Intro to Immunohematology

Question 1

Immunohematology

Answer 1

Study of immunology as it relates to blood

Question 2

Blood Bank

Answer 2

Selects, collects blood bank products
Performs testing
Distributes products
Established by the AABB
Regulated by FDA

Question 3

Landsteiner

Answer 3

ABO Blood Groups

Question 4

First Blood Bank

Answer 4

Cook County Hospital

Question 5

WWII Techniques

Answer 5

Albumin
Antiglobulin testing

Question 6

Transfusion Service

Answer 6

Similar to Blood Bank
Doesn’t typically collect products

Question 7

RBC Membrane Permeable

Answer 7

• Water
• Anions (Cl-, HCO3-)
  O2 and CO2

Question 8

RBC Membrane Impermeable

Answer 8

Na+
K+
Ca2+

Question 9

Anaerobic Glycolysis

Answer 9

90% of energy

Question 10

Monophosphate Shunt

Answer 10

10% of energy

Question 11

Methemoglobin Reductase Pathway

Answer 11

Accounts for a small amount of energy
Keeps Iron in Fe2+ state - O2 Transport

Question 12

2,3 DPG

Answer 12

Increase allows for greater O2 release at a certain PO2
Right Shift

Question 13

Oxygen Dissociation Curve

Answer 13

Increase O2 delivery with small decrease in PO2

Question 14

Primary Goals

Answer 14

Maintain Viability and Function
Prevent Detrimental Physical & Chemical Changes
Minimize Bacterial Proliferation

Question 15

Viability

Answer 15

The measure of in vivo survival of RBCs after transfusion
Minimum requirement for unit of pRBC 75% after 24 hrs

Question 16

Storage

Answer 16

Stored at 1-6 C
Limited Shelf Life (3 to 4 wks with 2 being the normal)
Decreasing ATP and 2,3 DPG
Increasing O2 Affinity - less functional

Question 17

Lesion of Storage

Answer 17

Loss of RBC viability with Associated Biochemical Changes:
- Decrease in pH
- Increase in Lactate
- Decrease in Glucose Availability
- Decrease in ATP
- Loss of RBC function (increase in K+ levels)

Question 18

Coagulation Factors

Answer 18

After 24 hrs
- Decrease in labile coagulation factors
- Very few functional platelets

Question 19

Zero Days of Storage

Answer 19

Viable - 100%
pH - 7.55
ATP - 100%
2,3 DPG - 100%
Plasma K+ - 5.1 mmol/L
Plasma Na+ - 169 mmol/L
Plasma Hgb - 78 mg/L

Question 20

At 21 - 35 Days of Storage

Answer 20

Viable Cells - 71%
pH - 6.71
ATP - 33-57%
2,3 DPG - 100%
Plasma K+ - 79 mmol/L
Plasma Na+ - 111 mmol/L
Plasma Hgb - 65.8 mg/L

Question 21

Blood Preservatives

Answer 21

Prevents clotting
Maintains Cell viability and function

Question 22

One unit of pRBC

Answer 22

405 - 495 + 63 mL anticoagulant

Question 23

Additive Example

Answer 23

Dextrose to support ATP
Adenine - Substrate for ATP production
Phosphate buffer to control pH
Citrate to prevent clotting - binds Ca2+ (removes coag cascade)

Question 24

Additives with 21 Day Storage

Answer 24

CPD (Citrate-Phosphate-Dextrose)
CP2D (Citrate-Phosphate-Dextrose-Dextrose)

Question 25

35 Day Storage

Answer 25

CPDA-1 (Citrate-Phosphate-Dextrose-Adenine)

Question 26

Additives

Answer 26

Added when RBCs are separated from plasma
Increases viability of RBC units
Added to RBCs within 72 hrs of collection
Increase expiration to up to 42 days

Question 27

Storage Bag

Answer 27

Permeable to CO2
Made of Polyvinyl Chloride - potential toxicity

Question 28

Storage Temperature

Answer 28

WB & RBC: 1-6 C
Plasma (Fresh Frozen Plasma - FFP): -18 C or less
Platelets: 20-24 C (3-7 day shelf life)
Frozen RBCs (rare blood): -65 C or less, 10 yrs, needs glycerol

Question 29

Advantages of PolyHeme and Hemopure

Answer 29

Long Shelf Life
Very Stable
No Antigenicity
Blood Typing NOT Required

Question 30

Disadvantages of PolyHeme and Hemopure

Answer 30

Short Intravascular Half-Life
Possible Toxicity
Increased O2 affinity
Increased Oncotic Effect (causes cancer)

Question 31

Advantages of Perfluorochemicals

Answer 31

Biologic Inertness
Lack of Immunogenicity
Easily Synthesized

Question 32

Disadvantages of Perfluorochemicals

Answer 32

Adverse Clinical Effects
Retention in Tissues
High O2 Affinity
O2 Required with infusion
Deep Freeze Storage Required