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Blood Bank: Spring 2024 > Auto Immune Hemolytic Anemias > Flashcards

Auto Immune Hemolytic Anemias Flashcards

(51 cards)

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1
Q

Clinical findings of AIHA?

A
  • Positive DAT
  • Hemolysis
  • ABO discrepancy maybe
  • Schistocytes
  • Reticulocytes
  • Bilirubin
  • LDH
  • Hemoglobinemia
  • Hemoglobinuria
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2
Q

List AIHA diseases?

A
  • Cold agglutinin syndrome
  • PCH
  • Warm AIHA
  • Drug-dependent
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3
Q

Differentiating IHA questions to ask

A
  • thermal amplitude
  • benign vs pathologic
  • Ig class
  • complement fixation
  • titer
  • underlying disease
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4
Q

Complement binding capacity of warm and cold antibodies

A
  • Warm: may bind
  • Cold: binds complement
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5
Q

Warm antibody DAT results

A

IgG+
C3+ or -

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6
Q

Cold antibody DAT results

A

IgG-
C3+

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7
Q

Warm antibody hemolysis site

A

Extravascular

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8
Q

Cold antibody hemolysis site

A

Intravascular or extravascular

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9
Q

Warm antibody specificity

A

Frequently Rh

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10
Q

Cold antibody specificity

A

Frequently I or P

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11
Q

Warm auto-Ab clinical presentation

A

Exhausted
Anemic

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12
Q

Cold auto-Ab clinical presentation

A

Purpling of extremities

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13
Q

Describe benign cold-reactive Ab

A
  • Low titer
  • Enhanced with albumin and enzyme
  • IgM
  • Anti-I or anti-IH or anti-i
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14
Q

Describe pathologic cold-reactive Ab

A
  • Not common
  • High titer > 1000
  • Enhanced with albumin and enzyme
  • IgM
  • Anti-I or anti-P or anti-M
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15
Q

List benign cold agglutinins

A
  • anti-I
  • anti-i
  • anti-IH
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16
Q

What does anti-I react with?

A

Adult RBCs, NOT cord cells

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17
Q

What does anti-i react with?

A

Cord cells, NOT adult RBCs

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18
Q

What does anti-IH react with?

A

Does NOT react with A1, B, or AB RBCs

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19
Q

How to handle cold agglutinins

A

Prewarm immediate spin crossmatch and reverse type

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20
Q

List pathologic cold agglutinins

A
  • anti-I
  • Wide thermal range igM
  • Donath-Landsteiner anti-P
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21
Q

How to handle pathologic cold agglutinins

Study These Flashcards
A

May have to perform 60 min settling technique to obtain negative results for reverse or screen

22
Q

How to test for Donath-Landsteiner anti-P?

Study These Flashcards
A
  1. 0°C for 90 min patient serum
  2. 37°C for 90 min patient serum
  3. 0°C for 30 min
  4. 37°C for 60 min
23
Q

The most annoying about warm auto-Ab

Study These Flashcards
A

They prevent serological ID of allo-antibodies because everything is reactive

24
Q

How to remove warm auto-Ab

Study These Flashcards
A
  • Autoadsorption is best
  • Alloadsorption (ref lab)
  • Phenotype/molecular
  • Reduce enhancement to just saline and cells
  • Transfuse incompatible cells (bad idea)
25
What's the most annoying thing about drug-induced Ab?
They look like warm auto-Ab
26
How to tell if you have hemolysis
Tea-like plasma color (dark)
27
Mechanism of drug-adsorption
- Drugs attach to RBC membrane - Anti-drug Ab causes RBC destruction (intravasc/extravasc hemolysis) - IgG, no complement (but RBC blown up)
28
Which drugs feature drug-adsorption? List in highest to lowest severity
Highest Cefotetan Streptomycin Penicillin Lowest
29
Drug-adsorption Ab detection in DAT
IgG+ C3-
30
Drug-adsorption Ab detection in eluate
Neg
31
Mechanism of immune complex drug Ab
- Patient forms an antibody to a drug, and the Ab-drug complex absorbs onto RBC membrane - Complement activated that cause RBC destruction - "innocent bystander" - Complement, no IgG - Intravascular hemolysis only
32
Which drugs feature immune complex formation?
- Quinidine - Phenacetin
33
Drug immune complex formation detection in DAT
IgG+/- C3+
34
Drug immune complex formation detection in eluate
Negative
35
Mechanism of membrane modification Ab
- Drug modifies RBC membrane so that IgG/IgM/IgA can attach - Non-immune process - **No hemolysis** - Rare/not fully researched
36
Drugs involved in membrane modification Ab
Cephalosporin
37
Membrane modification Ab detection in DAT
IgG+ C3+
38
Membrane modification Ab detection in eluate
Negative
39
Mechanism of drug-independent Ab
- **Mechanism unknown** - Auto-Ab forms after 6 months of taking the drug and resolves gradually once stopped - Hemolysis mimics WAIHA
40
Which drugs feature drug-independent Ab?
Alpha-methyldopa "Aldomet"
41
Drug-independent detection in DAT
IgG+ C3+/-
42
Drug-independent detection in eluate
Positive with all cells
43
Mechanism of chemo drug Ab
The drug is an antibody that attaches to **CD38** as its method of chemotherapy
44
Drugs that feature chemo drug Ab
- Darzalex (multiple myeloma patients) - -umab
45
Chemo drug Ab detection in DAT
Weak positive DAT poly-AHG and IgG
46
Chemo drug Ab detection in eluate
Positive with all cells and auto (Ab ID also has same results)
47
How to remove chemo drug antigen (CD38 I think) to make the Ab ID negative?
DTT
48
Transfusion/treatment recs for cold Ab
- skip immediate spin testing - run slowly thru blood warmer - keep warm
49
Transfusion/treatment recs for warm Ab
- do not trust serological presentation - transfuse only to support cardio function - transfuse "least incompatible" blood slowly (in vivo crossmatch) - plasma exchange to remove Ab - steroids or IVIG to reduce immune response - splenectomy
50
Transfusion/treatment recs for drug-induced Ab
- transfusion recommended in most cases - plasma exchange may also help - stop taking drug
51
What does IgM wide thermal range look like serologically?

Blood Bank: Spring 2024 (10 decks)

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