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Transfusion > Week 2 > Flashcards

Week 2 Flashcards

The ABO and Rh Blood Group System

1
Q

Which blood group system is the most clinically significant?

A

The ABO Blood Group System.

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2
Q

How are ABO antibodies stimulated?

A

ABO antibodies are non-red blood cell stimulated; individuals possess ABO antibodies to the antigens they lack.

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3
Q

What type of immunoglobulin are ABO antibodies primarily composed of?

A

IgM.

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4
Q

How many IgM molecules are required to initiate the classical complement pathway in the ABO system?

A

Only one IgM molecule is needed to initiate the classical complement pathway.

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5
Q

What is the result of complement activation in the ABO Blood Group System?

A

Immediate cell lysis and intravascular hemolysis.

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6
Q

What type of hemolysis is caused by ABO incompatibility?

A

Intravascular hemolysis.

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7
Q

Who typically gets blood typing done?

A

Blood donors
Transfusion Recipients
Transplant Candidates
Prenatal Patients
Newborns
Dads for Paternity Testing

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8
Q

Who discovered the ABO Blood Group System and in what year?

A

Karl Landsteiner discovered the ABO Blood Group System in 1900.

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9
Q

How did Karl Landsteiner discover the ABO Blood Group System?

A

He mixed the serum and cells of his colleagues in his lab and observed three different patterns of agglutination.

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10
Q

What did Karl Landsteiner develop from his studies on blood agglutination?

A

He developed what we now know as Landsteiner’s rules for the ABO Blood Group.

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11
Q

What is the first rule of Landsteiner’s Rules?

A

A person does not have the antibody to their own antigen.

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12
Q

What is the second rule of Landsteiner’s Rules?

A

Each person has antibodies to the antigen they lack (only in the ABO system).

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13
Q

What antibodies are present in individuals with blood type A?

A

Anti-B antibodies.

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14
Q

What antibodies are present in individuals with blood type B?

A

Anti-A antibodies.

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15
Q

What antibodies are present in individuals with blood type AB?

A

None (no anti-A or anti-B antibodies).

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16
Q

What antibodies are present in individuals with blood type O?

A

Both Anti-A and Anti-B antibodies.

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17
Q

On which chromosome are the A and B genes of the ABO blood group system located?

A

Chromosome #9.

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18
Q

How are the A and B alleles expressed in an individual?

A

A and B alleles are co-dominant, meaning both are expressed when present.

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19
Q

What is unique about the O gene in the ABO blood group system?

A

The O gene has no A or B antigens on the RBC and is not expressed unless the individual is OO, meaning it is a recessive gene.

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20
Q

What is the CIS-AB genotype in the ABO Blood Group System?

A

The CIS-AB genotype is a rare mutation in which both A and B antigens are inherited from one parent on a single chromosome.

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21
Q

How does CIS-AB inheritance differ from traditional AB inheritance?

A

In traditional AB inheritance, the A and B alleles are inherited separately from each parent, while in CIS-AB inheritance, both A and B are passed from one parent due to crossing over during meiosis.

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22
Q

What genetic event causes CIS-AB inheritance?

A

Unequal crossing over during meiosis leads to the formation of the CIS-AB genotype.

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23
Q

How are A and B antigens expressed in the CIS-AB genotype?

A

Both A and B antigens are expressed from a single chromosome that comes from one parent.

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24
Q

Where are ABO antigens found on the body’s cells?

A

ABO antigens are found on RBC membranes, endothelial cells, platelets, lymphocytes, and tissue.

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25
Q

In what form can ABO antigens be found in the plasma?

A

ABO antigens can be found in a soluble form in plasma and other body secretions.

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26
Q

What gene influences the presence of soluble ABO antigens in body secretions?

A

The Secretor gene.

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27
Q

What do the A and B genes code for in the ABO system?

A

The A and B genes code for enzymes called transferases.

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28
Q

What is the function of transferase enzymes in the ABO system?

A

Transferases transfer a sugar to a basic precursor substance on the RBC membrane.

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29
Q

What type of molecules are ABO antigens?

A

ABO antigens are carbohydrates.

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30
Q

How are ABO antigens attached to the RBC membrane?

A

ABO antigens are attached through the action of a transferase enzyme.

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31
Q

What type of structure are ABO antigens based on?

A

ABO antigens are based on oligosaccharide chains.

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32
Q

What is the main difference between Type 1 and Type 2 oligosaccharide chains in the ABO system?

A

Type 1 chains are primarily found in body fluids and secretions, while Type 2 chains are found on red blood cells and also in body fluids and secretions.

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33
Q

What type of linkage is found in Type 1 oligosaccharide chains?

A

Type 1 chains have a β1→3 linkage.

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34
Q

What type of linkage is found in Type 2 oligosaccharide chains?

A

Type 2 chains have a β1→4 linkage.

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35
Q

In what forms are oligosaccharide chains (for ABO antigens) bound to cells?

A

Oligosaccharide chains are bound to either proteins or lipids.

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36
Q

Where are A and B antigens located in the oligosaccharide chain?

A

A and B antigens are the last sugars added to the oligosaccharide chain.

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37
Q

What is unique about the O blood group in terms of antigen structure?

A

The O blood group lacks A and B antigens and has the most amount of the last terminal sugar called the H antigen.

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38
Q

What type of molecules are oligosaccharides attached to on the RBC membrane?

A

Oligosaccharides are attached to lipids and proteins on the RBC membrane.

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39
Q

What controls the production of A, B, and H antigens?

A

The production of A, B, and H antigens is controlled by the action of transferases.

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40
Q

What are transferases?

A

Transferases are enzymes that catalyze the addition of specific sugars to the oligosaccharide chain.

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41
Q

How do the A, B, and H genes contribute to antigen development?

A

A, B, and H genes each produce a different transferase, which adds a specific sugar to the oligosaccharide chain.

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42
Q

What is the gene product responsible for H antigen production?

A

The gene product for H antigen is L-Fucosyltransferase.

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43
Q

What is the immunodominant sugar for the H antigen?

A

The immunodominant sugar for the H antigen is L-Fucose.

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44
Q

What is the gene product responsible for A antigen production?

A

The gene product for A antigen is N-Acetylgalactosaminyltransferase.

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45
Q

What is the immunodominant sugar for the A antigen?

A

The immunodominant sugar for the A antigen is N-Acetylgalactosamine.

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46
Q

What is the gene product responsible for B antigen production?

A

The gene product for B antigen is D-Galactosyltransferase.

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47
Q

What is the immunodominant sugar for the B antigen?

A

The immunodominant sugar for the B antigen is D-Galactose.

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48
Q

How many A antigen sites are typically found on the RBC membrane of an A1 adult?

A

810,000 to 1,170,000 A antigen sites.

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49
Q

How many B antigen sites are typically found on the RBC membrane of a B adult?

A

610,000 to 830,000 B antigen sites.

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50
Q

Are all H antigens converted to A or B antigens in A, B, or AB individuals?

A

No, not all H antigens are converted in A, B, or AB individuals.

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51
Q

What happens to H chains when both A and B genes are present?

A

Some H chains are converted to A antigen, while others are converted to B antigen.

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52
Q

What enzyme production occurs in individuals with the OO genotype?

A

There is no production of either A or B enzymes in individuals with the OO genotype.

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53
Q

What happens to the precursor substances in individuals with the OO genotype?

A

The precursor substances are not converted to A or B antigens.

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54
Q

What antigen do individuals with the O blood group have?

A

Individuals with the O blood group have unconverted H antigen.

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55
Q

What is unique about the O gene?

A

The O gene is an amorph, meaning it does not express a detectable product.

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56
Q

Which blood group has the most H antigens on red blood cells?

A

The O blood group has the most H antigens.

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57
Q

In which blood group is almost all of the H antigen converted to A1 and B antigens?

A

In the A1B blood group, almost all of the H antigen is converted to A1 and B antigens.

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58
Q

Arrange the following blood groups in order from most to fewest H antigens: A1, B, O, A2, A1B, A2B.

A

O > A2 > B > A2B > A1 > A1B.

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59
Q

Which blood group has the fewest H antigens on the red blood cells?

A

The A1B blood group has the fewest H antigens.

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60
Q

Which ABO blood type has the most common and strongest A antigen expression?

A

The A1 subgroup of Type A.

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61
Q

What are the two main subgroups of Type A in the ABO system?

A

A1 and A2.

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62
Q

How are reverse cells labeled in Type A subgroups?

A

Reverse cells are labeled A1, the most common and strongest A antigen expressed.

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63
Q

What is unique about the Bombay phenotype in the ABO system?

A

Individuals with the Bombay phenotype do not inherit a normal H gene and have Anti-H in their plasma.

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64
Q

How common is the Bombay phenotype?

A

The Bombay phenotype is rare.

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65
Q

Are ABO antibodies the result of known exposure to blood or blood products?

A

No, ABO antibodies are thought to be naturally occurring without known exposure to blood or blood products.

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66
Q

What is the current hypothesis regarding the natural occurrence of ABO antibodies?

A

The hypothesis is that biochemical structures similar to A or B antigens are present in bacteria, plants, and pollen.

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67
Q

How do individuals produce ABO antibodies?

A

Environmental exposure to antigens similar to A and B allows individuals to respond immunogenically and produce ABO antibodies.

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68
Q

When does possible exposure to similar forms of A and B antigens begin?

A

Possible exposure begins at birth.

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69
Q

Why might the term “naturally occurring” be incorrect for ABO antibodies?

A

Because our bodies are being stimulated by other substances, not necessarily through natural occurrence.

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70
Q

What alternative term can be used instead of “naturally occurring” for ABO antibodies?

A

The term “Non-Red Cell Immune” can be used.

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71
Q

At what age do newborns start producing their own ABO antibodies?

A

Newborns start producing their own ABO antibodies at 3 to 6 months of age.

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72
Q

Why should reverse grouping (RA/RB) not be performed on infants younger than 4 months of age?

A

Because ABO antibodies detected in infants less than 4 months old may be maternal in origin.

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73
Q

What type of unique antibody do Group O individuals produce?

A

Group O individuals produce Anti-A,B antibodies, which are of the IgG type.

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74
Q

With which antigens do Anti-A,B antibodies react?

A

Anti-A,B antibodies react with both A and B antigens.

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75
Q

Can Anti-A,B antibodies be separated into Anti-A and Anti-B?

A

No, Anti-A,B antibodies cannot be separated into Anti-A and Anti-B.

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76
Q

What does Anti-A,B seem to react with on both A and B antigens?

A

Anti-A,B appears to react with a shared epitope on both A and B antigens.

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77
Q

What do we need to add to RBCs to detect antigens during routine blood bank testing?

A

We need to add an antibody (known antisera found on our reagent rack).

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78
Q

What is the purpose of routine testing on RBCs in the blood bank?

A

To determine the ABO group by detecting unknown antigens on RBCs.

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79
Q

What kind of antisera is used to determine the antigens on RBCs?

A

Commercially purchased antisera, such as Anti-A, Anti-B, and Anti-A,B.

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80
Q

What is needed to detect an antibody present in the patient’s plasma during routine blood bank testing?

A

A known antigen is needed to detect the antibody in the patient’s plasma.

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81
Q

What is the purpose of testing a patient’s plasma in the blood bank?

A

To determine the ABO group by identifying the unknown antibody present in the plasma.

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82
Q

What commercially purchased reverse cells are used to test the patient’s plasma for ABO antibodies?

A

Reverse cells RA and RB, which contain the known antigens (A1 cells and B cells).

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83
Q

What are the four basic categories of reagents used in the blood bank?

A

Red blood cells with known antigens
Antisera with known antibodies
Potentiators to enhance antibody reactions
Antihuman globulin reagents (polyclonal and monoclonal)

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84
Q

What is the purpose of red blood cells with known antigens in blood bank testing?

A

They are used to identify unknown antibodies in a patient’s plasma.

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85
Q

What is the role of antisera with known antibodies in blood bank testing?

A

Antisera is used to detect the presence of specific antigens on red blood cells.

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86
Q

What are potentiators used for in blood bank testing?

A

Potentiators enhance antibody reactions to improve the detection of antibodies.

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87
Q

What are the two basic methods for blood bank testing?

A

Immediate spin – IgM
Antiglobulin test – IgG

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88
Q

How are polyclonal antibodies made?

A

Polyclonal antibodies are made from several different clones of B cells that secrete antibodies of different specificities.

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89
Q

What is a key characteristic of polyclonal antibodies?

A

Polyclonal antibodies can recognize multiple epitopes.

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90
Q

Give an example of a polyclonal antibody used in blood bank testing.

A

An example is Anti-Human Globulin.

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91
Q

How are monoclonal antibodies made?

A

Monoclonal antibodies are made from a single clone of transformed B cells (plasma cells) that secrete antibodies of the same specificity.

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92
Q

What technology is used to produce monoclonal antibodies?

A

Hybridoma technology.

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93
Q

How many epitopes do monoclonal antibodies recognize?

A

Monoclonal antibodies recognize a single epitope.

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94
Q

Give examples of monoclonal antibodies used in blood bank testing.

A

Examples include Anti-C, Anti-A, and Anti-IgG.

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95
Q

What reagents are used to determine ABO blood type in forward testing?

A

Anti-A, Anti-B, and Anti-A,B reagents.

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96
Q

What do antisera target in ABO forward testing?

A

Antisera are directed toward specific antigens on the patient’s RBCs.

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97
Q

What antigen does Anti-A target?

A

Anti-A targets the A antigen.

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98
Q

What antigen does Anti-B target?

A

Anti-B targets the B antigen.

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99
Q

Is Anti-A,B used in all clinical settings?

A

No, Anti-A,B may be used in some clinical settings but not all.

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100
Q

What is one advantage of using Anti-A,B in testing?

A

Anti-A,B may detect some subgroups that have weaker reactions.

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101
Q

What does forward typing test in the ABO system?

A

Forward typing tests the patient’s cells for antigens.

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102
Q

What does reverse typing test in the ABO system?

A

Reverse typing tests the patient’s serum for antibodies.

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103
Q

What kind of Immunoglobulins are we testing for in ABO grouping?

A

Antibodies are Anti-A, Anti-B in the patient plasma…IgM. Anti-A,B is IgG

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104
Q

What test method are we using in ABO grouping? (IS or AHG)

A

Test method is Immediate Spin

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105
Q

Why is it important to determine a patient’s ABO type?

A

To find compatible blood for transfusion.

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106
Q

Why are ABO antibodies clinically significant?

A

ABO antibodies are IgM and bind complement, leading to intravascular hemolysis with donor red cells.

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107
Q

Should patients always be transfused with ABO identical blood?

A

No, the patient must be transfused with ABO compatible but not necessarily identical blood.

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108
Q

Why should blood never be issued based on a historical ABO type?

A

Always use a current type and screen, as issuing blood based on a historical type can cause a life-threatening acute hemolytic transfusion reaction.

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109
Q

The notation AO represents:
a) Bombay Phenotype
b) Genotype
c) Phenotype
d) Transferase

A

b) Genotype

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110
Q

Anti-H is found in the sera of individuals of group:
a) A
b) B
c) AB
d) Oh

A

d) Oh

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111
Q

Parents of Group AA and AB cannot produce offspring of the group?
a) A
b) B
c) AB
d) O

A

d) O

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112
Q

What are the gene products of A, B genes?
a) Glycolipids
b) Glycoproteins
c) Oligosaccharides
d) Transferase Enzymes

A

d) Transferase Enzymes

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113
Q

According to Landsteiner’s Rule, if a patient has no antibodies after serum testing, what ABO antigens should be present on the patient red cells?
a) A
b) B
c) A and B
d) No antigens

A

c) A and B

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114
Q

Which of the following statements is true about the ABO antibody production?
a) ABO antibodies are present in newborns
b) Titres remain constant levels throughout life
c) Stimulated by bacteria/environment factors
d) All statements above are true

A

c) Stimulated by bacteria/environment factors

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115
Q

Which Immunoglobulin is primarily associated
with the ABO antibodies?
a) IgA
b) IgG
c) IgE
d) IgM

A

d) IgM

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116
Q

Which Immunodominant sugar confers with the B blood group specificity?
a) D-Galactose
b) L-Fucose
c) N-Acetylgalactosamine
d) L-Glucose

A

a) D-Galactose

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117
Q

Individual with AO, HH genotype, what antigens are present on the red cells?
a) A antigens
b) A and H antigens
c) A and O antigens
d) None of the above

A

b) A and H antigens

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118
Q

Who linked the cause of Hemolytic Disease of the Fetus and Newborn (HDFN) to an antibody in the Rh system?

A

Levine and Stetson in 1939.

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119
Q

In what year did Levine and Stetson make their discovery about HDFN and the Rh antibody?

A

1939

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120
Q

What significant discovery about antibodies and human red cells was made by Landsteiner and Wiener in 1940?

A

They discovered that a Rhesus monkey produced an antibody that reacted with 85% of human red cells.

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121
Q

What percentage of human red cells reacted with the antibody produced by the Rhesus monkey, according to Landsteiner and Wiener’s discovery?

A

85%

122
Q

Which animal was used by Landsteiner and Wiener in their 1940 discovery related to the Rh system?

A

The Rhesus monkey.

123
Q

What stimulates the production of Anti-D antibodies in a mother during the initial pregnancy?

A

Exposure to D-positive fetal cells.

124
Q

Can maternal Anti-D antibodies cross the placenta?

A

Yes, maternal Anti-D antibodies can cross the placenta.

125
Q

What happens to fetal red cells in subsequent pregnancies if the baby is Rh-positive and the mother has Anti-D antibodies?

A

The fetal red cells are destroyed by the mother’s Anti-D antibodies.

126
Q

What is the role of RhIg in Rh-negative mothers?

A

RhIg protects Rh-negative mothers from producing Anti-D antibodies after delivery.

127
Q

In what scenario is RhIg administered to prevent HDFN?

A

RhIg is administered to Rh-negative mothers after delivery of an Rh-positive baby to prevent the production of Anti-D antibodies.

128
Q

What does the Fisher-Race theory propose about Rh genetics?

A

It proposes that a gene complex is inherited that codes for 3 closely linked sets of alleles.

129
Q

According to the Fisher-Race theory, how many sets of alleles are involved in Rh genetics?

A

Three closely linked sets of alleles.

130
Q

What does the Wiener theory propose about the Rh Blood Group system?

A

The Wiener theory proposes that 1 gene is responsible for the expression of all Rh Blood Group systems.

131
Q

How does the Wiener theory differ from the Fisher-Race theory in explaining Rh genetics?

A

The Wiener theory suggests that a single gene controls Rh expression, while the Fisher-Race theory suggests that a gene complex with 3 linked alleles is responsible.

132
Q

What do modern molecular techniques suggest about the Rh Blood Group System?

A

They suggest that Rh Blood Group System antigens are determined by 2 genes.

133
Q

What type of alleles are Rh genes?

A

Rh genes are co-dominant alleles.

134
Q

What does the RHD gene code for, and what are its possible states?

A

The RHD gene codes for the D antigen, and its possible states are homozygous (DD) or heterozygous (Dd).

135
Q

How many alleles are present at the same locus for the RHCE gene?

A

There are four alleles at the same locus for the RHCE gene.

136
Q

What are the four alleles of the RHCE gene?

A

The four alleles are RHCE, RHCe, RHcE, and RHce.

137
Q

What percentage of the population has the D antigen?

A

85% of the population has the D antigen.

138
Q

What percentage of the population has the C antigen?

A

70% of the population has the C antigen.

139
Q

What percentage of the population has the E antigen?

A

30% of the population has the E antigen.

140
Q

What percentage of the population lacks the D antigen (d)?

A

15% of the population lacks the D antigen.

141
Q

What percentage of the population has the c antigen?

A

80% of the population has the c antigen.

142
Q

What percentage of the population has the e antigen?

A

98% of the population has the e antigen.

143
Q

After which antigens is the D antigen the most immunogenic?

A

The D antigen is the most immunogenic after the A and B antigens.

144
Q

When is Anti-D produced in an individual?

A

Anti-D is produced if an individual lacking the D antigen is exposed to D-positive red cells.

145
Q

How can exposure to D-positive red cells occur?

A

Exposure occurs through pregnancy or transfusions.

146
Q

What do Rh-positive and Rh-negative refer to?

A

Rh-positive refers to the presence of the D antigen on RBCs, while Rh-negative refers to its absence.

147
Q

What is the structure of Rh antigens?

A

Rh antigens have a protein structure made of amino acids.

148
Q

What type of immune response do Rh antigens elicit?

A

Rh antigens elicit an IgG immune response and are highly immunogenic.

149
Q

How is exposure to Rh antigens typically caused?

A

Exposure occurs through transfusion or pregnancy.

150
Q

Are Rh antigens expressed on tissues?

A

No, Rh antigens are not expressed on tissues.

151
Q

Are Rh antigens well-developed at birth?

A

Yes, Rh antigens are well-developed at birth.

152
Q

How are Rh antigens produced?

A

Rh antigens are direct gene products, not produced by enzymes.

153
Q

Which genes code directly for Rh antigens?

A

The RHD and RHCE genes code directly for Rh antigens.

154
Q

What role do Rh antigens play in Hemolytic Disease of the Fetus and Newborn (HDFN)?

A

Rh antigens can easily cause HDFN when there is an immune response against fetal red cells.

155
Q

What is the structure of the Rh (D) antigen in relation to the membrane?

A

The Rh (D) antigen spans the membrane multiple times, with an epitope on the outside of the cell membrane.

156
Q

Where is the D epitope located on the Rh protein?

A

The D epitope is located on the outer part of the Rh protein, exposed outside the cell membrane.

157
Q

What is the significance of the NH2 (amino) and COOH (carboxyl) groups in the Rh antigen structure?

A

The NH2 (amino) group is on the inside of the cell, and the COOH (carboxyl) group is on the outside, indicating the orientation of the Rh protein across the membrane.

158
Q

How many amino acids make up Rh antigens?

A

Rh antigens are proteins made up of 417 amino acids.

159
Q

How many times do Rh antigen proteins cross the RBC membrane?

A

Rh antigen proteins cross the RBC membrane 12 times.

160
Q

What part of the Rh antigen acts as the antigenic determinant?

A

The exposed loops of the Rh antigen protein act as antigens.

161
Q

How many D antigens are typically present on the RBC membrane?

A

There are typically between 10,000 and 200,000 D antigens on the RBC membrane.

162
Q

Do Rh antigens have more or fewer antigen sites than the ABO group?

A

Rh antigens have fewer antigen sites than the ABO group.

163
Q

How do Rh antibodies differ from ABO antibodies in terms of production?

A

Rh antibodies are red cell immune, meaning they are not produced unless exposed to red cells through transfusion or pregnancy.

164
Q

What class of antibodies are Rh antibodies?

A

Rh antibodies are IgG antibodies.

165
Q

How effective are Rh antibodies at complement binding?

A

Rh antibodies have poor complement binding.

166
Q

What is the most common antibody seen in Rh-negative individuals?

A

Anti-D is the most common antibody seen in Rh-negative individuals

167
Q

Which antibody is commonly seen in Rh-positive individuals and why?

A

Anti-E is the most common antibody seen in Rh-positive individuals because only 30% of the population have the E antigen.

168
Q

Why are Anti-C and Anti-c antibodies less common?

A

Anti-C and Anti-c are less common because more people have the C and c antigens.

169
Q

Why is Anti-e often difficult to manage in transfusions?

A

Anti-e is often seen as an autoantibody, and it is difficult to find compatible blood since 98% of the population have the e antigen.

170
Q

How many separate genes and alleles are there in the Fisher-Race nomenclature, and which ones are they?

A

There are 3 separate genes and alleles: D, C, E, c, and e. These genes are closely linked on the same chromosome and inherited as a gene complex.

171
Q

What are the possible antigens in the Fisher-Race nomenclature?

A

The possible antigens are D, C, E, c, and e.

172
Q

What does the “d” antigen represent in Fisher-Race nomenclature?

A

The “d” antigen is an amorphic or deleted gene, meaning it does not produce an antigen.

173
Q

If the D antigen is present, what are the possible genotypes?

A

If the D antigen is present, the genotype can be either DD or Dd.

174
Q

What are the common Fisher-Race nomenclature designations for Rh gene complexes?

A

The common designations are:
DCE
DCe
DcE
Dce
dCE
dCe
dcE
dce

175
Q

According to the Wiener nomenclature, how many alleles are responsible for the expression of Rh antigens?

A

One gene is responsible for the expression of 8 alleles, resulting in various Rh antigens.

176
Q

Was the genetic theory behind the Wiener nomenclature correct?

A

Although the genetic theory was incorrect, the terminology is still commonly used in labs.

177
Q

What are the 8 alleles in the Wiener nomenclature?

A

The 8 alleles are Ro, R1, R2, Rz, r, r’, r”, and ry.

178
Q

What do the Wiener nomenclature alleles express?

A

The 8 alleles express different Rh antigens on red cells.

179
Q

What is the Wiener notation for the Fisher-Race equivalent “Dce”?

A

Ro

180
Q

What is the Fisher-Race equivalent of the Wiener notation “R1”?

A

DCe

181
Q

What is the Wiener notation for the Fisher-Race equivalent “DcE”?

A

R2

182
Q

What is the Fisher-Race equivalent of the Wiener notation “Rz”?

A

DCE

183
Q

What is the Wiener notation for the Fisher-Race equivalent “dce”?

A

r

184
Q

What is the Fisher-Race equivalent of the Wiener notation “r’”?

A

dCe

185
Q

What is the Wiener notation for the Fisher-Race equivalent “dcE”?

A

r”

186
Q

What is the Fisher-Race equivalent of the Wiener notation “ry”?

A

dCE

187
Q

What Rh phenotype corresponds to the antigens D+, C+, E-, c+, e+?

A

The Rh phenotype D+C+E-c+e+.

188
Q

What does the Rh phenotype D+C+E-c+e+ indicate in terms of serologically detectable antigens?

A

The antigens D, C, c, and e are serologically detectable.

189
Q

What are the possible genotypes for the phenotype D+C+E-c+e+?

A

Possible genotypes include DCe/Dce, Dce/dCe, and DCe/dce

190
Q

What type of antibodies do patients produce in response to Rh antigens?

A

Patients produce IgG Rh antibodies.

191
Q

What testing method is required to detect IgG Rh antibodies?

A

The Indirect Antiglobulin Test (IAT) method is required to detect IgG Rh antibodies.

192
Q

What method is used in the lab for quick Rh grouping?

A

A fast Immediate Spin (IS) method is used for Rh grouping.

193
Q

How do manufacturers speed up Ag-Ab reactions in Rh testing?

A

They enhance Ag-Ab reactions by adjusting temperature, time, pH, ionic strength, and using protein to reduce zeta potential.

194
Q

What type of diluent is used in Monoclonal Anti-D reagents, and how is it similar to ABO reagents?

A

Monoclonal Anti-D uses a low protein diluent formulation similar to ABO reagents (6% bovine albumin).

195
Q

What is the class of Monoclonal Anti-D antibodies?

A

Monoclonal Anti-D antibodies are IgM.

196
Q

What is the purpose of using a blend of Monoclonal (IgM) and Polyclonal (IgG) Anti-D reagents?

A

The blend is used to detect the Weak D antigen.

197
Q

What is the advantage of using a low protein diluent in Rh typing reagents?

A

The low protein diluent does not promote false positive agglutination, which is associated with high protein D typing reagents.

198
Q

What combination of Rh antisera is commonly used at clinical sites?

A

A combination of two different Rh antisera, either Monoclonal or a blend of Monoclonal and Polyclonal.

199
Q

What Rh antisera are used at Michener?

A

Anti-D1 and Anti-D2 are used at Michener.

200
Q

What do QMPLS and AABB suggest regarding Rh antisera?

A

They suggest using two different types of antisera from different manufacturers or types.

201
Q

What is the role of the AABB in transfusion services?

A

The AABB is a professional organization that accredits and provides educational and technical guidance to transfusion services.

202
Q

When is an Rh control required?

A

Any manipulation of antisera requires a control.

203
Q

Why can protein media cause issues in Rh testing?

A

Protein media can cause a false positive result.

204
Q

What does Rh control contain, and what is it missing?

A

Rh control contains the same diluent as the reagent (6% bovine albumin) but no Anti-D.

205
Q

What is the purpose of performing an Rh control?

A

The Rh control is done to prove that the reaction is due to the Anti-D and not just the diluent.

206
Q

What result should Rh control always show for a valid test?

A

Rh control should always be negative for a valid test.

207
Q

When is Rh control added in cases of questionable results?

A

Rh control is added when only one reagent reacts and the other does not (e.g., Anti-D1 is 2+ but Anti-D2 is 0).

208
Q

What type of testing is needed for Weak D testing with very weak reactions?

A

IAT testing is needed for Weak D testing when there are very weak reactions.

209
Q

In which patient blood type is Rh control added as a precaution?

A

Rh control is added when the patient is AB Rh positive.

210
Q

When is Rh control set up for a patient typing as AB Rh Positive?

A

Rh control is set up when all their red cells react with all the antisera: Anti-A, Anti-B, Anti-A,B, Anti-D1, and Anti-D2.

211
Q

What does it mean if a patient’s cells are pan agglutinating with all antisera?

A

It means their red cells are reacting with all the antisera, which could indicate the need for further testing, including Rh control.

212
Q

What result must Rh control testing show to report valid ABO and Rh typing?

A

Rh control testing must be negative to report valid ABO and Rh typing.

213
Q

What must be done before reporting a group for an AB Rh Positive patient?

A

An Rh control tube must be added before reporting the blood group.

214
Q

What is the most common cause of a positive Rh control?

A

A positive Direct Antiglobulin Test (DAT), indicating an antibody already on the red cells.

215
Q

What is the resolution for a positive Rh control caused by a positive DAT?

A

Use an alternate Anti-D reagent, such as monoclonal, chemically modified, or saline Anti-D.

216
Q

What is another possible cause of a positive Rh control aside from a positive DAT?

A

Rouleaux or cold agglutinins.

217
Q

What is the resolution for a positive Rh control caused by Rouleaux or cold agglutinins?

A

Use washed red blood cells (3x washed RBCs).

218
Q

What could bacterial contamination of reagents or the specimen cause in Rh control testing?

A

It could cause a positive Rh control.

219
Q

What is the resolution if bacterial contamination is suspected in Rh control testing?

A

Repeat the test with a new sample or reagents.

220
Q

How can genetics influence D antigen development?

A

Genetics can influence the variation in the number of D antigens present on red blood cells.

221
Q

When does Weak D occur?

A

Weak D occurs when D antigens are very low in number or are slightly modified.

222
Q

How is Weak D similar to subgroups of the A blood group?

A

Weak D is similar to A subgroups in that it involves missing or altered epitopes.

223
Q

What is the order of the most to fewest D antigens in different genetic variations?

A

The order is: -D- > R²R² > R¹R¹ > R¹r or R⁰r > R¹r’ or R⁰r’.

224
Q

What is the first general type of Weak D, and what causes it?

A

Genetic Weak D, where the gene codes for fewer D antigens.

225
Q

What type of testing is usually needed for Genetic Weak D?

A

IAT (Indirect Antiglobulin Test) Weak D testing is usually required.

226
Q

Does Genetic Weak D usually produce Anti-D antibodies?

A

No, Genetic Weak D does not usually produce Anti-D antibodies.

227
Q

What is the second general type of Weak D related to the C antigen?

A

C Trans (positional) Weak D, where the C antigen is inherited in trans position to the D antigen.

228
Q

How does the trans position of the C antigen affect the D antigen?

A

It leads to weaker expression of the D antigen.

229
Q

Can monoclonal Anti-D detect C Trans Weak D?

A

Yes, monoclonal Anti-D can detect C Trans Weak D.

230
Q

Does C Trans Weak D usually produce Anti-D antibodies?

A

No, C Trans Weak D does not usually produce Anti-D antibodies.

231
Q

What is the third general type of Weak D?

A

Partial D or Mosaic D, where part of the Rh antigen is missing.

232
Q

What causes Partial D or Mosaic D?

A

It is caused by a mutated gene, leading to changes in amino acids and protein structure.

233
Q

How many variations of Partial D are there?

A

There are several variations of Partial D.

234
Q

How is Partial D or Mosaic D detected?

A

It can be detected by monoclonal Anti-D or may require Weak D testing (IAT).

235
Q

Can individuals with Partial D produce Anti-D?

A

Yes, individuals can make Anti-D to the part of the D antigen that is missing.

236
Q

How is Weak D generally detected in serological testing?

A

Antisera can generally detect Weak D even if it is weak.

237
Q

What result might be seen in the immediate spin method for Weak D?

A

There may be a weak positive result, but it is still considered Rh positive.

238
Q

What issue can arise during immediate spin testing for Weak D?

A

A discrepancy in testing may occur.

239
Q

What discrepancy might be found when automation is used for Weak D testing?

A

A discrepancy between D1 and D2 testing may occur in automated testing.

240
Q

What should be done if a patient’s results with Anti-D1 and Anti-D2 are negative (0) at immediate spin?

A

The patient should be called Rh negative, and no further testing is performed.

241
Q

What is the safest practice for giving blood to a patient who is Weak D but not detected?

A

It is safest to give them Rh-negative blood, even if they are Weak D.

242
Q

Why is it important to give Rh-negative blood to a patient who may have Weak D?

A

They could possibly be a Weak D mosaic that can produce Anti-D.

243
Q

What must be done if a donor has Weak D or a partial expression of the D antigen?

A

The donor must be typed for Weak D testing.

244
Q

What is the risk of giving Weak D donor blood to a Rh-negative patient?

A

The patient can potentially make Anti-D antibodies.

245
Q

What is the policy for Rh-negative donors regarding Weak D testing at CBS?

A

All Rh-negative donors must be typed for Weak D testing.

246
Q

What is the first step in Weak D policies for Rh typing?

A

Perform initial Rh typing on everyone

247
Q

What should be done if the immediate spin (IS) Anti-D is negative for an adult patient?

A

Stop further testing and result as Rh Negative.

248
Q

Who should undergo Weak D testing at CBS?

A

All donors should undergo Weak D testing at CBS.

249
Q

When should Weak D testing be performed on babies?

A

Weak D testing should be performed on Rh-negative babies of Rh-negative mothers.

250
Q

What is the result if Weak D testing is positive for donors and babies?

A

Donors and babies are called Rh Positive if Weak D testing is positive.

251
Q

What is the first step in Weak D IAT testing?

A

Start with routine testing using Anti-D1 and Anti-D2.

252
Q

What might happen if less antigen is present in Weak D testing?

A

Sensitization may occur without visible agglutination.

253
Q

What should be done after incubation in the Anti-D test?

A

Wash to remove excess antisera and add AHG (Anti-Human Globulin).

254
Q

What role does AHG play in the IAT method for Weak D testing?

A

AHG can display visual agglutination if sensitization has occurred.

255
Q

What should not be forgotten when performing the IAT Weak D test?

A

Do not forget to add the Rh Control (RhC) tube

256
Q

How many tubes are used in Weak D IAT testing, and what are they?

A

Three tubes: Anti-D1, Anti-D2, and Rh Control (RhC).

257
Q

What is the first step after setting up the tubes in Weak D IAT testing?

A

Perform an immediate spin (IS) and grade the reaction.

258
Q

At what temperature and for how long should the tubes be incubated in Weak D IAT testing?

A

Incubate at 37°C for 15 minutes.

259
Q

How many times should the tubes be washed to remove excess antibodies?

A

Wash the tubes 3 times to remove excess antibodies

260
Q

What is added after washing the tubes in Weak D IAT testing?

A

Add AHG (Anti-Human Globulin), spin, and read the results.

261
Q

Is checking under the microscope allowed in Weak D IAT testing?

A

No, checking under the microscope is not allowed.

262
Q

What should be added to all negative reactions in Weak D IAT testing?

A

Add Coombs Control Cells (CCC) to all negative reactions.

263
Q

What can cause a false positive in Weak D IAT testing?

A

In vivo coating of red cells with IgG antibodies can cause a false positive.

264
Q

What will the Rh control show if there is a false positive in Weak D testing?

A

The Rh control will be positive.

265
Q

Why does AHG react in a false positive Weak D test?

A

AHG will react with the IgG on the red cell surface, even if no Anti-D has attached.

266
Q

What is the result of Weak D testing if a false positive occurs?

A

The Weak D test will be invalid.

267
Q

What are some examples of situations that can cause a false positive in Weak D testing?

A

Examples include autoantibodies, maternal antibodies on fetal cells, and patient antibodies on donor cells.

268
Q

What is the interpretation of a Weak D test where Anti-D1, Anti-D2, and Rh control all show negative (0) reactions in the immediate spin (I.S.), 37°C incubation, and IAT phases?

A

The Rh type is Negative.

269
Q

What is the interpretation of a Weak D test where Anti-D1 and Anti-D2 show 4+ reactions in the IAT phase, and Rh control shows negative (0) reactions?

A

The Rh type is Positive (Weak).

270
Q

What is the interpretation of a Weak D test where both Anti-D1 and Anti-D2 show 4+ reactions in the IAT phase, and the Rh control also shows 4+?

A

The Rh type is Invalid. The positive reaction is likely due to another antibody attached to red cell antigens other than Anti-D.

271
Q

Who performs molecular testing to determine the type of Weak D?

A

Canadian Blood Services (CBS) performs molecular testing to determine the type of Weak D.

272
Q

Why is it important to conserve Rh-negative blood?

A

Rh-negative blood is in chronic short supply, so it is conserved for true Rh-negative and Weak D patients who can make Anti-D.

273
Q

Why must molecular testing differentiate between various Weak D types?

A

Differentiating genetically between various Weak D types helps in determining the best transfusion strategies.

274
Q

What is the goal of differentiating Weak D types through genetic testing?

A

The goal is to save Rh-negative blood for those who truly need it, including Weak D patients who might make Anti-D.

275
Q

What do variant genes result in on the D antigen?

A

Variant genes result in amino acid substitutions on the D antigen.

276
Q

Do most variant genotypes elicit the production of Anti-D?

A

No, most variant genotypes do not elicit the production of Anti-D.

277
Q

What is the CBS policy for molecular Weak D testing in prenatal patients?

A

Prenatal patients with discrepant, weak, or inconclusive serological RHD testing results, where RHD genotyping may modify their blood product or Rh Immune Globulin (RhIG) requirements.

278
Q

When is molecular Weak D testing indicated for patients likely to require chronic transfusions?

A

Molecular testing is indicated where RHD genotyping may modify their blood product requirements.

279
Q

When would molecular testing for Weak D be performed on patients who appear serologically D positive?

A

Testing is performed for patients who likely require transfusions with Anti-D but appear serologically D positive.

280
Q

What type of immune response do Rh antibodies elicit?

A

Rh antibodies are red cell immune.

281
Q

Do Rh-negative individuals automatically produce Anti-D?

A

No, Rh-negative individuals do not automatically produce Anti-D.

282
Q

Can Rh-negative patients safely receive Rh-positive red cells?

A

Yes, Rh-negative patients can safely receive Rh-positive red cells at least once.

283
Q

What type of antibody is Anti-D, and how does it affect donor red cells?

A

Anti-D is an IgG antibody, does not bind complement, and causes extravascular hemolysis of donor red cells.

284
Q

How long does it take for a primary immune response to Anti-D to occur?

A

The primary response typically occurs in 5-10 days.

285
Q

Why might an Rh-negative patient produce Anti-D after receiving an Rh-positive unit of blood?

A

The D antigen is very antigenic, and exposure may lead to Anti-D production.

286
Q

In what situations might an Rh-negative patient be given Rh-positive blood?

A

This may occur in emergency or trauma situations.

287
Q

What potential problem can arise with future transfusions if an Rh-negative patient produces Anti-D?

A

Problems arise with the next transfusion if Anti-D has been produced, as it may cause a transfusion reaction.

288
Q

When are C, E, c, or e antigens considered in transfusion selection?

A

These antigens are only considered if the patient has the corresponding antibody.

289
Q

In what special circumstances might antigen selection beyond Rh be considered?

A

Special consideration is given to sickle cell and thalassemia patients who require multiple transfusions.

290
Q

If the patient has Anti-e, which units
can they receive?
a) R2R2
b) R1R1
c) R1R2
d) R1r

A

a) R2R2

291
Q

Percentage of offspring who are Rh Negative
from a R1R1 mother and R1r Father?
a) 25%
b) 50%
c) 75%
d) 0%

A

d) 0%

292
Q

Which individual can develop Anti-c?
a) R1r
b) R1R1
c) r’r
d) rr

A

b) R1R1

293
Q

R1R1 patient transfused with an R2R2 pack cell. What
antibody can they develop?

A

they can develop Anti-c and Anti-E

294
Q

Which offspring is NOT possible from a mother who is R2r
and a father who is R1r
a) DcE/DcE
b) DCe/DcE
c) DcE/dce
d) dce/dce

A

a) DcE/DcE

295
Q

Convert the phenotypes to Possible Genotypes (FR and Wiener)
1) D+C-E-c+e+
2) D+C+E-c+e+

A

1) Dce/Dce RoRo
Dce/dce Ror

2) DCe/Dce R1Ro
DCe/dce R1r
Dce/dCe Ror’

296
Q

The test for the Weak D antigen involves:
a) The IAT method
b) The DAT method
c) Anti-Weak D Antisera
d) Anti-D antisera with the LISS potentiator

A

a) the IAT method

297
Q

Results of a weak D test on a patient with a positive direct
antiglobulin test would be:
a) Accurate if the check cells were positive
b) Unreliable because the immunoglobulins are already on
the cells
c) Reliable if high albumin Anti-D was used
d) False negative because the antibody was neutralized

A

b) Unreliable because the immunoglobulins are already on
the cells

298
Q

The Rh null phenotype is associated with:
a) Elevated D antigen expression
b) Increased Duffy antigen expression
c) The Bombay Phenotype
d) Red cell membrane abnormalities

A

d) Red cell membrane abnormalities

299
Q

Antibodies to the Rh blood group system antigens are
usually characterized as
a) Naturally occurring
b) Immune IgG
c) Immune IgM
d) Non red cell Immune

A

b) Immune IgG

300
Q

What is the likelihood that two heterozygous D positive
parents will have a D negative child
a) Less than 1%
b) Not Possible
c) 25%
d) 75%

A

c) 25%

301
Q

Anti-D was detected in the serum of a D positive person.
What is the possible explanation?
a) The antibody is an Anti-G
b) Compound antibody was formed
c) Regulator gene failure
d) Missing antigen epitope

A

d) Missing antigen epitope

Transfusion (8 decks)

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