BB

The transfusion nurse calls the BB 5 minutes adter a unit of packed cells were issued to say that the unit is not needed at this time. It is important for the nurse to bring the unit back immediately so that the temperature of the unit does not exceed

10˚C

None (rbc) AB (secretions)

AB hh Sese

The replacement fluid indicated during plasma exchange for TTP

FFP

Which of the following is the most common transfusion reaction reported to blood banks?

Febrile reaction

4 cardinal signs of inflammation

Heat, Pain, Swelling, Redness

What class of immunoglobulin is associated with Rh antibodies?

IgG class

Why is the D antigen of such importance?

It is highly antigenic.

Which patient does not need an irradiated component?

Adult receiving an RBC transfusion

The IS phase in the antibody screen/panel and crossmatch is designed to detect: A. Rh antibodies B. IgG antibodies C. ABO antibodies D. Rh typing errors

C. ABO antibodies

If the DAT is positive on a donor unit, this could be the result of: A. antibody to donor unit additives B. a cold reacting auto-antibody C. medications/drugs coating RBCs D. all of these are possible

D. all of these are possible (antibody to donor unit additives, a cold reacting auto-antibody, medications/drugs coating RBCs)

The swelling and pain at the site of inflammation is due to

Dilation of blood vessels

What should be done in the transfusion process when the patient temperature spikes from 37.5°C to 38.5°C within 30 minutes of transfusion?

Stop the transfusion and keep the intravenous line open

Irradiation of blood is performed to prevent

Transfusion associated graft vs host disease

Anti Lu is usually a cold agglutinin that reacts best at 4°C True or false?

True

Anti-K

most common Ab seen in bloodbank after ABO and Rh

The inability to determine the ________ of anti-C3b and anti-C3d individually is one of the difficulties with polyclonal reagents.

potency

RBC liquid storage temp

1-6 celcius

What is the minimum hemoglobin level for a potential allogeneic donor?

12.5 g/dL

Prestorage pooled platelets can be stored for

5 days

6-yr old ____ and 2-yr old _____ visited the ___.

6-yr old Chido and 2-yr old Rodger visited the White House (WH)

Upon the event of an adverse reaction that results in a transfusion-related fatality, the CBER must be notified within what time frame ?

7 days

recipients blood sample and a sample of the donors red cells must be kept at 1-6c for at least

7 days

crossmatch specimen storage

7 days post transfusion, 1-6 celcius

Common substances utilized for Neutralization:

- P1 substance (hydatid cyst fluid) -Lea and Leb subtance (sluble subtance found in plasma and saliva) -I subtance (Breast milk) -Sda subtance (human or guinea pig urine)

Ag on red cells of blood group A, B, AB, O

A-A B-B AB- A and B O- none H Ag

Which Abs usually react at IS?

(IgM= No clinical significant) Cold auto-Abs. I,H, IH M,N P1 Lea, Leb Lua

Reduces Zeta potential

ALB

___ antibodies are destroyed by enzymes.

Duffy

R2 and r" correlates to

E

Anti-U is associated with which ethnicity?

African descendants

Of the following, the :"the unexpected" antibody that is encountered most frequently during pre-transfusion testing is:

Anti-K

Adaptive Immunity

Antibodies are the humoral response of which system in the immune response?

Which factor can affect AHG testing, yet is uncontrollable in the lab?

Antibody affinity

Weak D: _____ = position effect or gene interaction effect; allele carrying D is opposite to the allele carrying C (e.g. Dce/dCe) => steric interaction leads to interference with D Ag expression; D Ag is normal.

C trans

G antigen is present on all of which type of red blood cells?

C-positive

The biochemical structure of the Rh antigens is a nonglycosylated protein, meaning:

Carbohydrates are not attached to protein structure

MHC class I codes for classic molecules HLA-__, HLA-__, HLA__, and nonclassic HLA-__, HLA-__, and HLA-__

Classic: HLA-A, HLA-B, HLA-C nonclassic: HLA-E, HLA-F,and HLA-G

Co_ and Co_= high-incidence.

Co a and Co3

___ Ag is present on RBCs carrying Co a and/or Co b Ag's.

Co3

How are Rh antigens inherited

Codominant alleles

Polyethelene glycol enhances antigen-antibody reactions by

Concentrating antibody by removing water

Which of the following products does not necessarily need to be ABO compatible in order to be transfused?

Cryoprecipitate

Frequencies of Rh antigens in caucasians:

D - 85% (no D 15%) C - 70% E- 30% c - 80% e - 98% Most common genotypes in (whites): DCe/dce (R1r) DCe/DCe (R1R1) dce/dce (rr) DCe/DcE (R1R2) DcE/dce (R2r) DcE/DcE (R2R2)

The classic "minor" crossmatch is performed using: A. saline room temp phase only B. the antiglobulin phase only C. antibody to low frequency antigen D. donor plasma against patient cells

D. donor plasma against patient cells

A unit of blood may be considered safe for transfusion purposes when the crossmatch shows: A. no agglutination or hemolysis in AHG phase only B. hemolysis, but no agglutination in any phase C. agglutination in every tube in all phases D. no hemolysis or agglutination in any tube @ any phase

D. no hemolysis or agglutination in any tube @ any phase

Rz

DCE

Allows RBCs to take up the antibodies more rapidly

LISS

______ test is used to detect HLA Ag's.

Microlymphocytotoxicity test

Blood for intrauterine transfusion should be all of the following except:

More than 7 days old.

RhIG is indicated in which of the following circumstances?

Mother D-negative, infant D-positive

Cold Autoantibodies >>>>>Potentially affect testing at room temperature: >ABO typing >Keep sample warm; incubate/wash at 37C >>>>>Direct Antiglobulin Test (DAT) >Use EDTA specimens >Negative control with saline >>>>>Antibody screen and Antibody ID >Use Anti-IgG AHG >Cold autoadsorption >Prewarm technique >>>>>Compatibility Testing >Prewarm technique >Use autoadsorbed serum/plasma Benign Cold Autoantibodies •Antibody is usually IgM >Efficiently binds complement •Antibody specificity >Anti-I is the most common >>I antigen is fully expressed on adult red blood cells •Anti-i >Associated with Infectious mononucleosis >Less common •Anti-P1 >Rare -Anti-H = blood type A1, a1b Carrie Oki is being seen for prenatal care. she is pregnant with her third child. blood type: B positive Antibody screen: Positive Antibody ID: Anti-K is there any additional testing that the blood bank may need to perform on Carries blood? the blood bank needs to perform an antibody titer Cold Hemagglutinin Disease •Also known as Cold Idiopathic Autoimmune Hemolytic Anemia •Cold autoantibody reacts at 4°C and reacts between 25°C and 30°C Chronic •Idiopathic Acute •Mycoplasma pneumoniae infections •Infectious mononucleosis Cold hemagglutinin Disease Laboratory Analysis: •Increased reticulocytes •Decreased haptoglobin •Positive DAT •Complement only •Eluate is nonreactive Antibody screen •Positive if tested at the Immediate Spin phase Peripheral blood smear: •Agglutinated red blood cells •Polychromasia •Anisocytosi Cold Hemagglutinin Disease •Treatment: •Therapy is generally unnecessary, and most patients require no treatment •Stay warm and avoid the cold •Move to a more temperate climate •Corticosteroids •Poor response •Plasma exchange to lower antibody titer •Rituximab has been used in severe case Paroxysmal Cold Hemoglobinuria (PCH) •Rare •Red cell destruction is due to a cold autoantibody that binds to the patient's red cells at lower temperatures and fixes complement •Biphasic autohemolysin •IgG •Hemolysis is seen when the red cells are exposed to 37C and lyse Viral infections in children: •Measles Mumps •Chickenpox •Infectious mononucleosis •Flu -Associated with Syphilis •No longer commonly reported due to effective treatment with antibiotics Donath-Landsteiner Antibody •IgG antibody with biphasic activity •Autoantibody with Anti-P specificity •Donath-Landsteiner test is used to confirm the diagnosis of PCH Paroxysmal Cold Hemoglobinuria (PCH) Signs and Symptoms: Sudden onset of fever •Shaking chills •Abdominal pain •Back pain •Jaundice •Laboratory Analysis: •Increased reticulocytes •Increased bilirubin •Decreased haptoglobin •Positive Donath-Landsteiner test •Positive DAT •Complement Paroxysmal Cold Hemoglobinuria (PCH) •Treatment: •Acute •Treat underlying disease/infection •Chronic •Protect from exposure to the colD Warm Autoantibodies •Autoantibodies that react at 37C •70% of the AIHA are of the warm type Warm Autoimmune Hemolytic Anemia (WAIHA) •Most frequent cause of autoimmune hemolytic anemia •Reacts best at 37c •Most patients have IgG and complement on their red cells •Can interfere with: >Rh testing >>Use Rh control Antibody screen and Antibody ID >Perform DAT >Warm Auto adsorption Warm Autoimmune Hemolytic Anemia (WAIHA) •Signs & Symptoms: •Pallor •Weakness •Dizziness •Dyspnea •Jaundice •Unexplained fever Cause: •Infection •Trauma •Surgery •Pregnancy •Underlying disease Warm Autoimmune Hemolytic Anemia (WAIHA) Laboratory Analysis: •Increased reticulocytes •Increased bilirubin •Decreased haptoglobin •Positive DAT •increased LDH •Peripheral blood smear: >Polychromasia >Macrocytosis >Nucleated red blood cells >Spherocytosis Warm Autoimmune Hemolytic Anemia (WAIHA) Treatment: •Treat underlying disease if present •Support cardiovascular function for those that are severely anemic Corticosteroid •Reduces the clearance of the red cells coated with the antibody and suppresses the immune response •Maintained until the patient's hematocrit rises IVIG •Given to patients that do not respond to steroid therapy Splenectomy Warm Autoimmune Hemolytic Anemia (WAIHA) Treatment: •Immunosuppressive drugs •Rituximab •Monoclonal antibody that targets antibody -producing B lymphocytes Azathioprine (Imuran) and Cyclophosphamide •Interfere with antibody synthesis by destroying dividing cells Cyclosporin •Risk of renal damage Warm Autoimmune Hemolytic Anemia (WAIHA) •Blood Transfusion- •Many patients may never require a transfusion •Some the anemia may be so severe that a transfusion is needed Compatible blood >Alloantibodies >Autoantibodies >>Specificity with Anti-e Least incompatible blood given Mixed-Type Autoimmune Hemolytic anemia •Antibody activity that is both "warm" and "cold" •Lab results will demonstrate the presence of both warm and cold antibodies •Rare •Clinical- •Acute hemolysis and require frequent transfusions •Idiopathic •Lymphoproliferative disorder •SLE •HIV infection •Laboratory Analysis: •Positive DAT for both IgG and complement Drug-Induced Immune Hemolytic Anemia •Therapeutic drugs may induce an immune response •Destruction of RBCs, WBCs, and platelets Acquired Mechanisms 1.Drug-Adsorption Mechanism 2.Immune Complex ("Innocent Bystander") Mechanism 3.Membrane Modification Mechanism 4.Autoantibody Formation Drug-Induced Immune Hemolytic Anemia •Drug-Adsorption Mechanism: •Drug binds to the red cell membrane •Patient forms antibody to the drug •Antibody reacts with the drug bound to the red cell •Penicillin is the drug most commonly associated with absorption mechanism Drug-Induced Immune Hemolytic Anemia •Immune Complex "Innocent Bystander" Mechanism •Drug-dependent •Drug combines with plasma proteins to induce an immune response •Antibody is produced •Patient ingest drug and drug + anti-drug forms a complex that adsorbs onto the red cell membrane •Complement is activated and leads to intravascular hemolysis Drug-Induced immune Hemolytic Anemia •Immune Complex "Innocent Bystander" Mechanism •DAT positive for complement •Quinidine and 3rd generation cephalosporin Drug-Induced Immune Hemolytic Anemia •Membrane Modification •Modify the red cell membrane so plasma proteins can bind to the membrane •Mechanism in nonimmunologic •No hemolysis •3% of the patients may develop a positive DAT •Cephalosporins, cephalothin Drug-Induced Immune Hemolytic Anemia •Autoantibody •Aldomet(α-methyldopa) induces the production of an autoantibody that recognizes red cell antigens -Antibodies produced are indistinguishable from patients with WAIHA •Theories: •The drug alters the red cell antigen and is no longer recognized as self •The drug alters the suppressor T -cell function and allows production of autoantibodies •positive DAT for Ig Why is it difficult to find compatible blood for patients with autoimmune disease? Potential of underlying alloantibodies Which of the following is not a characteristic of warm autoimmune hemolytic anemia? Positive for Donath-Landsteiner test Which of the following is true concerning autoimmune hemolytic anemia? Antibodies are produced against one own's erythrocyte antigens What are the features of cold agglutinin syndrome? a. Usually an IgM antibody b. Reticulocytosis and positive DAT c. Tendency for spontaneous autoagglutination of red blood cell samples **d. All of the above What is the principle of the Donath-Landsteiner test? Antibody bind the red blood cells at 4°C and causes lysis at 37°C an a negative mother has given birth to an A positive infant. Rhig should be administered with __ of delivery? 72 hrs an acid elution stain was made using a 1 hour post delivery maternal blood sample. two thousand cells were counted and thirty of these appeared to contain fetal hemoglobin. calculate the number of vials of Rh immune globulin that would be indicated under these circumstances? 4 Excessive level of unconjugated bilirubin in the newborn cause a condition known as? kernicterus the principle of the kleihauer betke stain is resistance? of fetal hemoglobin to acid solution A 35-year-old male was diagnosed with pneumonia 3 weeks ago. He is being seen in the emergency room due to shortness of breath on slight exertion and severe weakness. The physical exam revealed a pale and jaundiced patient. A type and screen and crossmatch were ordered based on the patient's hemoglobin of 7.9 g/dL. The crossmatch and antibody screen were both strongly positive at the immediate spin phase and the hematology technologist noted red blood cell agglutination on the peripheral blood smear. Which of the following laboratory tests may be useful in diagnosing the patient?Donath-Landsteiner test On further testing in the blood bank, the patient's DAT was strongly positive with polyspecific AHG and strongly positive with monoclonal C3d AHG. Based on the laboratory results and the patient's signs and symptoms, what is the most probable diagnosis? (2 points) Cold agglutinin syndrome A 40-year-old female is being seen by her physician for routine blood work due to her history of systemic lupus erythematosus (SLE). She complains of photosensitivity and joint pains in her hands and wrists. She is being treated with NSAIDs and corticosteroids on occasion. The following laboratory results were obtained: CBC: WBC 5.2 X 109 /L RBC 2.44 X 1012/L Hgb 8.0 g/dL Reticulocytes: 13% Hct 24.5% MCV 100.2 fL DAT: MCH 32.1 pg Polyspecific AHG 4+ MCHC 36.9 g/dL Anti-IgG 4+ RDW 18.5% Anti-C3d 0 Platelet 190 X 109 /L Control 0 Manual Differential: Segmented neutrophils 62% Band neutrophils 4% Lymphocytes 20% Monocytes 12% Eosinophils 2% Anisocytosis 2+ Spherocytes 2+ Polychromasia 1+ Based on the patient's results and clinical history, what may be a possible diagnosis? Drug-induced hemolytic anemia A 27-year-old female is admitted to the hospital with anemia of undetermined origin. The physician orders a type and screen with a crossmatch for six units of leukocyte-reduced packed red blood cells. She has no history of transfusion or pregnancy. The following results were obtained: Blood Type Anti-A Anti-B Anti-D Rh Control A1 cells B cells 4+ 0 0 3+ 0 4+ Antibody Screen IS 37C AHG Check Cells (CC) Selectogen I 0 0 3+ NT Selectogen II 0 0 3+ NT Selectogen III 0 0 3+ NT The best way for the blood bank technologist to find compatible blood is to:Perform a warm autoadsorption A 52-year-old male has a diagnosis of cold hemagglutinin disease with a positive direct antiglobulin test (DAT). When the blood bank technologist repeats the DAT using monospecific antiglobulin sera, which of the following is the most likely to be detected causing the positive DAT?C3d Which of the following medications is most likely to cause a positive DAT and the production of autoantibodies?Methyldopa Which of the following is the antibody specificity that has been associated with Warm Autoimmune Hemolytic Anemia (WAIHA)?Anti-e The following laboratory tests may be ordered to assist in the diagnosis of a patient with acquired autoimmune hemolytic anemias. Which of these laboratory tests is considered to be the most characteristic finding in a patient with a possible diagnosis of an autoimmune hemolytic anemia?Positive direct antiglobulin test (DAT) The following results were obtained on a CBC analyzer from a patient's specimen in the emergency room: CBC: WBC 72.1 X 109 /L RBC 1.22 X 1012/L Hgb 9.1 g/dL Hct 19.1% MCV 132 fl MCH 42 pg MCHC 57.1 g/dL What action should the laboratory technologist take next to obtain accurate results?Warm the patient's specimen and rerun Lynn Guini is being evaluated for a low hemoglobin. The physician has ordered a type and screen with a 2-unit crossmatch. The following results were obtained: Based on these results, the blood bank technologist performs an antibody identification. The following results were obtained: What is the next blood bank test the technologist should perform to determine what is causing these results? ALL 4+ EVERY GEL SPOT? DAT The indirect antiglobulin test detects the in vitro sensitization of the cells? true Enhanced enzymes: RH,KIDD,LEWIS,P1,I,ABO Inactivate enzymes: Duffy,MNS,Xga A positive direct antiglobulin test would denote the presence of? antibody on the red cells Antibody in the serum (IAT) which of the following is consistent with hemolytic disease of the fetus and newborn(HDFN)? maternal antibody coating fetal red blood cells coated with antibodies A positive direct coombs test will invalidate the results of all the following test except. reverse groupings antibodies in the polyspecific anti human (AHG) reagent used for routine immunohematology testing are? a and B only C3 component of complement ,Fc portion of IgG when investigation a positive DAT it is important to get an accurate patient history which includes? B,C,D diagnosis, medications, transfusions. a too heavy or too weak of red cell suspension can cause a ___ reaction? False negative a positive direct antiglobulin test due to alloantibodies directed as red blood cell antigens may be found in which of the following b,c - HDFN, HTR Indirect antiglobulin test detects the in vitro sensitization of the cells? true the following would be a reason that the blood bank would use coombs control cells are? all of the above- to insure that AHG reagent, To insure that the AHG reagent had not been neutralized, to insure that the wash step had been adequately performed. a patient is discovered to have anti-fya in their serum. the medical technologist needs to phenotype the patients cells for. what test is appropriate for phenotyping? IAT what are the heck cells composed of? Rh positive red blood cells coated with Anti-D how would the technologist interpret these results Anti-A 0 Anti-B 0 Anti-D 0 Weak-D 2+ CC- NA A1 3+ B 4+ SS1 4+ SS2 4+ DAT 3+ * O patient unable to determine RH status until the antibody identification has been performed the types of antihuman globulin reagents involved in a direct antiglobulin test are? IgG, C3d, IgG andC3d( all of the above) when performing antigen typing using a reagent that requires the antiglobulin test the positive control fails to yield a positive? failure to add the patients plasma Anti human globulin is made by injecting guinea pigs with human serum globulins? False what is the action of PEG as an enhancement/potentiator when performing an antiglobulin test? removes water molecules therby concentrating the antibody which of the following conditions is necessary for the production of maternal antibody in HDFN? Antibody must be IgG in class which of the following antibodies is classified as a immune antibody? Anti-K which of the following immunoglobulins can cross the placenta? IgG excessive levels of unconjugated bilirubin in the newborn can cause a condition known as? Kernicterus the FMH screen or rosette test is? a screening test to determine the amount of a fetal maternal bleed which of the following blood bank test is not part of a blood test? Antibody screen the liley method pf predicting the severity of hemolytic disease of the newborn is based on the amniotic fluid ? change in optical density measured at 450nm the principle of the Kleihauer betke stain is resistance? of fetal hemoglobin to acid solution in all of the following scenarios Rhig should be administered except? Rh negative women following an ultrasound a rise in antibody titer of ___ or more tubes is considered significant? 2 which of the following test is used to quantitate the amount of fetomaternal bleed? Kleihauer betke Monoclonal antibodies: are derived from one clone of plasma cells and recognized as a single epitope mouse polyclonal antibodies: are a mixture of antibodies from different plasma cell clones different(epitopes) rabbits polyspecific AHG contains both IgG and anti C3 - detection of IgG antibodies monospecific AHG: separate IgG and C3d Direct antiglobulin test (DAT): (coombs test) detects in vivo sensitization of rbcs with IgG or complement. to detect cells that have become coated with IgG antibodies and or complement. 1 step before washing *Detect IgG alloantibodies IgG Auto antibodies Complement Patient cells are used for testing: -hemolytic disease of the newborn (HDN) maternal antibody coating fetal rbc. IgG, alloantibody, ABO -Hemolytic transfusion reactions (HTR) recipient antibody coating donor rbc. IgG, alloantibody -Autoimmune and drug induced hemolytic anemia( AIHA) autoantibody coating individuals rbc. IgG complement (DAT): 1 drop of 3-5% suspention of washed RBCs with polyspecific( IgG,C3d) Positive- perform a Monospecific (separate IgG and C3d) Indirect antiglobulin test (IAT). performed to determine in virto sensitization detection of incomplete nonagglutinating antibodies to potential donor. 2 step process ###Patient's red cells#### Antigen typing: Add anti serum that contains antibodies Weak D testing: Indirect Auto control: patients red cells *Antibody screen-forces red cell sensitization in vitro by incubating sample at 37c to allow the antibody to sensitize to the red cell. INCREASE LATTUS FORMATION, DECREASE ZATA POTENTIAL *Antibody ID *Blood group phenotyping (Kidd, Duffy) *Crossmatch-antibody or history Reagents used as potentiators -22% albumin -high molecular weight reduces the zeta potential, rarely used for routine IAT -LISS- enhances antibody uptake by the red cells decreases incubation time to 10-15 min lower seta potential. -PEG- Polyethylene glycol removes water from the test and will allow the antibody to become concentrated if present increases the detection of clinically significant antibodies Weak D testing- latus formation comes together. 37C incubation 30 min if peg or liss- 10-15 min 37C optimum temperature for complement PH of 7.2-7.4 Factors affecting antiglobulin test: DAT can detect a level 100-500IgG molecules IAT: 100-200 IgG or C3 molecules REMEMBER************************************ ####Positive DAT will invalidate any IAT using patient cells because they are already coasted with antibody. false positive: overcentrifugation overreading dirty glassware clot tube for testing False positive: inadequate washing AHG deteriration or neutralization failure to add AHG undercentrifuged cell suspension to heavy or weak AHG test (coombs serum) reagent that is prepared antibody that reacts with human globulins that is prepared by injecting rabbits with human antibody molecules. Human IgG/ complement this will stimulate the rabbits immune system to produce antibodies and avoid human interference. *Used to detect: IgG alloantibodies IgG autoantibodies complement **Polyspecific: IgG, C3d ** Monospecific IgG, (C3d, C3b) The AHG combines with the FC portion of a sensitizing antibody on the cell and this allows agglutination. Coombs control cells: Rh positive cells that are coated with anti D antibodies or the C3 portion of complement. **A negative result using AHG coombs control cells must be added to get a positive result-to make sure wash and reagents was done right **Adding coombs control cells will prove: 1)coombs reagent was added 2) coombs reagent active 3)the wash step was adequately enough to remove any unbound globulins. Positive DAT: A cells become coated with antibodies in: what is coating your red cells??? indicator of potential immune mediated red cell destruction. IgG or complement on the RBC which signals the macrophages to clear it from the system. can lead to anemia, low hgb, Hct, bilirubin Transfusion reactions: DAT postive- due to a recipient antibody we missed an antibody in the patients plasma, titer was to low, dosage- eliminated, weak, didnt follow procedure. Hemolytic Transfusion reactions: an antibody in the patients plasma is directed against an antigen on the donor red blood cells *The antibody coats the donor cells intravascular lysis, extravascular phagocytose, complement activate lysis Acute (immediate) Hemolytic Transfusion reactions: complement is activated intravascular hemolysis occurs when complement lysis the donor cells *Positive DAT: due to IgG or complement **may be negative if all the donor cells are destroyed Delayed Hemolytic Transfusion reactions: Extravascular lysis occurs when the antibody coated red blood cells is removed by phagocytosis -patient had drop in hemoglobin 2-10 days following transfusion. -DAT positive due to IgG Hemolytic disease of the fetus and newborn (HDFN): mother is stimulated to make antibody-IgG -antibody cross the placenta -Fetus must be positive for the corresponding antigen -- fetal cells are coated with the maternal antibody and are cleared by the fetal RES ****Fetal cells are coated with maternal antibody ****Positive DAT in the infant infants born to group O mothers Ph positive infants born to rh negative mothers Autoimmune Hemolytic Anemia: you have auto antibodies that coat the red cells or active complement that coats the red cells and leads to destruction of the red cells and cause anemia. --Disease *cold autoimmune hemolytic anemia: DAT positive due to complement, Auto anti I. *Warm Autoimmune Hemolytic anemia: DAT positive due to complement- elution's or absorptions "Lupus" *Paroxysmal cold hempoglobinuria: DAT positive due to complement Drug induced Hemolytic Anemia: Drug absorption: drug attaches to the red blood cell antibodies are produced hemolysis is extravascular DAT positive due to IgG Immune complex: drug or drug metabolite combines with plasma protein forming an antigenic complex and stimulates IgM or IgG complex-rbc-activates complement hemolysis is intravascular DAT positive due to complement Autoantibody induction: drug modifies the red cell membrane that results in production of autoantibody by altering the red cell antigens to be seen as foreign. hemolysis is extravascular Aldomet-methyldopa DAT positive due to IgG and occ complement Membrane modification: nonspecific absorption of plasma proteins DAT positive due to whatever is stuck to the red cell membrane. IgG or complement Immunoglobulin therapy: contains pooled immunoglobulins G from the plasma of approximately thousands of blood donors. DAT positive Elution- to identify possible antibodies POSITIVE DAT!!! Adsorption: removing the autoantibody and leave the alloantibody in the serum/plasma -Autoadsorption -Allogeneic adsorption (known red cell antigen reagents) * treat red cells with -zzap: warm -mixture or papain or ficin -DTT Immune Hemolytic Anemia: >Shortened red blood cell survival due to a humoral (antibody molecules that are secreated by plasma cells) immune response •Autoimmune Hemolytic Anemia: >Immunologically based anemia that results in the "self-destruction" of one's own red blood cells •Categories of Immune Hemolytic Anemia >Alloimmune - patients produce antibodies to the foreign red cell antigens thru transfusion, transplant, pregnancy. >Autoimmune when a patient produces antibodies against his or her own Red blood cells antigens >Drug induced when a patient produces antibodies to a particular drug or drug complex. Direct Antiglobulin Test (DAT) •Key test in determining an immune hemolysis •Determine if IgG or Complement is sensitizing the patient's red blood cells in vivo Adsorption Adsorption POSITIVE DAT!! •Remove the autoantibody to determine if alloantibodies were masked >Two Types of Adsorption: >>>>Autologous Adsorption •Patient cannot be recently transfused >>>>Allogeneic Adsorption Signs and Symptoms of Anemia •signs and Symptoms: •Fatigue •Tachycardia •Pallor Laboratory Analysis of Anemia: •Complete Blood Count (CBC) •Reticulocyte count INCREASED •Bilirubin levels INCREASED •Haptoglobin DECREASED •LDH INCREASED •Schistocytes or Spherocytes on the peripheral blood smear Autoimmune Hemolytic Anemia •Autoantibodies: >Antibodies against the patient's own red blood cells >Important to identify the type of autoimmune hemolytic anemia because treatment is different •Warm Autoimmune Hemolytic Anemia •Cold Autoimmune Hemolytic Anemia •Drug-induced Autoimmune Hemolytic Anemia >May be due to a failure in the mechanism that regulates the immune response that involves a loss of T-suppressor function Cold Autoantibodies Benign Cold Autoantibodies: •Low titer at 4°C •< 64 •May be found in normal, healthy individuals •No treatment necessary Pathological Cold Autoantibodies: •High titer at 4C •>1000 •Clinically significant •Associated with a disease process •Treatment is require Cold Autoantibodies Cold Hemagglutinin Disease (CHD) or Cold Agglutinin Syndrome (CAS) or Cold Agglutinin Disease (CAD) >>>Most are clinically insignificant •Can occasionally cause immune hemolytic anemia •Primarily IgM autoantibodies •Hemolysis that is weak or reactive at or near 37°C is referred to as Cold Agglutinin Disease *** can cause hemolysis can cause spontaneous agglutination IgM auto antibodies what are the check cells composed of? Rh positive red blood cells coated with anti-d An 83-year-old female is undergoing pre-op testing which includes a type and screen with a 2-unit Red Cell crossmatch. One 7mL EDTA tube was collected, labeled with her full name, date of birth, medical record number, collection date and time, and the collector's initials. The sample was acceptable per the blood bank's Specimen Acceptability procedure. The sample was processed and tested on the bench with the traditional tube method. Results are as follows. Review the reactions (shown in the images on the right and listed in the table) and consider how to respond to each item listed below. Then click on the item for interpretation and case resolution. Anti-A 0 Anti-B 0 A1 0 B 0 Yes, there is a discrepancy. The forward type appears to be type O while the reverse type appears to be type AB. Missing reaction in the reverse typing. resolution: Increase the serum to cell ratio or incubate the reverse group at 4°C for 15 minutes or at room temperature for 15-30 minutes. Remember: An auto control should be tested concurrently when incubating plasma at lower temperatures. This ensures that no cold reacting antibodies are interfering with resolution. conclution: This is an example of an ABO discrepancy caused by a decrease in the amount of naturally occurring antibodies. This can be found in a geriatric or immunosupressed patient. A 38 year old female patient has a history of chronic anemia which has resulted in 4 previous allogenic packed red blood cell transfusions. At present, she is experiencing lethargy, pallor, shortness of breath, and extreme malaise. Her physician orders hemoglobin testing which results in a value of 7.0 g/dL. Upon review of the testing, her physician orders pretransfusion testing and 2 units of packed red blood cells to be transfused, each over a 4 hour period of time. Her pretransfusion testing results are listed below. Review the testing and determine the next course of action. Anti-A mf/+1 Anti-B 0 A1 0 B 3+ Antibody screen: neg Yes, there is a discrepancy. The forward type appears to be weakly reactive A that is demonstrating mixed field agglutination, while the reverse type appears to be a strongly reactive type A. Missing or weak reaction in the forward typing.There are a few potential causes for this discrepancy, but it is most likely due to a subgroup of A. A3 typically demonstrates a mixed field agglutination with polyclonal anti-A reagent antisera, and the potential presence of anti-A1 in the reverse typing. Patients may demonstrate a subgroup of A without the presence of a detectable anti-A1 titer. Testing patient plasma with A1, A2, and O reagent cells will aid in the resolution of the suspicion of an A subgroup. Testing should demonstrate negative results. Additionally, testing with anti-A1 lectin will prove that the patient is not group A1.In this case study, the patient reverse type is not macroscopically demonstrating the presence of anti-A1. This is an example of an ABO discrepancy caused by a subgroup of A, possible A3. A 36 year old man has a history of gastrointestinal conditions including Crohn's Disease. He has been admitted to the hospital for a general surgical procedure related to his condition. Preoperative lab work has been ordered and includes a type and screen. Results of the type and screen are below. Review the results and determine if there are any potential issues with the reported reactions. A sensitized red blood cell means that the cell is? coated with antibodies 22% Albumin •Reduces the zeta potential to promote agglutination LISS •Accelerates antibody binding to red cells by increasing the amount of antibody taken up by the red cells and reducing the zeta potential PEG •Accelerates antibody red cell binding by removing water and concentrating the antibodies present Antibody Panel 11 to 20 Group O red blood cells with various antigen expression •Show homozygous expression of Rh, Duffy, Kidd, and MNSs antigens Interpretation: •Crossout technique •Phase of reactions •Strength of reaction Dosage Weak expression of antigens on the red cell Heterozygous expression •Weak reactions •Patient with the genotype MM, which is homozygous will have more antigen sites than a patient having the genotype MN, which is heterozygous Dosage MN:blood group system Rh: blood group system Kidd: blood group system Duffy: blood group system Phases of Reactivity Immediate Spin (IS) Cold antibodies!! M, N, P1, Lewis, Lua, cold antibodies, I 37°C Possibly D, E, C, e, e, K Antiglobulin(AHG) Rh, Kell, Kidd, Duffy, Ss, Lub, Xga Enzymes •Complex antibody ID •Multiple antibodies present, may treat sample with enzymes to separate the antibodies and allow for identification •Modify the red blood cell surface by removing sialic acid residues and denature or remove glycoprotein Panel cells treated with enzymes •Modify the surface of the red cell by removing sialic acid residues and by denaturing or removing glycoproteins Ficin and papain are the most frequently used enzymes Bromelin or trypsin are used as well Compare the antibody panel before and after enzyme treatment ENZYMES ENHANCED: Rh, kidd, lewis, P1, I, ABO ENZYMES DESTROYED OR WEAKEND M, N, S, Xga Total Elution •The red blood cells are destroyed •Not used for phenotyping or autoadsorption •Methods: 56 ̊C heat where red cells are destroyed •Easy to perform, but limited applications Lui Freeze where red cells are frozen and then rapidly thawed to cause lysis •Used in HDFN investigations •Easy to perform, but limited applications Acid: pH of 3.0 •Gamma Elu Kit II Partial Elution Removes the antibody but leaves the red cell membrane intact Treated red cells can still be used for phenotyping or autoadsorption Methods: •Gentle heat 45 ̊C releases the IgG from the surface of the red cell •Allows for antigen typing •ZZAP or chloroquine •EGA (EDTA Glycine Acid) uses an acidic pH to dissociate the antibody from the red cell elution methods: acid: lowers ph-rapid and sensitive commercially available Lui Freeze: physical- rapid effective for ABO antibodies Heat: physical- rapid effective for ABO antibodies Neutralization •Lewis substances are present in saliva •P1 substances are present in hydatid cyst fluid and pigeon eggs •Sda substances are present in urine HPC: Human Platelet Concentrate •Made from pooled platelets •Removes unwanted HLA antibodies from serum or plasma •HLA antigens on platelets are used to absorb anti-Bg antibodies that may mask clinically significant antibodies and cause hemagglutination WHAT IS DAT Test •To detect cells that have become coated with IgG antibodies and/or complement •In vivo WHAT IS IAT •Reaction of red cells and antibodies •In vitro Antiglobulin Test (Indirect) Forces red cell sensitization in vitro by incubating sample at 37 ̊C •Antibody screening •Weak D testing •Determine RBC phenotype using known antisera •Kidd, Duffy Indirect Antiglobulin Test •In vitro sensitization of the cell •Sample is incubated at 37 ̊C to allow the antibody to sensitize to the red cell •Enhancement reagent may be added to increase the sensitization and agglutination •AHG reagent is added to complete the "bridging" between the red cell Indirect Antiglobulin Test •Patient's serum •Antibody screen •Detects antibodies in the patient's serum •Antibody panel •Identifies antibodies •Antiglobulin crossmatch •Determines compatibility with donor red cells Antigen Typing •Identifies a specific red cell antigen in a patient or donor Patient's Red Cells •Antigen Typing •Anti-serum that contains antibodies •Weak D testing •Auto Control •Patient's plasma vs. Patient's red cells Positive DAT will invalidate any IAT using patient's cells because they are already coated with antibody Factors that Affect the IAT •Serum/Cell ratio •2 drops of serum to 1 drop of red cell suspension •Incubation temperature •37 ̊C is optimal reaction for IgG antibodies •Optimal temperature for complement activation •Incubation time •Clinically significant antibodies can be detected around 30 minutes •Enhancement media can shorten the time to 10-15 minutes •pH •Saline should be fresh or buffered at 7.2 to 7 WHAT IS AHG: Anti Human Globulin The AHG combines with the Fc portion of a sensitizing antibody on the cell •This allows agglutination •AHG must contain IgG to detect clinically significant antibodies WHAT IS Coombs Control Cells •Rh positive cells that are coated with anti-D antibodies or the C3 portion of complement •Control cells react with the antibody in the AHG reagent •A negative result using AHG, Coombs Control Cells must be added to get a positive result Positive DAT •A cells becomes coated with antibodies in: transfusion reactions: Hemolytic +++Transfusion Reaction •An antibody in the patient's plasma is directed against an antigen on the donor red blood cells •The antibody coats the donor cells ***Acute (Immediate) Hemolytic Transfusion Reaction •Complement is activated •Intravascular hemolysis occurs when complement lysis the donor cells •Positive DAT due to IgG or complement •May be negative if all the donor cells are destroyed ***Delayed Hemolytic Transfusion Reaction •Extravascular lysis occurs when the antibody coated red blood cell is removed by phagocytosis •Patient has a drop in hemoglobin usually 2-10 days following transfusion •DAT is usually positive due to IgG ***Hemolytic Disease of the Fetus and Newborn (HDFN) •Mother is stimulated to make antibody •IgG •Antibody must cross the placenta •Fetus must be positive for the corresponding antigen Fetal cells are coated with the maternal antibody and are cleared by the fetal RES •HDFN •Infant cells are coated with maternal antibody •Positive DAT in the infant •Infants born to Group O mothers •Rh positive infants born to Rh negative mothers •Infants born to mothers with clinically significant antibodies •IgG ***Autoimmune Hemolytic Anemia •Diseases that may have an autoantibody coating the red cells of the patient •Cold Autoimmune Hemolytic Anemia **Warm Autoimmune Hemolytic Anemia •DAT is positive due to IgG •May sometimes be positive due to complement •Paroxysmal Cold Hemoglobinuria •DAT may be positive due to complemet 22% Albumin •High molecular weight protein •Reduces the zeta potential by dispersing some of the cations surrounding the negatively charged red cell •May miss several clinically significant antibodies •Rarely used for routine IAT test Low Ionic Strength Solution (LISS) •Enhances antibody uptake by the red cells •Decreases incubation time to 10-15 minutes Polyethylene Glycol (PEG) •Increases the detection of clinically significant antibodies Sources of Error of the Antiglobulin Test False Positive •Over centrifugation •Overreading •Dirty glassware •Clot tube for testing False Negative •AHG deterioration or neutralization •Failure to add AHG •Under centrifuged •Cells suspension too heavy or weak Donor Deferments: Permanent Deferral: High risk behavior or positive results. •HIV, Hepatitis, HTLV I/II, Hep c, Hep B surface antigen: spread by blood transfusions, sexual contact, sharing needles *Diabetes Insipidus: Permanent deferral-water imbalance, increase thirst •Family history of Creutzfeldt-Jakob disease: brain disease test for mutation •Received tissue or tissue •History of Babesiosis or Chagas: parasite can survive in RBC and platelets •Cirrhosis: Hep, chronic alcohol •Multiple sclerosis •Polycythemia *Donor life style: needles for drugs, Ebola *Spent time in the United Kingdom that adds up to 3 months from 1980 to 1996 *Member of the U.S. military, civilian military employee, or a dependent of a member of the U.S. military and spent a total of 6 months on a base in Europe from 1980 to 1996 •Military bases in Belgium, Netherlands, Germany, Turkey, Spain, Italy, or Greece Donation Process: Venipuncture •Drawn from the antecubital area •Disinfect draw site: •Scrub with a 0.7% aqueous scrub solution of iodophor compound to remove dirt and bacteria •10% povidone-iodine beginning at the intended puncture site and continues in a concentric circle outward •Donor sensitivities: •May use ChloraPrep 2% chlorhexidine and 70% isopropyl alcohol •Blood pressure cuff inflated to 40-60 mm Hg •16-gauge needle •Donation time usually takes 8-12 minutes •Balance system monitors the volume being drawn from the donor Adverse donor reactions Symptoms/Treatment Weakness, Sweating, Dizziness, Pallor, Nausea, and Vomiting Remove the needle and tourniquet Raise donor's feet above their head Apply cold compress to forehead and back of the neck Instruct the donor to breathe slowly Syncope(Fainting): Provide oxygen Hematoma: Apply pressure for 7-10 minutes Apply ice to the are for 5 minute Loss of consciousness: Check vitals signs frequently Administer oxygen Convulsions: Get assistance Prevent the donor from falling from the donor chair and injuring Make sure the airway is adequate Cardiac Difficulties: Begin CPR Call for emergency help Donor records mandated by AABB and FDA •Ensure donor confidentiality •Donor records are not altered •Donor records are stored 5-10 years Donor Deferments: Temporary Deferral: *Colds-symptom free 72 hrs •Flu-symptom free 72 hrs •Diabetes *Diabetes Mellitus: Ok if dosage controlled and stable •Tuberculosis-ask questions •Syphilis *Defer 12 months after treatment completed •Infections *Antibiotic •Heart Disease- May need physicians approval •Arrhythmias •Congenital Heart Disease •Coronary Arter Disease •Angina •Heart attack •Lung Disease •Active lung infections •COPD on oxygen •History of Cancer-ask questions •Abnormal bleeding •Factor Deficiencies is a permanent defer No deferral •Birth control •Vitamins •Allergies •No sinus or respiratory infections •Breastfeeding •Blood pressure medication •Glaucoma •Hernia •Kidney stones 3 day deferral •Aspirin donor •Source of platelets-platelet foresees •Aspirin inactivates platelets 2 week deferral •Measles (rubeola) vaccine •Mumps vaccine •Polio (oral) vaccine •Yellow fever vaccine 1 month deferral •Medication Deferral List •Proscar-enlarge prostate •Accutane-acne •Propecia- baldness hair 4 week deferral •Rubella: German measles •Varicella-Zoster: chicken pox •History of ZIK V infection should self-defer for 4 weeks after the resolution of the symptom: shingles 6 week deferral •Termination of pregnancy •Abortion •Miscarriage •Ectopic 8 week deferral 56 days *The interval between donations for a full unit of blood 1-year deferral •Tattoos •Ok to donate if received tattoo in SD, IA, and NE •Body Piercing •Needlestick exposure •Incarcerated for more than 72 hours •Close contact with a patient with hepatitis •Living in the same house •Contact with body secretions •Completing therapy for syphilis or gonorrhea •Travel to an area where malaria is endemic •Hepatitis B immune globulin •Sexual contact with an individual at high risk for HIV •Transfusion of blood, components, or derivatives •Travel to Iraq •Potential Leishmania exposure 3-year deferral Diagnosis of malaria •Plasmodium vivax •Plasmodium falciparum •Plasmodium malariae •Plasmodium ovale •After residence in an area endemic for malar A 28-year-old woman; 112 lb; hemoglobin, 12.5 g/dL; miscarried 2 weeks ago Temporarily defer A 56-year-old man; 168 lb; hematocrit, 44%; took aspirin 4 hours ago for arthritis pain Accept A 35-year-old woman; 115 lb; temperature, 37 C; pulse, 75 Accept A 17-year-old female high-school student; taking isotretinoin (Accutane) for acneTemporarily defer A 75-year-old male donor center volunteer; first-time blood donor; contracted hepatitis 20 years ago after surgery Permanent defer A 22-year-old male; received tattoo while in the service 4 months ago, just before he returned from Iraq Temporarily defer A 65-year-old female; has instructions from physician to donate for upcoming surgery; had syphilis and was treated 40 years ago; hematocrit, 37%; temperature 99 F Accept A 38-year-old male; received recombinant hepatitis B vaccine as a new employee 3 months ago Accept A 19-year-old male first-time donor; received human growth hormone 12 years ago Permanent defer A 24-year-old female with a history of positive test for hepatitis C from another blood center Permanent defer A 52-year-old businessman who was a resident in England for 1 year in 1993 Permanent defer A 130-lb, 5-feet-1-inch female; hematocrit, 40%; would like to donate two RBC units by apheresis Permanent defer Which of the following is a cause for temporary deferral of a whole blood donor? rubella vaccine 2 weeks ago A donor with a physician's request to donate for planned surgery in 3 weeks has a hemoglobin value of 10 g/dL. What is her eligibility status? deferred because of low hemoglobin What is the maximum number of donations for plateletpheresis donors in the period of a year? 24 Viral marker tests are not required on autologous blood intended for use within the collection facility. True Autologous units may be given to other patients if they are not used for the patient who donated the units. False A unit donated therapeutically from a person with hereditary hemochromatosis cannot be used for transfusion purposes. False Donor centers are authorized to release positive test results to their state health department if the donor signs a consent form. True According to the FDA, prospective donors with a history of cancer are not permitted to donate blood. False What term describes the determination that the donor is qualified to donate blood and blood components? Donor eligibility When can a person donate blood after a plateletpheresis collection? 2 days What term describes a donation reserved for use by a specific patient? Directed What is the name of the document in which the health history assessment is recorded? Donor history questionnaire Which of the following statements contributes to a temporary deferral status for a donor? Pregnancy within last 4 weeks Which of the following vaccines has a 2-week temporary deferral period? Yellow fever What are the acceptable hemoglobin and hematocrit for a male donor? 13.0 g/dL and 39% What values represent the acceptable blood pressure requirements for allogeneic whole blood donors? BP: 90-180 mm Hg/50-100 mm Hg What is the most common adverse reaction to donation? Vasovagal What type of donation is described as blood is removed from a patient and the portion that might be contributing to a pathologic condition is retained? Therapeutic apheresis Which one of the following histories represents an acceptable male donor? Hct=39, Blood Pressure= 90/60 mm/Hg, Temp= 98.9 F, Pulse= 65, Age= 65 How often can a person donate a unit of whole blood for a directed donation? 8 weeks Which of the following statements contributes to a permanent rejection status for a donor? Confirmed positive test for hepatitis B surface antigen 10 years previously Autologous donors may not donate if they: are on antibiotics for an infection A male donor has a reactive nucleic acid test for hepatitis C. What kind of deferral is assigned to this donor? Permanent How long must a donor wait to donate red blood cells again following a 2-unit red blood cell apheresis donation? 16 weeks If a prospective donor has participated in a plasmapheresis program, how long must he or she wait to donate whole blood? 48 hours Following delivery, what is the deferral time for donating a unit of whole blood? 6 weeks How would the following allogeneic donor be classified? 27-year-old woman returning from the Peace Corps in Nigeria who was vaccinated for typhoid 6 months ago: Temporarily deferred How would the following allogeneic donor be classified? 18-year-old woman currently taking Accutane for acne: Temporarily deferred How would the following allogeneic donor be classified? 48-year-old man taking Propecia for baldness: Temporarily deferred What is the minimum hemoglobin level for a potential female donor? 12.5 g/dL What is the purpose of a "diversion pouch" used when collecting blood from a donor? Avoid bacterial contamination of the blood product Allogeneic whole blood donors may donate every __________ days. 56 Blood collected from a therapeutic phlebotomy is: acceptable for inventory under certain Food and Drug Administration guidelines. Which disease has the highest potential for transmission through a transfusion? hepatitis Syphilis tests on donors are usually performed by which method or methods? both a and c (RPR, hemagglutination) What characteristic is associated with HTLV-I/II? All of the above (an oncornavirus, found in patients with tropical spastic paraparesis, associated with adult T-cell leukemia) What marker demonstrates a previous exposure to hepatitis B that remains in convalescence? anti-HBc Which of the following is the confirmatory test for a positive anti-HIV screen? HIV RNA Which of the following conditions requires a thorough donor history because it is not a routinely tested disease? Creutzfeldt-Jakob disease Why is a HAV transmission through a blood transfusion unusual? all of the above (transmitted enterically, an acute hepatitis, not infective after 2 weeks What is the donation status of a donor who is positive for HBsAg? Permanently deferred Which of the following was a surrogate test for hepatitis and is no longer required? ALT In a _________, a lower absorbance value indicates the detection of the viral marker. competitive ELISA What is the term that describes the number of cases of a disease present in a particular population at a given time? Prevalence What test for syphilis uses sensitized sheep erythrocytes coated with Treponema pallidum? T. pallidum antibody test What term describes ability of an assay to identify samples from infected individuals as positive? Sensitivity Which of the following tests does NOT detect a hepatitis B infection? Anti-HCV What is the window period for the detection of HIV-1 infection with the HIV RNA test? 9-9.1 days What is the vector that carries the West Nile virus? Mosquito What test requirement is performed on blood products rather than on the donor blood samples? Bacterial contamination detection What term defines the process of identifying persons who have received seronegative or untested blood from a donor subsequently found to be positive for disease markers? Look-back What disease is also described as the American trypanosomiasis? Chagas disease The Clinical Laboratory Improvement Amendment (CLIA) regulations state that a positive and a negative control are not required when testing each run of donor specimens. False Why is Hepatitis A virus transmission in blood unusual? All of the above (Hepatitis A is usually transmitted by the enteric route, Hepatitis A is usually an acute hepatitis, infectivity after a Hepatitis A infection is usually only 2 weeks) Transfusion-associated hepatitis can be caused by hepatitis _______ virus. All of the above (B, C, D) Which of the following patients should not receive cytomegalovirus (CMV)-positive blood? All of the above (Premature infants, HIV-positive patients, bone marrow recipients, unborn infants of pregnant women who are seronegative) Which of the following diseases relies on obtaining a thorough donor history to reduce potential transmission in blood donors? Malaria Which of the following blood products is tested for bacterial contamination following storage? Platelets Which of the following characteristics is associated with human T-cell lymphotropic virus-I? All of the above (it can be transmitted in blood products, it is found in patients with tropical spastic paraparesis, is is found in patients with adult T-cell leukemia) What is the advantage of testing donors' blood using nucleic acid test methods? detection of small amounts of the virus Some donor centers have implemented the practice of diverting the first few milliliters of blood collected into a pouch attached to the collection bag. What is purpose of this procedure? Avoid bacterial contamination What is the most sensitive test for HIV? Nucleic acid When are surrogate marker tests useful? When direct testing is not yet available Goals of donor Acceptance or rejection:>>Will the donor be harmed by giving blood>> Will the transfused product in any way harm the recipient AABB (American Association of Blood banks)*International association of blood bank center, transfusions, and transplantation services, and individuals involved in transfusion medicine. Mission: to establish and provide the highest standard of care for patients and donors on all aspects of transfusion medicine>>updated every 2 years, inspections, blood banks, transfusion services The Food And Drug administration (FDA)*Blood is biologic and a drug*they license the blood bank centers and ship blood*Establish and maintain regulations of blood collection and processing inspections-*inspection every 2 years>Licensing College of American Pathologists (CAP)*Most transfusion services are part of the clinical laboratory in a hospital.*proficiency testing* inspections Intended used of the donation: Allogeneic Donation-Biggest>donation for use by the general patient population>Volunteer Directed Donation:>Donation reserved for use by a specific patient>Collected from a blood relative then the blood product needs to be irradiated Autologous donation:>donation by the donor reserved for their use later.>Rare blood type>Multiple antibodies, anti salano, little k older population, physicians orders Intended use of the donation: Therapeutic phlebotomy: removing blood for medical purposes take a unit off> Polycythemia vera>Hemochromatosis-use blood but need to state hemochromatosis iron overload Apheresis donations:whole blood removed from the patient or the donor and separate out a component by mechanical means and give the remained of the blood back to the patient or donor.>Leukopheresis: collecting just WBC>Plateletpheresis: collecting just platelets, come from one donor.>Plasmapheresis: Plasma is removed>Double RBC Pheresis: collecting RBC. You take 2 blood cell units that is removed every 16 weeks, weight increased for donor, male 130. Female 150., hct 40%>Stem cell pheresis: give the donor a drug that pushes their stem cells out from the bone marrow to their blood and collect it, freeze or dive it right back * These are done in patients with specific disease we need a specific component. Physical examination: donor screening >Donor should appear in generally good health >Donors are deferred if they are not feeling well. Basic QualificationsAge: At least 17 years of age Weight: 110 lbs Temperature: <37.5 ̊C or 99.5 ̊F Pulse: 50-100 beats per minute Blood Pressure: Systolic-No higher than 180 mm Hg Diastolic-No higher than 100 mm Hg Hemoglobin>12.5 g/dL Hematocrit>38%Skin lesions Inspect both arms Medical History: Questionnaire: Approved by FDA, they meet FDA and AABB regulations. •Standardized medical history-protect the donor benefit the recipient. •Donor is interviewed in a secluded area •"Yes" or "No" •Donor is questioned the same day as donation •Questions on health, medication, travel, previous donations, pregnancies, needle stick exposure. Informed consent: Obtained before donation •AABB mandates that informed consent of allogenic, autologous, and apheresis donors be obtained •Know risks involved •Tests performed to reduce the risk of transmission of infectious disease •Ask questions Whole blood donation (allogenic)A 28-year-old female who weighs 112lbsand has a hemoglobin of 12.5 g/dL had a miscarriage 2 weeks ago. temporary deferral- 6 weeks Whole blood donation (allogenic)A 21-year-old male who weighs 150lbsand has a hematocrit of 40%, received a tattoo in the service 4 months ago temporary deferral- 1 year Whole blood donation (allogenic)A 56-year-old male who weighs 169lbswith a hematocrit of 44%, and blood pressure of 160/95 Accept PlateletpheresisA 62-year-old male who weighs 180lbs, hematocrit of 40%, blood pressure of 152/92 and took his daily dose of aspirin Accept- whole blood donation Temporary deferral-72 hrs no aspirin Which of the following information is not required for whole blood donors?a. Nameb. Addressc. Occupationd. Sexe. Date of birth c-Occupation Which of the following would be cause for deferral? a. Temperature of 99.2 degrees Fahrenheit. Pulse of 90 beats per minute. Blood pressure of 110/70 mm Hgb. Hematocrit level of 37%e. None of the above Which of the following would be cause for permanent deferral? a. History of hepatitis after 11th birthday. Positive hepatitis C test result c. Positive HTLV-I antibodyd. Positive anti-HBc test resulte. All of the above e13.3 Immunization for rubella would result in a temporary deferral for:a. 4 weeksb. 8 weeksc. 6 monthsd. 1 yeare. no deferral required a13.4 Which of the following donors is acceptable?a. Donor who had a first-trimester therapeutic abortion 4 weeks agob. Donor whose husband is a hemophiliac who regularly received cryoprecipitate before 1989c. Donor who was treated for gonorrhea 6 months agod. Donor who had a needlestick injury 10 months ago a13.5 Which of the following tests is not required as part of the donor processing procedure for allogeneic donation?a. ABOb. Rhc. STSd. Anti-HTLV Ie. Anti-CMV e13.6 Which of the following lists the correct shelf-life for the component?a. Deglycerolized RBCs, 24 hoursb. RBCs (CPD), 35 daysc. Platelet concentrate, 7 daysd. FFP, 5 yearse. RBCs (CPDA-1), 21 days a13.7 Each unit of cryoprecipitate prepared from whole blood should remain approximately how many units of AHF activity?a. 40 IUb. 80 IUc. 120 IUd. 160 IUe. 180 IU b13.8 Platelet concentrates prepared by apheresis should contain how many platelets?a. 5.5 x 10^10b. 6 x 10^10c. 3 x 10^11d. 5.5 x 10^11e. 6 x 10^11 c13.9 The required storage temperature for frozen RBCs using the high-glycerol method is:a. 4 degrees Celsiusb. -20 degrees Celsiusc. -18 degrees Celsiusd. -120 degrees Celsiuse. -65 degrees Celsius e13.10 How does irradiation affect the shelf-life of red blood cells?a. Irradiation has no effect on the shelf-life.b. The expiration date is 28 days from the date of irradiation or the original outdate, whichever is later.c. The expiration date is 28 days from the date of irradiation or the original outdate, whichever is sooner.d. The expiration date is 25 days from the date of irradiation or the original outdate, whichever is later.e. The expiration date is 25 days from the date of irradiation or the original outdate, whichever is sooner. c13.11 Once thawed, FFP must be transfused within:a. 4 hoursb. 6 hoursc. 8 hoursd. 12 hourse. 24 hours e13.12 Quality control for RBCs requires a maximum hematocrit level of:a. 75%b. 80%c. 85%d. 90%e. 95% b13.13 Prothrombin complex concentrates are used to treat which of the following?a. Factor IX deficiencyb. Factor VIII deficiencyc. Factor XII deficiencyd. Factor XIII deficiencye. Factor V deficiency a13.15 AHF concentrates are used to treat:a. Thrombocytopeniab. Hemophilia Ac. Hemophilia Bd. von WillebranHF concentrates are used to treat:a. Thrombocytopeniab. Hemophilia Ac. Hemophilia Bd. von Willebrand diseasee. Factor XIII deficiencyd diseasee. Factor XIII deficiency b13.14 How is the antibody screen test different for donors than for patients?a. In donors, a 2-cell screen is used.b. In donors, a 3-cell screen is used.c. In donors, a pooled cell is used.d. There is no difference in testing. d13.16 RBCs that have been leukoreduced must contain less than ________ and retain at least ___ of original RBCs.a. 8 x 10^6/85%b. 8 x 10^6/90%c. 5 x 10^6/85%d. 5 x 10^6/80% c13.17 Random-donor platelets that have been leukoreduced must contain less than ___________ leukocytes.a. 8.3 x 10^5b. 8 x 10 ^6c. 5 x 10^6d. 3 x 10^11 a13.18 A single unit of FFP or PF24 should contain _______ mL of plasma.a. 100-150b. 200-400c. 150-250d. 50-150 c13.19 Cryoprecipitate that has been pooled must be transfused within __ hours.a. 24b. 6c. 4d. 8 c13.20 Which of the following is not involved in the acquired or adaptive immune response?a. Phagocytosisb. Production of antibody or complementc. Induction of immunologic memoryd. Accelerated immune response upon subsequent exposure to antigen a3.1 Which cells are involved in the production of antibodies?a. Dendritic cellsb. T lymphocytesc. B lymphocytesd. Macrophages c3.2 Which of the following cells is involved in antigen recognition following phagocytosis?a. B lymphocytesb. T lymphocytesc. Macrophagesd. Granulocytes b3.3 The role of the macrophage during an antibody response is to:a. Make antibodyb. Lyse virus-infected target cellsc. Activate cytotoxic T cellsd. Process antigen and present it d3.4 Which of the following immunoglobulins is produced in the primary immune response?a. IgAb. IgEc. IgGd. IgM d3.5 Which of the following immunoglobulins is produced in the secondary immune response?a. IgAb. IgEc. IgGd. IgM c3.6 Which of the following MHC classes are found on antigen presenting cells?a. Class Ib. Class IIc. Class IIId. Class IV b3.7 Which of the following MHC classes encodes complement components?a. Class Ib. Class IIc. Class IIId. Class IV c3.8 Which of the following immunoglobulins is most efficient at binding complement?a. IgAb. IgEc. IgGd. IgM d3.9 Which portion of the immunoglobulin molecules contains complement binding sites?a. Heavy chain variable regionb. Light chain variable regionc. Heavy chain constant regiond. Light chain constant region c3.10 Which complement pathway is activated by the formation of antigen-antibody complexes?a. Classicalb. Alternativec. Lectind. Retro a3.11 Which of the following is known as the "recognition unit" in the classical complement pathway?a. C1qb. C3ac. C4d. C5 a3.12 Which of the following is known as the "membrane attack complex" in the classical complement pathway?a. C1b. C3c. C4, C2, C3d. C5b, C6, C7, C8, C9 d3.13 Which of the following immunoglobulin classes is capable of crossing the placenta and causing hemolytic disease of the newborn?a. IgAb. IgEc. IgGd. IgM c3.14 Which of the following refers to the effect of an excess amount of antigen present in a test system?a. Postzoneb. Prozonec. Zone of equivalenced. Endzone a3.15 Which of the following refers to the presence of an excess amount of antibody present in a test system?a. Postzoneb. Prozonec. Zone of equivalenced. Endzone b3.16 Which of the following refers to a state of equilibrium in antigen-antibody reactions?a. Postzoneb. Prozonec. Zone of equivalenced. Endzone c3.17 Which one of the following properties of antibodies is NOT dependent on the structure of the heavy chain constant region?a. Ability to cross the placentab. Isotype (class)c. Ability to fix complementd. Affinity for antigen d3.18 Molecules that promote the update of bacteria for phagocytosis are:a. Opsoninsb. Cytokinesc. Haptensd. Isotypes a3.19 Select the term that describes the unique confirmation of the antigen that allows recognition by a corresponding antibody:a. Immunogenb. Epitopec. Avidityd. Clone b3.20 Which of the following terms refers to the net negative charge surrounding red blood cells?a. Dielectric constantb. Van der Waals forcesc. Hydrogen bondingd. Zeta potential d3.21 What is the shipping temperature requirement for plasma? -18°C or lower Antibody serial titration studies are most often associated with which of the following blood bank test groupings? Prenatal evaluation The prewarm technique is most useful in investigating which types of blood bank problems? Cold antibodies It is most important to perform weak-D testing in which of the following blood bank test groupings? Cord blood evaluation Which of the following is a method for determining approximate volume of fetal-maternal bleed? Kleihauer-Betke test Which of the following may not be used as a patient identifier? Patient's room number Which of the following is not an enhancement media that may be used in antibody screening and identification? Normal saline Which of the following methods may be useful in investigating a positive DAT? -Elution techniques-Removal of cell-bound antibody using chloroquine diphosphate-Drug studies Which of the following information is not required for whole blood donors? occupation which of the following would be cause for deferral? hematocrit of 37% which of the following would be cause for permanent deferral? history of hepatitis after 11th birthday, positive hepatitis C test result, positive HTLV-1 antibody, positive anti-HBc test result immunization for rubella would result in a temporary deferral for: 4 weeks which of the following donors is acceptable? donor who had a first-trimester therapeutic abortion 4 weeks ago which of the following tests is not required as part of the donor processing procedure for allogeneic donation? anti-CMV which of the following lists the correct shelf-life for the component? deglycerolized RBCs- 24 hours each unit of cryoprecipitate prepared from whole blood should contain approx. how many units of AHF activity? 80 IU platelet concentrates prepared by apheresis should contain how many platelets? 3 X 10 ^11 the required storage temperature for frozen RBCs using the high-glycerol method is: -65 C how does irradiation affect the shelf-life of red blood cells? irradiation has no effect on the shelf-life once thawed, FFP must be transfused within: 24 hours quality control for RBCs requires a max hematocrit level of: 80% AHF concentrates are used to treat: Hemophilia A prothrombin complex concentrates are used to treat which of the follow? factor IX deficiency how is the antibody screen test different for donors than for patients? there is not a difference RBCs that have been leukoreduced must contain less than ___ and retain at least ____ of original RBCs 5 X 10 ^6/ 85% random-donor platelets that have been leukoreduced must contain less than ___ leukocytes 8.3 X 10^5 a single unit of FFP or PF24 should contain ___ mL of plasma 150-250 cryoprecipitate that has been pooled must be transfused within ____ hours 4 hours Which of the following phenotypes is seen MORE frequently in those of European descent than in those of African descent? K+k+ phenotype A person with which one of the following red cell phenotypes is expected to be resistant to Plasmodium vivax malaria? Fy(a-b-) phenotype Which of the following red blood cell antigens shows increased expression following incubation with proteolytic enzymes? Kidd antigens You are told that a patient has the "McLeod Syndrome." Which of the following is most likely to be TRUE regarding the patient? The patient presents with seizures or involuntary movements Which of the following lectins is matched appropriately with its target antigen? Vicea graminea: N antigen Which of the following red cell antigens is fully and strongly expressed on red blood cells from a term neonate? K antigen Which of the following is TRUE about the I blood group system? Patients with auto-anti-I may require a "prewarmed" crossmatch before transfusion Which of the following is TRUE of the P1PK and GLOB blood group systems? Anti-P1 is an insignificant antibody neutralized by pigeon egg white fluid A 5 year old child had an upper respiratory infection 5 days ago. Today, his mother brings him to the emergency room because his urine was bright red this morning. Upon admission, he appears pale, his hemoglobin is 6.4 g/dL, his urine and serum have free hemoglobin, and his direct antiglobulin test (DAT) is weakly positive with anti-C3 only (anti-IgG is negative). Which of the following is most likely TRUE? The antibody specificity is most likely anti-P If a patient has a positive antibody screen, a request for a red blood cell (RBC) product transfusion will usually be delayed due to the extra testing that is now required to identify the antibody and find compatibl

Neonate: Newborn from birth to 4 weeks of age Infant: Baby during the first year of life Gravid: Pregnant female Gravida: Number of pregnancies experienced by a woman Para: Delivery of a live infant Prenatal testing is ideally performed during the first trimester •May identify a woman at risk of causing Hemolytic Disease of the Fetus & Newborn (HDFN) May estimate the severity of HDFN ABO Rh Other antibodies •May alert the blood bank in the event of special blood is needed Exchange transfusion •Previous history of a problem pregnancy PRENATAL LABORATORY TESTING ▪ABO and Rh typing ▪Antibody screen •Differentiate between IgM and IgG •Clinically significant antibodies ▪Hemoglobin POSITIVE ANTIBODY SCREEN ▪dentify the antibody ▪Does the father have the corresponding antigen? •Homozygous vs. Heterozygous ▪Antibody Titer >Serial dilutions >AHG phase •Gel Method (Not Validated in Most Clinical Blood Banks) >May give results higher than the recommended method >May lead to invasive testing that is inappropriate ANTIBODY TITER TESTING ▪Establish baseline in first trimester ▪Not a reliable index of severity •May show fetal involvement ▪Needs to be performed monthly •Two tube change is significant •Parallel titrations with the previous specimen >Test previously frozen samples >Variability of technique between blood bank technologists >Reagents •Critical titers: ❑Anti-D is 16 or 32 ❑Anti-K is >8 PRENATAL LABORATORY TESTING ▪Immunity status: •Rubella •Varicella zoster ▪Other testing performed: •Toxoplasmosis •Hepatitis B •Hepatitis C •Chlamydia •Gestational diabetes •Group B Streptococcus •Genetic testing MIDDLE CEREBRAL ARTERY PEAK SYSTOLIC VELOCITY ▪Measurement of the fetal middle cerebral artery peak systolic velocity (MCA-PSV) •Middle artery is easily accessible ▪Noninvasive ▪Reliably predicts if the fetus is anemic by having readings taken every 2 weeks ▪No adverse effects on the fetus CORDOCENTESIS ▪Advanced sonography ▪Obtain a sample of fetal blood •Needle is inserted into the umbilical vein and a sample of fetal blood is obtained ▪Fetal blood is tested for: •Hemoglobin •Hematocrit •Bilirubin •Blood type •Direct Antiglobulin test (DAT) •Antigen typing AMNIOCENTESIS ▪Removal of amniotic fluid from the amniotic cavity ▪Aqueous medium with cellular material ▪Affected by UV light ▪Can be cultured Indications for testing amniotic fluid: Fetal maturity ❑Creatinine ▪Urine or amniotic fluid ❑Fetal Lung Maturity (FLM) ▪Lamellar body count ❑L/S Ratio (Lecithin/Sphingomyelin) ▪Fetal lung maturity confirmation ▪>2 indicates the lung maturity and low risk of respiratory distress ❑PG (Phosphatidylgycerol) ▪Fetal lung maturity indicator ▪Positive = Lungs mature ▪Negative = Lungs immature PRENATAL MANAGEMENT OF HDFN ▪May induce early labor ▪Intrauterine transfusion: hgb <10 g/dL, high amitotic fluid 450 •Only performed when there is a high risk of death before delivery can be done •Blood Selection: 1.Irradiated to prevent Graft vs. Host Disease 2.O negative packed red blood cells 3.CMV negative or Leukocyte Reduced packed red blood cells 4.Negative for Hgb S 5.Packed red blood cells are antigen negative for mother's antibodies 6.Packed red blood cells are crossmatch compatible with maternal plasma •Fetal umbilical vein is injected with donor red blood cells CORD BLOOD ▪Collected from all newborns •Collected using a syringe ▪Routine blood bank testing: •ABO and Rh typing ❑No reverse type as may detect maternal antibodies •Direct Antiglobulin Test/Direct Coombs ❑Most important test for diagnosing HDFN ▪Use reagent with Anti-IgG ▪Positive result indicates an antibody is coating the infant's red blood cells Wharton's Jelly •Gelatinous substance within the umbilical cord •Provides support for the vein and arteries of the umbilical cord •Need to wash cord blood numerous times to remove Wharton's Jelly ❑False results EXCHANGE TRANSFUSION ▪Use of whole blood or equivalent to replace the neonate's circulating blood ▪Used primarily: •Remove high levels of unconjugated bilirubin •Remove circulating maternal antibody •Remove sensitized red blood cells •Replace incompatible red blood cells with compatible red blood cells Packed red blood cells are typically resuspended in ABO -compatible Fresh Frozen Plasma (FFP) ▪Packed red blood cells should be: 1.< 7 days old 2.Negative for Hgb S 3.Leuckocyte Reduced packed red blood cells or CMV negative 4.Lack the antigen to the corresponding maternal antibody 5.Irradiated before the exchange 6.Hematocrit of 45 -60% 7.Outdates 24 hours after the packed red blood cells and plasma are mixed RH IMMUNE GLOBULIN ▪Criteria: •Mother is D negative and weak D negative •Infant is D positive or Weak D positive •Infant D status is unknown ▪RhIG mechanism of action is unclear •Interferes with antigen recognition and the phase of immunization •Interferes with B cell priming to make Anti-D ▪RhIG Is given: •28 weeks gestation •After delivery if infant is Rh positive ❑ Takes only 1 mL of fetal red blood cells to elicit an immune response RH IMMUNE GLOBULIN ▪Administered within 72 hours after delivery •If the infant is D negative and weak D negative, then no RhIG is needed ▪300 μg of antibody •One vial can suppress a 30 mL whole blood bleed •Fetal -Maternal Hemorrhage (FMH) screen is negative FETAL-MATERNAL HEMORRHAGE (FMH) SCREEN ▪Also known as the Rosette test ▪Infant is D positive; the mother needs postpartum specimen drawn to determine the appropriate dose of RhIG ▪Screen is sensitive to a >10 mL fetal bleed ▪False positive: •Mother is weak D positive ▪False negative: •Infant is weak D positive POSITIVE FMH SCREEN ▪Indicates a large fetal-maternal bleed ▪Quantitative testing performed to calculate the dose of RhIG •Kleihauer-Betke ❑Resistance of fetal hemoglobin to an acid treatment ❑Fetal cells stain pink ❑Maternal cells will appear as ghost cells •Flow cytometry ❑Detection of fetal blood cells using monoclonal Anti -HbF antibody ❑Detection of D positive antigens on fetal red blood cells RULES TO THE AMOUNT OF RHIG GIVEN ▪If the calculated dose to the right of decimal point is >0.5 vial, then round up to the next whole number plus one vial •1.7 vials calculated = 2 (rounded up) + 1 vial ❑Total vials of RhIG given is 3 ▪If the calculated dose to the right of the decimal point is<0.5, then round down plus one vial •1.3 vials calculated = 1 (rounded down) + 1 vial ❑ Total vials of RhIG given is 2 Definition of Hemolytic Disease of the Fetus and Newborn •Destruction of the fetal or neonate red blood cells by antibodies produced by the mother * fetal red cells caused by the maternal antibodies that attach to the corresponding antigens on the babies red cells and then get destroyed. •Hemolysis occurs when the mother's antibody binds to the fetus's red cell antigen >Rate of hemolysis is determined by the antibody and antigen sites on the red blood cells •IgG1 and IgG3 are more efficient at causing hemolysis than IgG 2 or IgG 4 Etiology of HDFN •During pregnancy, the function of the placenta: •Site of oxygen exchange •Site of nutrient exchange •Site of waste exchange •Time of delivery: •Placenta separates from the uterus •Fetal cells escape into maternal circulation •Fetal Maternal Hemorrhage (FMH) Pathophysiology •Factors in the pathogenesis of HDFN: 1.Mother must lack the antigen present on the fetal red blood cells 2.Fetal antigen must be well developed in utero 3.Mother is exposed to the fetal antigen 4.Mother produces an IgG antibody to the antigen, capable crossing the placenta Limiting conditions of HDFN •Mother's ability to make an antibody •Previous transfusions •Previous or current pregnancy •Ability of the antibody to cross the placenta •Antibody attach to the fetal red blood cells •Antigen must be sufficiently developed in utero for the antibody to react **significant numbers D and Kell In utero-HDFN •Erythrobastosis fetalis is when the destruction of the fetal red cells stimulates the fetal bone marrow to produce red cells at an accelerated rate •Erythroblasts are produced (Nucleated red blood cells) •Causes anemia Hydrops fetalis: abnormal accumulation of fluid in two or more fetal compartments. •Cardiac failure •Edema •Ascites Effects of HDFN Post natal- look for jandus-bilirubin levels Increased bilirubin •During gestation, the hemoglobin broken down into bilirubin is taken care of by the mother's liver •After birth, the bilirubin cannot be broken down by the infant's liver and stays in circulation •Causes kernicterus(Bilirubin 20 mg/dl) •Large amounts of bilirubin pass the blood -brain barrier, Causes brain damage •Positive DAT Primary vs. Secondary Immune Response •Primary Response-she must lack the antigen that the fetus possesses. >Occurs the first-time mother is exposed, needs to have red cell stimulation •Secondary Response >Occurs during successive pregnancies >Very small hemorrhage can cause a response >IgG antibodies can cross the placenta and attack fetal red cell Immune Response As severity increases: >Anemia increases >Hepatosplenomegaly Monitoring the fetus: >Antibody titers >Amniocentesis >Cordocentesis >Fetal blood to test for: >Hgb and Hct >Bilirubin >Blood type >DAT >Antigen typing Antigens >Not all antigens are equal in stimulating an immune response >Antigens on the red blood cells seem to be more antigenic than those found in the tissues, duffya, duffyb,- tissue, D, kell- HDFN >Early maturation of the antigens >Structure of the antigen- EARLY MATUATION Predicting HDFN-1st trimester prenatal testing •Maternal history: >Identify D negative females >Identify females with antibodies capable of causing HDFN >Previous pregnancy affected by HDFN >Infant requiring transfusion during the pregnancy or following birth Paternal phenotype:- LOOK AT DAD, does dad have the antigen heterozygous or homozygous >Predict if the fetus could carry the antigen to which the mother has formed an antibody >Blood bank testing:(mom) >ABO/Rh- blood type >Antibody screen ABO HDFN Most common type of HDFN >Group O mothers may have a naturally occurring IgG Anti-A,B antibody that reacts to either A or B cells >IgG antibody crosses the placenta and binds to fetal red blood cells that express the A or B antigens Can occur in any pregnancy Usually mild hemolysis >Rarely causes anemia May see hyperbilirubinemia or jaundice 12 -48 hours after birth-PHOTOTHERAPY •DAT is negative to weakly positive Rh HDFN number 1 cause!!! •Responsible for the most severe cases of HDFN •Occurs in the 2nd or 3rd pregnancy >Mother is not yet immunized with the first born •Predictable >Observe Anti-D in the mother •Leading cause of severe HDFN before RhIG came along in the 1960s. •DAT is strongly positive- mom develops anti D IgG cross the placenta and bind to the fetal RH, D positive cells. Cells are all hemolyzed Rh HDFN •Factors that affect immunization: >Antigenic exposure - >Fetomaternal hemorrhage during pregnancy •Host factors- RHD,RHC gene >Genetic factors to cause antibody response due to antigenic exposure >Fetuses with cDE/cde genotype are more likely to cause sensitization •Immunoglobulin class- >IgG •Antibody specificity- >D is the most antigenic •Influence of ABO Group- •ABO incompatibility may cause a decrease immunization with Rh system antibodies •Anti-c is a common cause of HDF Rh Immune Globulin (RhIG) •Solution of concentrated anti- Rh o (D) •Prepared from pooled human plasma that has been hyperimmunized and contains IgG anti -D •Prevention of Rh HDFN •During pregnancy and delivery, fetal and maternal blood mix •Rh-negative mothers with a Rh -positive fetus •16% chance of being stimulated to form anti-D •<1 mL of fetal red blood cells can cause a response Action of RhIG •RhIG attaches to the fetal Rh-positive red blood cells in the maternal circulation •Antibody -coated fetal red blood cells are removed by the macrophages in the mother's spleen Other indications for RhIG •Amniocentesis •Chorionic villus sampling •Abortion •Spontaneous •Induced •Ectopic pregnancy •Abdominal trauma •Greater than 40 weeks gestation •Accidental or inadvertent transfusion Cord blood •Assess the severity of the anemia •Cord hemoglobin •Direct Antiglobulin Test (DAT)-maternal IgG antibodies. >Detects in vivo sensitization of the infant's red blood cells- ellution-coating babies rbc •Bilirubin >Cord levels >4.0 mg/dL and heel stick levels of > 20 mg/dL are associated with kernicterus Cord blood •ABO and Rh typing >No reverse type is performed •Major source of hematopoietic stem cells •Antibody screen (Rarely performed) >Test for mother's antibody in cord blood serum Direct antiglobulin test (DAT)-HDFN •Differentiate between immune jaundice and physiologic jaundice •Immune jaundice >Extravascular destruction of sensitized red blood cells •Physiologic jaundice >G6PD deficiency >Hereditary spherocytosis >Drug therapy >Infections Therapy Options for HDFN Phototherapy >460-490 nm is used to convert the toxic unconjugated bilirubin to a nontoxic isomer >Effective in most cases IVIG >Treat hyperbilirubinemia >Reduces the amount of hemolysis Therapy Options for HDFN Exchange Transfusion: •Purpose- >Remove bilirubin >Removal of maternal antibody >Removal of sensitized red blood cells >Replace incompatible red cell with compatible red cells Components- >Suspend packed red blood cells in ABO-compatible thawed fresh frozen plasma >Negative for Hgb S >CMV negative >Irradiated >Final hematocrit of unit should be 45- 60% Therapy Options Small volume transfusions >Correct the anemia of prematurity more often than treating for HDFN >>Hgb of 7-10 g/dL >Neonatal transfusions >>Aliquots to minimize donor exposure >Mainly give O negative packed red blood cells that are irradiate Antigen A substance that has the potential to stimulate an immune response and reacts specifically with the substance that is produced in response to the stimulation (ie, antibody). Antibody A protein manufactured by B-cell lymphocytes in response to an immune stimulus. The stimulus may be a foreign antigen or it may be a naturally occurring antigen, as in the case of ABO antibodies. There are 5 general classes of antibodies: IgM IgG IgA IgD IgE Naturally occurring ABO antibodies are of the IgM class. Affinity Immunological concept that refers to the strength of attraction that an antibody has to a specific antigenic determinant. Avidity Immunology concept that refers to the strength that the antigen-antibody immune complex possesses after the paratope(s) and epitope(s) bond. Agglutination Also referred to as hemagglutination. In blood banking, it is the clumping of red blood cells that demonstrates immune complex formation. Agglutination may be either macroscopic or microscopic. Immunologically, agglutination is defined as a soluble substance (antibody) reacting with an insoluble substance (antigen). IgA Not typically addressed in immunohematology. Immunoglobulin found in serum (IgA1) and in secretions of mucosal surfaces (IgA2). Plays a major role as an anti-inflammatory molecule. IgG Immunoglobulin that is responsible for secondary immune responses. Manufactured by B-cell lymphocytes in response to an immunogen. IgG antibodies are acquired, being stimulated by exposure to an immunogen. IgG antibodies have the ability to bind up to two epitopes and typically react at body temperature (37°C). IgM Largest of the 5 classes of antibodies found in humans. IgM antibodies have the ability to bind up to 10 epitopes, equating to high avidity. IgM antibodies react stronger and faster at colder temperatures. Naturally occurring ABO antibodies (anti-A, anti-B, anti-A,B) are IgM in nature. Agglutination not only requires complementary antigens and antibodies (creating an immune complex), it also hinges upon the degree of attraction between the antigens and antibodies and the strength of the bonds created in the formed immune complex. Affinity refers to the attraction that a specific antibody possesses to its corresponding antigen. A high degree of specificity equates to bonding of that antibody to a specific antigenic epitope. Naturally occurring ABO antibodies possess a high degree of specificity to their antigenic counterparts. Avidity refers to the strength that an antigen-antibody immune complex possesses at that epitope. Naturally occurring ABO antibodies have a high degree of avidity, resulting in a powerful paratope-epitope bond. Zeta potential is defined as the degree of negative charge on the surface of a red blood cell. Clearly stated, it is the potential difference between the negative charges on the red cell and the cations in the fluid portion of the blood. Larger zeta potential around the red blood cell results in a decrease in the affinity between the antibody and antigen. Zeta potential is defined as the degree of negative charge on the surface of a red blood cell; it is the potential difference between the negative charges on the red blood cells (RBCs) and the cations in the fluid portion of the blood. Larger zeta potential around the RBCs results in a decrease in the affinity between the antibody and antigen. van der Waals forces are the attractive or repulsive forces between molecules. These forces play a crucial role in the strength of agglutination (avidity). The agglutination chart shows basic grading: 0, 1+, 2+, 3+ and 4+ reaction strengths. Negative (0): Red cell button entirely resuspended and not visible agglutination 1+: Red cell button entirely resuspended with many small aggregates present 2+: Red cell button entirely resuspended with several medium sized aggregates present, clear supernatant 3+: Red cell button entirely resuspended with few medium to large sized aggregates present, clear supernatant 4+: Red cell button entirely resuspended with one large sized aggregate present, clear supernatant Antigens and antibodies specifically combine to form immune complexes. What term refers to the antibody's attraction to a particular antigenic determinant (epitope)? Affinity explanation, description, or definition to its correct immunology term. Antigen: In postzone, there is an excessive amount of this. May or may not be considered an immunogen RBC cell membrane proteins are considered these Antibody: In prozone, there is an excessive amount of this. These can be naturally occurring or produced after stimulation There are 5 general classes of these These are soluble and found in plasma An ABO typing discrepancy occurs when forward and reverse typing reactions do not correlate or when test results are interpreted as unexpected reactions. ABO discrepancies MUST be resolved PRIOR to the administration of blood components. A transfusion reaction could occur if cellular or non-cellular blood components are administered to a patient who demonstrates an ABO discrepancy The two most common subgroups of A are A1 and A2. Both have strong reactions with anti-A reagent. Anti-A1 lectin is used to identify A1 and A2 cells. Anti-A1 lectin (prepared from Dolichos bifloris seeds) reacts with A1 but not A2 red cells. While anti-A1 may be found as an alloantibody in the serum of group A2 individuals, it is more commonly found in group A2B individuals. Mixed-field agglutination is a characteristic of A3 red cells with anti-A. A mixed-field reaction is defined as the appearance of strongly agglutinated cell clumps admixed with unagglutinated cells. A microscopic representation of mixed-field agglutination is shown on the right. A group sugar (N-acetyl-D-galactosamine) into a structure that highly resembles the B group sugar structure (D-galactose). multiple myeloma, Waldenstrom macroglobulinemia, and certain leukemias, can impact ABO testing. For example, there is an increase in the amount of circulating immunoglobulin in multiple myeloma, which results in an overall increase in total circulating protein. This increase in protein can cause interference in the forward ABO typing. Red blood cells coated with protein have a tendency to clump together and demonstrate a "stacked coins" appearance. This is called rouleaux. Rouleaux can macroscopically look like agglutination; however, with vigorous shaking, the reaction will dissipate. In vitro, rouleaux can be misinterpreted as agglutination, causing discrepancy between the patient's forward and reverse testing. Although this can be a significant discrepancy, it is one of the easiest to resolve. Group AB patient massively transfused with type O donor unitsMixed field agglutination in the forward type can occur in subsequent patient samples Cold reacting autoanti-I, coating patient red blood cellsSensitized patient red blood cells could cause discrepancy in the forward type Cold reacting alloantibody such as anti-MThe prevalence of the M antigen could result in detection on either the A1 or B cells in the reverse type. The stimulation of anti-A1 formation in the plasma of patient with a subgroup of A or AB.This can happen as a result of exposure to donor red cells or through pregnancy. Anti-A1 lectin (Dolichos biflorus) Anti-H lectin (Ulex europaeus) A2 reagent red cells O reagent red cells By how much does one unit of packed RBC's raise the H&H of a patient?1 g/dL Hgb and 3% Hct2. Cryoprecipitate - frozen-18° or less 12 months Cryoprecipitate - thawed20-24° 6 hours4. Cryoprecipitate - thawed - pooled20-24° 4 hours5. Donor Hx alone is relied on for what diseases?- malaria- babesiosis- Chagas- variant CJD6.FFP-18° or less 12 months7. Frozen whole blood - deglycerolized1-6° 24 hours (open) or 14 days (closed)8. Frozen whole blood - glycerolized-65° 10 years9. How long to RBCs last in the different preservative solutions?-ACD, CPD, CP2D = 21 days-CPDA-1 = 35 days-additive solution (SADMAN), AS 1/3/5 = 42 days10. How much plasma, fibrinogen, and activity/mL of the stable clotting factors are contained within a unit of FFP or PF24?150-250 mL of plasma~400 mg of fibrinogen1 U11. Maximum % of blood volume removed from a donor.15%12. Minimum total platelets required in apheresis platelets?>3.0 x 10^11 total platelets13. Minimum total platelets required in platelet concentrate>5.5 x 10^10 total platelets Once the seal on a blood product unit is breached how long is the product good for?- 4 hrs if stored at RT-24 hrs if refrigerated Outdated RBCs can be rejuvenated up to how many days past out-date?3 days (by adding solutions with ATP and 2,3-DPG) Plasma water bath temperature. 30-37 C Platelets - Pooled 20-24° 4 hours Platelets - Single or Random donor20-24° 5 days RBC's with additive1-6° 42 days. Shelf life/storage temp: apheresis platelets5 days at RT (20-24C) with agitation (same as platelet concentrate) Shelf life/storage temp: CRYO1 year at -18 C or colder Shelf life/storage temp: FFP1 year at -18 C or colder Shelf life/storage temp: platelet concentrate5 days at 20-24 C with agitation24. Temperature required to thaw plasma for CRYOprecipitate.1-6 C25. Thawed FFP1-6° 24 hours The use of FFP or PF24 is indicated for this type of patient.Patient is actively bleeding with multiple clotting factor deficiencies.27. Volume of 1 unit cryo?10-15 ml28. Volume of 1 unit FFP?~200 ml29. The volume of 1 unit of RBCs150 to 230ml red cells30. Volume of whole blood collected:450ml bag with 63ml of anticoagulantOR500ml bag with 70ml of anticoagulant31. What does cryoprecipitate contain? (2)1. >80 U of factor VIII, anti-hemophilic factor2. >150 mg of fibrinogen32. What does the RBC rejuvenation fluid contain?Pyruvtae, inosine, phosphate, adenine33. What happens to 2,3-DPG of stored RBCs?-decreases linearly after 2 weeks, but regenerates once transfused-1/2 of the 2,3-DPG regained at 12 hrs post-transfusion and full levels by 24 hrs34. What is CRYO?Cold insoluble proteins precipitated from 1 unit FFP when it is thawed in refrigerator35. What is FFP?Plasma separated by centrifugation from a whole blood unit and frozen within 8 hours of donation36. What is in CRYO?1) 200-250mg fibrinogen (>150 required)2) 80-120 units Factor VIII (>80 required)3) vWF4) Factor XIII5) Fibronectin37. What is in FFP?Stable and labeled coagulation factors---1 unit of each clotting factor per mL plasma---2-4mg fibrinogen per mL plasma20% of volume is CPD anticoagulant solution Baby girl jones was delivered one hour ago. a cord blood was sent to the blood bank A 4+ B 0 D 3+ CTL 0 A1 0 B 4+ IgG,C3d 0 based on these results does Baby girl jones have a hemolytic disease of the fetus? *No, baby girl jones does not have HDFN the most common type of HDFN is due to antibodies of the? ABO system the antigen that stimulates the production of antibody in hemolytic disease of the fetus and newborn? is the paternal antigen not found in the mother which of the following is the best choice for the initial compatibility testing for an exchange transfusion? a maternal specimen passive Rh immunization RhIG is intended to? prevent Rh immunization by the D antigen which of the following is associated with Rh hemolytic disease of the fetus and newborn? strongly positive DAT May Onaise is pregnant and the blood bank has a positive antibody screen and panel on her sample that is.. antibodies with hemolytic disease of the fetus and newborn? is not associated with HDFN Prenatal screening test performed on the serum of plasma of women are used to? determine whether any atypical antibodies are present which is the class of immunoglobins uniquely associated with hemolytic disease of the fetus and new born? IgG a female that is O negative received antepartum RhIG and gave birth to a A positive infant. she received one vial of RhIG 2 units of packed red blood cells because of a post partum hemorrhage she obtained 2 days after delivery? passively acquired anti-d If a mother has no anti-d in her serum rhig should be injected postpartum in the following situations? mother is rh negative and baby is rh positive which of the following would cause a positive dat? all of the above-autoimmune disease, transfusion reactions, HDFN, drugs the best screening test for detect a fetal maternal hemorrhage is? rosette test when using coombs check cells to control the antiglobulin phase of the crossmatch the cell will?a,b,and c only. show agglutination id the washing of the red cells, show agglutination if the AHG reagent was neutralized, show no agglutination if the AHG was defective the direct antiglobulin test dat is most likely to be helpful in? investigation of transfusion reactions what effects does a positive DAT have on antigen typing that uses a reagent requiring an AHG phase? invalidates antigen typing as the patients cells are already coated with an antibody coombs check cells were added to a negative antiglobulin test. a positive result was obtained which of the following result? the control cells were coated with IgG in the direct antiglobulin test the patient cells are negative for agglutination after the ahg reagent.? repeat the procedure jay bird is being seen by his physician for a diagnosis of graves disease. the blood bank performes a type and screen A 0 B 0 D 3+ CTL 0 A1 4+ B 4+ I 3+ II 3+ THE BLOOD BANK TECHNOLOGIST PERFORMES AN ANTIBODY IDENTIFICAION PANEL AND IT DEMONSTRATED AGGLUTINAION? perform an autocontrol and direct antiglobulin test on the patient the criteria to determine the Rh immune globulin eligibility include? the mother does not have an immune anti-d a single vial of 300 of Rh immune globulin will cover a maximum fetal maternal bleed equivalent to how many ml of whole? 30 an acid elution stain kleihauer betke was made using a one hour post delivery maternal blood sample. it was determined that 3% of the found to contain fetal hemoglobin. how many vial of rhig would be indicated to give to the mother? 6 what is the most likely explanation when all screening cells and antibody panel cells are positive and the auto control is positive? warm autoantibody which of the following test can distinguish between warm autoimmune hemolytic anemia WAIHA and hereditary spherocytosis ? DAT a positive direct antiglobulin test dat will be seen in all of the following conditions except? paroxysmol nocturnal hemoglobinurea PNH paroxysmal cold hemoglobinuria PCH is best associated with which blood group? P which of the following is not true of drug induced hemolytic anemia caused by aldomet? autoantibody is not found in the serum/plasma autoantibodies are? antibodies directed at ?self antigens what can be done if hemolytic disease of the fetus and newborn HFDN is caused by a maternal anti K? monitor the mothers antibody level by performing antibody titers dinah mites has a blood type A negative who has just had a miscarriage. is she a candidate for rhogam? yes but only if she does not have evidence of active anti d the blood bank technologist receives an order order to perform an antibody titer on a B positive patient, what antibody do they need to titer out on this patient? Anti A Describe the storage lesion of donor blood. Storage lesion - changes that occur in red blood cells stored at 1-6oC. a. pH falls as lactic acid increases b. ATP level falls as glucose consumption is decreased. c. 2,3-DPG level falls, increasing Hgb affinity for O2. d. In plasma potassium rises, sodium falls, and plasma hgb rises. Purpose of Mannitol: Osmotic diuretic acts as membrane stabilizer (maintains shape) After the plasma is expressed off the PRBCs, about 100 mLs of an additive solution is added if not already in the primary bag to ? extend the storage limit of RBCs Storage limit of CPD & CP2D: 21 days Storage limit of CPDA-1: 35 days Storage limit of all AS's: [AS-1, AS-3, AS-5, & AS-7]: 42 days Additional Functions of Preservatives • Enhances the flow rate (less viscosity)• Easier to filter out WBCs pre‐storage and anychunks post‐storage at the bedside PLT's Limiting factor is ? bacterial contamination a 32 year old female is admitted to the hospital in labor with her second child. she has a neglected her prenatal care and only has seen a physician for emergencies during her pregnancy. the following results were obtained on the mother as she was admitted to the hospital. moms blood type anti A 4+ anti B 0 anti D 0 weak D 0 Rh control 0 I 2+ II 2+ antibody ID: anti-D the following results were obtained on the infants cord blood sample anti A 0 anti B 0 anti D 0 weak D 2+ Rh control 2+ DAT 4+ IF POSITIVE IT INVALIDATES THE WEAK D RH CONTROL BABY IS GROUP O with a DAT thats positive what is the most probable explanation for these results Rh hemolytic disease of the newborn with a false Rh typing due to positive DAT result Good Manufacturing Practices apply to: blood, tissue, progenitor cells, pharmaceuticals Which of the following statements about mixed-field agglutination (MFA) are true? Select all that are correct.? MFA is unlikely to occur in antigen typing if 5 months has elapsed since the patient's last transfusion. MFA may be seen when typing a patient for ABO, Rh, and other RBC antigens.MFA is unlikely to occur in antigen typing if 5 months has elapsed since the patient's last transfusion. MFA may be seen when typing a patient for ABO, Rh, and other RBC antigens. Which of the following most likely accounts for the patient's post-transfusion plasma giving negative panel results?Most or all of the patient's antibody has adsorbed to antigen-positive transfused donor RBCs. Which of the following signs and symptoms is most likely to indicate a severe immediate hemolytic transfusion reaction?Lower back pain in the area of the kidneys Which of the following cells would be the one most useful cell to exclude both anti-E and anti-K in this patient?Jk(a-b+) E+e-K+k- Which of the following statements about antigen phenotyping are TRUE? (Select all that apply?A positive DAT can cause false-positive results when antigen typing a patient by IAT.Recent transfusion may cause mixed-field agglutination in a patient's antigen typing results.Using the patient's pretransfusion specimen is one solution to antigen typing a recently transfused patient. True or false: A patient who received an autologous transfusion one week ago cannot be reliably antigen typed.false True or false: A patient with a positive direct antiglobulin test (DAT) due to IgG cannot be reliably antigen phenotyped using antisera that reacts by the indirect antiglobulin test (IAT).true Why do so few patients transfused with un-crossmatched red cells in an emergency experience a hemolytic transfusion reaction? Select the one best reason.The incidence of unexpected red cell antibodies is relatively low. Which of the following signs and symptoms may be associated with immediate transfusion reaction in a patient who has undergone surgery, but is NOT usually associated with delayed hemolytic transfusion reaction? Unexplained bleeding from surgical site Patient A.D., a 30 year old female, was admitted to the hospital in active labor to deliver at 37 weeks gestation. Transfusion service (TS) records showed A.D. to be group O Rh negative with no record of unexpected red cell antibodies. Maternal history showed two prior pregnancies. Her first pregnancy, four years ago, ended in spontaneous abortion at 9 weeks gestation and she received a mini-dose (50 µg) of RhIG. In the second pregnancy, two years ago, the infant typed as Group A Rh positive, DAT negative. Patient A.D. was injected with RhIG within 72 hours of delivery. The laboratory also confirmed that in the current pregnancy RhIG was administered at approximately 28 weeks gestation subsequent to a negative antibody screen.After many hours of non-productive labor, the physician considered that labor had stalled and decided to do a cesarian section (C-section). According to hospital policy for C-sections, a type and screen was ordered. *Which of the following are possible causes of the positive antibody screen?Anti-D (passive, from RhIG administration)Anti-D (immune)Antibody other than anti-DAnti-D plus another antibody*****All of the above are possible Why might screen cell #2 be reacting stronger than screen cell #1?All of the above are possible Which of the possible causes is the MOST likely cause of the positive antibody screen?Anti-D (passive, from RhIG administration) Which of the following factors is most likely to cause a false-negative antibody screen following RhIG injection?Large maternal physical size A pregnant female has been injected with RhIG antenatally and has a positive antibody screen at delivery. If the antibody has been confirmed as anti-D alone and reacts only weakly (1+ in the indirect antiglobulin test), the anti-D is definitely passive. false A pregnant female who received RhIG at 28 weeks gestation has a positive antibody screen at delivery. If the antibody has been confirmed as anti-D alone and reacts 1+ in the indirect antiglobulin test with D+ red cells, performing a titration to investigate if the anti-D is immune is good practice. false The newborn's ABO group is invalid because no reverse (serum) group was set up with A1 and B cells. false The newborn's Rh(D) type is invalid because the DAT is positive. false The positive DAT on the newborn means that the infant probably has clinically significant hemolysis. false Which of the following tests are suitable for quantifying the size of fetomaternal hemorrhage (FMH)? Select all that apply.Flow cytometryKleihauer-Betke test Facilities that use a special calculation for RhIG dosage add one vial, regardless if they round up or round down. true Blood safety standards such as AABB Standards directly specify that an electronic crossmatch cannot be done when an Rh negative female has an anti-D consistent with antenatal RhIG administration. false A 1500 IU (300 µg) dose of RhIG can suppress immunization to _____ mL of D-positive whole blood. 30 If a pregnant female who was injected with RhIG antenatally has anti-D at delivery, routine antibody titration to determine the titer of the anti-D is considered a good practice. false A pregnant female who was injected with RhIG antenatally has a positive antibody screen at delivery. The antibody has been confirmed as anti-D and reacts only in the indirect antiglobulin test. Many laboratories consider reaction strength to be an indicator of whether the anti-D is likely passive or immune.To be considered probably passive, an anti-D reaction strength is typically less than or equal to which reaction grade?2+ A group A Rh positive infant born to a group O Rh negative woman has a 1+ positive DAT. The mother had a negative antibody screen at deliver and received antenatal RhIG. Which of the following are possible causes of the newborn's positive DAT?Anti-A Passive anti-D Antibody to a low frequency antigen ***All of the above are possible causes The following results were obtained at delivery for a pregnant woman who received antenatal RhIG. Which of the following are possible causes of the positive antibody screen?Anti-D (passive, from RhIG administration)Anti-D (immune)Antibody other than anti-Danti-D and another antibody****All of the above are possible In the interest of safety, it is the policy at XYZ hospital to always add one extra 300 µg vial of RhIG, regardless if the dosage calculation is rounded up or rounded down. After performing a Kleihauer-Betke test, a technologist in the laboratory at XYZ hospital calculates the fetomaternal hemorrhage (FMH) to be 45 mL of fetal whole blood. If the formula below is used, how many 300 µg vials of RhIG should be administered to this woman? 3 A group B Rh positive female has been admitted to hospital and is in labor. Is it an acceptable (good) practice not to test the newborn (ABO, Rh, DAT)? yes Antenatal RhIG (1500 IU dose) is typically given at how many weeks gestation? 28 The Kleihauer-Betke test used to quantitate fetomaternal hemorrhage has good reproducibility? false The most commonly reported cause of severe/fatal TRALI is:Donor HLA antibodies transfused into recipients with the corresponding antigen An 86-year-old male patient presented with shortness of breath and systolic hypertension 2 hours after receiving 6 units of FFP. The patient responded well to diuresis and the symptoms subsided within 2 hours. Which of the following reactions is/are MOST probable? TACO Which of the following components would be suitable for a recipient with a high-titer class-specific anti-IgA antibody? Fresh Frozen Plasma from an IgA-deficient donor Which of the following is NOT one of the published indications for FFP transfusion? volume replacement All transfusion reaction initial workups must include which of the following? Checking records and labels for identification errors Which of the following components would MOST LIKELY be associated with TRALI? FFP from a female donor with a history of one full term pregnancy If a patient experiences an acute transfusion reaction and TRALI is suspected, who must be notified immediately? The transfusion service. The donor center. The patient's physician **All of the above Which of the following components is NOT addressed by the AABB TRALI mitigation standard 5.4.1.2? red blood cells Which of the following adverse reactions to plasma transfusion are theorized to involve both a donor and recipient factors (two-hit type of mechanism)? Both TRALI and Anaphylaxis TRALI: fever often present, hypotension, donor wbc antibodies generally present TACO: not associated with fever, significant response to diuretics, increase in systolic pressure Which ABO type of FFP would be the BEST choice for a group A recipient? group a A patient had a pretransfusion factor V activity of 20%. Immediately after administration of one dose of FFP (20 mL/kg) approximately what should his factor V level be? 40% Which of the following components would be suitable for a patient with a history of severe anaphylactic reactions to Red Blood Cell transfusion associated with haptoglobin antibodies? Red Blood Cells, Saline Washed RhoGAM Rh immune globulinspecial immune globulins that prevent mother's sensitization to the Rh positive baby in her Rh negative blood28 weeks and after birth Indirect Co0mbs test done on mothers blood to measure amount of RH+ antibodies titer of 1:8 Direct Coombs Test done on infants blood to detect antibody coated Rh+ red blood cells Function of the HLA System •Role in the immune system •Recognition and elimination of foreign antigens •Self and non-self discrimination Human Leukocyte Antigens (HLA) •Antigens on the cell surface •Leukocytes •Tissues •Genes encoding the expression of these antigens are associated with the MHC •HLA antigens and antibodies are involved in areas of transfusion medicine. Major Histocompatibility Complex (MHC)Located on the short arm of chromosome 6 •Class I, Class II, and Class III regions •Polymorphic •Several alleles exist at each locus. MHC Role in Immunity and Autoimmunity •MHC synthesizes antigens for display on cellular surfaces •Immune system monitoring •Cells presenting native antigens are designated as "self" by the immune system •Cells presenting foreign antigens are designated as "non-self" by the immune system •Destroyed through a cascading immunological response Nomenclature of HLA •Naming of HLA is the responsibility of the WHO Nomenclature Committee for the Factors of the HLA System •Class I alleles: 20,597 •Class II alleles: 7,723 •HLA alleles: 28,32 Autograft: •Graft transferred from one position to another in the same patient Syngraft •Graft transplanted between different but identical recipient donors Allograft: •Graft between genetically different recipient and donor of the same species Xenograft: •Graft between individuals of different species Antigens and Antibodies •HLA antigens composition •Platelet transfusions due to refractory to random donor platelets •Presensitiziation may cause rejection or poor platelet survival •Majority of HLA alloantibodies are IgG Bg ANTIGENS •HLA Class I antigens •Found on red blood cells •Remnants of HLA antigen •Found in greater quantities on nucleated red blood cell precursors •May present as "unwanted" antibodies when using commercial typing sera Solution to rejection •Suppress the immune system •Immunosuppressive Treatments: •Cyclosporine •Tacrolimus •Sirolimus Graft vs Host disease •Blood products, bone marrow transplants, organ transplants •HLA differences between donor and patient •The stronger the antigen difference, the severe the reaction •Severely immunocompromised •IRRADIATED BLOOD PRODUCTS Diseases/conditions •Paternity testing •Transplants •Immunosuppressive treatment •Platelet transfusions •HLA alloimmunization can result in becoming refractory to random donor platelets •Transfusion Related Acute Lung Injury •Addison's Disease •Celiac Disease The reactivity of blood group A is confirmed by detecting the presence of which immunodominant sugar molecule? N-acetyl-D-galactosamine The mating of parents of which two ABO phenotypes can potentially produce offspring with ALL of the common four blood types? A and B Bombay phenotype (Oh) individuals may have antibodies with all the following specificities EXCEPT: Anti-O Which cells agglutinate most strongly with Ulex europaeus lectin? O and A2 Immune A and B alloantibodies differ from non-red cell stimulated (naturally occurring) A and B alloantibodies in that the immune antibodies: Are generally IgG rather than IgM Which ABH substances would you expect to find in the saliva of a group A secretor? H and A Which of the following is the best explanation for why the ABO system is the most important blood group system in transfusion safety? ABO antibodies are capable of causing rapid, severe intravascular hemolysis A 26 year old pregnant female is being tested prior to a scheduled C-section tomorrow. Her cell grouping (forward typing) is consistent with blood group O, while her serum grouping (reverse grouping or "back-typing") appears to be group A. The most common reason for this type of ABO discrepancy is: Clerical errors or a sample mix-up An ABO discrepancy between forward and reverse grouping owing to weak-reacting or missing antibodies could be BEST explained by which of the following: Patient is very old or very young A blood donor has the genotype hh, AB. What is his apparent red cell phenotype during routine forward and reverse group typing? O Approximately what percentage of group A individuals could be further classified as subgroup A1? 80% Which of the following statements is TRUE regarding the A2 blood group? A2 RBCs have more H antigen than A1 RBCs Which of the following genes codes for production of the same basic antigen as the gene known as H? Se The labels have come off of some of the reagent bottles in your transfusion service, so the ABO testing reagents are just sitting there, label-less (and they just look ridiculous!). A new lab scientist is trying to find the anti-B, and he asks, "What color is anti-B?" Yellow Which of the following statements is TRUE regarding Hemolytic Disease of the Fetus/Newborn (HDFN) caused by ABO antibodies? A negative cord blood direct antiglobulin test excludes it Name the three genes responsible for the production of Rh antigens. RHAG, RHD, and RHCE Which of the following is TRUE regarding the weak D phenotype? Was traditionally identified by an indirect antiglobulin test Which of the following red blood cell abnormalities is associated with the Rhnull phenotype? Stomatocytes A patient has the following Rh phenotype: D:+ C:+ c:+ E:+ e:+ What is her most likely Rh genotype? R1R1 A Caucasian patient has the following Rh phenotype: D:+ C:+ c:+ E:- e:+ Which of the following is his most likely Rh genotype? R1r An African-American patient has the following Rh phenotype: D:+ C:+ c:+ E:+ e:+ f:- Which of the following is her most likely Rh genotype? R1R2 An African-American male potential blood recipient has the following Rh phenotype: D:+ C:+ E:- c:+ e:+ Which of the following is his most likely genotype? R1R0 A 35 year old O-negative male trauma patient receives a transfusion of two units of O-positive red blood cells before his blood type is known. After his typing is completed, he is switched to O-negative and he receives 6 additional type-specific RBC units. He survives and is transferred to the surgical ICU. Which of the following is TRUE regarding his situation? He is unlikely to develop delayed hemolysis What percentage of blood specimens derived from those of European descent will have a positive agglutination result with the anti-c reagent? 80% Which alloantibody is most likely to be produced if a patient that has the Rh genotype of R1R1 is transfused with red blood cells that have an Rh genotype of R0R0? anti-c A 63 year old male presents with a positive antibody screen and clinical and serologic findings consistent with warm autoimmune hemolytic anemia. In addition, the reference lab technologist also identifies an antibody that reacts stronger when the test RBCs are D-positive. The supervisor suggests the technologist consider anti-LWa in addition to anti-D. Which of the following TWO techniques will MOST assist in differentiating between these two antibodies? Adsorption/elution with D-negative RBCs: Anti-LWadetected, anti-D not detected In which of the following groups is Weak D testing required if the initial D typing results appear negative? Rh typing of allogeneic (volunteer) whole blood donors Which of the following is TRUE about Anti-D? It is primarily the IgG isotype rather than IgM Anti-G will react with red blood cells of each of the following phenotypes except: D-C- If a patient had a positive direct antiglobulin test (DAT) with Anti-IgG, what would happen if you performed a Weak D test on the patient cells? A false-positive result

What blood type should be transfused when crisis does not permit time to collect and test a patient sample?

O-negative

Molecules that promote the uptake of bacteria for phagocytosis are

Opsonins

Which of the following is not involved in the acquired or adaptive immune response? - Phagocytosis - Production of antibody or complement - Induction of immunologic memory - accelerated immune response upon subsequent exposure to antigen

Phagocytosis

Which blood product should be selected for vitamin K deficiency?

Plasma

Which of the following refers to the effect of an excess amount of ANTIGEN present in a test system?

Postzone

What effect does aspirin have on platelets?

Prevents Plt aggregation

What anticoagulant is used to eliminate false-negative reactivity caused by cold autoantibodies and rouleaux?

EDTA

Which of the following is the most common cause of bacterial contamination of platelet products?

Entry of skin plugs into the collection bag

T or F: Kidd Ag's are NOT present on neonate RBCs.

F

Tests performed on donor's (ABO, Rh, Ab Screen, Viral testing) are only performed on first donations?

False

What is the basic unit of inheritance that determines the production or nonproduction of specific markers?

Gene

A graduated pipette can be used when:

Great accuracy is not needed

Anti-Le(bH) will not react or will react more weakly with which of the following RBCs? - Group O Le(b+) - Group A2 (Leb+) - Group A1 (Leb+) - None of the above

Group A1 (Leb+)

What is the most common ABO blood group in Caucasians?

Group O

Lu a and Lu b Ag's do NOT cause ____.

HDN (Lu Ag's are poorly developed at birth; anti-Lu a is IgM)

What does the term HLA-DQ designate?

HLA gene region, locus D, sub-region Q

MHC class III is physically located between HLA-__ and HLA-__.

HLA-A and HLA-C

Individuals who possess the Oh (Bombay phenotype):

Have the genotype hh

Which portion of the immunoglobulin molecules contains complement binding sites?

Heavy chain constant region

Functions of the compliment system include

Host defense against infection, such as chemotaxis, clearance of apoptotic cells, clearance of immune complexes from the tissues, ALL OF THE ABOVE is correct

Cryoprecipitate AHF contains factor VIII. What other coagulation factor is present?

I

In addition to nonhemolytic febrile transfusion reactions, what other indication exists for washed red blood cells?

IgA-deficient patient with anti-IG A

Kell Ab's are mostly Ig_.

IgG

Duffy

IgG, shows dosage, capable of causing transfusion reactions and HDN, destroyed by enzymes

What would be the result of group B blood given to a group O patient?

Immediate hemolytic transfusion reaction

The earliest host response to a vaccination is a(n)

Innate immune response

How do internal assessments differ from compliance inspections?

Internal assessments are more frequent than compliance inspections

Jk_ is very common.

Jk a

RBCs can be frozen for

10 years

Precipitation is a term applied to:

The aggregation of soluble test ANTIGENS

Kernicterus is caused by the effects of:

Unconjugated bilirubin.

IgM agglutination in immediate phase

YES

Rh blood group Ag's (are/are not) naturally-occurring.

are not

A safety feature in the SPRCA is

color change of the LISS

r correlates as

lowercase for everything

37C detects

possibly: D,E,C,e,c,K

RBC transfusions should be given

within 4 hours

Causes of Group I discrepancies: 1) ____ patients 2) ____ 3) patients with ____ or ____ 4) patients taking ____ ____. 5)Patients with congenital_____ or _____ 6) ___ ___ recipients 7) ____ transfusion 8) ____ ___ 9) ____ or ____

1) elderly 2) newborns 3) leukemia or lymphoma 4) immunosuppressive drugs 5) congenital agammaglobulinemia or immunodeficiency 6) bone marrow transplant 7) plasma transfusion 8) ABO subgroups 9) mosaicism or chimerism

Causes of Group III discrepancies: 1) ___ ___ or ____ ____ 2) _____ 3) _____ 4) _____ _____

1) multiple myeloma or Waldenstroms macroglobulinemia 2) fibrinogen 3) expanders 4) Wharton's jelly

RBC liquid shipment temp

1-10 celcius

Shipment temp for RBC frozen

-40c or less

Donnor testing includes:

-ABO/Rh including Dw (must repeat at transfusion site). -Test for transmittable infections (CMV optional) -Ab screen

Which of the following might explain how a patient could have an antibody but the blood bank tech could not detect it using routine Ab screen methods:

-Ab is too low in titer for the current method -Ab is directed against a low frequency Ag that may not have been present in screening cells -Ab may be showing dosage All of the above are correct

Erythroblastosis fetalis

-Bone marrow of fetus is stimulated to produce RBCs at accelerated rate -Immature RBCs (erythroblasts) are released into the circulation -Erythropoiesis outside of BM occurs in the spleen and liver to keep up with anemia Result: enlarged spleen and liver

For what purpose would a newborn transfusion be used?

-Correct anemia from HDFN (when bilirubin is otherwise successfully treated) -Replace blood from lab work

What are Addition laboratory findings for ABO HDFN?

-Could do testing of eluate from fetal cells (cord blood) -Easier to perform Immune A or B test >Infant serum with A/B cells and perform IAT ~Incubate, wash, add Anti-IgG

Limitations of the Ab screen?

-Does not detect Ab titers below the sensitivity of the method employed. -Will not detect Abs to low freq Ags that are not present on any of the cells in the screen cell set.

Ab ID pt history

-HISTORY OF TRANSFUSION -HISTORY OF PREGNANCY -history of transfusion within the last 3 months -medications -diagnosis -race -age

What can the DAT tell you?

-Transfused patient--> AlloAb coating the transfused cells. -Patient has not been transfused--> AutoAb coating their own cells

How to avoid the reactivity of cold autoAbs?

-Use anti-IgG AHG instead of polyspecific (they fix complement) -Skip IS phase -Use 22% BSA instead of LISS

Neutralization

-Uses soluble Ag to inhibit reactivity of some Abs in testing. -Add soluble Ag to serum, incubate, then use serum to do testing. -Helpful when a patient has nuisance cold Ab (neutralized) and a significant Ab (not neutralized).

Autosomal Recessive

-about 1/4 -most often trait is expressed in OFFSPRING and NOT seen in parents -1/4 of offspring are affected on average -parents of affected offspring may be related -affects both males and females equally Ex: cystic fibrosis, sickle cell anemia, tayzeaches(?) -jewish population

Tippett

-another inheritance theory -2 closely linked genes on chromosome 1 -RHD (determines D Ag expression on the surface of the red cells) (D-neg individuals have NO genetic material at this site) -RHCE (determines the C,c,E,e Ag)

HDFN due to ABO inompatibility

-most common form of HDFN -Mother is "O" with IgG form of Anti-A,B -Baby is "A" or "B" -May occur with 1st or subsequent pregnancies -Usually less severe than Rh HDFN -Most cases treated only with phototherapy

Haplotypes

-person inherits 1 haplotype from each parent -where Wiener and Fisher-race nomenclature comes from -genes are inherited as a unit

What would cause a false negative?

-sites already bound (anti-IgG may not be able to bind)

Factors affecting Ab ID -Variation if Ag expression

-technical error -weak AB rxn -dosage -some ag deteriorate more rapidly when stored (Duffy, M, P1) -multiple Ab (reactivity at diff phases) -positive DAT

prewarming

-use after ruling out ALL CS Ab -prevent COLD AB from reacting or binding complement in the LISS and Coombs phage -prewarm serum/plasma and cells separated at 37C ad then combine serum and maintain 37C throughout testing -you can prewarm CS away (kidd and duffy) with weak rxn

Elution

-used on +DAT samples used to release, concentrate, and purify Ab Methods: -change the thermodynamic of the environment (temperature change heat vs cold) -change the forces between the Ag and Ab (pH) -change the structure of the surface of the red cell (organic solvents)

Treatment for ABO HDFN

-usually treatable using only phototherapy if infant is jaundiced -Remember: ABO HDFN sometimes protects babies from more severe forms of Rh HDFN (or other BGS abys) -If exchange transfusion required, use type "O" cells and "AB" plasma (rare)

Donors who have tested positive for syphilis are deferred for what period of time?

1 year post diagnosis with documentation of treatment

Factors affect immunization and severity

1. Exposure 2. Host factors 3.Immunoglobulin class 4. Immunogenicity 5. The "ABO" Effect

Which genotypes result in A phenotype?

AO (heterozygous) or AA (homozygous)

Adsorption

Ab removed from sample by adding a target Ag and allowing the Ab to bind to the Ag

Kernicterus

Accumulation of bili in brain: can cause permanent brain damage

Vaccination & Contracting a disease

Acquired immunity can result from:

An antibody demonstrates weak reactivity at the AHG phase when using a tube method with no enhancement reagent and monospecific anti-IgG AHG reagent. When repeating the test, which of the following actions may increase the strength of the positive reactions?

Adding an enhancement reagent, such as LISS or PEG

Which of the following nitrogenous bases make up DNA

Adenine, cytosine, guanine ,thymine

What is the minimum hemoglobin level for a potential AUTOlogous donor?

11 g/dL Hct >=33%

Solid phase antibody screening is based on

Adherence

Min weight for homologous blood donation

110 lbs/ 50kg

In what year did the FDA take over biologics regulation?

1972

A crossmatch for 2 units is received for a patient with anti-E and anti-c, the calculation would be:

2/(0.70 x 0.20)= 14.3 14 or 15 units would have to be Ag typed forE and c in order to find 2 units that are neg for both Ags.

What dose of RhIG would be appropriate for a D-negative woman who has had a miscarriage at 11 weeks gestation?

50ug

What is the maximum volume of blood that can be collected from a 110-lb donor, including samples for processing?

525mL

Chido/Rodgers Ag's: __ Chido Ag's, __ Rodgers Ag's, and the ___ Ag.

6 Chido, 2 Rodgers, and WH Ag

What is the lowest allowable pH for a platelet component at outdate?

6.2

Random donor platelets that have been leukoreduced must contain less than _____ leukocytes

8.3x10^5

Packed RBCs must have a final hematocrit of less than or equal to

80%

Frequency of e: __%

98%

__% of the population has Jk3

99%

To be used for enzyme immunoassay (EIA), an enzyme must exhibit:

A high degree of stability, Extreme specificity, Not be present in the antigen or antibody being tested...ALL OF THE ABOVE is correct

If an untransfused male has an unexpected alloantibody, what type of antibody must it be?

A naturally-occurring antibody. An untransfused male has not been exposed to foreign RBC antigens.

What type of antibody is anti-H?

A naturally-occurring cold antibody.

The first acceptable alternate blood group for transfusion to a group AB recipient is: A. Group A B. Group B C. Group O D. Bombay

A. Group A

The blood group and type that is given in an emergency release situation is: A. O neg packed cells B. O pos whole blood C. AB negative units D. ABO & Rh specific

A. O neg packed cells

Antibodies always considered clinically significant when found during a transfusion work-up include: A. anti-C & anti-Js (a) B. anti-Le (a) & anti-P1 C. anti-I and anti-P1 D. none of these

A. anti-C & anti-Js (a)

INTERPRETATION: A patient sample was drawn on a patient admitted on October 12th. A crossmatch was ordered on October 14th. The best course of action is: A. if sample under 72 hours old, new sample not needed B. Oct 12th sample okay, if antibody screen is negative C. sample is over 48 hrs old, so new sample is needed D. a new sample is needed for each crossmatch regardless

A. if sample under 72 hours old, new sample not needed

The abbreviated crossmatch procedure consists of: A. immediate spin with LISS B. immediate spin with albumin C. ISA, 37 C and AHG phase D. immediate spin with AHG

A. immediate spin with LISS

INTERPRETATION: If a group B packed cell unit is transfused into a Group O positive patient, the crossmatch will be: A. incompatible major side only B. incompatible minor side only C. compatible major & minor sides D. incompatible both major & minor

A. incompatible major side only

The single most important aspect of compatibility testing is: A. patient identification B. major crossmatch C. minor crossmatch D. antibody screen

A. patient identification

The presence of anti-I antibodies is/are associated with: A. primary atypical pneumonia B. hemolytic disease of newborn C. viral myelogenous leukemia D. Waldenstrom's macroglobulinemia

A. primary atypical pneumonia

Which of the following genotypes would explain RBCs typed as group A (LeA+b-)?

A/A Lele HH sese

Which of the following genotypes would explain RBCs types as group A Le(a+b-)? - A/O Lele HH Sese - A/A Lele HH sese - A/O LeLe hh SeSe - A/A LeLe hh sese

A/A Lele HH sese

A m individuals do not produce anti-__ in their sera.

A1

What blood group antigen reacts with Dolchos Biflorus

A1

Dolichos biflorus lectin will agglutinate cells of the ______

A1 subgroup

What ABO group contains the least amount of H substance?

A1B

Which of the following ABO blood groups contains the least amount of H substance?

A1B

Which of the following ABO blood groups contains the least amount of H substance?

A1B O>A2>B>>A2B>A1>AB

ABO discrepancies: Anti-A1 (suspected A2): test serum with ___ ____.

A2 cells

An ABO type on a patient gives the following reactions: Patient cell anti-A: 4+; anti-B: 4+; anti-A1: neg Patient serum A cell: 2+; B cell: neg This reaction may be seen in a patient who is

A2B with an anti-A1

An ABO type on a patient gives the following reactions: Patient Cells With Anti-A (4+) Anti-B (4+) Anti-A1 (neg) Patient Serum With A1 cells (2+) B cells (neg) The reactions above may be seen in a patient who is:

A2B with anti-A1

An ABO type on a patient gives the following reactions: Patient Cells With Anti-A (4+) Anti-B (4+) Patient Serum With A1 cells (neg) B cells (neg) What is the patient's blood type?

AB

AB

AB 4% caucasions 4% AA rare -A substance (++) -B substance (++) -H substance (+)

ABH (rbc) ABH(secretions)

AB Hh Sese

mother is AB, what are possible genotypes?

AB only

In paternity testing, which of the following systems is the first to be tested against samples drawn from the mother, alleged father, and child?

ABO

What substances are found in a group A secretor?

AH

What is the most common pattern of inheritance for blood group genes?

Autosomal codominant. The genes are inherited equally by males and females and they are always expressed. For example, if one inherits the A and B genes, both A and B antigens are detected on the RBCs.

Which blood groups are most likely to have anti-H?

A₁ and A₁B. (Bombays also have anti-H.)

RBC surface Ag for Type B (BB;BO) (phenotype)

B

Plasma Ab for Type bombay (hh) (phenotype)

B A H

What ABH substance would be found in the saliva of a group B secretor?

B and H

Which cells are involved in the production of antibodies?

B lymphocytes

MHC class II molecules are found only on __ ____, activated __ ___, ___, ___, and ___ cells.

B lymphocytes, activated T lymphocytes, macrophages, monocytes, and endothelial cells

What substances would be fond in the saliva of a group B secretor who also has Lele genes.

B, H, Le(a), Le(b)

In the antibody screen/panel procedure, without LISS, the incubation phase is: A. 5 - 10 mins at 37 C B. 15 - 60 mins @ 37 C C. 30 mins at room temp D. 30 mins at 4 C

B. 15 - 60 mins @ 37 C

Donor units may NOT be returned and reissued from the Blood Bank if the donor unit has NOT been refrigerated for more than: A. 5 mins B. 30 mins C. 12 hours D. 2 days

B. 30 mins

INTERPRETATION: The Maj S (major saline) and Maj A (major albumin) phase are positive, but the A/C (autocontrol) and antibody screen are negative. The most likely cause is: A. cold autoantibody B. ABO incompatibility C. warm allo antibody D. high incidence antibody

B. ABO incompatibility

If sensitized after a first time transfusion, antibody production to RBC antigen begins: A. by 7 - 10 days B. at about 5 days C. within 48 hours D. within 3 months

B. at about 5 days

The first step in the laboratory investigation of an incomplete crossmatch is: A. DAT on the pre-transfusion sample B. check paperwork/samples for clerical errors C. repeat ABO & Rh on patient donor D. AB screen on post-transfusion samples

B. check paperwork/samples for clerical errors

The purpose of including an autocontrol (A/C) with the crossmatch is to: A. confirm the ABO group and Rh type of the patient B. detect autoantibodies against antigen on red cells C. detect an antibody not detectable in patient's serum D. demonstrate previously undetected alloantibodies

B. detect autoantibodies against antigen on red cells

The main difference between the fetus and the newborn is

Bilirubin metabolism

The main difference between the fetus and the newborn is:

Bilirubin metabolism.

Neutralization-Inhibition

Binding Ab to specific Ag substance to inhibit reactivity of Ab

A donor has the following genotype: LE(a-b-), Fy(a-b-), Js(a+b+). What is the most likely race of this donor?

Black

What does the hh genotype refer to?

Bombay

anti-A, anti-B, A1 cells, B cells, O cells 0 0 4+ 4+ 0 could be: resolve this:

Bombay (Oh) phenotype use anti-H lectin; test Oh cells; send to reference lab

How is anti-A₁ usually discovered?

By an ABO discrepancy in which there is an unexpected agglutination of A₁ cells in the reverse grouping of a group A.

Rh2

C

The usual concentration of albumin used in the tube method for antibody screen/panel procedure is: A. 2 - 3% B. 5 - 10% C. 22% D. 0.85%

C. 22%

Antibodies to antigens in which of the following blood groups are known for showing dosage? - I - P - Kidd - Lutheran

Kidd (Jka and b)

INTERPRETATION: A patient has a negative allo antibody screen, and one of two units crossmatched is incompatible. This excludes: A. a misgrouped donor unit of blood B. antibody to donor unit preservative C. antibody to low frequency antigen D. anti-A1 to A2 or A2B recipient

C. antibody to low frequency antigen

The anti-P1 antibody is usually detected: A. in the albumin phase B. after 37 C incubation C. at room temp or below D. after addition of AHG

C. at room temp or below

INTERPRETATION: On a transfusion reaction work-up, the major crossmatch and autocontrol are positive, and the antibody screen is negative. The most likely cause is: A. low incidence antibody B. high incidence antibody C. cold auto-antibody D. ABO incompatibility

C. cold auto-antibody

The antihuman globulin (AHG) reagent can be neutralized by the presence of: A. bacterial contamination B. physiological saline C. human serum protein D. non-protein hormones

C. human serum protein

____ antibodies and anti-__ and anti-__ are associated with delayed transfusion reactions.

Kidd; Fy a and Fy b

The major crossmatch consists of a mixture of: A. donor serum and patient red cells B. donor serum and donor red cells C. patient serum and donor red cells D. patient serum and patient red cells

C. patient serum and donor red cells

The purpose of the major crossmatch is to: A. prevent transfusion of units with autoantibodies B. allow transfusion of Rh pos to Rh neg patients C. prevent transfusion of ABO incompatible blood D. detects units with a drug-induced hemolytic anemia

C. prevent transfusion of ABO incompatible blood

What quantitative test is performed when the rosette test for fetal maternal hemorrhage is positive?

Kleihauer-Betke

Which of the following is a method for determining approximate volume of fetal maternal bleed?

Kleihauer-Betke test

An example of a high incidence antigen would be:

Kpb

List several high incidence blood group antigens.

Kpb, k, Jsb, Lub, I, Vel, Coa, and U. These antigens are found in more than 99% of the population.

Kell glycoprotein is linked to ___ by a single disulfide bond.

Kx

When Kell Ag's are denatured with AET or DTT, ___ expression increases.

Kx

A variety of cell types express surface membrane glycoproteins that react with one or more of the fragments of _______ produced degradation

C1

Which of the following is known as the "recognition unit" in the classical complement pathway?

C1

An example of a technical error that can result in ABO discrepancy is

Cell suspension that is too heavy

An example of a technical error that can result in an ABO discrepancy is:

Cell suspension that is too heavy.

Which complement pathway is activated by the formation of ag-ab complexes?

Classical

Colton system Ag's: ___ and ___ (antithetical), and ___ (high-incidence.)

Co a and Co b (antithetical), and Co3 (high-incidence)

How are the Rh antigens inherited?

Codominant alleles

The prewarm technique is most useful in investigating which type of blood bank problems?

Cold antibodies

In which of the following is the DAT reactive with anti-C3d only?

Cold hemagglutinin disease

What might cause a positive direct antiglobulin test with a negative eluate?

Complement or drugs

Polyethylene glycol enhances antigen-antibody reactions by:

Concentrating antibody by removing water.

Which Rh phenotype has the strongest expression of D?

D-- (exalted D)

B antigen

D-glactose

What is the Lewis genotype of most newborns?

Le (a-b-), because the antigens are not absorbed onto the RBCs until after birth.

In what way do the Lewis antigens change during pregnancy?

Le(a) and Le(b) both decrease

In what ways do Lewis antigens change in pregnancy?

Le(a) and Le(b) both decrease

An individual from Bombay who has inherited the Le gene will have a phenotype of

Le(a+b-)

Which of the following terms is defined as the removal of WBCs with the return of RBCs, plasma and plts?

Leukapheresi

Which of the following term is defined as the removal of white blood cells with the return of red blood cells, plasma, and platelets?

Leukapheresis

What is the most efficient way to remove leukocytes from red blood cell units?

Leukoreduction filters

Which alloantibodies may react in any phase of testing?

Lewis

How is the Lewis system related to the ABO system?

Lewis antigens and ABO antigens are derived from the same precursor (H substances).

IgM class Ab

Lewis, Lua, I, P, MN

Chemiliminescence refers to:

Light Emitted, and A Chemical Reaction (Both A and C)

____ ____ = occurrence of HLA genes more frequently in the same haplotype than would be expected by chance alone.

Linkage disequilibrium

Vaccines are divided and classified into which category?

Live, attenuated and Non-Replicating

When a new assay is implemented, what measure is taken to determine equivalency?

Lot to lot testing of new and old lot numbers of reagent

Lu_ is high frequency.

Lu b

A patient with group A blood type may be transfused with: A. group AB packed cells B. group B packed cells C. group O whole blood D. group O packed cells

D. group O packed cells

Which of the following tests is not available for both the gel testing method and solid phase technology?

DAT

R1

DCe

Rh0rh'hr" = _ _ _

DCe

An individual has the following Rh phenotype: D+C+E+c+e+. Using Fishcer Race terminolgy, what is there most likely phenotype?

DCe/DcE Weiner: R1R2 *Most common: R1r (DCe, dce)

R1r

DCe/dce

Which of the following genotypes would demonstrate the strongest expression of D antigen?

DCe/dce

What is the recommended treatment for mild von willebrand's disease?

DDAVP

The null Ko RBC can be artifically prepared by which of the following treatments?

DTT and glycine acid EDTA

Rh0hr'hr" = _ _ _

DcE

R2R2

DcE/DcE

R2r

DcE/dce

R0

Dce

Which of the following is characteristic of iron overload

Delayed, nonimmune complication Chelating agents are used Multiorgan damage may occur

Monoclonal anti-C3d is:

Derived from one clone of plasma cells.

A central concept of serologic testing is:

Determination of antigen titer

HDFN is characterized by

Different RBC antigens between mother and father

HDFN is characterized by:

Different RBC antigens between mother and father.

Multi-Determinant

Different epitopes present on one Antigen

A woman without prenatal care delivers a healthy term infant. A cord blood sample shows the infant is A-positive with a positive DAT. The workup of the unexpected finding should include:

Direct antiglobulin testing of the mother's specimen.

Why was the minor crossmatch discountinued?

Donor screening for antibody was incorported into donor processing

What technology is used to demonstrate the presence of allelic variants of red blood cell enzymes and serum proteins?

Electrophoresis

What characteristic differentiates Ss antigens from MN antigens?

Enzyme degradation

Select the term that describes the unique confirmation of the antigen that allows recognition by a corresponding antibody

Epitope

How often can a blood donor donate whole blood?

Every 8 weeks

T/F: Vel does NOT bind complement.

F

Which of the following is NOT a function of the hospital transfusion committee?

FDA certification

Prothrombin complex concentrates are used to treat

Factor IX deficiency

Which of the following is not an indication for fresh frozen plasma (FFP) transfusion?

Factor VIII deficiency

Fetomaternal bleeding

Fetal RBCs enter mom's circulation: -trauma to abdomen, aminocentesis, during birth, etc. -maternal abys are formed against foreign fetal red cell ags- on baby's cells (inherited from father)

The coagulation factors that are found in cryoprecipitate are:

Fibrinogen, factor VIII, VonWillebrand

Explain the correct way to examine a tube for signs of an antigen-antibody reaction.

Following centrifugation, the tube should be gently shaken or tilted until the cell button is completely dispersed. The manner in which cells come off the button should be observed. An optical aid, such as an agglutination viewer with a light and a magnifying mirror, should be used.

Which of the following statements concerning equipment is true?

Frequency of testing is determined by manufacturer recommendations.

Which of the following blood products has the longest expiration date?

Frozen Red Blood Cells

Fy (a-b-) in blacks: express ____ in tissue but not on RBC => no anti-___.

Fy b in tissue => no anti-Fy b.

Which of the following Duffy phenotypes is prevalent in blacks but virtually nonexistent in whites?

Fy(a-b-)

Which of the following Duffy phenotypes is prevalent in blacks but vitually non-existent in whites?

Fy(a-b-)

Which of the following can be given to an apheresis donor to increase the number of circulating granulocytes?

G-CSF

Polymorphisms in the HLA locus arise primarily through what type of genetic event?

Gene conversion

Meiosis is necessary to

Generate new DNA sequences in daughter cells

Which of the following statements best describes mitosis

Genetic material is duplicated, equally divided between two daughter cells

What additive is used to freeze blood for long term storage at -65˚C?

Glycerol

Which part of quality assurance ensures that products are consistently manufactured according to, and controlled by, the quality standards appropriate for their intended use?

Good manufacturing practices

Which is not an FDA approved test for quality control of platelets? - BacT/ALERT - eBDS - Gram stain - Pan Genera Detection (PGD) test

Gram stain

The specific product used for treating sepsis is the:

Granulocyte

Which cell type is densest in the white blood cell layer when anticoagulated blood is centrifuged?

Granulocyte

Anti Le(bH) will not react or will react more weakly with which group of RBCs?

Group A1Le(b+)

Which cells contain the most H substance?

Group O

What substances would be found in the saliva of a group B secretor who also has Lele genes?

H, B, Le(a), Le(b)

In an individual infected with hepatitis B virus, which of the following is detected first?

HBsAg

A positive DAT may be found in which of the following situations

HDN

A positive DAT may be found in which of the following situations?

HDN

A positive DAT may be found in which of the following situations? - a weak D positive patient - a patient with anti-K - HDN - an incompatible crossmatch

HDN

anti-Co3 is associated with severe ____.

HDN

Duffy Ab's can cause ____ and ____.

HDN and HTR

Kell Ab's can cause ____,____, ____ and ____ ____.

HDN, HTR, stillbirth, and fetal anemia.

MHC class II codes for HLA-__, HLA-__, and HLA-__.

HLA-DR, HLA-DP, and HLA-DQ

When RBCs are stored there is a "shift to the left". This means:

Hemoglobin oxygen affinity INCREASES, owing to a DECREASE in 2,3-DPG

Which of the following is an indication for immunoglobuin administration?

Hepatitis A

Which IgG antibodies are contained in polyspecific AHG?

High titer, high avidity

What is the most common clinical manifestation of ABO HDFN?

Hyperbilirubinemi

Which statement best describes the relationship between a crossmatch and a compatibility test?

If a compatibility test were a pie, a crossmatch would be a slice

Rh Immunoglobulin

IgG -crossing placenta key for HDFN

anti-Lu b is Ig__.

IgG (=> can cause mild HDN)

What does broad spectrum antihuman globulin detect?

IgG and C3d

Which antibodies can cross the placenta and cause hemolytic disease of the newborn?

IgG antibodies such as Rh, Kell, Duffy, and Kidd.

Most clinically significant blood group antibodies are of which IgG subclasses?

IgG1 and IgG3

"Complete" agglutinins that agglutinate red blood cells in saline are of which immunoglobulin class?

IgM

Anti-A from a group B individual is primarily what class of immunoglobulin?

IgM

The major immunoglobulin class of anti-B in a group A individual is

IgM

Vel is Ig__

IgM

In what circumstance would it be feasible to transfuse Rh-positive blood to an Rh-negative individual?

In an elderly woman

IAT

In-Vitro sensitization Titration of antibodies Detects ABO phenotype Detection of incomplete antibodies

In blood bank records, what must be recorded in addition to the degree of reactivity in all phases of testing?

Interpretation of the reactions; Identity of the person who performed the tests; Date of the testing;

M-protein

Is a major virulence factor of Streptococcus pyogenes

What is an advantage of using chemically modified anti-D?

It provides a low-protein medium

How does the acquired B antigen usually react?

It typically agglutinates strongly with anti-A and weakly with anti-B and the serum contains strong anti-B.

Majority of whites and Asians (50%) are Jk (a_b_)

Jk (a+b+)

Mice with compromised immune systems are still capable of graft rejection due to what proteins?

KIR (Killer Cell Immunoglobulin like Receptor)

Which patient does NOT need an irradiated component

Adult receiving RBC transfusion Does need: - bone marrow transplant recip - neonate weighing less than 1,200g - adult receiving an RBC transfusion from a blood relative

Which one the following properties of antibodies is NOT dependent on the structure of the heavy chain constant region? - ability to cross placenta - isotype (class) - ability to fix complement - affinity for antigen

Affinity for antigen

AO Hh Sese

Ag on red cells= A and H Ag expression in saliva+ A and H

Group II discrepancies: weakly reactive or missing ___.

Ag's

Cold Agglutinins

Agglutinating Antibodies at 4 degrees C

Cold Agglutinins

Agglutinating antibodies at 4 °C

With agglutination inhibition in pregnancy testing, a negative result is evidenced by:

Agglutination

What are two visible signs of an antigen-antibody reaction in blood bank testing?

Agglutination and hemolysis.

Hemagglunination

Agglutination of Red Blood Cells

Hemagglutination

Agglutination of red blood cells

CHEMILUMINESCENT ENZYME LABELS OFTEN USED IN INDIRECT PROCEDURES ARE:

Alkaline phosphatase, Horeseradish peroxidase, Beta-glactosidase...ALL OF THE ABOVE is correct

Why is determination of Rh status crucial for obstetric patients?

All Rh-negative mothers are possible candidates for Rh immune globulin

Which cells are agglutinated by anti-I?

All adult cells, with the exception of the rare i adult cell.

Uni-determinant

All epitopes on one antigen are the same

Bone marrow transplants and peripheral blood stem cell transplantation (PBSCT) are most commonly used in the treatment of which of the following diseases?

All of the above

Fresh frozen plasma (FFP) is not the optimal product for replacement fluids for a therapeutic plasma exchange procedure. For which patient is FFP the optimal product of choice?

All of the above

HLA testing is useful in what other area of study?

All of the above

In the Fisher-Race nomenclature what does "d" refer to?

All of the above

Infection with which organism is associated with naturally occurring IgM anti-K

All of the above

What clinical manifestation may be associated with the Rh-null syndrome?

All of the above

What is a disadvantage of choosing fresh frozen plasma for fluid replacement in persons undergoing therapeutic plasmapheresis?

All of the above

What is the purpose of Coombs' control cells?

All of the above

Where are ABH substances detected in secretors?

All of the above

Which of the following factors are likely to cause false-positive results while using gel technology?

All of the above

Which of the following might lead to unacceptable quality control results?

All of the above

Which of the following types of blood should be transfused if necessary prior to a patient receiving a hematopoietic progenitor cell transplant?

All of the above

how can the ABO and Rh of the fetus be determined in utero?

All of the above Amniocentesis Chorionic villus sampling Percutaneous umbilical cord sampling

In the Fisher-Rache nomenclature what does "d" refer to?

All of the above Amorph Absence of D Silent allele

Why was anticomplement introduced into AHG sera?

All of the above Certain clinically significant antibodies demonstrate completement activity Complement components enhance Kell antibodies It provides additional information for transfusion reaction workups

What type of globulin does the antiglobulin test detect?

All of the above IgG alloantibodies C3b complement components IgG autoantibodies

Explain the "cross-out" or "rule-out" method red cell panel interpretation.

All of the antigens found on cells that did not agglutinate in any phase of testing are crossed off the top of the antigram. The antibody is directed against one or more of the antigens that remain. Sometimes antibodies can be rules out based on their usual phase of reactivity.

Interpretation: Ab screen= Pos Auto-control= Neg

Alloantibody

Given the following results, what is the probably cause of a positive reaction in the major crossmatch? IS= 0 37 = 0 AHG = 2+ CC= ND Autocontrol = neg

Alloantibody in patient serum reacting with antigen on donor cells

What is the term for recognition of two or more antigens by the same antibody?

Ambiguity

______ type Rh null syndrome: mutation in each of the RHCE genes and a deletion of the RHD gene. Normal RHAG gene.

Amorphic

In HLA nomenclature, the letter N indicates what type of allele?

An allele with no reaction to antibody

Recipient serum that reacted with one out of five donor units in the AHG phase and where the antibody screen was negative is probably due to

An alloantibody directed against a low frequency antigen

What is an alloantibody?

An antibody to a foreign antigen from someone from the same species.

HDFN before birth (prenatal)

Anemia (hemolytic disease of RBCs) Heart failure Fetal Death

Human Leukocyte Antigen

Another name for the major histocompatibility complex (MHC) in humans is:

An antibody reacted with untreated RBCs and DTT treated RBCs but not with ficin treated RBCs. Which of the following antibodies could explain this pattern of reactivity?

Anti-Ch

Ab's formerly HTLAs: Anti-__, anti-__, anti-__, anti-__, anti-__, anti-__, anti-__, and anti-__.

Anti-Ch , anti-Rg, anti-Kn,anti-McC, anti-Yk a, anti-Sl, anti-Cs a, and anti-JMH. (Focus on Chido and Rodgers)

Anti-Fy_ and anti-Fy_ are clinically significant.

Anti-Fy a and anti-Fy b.

Which alloantibodies react best at room temperature?

Anti-M, N, and P₁

Which of the following antibodies would most likely be encountered in an untransfused male: Anti-D, and anti-Jk_a, anti-K, or anti-M?

Anti-M. An untransfused male will only have naturally-occurring antibodies. Anti-M is usually naturally-occurring: the others are immune antibodies.

Which of the following antibodies does NOT match the others in terms of optimal reactive temp? Anti-Fya, Anti-JKb, Anti-Xga, Anti-N

Anti-N

Which autoantibody specificity is found in patients with PCH?

Anti-P

Which autoantibody specificity is found in patients with paroxysmal cold hemoglobulinuria (PCH)?

Anti-P

Which of the following has been associated with causing severe immediate HTRs?

Anti-Vel

Why is reverse grouping not performed on cord blood specimens?

Antibodies are generally not present at birth.

Which antibodies cause in vitro hemolysis?

Antibodies in the ABO, Lewis, and Kidd systems, anti-Vel, and rarely anti-P₁

Rh reaction phase

Antiglobulin -IgG -have to add enhancement -do incubation phase -takes more for us to bring together these Ab

A 35-year-old woman was transfused with 1 unit of packed red blood cells. The nurse monitoring the transfusion noticed hives on the patient's arm and an increase in body temperature. What is the choice of treatment for this patient?

Antihistamines

Which cell is invaded by the HIV viruses?

Lymphocyte

Anti-U will not react with which of the following RBCs?

M+N-S-s-

Kx is not found in the _____ phenotype.

McLeod

Weakened expression of the Kell Ag's is seen in _____ phenotype.

McLeod

Interferons

Mediate the early immune response to viral infections

Why are antibodies to high-frequency antigens, such as cellano (k), rarely seen in patient samples?

Most persons are not antigenically stimulated to produce the antibody, because their red blood cells are positive for the antigen

RhIG is indicated in which of the following circumstances

Mother D negative, infant D positive

RhIG is indicated for:

Mothers who are Rh-negative.

ABO Ab

Natural -have at birth due to bacteria closely resembling Ab

Flocculation

Natural clumping

An advantage of enzyme immunoassay (EIA) compared to radioimmunoassay (RIA) is:

No radioactive hazardous waste

A woman received a transfusion of packed RBCs while delivering her baby. Six months later she wanted to donate a unit of blood back to the American Red Cross. If the woman meets all the other criteria for donation, is she allowed to donate at this time?

No, she needs to wait 6 more months

Four units of packed RBCs were used in the operating room at 3pm. Can the remaining 2 units be returned to the blood bank at 5pm?

No, units have been out of the blood bank for longer than 30 mins

Why must there be alpha designations in the Rosenfield system?

Nomenclature applies to other blood group systems beside Rh

An ABO type on a patient give the following reaction: Patient cell anti-A: 4+; anti-B: neg Patient serum A1 cells: 2+; B cells: 4+; O cells: 2+ Autocontrol: neg These results are most likely due to

Non-ABO alloantibody

____ of the Chido/Rodgers Ag's are antithetical.

None

What alternative type can be given to an O-positive person when group O blood is not available?

None of the above

What is found in secretions of Le(a-b-) individuals?

None of the above

Which of the following is not an enhancement media that may be used in antibody screening and indentification? - Albumin - LISS - Normal saline - Polyethylene glycol

Normal saline

Acute phase reactants are defined as:

Normal serum constituents that increase rapidly in response to inflammation

Albumin should not be given for:

Nutrition

A 4-unit crossmatch is ordered on a patient for emergency surgery. The patient's blood type is group B-positive. The blood bank inventory only contains two B positive packed cells. What other type is ABO compatible with this patient?

O-negative

What type of blood must be given in an intrauterine transfusion if the blood type of the fetus is unknown?

O-negative

How often must controls be run on infrequently used antisera?

On the day of use.

When compliment proteins such as C4 or C3 are cleaved, what is the term applied to the fragment deposited on the cell membrane?

Opsonin

Molecles that promote the uptake of bacteria phagocytosis are:

Opsonins

Activities of C5a include all of the following except

Opsonization

Which of the following most commonly causes an individual to type RhD positive yet possess anti-D?

Partial D

When detecting and/or identifying Abs, test _________ (unknown) with __________ (known)

Patient serum Reagent RBC's

Structure of IgM

Pentamer - bigger

Streptococcus pyogenes is the most common causative agent of:

Pharyngitis

When a person is said to be Group A, it refers to the person's:

Phenotype

What is the final step in antibody identification? if the patient has not been transfused

Phenotype patient's RBCs for corresponding antigen

Which of the following treatments uses ultraviolet light to treat hyperbilirubinemia after the infant is delivered?

Phototherapy

Fy (a-b-) RBCs resist infection with _____ _____.

Plasmodium vivax

During an antiglobulin crossmatch, the cells had a jagged edge appreaance after the addition of AHG and centrifugation. This indicates a(n) _________ result

Positive

For which of the following transfusion candidates would CMV negative blood be most likely indicated?

Pregnant women

Antibody serial titration studies are most often associated with which of the following blood bank test groupings?

Prenatal evaluation

What does the "R" represent in Rh-Hr terminology?

Presence of D antigen

Leukocyte-reduced filters can do all of the following except:

Prevent TA-GVHD

Autoanti-I was identified in a patient transfused 1 month ago. Which technique is advocated to detect alloantibodies in this patient?

Prewarming

What is the most likely cause of the following ABO grouping result?<br> Anti-A: 0<br> Anti-B: 0<br> A₁ cells: 0<br> B cells: 0

Probably a group O with missing isoagglutinins. The reverse grouping tubes should be incubated at room temperature for 15-30 minutes. If there is still no reaction the tubes should be incubated at 4°C for 15-30 minutes along with an autocontrol and antibody screen. The auto control would detect false positive reactions due to non-specific cold aggultinins and the screening cells would detect cold alloantibodies.

Most common Rh phenotype in whites: ____.

R1r (DCe/dce)

DCEe

R2R1 Rzr',R1ry

In what department of the blood bank laboratory is knowledge of patient diagnosis, drug history, age, and transfusion history most important?

Reference laboratory

In which blood group systems are antibodies usually immune?

Rh, Kell, Duffy, and Kidd.

Wiener

Rh-Hr terminology -major Ag -Rh0,Rh1,Rh2,Rhz,rh,rh',rh",rhy proposed that 1 gene produced an agglutinogen (Rh0...) that then produced at least 3 factors (Rh0...) then the Rh factor is on the surface of the red cell

A 35-year-old man w/ von Willebrand's disease has an acute Nosebleed & a hemoglobin level of 9.9gm/mL. What blood component is the MOST appropriate choice for transfusion to this patient. Cryoprecipitated AHF The test for weak D is performed by incubating a patient's red cells with: Definition: anti-D serum followed by washing and antiglobulin serum The most effective component to treat a patient w/ fibrinoen deficiency is: Definition: Cryoprecipitated AHF A patient is typed as group O,Rh-pos & crossmatched w/ 6 units fo blood. At the indirect antiglobulin (IAT) phase of testing, both antibody screening cells & 2 crossmatched units are incompatible. What is the most likely cause of the incompatibility? Definition: recipient alloantibody According to the AABB standards, what is the minimum pH required for platelets? Definition: 6 Which of the following antigens in MOST likey to be involved in hemolytic disease of the newborn? Lea, P1, M or Kell Definition: Kell The most frequent transfusion-associated disease complication of blood transfusions is: Definition: hepatitis A blood component used in the trreatment of hemophilia A is: Definition: Factor VIII concentrate Mixed-field sgglutination athe the anti-human globulin phase of a crossmatch may be attributed to: Definition: an antibody such as antiSda a Pt is group A2B POS & has an antiglobulin-reacting anti-A1 in his serum. He is bleeding profusely in the OR & group A2B RBC's are NOT available. What type of blood should be given as a 1st choice? Definition: B, Rh-positive Although ABO compatibility is prefered, ABO incompatible product may be administered when transfusing: Definition: cryoprecipitated AH the purpose of a low-dose irradiation of blood components is to: Definition: prevent graft-vs-host (GVH) disease What blood component is the best source of Factor IX? Definition: Prothronbin complex Which plateletpheresis priduct should be irradiated? Definition: a directed donation given by a mother for her son An antibody that causes in vitro hemolysis ans reacts with the red cells of three of ten crossmatched donor units is most likely: Definition: anti-Lea'' What is a characteristic of polyagglutinable red cells? Definition: are agglutinated by most adult sera Anti-I usually results in a positive direct antiglobulin test (DAT) because of: Definition: C3d bound to the red cells Mixed field agglutination encountered in ABO grouping would most likely be due to: Definition: A3 red cells An Rh-positive patient's serum is known to contain anti-LW. Red Blood Cells selected for crossmatch should be from what genotype? Definition: rr During storage, the concentration of 2,3-diphosphoglycerate (2,3-DPG) decreases in a unit of: Definition: Red Blood Cells The purpose of testing with anti-A,B is to detect: Definition: subgroups of A Fever and chills are symptoms fo what transfusion reaction? Definition: febrile which of the following HTLA antibodies is considered to be most clinically significant? anti-Yta, anti-Ch, anti-Yk, or anti-Cs Definition: anti-Yta which of the following hemolytic disease of the fetus and newborn is most likely to occur in a first born child? ABO HDFN The optimum storage temperature for Platelets is: Definition: 22 degrees C A unit of FFP was inadvertently thawed and then immediately refrigerated at 4 degrees C on Monday morning. On Tuesday evening this unit may still be transfused as a replacement for: Definition: Factor IX A group B, Rh-negative patient is shock from acute blood loss would benefit most from a transfusion: Definition: group B, Rh-negative Whole Blood the purpose of irradiating a packed red blood cell for an infant is to? prevent graft vs host disease Pretransfusion compatibility testing must include: Definition: antibody screening by antiglobulin test Transfusion of what is needed to help correct hypofibrinogenemia due to DIC? Definition: Cryoprecipitated AHF Mixed field reactions with anti-A and antiA,B and negative reactions with anti-B and anti-A1 lectin(Dolichos biflorus) are observed. Without further testing, the most likely conclusion is that the patient is group: Definition: A3 What is correct storage temperature for Fresh Frozen Plasma? Definition: -20 degrees C The quality assurance program for RBCs, Deglycerolized should include regularly scheduled monitoring to determine: Definition: acceptable glycerol removal What is an immediate non immunologic adverse effect of a transfusion? Definition: congestive heart failure Cells of the A3 subgroup will: Definition: give a mixed field reaction with anti-A,B As a preventive measure against graft-versus-host disease, red blood cells prepared for infants who have received intrauterine transfusions should be: Definition: irradiated An obstetrical patient has had 3 previous pregnancies. Her 1st baby was healthy, the 2nd was jaundiced at birth and required an exchange transfusion, while the 3rd was stillborn. Which os the following is the most likely cause? Definition: Rh incompatibility Anti-Fya is: Definition: capable of causing hemolytic transfusion reactions The enzyme responsible for conferring H activity on the red cell membrane is alpha-: Definition: glucosyl transferase Platelet transfusions are of most value in treating: Definition: functional platelet abnormalities What blood component must be prepared w/i 8 hours after phlebotomy? Definition: Fresh Frozen Plasma What represents an acceptably identified patient for sample collection and transfusion? Definition: A handwritten band with patient's mane and hospital identification number is affixed to tha patient's leg. the antibody in the Lutheran system that is best detected at lower temeratures is: Definition: anti-Lua Which would most likely be responsible for an incompatible major crossmatch? recipient's RBCs posses a low-frequency antigen, anti-K antibody in donor serum, recipient's RBCs are polyagglutinable, donor RBCs have a positive DAT Definition: Donor red calls have a positive direct antiglobulin test (DAT) the most serious transfusion reactions are due to incompatibility in which of the following blood group systems? Definition: ABO In an emergency situation, Rh-negative red cells are transfused into ans Rh-positive person of the genotype CDe/CDe. The first antibody MOST likely to develope is: Definition: anti-c The oprimum storage temperature for Red Blood Cells, Frozen is: Definition: -80 degrees C What situation could result in an ABO discrepancy that is caused by problems with the patient's red cells? Definition: Tn activation The major crossmatch will detect a(n): Definition: reciepient antibody directed against antigens on the donor red cells The optimum storae temperature for Whole Blood is: Definition: 4 degrees C A patient who is group AB, Rh-negative needs 2 units of Fresh Frozen Plasma. Which units of pf plasma would be MOST acceptable for transfusion? Definition: group AB, Rh-positive Which of the following antigens gives enhanced reactions with its corresponding antibody following treatment of the red cells with proteolytic enzymes? Definition: E Under extreme emergency conditions when there is no time to determine ABO group for transfusion, the technologist should: Definition: release O, Rh-negative red blood cells irradiation of a unit of red Blood Cells is done to prevent the replication of donor: Definition: lymphocytes Which of the following immunoglobulins is present in the highest concentration in normal human serum? IgM, IgG, IgA or IgE Definition: IgG Washed RBCs would be the product of choice for a patient with: Definition: anti-IgA antibodies Severe intravascular hemolysis is most likely caused by antibodies of which blood group system? Definition: ABO current testing on all donor blood must include serological test for: Definition: syphilis What unit should be selected for exchange transfusion if the newborn is group A, Rh-positive and the mother is group A, Rh-positive with anti-c? Definition: A, CDe/CDe In performing an antibody screening test and/or compatibility test, the use of a patient's specimen collected in an EDTA tube will: Definition: prevent the setection of compliment-dependent antibodies

Rh-immune globulin is requested for an Rh-negative mother who has the following results: Mothers postpartum sample D=0, D control=0, Du=1+mixed field, Du control =0. What is the most likely explanation? Mother has a fetomaternal hemorrhage of D+ cells. Even in the absence of prior transfusion or, individuals with the Bombay pheno-type (Oh) will always have naturally occurring: Definition: anti-H Useof EDTA plasma prevents activation of the classical complement pathway by: Definition: chelating C++ ions, which prevents assembly of C1 In the autoadsorption procedure for the removal of cold agglutinins from plasma, pretreatment of the patient's red cells with what reagent is helpful? Definition: ficin A blood specimen fron a pregnant woman is found to be group B, Rh-ne & the serum contains anti-D with a titer of 512. What would be the most appropriate type of blood to have available for a possible exchange transfusion for her infant? Definition: O, Rh-negative When evaluating a suspected transfusion reaction, what is the ideal sample collection time for a bilirubin determination? Definition: 6 hours posttransfusion Which of the following blood group systems is most commonly associated with delayed hemolytic transfusion reactions? Lewis, Kidd, MNS, or I Definition: Kidd A patient in the immediate post-bone marrow transplant period has a hematocrit of 21%. The red cell product of choice for this patient would be: Definition: irradiated the antibodies of the kidd blood group system react best by: Definition: the indirect antiglobulin test What test is most commonly used to demonstrate antibodies that have become attached to a patient's red cells in vivo? Definition: direct antiglobulin 4 units of blood are needed for elective surgery. The patient's serum contains anti-C, anti-e, anti-Fya, and anti-Jkb. Which would be the best source of donor blood? Definition: autologous donations If the seal is entered on a unit of Whole Blood stored at 1-6 degrees C, What is the maximum allowable storage period, in hours? Definition: 24 hours Which of the following Rh antigens has the highest frequency in Caucasians? D, E, c, or e Definition: e How many units of RBC's are required to raise the hematocrit of a 70-kg non-bleeding man from 24 to30%? Definition: 2 Blood selected for exchange transfusion must: Definition: lack red blood cell antigens corresponding to maternal antibodies In a delayed transfusion reaction, the causative antibody is generally too weak to e dected in routine compatibility testing and antibody screening tests but becomes detectable at what point after transfusion? Definition: 1 to 5 days Isoimmunization to platelet antigen (P1^A1) and the placental transfer of maternal antibodies would be expected to cause newborn Definition: thrombocytopenia During the preparation of platelet concentrates from Whole Blood, the blood should be: Definition: kept at room temperature According to AABB standards, Fresh Frozen Plasma must be infused within what period of time following thawing? Definition: 24 hours while performing an antibody screen, a test reaction is observed that is suspected to be rouleaux. a saline replacement test is done and the reaction remains. What is the best interpretation? Definition: 'The original reaction was due to true agglutination. What is characteristic of Tn polyagglutinable red cells? Definition: If group O, they may appear to have acquired a group A antigen Whole Blood for exchange transfusion of a newborn with hemolytic disease due to ABO incompatibility should be: Definition: group O with no hemolytic anti-A or Anti-B polyspecific reagents used in the direct antiglobulin test should have specificity for: Definition: IgG and C3d The optimum storage temperature for Cryoprecipitated AHF is: Definition: -20 degrees C Fresh frozen Plasma should be transfused within: Definition: 24 hours of thawing Anti-Sda is strongly suspected if: Definition: the agglutinates are mixed-field and refractile Which of the following red cell antigens are found on glycophorin-A? M and N, Lea ad Leb, S and s, P and P1 and Pk Definition: M and N Quality control tests must be performed daily on: Definition: reagent red blood cells the drug cephalosporin can cause a positive direct antiglobulin test by what mechanism? Definition: membrane modification The use of Red Blood Cells, Deglycerolized would ve most beneficial when transfusing a patient: Definition: who is sensitized to platelet antigens What might cause a false-negative indirect antiglobulin test (IAT)? Definition: Too heavy a cell suspension What is the purpose of Acid Elution when testing for antibodies? used to remove warm-reactive IgG antibodies from RBCs; RBCs hemolyzed and antibodies salvaged in supernatant; citric acid, glycine, and digitonin acids can be used. What is the purpose of adding enzymes when testing for antibodies? Give some examples. Enzymes modify the RBC surface by removing sialic acid residues and denaturing or removing glycoproteins. This destroy certain antigens and enhance the expression of other antigens. The most commonly used enzyme is ficin. bromelin, papain, trypsin also used. Cold-reacting Antibodies (room temp or colder) Lewis, M, N, P1, Lua, I Antibodies that react optimally in the AHG phase Rh, Kell, Duffy, Kidd, Ss, Lub Antibodies causing in-vitro hemolysis anti-Lea, anti-Leb, anti-P1PPk, anti-Kidd, anti-Vel Antigens whose expression is enhanced by adding enzymes: ABH, Rh, Lea and Leb, Jka and Jkb, P1, I, some Kell Antigens that are destroyed by adding enzymes: M, N, S, Fya, Fyb, Fy6, Yta, Ch, Rg, Pr, JMH, Ge2, Xga REST absorption rabbit erythrocyte stroma (absorbs anti B).-- used to absorb cold reacting antibodies. What is the purpose of adding sulfhydryl reagents when testing for antibodies? sulfhydryl reagents destroy IgM (specifically by cleaving intersubunit disulfide bonds, thereby destroying antigens with folded disulfide bonds) Antibodies in which of the following blood group systems are "notorious" for escaping detection on an antibody screen and cause a severe delayed hemolytic transfusion reaction when antigen positive red blood cells are transfused to a patient? Kidd Why might some blood banking facilities prefer the use of monospecific IgG over polyspecific antihuman globulin (AHG) in their antibody screens? Interference from naturally occurring cold antibodies in patient sera is reduced What step in the antibody screen is known as the "sensitization phase"? 37 degrees C incubation A positive autocontrol in antibody detection procedures is usually indicative of a positive in what other test method? Positive DAT What might a positive antibody screen and a negative autocontrol indicate? An alloantibody has been detected Why should only homozygous cells be used to rule out an antibody? weakly reacting antibody may not react with heterozygous cells If you suspect anti-C is present in a patient's serum, and anti-Fya still has to be ruled out using other reagent cells, what would the phenotype of the rule out cell have to be? Fy (a+), C-, Fy (b-) Tests with what kind of AHG reagents (monospecifc, polyspecific) can determine if IgG, complement, or both are coating red blood cells? Monospecific(can use monospecific anti-C3b, anti-C3d, or anti-IgG to determine which component is coating RBCs) How can neutralization aid in the identification of multiple antibodies? Once antibody has been neutralized serum can be further tested in panel studies Why are antibodies to high-frequency antigens, such as cellano (k), rarely seen in patient samples? Most persons are not antigenically stimulated to produce the antibody because their red blood cells are positive for the antigen Which of the following high-frequency antigens do not cause in vivo red blood cell destruction when complexed with corresponding antibody?kJs(b)Ch(a)Lu(b) Ch(a) What is the purpose of treating serum containing cold autoantibodies with dithiothreitol (DTT) or 2-mercaptoethanol (2-ME)? to denature IgM cold autoantibody and test serum for presence of IgG alloantibody

Anti-LW will not react with which of the following?

Rhnull RBCs

How can rouleaux be differentiated from true agglutination?

Rouleaux appear as stacks of coins microscopically and can be dispersed by saline replacement.

Wiener nomenclature: ___ = DCE

Rz

Scianna (SC) system: ___ and ___ (antithetical); ___, and ___.

Sc1 and Sc2 (antithetical), Sc3, and Rd.

The antibody to this high prevalence antigen demonstrates MF agglutination that appears shint and refractile unter the microscope

Sd(a)

Immunoelectrophoresis (IEP) involves:

Separation of proteins based on the rate of migration of individual components in an electrical field, electrophoresis of serum or urine, Double immunodiffusion following electrophoresis ALL OF THE ABOVE is correct

Define SSOPH. Does it represent serological or nucleic acid-based HLA typing?

Sequence-specific oligonucleotide probe hybridization utilizes PCR-amplified DNA for HLA typing

In what circumstance is a plasmapheresis donor rejected from donation?

Serum protein = 5.0 g/dL

Transfusion reactions are classified according to

Signs pr symptoms presenting during or after 24 hours Immune or nonimmune Infectious or noninfectious

Why is it necessary to use single-donor screening cells instead of pooled screening cells for patient samples?

Single-donor screening cells are complementary among each other

Ten

The number of individual heavy chains found in a molecule of IgM is:

If an individual with a partial D expression is transfused with a normal Rh-positive unit of blood, a likely result will be:

The patient will form an antibody to the portion of Rh(D) protein that they are missing

*Length of incubation with the serum containing the antibody *amount of antigen conjugated to the carrier * pH All of the above is correct!!

The quality of agglutination or precipitation depends on:

Why is the Center for Biologics Evaluation and Research (CBER) notified in the case of a transfusion-related fatality?

To determine if appropriate corrective action has been taken to prevent recurrence

What is the purpose of a prelicense inspection by the CBER?

To determine the firm's ability to operate in compliance with applicable regulations

In the production of polyspecific AHG, why are IgG and complement antibodies absorbed with A1, B and O cells?

To remove heterospecific antibody

Agglutination

With agglutination inhibition in pregnancy testing, a NEGATIVE result is evidenced by:

RBC transfusions should be given:

Within 4 hours

When a male possesses a phenotypic trait that he passes to all his daughters and none of his sons, the trait is said to be

X-linked dominant

Mating of Xg (a+) man with Xg (a-) woman = all Xg (a+) ____ and Xg (a-) ____.

Xg (a+) daughters and Xg (a-) sons.

Rh Fully developed at birth

YES -watch HDFN

IgG agglutination in the antiglobulin phase?

YES- we can detect in the AHG phase of your Ab screen and Ab ID

IgG ability to cross the placenta

YES-can cross the placenta because it's a monomer and is pretty small but can cause RBC destruction

IgG activation of complement?

YES-not very efficient

IgG cause HDFN?

Yes - can cause hemolytic disease of the fetus and newborn

Convert from Weiner to Fischer Race and Rosenfield: a) R1r b) R2R0 c) RzR1 d) ryr

a) DCe/dce; 1, 2, -3, 4, 5 b) DcE/Dce; 1, -2, 3, 4, 5 c) DCE, DCe; 1, 2, 3, -4, 5 d) dCE, dce -1, 2, 3, 4, 5

Autocontrol negative

alloantibody (they had immune stimulation)

HLA system

ankylosing spondylitis, useful for paternity testing, organ transplantation

A3 subgroup

anti-A = mixed field anti-A,B = mixed field anti-H = 3+ anti-A1 = 0

A m RBCs are not agglutinated (or only weakly agglutinated) by anti-__ or anti-__.

anti-A or anti-A,B

hh

bombay! no detectable product-lack H Ag and ABO -CS -Type as Oh -pt serum contain anti-H -react with Anti-A,B and O cells (how we diff from O) -nonfunctional secretors BOMBAY IS CONFIRMED WITH: no reaction with Anti-H (lectin Ulex europaeus)

what would be the first thing to do with a group 1 discrepancy, after ruling out all clinical and technical errors

check patient history to see the age and whatever disease process they are in

The endpoint of the solid phase immunosorbent assay (ELISA) is

color change in substrate

The endpoint of the luminex assay is change of

color of indicator on the beads

Rh Null

compensated hemolytic anemia -stomatocytes -increased reticulocytes, Hgb F -slight decrease for hgb and hct

MHC class III codes for ____ factors and ___ ___ factor.

complement and tumor necrosis factor

____ ____ = antiserum directed against one HLA determinant reacts against other HLA antigenic determinants as well.

cross reactivity

anti-D can

cross the placenta -HDFN! -IgG

r'

dCe

hr'rh" = _ _ _

dcE

r"

dcE

what is the common use of performing an absorption in blood bank? removal of autoantibody from the patients serum/plasma. match the four common enzymes used in antibody identification with their source Hog stomach-trypsin papaya-papain Figs-ficin pineapple-bromelin

elution procedures may be used: -to confirm antibody specificity -in combination with adsorption procedures -in the investigation of hemolytic transfusion reactions -in preparing reagents *****aLL OF THE ABOVE match the antibodies with the source of soluble substances that neutralizes them? hydatid cyst fluid- Antip1 Saliva- AntLea Urine- Antisda Human milk- AntiI If a patient is refractory to platelets they? b and c only- do not show the expected increase in the platelet count following a transfusion. should be transfused with HLA matched platelets incomplete cleaning of donor venipuncture site could be a cause of bacterial contamination of donor unit. true fatal transfusion reactions are mostly caused by? clerical errors what component is most frequently involved with transfusion associated sepsis-platelets Sever intravascular hemolysis is most likely caused by antibodies of which blood group system? ABO Hives and itching are symptoms of which of the following transfusion reactions? Allergic when a patient may be suspected of having an acute hemolytic reaction the first thing that should be done is? stop the transfusion but keep the intravenous line open with saline the following steps are taken by the blood bank when investigating a transfusion reaction when the clinical signs are anything other than urticarial except? antigen typing which of the following blood bank test is used to identify a transfusion reaction? direct antiglobulin test which of the following transfusion reactions presents with a fever maculopapular rash watery diarrhea abdominal liver function and pancytopenia? transfusion associated graft vs host disease the following are all laboratory findings of an acute hemolytic transfusion reaction, except? increased haptoglobin a 65 year old female experienced shaking chills and a fever of 103F approximately 40 minutes following the transfusion of a second unit of packed red blood cells the most likely explanation for the patients symptoms is? severe febrile transfusion reaction the most common presenting symptom of an acute hemolytic transfusion reaction is? fever intravascular hemolysis which is red cell destruction occurs in the? blood vessels which of the following transfusion reactions have predominately respiratory symptoms? a,b,and c-trali, taco, anaphylactic reactions coughing cyanosis and difficulty breathing are symptoms of which of the following transfusion reactions? circulatory overload which type of hemolytic transfusion reaction is typically the result of red blood cells being removed by the RE system( liver and spleen) and can usually be attributed to blood groups other than ABO (kidd, fy, kell, ect..) *extravascular hemolytic transfusion reactions what is the usual cause of a febrile transfusion reaction? recipient antibody to donor leukocytes what is the treatment for an allergic transfusion reaction? antihistamine which of the following is characteristic of iron overload? all of the above- delayed nonimmune complications, chelating, organ damage. the two most common types of transfusion reactions are? allergic and febrile non hemolytic possible cause of non immunologic hemolysis during transfusion include? all of the above- bacterial,lysis,improper storage,fluid other than saline a temperature rise of 1c or more occurring in association with a transfusion is usually indicative of the which of the following transfusion reactions? Febrile the acceptable hemoglobin for a whole blood donation is 12.5% dl and a hematocrit of 38%? True the acceptable time interval between whole blood donations is? 56 days a father donating blood for his newborn is what type of donation? directed which of the following prospective donors would be accepted for donation? 22 year old college student who has a temperature of 99.2 F and states that he fells well but is nervous about donating. According to the AABB standards which of the following donors may be acceptable as a blood donor? spontaneous abortion at 2 months of pregnancy 3 months ago. a 35 year old female is donating blood for herself in the event she needs a blood transfusion during her surgery. this is known as what type of donation? Autologous a cause for permanent deferral of blood donations is? history of jaundice of uncertain cause the acceptable temperature for a blood donor is less than 37.5c? true a donor that has just returned from a visit to an endemic malarial region is deferred for how long? 1 year which of the following refers to a temporary deferral? donor received varicella zoster live attenuated vaccine the minimum weight for allogenic donations is 100 lbs? false why are donors deferred for a year following receipt of blood products? to permit adequate screening for transfusion acquired viral infections which of the following medications is on the permanent deferral list? growth hormone of human origin what is the acceptable range for the pulse rate of a donor? 50-100 bpm what is the purpose of the donor questionnaire? protect the donor and provide a blood component that will benefit the patient? any exposure to hepatitis that includes a needle stick requires that the donor be rejected for how long? 1 year a women who was requested to be a directed donor had a mastectomy with radiotherapy for breast carcinoma 5 years ago. currently she is well and has a hemoglobin of 14 g/dl and a hematocrit of 41%. the blood bank should? defer the donor permanently match the donor history with the appropriate deferral period? 3)treatment for acne 10 years ago with Accutane 2)released from prison after spending 2 years behind bars 2) Treatment for malaria 1 year ago 1) sibling with a diagnosis of creutzfeld-jakob 1) Donor lived in the United Kingdom from 1991 to 1993 2) blood transfusion 5 months ago 1) babesiosis 2 years ago 1. permanent deferral 2. Temporary deferral 3. Accept the donor has been taking oral contraceptives for years. how long would they be deferred before they can donate blood? not a reason for deferral which is the temperature range to transport packed red blood cells? 1-10c which of the following would constitute a permanent deferral of donor? confirmed positive test for HBSAG 10 years previously what is the temperature range to store packed red blood cells? 1-6c for long term storage red cells are frozen in ? grycerol according to AABB standard what is the minimum Ph required for platelets? 6 which metabolic pathway generates 90% of the ATP needed by the red cells? Glycolytic pathway The FDA states that ___ of the red cells must remain viable 24 hours after transfusion? 70-75% Blood products have additive to? all of the above. prolong storage time, obtain optimal viability of cellular elements, lower storage lesions. Red blood cells can be frozen in glycerol for? 10 years which of the following additives enhances the shelf life increasing ATP levels allows packed red blood cells to be stored for 35 days at 1-6c? Adenine what is the only solution allowed to be added to blood? 0.9% saline changes that occur when blood is stored at 1-6c are termed the storage lesion. what are these changes? all of the above glucose 6 phosphate dehydrogenase (g6pd) is? necessary to maintain reduce gluathione in the mature red cells what is the expiration date of CPDA-1 blood? 35 days what is the final hematocrit of an Adsol red cell unit? 55% addition of which of the following will enhance the self life of whole blood? adenine what important function does 23bpg perform? facilitates the delivery of oxygen to the tissues The most important consideration for the transport of blood components between sites? shipping temperature what is the current storage time and storage temperature for platelet concentrates and apheresis platelet components? 5 days at 20-24c what is the expiration date of adsol (As or AS-1) blood? 42 days increased levels of 23DPG results in ______ hemoglobin affinity for oxygen? decreased leukoreduced units have a reduced risk of CMV transmission? true leukocyte reduced filters can do all of the following except? prevent transfusion associated graft vs host disease which blood component would be given to a patient needing fibrin for cornea surgery? cryoprecipitate which of the following viral markers used to test blood donors requires confirmation if the screening test is reactive/positive? HCV All of the following are true concerning random donor platelets except? expire in 7 days which of the following is found on a blood component label per guidelines? volume of blood collected and amount of anticoagulant all of the following infectious disease tests are performed on donor samples after collection except? HBsAB which of the following blood components must be prepared within 8 hours after phlebotomy? fresh frozen plasma FFP Cryoprecipitate is prepared from FFP thawed at 1-6c it is stored at -18c or colder for 12 months from the original collection date. once thawed it is kept at 2024c and will expire in 6 hours if not transfused? true when random donor platelets are pooled together they will expire in? 4 factors found in cryoprecipitate include? b,c,d only, fibrinogen, factor vIII and XIII, von willebrand factor, the use of red blood cells deglycerolized would be most beneficial when transfusing a patient? who is sensitized to platelet antigens all platelet products must be tested for bacterial contamination? true what component is indicated for a patient who has anti IgA antibodies? washed packed red blood cells although ABO compatibility is preferred ABO incompatible product may be administered when transfusing? cryoprecipitate AHF which of the following is the proper procedure for the preparation of platelets from? light spin followed by a hard spin which of the following blood components would Chester receive based on the results? B positive fresh frozen plasma all of the following are true concerning fresh frozen plasma except? once thawed the plasma is kept at room temperature until transfusion irradiation of blood components? prevents graft vs host disease which of the following is the correct storage temperature for the component listed? fresh frozen plasma (FFP) - 20c

Leukoreduction filters are used in the transfusion of red blood cells and platelets to prevent

fibrile nonhemolytic transfusion reactions

Mixed field reactions can be observed in - Gel - SPRCA - Protein A technology - Luminex

gel

celis of the A3 subgroup will

give a mixed field reaction with anti-A,B

What additive is used to freeze blood for long-term storage at -65°C?

glycerol

the most commonly encountered group of discrepancies

group 1

What blood-banking research product hopes to provide oxygen-carrying capacity without the need for capability testing?

hemoglobin substitutes

Reuleaux

increased serum protein, corrected by serum replacement

All of the following statements regarding the AHG test are true except:

incuation time with LISS should be a minimum of 30 minutes

Resolving Group I discrepancies:

incubate at room temperature or 4 degrees C; include group O and autocontrol cells

Resolving Group II discrepancies:

incubate at room temperature or 4 degrees C; include group O and autocontrol cells; pretreat RBCs with enzymes

to resolve group 4 discrepancies what should be done?

incubate the RBCs at 37oC for short period then wash them in saline three times and retype

Immunogenicity of Kidd Ag's: ____

low

Js a is ___ frequency.

low

K is ___ frequency.

low

Kp a is ___ frequency.

low

Yt b is ___-incidence.

low

Albumin

lowers zeta potential and brings red blood cells closer

All of the following procedures might be done in an investigation of an ABO discrepancy except:

neutralization studies with urine

All of the following may be used for the antibody screen before transfusing an infant EXCEPT

paternal serum

What criterion governs the use of the electronic crossmatch?

patient's ABO group must have been determined on two separate occasions

A blood donor with a history of hepatitis B should be excluded:

permanently

HLA genes are highly _____.

polymorphic

Anti-Xg a is a ____ immunogen.

poor immunogen

Lu Ag's are ___ developed at birth.

poorly

potent cold autoantibodies can cause spontaneous agglutination and yield a ______ direct AHG test (DAT)

positive

A positive autocontrol in antibody detection procedures is usually indicative of:

positive DAT

Foward/front typing

pt red cells are tested with commercially prepared anit-sera -Anti-A, anti-B, and some times Anti-A,B -direct agglutionation -so we are testing the pt's RBC looking for what Ag are on them by using reagents that have the Ab

What is the Kleihauer Betke test?

purpose: to detect the presence of Hemoglobin F >If a fetomaternal bleed has occurred then fetal red cells will be present Quantitative: determine the extent of the fetomaternal bleed >How much fetal blood entered the maternal circulation >Will determine how much RhIg to administer!

CEce

r'r" ryr

Wiener nomenclature: ___ = dCE

r^y

Anti-C

rarely encountered as a single Rh Ab

Anti-S, Anti P

rarely naturally occuring IgM

The rejection of platelets in multiply transfused patients is called

refractoriness

Elution

removal and recovery of an Ab that is attached to RBC

RBCs must be washed in saline at least three times before the addition of AHG reagent to:

remove traces of free serum globulins

PEG

removes water to concentrate Ab

Rh

represents the presence or absence of the D Ag 85% of population are Rh + 15% of population are Rh - -require an immune stimulation, they have to come from being exposed to red cells and Ag in that way (transfusion or pregnancy)

Di a and Di b Ags are ____ to enzymes and reducing agents.

resistant to enzymes and reducing agents.

group 1 discrepancies are associated with unexpected reactions in the ________ grouping due to weakly reacting or missing ________

reverse, antibodies

If an O negative male who had never been transfused is crossmatched against an O positive

the crossmatch will be compatible

Kernicterus is caused by the effects of

unconjugated bilirubin

In PCR-SSOP, how is the HLA allele identified?

using probes that are specific for particular alleles

Cryoprecipitated AHF can be used in the treatment of

vWD

All coagulation factors are produced in the liver EXCEPT

vWF

Cryoprecipitated AHF can be used in the treatment of:

von Willebrand's disease (vWD).

which of the following statements is most likely the cause of the following ABO discrepancy TRICITY ALEC A 0 B 0 D 3+ CTL. 0 A1 0 B 0 Hypogammaglobulinemia due to advanced patient age. a patient is typed with the following results A 0 B 0 D 2+ CTL. 1+ A1 2+ B 4+ the most probable reason for these findings is that the patient is Ax with anti A1 antibody which of the following is a source of technical error that can cause an ABO discrepancy? all of the above are technical error that can cause a discrepancy which of the following would most likely indicate that a patients red blood cells are a subgroup of A? discrepancy between the red cells and the plasma for ABO typing why is the ABO reverse typing not routinely performed on infants less than four months old? antibodies detected are usually of maternal origin mixed field agglutination encountered in ABO grouping would most likely be sue to? A3 red blood cells which of the following is characteristic of Tn polyagglutinable red blood cells? if the patient is group O they may appear to have acquired a group a antigen A1 lectin agglutinates? only red blood cells with the A1 antigen which of the following combinations make up an autocontrol used in the blood bank testing? patients serum plasma and patient cells when should multiple antibodies be suspected in a positive antibody screen? screening cells react at different phases and strengths the following techniques may be used to enhance weakly reacting antibodies, except? prewarm technique-get ride of something the process of removing antibody from the red cell membranes is called? elution what is tested in an antibody screen? patient serum is tested against group O reagent screening cells why should only homozygous cells be used to rule out an antibody? weakly reacting antibody may not react with heterozygous cells Vic torius is being admitted to the hospital for uncontrolled bleeding. he currently take a blood A 4+ B 4+ D 3+ CTL 0 A1 0 B 0 I 0 II 0 THE PHYSICIAN ORDERS 2 UNITS OF FRESH FROZEN PLASMA (FFP) AB only**** which of the following antibodies are clinically significant anti-a Kidd antibodies commonly bind complement usually occur with other immune blood group antibodies deteriorate rapidly on storage **all of the above

when a patient may have acquired or inherited changes to their red blood membrane that causes their cells to agglutinate that regardless of their blood type is known as? polyagglutination forward typing grouping is defined as? detecting antigens on an individuals red blood cells via reagent antisera which of the following situations could result in an ABO discrepancy that is caused by problems with the patients red blood cells Tn activation Kal ceeum is being evaluated for a pre employment physical. he recieved 4 units of blood 5 years ago A 4+ B 0 D 3+ CTL 0 A1 2+ B 4+ The blood bank technologist repeated the blood type and received the same results. Anti A1 what is an ABO discrepancy? an ABO discrepancy is when the forward and reverse testing do not match what is expected

Platelets prepared from _____ are referred to as random donor platelets

whole blood units

0's across the board in forward and reverse typing could be due to

group O newborn; elderly patient; hypogammaglobulinemia; agammaglobulinemia; immunosuppressive drugs

the best way to resolve a group 1 discrepancy is to

incubate the patient serum with reagent A1 and B cells at room temp for 15-30 mins or add more patient serum to the test.

the agglutination of weakly reactive antigens with reagent antisera can be enhanced how? Why?

incubating the test mixture at room temp for 15-30 mins; to increase the association of the antibody with the RBC antigen.

MNS

naturally occuring IgM, shows marked dosage, homozygous cells, react stronger with antisera, destroyed by enzymes, antigens have sialic acid in their structure, reactions enhanced by lowering pH

common populations with group 1 discrepancies include:

newborns; elderly; leukemia or lymphoma; congenital agammaglobulinemia; immunodeficiency disease; bone marrow transplant patients; plasma transfusion patients

FFP

no acceptable alternative for neonates, should be compatible with patients RBC

Anti-s, anti-Lub

rare antibody IgG

anti-e

rarest Rh Ab

Indefinite retention

records of blood component/unit final disposition

FFP/Cryoprecipitate storage/shipment temp

-18c or less

HDFN: Mechanism

-During subsequent pregnancies, if fetal cells carry the same foreign antigen, IgG aby crosses placenta and attaches to fetal RBC Ags eventually causing hemolysis

Which techniques are used when warm autoAbs are suspected?

-Elution: Frees Abs from sensitized RBC so Abs can be identified. Useful when DAT is pos (HDN, HTR, Autoimmune disease). Use of heat, freeze/thaw, organic solvent, and acidic slns. -Adsorption: Removal of Ab from serum by combining serum with appropriate RBCs. ZZAP, Chloroquine diphosphate (CPD), and Glycine acid EDTA. Dissociate IgG Abs from RBC.

Anti-K

-May cause severe fetal anemia -Most severe after Anti-D

Rh HDFN

-Mother must be Rh negative -Exposed to Rh+ red cells -Anti-D produced and detect in serum -Current pregnancy: Fetus must be Rh+

reasons for mild nature of the ABO HDN

-Presence of soluble A and B substances in fetal circulation -Weaker Ag strength of fetal A and B Ag -Competition for anti-A and anti-B between tissues and RBCs

when a reaction in the serum grouping is weak or missing what group discrepancy should be suspected?

group 1

Vel can cause _____.

hemolysis

ABO reaction phase

immediate spin -due to IgM -centrifuge and done -big enough and come together

A disadvantage for both gel and solid phase technology is

inability to detect C3d complement coated cells

what will dithiothreitol (DTT) do to resolve forward type discrepancies?

inactivate IgM antibodies

All of the following conditions may produce a positive DAT except

lymphoma

All of the following conditions may produce a positive DAT except:

lymphoma

Anti-I

may mask other more significant Ab,

P antigen

naturally occuring IgM, --- PCH autoantibody called Donath Landsteiner Ab (IgG)

AB Hh sese

nonsecretor -Ag on red cell = A,B,H -Ag found in the saliva=none

MHC class I Ag's are present on all ____ cells.

nucleated cells

MHC class I molecules are present on all ____ cells, ____ cells, and ____.

nucleated cells, dendritic cells, and platelets

Cis

opposite so no suppression because there is space between them

Which of the following occurs during storage of red blood cells? - pH decrease -2,3-DPH increase - ATP increases - plasma K+ decreases

pH decreases

-positive

pt possess the antigen and so cannot make the antibody

All of the following statements are consistent with CFC EXCEPT

reinfusion to the patient completes one cycle

The FDA-directed civil action that calls for removal of products from distribution channels is known as:

seizure

An advantage for both gel and solid phase technology is

standardization

some causes of discrepancies in group 2 include:

subgroups of A or B or both; leukemias may yield weak A or B antigens; Hodgkins disease; acquired B phenomena

what is the purpose of the immediate spin crossmatch?

to detect ABO incompatibility between the patient and the donor

72 hour deferral

tooth extraction, released from penal/mental institution

AHG

warm or IgG antibody CLINICALLY SIGNIFICANT

A donor unit that has been returned to the Blood Bank unused may be reused & reissued if: A. unit closure has not been disturbed (opened) B. blood has not been allowed to warm above 10 C C. blood has not been allowed to cool below 1 C D. all of these criteria apply to reissue of blood

D. all of these criteria apply to reissue of blood (unit closure has not been disturbed (opened), blood has not been allowed to warm above 10 C, blood has not been allowed to cool below 1 C)

Immunogenicity of Rh Ag's: __>__>__>__>__

D>c>E>C>e

Rh0rh'rh"= _ _ _

DCE

R2

DcE

Rh0hr'hr" = _ _ _

Dce

Which of the following genotypes is consistent with f antigen expression?

Dce/DCE

R0R0

Dce/Dce

Which of the following genotypes would form the f antigen?

Dce/Dce

R2r'

Dce/dCe

Lu Ag's are ____ reactive; ____ immunogenicity.

weakly reactive; questionable immunogenicity

The myeloid line of hematopoietic progenitor cells (HPC) includes all but which of the following?

Dendritic cells

___ Ag is a tool in anthropologic studies of Mongolian ancestry.

Di a

A woman without prenatal care delivers a healthy term infant. A cord blood sample shows the infant is A positive with a positive DAT. The workup of the unexpected findings should include

Direct antiglobulin testing of the mothers specimen

Has memory & specificity

Specific immune response (adaptive) differs from non-specific (normal or innate) immune response in that the specific immune response:

Immunoelectrophoresis is useful for clinically detecting:

Structural Abnormalities, Concentration changes in proteins, Congenital deficiency of some complement components...ALL OF THE ABOVE is correct

Sd a = ___ ___.

Super Sid

ABO discrepancies: Anti- A1 (suspected A2): test cells with ____ ____.

Dolichos bifluorus

how do you select blood for an exchange transfusion?

Donor RBCs -need to be compatible with Mom's ABO Abys -in addition need to be Ag neg for other implicated abys Group O red cells (<5 days old) suspended in Group AB plasma are commonly used >Hct levels are determined by physician (remember we are replacing entire blood volume, not just providing O2 carrying capacity) The blood should also be: > Irradiated > CMV negative > Hgb S negative Usually, 2x the infant's blood volume is transfused

How is a donor's eligibility status affected when Western blot results are indeterminate over a period of 6 months and deemed as false-positives?

Donor is not eligible to donate

The ABO dipstick test is based on what principle?

Dot immunobinding assays

Which of the following methods may be useful in investigating a positive DAT?

Elution techniques Removal of cell bound antibody using chloroquine diphosphate Drug studies

Kidney transplants are used to treat which disease?

End-stage renal disease

ABO enzyme effects

Enhanced

Rh enzyme effects

Enhanced

An antibody screen using LISS enhancement is incubated at 37°C for 1 hour. What effect would this incubation period have on antigen/antibody reactions?

False negative. This incubation period is too long for this method

How are antiglobulin test results affected by inadequate washing of the cells?

False negatives may result due to neutralization of anti-human globulin by residual serum proteins.

Covalent interactions

The following are intermolecular interactions the occur between antigen and the FASB region of an antibody

Protein A captures antibodies by binding to

Fc portion of immunoglobulin

High titer low avidity

HTLA is when you get a (+) rxn in your Ab screen and panel cells but your autocontrol was (-) so we've ruled out autoAb but they're weak rxns 1+ so in some cases your have to test with selected cells and sometimes you have to look at race or ethniticity of your pt. that is helpful in AbId

_____: Chido Rodgers Knops McCoy from York with a Swain-Langley that Cost John Milton Hagen $100

HTLAs

What term is used to describe a set of alleles on the same chromosome?

Haplotype

Antigenic when coupled to a carrier molecule

Haptens are characterized as being:

Chemiluminescence:

Has excellent sensitivity and dynamic range, and Does not require sample radiation (Both A and B)

What are the only 3 things that would cause a (+) DAT

Hemolytic transfusion reactions HDFN Autoimmune and drug induced hemolytic anemias

AHF concentrates are used to treat

Hemophilia A

Explain the racial differences in the Duffy blood group.

The genotype Fy(a-b-) is common in Blacks, but rare in Caucasians. It confers resistance to <i>P. vivax</i>.

Antigen and antibody are present in approximately equal proportions

The lattice hypothesis states that an optical reaction occurs between antigen and antibody when:

Group __ discrepancies are the least frequently encountered.

II

Group __ discrepancies: unexpected reaction in forward grouping due to weakly reactive or missing Ag's.

II

Categories of HDFN

1. Rh System Abys 2. Other Blood Group Abys 3. ABO Abys

Anti-M was detected in a 27-year-old man before surgery. Units negative for M antigen were not available; however, the units were approved for transfusion when major crossmatch using M+N+ donor cells and patient serum resulted in

IS = 1+, 37 = 0, AHG = 0

A patient who recently stopped taking Clopidegrel needs to donate platelets. How long must the patient defer donation after completing the medication?

14 days

RBC frozen, post thaw shelf life

14 days

Increase incubation time

15 min may not be enough -30-60 min may improve reactivity (saline or albumin) -be careful with reagents (PEG and LISS)

Approximately what percentage of the U.S. Caucasian population is Rh negative?

15%

A single unit of FFP or PF24 should contain _____ mL of plasma

150-250

A male patient of average size has a hemolglobin count of 8.1 g/dL. the surgeon wants a hemoglobin count of 10g/dL before doing surgery. How many units of RBCs need to be given before the surgeon will accept the patient into surgery?

2

The minimum interval allowed between plateletpheresis component collection procedures is

2 days

How is a 40:1 ratio of serum to cells prepared for the AHG test?

2 drops of serum + 1 drop of 5% v/v RBC suspension

Which of the following immunoglobulins is produced in the secondary immune response?

IgG

Which of the following immunoglobulins is produces in the secondary immune response?

IgG

The saline phase of an antibody screen is designed to detect:

IgM antibodies

Sandy Beech is being evaluated for hip surgery. she has a history of B positive with no a the following results were obtained A 0 B 4+ D 3+ Ctl. 0 A1 4+ B 0 I 0 II 0 if the physician orders blood, what type of crossmatch can be performed

Immediate spin crossmatch

Platelets concentrates prepared by apheresis should contain how many platelets?

3.0 x 10^11

What does the hematocrit need to be (regardless of gender) for a double red blood cell collection?

40%

Whites: __% Fy(a+b+)

50%

How long after a transfusion must donor and recipient samples be stored at 1-6˚C?

7 days

What platletpheresis product should be irradiated?

A directed donation given by a mother to a son

What is an antibody?

An immunoglobulin that is produced in response to stimulation by a specific antigen and is capable of combining with the antigen that elicited its production. Antibodies are also known as agglutinins. They are found in the plasma and serum.

Streptolysin S is:

An oxygen-stable enzyme

Why group O RBC's are used for the Ab screen?

Anti-A and anti-B will interfere in the detection of Abs to other blood group systems.

When would transfusing non-group-specific blood be warranted?

Anti-A is shown in an A person who has been massively transfused with group O blood

What one forward-typing reagent can be used to confirm O units collected from another facility?

Anti-A,B

Polyspecific AHG reagent contains

Antig-IgG and anti-C3d

In which population is the genetic Du usually found?

Asian

Host factors

Is mother a responder/ nonresponder?

Hemolytic Disease of the Fetus and Newborn

Is the destruction of the red blood cells of the fetus/neonate by antibodies produced by the mother

Transformation to Le(b) phenotype after birth may be as follows:

Le(a-b-) to Le (a+b-) to Le(a+b+) to Le (a-b+)

Transformation to Le(b) phenotype after birth is as follows:

Le(a-b-), Le(a+,b-), Le(a+b+), Le(a-b+)

Anti-M will react strongest with which cells?

M+N-

Which of the following characterizes an alloimmune response in immune hemolytic anemia?

The patient produces anti-K to transfused red blood cells

What are the dangers of transfusing donor Rh-negative RBCs to an Rh-positive patient?

Most Rh-negative blood is c and e positive, and because of their immunogenicity the patient may for an antibody to those antigens

IgG agglutination in immediate phase?

NO

ALbumin should NOT be given for - burns - shock - nutrition - plasmapheresis

Nutrition

H concentrations most to least

O>A2>B>A2B>A1>A1B

The classic antistreptolysin O (ASO) procedure has been replaced by:

Optical immunoassay procedure

How is the hepatitis A virus usually spread?

Oral-fecal route

True

Outer surfaces of bacteria can be immunogenic True or False?

Allows rbcs to move in closer proximity to increase aggregation

PEG

5 days

PLT shelf life

Antibodies are on the ?

Plasma

A vaccine must:

Produce protective immunity with minimal side effects, Be immunogenic enough to produce a strong and measurable immune response, Be stable during it's shelf life with potency remaining at a proper level. ALL OF THE ABOVE

To meet the FDA requires, a vaccine must:

Produce protective immunity with only minimal side effects | Be immunogenic enough to produce a strong and measurable immune response | Be stable during its shelf life ALL OF THE ABOVE is correct

A humoral response:

Produces antibodies as the effector molecule

A "secretor" is defined as an individual who:

Produces soluble ABH antigens in secretions

The study of Hematopoiesis

Properties of the immune response includes all of the following except:

What whole blood component contained in pheresed granulocyte concentrate warrants crossmatching of this product?

Red blood cells

Which of the following is not normally collected as a pheresis product?

Red blood cells

True

Red blood cells can be antigenic

______ type Rh null syndrome: mutation in RHAG gene.

Regulator

RBCs must be washed in saline at least three times before the addition of AHG reagent to:

Remove traces of free serum globulins

RBCs must be washed in saline atleast 3 teims before the addition of AHG reagen to

Remove traces of free serum globulins

What is the action of PEG?

Removes water molecules, thereby concentrating antibody

A technologist on 3rd shift is called away from the blood bank in the middle of an indirect antiglobulin test to help with stats in the chemistry department. By the time he returns to the blood bank, the tubes have been incubating at 37°C for an hour and a half. What should he do?

Repeat the test. The prolonged incubation could result in antibody eluting off of the red cells, causing false negative reaction. The max length of incubation varies with the method (saline, albumin, LISS, PEG). The manufacturer's direction should be followed.

What term is used to describe the level of detail to which an allele is determined?

Resolution

TRALI presents with the following symptoms

Respiratory distress Severe hypoxemia and hypotension Fever

A type 1 chain has

The terminal galactose in a 1-3 linkage to subterminal N-acetylGLUCOSEamine

The type 1 chain has

The terminal galactose in a 1-3 linkage to subterminal N-acetylglucosamine

Where will the ABO discrepancy occur in cis-AB individuals?

Reverse grouping with B cells

What is required in ABO grouping that is not required in typing of other blood group systems?

Reverse grouping. When typing for other blood group systems, only the RBCs are tested because there are no naturally-occurring antibodies in the plasma/serum.

Name the most common groups systems that exhibit dosage:

Rh (except D) Kidd Duffy MNSs Lutheran

The Rh phenotype that is associated with hemolytic anemia is:

Rh Null

Severe HDN is usually caused by ____ or ____ Ab's.

Rh or K

What do "check cells" contain?

Rh(D)+ red blood cells coated with anti-D

IgG class Ab

Rh, Kell Duffy Kidd, Lutheran, MNSs, Xg (sex link)

The Rh testing on a blood donor was negative at immediate spin. The tube was incubated at 37C for 15 minutes. The tube was centrifuged and read macroscopically. The test was negative at 37C. The tube was washed 3 times with saline, and two drop of AHG were added. After centrifugation, the tube yielded at 2+ reaction. How is this Rh type reported on the donor unit?

Rh-positive

What is the causative agent for Rocky Mountain spotted fever?

Rickettsia rickettsii

Anti-Lua reacts at what temperature?

Room temperature

Numeric terminology is the ______ nomenclature system.

Rosenfield

"Shock-Like" symptoms can be produced by high levels of :

S. pyogenes superantigens and cytokines (Both B and C)

If a patient has a positive direct antiglobulin test with broad spectrum antihuman globulin, what should be done?

The test should be repeated using monospecific antihuman globulin to determine if the reaction is due to IgG or complement.

Selected cells

They are chosen from other panel or screening cells to confirm or eliminate the Ab.

Ctyokines are referred to as interleukins.

True

What does hemolysis represent in an antigen-antibody reaction? a positive result All of the following are factors of antigens that affect the type and extent of immune response except: genetic locus How is the classical pathway of complement activated? by binding of antigen with antibody Which metabolic pathway permits the accumulation of 2,3 DPG? Luebering-Rapoport shunt What is the definition of an immunoglobulin? a protein molecule produced in response to an antigen A patient with multiple myeloma exhibits rouleaux formation in an immediate spin crossmatch. What procedure is recommended to distinguish true red cell agglutination from nonspecific agglutination? saline dilution A gene, such as the O gene, that produces no detectable product is called: an amorph Which red cell preservative has a storage time of 35 days? CPDA-1 What would the hemoglobin oxygen dissociation curve depict in a patient exhibiting clinical signs of alkalosis? shift to the left Alternate forms of a gene that can occur at a single chromosome locus are referred to as: alleles Which of the following must be true when using the Hardy-Weinberg equation? all of the above When an individual is said to have blood group A, it refers to the individual's: phenotype What is responsible for recognition of the antibody-binding sit to homologous antigen? variable region of light/heavy chain which metabolic pathway is responsible for generating 90% of the ATP for the RBC? glycolysis Which of the following metabolic pathway is responsible for maintaining heme iron in the ferrous (Fe) state? methemoglobin reductase How do restriction endonucleases function? cut DNA into smaller fragments Which of the following corresponds to the basic structure of immunoglobulin? two light chains and two heavy chains held together by covalent disulfide bonds The diploid chromosomes number in humans is: 46 ABO hemolytic disease of the newborn? is usually seen only in the newborns of group o mothers which of the following types of HDFN is preventable? HDFN due to anti-d which of the following indications may require a rh negative mother to receive another shot of rhig before the birth of the baby? all of the above, amniocentesis, trauma due to fall, grater than 40 weeks gestation ABO HDFN can occur in infants of mothers with which blood type? O why havent lewis antibodies been implicated in HDFN? a and B only, infants are born Le(a-b-)lewis antibodies cannot cross he placenta an OB patient has had three previous pregnancies. her first baby was healthy. second baby was jaundiced at birth an? RH incompatibility which of the following is a therapy option that is typically used for mild case of HDFN? Phototherapy which of the following antibodies may cause HDFN? RH,KELL,KID,DUFFY **aLL OF THEABOVE following delivery what is the single best test for the diagnosis of HDFN? DAT in suspected cases of HDFN what significant information can be obtained? determination of the presence of spherocytosis and elevated numbers of NRBC if a pregnant female has anti E and the babies father is R1R1 the baby may be affected by HDFN? false All of the following are requirements of the packed red blood cell for an exchange transfusion except? negative for Hgb c an exchange transfusion is used primarily in all the following circumstances except? provides platelets to prevent disseminated intravascular coagulation. a rise in antibody titer of _____ or more tubes us considered significant? 2 a blood bank technologist is performing a type and screen on a post natal specimen from a rh negative mother. the antibody screen is weakly positive and anti d was identified? RhIG was given to the mother at 28 weeks gestation why is the use of anti c3d not required for direct antiglobulin test in the investigation of HDFN? the antibodies that cause HDFN are maternal IgG antibodies Only 5% OF Kell-negative individuals will develop antibodies to Kell if exposed tot eh Kell antigen, whereas 50% to 70% of Rh (D) negative individuals would produce antibodies to D upon exposure. What is the reason for this? difference in immunogenicity How is it genetically possible for a child to type Rh negative? both parents are (Dd) In the normal hemoglobin oxygen dissociation curve, what percentage of oxygen is released to the tissues when PO2 averages 40 mmHg? 25% Which immunoglobulin is found in greatest concentration in serum? IgG At what temperature do IgM antibodies react? 22 C Which blood group antibodies are known to activate complement leading to intravascular hemolysis? ABO What does polyspecific AHG contain? all of the above At what temperature do IgG antibodies react optimally? 37 C What class of immunoglobulin is capable of crossing the placenta? IgG What immunoglobulin exists in a pentameric configuration? IgM What is meant by the term "autosomal"? Trait is not carried on the sex chromosomes If not labeled "gamma heavy chain specific," monospecific anti-IgG may contain antibodies to: immunoglobulin light chains How is a 40:1 ratio of serum to cells prepared for the AHG test? 2 drops serum + 1 drop of a 5% v/v red cell suspension Why is incubation omitted in the direct AHG test? In vivo antigen (antibody complex is already formed. What is the incubation time for the IAT when saline is used instead of LISS? 30 minutes A patient came in for a routine type and screen prior to surgery. The antibody screen was negative at 37°C and AHG phase. Check cells did not produce agglutination often. What is a possible explanation for this result? inadequate washing At what temperature is the incubation phase of the AHG test? 37°C What is a possible consequence of incubating tubes too long with LISS when performing the IAT? elution of antibody from red cell Most clinically significant blood group antibodies are of what IgG subclass? IgG1 and IgG3 Polyspecific AHG contains: anti-IgG and anti-C3b-C3d What do "check cells" contain? Rh(D)+ red cells coated with anti-D All of the following are important in evaluating a positive DAT except: donation history The indirect antiglobulin test detects which antigen-antibody reactions? in vitro

Which of the following statements are false concerning the structure of immunoglobulins? IgM participates in placental trasfer What is the function of helicases and gyrases in the polymerase chain reaction? to unwind the DNA What MHC Class encodes complement components? Class III The portion of the immunoglobulin molecule which determine class: heavy chain When 1000 donors were tested, 75% were positive for C and 25% were negative for C; the gene frequency of C is: 0.5 A woman with blood group A marries a man with blood group O. Their first bone child has blood group O. The mother's most probable genotype is: AO In an immune response, what is the time called in which no antibody is detected in test serum? latency period In an immune response, _____ antibodies are formed before ______. IgM, IgG A human gamete (egg or sperm) contains how many chromosomes? 23 chromosomes In the MN blood group system, a person who inherits and "M" allele and "N" allele expresses both M and N antigens on the red blood cells. Which of the following is true? M and N are codominant alleles In Mendel's law of separation, the first-filial generation is: heterozygous Which of the following is representative of the "central dogma" of molecular biology? The basic information of life flows from DNA through RNA to proteins A father carries the Xga trait and passes it on to all of his daughters, but none of his sons. What type of inheritance does this represents? X-linked dominant All of the following are functions performed by the complement system except: decreased vascular permeability What is a vector? extrachromosomal genetic element that can carry a recombinant DNA molecule into a host bacterial cell IgG-coated red cells will be phagocytized by what effector cells? monocytes/macrophages What is the function of mononuclear phagocytes? present processed antigen to lymphocytes All of the following biochemical changes are associated with loss of red cell viability upon storage except: increased ATP level All of the following are consistent with a "shift to the right" of the hemoglobin oxygen dissociation curve except: decreased 2,3 DPG Which of the following best describes the process of mitosis? cell division that produces two daughter cells having the same number of chromosomes as the parent How is RNA different from DNA? all of the above Why was anticomplement introduced into AHG sera? all of the above How many IgG molecules must be present on the red cell for a positive IAT to occur? 100 All of the following conditions may produce a positive DAT except: lymphoma A patient is discovered to have anti-Fya in their serum. The medical technologist needs to phenotype the patient cells for the corresponding antigen. What test is appropriate for phenotyping? IAT Why are "check cells" added to all negative reactions in the AHG test? to ensure AHG was not neutralized by free globulin molecules What type of globulin does the antiglobulin test detect? all of the above All of the following is true regarding the AHG test except: Incubation time with LISS is a minimum of 30 minutes. An antibody screen is performed, and all three tubes are negative after adding AHG. Check cells are added, and the tubes are centrifuged. No agglutination occurs after the addition of check cells. What is the next course of action? repeat the antibody screen Anti-IgG is specific for what part of the IgG molecule? Fc fragment What is the purpose of washing cells in the AHG test? to remove all unbound protein Saline used for blood banking tests should have a pH of _________. 7.2 to 7.4 How would a negative IAT be demonstrated in solid phase methodology? pellet at bottom of well Anti-A from a group B individual is primarily what class of immunoglobulin? IgM Which of the following criteria is used to classify the B subgroups? all of the above What substances are found in a group A secretor? A,H What is a "lectin"? seed extracts that agglutinate human cells with moderate specificity What ABO group contains the least amount of H substance? A1B What is the source of anti-A1 lectin? Dolichos biflorus Secretor studies were performed on a person who expressed weak reactions in forward grouping. Only B and H substance were present in saliva. What is this person's ABO group? B Why can anti-H sometimes be found in an A1B individual? The specific immunodominant sugar blocks the presence of H antigen. All of the following may result in weak or missing antigens except: hypogammaglobulinemia What is the biochemical structure of secreted A,B, and H substances? glycoprotein All of the following statements are true concerning ABH soluble substances except: The precursor chain is type 2 (beta 1-4 linkage). All of the following may result in rouleaux formation except: leukemia What percentage of the type A population are A1? 80% Persons who inherit the h allele do not produce ___________ transferase necessary for formation of the H structure. L-fucosyl All of the following may depress antigen expression except: coronary heart disease What immunodominant sugar is responsible for B specificity? D-galactose What percentage of A2 individuals produce anti-A1? 5% How are ABH antigens formed? production of specific glycosyltransferases add sugars to precursor substances Reverse grouping was performed on an AB person. The technologist observed a very weak agglutination macroscopically. The cells appeared as "stacked coins" under a microscope. Which reagent should be added to the tube and recentrifuged in an attempt to resolve the discrepancy? saline Which substance must be formed first before A or B specificity is determined? H A patient was previously typed as blood group O. Forward grouping was negative with anti-A and anti-B. Reverse grouping showed reactivity with A1 cells and B cells. The technologist reported this patient's type as A. What technical error occurred? clerical error A patient who was recently diagnosed with an obstructed bowel became septic from Proteus vulgaris. Prior to surgery, a routine type and screen was performed. Though this person typed as an A two years ago, his forward type is consistent with an AB individual, albeit weaker in strength with anti-B. What is the reason for this discrepancy? acquired "B" What does the hh genotype refer to? Bombay Which blood group contains the highest concentration of H antigen? O What are the advantages of using chemically modified anti-D? provides a low-protein medium The Rh antibody agglutinates what percentage of red cells. 85% Why is determination of Rh status crucial for obstetric patients? All Rh negative mothers are possible candidates for Rh immune globulin. Which antigen represents Rh3 in Rosenfield terminology? E G antigen is present on all of which type of red cells? C positive Where is the Rh antigen located relative to the red cell membrane? integrally Which of the following is true regarding anti-LW? It appears frequently as an auto antibody. Why is it acceptable for "C Trans" individuals to receive D-positive red cells? all of the above A cord blood sample was sent to the blood bank for a type and DAT. Cells were washed six times with saline before testing. The forward grouping typed as an O. There was no agglutination with anti-D and washed cord cells. The DAT was 3+ with polyspecific AHG. What is the Rh type of the baby? Rh type cannot be determined Which of the following genotypes is consistent with f antigen expression? Dce/DCE How are the Rh antigens inherited? codominant alleles Most Rh antibodies are of what immunoglobulin class? IgG Which IgG subclasses carry the most significance with regard to Rh antibodies? IgG1/IgG3 All of the following are true regarding Rh antibodies except: Rh antibodies can bind complement on the red cell membrane. What is the principle of the Rh-Hr (Weiner) terminology? The Rh gene produces at least 3 factors within an agglutinogen The Rh gene is located on which chromosome? 1 Which of the following Rh antigens is the most immunogenic? D What is the basis of Rosenfield Rh terminology? (+) or (-) sign demonstrates the presence or absence of antigen on a red cell. What class of antibody is found in AHG? all of the above Why are Lewis antibodies not generally implicated in hemolytic disease of the newborn (HDN)? Lewis antibodies are IgM and cannot cross the placenta Which of the following may be a possible cause for the lack of expression of Lewis antigens during pregnancy? increased ration of plasma lipoproteins to red cell mass At which phase are Lewis antibodies usually detected? immediate spin Why is the Le system not implicated in hemolytic disease of the newborn (HDN)? Lewis antigens are not well developed at birth How is Le^b substance formed? L-Fucose is added to subterminal N-acetylglucosamine of type 1 H substance Where are Lewis antigens found? all of the above Lewis antibodies are of what immunoglobulin class? IgM Lewis cell-bound antigens absorbed from plasma on to the red cell membranes are: glycolipids Person who inherit the Se and Le gene will have _____ A or B glyolipids in plasma than persons who are Se le. less Pregnant women usually express which phenotype? Le(a-b-) In order for an individual to express Le^b antigen on their red cells, they must have inherited which gene? all of the above A Bombay individual who has inherited the Le gene will have a phenotype of: Le(a+b-) Why is anti-i implicated in hemolytic diseases of the newborn? Two of the above Which of the following is not involved in the Kell blood group system? Jk^a Where are the Duffy antigens found? red cells Why is it relatively easy to find compatible units for a patient with anti-K? Kell is a low-frequency antigen Red cells were ficin treated to help rule in anti-M from a panel study. Cells not treated reacted at 2+ at immediate spin and 1+ at 37C. There was no reactivity in the Coombs phase. Ficin-treated cells demostrated a ______ reaction with patient serum containing anti-M. negative A blood bank technologist needed to confirm the presence of anti-P1 in a patient specimen. Fresh cells were not available for use, so an old panel taht contained cells positive for P1 was used. No cells positive for the antigen reacted at any phase of the antiglobulin test, whereas cells from the screening cells showed specificity for the presence of anti-P1. What is a possible explanation for this? P1 antigen deteriorates rapidly upon storage Anti-M was detected in a 27-year-old man before surgery. Units negative for M antigen were not available; however, the units were approved for transfusion when major crossmatch using M+N+ donor cells and patient serum resulted in: IS=1+, 37=0, AHG=0 Anti-Lua reacts at what temperature? room temperature Persons who phenotype negative for U antigen lack Ss-SGP because of a partial or complete deletion of ______. GPB The M and N antigens are found in which glycoprotein? glycophorin A How can pathologic anti-I be differentiated from benign anti-I? broad thermal range of reactivity Which of the following distinguishes the recessive LuLu gene for the dominant In(Lu) gene? normal expression of P1 All of the following are characteristics of Kidd antibodies except: naturally occuring When red cells are placed in a solution of 2M urea, the red cells will lyse. However, it has been shown that which red cells are resistant to lysis? Jk(a-b-) The M and N antigens exhibit dosage. Therefore, if a person inherits the homozygous genotype MM their red cells will react ____ with anti-M than a person with heterozygous genotype of MN. Stronger The homozygous phenotype Fy(a+b-) has _____ antigentic Fy" sites than heterozygous cells, Fy(a+b+). more At what age does I antigen become detectable on infant cells? 18 months What characteristic differentiates Ss antigens from MN antigens? enzyme degradation Persons who express the phenotype P2 are at risk for developing anti-P1 when handling what animal species? pigeons What abnormal blood cell morphology is associated with the McLeod phenotype? acanthocytes What type of hemolytic transfusion reaction occurs more frequently in patients with Jk antibodies? delayed

Carwright (YT) system: two antithetical Ags, ___ and ___.

Yt a and Yt b

B

BO BB 11% caucasions 19% AA -A substance (none) -B substance (++) -H substance (+)

BH (rbc) none (secretions)

BO Hh sese

Routine pre-transfusion testing consists of all of the following except

a DAT

The Rh system was first recognized in a case report of

a hemolytic transfusion reaction

Mixing patient serum and donor red blood cells together and observing for direct cell lysis or agglutination is known as

a major crossmatch

agglutination at any stage is

a positive result -but still continue to AHG phase

Which of the following criteria warrants a granulocyte concentrate transfusion?

a septic patient unresponsive to antibiotics

A standard operating procedure (SOP) is:

a set of directions for how to perform a particular task.

what must always be tested concurrently with the reverse typing when trying to solve a discrepancy? Why?

an auto and O cell control; b/c lower temperature will likely enhance the reactivity of commonly occurring cold agglutinins such as anti-I

D, C, c, E, and e are _____.

antigens

Anti-LW most frequently is an ____antibody.

auto

The G antigen is present on all cells that are positive for either of these two Antigens:

D & C

Cromer system Ab's are rarely observed; seen most often in ____ individuals.

black

Genotype is?

blood type

Which type of transplantation requires all cellular blood components to be irradiated

bone marrow

Passive acquisition of anti-A, B, AB may occur through

bone marrow transplanation

What does hr' refer to in the Weiner nomenclature?

c

Wiener to Fisher-Race translation: no 1 or ' =

c

"AB" plasma

can be given to "A, B, O", but can only recieve "AB"

"O" RBC

can only recieve "O" RBCs, no alternative

ABO discrepencies: 2 cell populations, mixed field reactions, no resolution

chimerism

The most common anticoagulant used for apheresis procedures is

citrate

The most common adverse effect of plateletpheresis collection is

citrate effect

enzymes will

cleave the sialic acid residues -it enhances and destroys some so we dont use it very often

Anti-LW reacts equally well with ___ cells regardless of D type => use to differentiate anti-LW from anti-D.

cord

Wiener to Fisher-Race translation: r =

d

What is the titer and score for this prenatal anti-D titer? (Refer to Figure 9-20.)

d. Titer = 32; score = 52

rh'rh" = _ _ _

dCE

ry

dCE

A1

detected by Anti-A1 lectin -Dolichos biflorus

Weak D

detected only by IAT -seen in cDe haplotype -position effect or steric hinderance -opposite chromosome of the C Ag or trans to C

acquired B phenomena is often associated with

diseases of the digestive tract

ABO Ab's (do/do not) bind complement.

do

One change that occurred under the FDA for oversight of biologics was that the FD&C Act now labeled biologics as:

drugs

alter pH

enhance anti-M in a pH of 6.5 but may lose reactivity of CS Ab RH, Duffy, Kidd

Rh typing

for babies of Rh neg moms is significant

The specific cell product used for treating sepsis is the

granulocyte

What is the most critical step in blood transfusion?

Checking patient identification and compatibility of donor unit

Washed RBCs

Shelf: 24 hours Temp: 1-6 Use: IgA negative; PNH Content: <5x10^8 WBCs RBCs

RBC deglycerolized

Shelf: 24 hours Temp: 1-6˚C Use; rare phenotypes, increase O2 Content: RBC, saline, dextrose <1%, WBC, platelets

Platelets, pooled

Shelf: 4 hours Temp: 20-24˚C Use: Thrombocytopenia, DIC, bleeding pH >= 6.2

Platelets (random donor)

Shelf: 5 days Temp: 20-24˚C Use: Thrombocytopenia, DIC, bleeding Content: >= 5.5x10^10 platelets ph>= 6.2

Why is it essential that irradiated blood components be used in bone marrow transplant recipients?

Bone marrow recipients are on immunosuppressive therapy

A person who inherits alleles Fya and Fyb will carry which antigens on their red blood cells?

Both Fya and Fyb antigen

Most cases of warm autoimmune hemolytic anemia will be DAT-positive with which of the following?

Both anti-IgG and Anti-C3d

What is the hemoglobin source for hemoglobin-based oxygen carriers in advanced clinical testing?

Both bovine and human hemoglobins

Neonatal exchange transfusion is performed using which blood preservative?

CPD and CPD-A1 (both can be safely used)

RBCs

Shelf life: CPD, CP2D, ACD: 21 days CPDA1: 35 days AS: 42 days Temp: 1-6˚C Use: increase O2

PF24

Shelf: 1 yr @ -18˚C 7yr @ - 65˚C Use: Coag deficiency, liver disease, DIC, massive transfusion - Less labile factors than FFP

Which of the following factors influenced the need for apheresis technology?

The blood component needs of patients on chemotherapy

An immediate spin crossmatch was performed using recipient serum and donor cells from a group AB unit. At immediate spin, the reaction was 4+. What is the reason for this positive reaction?

ABO incompatibility

an immediate spin crossmatch was performed using recipient serum and donor cells from... is the reason for this positive reactions

ABO incompatibility

(Wiener)

(Fisher-Race)

What does compatibility testing include?

ABO, Rh, antibody screen, major crossmatch

Immunogenicity of common Ag's: ___>___>___

ABO>D>K

IS and not CS Ab

A,B,H,I,M,N,Lea,Leb,P1

The antigen ceCF is known as:

Crawford antigen

O gene

H Ag

An identical twin donating to its twin sibling is an example of what kind of hematopoietic progenitor cell donation?

Syngeneic

Where are the Lewis antibodies produced?

Tissues

Which of the following regarding blood issued on an emergency basis without patient testing is true?

Units are tagged for emergency release and segments are pulled for later testing

Autoadsorption

adsorption that uses the pt own cells

K-B stain calculation

# fetal cells/ 2000 adult cells x 100= % of Fetal cells present in maternal circulation % of Fetal cells x 50= # of mls of fetal bleed # of mls of fetal bleed/30= # vials of RhIg require plus one

Which Abs usually react after 37C incubation?

(IgG= Clinical significant) Potent cold Abs (causing hemolysis) D, E K

Which Abs usually react in antiglobulin phase (AHG)?

(IgG= Clinical significant) Rh Abs Kell Duffy Kidd S,s Lub Xg

What is the shipping temperature requirement for plasma

-18˚C or lower

Selectogens/Panoscreens (screen cells)

-2 or 3 suspensions -group O individuals -Ag profile sheet -homo/heter (have to have a mixture) -dosage

mother is AB and father is A, what are the possible genotypes?

-50% group A or AB -50% A, 25% AB, 25% B

Storage temp for RBC frozen

-65c or less

The required storage temp for frozen RBCs using the high glycerol method is:

-65˚C

Monoclonal antibodies are:

-Able to recognize and bind to a specific Ag -derived from a single clone of cells -used to deliver immunotherapy All of the above are correct

When would an antibody be considered clinically significant?

-Are capable of destroying transfused Ag-positive RBCs -Causing anemia -Causing transfusion reactions -All of the above is correct

In which cases mixed-field agglutinations might be observed?

-Comonly seen with Anti Sda and Lutheran Abs. -Recently transfused patient.

How do you diagnosis and manage HDFN with a positive ABSC?

-ID the aby -Perform Titration if aby is clinically significant (serial dilutions) -Freeze the serum sample >If a subsequent titer is requested, must compare the 1st titer results with the 2nd titer ~Run both titers in parallel and compare endpoints ~Use same genotype each time, etc. ~ Patients are monitored throughout pregnancy (~once per month)

How do get warm autoAb?

-Idiopathic -Known disorder (SLE, RA, leukemias, pregnancy, infectious diseases, etc) -Medications

Advantages of monospecific AHG with anti-IgG

-Less interference from nuisance cold agglutinins. -Minimal risk of missing C' dependant Abs.

Pathogenesis

-Maternal antibody coast AG positive fetal cells -Cells are destroyed by fetus' RES (liver/spleen) -Rate of destruction is dependent on antibody titer and specificity -Destruction of fetal cells results in anemia

immunoglobulin

-Only IgG can transport across placenta via the Fc portion -Active transport begins in second and third trimester

Suspected subgroup of A: 1) test patient cells with ____ ____ 2) test patient serum with ___ and ___ ___

1) lectin A1 (Dolichos bifluorus) 2) A1 and A2 cells

In which cases the AABB requires the use of Ab screen?

1. Pretransfusion testing on the recipient. 2. Prenatal testing: Risk for HDN and RhIg prophylaxis. 3. Donors, specially those with hystory of pregnancy and transfusion.

Who should get RhIG?

1. Rh negative women who do not have immune anti-D in their serum 2. Rh negative women during pregnancy: Antenatal (or antepartum) administration 3. Rh neg women who delivers Rh+ baby (postpartum)

What can be done in order to confirm an Ab when doing an Ab typing?

1. The rule of 3: Patient serum must be pos with 3 cells with Ag and Neg with 3 cells without the Ag. 2. If the rule of 3 is not fulfill: Use additional cells from another panel. 3. Ag typing the patient cells: Reagent antisera is added to the patient RBCs and a neg rxn results (Patient also has the Ab because doesn't have the Ag). Perform in patients that have not been previously transfused.

A patient with anti-K and anti Jka needs two units of RBCs for surgery. How many group specific units would need to be screened to find 2 that are compatible?

10

Upon centrifugation of an antibody screen procedure done by the gel system, the red blood cell agglutinates are dispersed throughout the gel column with a few agglutinates at the bottom of the microtubes. This reaction should be graded as a:

2+ reaction

In ABO grouping by test tube method, what concentration of cells is used for forward grouping?

2-5%

Guideline for Interpretation: Rule of 3

3 Positives -suspected Ab is reactive with at least 3 panel cells that are Ag positive 3 Negatives -suspected Ab is negative with at least 3 panel cells that do not possess the antigen -in some cases if we're looking at Ab panel and we cant get our rule of 3 we may refer to the Ab screen. Depending if you used 2 or 3 selectogens we can use those to help us use the rule of 3 for the 3+ or 3-

Serologic testing for S. Pyogenes should compare acute and convalescent specimens collected ______Apart

3 weeks

What is the minimum number of platetlets required in an apheresis component (90% of the sampled units)?

3 x 10^11

In tube testing, how would three large agglutinates against a clear background be graded?

3+

How many targets are required for HLA antibody screening?

30

A 300-µg dose of Rh-immune globulin contains sufficient anti-D to protect against how much whole blood?

30 mL

A blood component should be transfused within:

4 hours

All blood components should be transfused within what time period to avoid bacterial contamination

4 hours

Cryoprecipitate that has been pooled must be transfused within

4 hours

What is the expiration time for platelet concentrates that have been pooled?

4 hours

Each unit of cryo prepared from whole blood should contain approximately how many units of AHF activity?

80 IU

QC for RBC requires a maximum hematocrit level of

80%

What is the most common Rh antigens in Caucasians?

98% of Caucasians are positive for e.

Ab to High Incidence Ag

99% of population have k, Kpb, Jsb -if we have - DAT and - autocontrol but all + rxns look at High incidence Ag

k frequency = __%

99.8%

Absolute IgA deficiency is a classic example of a severe allergic reaction. Results indicateing an absolute IgA deficiency:

<0.05 mg/dL

What is a Marsh Score?

> 10 (change) is also a significant indicator the agglutination reactions for each dilution are given corresponding score; scores are added: 4+ 12 3+ 10 2+ 8 1+ 5 w+ 3

THe platelet count of the plateletpheresis donor must be ______ prior to the procedure

>150 x 10^9/L

Fix complement & transfer through the placenta

A secondary function of an antibody is to:

Pro-Zone Phenomenon

A serum sample that is strongly Positive and undiluted that shows little or no agglutination

Pro-zone Phenomenon

A serum sample that is strongly positive and undiluted that shows little or no agglutination

Post-zone phenomenon

A serum sample that is very dilute & shows little or no agglutination

Post-Zone Phenomenon

A serum sample that is very dilute and shows little or no agglutination

Typing discrepancies: AB forward; B reverse => ___ ___

A subgroup

anti-A, 4+ anti-B, 0 D 3+ Control 0 A1 cells, 1+ B cells, 4+ anne chovee is being seen by her physician for a routine physical. when she was younger she received a transfusion. could be due to: resolve this:

A subgroup; probable A2 with anti-A1 she can receive A positive blood that is negative for the A1 antigen. O positive also

What is an elution?

A technique used to dissociate IgG antibodies from sensitized RBCs

Direct Agglutination

A test in which an antigen is an intrinsic component of the particle; used to determine if antibody specific for antigen is present in biological fluids

What are the possible ABO phenotypes of the offspring from the mating of a group A individual with a group B individual?

A, B, AB, and O

Which RBC antigens are not fully expressed at birth?

A, B, I, P₁, Lewis, and Lutheran

A newborn is typed as Group O; her mother is Group A. Determine the maximum number of theoretical blood types that the father could be to produce a child of this ABO type.

A, B, O

A 39 year old male is hemorrhaging severely. He is AB Rh-negative. Eight units of blood are required STAT. Of the following types available in the blood bank, which is most preferable for crossmatch?

A, Rh negative

A 39-year-old male is hemorrhaging severely. He is AB Rh-negative. Eight units of blood required STAT. Of the following types available in the blood bank, which is most preferable for crossmatch?

A, Rh-negative

INTERPRETATION: A major crossmatch is incompatible at room temp, but the antibody screen and autocontrol are both negative. The most likely cause of the problem is: A. ABO incompatibility B. IgG alloantibody C. anti-platelet antibody D. cold autoantibody

A. ABO incompatibility

The blood bank error that would cause the most severe transfusion reaction is: A. Group A blood given to a Group O patient B. Group O blood given to a Group A patient C. Group B blood given to a Group AB patient D. Group O blood given to a Group B patient

A. Group A blood given to a Group O patient

An ABO type on a patient give the following reactions: Cells with-- Anti-A: 4+l anti-B: 4+ Serum with A cells: Neg; B cells: neg What is the patient's blood type?

AB

Ag Typing

AB Identifies, need to check for corresponding Ag on the pt cells and donor units Make sure you do QC

anti-A, anti-B, A1 cells, B cells, O cells 4+ 4+ 1+ 0 0 could be due to: resolve this:

AB subgroup; probable A2B with anti-A1 react patient cells with anti-A lectin; test against A1, A2, and O cells

Serological testing

ABO and Rh typing of specimen Ab screening of specimen ABO, Rh, ABS etc. testing donor Crossmatching of blood for transfusion

Which of the following is not characteristic of antibodies within the ABO system?

ABO antibodies do not activate complement

ABO HDFN is usually mild because

ABO antigens are poorly developed in the fetus

ABO HDFN is usually mild because:

ABO antigens are poorly developed in the fetus.

When a patient has Rh-null syndrome, what kind of packed RBCs need to be transfused?

ABO compatible Rh-null blood

Antibodies in which blood group systems bind complement?

ABO, I, Kidd, and Lewis

In which blood group systems are antibodies usually naturally-occurring?

ABO, Lewis, P₁, M, and Lu^a

The indicator cells used to detect antibodies in a solid phase technology are:

AHG-coated RBCs

A

AO AA 40% caucasions 26% AA common -A substance (++) -B substance (none) -H substance (+) (detect if secretor)

Group I discrepancies: weakly reactive or missing ___.

Ab's

Monoclonal Antibodies are:

Able to recognize and bind to a specific antigen, Derived from a single clone of cells, used to deliver immunotherapy...ALL OF THE ABOVE is correct

What causes rouleaux to form?

Abnormal A/G ratio

What dosage is referred to?

Abs that react more strongly with a "homozygous" cell.

What abnormal blood cell morphology is associated with the McLeod phenotype?

Acanthocytes

Pain at infusion site and hypotension are observed with what type of reaction?

Acute hemolytic transfusion reaction

A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except:

Acute immune hemolytic transfusion reaction

Solid-phase antibody screening is based on:

Adherence.

Which one of the following properties of antibodies is NOT development on the structure of the heavy chain constant region? - Ability to cross placenta - Isotope (class) - Ability to fix complement - Affinity for antigen

Affinity for antigen

Which of the following antibodies would more likely be found in a black patient? - anti-Cr(a) - anti-At(a) - ANti-Hy - all of the above

All anti-Cr(a) anti-At(a) anti-Hy

Why do false-negative Rh testing results occur in babies with severe hemolytic disease of the newborn due to anti-D?

All D sites are covered by maternal anti-D, which blocks the reagent

What is revealed in the minor crossmatch?

Alloantibodies in donor plams reacting with antigen on patient cells

Given the following results, what is the probable cause of a positive reaction in the major crossmatch? IS=0, 37C=C, AHG=2+, CC=ND, autocontrol was negative

Alloantibody in patient serum reacting with antigen on donor cells

How can the ABO and Rh of the fetus be determined in utero?

Amniocentesis Chorionic villus sampling Percutaneous umbilical cord sampling (All of the above)

What is an autoantibody?

An antibody to an antigen that one possesses. Autoantibodies are usually only produced in disease states.

Stimulates AB formation Has the ability to bind to an AB Is capable of stimulating an immune response ALL OF THE ABOVE are correct

An antigen is described as

Which cold autoantibody is associated with infectious mononucleosis?

Anti-I

Polyspecific AHG reagent contains:

Anti-IgG and anti-C3d

Anti-Jk_ is more frequently encountered than anti-Jk_.

Anti-Jk a more frequent than anti-Jk b

Which antibody is most commonly associated with delayed hemolytic transfusion reactions? - Anti-s - Anti-k - Anti- Le(a) - Anti- Jk(a)

Anti-Jk(a)

Which is not an example of the most common form of error associated with fatal transfusion reactions? - Phleb labels patient A tubes with patient B infor - Tech enters results of patient A testing into patient B field - Wrong RBC unit is tagged for transfusion - Antibody below detectable levels during pretransfusion testing

Antibody below detectable levels during pretransfusion testing

What is the main concern for obstetric patients in prenatal testing?

Antibody that causes hemolytic disease of the newborn (HDN)

____ ____ are designated by numbers following the locus symbol.

Antigenic specificities (e.g. HLA-A1)

Which of the following DOES NOT describe Lewis antigens?

Antigens are integral membrane glycolipids Le(a) and Le(b) are antithetical antigens Le(a+b-) phenotype is found in secretions

Multi-Valent

Antigens having more than one epitope

Most warm autoantibodies seem to be directed against which antigens?

Antigens in the Rh system

Which blood bank tests will be invalid in a patient with a positive direct antiglobulin test?

Any test requiring the indirect antiglobulin phase, for example, weak D testing. Since the RBCs are already sensitized, they will always agglutinate when antihuman globulin is added

The majority of platelets transfused in the United States today are:

Apheresis platelets

What transfusion therapy is indicated for a patient who is found to be refractory to random platelets?

Apheresis platelets from an HLA compatible donor

How is HES used in apheresis procedures?

As a sedimenting agent to separate white blood cells from red blood cells

How are 8 units of cryoprecipitate usually issued?

As one pooled unit

The Del phenotype is most commonly found in individual's of which ethnicity?

Asian

Middle cerebral artery-peak systolic velocity is used to:

Assess for anemia.

The antibodies most likely to be detected in the saline phase of an antibody screen/panel are: A. ABO antibodies B. Anti-P1 C. Anti-D D. Anti-Kell

B. Anti-P1

The first step in the crossmatch procedure after identification of antibodies in the patient serum is to: A. perform DAT on patient cells and donor units B. antigen type patient cells and donor units C. adsorb any antibody from the patient serum D. obtain different enhancement medium for testing

B. antigen type patient cells and donor units

What are the advantages of gel technology?

Better standardization, increased sensitivity, and clearer end-points. Tube shaking, cell washing, red cell resuspension, and antiglobulin controls are not required. Reactions are stable for 24 hours. Gel technology can now be automated. Gels are available for antigen typing, antibody detection and identification, and crossmatching.

Which races have the higher percentage of group B?

Blacks and Chinese

In preparing anti-IgG, how is excess antibody removed for titer adjustment?

Block titration

Which of the following statements best describes the apheresis concept?

Blood is removed from an individual and separated, the desired component is retained, and the remaining portions of are returned to the donor/patient.

Which of the following statements best describes the apheresis concept?

Blood is removed from and individual- ANTICOAGULATED- & separated- the desired component is retained AND THE Remaining portions are returned to the donor/patient

do Ab screen on

Blood transfusion pt OB pt (those that are pregnant or looking to get pregnant) Donors (blood, organ, tissue)

All of the following constitute variables of apheresis procedures EXCEPT

Blood type

Why is the increase in hemoglobin and hematocrit evident more quickly in red cell transfusions than in whole blood transfusions?

Blood volume adjustment is less when red blood cells are transfused

Which type of transplantation requires all cellular blood components to be irradiated?

Bone marrow

R1 and r' correlates to

C

Which of the following Rh phenotypes invites Cw antigen testing?

C+c-

An acute phase protein that binds to the membrane of certain microorganisms and activates the compliment system is:

C-reactive protein

Which of the following is known as the "recogntion unit" in the classical complement pathway?

C1q

At what stage does the complement system reach its full amplitude?

C3

All of the following complement proteins can be found on the red blood cell membrane except:

C4a

Which of the following activated molecules is known as C3 convertase?

C4b2a

Which of the following is known as the "membrane attack complex" in the classical complement pathway?

C5b, C6, C7, C8, C9

Which of the following is known as the "membrane attack complex" in the classical complement pathway?

C5b. C6, C7, C8, C9

What method used to determine HLA types is only a low-resolution method?

CDC (Complement-dependent cytotoxicty)

Fisher Race

CDE terminology -5 major Ag -inherited as a set of 3 genes -depending on how they are inherited, thats what we end up with -this is what we use alot in the BB because they are the reagents we use to Ag type pts and packed RBC -3 closely linked genes -each gene is responsible for the expression of 1 Ag and then Ag on the surface of the red cell

Wiener to Fisher-Race translation: z or y =

CE

Like Lewis Ab's, ____ Ab's can be neutralized or inhibited by plasma positive for the Ag.

CH/RG

All of the following viral tests are required for donor processing EXCEPT

CMV

All of the following viral tests are required for donor processing except

CMV

besides an ABO RH and antibody screen all of the following test must be performed on

CMV

Which of the following anticoagulant preservatives provides a storage time of 35 days at 1-6˚C for units of whole blood and prepared RBCs if an additive solution is not added? - ACD-A - CP2D - CPD - CPDA-1

CPDA-1

An intern calls the laboratory. He is concerned with a patient that has an autoimmune disease. He wishes to order a test that would most rapidly show changes if the treatment provided is appropriate. What test would you suggest to use to monitor the patient?

CRP

___ = autosomal dominant condition which leads to a permanent polyagglutinable state.

Cad

In selecting cells to use as a positive control for anti-c typing serum, which of the following would be the best choice: CC, Cc, or cc?

Cc. They will test the ability of the antiserum to detect the antigen in the heterozygous state.

Based on the following phenotypes, which pair of cells would make the best screening cells?

Cell 1: Group O, D+C+c-E-e+, K+, Fy(a-b+), Jk(a-b+), M-N+S-s+ Cell 2: Group O, D- C-c+E+e-, K-, Fy(a+b-), Jk(a+b-), M+N-S+s-

Gel method

Contains IgG -screen cells are suspended with LISS -concentration of 0.8% (tube method screening cells are 2-5%

What testing should be performed after blood has been issued on emergency release?

Continue the crossmatch; report antibodies or incompatibilities

The antihuman globulin (AHG) test was discovered in 1945 by whom?

Coombs

How do you diagnosis and manage HDFN?

Cooperation between -Pregnant patient -Obstetrician -Baby's father: related discussion: at LGH, we discourage male sexual partners of women of child bearing age from being directed donors for these women -clinical laboratory

It is most important to perform weak D testing in which of the following blood bank test groupings?

Cord blood evaluation

What specimen(s) can be used for ABO grouping of a newborn?

Cord blood, capillary blood, or venous blood

Conventional tube testing in AHG testing has one distinct advantage over gel testing, Identify the advantage.

Cost

All of the following are intermolecular interactions that occur between antigen and the FAB region of an antibody EXCEPT:

Covalent interactions

Rh1

D

Clinically significant antibodies

D,C,E,c,e,K,Fy,Jk,S,s,Lea,Leb IgG's immune Ab can cross the placenta

Greatest number of D Ag sites are on the cells of the rare phenotype ____.

D--

What is the terminal sugar on the B antigen?

D-galactose.

Anti-LW reacts ___ with D-positive RBCs, ____ with Rh-negative RBCs, and ___ with Rh null cells.

D-positive RBCs: strongly Rh-negative RBCs: weakly Rh null cells: never

If a patient has an anti-D antibody in his/her serum and is crossmatch with an Rh neg (rr) donor: A. the major crossmatch will be incompatible B. only minor crossmatch will be incompatible C. both major & minor crossmatch will not be compatible D. both major & minor crosswatch will be compatible

D. both major & minor crosswatch will be compatible

INTERPRETATION: If an O negative whole blood donor unit is transfused into an A positive patient, the crossmatch would be: A. compatible major & minor sides B. incompatible major & minor sides C. incompatible major side only D. incompatible minor side only

D. incompatible minor side only

A 27 year old Group O mother has just given birth to a beautiful Group A baby girl. Since the mothe has IgG anti-A in her plasma, it is likely that the baby is experiencing some in vivo red cell destruction. Which of the following methods and tests would be most effective at detecting the anti-A on the baby's RBCs?

DAT using gel

A 27-year-old group O mother has just given birth to a beautiful, group A baby girl. Since the mother has IgG anti-A in her plasma, it is likely that the baby is experiencing some in vivo red cell destruction. Which of the following methods and tests would be most effective at detecting the anti-A on the baby's RBCs?

DAT using gel

Which of the following methods and tests would be most effective at detecting the anti-A on a baby's RBC with a mother who is group O and has IgG anti-A in plasma?

DAT using gel

How might transfusion of non-group specific blood affect subsequent blood grouping results?

Donor cells are detectable in the recipient for up to four months, the life span of an RBC. Front grouping reactions may be weak or mixed-field if group O cells have been transfused to a patient of another group. Passive anti-A and/or anti-B might be detected in reverse grouping if large volumes of group O RBCs have been transfused to patient of another group.

During pretransfusion testing, it's discovered that a patient has anti-K. What additional step is required prior to crossmatching units of blood for this recipient?

Donor units must be screened for the K antigen. Only K negative unites should be selected for crossmatch.

Which of the following donors is acceptable? - Donor who had first trimester therapeutic abortion 4 weeks ago - Donor whose husband is a hemophiliac who regularly recieved cryotherapy before 1989 - Donor who was treated for gonorrhea 6 months ago - Donor who has a needlestick injury 10 months ago

Donor who had first trimester therapeutic abortion 4 weeks ago

Which antigens seem to be required in order for the parasite <i>Plasmodium vivax</i>to invade the RBCs?

Duffy

Which blood group system is associated with resistance to P. vivax malaria?

Duffy

Which antigen(s) is(are) destroyed by enzymes?

Duffy (Fy a and b) MN

Which blood group is associated with resistance to P. vivax

Duffy (Fy)

Which antigen is destroyed by enzyme?

Duffy, MNS (Fya)

Enzymes inactivate

Duffy, MNS, Xga

A woman requires a kidney tranplant. Five members of her family would like to be tested to determine if they are eligible donors. Technologists use sequence-specific oligonucleotide probe hybridization methods to perform HLA typing. What anticoagulant is preferred when collecting blood from the woman and her family?

EDTA (ethylenediaminetetraacetic acid)

What specimen is required for an elution?

EDTA RBCs

Why is it preferred EDTA plasma over serum?

EDTA plasma binds complement while serum doesn't.

What quality control is required of reagents used daily?

Each day of use reagents must be tested to determine if they have been contaminated or lost their potency. Positive and negative controls must be performed.

What is a possible consequence of incubating tubes too long with LISS when performing the IAT?

Elution of antibody from red blood cells

What effect does a low pH have on a saline AHG test?

Enhances antibody elution

Select the tern that describes the unique confirmation of the antigen that allows reognition by a corresponding antibody

Epitope

In PCR-SSOP methods for HLA typing, the primers used to amplify the region are complementary to sequences present in which exon of the class II genes?

Exon 2

In innate immunity, cytokines stimulate proliferation and diffraction of antigen-stimulated lymphocytes and active special effector cells

FALSE

T/F: A positive DAT result in a patient transfused within the past 3 months is not significant.

FALSE! It may indicate a delayed hemolytic transfusion recation (DHTR).

Anti-IgG is specific for what part of the IgG molecule?

FC fragment

A suspected transfusion related death must be reported to

FDA

All blood banks in the United States are regulated by what agency?

FDA

T/F: It is not possible to observe mixed field agglutinations in Ab screen with pooled cells of blood donors.

False: Target Ags may only be expressed on one cell in the pool.

Early manifestation of an acute hemolytic transfusion reaction can be confused with

Febrile nonhemolytic reaction

Immunization and production of antibodies

Fetomaternal Bleed Pregnant women is now sensitized to a red cell antigen (IgG antibody Note: sensitization can also occur via tx

Are there more, fewer, or equal numbers of HLA alleles that have been identified by serological methods as compared with DNA analysis method?

Fewer

Name the enzymes used in blood banking.

Ficin, papain, bromelin, and trypsin.

DCE = ____ nomenclature.

Fisher-Race

Proteins can be separated into this many number of fractions by the use of serum electrophoresis

Five

The hepatitis C virus is thought to be included in which family?

Flaviviridae

RhIG is given without regard for fetal Rh type in all of the following conditions except

Full term delivery

RhIG is given without regard for fetal Rh type in all of the following conditions except:

Full-term delivery.

What is the ABO group of the cells used in antibody screens and panels? Why?

Group O, to eliminate reactions caused by anti-A and/or anti-B in the serum being tested.

A world traveler came to do a directed donation for his sister when he found out she needed surgery for her hip. After spending 5 weeks in Europe, he traveled extensively thoughout Africa. How should his case be handled?

He would not be able to donate because all directed donors must meet the same criteria as allogenic donors.

Factors that can denature, coagulate, or alter protein molecules include:

Heat and Bacteria (Both A an B)

The cytomegalovirus and Epstein-Barr virus belong to which family of viruses?

Herpesviridae

Which of the following is not a clinical application for a direct antiglobulin test?

Heterophile detection

What department evaluates and certifies employee credentials and determines the literacy of the employee?

Human Resources

HLA is an abbreviation for what term?

Human leukocyte antigen

How is polyclonal antiglobulin serum made?

Human serum is injected into rabbits, and an immune response triggers the production of an antibody

Most Duffy Ab's are Ig__.

IgG

Most HLA Ab's are Ig__.

IgG

Most Rh antibodies are of what immunoglobulin class?

IgG

Rh antibodies are primarily of which antiglobulin class?

IgG

The majority of HLA alloantibodies are _______ immunoglobulins

IgG

Which class of antibodies are considered clinically significant?

IgG

Which immunoglobulin class can cross the placenta?

IgG

CS Ab

IgG -reacting in vivo (within body) -cause decreased red cell survival -activates complement -destroy Ab coated red cells by HTR (hemolytic transfusion reactions) and HDFN (hemolytic disease of the fetus and newborn)

Which IgG subclasses carry the most significance with regard to Rh antibodies?

IgG1/IgG3

The major immunoglobulin class(es) of anti-B in a group A individual is (are):

IgM

What class of antibodies are ABO

IgM

Which immunoglobulin class is most efficient at activating complement?

IgM

Which of the following immunoglobulins is most efficient at binding complement>

IgM

Which of the following immunoglobulins is most efficient at binding complement?

IgM

Which of the following immunoglobulins is produced in the primary immune response?

IgM

A patient came in for a routine type and screen prior to surgery. The antibody screen was negative at 37°C and at the AHG phase. Check cells did not produce agglutination often. What is a possible explanation for this result?

Inadequate washing

A patient came in for a routine type and screen prior to surgery. the antibody screen was negative at 37C and at the AHG phase. Check cells did not produce agglutination often. What is a possible explanation for this result?

Inadequate washing

All of the following may occur following an Rh-mediated hemolytic transfusion reaction except:

Intravascular hemolysis

What can be done to prevent the development of HLA alloimmunization and platelet refractoriness?

Irradiate the platelet concentrate

Select the appropriate product for a bone marrow transplant patient with anemia

Irradiated RBCs

Select the appropriate product for a bone marrow transplant patient with anemia:

Irradiated RBCs

How can GVHD be prevented in transplant recipients

Irradiation of cellular components

K₀ RBCs are Js(a_b_)

Js(a-b-)

All of the following antigens are found on reagent screening cells except:

Jsa

_____ tests for MLR

MLC

Ab destroyed by enzyme

MNS, duffy

IgM agglutination in antiglobulin phase

NO

IgM worry about HDFN?

NO

IgM ability to cross the placenta

NO - too big

What percentage of Rh-negative children would be expected from an R¹R¹ mother and an R¹r father?

None, All offspring would be Rh positive.

Why is the 37C reading omitted when using PEG additive?

PEG may cause aggregation of RBCs at 37C

Of the three following categories of altered D antigen, in which variation of D antigen expression are you more likely to encounter an all-anti-D?

Partial D

Identify the antibodies in the following cold panel: <br> p293, 25

Patient 1 has an anti-I. It reacts strongly with all adult cells, except the i adult cells, and weakly with cord cells. Patient 2 has anti-I since the reactions are strongest with the i adult cells and cord cells. Patient 3 has anti-A₁. Additional cells should be tested to reach the 95% confidence limit.

You are working on a specimen in the laboratory that you believe to be a Bombay phenotype. Which os the following reactions would you expect to see?

Patient cells + Ulex europaeus = no agglutination

Why is rouleaux not usually found in the AHG phase of antibody screens?

Patient serum is washed away before adding AHG

Which patient is most likely to require irradiated blood products?

Patient undergoing a bone marrow transplant

Which of the following may not be used as a patient identifier?

Patient's room number

Which of the following is not involved in the acquired or adaptive immune response? - Phagocytosis - Production of antibody or complement - Induction of immunologic response - Accelerated immune response upon subsequent exposure to antigen

Phagocytosis

Which blood product should be selected for vitamin K deficiency?

Plasma (FFP)

Duffy antigens are in some way associated with the invasion with:

Plasmodium species

When a constant amount of antigen is mixed with an increasing amount of antibody, until no agglutination occurs, this effect is referred to as the :

Post-zone phenomenon

Which of the following refers to the effect of an excess amount of antigen present in a test system?

Postzone

The aggregation of soluble test antigens

Precipitation is the term applied to:

What doe the "R" represent in the Rh-Hr terminology?

Presence of D antigen

What effect does aspirin have on platelets?

Prevents platelet aggregation

While performing an antibody identification panel, the blood bank technologist observes agglutination with all panel cells and the autocontrol at 37°C, but no agglutination in the indirect antiglobulin phase. What might account for these findings?

Probably rouleaux. The patient's serum causes pseudoagglutination of all cells, including his own. The pseudoagglutination is dispersed by saline during the indirect antiglobulin phase.

In a changing environment, indirect immunofluorescent assay (IFA) has been replaced with enzyme immunoassay (EIA). A disadvantage of this trade-of is:

Problematic for patients with less than a 1:160 antinuclear antibody (ANA) Titer

Wiener nomenclature: ___ = Dce

R0

Cold-reactive autoantibodies can be selectively removed from patient serum by adsorption with autologous red blood cells (RBCs). What other cells can be used?

Rabbit RBCs

Explain the principle of gel technology.

Rather than using traditional test tubes, cards containing microtubes are used. Each microtube contains gel particles and a reagent specific for the test being performed. Following addition of serum or cells, the cards are incubated and centrifuged. If agglutination has occurred, the agglutination complexes are trapped in the gel; non-agglutinated cells settle to the bottom of the microtube. Reactions are scored from 0-4+ depending on the disbursement of the red cells in the microtube.

Which does not represent requirements set forth by the AABB for the performance of a computer crossmatch? - Computer system must be validated on site - Two determinations of the recipient ABO and Rh must be performed - Computer system must have logic - recipient antibody screen must be positive

Recipient antibody screen must be positive

Describe "crossmatching" by CDC of recipient serum and donor lymphocytes for organ transplant

Recipient serum is tested for pre-existing antibodies directed against antigens on donor lymphocytes by complement-dependent cytotoxicity

False-positive DAT results are most often associated wihth:

Refrigerated clotted blood samples in which complement components coat RBCs in vitro

An elevated antistreptolysin O (ASO) titer indicates:

Relatively recent streptococcal infection

In warm autoimmune hemolytic anemia, the autoantibody will frequently demonstrate _________ -like specificity

Rh

What do Rhnull cells lack

Rh antigens

DCE

RzRz R2ry

What is the most common genotype for Rh positives?

R¹r

Which Rh typing reagent can not be used for weak D typing?

Saline anti-D. It's predominately IgM and not appropriate for indirect antiglobulin testing.

RBC aliquots

Sheld=f life: CPDA1: 35 days (closed system) Temp: 1-6C Use: increase O2

Whole blood

Shelf life: CPD, CP2D, ACD: 21 days CPDA1: 35 days Temp: 1-6 Use: Volume expansion, increas O2 Content: RBC, Plasma, Platlets, WBC

FFP

Shelf: 1 yr @ -18˚C 7yr @ - 65˚C Use: Coag deficiency, liver disease, DIC, massive transfusion

Cryoprecipitate

Shelf: Frozen (-18˚C): 1 yr Thawed: 6 hours (20-24) Pooled: 4 hours Use: Hemophilia A, VWD, FXIII deficiency, Fibrin sealant, Hypofibrinogenemia Content: FVIII(8), vWF, FXIII(13), Fibrinogen

Life span of the fetal/neonatal red cells is

Shortened due to maternal allo-antibodies against red cell antigens [which the baby would acquire from the father]

What would be a realistic source of finding compatible units for a person with an antibody to a high-frequency antigen?

Siblings

Interpretation: All cells reacted at the same phase and strength.

Single Ab

What does the term exalted D refer to?

Stronger expression of D antigens when Cc and Ee are missing

Transcription can be defined as

Synthesis of RNA using DNA as a template

T or F: Rh Ag's are highly immunogenic.

T

T/F: Diego Ab's can cause HTR and HDN.

T

Which of the following cells is involved in antigen recognition following phagocytosis?

T lymphocytes

How is HLA serologic testing performed?

T lymphocytes are harvested and introduced to a panel of test sera specific for antigens of the HLA system.

With febrile nonhemolytic transfusion reactions

THey are self limited Fever resolves within 2-3 hours

Single Immunodiffusuin

Technique in which one of the reactants remains fixed in the gel and the other is allowed to move or interact with the reagent that is immobilized

Reverse Agglutination

Test in which the biological fluid is tested for the presence Antigen

What is the primary focus of quality assurance?

To amend the system, procedure, or standard operating procedures, if deemed faulty

What is the main purpose of linking Current Good Manufacturing Practices (CGMPs) to process control?

To build quality into the manufacturing process from the beginning to the end

What is the purpose of the immediate spin crossmatch?

To detect ABO incompatibility between the patient and donor

Why is an RH control included when using high-protein Rh typing sera?

To detect false positive reactions.

What is the primary objective of the major crossmatch?

To detect the presence of antibody in the reciptient's serum

A history check of the patent is one of the requirements according to AABB for part of the ore

True

An ABO antibody will cause a more severe hemolytic transfusion reaction in a patient who has received mismatched blood than an alloantibody will

True

True or False: For Ab screen in blood donors it is acceptable to use a pooled screening reagent that contains cells from at least 2 different individuals.

True

Zeta potential is defined as: The difference in charge density between the inner & outer layers of the ionic cloud that surrounds red blood cells in an electrolyte solution True or False

True

Sequence-specific PCR using allele-specific primers and primers for an amplification control has been performed on DNA isolated from a patient requiring bone marrow transplantation. Analysis of the reaction by gel electrophoresis reveals the presence of tow bands in a gel lane. How is this interpreted?

True positive

In HLA serologic testing, how are cytotoxic effects of antigen-antibody interactions detected?

Trypan blue or eosin stains the cells because of loss of membrane integrity.

Which organism is responsible for transmitting Chagas disease?

Trypanosoma cruzi

Antibody Detection Methods

Tube Gel Solid phase red cell adherence Liquid microwell.

When a recessive trait is expressed, it means that

Two genes carrying the trait were present

A kleihaur betke test of flow cytometry indicates 10 fetal cells per 1,000 adult cells. For a woman with 5,000 mL blood volume, the proper dose of RhIG is

Two regular dose vials, plus one (# of fetal cells x maternal blood volume) / number of maternal cells = volume of fetomaternal hemorrhage Divide by 30 to determine # of vials of RhIG

A Kleihauer-Betke test or flow cytometry indicates 10 fetal cells per 1,000 adult cells. For a woman with 5,000 mL blood volume, the proper dose of RhIG is:

Two regular-dose vials, plus one.

False positive DAT results are most often associated with

Use of refrigerated, clotted blood samples in which complement components coat RBCs in vitro

False-positive DAT results are most often associated with:

Use of refrigerated, clotted blood samples in which complement components coat RBCs in vitro.

Nonimmune hemolysis can be caused during transfusion by

Use of small bore size needle Use of an infusion pump Improper use of a blood warmer

Anti-c

Usually less severe than Rh (D) HDN

PCR technology can be used to

amplify small amounts of DNA

Recipient serum that reacted with one out of five donor units in the AHG phase and where the antibody screen was negative is probably due to

an alloantibody directed agains a low-frequency antigen

The endpoint of the SPRCA test is detected by

attachment of indicator cells

Autocontrol positive

autoantibody

In resolving Type I discrepancies, always run an ___ and ___ cells.

autocontrol and O cells

Autoantibody

autocontrol is positive -antibody directed against the individuals own antigen

The anticoagulant added to blood as it is removed from a donor or patient during apheresis procedure acts by

binding calcium ions

BO hh Sese

bombay Ag on red cells = None (no H Ag) so nothing Ag is saliva = None (even though secretor they are bombay)

Rh4

c

Anti-Sda has been identified in patient ALF. What substance would neutralize this antibody and allow detection of other alloantibodies?

c. Urine

ryr"

dCE/dcE

Duffy Ag's are _____ by papain, bromelin, ficin, chymotrypsin, and ZZAP.

destroyed

Lutheran Ab

destroyed by enzymes

HLA gene products are ____ ______ composed of two non-covalently linked chains, class __ and class __.

globular glycoproteins; class I and class II

Kell Ag's are located on a RBC _____.

glycoprotein

the least commonly encountered group of discrepancies

group 2

12 month deferral

major surgery - blood products required

Bg Ab's are considered _____ Ab's.

nuisance

The onset of warm autoimmune hemolytic anemia (WAIHA) may be precipitated by:

trauma

Granulocyte concentrates follow the same compatibility protocol as packed RBCs?

true

Reverse/Back Typing

-pts serum or plasma is tested with commercially prepared red blood cell reagents -red cells are Rh negative red cells -have known Ag on them -Direct agglutination -So the pts serum or plasma, we add A1 cells and B cells. A1 cells have A1 Ag on them and B cells have B Ag on them

Immunogenicity

-some antigens elicit stronger response D>K>c>E, etc... -Anti-K is the next most severe after anti-D (remember Kell antigen is well developed on fetal cells)

Uni-Determinant

All epitopes on one Antigen are the same

A cord blood specimen from a jaundiced infant should be tested for which of the following?

All of the above

What class of antibody can be present in AHG?

All of the above IgG, IgA, IgM

How can the sensitivity of antibody detection be increased?

All of the above Increase the ratio of patient serum to screening cells. Extend the incubation time. Add potentiators such as albumin.

False-negative results in anti-human globulin testing can be caused by:

All of the above Over-centrifugation Under-centrifugation Cell suspensions that are too weak or too heavy

What clinical manifestation may be associated with the Rh-null syndrome?

All of the above Reticulocytosis Low hemoglobin Stomatocytosis

Nucleic acid amplification testing (NAT) is used to test donor blood for which of the following infectious diseases? - Hep C - HIV - West Nile Virus

All of the above (Hep C, HIV, WNV)

Antigens must be multi-determinant

All of the following conditions are required for the precipitation of antigen/antibody complexes except:

It is capable of crossing the maternal fetal placental barrier

All of the following conditions are true about IgM EXCEPT:

Whole blood and RBC units are stored at what temperature?

1˚C to 6˚C

A crossmatch for 2 units is received for a patient with anti-E, the calculation would be:

2 units/0.70 (freq of E neg individuals)= 2.8 3 units would be need to be typed for E in order to find 2 E neg units.

In order to be considered fresh frozen plasma, the plasma needs to be prepared within how many hours of collection?

8 hours

Packed RBCs must have a final hematocrit of less than or equal to:

80%

The Rh antibody agglutinates what percentage of RBCs?

85%

K frequency = __%

9%

Chinese: __% Fy(a+b-)

90%

The platelet count of the plateletpheresis donor must be ________ prior to the procedure.

>150 × 109 per L

Rzr

DCE/dce

R0r

Dce/dce

Which of the following viral tests ARE required for donor processing

HbsAg anti-HIV anti-HTLV-1

Which Ags may present variable expression?

I, P1, Lea, Leb, Vel, Ch/Rg, and Sda Ags are expressed more strongly on some cells than on others.

I antigen

I-developed seen only in adults, I-fetal seen mostly in cord, IgM Ab, cold autoantibody

A patient is discovered to have anti-Fya in their serum. The medical technologist needs to phenotype the patient's cells for the corresponding antigen. What test is appropriate for phenotyping?

IAT

An in vitro phenomenon associate with a positive IAT is

ID of alloantibody specificity using a panel of reagent RBCs

Factor IX concentrates contain which factors (otherwise known os "prothrombin complex")

II, VIII, IX, X

Causes of Group ___ discrepancies: 1) multiple myeloma or Waldenstroms macroglobulinemia 2) fibrinogen 3) expanders 4) Wharton's jelly

III

Rouleax formation is a Group __ discrepancy.

III

IgG complete or incomplete?

INCOMPLETE antibodies- means you have to add something to your test to bring those Ab together

rare antibodies that cause HDFN

Anti-Fya, Anti-s, Anti-M, Anti-N, Anti-S, Anti-Jka

Plasma Ab for Type A (phenotype)

B

Plasma Ab for Type O (phenotype)

B A

Trending management techniques

Color Doppler Middle Cerebral Artery Peak Systolic Velocity (MCA-PVS): - Ultrasound of fetal middle cerebral artery - Measures arterial blood flow - detects reduced viscosity/faster velocity seen at lower hematocrits -plotted on graph to determine critical point for cordocentesis

Name two new methods that are being used in blood bank testing.

Column (gel) technology and solid phase red cell adherence (SPRCA). Both of these methods can be automated.

What is an "electronic" crossmatch?

Comparison of donor and patient ABO groups and serologic data from a computer file

If Abs are detected on donor Ab screen, which components don't need to be labeled with the identified Ab?

Cryoprecipitate Washed or frozen deglycerolyzed RBCs

Wiener to Fisher-Race translation: R =

D

Immunogenicity

D > G > c > E > C > e

(0) anti-D initial spin (0) anti-D IAT Rh control (0)

D negative

Which of the following characteristics best describes Lewis antibodies?

IgM Naturally occurring do NOT cause HDFN

anti-Lu a is Ig__.

IgM ( => no HDN)

ABO Immunoglobulin

IgM (some IgG - group O)

Immunoglobulin class(es) of Rh Ab's:

IgM and IgG

Anti-A and anti-B usually belong to which immunoglobulin class?

In group A and B individuals, predominantly IgM. IgG is the predominant class in group O individuals.

Weak D: ______ = one or more of D epitopes is missing and/or altered.

Partial D (D mosaic)

In HDFN, the IgG antibodies are directed against which antigen on the fetal red blood cells?

Paternal

The ____ gene is neccessary for expression of Rh Ag's.

RHAG

IgM temperature

ROOM TEMP or BELOW (will react better at colder temperatures

What is the treatment for Intrauerine Transfusions?

Indication: -correct fetal anemia: Hgb <10gm/dl -Amniotic fluid delta OD450 results are high -hydrops fetalis noted on ultrasound -24-26 week gestation -repeated every 2-4 weeks until delivery > Intrauterine tx may actually suppress fetal BM rbc production: require post natal tx > Invasive procedures can actually increase mom's aby titer

Weak D test requires

Indirect Antiglobulin test

Proteins and peptides are composed of

Linear arrangements of amino acids

A request for 8 units of packed RBCs was received for patient LF. The patient has a negative antibody screen, but one of the 8 units was 3+ incompatible at the AHG phase. Which of the following antibodies may be the cause?

Low frequency anti-Kpa

Most common Lutheran phenotype (92.35%) : Lu (a_b_)

Lu (a-b+)

Lu_ is low frequency.

Lu a

These two warm group antibodies are IgM: anti-___ and anti-___ (naturally-occurring; associated with bacterial infections.)

Lu a and K

What is the terminal sugar on the A antigen?

N-acetylgalactosamine.

ABO fully developed at birth?

NO -be careful if we're detecting mom or maternal Ab

Is the production of an antibody always of seriuous consequence to an individual?

No, because the individual does not possess the corresponding antigen. A problem might arise with future transfusions or pregnancies, if the individual is exposed to RBCs possessing the corresponding antigen.

An ABO type on a patient gives the following reactions: Patient Cells With Anti-A (4+) Anti-B (neg) Patient Serum With A1 cells (2+) B cells (4+) O cells (2+) Autocontrol (neg) These results are most likely due to:

Non-ABO alloantibody

A unit of Rh-positive blood is erroneously typed as Rh negative. Will this mistake be caught in the crossmatch?

Not unless the Rh-negative recipient has anti-D.

Sc_ is high-incidence.

Sc1

testing required on cord blood in the diagnosis of HDFN

Serological testing on newborns when: -Rh Negative Mom -Maternal antibody that causes HDFN -type "O" Mother Will confirm HDFN

HLA specificities were first defined in the laboratory based on what type of methodology?

Serology

RBC Frozen

Shelf: 10 years Temp: <= -65˚C Use: rare phenotypes, increase O2 Content: RBC, glycerol

If you had the authority to decide which primary AHG methodology to utilize in your lab, which method would you choose based on the knowledge that the majority of the staff are generalists?

Solid phase or gel

What is the relationship between the H gene and the A and B genes?

The H gene produces the H substance which is the precursor for the products of the A and B genes (A and B antigens).

What are monoclonal blood banking reagents?

They are reagents produced in the laboratory that are more specific and more sensitive than human-derived counterparts.

Do a and Do b are ____ Ag's.

antithetical

The most sensitive test for the detection of HIV infection is the:

polymerase chain reaction

What is the most common genotype for Rh negatives?

rr

Limitations of Ab screen

-does NOT detect ABO incompatibility -does NOT detect Ab to Ag that are not on the screening cells -does NOT detect Ab that have a low titer -review pt history always!!

A male patient of average size has a hemoglobin count of 8.1 g/dl. The surgeon wants a hemoglobin count of 10 g/dl before doing surgery. How many units of RBCs need to be given before the surgeon will accept the patient into surgery?

2

What is the incubation time for the IAT when saline is used instead of LISS?

30 minutes

What is the frequency of E antigen in the general population?

30%

Plasma Ab for Type B (phenotype)

A

What might not be detected in the serum of a patient with a warm autoantibody?

A clinically significant alloantibody may be masked by the autoantibody.

Which of the following reagents or methods is best for categorizing partial D types?

A combination of serolofical typing and molecular analysis

What is Rh Immune Globulin?

A concentrate of predominately IgG anti-D developed from pools of human plasm (one trade name is RhoGam)

Which is true regarding compatibility testing for the infant younger than 4 months old?

A crossmatch is not needed with the infants blood when unexpected antibodies are present

An immediate spin crossmatch was performed using recipient serum and donor cells from group AB unit. At immediate spin, the reaction was 4+. What was the reason for this positive reaction?

ABO incompatibility

Which Abs are known for causing in-vitro hemolysis?

Anti-Lea Anti-Leb Anti-PP1Pk Anti-Vel

A phlebotomist enters a patient room to draw blood for a 2-unit crossmatch. The patient is not wearing a wristband. how can the patient be identified?

Ask patient to state their full name, address, and social security number and match responses to information on requisition form

How do Rh antibodies typically react?

At 37°C and/or the antiglobulin phase.

The test that detects cells that have been coated with antibody in-vivo is: A. forward B. reverse C. DAT D. Ab screen

C. DAT

Why are hemolyzed samples unacceptable for compatibility testing?

Complement activation by antigen-andtibody complexes will be masked

Why are hemolyzed samples unacceptable for compatibility testing?

Complement activation by antigen-antibody complexes will be masked

A normal healthy donor undergoes a procedure to obtain platelets that will be transfused to a patient is representative of:

Component apheresis collection

This disease can be transmitted through blood transfusion and is characterized by sponge-like lesions of the brain.

Creutzfeldt-Jakob disease

Cord blood Rh typing

Critical for babies of Rh neg moms -if baby is Rh NEG, mother is not candidate for RhIg -IF baby Rh Positive >mother IS potentially a candidate for RhIg >Potential for Rh HDFN if mom's serum contains Anti-D

____ null phenotype associated with chronic intestinal conditions.

Cromer

Laboratory diagnosis of S. Pyogenes can be made by:

Culturing of throat or nasal specimens, ASO procedure, Anti-DNase B (SDN-B)...ALL OF THE ABOVE is correct

The meniscus is the:

Curvature in the top surface of a liquid

Antigens on antibody identification panels with low frequency: __,__,__,__, and __.

Cw, V, Kp a, Js a, Lu a

Which Rh antigen determines Rh type?

D (Rh₀). The presence of the D antigen denotes Rh-positive blood.

NO __ Ag

D Ag d is used for the absence of the D Ag -Rh negative

Which of the following antibodies will not cause HDFN a)I b)Kidd c)Lewis d) a and c only

D) a and c only (I and Lewis)

Which of the following methods may be employed to remove IgG antibodies that are coating a patient's red blood cells?

Elution

Rh antibodies have been associated with which of the following clinical conditions?

Erythroblastosis fetalis

Having checked the patient's prior history after having received the specimen and request you,

Have to compare the results of your ABO Rh and IAT with the previous results

Having checked to patients prior history after having received the specimen and request you:

Have to compare the results of your ABO, Rh, IAT with previous results

CH

Which region determines the class of an immunoglobulin molecule?

Liquid plasma is not indicated for factor ____ deficiency

XI

IgM activation of complement

Yes-very efficient BEST

The most important step in the safe administration of blood is to

accurately identify the donor unit and intended recipient

AB forward; A reverse => _____ ___

acquired B

Forward grouping = AB; Reverse grouping = A => ____ ____

acquired B (Type II discrepancy)

Solid-phase antibody screening is based on

adherence

A technician receives a phone call in the middle of washing for an antiglobulin test. She can't remember if she was on the second or third wash. What should she do?

Wash again. False reactions only occur from underwashing, not overwashing

What component is indicated for patients who have had moderate to severe allergic transfusion reactions and have anti-IgA antibodies because of IgA deficiency?

Washed RBCs

What are private epitopes?

Molecules that bind to one specific HLA antibody type

What are blood group antigens?

Most blood group antigens are proteins, glycoproteins, or glycolipids embedded in or protruding from the RBC membrane. Lewis antigens are an exception. They are soluble substances in the plasma that are absorbed from plasma onto the RBC membrane. Antigens are also known as agglutinogens or immunogens.

What conditions must be met for a woman to be considered a candidate for rhogam (RhIg)

Mother is Rh - and fetus is Rh +

A gel microtube shows a well-delineated pellet at the bottom following incubation and centrifugation. How should this reaction be graded?

Negative.

H (rbc) H (secretions)

OO Hh Sese

H (rbc) None (secretions)

OO Hh sese

father is type O, what are possible genotypes?

OO only

Which of the following information is not required for whole blood donors

Occupation

Translation of proteins from RNA takes place

On the ribosomes in the cytoplasm of the cell

How is an HLA haplotype inherited?

One haplotype (as a block of chromosomal sequence) is inherited from both the mother and the father

What protocol is put in place to validate Rh testing when high-protein reagents are used, especially when the patient types as an AB-positive?

Run a control with Rh test

Which Rh gene complex is common in Blacks and uncommon in Caucasians?

R⁰. (The frequency is 44% for Blacks and 4% for Caucasians.)

Which of the following methods used to determine HLA types always give high-resolution results?

SBT (Sequence-based typing)

Bone marrow is going to be transplanted from a man into his sister. What labroatory procedure should be performed prior to this transplant to determine the HLA alleles of the donor and recipient at the highest resolution?

SBT (sequence-based typing)

Granulocytes

SHelf: 24 hours Temp: 20-24 Use: Neutropenia, septic

Leukoreduced platelets

SHelf: 5 days Temp: 20-24 Use: Febrile reactions Content: < 5x10^6 SD < 8.3 x 10^5 RD

HDFN mechanism: most often involved

Rh and ABO blood group systems, but can result from any blood group system

__ and __ antibodies are enhanced by enzymes.

Rh and Kidd

2-7 days

Rh antibodies appear in serum ___ to ___ days after secondary exposure

120 days

Rh antibodies appear in serum _____ days after initial exposure.

All of the following are true regarding Rh antibodies except:

Rh antibodies can bind complement on the red blood cell membrane

What does Rh genotype refer to?

Rh genes inherited from both parents

AHG detects

Rh, Kell, Kidd, Duffy, s, Xga

Ab enhanced by enzyme

Rh, Kidd, Lewis, Anti-P, Anti-I

(0) Anti-D initial spin (+) anit-D IAT Rh Control (0)

Weak D positive

Majority of African Americans are Fy (a_b_).

Fy (a-b-)

Antibody titer

determines quantitative concentration of ABY -delta increase of 2 serial dilutions (endpoint) is significant [last "1+" reactive dilution] - Titers of 16 higher: pregnancy should be monitored with monthly titers >Perform amniocentesis: recommmended when aby titer is >16 -Marsh score Antibody titer alone cannot predict severity of HDFN

Rh Ab's (do/do not) bind complement.

do not

AB forward; O reverse => _____

polyagglutination

ABO discrepancies: _____ or _____ abnormalities lead to Rouleax formation.

protein or plasma

Biochemically speaking, what type of molecules are Rh antigens?

proteins (nonglycosylated)

Phenotype pt -> Ag typing -> do to confirm or deny that the Ab is a possibility -Negative

pt does not possess the Ag and so it is possible to make the antibody

Wiener nomenclature: ___ = dce

r

Platelets are stored on/in a(n) ____________, which provides constant agitation

rotator

All of the following may cause a false-negative reaction with Rh typing except:

rouleaux

Anti-c

second most frequently encountered Rh Ab

DNA is replicated

semiconservativiely from DNA

a high incidence of cis-AB is found where?

Japan

Lewis

absorbed onto RBC surface, influenced by secretor genes, causes hemolytic tx rx, IGM class but can react on all phases

anti-A, anti-B, A1 cells, B cells, O cells 4+ 2+ 0 4+ 0 could be: resolve this:

acquired B phenomena check for history of gastrointestinal problems; acidify anti-B typing reagent to pH 6 by adding 1N HCL to 1mL of anti-B antisera (will only agglutinate true B)

group 3 discrepancies which result in rouleaux formation or pseudo agglutination are due to :

elevated globulin levels from certain disease states such as multiple myeloma; Waldenstroms macroglobulinemia; Hodgkins lymphoma; elevated levels of fibrinogen; Whartons jelly found in cord blood; plasma expanders

Group 2 discrepancies are associated with unexpected reactions in the _________ grouping due to weakly reacting or missing ________

forward, antigens

Potentiator

substance that will enhance Ag-Ab reactions

Enzyme

technique to modify Ag on RBC (ficin, papain, bromelin, trypsin) - remove sialic acid from RBC membrane to enhance/destroy specific Ag

Rh Ag's are _____ polypeptides and are an integral part of the RBC membrane.

transmembrane

Blood donor and recipient samples used in crossmatching must be stored for a minimum of how many days following transfusion?

7

Blood transfused to infants (less than 4 months old) muss be less than ___ days hold.

7

Blood donor and recipient samples used in crossmatching must be stored for a minimum of how many days following transfusion?

7 days

Rosenfield Terminology

-numeric terminology -no genetic basis -no theory based on Rh inheritance -demonstrates the presence or absence of the Ag on the red cell -Assigns a number to each Ag of the Rh system -basically computerized date entry -it allows for the opportunity if your ID more, you just add on another number

Aminocentesis

-performed at 18-20 weeks gestation -titer endpoint is>32 (16?) dilution in titration -Concentration of bilirubin (for Liley Graph) -Spectrophotometric scan -Indirect method >Increase or unchanged OD as pregnancy advances shows worsening of the fetal hemolytic disease -Not used as frequently anymore due to invasive procedure -Amt of Bilirubin in amniotic fluid >A good indicator of intrauterine hemolysis and fetal well-being -A change in optical density >value of the amniotic fluid in the upper mid zone of a Liley graph indicates the need for fetal blood sampling

Ab screen performed to detect Ab in

-pts requiring transfusion -women who are pregnant or after delivery -pts with a suspected transfusion rxn -donors -DONE TO DETECT AS MANY POTENTIALLY CLINICALLY SIGNIFICANT ANTIBODIES AS POSSIBLE IN THE PLASMA OF OUR DONORS AND OUR PATIENTS -pts serum or plasma is tested against red cells with known Ag

A 28 year old female is being admitted for a surgical procedure to clear the uterus (D and C) after the patent experienced a spontaneous abortion... the following type and screen was obtained Anti A 0 Anti B 4+ Anti D 0 RH control 0 A1 4+ B cells 0 selectogen I II III 0 0 3+AHG phase

B negative with a positive antibody screen

INTERPRETATION: Check cells were added to all negative tubes in the last step of the AHG phase of a crossmatch. After addition of the check cells, all the tubes are negative. The most likely explanation is: A. AHG results are valid B. AHG was neutralized C. cells were contaminated D. test results can be reported

B. AHG was neutralized

Which of the following are not at risk for developing CMV via CMV positive blood products

CMV- positive heart transplant recipients

IgM complete or incomplete?

COMPLETE - big enough that all ew have to do is centrifuge and we get agglutination -blood type just spin and done

Anti-D is clinically significant because it:

Can cause hemolytic transfusion reactions

The ____ and the ____ are not like everyone else. They are just ____. a = high-incidence and b = low-incidence.

Cartwright's and the Colton's (as well as the Knops and the McCoys) are just Kidds.

Histocompatibility antigens autoantigens blood group antigens *ALL OF THE ABOVE is corrrect

Cellular antigens of importance to immunologists include:

What is the only blood component that provides high concentrations of vWF?

Cryoprecipitated AHF

Ab to low frequency Ag

Cw, Kpa, Jsa --may need to be considered in a pt that has been multiply transfused or if you're doing a crossmatch and you're doing 4 units and 1 of those are incompatible but the rest are compatible

A double-lung transplant is indicated in which of the following disorders?

Cystic fibrosis

The advantages of cordocentesis include all of the following EXCEPT

Decreases risk of trauma to placenta Advantages: allows measurement of fetal hemoglobin and hematocrit levels, allows antigen typing of fetal blood, allows direct transfusion of fetal circulation)

How would the fourth specific allele of the HLA-A31 family be noted in accepted HLA nomenclature for identifying HLA alleles by DNA sequence information?

HLA-A*31:04

Particulate antigens aggregate to form large complexes in the presence of specific antibody

In the process of agglutination:

A patient was phenotyped for the presence of Lewis antigens (Lea and Leb). A 3+ reaction was observed when patient cells were incubated with anti-Lea. No reaction was observed with anti-Leb. Based on these results, the patient's phenotype is _____________ and the patient is a ____________ of ABH substances

Le(a+b-)/nonsecretor

An antibody of this specificity is frequently found in dialysis patients

N

A antigen

N-Acetyl D galactosamine

Why is transmission of cytomegalovirus (CMV) through blood components not a significant risk to most recipients?

Most recipients are CMV-positive

In an intrauterine transfusion, whos serum is used for compatibility testing?

Mother's

In an intrauterine transfusion, whose serum is used for compatibility testing?

Mother's

What are the ABO genotypes of the mother when the mother is Group A & the father is Group B and their child is Group O?

Mother's genotype AO Father's genotype BO

RhIG is indicated for

Mothers who are Rh negative

The immunodominant sugar responsible for blood group A specificity is

N-acetyl-D-galactosamine

The immunodominant sugar responsible for blood group A specificity is:

N-acetyl-D-galactosamine

Plasma Ab for Type AB (phenotype)

NONE

RBC Surface Ag for Type Bombay (hh) (phenotype)

NONE -no H Ag - have to give blood from another bombay

RBC surface Ag for Type O (OO) (phenotype)

NONE -only H Ag

Which Abs should be suspected in patients with no transfusion or pregnancy history?

Naturally occurring Abs such as anti-M or Leb.

Why is the ABO system the most important one in transfusion therapy?

Naturally-occurring anti-A and anti-B are potent hemolytic antibodies. Life-threatening acute hemolytic transfusion reactions may result from an ABO incompatible transfusion.

In ABO grouping, what is identified in the reverse or serum grouping?

Naturally-occurring isoagglutinins (anti-A and/or anti-B) in the serum

The following results were obtained during paternity testing: mother MM, baby MN, alleged father MM. Is the alleged father the father of this child?

No. The alleged father is excluded from paternity because he does not have the N gene.

A patient's records indicate the presence of anti-M four years ago. A student performs a panel on the serum and obtains the following results: MM 2+, MN 0, NN 0. Based on these results, he concludes that the patient has no longer has anti-M, but has developed another antibody. Is his conclusion correct?

No. The reactions are most likely due to an anti-M showing dosage. The antibody is reacting more strongly with homozygous cells than with heterozygous cells.

Which ABO antigens will be detected on the RBCs of a patient of genotype AB, hh?

None. Although the A and B genes were inherited, the antigens cannot develop without the H gene. This is the Bombay phenotype?

A blood donor states that according to his military "dog tag" he is O positive. The blood bank records indicate he is A positive. What is the explanation for these different results?

One of the typings was in error. Blood types don't change (unless the person has received a bone marrow transplant).

What is a naturally-occurring antibody?∑∉

One that develops without known antigenic stimulus, for example, anti-A and anti-B.

What is an immune antibody?

One that results from exposure to a foreign red cell antigen through transfusion or pregnancy.

Which of the following is an indication for plasma transfusion in a patient who has been massively transfused?

PTT greater than 60 seconds

Which patient is most likely to require irradiated products?

Patient undergoing a bone marrow transplant

Autologous control

Patient's cells + Patient's serum

You are working on a specimen in the laboratory that you believe to be a Bombay phenotype. Which of the following reactions would you expect to see?

Patient's cells + Ulex europaeus = no agglutination

Which of the following might be used to investigate a cold autoantibody?

Rabbit erythrocyte stroma

What is sensitization?

The attachment of antibodies to antigens on a red blood cell.

Why is histocompatibility testing negated in both lung and heart transplants?

The cold ischemic time is too short

Which of the following represents the final clerical check of a transfusion

The nurse uses the patient's armband to compare patient identification with the patient crossmatch report and tags attached to the unit

Properties of the immune response include all of the following except:

The study of Hematopoiesis

All of the following may be used as potentiators in the antiglobulin crossmatch except

papain

Why do Ab detection?

- Avoid incompatibilities and hemolytical transfusion effects. - Promote effective and timely RBC transfusion.

what is the methodology behind the Kleihaure Betke test?

-Draw a postpartum EDTA sample from the mother; fix a blood smear on a glass slide -Flood the smear with an acid solution -rinse slide and counter stain (Safranin) the smear >Hgb A in adult red cells is washed out by the acid solution while red cells with Hgb F are not. -cells with Hgb F stain red while the red cells remain transparent (ghost cells) -Count number of stained Hgb F red cells wihtin 2000 adult (Hgb A) red cells

how do you select blood for an intrauterine transfusion?

-Group O RBCs -Rh-negative: if aby is Anti-D -Must LACK antigen of maternal antibody -CMV negative -Irradiated -Lack Hemoglobin S -Blood less than 7 days old >Some texts <5 days old

Newborn transfusion conditions

-O positive or O negative -CMV Negative (or LR) -Lack antigen (if mother has one) -Does not need to be HgS negative -Can use unit until date of expiration (as long as it is an Optisol/ Adsol unit)

Techniques to remoce autoAbs

-Pre-warm: Red cells, serum, and saline are incubated at 37C before being combined. -Auto-adsorption: Use own patient' RBC. Performed is patient has not been transfused recently.

Recipient testing may be performed in advance and includes:

-Review of medical history -ABO/Rh (Dw optional) -Ab screen

What techniques can be performed to identify multiple Abs?

-Selected cells -Neutralization -Chemical treatment: Proteolytic enzymes, sulfhydril reagents, ZZAP

What are the characteristics that allow you to differentiate rouleaux from agglutination?

-Stacked coin appearance (microscopically) -Observed in all tests containing patient's serum, including autologous control and the reverse ABO typing. -Does not interfere with AHG phase (patient serum is washed away prior adding AHG reagent) -Dispersed by adding 1-3 drops of saline

What are the disadvantages of crossmatching that justify the use of Ab screening?

-The crossmatched unit will possess only some of the most clinical significant Ags. -Weak Abs may not be detected.

Antibody detection cells will NOT routinely detect which antibody specificity? - Anti-M - Anti-Kp(a) - Anti-Fy(a) - Anti- Lu(b)

Anti-Kp(a)

A request for 8 units of packed RBCs was received for patient LF. The patient has a negative antibody screen, but one of the 8 units was 3+ incompatible at the AHG phase. Which of the following antibodies may be the cause?

Anti-Kpa

Which of the following statements regarding anti-LW is true?

Anti-LW reacts stronger with Rh-positive cells than with Rh-negative cells

never antibodies that cause HDFN

Anti-Lea, Anti-Leb, Anti-I, Anti-IH

A patient's serum reactions with all cells in the antiglobulin phase of a panel. The auto control is negative. Which of the folliwng antibodies is the most likely cause of these reactions: anti-Lu^b, anti-Bg^a, anti-Di^a, anti-K?

Anti-Lu^b. This antigen is found on more than 99% of cells. Because of the high frequency of this antigen, the antibody is not often encountered.

Which antibodies cannot be detected with enzymes?

Anti-M, N, and Duffy. The antigens are destroyed by enzymes.

Name the biphasic autoantibody that is detected by the Donath-Landsteiner test.

Anti-P. It is an IgG autoantibody that binds to RBCs at low temperatures and causes hemolysis due to activation of complement when the RBCs are warmed to 37°C. It is the most common cause of paroxysmal cold hemoglobinuria (PCH).

Which antibody does not fit with the other with respect to optimum phase of reactivity? - Anti-S - Anti-P1 - Anti- Fy(a) - Anti- Jk(b)

Anti-P1

Which of the following antibodies would present the greatest difficulty in finding compatible blood: anti-e, anti-Kell, anti-D, anti-Le_a?

Anti-e. It's present in 98% of the Caucasian population

Anti-__ will react with cells that carry c and e on the same Rh polypeptide.

Anti-f

Which of the following factors distinguishes a cold autoantibody produced in a patient with infectious mononucleosis from that produced in a patient with pneumonia?

Anti-i specificity

Antibodies are excluded using RBCs that are homozygous for the corresponding antigen because

Antibodies may show dosage

Antibodies are excluded using RBCs that are homozygous for the corresponding antigen because:

Antibodies may show dosage

What are high-titer, low-avidity blood group antibodies (HTLA)?

Antibodies that cause weak, variable, and sometimes irreproducible reactions in the antiglobulin phase at high dilutions. They are not clinically significant.

Which factor can affect AHG testing, yet is uncontrollable in the lab? - temperature - antibody affinity - gravitational force in the centrifuge - incubation time

Antibody affinity

Which factor can affect AHG testing, yet is uncontrolled in the lab?

Antibody affinity (controled: temp, incubation time, gravity in centrifuge)

Why is anti-A₁ not detected in an antibody screen?

Antibody screening cells are group O. Anti-A₁ only reacts with A₁ cells.

What is the physiological mechanism of Rh-immune globulin?

Attachment of fetal Rh-positive red blood cells in maternal circulation, inhibiting production of anti-D

Interpretation: Auto-Control= Pos

Auto-Ab or Ab to medications Recently transfused patient--> Allo-Ab coating circulation donor RBCs

Indirect immunofluorescent assay (IFA) is widely used for detection of:

Autoantibodies, Antibody to tissue antigen, Anitbody to cellular Antigen ALL OF THE ABOVE is correct

Name some causes of a positive direct antiglobulin test.

Autoimmune hemolytic anemia, incompatible blood transfusion , hemolytic disease of the newborn, and drugs

A 26 year old B Rh0 (D) negative patient requires a transfusion. No B Rh0 (D) neg donot units are available. Which should be chose for transfusion?

O negative RBCs

A 40 yr old presented to the ER with acute bleeding. The Tech received a specimen but was unable to resolve a typing discrepancy between the forward and reverse typing. What blood type should the patient receive for an emergency transfusion?

O negative uncrossmatched packed RBCs

A crossmatch is ordered on an O positive patient. A check of the patients blood bank records reveals the presence of anti-Jk^a two years ago, but the antibody screen is currently negative. What type of blood should be provided?

O positive, Jk^a negative. This will prevent an anamnestic response and delayed transfusion reaction.

What are the possible ABO phenotypes of the offspring from the mating of a group A to a group B individual?

O, A, B, AB

A 4 unit crossmatch is ordered on a patient for emergency surgery. The patient's blood type is group B-positive. The blood bank inventory only contains two B positive packed cells. What other type is ABO compatible with this patient?

O-negative

O

OO 45% Caucasions 51% AA common -A substance (none) -B substance (none) -H substance (++)

It is December 1, 2012, and you irradiate an O-negative packed RBC that you have in inventory, which outdates January 5, 2013. What will the new outdate be for that unit?

December 29, 2012

The advantages of cordocentesis include all of the following except:

Decreases risk of trauma to the placenta

Which of the following lists the correct shelf life for the component? - Deglycerolized RBCs - 24 hours - RBCs (CPD) - 35 days - Platelet concentrate - 7 days - FFP - 5 years - RBCs (CPDA-1) - 21 days

Deglycerolized RBCs - 24 hours RBCs(CPD) - 21 days Platelet concentrate - 5 days FFP - 1yr/7yrs RBCs(CPDA-1) - 35 days

What is suspected when the hematocrit has decreased by 4% and the total bilirubin level is increased 5 days after transfusion?

Delayed hemolytic transfusion reaction

With which clinical conditions is the acquired B antigen associated?

Diseases of the lower intestinal tract, carcinoma of the colon or rectum, intestinal obstruction, gram negative septicemia, or gangrene of the lower extremities. The acquired B antigen is most often seen in A₁ individuals. It is thought that bacterial enzymes convert the terminal sugar of the A antigen to one which resembles that of the B antigen.

How does ABO grouping of a newborn differ from that of an adult?

Only a forward grouping is done because any antibody in the newborn's serum is maternal antibody. RBC antigens are not fully developed at birth, so reactions in the forward grouping may be weaker than those in an adult.

Anti-Jka was identified in a donor sample. What blood products can be made from the parent unit?

Packed RBCs

Why would an Rh type be ordered on a cord sample?

To determine the mother's candidacy for RhIg (Rhogam) if she is Rh -

Why would A2 cells be used in the reverse group in donor processing?

To differentiate an A subgroup from a group O

Why are check cells added to all negative reactions in the AHG test?

To ensure AHG was not neutralized by free globulin molecules

What is the function of the CBER?

To issue federal licenses to establishments that are manufacturing biological products

Why are donors deferred for 6 months following receipt of blood products?

To permit adequate screening for transfusion-acquired viral infections

Why are screening cells group O?

To prevent interference with anti-A and anti-B in patient serum

Why is the immediate spin eliminated in the prenatal antibody screen?

To reduce the detection of IgM antibodies

What is the purpose of washing the cells after the initial cell-serum incubation in the Amos-modified antibody screen procedure?

To remove aggregated immunoglobulin in the serum

What is the last step in identification studies?

To test the patient's RBCs for the corresponding Ag. A negative result is expected.

Why is it important for screening cells to be from individuals who have a homozygous expression of antigens?

Weakly reacting antibodies may not agglutinate heterozygous cells

Which of the following describes MN antigens and antibodies?

Well developed at birth Susceptible to enzymes (destroyed) Generally saline reactive

Which of the following best describes MN antigens and antibodies?

Well developed at birth, susceptible to enzymes, generally saline reactive

A post zone phenomenon

When a constant amount of antigen is mixed with an increasing amount of antibody until no agglutination occurs, this effect is referred to as the:

IGG

Which immunoglobulin class is produced in the highest concentration in secondary (anamnestic) response?

IGM

Which immunoglobulin class is the first to be manifested after antigen exposure?

When a sample of whole blood is spun, distinct layers form. What cell line or lines make up the buffy coat?

White blood cells and platelets

Rr= ____ nomenclature.

Wiener

An advantage of monoclonal anti-C3 over polyclonal anti-C3 is

With monoclonal anti-C3, the antibody potency can be controlled

Immunofixation electrophoresis (IFE) is best used in the?

Workup of a monoclonal gammopathy

When a female possess a phenotypic trait that she passes to all of her sons and none of her daughters the trait is said to be

X-linked recessive

Are ABO antigens found on any cells other than RBCS.

Yes. They are also on tissue cells, platelets, lymphocytes, and in a soluble form in the body fluids of secretors.

Since blood types don't change, if the technologist finds previous records on the patient is it necessary to repeat the ABO and Rh type?

Yes. Types must always be repeated on the specimen received. One should never rely on previous records.

Which f the following terms refers to the net negative charge surrounding red blood cells?

Zeta potential

Which of the following terms refers to the net charge surrounding red blood cells?

Zeta potential

How do you interpret the severity of the disease from a Liley graph?

Zone I -mild or no evidence of disease, no intervention needed Zone II -depedns where on the graph - if low: mild disease, continue to monitor - if high: treat same as severe (III) Zone III -Further investigation/ntervention -cordocentesis blood sample: Hgb < 10g/dl -Ultrasound evidence of hydrops -Intrauterine transfusion -Early delivery if adequate gestational age

Which of the following refers to a state of equilibrium in antigen-antibody reactions?

Zone of equivalence

A patient with paroxysmal cold hemoglobulinuria (PCH) would require _____ in the event of a blood transfusion

a blood warmer

The I antigen in normal individuals:

a) Varies in strength b) Is recognized as a cold antibody A and B ore correct

Pre-transfusion testing will:

a)Verify ABO compatability b)Detect most clinically significant antibodies Both A and B are correct

if ab screen is positive we do

ab ID panel

d is the _____ of the D Ag.

absence

The process of removing antibody from serum by combining a serum sample with appropriate red blood cells under optimal conditions is called:

absorption

Anti-LW will react most strongly with

adult Rh-positive RBCs

RNA is processed

after RNA is copied from DNA template

The end point of the gel test is detected by

agglutination

Rh Wiener nomenclature: _______ = single haplotype expressing three different Ag's.

agglutinogen

How can the sensitivity of antibody detection be increased?

all of the above

All of the following antibodies are clinically significant except:

anti- Bg

Antibody detection cells NOT routinely detect which antibody specificity? - anti-M - anti-Kps - anti- Fya - anti-Lub

anti- Kps (Kell - high frequency antigen, few people lack)

Ax subgroup

anti-A = 0 anti-A,B = 1+ anti-H = 3+ anti-A1 = 0 -Ax only p/u by A,B reagent

A2 subgroup

anti-A = 3+ anti-A,B = 3+ anti-H = 3+ anti-A1 = 0

A1 subgroup

anti-A = 4+ anti-A,B = 4+ anti-H = 2+ anti-A1 = 4+ -ONLY one (+) for Anti-A1 Lectin

Polyspecific AHG contains:

anti-IgG and anti-C3d

Polyspecific AHG reagent contains

anti-IgG and anti-C3d

Which antibody is most commonly associated with delayed hemolytic transfusion reactions?

anti-Jk(a)

Which of the following is a clinically significant antibody whose detection has been reported in some instances to be depndent on anticomplement activity in polyspecific AHG?

anti-Jka

Which of the following is the most common antibody seen in the blood bank after ABO and Rh antibodies?

anti-K

Which of the following is the most common antibody seen in the blood bank after ABOand Rh antibodies?

anti-K

Anti-__, anti-__, anti-__, anti-__, anti-__, and anti-__ can be netralized.

anti-Lewis, anti-P1, anti-I, anti-Ch, anti-Rg, and anti-Sd a

What tests are not required on autologous units transfused within the collecting facility?

antibody screen

C/c and E/e are _____ => can't have both C and c or E and e from the same chromosome.

antithetical

Middle cerebral artery peak systolic velocity is used to

assess for anemia

The endpoint of the solid phase protein A assay is

attachment of cells to microwell

Big R correlates to

big D -so they all have the D Ag

Silent Fy, R₀, S-s-, V+VS+, Js a, Le (a-b-): most likely a ____ donor.

black

Js a is more frequent in ____ (20%).

blacks

Before compatibility testing commences, donor units should be observed for

blood clots

IgG

clinically significant!!

B gene

codes for D-galactosyltransferase (enzyme) D-galactose (terminal sugar that attaches to H) to H Ag B Ag

H gene

codes for L-fucosyltransferase (enzyme) fucose (terminal sugar) H Ag

A gene

codes for N-acetylgalactosaminyltransferase (enzyme) N-acetylgalactosamine (terminal sugar) to H Ag A Ag

ABO discrepancies: negative autocontrol => _____ _____.

cold alloantibody

Phases of reaction: Room temperature or IS

cold antibody or IgM antibody (IgM like to react at room temp or colder)

ABO discrepancies: positive autocontrol => _____ _____.

cold autoantibody (think autoanti-I)

Why are hemolyzed samples unacceptable for compatibility testing?

complement activation by antigen-antibody complexes will be masked

Polyethylene glycol enhances antigen-antibody reactions by

concentrating antibody by removing water

Ryr

dCE/dce

rh'hr" = _ _ _

dCe

r'r"

dCe/dcE

r"r

dcE/dce

hr'hr" = _ _ _

dce

r

dce

rr

dce/dce

Kidd Ab's are a common cause of ____ ____ .

delayed TRXN

A patient transfused with 2 units of packed cells spiked a fever of 99.5°F and complained of chills 3 days after transfusion. The DAT was positive with polyspecific antisera and anti-IgG, but negative with anti-C3d. Compatibility testing was performed on the pre- and post-transfusion specimens. The latter was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion specimens. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jka. This transfusion reaction is most likely caused by:

delayed hemolytic transfusion reaction (DHTR) caused by anamnestic response.

Monoclonal anti-C3d is

derived from one clone of plasma cells

Monoclonal anti-c3d is

derived from one clone of plasma cells

DAT is

detecting Ab that coat the red cells -in vivo sensitization of red cells (Polyspecific AHG, IgG, C3b) WE do DAT to investigate

Pretransfusion testing

detects most errors in the ABO grouping

The gel system has all of the following advantages over the traditional tube procedure except:

different grading system

A patient sample provides the following blood bank result anti a 3+ anti b 4+ anti D 3+ a1 4+ B 0

dolichos biflorus

All of the following are important in evaluating a positive DAT except

donation history

All of the following are important in evaluating a positive Dat except:

donation history

-D- : a ____ ____ => D_ C_ c_E-e_

double deletion => D+C-c-E-e-

In the black population, a mosaic form of which antigen may be found?

e

Rh5

e

Wiener to Fisher-Race translation: no 2 or " =

e

Persons making pre deposit donations for planned surgery will take iron supplements to replenish iron and stimulate

erythropoeisis

discrepancies between the forward and reverse groupings caused by protein or plasma abnormalities are

group 3

discrepancies between the forward and reverse groupings caused by miscellaneous problems are

group 4

k is ___ frequency.

high

Chido Ag's are ___ incidence, are ____ by enzymes, and are clinically _____.

high incidence, destroyed by enzymes, and clinically insignificant

D antigen

highly immunogenic highly developed at birth

Bg Ab's are directed against ___ ___ ___ (____)

human leukocyte antigens (HLA)

A type and screen is done on a 49-year-old woman who is scheduled for a hysterectomy in 1 week. Her blood type is A-positive, and her antibody screen was positive. What must be done before her surgery date?

identify antibody and phenotype units

Characteristics of deglycerolized RBCs include the folloing EXCEPT - inexpensive - 24 hour expiration date after thawing - used for rare antigen type donor blood - used for IgA-deficient recipient with history of severe reaction

inexpensive

cis-AB

inheritance of both AB genes from one parent carried on one chromosome and an O gene from the other

The plasma level of unconjugated bilirubin is elevated in:

intravascular and extravascular hemolysis

All of the following may occur following an Rh-mediated hemolytic transfusion reaction except:

intravascular hemolysis

A crossmatch is positive at AHG with polyspecific AHG reagent but is negative with monospecific anti-IgG AHG reagent. This may indicate the antibody:

is a clinically insignificant Lewis antibody

little r correlates to

little d or the placeholder because there is no little d we just have a placeholder depending on the terminologies you're looking at

PEG

lowers zeta potential by removing water from the test system and concentrates the Ab making it more likely that the Ag and Ab will encounter each other These 3 are potentiators and are added to decrease incubation time

LISS

lowers zeta potential to increase Ab uptake onto the RBC -lowers zeta potential and removes shielding which will promote cell sensitization as well as agglutination

Red blood cells were treated with ficin to help rule in anti-M from a panel study. Cells not treated reacted at 2+ at immediate spin and 1+ at 37°C. There was no reactivity in the Coombs phase. Ficin-treated cells demonstrated a _______ reaction with patient serum containing anti-M.

negative

Fy (a-b-) in whites: no ___ on RBCs or in tissue => anti-___ and anti-___.

no Fy b => anti-Fy b and anti-Fy 3.

Alan Rhench is being seen in the ER for uncontrolled bleeding. He currently is on blood thin... 2 units of fresh frozen plasma (FFP) A 0 B 4+ D 3+ Ctl. 0 A1 4+ B 0 I 0 II 0 BASED ON THESE RESULTS WHAT TYPE OF CROSSMATCH WILL BE PERFORMED ON Alan to find compatible units of plasma?

no cossmatch needed for fresh frozen plasma (FFP)

All of the following are transfusion service quality assurance indicators used to monitor patient care except:

number of therapeutic units drawn

a 27 year old female patient requires a transfusion of packed red cells. Her blood type is A negative8ujm donor units available. which of the following units should be chosen for a transfusion

o negative

What is the treatment for Exchange Transfusions?

occurs following birth: uses whole blood equivalent to replace the neonates circulating blood What it accomplishes -Removal Aby-coated RBCs -Removal of maternal Aby >Remember this Aby is passively transferred so the more we remove the better -Removal of bilirubin: decrease in newborn -Replacement of RBCs: treating the anemia

Which of the following regarding blood issued on an emergency basis without patient testing is true?

packed cell units are tagged for emergency release and segments are pulled for later testing

When one or more D epitopes within the entire D protein is missing it is termed _________

partial D

All of the following may be used for the antibody screen before transfusing an infant except:

paternal serum

The rejection of the transplantation of platelets from one individual to another is termed or defined as

platelet refractoriness

MHC class II molecules are expressed on all of the following except:

platelets

An advantage of polyclonal anti-IgG over monoclonal anti-IgG is:

polyclonal anti-IgG will recognize IgG variants

DAT

postive- mother's antibody coating cells >If elution was performed, it would show specificity for the antibody of the mother Infant may be anemic (based on titer of antibody)

Leukocyte reduced filters can do all of the following EXCEPT - reduce the risk of CMV infection - prevent or reduce the risk of HLA alloimmunization - prevent febrile, nonhemolytic transfusion reactions - prevent TA-GVHD

prevent TA-GVHD

How does RoIG work?

prevents mom from making immune anti-D by suppression of immune response -RhIg attaches to Rh positive fetal red cells -Mother's immune system destroys ag-aby complexes -Occurs before the 'foreign' ag is detected and the production of anti-D initiates

What effect does aspirin have on platelets?

prevents platelet aggregation

Reaction strength: single

probably one antibody specificity

High protein based

problem: any cell thats coated with IgG would agglutinate so have to perform a control to ID and false (+) -have to do control tube -added 20-24% protein to bring red cells closer together and for the IgG anti-D to cause aggl.

Ab screen tube method

pt plasma (unknown ab) tested against reagent red cells (known Ag) -incubate together at 37C -LISS/PEG/Albumin added to increase sensitization -AHG phase allows cross linking of the Ag/Ab complexes IGG MUST BE IN THE AHG REAGENT**** polyspecific -IgG and complement then theres just IgG

Ab titration

quantify Ab present -serial dilutions -increase is signf. -complications: HDFN and Anti_D (immune vs Rhlg)

Rh-Hr Wiener blood factor terminology: __ preceding __ = C or E

r preceding h

Wiener nomenclature: ___ = dcE

r"

Wiener nomenclature: ___ = dCe

r'

Of the following donor units, which could be selected for an Rh-negative recipient with anti-c: R⁰R¹, R²r", r'r', or r'r"?

r'r' (dCe/dCe). All of the others have the c antigen.

anti-k is ___ encountered.

rarely

IgG temperature?

reacts best at 37C

The most important initial step in evaluating a suspected hemolytic transfusion reaction is to:

reconfirm the patient's identity and reexamine all pre-transfusion testing.

What is the best tolerated form of transplantation in humans?

red blood cells

Adsorption

remove Ab from serum by reacting that Ab with specific Ag on RBC

Recipient lymphocytotoxic HLA-antibody to donor antigens is associated with:

respiratory distress

Alloantibody

response to transfusion, transplantation, pregnancy -Ab directed against Ag that the individual does not have -these Ab are produced due to some kind of red cell stimulation

unexpected ABO isoagglutinins in the patients serum react at

room temperature

anti-A, anti-B, A1 cells, B cells, O cells 4+ 4+ 2+ 2+ 2+ could be due to: resolve this:

rouleax; multiple myeloma; cold autoantibody; RT reacting alloantibody wash RBCs with saline & perform cold panel and auto absorb

Kell

second to Rh system for HDN severity, CGD, muscular dystrophy, cardiomegaly

If we find multiple Ab and need to rule more out we can use : Enzymes

separate multiple Ab in a sample -Ficin (figs), Papain (papai), bromelin (pinapple), or trypsin (hog stomach) Work by: modify the surface of the red cells -removes sialic acid residues from RBC membrane -denature or remove glycoproteins

Kidd

shows marked dosage, IgG, active at 37c, enhanced by enzyme, may cause delayed hemolytic reactions

Trans

steric hinderance - too close together

Neutralization

substance to neutralize Ab in a sample to allow separation of Ab or confirmation for the presence of an antibody

P1 antigens

take up to 6 or 7 years to develop

After completing an antibody screen using the gel testing method, results after centrifugation yield a pellet of unagglutinated cells at the bottom of the microtube and a thin layer of cells at the top gel column. This situation commonly indicates:

that fibrin from serum that has not clotted completely

American Association of Blood Banks (AABB) Standards mandate the donor of blood or component given to a recipient who develops clinical or laboratory evidence of transfusion-associated hepatitis (TAH), HIV infection, or HTLV-I/II infection must be permanently deferred if the unit was:

the only unit transfused

Low protein based or saline based

what we use today in clinical labs -DO NOT require an Rh control

MLC = ____ ____ ____

mixed lymphocyte culture

MLR = _____ _____ _____

mixed lymphocyte reaction

Rh___ = weakened expression of all Rh Ag's.

mod

Wiener to Fisher-Race translation: 2 or " =

E

Fatal transfusion reactions are mostly caused by

Clerical errors

AB ID is a panel of

is a panel of 11-20 group O cells with various Ag

Kell system Ag's: __, __, __, __, __, __, __.

K, k, Kp a, Kp b, Kp c, Js a, Js b.

Which of the following antibodies is least likely to bind complement?

Kell

___ antibodies are not affected by enzyme treatment.

Kell

Why is it relatively easy to find compatible units for a patient with anti-K?

Kell is a low-frequency antigen

Group __ discrepancies: weakly reacting or missing Ab's.

I

Which blood product is used in the treatment of DIC

plasma, platelets, cryoprecipitate (all of the above)

autocontrol is testing

the pts red cells with their plasma and if its (+) we are looking at autoantibody

Blood transfused to infants (less than 4 months old) must be less than _________ days old.

7

Elderly: lower levels of ___ and ___ in serum => may be undectable in ____ ____.

anti-A and anti-B; reverse grouping

Ax : agglutination with anti-A? ____ agglutination with anti-A,B? ____

anti-A: no anti-A,B: yes

A3: agglutination with anti-A? ___ agglutination with anti-A,B? ___

anti-A: yes; MF anti-A,B: yes; MF

All of the following antibodies are clinically significant except:

anti-Bga

A male patient of average size has a Hgb of 8.1 g/dL. THe surgeon wants a hemoglobin count of 10 g/dL before doing surgery. How many units of RBCs need to be given before the surgeon will accept patient into surgery>

2

_____% of the general population have irregular RBC Abs

0.5-2%

What percentage of the type A population is A2?

20%

Optimal thermal range for IgG

37 degree C

Immunization for rubella would result in a temporary deferral for

4 weeks

A newly hired technologist prepares a suspension of RBCs that is too concentrated. How could this affect the Rh typing results?

A false negative may occur.

The compliment system is:

A heat labile series of plasma proteins, composed of many proteins, involved in both specific and non-specific immunity BUT NOT a heat stable series of plasma protiens

Produces antibodies as the effect or molecule

A humoral response:

Anne Chovee is being seen for prenatal care with her third child. She currently has screen and a 2 unit crossmatch of packed red cells. The following results A 4+ B 4+ D 0 Ctl. 0 A1 0 B 0 I 0 II 0 based on these results which of the following packed red blood cell units can be safetly

A negative

In the nomenclature: DR*10:04N, what does the "N" denote?

A null allele

Wiener to Fisher-Race translation: 1 or ' =

C

An autoimmune disorder

An undesirable consequence of immunity is:

Which antibody is enhanced by acidification of the serum?

Anti-M

Which of the following MHC classes encodes complement components?

Class III (3)

HLA-D is in which MHC region?

Class II

R1R1

DCe/DCe

Pretransfusion testing:

Detects most errors in the ABO grouping

What quality control is performed on antihuman globulin?

It's tested for IgG activity by reacting with IgG-coated RBCs

H antigen

L-fucose

How is donor platelet survival determined in the recipient?

Platelet count increment (1 hour after transfusion)

Dce

R0r R0R0

The morbidity and mortality is highest for which adverse reaction to hematopoietic progenitor cell transplantation?

TA-GVHD

What is the principle of the Rh-Hr (Weiner) terminology?

The Rh gene produces at least three factors within an agglutinogen

IgM

The most efficient type of antibodies in agglutination reactions are:

The major crossmatch is performed using:

The patient's serum and the donor's red cells

Besides ABO and Rh Ab's, anti-__ is the most common Ab seen in the blood bank.

anti-K

Cad-positive RBCs are agglutinated by anti-___.

anti-Sd a (Super Sid)

Patient JM appears to have a warm autoantibody. She was transfused 2 weeks ago. What would be the next step performed to identify any alloantibodies that might be in her serum?

c. Warm differential adsorption

others

clinically significant IgG

In vivo RBC destruction due to anti-K is usually ____.

extravascular (macrophages in spleen)

__ = r and R0

f

DTT

found in reagents and used to weaken or destroy Ag in the Kell system

Prior to the recipient receiving the transplant of hematopoietic progenitor cells, the cells must be conditioned with:

gamma radiation, high-dose chemotherapy, or both

In plasma exhange, the therapeutic effectiveness is

greatest with the first plasma volume removed

Rh-Hr Wiener blood factor terminology: __ preceding __ = c or e.

h preceding r

Cryoprecipitate is indicated for all of the following disorders except:

hemophilia B

JMH is ____-incidence.

high

Js b is ___ frequency.

high

Kp b is ___ frequency.

high

Yt a is ___-incidence.

high

High frequency Ag's: __, __, __, and __.

k, Kp b, Js b, Lu b

ABO abys

least severe. Group O mom with A or B fetus. Most common form of HDFN

What is the optimal time interval for compatibility testing if the patient has been transfused in the past 3 months?

less than 72 hours after collection

anti-Jk a and anti-Jk b rarely cause ____ ____.

severe HDN

CC

should be (+) done to make sure we did everything right -if theyre negative have to start over

Therapeutic cytapheresis has a primary role in treatment of patients with

sickle cell disease and acute chest syndrom

All of the following are consistent with graft vs. host disease (GVHD) EXCEPT

transplantation of immunologically naive T lymphocytes

Which of the following antibodies is most common in Rh negatives following transfusion or pregnancy: anti-D, anti-c, anti-e, or anti-c+E?

anti-D

Rh typing reagents

anti-D -weak D requires an Rh control (IAT)

Cold ab

may also mask allo ab -why AABB req 37 and AHG testing + in IS and disappears as we warm up

The use of ________ in compatibility testing has allowed for the efficient processing of large numbers of donor units via solid phase technology.

microtiter plates

ABO discrepancies: Chimerism: rxns are typically ___ ___.

mixed field

A3

mixed field agglutination

IgG structure

monomer

Reaction strength: varying

more than 1 antibody or one antibody demonstrating dosage (check pt history-did they have previous Ab, did they have transfusion or pregnancy?)

Blood for intrauterine transfusion should be all of the following EXCEPT

more than 7 days old Should be: screened for CMV, gamma irradiated, compatibile with maternal serum

Anti-E

most common Rh Ab

Rh system abys

most severe form of HDFN Anti-D is #1 Less common due to RhIg

ABO discrepancies: Cells: Serum: Anti-A = 4+ A1 cells = 2+ anti-B = 3+ B cells = 4+ anti-A,B = 4+ washed cells w/saline: saline replacement: anti-A = 4+ A1 cells = 0 anti-B = 0 B cells = 4+ These results are consistent with ____ _____.

multiple myeloma (Type III discrepancy caused by elevated globulin)

Anti-Lua

naturally occuring IgM, shows mixed field reaction, may show dosage

a specimen for pre transfusion compatibility testing must be labeled at the patents bedside with all the following except

the ordering physicians name

How to read titer

the titer is the last (+) result -if its 1:4 we just report to physician as 4 -when you do a serial dilution you always read from the higher titer down because you could have the prozone affect where you think its a 1:8 but we kind of had some excess and se we skipped 16 and 32 and then it is (+) again

The only presenting sign most often accompanying a delayed hemolytic transfusion reaction is

unexplained decrease in hemoglobin

ZZAP

warm treatment used w/adsorption techniques so WARM reagent -alters antigens MNS Duffy Kell Chido Rogers

Forward group: Reverse group: anti-A = 0 A1 cells = 0 anti-B = 0 B cells = 3+ ABO discrepancy caused by:

weak subgroup of A

RBC liquid shelf life

35-42 days

Max body temp to donate homologous blood

37.5 c, 99.5 f

why is testing usually not performed on cord serum?

because the antibodies detected are usually of maternal origin

some causes of group 4 discrepancies are

cold reactive auto-antibodies in which RBCs are so heavily coated with antibody they spontaneously agglutinate; circulating RBCs of more than 1 ABO group due to RBC transfusion or marrow transplant; unexpected ABO isoagglutinins and non-ABO alloantibodies; bacterial or viral infection

source of error

-improper wash -failure to add plasma -not incubating long enough -failure to add AHG -under/over centrifugation -contaminated reagents -debris (false +) -rouleux -Ab to preservative ratio -Fibrin (cause false +)

Calculate the Calculate the paternity index, given the X and Y probabilities:

0.452

How is the Rosette test performed

1. Add chemically modified anti-D to mother's post partum (EDTA) red cells and incubate at 37C >Anti-D will attach to Rh positive (fetal) cells present 2. Wash cells and add inicator cells (which are Rh+ cells coated with IgG antibody) Indicator cells will "rosette" around anti-D that has attached to the Rh positive cells 3. Centrifuge: resuspend cells; read microscopically looking for rosettes >If no rosettes seen can effectively assume no fetal maternal hemorrhage: 1 RhIg sufficient >Rosettes present? Rh positive cells are present. unable to determine quantity.

A. anti-D B. anti-I C. anti-Le (a) D. anti-M E. anti-Fy (a) F. anti-P1 1. shows dosage effect at room temp 2. cold reacting IgM antibody 3. warm reacting IgG antibody 4. reacts best in the AHG phase 5. neutralized by body fluid substances 6. cold reacting auto-antibody

1. d 2. f 3. a 4. e 5. c 6. b

A patient with anti-K and anti-Jka needs two units of RBCs for surgery. How many group specific units would need to be screened to find two that are compatible?

10

Hemophilia A is clinically apparent when the factor VIII level is less than

10%

Hemophilia A is clinically apparent when the factor VIII level is less than:

10%

A unit of red blood cells has an expiration date of 10/15/2017. A patient currently on a fludarbine regimen requires irradiated packed rbcs. The unit is irradiated on 10/2/2017. What is the correct expiration date?

10/15/2017

How many IgG molecules must be present on the red blood cell for a positive IAT to occur?

100

The transfusion nurse calls the blood bank 5 minutes after a unit of packed cells were issued to say that the unit is not needed at this time. It is important for the nurse to bring the unit back immediately so that the temperature of the unit does not exceed:

10C

The physician has requested 2 units of RBCs for patient DB, who has two antibodies, anti-L and anti-Q. The frequency of antigen L is 45%, and the frequency of antigen Q is 70% in the donor population. Approximately how many units will need to be antigen-typed for L and Q to fill the request?

12

What is the minimum hemoglobin levelfor a potential ALLOgenic donor?

12.5 g/dL Hct >= 38%

What are some potentiators that are used to enhance antigen-antibody reactions?

22% albumin, low ionic strength salt solution (LISS), and polyethylene glycol (PEG).

Frozen and thawed RBCs processed in an open system can be stored for how many days/hours?

24 hours

What is the expiration on washed red blood cells?

24 hours

What is a full dose of Rh Immune Globulin?

300 microgram of anti-D -Sufficient to counteract a volume of D positive blood that is >30 mL whole blood or 15 mL packed rbc

A patient has a baseline platelet count of 30,000/UL. Upon receiving a platelet pool of 4 random platelets, what would you expect the post transfusion platelet count to be?

35,000

All of the following are consistent with International Society of Blood Transfusion (ISBT) terminology except?

All genes are written in bold print

Why is the transfusion product tagged before it is issued and transfused?

All of the above To identify the patient To verify compatibility results To verify the donor number

A patient has a positive direct antiglobulin test with anti-IgG antihuman globulin and a negative reaction with anti-C3d antihuman globulin. An antibody screen on the patients' serum is negative. Explain.

All of the antibody causing the positive DAT may be absorbed onto the RBCs. Only after all sites are saturated will the autoantibody be detected in the serum. Another possibility is that the positive reaction is drug-induced. An elution would clarify the situation. If the positive DAT is due to drugs, the eluate will be nonreactive in antibody identification tests.

The earliest host response to vaccination is a(n)

Innate immune response

HDFN after birth (neonatal)

Anemia (destruction of red cells) Heart failure Build up of bilirubin Kernicterus Severe growth retardation Potential Death

Which of the following are soluble mediators of the immune response related by cells during T cell activation?

Answer: Cytokines

we report AB Id findings as

Anti-

Which antibody does NOT fit with the others with respect to optimum phase of reactiviy? - Anti- S - Anti- P1 - Anti- Fy(a) - Anti - JK(b)

Anti- P1(IS - rest react @ AHG)

Interpretation: Autologous control was positive.

Auto-Ab

Members of the S. Pyogenes species are almost always _____-hemolytic

Beta

How are RBC aliquots prepared for neonate transfusion?

Blood is transferred from collection bag to satellite bag and withdrawn using a syringe

What antigen is found in 85% of the white population as is always significant for transfusion purposes?

D

Which of the following Rh antigens is the most immunogenic?

D

The null K0 RBC can be artificially prepared by which of the following treatments?

DTT and glycine-acid EDTA

THe purpose of the immediate spin crossmatch is to

Determine ABO comp between donor and recip

The prupose of the immediate spin crossmatch is to

Determine ABO compatibility between donor and recipient

Diego system: two sets of indpendent pairs of antithetical Ags, __/__ and __/__.

Di a / Di b and Wr a / Wr b

Diego system: ___ and ___ are low-incidence.

Di a and Wr a

Diego system: ___ and ___ are high-incidence.

Di b and Wr b

The measurement of C reactive protein can be used for all of the following except

Diagnosis of a viral septicemia

Multi-Determinant

Different epitopes present on one antigen

A child was found to express the M+N+ phenotype. The mother's phenotype was M+N-, as was the father's. What type of exclusion is evident in this case?

Direct

What is the most definitive molecular-based method to perform HLA typing?

Direct DNA sequencing

Rh3

E

Which antigen represents Rh3 in Rosenfield terminology?

E

Weak D: ____ = D genes code for weakened expression of D Ag. D Ag's are complete but few in number

Genetic

What additive is used for freezing blood for long-term storage at -65°C

Glycerol

What ABH substance(s) would be found in the saliva of a group B secretor?

H and B

Nucleic amplification testing (NAT) is performed for which of the following?

HIV, WNV, HCV

Autoantibodies are generally directed against which antigens?

High-frequency

Which of the following immunoglobulin classes is capable of crossing the placenta and causing hemolytic disease of the newborn?

IgG

Which of the following immunoglobulin classes is capable of crossing the placents and causing HDN?

IgG

Which type of antibodies are detected by the antiglobulin test?

IgG

Which immunoglobulin molecules are most frequently encountered in blood banking?

IgM and IgG.

The indirect antiglobulin test detects which antigen-antibody reactions?

In vitro

A crossmatch is positive at AHG phase with polyspecific AHG reagent but is negative with monospecific anti-IgG AHG reagent. This may indicate the antibody

Is a clinically insignificant Lewis antibody

An Antigenic determinant:

Is a specific chemical or molecular configuration against which the immune response is directed, can result in the production of antiimmunoglobulins, can result in the production of antiglobulins...ALL OF THE ABOVE is correct

A characteristic of necrotizing fasciitis is that it:

Is known as the "flesh eating" bacteria, Is caused by Streptococcus pyogenes, Destroys the tissue covering the muscles....ALL OF THE ABOVE is correct

How does the drug Aldomet (methyldopa) affect blood bank test results?

It can cause a drug-induced autoimmune hemolytic anemia that's indistinguishable from a warm autoimmune hemolytic anemia. About 15% of patients on Aldomet develop a positive DAT and 1% experience immune hemolysis. The antibody causing the positive DAT is often directed against an Rh antigen, usually e. This phenomenon is encountered less frequently now because of the use of newer antihypertensive drugs. Other drugs may also cause positive DATs and/or immune hemolysis

What is the optimal time interval for compatibility testing if the patient has been transfused in the past 3 months?

Less than 72 hours after collection

Apheresis technology can be used to collect each of the following components EXCEPT - leukocytes - macrophages - hematopoietic progenitor cells - platelets

Macrophages

Which of the following is not an indication for transfusing platelets?

Massive transfusion, platelet count 250,000/uL

In some institutions, compatibility testing may be eliminated in which type of patient?

Massively transfused

Which of the following is consistent with hemolytic disease of the newborn (HDN)?

Maternal antibody coating fetal red blood cells

WHat does MSBOS stand for

Maximum surgical blood order schedule

What does MSBOS stand for?

Maximum surgical blood order schedule

_____ phenotype: very rare, X-linked, lack Kx and Km, depression of all other Kell Ag's, acanthocytic RBCs, and nerve and muscle disorders.

McLeod

What is one indication a positive DAT might be due to alloantibody coating donor red blood cells?

Microscopic mixed-field appearance

Which of the following Rh negative patients may be transfused with Rh positive units when few O negative units are available in an emergency?

Middle aged male

Which of the following Rh-negative patients may be transfused with Rh-positive units when few O-negative units are available in an emergency?

Middle-aged male

What can cause graft rejection of MHC-identical transplants?

Minor histocompatibility antigens

What is the most common cause of clerical errors in transfusion therapy?

Misidentification of the patient

DCEc

R2R2 R2r" R2ry

What component is most frequently involved with transfusion associated sepsis?

Platelets

When a sample of whole blood is spun, distinct layers form. What cell lines are included in the plasma?

Platelets

Which of the following products is more likely to become contaminated with microorganisms?

Platelets

Peripheral blood stem cells are

Pluripotential hematopoietic precursors that circulate in the peripheral blood

An advantage of polyclonal anti-IgG over monoclonal anti-IgG is:

Polyclonal anti-IgG will recognise IgG variants

Which of the following is known to enhance K antigen expression in the antihuman globulin test?

Polyethylene glycol

The role of the machrophage during an antibody response is to

Process antigen and present it

The role of the macrophage during an antibody response is to

Process antigen and present it

Ina pedigree, the "index case" is another name for

Propositus

Whay may be added to samples from patients taking heparin to induce clotting?

Protamine sulfate

Which of the following refers to the effect of an excess amount of ANTIBODY present in a test system>

Prozone

Which of the following refers to the presence of an excess amount of antibody present in a test system?

Prozone

DEce

R2r RxR0 r"

A STAT type and screen comes from surgery. Your institution uses a blood bank band ID bracelet system. The nurse who obtained specimens did not label them with the blood bank number before she handed them to transport to take to the lab. What would be the most appropriate action to take?

Reject the specimen and have it recollected

The emergency room requests 6 units of packed RBCs for a trauma patient prior to collection of the patient's specimen. The most appropriate course of action is

Release group O RBCs to ER with trauma patient identification on each unit sent

What is the most common use of adsorption?

Removal of autoantibody from patient serum

Enzyme treated cells

Remove Ab to Fya and Fyb, M, N, S

The Rh testing on a blood donor was negative at immediate spin. The tube was incubated at 37°C for 15 minutes. The tube was centrifuged and read macroscopically. The test was negative at 37°C. The tube was washed three times with saline, and two drops of AHG were added. After centrifugation, the tube yielded a 2+ reaction. How is this Rh type reported on the donor unit?

Rh-positive

Which Ags must be present in the screening cell reagents?

Rh= D,C,c,E,e Kell= K,k Duffy= Fya, Fyb Kidd= Jka, Jkb Lewis= Lea, Leb P= P1 MNS= M,N,S,s

What is given to patients who have corssed over to an Rh-positive blood type via massive transfusion to prevent anti-D formation?

RhIG

What is given to patients who have crossed over to an Rh postive blood type via massive transfusion to prevent anti-D formation?

RhIG

What is given to patients who have crossed over to an Rh-positive blood type via massive transfusion to prevent anti-D formation?

RhIG

How can rouleaux interfere with blood bank tests?

Rouleaux cause false positive reactions with all cells mixed with the serum. Rouleaux are due to a serum protein abnormality and are usually seen in patients with multiple myeloma.

Platelets (single donor)

SHelf: 5 days Temp: 20-24˚C Use: Platelet refractoriness Content: >= 3.0 x 10^11 pH: >= 6.2

The antibody to this high prevalence antigen demonstrates mixed field agglutination that appears shiny and refractile under the microscope

Sda

What is a lectin?

Seed extracts that agglutinate human cells with moderate specificity

The "ABO" Effect

Seen only with type "O" moms -Fetus is type A or B -Fetal cells remain only ~1 hour -Destroyed by IgG anti-A, -B, -AB before mother's immune system ever recognizes other foreign antigens -therefore low incidence of sensitization

Where are the donor red blood cells usually acquired from when performing a major crossmatch?

Segament from donor unit

You are performing an IAT, and you are suspicious of the results. It appears there may be a weak alloantibody present. You decide to repeat the test, and at the LISS stage you decide to add an extra two drops of serum to each tube being tested. What can you expect to happen?

Sensitivity of the test decreases, because you increased the ionic strength of the mixture

What is the definition of apheresis?

Separation or removal of a blood component from whole blood

The case definition of STSS and necrotizing fasciitis includes:

Serologic confirmation of group A streptococcal infection by a fourfold rise against SLO and DNAse B (Both A and B)

What specimens may be used for antibody screens and crossmatches?

Serum or plasma. There are some problems associated with the use of plasma. If small fibrin clots are present, RBCs may be trapped and may be mistaken for agglutinates. High levels of fibrinogen may result in rouleaux formation. Antibodies that are only demonstrable by their ability to activate complement may be missed in plasma collected in citrate or EDTA since these anticoagulants chelate calcium, a necessary component of complement activation . On the other hand, serum specimens that have not been allowed to clot completely prior to centrifugation may also cause pseudo-agglutinates due to fibrin. Because of the possibility, EDTA is the recommended sample when performing gel testing.

Platelets irradiated

Shelf: 5 days Temp: 20-24 Use: Prevent GVHD 25Gy to center of canister

RBC irradiated

Shelf: original outdate or 28 days after irradiation Temp: 1-6˚C Use: Prevent graft vs. host disease, increas O2

Why is it necessary to use single-donor screening cells instead of pooled screening cells for patient samples?

Single donor screening cells are complementary among each other

Name several sources of error in ABO grouping.

Specimen mix-up, failure to follow the manufacturer's directions, failure to use the correct reagents, use of expired reagents, bacterial contamination of the specimen or reagents, failure to add serum or antiserum, incorrect serum: cell ratio, incubating tubes at 37°C, over- or under-centrifugation, over- or under-shaking of the tubes, careless reading of results, failure to identify hemolysis as a positve reaction, and clerical error.

A substance that could mediate the fever, shock, and tissue injury observed in patients with STSS is:

TNF-a

In adaptive immunity, cytokines mediate early inflammatory reactions to microbial organisms and stimulate adaptive immune responses

TRUE

T/F: Since anti-I is a common autoantibody, cord blood cells are usually included in mini-cold panels for the Id of cold autoAbs.

TRUE. Cord blood cells don't have I Ag.

IgA

Tears, Saliva, & other body secretions typically contain:

Double Immunodiffusion

Technique in which both reactants are free to move

Single Immunodiffusion

Technique in which one of the reactants remains fixed in the gel and the other is allowed to move & interact with the reagent that is immobilized

Reverse Agglutination

Test in which the biological fluid tested for the presence of an antigen

What is the purpose of washing cells in the AHG test?

To remove all unbound protein

What must be done prior to transfusion of non-group O blood to an infant?

Testing infant serum for anti-A and anti-B at AHG

Antibody Screen

Testing patient serum against 2-3 reagent RBC samples (not pooled): -O cells -2 to 3 samples with known Ags -Homozygous expression valued over heterozygous expression (dosage)

What is the "3 and 3 rule"?

Testing the patient serum with at least 3 Ags positive and 3 Ag negative cells (Probability= 0.05). Guaranties the interpretation of the data will be correct 95% of the time.

Zeta Potential

The electrostatic potential generated around red blood cells in a solution

Unbroken skin or mucous membranes

The first line of defense against infection is:

Why is whole blood contraindicated for patients with severe chronic anemia?

The plasma volume of these patients is increased

What is the basis of Roesnfield Rh terminology?

The positive (+) or negative (-) sign demonstrates the presence or absence of antigen on a red blood cell

Zone of equivalence

The region in a serum sample where maximal agglutination occurs

A husband volunteers to be the donor for his wife's organ transplant. In pre-transplantation testing, the woman's serum was mixed in vitro with lymphocytes from her husband. After a few hours, complement and Trypan blue were added to the culture well. The cells were observed under the microscope and determined to be viable. What is the interpretation of this assay?

The wife has no pre-existing antibodies directed against her husband's cells; therefore the husband can serve as a donor for his wife.

How would a negative IAT be demonstrated in solid phase methodology?

There is a pellet at the bottom of the well

How is the antibody screen test different for donors than for patients?

There is no difference

What are the consequences of infusing D positive RBCs into an Rh-negative recipient with a negative antibody screen?

There would not be a transfusion reaction, but the recipient might develop anti-D.

Why are fresh blood units (less than 7 days old) preferred for a neonate transfusion?

They reduce the risk of hyperkalemia

Which transfusion reaction present with fever, maculopapular rash, watery diarrhea, abnormal liver function, and pancytopenia?

Transfusion associated graft vs host disease

How are mild allergic transfusion reactions with isolated symptoms or hives and urticaria treated?

Transfusion is stopped and antihistamines administrated; when symptoms improve, transfusion is restarted

What is the most frequent cause of circulatory overload?

Transfusion of a unit at too fast a rate

T/F: Auto-Abs may mask the presence of clinical significant allo-Abs.

True. Auto-Abs react with all cells tested

The Le gene codes for a specific glycosyltransferase that transfers a fucose to the N-acetylglocosamine on:

Type 1 precursor chain

The Le gene codes for a specific glycosyltransferase that transfers a fucose to the N-acetylglucosamine on

Type 1 precursor chain

How are weaker than expected reactions with anti-D typing reagents categorized?

Weak D

Which of the following tests is not requires as part of the donor processing for allogenic donation? - ABO - Rh - STS - anti-HTLV-1 - anti-CMV

anti-CMV

Polyspecific AHG contains:

anti-IgG and anti- C3d

possible genotypes of the offspring?

50% A or B, WILL NOT BE O

X linked dominant

-affected males transmit the trait to all their daughters and none of their sons -affected heterozygous females transmit the trait to half of their children of either sex -affected homozygous females transmit the trait to all their children -RARE

Warm autoAb

-can cause a condition known as autoimmune hemolytic anemia and can have lupus -all cells agglutinate or panagglutinate -we have to get rid of autoab to see if theres any alloab underneath that are CS -this is where we would do a DAT and if DAT is + and autocontrol is + we have a situation

Percutaneous Umbilical cord sampling

-cordocentesis -blood sampling form cord >in-utero, ultrasound guided -Allows for actual testing of fetal blood > Test for hemoglobin, HCT, Blood type, antigen typing, DAT, and other tests (fetal DNA typing) > Can give more accurate picture of anemia

What is the Rosette test?

-determine if a bleed occurred. may need to quantitate fetal bleed -Qualitative test first: Rosette test -purpose: Screening test to detect the presence of Rh positive RBCs in the circulation of Rh negative person. (does not test for "fetal cells", per se!)

Individuals that require weak D testing

-donors -Rh negative infants born to Rh negative mothers (have to make sure baby is truly Rh (-) -Pts who have a history of being Rh (+), but are currently typing as Rh (-) (need to confirm) -women of child bearing age that are Rh negative

sources of error for AHG test

-inadequate washing -contamination -too heavy or too weak red cell suspension -37C not maintained -reagent not added -improper centrifugation -plasma not added

X linked recessive

-incidence of trait is HIGHER IN MALES than in females -trait is transmitted from affected male to his daughters who as carriers pass the trait to approximately half of their sons who are affected and half of their daughters who are carriers -trait is NEVER passed form father to son (because its on X chromosome) -is COMMON -Ex: hemophilia and muscular dystrophy

IAT

-mostly use pts serum or plasma -detects rbc that are sensitized in vitro (in the test tube) -incubate at 37C -requires potentiators to facilitate a response -Ab screen and Ab ID -crossmatching -some Ag typing

Why should you give Rh Immune Globulin postpartum?

-mother is Rh negative; baby is Rh pos; mother's serum does not show immune allo-anti-D -Sample is collected within 3 hours post-delivery -perform ABORh/antibody screens -Qualitative test for fetal bleed -Post-partum RHIG must be given with 72 hours of delivery -Usual dose: 1 vial: <1% of deliveries have >30 ml fetal maternal hemorrhage

Hydrops Fetalis

-severe anemia and hypoprotienemia (due to hepatomegaly) -Leads to high-output cardiac failure and generalized edema, effusions and ascites -Can occur as early as 18-20 wks -respiratory distress -leads to intrauterine death

Autosomal Dominant

-trait appears in every generation -occurs equally in males and females -an affected person will pass the trait to approximately half of his or her children -carriers of the trait do NOT pass the trait to their offspring Ex: Huntington's disease, Familia hypocholesteremia

Exposure

-transplacental hemorrhage during gestation: approx. 7% of pregnancies -Intervention: Amniocentesis, chronic villus sampling; trauma to abdomen -50% at delivery -but volume of fetal cells is usually small [however immunization can occur with as little as 1 ml of fetal rbcs]

DAT

-uses pt rbc for testing -detects rbc that are sensitized in vivo (in the body)

Cord blood DAT

-why do you do it: coating cells by IgG -If DAT positive-> elution >to ID the Aby that is coating the baby's red blood cells- results do not change therapy >Not necessary to perform eluate if infant cells test "+" for the implicated antigen ~Positive for ag= assume+DAT due to maternal antibodies -If DAT is neg but baby is jaundiced other causes should be investigated (beware false negative however)

Which of the following can be added to blood prior to or during transfusion?

0.85% sodium chloride solution (USP grade)

Which fluid should be used to dilute RBCs

0.9% saline

Which fluid should be used to dilute RBCs?

0.9% saline

The Rh gene is located on which chromosome?

1

Immunization of the mother can be caused by as little as ____________ D-positive fetal cells.

1 mL

FFP/ Cryoprecipitate shelf life

1 year

Number the following steps in serologic testing for antibody identification in the correct sequence of performance:

1) perform an antibody screen on the patient 2) perform a panel for Ab identification 3) Antigen type the patients RBCs for the Ag 4) Perform Ag typing on packed RBCs for crossmatch

Group II discrepancy causes: 1) ____ of __ or __ 2) _____ 3) _____ disease 4) ____ __ phenomenon

1) subgroups of A or B 2) leukemias 3) Hodgkin's disease 4) acquired B phenomenon.

How to select compatible units for crossmatch?

1. # of units/freq of Ag neg individuals 2. For patient with multiple significant Abs: -Population freq. of one neg Ag * Freq of neg for other Ag -#units/freq of neg Ag (Previous result)

Ab SCREEN PROTOCOL: 1. Add ___ drops of _____ _____ to 2 to 3 appropriately labeled tubes. 2. Add ___ drop of ____ ____ . 3. ________ and _____ for agglutination. Record ____. 4. Add ___ drops of ______. Incubate ____ ____. 5. _____, _____, and ______. 6. ____ 3-4x with saline. 7. Add _____. Centrifuge, ______, and _____. 8. Add ____ ____. Centrifuge, read, and record.

1. 2/ unknown serum 2. 1/ screen cells 3. Centrifuge/ read/ 0-4+ 4. 2/ adjuvant/ 15"/ 37C. 5. Centrifuge, read, record. 6. Wash 7. AHG/ read, record. 8. Check cells

Once thawed, FFP must be transfused within

24 hours. (can be stored for 5 days )

What is a mini dose of Rh Immune Globulin?

50 microgram of anti-D -For first trimester abortion or miscarriage (<12 weeks gestation; est. fetal total blood volume <5ml) -Baby has lower blood volume -Rarely used anymore: does not harm mother to get full dose

Due to a short supply of O-negative packed cells, an Rh-negative patient was transfused with 1 unit of Rh-positive red blood cells. Calculate the number of Rh-immune globulin vials needed to protect against 250 mL of Rh-positive packed cells.

17

One unit of apheresed platelets should increase the platelet count

20,000-60,000

A 160 lb man was transfused with 1 unit of whole blood after being rescued from a burning apartment building. His hematocrit was determined to be 27% before transfusion. What would you expect his hematocrit to be in 48 hours?

30%

A 160-pound man was transfused with 1 unit of whole blood after being rescued from a burning apartment building. His hematocrit was determined to be 27% before transfusion. What would you expect his hematocrit to be in 48 hours?

30%

What is the minimum number of platelets required in a platelet concentrate prepared from whole blood by centrifugation (90% of sampled units)?

5.5 x 10^10

At what temperature is the incubation phase of the AHG test?

37C

In what phase of reactivity is rouleaux usually found?

37C

What is the optimal temperature for complement activation?

37C

hemolysis and agglutination are (+) results at

37C

required by AABB

37C and AHG because we are detecting CS Ab

At which phase(s) of testing are most IgG antibodies detected?

37°C and/or indirect antihuman globulin.

Rh antibodies react best at what temperature?

37˚C

A blood component should be transfused within

4 hours

What is the expiration time for platelet concentrates that have been pooled?

4 hrs

What is the deferral period for a donor who has received a live attenuated vaccine for rubella

4 weeks

What is the deferral period for a donor who has received a live attenuated vaccine for rubella?

4 weeks

A gel microtube shows a solid band of red cell agglutinates on the top of the gel following incubation and centrifugation. How should this reaction be graded?

4+

Optimal thermal range for IgM

4-22 degrees C

what age do children start to develop ABO antibodies?

4-6 months

Methods of preparation of platelet concentrates from single units of whole blood must produce a product that yields a minimum of:

5.5x10^6 per unit in 75% of units tested

Additive solutions are approved for storage of red blood cells for how many days?

42

If a prospective blood donor has participated in a pheresis donation (platelets, plasma, granulocytes), at least how much time must pass before they can donate whole blood?

48 hours

What are the current storage time and storage temperature for platelet concentrates and apheresis platelet components?

5 days at 20-24˚C

Complement can be inactivated in human serum by heating to ______degrees for ______minutes

56 degrees, 30 minutes

RBCs that have been leukoreduced must contain less than ____ and retain atleast ____ of original RBCs

5X10^6 (WBCs) 85%

Packed RBCs must have an absolute white blood cell count of less than ____ and contain at least what percent of original RBC mass?

5x10^6 85%

_____% of various multiply transfused populations have irregular Abs.

6-53%

During the storage period, platelets must maintain a pH of at least:

6.2

What is the minimal pH required for platelets?

6.2

In ABO grouping, what is identified by the forward or cell grouping?

A and/or B antigens on the surface of the RBCs.

Recipient; blood sample and a sample of the donor's red blood cells must be kept at 1-6°C for at least _______ days after transfusion?

7

How long after a transfusion must donor and recipient samples be stored at 1C to 6C?

7 days

How long after a transfusion must donor and recipient samples be stored at 1°C to 6°C?

7 days

Most patients who have Streptococcus pyogenes infection begin to demonstrate a rise in antibody titer in:

7 days

What hemoglobin level is considered critical and may warrant a red blood cell transfusion?

7 g/dL

What does a mixed field reaction look like in a gel?

A band of red cell agglutinates on top of the gel and a pellet of unagglutinated cells at the bottom of the microtube.

Saline used for blood banking tests should have a pH of

7.2 to 7.4

Mortality following an outbreak of S. Pyogenes that progresses to toxic shock can be as high as:

70%

An autologous unit should be donated what time period prior to the patients surgery/need

72 hours

One criterion used by the FDA for approval of new preservative solutions and storage containers is an average 24-hour post transfusion RBC survival of more than

75%

In order to be considered fresh frozen plasma, the plasma needs to be prepared within ________of collection?

8 hours

What other technique is available for neonates with sepsis when apheresis is unavailable?

A buffy coat prepared from a whole blood unit less than 12 hours old

Which is true regarding compatability testing for an infant younger than 4 months?

A crossmatch is not needed with the infants blood when unexpected antibodies are present.

The concentrate obtained from plateletpheresis via a closed system is stored for 5 days at room temperature. What must the pH be at the end of storage?

>= 6.0

The concentrate obtained from plateletpheresis via a closed system is stored for 5 days at room temperature. What must the pH be at the end of storage?

>= 6.5 (has to be above 6.2)

RBC surface Ag for Type A (AA;AO) (phenotype)

A

RBC surface Ag for Type AB (AB) (phenotype)

A B

The following blood donors regularly give blood. Which donor may donate on September 11th?

A 28-year old man who had plateletpheresis on August 24th

Cis-AB: weakly reactive __ and __ antigens; weak anti-_ in serum => discrepancy in ____ grouping.

A and B; anti-B; reverse grouping

Which patient is most likely to require irradiated products?

A patient undergoing a bone marrow transplant

Combine with an antigen

A primary function of an antibody in body defense is to:

Indirect Agglutination

A reaction in which the antigen has been affixed or absorbed to the particle surface

Direct Agglutination

A test in which the antigen is an intrinsic component of the particle; used to determine if antibody specific for antigen is present in biological fluids

What is an abbreviated crossmatch?

A type and screen plus an immediate spin crossmatch

What type of blood should a patient who is weak D receive?

A weak D recipient may be transfused with either Rh positive or Rh negative. In many blood banks, the test for weak D is not performed on recipients, so Rh-negative blood should be provided.

HDFN other BGS abys

Anti-K, Anti-c, others Blood transfusion for treatment should lack the appropriate antigen!!

INTERPRETATION: If group AB whole blood is transfused into a patient with group A blood type, the crossmatch would be: A. incompatible major side only B. incompatible minor side only C. incompatible major & minor D. compatible both major & minor

A. incompatible major side only

What does compatibility testing include?

ABO, RH, Antibody screen, Major crossmatch

What tests are indicated for cord blood specimens if the mother has made anti-K?

ABO, Rh, DAT

Which test must be performed on the donor sample?

ABO, Rh, Du, antibody screen

Which tests must be performed on the donor sample?

ABO, Rh, antibody screen

Which of the following is acceptable for cytotoxicity techniques?

ACD

Which of the following are approved preservative solutions for blood storage at 1-6 for 21 days

ACD, CPD, CP2D (all of the above)

If donor cells were coated with antibody resulting in a positive DAT, what phase of the major crossmatch would generally react?

AHG

Ellie Vator is being admitted to the hospital for anemia. She has been receiving transfu and anti-C. the physician orders a type and screen and 2 units of packed red blood cells A 0 B 0 D 0 Ctl. 0 A1 4+ B 4+ I 0 II 0 based on these results and the patients history, what type of crossmatch will be performed

AHG Crossmach

A principle of the antiglobulin test is:

AHG reacts with human globulin molecules bound to RBCs of free in serum

A principle of the antiglobulin test is

AHG reacts with human globulin molecules bound to RBCs or free in serum

A principle of the antiglobulin test is:

AHG reacts with human globulin molecules bound to RBCs or free in serum.

Interpretation: More than one screening cell sample positive at different phases and strengths.

Ab screen= Multiple Abs Panel Ab Id= May be also an Ab showing dosage, with the homozygous cells reacting at an earlier phase than the heterozygous cells.

Important consequences of an S pyogenes infection include:

Acute rheumatic fever, Poststreptococcal glomerulonephritis (Both A and B)

While undergoing plasmapheresis, the donor experienced numbness around his mouth, which is indicative of citrate toxicity. How can this be treated?

Administering exogenous calcium

What reagents are required by the American Association of Blood Banks (AABB) for ABO grouping?

Anti-A and anti-B for the front grouping: A₁ cells and B cells for the reverse grouping.

In addition to anti-A and anti-B, what other ABO antibody if found in the plasma/serum of group O individuals?

Anti-A, B. This antibody reacts with cells that possess either A or B antigens and is predominantly IgG.

When might anti-A,B be used?

Anti-A,B is no longer used for routine typing but some labs use it for confirmatory typing of Group O red cell units.

Which antibodies are usually not clinically significant and do not necessitate transfusion with antigen negative blood, unless reactive at 37°C?

Anti-A₁, Le_a, Le_b, Lu_a, M, N, and P

A weakly reactive antibody with a titer of 128 is neutralized by plasma. Which of the following could be the specificity?

Anti-Ch

Rh-immune globin is effective in preventing which type of hemolytic disease of the newborn (HDN)?

Anti-D

Which of the following statements is false?

Anti-D usually stimulates complement

Which set of antibodies could you possibly find in a patient with no history of transfusion or pregnancy?

Anti-D, Anti-C, and Anti-E

common antibodies that cause HDFN

Anti-D, Anti-D+C, Anti-D+E, Anti-C, Anti-E, Anti-c, Anti-e, Anti-K

Which antibodies are always considered clinically significant?

Anti-D, C, E, c, e, f, Fy_a, Fy_b, JK_a, JK_b, K, S, and s. When these antibodies are present in the recipient, antigen negative blood must always be provided.

A group O R¹R¹ recipient is compatible with a group O R¹r donor, but incompatible with a group O R¹R² donor at 37°C in the antiglobulin phase. What is the most likely irregular antibody in the recipient's serum?

Anti-E

Which of the following is a clinically significant antibody whose detection has been reported in some instances to be dependent on anticomplement activity in polyspecific AGH?

Anti-Jk(a)

Which of the following is a clinically significant antibody whose detection has been reported in some instances to be dependent on anticomplement activity in polyspecific AHG?

Anti-Jka

A technologist has decided to test an enzyme-treated panel of RBCs against a patient's serum. Which of the following antibody pairs could be separated using this technique?

Anti-Jka and anti-Fya

Other Blood group Abys

Anti-K, -Fya, -s, etc

Antibody screening cells will not detect the presence of: A. anti-K B. anti-A1 C. anti-N D. anti-P1

B. anti-A1

A minor crossmatch is not routinely performed because: A. only detects clinically insignificant IgM antibody B. no need to detect antibody in donor packed cell units C. it will not detect ABO incompatibilities D. the use of AHG anti-sera is more sensitive

B. no need to detect antibody in donor packed cell units

The direct antiglobulin test (DAT) is used to detect: A. low titers of IgG antibody in plasma/serum B. red cells that have been sensitized in vivo C. reactions of complement binding antibodies D. red cells that have been sensitized in-vitro

B. red cells that have been sensitized in vivo

How are RBC aliquots prepared for a neonate transfusion?

Blood is transferred from collection bag to satellite bag and withdrawn using a syringe.

Which of the following binds to and is readily phagocytized by mononuclear phagocytes and neutrophils?

Bound complement protein C3b

How can autoantibody be removed from the serum of a patient with warm autoimmune hemolyic anemia?

By autoabsorption using the patient's RBC and serum. This procedure allows the serum to be evaluated for alloantibodies. Autoadsorption should not be performed if the patient has been transfused in the past four months because circulating donor cells could absorb alloantibody.

How can the antibody causing a positive antiglobulin test be identified?

By performing an elution, followed by a panel on the eluate

Which of the following is the most common Rh phenotype in African Americans?

Dce/dce (R0r)

Fresh serum must be used for antibody screen/panel and crossmatch procedures to preserve: A. chelating agents B. patient cells C. native complement D. autoantibodies

C. native complement

A patient has anti-e and another antibody that has not been identified. The blood bank technologist wants to remove the anti-e from the serum so that the other antibody can be identified. She has a choice of the following cells to use for the adsorption. Which should she use?<br>

Cell 3 (ee). It is best to use cells homozygous for the corresponding antigen because there will be more sites for antibody adsorption.

You have just received a request and sample for pretransfusion testing. Which is the MOST appropriate to do first?

Check the record for prior type and screen results

You have just received a request and sample for pretransfusion testing. Which is the most appropriate to do first?

Check the records for prior type and screen results on the patient

What is the most critical step in blood transfusion?

Checkin patient identification and compatibility of donor units.

_____ Ag's are adsorbed onto the RBC membrane from the plasma.

Chido/Rodgers

On which chromosome are the genes that code for RH proteins, namely, RHD and RHCE located?

Chromosome 1

___-___ : weakly reactive A and B Ag's; weak anti-B in serum => discrepancy in reverse grouping.

Cis-AB

_____: inheritance of both AB genes from one parent and the O gene from the other parent.

Cis-AB

What MHC region encodes HLA-A, HLA-B, and HLA-C?

Class I

Which of the following MHC classes are found on antigen presenting cells?

Class II

Which of the following MHC classes are found on antigen presenting cells?

Class II (2)

Which HLA antigens are only expressed constitutively on "profession antigen-presenting cells," such as B lymphocytes?

Class II antigens

Which of the following MHC classes encodes complement components?

Class III

Which complement pathway is activated by the formation of antigen-antibody complexes?

Classical

Which gene combination is expressed in the greatest frequency in the black population?

Dce

Cord blood ABO group testing

If mother is Grp O and Baby is Grp A or B... baby may have ABO HDFN

Which of the following methods requires the use of check cells? - LISS - Gel - SOlid-phase - Enzyme-linked

LISS

What antigen system is closely associated phenotypically with Rh?

LW

A nurse just called to request additional RBC units for a patient for whom you performed compatibility testing 4 days ago. She would like you to used to the original specimen as you keep it for 7 days anyway. Your most appropriate course of action would be to:

Indicate that a new specimen is necessary because the patient has been recently transfused.

What group of blood should be transfused to a patient with Anti-A₁?

If the antibody is reactive at 37°C, cells lacking the A₁ antigen (subgroup of A or group O) should be transfused. Anti-A₁ that only reacts below 30°C is not considered clinically significant. In practice, some blood banks would provide subgroup of A or group O blood without testing the thermal range of the Anti-A₁. The laboratory's standard operating procedures (SOP) should be followed.

Cells carrying a weak-D antigen require the use of what test to demonstrate its presence?

Indirect antiglobulin test (IAT)

The serologic method most widely used for detection of diverse antibodies is:

Indirect immunofluorescent assay

Characteristics of deglycerolized RBCs include the following except:

Inexpensive

(0) anti-D initial spin (+) anti-D IAT Rh control (+)

INVALID because of + control = repeat! -(+) control could be because your pt might have a (+) DAT so they may have something coating their red cells that you have to troubleshoot and interpret

An in vitro phenomenon associated with a positive IAT is

Identification of alloantibody specificity using a panel of reagent RBCs

An in vitro phenomenon associated with a positive IAT is:

Identification of alloantibody specificity using a panel of reagent RBCs

A type and screen is done on a 49-year old woman who is scheduled for a hysterectomy in 1 week. Her blood type is A positive and her antibody screen was positive. What myst be done before her surgery date?

Identify antibody and phenotype units

A type and screen is done on a 49-year-old woman who is scheduled for a hysterectomy in 1 week. Her blood type is A-positive, and her antibody screen was positive. What must be done before her surgery date?

Identify antibody and phenotype units

DNA-based typing methods are used for which of the following: determining serum antibody status; crossmatching donors and recipients; measuring T cell-mediated cytotoxicity; or identifiying HLA types?

Identifying HLA types

What is Bombay in immunohematology?

Lacks ABH expression

Which of the following would be cause for deferral? - Temp of 99.2˚F - Pulse of 90 beats per minute - BP of 110/70 - Hct level of 37% - None of the above

Hct of 37% Temp => 37.5 (99.5˚F) Pulse: btween 50 and 100 bpm BP: >=180/100 Hgb: >= 12.5 Hct >= 38

Cryoprecipitate is indicated for all of the following disorders EXCEPT

Hemophilia B (indicated in Hemophila A, vWD, hypofibrinogenemia)

Which of the following would be cause for permanent deferral?

History of Hepatitis after 11th birthday Positive hepatitis C test result Positive HTLV-1 antibody Positive anti-HBc test result

What are the recommended Obstetric Practices?

History: Prev. pregnancies, blood tx Serological testing of mother -ABO and Rh testing -Antibody detection >For clinically significant IgG Aby ~reacts at 37C/AHG >should repeat testing at 24 or 28 weekks if first test negative [Rh (D)] -Antibody specificity -Parent phenotype: type father for antigen of maternal antibody >Determine zygosity may be helpful

Who is at risk for transfusion associated graft versus host disease

Hodgkins lymphoma patients, bone marrow transplant recipients, person's recieving nonirradiated directed donations (al of the above)

What might cause the naturally-occurring isoagglutinins to be decreased in titer or missing?

Hypo- or agammaglobulinemia, leukemia, or the age of the patient. Babies do not have detectable levels of naturally-occurring isoagglutinins in their plasma/serum until 3-6 months of age and titers decrease in the elderly.

A patient with M. pneumoniae infection will most likely develop a cold autoantibody with specificity to which antigen?

I

A patient with an M. pneumo infection will most likely develop a cold autoantibody with specificity to which antigen?

I

Antibody Screen is a

INDIRECT ANTIGLOBULIN TEST

Antigen typing

Infant RBCs: typed for antigen corresponding to maternal antibodies -ex. If mom has Anti-c, type cord cells for "c" antigen

A physician orders a direct antiglobulin test on a patient that sees in her office late in the day. The medical assistant draws a red top tube and places it in the refrigerator uncentrifuged. At 7am the next day, it's picked up by a courier and delivered to the local medical center laboratory for testing. How might the results adversely affected by the handling of the specimen?

If the lab uses broad spectrum anti-human globulin, a false positive reaction might be obtained due to complement binding to the RBCs during refrigeration. Complement reaction can be avoided by drawing EDTA samples. Calcium ions are required for complement activation and EDTA chelates calcium ions.

Rh Ab

IgG -stimulated or produced by red cell stimulation either by pregnancy or transfusion -CLINICALLY SIGN -cause HDFN and HTR -do not activate complement -enhanced by enzymes -react best at AHG phase

Compare the molecular structure of IgG and IgM and explain how their structures affects their reactivity in blood bank testing.

IgG is a monomer. Because of its small size, it usually cannot agglutinate saline suspended in RBCs. A potentiating medium or antiglobulin test is required. IgM is a pentamer. Because of its large size, it is a potent agglutinator, even of saline-suspended cells at room temperature, and it is an efficient activator of complement.

37c

IgM or IgG

Which of the following characteristics best describes Lewis antibodies?

IgM, naturally occurring, do not cause HDN

At which phase are Lewis antibodies usually detected?

Immediate spin

Rh Ab

Immune -anything where you came into contact with someone elses RBC -have to have received a transplant, had a pregnancy, or transfusion

If not labeled "gamma heavy chain-specific," monospecific anti-IgG may contain antibodies to:

Immunoglobulin light chains

M protein contributes to S. Pyogenes invasiveness because it:

Impedes Phagocytosis

Under what circumstances might it be acceptable to transfuse Rh-positive blood to an Rh-negative recipient?

In an emergency. Rh-positive blood may be given to an Rh-negative recipient, provided the recipient does not have anti-D. Depending on the childbearing potential of the patient, Rh immune globulin may be administered to prevent immunization.

Pattern of partial identity

In ouchterlony immunodiffusion in which two wells contain 2 different multi-determinant antigens that share on epitope, the precipitation patterns seen would be categorized as:

Describe the ABO grouping results for a Bombay.

In routine ABO typing, the results are the same as a group O. The problem is recognized when the serum agglutinates all cells in the antibody screen and panel. Testing the RBCs for H with <i>Ulex europeus</i> differentiates the Bombay phenotype from a normal group O. Reactions are negative in a Bombay and positive in a normal group O.

What determins whether an antibody is clinically significant?

In the case of transfusions, whether or not it reacts at 37°C. In the case of pregnancy, whether or not it's IgG, since only IgG molecules can cross the placenta.

Why is incubation omitted in the direct AHG test?

In vivo antigen antibody complex is already formed

What does the direct antiglobulin test (DAT) detect?

In vivo sensitization of RBCs

In interpreting an antibody screen, which of the following questions might be asked to decipher the class of antibody?

In what phase did the reaction occur?

DAT

In-vivo sensitization Detect hemolytic transfusion reaction Detects HDFN Detects autoimmune/drug induced hemolytic anemia

Evaluate the following Ab screen result. How should it be interpreted? selectogen IS 37° AHG CC I 0 0 0 0 II 0 0 0 2+ III 0 0 0 2+

Inconclusive, repeat all phases of testing for Selectogen I

Which of the following events of a systemic inflammatory response provides necessary compounds and cells to the injured area and maintains the health of the surrounding tissue?

Increased blood flow

An elderly patient is documented as being type O. The forward grouping is negative with anti-A and anti-B. The reverse grouping shows o reactivity with A1 cells and B cells. What can be done to correct this discrepancy?

Incubate the patient's serum and reagent cells for 15 minutes at room temperature

What step is required in the indirect antiglobulin test that is not required in the direct antiglobulin test?

Incubation of antigens (RBCs) and antibodies (serum or antiserum). In the DAT, sensitization of RBCs has already occurred in vivo

After an unexpected clinically-significant antibody has been identified, how long should the blood bank records be retained?

Indefinitely. They may alert the blood banker to the presence of an antibody that is no longer detectable in the future. Records of discrepancies, transfusion reactions, and special transfusion requirements such as irradiation should also be retained indefinitely.

Which of the following AABB standards must be met in paternity testing?

Independent reading of electrophoretograms by two technologists

Which antibodies are labile in vivo and in vitro and are noted for causing anamnestic responses?

Kidd antibodies.

Antibodies to antigens in which of the following blood groups are known to show dosage? - I - P - Kidd - Lutheran

Kidd,

Passive Immunity

Injecting an individual with immunoglobulin specific for an infectious agent in which they have been exposed in an example of:

Where is the Rh antigen located relative to the red blood cell membrane?

Integrally

Which is not true of rouleaux formation

It cannot cause a false positive immediate spin cross match

Which is NOT true of rouleaux formation? - It is stacking of RBCs to form aggregates - It can usually be dispersed by adding saline - It can appear as an ABO incompatibility - It cannot cause false positive immediate spin crossmatch

It cannot cause false positive immediate spin crossmatch

What is the advantage of using LISS?

It increases the rate at which an antibody binds to red cell antigens so the incubation time can be shortened to 10 minutes.

How can auto anti-I interfere with blood bank tests?

It may mask the presence of significant alloantibodies. It may also activate complement, causing agglutination in the antiglobulin phase when broad spectrum antihuman globulin is used.

What should be done with a unit of blood that has a positive direct antiglobulin test?

It should be returned to the collecting facility. Compatibility cannot be demonstrated because the cells will always agglutinate in the indirect antiglobulin phase of any crossmatch. (A positive DAT on a donor unit will go undetected if an immediate spin or electronic crossmatch is performed.

How does the ABO system differ from all others?

It's the only one in which there are naturally-occurring antibodies in the plasma/serum (except in group AB).

Majority of blacks are Jk (a_b_)

Jk (a+b-)

In vitro hemolysis is seen for these antibodies: anti-__ and anti-__.

Jk a and Jk b

Kidd Ag's: ___, ___, ___

Jk a, Jk b, Jk3

Which phenotype could not result from the mating of a Jk(a+b-) female and a Jk(a-b+) male?

Jk(a-b-)

Which of the following is not involved in the Kell blood group system?

Jka

Kidd antibodies

Jka and Jkb

Most whites are Js (a_b_)

Js (a-b+)

How many genotypes result in the AB phenotype?

Just one - AB.

What is the next potent antigen after A, B, and D?

K

anti-___ and anti-___ are associated with severe HDN.

K and Fy a

These warm group antibodies bind complement: some anti-__ (20%) anti-__, anti-__, anti-__ and some __ and __.

K, Jk a and Jk b, Lu a, some Duffy and Xg a.

Low frequency Ag's: __, __, __, and __.

K, Kp a, Js a, and Lu a

Common low freq. Ags

K, Kpa, Jsa, and Lua.

Antibodies in which blood group systems usually only react in AHG?

Kell, Duffy, and Kidd

Which severe outcome can be caused by indirect bilirubin levels greater than 18 mg/dL in the newborn?

Kernicterus

___ Ab's are difficult to detect and are a common cause of HTR.

Kidd

____ Ab titers can rise/drop rapidly.

Kidd

There are dominant inhibitors of the ____ and ____ systems.

Kidd and Lutheran

Dosage

Kidd and duffy homozygous = 1 is + and 1 is - kidd homoz- JkA+ and JkB- Heterozygous is if they are both +

Which of the following methods requires the use of check cells?

LISS

Immediate spin detects

M,N,P1, Lewis, cold Ab, I -not required by AABB

What does the minor crossmatch consist of?

Mixing donor plasma with patient red blood cells

Antibodies

Molecules in the plasma of individuals that are produced in response to foreign antigens which can be measured in the laboratory to prove immunity

Which of the following is consistent with a low probability of paternity?

More than 3 POGs were found in the HLA and MNS groups

A Group O R¹R² has a positive antibody screen with reactions at 37°C and in the indirect antiglobulin phase. Could the antibody be any of the following: Anti-D, anti-C, anti-c, anti-E, anti-e?

No, because the patient is positive for D, C, c, E, and e. (R¹=DCe. R²=DcE.)

A woman received a transfusion of packed RBCs while delivering her baby. Six months later she wanted to donate a unit of blood back to the American Red Cross. If the woman meets all other criteria for donation, is she allowed to donate at this time?

No, she needs to wait 6 more months

Is it difficult to find compatible blood for a patient with anti-K?

No. Only 10% of Caucasians and 3% of Blacks are positives for the K antigen.

Which of the following best describes Lewis antigens? - THe antigens are integral membrane glycolipids - Lea and Leb are antithetical antigens - THe Le(a+b-) phenotype is found in secretors - None of these

None of these (The antigens are adsorbed from plasma onto RBC membrane, They are not antithetical, the Le(a+b-) phenotype is found in nonsecretors)

Of the following which blood type is selected when a patient cannot wait for ABO matched RBCs

O

Of the following, which blood type is selected when a patient cannot wait for ABO-matched RBCs?

O

What ABO blood group are screening cells?

O

What type of blood should be given in an emergency situation

O Rh neg, packed cells

What type of blood must be given in an intrauterine transfusion if the blood type of the fetus is unknown?

O neg

A 26-yo B neg female patient requires transfusion. No B neg donor units are available. Which should be chosen for transfusion>

O neg RBCs

What type of blood should be given in an emergency transfusion when there is no time to type the patients sample?

O neg packed cells

A physician orders two units of blood to be given in an emergency situation in surgery. At a blood type and crossmatch. which of the following units can be given in this situation

O negative

Which antigens are known to deteriorate on reagent screening cells over time?

P₁, Lewis, and M.

___, ___, ___, and ___ antigens belong to the high-incidence series.

Vel, Lan, At a, and Sd a. (High Vel Landed At South dakota) Focus on Vel and Sd a (Super Sid)

A specimen for pre-transfusion compatibility testing must be labeled at the patient's bedside with all of the following except:

The ordering physician's name

The CRP level of a patient was 4.2 mg/dL (<0.5 mg/dL). What conclusion can be drawn from this result?

The patient has some type of inflammation and may be at increased risk for a heart attack.

pre transfusion testing will

Verify ABO compatibility Detect most clinically significant antibodies

DCce

R1r R1R0 R0r'

Wiener nomenclature: ___ = DcE

R2

DEc

R2R2 R2r"

Antigens are on the ?

RBC

Bilirubin

RBC destruction release Hgb which is metabolized to bilirubin -in utero, bilirubin is not problem -indirect bilirubin is transported across the placenta and conjugated in maternal liver (direct) and excreted by mother -after birth: newborn liver not developed enough to conjugate effectively -toxic accumulations: 18- 20 mg/dl -Kernicterus

Fluorescent molecules in immunofluorescent techniques are used as substitutes for:

Radioisotopes and Enzyme labels (Both A and B)

When is it permissible to use expired reagents?

Rare reagents, such as anti-Jk(a) and anti-Le(a), may be used beyond their expiration date if appropriate positive and negative controls are run and react as expected. This exception is permitted by the U.S. Food and Drug Administration. This does not apply to reagents that are readily available.

A positive DAT may be seen in

Warm autoimmune hemolytic anemia cold agglutinin syndrome hemolytic transfusion reaction (all of the above)

Which of the following is used to determine if reagents and equipment are functioning prior to testing?

Quality control

Wiener nomenclature: ___ = DCe

R1

DCe

R1R1 R1r'

DCEce all +

R1R2 R1r" R2r' Rzr R2R0 Rory

Which antibodies commonly display dosage?

Rh antibodies other than Anti-D, and antibodies in the MNS, Duffy, and Kidd systems.

If the patient originally has an invalid Rh typing and needs an emergency transfusion, which Rh type should be selected?

Rh negative. Since the recipients Rh typing is invalid, it is best to transfuse with Rh negative, particularly if the patient is a woman of childbearing age.

A cord blood sample was sent to the blood bank for a type and DAT. Cells were washed six times with saline before testing. The forward grouping types as an O. There was no agglutination with anti-D and washed cord cells. The DAT was 3+ with polyspecific AHG. What is the Rh type of the baby?

Rh type cannot be determined

Enzymes enhance:

Rh, Kidd, Lewis, P1, I, ABO

Antibodies in which blood group system are enhanced by enzymes treatment of test cells?

Rh, Lewis, Kidd, and P₁

If you had a lipemic and icteric sample that needed to have an antibody screen done, which of the following would obtain the best results?

SPRCA

Which Rh typing sera do not require use of an Rh control?

Saline anti-D, chemically modified anti-D, or anti-D monoclonal/polyclonal blend. These reagents have a low protein content. Manufactures frequently recommend the ABO front type as a suitable control. For group AB patients, and autocontrol, 6% bovine albumin, or saline may be recommended. The manufacture's instructions should be followed. An Rh control is required in gel testing.

Sc_ is low-incidence.

Sc2

___ is expressed on RBCs carrying Sc1 and/or Sc2 Ags.

Sc3

If you had the authority to decide which primary AHG methodology to utilize at your lab, which method would you choose based on the knowledge that the majority of the staff are generalists?

Solid phase or gel

An antibody screen and crossmatch for five unites are performed and carried though the antiglobulin phase. The antibody screen is negative and four of the five units are compatible. The fifth unit shows agglutination in the antiglobulin phase only. What should be suspected?

That the incompatible unit may have a positive DAT. If confirmed, the unit should be returned to the drawing facility because it will appear to be incompatible in all AHG crossmatches. Another possibilty is that the patient could have an antibody to a low-incidence antigen that is not on the screening cells but is present on the donor cells.

Three victims of an automobile accident arrive at the trauma center at the same time-an 18-year old female, a 54-year old male, and a 76-year old female. All require blood. All are O-negative and the 76-year-old woman has anti-D. The blood bank inventory includes only one unit of O negative. Which of the patients should receive the O negative unit?

The 76-year old female because she has anti-D and transfusion with Rh-positive blood would lead to a transfusion reaction. Had the elderly woman not had anti-D, the Rh-negative unit should have been given to the 18-year-old woman to prevent immunization to D and the possibility of hemolytic disease of the newborn in future pregnancies. When transfusion of Rh-positive blood to Rh-negative recipients is unavoidable, RhIG can be administered to prevent immunization.

How is testing for weak D (Du) performed and when is it required?

The Rh typing is carried through an indirect antiglobulin phase. Weak D testing is required on blood donors who type Rh negative.

A male patient was seen in the emergency room with an acute bleed. The recommendation from the blood supplier is to give O-positive RBCs as uncrossmatched blood. The patient has already been exposed to Rh-positive blood after a previous accident. What is a possible outcome?

The patient may have a hemolytic transfusion reaction from an allo immunized anti-D

While retyping a group B trauma patient, the technologist observes mixed field agglutination with anti-B. Typing at the time of admission showed 4+ agglutination with anti-B. What might have caused this change in reactivity?

The patient may have been transfused with a large volume of group O RBCs. The transfusion history should be checked.

After an antibody has been identified, what step should be taken to confirm the result?

The patient's RBC's should be typed for the corresponding antigen. They should be negative.

Why are Lewis antibodies not generally implicated in hemolytic disease of the newborn (HDN)? Lewis antibodies are IgM and cannot cross the placenta Which of the following may be a possible cause for the lack of expression of Lewis antigens during pregnancy? increased ration of plasma lipoproteins to red cell mass At which phase are Lewis antibodies usually detected? immediate spin Why is the Le system not implicated in hemolytic disease of the newborn (HDN)? Lewis antigens are not well developed at birth How is Leb substance formed? L-Fucose is added to subterminal N-acetylglucosamine of type 1 H substance Lewis antibodies are of what immunoglobulin class? IgM Lewis cell-bound antigens absorbed from plasma on to the red cell membranes are: glycolipids Person who inherit the Se and Le gene will have _____ A or B glyolipids in plasma than persons who are Se le. less(I don't know why this is true...) Pregnant women usually express which phenotype? Le(a-b-) A Bombay individual who has inherited the Le gene will have a phenotype of: Le(a+b-) What substance would be present in the saliva of a person with the LeLe HH SeSe AA genotype? A, H, Lea, Leb How does anti-Lea differ from anti-Leb? Anti-Lea can bind complement more efficiently What is the most important use for anti-B lectin? differentiating a true B from an acquired-like B All of the following are technical errors that could result in ABO discrepancies: sample misidentifiedfailure to add reagentsclerical errors Reverse grouping was performed on an AB person. The technologist observed a very weak agglutination macroscopically. The cells appeared as "stacked coins" under a microscope. Which reagent should be added to the tube and recentrifuged in an attempt to resolve the discrepancy?

The Wright blood group antigens belong to which blood group system? DI Which antigen is useful as a genetic marker for Mongolian derivation and anthropologic studies? Di(a) Which antigen is expressed on C4B complement fragments? Ch(a) How does complement aid in the identification of alloantibodies masked by anti-Ch(a)? C4d in plasma will absorb anti-Ch(a) Bg antibodies are primarily directed toward antigenic determinants present on what type of cells? White Blood Cells How are antigens in the CH/RG blood group systems expressed on RBCs? absorbed on to the red cell membrane Why are the M and N antigens important for paternity testing? Antigens are well developed at birth What characteristic differentiates Ss antigens from MN antigens? enzyme degradation The M and N antigens are found in which glycoprotein? glycophorin A List some key characteristics of the En(a) antigen It's a high frequency antigen (99.9% of the population)Individuals negative for En(a) lack MN-SGPMost En(a)-negative individuals produce anti-En(a)Part of the MNS blood group system The structures that carry the P antigens also carry which determinants? A, B, I At birth, infant cells are rich in _______, and ________ is nearly undetectable. i/I List some key characteristics consistent with Benign anti-I naturally occurringIgMbind complementreactive at 4 degrees C How can pathologic anti-I be differentiated from benign anti-I? broad thermal range of reactivity Anti-i is found in association with what disease? infectious mononucleosis The Ii antigens are found on the membranes of which structures? PlateletsWhite Blood CellsRed Blood Cells At what age do infants start to have detectable levels of I antigen on their cells? 18 months Why is it relatively easy to find compatible units for a patient with anti-K? Kell is a low-frequency antigen At what phase of the antihuman globulin test will anti-Kell be detected? AHG phase What is the most common genetic combination in the Kell blood group system? kKpb Jsb K11 List some key characteristics of Kidd antibodies IgG immunoglobulinsability to bind complementnot naturallly occurringexhibit dosage Why is it strongly recommended to use only homozygous cells when ruling out Kidd antibodies? Anti-Jka may appear compatible with heterozygous cells [Jk(a+b+)] When red cells are placed in a solution of 2M urea, the red cells will lyse. However, it has been showed that which red cells are resistant to lysis? Jk(a-b-) What Kidd antibody will react with all panel cells and phenotype as Jk(a-b-)? anti-Jk3 What organism is capable of converting Jk(b-) red cells to Jk(b+)? Micrococcus species Why does anti-Lu(a) go undetected in routine testing? Most reagent cells are Lu(a-) The Lu(3) antigen is present whenever: Lu(a) and Lu(b) are present What red cell antigens in the Kell group do homozygous K(0) individuals express? they don`t express any antigens

Why is it acceptable to transfuse an AB person with A packed red blood cells but unacceptable to transfuse type A whole blood?

The anti-B in donor whole blood would sensitize recipient cells

Most effective vaccines that are currently in widespread use are specific for pathogens viruses and the immunity induced by the vaccines is mediated largely by antibodies. Which of the following statements accurately describes the major mechanism by which these vaccine-dependent antibody responses function

The antibodies bind extracellular viral particles and prevent them from infecting cells

An individual of the dce/dce genotype given dCe/dce blood has an antibody response that appears to be anti-C and anti-D. The most likely explanation for this is?

The antibody is anti-G

After the addition of IgG coated RBCs (check cells) to a negative AHG reaction during an antibody screen, a negative result is observed. Which of the following is a correct interpretation?

The antibody screen must be repeated

After the addition of IgG coated RBCs (check cells) to a negative AHG reaction during an antibody screen, a negative result is observed. Which of the following is the correct interpretation

The antibody screen needs to be repeated

After the addition of IgG-coated RBCs (check cells) to a negative AHG reaction during an antibody screen, a negative result is observed. Which of the following is a correct interpretation?

The antibody screen needs to be repeated.

What is the physiological cause of citrate toxicity in cytapheresis procedures?

The anticoagulant in plasma contains citrate, which binds calcium, lowering the body's ionized calcium.

How does the Lewis system differ from all others?

The antigens are soluble substances that are absorbed onto the RBC membranes the plasma

Exon refers to

The coding region of a gene

A donor's RBC's fail to react with anti-D typing serum during routine testing. When the tubes are carried through the indirect antiglobulin phase, agglutination is observed with anti-D, but not with the Rh control. How should this blood be classified for transfusion purposes?

The donor is a weak D, therefore, the unit is labeled Rh positive.

How does irradiation affect the shelf life of red blood cells?

The expiration is 28 days from the date of irradiation or the original outdate, whichever is sooner

Which of the following characteristics is representative of CRP?

The first acute phase reactant to become elevated, Nonspecific indicator of inflammation, Acute phase reactant...ALL OF THE ABOVE is correct

Why should serum separator tubes not be used for blood bank testing?

The gel can contaminate the RBCs during sampling and cause false-positive test results.

Which of the following statements concerning red blood cells prepared with additive solution (AS-1) is true?

The hematocrit is lower than CPDA-1 red blood cells

Natural Immune Response

The host's first defense directed against any foreign antigen that does not require specific antigen recognition by the immune system is the:

In a complement-dependent cytotoxicity assay, lymphocytes were incubated in the presence of antibody of known HLA specificity. Complement was added, and the cells absorbed trypan blue. What is the interpretation of this assay?

The lymphocytes express antigens specific for the antibodies in the assay

Streptolysin O is:

The most frequently used serologic indicator of an antibody response to a recent streptococcal infection

How might agammaglobinemia or leukemia affect a patients blood grouping?

The naturally-occurring isoagglutinins might be weak or missing. With leukemia, certain antigens may also be weak or missing.

Interpret the following Rh typing results:<br> Anti-D: 3+<br> Rh control 3+

The positive Rh control makes the Rh typing invalid. The typing should be repeated with a low protein Rh typing reagent. A direct antiglobulin test should be performed on the RBCs to determine if that is the cause of the positive Rh control.

Zone of equivilence

The region in a serum sample where maximal agglutination occurs

What is therapeutic plasmapheresis?

The removal of large volumes of patient plasma

What is the Bombay phenotype?

The result of genotype hh. Without the H gene, RBCs do not develop A or B antigens, even when the corresponding genes are inherited. A Bombay's RBCs are negative for H, A, and B and the serum has anti-H, anti-A, and anti-B. The serum agglutinates all RBCs, except those from another Bombay.

List several factors that affect hemagglutination.

The sensitization phase is affected by the temperature, the pH, the ionic strength of the medium, the antigen-antibody ratio, and the time of incubation. The agglutination phase is affected by the type of the antibody, the density and the location of the antigens, and the zeta potential (electrostatic repulsion).

An antibody panel is performed on an O negative patient. Anti-D and anti-Jk^b cannot be ruled out. What futher testing could be done to rule out anti-Jk^b?

The serum should be tested with D negative, Jk^b positive cells. If no agglutination occurs, anti-Jk^b is ruled out.

What does it mean if IgG-coated red cells (check cells, Coomb's control cells) do not agglutinate in the final phase of the antiglobulin test?

The test is invalid and must be repeated. If the IgG-coated red cells do not agglutinate, it means that the antihuman globulin was not added or it was inactivated. Residual serum proteins from inadequate cell washing can neutralize antihuman globulin.

when is Additional Laboratory Testing for ABO HDFN done?

These are performed ONLY if indicated: -Hgb and Peripheral Blood Smear > Microspherocytes characteristic of ABO-HDN > few nRBCs > Mild or no anemia [different clinical picture than Rh-HDN] -Bilirubin Assay > Bilirubin peak is later; 1-3 days after birth > Treat with Phototherapy

Why are Kidd antibodies so dangerous in transfusion therapy?

They decline in titer quickly so that they may not be detectable in antibody screens. If the patient is re-exposed to Kidd antigens, an anamnestic response and delayed transfusion reaction can occur.

Interpret the following ABO grouping results obtained using washed saline-suspended red cells for the front type. <br> Anti-A: 4+<br>Anti-B:4+<br>A₁ cells: 2+<br>B cells:2+<br> Auto control: 2+

This ABO discrepancy could be due to a cold autoagglutination or rouleaux in a group AB. A saline replacement should be performed on the reverse grouping. Saline will disperse rouleaux but not true agglutination.

Interpret the following ABO grouping results.<br> Anti-A: 3+<br>Anti-B:4+<br>A₁ cells: 2+<br>B cells:0

This is an ABO discrepency, possibly and A₂B with anti-A₁. Approximately 25% of A₂Bs have naturally-occurring anti-A₁ in their plasma/serum. An antibody screen and testing with additional A₁ and A₂ cells should be performed. No interpretation should be made until the forward and reverse grouping agree. If additional testing confirms the presence of anti-A₁ in the serum, A₂ cells should be used for the reverse grouping.

In order to have 95% confidence in the antibody identification, how many positive and how many negative reactions are required?

Three positives and three negatives.

What do Coombs control cells consist of>

Type O positive cells coated with anti-D

What to Coomb's control cells consist of?

Type O positive cells coated with anti-D

What do Coombs' control cells consist of?

Type O-positive cells coated with anti-D

A patient developed an anti-s 2 years ago. His antibody screen is now negative. Which of the following would be the BEST procedure in selecting units for transfusion?

Type the donor units for the s antigen and crossmatch with the patient's serum

A patient developed and anti-Jk(a) antibody 5 years ago. The antibody screen is currently negative. TO obtain suitable blood from transfusion, which procedures apply?

Type the patient and donor units for the Jk(a) antigen and then crossmatch the Jk(a) neg units with patient serum

A patient developed an anti-Jka antibody 5 years ago. The antibody screen is currently negative. To obtain suitable blood for transfusion, which procedures apply?

Type the patient and donor units for the Jka antigen, and then crossmatch the Jka negative units with the patient serum

Mixed-field reactions with Anti-A and Anti-A,B and negative reactions with anti-B and anti-A1 lectin (dolichos biflorus) are observed. Without further testing, the most likely conclusion is that the patient is group? A3 cells of the A3 subgroup will? give a mixed field reaction with Anti-A,B Mixed-field reactions with Anti-A and Anti-A,B and negative reactions with anti-B and anti-A1 lectin (dolichos biflorus) are observed. Without further testing, the most likely conclusion is that the patient is group?A3 isoimmunization to platelet antigen and the placental transfer of maternal antibodies would be expected to cause newborn:thrombocytopenia A patient sample provides the following blood bank results anti A 3+ anti B 4+ Anti D 3+ A1 cells 4+ B cells 0 dolichos biflorus which of the following reagents are used to perform the forward typing in an individual: Anti-B Which of the following statements about enhancement media and potentiators is correct? Low ionic strength saline(LISS) enhances antibody uptake by reducing the zeta potential and allows increase blood cells what immunoglobulin class is primarily associated with ABO antibodies? IgM what immunoglobulin class is primarily associated with RH antibodies? IgG the patient had a genotype of BO,Hh,sese. what antigens would be present on the red blood cells of this patient? B and H what blood bank test is needed to determine weak D antigen status of the patient? IAT Do these antibodies cause Hemolytic disease of the fetus and newborn (HDFN) Yes (Anti E, Anti K) what additional testing would the blood bank need to perform to confirm that the patient is capable of producing this type of antibody(ies) antigen type the patents red cells. phenotyping Kris Koh has been rushed to the emergency room following a motorcycle accident. the physician orders a type and screen A 4+ B 0 D 3+ Ctl. 0 A1 0 B 4+ I 0 II 0 A positive with a negative antibody screen what blood type for packed red blood cells can kris receive? a positive, a negative, o positive, o negative rusty nails has been antigen typed for the Rh system. the following results were obtained D 3+ C 3+ E 0 c 0 e 4+ Ctl. 0 genotype: DCe/DCe Leukocyte reduced packed red blood cells are ordered for a newly diagnosed bone marrow candidate what is the best way ? Irradiate the unit with 1500 rads A patient admitted to the trauma unit requires emergency release of fresh frozen plasma (FFP). His blood donor card states that he is A of the following blood groups of FFP should be issued? AB. if an O negative male who has never been transfused is crossmatched against an O positive? the crossmatch will be completable which of the following test could be used to enhance a weak reacing antibody> enzyme treatment which of the following statements is most likely the cause of the following ABO discrepancy? A 4+ B 1+ A,B NA D 4+ A1 LECTIN NA A1 0 A2 NA B 4+ AUTO CONTROL NA DAT NA *Aquired B5t

Under extreme emergency conditions when there is no time to determine ABO group for transfusion, the technologist should?Release O, Rh-negative red blood cells optimum storage temperature for whole blood is? 4C quality control tests must be performed daily on? reagent red cells based on the patents clinical history provided before surgery. how did she develop the positive antibody screen. pregnancy the blood bank decided to RH genotype the patient. the following results are obtained. D E C e c 0 0 + + + what is he patients genotype based on the fisher race theory dCe/dce The OR notifies the blood bank that they are ordering two units of packed red blood cells to be on hold in case there is a major bleed or complication requiring blood. what blood packed red blood cells? explain how he blood bank would crossmatch units to determine if they are compatible. B negative O negative antigen type units to find two units that are negative for E and K. crossmatch units through the AHG phase to determine units given to the patent. the optimum storage temperature for the leukocyte reduced packed red blood cells is 4c under extreme emergency conditions when there is no time to determine ABO for transfusion the blood bank technologist should. release O, Rh negative packed red blood cells the OR nurse calls the blood bank and ask if she needs to order the blood be irradiated. the purpose of a low dose irradiation of blood components is to? prevent graft vs host disease Ann Teeks is being seen by her physician for a hemoglobin of 6.1 g/dl. the physician orders a type and screen. The following results were obtained. A 4+ B 4+ D 3+ Ctl. 4+ A1 0 B 0 I 0 II 0 invalid blood type due to positive control tube negative antibody screen. which of the following blood products has the longest expiration date? Frozen red blood cells 10 years the I antigen of normal individuals varies in strength and is recognized as a cold antibody anti sda is strongly suspected in a patient if? the agglutinates are mixed field and refractile which of the following statements is a definition of collecting a blood product by apheresis? separation or removal of blood component from whole blood which of the following blood group systems is most commonly associated with delayed hemolytic transfusion reactions? KIDD the saline phase or immediate spin (is) phase of an antibody screen is designed to detect IgM antibodies which of the following genotypes would form the f antigen? Dce/Dce which of the following might explain how a patient could have an antibody but the blood bank technologist could not detect it screen methods all of the above individuals who possess the Oh (Bombay) phenotype: have the genotype hh the M and N antigens are will developed at birth susceptible to enzymes generally saline reactive. remain constant throughout life what is the purpose of the immediate spin crossmatch? to detect ABO incompatibility between the patient and the donor of the following blood group systems which blood group antigens may be susceptible to destruction by enzymes: Duffy

List several blood group antigens of low incidence.

V, Kpa, Jsa, Lua, Vw, Di, Wr, Cob. These antigens are found in less than 1% of the population.

Which of the following factors are found in therapeutic levels in fresh frozen plasma

VIII, V, XI (all factors)

Which phlebotomy site is unacceptable for compatibility testing?

Vein above the intravenous line

Which of the following antigens is not in a blood group system? - Do(a) - Vel - JMH - Kx

Vel

which of the immunoglobulins is associated with ABO antibodies IgM the G antigen is present on all cells that are positive for either of these two antigens D and C which of the following antibodies does not match the others in term of optimal temperature- Anti N which of the following blood products would be used to treat a patient with sepsis granulocytes which blood group has the highest concentration of H antigen O all of the following are true concerning antiP except? is inhibited by hydatid cyst fluid when an individual is said to be group b it refers to their? phenotype which of the following patients is most likely to require irradiated product? patient undergoing a bone marrow transplant paroxysmal cold hemoglobinuria (pch) is best associated with which of the following blood group systems? P which of the following is a characteristics of Xga blood group system? the Xga antigen has a higher frequency in women then in men which blood group system has been associated with infections caused by mycoplasma pneumonia? I/i which of the following blood group systems is naturally occurring? ABO which of the following blood group systems is located on a component of complement? Chido/Roger which of the following antibodies is encountered most frequently? Anti K washed packed red blood cells would be the product of choice for a patient with? anti IgA antibodies individuals of the Mcleod phenotype are found in which blood group system? Kell Duffy antigens are receptors for ? Plasmodium vivax where are the Lewis antigens produced? Tissue cells an antibody screen using Liss enhancement is incubated at 37c for 1 hour? False negative this incubation period is too long for the method a secretor is defined as an individual who? produces soluble ABH antigens in secretions an antibody directed against self antigens is a? Autoantibody the RH phenotype that is associated with a hemolytic anemia is? Rh null ALL OF THE FOLLOWING ANTIBODIES MAY CAUSE HDFN EXCEPT? Lewis an example of high incidence antigen would be? Kpb

which of the following terminal sugars is associated with the H antigen on the red blood cells L-furcose which class of immunoglobulins is associated with RH antibodies? IgG anti D is clinically significant antibody because it? can cause hemolytic transfusion reactions the use of leukoreduced packed red blood cells and platelet concentrates is indicated for which of the following? victims of acute trauma with massive bleeding

ABO typing

while performed is not critical in the lab diagnosis

PLT storage/shipment temp

20-24 celcius