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ASCP MLT BOC Immunohematology

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Question
Answer
What stimulates the Primary Immune Response?   First exposure to an antigen  
How long is the lag phase for Primary Immune Response?   Days to Months  
What type of antibodies are associated with Primary Immune Response?   IgM at first. May switch to IgG after 2-3 weeks (isotype switching)  
What is the titer reaction for Primary Immune Response?   Rises slowly. Peaks then declines.  
What does "lag phase" mean?   The period of inactivity after exposure to an antigen before the body produces an immune response.  
What stimulates the Secondary Immune Response?   Subsequent exposure to antigen  
How long is the lag phase for Secondary Immune Response?   Hours  
What type of antibodies are associated with Secondary Immune Response?   IgG only  
What is the titer reaction for Secondary Immune Response?   Rises faster and higher and stays elevated longer.  
What is the structure and number of binding sites of IgG?   Monomer and 2 binding sites  
What is the optimum temperature of reactivity for IgG?   37°C  
Which antibody (IgG or IgM) reacts in saline?   IgM  
Which antibody (IgG or IgM) reacts best by the indirect antiglobulin test (IAT)?   IgG  
What is the strength of complement fixation for IgG?   Moderate  
Which antibody (IgG or IgM) causes transfusion reactions?   IgG Not usually IgM, except ABO  
Which antibody (IgG or IgM) crosses the placenta?   IgG  
Which antibody (IgG or IgM) is destroyed by sulfhydral compounds? (dithiothreitol [DTT], 2-mercaptoethanol [2-ME]   IgM  
What is the structure and number of binding sites for IgM?   Pentamer and 10 binding sites  
Which antibody (IgM or IgG) is naturally occurring and which is Immune?   IgM is naturally occurring IgG is Immune  
What is the optimum temperature of reactivity for IgM?   25°C or lower  
What is the strength of complement fixation for IgM   Strong  
What are the 2 signs of Antigen-Antibody reactions in blood bank testing?   Hemolysis and agglutination  
What is the optimum pH for Ag/Ab reactions?   pH 5.5-8.5  
What is LISS?   Low Ionic Strength Solution: lowers ionic stregth of suspending medium, allowing AG and AB to move closer together. Reduces incubation time to 10 minutes  
What is prozone?   Too much antibody, not enough antigen, can cause false-negative  
What is 20-30% albumin used for?   Causes agglutination by adjusting zeta potential between RBCs  
What is zeta potential?   The difference in charge between the negative charged RBC surface and the cloud of positive ions that surround the RBCs. Reducing zeta potential allows RBCs to move closer together.  
What is PEG?   Polythyleneglycol: Increases antibody uptake. Used for the detection and ID of weak IgG antibodies  
What are enzymes used for in Blood Bank testing?   Reduces RBC surface charge by cleaving sialic acid molecules. M, N, S, Fya, and Fyb antigens are destroyed. i.e. ficin, blomelin, and papain.  
What is AHG?   Antihuman Globulin: Used to agglutinate cells that are sensitized (have antibody or complement attached)  
Polyspecific (broad spectrum) AHG   Detects IgG and C3d Used for DAT and in some labs, routine compatibility tests and anitbody detection  
Monospecific AHG   anti-IgG only: detects clinically significant antibodies  
What is the DAT?   Direct Antiglobilin testing: Detects in-vivo sensitization of RBCs by IgG antibody  
What is the preferred specimen for DAT?   EDTA red cells  
Which antiglobulin test (DAT or IAT) is incubation required?   IAT: Patient serum or plasma with reagent RBCs or Patient RBCs with reagent antiserum  
When is the DAT done? What is it's purpose?   Hemolytic disease of the newborn Transfusion reactions Autoimmune hemolytic anemia Drug induced hemolytic anemia  
What is the IAT?   Indirect Antiglobulin Testing: Detects in-vitro sensitization of RBCs by IgG antibody  
What is the preferred specimen for IAT?   Serum, plasma, RBCs  
When is the IAT done? What is it's purpose?   Antibody screen, Crossmatch, RBC phenotyping, weak D testing  
What is the A antigen's precursor and terminal sugar?   H substance and N-acetylgalactosamine  
What is the B antigen's precursor and terminal sugar?   H substance and D-galactose  
What is the frequency of ABO blood types in whites?   45% O, 40% A, 10% B, 5% AB  
What is the frequency of ABO blood types in Blacks?   49% O, 27% A, 20% B, 4% AB  
What is the frequency of ABO blood types in Hispanics?   56% O, 28% A, 12% B, 4% AB  
What is the frequency of ABO blood types in Asians?   43% O, 27% A, 25% B, 5% AB  
What is the genotype of Rh positive bood?   DD or Dd  
What is the genotype of Rh negative blood?   dd  
What is the frequency of D antigen in Whites and Blacks?   Whites 85% Blacks 93%  
R0   Dce  
R1   DCe  
R2   DcE  
Rz   DCE  
r   dce  
r'   dCe  
r"   dcE  
ry   dCE  
Most common Rh genes in Whites (in decending order)   R1, r, R2, R0,r', r"  
Most common Rh genes in Blacks (in decending order)   R0, r, R1, R2, r'  
Which blood antigens are uncommon in Whites? (<25%)   K, Lea, Lua  
Which blood antigens are uncommon in Blacks? (<50%)   K, Fya, Fyb, S, Lea, Lua, Lub  
Which blood antigens are most common in Whites? (>80%)   k, Fyb, s, U, I, Lub  
Which blood antigens are most common in Blacks? (>80%)   k, Jka, s, U, I, P1  
I antigen presence   Much in Adult cells Trace in cord  
i antigen presence   Trace in Adult cells Much in Cord cells  
Naturally occuring antibodies   ABO, Lewis, P1, MN, Lua  
Clinically significant Antibodies   ABO, Rh Kell, Duffy, Kidd, SsU  
Warm antibodies   Rh, Kell, Duffy, Kidd  
Cold antibodies   M, N, P1  
Antibodies that usually only react with AHG   Kell, Duffy, Kidd  
Which antibody can react in any phase of testing?   Lewis  
Detection of antibody enhanced by enzyme treatment of test cells   Rh, Lewis, Kidd, P1  
Antibodies not detected with enzyme treatment of test cells   M, N, S, Duffy  
Which antibody is enhanced by acidification   M  
Which antibodies show dosage?   Rh(not D), MNS, Duffy, Kidd  
Which antibodies bind complement?   I, Kidd, Lewis  
Which antibodies cause in vitro hemolysis?   ABO, Lewis, Kidd, Vell, and some P1  
Which antibodies are labile in vivo and in vitro?   Kidd  
What does labile mean?   deteriorates rapidly in storage  
antibody that commonly causes anamnestic response   Kidd  
Define anamnestic response   delayed transfusion reaction  
Which antibody is associated with paroxysmal nocturnal hemoglobinuria?   Anti-P  
What is paroxysmal nocturnal hemoglobinuria PNH?   Defect in RBC membrane, makes in more susceptible to hemolysins in an acid environment. Hgb found in urine after periods of sleep.  
Which antibody is associated with cold agglutinin disease and Mycoplasma pneumoniae infections   Anti-I  
Which antibody is associated with infectious mononucleosis?   Anti-i  
Antibody ID Reaction: same strength and in one phase only   Suggestive of single antibody  
Antibody ID Reaction: Varying strength   Multiple antibodies, antibody exhibiting dosage, antigens of differing strength  
Antibody ID Reaction: in different phases   Combination of warm and cold antibodies, antibody with wide thermal range  
Antibody ID Reaction: All cells in AHG, autocontrol negative   Multiple antibodies, antibody with high frequency antigen  
Antibody ID Reaction: All cells in AHG, autocontrol positive   Warm autoantibody  
Antibody ID Reaction: All cells at 37°C, negative in AHG, autocontrol positive   Rouleaux  
How long do you retain patient specimen and unit segment and what temperature do you store it at?   7 days following transfusion at 1-6°C  
How many days before a transfusion must the specimen be collected for compatability testing?   3 days  
What is an antiglobulin crossmatch?   Recipient serum and donor RBCs are tested with the IAT. Required when recipient has, or previously had, a clinically significant antibody  
What is an abbreviated crossmatch?   Recipient serum and donor RBCs are tested in immediate spin only. Permissible if recipient doesn't have, and has never had, clinically significant antibodies. Test of ABO compatibility.  
What is a computer crossmatch?   Computer check of donor ABO and Rh type and recipient ABO and Rh type. Permissible if recipient doesn't have, and has never had, clinically significant antibodies.  
What tests are done on newborns for transfusion?   ABO and Rh typing (forward grouping only), Antibody screen,and crossmatch (only need if AB screen is positive)  
What conditions must be met if RBCs are being used for reissue?   1-10°C, closure not broken, at least one segment left, unit inspected, records indicate blood has been reissued  
Clinical signs of hemolytic (intravasuclar) txrxn   Fever, chills, shock, renal failure, DIC, Pain in chest, back, or flank  
Clinical signs of hemolytic (extravascular) txrxn   Fever, anemia, mild jaundice 2 or more days after tranfusion  
Clinical signs of febrile txrxn   Increase of temperature > or = to 1°C within 24 hours of transfusion with no other explanation  
Clincal signs of allergic txrxn   Hives  
Clinical signs of anaphylactic txrxn   Bronchospasms  
Clinical signs of circulatory overload txrxn   Coughing, cyanosis, difficulty breathing  
Clinical signs of septicemia txrxn   Fever, cramps, diarrhea, vomiting, muscle pain, DIC, shock, renal failure  
Specimens needed for a txrxn investigation   Pre-transfusion blood Post-transfusion blood Post-transfusion urine Segment from unit Blood bag with administration set and attached IV solutions  
At what gestational age is RhIG administered?   28 weeks  
How long postpartum is RhIG given to Rh negative women with Rh positive baby?   within 72 hours  
What is the dose of RhIG given to Rh negative mother with Rh positive baby?   One dose per 15 ml of D postive fetal RBCs.  
AABB age requirement for blood donation   At least 17 yrs old  
AABB weight requirement for blood donation   At least 110 lbs to donate 525 ml  
How often can you donate blood (AABB)?   Every 8 weeks  
AABB blood pressure requirement   Systolic < or =180 Diastolic < or =100  
AABB pulse requirement   50-100 with no pathological cardiac irregularities  
AABB hemoglobin/hematocrit requirement   > or = 12.5 g/dL HGB > or = 38% HCT  
AABB body temp requirement   < or = 37.5°C (99.5°F)  
3 day blood donor deferral (AABB)   Apirin containing medicaitons if donor is sole source of plts  
2 week donor deferral (AABB)   Measles, mumps, polio, or yellow fever vaccines  
4 week donor deferral (AABB)   Rubella vaccine  
6 week donor deferral(AABB)   Pregnancy  
12 months donor deferral (AABB)   Syphilis, Gonorrhea, Animal bite, HBIG, Tattoo, Mucous membrane exposure to blood, Needle stick, Household or sexual contact with individual with hepatitis, sexual contact with individual with HIV, Traval to area endemic with Malaria  
3 year donor deferral (AABB)   Malaria, or from an area endemic for malaria  
Permanent donor deferral (AABB)   Parenteral drug use, family history of Creutzfeldt-Jakob disease, Treated with growth hormone, Viral hepatitis after 11th bday, Postive HBsAg, Repeatedly reactive anti-HBc, anti-HCV, anti-HTLV, or anti-HIV,Babesiosis, Chagas' disease  
Volume of anticoagulant for blood unit collection   63 ml  
Volume of blood collected for blood unit   450 +-45 ml  
Low volume unit   300-404 ml; label "low volume unit" don't use to prepare platelets or plama components  
When should the volume of anticoagulant be reduced?   When the blood volume is <300 ml  
Time of collection for blood unit   4-10 minutes, if >15 minutes, blood may not be suitable for preparation of plts or FFP  
Temperature of blood unit   20-24°C for up to 8 hours if components are going to be prepared, otherwise 1-6°C  
Acid-citrate-dextrose   ACD anticoagulant shelf life 21 days  
Citrate-phosphate-dextrose   CPD Anticoagulant shelf life 21 days High pH preserves 2,3-DPG better. Better O2 delivery.  
Citrate-phosphate-dextrose with adenine   CPDA-1 shelf life 35 days Adenine increases adenosine disphosphate ADP  
Adsol   AS-1 Additive Shelf life 42 days Provides nutrients for improved viability  
Nutricel AS-2   AS-2 Additive Shelf life 35 days Provoides nutrients for improved viability  
Nutricel AS-3   AS-3 additive shelf life 42 days  
Phosphate-inosine-pyruvate-adenine   PIPA rejuvinating solution used to salvage rare or type O units up to 3 days beyond expiration, must then be transused within 24 hours or frozen  
Donor serological testing (AABB or FDA)   ABO, Rh, AB Screen, RPR, HBsAg, Anti-HBc, Anti-HCV, Anti-Hiv 1/2, HIV-1-Ag, Anti-HTLV-1 and 2  
Autologous donation frequency   every 3 days but not within 72 hours of transfusion  
Autologous donation Hgb requirement   not less than 11 g/dL  
Temperature and shelf life of RBCs   1-6°C and 35 days in CPDA-1, 42 days in AS-1  
Temperature RBCs frozen   40% glycerol: < or = -65°C 20% glycerol: < or = -120°C 1-6°C after glycerolization  
Shelf life or RBCs frozen   10 years after phlebotomy, 24 hours after deglycerization  
Temperature and shelf life of washed RBCs   1-6°C 24 hours after washing  
Temperature and shelf life of Leukocyte reduced RBCs   1-6°C Closed system:10 years Open system: 24 hours  
Temperature and shelf life of Rejuvinated RBCs   1-6°C 24 hours after rejuvination if not frozen  
Temperature and shelf life of irradiated RBCs   1-6°C Original outdate or 28 days from irradiation, whichever occurs first  
Temperature and shelf life of FFP   < or = -18°, After thawing 1-6°C 12 months, After thawing transfuse within 24 hours  
Temperature and shelf life of Cryoprecipitate   < or = -18°C, After thawing room temperature 12 months, After thawing transfuse within 6 hours if unit is not entered, within 4 hours in pooled  
Temperature and shelf life of platelets   20-24°C 5 days 5 days with agitation  
Temperature and shelf life of granulocytes   20-24°C 24 hours  
Increased in stored blood   Plasma K+, Plasma NH3, Plasma Hgb, microaggregates  
Decreased in stored blood   pH, ATP, 2,3-DPG, Viable RBCs, WBCs, and platelets, Labile coagulation factors  
Centrifuge QC   Check RPM and timers quarterly Determine optimum speed and time for procedures upon receipt, after repairs, and semiannually.  
Cell washers QC   Check volume of saline and AHG in each tube, verify time and speed of centrifugation periodically  
Waterbaths QC   Check temperature daily  
Heat blocks QC   Check temperature daily. Periodically check each well.  
Refrigerators QC   System to monitor temperature continuously and to record temperature at least every 4 hours. Alarm system with audible signal. Must be 1-6°C  
Freezers QC   System to monitor temperature continuously and to record temperature at least every 4 hours. Alarm system with audible signal.  
Alarms QC   Check high and low temperatures of activation quarterly  
Platelet incubators QC   System to monitor temperature continuously and to record temperature at least every 4 hours. Should be 20-24°C. Check RPM periodically.  
Pipettes and droppers QC   Determine average delivery volume. Calculate # of drops that will give 80:1 serum to cell ratio  
Antisera QC   Test with positive and negative controls each day of use. Use heterozygous cells for positive controls  
Reagent cells QC   Check for hemolysis. Test daily with pos and neg controls  
AHG QC   Check anti-IgG activity by testing Rh-positive cells sensitized with anti-D  
How long should QC records be kept?   5 years or longer  
When are washed RBCs needed?   Anemic patients with paroxysmal nocturnal hemolgobinuria, ABs to IgA, or history of febrile reactions  
When are leukocyte reduced RBCs needed?   Anemia with history of febrile reactions  
When are irradiated RBCs needed?   Intrauterine transfusions, immunocompromised recipients, recipients of blood from a relative, or bone marrow transplant patients  
When is FFP needed?   Deficiency of coagulation factors  
When is cryoprecipitate needed?   Hemophilia A, Von Willebrand's disease, hypofibrinogenemia, Factor XIII deficiency  
When are platelets needed?   Prevent or stop bleeding in patient with thrombocytopenia or abnormal platelet function.  
When are granulocytes needed?   Neutropenia with infection  
How long after receiving a donation of blood products are patients deferred for donation?   12 months  
CPDA-1 ingredients   Citrate, Dextrose, Adenine, Sodium biphosphate  
Citrate purpose in CPDA-1   Prevents coagulation by chelating calcium  
Dextrose purpose in CPDA-1   Supports adenosine triphosphate (ATP) generation  
Adenine purpose in CPDA-1   Substrate for ATP synthesis  
Sodium biphosphate in CPDA-1   Prevents excessive fall in pH during storage  
Blood product that must be separated from whole blood and frozen within 8 hours of collection   Fresh Frozen Plasma  
How is cryoprecipitate prepared?   By thawing FFP between 1-6°C, removing plasma, and freezing within 1 hour.  
RBCs must be frozen in:   glycerol within 6 days of collection  
How long after plasmapheresis must a person wait to donate a unit of Whole Blood?   48 hours  
Each unit of whold blood will yield approximately how many units of cryoprecipitated AHF?   80 units  
90% of all platelet pheresis units tested contain how many platelets per ul?   3.0 x 10"  
Terminal sugar for H antigen   L-fucose  
Approximate % of original plasma content of Factor VIII recovered in Cryoprecipitated AHF   40-80%  
What is the formula to calculate fetomaternal hemorrhage for RhIg?   (fetal cells/number of cells counted)x maternal blood volume  
Liley method of predicting the severity of HDN is based on aminiotic fluid:   change in optical density measured at 450 nm  
   


   






 
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