Transfusion Medicine - Fung Flashcards
In blood bank testing, what are the first things to come off in the immediate spin>?
IgM and random shit
What comes off in the IAT phase of blood bank testing?
RBCs coated with IgG +/- complement
T/F: Abs that react with IAT are more significant than those that come off in the immediate spin
true
Describe the DAT?
IgG coated RBCs are taken from the pt and washed. Anti-IgG is added and the cells agglutinate
Describe the IAT?
Pt serum is taken to test for presence of IgG that will bind to TEST RBCs; anti IgG is added and it all agglutinates
What types of molecules determine blood groups?
Proteins, glycoproteins, and glycolipids
T/F: IgM can cross the placenta
FALSE
What is the only type of Ig that can cross the placenta and cause hemolytic disease of the newborn (HDFN)
IgG
What type of Ab requires previous exposure and is warm reactive?
IgG
What type of Ab is cold reactive and is naturally ocurring?
IgM
Type (1/2) chains of the ABO blood group are glycoproteins and glycolipids free floating in the secretions and plasma
type 1
Type (1/2) chains of the ABO blood group are glycolipid and glycoprotein ANTIGENS bound to the red cell membrane
type 2
Which type of ABO chain shows B1-4 linkage?
type 2
Se gene modifies type (1/2) chains to produce H antigen
type 1
H gene modifies type (1/2) chains to produce H antigen
type 2
H antigen is further modified to make what two antigens?
A and B
What is the O antigen with respect to the H antigen?
Naked H with no further mod
T/F: ABO expression is codominant
true
What other tissue types carry the ABO system?
platelets, endothelium, kidney, heart, lung, bowel and pancreas
ABO ags are present on fetal RBCs by week (blank)
6
By what age do ABO blood groups reach adult levels?
year 4
What are the most common blood groups and their percent frequency?
O 45
A 40
B 11
Fung says 40 40 8
What is the Bombay (Oh) blood type?
lacks of H, A, and B Ags
What causes the Bombay blood type?
lack of H and Se genes (hh,sese)
Because the Bombay blood type doesn’t have H ag, they can’t make any (blank) for ABO, so they react to fucking everything
ABO antigens
T/F: Bombay blood types cannot be transfused because they will always have a transfusion reaction
true
How do you give blood to a Bombay blood type?
has to be an autologous donation
T/F: Antibodies to ABO are naturally ocurring and activate complement
true
T/F: ANTIBODIES to ABO will cause a delayed HTR (hemolytic transfusion rxn)
FALSE; IMMEDIATE
At what age to ABO ANTIBODIES appear and at what age do they reach adult levels?
appear at four months
adult levels at 10 years
T/F: ABO Abs may disappear with age
true
What type of Abs do A people make?
Anti-B IgM that is warm reacting
What type of Abs do B people make?
Anti A IgM that is warm reacting
what type of Abs do O people make?
Anti-A,B IgG that is warm reacting
Group O moms put their fetuses at risk of (blank) because the anti-A.B IgG can cross the placenta
HDFN
Describe forward blood typing?
Similar to DAT: test for the Ags attached directly to PT RBCs
Describe reverse blood typing?
Similar to IAT: test for the Abs in the serum that react to TEST RBCs
Explain why in blood typing a group A will be pos for Anti-A and B cells???
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)
What are the two genes that code for the Rh blood group?
RhD and RHCE
T/F: Rhd: either you got the D or ya don’t
true; either the D Ag is present or nothing, there is no secondary form
Rh D, E, and C, (both lower and upper case), in descending order which three Ags make the most Ab?
D, c, E
What percent of D negative people make D Ab
80%
Rh Abs can result in (intra/extra)vascular hemolysis
extravascular hemolysis
What two Rh Abs cause severe HDFN?
anti D and anti-c
What two Rh Abs make mild HDFN?
antiC and anti-e
T/F: HDFN usually happens with the first pregnancy
false; UNLESS mom was previously transfused
What is normally the Rh type of mom and baby that leads to HDFN?
mom is D neg and baby is D pos
When do you give RhoGam?
at 28 weeks then again less than 72 hours before baby’s birth
Who do you give rhogam to?
D neg with positive baby or D negative with pregnancy complications or invasive procedures
What are the contraindications for Rhogam?
D neg female who already has anti-D abs
D pos females
D neg mom with D neg baby (duh)
What is the dosing of Rhogam?
on full vial (300ug) per 30 ml of D pos whole blood or one vial per 15ml of D pos RBCs
What are the three ways we determine the percentage of fetal-maternal hemorrhage?
- fetal blood screen: qualitative
- Kleihauer-Betke: quantitative but poorly reproducible
- Flow: quantitative and accurate
KB% x blood volume of mother =
baby blood in mom
When giving Rhogam, you always round up (blank) times for a decimal less than five and (blank) times for a decimal greater than five
round up once for decimal 5
What Lewis blood group is found in secretors?
Leb
What Lewis blood group is found in non-secretors?
Lea
T/F: Lewis blood groups are insignificant
true
Are lewis blood groups warm or cold reacting?
cold reacting
Which MNS system groups are cold reacting and insignificant?
antiM and antiN
Which MNS system groups are significant and warm reacting IgG?
AntiS, anti-s, anti-U, REQUIRES EXPOSURE
Which MNS system group is assocated with severe HDFN>
anti-M
In the I system, (blank) chains are found in neonates and (blank) chains are found in adults
simple i chains in neonates and branched I chains in adults
Are I system chains cold or warm reacting?
cold reacting IgM
Auto-anti-I Abs are seen in (blank) infections and cold agglutinin disease
mycoplasma pneumonia
Auto-anti-i Abs are seen in (blank) infections
infectious mono
P ag is the receptor for what virus?
parvovirus b19
Pk antigen is the (blank) for various bacteria and toxins
receptor
Is the P system warm or cold reacting?
cold reacting IgM
Auto-anti-P is seen in what diease and exhibits biphasic (blank) autoantibodies
seen in PNH (P for pee)
biphasic Igg
T/F: the Kidd system is significant and requires exposure
true
T/F: the kidd system is IgG but requires an IgM component
true
What is the IgM component able to do in the Kidd system?
fix complement
Severe acute (blank) is possible with Kidd mismatch
HTR
Delayed anamnestic intravascular severe (blank) is also possible with kidd system
HTR
Can kidd system mismatch cause HDFN?
yes, but mild
What is the most common non-ABO Ab after anti-D?
Anti-K from Kell system
Does the K or k Ag have high frequency?
little k
Does Anti-K require previous exposure?
yes it does
T/F: most Anti-K exposures are because of pregnancy and not transfusion
false; other way around
Are anti-K antibodies common?
nope because of high frequency of the little k antigen expression, everyone has it!!
Is antiK or anti-k capable of causing severe HDFN along with severe acute or delayed extravascular HTR?
anti-k,
What is the McLeod syndrome?
All Kell Ags decreased; hemolytic anemias with acanthocytes, myopathy, ataxia, peripheral neuropathy, cardiomyopathy
What is the mode of inheritance of McLeod syndrome?
X linked CGD
Which duffy Ab is more significant?
Anti-Fya
Does Duffy Ab production require previous exposure?
yes
What type of Ig is Duffy?
IgG
What are some complications of Duffy mismatch?
severe HTR, delayed and extravascular, mild HDFN
What is the most common duffy phenotype in African Americans?
Fy(a-b-)
What types of infections is Fy(a-b-) resistant to?
Plasmodium vivax and p. knowlesi
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
permanent deferrals
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
permanent deferrals
What type of deferrals are these:
Recovered from malaria
Immigrants from malaria endemic areas (5 years of living)
Medication teratogens: Soriatane
3 year deferrals
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
1 year deferrals
What type of deferrals are these?
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
How long are deferred from giving blood after giving birth?
6 weeks
How long are you kept from giving blood after nonroutine dental work?
72 hours
How long are you deferred from giving blood after getting vaccines?
2-4 weeks
List the deferral times for the following meds: Accutaine or finsteride Duasteride Aspirin Plavix or Ticlid
- 30 days
- 30 days
- 48 hours
- two weeks
Which diseases are screened for using a nuclear antigen test?
West nile
Hep B
Hep C
HIV
How do you screen for serologic syphilis?
RPR/VDRL
FTA-ABS
What parasitic infection is screened for in blood donation in the US?
Chagas disease (trypanosoma)`
T/F: pts of autologous blood transfusion can give blood in the regular pool
noooooope
A major type and crossmatch occurs between the recipient’s (serum/RBCs) and the donor (serum/RBCs)
recipient serum and donor RBCs
What are the two components of whole blood?
Platelet rich plasma
Packed RBCs
What are the two components of Platelet rich plasma
Platelet concentrates
Fresh Frozen Plasma
What are the two components of fresh frozen plasma?
cryoprecipitate
Plasma derivatives
How long do frozen RBCs last?
10 years, but only 24 hours after the thaw
What changes in HCT and HGB will you see after transfusion?
increase HCT 3% and HGB 1%
how soon after can you measure blood tests after a transfusion?
15 minutes!!
In what solution do you transfuse RBCs?
NS, ABO compatible plasma and 5% albumin
How much will platelets rise in 1 hour after transfusion?
20-30k
T/F: platelets do not require crossmatch or ABO compatiblitiy
true
T/F: filtering of transfusion blood happens prestorage and at the bedside to lower the numbers of WBCs in the blood
true
When is washing of blood used?
in IgA deficiency, presents a hypersensitivity reaction
What does irradiation of blood products do?
inactivates T cells
When is it indicated to irradiate blood products?
Immunosuppression
Intrauterine transfusions, neonatal transfusions
Hematologic malignancies
Granulocyte transfusion
Receiving blood from first degree relative donor
Receiving HLA-matched units
why do we irradiate HLA matched blood?
recipient may not recognize blood as foreign and produce appropriate counter response to the foreign RBC attack
Does TRALI present with or without fever? Is is acute or delayed?
Acute with fever
Does TACO present with or without fever? Is it acute or delayed?
Without fever, acute
Does GvH present with or without fever? Is it acute or delayed?
without fever, delayed
Does Delayed serologic post-transfusion purpura present with or without fever?
without
Does an allergic rxn to blood products come with fever?
nope
What time period is considered “acute” for a transfusion reaction
within 24 hours
what is the etiology for an acute HTR?
type II IgG/IgM hypersensitivity response
WHat causes intravascular HTR?
ABO incompatibility; ABO Abs fix complement and cause rapid lysis
What causes extravascular HTR?
seen with Rh, Kell, Duffy Abs;
less severe, lack of systemic complemetn and cytokine activation
What is the Tx for acute HTR?
hydration/diuresis, and exchange transfusion
T/F: Positive DAT proves AHTR and negative disproves HTR
FALSE
What is the most frequent transfusion rxn?
febrile non-hemolytic TR
How much does the temp rise in FNHTR?
1C
What is the Tx for FNHTR?
antipyretics and demerol
Mild and moderate allergic TRs are caused by what mechanism?
Type I IgE mediated hypersensitivity to plasma proteins; mast cell degranulation
What is the mechanism of anaphylactic TRs?
Iga deficient recipient with IgE and anti-IgA; haptglobin def.
What is the only type of allergic reaction in which the transfusion may be restarted?
mild, can restart as soon as the rxn clears
In what types of allergic reactions do you give epi?
moderate and severe
T/F: benadryl may be preventative for mild allergic TRs
true
What Abs normally show a delayed hemolytic TR?
Kidd, Duffy, and Kell
What is the primary response that causes a delayed HTR?
Ab is quickly formed and attacks still circulating transfused RBCs
Transfusion GvH is an attack on the (donor/host) RBCs
HOST
When does the fever onset for transfusion GvH?
7-10 days after
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
TA-GVHD
Which bacteria normally causes transfusion sepsis?
Staph, strep, Yersinia, bacillus, pseudomonas, E. coli
What are the BP ranges to be considered a hypotensive rxn?
> 30mmHg drop systolic or diastolic <80mmHg
Pts taking (blank) often get hypotensive rxns
ACE inhibitors or receiving blood with negatively charged filters
What is the number one cause of transfusion death in teh US?
TRALI
How soon after the transfusion does TRALI set in?
<6 hours
What are the two methods of TRALI action?
- Neutrophils produce toxic free radicals that damage endothelial cells
- Donor anti-HLA or anti-neutrophil antibodies bind to recipient antigens and damage endothelial cells
What is TACO?
Acute onset of congestive heart failure as a direct result of blood transfusion
Post transfusion purpura has marked (blank) and an increased risk of bleeding 10 days following transfusion
thrombocytopenia
What Abs against common platelet ags cause Post transfusion purpura?
AntiHPA 1A, PLA1
