26 Transfusion Science Flashcards

1
Q

characteristics of blood group antibodies (ABO, Rh, & others)

ABO Blood group:
Genes?
Inheritance?
Dominance?

A

Genes:
- A, B, O alleles
- Inherit one from each parent
- A and B are codominant

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2
Q

characteristics of blood group antibodies (ABO, Rh, & others)

Rh Blood group:
Antigens?
- Proteins on ?
- ? most immunogenic
- Presence of ? on ? = Rh Pos
- Absence of ? on ? = Rh Neg
- ?, and ? also important
- Around ? antigens in system

A

Rh Blood group:
Antigens?
- Proteins on RBC membrane
- D antigen most immunogenic
- Presence of D on rbc = Rh Pos
- Absence of D on rbc = Rh Neg
- C, c, E, e also important
- Around 50 antigens in system

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3
Q

characteristics of blood group antibodies (ABO, Rh, & others)

ABO Blood group:
Antigens?

A

Antigens:
- Carbohydrates (oligosaccharides)
- Abundant on red blood cells, epithelial and endothelial cells
- Produce antibodies to antigen they lack unique

Genes:
- A, B, O alleles
- Inherit one from each parent
- A and B are codominant

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4
Q

ABO antibodies:
- Occur ?
- Stimulated by ?

Appear at ?age? // do they change?

Predominantly ?

? significant

Good binders of complement to ?

Cause ?

A

ABO antibodies:
- Occur naturally
- Stimulated by environment (bacteria, food, or pollen)

Appear at 3-6 months // Remain constant throughout life

Predominantly IgM

Clinically significant

Good binders of complement to C9

Cause Intravascular hemolysis

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5
Q

Complete the table

A

see image

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6
Q

Discuss acute and delayed hemolytic transfusion reactions to include cause, blood groups involved, symptoms, type of hemolysis, and laboratory indicators

A

Acute Hemolytic Transfusion Reaction:
- Immediate destruction of donor red cells due to ABO incompatibility // Complement activation causes IVH
- Indicators of IVH: ↑plasma hemoglobin // ↑Lactate dehydrogenase (LD) // ↓haptoglobin (binds free Hb) // Hemoglobinuria

Delayed Hemolytic Transfusion Reaction:
- Donor Red cell destruction caused by IgG antibody formation over time (2-14 days) resulting in EVH
- Blood groups involved in EVH: Rh, Kell, Kidd, Duffy
- Mild (usually not fatal)
- Indicators of EVH: ↓Hb (donor cells destroyed) // ↑Bilirubin (b/d prod of Hb) // ↑LD // Pos Antibody screen // Pos DAT

IVH = Intravascular Hemolysis = Destruction of RBC causing release of free hemoglobin

EVH: Removal of red cells by macrophages in tissues (liver, spleen)

DAT = Detects antibody coating red cells

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7
Q

Discuss hemolytic disease of the fetus and newborn (HDFN) in terms of pathogenesis, treatment, and prevention

A

Hemolytic Disease of the Fetus and Newborn (HDFN)
- Maternal red cell antibodies (IgG) cross the placenta and attach to fetal cells = hemolysis
- Anemia
- Erythropoiesis “Erythroblastosis fetalis”
- Mild to severe depending on antibody identity and concentration

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8
Q

Discuss hemolytic disease of the fetus and newborn (HDFN) in terms of pathogenesis, treatment, and prevention

In Utero:
- IUT:

A

In utero tx:
Intrauterine Transfusion (IUT)
- Blood infused through umbilical vein
- >20 weeks gestation
- RBC must be antigen negative to corresponding maternal antibody
- May require multiple transfusions throughout gestation

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9
Q

Discuss hemolytic disease of the fetus and newborn (HDFN) in terms of pathogenesis, treatment, and prevention

Postpartum

A

Postpartum tx:
Exchange transfusion
- Remove antibody
- Remove sensitized cells
- Remove Bilirubin
- Increase Hemoglobin

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10
Q

Discuss hemolytic disease of the fetus and newborn (HDFN) in terms of pathogenesis, treatment, and prevention

  • Screen for ?
  • ? at greatest risk
  • Provide ? at 28 weeks gestation
  • Provide ? postpartum if baby is ?
A

Hemolytic disease of fetus and newborn prevention

  • Screen Pregnant women for RBC antibodies
  • Rh Neg women at greatest risk
  • Provide Rhlg at 28 weeks gestation
  • Provide Rhlg postpartum if baby is Rh Pos

Rhlg : The anti-D immunoglobulin neutralises any RhD positive antigens that may have entered the mother’s blood during pregnancy.
- Human source anti-D
- Attaches to fetal cells (Rh Pos)
- Splenic macrophages remove fetal cells from maternal circulation
- Cleared before immune system recognizes foreign antigen

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11
Q

Hemolytic disease of fetus and newborn (HDFN)

  • Foreign antigen stimulus ?
A
  • previous transfusion
  • Pregnancy:
    1st pregnancy usually unaffected
  • Rh Neg mothers delivering Rh Pos infants
  • Rh D most immunogenic
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12
Q

characteristics of blood group antibodies (ABO, Rh, & others)

Rh Blood group:
Rh Antibodies:
? antibodies
- Form in response to?

Requires what kind of response(s)

? significant

Do not bind ?

Cause ?

A

Rh Blood group:
Rh Antibodies:
Immune antibodies
- Form in individuals lacking antigen once exposed during transfusion or pregnancy

Requires what kind of response(s)
- Primary and Secondary response needed

Clinically significant

Do not bind complement

Cause extravascular hemolysis

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13
Q

characteristics of blood group antibodies (ABO, Rh, & others)

Other blood groups

-Clinically significant:
- ? antibodies
- ?most common antibody
- React at ?
- Some bind ?
- Cause ?

Examples 4
1. ?: K, k, Kpa, Kpb, Jsa, Jsb
2. ?: Jka, Jkb
3. ?: Fya, Fyb
4. ?: S, s

A

Other blood groups

-Clinically significant:
- immune antibodies
- IgG
- React at 37°C (warm)
- Some bind complement
- Cause extravascular hemolysis

Examples 4
1. Kell: K, k, Kpa, Kpb, Jsa, Jsb
2. Kidd: Jka, Jkb
3. Duffy: Fya, Fyb
4. MNS: S, s

-Clinically insignificant:
- Naturally occurring antibodies
- IgM
- React below 37°C
- Some bind complement
- Do Not cause hemolysis

Examples 3
1. Lewis: Lea, Leb
2. P: P1
3. MNS: M, N

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14
Q

characteristics of blood group antibodies (ABO, Rh, & others)

Other blood groups

-Clinically insignificant:
- ? antibodies
- ?most common antibody
- React at ?
- Some bind ?
- Cause hemolysis?

Examples 3
1. ?: Lea, Leb
2. ?: P1
3. ?: M, N

A

Other blood groups

-Clinically insignificant:
- Naturally occurring antibodies
- IgM
- React below 37°C
- Some bind complement
- Do Not cause hemolysis

Examples 3
1. Lewis: Lea, Leb
2. P: P1
3. MNS: M, N

-Clinically significant:
- immune antibodies
- IgG
- React at 37°C (warm)
- Some bind complement
- Cause extravascular hemolysis

Examples 4
1. Kell: K, k, Kpa, Kpb, Jsa, Jsb
2. Kidd: Jka, Jkb
3. Duffy: Fya, Fyb
4. MNS: S, s

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15
Q

A T&S is always performed before blood is given. What is a T&S?

? detects antibodies in patients plasma formed to ? (exmples)

A

Type and Screen
- ABO Rh
- Antibody screen

Antibody screen detects antibodies in patients plasma formed to blood groups other than ABO (Rh, Kell, Kidd, Duffy etc)

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16
Q

Case study

MF: 24F MVA requires blood transfusion
T&S results for MF:
- ABO Rh: A-
- Ab Screen: neg

What type of blood can she recieve?

What would happen if ABO incompatible blood was given?

A

? or ? antibodies present in patient plasma bind ? cells and fix ? = ? (IVH)
- Usually caused by ? when collecting sample or infusing blood

Symptoms:
- ?
- ?
- ?
- low ?
- ? tightness
- ? failure
- ?

Can be ? if no intervention

A negative antibody screen result means no RBC antibodies were found

Intravascular hemolysis (IVH):
Anti-A or anti-B antibodies present in patient plasma bind donor cells and fix complement = IVH

17
Q

What is Acute hemolytic transfusion reaction?

A

Anti-A or Anti-B antibodies present in patient plasma bind donor cells and fix complement = Intravascular hemolysis (IVH)
- Usually caused by patient misidentification when collecting sample or infusing blood

Symptoms:
- fever
- chills
- hemoglobinuria
- low BP
- Chest tightness
- renal failure
- DIC

Can be fatal if no intervention

18
Q

What are four indicators of IVH?

A
  1. Increased plasma hemoglobin
  2. decreased haptoglobin (binds free hemoglobin)
  3. Increased Lactate dehydrogenase (LD)
  4. Hemoglobinuria

Intravascular hemolysis (IVH):
Anti-A or anti-B antibodies present in patient plasma bind donor cells and fix complement = IVH

If the level of hemoglobin in the blood rises too high, then hemoglobin begins to appear in the urine (hemoglobinuria)

19
Q

Case study

One week after accident MF moved to ICU; Hemoglobin level is low; developing fever, chills and jaundice
New T&S ordered:

ABO Rh: A neg
Ab Screen: Pos

Why is antibody screen positive?
What could be the identity of the antibody?

A

One week after accident MF moved to ICU; Hemoglobin level is low; developing fever, chills and jaundice
New T&S ordered:

ABO Rh: A neg
Ab Screen: Pos

Why is antibody screen positive?
- Exposure to foreign antigens on donor red cells can cause immune antibody formation (rbc stimulated)

What could be the identity of the antibody?
- Antibodies to other blood groups (Kell, Kidd, Duffy, Rh antigens other than D

20
Q

Case study

Anti-K (Kell) was identified in MF’s plasma, and she was crossmatched with two units of A neg K neg blood.
What is causing the fever chills and jaundice?

A

Delayed hemolytic transfusion reaction
- Antibodies formed to donor antigen upon secondary exposure bind donor cells and are removed in the spleen = extravascular hemolysis

RH, Kell, Kidd, Duffy blood groups involved

Symptoms:
- fever +/- chills
- jaundice
- sometimes asymptomatic

21
Q

What are five indicators of Delayed hemolytic transfusion reaction (EVH)?

A
  1. increased Bilirubin (b/d product of Hb)
  2. decreased Hb (donor cells are destroyed)
  3. Increased lactate dehydrogenase (LD)
  4. Positive antibody screen
  5. Positive direct antiglobulin test (DAT)
    - DAT detects antibody coating red cells

Hb = hemoglobin