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Immunohematology > Blood Bank Immunology Principles & Application > Flashcards

Blood Bank Immunology Principles & Application Flashcards

1
Q

Immunology as it relates to Blood Banking

A

involves the immune response to transfusion of cellular elements containing antigens and/or antibodies

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2
Q

Immunohematology

A

the study of blood group antigens and antibodies

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3
Q

Blood Banking

A

originally referred to as the storage of blood and blood products for later transfusion

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4
Q

Transfusion Medicine

A

medical field that deals with the transfusion of blood and blood products

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5
Q

Innate Immunity Overview

A

includes phagocytic cells, chemical mediators, and promotion of the inflammatory system
NO MEMORY

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6
Q

Physiologic responses leading to inflammation

A

vasodilation: increased blood flow & increased temp
edema: increased capillary permeability w/ an increase in fluid
phagocyte migration into tissue

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7
Q

Symptoms following transfusion

A

most common - raised, red, itchy skin rash (urticaria)
swelling of hands, feet, arms, etc
dizziness
headaches

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8
Q

Acquired immunity overview

A

specific immune response w/ memory involving antibodies and complement etc

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9
Q

immunogen

A

any antigen that causes a detectable immune response

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10
Q

epitope

A

part of an antigen that is recognized and bound by specific antibody

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11
Q

haptens

A

low molecular weight molecules that are only antigenic when combined with a carrier

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12
Q

relative antigenicity

A

proteins > CHO > lipids /DNA
glycoproteins > CHO
lipoproteins > glycolipies > lipids

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13
Q

Immunogenicity

A 
more foreign 
3D structures
over 10,000 daltons
greater the dose
intravenous > other routes of administration
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14
Q

Red Cell antigens

A

over 250

proteins (RhD), CHO (A,B) or glycolipids (P family)

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15
Q

Platelet Antigens

A

90% of platelet antibodies are to HLA proteins on the surface of platelets
10% are to platelet proteins
can cause post transfusion purpura in which the platelets are destroyed following transfusion

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16
Q

Relevance of IgG antibodies

A

IgG can cross the placenta! & can cause destruction of fetal RBC in HDNB

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17
Q

Anamnestic Response

A

also called the secondary immune response - the characteristic short lag phase that occurs within 1-2 days of exposure
bc of memory cells from primary exposure, the concentration of circulating antibody is much higher (IgGs)

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18
Q

RBC antibody production

A 
depends on : 
person must lack the antigen
immunocompetence 
survival of antigen in circulation
antigenicity of the antigen
number of antigenic exposures
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19
Q

‘Naturally Occuring Antibodies’

A

present in people not sensitized by RBC antigen exposure

produced by environmental substances that contain antigens similar to RBC antigens

20
Q

Immune-Stimulated Antibodies

A

produced in response to exposure to specific RBC antigens through TRANSFUSION or PREGNANCY
most are IgG
most common are Rh, Kell, Duffy, Kidd, and Ss

21
Q

Affinity

A

the binding between a single antibody and epitope of an antigen

22
Q

affinity is effected by

A

goodness of fit (size & shape)

strength of molecular forces leading to binding

23
Q

avidity

A

overall strength of reactions between antigen-antibody complexes

24
Q

avidity is effected by

A

valency of antibody

affinity

25
Q

Antigen-antibody reactions

A

high Ag & Ab drives reaction forward (form complexes)
low Ag & Ab drives the reverse reaction
when Ab is IgG - at 37 AgAb complexes are favored
when Ab is IgM - at 25 AgAb complexes are formed

26
Q

hemagglutination

A

agglutination of RBCs to form a visible clump
antibodies bind to antigens on RBC surface
0, +/-, 1+,2+,3+.4+

27
Q

RBC hemolysis

A

occurs when complement is activated, membrane is damaged, intracellular fluid is released & supernatant becomes red

28
Q

Sensitization phase

A 
first stage of in vitro antibody antigen binding
usually not visible
influenced by : 
cell: serum ratio
temp
incubation time
pH & ionic strength
29
Q

Effect of Temperature

A

cold antibody vs warm antibody

30
Q

effect of pH

A

6.5-7.5 is usually best some antibodies (anti-M) react better in more acidic pH

31
Q

effect of Incubation time

A

longer time enhances lattice formation

32
Q

effect of ionic strength of medium

A

reducing ionic strength by using LISS will enhance some antigen-antibody reactions

33
Q

second stage of agglutination

A

formation of aggregated RBCs or lattice formation that are visible
important factors :
immunoglobulin class
# of antigen sites on RBCs
location & proximity of antigen sites on RBC
zeta potential

34
Q

Zeta Potential

A

force of repulsion between RBCs in a normal saline suspension
RBC have - charge & + cations form an ion cloud around RBC preventing 2 RBCs from getting close enough to agglutinate
LOWER zeta potential = better

35
Q

Enhancing Agglutination in vitro

A

physical methods & enhancement media/ potentiators

36
Q

physical methods of enhancing agglutination

A

centrifugation
temperature
pH
AHG

37
Q

Potentiators for enhancing agglutination

A

PEG
LISS
Albumin
Enzymes

38
Q

Anti-Human Globulin(AHG)

A

anti-human antibodies bind to sensitizing globulin antibodies and form bridges between antibody coated red cells resulting in visible agglutination
strength of reaction is proportional to the amount of globulin coating the RBC

39
Q

DAT: direct antiglobulin testing

A

looks for antibody bound ‘in vivo’
for hemolytic immune diseases
looks for anti-IgG & anti C3b/d

40
Q

IAT: indirect anti-globulin testing

A

looks for antibody bound ‘in vitro’ - detect IgG bound to RBC in vitro
read for agglutination

41
Q

Antibody Detection

A

uses screening cells to detect antibodies w/ specificity to RBC antigens

42
Q

Antibody ID

A

IDs specific RBC antibodies

43
Q

Crossmatch

A

determines serologic compatibility between donor and patient

44
Q

Antigen typing

A

IDs specific RBC antigen in patient or donor

45
Q

sources of false positive results

A

contaminated specimen or inappropriate specimen
over-reading
spontaneous agglutination
sample storage
can be caught through the use of an autocontrol

46
Q

sources of false negative results

A 
failure to adequately wash cells
delay in reading
under reading 
excessive shaking of tube
inoptimal temperature 
can be caught through the use of check cells (IgG sensitized RBCs)
47
Q

IgG Sensitized cells : Check Cell

A

ensures all negative AHG tests that in fact AHG was added, cells were washed sufficiently, & AHG would be able to react
CHECK CELLS SHOULD GIVE A POSITIVE reaction

Immunohematology (16 decks)

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