WorksheetsAUTOIMMUNE HAEMOLYTIC ANAEMIA (AIHA)
Total questions: 41
Worksheet time: 25mins
Autoimmune Hemolytic Anemia (AIHA) is ...
Autoantibodies bind to RBC and cause premature destruction of RBC
Antigen bind to RBC and cause premature destruction of RBC
Autoantibodies bind to foreign antigen and cause premature destruction of RBC
Antigen bind to antibodies and cause premature destruction of RBC
The binding of autoantibodies to RBC activates .. ?
Phagocytosis by macrophages
Phagocytosis by monocyte
Apoptosis by macrophages
Apoptosis by monocyte
If the RBC destroyed at the spleen and liver, it is called .. ?
Extracellular hemolysis
Intracellular hemolysis
Extravascular hemolysis
Intravascular hemolysis
If the Ag-Ab complex triggers the complement cascade and destroy RBC directly, this is .. ?
Extracellular hemolysis
Intracellular hemolysis
Extravascular hemolysis
Intravascular hemolysis
Autoantibodies is .. ?
Directed against foreign substance
Directed against own RBC
Directed against pathogen's antigen
Directed against donor's RBC
Primary AIHA is .. ?
Rises spontaneously
Due to genetic
No identifiable cause
Due to other diseases
We can classify AIHA into ... groups.
1
2
3
4
Choose the CORRECT types/classification of AIHA.
Warm
Cold
Drug-induced
Heredity
Mixed
Autoantibodies of warm AIHA works best at what temperature?
(a)
Warm AIHA is .. ?
When autoantibodies attach and destroy RBC at normal body temperature
When autoantibodies attach and destroy RBC at low temperature
When autoantibodies attach and destroy foreign substance at normal body temperature
The most common type of AIHA is .. ?
Warm
Cold
Mixed
Drug-induced
Why is IgG is mainly the causes of warm AIHA?
IgG is a warm agglutinin
IgG is a cold agglutinin
IgG is a large antibody
IgG is a small antibody
When RBC is sensitized with IgG antibodies, it usually cause ..... in the reticuloendothelial systems of liver and spleen.
Intracellular hemolysis
Extracellular hemolysis
Intravascular hemolysis
Extravascular hemolysis
When the RBC is coated with IgG and eventually its membrane digested by macrophage, RBC will transform into .. ?
Aphrocyte
Spherocyte
Triphocyte
Phorocyte
When the RBC is lightly coated with IgG, it cannot activate the complement system, thus it will be removed in the .. ?
Bone Marrow
Kidney
Spleen
Liver
When the RBC is heavily coated with IgG, it will activate the Complement System and cause C3b to bind on the RBC. It will be removed in the .. ?
Bone marrow
Kidney
Spleen
Liver
The cold AIHA usually happens due to a secondary infection of .. ?
Mycobacterium gordona
Mycoplasma Pneumoniae
Mycobacterium tuberculosis
Mycobacterium ulcerans
Choose the CORRECT characteristics of cold AIHA.
Predominantly affect older people
Usually IgM
Secondary to mycobacterium tuberculosis infection
Optimally react at 4'C
Choose the common symptoms of cold AIHA
Acrocyanosis
Intravascular hemolysis
Usually a seasonal disease (winter)
A very severe disease
How does cold autoantibodies bind to RBC during cold winter season?
Cold temperature activates IgM
Cold temperature activates IgG
Warm temperature activates IgM
Warm temperature activates IgG
The least common type of AIHA is .. ?
Warm
Cold
Paroxymal Cold Haemoglobinuria
Mixed
These are the characteristics of Paroxymal Cold Haemoglobinuria, EXCEPT
Affect children and young adults
Associate with viral infection
Cause by both cold and warm antibodies
The autoantibody present is Donath-Landsteiner
How does Donath-Landsteiner autoantibody cause Paroxymal Cold Haemoglobinuria?
D-L Ab activated in cold temperature, fix complement and cause intravascular hemolysis
D-L Ab activated in cold temperature, fix complement and cause extravascular hemolysis
D-L Ab activated in warm temperature, fix complement and cause intravascular hemolysis
D-L Ab activated in warm temperature, fix complement and cause extravascular hemolysis
Paroxymal Cold Haemoglobinuria usually has a symptoms like ... ?
Haemoglobinemia
Haemoglobinuria
Intravascular hemolysis
Extravascular hemolysis
This set of tubes is for .. ?
ABO blood grouping
DAT
D-L Ab test
Crossmatch
Tube 7 is filled with patient serum
Tube 8 is filled with normal serum
Tube 9 is filled with patient + normal serum
The tubes incubated at 0'C and followed by 37'C
If the patient has D-L Ab, what will happen to Tube 7, 8 and 9?
All hemolysis
7 : Hemolysis
8 : Normal
9 : Hemolysis
7 : Hemolysis
8 ; Normal
9 : Normal
All no hemolysis
Why is tube 1,3,4,6 show no sign of hemolysis despite having the patient's serum? The patient has D-L Ab.
D-L Ab only activated in cold temperature and fixes complement system at warm temperature
D-L Ab only activated in warm temperature and fixes complement system at cold temperature
D-L Ab only activated and fixes complement system at warm temperature
D-L Ab only activated and fixes complement system at cold temperature
D-L Ab reacts with ... antigen.
I
M
P
O
Cold AIHA can either be Cold Agglutinin Syndrome (CAS) or Paroxymal Cold Haemoglobinuria.
Choose the factors we can investigate in order to differentiate these two.
Age of the patient
DAT result
Antibody class
Antibody specificity to antigen
What is Mixed-type AIHA?
Patient has IgG autoantibodies
Patient has IgG and IgM autoantibodies
Patient has biphasic IgG autoantibodies
Patient has IgM autoantibodies
What illness can cause secondary Mixed-type AIHA?
Tuberculosis
Multiple myeloma
Systemic lupus erythematosus (SLE)
Multiple sclerosis
How does certain drug caused Drug-induced AIHA?
Drug circulates in the bloodstream
Drug attach to RBC membrane
Drug produce autontibodies
Drug attach to WBC membrane
When do we suspect Drug-induced AIHA?
When there is no other possible cause of hemolysis anemia
When the patient is a drug seller
When the patient has a history of sexual activity with a drug addict
We can diagnose a patient with AIHA by using these test, EXCEPT
DAT
IAT
Full blood count
ABO blood grouping
Which of these is NOT the sign of anemia?
Low hematocrit
Low hemoglobin level
High hemoglobin level
Low RBC count
Why do we test for DAT to detect AIHA?
Used to determine whether autoantibodies or complement protein bound to WBC membrane
Used to determine whether antibodies or complement protein bound to RBC membrane
Used to determine whether autoantibodies or complement protein bound to RBC membrane
Used to determine whether antibodies or complement protein bound to WBC membrane
Choose the ways to evaluate a POSITIVE DAT result
Test the red cell with anti-IgG and C3d reagents
Test using an eluate from the red cell
Test the serum to identify autoantibodies
Test the red cell with anti-ABO reagent
Red cell elution from a POSITIVE DAT results are ..... when the RBC is only coated with complement protein.
Non reactive
Reactive
Not agglutinate
Agglutinate
How does RBC elution from a POSITIVE DAT can detect autoantibodies activity on the RBC membrane?
Elution frees autoantibodies molecule from sensitized RBC
Elution frees autoantibodies molecule from hemolyzed RBC
Elution frees autoantibodies molecule from sensitized WBC
Elution frees autoantibodies molecule from hemolyzed WBC
We can do ..... from the elution that frees antibodies from a POSITIVE DAT red cell result.
IAT
GXM
Ab identification
ABO blood grouping
Choose a possible reason why AIHA patient shows NEGATIVE DAT result.
Autoantibodies has a low binding affinity
The autoantibodies is IgM or IgA
The autoantibodies is IgG
AHG reagent used in DAT test cannot detect cold antibodies
