WPC LCekŸdqHωz  0 @X<<<<@ExLLx d'dxd Level 1 Level 2 Level 3 Level 4 Level 5(2$ Mn! I(43O   ($     (2$ Mn! I(43O   ! C<< c l !"C I $#OC   @XX$ @@ NonProfitOrg.  @PP U.S.Postage@ PAID@uu Permit2757  @EE Austin,Texas.D4A`ArialTTP,BoardBoard of TrusteesC$.D4A`ArialTTC BoardofTrustees -&.D4`-Dr.BruceM.Murray,ChairmanDellaMayMoore,ViceChairmanRooseveltLeaks,SecretaryJanAlbersPeteFosterLindaGrayMackRayHernandezLawrenceE.JenkinsMurrayShawDr.DanAngel,President.D4`T}0HeadingFancy ACC Heading    xxxW(64 *Times New RomanTTW@.. AustinCommunityCollege  6)'Fd66)'Fd66)'t"Fd664 *Times New RomanTTP:FTFA MinutesFirst Pages%Xf$ hN p x (#%'0*,.8135@8:<H?AXX8(1Xdd8  @  FULLTIMEFACULTYASSOCIATION  @+Minutes   +  ,'C I $#OC   (1XXXs%Xf$ hN p x (#%'0*,.8135@8:<H?AX J(# Minutes   ?)' xdEx?(2$ Mn! I(43O   ^>8ACC AddressACC Return AddressAustinCommunityCollegeP.O.Box140526Austin,Texas78714dC,EqualEqual Opportunity Statement@.. ACCisanequalopportunityinstitution. N24 labels4 line labels ,  , ,       \RA'*ty CollegeInternal Audit Department\ X X '  &10. Delayed Transfusion Reaction 2lab10 (Carolyn Ragland 0 .  ~Crossmatch; Task; To perform complete crossmatch procedure. ; Aim; To perform with 100% accuracy a patient's ABO and Rh type, donor typing, antibody screen, and crossmatch procedure. ; Introduction; Blood bank personnel are responsible for providing serologically compatible blood within an appropriate time frame.R& 8BibliogrphyBibliography0....fE2Doc InitInitialize Document Style3( 7   (456($0 ($0 0 (($0 0 0   A_ekqwDocumentDocument StyleI.1.A.a.(1)(a)i)a)jD4Tech InitInitialize Technical Style( 9 ( CuyTechnicalTechnical Document Style11.11.1.11.1.1.11.1.1.1.11.1.1.1.1.11.1.1.1.1.1.11.1.1.1.1.1.1.1x?;u2PleadingHeader for numbered pleading paper ;  <(C I $#OC   (1XXXXX?)'*dE*??)'*dE*?\\1\\2\\3\\4\\5\\6\\7\\8\\910111213141516171819202122232425262728  .+(2$ Mn! I(43O     ,' I(4$I   _HH>XXXX EXERCISE11:$LaboratoryProcedureManual  X ?)'  xdEH9H!?'6X'A`"Sans Serif PS :_ @ I(4$I   ?)' XxdEWx? X HH0?g>XXXX>ɓX>XDelayedTransfusionReactionF$>&)%>ɓ_MLAB_Ԁ2431  114  #>ɓ%>&)# (2$ Mn! I(43O   'dxd Level 1 Level 2 Level 3 Level 4 Level 5($     BCAA<< cWPC(e42TZ5139Èw "4z J> *!6L0LTvP O, \AZ"Arial RegularOWWW        @@..AUTOCONTROL *"6L0LTv w O, \AZ"Arial RegularOWWW        @@..4Positive *#6L0LTvW  O, \AZ"Arial RegularOWWW        @@..Negative+ $n3n& %] 3] & &n> K ' K] >+ *(6L0LTvW M c O, \AZ"Arial RegularOWWW        @@..Nothingmore *)6L0LTvC JO, \AZ"Arial RegularOWWW        @@..PerformDAT@..(onEDTASpecimen@..ifavailable) **6L0LTvO, \AZ"Arial RegularOWWW        @@..4Positive *+6L0LTvZ O, \AZ"Arial RegularOWWW        @@..Negative+ ,WW  -  + *.6L0LTv2 O, \AZ"Arial RegularOWWW        @@..Nothingmore */6L0LTv2O, \AZ"Arial RegularOWWW        @@..Performelution *06L0LTvZx%O, \AZ"Arial RegularOWWW        @@b..ITesteluate@b..againstpanel+ 1T Tz  2n]W 3] + "B; G *56L0LTv S O, \AZ"Arial RegularOaaa        @@..ANTIBODYSCREEN *66L0LTv  ' O, \AZ"Arial RegularOaaa        @@ ..APositive *76L0LTv  O, \AZ"Arial RegularOaaa        @@..Negative+ 8 9   :1oF ;F 1+ *<6L0LTv nN 'O, \AZ"Arial RegularOaaa        @@S..Performpanel@S..andinterpret *=6L0LTvl 'N O, \AZ"Arial RegularOaaa        @@ ..Nothingmore *>6L0LTv PO, \AZ"Arial RegularOaaa        @@..Testpatientand@..sdonorswith@..appropriateantisera+ *?6L0LTvz w"O, \AZ"Arial RegularOaaa        @  Giveantigennegativecrossmatchcompatibleblood @<& AC  + *C6L0Lv 8! O, \AZ"Arial RegularOttt        @@*..tCROSSMATCH *D6L0LvY= e O, \AZ"Arial RegularOttt        @@..Incompatible *E6L0Lv8F D#' O, \AZ"Arial RegularOttt        @@..Compatible *F6L0LvgL ^O, \AZ"Arial RegularOttt        @@..Ifscreens@..;arenegative,@..:performDAT@..onunit *G6L0LvZ#  $O, \AZ"Arial RegularOttt        @@..Ifscreens@..arepositive *H6L0Lv8&$d VO, \AZ"Arial RegularOttt        @@v..Antigentypeif@v..8necessary,otherwise@v..nothingmore *I6L0Lv=O, \AZ"Arial RegularOttt        @@*..PositiveDAT *J6L0LvO, \AZ"Arial RegularOttt        @@..NegativeDAT *K6L0Lv*'O, \AZ"Arial RegularOttt        @@..-Returnunitto@..Kbloodcenter *L6L0Lv'O, \AZ"Arial RegularOttt        @@v..Performpanel@v..andinterpret *M6L0LvO_O, \AZ"Arial RegularOttt        @@..0Testpatientand@..idonorswithappropriate@..antisera(ifavailable)+"N'>#y"O)>+y"PL+bL+:"Q6#OI!"R#O&&"SRRc "T # # "U # # + *V6L0Lvc O, \AZ"Arial RegularO        @@i ..ANTIBODYIDENTIFICATIONFLOWCHART+"W&x& C& "Xn ~"Y ~X#E^FLOWCHAR.DPG l_Printfile_Antigen.frm_ԀfromMLTMiscdisketteforthispage.G$35;AGMU]c1I.A.1.a.(1)(a)i)a)  CRight ParRight-Aligned Paragraph NumbersI.A.1.a.(1)(a)i)a)3|n'\  `Roman PSXn\  Ps: XP.D4A`ArialTTRD4PkCP.D4A`ArialTT[D4PkCP.D4`lTT|ID4PkCP64 *Times New RomanTTxx/4 pTCxp'6X'A`"Sans Serif PSTTXn6XPT} XP(On$C I $#OC  3#37=CIQYag1.a.i.(1)(a)(i)1)a) v.5xU1, 2, 3,Level 1Level 2Level 3Level 4Level 54#>2Quick 1.T  .0 T34 `(Times NewRomanTT(9 Z 6Times New Roman Regularhp LaserJet 1300 PCL 5e,,,,0e0 Oi)9j3CIOU[agmNumbers1.1.1.1.1.1.1.1.[1.(;$2j  0  .3  0  WPWin 6.0/OLE 1.0 Prefix Information MarkerPresentations.Drawing.11Xࡱ>   !"#$%&'()*Root EntryCY@r6DXK(j @Ole WPG20(CompObj}onitorC:\WINDOWS\Syst CY@r6DXK(Corel Presentations 11 Drawing Embed SourcePresentations.Drawing.119ql32X86\3\UNIDRVUI.DLLCX_dDOWS\System32\spool\DRIVERS\W32X86\3\HPC13005.GPDC:\WINDOWS\System32\spool\DRIVERS\W32X86\3\UNIDRV.DLLWindows NT x86hp LWPC(e42TZ5139Èw "4z J> *!6L0LTvP O, \AZ"Arial RegularOWWW        @@..AUTOCONTROL *"6L0LTv w O, \AZ"Arial RegularOWWW        @@..4Positive *#6L0LTvW  O, \AZ"Arial RegularOWWW        @@..Negative+ $n3n& %] 3] & &n> K ' K] >+ *(6L0LTvW M c O, \AZ"Arial RegularOWWW        @@..Nothingmore *)6L0LTvC JO, \AZ"Arial RegularOWWW        @@..PerformDAT@..(onEDTASpecimen@..ifavailable) **6L0LTvO, \AZ"Arial RegularOWWW        @@..4Positive *+6L0LTvZ O, \AZ"Arial RegularOWWW        @@..Negative+ ,WW  -  + *.6L0LTv2 O, \AZ"Arial RegularOWWW        @@..Nothingmore */6L0LTv2O, \AZ"Arial RegularOWWW        @@..Performelution *06L0LTvZx%O, \AZ"Arial RegularOWWW        @@b..ITesteluate@b..againstpanel+ 1T Tz  2n]W 3] + "B; G *56L0LTv S O, \AZ"Arial RegularOaaa        @@..ANTIBODYSCREEN *66L0LTv  ' O, \AZ"Arial RegularOaaa        @@ ..APositive *76L0LTv  O, \AZ"Arial RegularOaaa        @@..Negative+ 8 9   :1oF ;F 1+ *<6L0LTv nN 'O, \AZ"Arial RegularOaaa        @@S..Performpanel@S..andinterpret *=6L0LTvl 'N O, \AZ"Arial RegularOaaa        @@ ..Nothingmore *>6L0LTv PO, \AZ"Arial RegularOaaa        @@..Testpatientand@..sdonorswith@..appropriateantisera+ *?6L0LTvz w"O, \AZ"Arial RegularOaaa        @  Giveantigennegativecrossmatchcompatibleblood @<& AC  + *C6L0Lv 8! O, \AZ"Arial RegularOttt        @@*..tCROSSMATCH *D6L0LvY= e O, \AZ"Arial RegularOttt        @@..Incompatible *E6L0Lv8F D#' O, \AZ"Arial RegularOttt        @@..Compatible *F6L0LvgL ^O, \AZ"Arial RegularOttt        @@..Ifscreens@..;arenegative,@..:performDAT@..onunit *G6L0LvZ#  $O, \AZ"Arial RegularOttt        @@..Ifscreens@..arepositive *H6L0Lv8&$d VO, \AZ"Arial RegularOttt        @@v..Antigentypeif@v..8necessary,otherwise@v..nothingmore *I6L0Lv=O, \AZ"Arial RegularOttt        @@*..PositiveDAT *J6L0LvO, \AZ"Arial RegularOttt        @@..NegativeDAT *K6L0Lv*'O, \AZ"Arial RegularOttt        @@..-Returnunitto@..Kbloodcenter *L6L0Lv'O, \AZ"Arial RegularOttt        @@v..Performpanel@v..andinterpret *M6L0LvO_O, \AZ"Arial RegularOttt        @@..0Testpatientand@..idonorswithappropriate@..antisera(ifavailable)+"N'>#y"O)>+y"PL+bL+:"Q6#OI!"R#O&&"SRRc "T # # "U # # + *V6L0Lvc O, \AZ"Arial RegularO        @@i ..ANTIBODYIDENTIFICATIONFLOWCHART+"W&x& C& "Xn ~"Y ~X#4Pd?TERRY_KOTRLABOlePartOlePres000!WPGExtents n:>! :  :n   82"Arialw@U 4ww w0-- .  "System !w--2 f AUTOCONTROL  fS-- .  --2 Positive-- .  --2 JNegative x-  --  -^^-  -n-  -n,^-- .  --2 B Nothing more  -- .  --2 Perform DATe  --!2 (on EDTA Specimen  --2 if available)-- .  --2 Positive-- .  --2 Negative 1-  - !-  - !-- .  --2 / Nothing more  /A-- .  --2 /Perform elutione /-- .  --2 Z Test eluateeZ--2 f against panelf-  -7L-  --  --"Arialw@i ww w0-- .  --2 fANTIBODY SCREEN    fb-- .  --2 Positive-- .  --2 NNegative ~-  --  -bb-  -o-  -o.b-- .  --2  Perform panel  --2  and interpret-- .  --2 E Nothing more  -- .  --2 Test patient and--2  donors withe --%2 appropriate antisera"-- .  --2 R Give antigen R--$2 _negative crossmatcha _--2 lcompatible blood l-  --  -'E-"Arialw@ ww w0-- .  --2 h_ CROSSMATCH   h-- .  --2  Incompatible O-- .  --2  Compatible  -- .  --2  If screens--2  are negative,--2  perform DATe  --2 on unit-- .  --2 > If screens ez--2 < are positive}-- .  --2  Antigen type "Arialw@ :ww w0-"Arialw@ 3ww w0--- 2 if---%2 necessary, otherwise --2  nothing more -- .  --2  Positive DAT  -- .  --2  Negative DAT  G-- .  --2 3Return unit to 3--2 @ blood center@-- .  --2 / Perform panel  /K--2 < and interpret<G-- .  --2 mTest patient andmU--*2 {donors with appropriate {j--*2 antisera (if available)b-  -o}.-  -o-  --  --  -.e-  - %-  - !-  -H`-"Arialw@ ww w0-- .  --:2 4M"ANTIBODY IDENTIFICATION FLOW CHART 4L-  - %ff5\5-  --  - -NANI METAFILEPICTnfF!n: :  :n   82"Arialw@U 4ww w0-- .  "System !w--2 f AUTOCONTROL  fS-- .  --2 Positive-- .  --2 JNegative x-  --  -^^-  -n-  -n,^-- .  --2 B Nothing more  -- .  --2 Perform DATe  --!2 (on EDTA Specimen  --2 if available)-- .  --2 Positive-- .  --2 Negative 1-  - !-  - !-- .  --2 / Nothing more  /A-- .  --2 /Perform elutione /-- .  --2 Z Test eluateeZ--2 f against panelf-  -7L-  --  --"Arialw@i ww w0-- .  --2 fANTIBODY SCREEN    fb-- .  --2 Positive-- .  --2 NNegative ~-  --  -bb-  -o-  -o.b-- .  --2  Perform panel  --2  and interpret-- .  --2 E Nothing more  -- .  --2 Test patient and--2  donors withe --%2 appropriate antisera"-- .  --2 R Give antigen R--$2 _negative crossmatcha _--2 lcompatible blood l-  --  -'E-"Arialw@ ww w0-- .  --2 h_ CROSSMATCH   h-- .  --2  Incompatible O-- .  --2  Compatible  -- .  --2  If screens--2  are negative,--2  perform DATe  --2 on unit-- .  --2 > If screens ez--2 < are positive}-- .  --2  Antigen type "Arialw@ :ww w0-"Arialw@ 3ww w0--- 2 if---%2 necessary, otherwise --2  nothing more -- .  --2  Positive DAT  -- .  --2  Negative DAT  G-- .  --2 3Return unit to 3--2 @ blood center@-- .  --2 / Perform panel  /K--2 < and interpret<G-- .  --2 mTest patient andmU--*2 {donors with appropriate {j--*2 antisera (if available)b-  -o}.-  -o-  --  --  -.e-  - %-  - !-  -H`-"Arialw@ ww w0-- .  --:2 4M"ANTIBODY IDENTIFICATION FLOW CHART 4L-  - %ff5\5-  --  - -(cf$0  0` (#(#2j  0  .3  0 ` (#` (# Mn! I(43O   _HHr  X,=_?_L0X~ \ X0 8HXXdd8Exercise110 > DelayedTransfusionReaction I> $> $ L_Textbook:_Ԁ_Quinley_,Chapter13  Skills:40  Objectives: y  [(j94I"]"  ]2j  1  .3  0    Compareandcontrastahemolytictransfusionreactionduetoaprimaryandsecondaryimmuneresponse  Q including:timeframeofantibodyproduction,antibodyclassinvolvedandclinicalpicture.]݌ =$$ Ќ  "]"  ]!2j  2  .3  0    Statethesourceofantibody,specificallywhatcellsantibodywasattachedto,inaneluatepreparedfrom r )  arecentlytransfusedpatientwhoisundergoingadelayedhemolytictransfusionreaction.]!N݌^  $$ Ќ  "]"  ]2j  3  .3  0    StatetheserologicalreasonforobtainingamixfieldagglutinationreactioninaDATperformedona J  recentlytransfusedpatientwhoisundergoingadelayedhemolytictransfusionreaction.]݌6 $$ Ќ  "]"  ]\2j  4  .3  0    Illustratetheserologicalpictureofapatientundergoingaresponsetotransfuseddonorcellsasfollows: "  initialantibodyscreenand_crossmatch_,resultsofantibodyscreenandDATweeksandmonthslater.]\݌ $$ Ќ  "]"  ]( 2j  5  .3  0    Giventheresultswhichillustrateadelayedhemolytictransfusionreactioncorrectlyinterpretandexplain  allfinding.]( U ݌$$ Ќ  "]"  ]} 2j  6  .3  0    Performandinterpretalltestingassociatedwithadelayedhemolytictransfusionreaction_workup_Ԁincluding  rationaleforeachresultobtained.]} ݌u$$ Ќ  Introduction  M Thetransfusionofbloodisusuallyaverysafe,effectivewaytocorrectsymptomaticanemia.Sometimes n% unforeseenreactionscanoccureitherduringthetransfusion,shortlyaftertransfusion,orweeksaftertransfusion. Z  Principle  2 Thebloodbankmayberesponsibleforthediagnosisofdelayedhemolytictransfusionreactions.Thesemaybe   oftwotypes.  1.0  Theinitialantibodyscreenisnegativeandtheunitsappearcompatible.Thepatientistransfusedand  undergoesaprimaryimmuneresponsetothetransfusedredcells.Theantibodymaytakeseveralweeks  q ormonthstoachievealevelthatcanbedetectedintheantibodyscreen.Theinitialantibodyclass !]  producedis_IgM_,andpositiveresultsmaybeseenontheISphaseportionofthe_crossmatch_.Asthe "I! immuneresponsecontinuesthe_IgM_Ԁproductiondiminishesandthereisadramaticincreasein_IgG_.Due ~#5 " tothefactthatthisisaprimaryresponse,whichtakesawhiletogetgoing,thereisusuallynoclinical j$!!# evidenceofhemolysis.Thedonorcellsareslowlycoatedandslowlyremovedfromthebody.Once V% "$ produced,theantibodymaybedetectableforthelifeofthepatient,oritmayfallbelowthelevelof B&"% _detectability_..'#&$$ 2.0  Thesecondtypeofreactionisduetoananamnesticresponse.Theantibodyproducedinresponseto )%( previoustransfusionorpregnancymayfallbelowthelevelof_detectability_.Theantibodyscreenwill )&) appearnegativeandtheunitsappearcompatible,butwithindaysorsometimesweeksafterthetransfusion *'* thesecondaryimmuneresponseproducesmassivequantitiesof_IgG_Ԁantibody.Thelargequantitiesof +(+ antibodyalongwiththepresenceoflargequantitiesoftransfusedcellspresentinthepatient'scirculation ,m), mayresultinsymptomsofhemolysis,i.e.,jaundice,decreaseinhemoglobin,increased_reticulocyte_Ԁcount, -Y*- decreased_haptoglobin_,etc.Ifmorebloodisorderedintheappropriatetimeframethepatientwillhave .E+. apositiveDATduetoantibodycoateddonorcellsinthecirculationandapositiveantibodyscreen.z/1,/$$ ЇOnceanantibodyisidentifiedinapatientsserumthepatientisantigentypedtoconfirmthattheyarenegative I fortheantigen.Antigentypingcannotbeperformedonrecentlytransfusedpatients.Theirsamplenotonly 5 containstheirownredbloodcells,buttheredbloodcellsofeverydonortheyweretransfusedwith.Cell ! separationtechniquesareavailablewhichcanbeusedtoseparatepatientcellsfromtransfusedcell.Once   separatedantigentypingcanbeperformed.   Reagents   t 1.0  Seepage1 L $$ 2.0  Gamma_Elu_ԀKit  8 $$  Procedure  Y  U>  U>rT1  .0    Performa2unit_crossmatch_Ԁonthepatientsample.Usethepatientandpanelformstorecordyourresults.U>rTی1 $$ Ќ  U>  U>T2  .0    Followtheflowchartonthenextpagetodetermineadditionaltestingtoperform.U>Tی $$ Ќ  U>  U>T3  .0    Usethe InterpretationofResultssheettoexplainyourfindings.Ifyouhaveanyproblemsmakean  appointmentwiththeinstructor.Theinterpretationofresultsisamajorportionofthislabgrade.U>Tی$$ Ќ   p ЇDFcSOz|A ,`e4Z@ H@Ev ,_ Uv ,  ! _H<_x^X$` hp x (#%'0*,.8135@8:<H?AX~Jx@PP* Procedure I< @CC&Gamma_Elu_ԄKitII   Thereare2stepstothisprocedure:   TU>  U>!T1  .0    Preparingtheeluate.U>!!Tی$$ Ќ  U>  U>"T2  .0    Testingtheeluate.U>""Tی$$ Ќ  Followtheinstructionsverycarefully.    PreparingtheEluate  } p  "_f"  _f#0  00$$2j  1  .3  00$0$  0P $$Spin_EDTA_Ԁtubeforthree(3)minutes.Placesupernatantplasmainproperlylabeled t  tube._f#$݌m`P $P $ Ќ  "_f"  _ft%0  00$$2j  2  .3  00$0$  0P $$Place20largedropsof_EDTA_Ԁpackedcellsintotheoriginal_EDTA_Ԁcellsuspensiontube E8 usedfortheDATprocedure.Labelanothertubewithpatientsnameand LastWash, 1$ forthelastwashcontrol._ft%%݌P $P $ Ќ  "_f"  _f'0  00$$2j  3  .3  00$0$  0P $$Washthecellsonetimewithsaline, DONOTdecant ,usea_pipet_Ԁtoremovethe  supernatantsaline.Washanadditionalfourtimeswiththeworkingwashsolutionto  removeallunboundantibodyusinga_pipet_Ԁeachtimetoremoveanddiscardthe  supernatantsaline.* Reserveasmallaliquotofthe_supernate_Ԁfromthefinalwashto  serveasacontrol. _f''݌P $P $ Ќ  "_f"  _f*0  00$$2j  4  .3  00$0$  0P $$Add20drops(1ml)of_Eluting_ԀSolutiontothewashedredbloodcells,_parafilm_Ԁthetop yl andmix GENTLY byinvertingthetubefourtimes.Centrifuge immediately for60 eX secondsat3400rpms. NOTE :Prolongedimmersionofthecellsin_Eluting_ԀSolution UH causeshemolysis.TheconsequentreleaseofhemoglobinintotheeluatealtersthepH E8 andmayaffectthevolumeofBufferingSolutionrequiredtoadjustthepHoftheeluate 1$ toneutral._f*+݌ P $P $ Ќ  "_f"  _fv.0  00$$2j  5  .3  00$0$  0P $$Transferthesupernatanteluate(thefluidabovetheredcelllayer)intoaclean,properly  " labeledtesttube.Discardtheredcells._fv..݌! #P $P $ Ќ  "_f"  _f00  00$$2j  6  .3  00$0$  0P $$Totheseparatedacideluate,add20drops(1ml)ofBufferingSolution. NOTE: The #"% presenceofablueindicatorintheBufferingSolutionprovidesameanstodeterminethat $#& theeluatehasbeenadjustedtowithintherequiredpHrangefortesting(6.47.6).When %$' BufferingSolutionisfirstaddedtoafreshlypreparedeluate,itwillbenotedtoturn &t%( yellowoncontactwiththeacidsolution.AsthevolumeofBufferingSolution m'`&) approachestheoriginalvolumeofeluate,however,thecolorchangestoapaleblue.This Y(L'* persistsuponmixingifthepHoftheeluatehasbeenadjustedtowithinthedesiredrange. E)8(+ ThevolumeofBufferingS_olution_Ԁrequiredforthispurposemayvarywithdifferent 1*$), _eluates_,dependingonanumberoffactors.Ifthecoloroftheeluateremainsyellow +*- afteradding20dropsofBufferingSolution,continuetoaddBufferingSolution,one  ,*. dropatatime,untilapalebluecolorpersistsuponmixing._f0C0݌,+/P $P $    -,0 "_f"  _f50  00$$2j  7  .3  00$0$  0P $$Mixwellandcentrifugetoremoveanyprecipitateorcellulardebris,thentransfereluate I  toaclean,properlylabeledtesttube._f56݌5P $P $ Ќ  _______ Testing_ԀtheEluate    / /"_f"  _f{80  00$$2j  1  .3  00$0$  0P $$Label11tubesfortestingeluatewithpanelcells111,andthree(3)additionaltubesfor  testingthelastwashcontrol(LW)withthe3screencells._f{88݌P $P $ Ќ  "_f"  _f,:0  00$$2j  2  .3  00$0$  0P $$Placeonedropofthepanelcell(foreluate)andscreencell(forLW)tobetestedinits   appropriatelylabeledtube._f,:Y:݌ x P $P $ Ќ  "_f"  _f;0  00$$2j  3  .3  00$0$  0P $$Addasmallvolume(approximately10drops)ofsalinetoeachtube.Mixwelland  P  centrifugefor30seconds.Decantcompletelyandblotthetubesdry._f;;݌< P $P $ Ќ  "_f"  _fm=0  00$$2j  4  .3  00$0$  0P $$Addthree(3)dropsofeluatetoeachtubeofpanelcells.Addthree(3)dropsoflastwash ]  toeachtubeofscreencells._fm==݌IP $P $ Ќ  "_f"  _f?0  00$$2j  5  .3  00$0$  0P $$Mixthecontentsofalltubesthoroughlyandincubateat37$Cfor15minutes._f?.?݌!P $P $ Ќ  Readthefollowingcarefully!   "_f"  _f@0  00$$2j  6  .3  00$0$  0P $$Afterappropriateincubation,addten(10)dropsoftheworkingWashSolutiontothe  tubeandmixwell._f@@݌tP $P $ Ќ  "_f"  _fB0  00$$2j  7  .3  00$0$  0P $$Centrifugefor30seconds.DecanttheworkingWashSolutioncompletelyandblotthe L tubesdry._fB>B݌8P $P $ Ќ     0    P     X      `   "_f"  _fD0  00$$2j  8  .3  00$0$  0P $$ Withoutfurtherwashing ,addtwo(2)dropsofantihumanglobulinserumtoeachtube Y andmixwell._fD;D݌EP $P $ Ќ  "_f"  _fE0  00$$2j  9  .3  00$0$  0P $$Centrifugeimmediatelyfor15seconds.Resuspendthecellsbygentleshaking,readfor  agglutination(macroandmicroscopically)andrecordtestresults._fEE݌ P $P $ Ќ  "_f "  _fKG0  00$$2j  10  .3  00$0$  0P $$Addone(1)dropof_Coombs_ԀControlCellstoallnegativetubes.Mixandcentrifuge. !! Agglutinationmustbeobtainedortestmustberepeated._fKGxG݌""P $P $ Ќ  NOTE:Readreagentpackageinsertforprincipleandlimitationsoftheprocedure. $\!$  Reference  i' $' /  /"_f"  _fI0  00$$2j  1  .3  00$0$  0P $$Gamma_Elu_ԄKitIIreagentpackageinsert,1190revision._fIJ݌m)$&)P $P $ Ќ   Y*'* _? XT8| pX$` X?0$Name_________________________________ I 0$Date_________________________________ ! @   DelayedTransfusionReactionWorkup     InterpretationofResults  Y L PatientHistory:   H Yourpatientwastransfusedduringasurgicalprocedure10yearsago.Twoweeksagothepatientwastransfused i  with2unitsofpackedredbloodcellsduringanothersurgicalprocedure.Atthattimethepatientsantibody U  screenwasnegative.Thephysicianhasrequestedtwomoreunitsofbloodonthispatientduetoadecreaseof A  thepatientshemoglobin.Foreachofthefollowingstatetheresultsofyourtesting: -  TU>  U>(OT1  .0    ABO/DandAntibodyScreenresults:U>(OCOTی$$ Ќ  U>  U>PT2  .0    Weredonorunitscompatible?U>P"PTی$$ Ќ  U>  U>PT3  .0    Resultofpanel(serumtesting):U>PPTیD$$ Ќ  U>  U>QT4  .0    ResultofDAT:U>QQTی=$$ Ќ  U>  U>RT5  .0    Resultofpanel(eluate):U>RRTی$$ Ќ  Inyourownwordsdescribeindetailwhatishappeningtothispatient.Correlateeachtest(15)withthenexttest "T! performed,ie,whywasitdone,andhowdoestheresultfitintothepatientscurrentserologicalpicture. #@ " _ /<,/ ЇVX#XXXName_________________________________ 5  #XHXVX#T#WX#XXHExercise11 󀀀 DelayedTransfusionReactionWorkUp  @'StudyQuestions  Y 1.0  Describethehemolytictransfusionreactionduetoa primaryimmune responsespecificallyaddressing  H thefollowing: 8 $$   a.  timeframe Y    b.  antibodyclassinvolved 1    c.  hemolysisoftransfusedcells   2.0  Describethehemolytictransfusionreactionduetoa secondaryimmune responsespecifically  addressingthefollowing:t$$   a.  timeframe L   b.  antibodyclassinvolved m$   c.  WhyareDATresultspositive? E   d.  Listtheadditionallaboratorytestingandwhethertheresultswillbeincreasedordecreased      whenimmunehemolysisoccurs.   3.0  Define mixedfieldagglutination.Inadelayedhemolytictransfusionreactionwhosecellsareinthe   clumpsseen?Whyarethesecellsclumped?!p $$ 4.0  Wheredoestheantibodyrecoveredintheeluatecomefrom?U& #%$$ 5.0  Explainwhyarecentlytransfusedpatientcannotbeantigentyped.*&)$$ #XHXXWX#%U#