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Mercy CLS 4: Blood Bank > Problem Resolution Dept Exam > Flashcards

Problem Resolution Dept Exam Flashcards

1
Q

calculate number of units to test

A

2/(frequency in decimal form)

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

2/0.34 = 5.9 = six units

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2
Q

select control cells for Ag typing

A

positive: heterozygous positive
negative: negative

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3
Q

When can you do a selected cell panel?

A

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

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4
Q

prewarm technique use

A

only for XM
careful not to prewarm a new IgM away

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5
Q

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

A

weak reverse type

requires controls

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6
Q

auto-adsorption cannot be used when…

A

tx in the last 3 months

instead, use allogeneic adsorption

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7
Q

instances when allogeneic adsorption is used

A
  • short sample
  • tx in last 3 months
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8
Q

phenotyping must be done on a —– sample

A

pre-tx

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9
Q

example of an enzyme tx

A

DTT for darzalex
destroys K

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10
Q

acidification of serum

A

increases anti-M activity

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11
Q

which antigens are neutralized using blood group substances?

A

P1
Lewis
urine Sda

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12
Q

AHG XM used for…

A

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

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13
Q

3 reasons for DAT+

A
  • HDFN
  • transfusion rxn
  • autoAb
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14
Q

how to perform weak D if DAT+

A

EGA treat cells

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15
Q

last wash testing purpose

A

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

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16
Q

3 causes of IS problems

A
  • IgM alloAb
  • cold autoAb
  • rouleaux
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17
Q

2 causes of AHG problems

A
  • IgG or C’ binding alloAb (low-freq)
  • warm autoAb
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18
Q

how to release blood when a patient has a warm autoAb

A

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

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19
Q

how do you determine which tests to run after trxn?

A

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

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20
Q

acute hemolytic trxn

A
  • red cell incompatibility
  • chills, fever, hemoglobinuria, hypotension, renal failure, oliguria, DIC, back pain, pain along infusion site, anxiety
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21
Q

febrile nonhemolytic trxn

A
  • Ab to donors’ WBCs or cytokines in a plt bag
  • fever, chills, h/a, vomiting
  • avoid with leukocyte reduction
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22
Q

urticarial trxn

A
  • Ab to to donor’s IgE
  • urticaria, flushing, angioedema
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23
Q

anaphylactic trxn

A
  • 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
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24
Q

TRALI

A
  • 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
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25
Q

delayed hemolytic trxn

A
  • anamnestic response to RBC Ag
  • fever, decreasing Hgb, new positive ABS, jaundice, DAT+/=
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26
Q

alloimmunization

A
  • delayed
  • immune response to foreign Ag on RBCs, WBCs or plts
  • ABS+, platelet refractoriness, delayed HTR, HDFN
27
Q

GVH disease

A
  • delayed
  • donor lymphs attack host tissues
  • erythroderma, maculopapular rash, anorexia, n/v/d, hepatitis, pancytopenia, fever
  • avoid with irradiation
28
Q

TRIM

A
  • transfusion-related immune modulation
  • delayed
  • incompletely understood; donor WBC or plasma factors interact with host immune system
  • transient immunosuppression
  • avoid with leukocyte reduction
29
Q

transfusion-related sepsis

A
  • acute
  • fever, chills, hypotension
30
Q

TACO

A
  • transfusion-associated circulatory overload
  • dyspnea, cough, cyanosis, tachycardia, HTN, h/a
31
Q

nonimmune hemolysis

A
  • acute
  • physical/chemical destruction of blood
  • heating, freezing, hemolytic drug
  • hemoglobinuria, hemoglobinemia
32
Q

air embolus

A
  • sudden SOB, acute cyanosis, pain, cough, HTN, cardiac arrhythmia
33
Q

hypothermia

A
  • cardia arrhythmia
34
Q

hypocalcemia

A
  • rapid citrate infusion; delayed metabolism of citrate
  • paresthesia, tetany, arrythmia
  • tx: TUMS
35
Q

iron overload

A
  • transfusion-dependent patients
  • DM, cirrhosis, cardiomyopathy
36
Q

weak extra reverse cell rxn
ABS=

A
  • weak isoagglutinin
  • extended RT incubaton/4° incubation
  • children, elderly
37
Q

weak extra reverse cell rxn
ABS+

A
  • cold alloAB
  • ABID
  • retest with Ag= cells
  • (commonly happens with anti-M)
38
Q

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

A
  • subgroup A2
  • test with 3 A1, 3 A2 cells
  • look at transfusion hx
  • test with A1 lectin
39
Q

weak extra reverse cell rxn
all ABS cells +

A
  • cold autoAb: cold autoadsorption or mini cold panel
  • rouleaux: saline replace
40
Q

MF forward type

A
  • check tx hx, HPC transplant, or obstetrical pt
  • may be A3; test A1 lectin
41
Q

extra forward type reactivity

A
  • 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
42
Q

type O with strong ABS+ with all cells

A
  • possible Bombay type, with anti-H
  • ABID + type with anti-H
43
Q

IgG antigens

A
  • Rh
  • Ss
  • Duffy
  • Kidd (also bind C’)
  • Lub (high freq)
  • Kell
44
Q

IgM antigens

A
  • Lewis
  • MN
  • P1
  • Lua
  • I (cold auto)
45
Q

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

A

Kidd

46
Q

used to enhance any IgM rxn

A

extended RT or 4° incubation

47
Q

like weak D, a DAT+ gives false positives

A

phenotyping a patient’s cells

48
Q

anti-CD38 drug that creates panagglutinins

treat with what?

A

darzalex
DTT (inactivates Kell)

49
Q

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

A

give K= blood

50
Q

enhanced by enzyme tx

A
  • Kidd
  • Rh (some)
  • Ss (variable)
51
Q

destroyed by enzyme tx

A
  • Duffy
  • MN
52
Q

unchanged by enzyme tx

A

Kell

53
Q

used when certain antibodies are preventing others from being detected

A

neutralization procedures

Lewis and P1 – blood group substance
Sda – urine

54
Q

required when using neutralization procedures

A

controls, as the substance may dilute out an Ab

55
Q

use —- to enhance auto-adsorption

A

PEG

56
Q

for ————, you need a large sample

A

auto adsorption

57
Q

requirements for units used in allogeneic adsorption

A

each antigen must have a negative in at least one unit used

3 units: R1R1, R2R2, rr

58
Q

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

A

anti-M

59
Q

XM may detect IgG when…

A

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

60
Q

unit problem that can cause incompatible XM

A

donor is DAT+

61
Q

drug that frequently causes DAT+

A

TZP

62
Q

perform an eluate if DAT+ with…

A
  • IgG
  • C3, if tx in last 3 weeks
63
Q

antigen that may cause C3+ DAT, and IgG=

A

Kidd

Mercy CLS 4: Blood Bank (13 decks)

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