amtbb 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
Vaccine defferments..
TB skin pos…
measles/mumps/rubeola/polio no symptoms..
Hep B…
Germen measles/chicken pox/ West Nile….
Vaccine defferments..
TB skin pos…no defferal if all else normal
measles/mumps/rubeola/polio no symptoms..2 wks
Hep B…3 wks
Rubella/Germen measles/chicken pox/ West Nile….4 wks
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…
exposure to hepatitis, malaria, HIV
-had sex/living with, tatoo/trans, hep B immuneglobulin, mucous/skin
->72hrs in jail
-completed syphillis/gonn treatment or reactive STS
-bitten by dog
Reason to be deffered 3yrs
asymptomatic from endemic area of malaria or had malaria before/completed treatment
Permnament deferral main reasons…
random reason…
Permnament..
-definete disease, habits high risk for hep/malaria/CJD,Babeosis,T.cruzi, HIV, HTLV
-Viral hep after age 11
-drug
-human growth hormone
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
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
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
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
Tja part of..
Cw/f part of…
U part of…
Tja/PP1PK part of P
Cw/f part of Rh
U part of MNS
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
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
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
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.
