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I-2 > Immune-Mediated Anemia > Flashcards

Immune-Mediated Anemia Flashcards

1
Q

What is agglutination?

A

When antibody binds to RBCs and causes them to form aggregates. Each antibody has two binding sides so it can easily aggregate with multiple antibodies and multipple RBCs

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2
Q
A
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3
Q

Differentiate a direct coombs test from an indirect coombs test.

A

Direct Antiglobulin: Dtects antibody present on patient’s RBC, the antigen must be present on the patients RBCs, this it ptRBC+anti-Ig

Indirect Antiglobulin: Dtects antibody present in patients serum, antigen is present on anyone’s RBC, this is pt SERUM + NORMAL RBC +anti-Ig

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4
Q

What must occur for a positive result vs. a negative result in a direct coombs

A

In direct coombs, there is coombs reagent bound to pt RBC, because the ragent is binding to and detecting the antibody that is bound to the antigens of the patients RBCs

-in negative direct there is no antibody binding, so coombs reagent is not bound to RBCs

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5
Q

What is a positive result in a indirect coombs test? what about a negative

A

In a positive result you would see the patients serum and their antibodies binding to a normal RBC and the coombs reagent would bind to this

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6
Q

Compare warm with cold agglutination

A

Warm is IgG where cold is IgM

  • warm is used for inflammation and neoplasms
  • cold is used for myocplasma pneumonia and B cell lymphoproliferative disorders
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7
Q

What would you expect to happen in a Coomb’s test where A/B/AB blood is put into serum with Anti-A or Anti-B antibodies?

A
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8
Q

For the following conditions, would you use cold or warm agglutination?

Idiopathic, Chronic inflammation, Mycoplasma pneumonia, Neoplasms, B cell lymphoproliferative disorder

A

Warm: Idiopathic, Chronic inflammation, Neoplasms

Cold: Idiopathic, Mycoplasma pneumonia, B cell lymphoproliferative disorder

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9
Q

Which of the following would you NOT expect to generate a positive antiglobulin test?

A.Drug-induced hemolytic anemia

B.Mismatched blood transfusion

C.Systemic lupus erythematosus

D.Paroxysmal nocturnal hemoglobinuria

E.Rheumatoid arthritis

A

D. Paroxysmal nocturnal hemoglobinuria, because is is not antibdoy driven, it is a complement disorder. All antiglobulin tests require antibody

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10
Q

Which of the following antibody isotypes will most likely bind ABO antigens?

A.IgA

B.IgD

C.IgE

D.IgG

E.IgM

A

E. IgM

Explanation: Since ABO antigens are carbohydrates, they will elicit a T cell-independet responses. The primary Ab’s produced in a T cell-independent response are IgM. B cells are dependent upon T cells for the induction of class switching

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11
Q

What would you expect the results of direct and indirect Coomb’s tests to be in a patient who was given a mismatched transfusion?

A

Pos/Pos

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12
Q

What does an increased MCV mean?

A

Mean that the BM is trying to pump out RBCs, response to anemia usually.

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13
Q

Explain the immunologic process that links the transfusion of mismatched blood to the backache and decrease in blood pressure.

A

IgM in the serum binding onto the patient’s RBCs leading the the activation of complement. Complement initiates inflammation, which increases vasopermability resulting in a drop in BP.

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14
Q

Which of the following antibody isotypes most readily crosses the placenta?

A.IgA

B.IgD

C.IgE

D.IgG

E.IgM

A

D. IgG

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15
Q

Which of the following proteins is responsible for transferring immunoglobulin across the placenta?

A.FcεRI

B.FcγRII

C.FcμR

D.FcRn

E.Poly-Ig receptor

A

D. FcRn

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16
Q

Which of the following biochemical moieties is IgG most likely to bind?

A.Carbohydrate

B.DNA

C.Lipid

D.Protein

A

D. Protein

17
Q

What are the 2 examples of antibdoy binding without an antigen?

A

FcRn is neonates and FcepsilonR on mast cells

-The Fc-gamma-RII is the offswtich for B cells and requires antibody cross linking

18
Q

What antibody would initiate a T cell dependent response?

A

IgG because it requires a class swithc, IgM would be T cell Independent becase no class switching,

IgG binds protein while IgM can bind carbohydrates

19
Q

What are ABO antigens made of? What are Rh antigens made of?

A

ABO are cabrohydrates so IgM binds

Rh are protein is IgG binds

20
Q

Which Rh gene is more immunogenic? Are most people Rh-pos or neg?

A

There are two closely linked Rg genes: D and CE, where D is more immunogenic so it is the one we are testing for.

Most people are Rh postive, so RhD postivie, only about 15% are Rh negative

21
Q

When are you most concerned about a mother regarding Rh-type? What do you assume about the baby?

A

It is bad when the mother is Rh (-) and you assume the baby is Rh (+)

worry because mom will produce antibodies to the babies Rh antigen

22
Q

What is Rh disease of the newborn called?

A

Hemolytic disase of the fetus and the newborn (HDFN)

-eryhtroblastosis fetalis

23
Q

In a second preganancy with an Rh (-) mother and her previous baby was Rh(+), what will the result of a direct coombs be?

A

A direct coombs would be positive, because moms antibody would be stuck to the fetus RBC

24
Q

What is Rhogam? Who is it given to? What is its mechanism of action?

A

Rhogam is IgG agasint Rho D, given to Rh (-) mothers

Rhogam binds fetal RBcs, inhibits B cells, and induces complement-mediated lysis of fetabl RBC in maternal circulation because it prevents the mother antibodies from being able to find to the fetabl RBC since Rhogam is already bound

25
Q

In drug induced hemolytic anemia would what would the result of the direct and indirect coombs test be
?

A

Direct would be positive because there is antibody (drug) bound to RBCs

Indirect would be Negative because his serum will not bind normaly health RBC

26
Q

What is the drug an example of in hemolytic anemia?

A

It is a hapen and is binding to the RBC, this causes the body to recognize this as foregin, make antibodies against it, and initate the destruction of RBCs

27
Q

What are the results of direct and indirect results of

  1. Transufsion reaction
  2. Rh disase of the newborn
  3. autoimmune diseases
  4. Drug-induced hemolytic anemia
A

Transfusion, Rh disease of the newborn, and autoimmune disease are direct positive and indirect postivie

Drug-induced hemolytic anemia is direct postivie but indirect negative

It is not possible to have a direct negative and indirect positive

I-2 (36 decks)

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