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Blood Banking Review
Immunohematology
| Question | Answer |
|---|---|
| What is Dosage? | When stronger agglutination is seen when a red cell antigen is expressed from homozygous genes. |
| What are the most common blood systems to show dosage? | Kidd, Duffy, Rh and MNSsU (Kell occasionally) |
| How are Blood systems catagorized in terms of Enzymes? (i.e. Enzyme enhanced, Enzyme decreased or Enzyme unaffected)? | Enhanced (ABO, Lewis, P, Rh, Kidd); Decreased (MNSs, Duffy) Unaffected(Kell) |
| What is the difference between a warm and a cold antibody? | Warm: IgG, Requires exposure to the Antigen, Causes HDN/ HTR, Clinically significant Cold: IgM, Naturally occuring, (((No HDO/ HTR's and NOT significant))) EXCEPT ABO!!! |
| What does clinically significant refer to? | -Causes HTR or HDN - Most are warm reactive (37C or IAT) - if "Cold reactive" or RT reactive, they are most insignificant - Usually IgG (warm) vs IgM (cold) - IgM's are "naturally occurring", i.e. NOT due to transfusion/ or pregnancy |
| Which sugars are associated with each Antigen: A, B and H? | A: N-acetyl galactosamine B: Galactose H: Fucose |
| what is the order of relative amounts of H antigen present on a RBC, by blood group? | 0>A2>B>A2B>A1>A1B |
| What do each of the following Lectin's indicate? A: Dolichos biflorus B: Ulex europaeus C: Vicea graninea | A: A1, Sda B: H C: Vicea Graninea |
| What are the Big 4 types (most common) for Whites and Blacks? | Whites: R1>r>R2>Ro Blacks: Ro>r>R1>R2 |
| Which Ab's are clinically significant? | Kell, Duffy, Kidd, SsU, P, Pk, Lub |
| What alleles does the Kell blood group contain? What are the frequencies for each? | K(9%/2%)/k(91%/ 98%) Kpa (2.3%/ Rare)/ Kpb (100%/ 99%), Jsa(Rare/ 20%)/ Jsb(100%/ 99%) |
| What alleles does the Duffy blood group contain? What are the frequencies of positive for each (white/black)? | Fya and Fyb, codominance Fya 65/ 10% Fyb- 83%/ 23% Fya-/fyb- rare/ 68% |
| What alleles does the Kidd system contain? What are the frequencies of each (White/ Black)? | Codominant: Jka: 77%/ 91% Jkb: 72%/ 43% ***negative for both is extremely rare |
| What alleles does the MNSsU system contain? What are the frequencies of each (White/ Black)? | M: 78%/ 74% N: 72%/ 75% S: 55%/ 31% s: 89%/ 93% U: 99.9%/ 99% |
| What is the frequency of the I system? | I: 99% i: only in neonates/ newborns |
| What are the frequencies of the Lewis system? | Lea: 22%/ 23% (non secretory) Leb: 72%/ 55% (secretory) Lea-/ Leb-: 6%/ 22% |
| What are the frequencies of the P system? | P1: 79%/ 94% p2: 21%/ 6% p1k, p2k, p: Very rare |
| What are the frequencies of the Lutheran system? | Lua: 7.6% Lub: 99.8% Lu: Rare |
| Which classes of AB are IgG? | Kell, Duffy, Kidd, SsU, Lutheran (some) |
| Which classes of Ab are IgM? | M, N, I, Lewis, P, Lutheran |
| Which classes of Ab are clinicially signicant? | Kell, Duffy, Rh, Kidd, SsU Sometimes, P and Lutheran |
| What chromosome is the Kell gene on? | 7 |
| What chromosome is the Duffy gene on? | 1 |
| What chromosome is the Kidd gene on? | 18 |
| What chromosome is the MNSsU gene on? | 5 |
| What chromosome is the Lewis gene on? | 19 |
| What chromosome is the P gene on? | 22 |
| What chromosome is the Lutheran gene on? | 19 |
| What chromosome is the ABO gene located on? | 1 |
| What chromosome is the H gene located on? | 19 |
| Which Blood systems are RBC Immune? | Kell, Duffy, Kidd (due to pregnancy or transfusion), SsU, Lub |
| Which Blood systems will agglutinate optimally at RT or below? | ABO, I, Lewis, P1(NOT P or Pk), Lub (all are IgM) |
| Which Blood systems will agglutinate best at 37C? | Kell, Duffy, Kidd, MNSs, P, Pk, Lua |
| What is the reaction of each Ab to produce HDN or HTR? Kell, Duffy, Kidd, M, N, S, s, U, I, Lewis, P, Lutheran | Kell: Ab associated with both, Duffy: Yes, but uncommon, Kidd: Yes, mainly associated with delayed HTR, M: Rarely, only if it reacts at 37C, N: not usually associated SsU: Yes, I, Lewis: No P: Yes, with anti-PP1Pk Ab Lub: both Lua:m |
| Are Blood group Ag's present on the cell at birth? | Yes: Kell, Duffy(expressed on cord RBC's), Kidd (detectible on fetal RBC's), M, N, SsU, i(on newborns before convert to adult) NO: Lewis (develops 1 week after birth), P and Lutheran poorly developed/ weakly expressed at birth |
| Which Ab's bind complement? | Kell, Kidd, I, Lewis, P |
| What is the ethnic association of the Kell system? | Whites have a Kpa mutation. Blacks have a Kpb mutation |
| What is the ethnic association with the Duffy system? | 68% of blacks are Fya-Fyb-. This allows them a resistance to Plasmodium vivax infection |
| What is the ethnic association of the U system? | <1% of Blacks are negative, making it hard to find blood. |
| What is the Ethnic association with hte Lewis system? | Lea-Leb- is more common in blacks (22%W vs 66% blacks) |
| What disease is associated with the Kell system? | McLeod disease- Chronic granulomatous disease |
| What is always present if U is inherited? | S and s |
| What is the biochemical composition of the Kell Ag's? | Glycoprotein, integral to RBC membrane. |
| What is the biochemical composition of the Duffy Ag's? | Glycoprotein that spans RBC lipid bilayer |
| What is the biochemical composition of the Kidd system? | Single protein band, part of the urea transit system. |
| Which system is sensitive to sulfhydryl reagents (2-ME, DTT, AET)? | Kell system |
| What is the strongly immunogenic component of the Kell system? | K Antigen |
| Do the Duffy and Kidd store well? | NO |
| Does LISS enhance Kell Ag reactions? | No |
| Does LISS or PEG enhance Kidd system reactions? | Yes |
| What are the Blood group Ag's that are associated with the Glycophorins (A and B)? | M & N- A SsU- B |
| What are the structural differences between the I and i Ag's? | I is branched. i is linear. i converts to I over the 2 years after birth |
| What Ag is associated with Mycoplasma pneumoniea and cold hemagglutinin diagnosis? | I |
| What is associated with mononucleosis | i |
| What is the biochemical composition of the Lewis group Ag's? | Glycolipid, a glycosyltransferase, depends on H, Se, and Le genes... often see a transition from a+b+ to a-b+ |
| What do null phenotypes of P cause? | production of anti-PP1Pk Ab (anti-Tja) |
| Which blood group is linked to adhesion properties and mediation of intracellular signalling? | Lutheran |
| What cells are involved primarily in innate immunity? | Phagocytic cells |
| What cells are primarily involved with adaptive immunity? | T and B cells, Phagocytes such as monocytes(blood) and macrophages (tissue) |
| What does ILK-1 do? | Activates T helper cells, which induce inflammatory responses and fever |
| What is hematopoiesis? | development of mature blood cells from stem cells in the bone marrow |
| What are the factors that affect an immune response? | Route of inoculation, genetic makeup, overall health (i.e. diet, stress, fatigue, immunosuppressive meds, disease) |
| Which antibody is associated with a primary immune response? | IgM produced first, followed by IgG |
| Which antibody is associated with a secondary immune response? | IgG primarily, though some IgM can be produced |
| How long is the lag phase for a primary immune response? | 5-7 days |
| What is an antigen? | A substance capable of eliciting an immune response when introduced into an immunocompetent individual to whom it's foreign |
| What is an epitope? | A single antigenic determinent or the structural sites on the antigen to which the antibody attaches |
| What is an immunogen? | An antigen in it's role of eliciting an immune response, whether humoral, cellular or both |
| What sort of factors affect antigenicity? | Route of administration, dosage, antigen density, Chemical composition(proteins most, then carbs, with lipids generally inert), complexity, size, degree of foreignness |
| Of the non-ABO blood group antigens, which are most immunogenic? | K>c>E>k>e>fya>C>Jka>S,Jkb>s |
| Define RBC immune immunogloblulin. | Alloantibody that results from exposure to RBC Ab via pregnancy or transfusion |
| Define non RBCimmune immunogloblulin | isoagglutinins, which are naturally occuring with no evidence of RBC exposure |
| Definte autoantibody | antibody that built against the self. It can be either specific or non specific. Warm and cold forms are possible |
| What are the common characteristics of an IgM antibody? | Pentamer structure; Phase of Reactivity: cold- best at 4-10C; Cannot cross placenta; Good complement activator; Not usually clinically significant, except for the ABO system; Many are naturally occuring |
| What are the subclasses of IgG? | 1,2,3,4; Most are IgG3, some 1 and 2, not often 4 |
| Which IgG subclasses can cross the placenta? | IgG1, IgG3, IgG4 |
| What is the half life of IgG1, 2 and 4? | 23 days, longer than other immunogloblulins |
| What are the common characteristics of an IgG antibody? | Structure: Monomer; Phase of reactivity: 37C; CAN cross the placenta Poor to good activator of Complement, though requires 2; USUALLY clinically siignificant |
| What type of Antibody interact with the ABO Ag's? | IgM, though sometimes IgG can be directed depending on the angtigen |
| What is the cause of most transfusion fatalities? | ABO incompatibility |
| Are IgM's clinically significant? | Not usually, except for ABO OR if they are reactive at 37 |
| Which Antigen groups create IgG Antibodies? | Rh, Kell, Kidd, Duffy, Ss |
| Which IgG antibodies are known to bind complement? | Kidd- Jka, Jkb |
| What does LMNOP and I denote? | the IgM Antibodies of ABO, Ii, Lewis, MN, and P |
| What is the term to describe a decrease in the expected increments of platelets following a transfusion? | Refractory |
| What is a major cause of neonatal thrombocytopenia? | Platelet antibodies |
| What is post transfusion purpura? | destruction of transfusion recipients platelets following a transfusion |
| Why do neonates get thrombocytopenia? | Alloantibodies are directed at antigen on platelets inherited from the father |
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Ring the Bell
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