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Blood Bank/Transufsions > Blood Bank from Osler > Flashcards

Blood Bank from Osler Flashcards

1
Q

Stronger agglutination IgM vs IgG?

Extravascular hemolysis raises what lab?

What are the two Antiglobulin reagents used?

A

IgM agglutinates more (Pentamere)

Bilirubin

Anti-IgG and C3d: polyspecific

Anti-IgG and be poly or mono

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2
Q

If no agglutination what must be done?

A

Check cells; RBCs with IgG attached to them

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3
Q

Which ABO groups Enhance with enzymes?

Decrease?

Unaffected?

A

“A Rotten Kid”: ABO/H, Lewis, I, P, Rh, Kidd

Decreased: “My Dog Lassie” MNS, Duffy, Lutheran

Unaffected? Kell, Diego, Colton

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4
Q

Anti-P1 neutralized by?

Anti lewis?

Anti-Chadio and Rodgers?
Anti-Sd?

Anti-I?

A

P1; Hydadid cyst fluid, prigeon dropping, turtledoves egg white

Lewis: Plasma or serum, saliva

Chadio/Rogers: Serum (complement)

Sd: Urine

I: Human breast milk

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5
Q

What lechtin binds A1?

B?

O and H?

N?

T?

T, Tn?

Tn?

A

A: Dolichous biflorurus
B: Banderiraea simplicifolia

O: Ulex europaeus

N: Vicea gramlnea

T: Arachis hypogea

T/Tn: Glycine Max

Tn: Salvia

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6
Q

ABO Chr, Rh?

Warm antibodies are IgG or M and do they cause HDFN or HTR?

A

ABO 9; Rh 1

IgG and do cause HDFN and HTR

Cold tends to be IgM and “natural” BUT EXCEPTION IS ABO!!!

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7
Q

Type 1 or 2 most common on red cells?

Type 1 chain has what type of linkage, seen in?

Type 2 linkage, seen in?

What gene adds FUT to type 2 to make H; Type 1?

A

Type 2

Type 1; Beta 1-3 linkage; Gal to GalNAc; seen in secreations glycoprotein/glycoplipids

Type 2: Beta 1-4 Gal-GalNAc; RBC membrames and glycolipids

FUT1 added to type 2 makes H antigen (RED CELLS); FUT2 adds Fuctose to Type 1 (SECRETING CELLS)

FUT1 found on ~100% of people and FUT2 in 80% of people

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8
Q

Blood group A has fuctuose on what sugar?

B?

Which group has the most H?

Least H?

A

A: GalNAc conntect to Gal with Fructose
B: Gal to Gal with Fructose

Most: O (Auto recessive), Least: AB

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9
Q

Do ABO antibodies deacrease during life?

Which Anti-A, B, AB antiboies are IgG, why do we care?

Most common blood types?

A

Yes; drops in elderly

Anti-A, and Anti-B, Not anti-A,B; CROSS PLACENTA

O>A>B>AB

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10
Q

Percent of group A1 and A2?

Why do we care?

What lectin can be used to detect this?

A

80% A1; 20% A2

Anti-A1 at 37 degrees can cause reaction to A blood

Dolichos biflorus detects A1 but not A2

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11
Q

Reasons that Forward cell grouping does not equal serum grouping?

A

ABO Subgroups

Transfusion

Transplant

Acquired B (AB patient with bacterial infection)
Polyagglutiniation

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12
Q

What is acquired B?

Associated with?

Forward and reverse type?

A

A1 RBCs contact enteric gram negative organisms; End GalNAC deacytylated to Gal-amine similar to B

AW: Colon cancer, GI obstruction, gram - sepsis

Forward: AB (strong A and weaker B), Reverse A

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13
Q

What phenotype lacks H?

What gene is missing?

Forward and reverse screen?
What is Para-Bombay?

Both need?

A

Bombay (Oh); NO H, A or B

Lacks FUT1 (H) and FUT2 (Secretor)
Forward O, Reverse: O; Screen: POSITIVE

Para-Bombay: Ah, Bh, ABh, Nonfunctional FUT1, at least one Functional FUT2, may have Anti-H

H negative blood

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14
Q

What gene makes the Lewis?

What makes the Lewis system different from other Blood groups?

Is it clinically significant, what type of antibody?

Neutralized by?

Who tends to lack Lewis antibodies?

A

FUT3 makes lewis (Lewis A; not secreted); FUT2 secretor can make lewis b (secreted)

Lewis is Adsorbed; LeB is better than A; Adults normally Le(a neg, b positive)

Not really significant, IgM

Secretor saliva

Blacks

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15
Q

H. Pylori and Norwalk virus attach to what antigens?

Le A and B negative kids susceptibilitiy increased to?

A

H and Le b

E. Coli and UTIs

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16
Q

I system has what type of chains?
Who is I and i seen in?

Auto-I seen in?
Auto-i seen in?

A

ABO type 2 chains; related to chain complexity
I: Adults (branced) i: babies (linear)

Big I in big people

Auto-Anti-I: Myoplasma pneuomonia and cold agglutinin

Auto-Anti-i: EBV

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17
Q

What receptor is for Parvo B19?

Why do we care about this group?

What is paroxysmal cold hemoglobinuria association?

How to collect tubes?

A

**P

Care:**
99% patients are P1+, 1% P2 and have anti-P1 antibody which can cause Acute HTRs and spontaneous abortions

Biphasic IgG hemolysin from Auto Anti-P; Syphilis and viral infection
Collect at 37 degrees C; lyses at room temp

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18
Q

What antigens are in Rh blood group?

Chr?

Common cause of D negative?

Capital R indicates, little r, and 1 or ‘ and ‘’?

A

D, C, E, c, e; Rh+=D

1

Deletion

R/r=D or d

1 or ‘: C

2 or ‘’: E

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19
Q

What race is more common to be R zero (Dce)?

Who has more R1 (DCe)?

A

(Dce) seen in Blacks and less common whites

R1 most common in whites (DCe) and least common in blacks

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20
Q

Rh antibodies IgG or M?

What percent of Rh- who get Rh+ make antibody?

Why do we care?

A

Warm IgG

20-30% with single unit of RBCs

Severe HDFN, extravascular

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21
Q

What is weak D?

What is partial ?

A

Weak: D detected at IAT and 37 degree C and not at immeidate spin or 37 degree!

Partial: Lack soem D epitopes; may have Antibodies to missing parts: Might need molecular testing; test as Rh positive but give Rh+ blood and they develop Anti-D

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22
Q

Rules of B’s?

What does Kidd antibodies do?

Why do we care about Kidd?

A

If you have an A antigen and B antigen; the B is more common EXCEPT IN KIDD!

More exposure means more/stronger antibodies!; IgG and IgM that fixes complement?

Reaction/antibody to Kidd can disappear until given blood then HEMOLYTIC REACTION

23
Q

MNS seen on?

Why do we care?

Lectin?

A

Glycopherin A (M and N) and B (S, s,, U)

<1% of blacks are S-s-U- so sickle cell patients; Get Anti-S, s, and U which cause hemolysis

Vicea graminesia acts as anti-N

24
Q

Duffy is negative in what population?

IgG or M antibodies?

Big worry?

A

Common Duffy NEGATIVE in blacks (so have anti-body) and rare in caucasians;

Duffy glycoprotein is receptor to P. Vivax; Fy (y close to V mnemonnic)

IgG

Delayed HTR

25
Q

Big K present in and little k?

What is Xk?

Is anti-K common?

What is Kell null (K0)

A

Big K: 9% white, 2% black Little k: 99.8%

Xk protein express Kx blood group antigen and closs to K antigens on RBC surface

Anti-K: second most antigenic after anti D; Exposure requring warm IgG, Severe HTR and HDFN

Anti-k: Like anti-K but only 0.2%

K0: Lacks kell antigens an dhas Anti-Ku; needs Kell null individuals

26
Q

What is Mcleod syndrome, and inheritience?

Caused by?

Why do we care?

A

X-linked recessive

Acantholytic hemolytic anemia, Chronic granulomatous disease association

Abscense of Kx antigen and decreased Kell antigens

Transfused patients make anti-K and anti-Kx making it impossible to find donors

27
Q

Blood sugar that defines Blood group A?
B?

H?

A

A: N-acetyl-D-galactosamine

B: D-galactose

H: L-fucose

28
Q

Who regulates blood banks?
Who accredits them?

A

FDA regulated, AABB accredits

29
Q

Donation dates (from last):
Whole blood?
DRBCs?

Infrequent plasmapheresis?
Single apheresis?

Double/Triple apheresis?

A

Whole blood: > or equal 8 weeks

DRBC: > or equal 16 weeks
Infrequent plasmaphoresis: > or equal 4 week

Single apheresis: > or equal 48 hrs.

Double/Triple: > or equal 7 days

30
Q

Permanent deferals, viruses?

Graft of what, meds?

Babesiosis/Chagas?

A

**HIV (IVDA); Paid for sex/drugs, Human GH pre 1985 (from cadavers), HBV, HCV, HIV, HTLV

DURA MATER GRAFT, BOVINE INSULIN from UK, Teratogens, Etretinate (Tegison)**

As of 2017 no longer permanent

31
Q

3 year deferals:
Disease?

Teratogen?

A

History of malaria

Residence in malaria endemic country for longer th an 5 years

Acitretin (Soriataine)

32
Q

Some 12 month deferals (remember not perm or 3 years)?
Note: Put in place a long time ago

A

Needle stick, sex with HIV/Hepatitis patients, Sex with IV drug uder, Incarcerate >72 hrs, PAYING money/drugs sex

Blood transfusion, allogenic organ/skin/bone transplant, living iwth person with active Hepatitis​

Receiving HBIG

Tattoos/piercings (unless by state regulated entitiy)
Travel to malaria country (< 5 years), Syphillis or gonorrhea (after tx)
MSM

33
Q

Can a person with a malignancy donate?

Heart lung disease?

Pregnant women?

CJD deferrals?

A

Director discetion

Director discretion

Preg: 6 weeks postpartum

CJD: Complex but 3 months to 5 years from 1980’s and lead to deferals

34
Q

No deferral (long list)?

Deferral 2 weeks (memorize these)?

A

Toxoids, synthetic or killed viral, bacterial rickettsial vaccines if donor sympthom free and febrile

Many vaccines; Recombinant vaccine, live intranasal attenulated flu, Anthrax, cholera, diptheria, Hep A/B, Influenzsa, Lyme, Parathphoid, Pertussis, Plague, Pneumococcal polysaccharide, Polio injection, Raabies, Rockey mountain spotted fever, tetanus, hyphoid (injection)

Deferal: Measles (rubeola), Mumps, Polio (Sabin/oral), Typhoid (oral),m Yellow Fever, Receipt live attenuated viral or bacterial vaccine

35
Q

4 week deferals for vaccine?

12 months unless Med director clears?

A

4: Receipt of live attenu ated viral and bvacterial vaccines, German measles (rubella), chicken pox/shingles (varicella zoster)
12: Other vaccines including unlicensed

36
Q

30 day medication deferals?

60 days:

Plt agents 48 hours?

2 weeks?

A

Isotretinoin (absorica, accutane, etc)
Finasteride (Proscar, propecia)

6 months: Dutasteride (Avodart, Jalyn)

Flowmax is not a deferral

48 hrs: Asppirin, and aspirin medications

2 weeks: Clopidogrel, Ticlopidine, Vorapaxar

37
Q

Deferral for heparin and warfarin?

Direct thrombin inhibitors Dabigatran, Direct Xa ihibitors (riveroxaban)?

BCC meds Vismodeg and Soniderib

Xenotransplant?

A

7 day deferral

2 days deferral

BCC: 24 months

Xenograft: Indefinite

38
Q

To donate:
Minimum weight?

Temperature below?
Pulse?
BP?

Hemoglobin/Crit?

A

110 lbs (50 kg)
<99.5 F (37.5 C)
50-100 bpm or MD discretion on call
BP: 90-180/50-100 mmHg (MD can be on site to approve discretion)

Female: 12.5 g/L, 38%

Male: 13.0 g/dL, 39%

Arm check for puncture sites

39
Q

Allogenic:

What is a successful RBC collection volume?

Time limit to collect?

Min age, max age to donate?

Can AUTOLOGOUS donor be used for general population?

T/F auto donation has less reactions?

A

500 +/- 50mL or 450+/- 45 mL

AABB BB/TS max 10.5 mL/kG; 8 week deferral

Trick: NO TIME LIMIT; >15-20 min not great for plt and plasma

16 is min or state law; no max

Auto: NO!!; Hgb/Hct: 11.0 Hb and 33%
FALSE; have more

40
Q

Plt donor criteria, Hgb?

Time between single donation?

Double/Triple?

Max donations in a year?

Min plt count?

A

Hg is the same as for RBC 12.5 males, 13.0 female
Single: 48 hrs
Double/Triple: 7 days (most cases)

No more than 2 collections a week and 24 a year

150,000/uL

41
Q

Plasma donor’s: Infrequent vs serial?

Double red cell deferal after donation?

A

Infrequent: Less than every 4 week anda less than 12.0 or 14.4 L in people >175lbs per year

16 weeks

42
Q

What do you need if there is a rxn during donation?

If donor has bruise/hematoma are they deferred?

Tx?

A

Documentation and through investigation!

Common and more common with apheresis; does not prevent future donation, 0.3-1%

Tx: 24 hrs cold pack, warm compress after 24 hrs and NSAIDS, if bad ED

43
Q

Donation nerve injury, is it common?

Symptoms?

Tx?

A

No! 40% of cases are easy phlebotomy; 0.9% of donors

“Shock” down arm
Most transient, 7% 3 to 9 months and give donor offer to see other docs.

44
Q

Donation signs of arterial puncture?

Tx?

Incidence?

A

Rapid filling of bad with BRIGHT RED BLOOD, pulsatile needle, rapid expanding hematoma

Tx: Direct pressure and ice at least 10 min (time it); Wrap with Coban and check for radial pulse, advise to avoid stenuous activity

<0.001%

45
Q

What is a pseduoaneurym when doing donation?

Incidence?

Tx?

A

Hematoma from aterial pu ncture; not surrounded by aterial wall

MOST SERIOUS COMPLECIATION AFTER ARTERIAL PUNCTURE

0.1-0.4% of aterial punctures

Tx: Might need surgury to evacuate hematomas and thromboses

46
Q

Signs of donor vasovagal reactions?

Population who gets it?

Tx?

What to do if patient has a reaction?

A

Dizzy, sweating, nausea, vomiting, weakness, apprehension, pallor

Young, low blood volume, 1st time

Can go to syncope and have low pulse rate that needs to be seperated from volume depletion

Tx: Keep under observation and IV fluids if bad

Follow up

47
Q

Signs of low calcium during donation?
Tx?

Do you use paper bag in patients with hyperventilation?

A

Tingling (paresthesias); Tetany and arrythmias uncommon
Slow influsion and give oral calcium

No!

48
Q

Do donors get infections?

Signs of thrombophlebitis?

Tx?

A

Rare; can get cellulitis, give warm soaks and antibiotics

Thrombophelbitis: Linear red streak from or near puncture site, warm, red, and painful indicates infection

Tx: Heat and symptomoatic releif and abx if warm, red, and painful

49
Q

What is acute normovolemic hemodilution?

Store?

A

Remove whole blood (normally before surgury) and repalce with acellular fluid; benefit is reduces RBC loss due to dilution and can give RBCs later; Good for high blood loss procedure (1.5L or more)

Room temp; Plts and Coag factors are viable

50
Q

Advantage of cell salvage?

What about post op collecction from woulds, indications?

A

Gives patients “lost” blood back; reduces transfusions. Blood going back has Hct 45-60%

Can be done if enough blood; Cardiac and orthopedic surgery if volume 500 mL or more

51
Q

In Donor do you test for Weak (D)?

How many days to replace receipient’s blood for testing?

How long to keep if patient has been transfused?

A

Yes!; not needed to check in Recepient

Every 3 days if transfused or pregnant in last 3 months

Keep 7 days post transfusion

52
Q

Neonates under 4 months what do you test for pretransfusion?

Antibodies can be from?
How often to repeat ABO and Rh?

A

ABO but only Anti-A and B Forward only

Rh per procedure

Unexpected antibodies can be from mom or baby

REPEAT ABO and Rh may be omitted for rest of admission

Eliminate crossmatch if intial screen is negative

53
Q

When can you use electronic cross match?

Does the system need to be validated?

A

When no clinically significant antibodies have been detected by antibody tetection test and history review

Omit IS and AHG phase; ABO verified by electronic crossmatch

Yes validated

Blood Bank/Transufsions (5 decks)

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