The blood is a very important body fluid, not only because of its role in the transport of molecules in the body, but apart from this function, the blood is an important part of the immune system. The whole blood cells has a role to play in the protection of the body.
<sup>Image credit <a href="https://commons.wikimedia.org/wiki/File:Sterile_blood_transfusion_%27giving_apparatus%27,_England,_1946-_Wellcome_L0057841.jpg">Wikimedia</a>. Creative Commons Attribution 4.0 International license. </sup>
<h6>The blood cells (Labor divided)</h6>
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The blood platelets contains coagulation factors which are involved in the formation of a stable fibrin mesh that covers a ruptured blood vessel, it is also involved in inflammation by producing platelet activating factor which is a vasoactive mediator of inflammation, the platelets also activates the complement system which enhances the cytotoxicity of the humoral branch of the adaptive immune system.
<div class="pull-left"><center><img src="https://steemitimages.com/0x0/)" /><br /><em><sup>The white blood cell. Image credit: <a href="https://commons.wikimedia.org/wiki/File:Diagram_of_a_white_blood_cell_CRUK_028.svg" rel="noopener">Wikimedia</a>. CC4.0 license. Image author Cancer Research UK</sup></em></center></div>
The white blood cells (leukocytes) on the other hand are the principal cells of immunity, consisting of several powerful lytic cells which destroys immunogens. During immune reactions; antibodies forms complexes with the antigens and immunogens, after the immune reaction, these complexes remain in the body, they circulate and attach to the blood vessels and other vessels of the body, this leads to hypersensitivity of the type 3 form.
Hence there is need to clear these complexes after an immune response, the complexes are destroyed in the liver and cleared from the body, the red blood cells (erythrocytes) are tasked with the transportation of these complexes to the liver. The fluid part of the blood on the other hand contains very active proteins and other organic and inorganic molecules which are involved in almost every action of the immune system, the blood cells are also suspended on it and conveyed via this fluid portion known as the plasma.
<h6>Indications for blood transfusion</h6>
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This shows the need for a constant amount of blood in the body so as to ensure that there are adequate concentration of these cells and molecules to prevent a total halt or impairment of these vital functions. The total blood volume in the body is about 4-5 litres, there may be physiological variation due to age, sex and geographical location; hence males have a larger blood volume than the female counterpart, and people living in areas of high altitudes also have more blood volume than those living in areas of lower altitudes, this is due to hypoxic conditions in areas of high altitudes which stimulate the production of erythropoietin, a growth factor and hormone which stimulate the production and differentiation of blood cells, mainly the erythrocytes. Aged people tend to have a lesser blood volume than the younger ones.
There is also a physiological loss of blood during menstruation this is however no normally associated with any infection at all. Pathologically, blood may be lost in cases of rupture of blood vessels in trauma and infections and physically in cases of injuries, this ranges from moderate to severe injuries, in moderate injuries, the blood and the blood vessels initiates a cascade system to produce insoluble molecules to fill up the ruptured vessels and prevent excess loss of blood before the injury heals.
<div class="pull-right"><center><img src="https://steemitimages.com/0x0/)" /><br /><em><sup>Severe injuries which results in serious blood loss demands blood transfusion to restore blood balance. Credit: <a href="http://www.keesler.af.mil/News/Photos/igphoto/2000072948/" rel="noopener">Keeslar air force base</a>. Creative commons license.</sup></em></center></div>
In severe injuries, the blood clotting system is even more active as large number of clotting factors are produced at the site of the injury and functioning more efficiently in an attempt to plug the created hole; but unfortunately, this hole is usually too big to an extent that excess blood is lost before the bleeding is arrested. The volume of blood deviates from it’s normal range, the hemoglobin level falls below 85g/l and the packed cell volume is reduced by mire than 30% of it’s normal value. Certain sickness might also lead to excess loss of iron from the body and destruction of the blood cells.
In this condition; there is a need for rapid transfusion of blood as the normal physiologic procedure for blood cell formation is too slow and cannot restore the normal blood values within the required period of time. The act is transferring blood or it’s constituents from a healthy individual to a patient is referred to as blood transfusion.
<h6>Blood transfusion and the immunoglobulins</h6>
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Blood transfusion is a very tasking medical procedure as the blood is a very sensitive fluid, the blood contains antibodies to which the both synthesizes corresponding antigens in such a way to prevent autoimmunity and immunologic reactions.
The major antibody of the blood is Immunoglobulin M. The Immunoglobulin M in the blood is very much different from the monomeric 180KDa molecular weight membrane receptor immunoglobulins already described. The Immunoglobulin M is located on the surface of the red blood cells. The blood Immunoglobulin M is pentameric, hence it has five units if the basic Immunoglobulin structure, polymerised by aid of the J-chain, it is decavalent, having ten antigen binding sites and five FC regions.
<div class="pull-left"><center><img src="https://steemitimages.com/0x0/)" /><br /><em><sup>Immunoglobulin M. Image credit <a href="https://commons.wikimedia.org/wiki/File:IgM_scheme.svg" rel="noopener">Wikimedia</a>. Creative Commons Attribution-Share Alike 2.5 Generic license.</sup></em></center></div>
Immunoglobulin M is the heaviest of all the immunoglobulins subtypes with a molecular weight of about 900KDa, it is known as the macroglobulin due to this fact. This large size account for the little concentration of this Immunoglobulin as it does not diffuse well due to its size; Immunoglobulin M is the principal Immunoglobulin produced during primary response to an antigen, that is the first time the immune system is exposed to an antigen, this is also applied in the diagnosis of diseases as a detection of the Immunoglobulin M is an evidence of recent microbial infection.
The Immunoglobulin M is the first immune synthesized by the neonate. Polymerization of the macroglobulin occurs just before its secretion as the J-chain is added at this time. Due to the large structure of the Immunoglobulin, it is the most efficient Immunoglobulin in the binding of antigens and also the activation of the complement system, it triggers a stronger immune response and at a rate which is faster than any other immunoglobulins, the activation of the complement system requires two fragment crystallizable regions (FC regions) located very close to each other, the
Immunoglobulin M having five FC regions in close proximity is very much effective in this action and accounts for the intense immune reaction seen in a faulty blood transfusion. The presence of Immunoglobulin M in the red blood cells has made the blood transfusion procedure more tasking and requiring adequate skills, professionalism and more time tasking, as the care giver has to monitor a patient on the blood transfusion scheme very closely to detect any reaction and proffer required solution on time.
The practice of blood transfusion dates back to as far as the 17th century sets of blood transfusion were performed around this time but most were fatal, leading to a halt in this practice; I however, the discovery and explanation of the blood antigens and antibodies by Karl Landsteiner simplified this practice.
Reuben Ottenburg in 1907 introduced the idea of cross-matching of the blood groups before commencing the transfusion process, these two events have enormously decreased the risk and death rates of blood transfusion and is presently a relatively safe medical practice, though there are still rare cases of death of patients from blood transfusion, this maybe due to fault transfusion apparatus, insufficient examination and inadequate attention to the patient.
<div class="pull-right"><center><img src="https://steemitimages.com/0x0/)" /><br /><em><sup>Gaseous exchange in human aveolus . Image credit <a href="https://commons.wikimedia.org/wiki/File:Gas_exchange_in_the_aveolus_simple_(en).svg" rel="noopener">Wikimedia</a>. CC4.0 license. Image author <a href="https://commons.wikimedia.org/wiki/User:Domdomegg">Domdomegg</a></sup></em></center></div>
Blood transfusion procedure involves testing the fitness of the blood and it’s efficiency in oxygen transport, this involves the assessment of the haemoglobin value of the blood through the cyanmethemoglobin method or copper sulphate specific gravity method, the required haemoglobin value for blood transfusion in Nigeria is 13g/dl, a deviation (reduction) from this value makes the blood unfit for transfusion and is an indication of hypochromic anaemia due to iron loss.
Further test are carried out to detect the donor’s blood group; the donor is tested for the presence of specific antibodies and their matching antigens, this is through the observation for any agglutination when the blood is reacted with the sera of other blood groups, agglutination presents clumping of the blood; this indicates that the blood and the serum has contrasting antigens and antibodies, the absence of agglutination confirms the compatibility of both blood groups and hence the group of the donor’s blood is determined and subsequently, the patient’s blood is also tested in a similar way to detect his/her blood group.
The both blood groups are cross-matched so as to confirm the compatibility and when the blood groups are compatible, the blood will not produce any immune reaction when transfused. The donor’s blood is also tested for any blood borne infection such as HIV/AIDs or any other infection which maybe transmitted through blood, the blood cells may also be examined individually as there may be cases of specific infections, in some practice, the white blood cell concentration of the blood may be reduced so as to reduce the risk of immune reaction.
<sup>Blood group compatibility cross-matching. Image credit <a href="https://commons.wikimedia.org/wiki/File:Compatibility_testing_concerning_RBCs_2014-02-01_00-42.jpg">Wikimedia</a>. Creative Commons Attribution-Share Alike 3.0 Unported license. Image by <a href="https://commons.wikimedia.org/w/index.php?title=User:Luigi_Albert_Maria&action=edit&redlink=1">Luigi Albert Maria</a></a>
Subjecting the blood to ultraviolet rays have also been found to reduce the amount of pathogens in the blood.
A slight failure or insufficiency of any of these preventive measures may lead to an overall failure of the blood transfusion exercise with effects ranging from controllable to fatal. There might also result the spread of infection from the donor to the patient.
Haemolytic reactions may also result as the antibody-graft system tends to get rid of these unhealthy transfused blood, allergic and anaphylactic reactions may result, leading to hypersensitivity due to the antigen being complexed with Immunoglobulin E and cross-linked with mediators of anaphylaxis such as mast cells and basophils. Care should thus be taken before blood is being transfused to ensure that these precautions are properly taken and these dangers averted; after a successful transfusion, patients should still be under close surveillance as delayed Haemolytic reactions may occur days after the transfusion.
The donor and receiver of the blood should also commence a good feeding habit so as to replace the donated blood and to ensure that the received blood works properly respectively.
<h6>Conclusion</h6>
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The blood is drug, and must be treated as such, the Principles of blood transfusion as well as the criteria for accessing blood donors and regulation of the donation processes as stated by the World Health Organization (WHO) bland and the FDA must be strictly adhered to if blood must be transfused successfully without any complications, the negative effects of a faulty transfusion may be more severe than one could think.
In cases of blood banking, the blood bank organization is very vital to ensure that haemolysed blood or a pool handled blood is not transfused to the patient, specific blood components are stored at specific temperatures, this may vary depending on the component, thus the specified temperature for any blood component should be maintained so as to ensure the cells do not lose their function, transfusion transmitted diseases and death of the patient is a very big dent to the image of a hospital and such care should be taken in every case of blood transfusion
<h6>REFERENCES</h6>
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<ol>
<li><a href="https://en.wikipedia.org/wiki/Blood_transfusion">Blood transfusion -Wikipedia</a></li>
<li><a href="http://asheducationbook.hematologylibrary.org/content/2013/1/638.full">Transfusion guidelines: when to transfuse -asheducationbook</a></li>
<li><a href="https://en.wikipedia.org/wiki/Immunoglobulin_therapy">Immunoglobulin therapy
-Wikipedia</a></li>
<li><a href="https://en.wikipedia.org/wiki/Immunoglobulin_M">Immunoglobulin M
-wikipedia</a></li>
</ol>
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