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CCHS SBB > Immune Hemolytic Anemia > Flashcards

Immune Hemolytic Anemia Flashcards

1
Q

disease state in which antibodies attach to red cells in circulation and those red cells either lyse in circulation or are removed from circulation, resulting in anemia

A

immune hemolytic anemia

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2
Q

types of immune hemolytic anemia

A
  • allo-immune
  • drug-induced
  • autoimmune
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3
Q

HDFN and HTR are what type of immune hemolytic anemia?

A

allo-immune

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4
Q

drug-induced hemolytic anemia is what type hypersensitivity?

A

II and III

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5
Q

autoimmune hemolytic anemia is what type hypersensitivity?

A

II

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6
Q

~80% of all AIHA are what type?

A

warm autoimmune

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7
Q

what antibody class is implicated in WAIHA?

A

IgG

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8
Q

in WAIHA, is the DAT or IAT stronger?

A

DAT

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9
Q

do WAIHA cases bind complement?

A

sometimes (75%)

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10
Q

optimum reactivity temperature of WAIHA

A

37C

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11
Q

what percentage of WAIHA are primary (idiopathic)?

A

30%

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12
Q

why are all crossmatches incompatible at AHG in WAIHA?

A

antibody spill-over when all patient red cell antigen sites are full

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13
Q

elution results in WAIHA

A

panreactive

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14
Q

what can be used to reduce autoantibody production?

A

corticosteroids

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15
Q

what does rituximab act on in regard to WAIHA?

A

CD20 on B cells

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16
Q

antibody class implicated in cold agglutinin syndrome

A

IgM

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17
Q

optimum reaction temperature for cold agglutinin syndrome

A

room temp and below

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18
Q

cold agglutinin syndrome is associated with ___vascular immune destruction

A

extra

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19
Q

paroxysmal cold hemoglobinuria is associated with what disease state in adults

A

syphilis

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20
Q

paroxysmal cold hemoglobinuria is associated with what disease state in children?

A

viral infections

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21
Q

antibody class implicated in paroxysmal cold hemoglobinuria

A

IgG

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22
Q

what antigen is antibody directed against in paroxysmal cold hemoglobinuria?

A

P carbohydrate antigen

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23
Q

Donath-Landsteiner is confirmatory test for what?

A

paroxysmal cold hemoglobinuria

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24
Q

biphasic hemolysin is associated with what disease state?

A

paroxysmal cold hemoglobinuria

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25
paroxysmal cold hemoglobinuria presents with ___vascular immune destruction
intra
26
disease states associated with cold agglutinins
``` Mycoplasma pneumonia Epstein Barr CLL mono carcinomas ```
27
diagnostic test for paroxysmal nocturnal hemoglobinuria
sucrose hemolysis
28
most common cold agglutinin
auto-anti-I
29
auto-anti-I antibody class
IgM
30
autoantibody associated with Mycoplasma pneumoniae
auto-anti-I
31
autoantibody associated with infectious mono
auto-anti-i
32
what blood types is auto-anti-H seen in?
A and AB
33
anti-H strongly agglutinates what cells
group O
34
cold agglutinin that agglutinates both cord cells and adult cells and patient autocontrol
nonspecific cold agglutinin
35
disease states associated with mixed autoimmune hemolytic anemia
lymphoproliferative disorders lupus HIV
36
most common current drug associated with drug induced hemolytic anemia
cephalosporins
37
DAT in drug-induced hemolytic anemia
positive
38
IAT in drug-induced hemolytic anemia
negative
39
drug induced hemolytic anemia mechanism: positive IgG DAT negative C3 negative elution
drug adsorption
40
drug-induced hemolytic anemia mechanism: positive IgG DAT positive C3 negative elution
membrane modification
41
drug-induced hemolytic anemia mechanism: negative IgG DAT positive C3 negative elution
immune complex
42
drug-induced hemolytic anemia mechanism: positive IgG DAT negative C3 positive elution
autoantibody
43
DIHA mechanism in which drug binds tightly to red cell membrane proteins and patient makes IgG antibody to the drug
drug adsorption
44
most common drug associated with drug adsorption mechanism of DIHA
penicillin-G
45
when can the eluate be positive in drug adsorption mechanism of DIHA?
if red cells are pretreated with the drug
46
drugs associated with drug adsorption mechanism of DIHA
penicillin-G, cephalosporin, erythromycin, methicillin, carbromal, nafcillin, cefazolin, tetracycline, cefamandole
47
drug adsorption mechanism DIHA patients develop hematologic complications?
usually no
48
DIHA mechanism in which presence of the drug causes modification of RBC membranes and this modification causes proteins to adsorb onto red cells
membrane modification
49
antibody class associated with membrane modification DIHA
IgG, IgM, IgA, C3, C4, albumin, fibrinogen
50
is membrane modification DIHA associated with red cell destruction?
no
51
drugs associated with membrane modification DIHA
``` keflin cephalothin cisplatin diglycoaldehyde suramin ```
52
drug most commonly associated with membrane modification DIHA
Keflin
53
DIHA mechanism in which drug-antibody complex is bound loosely and transiently to the red cell membrane
immune complex
54
antibody class associated with immune complex DIHA
IgM
55
drugs associated with immune complex DIHA
quinine, quinidine, sulfonamides, phenacetin, acetaminophin
56
DIHA mechanism that activates complement cascade
immune complex
57
DIHA mechanism in which drug does not attach to red cells but presence of drug stimulates production of antibody with IgG specificity
autoantibody
58
autoantibody mechanism DIHA antibody class
IgG
59
most common drug associated with autoantibody DIHA
methydopa/Aldomet
60
technique used to remove bound antibody from red cells
elution
61
applications of elution
positive DAT purification or concentration of antibodies preparation of antibody-free red cells for phenotyping
62
technique used to separate two or more antibodies or remove autoantibodies from a sample so that it may be evaluated for presence of alloantibodies
adsorption
63
products of elution
stroma-rbc membrane fragments eluate-liquid portion containing antibody
64
primary means for determining whether immune-mediated destruction of red cells is contributing to patient's anemia
DAT
65
what does a positive DAT confirm?
presence of red cells coated in vivo with antibodies or complement
66
elution technique in which acid lyses red cells
acid elution
67
elution technique that results in negative DAT to allow for phenotyping
glycine-HCl/EDTA
68
elution technique used for ABO and IgM antibodies that has poor recovery of IgG antibodies
heat/Landsteiner-Miller
69
elution technique that doesn't destroy red cells
heat/Landsteiner-Miller
70
elution technique used for ABO HDFN
Lui Freeze-Thaw
71
why should adsorption procedures not be performed on samples from patients that have been transfused in the last 3 months?
potential exists for adsorption of significant alloantibodies onto transfused donor cells
72
removal of warm-reactive autoantibody from patient serum using patient's cells to allow detection of possible alloantibody
adsorption
73
adsorption technique that contains enzymes and therefore destroys some antigen sites and cannot be used for phenotyping
W.A.R.M
74
adsorption technique that is mixture of proteolytic enzyme and sulfhydryl reagent that destroys enzyme sensitive antigen sites and Kell antigens
ZZAP
75
adsorption technique that does not contain enzymes and dissociates antibody from red cells with little or no damage to antigens allowing for phenotyping
chloroquine diphosphate
76
3 red cell phenotypes used in allo-adsorption technique
group O R1R1, R2R2, rr, one Jka- and one Jkb-
77
removal of cold reactive autoantibody from patient serum onto patient's own cells to allow for detection of alloantibody and reverse grouping
cold auto-adsorption
78
why are patient cells enzyme treated in cold-autoadsorption technique?
enzyme treated autologous cells have increased ability to bind cold autoantibody for removal from serum
79
adsorption technique that utilizes rabbit stroma with cross-reactivity to adsorb out auto anti-I, H, and IH
RESt (rabbit erythrocyte stroma)
80
adsorption technique that doesn't use patient cells and can be performed for a patient that has been recently tranfused
RESt
81
can adsorbed serum from RESt technique be used for ABO typing?
no, anti-B is also adsorbed
82
technique that eliminates interfering reactivity of cold autoagglutinins that react in AHG phase of testing
pre-warming
83
why would serum be treated to inactivate IgM?
abolishes agglutinating and complement-binding activities
84
treatments to inactivate IgM
AET, DTT, 2-ME

CCHS SBB (40 decks)

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