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325 Cards in this Set
- Front
- Back
donor deferral (time/year)- possible exposure to: hepatitis B immune globulin
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1 year
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donor deferral (time/year)- possible exposure to: poss exposure to hep, hiv, & malaria
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1 year
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donor deferral (time/year)- possible exposure to: recipient of blood/blood products
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1 year
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donor deferral (time/year)- possible exposure to: tattoo
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1 year
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donor deferral (time/year)- possible exposure to: mucous membrane exposure to blood
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1 year
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donor deferral (time/year)- possible exposure to: skin penetration w/ instrument contaminated w/ blood/blood fluid
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1 year
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donor deferral (time/year)- possible exposure to: sexual contact with indvdl symptomatic for any viral hep, confirmed + for HBsAg/Hiv or in high risk category
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1 year
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donor deferral (time/year)- possible exposure to: from completion of therapy for syphilis or gonorrhea or reactive STS
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1 year
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donor deferral (time/year)- possible exposure to: traveled to endemic areas for malaria w/ or w/out antimalarial drug, & were free of malarial symptoms during that time
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1 year
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donor deferral (time/year)- possible exposure to: >72 hours in correctional institution
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1 year
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donor deferral (time/year) if exposure to: asymptomatic during time: vistor/immigrant from area endemic for malaria or previous diagnose w/ malaria
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3 years
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donor deferral (time/year) if exposure to: viral hep after age 11
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indefinite
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donor deferral (time/year) if exposure to: + confirmation test for HBsAg
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indefinite
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donor deferral (time/year) if exposure to: repeatly reactive test for anti-HBc
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indefinite
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donor deferral (time/year) if exposure to: doanted only unit to recipient who developed post transfusion hep, HIV, HTLV
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indefinite
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donor deferral (time/year) if exposure to: present/past infection of HCV, HTLV or HIV
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indefinite
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donor deferral (time/year) if exposure to: evidence of parenteral drug use
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indefinite
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donor deferral (time/year) if exposure to: recieved dura mater or pituitary growth hormone of human origin, family history of CJD (Creutzfeldt-Jakob disease) or risk of vCJC
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indefinite
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donor deferral (time/year) if exposure to: history of Chagas' disease or babesiosis
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indefinite
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what is Creutzfeldt-Jakob disease and what does it cause and how it is related to mad cow disease
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(CJD) is a transmissible, rapidly progressing, neurodegenerative disorder called a spongiform degeneration related to "mad cow disease."
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terms for separation & collections of: CYTA-phresis
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cells
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terms for separation & collections of: plasma-phresis
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plasma
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terms for separation & collections of: platelet-phresis
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platelets
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terms for separation & collections of: leuka=phresis
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leukocytes/granulocytes
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RBCs (packed cells) - needs to be storage (open/close system, CDP, CPDA & Additive) how & what is the standard of this component
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1-6 c - closed system
21 days (CPD) 35 days (CPDA-1) 42 days (Additive) 1-6 c open - 24 hours HCT = 80% max |
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Leukocyte Reduce Cells - needs to be storage how (open/close system, CDP, CPDA & Additive) & what is the standard of this component
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1-6 c - closed system
21 days (CPD) 35 days (CPDA-1) 42 days (Additive) 1-6 c open - 24 hours 85% of original cells, <5 x 10 6 leukocytes in 95% unit tested |
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Frozen Red Cells - needs to be storage how & what is the standard of this component
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10 years = -65c or colder (40% glycerol)
-120 c (20% glycerol) 24 hours once deglycerolized 80% original red cells, adequate removal of cryoprotective agent |
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FFP needs to be storage how & what is the standard of this component
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10 years = -65c or cooler (40% glycerol)
-120c (20% glycerol) 24 hours once deglycerolized frozen to <18c or <-65 w/ 6-8 hours (depends on anticoag) |
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Cryo needs to be storage how & what is the standard of this component
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12 months <-18c
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Platelet (single donor/close system) needs to be storage how & what is the standard of this component
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3-5 days depends on collection bag
20-24 c w/ constant angitation >5.5 x 10 10/plt unit in 90% units tested ph:6.2or greater in 90% united tested at max storage time |
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Platelets (open system) Pooled needs to be storage how & what is the standard of this component
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4 hours
20-24 with agitation |
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Platelet, leukocyte reduced needs to be storage how & what is the standard of this component
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3-5 days depends on collection bag
20-24 c w/ constant angitation >5.5 x 10 10/plt unit in 90% units tested <8.3 x 10 5/leukocyte in 95% units tested <5x 10 6/in pooled platelets |
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Platelet - phresis needs to be storage how & what is the standard of this component
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5 days, 20-24 c with constant agitation
24 hours in open system |
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Granulocytes - phresis needs to be storage how & what is the standard of this component
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24 hours, 20-24 c
>1.0 x 10 10/granulocytes in 75% of units tested |
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what is the expiration of CPD-anticoag and what chemicals are added
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21 days expiration
citrate, phosphate & dextrose |
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what is the expiration of CPDA-1-anticoag and what chemicals are added
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35 days expiration
adenine added |
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name four main additives and how much longer would it enhance red cell survival
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contains: dextrose, adenine & sodium chloride + other subtx
enhance red cell survival 42 days |
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when rejuvenating solution is added, what chemical does it contain (4) and what does it restores (2)
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contains: pyruvate, inosine, phosphate & adenine (PIPA, instead of HIPA)
rejuv PIPA!! restores: 2,3 - DPG and ATP |
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when rejuvenating solutions are added to product, how much longer does it it be used after expiration date
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up to 3 days after expiration date
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what must happen once you add rejuvenating solution in a freeze unit (if stored in 24 hours at 1-6c)
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must wash cells before transfusion to remove solution
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what is autologous donation and what are its benefits
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donation for self and its benefits is that it has no bacteremia
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autologous donation - what does the patient hct/hgb need to be to donate
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hct = 33%
hgb = 11 g/dl |
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autologous donation - what must the preoperative collection be labeled that will indicate use for only for this patient
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"for autologous use only" & it must be separated from allogenic units (from other units)
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what is the MAX collection for donor blood
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no more than 10.5 mL of whole blood per kilogram of body weight, including samples
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autologous donation - Low volume collection - if 300 - 404 ml of blood are drawn, what must be label the unit as
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label as "Red Blood Cells Low Volume" - these components may not be made from these units
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autologous donation - Low volume collection - if blood is drawn <300 ml, what must be done
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use proportionately less anticoag
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autologous donation - what is the calculation for low volume collection ex: 90 lb donor
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90 lb/110 lb x 450 ml (std dontx) = 368 ml
if donor is given in kg, div donor by 50, then mx by 450 amt of anticoag use: 368 x 14% = 51.5 = 52 % amt of anticoag 63 - 52 = 11ml, remove 11ml of anticoag from primary bag into attached satellite bad prior to draw |
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autologous donation - what happens to inoperative collections
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they become "salvaged" blood collected during surgery, washed onsite & returned to patient during procedure
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autologous donation - remember must be this amount for mim weight collection
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<10.5 mL/kg body weight for minimum weight (450 + 45 ml plus testing samples)
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hemaphresis/apheresis collection - what is the waiting period after aphresis procedure to donate whole blood
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must wait 48 hours after aphresis procedure to donate whole blood
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hemaphresis/apheresis collection - what is the FDA limits on this type of collection
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FDA limit to 500 ml/collection or
if weigh > 175 lbs = 600 mL |
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hemaphresis/apheresis collection - what are the methods on centriugation
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centrifugation - withdrawl of WB, removing selected fraction & reinfusion of the remaining components into the donor
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hemaphresis/apheresis collection - what are the methods on filtration
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filtration - removal of only plasma through a membrane for normal plasma collection or for therapeutic purposes
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hemaphresis/apheresis collection - what are the methods on adsorption
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adsorption - removal of only selected constituent of plasma with reinfusion of plasma after constituent removed
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this is used to reconstitute BM post chemo/irradiation or to replace abn marrow cells w/ normal marrow cells (congenital immune def, anemias, malignant, disorders of BM, red cell disorders etc)
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hematopoietic progenitor & stem cell collection
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cells obtains from BM, umbilical cord blood & peripheral blood (apheresis)
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hematopoietic progenitor & stem cell collection
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allogeneic marrow - HLA id match LOWERS GVHD link or risk, ABO comp not required
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hematopoietic progenitor & stem cell collection
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this blood component is given when: severe shock (blood loss >25% blood volume) needs rbcs for O2 & plasma for volume)
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whole blood
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this blood component is given when: rarely used due to increase use & availability of components
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whole blood
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this blood component is ___ with plasma removed by sedimentation, centrifugation or washing
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red blood cells (packed cells)
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this component is given to provide same O2 carry capacity as whole blood with less volume
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red blood cells (packed cells)
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this blood component is used when: <80% hct (indicates sufficient plasma removal), 55-65% hct if additive solution used
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red blood cells (packed cells)
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this blood component is given to help raise 1g HGB or 3% HCT
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red blood cells (packed cells)
1 unit raises HGB 1g 1 unit raises HCT 3% |
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this blood component requires plasma removed by successive saline washes (automated instruments)
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wash red cells
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this blood component is given to prevent allergic response to plasma protein & anaphylactic shock in IgA def pat w/ anti-IgA (IgA is in normal plasma)
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washed red cells
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this blood component is expired 24 hours after seal of original unit is broken
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washed red cells
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this blood component has 85% of red cells retained
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leukocyte reduced red cells
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this blood component can help the final WBC count <5 x 10 6 to prevent febrile nonhemolytic rtx & other use ex: prevent CMV transmission
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leukocyte reduced red cells
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this blood component is (preferred) prepare by filtration, washing will remove leukocytes also
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leukocyte reduced red cells
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this blood component is used primarily for pat w/ repeated febrile nonhemolytic (FNH) rtx, usually due to presence of CYTOKINES related from white cells or alloimmunization to HLA or leukocyte antigens
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leukocyte reduced red cells
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this blood component has cells protected from low temp by cryoprotective agent *glycerol*
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frozen cells
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this blood component must be thawed @37c & glycerol removed prior to transfusion
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frozen cells
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this blood component has 80% of original red cells must be recovered
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frozen cells
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this blood component is used for storage of autologous units & rare units, expires 10 years
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frozen cell
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this blood component is prepared by separating cells & plasma by centrifugation & freezing plasma within 8 hours of collection
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FFP
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this blood component expires 1 year from date of collectio when stored at <-18 c or colder at 7 years at <-65c
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FFP
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this blood component once thawed (btwn 30-37c) expires in 24 hours if kept in 1-6c
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FFP
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this blood component MUST be ABO compat w/ recipient cells, not necessarily ABO identical
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FFP
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this blood component is used for mx coag def, factor 13 defncy, & other coag def for which no concentrate is available
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FFP
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this blood component is made after FFP is frozen within 8 hours of WB collection is thawed at 1-6c, a cold INSOLUBLE portion of plasma is formed....
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component has to be separated from thawed FFP & refrozen asap
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component must contain >150 mg of fibrinogen & >80 IU/bag of factor 8
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component also contains factor 8C & VWF of Factor 8 molecule & factor 13
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component must be stored at <-18 c for 1 year from date of phlebotomy, 1-6c after thawing
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component must be transfused w/in 6 hours after thawing, 4 hours after pooling
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component is used for fibrinogen & Factor 13 defncy
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component is use for severe VWD (some factor 8 concentrates contain vWF)
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component is used as a topical fibrin sealant
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cryoppt (cryo ppt anti-hemophilic factor)
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this blood component is seldom used for hemophilic cz of factor 8 concentrates which have little or no risk of viral infection transmission (use DDAVP or mild hemo A)
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cryoppt (cryo ppt anti-hemophilic factor)
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VWD can be treated with two different products
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Factor 8 concentrates that have VWF & DDVAP (milder cases)
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Inhibitors of Factor 8 can be treated with two different products
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porcein Factor 8 (low crx reactivity) &
Factor 9 complex (bypass factor 8 in cascade) |
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Hem B can be treated with this product
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treated w/ Factor 9 (better than Factor 9 complex which can lead to thrombosis)
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Hem A can be treated with this product
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treat severe w/ factor 8 ad mild w/ DDAVP (stimulates endogenous factor 8 release)
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what is the benefit of using factor concentrates vs FFP
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factor concentrates increases level of specific factors w/ minimal volume compared to FFP
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factors concentrates - where do recombinant products come from & what are their added benefits
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recombinant products are prepared from plasma pools, plasma pool is processed to purify & concentrate the protein & inactivate viruses
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where do platelets come from & how are they stored
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prepared from WB stored at 20-24c prior to processing
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what are the steps to preparing/processing platelets
1. spinning 2. how it gets expressed (divided/separated into another bag) 3. remaining portion |
1. first LIGHT spin (to remove red cells) followed by a HEAVY centrifuge (to spin down platelets & white cells
2. supernatant plasma is expressed into another bag & may be frozen (FFP) 3. remaining platelets & white cells = platelet concentrate |
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under this conditions, what blood product would be used: for severe thrombocytopenia & platelet dysftx
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platelets
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under this conditions, what blood product would be used: prophylactic use platelet count is low is controversial (threshold depends on pat's risk of bleeding)
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platelets
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under this conditions, what blood product would be used: contraindicated in TTP & heparin induced thrombocytopenia
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platelets
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why can't lab use platelets from donors who are w/in 36 hours of taking drugs (ex: aspirin)
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this would impair the platelet functions and should not be used as a "single source" (aphresis product or single unit for newborn
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what two things can cause platelet refractoriness (Inappropriately low increment in platelet count following a transfusion)
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1. antibodies to HLA class I antigens
2. platelet antibodies or neutrophils/lymphocyte antibodies |
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on platelet transfusion, how much can 1 unit of platelet raise platelet count
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5,000 - 10,000 avg size adult
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on platelet transfusion, can you transfuse through a microaggregate filter
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no
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on platelet transfusion - ABO type/pooled expires when after pooling
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4 hours
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platelet QC - what is the pH needed for storage
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pH >6.2 at end of storage, stored in volume of plasma necessary to maintain pH, usually 30-70cc
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platelet QC - what is the amount of viability needed on the units tested
|
5.5 x 10 10/platelets/units or
>3 x 10 11/platelets/platelephresis in 90% of units tested |
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platelet QC - what must be done continuously to platelets
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stored continuously rotating at 20-24 c (room temp)
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platelet QC - what is important about the following values
<8.3 x 10 5/ leukocytes <5 x 10 6/ leukocytes |
indvdl leukoreduced platelets
<8.3 x 10 5/ leukocytes leukoreduced pooled platelets or plateletphressis product <5 x 10 6/ leukocytes |
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platelets - is it needed for ABO compatibility testing for infants
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yes - transfuse ABO compatibility needed for infants
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granulocytes - why is there a decrease in this product and name an adverse effect on this transfusion
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decline in use due to new antibiotics, recombinant growth factor & adverse effects from granulocyte transfusion (lung injury)
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granulocytes - when would this be used on patients
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used for NEUTROPENIC patients with documented gram negative sepsis who have not responded to antibiotics
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granulocytes - if not irradiated what are some things it can transmit or induce and then cause (3)
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transmit = CMV
induce = HLA immunization GVHD if not irradiated |
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granulocytes - what is the storage reqmnt and when should it be transfused
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stored WITHOUT agitation at 20-24c for up to 24 hours, but should be transfused ASAP
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granulocytes what makes this blood component different from other components when it comes to ABO testing
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it must be ABO compatible w/ recipient
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irradiated blood & components - what is the main benefits of using this product
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prevents graft (donor LYMPHOCYTES) vs host (pat's LYMPHOCYTES) disease by inactivating donor lymphs
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irradiated blood & components - when would it be recommended for usage (2)
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1. fetus receiving intrauterine transfusion
2. immunosupressed/compromised patients |
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irradiated blood & components - what is the minimum product given
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25 Gy (2500 cGy)
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irradiated blood & components - when does it expires
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RBCs expired on original outdate or 28 days after irradiation, whichever is first
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how much anticoag is in a blood bag
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63 ml of anticoag/bag
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expiration based on expectation of ___% of transfused cells will be in circulation 24 hours after transfusion
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75%
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what should you expect would change in plasma during storage (1-6c)
|
INCREASE: Nha & K (fly w/ NhaKKK birds)
DECREASE: Na & pH (go down with a NAP) |
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how should transporting blood & components for the following be:
1. Red cells 2. platelets & granulocytes 3. frozen components |
1. Red cells 1-10 c
2. platelets & granulocytes 20-24 c 3. frozen components = freezzee |
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what is the expiration of blood/components when seal is broken (packing cell/pooling)
1. product stored at 1-6 c = 2. product stored at 20-24 c = |
1. product stored at 1-6 c = 24 hours
2. product stored at 20-24 c = 4 hours |
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what is the expiration of pool components:
1. platelets (open system) = 2. cryoppt (open system) = |
1. platelets (open system) = 4 hours
2. cryoppt (open system) = 4 hours |
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when can a unit of blood NOT able to return & reissued
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unit of blood cannot be returned/reissued if >10c (room temp 15-30 mins) or if seal disturbed
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chains of sugar molecules in which specificity is determined by
|
immunodominant sugar
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what is the genetic pathway (draw)
|
....
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what is Anti-A1 made up
|
Dolichos biflorus (or anit-A1 human)
lectin - plant or seed extract diluted to agglutinate specific human blood grp antigens |
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what are the reactions when Anti-A1 is added to Subgroup
1. A1 2. A2 2. A3 |
1. A1 = POSITIVE
2. A2 = negative 2. A3 = negative |
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Other Subgroup of A are rare, but contain what ratio when it comes to A antigen and H antigen
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less A antigen and more H antigen
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lack of H is genetically called
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hh = Bombay phenotype
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hh has no _____ which is needed for attachment of A or B sugars, what reaction will happen Bombay forward typing
|
has no fucose
Bombay forward typing will look like O type |
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Anti-H (ulex europaeus) will react how with Bombay cells & O cells
|
Bombay cells = neg aggltx
O cells = positive aggtlx |
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Se (secretor) gene allows which expression in saliva (4)
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A, B, H and Le b in saliva
|
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these plasma antigens which absorb onto red cells as individual matures, who am I
|
Le antigens
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Antigens in the Lewis (Le) blood grp system do not develop as integral part of the RBC membrane but are
|
ADSORBED by the RBC from the surrounding plasma (develops gradually)
|
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reagent Anti-A & Anti-B are designed so testing is performed at what temp
|
room temp
|
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unknown cells + antisera = no aggltx what does that mean
|
no aggltx = cells lack antigen to which antisera (reagent antibody) corresponds
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unknown cells + antisera = aggltx
what does that mean |
cells posses antigen to which antisera corresponds
|
|
opt reactivity of serum Anti-A and anti-B is
|
4c
|
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serum grp/reverse grouping - these cells is performed at **ROOM TEMP w/ saline suspended known group
|
A1 and B red cells
|
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unknown serum + reagent red cells - NO aggltn
what does that mean |
serum lack antibody to antigen on red cell
|
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unknown serum + reagent red cells - aggltn
what does that mean |
serum has antibody to antigen on red cells
|
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what is saline replacement and what does it differentiate
|
saline replacement can diff ROULEAUX from AGGLUTINATION
Rx - "stack of coins" appearance, when serum in the test mixture is replaced with saline, the cells dissociated. in assessing Rx formtx knowledge of the pat's diagnosis & serum protein content & proportions is helpful |
|
what can rouleaux formation be associated with (disease)
|
multiple myeloma & waldernstrom's macroglobulinemia
|
|
I am the MOST immunogenic of all blood group antigens
|
D
|
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D grouping (Rh type) is based on what
|
presence or absence of D when tested with anti-D
|
|
When is weak D required
|
on DONORS and OB patients
|
|
Weak D is consider what positive
|
D positive
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D reactive at which phase only
|
antiglobulin phase only
|
|
monoclonal/polyclonal Anti-D - is separate D control necessary
|
separate D control not necessary
|
|
monoclonal/polyclonal Anti-D - control is a _____ reaction with anti-A or anti-B in ABO cell grouping (patient A & B cells not spontaneously agglutinating)
|
control is a NEGATIVE reaction
|
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monoclonal/polyclonal Anti-D - if patient is AB positive, what controls (3) must be used
|
6-8 % albumin control
autocontrol or DAT |
|
D controls are used with high protein
|
anti-D reagents
|
|
D controls what does it mean when its POSITIVE or when its NEGATIVE
|
if positive - repeat with another type of anti-D (monoclonal, chemically modified or saline)
must be negative for D negative grping to be valid |
|
D controls - must contain same media as anti-D reagent without
|
the anti-D (use same manufacturer's control)
|
|
D controls - ensures aggltnx w/ anti-D reagent is use to presence of F antigen and NOT
|
due to proteins in reagents or aggltnx of in vivo antibody coated cells (POSITIVE DAT)
|
|
D controls - most common cause of positive D control is
|
a positive DAT
|
|
since Rh structure is integral part of the RBC membrane, what does it mean to have a Rh null & what is it associated with
|
no D, C, E, c or e antigens; cells have associated hemolytic anemia
|
|
___ is missing one or more of normal Rh alleles
|
Deleted cells (--D--)
|
|
what is the resolution techx for the following problems with red cells: rouleaux - failure to wash
|
repeat with SALINE WASHED cell
|
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what is the resolution techx for the following problems with red cells: mixture of cell types (ex: A or B transfused with O
|
check transfuse history
|
|
what is the resolution techx for the following problems with red cells: subgroups (ex: A2 with or without anti-A1)
|
test with Anti-A1 for A subgroups
|
|
what is the resolution techx for the following problems with red cells: unusual genotypes (ex: bombay)
|
test with Anti-H for Bombay (bombay lacks H antigen & cells will NOT AGGLTNX with anti-H, Bombay serum will agglutinate A1 & B cells as well as Group O screening cells
|
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what is the resolution techx for the following problems with red cells: disease process (ex: leukemia or bacteria - acq B phenomenon)
|
check patient diagnosis
|
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what is the resolution for the following problems with serum: rouleaux due to increase serum proteins (ex: Waldenstrom's or MM)
|
saline replacement
|
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what is the resolution for the following problems with serum: room temp or cold reacting antibody (H, I, M, N, P1 or Lewis or anti-A1 in an A2 or A2B indvdl) reacting with their corresponding antigens on reverse cells
|
mini cold screen or panel (test at lower temp)
|
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what is the resolution for the following problems with serum: age-elderly (antibody produce is decreased) or newborn (antibody produce has not reached opt levels, missing antibodies) (2)
|
check patient age, mini cold panel (may enhance serum Anti-A or Anti-B so interpretation will agree with cell grouping)
|
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what is the resolution for the following problems with serum: compromised immune system (ex: a/hypogrammaglobulinemia) (2)
|
check patient diagnosis, mini cold panel/screen
|
|
what blood group system am I - plasma antigen that adsorb onto RBCs, not alleles
|
Lewis
|
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what blood group system am I - not on cord cells
|
Lewis
|
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what blood group system am I - my antibodies DO NOT cause HDN (i'm not on fetal cells & my antibodies are usually IGM - though I can be hemolytic
|
Lewis
IgM antibody - can be hemolytic, usually seen in Le (a-b-) persons |
|
what blood group system am I - my antibodies are often seen in pregnant woman who may temporarily become me
|
Le (a-b-) Lewis
|
|
what blood group system am I - absent or week on cord cells
|
I/i
|
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what blood group system am I - ___ convert to ___ as infant matures due to branching of carbohydrate chains, not alleles (what do I look like when I am an Adult and when I am an Infant?)
|
I/i
Infant - i positive/ I negative Adult - I positive, i negative |
|
what blood group system am I - IgM antibody that reacts with ALL adults cells
|
Antibody I except rare i adult
|
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what blood group system am I - to detect me you have to do
1. an autoadsorption (if not recently transfused) or allogenic adsorption 2, RESt adsorption 3. prewarmig serum & using IgG AHG instead of polyspecific |
Antibody I
|
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what blood group system am I - my antigen strength deteriorates upon storage
|
P1 antigen
|
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what blood group system am I - IgM cold antibody can be neutralized to reveal other clinically significant ALLO-ANTIBODIES (my substance in hyadatid cyst fluid)
|
Anti-P1
|
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what blood group system am I - frequently the specificity of the biphasic Donath-Landsteiner antibody found in Paroxysmal Cold Hemoglobinuria
|
Anti-P
|
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what blood group system am I - my antibody reacts with all P or P1 positive cells
|
Anti-P
|
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what blood group system am I - my antigens are CO DOMINANT alleles
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M and N
|
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what blood group system am I - my antibodies usually cold IgM but NO HDN
|
Antibody M and N
|
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what blood group system am I - my antibody often shows dosage (property where cells having a homo expression of antigen as opposed to hete cells)
|
Antibodyy M and N
|
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what blood group system am I - my antibodies WILL NOT react to emz treated cells (my antigens are destroyed by emz)
|
Antibodyy M and N
|
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what blood group system am I - my antibodies are IgG can cause HDN & may require acidification of serum to identify
|
Antibodyy M
|
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what blood group system am I - what kind of immunoglobin am I: Anti-S and anti-s
|
IGG
|
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what blood group system am I - my antibody form by black pple who lack S, s and U and which group of immunoglobins & antibody do I belong to
|
Anti-U and IGG
|
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what blood group system am I - beside M and N, we are also CODOMINANT alleles
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K and K (cellano)
|
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what blood group system am I: my antigens are second most immunogenic (next to D)
|
K antigen
|
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what blood group system am I: what percentage are K antigen negative in the population
|
91% are K negative
|
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what blood group system am I: my antigens are inactivated w/ 2-ME, DTT or AET and I am an IGG
|
K
|
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what blood group system am I: besides M and N, K and k - we are also codominant allelets
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Jka and Jkb (Kidd)
|
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what blood group system am I: we are Igg, react STRONGER w/ EMZ treated cells
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Antibody Jka and Jkb (Kidd)
|
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what blood group system am I: our titer rise & fall rapidly and associated with delay transfusion reactions
|
Antibody Jka and Jkb (Kidd)
|
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what blood group system am I: we are found in 68% of Blacks
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Fy (a-b-): duffy which are also CODOMINANT ALLELES
|
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what blood group system am I: our antigens are destroy by emz
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Fy (a-b-): duffy
|
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what blood group system am I: what can you tell me about antigen typing Fy (a+b-) and how it relates to whites and black
|
white - homo for Fya (Fya Fya)
blacks - heter for Fya (FyaFy-) --dosage problem |
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what blood group system am I: our antibodies are IgG, weak examples that show dosage and have negative reaction w/ emz treated cells
|
antibody Fya & Fyb (Duffy)
|
|
try to name 7 IgM antibodies
|
Anti-
I, H M, N P1 Lea, Leb |
|
try to name 12 IGG antibodies
|
Anti-
D C, c E, e M (some) K, k Fya, Fyb Jka, Jkb |
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name 4 interesting thing about Paternity testing
|
1. maternity is assumed
2. you may have problems that inc ABO and or D grouping 3. PT requires chain of sample custody that must be adhere to in legal cases |
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RBCs blood group with _____ ______ can be used for parentage testing along with HLA system & DNA analysis
|
codominant alleles
|
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____ _____ marker present in child, ABSENT from father and mother
|
direct exclusion
dad: K k mom: Kk baby: KK |
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____ _____ child lacks a marker that is alleged father must transmit
|
indirect exclusion
|
|
Paternity test example of: Direct
(when its positive for the Dad DNA) |
Anti-K Anti-k
Alleged father + 0 Mom + 0 baby + + |
|
Paternity test example of: Indirect (baby has same positive with MOM)
|
Anti-K Anti-k
Alleged Dad + 0 Mom 0 + baby 0 + |
|
is the alleged father, excluded
Father: KK Mom: kk baby: Kk |
the alleged father is NOT excluded
|
|
which emz enhancement am I:
1. decrease NET SURFACE CHARGE 2. ONLY increase AB uptake if under low ionic conditions 2. Rh AB may show @37c |
albumin (bovine)
|
|
which emz enhancement am I:
1. INCREASE AB uptake which allows decrease in incubation time 2. removes SIALIC ACID which decrease negative surface charge and promote cell aggltnx 3. increase reactivity of Rh, Kidd & Lewis AB 4. usually increase WARM & COLD autoAB 5. DESTROYS: M, N,S, Fya & Fyb antigents |
Low ionic strength saline (liss) Emz: bromelin, ficin, papain & trypsin)
|
|
which emz enhancement am I:
1. INCREASE AB activity, decrease incubation time 2. cause reversible cell aggregation 3. if AG-AB RXT occurs during aggregation, this aggltnx does not reverse |
polybrene
|
|
which emz enhancement am I:
1. INCREASE AB uptake 2. remove WATER which increase antibody concentration which promotes antibody uptake |
polyethylene glycol (PEG)
|
|
how do IGGs, RBC membrane, complement protein related to Direct Antiglobulin Test (DAT) --in VIVO
|
1. in certain disease & conditions, pat's blood contains IGG (2): IgG AlloAB and IgG AutoAB that binds to RBC membrane & circulating RBC
2. also COMPLEMENT PROTEIN may subsequently bind to bound antibodies 3. DAT---> is used to detect the AB &/OR COMPLEMENT protein that bound to the surface of RBC |
|
what is IAT and when is it used
|
indirect aggltnx test is use in prenatal testing of pregnant woman & detect very low concentrations of antibodies present in a patient's plasma/serum prior to a blood transfusion
DETECTS: ANTIBODIES against RBC that are present unbound in pat's serum (antigenicity) |
|
what are the steps in IAT (5)
|
1. AB attaches to corresponding AG on red cells @37c
2. SALINE WASH (excess serum/AB removed) 3. + AHG (which will bind to AB on the cells) 4. POSITIVE rtx = agglutnx or DECREASE in size of button due to hemolysis @37c 5. + CHECK CELLS - (IgG sensitive cells), these should be POSITIVE indicating AHG was actually added in the final step & was not NEUTRALIZED |
|
what happens in IAT if you fail to wash cells adequately
|
failure to adequately wash ells ma cause a FALSE NEGATIVE --human globulin, ex: antibodies protein etc..not wash away will NEUTRALIZE the AHG
|
|
when emz treated & untreated cell which antigens are ENHANCED (3)
|
1. Kidd
2. I 3. some Rh (NOT D) |
|
when emz treated & untreated cell which antigens are DESTROYED (4)
|
1. Duffy
2. M 3. N 4. S |
|
when emz treated & untreated cell which antigens show DOSAGE (5)
|
1. Rh (other than D)
2. M 3. N 4. Kidd (JKa and JKb) 5. Duffy (Fya and Fyb) |
|
Autocontrol - if POSITIVE may indicate (2)
|
1. delay transfusion reaction
2. if POSITIVE along with all panel cells, AUTOANTIBODY indicated |
|
in DAT, what type of tube is the sample of choice & why
|
EDTA because it chelates CA++ preventing complement activation by plasma antibody (cause a FALSE POSITIVE DAT)
|
|
AUTOimmune or ALLOimmue hemolytic anemia - warm autoantibodies (WAIHA)
|
autoimmune
|
|
AUTOimmune or ALLOimmue hemolytic anemia - cold hemagglutinin (CHD)
|
autoimmune
|
|
AUTOimmune or ALLOimmue hemolytic anemia - mixed type of AIHA (autoimmune hemolytic anemia)
|
autoimmune
|
|
AUTOimmune or ALLOimmue hemolytic anemia - paroxysmal cold hemoglobinura (PCH)
|
autoimmune
|
|
AUTOimmune or ALLOimmue hemolytic anemia - HDN & transfusion reaction
|
ALLOimmune hemolytic anemia
|
|
warm autoantibodies hemolytic anemia is caused by what protein coating red cell is caused by what protein coating red cell
|
IGG and or complement
|
|
cold hemagglutinin disease (CHD) is caused by what protein coating red cell
|
complement
|
|
mixed type of AIHA is caused by what protein coating red cell
|
IGG and or complement
|
|
drug induced hemolytic anemia (DIHA) is caused by what protein coating red cell
|
IGG and or complement
|
|
HDN is caused by what protein coating red cell
|
IgG
|
|
Transfusion reaction is caused by what protein coating red cell
|
IgG
|
|
name 4 things about AHG reagents
|
1. monoclonal/polyclonal
2. polyspeicific (anti-IGG & anti-C3B or C3D) 3. Anti-IgG 4. Anti-complement |
|
why should you avoid refrigerating a red top tube before performing DAT
|
--Auto anti-I may attach to I antigen present on red cell & cause FALSE POSITIVE DAT---this will also cause a FALSE NEGATIVE COLD AGGLUTININ TITER since that test measure the anti-I (cold agglutinin) in serum
|
|
AHG reagents - what is blended/in chemical wise in Polyclonial and Monoclonal
|
Poly - inject animal w/ purified IgG, IgA, IgM, C3 or C4
Mono - hybridoma derived |
|
Polyspeicific
|
antibody to human IgG & C3d component of complement, other complement components may be present
|
|
Monospeicific
|
antibody to IgG or to C3b, C3d
|
|
Perform ___(DAT/IAT) with polyspeicific to screen & monospeicific to characterize the globulin
|
DAT
|
|
Perform ___(DAT/IAT) with monospeicific anti-IgG to avoid cold, complement binding antibodies
|
IAT
|
|
why do we use check cells for
|
to confirm all negative antiglobulin test in antibody detection & compatibility testing --- when using anti-IgG; confirm AHG added & not neutralized (insufficient removal of serum proteins prior to addition of AHG)
|
|
what is the principle of ELUTION
|
principle based on BREAKING antigen-antibody bond, REMOVING antibody from cell surface
|
|
elution is used to determine what
|
use to determine antibody specificity in cases of positive DAT due to IgG antibody(ies) ex: HDN & transfusion reactions
|
|
name 2 types of elution method
|
1. Lui freeze thaw & heat - ABO antibodies
2. Low pH acid, digitonin acid, cold acid, & dichloromethane -- all antibodies |
|
_____ _____ can bind with antibody to inhibit a reaction with RBCs, allow detection of ALLOANTIBDOIES "masked" by the antibodies
|
soluble antigens
|
|
where can you find the following antibodies: Lewis substance
|
saliva
|
|
where can you find the following antibodies: P1 substance
|
hydatid cyst fluid
|
|
warm autoantibodies hemolytic anemia is caused by what protein coating red cell is caused by what protein coating red cell
|
IGG and or complement
|
|
cold hemagglutinin disease (CHD) is caused by what protein coating red cell
|
complement
|
|
mixed type of AIHA is caused by what protein coating red cell
|
IGG and or complement
|
|
drug induced hemolytic anemia (DIHA) is caused by what protein coating red cell
|
IGG and or complement
|
|
HDN is caused by what protein coating red cell
|
IgG
|
|
Transfusion reaction is caused by what protein coating red cell
|
IgG
|
|
name 4 things about AHG reagents
|
1. monoclonal/polyclonal
2. polyspeicific (anti-IGG & anti-C3B or C3D) 3. Anti-IgG 4. Anti-complement |
|
why should you avoid refrigerating a red top tube before performing DAT
|
--Auto anti-I may attach to I antigen present on red cell & cause FALSE POSITIVE DAT---this will also cause a FALSE NEGATIVE COLD AGGLUTININ TITER since that test measure the anti-I (cold agglutinin) in serum
|
|
AHG reagents - what is blended/in chemical wise in Polyclonial and Monoclonal
|
Poly - inject animal w/ purified IgG, IgA, IgM, C3 or C4
Mono - hybridoma derived |
|
Polyspeicific
|
antibody to human IgG & C3d component of complement, other complement components may be present
|
|
Monospeicific
|
antibody to IgG or to C3b, C3d
|
|
Perform ___(DAT/IAT) with polyspeicific to screen & monospeicific to characterize the globulin
|
DAT
|
|
Perform ___(DAT/IAT) with monospeicific anti-IgG to avoid cold, complement binding antibodies
|
IAT
|
|
why do we use check cells for
|
to confirm all negative antiglobulin test in antibody detection & compatibility testing --- when using anti-IgG; confirm AHG added & not neutralized (insufficient removal of serum proteins prior to addition of AHG)
|
|
what is the principle of ELUTION
|
principle based on BREAKING antigen-antibody bond, REMOVING antibody from cell surface
|
|
elution is used to determine what
|
use to determine antibody specificity in cases of positive DAT due to IgG antibody(ies) ex: HDN & transfusion reactions
|
|
name 2 types of elution method
|
1. Lui freeze thaw & heat - ABO antibodies
2. Low pH acid, digitonin acid, cold acid, & dichloromethane -- all antibodies |
|
_____ _____ can bind with antibody to inhibit a reaction with RBCs, allow detection of ALLOANTIBDOIES "masked" by the antibodies
|
soluble antigens
|
|
where can you find the following antibodies: Lewis substance
|
saliva
|
|
where can you find the following antibodies: P1 substance
|
hydatid cyst fluid & pigeon egg whites
|
|
where can you find the following antibodies: Sda substance
|
most abundant in urine
|
|
where can you find the following antibodies: ABH sugars
|
inhibit anti-A, B, H
|
|
where can you find the following antibodies: Chido & Rogers substance
|
epitopes of C4 (complement)
|
|
how does it inactivation Sulfhydryl reagents - AET & DTT
|
destroys or weakens Kell system
|
|
how does it inactivation Sulfhydryl reagents - ZZAP - emz + DTT
|
Kell system & those destroyed by emz
|
|
how does it inactivation Sulfhydryl reagents - DTT & 2-ME
|
destroys or diminish activity of IgM antibodies
|
|
name 4 times when Adsorption is used
|
1. separate multiple AB
2. remove AUTOantibody - reveals alloantibody "masked" by autoantibody 3. confirm antigen existence on RBC 4. confirm antibody specificity |
|
what is autologous adsorption
|
(pat own serum + cell) can be used for patient not recently transfused
|
|
what is ALLOGENEIC adsorption
|
(patient serum + other cells) can be used on patients recently transfused
|
|
for pretransfusion testing, what test are required (3) and how long do you have to keep the tube after transfusion
|
1. ABO & D grouping
2. Antibody screen 3. Crx match 4. autocontrol not required 7 Days |
|
when crossmatching, which is which when it comes to pat serum or cell to donor serum or cell
|
patient serum react with donor cells
|
|
antigen typing -- patient with clinically significant antibodies should receive
|
antigen NEGATIVE units
|
|
antigen typing -- confirm antigen negative status by
|
reacting cells with commercial preparation of the antibody
|
|
antigen typing -- what is the Positive control
|
heter cell (ex: anti-K tested with a Kk cell rather than a KK cell)
|
|
antigen typing -- what is the Negative control
|
cell without antigen (ex: anti-K test with kk cell)
|
|
can a D negative get D positive
|
yes - in emergency if no D negative is available (follow with RhIg, if possible)
|
|
remember this!
|
decide what ABO antibody (ies) are in the patient's plasma, any red cell LACKING those ANTIGEN will be compatible
|
|
Neonatal crx match -- whats the 2 initial test
|
ABO & D grouping
|
|
Neonatal crx match -- when is ABO serum grouping not required
|
ABO serum grouping is not required unless giving ABO type not compatible with MOTHER
|
|
Neonatal crx match -- is crx match necessary if initial antibody screen negative using infant or maternal serum/plasma & group O is given
|
no crx match necessary
|
|
Neonatal crx match -- do you have to repeat test for infant less than 4 months for any one hospital visit
|
no
|
|
Neonatal crx match -- in major institutions, what 1 unit of blood is used for neonates
|
1 - O negative - aliquots are taken through a sterile docking device so expirations date is not altered
|
|
Neonatal crx match -- for infants weighing _____ at birth, blood products with reduced risk of CMV transmission should be used if the mother is CMV negative or CMV status is unknown
|
<1200 g
|
|
what is the most common transfusion reaction (intravascular hemolytic transfx rtx)
|
fever - accompanied by chills, low back pain, anxiety
|
|
name 4 physiological events that can happen in a transfusion reaction (intravascular hemolytic transfx rtx)
|
1. hemoglobinemia
2. hemoglobinuria 3. hyperbilirubinemia 4. can result to kidney failure & death |
|
extravascular hemolytic transfx rtx -- name 4 examples of clinically significant antibodies that usually occurs after transfusion completed
|
Rh
Kell Kidd Duffy |
|
extravascular hemolytic transfx rtx -- name some 4 examples that can occur
|
1. urticarial
2. febrile hemolytic 3. allergic reactions 4. transfused related acute lung injury (TRALI) |
|
based on delay transfusion reactions, what can one expect to happen to
1. time span 2. change in HGB 3. DAT 4. by which antibody |
1. hours to day after transfusion
2. indicated by NO rise or a DECREASE in HGB after transfusion 3. Positive DAT (key characteristics) 4. often due to KIDD antibody |
|
name some of urticaral symptoms & treatment and what is it caused by
|
1. itching & hives
2. treatment - if urticaria only symptom give antihistamine & transfusion may continue 3. caused by DONOR ANTIBODIES to soluble plasma antigens |
|
what is febrile nonhemolytic (FNH) and name three things that can cause it
|
1. temp rise ass w/ transfusion
2. Due to: a. recipient preformed antibodies reacting with DONOR LYMPHOCYTES, GRANULOCYTE, or PLATELES b. infusion of CYTOKINES in donor bag from storage c. LEUKOCYTE REDUCED BLOOD COMPONENTS - prestorage leukoreduction prevents cytokines buildup |
|
which immunoglobulin cz allergic reactions recipient preformed ___ antibodies to soluble subtx in plasma
|
IGE
|
|
allergic reactions if severe enough - what are the symptoms
|
systemic symptoms including hypotension, shock & sometimes death
|
|
describe the classical anaphylaxis & what is the cure/treatment
|
IgA deficient patient w/ anti-IgA reacting with IgA donor plasm
treatment: give washed cells or plasma components from IgA deficient donors |
|
what is transfuse related acute lung injury (TRALI)
|
acute respiratory insufficiency & bilateral pulmonary edema by x-ray without cardiac failure, includes chills, fever & hypotension
|
|
donor antibodies recipient HLA or neutrophil antigen; rarely, recipient antibodies to transfused _____
|
granulocytes
|
|
transfusion reaction - determine the type from the following cause: antibody to RBC antigens (usually ABO)
|
hemolytic
|
|
determine the type from the following cause transfusion reaction: antibody to wbc/plt antigens/preferred cytokines
|
febrile
|
|
transfusion reaction: what happens when an antibody to soluble antigen is mixed in a donor plasma, what happens to the patient
|
urticarial
|
|
transfusion reaction - determine the type from the following cause: anti-IgA
|
anaphylatic
|
|
transfusion reaction - determine the type from the following cause: donor antibody to recipient HLA or neut antigens
|
transfusion related acute lung injury
|
|
keep in mind:
Positive + hemolysis & Negative -- Dat: |
- patient with sickle cell crisis
- thalassemia or G6PD deficient pat - unit overheated/frozen - all cells hemolyzed |
|
___ contamination is now the most common since current tests detect most viruses, what else must be tested for prior to issuing
|
all PLATELETS must be tested for bacterial contamination before issue
|
|
name some other transfuion transmitted infections:
|
HBV, HCV
HIV, HTLV CMV, EBV Babesiosis, Malaria, Chagas dz & West Nile virus |
|
what is a "Look back"
|
identification of indvdl who have received seronegative or untested blood from donor later found to be infected
|
|
HDN - where do infants inherit antigen from
|
from biological father
|
|
HDN - mother has corresponding ___ antibody (sensitized by previous pregnancies or transfusion)
|
IgG antibodies
|
|
HDN - maternal ____ cross the placenta & coats fetal cells
|
material antibodies
|
|
HDN - ___ has affinity for lipid rich layers of skin & brain and is potent neurotoxin causing brain damage (kernicterus)
|
bilirubin
|
|
ABO or RH cause:
1. increase Spherocytes 2. DAT weak or negative 3. Delayed jaundice 4. Bili rarely > 15 mg% 5. 1st prgncy: usually O mother with AB baby |
ABO
|
|
ABO or RH cause:
1. increase Reticulocytes 2. DAT + 3. immediate jaundice 4. Bili often >20 mg % 5. usually not 1st prgncy: D neg mom w/ D pos baby |
Rh
|
|
in which type of HDN (rh or ABO caused) would an exchange transfusion be more likely needed and why
|
RH because bili is neurotoxic to the brain & levels >20 mg% (lower in premies) can lead to mental retardation &/or death
|
|
HDN intrauterine transfusion - supplies antigen ___ blood
|
negative blood
|
|
HDN intrauterine transfusion unit selection - name 6 criteria
|
1. Grp O, D negative
2. Negative for antigen to which maternal anitbody directed (comp wi/ maternal antibody) 3. must be IRRADIATED 4. donor = CMW SERONEGATIVE or LEUKOREDUCED unit if mother status CMV negative or unknown 5. should be HGB S negative 6. should be FRESH <3 days |
|
HDN exchange transfusion -- what does it replace
|
it replaces antibody coated cells (which would increase bili level if destroyed) with antigen negative cells
|
|
HDN exchange transfusion -- what does it reduces
|
maternal antibody & bili levels
|
|
HDN exchange transfusion -- what does it remove
|
removal antibody coated cells which would increase bili levels when destroyed
|
|
HDN exchange transfusion -- name 3 acceptable samples for crx match
|
1. maternal sample - highest concentration of maternal antibody
2. eluate from infant's cell 3. infant serum |
|
HDN exchange transfusion -- what is the unit selection criteria (5)
|
1. Grp O, if ABO HDN, D neg, if Rh HDN
2. Negative for antigen to which maternal antibody directed (comp w/ mom antibody) 3. < 5 days old 4. HGB S = negative 5. should be IRRADIATED |