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Rh Flashcards

(54 cards)

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1
Q

Rh genes and location

A

RHD, RHCE

Chromosome 1

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2
Q

cause of most D- phenotype

A

complete deletion of RHD gene

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3
Q

Most prevalent Rh phenotypes in whites?

A

R1 (42%) > r (37%) > R2 (14%) > Ro (4%)

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4
Q

Most prevalent Rh phenotypes in Blacks?

A

Ro (44%) > r (26%) > R1 (17%) > R2 (11%)

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5
Q

Characteristics of Rh antibodies

A

IgG; rarely IgM
Do not activate complement
- Causes extravascular hemolysis
Enhanced by enzymes

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6
Q

Rh most to lease immunogenicity

A

D > c > E > C > e

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7
Q

What is anti-f?

A

f is present with c and e are in cis
present on Ro and r cells
Appears to be anti-c and -e, but only reacts to shared determinate

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8
Q

What is anti-G?

A

reacts with all cells carrying D or C or both
Transfuse D- C- blood
Differentiate in pregnant females for RHIG

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9
Q

What causes anemia in Rh null or Rh mod people

A

RHag is required for strong cytoskeleton of RBC
Integrity of membrane is compromised
Increased osmotic fragility - abn cation fluxes
Stomatocytes present

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10
Q

What chromosome is RHAG located on?

A

Chromosome 6

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11
Q

What chromosome is LW located on?

A

Chromosome 19

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12
Q

What is rr (double bar)

A

Amorph Rh null
No DCE or LW antigens
RHAG is normal
D deletion with homozygous inactive RHCE genes

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13
Q

% of Whites and Blacks that D+?

A

85% of whites

92% of blacks

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14
Q

% of Asians and Native Americans that are D+?

A

99%

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15
Q

Weak D

A 
Quantitative = Less D antigen present
Amino acid change occurs inside the membrane
May need AHG to detect
All D epitopes are present
Types 1-3 will not make anti-D
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16
Q

Partial D

A 
Qualitative
Missing some D epitopes
Many will react as IS
Most due to hybrid gene with RHCE gene
Amino acid change on external loops of D antigen
Can make allo-anti-D to missing epitopes
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17
Q

C in Trans to D

A

Occurs in Ror’

Steric arrangement if C and D interferes with D expression

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18
Q

What is Ceppellini effect?

A

D is weaker in Presence of C

R1 is weaker than R2 cells

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19
Q

What partial D’s will type D positive?

A

III, IV, VII

3 + 4 = 7

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20
Q

What is the function of LW antigen?

A

It’s an Intercellular adhesion molecule (ICAM)
maker for lymphocyte maturation and differentiation
May help stabilize the erythroblastic islands
Involved in removal of old RBC’s

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21
Q

How do you differentiate anti-D and anti-LW?

A

LW will react with all cord cells regardless of D type
LW is destroyed by DTT and pronase
Both are resistant to Ficin/papain

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22
Q

DVI

Study These Flashcards
A

Most common partial D in individuals of European ethnicity
Current FDA reagents have IgM clones selected to be nonreactive with DVI in direct tests
Can make anti-D (fatal HDFN)

23
Q

Rh antibodies

HDFN

Study These Flashcards
A

Anti-D and –c can cause severe HDFN

Anti-C, -E, and –e do not often cause HDFN (maybe mild)

24
Q

Fisher Race and population prevalence of:

R1

Study These Flashcards
A

DCe

White: 42%
Black: 17%
Asian: 70%

25
Fisher Race and population prevalence of: r
ce White 37% Black: 26% Asian: 3%
26
Fisher Race and population prevalence of: R2
DcE White: 14 Black: 11 Asian: 21
27
Fisher Race and population prevalence of: R0
Dce White: 4 Black: 44 Asian: 3
28
Fisher Race and population prevalence of: r’
Ce White: 2% Black: 2% Asian: 2%
29
Fisher Race and population prevalence of: r’’
cE White: 1% Black: <0.01% Asian: <0.01%
30
Fisher Race and population prevalence of: Rz
DCE White: <0.01% Black: <0.01% Asian: 1%
31
Fisher Race and population prevalence of: ry
CE White: <0.01% Black: <0.01% Asian: <0.01%
32
most common weak Ds in African ancestry
DIIIa and DAR | Types as RhD pos at IS
33
Del
Type as D neg (IS &IAT) | Adsorb and elute anti-D
34
ceCF
Crawford phenotype D Epitope on RHCE gene Pos with gammaclone, neg with most other reagents
35
ceHAR
D epitope on RHCE gene Reactive with most anti-D reagent but not ortho bioclone
36
Immune response to RhD
1st exposure: slow response (up to 4 weeks) Primarily IgM Response on restimulation: strong IgG usually within 24 hrs Peaks usually w/in 6 days
37
Most Cw and Cx+ are also...
C+
38
Antithetical antigen to Cw/Cx
Mar (high frequency)
39
Anti-MAR nonreactive with what phenotypes
Rh null D- - CwCw CxCx CwCx
40
Describe differential adsorbtion for anti-G determination
First adsorption r’ Elution: Anti-C if it’s really a D and C Anti-G, -C if a G and C Second adsorption R0 Elution Negative for D and C anti-G for G and C
41
Partial e
Most often found in African Americans Anti-hrs (-f like) Anti-hrb (-Ce like)
42
Rh null amorph Rh protein, RhAg, and genes
Rh protein: absent RhAG: reduced Altered gene: RHD deleted (RHCE present)
43
Rh null regulator Rh protein, RhAg, and genes
Rh protein: absent RhAg: absent Altered genes: RHAG mutation or deletion
44
Rh mod Rh protein, RhAg, and genes
Rh protein: reduced RhAg: reduced Altered genes: RHAG mutation
45
LW(a-b-) associated with
Rh null
46
LW Antigens
Weaker on D- RBCs Strong presence on all cord cells (D+ and D -)
47
Anti-LW
Shows relative D specificity Non reactive with AET/DTT treated cells
48
D- -
Missing RHCE gene
49
Del
Express extremely low amount of D antigen that can only be detected by adsorption elution studies (Negative IAT) Found in 10-30% of D- people of Asian ethnicity
50
DHAR and Crawford antigens
D epitopes on Rhce Show strong agglutination with some monoclonal D reagents but negative with others Can still be sensitized to D
51
Elevated D seen in D- -, Dc-, and DCw- caused by
Replacement of parts of RHCE with RHD sequences
52
Weak D types that can be treated as Rh pos
1, 2, 3
53
Weak D types that can make anti-D
11 and 15
54
Antigens in the RHAG Blood group system (4)
Duclos (RHAG1) Ol^a (RHAG2) DLSK (RHAG3 and RHAG4)

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