Goljan Rapid Review Blood Banking And Transfusion Disorders

Front 1

Definition of ABO blood group antigens

Back 1

They are glycoproteins attached to the RBC surface

Front 2

Blood group antibodies are natural antibodies that are synthesized where

Back 2

Peyer's patches

Front 3

A and B antigens that are normally present in food are trapped by specialized epithelial cells called ?????? that overlie ??????.

Back 3

M cells

peyer's patches

Front 4

M cells have close proximity to what other cells

Back 4

B lymphocytes

Front 5

Most common blood group

Back 5

O

Front 6

Blood group O natural Ab's

Back 6

# Anti-A-IgM, anti-B-IgM
# Most people have anti-AB-IgG antibodies.

Front 7

Which blood type has
Increased incidence of duodenal ulcers

Back 7

Type O

Front 8

Blood group A natural Ab's

Back 8

Anti-B-IgM antibodies

Front 9

Which blood type has
Increased incidence of Gastric Carcinoma

Back 9

Type A

Front 10

Blood group B natural Ab's

Back 10

Anti-A-IgM antibodies

Front 11

Least common blood group

Back 11

type AB

Front 12

Blood group AB natural Ab's

Back 12

No natural antibodies

Front 13

Newborns Ab's at birth

Back 13

# Do not have natural antibodies at birth
# IgG antibodies are of maternal origin. bc they cross the placenta

Front 14

Elderly people and special considerations wrt transfusions

Back 14

Frequently lose their natural antibodies

may not have a hemolytic transfusion reaction if they are transfused with the wrong blood group

Front 15

Paternity issues in newborns
# Blood group AB parents cannot have an

# Blood group O parents cannot have

# Blood group A and B parents can have O children if

Back 15

-Type O child

-AB, A, or B child

-both have AO and BO phenotypes.

Front 16

Determining the ABO group
forward type
what is indentified
describe the process

Back 16

# Identifies the blood group antigen

* Patient RBCs are added to test tubes that contain either anti-A or anti-B test serum.

Front 17

Determining the ABO group
Back type
what is indentified
describe the process

Back 17

# dentifies the natural antibodies

* Patient serum is added to test tubes containing either A or B test RBCs.

Front 18

Forward or back
# Example-blood group A serum

* Patient anti-B-IgM antibodies agglutinate B test RBCs but not A test RBCs.

Back 18

Back type

Front 19

Forward or back
# Example-blood group A RBCs

* Agglutination reaction with anti-A test serum but not with anti-B test serum

Back 19

Forward type

Front 20

Rh antigen system
describe the gene locus/loci

Back 20

# t has three adjoining gene loci.

1. Locus coding for D antigen (no d antigen)
2. Locus coding for C and c antigen
3. Locus coding for E and e antigen

Front 21

Rh antigen system
inheritance

Back 21

# Autosomal codominant inheritance

1. One of the sets of three Rh antigens from each parent is transmitted to each child.

Front 22

Possible Rh antigen profiles

Back 22

# DD, Dd, or dd
# CC, Cc, or cc
# EE, Ee, or ee

Front 23

An individual who is Rh positive is ???? antigen positive.

Back 23

D antigen

Front 24

Approximately ????% of the population has D antigen.

Back 24

85

Front 25

ndividuals lacking D antigen are considered ?????.

Back 25

Rh negative

Front 26

Rh phenotype of an individual
how tested
example

Back 26

# RBCs are reacted with test antisera against each of the Rh antigens.

# Example-Rh phenotype that is positive for C, c, D, and E antigens but negative for e antigen (phenotype is CcDE)

Front 27

define Alloimmunization

Back 27

Production of an antibody against a foreign antigen not present on an individual's RBCs

Front 28

Production of an antibody against a foreign antigen not present on an individual's RBCs

and what is the Ab called

Back 28

Alloimmunization

atypical antibodies.

Front 29

Significance of atypical antibodies

Back 29

May produce a hemolytic transfusion reaction (HTR)

Front 30

??????antibodies are more likely to produce an HTR than ????? antibodies

Back 30

IgG

IgM

Front 31

????? antibodies react best in warm temperatures, but ???????antibodies react best in cold temperatures.

Back 31

IgG

IgM

Front 32

Transfusion requirements in an individual with atypical antibodies

Back 32

Individual must receive blood that is negative for the foreign antigen.

Front 33

Duffy (????) antigens

Back 33

Fy

Front 34

Fy antigens aka

Back 34

Duffy (Fy) antigens

Front 35

Fy antigens are the binding site for

Back 35

infestation of RBCs by Plasmodium vivax.

Front 36

????? antigens are the binding site for infestation of RBCs by Plasmodium vivax.

Back 36

Fy

Front 37

Majority of black Americans lack the ???? antigen.

and implications

Back 37

Fy antigen.

* Offers protection against contracting P. vivax malaria

Front 38

????? may develop against I or i antigen.

Back 38

IgM antibodies (cold agglutinins)

Front 39

antigens and Increased risk for developing a cold autoimmune hemolytic anemia

Back 39

IgM antibodies (cold agglutinins) may develop against I or i antigen.

# Anti-i hemolytic anemia may occur in infectious mononucleosis.

# Anti-I hemolytic anemia may occur in Mycoplasma pneumoniae infections.

Front 40

The most common infectious agent transmitted by blood transfusion is

Back 40

cytomegalovirus (CMV)

Front 41

The most common infectious agent transmitted by blood transfusion is cytomegalovirus (CMV), which is present ????????

Back 41

in donor lymphocytes.

Front 42

Autologous transfusion

Back 42

Process of collection, storage, and reinfusion of the individual's own blood

Front 43

Safest form of transfusion

Back 43

Autologous transfusion

Front 44

Tests performed on donor blood

Back 44

# Group (ABO) and type (Rh)
# Antibody screen (indirect Coombs' test)

* Detects atypical antibodies (e.g., anti-D, anti-Kell)

# Screening tests for infectious disease

* Examples-syphilis, hepatitis B and C, HIV-1 and 2, HTLV-1

Front 45

Before blood is transfused into newborns or patients with T-cell deficiencies, it must be ??????

and Why

Back 45

irradiated to kill donor lymphocytes.

prevents graft-versus-host reaction (see Chapter 3) or a CMV infection.

Front 46

Components of a standard crossmatch

Back 46

# ABO group and Rh type
# Antibody screen for atypical antibodies
# Direct Coombs' test to identify atypical IgG antibodies on patient RBCs
# Major crossmatch

Front 47

Patient crossmatch wrt guarantee

Back 47

a compatible crossmatch does not guarantee that the recipient will not develop atypical antibodies, a transfusion reaction, or an infection.

Front 48

Purpose of a major crossmatch

Back 48

Detect atypical antibodies that are directed against foreign antigens on donor RBCs

Front 49

Major crossmatch process

Back 49

# Patient serum is mixed with a sample of RBCs from a donor unit.

1. Each unit of donor blood must have a separate crossmatch.
2. Lack of RBC agglutination or hemolysis indicates a compatible crossmatch.

Front 50

Use of blood group O packed RBCs for transfusion

Back 50

Can be transfused into any patient, regardless of the blood group

Front 51

Blood group ?????? individuals are considered universal donors.

Back 51

O

Front 52

Blood group O individuals can receive ????? blood.

Back 52

O

Front 53

in typw O patients
??????will hemolyze transfused A, B, or AB RBCs.

Back 53

Anti-A-IgM and anti-B-IgM

Front 54

Blood group AB individuals can receive ????? blood.

Back 54

Any group

Front 55

Blood group ?????? individuals are considered universal recipients

Back 55

AB

Front 56

Packed RBCs
purpose

Back 56

increase O2 transport to tissue

Front 57

Each unit of packed RBCs should raise the Hb ?????and the Hct ?????; lack of an increment implies ??????

Back 57

1 g/dL

3%;

a hemolytic transfusion reaction or blood loss in the patient

Front 58

is the most common contaminant of stored blood

Back 58

Yersinia enterocolitica, a pathogen that thrives on iron

Front 59

Platelets
purpose

Back 59

stop medically significant bleeding related to thrombocytopenia or qualitative platelet defects (e.g., aspirinView drug information)

Front 60

Platelets have which antigens

Back 60

HLA antigens and ABO antigens on their surface;

however, they lack Rh antigens

Front 61

Each unit of platelets should raise the platelet count

Back 61

by 5000-10,000 cells/μL

Front 62

Fresh frozen plasma
purpose

Back 62

treatment of multiple coagulation deficiencies (e.g., DIC; cirrhosis) or treatment of warfarin over-anticoagulation if bleeding is life-threatening

Front 63

Cryoprecipitate
purpose

Back 63

treatment of coagulation factor deficiencies involving fibrinogen and factor VIII (e.g., DIC)

Front 64

Cryoprecipitate contains

Back 64

contains fibrinogen, factor VIII, and factor XIII

Front 65

??????is used instead of cryoprecipitate in treating mild hemophilia A and von Willebrand disease

Back 65

Desmopressin acetate

Front 66

Desmopressin acetate
purpose

Back 66

used instead of cryoprecipitate in treating mild hemophilia A and von Willebrand disease

Front 67

IgA deficient individuals must receive blood or blood products that

Back 67

lack IgA.

Front 68

Women commonly have these reactions owing to pregnancy, when there is an increased risk for exposure to fetal blood during delivery or after a spontaneous abortion.

Back 68

Anti-HLA antibodies

Front 69

Anti-HLA antibodies develop when

Back 69

individuals are exposed to foreign HLA antigens (e.g., previous blood transfusion or organ transplant)

Front 70

an extravascular hemolytic anemia. This reaction may occur within hours to 3 to 10 days after the transfusion.

Back 70

he pretransfusion antibody screen is negative but
memory B cells are present and reexposure to the foreign antigen causes them to produce antibodies,

Front 71

Most common transfusion reaction

Back 71

Allergic reactions

Front 72

transfusion Allergic reactions
mediator

Back 72

Type I IgE-mediated hypersensitivity reaction against proteins in the donor blood

Front 73

transfusion Allergic reactions
clinical findings

Back 73

# Urticaria with pruritus
# Fever, tachycardia, wheezing
# Potential for anaphylactic shock

Front 74

transfusion Allergic reactions
Tx

Back 74

# Mild cases are treated with antihistamines.

Front 75

Transfusion reactions
# Febrile reaction

1. Pathogenesis

Back 75

# Recipient has anti-human leukocyte antigen (HLA) antibodies directed against foreign HLA antigens on donor leukocytes.

* There are no HLA antigens on RBCs.

Front 76

Transfusion reactions
Type II hypersensitivity reaction

Back 76

Febrile reaction

Front 77

Transfusion reactions
Febrile reaction
what type of Hypersensitivity reaction is it

Back 77

Type II hypersensitivity reaction

Front 78

Transfusion reactions
Febrile reaction
Clinical findings

Back 78

# Clinical findings

1. Fever, chills, headache, and flushing

Front 79

Transfusion reactions
Febrile reaction
Tx

Back 79

Treated with antipyretics

Front 80

Acute hemolytic transfusion reaction (HTR)
clinical findings

Back 80

# Fever, back pain, hypotension
# Disseminated intravascular coagulation, oliguria (renal failure)

Front 81

-Transfusion reactions
--Acute hemolytic transfusion reaction (HTR)
-----where in vasculature is it

Back 81

May be intravascular or extravascular hemolytic reactions

Front 82

Transfusion reactions
Acute hemolytic transfusion reaction (HTR)
intravascular Rxn
due to what?
which type of hypersensitivity reaction?

Back 82

# ABO blood group incompatibility
# Example-group B patient receives group A donor blood.

* Anti A-IgM attaches to A positive donor RBCs producing intravascular hemolysis.

# Type II hypersensitivity reaction

Front 83

Transfusion reactions
Acute hemolytic transfusion reaction (HTR)
Extraavascular Rxn
due to what?
which type of hypersensitivity reaction?

Back 83

# n atypical antibody reacts with a foreign antigen on donor RBCs.

* Macrophage phagocytosis and destruction of donor RBCs coated by the atypical antibody

Type II hypersensitivity reaction

Front 84

Transfusion reactions
Acute hemolytic transfusion reaction (HTR)
extravascular
what commonly occurs

Back 84

# Jaundice commonly occurs.

* Unconjugated bilirubin is the end product of macrophage degradation of Hb.

Front 85

Acute hemolytic transfusion reaction (HTR)
lab findings

Back 85

# Positive direct Coombs' test

* IgG antibody and/or C3b is coating donor RBCs.

# Positive indirect Coombs' test

* Atypical antibody is present in serum.

# No significant increase in Hb over pretransfusion levels.
# Hemoglobinuria (sign of intravascular hemolysis)
# Jaundice (sign of extravascular hemolysis)

Front 86

Hemolytic disease of the newborn (HDN)
mech and results

Back 86

HDN results from the transplacental passage of maternal IgG antibodies (e.g., anti-D antibodies, anti-AB antibodies in O mothers)

resulting in an extravascular hemolytic anemia in the fetus.

Front 87

ABO Hemolytic disease of the newborn (HDN)
how common

Back 87

# Most common HDN

* Present in 20% to 25% of all pregnancies

Front 88

ABO Hemolytic disease of the newborn (HDN)
pathogenesis

Back 88

# Pathogenesis

1. Blood group O individuals have anti-AB-IgG antibodies.
1. IgG antibodies cross the placenta and attach to fetal A or B RBCs.
2. Fetal splenic macrophages phagocytose RBCs, causing anemia.
3. Unconjugated bilirubin from extravascular hemolysis is disposed of in the mother's liver.

Front 89

ABO Hemolytic disease of the newborn (HDN)
who is effected

Back 89

Mothers are blood group O and the fetus is either blood group A or B


May affect the firstborn or any future pregnancy if ABO incompatibility exists

Front 90

ABO Hemolytic disease of the newborn (HDN)
clinical findings

Back 90

Jaundice develops within the first 24 hours after birth.


Mild normocytic anemia or no anemia at all

Front 91

ABO Hemolytic disease of the newborn (HDN)
Risk for kernicterus

Back 91

is very smal

Front 92

ABO Hemolytic disease of the newborn (HDN)
wrt transfusion

Back 92

Exchange transfusions are rarely indicated.

Front 93

ABO Hemolytic disease of the newborn (HDN)
lab findings

Back 93

# Positive direct Coombs' test on fetal cord blood RBCs

* Due to anti-AB-IgG antibodies coating fetal A or B RBCs

# Spherocytes are present in the cord blood peripheral smear.

* Due to macrophage removal of a portion of the RBC membrane

Front 94

most common cause of jaundice in 24 hours after birth

Back 94

ABO HDN

Front 95

Rh HDN
wrt quantity of blood

Back 95

he amount of fetal blood is quantified so that the appropriate amount of anti-D globulin is given to the mother.

Front 96

Rh HDN what does Anti-D do

Back 96

Anti-D globulin masks the antigenic sites on the fetal RBCs or destroys the fetal RBCs so that the mother does not host an antibody response against the D antigen.

Front 97

when is thereno indication for giving the Anti-D globulin either during or after delivery,

Back 97

the patient develops anti-D antibodies,because its main purpose is to prevent sensitization.

Front 98

Kernicterus refers to

Back 98

deposition of free (not bound to albumin) lipid-soluble unconjugated bilirubin in the basal ganglia owing to an incompletely formed blood-brain barrier.

Front 99

what non drug protects the mother from developing Rh sensitization.

Back 99

ABO incompatibility
----any A positive fetal RBCs entering her circulation will be destroyed by maternal anti-A-IgM antibodies, thereby preventing sensitization.

Front 100

???????is absent during the last trimester.

* Increases the risk for a fetomaternal bleed

Back 100

Cytotrophoblast

Front 101

Rh HDN
when is mom exposed to fetal blood

Back 101

Occurs during the last trimester or during childbirth itself

Front 102

Rh HDN
pathogenesis of sensitization

Back 102

# Mother is Rh (D antigen) negative and the fetus is Rh positive.
# Mother is exposed to fetal Rh positive blood (fetomaternal bleed).

# Mother develops anti-D-IgG antibodies when exposed to fetal Rh positive cells.

Front 103

Rh HDN
pathogenisis of later babies

Back 103

# Anti-D-IgG antibodies cross the placenta and attach to fetal Rh positive RBCs.
# Fetal splenic macrophages phagocytose RBCs, causing severe anemia.

Front 104

Rh HDN
results of Fetal splenic macrophages phagocytose RBCs, causing severe anemia.

Back 104

extravascular hemolytic anemia in the fetus.

# Fetus may develop high-output cardiac failure leading to hydrops fetalis and death.
# Hydrops fetalis is a combined left- and right-sided heart failure with ascites and edema.

Front 105

Rh HDN

hematopoiesis

Back 105

Extramedullary hematopoiesis is present in the liver and spleen.

Front 106

Rh HDN
who deals with the unconjugated bilirubin

Back 106

Unconjugated bilirubin is conjugated in the mother's liver.

Front 107

Rh HDN
Prevention of Rh HDN in Rh negative mothers who don't make anti-D

Back 107

Receive anti-D globulin (Rh immune globulin) during the 28th week of pregnancy

Front 108

Anti-D globulin ????? cross the placenta

Back 108

does not

Front 109

Anti-D globulin protects the mother from

Back 109

sensitization to fetal Rh positive cells

Front 110

Anti-D globulin lasts ????? in the mother's blood.

Back 110

∼3 months

Front 111

Additional anti-D globulin is given to the mother after delivery if the baby is?

Back 111

Rh positive.

Front 112

Rh HDN
clinical findings

Back 112

Jaundice develops shortly after birth.

Front 113

Degree of anemia is more severe than with ABO HDN.

Back 113

Rh HDN

Front 114

Rh HDN
wrt kernicterus

Back 114

Increased risk for kernicterus

* The free, unbound lipid soluble unconjugated bilirubin poses the greatest risk for bilirubin entry into the brain

Front 115

Level of unconjugated bilirubin is much higher than with ABO HDN.

Back 115

Rh HDN

Front 116

Rh HDN vs

ABO HDN

WRT Anemia
WRT jaundice

Back 116

Degree of anemia is more severe than with ABO HDN.

Level of unconjugated bilirubin is much higher than with ABO HDN.

Front 117

Rh HDN
lab tests

Back 117

# Positive direct and indirect Coombs' tests on fetal cord blood
# Spherocytes are not present in cord blood.

* Macrophages phagocytose the entire RBC.

Front 118

Rh HDN
wrt transfusion

Back 118

# Exchange transfusions are required.

1. Newborn's blood is removed and replaced with fresh blood.
2. Transfusion corrects anemia and removes antibodies and unconjugated bilirubin.

Front 119

Which HDN is this
Spherocytes are not present in cord blood.

Back 119

Rh HDN

Front 120

Which HDN is this
Positive direct and indirect Coombs' tests on fetal cord blood

Back 120

Rh HDN

Front 121

Which HDN is this
Exchange transfusions are required.

Back 121

Rh HDN

Front 122

Which HDN is this
Most common HDN

Back 122

ABO HDN

Front 123

Which HDN is this
Risk for kernicterus is very small

Back 123

ABO HDN

Front 124

Which HDN is this
Mild normocytic anemia or no anemia at all

Back 124

ABO HDN

Front 125

Which HDN is this
Exchange transfusions are rarely indicated.

Back 125

ABO HDN

Front 126

Which HDN is this
Spherocytes are present in the cord blood peripheral smear.

Back 126

ABO HDN

Front 127

Newborn
Use of blue fluorescent light

Back 127

# Used as a treatment of jaundice in the newborn
# Unconjugated bilirubin in the skin absorbs light energy from blue fluorescent light.

Front 128

Newborn
Use of blue fluorescent light
describe the reaction

Back 128

# Photoisomerization converts unconjugated bilirubin to a nontoxic water-soluble dipyrrole (called lumirubin).

* Lumirubin is excreted in bile or urine.

Front 129

What is Lumirubin
and how is it excreted

Back 129

# Photoisomerization converts unconjugated bilirubin to a nontoxic water-soluble dipyrrole (called lumirubin).

* Lumirubin is excreted in bile or urine.