Transfusion Medicine

Question 1

What is the difference between forward typing and reverse typing?

Answer 1

Forward = mixing the patients red blood cells with a serum containing anti-A, anti-B and anti- AB and seeing which one they agglutinate with. If they don’t agglutinate with any, that means they are O, if they agglutinate with all, that means they are AB.

Reverse typing = the patients sera is exposed to commercially available A cells and B cells to see which one the serum antibodies react with. If theres no agglutination with A cells, that means they don’t have A antibodies so they have A antigen on their RBC. Same for B. no agglutination would mean AB blood.

Question 2

Which blood type has only H Ag?

Answer 2

Type O blood

Question 3

What blood type has H + A Ag?

Answer 3

A blood

Question 4

Which blood type has H + B Ag?

Answer 4

B blood

Question 5

which blood type has H + A + B?

Answer 5

AB Blood type

Question 6

What is a secretor? (Se)

Answer 6

Someone who is capable of making ABO antigens in their secretions and plasma

Question 7

What is the Bombay phenotype?

Answer 7

Blood cells with the absence of H antigen (hh)

Question 8

Who can Bombay phenotype people receive blood from?

Answer 8

Bombay blood (because their blood has anti H antibodies)

Question 9

Are Rh anti-bodies naturally occurring?

Answer 9

Nope - exposure to the antigen is needed to make anti bodies

Question 10

What are the antigens in Rhesus system?

Answer 10

D, Cc, Ee

Question 11

What does Kell Kill’s mean?

Answer 11

Anti-K is the next most common immune red cell antibody. It can cause hemolytic disease of the newborn and hemolytic transfusion reaction.

Question 12

What immunoglobulin does anti-Kell present as?

Answer 12

IgG

Question 13

What is seen on the peripheral blood smear of McLeod phenotype?

Answer 13

Acanthocytes and hemolytic anemia

Question 14

Chronic granulomatous disease is caused by a deficiency in which enzyme?

Answer 14

NADH oxidase -> no H202 to destroy microbes

Question 15

What are the antigens present in the Kidd system?

Answer 15

Jka and Jkb

Question 16

What does treacherous Kidds mean?

Answer 16

Delayed hemolytic transfusion reaction

Because antibodies disappear rapidly so are often not seen on initial AB screen and cross match.

Question 17

What are the antigens in the Duffy system?

Answer 17

Fya and Fyb

Question 18

Why are African Americans resistant to plasmodium vivax?

Answer 18

They have the Fyab- phenotype which confers resistance to that plasmodium

Question 19

Which immunoglobulin will anti Fy antibodies present as? Which reactions can it cause? (Duffy dies)

Answer 19

IgG; HDN and hemolytic transfusion reactions

Question 20

Which immunoglobulin does anti-M antibody present as?

Answer 20

IgM

Question 21

What does Lewis Lives mean?

Answer 21

Lewis antibodies are clinically insignificant because transfused red cells shed their Lewis antigens and acquire the Lewis phenotype of the recipient

Also, the antibodies are absorbed by free serum Lewis antigens onto the RBC membrane

Question 22

When should the specimen from collection be labeled?

Answer 22

At the bedside!!! With time, date and initials of the phlebotomist

Question 23

What is the difference between type and screen (T&S) and crossmatching?

Answer 23

Type and screen only detects ABO, Rh, and Ab screen

Cross match is actual testing of patients serum compatibility with donor cells

Question 24

What does the antibody screen aka indirect antiglobulin test aka indirect Coombs test detect?

Answer 24

Antibodies in the patients serum against antigens on commercially available RBCs

Question 25

What does the direct Coombs test detect?

Answer 25

Autoimmune hemolytic anemia and transfusion reaction work up

Question 26

What does the indirect Coombs test used for?

Answer 26

Used prior to the blood transfusion and in prenatal testing of pregnant women

Question 27

What antibodies do you detect at room temperature?

Answer 27

Cold antibodies: IgM

Question 28

What antibodies do you detect at 37C?

Answer 28

Warm antibodies: IgM-IgG; IgG Rh, Kell, Kidd and Duffy

Question 29

What antibodies do you detect with anti human antibodies?

Answer 29

Warm antibodies; IgG that coats the RBC membrane

Question 30

What is the most common auto antibody?

Answer 30

Benign cold agglutinin

Question 31

What immunoglobulin do cold agglutination auto antibodies present as?

Answer 31

IgM

Question 32

What immunoglobulin do warm agglutination auto antibodies present as?

Answer 32

IgG

Question 33

What infection is cold agglutination disease associated with?

Answer 33

Mycoplasma pneumoniae

Question 34

What is a cross match?

Answer 34

Mixing the recipient serum with donor RBC to detect agglutination

Question 35

What is the first thing you do if the patient is reacting poorly to a transfusion?

Answer 35

Stop the transfusion!!!!

Question 36

Acute and delayed hemolytic transfusion reactions are due to what?

Answer 36

RBC incompatibility

Question 37

Febrile non hemolytic transfusion reactions are due to what?

Answer 37

Antibodies to donor leukocyte antigens (HLA)

Question 38

TRALI transfusion reactions are due to what?

Answer 38

Antibodies from donor plasma to recipient WBC

Question 39

Transfusion related GVHD is caused by what?

Answer 39

Infusion of immunocompetent donor lymph’s to immunocompromised recipient

Question 40

What are the symptoms of acute hemolytic transfusion reaction? (5)

Answer 40

``` Hypotension Hemoglobinuria DIC Flank pain Infusion site pain ```

Question 41

What are the symptoms of delayed hemolytic transfusion reaction?

Answer 41

Unexplained rise in unconjugated Hgb | Drop in H/H

Question 42

What are the symptoms of febrile non hemolytic transfusion reaction?

Answer 42

Fever chills hypertension

Question 43

What are the symptoms of allergic transfusion reactions?

Answer 43

Urticaria

Question 44

What are the symptoms of TRALI?

Answer 44

Non cardiogenic pulmonary edema | ARDS

Question 45

What are the symptoms of septic transfusion reaction?

Answer 45

``` Fever Chills Rigors Shock Caused by platelets ```

Question 46

What is the pathogenesis of acute hemolytic transfusion reaction?

Answer 46

Pre existing natural IgM antibodies induce complement mediate intra vascular hemolysis

Question 47

What is the single most common cause of acute hemolytic transfusion reaction?

Answer 47

Proper ID of patient

Question 48

Is delayed hemolytic transfusion reaction intra or extra vascular hemolysis?

Answer 48

Extra vascular

Question 49

What Ig does delayed hemolytic transfusion reaction antibodies present as?

Answer 49

IgG

Question 50

What is the treatment for delayed hemolytic TR?

Answer 50

IVIG

Question 51

What is the definition of febrile non hemolytic reaction?

Answer 51

A rise in temperature of 1C or greater; fever, chills

Question 52

What is the treatment of febrile TR?

Answer 52

Antipyretic (acetaminophen); NO ASA!!!

Question 53

How do you prevent febrile TR?

Answer 53

Pre medicate with antipyretic

Question 54

Sx of pruritis, urticaria, erythema and cutaneous flushing would cue you into which TR?

Answer 54

Allergic (urticaria)

Question 55

How do you prevent allergic TR?

Answer 55

Antihistamines

Question 56

What is the treatment for anaphylactic TR?

Answer 56

Intubate, epinephrine, diphenhydramine with cutaneous sx, aminophylline with bronchospasm

Question 57

How do you transfuse with patients with IgA deficiency?

Answer 57

Give IgA deficient products

Question 58

What is the onset of TRALI?

Answer 58

Hours of transfusion

Question 59

What is the pathogen of TRALI?

Answer 59

Donor antibodies bind with MHC class 1 antigens on neutrophils (in lungs)

Question 60

What is the manifestation of TRALI?

Answer 60

Non cardiogenic pulmonary edema

Question 61

When does TRALI resolve?

Answer 61

48-96 hours from onset

Question 62

What is the treatment of TRALI?

Answer 62

Antipyretic and fluids

Question 63

Which organisms grow at low temperature and high iron environments?

Answer 63

Yersinia and pseudomonas

Question 64

Which organisms grow in platelets? (Room temperature)

Answer 64

Staph, strep, salmonella, E. coli, serratia

Question 65

What transfusion product do you use for symptomatic anemia?

Answer 65

Packed red blood cells

Question 66

When is packed red blood cells contraindicated?

Answer 66

Volume expansion Coagulation deficiency Drug treatable anemia

Question 67

When is platelet transfusion contraindicated?

Answer 67

Plasma coagulation deficiency | Clinical conditions of rapid platelet destruction (ITP/TTP)

Question 68

What does irradiation do to platelets/RBC?

Answer 68

Inactivated donor lymphocytes and decreases the risk of GVHD

Question 69

What is FFP used for?

Answer 69

Coagulation deficiencies

Question 70

What is a cryoprecipitate transfusion?

Answer 70

Fibrinogen, factor VIII or vWB factor replacement

Question 71

What is cryoprecipitate used for?

Answer 71

Hemophilia A VWD DIC Factor XIII

Question 72

What does the Kleihauer Betke test measure?

Answer 72

Fetal Hgb in mothers circulation

Question 73

What is the only fluid that can be transfused with blood?

Answer 73

Normal saline