Problem Resolution Dept Exam

Question 1

calculate number of units to test

Answer 1

2/(frequency in decimal form)

ex) 2 units of blood with 34% frequency of Ag:

2/0.34 = 5.9 = six units

Question 2

select control cells for Ag typing

Answer 2

positive: heterozygous positive
negative: negative

Question 3

When can you do a selected cell panel?

Answer 3

historical Ab
only 1 positive necessary to confirm
select cells in order to r/o other Abs

Question 4

prewarm technique use

Answer 4

only for XM
careful not to prewarm a new IgM away

Question 5

what is extended RT incubation, or 4°incubation, used for?

Answer 5

weak reverse type

requires controls

Question 6

auto-adsorption cannot be used when…

Answer 6

tx in the last 3 months

instead, use allogeneic adsorption

Question 7

instances when allogeneic adsorption is used

Answer 7

• short sample
• tx in last 3 months

Question 8

phenotyping must be done on a —– sample

Answer 8

pre-tx

Question 9

example of an enzyme tx

Answer 9

DTT for darzalex
destroys K

Question 10

acidification of serum

Answer 10

increases anti-M activity

Question 11

which antigens are neutralized using blood group substances?

Answer 11

P1
Lewis
urine Sda

Question 12

AHG XM used for…

Answer 12

current OR clinically significant Ab (even historical) from ABS/Hx

Question 13

3 reasons for DAT+

Answer 13

• HDFN
• transfusion rxn
• autoAb

Question 14

how to perform weak D if DAT+

Answer 14

EGA treat cells

Question 15

last wash testing purpose

Answer 15

control; tells us that we washed enough, and the Ab detected in the eluate was coating the RBCs, not present in plasma

Question 16

3 causes of IS problems

Answer 16

• IgM alloAb
• cold autoAb
• rouleaux

Question 17

2 causes of AHG problems

Answer 17

• IgG or C’ binding alloAb (low-freq)
• warm autoAb

Question 18

how to release blood when a patient has a warm autoAb

Answer 18

use adsorbed plasma
neat plasma will be incompatible
requires emergency release by Dr

Question 19

how do you determine which tests to run after trxn?

Answer 19

investigate what is different between the “pre” sample and the “post” sample

Question 20

acute hemolytic trxn

Answer 20

• red cell incompatibility
• chills, fever, hemoglobinuria, hypotension, renal failure, oliguria, DIC, back pain, pain along infusion site, anxiety

Question 21

febrile nonhemolytic trxn

Answer 21

• Ab to donors’ WBCs or cytokines in a plt bag
• fever, chills, h/a, vomiting
• avoid with leukocyte reduction

Question 22

urticarial trxn

Answer 22

• Ab to to donor’s IgE
• urticaria, flushing, angioedema

Question 23

anaphylactic trxn

Answer 23

• Ab to donor’s IgA, haptoglobin or C4
• hypotension, urticaria, respiratory distress, angioedema, abd pain, anxiety
• avoid by washing product or using IgA deficient plasma

Question 24

TRALI

Answer 24

• transfusion-related acute lung injury
• donor’s Ab to WBCs (from plasma products); HLA related; no female plasma used
• bilateral pulmonary edema, hypoxemia, resp failure, hypotension, fever

Question 25

delayed hemolytic trxn

Answer 25

- anamnestic response to RBC Ag - fever, decreasing Hgb, new positive ABS, jaundice, DAT+/=

Question 26

alloimmunization

Answer 26

- delayed - immune response to foreign Ag on RBCs, WBCs or plts - ABS+, platelet refractoriness, delayed HTR, HDFN

Question 27

GVH disease

Answer 27

- delayed - donor lymphs attack host tissues - erythroderma, maculopapular rash, anorexia, n/v/d, hepatitis, pancytopenia, fever - avoid with irradiation

Question 28

TRIM

Answer 28

- transfusion-related immune modulation - delayed - incompletely understood; donor WBC or plasma factors interact with host immune system - transient immunosuppression - avoid with leukocyte reduction

Question 29

transfusion-related sepsis

Answer 29

- acute - fever, chills, hypotension

Question 30

TACO

Answer 30

- transfusion-associated circulatory overload - dyspnea, cough, cyanosis, tachycardia, HTN, h/a

Question 31

nonimmune hemolysis

Answer 31

- acute - physical/chemical destruction of blood - heating, freezing, hemolytic drug - hemoglobinuria, hemoglobinemia

Question 32

air embolus

Answer 32

- sudden SOB, acute cyanosis, pain, cough, HTN, cardiac arrhythmia

Question 33

hypothermia

Answer 33

- cardia arrhythmia

Question 34

hypocalcemia

Answer 34

- rapid citrate infusion; delayed metabolism of citrate - paresthesia, tetany, arrythmia - tx: TUMS

Question 35

iron overload

Answer 35

- transfusion-dependent patients - DM, cirrhosis, cardiomyopathy

Question 36

weak extra reverse cell rxn ABS=

Answer 36

- weak isoagglutinin - extended RT incubaton/4° incubation - children, elderly

Question 37

weak extra reverse cell rxn ABS+

Answer 37

* cold alloAB * ABID * retest with Ag= cells * (commonly happens with anti-M)

Question 38

weak A1 reverse cell rxn on a patient that types A or AB

Answer 38

- subgroup A2 - test with 3 A1, 3 A2 cells - look at transfusion hx - test with A1 lectin

Question 39

weak extra reverse cell rxn all ABS cells +

Answer 39

- cold autoAb: cold autoadsorption or mini cold panel - rouleaux: saline replace

Question 40

MF forward type

Answer 40

- check tx hx, HPC transplant, or obstetrical pt - may be A3; test A1 lectin

Question 41

extra forward type reactivity

Answer 41

- wash 3-4 times and repeat - if weak anti-B reaction, could be acquired anti-B; check hx for GI issues or GN infection - repeat with monoclonal acidified anti-B - perform autocontrol

Question 42

type O with strong ABS+ with all cells

Answer 42

* possible Bombay type, with anti-H * ABID + type with anti-H

Question 43

IgG antigens

Answer 43

- Rh - Ss - Duffy - Kidd (also bind C') - Lub (high freq) - Kell

Question 44

IgM antigens

Answer 44

- Lewis - MN - P1 - Lua - I (cold auto)

Question 45

tends to disappear with time; may be only historical, not current

Answer 45

Kidd

Question 46

used to enhance any IgM rxn

Answer 46

extended RT or 4° incubation

Question 47

like weak D, a DAT+ gives false positives

Answer 47

phenotyping a patient's cells

Question 48

anti-CD38 drug that creates panagglutinins treat with what?

Answer 48

darzalex DTT (inactivates Kell)

Question 49

special consideration for a darzalex patient that was not phenotyped before tx

Answer 49

give K= blood

Question 50

enhanced by enzyme tx

Answer 50

- Kidd - Rh (some) - Ss (variable)

Question 51

destroyed by enzyme tx

Answer 51

- Duffy - MN

Question 52

unchanged by enzyme tx

Answer 52

Kell

Question 53

used when certain antibodies are preventing others from being detected

Answer 53

neutralization procedures Lewis and P1 -- blood group substance Sda -- urine

Question 54

required when using neutralization procedures

Answer 54

controls, as the substance may dilute out an Ab

Question 55

use ---- to enhance auto-adsorption

Answer 55

PEG

Question 56

for ------------, you need a large sample

Answer 56

auto adsorption

Question 57

requirements for units used in allogeneic adsorption

Answer 57

each antigen must have a negative in at least one unit used 3 units: R1R1, R2R2, rr

Question 58

anti------ is frequently an IgM alloantibody discovered at IS XM

Answer 58

anti-M

Question 59

XM may detect IgG when...

Answer 59

it is against a low-freq that is not represented on the screening cells

Question 60

unit problem that can cause incompatible XM

Answer 60

donor is DAT+

Question 61

drug that frequently causes DAT+

Answer 61

TZP

Question 62

perform an eluate if DAT+ with...

Answer 62

- IgG - C3, if tx in last **3 weeks**

Question 63

antigen that may cause C3+ DAT, and IgG=

Answer 63

Kidd