Immunohematology Principles and Practice

by Quinley, Eva D.

• ISBN13: 9780397554690
• ISBN10: 0397554699
• Edition: 2nd
• Format: Hardcover
• Copyright: 1998-02-06
• Publisher: LWW

Summary

If your Med Tech and Med Lab Tech students buy one book this should be it! The second edition of this respected text provides a well-rounded introduction to immunohematology that includes superior explanations of procedures. Utilizing an easy-to-read, user-friendly format, the text successfully conveys the complex principles and practices of blood banking. Following a clear progression from basic to complex concepts, coverage more than meets the most current requirements of the AABB. Actual work experience references provide an accurate look at the field. New in this edition: 3 New Chapters -- Hemapheresis, Regulatory Overview, and Process Control; 2 New Sections -- Quality Assurance/Regulatory Issues, and Serologic Techniques; Two-Color Format; 40 New Illustrations; 8-Page, 4-Color Insert; includes Chapter Outlines, Summaries, Summary Boxes, Tables and Case Studies.

Table of Contents

UNIT 1 Blood and Blood Components	1	(44)
1 BLOOD COLLECTION AND PROCESSING	3	(19)
Donor Registration	4	(1)
Educational Material Provided to the Prospective Donor	5	(1)
Donor Selection	5	(8)
Medical History	5	(7)
Confidential Unit Exclusion	12	(1)
Physical Examination	12	(1)
Blood Collection	13	(2)
Materials	13	(1)
Blood Containers	14	(1)
Identification	14	(1)
Selection of Vein and Arm Preparation	14	(1)
Phlebotomy and Collection of Samples	14	(1)
Care of the Donor	15	(1)
Donor Reactions	15	(1)
Grade I and II Reactions	15	(1)
Grade III Reactions	16	(1)
Donor Unit Processing	16	(2)
ABO	16	(1)
Rh	16	(1)
Detection of Unexpected Antibodies to Red Cell Antigens	16	(1)
Serologic Test for Syphilis	16	(1)
Viral Marker Testing	17	(1)
Special Donations	18	(1)
Autologous Donation	18	(1)
Directed Donation	19	(1)
Therapeutic Phlebotomy	19	(1)
Summary	19	(3)
2 HEMAPHERESIS	22	(9)
Separation Devices	23	(3)
Separation by Centrifugation	23	(1)
Bowl Technology	23	(1)
Continuous-Flow Technology	24	(2)
Separation by Membrane Filtration	26	(1)
Separation by Adsorption	26	(1)
Component Collection	26	(2)
Platelet Concentrates	27	(1)
Plasma	27	(1)
Granulocyte Concentrates	28	(1)
Hematopoietic Progenitor Cells	28	(1)
Therapeutic Applications of Apheresis	28	(1)
Therapeutic Plasmapheresis	28	(1)
Therapeutic Cytapheresis	28	(1)
Use of Therapeutic Apheresis in Disease	29	(1)
Summary	29	(2)
3 BLOOD COMPONENTS: PREPARATION, STORAGE, AND TRANSPORTATION	31	(14)
Anticoagulants	32	(1)
Additive Solutions	32	(1)
Rejuvenation	32	(1)
Blood Collection Bags	33	(1)
Whole Blood	34	(1)
Red Blood Cells	34	(2)
Leukocyte-Reduced Red Blood Cells	34	(1)
Washed Red Blood Cells	35	(1)
Frozen, Thawed, Deglycerolized Red Blood Cells	35	(1)
Plasma Components	36	(1)
Fresh Frozen Plasma	36	(1)
Plasma	36	(1)
Cryoprecipitated Antihemophilic Factor	37	(1)
Platelets	37	(1)
Leukocyte-Reduced Platelets	38	(1)
Granulocytes	38	(1)
Labels	38	(1)
ISBT 128	39	(1)
Irradiation of Blood Components	39	(1)
Storage of Blood Components	40	(1)
Transportation of Blood Components	41	(1)
Whole Blood and Red Blood Cell Components	41	(1)
Frozen Components	41	(1)
Platelets and Granulocytes	41	(1)
Shipping Containers	42	(1)
Summary	42	(3)
UNIT 2 Genetic and Immunologic Principles	45	(44)
4 GENETICS	47	(11)
Mitosis and Meiosis	48	(3)
Phenotypes and Genotypes	51	(1)
Inheritance Patterns	51	(2)
Contribution of Blood Group Genetics to the Field of Human Genetics	53	(1)
Population Genetics	53	(1)
Linkage	53	(1)
Crossing Over and Recombination	54	(1)
Positional or Modifier Effects of Genes	54	(1)
Gene Action	54	(1)
Silent Genes	55	(1)
Blood Group Nomenclature	55	(1)
Public and Private Genes	56	(1)
Blood Group Genes as Genetic Markers	56	(1)
Summary	56	(2)
5 BASIC IMMUNOLOGY	58	(21)
Background and Early History of Immunology	59	(1)
Cellular and Humoral Immunity	59	(1)
Leukocytes: Cells of the Immune System	60	(6)
Macrophages	60	(1)
Lymphocytes and Specific Antigen Binding by Cell Surface Receptors	61	(1)
T Lymphocytes	62	(3)
B Lymphocytes	65	(1)
Immunogens Versus Antigens	66	(1)
Route of Administration	67	(1)
Shape and Charge	67	(1)
Antibodies	67	(4)
Structure and Physiochemistry	68	(2)
IgG Subclass and Function	70	(1)
Hybridomas and Monoclonal Antibodies	71	(1)
Antigen-Antibody Reactions	71	(1)
The Zeta Potential	71	(1)
Hydration and Surface Tension	72	(1)
Immune Response to Blood Products and Subsequent Hemagglutination	72	(2)
Mechanisms of Agglutination	72	(2)
Complement	74	(3)
Components of the Complement System	74	(3)
Effects of Complement Activation	77	(1)
Summary	77	(2)
6 ANTIGLOBULIN TESTING	79	(10)
History of Antiglobulin Testing	79	(1)
Principle of the Antiglobulin Test	80	(1)
Indirect Antiglobulin Test	81	(1)
Factors Affecting the Indirect Antiglobulin Test	81	(1)
Applications of the IAT	81	(1)
Direct Antiglobulin Test	82	(1)
Applications of the DAT	82	(1)
Anti-Human Globulin Reagents	83	(1)
Polyspecific Anti-Human Globulin Serum	84	(1)
Monospecific Anti-Human Globulin Sera	84	(1)
Traditional Antiglobulin Testing	84	(1)
Indirect Antiglobulin Testing	84	(1)
Direct Antiglobulin Testing	84	(1)
Sources of Error in Antiglobulin Testing	85	(1)
False-Positive Results	85	(1)
False-Negative Results	85	(1)
Nontraditional Antiglobulin Testing	85	(4)
Enzyme-Linked Immunosorbent Assay	86	(1)
Solid-Phase Red Cell Adherence	86	(1)
Gel Test	86	(3)
UNIT 3 Red Blood Cell Groups	89	(72)
7 THE ABO BLOOD GROUP SYSTEM	91	(20)
Inheritance	92	(2)
Bombay Phenotype	94	(1)
Inheritance of the Bombay Phenotype	95	(1)
Cis-AB	95	(1)
Antigen Development	95	(2)
Antibodies of the ABO System	97	(3)
Anti-A	97	(1)
Anti-A(1)	98	(1)
Anti-B	98	(1)
Anti-A(1)B	98	(1)
Anti-H	99	(1)
Forward Grouping	99	(1)
Microplate and Miscellaneous Testing	99	(1)
Reverse Grouping	99	(1)
ABH System in Disease	100	(1)
Secretor Status	100	(1)
Subgroups of A	101	(1)
Subgroups of B	101	(1)
Discrepancies in ABO Grouping	102	(4)
Technical Errors	102	(1)
Weak or Missing Antibodies	103	(1)
Weak or Absent Antigens	103	(1)
Unexpected Cold-Reactive Autoantibodies	104	(1)
Unexpected Cold-Reactive Antibodies	104	(1)
Rouleaux	104	(1)
Miscellaneous	105	(1)
Summary	106	(5)
8 The Rh Blood Group System	111	(13)
Nomenclature	112	(2)
The Fisher-Race Terminology	112	(1)
The Wiener Terminology	112	(1)
The Rosenfield Terminology	113	(1)
Most Probable Genotypes	113	(1)
The RH(o) (D) Antigen	114	(1)
The D mosaic	114	(1)
Weakened Expression of the D Antigen	114	(1)
Other Rh Antigens Encoded at the D Locus	115	(1)
The C and C Antigens	115	(6)
Other Antigens Encoded at the Cc Locus	115	(1)
The E and e Antigens	115	(1)
Other Antigens Encoded at the Ee Locus	115	(1)
The e Mosaic	116	(1)
The G Antigen	116	(1)
Compound Antigens	116	(1)
D Deletion	116	(1)
Rh(null)	116	(1)
The LW Antigens	117	(1)
Rh System Antibodies' Characteristics and Reactivity	118	(1)
Rh Immunoglobulin	119	(1)
Detection of Rh Antigens	119	(1)
Sources of Error	120	(1)
Summary	121	(3)
9 OTHER BLOOD GROUP SYSTEMS	124	(37)
Nomenclature and Classification	127	(1)
The Lewis Blood Group System	128	(4)
The Lewis System Phenotypes and Antigenic Expression	128	(1)
Genetics and Biochemistry of the Lewis System	129	(1)
Biochemistry of the Lewis Antigens	129	(2)
Acquisition of Lewis Antigens by Red Blood Cells	131	(1)
Other Lewis Antigens	131	(1)
Lewis System Antibodies	131	(1)
Clinical Significance of Lewis System Antibodies	132	(1)
Reagents and Testing Methods	132	(1)
Lewis Antibody Neutralization	132	(1)
The I Blood Group System	132	(2)
Biochemistry of the Ii Antigens	132	(1)
Development of I and i Antigens	132	(1)
Antibodies Defining the I System Antigens	133	(1)
Clinical Significance of Anti-I and Anti-i	133	(1)
I Blood Group System Disease Associations	134	(1)
Reagents and Testing Methods	134	(1)
The P Blood Group System	134	(3)
P System Phenotypes and Antigen Expression	134	(1)
Genetics and Biochemistry of the P Blood Group System	135	(1)
Antibodies of the P Blood Group System	135	(1)
Clinical Significance of P System Antibodies	136	(1)
P Blood Group System Disease Associations	137	(1)
Reagents and Testing Methods	137	(1)
The MNSs Blood Group System	137	(5)
Genetics and Biochemistry of the MNSs Blood Group System	137	(3)
MNSs Blood Group Antigens in Paternity Testing	140	(1)
Antibodies of the MNSs Blood Group System	140	(1)
Clinical Significance of MNSs System Antibodies	141	(1)
Reagents and Testing Methods	141	(1)
The Kell Blood Group System	142	(3)
Kell Blood Group System Antigens and Genetics	142	(1)
The McLeod Syndrome and Chronic Granulomatous Disease	143	(1)
Other Weak Kell Phenotypes	144	(1)
Kell System Biochemistry	144	(1)
Antibodies of the Kell Blood Group System	144	(1)
Clinical Significance of Kell System Antibodies	145	(1)
Reagents and Testing Methods	145	(1)
The Duffy Blood Group System	145	(2)
Antibodies Defining the Duffy System	145	(1)
Genetics and Biochemistry of the Duffy System	146	(1)
Clinical Significance of Duffy System Antibodies	147	(1)
Reagents and Testing Methods	147	(1)
Kidd Blood Group System	147	(2)
Antibodies Defining the Kidd System	147	(1)
Genetics and Biochemistry of the Kidd Blood Group System	148	(1)
Clinical Significance of Kidd System Antibodies	148	(1)
Reagents and Testing Methods	149	(1)
The Lutheran Blood Group System	149	(2)
Lutheran System Antigens and Genetics	149	(1)
Antibodies Defining the Lutheran Blood Group System	150	(1)
Biochemistry of the Lutheran System Antigens	150	(1)
Clinical Significance of Lutheran System Antibodies	151	(1)
Reagents and Testing Methods	151	(1)
Miscellaneous Blood Group Systems	151	(3)
Wright	151	(1)
Xg	151	(1)
Diego	151	(1)
Cartwright (Yt)	152	(1)
Dombrock	152	(1)
Colton	153	(1)
Scianna	153	(1)
Cromer	153	(1)
Gerbich	154	(1)
Other Blood Group Antigens	154	(7)
Sd(a)	154	(1)
Bg	154	(1)
Antigens Detected by High-Titer, Low-Avidity Antibodies	155	(1)
Independent High-Frequency Antigens	155	(1)
Independent Low-Frequency Antigens	155	(6)
UNIT 4 Transfusion Practices	161	(78)
10 ANTIBODY DETECTION AND IDENTIFICATION	163	(39)
Direct Antiglobulin Test	164	(1)
Applications	164	(1)
Indirect Antiglobulin Test	164	(2)
Applications	164	(1)
Phases of Testing	165	(1)
Identification of Antibodies	166	(6)
Antigrams	166	(1)
Routine Panels	166	(2)
Categoric Identification of Antibodies	168	(4)
Selected Case Studies	172	(1)
Case Study 1	172	(5)
Medical History	172	(1)
Discussion	172	(5)
Case Study 2	177	(1)
Medical History	177	(1)
Discussion	177	(1)
Case Study 3	178	(1)
Medical History	178	(1)
Discussion	178	(1)
Case Study 4	178	(3)
Medical History	178	(1)
Discussion	178	(3)
Case Study 5	181	(3)
Medical History	181	(1)
Discussion	182	(2)
Case Study 6	184	(2)
Medical History	184	(1)
Discussion	184	(2)
Case Study 7	186	(3)
Medical History	186	(1)
Discussion	186	(3)
Case Study 8	189	(2)
Medical History	189	(1)
Discussion	189	(2)
Case Study 9	191	(1)
Medical History	191	(1)
Discussion	191	(1)
Summary	192	(10)
11 PRETRANSFUSION TESTING	202	(12)
Pretransfusion Testing	203	(2)
The Requisition	204	(1)
Request Forms	204	(1)
Patient Identity	204	(1)
The Patient Sample	204	(1)
Type and Screen	205	(2)
The ABO Blood Group	205	(1)
The Rh Type	205	(1)
Antibody Detection (Antibody Screen)	206	(1)
Blood Selection Guidelines	207	(1)
The Crossmatch	207	(2)
The Immediate-Spin Crossmatch	208	(1)
The Indirect Antiglobulin Test Crossmatch	208	(1)
Additional Considerations for Patients with Antibodies	208	(1)
Interpretation of Crossmatches	208	(1)
Special Considerations for Infants Younger than 4 Months of Age	209	(1)
ABO/Rh	209	(1)
Antibody Screen	209	(1)
Crossmatch	209	(1)
The Electronic "Computer" Crossmatch	210	(1)
Blood Requests for Surgery	210	(1)
Exceptional Protocols	210	(1)
Massive Transfusion	210	(1)
Emergency Requests for Blood	211	(1)
Autoimmune Hemolytic Anemia	211	(1)
Issuing Blood	211	(1)
Summary	211	(3)
12 TRANSFUSION THERAPY	214	(25)
Red Blood Cell Component Transfusion	216	(2)
Description of Components	216	(1)
Red Blood Cell Component Indications	216	(1)
Contraindications to Red Blood Cell Component Transfusion	216	(1)
Administration of Red Blood Cell Components	217	(1)
Platelet Transfusion Therapy	218	(3)
Description of Platelet Components	218	(1)
Platelet Transfusion and ABO Compatibility	218	(1)
Indications for Platelet Transfusion	218	(1)
Contraindications to Platelet Transfusion	219	(1)
Administration of Platelet Components and Assessment of Response to Transfusion	220	(1)
Prevention and Management of Platelet Refractoriness	220	(1)
Granulocytes	221	(1)
Description of Component	221	(1)
Indications for Granulocyte Transfusions	221	(1)
Contraindications to Granulocyte Transfusions	221	(1)
Administration of Granulocytes	222	(1)
Fresh Frozen Plasma	222	(1)
Description of Component	222	(1)
Indications for Fresh Frozen Plasma	223	(1)
Contraindications to Fresh Frozen Plasma	223	(1)
Administration of Fresh Frozen Plasma	223	(1)
Assessment of Response to Transfusion	223	(1)
Cryoprecipitated Antihemophilic Factor (Cryoprecipitate)	223	(2)
Description of Component	223	(1)
Indications for Transfusion	223	(1)
Contraindications to Transfusion	223	(1)
Administration of Cryoprecipitate	223	(1)
Assessment of Response to Transfusion	224	(1)
Clotting Factor Concentrates	224	(1)
Other Plasma Components	225	(1)
Guidelines for Pediatric Transfusion	225	(2)
Whole Blood, Reconstituted Whole Blood, or Modified Whole Blood Transfusion	225	(1)
Red Blood Cells	225	(1)
Platelet Concentrate Transfusions	226	(1)
Transfusion of Fresh Frozen Plasma	226	(1)
Transfusion of Cryoprecipitate	227	(1)
Granulocyte Transfusions	227	(1)
Alternatives to Homologous Component Transfusions	227	(7)
Autologous Transfusion Therapy	227	(1)
Preoperative Autologous Blood Donation	228	(1)
Donor Selection Criteria	228	(1)
Limitations of Preoperative Autologous Donation	229	(1)
Use of Autologous Components	229	(1)
Acute Normovolemic Hemodilution	230	(2)
Intraoperative Blood Salvage	232	(1)
Postoperative Blood Salvage	233	(1)
Summary	234	(1)
Pharmacologic Agents Used in Transfusion Therapy	234	(1)
DDAVP	234	(1)
Administration of DDAVP	234	(1)
Antifibrinolytic Agents	235	(1)
Other Pharmacologic Agents	235	(1)
Growth Factors	235	(1)
Recombinant Human Erythropoietin	235	(1)
Other Growth Factors	236	(1)
Summary	236	(3)
UNIT 5 Clinical Conditions Associated with Immunohematology	239	(76)
13 ADVERSE EFFECTS OF TRANSFUSION	241	(12)
Red Blood Cell Antigen-Antibody Reactions	242	(1)
Immediate Intravascular Hemolysis	242	(1)
Case Study 1	243	(1)
Medical History	243	(1)
Discussion	243	(1)
Delayed Extravascular Hemolysis	244	(1)
Case Study 2	244	(1)
Medical History	244	(1)
Discussion	244	(1)
Pseudohemolytic Reactions	245	(1)
Case Study 3	245	(1)
Medical History	245	(1)
Discussion	246	(1)
White Blood Cell Antigen-Antibody Reactions	246	(1)
Febrile Reactions	246	(1)
Pulmonary Infiltration	246	(1)
Case Study 4	246	(1)
Medical History	246	(1)
Discussion	247	(1)
Bacterial Reactions	247	(1)
Plasma Component Reactions	248	(1)
Allergic	248	(1)
Anaphylactic	248	(1)
Graft-versus-Host Reactions	248	(1)
Miscellaneous Reactions	248	(1)
Hyperkalemia	248	(1)
Transfusion Hemosiderosis	249	(1)
Citrate Toxicity	249	(1)
Hypothermia	249	(1)
Circulatory Overload	249	(1)
Posttransfusion Purpura	249	(1)
Disease Transmission	249	(1)
Cell-Mediated Alloimmunization	249	(1)
Inhibition of Immune Response	250	(1)
Transfusion of ABO-Incompatible Plasma	250	(1)
Case Study 5	250	(1)
Medical History	250	(1)
Discussion	250	(1)
Investigation of Adverse Reactions	250	(1)
Specific Requirements	250	(1)
Investigation of Disease Transmission	251	(1)
Summary	251	(2)
14 TRANSFUSION-TRANSMITTED DISEASES	253	(29)
Viral Infections	254	(19)
Hepatitis Viruses	254	(10)
Retroviruses	264	(6)
Herpesviruses	270	(2)
Parvovirus	272	(1)
Prions	273	(1)
Bacterial Infections	273	(2)
Syphilis	273	(1)
Lyme Disease (Borreliosis)	274	(1)
Parasitic Infections	275	(3)
Malaria	275	(1)
Chagas Disease	276	(1)
Toxoplasmosis	277	(1)
Babesiosis	277	(1)
Leishmaniasis	278	(1)
Summary	278	(4)
15 HEMOLYTIC DISEASE OF THE NEWBORN	282	(13)
Definition	283	(1)
Etiology of HDN	283	(1)
Historical Perspective	283	(1)
Pathogenesis	283	(1)
Red Blood Cell Antibodies That Cause HDN	284	(1)
Rh HDN	284	(1)
ABO Protection	284	(1)
Other Rh Antibodies	284	(1)
Antibodies Outside of the Rh System	284	(1)
ABO HDN	285	(1)
In Vitro Assays to Predict the Severity of HDN	285	(2)
Prevention	287	(1)
Laboratory Investigation	288	(2)
Neonatal Studies	288	(1)
Serologic Problems Seen in HDN	288	(1)
ABO/Rh Testing	288	(1)
Direct Antiglobulin Test	288	(2)
Detecting and Quantifying Fetal-Maternal Hemorrhage	290	(1)
Treatments for HDN	290	(1)
In Utero	290	(1)
Postpartum	290	(1)
Maternal Intervention	291	(1)
Plasma Exchange	291	(1)
Intravenous Immune Globulin	292	(1)
Maternal Immunization to Other Blood Proteins	292	(1)
Summary	292	(3)
16 AUTOIMMUNE HEMOLYTIC ANEMIAS AND DRUG-INDUCED HEMOLYTIC ANEMIAS	295	(20)
Production of Autoantibodies	296	(1)
Classification of Immune Hemolytic Anemias	296	(1)
Pathophysiology of Immune Hemolysis	296	(1)
Laboratory Investigation of Immune Hemolysis	297	(2)
Direct Antiglobulin Test	298	(1)
Elution	298	(1)
Antibody Detection	298	(1)
Adsorption	298	(1)
Warm Autoimmune Hemolytic Anemia	299	(3)
Clinical Description	299	(1)
Treatment	299	(1)
Etiology of WAIHA	300	(1)
Serologic Investigation	300	(2)
Cold Hemagglutinin Syndrome and Cold Hemagglutinin Disease	302	(2)
Clinical Description	302	(1)
Treatment	303	(1)
Etiology of Cold Hemagglutinin Syndrome	303	(1)
Serologic Investigation	303	(1)
Paroxysmal Cold Hemoglobinuria	304	(1)
Clinical Description	304	(1)
Treatment	304	(1)
Serologic Investigation	304	(1)
Drug-Induced Immune Hemolytic Anemia	305	(1)
Mechanisms of Drug-Induced Hemolytic Anemia	306	(5)
Drug Adsorption or Passive Agglutination	306	(2)
Immune Complex or Drug-Dependent Antibody Mechanism	308	(1)
Membrane Modification Mechanism	309	(1)
"True" Drug-Induced Autoimmune Hemolytic Anemia	310	(1)
Unified Mechanism	310	(1)
Summary	311	(4)
UNIT 6 Quality Assurance/Regulatory Issues	315	(46)
17 QUALITY ASSURANCE AND SAFETY IN IMMUNOHEMATOLOGY	317	(21)
Quality Assurance	318	(12)
Quality Assurance Department	319	(1)
Personnel	319	(1)
Standard Operating Procedures	320	(2)
Documentation and Records	322	(1)
Nonconformance	323	(1)
Peer Review	324	(1)
Quality Assurance Audits	324	(1)
Inspections	324	(1)
Supplier Qualification	325	(1)
Facilities, Equipment, and Process Activities	325	(2)
Label Control	327	(1)
Lot Release	327	(1)
Problem-Solving	327	(2)
Performance Indicators	329	(1)
Prevention	329	(1)
Summary	330	(1)
Biosafety in the Blood Center and Transfusion Service	330	(6)
Regulatory Agencies	330	(1)
Classification of Work Activity	330	(1)
Standard Operating Procedures and Training	331	(1)
Universal Precautions	331	(1)
Personal Protective Equipment	331	(1)
Safety Practices	332	(1)
Needle Precautions	333	(1)
Storage	333	(1)
Basic Safety Precautions	334	(1)
Injuries and Exposures	334	(1)
Waste Management	335	(1)
Radiation	336	(1)
Summary	336	(2)
18 REGULATIONS AND STANDARDS	338	(11)
American Association of Blood Banks	339	(1)
Objectives	339	(1)
AABB Quality Plan	340	(1)
The Food and Drug Administration	340	(2)
History	340	(1)
Objective	340	(2)
Health Care Finance Administration	342	(4)
Clinical Laboratory Improvement Amendments of 1988	342	(2)
Joint Commission on Accreditation of Healthcare Organizations	344	(1)
College of American Pathologists	345	(1)
Other Agencies	346	(1)
International Organization for Standardization	346	(1)
Nuclear Regulatory Commission	346	(1)
Department of Transportation	346	(1)
Environmental Protection Agency	346	(1)
Occupational Safety and Health Administration	347	(1)
Summary	347	(2)
19 PROCESS CONTROL	349	(12)
Understanding Processes	349	(1)
Process Control Elements	350	(1)
Standard Operating Procedures	350	(1)
Training	350	(1)
Instrument and Equipment Monitors	350	(1)
Review	350	(1)
Quality Control	351	(1)
Internal Self-Assessment	351	(1)
Statistical Process Control	351	(1)
Data Collection	351	(1)
Total Quality Tools	351	(7)
Pareto Chart	352	(1)
Flowchart	352	(1)
Histograms	352	(2)
Scatter Diagrams	354	(1)
Run Charts	355	(1)
Control Charts	355	(1)
Cause-and-Effect Diagrams	356	(2)
Supplier Qualification	358	(1)
Supplier Impact	358	(1)
Supplier Qualification	358	(1)
Change Control	359	(1)
Summary	359	(2)
UNIT 7 Additional Topics to Consider	361	(24)
20 HUMAN LEUKOCYTE ANTIGENS	363	(22)
Nomenclature and Genetics	364	(3)
Antigens and Antibodies	367	(2)
Histocompatibility Typing Procedure	369	(6)
Microlymphocytotoxicity Assay for HLA-A, HLA-B, and HLA-C	369	(1)
Mixed Lymphocyte Reaction for HLA-D	370	(1)
HLA Typing by DNA Analysis	371	(4)
Applications of HLA Testing	375	(4)
Paternity Testing	375	(1)
HLA in Platelet Transfusion	376	(1)
HLA in Transplantation	377	(1)
HLA Disease Association	378	(1)
Summary	379	(6)
Answers to Review Questions	385	(2)
Glossary	387	(10)
Appendix A/Study Aid	397	(52)
Index	449