MLSC 4063: Advanced Immunohematology. Name. Module 2 Assignment

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1 Name Module 2 Assignment Instructions: Answer the following questions. Follow the guidelines in the course syllabus for proper submission of your document. All references, including course materials, must be cited using APA guidelines at the end of the document. If the answer was found in course materials, a citation is required. If a direct quote is used, the reference should be cited using APA style. Failure to follow the citation directions will result in a deduction of 10% of the possible assignment points. Grading: A total of 32 points will be converted by ratio 20 points for this assignment. Due Date: Thursday, October 6 th at 11:55 PM (EST) Rh Phenotype Vial # D C c E e f C w K k Kp a Kp b Js a Js b Fy a Fy b Jk a Jk b Le a Le b P1 M N S s Lu a Lu b Xg a Other R z R R 1 R R 2 R R r r r r rr rr Co(b+) rr rr R 1 r I Patient s Cell PC 1. Referring to the panel sheet above, answer the following: 1 point each a e a. What do the (+) and (0) signs in the column below the antigen symbol mean? b. Which cell(s) have a double dose (homozygous) of the E antigen? Page 1 of 6

2 c. Which cell(s) have a double dose (homozygous) of the Fy b antigen? d. Which cell(s) have a single dose (heterozygous) of the Jk a antigen? e. Which cell(s) have a single dose (heterozygous) of the S antigen? 2. Anti M is an antibody that is known to express dosage. Explain the term dosage and describe how this antibody is expected to react? 2 points 3. Why don t Lewis antibodies express dosage? 1 point 3. What is the difference between an autocontrol and a direct antiglobulin test (DAT)? 1 point 4. Name two technical errors that can results in an ABO discrepancy. 2 points 5. What is the difference between the acquired B antigen and the B(A) phenotype? 1 point 6. The ABO type of antibody screen and antibody panel cells is type O? Why? 1 point Page 2 of 6

3 Case Study 1: Patient ABO/Rh type: A, Rh pos Rh Phenotype D C c E e f K k Fy a Fy b Jk a Jk b Le a Le b P1 M N S s Other Patient Results LISS IS IgG R 1 R R 1 R R 2 R R r r r r rr rr rr rr R 2 R Patient s Cell PC Evaluate each of the nonreactive reagent panel cells individually. List all antibody specificities that can be ruled out with each of the following reagent red cells: (4 points) Cell 1: Cell 3: Cell 6: Cell 8: 2. What antibody specificity (ies) is not ruled out? (1 point) 3. What is the most likely antibody specificity(ies) in this patient s serum and why? (1 point) Page 3 of 6

4 Case Study 2: A 25 year old obstetric patient s sample was referred to the hospital for antibody identification. One of the antibody screening cells was weakly positive using LISS enhancement. A panel was tested; results are shown below: Rh MNSs P1 Lewis Lutheran Kell Duffy Kidd LISS Cell D C E c e f C W M N S s P1 Le a Le b Lu a Lu b K k Fy a Fy b Jk a Jk b IS 37 AHG 1 R1R1 (51) R1R1 (32) R2R2 (64) r r (75) rr (87) rr (98) rr (76) rr (53) rr (23) R1R1 (34) Patient Cells During which phase are the reactions the strongest? 1 point 2. What does the phase suggest about the immunoglobulin class of this antibody? 1 point Page 4 of 6

5 3. Is this an alloantibody or autoantibody? 1 point 4. Could this antibody cross the placenta? 1 point 5. What is the most likely identity of the antibody demonstrating? 1 point 6. If the panel cells were treated with enzymes and testing was repeated, what would be the expected reactions? 1 point 7. Is this antibody usually clinically significant? Define clinically significant. 1 point Case Study 3: RT, a 37 year old woman, is a first time donor at your blood center. She is a healthy donor, has an unremarkable medical history, and is not taking any medications. Initial ABO phenotyping results indicate an ABO discrepancy. ABO Testing Results Donor Red Cells with Donor Serum with Reagent Red Cells Anti A Anti B A 1 B Evaluate the ABO phenotyping results. Is the discrepancy associated with the red cell testing or the serum testing? State the reasons for this selection. 2 points Page 5 of 6

6 2. How would you classify the category of ABO discrepancy shown in this problem? 1 point 3. What are the potential causes of an ABO discrepancy in this category? 1 point Additional Testing No technical errors were found. The donor s red cells were washed, and the ABO phenotyping was repeated. Red cell testing results were identical to the first set. Testing with anti A 1 lectin showed a 3+ reaction. In addition to A 1 and B reagent red cells, commercial screening cells and an autologous control were tested with the donor s serum. The results of the testing are depicted in the following table. Additional Testing Results Donor s Serum Testing with A 1 Red Cells B Red Cells Screening Cells Autologous Red Cells What conclusions can be drawn from the results of additional serum testing? 1 point 5. What additional steps are required to resolve this ABO discrepancy? 1 point Page 6 of 6