RH BLOOD GROUP SYSTEM Flashcards
1
Q
Second most important blood group system in terms of transfusion ; 2nd most immunogenic
A
Rh D / Rh blood group
2
Q
Described a hemolytic transfusion in an obstetrical patient
A
Levine & Stetson
3
Q
A blood group PHENOTYPICALLY RELATED to Rh blood group ; Guinea pigs and rabbits + Rhesus macaque monkey’s blood —> (anti Rhesus) antibody agglutinated 85% human RBCs
A
Landsteiner and Wiener (LW)
4
Q
Rh system nomenclature ; most to least immunogenic
A
D > c > E > C > e
5
Q
ISBT : 004001
Rosenfield (numerical): Rh1
Fisher-Race : ____
A
D
6
Q
ISBT : 004002
Rosenfield (numerical): Rh2
Fisher-Race : ____
A
C
7
Q
ISBT : 004003
Rosenfield (numerical): Rh3
Fisher-Race : ____
A
E
8
Q
ISBT: 004004
Rosenfield (numerical): Rh4
Fisher-Race : ____
A
c
9
Q
ISBT: 004005
Rosenfield (numerical): Rh5
Fisher-Race : ____
A
e
10
Q
Wiener : Rh0
Fisher-Race : ____
A
D
11
Q
Wiener : rh’
Fisher-Race : ____
A
C
12
Q
Wiener : rh’’
Fisher-Race : ____
A
E
13
Q
Wiener : hr’
Fisher-Race : ____
A
c
14
Q
Wiener : hr”
Fisher-Race : ____
A
e
15
Q
Placing _____ around (D), (C), and (e) indicates weakened antigen expression
A
Parenthesis
16
Q
Agglutinates is described by a letter and symbol assigned based on the factors present
A
Modified Wiener Nomenclature
17
Q
MODIFIED WIENER NOMENCLATURE : Presence of the D antigen
A
R
18
Q
MODIFIED WIENER NOMENCLATURE : Absence of D antigen
A
r
19
Q
MODIFIED WIENER NOMENCLATURE : C antigen
A
1 / ‘
20
Q
MODIFIED WIENER NOMENCLATURE : c antigen
A
NO 1 / ‘
21
Q
MODIFIED WIENER NOMENCLATURE : E antigen
A
2 / “
22
Q
MODIFIED WIENER NOMENCLATURE : e antigen
A
NO 2 / “
23
Q
MODIFIED WIENER NOMENCLATURE : When both C and E are present
A
z / y
24
Q
Wiener to Fisher : R1
A
DCe
25
Wiener to Fisher : r’
_Ce or dCe
26
Wiener to Fisher : R0
Dce
27
system that assigned a NUMBER to each antigen of the Rh system in order of its discovery or recognized relationship to the Rh system ; demonstrates the presence or absence of the antigen on the RBC
Rosenfield nomenclature
28
Rosenfield nomenclature : A ______ preceding a number designates the absence of the antigen
Minus
29
Rosenfield nomenclature : if an antigen has not been phenotypes, its number will ______ in the sequence
Not appear
30
Fisher-Race : DCe/dCe
Rosenfield : _____
Rh : 1, 2, -3, 4, 5
31
Fisher-Race : Dce/dce
Rosenfield : _____
Rh: 1, -2, -3, 4, 5
32
Fisher-Race : Dce/dce
Rosenfield : _____
Rh: 1, -2, -3, 4, 5
33
Fisher-Race :dcE/dcE
Rosenfield : _____
Rh : -1, -2, 3, 4, -5
34
Fisher-Race : DCe/dCe
Rosenfield : _____
Rh : 1, 2, -3, -4, 5
35
Establish a UNIFORM NOMENCLATURE that is both eye- and machine-readable and is in keeping with the genetic basis of blood groups ; adopted a SIX DIGIT-NUMBER for each authenticated antigen belonging to a blood group system
International Society of Blood Transfusion Committee: Updated Numeric Terminology
36
Wiener : R1r
Fisher-Race : ___
Rosenfield : ____
DCe/dce
Rh : 1, 2, -3, 4, 5
37
Wiener : R0r
Fisher-Race : ___
Rosenfield : ____
Dce/ce
Rh : 1, -2, -3, 4, 5
38
Wiener : r”r”
Fisher-Race : ___
Rosenfield : ____
dcE/dcE
Rh : -1, -2, 3, 4, -5
39
Rh gene responsible for making antigen D
RHD gene
40
Rh gene responsible for making antigen Cc and Ee
RHCE
41
D antigen is present while Cc and Ee antigens are absent ; greatest concentration of D antigen
Exalted D
42
D antigen is present while Cc and Ee antigens are absent ; greatest concentration of D antigen
Exalted D
43
Gene important to RH ANTIGEN EXPRESSION ; termed a COEXPRESSOR and must be preset for successful expression of the Rh antigens
Rh-associated glycoprotein (RHAG)
44
RH BIOCHEMISTRY : important in determining C or c antigen
Amino acid position 103
45
RH BIOCHEMISTRY : Differentiates E from e
Amino acid position 226
46
Variations in the quantity of D antigen or the specificity of D antigen epitopes ; variations of D antigen expression
Weak D
47
The Rh antigen on the RBC is normal but the steric arrangement of the C antigen in relationship to the D antigen appears to interfere with the EXPRESSION OF D ANTIGEN
POSITION EFFECT
48
Inheritance of RHD genes that code for WEAKENED EXPRESSION of the D antigen ;antigens expressed appear to be COMPLETE but FEWER in number ; low concentration of D antigen
Quantitative
49
Extremely low number of D antigen sites that most reagent anti-D are unable to detect
Del
50
Most significant ; associated with anti-D formation ; Wiener and Unger postulated that the D antigen is made of antigenic subparts, genetically determined, that could be ABSENT in rare instances ; individual LACKS 1 or more pieces or epitopes of the total antigen, alloantibody can be made to the missing epitope(s) if exposed to RBCs that possessed the complete D antigen
Partial D-antigen
51
Weak D categories that can receive Rh positive blood
Position Effect and Quantitative weak D
52
Weak D category that cannot receive Rh positive blood as it can induce anti-D formation
Partial-D / D-mosaic
53
General rule for weak D
Donor must be Rh positive ; patient must be Rh negative
54
React best at 37C (IgG in nature) ; immune antibodies ; do not bind compliment ; show dosage
RH antibodies
55
Clinical consideration for Rh antibodies
HTR and HDFN
56
Fail to express any Rh antigens on the RBC surface ; completely negative
Rh null
57
Rh null genotype
little r double bar
58
Rh antibodies can be detected through
Antibody screening and identification
59
Rh antibodies demonstrate dosage except
D antigen
60
Severely reduced expression of all Rh antigens ; weakened
RHmod
61
Rh typing : Rh view box with a temp of 45C
SLIDE TEST
62
Rh typing : incubated a 37C
Tube test
63
Rare / unusual phenotypes
C^w
f(ce)
rhi (Ce)
G
Exalted D (D-)
64
Rare antigen phenotype that is present on most D-positive and all C-positive RBCs
G phenotype
65
The destruction of the red blood cells of a fetus and neonate by antibodies produced by the antibodies of the mother ; mother can be stimulated to form RBC antibodies naturally (ABO), by previous pregnancy, or transfusion (RBC alloimmunization)
HDFN - hemolytic disease of the fetus and newborn
66
3 important factors for HDFN to occur
1) the red cell antibody produced by the mother must of the _______
2) the fetus must possess an antigen that is _______
3) the antigen must be ______ at birth
IgG class ; lacking in the mother ; well-developed
67
ABO antigens develop after ____ to ___ years of age
2 to 4 years of age
68
ABO HDFN occur if the mother is blood type ____ and the baby is blood type _____
O ; A or B or AB
69
Occurs when maternal IgG attaches to specific antigens of the fetal RBCs
Hemolysis
70
Destruction of red cells
Anemia
71
Increased production of red cells
Erythropoiesis
72
Fetal hemolysis of the newborn ; swollen liver
Hydrops fetalis
73
Hemolysis releases hemoglobin which is then metabolized further into bilirubin (b1/indirect/unconjugated). If left untreated, this can cause _____ or permanent damage to parts of the brain
Kernicterus
74
Highly specialized prenatal test in which a sample of the baby’s blood is removed from the umbilical cod for testing
Cordocentesis (percutaneos umbilical cord testing)
75
Collecting amniotic fluid from the mother - determine the severity of HDFN - test for fetal lung maturity
Amniocentesis
76
Used to correct anemia which maintains hemoglobin >10g/dL ; Performed by accessing the fetal umbilical vein (cordocentesis) and injecting donor RBCs directly into the vein
Intrauterine transfusion
77
blood group commonly used to treat HDFN for intrauterine and neonatal transfusions
Group O RBCs
78
Neonatal transfusion requirements
Blood should less than 7 days old
CMV negative
ORh negative blood
79
In neonatal transfusion, the blood must be less than 7 days old in order to prevent _____ and maximize _____
Hyperkalemia ; 2,3-DPG
80
Used to remove toxic elements in the neonate’s blood ; use of whole blood or equivalent to replace the neonate’s circulating blood
Exchange transfusion
81
Used to remove bilirubin (light sensitive) from the neonate
Phototherapy
82
Prevents hemolysis ; Competes with the mother’s antibodies for the FC receptors on the macrophages in the infant’s spleen
Intravenous immunoglobulin
83
Prevents immunization to D antigen ; prevents HDFN by preventing formation of anti-D
Rhogam
84
Rhogam mechanism of action:
Rhogam attaches to the fetal Rh ____ RBC in the maternal circulation
Rh positive
85
Regular -dose vial : sufficient anti-D to protect against _____ mL of packed RBCs or ____ mL of whole blood (most commonly used)
15 mL ; 30 mL
86
Rhogam is given during ____ week of gestation or ____ hours after death
28th-week ; 72 hours
87
Rhogam : Always add ___ vial to correct mistakes in the computation
1 vial
88
A screening test for Rhogam ; used to determine if there is fetal bleed of fetal-maternal hemorrhage
Rosette testing
89
Rosette testing : Reagent that is added to maternal blood ; attaches to fetal blood
Reagent 1 : anti-D
90
Rosette testing : after the addition of reagent 1 or anti-D (reaction will not occur, since the maternal blood is more concentrated than the fetal blood), you now then add the reagent 2 or ____, concentrating the fetal blood
Rh (+) cells
91
If positive for rosette testing, this test is performed next
Quantitative test : Kleihauer-Betke acid elution
92
Kleihauer-Betke Acid Elution
Quantitative test
93
Kleihauer-Betke acid elution : Hemoglobin A of the mother is ______ to acid elution whereas the Hemoglobin F of the infant is _____ to acid elution
Not resistant ; resistant
94
Kleihauer-Betke acid elution
ghost cell : ____
Mother cell
95
Kleihauer-Betke acid elution
Intact cell : ____
Infant cell
96
% Fetal Red cell formula
# of FRC / 2000 cells x 100
97
% Fetal Red cell formula
# of FRC / 2000 cells x 100
98
FHM (fetal-maternal hemorrhage) formula
FMH = %FRC X 50
99
Rhogam is indicated in
Rh (-) without anti-D
Rh (-) with complicated pregnancy
Rh (-) with Rh (+) baby
