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Transfusion > Trans lecture 2 > Flashcards

Trans lecture 2 Flashcards

1
Q

What is hemagglutination?

A

Hemagglutination is the agglutination or clumping of red blood cells.

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2
Q

Which blood cell surface allows easy access to antigens?

A

The red cell surface allows easy access to antigens.

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3
Q

Which blood group systems have antigens protruding from the red cell surface?

A

Most blood group systems have antigens protruding from the red cell surface.

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4
Q

What are the factors that contribute to immunogenicity?

A

The factors that contribute to immunogenicity are chemical composition and antigen complexity.

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5
Q

Which antigens are the best immunogens?

A

Proteins are the best immunogens.

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6
Q

Which antigens are less immunogenic?

A

Lipids are not antigenic at all.

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7
Q

What is the role of the Degree of Foreignness in immunogenicity?

A

The Degree of Foreignness determines how immunogenic an antigen is.

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8
Q

What is the minimum size required for an antigen?

A

The antigen must be larger than 10,000 D.

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9
Q

What factors influence antigen-antibody binding?

A

Factors that influence antigen-antibody binding include electrostatic forces, hydrogen bonding, hydrophobic bonding, and van der Waals forces.

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10
Q

Which force does not influence antigen-antibody binding?

A

Covalent bonding does not influence antigen-antibody binding.

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11
Q

What is the affinity of an antibody?

A

Affinity is the strength of binding between a single antibody and epitope of an antigen.

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12
Q

What is avidity?

A

Avidity is the overall strength of reactions between several epitopes and antibodies.

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13
Q

What are the potential consequences of transfusion and pregnancy?

A

Transfusion and pregnancy have the potential to produce antigen-antibody complexes in vivo.

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14
Q

How does immunization occur in pregnancy?

A

Immunization may occur in pregnancy when fetal cells cross the placenta.

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15
Q

Which cells can autoantibodies be produced against?

A

Autoantibodies can be produced against RBCs, WBCs, and platelets.

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16
Q

How are antigen-antibody reactions detected in laboratory testing?

A

Antigen-antibody reactions in laboratory testing are detected by visible agglutination or evidence of hemolysis.

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17
Q

What is the first stage of in vitro antigen-antibody binding?

A

The first stage of in vitro antigen-antibody binding is usually not visible and does not form a visible lattice.

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18
Q

What factors can influence the first stage of in vitro antigen-antibody binding?

A

The first stage of in vitro antigen-antibody binding can be influenced by cell-to-serum ratio, temperature, incubation time, pH, and ionic strength.

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19
Q

What is the meaning of lag phase in primary immune response?

A

The lag phase in the primary immune response is the time it takes for the immune system to mount an initial response, which is typically 5 to 10 days.

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20
Q

What happens to IgM and IgG levels during a primary immune response?

A

During a primary immune response, the initial antibody isotype is IgM, which over time converts to IgG.

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21
Q

How does the concentration of IgM change in a secondary (anamnestic) immune response?

A

In a secondary (anamnestic) immune response, the concentration of IgM is lower compared to the primary response, while the concentration of IgG is increased.

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22
Q

What is the Zone of Equivalence?

A

The Zone of Equivalence is the optimum ratio of antigen and antibody, where agglutination occurs.

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23
Q

What is the Prozone?

A

The Prozone is a situation where there is an excess of antibodies, saturating all antigen sites and preventing cross linkages between cells, resulting in no visible agglutination.

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24
Q

What is the Postzone?

A

The Postzone is a situation where there is an excess of antigen, making it difficult to observe agglutination due to the presence of numerous unagglutinated antigens.

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25
Q

What are Landsteiner’s rules regarding antigen-antibody reactions?

A

According to Landsteiner’s rules, if a person’s cells have the antigen, the antibody should not be present in that person’s serum, and if an antibody to a blood group antigen is present in the serum of a person, his or her cells should lack that antigen.

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26
Q

Where are the antigens and antibodies located in the body?

A

Antigens are on the cells, while antibodies are in the serum.

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27
Q

What are the antigen combining sites in antibodies called?

A

Fab regions

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28
Q

How are antigens and antibodies held together?

A

By non-covalent forces

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29
Q

What happens when an antibody molecule binds to the surface of red blood cells (RBCs)?

A

It increases the attraction of antibodies to the RBC surface

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30
Q

What does the term ‘sensitization’ refer to?

A

It refers to cells coated with antibody

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31
Q

Does sensitization always result in agglutination?

A

No, sensitization does not necessarily lead to agglutination

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32
Q

What are the different dilutions used in lab titration?

A

Neat, 1:2, 1:4, 1:8, 1:16

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33
Q

At which dilutions in lab titration may agglutination be observed?

A

Agglutination may be seen at 1:8 and 1:16 dilutions

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34
Q

What is the second stage of the agglutination process?

A

Lattice formation and agglutination

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35
Q

What is the lattice structure formed during the second stage of agglutination?

A

A lattice is essentially many antigen-antibody bridges that form between red cells and antibodies

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36
Q

What is agglutination?

A

Agglutination is the actual linking of cells in solution

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37
Q

What are the factors to consider for optimum reactions?

A

Concentration of antigen and antibody, specificity, electrical charges and pH, temperature, incubation time, and ionic strength

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38
Q

How does the concentration of antigen and antibody affect agglutination?

A

Working within the zone of equivalence is important, and adjusting the ratio of antigen to antibody can increase sensitivity

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39
Q

What is the recommended concentration of RBC suspensions for optimal antibody binding?

A

5% RBC suspensions are recommended

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40
Q

What is the ‘fit’ in the context of antigen-antibody reactions?

A

The ‘fit’ refers to the spatial and chemical fit between antigen and antibody

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41
Q

How do electrical charges and pH affect antigen-antibody reactions?

A

Electrical charges found on antigens and antibodies, and difference in pH can affect the ‘fit’ of the reaction

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42
Q

What is the optimal pH range for antigen-antibody reactions?

A

Optimal reactions occur between pH 7.0 and pH 7.2

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43
Q

What is the temperature commonly used for testing antigen-antibody reactions?

A

Testing is carried out at 37°C to mirror what happens in the body

44
Q

Does temperature affect antigen-antibody binding or the rate of reaction?

A

Temperature affects the rate of reaction but not antigen-antibody binding. IgG reacts best at 37°C, while IgM reacts best at 4°C

45
Q

What happens when the temperature is increased above 37°C during antigen-antibody testing?

A

The dissociation rate of the reaction increases, leading to false negative results

46
Q

What is the importance of incubation time in antigen-antibody testing?

A

Incubating for 30 minutes at 37°C allows 75% of the antigen-antibody to be bound together, but incubation should not exceed one hour

47
Q

What does ionic strength measure?

A

Ionic strength measures the intensity of the electrical field resulting from ions in a solution

48
Q

What is typically used as a suspending medium for test cells?

A

NaCl (saline) is commonly used

49
Q

What is the most common anticoagulant used in blood bank labs?

A

K2EDTA (pink-stoppered)

50
Q

Why were anticoagulated specimens historically not used for testing?

A

It was believed that complement activation was required for detection of antibodies and anticoagulants have anticomplementary properties.

51
Q

What is the specimen of choice for GEL methodology?

A

EDTA

52
Q

What can occasionally be found in plasma samples and is difficult to distinguish from true agglutination?

A

Small fibrin clots

53
Q

What is the purpose of gel methodology in blood testing?

A

To trap agglutinated RBCs using dextran acrylamide gel particles

54
Q

What does the Gel method use to standardize tube methodology?

A

0.8% suspension of red cells

55
Q

How are positive reactions identified in Gel methodology?

A

Agglutinated RBCs trapped at various levels in the gel

56
Q

How are negative reactions identified in Gel methodology?

A

Non-agglutinated red cells pass through the gel, forming a button on the bottom of the reaction chamber

57
Q

What is the purpose of microplate testing in blood group serology?

A

To detect antigen-antibody reactions using 96-well plates

58
Q

How can results in microplate testing be observed?

A

By using a photometric device or by observing the RBC streaming pattern

59
Q

What does hemolysis indicate in blood testing?

A

Ag/AB reaction in vitro, excessive RBC breakdown, release of Hgb

60
Q

What is the significance of hemolysis in serologic testing?

A

It often obscures agglutination and is important for accurate interpretation of results

61
Q

What is the purpose of solid phase red cell adherence methodology?

A

To detect and identify antigen-antibody reactions using chemically modified microplates coated with RBCs

62
Q

How are RBC membranes bound to microplate walls in solid phase adherence methodology?

A

Screening cells are bound or adhered to the surface of the microplate walls

63
Q

What happens when patient or donor serum is added to the wells in solid phase adherence methodology?

A

Red cell membranes capture IgG antibodies during the incubation phase

64
Q

How are results interpreted in solid phase adherence methodology?

A

Negative: Formation of RBC button on the bottom of wells
Positive: Attachment of indicator cells to the sides and bottom of the wells, with RBCs adhered to the wells

65
Q

What are the possible outcomes of complement activation in blood banking?

A

Normal survival of RBCs, intravascular hemolysis, extravascular hemolysis

66
Q

What are the advantages of using PEG as an enhancement media?

A

PEG produces specific reactions and is less likely to produce false-positives.

67
Q

What are the advantages of using proteolytic enzymes for agglutination enhancement?

A

Proteolytic enzymes enhance agglutination of IgG antibodies.

68
Q

Which antibodies can be detected by enzyme tests?

A

Enzyme tests can detect IgG antibodies in the Rh system, clinically insignificant cold ABs, and some Kidd antibodies if IAT is tested.

69
Q

What is the one-stage method for enzyme testing?

A

In the one-stage method, serum is incubated with cells and enzyme, then read macroscopically for agglutination and hemolysis.

70
Q

What is the advantage of the two-stage method in enzyme testing?

A

The two-stage method is more sensitive than the one-stage method and can’t break the antibody apart.

71
Q

How does albumin enhance antibody detection?

A

Albumin increases the dielectric constant and decreases the zeta potential, allowing coated cells to come closer together.

72
Q

What antibodies can be detected if albumin is used?

A

Albumin can detect IgG Rh antibodies and any IgM antibody that can react at 37°C.

73
Q

What are the disadvantages of using albumin as an enhancement media?

A

Albumin is relatively insensitive for both IgG and IgM antibodies and adds cost to the test, while also enhancing some clinically insignificant cold antibodies.

74
Q

What is the main purpose of grading associated with agglutination?

A

Grading helps determine the strength of agglutination and is used in various procedures like antibody screen and crossmatch.

75
Q

When is an antibody considered agglutinating?

A

An antibody is considered agglutinating when it is capable of producing red cell agglutination in saline.

76
Q

When is an antibody considered non-agglutinating?

A

An antibody is considered non-agglutinating when its binding to red cells is not sufficient to agglutinate them in saline.

77
Q

Can serum or plasma be used for agglutination tests?

A

Yes, both serum and plasma can be used for agglutination tests.

78
Q

What are the possible consequences of activation of Hageman factor?

A

Possible consequences of activation of Hageman factor include coagulation activation.

79
Q

What can lead to the occurrence of Disseminated Intravascular Coagulation (DIC)?

A

Disseminated Intravascular Coagulation (DIC) can occur due to small clumps of agglutinated cells in the blood stream, fibrinogen consumption, activation of fibrinogen system, and fibrin destruction.

80
Q

How do leukocytes respond when exposed to various antigen-antibody complexes?

A

Leukocytes respond by secreting various cytokines, leading to fever, a drop in blood pressure, additional release of WBC’s from the bone marrow, and other activities.

81
Q

What is the most common complication of an untreated hemolytic transfusion reaction?

A

Renal failure is the most common complication of an untreated hemolytic transfusion reaction.

82
Q

What factors contribute to renal failure in an untreated hemolytic transfusion reaction?

A

Renal failure occurs due to a combination of hypotension, contraction of blood vessels in the kidneys, intravascular clots, and toxic effects of free hemoglobin.

83
Q

What are the signs of intravascular hemolysis?

A

The signs of intravascular hemolysis include a sudden drop in blood pressure due to anaphylatoxins, hemoglobinuria, hemoglobinemia, decreased haptoglobin levels, and no rise in Hct following blood transfusion.

84
Q

What may result from large amounts of complement activation in intravascular hemolysis?

A

Anaphylactic shock and death may result from large amounts of complement activation in intravascular hemolysis.

85
Q

How much should a unit of blood increase a patient’s hemoglobin by?

A

Every unit of blood should increase a patient’s hemoglobin by 10g/L.

86
Q

What should the difference in hemoglobin levels be between blood transfusions?

A

The difference in hemoglobin levels between blood transfusions should be three times.

87
Q

Why is the accessibility of antigens important for antibody-antigen reactions?

A

Antibodies must be able to reach antigens for agglutination to occur.

88
Q

Where are ABO antigens located?

A

ABO antigens are located on the surface of red blood cells.

89
Q

What is the role of centrifugation in agglutination reactions?

A

Centrifugation brings cells closer together, enhancing the antigen-antibody agglutination reaction.

90
Q

How does the size of IgM and IgG antibodies affect their ability to reach between cells?

A

IgM antibodies are larger and can reach between cells further apart, resulting in agglutination.

91
Q

What is zeta potential?

A

Zeta potential refers to the difference in electrostatic charges between the surface of red blood cells and the surrounding medium.

92
Q

How does zeta potential prevent red blood cells from sticking to each other?

A

The negative charge produced by static acid on red blood cells creates a negative charge around them, preventing sticking in peripheral blood.

93
Q

What is the role of potentiators in antibody testing?

A

Potentiators adjust the testing environment, promoting antigen-antibody agglutination by reducing zeta potential.

94
Q

Which antibodies require potentiators for enhanced detection?

A

IgG antibodies are clinically significant and require potentiators for optimal reaction and detection.

95
Q

Which enhancement solution is used to decrease zeta potential and increase agglutination?

A

PEG (Polyethylene Glycol) is used to decrease zeta potential and enhance agglutination.

96
Q

What is the purpose of low ionic strength solution (LISS) in antibody testing?

A

LISS increases antibody uptake during sensitization, resulting in a faster turnaround time.

97
Q

What is the scientific term for the division of immunology that deals with detection and measurement of specific antibodies?

A

SEROLOGY

98
Q

What is the term used to describe antibodies that can cause a decrease in red cell survival?

A

CLINICALLY ‘SIGNIFICANT’ ANTIBODIES

99
Q

Which antigens show dosage, meaning they require a double dose and homozygous pairing to exhibit their effect?

A

RH, DUFFY, M, N, C

100
Q

What is the term for the presence of an antibody other than ABO antibodies, resulting from exposure through pregnancy or transfusion?

A

UNEXPECTED ANTIBODY (ATYPICAL)

101
Q

What role does HLA typing/testing play in transplantation and transfusion?

A

MAJOR ROLE

102
Q

What is the term for when the donated tissue/organ/cells recognize the host as a threat and attack the host?

A

GRAFT vs HOST DISEASE (GVHD)

103
Q

What is the term for patients who receive multiple PLT transfusions and develop antibodies resulting in a poor response to PLT transfusion?

A

PLATELET REFRACTORIES

104
Q

Which class of MHC antigens is found on platelets, leukocytes, and most nucleated cells?

A

CLASS I

105
Q

What is the term for antigens that can induce the formation of antibodies when recognized as foreign by the immune system?

A

IMMUNOGENS

106
Q

How many known red cell antigens are there?

A

> 300

Transfusion (7 decks)

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