ISBB Flashcards

Question

Which immunologic mechanism is usually involved in BRONCHIAL ASTHMA? Immediate hypersensitivity Immune complex Antibody mediated cytotoxicity Delayed hypersensitivity

Answer 1

Immediate hypersensitivity

Answer 2

Gerald Edelman, Rodney Porter

Answer 3

Susumu Tonegawa

Answer 4

They kill target cells without prior exposure to them

Answer 5

Dendritic cell

Answer 6

Chromosome 6

Answer 7

Clusters of differentiation (CD)

Answer 8

Ankylosing spondylitis

Answer 9

IgM and IgD

Answer 10

Synthesis of antibody

Answer 11

T cytotoxic

Answer 12

Effective against virally infected cells

Answer 13

IgM and sIgA

Answer 14

IgG and IgM

Answer 15

Serum sickness

Answer 16

Rheumatoid arthritis

Answer 17

Primary biliary cirrhosis

Answer 18

Chronic active hepatitis

Answer 19

Hereditary angioedema

Answer 20

CRP and serum amyloid A

Answer 21

Systemic lupus erythematosus

Answer 22

Hinge region

Answer 23

Louis Pasteur

Answer 24

Dendritic cell Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

Answer 25

Dendritic cell Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

Answer 26

Contain surface immunoglobulins B cells carry surface immunoglobulins that react to a specific antigen. The antigen can then be internalized processed and presented to an appropriate T helper cell. B cells are not phagocytic, nor do they participate in antibody-dependent cellular cytotoxicity (ADCC) reactions. Complement proteins are secreted by hepatocytes.

Answer 27

Maternal IgG Antibody production is immunogen induced. Because the fetus develops in a sequestered site, it makes very little immunoglobulin. Maternal IgG crosses the placenta and is the primary antibody found in infant's circulation.

Answer 28

IgG Immunoglobulin G is Ihe predominant class of immunoglobulin found in serum. It accounts for approximately 80% of the total serum immunoglobulin. The normal range is 800-1600 mg/dL.

Answer 29

IgM The IgM molecule is a pentamer that contains 10 binding sites. However, the actual valence falls to 5 with larger antigen molecules, probably because of steric restrictions. IgA, IgG, IgD, and IgE monomers each have two antigenic binding sites.

Answer 30

An immediate allergic reaction Type I hypersensitivity reactions occur immediately after second exposure to an allergen. On the first, or primary, exposure, IgE specific to the allergen is produced. The IgE binds to Fc receptors on the surface of basophils and mast cells. Immune complexes and complement are not involved in the response.

Answer 31

Immunodeficiency with decreased or dysfunctional T and B cells SCID is defined as a condition in which adaptive immune responses (i.e., cell-mediated and humoral-mediated immune responses) do not occur because of a lack of T and B cell activity. A number of genetic defects can lead to this condition. Children born with SCID need to live in a sterile environment, and they have a short life expectancy.

Answer 32

IgM The first B cells to respond to antigen differentiate into plasma cells that produce IgM antibody. Later in the immune response, stimulated B cells undergo a phenomenon called "class switching" and begin to produce antibodies of the IgG, IgA, and IgE classes. High concentration of IgM in patient serum is indicative of a recent infection.

Answer 33

Isograft Identical twins have the same genetic makeup. Grafts between them would be isografts or syngeneic grafts.

Answer 34

The absence of all immunoglobulins Bruton disease is a congenital form of agammaglobulinemia. It is a sex-linked phenomenon that affects males. Because B cells are not produced, affected males have levels of IgA, IgD, IgE, and IgM undetectable by routine assays. IgG may be absent or present at very low levels.

Answer 35

Artificial active Active immunity follows exposure to an antigen that stimulates the recipient to develop his or her own immune response. Vaccines are an example of artificial immunity in that the animal was exposed to the immunogen by the actions of a healthcare provider (unnatural).

Answer 36

Artificial passive Artificial passive immunity results following the injection of antibody synthesized by another individual or animal. This type of immunity is only temporary but may be very important in providing "instant" protection from an infectious agent before the recipient would have time to actively synthesize antibody.

Answer 37

Phagocytosis by polymorphonuclear cells Innate, or nonspecific, immunity refers to host defenses that are in general present at birth and do not require immunogen stimulation. Phagocytosis of bacteria by polymorphonuclear cells is an example. Cytotoxic T cell activity is part of the adaptive cell-mediated immune response, and antibody production is the mechanism of protection in the adaptive humoral-mediated immune response.

Answer 38

Nuclear antigen Antinuclear antibody (ANA) is the most consistent feature of systemic lupus erythematosus (SLE).

Answer 39

Type I hypersensitivity reactions Elevated IgE levels are found in type I hypersensitivity reactions. The antibody binds via the Fc portion of the molecule to Fc receptors on mast cells and basophils. When the attached antibody binds its specific allergen, the cell degranulates.

Answer 40

Autoimmune disease The immune system recognizes host cells as self and is tolerant to antigens on those cells. The loss of tolerance will result in an autoimmune disease in which the immune system mounts an immune response against self cells. Graft-versus-host disease occurs when a bone marrow graft is incompatible with the host tissue and attacks the host.

Answer 41

Does not require previous exposure to an antigen The natural killer (NK) cells destroy target cells through an extracellular nonphagocytic mechanism. NK cells are part of the host's innate resistance and, therefore, do not need previous exposure to an antigen to be active.

Answer 42

Type 1 diabetes Destruction of the beta cells in the pancreas results in type 1 diabetes. An autoimmune response destroys the insulin-producing cells.

Answer 43

C5 The membrane attack complex forms following the binding of C5 to a biologic membrane. The complex is formed by the sequential addition of C6, C7, C8, and C9. When C5-C8 complex with C9, a tubule is formed that bridges the cell membrane.

Answer 44

Neutrophils The first response by the innate immune system consists of an influx of neutrophils into the tissue invaded by bacteria. Monocytes and macrophages, although they are phagocytic cells and part of the innate immune system, play only a minor role in the initial response to bacterial invasion.

Answer 45

Type II hypersensitivity reactions Incompatible blood transfusions are examples of a type II hypersensitivity reaction. These reactions are characterized as the antigen being a part of a cell. Antibody binds to the antigen, complement is activated, and the red blood cells are lysed.

Answer 46

Thyroid gland Hashimoto disease is a type of thyroiditis due to an autoimmune disease. Patients produce autoantibodies and T cells that respond to thyroid antigens. This results in inflammation and swelling of the thyroid gland (goiter). The autoantibody blocks the uptake of iodine, which results in a decrease in the production of thyroid hormones (hypothyroidism).

Answer 47

T lymphocytes Contact dermatitis is a delayed-type hypersensitivity reaction mediated by T cells.

Answer 48

Defective T lymphocyte production Congenital thymic hypoplasia (DiGeorge syndrome)

Answer 49

Dendritic cell Dendritic cells are considered the most effective APC in the body, as well as the most potent phagocytic cell.

Answer 50

Anti-CCP Antibodies to cyclic citrullinated peptide are often found in RF-negative patients with rheumatoid arthritis.

Answer 51

Nuclear matrix protein Nuclear matrix proteins (NMPs) are RNA-protein complexes. NMP-22 is shed into the urine in persons with bladder carcinoma and is about 25-fold higher than normal in this condition.

Answer 52

CA 15-3 CA 15-3 shares the same antigenic determinant as CA 27.29. The markers are used to monitor treatment and recurrence of breast cancer.

Answer 53

HER-2/neu Trastuzumab is an antibody to the HER-2/neu gene product, a tyrosine kinase receptor protein. HER- 2/neu is an oncogene that is overexpressed in some breast cancers. Overexpression is associated with a more aggressive clinical course but responds to treatment with trastuzumab, which blocks the attachment of growth factor to the receptor.

Answer 54

Hepatoma AFP is increased in all persons with yolk sac tumors and over 80% of those with hepatoma. Levels above 1000 ng/mL are diagnostic of hepatoma.

Answer 55

VH and VL Variations in the variable regions of the heavy and light chains of an immunoglobulin molecule define the idiotype.

Answer 56

C1q Mannose-binding lectin (MBL) of the lectin pathway of complement activation is found in circulation complexed with proteinases. It is considered to be similar in structure to C1q of the classical pathway. The MBL-proteinase complex does not require antibody for complement activation.

Answer 57

Antibody to thyroid-stimulating hormone receptor Autoantibody to the thyroid-stimulating hormone receptor ultimately causes release of thyroid hormones and a hyperthyroid condition.

Answer 58

Type IV Type IV hypersensitivity is the delayed-type hypersensitivity. Skin testing for tuberculosis causes a delayed-type hypersensitivity to intradermally injected antigens in individuals previously exposed to the organism.

Answer 59

Bruton’s agammaglobulinemia Bruton’s agammaglobulinemia is typically seen in infancy. These patients present with frequent recurring infections, especially after protective maternal antibody is gone and normal levels of circulating T cells. The syndrome is a genetic B cell enzyme deficiency in which the B cells fail to differentiate and mature to antibody-producing plasma cells.

Answer 60

C1 Inhibitor Hereditary angioedema is characterized by recurrent swelling. The condition is genetic or can be acquired and is the result of a deficiency of the complement protein C1 Inhibitor.

Answer 61

DiGeorge’s syndrome DiGeorge syndrome is the most likely cause. In this syndrome the thymus fails to develop before birth. These patients also show a marked decrease in T cells.

Answer 62

Chronic granulomatous disease Chronic granulomatous disease is an inherited disease that impairs the neutrophil’s ability to kill certain bacteria. The neutrophils lack the enzyme nicotinamide adenine dinucleotide phosphate oxidase, easily demonstrated by the failure to reduce nitroblue tetrazolium or produce a blue end result. These patients have normal levels of lymphocytes.

Answer 63

Hyperacute The hyperacute tissue graft reject occurs within minutes to hours of a transplant and is typically associated with transplantation across ABO blood groups and anti-ABO antibodies.

Answer 64

Procalcitonin Procalcitonin (PCT) is a biomarker that exhibits greater specificity than other proinflammatory markers (e.g., cytokines) in identifying patients with sepsis and can be used in the diagnosis of bacterial infections.

Answer 65

Kupffer cells MACROPHAGES NOMENCLATURE IN DIFFERENTTISSUES CNS - Microglial cells Kidney - Mesangial cells Liver - Kupffer cells Lung - Alveolar macrophage Lymph node - Lymph node macrophage Spleen - Splenic macrophage

Answer 66

pH 5.6 Lactic acid in sweat, for instance, and fatty acids from sebaceous glands maintain the skin at a pH of approximately 5.6. This acidic pH keeps most microorganisms from growing.

Answer 67

Calcium C1 forms the recognition unit of the complement pathway. It consists of three subunits stabilized by calcium.

Answer 68

Hashimoto's thyroiditis Hashimoto’s thyroiditis is an autoimmune disorder that results in hypothyroidism. More than 80% of the patients with the disease have serum anti-thyroglobulin and anti-microsomal antibodies.

Answer 69

ANCA ANCA: ANTINEUTROPHILIC CYTOPLASMIC ANTIBODY

Answer 70

IgM, IgD IgM and IgD are the classes of immunoglobulin that are found on most circulating B cells. They are in effect the B cell receptor.

Answer 71

Wiskott-Aldrich syndrome Wiskott Aldrich syndrome is an X-linked recessive defect that exhibits immunodeficiency, eczema and thrombocytopenia.

Answer 72

False-negative reaction

Answer 73

Diagnosis of monoclonal gammopathies

Answer 74

Direct immunofluorescent assay

Answer 75

Indirect fluorescence

Answer 76

Inhibition immunofluorescent assay

Answer 77

Less fluorescence polarization

Answer 78

Denaturation→Annealing→Extension The PCR process results in identical copies of a piece of double-stranded DNA. The process involves three steps that are repeated to double the number of copies produced with each cycle. The first step is denaturation to separate the complementary strands. Annealing occurs when a primer binds upstream to the segment of interest on each strand, called the template. Extension involves the enzymatic addition of nucleotides to the primer to complete the new strand.

Answer 79

Heat In PCR, the separation of dsDNA occurs by heating the sample. This breaks the double bonds between the base pairs and is reversible by lowering the temperature.

Answer 80

94 °C DENATURATION: 94C ANNEALING: 50 to 58C or higher EXTENSION: 72C

Answer 81

Hepatitis B surface antigen (HBsAg)

Answer 82

Hepatitis B core antibody

Answer 83

Chronic hepatitis B virus infection Persons with chronic HBV infection show a positive test result for anti-HBc (IgG or total) and HBsAg but not anti-HBs. Patients with active chronic hepatitis have not become immune to the virus.

Answer 84

All of the above

Answer 85

CD4+ T lymphocytes

Answer 86

Kaposi’s sarcoma

Answer 87

p24 In HIV-1 infection, antibodies to the gag proteins p24 and p55 appear relatively early after exposure to the virus, but tend to decrease or become undetectable as clinical symptoms of AIDS appear. Antibodies to the envelope proteins gp41, gp120, and gp160 appear slightly later but remain throughout all disease stages in an HIV-infected individual, making them a more reliable indicator of the presence of HIV.

Answer 88

HIV-1 and HIV-2 antibodies and p24 antigen FIRST GENERATION Solid-phase, indirect Anti-HIV1 SECOND GENERATION Indirect binding Anti-HIV1, anti-HIV2 THIRD GENERATION Sandwich technique Anti-HIV1, anti-HIV2 Simultaneously detecting HIV antibodies of different immunoglobulin classes, including IgM FOURTH GENERATION Detects anti-HIV1, anti-HIV2 and p24

Answer 89

Bands at p24 and gp120 Criteria for determining a positive test result have been published by the Association of State and Territorial Public Health Laboratory Directors and CDC, the Consortium for Retrovirus Serology Standardization, the American Red Cross, and the FDA. According to these criteria, a result should be reported as positive if at least two of the following three bands are present: p24, gp41, and gp120/gp160.

Answer 90

Gel In an RID test system, for example, one measuring hemopexin concentration, the gel would contain the antihemopexin. A standardized volume of serum containing the antigen is added to each well. Antigen diffuses from the well into the gel and forms a precipitin ring by reaction with antibody. At equivalence, the area of the ring is proportional to antigen concentration.

Answer 91

Nonidentity between wells 1 and 2 Crossed lines indicate nonidentity between wells 1 and 2. The antibody from well 1 recognizes a different antigenic determinant than the antibody from well 2.

Answer 92

Result will be falsely increased If unbound enzyme-conjugated anti-immunoglobulin is not washed away, it will catalyze conversion of substrate to colored product, yielding a falsely elevated result.

Answer 93

Result will be falsely increased If the color reaction is not stopped within the time limits specified by the procedure, the enzyme will continue to act on the substrate, producing a falsely elevated test result.

Answer 94

Possible false-positive result Failure to follow directions, as in this case where the reaction was allowed to proceed beyond the recommended time, may result in a false-positive reading. Drying on the slide may lead to a possible erroneous positive reading.

Answer 95

Decreased numbers of CD4 T cells.

Answer 96

1:2 An inverted CD4:CD8 ratio (less than 1.0) is a common finding in an AIDS patient. The Centers for Disease Control and Prevention requires a CD4-positive (helper T) cell count of less than 200/μL or 14% in the absence of an AIDS-defining illness (e.g., Pneumocystis carinii pneumonia) in the case surveillance definition of AIDS.

Answer 97

Hepatitis A Hepatitis A is spread through the fecal–oral route and is the cause of infectious hepatitis. Hepatitis A virus has a shorter incubation period (2–7 weeks) than hepatitis B virus (1–6 months). Epidemics of hepatitis A virus can occur, especially when food and water become contaminated with raw sewage. Hepatitis E virus is also spread via the oral–fecal route and, like hepatitis A virus, has a short incubation period.

Answer 98

HBsAg Hepatitis B surface antigen (HBsAg) is the first marker to appear in hepatitis B virus infection. It is usually detected within 4 weeks of exposure (prior to the rise in transaminases) and persists for about 3 months after serum enzyme levels return to normal.

Answer 99

Anti-HBc IgM Antibody to the hepatitis B core antigen (anti-HBc) is the first detectable hepatitis B antibody. It persists in the serum for 1–2 years post-infection and is found in the serum of asymptomatic carriers of HBV.

Answer 100

Alanine aminotransferase (ALT) ALT is a liver enzyme and may be increased in hepatic disease. Highest levels occur in acute viral hepatitis, reaching 20–50 times the upper limit of normal.

Answer 101

HIV viral load The HIV viral load will rise or fall in response to treatment more quickly than any of the other listed parameters. The absolute CD4 count is also an indicator of treatment effectiveness and is used in resource-poor areas that might not have facilities for molecular testing available. Note that the absolute CD4 count is not one of the choices, however.

Answer 102

Zone of equivalence

Answer 103

Radial immunodiffusion

Answer 104

It may be too small to produce lattice formation.

Answer 105

Agglutination inhibition

Answer 106

Direct hemagglutination

Answer 107

Intimate sexual contact.

Answer 108

Collection of the test sample before seroconversion.

Answer 109

Agglutination occurs when the antigen is particulate Precipitation reactions occur between soluble antigen and soluble antibody that produce a visible end result typically in the form of a visible line of precipitate. Agglutination reactions occur when the antigen is particulate or coated on a particulate such as latex beads.

Answer 110

Excess antigen in test PROZONE Antibody excess, false negative Remedy: serum dilution POSTZONE Antigen excess, false negative Remedy: repeat test after a week to give time for antibody production

Answer 111

Acute hepatitis B The most likely answer is acute hepatitis B because of the presence of IgM anti-HBc in combination with the hepatitis surface antigen. Typically the presence of IgM indicates the presence of an acute phase of a disease.

Answer 112

Nephlometry measures light scattered in a solution, and turbidimetry measures light transmitted through a solution Nepholometry measures light at angles. The light source used for detection is placed at an angle from the detection device. Turbidometry detection devices are placed directly across from the light source and measures the intensity of the light as it passes through solution.

Answer 113

Polymorphonuclear leukocytes In addition to T lymphocytes, macrophages, peripheral blood monocytes, and cells in the lymph nodes, skin, and other organs also express measurable amounts of CD4 and can be infected by HIV-1.

Answer 114

Staphylococcal protein A Protein A, found in the cell walls of Staphylococcus aureus bacteria, has high affinity for the Fc region of IgG and can be used to bind IgG in some laboratory assays.

Answer 115

RAST RIST - measures TOTAL IgE RAST - measures SPECIFIC IgE

Answer 116

Destruction of complement

Answer 117

Solid phase A variety of solid-phase supports are used, including microtiter plates, nitrocellulose membranes, and magnetic latex beads.

Answer 118

Antigen and antibody

Answer 119

Enzyme-conjugated

Answer 120

Charcoal particles

Answer 121

100 RPM for 8 minutes

Answer 122

Treponemal antibody

Answer 123

Todd or International Units

Answer 124

Rickettsial

Answer 125

IFA and micro-IF IFA - indirect fluorescent assays Micro-IF - microimmunofluorescent assay The IFA test and the micro-IF are currently considered the gold standard for detecting rickettsial antibodies.

Answer 126

Strains of Proteus vulgaris

Answer 127

Inflammation

Answer 128

Mycoplasma pneumoniae

Answer 129

CREST syndrome Most patients with CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) demonstrate anti-centromere antibody.

Answer 130

Crithidia luciliae One particularly sensitive assay for ds-DNA is an immunofluorescent test using Crithidia luciliae, a hemoflagellate, as the substrate. This trypanosome has circular ds-DNA in the kinetoplast. A positive test is indicated by a brightly stained KINETOPLAST with patient serum and an antibody conjugate.

Answer 131

Fc portion of IgG

Answer 132

Anticardiolipin antibody Reagin is the name for a nontreponemal antibody that appears in the serum of syphilis-infected persons and is detected by the RPR and VDRL assays. Reagin reacts with cardiolipin, a lipid-rich extract of beef heart and other animal tissues.

Answer 133

Cardiolipin Cardiolipin is extracted from animal tissues, such as beef hearts, and attached to carbon particles. In the presence of reagin, the particles will agglutinate.

Answer 134

Fluorescent T. pallidum antibody absorption test (FTA-ABS) The FTA-ABS test is more specific for T. pallidum than nontreponemal tests such as the VDRL and RPR and would be least likely to detect a biological false-positive result. The FTA-ABS test uses heat-inactivated serum that has been absorbed with the Reiter strain of T. pallidum to remove nonspecific antibodies.

Answer 135

CSF If neurosyphilis is present, cerebrospinal fluid serology will be positive and the CSF will display increased protein and pleocytosis characteristic of central nervous system infection.

Answer 136

CD4-positive T-cell count and clinical symptoms The classification system for HIV infection is based upon a combination of CD4-positive T-cell count (helper T cells) and various categories of clinical symptoms. Classification is important in determining treatment options and the progression of the disease.

Answer 137

Occurs in patients with hepatitis B Hepatitis D virus is an RNA virus that requires the surface antigen or envelope of the hepatitis B virus for entry into the hepatocyte. Consequently, hepatitis D virus can infect only patients who are coinfected with hepatitis B.

Answer 138

Only IgM antibodies positive If only IgM antibodies are positive, this result indicates a recent vaccination or an early primary infection.

Answer 139

IgM Rheumatoid factor (RF) is an immunoglobulin that reacts with antigenic determinants on an IgG molecule. Although they may be of several types, the one that is easily serologically detectable is IgM. This is because of the agglutination activity of the molecule. RF tests are commonly used in the diagnosis of rheumatoid arthritis.

Answer 140

Anti-DNase B The serological diagnosis of group A streptococcal infection can be made by demonstrating anti-DNase B. The antistreptolysin O (ASO) assay can also be used; however, ASO response is poor in skin infections.

Answer 141

IgG Staphylococcal protein A binds only the IgG class (subclasses IgG1, IgG2, and IgG4) of immunoglobulin. Binding occurs via the Fc portion of the antibody molecule, leaving the Fab portion available to bind antigen in an immunologic assay.

Answer 142

Complexed with charcoal The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests use a cardiolipin antigen. However, in the RPR test, charcoal particles are included with the antigen. When antibody in the patient sample combines with the antigen, the charcoal is trapped in the immune complex, allowing the reaction to be read macroscopically.

Answer 143

Flocculation reaction The cardiolipin antigen is particulate, not soluble, in the VDRL test. However, the particles are too small to make macroscopic agglutinates when combined with antibody. This type of reaction is called a flocculation reaction and needs to be read with low-power microscopy.

Answer 144

Flocculation reaction The cardiolipin antigen is particulate, not soluble, in the VDRL test. However, the particles are too small to make macroscopic agglutinates when combined with antibody. This type of reaction is called a flocculation reaction and needs to be read with low-power microscopy.

Answer 145

Systemic lupus erythematosus Patients with connective tissue disorders such as systemic lupus erythematosus may show a false positive reaction in the VDRL test. Other causes of false positives include rheumatic fever, infectious mononucleosis, malaria, and pregnancy.

Answer 146

Antinuclear antibody (ANA) Testing for antinuclear antibodies (ANAs) is commonly performed by the immunofluorescence method—using fluorescein-conjugated antihuman antibody to detect patient antibody bound to nuclear components of test cells.

Answer 147

It is an indicator of ongoing inflammation. CRP is an acute-phase reactant. Although it is elevated in inflammation, its presence is not diagnostic for any one disease, such as rheumatic fever. It does not correlate with antibody levels or with neutrophil phagocytic function. CRP levels are sometimes elevated during heart disease.

Answer 148

Precipitation reactions Precipitation reactions involve both soluble antigens and antibodies. With agglutination reactions, one of the reactants is soluble and the other is insoluble. A reactant is made insoluble by combining with a carrier particle such as latex beads.

Answer 149

FTA-ABS The fluorescent treponemal antibody absorbance (FTA-ABS) test is often used as a confirmatory test for syphilis. Treponema pallidum subsp. pallidum, the causative agent of syphilis, is the source of the antigen. The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) are diagnostic tests for syphilis that use nontreponemal antigen.

Answer 150

Lyme disease IMPORTANT! IgM antibody to OspC is an important early marker in the diagnosis of Lyme disease.

Answer 151

Epstein-Barr virus INFECTIOUS MONONUCLEOSIS (EBV) The Davidsohn differential test can be used to detect heterophile antibodies produced during infectious mononucleosis. These antibodies are not adsorbed by guinea pig antigens. Therefore, the antibodies are available to agglutinate horse red blood cells.

Answer 152

A sibling (brother or sister) Because the human leukocyte antigen (HLA) system is extremely polymorphic, the odds are greatly against finding an HLA-compatible donor in unrelated individuals. The genes coding for HLA antigens are inherited from one's parents and are expressed co-dominantly. Between an offspring and either parent, there is, statistically, a 25% chance of an HLA match. Between siblings, there is a 50% chance of an HLA match.

Answer 153

Latex agglutination

Answer 154

Immunofluorescence

Answer 155

Acute rheumatic fever

Answer 156

MHA-TP test

Answer 157

All of these

Answer 158

HSV1 and HSV2

Answer 159

Past infection, reactivation of latent infection VCA - VIRAL CAPSID ANTIGEN EBNA - EBV NUCLEAR ANTIGEN EA - EARLY ANTIGEN CHARACTERISTICS DIAGNOSTIC PROFILE OF EBV SUSCEPTIBILITY If the patient is seronegative (lacks antibody to VCA) PRIMARY INFECTION Antibody (IgM) to VCA is present; EBNA is absent. PAST INFECTION Antibodies to VCA and EBNA are present. REACTIVATION If antibody to EBNA and increased antibodies to EA are present, patient may be experiencing reactivation.

Answer 160

72 hours IgM antibodies become detectable 3 to 4 days after appearance of symptoms and persist for 8 to 12 weeks.

Answer 161

ELISA Varicella-Zoster virus (VZV) Antibodies ELISA - most common, easiest Automated, provides objective results, and does not require viral culture FAMA - reference method Considered to be the reference method for VZV antibody, it requires live, virus-infected cells and is not suitable for large-scale routine testing FAMA (fluorescent antibody to membrane antigen)

Answer 162

IgM anti-HAV

Answer 163

Southern blot SNOW DROP S - Southern Blot = D - DNA N - Northern Blot = R - RNA W - Western Blot = P - PROTEINS

Answer 164

Plasmodium falciparum HRP-II: Plasmodium falciparu pLDH AND ALDOLASE TESTS: All four Plasmodium spp.

Answer 165

FOUR DIFFERENT FORMS OF ANTIGENS. Two of which are unbranched straight chains (H1 and H2) and two of which are complex branched chains (H3 and H4).

Answer 166

Phenotyping Phenotyping, or the physical expression of a genotype, is the type of testing routinely performed in the blood bank. An individual, for example, may have the AO genotype but phenotypes as group A.

Answer 167

hh only The Bombay phenotype will be expressed only when no H substance is present. The Oh type is expressed by the genotype hh. Bombays produce naturally occurring anti-H, and their serum agglutinates group O red cells in addition to red cells from groups A, B, and AB persons.

Answer 168

Codominant The inheritance of most blood group genes is codominant, meaning that no gene or allele is dominant over another. For example, a person who is group AB expresses both the A and B antigen on his or her red cells.

Answer 169

All are possible A mating between AO and BO persons can result in an offspring with a blood type of A, B, AB, or O.

Answer 170

The patient may be a Bombay

Answer 171

Anti-A, anti-B and anti-H A Bombay individual does not express A, B, or H antigens; therefore anti-A, B, and H are formed. Because a Bombay individual has three antibodies, the only compatible blood must be from another Bombay donor.

Answer 172

Group A persons The acquired B phenomenon is only seen in group A persons.

Answer 173

Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+ In forward typing, a 1+ reaction with anti-B is suspicious because of the weak reaction and the normal reverse grouping that appears to be group A. This may be indicative of an acquired antigen. In the case of an acquired B, the reverse grouping is the same for a group A person.

Answer 174

A1B The A1B blood group has the least amount of H antigen. This is due to both A and B epitopes present on red cells compromising the availability of H epitopes. A1B cells will yield weak reactions with anti-H lectin.

Answer 175

Incubate at 22°C or 4°C to enhance weak expression All negative results may be due to weakened antigens or antibodies. Room temperature or lower incubation temperature may enhance expression of weakened antigens or antibodies.

Answer 176

Dolichos biflorus The immunodominant sugar N-acetyl-galactosamine confers A antigen specificity when present at the terminus of the type 2 precursor chain on the RBC membrane. Therefore, its presence would cause RBCs to react with anti-A1 lectin, Dolichos biflorus.

Answer 177

Immunodeficiency WEAK OR MISSING ANTIBODIES A transplant patient is probably taking immunosuppressive medication to increase graft survival. This can contribute to the loss of normal blood group antibodies as well as other types of antibodies.

Answer 178

Rh negative Rh positive refers to the presence of D antigen; Rh negative refers to the absence of the D antigen. These designations are for D antigen only and do not involve other Rh antigens.

Answer 179

A D mosaic may make antibodies to missing antigen parts The D antigen is comprised of different parts designated as a mosaic. If an individual lacks parts of the antigen, he or she may make antibodies to the missing parts if exposed to the whole D antigen.

Answer 180

Rh null A person who is Rh null shows no Rh antigens on his or her RBCs.

Answer 181

37°C incubation + indirect antiglobulin test Weak D testing requires both 37°C incubation and the IAT procedure.

Answer 182

L-Fucose Without H substance present, the sugars giving A or B antigenic activity cannot attach.

Answer 183

A plant substance that chemically reacts with certain RBC antigens Lectins are proteins present in plants, often derived from the seeds of plants.

Answer 184

Anti-c The unit from the DCe/dce donor has the c antigen that the patient lacks.

Answer 185

Lewis Lewis system antibodies are generally IgM.

Answer 186

Lewis The Lewis typings of a pregnant woman may appear to be Le(a-b-), even though the original typing may have been Le(a-b+).

Answer 187

Subgroups of A or B

Answer 188

50% B, 50% O

Answer 189

Between 45 and 50C

Answer 190

AH, Le (a-b-)

Answer 191

They are well-developed at birth

Answer 192

Type 2 precursor chain Type 1 precursor substance Beta 1 → 3 linkage between galactose and N-acetylglucosamine Type 2 precursor substance Beta 1 → 4 linkage between galactose and N-acetylglucosamine

Answer 193

Mother is Rh (-), child is Rh (+)

Answer 194

3 to 6 months after birth

Answer 195

The patient’s serum will react with A1 cells if anti-A1 is present The A2 subgroup is described as having both qualitative and quantitative differences when compared to the A1 subgroup. This means that there is less A antigen found on the red cells of people with A2, and their A antigen looks “different” when compared to that of people with type A1. Therefore the red cells from those with type A2 will not react with anti-A1 lectin. Approximately 20% of those with type A have the A2 phenotype, and between 1% and 8% of those individuals make anti-A1. There is no anti-A2 reagent, and people with the A2 phenotype would not react with A2 cells, because that would imply an autoantibody is present.

Answer 196

D- - / D - - Individuals with the D - - phenotype may possess more D antigen because they have inherited a nonfunctioning RHCE gene.

Answer 197

All of the above The patient can receive all of the blood types listed, but good blood management would dictate the order in which they were transfused. Generally, the best course of action would be to transfuse type A first because it is usually more plentiful than type B. Patients with O type can receive only type O blood, so it is best to conserve type O when possible. If type A is not plentiful, type B can be given. Once either type A or type B is given, types should not be mixed, to help avoid potential reactions. If type A or B is exhausted, it is then appropriate to move to type O.

Answer 198

Lea substance Le and secretor gene interaction: If Le is inherited without Se, only Lea will be found on red cells and in saliva. Because this person is a nonsecretor, only Lea antigen will be present in the secretions.

Answer 199

R2R2 * RoRo Dce/Dce * R1R1 DCe/DCe * R2R2 DcE/DcE * rr dce/dce Therefore anti-E will react only with R2R2 cells because they are the only ones in this list that possess the corresponding E antigen

Answer 200

DCe R1 (DCe) - Whites, Asians and Native Americans R0 (Dce) - Blacks

Answer 201

IgM, naturally occurring, do not cause HDN

Answer 202

Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+) In children who inherit both Le and Se genes, the transformation can be followed from the Le(a–b–) phenotype at birth to Le(a+b–) after 10 days to Le(a+ b+) and finally to Le(a–b+), the true Lewis phenotype, after about 6 years.

Answer 203

Leukocyte-reduced RBCs Febrile reactions are brought about by the interaction of antibodies in the recipient directed against antigens on donor leukocytes or by cytokines secreted by leukocytes. The antigens involved are both the HLA and granulocyte-specific antigens. Leukocyte-reduced RBCs are the component of choice for a patient with repeated febrile transfusion reactions. Although frozen RBCs that have been thawed and deglycerolized are considered leukocyte reduced, the cost and time involved in preparation make them an unpractical choice.

Answer 204

Physiologic saline Physiologic saline (NSS) is the only generally acceptable solution that is allowed to be added to blood or blood components.

Answer 205

Clerical The majority of deaths due to hemolytic transfusion reactions are caused by clerical errors, not laboratory errors. Patients, blood samples, and lab records, if misidentified, may lead to the wrong ABO type blood being administered to the patient. These deaths most often occur in areas of high stress, such as in emergency departments and surgical suites.

Answer 206

IgA Some people are genetically deficient in IgA. If these individuals have anti-IgA in their plasma, they may suffer a severe anaphylactic reaction when subsequently exposed to IgA in donor plasma. Once these people are identified, they must receive IgA-deficient components such as multiple-washed or frozen-thawed RBC or components drawn from IgA-deficient donors.

Answer 207

Discontinue the unit, keep the line open The transfusion of the unit should be stopped, and the transfusionist should keep the patient's intravenous (IV) line open with physiologic saline in case medications must be given quickly to counteract the transfusion reaction.

Answer 208

Intravascular transfusion reaction Red-tinged plasma is indicative of hemolysis. When this is seen in the posttransfusion sample but not in the pretransfusion sample, it is evidence that an intravascular hemolytic transfusion reaction has occurred.

Answer 209

Septic Although rigors and shock may be caused by hemolytic or anaphylactic reactions, bacterial sepsis is the most likely cause in this case. The sudden rise of the patient's temperature from normal to 40°C or above is typical of such an infection.

Answer 210

IgG IgG is the only immunoglobulin that is transported across the placenta. IgG molecules are actively transported via the Fc portion beginning in the second trimester. Therefore, potentially any IgG blood group antibody produced by the mother could cause HDN, if the fetus possesses a well-developed corresponding antigen.

Answer 211

Adult hemoglobin is more soluble in acid buffer than fetal hemoglobin. The Kleihauer-Betke acid elution stain is used to quantify the amount of fetal cells present in the maternal circulation postpartum to calculate the correct dose of RhIG to administer. Adult hemoglobin is soluble in acid buffer, whereas fetal hemoglobin is resistant to acid elution.

Answer 212

Every 4 hours Per AABB Standards, if an automated temperature recording device is not used, then temperatures of the blood component storage environment must be measured manually every 4 hours.

Answer 213

Every 4 hours Per AABB Standards, if an automated temperature recording device is not used, then temperatures of the blood component storage environment must be measured manually every 4 hours.

Answer 214

Once daily As suggested by AABB, red cell reagents, antisera, and antiglobulin serum should have quality control performed each day of use.

Answer 215

Unconjugated bilirubin Kernicterus occurs because of high levels of unconjugated bilirubin. High levels of this pigment cross into the central nervous system, causing brain damage to the infant.

Answer 216

Antibody screen An antibody screen is not performed routinely on a cord blood sample because a baby does not make antibodies until about 6 months of age. Any antibodies detected in a cord blood sample come from the mother.

Answer 217

Check for a clerical error(s) Over 90% of transfusion reactions are due to some type of clerical error. The most time-saving approach would be to check all paperwork before performing any laboratory testing.

Answer 218

Antileukocyte antibody TRALI is associated with antibodies to human leukocyte antigens or neutrophil antigens, which react with patient granulocytes and cause acute respiratory insufficiency.

Answer 219

Febrile nonhemolytic reaction A febrile nonhemolytic transfusion reaction (FNHTR) is defined by a rise in temperature of 1°C or higher within 24 hours post-transfusion, and unexplained by other causes. The patient has formed antibodies to HLA, which react with donor cells and result in release of pyrogens.

Answer 220

Immediate hemolytic transfusion reaction Group A blood given to a group O patient would cause an immediate hemolytic transfusion reaction because a group O patient has anti-A and anti-B antibodies and would destroy A cells.

Answer 221

Clerical errors

Answer 222

Acute hemolytic transfusion reaction In the immune mediated acute hemolytic transfusion reaction, accompanying signs and symptoms include abdominal, chest, flank, or back pain; pain at infusion site; feeling of impending doom; hemoglobinemia; hemoglobinuria; hypotension; renal failure; shock; and diffuse intravascular coagulopathy. Red or dark urine or diffuse oozing may be the only sign in the anesthetized patient.

Answer 223

Transfusion-associated graft-versus-host disease

Answer 224

Unexplained decrease in hemoglobin

Answer 225

Transfusion-associated graft-versus-host disease

Answer 226

Transfusion-associated graft-versus-host disease

Answer 227

All of the above

Answer 228

RIBA Recombinant immunoblot assays (RIBA) can be used to confirm anti-HCV tests.

Answer 229

Plasmodium species

Answer 230

Agglutination

Answer 231

Attachment of indicator cells SPRCA: Solid-Phase Red Cell Adherence

Answer 232

Standardization

Answer 233

15 minutes

Answer 234

10 minutes

Answer 235

Plasma pH The pH of platelets should be maintained at 6.2 or above throughout the storage period.

Answer 236

Lymphocytes Irradiation inhibits proliferation of T lymphocytes.

Answer 237

Change in optical density measured to 450 nm The change in optical density (absorbance) of amniotic fluid measure spectrophotometrically at 450nm is calculated and plotted on a Liley graph according to the weeks of gestation. The graph is divided into 3 zones, which predict the severity of HDFN and the need for intervention and treatment.

Answer 238

Unconjugated bilirubin

Answer 239

More than 7 days old

Answer 240

Mothers who are Rh-negative

Answer 241

Maternal serum

Answer 242

Anti-HPA Antibodies to human platelet antigen (HPA)

Answer 243

3 to 7 days Delayed hemolytic transfusion reactions are caused by a secondary anamnestic response in a previously alloimmunized recipient. Unlike a primary response, a secondary response is rapid. Antibody may be detectable 3 to 7 days from the time of transfusion.

Answer 244

Bacterial contamination In septic transfusion reactions patient experience fever >101˚F (38.3˚C), shaking chills and hypotension. In severe reactions, patients develop shock, renal failure, hemoglobinuria and DIC.

Answer 245

Hemolytic Clinical signs of a hemolytic transfusion reaction include fever and chills, and in severe cases, DIC. Circulatory overload, allergic and anaphylactic tractions are not characterized by fever and DIC.

Answer 246

Fever FEVER is the MOST COMMON initial manifestation of an cute transfusion reaction and is frequently accompanied by chills.

Answer 247

Febrile nonhemolytic transfusion reaction Leukocyte antibodies are a primary cause of febrile transfusion reactions. Leukocyte reduced blood components reduce the risk of febrile non-hemolytic reactions.

Answer 248

Allergic Allergic reactions are a Type I immediate hypersensitivity reaction to an allergen in plasma. Most are mild reactions shown by urticaria (hives, swollen red wheals) which mat cause itching.

Answer 249

TACO TACO: Transfusion-associated circulatory overload The laboratory assay of brain natriuretic peptide (BNP), consisting of the measurement of a peptide secreted from the ventricles in response to increased filling pressures and a marker of congestive heart failure, may be used to aid in the diagnosis of TACO.

Answer 250

Yersinia enterocolitca According to the CDC, Yersinia enterocolitica is the most common isolate found in RBC units, followed by the Pseudomonas species. Together, these two account for more than 80% of all bacterial infections transmitted by RBCs.

Answer 251

Staphylococcus epidermidis, Bacillus cereus Staphylococcus epidermidis, and Bacillus cereus (both gram-positive) are the organisms most frequently recovered from donated blood and contamination of platelets.

Answer 252

Circulatory overload Transfusion-induced hypervolemia causing edema and congestive heart failure is a feature of transfusion-associated circulatory overload (TACO). Hypervolemia is not a complication of hemolytic, febrile or anaphylactic transfusion reaction.

Answer 253

Hepatitis Hepatitis transmission is unlikely, but a higher risk of transmission through blood transfusion than CMV (rare), syphilis (no transfusion transmitted cases reported in >30 years), or HIV (1:2,300,000 units).

Answer 254

Occupation

Answer 255

Hematocrit of 37%

Answer 256

All of the above

Answer 257

Donor who had a first-trimester abortion 4 weeks ago First-trimester or second-trimester abortion or miscarriage is not cause for deferral.

Answer 258

Deglycerolized RBCs—24 hours

Answer 259

3 × 10 11th

Answer 260

Factor IX deficiency

Answer 261

5 × 10 6th /85%

Answer 262

G-CSF The administration of granulocyte colony-stimulating factor (GCSF), a recombinant hematopoietic growth factor, to granulocyte donors has resulted in marked increases in granulocyte yield. Although mild side effects, such as muscle and skeletal pain, have been reported with the use of these growth factors, they are usually well tolerated by donors.

Answer 263

Prevent TA-GVHD

Answer 264

Bone marrow

Answer 265

Irradiated RBCs

Answer 266

Hemoglobin oxygen affinity increases, owing to a decrease in 2,3-DPG.

Answer 267

5 days at 20°C to 24°C

Answer 268

5.5 x 10 10th

Answer 269

1°C to 6°C

Answer 270

pH decreases

Answer 271

Granulocytes Patients with CGD cannot fight bacterial infections due to dysfunctional phagocytic enzymes; granulocyte concentrates are the product of choice for these patients.

Answer 272

Pan genera detection (PGD) assay The FDA has mandated that pH and glucose can no longer be used as a screening test for platelets. The Verax PGD assay has been FDA approved for both single-donor platelets and random-donor platelets for bacteria screening.

Answer 273

Must be issued within 24 hours The other half unit must be issued within 24 hours, if an open system is used to split the unit.

Answer 274

Gamma rays and x-rays destroy the lymphocytes’ ability to divide Gamma rays or x-rays have the ability to prohibit a lymphocyte’s ability to divide, preventing TA-GVHD.

Answer 275

Frozen RBCs Frozen RBCs may be kept for up to 10 years. FFP and cryoprecipitate stored at -18°C or lower expire in 1 year. If FFP is kept at -65°C or lower, the expiration time is 7 years. Platelet concentrates expire in 5 days.

Answer 276

12 months Deferral for HBIG injection is 12 months.

Answer 277

Platelets Clopidogrel renders platelets nonfunctional and therefore potential donors on this medication cannot donate platelets.

Answer 278

Discontinue the donation and provide a paper bag This woman is HYPERVENTILATING; therefore, the donation should be discontinued. A paper bag should be provided for the donor to breathe into in order to increase the carbon dioxide in the donor’s air.

Answer 279

Blood could have transmitted hepatitis (HBV or HCV) or HIV Hepatitis viruses and HIV have extended incubation periods in which exposure has occurred but neither serological nor clinical manifestations of the disease are evident. The current screening tests, although quite sensitive, are unable to detect the viruses if testing is performed during this incubation period. To safeguard against the possibility that the donor received blood or blood products collected during the incubation period, a 12-month deferral is incurred to allow for fulmination of the disease.

Answer 280

CMV Of the viruses listed, CMV is the only one that resides exclusively in leukocytes.

Answer 281

Platelets FFP contains all the plasma clotting factors. FFP's primary use is for patients with clotting factor deficiencies for which no concentrate is available and patients who present multiple factor deficiencies such as in liver disease. Platelets are CELLULAR elements, not a plasma clotting factor, and they must be maintained at 20-24°C with continuous gentle agitation to maintain their viability.

Answer 282

72 hours Autologous blood should not be drawn later than 72 hours prior to surgery. The reason is to allow time for adequate volume repletion. However, the medical director may decrease this time if the patient's condition warrants it.

Answer 283

200 to 250 mL plasma removed If CPDA-1 is used, 200 to 250 mL of plasma can be removed, leaving the RBC product with a hematocrit of 65% to 80%. If additive solutions (AS) are employed, an additional 50 mL of plasma can be removed, because 150 mL of adenine-saline is added back to the cells, achieving the desired hematocrit level of less than 80%.

Answer 284

200 to 250 mL plasma removed If CPDA-1 is used, 200 to 250 mL of plasma can be removed, leaving the RBC product with a hematocrit of 65% to 80%. If additive solutions (AS) are employed, an additional 50 mL of plasma can be removed, because 150 mL of adenine-saline is added back to the cells, achieving the desired hematocrit level of less than 80%.

Answer 285

At least 150, 000/uL The minimum platelet count required for a frequent repeat donor is 150 X 10 9th/L).

Answer 286

At least 150, 000/uL The minimum platelet count required for a frequent repeat donor is 150 X 10 9th/L).

Answer 287

At least 150, 000/uL The minimum platelet count required for a frequent repeat donor is 150 X 10 9th/L).

Answer 288

5, 000 x g for 5 minutes HEAVY SPIN 3, 600 RPM 5,000 x g 5 minutes LIGHT SPIN 3, 200 RPM 2,000 x g 2-3 minutes

Answer 289

6 g/dL Plasmapheresis donors must have a serum total protein of at least 6 g/dL.