Blood Group Shit Flashcards by Iseoluwa Ojo

ERYTHROCYTE ANTIGENES AND ANTIBODIES

A blood groups system is a group of ______ encoded by _____ at a _______ gene locus or at gene loci _______ that _______ does not occur

antigens; alleles

single; so closely linked

cross over

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ERYTHROCYTE ANTIGENES AND ANTIBODIES

An antigen collection is a group of antigens that are _________________________________________ but ______________________

phenotypically, biochemically or genetically related

their genes are not known to be allelic.

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International Society of Blood Transfusion has recently recognized ____ blood group systems.

Apart from _______ and ________, many other types of antigens have been noticed on the red cell membranes.

______ antigen collection have been defined generally.

34; ABO and Rhesus system

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Immunology of the blood group system.

An antigen is a substance that can _______, when introduced into an immuno competent host and can ___________

evoke an immune response

react with the antibody.

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Most blood group antigens are ________ and their specificity is mostly determined either by the ________ (e.g. ABO) or ____________(e.g. MN, Kell, Duffy, Kidd, Diego)

glycoproteins

oligosaccharide

amino acid sequence

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Specificity of an antigen is determined by _________ and _______________ with its _______

its structure

stereochemical fit with its antibody

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An antigen can have several ________ or ____________ with each epitope capable of eliciting an antibody response.

epitopes or antigenic determinant

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The ability of an antigen to _____________ is called immunogenicity

stimulate an immune response

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Antigen’s ability to _____________ is called its antigenicity

react with the antibody

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So, ____,____,______ and the _______ and _______ of the epitope on the red cell membrane affect these immunogenicity and antigenicity

size, shape, rigidity

number and location

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Antigen expression

_______-labelled _____ and _____ conjugated _____ is used to estimate number of antigenic site.

125I; antibody

ferritin; anti-IgG

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Antigen development

Most erythrocyte antigen are detected early in fetal development

T/F

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erythrocyte Antigen development

ABH = ____-____ in fetal development

5- 6wks

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Antigen development

all erythrocyte antigen however are fully developed at birth

Not all erythrocyte antigen however are fully developed at birth

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Adult expression of ABH, I and lewis antigen may take _______

2yrs

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Adult expression of ______,_____ and ______ antigen may take 2yrs

ABH, I and lewis

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Lutheran and P1 adult development may take > ________

7yrs

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_______ and ______ adult antigen development may take >7yrs

Lutheran and P1

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Genetic variation

Homozygous individual may have (more or less?) number of antigen site than heterozygous for a particular allele and May possess (stronger or weaker?) reaction with the antibody (i.e dosage) allelic antigen like Cc, Ee, Kk, Mn, Ss, Jka and JK5 usually show dosage
Dosage is less with D and lutheran

Stronger

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Haplotype ________ and _______ can affect phenotype expression (e.g inheriting ___ with ____ can suppress expression of D)

pairing and gene interaction

C; D

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Immunogenicity

After ______ and _____ , ____ is the next immunogenic followed by ____ and ____

A and B

K and C.

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BIOCHEMISTRY OF ANTIGEN
An antibody will recognise

1)4-5 ___________ resided on _______

2)1 -7 _____ resided on _______

Amino acids sequence; linear polypeptide

sugar; linear polysaccharides

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BIOCHEMISTRY OF ANTIGEN

Polysaccharides are made by ______ addition of __________ by _________

sequential

specific sugars by specific transferase enzymes

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sugars involved in red cell antigens are:

_________
2.___________
___________
4.__________
5.N-acetylneuraminic acid (sialic acid) and
D-manose

D- galactose

N-acetyl D-Galactosamine

N-acetyl-D-glucosamine

L-fucose,

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CARBOHYDRATE ANTIGENS _________________ blood group antigens are examples of Carbohydrate antigens.

P, ABO and Lewis

CARBOHYDRATE ANTIGENS Their specificity depends on ______ or ___________ sugar, the type of polysaccaride to which the sugar is attached and on the type of linkage

terminal or immunodominant

CARBOHYDRATE ANTIGENS _______________ is the immuno- dominant sugar for A and P antigen __________– for B, P1 and Pk _______ for substace H, Lewis

N-acetyl-D-Galactosamine D-galactose fucose

CARBOHYDRATE ANTIGENS N-acetyl-D-Galactosamine is the immuno- dominant sugar for _____ and ____ antigen D-galactose – for _____,_____, and _____ fucose for ______,_______

A and P B, P1 and Pk substace H, Lewis

In the ABO system, the ___ antigen encodes the gene that encodes, for the transferase enzyme. The ABO locus is located on chromosome ____ at The H-antigen gene is located on chromosome _____ and expressed as a ______ containing glycan

I 9 19 fucose

PROTEIN ANTIGEN -______,_____,______, and ______ are all glycoylated protein __________ antigen are non- glycocylated protein

MNS, Kell, Duffy and Lutheran RH and kidd

PROTEIN ANTIGEN - MN: Resides on ________ (with 131 ass and 15-G-linked oligosaccharide chains)

glycophorin A

The RH protein is especially hydro______ and transverse the red cell membrane the RH. The gene coding for the RH antigen are located on _______ loci on long arm of chromosome ___(_____-_____)

phobic two gene 1 p36-p34

DISTRIBUTION OF RED CELL ANTIGEN IN HEALTH AND DISEASE RH, Kell, Duffy and Kidd antigens are found only on red cell so also is MNS and Lutheran except. Lub (on renal endothelial cell and liver hepatocytes) MN activity is seen on renal capillary endothelium

DISTRIBUTION OF RED CELL ANTIGEN IN HEALTH AND DISEASE ____,_____,_______ and _______ antigens are found only on red cell so also is ______ and _______ except. _____ (on __________ and _________)

RH, Kell, Duffy and Kidd MNS and Lutheran Lub renal endothelial cell and liver hepatocytes

MN activity is seen on renal capillary endothelium T/F

Physiologic disorders of red cell antigen and some observed associated medical conditions ABH are found on endothelial cells and epithelial cells except for these of the _________. ABH, Lewis I and P blood group antigen seen in _______,_______, And _______

CNS plasma, platelets, lymphocyte

Physiologic disorders of red cell antigen and some observed associated medical conditions Blood group A = carcinoma of ____,_____,______,_______ and also with thrombosis. blood group o: ______,_______,______,______. non secretion of ABH is associated with __________

salivary gland , stomach, colon and ovary duodenal ulcers , gastric ulcers , rheumatoid arthitis, vWD Candida Albicans

Erythrocyte that lack Duffy (Fya and Fyb ) antigen are ________________ (_________)

not infected by malaria parasite (P vivax)

Rhnull syndrome (an autosomal recessive condition characterized by ______________________ is associated with ____________________

complete lack of all Rh antigens hereditary stomatocytosis

Mcleod phenotype: resulting from decreased expression of the 23 _____ blood group antigens with absence of the ________ antigen on red cell i.e the ____ synthesized by _____ on the ___ chromosome is lost due to a mutation...

kell xK xK protein ; Xk gene; X

this xk protein interact with the _______ to help _______ the RBC membrane. And also protect _________ functions.

cytoskeleton stabilized neurological

McLeod phenotype This patient are: Mostly (male or female?) Have defect in _____ transport ___________cytosis After ____yrs they develop a progressive form of _________ are associated with deletion on the X-chromosome at position XP21.

Male ; H2O Acantho 40; muscular dystrophy

Gerbich Negative phenotype •(_____ type) •lacks _____ or ——— •Tend to have _____cytosis •Have weakened expression of ____ blood antigen. All these are associated with ________

leach glycophorin C or D elipto; Kell haemolytic Dx

Bombay Phenotype: presents a serious problem in blood transfusion practice. They ____________ and thus develop __________

lack substance H anti-H antibodies

RED CELL ANTIBODIES Classification Based on target site: _____-antibodies ______-antibodies

Auto Allo

RED CELL ANTIBODIES Classification In terms of mode of sensitization ___________ – usually ________ from substance similar to red cell antigen ________ antibodies

Naturally occurring hetero agglutinin Immune

RED CELL ANTIBODIES Classification In term of optimal temperature Cold – ___-____oc Warm – ______oc

2-4 37

RED CELL ANTIBODIES Classification TYPES Ig____ is the immune type red cell antibody, receptors or macrophage in the liver

spleen removes Ig__ coated red cell from circulation.

IgG anti RBC antibody are capable of complement fixation T/F

Arrange the IgG anti RBC antibody in order of decreasing capability to fix complement

IgG 3>IgG1>IgG2>IgG4

Binding to complement by IgG antibody is determined by ________ ____________________

Surface density Location of the recognized antigen

Binding to complement by IgG antibody is determined by: Surface density Location of the recognized antigen Why?

This is because C1q requires that at least two IgG molecule bind to a red cell within a span of 20-30nm to initiate the complement cascade

IgG-anti-D often bind complement T/F

F IgG-anti-D rarely bind complement

IgG-anti-D rarely bind complement because _________________; and the epitope is _______________

most D sites are spaced too far apart so small that only one anti –D molecule per epitope can bind

- Most IgG anti ABH antibody agglutinate saline suspended red cell T/F

F Most IgG anti ABH antibody do not agglutinate saline suspended red cell rather they sensitize red cell at 37oc and can be detected with the help of AHG.

IgG antibody crosses placenta. IgM antibody crosses placenta. T/F

T F IgG antibody crosses placenta. IgM is a pentamer, does not cross the placenta.

Ig__ and Ig___ can agglutinate red cells and activate complement effectively

G M

Note both haemolytic and agglutinating abilities of antibodies can be destroyed by ___________ or _________

dithiothreitol or 2-mercaptoethanol

Low affinity IgM may agglutinate red cells only at temp _________% Meaning they bind to red cells at _____ temperature and dissociate at ____oc)

below 37 low 37

Ig____ is the primary antibody in secretion

IgA Exist predominately as _____ with a secretory component there in

dimers

IgA Does not cross placenta Does not fix complement T/F

T T

aggregated IgA can activate ______ pathway of complement Multmeric IGA antibodies in serum are as __________ in serology tent and are associated with ___,_____,______ activity

alternate haemaglutinins A, B or Lutheran

IgG levels in fetal circulation rise between _________ -_______ as the selective transport system matures in the placenta actual fetal antibody production begins ______________ (all detected antibodies in fetus are ______) low levels of Ig___ followed by Ig___ and Ig__ develop several weeks after birth (Anti A and Anti B takes _________)

22-23weeks shortly after birth maternal M; G; A 2-6month

Naturally occurring allo-antibodies are mostly associated with ______ antigen (____,_____,_____) They occur in person ___________________________

carbohydrate ABO, Lewis and P lacking the corresponding antigen

Immune antibodies are found mostly in ______________________ individual

multiply transfused

CLINICAL SIGNIFICANCE OF RED CELL ANTIBODY 1. Haemolytic transfusion reaction: Intravascular Immediate transfusion reaction:_______ Delayed:______ (Jka, JKb)

ABO KIDD

CLINICAL SIGNIFICANCE OF RED CELL ANTIBODY 1. Haemolytic transfusion reaction: Extravascular: IgG1 and IgG3 reacting at ——- temperature(IgG antibodies of _______,_____,_____,_____,______ antigen) and these make up the bulk of clinically significant antibodies

body Rh, Kidd, Kell, Duffy or Ss

Haemolytic Disease of the newborn a.k.a ___________ Ig___ and Ig____ which crosses placenta are mostly implicated

erythroblastosis fetalis G1; G3

HDN Aetio-pathogenesis 1.______ related 2._____ related 3. other red cell antigen/antibody

Rhesus; ABO

Rhesus Related HDN • 1. sensitization of rhesus ____ mothers by previous blood transfusion using _____ donors, ____ transfusion or other means which leads to ______ of Rh ______ fetus, abruption placenta etc

negative; Rh + ; fetal abortions; positive

Rhesus Related HDN Is the (more or less?) severe phenotype With reason

More because Rh antigens are more concentrated on red cells and fully developed in-utero

Rhesus Related HDN critical titer is ___:____ which would lead to _________

1:32 fetal hydrops

ABO related HDN affects women with blood group ______ with a ________ of _________ and a fetus with blood group _________

O+ high titer of immune anti A or B. A or B.

ABO related HDN it is usually (more or less?) severe With reason!!

Less ABH antigen is widely distributed on virtually all nucleated cells ABO is not fully developed till after birth

HDN: Other red cell antigen/antibodies Over ____ other red cell surface antigens have been implicated in HDN (E.g Kell, duffy- -Fya). However only anti-____ and anti- ____ (K1) are associated with severe disease. Critical value for k1 is ___:____

50 Rhc; kell 1:8

Clinical features of HDN _______ skin _________ amniotic fluid, umbilical cord and eyes Enlarged______ or _______ Hydrops fetalis( _______,______,______) ____________

Pale skin Yellowish liver and or spleen. massive edema, heart failure and organomegally kernicterus

Laboratory features of HDN ___________ _______________ Peripheral blood film:_____________ features _________

Anaemia Thrombocytopaenia erythro-leucoblastic polychromasia

diagnosis of HDN ________ ________________ sampling _________

Amniocentesis Percutaneous umbilical cord blood ultrasonography

treatment of HDN Prophylaxis (maternal after a ______ test) ________ transfusion Early_______ ______therapy Exchange blood transfusion Intravenous _________

Keilhauer Intra-uterine delivery immunoglobulin

______ antigen is a typical example of a haplotype

Rhesus

Rhesus antigen has 2 different loci that has 2 different set of alleles One by _____ One by ______

D CE Or Ce Or ce Or cE

Absence of ___ = Rhesus negative

Which is more antigenic?? A or B

Which is more immunogenic ?? B or D

___________ is the baseline glycoprotein

Substance H

Substance H is the raw material from which ______ is formed

ABH

Substance H is located on chromosome ____

Substance H is located on the same loci on chromosome 9 as the AB antigen T/F

F Different

Substance H circulates in the blood and attaches to the _____ membrane and as well as any ___________ cell

Rbc Nucleated

Erythropoietin acts on already committed stem cells T/F

Red cell antigens are formed with the membrane T/F

F They are not

Dosage phenomenon: Antigenicity of _____zygous > Antigenicity of _____zygous

Homo Hetero

A group of genotype that are closely linked together = ___________

Haplotype

In the case of ______ on the loci of ____________ genes, where __________ , The H antigen ____________ Hence this people have H blood group

mutation; enzyme producing the enzyme isn’t produced remains unremodelled

_________ and ________ are pure proteins

Rhesus Kidd

________ phenotype is usually mistakenly grouped as blood group O

Bombay

Bombay phenotype Production of ______,______,_____

Anti-A Anti-B Anti-H

Which is better, agglutinin or hemolysin?

Agglutinin

agglutinin is to Ig__ As hemolysin is to Ig__

M G

Young RBCs are usually resistant to _____

HCL

Anti-Rhesus C is just as severe as RH HDN T/F

Anti-Rhesus preparation = ______

Rhogam D