Blood bank I-blood groups

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what are the 2 stages of agglutination

1. coat cells (sensitization)
2. formation of bridges (Ab & RBCs)

What is the direct lysis of RBC as a result of Ab coating called?

Hemolysis

What Ig is the best at fixing complement?

IgM (pentamer)

What is the phase that has pt serum + 2-5% RBC solution in a tube, centrifuge and examine?

Immediate spin phase

What is the most common combo of pt serum and RBCs for tube testing?

2 drops serum, 1-2 drops RBCs

True or False: it Ab rxts in IS phase they are clin sig Ab?

False

WHat phase duplicates body temp, takes mixture, incubates at 37C for a specified time, centrifuge and examine?

37C phase

How long do you incubate the mix with LISS?

10-15min

How long do you incubate the mix with PEG or alb?

15-30min

How long do you incubate the mixture with no Ab-Ag enhancers?

30-60min

What is the indirect antiglobulin test (aka Coombs test, Antihuman globulin)?

wash mix of pt serum and RBC solution to remove unbound Ab
Add AHG (look for something coating RBCs)
centrifuge and examine

What is a positive gel test result?

no button, gets stuck in gel as RBC Ab bind to column

What is positive solid phase result?

A lawn of RBCs coating the well bound to Ab in the well

What is an negative solid phase result?

A button

What is the test where UNCOATED RBC + Ab is put together, washed, AHG added and examined?

INDIRECT Antiglobulin test

What is the test where you take the RBC's directly from the pt, wash unbound Ab, add AHG and examine?

DIRECT Antiglobulin test

What 3 uses can you use the IAT for?

1. check for unknown Ab (RBCs + known Ag profile-ie Ab scrn)
2. check for unknown RBC Ag (serum + known Ab specif--ie RBC Ag test)
3. check for rxting unknown Ag AND unknown Ab--ie crossmatch

What is the specific AHG that detects RBC coated with either IgG or C3d and may detect other Ig?

Anti-IgG,-C3d (polyspecific)

What is the AHG that detects IgG and light chains assoc c other Ab classes (IgM, IgA)?

Anti-IgG and anti-IgG (heavy chains)

What is the AHG that detects complement components, is good for IgM related hemolysis and certain WAIH w/o IgG?

Anti-C3b,C3d

What are the 3 specificities of AHG?

1. Anti-IgG, C3d
2. Anti-IgG, anti-IgG (heavy chains)
3. Anti-C3b, -C3d

What test do you do to make sure your DAT or IAT reagent is working if you get a negative DAT or IAT?

Coomb's control

How does the Coomb's control work?

add IgG coated RBCs to the mix you had for the IAT
if test negative, bad AHG or didn't add AHG

What blood group Ab exhibit dosage?

Rh
Kidd
Duffy
MNSs

What is the neutralizing substance for ABO?

saliva

What is the neutralizing substance for Lewis?

saliva

What is the neutralizing substance for Sda?

guinea pig urine

What is the neutralizing substance for P1?

Pigeon egg fluid or hydatid cyst fluid

What is the neutralizing substance for Chido, Rodgers?

serum

What does a blood group being clin sig mean?

causes HDN, HTR

What are the 5 traits of a warm reacting Ab?

1. IgG
2. clin sig
3. require exposure
4. cause HDN
5. cause HTR

What are the 5 traits of a cold reacting Ab?

1. IgM
2. not clin sig
3. naturally occurring
4. no HDN
5. no HTR

What is the one exception to the rule of the warm and cold reactive Ab?

ABO, it's cold reactive and IgM but clin sig

Name the blood groups enhanced by enzymes like papain and ficin?

Lewis Is A Rhotten Peeing Kidd
ABO, Lewis, I/i, P, Rh, Kidd

What are the blood groups destroyed by enzymes?

Duffy, MNSs

What are the blood groups unaffected by enzymes?

Kell (kell doesn't care about enz)

What are type I ABO blood group chains composed of and where are they found?

Glycoproteins.
Found in secretions.

What are the type II ABO blood group chains composed of and where are they found?

Glycosphingolipids
Found on RBCs

What ch is the secretor gene on?

Ch 19

What Ag can a person make if they are a secretor?

A or B Ag in their secretions (ie saliva)

What does an Se gene add to a Type I chain and where?

Adds FUCOSE to type I chains at the TERMINAL GALACTOSE

What is the product of an Se gene adding fucose?

H Ag

What % of pop can make H Ag on Type I chains?

80%

What ch is the H gene on?

Ch 19--closely linked to Se gene

What does the H gene do?

Adds FUCOSE to TERMINAL GALACTOSE ON TYPE II chain

What is the product of the H gene?

H Ag

What % of pop can make H Ag with H gene?

100%

What has to be on type II chains before A or B Ag can be made on RBCs?

H Ag

What is required on Type I chains before A or B can be made in secretions?

Type I H (H Ag)

How many sugars have to be added to H Ag chain to make an A or B Ag?

One

What is added to the terminal galactose to make A Ag?

N-Acetylgalactosamine

What is added to the terminal galactose to make B Ab?

Galactose

What happens to the amount of H Ag when you make A or B Ag?

more A or B, less H (reciprocal relationship)

What is the amount of H in each blood group in order of decreasing freq?

O>A2>B>A2B>A1>A1B

What ch has the genes for the ABO blood group?

Ch 9

Are ABO clincally significant and naturally occurring?

Yes, the exception to the cold/IgM "rule"

What is the universal dOnOr?

Group O

What is the most common blood group?

Group O

What is the genotype for O?

OO

What is the Ag for O?

H

What lectin agglutinates cells with H Ag?

Ulex europaeus

What Ab are on O?

Anti-A and Anti-B

Are group O Ab IgG or IgM?

IgG, so can cross placenta

Can Group O cause HDN?

Yes, mild HDN--MOST COMMON CAUSE OF HDN!!!!

What is low in group O?

vWF

What is the genotype for group A?

AA, AO

What are the antigens on A?

A, H

What are the Ab on A?

Anti-B; it's an IgM so no cross placenta

What are the subgroups and % of A?

A1 (80%) and A2 (20%)

How much more A is on A1 than A2?

4x more A Ag on A1

What does a small % of A2 form Ab to?

Anti-A1, clin insig but screws up ABO testing

What lectin agglutinates A1?

Dolichos biflorus; use to ddx A1 from A2

What is the genotype for group B?

BB, BO

What are the Ag on B?

B, H

What are the Ab on B?

Anti-A

What lectin agglutinates B?

BS-1

What group is the universal recipient?

AB, least freq blood type (~4%)

What are the Ag on AB?

A and B (very little H)

What are the Ab on AB?

None

What are the two types of ABO testing?

forward grouping (cell typing)
reverse grouping (back or serum typing)

Which ABO test uses pt's RBC (Ag), add known anti-A and anti-B sera?

Forward grouping (tells you pt RBC type)

Which ABO test uses pt's SERUM/plasma (Ab), add known A1 and B RBCs?

Reverse grouping (tells you pt Ab)

If a pt has forward Anti-A and reverse B cells agglutination what is cell type?

A

If pt has forward Anti-B and reverse A1 cells agglutination what is cell type?

B

If a pt has forward Anti-A and B and no A1 or B agglutination what is cell type?

AB

If a pt has no forward Anti-A or B and + A1 and B what is cell type?

O

What is the relationship of ABO forward and reverse typing?

Opposite, if not, discrepancy

Serum and cell typing are required unless what 2 reasons?

1. baby < 4 months old
2. reconfirming testing done elsewhere (just do cell/fwd typing)

What are ABO discrepancies usually due to?

Ab and Ag probs

What are the main Ag probsin ABO typing discrepancies?

1. Lack of expected Ag
2. Presences of unexpected Ag

What reasons do you get lack of expected Ag in ABO typing?

1. A or B subgroups
2. txp or transfusion

What reasons do you get presence of unexpected Ag in ABO typing?

1. Acquired B phenotype-colon ca, G- sepsis
2. recent marrow/stem cell txp
3. nonspecific polyagglutination

What are reasons you get lack of expected Ab in ABO typing?

1. immunodef
2. immunocompromised, elderly, neonate
3. really high [ ] of Ab-->prozone effect
3. txp or tranfusion

What are reasons you get unexpected Ab in ABO typing?

1. Anti-A1 (from A2 pts)
2. rouleaux
3. cold auto/alloAb
4. txp or transfusion

What is the pt's real blood type in acquired B phenotype?

A

What does an acquired B look like forward and reverse typing?

Forward: AB (weak + in B)
Reverse A

When bact deacetylate A so it looks like B (term galactose) and the remaining galactosamine cross reacts with Anti-B what is that?

Acquired B phenotype

How do you fix an acquired B to get the right results?

A's:
Acidify serum
Acetic acid (re-acetylates)
Autoincubation (no rxn)
Bs-1 lectin (no rxn, only rxn with real B)

What is the B(A) phenotype's real ABO group?

B, tests forward like AB (weak A)

What type of phenotype rxts with a particular form of Anti-A?

B(A) phenotype, to fix just use diff Anti-A

What phenotype looks like an O but doesn't make ANY Ag?

Bombay (Oh)

How does the ABO typing look in Bombay?

Forward: O
Reverse: O
Ab scrn is WILDLY + and all units incompatible

What do you transfuse Bombay pts with?

Only other Bombay donors

What does ParaBombay have that Bombay does not?

Se, partially compensates for lack of H

How does the ParaBombay ABO typing look?

Forward: O
Reverse: H and A or B Ag (unless group O), have anti-H in serum

What blood group is the most freq cause of blood bank fatalities?

ABO

What is the most freq cause of HDN?

ABO, mild

What is a consequence of ABO incompatibility?

Severe acute hemolytic transfusion reactions--death

How many genes are in the Lewis blood group?

one; the Le gene

What type of chains are in Lewis?

Type I chains only

How is Le a Ag made?

gene pdct adds FUCOSE to SUBTERMINAL GlcNAc

In a non-secretor what is the only type of Lewis Ag?

Le a

How is Le b Ag made?

1rst: Se gene adds fucose to term galactose->makes type I H
2nd: Le gene adds fucose to subterm GlcNAc->Le b
b is the 2nd letter of the alphabet, b goes on 2nd

Are the majority of secretors Le a or b?

Le b

Which Le adsorbs better to RBC surface?

Le b is BETTER, that's why most adults that are Le and Se are Le (a-b+)

Do Le (a-b+) pts have Le a?

yes, not all chains converted, just can't detect on RBCs

T or F, the same chain carries Le and ABO Ag?

True

Which Le is more freq a or b?

Le b (b is better)

22% of blacks have what Le Ag?

Le (a-b-); 6% of whites have this

What types of Ab are the Lewis?

Naturally occurring
cold reacting IgM

What neutralizes Lewis?

Saliva

What are consequences of Lewis incompatibility?

None really, no Le Ag on fetal RBCs

What happens to Le Ag during pregnancy?

Decreases, can have transient insig Le Ab

If pt is Le (a-b+) do they have anti-Le a?

no, they still have Le a too, just not detected on RBC surface

What type of Le seen in kids?

Le a >b, varies w age as Ag chains get converted

What uses Le b to attach to gastric mucosa?

H. pylori

What Le phenotype is seen in kids with increased UTIs?

Le (a-b-)

What are the 5 major Ag of the Fisher-Race blood group?

D, C, E, c, e

What makes up a haplotype?

DCE, Dce, etc

What is the Fisher-Race haplotype for the Wiener classification system for R1?

DCe

What is the Fisher-Race haplotype for the Wiener classification system for R2?

DcE

What is the Fisher-Race haplotype for the Wiener classification system for R0?

Dce

What is the Fisher-Race haplotype for the Wiener classification system for Rz?

DCE

What is the Fisher-Race haplotype for the Wiener classification system for r?

dce

What is the Fisher-Race haplotype for the Wiener classification system for r'?

dCe

What is the Fisher-Race haplotype for the Wiener classification system for r"?

dcE

What is the Fisher-Race haplotype for the Wiener classification system for r y?

dce

What is the most to least common Wiener in whites?

R1>r>R2>R0

What is the most to least common Wiener in blacks?

R0>r>R1>R2

What types of Ab are Rh?

Warm reacting IgG
Exposure required

What are consequences of unexposed Rh- pts?

80% chance develop Ab after 1U of RBC Rh+ blood

What are consequences of exposed Rh- pts that have Anti-D?

HTR with EXTRAvascular hemolysis

What blood group causes most severe HDN?

Rh, give RhoGam

What is the test needed to detect weak D phenotype?

need IAT to detect D Ag in D+ pts

What are reasons for weak D?

C in trans (C on opp ch to D)
mosaic partial D, lack portions of D Ag

What test is required of all blood donors?

IAT (weak D test) for ALL D- blood DONORS

What phenotype has hemolytic anemia with stomatocytes, associated altered activity of S, s and U and no Rh Ag at all?

Rh null

What is a less severe form of Rh but also has hemolysis?

Rh mod

What causes a warm autoimmune hemolytic anemia?

Ab specific to basic Rh struct Ag

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