1
Q
what cell increased in chronic infections like tuberculosis
A
monocyte
2
Q
cell known as the homeostatic regulator of inflammation
A
eosinophil
3
Q
differentiate postzone and prozone
A
postzone = excess antigen
prozone = excess antibody
postzone - repeat test in 1-2 week | prozone - dilute & retest
4
Q
differentiate cellular and humoral immunity in terms of the cells involved
A
cellular = T lymphs, macrophage
humoral = B lymphs, plasma cells
C = graft rejection, hypersensitivity, etc.
H = antibody production
5
Q
identify the type of adaptive immunity
MMR, Polio, tetanus, Hib vaccine
A
Artificially acquired active immunity
individual exposed to ag thru vax develops immunity w/out having infecti
6
Q
identify the type of adaptive immunity
Maternal Abs that cross placenta & are present in breast milk
A
naturally acquired passive immunity
individual protected by abs produced by another person
7
Q
identify the type of adaptive immunity
Rh immune globulin, HBIG, antitoxins
A
artificially acquired passive immunity
individual receives immune globulin containing abs produced by another person
8
Q
refers to cell that are considered as the1st line of defense against tumor cells & cells infected with voruses
A
Lymphocyte Natural killer (NK) cells
9
Q
enumerate the positive APRs
level increase during acute inflammation
A
- serum amyloid A
- C-reactive protein
- complement proteins (C1-C9, factor B & D, properdin)
- Coagulation proteins (fibrinogen, vWF)
- a1-antitrypsin
- a1-acid glycoprotein
- mannose binding protein
- haptoglobin
- ceruplasmin
10
Q
enumerate the negative APRs
levels decrease during acute inflammation
A
Albumin
Transferrin
Antithrombin
11
Q
read and skip!!
heavy chain - Fc and Fab
light chain - Fab
fAB = antigen binding
A
remember!! Fab consist of light and heavy chain!
Fc region of IgM and IgG fixes complement.
12
Q
this immunoglobulin is the most produced antibody overall but has lower serum concentration
produced in GI tract, protects against gut infections
A
IgA
monomer = circulation | dimer = secreted
13
Q
read and skip!!
Bence-Jones proteins produced in multiple myeloma “light chain diease”
A
nice to know!
the cancerous plasma cells produce* excess of light chains* which are accumulatedi n Px serum and excreted in urine.
14
Q
a lymphoma affecting B cells producing excess IgM
A
Waldenstrom’s Macroglobulinemia
been seen in multiple myeloma
15
Q
what antigen is used in Weil-Felix reaction test?
A
PROTEUS ANTIGENS
OX-19, OX-2 = P. vulgaris
OX-K = P. mirabilis
Weil-Felix - used to diagnose Rickettsiae
16
Q
what antigen is used in Paul-Bunnell test?
A
sheep RBC antigens
Paul-Bunnell - used for Infectious Mononucleosis caused by EBV
17
Q
read and skip!!
Superantigen are antigens that does not require antigen processing but generate massive immune response
A
examples of superantigens are:
* Staphylococcal enterotoxins (F) - Kawasaki disease
* Pyrogenic exotoxin C
* TSST-1 - produced by S. aureus
* erythrogenic exotoxin A
18
Q
activation pathways
Classical pathway is — and — mediated
A
IgG and IgM mediated
alternative - microbe surface molecules
lectin - mannose or other sugars
terminal - formation of MAC, not a separate activation pathway
19
Q
identification: complement system
- function of C3b
- complement that plays a role in capillary permeability
- most powerful anaphylatoxin
- concentration of this complement protein in serum is higher than any of the complement component
- this complement protein initiates the formation of the membrane attack complex
- complement that causes degranulation of mast cells and basophils
- synthesizes complement
A
- opsonization
- C2b
- C5a
- C3
- C5b
- C4a
- macrophage & liver
C5a also works as neutrophil chemotaxis
20
Q
complement system
anaphylaxis
A
C3a, C4a, C5a
21
Q
complement deficiencies
what complement is deficient in Hereditary angioneurotic edema (HANE)
A
C1 INH
HANE is due to unregulated activation of kallikrein (incrsd bradykinin)
22
Q
complement deficiencies
C2 and C4 deficiency associated in what disorder?
A
Immune complex disorders
23
Q
complement deficiencies
what complement/s is deficient in pyogenic infections with encapsulated bacteria?
A
C3
24
Q
complement deficiencies
what complement/s deficienct in recurrent infections with Neisseria spp
A
C5, 6, 7, 8, 9
25
# complement deficiencies
GPI Linkages (DAF CD59) is associated in what disorder?
Paroxysmal nocturnal hemoglobinuria (PNH)
26
# read and skip!!
CYTOKINES
* secreted by macrophages - IL1, IL6, IL8, IL12, TNF-alpha
* secreted by T cells - IL2 & IL3
* from Th1 cells - interferon gamma
* from Th2 cells - IL4, IL5, IL10
27
most important antibody to cause type I hypersensitivity
IgE
| type I immediate - mast cells | type II late - chemokines
28
# read and skip!!
Type II hypersensitivity examples **"Antibody-mediated"**
* Autoimmune hemolytic anemia
* Immune thrombocytopenia
* Transfusion reactions
* HDFN
| type II - antibodies bind to **cell surface antigens**
29
# identify what type of hypersensitivity
Pernicious anemia
Rheumatic fever
Grave's disease
Myasthenia gravis
Insulin resistant Diabetes
type II hypersensitivity
30
# identify what type of hypersensitivity
* SLE
* Polyarteritis nodosa
* Poststreptococcal glomerulonephritis
* Henoch-Schonlein purpura
* Serum sickness
type III hypersensitivity
**immune complex**
| type III - **antigen-antibody-complement**
31
# identify what type of hypersensitivity
Arthus reaction
**type III hypersensitivity**
"subacute immune complex-mediated hypersensitivity"
32
# identify what type of hypersensitivity
Graft-versus-host disease
type IV hypersensitivity
33
# read and skip!!
type IV (delayed type) response **does not** involve antibodies but it has 2 mechanisms: direct cell cytotoxicity **"CD8+"** and inflammatory reaction **"CD4+"**
Type IV examples are:
* contact dermatitis (poison ivy, etc.)
* GVH disease
* tests (PPD, Patch test, Candida extract)
## Footnote
mnemonic: **4T's** (T cells, transplant rejections, TB skin tests, touching or the contact dermatitis)
34
# identify
Bruton agammaglobulinemia
| choices: **T-cell, B-cell, B & T, Phagocyte dysfunctions**
B cell disorder
| defect in BTK gene **"no B-cell maturation"**
35
# identify
DiGeorge syndrome
Job Syndrome
Chronic mucocutaneous candidiasis
| choices: **T-cell, B-cell, B & T, Phagocyte dysfunctions**
**T cell disorder**
since one of the main function of T cell dba is to kill virally infected cells
## Footnote
* **DiGeorge** - recurrent viral/fungal infections due to T-cell deficiency
* **Job syndrome** - deficiency of Th17 cells due to STAT3 mutation, impaired recruitment of neutrophils to sites of infection
* **Chronic mucocutaneous** - T cell dysfunction, or absent in vitro T-cell proliferation in response to Candida antigens
36
# identify
Ataxia-telangiectasia
Wiskott-Aldrich syndrome
Hyper-IgM syndrome
| choices: **T-cell, B-cell, B & T, Phagocyte dysfunctions**
B & T cell disorder
## Footnote
* **Ataxia** - defects in ATM gene, high risk of lymphoma and leukemia
* **Wiskott** - mutation in WASp gene (defective antigen presentation)
* **Hyper-IgM** - defective CD40L on Th cells (class switching defect)
37
# identify
Leukocyte adhesion deficiency (type I)
Chediak-higashi syndrome
Chronic granulomatous disease
| choices: **T-cell, B-cell, B & T, Phagocyte dysfunctions**
Phagocyte dysfunctions
## Footnote
**Leukocyte adhesion** - impaired migration and chemotaxis (increase neutro in blood but absence of neutro at infection sites
**Chediak** - defect in lysosomal trafficking regulator gene/microtubule dysfunction in phagosome-lysosome fusion
**CGD** - defect of NADPH oxidase
38
enumeraye the structural genes involved in HIV
env: **gp120 & gp41**
39
what is the most common fungal infection in AIDS in worldwide
**Pneumocystis jiroveci** which causes pneumonia
40
what is the most common cancer in AIDS patients
Kaposi's sarcoma
41
# enumerate
screening and confirmatory test for HIV
1. screening = ELISA **most sensitive**
2. confirmatory = WESTERN BLOT **most specific**
42
what test highly specific for SLE
anti dsDNA
| if **highly sensitive = Anti-nuclear antibody (ANA)**
43
# identify the type of hypersensitivity
SLE
type II and type III hypersensitivity
## Footnote
Systemic lupus erythematosus (SLE) is primarily a type III hypersensitivity disease, where widespread organ damage results from immune complexes depositing in tissues like the kidneys and joints. It also involves significant type II mechanisms, such as when autoantibodies directly attack and destroy specific cells, which can lead to complications like anemia.
44
differentiate the 4 types of graft
* **autograft** - from self
* **isograft** - from identical twin or clone
* **allograft** - from nonidentical individual of same species
* **xenograft** - from different species
45
# read and skip!!
LIVE ATTENUATED VACCINES
| induces cellular and humoral responses
* Adenovirus
* Polio (sabin)
* Varicella (chickenpox)
* Smallpox
* BCG
* Yellow fever
* Influenza
* MMR
* Rotavirus
46
# read and skip!!
KILLED VACCINE
| induces humoral response
Rabies
Influenza
Polio (salk)
Hepatitis A
| mnemonic: killed RIP Always
47
# recall
differentiate cell mediated immunity and humoral immunity
cell mediated = **T cells**
humoral = **B cells**
48
markers of NK cells
CD16 & CD56
49
what is the primary function of Toll-like receptors?
activation of innate immune system
## Footnote
fun fact: TLR recognize bacterial endotoxin of all gram (-) **except leptospira**
50
differentiate MHC I and MHC II
| NTK! MHC gene region is located in **chromosome 6**
MHC I is present on **all nucleated cells and platelets** (not on RBCs)
MHC II is present on the **antigen presenting cells (APCs)**
51
marker of hematopoietic stem cell
CD34
52
How many fragments does antibodies produced?
What are those?
3 fragments **2 Fab + 1 Fc**
53
#read and skip!!
Always remember:
**antigens** - surface of RBC
**antibodies** - serum/plasma
Immunogenicity of Blood Group Antigens
1. A, B, and D (Rho) **most immunogenic**
2. Duffy (Fya & Fyb)
3. Kidd (Jka & Jkb)
54
Out of four phenotypes of (ABO), which are autosomal dominant, autosomal co-dominant, and autosomal recessive?
A & B = autosomal **co-dominant**
O = autosomal **recessive** (and the most frequent)
55
Enumerate the sugars responsible for A, B, and H antigen specificity
A = N-acetylgalactosamine (GALNAC)
B = D-Galactose
H = Fucose
56
classify these posible genetic combinations of H antigen
HH, Hh, hh
HH or Hh - produce H antigen (**Caucasians**)
hh - does not produce antigen (**Bombay**)
## Footnote
remember: as long as naay "H", mo-produce jud a og H antigen
nice to know! type O has more H antigen ingon si bbguy xD
57
from ABO subtypes, which one is the most common and the most antigenic?
**A1** (80%)
## Footnote
A1 & A2 are differentiated using antisera specific for A1 (*anti-A1 lectin*). A1-lectin is prepared from seed **"Dolichos biflorus"**
58
differentiate the 2 null phenotypes (Bombay & para-Bombay)
Bombay (Oh) = no A, B or H antigen on red cells and sections but it has **anti-A, anti-B & anti-H in their sera**
Para-bombay = **absent or trace A, B, & H** antigens are detected
| para means mura'g xD (mura'g naa/mura'g wala)
59
# true or false:
newborns has their natural ABO antibodies right after birth.
**FALSE**
Newborns does not have antibodies of their own, but they begin to **produce Ab with detectable titer at 6 months**.
| mao gani if newborn, FORWARD BT rjud always. oki?
60
differentiate the ABO routine testing based on the principle (or kung unsa ila ginadetect)
forward = detect **antigens**
reverse = **antibodies**
## Footnote
kay remember dba if we do reverse testing, we use px plasma or serum tas rcs (known cells). unya if forward, px red cells + antisera. **NOTE!! Ag = rbc Ab = plasma/serum**
61
# read and skip!!
**Anti-A,B** is not a mixture of anti-A and anti-B, rather they are separate Ab that reacts with both A and B antigens. used for validating reaction of the anti-A and anti-B.
(+) reaction = **weak subgroups of A and B** but do not react w/ the anti-A and anti-B
62
# read and skip!!
Acquired B antigen result from Px with **colon/gastric CA** and **intestinal obstruction**
| si Colon og gastric ky gaproduce of B antigen
if there could be discrepancies in ABO testing, what to do?
1. wash cells (3-4x)
2. test for subgroups A using anti-A1 and anti-A
3. use cell panels
63
true or false: Reverse typing is also applicable in Rh blood group system to confirm antibodies.
**FALSE!**
we cannot do reverse typing in Rh since dili sya naturally-occuring antibodies.
64
enumerate the antigens of Rh according to **Fisher & Race**
**D > c > E > C > e**
Rh (+) = D+ | Rh (-) = d
| Wiener: **Rho | rh' | rh" | hr' | hr"**
65
only way to determine if weak D or Rh negative
Bovine anti-D
## Footnote
TAKE NOTE: when you report weak D results, only use **Rh positive** if donor ang nag weak pos sa 37C. If the patient tested weak pos sa 37C, only use **Rh weak positive**
66
# read and skip!!
women who appear to be Rh (-) **should be proven to be Du (-)** before they are considered to be eligible to receive transfusion
| (+) Du > considered **Rh positive**
1. use bovine or albumin-suspended anti-D reagent
2. incubate at 37C for 15-60 mins to facilitate Ag-Ab complex
67
# read and skip!!
minor blood groups and their antibody class:
* Kell - IgG
* Duffy - IgG
* Kidd - IgG
* Lewis - IgM
* I - IgM
* P - IgM
* M & N - IgM
* S & s - IgG
REMEMBER!!
**WARM** - Rh, Kell, Kidd, Duffy, Ss
**COLD** - Lewis, MN, Pp, Ii
68
what blood group does **McLeod phenotype** belong?
Kell
| McLeod - are the individuals with **decreased Kx**
69
what blood group and phenotype that are resistant to malarial infection **P. vivax**
DUFFY
**Fy (a-b-)**
| **take note:** enzyme treatment of Duffy destroys Fya & Fyb
70
what blood group and specifically antibody that can cause Infectious mononucleosis,?
**I "cold agglutinin"**
anti i
| auto-anti I = **M. pneumoniae**
71
autoanti-P is a?
Donath-Landsteiner antibody which is associated with **Paroxysmal Cold Hemoglobinuria**
| Px with autoanti-P may *require a blood warmer for transfusion*.
72
# read and skip!!
Diego - Chippawah, Japanese, etc.
Diego - **mongolian ancestry**
XG - dominant in female
73
#identify what blood product should be transfused
Px with congenital hypogammaglobulinemia
**Immune serum globulin** should be given monthly
74
Prothrombin complex is used for treating Px with?
Hemophilia B (II, VII, IX, X)
75
#identify what blood product should be transfused
Px with chronic granulomatous disease
Granulocyte concentrates
76
#identify what blood product should be transfused
Px with multiple coagulation deficiency
Fresh frozen plasma
77
Cryoprecipitate is used to treat Px with?
DIC, vWF disease, Hemophilia A, Hypofibrinogenimia
78
This blood product is used for px with quantitative or qualitative platelet defect, for prevention of HLA alloimmunization
Single donor platelets
79
Irradiated blood component is used for newborn and patients with marrow transplant since this prevent?
GVHD disease
80
When do we use frozen/deglycerolized rbc?
This is used for px with **rare phenotype** for autologous donation
81
#read and skip!!
THINGS TO RMMBR IN SPECIAL BLD COMPONENTS!
**Irradiated** - inactivate lymphocytes using 25Gy, prevents GVHD but NOT FEBRILE REACTIONS (expiration 28days from irradiation)
**Leukopoor** - reduces leukocytes to <5 x 10^6, prevent febrile reactions
**Frozen RBCs** - rare blood units / autologous
**Washed RBCs** - used within 24hrs if open system
**RBC aliquot** - for neonates or infants <4 mos. requiring only 10-25 mL (must be used within 24hrs)
82
Leuko-poor components is used to minimize exposure of patient to donor leukocyte, to prevent what?
Febrile reaction & CMV transmission
83
#identify what blood product should be transfused
For IgA deficient patients
Washed RBC
| Plasma proteins are already removed in this component, used for px with severe allergic reactions or IgA deficiency
84
#read and skip
IMPORTANT THINGS TO REMEMBER IN BLOOD PRODUCTS !!!!
* All anticoagulant storage time are 21days, EXCEPT CPDA-1(35 DAYS)
* Anticoagulant + Additive *PIGPA* = 42 days
* Shipment of blood temp: 2-10C
**PRBC**
* Centri to yield PRBC: 3200 for 3 mins
* 1 prbc should yield HCT of not more than 80%
**PC**
* WB to be used for RDP must be processed within 6-8 hrs after collection (maintained at 20-24C)
* storage = 3-5 days at constant agitation (room temp)
* 1 unit = 5.5x10^10 (RDP) | >3x10^11 (SDP)
* 50-60 mL
* pooled = 4 days
**CRYOPRECIPITATE**
* 1 unit = 10-20 mL freeze -25C can be stored for 1 yr
* before use, thaw 37C for 15 mins before using
* 1 unit *used within 6 hrs* after thawing kept at room temp until transfusion
* multiple units pooled *used within 4 hrs*
* for Hemophilia A&B, vWF disease, etc.
**FFP**
* prepared within 6hrs ACD | 8 hrs CPDA1
* should be thawed at 30-37C WITH AGITATION
* once thawed, store within 1-6C and transfused within 24 hours
* FFP store at -18C for 1 yr | -65C for 7yrs
85
what factor concentrates are in lyophilized products prepared from pooled plasma
Factor VIII, IX, XIII
86
#read and skip! DONOR DEFERRALS
**Permanent:**
- HTLV, HIV, HCV, HbsAg, repear reactive test anti-Hbc
- viral hepatitis after 11th bday
- babesiosis or Chagas, lymphoma, leukemia
- Tegison, **human-derived** GH
**1 year:**
- sexual contact with HbsAg, viral hepatitis, HIV person
- incarceration >72 consecutive hours
- syphilis, gonorrhea, rabies
**1 month:**
- german measles or chickenpox
- accutane or proscar (from last dose)
**2-weeks:**
- MMP vaccines, typhoid or yellow fever, smallpox vax
**OTHERS:**
- previous donation = 3 mos (if regular donor 2 mos)
- previous pheresis donor = at least 48 hrs
- pregancy = 6 wks after postpartum
- malaria = 3 yrs after asymptomatic
- aspirin = 3 days
**NO DEFERRAL:**
- toxoid or killed or synthetic vaxx
- previous history of TB
- recombinant type of GH
87
Enumerate the ABO blood groups with from the **greatest** amount to **least** of H antigen
1. O
2. A2
3. B
4. A2B
5. A1
6. A1B
*remember, type O has the most numbers of H antigen. whereas, A1b has the least H antigens.*
88
Why group O donors are often referred to as the UNIVERSAL DONOR?
Since RBCs of group O individuals **does not contain any antigens** and can be transfused to any blood type.
Remember, type O have anti-A, anti-B, and anti-A,B.
89
Why type AB people often known to be UNIVERSAL RECIPIENT?
RBCs from any blood group can be transfused to group AB recipients, since they **possess both A and B antigens** and consequently do not have anti-A and anti-B.
90
What rbc poikilocyte does present in Rh null phenotype?
Stomatocytes “mouth cell”
| Rh null phenotype = **lack Rh antigens**
91
LW antigen is present on?
| LW = **Landsteiner-Wiener**
Rhesus monkey
| NTK: anti-LW reacts strongly with most D-positive RBCs
92
# read and skip!
WIENER = FISHER-RACE
* R0 = Dce
* R1 = DCe
* R2 = DcE
* R2 = DCE
| Wiener: **Rh0 = D | rh' = C | rh' = E | hr' = c | hr" = e**
WIENER = FISHER-RACE
* r = dce
* r' = dCe
* r" = dcE
* ry = dCE
93
control used for Rh typing
Bovine serum albumin
| reagent: **anti-D**
94
# read and skip!
DIRECT ANTIGLOBULIN (DAT) | COOMBS
* detects **in vivo**
* EDTA
* positive = agglutination
| conditions: **HTR, HDFN, Autoimmune hemolytic anemia**
INDIRECT ANTIGLOBULIN (IAT)
* detects **in vitro**
* serum
* positive = agglutination
95
differentiate the 3 types of test in antibody determination
* Crossmatching - detects recipient antibody reacting with donor cells
* Antibody screen - detects Ab reacting with screening cells
* Antibody panel - detects Ab reacting with panel cells
96
Le*b* antigens act as receptor for what organism?
Helicobacter pylori
| Le (a-b-) --> Le (a+b-) --> Le (a+b+) --> Le (a-b+)
97
# classify what immunoglobulin in each blood group
1. ABO
2. Rh
3. Lewis
4. MNSs
5. I
6. P
7. Kell
8. Duffy
9. Kidd
10. Lutheran
| choices: **IgM** or **IgG**
1. A,B (IgM) | O (IgG)
2. IgG
3. IgM
4. MN (IgM) | Ss (IgG)
5. IgM
6. IgM
7. IgG
8. IgG
9. IgG
10. Lu*a* (IgM) | Lu*b* (IgG)
98
# identification
1. Mycoplasma pneumoniae
2. Infectious mononucleosis
3. Epstein Barr virus
4. Paroxysmal cold hemoglobinuria
| choices: **anti-I, anti-i, auntoanti-I, P antigen, autoanti-P**
1. autoanti-I
2. anti-i
3. anti-i
4. autoanti-P
99
Most common type of hepatitis
(enumerate the other name)
HAV
Infectious hepatitis
Short incubation hepatitis
| test: **ALT, Bilirubin, ALP**
100
HBV is also referred as?
Serum hepatitis
Long incubation hepatitis
| remember for **dane particle | australian antigen**
101
post transfusion hepatitis
HCV
102
major etiological agent of enterically transmitted non A, non B hepatitis worldwide (enumerate also the other name)
HEV
Water-borne hepatitis
| NTK: **high mortality rate in women**
103
# interpret the results
HBsAg (-)
Anti-HBc (+)
Anti-HBs (+)
Immune because of **natural infection**
104
# interpret the results
HBsAg (-)
Anti-HBc (-)
Anti-HBs (+)
Immune because of **Hep B vax**
105
# interpret the results
HBsAg (+)
Anti-HBc (+)
IgM anti-HBc (-)
Anti-HBs (-)
Chronically infected
106
# interpet the results
HBsAg (-)
Anti-HBc (+)
Anti-HBs (-)
ERROR
107
# what could be the possible cause of this ABO discrepancy?
* Anti-A = 4+
* Anti-B = 0
* A1 cells = 0
* B cells = 4+
* O cells = 3+
## Footnote
choices: acquired B phenomenon, a2 subgroup, a1 subgroup with anti-H, or poly agglutination
a1 subgroup with anti-H
| O cells = **anti-H**
108
# what could be the possible cause of this ABO discrepancy?
* Anti-A = 4+
* Anti-B = 4+
* Anti-AB = 4+
* A1 cells = 2+
* B cells = 2+
* O cells = 3+
* Autocontrol = 2+
| choices: **rouleaux, subgroup of A, group O newborn, bombay**
ROULEAUX
109
# what could be the possible cause of this ABO discrepancy?
* Anti-A = 0
* Anti-B = 0
* Anti-AB = 0
* A1 cells = 4+
* B cells = 4+
* O cells = 4+
* Autocontrol = NEG
| choices: **rouleaux, subgroup of A, group O newborn, bombay**
BOMBAY
110
# interpet the results
* HBsAg **-**
* HBeAg **-**
* Anti-HBe **-**
* Anti-HBc (IgM) **-**
* Anti-HBc **-**
* Anti-HBs **-**
* Anti-HAV (IgM) **+**
* Anti-HCV **-**
Recent acute hepatitis A infection
111
# interpret the results
* HBsAg **+**
* HBeAg **+**
* Anti-HBe **-**
* Anti-HBc (IgM) **+/-**
* Anti-HBc **+/-**
* Anti-HBs **-**
* Anti-HAV (IgM) **-**
* Anti-HCV **-**
acute hepatitis B infection
(highy infectious)
112
# read and skip! DISCREPANCIES IN ABO TYPING
**WEAK OR MISSING *ANTIBODIES***
Anti-A = 0
Anti-B = 0
A1 cells = 0
B cells 0
causes: **newborns, elders, px leukemia, agammaglobulinemia, plasma transfusion, patients on immunosuppresive drugs, bone marrow transplants**
**WEAK OR MISSING *ANTIGENS***
Anti-A = 4+
Anti-B = 2+
A1 cells = 0
B cells 4+
causes: **acquired B phenomenon, leukemia, subgroups, Hodgkin's**
| BLOOD GROUP: **A1** - POSITIVE, POSITIVE | **A2** POSITIVE, NEGATIVE
**PLASMA OR PROTEIN ABNORMALITIES**
Anti-A = 4+
Anti-B = 2+
A1 cells = 2+
B cells 4+
causes: **elevated globulins, plasma expander, elevated fibrinogen, Wharton's jelly in cord blood**
113
compare the results of CRP in viral and bacterial infection
viral = **low** CRP
bacterial = **high**
| hsCRP = detects risk for a heart disease
114
# read and skip! SYPHILIS
* Primary = chancre
* Secondary = condylomata lata
* Latent = neurosyphilis
* Tertiary = gumma
| NTK: syph can be transmitted to a fetus (18th week gestation)
antibodies that develop:
* primary = Ig**M**
* secondary = Ig**G**
115
differentiate the types of flocculation in **nontreponemal tests** (syphilis)
| Nontreponemal tests = **REAGIN TESTS**
* VDRL = **micro**
* RPR = **macro**
| false POSITIVE: **malaria 100%**, SLE, RA, hepa, pneumonia, aging, IM
116
test of choice for screening CSF in syph
**VDRL**
Antigen = *cardiolipin + lecithin*
| NTK! VDRL serum **requires heat inactivation**
117
# identification: **SYPHILIS**
1. antigen used in Rapid Plasma Reagin (RPR)
2. reagent antigen in FTA-Abs
3. adosrbent used in FTA-Abs
4. Principle of MHA-TP
5. specimen of choice for neurosyphilis
6. known to interfere with reactions of certain Syphilis tests (VDRL)
1. cardiolipin + charcoal
2. nichol's strain
3. reiter treponemes
4. hemagglutination
5. CSF
6. complement
## Footnote
RPR is **more sensitive** but less specific than VDRL.
No heat inactivation necessary.
118
enumerate the **treponemal tests** of Syphilis
| NTK: syph is easier to detect in **men** than women.
1. Darkfield microscopy
2. FTA-Abs (most sensitive)
3. TPI
4. MHA-TP
| NONTREPONEMAL: VDRL & RPR
119
# read and skip! | **TEST SENSITIVITIES**
NONLATTICE **more sensitive**
* Radial Immunoassay (RIA)
* Enzyme Immunoassay (EIA)
* Fluorescent Immunoassay (FIA)
* Nephelometry
LATTICE **less sensitive**
* Complement fixation
* Agglutination
* Flocculation
* Rocket electrophoresis
* Radial immunodiffusion
* Ouchterlony (double immunodiffusion)
* Immunofixation
* Immunoelectrophoresis
120
# read and skip! | **ANTINUCLEAR ANTIBODIES**
ANA PATTERN = ANTIBODY
* Homogenous (diffuse) = *anti-histone*
* Peripheral (rim) = *anti-ds DNA*
* Speckled = *anti-RNA, anti-ENA*
* Nucleolar = *anti-nucleolar RNA*
ANA PATTERN = DISEASE
* Homogenous = usually SLE
* Peripheral (rim) = SLE
* Speckled = SLE, Scleroderma, RA, MCTD
* Nucleolar = Scleroderma, Sjogren's
121
# identification: **HIV**
1. cells main target of infection
2. major structural protein of HIV
3. standard screening test
4. confirmatory test
5. hallmark of HIV infection
6. viral antigens first to be detected in HIV
1. CD4 T helper cells (+ macrophage)
2. p24
3. ELISA
4. Western blot
5. decreased CD4 Th cells
6. p24
| **gp41 & gp120** are the ones represent a positive Western Blot for HIV
122
how to **inactivate** complement?
and **reactivated**
inactivate **56C for 30 mins** and can be reactivated once 4 hours has lapsed by heating to **56C for 10 mins**
123
# identification
1. these cells recognize epitopes on intact antigen
2. this molecule extends the half-life of C3 convertase
3. this antibody is found on the surface of naive B cells
4. aggregated forms of this immunoglobulin can activate alternative pathway of complement
5. molecules that attract cells so they are recruited to the site of infection
6. a link between the cell and the antigen
1. B cells
2. properdin
3. IgD
4. IgA
5. chemokines
6. opsonin
124
# identification | **TUMOR MARKERS**
1. pancreas
2. ovary
3. colon
4. breast
5. prostate
6. liver/testes
| clue: some has multiple answers :)
1. CA 19-9
2. CA 125
3. CEA
4. CA 15-1, BR 17.29, BR 27.29, ERPR
5. PSA
6. AFP
125
What is the most likely complement deficiency of the patient with Gonoccocal infection?
| choices: **C1 INH, C3, MAC, C2**
MAC
126
# identification: **TRANSPLANT REJECTION**
1. type of transplant rejection where the donor cells attach the recipient's tissue
2. caused by repeated blood transfusion, repeated pregnancies, or previous grafts
3. occur from months to years after transplantation
4. begin in the first few weeks after transplantation
5. due to pre-existing antibodies specific for allogenic MHC antigen
| choices: **acute, hyperacute, chronic GVHD**
1. GVHD
2. hyperacute
3. chronic
4. acute
5. hyperacute
## Footnote
Graft rejection is caused by **cell-mediated** immune response to alloantigens expressed on cells of the graft. Both delayed-type hypersensitivity and cell-mediated cytotoxicity reactions have been implicated.
127
# identification | **ANTIBODIES**
1. present in **breast milk**
2. can cause ABO incompatibility
3. fixes complements best
4. its function is unknown
5. first immunoglobulin to be produced
6. immunoglobulin detected in the immediate spin phase
| Igs are glycoprotein substances secreted by antigen-stimualted B cells.
1. IgA & IgG
2. IgG (and IgM? Not sure)
3. IgM (pentameric - binds C1 - activates classical pathway)
4. IgD
5. IgM
6. IgM
128
# identification | **HYPERSENSITIVITY**
1. Mantoux test
2. Rh incompatibility
3. Cytokine production
4. Differentiation to plasma cells
5. Allergies
6. Opsonization
7. Complement activation
| choices: *immediate, antibody-mediated, immune complex, T cell mediated*
1. T cell mediated
2. T cell mediated
3. T cell mediated
4. Immune complex mediated
5. Immediate
6. Antibody-mediated
7. T cell mediated
129
# identification: **INNATE OR ADAPTIVE IMMUNITY**
1. Peyer's patches
2. plasma cells
3. MALT
4. dendritic cells
5. memory
6. lymphocytes
7. APC
8. antibodies
9. innate
10. cytokines
1. innate
2. adaptive
3. innate
4. innate
5. adaptive
6. adaptive
7. innate
8. adaptive
9. cilia
10. adaptive
130
#adaptive immunity |**CELLULAR OR HUMORAL**
1. Viral infections
2. B cells / antibody
3. Transplant rejection
4. Bacterial infection
5. Fungal infection
6. Type IV hypersensitivity
7. Type I hypersensitivity
8. T cell / lymphokines
9. Type I hypersensitivity
1. Cellular
2. Humoral
3. Cellular
4. Humoral
5. Cellular
6. Cellular
7. Humoral
8. Cellular
9. Humoral
131
Differentiate the two subclasses of IgA
Serum IgA - MONOMER
Secretory IgA - DIMER
132
Normal T cell : B cell ratio
Normal T helper: T regulatory ratio
Normal T helper: T regulatory ratio **(if AIDS patient)**
| CD4:CD8 ratio: **2:1** in the peripheral blood
8:1
2:1
**1:2** (or a ratio that is <1:1)
133
# double diffusion test patterns
A crossed-line pattern indicates?
- serological identity
- partial identity
- non-identity
**NON-IDENTITY**
## Footnote
**partial identity:** two lines meet (spur formation)
**identity:** single smooth arc of precipitation
134
How much AHF and fibrinogen does a unit of cryoprecipitate contain at minimum?
**80 units AHF; 150 mg fibrinogen**
| Remember, cryo is a concentrated source of Factor 8 (AHF) and fibrinogen
135
Enumerate the screening and confirmatory test for RA
| RA is the production of IgM or IgG **directed against IgG**
RF assay = screening
Anti-CCP = confirmatory
## Footnote
*anti-cyclic citrullinated peptide* is a very specific marker for Rheumatoid arthritis.
136
What is the most common parasitic complication during blood transfusion? (referring to the spp)
Plasmodium species
137
# radioimmunoassay (RIA)
differentiate Radioimmunosorbent Test (RIST) and Radioallergosorbent Test (RAST)
RIST - total IgE **competitive**
RAST - IgE specific to allergen **non-competitive**
138
# read and skip! **EXAMPLES OF METHODS**
* Nephelometry - complement or Ab concentration
* Indirect Immunofluorescence - ANA, FTA-Abs
* Hemagglutination inhibition test - Rubella
* Latex agglutination inhibition - viruses
* ELISA - serum HCG, HIV, hepatitis antigen and antibodies, antibodies to bacteria and viruses
* Double diffusion - identify Antibodies associated with autoimmune diseases
* Immunoelectrophoresis - to determine heavy and light chains involved
* Immunofixation - to classify monoclonal gammopathies
139
enumerate the 5 streptococal antigens
1. streptolysin
2. streptokinase
3. DNase
4. NADase
5. hyaluronidase
| **anti DNase-B test** - highly specific better than ASO
140
# read and skip! **SPECIFICITY OF AUTOANTIBODIES**
* Grave's disease = TSH
* Goodpasture's disease = Basement membrane
* Hashimoto's = thyroglobulin
* Multiple sclerosis = myelin sheath/myelin basic protein
* Myasthenia gravis = acetylcholine
* Rheumatoid A. = IgG (fc)
* Sjogren's syndrome = salivary duct/tear duct
141
# enumeration
naturally occurring antibodies & clinically significant antibodies
**NATURALLY OCCURRING:**
* ABO
* Lewis
* P1
* MN
* Lu a
**CLINICALLY SIGNIFICANT**
* ABO & Rh
* Kell
* Kidd
* Duffy
142
# identification: **ANTIBODY CHARACTERISTICS**
1. usually react in AHG
2. can react in any phase of testing
3. enhanced by acidification
4. bind complement
5. common cause of anamnestic response
1. Kell, Kidd, Duffy
2. Lewis
3. M
4. ABO, I, Kidd, Lewis, P
5. Kidd
| Ab that show dosage: **Rh** except D, MNS, Duffy, Kidd, Lutheran
143
# read and skip! **ISBT SYSTEM**
1. ABO
2. MNS
3. P
4. Rh
5. Lutheran
6. Kell
7. Lewis
8. Duffy
9. Kidd
10. Diego
| chromosome number: **ABO = 9 | Rh = 1**
11. Cartwright
12. Xg
13. Scianna
14. Dombrock
15. Colton
16. Landsteiner-Wiener
17. Chido/Rodgers
18. H
19. Kx
20. Gerbhich
| others: **22 = Indian, 27 = I, 28 = Globoside**
144
duration of whole blood donation and apheresis donation
WB: <10 mins (prc = 5-10 mins)
Apheresis : 45 - 120 mins
145
# read and skip! **MUST KNOW IN BLOOD DONATION**
PHYSICAL EXAMINATION:
* weight 50 kilos up
* temp <37.5 C | 99.5 F
* pulse rate 50-100 bpm
* BP systolic <180 | diastolic <100
* Hgb 12.5 g/dL (in general) | m: 14-16 f: 12-14
* Hct >38%
## Footnote
Hgb copper sulfate (CuSO4) - **sinks if >1.053**
whole blood volume: **405 - 550 mL**
FREQUENCY OF DONATION:
* whole blood: 8 weeks or 56 days
* plasma & granulocytes: at least 48 hrs
* plateletpheresis: 72 hrs ideal
Donate blood **every 3 months**!!
APHERESIS FREQUENCY:
* From donating WB to apheresis: **4 weeks**
* Apheresis to apheresis: **2 weeks**
| donor records retention time: **5 - 10 years**
146
During apheresis, blood collected into the machine that will be returned to the donor is anti-coagulated. Hence, citrate will bind free calcium inside the body and may cause **hypocalcemia**. The platelets are also suspended in plasma, **electrolytes loss** may occur. So, what should be given to the donor to prevent this circumstance?
* Give **calcium carbonate** 30 mins. before the procedure.
* Give calcium-rich drink during and after the procedure.
* Give electrolyte-rich drink during and after the procedure.
## Footnote
TAKE NOTE! platelet can cause electrolyte-loss while citrate can cause hypocalcemia.
147
# read and skip! **BRIEF HISTORY IN BB & IS**
* 1492 - first ever blood transfusion to Pope Innocent VIII
* 1667 - first successful human blood transfusion
* 1943 - discovery of ACD
* 1957 - discovery of CPD
* Karl Landsteiner & Von Descastello - ABO blood gr.
* K. Landsteiner & Wiener - Rh blood gr. system
* Landsteiner & Sturli - discovered AB blood gr
* World war II - establishments of blood banks
| remember the creation of saline as **plasma volume expander**
* Chinese - dried powder from smallpox lesions "variolation"
* 15th century - inoculation
* Edward Jenner - smallpox vaccination
* Elie Metchnikoff - phagocytosis
* Jules Bordet - discovered complement
* Robert Kaus - discovered precipitins
* Almoth Wright - cellular and humoral immune response
**LOUIS PASTEUR**
- father of Immunology
- first attenuated vaccine for rabies
148
Enumerate examples of **Negative** Acute Phase Reactants (APRs)
Albumin
Transferrin
Prealbumin (transthyretin)
| Negative acute phase reactants (APRs) decrease during inflammation because the liver shifts protein synthesis toward positive APRs.
149
Enumerate the tests for SLE and their purpose
ANA test - initial screening test
Anti-dsDNA - highly specific
Anti-Smith (Sm) - highly specific but less sensitive
150
What blood type is considered the universal plasma donor in transfusion practice?
Type **AB**
| In plasma transfusion, compatibility depends on the antibodies present in plasma, not the RBC antigens. AB plasma has no anti-A or anti-B antibodies, so it can be given to patients of any ABO blood type. That’s why AB individuals are universal plasma donors. Plasma from type O contains both anti-A and anti-B, so it’s the worst choice for plasma donation.
151
Haemophilus influenzae can activate the complement system through which of the following pathways?
**ALTERNATIVE PATHWAY**
| Haemophilus influenzae, particularly encapsulated strains, can activate the alternative complement pathway without the need for antibodies. This is because the Alternative pathway can be activated directly by microbial surfaces (lipopolysaccharides, bacterial cell walls). This leads to opsonization, inflammation, and formation of the membrane attack complex (MAC).
152
#FINAL PABAON QUIZ!
Identification:
1. What complement deficiency is most associated with SLE?
2. Deficiency that causes recurrent infections with encapsulated bacteria (H. influenzae, S. pneumoniae)
3. Father of Immunization
4. ABO blood group is most likely to produce predominantly IgG antibodies rather than IgM
5. Immunoglobulin that is predominantly found in secretions such as saliva, tears, and breast milk
6. Which part of an antibody provides flexibility?
7. What is used for the diagnosis of Hemolytic Disease of the Fetus and Newborn (HDFN)?
1. C1q
2. C3
3. Edward Jenner
4. Type O
5. Dimeric IgA
6. Hinge region
7. DAT with anti-IgG reagent
153
#refresher!
* Southern blot - DNA
* Northern blot - RNA
* Western blot - protein
* hairy cell - B cell (b for buhok)
* sezary cell - T cell (t for utak)
REVALIDA
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