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IMMUNOHEMA MT > RH GROUP PPT 2 > Flashcards

RH GROUP PPT 2 Flashcards

1
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

_______: usually produced following exposure of the individual’s immune
system to foreign RBCs, through either transfusion or pregnancy

A

Rh Antibodies

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2
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

May show _______ Reacting preferentially with RBCs possessing double- dose
Rh antigen.

For example, anti-E may show 3+ positive reactivity with E+e- RBCs
versus 2+ positive reactivity with E+e+ RBCs

A

dosage

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3
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

IgG1, IgG2, IgG3, IgG4 subclasses of Rh Ab have been reported.

_____ AND ______ – greatest clinical significance because the reticuloendothelial system
rapidly clears RBCs coated with IgG1 and IgG3 from the circulation.

A

IgG1 and IgG3

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4
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

_____ Rh Ab are formed initially, followed by ___

A

IgM ; IgG.

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5
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

Individuals with low-titer Rh Ab may experience ________ (secondary) Ab response if exposed to same sensitizing Ag.

A

anamnestic

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6
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

_______ blood must be provided to any patient with history of Rh-antibody
sensitization.

A

Antigen-negative

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7
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

Rh Ab do not bind _______

A

complement

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8
Q

(DETECTION OF RH ANTIBODIES AND ANTIGEN)

For complement to be fixed (To activate complement cascade): two _________ must attach to an RBC antigen in close proximity to each other

A

IgG immunoglobulins

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9
Q

(Rh Antibodies in Pregnancy)

Rh antibodies are primarily _____ and can traverse the placenta and because Rh antigens are well
developed early in fetal life, Rh Ab formed by Rh-negative pregnant women cross placenta and coat fetal RBCs carry corresponding Ag.

A

IgG

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10
Q

(Rh Antibodies in Pregnancy)

_____ was the most frequent cause of HDFN

A

anti-D

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11
Q

(RH TYPING REAGENT)

____ may be high-protein-based or low-protein- based, saline based, chemically modified, monoclonal,
or blends of monoclonals.

A

Reagent

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12
Q

(RH TYPING REAGENT)

_________ – contain IgM immunoglobulin, first typing reagents available to test for D antigen.

________: low-protein-based, used to test cells already coatedwith IgG antibody

_________: limited availability, cost of production, lengthy incubation time. An IgM immunoglobulin, it
cannot be used for weak-D typing.

A

Saline reactive reagents ; Advantage ; Disadvantage

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13
Q

(RH TYPING REAGENT)

___________ - contain IgG anti-D.

_______ containing high-titer D- specific antibody was used as raw material.

Potentiators of _______ and macromolecular additives such as _______ OR ________ were
added to the source material to optimize reactivity in standard slide and rapid tube tests to allow for direct agglutination of red cells using an IgG anti-D.

A

High-protein anti-D reagents ; Human plasma ; bovine albumin ; dextran or polyvinylpyrrolidone

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14
Q

(RH TYPING REAGENT)

Major advantages of high-protein anti-D reagents

A
  1. Reduced incubation time
  2. Ability to perform weak-D testing and slide typing with the same reagent.
  3. Reagent is polyspecific.
  4. More than one clone of anti-D is produced by immunized human donors, thus recognize multiple epitopes on
    RhD protein.
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15
Q

(RH TYPING REAGENT)

Disadvantages of high-protein anti-D reagents

A

a false-positive reaction would be obtained because the RBCs would agglutinate on their own

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16
Q

(RH TYPING REAGENT)

______________ by breaking disulfide bonds that maintain antibody’s rigid shape.

This allows antibody to relax and span distance between RBCs in low- protein medium.

Chemically modified reagents can be used for both ____ and _____ testing and do not require a separate, manufactured Rh control as long as the samples type as A,B,or O.

Sample test AB Rh-positive or when Rh test is performed by itself, separate _____ control or _________ control must be used to ensure observed reactions are true agglutination, not a result of spontaneous agglutination.

A

Chemically modified the IgG anti-D molecule ; tube and slide ; saline or 6% to 8% albumin

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17
Q

(RH TYPING REAGENT)

____________: reagents are derived from single clones of antibody-producing cells.

A

Rh monoclonal antibodies

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18
Q

(Rh monoclonal antibodies)

  • Antibody-producing cells are hybridized with _______ to increase their reproduction rate, thereby maximizing their antibody- producing capabilities.
  • ___________ are usually combination of monoclonal anti-D reagents from several different
    clones to ensure reactivity with broad spectrum of Rh-positive RBCs.
A

myeloma cells ; Monoclonal anti-D reagents

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19
Q

(Rh monoclonal antibodies)

  • Some companies blend _____ and ______ to maximize visualization of reactions of immediate spin testing to allow indirect antiglobulin testing for weak D antigen with same reagent.
  • Monoclonal blends can be sued for _____, _____, ____ and _______ testing. Not human derived so it lacks potential transmitting infectious disease.
A

IgM and IgG anti-D ; slide, tube, microwell, and most automated Rh

20
Q

FALSE REACTIONS WITH RH TYPING REAGENTS : FALSE-POSITIVE

LIKELY CAUSE:
1. Cell suspension too
heavy
2. Cold agglutinins
3. Test incubated too long
or drying (slide)
4. Rouleaux
5. Fibrin interference

whats the corrective action??

A

CORRECTIVE ACTION:

  1. Adjust suspension, retype
  2. Wash with warm saline, retype
  3. Follow manufacturer’s
    instructions precisely
  4. Use saline-washed cells, retype
  5. Use saline-washed cells, retype
21
Q

FALSE REACTIONS WITH RH TYPING REAGENTS : FALSE-POSITIVE

LIKELY CAUSE:
6. Contaminating lowincidence antibody in
reagent
7. Polyagglutination
8. Bacterial contamination
of reagent vial
9. Incorrect reagent
selected
10. Centrifugation too long
11. rpm too high

whats the corrective action??

A

CORRECTIVE ACTION:

  1. Try another manufacturer’s
    reagent or use a known serum
    antibody
  2. See chapter on polyagglutination
  3. Open new vial of reagent, retype
  4. Repeat test; read vial label
    carefully
  5. Repeat test using shorter
    centrifugation time
  6. Repeat test using lower rpm
22
Q

FALSE REACTIONS WITH RH TYPING REAGENTS : FALSE-NEGATIVE

LIKELY CAUSE:
1. Immunoglobulin-coated
cells (in vivo)
2. Saline-suspended cells
(slide)
3. Failure to follow manufacturer’s directions precisely
4. Omission of reagent
manufacturer’s directions
5. Resuspension too vigorous

A

CORRECTIVE ACTION:

  1. Use saline-active typing reagent
  2. Use unwashed cells
  3. Review directions; repeat test
  4. Always add reagent first and
    check before adding cells
  5. Resuspend all tube tests gently
23
Q

FALSE REACTIONS WITH RH TYPING REAGENTS : FALSE-NEGATIVE

LIKELY CAUSE:
6. Incorrect reagent selected
7. Variant antigen
8. Reagent deterioration
9. Incorrect reagent selected
10. Centrifugation too short
11. rpm too low

A

CORRECTIVE ACTION:
6. Read vial label carefully; repeat
7. Refer sample for further
investigation
8. Open new vial
9. Repeat test, read vial label
carefully
10. Repeat test using longer
centrifugation time
11. Repeat testing using higher rpm

24
Q

(CLINICAL CONSIDERARTION: TRANSFUSION REACTION)

Detection of _____ needs careful medical history that reveals RBC exposure through pregnancy or transfusion of products
containing RBCs.

A

anti-D

25
Q

(CLINICAL CONSIDERARTION: TRANSFUSION REACTION)

Circulating antibody appears within ___ days of primary exposure and within __ to ___ days after a secondary exposure.

A

120 ; 2 to 7

26
Q

(CLINICAL CONSIDERARTION: TRANSFUSION REACTION)

Whether caused by primary ______ or secondary ______, usually result in ________ of
immunoglobulin coated RBCs.

A

sensitization ; immunization ; extravascular destruction

27
Q

(CLINICAL CONSIDERARTION: TRANSFUSION REACTION)

_______ may have unexplained fever, mild bilirubin elevation, and decrease hemoglobin and haptoglobin.

A

Transfusion recipient

28
Q

(CLINICAL CONSIDERARTION: TRANSFUSION REACTION)

DAI test: usually ______.

A

positive

29
Q

(CLINICAL CONSIDERARTION: TRANSFUSION REACTION)

________: may or may not demonstrate circulating antibody.

A

Antibody screen

30
Q

(CLINICAL CONSIDERARTION: Hemolytic Disease of the Fetus and Newborn)

_________ postulated that antibody causing transfusion reaction also crossed placenta and destroyed RBCs of
fetus, causing death.

Offending antibody was subsequently identified as _____

A

Levine and Stetson ; anti-D.

31
Q

(CLINICAL CONSIDERARTION: Hemolytic Disease of the Fetus and Newborn)

Often severe because Rh antigens are well developed on fetal cells and Rh antibodies are _______

A

primarily IgG.

32
Q

(CLINICAL CONSIDERARTION: Hemolytic Disease of the Fetus and Newborn)

__________ – purified preparation of IgG anti-D is given to D-negative woman during pregnancy and following
delivery of a D-positive fetus.

Effective only in preventing _____

A

Rh-immune globulin ; RhD HDFN.

33
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

__________ – fail to express any Rh antigens on RBC surface.

A

Rh deficiency or Rhnull syndrome

34
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

Syndrome is inherited in one of two ways: _______ and ______

A

amorphic and regulator

35
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

Individuals who lack ______ in their RBCs.

A

Rh antigens

36
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

Individuals demonstrate:

A

▪ Mild compensated hemolytic anemia
▪ Reticulocytosis
▪ Stomatocytosis
▪ Slight-to-moderate decrease in hemoglobin and hematocrit levels
▪ Increase in hemoglobin F
▪ Decrease in serum haptoglobin
▪ Elevated bilirubin level.

37
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

___________ – mutation occurs in the RHAG gene.

A

Regular-type Rhnull syndrome

38
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

No RhAG protein expression and subsequently no RhD or RhCE protein expression on the RBCs, even though individuals have a normal complement of RHD and RHCE genes.

Can pass normal _____ genes to their children.

A

RHCE

39
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

__________ – mutation in each of the RHCE genes inherited from each parent and common deletion of the RHD gene found in most D-negative individuals. RHAG gene is normal.

A

Amorphic-type Rhnull syndrome

40
Q

(RH DEFICIENCY SYNDROME: RHNULL AND RHMOD)

When transfusion of individuals with Rhnull syndrome is necessary, only _____ blood can be given.

A

Rhnull

41
Q

(RH DEFICIENCY SYNDROME: RHMOD)

______ – phenotype of severely reduced expression of all Rh antigens.

A

Rhmod

42
Q

(RH DEFICIENCY SYNDROME: RHMOD)

Partial suppression of RH gene expression caused by mutations in the _________

A

RHAG gene

43
Q

(RH DEFICIENCY SYNDROME: RHMOD)

________ is altered, normal Rh antigens are also altered, causing weakened expression of normal Rh and LW antigens.

A

RhAG protein

44
Q

(RH DEFICIENCY SYNDROME: RHMOD)

Exhibit other blood group antigens.

A

RHMOD

45
Q

(RH DEFICIENCY SYNDROME: RHMOD)

___, ___, and __ antigens found on glycophorin B may be depressed.

A

S, s, and U

46
Q

(RH DEFICIENCY SYNDROME: RHMOD)

Clinical symptoms are usually ______ and rarely _______

A

less severe ; clinically remarkable

IMMUNOHEMA MT (4 decks)

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