Immunohematology
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| What is Dosage? | When stronger agglutination is seen when a red cell antigen is expressed from homozygous genes.
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| What are the most common blood systems to show dosage? | Kidd, Duffy, Rh and MNSsU (Kell occasionally)
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| 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)
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| 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!!!
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| 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
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| Which sugars are associated with each Antigen: A, B and H? | A: N-acetyl galactosamine
B: Galactose
H: Fucose
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| what is the order of relative amounts of H antigen present on a RBC, by blood group? | 0>A2>B>A2B>A1>A1B
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| 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
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| What are the Big 4 types (most common) for Whites and Blacks? | Whites: R1>r>R2>Ro
Blacks: Ro>r>R1>R2
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| Which Ab's are clinically significant? | Kell, Duffy, Kidd, SsU, P, Pk, Lub
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| 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%)
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| 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%
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| 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
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| 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%
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| What is the frequency of the I system? | I: 99%
i: only in neonates/ newborns
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| What are the frequencies of the Lewis system? | Lea: 22%/ 23% (non secretory)
Leb: 72%/ 55% (secretory)
Lea-/ Leb-: 6%/ 22%
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| What are the frequencies of the P system? | P1: 79%/ 94%
p2: 21%/ 6%
p1k, p2k, p: Very rare
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| What are the frequencies of the Lutheran system? | Lua: 7.6%
Lub: 99.8%
Lu: Rare
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| Which classes of AB are IgG? | Kell, Duffy, Kidd, SsU, Lutheran (some)
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| Which classes of Ab are IgM? | M, N, I, Lewis, P, Lutheran
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| Which classes of Ab are clinicially signicant? | Kell, Duffy, Rh, Kidd, SsU
Sometimes, P and Lutheran
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| What chromosome is the Kell gene on? | 7
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| What chromosome is the Duffy gene on? | 1
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| What chromosome is the Kidd gene on? | 18
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| What chromosome is the MNSsU gene on? | 5
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| What chromosome is the Lewis gene on? | 19
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| What chromosome is the P gene on? | 22
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| What chromosome is the Lutheran gene on? | 19
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| What chromosome is the ABO gene located on? | 1
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| What chromosome is the H gene located on? | 19
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| Which Blood systems are RBC Immune? | Kell, Duffy, Kidd (due to pregnancy or transfusion), SsU, Lub
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| Which Blood systems will agglutinate optimally at RT or below? | ABO, I, Lewis, P1(NOT P or Pk), Lub (all are IgM)
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| Which Blood systems will agglutinate best at 37C? | Kell, Duffy, Kidd, MNSs, P, Pk, Lua
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| 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
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| 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
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| Which Ab's bind complement? | Kell, Kidd, I, Lewis, P
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| What is the ethnic association of the Kell system? | Whites have a Kpa mutation. Blacks have a Kpb mutation
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| What is the ethnic association with the Duffy system? | 68% of blacks are Fya-Fyb-. This allows them a resistance to Plasmodium vivax infection
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| What is the ethnic association of the U system? | <1% of Blacks are negative, making it hard to find blood.
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| What is the Ethnic association with hte Lewis system? | Lea-Leb- is more common in blacks (22%W vs 66% blacks)
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| What disease is associated with the Kell system? | McLeod disease- Chronic granulomatous disease
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| What is always present if U is inherited? | S and s
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| What is the biochemical composition of the Kell Ag's? | Glycoprotein, integral to RBC membrane.
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| What is the biochemical composition of the Duffy Ag's? | Glycoprotein that spans RBC lipid bilayer
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| What is the biochemical composition of the Kidd system? | Single protein band, part of the urea transit system.
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| Which system is sensitive to sulfhydryl reagents (2-ME, DTT, AET)? | Kell system
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| What is the strongly immunogenic component of the Kell system? | K Antigen
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| Do the Duffy and Kidd store well? | NO
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| Does LISS enhance Kell Ag reactions? | No
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| Does LISS or PEG enhance Kidd system reactions? | Yes
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| What are the Blood group Ag's that are associated with the Glycophorins (A and B)? | M & N- A
SsU- B
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| 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
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| What Ag is associated with Mycoplasma pneumoniea and cold hemagglutinin diagnosis? | I
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| What is associated with mononucleosis | i
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| 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+
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| What do null phenotypes of P cause? | production of anti-PP1Pk Ab (anti-Tja)
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| Which blood group is linked to adhesion properties and mediation of intracellular signalling? | Lutheran
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| What cells are involved primarily in innate immunity? | Phagocytic cells
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| What cells are primarily involved with adaptive immunity? | T and B cells, Phagocytes such as monocytes(blood) and macrophages (tissue)
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| What does ILK-1 do? | Activates T helper cells, which induce inflammatory responses and fever
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| What is hematopoiesis? | development of mature blood cells from stem cells in the bone marrow
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| What are the factors that affect an immune response? | Route of inoculation, genetic makeup, overall health (i.e. diet, stress, fatigue, immunosuppressive meds, disease)
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| Which antibody is associated with a primary immune response? | IgM produced first, followed by IgG
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| Which antibody is associated with a secondary immune response? | IgG primarily, though some IgM can be produced
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| How long is the lag phase for a primary immune response? | 5-7 days
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| What is an antigen? | A substance capable of eliciting an immune response when introduced into an immunocompetent individual to whom it's foreign
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| What is an epitope? | A single antigenic determinent or the structural sites on the antigen to which the antibody attaches
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| What is an immunogen? | An antigen in it's role of eliciting an immune response, whether humoral, cellular or both
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| 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
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| Of the non-ABO blood group antigens, which are most immunogenic? | K>c>E>k>e>fya>C>Jka>S,Jkb>s
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| Define RBC immune immunogloblulin. | Alloantibody that results from exposure to RBC Ab via pregnancy or transfusion
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| Define non RBCimmune immunogloblulin | isoagglutinins, which are naturally occuring with no evidence of RBC exposure
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| Definte autoantibody | antibody that built against the self. It can be either specific or non specific. Warm and cold forms are possible
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| 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
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| What are the subclasses of IgG? | 1,2,3,4;
Most are IgG3, some 1 and 2, not often 4
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| Which IgG subclasses can cross the placenta? | IgG1, IgG3, IgG4
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| What is the half life of IgG1, 2 and 4? | 23 days, longer than other immunogloblulins
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| 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
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| What type of Antibody interact with the ABO Ag's? | IgM, though sometimes IgG can be directed depending on the angtigen
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| What is the cause of most transfusion fatalities? | ABO incompatibility
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| Are IgM's clinically significant? | Not usually, except for ABO OR if they are reactive at 37
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| Which Antigen groups create IgG Antibodies? | Rh, Kell, Kidd, Duffy, Ss
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| Which IgG antibodies are known to bind complement? | Kidd- Jka, Jkb
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| What does LMNOP and I denote? | the IgM Antibodies of ABO, Ii, Lewis, MN, and P
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| What is the term to describe a decrease in the expected increments of platelets following a transfusion? | Refractory
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| What is a major cause of neonatal thrombocytopenia? | Platelet antibodies
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| What is post transfusion purpura? | destruction of transfusion recipients platelets following a transfusion
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| Why do neonates get thrombocytopenia? | Alloantibodies are directed at antigen on platelets inherited from the father
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