BB05 - Hemolytic Anemia and Adverse Effects of Transfusion

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  1. Compare and contrast typically cold- reactive autoantibodies with warm- reactive autoantibodies:

    1) Briefly list the immunoglobulin class and optimal temperature of reactivity, DAT profile results, and serologic specificity of the autoantibodies involved with each type. How does each type of autoantibody affect routine ABO/Rh and antibody screening tests.?
    2) Discuss the techniques used in the lab to detect underlying, clinically significant alloantibody(ies) that may also be present together with the cold or warm autoantibodies.
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    • 1. Ig class- cold rxt ab are generally IgM, warm rxt Ab are generally IgG.
    • DAT profile- Cold-Ab rxt best at 4C but pathological cold Ab will have a greater thermal range, rxt at
    • higher temp (~30). Warm-Ab react best at 37C. Both cold and warm tend to cause DAT(+) rxt with
    • polyspecific Ab but cold are DAT(+) with C3 monospecific rgt, as they activate complement, while warm
    • Ab are DAT(+) with monospecific IgG.
    • Since routine ABO/Rh tests are performed at RT cold-Ab will cause ABO/Rh discrepancy, while warm-Ab
    • will not effect ABO/Rh routine testing. With the XM panel cold-Ab will cause rxns with all panel cells at IS
    • and RT, being generaaly IgM. Warm-Ab are Rh specific and will cause panel rxns with most donor cells at
    • the 37C and AHG phases.
    • 2. With a cold rxt auto-Ab you could Pre-warm the serum perform the washes with warm saline to prevent
    • cold-Ab rxt and complement activation but this can only be done if a cold-Ab is obvious, ex: AC(+),
    • DAT(+)C3 and rxns at IS or RT. Cold adsortion is also an option, using pt cells and serum if they have not
    • been recently transfused (txn). This method is enhanced with enzymes like ficin and incubatons done at
    • 4C. Allows detection of underlying allo-Ab.
    • Warm auto-Ab can be removed from RBCs via ZZAP auto adsorption. This process also requires that the
    • pt has not been txn recently. Auto-Ab are removed allowing allo-Ab detection. The method destroys Kell
    • antigens be aware.
  2. In a patient who has NOT been recently transfused, the presence of a positive DAT or a positive autocontrol:
    1) confirms a diagnosis of autoimmune hemolytic anemia
    2) could be due to a drug-related cause
    3) verifies the presence of immune-mediated RBC destruction
    4) can indicate the presence of autoantibody

    A) 2 and 4
    B) 2 and 3
    C) 3 and 4
    D) 1 and 2
    A) 2 and 4
    (this multiple choice question has been scrambled)
  3. Reactions caused by a cold autoantibody can mask the presence of clinically significant alloantibodies. Inorder to differentiate these:

    A) All of the above
    B) Anti-IgG antiglobulin reagent can be used to decrease problems with cold autoantibodies in the AHG phase
    C) Cold-reacting autoantibodies can be removed by adsorption techniques
    D) Prewarmed testing is helpful, but should only be used when reactions indicate the presence of a cold autoagglutinin
    A) All of the above
    (this multiple choice question has been scrambled)
  4. Paroxysmal cold hemoglobinuria (PCH) is:

    A) An acute hemolytic anemia occurring primarily in adults over 55 years old
    B) Caused by an IgM immunoglobulin that has the specificity of an autoanti-I
    C) Caused by a biphasic IgG antibody and confirmed by the Donath-Landsteiner test
    D) The most common type of AIHA
    C) Caused by a biphasic IgG antibody and confirmed by the Donath-Landsteiner test
    (this multiple choice question has been scrambled)
  5. (T/F) Harmless warm autoantibodies are NOT serologically distinguishable from harmful ones.
  6. Diseases reported to be frequently associated with warm autoimmune hemolytic anemia (WAIHA) include:

    A) All of the above
    B) Collagen diseases such as lupus erythematosus, scleroderma and rheumatoid arthritis
    C) Infectious diseases, such as viral syndromes in children and adults
    D) Diseases such as dysglobulinemia , CLL, and lymphoma
    A) All of the above
    (this multiple choice question has been scrambled)
  7. (T/F) ABO grouping is frequently affected by warm reactive autoantibodies because they are direct agglutinins.
  8. (T/F) In the drug-induced immune complex mechanism, the patient presenting with acute intravascularhemolysis can recover rapidly once the drug is withdrawn.
  9. Problems in routine serologic testing caused by cold- reactive autoantibodies can usually be resolved by all of the following EXCEPT:

    A) Washing with warm saline
    B) Collecting clotted blood specimens
    C) Prewarming
    D) Using anti-IgG antiglobulin serum
    B) Collecting clotted blood specimens
    (this multiple choice question has been scrambled)
  10. Most warm reactive autoantibodies have a broad specificity within which of the following blood groups?

    A) Kell
    B) I
    C) Rh
    D) Duffy
    C) Rh
    (this multiple choice question has been scrambled)
  11. One method that can be used to separate patient's red cells from recently transfused donor cells is:

    A) Treatment of the red cells with chloroquine diphosphate
    B) Reticulocyte harvesting
    C) Donath-Landsteiner testing
    D) Elution
    B) Reticulocyte harvesting
    (this multiple choice question has been scrambled)
  12. Autoadsorption to remove either warm or cold autoantibodies should not be used with a recentlytransfused patient. Recently means:

    A) 6 weeks
    B) 3 weeks
    C) 3 months
    D) 3 days
    C) 3 months
    (this multiple choice question has been scrambled)
  13. Hemoglobin 7.4g/dL
    HCT 22%
    Retic Count 10%
    Direct Ag Test: Poly=3+, IgG=3+, C3=0
    Antibody Screen: SCI=3+, SCII=3+, Auto=3+

    Which clinical condition is consistent with the lab results shown above for a patient who has NOT been recently transfused?

    A) Cold Hemagglutinin Disease
    B) Warm Autoimmune Hemoytic Anemia
    C) Delayed Hemolytic Transfusion Reaction
    D) Penicillin-Induced Hemoytic Anemia
    B) Warm Autoimmune Hemoytic Anemia
    (this multiple choice question has been scrambled)
  14. +Cold Agglutinin Disease
    +Drug Adsorption (Hapten) Mechanism of hemolytic anemia
    +Aldomet, L+
    -dopa Induced Hemolytic Anemia
    +Paraxysmal Cold Hemoglobinuria (PCH)
    +Immune Complex Mechanism ofhemolytic anemia

    -IgG autoantibody, reacts with R
    -Drug and anti-drug antibody lo
    -Penicillin and cephalosporin in
    -Warm autoantibody reacts aga
    -Acrocyanosis, autoagglutination
    • Cold Agglutinin Disease: Acrocyanosis, autoagg
    • Drug adsorption (Hapten): Penicillin and cephalosporin
    • Aldomet, L-dopa: Warm autoantibody reacts
    • PCH: IgG autoantibody reacts with R
    • Immune complex Mechanism: Drug and anti-drug
  15. A patient exhibits hemoglobinemia and decreased haptoglobin 2 hours after transfusion of 2 units packed RBCs. Post-transfusion testing reconfirms his ABO type is A positive: the transfused donor units also reconfirmed as A positive. His post-transfusion antibody screen and DAT are negative. The patient has no physical symptoms of discomfort and his temperature is normal. Which of the following would most probably be associated with this clinical picture?

    A) nonimmune hemolysis
    B) delayed immune hemolysis
    C) acute immune hemolysis
    D) bacterial contamination of blood products
    A) nonimmune hemolysis
    (this multiple choice question has been scrambled)
  16. The process of separation of anti-RBC antibody from its antigen is known as:

    A) lyophilization
    B) diffusion
    C) elution
    D) adsorption
    C) elution
    (this multiple choice question has been scrambled)
  17. Which of the following can be used to remove antibodies from the surface of RBCs?

    a) organic solvents (ether)
    b) heat
    c) acid
    d) all of the above
    d all of the above
  18. (T/F) IgA deficient patients who have anti-IgA antibodies can suffer anaphylactic reactions when transfused with blood products. One way to avoid this reaction is to transfuse washed RBCs.
  19. (T/F) Graft versus host disease (GVHD) occurs when donor lymphocytes attack foreign antigens of tissues in immunocompromised recipients.
  20. (T/F) The only effective way to prevent transfusion-associated GVHD is to irradiate the units.
  21. Possible cause(s) of a non-immune hemolytic event following transfusion:

    A) Incompatible intravenous solution
    B) Delayed transfusion reaction due to anti-Jka
    C) ABO Incompatibility
    d) All of the above
    A) Incompatible intravenous solution
    (this multiple choice question has been scrambled)
  22. Anti-HLA and anti-leukocyte antibodies in transfused donor plasma are thought to initiate antibody mediatedpulmonary edema in which condition?

    A) Platelet refractoriness
    B) TRALI
    C) GVHD
    D) Febrile non-hemolytic transfusion reaction
    B) TRALI
    (this multiple choice question has been scrambled)
  23. Examples of non-immune RBC abnormalities that may cause hemolytic anemia include all of the following except:

    A) G6PD Deficiency
    B) Sickle Cell Disease
    C) Aldomet-Induced Hemolytic Anemia
    D) Hereditary Spherocytosis
    C) Aldomet-Induced Hemolytic Anemia
    (this multiple choice question has been scrambled)
  24. Which of the following is NOT associated with mild or severe Allergic Transfusion Reactions:

    A) Fever and increased blood pressure (hypertension)
    B) Hypotension and shock in severe reactions
    C) Treatable with anti-histamines and/or epinephrine
    D) Rash/ hives and itching
    A) Fever and increased blood pressure (hypertension)
    (this multiple choice question has been scrambled)
  25. Match the type of transfusion reactions on the left with the characteristics listed on the right.

    +Febrile Non-Hemolytic
    +Delayed Hemolytic
    +Iron Overload

    -Delayed immune, decreased Hgb/
    -Acute immune, severe hypoxemia
    -Acute non-immune, fever/chills
    -Delayed non-immune, multiransfused
    -Acute immune, fever/chills, increased
    • Febrile Non-Hemolytic: Acute immune, fever/chills, increased
    • TRALI: Acute immune, severe hypoxemia,
    • Septic: Acute non-immune, fever/chills,
    • Delayed Hemolytic: Delayed immune, decreased Hgb/
    • Iron Overload: Delayed non-immune, multitransfused,
Card Set:
BB05 - Hemolytic Anemia and Adverse Effects of Transfusion
2017-01-10 02:46:52
BB05 Hemolytic Anemia Adverse Effects Transfusion
BB05 - Hemolytic Anemia and Adverse Effects of Transfusion
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