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Which antigens show dosage?
Kidd, Duffy, Rh, MNS
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Most common cause of HDN?
ABO, anti-A,B IgG, usually weak
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Proteolytic enzymes enhance which antigens?
ABO, I/i, P, Lewis, Rh, Kidd
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Proteolytic enzymes decrease which antigens?
MNS, Duffy
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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
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Proteolytic enzymes do not affect which antigen?
Kell
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Group A blood
Add N-acetyl galactosamine to H antigen
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Group B blood antigen
Add galactose to H antigen
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List blood types with most H antigen from left to right
O > A2> B > A2B > A1 > A1B
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Dolichos biflorus lectin
A1 and Sda
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Ulex europaeus lectin
H antigen
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Vicea graminea lectin
N antigen
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Acquired B phenotype
Associated with Gram Neg sepsis, bowel obstruction, GI cancer. Forward type AB, reverse type A.
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Anti-I autoantibody is associated with?
- In adults, cold agglutinin disease and mycoplasma pneumoniae infection
- IgM cold reacting
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Anti-i autoantibody is associated with?
In kids, infectious mononucleosis
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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
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Hydatid cyst fluid and pigeon egg fluid neutralizes?
anti-P antibody
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Secretor (+) saliva neutralizes?
anti-ABO antibody
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Guinea pig urine neutralizes?
Sda antibodies
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What are the most common weiner haplotypes in whites?
- R1 > r > R2 > R0
- DCe > dce > DcE > Dce
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What are the most common wiener haplotypes in blacks?
- R0 > r > R1 > R2
- Dce > dce > DCe > DcE
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Anti-Jka and Anti-Jkb
Jka more common, IgG that fixes complement, marked dosage effect, DELAYED HTRs - intravascular, antibody can go undetected
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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
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Knull
Increased Kx, hemolytic anemia with stomatocytes
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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.
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anti-M and anti-N
Naturally occuring, cold reactive, IgM, clinically insignificant
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anti-S, anti-s, and anti-U
Warm reacting, requires exposure, IgG, significant. Resides on Glycophorin B.
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What is the #1 infectious risk for transfusion?
Bacterial contamination
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What is the #1 cause of transfusion related mortality
TRALI
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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
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The FDA requires notification within what period of time following a suspicious death that is possibly transfusion related?
24 hours
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What is the risk of acute hemolytic transfusion reaction?
1 per 25k transfusions
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What is the risk for HIV-1 transmission?
1 per 2 million
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What is the risk for HCV transmission?
1 per 2 million
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What is the risk for HBV transmission?
1 per 137k
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What is the risk for HTLV transmission?
1 per 641k
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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.
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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)
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Which Ig's can cross the placenta and which cannot?
IgG1,3 and 4 can cross placenta. IgG2 and IgM cannot.
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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.
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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.
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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.
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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
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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
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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!
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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%
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What product can be used to prevent Protein C and S deficiency?
FFP
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What is the typical volume for pRBC transfusion?
350 mL (100 mL of additive solution)
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What is the typical volume of whole blood donation?
450 mL
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What is the typical volume for platelet transfusion?
50 mL for PC and 100 mL for apheresis platelets
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What is the typical volume for FFP?
200 mL
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What is the typical volume for cryoprecipitate?
10-15 mL
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FFP contains how much fibrinogen?
typicall 400 mg or approx 2-4 mg/mL assuming FFP is approx 200mL volume
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Unfrozen FFP or FFP not frozen within 8 hours of collection has a decreased amount of which factors?
Factor V and Factor VIII
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Donors are screened for HBV by which serologic tests?
anti-HBsAg and anti-HepBcore antibodies
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