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Immunohematology 480 > HDN/HTR/QA > Flashcards

HDN/HTR/QA Flashcards

1
Q

What is hemolytic disease of newborn (HDN)?

A

Destruction of fetal or neonate RBC’s by antibodies produced by the mother
Caused by IgG antibodies

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2
Q

What blood bank tests are typically completed on all pregnant women?

A

Type and screen, Du (weak D) testing

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3
Q

What process is occurring in the fetus to compensate for the maternal antibody destruction of RBCs?

A

Kernicterus increases. Hematopoietic tissue, fetal bond marrow, spleen, and liver increase RBC production as anemia increases due to mother’s antibody.

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4
Q

What may be done to evaluate the severity of HDN during pregnancy?

A

Amniocentesis or cardocentesis.

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5
Q

What blood bank tests should be done on all cord bloods, when HDN is suspected?

A

ABO grouping, Rh typing, DAT

elution - antibody ID if necessary

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6
Q

What further tests may be helpful if the baby is sensitized?

A

Bilirubin

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7
Q

What criteria must blood meet in order to be suitable for an exchange transfusion for a fetus or newborn?

A

Group O RBCs, gamma irradiated to decrease GVHD, antigen for mother’s antibody, CMV neg, blood < 7 days old.

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8
Q

What specimen do you use for crossmatching in a fetal transfusion?

A

Mother’s serum

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9
Q

Why should cord cells be washed 4 times before testing for ABO, Rh, and DAT?

A

To remove Wharton’s jelly, which will cause false positive agglutination

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10
Q

What screening test can be done to detect fetal blood in the mother’s post delivery specimen?

A

Rosette technique

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11
Q

What is the theory behind the rosette screen for fetal RBCs?

A

A sample of the mother’s blood is mixed with anti-D. The anti-D attaches to the fetal D pos cells, which makes it invisible. O pos cells are added that attache to the anti-D on the fetal cells, making a circle around them (a Rosette). A pos test indicates a large fetal bleed into the mother’s circulation

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12
Q

What quantitative test can be completed to determine how many fetal cells are in the mother’s serum?

A

Confirmation test such as Kleihauer-Betke for quantitation

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13
Q

What is the shelf life and storage temp for RhIg?

A

2 years at 1-6 degrees

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14
Q

What else can be done to quantitate fetal bleed into the mother’s circulation besides the Kleihauer-Betke test?

A

Flow cytometry

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15
Q

Which immunoglobulin class can cross the placenta and enter a fetus’ circulation?

A

IgG 1-4

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16
Q

When are multiple doses of Rh immune globulin indicated?

A

Confirmatory test - Bleihauer-Betke pos

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17
Q

Why are antibodies titered? When is this important?

A

Antibodies are titered in the mother to give a relative # of antibodies that are crossing the placenta and also to see if the titer is increasing

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18
Q

Why must the RBCs be standardized for each antibody titer?

A

The RBCs used for each titration should be from the same donor, approximately same storage time & same concentration. The 1st serum specimen should be frozen and done in parallel with each subsequent titer

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19
Q

A babe is found to have a pos DAT. How would you interpret?

A

Elution - antibody ID

20
Q

What would you do if the mother was a pos for weak D and had a negative FMH screen?

A

No work up

21
Q

What would you do if the mother has a negative weak D and pos FMH screen?

A

Quantitate by Kleihauer-Betke or similar technique

22
Q

What is the incidence of forming anti-D for an Rh negative mother giving birth to an Rh positive baby?

A

9%

23
Q

In HDN, the greatest risk to the newborn after 24 hours is ?

A

Hyperbilirubinemia

24
Q

The most frequently seen cause of HDN is:

A

anti-A, anti-B, anti-A,B

25
Q

One of the most severe cause of HDN is:

A

anti-D

26
Q

Why isn’t anti-Le(a) associated with HDN?

A

Most anti-Le(a) are IgM so they don’t cross the placenta and if they are a rare IgG, the Lewis antigens are not well developed on fetal or newborn RBCs

27
Q

List the blood group systems that are rarely involved with hemolytic disease of the newborn or fetus

A

Lewis, P, MN

28
Q

If a fetus or newborn has a positive DAT, what are the next steps to be don before a transfusion?

A

Elution, antibody ID, blood selection that is CMV neg, irradiated and without the corresponding antigen involved, crossmatch

29
Q

How many vials of RhIg should be administered if the mother had a positive Rosette test and no fetal cells were seen on Kleihauer-Betke slide?

A

One

30
Q

What is the principle of the Kleinhauer-Betke test for fetal maternal bleed?

A

Maternal blood smear is treated with acid & then stained with a counterstain. Fetal cells (containing Hgb F) will remain pink because they are resistant to the acid. Mother’s cells will appear ghost-like. the % of fetal cells is calculated after 2000 cells are counted. From this, the volume of fetal cells in the mother’s circulation is counted

31
Q

Which RBC antigens are not expressed on RBCs at birth?

A

Lewis, P, Lutheran

32
Q

What class of antibody and temperature of reaction is the cause of the most sever intravascular transfusion reactions?

A

IgM broad thermal range, ABO

33
Q

What signs and symptoms are occurring in the patient who is having a febrile transfusion reaction?

A

One degree C rise of temp over baseline temp during/within 24 hours after transfusion
One degree C rise of temp over baseline during/within 8 hours after transfusion
Probable causes: antibodies to human leukocyte antigens and cytokines in the unit of blood if not leukoreduced shortly after collection

34
Q

What can be done to prevent further problems with febrile nonhemolytic transfusion reactions?

A

Better filtering out WBCs
Could use washed RBCs or deglycerized to remove all WBCs including fragments and cytokines produced during storage if not pre-storage leukoreduced

35
Q

What signs and symptoms are occurring in the patient who is having an allergic transfusion reactions?

A

Erythema, pruritis, hives. Fevers may or may not be present

36
Q

What can be done to prevent further problems with allergic transfusion reactions?

A

Removal of plasma with blood components (washed RBCs and platelets) and premedication with antihistamine

37
Q

What signs and symptoms are occurring in the patient with immediate intravascular hemolytic transfusion reaction?

A

Immediate, pt frequently has fever, chills, oliguria. some experience anuria, coagulapathy and 1 out of 10 ie o hypotension

38
Q

What signs and symptoms are occurring in the patient with delayed extravascular hemolytic transfusion reaction?

A

Fever, chills, jaundice, unexpected anemia, and decreased haptoglobin

39
Q

What is transfusion-associated circulatory overload (TACO)? What is the likely cause?

A

Symptoms are seen when the patient’s cardiovascular system’s inability to handle too much volume occurs. Congesting heart failure signs and symptoms occur. Circulatory overload

40
Q

What would the complication for a patient that has received frequent RBC transfusions over a life time?

A

Iron overload

41
Q

What needs to be done to a unit of RBCs before issue them to a severely immunocompromised recipient?

A

Irradiated

42
Q

What would possibly cause a physically induced transfusion reaction?

A

RBC hemolysis from heat damage
RBC hemolysis from freezing/washing process
Pushing donor unit too fast through transfusion needle - causing hemolysis

43
Q

What is the most likely cause of transfusion related acute lung injury?

A

Donor antibodies to MHC antigens

44
Q

What is the primary cause of post-transfusion purpura and a severe drop in the platelet count of the recipient?

A

Platelet antibodies HPA (Ia) in recipient

45
Q

If a patient has a massive transfusion, what electrolyte may fall because of citrate toxicity?

A

Calcium

46
Q

If a patient has antibodies to IgA, what type of transfusion reaction may occur?

A

Anaphylactic

47
Q

If a person has anti-IgA and needs RBC products, what can be done to make a safe transfusion?

A

Wash the RBCs

Immunohematology 480 (8 decks)

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