AMT BB Flashcards
3 bacteria implicated in contamination of blood, 1 thats not
3 parasites transmitted by blood
Yersinia, Citrobacter, Pseudomonas
-these are the books answer
-possibly staph/strep
E.Coli has not
Plasmodium, Trypanosoma(cruzi), Babesia
Primary resonse Ig, time appears…
Secondary response Ig, time appears…
% get immunizied to blood grp ag
Primary IgM, 7-14 days
Secondary IgG 1-2 days
1-4%
ABO labels versus dyes colors
-A,B,O,AB
-A,B,D/A1B
Labels:
-A: yellow
-B: pink
-O: blue
-AB: black/gray/white
Dye:
-A: blue
-B: yellow
-D/A1B: clear
anti -A1 made from…
anti-H made from…
anti -A1 made from…Dolichos biflorus
anti-H made from…Ulex europeus
Potentiators:
-which one decreases incubation
-which one books says increases sensitivity
-shortens incubation, increases speed/sensitivity, decreases zeta, phosphate buffered saline/glycine
-increases sensitivity for IAT, longer incubation
-increases sensitivity, removes water increasing concentration of ab, enhances warm auto
-eliminate rxns, can enhance coldwarm auto
-reduce disulfide bonds, eliminates Kell
Potentiators:
-decreasse incubation LISS
-increase sensitvity albumin
LISS low ionic strenght sln
-shortens incubation, increases speed/sensitivity, decreases zeta, phosphate buffered saline/glycine
BSA/albumin
-increases sensitivity for IAT, longer incubation
PEG
-increases sensitivity, removes water increasing concentration of ab, enhances warm auto
Proteolitic enyzmes
-eliminate rxns, can enhance coldwarm auto
DTT, dithiothreitol
-reduce disulfide bonds, eliminates Kell
Reaction grading…
which one is caused by transfusion, some agg with sea of free rbc…
which one is microscopic/cloud…
4+
3+
2+
1+
MF
WP
Neg
Reaction grading…
4+ solid button,clear
3+ lrg clump, clear
2+ med clumps, clear
1+ sml agg, turbid
MF some agg, sea of free(transfusion)
WP microscopic cloudy
Neg no agg,cloudy
Allogenic Donor reqs:
Age:
Temp/C/F:
Wt:
Hmg/Hct:
female
male
BP:
Pulse:
Allogenic Donor reqs:
Age: >=16
Temp/C/F: 37.5C/99.5F
Wt: >=110lb/50kg
Hmg/Hct: 12.5/38%
female 12.5/38%
male 13/39
BP: 90-180/50-100
Pulse: 50-100
Autologous donor req…
Age..
Hmg/HCT..
other…
Autologous
-no age req
-Hmg/HCT 11/33%
-no bacterimia
-collect >72hrs before
-ABO/Rh testing
Deferal:
aspirin 2 days
oral surgery 3 days
Warfain, Heparin 7 days
antibiotic injection 10 days
Plavix 2 weeks
pregnancy 6 weeks
WB donation 8 weeks
Vaccine defferments..
TB skin pos…
measles/mumps/rubeola/polio no symptoms..
Hep B…
Germen measles/chicken pox/ West Nile….
Vaccine defferments..
No defferal:
-TB, Tdap, flu, tetanus, meningitis if no symptoms
2 weeks:
-rubeola, mumps, polio, measles
3 weeks:
-hep b vaccine (no immunoglobulin)
4 weeks:
-rubella, MMR, chix pox, shingles
No more than 10.5ml WB/kg wt
Wait time for plasmapheresis donor to wait before donate WB…
Wait time for WB donor to donate plasmapheresis…
Wait time for plasmapheresis donor to wait before donate WB…48hrs
Wait time for WB donor to donate plasmapheresis…72hrs
-need to test TP if >1x/2mths at 4mth intervals
Main reason to be defered for 1yrs…
3 random…
1 yr defferal for exposure to hepatitis, malaria, HIV
-had sex/living with somewho is infected
->72hrs in jail
-tatoo/trans, mucous/skin
(Acupuncture and piercing ok)
-hep B immunoglobulin(not vaccine)
-completed syphillis/gonn treatment or reactive STS
-return from trip from area endemic for malaria
-bitten by dog
Reason to be deffered 3yrs
asymptomatic from endemic area of malaria or had malaria before/completed treatment
Permnament deferral
Permnament..
-definete disease, habits high risk for hep, HIV, HTLV
-Viral hep after age 11
-drug/needle use
-Tegison
-UK bovine insulin
-human growth hormone
(hormone replacment like menopause ok)
-dura mater
-Babeosis,T.cruzi
-CJD: lived in UK/Europe during certain time, UK/France transfusion
Not aloud until resolved: cold/flu symptoms
Main testing for products…
ABO/Rh, ab screen
-Syphillis/RPR
-Hepatitis(HBsAg,antiHBc, antiHCV)
-HIV(anti1/2)
-HTLV(anti1/2)
-T.cruzi, WN, Zika, Babesia
ISBT 128 bar code
-product name, ID#
-donor category: volunteer etc, autologous
-recipient intended
-prescription req, disease, circular of info, biohazard
-method, temp, anticoag
-# units if pooled
-expiration
-ABO/RH
-Collection/processing facility info: address, name, reg/license #
RBC temps etc
storage…
transport..
open good for…
Frozen RBC temp, time
-% glycerol, thaw at, store at, good for
1 unit raises hmg/hct by
RBC nonfrozen
-store 1-6C
-transport 1-10
-open=24hrs
*HCA 80% max
*Packed rbc has plasma removed, WB not used much
Frozen: -65C, 10yrs
-40% glycerol, thaw at 37C, store 1-6, good for 24hrs
Washed has plasma removed by saline, prevents allergy to plasma proteins and anaphylaxis in IgA def PT
raise 1g/3%
(rbcx3=hct)
FFP storage:
-shorest time, longest time
-thaw temp, store at, time
-good for..
Cryo storage
-2 main things contain
-good for once thawed, kept at
-thawed/open time
FFP coag def
-1 yr at -18
-7yrs at -65
-thaw at 30-37, store 1-6, 24hrs
Cryo fibrinogen, F8 for DIC
>80 IU F8, 150mg Fibrinogen
-1 yr at -18
-6hrs thawed, leave at RT
-4hrs thawed/pooled
FFP frozen w/in 8hrs, thawed in fridge, cryo precipitates and is refrozen in an hour
PLTS:
-days, temp, with
-open: pooled, apheresis
Granulocytes/washed
-time good for with no
-washed prevents
Irradiated
-days
-prevents
PLTS
-light spin removes rbc, heavy spins down wbc/plts
-5 days, 20-24 w/agitation
-4 hrs plts pooled open
-24hrs aphresis open
*1 unit PLT raises 5-10,000, 1 apheresis 20-60,000
…
Granulocytes: 24hrs, 20-24,no agitation
*neutropenia, gramneg sepsis
*can transmit CMV, HLA imm, GVHD
…
washed rbc: 24hrs, prevents allergy to plasma proteins in IgA def
…
Irradiated: 28 days, prevents GVHD by inactivating T cells; donor lymphs is the issue
additives
shorest to longest…
rejuvenating sln: restores 2,3DPG/ATP
-store 1-6C, use w/in 24hrs
ACD/CPD/CPD2: 21 days
-anticoag citrate dextrose,
-citrate phosphate dextrose
CPDA-1: 35 days, has adenine at end, increases ADP, more glucose to cells
ADSOL/AS/additives: 42 days
Storage of blood changes
Decreased:
-pH (lactic acid)
-Na (moves into cells while K moves out)
-2-3DPG
Increased:
-K(moves out while Na moves in)
-NH4
Backbone of sugars is…
O gene is…H is…
-H gene(not O) codes for/what is glycosyltransferase/sugar
A gene codes for..
B gene codes for..
Backbone is Gal with Fuc off bottom
Genes add onto Gal to the left…
O gene is inactive, H is unmodified
H gene codes for fuco-syl-transferase/fucose
A gene codes for N-acetyl-galac(NAC)
B Gene codes for D-galac
Bombay phenotype is..
antibodies in serum..
Phenotype with absense of Rh…
absense of ABO ag, Oh
has A,B,H
-type as O
-not agg w/anti-H, no H
Rhnull is absense of Rh ag
H ag greatest to least
greatest, least
greatest H is O, least is Oh(none)
O>A2>B>A2B»A1>A1B>Oh
-A2>B
-more A, B less H so A2>A2B
-A2>A1
Se: expression ABO ag in BF, secretor status
-dominant, 80% have Se gene
Se codes for these three…
-need….to have A or B
-Se doesn’t code for
Le: adsorbed onto red cell, in saliva/plasma, doesn’t cause HDFN/not on fetal cells
-need Le to make…
-need.. to make…
Se codes for H, then A and B, doesn’t code for Se
Le:
-need Le to make Lea
-need Lea to make Leb
ABO frequency greatest to least/% in whites
-proportions same in others
-blacks and asians have higher B
O>A>B>AB
O 46
A 41
B 9
AB 4
Dolichos biflorus: agglulinates A1 cells
(diff A1 from A2)
Ulex europaeus: agglutinates H (wont agg Bombay due to no H)
Subgroups:
-MF with antiA, neg with antiA1 lectin…
-A1 cell pos, antiA1 lectin neg
-antiA 3+, antiB 3+, A1 cells 2+,
antiA1Lectin neg
Subgroups:
A3 is mixed field w/antiA1
Ax isnt mixed
MF with antiA, neg with antiA1 lectin: A3
-barely any A=MF,
-antiA1 lectin neg=no A1 ag=not A1
A1 cell pos, antiA1 lectin neg=Ax
-A1 cell pos=has antiA1
-antiA1 lectin neg=not A1
antiA 3+, antiB 3+, A1 cells 2+,
antiA1Lectin neg: A2B
-antiA,anti B 3+=AB
-A1 cells 2+=has antiA1=not A1
-antiA1 lectin neg=not A1=A2
ABO Discrepancies
All typing 0=missing reserve, incubate RT 30min and/or at 4C
4+ anti A, 1+ A1 cells= A2 w/antiA1, Dolichos lectin
2+,2+ reverse typing could be rouleaux or cold alloab; rolleaux wash RBC,saline replacment; cold all ab panel at RT
3+ antiA, 4+ antiB, 1+ A1cells: A2B w/antiA1, dolichos lectin
4+ antiA,2+antiB: acquired B ag, GI infection
Autoab that is IgG, donath landsteiner, PCH
ab that is IgM, cold agg disease, Mycoplasma pneumonia, blacks…
ab seem infants, infectious mono…
P: Autoab that is IgG, donath landsteiner, PCH
I: ab that is IgM, cold agg disease, Mycoplasma pneumonia, blacks…
i: ab seem infants, infectious mono…
5 naturally occuring ab
ABO
Lewis, P, M
Cw
Rh null…
Oh…
Rh null no Rh ag
Oh no ABO ag
R =D
r =d
1 or ‘ =C
2 or ‘’ =E
0 or nothing about C/E= ce
z or y =CE
Tja part of..
Cw/f part of…
U part of…
Tja/PP1PK part of P
Cw/f part of Rh
U part of MNS
False Pos Rh typing
-autoag, poly agg, reagent agg, roleaux
False Neg Rh typing
-RBC too heavy, blocking of ag sites w/ab
Weak D:
Do when antiD and Rh CTRL is neg in donor and infants w/moms who want RhIg
37,AHG, 15-60min
if Rh CTRL is pos test is invalid
Weak D gets Dpos/neg
Dneg gets Dneg
D only shown once in phenotype even if on both parents genotype
Most common Rh genes: DCe, dce
D: 85%
c, e: 80-98%
Not as common Rh genes: E, C
E: 29% common antibody
C: 68%
D how many have…
K, k how many have…
D 85% have
most people have D
K only 9% has
Most people don’t have K
k 99% has
most little letters has 90-100% frequency
c=80
e=98
s=90
k=99
most big letters have
70-85%
exceptions…
K 9
Lea=22
E=29
S 55
Antigen typing:
If have multiple ab need ag neg, multiply the decimals and change to percent…
C=30% ag neg=0.3, Jka=25% ag neg 0.25
0.3x0.25=0.075= 7.5% of 100 units should be neg for C/Jka
Pos CTRL is heterozygous cell
Neg CTRL cell w/out ag
Natural:
-ABO, Lewis, P1, MN, Lua
Warm:
-Rh, Kell, Duffy, Kidd
Cold:
-M,N,P1
Delayed rxn:
-Kidd
antibodies:
P: IgG, biphasic, donath landsteiner, PCH
P1=IgM, cold, hydatid cysts, naturally ocurring
null p=PP1PK/Tja
I: cold agg, M.pneumoniae
-Can use autoadsorption, RESt adsorption to remove anti-I/cold
i: infectious mono
Fy…
-Ig, temp
-dosage/enzymes?
-Fya-b-, seen in, %, resistance to
-most common ab
Fy
-IgG, 37/AHG
-dosage/destroyed by enzymes
-Fya-b- blacks, 68%, resist vivax/knowlesi
-Fya ab more common
3 groups that dont cause HDN
lewis, lutheran
M/N
Kidd…Jka/Jkb/Jk3
Ig, temp, dosage/enzymes, seen in
IgG, 37/AHG, show dosage, enhanced by enzymes, seen in delayed trans rxn
Kell: next to D, 2nd most potent ag
-% lack
Ig, temp, enzymes, dosage
Two systems in K, which one low/high
which one Mcleod, xlinked males, Ko genes
k: cellano
-how many have
Kell: no one has, no dosage/no enzyme
-90% lack, antibody common easy to find units
-IgG,37/AHG, unffected by enzymes/no dosage
-Kpa/Jsa is low
-Kpb/Jsb is high
-Kx: 100% have, ones that don’t are McLeod,males
-K0/null
k/Cellano: 99 have
System with MF, RT/saline, no HDN destroyed by enzymes
Lutheran
Grp IgM, common in all esp blacks, cold reactive, not on infant, cold agg disease, M.pneumo
I
Rh..
Ig, temp, dosage enzymes
% have D…
most common rh neg genotype…
most common cause of HDN next to D…
weak D common in…
Rh
-IgG, 37/AHG, dosage/enzymes
-85% have, weak D blacks
-genotype: cde/cde
-most common HDN after D is c
IgM, enhanced by enzymes, naturally occuring, neutralized by hydatid cyst
P1
IgG, 37/AHG
part of M/N, if you have this you have U
U neg is seen in…and resistant to…
S/s
part of M/N, have S, have U
Uneg blacks, resistant to ficin
Dosage…4 grps
-Kidd, Fy, Rh
-M/N/S
kidd and duffy the rh monkey
eat lots of MNS
Enyzmes destroy…
all but….are enhanced…
bromein, ficin, papain, trypsin
removes negative charges from rbc membranes and reduces zeta potential bringing cells closer
enzymes destroy
-Fy
-Luteran
-M/N/S
all but Kell are enhanced
typically enhance cold but destroy IgG
QC
fridge, freezer..temp, how often
check alarm…charts
temp…
waterbath/heat…
centrifuge…how often
fridge 1-6, freezer -18 daily
charts weekly
centrifuge 6mths
alarm 3x mth
temp w/NIST yearly
waterbath/heat 37
Polyspecific AHG has…color…
how to check reagent…type of cells, rxn
If CC agg, means these 3 things
Monospecic has these two, color…
Polyspecific AHG DAT
-complement, immune HA
Only 2: IgG and C3d (not b), green
check with check cells, grpO, WP
Can’t uses for DonathLansteiner
CC agg means
-ahg added
-washed well
-ahg didnt react with PT red cells
Monospecic:
Only IgG, antiC3b,-C3d clear
-used for compatibility, ID ab
AHG testing..
AHG reagents can be used in both direct and indirect antiglobulin tests.
Anti-human globulin (AHG) reagents are used in pretransfusion compatibility tests to detect the presence of red blood cell antibodies or to type blood group antigens. AHG reagents work by binding to antibodies that coat red blood cells, which causes the cells to agglutinate. Uncoated red blood cells will not agglutinate.
false pos..
false neg…
false pos:
-pos DAT/complement fixed
-over centrifuging/reading
-septicemia/bacteria
-Whartons jelly in cord
false neg:
-inadequate washing: ahg neutralized, ab eluted
-prozone
-dilution w/saline, didn’t add reagent
-over/under centrifugation/incubation
The indirect Coombs test detects antibodies that are floating freely in the blood.[1] These antibodies could act against certain red blood cells; the test can be carried out to diagnose reactions to a blood transfusion.[1]
The direct Coombs test is used to test for autoimmune hemolytic anemia, a condition where the immune system breaks down red blood cells, leading to anemia. The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells.
IAT time, temp
DAT temp
IAT 15-60min (w/out LISS) at 37, wash
DAT wash cells first, then add poly, IS
-if neg sit RT
3 drugs that cause false pos DAT
1 drug doesn’t
penicillin, cephalothin
methyldopa
aspirin wont
Common Rh antigen that warm autoab directed against
e
Ab screen/ID rxns…
-same strength in 1 phase…
-varying strength…
-rxn diff phases…
-all cells in AHG, AC pos…
-all cells in AHG AC neg…
-all cells at 37, neg AHG, AC pos….
-no rxn in screen/ab panel but xmatch incompatible….
-only rxn in AHG and PT anemic, AC pos….
Ab screen/ID rxns…
-same strength in 1 phase…single ab
-varying strength…multiple ab
-rxn diff phases…warm, cold
-all cells in AHG, AC pos…warm auto
-all cells in AHG, AC neg…high frequency ag
-all cells at 37, neg AHG, AC pos….rouleaux
-no rxn in screen/ab panel but xmatch incompatible….low freq ab
-only rxn in AHG and PT anemic, AC pos….warm auto HA
Procedure to remove ab bound to sensitized rbc…cannot remove….
Procedure to separate multiple ab…
elution, cannot remove complement
multiple=adsorption
AET/DTT, ZZAP, 2ME all are….and….
sulfhydrl reagents, inactivate
Hep most common cause of transfusion
optional/not option lol
hep C
antiHBc
Two things in polyspecific, 1 not
IgG, C3d
NOT b
First thing you do after stopping transfusion rxn
DAT on post transfusion sample
ABO HDN
-mom type
-1st?
-rbc type
Rh HDN
-mom, baby type
-1st?
-rbc type
ABO HDN
-mom type: Grp O
-1st? yes
-rbc type: sperocytes
Rh HDN
-mom, baby type: mom Rh neg, baby Rh pos
-1st? 2nd
-rbc type: retics
*strong DAT
Prenatal workup includes…
what to do after ab in screen…
abo/rh, screen
titrate ab after id
Rho(D) immune globulin (RhIG) is a medication used to prevent RhD isoimmunization in mothers who are RhD negative and to treat idiopathic thrombocytopenic purpura (ITP) in people who are Rh positive.[2] It is often given both during and following pregnancy.[2] It may also be used when RhD-negative people are given RhD-positive blood.[2] It is given by injection into muscle or a vein.[2] A single dose lasts 12 weeks.[2] It is made from human blood plasma.
RhIg…
protects…with….
Give to Dneg mom…b4 or ….after
titer less than 8 to post partum Rh candidate might be…
RhIg
protects 30mL fetal blood with 300microg
28wks before
72hrs after
Dneg mom to Opos baby
if titer <8 postpartum, not ab but antepartum admin of RhIg
0=no cell
1=C
2=E
y/z= CE
’ =C
‘’ = E
Kell antigens
Kidd antigens
Kell:
K, k
Kp(a,b)
Js(a,b)
Kidd:
Jk(a,b,3)
Window period
Early recovery, convalescent phase ab
Window: antiHBc
Convalescent:AntiHBc, antiHBs
Stored blood, pH?
Decreases, lactic acid
Immune serum globulin given for _______________ and ______________ are examples of passive immunization.
hepatitis exposure, RhIG
Examples of passive immunization are hepatitis immune serum globulin and Rh Immunoglobulin.
What is believed to be the cause of naturally occurring ABO antibodies?
Bacterial antigen exposure
The presence of naturally occurring ABO antibodies is believed to be the result of exposure to bacterial antigens that share structural similarities with ABO blood group antigens. This exposure can occur through various means, such as infections or the consumption of certain foods. As a result, individuals who have never been transfused or pregnant can still have detectable levels of ABO antibodies in their blood.
Which immunohematology test is used to detect antibody bound to red cells in-vivo and uses the AHG reagent?
Direct antiglobulin test
The direct antiglobulin test (DAT) is used to detect antibody bound to red cells in-vivo.
Which theory regarding Rh suggests that each parent contributes one Rh gene but the expression of Rh system antigens on red cells is determined by alleles at one gene locus?
Weiner, One Weiner
The Weiner theory states that each parent gives one Rh gene but alleles at one gene locus are responsible for the expression of their system antigens on the red cell.
Red cells from donors are stable up to…in…
stable up to 42 days in additive solution.
After collection in a primary anticoagulant, red blood cells are separated from plasma. They are further modified, which includes leukocyte reduction and additive solution is added to the red cells. This extends to life of red cells to 42 days stored at 1-6°C.
What is the leading cause of transfusion-related death reported to the FDA?
TACO (Transfusion-associated circulatory overload)
TACO is a leading cause of transfusion-related death reported to the FDA for fiscal year 2019 (for years 2015-2019).
When bringing in a new test to the blood bank/transfusion service, what must be done with the assay prior to its use for patient/donor testing?
Validation refers to the process of ensuring that a test or procedure is reliable, accurate, and meets its intended purpose. It is a critical component of quality assurance and is essential to ensure the safety and effectiveness of blood transfusion therapy. The validation process involves establishing and documenting evidence that a test or procedure consistently produces results that are accurate and reliable, and that meet the intended specifications. This may involve testing different samples, using different equipment, and comparing results to a known standard.
Which of the following are examples of immune-mediated, acute adverse complications of blood transfusion?
Febrile non-hemolytic reactions result from accumulated cytokines in the blood product.
When may GVHD occur?
GVHD may occur after a bone marrow or stem cell transplant in which someone receives bone marrow tissue or cells from a donor (an allogeneic transplant).
Febrile and allergic reactions are examples of what type of transfusion reaction?
Febrile and allergic transfusion reactions are examples of non-hemolytic reactions.
In blood banking, what does market withdrawal mean?
A market withdrawal in blood banking is defined as the manufacturer’s removal of products from the market that may compromise the safety of the recipient. The supplier will provide additional testing along with the reason for withdrawal.
Pre-storage leukocyte reduction has been shown to reduce the transmission risk of _________.
Cytomegalovirus (CMV)
Reduce WBC before they release cytokines thus decrease febrile nonhemolytic trans rxn, HLA alloimm, and CMV
Leukocyte reduction is done pre-storage on virtually all cellular components. This reduces the number of white cells to ≤ 5x106. Leukocyte reduced products are considered CMV safe.
Aphresis, filtration
What are the minimum years of retention on records relating to therapeutic apheresis?
The record for therapeutic apheresis should be kept for a minimum of 5 years.
What is one method to remove reactivity from a cold antibody?
Rabbit erythrocyte stroma (R.E.S.T) is a commercial reagent produced to adsorb cold-reacting antibodies from patient plasma/serum that have I or IH specificity.
Also prewarming and cold adsporption
IgG antibody complexes on red blood cells can be dissociated and placed in a solution to test specificity. What process is this?
Elution is a process in which you dissociate the IgG antibody complexes on red blood cells.
Break ag/ab bond to release ab into sln/eluate.
-test eluate to find ab in pos DAT due to IgG/not complement
-Lui freeze/thaw and heat for ABO ab
-Acid/organic solvent for auto/allo warm ab
-last wash as control to make sure red cells were washed to remove residual ab
-test last wash/supernatant before elution or in parrallel
Which blood product would be best for a patient at risk for Transfusion Associated Graft-vs-Host Disease?
Irradiated red blood cells
A patient at risk for Transfusion Associated Graft-vs-Host Disease would benefit from irradiated red blood cells of cellular products inactive viable lymphocytes. This prevents engraftment of donor lymphocytes into host tissues.
Fresh frozen plasma (FFP) contains coagulation factors, including labile factors V and VIII. What does the term labile mean?
Does not store well at temperatures above -18 °C.
The term labile means that the proteins are easily altered. For this reason, plasma must be stored at cold temperatures to ensure the integrity of coagulation factors. Once thawed, it can be called fresh frozen plasma for up to 24 hours after thaw. The product must then be changed to thawed plasma, which has a five day outdate from the time of thaw.
Granulocytes may be harvested from whole blood by apheresis. They are used for the treatment of neutropenia.
Granulocytes are used to treat prolonged neutropenia with intensive chemotherapy for hematologic malignancies or in the setting of hematopoietic stem cell transplants. They must be transfused within 24 hours of collection.
What are the steps of the transfusion process?
Recipient identification, sample identification, order verification, choose component and prepare, issue product from blood bank, verify recipient at bedside, and begin transfusion
The transfusion process begins with the recipient identified and arm banded when order is received. The blood bank also verifies sample, chooses correct component, and performs crossmatch or other preparation. The product is then issued from the blood bank to the transfusionist, who must also do a recipient verification process at the bedside prior to beginning transfusion.
Cryoprecipitated AHF is stable for one year frozen and can be used to treat hypofibrinogenemia.
Cryoprecipitated Antihemophilic Factor (cryo) is a portion of plasma rich in clotting factors, including Factor VIII and fibrinogen. It is mainly used to replace fibrinogen, but also can be used to treat von Willebrand disease and hemophilia when factor concentrates are unavailable.
Immunoglobulin (Ig)
Immunoglobulins, commonly abbreviated as Igs, are glycoprotein molecules produced by plasma cells (a type of white blood cell). They play a pivotal role in detecting and binding to antigens (foreign substances that trigger an immune response), such as bacteria and viruses. Immunoglobulins are the physical manifestation of antibodies, serving as the basis for the immune system’s ability to recognize and remember pathogens.
Antibody
An antibody refers to the immune system’s response to an antigen. In essence, antibodies are a subset of immunoglobulins that are specifically produced in response to and counteract a specific antigen. They are the “soldiers” that seek out and mark pathogens for destruction by other immune cells.
Genotype and phenotype are terms used in genetics to describe an organism’s hereditary information and observable properties:
Genotype
An organism’s genotype is its unique combination of alleles for a specific gene, which it inherits from its parents.
Phenotype
An organism’s phenotype is the physical traits or characteristics that result from its genotype interacting with its environment. These traits can include an organism’s appearance, development, and behavior.
Hep B ag/ab
1)HBs Ag early acute
2.)HBe Ag very infective
3.)anti HBc acute, window
4.)anti HBe
5.)anti HBs recovery, vaccine
Tube test:
-ab attach to ag on RBC, bridges, agglutination/hemolysis
Gel test:
-plastic microtube w/dextranacrylamide gel acts as a sieve
-large agglutinates stay at top
-position indicates strength of rxn
-neg is button at bottom
-more sensitive, rxn stable 2-3 days-no washing or CC
Solid-phase:
-microplate w/RBC membranes bound to surface of wells
-abs in sample attach to RBC ag on surface of well
-unbound ab removed washed, antiIgG labeled indicator RBCs added
-indicator rbcs adhere diffusely to surface of well
-Neg is button
Grading Rxns
tube:
4+ One solid
3+ several large
2+ medium
1+small, turbid
MF some agg, sea off free
gel:
4+ solid band at top
3+ band at top w/few staggered below
2+ agg throughout
1+ mostly in lower half, some at bottom
MF layer of agg at top and pellet of unagglutinated at bottom
Neg well defined pellet of unagglutinated at bottom
Enhancement
Albumin:
- 22% bovine serum
-reduces neg charge to come closer and promotes agglutination
LISS:
-low ionic strength sln
-lowers ionic strength allowing ag/ab to move closer
-accelterates ab binding to red cells and reduces incubation time for IAT
Poly-thylene-glycol:
-increases ab uptake
-accelerates by excluding water molecules
-ID weak IgG ab
Enzymes:
-reduce rbc surface charge
IMMUNE RELATED TRANS RXN: antibodies
Acute meaning w/in 24hrs of transfusion
HEMOLYTIC…
Acute Intravascular Hemolysis:
-ABO ab during transfusion, serious
NONHEMOLYTIC…
Febrile:
-anti-WBC ab/cytokines
-temp increase 1C/2F in 1hr
-use leukoreduced
Allergic Mild:
-preformed IgE to donor plasma proteins
-hives uticaria
Allergic Severe:
Anaphylactic:
-anti-IgA reacts w/IgA in donor plasma, IgA def PT, lung edema
-washed RBCs
TRALI:
-Acute, respiratory insufficiency, edema
-donor ab in their plasma to neutrophils or HLA ag in recipient
NONIMMUNE RELATED: not antibodies
Sepsis: bacteria, decreased BP, shaking, RT PLTs
TACO: too much vol, kids/elderly; cyanosis, pulmonary edema
-most deaths
Hemolysis: temp/meds destroy rbcs, increased hmg in urine/blood
hypothermia: cold blood, too fast, cardiac arrthymia
DELAYED IMMUNE
-Extravascular Hemolysis: Kidd ab, removes donor RBC, 2-14 days after due to amnestic response, pos DAT
-Alloimmunization: ab
-TA-GVHD: immunocompetent donor tlymphs attach immunocompromised recipient, also HLA ag different, pancytopenia/fatal, irradiate
DELAYED NONIMMUNE
-Iron overload
Transfusion Rxn workup
-fever, chills, respiratory, jaundice
-Pre/post blood/urine
-segment/blood bag
1.)Stop transfusion
2.)Check IDs, labels
3.)Repeat ABO
4.)Check hemolysis pre/post, hemolysis in post but not pre
5.)DAT post, if pos DAT pre
RhIg Workup
Prenatal:
-ABO/Rh , Rh pos not candiate for RhIg
-Ab screen: if pos and antiD, not able to get RhIg
Postnatal:
-ABO/Rh, weak D on baby; if Rh neg mom cant get RhIg
-Baby Rhpos: rosette test, is pos KB, stain pink
RhIg: antiD
-prevent immunization to D
-B4 w/in 28wks gestation
-After w/in 72hrs Rhneg mom, Rh pos baby
-1 dose of 300microg/30ml WB or 15ml RBC fetal maternal hemmorhage
Calculation of vials:
KB test
-count 2000 cells noting fetal vs maternal
-fetal cells/2000 x 5000 =vol fetal WB
-vol fetal WB/30=vials
QC BB
Temp: daily
-recorder, bath, heat block
Antisera/Reagent cells: daily
Alarms, Pipette: quarterly
Centrifuge timer: 3 mths
Centrifuge speed: 6mth, tachometer
Enzymes:
M/N/S/s and Duffy are all chopped down by enzymes
Dosage:
Kidd and Duffy the Rh Monkey eat lots of M&NSs
Kidd, Duffy, Rh
MNSs
NEUTRALIZATION/INHIBITION TESTS:
-soluble ag binds ab to inhibit rxn w/rbc
-can detect alloab that are masked by Lewis, P1, Sda, chido/rogers
INACTIVATION:
-Sulfhydryl reagents: AET, DTT weakens Kell
ZZAP/DTT: destroys Kell, MNSs, Fy
2-ME/DTT: destroy IgM, cleaves disulfide
-Choloroquine diphosphate
removes IgG from rbc for phenotyping
-Acid glycine/EDTA
dissociates ab, destroys Kell
ADSORPTION:
-separate multiple ab, remove autoav
-autoadsorption: pt serum/cells, used for transfusions greater than 3mths
-allogenic adsorption: Pt serum/other cells, can be used for trans less than 3 mths
ELUTION:
Elution is a process in which you dissociate the IgG antibody complexes on red blood cells.
Break ag/ab bond to release ab into sln/eluate.
-test eluate to find ab in pos DAT due to IgG/not complement
-Lui freeze/thaw and heat for ABO ab
-Acid/organic solvent for auto/allo warm ab
-last wash as control to make sure red cells were washed to remove residual ab
-test last wash/supernatant before elution or in parrallel
HLA not HTLA
Glycoproteins on cells surface that helps discriminate self/nonself, important in transplant
-Class I PLTs/nucleated
ABC
-Class II B lymphs
DP,DQ,DR
Can be seen in
-PLT refractoriness
-Febrile nonhemolytic
-TRALI
-GVDH
Used in
-see if suspectible to disease
-parentage
-forensic
HLA xmatch, lymphocyte xmatch
Antibodies with “high titer, low avidity” (HTLA) features
a. High frequency antigens that are generally c Hlinically benign (no HTRs or HDN) b. Chido, Rodgers most frequent 1) Complement components (C4)
c. Multiple others known 1) Knops (Kna), McCoy (McCa), JMH
d. Must be careful, because some antibodies with similar features may be significant (anti-Vel, anti-Yta)
Therapeutic phlebotomy
Remove WB due to hemachromatosis, Polycythemia vera and porphyria cutanea tarda
Which population in the U.S. has the highest frequency of the group B phenotype?
Question 137Answer
a.
Asian
The group B phenotype has a higher frequency in the Asian U.S. population.
What is likely the cause of incompatible results during an immediate spin crossmatch?
Question 141Answer
a.
Donor identification error
b.
E antibody
c.
K antibody
d.
Patient identification error
The major cause of immediate spin crossmatch is unexpected incompatibilities due to ABO typing errors due to patient misidentification.
What is one method to remove reactivity from a cold antibody?
Question 151Answer
a.
Rabbit erythrocyte stroma
b.
Repeat at 1° – 6°C
c.
Use only polyclonal AHG reagent
d.
Warm auto adsorption
Rabbit erythrocyte stroma (R.E.S.T) is a commercial reagent produced to adsorb cold-reacting antibodies from patient plasma/serum that have I or IH specificity.
What is one method to remove reactivity from a cold antibody?
Question 151Answer
a.
Rabbit erythrocyte stroma
b.
Repeat at 1° – 6°C
c.
Use only polyclonal AHG reagent
d.
Warm auto adsorption
Rabbit erythrocyte stroma (R.E.S.T) is a commercial reagent produced to adsorb cold-reacting antibodies from patient plasma/serum that have I or IH specificity.
When may GVHD occur?
Question 158Answer
a.
After an allogeneic transplant of bone marrow or stem cells
b.
After an autologous transplant
c.
Only if the donor is an identical twin
d.
When newly transplanted cells are accepted by the recipient
GVHD may occur after a bone marrow or stem cell transplant in which someone receives bone marrow tissue or cells from a donor (an allogeneic transplant).
Which blood product would be best for a patient at risk for Transfusion Associated Graft-vs-Host Disease?
Question 159Answer
a.
CMV negative cells
b.
Frozen red blood cells
c.
Irradiated red blood cells
d.
Leukocyte reduced
A patient at risk for Transfusion Associated Graft-vs-Host Disease would benefit from irradiated red blood cells of cellular products inactive viable lymphocytes. This prevents engraftment of donor lymphocytes into host tissues
Febrile and allergic reactions are examples of what type of transfusion reaction?
Question 161Answer
a.
Delayed-Hemolytic
b.
Hypotensive
c.
Infectious
d.
Non-hemolytic
Febrile and allergic transfusion reactions are examples of non-hemolytic reactions.
