MEDICAL TECHNOLOGY
PROGRAM
MEDT
340: IMMUNOHEMATOLOGY
3 Credit Hours Spring Semester
INSTRUCTOR: Patricia L.
Office: 105 Farr-Chinnock Hall, Telephone 869-6232
Email: pramsey@lmunet.edu
Home
Telephone: (276)-861-4647
Conference
Time: Instructor will be available for
student conference
during office hours on:
Tuesday:
Wednesday:
Thursday:
CO-REQUISITE: MEDT 392-Intermediate Clinical Practice II
(Blood Bank
Section)
COURSE
DESCRIPTION: MEDT
340 focuses on the genetics of blood groups, antigen and antibody reactions
within the different blood group systems, with associated immunologic
principles. The course includes blood typing, compatibility testing, antibody
screening, unexpected antibody identification, and quality control. Donation
and transfusion of blood, component hemotherapy, and related aspects of
operating clinical transfusion services according to AABB guidelines are
included also.
TEXTBOOK: Quinley, Eva D.
(1998). Immunohematology: Principles and Practice,
2nd
edition.
AABB Standards and Technical Manual
are used for reference also.
METHODS OF INSTRUCTION:
Lectures and Discussions
Case Studies
Assigned
Demonstration
Clinical
Correlation
COURSE OBJECTIVES: Upon completion of MEDT 340, the student will
be responsible for attaining the following objectives:
1.
Discuss the genetic inheritance and biochemical expression of ABO
antigens.
2. Evaluate paternity based upon antigen typing
of mother, child, and alleged father.
MEDT 340
Page
2
3. Explain the difference between phenotype and genotype.
4. With regard to genotype and phenotype,
describe the "
and discuss the associated transfusion
problems.
5. When given a complete Rh phenotype, express
the possible genotypes in three systems of
nomenclature:
Fisher-Race, Wiener shorthand, and Rosenfield.
6.
Explain the meaning of “weak
D-positive” and “weak D-negative” test results; discuss the application of an Rh control to the weak D
procedure.
7.
Describe the antigenic difference in D-mosaic, and explain the serologic
characteristics of
this phenomenon in Blood Bank tests.
8. Apply principles of quality control to Blood
Bank reagents; be able to design a QC
system
for testing reagents when there is no
commercial QC package available.
9. Recognize three possible causes for ABO
discrepancies in cell and serum grouping.
10. Explain the difference between a direct and indirect antiglobulin test (DAT and IAT);
be able to recognize causes of false-positive
or false-negative results, as indicated in the textbook and supplemental handouts.
11. Categorize the following blood groups with regard to optimum temperature of reaction, usual immunoglobulin class of the antibody, and the effect of enzymes upon in-vitro antigen-antibody reactions within each system:
a. Rh
family e. Lewis
b. Kell f. M N S s
c.
Duffy g. P,
I
d. Kidd h. Lutheran
12.
Discuss the effects of rouleaux on ABO, Rh, crossmatch, and antibody
screening;
identify two remedies for rouleaux.
13. Cite
three reasons for an incompatible
crossmatch yet a negative antibody screen.
14.
Define HLA Class I and II antigens, and give their location within the
body.
15.
Recognize HLA typings that are important in kidney transplants, platelet
transfusions, and ankylosing spondylitis.
16. When given the HLA phenotype of the
children, determine the most likely HLA genotype
of
a
parent.
17.
Discuss the labeling of blood if the donor
is weak D-positive, and the selection of blood for
transfusion if the patient is
weak D-positive.
MEDT
340
Page 3
18.
Identify the regulations and requirements--as outlined by AABB--for
collecting, processing, storing, and transfusing RBCs,
frozen RBCs, FFP, platelets (pheresis and
random-donor),
and cryoprecipitate.
19. Cite
one condition for which the following blood components are indicated:
RBCs Frozen
RBCs
FFP Cryoprecipitate
Pheresed platelets AT-III
20.
Evaluate pre- and post-transfusion data to recognize the following types
of transfusion reactions:
febrile, hemolytic, delayed hemolytic, allergic, anaphylactic, and circulatory overload.
21.
Compare and contrast the donor requirements and serologic testing
for autologous,
homologous, and directed donation of blood.
22.
Recognize, interpret, and resolve serologic reactions associated with:
a. Incompatible crossmatch
b. Positive IAT
c. Subgroups of A
d. Positive DAT
23.
Interpret test results with anti-A1 lectin, A2 cells, O cells, A1 cells, and B cells to
identify a
subgroup of A with anti-A1 in the serum.
24. State
the requirements for the retention of various Blood Bank records, as indicated
by the instructor.
25.
Describe two methods for preparation of anti-A1 reagent.
26.
Identify five sources of error in the antiglobulin test, and associate
each with false-positive
or
false-negative results.
27.
Discuss the use of donor blood that has a positive antibody screening
test.
28.
Identify the serological tests presently required by the FDA on each
unit of donor blood.
29. Explain
the AABB requirements for using the computer crossmatch.
30.
Discuss the conditions under which it is acceptable to perform the
“immediate spin” crossmatch only.
31.
Explain the proper Blood Bank protocol for issuing uncrossmatched blood
in an emergency situation.
32.
Select the correct ABO and Rh for transfusion of RBCs, FFP, and
platelets in situations when group-specific is not available.
MEDT
340
Page
4
33. Determine
the Blood Bank tests that must be performed prior to administering ante-partum and post-partum
RhIG.
34.
Discuss the cause of a positive
Fetalscreen test, and describe follow-up testing required.
35.
Determine candicacy RhIG when
given results of mother's Rh, Du, and antibody screen together with
baby's Rh, Du, and DAT.
36.
Calculate the dosage of RhIG necessary based on Kleihauer-Betke testing.
37.
Define specifically when a
micro-dose of RhIG is acceptable.
38.
Compare and contrast ABO vs. Rh
HDN as to frequency, severity of
the disease, and
typical Blood Bank results for both the mother and baby.
39.
Explain the Blood Bank testing requirements for exchange transfusion on
a baby, including the specimens to be used and the
special requirements for blood selected for
exchange.
40.
Compare and contrast absorption
and elution, and describe the uses of
these techniques in antibody identification.
41. Be
able to answer the questions at the end of each assigned chapter.
42.
ULTIMATE OBJECTIVE: The graduate
will be able to confidently work in any Blood Bank, following an orientation period of four
weeks.
EVALUATION
METHOD:
There will be four
written exams and a comprehensive final exam in this class. In addition, there will be homework and scheduled
quizzes. The overall grade in this
course will be determined as follows:
Exam #1 16% of
grade
Exam
#2 16% of
grade
Exam
#3 16% of
grade
Exam #4 16% of
grade
Homework/Quizzes 16%
of grade
Comprehensive Final Exam 20% of
grade
In support of the
University's policy on Writing Across the
Curriculum, there is a special
writing assignment that will count 20% of the homework/quiz average in MEDT 340. Details of the SEWS assignment (sequential enhancement of writing style)
are given on the last page of this
syllabus.
MEDT
340
Page
5
EVALUATION METHOD (continued):
Grading scale is as follows:
A = 90 -100 % Medical Technology students must maintain
an
B+ = 87 -
89 %
average of 80% or above in order to pass this
B = 83 -
86 % course.
B- = 80 -
82 %
C+ = 77 -
79 %
C = 73 -
76 %
C- = 70 -
72 %
D = 60 -
69 %
F = below
60%
Students are encouraged
to ask questions in this class and participate in class discussions.
Independent performance is expected on all exams, quizzes, and homework
assignments. Any make-up exam will be
given by appointment only, with the format of the make-up exam differing from
the original exam. Rules for academic integrity as stated on page 39
of the LMU Undergraduate Catalog 2003-2004 will be strictly
applied in this class.
As upperclassmen, students
are responsible for completing all reading assignments, and class attendance is
expected. Students who come to class and
listen, take notes, and read the textbook have twice the chance of remembering the subject material on board
exams. If you are unable to attend
class, please notify the instructor at work or at home.
UNITS OF INSTRUCTION:
I. INTRODUCTION to the BLOOD BANK
II. GENETICS
in BLOOD BANKING
III. IMMUNOLOGY
PRINCIPLES
IV. DIRECT
and INDIRECT ANTIGLOBULIN TESTING
V. ABO
and RH BLOOD GROUP SYSTEMS
VI. PRETRANSFUSION
TESTING and the AABB STANDARDS
A. Quality
Control D. Selection of Blood for Transfusion
B. ABO, Rh, and Other Antigen Typing E. Crossmatch:
Immediate Spin, AHG,
C. Direct and Indirect Antiglobulin Tests and Computer Crossmatch
VII. OTHER
BLOOD GROUP SYTEMS: KELL, DUFFY,
KIDD, M, N, S,
s, LEWIS,
P, I,
H, LUTHERAN, and
HLA; miscellaneous blood group
systems
MEDT
340
Page
6
VIII. IDENTIFICATION
of UNEXPECTED ALLOANTIBODIES
IX. MULTIPLE
ALLOANTIBODIES
X. ADSORPTION, ELUTION,
and TITRATION OF ANTIBODIES
XI. AUTOANTIBODIES
XII. DRUG-INDUCED HEMOLYSIS
XIII. NEONATAL
and OBSTETRICAL TRANSFUSION PRACTICE/ AABB STANDARDS
XIV. EXCHANGE
TRANSFUSION and HEMOLYTIC DISEASE OF THE NEWBORN
XV. RH
IMMUNE GLOBULIN/AABB STANDARDS
XVI. BLOOD
AND BLOOD COMPONENTS:
PREPARATION, STORAGE,
and SHIPMENT by AABB STANDARDS
XVII. HEMOTHERAPY: TRANSFUSION
of RBCS, PLATELETS,
FFP, CRYO, and FACTOR VIII
XVIII. CRYOPRESERVATION of BLOOD
XIX. TRANSFUSION
REACTIONS/ AABB STANDARDS
XX. TRANSFUSION-ASSOCIATED
INFECTIONS
XXI. DONORS: HOMOLOGOUS,
AUTOLOGOUS, DIRECTED DONORS/ AABB
STANDARDS
XXII. HEMAPHERESIS and THERAPEUTIC PHLEBOTOMY
A Tentative Lecture Schedule
with chapter assignments and exam dates is appended to this syllabus.
DATE OF REVISION:
January, 2004
W R I T I N G A C R O S S T H E
C U R R I C U L U M
MEDT 340
The Medical Technology
faculty strongly endorse the philosophy that our baccalaureate graduates need
excellent writing skills.
ASSIGNMENT: Select an article of
medical interest from any of the professional journals listed below. The article must be dated 2003-2004 and
consist of a minimum of three journal pages in length.
Laboratory
Medicine
Clinical
Laboratory Science
Journal
of the American Medical Association
The
New England Journal of Medicine
1. Prepare a critique of the article using APA writing style. Include a title page and a reference
page also.
2. Summarize the article in your own words. Include the author’s major premise (key point), any research
methods, and data that support his conclusion.
3. In your conclusion, critique the author’s
presentation of information. Explain why
you chose this article, and
discuss the most intriguing fact that you learned from your reading.
OBJECTIVES OF THE
ASSIGNMENT: Students will have the opportunity to
achieve the following objectives:
1. Become acquainted with professional journals
in the field of laboratory medicine.
2. Review APA writing style.
3. Enhance writing skills at the college junior level.
4. Exercise critical thinking skills.
GRADING: This short paper, due
on March 11th, should be submitted in Microsoft Word format on a computer
disk, as well as in paper copy. The
assignment will be graded on writing skills--including punctuation, spelling,
sentence structure, paragraph organization, and written expression. The grade
on this assignment will comprise 20% of your homework/quiz average in MEDT 340.
In fulfillment of LMU’s requirement for sequential enhancement of writing style
(SEWS), your paper will be forwarded to the Chair of the SEWS Committee and kept on
file. Submission of an acceptable paper in this course is
documented on your transcript as a passing grade for MEDT 340-X, and it is a requirement for graduation from
the university.