Virtual transfusion science laboratory
Comprehensive interactive blood bank laboratory with realistic workflows, emergency scenarios and progressive training modules, for graduates through advanced practitioners.
Virtual Transfusion Science Laboratory Suite is available to premium subscribers and trial users.
Advanced transfusion LIMS
Laboratory information management for transfusion validation, blood product management and cross-department result analysis.
Transfusion LIMS System is available to premium subscribers and trial users.
Major haemorrhage protocol training
Practise life-critical protocols in an immersive simulation environment: the scenarios every transfusion BMS must defend in panel and at coroner inquest.
Major Haemorrhage Protocol
Code Red Simulation Training
Immersive simulation for UK Blood Transfusion Scientists handling life-threatening haemorrhage emergencies. Practice MHP activation, component selection, and clinical decision-making under time pressure.
12 Scenarios
15-20 mins
BSH Based
Key Learning: MHP activation, O D negative stewardship, component choice without a fixed ratio, fibrinogen replacement, SBAR communication, and clinical decision-making reflecting BSH and NICE guidelines.
Kleihauer testing
Kleihauer-Betke assay workflow and FMH quantification for anti-D dosing decisions.
Kleihauer Blood Film Examination
Learn how to interpret Kleihauer-Betke test results, calculate fetomaternal haemorrhage volume, and determine appropriate anti-D immunoglobulin dosing according to UK guidelines
Kleihauer-Betke Test Examination & Interpretation
Laboratory professionals examine Kleihauer-Betke tests microscopically to detect fetal haemoglobin in maternal blood. Adult haemoglobin is eluted and the cells appear as "ghosts", while fetal haemoglobin resists acid elution and stains pink/red. Use the virtual microscope to examine each sample in detail.
Negative
0% fetal cells
Negative acid elution field: every red cell is a pale adult ghost and no pink fetal cells are seen.
Positive: about 11 mL FMH
0.5% fetal cells
Positive acid elution field with about 0.5% fetal cells (pink) among adult ghost cells, equivalent to about 11 mL of fetal red cells (0.5 × 18 × 1.22). This exceeds the 4 mL covered by a 500 IU standard dose.
Positive: about 44 mL FMH
2% fetal cells
Positive acid elution field with about 2% fetal cells (pink) among adult ghost cells, equivalent to about 44 mL of fetal red cells.
Positive: about 110 mL FMH
5% fetal cells
Positive acid elution field with about 5% fetal cells (pink) among adult ghost cells, equivalent to about 110 mL of fetal red cells. A bleed of this size needs flow cytometry confirmation and urgent clinical and specialist advice.
Laboratory Examination Procedure
In laboratory practice, Kleihauer-Betke (KB) tests are examined using brightfield microscopy. The microscopist:
- Prepares a maternal blood smear and treats it with acid buffer (pH 1.5-2.0)
- Stains the slide so that fetal cells stain pink/red and adult cells remain as pale ghosts
- Screens at least 25 low power fields (x10 eyepiece, x10 objective) for fetal cells
- Counts both adult cells (appear as "ghosts") and fetal cells (stained pink/red)
- If quantification is needed, counts fetal cells against at least 10,000 maternal ghosts using a x40 objective and an eyepiece grid (Miller square)
- Reports the estimated FMH in mL of fetal red cells, with advice on any additional anti-D and follow-up
Interpretation Guide
Less than 2 mL fetal red cells
Covered by the standard anti-D dose. The report says the FMH is less than 2 mL rather than "negative", so the standard dose is still given.
2 mL or more
Confirm by flow cytometry on the original sample. Phone a preliminary result to the ward so additional anti-D can be given within 72 hours.
4 mL or more
A significant FMH. A 500 IU dose covers up to 4 mL, so give additional anti-D at 125 IU per mL of fetal red cells (IM) and take a follow-up sample to check clearance.
Follow-up sample
Taken 72 hours after intramuscular anti-D (48 hours if given intravenously). Repeat anti-D and testing until fetal cells have cleared.
The virtual microscope simulation replicates the examination process used in clinical laboratories, allowing for practice in identifying and differentiating adult and fetal cells.
Blood group serological reactions
Professional guide to serological reactions of different blood groups, their identification, and compatibility for transfusions.
In serological testing, "+" indicates agglutination (positive reaction) and "−" indicates no agglutination (negative reaction). These reactions help identify blood group antigens and antibodies.
| Blood Group | Anti-A | Anti-B | Anti-D | Interpretation |
|---|---|---|---|---|
| A+ | + | − | + | A antigen present, B antigen absent, Rh(D) antigen present |
| A- | + | − | − | A antigen present, B antigen absent, Rh(D) antigen absent |
| B+ | − | + | + | B antigen present, A antigen absent, Rh(D) antigen present |
| B- | − | + | − | B antigen present, A antigen absent, Rh(D) antigen absent |
| AB+ | + | + | + | Both A and B antigens present, Rh(D) antigen present |
| AB- | + | + | − | Both A and B antigens present, Rh(D) antigen absent |
| O+ | − | − | + | Neither A nor B antigen present, Rh(D) antigen present |
| O- | − | − | − | Neither A nor B antigen present, Rh(D) antigen absent |
Antibody panel interpretation
Interpret antibody panels through practical examples: IgG and enzyme reactions and complex cases requiring referral to the reference laboratory.
Antibody Panel Interpretation
Interactive examples of common antibody panels with interpretation guidelines
Anti-D Antibody Example
Common antibody in the Rhesus system
Patient Details
Interpretation Summary
Positive reactions with D-positive cells only
Conclusion
Anti-D antibody identified
| Cell | RT (IS) | IAT 37°C | Enzyme |
|---|---|---|---|
| 1 | NEG | 3+ | POS |
| 2 | NEG | 3+ | POS |
| 3 | NEG | NEG | NEG |
| 4 | NEG | 4+ | POS |
| 5 | NEG | NEG | NEG |
| 6 | NEG | 3+ | POS |
| 7 | NEG | NEG | NEG |
| 8 | NEG | 3+ | POS |
| 9 | NEG | 2+ | POS |
| 10 | NEG | NEG | NEG |
| 11 | NEG | 3+ | POS |
Reaction Key
Understanding blood transfusion reaction strengths
Testing Methods:
RT: Room Temperature (Immediate Spin)
IAT 37°C: Indirect antiglobulin test (anti-human globulin), the phase that detects IgG alloantibodies
Enzyme: Enhanced testing with enzymes
Learning Resources
Recommended resources for antibody identification
JPAC Red Book
Guidelines for the Blood Transfusion Services in the UK, chapter 13: patient testing and red cell immunohaematology
British Society for Haematology (BSH)
Guidelines for pre-transfusion compatibility procedures in blood transfusion laboratories (2013)
Serious Hazards of Transfusion (SHOT)
UK haemovigilance annual reports and case lessons on antibody-related incidents
Key Concepts:
Transfusion science data visualisation
Interactive charts and graphs showcasing key transfusion science metrics, major haemorrhage protocols and their clinical significance.
Blood Group Distribution
Approximate distribution of ABO and Rhesus blood groups in the UK population
Approximate UK blood group distribution: O+ 37%, A+ 35%, B+ 8%, AB+ 3%, O- 7%, A- 7%, B- 2%, AB- 1%.
Clinical Significance:
- O negative is the universal donor for red cells
- AB positive is the universal recipient for red cells
- Donor recruitment strategies target rarer blood types
- Blood group distribution varies by ethnicity and geographic region
Transfusion science quick guide
Essential knowledge areas for transfusion science, from foundational concepts to specialised techniques.
Blood Group Systems
ABO, Rhesus and other blood group systems, including antibody identification and compatibility testing.
Component Preparation
Processing, preparation, storage and quality control of different blood components.
Clinical Applications
Indications for transfusion, major haemorrhage protocols, and patient blood management.
Adverse Reactions
Types of transfusion reactions, investigation protocols, and preventive measures.
Transfusion Safety
Haemovigilance, traceability, SHOT reporting, and error reduction strategies.
Regulations & Guidelines
BSH transfusion guidelines, the JPAC Red Book, MHRA requirements, quality management systems and UKAS accreditation standards.
Sources and guidance
This hub's content aligns with the UK's professional and regulatory references for the specialty: