transfusion

Question 1

ABO blood group
antigens - what class of molecules?

Answer 1

carbs. 
antibodies naturally occuring
predominantly IgM. 
clinically significant - bind complement (membrane attack complex formes) 
cause intravascular hemolysis

Question 2

intravascular hemolysis

Answer 2

agglutination & complement fixation = membrane attack to destroy rbc.

Question 3

rh blood group

Answer 3

Antigen = protein
d-type most immunogenic.
Ab = not naturally occuring. primary and secondary response needed.
IgG
clinically significant. extravascular hemolysis

Question 4

extravascular hemolysis

Answer 4

destroy rbc by macrophage englufing.

Question 5

other clinically significant blood groups

Answer 5

kell
kidd
MNS
duffy
- IgG, react at body temp, cause extravascular hemolyssis

Question 6

clinically insignificant blood groups

Answer 6

lewis
P
MNS
react at low temp, IgM. no hemolysis

Question 7

type and screen

Answer 7

ABO RH screen - type the blood. then check antibodies for RH, Kell, Kidd, MNS, Duffy
* screen only valid for 3 days because Ab may have formed.

Question 8

acute hemolytic transfusion reaction
- what blood groups?
effects?
cause?
symptoms?

Answer 8

immediate
anti-A/B Ab present in pateint plasma bind donor cells - fix complement = IVH
cause: mis-ID when collecting, infusing.
symptoms = fever, chills, hemoglobinuriea, decrease bp, renal failure.

Question 9

indicators of IVH

Answer 9

• increase plasma Hb
• decrease haptoglobin (binds free Hb)
  increase lactate dehydrogenase (comes from inside of lysed rbc)
  hemoglobinuriea

Question 10

delayed hemolytic transfusion reaction
-what blood groups
symptoms

Answer 10

delayed.
Ab formed removed in spleen (EVH)
rh, kell, kidd, duffy
symptoms: fever, chill, jaundice (due to bilirubin increase from rbc breakdown)

Question 11

indicators of EVH

Answer 11

increase bilirubin
decrease Hb
increase lactate dehydrogenase
positivity antibody screen
positive direct antiglobulin test = detect antibody coating rbc

Question 12

immune response in IgG vs IgM

Answer 12

IgG = larger secondary response than IgG primary and IgM secondary.

Question 13

hemolytic disease of fetus and newborn

Answer 13

maternal rbc cross placenta and attach to fetal cells causing hemolysis.
- anemia & erythropoiesis
mild to severe.
first pregnancy unaffected. Rh (-) mom delivering Rh (+) baby.

Question 14

HDFN - in utero
severe case
treatment

Answer 14

severe case - profound anemia, hepatosplenomegaly (increase size of liver & spleen because removing coated red cells
hypoproteinemia - less proein because liver focusing on making new rbc’s
cardiovascular failure - enlarged heart
hydrops fetalis - severe edema

treat: intrauterine transfusion (IUT) - transfuse blood that has antigens negative to moms blood into umbilical cord.

Question 15

HDFN - post partum

Answer 15

severe cases: anemia, hyperbilirubinemia, hemolysis
treatment: exchange transfucion (swap 5 mL with “good blood” slowly exchange all the blood.
prevention - screen pregnant women for RBC antibodies. Rh (-) greatest risk. Rh Ig (anti-d) if mother delivers positive baby. high dose will quickly bind to any D+ cells from baby, remove before immune system can react.

Question 16

RhIg

Answer 16

human source anti-D. given to mother intravenously to attach to fetal cells in her blood. cleared before immune system recognizes and reacts - no memory cells made.