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SBB Review > Rh > Flashcards

Rh Flashcards

1
Q

Rh genes and location

A

RHD, RHCE

Chromosome 1

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2
Q

cause of most D- phenotype

A

complete deletion of RHD gene

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3
Q

Most prevalent Rh phenotypes in whites?

A

R1 (42%) > r (37%) > R2 (14%) > Ro (4%)

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4
Q

Most prevalent Rh phenotypes in Blacks?

A

Ro (44%) > r (26%) > R1 (17%) > R2 (11%)

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5
Q

Characteristics of Rh antibodies

A

IgG; rarely IgM
Do not activate complement
- Causes extravascular hemolysis
Enhanced by enzymes

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6
Q

Rh most to lease immunogenicity

A

D > c > E > C > e

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7
Q

What is anti-f?

A

f is present with c and e are in cis
present on Ro and r cells
Appears to be anti-c and -e, but only reacts to shared determinate

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8
Q

What is anti-G?

A

reacts with all cells carrying D or C or both
Transfuse D- C- blood
Differentiate in pregnant females for RHIG

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9
Q

What causes anemia in Rh null or Rh mod people

A

RHag is required for strong cytoskeleton of RBC
Integrity of membrane is compromised
Increased osmotic fragility - abn cation fluxes
Stomatocytes present

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10
Q

What chromosome is RHAG located on?

A

Chromosome 6

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11
Q

What chromosome is LW located on?

A

Chromosome 19

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12
Q

What is rr (double bar)

A

Amorph Rh null
No DCE or LW antigens
RHAG is normal
D deletion with homozygous inactive RHCE genes

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13
Q

% of Whites and Blacks that D+?

A

85% of whites

92% of blacks

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14
Q

% of Asians and Native Americans that are D+?

A

99%

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15
Q

Weak D

A 
Quantitative = Less D antigen present
Amino acid change occurs inside the membrane
May need AHG to detect
All D epitopes are present
Types 1-3 will not make anti-D
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16
Q

Partial D

A 
Qualitative
Missing some D epitopes
Many will react as IS
Most due to hybrid gene with RHCE gene
Amino acid change on external loops of D antigen
Can make allo-anti-D to missing epitopes
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17
Q

C in Trans to D

A

Occurs in Ror’

Steric arrangement if C and D interferes with D expression

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18
Q

What is Ceppellini effect?

A

D is weaker in Presence of C

R1 is weaker than R2 cells

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19
Q

What partial D’s will type D positive?

A

III, IV, VII

3 + 4 = 7

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20
Q

What is the function of LW antigen?

A

It’s an Intercellular adhesion molecule (ICAM)
maker for lymphocyte maturation and differentiation
May help stabilize the erythroblastic islands
Involved in removal of old RBC’s

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21
Q

How do you differentiate anti-D and anti-LW?

A

LW will react with all cord cells regardless of D type
LW is destroyed by DTT and pronase
Both are resistant to Ficin/papain

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22
Q

DVI

A

Most common partial D in individuals of European ethnicity
Current FDA reagents have IgM clones selected to be nonreactive with DVI in direct tests
Can make anti-D (fatal HDFN)

23
Q

Rh antibodies

HDFN

A

Anti-D and –c can cause severe HDFN

Anti-C, -E, and –e do not often cause HDFN (maybe mild)

24
Q

Fisher Race and population prevalence of:

R1

A

DCe

White: 42%
Black: 17%
Asian: 70%

25
Q

Fisher Race and population prevalence of:

r

A

ce

White 37%
Black: 26%
Asian: 3%

26
Q

Fisher Race and population prevalence of:

R2

A

DcE

White: 14
Black: 11
Asian: 21

27
Q

Fisher Race and population prevalence of:

R0

A

Dce

White: 4
Black: 44
Asian: 3

28
Q

Fisher Race and population prevalence of:

r’

A

Ce

White: 2%
Black: 2%
Asian: 2%

29
Q

Fisher Race and population prevalence of:

r’’

A

cE

White: 1%
Black: <0.01%
Asian: <0.01%

30
Q

Fisher Race and population prevalence of:

Rz

A

DCE

White: <0.01%
Black: <0.01%
Asian: 1%

31
Q

Fisher Race and population prevalence of:

ry

A

CE

White: <0.01%
Black: <0.01%
Asian: <0.01%

32
Q

most common weak Ds in African ancestry

A

DIIIa and DAR

Types as RhD pos at IS

33
Q

Del

A

Type as D neg (IS &IAT)

Adsorb and elute anti-D

34
Q

ceCF

A

Crawford phenotype
D Epitope on RHCE gene

Pos with gammaclone, neg with most other reagents

35
Q

ceHAR

A

D epitope on RHCE gene

Reactive with most anti-D reagent but not ortho bioclone

36
Q

Immune response to RhD

A

1st exposure: slow response (up to 4 weeks)
Primarily IgM

Response on restimulation: strong IgG usually within 24 hrs
Peaks usually w/in 6 days

37
Q

Most Cw and Cx+ are also…

A

C+

38
Q

Antithetical antigen to Cw/Cx

A

Mar (high frequency)

39
Q

Anti-MAR nonreactive with what phenotypes

A

Rh null
D- -

CwCw
CxCx
CwCx

40
Q

Describe differential adsorbtion for anti-G determination

A

First adsorption r’
Elution:
Anti-C if it’s really a D and C
Anti-G, -C if a G and C

Second adsorption R0
Elution
Negative for D and C
anti-G for G and C

41
Q

Partial e

A

Most often found in African Americans

Anti-hrs (-f like)
Anti-hrb (-Ce like)

42
Q

Rh null amorph

Rh protein, RhAg, and genes

A

Rh protein: absent
RhAG: reduced
Altered gene: RHD deleted (RHCE present)

43
Q

Rh null regulator

Rh protein, RhAg, and genes

A

Rh protein: absent
RhAg: absent
Altered genes: RHAG mutation or deletion

44
Q

Rh mod

Rh protein, RhAg, and genes

A

Rh protein: reduced
RhAg: reduced
Altered genes: RHAG mutation

45
Q

LW(a-b-) associated with

A

Rh null

46
Q

LW Antigens

A

Weaker on D- RBCs

Strong presence on all cord cells (D+ and D -)

47
Q

Anti-LW

A

Shows relative D specificity

Non reactive with AET/DTT treated cells

48
Q

D- -

A

Missing RHCE gene

49
Q

Del

A

Express extremely low amount of D antigen that can only be detected by adsorption elution studies

(Negative IAT)

Found in 10-30% of D- people of Asian ethnicity

50
Q

DHAR and Crawford antigens

A

D epitopes on Rhce

Show strong agglutination with some monoclonal D reagents but negative with others

Can still be sensitized to D

51
Q

Elevated D seen in D- -, Dc-, and DCw- caused by

A

Replacement of parts of RHCE with RHD sequences

52
Q

Weak D types that can be treated as Rh pos

A

1, 2, 3

53
Q

Weak D types that can make anti-D

A

11 and 15

54
Q

Antigens in the RHAG Blood group system (4)

A

Duclos (RHAG1)
Ol^a (RHAG2)
DLSK (RHAG3 and RHAG4)

SBB Review (24 decks)

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