Blood Banking Flashcards
The FIRST three numbers in ISBT nomenclature represents
Blood group system
The SECOND three numbers in ISBT nomenclature represents
Antigenic specificity
Chromosomal number of ABO gene
9q
HLA-related blood group antigen
Bennett-Goodspeed (Bg)
Bg (a), Bg (b), Bg (c)
Bg (a) = HLA-B7
Bg (b) = HLA-B17
Bg (c) = HLA-A28
Recessive genes are able to express themselves only when they are in
Homozygous form
Blood group antigens may be found in
RBCs
Body fluids
Secretions
Epithelial cells
First blood transfusion recipient
Pope Innocent VII
Universal blood donor
O-
Universal blood recipient
AB+
HIGH incidence antigens are called
Public antigen
LOW incidence antigens are called
Private antigen
Blood group antibody associated with severe HTR
ABO antibodies
Blood group antibody associated with severe HDN
Rh antibodies
Blood group antibody that is common cause of delayed HTR
Kidd (Jk) antibodies
Nature of ABO antibodies
IgG, IgM, IgA
Predominant immunoglobulin class of ABO antibodies
IgM
Frequency of ABO blood group system (most to least frequent)
O > A > B > AB
Antigen (s) found in Group A1 individuals
A1 and A
Antigen (s) found in Group A2 individuals
A only
Dolichos biflorus will agglutinate on what cell (s)
A1 and A1B cells
Bandeiraea simplicifolia will agglutinate on what cell
B cells
Ulex europaeus will react on what antigen
H antigen
A and B genes are present, Both A and B antigens are expressed on RBC. What principle
Law of codominance
Amorph gene
O gene
The gene is called an amorph because
No detectable antigen on RBCs
Possible blood type on an offspring of an AO and BO mating
A, B, AB, and O
Immunodominant sugar in the chain of A blood group antigen
N-acteyl-D-galactosamine
Immunodominant sugar in the chain of B blood group antigen
D-galactose
Immunodominant sugar in the chain of H blood group antigen
L-fucose
The H antigen is present on RBCs of what blood type
A, B, AB and O
Number of H antigen structures currently identified
4 (H1-H4)
Amount of H substance from greatest to least
O > A2 > B > A2B > A1 > A1B
Cells of approximately 80% of all group A individual are _____ and 20% are _____ or weaker subgroups
80% = A1
20% = A2
Homozygous genes (hh) cause the development of
Bombay phenotype
No agglutination with anti-A, anti-B, anti-H and autocontrol. What phenotype
Bombay phenotype
Antibodies possessed by a Bombay phenotype individual
Anti-A, Anti-B, Anti-H
Even without prior transfusion or pregnancy, Bombay individuals will always have
Anti-A, Anti-B, Anti-H antibodies
Blood group of an individual with acquired B phenomenon
Group A
Bacteria linked to acquired A phenomenon
Proteus mirabilis
Bacteria linked to acquired B phenomenon
Proteus vulgaris
Most complex blood group system in humans today
Rh
Rh phenotype frequent in Asians and Whites
R1 (DCe)
Rh phenotype frequent in Blacks
R0 (Dce)
Convert RZ to Fisher-Race nomenclature
DCE
Blood factors present in Rh0 individuals
Rh0, h’, h”
What antibody(ies) could and R1R1 make if exposed to R0R0 blood
Anti-c
What does “d” mean in the Fisher-Race nomenclature
Absence of D antigen
Rh phenotype with the HIGHEST number of D antigen sites
D–
Beta 1 to 3 linkage of the terminal galactose to N-acetylglucosamine of the precursor
Precursor type 1 chain
Beta 1 to 4 linkage of the terminal galactose to N-acetylglucosamine of the precursor
Precursor type 2 chain
Genes that affect the expression of the Le (b) in secretions
Le and Se genes
Effect of Lewis antibodies of a pregnant woman to the developing baby
No effect (Lewis antibodies are IgM)
Lewis phenotype in newborns <10 days old
Le (a-b-)
k (Cellano) is a high frequency antigen and is found on most RBCs. How often would one find anti-K
Rarely
What can be done if HDN is caused by maternal anti-K
Monitor the mother’s antibody level
What procedure would help to distinguish between anti-e and anti-Fy (a) in an antibody mixture
Run an enzyme panel
Null phenotype common in Filipinos, Indonesians, Japanese, and Polynesians
Jk (a-b-)
This antibody is found in black people who possess the S-s-U- phenotype
Anti-U
Antibody that gives a refractile mixed-field agglutination reaction
Anti-Sd (a)
Blood collected from an individual transfused into ANOTHER individual is called
Allogenic blood
Blood collection from the donor should be done within
15 minutes (7-10 minutes)
For preparing platelet components, blood collection should be completed within
12 minutes
Units requiring >15 minutes to draw may not be suitable for preparation of
Platelets
FFP
Cryoprecipitate
Cause of JET-LIKE PULSATING with bright red blood during donation
Arterial puncture
Who can bleed blood donors
RMT, MD, RN
53 y.o. woman donates blood; 150 lbs; hgb is 13 g/dL; on warfarin and vitamin B12. Accepted?
Yes, for red cells only
Woman has a miscarriage in her 4th month of pregnancy. What is the deferral period
None
Blood and blood products are considered _____ because of their use in treating diseases
Drugs
Blood to anticoagulant ratio in blood bags
7:1
If a blood volume collected from a donor is in the low volume range, what will you do
Label unit as a “low volume unit”
How much anticoagulant is removed from blood bag given a donor who weighs 90lbs
12 mL
If CPDA-1 is used, ___ mL of plasma can be removed from whole blood
200-250 mL
If freezing centrifuge is broken, how are packed red cells prepared
Sedimentation
Why does platelet concentrate need constant agitation
To facilitate oxygen transfer
Shelf-life of POOLED platelet concentrate
4 hours
How to prepare platelet concentrate from whole blood donation (RDP)
Light spin then heavy spin
HARD spin speed and duration for platelet concentrate preparation
3600 RPM, 5 mins
LIGHT spin speed and duration for platelet concentrate preparation
3200 RPM, 2-3 mins
Single donor platelets contain a therapeutic equivalent of _____ random donor platelets
4-6
Minimum number of platelets in a SINGLE donor platelet concentrate
3.0 x 10^11
Minimum number of platelets in a RANDOM donor platelet concentrate
5.5 x 10^10
Minimum pH requirement for platelet concentrate
6.2
Storage and viability of thawed FFP
1-6C for 24 hours
Plastic bag overwraps are used when thawing FFP in water baths because they prevent
Entry ports from water contamination
Blood component that helps reduce CMV transmission
Leukoreduced RBCs (CMV infects WBCs)
Radioactive source used to irradiate blood components
Celsium-137, Cobalt-60, X-ray
1 unit of whole blood increases HEMATOCRIT by
3-5%
1 unit of whole blood increases HEMOGLOBIN by
1-1.5 g/dL
The citrate in the ACD functions as
Anticoagulant
Prevents caramelization of dextrose when heated
Citric acid
Function of phosphate in CPD
Maintains pH and 2,3-DPG
Anticoagulant component that serves as substrate for ATP production (energy)
Dextrose / glucose
Function of adenine in the CPDA1
Improve survival of RBCs
% RBC retained after leukoreduction of a unit
85%
Process to restore depleted metabolites and improve function of RBCs
Rejuvenation
The only allowed (FDA approved) rejuvenation solution
Rejuvesol
Rejuvesol contains
Phosphate
Inosine
Pyruvate
Adenine
A plasma expander and a sedimenting agent in leukapheresis
HES (hydroxyethylstarch)
Position of blood bags when stored inside the refrigerator
Upright/vertical
Temperature of blood bank refrigerators
1-6 C
Temperature for transporting blood components
1-10 C
Shelf-life of blood bag stored in an ICE BOX during mass blood donation
8 hours
Shelf-life of blood bag stored in a HOUSEHOLD REF during mass blood donation
24 hours
% glycerol used in SLOW freezing of RBCs
40% (high glycerol)
% glycerol used in FAST freezing of RBCs
20% (low glycerol)
It contains albumin, factors II, V, VII, IX, X, XI and ADAMTS13
Cryo-poor plasma (cryosupernatant)
Concentrate that contains factors II, VII, IX, X
Prothrombin complex (Factor IX) concentrate
Cryoprecipitate + thrombin =
Fibrin glue
Blood component for individuals with Rosenthal syndrome
FFP
Transfusion of 1 unit of blood must be completed within ___ hours of transfusion
4 hours
Needle gauge for blood transfusion (AABB)
18 (24 or 25 for newborns)
Blood given in an emergency situation (no time to type for recipient’s sample)
Group O, Rh-negative pRBCs
Patient for blood transfusion. 6 units ordered STAT. No time to draw patient specimen. O- blood is released. When to do crossmatch?
When patient sample is available
Blood given for intrauterine and neonatal transfusions
Group O Rh-negative RBCs
While ABO-compatible units are preferred, it is okay to use ABO-compatible units with
Cryoprecipitate
Fetal specimen used to confirm HDFN
Cord blood
Test to determine if there is fetal blood in maternal circulation
Kielhauer-Betke test
Appearance of RBCs containing ADULT hemoglobin in the Kleihauer-Betke test
Pale pink (ghosts)
Appearance of RBCs containing FETAL hemoglobin in the Kleihauer-Betke test
Deep red
The final clerical check before blood transfusion is done by
Nurse (DOH) and/or attending physician
Transfusions of NEOCYTES is indicated for chronically transfusion-dependent patients such as in
Thalassemia
Neocytes have a _____ post-transfusion survival time
Longer
EXCHANGE TRANSFUSIONS are used to primarily to remove high levels of unconjugated bilirubin and thus prevent
Kernicterus
It involves removal of part of the circulating maternal antibody and removal of sensitized RBCs
Exchange transfusion
Blood for exchange transfusion be _____ old, CMV-_____ and should not contain _____
<7 days old
CMV-negative
No hemoglobin S
Blood units <7 days old are preferred to reduce risk of _____ and to maximize 2,3-DPG levels in newborns
Hyperkalemia
If the temperature of off-site storage cannot be documented, blood should not be away from the blood bank for __________
More than 30 minutes
Both donors and recipient samples must be stored for a minimum of _____ following transfusion
7 days
Automated method that uses microwells
Solid-phase
Reagent used for WASHING red cells for preparing an RBC suspension
NSS
Type of serology testing a BB technologist perform when determining blood group of a patient
Phenotyping
How to determine fetal blood type
Obtain cord blood
Removal of baby’s blood from the umbilical cord for testing
Cordocentesis / PUBS
What are perfluorocarbons (PFC)
Blood substitute (artificial O2 carriers)
To remove Wharton’s jelly, cord cells should be washed
6-8x
Components of MAJOR crossmatch
Donor cell, patient serum
Components of MINOR crossmatch
Donor serum, patient cell
Replaces minor crossmatch
Antibody screen
SERUM to RED CELLS ratio (in drops) used in tube crossmatching
2:1
10% red cell suspension in saline is used in a compatibility test. What would occur
False-negative due to antigen excess
Antiglobulin crossmatch temperature
37C
Technique necessary for weak D testing
37C incubation + IAT
When may immediate spin (IS) crossmatching be performed?
If no history of antibody and antibody screen is negative
Major crossmatch and screen cells are 2+ at IS phase, 1+ at 37C and (-) at IAT phase. Cause?
Cold alloantibody
Antibody screen is (+) at IAT phase using a three-cell screen and autocontrol is negative. Cause?
High-frequency alloantibody or mixture of alloantibodies
6 units are crossmatched. 5 compatible, 1 incompatible. Patient’s antibody screen is negative. Cause
Donor unit may have a positive DAT
What should be done if all forward and reverse ABO results as well as automated control are (+)
Wash cells with warm NSS, adsorb serum
Purpose of autocontrol in blood banking
To detect the presence of autoantibodies
What is the disposition of a donor red blood cell unit that contains an antibody
Label that it has antibody and release to inventory
Purpose of water bath in the blood bank laboratory
Incubation of serum and RBCs
The most important initial test for a kidney transplant donor
ABO typing
(+) DAT is seen in
HDN, HTR, AIHA, DIHA
Specimen used in DAT
EDTA / citrated whole blood
Plasma is not the specimen of choice for blood banking because
Anticoagulant interferes with complement
Incubation temperature for indirect antiglobulin test (IAT)
37C
Enhances agglutination by cross-linking sensitized cells
AHG reagent
Polyspecific AHG contains
Anti-IgG and anti-C3d
Most common monospecific AHG reagent
Anti-IgG
Action of protein media, LISS, proteolytic enzymes
Reduce the zeta potential
Cause of POSITIVE autocontrol in serologic testing
Autoantibodies/abnormal protein
Methyldopa can cause positive DAT by what mechanism
Autoantibody formation
Most common initial manifestation during hemolytic transfusion reactions
Fever
The only presenting sign of delayed hemolytic transfusion reaction is
Unexplained drop ini HGB or HCT
1st thing to do in cases of transfusion reactions
STOP the transfusion
Cut-off point for BNP in TACO
1.5
Most common transfusion transmitted infection
Hepatitis
Most common transfusion-related sepsis is transfusion of
Platelet concentrate
This organism is destroyed under prolonged cold temperature storage
Treponema pallidum
Donor blood is reactive for RPR. What to do next
Do a confirmatory testing
What to do when a woman who is 24 weeks pregnant has a positive antibody screen
Do antibody identification panel; titer if needed
Common treatment for HDN
Phototherapy
The first discovered human retrovirus
HTLV-1
Blood bank SOPs should be reviewed every
1 year
BB utilization management team includes
BB medical director
BB supervisor
Nurse
Clinical staff
IT associate
LIS password for laboratory personnel should be
Strictly confidential
