Pathology 3

Front 1

People with blood Type O express what antigen?

Back 1

H antigen

Front 2

N-acetyl galactosamine is expressed on the ___ antigen
Galactose is expressed on the ___ antigen

Back 2

A
B

Front 3

Anti-A and Anti-B are what type of antibodies?

Back 3

IgM in group A and B individuals
IgG in group O serum

Front 4

ABO antibodies activate complement and lead to ___ vascular hemolysis

Back 4

intravascular

Front 5

Are ABO antibodies high or low titer?

Back 5

high titer

Front 6

An person with AB blood type can receive what type of plasma?

Back 6

AB plasma

Front 7

Who is the universal donor for plasma?

Back 7

AB

Front 8

After ABO, the Rh ___ antigen is the most immunogenic antigen on RBCs.

Back 8

D

Front 9

Is most of the population Rh positive or Rh negative?

Back 9

Rh negative

Front 10

Rh negative mothers usually have what Rh phenotype?

Back 10

rr
R1= CDe
Ro= cDe
r = cde

Front 11

About ____ of Rh D negative individuals will make antibody to Rh D if exposed to the antigen by transfusion or pregnancy

Back 11

80%

Front 12

Do platelets have RH blood groups on them?

Back 12

No

Front 13

Rh antibodies only made after transfusion/pregnancy, predominantly ____, unlike ABO which is mostly ____, get ____ hemolysis with RH antibodies, rather than _____ hemolysis

Back 13

IgG
IgM
extravascular
intravascular

Front 14

Does RH antibodies activate complement?

Back 14

No

Front 15

ABO blood typing is performed at what temperature?

Back 15

room temperature
IgG reacts at 37 degrees

Front 16

What is front typing in ABO blood group typing?

Back 16

Patients red blood cells are incubated with either Anti-A or Anti-B antibodies. Agglutination demonstrates a positive test

Front 17

What is back typing in ABO blood group typing?

Back 17

Incubate known RBC with patient's sera
A negative test suggests the patient is that blood group
A positive test (agglutination) suggests that is not the patient's blood group

Front 18

With back typing, if there is agglutination with A cells but not B cells, what does this suggest the patient's blood type is?

Back 18

B because the patient is producing Anti-A

Front 19

What is the procedure for an antibody screen?

Back 19

Patients serum is incubated with a Group O person's RBCs. If agglutination occurs, person has made antibodies against some specific antigen

Front 20

What is crossmatching?

Back 20

Incubating the patient's serum with the donor's RBCs. If no agglutination is see, transfusion can occur.

Front 21

Only RBC containing components need to be crossmatched. True or False?

Back 21

True

Front 22

How does the direct Coomb's test work. What does it test?

Back 22

The Direct Coomb's test tests whether a patient's red blood cells have been coated with immuglobulin or complement. The patient’s RBC are incubated with Coombs reagent, which is rabbit anti-human IgG and rabbit anti-human complement (C3

Front 23

HIV, Hep B, Hep C, HTLV I/II, Syphilis, Chagas Disease, West Nile Virus are all tested for before a blood donor can donate blood. True or False?

Back 23

True

Front 24

If you have had babesiosis or malaria, can you donate blood?

Back 24

no

Front 25

Are you more likely to contract Hepatitis B, C or HIV via blood transfusion

Back 25

Hep C

Front 26

If testing for infectious diseases have improved, why is there still a risk of developing disease from transfusions?

Back 26

window period
defined as the lag time between exposure and onset of infectiousness and appearance of diagnostic marker of infection in a donor

Front 27

What are the three component you can derive from whole blood?

Back 27

Red blood cells
Plasma
Platelets
With aphresis you can also get granulocytes

Front 28

What is the indication to use red blood cell concentrate?

Back 28

To increase red cell mass in symptomatic anemia

Front 29

How much does one unit of red blood cells increase the hemoglobin count? hematocrit count?

Back 29

Hb by 1
hematocrit by 3%

Front 30

With increased length of storage of red blood cells does 2,3 BPG increase or decrease?

Back 30

decrease, lower levels means hemoglobin binds more avidly to oxygen, meaning less oxygen delivery. However after transfusion, RBCs regenerate 2, 3 DPG

Front 31

When should you transfuse a person with platelets?

Back 31

when they are bleeding due to thrombocytopenia or thrombocytopathy

Front 32

Fresh frozen plasma contains coagulation factors and complement but no platelets. True or False?

Back 32

True

Front 33

Potassium in the RBC supernatant _____ during storage. This affects what type of people?

Back 33

increases
newborns, patients with renal failure

Front 34

Should platelets ever be stored in a refrigerator like RBC's?

Back 34

NO

Front 35

What coagulation factors are in highest concentration in plasma?

Back 35

II, 7, 9, 10

Front 36

Should you use fresh frozen plasma to replace Factor 8?

Back 36

No because it degrades rapidly

Front 37

What are the three indication to use FFP?

Back 37

1) Replace clotting factors
2) Reverse warfarin
3) Plasma exchange to treat HUS or TTP

Front 38

When should you use cryoprecipitate?

Back 38

When a patient has low fibrinogen and also a Factor 13 deficiency
Cryoprecipitate contains concentrated Factor VIII, Von Willebrand factor (vWF) and Factor XIII

Front 39

Oxygen delivery (DO2) is the product of cardiac output (CO) and arterial oxygen content (CaO2). True or false?

Back 39

True

Front 40

There are EKG changes when Hemoglobin is below what g/dL

Back 40

5 g/dL
morbidity and mortality increase if the post op Hb was below 5

Front 41

Leukoreduction reduces the changes the patient will be infected with what virus?

Back 41

CMV

Front 42

Hemolytic disease of the newborn is limited to what type of antibodies?

Back 42

IgG which is actively transported across the placenta

Front 43

Is an RH positive or RH negative mother at risk for developing anti-D antibodies that may lead to hemolytic disease in the fetus?

Back 43

Rh negative

Front 44

Hydrops fetalis (aka erythroblastosis fetalis)- leads to problems with liver function which can lead to hypoproteinuira and therefore ____

Back 44

edema

Front 45

Kernictus is when _____ bilirubin accumulates in the CNS

Back 45

unconjugated
especially deposits in the basal ganglia

Front 46

When is Anti-D Immune Globulin Prophylaxis given?

Back 46

To Rh negative mother at 28 weeks gestation or within 72 hours postpartum

Front 47

What is the criticial titer for Anti-D antibodies in a mother where you may begin to worry about HDN?

Back 47

1:16

Front 48

Paternal zygosity can be tested to see the chances the fetus is RH negative or positive. True or False

Back 48

True

Front 49

With the middle cerebral artery doppler, is faster bloodflow a signal of low or severe anemia?

Back 49

severe

Front 50

____ present in the amniotic fluid correlates with the degree of fetal hemolysis

Back 50

Bilirubin

Front 51

With the liley curve, should you be worried if the bilirubin was in Zone 1 or Zone 3?

Back 51

Zone 3

Front 52

If you suspect HDN in the fetus, how do you treat the fetus?

Back 52

With intrauterine transfusion. D negative RBCs transfused via umbilical vein
Repeat until 34 weeks

Front 53

Milder forms of HDN can be treated with phototherapy. True or False?

Back 53

True

Front 54

If biliribun is over 20 mg/dL and phototherapy does not work in the baby, consider ____

Back 54

exchange transfusion

Front 55

With post partum management If antibody screen is negative, and rosette test is negative, ____ vial (300 ug) Rh immune globulin given

Back 55

one

Front 56

If the Rosette Test is positive, large materal fetal hemorrhage has occurred. True or False

Back 56

True

Front 57

In this test, a sample of maternal blood is incubated with Rho(D) immune globulin, which will bind to any fetal Rh positive red blood cells, if present. Upon addition of R2R2 cells, the presence of Rh positive fetal blood causes rosetting, which can be seen by light microscopy

Back 57

Rosette Test

Front 58

If the Kleihauer-Betke test came back as 1.3%, how much RhIG should you give?

Back 58

Assume mom blood volume = 5000 mL
1.3/100 X 5000 mL = 65 mL fetal blood
65 mL/ 30 mL per dose = 2.2 doses of RhIG
Round up so 3 vials of RhIG is needed

Front 59

ABO HDN is usually seen in what situation?

Back 59

Group O mother with Group A or Group B infant

Front 60

The most severe form of HDN is anti___

Back 60

Kell

Front 61

Why is anti-Kell most severe form of HDN?

Back 61

Kell is expressed not only on RBCs but also progenitor cells so fetus can't even make new red blood cells

Front 62

Neonatal alloimmune thrombocytopenia is caused by materal IgG alloantibodies directed against a ____ specific alloantigen present on the fetus

Back 62

platelet
can lead to thrombocytopenia and intracranial hemorrhage

Front 63

Blueberry muffin baby suggest what disease?

Back 63

Neonatal alloimmune thrombocytopenia (NAIT)
increased in severity in subsequent pregnancies

Front 64

Antibodies against human platelet antigens (HPA) can cause what in the newborn?

Back 64

NAIT
HPA-1a has most alloimmunization

Front 65

Acute hemolysis occurs with 24 hours after blood transfusion. True or False?

Back 65

True
Delayed hemolysis - 5-7 days after

Front 66

Can you use anything other than normal saline with tranfusions?

Back 66

No

Front 67

The most fatal acute hemolytic transfusion reaction occurs due to what antigens?

Back 67

ABO

Front 68

Complement activation, Hemoglobinemia, hemoglobinuria, back pain, red/pink urine is seen in ____ hemolysis

Back 68

intravascular

Front 69

The severe clinical symptoms of shock and hypotension seen in acute hemolytic transfusion reactions are caused by the complement fragments ____ and ____

Back 69

C3a and C5a

Front 70

With intravascular hemolysis is there a positive or negative Coomb's test?

Back 70

negative, because all the red cells have been lysed

Front 71

Delayed Hemolytic Transfusion Reactions occur due to _______ hemolysis

Back 71

extravascular

Front 72

Fever, jaundice, a drop in hemoglobin and a positive DAT can suggest ____ hemolysis

Back 72

extravascular

Front 73

Is intravascular hemolysis or extravascular hemolysis a more life threatning event?

Back 73

intravascular hemolysis

Front 74

Allergic reaction to transfusions are limited to itching and hives. Antibodies to donor plasma antigens such as IGA or C4, haptoglobin with symptoms such as hypotension, urticaria, bronchospasm, local edema, should be assessed for _____ reaction

Back 74

anaphylaxic

Front 75

How do you treat an allergic reaction to transfusion?

Back 75

anti-histamine

Front 76

Would you expect the DAT to be positive or negative in an anaphylactic reaction?

Back 76

negative

Front 77

What is the most common antibody deficiency see in anaphylactic reaction?

Back 77

IgA

Front 78

What is the #1 cause of transfusion related death in the US?

Back 78

TRALI (transfusion related acute lung injury)

Front 79

Fever, Dyspnea, Hypotension, Tachypnea, Tachycardia, and frothy endotracheal aspirate can suggest what transfusion reaction?

Back 79

TRALI

Front 80

Symptoms of TRALI must occur within ___ hours after transfusion or it is not considered TRALI

Back 80

6

Front 81

TRALI is caused by ____ antibodies

Back 81

HLA
also antibodies to neutrophil antigens

Front 82

To prevent TRALI usually no _____ is accepted from multiparous women

Back 82

plasma (contains serum with all antibodies)

Front 83

Transfusion associated circulatory overload can occur due to renal insufficiency or cardiac impairment. True or False?

Back 83

True

Front 84

How do you distinguish TRALI from TACO

Back 84

TRALI = hypotension
TACO = hypertension
In TACO there will also be increased production of BNP

Front 85

Febrile Nonhemolytic Transfusion Reactions (FNHTR) are defined by temperature increases of greater than ___ post tranfusion

Back 85

1 degree celcius

Front 86

Septic transfusion reactions happen more often after transfusion of RBCs or platelets?

Back 86

platelets

Front 87

In Febrile Nonhemolytic Transfusion Reactions (FNHTR) antibodies in recipient plasma react with antigens on donor ____ or ____

Back 87

WBCs or plasma

Front 88

Yersinia enterocolitica and serratia liquifaciens are the primary cause of ___ mediated septic reactions after transfusion

Back 88

RBC

Front 89

Discarding of first aliquot of donor blood helps decrease the chances of septic reactions due to transfusion. True or False?

Back 89

True

Front 90

These precursor red blood cells have a blue hue to them because there is some RNA left in them (Giemsa Stain)

Back 90

reticulocytes

Front 91

The reticulin stain stains ____ blue

Back 91

RNA

Front 92

The normal life span of a RBC is ____. Red blood cells are eaten up in the ____

Back 92

120 days
spleen

Front 93

Anemia is defined as a reduction in circulation ____ blood cell mass

Back 93

red

Front 94

Does the hemoglobin or hematocrit count correlate best with red blood cell mass?

Back 94

hemoglobin

Front 95

RBC X MCV = ____

Back 95

hematocrit

Front 96

The MCHC is increased in ____

Back 96

hereditary spherocytosis

Front 97

The normal Red cell distribution width is 11-15%. In iron deficiency anemia is the RDW normal or increased? What about thalassemia trait?

Back 97

Iron deficiency - increased
thalassemia trait = normal

Front 98

Is Paroxysmal Noctrunal Hemoglobinuria an example of intravascular or extravascular hemolysis?

Back 98

intravascular

Front 99

Is hereditary sperocytosis and thalassemia major examples of intravascular or extravascular hemolysis?

Back 99

extravascular

Front 100

Should red blood cells have an area of central pallor?

Back 100

Yes

Front 101

Does iron deficiency, B12 deficiency, and aplastic anemia lead to increased or decreased reticulocyte counts? What about immune hemolytic anemia, sickle cell disease and hereditary spherocytosis?

Back 101

first group = decreased reticulocyte count
second group = increased reticulocyte count

Front 102

Can schistocytes occur with DIC?

Back 102

Yes

Front 103

Anemia due to defective protophoryin synthesis is known as ___ anemia and presents as a hypochromic, microcytic anemia

Back 103

sideroblastic

Front 104

Serum ____ reflects iron stores in macrophages and liver

Back 104

ferritin

Front 105

Most iron is absorbed in what part of the intestine? Is absorbing heme or non-heme iron more efficient?

Back 105

duodenum
heme

Front 106

Is transferrin increased or decreased in iron deficiency?

Back 106

increased as the body is searching for more iron

Front 107

Iron can be stored as ____ in macrophages and bone marrow

Back 107

hemosiderin

Front 108

Why can aspirin be a risk for anemia?

Back 108

Taking too much aspirin can put you at risk for GI bleeding

Front 109

In iron deficieny anemia should TIBC be up or down?

Back 109

up

Front 110

In sideroblastic anemia, iron becomes trapped in ____

Back 110

mitochondria

Front 111

gheilosis is a sore on the mouth that could be a sign of ____

Back 111

anemia

Front 112

The three symptoms of microcytic, hypochromic anemia, glossitis, and esophageal webs defines what syndrome?

Back 112

Plummer- Vinson

Front 113

A mutation in TMPRSS6 can lead to iron deficiency anmeia because this genetic defect leads to a high level of ____, an acute phase reactant that sequesters iron in storage sites in an aim to prevent bacteria from accessing iron

Back 113

hepcidin

Front 114

The most common cause of iron-deficiency in the US is chronic blood loss. True or False?

Back 114

True

Front 115

Fecal guaiac test tests what?

Back 115

for upper GI bleed

Front 116

Anemia of chronic disease is associated with chronic inflammation caused by example by endocarditis or autoimmune conditions. True or False?

Back 116

True

Front 117

In anemia of chronic disease is transferrin usually increased or decreased? What about ferritin?

Back 117

ferritin = increased
transferrin = decreased

Front 118

Hypersegmented neutrophils can result from a ____ anemia

Back 118

macrocytic

Front 119

If the Coombs test is negative, does this suggest that hemolytic anemia is occuring?

Back 119

no

Front 120

IF the LDH is high, what does this suggest?

Back 120

liver damage and/or hemolysis

Front 121

B___ is first bound to R-binder, goes down to duodenum, proteases in pancreas break away R-B__ complex

Back 121

B12

Front 122

Does folic acid or B12 (cobalamin) deficiency result in neurologic disorders?

Back 122

B12 only

Front 123

Pernicious Anemia is due to a ___ deficiency

Back 123

B12
lack of parietal cells

Front 124

Do spherocytes have central pallor?

Back 124

NO

Front 125

With the osmotic fragility test do cells with a membrane defect lyse earlier or later compared to controls?

Back 125

eariler

Front 126

Hereditary Spherocytosis, immune hemolytic anemia, pyruvate kinase deficiency, and thalassemia all see increased or decreased osmotic fragility?

Back 126

increased

Front 127

Is the cause of hereditary spherocytosis usually autosomal dominant or recessive?

Back 127

dominant

Front 128

In hereditary spherocytosis, is the spleen enlarged?

Back 128

Yes, treatment is splenctomy

Front 129

An aplastic crisis can be caused by what viral infection?

Back 129

parvovirus
virus infects erythroid progenitors

Front 130

After splenectomy for an individual with hereditary spherocytosis, would you still see a markedly elevated reticulocyte count?

Back 130

Yes

Front 131

Howell-Jolly bodies (nuclear DNA remnant) occur because you have removed what organ?

Back 131

Spleen
also see basophilic stippling due to RNA/endoplasmic reticulum remnant

Front 132

Haptoglobin binds _____. If you see a decrease in haptoglobin you are lysing ____

Back 132

hemoglobin

Front 133

_____ are inclusions within red blood cells composed of denatured hemoglobin.

Back 133

Heinz bodies

Front 134

The supravital stain allows you to visualize ___ within RBCs

Back 134

Heinz bodies

Front 135

G6PD is a recessive X-linked disorder. True or False?

Back 135

true

Front 136

Decreased G6PD will lead to decreased NADPH which will lead to decreased reduced glutathoine. This will lead to increased ____ which will lead to intravascular hemolysis

Back 136

hydrogen peroxide

Front 137

Nitrofurantoins and fava beans can cause anemia in people with a ____ deficiency

Back 137

G6PD

Front 138

Is the African or Mediterranean variant of G6PD deficiency more severe?

Back 138

Mediterranean

Front 139

Heinz bodies are removed from RBCs by splenic marcophages, resulting in ___ cells

Back 139

bite

Front 140

Are older or younger RBCs more susceptible to oxidant injury?

Back 140

older

Front 141

If a patient has anemia and their DAT is positive, this suggests they have immune hemolytic anemia. True or False?

Back 141

True

Front 142

If the hemolytic anemia is IgG mediated it usually involves ___ hemolysis, whereas if the hemolytic anemia is IgM mediated, it usually involves ___ hemolysis

Back 142

extravascular
intravascular

Front 143

IgG binds RBCs in relatively ____ temperatures whereas IgM binds RBCs in relatively ___ temperatures

Back 143

warm
cold

Front 144

IgG mediated hemolytic anemia is associated with lupus and certain drugs such as penicillin and cephalosporin. True or False?

Back 144

True

Front 145

Loss of RBC membrane to IgG coating on RBCs leads to the formation of ____

Back 145

spherocytes

Front 146

Mycoplasma infection, mono, CMV, influenza and HIV can lead to hemolytic anemia mediated by what antibody?

Back 146

IgM

Front 147

Raynaud phenomeon can occur via hemolytic anemia caused by IgG or IgM mediated disease?

Back 147

IgM

Front 148

If a person develops immune hemolytic anemia at normal body temperature is this IgG or IgM mediated?

Back 148

IgG