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Maddy - SBL Pharm > Exam II Clin > Flashcards

Exam II Clin Flashcards

1
Q

what is a “secretor”

A

someone who is capable of making ABO antigens in their secretions (like saliva) and plasma

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2
Q

what autoantibodies does an O blood person have

what autoantibodies does an A blood person have

what autoantibodies does an B blood person have

what autoantibodies does an AB blood person have

A

type O: anti-A, anti-B, anti-A,B

typeA: anti-b

type B: anti-a

type AB: none

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3
Q

how does leukemia affect ABO antigen expression

A

decreased antigen

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4
Q

describe acquired B phenomenon

A

pt w/ intestinal obstruction –> increases bowl permeability –> bacterial polysaccharides enter circulation and are absorbed by group A cells –> N-acetylcysteine is converted to a-galactosamine (similar to B antigen) –> positive B antigen test results

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5
Q

how does gastric or pancreatic carcinoma affect expression of ABO antigen

A

serum contains excessive blood group specific soluble substances (BGSS) which neutralizes the antisera used in forward grouping

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6
Q

describe bombay phenotype of RBCs and what autoantibodies those patients have

what blood can bombay pts receive

A

absence of H (Oh)

anti-A, anti-B, anti-AB, anti-H
(anti-H IgM binds complement and lyses cells)

pts can only receive bombay blood

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7
Q

in bombay patients, what are the consequences of the anti-H antigen

A

1) intravascular hemolysis (anti-H can activate complement cascade which lyses RBCs)
2) transfusion reaction (acute hemolytic transfusion reaction)
3) hemolytic disease of the newborn

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8
Q

what is needed to produce Rh antibodies

A

exposure to the antigen (pregnancy or transfusion)

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9
Q

describe the Kell system antibodies

A 
K = kell
k = cellano (most are kk)

IgG antibodies that react at 37 degrees celsius

can cause hemolytic disease of the newborn and a hemolytic transfusion rxn

“kell kills”

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10
Q

the McLeod phenotype of a patient with kell system antibodies is associated with what conditions

A

1) chronic compensated hemolytic anemia and presence of acanthocytes (spur cells) on peripheral blood smear

2) chronic granulomatous disease (CGD)
- lack of NADH-oxidase

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11
Q

describe the Kidd system antibodies and what they are associated with

A

anti-Jka (kidd a) and anti-Jkb (kidd b)

associated with delayed hemolytic transfusion reactions (IgG)

the antibodies “disappear” meaning no antibodies are detected during the initial antibody screen and cross match –> antibodies reappear upon transfusion with Kidd + unit

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12
Q

describe the duffy system antibodies

what are they associated with

describe how race affects antibodies

A

Fya (duffy a) and Fyb (duffy b)

hemolytic disease of the newborn and hemolytic transfusion reactions

caucasians: Fy(a+b+) or Fy(a+b-) or Fy(a-b+)

african americans: Fy(a-b-)

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13
Q

why are the Fy(a-b-) duffy antibodies moer often seen in african americans as compared to caucasians

A

b/c the Fy(a-b-) phenotype is resistant to Plasmodium vivax infection

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14
Q

describe the MNS system antibodies and what they are associated with

A

anti-M & anti-N and anti-S & anti-s

usually IgM, non-hemolytic usually

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15
Q

describe Lewis system antibodies and what they are associated with

A

naturally occurring, usually IgM “warm” anti-Le antibodies found in secretions and plasma

rather mild - “lewis lives”

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16
Q

compare type and screen and crossmatching

A

type and screen: only ABO, Rh, and Ab screen performed

crossmatch: tests all those things plus actual testing of patient’s serum compatibility w/ donor cells (mixed recipient serum with donor RBCs to detect agglutination)

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17
Q

what is the indirect coombs test (IAT) used for

in what patients is it used

A

tests pt’s SERUM for developed antibodies against foreign RBCs

uses serum (Ab must NOT be bound to RBC to enable detection)

used prior to blood transfusion and in prenatal testing of pregnant women

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18
Q

describe the direct coombs test (DAT)

when is it used

A

tests for Ab of complement proteins attached to the RBCs

uses washed red blood cells w/o plasma

used to detect autoimmune hemolytic anemia and in transfusion reaction work ups

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19
Q

describe the phases of the indirect coombs test (IAT)

A

room temp phase:

  • initial combination of patient sera w/ commercial suspension of RBCs
  • detection of “cold” IgM Ab

37 degrees C phase:

  • detection of “warm” IgM-IgG Ab mixture
  • Rh, Kell, Kidd, and Duffy system detections

Anti-Human globulin (AHG) phase:
- detection of “warm” IgG Ab that coat RBC membrane

Check Cell phase:
- verify AHG was added and working

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20
Q

what are the reticulocyte, unconjucated bilirubin, and haptoglobin levels in autoimmune hemolytic anemia

A

increased reticulocyte

increased unconjugated bilirubin

decreased haptoglobin

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21
Q

what symptoms are characteristic of intravascular hemolysis

A

hemoglobinemia and hemoglobinuria

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22
Q

how do you confirm autoimmune hemolytic anemia

A

DAT (direct coombs) and characterization of auto-Ab as cold or warm reactive

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23
Q

what is the most common autoAb

A

benign cold agglutinin

most commonly auto-anti-I

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24
Q

because cold autoantibodies can obscure alloantibodies, what should you use when doing an alloantibody test

A

prewarm or autoabsorbed serum

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25
Q

3 causes of warm autoimmune hemolytic anemia

A

idiopathic, SLE associated, drug-induced

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26
Q

treatment for warm autoantibody positive autoimmune hemolytic anemia

A

splenectomy and steroids

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27
Q

what infections are associated with cold agglutinin AIHA

A

mycoplasma pneumoniae or infectious mononucleosis

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28
Q

what can O+ patients receive

what can O+ patients donate

A

receive: O+ and O-
donate: O+, A+, B+, AB+

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29
Q

what can A+ patients receive

what can A+ patients donate

A

receive: A+, O+, O-, A-
donate: A+, AB+

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30
Q

what can B+ patient receive

what can B+ patients donate

A

receive: O+, B+, O-, B-
donate: B+, AB+

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31
Q

what can AB+ patients receive

what can AB+ patients donate

A

receive: everything
donate: AB+

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32
Q

what can O- patients receive

what can O- patients donate

A

receive: O-
donate: everything

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33
Q

what can A- patients receive

what can A- patients donate

A

receive: O-, A-
donate: A+, AB+, A-, AB-

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34
Q

what can B- patients receive

what can B- patients donate

A

receive: O-, B-
donate: B+, AB+, B-, AB-

35
Q

what can AB- patients receive

what can AB- patients donate

A

receive: O-, A-, B-, AB-
donate: AB+, AB-

36
Q

common viral causes of transfusion reactions

A

HIV, HTLV-1, Hep B, Hep C

37
Q

what lab/tests need to be done after a transfusion reaction occurs

A
  • direct coombs
  • ABO/Rh on pre and post samples
  • IAT
  • repeat crossmatch
  • send donor unit for gram stain and culture
  • follow up with hemoglobin/hematocrit and urine for hemolysis
  • rule out TRALI
38
Q

symptoms of acute hemolytic transfusion reaction

A

hypOtension, hemoglobinuria, DIC, flank pain, infusion site pain, fever, chills, N/V

39
Q

symptoms of delayed hemolytic transfusion reaction

A

unexplained rise in unconjugated hemoglobin, drop in hemoglobin/hematocrit

40
Q

symptoms of febrile non-hemolytic transfusion reaction

A

fever, chills, hypERtension

41
Q

symptoms of allergic transfusion reaction

A

urticarial rxn, erythema, cutaneous flushing, laryngeal edema, bronchoconstriction, N/V/D

42
Q

symptoms of TRALI

A

non-cardiogenic pulmonary edema

lack of abnormal breath sounds, no signs of cardiac failure

pulmonary arterial wedge pressure NOT elevated

resolves 48-96 hours from onset

43
Q

symptoms of septic transfusion reaction

A

fever, chills, rigors, shock

44
Q

common cause of septic transfusion reaction

A

usually contaminated platelets (since they have to be stored at room temperature)

45
Q

describe acute hemolytic transfusion reactions

A

presents within 24 hours

pre-existing natural IgM Abs induce complement-mediated intravascular hemolysis

46
Q

describe delayed hemolytic transfusion reactions

A

presents after 24 hours post transfusion

IgG reaction from prior transfusion/exposure causing extravascular hemolysis

47
Q

what are the levels of LDH, bilirubin, haptoglobin, and leukocytes in delayed hemolytic transfusion reaction

A
  • increased LDH
  • increased bilirubin
  • decreased haptoglobin
  • leukocytosis
48
Q

treatment for delayed hemolytic transfusion reaction

A

IVIG

49
Q

what type of transfusion reaction can cause sickle crisis in sickle patients

A

delayed hemolytic transfusion reaction

50
Q

describe febrile non-hemolytic transfusion reaction

what is the treatment

A

rise in temp of 1C or greater in 30min-1hour after transfusion

caused by acquired Ab to leukocyte Ag in transfused products (attributed to pyrogenic cytokines in units during storage)

tx: anti-pyretic (NO ASA)

51
Q

prevention and treatment for allergic transfusion rxn

A

pre-medicate with antihistamine

intubate prn, O2 prn, IV antihistamine

52
Q

prevention and treatment of severe allergic (anaphylactic) transfusion rxn

A

give IgA deficient products to prevent anti-IgA antibodies, pre-medicate with antihistamine or steroids

epi, diphenhydramine, aminophylline

53
Q

describe TRALI

who is it often seen in

A

Ab bind with MHC class 1 Ag on neutrophils

seen in multiparous women

54
Q

bacterial contamination of packed cells and platelets often results from what species

A

packed cells: yersinia enterocolitica and Pseudomonas (due to ability to grow at low temp and high iron environment)

platelets: staph, strep, salmonella, escherichia, serratia

55
Q

what tests does donated blood undergo

A
  • ABO and Rh groups, unexpected RBC antibodies
  • Hep B and C, HIV-1 and 2, HTLV-1 and 2, west nile, syphilis
  • trypanosoma cruzi (Chaga’s)
  • NAT testing (nucleic amplification testing for RNA of viruses or DNA of HBV)
56
Q

list the thresholds for RBC transfusions

A
  • increased oxygen carrying capacity (pt is hypoxic)
  • Hgb < 7 or Hct < 21% in an otherwise healthy individual w/ acute anemia
  • Hgb 7-9 in pt w/ cardiovascular or cerebrovascular risk factors
  • HbS 30-50% in sickle cell patients to prevent stroke
57
Q

indications for transfusing packed red blood cells (PRBCs)

contraindications for transfusing PRBCs

A

SYMPTOMATIC anemia as a result of increased loss, decreased survival, or decreased production of RBCs

contraindications: volume expansion, coagulation deficiency, drug treatable anemia

58
Q

indications for transfusing frozen/deglyced RBCs

A

hypersensitivity to plasma proteins

59
Q

indications for transfusing washed RBCs

A

recurrent severe allergic rxn to unwashed RBCs

60
Q

indications for transfusing irradiated RBCs

A

risk of GVHD in immunocompromised pt

61
Q

indications for transfusing leukocyte reduced RBCs

A

febrile rxns due to leukocyte antibodies

62
Q

indications for transfusion of platelets

contraindications

what is the threshold

A

bleeding due to thrombocytopenia

contraindications: plasma coagulation deficit, ITP, TTP

<10,000 platelets in absence of bleeding
<50,000 platelets w/ significant hemorrhage
<100,000 platelets w/ risk of CNS bleed

63
Q

what are “pooled” platelets

A

6 single units of platelets from whole blood pooled into a single standard dose (six pack)

5.5 x 10^10 platelets

80 mg fibrinogen

64
Q

what are pheresis platelets

A

from a single donor, automated cell separator

decreased exposure to single donors, increased platelet retention

65
Q

what are irradiated platelets

A

leuko-reduced platelets to reduced risk of GVHD

66
Q

what are the contents of fresh frozen plasma

A

all coagulation factors, 400 mg fibrinogen, very few RBC, WBC, or platelets

67
Q

indications and contraindications for fresh frozen plasma

A

indications: deficiency of stable and labile plasma coagulation factors (ex: emergent reversal of warfarin, TTP) with or without bleeding
contraindications: volume expansion

68
Q

threshold for transfusing fresh frozen plasma

A

prophylactic: PT or PTT prolonged and active risk of bleeding

documented factor deficiency in bleeding pt

isolated factor deficiency for which factor derivative unavailable

69
Q

indications cryoprecipitate transfusion

threshold?

A

Hemophilia A, vWF disease, hypofibrinogenemia DIC, bleeding uremia pt, topical glue

threshold: fibrinogen < 80 with ongoing bleed

70
Q

contents cryoprecipitate

A

150-250 mg fibrinogen

80-120 units vWF

40-60 units Factor 8

71
Q

what is in RhoGAM

when is it used

A

immunoglobulin made from human plasma with high levels of polyclonal Ab against D antigen

  • Rh negative mom with an Rh positive fetus/neonate
  • transfusion of Rh positive blood to Rh negative pt
  • treatment of ITP
72
Q

what is the Kleihauer-Betke test

A

measures fetal Hgb in mother’s circulation

73
Q

when is RhoGAM given

A

1 full dose at 26-28 weeks or within 72 hours of Rh+ infant

74
Q

what is solvent detergent treated plasma (SDP plasma)

A

pooled plasma from up to 2500 donors

inactivates enveloped viruses (HIV and Hep B)

75
Q

what is granulocyte pheresis

indications?

hazards?

A

contains WBC 1 x 10^10, platelets 3x10^11

indications: neutropenia unresponsive to appropriate antibiotics
hazards: allergic and febrile rxns

76
Q

what is the only substance that can be transfused with blood

A

normal saline

77
Q

infusions must be completed in what time

A

4 hours

78
Q

what specific sterile technique is used in neonatal transfusions

A

quad pack

79
Q

what is a massive transfusion

how much is it for an adult

what are the associated problems

A

transfusion that amounts to full blood volume within 24 hours

10-12 units in an adult per day

coagulopathy, hypothermia, hypocalcemia

80
Q

what is the rule of thumb for massive transfusion management

A

1 unit FFP per every 2-3 units of RBCs

81
Q

indications for donor apheresis

A

stem cell collection for BM transplant

82
Q

indications for plasma exchange

A

TTP and HUS

83
Q

indications for therapeutic plasma pheresis

A

hematological and neurological dz

84
Q

indications for therapeutic RBC exchange

A

sickle cell

fetal and neonatal HDN

Maddy - SBL Pharm (11 decks)

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