MLT 261 - Immunohematology

1. Apply genetics to blood banking.
   1. Define genotype, phenotype, dominant, recessive, codominant, amorph, and haplotype.
   2. State the Mendelian Laws.
   3. State the reason most blood groups are considered codominant.
   4. Determine an individual’s possible genotype and phenotype.
   5. Describe the dosage effect, including single dose and double dose genes and antigens, and explain its significance in testing.
   6. Differentiate direct exclusion, indirect exclusion, and non-exclusion in paternity testing.
   7. Explain gene linkage and haplotypes relating to blood groups system alleles.
   8. Select screening cells homozygous and heterozygous for various antigens.
2. Evaluate basic principles of immunology in blood banking.
   1. Describe the type of immune response associated with blood banking.
   2. Distinguish in vivo antigen-antibody reactions from in vitro antigen-antibody reactions.
   3. Name the two stages in agglutination; and, list and describe factors affecting those stages.
   4. Describe the different enhancement media used in antibody detection.
   5. Describe complement-mediated antigen-antibody reactions and hemolysins.
   6. Describe the principle of the antiglobulin test and how anti-human globulin is produced.
   7. Name the two major components of polyspecific anti-human globulin.
   8. List the different antiglobulin reagents used in the blood bank.
   9. Discuss the test methodology and application for direct and indirect antiglobulin testing.
   10. List causes of a positive direct antiglobulin test (DAT) and the mechanisms responsible.
3. Demonstrate basic immunologic techniques.
   1. Make an accurate and estimated 4% suspension of red blood cells.
   2. Manually wash red blood cells.
   3. Perform antigen-antibody testing.
   4. Interpret various strengths of positive reactions, negative reactions, and mixed field reactions.
   5. Perform indirect and direct antiglobulin testing.
4. Assess the ABO (ABH) blood group system.
   1. State Landsteiner’s Rule.
   2. Explain the inheritance and frequencies of the ABO blood groups.
   3. Discuss the biochemistry of the A, B, and H genes and how they relate to Lewis and Secretor genes and antigens.
   4. Describe the antigens and antibodies of the ABH system (A, B, H, anti-A, -B, -H), as well as development of antibodies, immunoglobulin class and clinical significance.
   5. State the reason the ABO group is considered the most significant blood group, and why blood groups must be matched for transfusion.
   6. Explain the Bombay phenotype, including: genetics, antigens on red blood cells, antibodies in serum, and transfusion options.
   7. Discuss subgroups of A, and acquired A- and B-like antigens.
   8. Name which ABO blood group is considered the universal donor and which is considered the universal recipient.
   9. Describe the selection of ABO-compatible red blood cells.
   10. Define type-switching; and list the rationales.
   11. Perform and interpret forward and reverse ABO grouping.
   12. Resolve ABO discrepancies.
5. Examine the Rh blood group system.
   1. Explain the Fisher-Race and current (ISBT) Rh nomenclatures and the applicable genetic theory.
   2. Discuss the common Rh antibodies (Anti-D, -C, -E, -c, -e) specifically to include: immunoglobulin class, phase of reactivity, usual form of stimulation, inability to bind complement and clinical significance.
   3. Explain the weak D phenotype, including clinical significance in donors and recipients.
   4. Perform and interpret Rh (D) typing.
   5. Perform ABORh testing.
6. Assess the other major blood groups: Kell, Kidd, Duffy, MNS, P, Lutheran, and I.
   1. Discuss the antigens of each blood group with regard to development, immunogenicity and frequency.
   2. Summarize the antibodies of each blood group to include: immunoglobulin class, phase of reactivity, and clinical significance.
   3. Identify special characteristics and clinical significance for each blood group.
7. Perform antibody identification.
   1. Define unexpected antibodies.
   2. Describe antibody identification techniques, including the use of enhancement methods.
   3. State the three rules of antibody identification, as well as exceptions to the rules.
   4. Interpret single and multiple specificity antibody panels utilizing the elimination method.
   5. Discuss the auto control test and its significance in antibody identification.
   6. Discuss the use of selected cells (or selected cell panels).
   7. Summarize adsorption and elution techniques.
   8. Select blood for a recipient with one or more antibodies and calculate the number of unit of blood that must be screened.
   9. Perform antigen testing.
   10. Discuss and/or perform techniques used in the detection and identification of various warm and cold antibodies.
   11. Discuss and/or perform techniques used in the detection and identification of anti-I, -i, and IH including the use of adult cells, cord cells and the pre-warming technique.
8. Perform compatibility testing.
   1. List the information that MUST appear on transfusion request forms and patient samples.
   2. Describe pre-transfusion compatibility testing procedures, including: positive identification of recipient and sample, review of patient history, ABO and Rh testing, appropriate selection of blood components, antibody detection, routine crossmatch procedures, labeling and issuing blood components.
   3. Differentiate between a major and minor crossmatch.
   4. Explain the expected outcomes of a crossmatch, as well as what a crossmatch cannot detect or do.
   5. Distinguish among immediate spin, antiglobulin, and electronic crossmatches.
   6. Discuss release of blood in emergency situations, massive transfusions and neonatal transfusions.
   7. Discuss non-type specific transfusion including selection of blood type for various products.
   8. Select blood for a recipient with one or more antibodies and perform crossmatching.
9. Evaluate donor blood collection, testing, and component preparation.
   1. Discuss donor selection criteria.
   2. Summarize the mini-physical; and, state acceptable ranges for donor regarding hemoglobin or hematocrit level, pulse, blood pressure, and temperature.
   3. Describe donor phlebotomy technique including preparation of site, method of collection and amount collected.
   4. State the purpose of confidential donor self-exclusion.
   5. Contrast autologous from allogeneic blood donations.
   6. Summarize apheresis donations with respect to donor selection and products.
   7. List the tests that must be performed on allogeneic donor blood and the methodology for each test.
   8. List the information included on a donor unit label.
   9. Compare internal and external controls in testing.
10. Assess component preparation and transfusion therapy.
    1. Discuss CPD and CPDA-1 anticoagulants and optional additive systems (CPD-ADSOL plus others) for collection of whole blood.
    2. Describe the storage lesion with regard to ATP, pH, 2, 3-DPG and K+.
    3. Discuss method(s) of preparation, modifications, temperature and length of storage, and quality control for red blood cell, plasma, platelet, and cryoprecipitate products.
    4. Explain the Food and Drug Administration’s (FDA) and AABB?s roles in regulation and accreditation issues regarding blood components.
    5. Describe the requirements and methods for shipping blood products.
    6. Calculate the amount the hemoglobin and hematocrit are raised upon transfusion on one unit of packed RBCs.
    7. Discuss the indications for transfusing: red blood cells random platelets, apheresed platelets, fresh frozen plasma (FFP), cryoprecipitate (cryo), and plasma derivatives.
    8. State the rationale for transfusing leukocyte-reduced products and gamma irradiated components.
    9. Define massive transfusion.
    10. Explain emergency release and transfusion of blood components.
11. Evaluate transfusion reactions.
    1. Distinguish among the following types of transfusion reactions: hemolytic vs. non-hemolytic, acute vs. delayed, immune-mediated vs. non-immune-mediated, and infectious vs. non-infectious.
    2. State the most common cause of fatal transfusion reactions.
    3. Describe the clinical and laboratory features and treatment of transfusion reactions.
    4. Discuss the work-up in the blood bank investigation of reactions.
12. Perform Direct Antiglobulin Testing (DAT).
    1. State the relationship of the DAT autoimmune hemolytic anemia (AIHA).
    2. List the main types of autoimmune hemolytic anemia (AIHA).
    3. Discuss disease association, DAT results, autoantibody class and specificity, diagnostic testing, and transfusing blood for patients with Paroxysmal Cold Hemoglobinuria (PCH), Cold Agglutinin Syndrome (CAS), and warm autoimmune hemolytic anemia (WAIHA).
    4. Describe the basic mechanisms for drug induced hemolytic anemia and list at least one drug implicated in each mechanism.
    5. For each drug mechanism, describe typical clinical and laboratory features including: method of red cell destruction, DAT results, other pre-transfusion testing results, and treatment.
    6. Perform an acid elution and/or heat (freeze-thaw) elution.
13. Perform prenatal and post-partum testing.
    1. Describe the physiology of hemolytic disease of the fetus and newborn (HDFN).
    2. Describe the use of paternal antigen testing, amniotic fluid, and percutaneous umbilical blood analysis in prenatal investigation.
    3. Describe routine prenatal testing, including ABO and Rh typing, weak D testing, antibody screening and identification, titrations and follow-up.
    4. Describe post-natal/postpartum investigation of the mother and infant, including ABO and Rh testing on cord blood, DAT testing and elutions and appropriate use of hemoglobin and bilirubin tests.
    5. List three instances in which RhIG is NOT issued postpartum.
    6. Discuss treatment of ABO and Rh HDFN, including requirements for intrauterine and neonatal exchange transfusions.
    7. List special characteristics of blood used for intrauterine and exchange transfusions.
    8. State the purpose of Rh Immune Globulin (RhIG).
    9. Calculate the dosage of Rhogam after birth or to prevent maternal alloimmunization.
    10. Perform RhIG and antibodies titers, cord blood testing, the fetal blood screen, and the Kleihauer-Betke test; and, state the purpose of each.
14. Assess laboratory safety and quality control.
    1. Identify safety and precaution labels and signs.
    2. Disinfect work area.
    3. Wear appropriate personal protective equipment.
    4. Practice correct hand-washing technique.
    5. Dispose of biohazardous waste.
    6. Protect self, student-patient, and clinical patients from transmission of infectious disease.
    7. Perform appropriate error correction and documentation.
    8. Identify government agencies regulating laboratory results.
    9. Explain the use of quality control in the lab.
    10. Determine factors that affect procedures and results.
15. Demonstrate professional conduct.
    1. Demonstrate interpersonal communication skills with patients, other health care professionals, and the public.
    2. Practice confidentiality.
    3. Follow written and verbal instructions.
    4. Demonstrate ethical time management.
    5. Choose workplace-appropriate clothing and jewelry.
    6. Recognize the responsibilities of other laboratory and health care personnel, interacting with them with respect to their jobs and patient care.
    7. Recognize the need for continuing education as a function of growth and maintenance of professional competence.
    8. Maintain professional growth and competence through involvement in continuing education.
    9. Demonstrate workplace basic skills of listening, writing, leadership, and time management.
    10. Practice written and oral communication skills.
    11. Create a team atmosphere in laboratory functions.
16. Demonstrate judgment and decision making skills.
    1. Analyze laboratory findings to trouble-shoot common procedural and technical problems.
    2. Perform corrective action.
    3. Check for sources of error.
    4. Evaluate laboratory findings to recognize and report the need for additional testing.