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Blood Bank 6-7

A practice test for Blood Bank chapters 6-7 DelTech Owens

The Kell blood group has which 2 major antigens? (24 exist in total) K(or K1) and k (or K2/cellano)
Which of the 2 Kell antigens is more immunogenic? K or K1
The K and k antigens are __. antithetical
Two other important sets of antigens in the Kell group are ? Kp and Js
Kpa and Kpb are Kell antigens, but one is of higher frequency (99%). Which one? Kpb
Jsa and Jsb are Kell antigens, but which one is higher frequency (80%-100%)? Jsb
The disulfid-bonded regions on the glycoproteins of Kell antigens make them sensitive to __ reagents. sulfhydryl reagents
Someone who is Kell null (K0K0) can develop anti-Ku, which is on RBCs that have __ antigens. Kell
Another set of Kell antigens are KEL11 and KEL17. Which is the low-incidence allele? KEL17
Antibodies to Kell are of which type? IgG
Kell antibodies are RBC stimulated, so they can develop as a result of __ or __. pregnancy or transfusion
Kell antibodies agglutinate best in which test? IAT (indirect antiglobulin test)
Do Kell antibodies bind complement? not usually
Kell antibodies are associated with what 2 conditions? HTRs (hemolytic transfusion reactions) and HDFNs (hemolytic disease of the newborn)
Kell antibodies have no effect when treated with ? enzymes
Which Kell antibody is the most common? anti-K (K1)
Kx antigens are not genetically similar to Kell antigens. But how are they related? phenotypically
Anyone lacking Kx antigens may demonstrate RBC abnormalities called ? McLeod phenotype
McLeod phenotype (or McLeod syndrome) is often seen in ? males (inherited on the X chromosome)
What abnormalities increase in cases of McLeod syndrome? Acanthrocytes and reticulocytes
What RBC qualities are decreased by McLeod syndrome? 1. Water permeability 2. RBC survival
Name 3 symptoms of McLeod syndrome. 1. RBC abnormalities 2. Muscle/neurological defects 3. Raised creatine kinase
McLeod syndrome is associated with __ __ disease. chronic granulomatous disease
People with chronic granulomatous disease (due to McLeod Syndrome) have impaired phagocytes that can __ but cannot __ invaders. can engulf but cannot kill invaders
Like the Kell blood group system, the antigens for the Duffy blood group system are well developed at __. birth
Can Duffy antigens be destroyed by enzymes? Yes
What are the 2 codominant antigens/alleles for Duffy? Fya and Fyb
The Duffy (Fya and Fyb) antigens are important for __ purposes. transfusion
Anti-Fya and anti-Fyb antibodies are of which antibody class? IgG
Do Duffy antibodies bind complement? No
Do Duffy antibodies react with enzyme-treated RBCs? No
Like many other blood group antibodies, production of Duffy antibodies (anti-Fya and anti-Fyb) can be stimulated by a __ or __. transfusion or pregnancy
Most members of which group of Americans have Fya or Fyb? African Americans
What kind of parasites will not invade cells that are negative for Fya or Fyb? Malarial parasites (Plasmodium)
Fya or Fyb act as receptors for the malarial __ to attach to the RBC. merozoite
The Fya/b phenotype is often found in people from west of central __. Africa
What are the 3 antigens in the Kidd blood group system? Jka, Jkb, Jk3
Jk3 is present whenever what is present? Jka and Jkb
People who are null for the Kill (Jk*) phenotype are usually from where? Far East or Pacific Islands (rare)
People who are Kidd null may produce antibodies for ? Jk3
Kidd null RBCs are resistant to ? 2M urea
Anti-Jka and anti-Jkb are of which antibody class? IgG
Can Kidd antibodies bind complement? Yes! (Most IgG abs can't bind complement or only bind it very poorly)
Kidd antibodies can cause __ and __. HTRs (hemolytic transfusion reaction) HDFN (hemolytic disease of the newborn)
Kidd antibodies usually appear with other __ when detected. antibodies
Jka has a weak reaction in testing called ? evanescence
What blood group antigens are weakly expressed on cord blood cells? Lutheran
Lutheran antigens are (high or low?) incidence antigens. high
There are 19 Lutheran antigens, but the primary ones are called ? Lua and Lub
Are Lutheran antigens effected by enzymes? no
Anti-Lua is of what class of antibody? IgM and IgG
Anti-Lua reacts best at ? room temp or refrigerator temps
Anti-Lua and anti-Lub often have a __ pattern when seen in vitro. mixed-field
Is anti-Lua considered clinically significant? no
Anti-Lub is rare because so many people have the __. antigen
What class of antibody is Lub? IgG
Anti-Lub reacts best at which phase? AHG
Is anti-Lub clinically significant? yes
Lewis B antigens can be found in plasma and in __. secretions
Lewis antigens adsorb onto the __ __. RBC membrane
Are Lewis antigens present at birth? no
Lewis antigens can sometimes carry over from the IS phase into what phase? AHG
Lea and Leb are not __. alleles
The Lewis blood group system needs all three of which genes to be present? Hh, Se, Le
Will le, h, and se genes produce Lewis antigens? no
Lewis antibodies belong to which class? IgM
Are Lewis antibodies clinically significant? no
Agglutination can occur with Lewis antibodies during which phases? All of them; Is, 37C, AHG
Enzymes can __ anti-Leb reactivity. enhance
Can anti-Lea bind complement? Yes - it's IgM
What can confirm the presence or eliminate reactions caused by the Lewis antibody? Neutralization
The I blood group system: adults have the __ antigen while infants have the __ antigen. adults have I, infants have i
I antibodies (are or are not?) clinically significant? are NOT
Anti-I is of which class of antibody? IgM
How do you avoid reactions with anti-I in vitro? prewarming 37C (they are cold reacting)
Anti-I is stronger reacting with which the RBCs of which blood group type? O (many H sites) and A2
Autoanti-I is associated with what diseases? 1. Mycoplasma pneumoniae 2. cold hemagglutinin
Anti-i is associated with what diseases? Infectious mononucleosis, lymphoproliferative disease, and (sometimes) cold hemagglutinin disease
P1 phenotypes have P1 antigens and what other antigen? P
The P antigen is part of the __ blood group system. Globoside (they are also part of their own, the P blood group system)
Can P2 patients have the P1 antibody? yes
What class of antibody does P1 belong to? IgM
Anti-P1 can be neutralized by __ __. P1 substance
Autoanti-P is belongs to which class of antibody? IgG (Donath-Landsteiner antibody)
Donath-Landesteiner antibody binds with P1 or P2 cells at low __. temperatures (in vitro)
Autoanti-P may appear in children after __ __. viral infection
Antigens similar to P/Globoside antigens can be found in nature and used to neutralize the effect of anti-P. Name 3 of them. (This was mentioned in class, but is not in our outline.) Pigeon eggs, bird droppings, hydatid cyst fluid
Homozygous inheritance enhances agglutination in people who are ? (Applies to MNS blood group system.) M+N- or M-N+
Besides M and N, what other types are part of the MNS blood group system? S,s,U
M antibodies belong to what class of antibody? IgM AND IgG
MNS antibodies are rarely encountered in __. HDFN
Variable reactions of anti-M depend on __ __. reagent pH
Anti-N belongs to which class of antibodies? IgM
N-like antibodies can form in __ patients. dialysis
Dialysis patients with N-like antibodies formed from formaldehyde-sterilized dialysis instruments need what kind of blood in cases requiring a blood transfusion? N-negative
Anti-U can be found in patients who are ? S and s negative (also, if they are U negative)
The test used to detect antibodies is called an __ __. antibody screen
Antibody screens are used in cases involving what 4 things? 1. transfusions 2. pregnancy 3. patients who've had transfusion reactions 4. blood and plasma donors
An antibody screen uses a patient's __ against reagent RBCs to detect antibodies. plasma (plasma is preferred, but serum can also be used)
Antibody screens are used when a patient is found to have __ antibodies. unexpected
Unexpected antibodies develop as a result of RBC stimulation. This means what 2 things can stimulate their production? Transfusion reactions and HDFN
Can unexpected antibodies be both IgG and IgM? yes
Antibody screens use a patient's plasma against reagent __ to detect antibodies. RBCs
IgG antibodies react best at __C. 37C
IgG antibodies react best during which phase? AHG/IAT/Coombs (they all mean the same thing)
Clinically significant antibodies (usually IgG) are associated with __ and __. HTRs (hemolytic transfusion reactions) and HDFN (hemolytic disease of the newborn)
When performing an antibody screen, the patient's plasma or serum is incubated with __ __. screening cells
After incubating the patient's plasma with screening cells, an IAT is performed using __ reagent. AHG
Incubation during an antibody screen refers to which phase? 37C
Antibody screens use a patient's plasma or serum against reagent RBCs to detect __. antibodies
IgG antibodies usually won't be detected during which phase? IS (immediate spin)
Screening cells are single or pooled donor cells of which type? O
Group O cells are used so what 2 things will not react? anti-A and anti-B
Screening cells come in sets of how many vials each? 2 or 3
How many antigens are required to be tested when running an antibody screen? 18 (remember that all the types will be listed, so don't bother memorizing them as a list)
Screening cells come with a sheet of paper that lists the antigens present in each vial of screening cells. The paper is called an __. antigram
What do you use to test a patient's serum with his own RBCs? an autocontrol
When running an autocontrol, the autocontrol is incubated with the __ __ or __ __. antibody screen or antibody panel
If the autocontrol is positive, the lab tech may run a__ to detect in vivo coating. DAT
When a DAT is used to check an autocontrol, the DAT consists of what? Patient cells plus AHG
The AC and the DAT, when combined, can help determine if the antibodies are directed against which of 2 things? 1. patient's cells (autoantibodies), or 2. transfused cells (alloantibodies)
Substances that are used to enhance an antigen-antibody reaction for identification purposes are known as ? potentiators
Name 5 potentiators. 1. Saline 2. LISS 3. BSA 4. PEG 5. Proteolytic enzymes
Saline is a potentiator, but it only helps if the sample is ? incubated for a long time
LISS stands for low-ionic-strength solution. What LISS is used in our class? N-Hance and Immuno-Add
BSA stands for bovine serum albumin. Why isn't this potentiator used more often? It takes a long time.
What antibody class is most enhanced by PEG (polyethylene glycol)? Rh
Proteolytic enzymes are potentiators that can do what to antigens? destroy some of them
LISS best enhances what kind of antibodies? cold autoantibodies
Some weak __ antibodies may be missed when using LISS as a potentiator? anti-K
When using LISS, the reagent and plasma or serum must be used in __ amounts. equal
LISS is sensitive, cheap, and allow for a __ incubation time. shorter
BSA effects the second stage of agglutination and does not enhance ? warm autoantibodies
BSA needs a long incubation period (30 mins) and is not very sensitive for most antibodies except ? Rh
PEG enhances __ __. warm autoantibodies
PEG usually works best when which version of it is used? monospecific/anti-IgG AHG (not anti-IgG, -C3d AHG)
PEG may require extra __ and cannot provide readings at __ C. extra washing, no readings at 37C
Ficin/papain potentiators eliminate the reactivity of which 6 antigens? Fya, Fyb, M, N. S and s are variable.
Ficin/papain potentiators enhance which antibodies? Rh, JK, LE, P1
Ficin enhances what autoantibodies? cold and warm
Ficin should not be used __. alone (use other methods along with it)
Weak anti-K may be missed by gel technology due to __-suspended red cells. LISS
Both gel technology and solid phase technology void __ __ antibodies and can be automated. cold reactive
In blood banking, it is always important to check the patient's __. history
Mixed RBC populations from a previous transfusion can remain for up to how long? 3 months
What else is important to learn besides patient history? race, age, diagnosis, other diseases
An __ __ is just an extended version of an antibody screen. antibody panel
Each panel cell is __ typed. antigen
The antigram lists the __ of each panel. phenotypes
A negative autocontrol indicates __. alloantibodies
A positive autocontrol AND a DAT indicate what kind of antibodies? autoantibodies or alloantibodies from a recent transfusion
A positive autocontrol and a negative DAT indicate what? a false positive
Which antibodies react at room temp and during the IS phase? anti-Lea, anti-Leb, anti-M, anti-N, anti-I, anti-P1
Reactions at different phases may indicate involvement by what class of antibodies? both IgM and IgG
Reaction strength is related to __. dosage
Reactions with varying strengths indicate what? multiple antibodies
The rule of 3 says you should have what when recording a panel? 3 pos and 3 negs
When interpreting a panel, cells that are heterozygous should NOT be crossed out because the antibody may be too __ to react. weak
What happens if the rule of 3 does not work? additional panel cells should be used
If the patient has been transfused, what should be done before phenotyping? RBC separation techniques
Dithiothreitol is often used to denature __ antigens. Kell
Proteolytic enzymes can destroy __ and __ antigens. Duffy and MNS
Proteolytic enzymes will enhance __, __, and __ antigens. Rh, Kidd, Lewis
You should suspect an alloantibody to a high-fequency antigen (98% of population) is most panel cells are __. positive
HTLAs stand for ? high-titer, low-avidity antibodies
HTLAs are antibodies to high frequency antigens that react __. weakly
HTLAs react at what phase? AHG
Do HTLAs cause tranfusions reactions or HDFN? no
What do you need to test an HTLA that is reacting weakly? a higher titer or concentration of antibodies
You should suspect antibodies to low fequency antigens when the screen is __ and the crossmatching is __. screen is negative, crossmatching is positive
You can enhance weak IgG antibodies by repeating the procedure with a different __. enhancement (try something you haven't tried yet if it isn't working)
You can enhance IgG antibody reactions by increasing the __ to __ ratio. serum to reagent/cell
You can __ the sample longer to enhance weak IgG antibody reactions. incubate
If the panel cells aren't revealing the presence of the weak IgG antibodies, you can try using __ __ from a new panel. different cells
If you need to enhance weak IgG antibodies, you can check the antigen __. dosage
Another way of enhancing weak IgG antibodies is to __ the patient if he has not been recently transfused. phenotype
Cold alloantibodies are IgM and react during the __ phase; they sometimes also react during the __ phase. they react during the IS crossmatching phase, and sometimes at the 37C phase
Are cold alloantibodies clinically significant? no
Which cold alloantibodies have variable reactions? anti-P1, anti-M, anti-N
To enhance cold alloantibody reactions, you should incubate them below __ temp. room
How do you avoid cold alloantibody reactions so other, clinically significant reactions can be detected? neutralization of alloantibodies
If the AHG phase is positive, should you use check cells? No - check cells are also positive
__ techniques are usually performed to remove autoantibodies. Adsorption
Cold autoantibodies may occur in patients with a history of what 3 things? 1. mild anemia 2. Mycoplasma pneumoniae 3. infectious mononucleosis
Most cold autoantibodies are of what 3 groups? anti-I, anti-H, anti-IH
How can you ID anti-I, anti-H, or anti-IH autoantibodies? cold panel
Cord cells are negative for __ antigens but positive for __ antigens. negative for I, positive for i
I is present in all __ cells. adult
If all antigens are positive during the immediate spin (IS) phase, then __ autoantibodies could be to blame. cold autoantibodies
One way to avoid cold autoantibody reactions is to skip which of phase? IS - go straight to 37C and keep the sample warm
One way to avoid cold autoantibody reactions is to use what instead of LISS? 22% bovine serum
One way to avoid cold autoantibody reactions is to prewarm all tubes to ? 37C
When prewarming tubes, what should you avoid? washing with warm saline
If all else fails when trying to avoid cold autoantibody reactions, what should you do? use adsorption techniques
One adsorption technique is called RESt (rabbit erythrocyte stroma). It removes __ antibodies. IgM/cold
One problem with RESt is that may also adsorb __ and other IgM antibodies, which can lead to hemolysis. anti-B
One adsorption technique is called cold autoadsorption. Patient RBCs are used to remove cold autoantibodies to determine if __ antibodies are present. allotransfused
One adsorption technique is called warm autoadsorption. It works like cold autoadsorption techniques, but removes __ autoantibodies. warm (instead of cold)
Cold autoadsorption and warm autoadsorption should not be used if the patient has been recently __. transfused
Another adsorption technique is called differential adsorption. It uses known phenotyped RBCs to separate __. specificities (like warm autoantibodies from alloantibodies or alloantibodies with several specificities)
Differential (allogeneic) adsorption may also adsorb __ __ allantibodies. high frequency
Can you use cold autoadsorption with a sample from a patient who received a blood transfusion just 4 months ago? Yes - less than 3 months would be no
Which is more common: cold or warm autoantibodies? warm
Warm autoimmune hemolytic anemia may be idiopathic or the result of what 2 things? 1. disease 2. drug
Like the autocontrol, most panel cells will be __ when warm autoantibodies are present. positive
Using __ __ decreases the reactivitiy of warm autoantibodies. 22% albumin
What autoimmune condition can cause warm autoantibodies? Lupus
Can you transfuse a patient if unidentified, warm autoantibodies are present? no - they react at body temp, so they will react in vivo if the wrong blood type is given
Most warm autoantibodies are directed to the __ system. Rh system, especially toward the e antigen
Patients with warm autoantibodies will have __ and the __ antigen. anti-e and the e antigen
Warm autoantibodies will have a positive __. DAT
How can you increase donated RBC survival time in patients with warm autoantibodies? e-negative (because patient will anti-e)
__ can cause formation of warm autoantibodies. Medication
Drug induced autoantibodies will stop reacting when the RBCs affected by the drug have left the patient. This will take how long? 2-3 months after last drug dose
Name some commonly taken drugs that can cause warm autoantibodies to develop if the drug is taken for a long time. 1. Methyldopa 2. Cephalosporin 3. Penicillin 4. nonsteroidal antiinflammatory drugs
To ID antibodies when the DAT is positive, the IgG must be detached using the __ technique. elution
An eluate is used in an __ __ to identify an antibody. antibody panel
Is the elution technique always effective in all cases? no
Which eluate lowers the pH of the sample to remove the antibody? Glycine acid
Another elution technique involves heating to __C. 56C
An adsorption technique for removing attached antibodies involves dithiothreitol (DTT). Sometimes, DTT is combined with enzymes. This is called ? ZZAP
Treating cells with __ __ will disassociate the IgG from the RBCs without harming the antigens. chloroquine diphosphate
Created by: IsaacJ