Medina College

Bulatok, Pagadian City

MIDTERM ACTIVITY

IMMUNOHEMATOLOGY/BLOOD BANKING DATE: 04-23-04

NAME: DATU-OTO, BANIZA M._

I. TRUE OR FALSE

TRUE_1. Haemophilus influenza uses the AnWj antigen as a receptor to enter RBCs.
FALSE 2. The antigens in the Chido/Rodgers system are located on the complement fragments
C4B and C4C, respectively.
FALSE 3. HLA antigens are considered as a blood group antigen.
FALSE 4. Males who have had sex with another male (MSM) in the past 12 months are
permanently deferred.
FALSE_5. Stored RBCs contain phosphate, an anticoagulant that can cause hypocalcemia and
can leak potassium from the cells into the supernatant causing hyperkalemia, especially in
neonates.
FALSE_6. If two units of RBCs are collected by apheresis, the donor must wait 56 days before
providing another donation that includes RBCs.
TRUE 7. A patient with an M. pneumoniae infection will most likely develop a cold autoantibody
with specificity to antigen I.
TRUE 8. Sexual contact or living with a person who has acute or chronic hepatitis B or who has
symptomatic hepatitis C or other hepatitis virus requires a 12- month deferral following
discontinuation of the "close contact."
FALSE 9. Evidence of skin lesion is cause for temporary deferral.
FALSE 10. Intermittent-flow centrifugation (IFC) pertains to procedures withdraw, process, and
return the blood to the individual simultaneously. Two sites are necessary.
II. ESSAY

1. List criteria for appropriate selection of donor units

ANSWER :

● Blood Type and Rh Factor Compatibility: Match donor blood type and Rh factor with
recipient to prevent adverse reactions.
● Infectious Disease Screening: Rigorous testing for HIV, hepatitis, and other diseases to
prevent transmission.
● Transfusion-Transmitted Infections: Test for specific infections like Zika virus based on
geographic risks.
● Donor Health History: Evaluate past illnesses, travel, and behaviors for potential risks.
● Physical Examination: Ensure donors are healthy and free from conditions that may
affect donation.
● Age, Hemoglobin Levels, and Volume: Consider donor's age, hemoglobin levels, and
safe blood volume for donation.
● Consent and Ethical Considerations: Ensure donors provide informed consent and
comply with ethical guidelines.
● Tissue Matching (for organ transplantation): Match tissue types to minimize rejection
risk.
● Organ Functionality: Assess organ function for transplantation suitability.
● Geographic Considerations: Proximity between donor and recipient to minimize logistical
challenges.
● Waiting List Priority: Prioritize based on medical urgency and compatibility, especially in
organ transplantation.

2. Describe elution methods and give an example of when each would be used

ANSWER:
Elution methods are techniques used to remove antibodies or antigens from cells or
matrices. Here are some common elution methods along with examples of when each
would be used:
 ● Heat Elution:
Method: Heating the sample to a specific temperature to disrupt antigen-antibody
complexes.
Example Usage: Used in blood banking to elute antibodies bound to red blood cells in
order to identify the specificity of antibodies in patients with autoimmune hemolytic
anemia.
● Acid Elution:
Method: Treating the sample with a low pH solution to dissociate antigen-antibody
complexes.
Example Usage: In forensic science, acid elution is used to remove DNA from surfaces
or fabrics for analysis in cases such as sexual assaults or other criminal investigations.
● Alkaline Elution:
Method: Using a high pH solution to break antigen-antibody bonds.
Example Usage: In cancer research, alkaline elution is employed to isolate DNA adducts
formed by carcinogens, aiding in the study of mutagenesis and carcinogenesis.
● Organic Solvent Elution:
Method: Using organic solvents like ethanol or chloroform to disrupt antigen-antibody
complexes.
Example Usage: In immunoassays, organic solvent elution can be used to remove
interfering substances from samples, enhancing the accuracy of the assay results.
● Enzymatic Elution:
Method: Employing enzymes like proteases or neuraminidase to cleave antigen-antibody
bonds.
Example Usage: In research on infectious diseases, enzymatic elution is used to release
viral antigens from infected cells for further analysis, aiding in the development of
diagnostic tests or vaccines.
● Dialysis Elution:
Method: Placing the sample in a dialysis membrane and subjecting it to buffer exchange
to remove antibodies or antigens.
Example Usage: In protein purification, dialysis elution is used to remove unwanted
contaminants or salts from protein samples, resulting in a purified protein solution for
downstream applications.
3. Explain I and P1 antigens as being poorly expressed on cord RBCs
 ANSWER:
The I and P1 antigens are blood group antigens that are typically found on the surface of
red blood cells (RBCs) in adult individuals. However, these antigens are known to be
poorly expressed or absent on the RBCs of newborns or cord blood. This phenomenon
is due to the immaturity of the glycosyltransferase enzymes responsible for synthesizing
these antigens during fetal development.
I Antigen:
The I antigen is a precursor antigen in the ABO blood group system. It serves as the
foundation for the production of A, B, and H antigens.
In adult RBCs, the expression of the I antigen is prominent, and it can be further
modified into A, B, or H antigens depending on the individual's ABO blood type.
However, in newborns or cord blood, the expression of the I antigen is typically reduced
or absent due to the immaturity of the enzymes involved in its synthesis.
As a result, newborns often exhibit weaker reactions in ABO blood typing tests
compared to adults.
P1 Antigen:
The P1 antigen is a carbohydrate antigen belonging to the P blood group system. It is
composed of a specific type of glycosphingolipid.
Like the I antigen, the expression of the P1 antigen on RBCs is generally weak or absent
in newborns due to the immaturity of the enzymes responsible for its synthesis.
As a result, P1 antigen typing may not yield reliable results in newborns or cord blood
samples.

4. Describe the phenotypic relationship between LW and Rh

ANSWER:

The phenotypic relationship between LW (Landsteiner-Wiener) and Rh blood group

systems is that they are independent of each other. LW antigens are found on the LW
blood group system, which consists of antigens LWa and LWb. These antigens are
carried on glycophorin A, a protein found on the surface of red blood cells.
On the other hand, the Rh blood group system consists of antigens such as D, C, c, E,
and e, among others. These antigens are encoded by the RHD and RHCE genes
located on chromosome. The presence or absence of Rh antigens determines an
 individual's Rh blood type, such as Rh-positive (presence of D antigen) or Rh-negative
(absence of D antigen).
The LW and Rh blood group systems are inherited independently of each other and are
not genetically linked. Therefore, an individual can have any combination of LW and Rh
blood group antigens. For example, someone could have LWa/LWb antigens and be Rh-
positive (D antigen present), or they could have LWa/LWb antigens and be Rh-negative
(D antigen absent).

5. List the characteristics of the Lewis antibodies, including clinical significance

ANSWER:
Lewis antibodies are often naturally occurring and made by Le(a–b–) persons; that is,
they occur without any known RBC stimulus. They are generally IgM and do not cross
the placenta. Because of this and because the Lewis antigens are not well developed on
fetal RBCs, the antibodies do not cause hemolytic disease of the fetus and newborn
(HDFN).
● Anti-Lea and anti-Leb may occur together and can be neutralized by the Lewis
substances present in plasma or saliva or with commercially prepared Lewis
substance. Lewis antibodies occur quite frequently in the sera of pregnant
women who transiently exhibit the Le(a–b–) phenotype. *
● Anti-Lea is the most commonly encountered of the Lewis antibodies and is often
detected in room temperature tests, but it sometimes reacts at 37°C and in the
indirect antiglobulin test. It is produced by Le(ab-)
● Rare hemolytic transfusion reactions (HTR) have been reported in patients with
anti-Lea who were transfused with Le(a+) RBCs, so anti-Lea that are reactive at
37°C, particularly those that cause in vitro hemolysis, should not be ignored. It is
relatively easy to find Le(a–) units since 80% of the population are secretors.
Persons whose RBCs are Le(a–b+) do not make anti-Lea, because small
amounts of unconverted Lea are present in their plasma and saliva
● . Anti-Leb is not as common or generally as strong as antiLea . It is usually an
IgM agglutinin and can bind complement. Anti-Leb is infrequently made by
Le(a+b– ) individuals and can be classified into two categories: anti-LebH and
anti-LebL .
 ● Anti-LebH reacts best when both the Leb and the H antigens are present on the
RBC, such as group O and A2 cells. Anti-LebH represents an antibody to a
compound antigen.
● Anti-LebL recognizes any Leb antigen regardless of the ABO type. Anti-LebH
should be suspected when anti-Leb is identified with a panel of RBCs (group O)
but most or all group A donor units are crossmatch compatible,
● Lewis antigens are not intrinsic to the RBC membrane and are readily shed from
transfused RBCs within a few days of transfusion. Also, Lewis blood group
substance present in transfused plasma neutralizes Lewis antibodies in the
recipient. This is why it is exceedingly rare for anti-Lea or anti-Leb to cause
hemolysis of transfused RBCs.
● Clinical Significance:
- Hemolytic Disease of the Newborn (HDN): Lewis antibodies can cause
HDN in newborns if maternal antibodies cross the placenta and attack
fetal RBCs expressing incompatible Lewis antigens.
- Transfusion Reactions: Incompatible Lewis antibodies in transfused blood
can lead to hemolytic transfusion reactions, particularly if the recipient
lacks the corresponding Lewis antigens.
- Crossmatching: Detection of Lewis antibodies is important in pre-
transfusion compatibility testing to prevent transfusion reactions.
- Autoimmune Hemolytic Anemia: Rarely, Lewis antibodies can be
implicated in autoimmune hemolytic anemia, where the body's immune
system attacks its own RBCs.

6. Define the relationship of autoanti-I with Mycoplasma pneumoniae infections and

autoanti-i with infectious mononucleosis.

ANSWER:
Mycoplasma pneumoniae infections are associated with the production of autoanti-I
antibodies, leading to cold agglutination and hemolytic anemia in CAD. Infectious
mononucleosis caused by EBV is associated with the production of autoanti-i antibodies,
resulting in cold agglutinins and transient hemolytic anemia. Understanding these
relationships is crucial for diagnosing and managing hemolytic conditions associated
with specific infections.
7. Identify which antigens are expressed on placental tissue and the role that plays in
HDFN.
ANSWER:
Placental tissue expresses both the A and B antigens of the ABO blood group system
and the Rh D antigen of the Rh blood group system. This expression is crucial for
maintaining the integrity of the placental barrier and facilitating nutrient and waste
exchange between the mother and fetus during pregnancy.
In the context of hemolytic disease of the newborn (HDFN), the presence of these
antigens on placental tissue can lead to maternal-fetal blood group incompatibility. If the
mother is sensitized to fetal blood group antigens that differ from her own, such as ABO
or Rh antigens, she may produce antibodies against these antigens.
During subsequent pregnancies, these maternal antibodies can cross the placenta and
attack fetal red blood cells (RBCs) expressing the corresponding antigens, leading to
hemolysis and HDFN. This can result in severe anemia, jaundice, kernicterus, and even
fetal death if left untreated.
Rh D incompatibility is particularly significant in HDFN, as anti-D antibodies produced by
Rh-negative mothers can cross the placenta and cause hemolysis in Rh-positive
fetuses. This can be prevented with the administration of Rh immunoglobulin (RhIg) to
Rh-negative mothers to prevent sensitization to Rh D antigen during pregnancy and
childbirth.
8. Explain the principles behind enzyme and neutralization techniques.
ANSWER:
Enzyme techniques utilize proteolytic enzymes to uncover hidden blood group antigens
on red blood cells (RBCs), enhancing their detection. Neutralization techniques involve
mixing known antibodies with patient serum to neutralize corresponding antigens, aiding
in identifying antibody specificities. Both methods are vital for accurate blood typing and
antibody identification in transfusion medicine.

9. Describe the procedure for a whole blood donation, including arm preparation, blood
collection, and postphlebotomy care instructions for the donor.

ANSWER:
Here's a step-by-step description of the procedure for a whole blood donation, along with
arm preparation, blood collection, and post-phlebotomy care instructions for the donor:

● Arm Preparation:
The donor is seated comfortably in a donation chair.
The phlebotomist cleans the donor's arm, typically in the area of the antecubital fossa,
with an antiseptic solution to disinfect the skin.
A tourniquet is applied to the upper arm to make the veins more visible and accessible.
● Blood Collection:
The phlebotomist selects a suitable vein, often the median cubital vein, and inserts a
sterile needle connected to a blood collection bag into the vein.
Blood flows from the donor's arm into the collection bag through the needle.
The bag may contain anticoagulants to prevent clotting and preservatives to maintain the
integrity of the blood components.
● Post-Phlebotomy Care Instructions:
After blood donation is complete, the needle is removed, and pressure is applied to the
venipuncture site to stop any bleeding.
A bandage or adhesive strip is placed over the puncture site to protect it.
The donor is encouraged to rest for a few minutes and drink fluids to help replenish
blood volume.
Donors are advised to avoid heavy lifting or strenuous activity with the donation arm for
the next few hours to prevent bruising or discomfort.
Refreshments are typically provided to donors to help restore energy levels.
● Monitoring and Follow-up:
Donors are monitored for any signs of adverse reactions, such as dizziness, fainting, or
excessive bleeding, and appropriate care is provided if needed.
Donors may be advised to contact the donation center if they experience any delayed
reactions or complications after leaving the facility.
Follow-up communication may be conducted to ensure donors' well-being and
encourage future donations.

By following these procedures and providing appropriate care instructions, blood

donation centers aim to ensure the safety and comfort of donors throughout the donation
process.
 10. Describe the various factors that influence the development of alloimmunization to RBC
antigens

ANSWER:

Several factors can influence the development of alloimmunization to red blood cell (RBC)
antigens, leading to the production of antibodies against non-self RBC antigens. Here are some
of the key factors:

● Transfusion History: Previous exposure to foreign RBC antigens through blood

transfusions is a significant risk factor for alloimmunization. Repeated transfusions
increase the likelihood of developing antibodies against mismatched antigens.
● Pregnancy and Childbirth: Pregnancy, particularly in Rh-negative mothers carrying Rh-
positive fetuses, can lead to sensitization to Rh antigens. Maternal exposure to fetal
RBC antigens during childbirth or fetal-maternal hemorrhage can trigger antibody
production.
● Transplantation: Solid organ and hematopoietic stem cell transplantation can introduce
foreign RBC antigens to the recipient's immune system, potentially leading to
alloimmunization.
● Immune Status: Individuals with compromised immune systems, such as those with
autoimmune disorders, malignancies, or receiving immunosuppressive therapy, may
have altered immune responses to RBC antigens, increasing the risk of
alloimmunization.
● Genetic Factors: Genetic predisposition may influence an individual's propensity to
develop alloantibodies. Certain genetic polymorphisms in genes encoding RBC antigens
or immune response pathways may affect antibody production.
● Inflammatory Conditions: Chronic inflammatory conditions, such as autoimmune
diseases, infections, or inflammatory bowel disease, can stimulate immune responses
and increase the likelihood of alloimmunization.
● Blood Group Antigen Diversity: Variability in the antigenic diversity of RBC antigens
across populations can influence the likelihood of encountering mismatched antigens
and developing alloantibodies.
● Age: Alloimmunization is more common in pediatric populations, particularly in
chronically transfused children with conditions like sickle cell disease or thalassemia,
due to increased exposure to foreign antigens.
● Immune Response to Minor Antigens: While major blood group antigens (e.g., ABO and
Rh) are most commonly associated with alloimmunization, antibodies against minor
antigens, such as Kell, Duffy, and Kidd, can also develop, especially in individuals with
multiple transfusions.

Understanding these factors is crucial for risk assessment, donor selection, and transfusion
management strategies to minimize the risk of alloimmunization and prevent adverse
transfusion reactions in clinical practice.