Blood Group Immunology

Question 1

Serum is made up of?

Answer 1

liquid (proteins, carbs, lipids, salts, electrolytes, abys, etc)

NO clotting factors

*plasma= liquid minus blood cells.

Question 2

Plasma made up of?

Answer 2

90% H20 & serum

*serum=liquid minus clotting factors

Question 3

Indirect anti-globulin test & Direct anti-globulin tests are used for what?

Answer 3

important in differentiating the types of blood groups so that you dont transfuse pt w/ incompatible blood.

Question 4

Immunohematology is what?

Answer 4

the study of human blood groups, evaluation of blood groups, blood banking, testing for blood group Ags, antiglobulin test

Question 5

Applications of Immunohematology?

Answer 5

Transfusion medicine, pregnancy, HDN, organ transplant, paternity testing

Question 6

What blood products would you require if you needed to increase volume and cells?

Answer 6

Whole blood

Question 7

What blood products would you require if you need to increase cell mass?

Answer 7

Packed cells

Question 8

What blood products would you require if you need to increase clotting?

Answer 8

platelets, plasma (factor V and VIII)

Question 9

Blood group Antigens are made up of what?

Answer 9

Sugars, they are inherited.

Question 10

In emergency transfuse which blood group?

Answer 10

O negative (universal donor)

Question 11

What is the most and least common blood group?

Answer 11

Most= O
Least = AB

Question 12

Most common blood group systems after ABO, Rh

Answer 12

Kell, Duffy, Kidd, HLA (important for transplants)

Question 13

REVIEW THIS IN ONENOTE

Answer 13

SLIDE 17; ABO system genetics chart

Question 14

What would happened to an individual trasnfused with an incompatible blood group?

Answer 14

transfusion rxn: may be acute or delayed (delayed is worse) agglutination leading to hemolysis.

Question 15

What aby is responsible for hemolytic transfusion rxn?

Answer 15

IgM

Question 16

Signs/Symptoms of Transfusion Rxn

Answer 16

• fever
• chills
• backache (d/t kidneys)
• HA
• apprehension
• dyspnea
• hypotension
• vascular collapse
• anaphylactic rxn (if IgA deficient and blood contains IgA)
• Contaminated blood»>septicemia
• in very severe cases:
• -Diffuse intravascular coagulation (DIC) (excessive clotting followed by excessive bleeding)
• -Acute Renal Failure (from tubular necrosis and clotting in renal system)

Question 17

Treatment of Hemolytic transfusion rxns

Answer 17

• stop transfusion
• watch for hemoglobinemia (pink urine)
• vigorously hydrate patient
• Manitol (for forced diuresis)
• if septicemia treat w/ abx

Question 18

Which blood group do abys occur naturally in ?

Answer 18

ABO

*Rh abys do not occur naturally

Question 19

Rh antibodies are produced under what circumstance?

Answer 19

when an Rh(D) negative person has been sensitized or exposed to the D Ag.

*can occur during pregnancy or after blood
transfusion

• D antigen is very immunogenic; individuals exposed to it will very likely make and aby to it.

Question 20

Anti-D is which type of Immunoglobulin?

Answer 20

IgG

Question 21

Most important patient population to consider for Rh Ag?

Answer 21

females of child-bearing age

Question 22

Can Rh(D) Ag cross the placenta?

Answer 22

YES!

Question 23

Hemolytic Disease of Newborn: What is this and under what circumstances does it occur?

Answer 23

this happens when Rh D antibody (developed from first pregnancy) crosses the placenta and destroys Rh (D)+ fetal cells resulting in death.

Circumstances: Usually affects subsequent pregnancies, 1st pregnancy is not affected.

• Mother is Rh- and baby is Rh+
• Father typing for Rh group
• if both mother and father are Rh+, mom + and dad -, screening test doesnt need to be done

Question 24

Prevention of Hemolytic Disease of Newbown

Answer 24

Rhogam (Rh immune globulin RhIG)

Question 25

Fetal outcomes of HDN

Answer 25

Mild cases: mild anemia, jaundice, breathing problems

Severe: heart failure, brain damage, stillbirth, miscarriage

Question 26

Genetics of Rh Blood Groups

Answer 26

Rh+=DD, or Dd (D =dominant), you do have D Ag.

Rh- = dd (d=recessive), you do not have D Ag.

Question 27

Administration of Anti-D aby provides what type of immunization?

Answer 27

passive!

Question 28

Anti-D aby is what type of Immunoglobulin?

Answer 28

IgG

Question 29

Treatment for Rh(-) Mothers

Answer 29

1. ) screen for Rh Aby at 1st prenatal visit:
   - if Rh+: monitor fetus
   - if Rh-: retest mother at 28weeks.
2. ) 28week test
   - if +: monitor fetus
   - if -: give RhoGAM
3. ) At delivery; test infants blood type:
   - if +: give 2nd dose to mother
   - if -: no further doses are needed

*Repeated with each pregnancy

Question 30

indications for RhoGAM if Rh- mother

Answer 30

• Post partum- 72hrs after delivery
• Antepartum- 28weeks
• Antepartum- amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling
• Antetpartum- abdominal trauma, ectopic pregnancy, abortion oor threatened abortion at any stage in gestation with continuation of pregnancy
• Transfusion of Rh- incompatible blood

*if father is abosloutely know to be Rh- RhoGAM is not needed.

Question 31

Anti-A and Anti- B are which type of immunoglobulins?

Answer 31

IgM, cannot cross the placenta

Question 32

How to test blood group ag

Answer 32

pts RBC combined with known antiserum (Abys) and observer for agglutination, if Ag present on cell correspond t the ABy in reagent. Aby will bind to the Ag and cause clumping of cells.

Question 33

What are the types of tissue transplants?

Answer 33

Autografts: from same individual

Allograft: from same species

*ABO and Rh must be matched along w/ histocompatibility testing

Question 34

Coombs test

Answer 34

antihuman globulin test, uses a commercial aby against human globulin to detect globulin coated RBCs.