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Transfusion > Trans lecture 5 > Flashcards

Trans lecture 5 Flashcards

1
Q

How does the presence of a Lewis antibody affect the reactivity of the antibody?

A

The presence of a Lewis antibody eliminates the reactivity of the antibody.

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2
Q

Why is phenotyping for Lewis not done for patients with Lewis antibodies?

A

Phenotyping for Lewis is not done for patients with Lewis antibodies because the donor plasma would readily neutralize the Lewis antibodies.

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3
Q

What happens to the Lewis phenotype of transfused RBCs in a patient?

A

Transfused RBCs acquire the Lewis phenotype of the recipient within a few days.

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4
Q

What is the most commonly encountered antibody of the Lewis system?

A

The most commonly encountered antibody of the Lewis system is anti-Lea.

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5
Q

In which individuals is anti-Lea produced?

A

Anti-Lea is produced in approximately 20% of individuals with Le (a-b-) phenotype.

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6
Q

In what form may potent anti-Lea sera be?

A

Potent anti-Lea sera may be a mixture of IgM and IgG, with IgG Lewis antibodies potentially formed post massive transfusions.

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7
Q

What is the nature of anti-Leb?

A

Anti-Leb is IgM in nature and does not react as strong as anti-Lea.

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8
Q

Which individuals typically produce anti-Leb?

A

Anti-Leb is usually produced by individuals with Le (a-b-) phenotype, occasionally by Le (a+b-) individuals.

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9
Q

What are the sub-groups of anti-Leb?

A

Anti-Leb can be classified into LebH and LebL sub-groups.

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10
Q

Which cells does anti-LebH react best with?

A

Anti-LebH reacts best with Le(b+) cells that are either Group O or A2.

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11
Q

Which cells does anti-LebL react equally well with?

A

Anti-LebL reacts equally well with Le(b+) cells of any ABO type.

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12
Q

Which individuals does anti-Le react with?

A

Anti-Le reacts with non-secretors who lack the Le gene (Le(a-b-)).

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13
Q

Which individuals does anti-Led react with?

A

Anti-Led reacts with Lewis negative secretors (Le(a-b-)).

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14
Q

What does the Lex antigen presence indicate on RBCs?

A

The Lex antigen is present on all RBC’s expressing either the Lea or Leb antigen.

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15
Q

What is one of the challenges in identifying the Lewis system?

A

One of the challenges in identifying the Lewis system is that reactions have a wide temperature range.

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16
Q

How is agglutination often observed in the Lewis system?

A

Agglutination is often observed at immediate spin, 37 °C, and AHG phase, and is often fragile and easily dispersed.

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17
Q

What can enhance the reactivity of Leb antibodies?

A

Enzymes can enhance the reactivity of Leb antibodies.

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18
Q

When can hemolysis be seen in the Lewis system?

A

Hemolysis can sometimes be seen in vitro, especially if fresh serum is used because anti-Lea efficiently binds complement.

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19
Q

How many antigens are found within the MNS blood group system?

A

There are 49 antigens found within the MNS blood group system.

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20
Q

Which antigens in the MNS system are closely linked to S and s antigens?

A

The M and N antigens in the MNS system are closely linked to S and s antigens.

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21
Q

On which glycoprotein are the antigens in the MNS system located?

A

The antigens in the MNS system are located on the glycoprotein known as glycophorin A (GPA).

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22
Q

How are the antigens in the MNS system destroyed?

A

The antigens in the MNS system are easily destroyed by common blood bank enzymes and by ZZAP used in autodsorptions.

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23
Q

What is the effect of homozygous M or N inheritance on antigen expression?

A

Inheritance of homozygous M or N enhances the strength of antigen expression (dosage effect).

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24
Q

Where are the M antigens located on the glycoprotein?

A

The M antigens are located on the outer portion of the glycoprotein closer to the red cell membrane.

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25
Q

What is the U antigen in the MNS system?

A

The U antigen is an antigen found within the MNS system.

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26
Q

How can the U antigen be destroyed?

A

The U antigen can be destroyed by enzymes and by ZZAP used in autodsorptions.

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27
Q

What is the temperature at which reactivity is rare but can cause in vivo RBC destruction?

A

37 °C

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28
Q

What are the potential reactions associated with anti-P1 antibodies?

A

Immediate and/or delayed hemolytic transfusion reactions

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29
Q

How can reactivity of anti-P1 antibodies be enhanced?

A

By incubation at room temperature or pre-treatment of RBC’s with enzymes

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30
Q

When may the reaction caused by anti-P1 antibodies only be seen?

A

When fresh cells are used and there is deterioration on storage

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31
Q

Does anti-P1 antibody decrease red cell survival?

A

Rarely

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32
Q

What should be done if P1 antibody is suspected?

A

Enhance the reaction by performing testing at room temperature or colder and treating cells with enzymes

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33
Q

Is it necessary to phenotype if the units test compatible at 37ºC by IAT?

A

No

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34
Q

What is a rare example of anti-P1 antibody?

A

An antibody that can react at 37ºC

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35
Q

Is anti-P1 implicated in Hemolytic Disease of the Fetus and Newborn (HDFN)?

A

No

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36
Q

What is the autoantibody associated with Paroxysmal Cold Hemoglobinuria (PCH)?

A

Autoanti-P

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37
Q

What happens to RBCs when temperature reaches 37 °C in patients with autoanti-P?

A

They hemolyze

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38
Q

What type of antibody is autoanti-P?

A

IgG

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39
Q

What is the autoantibody known as in the CSMLS P Blood Group System?

A

Donath-Landsteiner antibody

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40
Q

What viral infection is associated with the development of autoanti-P in children?

A

Unknown, but it can occur following viral infections

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41
Q

What stage of tertiary syphilis is associated with the development of autoanti-P in adults?

A

3rd stage, very advanced involving brain, spinal cord, heart, and liver

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42
Q

Do autoanti-P typically show a reaction in routine in vitro testing?

A

No, the reaction is very weak or there is no reaction at all

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43
Q

What test is required to confirm autoanti-P?

A

Donath-Landsteiner test

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44
Q

What results indicate a positive Donath-Landsteiner test?

A

Positive test indicates the autoantibody has anti-P specificity

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45
Q

How is the Direct Method of the Donath-Landsteiner Test performed?

A

Warm 2 tubes to 37 °C, add blood, one tube placed at 4 °C, transfer to 37 °C after 30 minutes, examine for hemolysis

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46
Q

How is the Indirect Method of the Donath-Landsteiner Test performed?

A

Separate serum from clot, add serum to tubes with cells, incubate at 0 °C, transfer to 37 °C, examine for hemolysis

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47
Q

What does a positive Donath-Landsteiner test indicate?

A

Hemolysis in tubes #1 and #2, or only in tube #2 if the patient is complement deficient

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48
Q

What happens after the patient’s serum and red blood cells are incubated in the Donath-Landsteiner test?

A

Complement binds only at lower temperatures and causes hemolysis at 37° C

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49
Q

Which is the most common antibody in the P system?

A

Alloanti-P

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50
Q

In whom is anti-P a naturally occurring antibody?

A

In serum/plasma of all Pk individuals

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51
Q

Is anti-P a potent hemolysin?

A

Yes

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52
Q

What is the frequency of Kpb antigen in the Caucasian population?

A

99.9%

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53
Q

What percentage of Caucasians express the Kpa antigen?

A

2%

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54
Q

In which population is Jsa antigen found and what is its frequency?

A

Black population, 20%

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55
Q

What is the frequency of Jsa antigen in the Caucasian population?

A

0.01%

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56
Q

What is the phenotype of individuals with two Ko genes homozygous (Ko Ko)?

A

Null phenotype

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57
Q

Which antigens are considered low frequency?

A

K, Kpa, and Jsa

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58
Q

Which antigens are considered high frequency?

A

k, Kpb, and Jsb

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59
Q

What is the rare Kell phenotype called, and what antigens are not expressed in it?

A

K null (Ko or K5), K, k, Kpa, Kpb, Jsa, Jsb

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60
Q

What is the antigen found in individuals with K null phenotype but not in individuals with K phenotype?

A

Kx antigen

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61
Q

What type of antibodies are produced in response to exposure to Kell antigens?

A

IgG antibodies

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62
Q

At which temperature do Kell antibodies optimally react?

A

37℃

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63
Q

Do Kell antibodies usually bind complement?

A

No

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64
Q

What conditions have Kell antibodies been associated with?

A

Severe HTR and severe HDN

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65
Q

What is the most common antibody seen, other than considering ABO and Rh?

A

Anti-K antibody

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66
Q

What antigen is strongly immunogenic and ranks second in terms of eliciting an immune response after the D antigen?

A

K antigen

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67
Q

What percentage of patients negative for K antigen will develop anti-K if transfused with K positive blood?

A

1 in 10

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68
Q

What is the role of anti-K in stillbirths?

A

Implicated in stillbirths

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69
Q

How is anti-K recognized in cases of HDFN?

A

By anemia in fetus due to erythropoietin suppression and erythroid precursor cell destruction

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70
Q

What should be done if a pregnant woman presents with an anti-K antibody?

A

Father should be tested for Kell status and fetus should be monitored for signs of HDFN

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71
Q

What are the characteristics of antibodies showing reactivity with some enhancement solutions?

A

May show decreased reactivity with some enhancement solutions like LISS and may show increased reactivity if PEG is used

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72
Q

Which phase of the antiglobulin test (DAT) do Kell antibodies typically react in?

A

AHG (anti-human globulin) phase

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73
Q

Do Kell antibodies show dosage?

A

No, both homozygous and heterozygous individuals react the same

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74
Q

Which antibodies are not considered in dosage testing?

A

Anti-K antibodies

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75
Q

What antigen is found on all cells except rare McLeod phenotype?

A

Kx antigen

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76
Q

What is the relationship between the XK1 gene and the Kell system?

A

The XK1 gene carries the Kx antigen and its absence leads to reduced expression of Kell blood group antigens

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77
Q

What are the red cell abnormalities seen in individuals with the McLeod phenotype?

A

Anisocytosis, acanthocytosis, reticulocytosis, immature RBC’s with increased RNA content

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78
Q

What are some of the symptoms associated with McLeod syndrome?

A

Muscular and neuralgic defects, splenomegaly, decreased haptoglobin levels

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79
Q

What disorder is associated with McLeod syndrome?

A

Chronic granulomatous disease (CGD)

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80
Q

What is the gender and inheritance pattern for McLeod syndrome?

A

Males, X-linked inheritance

81
Q

What is the major defect in chronic granulomatous disease (CGD)?

A

Phagocytes are unable to kill certain microorganisms due to their inability to generate super-oxides

82
Q

What are some of the recurring symptoms of CGD?

A

Pneumonia, swollen lymph nodes, abscesses

83
Q

At what age do Lutheran antigens reach adult levels?

A

At the age of 15

84
Q

On which cells have Lutheran antigens not been detected?

A

Platelets, lymphocytes, and granulocytes

85
Q

What is the immunoglobulin class of Anti-Lua antibodies?

A

IgM and IgG

86
Q

At which temperatures do Anti-Lua antibodies show optimal reaction?

A

22 °C and 4 °C

87
Q

What is the reactive phase for Anti-Lua antibodies?

A

Room temperature and AHG

88
Q

What type of reactions are typically seen with Anti-Lua antibodies?

A

Characteristic mixed field agglutination

89
Q

What is the immunoglobulin class of most Anti-Lu antibodies?

A

IgG

90
Q

How are most Anti-Lu antibodies produced?

A

Through pregnancy or transfusion exposure

91
Q

At which temperature do most reactions with Anti-Lu antibodies occur?

A

37 °C

92
Q

What are the potential implications of Anti-Lu antibodies?

A

Transfusion reactions and mild cases of HDN

93
Q

Which three blood group antigens define the overall P phenotype?

A

P1, P, and Pk

94
Q

Which antigen in the P system is designated as P1?

A

P1 antigen

95
Q

Which antigen is part of the globoside system?

A

P antigen

96
Q

What is the antigen found on platelets, epithelial cells, and fibroblasts?

A

P antigen

97
Q

Where are P, P1, and Pk antigens found?

A

On RBCs, lymphocytes, granulocytes, and monocytes

98
Q

Which commercially available antisera can neutralize the anti-P1 antibody?

A

Antisera made from hydatid cyst fluid

99
Q

Which populations have a higher expression of P1 antigen?

A

African Americans

100
Q

Why should the expiry date of control cells be checked when testing P phenotype?

A

P1 antigen deteriorates rapidly

101
Q

What can cause false negative reactions when testing P phenotype?

A

Use of older cells and variable amounts of different red cells

102
Q

What substances can be used to neutralize anti-P antibody in a patient’s serum?

A

Bird droppings, pigeon eggs, and hydatid cyst fluid

103
Q

What is the most common phenotype of people with P antigen?

A

P1

104
Q

What is the phenotype of individuals with the absence of P1 antigen?

A

P2

105
Q

Which individuals consistently have an alloanti-P antibody?

A

People who are Pk phenotype

106
Q

What is the rarity of absence of the P antigen?

A

Very rare and designated as p

107
Q

When do P antigens usually reach full expression?

A

Up to 7 years after birth

108
Q

What is the clinical significance of IgM antibodies?

A

IgM antibodies are clinically insignificant but can react at 37 °C.

109
Q

How can you test for the clinical significance of IgM antibodies at 37 °C?

A

You can test for the clinical significance of IgM antibodies by pre-warming.

110
Q

Are most anti-M antibodies naturally occurring?

A

Yes, most anti-M antibodies are naturally occurring.

111
Q

Are IgM antibodies implicated in Hemolytic Disease of the Newborn (HDFN) or Hemolytic Transfusion Reactions (HTR)?

A

Rarely, IgM antibodies are implicated in HDFN or HTR.

112
Q

What does it mean for an antibody to show dosage?

A

An antibody showing dosage means that the reaction is stronger with increased antigen sites.

113
Q

How can the reactivity of anti-M antibodies be enhanced?

A

The reactivity of anti-M antibodies can be enhanced by reacting them weekly, increasing the cell-to-serum ratio, decreasing the incubation temperature, or using a potentiator/enhancement solution.

114
Q

At what pH do some anti-M antibodies react best?

A

Some anti-M antibodies react best at pH 6.5.

115
Q

How can you provide crossmatch compatible blood for a patient with IgG anti-M antibodies?

A

If the patient has IgG anti-M antibodies, you may be able to use the prewarm technique or phenotype units to provide crossmatch compatible blood.

116
Q

What is the clinical significance of anti-N antibodies?

A

Anti-N antibodies are considered clinically insignificant but are only clinically significant if they react at 37 °C.

117
Q

Are anti-N antibodies naturally occurring?

A

Yes, virtually all examples of anti-N are naturally occurring cold-reacting antibodies.

118
Q

How are anti-N antibodies destroyed?

A

Anti-N antibodies are destroyed by enzymes.

119
Q

In which cases have anti-N antibodies been identified in Hemolytic Disease of the Newborn (HDFN)?

A

Anti-N antibodies have been identified in rare situations of HDFN.

120
Q

In which patients are anti-N antibodies most often seen?

A

Anti-N antibodies are most often seen in kidney dialysis patients as a cross-reacting antibody to formaldehyde.

121
Q

What is the probability of finding U negative blood in the Black population?

A

The probability of finding U negative blood in the Black population is less than 1%.

122
Q

Is the U antigen found in Caucasian donors?

A

No, the U antigen is not found in Caucasian donors.

123
Q

When should anti-U antibodies be suspected?

A

Anti-U antibodies should be suspected in cases of a previously transfused or pregnant Black individual with an antibody to a high incidence antigen that reacts with S+ and s+ cells.

124
Q

What is the frequency of the Kell system in the Caucasian population?

A

The frequency of the Kell system in the Caucasian population is about 9%.

125
Q

What is the antithetical (related) antigen to K in the Kell system?

A

The antithetical antigen to K in the Kell system is k or k2 (Cellano).

126
Q

Where is agglutination best observed for cold-reacting antibodies?

A

At room temperature (RT) or colder.

127
Q

Where is agglutination best observed for warm-reacting antibodies?

A

At 37°C.

128
Q

What is a blood group system?

A

A group of related antigens that reside on the RBC membrane.

129
Q

How many blood group systems and associated antigens are there currently?

A

There are currently 36 blood group systems and 346 associated antigens.

130
Q

How are most blood groups inherited?

A

Most blood groups are inherited as codominant alleles.

131
Q

What is the definition of null phenotype?

A

Null phenotype occurs when the same paired chromosome possesses a silent allele.

132
Q

How are phenotypes recorded?

A

Phenotypes are recorded using + and/or - symbols to designate presence or absence of antigens.

133
Q

How are antibodies detected and identified?

A

Antibodies detected are identified by using ISB terminology with a system of 6 numbers.

134
Q

What is distinct about the Lewis blood group system?

A

It is the only blood group system not manufactured by RBCs but by tissues.

135
Q

Are Lea and Leb alleles?

A

Lea and Leb are not alleles.

136
Q

What are the major antigens belonging to the Lewis system?

A

The major antigens are Lec, Led, and Lex (LE3).

137
Q

What are the three sets of independently inherited genes determining the inheritance of Lewis system?

A

The Lewis genes, secretor genes, and Hh genes.

138
Q

Where are the Lewis and secretor genes located?

A

The Lewis and secretor genes are located on chromosome 19.

139
Q

What do the Lewis and secretor systems secrete?

A

They secrete soluble Lewis and ABH substance in saliva and plasma.

140
Q

What does the secretor gene encode?

A

The secretor gene encodes the H transferase available in secretions.

141
Q

What happens if a Le gene is inherited?

A

Lea antigens will be found in secretions and are adsorbed onto the RBCs regardless of secretor status.

142
Q

What happens if the Se gene is inherited with the Le gene?

A

The Lewis transferase converts available H structure to Leb antigen and the RBCs adsorb Leb instead of Lea.

143
Q

What happens if le/le is inherited?

A

No Lewis antigen structure is present on RBCs, but if Se is present with le/le, A, B, and H are still present in secretions.

144
Q

What does a person with se/se genotype and one Le gene have?

A

They will have the Lewis antigen structure adsorbed onto RBCs and A, B, H in their secretions.

145
Q

Which genes must be inherited to convert Lea to Leb?

A

Le, Se, H

146
Q

What happens if the Le gene is present?

A

The precursor substance is converted to Lea

147
Q

What is the role of the Se gene in Lewis antigen conversion?

A

It converts Lea to Leb

148
Q

What antigens are produced in individuals with le/le genotype?

A

No Lewis antigens are produced

149
Q

Which Lewis antigen is preferentially adsorbed over Lea?

A

Leb

150
Q

Which sugar is fucose added onto to form Lea?

A

The second sugar from the end

151
Q

Which sugar is fucose added onto to form Leb antigen in secretors?

A

The terminal sugar of the precursor substance

152
Q

Are Lewis antigens poorly developed at birth?

A

Yes

153
Q

What is the phenotype of individuals typing as Le(a+b-)?

A

ABH non-secretors

154
Q

What is the phenotype of individuals typing as Le(a- b+)?

A

ABH secretors

155
Q

Can the Lewis system cause Hemolytic Disease of the Newborn (HDN)?

A

No, because the antigens are poorly developed at birth

156
Q

Which individuals may produce transient Lewis antibodies during pregnancy?

A

Le(a-b-) pregnant women

157
Q

Are Lewis antibodies usually clinically significant?

A

No, they are clinically insignificant unless they react at 37°C

158
Q

What is the clinical significance of Lewis antibodies in HDFN?

A

They are not implicated in HDFN

159
Q

What can neutralize Lewis antibodies in vitro?

A

Addition of Lewis substance

160
Q

What is the purpose of auto adsorption?

A

To remove the cold autoantibody from the serum.

161
Q

What should be done prior to cross-matching?

A

Donor cells and patient serum should be warmed.

162
Q

What should be omitted when cross-matching?

A

Potentiators like LISS.

163
Q

What type of anti-I antibodies are there?

A

Anti-I, Anti-IH, and Anti-H antibodies.

164
Q

Which cells do Anti-IH antibodies react most strongly with?

A

Group O adult cells.

165
Q

What problems can Anti-IH antibodies cause?

A

Problems with ABO grouping and crossmatch results.

166
Q

Is alloanti-i commonly seen?

A

No, alloanti-i has never been described.

167
Q

What is the significance of auto-anti-i?

A

Auto-anti-i is rare.

168
Q

What type of cells does anti-i strongly react with?

A

Cord cells and adult i cells.

169
Q

What is the serologic characteristic of HTLA antibodies?

A

HTLA antibodies are weak and have low avidity.

170
Q

What do HTLA antibodies react optimally with?

A

Most cells, especially antibodies to high frequency antigens.

171
Q

Can HTLA antibodies cause HDN or hemolytic transfusion reaction?

A

No, they are not clinically significant.

172
Q

What can HTLA antibodies mask?

A

Clinically significant antibodies present in the serum/plasma.

173
Q

What is CSMLS?

A

CSMLS stands for Canadian Society for Medical Laboratory Science.

174
Q

What antibody is produced by individuals homozygous for the ‘p’ gene?

A

Anti-PP Pk1

175
Q

Which antibody was initially referred to as anti-Tja?

A

P Antibody

176
Q

What is the clinical significance of the P Antibody?

A

Causes hemolysis in vitro

177
Q

Which antibody is associated with cold paroxysmal hemoglobinuria?

A

Autoanti-P

178
Q

What is the optimal temperature for the I antigen?

A

4 °C

179
Q

What is the age dependency of the I antigen expression?

A

‘I’ on adults and ‘i’ on children

180
Q

What is the phenotype of individuals lacking the I antigen?

A

I i

181
Q

What antibody is most commonly encountered as an autoantibody?

A

Anti-I

182
Q

What is the association of strong autoanti-I with?

A

Mycoplasma pneumoniae infections and cold hemagglutinin disease

183
Q

What disease is associated with anti-i antibody?

A

Infectious mononucleosis and lymphoproliferative disease

184
Q

What can high titers of auto-anti-I interfere with?

A

Serological testing

185
Q

What is the abbreviation for the Duffy Blood Group System?

A

Fy

186
Q

At what temperature do Duffy antigens optimally react?

A

37 °C

187
Q

Which enzyme treatment destroys Duffy antigens?

A

Papain, ficin, trypsin, bromelin

188
Q

Do Duffy antibodies bind complement?

A

No

189
Q

Which Duffy antigen occurs in 80% of the Caucasian population?

A

Fyb

190
Q

Are Duffy antibodies stimulated by transfusion or pregnancy?

A

Yes

191
Q

How many antigens are there in the Kidd blood group system?

A

3

192
Q

What is the antibody class for the Kidd system?

A

IgG

193
Q

What is the optimally reactive temperature for Kidd antibodies?

A

37 °C

194
Q

Which Kidd phenotype may produce anti-Jk3 antibodies?

A

JK (a-b-)

195
Q

Is the Lutheran blood group system linked to the SE locus?

A

Yes

196
Q

What are the two antithetical partners in the Lutheran blood group system?

A

Lua and Lub

197
Q

How many antigens are there in the Lutheran blood group system?

A

20

198
Q

Are Lutheran antigens high incidence or low incidence?

A

Both

199
Q

Which other blood group systems are located on the same chromosome as the Lutheran system?

A

H, Le, and LW

Transfusion (7 decks)

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