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Blood Bank: Spring 2024 > Auto Immune Hemolytic Anemias > Flashcards

Auto Immune Hemolytic Anemias Flashcards

1
Q

Clinical findings of AIHA?

A
  • Positive DAT
  • Hemolysis
  • ABO discrepancy maybe
  • Schistocytes
  • Reticulocytes
  • Bilirubin
  • LDH
  • Hemoglobinemia
  • Hemoglobinuria
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2
Q

List AIHA diseases?

A
  • Cold agglutinin syndrome
  • PCH
  • Warm AIHA
  • Drug-dependent
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3
Q

Differentiating IHA questions to ask

A
  • thermal amplitude
  • benign vs pathologic
  • Ig class
  • complement fixation
  • titer
  • underlying disease
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4
Q

Complement binding capacity of warm and cold antibodies

A
  • Warm: may bind
  • Cold: binds complement
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5
Q

Warm antibody DAT results

A

IgG+
C3+ or -

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6
Q

Cold antibody DAT results

A

IgG-
C3+

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7
Q

Warm antibody hemolysis site

A

Extravascular

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8
Q

Cold antibody hemolysis site

A

Intravascular or extravascular

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9
Q

Warm antibody specificity

A

Frequently Rh

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10
Q

Cold antibody specificity

A

Frequently I or P

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11
Q

Warm auto-Ab clinical presentation

A

Exhausted
Anemic

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12
Q

Cold auto-Ab clinical presentation

A

Purpling of extremities

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13
Q

Describe benign cold-reactive Ab

A
  • Low titer
  • Enhanced with albumin and enzyme
  • IgM
  • Anti-I or anti-IH or anti-i
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14
Q

Describe pathologic cold-reactive Ab

A
  • Not common
  • High titer > 1000
  • Enhanced with albumin and enzyme
  • IgM
  • Anti-I or anti-P or anti-M
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15
Q

List benign cold agglutinins

A
  • anti-I
  • anti-i
  • anti-IH
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16
Q

What does anti-I react with?

A

Adult RBCs, NOT cord cells

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17
Q

What does anti-i react with?

A

Cord cells, NOT adult RBCs

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18
Q

What does anti-IH react with?

A

Does NOT react with A1, B, or AB RBCs

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19
Q

How to handle cold agglutinins

A

Prewarm immediate spin crossmatch and reverse type

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20
Q

List pathologic cold agglutinins

A
  • anti-I
  • Wide thermal range igM
  • Donath-Landsteiner anti-P
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21
Q

How to handle pathologic cold agglutinins

A

May have to perform 60 min settling technique to obtain negative results for reverse or screen

22
Q

How to test for Donath-Landsteiner anti-P?

A
  1. 0°C for 90 min patient serum
  2. 37°C for 90 min patient serum
  3. 0°C for 30 min
  4. 37°C for 60 min
23
Q

The most annoying about warm auto-Ab

A

They prevent serological ID of allo-antibodies because everything is reactive

24
Q

How to remove warm auto-Ab

A
  • Autoadsorption is best
  • Alloadsorption (ref lab)
  • Phenotype/molecular
  • Reduce enhancement to just saline and cells
  • Transfuse incompatible cells (bad idea)
25
Q

What’s the most annoying thing about drug-induced Ab?

A

They look like warm auto-Ab

26
Q

How to tell if you have hemolysis

A

Tea-like plasma color (dark)

27
Q

Mechanism of drug-adsorption

A
  • Drugs attach to RBC membrane
  • Anti-drug Ab causes RBC destruction (intravasc/extravasc hemolysis)
  • IgG, no complement (but RBC blown up)
28
Q

Which drugs feature drug-adsorption? List in highest to lowest severity

A

Highest
Cefotetan
Streptomycin
Penicillin
Lowest

29
Q

Drug-adsorption Ab detection in DAT

A

IgG+
C3-

30
Q

Drug-adsorption Ab detection in eluate

A

Neg

31
Q

Mechanism of immune complex drug Ab

A
  • Patient forms an antibody to a drug, and the Ab-drug complex absorbs onto RBC membrane
  • Complement activated that cause RBC destruction - “innocent bystander”
  • Complement, no IgG
  • Intravascular hemolysis only
32
Q

Which drugs feature immune complex formation?

A
  • Quinidine
  • Phenacetin
33
Q

Drug immune complex formation detection in DAT

A

IgG+/-
C3+

34
Q

Drug immune complex formation detection in eluate

A

Negative

35
Q

Mechanism of membrane modification Ab

A
  • Drug modifies RBC membrane so that IgG/IgM/IgA can attach
  • Non-immune process
  • No hemolysis
  • Rare/not fully researched
36
Q

Drugs involved in membrane modification Ab

A

Cephalosporin

37
Q

Membrane modification Ab detection in DAT

A

IgG+
C3+

38
Q

Membrane modification Ab detection in eluate

A

Negative

39
Q

Mechanism of drug-independent Ab

A
  • Mechanism unknown
  • Auto-Ab forms after 6 months of taking the drug and resolves gradually once stopped
  • Hemolysis mimics WAIHA
40
Q

Which drugs feature drug-independent Ab?

A

Alpha-methyldopa “Aldomet”

41
Q

Drug-independent detection in DAT

A

IgG+
C3+/-

42
Q

Drug-independent detection in eluate

A

Positive with all cells

43
Q

Mechanism of chemo drug Ab

A

The drug is an antibody that attaches to CD38 as its method of chemotherapy

44
Q

Drugs that feature chemo drug Ab

A
  • Darzalex (multiple myeloma patients)
  • -umab
45
Q

Chemo drug Ab detection in DAT

A

Weak positive DAT poly-AHG and IgG

46
Q

Chemo drug Ab detection in eluate

A

Positive with all cells and auto (Ab ID also has same results)

47
Q

How to remove chemo drug antigen (CD38 I think) to make the Ab ID negative?

A

DTT

48
Q

Transfusion/treatment recs for cold Ab

A
  • skip immediate spin testing
  • run slowly thru blood warmer
  • keep warm
49
Q

Transfusion/treatment recs for warm Ab

A
  • do not trust serological presentation
  • transfuse only to support cardio function
  • transfuse “least incompatible” blood slowly (in vivo crossmatch)
  • plasma exchange to remove Ab
  • steroids or IVIG to reduce immune response
  • splenectomy
50
Q

Transfusion/treatment recs for drug-induced Ab

A
  • transfusion recommended in most cases
  • plasma exchange may also help
  • stop taking drug
51
Q

What does IgM wide thermal range look like serologically?

A

Blood Bank: Spring 2024 (10 decks)

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