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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
People with blood type A have what hemoglutinins? What about B, AB, O & Oh?
``` A = anti-B B = anti A AB = none O = Anti-A & Anti-B Oh = Anti-A, Anti-B & Anti-H ```
26
What blood type is universal donor?
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
27
What donor is universal recipient?
AB Donor doesn't have Ab against A or B (tolerant to both cuz have both)
28
What type of molecules are the Rh antigens? What cells have these?
Proteins Only RBCs have them
29
What are the 5 Rh antigen products? Which one is most important and why?
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
30
When refering to somebody as Rh - or +, what antigen are you referring to?
D
31
A person with dd for Rh gene has what antigen?
Absent for D gene (d = completely absent, not slightly different versions of 2 proteins)
32
How common is Rh - (dd)?
Rare
33
Are C/c & E/e dominant, recessive or co-dominant?
Co-dominant C,c has C & c protein both present
34
What Rh alleles are on the same gene? Which one is on its own gene?
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
35
Which Rh antigens are typed for usually?
Only D (not C or E)
36
When is there a problem if a mother is Rh - & fetus is Rh +?
First pregnancy is ok During birth (when placenta ripped off) --> mom is sensitized -->second pregnancy with same antigen make up has problems
37
Are ABO & Rh antigens only blood antigens that can cause problems?
No there are other minor blood groupings that can cause problems (we don't need to know the specifics)
38
We naturally develop Ab against what blood antigens (without being exposed)?
Only ABO Only one with similar antigens in environment
39
How do you do Forward Typing of ABO blood group? What do you see with naked eye and what do you see under microscope?
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
Main difference between forward type & Reverse Typing of ABO groups?
Forward = detecting antigen on RBCs Reverse = detecting Anti-antigen in plasma
41
How do you do reverse Typing of ABO blood group?
Take exogenous RBCs + patients plasma --> is patient has anti-A/B IgM --> links exogenous RBCs together --> clumping
42
When is forward & reverse ABO typing used?
Always do both & they must match before transfuse blood Test recipient and donor before transfusion
43
What blood type is the patient if forward ABO typing has clumping when Anti-A IgM is added?
Patient has A antigen on their RBCs --> Type A
44
What blood type is a donor if reverse ABO typing shows clumping with the addition of A RBC or B RBCs?
Donor plasma has IgM against A & B antigens --> Donor is type O or OH
45
How is Rh blood typing determined?
Same as ABO
46
What is an antibody screen?
Screen plasma for IgM against Rh or minor blood antigens
47
What tests are done before transfusion takes place?
Type (forward and reverse ABO typing) Screen (Rh & minor Ab screen) Done on donor & recipient
48
Donor and recipient are ABO/Rh compatible & antibody screen was negative. Can you transfuse blood?
Not yet Must do crossmatch first
49
What is the next step if patients blood has a positive Ab screen?
Determine which Ab are present Select donor that does not have that antigen
50
What is crossmatching?
Recipient RBCs + donor plasma + --> clumping or hemolysis --> recipient has Ab against donor RBC antigen
51
What type of blood is best to give to a patient that is type A?
Best to give A Can give O, but then will run out of O
52
A patient that is Rh + can receive blood from what type of donors?
Rh + or -
53
A patient that is Rh - can receive blood from what type of donors?
Rh - only
54
What is it called when sensitized (previous exposure) Rh- patient receives Rh+ blood?
Acute Hemolytic Transfusion reaction
55
What is it called when sensitized (previous exposure) Rh- mother has Rh + fetus?
Hemolytic Disease of Newborn (HDN)
56
Why are ABO mismatches between mother and fetus not an issue like Rh?
Because ABO IgM can bind to any cell --> diluted out & not concentrated to just RBCs like Rh
57
What is the pathophysiology if Hemolytic Disease of Newborn (HDN) & clinical presentation?
Hemolysis --> anemia --> extramedullary hematopoesis Hemolysis --> anemia --> increase CO --> high output CHF --> pulmonary edema --> respiratory distress Hemolysis --> jaundice Anascara = full body edema
58
What is Anascara?
full body edema seen in fetus after HDN
59
How is Hemolytic Disease of a newborn prevented?
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
Patient had an abortion or other pregnancy loss where the childs Rh status was not known. What should be done with next pregnancy?
Treat with Rhomgram as if the previous baby was Rh + just in case
61
What is alloimmunization to HLA?
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
What type of compatibility is really only important to transfusion of platelets?
HLA comparability
63
What should be suspected when give thrombocytopenic patient platelets but their plt count doesn't go up? What is this called?
HLA incompatibility where patient has previously been exposed Platelet Refractoriness
64
If recipient has Ab against donor RBCs what happens? What is this called?
Hemolysis = Hemolytic Transfusion Reaction
65
If the recipient has Ab against donor WBC or platelet what happens? What is this called?
Fever = Acute Febrile Non-Hemolytic Reaction
66
What happens if donor plasma has cytokines present in it? What is this called?
Fever= Acute Febrile Non-Hemolytic Reaction
67
If the recipient has Ab against the proteins in the donor plasma what happens? What is it called?
Urticaria (hives) = Acute Urticarial reaction
68
What are the 2 types of Hemolytic Transfusion Reactions?
``` Acute = < 24 hours Delayed = > 24 hours ```
69
How much of a blood transfusion is needed to cause hemolysis?
As little as 50 mL Why watch patient during first 10 minutes of a transfusion
70
What type of hemolysis is caused if the recipient has IgG against donor antigen? What about IgM?
IgG --> strong C' fixation --> intravascular hemoylsis IgG --> weak C' fixation --> extravascular hemolysis IgM --> weak C' fixation --> intravascular hemolysis
71
What blood group incompatibilities cause hemoylsis?
ABO, Rh or minor antigens
72
Hemolysis due to transfusion causes what clinical presentations?
``` Fever/chills Chest pain/SOB Burning at Infusion site Tachycardia DIC Hypotension Shock Death ```
73
What tests are performed after hemolysis occurs?
Redo typing and cross match + do direct coombs
74
How do you do a Direct Coombs Test for IgG?
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
How do you do a direct coombs test for IgM?
You don't. Test for complement instead
76
How do you do a direct coombs test for C3?
Give rabbit anti C3 Ab --> links together C3 on surface of newly acquired RBCs --> clumping
77
Ho do you do an indirecr coombs test?
Exogenous RBCs + patients plasma + rabbit anti-Ab --> patients Ab bind exogenous RBc surface & Rabbit ab links together coated RBCs --> clumping
78
What is another name & abbreviation for direct coombs?
Direct Anti-globin Test = DAT | IAT = indirect coombs
79
What causes delayed hemolysis? Can it cause disease? Are they DAT +?
Low titer of Ab --> not detected in screening --> takes longer to act Can be fatal DAT +
80
Are patients with Acute Febrile Non-Hemolytic Reactions DAT +?
No
81
How can you prevent Febrile Non-hemolytic Transfusion reactions?
Leuko-reduced blood
82
What causes Acute Urticarial Transfusion Reaction?
Recipient has IgE against donor antigen --> allergic symptoms
83
Are patients with Acute Urticarial Transfusion Reaction DAT +?
No
84
Clinical presentation of Acute Urticarial Transfusion Reaction?
``` Hives Itching Bronchospasm Anaphylactic shock Death ```
85
Treatment for Acute Urticarial Transfusion Reaction?
Anti-histamines
86
What happens when donor has Ab against recipient RBCs? Why is this unlikely to occur?
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
What happens if donor has Ab against recipient WBCs in a plasma transfusion? Pathophysiology?
TRALI = Transfusion Related Acute Lung Injury Anti-HLA Ab activates marginated WBCs in lung --> lung injury --> respiratory distress
88
What happens if donorcytokines presnet in a plasma transfusion? Pathophysiology?
TRALI = Transfusion Related Acute Lung Injury Cytokines --> activate WBCs in lung --> lung injury
89
Outcome of TRALI?
5% mortality Survivors recover in a couple days
90
Clinical presentation of TRALI?
Acute Respiratory Distress Fever/Chills Hypotension Pulmonary edema
91
Plasma donations from what type of donors reduce the risk of TRALI?
Males have less HLA sensitization
92
For hypothetical antigen, if recipient is AB & donor is BB, will the recipient be tolerant to blood they are receiving?
yes
93
For hypothetical antigen, if recipient is AB & donor is BB, will the donors blood be tolerant of donor tissue it comes into contact with?
No
94
What is Transfusion graft vs. host disease? How is it prevented?
Transfused blood not tolerant of antigens present in donor Donor WBCs recognize reciepient as foreign Irradiate blood before transfusion to kill WBCs
95
Most common cause of fatality related to transfusions?
TRALI
96
Most common adverse reaction during transfusion? How common?
Acute Febrile Non-Hemolytic Reaction Relatively common

Unit 2 SPATH UFCOM (17 decks)

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