Section 6 Flashcards
(253 cards)
1
Q
What is the criteria for an allogeneic blood donor?
A
- age = >= 15 or as followed by state law
- HGB
— Women = >=12.5 g/dL
— men = > 13 g/dL - HCT
— women = >= 38%
— men = >39% - temp = <=37.5 C
- venipuncture site = no infections skin disease or scars indicative of drug use
2
Q
What is the criteria for an autologous blood donor?
A
- age = as determined by medical director
- Hgb = >= 11.0 g/dL
- Hct = >=33%
- no donations within 72 hours of surgery
- temp = as determined by medical director. Bacteremia is cause for deferral
- venipuncture site = as determined by medical director
3
Q
What would cause a 2 day deferral for blood donation?
A
- aspirin, if donor is sole source of platelets
4
Q
What would cause a 2 week deferral for blood donation?
A
- measles (rubeola) vaccine
- mumps vaccine
- polio vaccine
- thyphoid vaccine
- yellow fever vaccines
5
Q
What is the cause of a 4 week deferral for blood donations?
A
- rubella vaccine
- chicken pox vaccine
6
Q
What is another name for chicken pox?
A
- varicella zoster
7
Q
What is the cause of a 6 week deferral for blood donations?
A
- pregnancy
8
Q
What is the cause of a 8 week deferral for blood donations?
A
- whole blood donation
9
Q
What is the cause for a 16 week deferral for blood donations?
A
- after 2 unit RBC collection
10
Q
What is the cause for a 12 month deferral for blood donations?
A
- syphilis
- gonorrhea
- HBIG
- mucous membrane exposure to blood
- skin penetration with sharp contaminated with blood or body fluids
- household or sexual contact with individual with HIV or at high risk
- incarceration in correctional facility for >72 consecutive hours
- travel to areas endemic for malaria
- recipient of blood, blood components, plasma-dried clotting factors concentrates, or transplant
11
Q
What is the cause for a 2 year deferral for blood donation?
A
- malaria, or from an area endemic for malaria
12
Q
What is the cause for a permanent deferral of blood donation?
A
- confirmed POS HBsAg
- receipt of dura matter or pituitary growth hormone of human origin
13
Q
What is the cause of indefinite deferral for blood donations?
A
- parenteral drug use
- family history of Cruetzfeldt-Jakob disease
- repeated reactive test for anti-HBc on more than 1 occasion
- POS HBV NAAT result
- repeatedly reactive for HTLVon more than one occasion
- present or past clinical evidence of infection with HIV, HCV, HTLV, or trypanosoma Cruzi
14
Q
What is the volume of blood routinely collected for donation?
A
- 450 +/- 10% or 500 mL +/- 10%, depending on collection bag
15
Q
Describe low volume collections for donation
A
- 300-404 mL in 450-mL bag or 333-449 mL in 500-mL bag
- labeled low volume
- RBCs may be transfused but plasma and platelets from a low volume unit should be discarded
16
Q
What is the storage temp of blood unit between collection and processing?
A
20-24C if platelets are to be prepared; otherwise 1-6C
17
Q
Describe apheresis
A
- automated blood collection system that allows removal of 1 or more component from blood and return of remainder to donor
- advantages = allows collecting of large volume of specific components. Can reduce # of donors to which patient is exposed
18
Q
Describe Platelet apheresis
A
- plateletpheresis
- can collect HLA matched for patients who are refractory to random platelets
- can be leukoreduced during collection
- contain >=3 x 10^11 platelet
- indication = severe t thrombocytopenia or abnormal platelet function
- shelf life = 5 days with agitation
- storage temp = 20-24 C
- equivalent to 4-6 units
- exposes recipient to fewer donors
19
Q
Describe apheresis of plasma
A
- called plasmapheresis
20
Q
Describe RBC apheresis
A
- 2 units can be collected as same time from donors who are larger and have higher HCT. 16 weeks between donations
21
Q
Describe apheresis of granulocytes
A
- leukopheresis
- not widely used to date
22
Q
Describe apheresis of stem cells
A
- for bone marrow reconstitution in patient with cancer, leukemia, lymphoma
- autologous or HLA matched
23
Q
What are therapeutic uses for apheresis?
A
- therapeutic plasmapheresis (plasma exchange) used to remove abnormal plasma proteins and replace with crystalloid, albumin, or fresh frozen plasma (FFP).
- therapeutic cytapheresis used to remove cellular elements, such as an exchange transfusion for sickle cell patients, leukemic WBCs, lymphocytes ( to induce immunosuppression)
24
Q
Describe donor tests required by AABB
A
- typing = ABO and Rh (including Weak D)
- antibody screen
- syphilis testing = antibodies to Treponema pallidum or nontreponemal serological test for syphilis (RPR)
- hepatitis testing = HBsAg, anti-HBc, anti-HCV, HCv ribonucleic acid (RNA) (NAT)
- HIV testing = Anti-HIV 1/2
- HIV-1 RNA (NAT)
- anti-HTLV-I/II
- West Nile virus RNA (NAT)
- anti-trypanosoma cruzi (FDA recommended 1-time donor screening)
- Zika virus (FDA recommends testing pooled donations
25
What test is used to detect bacterial contamination of platelets?
- culture of platelets or FDA-approved rapid test PGD test
26
What are the anticoagulants for preservation of blood donation collections?
- acid citrate-dextrose (formula A)
- Citrate-phosphate- dextrose
- citrate-phosphate-dextrose-dextrose
- citrate-phosphate-dextrose with adenine
27
Describe Acid citrate-dextrose (ACD-A)
-“formula A”
- shelf life = 21 days
- citrate prevents coagulation by chelating calcium
- dextrose (glucose) supports ATP generation
- used for apheresis
28
Describe citrate-phosphate dextrose (CPD)
- RBC shelf life is 21 days
- higher pH preserves 2,3-DPG better
- better O2 delivery
29
Describe citrate phosphate dextrose dextrose (CP2D)
- RBC shelf life = 21 days
- contains 100% more glucose than CPD
30
Describe citrate phosphate dextrose with adenine (CPDA-1)
- RBC shelf life = 35 days
- adenine increased ADP which increases synthesis of ATP
- Contains more glucose to sustain cells during longer storage
31
Describe additive solutions
- extend shelf life of RBC to 42 days
- constituents = glucose for energy, adenine to support ATP levels
- procedure = plasma expressed from whole blood. 100-110 mL additive transferred from attached satellite bag to RBCs within 72 hours of collection or per manufacturers instructions
- final Hct = 55-65% (HCT of RBCS without additives 65-80%)
- examples = adsol (AS-1), Nutricel (AS-3) and Optisol (AS-S)
32
Describe open system of blood bag
- seal on unit is broken to attach eternal transfer bag
- exposure to air poses threat of bacterial contamination
- components stored at 1-6C must be used within 24 hours after system opened: components stored at 20-24C within 4 hours
33
Describe closed system of a blood bag
- sterility maintained through use of attached satellite bags or sterile connecting device that welds tubing from 1 bag to another
- no exposure to air
- no change
34
Describe RBCs as blood component
- prep = separated from whole blood by centrifugation or sedimentation any time before expiration date of Whole blood or collected by apheresis
- storage temp = 1-6C
- shelf life = 35 days in CPDA-1
- indications = inadequate tissue oxygenation
- should have HCT <=80%; otherwise not enough preservative to support RBCs
- 1 unit should increased Hgb 1 g/dL or HCT 3%
35
Describe RBCs adenine, saline added as blood component
- prep = additive solution added to RBCs following removal of most plasma
- storage temp = 1-6C
- shelf life = 42 days
- indications = inadequate tissue oxygenation
- most commonly used RBC product
36
Describe Frozen RBCs as blood components
- prep = frozen in glycerol within 6 days of collection.
- high glycerol (40%) method most commonly used
- storage temp = frozen in high glycerol (washing in decreased concentration of saline): 1-6C
- shelf life = frozen: 10 years. After removing glycerol fix: 24 hour (unless closed system)
- indications = inadequate oxygenation of tissues
- osmolality to monitor glycerol removal.
- virtually all plasma, anticoagulant, WBCs and platelets removed
- safe for IgA deficient patient
- used to store rare cells
37
Describe washed RBCs as blood component
- prep = RBCs washed with saline
- storage temp = 1-6C
- shelf life = 24 hours after washing
- history of severe allergic reaction, other plasma proteins
- not a substitute for leukoreduced RBCs
- About 20% of RBCs lost in process
38
Describe RBCs leukocytes reduced as blood component
- prep = filtration or apheresis processing
- storage temp = 1-6C
- shelf life = closed systems: same as RBCs. Open system: 35 days in CPDA-1
- history of febrile reaction
- must retain 85% of original RBCs.
- 5 x 10^6 WBCs
39
Describe RBCs irradiated as blood components
- prep = irradiation at 2,500 cGy
- storage temp = 1-6C
- shelf life = original outdate or 28 days from irradiation, whichever comes 1st
- indications = immunodeficiency, immunocompromised patients, HSC transplantation; bone marrow transplant, blood relative, intrauterine and neonatal Tfs
- for preservation of graft vs host disease
- kill donor T cells
40
Describe FFP as blood components
- prep = plasma separated from whole blood and frozen with 8 hours of collection
- storage temp = frozen <=18C. After thawing: 24 hours
- indications = deficiency of coagulation factors
- contains all coagulation factors
- thawed at 30-37C or by FDA-approved microwave
41
Describe cryoprecipitate as blood components
- prep = prepared by thawing FFP at 1-6C, removing plasma and refreezing within 1 hour
- storage temp = frozen: 12 month after thawing: single units 6 hours, pools 6 hours if sterile connecting device used, otherwise 4 hours
- indications = fibrinogen and factor XIII deficiencies
- used for hemophilia A and VWD only if factor VIII concentrate or recombinant factor preparations not available
- should contain >=80 IU of factor VIII and >=150 mg of fibrinogen
42
Describe platelets as a blood component -
Prep = centrifugation of whole blood at RT within. 8 hours of collection. 1st soft spin yields platelet-rich plasma. 2nd hard spin separates platelet from plasma
- storage temp = 20-24C
- shelf life = 5 days from collection with agitation. After pooling, 4 hours
- indications = severe thrombocytopenia or abnormal platelet function
- 40-70 mL plasma
- >= 5.5 x 10^10 platelet
- pH >=6.2
- 1 unit should increase platelet by 5,000-10,000/uL in 75-kg recipient
- should not be used if visible if aggregates present
- may contain residual RBCs
- usually pooled (4-6 units)
43
Describe leukocyte-reduced platelets as a blood component
- prep = WBCs removed by filtration or during apheresis processing
- storage temp = 20-24C
- shelf life
— open system = 4 hours
— apheresis = 5 days
- indications = recurrent febrile reaction and to decreased risk of CMV transmission or HLA alloimmunization
44
Describe prestorage pooled platelet
- prep = 4-6 ABO- identical platelet pooled using closed system
- storage temp = 20-24C
- shelf life = 5 days from collection
- indications = recurrent febrile reaction and to decrease risk of CMV transmission or HLA alloimmunization
- blood center prepares platelet pool using sterile technique
45
What are the labeling requirement for blood and components
- ISBT 128 bar-code symbology
- name of product
- method precipitation (whole blood, apheresis)
- storage temp
- preservatives/anticoagulants
- # of units in pooled components
- name, address, registration # and License # of collection and processing facility
- expiration date (and time if applicable), when expiration date not indicated, expiration is at midnight
- ID # for unit or pool
- donor category (volunteer, autologous)
- ABO group and Rh type, if applicable
- special handling information
- statements regarding recipient ID, circular of information, infectious disease risk and prescription requirement
- autologous unit = “for autologous use only”
- biohazard labe if any infectious disease markers are POS or “donor untested” if testing not performed
46
Describe leukoreduction
- to decrease WBCs to decrease febrile nonhemolytic transfusion reactions, transmission of CMV, and HLA alloimmunization
- WBCs = <5 x 10^6
- methods
— by apheresis processing
— by filtration during manufacture of components or after storage. Prestorage leukocyte reduction is most effective. WBCs removed before the release cytokines
— used of filter during infusion
47
What levels can increase in storage of RBCs?
- lactic acid
- plasma K+
- plasma hgb
- microaggregates
48
What levels are decreased in RBC storage?
- ATP
- 2,3-DPG
- pH
- glucose
- viable ceels
- coagulation factors (the plasma has been removed)
49
What changes can occur during RBC storage? (Not levels)?
- shift to left of O2 dissociation curve (increased Hgb/O2 affinity, decrease O2 delivery to tissues)
50
Describe primary antibody response
- stimulus = 1st exposure to antigen
- lag phase = days to months
- type of antibody = IgM at first. May switch to IgG after 2-3 weeks (isotope switching)
- titer = rise slowly, peaks, then declines
51
Describe secondary antibody responses
- stimulus = subsequent exposure to antigen
- lag phase = hours
- type of antibody = IgG
- titer = rises faster and higher stays elevated longer
52
Describe the characteristics of IgG
- monomer
- 2 binding site
- adaptive immune antibody
- best temp for reactivity = 37C
- does not react in saline
- reacts best by IAT
- moderate complement fixation
- can cause transfusion reactions
- can cross placenta
- can cause HDFN
- can cause delayed hemolytic transfusion reaction
- is not destroyed by DTT, 2-ME
53
Describe characteristics of IgM
- pentameter
- 10 binding sites
- naturally occurring antibody
- best temp for reactivity is 25C or lower
- reacts in saline
- does not react best by IAT
- strong complement fixation
- does not cause transfusion reactions unless ABO
- does not cross placenta
- does not cause HGFN
- does not cause delayed hemolytic transfusion reaction
- is destroyed by DTT, 2-ME
54
What factors of the sensitization stage affects agglutination in tube testing?
- temp
- pH
- ionic strength
- Ag/Ab ratio
- incubation time
55
Describe the sensitization stage
- attachment of antibody to antigen
56
What is optimum temp important in the sensitization stage?
- clinically significant antibodies react best at 37C
57
Why is optimum pH important in the sensitization stage?
- most antibodies react at pH 5.5-8.5
58
Why is optimum ionic strength is important in the sensitization stage?
- reducing ionic strength of medium facilitates interaction of antibody with antigen (LISS)
59
Why is optimum Ag/Ab ratio important in the sensitization stage?
- too much antibody can cause prozone (false NEG)
- optimum serum to cell ratio is 80:1
- usually 2 drops serum to 1 drop of 2-5% RBCs
- follow manufacturers directions
60
Why is optimum incubation time important in the sensitization stage?
- depend on medium
- usuallu 10-30 minute
- follow manufacturers directions
61
What factors can affect agglutination in tube testing during the agglutination stage?
- type of antibody molecule
- density of antigens and location on RBC surface
- Zeta potential
62
How does the type of antibody affect the agglutination stage?
- IgM is larger, can span distance between RBCs more easily
63
Describe the agglutination stage
- formation of the lattice-type structure composed of the antigen-antibody bridges
64
How does density of antigens and location on RBC surface affect the agglutination stage
?
- affects ease of attachment of antibodies
65
How does the zeta potential affect the agglutination stage ?
- difference in change between NEG-charged RBC surface and cloud of POS ions that surround RBCs
- Reducing zeta potential allows RBCs to move closer together
- commercially available enhancement media reduces the zeta potential, allowing positively charged antibodies to get closer to NEG charged RBCs and increasing the RBC agglutination by IgG molecules
66
Describe tube testing
- glass test tubes
- antbodies attach to corresponding antigens on RBCs, forming bridges between cells
- RBC agglutinates
- POS rxn = agglutinated RBCs or hemolysis
- NED rxn = no agglutinated RBCs or hemolysis
- not adaptable to automation
- pro = low cost
67
Describe column agglutination testing
- plastic micro tube containing dextranacrylamide gel
- Ag-Ab rxn results in agglutinated RBCs
- Gel acts as sieve
- large agglutinates can’t pass through, remain at top
- small agglutinates pass into gel
- unagglutinated cells go to bottom
- POS rxn = agglutinate RBCs suspended in gel. Position indicates strength of reaction. Larger agglutinates at top
- NEG rxn = button of unagglutinated RBCs in bottom of micro tube
- adaptable to automation
- pro = standardized. More sensitive than tube testing. Reaction stable 2-3 days; can be captured electronically. AHG tests don’t require washing or control cells
68
Describe solid-phase testing
- microplate with RBC membrane bound to surface of wells
- antibodies in sample of attach to RBC antigens on surface of wells
- after incubatation, unbound Ab removed by washing
- anti-IgG-labeled indicator RBCs added
- attach to antibodies bound to reagent RBC antigens during centrifugation
- POS rxn = indicator of RBCs adhere diffusely to surface of well
- NEG rxn = no adherence of RBCs. Button of RBCs in bottom of well
- adaptable to automation
- pro = standardized. More sensitive than tube testing
- reaction stable for 2 days
69
Describe a 4+ agglutination reaction in tube and column testing
- tube = one solid agglutinate
- column = solid band of agglutinated RBCs at top
70
Describe 3+ agglutination reaction of tube and column testing?
- tube = several large agglutinates
- column = band of agglutinated RBCs near top with a few staggered below
71
Describe 2+ agglutination reactions of tube and column testing
- tube = medium-sized agglutinates, clear background
- column = agglutinates throughout
72
Describe a 1+ agglutination reaction of tube and column testing-
- tube = small agglutinates, turbid background
- column = agglutinates predominately in lower half of column with some RBCs at bottom
73
Describe a mixed field agglutination of tube and column testing
- tube = some agglutinated RBCs in sea of free RBCs
- column = Layer of agglutinated RBCs at top and pellet of unagglutinated RBCs at bottom
74
Describe a NEG agglutination rxn of tube and column testing
- tube = no agglutinates
- column = well-defined pellet of unagglutinated RBCs at bottom
75
What is the genotype of an A phenotype?
- AA
- AO
76
What is the genotype for B phenotype?
- BB
- BO
77
What is the genotype for AB phenotype?
- AB
78
What is the genotype of O phenotype?
- OO
79
What is the frequency of O blood type?
- white = 45%
- Black =49%
- Hispanic = 57%
- Asian = 40%
80
What is the frequency of A blood type?
- white = 40%
- black = 27%
- Hispanic = 31%
- Asian = 27%
81
What is the frequency of type B blood?
- white = 11%
- black = 19%
- Hispanic = 10%
- Asian = 25%
82
What is the frequency of type AB blood?
- white = 4%
- black = 4%
- Hispanic = 2%
- Asian = 7%
83
What are the antigens and antibodies of type O blood?
- no antigens
- antibodies = anti-A and anti-B
84
What are the antigens and antibodies of type A blood?
- Ag = A
- Ab = anti-B
85
What are the antigens and antibodies in type B blood?
- Ag = B
- Ab = anti-A
86
What are the antigens and antibodies for type AB blood?
- Ag = A and B
- Ab = none
87
What is the possible cause for the following results:
Anti-A = 0
Anti-B = 0
A1 cells = 0
B cells = 0
- missing isoagglutinins in group O
- resolution = incubate reverse grouping at RT for 30 minutes. If soil NEG, incubate at 4C for 15-30 minutes. Include controls: patient RBCs in 4% albumin, patient serum with O cells
88
What is the possible cause for the following results:
- Anti-A = 4+
- Anti-B = 0
- A1 cells = 1+
- B cells = 4+
- A2 with anti-A1
- resolution: type RBCs with anti-A (dolichos biflorus lectin). Test serum with several additional A1, A2, and O cells
89
What is the possible cause of the following results:
Anti-A = 4+
Anti-B = 4+
A1 cells = 2+
B cells = 2+
- rouleaux
—resolution = used washed RBCs suspended in saline for forward grouping. Perform saline replacement technique in reverse grouping
- AB with cold alloantibody
— perform antibody panel at RT. If cold alloantibody ID, repeat reverse grouping with A1 and B cells that lack corresponding antigen
90
What is the possible cause for the following results:
Anti-A = 3+
Anti-B = 4+
A1 cells = 1+
B cells = 0
- A2B with anti-A1
- resolution = type cells with anti-A1. Test serum with several additional A1, A2, and O cells
91
What is the possible cause for the following results:
Anti-A = 4+
Anti-B = 2+
A1 cells = 0
B cells = 4+
- acquired B antigen
- resolution = check medical history for infection by GI bacteria (some have enzymes that convert A antigen to B-like antigen (ag). Retype RBCs with different monoclonal anti-B (pH 6.0; doesn’t react with acquired B Ag
92
What is the genotype of Rh positive phenotype?
- DD
- Dd
93
What is genotype for Rh NEG phenotype?
- did
94
What is the Weiner and Rosenfield translation of D antigen?
- weiner = Rhv0
- Rosenfield = Rh1
95
What is the Weiner and Rosenfield translation of C antigen?
- Weiner = rh’
- Rosenfield = Rh2
96
What is the Weiner and Rosenfield translations of the E antigen?
- Weiner = rh’’
- Rosenfield = Rh3
97
What is the Weiner and Rosenfield translations of c antigen?
- Weiner = hr’
- Rosenfield = Rh4
98
What is the Weiner and Rosenfield translations of e antigen?
- Weiner = hr’’
- Rosenfield = Rh5
99
What is the frequency of antigen D?
- white = 85%
- black = 92%
100
What is the frequency of C antigen?
- white = 68%
- black = 27%
101
What is the frequency of E antigen?
- white = 29%
- black = 22%
102
What is the frequency of c antigen?
- white = 80%
- black = 96%
103
What is the frequency of e antigen?
- white = 98%
- black = 98%
104
What is the gene for Dce Antigen?
- Rh^0
105
What is the gene for DcE antigen?
- Rh^2
106
What is the gene for DCe antigen?
- Rh^1
106
What is the gene for DCE antigen?
-Rh^z
107
What is the gene for DCe antigen?
- Rh^1
108
What is the gene for dce antigen?
- rh
109
What is the gene for dCe antigen?
- rh’
110
What is the gene for dcE antigen? -
- rh’’
111
What is the gene for dCE antigen?
- rh^y
112
What is the frequency for the Rh^0 gene?
- white = 4%
- black = 44%
- Asian = 3%
113
What is the frequency of the Rh^1 gene?
- white = 42%
- black = 17%
- Asian = 70%
114
What is the frequency of Rh^2 gene?
- white = 14%
- black = 11%
- Asian = 21%
115
What is the frequency of the Rh^z gene?
- white = <0.01
- black = <0.01
- Asian = 1%
116
What is the frequency of the rh gene?
- white = 37%
- black = 26%
- Asian = 3%
117
What is the frequency of the rh’ gene?
- white = 2%
- black = 2%
- Asian = 2%
118
What is the frequency of the rh’’ gene?
- white = 1%
- black = <0.01
- Asian = <0.01
119
What is the frequency of rh^y gene?
- white = <0.01
- black = <0.01
- Asian = <0.01
120
Describe high protein anti-D typing sera?-
- prepared from pools of human sera (immunized Rh-NEG individuals)
- control = same ingredients as reagent, except no anti-D. Should be purchased from same manufacturer as anti-D
- more false POS than low protein reagents
121
Describe low-protein anti-D typing sera
- mixture of monoclonal IgM and monoclonal or polyclonal IgG
- control = any NEG typing reaction serves as control. When RBCs react with all antisera run control recommended by manufacturer
- most widely used
- lower rate of false POS with Ig-coated RBCs
122
What causes false POS of Rh typing?
- warm or cold autoagglutinins
- rouleaux
- polyagglutinable RBCs
- Nonspecific agglutination due to ingredient in reagent
- contaminant or incorrect reagent
123
What causes false NEGs in Rh typing?
- failure to add reagent
- RBC suspension too heavy
- Resuspending cell button too vigorously
- contaminated or incorrect reagent
- blocking of antigen sites by antibodies
124
Describe weak D testing
- done when anti-D and Rh control are NEG in Rh typing of donor or infant being evaluated from RhIG
- reagent = not all anti-D reagents are appropriate for use. Refer to manufacturers package insert
- method = incubate Rh typing tubes at 37C for 15-60 minutes IAT
125
If the recipient is Rh POS, what should the patient transfused with?
- Rh POS or Rh NEG
126
If the recipient has a weak D, what type of Rh blood would the patient receive?
- Rh POS or Rh NEG, depending on the Weak D phenotype
127
If the recipient is Rh NEG, what type of Rh blood would the patient receive?
- Rh NEG only, especially women of childbearing age
- if Rh POS must be given in emergency, RhIG can be given to prevent immunization
128
What is the frequency of antigen K?
- white = 9%
- black = 2%
129
What is the frequency of the k antigen?
- white = 99.8%
- black = 100%
130
What is the frequency of the Fya antigen?
- white = 68%
- black = 13%
131
What is the frequency of the Fyb antigen?
- white = 80%
- black = 23%
132
What is the frequency of the Jka antigen?
- white = 76%
- black = 92%
133
What is the frequency of Jkb anitgen?
- white = 74%
- black = 48%
134
What is the frequency of the M antigen?
- white = 79%
- black = 74%
135
What is the frequency of the N antigen?
- white = 70%
- black = 75%
136
What is the frequency of the S antigen?
- white = 55%
- black = 30%
137
What is the frequency of the s antigen?
- white = 90%
- black = 92%
138
What is the frequency of the Lea antigen?
- white = 22%
- black = 23%
139
What is the frequency of the Leb antigen?
- white = 72%
- black = 55%
140
What is the frequency of the P1 antigen?
- white = 79%
- black = 94%
141
What are the amounts of i/I in adult cells?
- I = much
- i = trace
142
What are the amounts of i/I in cord cells?
- I = trace
- i = much
143
What are the amounts of i/I in i adult cells?
- I = trace
- i = much
144
Which antibodies are naturally occurring?
- ABO
- Lewis
- P
- MN
- Lua
145
Which antibodies are clinical significant?
- ABO
- Rh
- Kell
- Duffy
- Kidd , SsU
146
Which antibodies are warm Antibodies?
- Rh
- Kell
- Duffy
- Kidd
147
Which antibodies are cold antibodies?
- M
- N
- P1
148
Which antibodies usually only reacts in AHG?
- Kell
- Duffy
- Kidd
149
Which antibodies can react in any phase of testing?
- Lewis
150
Which antibodies are have enhanced detection by enzyme treatment of test cells?
- Rh
- Lewis
- Kidd
- P
151
Which antibodies are not detected with enzyme treatment of test cells?
- M
- N
- Duffy
152
Which antibodies are enhanced by acidification?
-
- M
153
Which antibodies show dosing?
- Rh other than D
- MNS
- Duffy
- Kidd
154
Which antibodies bind complement?
- I
- Kidd
- Lewis
155
Which antibodies cause in vitro hemolysis?
- ABO
- Lewis
- Kidd
- Vell
- Some P1
156
Which antibodies are labile in vivo and in vitro?
- Kidd
157
Which antibodies are the common cause of anamnestic response (delayed transfusion reaction)?
- Kidd
158
Which antibody is associated with paroxysmal nocturnal hemoglobinuria?
- anti-P
159
Which antibodies are associated with cold agglutinins disease and mycoplasma pneumonia infections?
- anti-I
160
Which antibody is associated with IM?
- Anti-i
161
Describe albumin reagent
- 22% bovine serum albumin
- reduces net NEG charge of RBCs, allowing them to come closer together
162
Describe LISS
- reduced ionic strength of suspending medium (lowers zeta potential), allowing Ag and Ab to move closer together more rapidly
- reduces incubation time for IAT
163
Describe PEG
- polyethylene glycol
- increases antibody uptake
- used for detections and ID of weakIgG antibodies
164
Describe enzymes that enhance Ag-Ab
- Ficin and Papain most commonly used
- reduced RBC surface charge by cleaving sialic acid molecules.
- M, N, S, Fya, Fyb, antigens destroyed
165
Describe polyspecific (broad spectrum) AHG serum
- detects IgG and C3d
- used for DAT
- if POS, monospecific sera used for follow-up testing
- advantage: may detect complement-binding antibody more readily
- disadvantage: reaction due to complement binding by clinically insignificant cold antibody
166
Describe monospecific Anti-IgG AHG serum
- detects IgG
- can be used for routine compatibility tests and antibody ID
- detects clinically significant antibodies
167
Describe monospecific Anti-C3d or anti-C3b-C3d
- detects complement
- helpful in investigation of immune hemolytic anemia
168
Where the characteristics of DAT?
- direct antiglobulin test
- detects in vivo sensitization of RBCs by IgG antibodies
- specimen is EDTA red cells
- no incubation required
- application = HDFN, transfusion rxn, autoimmune hemolytic anemia drug-induced hemolytic anemia
169
What causes false POS with DAT?
- complement binding in vitro if RBCs are taken from red-top tube and broad-spectrum AHG used
- septicemia
- contamination of specimen
- Wharton jelly in cord blood
- overcentrifugation
170
What causes false NEG in DAT?
- interpretation in testing
- contamination, improper storage
- failure to add AHG
- neutralization of AHG from inadequate washing
- dilutions of AHG by residual saline
- under centrifugation
171
Describe the characteristics of IAT
- indirect antiglobulin test
- detects in vitro sensitization of RBCs by IgG antibody
- specimen = serum, plasma, RBCs
- incubation = serum or plasma with reagent RBCs or RBCs with reagent antiserum
- application = antibody screen, crossmatch, RBC phenotyping, weak D testing antibody ID
172
What causes false POS of IAT?
- cells with POS DAT
- over centrifugation
173
What causes false NEGs of IAT?
- interpretation in testing
- contamination, improper storage
- failure to add AHG
- neutralization of AHG from inadequate washing
- dilutions of AHG by residual saline
- under centrifugation
- under incubation
174
What is the possible explanation of same strength and in 1 phase only of Ab ID?
- suggestive of single antibody
175
What is the possible explanation of varying strengths of Ab ID?
- multiple Abs, antigens exhibiting dosage
176
What is the possible explanation of reaction in different phases of ID Ab?
- combo of warm and cold antibodies, antibody with wide thermal range
177
What is the possible explanation for rxns in all cells of AHG and auto control NEG of Ab ID?
- multiple antibodies, antibody to high frequency antigen
178
What is the possible explanation for rxns in all cells of AHG and auto control POS of Ab ID?
- warm autoantibodies
179
What is the possible explanation for rxns in all cells at 37C, NEG in AHG, and autocontrol POS in Ab ID?
- rouleaux
180
What are the cold antibodies?
- Anti-A1
- Anti-I
- anti-i
- Anti-H
- Anti-IH
181
Describe Anti-A1 cold antibodies
- only found in subgroups of A
- agglutinates A1 and A1B cells but not A2 or )
182
Describe Anti-Icold antibodies
- agglutinates all adult cells, except i adult.
- doesn’t agglutinate cord cells
183
Describe Anti-i cold antibodies
- agglutinates cord cells more strongly than adult cells
184
Describe anti-H cold antibodies
- most common in A1 and A1B
- agglutinates O most strongly, followed by A2 and B; least likely in A1B
185
Describe anti-IH
- most common in A1 and A1B
- agglutinates cells that possess both I and H
- agglutinates adult O cells most strongly
- weaker reactio with A1 cells
- doesn’t agglutinate cord cells
186
What are the components of compatibility testing?
- specimen collected within 3 days of transfusion if patient has been pregnant or transfused in preceding 3 months
- confirmation of ID information on request form and specimen
- patient sample ID’dby two independent identifiers utilizing mechanism to identify the date and time of sample collection and the individuals who collected the sample from the patient
- check of blood bank records
187
What are the components of compatibility testing?
- specimen collected within 3 days of transfusion if patient has been pregnant or transfused in preceding 3 months
- confirmation of ID information on request form and specimen
- patient sample ID’dby two independent identifiers utilizing mechanism to identify the date and time of sample collection and the individuals who collected the sample from the patient
- check of blood bank records
- repeat ABO type on donor
- repeat Rh type of donor if units is labeled Rh neg (weak D not required)
- ABO type on recipient (2 determinations of the recipients ABO group)
- Rh type on recipient serum and donor RBCs
- retain patient specimen and unit segment at 1-6C for 7 days after transfusion
188
Describe antiglobulin crossmatch
- recipient serum and donor RBCs tested through AHG
- performed when = if recipient has or had clinically significant antibody
189
Describe Immediate spin (IS) crossmatch
- recipient serum and donor RBCs tested in IS only
- performed when = if recipient doesn’t have and never had clinically significant antibody
- detects ABO incompatibility
- antibody screen carried through AHG must be performed and must be NEG
190
Describe electronic crossmatch
- computer check of donor ABO and Rh type and recipient ABO and Rh type
- performed when = if recipient doesn’t have and never had clinically significant antibodies
- detects ABO incompatibility
- ABO tying of recipient must be done twice
- antibody screen carried through AHG must be performed and must be NEG
- computer system must be validated to prevent release of ABO-imcompatible blood and must alert user to discrepancies and incompatibilities
191
What does a major crossmatch detect?
- ABO incompatibilty
- most antibodies against donor cells
192
What is the possible cause and resolution when the reaction is NEG Ab screen, incompatible IS crossmatch?
- cause = ABO incompatibility
- resolution = retype donor and recipient. Crossmatch with ABO compatible donor
193
What is the possible cause and resolution when the reaction is 1 Ab screening cell and 1 donor POS in AHG?
- cause = alloantibody
- resolution = ID Ab. Crossmatch units NEG for corresponding Ag
194
What is the possible cause and resolution when the reaction is Ab screening cells and all donors except 1 NEG at 37C and in AH, 1 donor POS in AHG?
- cause = POS DAT on donor
- resolution = perform DAT on unit. If POS, return to collecting facility
195
What is the possible cause and resolution when the reaction is Ab screening cells, donors ad autocontrol POS in AHG?
- cause = warm autoantibody
- resolution = important to detect any underlying clinically significant alloantibodies prior to transfusion. Adsorption testing is typically required. If patient situation is life-threatening, consult with medical director and provide transfusion
196
What is the possible cause and resolution when the reaction is Ab screening cells, donors and autocontrol POS at IS and 37C, NEG in AHG?
- cause = rouleaux
- resolution = saline replacement technique
197
If the patient has a O blood type, what type of RBCs and plasma can the patient receive?
- RBC = O only
- plasma = O, A, B, AB
198
If the patient has an A blood type, what type of RBCs and plasma can the patient receive?
- RBC = A, O
- plasma = A, AB
199
If the patient has a B blood type, what type of RBCs and plasma can the patient receive?
- RBC = B, O
- plasma = B, AB
200
If the patients blood type is AB, what type of RBCs and plasma can the patient receive?
- RBC = AB, A, B, O
- plasma = AB
201
What are the conditions for reissue of RBCs?
- maintained at 1-10C
- closure wasn’t broken
- at least 1 sealed segment remains attached to unit
- unit is inspected and is acceptable for reissue
202
Describe emergency transfusion thresholds
- if time allows for typing, give ABO and Rh compatible; otherwise give O-NEG RBCs
- label must indicate that crossmatch wasn’t completed
- physician must sign emergency release
- routine testing must be completed and physician notified immediately of any incompatibility
203
What are transfusion-associated infections?
- HIV
- HBV
- HCV
- HLTV-1 and 2
- syphilis
- Malaria
- babesiosis
- Chaga’s disease
- CMV
- Zika virus
- West Nile Virus
- Sepsis
204
What are the types of acute immunologic transfusion reactions?
- hemolytic, intravascular
- febrile
- allergic
- anaphylactic
- transfusion-related acute lung injury (TRALI)
205
Describe hemotlytic, intravascular transfusion reaction
- clinical signs = fever; chills; shock; renal failure; DIC; pain in chest, back or flank
- cause = immediate destruction of donor RBCs by recipient antibody
- in post transfusion specimen: hgb in urine and serum; mixed field DAT; decreased haptoglobulin, Hgb and Hct
- most serious rxn.
- may be fatal
- usually due to transfusion of ABO-incompatible blood
206
Describe febrile transfusion reaction
- clinical signs = temp increased >/= 1C or 2C during or shortly after transfusion, with no other explanation
- cause = anti-leukocyte antibodies or cytokines
- no laboratory findings
- common
- most often in multiply transfused patients or women with multiple pregnancies
- future transfusions should be with leukoreduced components
- antipyretics can be used to premedicate
207
Describe an allergic transfusion rxn
- clinical signs = Hives (urticaria), wheezing
- cause = foreign plasma proteins
- no laboratory findings
- common
- treat with antihistamines
- transfusion rxn investigation not required
208
Describe an anaphylactic transfusion rxn
- clinical signs = pulmonary edema, bronchospasms
- cause = anti-IgA in IgA-deficient recipient
- no laboratory findings
- rare but dangerous
- treated with epinephrine
- transfuse with washed cellular blood products
209
Describe TRALI transfusion reaction
- transfusion-related acute lung injury
- clinical signs = fever, chills, coughing respiratory distress, fluid in lungs, decreased blood pressure (BP) within 6 hour of post transfusion
- cause = unknown. Possibly donor antibodies to WBC antigens
- no laboratory findings
- most common cause of post transfusion-related deaths in US
- related to infusion of plasma
- all components have been implicated
- reduced use of plasma from female donors appears to be reducing TRAL fatalities
210
What are the acute non-immunologic transfusion reactions?
- sepsis
- transfusion-associated circulatory overload (TACO)
- nonimmune hemolysis
- hypothermia
211
Describe sepsis transfusion reactions
- clinical signs = fever, chills, decrease BP, cramps, diarrhea, vomiting, muscle pain, DIC, shock, renal failure
- cause = bacterial contamination
- POS gram stain and culture on unit POS blood culture on patient
212
Describe transfusion-associated circulatory overload (TACO)
- clinical signs = coughing, cyanosis, difficulty breathing, pulmonary edema
- cause = too large a volume or too rapid rate of infusion
- no laboratory findings
- problem in children, cardiac and pulmonary patients, elderly, and those with chronic anemia
213
Describe nonimmune hemolysis transfusion reaction
- clinical signs = variable
- causes = destruction of RBCs due to extremes of temp, addition of meds to unit
- laboratory findings = hemoglobinuria and hemoglobinemia
214
Describe hypothermia transfusion reaction
- clinical signs = cardiac arrhythmia
- cause = rapid infusion of large amounts of cold blood
- use blood warmer for rapid infusions
215
What are the delayed transfusion reactions?
- hemolytic, extravascular
- alloimmunization
- transfusion-associated graft vs. host disease (TA-GVHD)
- iron overload
216
Describe hemolytic extravascular Transfusion reaction -
- clinical signs = fever, anemia, mild jaundice 2-14 days after post transfusion
- cause = donor RBCs sensitizedby recipient IgG antibody and removed from circulation
- increased bile, mixed-field DAT, decreased haptoglobin, hgb and Hct. POS antibody screen
- may be due to anamnestic response
- Kidd antibody most common cause
- usually not life-threatening
217
Describe allimmunization transfusion reactions
- clinical signs = none, unless subsequently exposed to same foreign antigens
- cause = development of antibodies to foreign RBCs, WBC, platelets, plasma proteins following transfusion
- antibody to RBCs detected in antibody screen
- other require specialized testing
- use leukoreduced components for patients with WBC antibodies
218
Describe TA-GVHD transfusion reaction
- transfusion-associated graft vs. host disease
- clinical signs = rash, nausea, vomiting, diarrhea, fever, pancytopenia. Usually fatal
- cause = viable T lymphs in donor blood attack recipient
- no laboratory findings
- irradiate components for premature infants, intrauterine or exchange transfusion, stem cell or bone marrow transplants, recipients of blood from a 1st degree relative, immunocompromised, patients with leukemia or lymphoma
219
Describe iron overload transfusion reaction
- clinical signs = diabetes, cirrhosis, cardiomyopathy
- cause = build-up of iron in body
- increased serum ferritin
- problem for patients receiving repeated post transfusion over long period of time
220
What are signs and symptoms of possible transfusion reaction?
- fever
- chills
- respiratory distress
- hyper or hypotension
- back, flank, chest, or abdominal pain
- pain at site of infusion
- hives
- jaundice
- hemoglobinuria
- nausea/vomitting
- abnormal bleeding
- oliguria/anuria
221
What are the specimens needed for transfusion reaction investigation?
- pre-transfusion blood
- post-transfusion blood
- post-transfusion blood
- segement from unit
- blood bag with administration set and attached IV solutions
222
What are the immediate steps that need to be taken when a transfusion reaction starts?
- stop transfusion
- check all IDs and labels
- repeat AB on post-transfusion samples for hemolysis
- DAT on post-transfusion samples. if POS, perform on pre-transfusion sample
223
What are the signs of possible hemolytic reaction?
- hemolysis in post-transfusion sample, but not in pre-transfusion sample
- mixed field agglutination in DAT on post transfusion, sample, but not pre-transfusion sample
- other possible signs
— check hgb in first voided urine after transfusion
— repeat ABO and Rh on pre and post transfusion sample and unit
— repeat antibody screen on pre and post transfusion samples and unit
— repeat antibody screen on pre and post-transfusion samples
— AHG crossmatch with pre and post-transfusion samples
224
What are additional tests that may be performed?
- Haptoglobin (decrease with hemolysis)
- gram stain and culture of unit
- bilirubin 5-7 hours after transfusion (signs of extravascular hemolysis)
- BUN and creatinine (sign of renal involvement)
225
What reporting needs to occur when a patient has a transfusion reaction?
- must be reported to FDA center for biologics Evaluation and research (CBER) by phone or email as soon as possible (ASAP), followed by submission of written report within 7 days
226
What testing is done on neonates?
- ABO and Rh
- antibody screen
- crossmatch
227
Describe ABO and Rh testing of neonates
- specimen = cord blood, capillary, or venous blood
- ABO forward grouping only
- only required once per admission
228
Describe antibody screen of neonates -
- specimen = serum or plasma of mother or baby
- only required once per admission
229
Describe crossmatch of testing of neonates
- specimen = serum or plasma of mother or baby
- if antibody screen POS, perform AHG crossmatch on units NEG for corresponding antigen
- if antibody screen NEG, crossmatch not required
230
Describe if the mother is at risk for HDFN?
- ABO = usually group O
- Rh = Rh NEG
231
Is the first child affected by HDFN?
- ABO = yes
- Rh = not usually
232
What is the severity of HDFN?
- ABO= mild
- Rh = can be severe
233
What is the reaction of DAT in HDFN?
- ABO = Weak POS or NEG
- Rh = strong POS
234
Are there spherocytes seen in HDFN?
- ABO = yes
- Rh = rare
235
What is the frequency of HDFN?
- ABO = common
- Rh = un common
236
Is HDFN preventable?
- ABO = no
- Rh = yes RhIG
237
Is HDFN predictable?
- ABO = no
- Rh = yes
238
Describe prenatal evaluation of RhIG work up
- ABO and Rh (weak D not required). If POS, woman isn’t candidate doe RhIG
- antibody screen. If POS, ID Ab. If anti-D presents, woman is not a candidate
239
Describe postpartum evaluation of a RhIG workup
- ABO and Rh, including weak D, on baby. If baby is Rh NEG, mother is not candidate
- if baby is a Rh POS, draw mothers blood after delivery and perform rosette test to screen for fetal bleed
- mothers RBCs incubated with anti-D, Anti-D coats real D-POS RBCs. Indicator D-POS RBCs added. Attach to anti-D on fetal D-POS RBCs, forming rosettes
- if rosette test is POS, quantitiate fetal bleed by flow cytometry or Kleihauer-Bette acid-elution test. Fetal cells resist acid elution; stain pink
- Adult cells lose Hgb; appear as ghost cells
240
Describe Rh immune globulin (RhIG)
- composition = anti-D derived from pools of human plasma
- purpose = prevent immunization to D
- administrationmn
— antepartum - to Rj NEG woman at 28 weeks of gestation
— postpartum = within in 72 hours of delivery when Rh-NEG woman delivers Rh-POS baby
— other obsteric events: to Rh-NEG woman after spontaneous or therapeutic abortion, ectopic pregnancy, amniocentesis, Chorionic villus sampling, antepartum hemorrhage, or fetal death
— may also be administered rot Rh-NEG recipients of Rh-POS blood or components
- dose = 1 dose per15 mL of D POS fetal WBCs (30 mL of fetal whole blood
241
What is the quality control for blood storage refrigerators and freezers, and platelet incubators?
- system for continuous temp monitoring and audible alarms
242
What is the quality control for temperature recorder?
- compares against thermometer daily
- calibrate as necessary
243
Describe Rh immune globulin (RhIG)
- composition = anti-D derived from pools of human plasma
- purpose = prevent immunization to D
- administrationmn
— antepartum - to Rj NEG woman at 28 weeks of gestation
— postpartum = within in 72 hours of delivery when Rh-NEG woman delivers Rh-POS baby
— other obsteric events: to Rh-NEG woman after spontaneous or therapeutic abortion, ectopic pregnancy, amniocentesis, Chorionic villus sampling, antepartum hemorrhage, or fetal death
— may also be administered rot Rh-NEG recipients of Rh-POS blood or components
- dose = 1 dose per15 mL of D POS fetal WBCs (30 mL of fetal whole blood
244
What is the quality control method for alarms?
- check high and low temp of activation quarterly
245
What is the quality control method for water baths
- check temp daily
246
What is the quality control method for heat blocks?
- check temp daily
- periodically check each well
247
What is the quality control method of centrifuges?
- determine optimum speed and time for different procedures upon recipient, after repairs, and periodically
- check timer every 3 months, RPM every 6 months (with tachometer)
248
What is the quality control method of cell washers?
- check tube fill level daily, AHG volume monthly.
- verify time and speed quarterly
249
What is quality control method for antisera?
- test with POS and NEG controls each day of use
- Use heterozygous cells for POS controls
250
What is the quality control method for reagent cells?
- check for hemolysis
- test each of use With POS and NEG controls
251
What is the quality control method for pipette?
- calibrate quarterly
252
What is the quality control method of AHG?
- checks anti-IgG activity. Each day of used by testing Rh-POS cells sensitized with anti-D
