Anti-k Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Anti-k and links to relevant pages within the course.

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Antibody Detection and Identification
Case Study Three Rule-Outs Key Antibodies ruled out with 3 reactions: D, c, k, Kpb, Jsb, Leb, P1, and Lub (panel cells used for rule out are in green). Antibodies still needing selected cells for rule outs: C, Lea, E, M, Jkb, S, s (need 2 reactions)Fya,Jka, N, K (need 3 reactions)e, Fyb (needs 1 reaction) Jsa, Kpa, Cw, and Lua all need three reactions for rule-out but these are all low-frequency antigens. It is difficult to find panel cells with these antigens present to allow testing. They will fall in the "unable to rule out" category.Reactions are occurring in the AHG phase only and there is varying strengths of reactivity, which could indicate dosage and/or multiple antibodies.The pattern of reactivity closely matches Fya (cells 2,5,7,8,9 are positive). Of the remaining antibodies that have no rule-out reactions, anti-K is the possible second antibody (present on cell 2 and 10 and screen cell I). Explanation for the varying strengths in reactions: Panel cell 2: Fya (heterozygous) and K present so stronger reaction of 4+. Panel cell 5 and 8: Fya is heterozygous, so weaker reaction of 2+. Panel cell 7 and 9: Fya is homozygous, so stronger reaction of 3+. Panel cell 10: K is (homozygous, so stronger reaction of 3+.	View Page
Immune Antibodies Immune antibodies occur in the serum of individuals who become sensitized to foreign antigens through pregnancy or transfusion. IgM predominates in the primary response, IgG in the secondary response. Most react at 37°C and are considered clinically significant. Examples include antibodies in the Kell, Rh, Duffy, and Kidd systems. Immune antibodies can be classified as alloantibodies or autoantibodies.Alloantibodies Produced by exposure to foreign red cell antigens which are non-self antigens but are of the same species. They react only with allogenic cells. Exposure occurs through pregnancy or transfusion. Examples include anti-K and anti-E. Autoantibodies Produced in an autoimmune process and directed against one's own red cell antigens. React with patient's own cells and all cells tested. Can possibly mask the presence of other significant antibodies. It is very important to make sure that no underlying significant antibodies are present if an autoantibody is suspected. A positive direct antiglobulin test (DAT) or auto control could indicate the presence of an autoantibody. Examples include cold auto (P or I) or warm auto (Rh specificity).	View Page
Antibodies to Low- and High-Incidence Antigens Low-incidence antigens are antigens that occur in less than 1% of the population.Antibodies to low-incidence antigens Low-incidence antigens are not usually found on screen cell and antibody panels. Antibodies are hard to test for, but it is usually not difficult to find compatible blood. Suspect this antibody if an AHG crossmatch is incompatible and other causes have been ruled out, such as a positive donor DAT or ABO incompatibility. Examples of low-incidence antigens include: Cw, V, Kpa, Jsa. When going through the process of Ruling Out, antibodies like anti-V, anti-Cw, anti-Lua, anti-Kpa, and anti-Jsa usually fall into the "unable to rule out" category. High-incidence antigens are antigens that occur in greater than 99% of the population. Antibodies to high-incidence antigens Antibodies are rare and may be difficult to identify due to lack of negative panel cells for other high-incidence antigens (difficult to rule out). Reactions with screen and panel cells will all be positive (same strength and same phase). Auto control will be negative. Difficult to find antigen-negative compatible blood. Examples of antibodies to high-incidence antigens are: anti-k, anti-Kpb, anti-Jsb, and anti-Lub. If an antibody to either a high- or low-incidence antigen is present, it may be difficult to identify and may require further testing in a reference blood bank.	View Page
Examples of Antibodies to High-Incidence Antigens Suspect an antibody to a high-incidence antigen if: Reactions with all panel and screen cells are positive (same strength and same phase) Auto control is negative Antibodies to high-incidence antigens include: anti-k, anti-Kpb, anti-Jsb, anti-Lub (highlighted in turquoise)	View Page

CLIA Blood Banking Review
Match the following antibodies to their appropriate immunities:	View Page
Based on the phenotype of the RBC screening cells, and patient results given below, which of the following antibodies cannot be ruled out:	View Page
Which of the following list of antibodies generally reacts most strongly at 4o C:	View Page

The Disappearing Antibody: A Case Study
Which statement best describes a p value of 0.05 generated by a panel that identifies anti-K as the probable antibody?	View Page
When performing an antibody investigation, which of the following would indicate an inconsistency that needs to be further investigated? (Select all that apply)	View Page
Balancing the risks Life-Threatening HemorrhageDespite potential risk, sometimes immediate transfusion is necessary, even for patients with red cell antibodies. In such cases transfusion service staff should alert the medical director, who can discuss options with clinical staff.The medical director will generally talk to the staff attending the patient and indicate that, if possible, they should hold off transfusion. But if it is a case of massive bleeding where exsanguinating hemorrhage is likely, it is better to give some blood and monitor for a delayed hemolytic transfusion reaction than to let the patient bleed to death.Transfusing when bleeding is brisk will result in much of the autologous and incompatible blood bleeding out, with the possibility of a delayed hemolytic reaction once the patient's antibody rebounds and destroys still present antigen-positive donor red cells.Some transfusion services also try to minimize the risk of unmatched blood by typing their emergency supply of O Rh negative RBCs for the K antigen, since anti-K is a relatively common clinically significant antibody. See Resources for two papers that discuss the risks of transfusing un-crossmatched emergency blood.	View Page
Using the guidelines in the Antibody Exclusion Protocol, which antibodies are possible (have not been excluded) using this panel? Select all that apply.Antibody identification results CellRhRhesusKellDuffyKiddMNSsPLewisLuResultsCell CDEceCwKkKpaFyaFybJkaJkbMNSsP1LeaLebLuaGel IAT* 1rr000++00+0+0+00++++S+001+1 2rr000++00+0+0++0++++S+00w+2 3rr000++00+0++0+0++0+0+003 4r"r00+++00+0++0+0+0+++0004 5R2R20+++00+00+++++0+0+0+0w+5 6		View Page
Which of the following cells would be the one most useful cell to exclude both anti-E and anti-K in this patient?	View Page
Which of the following antibodies in this scenario could explain all reactions by itself?Antibody identification results CellRhRhesusKellDuffyKiddMNSsPLewisLuResultsCell CDEceCwKkKpaFyaFybJkaJkbMNSsP1LeaLebLuaGel IAT* 1rr000++00+0+0+00++++S+001+1 2rr000++00+0+0++0++++S+00w+2 3rr000++00+0++0+0++0+0+003 4r"r00+++00+0++0+0+0+++0004 5R2R20+++00+00+++++0+0+0+0w+5 6R2R20++<	View Page

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