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Block 7 Week 3 Colt > Transfusion Medicine - Fung > Flashcards

Transfusion Medicine - Fung Flashcards

1
Q

In blood bank testing, what are the first things to come off in the immediate spin>?

A

IgM and random shit

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2
Q

What comes off in the IAT phase of blood bank testing?

A

RBCs coated with IgG +/- complement

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3
Q

T/F: Abs that react with IAT are more significant than those that come off in the immediate spin

A

true

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4
Q

Describe the DAT?

A

IgG coated RBCs are taken from the pt and washed. Anti-IgG is added and the cells agglutinate

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5
Q

Describe the IAT?

A

Pt serum is taken to test for presence of IgG that will bind to TEST RBCs; anti IgG is added and it all agglutinates

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6
Q

What types of molecules determine blood groups?

A

Proteins, glycoproteins, and glycolipids

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7
Q

T/F: IgM can cross the placenta

A

FALSE

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8
Q

What is the only type of Ig that can cross the placenta and cause hemolytic disease of the newborn (HDFN)

A

IgG

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9
Q

What type of Ab requires previous exposure and is warm reactive?

A

IgG

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10
Q

What type of Ab is cold reactive and is naturally ocurring?

A

IgM

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11
Q

Type (1/2) chains of the ABO blood group are glycoproteins and glycolipids free floating in the secretions and plasma

A

type 1

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12
Q

Type (1/2) chains of the ABO blood group are glycolipid and glycoprotein ANTIGENS bound to the red cell membrane

A

type 2

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13
Q

Which type of ABO chain shows B1-4 linkage?

A

type 2

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14
Q

Se gene modifies type (1/2) chains to produce H antigen

A

type 1

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15
Q

H gene modifies type (1/2) chains to produce H antigen

A

type 2

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16
Q

H antigen is further modified to make what two antigens?

A

A and B

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17
Q

What is the O antigen with respect to the H antigen?

A

Naked H with no further mod

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18
Q

T/F: ABO expression is codominant

A

true

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19
Q

What other tissue types carry the ABO system?

A

platelets, endothelium, kidney, heart, lung, bowel and pancreas

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20
Q

ABO ags are present on fetal RBCs by week (blank)

A

6

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21
Q

By what age do ABO blood groups reach adult levels?

A

year 4

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22
Q

What are the most common blood groups and their percent frequency?

A

O 45
A 40
B 11
Fung says 40 40 8

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23
Q

What is the Bombay (Oh) blood type?

A

lacks of H, A, and B Ags

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24
Q

What causes the Bombay blood type?

A

lack of H and Se genes (hh,sese)

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25
Q

Because the Bombay blood type doesn’t have H ag, they can’t make any (blank) for ABO, so they react to fucking everything

A

ABO antigens

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26
Q

T/F: Bombay blood types cannot be transfused because they will always have a transfusion reaction

A

true

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27
Q

How do you give blood to a Bombay blood type?

A

has to be an autologous donation

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28
Q

T/F: Antibodies to ABO are naturally ocurring and activate complement

A

true

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29
Q

T/F: ANTIBODIES to ABO will cause a delayed HTR (hemolytic transfusion rxn)

A

FALSE; IMMEDIATE

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30
Q

At what age to ABO ANTIBODIES appear and at what age do they reach adult levels?

A

appear at four months

adult levels at 10 years

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31
Q

T/F: ABO Abs may disappear with age

A

true

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32
Q

What type of Abs do A people make?

A

Anti-B IgM that is warm reacting

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33
Q

What type of Abs do B people make?

A

Anti A IgM that is warm reacting

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34
Q

what type of Abs do O people make?

A

Anti-A,B IgG that is warm reacting

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35
Q

Group O moms put their fetuses at risk of (blank) because the anti-A.B IgG can cross the placenta

A

HDFN

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36
Q

Describe forward blood typing?

A

Similar to DAT: test for the Ags attached directly to PT RBCs

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37
Q

Describe reverse blood typing?

A

Similar to IAT: test for the Abs in the serum that react to TEST RBCs

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38
Q

Explain why in blood typing a group A will be pos for Anti-A and B cells???

A

You’re testing the blood group, so if you add AB to look for bond Ag (forward), youre going to get a pos Ab to the actual blood group (So anti-A for A), and in reverse typing, you should have Abs against OTHER cells than the blood group (so pos for B cells if you have type A)

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39
Q

What are the two genes that code for the Rh blood group?

A

RhD and RHCE

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40
Q

T/F: Rhd: either you got the D or ya don’t

A

true; either the D Ag is present or nothing, there is no secondary form

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41
Q

Rh D, E, and C, (both lower and upper case), in descending order which three Ags make the most Ab?

A

D, c, E

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42
Q

What percent of D negative people make D Ab

A

80%

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43
Q

Rh Abs can result in (intra/extra)vascular hemolysis

A

extravascular hemolysis

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44
Q

What two Rh Abs cause severe HDFN?

A

anti D and anti-c

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45
Q

What two Rh Abs make mild HDFN?

A

antiC and anti-e

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46
Q

T/F: HDFN usually happens with the first pregnancy

A

false; UNLESS mom was previously transfused

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47
Q

What is normally the Rh type of mom and baby that leads to HDFN?

A

mom is D neg and baby is D pos

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48
Q

When do you give RhoGam?

A

at 28 weeks then again less than 72 hours before baby’s birth

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49
Q

Who do you give rhogam to?

A

D neg with positive baby or D negative with pregnancy complications or invasive procedures

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50
Q

What are the contraindications for Rhogam?

A

D neg female who already has anti-D abs
D pos females
D neg mom with D neg baby (duh)

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51
Q

What is the dosing of Rhogam?

A

on full vial (300ug) per 30 ml of D pos whole blood or one vial per 15ml of D pos RBCs

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52
Q

What are the three ways we determine the percentage of fetal-maternal hemorrhage?

A
  1. fetal blood screen: qualitative
  2. Kleihauer-Betke: quantitative but poorly reproducible
  3. Flow: quantitative and accurate
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53
Q

KB% x blood volume of mother =

A

baby blood in mom

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54
Q

When giving Rhogam, you always round up (blank) times for a decimal less than five and (blank) times for a decimal greater than five

A

round up once for decimal 5

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55
Q

What Lewis blood group is found in secretors?

A

Leb

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56
Q

What Lewis blood group is found in non-secretors?

A

Lea

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57
Q

T/F: Lewis blood groups are insignificant

A

true

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58
Q

Are lewis blood groups warm or cold reacting?

A

cold reacting

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59
Q

Which MNS system groups are cold reacting and insignificant?

A

antiM and antiN

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60
Q

Which MNS system groups are significant and warm reacting IgG?

A

AntiS, anti-s, anti-U, REQUIRES EXPOSURE

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61
Q

Which MNS system group is assocated with severe HDFN>

A

anti-M

62
Q

In the I system, (blank) chains are found in neonates and (blank) chains are found in adults

A

simple i chains in neonates and branched I chains in adults

63
Q

Are I system chains cold or warm reacting?

A

cold reacting IgM

64
Q

Auto-anti-I Abs are seen in (blank) infections and cold agglutinin disease

A

mycoplasma pneumonia

65
Q

Auto-anti-i Abs are seen in (blank) infections

A

infectious mono

66
Q

P ag is the receptor for what virus?

A

parvovirus b19

67
Q

Pk antigen is the (blank) for various bacteria and toxins

A

receptor

68
Q

Is the P system warm or cold reacting?

A

cold reacting IgM

69
Q

Auto-anti-P is seen in what diease and exhibits biphasic (blank) autoantibodies

A

seen in PNH (P for pee)

biphasic Igg

70
Q

T/F: the Kidd system is significant and requires exposure

A

true

71
Q

T/F: the kidd system is IgG but requires an IgM component

A

true

72
Q

What is the IgM component able to do in the Kidd system?

A

fix complement

73
Q

Severe acute (blank) is possible with Kidd mismatch

A

HTR

74
Q

Delayed anamnestic intravascular severe (blank) is also possible with kidd system

A

HTR

75
Q

Can kidd system mismatch cause HDFN?

A

yes, but mild

76
Q

What is the most common non-ABO Ab after anti-D?

A

Anti-K from Kell system

77
Q

Does the K or k Ag have high frequency?

A

little k

78
Q

Does Anti-K require previous exposure?

A

yes it does

79
Q

T/F: most Anti-K exposures are because of pregnancy and not transfusion

A

false; other way around

80
Q

Are anti-K antibodies common?

A

nope because of high frequency of the little k antigen expression, everyone has it!!

81
Q

Is antiK or anti-k capable of causing severe HDFN along with severe acute or delayed extravascular HTR?

A

anti-k,

82
Q

What is the McLeod syndrome?

A

All Kell Ags decreased; hemolytic anemias with acanthocytes, myopathy, ataxia, peripheral neuropathy, cardiomyopathy

83
Q

What is the mode of inheritance of McLeod syndrome?

A

X linked CGD

84
Q

Which duffy Ab is more significant?

A

Anti-Fya

85
Q

Does Duffy Ab production require previous exposure?

A

yes

86
Q

What type of Ig is Duffy?

A

IgG

87
Q

What are some complications of Duffy mismatch?

A

severe HTR, delayed and extravascular, mild HDFN

88
Q

What is the most common duffy phenotype in African Americans?

A

Fy(a-b-)

89
Q

What types of infections is Fy(a-b-) resistant to?

A

Plasmodium vivax and p. knowlesi

90
Q

What type of defferals are these?
High risk behavior for AIDS (IVDA, male-male sex, exposure)
Receiving money for sex
Serologic positivity for HIV, HBV, HCV, HTLV
Viral hepatitis after 11th birthday
Use of transfusion clotting concentrates
History of babesiosis or Chagas disease

A

permanent deferrals

91
Q 
What type of defferals are these: 
Growth hormone from human source
Insulin from bovine sources
Dura mater graft
Lymphoma or leukemia
Medication teratogens: Tegison
vCJD risk
A

permanent deferrals

92
Q

What type of deferrals are these:
Recovered from malaria
Immigrants from malaria endemic areas (5 years of living)
Medication teratogens: Soriatane

A

3 year deferrals

93
Q 
What type of deferrals are these: 
Needle stick or other contact with blood
Sex with person with HIV or hepatitis
Sex with IVDA
Rape victims
Incarcerated >72 hrs.
Paying for sex
Allogeneic blood transfusion
Allogeneic transplant
A

1 year deferrals

94
Q

What type of deferrals are these?

A 
Living with person with active hepatitis
Receiving HBIG
Tattoos/piercings
Travel to malaria endemic area
Syphilis or gonorrhea
Non-prophylactic  rabies vaccines
Travel to Iraq
95
Q

How long are deferred from giving blood after giving birth?

A

6 weeks

96
Q

How long are you kept from giving blood after nonroutine dental work?

A

72 hours

97
Q

How long are you deferred from giving blood after getting vaccines?

A

2-4 weeks

98
Q 
List the deferral times for the following meds:
Accutaine or finsteride
Duasteride
Aspirin
Plavix or Ticlid
A
  1. 30 days
  2. 30 days
  3. 48 hours
  4. two weeks
99
Q

Which diseases are screened for using a nuclear antigen test?

A

West nile
Hep B
Hep C
HIV

100
Q

How do you screen for serologic syphilis?

A

RPR/VDRL

FTA-ABS

101
Q

What parasitic infection is screened for in blood donation in the US?

A

Chagas disease (trypanosoma)`

102
Q

T/F: pts of autologous blood transfusion can give blood in the regular pool

A

noooooope

103
Q

A major type and crossmatch occurs between the recipient’s (serum/RBCs) and the donor (serum/RBCs)

A

recipient serum and donor RBCs

104
Q

What are the two components of whole blood?

A

Platelet rich plasma

Packed RBCs

105
Q

What are the two components of Platelet rich plasma

A

Platelet concentrates

Fresh Frozen Plasma

106
Q

What are the two components of fresh frozen plasma?

A

cryoprecipitate

Plasma derivatives

107
Q

How long do frozen RBCs last?

A

10 years, but only 24 hours after the thaw

108
Q

What changes in HCT and HGB will you see after transfusion?

A

increase HCT 3% and HGB 1%

109
Q

how soon after can you measure blood tests after a transfusion?

A

15 minutes!!

110
Q

In what solution do you transfuse RBCs?

A

NS, ABO compatible plasma and 5% albumin

111
Q

How much will platelets rise in 1 hour after transfusion?

A

20-30k

112
Q

T/F: platelets do not require crossmatch or ABO compatiblitiy

A

true

113
Q

T/F: filtering of transfusion blood happens prestorage and at the bedside to lower the numbers of WBCs in the blood

A

true

114
Q

When is washing of blood used?

A

in IgA deficiency, presents a hypersensitivity reaction

115
Q

What does irradiation of blood products do?

A

inactivates T cells

116
Q

When is it indicated to irradiate blood products?

A

Immunosuppression
Intrauterine transfusions, neonatal transfusions
Hematologic malignancies
Granulocyte transfusion
Receiving blood from first degree relative donor
Receiving HLA-matched units

117
Q

why do we irradiate HLA matched blood?

A

recipient may not recognize blood as foreign and produce appropriate counter response to the foreign RBC attack

118
Q

Does TRALI present with or without fever? Is is acute or delayed?

A

Acute with fever

119
Q

Does TACO present with or without fever? Is it acute or delayed?

A

Without fever, acute

120
Q

Does GvH present with or without fever? Is it acute or delayed?

A

without fever, delayed

121
Q

Does Delayed serologic post-transfusion purpura present with or without fever?

A

without

122
Q

Does an allergic rxn to blood products come with fever?

A

nope

123
Q

What time period is considered “acute” for a transfusion reaction

A

within 24 hours

124
Q

what is the etiology for an acute HTR?

A

type II IgG/IgM hypersensitivity response

125
Q

WHat causes intravascular HTR?

A

ABO incompatibility; ABO Abs fix complement and cause rapid lysis

126
Q

What causes extravascular HTR?

A

seen with Rh, Kell, Duffy Abs;

less severe, lack of systemic complemetn and cytokine activation

127
Q

What is the Tx for acute HTR?

A

hydration/diuresis, and exchange transfusion

128
Q

T/F: Positive DAT proves AHTR and negative disproves HTR

A

FALSE

129
Q

What is the most frequent transfusion rxn?

A

febrile non-hemolytic TR

130
Q

How much does the temp rise in FNHTR?

A

1C

131
Q

What is the Tx for FNHTR?

A

antipyretics and demerol

132
Q

Mild and moderate allergic TRs are caused by what mechanism?

A

Type I IgE mediated hypersensitivity to plasma proteins; mast cell degranulation

133
Q

What is the mechanism of anaphylactic TRs?

A

Iga deficient recipient with IgE and anti-IgA; haptglobin def.

134
Q

What is the only type of allergic reaction in which the transfusion may be restarted?

A

mild, can restart as soon as the rxn clears

135
Q

In what types of allergic reactions do you give epi?

A

moderate and severe

136
Q

T/F: benadryl may be preventative for mild allergic TRs

A

true

137
Q

What Abs normally show a delayed hemolytic TR?

A

Kidd, Duffy, and Kell

138
Q

What is the primary response that causes a delayed HTR?

A

Ab is quickly formed and attacks still circulating transfused RBCs

139
Q

Transfusion GvH is an attack on the (donor/host) RBCs

A

HOST

140
Q

When does the fever onset for transfusion GvH?

A

7-10 days after

141
Q

What is this severe reaction:
Fever 7-10 days post-transfusion
Face/trunk rash that spreads to extremities
Mucositis, nausea/vomiting, watery diarrhea
Hepatitis
Pancytopenia

A

TA-GVHD

142
Q

Which bacteria normally causes transfusion sepsis?

A

Staph, strep, Yersinia, bacillus, pseudomonas, E. coli

143
Q

What are the BP ranges to be considered a hypotensive rxn?

A

> 30mmHg drop systolic or diastolic <80mmHg

144
Q

Pts taking (blank) often get hypotensive rxns

A

ACE inhibitors or receiving blood with negatively charged filters

145
Q

What is the number one cause of transfusion death in teh US?

A

TRALI

146
Q

How soon after the transfusion does TRALI set in?

A

<6 hours

147
Q

What are the two methods of TRALI action?

A
  1. Neutrophils produce toxic free radicals that damage endothelial cells
  2. Donor anti-HLA or anti-neutrophil antibodies bind to recipient antigens and damage endothelial cells
148
Q

What is TACO?

A

Acute onset of congestive heart failure as a direct result of blood transfusion

149
Q

Post transfusion purpura has marked (blank) and an increased risk of bleeding 10 days following transfusion

A

thrombocytopenia

150
Q

What Abs against common platelet ags cause Post transfusion purpura?

A

AntiHPA 1A, PLA1

Block 7 Week 3 Colt (5 decks)

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