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Clinical Pathology > Lecture 4: Immunohematology > Flashcards

Lecture 4: Immunohematology Flashcards

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1
Q

Define Immunohematology

A

studies antigen-antibody interactions as they related to pathogenesis and clinical manifestations of blood disorders

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2
Q

why is Immunohematology important

A
  1. Provide safe transfusion therapy
  2. Prevent NI
  3. Understand immune mediated mechanism of disease
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3
Q

define antigen

A

substance that is recognized as foreign and therefore can illicit an inflammatory response and production of antibodies

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4
Q

define alloantigen

A

Any antigen that is present in only some individuals of the same species and that illicit the production of alloantibodies in individuals that do not express that antigen

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5
Q

what is alloantibody

A

an antibody produced in response to introduction of alloantigen that is not expressed in that animal

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6
Q

what Ig’s are produced in type II hypersensitivity reactions

A

IgG and IgM

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7
Q

In type II hypersensitivity reactions is the antigen soluble or cell bound

A

cell bound

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8
Q

what is the mechanism for type II hypersensitivity reactions

A

IgG or IgM bind to self antigen

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9
Q

what are some examples of type II hypersensitivity reactions

A
  1. IMHA
  2. NI
  3. Transfusion reactions
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10
Q

what is alloimmunity

A

sensitization, formation of antibodies against alloantigens

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11
Q

what causes alloimmunity to occur

A
  1. Blood transfusions
  2. Vaccination with blood products
  3. Sensitization of dam transplacentally or from exposure at birth
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12
Q

what are naturally-occurring antibodies

A

antibodies to blood group antigens not expressed in that individual, no known previous exposure to these antigens

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13
Q

what is an example of naturally-occurring antibodies

A

type B cats

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14
Q

blood group antigens are inherited as ___ or __

A

autosomal dominant or co-dominants

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15
Q

what is blood typing

A

process of classifying an animals blood type by determining which antigens are present on rBC membranes

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16
Q

Order species most to least at risk of transfusion reactions

A

cats> dogs > equine> bovine

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17
Q

what are the two most antigenic blood groups in dogs

A

DEA- 1.1, DEA 1.2

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18
Q

in dogs is an incompatible blood transfusion more dangerous the first or second exposure

A

second

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19
Q

natural antibodies against DEA 1.1 or DEA 1.2 are extremely rare, making first time transfusions relatively __ without typing

A

safe

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20
Q

In dogs, transfusion reactions are usually result of ___

A

DEA 1.1 or DEA 1.2 negative dogs receiving 2 or more tranfusions from DEA 1.1 or DEA 1.2 positive dog

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21
Q

which species have natural alloantibodies against other blood types

A

cats

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22
Q

in which species is a first time blood transfusion always a risk without blood typing

A

cats

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23
Q

Type A cats are born with antibodies against __

A

B

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24
Q

type B cats are born with antibodies against __

A

A

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25
type AB are born with __ antibodies because has both A and B
no antibodies
26
what is the most common blood type in cats
type A
27
type A cats have __ levels of naturally occurring anti-B antibodies
low
28
type B cats have __ levels of anti-A antibodies
high
29
what breeds are more likely to be type B in cats
British shorthair, Devon Rex, Abyssinian, Himalayan
30
what is the universal recipient blood type for cats
type AB
31
t or f: type AB cats can donate blood
false
32
what are the most antigenic blood types in horses and what is a major associated disease
A and Q Disease: NI
33
what are some immediate reactions to blood transfusions
1. Rapid hemolysis 2. Hemoglobinuria, hemoglobinemia (intravascular hemolysis) 3. Fever 4. Seizures
34
what are some examples of delayed reactions from blood transfusions
1. Progressive anemia 2. Icterus
35
what species have minimal natural antibodies and therefore first time transfusions are usually safe without blood typing
dogs and horses
36
which species plasma contains natural anti-erythrocyte antibodies and first time transfusions without typing are not safe
cats
37
What is neonatal isoerythrolysis
lysis of neonatal RBC’s due to maternal antibodies direct against neonate RBC antigens
38
what is difference between NI and IMHA
IMHA antibodies are produced by the same animal who has reaction, in NI antibodies are produced by mare
39
in NI after newborn ingests colostrum from dam they develop signs of __ within hrs or days
hemolytic anemia- weakness, hemoglobinema, hemoglobinuria, icterus
40
how can you test for/ prevent NI
coomb’s test on newborn or cross- match between newborn RBC’s and maternal serum
41
are firstborn or second born foals to mare with antibodies against RBC more affect
secondborn foals
42
are the mares of foals Aa or Qa positive and describe what happens
Mares are negative, Foals are Aa or Qa+ and sensitized to Aa- or Qa- negative mares—> foals ingest A or Q antibodies from mare colostrum—> RBC hemolysis
43
what is tx for NI
transfuse foal with mares washed RBC’s (not sires)
44
why would you not want to transfuse NI foal with sire’s RBC
foal has anti-sire antibodies from mares colostrum
45
what are some clinical signs of NI
lethargy, weakness, tachycardia, tachypnea, bilirubinemia (hemolysis), Hematuria, acute renal injury
46
how would cats get NI
occurs in A or AB kittens born to a B queen, B queen makes antibodies against A
47
how can dogs get NI
occurs in DEA 1.1 + pups born to previously sensitized DEA 1.1 - bitch
48
IMHA most common in what species
dogs
49
MOA of IMHA
RBC’s destroyed by antibodies direct against them
50
what would you see on blood smear with IMHA
1. Autoagglutination 2. Regenerative anemia 3. Spherocytosis
51
blood smear from dog with suspected IMHA- how does this support that dx
autagglutination, spherocytes
52
Is IMHA intravascular or extravascular hemolysis
extravascular and intravascular
53
what Ig is most commonly seen with IMHA
igG
54
what abnormal RBC is seen in extravascular IMHA and how does that happen
spherocytes- portion of RBC membrane removed by splenic macrophages
55
what is the mechanism of intravascular IMHA
fixation of complement—> MAC complexes poke holes in RBC’s
56
what abnormal RBC is seen with intravascular IMHA
ghost cells
57
t or f: can have false positive and negative results for Coombs testing for IMHA
true
58
t or f: a negative Coombs test does not rule out IMHA
true
59
case ex: 6yr MC mix breed dog with 1 week hx of lethargy, exercise intolerance. PE- icterus. Characterize the erythron and thrombin. Blood smear showed: marked spherocytes, ghost cells, marked anisocytosis, marked polychromatic Provide top differentials
1. Low hematocrit- anemic 2. MCV high- macrocytic 3. MCHC low- hypochromic 4. High retics- regenerative 5. Appropriate metarubriocytosis 6. Thrombocytopenia Spherocytes: extravascular hemolysis Ghost cells: intravascular hemolysis Icterus- intravascular hemolysis Top dx: IMHA with immune mediated thrombocytopenia—> Evans syndrome
60
case ex: 3 day old foal, hx of weakness since brith, red tinged urine, icterus mm. Mares third foal. Blood smear: monocytes that contain phagocytized erythrocytes Characterize the erythron and top dx
1. Low hematocrit- anemic 2. MCV normal- normocytic 3. MCHC: normal- normochromic 4. Red tinged urine- intravascular hemolysis- hemoglobinuria 5. Icterus- intravascular hemolysis Top dx: NI

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