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ASCP BB MT Test Study

Antibody Characteristics: Naturally Occurring ABO, Lewis, P1, MS, Lua
Antibody Characteristics: Clinically Significant ABO, Rh, Kell, Duffy, Kidd
Antibody Characteristics: Warm Antibodies Rh, Kell, Duffy, Kidd
Antibody Characteristics: Cold Antibodies M, N, P1
Antibody Characteristics: Usually only react in AHG Kell, Duffy, Kidd
Antibody Characteristics: Can react in any phase of testing Lewis
Antibody Characteristics: Enhanced by enzyme treatment Rh, Lewis, Kidd, P1
Antibody Characteristics: Not detected by enzyme treatment M, N, Duffy
Antibody Characteristics: Enhanced by acidification M
Antibody Characteristics: Show dosage Rh (other than D), MNS, Duffy, Kidd
Antibody Characteristics: Bind complement I, Kidd, Lewis
Antibody Characteristics: Cause in vitro hemolysis ABO< Lewis, Kidd, Vell, some P1
Antibody Characteristics: Labile in vivo & in vitro Kidd
Antibody Characteristics: Common cause of anamnestic response (delayed transfusion reaction Kidd
Antibody Characteristics: Associated w paroxysmal nocturnal hemoglobinuria Anti-P1
Antibody Characteristics: Associated w cold agglutinin disease & Mycoplasma pneumoniae infections Anti-I
Antibody Characteristics: Associated w infectious mononucleosis Anti-i
Ag-Ab Enhancement: Albumin 22% bovince serum albumin. Reduces net neg charge of RBCs, allows them to come closer together
Ag-Ab Enhancement: Low ionic strength solution (LISS) Lowers IS of suspending medium >allows ags &abs to move closer together more rapidly. Reduce inc time for IAT
Ag-Ab Enhancement: Polythyleneglycol (PEG) Inc ab uptake. Used for detection & ID of weak IgG abs.
Ag-Ab Enhancement: Enzymes Ficin & Papain most common. Reduce RBC surface charge by cleaving sialic acid molecules. M, N, S, Fya, Fyb ag destroyed
Antigens destroyed by enzymes M, N, S, Fya, Fyb
DAT Direct Antiglobulin Testing. Detects in vivo sensitization of RBC's by IgG ab. EDTA red cells. Application: HDFN, tf rxn, autoimmune hemolytic anemia, drug-induced hemolytic anemia.
DAT: False Positives Complement binding in vitro (RBCs from red top tube & broad-spec AHG) Septicemia Contamination of specimen Wharton's jelly in cord blood Over-reading Overcentrifugation
DAT: False Negatives Interruption in testing Contamination, improper storage, or outdating of AHG Failure to add AHG Neutralization of AHG from inadequate washing Dilution of AHG by residual saline Over- or undercentrifugation
IAT Indirect Antiglobulin Testing. Detects in vitro sensitization of RBCs by IgG ab. Serum, Plasma, RBCs Application: Ab screen, xmatch, RBC phenotyping, weak D testing
IAT: False Positives Cells w pos DAT Overcentrifugation
IAT: False Negatives Interruption in testing Contamination, improper storage, or outdating of AHG Failure to add AHG Neutralization of AHG from inadequate washing Dilution of AHG by residual saline Over- or undercentrifugation Over- or underincubation
Incom. XM Reactions: Neg ab screen, incom IS Possible Cause: ABO incompatibility (retype donor & recipient. XM w ABO-compatible donor.)
Incom. XM Reactions: 1 ab screening cell & 1 donor pos in AHG Possible Cause: Alloantibody (Identify ab. XM units neg for corresponding ag.)
Incom. XM Reactions: Ab screening cells & all donors except 1 neg at 37*C & in AHG. 1 donor pos in AHG only Possible Cause: Positive DAT on donor (perform DAT on unit. If pos, return to collecting facility.)
Incom. XM Reactions: Ab screening cells, donors, & autocontrol pos in AHG Possible Cause: Warm autoantibody (Best not to tf. If unavoidable, find 'least incompatible' unit. May require in vivo XM.)
Incom. XM Reactions: Ab screening cells, donors & autocontrol pos at 37*C, neg in AHG Possible Cause: Rouleaux (saline replacement technique)
Transfusion-Associated Infections Testing: HIV, Hep B, Hep C, HTLV-I and -II, Syphilis Hx: Malaria (Plasmodium RBCs), Babesiosis (Babesia RBCs), Chagas' disease (Tryppanosoma cruzi RBCs) Selected donor testing: Cytomegalovirus (LRP or CMV= for at risk pts. Testing & Hx: Sepsis
Acute Immunologic Transfusion Reactions: Hemolytic, intravascular Signs: Fever, chills, shock, renal failure, DIC, pain (chest, back, flank) Cause: Immediate destruction of donor RBCs by recipient ab Other: HGB in urine & serum, mixed field DAT
Acute Immunologic Transfusion Reactions: Febrile Signs: Temp up 1*C/2*F Cause: Anti-leukocyte abs or cytokines Other: Common. May premedicate with antopyretics (aspirin, acetaminophen).
Acute Immunologic Transfusion Reactions: Allergic Signs: Hives (urticaria), wheezing Cause: Foreign plasma proteins Other: Common. Treat w antihistamines, Tf Rxn not required.
Acute Immunologic Transfusion Reactions: Anaphylactic Signs: Pulmonary edema, bronchospasms Cause: Anti-IgA in IgA-deficient recipient Other: Rare, but dangerous. Treat w epinephrine. Tx w washed products.
Acute Immunologic Transfusion Reactions: Transfusion-Related Acute Lung Injury (TRALI) Signs: Fever, chills, coughing, respiratory distress, fluid in lungs, decrease BP within 6 hr of tf. Life Threatening. Cause: Unknown. Possible donor abs to WBC ags. Other: Most common cause of tf-related deaths in US. Reduce F plasma donors.
Acute Nonimmunologic Transfusion Reactions: Sepsis Signs: Fever, chills, dec BP, cramps, diarrhea, vomiting, muscle pain, DIC, shock, renal failure Cause: Bacterial contamination Lab: Pos gram stain & culture on unit
Acute Nonimmunologic Transfusion Reactions: Transfusion-associated circulatory overload (TACO) Signs: Coughing, cyanosis, diff breathing, pulmonary edema Cause: Too lg volume or too rapid rate of infusion Lab: None Other: Problem in children, cardiac & pulmonary patients, elderly, & those w chronic anemia
Acute Nonimmunologic Transfusion Reactions: Nonimmune hemolysis Signs: Variable Cause: Destruction of RBCs due to extremes of temp, addition of meds to unit Lab: Hemoglobinuria, hemoglobinemia Other:
Acute Nonimmunologic Transfusion Reactions: Hypothermia Signs: Cardiac arrhythmia Cause: Rapid infusion of lg amts of cold blood Lab: None Other: Use blood warmer for rapid infusions
Delayed Transfusion Reactions (Immunologic): Hemolytic, extravascular Signs: Fever, anemia, mild jaundice 2-14 days after tf Cause: Donor RBCs sens by rec IgG ab & removed from circulation Lab: Inc bili, m-f DAT, d hapto, d Hgb & Hct, pos ab screen Other: Maybe due to anamnestic resp. Kidd ab most com. Not life threat.
Delayed Transfusion Reactions (Immunologic): Alloimmunization Signs: None, unless subs exposed to same foreign ag Cause: Develop abs to for. RBC, WBC, PLT, FFP proteins after tf Lab: Ab to RBC detected in ABSC. Others need special testing Other: Use LRP for patients with WBC abs.
Delayed Transfusion Reactions (Immunologic): Transfusion-associated graft-vs-host disease (TA-GVHD) Signs: Rash, nausea, vomiting, diarrhea, fever, pancytopenia. Usually fatal Cause: Viable T lymphs in donor blood attack rec Lab: None Other: IRR - for babies, fetus, immunocompromised, transplants, blood from relatives, leukemia/lymphoma
Delayed Transfusion Reactions (Nonimmunologic): Iron overload Signs: Diabetes, cirrhosis, cardiomyopathy Cause: Build up of Iron in body Lab: Inc Serum Ferritin Other: Problem for pts rec repeated tf over long time (pts w thalassemia, sickle cell anemia, other chronic anemias)
TRXN Investigation: Signs and Symptoms TRXN Investigation: Fever, chills, resp distress, hyper/hypo tension, pain (back, flank, chest, abdom), pain at site of infusion, hives (urticaria), jaundice, hemoglobinuria, nausea/vomiting, abn bleeding, oliguria/anuria
TRXN Investigation: Specimens Needed TRXN Investigation: Pre-tf blood, post-tf blood, post-tf urine, segment from unit, blood bag with admin set & attached IV solutions
TRXN Investigation: Immediate Steps TRXN Investigation: Stop TF, Check all IDS and labels, Repeat ABO on post tf blood, visual check pre and post blood for hemolysis, DAT on Post tf blood (if POS, DAT on Pre)
TRXN Investigation: Signs of Hemolytic Rxn TRXN Investigation: Hemolysis in post but not pre (repeat post draw avoiding mechanical hemolysis). M-F agglutination in DAT on Post but not on Pre.
TRXN Investigation: Further steps if possible hemolytic rxn TRXN Investigation: Check HGB in 1st voided urine post tf. Repeat ABO & Rh on pre, post, and unit. Repeat ABSC on pre & post. AHG XM w pre & post.
TRXN Investigation: Addtl tests that may be performed TRXN Investigation: Haptoglobin (dec w hemolysis), gram stain & culture of unit, bilirubin 5-7 hrs after tf (sign of extravascular hemolysis), BUN & creatinine (sign of renal failure).
TRXN Investigation: Reporting of Transfusion-related fatalities TRXN Investigation: Must be reported to FDA Center for Biologics Evaluation & Research (CBER) by phone or e-mail ASAP
Neonate Testing (<4 months) ABO & Rh: ASBC: XM:
Hemolytic Disease of the Fetus and Newborn (HDFN)
Created by: anb060708



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