to missing antigens A or V. is determined in the event of the incompatibility of the mother and the fetus on the antigens of the ABO system. The detection of anti-group antibodies in the blood of a pregnant woman is necessary for the diagnosis of intergroup conflict and timely conduct of therapeutic measures in order to prevent miscarriage, premature genera, the hemolytic disease of the fetus (newborn). Blood fence is made from veins. The research method is the reaction of agglutination. Normally (with the low probability of intergroup conflict) the result is negative. The readiness of the analysis results is one working day.

Antibodies according to ABO or anti-group antibodies - immunoglobulins, which are produced when an antigen is found incompatible in groupality. The blood group depends on the erythrocyte membranes present on the outside of special proteins - agglutinogen. IN medical practice Aglutinogens A, B, and D are determined. In people with the first blood group, red blood cells without proteins A and B, with the II group - with proteins of type A, with the group III - with proteins of type B, at the IV group - with proteins of types A and B . The presence or absence of agglutinogen D defines a positive or negative rhesus factor. Anti-group antibodies are produced by the body when erythrocytes with unfamiliar agglutinogencies A or B are falling into the bloodstream. The reaction of these antibodies leads to the destruction of alien erythrocytes.

The production of antibodies on the ABO system is possible when blood transfusions, when mixing the blood of the fetus and mother. Theoretically, group incompatibility of blood is determined in the following cases: if the recipient (mother) has the I or III group of blood, and the donor (fruit) - II; If the recipient (mother) has I or II group of blood, and the donor (fruit) - iii; If the recipient (mother) has I, II or III group of blood, and the donor (fruit) is IV. In practice, the production of anti-group antibodies is most often noted in women with a group of blood, since it does not contain agglutinogen A and B and at the same time is the most common. The immunoconflict during pregnancy is capable of leading the erythroblastosis of the newborn, during blood transfusions - to the intravascular hemolysis of red blood cells. The risk group are recipients after several transfsions, as well as pregnant women who have suffered blood transfusions, artificial and natural interruptions that have children with hemolytic disease.

To analyze blood on antibody on the ABO system, blood fence is made from veins. The most common method of research is the reaction of agglutination using a diffuse gel. The results are used in obstetrics and gynecology when planning and monitoring pregnancy, as well as in surgery and resuscitation when conducting hemotransfused.

Indications

The study of blood on antibodies on the ABO system is shown to women during pregnancy, if there is a possibility of developing an immunological group conflict. When determining risk, the combination of parents of parents is taken into account. The presence of antibodies in the blood is most often determined in pregnant women with the I group, if the child II, III or IV were transferred from the father. Also probabilities conflict are combinations II maternal + III or IV Father, III Maternal + II or IV Father. When appointing analysis, other risk factors are taken into account: disruption of the permeability of the placenta, abdominal injuries, invasive diagnostic procedures (for example, amniocentesis). In all these cases, the erythrocytes of the fetus in the blood of the mother, with the subsequent development of anti-group antibodies. It is impossible to clinically determine the presence of an immunological conflict of this type - a woman does not feel any changes. But if you do not track the titer of antibodies, then there is a risk of developing a hemolytic disease, which is manifested by eductions, jaggility, anemia, an increase in the spleen and liver, in severe cases - developmental lags.

Another indication for blood tests on antibodies on the ABO system are complications after hemotransphus. In group conflict, acute intravascular hemolysis is often developing - the reaction of the destruction of the edrocytes of the injected blood. It is manifested by burning at the place of infusion, fever, chills, pain in the back and in a torso, panic attacks. When monitoring pregnancy, the decision to carry out the analysis is made by a doctor, taking into account the set of risk factors for the development of group conflict. The study of blood on antibody on the ABO system is not a screening in contrast, for example, from the test for anti-raspielic antibodies. This is due to the fact that the immunological conflict of this type is developing infrequently, and hemolytic disease proceeds in a light form and is mainly manifested by jaundic newborns

Preparation for analysis and material fence

The material for research on antibody on the ABO system is venous blood. The fence procedure is usually performed in the morning clock. There is no special requirements for the preparation, it is desirable to donate blood after 4-6 hours after making food. The last 30 minutes must be carried out in a relaxed atmosphere, without physical and emotional tension. Blood is taken from the elbow vein using a vacuum system without an anticoagulant or with a coagulation activator. It is stored at temperatures from 2 to 8 ° C, for 2-3 hours is delivered to the laboratory.

Antibodies on the ABO system are determined in the blood by agglutination. The study procedure consists of several stages. First, the studied sample is added to the microbrobikes with the filtration gel. Then they are installed for some time in the incubator, after - in the centrifuge. Erythrocytes that are connected to anti-group antibodies have a larger size and therefore do not pass through the gel, but remain on its surface. Free red blood cells as a result of centrifugation settled on the bottom of the test tube. On the distribution of erythrocytes, the presence of antibodies in the sample is estimated. Preparation of research results takes 1 day.

Normal values

The ABO system antibodies are represented by two types - α and β. The first are produced in agglutinogen A, the second to agglutinogen B. Both types of antibodies can be natural and immune, that is, acquired as a result of sensitization. Normally, the titer of natural α-antibodies ranges from 1: 8 to 1: 256, the titer of natural β-antibodies - from 1: 8 to 1: 128. Immune anti-group antibodies are normal not detected. The physiological decrease in the level of natural antibodies can be determined in children and the elderly.

Enhance values

The reason for increasing the analysis values \u200b\u200bfor antibodies on the ABO system is the sensitization of the body caused by the arrival of the antigen incompatible according to the group trait. In these cases, the titers of natural anti-group antibodies are increasing, immune anti-group antibodies of complete and incomplete form are sometimes determined. Most often, the deviations of this nature are diagnosed in pregnant women with the I group of blood, since the erythrocytes do not have agglutinogen neither type A, nor type B, and the frequency of the group's occurrence is 45%.

Reduced values

Reducing the analysis values \u200b\u200bfor ABO antibodies does not have diagnostic valueHis reasons can be some pathologies, for example, Agamaglobulinemia, Hodgkin's disease, chronic lymphocytic leukemia. In the absence of isoimunization with specific factors, immune anti-group antibodies are absent, and the titers of natural low.

Treatment of deviations from the norm

Blood analysis on antibodies on the ABO system has the greatest prognostic significance When monitoring pregnancies in women with I group of blood. Its results allow you to identify the state of sensitization to group factors and prevent the development of the immunological conflict leading to the erythroblastosis of the newborn. If an increased titer of natural anti-grapple antibodies was found, immune antibodies are determined, then it is necessary to seek advice to the leading pregnancy of Akuster-gynecologist. The decision on the need and tactics of therapy is made by a specialist individually.

The procedure for determining blood groups according to the AVO system consists in identifying antigens A and B in red blood cells using standard antibodies and the use of agglutinins in plasma or serum of the blood analyzed by standard erythrocytes. The technique was developed at the beginning of the 20th century and is still actively used in medicine. The definition of antigens A and B is carried out due to the culcons of anti-a and anti-c.

Basic concepts

Donors are always determined not only antigens in red blood cells, but also agglutinins in serum (plasma) with the use of standard red blood cells. Venous blood is used as biomaterial. Before research, it is necessary to abandon fatty foods per day before analyzing and not smoking for half an hour before the test. Blood groups are determined twice: first in the medical department where the material is harvested, and then confirm the study in the laboratory.

Definition of blood groups over the AVO system is the main test that is used in transfusion. There is also a similar system of blood groups in some animals, for example, chimpanzees, gorillas and bonobo.

History opening

In science, there is a generally accepted view that the method of determining blood groups on the AVO system was revealed for the first time by Karl Landstiner, Austrian scientist, in 1900. Then he described three types of antigens in his work. For this in thirty years he was awarded the Nobel Prize for Medicine and Physiology. Because of the fact that there were no close connections between scientists, later it was established that the Czech Serisologist Yang Yansky, regardless of the research of K. Landshteiner first described four groups of human blood, but his research was not known to the wide audience. Currently, it is the classification developed by Yansky, applied in Russia and the republics of the former USSR. In the USA, U. L. Moss created his similar work in 1910

Methods of determining blood groups over the AVO system with the help of Zoliclon

The blood group should be determined in a room with good lighting in compliance with the temperature range from 15 to 25 degrees Celsius, since deviations from this norm may affect the results of the study. The patient's initials and surname are written on a record or plate. From left to right or in a circle, standard designations of groups (O (I), A (II), in (III)) are applied. The corresponding serums are placed on them with separate pipettes for each type. Then the patient's blood is added to them. Material for research is taken from the ear of the ear or finger. This requires the technique of determining the blood group on the AVO system.

It is also legally the use of erythrocytes in a test tube after the clutch was formed. It is necessary that the amount of serum is more than the amount of blood added ten times. After that, the drops are mixed with glass chopsticks (separately for each). For five minutes, gently swaying the record, look at the advent of the hemagglutination reaction. It is found in the fact that there are small red lumps that merging then into larger. Serum at this time almost completely loses color.

In order to eliminate the false hemagglutination of the simple bonding of red blood cells, it is necessary to add one drop of the physiological solution after three minutes and check whether agglutination is maintained. If so, it is true. Everything, the definition of blood groups on the AVO system on this completed.

Interpretation of results

As a result, four reactions may be observed:

• agglutination does not occur with one of the serums - the first group O (I);
• the reaction was manifested with serum I (AB) and III (A) - the second group A (II);
• agglutination occurs with serum I (AB) and II (B) - the third group in (iii);
• if the reaction occurs with three serum, it is necessary to carry out an additional procedure with the reagents of the AB (IV) group, which are standard; If there is no agglutination in such a drop, we can assume that this is the 4th blood group AV (IV).

Express Method for Rh Factor

The method of determining blood groups through the AVO system involves the simultaneous detection of the Rh (RH).

The surface of the plate is pre-wet and written "control serum" and "serum antipes" on it. Then, under the inscriptions there are one or two drops of the desired reagents and the material analyzed is added. For this, it is also possible to use blood from the finger (in the same amount as the volume of serum) or the red blood cells remaining at the bottom of the test tube after the appearance of a bunch (half of the serum volume). The choice of material to the end result does not affect. Then the blood and serum are mixed with a dry glass wand, after which the reaction is waiting for five minutes. In order to eliminate false readings, an isotonic solution of sodium chloride is added in three or four minutes (only a few drops). The determination of the blood group on the AVO and RH system is carried out very often.

If agglutination of erythrocytes in a drill with serum occurs, it indicates a positive reserves of blood. According to RH + statistics, 85% of the world's population is found. The absence of it allows us to talk about rhesus-negative accessories. If agglutination appeared in the control serum, it means it was unusable. Unfortunately, the algorithm for determining the blood group on the AVO system does not always work perfectly.

What errors can be allowed under this technique?

Inaccuracies in determining the blood supplies by a particular group depend on the following reasons:

• Technical.
• Biological specificity of the blood under study.
• The defective nature of standard sera and red blood cells.

Technical errors

Possible errors in determining the blood group of the system AVO cross way:

Biological Specific Errors

The errors associated with the biological specifics of the analyzed blood are divided into two types.

• Depending on the features of red blood cells.
• Errors caused by the biological peculiarities of serum.

Consider every kind in more detail.

Depending on the features of red blood cells

• Late agglutination explained by the "weak" forms of erythrocytes and antigens. In order to avoid mistakes, to determine the blood group of donors and recipients is needed using standard erythrocytes. Internification of agglutinogen A 2 follows a re-study with other types of reagents and other dishes, increasing the recording time of the reaction.
• "Panagglutination" ("autoaggglutination") - the ability of blood to show the same reaction of non-specific nature with all serums, including with its own. After five minutes, the sharpness of such agglutination weakens, although it should increase. Such cases are observed in cancer, burned, etc. As a control, it is necessary to estimate the manifestation of agglutination of the analyzed erythrocytes in the standard serum of the fourth group and physically. With "Panagglutination", the blood group is determined as a result of the triple laundering of red blood cells. If it does not give the desired result, it is necessary to repeat the blood sample into the test tube warmed before the procedure and put a sample into a thermal container to help maintain a temperature of 37 degrees Celsius and above. Then it should be delivered to the laboratory, where the above temperature is preserved and heated saline, plate and reagents are used.

• Sometimes the red blood cells of the analyzed blood are located as "coin columns", and they can be taken for agglutinates. If you add two drops of isotonic solution and gently shake the tablet, the red blood cells occupy the correct position.
• Incomplete or mixed agglutination, occurring in patients with the second, third and fourth groups as a result of bone marrow transplantation or in the first three months after blood transfusion 0 (i).

Conditioned by biological peculiarities of serum

Errors associated with the use of defective standard erythrocytes and sera

Weak serums with a past shelf life or having a titer less than 1:32 are capable of landing weak and late agglutination. The use of such reagents is unacceptable.

The use of unsuitable standard erythrocytes or serums prepared in non-sterile conditions and waste in a lack of degree leads to the appearance of "bacterial" agglutination with nonspecific nature.

There are many popular assumptions about the blood groups of the AVO system, which appeared immediately after its detection in different world cultures. For example, in the 30s of the last century in Japan and some other countries, the theory binding a blood group with one type or another personality is gained. Similar theories are popular today.

There is also the opinion that a person who has a group A is susceptible to a heavy hangover, about the associated with good teeth, and the group A2 - with the highest level IQ. But scientifically such statements have not been proven.

We considered the definition of blood groups on the AVO system using standard sera.

This system is a basic, determining compatibility or incompatibility of blood flowing. It includes two genetically deterministic important antigen: A and B - and two types of antibodies to them, agglutinin A and B. The combinations of agglutinogen and agglutinins define 4 groups of the AVO system. This system is the only one, where in plasma in nonimune people have natural antibodies to a missing antigen. Agglutinogen A in most people is well pronounced (has a large antigenic force): with anti-a (a) antibodies, it gives a sharply pronounced reaction of agglutination of erythrocytes. Approximately 12% of persons groups A (11) and AB (IV), the antigen has weak antigenic properties, it is denoted as A2 an antigen. Thus, there is a group of antigens A: A1 (strong) and weaker A2, A3, A4, and others. On the existence of a weak antigen agen, and should be remembered when determining blood groups, since erythrocytes with such antigens are able to give only late and low-voltage agglutination that may result in errors. Weak varieties of antigen in are very rare. Antibodies of the AVO A (anti-a) and in (anti-c) system are a normal property of blood plasma, which is not qualitatively varying during the life of a person, and in is complete, cold antibodies. In most cases, they are not found in newborns and appear during the first three months of life or even the year. Complete development Group agglutinins reach 18 years, and in old age, the titer (level) is reduced, which is also observed in immunodeficiency states. In addition to existing in the norm (natural) group angit, and in a number of cases, immune antibodies anti-a and anti-c are arisen. Most frequent cause This is a pregnancy at which mother and fruit have different groups Blood, more often, if mother 1 (0) groups, fruit 11 (a) or w (B). The blood type determination is necessary for compatible blood transfusion. At the same time, it is necessary to follow the rule: the red blood cells of the donor should not contain an antigen corresponding to the recipient antibodies, i.e. A and A, B and B, as otherwise there will be massive destruction of the antibodies of the patient administered by the erythrocytes, which can lead to the death of the recipient. Donor group antibodies can not be taken into account, as they are bred by the recipient plasma. Consequently, the blood of the O (I) band, which does not contain agglutinogen, can be transferred to people with any group of blood. Persons having 0 (1) Blood Group are considered "universal doors". The blood of the group A (P) can be transferred to the recipients of the group A (P) and AB (IV) groups, which does not have in the plasma of agglutinins. The blood of the group B (W) can be transferred to persons with a group in (W) and AB (IV).

The determination of blood groups of the AVO system is made by the following methods.

I. Determination of the blood type with standard isohemagglutinating serums. In this case, the method in the blood establishes the presence or absence of agglutinogen and, based on this, make a conclusion about the group affiliation of the blood under study.

2. Definition of blood group by crossflow, i.e., simultaneously using standard isohemagglutinating serums and standard red blood cells. In this case, the method, as well as at the first, determine the presence or absence of agglutinogen and, in addition, with the help of standard erythrocytes, there is a presence or absence of group agglutinins.

3. Definition of blood type with monoclonal antibodies (civiclons).

Errors in determining blood groups

Technical errors. Violation of the above-mentioned blood groups of blood groups may lead to incorrect assessment of the results of the reaction. The retreat from the rules may come:

The use of poor quality standard serums or erythrocytes (expired shelf life, contamination of serum drying);

Confusion of blood samples;

The erroneous location of standard serums or phodators in tripods;

Erroneous procedure for applying standard reagents on the plate;

Improper ratio of the amount of serum and erythrocytes (not 10: 1);

Study at a temperature of less than 15 ° C (cold agglutination occurs) or more than 25 ° C (agglutination slows down);

Non-compliance with the time required for the reaction (5 min);

The physiological solution is not added, followed by swinging the plate;

Do not use control reaction with serum AVO (IV) group;

The use of polluted or wet pipettes, sticks, plates.

In all cases of a fuzzy or dubious result, it is necessary to re-definition of a blood group by cross-method using standard serum serums.

Errors associated with the biological features of the blood under study.

Improper definition of a group A 2 and A 2 V. Erythrocytes with a weak antigen A with an antiserum form small, slowly emerging agglutinates. The reaction can be taken into account as negative, i.e., the group A 2 is erroneously recorded as O (1), and 2 B - as in (w). The risk of such an error is especially great with the simultaneous presence of technical errors (the ratio of serum and erythrocytes 10: 1 is broken, the temperature is above 25 ° C, accounting for the results earlier than 5 minutes).

Errors associated with the presence of nonspecific aggly tinability of the studied erythrocytes. Such a phenomenon is observed in patients malignant tumors, leukemia, sepsis, burns, liver cirrhosis, autoimmune hemolytic anemia and is due to disproteinemia. Recalls the presence of non-specific agglutination control with Serum (IV) group. In these cases, it is necessary to re-identify the group affiliation by the cross method. In drops, where agglutination is observed, a physiological solution heated to 37 ° can be added. If necessary, it is possible to wash with warm (37 °) physiological solution of the studied erythrocytes and again determine the blood group.

Errors related to the presence of extraAgglutinins. In the serum of the groups of groups A2 (P) and A2B (IV), approximately 1% of cases detect antibodies to A1 antigen - A1. This is complicated by determining the blood group by the cross-method, since the serum of such persons agglutins standard erythrocytes A (P) of the group, that is, manifests itself as a serum 0 (1) of the group.

In some diseases there is a decrease in the agglutinability of erythrocytes, especially groups A (P).

In immunodeficiency states, old people have a decrease in the level of group agglutinins.

In all cases of obtaining a dubious result, the definition of group affiliation of blood should be reused by the cross method using high activity sera.

18. INTIRENEES SYSTEMS RESS. Groups of the rhesus. Clinical meaning. Methods for determining antigens Rh and possible errors.

Antigen Rhws are the second in transfusion practice after blood bands of the AVO system during the period of active implementation in the hemotransfusion clinic significantly increased the number of post-transfusion complications after re-operations compatible with avo blood antigen. The rhesus in the system includes six antigens, for the designation of which two-items are used in parallel: Wiener (RH 0, Rh ", Rh", HR 0, HR ", HR"); Fisher and flight (D, C, E, D, C, E).

RH 0 - D, RH "- C, RH" - E, HR 0 - D, HR "- C, HR" - E.

Since this system is the most active is the RHO (D) antigen, it is called the Rh Factor. It is depending on the presence or absence of this factor, people are divided into rhesus-positive (Rh +) and rhesse-negative (RH-). This division is accepted only on recipients. RH antigens "(C) and Rh" (E) are less active than RHO (D), but they can also produce antibodies in people who do not contain antigens with and E in red blood cells. Therefore, the reserves of negative donors is more stringent to red blood cells. The erythrocytes should not contain not only the antigen D, but also C and E. HRO (D), HR (C), HR (E) antigens are characterized by low activity, although the antibodies HR "(C) may be caused by iso immunological conflicts. In 1-3% of the rhesus-positive persons in the erythrocytes, there is a weak version of the antigen D - D, which determines the presence of a fine, dubious agglutination when determining the cutter. In these cases, the reserves-affiliation of the blood recipient or a pregnant woman indicate as a rhesus-negative (RH-), and the reserves-belonging of the blood of the donor as a rhesus-positive (RH +). Blood transfusion with Engine D U Rh-negative recipients is not allowed. Antigens for 8-10 week embryogenesis are formed, and their antigen can even exceed the activity of antigens in adults. The rezes system in contrast to the AVO system does not have natural antibodies. Antibodies The antipes occurs only after the immunization of the rhesus-negative organism as a result of transfusion of reserves-positive blood or pregnancy rezes-positive fruit. In the body of sensitized persons, antibodies to rhesus antigens remain several years, sometimes throughout life. In most cases, the antibody titer antibodies gradually decreases, but again increases dramatically during re-hitting the rhesus-positive blood. Rh-antibodies differ in specificity (anti-D, AN-III C, etc.) and for serological properties (full and incomplete). Full antibodies cause agglutination of erythrocytes in a salt medium at room temperature. To manifest agglutination under the action of incomplete antibodies, special conditions are required: increased temperature, Colloid medium (gelatin, whey protein). Full antibodies (IgM) are synthesized at the beginning of the immune reaction and soon disappear from the blood. Incomplete antibodies (IgG, IgA) appear later, it is synthesized for a long time and the cause of the development of hemolytic bins of newborns, as they pass through the placenta and the fetus cells damage.

Determination of blood reserves

The method for determining the Rh-factor depends on the shape of the rhesus antibodies in standard serum and the method of its manufacture. A cross-searition instruction is applied to the serum with a description of the method for which this series of output serum is intended.

With each study to test the specificity and activity of serum, the antveusus must be controlled. For control, standard rhesus-positive erythrocytes of group 0 (1) or the same group are applied as the blood test, and standard rezes-negative erythrocytes are necessarily the same group as the blood test.

When determining the rhesus, two series of standard serums in cases where they are used by different methods, the result is taken into account as true when it coincides in both series of studies after checking the control samples confirming the specificity and activity of each series of serum antveusus, i.e. in the absence Agglutination with standard rhesse-negative erytoers of the same name of the same name and the availability of agglutination with standard rhesus-positive erythrocytes of the same name of the group or group 0 (1) and in control samples without serum (reagent) antveusus. If a weak or dubious reaction is observed when determining the rhesus, then the blood of this face should be re-explore the antveusus serum and it is desirable to turn on the serum containing full antibodies. If all the serum series containing incomplete antibodies will also give a weak or dubious reaction, and with complete antibodies the reaction will be negative, this means that the erythrocytes contain the weak presentiality of the antigen rhesus, the so-called factor d U. In these cases, the reserves-affiliation of a patient or a pregnant woman indicate as a rhesus-negative (RH-), A residence of the blood of a donor as a rhesus-positive (RH +), not allowing the transfusion of its blood to the rezes-negative recipient.

The definition of the ray factor can also be carried out by the following techniques.

Determination of the RH 0 (D) reaction with the reaction of conglutination using gelatin (in the heated tube to 46-48 ° C).

Determination of the RHO (D) Rho Factor (D) Conglutination Reaction in the serum medium on a heated plane.

Determination of the RH 0 (D) reactor of agglutination in the salt medium in small tubes. The agglutination reaction in the salt medium is suitable for operation only with serum containing complete rhesus antibodies.

Determination of the Rh Rh 0 (D) with monoclonal antibodies.

Determination of Rho (d Rho (D) Rho (D) with indirect Cumbac sample.

19 anemia. Classification and brief description. Etiology and pathogenesis of anemia. Anemia (from Greek Anemia - Bescro) is a large group of diseases, which is characterized by a decrease in the amount of hemoglobin or hemoglobin and erythrocytes in a unit volume of blood. Anemia is different in etiology, development mechanisms, a clinical hematological picture, so there are many different classificationsBut they are not perfect enough. L. I. I. Idevson proposed a working classification of anemia for clinician doctors: 1) sharp postghemorgic anemia; 2) iron deficiency anemia; 3) anemia associated with a violation of the synthesis or disposal of porphyrins (sederoblastic); 4) anemia related to the disruption of DNA synthesis, RNA (megaloblastic); 5) hemolytic anemia; 6) anemia associated with the oppression of the proliferation of bone marrow cells (hypoplastic, aplastic); 7) anemia associated with the replacement of blood-made bone marrow with a tumor process (metaplastic).

Anemia can be both an independent disease and related symptom or complicating some internal diseases, infectious and oncological disease. There are polyfact anemia, i.e. mixed genesis, for example: hemolytic anemia with iron deficiency, aplastic anemia with a hemolytic component, etc.

Depending on the:

1) the values \u200b\u200bof the color indicator distinguish between anemia:

Normochromic (color indicator 0.9-1.1);

Hypochromic (color less than 0.85);

Hyperchromic (color indicator greater than 1.15);

2) the magnitudes of the average diameter of red blood cells:

Normation (average diameter of erythrocytes 7.2-7.5 microns)

Microcolitan (average erythrocyte diameter less than 6.5 microns),

Macrocyte (average erythrocyte diameter is greater than 8.0 μm),

Megalocyte (average erythrocyte diameter is greater than 12 microns);

3) the values \u200b\u200bof the average volume of erythrocytes in femtolytera (FL, 1 PL is 1 μm 3):

Normocitar (medium volume of erythrocytes 87 ± 5 FL);

Microcolitan (average erythrocyte volume less than 80 FL);

Macrocyte (average erythrocyte volume greater than 95 FL);

4) levels of reticulocytes in peripheral blood.

Regenerator (number of reticulocytes 0.5-5%);

Hyperrhegenerator (the number of reticulocytes is greater than 5%);

Gyo-and theragenerator (the number of reticulocytes is reduced or they are absent, despite the serious course of anemia).

The level of reticulocytes is an indicator of the regenerator function of the bone marrow against erythropoese.

Normochromic anemia includes sharp postgemorrhagic (in the first days after blood loss), hypo- and aplastic, non-ferrocyte hemolytic, autoimmune hemolytic, metaplastic (under leukemia, myeloma, etc.), as well as anemia, developing in endocrine disorders (adrenal hypofunction), Diseases of kidneys, chronic infections.

Hypochromic anemia includes iron deficiency, siperoblastic, some myelotoxic, hemolytic (thalassemia).

Hyperchromic are B12- (Foliyevo) -mediy, some hemolytic anemia (hereditary microspherocytosis, if microspherocytes prevail among red blood cells). Sometimes vitamin-B1 2-state anemia is normal.

The normocitar includes sharp postgemorgic, aplastic, autoimmune hemolytic anemia, etc.

Microcitar includes iron deficiency, sideroblast anemia, to the macocytic - Vigamine-B12- (Foliyevo) -methy anemia, etc.

Regenerator are postghemorgic anemia; to hyperrhegenerator - hemolytic anemia, especially the state after a hemolytic crisis; To hypo-and argene - hypoplastic, aplastic anemia.

The bone marrow reacts to the development of iron deficiency, hemolytic anemia with irritation, hyperplasia of a red sprout. In hypoplastic anemia, there is a progressive drop in erythropoese up to its full exhaustion.

20.Laboratory diagnostics of iron-hearted and iron-wicked anemia. Iron-deficiency anemia. Types of iron deficiency. Laboratory tests reflecting iron deficiency in the body. Picture of peripheral blood and bone marrow with waiting. Laboratory diagnostics of sideroblastic anemia. Mechanism exchange and role in the body

The iron is of great importance for the body, is part of hemoglobin, myoglobin, respiratory enzymes. It is distributed according to the main funds.

Hemoglobine Fund. Hemoglobin iron is 60-65% of the total content of iron in the body.

Spare Fund. This is iron ferritin and hemosiderine, which are deposited in the liver, spleen, bone marrow, muscles. It is 30-40% of the iron level in the body. Ferrine is a water-soluble complex of trivalent iron and an apotheferritin protein containing 20% \u200b\u200biron. It is a labile fraction of the Iron Reserve Fund. If necessary, it is easily used for the needs of erythropoes. Hemosiderine is an insoluble protein in the water, in composition close to ferritine, but contains a greater amount of iron - 25-30%. It is a stable, firmly fixed fraction of iron reserves in the body.

The transport fund is represented by iron related to transport protein transferrin. It is 1% of the iron content in the body.

The fabric fund is represented by iron-containing enzymes (cytochromes, peroxidase, etc.), myoglobin. It is 1% of the iron content in the body.

The total iron content in the organism of adults is 4-5 g. It enters the body with a food diet. It is contained in animal and vegetable products (meat, especially beef, liver, eggs, legumes, apples, kuraga, etc.). Iron is absorbed much better of animal products than vegetable, as it is contained in them in the form of a hem. So, 20-25% is absorbed from meat, from fish - 11%, from plant products - 3-5% iron contained in them. Iron's absorption contribute ascorbic acid, Organic acids (lemon, apple, etc.), inhibit the suction tannin, high fat content in the diet. Suction of iron out food products limited. During the day, 2-2.5 mg of iron is absorbed, briefly after severe bleeding can be absorbed to 3 mg of iron. The main amount of iron is absorbed in the 12rdistanchine and in the initial part tochyan. A small amount of iron can be satisfied in all delicate sections.

Iron absorption occurs in two stages: 1) the intestinal mucosa is captured by iron coming with the edible diet; 2) Iron from the intestinal mucous membrane goes into the blood, loaded into transferin and is delivered to the place of use and in the depot. Transferrin also transfers iron from its funds and cells of the level of phagocytic monouk leaars, in which the destruction of the red blood cells is detected, into the bone marrow, where it is partially used for the synthesis of hemoglobin, and partially postponed in the form of iron stocks, as well as in other storage locations. Typically, 1/3 of Transferrin is binding to iron. It is called connected transferrin or serum iron. Normally, the iron content in the serum in men and women is, respectively, 13-30 and 12-25 μmol / l. Part of transferrin not bound to iron is called a free transferrin or unsaturated, latent iron binding ability of serum. The maximum amount of iron that could attach transfererin to its saturation is denoted as the overall iron binding ability of the serum (Жmss) (normally 30-85 μmol / l). The difference between the indicators of the yoss and serum iron reflects the latent iron binding ability, and the ratio of serum iron to the RUB, expressed as a percentage reflects the percentage of transferlic iron saturation (norm 16-50%). For judgment about the magnitude of the iron stocks and the body are carried out:

Study of the level of ferritin in serum by radioimun methods;

Refirerary test. Refieme (Desferoksamamine) is a complex, which after administration to the body selectively communicates with iron of reserves, i.e. with ferritin gland, and displays it with urine. The patient is once intramuscularly introduced 500 mg of presverial, they collect the daily urine and the iron content is determined. After the administration of the desferla with urine is normally derived from 0.8 to 1.2 mg of iron, while in patients with iron deficiency anemia or in the presence of a hidden iron deficiency, the amount of iron allocated to the urine is sharply reduced;

Counting in the bone marrow point of the number of siderobes, and in the peripheral blood - siderocytes. Sideroblasts are Normoblasts, that is, the kernel-containing cells of the red row, in the cytoplasm of which the blue colors of iron granules are revealed - ferritin. In the norm, 20-40% of the normoblasts are Sideroblasts. Siderocytes are erythrocytes, in which ferritin granules are detected. Normally in the peripheral blood: up to 1% of siderocytes. Ferrithin granules in Sideroblasts and Siderocytes are detected with a special color of the Berlin Azure.

The organism is characteristic of the physiological loss of iron with urine, feces, bile, lost cells of the mucosa of the skin, from then, with a haircut of hair, nails. Women lose iron with monthly.

Development iron deficiency anemia Preceded hidden (latent) iron deficiency. Patients appear complaints and clinical signscharacteristic of iron deficiency of peymia, but less pronounced (weakness, moderate pallor of skin and visible mucous membranes, headaches, heartbeat, often the perversion of taste and smell, dry skin, nail fragility, etc.). During the examination, changes have not yet been detected in the content of hemoglobin, erythrocytes and other peripheral blood indicators. But violations are detected in the exchanging of iron: decreases serum iron, General and latent iron binding cans of serum increases, the percentage of transferrin saturation decreases, the iron level of stocks is reduced. These are siderpins without anemia. Hidden iron deficit can develop at any age, especially women, teens and children suffer especially. If the hidden iron deficit is not compensated, and the iron deficiency anemia is inserted.

General research information

Blood AVO group is a system that reflects the presence or absence of antigens on the surface of the red blood cells and antibodies in the blood plasma. ABO (read as "A-BE-zero") is the most common system of blood groups in Russia.

Erythrocytes on their surface carry signal molecules - antigens - agglutinogens. The two main antigens embedded in the erythrocyte molecule are A and V. Blood Group are determined on the basis of the presence or absence of these antigens. The blood of people who have antigen agencies on the erythrocytes, refers to the second group - A (II), the blood of those who have an antigen in the erythrocytes belong to the third group - B (III). If antigens A and antigens are present on red blood cells - this is the fourth group - AB (IV). It also happens that in blood on red blood cells is not defined by any of these antigens - then it is the first group - O (I).

Normally, the body produces antibodies against those antigens (A or B), which are not on the erythrocytes - these are agglutinins in the blood plasma. That is, persons with the second group of blood - A (II) - on red blood cells there are antigens A, and the plasma will contain antibodies to antigens B - indicate as anti-B (beta-agglutinin). Since the antigens (agglutinogens) on the surface of the erythrocytes and agglutinine in plasma (A and alpha, B and beta) enter each other to the reaction and lead to the "gluing" of the erythrocytes, they cannot be contained in the blood of one person.

The discovery of the ABO group system made it possible to understand why blood transfusion sometimes happened successfully, and sometimes caused severe complications. The concept of compatibility of blood groups was formulated. For example, if a person with a second blood group - A (II), which contains antibodies to antigen in, pour the third blood group - b (III), there will be a reaction between antigens and antibodies, which will lead to gluing and destruction of red blood cells and may have severe consequences Up to death. Therefore, blood groups during transfusion must be compatible.

The blood group is determined by the presence or absence of gluing erythrocytes using serum containing standard antigens and antibodies.

In blood transfusion centers on bags with blood or with its components obtained from donors, "O (i)", "A (II)", "B (III)" or "AB (IV)", which allows you to quickly find Blood the needed group when it is required.

What is the study?

To find out what blood can be safely transfused to the patient. It is extremely important to make sure that donor blood is compatible with the blood recipient - a person who is going to overflow. If in donor blood or its components there are antibodies to antigens contained on the erythrocytes of the recipient, a severe transfusion reaction may develop, caused by the destruction of erythrocytes in the vascular bed.

When is the study assigned?

• Before the blood transfusion is both to those who are required and donors.

The transfusion of blood and its components is most often required in the following situations:

• • heavy anemia
  • bleeding arising during or after surgery
  • heavy injuries
  • massive blood loss of any origin,
  • oncological diseases I. side effects chemotherapy,
  • blood coagulation disorders, in particular hemophilia.
• Before surgical intervention.

General provisions

The system of blood group AVO is two group agglutinogen - A and B and two corresponding agglutinin in the plasma - alpha (anti-a) and beta (anti-c). The various combinations of these antigens and antibodies form four blood groups: group 0 (1) - both antigen are missing; Group A (II) - Only antigen A is present on red blood cells; Group in (III) - Only antigen B is present on red blood cells; AV (IV) group - on red blood cells there are antigens A and V.

The uniqueness of the AVO system is that in the plasma in non-immunized people there are natural antibodies to the absent on the erythrocytes of the antigen: in groups of group 0 (1) - antibodies to A and B; In persons group A (II) - anti-in-antibodies; In persons of the group in (III) - anti-A-antibodies; In AV (IV), there are no antibodies to antigens of the AVO system.

In the subsequent text, anti-a- and anti-in-antibodies will be designated as anti-A and anti-c.

Definition of blood group AVO is carried out by identification specific antigens and antibodies (double or cross reaction). Anti-A and anti-B detect in serum using standard erythrocytes A (II) and in (III). The presence or absence on erythrocytes of antigens A and B is installed using monoclonal or polyclonal antibodies (standard hemagglutinous sera) of the corresponding specificity.

The definition of a blood type is carried out twice: a primary study - in the medical department (a brigade of blood harvesting); A confirming study is in the laboratory department. The algorithm for conducting immunohematological laboratory studies during blood transfusion is presented in Fig. 18.1.

The result of determining the blood group is recorded in the upper right corner of the face list of the illness of the disease or to a donor magazine (map) indicating the date and signed by the doctor who made the definition.

In the North-West Russia, the distribution of blood groups of the AVO system in the population as follows: group 0 (I) - 35%; Group A (II) - 35-40%; Group in (III) - 15-20%; AB (IV) Group - 5-10%.

It should be noted that there are various species (weak options) as an antigen A (to a greater extent) and antigen V. The most common types of antigen a - a 1 and a 2 are most common. The prevalence of antigen A 1 in groups of groups A (II) and AB (IV) is 80%, and the antigen A 2 is about 20%. Blood samples C A 2 may contain anti-A 1 -ant, interacting with standard erythrocytes of Group A (II). The presence of anti-A 1 is detected at cross-definition of blood groups and when conducting a sample for individual compatibility.

For differentiated definition of antigen A (A 1 and A 2) options, it is necessary to use specific reagents (phytohemagglutinines or anti-A monoclonal antibodies. 2 (II) and A 2 V (IV). Transfusions of washed erythrocytes can also be recommended: 0 (i) - patients with a group of blood A 2 (II); 0 (I) and in (III) - patients with a group of blood and 2 V (II).

Table 18.4. Results of the definition of blood group avo
Results of research						Group affiliation
erythrocytes with reagent			serum (plasma) with standard red blood cells
anti-Av.	anti-A.	anti-B.	0 (i)	A (II)	In (III)
-	-	-	-	+	+	0 (i)
+	+	-	-	-	+	A (II)
+	-	+	-	+	-	In (III)
+	+	+	-	-	-	AV (IV)
Designations: + - the presence of agglutination, - - no agglutination

Definition of group supporting blood via avo system

Blood groups are determined by standard serums (simple reaction) and standard erythrocytes (double or cross-reaction).

A group of blood is determined by a simple reaction, be sure to two series of standard isohemagglutinating sera.

• Progress [show] .

  The determination of blood type is produced with good lighting and temperature from + 15 to + 25 ° C on tablets. On the left side of the tablet, 0 (1) is prescribed, in the middle - A (II), on the right side - in (iii). In the middle of the top edge of the tablet, the surname of the donor or the number of the blood studied is noted. Using active standard serums of three groups (O, A, B) with a titer not lower than 1:32, two episodes. Serums are placed in special tripods in two rows. Each serum corresponds to a labeled pipette. For additional control, serum AB (IV) is used.

  The tablet is applied on one to two drops of standard serums in two rows: Serum of group 0 (1) - on the left, Serum A (II) - in the middle, serum in (III) - on the right.

  Drops of blood from the finger or test tubes are applied by a pipette or glass wand near every drip of serum and mixed with a stick. The amount of blood should be 8-10 times less than serum. After mixing the plate or tablet gently shake in the hands, which contributes to a faster and clear agglutination of erythrocytes. As agglutination occurs, but not earlier than 3 minutes, to droplets of serum with red blood cells, where agglutination has occurred, a 0.9% solution of sodium chloride solution is added and continue to observe until the expiration of 5 minutes. After 5 minutes, they read the reaction in the transmitted light.

  If the agglutination is fuzzy, one drop of 0.9% solution of sodium chloride solution is additionally added to the serum and blood mixture, after which the group affiliation is made (Table 18.4).

• Results of the reaction [show] .
  1. The absence of agglutination in all three drops indicates that there is no agglutinogen in the blood under study, that is, the blood refers to group 0 (I).
  2. The attack of agglutination in droplets with serums 0 (I) and in (III) indicates that there is agglutinogen A in the blood, that is, the blood refers to the group A (II).
  3. The presence of agglutination in droplets with serums of group 0 (I) and A (II) indicates that there is agglutinogen in the blood under study, that is, the blood of the group in (iii).
  4. Agglutination in all three drops indicates the presence of agglutinogen A and B in the blood under study, that is, blood refers to the AB (IV) group. However, in this case, given that agglutination with all serums is possible due to a non-specific reaction, it is necessary to apply on a tablet or a plate of two or three drops of standard serum AB (IV) and add 1 drop in the blood under study. Serum and blood stirred and the result of the reaction is observed for 5 minutes.

     If agglutination has not come, then the blood under study refer to the AB (IV) group. If agglutination appears with the Serum of AB (IV), it means that the reaction is nonspecific. With weak agglutination and in all dubious cases, blood is anewly checked with standard serum series.

Definition of Blood Group AVO Double Reaction
(according to standard serums and standard erythrocytes)

Standard erythrocytes are 10-20% suspension of fresh native erythrocytes (or washed from preservative test cells) of groups 0 (I), A (II) and in (III) in 0.9% solution of sodium chloride or citrate salt solution. Native standard erythrocytes can be used within 2-3 days, provided that they are stored in an isotonic saline at a temperature of + 4 ° C. Canned standard erythrocytes are stored at a temperature of + 4 ° C for 2 months and washed from the preservative solution before use.

Ampoules or vials with standard serum and standard erythrocytes are located in special tripators with appropriate labeling. To work with typing reagents, dry clean pipettes are used, separate for each reagent. For washing glass (plastic) sticks and pipettes, glasses are prepared with a 0.9% sodium chloride solution.

To determine the group, taking 3-5 ml of blood into the tube without a stabilizer. Blood should be standing for 1.5-2 hours at a temperature of + 15-25 ° C.

• Progress [show] .

  Two drops (0.1 ml) of standard serums of groups 0 (I), A (II), B (III) of two series are applied to the tablet. Accordingly, each serum group is placed on one small drop (0.01 ml) of standard erythrocytes of groups of groups 0 (I), A (II), in (III). In standard serums added one drop of the blood under study, and two drops of serum under study are added to standard erythrocytes. The amount of blood should be 8-10 times less than serum. The drops are stirred by a glass stick and, shaking the tablet in their hands for 5 minutes, follow the onset of agglutination. If the agglutination is fuzzy, one drop of 0.9% solution of sodium chloride (0.1 ml) is additionally added to the serum and blood mixture (0.1 ml), followed by a group affiliation (Table 18.4).

• Evaluation of the results of determining the blood group of the AVO system [show] .
  1. The presence of agglutination with standard erythrocytes A and B and the absence of agglutination in three standard serums of the two series indicates that both agglutinin - alpha and beta are present in the serum under study, and there are no agglutinogen in the erythrocytes studied, that is, blood refers to group 0 (I) .
  2. The presence of agglutination with standard serums of groups 0 (I), B (III) and with standard erythrocytes of the group B (iii) indicates that in the erythrocytes studied, there is agglutinogen A, and in the test serum - agglutinin beta. Consequently, blood refers to the group A (II).
  3. The presence of agglutination with standard serums of groups 0 (I), A (II) and with standard erythrocytes of the group A (II) indicates that there are agglutinogen in the erythrocytes under study, and in the studied serum - agglutinin alpha. Consequently, blood refers to the group in (III).
  4. The presence of agglutination with all standard serums and the absence of agglutination with all standard erythrocytes indicates that both agglutinin are used in the erythrocytes studied, that is, blood refers to the AB (IV) group.

Definition of blood group supplies
using civiclons anti-a and anti-in

Cologicles anti-a and anti-B (monoclonal antibodies to antigens A and B) are designed to determine the blood group of the AVO system of human instead of standard isohemagglutinating sera. For each determination of the blood type, apply one series of reagent anti-A and anti-c.

• Progress [show] .

  The tablet (plate) is applied along one large drop of civiclons anti-a and anti-in (0.1 ml) under the appropriate inscriptions: "Anti-A" or "Anti-B". Nearby placed on one small drop of the blood under study (the ratio of bloodthater - 1:10), then the reagent and blood are mixed and monitored the progress of the reaction at easy swaying tablet or plate.

  Agglutination with colyclones Anti-A and anti-in usually occurs in the first 5-10 s. Observation should be conducted 2.5 minutes, due to the possibility of a later attack of agglutination with erythrocytes containing weak species of antigens A or V.

• Evaluation of the results of the reaction of agglutination with the colyclones of Anti-A and the anti-B is presented in Table. 18.4, which also includes the results of the definition of agglutinins in donor serum using standard erythrocytes.

In suspected spontaneous agglutination in persons with a group of Blood AB (IV), a control study with a 0.9% solution of sodium chloride is carried out. The reaction must be negative.

Cologicles anti-a (pink) and anti-in (blue) are produced in both native and lyophilized form in ampoules of 20, 50, 100 and 200 doses with a solvent applied to each ampoule, 2, 5, 10 , 20 ml, respectively.

Additional control of the correctness of the determination of the Blood Group AVO reagents Anti-A and Anti-B is the monoclonal anti-AV (hematologist, Moscow). The anti-AV reagent is advisable to use in parallel with both immune polyclonal serums and monoclonal reagents. As a result of the reaction with the reagent, anti-AV develops agglutination of erythrocytes of groups A (II), in (III) and AV (IV); In the erythrocytes of group 0 (i) there is no agglutination.

Errors in the definition of group supplies

Errors in determining blood groups may depend on three reasons:

1. technical;
2. inferiority of standard serum and standard erythrocytes;
3. biological features of the blood under study.

Errors for technical reasons include:

• a) improper arrangement of serum on the tablet;
• b) incorrect quantitative ratios of serum and red blood cells;
• c) the use of not enough clean tablets and other items in contact with blood. For each serum should be a separate pipette; Only a 0.9% solution of sodium chloride should be used for washing pipettes;
• d) incorrect entry of the blood under study;
• e) failure to comply with the reaction of agglutination time; when hasty, when the reaction is taken into account before 5 minutes, agglutination may not come if weak agglutinohynes are available in the blood under study; With over 5 minutes of the reaction, droplets from the edges, simulating agglutination, can occur, which also leads to an erroneous conclusion;
• e) lack of agglutination due to high (above 25 ° C) ambient temperature. To avoid this error it is advisable to use specially cooked serums to work in a hot climate; Determining blood groups on a plate or plastic tray, the outer surface of the bottom is omitted in cold water.
• g) Incorrect centrifugation: insufficient can lead to a false negative result, and excessive to false positive.

Errors depending on the use of defective standard serum and standard red blood cells:

• a) weak standard serums with titer lower than 1:32 or with an expired shelf life can cause late and weak agglutination;
• b) The use of unsuitable standard sera or erythrocytes, which were cooked smaller and not allowed, leads to nonspecific "bacterial" agglutination.

Errors dependent on the biological characteristics of the blood under study:

Errors depending on the biological characteristics of the studied erythrocytes:

• a) Late and weak agglutination is explained by the "weak" forms of antigens, erythrocytes, more often - the presence in groups A and AV of weak agglutinogen A 2. At the same time, in the case of determining the blood group without testing serum on the presence of agglutinins (simple reaction), errors may be observed, as a result of which the blood of the group A 2 B is determined as a group in (III), and blood A 2 is as group 0 (I). Therefore, in order to avoid errors, the definition of a blood group both donors and recipients must be carried out using standard erythrocytes (double or cross-reaction). To identify agglutinoogen A 2, it is recommended to repeat the study with other types of reagents using another laboratory dishes, with an increase in the recording time of the reaction.

  Specific reagents of clarification of the blood group in the presence of weak versions of antigen A (A 1, A 2, A 3) by the method of direct reaction of agglutination are the zoliclon anti-C and the anti-A reagent).

• b) "Panagglutination" or "autoagglutination", that is, the ability of blood to give the same non-specific agglutination with all serums and even with its own. The intensity of such a reaction after 5 min weakens, while true agglutination is enhanced. Most often occurs in hematological, oncological patients, burned and others. To control, it is recommended to estimate whether the agglutination of tested erythrocytes is occurred in the standard serum of the AB (IV) group and the physiological solution.

  A blood type with "Panagglutination" can be determined after three-time laundering of red blood cells. To eliminate nonspecific agglutination, the tablet is placed in a thermostat at a temperature of + 37 ° C for 5 minutes, after which nonspecific agglutination disappears, and the true remains. It is advisable to repeat the definition using monoclonal antibodies, setting the Cumbsis sample.

  In the case when the lamination of red blood cells does not give the desired result, it is necessary to repeat the blood sample into a pre-warmed tube, put the sample in the thermal container to maintain the temperature of + 37 ° C and deliver to the laboratory to research. The blood type determination must be made at a temperature of + 37 ° C, for which pre-heated reagents, saline and tablet are used.

• c) Erythrocytes of the test blood consisted in "Mint Columns", which in macroscopy can be taken for agglutinates. Adjustment of 1-2 drops of isotonic sodium chloride solution followed by mildly swaying the tablet, as a rule, destroys "coin columns".
• d) mixed or incomplete agglutination: part of the red blood cells agglutinates, and the part remains free. It is observed in patients of groups A (II), in (III) and AV (IV) after bone marrow transplantation or during the first three months after the blood transfusion of group 0 (I). The heterogeneity of the erythrocytes of peripheral blood is clearly verified in the gel test DIAMED.

Errors dependent on the biological features of the serum studied:

• a) Detection of antibodies of other specificity in routine testing is the result of previous sensitization. It is advisable to determine the specificity of antibodies and select typical red blood cells without an antigen, to which immunization has been detected. An individual selection of compatible donor blood is required to immunized recipient;
• b) when identifying the formation of "coin columns" of standard erythrocytes in the presence of test serum, an abnormal result is advisable to expose, using standard erythrocytes of group 0 (I). For differentiation of "coin columns" and true agglutinates, 1-2 drops of isotonic sodium chloride solutions are added and the tablet is shocked, while the "coin columns" are destroyed;
• c) the absence of anti-a- or anti-in-antibodies. Perhaps in newborns and patients with oppression of humoral immunity;
total pages:10

LITERATURE [show] .

1. Immunological selection of the donor and recipient during blood transfusions, its components and bone marrow transplants / comp. Shabalin V. N., Serov L. D., Bushmarin TD and other Leningrad, 1979.- 29 p.
2. Capaco S. P., Silvernaya N. B., Ignatovich G. P. and others. Allevousitization for hemocomponent therapy and optimization of the selection of histociable pairs "Donor Recipient" in the military medical institutions/ Methodology. Recommendations. - S.-Petersburg, 1994.- 16 p.
3. Practical transfusion / ed. Kozinets G. I., Biryukova L. S., Gorbunova N.A. And Dr.- Moscow: Triada-T, 1996.- 435 p.
4. Guide for military transfusion / ed. E. A. Nechaev. - Moscow, 1991. - 280 s.
5. Guide for transfusion medicine / ed. E. P. Swedenzova. - Kirov, 1999.- 716c.
6. Rumyantsev A. G., Agranenko V. A. Clinical transfusion. - M.: Goeotar Medicine, 1997.- 575 p.
7. Shevchenko Yu.L., Zhibut E.B., Secure blood transfusion: Guide for doctors. - SPb.: Peter, 2000.- 320 p.
8. Shevchenko Yu.L., Zhibut E.B., Silver N.B. Immunological and infectious safety of hemocomponent therapy. - SPB: Nauka, 1998.- 232 p.
9. Schiffman F.J. Pathophysiology of blood / trans. from English- M.- SPb.: Publishing house Binom - Nevsky Dialect, 2000.- 448 p.
10. Blood Transfusion in Clinical Medicine / Ed. P.l.mollison, C. P. Engelfriet, M. Contreras.- Oxford, 1988.- 1233 p.

A source: Medical laboratory diagnostics, programs and algorithms. Ed. prof. Karpischenko A.I., St. Petersburg, InterMedica, 2001