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Blood Banking Review

Immunohematology

QuestionAnswer
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
Created by: Ring the Bell