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Blood Bank > Unit 5 > Flashcards

Unit 5 Flashcards

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1
Q

What is HLA

A

human leukocyte antigen
polymorphic glycoproteins on surface of cells

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2
Q

What chromosome contains the human MHC

A

p arm / short arm of chromosome 6

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3
Q

Match Class I, class II and class III with their ___

DP, DR,DQ glycoproteins
A, B, C glycoproteins
complement and TNF

A

D- class II
ABC- class I
complement- class III
regions on chromosome 6 that contain genes for MHC (LOCI)

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4
Q

What are the 4 fields in HLA nomenclature

A

1- protein/ allele group
2- specific allele variants
3- synonymous DNA substitutions/ silent mutations and exons
4- non-coding regions- introns and UTRs

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5
Q

Are there more HLA class I genes or class II

A

class I- more than 20,000
class II- less than 7000

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6
Q

What type of inheritance do HLA genes tend to have

A

codominant
one haplotype from mom
one haplotype from dad

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7
Q

What is linkage disequilibrium and does it occur in HLA inheritance

A

when haplotypes occur at unexpected frequencies, yes it does
deviates from the hardy winburg principle

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8
Q

Name what class the following genes are from?
A1
B8
DR17

A

A1 and B8 class I
DR17 class II

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9
Q

What are the parts of the HLA class I protein

A

3 alpha chains and 1 B2 macroglobulin
2 alpha and 2 beta chains

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10
Q

What kind of cells have an HLA class I? and HLA class II?

A

all nucleated cells
antigen presenting cells

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11
Q

What is the source of antigens being screened by HLA class I?
And class II?

A

endogenous
exogenous

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12
Q

What part of the Ig chain does HLA class I code for?
and class II?

A

both for heavy chains of class I or II glycoproteins

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13
Q

When does a patient need HLA typing and abs

A

if they are getting a solid organ transplant, BM transplant, graft transplants

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14
Q

What is an allogenic BM? and an auto

A

when a pt receives BM from someone else
auto- when a pt receives their own
BM back

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15
Q

What elements must match for a BM transplant to be compatible

A

pt HLA abs must match donor lymphsq

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16
Q

How is HLA tested for transfusions with the CDC method

A

complement deficiency cytotoxicity assays are done to test pt serum against donor lymphs and reagent complement to see if compliment activates. AHG is also added as enhancement

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17
Q

How is flow cytometry used to test HLA

A

donor lymphs isolated by T and B cells, incubated with pt serum, if HLA is present it will react toward the pt lymphs

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18
Q

What is engraftment monitoring and how does it work

A

monitors signs of GvHD
identifies short tandom repeats STRs between donor and pt

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19
Q

practice slide 26`

A

slide 26

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20
Q

What do each of these terms mean
autologous
syngenic
allogenic
xenogenix
GvHD
HvGD

A

syn-twin donation
xeno-other species

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21
Q

What cells and what class can leav to GvHD and HvGD

A

T cells- class I
ab responses- class II
NK- class I
compliment

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22
Q

Which is worse, GvHD or HvGdg

A

GvHD

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23
Q

What kind of recognition do each of these cells do
T cell
Ab
NK

A

T cell- direct
Ab indirect
NK allorecognition

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24
Q

What cells mediate HvGD in hyper acute, acute or chronic phases

A

hyper acute- preexisting Abs - min to hours- complement activated
acute- CD4 and CD8 - 2 weeks to 1 month
chronic- CD4 and B cell responses

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25
What might cause a hyper acute HvGD
previous transplants or transfusions, multiple pregnancies
26
What are the effects of acute HvGD
vascular damage due to leukocytes attack inflammation tissue necrosis ab mediated respons
27
What can cause GvHD
BM, thymus, spleen, blood transfusion in neonate
28
What are the effects of acute GvHD
endothelial tissue damage, death to skin, liver, gastrointestinal tract rash, jaundice
29
What cells are activated in acute GvHD
mature T cells in the graft
30
What are the effects of chronic GvHD
gradual ab and slow rejection organ damage, scar formation on organs, fibrosis and atrophy of organ
31
How is GvHD treated? How to prevent it?
immunosuppression and steroids HLA testing prior to transplant
32
Describe the parts of direct allo recognition? and indirect?
direct-patient T helper CD4 attaches to MHC class II on donor APC, acute indirect- donor cell proteins are presented by APCs of recipient- chronic
33
How is HLA used for paternity testing
HLA genes from mom and dad are used to see if child matches these
34
What genetic markers are analyzed in paternity testing
RBC, HLA, enzymes, proteins
35
What are 1st and 2nd order exclusions
1st- gene in child that is not in mom nor dad 2nd- gene not in child that is in dad
36
practice slide 44, 46
slide 44 first order or 2nd
37
What does hydrops fetalis mean
edema in fetus
38
What does icterus gravis mean
jaundice
39
What does erythroblastosis fetalis mean
immature RBCs in circulation- related to anemia
40
What causes the most severe form of HDFN? and the least severe
Rh system ABO
41
What are the 3 main causes of HDFN
Rh, ABO, other
42
What are the 4 conditions that must be met for HDFN to occur
Mom is exposed to foreign antigen from pregnancy exposed to foreign antigens causing ab production Ab can cross the placenta (IgG) infant must have a well developed antigen that mom doesn't have
43
What is the function of placenta
O2 exchange, nutrients, waste products barrier between mom and fetus circulation
44
Describe fetal blood flow
fetal veins bring oxygenated blood to heart, pumps deoxygenated blood back to placenta via arteries maternal blood provides nutrients and removes waste
45
Which HDFN can occur in the first pregnancy as mild
ABO
46
Which HDFN does not affect the 1st pregnancy, but the second pregnancy can have severe issues
Rh
47
How can HDFN lead to jaundice, what is this condition called
plasma albumin binds to some bilirubin if there is too much it will remain unbound, accumulates in CNS kernicterus
48
Describe the bilirubin pathway
RBCs lyse and release heme heme is converted into unconjugated bilirubin free bilirubin in the bloodstream albumin conjugates bilirubin in liver, broken down into urobilinogen in gut can be excreted in feces or urine
49
What Rh type of HDFN is most severe
anti-D most common
50
What antigens cant cause HDFN and why
Lewis, I and P,not well established at birth
51
What DAT results are expected in ABO HDFN, what other lab results can be expected
weak positive or negative high ESR high osmotic fragility high spherocytes mild to high bilirubin
52
What is included in prenatal testing
ABO RH type, weak D, ab screen if Rh neg, need testing of rhogam if ab preset, must do panel
53
What is ab titration
serial dilution of abs to find what dilution abs are present
54
How many ab titrations are preformed
3- second usually done weeks later, and ran parallel with the third if change is more than 10 this is significant
55
practice slide 20 HDFN chapter
slide 20
56
What titers are clinically significant
16-32 or higher
57
What does the liley graph tell us
bilirubin test, change in A450
58
High billirubin means ___ RBC destruction
high
59
What do the zones of Liley graphs mean
1- baby is ok 2- baby affected, must monitor 3- life threatening anemia
60
What is cordocentesis
percutaneous umbilical blood sample need in umbilical cord while baby still in womb used to measure, Hgb, hematocrit, bilirubin, retics
61
What can be done if HDFN is occuring
deliver baby early, intrauterine exchange, docs call
62
What are the BB requirements for IUT
fresh blood- 5 days CMV neg Hgb S neg irradiated O neg RBCs and AB FFP sometimes C, E and K neg
63
When is cord blood testing necessary
Rh neg mom O mom NICU mom has ab no prenatal history
64
What testing needs to be done if Weak D test is pos
elution
65
What can interfere with cord blood testing
wharton's Jelly monoclonal reagents blocking- mom anti-D blocks binding sites on baby D cells, doesnt let reagents bind to it
66
What are the normal ranges for cord Hgb, and anemia
Hgb- 14-20 mild anemia- 13 moderate anemia 8-12 severe anemia <8
67
What bilirubin levels are bad for a fetus
4-7, too high
68
What is bilirubin is 16? and if its 18-20?
16- fetal IUT needed 18- kernicterus, need labor induction
69
If a DAT in cord blood is pos
acid elution, test supernatant for abs
70
What treatments for neonatal HDFN
phototherapy for jaundice transfusion exchange transfusion
71
How to give blood products to neonate
go off of baby blood type O best choice, AB FFL
72
How to give blood products to neonate
go off of baby blood type O best choice, AB FFP
73
What is rhogam
fake anti-D so that mom doesn't make her own
74
What kind of immunity is rhogam doing?
passive
75
What are the conditions to be a candidate for rhogam
rh neg mom weak D neg mom mom has not made anti-D yet Rh neg mom with Rh pos baby invasive procedure- miscarriage, abortion, ectopic pregnancy, amniocentesis
76
How long is Rhogam detectible in moms blood after administration
5 months
77
How much is each dose of rhogam
300ug
78
How much fetal blood will each dose of rhogam protect against
30mL of whole blood or 15mL of RBCs
79
What is massive fetomaternal hemorrhage
if tauma causes 30mL of fetal blood to enter moms circulation need rosette test
80
What is the purpose of a fetal screen
looks for Rh pos cells from fetus in mom
81
What is the purpose of a fetal screen
looks for Rh pos cells from fetus in mom pos if rosettes are found
82
What is the purpose of the Kleihauer Betke test?
quantitates how much fetal blood is in moms circulation
83
What is used to differ fetal hgb from adult hgb in KB test
acid elution- fetal hgb is resistant to it
84
What cells are adult and what cells are fetal in KB test
Adult- ghost fetal- hot pink
85
If KB test reveals 40 cells of fetal blood, how much rhogam must be transmitted
40/ 2000= 0.02 fetal index 0.02 x 5000 = 100 100/30 = 3.3 3+1 = 4 round up +1
86
What are the 3 categories of immune hemolytic anemia
alloimmune- foreign autoimmune- warm or cold ab drug induced- damage to pt RBCs by drug
87
Immune hemolytic anemia lab results hgb hct retic bilirubin haptoglobin LDH RBC morphology
hgb low hct low retic high bilirubin high haptoglobin low LDH high polychromasia, spherocytosis, NRBCs, hemoglobinemia, hemoglobinuria
88
What type of hemolysis causes sperocytes
extravascular
89
auto antibodies tend to have
panagglutination
90
What is the most common immune hemolytic anemia and what Ig causes it
Warm autoimmune hemolytic anemia, IgG 70%
91
How does Warm AIHA affect ABO and Rh results what are the results for DAT AB screen ABID
unaffected strongly positive positive all tested cells are pos - panagglutination
92
What is the most common autoantibody
anti little e
93
What is the most common autoantibody
anti little e pt is e positive
94
What is an elution ? What makes it positive
when you wash red cells and test the plasma for IgG will be negative with compliment
95
If a pt has warm autoimmune hemolytic anemia due to C3 what will the results for an elution be?
negative
96
the last wash of an elution should be ___
negative
97
What are the treatments for warm AIHA
steroids treat underlying condition splenectomy immunosuppressants
98
What is a warm autoabsorption
absorbs out the ab at 37C with ZZAP or PEG remove serum, mix enhancement with RBCs allow abs to be absorbed, repeat, put plasma back into mix, add ZZAP to destroy abs continue until auto control is neg
99
What are the cold abs
LIPMAN
100
What ab mostly causes cold hemolytic disease
anti- I
101
What can a cold ab do to the typing results
false positive in forward type
102
What results will an eluate show if there is a cold ab
negative
103
What ab is associated with infectious mononucleosis
anti-i
104
What DAT results can be expected from a cold hemagglutinin disease
+ if polyspecific - for IgG and - C3
105
What treatment is used in cold hemagglutinin disease
plasma exchange rapid erythrocyte stroma treatment- rabbit plasma
106
How does REST help in cold hemagglutinin disease
removes anti-I from the serum
107
What pts tend to get paroxysmal cold hemoglobinuria
children mostly after viral diseases like mono, measles, mumps
108
What is the Donath Landsteiner test for
to looks for paroxysmal cold hemoglobinuria exposes sample to low temps- allowing C to bind then warms them back up
109
What causes Paroxysmal cold hemoglobinuria
compliment binds to IgG abs
110
What ab is in question with Paroxysmal cold hemoglobinuria?
auto Anti -P
111
Why can drugs cause induced hemolytic anemia
abs react against the drug or against the RBC antigens if enhanced by drug
112
What DAT results are expected in drug induced hemolytic anemia
positive DAT
113
What are the 4 mechanisms of action that cause drug induced hemolytic anemia
drug adsorption immune complex membrane modification unknown
114
What is the drug that most often causes drug induced hemolytic anemia through adsorption
penicillin cephalosporin, erythromycin tetracycline
115
What eluate results can be expected in Drug induced hemolytic anemia drug adsorption
negative, unless tested against drug coated RBCs
116
What type of hemolysis occurs in drug induced hemolytic anemia through drug adsorption
extravascular
117
What DAT results are expected from Drug induced hemolytic anemia through adsorption
pos- polyspecific pos- IgG neg- C3
118
What is the best way to treat drug induced HA through drug adsorption
take the pt off the drug, usually ends in full recovery
119
What causes drug induced hemolytic anemia through an immune complex
drugs adsorbed onto RBC surface drug and abs form a complex complement activates
120
What type of hemolysis occurs in drug induced hemolytic anemia, through an immune complex
intravascular
121
What are the expected DAT results for drug induced hemolytic anemia by formation of immune complex
DAT polyspecific- pos DAT IgG- neg DAT C3-pos
122
What are the expected eluate results for drug induced hemolytic anemia by formation of immune complex
negative, only compliment is present not IgG
123
What treatment can be used in drug induced hemolytic anemia, immune complex
stop drug, steroids, sometimes
124
What drugs cause DIHA through unknown mechanisms
*aldomet*, L DOPA, ibuprofen
125
What are the expected DAT results in DIHA through unknown mechanisms
pos with everything
126
What are the expected eluate results in DIHA through unknown mechanisms
positive negative in absence of drug
127
What antigens have weak expression at birth
Lewis P Lutheran

Blood Bank (8 decks)

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