Blood Banking and Transfusion Practices: Antibody Detection and Identification, Exams of Nursing

Download Blood Banking and Transfusion Practices: Antibody Detection and Identification and more Exams Nursing in PDF only on Docsity! TEST BANK _ « od (J Fra Basic & Applied Concepts of Blood Banking and Transfusion Practices Test Bank For Basic & Applied Concepts of Blood Banking and Transfusion Practices 5th Edition – By Paula Howard ISBN: 9780323697392 Table of Contents Part I: Quality and Safety Issues 1. Quality Assurance and Regulation of the Blood Industry: Safety Issues in the Blood Bank Part II: Foundations: Basic Sciences and Reagents 2. Immunology: Basic Principles and Applications in the Blood Bank 3. Blood Banking Reagents: Overview and Applications 4. Genetic Principles in Blood Banking Part III: Overview of the Major Blood Groups 5. ABO and H Blood Group Systems and Secretor Status 6. Rh Blood Group System 7. Other Red Cell Blood Group Systems, Human Leukocyte Antigens, and Platelet Antigens Part IV: Essentials of Pretransfusion Testing 8. Antibody Detection and Identification 9. Compatibility Testing c. Following the employees’ first evaluation d. Before independent work is permitted and annually thereafter ANS: D The Occupation Safety and Health Administration requires safety training before independent work is permitted and annually thereafter. DIF: Level 1 REF: p. 17 5. In safety training, employees must become familiar with all of the following except: a. tasks that have an infectious risk. b. limits of protective clothing and equipment. c. the appropriate action to take if exposure occurs. d. how to perform cardiopulmonary resuscitation on a donor or other employee. ANS: D The Occupational Safety and Health Administration requirements include all of those listed except cardiopulmonary resuscitation. DIF: Level 1 REF: p. 13 6. Blood irradiators require all of the following safety procedures except: a. proper training. b. that the user have a degree in radiology. c. equipment leak detection. d. personal protective equipment. ANS: B Blood bank and transfusion service technologists require training but not a degree to use a blood irradiator. DIF: Level 2 REF: p. 16 7. Which of the following is true regarding good manufacturing practices (GMPs)? a. GMPs are legal requirements established by the Food and Drug Administration. b. GMPs are optional guidelines written by the AABB. c. GMPs are required only by pharmaceutical companies. d. GMPs are part of the quality control requirements for blood products. ANS: A Good manufacturing practices are requirements established by the Food and Drug Administration. DIF: Level 1 REF: p. 5 8. Which of the following is an example of an unacceptable record-keeping procedure? a. Using dittos in columns to save time b. Recording the date and initials next to a correction c. Not deleting the original entry when making a correction d. Always using permanent ink on all records ANS: A All records must be clearly written. Dittos are unacceptable. DIF: Level 1 REF: p. 7 9. A technologist in training noticed that the person training her had not recorded the results of a test. To be helpful, she carefully recorded the results she saw at a later time, using the technologist’s initials. Is this an acceptable procedure? a. Yes; all results must be recorded regardless of who did the test. b. No; she should have brought the error to the technologist’s attention. c. Yes; because she used the other technologist’s initials. d. Yes; as long as she records the result in pencil. ANS: B This is an example of poor record keeping; results must be recorded when the test is performed and by the person doing the test. DIF: Level 3 REF: p. 8 10. Unacceptable quality control results for the antiglobulin test performed in test tubes may be noticed if: a. preventive maintenance has not been performed on the cell washer. b. the technologist performing the test was never trained. c. the reagents used were improperly stored. d. All of the above ANS: D Training, equipment maintenance, and reagent quality can affect quality control. DIF: Level 2 REF: p. 5 11. All of the following are true regarding competency testing except: a. it must be performed following training. b. it must be performed on an annual basis. c. it is required only if the technologist has no experience. d. retraining is required if there is a failure in competency testing. ANS: C All employees must have competency testing following training and annually thereafter. If there is a failure in competency testing, retraining is required. DIF: Level 2 REF: p. 10 12. Which of the following organizations are involved in the regulation of blood banks? a. The Joint Commission b. AABB c. College of American Pathologists d. Food and Drug Administration ANS: D The Food and Drug Administration regulates blood banks, whereas the other organizations are involved in accreditation. DIF: Level 1 REF: p. 2 13. All of the following are responsibilities of the quality assurance department of a blood bank except: a. performing internal audits. b. performing quality control. c. reviewing standard operating procedures. d. reviewing and approving training programs. ANS: B Quality control is performed in the laboratory, not by the quality assurance department. DIF: Level 2 REF: p. 5 14. The standard operating procedure is a document that: a. helps achieve consistency of results. b. may be substituted with package inserts. c. is necessary only for training new employees. d. must be very detailed to be accurate. ANS: A Standard operating procedures are written procedures that help achieve consistency and should be clear and concise. DIF: Level 2 REF: p. 8 15. Employee training takes place: a. after hiring and following implementation of new procedures. b. following competency assessment. c. only for new inexperienced employees. d. as procedures are validated. ANS: A Training occurs with all new employees regardless of their experience and following implementation of new procedures. DIF: Level 1 REF: p. 10 16. Plans that provide the framework for establishing quality assurance in an organization are: a. current good manufacturing practices. b. standard operating procedures. c. change control plan. d. continuous quality improvement plan. ANS: D The total quality management or continuous quality improvement plan are part of the quality assurance program in an organization. DIF: Level 1 REF: p. 4 17. A facility does not validate a refrigerator before use. What is a potential outcome? a. The facility is in violation of current good manufacturing practices and could be cited by the Food and Drug Administration. TRUE/FALSE 1. The Occupation Safety and Health Administration does not require the routine use of gloves by phlebotomists working with healthy prescreened donors or changing unsoiled gloves between donors. ANS: T Because the risk of exposure is minimal with blood donors, the Occupation Safety and Health Administration (OSHA) does not require gloves, or if gloves are worn, OSHA does not require that unsoiled gloves be changed between donors. DIF: Level 1 REF: p. 15 2. All accidents, even minor ones, must be reported to a supervisor. ANS: T The Occupational Safety and Health Administration, workers’ compensation, and other regulatory agencies require reporting all accidents, and an investigation to avoid other injuries is mandatory. DIF: Level 1 REF: p. 16 3. Quality control is the same as quality assurance. ANS: F Quality control is performed on reagents and equipment; quality assurance is a system to ensure safe and effective products. DIF: Level 1 REF: p. 5 Chapter 02: Immunology: Basic Principles and Applications in the Blood Bank Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Select the cell involved in humoral immunity. a. Neutrophils b. T lymphocytes c. B lymphocytes d. Monocytes ANS: C B lymphocytes have the ability to transform into plasma cells to produce antibodies, which is considered a humoral response. DIF: Level 2 REF: p. 23 2. What process is described by opsonization? a. Lysis of cells b. Binding to cells or antigens c. Ingestion of cells d. Phagocytosis ANS: B Opsonization promotes phagocytosis by binding to cells or antigens. DIF: Level 1 REF: p. 35 3. Select the term that describes cells or tissue from a genetically different individual within the same species. a. Allogeneic b. Autologous c. Xenogeneic d. Autograft ANS: A Allogeneic cells or tissue come from a genetically different individual within the same species. DIF: Level 1 REF: p. 33 4. Select the substance that regulates the activity of other cells by binding to specific receptors. a. Cytokines b. Complement c. Immunoglobulins d. Anaphylatoxin ANS: A Cytokines are proteins secreted by cells that regulate the activity of other cells by binding to specific receptors. DIF: Level 1 REF: p. 23 5. Which of the following is responsible for the activation of the classic pathway of complement? a. Bacteria b. Foreign proteins c. Virus d. Antibody bound to antigen ANS: D An antigen-antibody complex activates the classical complement cascade, whereas bacterial membranes activate the alternative pathway. DIF: Level 1 REF: p. 33 6. What biological molecules are considered the most immunogenic? a. Carbohydrates b. Lipids c. Proteins d. Enzymes ANS: C Protein molecules are the most immunogenic, followed by carbohydrates and lipids, which tend to be immunologically inert. DIF: Level 2 REF: p. 24 7. What part of the immunoglobulin molecule distinguishes the isotype? a. Light chain b. Heavy chain c. Kappa chain d. Lambda chain ANS: B The five distinctive heavy-chain molecules distinguish the class or isotype. Each heavy chain imparts characteristic features, which permit them to have unique biological functions. DIF: Level 2 REF: p. 24 8. Select the immunoglobulin class produced first in the primary immune response. a. IgG b. IgE c. IgA d. IgM ANS: D IgM antibodies are produced first, followed by the production of IgG antibodies. DIF: Level 1 REF: p. 28 9. In a serologic test, the term prozone is also known as: a. Small antigen size b. Composed largely of carbohydrates c. Size greater than 10,000 daltons d. Similarity to the host ANS: C Antigens will elicit a better immune response if they are larger than 10,000 daltons, are foreign to the host, and are made of proteins. DIF: Level 1 REF: p. 25 19. Extravascular destruction of blood cells occurs in the: a. blood vessels. b. lymph nodes. c. spleen. d. thymus. ANS: C Extravascular destruction of blood cells is initiated by macrophage interaction with IgG molecules attached to red cells that transport the red cells to the spleen for clearance. DIF: Level 2 REF: p. 35 20. An antibody identified in the transfusion service appeared to be reacting stronger following the second exposure to an antigen from a transfusion. The most likely explanation of this observation is: a. affinity maturation of the immunoglobulin molecule. b. anamnestic response. c. isotype switching. d. All of the above ANS: D Genetic changes in the variable region, stimulation of memory B cells, and class switching contribute to the increased strength and specificity of an antibody following the second exposure to an antigen. DIF: Level 3 REF: p. 29 21. Which of the following components in the complement cascade mediates the lysis of the target cells? a. C1qrs b. C4a, C3a, and C5a c. C5 to C9 d. C3a and C3b ANS: C The membrane attack complex includes the C5 to C9 proteins that mediate lysis of the target cell. DIF: Level 2 REF: p. 34 22. Which of the following requires adjustment in order to enhance the reaction of an antibody in vitro? a. Temperature above 37° C b. Speed of the centrifuge above the calibrated settings c. Increase the concentration of red cells in the test system d. Increase the incubation time in the incubator ANS: D Increasing incubation time is effective in increasing antibody reactions; however, optimal temperatures, centrifugation, and antigen concentrations are normally not altered when performing routine transfusion service testing. DIF: Level 3 REF: p. 37 23. Hemolysis was observed at room temperature when testing a patient’s serum with reagent red cells used for screening. When this test was repeated using the patient’s plasma, no hemolysis was observed. What was the most likely explanation for the different reactions? a. The plasma sample was collected incorrectly. b. The serum sample was contaminated. c. Complement activation was inhibited by calcium in the plasma sample. d. The serum sample was fresher. ANS: C Complement can be activated by some red cell antibodies; however, fresh serum samples are necessary to observe this reaction. Plasma samples contain calcium to inhibit the coagulation cascade, which also will inhibit complement activation. DIF: Level 3 REF: p. 33 24. Which immunoglobulin class is impacted by the zeta potential in a hemagglutination test? a. IgM b. IgG c. IgA d. IgE ANS: B IgG is a small molecule that cannot span the distance between red cells suspended in saline. The zeta potential prevents direct agglutination with IgG molecules. DIF: Level 2 REF: p. 37 25. When testing for the A antigen in a patient, what would you use to perform the test? a. Patient’s plasma and commercial A red cells b. Commercial A cells and anti-A c. Patient’s red cells and anti-A d. None of the above ANS: C For antigen testing, antigens are on the red cell; antibodies are in the antisera (commercial antibodies). DIF: Level 2 REF: p. 40 26. A technologist added 4 drops of a 5% red cell suspension instead of the required 1 drop to a hemagglutination test. What is the potential consequence to the test results? a. False-positive b. False-negative c. Hemolysis due to complement activation d. Test results are not affected ANS: B Postzone occurs when the concentration of antigen exceeds the number of antibodies present. The amount of agglutinates formed under these circumstances is also suboptimal and diminished. DIF: Level 3 REF: p. 38 MATCHING Select the immunoglobulin class from the list below that best fits the characteristic described. Each class can be used more than once. a. IgA b. IgM c. IgG d. IgE 1. Found in secretions, such as breast milk 2. Able to cross the placenta 3. Associated with intravascular cell destruction 4. Associated with allergic reactions and mast cell activation 5. Efficient in activation of the complement cascade 6. Has the highest serum concentration 7. Associated with immediate-spin in vitro reactions 8. Has the highest number of antigen binding sites 1. ANS: A DIF: Level 2 2. ANS: C DIF: Level 2 3. ANS: B DIF: Level 2 4. ANS: D DIF: Level 2 5. ANS: B DIF: Level 2 6. ANS: C DIF: Level 2 7. ANS: B DIF: Level 2 8. ANS: B DIF: Level 2 Select the term from the list below that best fits the definitions. a. Kappa b. Epitope c. Hinge region d. Isotype e. Idiotype 9. Variable region of an immunoglobulin DIF: Level 2 REF: p. 49 5. Reagent antibodies prepared from human sources are: a. unsafe. b. too low in potency to be effective. c. polyclonal in specificity. d. preferred because of their lower cost. ANS: C Human-derived antisera have antibodies to multiple specificities and meet Food and Drug Administration guidelines for potency and safety. DIF: Level 1 REF: p. 49 6. Monoclonal antibodies are prepared in: a. vitro. b. vivo. c. laboratory animals. d. humans. ANS: A Monoclonal antibodies are prepared from antibody-producing B-lymphocytes and myeloma cells in a hybridoma, which is cultured in vitro. DIF: Level 1 REF: p. 51 7. Which of the following is not an advantage of using a monoclonal antibody over a polyclonal antibody? a. There are very few variations between lots. b. There are no contaminating antibodies. c. Direct agglutination is usually faster. d. All variations of the antigen can be detected. ANS: D Some monoclonal D antibodies may miss antigen variations, such as the partial D phenotype. DIF: Level 2 REF: p. 51 8. Where are product limitations and technical considerations for each reagent located? a. Standard operating procedure b. Product insert c. Food and Drug Administration code of regulations d. AABB standards ANS: B The product insert outlines the technical considerations, procedural guidelines, and product limitations for each reagent. DIF: Level 1 REF: p. 49 9. Solid-phase red cell adherence used for antibody detection has an advantage over tube testing because: a. there is no washing involved. b. incubation time is not necessary. c. the endpoint is more clearly defined. d. indicator cells (IgG-coated cells) are not necessary. ANS: C Well-defined endpoints make reading results more consistent and reliable. DIF: Level 2 REF: p. 67 10. Which of the following statements is true regarding IgG-sensitized red cells? a. They must be used to confirm a negative antiglobulin tube test. b. They must be used to confirm a positive antiglobulin test. c. They must be used to confirm a direct antiglobulin test that was negative with anti-C3d. d. They should be used only with the indirect antiglobulin test. ANS: A IgG-sensitized red cells are used as a control for false-negative antiglobulin tests. DIF: Level 2 REF: p. 62 11. What method displays a positive reaction as a compact red cell button? a. Gel test b. Microtiter plate c. Solid-phase red cell adherence d. Molecular testing ANS: B The microtiter plate method displays a positive reaction as a compact red cell button in the bottom of the well. Negative reactions will stream when tilted on an angle. DIF: Level 1 REF: p. 68 12. The antiglobulin test was performed using gel technology. A button of cells was observed at the bottom of the microtube following centrifugation. How do you interpret this result? a. There is a problem with the card. b. The result is a negative reaction. c. The result is a strong positive reaction. d. The test was not washed correctly. ANS: B Red cells that are not trapped by the antihuman globulin reagent will travel unimpeded through the length of the tube. DIF: Level 3 REF: p. 67 13. Which of the following statements is true regarding high-protein anti-D reagents? a. They have been largely replaced with low-protein monoclonal reagents. b. They contain high concentrations of bovine albumin. c. They may increase the possibility of a false-positive reaction, requiring the use of a control. d. All of the above are true. ANS: D High-protein anti-D reagent requires the use of a control to verify that positive reactions are the result of an antigen-antibody reaction and not agglutination caused by the reagent additive. For this reason, the use of monoclonal anti-D is more commonly used. DIF: Level 2 REF: p. 54 14. How would you interpret the results if both the anti-D reagent and the Rh control were 2+ agglutination reactions? a. D-positive b. D-negative c. Unable to determine without further testing d. Depends on whether the sample was from a patient or a blood donor ANS: C The Rh control should be negative for the test to be valid. DIF: Level 2 REF: p. 54 15. Which red cells are used to screen for antibodies in donor samples? a. Screening cells (two vials) b. Pooled screening cells c. Panel cells d. Screening cells (three vials) ANS: B Pooled screening cells are acceptable for screening antibodies in donor samples. DIF: Level 2 REF: p. 56 16. What specificities does polyspecific antihuman globulin contain? a. Anti-IgG. b. Anti-C3b and anti-C3d. c. Anti-IgG and anti-C3d. d. Anti-IgG and anti-IgM. ANS: C Polyspecific antihuman globulin contains specificities to the heavy chain IgG and complement component, C3d. DIF: Level 1 REF: p. 60 17. What temperature is used for incubation in the indirect antihuman globulin test? a. 22° C b. 37° C c. 4° C d. 56° C ANS: B Incubation takes place at body temperature, which is 37° C. b. Screening cells c. A1 and B cells d. ABO antisera e. Lectins 1. Reagent derived from plants used to distinguish group A1 from group A2 red cells 2. Reagent used to determine the ABO antigenic composition of a patient’s red cells 3. Reagent used to detect the presence of red cell antibodies 4. Reagent used to identify the specificity of a red cell antibody 5. Reagent used in the identification of ABO antibodies 1. ANS: E DIF: Level 2 2. ANS: D DIF: Level 2 3. ANS: B DIF: Level 2 4. ANS: A DIF: Level 2 5. ANS: C DIF: Level 2 Select the antiglobulin test that best fits the descriptions below. A selection may be used more than once. a. Indirect antiglobulin test b. Direct antiglobulin test c. Both the direct and indirect antiglobulin test 6. Incubation step is not necessary 7. Requires washing the cells several times before the addition of antihuman globulin reagent 8. Tests for certain clinical conditions such as hemolytic disease of the newborn and autoimmune hemolytic anemia 9. Detects IgG or complement-coated red cells 6. ANS: B DIF: Level 2 7. ANS: C DIF: Level 2 8. ANS: B DIF: Level 2 9. ANS: C DIF: Level 2 Chapter 04: Genetic Principles in Blood Banking Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. A person whose red cells type as M+N+ with antisera would be: a. a homozygote. b. a heterozygote. c. unable to be determined without family studies. d. linked. ANS: B Because M and N are alleles, the inheritance of both alleles makes the individual a heterozygote. DIF: Level 2 REF: p. 79 2. The children of a group AB mother and a group B father could phenotype as all of the following except: a. O. b. A. c. B. d. AB. ANS: A Unless there was a rare cis AB inheritance pattern, a group AB parent would not likely have a group O child. DIF: Level 3 REF: p. 78 3. In a family study, all four siblings in the family had a different blood type: A, B, O, and AB. What is the most likely genotypes of the parents? a. AA and BB b. AO and BB c. OO and AB d. AO and BO ANS: D Performing a Punnett square demonstrates that a cross between genotypes AO and BO could yield four offspring with different phenotypes. DIF: Level 3 REF: p. 76 4. If anti-M was reacted with red cells that are M+N+, how would they compare with red cells that are M+N–? a. Stronger b. Weaker c. The same d. Varies with the method ANS: B Because M+N+ cells are heterozygous, the “dosage” of the M antigen is less and would therefore be weaker in reaction strength. DIF: Level 2 REF: p. 80 5. A father carries the Xga blood group trait and passes it on to all of his daughters but to none of his sons. What type of inheritance pattern does this demonstrate? a. X-linked dominant b. X-linked recessive c. Autosomal dominant d. Autosomal recessive ANS: A Because the father passed the trait to only his daughters, it was carried on the X chromosome. Because only one allele is needed for expression, this is a dominant genetic trait. DIF: Level 2 REF: p. 79 6. Of the following markers used to test for paternity, which marker provides the most useful statistical value? a. Human leukocyte antigen typing b. D antigens c. ABO system antigens d. The Kidd system (Jka, Jkb) ANS: A Human leukocyte antigen typing provides most statistical value because of the polymorphism of the major histocompatibility complex. DIF: Level 2 REF: p. 83 7. Mitosis results in chromosomes as the original. a. four cells with half as many b. two cells with the same number of c. four cells with the same number of d. two cells with half as many ANS: B Mitosis is cell division of somatic cells, resulting in two cells with the same number of chromosomes as the original cell. DIF: Level 1 REF: p. 71 8. When does crossing over occur? a. Meiosis b. Mitosis c. Somatic cell division d. Zygote formation ANS: A 17. In a random population, 16% of the population is homozygous for a particular trait. What percentage of the same population is heterozygous for that particular trait? a. 32% b. 64% c. 48% d. 84% ANS: C Using the Hardy Weinberg formula, (p + q)2 = 1.0 therefore the square root of 16 is 4 and 4 + 6 = 1. Since the expanded formula is p2 + 2pq + q2 = 1.0, then 2pq is the heterozygous population, which is 2 × 4 × 6 = 48. DIF: Level 3 REF: p. 83 18. How are most blood group systems inherited? a. Autosomal recessive b. Autosomal dominant c. Sex-linked recessive d. Autosomal codominant ANS: D Most blood groups systems are inherited as autosomal codominant, which means each inherited allele is equally expressed. DIF: Level 1 REF: p. 77 19. The linked HLA genes on each chromosome are inherited as a: a. haplotype. b. phenotype. c. genotype. d. antithetical pair. ANS: A Closely linked genes on a chromosome such as the HLA genes are inherited as a group or haplotype. DIF: Level 1 REF: p. 80 20. In the PCR reaction, what is the term for the short pieces of single-stranded DNA that are complementary and mark the sequence to be amplified? a. Nucleotides b. Polymerases c. Primers d. Amplicons ANS: C Complementary strands of DNA that mark the target DNA for the initiation of replication during PCR are called primers. DIF: Level 1 REF: p. 84 21. Which of the following clinical applications applies to molecular testing for blood group antigens? a. Confirm the D type of blood donors b. Identify fetus at risk for HDFN c. Predict the phenotype of a patient with autoimmune hemolytic anemia d. All of the above ANS: D Molecular testing for blood group antigens is becoming more common and useful. The technique can predict a red cell phenotype, identify an at risk fetus, confirm a D typing and identify antigen-negative blood donors. DIF: Level 2 REF: p. 84 MATCHING Match the terms below with the definition that best fits. a. Haplotypes b. Recessive c. Amorphic genes d. Codominant genes e. Polymorphic 1. When two genes are close together on the same chromosome and are inherited as a “group” or “bundle” 2. A gene that does not express a detectable product 3. Equal expression of two different inherited genes as in most blood group systems 4. Having two or more alleles at a given gene locus 5. When a gene product is expressed only when it is inherited by both parents 1. ANS: A DIF: Level 1 2. ANS: C DIF: Level 1 3. ANS: D DIF: Level 1 4. ANS: E DIF: Level 1 5. ANS: B DIF: Level 1 Match the term with the definition that best fits. a. Primer b. Polymerase chain reaction c. Hybridization d. Probe e. Amplicon DNA sequence 6. The binding of two complementary pairs of DNA 7. Marks the sequence to be amplified during PCR 8. Amplified target sequences of DNA produced by polymerase chain reaction 9. Short segment of DNA with a known sequence that can be labeled with a marker 10. Technique used to replicate a specific DNA sequences 6. ANS: C DIF: Level 1 7. ANS: A DIF: Level 1 8. ANS: E DIF: Level 1 9. ANS: D DIF: Level 1 10. ANS: B DIF: Level 1 TRUE/FALSE 1. Parents, who both phenotype as group A, cannot have a group O child. ANS: F If the parents are both heterozygous (AO), two O genes can be inherited by the offspring. DIF: Level 3 REF: p. 77 c. Perform an autocontrol. d. Incubate tubes at room temperature or 4° C with an autocontrol. ANS: D ABO antibodies are stronger at room temperature or lower. The autocontrol determines whether the enhanced antibody reaction was due to the ABO antibodies or to a cold reacting antibody. The autocontrol should be negative for the ABO typing to be valid. DIF: Level 3 REF: p. 117 9. Predict the agglutination reaction of red cells from a Bombay phenotype when combined with anti-H lectin. a. Strong 4+ b. Mixed field c. Weak 1+ d. Negative ANS: D Bombay phenotypes have not inherited the H gene and therefore are negative with anti-H lectin. DIF: Level 2 REF: p. 118 10. Given the following ABO phenotyping data: FORWARD REVERSE Anti-A: 2+mf A1 cells: 0 Anti-B: 0 B cells: 3+ What could be a plausible explanation for this discrepancy? a. T-activation of red cells b. Group O blood products given to group A c. Rouleaux formation d. Positive direct antiglobulin test ANS: B Mixed-field reactions are often caused by transfusion of group O red cells, which may take place during an emergency or inventory issue. DIF: Level 3 REF: p. 113 11. What forward typing reagent can be used to confirm group O units before placing them in inventory? a. Anti-A b. Anti-B c. Anti-A,B d. Anti-H ANS: C A common use of anti-A,B is to test group O red cells to confirm the blood type before putting them in inventory. DIF: Level 1 REF: p. 106 12. Which of the following situations is most likely to cause intravascular hemolysis when an incompatible transfusion is given? a. Group B packed cells to a group O recipient b. Group A packed red cells to a group AB recipient c. Group AB plasma to a group A recipient d. Group AB plasma to a group O recipient ANS: A A group O recipient has anti-B that could potentially cause intravascular hemolysis if group B blood were transfused. DIF: Level 2 REF: p. 106 13. A blood sample from a 90-year-old man was submitted to the blood bank for a type and screen before surgery. The forward type demonstrates as a group A, whereas the reverse type appears to be group AB. What is the most likely cause of the discrepancy? a. Contaminated reagent antisera b. Rouleaux formation c. That the patient has autoantibodies d. That patient has low-titer isoagglutinins ANS: D In patients who are older, the level of ABO isoagglutinins can be below detectable levels. DIF: Level 3 REF: p. 117 14. Most “naturally occurring” ABO system antibodies fall into which immunoglobulin class? a. IgA b. IgM c. IgE d. IgG ANS: B ABO system antibodies are in the IgM class, which can agglutinate at immediate-spin and activate the complement cascade. DIF: Level 1 REF: p. 105 15. What substances are found in the saliva of a group A person who also inherited the secretor gene? a. A, H b. H c. A, Se d. A, B, H ANS: A The secretor gene codes for the secretion of H in secretions, allowing the expression of H, as well as the ABO antigens. DIF: Level 2 REF: p. 118 16. What percentage of the group A population are type as A2? a. 1% b. 10% c. 20% d. 35% ANS: C The A2 subgroup is coded by the A2 gene and is essentially a less branched version of the A antigen. DIF: Level 1 REF: p. 102 17. Approximately what is the percentage of individuals who demonstrate H in their saliva? a. 15% b. 50% c. 80% d. 98% ANS: C Finding the H antigen in secretions indicates that a secretor gene was inherited. DIF: Level 1 REF: p. 118 18. To distinguish between an A1 and A2 blood type, which reagent is used? a. Ulex europeaus lectin b. Anti-A,B c. Monoclonal anti-A d. Dolichos biflorus lectin ANS: D Anti-A1 lectin will agglutinate A1 red cells, not A2 red cells. DIF: Level 1 REF: p. 102 19. Why is it sometimes necessary to distinguish A1 and A2 blood types? a. To resolve a discrepancy between the forward and reverse typing b. To prevent A1 recipients from receiving A2 blood c. To determine the secretor status of group A individuals d. To prevent hemolytic disease of the newborn ANS: A Routine testing with anti-A1 lectin is necessary to resolve a discrepancy between the forward and reverse typing. Individuals who possess the A2 antigen can make anti-A1 antibody. DIF: Level 2 REF: p. 102 20. What subgroup of A possesses the least amount of A antigen? a. A3 b. Ax c. A2 d. Ael ANS: D 4. How would you label a donor who tested negative with anti-D reagent upon immediate- spin and positive in antihuman globulin test? a. D-positive b. D-negative c. Cannot label; more testing needed ANS: A Donor testing is required for the weaker D expression by the antihuman globulin test with the unit labeled as D-positive. DIF: Level 1 REF: p. 132 5. A patient phenotypes as D+C+E-c-e+. Predict the most likely genotype. a. R1r b. R1R1 c. R1r' d. R1R0 ANS: B R1R1 fits the phenotype and is also the more common of the choices given. DIF: Level 2 REF: p. 130 6. How is it genetically possible for a child to phenotype as D-negative? a. Both parents are heterozygous D-positive. b. Both parents are homozygous D-positive. c. Mom is homozygous D-positive, and Dad is heterozygous D-positive. d. The sibling is D-positive. ANS: A The heterozygous expression for both parents would allow the D-negative expression to be passed on to the child. DIF: Level 2 REF: p. 131 7. Current theory regarding the genetics of the Rh system suggests that: a. each Rh system antigen is coded by its own gene locus. b. Rh system antigens are coded by two closely linked genes. c. one gene locus with multiple alleles codes for the protein antigens. d. the Rh system genes are a haplotype that codes for three sets of alleles. ANS: B Two closely linked genes, RHD and RHCE, code for the Rh system antigens. DIF: Level 1 REF: p. 128 8. Red cells that phenotype as D-negative indicate that: a. they inherited two D genes. b. there is no genetic material inherited from the RHD gene from both parents. c. a suppressor gene was inherited that is turning off the D gene expression. d. reagents currently in use are not detecting the D antigen. ANS: B The D-negative phenotype is the absence of genetic material at the RHD gene locus. This lack of genetic material must be inherited from both parents to result in a negative expression. DIF: Level 1 REF: p. 126 9. Anti-D reagent and the D control were tested with patient’s red cells. Both tests were 2+ agglutination reactions. What is the interpretation of the results? a. D-positive b. D-negative c. Unable to interpret without further testing d. D-positive if the sample is from a patient ANS: C The D control should be negative for the test to be valid. DIF: Level 2 REF: p. 54 10. All of the following can cause the D antigen expression to be weaker except: a. inheriting the G gene. b. inheriting the C antigen in trans to the D antigen. c. an RHD gene that is genetically weaker. d. partial D expression. ANS: A The G gene is always inherited when the D or C gene is inherited and has no effect on the strength of the D gene. DIF: Level 1 REF: p. 133 11. An anti-E was identified in a patient who recently received a transfusion. What other Rh system antibody should be investigated? a. Anti-G b. Anti-f c. Anti-D d. Anti-c ANS: D Anti-c is often found in patients who make anti-E. Anti-c is often weaker and shows dosage when the patient is developing the antibody from the first exposure to the antigen. DIF: Level 1 REF: p. 137 12. The frequency of the D-negative phenotype in the population is: a. 15%. b. 85%. c. 50%. d. 35%. ANS: A Fifteen percent of the population is D-negative. DIF: Level 1 REF: p. 126 13. Testing for the weak D expression is performed by: a. using anti-Du antisera with an extended incubation. b. using monoclonal anti-D. c. performing the indirect antiglobulin test with anti-D. d. performing the direct antiglobulin test with anti-D. ANS: C The weak D test (previously called the Du test) involves the indirect antiglobulin test using anti-D reagent. DIF: Level 1 REF: p. 132 14. The numeric Rh4 nomenclature refers to which antigen in the Rosenfield notation? a. C b. c c. e d. E ANS: B The more common Rh system antigens are Rh1 = D, Rh2 = C, Rh3 = E, Rh4 = c, Rh5 = e. DIF: Level 1 REF: p. 128 15. The LW antigen expression is typically stronger on red cells. a. D-positive b. D-negative c. Rh null d. D-variant ANS: A The original anti-D found by experiments with rhesus monkeys was actually anti-LW that reacts best with D-positive cells. DIF: Level 1 REF: p. 138 16. Why is the determination of the D antigen important for women during pregnancy? a. A D-positive mother can form anti-D during pregnancy that may destroy the D- positive red cells of the fetus. b. A D-negative mother should be given Rh immune globulin to prevent potential formation of anti-D during delivery of a D-positive infant. c. A D-negative mother may form anti-D if the father of the child is also D-negative. d. A D-positive mother may pass her red cells to the D-negative fetus and cause hemolytic disease of the fetus and newborn. ANS: B D-negative females who are pregnant should be given Rh immune globulin at 28 weeks to prevent the formation of anti-D, which may cause hemolytic disease of the fetus and newborn on subsequent pregnancies. The exposure to the D antigen on delivery of a D-positive fetus triggers the formation of anti-D. DIF: Level 1 REF: p. 138 d. Dce 5. Rz 6. ry 7. r' 8. R0 5. ANS: C DIF: Level 2 6. ANS: B DIF: Level 2 7. ANS: A DIF: Level 2 8. ANS: D DIF: Level 2 Chapter 07: Other Red Cell Blood Group Systems, Human Leukocyte Antigens, and Platelet Antigens Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following facts is not a characteristic of Kell system antibodies? a. Usually clinically significant IgG antibodies b. Best detected in indirect antiglobulin test phases c. Lose reactivity with proteolytic enzyme reagents d. Do not bind complement proteins ANS: C Proteolytic enzymes do not affect the Kell system antigens. DIF: Level 1 REF: p. 151 2. Antibodies to Kidd, Kell, and Duffy blood group antigens share all the following characteristics except: a. can cause hemolytic disease of the newborn. b. usually detected only by the indirect antiglobulin test. c. enhanced with enzyme treatment. d. can cause transfusion reactions. ANS: C The Duffy system antibodies do not react with enzyme-treated cells. DIF: Level 1 REF: p. 157 3. K-positive donor red cells were mistakenly transfused to a recipient with anti-K. The patient’s posttransfusion blood sample has a positive direct antiglobulin test with polyspecific antihuman globulin. The direct antiglobulin test is positive because anti-K is an antibody that has sensitized the cells in vivo. a. IgG, donor’s b. IgM, donor’s c. IgG, recipient’s d. IgM, recipient’s ANS: A The anti-K in the recipient attached to the K antigen on the transfused donor red cells, which will cause them to be prematurely cleared by the spleen. DIF: Level 2 REF: p. 151 4. Which of the following phenotypes is heterozygous? a. Fy(a–b+) b. Jk(a+b–) c. Fy(a+b+) d. Le(a+b–) ANS: C If both alleles Fya and Fyb are present on the red cell, the genetic expression is heterozygous. DIF: Level 2 REF: p. 154 5. Antibodies to which of the following blood group system show dosage (i.e., are stronger with homozygous expression of the antigen)? a. Lutheran b. P c. Duffy d. Kell ANS: C Stronger reactions are typically seen with red cells that have a “double dose” of the antigen in the Duffy system. DIF: Level 1 REF: p. 155 6. Why are antibodies to Lub antigen not commonly detected? a. Lub antigen is of high incidence. b. The antibodies do not cause transfusion reactions. c. Lub antigen is not present on screening cells. d. The antibodies react best at 4° C. ANS: A Lub antigen occurs at an incidence of greater than 99%. DIF: Level 1 REF: p. 158 7. Why have Lewis system antibodies not been implicated in hemolytic disease of the fetus and newborn? a. The antigens are not fully developed at birth. b. Lewis system antibodies do not cross the placenta. c. The antibodies are not clinically significant. d. All of the above are correct. ANS: D Lewis antibodies are often found during pregnancy but do not cross the placenta because they are IgM. The antigens are not well developed at birth. DIF: Level 2 REF: p. 160 8. All the following statements are true regarding Lewis system antibodies except antibodies: a. may be observed at the immediate-spin, 37° C, and antihuman globulin phases. b. can be neutralized by Lewis substance. c. may cause hemolysis in vitro. d. do not react following enzyme treatment of cells. ANS: D Anti-Leb may be enhanced with enzyme treatment. DIF: Level 1 REF: p. 160 c. Cs in the Cost system. d. SC in the Scianna system. ANS: B Cellano is the original name of the k antigen (KEL2) in the Kell system, a high-frequency antigen that is antithetical to K (KEL1). DIF: Level 1 REF: p. 149 18. The major histocompatibility complex is located on chromosome 6 and is important in all the following immune functions except: a. recognition of nonself. b. graft rejection. c. hemolysis. d. coordination of cellular and humoral immunity. ANS: C The major histocompatibility complex codes for molecules on all nucleated tissues and cells to allow for immune recognition and response to foreign antigens. DIF: Level 2 REF: p. 172 19. The mixed lymphocyte culture (MLC) is a procedure that has been used in HLA testing to determine: a. class I HLA antigen determination. b. class II HLA antigen determination. c. HLA antibody identification. d. compatibility testing for tissue typing. e. B and D. ANS: E The mixed lymphocyte culture (MLC) was an in vitro procedure used to determine tissue compatibility and D (class II) typing that has been largely replaced by molecular typing and flow cytometry techniques. DIF: Level 2 REF: p. 175 20. HLA matching between the donor and recipient is important for progenitor cell transplantation to avoid: a. graft versus host disease (GVHD). b. graft rejection. c. transfusion reactions. d. A and B. ANS: D HLA typing is essential to avoid GVHD and rejection in HPC transplants. DIF: Level 2 REF: p. 174 MATCHING Match each characteristic with the appropriate blood group system. A selection may be used more than once. a. Cartwright b. MNSs c. Kidd d. Vel e. Xga f. Sda antigen g. Chido/Rodgers h. Kell i. Duffy 1. Antigen has a higher frequency in females 2. Antigen of high incidence; its antibody can cause hemolytic transfusion reactions 3. Antibodies are sensitive to enzymes and have high-titer low-avidity characteristics 4. System associated with McLeod phenotype 5. Antigens Yta and Ytb are in this system 6. System associated with glycophorin A and B 7. Antibodies in this system often fall below detectable levels and are associated with delayed transfusion reactions 8. Antibody to this antigen demonstrates weak mixed field reaction 9. System associated with chronic granulomatous disease 10. System associated with resistance to malaria 1. ANS: E DIF: Level 1 2. ANS: D DIF: Level 1 3. ANS: G DIF: Level 1 4. ANS: H DIF: Level 1 5. ANS: A DIF: Level 1 6. ANS: B DIF: Level 1 7. ANS: C DIF: Level 1 8. ANS: F DIF: Level 1 9. ANS: H DIF: Level 1 10. ANS: I DIF: Level 1 Chapter 08: Antibody Detection and Identification Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. In the process of identifying an antibody, the technologist observed 2+ reactions with 3 of the 10 cells in a panel at the immediate-spin phase. These reactions disappeared following incubation at 37° C and the antihuman globulin phase of testing. What is the most likely responsible antibody? a. Anti-E b. Anti-D c. Anti-I d. Anti-Lea ANS: D The Lea antigen is typically found on three to four cells in a panel, and the antibody reacts best at the immediate-spin phase of testing. DIF: Level 3 REF: p. 184 2. What is a characteristic of Rh system antibodies? a. Mixed-field reactions on panels b. Weak reactions with panel cells c. Strong reactions with panel cells when read at immediate-spin phase d. Reactions that are enhanced with enzymes ANS: D Rh system antibodies are typically strong and are enhanced with enzyme treatment. DIF: Level 1 REF: p. 193 3. Which of the following situations can be found in a classic case of autoimmune hemolytic anemia? a. Positive direct antiglobulin test b. False-positive Fya phenotyping c. Crossmatch incompatibility at antihuman globulin d. All of the above ANS: D Red cells of a patient with this condition are coated with IgG antibodies that are signaling premature destruction in the spleen. Because the red cells are coated, attempts to test them with antiglobulin reagent results in positive reactions. The antibody in the serum will react with all normal cells tested at the antihuman globulin phase. DIF: Level 2 REF: p. 199 4. What is the next step in the investigation of a positive direct antiglobulin test with polyspecific antihuman globulin reagent? a. Repeat the direct antiglobulin test using warm saline. 12. If an anti-I is suspected in a patient’s sample that requires a transfusion, what is the most acceptable course of action? a. Call the rare donor registry. b. Crossmatch cord blood. c. Perform a cold autoadsorption. d. Perform the prewarm technique. ANS: D Prewarming the patient’s serum and panel cells separately and then mixing at 37° C to avoid cold temperatures usually avoids the reactivity of the anti-I, which is not clinically significant but may mask other antibodies. DIF: Level 2 REF: p. 200 13. What is the most important concern when trying to identify antibodies in a patient with a warm autoantibody? a. Identifying the specificity of the autoantibody b. Determining whether there are underlying alloantibodies c. Identifying the antibody found in the eluate d. Determining whether complement is binding to the autologous red cells ANS: B Autoantibodies in the serum can mask underlying alloantibodies. DIF: Level 2 REF: p. 203 14. An autoadsorption may be performed to investigate underlying autoantibodies. When is this procedure acceptable? a. When the autoantibody is reactive at 4° C b. When the patient has not been recently transfused c. Only if complement is coating the red cells d. When the eluate is negative ANS: B If an autoadsorption is performed (using the patient’s red cells) and the patient has been recently transfused, the adsorbing red cells may remove developing alloantibodies to the transfused cells. DIF: Level 2 REF: p. 206 15. Why are proteolytic enzymes not used in the routine screening for antibodies? a. The reagent is too expensive for routine use. b. Clinically insignificant antibodies are enhanced. c. Red cells must be treated with enzymes first, which makes this technique impractical. d. Some antigens are destroyed by enzymes, which would cause the antibodies to be missed. ANS: D Proteolytic enzymes destroy some antigens in the Duffy and MNS system. Antibody screens using enzymes would not detect antibodies to these antigens. DIF: Level 1 REF: p. 186 16. High-titer, low-avidity antibodies typically: a. react with antigens of high frequency in the population. b. react with antigens of low frequency in the population. c. are clinically significant. d. react best at colder temperatures. ANS: A High-titer, low-avidity antibodies are typically reactive with most panel cells at the antihuman globulin phase and are not clinically significant. They may mask clinically significant reactions. DIF: Level 1 REF: p. 194 17. Select the example of a cold alloantibody. a. Anti-M. b. Anti-I. c. Anti-Lub. d. Anti-k. ANS: A Alloantibodies to anti-M react best at room temperature but can also demonstrate reactions at 37° C and antihuman globulin phases. DIF: Level 1 REF: p. 197 18. Select the best description of the elution technique. a. Technique that disassociates IgM antibodies from red cells for further identification b. Technique that disassociates IgG antibodies from red cells for further identification c. Technique that adsorbs IgG antibodies from serum d. Technique that separates IgG and IgM antibodies in serum ANS: B Elution procedures remove IgG antibodies from sensitized red cells to be used for identification using panel cells. DIF: Level 2 REF: p. 204 19. Which of the following antigens is not commonly used on screening cells? a. D b. k c. Kpa d. C ANS: C Kpa is a low-frequency antigen in the Kell system that is typically not present on screening cells. DIF: Level 1 REF: p. 184 20. What type of red cells is used in an autoadsorption to remove antibody from the serum? a. Antibody screening cells b. Donor red cells c. Patient red cells d. Antibody identification panel cells ANS: C Patient red cells are treated to remove IgG antibody and then are incubated with the patient’s serum to remove more autoantibodies that are interfering with alloantibody identification. DIF: Level 1 REF: p. 206 21. Anti-D, anti-K, and anti-Jka are the antibodies that are tentatively identified on a panel after initially ruling out on negative cells. What selected cell from another panel should be chosen to confirm the presence of anti-K? a. K–, D+, Jk(a+) b. K+, D+, Jk(a+) c. K+, D–, Jk(a+) d. K+, D–, Jk(a–) ANS: D To confirm the presence of a anti-K, a cell positive for K antigen and antigen negative for the other two suspected antibodies will confirm anti-K if it is reactive against it. DIF: Level 2 REF: p. 193 22. Select the antibody where DTT (dithiothreitol) would be useful in the identification investigation. a. Anti-Jsa b. Anti-Kpb c. Anti-Vel d. Anti-K ANS: B Anti-Kpb is a high-frequency antigen in the Kell system. If an anti-Kpb is suspected, the panel cells could be treated with DTT and the sample retested. If all reactions are eliminated, the anti-Kpb is confirmed and other underlying alloantibodies are ruled out. Although K would also be destroyed by DTT, there are sufficient negative cells on the panel to determine if underlying antibodies exist and confirm the specificity. DIF: Level 1 REF: p. 195 23. When should anti-Sda be suspected? a. Weak reactions at the antiglobulin phase occur with several panel cells b. Reactions are stronger with enzymes at the immediate-spin phase c. Antibody reacts with most panel cells and are mixed field and refractile microscopically d. Weak reactions at the AHG phase titer out to high dilutions ANS: C Chapter 9. Compatibility Testing if investigating possible antibodies that bind compliment when is a serum sample preferred over and EDTA sample? if the pre-transfusion testing is to be done on automated instruments when is an EDTA sample preferred? two independent patient identifiers, date of collection, collectors identification what is required on the label of a patients sample? drawn within 3 days of the expected transfusion due to the possibility of antibody production from the recent transfusion if the patient has been transfused in the past 3 months then the sample must be... patients on a heart bypass pump because these patients hemolyze their red cells hemolyzed samples should be avoided and recollected if possible. what is the exception and why? so that IV fluids do not contaminate testing why do all specimens collected for lab testing have to be drawn below the IV? ABO/Rh of patient and blood donor, antibody screen of patient and crossmatch between patient plasma and donor cells list the blood bank procedures required for compatibility testing prevent ABO incompatibility and prevent IgG alloantibody incompatibility what is the purpose of a full crossmatch (coombs, AHG) positive antibody screen on current sample or documentation of clinically significant antibody in patients medical record a full crossmatch is performed when patient needs RBCs and the patient either has a..... prevent ABO incompatibility purpose of immediate spin crossmatch (modified) negative antibody screen on current sample and no history of clinically significant antibodies an immediate spin crossmatch is performed when both of the following criteria are met: antibodies present in the recipients plasma against antigens on donor cells, some errors in ABO grouping, labeling, identification and positive DAT of donor serological crossmatch will detect the following: all ABO and/or Rh typing errors and all unexpected antibodies in recipients plasma serological crossmatch will not detect the following: Chapter 10. Blood Bank Automation for Transfusion Services What laboratory component in automation is essential to flag discrepancies with previous results? LIS What term is defined as productivity of a machine, procedure, process, or system over a unit time period? Throughput How does a 2+ reaction appear in the MTS gel test? Cells evenly distributed throughout the microtube A compact button of red cells in the bottom of the well is interpreted as a/an reaction when solid-phase testing is used for the antiglobulin test. negative Identify the forces driving the need for automation in the transfusion service. (Select all that apply.) Compliance with increased regulations, Higher testing volumes as a result of consolidation, Financial environment encouraging new economies Identify the benefit(s) for converting to automation testing. (Select all that apply.) Save operating funds, Opportunity to question and examine work processes and identify areas for improvement, Increase in productivity, Improve total quality of testing Select the challenges(s) for converting to automation testing. (Select all that apply.) Initial capital investment for equipment, Investment of time for validation protocols, training, and procedures Hemoglobinuria DIC Oliguria/anuria Renal failure Immune mediated AHTR Ab binding to RBC Activation of complement Activation of mononuclear phagocytes Release of cytokines Activation of coagulation Shock and renal failure What causes AHTR? Usually ABO incompatibility How do ab influence severity of clinical manifestation in AHTR? the density of rbc antigens or the distribution of antigens IgM activates complement free hemoglobin/ rbc stroma IgG interacts with Fc receptors on monocytes What happens during complement? -Opsonization -Anaphylatoxin -Red Cell lysis What happens during opsonization? Membrane bound complement mononuclear phagocytes What happens during anaphylatoxin? Mast cell/smooth muscle/neutrophils Vascular dilation and bronchospasm C3a/C5a - mast cells release serotonin/histamine -Increased vascular permeability -Bradykinin - vasodilation and hypotension -Ab-Ag complexes deposition and thrombus formation vascular compromise in kidneys What happens during red cell lysis? free hemoglobin (haptoglobin) Upgrade to remove adverts Only US$35.99/year What happens during DIC? Consumption of clotting factors Fibrinogen, FV and FVIII, platelets Diffuse uncontrolled microvascular bleeding Fibrin degradation products -D-dimer What happens during shock? Systemic hypotension Reactive renal vasoconstriction Deposition of intravascular thrombi Compromise of renal blood flow Release of norepinephrine -Vasoconstriction in kidneys and lungs -Renal ischemia - acute tubular necrosis/renal loss Renal failure Errors known to cause AHTR -Collection of blood from incorrect patient -incorrect labeling of blood samples Hypersensitivity type I Upgrade to remove adverts Only US$35.99/year Ranges from Urticaria to fulminant anaphylaxis Soluble allergens in donor plasma Hypersensitivity type I -Preformed IgE in recipient -Allergen from donor -Activates mast cells Degranulation Histamine, proteases and chemotactic factors Symptoms of an AHTR allergic transfusion rxn within 4 hours -Urticaria (hives) -Pruritis (itching) -Maculopapular rash -Generalized flushing -Localized angioedema -Edema of lips/tongue More issues from AHTR allergic transfusion rxn within 4 hours Erythema and edema of periorbital area Conjunctival edema Respiratory distress Hypotension Treatment with antihistamines History: premedication Only type of transfusion reaction where component may continue to be administered after treatment administration Anaphylactic (anaphylactoid) Transfusion Reaction, Non-IgE mechanisms of AHTR -IgA ab deficient patients -Make anti-IgA antibody -Receive plasma with IgA -Give washed RBC or platelets (why not washed FFP?) -Give IgA deficient plasma -Severe cases, treat with: Prednisone, epinephrine What are symptoms of AHTR of Transfusion related acute lung injury (TRALI) -Respiratory distress/pulmonary edema within 1-2 hrs -Severe hypoxemia -Tachycardia -Cyanosis (blue color due to lack of O2) -Hypotension -Fever TRALI consist of... -Donor HLA antibodies to recipient HLA antigens Activates neutrophils in pulmonary microvasculature -Pulmonary endothelial damage -Capillary leakage -Pulmonary edema Multiparous women - HLA-Aby in donated plasma -Male donors preferred Transfusion Associated Graft-Versus-Host Disease (TA-GVHD) in DHTR Rare but highly lethal - 90% mortality -Immunocompetent donor lymphocytes -Immunocompromised recipient Additional info on bacterial contamination Symptoms mimic AHTR Treatment with broad spectrum antibiotics Blood cultures from patient and donor units Visual inspection -Discoloration -Clots -Cloudiness -Hemolysis Transfusion-Associated Circulatory Overload (TACO) in AHTR- non immune Cardiopulmonary system exceeds volume capacity What are elderly (>70) and infants at risk with TACO Dyspnea Severe headache Peripheral edema Signs of congestive heart failure -aggressive oxygen thearpy and diuretics -packed RBC- slow rate of infusion in small volume aliquots (3-4 hrs) What are the normal transfusion rates for TACO -1 ml/ min for first 15 minutes -If no reaction, up to 4 ml/min Usual infusion time -RBC - can be divided to 2 , each transfused in3- 4 hours -Platelets, plasma - 10 ml/min (30 min) Hemolysis (RBC Destruction) AHTR non immune Examine segments or remaining blood in unit Questioning of transfusion process personnel Hemolyzed unit -Free hgb and red cell stroma --RBC stroma may stimulate complement, procoagulant What are causes of RBC hemolysis? -exposure to extreme temperature -improper deglycerolization -mechanical destruction -Osmotic rupture -Bacterially contaminated unit -Intrinsic RBC defect (donor) Upgrade to remove adverts Only US$35.99/year Exposure to extreme temperatures -Less than 0oC or above 50oC -Malfunctioning warming devices -Warming during storage -Frozen units Mechanical destruction -Small bore needles -Mechanical valves -Excess pressure -Blood salvage units Osmotic rupture -Nonphysiologic solutions Half-strength saline 5% dextrose in 0.18% saline Ringer's lactate -Medication Citrate toxicity of AHTR non immune Lg quantities of blood in short time frame it binds oxidized calcium patients with impaired liver function transfusion of preterm infants with liver or renal insufficiency Upgrade to remove adverts Only US$35.99/year What is the hemovigilance model? -National Healthcare Safety Network (NHSN) -In cooperation with AABB and CDC -Track, analyze and improve transfusion outcomes -Confidential and voluntary reporting system from participating hospitals of transfusion reactions to CDC -CDC publishes results to assist quality improvement activities How do you report out the hemovigilance component? -Presence of a transfusion reaction Definitive, probable or possible -Severity 1-4, (1 is least severe, 4 is death) -Relationship of reaction to transfusion Definitive, probable, or possible Records retained indefinitely Transfusion-transmitted disease or bacterial contamination reported to donor facility Chapter 12. Hemolytic Disease of the Fetus and Newborn HDFN hemolysis of fetal/infant red blood cells How does HDFN happen? trans placental passage of maternal group antibodies specific for fetal/infant RBC antigens What causes severity of HDFN mild anemia to neonatal death 1: dependent on the magnitude of rbc DESTRUCTION 2: ability of infant to compensate by increased rbc PRODUCTION What are the 4 kinds of HDFN? ABO Rh Due to other antibodies Alloimmune Neonatal Thrombocytopenia How does ABO HDFN happen? most common cause of HDFN mom has ABO ab directed against ABO antigen on fetal cells What is most common ABO HDFN? Anti-A,B in group O mothers Naturally occuring IgG antibody babies of group A or B and B moms? rarely occurs due to Anti-A or Anti-B Other ABO HDFN characteristics A1 + B + O 0 Monitor bilirubin levels Not exceed 12 mg/dl Rh HDFN Most severe form of HDFN. Mother is Rh neg Baby is Rh pos or weak D pos D antigen inherited from father When do Rh pos cells enter mother's circulation? 3rd trimester delivery (more common) placental membrane ruptured at delivery. exposure mom to produce Anti-D Why does Rh HDFN happen after 1st pregnancy? Anti-D crosses placenta and attaches to D pos fetal red cells after 1st exposure *1st pregnancy unaffected* Why is 1st pregnancy not affected? time IgM switches to IgG 2nd pregnancy has high tittered Anti-D What is different from ABO HDFN and Rh HDFN? Rh HDFN can be predicted & diagnosed during pregnancy Diagnosing Rh HDFN ABO/Rh Antibody screen Antibody ID Rh HDFN can occur if Ab is IgG corresponding ags are fully developed on fetal cells Symptoms of Rh HDFN anemia to still birth Why is Rh HDFN worse than ABO HDFN? antigens FULLY DEVELOPED at birth Rh antigens ONLY found on RBCs How does anemia occur w/ Rh HDFN? Anti-D (IgG) ab crosses & attaches to infant's cells (Rh pos cells) coated cells removed from infant by RE system indirect bilirubin by-product of hgb catabolism *before birth, moms liver removes bilirubin* Levels of anemia in Rh HDFN maternal history (other stillbirths) antigen type of father Titer of maternal antibody maternal serum (ab) tested against RBCs homozygous for corresponding ag What is a critical titer? greater or equal to 32 Indicates MCA-PSV and/or amniocentesis should be performed What antibody can cause affect infant or stillbirth with titer below 32? Anti-K MCA-PSV Middle cerebral artery peak systolic velocity watch blood flow from cerebral artery know hematocrit PUBS percutaneous umbilical blood sampling Cordocentesis infant blood drawn When can PUBS be done? 16-18 weeks Tests can be done w/ PUBS · blood type · hemoglobin and hematocrit · platelet count · DAT · antigen type the fetus · DNA typing Amniocentesis indirect prediction of severity of fetal anemia Procedure for Amniocentesis needle is inserted through the abdominal wall into the amniotic sac and fluid is withdrawn cannot be performed until 18-20 week gestation How do they read bilirubin in amniocentesis? Bili at 450 nm Correlates to magnitude of red cell destruction When would you do antigen testing on the father? see if father has antigen to corresponding maternal antibody can predict likelihood of fetus being antigen positive Blood type for exchange transfusion remove: sensitized cells circulating antibody some bilirubin What do you see on blood smear of Rh HDFN? nRBC Retics Schistocytes Rh Immune Globulin (RhIG) 300 ug of IgG Anti-D administered intramuscularly What is the maternal criteria for RhIG? Rh neg Has not been immunized to D ag Infant is Rh pos or weak D pos When do you give RhIG? 28 weeks gestation give within 72 hrs of delivery RhIG important information passive immunization to prevent active immunization counteracts immunizing potential of 15ml packed rbc or 30ml whole blood What test results are affected by RhIG? Maternal antibody screen Infant DAT Infant antibody screen RhIG workup Type and Screen Fetal bleed screen *Do not do weak D testing for typing* protective effect ABO incompatible fetal cells cleared more rapidly from maternal circulation Anti-D doesn't have time to form Mom less likely become immunized by D Blocking D Mom has high titer Anti-D Infant red cells falsely neg due to mother's Anti-D blocking all D antigen sites What are infants type with Blocking D?