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Transfusion > Week 1 > Flashcards

Week 1 Flashcards

Immunology Review and Basic Serological Techniques

1
Q

In the transfusion setting, what kind of immune response is the primary one and which kind of cell does it mainly involve?

A

In the transfusion setting, the immune response is primarily Humoral and involving mainly the B lymphocytes.

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2
Q

What does humoral immunity consist of?

A

Humoral immunity consists of the fluid parts of the immune system, such as the antibodies and complement components found in plasma, saliva, and other secretions.

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3
Q

In which bodily fluids are antibodies and complement components found?

A

antibodies and complement components are found in plasma, saliva, and other secretions.

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4
Q

What is humoral immunity mediated by and what can it initiate?

A

Humoral immunity is mediated by the B cells and can initiate antibody production

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5
Q

What kinds of cells are antibodies produced by?

A

Antibodies are produced by the B cells

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6
Q

What kinds of cells mediate cellular immunity?

A

Cellular immunity is mediated by the T cells and lymphokines.

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7
Q

What are Lymphokines, what can they do to cells?

A

Lymphokines are effective molecules that can activate and deactivate different cells (their main function is communication)

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8
Q

Which factors does antigenicity depend on?

A

1) Chemical Composition and Complexity
2) Degree of Foreignness
3) Molecular Weight (size)
4) Dosage and Antigen Density
5) Route of Administration

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9
Q

What kind of chemical composition can antigens have?

A

Protein
Glycolipid (carbohydrate and lipids)
Glycoprotein (carbohydrate and protein)
Lipoprotein
Nucleic Acid

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10
Q

In a protein antigen, what does the gene code for?

A

Gene codes directly for the protein

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11
Q

Where are protein RBC antigens produced and integrated into?

A

Produced and integrated into the red cell membrane

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12
Q

Are protein antigens on RBCs well developed at birth?

A

Yes

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13
Q

Are the protein antigens found on RBCs unique?

A

yes

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14
Q

In a carbohydrate antigen, what does the gene code for?

A

The gene codes for an enzyme such as
glycosyltransferase, which adds a sugar to a precursor substance on the red cell membrane to form the antigen.

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15
Q

Where are carbohydrate antigens produced and found on an RBC?

A

Produced and found on the surface of the RBC

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16
Q

Are carbohydrate antigens well developed at birth?

A

No; although enzyme production begins early, antigens are NOT well developed at birth.

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17
Q

Are the carbohydrate antigens found on RBCs unique?

A

No; Red cell antigens are very similar in structure to those found in nature on some pollen and bacterial membranes.

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18
Q

What are antibody isotypes or classes based on?

A

Isotypes or classes based on Heavy chain

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19
Q

What is antibody specificity based on?

A

Specificity is based on variable regions where binding of the antigens occurs.

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20
Q

Which two antibodies are the most significant in transfusion science?

A

IgG and IgM antibodies are the most significant
in Transfusion Science

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21
Q

What does the likelihood of an immune response depend on?

A

1) The immunogenicity of the antigen, which is the
ability to stimulate an immune response.
2) Patient’s own immune system’s sensitivity

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22
Q

What are the two types of exposure of antigens?

A

Naturally Occurring and Red Cell Immune (as a result of transfusion or pregnancy)

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23
Q

What happens after antibody production? What are the roles of IgM and IgG?

A

Antibody binds to the specific Antigen
Antigens (donor red cells) are targeted for
destruction
IgM Intravascular clearance of red cells
IgG Extravascular clearance of red cells

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24
Q

What is complement?

A

Complement is a series of activated proteins involved in immunological reactions.

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25
Q

In what format does complement become activated?

A

Complement becomes activated in a cascade format

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26
Q

What are the biological roles of complement?

A

Numerous biological roles related to antigen clearance, cell lysis, and vasodilation.

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27
Q

How is the classical complement pathway activated?

A

Activated by the presence of an antibody bound to
an antigen.

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28
Q

How is the alternative complement pathway activated?

A

Foreign cell surface constitutes such as bacteria, viruses, and foreign proteins and carbohydrates can activate this pathway

29
Q

What are the main components of the complement cascade?

A

C3 convertase (C4b2a)
C5 convertase (C4b2a3b)
C3a: anaphylatoxin and eosinophil chemotaxis
C3b: mediates phagocytosis and opsonin
C5a: anaphylatoxin and chemotaxis for
leukocytes and monocytes
C5b-9: Membrane Attack Complex
(C4b2a3b)

30
Q

What can we use to detect complement, why does this work for detection?

A

Anti-C3d sera
Some molecules of C3b and C4b are left on the red cell membrane, and then are further degraded into C3d and C4d. And while the antibody can disassociate, complement components will remain on the red cell

31
Q

Where does intravascular hemolysis happen?

A

Vascular: In veins, arteries and
capillaries

32
Q

Where does extravascular hemolysis happen?

A

Mainly in the spleen and liver

33
Q

What are the types of antigen and antibody reactions?

A

Precipitation
Sensitization
Agglutination
Hemolysis

34
Q

When does a hemolysis antigen antibody reaction happen?

A

If the complement gets activated

35
Q

What is going on in a sensitization reaction, is it visible?

A

the Antibody binds to Antigen Epitope
It is invisible

36
Q

What is going on in an agglutination reaction, which immunoglobulins are involved, and is it visible?

A

the formation of a lattice
Usually IgM molecules
Rarely IgG molecules
It is Visible

37
Q

What are the Factors Affecting Antigen & Antibody Reactions?

A

Goodness of fit and nature of the antibody for the specific antigen.
Factors such as the antigen’s shape, size, and charge
determine the antibody’s binding.
Affinity and Avidity
Type of Immunoglobulin
Red Cell Solution: Suspension and pH
Temperature and Time: Optimum conditions
Concentrations of Antigen or Antibody

38
Q

Can Reactions be manipulated to encourage and enhance Ag/Ab Reactions?

A

Yes

39
Q

How does zeta potential influence agglutination?

A

Net negative charges around the RBC repel each other, and as a result, there is no agglutination.

40
Q

How does IgM influence agglutination?

A

IgM is a pentamer and can bridge the GAP and agglutinate cells

41
Q

How can IgG influence agglutination?

A

IgG is too small and requires increased protein in solution to decrease the zeta potential.

42
Q

What do potentiators do?

A

Increase protein to reduce the positive and negative ions that prevent antibodies from binding with antigens and facilitate agglutination

43
Q

What roles can enzymes play in antibody reactions?

A

Enhances antibody reactions for some reactions
Depresses Reactivity of some antibodies
“Destroying” or altering the antigen

44
Q

How do you do the immediate spin technique?

A

Add Plasma and 3-5% red cells
Centrifuge and read

45
Q

How do you do the antiglobulin test?

A

Add plasma and 3-5% red cells
Incubate, wash, and add AHG
Centrifuge and read
Checks with CCC

46
Q

How is AHG sera made?

A

The rabbit is stimulated to produce antibodies to human globulins, the substance is called Antihuman Globulin

47
Q

Why do we need AHG for the antiglobulin test?

A

Because the IgG reaction by itself is too small for us to see, AHG acts as an antigen to give us a visible reaction

48
Q

What are the steps of IAT?

A

1) Mix plasma (antibody) with cells (antigen source); sensitization may occur.
2) Incubate, washing with saline, to remove any free antibody from the mixture; the only antibody left is the one bound to the red cells.
3) Add AHG; agglutination occurs IF Sensitization has occurred.

49
Q

Scenario 1: Antibody is present in the plasma and
attaches to the red cells (antigen). After adding AHG
Agglutination is present. What is your conclusion?

A

Positive IAT

50
Q

Scenario 2: No Antibody is present in the plasma. After adding AHG, no agglutination present. CCC is positive. What is your conclusion?

A

A true Negative IAT

51
Q

Scenario 3: Antibodies are present in the plasma but did not follow the procedure correctly, and the washing technique did not wash away all the unbound antibodies. Free antibodies NOT bound to the red cells are present in the test mixture. After adding AHG, no agglutination is present. What is your conclusion?

A

A false negative IAT. Sensitization occurred, but NO agglutination was seen because the AHG reagent added to the mixture was Neutralized.

52
Q

How do we tell the difference between a FALSE negative IAT and a TRUE negative IAT?

A

Quality Control: We have to use Coombs Control Cells (CCC)

53
Q

When do we add CCC?

A

If after AHG, the reaction is negative

54
Q

Which immunoglobulin requires IAT to detect
agglutination?

A

IgG

55
Q

Which complement components can be detected on the red cell membrane?

A

C3 and C4

56
Q

Different types of AHG reagents include?

A

Polyspecific includes Anti-IgG and Anti-C3d
Monospecific AHG reagent is only Anti-IgG or Anti-C3d

57
Q

Which kind of antigens are well developed at birth and can possibly elicit an immune response?

A

Protein

58
Q

Which kind of antigens similar to red cell antigens can be found in nature?

A

Carbohydrate

59
Q

What test is used to detect IgM?

A

IS

60
Q

What test is used to detect IgG antibodies?

A

IAT

61
Q

An IgM Molecule is a
a) Monomer
b) Dimer
c) Trimer
d) Pentamer

A

Pentamer

62
Q

Secondary antibody stimulation
results in a reaction that is termed
a) Anamnestic
b) A plateau
c) Graphic
d) Primary

A

Anamnestic

63
Q

Anti-Human globulin is
a) Directed against red cell antigens
b) An antibody to human globulins
c) Derived from antibody coated cells
d) Produced in humans

A

An antibody to human globulins

64
Q

Monospecific AHG is
a) Directed against one red cell antigen
b) Reactant with any human globulins
c) Specific for one type of immunoglobulin
d) Always specific for complement

A

Specific for one type of immunoglobulin

65
Q

Washing phase in the AHG test serves the
Purpose of
a) Removing the ab from red cell surface
b) Diluting strength of cell suspension
c) Changing the concentration of AHG sera
d) Removing the excess serum antibodies

A

. Removing the excess serum antibodies

66
Q

Most immune responses include
a) Both a cellular and humoral component
b) Inflammation and specific acquired immunity
c) Recognition of a non-self substance and cell
activation
d) All of the above

A

All of the above

67
Q

The following does not influence
immunogenicity
a) Shape and charge of the antigen molecule
b) Sterility
c) Route of administration
d) Size of the molecule

A

Sterility

68
Q

What is the potential effect of a tube
agglutination result if a red cell suspension
with a concentration of less than 3% used?
a) A false negative reaction
b) A false positive reaction
c) Hemolysis
d) No effect

A

A false negative reaction- Antibody access is in the prozone and will lessen the reaction causing a false negative reaction.

Transfusion (8 decks)

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