Question 1

About Blood

Accepted Answer

The ABO blood group system was discovered by Karl Landsteiner in 1900. 46 years later (1946) the Blood Transfusion Service was formed. In 1950 the National Blood Service was formed to collect and provide blood supplies for all the hospitals in Sri Lanka.   Blood comes in four main types - O, A, B and AB. Group O is the most common which means it is in high demand. Blood can also be subdivided into its main components - red cells, white cells, platelets and plasma. Unfortunately red cells only have a shelf-life of 35 or 42 days, while platelets shelf life is even less, only five days.   Almost anyone between the ages of 18 and 55 can become a new blood donor. And those who are regular donors can continue to donate till 60.   The average adult has around 5 trillion red blood cells in one litre of blood. Which means you have on average 25 trillion red cells running around inside you, although 25 million (or 0.1%) of them die every day. That works out at roughly 300 a second.   William Harvey was the first physician to discover that blood circulates round the body back in 1628. Sir Christopher Wren (St Paul's Cathedral Christopher Wren) actually injected fluids into the circulation of animals, using an instrument invented by the aforementioned Mr Harvey.   The first successful blood transfusion was carried out in 1665 by Dr Richard Lower. He used dogs as the donor and recipient. However, when they started performing transfusions on humans, they couldn't understand why the people receiving the blood kept dying. It wasn't until 1900 that Dr Karl Landsteiner discovered the ABO blood group system and realised that human patients needed to be given compatible blood. He got the Nobel Prize for his discovery.

Question 2

Who can donate blood?

Accepted Answer

The person must fulfill several criteria to be accepted as a blood donor. These criteria are set forth to ensure the safety of the donor as well as the quality of donated blood.   Donor Selection Criteria   Age above 18 years and below 60 years. If previously donated, at least 4 months should be elapsed since the date of previous donation. Hemoglobin level should be more than 12g/dL. (this blood test is done prior to each blood donation) Free from any serious disease condition or pregnancy. Should have a valid identity card or any other document to prove the identity. Free from "Risk Behaviours". Risk Behaviours   Homosexuals. Sex workers and their clients. Drug addicts. Engaging in sex with any of the above. Having more than one sexual partner Type of Donors   Voluntory non remunerated donors. (donate for the sake of others and do not expect any benefit. their blood is considered safe and healthy) Replacement donors. (donate to replace the units used for their friends or family members) Paid donors. (receive payment for donation Directed donors. (donate only for a specific patient's requirement) Replacement and Paid donors are no longer accepted by NBTS. Replacement donation was carried out until recently in some blood banks due to the shortage of blood stocks. Asking patients for replacement donors will lead to more pressure on the relatives, who are already in stress and this in turn results in illegal paid donations.   Directed donations are used in certain conditions such as in rare blood groups. NBTS achieved the mighty figure of 100% voluntory non-remunerated blood donor base.

Question 3

Blood Groups

Accepted Answer

Blood Groups   Blood is unique among other body tissues due to its liquefied nature. As a result of this curious researchers could obtain a blood sample and experiment with it more conveniently than any other body tissues. Some of the very early experiments involved blood transfusion from animal to animal and transfusion from animal to human. However, most of these experiments ended up with detrimental outcome to the recipient due to severe allergic reactions.        In 1901 the Austrian Scientist Karl Landsteiner, for the first time in the history, postulated the concept of blood groups. He obtained blood samples from several individuals and separated red cells and serum. Once separated, he mixed the red cells of one individual with serum of another simulating a transfusion in vitro. He demonstrated that the said mixing resulted in a visible agglutination reaction in some pairs while others did not do so. Finally he concluded that this observation is due to the existence of blood and the ABO blood group system was discovered. For this historical discovery Karl Landsteiner was awarded with the Nobel Prize for Medicine in 1030.   His birthday falls on 14th of June and World Health Organization selected this to celebrate “World Blood Donor Day” to pay tribute and motivate voluntary non remunerated blood donors.   Landsteiner’s postulation about ABO blood group system has been scientifically proven and studied in detail. According to the current understanding differences in the molecular structure of glyco-proteins known as antigens found on the surface of the red cells determine the blood group. For example in ABO blood Group system there are two antigens known as A antigen and  B antigen and they give rise to following blood groups.      In 1940 Karl Landsteiner and Alexander Wiener discovered another red cell antigen. It was identified as Rhesus factor or Rhesus antigen as it was discovered while they experimented using the red cells obtained from Rhesus Monkey (Rhesus macaque). Rh antigen can be found in more than 90% of the individuals they are typed as Rh-positive. Individuals who do not have the Rh antigen on their red cells are typed as Rh-negative. Accordingly the 4 blood groups in the ABO system can be subdivided further as follows.      The type of antigen present on your red cells and the resulting blood group is genetically determined. If you have the relevant gene responsible for the formation of a particular antigen inherited form your parents your blood group is determined accordingly.   Where there is an antigen there should be an antibody   Our immune system is in constant surveillance about the microbes invading our bodies. Various molecules formed by basic elements like carbohydrate and protein found on the outer surface of invading bacteria and viruses are recognized by the immune system as foreign. Since they stimulate the immune system such foreign substances are known as antigens. Once the immune system recognize a foreign antigen a protein that can react with those antigens are produced by the immune system. These proteins are known as antibodies and antibodies helps to neutralize the invading pathogens if the body expose to same pathogen in a subsequent occasion.   While this antibody production naturally occurs in healthy people immunization enhances the antibody production even before the natural pathogens invade the body. For example when you are vaccinated against polio the immune system produces antibodies against polio virus and even if you exposed to the virus subsequently the antibodies in your blood inactivate the virus and you are protected against polio.   Interestingly the immune system produces antibodies only against foreign antigens. Structures similar to A and B antigen found on the red cell are abundant in the microbes and food particles we expose in day today life. As a result of this our immune system produces antibodies against them and they are called A antibody and B antibody. However, the immune system makes surenot to produce an antibody against an antigen inherited on your red cells since it is not foreign. The production of A and B antibodies naturally occurs around 3 to 4 months after birth and the possible combination of antigen and antibodies are as follows.        Compatibility of blood donor and recipient   During a blood transfusion red blood cells obtained from a donor is given to a vein (a blood vessel that carry blood towards the heart) of the patient or recipient through a blood transfusion set. After the transfusion the donor’s red cells dissolves in the recipient’s plasma and circulates all over the recipient’s body. Since our immune system is on constant surveillance on the foreign substances entering into the blood circulation transfused red cells are also subjected to this surveillance. The immuno-globulins or antibodies in the recipient’s plasma would react against the antigens of donor red cells if they contain a foreign antigen. For example group A blood cannot be given to a group B patient since antigen A on donor red cells reacts with A antibody in the recipients plasma giving rise to a transfusion reaction. Furthermore, prior to a safe transfusion we must consider about the antigen on donor’s red cells and antibodies in the recipient’s plasma. In the transfusion laboratory this is determined by a compatibility testing. Compatible donors and recipients are marked in the following table,      Group O red cells are universal donors since they do not have A or B antigens on them they can escape the immune surveillance of any of the recipients. Group AB individuals are universal recipients since they do not have A or B antibodies in their plasma they do not mount a reaction against any of the ABO groups.

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