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'\  `Roman PSSXXc6Non-ProfitNon-Profit Stampc"#RB>z  0 @X<<<<@c d'dxd Level 1 Level 2 Level 3 Level 4 Level 5('2hT$ RU!   ($     ('2hT$ RU!   ! C<< c  !"  XX$@<< NonProfitOrg.  @xx U.S.Postage@00 PAID@ Permit2757  @nn Austin,Texas0D4`P,BoardBoard of TrusteesC&/D4A`ArialTTC BoardofTrustees |||-$0D4`-Dr.BruceM.Murray,ChairmanDellaMayMoore,ViceChairmanRooseveltLeaks,SecretaryJanAlbersPeteFosterLindaGrayMackRayHernandezLawrenceE.JenkinsMurrayShawDr.DanAngel,President/D4A`ArialTTT{0HeadingFancy ACC Heading    xxxU(64 (Times NewRomanTTU@.. AustinCommunityCollege  6)'Fd66)'Fd66)'t"Fd664 (Times NewRomanTTP h:FTFA MinutesFirst Pages%Xf$ hN p x (#%'0*,.8135@8:<H?AXX7?tXdd7  @  FULLTIMEFACULTYASSOCIATION  @+Minutes    + 2 ,'  ?tXXXs%Xf$ hN p x (#%'0*,.8135@8:<H?AX J(# Minutes   6)' xd6('2hT$ RU!   ^>8ACC AddressACC Return AddressAustinCommunityCollegeP.O.Box140526Austin,Texas78714dC,EqualEqual Opportunity Statement@.. ACCisanequalopportunityinstitution. 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X X9w90?gh h h % X XXXғ& 8%XX >&%%& 8MLAB2431  52  #& 8%%>&J# '6X'A`"Sans Serif PS     ,hT'   _wXXғXXSX >X:XXXғEXERCISE5Type&Screen#XғXX>X:u#00<%>X:XXXғLaboratoryProcedureManual#XғXX>X:#X XXXғ#XғXXX @#  X A))  xdGEwC $A D '6X'A`"Sans Serif PS,rAZ"Arial Regular,rAZ"Arial Regular N~&   _landscapetablegoeshere(4printedoutforSpring96)filesavedunderMLT1504_tableland.sca_ RU!   _HH4  X,L \Exercise5 @' TypeandScreen  5  LTextbook: 0  _Quinley_,Chapter6pages7985andChapter10pages1631660$$  Skills: 0  20points $$      P  Objectives:     ?(#33?"H3"  H3/2#  1  .3  0    Listthreesituationsinwhichscreeningforunexpectedantibodiesshouldbeperformed.H3/\݌ $$ Ќ  "H3"  H3O2#  2  .3  0    ListtwopatientpopulationswhoarecandidatesfortheTypeandScreenprocedureinsteadofthe  w  traditionalcrossmatch.H3O|݌c $$ Ќ  "H3"  H32#  3  .3  0    StatetheadvantageofperformingaTypeandScreeninsteadofthecrossmatch.H3݌O $$ Ќ  "H3"  H32#  4  .3  0    StatetherationalewhichmustbeconsideredwhenorderingaTypeandScreeninsteadofa p;  crossmatch.H3݌\' $$ Ќ  "H3"  H32#  5  .3  0    StatethetwotestingcomponentsinvolvedinperformingaTypeandScreen.H3*݌H$$ Ќ  "H3"  H3 2#  6  .3  0    Statethereasonforperformingasecondforwardtypingoneachpatientwhohasnohistoryonfile.H3 = ݌4$$ Ќ  "H3"  H3< 2#  7  .3  0    Statetheprincipleoftheindirectantiglobulintestasitrelatestotheantibodyscreenprocedure.H3< i ݌ $$ Ќ  "H3"  H3j 2#  8  .3  0    Define unexpectedantibodies.H3j ݌ $$ Ќ  "H3"  H3X 2#  9  .3  0    Statethecriteriaconsideredindeterminingthatabloodgroupantibodyis clinicallysignificant.H3X ݌$$ Ќ  "H3 "  H3 2#  10  .3  0    Listtwoobservationsthatareconsideredapositivereactioninbloodbanktesting.H3 ݌$$ Ќ  "H3 "  H32#  11  .3  0    Define dosageaffectasitrelatestobloodgroupantibodies.H3݌$$ Ќ  "H3 "  H32#  12  .3  0    StatetheABOtypeandsourceoftheantibodyscreeningcells.H3݌$$ Ќ  "H3 "  H32#  13  .3  0    Statethecomponentsandpurposeofan_autocontrol_Ԁinbloodbanktesting.H3݌s$$ Ќ  "H3 "  H32#  14  .3  0    Statethethreephasesoftestingintheantibodyscreenandtheantibodyclassdetectedineach.H3!݌_$$ Ќ  "H3"  H32#  15  .3  0    Statethepurposeofalbuminintheantibodyscreenprocedure.H3L݌K$$ Ќ  "H3"  H3'2#  16  .3  0    Describethereagent _Coombs_ԀControlCells(checkcells)andstatetheirpurposeforuse.H3'T݌l7$$ Ќ  "H3"  H3q2#  17  .3  0    Statewhatmustbedoneif_Coombs_ԀControlCellsdonotgivetheexpectedreaction.H3q݌X#$$ Ќ  "H3"  H32#  18  .3  0    Statewhatmustbedoneifapatienthasapositiveantibodyscreentest.H3݌D$$ Ќ  "H3"  H32#  19  .3  0    Listfourlimitationsoftheantibodyscreeningprocedure.H3݌0$$ Ќ  "H3"  H32#  20  .3  0    DeterminetheABOandDtypeofapatientredbloodcellsanddetectatypicalantibodiespresentin   thepatientserumbytestingitagainstscreencellsofknownantigenicmakeup.H3݌!$$ Ќ  "H3"  H3W2#  21  .3  0    PerformandinterprettheTypeandScreenprocedurewith100%accuracy.H3W݌!$$ Ќ  L\ Discussion  #! LPatientsmayformantibodiestobloodgroupantigenstheydonotpossessontheirredbloodcellsasaresult $ " ofexposuretotheantigensbypriortransfusionand/orpregnancy. %!# Screeningforantibodiesinpatientordonorserumisanestablishedbloodbankprocedure.Theadvantages '#% ofsystematicscreeningtodetectunexpectedantibodiesincludes:facilitatestheselectionof safedonor (y$& bloodfortransfusion,aidsintheprognosisandtreatmentofhemolyticdiseaseofthenewborn,andenables )e%' donorbloodcontainingantibodiesofpotentialclinicalsignificancetoberecognized. *Q&( K*SX:XXSXSX:XXSX:cb    K*  Beforethisprocedurebecamepopularmanyunitsofdonorbloodwere_crossmatched_Ԁandheldinreservefor ^,)(* patientswhowouldprobablynotneedit.Attimesthiswouldcauseshortagesofthebloodsupplyand J-)+ unnecessaryoutdatingofdonorunits.Thesefactors,alongwiththeaddedexpenseof_crossmatching_Ԁblood, 6.*, causedtheTypeandScreen(T&S)proceduretogainpopularity.K* ݌ "/*- ЌSX:XXSX:SX:XXSX:cb   _Thisprocedureismostfrequentlyusedtoscreenpre-operativeorobstetricalpatientswhoseriskofexcessive   bloodlossis minimal .Incaseofanemergency,wherebloodisneededforthesepatients,uncrossmatched  ABOandDcompatiblebloodcanbereleasedwith99.9%assuranceofsafety,aslongasthepatienthasno  unexpectedantibodies.Iftheantibodyscreenispositivethepatient isnot aT&Scandidate,theantibody  presentintheserummustbeidentifiedandantigennegativedonorunitsmustbecrossmatched.   Therearehundredsofdifferentantigensonthehumanredbloodcell.SofarwehavestudiedtheABOand  ` Rh(D,C,c,Eande)antigensandperformedtestingtodetectthepresenceorabsenceoftheseantigens.The  L   otherbloodgroupantigensarenotveryimmunogenicbutsomeindividualswhohavebeenexposedtothese m 8  antigensthroughprevioustransfusionsorpregnancymaybeexposedandrecognizeoneormoreoftheseas Y$  foreign,resultingintheformationofanantibodywhichwillreactwiththespecificantigen(s)whichcaused E  theirproduction. 1  Screeningforthepresenceofunexpectedantibodiesinpatientordonorserumisanestablishedbloodbank    procedure.Theantibodyscreen,alsoknownastheindirectantiglobulintest(IAT),involvestestingthe  patientsserumagainstreagentredbloodcellsselectedtopossessrelevantbloodgroupantigensfordetection  ofclinicallysignificant,unexpectedantibodies.Theterm unexpectedantibodiesreferstothoseantibodies  otherthanantiAorantiB.ItisexpectedthatagroupApersonwillhaveantiBintheirserum.Thelackof  expectedABOantibodieswillresultintheneedforadditionaltesting.Clinicallysignificantantibodiesare p oftheIgGclassandreactinvitro,preferentiallyat37Corattheantihumanglobulinphaseoftesting.These \ antibodiesweredeterminedtobeclinicallysignificantiftheyhavebeenresponsibleforhemolytictransfusion }H reactionsorhemolyticdiseaseofthenewborn.Simplystated,theyareresponsibleforredbloodcell i4 destruction.Invitrohemolysisand/oragglutinationofthescreencellsbythepatientserum/plasmaatanyof U  thevariousphasesoftestingconstitutesapositivetestresultandindicatethepresenceofunexpected A  antibodieswhichcouldpossiblycauseinvivohemolysiswhichmaymanifestasdecreasedsurvivalof - transfusedredbloodcellsorhemolyticdiseaseofthenewborn.Antibodiesthatarereactiveat37Cand/or  intheantihumanglobulintestaremorelikelytobesignificantthanthosereactiveatroomtemperatureor  below.Apositivereactionisobtainedintheantibodyscreenwillresultintheneedforadditiontestingto  determinethespecificityoftheantibodysothatappropriateantigennegativedonorunitscanbeselected.  Theabsenceofhemolysisand/oragglutinationconstitutesanegativetestindicatingtheserum/plasmabeing !  testeddoesnotcontaindetectableantibodiesdirectedtoanyofthewidevarietyofantigenspresentonthe "l! reagentscreencells. #X" Althoughtwocellscreensareavailableathreecellscreenisrecommended,especiallyforthosefacilitieswho e%0!$ routinelyutilizeaTypeandScreen(T&S)insteadofacrossmatchorwhoperformanabbreviatedcrossmatch Q&"% procedure(theabbreviatedcrossmatchwillbediscussedinLab6).Athreecellscreenprovidescellswhich ='#& arehomozygousfortheantigenstowhichindividualsmostfrequentlymakeantibodies.Thishelpsensure )(#' thedetectionofweaklyreactiveantibodies.Someantibodiesaresoweakthattheymayshowa dosageeffect . )$( IndosageeffecttheantibodiesmayreactmoststronglyorONLYwithcellswhicharehomozygous(havea *%) doubledoseoftheantigen,ie,Fya+Fyb=)andgivenegativeorweaklyreactiveresultswithheterozygouscells *&* (havesingledoseofantigen,ie,Fya+Fyb+).Theheterozygouscellspossesshalfasmuchantigenasthe +'+ homozygouscellswhichmayresultinweakornegativereactions. ,(, Thescreeningcellsaresuppliedasthreevials,eachcontainingasuspensionofhuman groupO redblood .h*. cellsderivedfroma singledonor .Theseredbloodcellshavebeenphenotypedfortheantigensto_which /X+/ patientsmostfrequentlymakeantibodiesto.Theresultsofthese_typings_Ԁareprovidedonapieceofpaper 5 knownasan _Antigram_ .A +inthecolumnundertheantigenindicatesthecellhasbeentestedandfound ! tobepositivefortheantigen,a 0"indicatesthecellhasbeentestedandfoundtobenegativefrotheantigen.   Itiscriticallyimportantthatthelotnumberonthe_Antigram_Ԁmatchthelotnumberonthescreencells.Each  lotnumberofscreencellswillhavedifferentdonorswhichwillchangetheantigenicmakeup.  ЀInsomelaboratoriesthepatient'sredcellaretestedwiththeirserumasanautologous(auto)control,bythe   samemethodusedfortheantibodydetectiontest.Thisprocedureisdonetodetectantibodieswhichare  t coatingredcellsinthepatientscirculation._AABB_ԀStandardsdoesnotrequirethatanautologouscontrolbe  ` done.Ithasbeenfoundthatevenwhenitispositive,itisoflimitedvalueinpretransfusiontesting.When  L  theautocontrolispositiveadditionaltestingmustbeperformed(DAT,possiblyaneluate,etc).The m 8  informationobtainedfromthesetestsrarelychangestheselectionofbloodfortransfusionwhentheantibody Y$  screenisnegativeandusuallycausesanunnecessarydelayingettingbloodtothepatient.Autocontrols are  E  routinelyperformedwhenanantibody_workup_Ԁisdone. 5   Principle     Thisprocedureconsistsoftwo(2)parts:  0  1.0$$PerformingacompleteABOandDtypingonthepatient'sbloodsample.$$ K*SX:XXSX:SX:XXSX:cb    K* >  L  2.0  Screeningthepatient'sserumforatypicalantibodiesusing2-3reagentscreencells.K* >>݌$$ ЌSX:XXSX:SX:XXSX:cb   TheprincipleoftheABOandDtypingprocedurewascoveredinExercise3,pleasereviewit.   LStartingwiththisprocedureandforallfutureproceduresrequiringanABO/Dtype,youwillsetupasecond ! setofforwardtypingtubesforaretype._AABB_Ԁrequiresthatallpatientswithoutahistoryhaveasecond   ABO/Dtypingdoneaspartofthetestingprocess.Mostinstitutionsperformbatchtestingwhichresultsin  thepotentialforthewrongserum/celltubestobeplacedinfrontofthewrongclottubes.Thiscouldresult  inaseriousABOtypingerror.Topreventthisfromhappeningtwosetsofforwardtypingtubesaresetup,  reagentsadded,thenonesetoftubeswillreceivedropsofbloodfromthewashedcellsuspensionwhilethe  secondofsetoftubeswillreceivedropsofbloodfromtheprimaryclottube.Ifadiscrepancyoccursbetween t thetwosetsoftubesthentestingmustberepeated. ` Theprincipleoftheantibodyscreenisasfollows:wellmixedantibodyscreencellsofknownphenotypesare m 8 addedtopatientserumandareevaluated/readatthreedifferentphasestodetermineifthereisanunexpected Y!$ antibodyinthepatientsserumwhichisreactingwithabloodgroupantigenpresentonthereagentscreen E"  cellsconstitutingapositivereaction. 1#! Youmustmemorizeeachphaseofthetestingprocedure_and_Ԁtheantibodyclassmostcommonlydetectedby  % # each. %!$  SalineImmediateSpin(IS)Phase  '#& Thisphaseprovidesconditionsthatbestallowsthedetectionof_IgM_Ԁclassantibodies.Duetotheirstructure, )p%( antibodiesofthe_IgM_Ԁclassreadilyagglutinateredcellssuspendedinsaline.Patientserumisaddedtothe3 *\&) screencells,thetubesareimmediatelyspundownandobservedforhemolysisand/oragglutinationby gently }+H'*  _resuspending_Ԁthecellbutton.Ifapositivereactionisobtainedatthisphase, proceedtotheincubationand m,8(+ _antiglobulin_Ԁphase toseeifthereactiongoesawayorgetsstronger. ]-(),   M.*- ReactivityatISonlyusuallyindicatesthepresenceofa nuisancecoldreactiveantibody.Additionaltesting 5  wouldbenecessarytoconfirmthis. ! _&  Albumin,37$CIncubationPhase   'KBovineserumalbuminorsomeotheradditiveisusedtoenhanceagglutinationofredbloodcellsbyantibodies  ofthe_IgG_Ԁclass.Onetheorystatesthatthealbuminreducesthezetapotential(electricalcharges)between   theredbloodcells,allowingthemtocomeclosertogether.Thismayallowthesmall_IgG_Ԁmoleculestobridge  t thegapbetweentheredcellsallowinglatticeformation(agglutination)tooccur.Albuminaffectsthesecond  ` stageofagglutination.Thereareseveralotherenhancement_medias_Ԁusedroutinelyinthebloodbank,_LISS_,  L  PEGandothers.Youwillgainexperiencewithsomeoftheseduringyourclinicalrotation. m 8  The_IgG_Ԁantibodiesreactoptimallyat37$C.Ifanantibodyisreactiveatthisphaseinvitro(inthetesttube) E  thenitmayalsoreactinvivo(inthebody). 1  Aftertheincubationphase,alltubesareagainspundownandobservedforagglutinationand/orhemolysis    bygentlydislodgingthecellbuttonandrecordthegradedreactions.Ifapositiveornegativereactionis  obtainedatthisphaseproceedtothe_AHG_Ԁphase.  & t Anti-humanGlobulinPhase(_AHG_Ԁor_Coombs_)   Manyantibodiesofthe_IgG_Ԁclassaresmallanddonotalwayscausevisibleagglutination.Duringthe \ incubationphase,theantibodiesmayattachtoantigensonindividualredcells(sensitize)but,duetotheir }H smallsize,cannotcauseagglutination. i4 Ѐ'tm#JiIi0  JX:XJiREMEMBER:Patientinitialsatthetopof each tube.Patient's fullnameandhospitalnumber on / serumandcells.#JiXJX:s#0$$  JX:XJiB.0  TypeandScreen Q2$$ 0  1.0$$Addone(1)dropofeachappropriatereagentanti-seratoitsproperlylabelledtube.)4$$ 0  2.0$$Addthree(3)dropsofpatientserumtoS1,S2,S3,AcellandBcelltubes. 5$$ 0  3.0$$ Visuallyinspectalltubesatthistimetomakesurethatallserumshavebeenadded. !6$$ 0  4.0$$Addone(1)dropofthepatientwashedcellsuspensiontotheforwardtypingtubes.!7$$   5.  Add1dropofcellsfromtheoriginalclottubetothe"retype"tubes. "8 0  6.0$$Addone(1)dropofreagentA,B,S1,S2andS3cellstotheappropriatelylabelledtubes.#9$$ 0  7.0$$SpinS1,S2andS3tubesintheserofugefor15seconds.$ :$$ 0  8.0$$Readeachofthesetubesforagglutinationand/orhemolysis. Recordresultsaseachtubeis %l!; read. &\"<$$ 0  9.0$$Addtwo(2)dropsof22%bovinealbumintoS1,S2andS3tubesandplacein37$Cwater }'H#= bathfor20minutes.i(4$>$$ 0  10.0$$SpindowntheforwardandreverseABOandDandtherepeatABO/Dtypingtubesfor15 U) %? seconds.A* &@$$ 0  11.0$$Readforagglutination. Recordtheseresultsnow. IfthepatientappearstobeDnegativeset -+&A uptheDctrltubeand immediately placetheanti-DandDctrltubesinthe37$Cwaterbath ,'B for15minutes(ifthisisdonequicklytheincubationshouldbecompletedatthesametimeas  -(C theantibodyscreen).-)D$$ 0    NOTE:  IfpatientappearstobeABpositive,anDcontrolmustberun..*E$$ 0  12.0$$Afterthe20minutesincubation,spintheS1,S2andS3for20seconds./+F$$ 0  13.0$$Readeachtubeforagglutinationand/orhemolysis. Recordresultsaseachtubeisread. 5$$ 0  14.0$$WashtheS1,S2andS3(andanti-DandDctrltubeifyourpatientappearedtobeDnegative) % three(3)timeswithsaline.$$ 0  0$$AHGPhaseWashingProcedureNotes$$ 0  0$$a.0P $$Washingprocessmustbecarriedoutintheshortesttimepossible.P $P $ 0  0$$b.0P $$Completelyresuspendcellbuttonsaftereachwash,visuallyinspectbottomoftubes   afteradditionofsaline,ifarbcbuttonisvisibleresuspensionwasnotachievedand  x anadditionalwashshouldbeperformed. dP $P $ ^_@  0  0$$_@#^c  .0P $$  Spintimeisoneminuteforeachwash._@#^^ی P P $P $ Ќ  0  0$$d.0P $$Completelydecantsalinebetweeneachwash,turntubesoverandallowsalineto q <  drain,donotshakethetubesastheyaredraining,thiswillresultinthelossofyour ](  rbcs.I P $P $ 0  0$$e.0P $$Afterthethirdwash,decantcompletelyand blottherimsofthetubesdrywith 5  biowipetoproduceadrycellbutton.! P $P $  0  15.0$$Addtwo(2)dropsofanti-humanglobulin(AHG)reagenttoeachtube,resuspendthecells  completelyandspinfor15seconds. NOTE: MakesureyouareaddingAHG,whichisgreen,  and NOT Coombscontrolcells,whichisacellsuspension!$$ 0  16.0$$Readforagglutinationmacro- and microscopically.Recordresultsafterreadingmicro.$$ 0  17.0$$Toalltubesshowinganegativereactionaddone(1)dropofCoombscontrol(check)cells. x Mixwellandspinfor15seconds.d$$ 0  18.0$$Readforagglutinationmacroscopically.A1-2+reactionmustbeobtainedorallresultsare P invalid.Recordresultsbyplacingacheckinthecheckcellcolumnifagglutinationwas q< obtained.]($$  NOTE: Somefacilitiesmaystillrunanautocontrol(patientserumandpatientcells)aspartoftheantibody 5 screen.Thisisnolongerrecommendedinroutinetesting,butmustbepartofanantibodyworkup. %   *%)   InterpretationofResults  5   Ifallthree(3)screencellsgivenegativeresultsthroughoutallthreephasesoftesting,theinterpretationofthe   testis negative.  Ifone(1)ormoreofthescreencellsispositive(agglutinationand/orhemolysisofthetestrbcshasoccurred),  theinterpretationoftheantibodyscreenis positive.Thisisindicativeofanantibodypresentinthepatient's   serumreactingwithanantigenpresentonthescreencells.Additionaltestingisnecessarytodeterminethe  t specificityoftheantibodyandtofindappropriateunitstocrossmatch.  `  RecordingResults  m 8       P  Clericalerrorswillbecountedoffheavilyaswellasmisinterpretationofresults. Remember,themost E  commoncauseoftransfusionrelateddeathsisduetothepatientreceivingABOincompatiblebloodandthis 5  isalmostalwaysduetoclericalerrors.Filltheformincarefullyaspointswillbedeductedforallclerical !  errors.JXJX: Recordeachtubeasyoureadit. #JX:XJW#     TermsUtilized   Thefollowingtermsmaybeusedinterchangeably.Memorizetheseterms:  0  IndirectAntiglobulinTest $$     0 P IATnP $P $ 0  0$$0P $$antibodyscreenZP $P $ 0  0$$0P $$screen{FP $P $ 0  0$$0P $$IndirectCoombsg2P $P $    IgGAntibodies  ?  0  0$$0P $$immuneantibodies+P $P $ 0  0$$0P $$incompleteantibodiesP $P $ 0  0$$0P $$clinicallysignificantantibodies P $P $ 0  0$$0P $$coatingantibodies P $P $ 0  0$$0P $$sensitizingantibodies! P $P $ 0  0$$0P $$unexpectedantibodies"!P $P $ 0  0$$0P $$atypicalantibodies#~"P $P $ 0  IgMAntibodies %V!$$$ 0  0$$0P $$naturallyoccurringantibodiesw&B"%P $P $ 0  0$$0P $$completeantibodiesc'.#&P $P $ 0  AntihumanGlobulinSerum ;)%($$ 0  0$$0P $$AHGserum'*%)P $P $ 0  0$$0P $$Coombsserum+&*P $P $ _  +'+   fnh8S:SXXdd8_"ݲ<_SX:XXJX:SɀXSX:'hhX 8"XX'X,hHXHTRO'3 Letter LandscapeX3' Letter'3Letter Landscape3'LetterTStudentName:򀀀     0  Exercise򀀀 X< Date:򀀀  *Ceg  d dIdd Idd dd dd 9dd 9dd dd dd dd dd  dd dd Idd Ih81h81C, dd , dd , dd ,dd ,dd ,Pdd ,dd ,dd ,dd ,dd ,dd ,dd ,Xdd ,dd ,dd ,dd ,dd ,dd ,dd ,dd +  ,hh@$@$ ,#SX:XSɀV#S\w$\XSX:Name    Hh;). hh HAntiA QhD2 "h QAntiB QhD2 "h QAnti   _A,B_ QhD2."h Q  AntiD QhD2h QDCtrl  * QhD2."h QDu QhD2"h Q4 QhD2"h QDu  Cont . ** QhD2"h Q4 QhD2"h QA1  Cells QhD2."h QB  Cells QhD2."h QInterp. 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Pt 9hh(!&h 9ID# +h'hh + +h(h + +h)h + +h*h + /h+h / @h/),h @ @h/)-h @ @h/). h @ @h/)/!h @ @h/)0"h @ @h/)1#h @ @h/)2$h @ @h/)3%h @ @h/)4h @ @h/)5h @ @h/)6h @ Ih8)7'h I RhA28"h R ThhA29"h T Nhh97:"  hh N  @@ @  @O #SX:X$\S\w?#SɀXSX:Retype#SX:XSɀ#S\w$\XSX:   o ; #SX:X$\S\wI#S\w$\XSX:#J\w$\$\S\w7#S\w$\$\J\w +hS 7 <hh + +h o =h +#SX:X$\S\w#S\w$\XSX:#J\w$\$\S\w#S\w$\$\J\w +h o >h + +h o ?h + /h o @h / 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 2h!' @h 2 ;h*' @h ; ;h*' @h ; =hh*' @h =+!' @  hh +*kl  d d dd  dd  dd dd dd Pdd Pdd dd dd dd dd dd Xdd Xdd dd dd dd dd dd dd egh81h81,Ddd",Xdd",dd",dd",dd", dd", dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd"+  %hh { A {  %BB#_  ԍ̎_  *h Bhh *Rack# )h Ch )Collected )h Dh )Completed )h Eh )Tech 4h' Fh 4Screen1 ?h2$ G"h ?  4 =h0! Hh =Screen2 ?h2$ I"h ?4 =h0! J"h = @  @ Screen3 ?h2$ K"h ?4 9h,! L"h 9Interp. <h/! M"h <4 ?hh,! N"h ?AntibodyID =hh,& O"  hh = @h/)Q"hh @ @h/) R"h @ @h/) S"h @ @h/) T"h @ ;.) U"h ;IS * V *37 * W *_AHG_ /h X / ;.) YEh ;IS * Z *37 * [ *_AHG_ /h \ / ;.) ]Ih ;IS * ^ *37 * _ *_AHG_ /h ` / @h/) aMh @ @h/) bNh @ Khh8) cOh K B82 d"Phh B  d   d   d   d  h d  +hfh + +h7gh + (7hh ( h h  +h7ih + +h7jh + (7kh ( h k  +h7lh + +h7mh + (7nh (  n   n   n n    Remarks o  *mn  d dDdd"DXdd"Xdd"dd"dd" dd"  dd" dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"klh81h81,dd ,dd",dd",dd",dd", dd", dd",Xdd",dd",wdd",Xdd",dd",dd",wdd",wdd", dd",wdd",dd", dd",dd",dd"+  K/sK/  ,hht ,BloodBank# u  ,h9vhh ,Donor# ,hwh ,Anti x A ,h9yh ,Anti z B ,h9{h ,Anti | A,B 3h&9}h 3AntiD <h/!~"h <  DCont <h/!h <Du  * <h/!9"h <4 <h/!"h <  DuCtrl  Ѐ** <h/!9h <4 <h/!"h <Donor  Type&Rh <h/!9"h <IS <h/!"h  <37 >h/!" h  >_AHG_ >h/!" h  > @  @ 4 >h/!" h  >Interp. >h/!" h  >Tech >h/!" h  >Date Bhh/!" h BTime >hh/!"hh  >#1 5&!W; hh 5 ,W; , ,W; , ,W;  , ,W; , 3&W; 3 </!W;" < </!W;" < </!W;" < </!W;" < </!W;" < </!W;" < </!W;" < </!W;"  < >/!W;"   > >/!W;"   > >/!W;"   > >/!W;"   > >/!W;"   > Bh/!W;"  B ;h,!W;"h ;#2 2#!uYh 2 )uY ) )uY ) )uY ) )uY ) 2#uY 2 ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ;,!uY" ; ?h,!uY" ? ;h,!uY"h ;#3 2#!wh 2 )w ) )w ) )w ) )w ) 2#w 2 ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ;,!w" ; ?h,!w" ? ;h,!w"h ;#4 2#!h 2 ) ) ) ) ) ) ) ) 2# 2 ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ?h,!" ? =hh,!"h =#5 4h#!hh 4 +hh + +hh + +hh + +hh + 4h#h 4 =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = =h,!"h = 6hh#!"h 6(  hh (#SX:X$\S\w#Ԁ*performedwhenpatient/donorappearstobeABpositiveorDnegative  **Ifaweak(positiveDu)isobtained,aDucontrol or DATmustbeperformed.S\w$\XSX: o #SX:X$\S\w#SɀXSX:#JB0/Sɀϯ#Sɀ/JB0   fnh  f;=,TRX3' LetterO'3 Letter Landscape3'LetterP $  0  15.0$$Addtwo(2'3Letter LandscapeT f  TRO'3 Letter LandscapeX3' Letter'3Letter Landscape3'LetterP $  0  15.0$$Addtwo(2 T=;,=[g<8S:SXXdSXXd8     p    x _     p    x    ( _StudentName:򀀀     0  Exercise򀀀  Date:򀀀 U  #SX:XSɀ#SɀXSX:*  d ddd dd"dd"dd"dd" dd"  dd" Xdd"Xdd"wdd"wXdd"Xdd"dd"wdd"wwdd"w dd" wdd"wdd" dd" dd"dd"mnh81h81, dd , dd , dd ,dd ,dd ,Pdd ,dd ,dd ,dd ,dd ,dd ,dd ,Xdd ,dd ,dd ,dd ,dd ,dd ,dd ,dd +  ,hh ,#SX:XSɀ^#S\w$\XSX:Name I   Hh;) s hh HAntiA QhD2I  " t h QAntiB QhD2I  " u h QAnti I   _A,B_ QhD2  " v h Q  AntiD QhD2I   w h QDCtrl I  * QhD2 " Bh QDu QhD2I " Ch Q4 QhD2I " Dh QDu I  Cont   ** QhD2] (" { h Q4 QhD2I " Fh QA1 I  Cells QhD2 " Gh QB I  Cells QhD2 " Hh QInterp. QhD2I "  h QDAT Ch6$I "h CElution I  Results ThhA2 "h h T_FBS_ 9/)I "  hh 9                                                 $   $Poly ;,!g 2" ;IgG ;,!g 2 " ;C3 1'!g 2!" 1 $  ! $  Pos ;,!g 2" ;Neg ?h,!g 2#" ?  Pt 9hh(!g 2$h 9ID# +h P%hh + +h P&h + +h P'h + +h P(h + /h P)h / @h/) P*h @ @h/) P+h @ @h/) P, h @ @h/) P-!h @ @h/) P."h @ @h/) P/#h @ @h/) P0$h @ @h/) P1%h @ @h/) P2Jh @ @h/) P3Kh @ @h/) P4Lh @ Ih8) P5'h I RhA2 P6" h R ThhA2 P7" h T Nhh97 P8"   hh N  @@ @  @O #SX:X$\S\w#SɀXSX:Retype#SX:XSɀ#S\w$\XSX:  0 9 #SX:X$\S\w#3S\w$\XSX:#J\w$\$\S\wW#S\w$\$\J\w +h :hh + +h0 ;h +#SX:X$\S\wB#S\w$\XSX:#J\w$\$\S\w#S\w$\$\J\w +h0 <h + +h0 =h + /h0 >h / 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 2h! >h 2 ;h* >h ; ;h* >h ; =hh* >h =+! >  hh +*  d d dd  dd  dd dd dd Pdd Pdd dd dd dd dd dd Xdd Xdd dd dd dd dd dd dd h81h81,Ddd",Xdd",dd",dd",dd", dd", dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd",dd"+  %hh< ?<  %_BB#_________________________________  ԍ̎  *hk @hh *Rack# )hk Ah )Collected )hk Bh )Completed )hk Ch )Tech 4h'k Dh 4Screen1 ?h2$k E"h ?  4 =h0!k Fh =Screen2 ?h2$k G"h ?4 =h0!k H"h = @  @ Screen3 ?h2$k I"h ?4 9h,!k J"h 9Interp. <h/!k K"h <4 ?hh,!k L"h ?AntibodyID =hh,&k M"  hh = @h/)H O"hh @ @h/) P"h @ @h/) Q"h @ @h/) R"h @ ;.) S"h ;IS * T *37 * U *_AHG_ /h V / ;.) WEh ;IS * X *37 * Y *_AHG_ /h Z / ;.) [Ih ;IS * \ *37 * ] *_AHG_ /h ^ / @h/) _Mh @ @h/) `Nh @ Khh8) aOh K B82 b"Phh B  xC b   xC b   xC b   xC b  h xC b  +hf1dh + +h eh + ( fh ( h xC f  +h gh + +h hh + ( ih ( h xC i  +h jh + +h kh + ( lh (  xC l   xC l   xC l xC l   #SX:X$\S\w#S\w$\XSX:#J\w$\$\S\w^#S\w$\$\J\w Remarks um  *uv  d dDdd"DXdd"Xdd"dd"dd" dd"  dd" dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"dd"h81h81,dd ,dd",dd",dd",dd", dd", dd",Xdd",dd",wdd",Xdd",dd",dd",wdd",wdd", dd",wdd",dd", dd",dd",dd"+  q  ,hhTr ,BloodBank# Ts  ,hthh ,Donor# ,hTuh ,Anti Tv A ,hwh ,Anti Tx B ,hyh ,Anti Tz A,B 3h&{h 3AntiD <h/!T|"h <  DCont <h/!T}h <Du T~ * <h/!"h <4 <h/!T"h <  DuCtrl T Ѐ** <h/!h <4 <h/!T"h <Donor T Type&Rh <h/!"h <IS <h/!T"h  <37 >h/!T" h  >AHG >h/!T" h  > @  @ 4 >h/!T" h  >Interp. >h/!T" h  >Tech >h/!T" h  >Date Bhh/!T" h BTime >hh/!T"hh  >#1 5&! hh 5 , , , , ,  , , , 3& 3 </!" < </!" < </!" < </!" < </!" < </!" < </!" < </!"  < >/!"   > >/!"   > >/!"   > >/!"   > >/!"   > Bh/!"  B ;h,!"h ;#2 2#!h 2 ) ) ) ) ) ) ) ) 2# 2 ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ;,!" ; ?h,!" ? ;h,!"h ;#3 2#!8h 2 )8 ) )8 ) )8 ) )8 ) 2#8 2 ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ;,!8" ; ?h,!8" ? ;h,!8"h ;#4 2#!V!h 2 )V! ) )V! ) )V! ) )V! ) 2#V! 2 ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ;,!V!" ; ?h,!V!" ? =hh,!V!"h =#5 4h#!t?hh 4 +ht?h + +ht?h + +ht?h + +ht?h + 4h#t?h 4 =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = =h,!t?"h = 6hh#!t?"h 6(t?  hh (#SX:X$\S\wp#Ԁ*performedwhenpatient/donorappearstobeABpositiveorDnegative B  **Ifaweak(positiveDu)isobtained,aDucontrol or DATmustbeperformed.S\w$\XSX: 0 #SX:X$\S\w7##JX:XXSX:#SX:XXJX:SɀXSX: # =[g  =TRX3' LetterO'3 Letter Landscape3'LetterrDnegative y **Ifaweak(positiveD'3Letter LandscapeTK\ =  wh#SX:XSɀJ8##JX:XXSX:+8#0  0'%%0'%'%0 %%0/ % %0/ %/ %0%%07%%Name_________________________________7%7%  Exercise5 @FF&{ TypeandScreen  @ee&{StudyQuestions    aA~  aA~;`1  .0    >X:XXJX:List2advantagesofusingaType&Screenprotocol.(1point)aA~;;`یU %% Ќ  aA~  aA~<`2  .0    List2patientpopulationsaregoodcandidatesforthisprotocol.(1points)aA~<=`ی%% Ќ  aA~  aA~ >`3  .0    List2eventswhichmayleadtoexposureandsensitizationtoredbloodcellantigensanindividualmaynot = possess.(1point).aA~ >&>`ی)%% Ќ  aA~  aA~a?`4  .0    Define unexpectedantibody.(1point)aA~a?|?`ی!T%% Ќ  aA~  aA~M@`5  .0    Define clinicallysignificantantibodyasitappliestobloodgroupantibodies.(1point)aA~M@h@`ی'"%%% Ќ  aA~  aA~nA`6  .0    List2observationswhichwillindicateapositivereactionintheantibodyscreenprocedure.(1point)aA~nAA`ی+x'*%% Ќ   q.<*- <  K   aA~  aA~B`7  .0    Statetheprincipleoftheantibodyscreen(IndirectAntiglobulinTest/IAT).(1point)aA~BC`ی5%% Ќ  aA~  aA~D`8  .0    Describe dosageeffectasitrelatestopositivereactioninthe_IAT_.(1point)aA~DD`ی t%% Ќ  aA~  aA~>E`9  .0    BasedonyourknowledgeoftheABObloodgroupsystemstatewhythedonorsusedforscreencellsaregroup  0.(1point)aA~>EYE` ی%% Ќ  aA~  aA~F`10  .0    Describethe autocontrolandstatethereasonthatitisoflimitedvalueinroutinepretransfusiontesting.(1 U  point)aA~FF` یA %% Ќ  aA~  aA~G`11  .0    ListthethreephasesoftheIAT AND statetheantibodyclassmostcommonlydetected.(3points)aA~GH` یe%0!$%% Ќ  *Y\]d ddd dd"dd"dd"dd" dd"  dd" Xdd"Xdd"wdd"wXdd"Xdd"dd"wdd"wwdd"w dd" wdd"wdd" dd" dd"dd"uvw%w%," dd ,dd +  )A' #&A' # )Phase 6,!'p#'"b 6AntibodyClassDetected 2(&'p#("  b 2a. %)$)   %)$* b. *p&+   *p&, c. %,'-  %,'.   /*0 aA~  aA~L`12  .0    Define zetapotential.Howdoesbovinealbuminaffectthezetapotential?(1point)aA~LL` ی5%% Ќ  aA~  aA~M`13  .0    Statetheprincipleoftheantihumanglobulintestanddrawapicturetoillustratethisprinciple.(2points)aA~MM` ی t%% Ќ  aA~  aA~N`14  .0    Describethereagent checkcellsandexplaintheimportanceofthisprocedure.Whatisthemostcommon  reasonforcheckcellsnot checking?(1.5points)aA~NO`ی%% Ќ  aA~  aA~qP`15  .0    TherearemanyreasonsorcausesoffalsepositiveandfalsenegativereactionsoccurringduringtheCoombs A  procedure.Basedoninformationprovidedinyourtextbook,lectureguideandinthislab,listthree(3)reasons - forfalsepositivereactions AND three(3)reasonsforfalsenegativereactions.(3pts)aA~qPP`ی%% Ќ  0  FalsePositive%% 0  a.%% 0  b.! %% 0  c.#\"%% 0  FalseNegativei%4!$%% 0  a.U& "%%% 0  b.-(#'%% 0  c.*%)%%  .l*. aA~  aA~5T`16  .0    Apatienthasapositiveantibodyscreen.StatewhythispatientwouldnotbeaT&Scandidate.(1point).aA~5TPT`ی5%% Ќ  aA~  aA~cU`17  .0    Foreachofthefollowingstateatleast1alternativetermswhichmaybeused:(2points)aA~cU~U`ی L %% Ќ    IAT Y$    IgGantibodies     IgMantibodies    AHGserum