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AMT MT Exam > Review Cards - Immunohematology > Flashcards

Review Cards - Immunohematology Flashcards

1
Q

Criteria for whole blood donation - Allogenic

A

Age: >=16

HGB/HCT:
–Women: HGB >=12.5 g/dL OR HCT .+38%
–Men: HCG >13 g/dL OR HCT >39%

Temperature: <=37.5C (99.5F)

Venipuncture site: no infectious skin disease or scars indicative of drug use

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2
Q

Criteria for whole blood donation - Autologous

A

Age: as determined by medical director

HGB/HCT:
–HGB >=11.0 g/dL OR
–HCT >=33%
(NOTE: no donations within 72 hours of surgery)

Temperature: as determine by medical director; bacteremia is cause for deferral

Venipuncture site: as determined by medical director

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3
Q

Donor deferrals (AABB) - aspirin (donor sole source of platelets)

A

2 days

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4
Q

Donor deferrals (AABB) - measles (rubeola) vaccine

A

2 weeks

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5
Q

Donor deferrals (AABB) - mumps vaccine

A

2 weeks

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6
Q

Donor deferrals (AABB) - polio vaccine

A

2 weeks

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7
Q

Donor deferrals (AABB) - typhoid vaccine

A

2 weeks

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8
Q

Donor deferrals (AABB) - yellow fever vaccine

A

2 weeks

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9
Q

Donor deferrals (AABB) - rubella vaccine

A

4 weeks

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10
Q

Donor deferrals (AABB) - chicken pox (varicella-zoster) vaccine

A

4 weeks

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11
Q

Donor deferrals (AABB) - pregnancy

A

6 weeks

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12
Q

Donor deferrals (AABB) - whole blood donation

A

8 weeks

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13
Q

Donor deferrals (AABB) - after 2-unit RBC collection

A

16 weeks

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14
Q

Donor deferrals (AABB) - syphilis

A

12 months

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15
Q

Donor deferrals (AABB) - gonorrhea

A

12 months

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16
Q

Donor deferrals (AABB) - hepatitis B immune globulin (HBIG)

A

12 months

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17
Q

Donor deferrals (AABB) - mucous membrane exposure to blood

A

12 months

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18
Q

Donor deferrals (AABB) - skin penetration with sharp contaminated with blood or body fluids

A

12 months

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19
Q

Donor deferrals (AABB) - household or sexual contact with individual with hepatitis

A

12 months

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20
Q

Donor deferrals (AABB) - sexual contact with individual with HIV or at high risk

A

12 months

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21
Q

Donor deferrals (AABB) - incarceration in correctional facility for >72 consecutive hours

A

12 months

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22
Q

Donor deferrals (AABB) - travel to areas endemic for malaria

A

12 months

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23
Q

Donor deferrals (AABB) - recipient of blood, blood components, plasma-derived clotting factor concentrates, or transplant

A

12 months

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24
Q

Donor deferrals (AABB) - Babesia infection

A

at least 2 years

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25
Q

Donor deferrals (AABB) - malaria, or from an area endemic for malaria

A

3 years

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26
Q

Donor deferrals (AABB) - confirmed positive hepatitis B surface antigen (HBsAg)

A

permanent

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27
Q

Donor deferrals (AABB) - recipient of dura matter or pituitary growth hormone of human origin

A

permanent

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28
Q

Donor deferrals (AABB) - parenteral drug use

A

indefinite

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29
Q

Donor deferrals (AABB) - family history of Creutzfeldt-Jakob disease

A

indefinite

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30
Q

Donor deferrals (AABB) - repeated reactive test for anti-HBc on more than 1 occasion

A

indefinite

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31
Q

Donor deferrals (AABB) - positive hepatitis B virus (HBV) Nucleic Acid Amplification Testing (NAAT) result

A

indefinite

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32
Q

Donor deferrals (AABB) - repeatedly reactive test for anti-human T-lymphocyte virus (HTLV) on more than 1 occasion

A

indefinite

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33
Q

Donor deferrals (AABB) - present or past clinical evidence of infection with HIV, HCV, HTLV, or Trypanosoma cruzi

A

indefinite

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34
Q

Collection of whole blood - skin preparation

A

aseptic method, e.g., povidone-iodine scrub & prep solution

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35
Q

Collection of whole blood - volume of blood routinely collected

A

450 mL +/- 10% or 500 mL +/- 10%, depending on collection bag

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36
Q

Collection of whole blood - maximum volume

A

10.5 mL of blood per kg of donor’s weight, including samples for testing

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37
Q

Collection of whole blood - low-volume collections

A

-300-404 mL in 450 mL bag OR
-333-449 mL in 500-mL bag
-labeled “low volume”
-RBCs may be transfused, but plasma and platelets from “low volume” unit should be discarded

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38
Q

Collection of whole blood - volumes of anticoagulant

A

-63 mL anticoagulant for 450-mL collection
-70 mL for 500-mL collection

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39
Q

Collection of whole blood - time of collection

A

-usually <10 minutes
-if >15-20 minutes, unit may not be suitable for preparation of platelets or plasma

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40
Q

Collection of whole blood - samples for testing

A

from diversion pouch or by 2nd phlebotomy

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41
Q

Collection of whole blood - storage temperature of unit between collection & processing

A

20-24C if platelets are to be prepared; otherwise 1-6C

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42
Q

Apheresis - explanation

A

automated blood collection system that allows removal of 1 or more components of blood & return of remainder to donor

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43
Q

Apheresis - advantages

A

-allows collection of larger volumes of specific components
-can reduce number of donors to which patient is exposed

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44
Q

Apheresis - donor requirements

A

vary with procedure

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45
Q

Apheresis - components collected - RBCs

A

-2 units can be collected at same time from donors who are larger & have a higher HCT
-16 weeks between donations

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46
Q

Apheresis - components collected - Platelets

A

-plateletpheresis
-can collect HLA matched for patients who are refractory to random platelets
-can be leukoreduced during collection
-contain >=3 x 10^11 platelets

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47
Q

Apheresis - components collected - Plasma

A

plasmapheresis

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48
Q

Apheresis - components collected - Granulocytes

A

-leukapheresis
-not widely used to date

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49
Q

Apheresis - components collected - stem cells

A

-for bone marrow reconstitution in patients with cancer, leukemia, lymphoma
-autologous or HLA matched

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50
Q

Apheresis - therapeutic uses - therapeutic plasmapheresis

A

(plasma exchange) used to remove abnormal plasma proteins & replace with crystalloid, albumin, or FFP

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51
Q

Apheresis - therapeutic uses - therapeutic cytapheresis

A

used to remove cellular elements, such as an exchange transfusion for sickle cell patients, leukemic WBCs, lymphocytes (to induce immunosuppression)

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52
Q

Donor testing required by AABB and/or FDA - Typing

A

-ABO
-Rh (including weak D)

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53
Q

Donor testing required by AABB and/or FDA - antibody screen

A

antibody screen

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54
Q

Donor testing required by AABB and/or FDA - Syphilis testing

A

antibodies to Treponema pallidum or nontreponemal serological test for syphilis, e.g., RPR

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55
Q

Donor testing required by AABB and/or FDA - Hepatitis testing

A

-HBsAg
-Anti-HBc
-Anti-HCV
-HCV RNA (nucleic acid testing [NAT])

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56
Q

Donor testing required by AABB and/or FDA - HIV testing

A

-Anti-HIV-1/2
-HIV-1 RNA (NAT)

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57
Q

Donor testing required by AABB and/or FDA - other infectious disease testing

A

-Anti-HTLV-I/II
-West Nile virus RNA (NAT)
-Anti-Trypanosoma cruzi (FDA recommends 1-time donor screening)
-Zika virus (FDA recommends testing pooled donations)

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58
Q

Donor testing required by AABB and/or FDA - test to detect bacterial contamination of platelets

A

culture of platelets or FDA-approved rapid test (e.g., Pan Genera Detection [PGD] test)

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59
Q

Anticoagulant/Preservative Solutions - Acid citrate-dextrose (Formula A) - abbreviation

A

ACD-A

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60
Q

Anticoagulant/Preservative Solutions - Acid citrate-dextrose (Formula A) - RBC shelf life

A

21 days

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61
Q

Anticoagulant/Preservative Solutions - Acid citrate-dextrose (Formula A) - function

A

Citrate - prevents coagulation by chelating calcium

Dextrose - (glucose) supports ATP generation

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62
Q

Anticoagulant/Preservative Solutions - Acid citrate-dextrose (Formula A) - function

A

Citrate - prevents coagulation by chelating calcium

Dextrose - (glucose) supports ATP generation

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63
Q

Anticoagulant/Preservative Solutions - Acid citrate-dextrose (Formula A) - used for?

A

apheresis

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64
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose - abbreviation

A

CPD

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65
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose - RBC shelf life

A

21 days

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66
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose - function

A

-high pH preserves 2,3-DPG better
-better oxygen delivery

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67
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose-dextrose - abbreviation

A

CP2D

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68
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose-dextrose - RBC shelf life

A

21 days

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69
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose-dextrose - glucose

A

contains 100% more glucose than CPD

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70
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose with adenine - abbreviation

A

CPDA-1

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71
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose with adenine - RBC shelf life

A

35 days

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72
Q

Anticoagulant/Preservative Solutions - Citrate-phosphate-dextrose with adenine - function

A

-Adenine - increases ADP, which increases synthesis of ATP
-contains more glucose to sustain cells during longer storage

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73
Q

Additive solutions - purpose

A

extend shelf life of RBCs to 42 days

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74
Q

Additive solutions - constituents

A

-glucose for energy
-adenine to support ATP levels

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75
Q

Additive solutions - procedure

A

-plasma expressed from whole blood
100-110 mL additive transferred from attached satellite bag to RBCs within 72 hours of collection or per manufacturer’s instructions

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76
Q

Additive solutions - final hematocrit

A

55-65%

(HCT of RBCs without additive: 65-80%)

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77
Q

Additive solutions - examples

A

-Adsol (AS-1)
-Nutricel (AS-3)
-Optisol (AS-5)

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78
Q

Open System - explanation

A

-seal on unit is broken to attach external transfer bag
-exposure to air poses threat of bacterial contamination

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79
Q

Open system - effect on expiration date of component

A

-components stored at 1-6C must be used within 24 hours after system is open
-components stored at 20-24C must be used within 4 hours

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80
Q

Closed system -explanation

A

-sterility maintained though use of attached satellite bags or sterile connecting device that welds tubing from 1 bag to another
-no exposure to air

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81
Q

Closed system - effect on expiration date of component

A

no change

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82
Q

Blood components - RBCs - RBCs - preparation

A

-separated from whole blood by centrifugation or sedimentation any time before the expiration date of whole blood, OR
-collected by apheresis

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83
Q

Blood components - RBCs - RBCs - storage temperature

A

1-6*C

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84
Q

Blood components - RBCs - RBCs - shelf life

A

35 days in CPDA-1

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85
Q

Blood components - RBCs - RBCs - indications

A

inadequate tissue oxygenation

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86
Q

Blood components - RBCs - RBCs - HCT

A

should have HCT <=80%; otherwise not enough preservative to support RBCs

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87
Q

Blood components - RBCs - RBCs - HGB/HCT after transfusion of 1 unit

A

1 unit should increase HGB 1 g/dL or HCT 3%

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88
Q

Blood components - RBCs - RBCs adenine, saline added - preparation

A

additive solution added to RBCs following removal of most plasma

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89
Q

Blood components - RBCs - RBCs adenine, saline added - storage temperature

A

1-6*C

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90
Q

Blood components - RBCs - RBCs adenine, saline added - shelf life

A

42 days

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91
Q

Blood components - RBCs - RBCs adenine, saline added - indications

A

inadequate tissue oxygenation

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92
Q

What is the most commonly used RBC product?

A

RBCs adenine, saline added

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93
Q

Blood components - RBCs - RBCs frozen - preparation

A

-frozen in glycerol within 6 days of collection
-high glycerol (40%) method most commonly used

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94
Q

Blood components - RBCs - RBCs frozen - storage temperature

A

-frozen in high glycerol (40%): <=65C
-after removing glycerol (washing in decreased concentration of saline): 1-6C

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95
Q

Blood components - RBCs - RBCs frozen - shelf life

A

-frozen: 10 years
-after removing glycerol fix: 24 hours (unless a closed system used)

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96
Q

Blood components - RBCs - RBCs frozen - indications

A

inadequate tissue oxygenation

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97
Q

Blood components - RBCs - RBCs frozen - monitor glycerol removal

A

osmolality

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98
Q

Blood components - RBCs - RBCs frozen - what is removed?

A

all plasma, anticoagulant, WBCs, and platelets

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99
Q

Blood components - RBCs - RBCs frozen - safe for which patients?

A

IgA-deficient patients

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100
Q

Blood components - RBCs - RBCs frozen - used to?

A

store rare cells

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101
Q

Blood components - RBCs - Washed RBCs - preparation

A

RBCs washed with saline

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102
Q

Blood components - RBCs - Washed RBCs - storage temperature

A

1-6*C

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103
Q

Blood components - RBCs - Washed RBCs - shelf life

A

24 hours after washing

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104
Q

Blood components - RBCs - Washed RBCs - indications

A

history of severe allergic reaction (e.g., IgA, other plasma proteins)

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105
Q

Blood components - RBCs - Washed RBCs - % of RBCs lost in the process of washing?

A

about 20%

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106
Q

Blood components - RBCs - Washed RBCs - not a substitute for?

A

leukoreduced RBCs

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107
Q

Blood components - RBCs - Washed RBCs - not a substitute for?

A

leukoreduced RBCs

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108
Q

Blood components - RBCs - RBCs leukocytes reduced - preparation

A

filtration or apheresis processing

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109
Q

Blood components - RBCs - RBCs leukocytes reduced - storage temperature

A

1-6*C

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110
Q

Blood components - RBCs - RBCs leukocytes reduced - shelf life

A

-closed system: 35 days in CPDA-1
-open system: 24 hours

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111
Q

Blood components - RBCs - RBCs leukocytes reduced - shelf life

A

-closed system: 35 days in CPDA-1
-open system: 24 hours

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112
Q

Blood components - RBCs - RBCs leukocytes reduced - indications

A

history of febrile reaction

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113
Q

Blood components - RBCs - RBCs leukocytes reduced - must retain what % of original RBCs?

A

85%

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114
Q

Blood components - RBCs - RBCs leukocytes reduced - WBCs

A

<5 x 10^6

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115
Q

Blood components - RBCs - RBCs irradiated - preparation

A

irradiation at 2,500 cGy

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116
Q

Blood components - RBCs - RBCs irradiated - storage temperature

A

1-6*C

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117
Q

Blood components - RBCs - RBCs irradiated - shelf life

A

original outdate or 28 days from irradiation, whichever comes first

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118
Q

Blood components - RBCs - RBCs irradiated - indications

A

-immunodeficiency
-immunocompromised patients
-hematopoietic stem cell transplantation (HSCT) patients
-bone marrow transplant
-blood from blood relative
-intrauterine & neonatal transfusions

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119
Q

Blood components - RBCs - RBCs irradiated - used for prevention of?

A

graft-vs.-host disease

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120
Q

Blood components - RBCs - RBCs irradiated - gets rid of?

A

donor T cells

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121
Q

Blood components - Plasma & Derivatives - FFP - preparation

A

plasma separated from whole blood & frozen within 8 hours of collection

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122
Q

Blood components - Plasma & Derivatives - FFP - storage temperature

A

-frozen: <=-18C
-after thawing: 1-6C

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123
Q

Blood components - Plasma & Derivatives - FFP - shelf life

A

-frozen: 12 months
-after thawing: 24 hours

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124
Q

Blood components - Plasma & Derivatives - FFP - indications

A

deficiency of coagulation factors

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125
Q

Blood components - Plasma & Derivatives - FFP - contains?

A

all coagulation factors

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126
Q

Blood components - Plasma & Derivatives - FFP - thawed at?

A

30-37*C or by FDA-approved microwave

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127
Q

Blood components - Plasma & Derivatives - Cryoprecipitate - preparation

A

prepared by thawing FFP at 1-6*C, removing plasma, & re-freezing within 1 hour

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128
Q

Blood components - Plasma & Derivatives - Cryoprecipitate - storage temperature

A

Frozen: <=-18*C
After thawing: room temperature

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129
Q

Blood components - Plasma & Derivatives - Cryoprecipitate - shelf life

A

Frozen: 12 months
After thawing: single units 6 hours; pools 6 hours if sterile connecting device used; otherwise 4 hours

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130
Q

Blood components - Plasma & Derivatives - Cryoprecipitate - indications

A

fibrinogen & factor XIII deficiencies

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131
Q

Blood components - Plasma & Derivatives - Cryoprecipitate - diseases

A

used for hemophilia A and von Willebrand disease ONLY if factor VIII concentrate or recombinant factor preparations are not available

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132
Q

Blood components - Plasma & Derivatives - Cryoprecipitate - should contain?

A

> =80 IU of factor VIII and >=150 mg of fibrinogen

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133
Q

Blood components - Platelets - Platelets - preparation

A

-centrifugation of whole blood at RT within 8 hours of collection
-1st soft spin yields platelet-rich plasma
-2nd hard spin separates platelets from plasma

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134
Q

Blood components - Platelets - Platelets - storage temperature

A

20-24*C

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135
Q

Blood components - Platelets - Platelets - shelf life

A

-5 days from collection, with agitation
-after pooling: 4 hours

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136
Q

Blood components - Platelets - Platelets - indications

A

severe thrombocytopenia or abnormal platelet function

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137
Q

Blood components - Platelets - Platelets - requirements for unit

A

-40-70 mL plasma
->=5.5 x 10^10 platelets
-pH >=6.2

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138
Q

Blood components - Platelets - Platelets - 1 unit of platelets

A

should increase platelets by 5,000-10,000/uL in 75-kg patient

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139
Q

Blood components - Platelets - Platelets - # of units pooled

A

4-6

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140
Q

Blood components - Platelets - Apheresis platelets - preparation

A

apheresis

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141
Q

Blood components - Platelets - Apheresis platelets - storage temperature

A

20-24*C

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142
Q

Blood components - Platelets - Apheresis platelets - shelf life

A

5 days with agitation

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143
Q

Blood components - Platelets - Apheresis platelets - indications

A

severe thrombocytopenia or abnormal platelet function

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144
Q

Blood components - Platelets - Apheresis platelets - unit requirements

A

> =3.0 x 10^11 platelets (equivalent to 4-6 units)

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145
Q

Blood components - Platelets - Apheresis platelets - why used?

A

exposes recipient to fewer donors

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146
Q

Blood components - Platelets - Leukocyte-reduced platelets - preparation

A

WBCs removed by filtration or during apheresis processing

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147
Q

Blood components - Platelets - Leukocyte-reduced platelets - storage temperature

A

20-24*C

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148
Q

Blood components - Platelets - Leukocyte-reduced platelets - shelf life

A

open system: 4 hours
apheresis: 5 days

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149
Q

Blood components - Platelets - Leukocyte-reduced platelets - indications

A

-recurrent febrile reaction
-decrease risk of CMV transmission or HLA alloimmunization

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150
Q

Blood components - Platelets - Prestorage pooled platelets - preparation

A

4-6 ABO-identical platelets pooled using closed system

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151
Q

Blood components - Platelets - Prestorage pooled platelets - storage temperature

A

20-24*C

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152
Q

Blood components - Platelets - Prestorage pooled platelets - shelf life

A

5 days from collection

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153
Q

Blood components - Platelets - Prestorage pooled platelets - indications

A

-recurrent febrile reaction
-decrease risk of CMV transmission or HLA alloimmunization

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154
Q

Leukocyte Reduction (Leukoreduction) - purpose

A

to decrease WBCS to decrease febrile nonhemolytic transfusion reactions, transmission of CMV, & HLA alloimmunization

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155
Q

Leukocyte Reduction (Leukoreduction) - WBCs

A

<5 x 10^6

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156
Q

Leukocyte Reduction (Leukoreduction) - methods

A

-by apheresis processing
-by filtration during manufacture of components or after storage; prestorage leukocyte reduction is most effective; WBCs removed before they release cytokines
-use of filter during infusion

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157
Q

RBC storage lesion - increased

A

-lactic acid
-plasma K+
-plasma hemoglobin
-microaggregates

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158
Q

RBC storage lesion - decreased

A

-ATP
-2,3-diphosphoglycerate (2,3-DPG)
-pH
-glucose
-viable cells
-coagulation factors (the plasma has been removed)

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159
Q

RBC storage lesion - O2 dissociation curve

A

shift to left (increased HGB/O2 affinity, decreased O2 delivery to tissues)

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160
Q

Primary vs. Secondary response - Primary - stimulus

A

1st exposure to antigen

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161
Q

Primary vs. Secondary response - Primary - lag phase

A

days to months

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162
Q

Primary vs. Secondary response - Primary - type of antibody

A

IgM at first - may switch to IgG after 2-3 weeks (isotype switching)

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163
Q

Primary vs. Secondary response - Primary - titer

A

rises slowly, peaks, then declines

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164
Q

Primary vs. Secondary response - Secondary - stimulus

A

subsequent exposure to antigen

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165
Q

Primary vs. Secondary response - Secondary - lag phase

A

hours

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166
Q

Primary vs. Secondary response - Secondary - type of antibody

A

IgG

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167
Q

Primary vs. Secondary response - Secondary - titer

A

rises faster & higher, stays elevated longer

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168
Q

IgG Versus IgM - structure

A

IgG: monomer

IgM: pentamer

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169
Q

IgG Versus IgM - number of antigen binding sites

A

IgG: 2

IgM: 10

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170
Q

IgG Versus IgM - type of antibody

A

IgG: immune (adaptive)

IgM: naturally occurring

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171
Q

IgG Versus IgM - optimum temperature of reactivity

A

IgG: 37*C

IgM: 25*C or lower

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172
Q

IgG Versus IgM - reacts in saline?

A

IgG: no

IgM: yes

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173
Q

IgG Versus IgM - reacts best by indirect antiglobulin test?

A

IgG: yes

IgM: no

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174
Q

IgG Versus IgM - complement fixation

A

IgG: moderate

IgM: strong

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175
Q

IgG Versus IgM - causes transfusion reactions?

A

IgG: yes

IgM: not usually , except ABO

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176
Q

IgG Versus IgM - crosses placenta?

A

IgG: yes

IgM: no

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177
Q

IgG Versus IgM - causes HDFN?

A

IgG: yes

IgM: no

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178
Q

IgG Versus IgM - causes delayed hemolytic transfusion reactions?

A

IgG: yes

IgM: no

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179
Q

IgG Versus IgM - destroyed by sulfhydryl compounds (dithiothreitol [DTT], 2-mercaptoethanol [2-ME])?

A

IgG: no

IgM: yes

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180
Q

Factors that affect agglutination in tube testing - sensitization stage -

A

attachment of antibody to antigen

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181
Q

Factors that affect agglutination in tube testing - sensitization stage - temperature

A

clinically significant antibodies react best at 37*C

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182
Q

Factors that affect agglutination in tube testing - sensitization stage - pH

A

most antibodies react at pH 5.5-8.5

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183
Q

Factors that affect agglutination in tube testing - sensitization stage - ionic strength

A

reducing ionic strength of medium facilitates interaction of antibody with antigen (e.g., low ionic strength solution [LISS])

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184
Q

Factors that affect agglutination in tube testing - sensitization stage - antigen/antibody ratio

A

-too much antibody can cause prozone (false negative)
-optimum serum-to-cell ratio is 80:1
-usually 2 drops serum to 1 drop of 2-5% RBCs

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185
Q

Factors that affect agglutination in tube testing - sensitization stage - incubation time

A

-depends on medium
-usually 10-30 minutes

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186
Q

Factors that affect agglutination in tube testing - agglutination stage

A

formation of the lattice-type structure composed of the antigen-antibody bridges

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187
Q

Factors that affect agglutination in tube testing - agglutination stage - type of antibody molecule

A

IgM is larger, can span distance between RBCs more easily

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188
Q

Factors that affect agglutination in tube testing - agglutination stage - density of antigens & location on RBC surface

A

affects ease of attachment of antibodies

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189
Q

Factors that affect agglutination in tube testing - agglutination stage - zeta potential

A

-difference in charge between negatively-charged RBC surface & cloud of positive ions that surround RBCs
-reducing zeta potential allows RBCs to move closer together
-commercially available enhancement media reduces the zeta potential, allowing positively charged antibodies to get closer to negatively charged RBCs & increasing the RBC agglutination by IgG molecules

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190
Q

Comparison of tube, column, and solid-phase testing - tube testing - reaction container

A

glass test tubes

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191
Q

Comparison of tube, column, and solid-phase testing - tube testing - principle

A

-antibodies attach to corresponding antigens on RBCs, forming bridges between cells
-RBCS agglutinate

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192
Q

Comparison of tube, column, and solid-phase testing - tube testing - positive reaction

A

agglutinated RBCs or hemolysis

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193
Q

Comparison of tube, column, and solid-phase testing - tube testing - negative reaction

A

no agglutinated RBCs or hemolysis

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194
Q

Comparison of tube, column, and solid-phase testing - tube testing - adaptable to automation?

A

no

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195
Q

Comparison of tube, column, and solid-phase testing - column agglutination testing - reaction chamber

A

plastic microtube containing dextranacrylamide gel

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196
Q

Comparison of tube, column, and solid-phase testing - column agglutination testing - principle

A

-antigen-antibody reaction results in agglutinated RBCs
-gel acts as sieve
-large agglutinates can’t pass through, remain at top
-small agglutinates pass into gel
-unagglutinated cells go to bottom

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197
Q

Comparison of tube, column, and solid-phase testing - column agglutination testing - positive reaction

A

-agglutinated RBCs suspended in gel
-position indicates strength of reaction
-large agglutinates at top

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198
Q

Comparison of tube, column, and solid-phase testing - column agglutination testing - negative reaction

A

button of unagglutinated RBCs in bottom of microtube

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199
Q

Comparison of tube, column, and solid-phase testing - column agglutination testing - adaptable to automation?

A

yes

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200
Q

Comparison of tube, column, and solid-phase testing - solid-phase testing - reaction chamber

A

microplate with RBC membranes bound to surface of wells

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201
Q

Comparison of tube, column, and solid-phase testing - solid-phase testing - principle

A

-antibodies in sample attach to RBC antigens on surface of wells
-after incubation, unbound antibody removed by washing
-anti-IgG-labeled indicator RBCs added
-attach to antibodies bound to reagent RBC antigens during centrifugation

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202
Q

Comparison of tube, column, and solid-phase testing - solid-phase testing - positive reaction

A

indicator RBCs adhere diffusely to surface of well

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203
Q

Comparison of tube, column, and solid-phase testing - solid-phase testing - negative reaction

A

-no adherence of RBCs
-button of RBCs in bottom of well

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204
Q

Comparison of tube, column, and solid-phase testing - solid-phase testing - adaptable to automation?

A

yes

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205
Q

Comparison of tube, column, and solid-phase testing - solid-phase testing - advantages

A

-standardized
-more sensitive than tube testing
-reaction stable for 2 days

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206
Q

Comparison of tube, column, and solid-phase testing - tube testing - advantages

A

low cost

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207
Q

Comparison of tube, column, and solid-phase testing - column agglutination testing - advantages

A

-standardized
-more sensitive than tube testing
-reaction stable for 2-3 days; can be captured electronically
-antihuman globulin (AHG) tests don’t require washing or control cells

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208
Q

Grading reactions - tube versus column - 4+

A

Tube: one solid agglutinate

Column: solid band of agglutinated RBCs at top

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209
Q

Grading reactions - tube versus column - 3+

A

Tube: several large agglutinates

Column: band of agglutinated RBCs near top with a few staggered below

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210
Q

Grading reactions - tube versus column - 2+

A

Tube: medium-sized agglutinates, clear background

Column: agglutinates throughout

211
Q

Grading reactions - tube versus column - 1+

A

Tube: small agglutinates, turbid background

Column: agglutinates predominantly in lower half of column with some RBCs at bottom

212
Q

Grading reactions - tube versus column - mixed field

A

Tube: some agglutinated RBCs in sea of free RBCs

Column: layer of agglutinated RBCs at top & pellet of unagglutinated RBCs at bottom

213
Q

Grading reactions - tube versus column - negative

A

Tube: no agglutinates

Column: well-defined pellet of unagglutinated RBCs at bottom

214
Q

True or False. In tube testing, hemolysis is also a positive reaction.

A

True

215
Q

ABO phenotype A - what is the genotype?

A

AA, AO

216
Q

ABO phenotype B - what is the genotype?

A

BB, BO

217
Q

ABO phenotype AB - what is the genotype?

A

AB

218
Q

ABO phenotype O - what is the genotype?

A

OO

219
Q

Frequency of ABO types - Type O
-European ancestry (%)
-African ancestry (%)
-Hispanic ancestry (%)
-Asian ancestry (%)

A

-European ancestry: 45%
-African ancestry: 49%
-Hispanic ancestry: 57%
-Asian ancestry: 40%

220
Q

Frequency of ABO types - Type A
-European ancestry (%)
-African ancestry (%)
-Hispanic ancestry (%)
-Asian ancestry (%)

A

-European ancestry: 40%
-African ancestry: 27%
-Hispanic ancestry: 31%
-Asian ancestry: 27%

221
Q

Frequency of ABO types - Type B
-European ancestry (%)
-African ancestry (%)
-Hispanic ancestry (%)
-Asian ancestry (%)

A

-European ancestry: 11%
-African ancestry: 19%
-Hispanic ancestry: 10%
-Asian ancestry: 25%

222
Q

Frequency of ABO types - Type AB
-European ancestry (%)
-African ancestry (%)
-Hispanic ancestry (%)
-Asian ancestry (%)

A

-European ancestry: 4%
-African ancestry: 4%
-Hispanic ancestry: 2%
-Asian ancestry: 7%

223
Q

ABO System - Group O
-antigen(s) on RBC?
-antibody(s) in serum?

A

-antigen(s) on RBC: neither
-antibody(s) in serum: anti-A, anti-B

224
Q

ABO System - Group A
-antigen(s) on RBC?
-antibody(s) in serum?

A

-antigen(s) on RBC: A
-antibody(s) in serum: anti-B

225
Q

ABO System - Group B
-antigen(s) on RBC?
-antibody(s) in serum?

A

-antigen(s) on RBC: B
-antibody(s) in serum: anti-A

226
Q

ABO System - Group AB
-antigen(s) on RBC?
-antibody(s) in serum?

A

-antigen(s) on RBC: A and B
-antibody(s) in serum: none

227
Q

Forward grouping:
Anti-A: 0
Anti-B: 0

Reverse grouping:
A cells: +
B cells: +

What is the blood type?

A

Type O

228
Q

Forward grouping:
Anti-A: +
Anti-B: 0

Reverse grouping:
A cells: 0
B cells: +

What is the blood type?

A

Type A

229
Q

Forward grouping:
Anti-A: 0
Anti-B: +

Reverse grouping:
A cells: +
B cells: 0

What is the blood type?

A

Type B

230
Q

Forward grouping:
Anti-A: +
Anti-B: +

Reverse grouping:
A cells: 0
B cells: 0

What is the blood type?

A

Type AB

231
Q

Anti-A: 0
Anti-B: 0
A1 cells: 0
B cells: 0

Possible cause?
Resolution?

A

Possible cause: missing isoagglutinins in group O

Resolution:
-incubate reverse grouping at RT for 30 minutes
-if still negative, incubate at 4*C for 15-30 minutes
-include controls: patient RBCs in 4% albumin, patient serum with O cells

232
Q

Anti-A: 4+
Anti-B: 0
A1 cells: 1+
B cells: 4+

Possible cause?
Resolution?

A

Possible cause: A2 with anti-A1

Resolution:
-type RBCs with anti-A1 (Dolichos biflorus lectin)
-test serum with several additional A1, A2, & O cells

233
Q

Anti-A: 4+
Anti-B: 4+
A1 cells: 2+
B cells: 2+

Possible cause?
Resolution?

A

Possible cause: Rouleaux

Resolution:
-use washed RBCs suspended in saline for forward grouping
-perform saline replacement technique in reverse grouping

Possible cause: AB with cold alloantibody

Resolution:
-perform antibody panel at RT
-if cold alloantibody identified, repeat reverse grouping with A1 & B cells that lack corresponding antigen

234
Q

Anti-A: 3+
Anti-B: 4+
A1 cells: 1+
B cells: 0

Possible cause?
Resolution?

A

Possible cause: A2B with anti-A1

Resolution:
-type cells with anti-A1 (Dolichos biflorus lectin)
-test serum with additional A1, A2, & O cells

235
Q

Anti-A: 4+
Anti-B: 2+
A1 cells: 0
B cells: 4+

Possible cause?
Resolution?

A

Possible cause: acquired B antigen

Resolution:
-check medical history for infection by GI bacteria (some have enzymes that convert A antigen to B-like antigen)
-retype RBCs with different monoclonal anti-B or acidified human anti-B (pH 6.0; doesn’t react with acquired B antigen)

236
Q

Phenotype: Rh positive - genotype?

A

DD, Dd

237
Q

Phenotype: Rh negative - genotype?

A

dd

238
Q

Rh antigens - Fisher-Race: D
-Weiner:
-Rosenfield:

A

-Weiner: Rho
-Rosenfield: Rh1

239
Q

Rh antigens - Fisher-Race: C
-Weiner:
-Rosenfield:

A

-Weiner: rh’
-Rosenfield: Rh2

240
Q

Rh antigens - Fisher-Race: E
-Weiner:
-Rosenfield:

A

-Weiner: rh”
-Rosenfield: Rh3

241
Q

Rh antigens - Fisher-Race: c
-Weiner:
-Rosenfield:

A

-Weiner: hr’
-Rosenfield: Rh4

242
Q

Rh antigens - Fisher-Race: e
-Weiner:
-Rosenfield:

A

-Weiner: hr”
-Rosenfield: Rh5

243
Q

Frequency of Rh antigens - D
-European ancestry:
-African ancestry:

A

-European ancestry: 85%
-African ancestry: 92%

244
Q

Frequency of Rh antigens - C
-European ancestry:
-African ancestry:

A

-European ancestry: 68%
-African ancestry: 27%

245
Q

Frequency of Rh antigens - E
-European ancestry:
-African ancestry:

A

-European ancestry: 29%
-African ancestry: 22%

246
Q

Frequency of Rh antigens - c
-European ancestry:
-African ancestry:

A

-European ancestry: 80%
-African ancestry: 96%

247
Q

Frequency of Rh antigens - e
-European ancestry:
-African ancestry:

A

-European ancestry: 98%
-African ancestry: 98%

248
Q

Frequency of Rh genes - Rh^0
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: Dce
-European ancestry: 4%
-African ancestry: 44%
-Asian ancestry: 3%

249
Q

Frequency of Rh genes - Rh^1
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: DCe
-European ancestry: 42%
-African ancestry: 17%
-Asian ancestry: 70%

250
Q

Frequency of Rh genes - Rh^2
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: DcE
-European ancestry: 14%
-African ancestry: 11%
-Asian ancestry: 21%

251
Q

Frequency of Rh genes - Rh^z
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: DCe
-European ancestry: <=0.01%
-African ancestry: <=0.01%
-Asian ancestry: 1%

252
Q

Frequency of Rh genes - rh
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: dce
-European ancestry: 37%
-African ancestry: 26%
-Asian ancestry: 3%

253
Q

Frequency of Rh genes - rh’
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: dCe
-European ancestry: 2%
-African ancestry: 2%
-Asian ancestry: 2%

254
Q

Frequency of Rh genes - rh”
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: dcE
-European ancestry: 1%
-African ancestry: <=0.01%
-Asian ancestry: <=0.01%

255
Q

Frequency of Rh genes - rh^y
-antigens:
-European ancestry:
-African ancestry:
-Asian ancestry:

A

-antigens: dCE
-European ancestry: <=0.01%
-African ancestry: <=0.01%
-Asian ancestry: <=0.01%

256
Q

Breaking the Rh Code - see r before h:
-think:
-example(s): rh’ = ?

A

-think: “big”
-rh’ = C

257
Q

Breaking the Rh Code - see h before r:
-think:
-example(s): hr’ = ?

A

-think: “little”
-hr’ = c

258
Q

Breaking the Rh Code - see R:
-think:
-example(s): Rh1 = ?

A

-think: presence of D
-Rh1 = DCe

259
Q

Breaking the Rh Code - see r:
-think:
-example(s): rh’ = ?

A

-think: absence of D
-rh’ = dCe

260
Q

Breaking the Rh Code - see 1 or ‘:
-think:
-example(s):
–Rh1 = ?
–rh’ - ?
–Rho = ?

A

-think: C
(if no 1 or ‘, then c)

-examples:
–Rh1 = DCe
–rh’ = dCe
-Rho = Dce

261
Q

Breaking the Rh Code - see 2 or “:
-think:
-example(s):
–Rh2 = ?
–rh” = ?
–Rho = ?

A

-think: E
(if no 2 or “, then e)

-examples:
–Rh2 = DcE
–rh” = dcE
–Rho = Dce

262
Q

Breaking the Rh Code - see 0:
-think:
-example(s): Rho = ?

A

-think: c + e

-Rho = Dce

263
Q

Breaking the Rh Code - see Z or y:
-think:
-example(s): rh^y = ?

A

-think: C + E

-rh^y = dCE

264
Q

Rh typing sera - High-protein anti-D - source

A

prepared from pools of human sera (immunized Rh-negative individuals)

265
Q

Rh typing sera - High-protein anti-D - control

A

-same ingredients as reagent, except no anti-D
-should be purchased from same manufacturer as anti-D

266
Q

Rh typing sera - High-protein anti-D - disadvantage

A

more false positives than low-protein reagents, e.g., RBCs with positive direct antiglobulin test (DAT)

267
Q

Rh typing sera - Low-protein anti-D - source

A

mixture of monoclonal IgM & monoclonal or polyclonal IgG

268
Q

Rh typing sera - Low-protein anti-D - control

A

-any negative typing reaction serves as control, e.g., negative reaction with anti-A or anti-B
-when RBCs react with all antisera (i.e., AB positive), run control recommended by manufacturer
-(usually patient RBCs with autologous serum or 6% or 8% albumin)

269
Q

Rh typing sera - Low-protein anti-D - advantages

A

-most widely used
-lower rate of false positives with Ig-coated RBCs

270
Q

Interpretation of Rh typing:
-anti-D: +
-control: 0

Rh type?

A

positive

271
Q

Interpretation of Rh typing:
-anti-D: 0
-control: 0

Rh type?

A

negative*

*test for weak D if donor or infant of mother being evaluated for RhIG

272
Q

Interpretation of Rh typing:
-anti-D: +
-control: +

Rh type?

A

invalid

273
Q

List the causes of false positive Rh typing results.

A

-warm or cold autoagglutinins
-rouleaux
-polyagglutinable RBCs
-nonspecific agglutination due to ingredient or reagent, e.g., dye, preservative
-contaminated or incorrect reagent

274
Q

List the causes of false negative Rh typing results.

A

-failure to add reagent
-RBC suspension too heavy
-resuspending cell button too vigorously
-contaminated or incorrect reagent
-blocking of antigen sites by antibodies, e.g., severe HDFN due to anti-D

275
Q

Weak D testing - when performed?

A

when anti-D & Rh control are negative in Rh typing of donor or infant of mother being evaluated for RhIG

276
Q

Weak D testing - reagent

A

not all anti-D reagents are appropriate for use
-refer to manufacturer’s package insert

277
Q

Weak D testing - method

A

incubate Rh typing tubes at 37C for 15-60 minutes indirect antibody test (IAT)

*RBCs with positive DAT will react in any IAT test

278
Q

Weak D testing - interpretation:
Anti-D = positive
Rh control = negative

Rh type?

A

Rh positive

279
Q

Weak D testing - interpretation:
Anti-D = positive
Rh control = positive

Rh type?

A

invalid

280
Q

Weak D testing - interpretation:
Anti-D = negative
Rh control = negative

Rh type?

A

Rh negative

281
Q

Recipient type: Rh positive

Rh type patient can receive?

A

Rh positive OR Rh negative

282
Q

Recipient type: weak D

Rh type patient can receive?

A

Rh positive OR Rh negative, depending on the weak D phenotype

283
Q

Recipient type: Rh negative

Rh type patient can receive?

A

Rh negative only, especially women of childbearing age

(If Rh positive must be given in emergency, RhIG can be given to prevent immunization)

284
Q

Frequency of other selected blood group antigens: K
-European ancestry:
-African ancestry:

A

-European ancestry: 9%
-African ancestry: 2%

285
Q

Frequency of other selected blood group antigens: k
-European ancestry:
-African ancestry:

A

-European ancestry: 99.8%
-African ancestry: 100%

286
Q

Frequency of other selected blood group antigens: Fya
-European ancestry:
-African ancestry:

A

-European ancestry: 68%
-African ancestry: 13%

287
Q

Frequency of other selected blood group antigens: Fyb
-European ancestry:
-African ancestry:

A

-European ancestry: 80%
-African ancestry: 23%

288
Q

Frequency of other selected blood group antigens: Jka
-European ancestry:
-African ancestry:

A

-European ancestry: 76%
-African ancestry: 92%

289
Q

Frequency of other selected blood group antigens: Jkb
-European ancestry:
-African ancestry:

A

-European ancestry: 74%
-African ancestry: 48%

290
Q

Frequency of other selected blood group antigens: M
-European ancestry:
-African ancestry:

A

-European ancestry: 79%
-African ancestry: 74%

291
Q

Frequency of other selected blood group antigens: N
-European ancestry:
-African ancestry:

A

-European ancestry: 70%
-African ancestry: 75%

292
Q

Frequency of other selected blood group antigens: S
-European ancestry:
-African ancestry:

A

-European ancestry: 55%
-African ancestry: 30%

293
Q

Frequency of other selected blood group antigens: s
-European ancestry:
-African ancestry:

A

-European ancestry: 90%
-African ancestry: 92%

294
Q

Frequency of other selected blood group antigens: Lea
-European ancestry:
-African ancestry:

A

-European ancestry: 22%
-African ancestry: 23%

295
Q

Frequency of other selected blood group antigens: Leb
-European ancestry:
-African ancestry:

A

-European ancestry: 72%
-African ancestry: 55%

296
Q

Frequency of other selected blood group antigens: P1
-European ancestry:
-African ancestry:

A

-European ancestry: 79%
-African ancestry: 94%

297
Q

I system - I antigen
Adult cells:
Cord cells:
i adult cells:

A

Adult cells: much
Cord cells: trace
i adult cells: trace

298
Q

I system - i antigen
Adult cells:
Cord cells:
i adult cells:

A

Adult cells: trace
Cord cells: much
i adult cells: much

299
Q

Antibody characteristics - naturally occurring

A

-ABO
-Lewis
-P1
-MN
-Lu^a

300
Q

Antibody characteristics - clinically significant

A

-ABO
-Rh
-Kell
-Duffy
-SsU

301
Q

Antibody characteristics - warm antibodies

A

-Rh
-Kell
-Duffy
-Kidd

302
Q

Antibody characteristics - cold antibodies

A

-M
-N
-P1

303
Q

Antibody characteristics - usually only react in AHG

A

-Kell
-Duffy
-Kidd

304
Q

Antibody characteristics - can react in any phase of testing

A

Lewis

305
Q

Antibody characteristics - detection enhanced by enzyme treatment of test cells

A

-Rh
-Lewis
-Kidd
-P1

306
Q

Antibody characteristics - not detected with enzyme treatment of test cells

A

-M
-N
-Duffy

307
Q

Antibody characteristics - enhanced by acidification

A

M

308
Q

Antibody characteristics - show dosage

A

-Rh other than D
-MNS
-Duffy
-Kidd

309
Q

Antibody characteristics - bind complement

A

-I
-Kidd
-Lewis

310
Q

Antibody characteristics - cause in vitro hemolysis

A

-ABO
-Lewis
-Kidd
-Vell
-some P1

311
Q

Antibody characteristics - labile in vivo & in vitro

A

Kidd

312
Q

Antibody characteristics - common cause of anamnestic response (delayed transfusion reaction)

A

Kidd

313
Q

Antibody characteristics - associated with paroxysmal nocturnal hemoglobinuria

A

Anti-P

314
Q

Antibody characteristics - associated with cold agglutinin disease & Mycoplasma pneumoniae infections

A

Anti-I

315
Q

Antibody characteristics - associated with infectious mononucleosis

A

anti-i

316
Q

Antigen-Antibody enhancement - reagent - albumin

A

22% bovine serum albumin
-reduces net negative charge of RBCs, allowing them to come closer together

317
Q

Antigen-Antibody enhancement - reagent - LISS

A

-reduces ionic strength of suspending medium (lowers zeta potential), allowing antigens & antibodies to move closer together more rapidly
-reduces incubation time for IAT

318
Q

Antigen-Antibody enhancement - reagent - Polyethylene glycol (PEG)

A

-increases antibody uptake
-used for detection & ID of weak IgG antibodies

319
Q

Antigen-Antibody enhancement - reagent - enzymes

A

-ficin & papain most commonly used
-reduce RBC surface charge by cleaving sialic acid molecules
-M, N, S, Fya, Fyb antigens destroyed

320
Q

Antihuman Globulin (AHG) serum - type - Polyspecific (broad spectrum) - detects

A

IgG & C3d

321
Q

Antihuman Globulin (AHG) serum - type - Polyspecific (broad spectrum) - used for?

A

DAT

322
Q

Antihuman Globulin (AHG) serum - type - Polyspecific (broad spectrum) - DAT positive

A

monospecific sera used for follow-up testing

323
Q

Antihuman Globulin (AHG) serum - type - Polyspecific (broad spectrum) - advantage

A

may detect complement-binding antibody more readily

324
Q

Antihuman Globulin (AHG) serum - type - Polyspecific (broad spectrum) - disadvantage

A

reaction due to complement binding by clinically insignificant cold antibody

325
Q

Antihuman Globulin (AHG) serum - type - Monospecific - Anti-IgG - detects

A

IgG

326
Q

Antihuman Globulin (AHG) serum - type - Monospecific - Anti-IgG - used for?

A

routine compatibility tests & antibody ID

327
Q

Antihuman Globulin (AHG) serum - type - Monospecific - Anti-IgG - advantage

A

detects clinically significant antibodies

328
Q

Antihuman Globulin (AHG) serum - type - Monospecific - Anti-C3d or anti-C3b-C3d - detects

A

complement

329
Q

Antihuman Globulin (AHG) serum - type - Monospecific - Anti-C3d or anti-C3b-C3d - detects

A

complement

330
Q

Antihuman Globulin (AHG) serum - type - Monospecific - Anti-C3d or anti-C3b-C3d - helpful in investigation of what?

A

immune hemolytic anemia

331
Q

Antiglobulin testing - Direct (DAT) - detects

A

in vivo sensitization of RBCs by IgG antibody

332
Q

Antiglobulin testing - Direct (DAT) - specimen

A

EDTA red cells preferred

333
Q

Antiglobulin testing - Direct (DAT) - incubation

A

none required

334
Q

Antiglobulin testing - Direct (DAT) - application

A

-HDFN
-transfusion reaction
-autoimmune hemolytic anemia
-drug-induced hemolytic anemia

335
Q

Antiglobulin testing - Direct (DAT) - false positives

A

-complement binding in vitro if RBCs are taken from red-top tube & broad-spectrum AHG used
-septicemia
-contamination of specimen
-Wharton jelly in cord blood
-overcentrifugation

336
Q

Antiglobulin testing - Direct (DAT) - false negatives

A

-interruption in testing
-contamination, improper storage
-failure to add AHG
-neutralization of AHG from inadequate washing
-dilution of AHG by residual saline
-undercentrifugation

337
Q

Antiglobulin testing - Indirect (IAT) - detects

A

in vitro sensitization of RBCs by IgG antibody

338
Q

Antiglobulin testing - Indirect (IAT) - specimen

A

serum, plasma, RBCs

339
Q

Antiglobulin testing - Indirect (IAT) - incubation

A

-serum or plasma with reagent RBCs OR
-RBCs with reagent antiserum

340
Q

Antiglobulin testing - Indirect (IAT) - application

A

-antibody screen
-crossmatch
-RBC phenotyping
-weak D testing
-antibody ID

341
Q

Antiglobulin testing - Indirect (IAT) - false positives

A

-cells with positive DAT
-overcentrifugation

342
Q

Antiglobulin testing - Indirect (IAT) - false negatives

A

-interruption in testing
-contamination, improper storage
-failure to add AHG
-neutralization of AHG from inadequate washing
-dilution of AHG by residual saline
-undercentrifugation
-underincubation

343
Q

Antibody identification - reactions: same strength & in 1 phase only - possible explanation?

A

suggestive of single antibody

344
Q

Antibody identification - reactions: varying strength - possible explanation?

A

-multiple antibodies
-antigens exhibiting dosage

345
Q

Antibody identification - reactions: in different phases - possible explanation?

A

-combination of warm & cold antibodies
-antibody with wide thermal range

346
Q

Antibody identification - reactions: all cells in AGH, autocontrol negative - possible explanation?

A

-multiple antibodies
-antibody to high frequency antigen

347
Q

Antibody identification - reactions: all cells at 37*C, negative in AHG, autocontrol positive - possible explanation?

A

rouleaux

348
Q

Antibody identification - reactions: all cells in AHG, autocontrol positive - possible explanation?

A

warm autoantibody

349
Q

Interpreting antibody panels - rule out (cross out)

A
  1. On row of antigens at top of antigram, cross out those that are present on cells that didn’t react in any phase.
  2. Circle antigens that aren’t crossed out. An antibody to 1 or more of these may be present.
  3. Look for matching patterns, e.g., if serum only reacted with cells #3 & #5, and E antigen is only on cells #3 and #5, the antibody is most likely anti-E

An antibody will react with all cells that possess the corresponding antigen (except for weak antibodies that only react with homozygous cells). An antibody won’t react with any cells that lack the corresponding antigen.

350
Q

Interpreting antibody panels - testing with selected cells

A

If other antibodies can’t be ruled out, further testing with selected cells might be required. Cells selected for testing should be positive for only 1 antigen corresponding to antibodies in question, e.g., if pattern reactivity matches anti-Jka, but anti-K and anti-S can’t be ruled out, serum should be tested with cells of the following type:
*Jk(a-), K+, S-
*Jk(a-), K-, S+
*Jk(a+), K-, S-
Homozygous cells are preferred to avoid missing weak antibodies that demonstrate dosage.

351
Q

Interpreting antibody panels - Confirmation

A

Conclusive ID requires testing sufficient numbers of cells that are positive and negative for the corresponding antigen, e.g., 3 positive & 3 negative. Some labs use other combinations that provide the same probability (p) value of <=0.05 (I.e., 95% confidence level that the antibody ID is correct). Once the antibody is identified, type patients RBCs for corresponding antigen. Should be negative.

352
Q

Cold antibodies - anti-A1

A

-only found in subgroups of A
-agglutinates A1 and A1B cells, but not A2 or O.

353
Q

Cold antibodies - anti-I

A

-agglutinates all adult cells, except i adult
-doesn’t agglutinate cord cells

354
Q

Cold antibodies - anti-i

A

agglutinates cord cells more strongly than adult cells

355
Q

Cold antibodies - anti-H

A

-most common in A1 and A1B
-agglutinates O cells most strongly, followed by A2 and B; least likely in A1B

356
Q

Cold antibodies - anti-IH

A

-most common in A1 and A1B
-agglutinates cells that possess both I and H
-agglutinates adult O cells most strongly
-weaker reaction with A1 cells
-doesn’t agglutinate cord cells

357
Q

Compatibility testing - specimen collected within how many days of transfusion if patient has been pregnant or transfused in preceding 3 months?

A

3 days

358
Q

Compatibility testing - should the Rh type on the donor unit be repeated if it is labeled Rh neg?

A

yes

359
Q

Compatibility testing - should weak D be performed on the donor unit if it is labeled Rh neg?

A

no

360
Q

Compatibility testing - how many determinations of the recipient’s ABO group per AAB Standard 5.14.5?

A

2

361
Q

Compatibility testing - what samples should the crossmatch be performed on?

A

recipient serum & donor RBCs

362
Q

Compatibility testing - how long should the patient specimen & unit segment be retained for after transfusion?

A

7 days (kept at 1-6*C)

363
Q

Crossmatches - antiglobulin - explanation

A

recipient serum + donor RBCs tested through AHG

364
Q

Crossmatches - antiglobulin - when performed?

A

if recipient has or had clinically significant antibody

365
Q

Crossmatches - immediate spin - explanation

A

recipient serum + donor RBCs tested in IS only

366
Q

Crossmatches - immediate spin - when performed

A

if recipient doesn’t have & never had clinically significant antibody

367
Q

Crossmatches - immediate spin - detects?

A

ABO incompatibility

368
Q

Crossmatches - electronic - explanation

A

computer check of donor ABO & Rh type AND recipient ABO & Rh type

369
Q

Crossmatches - electronic - when performed

A

if recipient doesn’t have & never had clinically significant antibody

370
Q

Crossmatches - electronic - detects?

A

ABO incompatibility

371
Q

Crossmatches - electronic - ABO typing of recipient must be done how many times?

A

twice

372
Q

The Major Crossmatch - will?

A

-detect ABO incompatibility
-detect most antibodies against donor cells

373
Q

The Major Crossmatch - will NOT?

A

-detect all ABO typing errors
-detect most Rh typing errors
-detect all antibodies
-detect platelet or leukocyte antibodies
-prevent immunization
-ensure normal survival of RBCs

374
Q

Incompatible Crossmatches: Negative antibody screen, incompatible IS crossmatch.
-possible cause?
-resolution?

A

Possible cause: ABO incompatibility

Resolution: retype donor & recipient; crossmatch with ABO-compatible donor

375
Q

Incompatible Crossmatches: 1 antibody screening cell & 1 donor positive in AHG
-possible cause?
-resolution?

A

Possible cause: Alloantibody

Resolution: ID the antibody; crossmatch units negative for corresponding antigen

376
Q

Incompatible Crossmatches: Antibody screening cells & all donor except 1 negative at 37*C & in AHG; 1 donor positive in AHG only
-possible cause?
-resolution?

A

Possible cause: positive DAT on donor

Resolution: perform DAT on unit; if positive, return to collecting facility

377
Q

Incompatible Crossmatches: Antibody screening cells, donors, & autocontrol positive in AHG
-possible cause?
-resolution?

A

Possible cause: warm autoantibody

Resolution: important to detect any underlying clinically significant alloantibodies prior to transfusion; Adsorption testing is typically required; if patient situation is life-threatening, consult with medical director and provide transfusion.

378
Q

Incompatible Crossmatches: Antibody screening cells, donors, & autocontrol positive at IS & 37*C, but negative in AHG
-possible cause?
-resolution?

A

Possible cause: rouleaux

Resolution: saline replacement technique

379
Q

Transfusion of Non-Group-Specific RBCs:
-Patient type: O
-RBC type patient can receive?
-Plasma type patient can receive?

A

RBC type patient can receive: O only

Plasma type patient can receive: O, A, B, AB

380
Q

Transfusion of Non-Group-Specific RBCs:
-Patient type: A
-RBC type patient can receive?
-Plasma type patient can receive?

A

RBC type patient can receive: A, O

Plasma type patient can receive: A, AB

381
Q

Transfusion of Non-Group-Specific RBCs:
-Patient type: B
-RBC type patient can receive?
-Plasma type patient can receive?

A

RBC type patient can receive: B, O

Plasma type patient can receive: B, AB

382
Q

Transfusion of Non-Group-Specific RBCs:
-Patient type: AB
-RBC type patient can receive?
-Plasma type patient can receive?

A

RBC type patient can receive: AB, A, B, O

Plasma type patient can receive: AB

383
Q

Pretransfusion testing - RBCs - crossmatch?

A

yes

-can be electronic crossmatch if negative antibody screen & no record of previously detected antibodies

384
Q

Pretransfusion testing - Plasma - crossmatch?

A

no

-must be ABO compatible with recipient RBCs

385
Q

Pretransfusion testing - Cryoprecipitate - crossmatch?

A

no

-all ABO groups acceptable; Rh type not considered

386
Q

Pretransfusion testing - Platelets - crossmatch?

A

No*

*for apheresis platelets containing >2 mL RBCs, ABO compatibility & crossmatch required

-any ABO group acceptable; compatible with recipient RBCs recommended; ABO-identical preferred

387
Q

List the conditions for reissue of RBCs.

A

-maintained at 1-10*C
-closure wasn’t broken
-at least 1 sealed segment remains attached to unit
-unit is inspected before release
-records indicate that blood has been inspected & is acceptable for reissue

388
Q

List the emergency transfusion thresholds.

A

-if time allows for typing, give ABO & Rh compatible; otherwise give O-neg RBCs
-label must indicate that crossmatch wasn’t completed
-physician must sign emergency release
-routine testing must be completed & physician notified immediately of any incompatibility

389
Q

Transfusion-associated infections - HIV - prevention

A

donor testing

390
Q

Transfusion-associated infections - HIV - estimated risk

A

1 in 1,467,000 transfusions

391
Q

Transfusion-associated infections - HIV - window period with NAT

A

9 days

392
Q

Transfusion-associated infections - Hepatitis B -prevention

A

donor testing

393
Q

Transfusion-associated infections - Hepatitis B - estimated risk

A

1 in 280,000 transfusions

394
Q

Transfusion-associated infections - Hepatitis C - prevention

A

donor testing

395
Q

Transfusion-associated infections - Hepatitis C - estimated risk

A

1 in 1,149,000 transfusions

396
Q

Transfusion-associated infections - Hepatitis C - window period with NAT

A

7.4 days

397
Q

Transfusion-associated infections - HTLV-II and -II - prevention

A

donor testing

398
Q

Transfusion-associated infections - HTLV-II and -II - estimated risk

A

rare in the US

399
Q

Transfusion-associated infections - Syphilis - prevention

A

donor testing

400
Q

Transfusion-associated infections - Syphilis - risk

A

-limited risk in refrigerated or frozen components - spirochetes cannot survive the cold
-HIGHEST risk from platelets

401
Q

Transfusion-associated infections - Malaria - prevention

A

donor testing

402
Q

Transfusion-associated infections - Malaria - transmission

A

Plasmodium is transmitted in RBCs

403
Q

Transfusion-associated infections - Babesiosis - prevention

A

donor testing

404
Q

Transfusion-associated infections - Babesiosis - transmission

A

B. microti is transmitted in RBCs

405
Q

Transfusion-associated infections - Chagas disease - prevention

A

donor testing

406
Q

Transfusion-associated infections - Chagas disease - transmission

A

Trypanosoma cruzi is transmitted in blood.

-potential risk in donors from Central & South America

407
Q

Transfusion-associated infections - CMV - prevention

A

-selected donor testing (not routine)
-use of CMV-neg or leukoreduced components for patients at risk

408
Q

Transfusion-associated infections - CMV - transmission

A

CMV transmitted in WBCs

409
Q

Transfusion-associated infections - CMV - risk

A

risk to CMV-neg immunocompromised patients & premature infants of CMV-neg mothers

410
Q

Transfusion-associated infections - Zika virus - prevention

A

donor testing

411
Q

Transfusion-associated infections - Zika virus - risk

A

-no confirmed transfusion-transmission cases of Zika in the US, but Brazil has reported platelet transfusion transmission

412
Q

Transfusion-associated infections - West Nile virus - prevention

A

donor testing

413
Q

Transfusion-associated infections - West Nile virus - NAT

A

used to screen all prospective donors in the US - most people are unaware they are infected

414
Q

Transfusion-associated infections - Sepsis - prevention

A

-donor screening (history, temp)
-aseptic technique
-use of diversion pouches (1st 30-45 mL of blood goes into pouch so that skin plug doesn’t enter unit)
-tests to detect bacterial contamination of platelets (e.g., culturing 24 hours after collection)

415
Q

Transfusion-associated infections - Sepsis - highest risk from what blood component?

A

platelets - due to RT storage

416
Q

Acute immunologic transfusion reactions - Hemolytic, intravascular - clinical signs

A

-fever
-chills
-shock
-renal failure
-DIC
-pain in chest, back or flank

417
Q

Acute immunologic transfusion reactions - Hemolytic, intravascular - cause

A

immediate destruction of donor RBCS by recipient antibody

418
Q

Acute immunologic transfusion reactions - Hemolytic, intravascular - laboratory findings

A

-post-transfusion specimen:
–HGB in urine & serum
–mixed field DAT (unless donor cells are all destroyed)
–decreased haptoglobin, HGB, & HCT

419
Q

Acute immunologic transfusion reactions - Hemolytic, intravascular - usually due to?

A

transfusion of ABO-incompatible blood

420
Q

Acute immunologic transfusion reactions - Febrile - clinical signs

A

temperature increased >=1C or 2C during or shortly after transfusion, with no other explanation

421
Q

Acute immunologic transfusion reactions - Febrile - cause

A

anti-leukocyte antibodies or cytokines

422
Q

Acute immunologic transfusion reactions - Febrile - laboratory findings

A

none

423
Q

Acute immunologic transfusion reactions - Febrile - most often in?

A

multiply transfused patients or women with multiple pregnancies

424
Q

Acute immunologic transfusion reactions - Febrile - what type of unit should be given if a patient has had a febrile reaction before?

A

leukoreduced components

425
Q

Acute immunologic transfusion reactions - Febrile - premedicate?

A

antipyretics (aspirin, acetominophen)

426
Q

Acute immunologic transfusion reactions - Allergic - clinical signs

A

-hives (urticaria)
-wheezing

427
Q

Acute immunologic transfusion reactions - Allergic - cause

A

foreign plasma proteins

428
Q

Acute immunologic transfusion reactions - Allergic - laboratory findings

A

none

429
Q

Acute immunologic transfusion reactions - Allergic - treatment?

A

antihistamines

430
Q

Acute immunologic transfusion reactions - Anaphylactic - clinical signs

A

-pulmonary edema
-bronchospasms

431
Q

Acute immunologic transfusion reactions - Anaphylactic - cause

A

anti-IgA in IgA-deficient recipient

432
Q

Acute immunologic transfusion reactions - Anaphylactic - laboratory findings

A

none

433
Q

Acute immunologic transfusion reactions - Anaphylactic - treatment

A

epinephrine

434
Q

Acute immunologic transfusion reactions - Anaphylactic - transfuse with?

A

washed cellular blood products

435
Q

Acute immunologic transfusion reactions - Transfusion-related acute lung injury (TRALI) - clinical signs

A

-fever
-chills
-coughing
-respiratory distress
-fluid in lungs
-decreased blood pressure within 6 hours of transfusion

LIFE THREATENING

436
Q

Acute immunologic transfusion reactions - Transfusion-related acute lung injury (TRALI) - cause

A

-unknown
-possibly donor antibodies to WBC antigens

437
Q

Acute immunologic transfusion reactions - Transfusion-related acute lung injury (TRALI) - laboratory findings

A

none

438
Q

Acute immunologic transfusion reactions - Transfusion-related acute lung injury (TRALI) - related to?

A

infusion of plasma

-all components have been implicated

439
Q

Acute immunologic transfusion reactions - Transfusion-related acute lung injury (TRALI) - reduction of what appears to be reducing TRALI fatalities?

A

reduced use of plasma from female donors

440
Q

Acute nonimmunologic transfusion reactions - Sepsis - clinical signs

A

-fever
-chills
-decreased BP
-cramps
-diarrhea
-vomiting
-muscle pain
-DIC
-shock
-renal failure

441
Q

Acute nonimmunologic transfusion reactions - Sepsis - cause

A

bacterial contamination

442
Q

Acute nonimmunologic transfusion reactions - Sepsis - laboratory findings

A

-positive gram stain & culture on unit
-positive blood culture on patient

443
Q

Acute nonimmunologic transfusion reactions - Transfusion-associated circulatory overload (TACO) - clinical signs

A

-coughing
-cyanosis
-difficulty breathing
-pulmonary edema

444
Q

Acute nonimmunologic transfusion reactions - Transfusion-associated circulatory overload (TACO) - cause

A

too large a volume or too rapid rate of infusion

445
Q

Acute nonimmunologic transfusion reactions - Transfusion-associated circulatory overload (TACO) - laboratory findings

A

none

446
Q

Acute nonimmunologic transfusion reactions - Transfusion-associated circulatory overload (TACO) - occurs most often in what patients?

A

-children
-cardiac & pulmonary patients
-elderly
-patients with chronic anemia

447
Q

Acute nonimmunologic transfusion reactions - Nonimmune hemolysis - clinical signs

A

variable

448
Q

Acute nonimmunologic transfusion reactions - Nonimmune hemolysis - cause

A

destruction of RBCs due to extremes of temperature, addition of meds to unit

449
Q

Acute nonimmunologic transfusion reactions - Nonimmune hemolysis - laboratory findings

A

-hemoglobinuria
-hemoglobinemia

450
Q

Acute nonimmunologic transfusion reactions - Hypothermia - clinical signs

A

cardiac arrhythmia

451
Q

Acute nonimmunologic transfusion reactions - Hypothermia - cause

A

rapid infusion of large amounts of cold blood

452
Q

Acute nonimmunologic transfusion reactions - Hypothermia - laboratory findings

A

none

453
Q

Acute nonimmunologic transfusion reactions - Hypothermia - prevention

A

use blood warmer for rapid infusions

454
Q

Delayed transfusion reactions - Immunologic - hemolytic, extravascular - clinical signs

A

-fever
-anemia
-mild jaundice
-2-14 days after transfusion

455
Q

Delayed transfusion reactions - Immunologic - hemolytic, extravascular - cause

A

donor RBCs sensitized by recipient IgG antibody & removed from circulation

456
Q

Delayed transfusion reactions - Immunologic - hemolytic, extravascular - laboratory findings

A

-increased bilirubin
-mixed-field DAT
-decreased haptoglobin
-decreased HGB & HCT
-positive antibody screen

457
Q

Delayed transfusion reactions - Immunologic - hemolytic, extravascular - may be due to?

A

anamnestic response

458
Q

Delayed transfusion reactions - Immunologic - hemolytic, extravascular - which antibodies are the most common cause?

A

Kidd

459
Q

Delayed transfusion reactions - Immunologic - hemolytic, extravascular - life threatening?

A

usually NO

460
Q

Delayed transfusion reactions - Immunologic - alloimmunization - clinical signs

A

none, unless subsequently exposed to same foreign antigens

461
Q

Delayed transfusion reactions - Immunologic - alloimmunization - cause

A

development of antibodies to foreign RBCs, WBCs, platelets, plasma proteins following transfusion

462
Q

Delayed transfusion reactions - Immunologic - alloimmunization - laboratory findings

A

-antibody to RBCs detected in antibody screen
-others require specialized testing

463
Q

Delayed transfusion reactions - Immunologic - alloimmunization - components that should be used for patients with WBC antibodies?

A

leukoreduced components

464
Q

Delayed transfusion reactions - Immunologic - Transfusion-associated graft-vs.-host disease (TA-GVHD) - clinical signs

A

-rash
-nausea
-vomiting
-diarrhea
-fever
-pancytopenia

USUALLY FATAL

465
Q

Delayed transfusion reactions - Immunologic - Transfusion-associated graft-vs.-host disease (TA-GVHD) - cause

A

viable T lymphocytes in donor blood attack recipient

466
Q

Delayed transfusion reactions - Immunologic - Transfusion-associated graft-vs.-host disease (TA-GVHD) - laboratory findings

A

none

467
Q

Delayed transfusion reactions - Immunologic - Transfusion-associated graft-vs.-host disease (TA-GVHD) - prevention

A

irradiate components for:
-premature infants
-intrauterine or exchange transfusion
-stem cell or bone marrow transplants
-recipients of blood from a 1st-degree relative
-immunocompromised
-patients with leukemia or lymphoma

468
Q

Delayed transfusion reactions - Nonimmunologic - iron overload - clinical signs

A

-diabetes
-cirrhosis
-cardiomyopathy

469
Q

Delayed transfusion reactions - Nonimmunologic - iron overload - cause

A

build-up of iron in body

470
Q

Delayed transfusion reactions - Nonimmunologic - iron overload - laboratory findings

A

increased serum ferritin

471
Q

Delayed transfusion reactions - Nonimmunologic - iron overload - problem for?

A

patients receiving repeated transfusions over long period of time, e.g., patients with thalassemia, sickle cell anemia, other chronic anemias

472
Q

Transfusion reaction investigation - signs & symptoms of possible transfusion reaction

A

-fever
-chills
-respiratory distress
-hyper- or hypotension
-back, flank, chest, or abdominal pain
-pain at site of infusion
-hives (urticaria)
-jaundice
-hemoglobinuria
-nausea/vomiting
-abnormal bleeding
-oliguria/anuria

473
Q

Transfusion reaction investigation - specimens needed

A

-pre-transfusion blood
-post-transfusion blood
-post-transfusion urine
-segment from unit
-blood bag with administration set & attached IV solutions

474
Q

Transfusion reaction investigation - immediate steps

A

-stop transfusion
-check all IDs & labels
-repeat ABO on post-transfusion sample
-visual check of pre- & post-transfusion samples for hemolysis
-DAT on post-transfusion sample; if positive, perform on pre-transfusion sample

475
Q

Transfusion reaction investigation - signs of hemolytic reaction

A

-hemolysis in post-transfusion sample, but NOT in pre-transfusion sample
-mixed field agglutination in DAT on post-transfusion sample, but NOT on pre-transfusion sample

476
Q

Transfusion reaction investigation - further steps if signs of possible hemolytic reaction

A

-check HGB in first voided urine after transfusion
-repeat ABO & Rh on pre- & post-transfusion samples & unit
-repeat antibody screen on pre- & post-transfusion samples
-AHG crossmatch with pre- & post-transfusion samples

477
Q

Transfusion reaction investigation - additional tests that may be performed

A

-haptoglobin (decreased with hemolysis)
-gram stain & culture of unit
-bilirubin 5-7 hours after transfusion (sign of extravascular hemolysis)
-BUN & creatinine (sign of renal involvement)

478
Q

Transfusion reaction investigation - reporting of transfusion-related fatalities

A

must be reported to FDA Center for Biologics Evaluation & Research (CBER) by phone or email ASAP, followed by submission of a written report within 7 days

479
Q

Testing of Neonates (< 4 months) - ABO & Rh - specimen

A

cord blood, capillary, or venous blood

480
Q

Testing of Neonates (< 4 months) - ABO & Rh - is ABO reverse grouping required?

A

no, ABO forward grouping only

481
Q

Testing of Neonates (< 4 months) - ABO & Rh - how many times per admission?

A

once

482
Q

Testing of Neonates (< 4 months) - antibody screen - specimen

A

serum or plasma of mother OR baby

483
Q

Testing of Neonates (< 4 months) - antibody screen - required how many times per admission?

A

once

484
Q

Testing of Neonates (< 4 months) - Crossmatch - specimen

A

serum or plasma from mother OR baby

485
Q

Testing of Neonates (< 4 months) - Crossmatch - positive antibody screen

A

perform AHG crossmatch on units negative for corresponding antigen

486
Q

Testing of Neonates (< 4 months) - Crossmatch - negative antibody screen

A

crossmatch not required

487
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - Mothers at risk:
-ABO:
-Rh:

A

ABO: usually group O

Rh: Rh negative

488
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - First child affected?
-ABO:
-Rh:

A

ABO: yes

Rh: not usually

489
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - frequency:
-ABO:
-Rh:

A

ABO: common

Rh: uncommon

490
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - Severity:
-ABO:
-Rh:

A

ABO: mild

Rh: can be severe

491
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - DAT:
-ABO:
-Rh:

A

ABO: weak pos or neg

Rh: strong pos

492
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - Spherocytes?
-ABO:
-Rh:

A

ABO: yes

Rh: rare

493
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - Predictable?
-ABO:
-Rh:

A

ABO: no

Rh: yes (maternal antibody screen)

494
Q

Hemolytic Disease of the Fetus and Newborn (HDFN) - Preventable?
-ABO:
-Rh:

A

ABO: no

Rh: yes (RhIG)

495
Q

Rh Immune Globulin (RhIG) Workup - prenatal evaluation

A

-ABO & Rh (weak D not required) - if Rh positive, woman isn’t candidate for RhIG
-Antibody screen (confirm patient has not received prenatal RhIG, which may be detected in antibody screen) - if positive, ID antibody; if anti-D present, woman isn’t candidate

496
Q

Rh Immune Globulin (RhIG) Workup - postpartum evaluation

A

ABO & Rh, including weak D, on baby:
–if baby is Rh neg = mother isn’t candidate
–if baby is Rh pos, draw mother’s blood after delivery & perform rosette test to screen for fetal blood
—Mother’s RBCs incubated with anti-D
—Anti-D coats fetal D-pos RBCs
—indicator D-pos RBCs added
—attach to anti-D on fetal D-pos RBCs, forming rosettes
–If rosette test pos, quantitate fetal bleed by flow cytometry or Kleihauer-Betke acid-elution test; fetal cells resist acid elution and stain pink; adult cells lose HGB and appear as “ghosts”

497
Q

Rh Immune Globulin (RhIG) - composition

A

anti-D derived from pools of human plasma

498
Q

Rh Immune Globulin (RhIG) - purpose

A

prevent immunization to D

499
Q

Rh Immune Globulin (RhIG) - administration

A

-Antepartum: to Rh neg woman at 28 weeks of gestation
-Postpartum: within 72 hours of delivery when Rh-neg woman delivers Rh-pos baby
-Other obstetric events: to Rh-neg woman after spontaneous or therapeutic abortion, ectopic pregnancy, amniocentesis, chorionic villus sampling, antepartum hemorrhage, or fetal death

Note: May also be administered to Rh-neg recipients of Rh-pos blood or components

500
Q

Rh Immune Globulin (RhIG) - Dose

A

1 dose per 15 mL of D-pos fetal RBCs (30 mL of fetal whole blood)

Calculating dose:
–if # to right of decimal point is >=0.5, round up to next whole # & add 1 vial, e.g., 1.6 vials calculated = 2 + 1 = 3
–if # to right of decimal point is <0.5, don’t round up; just use whole # & add 1 vial, e.g., 1.4 vials calculated = 1 + 1 = 2

501
Q

Equipment/Reagent Quality Control - blood storage refrigerators & freezers, platelet incubators

A

system for continuous temp monitoring & audible alarm

502
Q

Equipment/Reagent Quality Control - blood storage refrigerators & freezers, platelet incubators

A

system for continuous temp monitoring & audible alarm

503
Q

Equipment/Reagent Quality Control - temperature recorder

A

compare against thermometer daily; calibrate as necessary

504
Q

Equipment/Reagent Quality Control - alarms

A

check high & low temp of activation quarterly

505
Q

Equipment/Reagent Quality Control - water baths

A

check temp daily

506
Q

Equipment/Reagent Quality Control - heat blocks

A

check temp daily; periodically check each well

507
Q

Equipment/Reagent Quality Control - centrifuges

A

-determine optimum speed & time for different procedures upon receipt, after repairs, & periodically
-check timer every 3 months, RPM every 6 months (with tachometer)

508
Q

Equipment/Reagent Quality Control - cell washes

A

check tube fill level daily, AHG volume monthly; verify time & speed quarterly

509
Q

Equipment/Reagent Quality Control - pipettes

A

calibrate quarterly

510
Q

Equipment/Reagent Quality Control - antisera

A

test with pos & neg controls each day of use; use heterozygous cells for pos controls

511
Q

Equipment/Reagent Quality Control - reagent cells

A

-check for hemolysis
-test each day of use with pos & neg controls

512
Q

Equipment/Reagent Quality Control - reagent cells

A

-check for hemolysis
-test each day of use with pos & neg controls

513
Q

Equipment/Reagent Quality Control - AHG

A

check anti-IgG activity each day of use by testing Rh-pos cells sensitized with anti-D

514
Q

Which of the following enhancements allows antibodies and antigens to come closer together faster?

A. Albumin
B. LISS
C. Papain
D. PEG

A

B. LISS

515
Q

Which of the following is utilized in weak D testing?

A. 22C incubation
B. treatment with LISS
C. 37C incubation and IAT
D. 37*C incubation only

A

C. 37*C incubation and IAT

516
Q

Which of the following antibodies is/are often found as cold agglutinin(s)?

A. Anti-D and anti-C
B. Anti-K
C. Anti-M and anti-N
D. Anti-Fya and anti-Fyb

A

C. Anti-M and anti-N

517
Q

Which of the following tests is required on donated blood per AABB and/or FDA?

A. Syphilis testing
B. Hepatitis testing
C. HIV testing
D. All of the above

A

D. All of the above

518
Q

Select the preservative that will increase the shelf life of stored RBCs from 21 to 35 days.

A. Acid citrate dextrose
B. Citrate-phosphate-dextrose with adenine
C. Citrate-phosphate-dextrose-dextrose
D. Albumin

A

B. Citrate-phosphate-dextrose with adenine

519
Q

What ABO type is capable of donating to any other ABO type?

A. AB negative only
B. A negative and B negative
C. O negative only
D. O negative and AB negative

A

C. O negative only

520
Q

When a patient has a documented history of anaphylactic reactions, what should be done with the blood products before transfusion?

A. Wash the blood product
B. Irradiate the blood product
C. Only transfuse IgE-deficient blood
D. Wrm the blood product

A

A. Wash the blood product

521
Q

Which of the following are typical laboratory findings in a patient suffering from a delayed hemolytic (extravascular) transfusion reaction?

A. Elevated serum bilirubin
B. Decreased haptoglobin value
C. Decreased HGB & HCT value
D. All of the above

A

D. All of the above

522
Q

When performing an antibody ID, which of the following scenarios is expected if rouleaux is present?

A. Reaction with all cells in AHG, autocontrol positive
B. Reaction with all cells in AHG, autocontrol negative
C. Reaction with all cells at 37*C, neg in AHG, autocontrol positive
D. No reaction

A

C. Reaction with all cells at 37*C, neg in AHG, autocontrol positive

523
Q

In which situation/condition is a 12-month donor deferral required?

A. Pregnancy
B. Travel to area endemic for malaria
-C. Previous whole blood donation
D. Recipient of influenza vaccine

A

B. Travel to area endemic for malaria

AMT MT Exam (12 decks)

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