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NUR200 - EGCC - Med Surg 1 - Exam 2 Ch 11, 13- Questions & Answers
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NUR200 - EGCC - Med Surg 1 - Exam 2 Ch 11, 13- Questions & Answers
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NUR200 - EGCC - Med Surg 1 - Exam 2Ch 11, 13- Questions & Answers
Person has HLA genes Correct Ans-one half identical to each parent.
The HLA genes of one person have a 25% Correct Ans-chance of being identical to the HLA
genes of a sibling.
In organ transplantation A, B, and DR are Correct Ans-primarily used for compatibility
matching. The specific allele at each locus is identified by a number.
HLA associated diseases Correct Ans-Ankylosing spondylitis,
SLE,
DM,
Narcolepsy
Having the specific HLA allele does not mean the person will develop any of these diseases, it
just increases their risk for them (vs the general pop).
Common tissue transplants: Correct Ans-corneas,
skin,
bone marrow,
heart valves,
bone,
connective tissues
Common organ transplants: Correct Ans-Heart,
,lung,
liver,
kidney,
pancreas,
intestines.
Organ and tissue donation are regulated by Correct Ans-The uniform anatomical gift act
Pt's are matched to available donors based on Correct Ans-ABO blood and HLA typing,
medical urgency, time on the waiting list, and geographic location.
Recipient receives transplant from Correct Ans-An ABO blood group compatible donor (RH
factor does not matter).
HLA typing in transplantation Correct Ans-A, B, & DR antigens are clinically significant (each
has 2 alleles). This means a total of 6 antigens are identified. 5-6 antigen match is best, but can
get away with 4 antigen match in some situations.
Cornea transplant Correct Ans-HLA matching doesnt matter.
Kidney transplant Correct Ans-HLA matching really matters.
Panel of Reactive Antibodies (PRA) Correct Ans-Indicates the recipients sensitivity to various
HLA's before receiving a transplant.
This allows for the determination of whether the recipient is of high or low reactivity to
potential donors. (Results are in % form).
,Recipient's serum is mixed with a randomly selected panel of donor lymphocytes to determine
reactivity.
Previous pregnancy, blood transfusions, or transplants increases chances of HLA antigens being
present.
High PRA patients could have plasmapheresis or IVIG to lower antibody count.
Negative crossmatch Correct Ans-Indicates that no preformed antibodies are present and is is
safe to transplant.
Positive crossmatch Correct Ans-indicates that the recipient has cytotoxic antibodies to the
donor!
CONTRAINDICATED IN LIVING DONOR PATIENTS. (but if no other option, could do
plasmapheresis and IVIG to try and kill off antibodies)
Retrospective crossmatch Correct Ans-Done if a crossmatch couldn't be completed prior to
transplantation. The results will be used to determine care.
Crossmatch Correct Ans-Is done to determine the existence of antibodies against the
potential donor.
NOTE: important for kidney transplants, may not be done for lung, liver and heart transplants.
Hyperacute rejection Correct Ans-occurs within 24 hours after transplant.
Only option is to remove organ.
, Rare bc of all the testing.
Acute rejection Correct Ans-Most common first 6 months after transplant
Could be cell mediated or humoral.
Reversible with increased doses of steroids (this will raise their risk of infection!!!)
Chronic Rejection Correct Ans-Occurs over months to years after transplantation and is
irreversible.
Can occur for unknown reasons or from repeated episodes of acute rejection.
The transplanted organ is infiltrated with large numbers of T and B cells characteristic of an
ongoing low-grade, immune mediated injury.
There is no definitive therapy for this type of rejection. Treatment is primarily supportive.
This is difficult to manage and is not associated with the optimistic prognosis of acute rejection.
Immunosuppressive therapy Correct Ans-requires lifelong balance between rejection and
infection.
Most patients are initially on triple therapy. Usually includes a calcineurin inhibitor, a
corticosteroid, and a mycophenolate mofetil.
Doses of immunosuppressant drugs are reduced over time after the transplant.
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