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Transfusion > Week 6 > Flashcards

Week 6 Flashcards

Antibody Investigation: Initial Panel & Enzyme & Selected Cells

1
Q

What antibodies does the Tube IAT method detect?

A

Tube IAT detects both cold and warm antibodies.

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2
Q

What antibodies does the MTS method primarily detect?

A

MTS usually detects warm IgG antibodies.

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3
Q

At what stages is the Tube IAT method read?

A

It is read at Immediate Spin (IS), 37°C, and AHG stages.

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4
Q

What can the MTS method detect besides warm antibodies?

A

MTS may detect very strong cold antibodies (MF).

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5
Q

What type of crossmatching is used with the Tube IAT method?

A

Full IAT crossmatching is used.

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6
Q

What type of crossmatching is used with the MTS method?

A

Full Crossmatch (IAT) is used.

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7
Q

When is the prewarm technique used in Tube IAT?

A

The prewarm technique is used if a cold antibody is present.

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8
Q

Why is it necessary to identify all antibodies in a positive antibody screen, regardless of their significance?

A

Because if multiple antibodies are present, one antibody can mask the other.

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9
Q

What type of cells are used to test serum/plasma in a positive antibody screen?

A

Panel cells with known phenotyped red cells.

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10
Q

How many screening cells are typically used in a positive antibody screen?

A

Usually 2 or 3 cells, which are donor cells phenotyped positive for all significant antibodies.

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11
Q

What is the minimum number of cells in a panel cell test, and why?

A

A minimum of 10 cells, to identify patterns and include a combination of heterozygous and homozygous cells for all significant antibodies.

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12
Q

What is the purpose of an auto-control cell in an antibody screen?

A

To test the patient’s cells with their own plasma, which helps detect an autoantibody.

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13
Q

How are allo-antibodies usually acquired?

A

Through exposure during transfusion or pregnancy.

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14
Q

What is a common cause of auto-antibody production?

A

Secondary to infections or other diseases.

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15
Q

What is the primary classification for auto-antibodies not related to external factors?

A

Primary idiopathic autoimmune.

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16
Q

How do auto-antibodies react in antibody screening panels?

A

They are non-specific and can react with all cells in the panel.

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17
Q

Why is patient history and diagnosis important in antibody investigation?

A

It helps in understanding potential antibody presence and disease associations.

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18
Q

What can happen to previously identified antibodies over time?

A

They can sometimes fall to below detectable levels.

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19
Q

What is the difference between non-red cell immune and red cell immune antibodies?

A

Non-red cell immune antibodies are unrelated to transfusions or pregnancy, while red cell immune antibodies are related to these factors.

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20
Q

When should phenotyping be avoided in antibody investigation?

A

If the patient has been transfused within the last 3 months.

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21
Q

When can elution testing be performed in antibody identification?

A

Only if the patient has been transfused within the last 3 months.

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22
Q

What is the purpose of setting up a panel of cells along with an auto-control in antibody investigation?

A

To examine reactions and exclude or eliminate antibodies not present, based on reactions with panel cells.

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23
Q

What does a negative reaction with panel cells indicate in antibody investigation?

A

It indicates that no antigen or antibody reaction is present, allowing for the exclusion of certain antibodies.

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24
Q

What does it mean if many cells are positive in an antibody panel test?

A

It suggests multiple antibodies or an antibody to a high-incidence antigen.

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25
Q

What does it indicate if only a few cells are positive in an antibody panel test?

A

It may indicate an antibody to a low-incidence antigen or a weak antibody showing dosage.

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26
Q

What does variation in reaction strength suggest in an antibody panel test?

A

It indicates an antibody exhibiting dosage.

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27
Q

What cells should you examine when applying elimination rules in antibody investigation?

A

Examine the non-reacting cells.

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28
Q

What is “Reverse Elimination Logic” in antibody investigation?

A

It is a process where if a panel cell with a strong antigen (homozygous expression) does not react with the patient’s plasma, the antibody to that antigen is not present in the plasma.

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29
Q

What should you look for in reactions when using elimination rules?

A

Look at the reactions that are 0 (negative).

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30
Q

What does a negative reaction with a strongly expressed antigen on a panel cell indicate?

A

It indicates that the antibody to that specific antigen is not present in the patient’s plasma.

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31
Q

What is required to rule out Anti-D, Anti-Lea, and Anti-Leb antibodies?

A

One non-reacting positive cell.

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32
Q

What is required to rule out antibodies such as Anti-C, -E, -c, -e, -K, -k, -Fya, -Fyb, -Jka, -Jkb, -M, -N, -S, and -s?

A

One non-reacting homozygous cell.

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33
Q

How can Anti-K be ruled out if there are no homozygous cells on panels?

A

With two heterozygous cells.

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34
Q

What is required to rule out Anti-C and Anti-E in the presence of Anti-D?

A

Two non-reacting heterozygous cells.

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35
Q

What is needed to rule out Anti-C and Anti-E if RhIg was transfused?

A

One non-reacting heterozygous cell.

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36
Q

What is required to rule out Anti-P1?

A

Two non-reacting P1+ cells.

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37
Q

Why is an antibody that does not react with a heterozygous cell not fully eliminated?

A

Because it could be showing dosage, so it is listed under the Least Likely list of antibodies.

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38
Q

How should antibodies that are less likely to be present due to non-reacting heterozygous cells be categorized?

A

They should be listed under the Least Likely list of antibodies.

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39
Q

What list is created after reviewing the panel and performing eliminations on homozygous cells?

A

A Possible Antibody List.

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40
Q

Where do antigens in a heterozygous state that did not react go in the antibody investigation process?

A

They go on the Least Likely List (as dosage may be present).

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41
Q

What two lists should be created during the antibody investigation process?

A

The Most Likely List and the Least Likely List.

42
Q

What should be done with positive reactions in the antibody investigation process?

A

Review positive reactions and look for a pattern.

43
Q

When reviewing the Most Likely List, what additional test might aid in detection?

A

An enzyme panel.

44
Q

What is required if the auto control is positive?

A

Absorption or elution testing is required.

45
Q

What must be done to the patient cells to confirm they lack the antigen of an antibody they can make?

A

Phenotype the patient cells.

46
Q

What should be done if no pattern is detected in the antibody investigation process?

A

Use the process of elimination, as multiple antibodies may mask each other’s presence.

47
Q

What are some special techniques that can be used after the initial panel?

A

Neutralization techniques, absorption and elution, and cold panels.

48
Q

Which special technique might involve modifying antibodies to reduce reactivity?

A

Neutralization techniques.

49
Q

What is the purpose of absorption and elution in antibody identification?

A

To separate or concentrate specific antibodies for clearer identification.

50
Q

What is a “cold panel” in antibody identification?

A

A panel designed to detect cold-reactive antibodies.

51
Q

How many panels do most labs have for antibody identification?

A

Most labs have at least 2 or 3 different panels.

52
Q

Why is it important to check the lot number of cells and the Antigram in antibody identification?

A

Because the results are lot-specific.

53
Q

Why should you look at different panels when identifying antibodies?

A

To select cells that will help confirm or eliminate possible antibodies.

54
Q

What type of cells are required in antibody panel testing to confirm results?

A

Homozygous cells.

55
Q

What is the purpose of using selected cells in antibody identification?

A

Selected cells help to eliminate or confirm the presence of a particular possible antibody.

56
Q

Why might selected cells be preferred over setting up another entire panel?

A

Using selected cells is cheaper and faster than setting up another entire panel.

57
Q

What effect does enzyme treatment have on some antigens?

A

Some antigens are destroyed, while others are enhanced or unaffected.

58
Q

Which blood group antigens are destroyed by enzyme treatment?

A

Duffy and MNSs blood groups.

59
Q

How do manufacturers indicate which antigens are destroyed by enzymes?

A

Antigrams show destroyed antigens as shaded, depending on the manufacturer.

60
Q

What can disappearing reactions indicate in enzyme-treated panels?

A

The presence of at least one antibody that has been destroyed by enzymes.

61
Q

When should you set up an enzyme-treated panel in antibody testing?

A

If you suspect that one of the antibodies includes Duffy or MNSs in the mixture.

62
Q

Where should suspected antibodies ideally be listed before setting up an enzyme-treated panel?

A

In your “Most Likely List.”

63
Q

With what should the enzyme-treated panel be set up?

A

The patient’s plasma.

64
Q

What can happen to reactions in an enzyme-treated panel?

A

Reactions may get stronger, disappear, or remain unchanged.

65
Q

Where should results from enzyme reactions be recorded?

A

On the same Antigram sheet.

66
Q

What should you compare when analyzing enzyme-treated panels?

A

The reactions before and after enzyme treatment.

67
Q

What is the next step if an antibody is not destroyed by enzymes?

A

Continue to eliminate antibodies that are not destroyed by enzymes.

68
Q

When can enzyme panel results be used for exclusion purposes?

A

When the antigen is not destroyed by the enzyme.

69
Q

Which antibodies should NOT be ruled out using enzyme panel cells?

A

Fya, Fyb, M, N, S, and s antibodies.

70
Q

When can an antibody be excluded if the patient is positive for the antigen?

A

Only if the auto control is negative.

71
Q

When can phenotyping be performed on a patient?

A

Only if the patient has NOT been transfused within the last 3 months.

72
Q

Why is the IAT method of phenotyping invalid if the DAT is positive?

A

Because it indicates antigen and antibody sensitization in vivo.

73
Q

What should be used if molecular methods are available in phenotyping?

A

Determine the genotype of the patient.

74
Q

Which sample should be used for phenotyping in the investigation of a delayed transfusion reaction?

A

The pre-transfusion sample, not the post-transfusion sample.

75
Q

Which panel should be used if the antibody mixture includes Duffy and MNSs systems?

A

The enzyme panel.

76
Q

Which blood group systems might require the use of selected cells after the initial panel?

A

Rh, Kidd, Kell, and Lewis systems.

77
Q

What is the next step after using selected cells for Rh, Kidd, Kell, and Lewis systems?

A

Perform phenotyping to confirm.

78
Q

What is the purpose of the neutralization or inhibition technique in antibody identification?

A

To neutralize or inhibit the suspected antibody from reacting with the same red cell antigens on panel cells.

79
Q

How is neutralization achieved in antibody testing?

A

By mixing the serum/plasma with a fluid that contains the soluble antigen for the suspected antibody.

80
Q

What happens when an antibody reacts with the soluble form of its antigen in neutralization testing?

A

The antibody is neutralized or inhibited and will not react with the same red cell antigens on panel cells.

81
Q

List some antigens that can be neutralized in antibody testing.

A

A, B, H, Lea, Leb, P1, I.

82
Q

What is the result of using the neutralization or inhibition technique in antibody testing?

A

The antibodies will no longer react with the panel cells.

83
Q

Which antibodies can be neutralized to prevent interference in the identification of clinically significant antibodies?

A

Anti-Lea, -Leb, -P1, and -I.

84
Q

What reagent can be purchased to inhibit antibodies to Lewis antigens?

A

Soluble Lewis substance reagent.

85
Q

What can neutralize Anti-P1 antibodies?

A

Hydatid cyst fluid.

86
Q

What substances are used to inhibit Anti-P1 antibodies?

A

Pigeon droppings and turtledove’s egg whites.

87
Q

Is the neutralization or inhibition test commonly performed?

A

No, it is not a common test.

88
Q

When is absorption and elution particularly useful in antibody identification?

A

When more than one antibody is suspected, or if there is an antibody to a high-incidence antigen.

89
Q

What is absorption in antibody testing?

A

The process of removing an antibody from the plasma (often used interchangeably with adsorption).

90
Q

What is adsorption in antibody testing?

A

The process of adding a specific antigen so that the antibody can attach to it and be removed from the plasma.

91
Q

What is elution in antibody testing?

A

The process of removing an antibody bound to the cells, often used when autoantibodies are present or in cases of transfusion reactions.

92
Q

Under what condition can elution be performed on a patient?

A

Only if the patient has been transfused within the last 3 months.

93
Q

Why might you need to separate antibodies in a mixed antibody case?

A

To see the reactions clearly or to exclude other antibodies.

94
Q

What techniques are used if two warm antibodies are present in plasma?

A

Adsorption and elution techniques.

95
Q

What technique is used if one possible antibody (such as Lewis or P) can be inhibited?

A

Neutralization techniques.

96
Q

For which antibodies can neutralization techniques be particularly useful?

A

Lewis and P antibodies.

97
Q

What technique can be used to destroy Duffy antigen binding sites if Duffy, Kidd, Kell, or Rh antibodies are suspected?

A

Enzyme-treated panel cells.

98
Q

What happens to Duffy reactions when using enzyme-treated panel cells?

A

Reactions of Duffy will disappear, while other antibody reactions will remain.

99
Q

Which technique can be used to remove Lewis antibodies if Lewis and OBG antibodies are suspected?

A

Neutralization techniques.

100
Q

What method can be used if Kidd, Rh, and Kell antibodies are suspected?

A

Use selected cells.

101
Q

When should adsorption and elution techniques be used in antibody identification?

A

Only if necessary.

102
Q

What is phenotyping used for in antibody identification?

A

To confirm the identity of the antibody present.

Transfusion (8 decks)

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