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Unit 2 SPATH UFCOM > Q. Blood Banking > Flashcards

Q. Blood Banking Flashcards

1
Q

What are the 3 main types of blood you can order for transfusion?

A

Packed RBCs (for anemia)
Platelets (For bleeding/thrombocytopenia)
Plasma (hypovolemia/coagulopathy)

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2
Q

What type of blood is given for a patient that is anemic and hypovolemic?

A

Whole blood rarely used

Usually give packed RBCs & plasma

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3
Q

Why is blood frozen? Draw backs?

A

Increases shelf life (important for rare blood types)

WBCs die during storage –> less febrile reactions
Highly washed –> less allergic reactions

More complications

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4
Q

What is leuko-reduced blood? When is it used?

A

Remove WBC’s –> remove chance for getting infection like CMV, HIV & EBV that reside in WBCs

Used to have the options of asking for leuko-reduced, but now all blood is automatically leuko-reduced

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5
Q

Why is CMV Ab test ordered on blood? What is it testing for? When is it necessary?

A

Immunosuppressed individuals are susceptible to getting CMV from non-leukoreduced blood (if WBCs nor removed).

If donor has Ab against CMV, probably have CMV –> don’t give that blood to patient

Used to have to order a CMV Ab test (especially for immunosuppressed). However, due to leuko-reduction now being standard, there is no need for ordering this any longer

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6
Q

Advantages of transfusing leuko-reduced blood?

A

Less risk of infection (microorganisms that hide in WBCs)

Less acute febrile reactions

Less HLA alloimmunization

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7
Q

What is an autologous blood transfusion? When is it used?

A

When person saves up blood of their own

If going into surgery

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8
Q

What is a directed blood transfusion?

A

When friend/family member donates blood so you can have it

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9
Q

Why are some blood samples irradiated? When is this necessary?

A

Kill WBCs –> can’t proliferate and cause transfusion associated GVH

Immunodeficient patients need this

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10
Q

Why are some blood samples washed?

A

Removes donor plasma –> less risk of TRALI or allergic reaction

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11
Q

Does washing remove WBCs?

A

No, GVH possible

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12
Q

Does irradiation remove proteins found in plasma?

A

No

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13
Q

How are platelets usually obtained for transfusion? Why is this needed?

A

Apherises just removes donors platelets

Would many units of whole blood to get enough platelets for platelet transfusion –> can’t remove all of that blood from a single donor –> would get exposed to multiple donors. With this are exposed to only 1 donor

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14
Q

What type of molecule are ABO blood antigens? What cells express them?

A

Glycoproteins & glycolipids (carbs attached to lipid or protein)

All cells in the body express ABO antigens

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15
Q

What is the pathway for creating ABO antigens?

A

Sugar backbone has Fucose sugar added –> becomes H antigen. Process stops for O, because lacks enzymes for either of the next steps

If N-acetyl-galactosidae is added to H –> H becomes A antigen

If D-galactose is added to H –> H becomes B antigen

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16
Q

What is added to carb to create H antigen? Who has the enzymes to do this?

A

fucose

Everybody not Oh = A, B, AB & regular O

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17
Q

What is added to H antigen to create A antigen? Who has the enzymes to do this?

A

N-acetyl galactosamine

A & AB

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18
Q

What is added to H antigen to create B antigen? Who has the enzymes to do this?

A

D-galactose

B & AB

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19
Q

Why do we usually refer to patients as having O blood instead of H blood?

A

Usually don’t test for H antigen (because deficiency is rare) –> don’t know if have H, just know that don’t have A or B

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20
Q

What is the Bombay phenotyoe? Recessive or dominant?

A

Oh = hh (No H)

Lack enzyme to add fucrose to carb

Recessive = Hh has enzyme present

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21
Q

What are isohemoglutanins?

A

Ab against ABO antigens

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22
Q

Why do we have Ab against ABO blood antigens even without being exposed to blood of types other than our own? At what age do we usually have these antibodies?

A

Carbs in environment very much resemble ABO antigens –> immunity to them sensitizes us against ABO antigens even if our body hasn’t seen them yet

About 6 mo old

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23
Q

What type of antibody is usually created against the ABo blood antigens?

A

IgM

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24
Q

Why is a mother not sensitized to her babies ABO antigens during the course of the pregnancy?

A

Anti-blood antigen antibody is IgM which does not cross placenta

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25
Q

People with blood type A have what hemoglutinins? What about B, AB, O & Oh?

A 
A = anti-B
B = anti A
AB = none
O = Anti-A & Anti-B
Oh = Anti-A, Anti-B & Anti-H
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26
Q

What blood type is universal donor?

A

O

Donor RBCs don’t have A or B antigen so anybody can receive

Really Oh is universal as the few people with Oh can’t receive regular O

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27
Q

What donor is universal recipient?

A

AB

Donor doesn’t have Ab against A or B (tolerant to both cuz have both)

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28
Q

What type of molecules are the Rh antigens? What cells have these?

A

Proteins

Only RBCs have them

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29
Q

What are the 5 Rh antigen products? Which one is most important and why?

A

C, c, D, E, e

D, because either have D or have no D (there is not slightly different version of protein like for other genes) –> complete absence is more immunogenic than slightly different products

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30
Q

When refering to somebody as Rh - or +, what antigen are you referring to?

A

D

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31
Q

A person with dd for Rh gene has what antigen?

A

Absent for D gene (d = completely absent, not slightly different versions of 2 proteins)

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32
Q

How common is Rh - (dd)?

A

Rare

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33
Q

Are C/c & E/e dominant, recessive or co-dominant?

A

Co-dominant

C,c has C & c protein both present

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34
Q

What Rh alleles are on the same gene? Which one is on its own gene?

A

C/c & E/e are a single gene that is transcribed into one long protein with all 4 allele contributing a portion

RhD is on its own gene and gene product

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35
Q

Which Rh antigens are typed for usually?

A

Only D (not C or E)

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36
Q

When is there a problem if a mother is Rh - & fetus is Rh +?

A

First pregnancy is ok

During birth (when placenta ripped off) –> mom is sensitized –>second pregnancy with same antigen make up has problems

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37
Q

Are ABO & Rh antigens only blood antigens that can cause problems?

A

No there are other minor blood groupings that can cause problems (we don’t need to know the specifics)

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38
Q

We naturally develop Ab against what blood antigens (without being exposed)?

A

Only ABO

Only one with similar antigens in environment

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39
Q

How do you do Forward Typing of ABO blood group? What do you see with naked eye and what do you see under microscope?

A

Agglutination Reaction = To test for A antigen add Anti-A IgM. If antigen present of RBC, IgM acts as linker between RBCs –> clump up

Normal by eye is just sheet of blood. Agglutination = clumping & open spaces form

Under microscope are normally open spaces between cells but those spaces get bigger as cells clump together

40
Q

Main difference between forward type & Reverse Typing of ABO groups?

A

Forward = detecting antigen on RBCs

Reverse = detecting Anti-antigen in plasma

41
Q

How do you do reverse Typing of ABO blood group?

A

Take exogenous RBCs + patients plasma –> is patient has anti-A/B IgM –> links exogenous RBCs together –> clumping

42
Q

When is forward & reverse ABO typing used?

A

Always do both & they must match before transfuse blood

Test recipient and donor before transfusion

43
Q

What blood type is the patient if forward ABO typing has clumping when Anti-A IgM is added?

A

Patient has A antigen on their RBCs –> Type A

44
Q

What blood type is a donor if reverse ABO typing shows clumping with the addition of A RBC or B RBCs?

A

Donor plasma has IgM against A & B antigens –> Donor is type O or OH

45
Q

How is Rh blood typing determined?

A

Same as ABO

46
Q

What is an antibody screen?

A

Screen plasma for IgM against Rh or minor blood antigens

47
Q

What tests are done before transfusion takes place?

A

Type (forward and reverse ABO typing)

Screen (Rh & minor Ab screen)

Done on donor & recipient

48
Q

Donor and recipient are ABO/Rh compatible & antibody screen was negative. Can you transfuse blood?

A

Not yet

Must do crossmatch first

49
Q

What is the next step if patients blood has a positive Ab screen?

A

Determine which Ab are present

Select donor that does not have that antigen

50
Q

What is crossmatching?

A

Recipient RBCs + donor plasma

+ –> clumping or hemolysis –> recipient has Ab against donor RBC antigen

51
Q

What type of blood is best to give to a patient that is type A?

A

Best to give A

Can give O, but then will run out of O

52
Q

A patient that is Rh + can receive blood from what type of donors?

A

Rh + or -

53
Q

A patient that is Rh - can receive blood from what type of donors?

A

Rh - only

54
Q

What is it called when sensitized (previous exposure) Rh- patient receives Rh+ blood?

A

Acute Hemolytic Transfusion reaction

55
Q

What is it called when sensitized (previous exposure) Rh- mother has Rh + fetus?

A

Hemolytic Disease of Newborn (HDN)

56
Q

Why are ABO mismatches between mother and fetus not an issue like Rh?

A

Because ABO IgM can bind to any cell –> diluted out & not concentrated to just RBCs like Rh

57
Q

What is the pathophysiology if Hemolytic Disease of Newborn (HDN) & clinical presentation?

A

Hemolysis –> anemia –> extramedullary hematopoesis

Hemolysis –> anemia –> increase CO –> high output CHF –> pulmonary edema –> respiratory distress

Hemolysis –> jaundice

Anascara = full body edema

58
Q

What is Anascara?

A

full body edema seen in fetus after HDN

59
Q

How is Hemolytic Disease of a newborn prevented?

A

At end of first pregnancy mom given Rhogam –> Anti RhD antiserum –> destroys fetal RBCs before there is a problem –> prevents sensitization –> no problem with next pregnancy

60
Q

Patient had an abortion or other pregnancy loss where the childs Rh status was not known. What should be done with next pregnancy?

A

Treat with Rhomgram as if the previous baby was Rh + just in case

61
Q

What is alloimmunization to HLA?

A

Platelets (and to a lesser extent) WBCs have HLA antigens

After sensitization –> can have situaiton where donated platelets are destroyed

Should only transfuse HLA compatible blood for platelets

62
Q

What type of compatibility is really only important to transfusion of platelets?

A

HLA comparability

63
Q

What should be suspected when give thrombocytopenic patient platelets but their plt count doesn’t go up? What is this called?

A

HLA incompatibility where patient has previously been exposed

Platelet Refractoriness

64
Q

If recipient has Ab against donor RBCs what happens? What is this called?

A

Hemolysis = Hemolytic Transfusion Reaction

65
Q

If the recipient has Ab against donor WBC or platelet what happens? What is this called?

A

Fever = Acute Febrile Non-Hemolytic Reaction

66
Q

What happens if donor plasma has cytokines present in it? What is this called?

A

Fever= Acute Febrile Non-Hemolytic Reaction

67
Q

If the recipient has Ab against the proteins in the donor plasma what happens? What is it called?

A

Urticaria (hives) = Acute Urticarial reaction

68
Q

What are the 2 types of Hemolytic Transfusion Reactions?

A 
Acute = < 24 hours
Delayed = > 24 hours
69
Q

How much of a blood transfusion is needed to cause hemolysis?

A

As little as 50 mL

Why watch patient during first 10 minutes of a transfusion

70
Q

What type of hemolysis is caused if the recipient has IgG against donor antigen? What about IgM?

A

IgG –> strong C’ fixation –> intravascular hemoylsis
IgG –> weak C’ fixation –> extravascular hemolysis

IgM –> weak C’ fixation –> intravascular hemolysis

71
Q

What blood group incompatibilities cause hemoylsis?

A

ABO, Rh or minor antigens

72
Q

Hemolysis due to transfusion causes what clinical presentations?

A 
Fever/chills
Chest pain/SOB
Burning at Infusion site
Tachycardia
DIC
Hypotension
Shock
Death
73
Q

What tests are performed after hemolysis occurs?

A

Redo typing and cross match + do direct coombs

74
Q

How do you do a Direct Coombs Test for IgG?

A

Patients blood (with their original RBCs & recently recieved RBCs) + Rabbit Anti-IgG antibody –> links together new RBCs from donor that are coated in IgG –> clumping

75
Q

How do you do a direct coombs test for IgM?

A

You don’t. Test for complement instead

76
Q

How do you do a direct coombs test for C3?

A

Give rabbit anti C3 Ab –> links together C3 on surface of newly acquired RBCs –> clumping

77
Q

Ho do you do an indirecr coombs test?

A

Exogenous RBCs + patients plasma + rabbit anti-Ab –> patients Ab bind exogenous RBc surface & Rabbit ab links together coated RBCs –> clumping

78
Q

What is another name & abbreviation for direct coombs?

A

Direct Anti-globin Test = DAT

IAT = indirect coombs

79
Q

What causes delayed hemolysis? Can it cause disease? Are they DAT +?

A

Low titer of Ab –> not detected in screening –> takes longer to act

Can be fatal

DAT +

80
Q

Are patients with Acute Febrile Non-Hemolytic Reactions DAT +?

A

No

81
Q

How can you prevent Febrile Non-hemolytic Transfusion reactions?

A

Leuko-reduced blood

82
Q

What causes Acute Urticarial Transfusion Reaction?

A

Recipient has IgE against donor antigen –> allergic symptoms

83
Q

Are patients with Acute Urticarial Transfusion Reaction DAT +?

A

No

84
Q

Clinical presentation of Acute Urticarial Transfusion Reaction?

A 
Hives
Itching
Bronchospasm 
Anaphylactic shock
Death
85
Q

Treatment for Acute Urticarial Transfusion Reaction?

A

Anti-histamines

86
Q

What happens when donor has Ab against recipient RBCs? Why is this unlikely to occur?

A

Intravascular and Extravascular Hemolysis of recipient RBCs

Packed RBCs have very little plasma (rarely use whole blood). If going to give large amount of plasma check for compatibility

87
Q

What happens if donor has Ab against recipient WBCs in a plasma transfusion? Pathophysiology?

A

TRALI = Transfusion Related Acute Lung Injury

Anti-HLA Ab activates marginated WBCs in lung –> lung injury –> respiratory distress

88
Q

What happens if donorcytokines presnet in a plasma transfusion? Pathophysiology?

A

TRALI = Transfusion Related Acute Lung Injury

Cytokines –> activate WBCs in lung –> lung injury

89
Q

Outcome of TRALI?

A

5% mortality

Survivors recover in a couple days

90
Q

Clinical presentation of TRALI?

A

Acute Respiratory Distress
Fever/Chills
Hypotension
Pulmonary edema

91
Q

Plasma donations from what type of donors reduce the risk of TRALI?

A

Males have less HLA sensitization

92
Q

For hypothetical antigen, if recipient is AB & donor is BB, will the recipient be tolerant to blood they are receiving?

A

yes

93
Q

For hypothetical antigen, if recipient is AB & donor is BB, will the donors blood be tolerant of donor tissue it comes into contact with?

A

No

94
Q

What is Transfusion graft vs. host disease? How is it prevented?

A

Transfused blood not tolerant of antigens present in donor

Donor WBCs recognize reciepient as foreign

Irradiate blood before transfusion to kill WBCs

95
Q

Most common cause of fatality related to transfusions?

A

TRALI

96
Q

Most common adverse reaction during transfusion? How common?

A

Acute Febrile Non-Hemolytic Reaction

Relatively common

Unit 2 SPATH UFCOM (17 decks)

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