Blood Banking: Antibodies and Antigens
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1
how do autoantibodies develop (select all that apply)
- exposure to foreign antigens
- spontaneous development
- transfusion
- pregnancy
2
what makes an alloantibody clinically significant
- those that are capable of decreasing RBC survival
- all of the above
- those that are against Kell antigens
- those that react at immediate spin
3
when do clinically significant antibodies tend to react
- 37C/AHG
- DAT
- room temp/IS
- all temps/phases
4
which antigens show dosage
- C/c
- kidd
- E/e
- Lua/Lub
- MNSs
- Lea/Leb
- duffy
5
what are possible causes of a postive autocontrol
- cold alloantibody
- transfusion reaction
- warm alloantibody
- autoantibody
6
how do you select additional cells for a rule out
- negative for putative antibody and those you want to rule out
- negative for putative antibody, positive for those you want to rule out
- positive for putative antibody and those you want to rule out
- positive for putative antibody, negative for those you want to rule out
7
what does the rule of three determine
- antibodies that pass rule of three are present
- antibodies that pass rule of three are absent
- is used to determine whether more cells are suitable for further antibody testing
8
what is the purpose of antigen typing
- done to find more cells for antibody ID
- done to find donor cells negative for corresponding antigen
- done to determine ABO/Rh type
- done as a follow-up for panels to confirm antibody presense/absence
9
what is the function of PEG
- enhances cold allos
- enhances cold autos
- enhances warm autos
- enhances warm allos
10
which antigens are enhanced by enzymes
- MNSs
- kidd
- kell
- I/i (big and little i)
- duffy
- Rh
- Lewis
- P
11
which enzyme destroys kell antigens
- ZZAP
- trypsin
- ficin
- papain
12
what neutralizes P antigens
- hyatid cyst fluid
- P substance in pigeon eggs
- ficin
- pooled plasma
13
what is the purpose of an allo-adsorption/diff adsorption
- remove 1+ allos to ID other antibodies
- adds autoantibodies for rule outs
- remove 1+ autos to ID other antibodies
- destroys antigens that would react with alloantibodies
14
what best describes the FDA
- voluntary for blood banks, inspection every 2 years
- mandatory for blood banks, inspection every 4 years
- mandatory for blood banks, inspection every 2 years
- voluntary for blood banks, inspection every 4 years
15
what best describes the AABB
- voluntary for blood banks, inspection every 2 years
- mandatory for blood banks, inspection every 3 years
- voluntary for blood banks, inspection every 3 years
- mandatory for blood banks, inspection every 2 years
16
what best describes CAP
- mandatory for blood banks, inspection every year
- mandatory for blood banks, inspection every 2 years
- voluntary for blood banks, inspection every year
- voluntary for blood banks, inspection every 2 years
17
what best describes FACT
- mandatory for blood banks, inspection every 2 years
- voluntary for blood banks, inspection every 3 years
- mandatory for blood banks, inspection every 3 years
- voluntary for blood banks, inspection every 2 years
18
which agency uses the CFR
- AABB
- ISO
- FACT
- FDA
19
what is the purpose of the AABB
- meets additional cGMP/cGTP compliance requirements for FDA
- safety and efficacy of bloodlood components and reagents
- uses a checklist of transfusion medicine standards
- risk mitigation and patient assurance
20
what is the purpose of CAP
- meets additional cGMP/cGTP compliance requirements for FDA
- uses a checklist of transfusion medicine standards
- risk mitigation and patient assurance
- safety and efficacy of bloodlood components and reagents
21
what is the purpose of FACT
- uses a checklist of transfusion medicine standards
- safety and efficacy of bloodlood components and reagents
- meets additional cGMP/cGTP compliance requirements for FDA
- risk mitigation and patient assurance
22
what best describes the ISO
- mandatory for blood banks, inspections every 3 years
- mandatory for blood banks, inspections every 2 years
- voluntary for blood banks, inspections every 2 years
- voluntary for blood banks, inspections every 3 years
23
what is the purpose of the ISO
- risk mitigation and patient assurance
- has specific transfusion medicine standards
- focused on the quality management system
- meets additional cGMP/cGTP compliance requirements for FDA
24
what is the purpose of quality assurance
- validate protocols
- ensure quality of products and services
- investigates product recalls, errors, and complaints
- coordinates internal quality auditing programs
25
what are the 5 Ps of good manufacturing practices
- practices
- payments
- processes
- premises
- persistance
- primary materials
- procedures
- protocols
- people
26
how long must records be kept for products with an expiration date
- 5 yrs
- 8 yrs
- 10 yrs
- indefinitely
27
how long must records be kept for products without an expiration date
- 10 yrs
- indefinitely
- 5 yrs
- 8 yrs
28
define change control
- tracks the changes of a specific product over its lifespan
- methods of updating old equiptment
- develops or changes existing processes or procedures
- method of tracking how lab personnel changes over time
29
how often are competency assessments done
- every other year for all procedures performed
- annually for al procedures performed
- done only upon hiring and when an employee makes a mistake resulting in patient harm
- twice during the first year, then annually for all procedures performed
30
what is the function of a root cause analysis
- investiagates errors involving a donor or patient
- seeks to find reasons why an employee was fired and how to prevent those from happening again
- seeks to find the reason why a particular piece of equiptment failed
- ensures personnel competency on a regular basis
31
define validation
- establishes a valid reason to begin change control
- ensures that an employee is able to perform the duties asked of them
- establishes that a process can consistently produce a result that complies with predetermined standards
- ensures the functionality of new equiptment prior to implementation
32
define calibration
- ensures blood products are not compromised by equiptment
- resets an instrument to its original settings
- standardizes an instrument
- standardizes a reagent
33
define quality control
- determines accuracy and precision of testing components
- ensures that all blood products were processed and labeled accordingly
- ensure quality of products and services
- ensures that all reagents are within their expiration date
34
which agency prepares proficiency testing surveys
- FACT
- CAP
- ISO
- FDA
35
what is the purpose of proficiency testing
- validates the skill levels of new employees
- ensures test methods and equiptment are working properly
- ensures that all products and reagents are within their expiration date
- ensures employees are able to perform the duties asked of them
36
which label standard uses the four quadrant system
- ISBT 238
- ISBN 13
- ISBT 128
- ISO 128
37
how often must biological safety cabinets and clean rooms be certified
- every 3 yrs
- every 2 yrs
- twice annually
- annually
38
what occurs during the 37C incubation period when antigens are combined with their corresponding antibodies
- validation
- agglutination
- sensitization
- cold alloantibody binding
39
which antibodies likely react at 37C
- Kell
- Lutheran
- Rh
- Lewis
40
what are the clinically significant AHG-reacting antibodies
- P
- S/s
- Kidd
- Rh
- Kell
- Duffy
- M/N
- lewis
41
how should you proceed when the antibody screen and history are negative
- complete XM through AHG
- IS XM/computer XM
42
whats the best way to enhance a cold allo
- spin for an additional 10 sec
- incubate at 37C
- incubate at room temp
- incubate below room temp
43
which antibodies are clinically insignificant/nuisance antibodies
- cold auto
- cold allo
- warm allo
- warm auto
44
which antibodies tend to be cold allos
- anti N
- anti E
- anti M
- anti e
- anti P1
- anti s
- anti S
45
why would a cold allo/auto cause a discrepancy (choose all that apply)
- respective antigens exist on back type (A1/B) cells
- reactions are done at room temp which is best suited for IgM
- they are neutralized/destroyed when incubated as 37C
- they tend to cause pan-agglutination
46
autoantibodies can cause the following
- negative AC and DAT
- positive AC and DAT
- negative AC positive DAT
- positive AC negative DAT
47
which antibody type is associated with previous Mycoplasma pneumoniae or infectious mononucleosis history
- cold allo
- cold auto
- warm allo
- warm auto
48
which antibodies are cold allos
- anti-IH
- anti-N
- anti-I
- anti-M
- anti-H
- anti-P
49
when do cold autos tend to react
- 37C/AHG, positive AC and DAT (to polyspecific AHG, IgG, and C3)
- IS, postive AC and DAT (to C3)
- IS, postive AC and DAT (to polyspecific AHG)
- 37C/AHG, negative AC and positive DAT (to C3)
50
which cold auto do most healthy individuals have
- anti-N
- anti-i
- anti-I
- anti-M
51
which disease fits the following:
- idiopathic cause
- secondary to M. pneumoniae/infectious mononucleosis)
- peaks incidence >50 yrs old
- idiopathic cause
- secondary to M. pneumoniae/infectious mononucleosis)
- peaks incidence >50 yrs old
- paroxysmal cold hemaglobinuria
- cold hemaglutinin disease
- warm autoimmune hemolytic anemia
- Raynaud's syndrome
52
describe the pathophysiology of cold hemaglutinin disease
- cold weather triggers acute and rapid intravascular hemolysis
- cold agglutinin activates in skin capillaries, causing localized blood stasis, and IgM bonding activates C'
- spleen is unable to filter out C'-bound cells, resulting in poor circulation and a cold feeling to the skin
53
what happens to C'-bound cells when blood returns to warm areas of the body in cold hemaglutinin disease
- IgM attaches, causing extravascular hemolysis
- IgM detaches, spleen/liver phagocytes remove C'-bound cells
- IgM detaches, warmth activates C' and triggers agglutination
- IgM remains attached, causing intravascular hemolysis
54
what DAT results are associated with cold agglutinin syndrome
- negative DAT with poly AHG, anti C3d, and anti IgG
- positive DAT with poly AHG and anti C3d, negative with anti IgG
- positive DAT with poly AHG, anti C3d, and anti IgG
- negative DAT with poly AHG and anti C3d, positive with anti IgG
55
how can you resolve hematology testing issues caused by cold hemaglutinin disease
- remove clots and rerun sample
- add AHG
- incubate at 20-24C for 15 min
- warm at 37C for 15 min
56
which antibody is associated with paroxysmal nocturnal hemoglobinuria
- allo anti E
- auto anti M
- allo anti P
- auto anti P
57
what kind of hemolysis is associated with paroxysmal nocturnal hemoglobinuria
- extravascular
- intravascular
58
which antibody is a biphasic IgG
- anti N
- auto anti P
- anti M
- auto anti D
59
what does a positive donath-landsteiner test indicate
- negative for PCH
- positive for PCH
- negative for cold hemaglutinin disease
- positive for cold hemaglutinin disease
60
what kind of sample does the donath-landsteiner test use
- plasma
- serum
61
what DAT results are seen in PCH
- neg polyspecific AHG, neg IgG, pos C3d
- pos polyspecific, IgG, C3d
- pos polyspecific AHG, neg IgG, pos C3d
62
which of the following are valid methods for avoiding cold autoantibody reactions (select all that apply)
- using monspecific IgG AHG
- use PEG in place of LISS
- use bovine serum in place of LISS
- use adsorption techniques
- skip IS and 37C phases
- incubate at room temp for 15 min
- incubate at 20-24C for 15 min
- do IS and 37C phases only
- prewarm all tubes to 37C
63
what is the purpose of adsorption processes
- reduce reactivity of certain antigens
- provide excess antibodies
- remove interfering antibodies from plasma
- provide excess antigens
64
how can you autoadsorb plasma
- incubate at 37C
- add LISS after incubation
- perform elution
- incubate at cold temps
65
slide 155
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