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Blood Bank > Unit 4 > Flashcards

Unit 4 Flashcards

1
Q

What abs are good at activating complement

A

IgM

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2
Q

What abs are capable of causing intravascular hemolysis

A

ABO

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3
Q

What process causes intravascular hemolysis?
and extravascular?

A

intra- C3b- activated MAC- C8 and C9 pierce RBCs

Extra- C’ attaches- Fc receptors on spleen and liver destroy the opsonized cells

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4
Q

Acute transfusion reaction are associated with what hemolysis? what type of incompatibility?
What is the most often reason it occurs?

A

intravascular
ABO incompatibility
clerical error or negligence

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5
Q

What are the main reasons acute hemolytic transfusion rxns occur

A

-blood too fast
-bacterial contamination

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6
Q

How many ml of blood does it take to cause a reaction

A

10-15ml

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7
Q

How long should a patient be monitored after transfusion

A

15-30 min

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8
Q

What are the major complications caused by an acute hemolytic transfusion rxn

A

DIC, shock, renal failure, death

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9
Q

Explain the cascade effect when intravascular hemolysis occurs

A

Hb is free in circulation
haptoglobin cleans it
haptoglobin levels go down because it is being used up
if still in blood haptoglobin-> billirubin -> urobilinogen

LDH increases, body is compensating for less O2 distribution by using alternative metabolism

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10
Q

When a transfusion rxn occurs, when would we expect to see a positive DAT and why

A

if the rxn is immune based
DAT- in vivo sensitization due to abs opsonizing with antigens on RBCs
original test would be neg
after transfusion +

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11
Q

What type of transfusion rxn is this

DAT +
Hemoglobin - decrease
LDH- decrease
bilirubin- increase
haptoglobin- decrease

A

Acute hemolytic transfusion rxn

immune based
intravascular hemolysis is occuring

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12
Q

What should you do if a patient has a transfusion Rxn

A

stop transfusion
treat shock
document rxn
check for clerical error- name, unit, match
investigate rxn

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13
Q

What is the best way to prevent a transfusion rxn

A

patient identification

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14
Q

What type of transfusion rxn is most common in pregnancy
how long does it take to occur after transfusion

A

FNH febrile non hemolytic rxns

1-2 hrs

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15
Q

Caused by HLA abs in pt plasma against antigens on transfused WBCs and or platelets

A

FNH

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16
Q

Pt has fever, chills, tachycardia, increased bp 1 hr after transfusion

DAT neg

A

FNH
rxn is with abs in pt plasma against leukocytes in donor

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17
Q

Best way to prevent FNH

A

leukoreduction
CMV safe

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18
Q

Pt has erythema, redness, hives, itching 15 min after transfusion

DAT neg
no hemolysis

A

Allergic rxn

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19
Q

How long for an allergic rxn to occur after transfusion

A

15-20min

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20
Q

Best way to treat transfusion allergic rxn?

A

antihistamine
usually can continue transfusion

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21
Q

What type of blood products are most likely to become contaminated by bacteria

A

platelets
because they are stored in room temp

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22
Q

What are the 3 infection routes for Transfusion associated sepsis

A

TAS-
phleb
component prep
infection in donor

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23
Q

What 3 organism are capable of causing TAS

A

pseudomonas, yersinia, serratia

cold gram neg

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24
Q

pt has warm shock (not cold and clammy) high fever, DIC, renal failure, dry skin

DAT neg
hemoglobinuria

A

Bacterial contamination of blood

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25
Q

If blood looks purpleish and clotted in its bag, cloudy, line of hemolysis

A

It indicates bacterial contamination

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26
Q

What pts are more likely to get anaphylactic rxns to transfusions

A

IgA deficient patients who develp an anti IgA through pregnancy or transfusion

can also be caused by drugs like penicillin
blood must be washed

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27
Q

Pt is wheezing, coughing, has no fever, respiratory distress, shock

DAT neg
IgA deficient

A

anaphylactic rxn

IgA deficient pt must have blood washed before transfusion

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28
Q

If a pt is IgA deficient, what must be done to transfuse plasma? and RBCs

A

plasma- need rare donor that is also IgA deficient

RBCs- need to wash

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29
Q

Explain what TACO is

A

hypervolemia due to too much volume of blood or speed of transusion

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30
Q

What pts are more likely to develop TACO

A

elderly or pts with cardiac/ pulmonary issues

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31
Q

Pt is hypoxic, increased bp, jugular vein is bulging
coughing, headache,

BNP ratio increased
atrial hypertension on Xray

A

TACO

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32
Q

How to treat TACO

A

stop transfusion
oxygen,
sit upright

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33
Q

Explain what TRALI is

A

HLA donor abs attack patient granulocytes in lung tissue
complement activated
causes lung damage

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34
Q

Pt has hypoxemia, fever, chills, pulmonary edema 6hrs into transfusion

HLA abs present in donor and pt
Lung infiltrates on Xray

A

TRALI

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35
Q

How to treat TRALI

A

stop transfusion, give oxygen
steriods

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36
Q

How to prevent TRALI

A

no female plasma. multiparous women have HLA abs in plasma

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37
Q

Which transfusion reaction is associated with donor preformed antibodies or WBCs that attack recipient tissue specifically in the lungs?

A

TRALI

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38
Q

Why is multiparous women’s FFP discarded and not used for transfusion?

A

because they can make HLA abs and cause TRALI

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39
Q

Which Ig deficiency should be suspected if a patient has an anaphylactic response to an acellular product? What antibody of the patient is causing the response?

A

rxn to plasma,
IgA

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40
Q

What is more common, delayed or acute rxns

A

delayed
acute are usually our fault- almost never happens

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41
Q

When are transfusion rxns seen post transfusion

A

5-7 days after

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42
Q

What is occurring in a delayed hemolytic transfusion rxn DHTR

A

ab produced against antigen

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43
Q

What are the causes of a DHTR rxn

A

immunization
secondary response to RBC antigens

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44
Q

Pt feels fatigue, pallor, flu symptoms 6 days after transfusion

low Hematocrit and hemoglobin
DAT +
increased bilirubin

A

Delayed hemolytic transfusion rxn

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45
Q

What antigens are likely the culprits of DHTR

A

Deck
kidd, duffy, C, E abs

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46
Q

How to trat DHTR

A

give antigen neg red cells that are compatible at AHG

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47
Q

What follow up tests are done if DHTR is suspected?
What are the results if it is occurring

A

DAT Pos
elution pos- wash RBCs and test for abs present
ABID crossmatch- will be incompatible

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48
Q

What kind of diseases are transmitted by transfusion

A

hepatitis
CMV
Malaria
HIV

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49
Q

What is the most frequent/ serious complication for transfusion transmitted diseases

A

Hep B
Hep Cmore long term and serious

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50
Q

How is CMV transmitted and what can we do to prevent it

A

transmitted by leukocytes
leukoreduced
irradiation for those who need it

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51
Q

What strain of organism causes most malaria cases
how likely is it to be transmitted by blood products

A

P. falciparum

rare- but more likely in travelers

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52
Q

What causes syphilis, how do we prevent it from being transmitted during blood transfusion

A

Trepenoma pallodum
RPR, abb testing
if donor has it, 12 month deferment from donating

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53
Q

What causes babesia, how do we prevent it and what does it look like on RBCs

A

T cruzi
can be fatal, no screening test, maltese cross

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54
Q

Explain what is occuring during graft vs host disease

A

graft sees host as foreign and mounts an immune response

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55
Q

what causes graft vs host disease

A

donor lypmhs, or tissue

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56
Q

What type of patients are at most risk of graft vs host

A

immunocompromised
BM transplant, chemo, infants,

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57
Q

T or F you can get Graft vs host disease from blood from a blood relative

A

True
tissues and cells are so similar recipient doesnt recognize them as foreign, lymphs proliferate and grow

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58
Q

What is the mortality rate of GVHD and how soon do symptoms start

A

90% mortality
1-3 days

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59
Q

Pt has rash, fever, diarrhea, failing liver 2 days after received a transfusion from a blood relative

over time they develop sepsis and hemorrhaging
pancytopenia

A

graft vs host disease

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60
Q

How can graft vs host disease be prevented

A

irradiation with 25GY
kills proliferating lymphs

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61
Q

What is post transfusion purpura

A

anti-HPA antibody
HPA is a platelet antigen
destroys donor and patient plts

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62
Q

What type of patients are at most risk of developing post transfusion purpura

A

women with multiple pregnancies ONLY

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63
Q

pt is excessively bleeding, has large splotchy spots on skin, thrombocytopenia 1 week after transfusion

A

post transfusion purpura

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64
Q

What is occurring during iron orverload

A

too much iron creates free radicals that damage liver, heart and endocrine organs

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65
Q

What patients are at risk of getting iron overload

A

chronic transfusion patients

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66
Q

Pt has multiple organ failure and increased ferritin

A

irone overload, too many transfusions

67
Q

What should the transfusionist do after they realize a transfusion rxn of any kind has occured

A

send post transfusion samples to lab
send back blood unit
send post transfusion urine sample to check for hemoglobin uria

67
Q

What should the blood bank do after receiving specimen from a transfusion rxn

A

check clerical work
compare pre to post transfusion specimen
ABORh on post specimen
DAT on post specimen
T/S on post specimen- invalidate old one

68
Q

What is included in a transfusion rxn workup

A

ABORh
ab screen
crossmatch

69
Q

If a patient has a decrease in haptoglobin after a transfusion rxn this mean

A

intravascular hemolysis

70
Q

How much irradiation should be delivered to the unit of blood for it to be irradiated ID on the bb card

A

25 to center
15 to periphery

71
Q

If doc calls for more blood products for a pt who had a transfusion rxn, but you havent finished transfusion workup what should you do

A

tell them if they want the blood it would be considered emergency issue

must work up rxn first if possible

72
Q

How long is a blood bank sample good for

A

3 days

73
Q

What antibodies does the immune system create more upon first exposure to something? and second?

A

1s- IgM
2nd- IgG

74
Q

Antibody screening must include ___ and ___ to ensure we looked for IgG abs

A

37C incubation
coombs test

75
Q

Which is warm? cold?
IgG
IgM

A

IgG warm
IgM cold

76
Q

What is clinically significant
IgG
IgM

Why

A

IgG, decreases RBC survival rate the most

77
Q

What blood can you give an A pos pt?
First and second choice

A

Apos or neg then O pos or neg

78
Q

What blood can you give an A neg pt?
First and second choice

A

Aneg then O neg

79
Q

What blood can you give an B pos pt?
First and second choice

A

B pos or neg then O pos or neg

80
Q

What blood can you give an B neg pt?
First and second choice

A

B neg then O pos

81
Q

What blood can you give an AB pos pt?
First and second choice

A

AB pos or neg
then A pos or neg
Then B pos or neg
Then O pos or neg

82
Q

What blood can you give an AB neg pt?
First and second choice

A

AB pos or neg
then A neg
Then B or O neg

83
Q

What blood type can you give O pos pt

A

O pos or O neg

84
Q

What blood type can you give O neg pt

A

O neg only

85
Q

What is in a cross match
What does it prove

When do we need to do extended crossmatched

A

pt plasma + donor RBCs

ABO compatibility

if known ab is present or if screening cells are positive

86
Q

What will a compatible crossmatch do

A

detect error in ABO typing
detect abs in recipient serum

87
Q

What are 2 things a crossmatch will not do

A

cant garantee RBC survival
cant prevent immunization

88
Q

What are the 4 causes for an incompatible crossmatch

A

ABO grouping of donor or pt is incorrect
-allo ab in patient reacted with ag on donor
-auto ab reacted with ag on donor cells

89
Q

What does a positive DAT in donor cells mean?

A

auto ab present

90
Q

T or F We must crossmatch both RBCs and platelet products

A

F- we don’t crossmatch FFP

91
Q

What special considerations should be taken into account with emergency release transfusion

A

physcian decides, must sign
can give group specific if available
if not then give O- to F childbearing age and children
O+ to all others

remember this blood has not been crossmatched

92
Q

What must you always do with donor emergency blood before giving it to the doc

A

retain a segment

Must still crossmatch
T/S
if incompatible- must tell Doc and BB physician

93
Q

What is an MTP
what is included in it

A

massive transfusion protocol
total volume exchange 5 units of blood or more
FFP, cyro and platelets

94
Q

What does a T/S look like after a pt has an MTP

A

abnormal- mixed field for weeks

95
Q

How long should you maintain the blood after an MTP

A

7 days of pt and donor samples

96
Q

T or F the original pt sample is still good after an MTP

A

false- it is invalid and must be discarded

97
Q

What is given in an MTP

A

4 to 6 type specific or cross matched RBCs
4 plasma
1 platelet

98
Q

What are autologous units and what special considerations should be used for them

A

should do crossmatch
pt donates their own blood in prep for a surgery

99
Q

What considerations for neonate transfusions

A

forward type testing only
neonates do not produce their own abs

100
Q

Where are neonate abs from if they are present

A

from mom

101
Q

How are RBC transfusions for neonates given
what are the requirements

A

in a syringe
must be less than 7 days old
O neg or compatible with both mom and baby
CMV neg and leukoreduced and irradiated
Hb S neg

102
Q

How much blood is given in neonate transfusions

A

10mL over 2 to 3 hrs

103
Q

What requirements for returning blood to BB

A

undisturbed container
temp within 10C
blood inspected
one sealed donor segment on container
no more than 30 min outside of BB at room temp
8hrs if in cooler

104
Q

What is MSBOS

A

maximal surgical blood order schedule
blood products for surgical procedure

105
Q

When are electronic crossmatches permitted

A

if pt has had at least 3 ab screens
no abs present ever

106
Q

What are autoantibodies

A

abs that react with antigens on the same persons red cells

107
Q

What antigen groups are cold

A

LIPMAN

108
Q

What is the purpose of ab screens

A

to find clinically significant antibodies
IgG or warm abs

109
Q

What are the reagent cells used in ab screen

A

O cells
in sets of 2 or 3 with unique antigram
antigen typed for major antigens

110
Q

What are the 3 phases of an IAT
What ingredients

A

pt plasma + reagent cells
Immediate spin Ab test
read at 3 stages
IS-IgM- room temp cold ab
37C- IgG warm abs
AHG ad CC- IgG

111
Q

when do we need to do an antibody panel

A

If screen cells are pos
CC are pos
confirms there is an ab present and it needs to be IDed

112
Q

When are IAT ab screens necessary

A

pts with a history of abs or currently demonstrating abs

113
Q

What are enhancement medias for

A

for 37C and AHG testing to increase ab binding if abs are present

114
Q

What to do if ab screening leads to ab ID panel

A

critical result, must call

115
Q

What are the reagents in an ab panel

A

10-20 vials of known antigens

116
Q

If the auto control is pos on ab panels what does that mean? if it is neg?

A

+ auto ab present
- allo ab present

117
Q

What are the ingredients in auto control of ab panel

A

patient cell + patient serum

118
Q

What investigative questions should be asked if an ABID is pos

A

ask if pt has ever been pregnant
if any transfusions
if any transfusion rxns
search for old BB records
document all findings and who you spoke to

119
Q

What antibodies are destroyed by enzymes

A

duffy, MNs

120
Q

What antibodies are destroyed by enzymes

A

duffy, MNS

121
Q

What are the 4 enzymes used for enzyme treated cells

A

ficin
papain
trypsin
bromelin

122
Q

What abs are enhanced by enzymes

A

Rh, Lewis, P, Kidd and I (i)
Klipr

123
Q

What extra steps when using enzyme enhancement

A

increased incubation time

124
Q

What antigens can’t be used on ABID panel cells that use enzyme treated cells

A

MNS and Duffy

125
Q

What ab is not affected by enzymes

A

Kell

126
Q

What is enhancement media for? Name them

A

help increase agglutination
LISS, bovine albumin and PEG
has increased serum to cell ratio
has altered pH

127
Q

What does LISS do
what does it stand for

A

Low ionic strength saline
increases ab uptake

128
Q

What does PEG do

A

concentrates ab in test environment in LISS

129
Q

What do papain and ficin do

A

Whyremove neg charges from RBCs to reduce zeta potential, denatures some of their antigens

130
Q

Why does enhancement media have an increased ratio

A

larger serum to cell ratio
to help attach antigens to RBCs
can help in pts with less reactive abs like the elderly

131
Q

What is neutralization for

A

to neutralize abs that are in the way of us finding another
helpful for multiple abs

132
Q

What nuisance abs do we want to get rid of

A

Lewis, P1, Xga

133
Q

What are adsorptions

A

method to remove unwanted abs from serum or plasma
mix RBCs with antigens for nuisance ab so they can attach
when spun they will be in pRBCs and not plasma
for cold or warm autoabs

134
Q

Explain what allo-adsorptions and auto-adsorptions are

A

allo-cells with a known phenotype other than patient cells
auto- let pt plasma bind the same pt RBCs

135
Q

What is the risk of doing adsorptions if the pt had a transfusion in the last 3 months

A

might take up allo-abs and auto abs, donor cells will cause stronger rxn than allo abs

136
Q

When do we need to combine elutions with alloadsorptions

A

when a patient has an anti-G

137
Q

How can we get a better removal of Abs in warm auto absorption

A

pretreating with enzymes

138
Q

What is an elution

A

the removal of abs or complement that are bound to RBCs
abs can be recovered, IDed and tested

139
Q

When are elutions used

A

on pos DAT or autocontrol with a recent transfusion history

140
Q

Explain how to do an elution

A

Wash RBCs usually x3
last wash must be saved for QC
last wash must be neg

141
Q

What are elutions helpful for

A

suspected HDFN and Auto Immmune Hemolytic anemia or transfusion rxn

142
Q

What kind of Abs are detected at IS

A

IgM

143
Q

What type of Abs are detected at 37C

A

IgG

144
Q

Adsorption remove abs from ___
Elution removes abs from ___

A

adsorption- serum/ plasma
elution- RBCs

145
Q

What is the most common type of elution

A

acid elution with digitonin
destroys RBCs, allows us to collect IgG from supernatant

146
Q

How does Lui Freeze elution work

A

freezes cells to hemolyze them
RBCs lyse during thaw

147
Q

T or F panel cells are all the same on different lots

A

F- they are always different

148
Q

What might affect the positivity of an ab panel

A

dosage
Kidds Rh Diffy MNS

149
Q

What do homozygous pairs look like an a panel? and hetero?

A

homo- 0, +
heter- ++

150
Q

What part of the panel should you use to rule out and why

A

negative, because there was no reactivity there, ab is present by its not with that specific donor, can get ruled out

151
Q

What antigens can you rule out

A

homozygous pairs
max strength and expression

152
Q

What are the exceptions to homozygous rule outs

A

Kell- very low frequency, hard to find homozygous pairs, instead can get ruled out with 2 or 3 hetero or 1 homo

C and E- with suspected anti-D
2,3 hetero to rule out when pt has anti-D

153
Q

What is the RH SOP for rule outs

A

need 2 neg cells, at least 1 must be homozygous

154
Q

Explain the rule of 3

A

once ab specificity is determined
must validate statistical significance with a 95% confidence interval
must have 3 pos and 3 neg rxns for the ab you found to prove its there and report it out

155
Q

Where can you show rxns for rule of 3

A

on screening cells+
on panel+
on repeated panels+
use select cells if rule still not met

156
Q

What check cells you need to choose

A

cells that are neg for the antibody in question AND homozygous pos for the antigen you want to rule out

157
Q

What to do if autocontrol is pos

A

Run a DAT, if pos and pt was recently transfused, must do elution

158
Q

What to do once ab specificity is confirmed

A

antigen typing, find units of blood that are neg for antigens that are clinically significant

extended crossmatch with donor

159
Q

How can we know how long it will take to find the specific antigen negative unit we need for a pt with a clinically significant ab

A

units = (# of units needed)/ ( negative antigen frequency)

by calculating the antigen negative frequency
# units = (# units needed) / (negative antigen frequency)

160
Q

Docs need 2 units of pRBCs on patient that has an anti E

E present in- 30%

A

2/ 70 = every 3 units of blood do not have anti E

161
Q

Doc needs 1 unit of blood that is anti-K and anti-e
K present in 9%
e present in 98%

A

91% K neg
2% e neg
1/ (0.91x0.02) = every 55 units of blood will be compatible

162
Q

An A neg person with Fya needs blood, what is the probablity we will get that blood
Fya present in 65%
know the ABO frequencies yourself

A

Pt can get A neg or O neg blood
A-35% neg 15%
O 45% neg 15%

1/ (0.8x0.15x0.35) = 24

Blood Bank (8 decks)

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