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ABID / DAT / IMMUNE MEDIATED HEMOLYSIS Flashcards

1
Q

True/ false - in serologic antibody detection involving complement, plasma should be used for testing.

A

False.

Only serum provides complement. Otherwise, the terms are interchangeable

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2
Q 
Which of the ff antibodies to a blood group system does NOT show dosage?
A. Kidd
B. MNS
C. Kell
D. Rhesus
A

C. Kell

The rest of the choices, as well as Duffy show dosage

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3
Q

What might be the cause of a reactive (positive) autocontrol in the IAT phase, but non reactive (negative) with DAT?
A. Presence of WARM auto antibody
B. Presence of antibody against enhancement media
C. Presence of allo antibody coating donor red cells
D. Presence of anti -IH

A

B. Presence of antibody against enhancement media

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4
Q

What might be the cause of a reactive (positive) autocontrol in the IAT phase as well as with DAT?
A. Presence of WARM auto antibody
B. Presence of antibody against enhancement media
C. Presence of allo antibody coating donor red cells
D. Presence of anti -IH

A

C. Presence of allo antibody coating donor red cells

This occurs if recently transfused pt has formed allo antibody for which the donor red cells are positive for

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5
Q

True / false - In ABIDs of patients with partial / weak / altered Rh antigen, Rh antibodies should still be considered.

A

True

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6
Q

In antibody identification workups with negative auto control, which of the ff should be considered when some or all cells are reactive, in multiple strengths and phases?
A. Suspect the presence of a single antibody, perform rule outs, and test select red cells to rule in suspected antibody
B. Suspect multiple antibodies, consider dosage, perform extended phenotype to determine if the antibody is against common or high incidence antigen
C. Suspect weakly reactive antibody or antibody showing dosage, use enhancement techniques, select reagent cells that have double dose expression
D. Suspect antibody to low incidence antigen or antibody to HLA antigen, use reagents that are positive for low incidence antigens or known HLA antigens

A

B. Suspect multiple antibodies, consider dosage, perform extended phenotype to determine if the antibody is against common or high incidence antigen

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7
Q

In antibody identification workups with negative auto control, which of the ff should be considered when some red cells are weakly reactive and common antibodies appear to be ruled out?
A. Suspect the presence of a single antibody, perform rule outs, and test select red cells to rule in suspected antibody
B. Suspect multiple antibodies, consider dosage, perform extended phenotype to determine if the antibody is against common or high incidence antigen
C. Suspect weakly reactive antibody or antibody showing dosage, use enhancement techniques, select reagent cells that have double dose expression
D. Suspect antibody to low incidence antigen or antibody to HLA antigen, use reagents that are positive for low incidence antigens or known HLA antigens

A

C. Suspect weakly reactive antibody or antibody showing dosage, use enhancement techniques, select reagent cells that have double dose expression

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8
Q

In antibody identification workups with negative auto control, which of the ff should be considered when some red cells are reactive in same phases and showing similar strengths?
A. Suspect the presence of a single antibody, perform rule outs, and test select red cells to rule in suspected antibody
B. Suspect multiple antibodies, consider dosage, perform extended phenotype to determine if the antibody is against common or high incidence antigen
C. Suspect weakly reactive antibody or antibody showing dosage, use enhancement techniques, select reagent cells that have double dose expression
D. Suspect antibody to low incidence antigen or antibody to HLA antigen, use reagents that are positive for low incidence antigens or known HLA antigens

A

A. Suspect the presence of a single antibody, perform rule outs, and test select red cells to rule in suspected antibody

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9
Q

In antibody identification workups with negative auto control, which of the ff should be considered when only one red cell is reactive?
A. Suspect the presence of a single antibody, perform rule outs, and test select red cells to rule in suspected antibody
B. Suspect multiple antibodies, consider dosage, perform extended phenotype to determine if the antibody is against common or high incidence antigen
C. Suspect weakly reactive antibody or antibody showing dosage, use enhancement techniques, select reagent cells that have double dose expression
D. Suspect antibody to low incidence antigen or antibody to HLA antigen, use reagents that are positive for low incidence antigens or known HLA antigens

A

D. Suspect antibody to low incidence antigen or antibody to HLA antigen, use reagents that are positive for low incidence antigens or known HLA antigens

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10
Q

This occurs when the development of a new allo antibody in a patient following transfusion results in serologic or hemolytic evidence of destruction of incompatible transfused red cells that were compatible at the time of infusion.

A

Delayed transfusion reaction

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11
Q

What is the most likely cause of an autocontrol that is non reactive, but reactive with all reagent red cells with uniform strength an in the same phase?
A. Antibody to high prevalence antigen
B. Multiple allo antibodies
C. Presence of warm auto antibody
D. Presence of antibody against enhancement media

A

A. Antibody to high prevalence antigen

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12
Q 
Which ancestry / ethnicity is anti-Kpb mostly found in?
A. African american
B. Native american
C. European
D. Arabs
A

C. European

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13
Q 
Which ancestry / ethnicity is anti-Di(b) mostly found in?
A. African american
B. Native american
C. European
D. Arabs
A

B. Native american

An in Asians as well

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14
Q 
Which ancestry / ethnicity is the phenotype for this high prevalence antigens mosty found in?
S-, s-, U+
A. Blacks
B. Arabs
C. Whites
D. Mexicans
A

A. Blacks

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15
Q 
Which ancestry / ethnicity is the phenotype for this high prevalence antigens mosty found in?:
Yt (a+)
A. Blacks
B. Arabs
C. Whites
D. Mexicans
A

B. Arabs

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16
Q 
Which ancestry / ethnicity is the phenotype for this high prevalence antigens mosty found in?
k(+)
A. Blacks
B. Arabs
C. Whites
D. Mexicans
A

C. Whites

Whites>any

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17
Q

A patient’s antibody screen cells came up reactive but when DAT on autologous red cells were done, results were non reactive. What might be the possible cause for this pattern of reactivity?
A. Patient may have antibody to high prevalence antigen
B. Patient may have antibody to low prevalence antigen
C. Patient may have an autoantibody
D. Patient may have an allo antibody

A

D. Patient may have an allo antibody

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18
Q

What is the best way to obtain a patient’s red cells for phenotyping if the patient has been recently transfused?
A. Treat red cells with 0.01M DTT then centrifuge the sample
B. Obtain a sample immediately after transfusion, subject the patient’s red cells to heat elution to separate it from donor cells
C. Separate patient’s red cells by centrifugation using a sample drawn 3 days or more after last transfusion
D. Obtain sample 3 days after last transfusion, wash cells with hypotonic saline then centrifuge sample

A

C. Separate patient’s red cells by centrifugation using a sample drawn 3 days or more after last transfusion

Young / new cells will be on top

A - done when cold auto is present
B - this technique removes IgG antibodies coating red cells
D - Washing cells in hypotonic solution is used to separate patient’s sickled cells (will not lyse)

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19
Q 
Which of the ff enzymes / chemical modification treatment of red cells destroys or weakens CD38 in red cells?
A. Chloroquine diphosphate
B. Trypsin
C. Glycine HCl / EDTA
D. DTT
A

B. Trypsin

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20
Q 
Which of the ff enzymes / chemical modification treatment of red cells destroys or weakens Class I HLA antigens in red cells?
A. Chloroquine diphosphate
B. Trypsin
C. Glycine HCl / EDTA
D. DTT
A

A. Chloroquine diphosphate

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21
Q 
Which of the ff enzymes / chemical modification treatment of red cells destroys or weakens Bg antigen in red cells?
A. Chloroquine diphosphate
B. Trypsin
C. Glycine HCl / EDTA
D. DTT
A

C. Glycine HCl / EDTA

22
Q 
Which of the ff enzymes / chemical modification treatment of red cells destroys or weakens Rh antigens in red cells?
A. Chloroquine diphosphate
B. Trypsin
C. Glycine HCl / EDTA
D. DTT
A

A. Chloroquine diphosphate

23
Q 
Which of the ff is used to inhibit Sd(a) antibody reactivity ?
A. Hydatid cyst fluid from pigeoon eggs
B. Commercially prepared Le substance
C. Plasma from Sd(a+) individuals 
D. Urine from Sd(+) individuals
A

D. Urine from Sd(+) individuals

Sd(a) is present in various body fluids but urine has the highest concentration

C - plasma is used to inhibit anti-Ch and anti-Rg (use Ch+ and Rg+ plasma)

24
Q

______ is an indirect measure of hemolysis in the absence of bleeding.

A

Increased reticulocyte count

25
Q

___________ is primarily used in the investigation of hemolytic transfusion reaction, HDFN, AIHA, and drug induced hemolytic anemia.

A

Direct antiglobulin test (DAT)

26
Q

True / false: DAT should be performed as part of the routine pretransfusion testing and as a screening for hemolytic anemia.

A

False

No benefit in pretransfusion testing; should not be done to screen for hemolytic anemia

27
Q

What is the indication for performing DAT in a patient?
A. To distinguish immune vs non immune hemolytic anemia
B. Performed as part of a routine pretransfusion testing
C. Performed to screen patients for their likelihood of having hemolytic anemia
D. Performed as part of a transfusion reaction workup

A

A. To distinguish immune vs non immune hemolytic anemia

DAT is done on every patient in whom the presence of hemolysis has been established

28
Q

An adsorption must be performed on a specimen of a patient with strong warm auto antibody and is recently transfused. Patient’s phenotype cannot be determined due to history of recent transfusion. Which of the ff must be used to perform an alloadsorption for this sample?

A. Use ABO specific donor red cells that are R1R1, R2R2, rr
B. Use heat eluted patient autologous red cells
C. Use group O donor red cells that are R1R1, R2R2, rr
D. Select any donor red cell group that is R1R2, R2R2, r’r”

A

C. Use group O donor red cells that are R1R1, R2R2, rr

29
Q

True / false: the volume of unit to be transfused to patients with warm reactive AIHA should be determined based on the target hemoglobin level.

A

False

must transfuse the smallest amount required to maintain adequate oxygen delivery and not the amount required to reach arbitrary Hgb level

30
Q 
Which of the ff is associated with the acute form of cold agglutinin disease (CAD)?
A. CLL
B. Mycoplasma pneumoniae
C. Waldenstrom macroglobulinemia
D. Lymphoma
A

C. Waldenstrom macroglobulinemia

31
Q

Which of the ff is associated with paroxysmal cold hemoglobinuria?
A. IgG with antigen specificity
B. Complement binding IgM
C. An eluate showing specificity to anti-I
D. Cold reactive IgG complement binding autoantibody

A

D. Cold reactive IgG complement binding autoantibody

Choice C - eluate is almost always non reactiive

32
Q

Paroxysmal cold hemoglobinuria is a biphasic hemolysin and is diagnosed with the Donath-Landsteiner test

A

True

Biphasic hemolysin - Reactive binding at 4C, by hemolysis does not occur until complement coated cells are warmed to 37C

33
Q 
Paroxysmal cold hemoglobinuria usually has specificity against with antigen?
A. I
B. i
C. P
D. No specificity
A

C. P

PCH is caused by cold reactive IgG with P specificity (usually)

34
Q

True / false: patients with paroxysmal cold hemoglobinuria with sever hemolysis who are in need of transfusion should be given P negative red cells

A

False

P neg cells should be considered only for patients who do not respond to randomly selected units of donor blood. Transfusion is rarely necessary for adults with PCH

35
Q

________ is caused by drugs which then causes positive DAT often associated with drug induced hemolytic anemia

A

Nonimmunologic protein adsorption

36
Q 
Which of the ff drugs is mostly associated with drug independent antibodies?
A. Fludarabine
B. Cefoletan
C. Cephalosphorins
D. Piperacillin
A

A. Fludarabine

Choices B, C, D - associated with drug dependent antibodies

37
Q

Which of the ff does NOT apply to reagent Coombs check cells?
A. Are Rh positive, AHG coated RBCs.
B. Check cells react with the unbound AHG reagent in the test tube.
C. Check cells will prove that adequate washing was done
D. A positive result with check cells confirms that AHG reagent was added to the tube

A

A. Are Rh positive, AHG coated RBCs.

Check cells are anti-D coated, Rh pos RBCs.

38
Q 
Which of the ff antibodies are capable of agglutinating at the saline phase (immediate spin) and AHG phase of antibody identification?
A. Anti-N
B. Anti-s
C. Anti-Le(a)
D. Anti-I
A

C. Anti-Le(a)

Can either be IgM (reacts at RT or colder), IgG (AHG), or both.

39
Q

Patient Joe Byron has his labs drawn in preparation for his surgery the next day. His antibody screen came up 3+ reactive on both cells of the initial screening cell. All cells of the ABID panel were also 3+ reactive, including the autologus control. He has not received any blood transfusions in his lifetime. What is the most probable cause for these antibody screen and panel results?
A. Joe has an alloantibody
B. Joe has an autoantibody with underlying alloantibody
C. Joes has multiple alloantibodies
D. Joe has an autoantibody

A

D. Joe has an autoantibody

Also possible that he has antibodies to medication - full medical history needed to evaluate this.

40
Q 
Patient Karen’s initial antibody screen reacted 1+ on one cell. She has never been transfused or pregnant. She is only in the hospital for observation and currently not on any medications. Which of these antibodies may be causing the positive reactivity, given the patient’s history?
A. Anti-Le(b)
B. Anti-U
C. Anti-Jsa
D. Anti-Kpb
A

A. Anti-Le(b)

Lewis antibodies are often naturally occuring and can be made by Le(a-,b-) individuals without any known RBC stimulus

41
Q 
When reading an antibody panel, you notice mixed field agglutinations in some of the results. Which antibody is likely to be present?
A. Diego
B. Rh
C. Lewis
D. Lutheran
A

D.. Lutheran

Anti-Sda and Lutheran are associated with MF agglutination

42
Q

Antibody screening results show 1+ and 2+ reactivity at the IS phase for SCI and SCII, respectively. No reactivity is seen in the 37C and AHG phase, as well as with the autocontrol cells. What is the most likely interpretation of these results?
A. Single alloantibody, most likely an IgM
B. Possibly single OR multiple alloantibody, an IgM
C. Single IgG alloantibody present on both cells
D. Warm autoantibody

A

B. Possibly single OR multiple alloantibody, an IgM

43
Q

An antibody screen panel shows a 2+ reactivity on both SC I and SC II at the AHG phase, and no reactivity with the autocontrol cells. What is the most likely cause?
A. Antibody to a high prevalence or common antigen
B. Warm autoantibody
C. Multiple alloantibody, most likely an IgG
D. Single alloantibody, most likely an IgM

A

A. Antibody to a high prevalence or common antigen

44
Q 
Which of the ff set if antibodies has an optimat reactivity at the AHG phase?
A. Kidd, M, N
B. Lua, P1, S, s
C. Lea, Leb, Lub
D. Jka, S, s, Lub
A

D. Jka, S, s, Lub

45
Q 
Antigen phenotyping was requested for a patient with suspected warm autoantibody. This patient has no record of recent transfusion. The technologist uses the EGA method to remove the warm auto antibodies from his red cells. Which of the following antigens cannot be reliably typed for?
A. Jkb and Fya
B. M and S
C. Lutheran and Lewis
D. Kpb and K
A

D. Kpb and K

Kell antigens are denatured by EGA treatment

46
Q 
Which of the ff can be used to neutralize Lewis antibodies?
A. Hydatid cyst fluid
B. Saliva
C. Urine
D. human breast milk
A

B. Saliva

47
Q 
When performing neutralization as part of an ABID workup, which of the ff is used as a control?
A. Serum + neutralizing substance
B. Serum + saline
C. Serum only
D. Saline only
A

B. Serum + saline

This is your positive control

48
Q 
Which is the most appropriate reagent to use to adsorb anti-Bg from the plasma?
A. Human platelet concentrate
B. WARM reagent
C. Rabbit erythrocyte stroma (RESt)
D. Bg positive red cells
A

A. Human platelet concentrate

49
Q

DAT results on an newborn cord specimen reacted 3+ with polyspecific and AHG IgG reagents. There is no ABO incompatibility between newborn and mother and both their antibody screens are negative. What is the likely cause of this reactivity and what should the technologist do next?
A. Cord sample drawn from wrong patient; reject specimen and ask floor to redraw.
B. Cord cells are heavily coated with Wharton’s jelly; repeat the test manually and wash cells with saline before testing.
C. Mother has possible antibody to low prevalence antigen; perform antibody identification using panels positive for low prevalence antigens. Workup may be sent to reference lab.
D. Accept results as this can be possible; report positive DAT to floor

A

C. Mother has possible antibody to low prevalence antigen; perform antibody identification using panels positive for low prevalence antigens. Workup may be sent to reference lab.

50
Q 
A brilliant blood bank technologist wants to remove IgG antibodies that are bound to a patient’s red cells before performing an autoadsorption. The ff cell treatment reagents are available in the laboratory. Which one would NOT be beneficial for this method?
A. ZZAP
B. DTT
C. EGA
D. Chloroquine diphosphate
A

B. DTT

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