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Blood Bank > Unit 5 > Flashcards

Unit 5 Flashcards

1
Q

What is HLA

A

human leukocyte antigen
polymorphic glycoproteins on surface of cells

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2
Q

What chromosome contains the human MHC

A

p arm / short arm of chromosome 6

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3
Q

Match Class I, class II and class III with their ___

DP, DR,DQ glycoproteins
A, B, C glycoproteins
complement and TNF

A

D- class II
ABC- class I
complement- class III
regions on chromosome 6 that contain genes for MHC (LOCI)

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4
Q

What are the 4 fields in HLA nomenclature

A

1- protein/ allele group
2- specific allele variants
3- synonymous DNA substitutions/ silent mutations and exons
4- non-coding regions- introns and UTRs

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5
Q

Are there more HLA class I genes or class II

A

class I- more than 20,000
class II- less than 7000

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6
Q

What type of inheritance do HLA genes tend to have

A

codominant
one haplotype from mom
one haplotype from dad

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7
Q

What is linkage disequilibrium and does it occur in HLA inheritance

A

when haplotypes occur at unexpected frequencies, yes it does
deviates from the hardy winburg principle

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8
Q

Name what class the following genes are from?
A1
B8
DR17

A

A1 and B8 class I
DR17 class II

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9
Q

What are the parts of the HLA class I protein

A

3 alpha chains and 1 B2 macroglobulin
2 alpha and 2 beta chains

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10
Q

What kind of cells have an HLA class I? and HLA class II?

A

all nucleated cells
antigen presenting cells

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11
Q

What is the source of antigens being screened by HLA class I?
And class II?

A

endogenous
exogenous

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12
Q

What part of the Ig chain does HLA class I code for?
and class II?

A

both for heavy chains of class I or II glycoproteins

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13
Q

When does a patient need HLA typing and abs

A

if they are getting a solid organ transplant, BM transplant, graft transplants

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14
Q

What is an allogenic BM? and an auto

A

when a pt receives BM from someone else
auto- when a pt receives their own
BM back

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15
Q

What elements must match for a BM transplant to be compatible

A

pt HLA abs must match donor lymphsq

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16
Q

How is HLA tested for transfusions with the CDC method

A

complement deficiency cytotoxicity assays are done to test pt serum against donor lymphs and reagent complement to see if compliment activates. AHG is also added as enhancement

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17
Q

How is flow cytometry used to test HLA

A

donor lymphs isolated by T and B cells, incubated with pt serum, if HLA is present it will react toward the pt lymphs

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18
Q

What is engraftment monitoring and how does it work

A

monitors signs of GvHD
identifies short tandom repeats STRs between donor and pt

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19
Q

practice slide 26`

A

slide 26

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20
Q

What do each of these terms mean
autologous
syngenic
allogenic
xenogenix
GvHD
HvGD

A

syn-twin donation
xeno-other species

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21
Q

What cells and what class can leav to GvHD and HvGD

A

T cells- class I
ab responses- class II
NK- class I
compliment

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22
Q

Which is worse, GvHD or HvGdg

A

GvHD

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23
Q

What kind of recognition do each of these cells do
T cell
Ab
NK

A

T cell- direct
Ab indirect
NK allorecognition

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24
Q

What cells mediate HvGD in hyper acute, acute or chronic phases

A

hyper acute- preexisting Abs - min to hours- complement activated
acute- CD4 and CD8 - 2 weeks to 1 month
chronic- CD4 and B cell responses

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25
Q

What might cause a hyper acute HvGD

A

previous transplants or transfusions, multiple pregnancies

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26
Q

What are the effects of acute HvGD

A

vascular damage due to leukocytes attack
inflammation
tissue necrosis
ab mediated respons

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27
Q

What can cause GvHD

A

BM, thymus, spleen, blood transfusion in neonate

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28
Q

What are the effects of acute GvHD

A

endothelial tissue damage, death to skin, liver, gastrointestinal tract
rash, jaundice

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29
Q

What cells are activated in acute GvHD

A

mature T cells in the graft

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30
Q

What are the effects of chronic GvHD

A

gradual ab and slow rejection
organ damage, scar formation on organs, fibrosis and atrophy of organ

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31
Q

How is GvHD treated? How to prevent it?

A

immunosuppression and steroids
HLA testing prior to transplant

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32
Q

Describe the parts of direct allo recognition? and indirect?

A

direct-patient T helper CD4 attaches to MHC class II on donor APC, acute
indirect- donor cell proteins are presented by APCs of recipient- chronic

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33
Q

How is HLA used for paternity testing

A

HLA genes from mom and dad are used to see if child matches these

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34
Q

What genetic markers are analyzed in paternity testing

A

RBC, HLA, enzymes, proteins

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35
Q

What are 1st and 2nd order exclusions

A

1st- gene in child that is not in mom nor dad
2nd- gene not in child that is in dad

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36
Q

practice slide 44, 46

A

slide 44
first order or 2nd

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37
Q

What does hydrops fetalis mean

A

edema in fetus

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38
Q

What does icterus gravis mean

A

jaundice

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39
Q

What does erythroblastosis fetalis mean

A

immature RBCs in circulation- related to anemia

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40
Q

What causes the most severe form of HDFN? and the least severe

A

Rh system
ABO

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41
Q

What are the 3 main causes of HDFN

A

Rh, ABO, other

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42
Q

What are the 4 conditions that must be met for HDFN to occur

A

Mom is exposed to foreign antigen from pregnancy
exposed to foreign antigens causing ab production
Ab can cross the placenta (IgG)
infant must have a well developed antigen that mom doesn’t have

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43
Q

What is the function of placenta

A

O2 exchange, nutrients, waste products
barrier between mom and fetus circulation

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44
Q

Describe fetal blood flow

A

fetal veins bring oxygenated blood to heart, pumps deoxygenated blood back to placenta via arteries
maternal blood provides nutrients and removes waste

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45
Q

Which HDFN can occur in the first pregnancy as mild

A

ABO

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46
Q

Which HDFN does not affect the 1st pregnancy, but the second pregnancy can have severe issues

A

Rh

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47
Q

How can HDFN lead to jaundice, what is this condition called

A

plasma albumin binds to some bilirubin
if there is too much it will remain unbound, accumulates in CNS
kernicterus

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48
Q

Describe the bilirubin pathway

A

RBCs lyse and release heme
heme is converted into unconjugated bilirubin
free bilirubin in the bloodstream
albumin conjugates bilirubin in liver,
broken down into urobilinogen in gut
can be excreted in feces or urine

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49
Q

What Rh type of HDFN is most severe

A

anti-D most common

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50
Q

What antigens cant cause HDFN and why

A

Lewis, I and P,not well established at birth

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51
Q

What DAT results are expected in ABO HDFN, what other lab results can be expected

A

weak positive or negative
high ESR
high osmotic fragility
high spherocytes
mild to high bilirubin

52
Q

What is included in prenatal testing

A

ABO RH type, weak D, ab screen
if Rh neg, need testing of rhogam
if ab preset, must do panel

53
Q

What is ab titration

A

serial dilution of abs to find what dilution abs are present

54
Q

How many ab titrations are preformed

A

3- second usually done weeks later, and ran parallel with the third
if change is more than 10 this is significant

55
Q

practice slide 20 HDFN chapter

A

slide 20

56
Q

What titers are clinically significant

A

16-32 or higher

57
Q

What does the liley graph tell us

A

bilirubin test, change in A450

58
Q

High billirubin means ___ RBC destruction

A

high

59
Q

What do the zones of Liley graphs mean

A

1- baby is ok
2- baby affected, must monitor
3- life threatening anemia

60
Q

What is cordocentesis

A

percutaneous umbilical blood sample
need in umbilical cord while baby still in womb
used to measure, Hgb, hematocrit, bilirubin, retics

61
Q

What can be done if HDFN is occuring

A

deliver baby early, intrauterine exchange, docs call

62
Q

What are the BB requirements for IUT

A

fresh blood- 5 days
CMV neg
Hgb S neg
irradiated
O neg RBCs and AB FFP
sometimes C, E and K neg

63
Q

When is cord blood testing necessary

A

Rh neg mom
O mom
NICU
mom has ab
no prenatal history

64
Q

What testing needs to be done if Weak D test is pos

A

elution

65
Q

What can interfere with cord blood testing

A

wharton’s Jelly
monoclonal reagents
blocking- mom anti-D blocks binding sites on baby D cells, doesnt let reagents bind to it

66
Q

What are the normal ranges for cord Hgb, and anemia

A

Hgb- 14-20
mild anemia- 13
moderate anemia 8-12
severe anemia <8

67
Q

What bilirubin levels are bad for a fetus

A

4-7, too high

68
Q

What is bilirubin is 16?
and if its 18-20?

A

16- fetal IUT needed
18- kernicterus, need labor induction

69
Q

If a DAT in cord blood is pos

A

acid elution, test supernatant for abs

70
Q

What treatments for neonatal HDFN

A

phototherapy for jaundice
transfusion
exchange transfusion

71
Q

How to give blood products to neonate

A

go off of baby blood type
O best choice, AB FFL

72
Q

How to give blood products to neonate

A

go off of baby blood type
O best choice, AB FFP

73
Q

What is rhogam

A

fake anti-D so that mom doesn’t make her own

74
Q

What kind of immunity is rhogam doing?

A

passive

75
Q

What are the conditions to be a candidate for rhogam

A

rh neg mom
weak D neg mom
mom has not made anti-D yet
Rh neg mom with Rh pos baby
invasive procedure- miscarriage, abortion, ectopic pregnancy, amniocentesis

76
Q

How long is Rhogam detectible in moms blood after administration

A

5 months

77
Q

How much is each dose of rhogam

A

300ug

78
Q

How much fetal blood will each dose of rhogam protect against

A

30mL of whole blood or 15mL of RBCs

79
Q

What is massive fetomaternal hemorrhage

A

if tauma causes 30mL of fetal blood to enter moms circulation
need rosette test

80
Q

What is the purpose of a fetal screen

A

looks for Rh pos cells from fetus in mom

81
Q

What is the purpose of a fetal screen

A

looks for Rh pos cells from fetus in mom
pos if rosettes are found

82
Q

What is the purpose of the Kleihauer Betke test?

A

quantitates how much fetal blood is in moms circulation

83
Q

What is used to differ fetal hgb from adult hgb in KB test

A

acid elution- fetal hgb is resistant to it

84
Q

What cells are adult and what cells are fetal in KB test

A

Adult- ghost
fetal- hot pink

85
Q

If KB test reveals 40 cells of fetal blood, how much rhogam must be transmitted

A

40/ 2000= 0.02 fetal index
0.02 x 5000 = 100
100/30 = 3.3
3+1 = 4

round up +1

86
Q

What are the 3 categories of immune hemolytic anemia

A

alloimmune- foreign
autoimmune- warm or cold ab
drug induced- damage to pt RBCs by drug

87
Q

Immune hemolytic anemia lab results
hgb
hct
retic
bilirubin
haptoglobin
LDH
RBC morphology

A

hgb low
hct low
retic high
bilirubin high
haptoglobin low
LDH high
polychromasia, spherocytosis, NRBCs, hemoglobinemia, hemoglobinuria

88
Q

What type of hemolysis causes sperocytes

A

extravascular

89
Q

auto antibodies tend to have

A

panagglutination

90
Q

What is the most common immune hemolytic anemia and what Ig causes it

A

Warm autoimmune hemolytic anemia,
IgG 70%

91
Q

How does Warm AIHA affect ABO and Rh results
what are the results for DAT
AB screen
ABID

A

unaffected
strongly positive
positive
all tested cells are pos - panagglutination

92
Q

What is the most common autoantibody

A

anti little e

93
Q

What is the most common autoantibody

A

anti little e
pt is e positive

94
Q

What is an elution ? What makes it positive

A

when you wash red cells and test the plasma for IgG
will be negative with compliment

95
Q

If a pt has warm autoimmune hemolytic anemia due to C3 what will the results for an elution be?

A

negative

96
Q

the last wash of an elution should be ___

A

negative

97
Q

What are the treatments for warm AIHA

A

steroids
treat underlying condition
splenectomy
immunosuppressants

98
Q

What is a warm autoabsorption

A

absorbs out the ab at 37C with ZZAP or PEG
remove serum, mix enhancement with RBCs allow abs to be absorbed, repeat, put plasma back into mix, add ZZAP to destroy abs
continue until auto control is neg

99
Q

What are the cold abs

A

LIPMAN

100
Q

What ab mostly causes cold hemolytic disease

A

anti- I

101
Q

What can a cold ab do to the typing results

A

false positive in forward type

102
Q

What results will an eluate show if there is a cold ab

A

negative

103
Q

What ab is associated with infectious mononucleosis

A

anti-i

104
Q

What DAT results can be expected from a cold hemagglutinin disease

A

+ if polyspecific
- for IgG and - C3

105
Q

What treatment is used in cold hemagglutinin disease

A

plasma exchange
rapid erythrocyte stroma treatment- rabbit plasma

106
Q

How does REST help in cold hemagglutinin disease

A

removes anti-I from the serum

107
Q

What pts tend to get paroxysmal cold hemoglobinuria

A

children mostly
after viral diseases like mono, measles, mumps

108
Q

What is the Donath Landsteiner test for

A

to looks for paroxysmal cold hemoglobinuria
exposes sample to low temps- allowing C to bind then warms them back up

109
Q

What causes Paroxysmal cold hemoglobinuria

A

compliment binds to IgG abs

110
Q

What ab is in question with Paroxysmal cold hemoglobinuria?

A

auto Anti -P

111
Q

Why can drugs cause induced hemolytic anemia

A

abs react against the drug or against the RBC antigens if enhanced by drug

112
Q

What DAT results are expected in drug induced hemolytic anemia

A

positive DAT

113
Q

What are the 4 mechanisms of action that cause drug induced hemolytic anemia

A

drug adsorption
immune complex
membrane modification
unknown

114
Q

What is the drug that most often causes drug induced hemolytic anemia through adsorption

A

penicillin
cephalosporin, erythromycin tetracycline

115
Q

What eluate results can be expected in Drug induced hemolytic anemia drug adsorption

A

negative, unless tested against drug coated RBCs

116
Q

What type of hemolysis occurs in drug induced hemolytic anemia through drug adsorption

A

extravascular

117
Q

What DAT results are expected from Drug induced hemolytic anemia through adsorption

A

pos- polyspecific
pos- IgG
neg- C3

118
Q

What is the best way to treat drug induced HA through drug adsorption

A

take the pt off the drug, usually ends in full recovery

119
Q

What causes drug induced hemolytic anemia through an immune complex

A

drugs adsorbed onto RBC surface
drug and abs form a complex
complement activates

120
Q

What type of hemolysis occurs in drug induced hemolytic anemia, through an immune complex

A

intravascular

121
Q

What are the expected DAT results for drug induced hemolytic anemia by formation of immune complex

A

DAT polyspecific- pos
DAT IgG- neg
DAT C3-pos

122
Q

What are the expected eluate results for drug induced hemolytic anemia by formation of immune complex

A

negative, only compliment is present not IgG

123
Q

What treatment can be used in drug induced hemolytic anemia, immune complex

A

stop drug,
steroids, sometimes

124
Q

What drugs cause DIHA through unknown mechanisms

A

aldomet, L DOPA, ibuprofen

125
Q

What are the expected DAT results in DIHA through unknown mechanisms

A

pos
with everything

126
Q

What are the expected eluate results in DIHA through unknown mechanisms

A

positive
negative in absence of drug

127
Q

What antigens have weak expression at birth

A

Lewis
P
Lutheran

Blood Bank (8 decks)

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