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Immunohematology - 4444 > Deck B > Flashcards

Deck B Flashcards

1
Q

Enzymes are protiens that

A

that increase the rate of a chemical reaction

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2
Q

What are the most commonly used enzymes

A

ficin and papain.

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3
Q
  1. Less commonly used enzymes are
A

enzymes are bromelin, pronase, trypsin, and chemotrypsin.

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4
Q

Some red cell antigens are _________ by enzymes and others are ___________ by enzymes

A

Destroyed and enhanced

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5
Q
  1. Enzyme-treated red blood cells are typically used in two instances:
A

 If a weakly reactive antibody is present, enzyme-treated red blood cells may be tested in an effort to enhance the reactivity and possibly clarify the reaction pattern or confirm the presence of the antibody.
 Use of enzyme-treated red blood cells can often help differentiate antibodies.

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6
Q
  1. Enzyme treatment can be performed in two ways:
A
  • The one-step technique: Enzyme is added as an enhancement to the tube containing test plasma and red blood cells and carried through the IAT phase of testing.
  • The two-step technique: Requires treatment of the red blood cells with enzyme and washing prior to the addition of patient plasma. This method is often preferred because the enzymes in the one-step technique are added directly to the patient’s plasma and any antibodies present may be damaged.
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7
Q
  1. ________ red blood cells must be used in tandem with the ____________ red blood cells to identify all antibodies present in a test sample.
A

Untreated and enzyme-treated

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8
Q

Neutralization definition

A

The inactivation of an antibody by combining it with a soluble form of the corresponding antigen.

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9
Q

Neutralization can aid in

A
  1. Inactivation of the antibody can aid in identification of a suspected antibody that does not react with an ideal pattern.
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10
Q

Neutralization

Sources of

A
  1. Sources of neutralizing substances include saliva, hydatid cyst fluid, urine, plasma, breast milk, and amniotic fluid.
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11
Q

Elution

A

Frees antibody that is bound to a red blood cell.

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12
Q

Uses of an elution

A

 Identify one or more antibodies attached to the red blood cell membrane.
 Prepare antisera or to detect and identify weakly reactive antibodies.
 Prepare DAT-negative red blood cells for further testing.
 It can be combined with adsorption techniques to remove specific antibodies or antibodies.
 Adsorption and elution techniques can be used to detect a weakly reactive antigen, such as a weak ABO subgroup.

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13
Q
  1. Methods that are best at releasing cold-reactive antibodies or antibodies that have a broad temperature range of reactivity include:
A

 Lansteiner and Miller heat elution
 Weiner’s freeze–thaw method
 Lui’s freeze–thaw method and sonication

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14
Q
  1. Methods better suited for recovering warm-reactive alloantibodies or auto antibodies include
A

include use of organic solvents such as ether, zylene, methylene chloride, and chloroform or acids such as digitonin, citric, or glycine.

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15
Q
  1. Procedures that remove antibody but leave the red blood cells intact include
A

gentle heat, choloroquine, and acid glycine-EDTA methods.

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16
Q
  1. Preparation of a successful eluate can be influenced by several factors:
A

 Improper technique
 Inadequate stroma removal
 Insufficient washing of the sensitized red blood cells before eluting the antibody
 Incorrect method of transferring washed red blood cells
 Incorrect procedure used during the wash phase
 Use of saline to prepare eluates

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17
Q

Adsorption

A
  1. A technique used to remove an antibody or antibodies from plasma.
  2. Done most often to remove autoantibodies from a patient’s specimen in order to see if other antibodies are present in the plasma.
  3. Autologous adsorption and allogenic adsorption are the most common types used.
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18
Q

Adsorption

A

Is used to remove a antibody or antibodies from plasma

Done to remove autoantibodies to see if other antibodies are present In the patient plasma

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19
Q
  1. Autologous adsorption

cannot be used in the previous three months because the patient already has another type of red cell in his system

A

 The preferred method to remove autoantibodies.
 Cannot be used if the patient has been transfused within the previous 3 months because the patient’s specimen will also contain donor red blood cells.

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20
Q
  1. Allogenic adsorption

May be used when a patient with a autoantibody has been

A

Transfused

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21
Q
  1. Allogenic adsorption

Used either alone or paired with elution techniques to separate mixtures of

A

antibodies to allow for identification

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22
Q

 When choosing red blood cells for adsorption, the red cells that stimulate the most ___________ antibodies are considered.

A

Clinically significant

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23
Q

 Procedure requires a great deal of technical expertise because donor red blood cells adsorb both

A

autoantibodies and alloantibodies.

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24
Q

 Allogenic adsorptions run the risk of not detecting a

A

clinical significant antibody if a weakly reactive alloantibody is diluted or antibody to a high-frequency antigen is absorbed. Autoantibodies that are only partially absorbed may mimic the reaction pattern of alloantibodies.

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25
6. Rabbit erythrocyte stroma Can be used to adsorb certain Removes what antibodies Plasma absorbed by this method should not be used for
 Can be used to adsorb certain antibodies.  Removes cold autoantibodies and anti-B and antibodies in the P blood group system (anti-P1).  Plasma adsorbed by this method should not be used for ABO typing.
26
6. Rabbit erythrocyte stroma Decreases the strength of or complexity removes other ___ from plasma including _________ significant antibodies
 Decreases the strength of or complexly removes other IgM antibodies from plasma, including clinical significant antibodies.  Remains the adsorption medium of choice when an autoadsorption cannot be performed because a patient with a cold autoantibody has been recently transfused.  Available in commercial kits.
27
Titration A technique used to measure the _______ of an antibody
Strength ( concentration)
28
Serial dilution
2. Serial dilutions are made of the antibody containing plasma and tested against selected red blood cells to determine the highest dilution causing a positive reaction. The result or titer is expressed as the reciprocal of the highest plasma dilution reacting 1+.
29
Titer scores
3. Titers can be resulted as a score, where a number is assigned to each positive reaction in the titration based on the strength of the reaction. 4. The sum of these scores reflects the total binding strength of the antigen and antibody molecules (known as titration score or avidity).
30
7. Titration is most commonly used for determining
antibody activity and the potential severity of HDFN in alloimmunized pregnant women.
31
8. Titration can be a useful aid in identifying antibodies to certain
high-incidence antigens.
32
9. A titration can distinguish between a characteristic
high-titer, low-avidity antibody (HTLA) and a weakly reactive antibody with a low titer.
33
2. If the autocontrol or DAT is negative and the patient has been transfused or pregnant, then the reactions are likely due to
alloantibodies. Both combinations of multiple antibodies and a single antibody to a high-incidence antigen may cause this pattern of reactivity.
34
3. If the autocontrol or DAT is positive and the patient has not been transfused recently, then the results are likely due to an
autoantibody, either warm reactive, cold reactive, or both.
35
4. If the autocontrol or DAT is positive and the patient has been transfused recently
the results may indicate either an autoantibody or a delayed serological transfusion reaction.
36
False postives may result from
Pan agglutination or rouleaux
37
Multiple antibodies 1. Certain combinations of antibodies may cause all or most cells tested to react
positively, making antibody exclusion and subsequent identification very difficult
38
Multiple antibodies A combination of techniques is usually required to identify
identify the specificity of each antibody present within a complex mixture of them. The technique(s) that should be used depend(s) on which antibodies are suspected.
39
C. Antibodies to High-Incidence Antigens
Negative autocontrol but almost all positive Screen cells, panel cells, donor RBCs reacting +
40
Antibodies to High incidence antigens Testing with rare
Selected cells or plasma treated cells may confirm a + result Knowning the patients Ethnicity may help
41
Warm autoantibodies
Warm autohemolytic anemia positive DAT, with screen, panel, and donor RBCs +
42
3. An antibody that causes all cells tested to agglutinate is called a
Panagglutinatin
43
Patients with warm autoantibodies tend to have a increase risk of
Alloimmunization compared to the general Population
44
6. If the patient has not been transfused in the last 3 months, an ____________ can be performed and the adsorbed plasma tested for alloantibodies.
Autoabsorption
45
Cold agglutinins
optimum reactivity between 37.7 and 77.0C cause problems with a DAT because they can interfere with the detection of more clinically significant antibodies, and interfere with ABO typing
46
Cold autoantibodies most common types
specificities to I, i, IT, IH, and Pr antigens; autoanti-I is the most common.
47
Identify using
Cord and Adult RBCs
48
good indicators of clinical significance for cold-reactive autoantibodies.
antibody titers and thermal amplitude studies
49
4. If cold autoantibodies may be masking alloantibodies, the autoantibodies can be removed from plasma by
autoadsorption using a low temperature or by adsorption with rabbit erythrocyte stroma.
50
G. Cold Alloantibodies 1. Include specificities such as
anti-M, anti-N, anti-P1, anti-P, anti-Pk, anti-Lea, anti- Leb, and anti-Lua. they rarely cause in vivo hemolysis you can eliminate the IS, test with Anti-IgG, or eliminate microscopic readings
51
Prewarm technique
is used to eliminate the effect of Cold reacting auto and allo antibodies but it has show to show a 47% reduction in the performance in these antibodies
52
Cold agglutinins are shown to be a concern in cardiac bypass surgery because
the patient is constantly in a state of hypothermia Thermal amplitude and titer are a good indicator for potential complications
53
If problems arise then the patient can be kept above
Body temperature or plasma exchange may be used to remove the cold autoantibody prior to surgery.
54
2. With a delayed hemolytic reaction the patient exhibits symptoms of
Hemolysis but with serological transfusion reaction the patient does not exhibit symptoms of hemolysis
55
The reaction pattern will mimic a high frequency antigen but the cross match with donor red cells will be negative
Antibiotic: gentamycin, neomycin, and chloramphenicol sugars: glucose dyes acriflavine and tartrazine Bacteriostatic/ antifungal reagents: paraben, thimerosal, sodium azide Chemical: citrate, inosine, EDTA
56
HLA antigens reactions
Febrile, nonhemolytic reactions, and can cause platelet refractoriness. usually not clinically significant Plt transfusions may be given to absorb the HLA antigens off the RBC
57
Antibodies to low incidence antigens
Specificities include Wra, Kpa, Jsa, Cw, Dia, Goa, SC2, Mia, Lua, Cob, and Ytb. Typical patterns of reactivity  The antibody screen is negative but one donor unit is incompatible if an IAT crossmatch is performed.
58
Screen cells are
O in origin so A and B cells will not react
59
6. Anti-Sda and anti-Lua are characteristic of a
Mixed field reaction
60
5. Consent may be done at the time of admission or it may be obtained separately when the need to transfuse is identified.
61
Transfusion request forms must be
Verbal or written and have the physician's name and phone number, the date and time, the phone number, and have the number and amount of test ordered
62
– ABO typing may be performed at least
twice before transfusing RBCs
63
When selecting components for ABO typing
The components may be ABO compatible or ABO identical

Immunohematology - 4444 (17 decks)

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