blood bank

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blood bank
2010-05-05 19:11:59
Blood bank

List of blood bank topics for board review
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  1. Which antigens show dosage?
    Kidd, Duffy, Rh, MNS
  2. Most common cause of HDN?
    ABO, anti-A,B IgG, usually weak
  3. Proteolytic enzymes enhance which antigens?
    ABO, I/i, P, Lewis, Rh, Kidd
  4. Proteolytic enzymes decrease which antigens?
    MNS, Duffy
  5. Bombay phenotype
    Lack of H antigen, and thus A and B antigen as well. Forward and reverse type as O, but are incompatible with virtually all blood due to anti-H IgM
  6. Proteolytic enzymes do not affect which antigen?
  7. Group A blood
    Add N-acetyl galactosamine to H antigen
  8. Group B blood antigen
    Add galactose to H antigen
  9. List blood types with most H antigen from left to right
    O > A2> B > A2B > A1 > A1B
  10. Dolichos biflorus lectin
    A1 and Sda
  11. Ulex europaeus lectin
    H antigen
  12. Vicea graminea lectin
    N antigen
  13. Acquired B phenotype
    Associated with Gram Neg sepsis, bowel obstruction, GI cancer. Forward type AB, reverse type A.
  14. Anti-I autoantibody is associated with?
    • In adults, cold agglutinin disease and mycoplasma pneumoniae infection
    • IgM cold reacting
  15. Anti-i autoantibody is associated with?
    In kids, infectious mononucleosis
  16. P antigen is associated with?
    • Parvovirus B19 receptor
    • Paroxysmal cold hemoglobinuria (anti-P)
    • Patients lacking P,P1 and Pk can develop anti-PP1Pk antibodies that cause acute HTR and HDN
  17. Hydatid cyst fluid and pigeon egg fluid neutralizes?
    anti-P antibody
  18. Secretor (+) saliva neutralizes?
    anti-ABO antibody
  19. Guinea pig urine neutralizes?
    Sda antibodies
  20. What are the most common weiner haplotypes in whites?
    • R1 > r > R2 > R0
    • DCe > dce > DcE > Dce
  21. What are the most common wiener haplotypes in blacks?
    • R0 > r > R1 > R2
    • Dce > dce > DCe > DcE
  22. Anti-Jka and Anti-Jkb
    Jka more common, IgG that fixes complement, marked dosage effect, DELAYED HTRs - intravascular, antibody can go undetected
  23. Anti-Fya and anti-Fyb
    • Fyb is more common antigen, Fya antibody is more common antibody. Severe, delayed HTR with marked dosage.
    • Fya-Fyb- resistant to P vivax
  24. Knull
    Increased Kx, hemolytic anemia with stomatocytes
  25. McLeod phenotype
    Decrease in Kx and decrease in Kell antigens. Hemolytic anemia with acanthocytes. Linked with X-linked Chronic Granulomatous disease - defect in phagocytic function. Also-cardiac and nervous system disorders.
  26. anti-M and anti-N
    Naturally occuring, cold reactive, IgM, clinically insignificant
  27. anti-S, anti-s, and anti-U
    Warm reacting, requires exposure, IgG, significant. Resides on Glycophorin B.
  28. What is the #1 infectious risk for transfusion?
    Bacterial contamination
  29. What is the #1 cause of transfusion related mortality
  30. How does post transfusion purpura occur?
    Patient is PLA1 negative. Exposure through pregnancy and/or blood transfusion develops antibody. Antibody attacks subsequent PLA1 positive platelets and destroys them, ALONG WITH NEGATIVE PLATELETS
  31. The FDA requires notification within what period of time following a suspicious death that is possibly transfusion related?
    24 hours
  32. What is the risk of acute hemolytic transfusion reaction?
    1 per 25k transfusions
  33. What is the risk for HIV-1 transmission?
    1 per 2 million
  34. What is the risk for HCV transmission?
    1 per 2 million
  35. What is the risk for HBV transmission?
    1 per 137k
  36. What is the risk for HTLV transmission?
    1 per 641k
  37. What is considered a major incompatibility for transplant?
    An A donor graft into an O recipient. Stem cells need to be processed to remove RBCs and prevent hemolysis. Give O blood until anti-A antibody is gone.
  38. What is considered a minor incompatibility for transplantation?
    An O graft donor going into an A recipient. Need to process graft stem cells to remove plasma products (washing out antibodies) to prevent hemolysis of recipient RBCs. Give O blood (compatible with donor)
  39. Which Ig's can cross the placenta and which cannot?
    IgG1,3 and 4 can cross placenta. IgG2 and IgM cannot.
  40. What is the screening test for fetal maternal hemorrhage?
    Rosette test. Add anti-D anitbody to maternal blood and then add Rh+ indicator cells. Indicators cells should rosette around fetal cells.
  41. What is the Kleihauer Betke test?
    Test for fetal maternal hemorrhage, quantitative. Treat maternal blood with acid. Fetal Hb is acid resistant and cells remain dark, whereas maternal cells become pale pink. Calculate % fetal cells.
  42. How do you calculate RhIG dosage based on KB%?
    • KB% x 5/3 = # vials
    • Take number of vials and round up 1 if .1-.4 over whole number. Round up 2 if .5 or more over whole number

    Full equation is: KB% x maternal blood volume (weight x 70ml/kg) = baby blood volume. Take baby volume and divide by 30 = # of vials.
  43. How do you calculate corrected count increment CCI?
    ((Plt pre - Plt post) x BSA )/ # plt transfused (get rid of exponent!!)

    7500 or more considered adequate
  44. How do you calculate post transfusion platelet recovery (PPR)?
    • (Total blood volume (pre-post plt)) / # plt transfused (use exponent this time!!)
    • 20% or above considered adequate
  45. How to calculate cryo dosage for hypofibrinogenemia?
    • 1. Calculate blood volume (pt weight x 70ml/kg)
    • 2. Calculate plasma volume (blood volume x(1-Hct))
    • 3. Calculate mg of fibrinogen needed (plasma volume x concentration change desired) -- subtract desired level from current level (i.e.150 - 50), multiple level change by plasma volume (100 x 3600 ml), divide answer by 100 to get units in dL
    • 4. Calculate bags of cryo needed. Fibrinogen needed / 250 mg cryo per bag
    • whew!
  46. How to calculate Factor VIII dosages?
    • 1. Calculate blood volume (pt weight x 70 mg/kg)
    • 2. Calculate plasma volume (blood volume x (1-Hct))
    • 3. Calculate FVIII units needed (Plasma volume x %increase desired), (i.e. 50% - 4%= 46%, PV x 0.46)
    • 4. Calculate # of bags needed (FVIII/80 IU per bag)

    Targets= hemarthrosis shoot for 50% levels, major surgery or hemorrhage shoot for 100%
  47. What product can be used to prevent Protein C and S deficiency?
  48. What is the typical volume for pRBC transfusion?
    350 mL (100 mL of additive solution)
  49. What is the typical volume of whole blood donation?
    450 mL
  50. What is the typical volume for platelet transfusion?
    50 mL for PC and 100 mL for apheresis platelets
  51. What is the typical volume for FFP?
    200 mL
  52. What is the typical volume for cryoprecipitate?
    10-15 mL
  53. FFP contains how much fibrinogen?
    typicall 400 mg or approx 2-4 mg/mL assuming FFP is approx 200mL volume
  54. Unfrozen FFP or FFP not frozen within 8 hours of collection has a decreased amount of which factors?
    Factor V and Factor VIII
  55. Donors are screened for HBV by which serologic tests?
    anti-HBsAg and anti-HepBcore antibodies