Transfusion Practices 8.9

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Transfusion Practices 8.9
2010-10-11 16:40:10
Blood Bank Transfusion Practices NSHS MLT

Blood Bank Unit 8.9 Transfusion Practices
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  1. What are the three General indications of transfusion?
    • Increase oxygen carrying capacity
    • Increase blood volume
    • Maintain hemastasis
  2. O2 content is determined by ____ concentrations.
  3. Transfusions are contraindicated for what four patients.
    • stable clinical conditions
    • minor symptoms
    • normal blood test (HgB, HCT)
    • disease states (heart, coag abnormalities)
  4. What are the four indications for transfusion of whole blood?
    • acute massive blood loss (>30%)
    • restore intravascular volume
    • prevent hypovolemic shock
    • increase hgb concentration
  5. What volume of blood loss is indicated for whole blood transfusion?
  6. These patients should not receive whole blood due to adverse response to plasma by developing pulmonary edema and heart failure due to volume overload.
    severe chronic anemia
  7. pulmonary edema and heart failure due to whole blood transfusion is more likely in patients with ______ and ________ failure.
    • heart
    • kidney
  8. what are the three indications for packed dred blood cell transfusion.
    • increase O2 carrying capacity in anemic patients
    • chronic anemia
    • symptomatic anemia (Hct <21%)
  9. A unit of PRBC increases HgB by ___ g/dL and HcT by ___.
    • 1
    • 3%
  10. true or false
    a unit of PRBC and a unit of whole blood will increase HgB and HCT equally.
  11. PRBC's are specifically indicated for what three compromised patients du to possible volume overload?
    • elderly
    • infant/children
    • cardiac patients
  12. what are the five contraindications of PRBCs?
    • volume expansion
    • in place of B12/Fe/folate
    • to enhance wound healing
    • to improve general well being
    • low operative blood loss
  13. what are the three indications for washed PRBCs.
    • removal of excess plasma proteins
    • prevents alloimmunization
    • severly immunocompromised recipients
  14. what are the three indications for platelets?
    • control bleeding (bleeding time)
    • prevent bleeding (platelet count)
    • deficiency in number or function
  15. what quantity of platelets is indicative of transfusion? preoperative?
    • <10,000 to 20,000 /ul
    • <50,000 /ul, preoperative
  16. what are the four contraindications of platelets?
    • ITP
    • DIC
    • prophylactically with massive transfusion
    • prophylactic upon following cardiopulmonary bypass
  17. what are the two indications of fresh frozen plasma?
    • treat coagulation factor deficiency
    • when specific coagulation factor concentrates are not available
  18. Fresh Frozen Plasma id contraindicated for volume expansion due to what disease risk?
    hepatitis risk
  19. Fresh Frozen Plasma is contraindicated as a nutritional supplement for what factors?
    • Vitamin K dependent factors
    • Factor II, VII, IX, X
  20. Fresh Frozen Plasma is Contraindicated prophylactically in what two conditions?
    • massive blood transfusion
    • following cardiopulmonary bypass
  21. Fresh Frozen Plasma is contraindicated in a Pt/Ptt less than ____ times normal.
  22. This is a high molecular weight plasma protein concentrate that precipitate in cold.
    Cryopercipitate AHF
  23. Cryoprecipitate contains at least _____ mg fibrinogen and ____ units of AHF suspended in ___ mL of plasma.
    • 150
    • 80
    • 15
  24. what are the five concentrated factors in cryoprecipitate?
    • Factor VIII
    • Factor XIII
    • Fibrinogen
    • Von Willebrands Factor
    • Factor IX
  25. This disease caues prolonged bleeding time, prolonged PTT, and abnormal platelet plug formation.
    Von Willebrand Syndrome
  26. Von Willebrand Syndrome is caused by a partial deficiency of what factor?
  27. what blood product is indicated for Vonwillebrand syndrome?
  28. what are three Fibrinogens abnormalities that indicate use of cryoprecipitate?
    • congenital deficiency
    • acquired through DIC
    • severe liver disease
  29. This factor deficiency is indicative of cryoprecipitate as replacement therapy for hemophila A
    Factor VIII deficiency
  30. This is an opsonic glycoprotein that helps clear blood borne particulate such as bacteria and protein aggregates?
  31. This this cryoprecipitate product is used as treatment for sepsis, burns and trauma.
  32. this cryoprecipitate product can be administrated topically?
    finrin glue (Fibrin sealant)
  33. Fibrin glue is made from ___________ cryoprecipitate.
  34. Cryoprecipitate is indicated for this factor deficiency as therapy for hemophilia B and christmas disease.
    Factor IX deficiency
  35. this blood product is used to correct large scale loss of colloids, such as hypovolemic shock, burn patients, and retroperitoneal surgery.
    Albumin/Plasma protein fraction
  36. this blood product is contraindicated to correct hypoalbuminemia due to nutritional deficiency.
    albumin/plasma protein fraction
  37. this is a non-human blood product derivative so it has no viral disease transmission risk.
    albumin/plasma protein fraction
  38. what are the the two leukocyte reduced products?
    • RBCs
    • PLTs
  39. what are the three preparation methods for Leukocyte Reduced Products?
    • washing
    • filtration
    • centrifugation
  40. What are the two indications for Leukocyte reduced products?
    • prevention of HLA sensitization (Plt refractoriness)
    • prevention of febrile ransfusion reaction
  41. this is an alternative to pooled random platelets?
    apheresis platelets (SDP)
  42. 1 RP contains _________ platelets
    1 SDP contains __________ platelets
    1 SDP = ____ RP
    • 5.5x1010
    • 3.0x1011
    • 6 RP
  43. What are three advantages to Apheresis platelets?
    • limits exposure to foreign antigens and transfusion transmitted disease
    • avoid platelet refractoriness
    • can provide HLA matched
  44. Irradiated RBCs/Platelets are used to prevent what disease?
    Graft Versus Host Disease
  45. This is a disorder in which the grafted tissues or donor cells attack the hosted tissue.
    Graft versus host disease
  46. this disease may occur on immunocompromised patients who received an HLA-matched lymphocyte.
    graft versus host disease
  47. This prevents lymph replication in graft versus host disease.
    gamma irradiation
  48. what are the five indications of Irradiated RBCs/Platelets?
    • blood relative donor
    • intrauterine transfusions
    • severely immunosuppressed
    • hodgkin's disease
    • bone marrow transplantation
  49. These patients require a conservative approach due to serological difficulties and expected short red cell survival. patients must be phenotyped prior to transfusion.
    Transfusion in autoimmune hemolytic anemia
  50. this is when transfusion exceeds patient's blood volume withna a 24 hr period or about 10 units of blood in an adult.
    massive transfusion
  51. abbreviated crossmatch in massive transfusion is performed only in what phase?
  52. changing these depends on gender and age of patients?
    ABO or Rh types
  53. This may be seen in massive transfusion patients due to active metabolism uptake of potassium by the red blood cells.
  54. This may be seen in massive transfusion patients due to citrate anticoagulant.
  55. These two disorders may be caused by a decrease in citrate and lactate metabolism.
    • hypocalcemia
    • metabolic acidosis
  56. cold toxicity (hyopthermia) and increased cardiac dysrhthmias may be seen in what transfusion patients?
    massive transfusion
  57. This abnormalities may be due to dilution of platelets or coagulation factors during massive transfusion.
    coagulation abnormalitites
  58. hemostatic derangement in massive transfusion is due to ____________ mor than transfusion.
  59. before transfusion patient must give _________ consent.
  60. patient preparations, is who's responsibility?
  61. History of what two drugs should be checked before transfusion?
    • antihistamines
    • anti-pyretics
  62. IV meds may be given immediately _______ to transfusion.
  63. oral meds are give ________ prior to transfusiton
    30-60 min
  64. what gauge needle is used for transfusion?
    18-19 gauge
  65. what gauge needle is used for pediatrics?
    23 gauge scalp vein needle
  66. Administer ______ components through filters designed to remove blood colots/debris.
  67. this infusion set has an in-line filter with a 170-260 micron pore size to trap lage clots.
    standard blood infusion sets.
  68. what is the micron pore size of the rapid infusion device?
    > or = to 300 microns pore size
  69. gravity drip sets are used for what two blood products?
    PLTs and CRYO
  70. this infusion set is used for small volumes with in line filter.
    syringe push sets
  71. this infusion set is used for RBC transfusion, has a 20-40 micron pore size, and traps aggregates fo degenerating platelets, white cells, and fibrin strands.
    micro-aggregate filters
  72. this infusion set reduces risk of HLA alloimmunization, traps leukocytes but not RBCs and platelets.
    leukocyte reduction filters
  73. blood warmers should be used to decrease what two things?
    • cardiac arrest
    • Txn Rxn with cold Ab
  74. Blood warmers should have a thermometer, audible alarm and must not warm blood past what temp?
  75. These infusion sets have a mechanical pump with controlled delivery rate.
    electromechanical infusion device.
  76. This electromechanical infusion device is used to speed up infusion?
    pressure device
  77. this electromechanical infusion device is used to recover blood during operations.
    interoperative and postoperative blood collection (Cell Saver)
  78. Compatible I.V. solutions administered with blood products should be approved by who?
  79. Accurate ID of donor with the recipient should be checked at what two times?
    • donor issuance
    • transfusion
  80. If transfusion cannot be started within ____ minutes, blood should be returned to the blood bank for proer storage.
    30 minutes
  81. Transusionist should remain with the patients for at least the first ___ minutes of transfusion?
    15 minutes
  82. after 15 minutes of transfusion, transfusionist should check what?
    vital signs
  83. Normal transfusion are completed within ____ hours. maximum is ____ hours.
    • 2 hours
    • 4 hours
  84. what three factors affect the rate of transfusion?
    • patient's blood volume
    • cardiac status
    • hemodynamic condition
  85. Any unfavorable patient response to transfusion is called what?
    transfusion reactions
  86. This is a transfusion reaction with red cell destruction due to incompatibility.
    hemolytic transfusion reaction
  87. how much incompatible blood can cause a hemolytic transfusion reaction?
  88. This transfusion reaction is extremely life threatening.
    hemolytic transfusion reaction
  89. this transfusion reaction is characterized by fever, chills, pain, nausea, flushing, hypotension, bleeding, shock, and hemoglobinuria.
    hemolytic transfusion reaction
  90. what is the therapy for hemolytic transfusion reaction.
    • maintain BP with colloids
    • use diuretics for urine flow
  91. this transfusion reaction can be prevented with attention to detail.
    hemolytic transfusion reaction
  92. a temperature change of __ degree celcius indicates a febrile transfusion reaction.
  93. this is the most frequently encountered transfusion reaction.
    febrile transfusion reaction
  94. this transfusion reaction is characterized by fever and chills and should be treated with antipyretics
  95. what blood product should be used to prevent febrile transfusion reactions?
    leukocyte-poor blood
  96. This transfusion reaction is caused by an antibody to plasma proteins and is characterized by itching and hives.
    mild allergic-urticarial
  97. what is the therapy/prevention of mild allergic- urticarial transfusion reactions?
  98. this transfusion reaction is caused by an antibody to IgA and is characterized by urticaria, shock, wheezing, and cardiac arrest.
  99. what is the therapy for anaphylactic transfusion reaction?
  100. what is the preventionof anaphylactic transfusion reactions.
    washed cellular products and IgA deficient plasma
  101. This non immune transfusion reaction is caused by bacterial contamination.
  102. This transfusion reaction is characterized by a rapid onset of chills, high fever, vomiting, diarrhea, hypotension, shock, DIC.
  103. what is the therapy for sepsis?
    • IV antibiotics
    • vasopressors
    • steroids
  104. how is sepsis prevented in transfusion?
    aseptic technique
  105. This transfusion reaction is caused by fluid administered faster than circulation can accommodate.
    circulatory overload
  106. this transfusion reaction is characterized by cough, headache, pulmonary congestion, hypertension and tachycardia.
    ciculatory overload
  107. what is the therapy for circulatory overload?
    • upright position
    • diuretics,
    • oxygen
    • phlebotomy
  108. who is at high risk for circulatory overload?
    • old
    • young
    • debilitated
  109. this transfusion reaction is caused by an anamnestic antibody, kidd system is notorious.
    delayed hemolytic transfusion reaction
  110. delayed hemolytic transfusion reactions usually occur _______ days after transfusion.
    7-14 days
  111. This transfusion reaction is characterized by slight fever, mild jaundice, and fall in Hct usually 7-14 days after transfusion.
    delayed hemolytic
  112. true or false
    treatment is rarely needed for delayed hemolytic transfusion reactions.
  113. this is any adverse symptom occurring during transfusion.
    suspected transfusion reaction
  114. what is the first course of action for suspected transfusion reactions?
    STOP transfusion immediately
  115. medical and nursing presonnel should report suspected reactions to who?
    blood bank
  116. what is the blood bank test used to check for possible transfusion reactions?
  117. absence of hemoglobinemia and a negative DAT suggests ___ acute immune hemolytic reactions.
  118. What three tests should be repeated with pre and post transfusion samples to investigate for possible alloantibodies.
    • ABO/Rh
    • Crossmatch
    • antibody detection
  119. What tests should be performed on donor unit to test for possible bacterial contamination?
    • blood culture
    • gram stain
  120. who should be notified of transfusion reaction fatalities?
    • navy blood program office (NBPO)
    • FDA via NBPO
  121. This is an Ab induced hemolytic anemia where mother has IgG antibody and fetus has the corresponding antigen.
    hemolytic disease of the newborn
  122. HDN begins in ________ and continues after _______.
    • utero
    • birth
  123. HDN causes a _______ anemia where hemolytic is maximal at birth and diminishes as concentration of maternal Ab declines in infant circulation.
  124. This is when fetal RBCs enter maternal blood system.
    Feto-Maternal hemorrhage
  125. Immunization is possible when fetal cells possess ________ antigen foreign to mother.
  126. highest incidence of maternal immunization is when?
    at time of delivery
  127. What are three other maternal immunizing events besides delivery?
    • amniocentesis
    • miscarriage
    • abortion
  128. HDN will causes what two organs to become enlarged in newborn?
    • liver
    • spleen
  129. this clinical finding of HDN is secondary to anemia prior to brith.
    cardiac failure
  130. HDN causes this type of edema.
    hydrop fetalis
  131. this clinical finding of HDN is associated with deficient glucouronyl transferase.
    jaundice after birth
  132. Brain damage in HDN is caused by Kernicterus with what critical bilirubin level?
  133. what are the six laboratory finding of HDN?
    • NRBC in fetus
    • many retics
    • high bilirubin
    • low HgB/HcT
    • spherocytes (ABO HDN only)
    • Weak DAT (+/=)
  134. this laboratory finding is specifically indicates ABO HDN.
  135. Subclinical HDN is common in ____ HDN and is detected by a positive DAT.
  136. This is an uncommon form of HDN that is symptomatic and requires treatment.
    clinical HDN
  137. This form of HDN is usually do to Rh HDN (D antigen)
    Clinical HDN
  138. Clinical HDN severity can vary from a ______ disease to intrauterine ______.
    • mild
    • death
  139. This finding indicates severity of clinical HDN in newborn.
    cord hemoglobin
  140. in clinical HDN there is an inverse relationship between cord blood ____ and serum ________ level.
    • HgB
    • bilirubin
  141. What cord Hgb value indicates mild HDN.
    above 13 gm/dl
  142. what cord HgB value indicates moderate HDN.
    between 8-13 gm/dl
  143. what cord Hgb value indicates severe HDN?
    under 8 gm/dl
  144. this is the most common form of HDN.
  145. this HDN is mild and usually does not need transfusion/treatment.
  146. ABO HDN is seen with what DAT results?
    • weak positive
    • negative
  147. ABO HDN is seen in group ___ mothers with group ___ or __ infants.
    • O mother
    • A or B infant
  148. The following eluate reactions indicate what antibody causing HDN?
    A cells: +
    B cells: =
  149. The following eluate reactions indicate what antibody causing HDN?
    A cells: =
    B cells: +
  150. The following eluate reactions indicate what antibody causing HDN?
    A cells: +
    B cells: +
  151. Rh HDN is caused by what maternal antibody?
  152. Rh HDN is seen in Rh ____ mom with Rh ____ fetus.
    • NEG mom
    • POS fetus
  153. What DAT result indicates Rh HDN?
    strong POS
  154. This HDN is usually a severe disease which requires treatment.
  155. this HDN is characterized by a rapid increase in bilirubin
    Rh HDN
  156. treatment in Rh HDN is usually required to correct what?
    • anemia
    • high bilirubin
  157. This uncommon HDN is caused by other antibodies including those of Rh system except anti-D.
    other HDN
  158. This is done to Id women at risk of having HDN baby, ID mom's ABO and Rh, antibody screen.
    routine prenatal testing
  159. These two Thiol reagents are sued to differentiate unexpected maternal antibodies.
    • 2-mercaptoethanol (2-ME)
    • Dithiothreitol (DTT)
  160. Antibody titrations are performed on what class of maternal unexpected antibodies?
  161. maternal unexpected antibodies should be titered how often untill delivery?
  162. high titers that are increasing __ tubes or more indicates severe HDN in progress
  163. true or false
    titer alaways correlates with severity of HDN.
  164. dilutions greater than ___ or a score change greater than ___ indicates significant change in unexpected maternal antibody titer.
    • 2
    • 10
  165. true or false
    maternal antibody titer serum should be saved for comparison titer the next month.
  166. What are the two indications for aminocentesis?
    • history of HDN infant
    • high or increasing titers of IgG antibody
  167. amniocentesis is never indicated for what type of HDN.
  168. this is the process by which amniotic fluid is removed from amniotic sac.
  169. amniotic fluid is tested by ___________ for bilirubin like pigments (fetal hgb breakdown).
  170. amniotic fluids become increasingly _________ with HDN.
  171. what is the normal color of amniotic fluid?
  172. this is the best method of determining severity of in-utero hemolysis (HDN) prior to brith.
  173. HDN is also known as what?
    Erythroblastosis fetalis
  174. Aminocentesis indicates the amount of _______ that fetus is suffering.
  175. Amniotic fluid is tested at what wavelength?
    OD 450 nm
  176. Aminocentesis is plotted on what type of graph?
    • liley
    • liley versus weeks gestation
  177. low zone values on liley graph indicate what?
    mild hemolysis
  178. mid zone values on liley graph indicate what?
    • moderately affected
    • requires treatment after birth
  179. top zone values on liley graph indicates what?
    fetus may die
  180. if top zone values are indicated on liley graph, deliver infant if L/S ration (lecithin/sphingomyelin) above ___ indicates fetal lung maturity.
  181. intrauterine transfusion is performed with what liley graph values?
    top zone
  182. this type of transfusion is done prior to brith to treat severe anemia and keep infant alive until delivery is possible.
  183. intrauterine transfusion is injected into where?
    into fetus via umbilical cord
  184. this type of transfusion is done after birth to remove sensitized newborn cells and treat high bilirubin and sever anemia.
    exchange transfusion
  185. exchange transfusion reduces the amount of ______ antibody in HDN.
  186. this transfusion is done in HDN with iatrogenic blood loss to mantain Hct above 40%
    replacement transfusion
  187. intrauterine should be done with PRBCs with what HCT?
  188. blood for intrauterine transfusion should be no more than __ days old.
  189. what blood type should be used for intrauterine transfusion?
    o neg only
  190. Intrauterine transfusion donor units should be crossmatched compatible with ________ serum.
  191. Intrauterine transfusion blood units should be irradiated and washed to remove what antibodies?
  192. Exhange transfusion blood should be PRBC units mixed with FFP or 5% albumin to attain whole blood with HCT of what?
  193. true or false
    exhange transfusion donor cells should be ABO compatible with mother and infant.
  194. ABO HDN exhange transfusion units should be the ______ group and _____ Rh or group O.
    • mother's group
    • Babies's Rh
  195. Rh HDN Exchange transfusion units should be _________ Rh, ________ group or group O.
    • mother's Rh
    • Babies group
  196. for other HDN exchange transfusion, use the same ABO/Rh as infant or group O. Donor unit must _____ maternal Ab.
  197. this is commercially prepared IgG anti-D which prevents immunization.
    Rh immune globulin
  198. RhIg is a standard ____ug dose
  199. RhIg is given within ____ hours
  200. RhIg destroys ___ ml Rh WB or __ ml PRBC
    • 30ml Rh WB
    • 15 ml PRBC
  201. What is the criteria for RhIg?
    • mother is Rh neg
    • Mother is NOT producing Anti-D
    • infant is Rh pos or unknown
  202. what are the two contraindications fo RhIg?
    • Hx of IgA deficeincy
    • Hx of anaphylactic reactions
  203. RhIg contains trace amounts of what class of antibody?
  204. This is a qualatative fetal bleed screen test.
    Rosette test
  205. the Rosette test will detect as little as ____ml or less fetal maternal hemorrhage.
    10 ml
  206. D pos fetal cells + reagent (anti-D) + D pos indicator cells = rosettes, is the principle of what test?
    rosette test
  207. this is a quantitative test that measures the volume of fetal cells in mother's circulation.
    Kleihauer-Betke Test
  208. this test indicates a need for multiple doses of RhIg
    Kleihauer-Betke Test
  209. This test is also called the Acid Elution Stain method.
    Kleihauer-Betke test
  210. The Kleihauer-Betke test principle is that:
    ______ Hgb is NOT acid soluble
    ______ Hgb is acid soluble
    • fetal hgb (Hgb F)
    • Adult Hgb (Hgb A)
  211. normal adult Hgb F value is what?
  212. in Kleihauer-Betke test, a smear of maternal blood is made and fixed in ethanol, then treated with acid buffer, _____ hgb is lost from cells while ____ hgb remain in fetal cells.
    • adult hgb is lost
    • fetal hgb remains
  213. in Kleihauer Betke test, the smear is stained with what two stains?
    • Erythrocin B
    • Hematolxylin
  214. after the smear is stained in Kleihaur-betke test, _______ cells appear as pale ghosts, and ______ cells take stain and appear as bright pink-red cells.
    • adult cells = pale ghosts
    • fetal cells = bright pink-red cells
  215. how are test result calculations preformed on the kleihauer-Betke test?
    • count # of fetal cells seen while counting 2000 adult cells
    • determine % fetal cells in total count
    • % fetal cells x 50= WBFC
    • # of RhIG = WBFC/30+1
  216. calculate how many RhIg doses to give a patient with 1.3% fetal cells by acid elution
    • 1.3x50=65 ml fetal cells
    • 65/30=2.2
    • 2.2+1=3.2
    • round to 3
    • 3 vials RhIg needed
  217. what are the three routine tests performed at the first trimester?
    • ABO
    • Rh
    • Antibody screen
  218. Routine tests at first trimester are to ID who?
    women at risk of HDN infants
  219. For Rh negative mother antibody screen is repated at ___ weeks gestation and give RhIg anternatally.
  220. if IgG antibodies are found in an Rh negative mother what should be done?
  221. This is a semiquantitative method of determining antibody content, used to determine when to monitor fetus for HDN by amniocentesis.
    prenatal antibody titration
  222. what are errors that affect interpretation of prenatal antibody titration
    variations in technique can cause results to differ by as much as plus or minus one dilution
  223. cord blood in suspected HDN cases should be tested for what three things?
    • Hgb
    • Hct
    • Bilirubin
  224. cord blood should be washed how many times?
    4-6 times
  225. what ABO testing should be done on cord blood?
    forward only
  226. when is elution performed on cord blood?
    if DAT IgG positive
  227. in this specimen, accurate Rh testing is difficult in cells are heavily coated with IgG antibodes.
    cord blood
  228. this is a fast elution test where freezing ruptures cells to release antibody.
    Lui Rapid Freeze
  229. After Cord RBC's are washed 6 times this should be saved for later testing?
    final supernatant
  230. what quantity of washed cord RBCs are sued to test for Lui Rapid Freeze elution?
  231. how many drops of saline are added to the 0.5 ml washed cord RBC's in lui rapid freeze?
    3 drops
  232. in Lui rapid freeze, cord RBC's and saline are placed horizontally at what temperature for 10 minutes?
    -20 to -70
  233. in Lui Rapid Freeze, the eluate is tested in paralell with what?
    final wash
  234. any positive reaction on which Lui Freeze sample indicates an invalid test?
    final wash
  235. a positve eluate reaction with O cells in Lui Freeze indicates what antibody?
    unexpected antibody
  236. a positive eluate reaction with A cells in Lui Freeze indicates what antibody?
  237. a positive eluate reaction with AB cells in Lui Freeze indicates what antibody?
  238. What can cause a false positve on Cord RBC elution?
    High protein diluent or Wharton Jelly contamination
  239. False positves on Cord cell elutions will causes what tube to be positive?
    Rh control tube
  240. Fetal cells heavily coated with mother's antibody (Anit-D), can causes what false result when performing Cord Cell elution?
    false negative
  241. how is maternal Anti-D removed from cord cells?
    gentle heat elution