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| The Joint Commission (TJC) |
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Definition
| To continuously improve the safety and quality of care provided to the public provision of health care accreditation |
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Definition
Specimen with a known assay value
Tested concurrently with unknown samples |
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Definition
| Results for a specific group of patients |
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Definition
Study of serum (non-cellular liquid portion) components of blood
In vitro measurements of antibody and antigen reactions in serum |
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Definition
| When disease is initially discovered |
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Definition
| Aprrox 2 weeks after disease was first detected or suspected. |
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Definition
Reduction of a concentration of a chemical in a solution. The number of parts of a substance in the total number of parts of the mixture containing the substance
(Part/Whole) |
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| Each lab dilution contains |
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Definition
Solute- Material being diluted
Diluent- Solution used to dilute |
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| How are dilutions expressed? |
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Definition
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Definition
| Used to compare the relative amounts of antibody or antigen in different samples |
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| How are titers expressed? |
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Definition
| As the reciprocal of the last dilution that yields a positive test in the assay |
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| Doubling or two-fold dilution |
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Definition
| A specimen is diluted 1:2 |
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A sequence of dilutions made using the same ratio or fold-dilution
Referred to by the fold difference between the tubes |
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Definition
First dilution is a one part in two parts final dilution (1:2)
Next tube would be a 1:4
Next tube would be 1:8...... |
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| Number of moles of a substance in 1 liter of solution |
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Definition
Molarity (M)= grams/L
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Mol. Wt. |
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| For solution problems dealing with molarity, what equation should be used? |
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Definition
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| Measure of the tendency of a body to gain or lose thermal energy |
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Antibodies that react with human BC's below 37 degrees Celsius (optimal temp = 4 degrees Celsius
Don't react at normal body temp |
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| Most cold agglutinins have specificity for what antigen on RBC's? |
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Definition
"I" antigen
Some have specificity for "i" antigen |
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Definition
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Definition
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| What antigen is found on almost all adults? |
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Definition
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| The "I" antigen is part of the precursor component of what? |
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Definition
| Oligosaccharide that forms the H, A and B antigens |
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Term
| Naturally occurring Anti-I is often due to what? |
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Definition
| Mycoplasm pneumoniae infection (bacteria) |
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| Are "I" antigens usually clinically significant? |
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Definition
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| What does anti-I react with in all RBC's? |
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Definition
| Patient's own cells, all reagent cells and all donor cells |
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Term
| Cold agglutinin antibodies can cause what? |
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Definition
Immun Hemolytic Anemia
Invivo RBC agglutination when the body temp lowers |
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Term
| Cold agglutinins Disease (CAD) symptoms |
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Definition
Complement is activated in the cold
Activation may proceed at body temp 37 degrees Celsius |
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| What are some clinical manifestations of cold agglutinin disease? |
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Definition
Hemolysis
Peripheral necrosis |
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Term
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Definition
Associated with monoclonal IgM autoantibodies
Chronic disease state
Etiology: unknown
Age of onset: >50
Peak incidence: Mid 70's |
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Term
| What will the agglutinin titer of a patient with primary CAD be? |
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Definition
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| What is the treatment of Primary CAD? |
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Definition
| Keep patient warm, transfuse if needed, plasmapheresis, immunosuppresive therapies |
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| What are some drugs used to treat Primary CAD? |
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Definition
Corticosteroids
Rituximab
Combination therapy |
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Term
| Acute cold agglutinin syndrome associated with infection |
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Definition
| Development of a high titer, high thermal amplitude CA resulting in auto immune hemolytic anemia |
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Definition
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| Cold agglutinin titers are typically |
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Definition
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| Acute CAS cn also be produced secondary to |
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Definition
Mononucleosis (Epstein Bar Virus, EBV)
Lymphoproliferative disorders |
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| Cold agglutinin antibodies are found in what percent of Mycoplasm pneumoniae cases? |
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Definition
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Definition
| A semi quantitative assay used to determine the relative Ab concentration in a patient's plasma/serum |
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Term
| Antibody Detection (Antibody Screen) |
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Definition
| Detects pre-formed, unexpected, clinically significant antibodies with specificity to RBC antigens |
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Definition
Stimulated by foreign red cell antigens
Expressed frequency is 0.3-2.0% |
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Term
| Clinically significant ab |
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Definition
Active at 37 degrees Celsius
Detected with AHG
Known to alter the status of patient
Known to cause transfusion reactions and HDFN |
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Term
| Who gets screened for unexpected abs? |
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Definition
Blood recipients
Blood donors
Pregnant females
Patients experiencing suspected transfusion reaction |
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Term
| Components of an ab screen include |
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Definition
Reagent RBC's (as a source of ags)
Patient plasma or serum (as a source of unknown antibodies)
Patient RBC's (for auto control) |
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Definition
Must be stored in fridge
Cannot use beyond expiration date for required tests |
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Definition
| Available as pooled three-cell product (from multiple donors) |
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Term
| Reagent, Screen or Panel Cells must contain what clinically significant abs? |
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Definition
Rh
MNS
Lewis (Le a)
P1
Kell (K)
Duffy (Fy a)
Kidd (Jk a) |
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Term
| Why must patient serum that is less than 72 hours be used? |
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Definition
| Antibodies that bind complement may not be detected if aged serum is used |
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Term
| In order to perform ab screen what type of conditions are varied? |
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Definition
Temperature (tested at RT and 37 degrees Celsius)
Use of enhancing media
PEG (polyethylene glycol)
Use of enhancing media
Albumin
Proteolytic enzymes |
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Definition
Low ionic strength solution
Used to increase agglutination by reducing charges |
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Definition
Naturally occurs
Non-red cell stimulated
Prefers 4 degrees Celsius
Does not need enhancing media
Binds complement |
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Definition
Unexpected antibody
Immune-mediated |
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Definition
Step 1: Sensitization
Antigens on RBC's
Antibody in plasma or serum
Step 2: Visualization |
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Term
| What is the zeta potential of RBC's in a physiologic saline solution? |
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Definition
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| Enhancing media potentiators |
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Definition
Used to visualize reactions between IgG abs and ag
Increased the speed and/or sensitivity of ab-to-ag attachment |
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Term
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Definition
Product produced from monoclonal or polyclonal abs from an animal.
Used to detect IgG and/or complement attached to the RBC surface |
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Term
| Polyspecific must include what? |
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Definition
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Term
| Monospecific has what type of specificity? |
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Definition
| Single specificity (ex. anti-IgG) |
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Term
| False positive tests for ab screen |
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Definition
Over reading
Bacterial contamination of cells
Contamination of saline with heavy metals or silicon
Dirty glassware
Over centrifugation |
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Term
| False negative tests for ab screen |
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Definition
Forgot to add AHG
Inadequate washing
Nonreaction AHG (QC failed)
Forgot to add patient serum/plasma |
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Term
| Commonnly used proteolytic enzymes that reagent RBC's are treated with |
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Definition
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Term
| Other proteolytic enzymes that reagent RBC's are treated with include |
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Definition
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Term
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Definition
| Used as potentiating media in process of cleaving proteins (N-acetyl-neuraminic acid Neu Ac which is a major contributor to the RBC's negative charge)charge and zeta potential are reduced |
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Term
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Definition
| Presentation of Rh, Kidd, and Lewis ags |
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Definition
Any antigen that contains Neu Ac
M,N,S,s and Duffy |
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| Proteases have no impact on |
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Definition
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Term
| How do you determine the identity of an ab? |
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Definition
Ab detection using non-reactive cells for initial rule-outs. Ab identification using panel cells for rule-outs
Using the most probable ab determine the "p" value |
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Definition
Match phases of reactivity to serological characteristics of suspected ab
Evaluate ag dose
Perform probability test (p-value) |
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Term
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Definition
| Provides a confidence limit for identification of ab |
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| What must a p value be to prove test validity? |
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Definition
| p value < or equal to 0.05 |
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| What is the formula for calculating p value? |
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Definition
P value = P! x N!
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T! |
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Term
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Definition
| Number of ag positive cells that show agglutination (4+ 3+ 4+) |
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Definition
| Number of ag negative cells that do not show agglutination (0 0 0) |
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Term
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Definition
| Total number of cells (14) |
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| What are the total number of cells when performing an ab detection (screen) or an ABID (panel)? |
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Definition
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