BB 4: Rh Blood Group Review

Rh is a non-glycosolated protein. true or false?

true

the Rh antigens are transmembrane polypeptides that are an integral part of the ____ membrane.

RBC

what chromosome are RhD and RhCE found?

1

what gene determines the D antigen expression on the RBC?

RhD

what gene determines the C, c, E, and e antigens?

RhCE

Rh associated glycoprotein is an ammonia transporter protein that is encoded by the ____ gene.

RhAG

what chromosome is RhAG found on?

6

what is similar in structure to the Rh proteins and within the RBC membrane forms complexes with the Rh polypeptides?

RhAG

what gene is a coexpressor that must be present for expression of Rh antigens?

RhAG

the RhAG gene does not express Rh antigen by itself. true or false?

true

defects in the ____ gene are a cause of regulator type Rh-null hemolytic anemia (RHN) or Rh deficiency syndrome.

RhAG

what is the ISBT number for ABO?

001

what is the ISBT number for Rh?

004

Duffy and MNS have ____ reactivity to proteolytic enzymes.

decreased

ABO, Kidd, Rh, I, P1, Lewis have ____ reactivity to proteolytic enzymes.

increased

the ____ 3 digits of the ISBT number refers to the blood group system.

first

the ____ 3 digits of the ISBT number refers to the specific antigen that belongs to that blood group system.

second

in what corner of a blood product label would you find the following information:

• donation number

top left

in what corner of a blood product label would you find the following information:

• Blood type

top right

in what corner of a blood product label would you find the following information:

• the product itself

  • e.g., RBCs, Platelets, etc.

bottom left

in what corner of a blood product label would you find the following information:

• expiration date

• special testing/screening if applicable

bottom right

list the immunogenicity of Rh antigens from most to least.

D, c, E, C, e

____ antigens provide some functions on the RBC membrane:

• cation transport

• membrane integrity

• regulate cell volume

Rh

the lack of Rh system antigens can be denoted as ____.

Rh_null

what Rh phenotype causes a membrane abnormality that shortens the RBC survival?

Rh_null

for the weak D antigen, the gene position effect occurs when the C allele is in the ___ position to the D allele (suppressing the expression of the D antigen).

trans

D positive blood cannot be given to a weak D patient with weakened expression. true or false?

false

D positive blood cannot be given to a weak D patient with the gene position effect. true or false?

false

D positive blood cannot be given to a weak D patient with incomplete/partial D antigen (mosaic). true or false?

true

____ is used to denote weak RhD expression and absorption/elution studies (anti-D absorb to surface and eluted off).

D_el

a patient transfused with D positive red cells may develop an anti-D alloantibody to the part of the antigen (epitope) that is missing if they possess a ____ antigen.

mosaic

____ product antigens refers to the additional antigen product formed when 2 genes are inherited on the same chromosome.

cis

which cis product antigen refers to c and e inherited as a haplotype (dce or Dce)?

Rh6

which cis product antigen refers to C and e inherited as a haplotype?

Rh7

which cis product antigen refers to ce or f?

Rh6

which cis product antigen refers to Ce or rh_i?

Rh7

which cis product antigen refers to cE?

Rh27

which cis product antigen refers to CE?

Rh22

what Rh antigen refers to genes that code for C or D?

G

what antibody refers to when anti-C cannot be separated from anti-D (anti-C + anti-D)?

anti-G

what Rh antigen refers to a variant Rh antigen?

C^w

most individuals who are ____ antigen (+) are also C^w (+).

C

V and VS are high prevalence antigens. true or false?

false

which Rh antigen is described below:

• low frequency antigen found in only 2% of Caucasian and rare in African Americans

• Abs to these antigens can be naturally occurring

• May play a role in HDFN and HTR

C^w

what phenotype refers to the inherited characteristic in which none of the Rh antigens are expressed (“--/--”)?

Rh_null

which type of Rh_null is described below:

• more common

• mutation in RhAG gene

• can transmit normal RhD and RhCE

regulator

which type of Rh_null is described below:

• mutation in each RhCE gene and deletion in the RhD gene

• RhAG gene is normal

amorph

how is the regulator type Rh_null desginated?

Rh_null

how is the amorph type Rh_null desginated?

double bar over rr

what phenotype’s RBC abnormalities and serological observations are described below:

• mild compensated hemolytic anemia

• shortened RBC survival

• stomatocytes and reticulocytes observed in PBS

• decreased haptoglobin

• increased bilirubin

• increased fetal Hb

Rh_null

what phenotype’s RBC abnormalities and serological observations are described below:

• suppression of LW, S, s, U, and Fy5 antigens

• Abs to unusual/rare Rh antigens

• Anti-Rh29

Rh_null

what refers to anti-total Rh and must be Tx with other Rh_null blood?

anti-Rh29

what refers to the inherited characteristic associated with severely reduced Rh antigen expression:

• mutation in RhAG gene

• partial suppression of Rh antigens

• expression varies per individual

Rh_mod

which 2 Rh antibodies are rare examples that may be naturally occurring?

anti-E; anti-C^w

detectable ____ antibodies persist for many years and sometimes for life, so the possibility of an anamnestic response can occur when the antigen exposure recurs.

Rh

Rh antibodies are predominantly IgG, but may have minor IgM components and usually will not react in saline suspended cells during the ____ phase.

immediate spin

Rh antibodies may be detected at 37°C but most frequently detected by ____.

IAT

Rh antibodies do not bind C’ unless 2 closely attached IgG antibodies exist. true or false?

true

Rh antigens are not located closely together, so Rh antibodies “coat” RBCs which lead to ____ destruction.

extravascular

list the IgG subtypes that readily bind C’ from most to least.

IgG3, IgG1, IgG2, IgG4

which IgG subtype(s) bind complement?

IgG3; IgG1

which Rh antibodies may react more strongly with R²R² cells than R¹R¹ due to higher density of D antigen on cells?

anti-D

which Rh antibodies are rare as single antibodies?

anti-C

which Rh antibodies are rare and may not always be detected in ABS because the antigen is low frequency and is not present on ABS cells, but are usually detected in the Ab panel?

anti-C^w

which Rh antibodies are generally weak reacting Ab that is found with other Abs and reacts when both c and e antigens are present on the same haplotype (cis)?

anti-f

anti-f (ce) can be see in the ____ genotype and can be called the compound antigen.

rr

for _____ individuals, transfuse either c or e negative blood.

anti-f

which Rh antibodies react to most D and C antigen positive cells?

anti-G

which Rh antibodies are most frequently developed in rr phenotypes?

anti-G

for ____ individuals, D and C negative blood should be transfused.

anti-G

which Rh antibodies are most frequently encountered Ab followed by anti-c where anti-c can sometimes fall below detectable level?

anti-E

which Rh antibodies are rarely encountered as only 2% of the population is antigen negative?

anti-e

some autoimmune diseases can create an antibody that shows ____ antigen specificity.

e

which Rh antibodies are created in individuals found to be D deleted phenotypes (D - -)?

anti-Rh17

which Rh antibodies are known as total Rh Ab and can be developed in Rh_null individuals?

anti-Rh29

which Rh antibodies react to all cells with Rh antigens except the Rh_null?

anti-Rh29

which Rh antisera reagent is described below

• bovine albumin

• potentiators that increase likelihood of false positive, so must run manufactured control

• can be used for weak D typing

high protein

which Rh antisera reagent is described below

• hybridized to increase produce rate and Ab strength

• generally, combine several clones to ensure reaction with all mosaic parts

• also blend anti-IgM and IgG to enhance visualization

monoclonal

which Rh antisera reagent is described below

• usually IgM molecule

• low protein diluent (fewer false positive)

• limited availability

• high cost for production

• lengthy incubation time

• cannot be used for weak D typing

saline/low protein

which Rh antisera reagent is described below

• relaxed IgG Ab molecule where the disulfide bonds are broken to form a larger molecule mimicking an IgM molecule

• this allows Ab to span distance between RBCs in a low protein medium

• no required manufactured control (only AB+ uses saline control)

• fewer false positives

• can weak D type

chemically modified

which Rh antisera reagent cannot be used for weak D typing?

saline/low protein

a negative control is unnecessary unless patient types as ____ since everything else will turn out positive and it must be ensured that it is not due to rouleux or hypogammaglobulinemia.

AB+