Rh AND KELL ANTIGENS

Question 1

______ is a phenomenon where red cells from a DCe/Ce (R1/r’) individudal express significantly fewer D antigen sites than red cells from a DCe/ce (R1r) individual

Answer 1

Cepelleni Effect

-D expression is reduced due to the presence of C antigens in trans ( in opposite haplotype) to the D antigen

Question 2

True / false: The Rh haplotype can influence the expression of D antigen

Answer 2

True

Less D antigen expressed when C antigen is present (Cepellini effect?)

Question 3

True / false: Weak D phenotypes are a result of amino acid changes predicted to be located within the exofacial/ surface membrane of the red cells

Answer 3

False

The changes are located intracellularly or in the transmembrane region of the protein (aka area of the D protein located within cell membrane)

Question 4

True / false: weak D phenotypes are further weakened in the presence of C in trans to the weak D

Answer 4

True

Question 5

Which of the ff altered D phenotypes have altered proteins / amino acids that are located on the cells exterior membrane surfaces?
A. D(el)
B. Weak D
C. Partial D
D. Elevated D

Answer 5

C. Partial D

Question 6

Which of the ff altered D phenotypes has an enhanced expression of D antigen in the reduced expression or absence of C/c and E/e antigens?
A. D(el)
B. Weak D
C. Partial D
D. Elevated D

Answer 6

D. Elevated D

Question 7

In which ethnicity is the D-negative phenotype most common?
A. European
B. Asian
C. African-Am
D. Hispanics

Answer 7

A. European (15-17%)

B. Asian (<0.1%)
C. African-Am (~8%)
D. Hispanics (???)

Question 8

Which of the d scenarios can cause false-negative Rh typing results?
A. A neonate with severe HDFN caused by anti-D
B. IgG coating of red cells by warm or cold agglutinins
C. Washing and retesting a patient sample that showed rouleaux at initial spin
D. Patient red cells are non-specifically aggregating

Answer 8

A. A neonate with severe HDFN caused by anti-D
- will be strongly DAT positive; antigen sites are blocked by maternal Anti-D

B - this will show false pos; treat red cells with glycine or chloroquine
C - false pos by rouleaux; saline replacement should resolve this
D - false pos; may be due to reagent component

Question 9

Which of the ff Rh antibodies, aside from anti-D, can most likely cause severe HDFN?
A. Anti-C
B. Anti-E
C. Anti-e
D. Anti-c

Answer 9

D. Anti-c

Although the rest can also cause HDFN, but milder

Question 10

How should a female of child bearing age with partial D be considered as (Rh+ or Rh neg) when they come in as a blood donor vs as a patient?
A. D+ as donor; D+ as patient
B. D- as donor; D+ as patient
C. D+ as donor; D- as patient
D. D- as donor; D- as patient

Answer 10

C. D+ as donor; D- as patient

Patients with partial D (in general) can make allo anti-D

Question 11

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

R1R2

Answer 11

DCe/DcE

Question 12

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

R0R0

Answer 12

Dce/Dce

Question 13

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

Rzr’

Answer 13

DCE/DCe

Question 14

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

R2Rz

Answer 14

DcE/DCE

Question 15

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

r’r”

Answer 15

Ce/cE

Question 16

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

rr

Answer 16

ce/ce

Question 17

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

r”r

Answer 17

cE/ce

Question 18

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

R1r’

Answer 18

DCe/Ce

Question 19

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

R2R0

Answer 19

DcE/Dce

Question 20

Convert the Fisher-Race nomenclature into Weiner’s nomenclature:

Rzr^y

Answer 20

DCE/CE

Question 21

Which of the ff Rh phenotype is the compound antigen f will more likely be expressed in?
A. DCe/ce (R1r)
B. DCe/CE (R1Rz)
C. DcE/DCe (R2R1)
D. DCE/DCE (RzRz)

Answer 21

A. DCe/ce (R1r)

expressed on RBCs with c and e on the same protein (RhCe)
ex. DCe/ce or Dce/Dce

Question 22

Which of the ff Rh phenotypes will the compound antigen Ce more likely be expressed in?
A. DCE/ce (Rzr)
B. DcE/DCE (R2Rz)
C. DCe/Ce (R1r')
D. DcE/DcE (R2R2)

Answer 22

C. DCe/Ce (R1r’)

expressed when C and e are on the same protein
ex. Ce/ce or Dce/Ce

Question 23

The Rh26 antigen was identified in 1964 and antigen negative phenotype Rh26- has been found in Italians and Dutch. Which of the ff Rh antigens is Rh26 more likely to be expressed in?
A. c-
B. c+
C. C-
D. C+

Answer 23

B. c+

antigen is expressed in majority of c pos RBCs. anti-Rh26 is known as anti-c - like;
found in c+,Rh26 - phenotypes found in Italians and Dutch

Question 24

The Rh29 antigen can be found in nearly all populations (100%). Which of the ff Rh phenotypes was the Rh29- antigen been reported on?

a. Rzr
b. Rh (mod)
c. Rh (null)
d. D neg red cells

Answer 24

c. Rh (null)

the only Rh29- are Rh(null). Anti-Rh29 is the immune response of some Rh(null) individuals

Question 25

Which Rh antigen is associated with the partial D, subcategory DIVa phenotype? a. Hr b. CE c. Rh32 d. Go(a)

Answer 25

d. Go(a) Anti - Goa is found frequently with anti-Rh32 and anti-Evans, specificity NOT separable by absorption

Question 26

``` A patient has made an antibody against a rare Lutheran antigen (ex. Anti- Lu4, -5). Which of the ff family members would show the most compatibility for pRBCs in case transfusion is needed? A. paternal grandfather B. parents C. siblings D. maternal grandfather ```

Answer 26

C. siblings

Question 27

``` Which of the ff Kell phenotypes will anti-Ku be most likely found in? A. K-, k-, Kpa+, Kpb- B. K+, k-, Kpa-, Kpb- C. K+, k+, Kpa+, Kpb- D. K-, k-, Kpa-, Kpb- ```

Answer 27

D. K-, k-, Kpa-, Kpb- this is a phenotype from a K0 individual (null); Kell null individuals can make anti-Ku

Question 28

True / false - Patients who have anti-Kpa also usually has anti-K

Answer 28

True

Question 29

Anti-Km can only be made by which particular individuals? A. A female with McLeod syndrome, plus CGD B. A female with McLeod syndrome, without CGD C. A male with McLeod syndrome, plus CGD D. A male with McLeod syndrome, without CGD

Answer 29

D. A male with McLeod syndrome, without CGD McLeod syndrome is a recessive X-linked inherited mutation of the XK gene A male with McLeod syndrome, plus CGD = can make anti-Km and -Kx

Question 30

``` Rank the level of immunogenicity of these Rh antigens from most to least immunogenic A. D > E > c > C > e B. D > c > E > C > e C. D > C > E > c > e D. D > c > e > C > E ```

Answer 30

B. D > c > E > C > e

Question 31

``` Which of the ff is considered as a coexpressor and must be present for successful expression of the Rh antigens? A. Glycophorin A B. Type 1 chains C. RHAG D. LW ```

Answer 31

C. RHAG

Question 32

``` An individual’s Rh type is D+, C+, c+, E+, e+, f-. Which of the ff is his the most probable genotype? A. R0r’’ B. R2R0 C. R1r’’ D. Rzry ```

Answer 32

C. R1r’’ This individual is DCe, dcE An f+ individual must inherit c+e+ on the same allele Ex. dcE/Dce ( R2R0) or Dce/ dcE (R0, r’) or DCE/dce (Rzr)

Question 33

``` The antibody to Hr0 is directed to the entire protein resulting fromthe RHCE genes. Which of thr ff phenotype will moce likeley produce anti-Hr0? A. D(mod) B. Weak D C. Partial D D. D — ```

Answer 33

D. D -- Anti- Hr0 will react with most cells except D - -

Question 34

``` Which of the ff low prevalence Rh antigens is NOT associated with any of the categories of Partial D phenotype? A. Rh23 B. Rh 30 C. Rh 40 D. Rh33 ```

Answer 34

D. Rh33 Shows reduced amounts of Some Rh antigens

Question 35

Anti-LW is best distinguished from Anti-D by which of the ff serologic reactions? A. Anti-LW will react with cord cells regardless of their Rh type, and is non reactive with 0.2M DTT treated cells B. Anti-LW is reactive with O+ cord cells, non reactive with O- cord cells, and is non reactive with 0.2M DTT treated cells C. Anti-LW will react with cord cells regardless of their Rh type, and reactive with 0.2M DTT treated cells D. Anti-LW is reactive with O+ cord cells, non reactive with O- cord cells, and is reactive with 0.2M DTT treated cells

Answer 35

A. Anti-LW will react with cord cells regardless of their Rh type, and is non reactive with 0.2M DTT treated cells anti-LW reacts with cord cells regardless of Rh type; LW is a high prevalence antigen that is denatured by DTT treatment