-CATALOGUE #MLT 270
CIP #51.1004
DATE: February 1, 2008
Moberly Area Community College
COMMON SYLLABUS
Current Term
MLT 270 Immunohematology
Office Number:
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Contact information:
Classroom number:
Class days and time:
Catalogue description: The course studies concepts and applications of
immunohematology, blood banking concepts, procedures for grouping, testing, screening,
and identification. The student must satisfactorily perform in a laboratory setting as well
as pass written tests.
Prerequisites: BOE 171 Medical Terminology, BIO 205 Human Anatomy, BIO 209
Physiology and MLT 210 Immunology (with clinicals).
Text: Harmening, D.M. (2013). Modern Blood Banking and Transfusion Practices. (6th
ed.). F.A. Davis: Philadelphia, PA. ISBN: 978-0-8036-2682-9.
Other Required Materials:
Handouts, videos, training aids and transparencies as provided by the instructor.
Purpose of the Course: The purpose of this course is to provide MLT students with a
basic understanding of the function and structure of blood; the involvement of blood
group antigens and antibodies; the principles of transfusion therapy; the adverse effects of
blood transfusion, and the operations of blood collection services. Using this basic
knowledge they can develop practical skills to function competently in the blood bank
laboratory.
Cognitive Course Objectives:
It is the responsibility of the student to learn the following course material presented in
Immunohematology lectures, handouts, textbooks, audiovisuals, and computer-assisted
learning.
1. Describe a modern blood bank laboratory in terms of its operations, personnel,
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facilities, and equipment.
2. Discuss the structure, composition and preservation of red blood cells and
platelets as they relate to transfusion therapy.
3. Demonstrate an understanding of genetics at three levels, population, cellular and
molecular as it pertains to inheritance of blood groups and testing in
immunohematology.
4. Explain how principles of immunology relate to blood banking.
5. Characterize blood group antibodies: polyclonal and monoclonal, naturally
occurring and immune, expected and unexpected, alloantibodies and
autoantibodies, warm and cold.
6. Discuss factors that influence agglutination reactions when performing blood
bank testing.
7. Compare tube, gel and solid phase techniques in ABO and Rh typing,antibody
detection and compatibility testing.
8. Explain the principles of the antiglobulin test, application of it in blood bank
testing, factors that affect the test and sources of error.
9. Discuss the ABO blood group system, reciprocal relationship between ABO
antigens and antibodies, frequencies, subgroups, phenotypes and effects of
disease.
10. Interpret the results from ABO typing and resolve discrepancies if present.
11. Discuss the Rh blood group system, the Fisher-Race and Wiener nomenclature
and theories of Rh inheritance, antigen and antibody detection, characteristics of
Rh antibodies and clinical considerations.
12. Interpret the results from an Rh typing and resolve discrepancies.
13. Discuss the basic concepts of antigens and antibodies in the Lewis system and
their clinical and biological significance.
14. Discuss the basic concepts and crossmatch problems involving the following
major blood group systems: MNS, P, Ii, Kell, Duffy, Kidd and Lutheran.
15. State criteria for acceptable blood donors.
16. Describe autologous donation rules and requirements.
17. State the tests required for allogeneic, autologous and pheresis donation,
acceptable intervals and labeling criteria.
18. Identify the storage conditions, shelf life, quality control requirements,
indications for use and adverse reactions and laboratory evaluation of adverse
reactions for the following:
RBC’s
RBC’s irradiated
RBC’s leukoreduced
Random platelets
Apheresis platelets
Random platelets leukoreduced
Apheresis platelets leukoreduced
Washed RBC’s
Washed random platelets
Washed apheresis platelets
Pooled random platelets
Frozen, deglycerolized RBC’s
Fresh, frozen plasma
Liquid plasma
Whole blood modified
Cryoprecipitate
Granulocyte concentrates
Factor VIII concentrates
Factor IX concentrates
Factor XIII concentrates
Rho(D) immunoglobulin
Normal serum albumin
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Immune serum globulin
Plasma protein fraction
Antithrombin III concentrates
19. Explain the process for antibody identification including use of the following
techniques:
Cell panels
Enzymes
Neutralization
Adsorption
DAT
Elution
Titration
20. Explain compatibility testing procedures and protocols under normal and special
circumstances.
21. Describe general blood transfusion practices including practices followed under
special conditions.
22. Discuss reporting transfusion reaction work-ups.
23. Differentiate the clinical signs and symptoms of the following types of transfusion
reactions:
Immediate and Delayed Hemolytic Transfusion Reaction
Immediate Nonhemolytic Transfusion Reactions
Delayed Nonhemolytic Transfusion Reactions
24. Discuss diseases transmitted by transfusion.
25. Compare and contrast Hemolytic Disease of the Newborn when ABO versus Rh
is implicated.
Psychomotor Course Objectives
After completion of the course with instruction and practice in the student lab and at the
affiliate site, students are responsible for knowing how to do the following to minimal
competency standards:
1. Perform ABO and Rh typing proficiently.
2. Perform Direct (DAT) and Indirect (IAT) Antihuman globulin testing
proficiently.
3. Perform a type, antibody screen and crossmatch proficiently.
4. Identify the following antibodies by using a panel: Kell, Duffy, Kidd.
5. Perform a Transfusion Reaction Workup.
6. Utilize prewarming techniques to secure compatible units for crossmatch.
7. Utilize polyethylene glycol and/or LISS and polybrene for antibody enhancement
during identification.
8. Utilize gel and/or solid phase technology for type and crossmatch.
9. Perform quality control checks in the blood bank laboratory.
10. Prepare packed red cells and platelets for administration.
Affective Course Objectives
After completion of the course, students should be able to display the following behaviors
and attitudes:
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1. Consistently perform blood bank testing with precision, accuracy, and quality.
2. Use good technique in performing blood bank testing.
3. Demonstrate good working knowledge of blood bank theory and use of
equipment.
4. Adhere strictly to written procedures and follow verbal technical direction
carefully.
5. Use proper quality control measures.
6. Treat laboratory results and issues confidentially.
7. Generate accurate and legible reports.
8. Maintain a clean, orderly working area.
9. Maintain technical competency and emotional stability in times of tension or
stress.
10. Communicate effectively with other professional staff in a professional,
cooperative, and empathetic manner.
Course Outline:
I.
II.
III.
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Immunology for Blood Bankers
A. Overview
B. Basic immune system genetics
C. Immunoglobulins
D. Complement
E. Characteristics of blood group antibodies
1. Polyclonal and monoclonal antibodies
2. Naturally occurring and immune antibodies
3. Unexpected antibodies
4. Alloantibodies and autoantibodies
F. Characteristics and antigen-antibody reactions
G. Detection of RBC antigen-antibody reactions
1. Blood samples required for testing
2. Traditional laboratory methods
3. Factors that influence agglutination reactions
Antiglobulin Test (Coombs)
A. AHG reagents
1. Monospecific
2. Polyspecific
B. DAT
C. IAT
D. Modified and Automated Antiglobulin Test Techniques
1. Low ionic polybrene
2. Enzyme-linked
3. Solid phase
4. Gel test
RBC Biology and Preservation
A. RBC membrane
B. Hemoglobin structure and functions
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C. RBC preservation
D. Anticoagulant preservative solutions
E. Additive solutions
F. Freezing and rejuvenation
G. Platelet preservation
IV.
Basic Genetics for Blood Bankers
A. Mendel’s Laws of Inheritance
B. Hardy-Weinberg Principle
C. Inheritance patterns
D. Cellular genetics
1. Mitosis
2. Meiosis
3. Cell division
V.
ABO Blood Group System
A. Historical perspective
B. ABO antibodies
C. Inheritance of ABO blood groups
D. ABO subgroups
E. ABO discrepancies
VI.
Rh Blood Group System
A. History of the Rh system
B. Nomenclatures of the Rh system
C. Proposed genetic pathways
D. Weak D
E. Determination of D status
F. Detection of Rh antibodies and antigens
G. Clinical considerations
VII. Lewis System and the Biological Significance
A. Basic concepts: Lewis phenotypes
B. Lewis antibodies
C. Clinical significance
VIII. Other Major Blood Group Systems
A. MNS blood group system
B. P blood group
C. Ii Blood Group
D. Kell and Kx blood group
E. Duffy blood group
F. Kidd blood group
G. Lutheran blood group
IX. Detection and Identification of Antibodies
A. Antibody screen
1. Tube technique
a. RBC reagents
b. Enhancement
c. AHG reagents
2. Gel
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X.
XI.
XII.
3. Solid phase
B. Interpretation
C. Limitations
D. Antibody identification
E. Additional techniques
1. Selected cell panels
2. Enzymes
3. Neutralization
1. Adsorption
2. DAT and elution
3. Antibody titration
F. Providing compatible blood products
G. Resolving difficult antibody identification problems
Pretransfusion compatibility testing
A. Identification, collection and preparation of samples
B. Compatibility testing protocols
C. Selection of appropriate donor units
D. Crossmatch testing
1. Serologic crossmatch tests
2. Immediate spin crossmatch
3. Antiglobulin crossmatch
4. Interpretation of results
5. Resolving incompatibilities
6. Causes of positive results
E. Computer crossmatch
F. Compatibility testing in special circumstances
1. Emergencies
2. Transfusion of non-group-specific blood
3. Plasma products
4. Intruterine transfusions
5. Neonatal transfusions
6. Massive transfusions
7. Autologous
G. Effective blood utilization
Automation and Alternative Technologies
A. Gel technology
B. Solid-Phase Technology
Organization of the Blood Bank Facility
A. Government agencies
1. Center for Medicare and Medicaid Services (CMS)
2. Food and Drug Administration (FDA)
3. Occupational Safety and Health Administration (OSHA)
B. Facilities who collect/Facilities who do not
1. Donor processing
2. Labeling
3. Donor testing
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4. Main laboratory
C. Sample acceptance
D. Routine testing
E. Requests for other blood components
F. Issue of blood products
G. Reference Laboratory
H. Personnel
XIII. Donor Screening and Component Preparation
A. Governing agencies
B. Donor screening
C. Autologous donors
D. Directed donors
E. Pheresis donation
F. Whole blood collection
G. Donor records
H. Donor processing
I. Automation
J. Component preparation
1. Whole blood modified/irradiated
2. RBCs/aliquots/irradiated/leukoreduced/frozen, deglycerolized
3. Platelet concentrates/aliquots/leukoreduced
4. Single-donor plasma
5. Plasma and liquid plasma/pooled plasma
6. Cryoprecipitated antihemophilic factor
7. NovoSeven
8. Factor VIII concentrates
9. Factor IX
10. Factor XIII
11. Immune serum globulin
12. NSA
13. Plasma protein fraction
14. Rh(D) immune globulin
15. Synthetic volume expanders
16. Antithrombin III concentrates
K. Labeling of components
XIV. Transfusion therapy
A. Blood components
1. Whole blood
2. RBCs
3. Leukocyte-reduced RBCs/washed RBCs/frozen and deglycerolized
RBCs
4. Platelets
5. Granulocytes pheresis
6. FFP
7. Thawed or liquid plasma
8. Cryoprecipitate
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9. Factors
10. Albumin
11. Immune Globulin
B. Special considerations for transfusion
XV. Transfusion reactions
A. Immediate hemolytic transfusion reaction (IHTR)
B. Delayed hemolytic transfusion reaction (DHTR)
C. Immediate nonhemolytic transfusion reactions
D. Anaphylactic reactions
E. Bacterial contamination
F. Delayed nonhemolytic transfusion reactions
XVI. Transfusion-Transmitted Diseases
A. Donor testing
B. Hepatitis
1. HAV
2. HBV
3. HDV
4. HEV
C. HIV
D. HTLV-I and II
E. CMV
F. EBV
G. Parvovirus B19
H. Herpesvirus 6 and 8
I. Bacterial contamination
J. Syphilis
K. Parasites
L. Prion
XIII Hemolytic Disease of the Newborn and Fetus
General Notes: Library assignments, periodicals, computerized modules, and guest
speakers may be used as appropriate.
Assessment of Student Learning:
In both the didactic and the laboratory portions of the course, the student must achieve
78% or greater. Failure to achieve this minimum score will result in dismissal from the
program. In the laboratory portion of the course, the final grade will be recorded as
“Pass” or “Fail” and registered with the didactic portion.
The following grading scale applies to all programs within the Allied Health Division:
100 – 92% = A
83 – 91% = B
78 – 82% = C
66 – 77% = D
65% and below = F
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In the lecture portion of the clinical course, the final grade is derived from student
performance on examination(s) and/or assignments.
Unit exams averaged = 60%;
Final exam = 30%
Quizzes, case studies, study questions, class participation etc. averaged = 10%
TOTAL 100%
Grading/Student Assessment of lecture (didactic) portion of the course:
Final grade will be composed of the following:
1. Unit exams = 60%
2. Final exam = 30%
3. Quizzes, case studies, participation, assignments = 10%
Grading/Student Assessment of laboratory (student laboratory and
clinicals) portion of the course:
1. Skills Checklist: Passing is 78% of the total points available
2. Quizzes, practical assessments, or case studies: Passing is 78% of the
total points available
3. Professional Behaviors Evaluation: Passing is no less than 78%
Final Pass/Fail clinical grade is the average of the Skills Checklist, quizzes,
case studies, or practical assessments, and the Professional Behaviors
Evaluation.
Statement to Connect Course with General Education Outcomes or Technical
Program Outcome Statement: In compliance with MACC’S General Education
outcomes, the student who successfully completes this course will be able to:
I.
Demonstrate effective written and oral communication skills.
II.
Demonstrate an understanding of scientific principles and computational skills
and how to use them to solve problems and make informed decisions.
Program Outcomes and Assessments:
The Allied Health Department continually strives to meet the needs of the Medical
Laboratory Technician student through program improvements. This is a cooperative
effort that includes input from the faculty, student, Medical Laboratory Technician
Advisory Board, and other appropriate agencies or entities. Students are assessed on
mastery of the course concepts and essential skills throughout the courses of the Medical
Laboratory Technician Program.
Other program assessments include clinical
performance criteria, essential skills mastery, the clinical process evaluation, ASCP
examination scores, placement rates, and follow-up surveys.
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Instructor Policies/Expectations:
Instructors of this program expect the following from students:
1. Come to class prepared to discuss or apply important concepts by having read the
assigned material or reviewed materials for instrument operation.
2. Participate in class by listening, taking notes, and making contributions to
discussions.
3. Consult with faculty for clarification of difficult material or additional resources
to consult.
4. Respect the learning environment by averting distractions and disturbances such
as ringing cell phones and extraneous conversation in class.
5. Treat instructors and fellow students with consideration, concern, and fairness.
Academic Dishonesty: MACC board policy is as follows: “Academic dishonesty by
students damages institutional credibility and unfairly jeopardizes honest students;
therefore, it will not be tolerated in any form.” Forms of academic dishonesty include but
are not limited to the following: violations of copyright law, plagiarism, fabrication,
cheating, collusion, and other academic misconduct. Incidents of dishonesty regarding
assignments, examinations, classroom/laboratory activities, and/or the submission of
misleading or false information to the College will be treated seriously. The procedure
for handling academic dishonesty is outlined in the Student Handbook (Policy Handbook
M.010). In cases of alleged academic dishonesty, the burden of proof is on the student,
not on the instructor.
Attendance:
Students are expected to prepare for and attend all classes and clinical practice. Regular
attendance improves probability for success in the program. Habitual tardiness and
frequent absences are disruptive to the classroom and cause an unsafe environment in the
student laboratory. Instructors carefully plan learning experiences, so it is important as a
matter of courtesy and fairness to the class that all individuals be present. Students
absent for reasons beyond their control, such as verified personal illness or family illness
and/or death, can make up class work. If a student misses so many classes due to
extenuating circumstances that the instructor feels the student cannot catch up, the MLT
Program Coordinator will send a written report to the Director of Allied Health.
Students who miss two consecutive weeks of class during a regular sixteen-week
semester or the equivalent ratio of class time during a shorter session will be dropped
from that class unless acceptable justification is supplied to the instructor and the Dean of
Student Services. Additionally, students who miss more than one-fourth of the class
meetings during any scheduled session may be dropped from that class by the instructor
if, in the opinion of the instructor, the student does not have a reasonable opportunity to
succeed in the class.
Tardiness, make-up, and late work: Tardiness to class and clinicals is disruptive and
inconsiderate of others. Being on time is mandatory.
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Make-up and late work: See the MLT Student Handbook for guidelines. Remember that
communication, accountability and responsibility are very important professional
behaviors.
Refer to the MLT handbook for the following policies:
Drop policy
Drug/alcohol policy
Grade appeal procedure
Student code of conduct
Student due process and grievance procedure
Student rights and privacy act
Use of computing resources
ADA Statement
Students who have disabilities that qualify under the Americans with
Disabilities Act may register for assistance through the Office of Access
and ADA Services. Students are invited to contact the Access Office to
confidentially discuss disability information, academic accommodations,
appropriate documentation and procedures. For more information, please
call either the Moberly office at (660) 263-4100 x 11240 or the Columbia
office at (573) 234-1067 x 12120, or visit our web page at
http://www.macc.edu/index.php/services/access-office.
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