IMMUNOHEMATOLOGY

GROUP 8-A2
Ocso, Christine Grace
Pajayat, Shanaia Rondell
Parawan, Miguel Lorenz
Penaflor, Krystelle Anne
Querubin, Stella Rose

MODULE #5: RH BLOOD GROUP SYSTEM

CHECK FOR UNDERSTANDING:
Test A.Multiple Choice

1. Which of the following statement is correct:

a. Rh does not refers to a specific antigen
b. The only difference between Rh(+) and Rh(-) individual is the location of the Rh in locus 1 & 2
c. Fisher-Race postulated that a single gene produced a single product that can contain separately
recognized factors
d. Rh associated glycoprotein( RhAG) is located in the same location as that of Rh system hence named
RhAG

ANSWER: B
RATIONALIZATION: Rh (+) refers to the presence of the D antigen, while Rh(-) refers to its absence
which is represented by the amorph or silent allele (d). All Rh antigen codes for specific antigen that is
Rh D and Rh CE. As per location Rh system is located in Chromosome 1 in which if allele is present in
locus 1 and 2 it denotes Rh(+), however if allele is present only in locus 2 it denotes Rh(-).

2. Which of the following Nomenclature does not have a genetic basis

a. Wiener Blood Factor
b. Fisher-Race
c. Alpha Numeric Terminology
d. none of the above

ANSWER: C
RATIONALIZATION: Alpha Numeric Terminology was postulated by Rosenfield and coworkers and
it simply describes( codes)for the presence or the absence of a given antigen based on the Fisher-Race
terminology (DCEce terminology) does it does not have a genetic basis

3. Which of the following Weak D variations best describes the situation:

Situation: Assuming that the complete antigen in one’s cell membrane is 10k, however a person who
needs transfusion appears to be Du due to the presence of 8k antigen on its cell membrane. This Du
phenotype is due to what genotype?
a. C trans
b. D mosaic
c. Partial D
d. Genetic Weak D

ANSWER: D
RATIONALIZATION: Genetic Weak D is considered to be one of the 3 mechanisms for Weak D or Du
which codes for the presence of D antigen on the surface of the red blood cells genotypically but appears
to be incomplete or few in numbers. Thus phenotypically appears to be Rh(-) or Weak D. Therefore when
performing Rh testing( specially in cases of transfusion) and the result does not show agglutination, it is
safe not to report it immediately, however double check by re testing using the Du reagent or better yet
perform antibody screening and identification.

4. Which of the following consideration explains the occurrence of Transfusion reaction

a. D antigen is considered immunogenic outside ABO
b. Rh mediated always result in intravascular destruction of immunoglobulin -coated red cells
c. Circulating antigen appears immediately after transfusion

ANSWER: A
RATIONALAZATION: D antigen is considered to be most immunogenic outside ABO since D antigen
codes for specific antigen, and does not have naturally occurring antibody unlike ABO. Therefore if you
transfuse Rh (+) blood to an Rh (-) individual, the presence of that D antigen ( RhD) will stimulate the
production of anti-D. and for this same reason that is why it is advise to transfuse Rh(-) blood only to the
Rh(-) individual and it is safer to transfuse Rh(-) blood to Rh(+) individual, but still Rh(+) blood is also
safe to transfuse to an Rh(+) individual.

5. All of the following demonstrate Rh HDN, except

a. Mild compensation hemolytic anemia
b. slight-moderate decrease in hemoglobin and hematocrit
c. Increase serum haptoglobin
d. Possible elevation in bilirubin

ANSWER: C
RATIONALIZATION: IN CASES OF Rh HDN, serum haptoglobin usually decreases. Haptoglobin
(Hp) is a α2– sialoglycoprotein with hemoglobin (Hb) binding capacity. The well-known biological
function of Hp is capture of Hb to prevent both iron loss and kidney damage during hemolysis. In cases of
Rh HDN or even ABO HDFN hemoglobin hematocrit and hemoglobin decreases due to the destruction of
red blood cells, the same reason is true with Haptoglobin. The biologic functions of haptoglobin can be
related to the ability to bind hemoglobin or to modulate immune response.

Test B.ANALYSIS:
TRANSCRIBE THE FOLLOWING:

GENE WIENER BLOOD FISHER-RACE ROSENFIELD

FACTOR
1. R2 / r’ Rho hr’ rh” / rh’ hr” DcE / dCe Rh: 1, 2, 3, 4, 5
2. r / rY hr’ hr” / rh’ rh” dce / dCE Rh: -1, 2, 3, 4, 5
3. R0 / r” Rho hr’ hr” / hr’ rh” Dce / dcE Rh: 1, -2, 3, 4,- 5
4. r’ / R1 rh’ hr” / Rho rh’ hr” dCe / DCe Rh: 1, 2, -3, -4, 5
5. Rz / rY Rho rh’ rh” / rh’ rh” DCE / dCE Rh: 1, 2, 3, -4, -5

MODULE #6: HEMOLYTIC DISEASE OF THE FETUS AND NEWBORN

CHECK FOR UNDERSTANDING:
CHECK FOR UNDERSTANDING:
1. C
 RATIO: Mother/fetus blood type combination that is most likely to cause severe hemolytic
disease is Rh negative mother, Rh positive fetus.

2. D
RATIO: Anti-E is involved in causing HDFN. It has caused HDFN severe enough to require
intervention and treatment.

3. D
RATIO: hemolysis occurs when maternal IgG attached to the specific antigens of the fetal
RBC’s. Destruction of the fetal RBCs and the resulting anemia stimulates the fetal bone
marrow to produce RBCs at an accelerated rate.

4. C
RATIO: Erythroblastosis fetalis and Hydrops fetalis are considered serious and dangerous
clinical symptoms of HDFN.

5. C
RATIO: RhoGAM administered if fetomaternal hemorrhage will reach 20 mL.

6. A
RATIO: Anti-D is the most antigenic of the Rh antibodies and Anti-K is the most severe
type of HDF.

7. A
RATIO: ABO-HDN can be diagnosed in pre-delivery.

8. Differentiate Coombs DAT from Coombs IDAT on its role in detecting Rh compatibility
between mother and fetus.
ANSWER: Coombs DAT is used to detect if antibodies or complement system factors have
bound to RBCs surface antigens in vivo. The DAT is not currently required for pre-
transfusion testing but may be included by some laboratories. Coombs IDAT

MODULE #7: BLOOD GROUP TERMINOLOGY AND LEWIS SYSTEM

CHECK FOR UNDERSTANDING:

1. D
RATIO: H,B, Lea, Leb are present in the saliva of group B secretors who carry Lele genes.

2. C
RATIO: Lewis antibodies are naturally occurring antibodies, almost always IgM type but which do not
cause Hemolytic Disease of Fetus and Newborn (HDFN).

3. B
RATIO: Transformation to Leb phenotype after birth is as follows: Le(a-b-) to Le(a+b-) to Le(a+b+) to
Le(a-b+)
4. B
RATIO: A/A Lele HH sese would ebst explain RBCs typed as group A Le(a+b-).

5. C
RATIO: A type 1 chain has The terminal galactose in a 1-3 linkage to subterminal N-acetylglucosamine.

6. B
RATIO: During pregnancy, Lewis antigens (Lea and Leb) both decreases.