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Blood Bank - JD > Rh Blood Group System > Flashcards

Rh Blood Group System Flashcards

1
Q

What are the 5 antigens in the Rh blood group system?

A

D, C, c, E, e

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2
Q

What is the most common Rh phenotype?

A

dce

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3
Q

Which chromosome are the Rh genes located?

A

Chromosome 1

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4
Q

Which gene controls the expression of Rh antigens?

A

RHAg

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5
Q

Which Rh gene do individuals either possess or lack?

A

RhD

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6
Q

Which Rh gene expresses all alleles inherited - where all alleles are co-dominant?

A

RHCE

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7
Q

What type of antibody (immune or natural) are anti-D, C, c, E, e?

A

Immune. Exposure must occur in order for them to form.

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8
Q

What is an amorph?

A

Only a dominant form of the allele exists. An individual either has the gene or lacks the gene.

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9
Q

Which Rh gene is an amorph?

A

RhD

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10
Q

Which Rh antigen is the most important to test for, especially in child-bearing age women?

A

D

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11
Q

What percentage of D-negative individuals who receive a single unit of D-positive blood will develop anti-D?

A

80%

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12
Q

Which nomenclature suggested that Rh antigens were determined by 3 genes?

A

Fischer-Race

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13
Q

Explain how Fisher-Race nomenclature suggested the inheritance of Rh genes.

A

The 3 Rh genes (D, C and c, E and e) occupy loci in close proximity to one another, so close that they never separate and are passed on to each generation.

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14
Q

True or False: Crossing-over occurs in the Rh system.

A

False

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15
Q

Determine the phenotype and possible genotypes of an individual that had the following antisera results:

anti-D 4+ anti-C 4+ anti-c 0 anti-E 0 anti-e 4+

A

Phenotype: DCe

Possible Genotypes: DCe/DCe or DCe/dCe

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16
Q

Determine the phenotype and genotype of an individual that had the following antisera results:

anti-D 4+ anti-C 0 anti-c 4+ anti-E 0 anti-e 4+

A

Phenotype: Dce

Possible genotypes: Dce/Dce or Dce/dce

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17
Q

Determine the phenotype and genotype of an individual that had the following antisera results:

anti-D 4+ anti-C 4+ anti-c 4+ anti-E 0 anti-e 4+

A

Phenotype: DCce

Possible Genotypes: DCe/Dce or DCe/dce or Dce/dCe

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18
Q 
Translate the Fischer-Race nomenclature to the Wiener nomenclature for the following:
Dce
DCe
DcE
DCE
A

Dce - R0
DCe - R1
DcE - R2
DCE - Rz

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19
Q 
Translate the Fischer-Race nomenclature to the Wiener nomenclature for the following:
dce
dCe
dcE
dCE
A

dce - r
dCe - r’
dcE - r’’
dCE - ry

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20
Q

Which nomenclature postulated that two genes, one on each chromosome pair, controls the entire expression of the Rh system?

A

Wiener

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21
Q

Using both the Fisher-Race and Wiener nomenclature, which genotypes are the most common for D-positive and D-negative individuals?

A

D-positive: R2/r - DcE/dce

D-negative: r/r - dce/dce

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22
Q

Rosenfeld nomenclature is based only upon…

A

serologic (agglutination) reactions

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23
Q

Describe how the Rosenfeld system works.

A

The antigens are labeled: D=1, C=2, E=3, c=4, e=5

When tested, if agglutination occurs, the number is listed as is. If no reaction occurs, a negative number is indicated.

If not tested, simply omit the number.

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24
Q

Use the Rosenfeld nomenclature to describe the following results:

anti-D 4+ anti-C 0 anti-E 3+ anti-c 4+ anti-e 0

A

1, -2, 3, 4, -5

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25
Q

How does the International Society of Blood Transfusion label blood group systems?

A

Via a 6 digit code

First 3 numbers indicate the blood group system (004 = Rh)
Second 3 numbers indicate the specific antigen (004001 = D)

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26
Q

Reactions with antisera only determine

A

phenotype

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27
Q

What phenotype testing is used for parentage testing, predicting HDFN, locating compatible blood for recipients, and confirming Rh antibody specificity?

A

Rh phenotyping

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28
Q

If a patient tests D-negative with anti-D, what is the next step that should be taken?

A

Perform a weak D test (Du)

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29
Q

Describe the process for weak D (Du) testing.

A

Incubate cells with anti-D at 37 degrees C.
Wash cells 3X with saline.
Add AHG to bind anti-D bound to RBCs.
Agglutination = Weak D positive

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30
Q

List 3 mechanisms for Weak D

A

Genetic
Mosaic
Position Effect

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31
Q

Which mechanisms for weak D are quantitative?

A

Genetic

Position Effect

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32
Q

Which Weak D mechanism is qualitative and can be capable of producing anti-D?

A

Mosaic

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33
Q

If an individual inherits a D gene that codes for lowered densities of D antigen on RBC membranes, how will they type?

A

Weak D

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34
Q

What is the position effect?

A

The position of the C gene in correlation to the D gene

35
Q

What is the C-trans position effect?

A

The C gene is on a different haplotype from the D gene

Ex: DcE/dCE

36
Q

What is the C-cis position effect?

A

The C gene is located on the same haplotype as the D gene

Ex: DCE/dcE

37
Q

Which position effect results in a weak-D expression due to steric hindrance?

A

C-trans

38
Q

The absence of a portion(s) of the D antigen is termed as

A

Partial D (Mosaic D)

39
Q

Can an individual with Partial D develop anti-D?

A

Yes, to the portion of the antigen that they lack.

40
Q

Do normal D and Weak D have the same level of immunogenicity?

A

No. Weak D is substantially less immunogenic than Normal D.

41
Q

Is weak D capable of producing a transfusion reaction?

A

Yes, in patients with anti-D

42
Q

Failure to express Rh antigens on RBC surface is considered

A

Rh null

43
Q

What are the two mechanisms can cause Rh null?

A

Regulator-type or amorph-type

44
Q

A mutation in the RHAG gene results is what type of genetic mutation?

A

Regulator-type

45
Q

Mutations in each of the RHCE genes inherited from each parent along with the deletion of the RHD gene is considered what type of genetic mutation?

A

Amorph-type

46
Q

Partial suppression of Rh antigen expression is considered

A

Rh mod

47
Q

A mutation in the RhAG gene will cause

A

Rh mod

48
Q

In Rh null, which other antigens will test negative and which will be depressed?

A

negative: LW and FY5
depressed: S, s, U

49
Q

Which phenotype exhibits similar clinical symptoms as Rh null, but is less severe and is rarely clinically significant?

A

Rh mod

50
Q

Anti-LW will react more strongly in D-positive or negative individuals?

A

D-positive

51
Q

An unusual phenotype that occurs from a single amino acid change most often found on RhCe protein

A

Cw

52
Q

True or False: Cw can be expressed in the presence of C and c or in the absence of C and/or c.

A

True

53
Q

The F antigen will be expressed when?

A

When d and c are expressed on the same haplotype

54
Q

d and c are expressed on the same haplotype and the F antigen can be expressed. This occurrence can be termed…

A

compound antigen

55
Q

rh1 phenotype occurs when

A

C and e are expressed on the same RhCe protein

56
Q

anti-rh1 only reacts with which genotype?

A

DCe/dce

57
Q

If an RBC expresses D and/or C, it will also express which unusual antigen?

A

G antigen

58
Q

Anti-G can mimic

A

anti-C and anti-D

59
Q

What occurrence can result in excess expression of the D antigen due to a lack of Cc or Ee reactivity?

A

deletion

60
Q

D-deletion RBCs can only be transfused with

A

D-deletion RBCs

61
Q

Rh antibodies are typically which class of Ig?

A

IgG

62
Q

Order of Rh antigen immunogenicity

A

D > c > E > C > e

63
Q

Rh antibodies are unable to bind

A

complement (due to the location on the RBC)

64
Q

Most frequently encountered Rh antibody

A

Anti-E (followed by anti-c)

65
Q

Anti-C rarely occurs by itself, but may occur in the presence of

A

anti-D

66
Q

If anti-D is present, which other Rh antibody can be present?

A

anti-G (anti-D and anti-C)

67
Q

R1/R1 individuals who generate anti-E will frequently also make

A

anti-c

68
Q

Patients with anti-E should automatically be phenotyped for

A

c antigen

69
Q

Antibodies that tend to occur together are termed

A

concomitant

70
Q

What are the 4 types of anti-D reagent?

A

High protein, IgM anti-D, Chemically modified, monoclonal anti-D

71
Q

Autoagglutinins, abnormal serum proteins, antibodies to additives, and using unwashed RBCs can result in false positives with which anti-D reagent?

A

High protein

72
Q

IgG anti-D potentiated with high protein and other macromolecules

A

High protein anti-D

73
Q

Prepared from predominantly IgM antibodies and is only used when false positives occur with high protein anti-D

A

IgM anti-D (low protein/saline)

74
Q

Which anti-D reagent requires a diluent control?

A

high protein

The other reagents only require a control when AB positive

75
Q

Which anti-D reagents cannot be used in the weak-D test?

A

IgM anti-D

76
Q

IgG converted to saline agglutinin by weakening disulfide bonds at the hinge region, which produces stronger reactivity than IgM antibodies

A

Chemically modified anti-D

77
Q

Prepared from a blend of monoclonal IgM and polyclonal IgG and is used most frequently

A

Monoclonal anti-D

78
Q

IgM and IgG react when?

A

IgM - initial spin

IgG - AHG

79
Q

The control diluent used for protein reagents has protein concentration equaling

A

human serum

80
Q

What is a way you can tell if a false positive has occurred?

A

The forward type will appear AB positive and the control is positive

81
Q

How often is QC performed on anti-D?

A

daily

82
Q

Sources for false positives

A 
spontaneous agglutination
contaminated reagents
use of wrong serum/reagents
autoagglutinins or abnormal serum proteins coating the RBCs
Not following manufacturer instructions
83
Q

An IAT only needs to be performed only if

A

it is indicated in the manufacturer insert

Blood Bank - JD (16 decks)

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