Blood Bank - Blood Group Immunology & Physiology and Pathophysiology
34. Which procedure used to obtain a fetal blood sample to monitor severity of hemolytic disease of the fetus and newborn (HDFN) can also be used to deliver intrauterine transfusions? A. Amniocentesis B. Cordocentesis C. Doppler sonography D. Exchange transfusion via maternal circulation
B
41. Fresh frozen plasma should be used for which of the following? A. Platelet replacement B. Coagulation deficiencies C. Volume replacement D. Albumin replacement
B
97. Which of the following changes in titers would be considered significant when monitoring maternal antibodies using a doubling dilution? A. 16 to 32 B. 4 to 8 C. 8 to 32 D. 8 to 16
C
35. Which of the following is NOT considered a characteristic of paroxysmal cold hemoglobinuria (PCH)? A. Patient population: children and young adults B. Pathogenesis: following viral infection C. Site of hemolysis: intravascular D. Autoantibody class: IgM
D
1. The addition of Low Ionic Strength Solution (LISS) to the testing environment when performing an indirect antiglobulin test is designed to do what? A. Lowering the zeta potential B. Increasing the zeta potential C. Bind IgG antibodies attached to patient RBC's D. Bind IgM antibodies found in patient serum or plasma
A
18. ABO antibodies are classified as which of the following two immunoglobulin classes? A. IgG and IgM B. IgM and IgA C. IgA and IgG D. IgE and IgM
A
26. Following the treatment of an IgG molecule with papain, which of the following will remain? A. Two Fab fragments each with a light chain and a partial heavy chain attached with a disulfide bond B. Four separate light chains and two separate heavy chains C. One unit that consist of a two partial heavy chains, two light chains all attached with a disulfide bond D. Eight units, two complete light chains, and two heavy chains split in half
A
27. The majority of Lewis antibodies are of which immunoglobulin class? A. IgM B. IgG C. IgA D. IgE
A
28. Which one of the following tests BEST correlates with the severity of hemolytic disease of the fetus and newborn (HDFN)? A. Color Doppler ultrasonography B. An antibody screen of mother's blood C. Amniotic fluid bilirubin D. Antibody titer of mother's blood
A
3. What is the minimum volume (milliliters) of Rh positive red blood cells that would be needed to produce anti-D in an Rh negative individual? A. < 0.1 mL B. 1 mL C. 5 mL D. > 10 mL
A
37. A D-positive mother with a D-negative fetus eliminates the possibility of HDFN due to the: A. D antigen B. ABO antigen system C. Lewis antigen system D. Rh antigen system
A
39. A solution of gamma globulins containing anti-Rh(D) is given to an Rh(D) negative mother to: A. Prevent fetal cells from initially sensitizing the mother B. Neutralize any of the child's antibody that may have passed the placental barrier C. Neutralize any natural maternal antibodies present D. Prevent greater antibody response in a previously sensitized mother
A
46. In which of the following cases should Rh Immune Globulin (RhIG) be given? A. Ectopic pregnancy B. Rh positive mother carrying an Rh negative fetus C. Rh postive mother carrying an Rh positive fetus D. Rh negative mother with anti-D formed from previous pregnancy
A
51. After birth, which of the following is the biggest concern for a newborn infant suffering from hemolytic disease of the fetus and newborn? A. Accumulation of bilirubin B. Anemia due to red blood cell destruction C. Decrease in bilirubin level D. Low hematocrit values
A
62. Which of the following is the most important factor in determining the immediate outcomes of kidney transplants? A. ABO compatibility B. HLA compatibility C. Rh compatibility D. Other blood group system compatibility (Kell, Kidd, and Duffy)
A
64. In order to detect the presence of antibodies fixed on the RBC's of newborns one should: A. Perform a direct antiglobulin test (DAT) on the cord blood B. Perform an indirect antiglobulin test (IAT) on the cord blood C. Test the baby's cells with typing antiserum D. Look for agglutination in a mixture of mother's serum and baby's cells
A
67. Which of the following is the most common type of autoimmune hemolytic anemia? A. Warm autoimmune hemolytic anemia. B. Cold agglutinin disease. C. Paroxysmal cold hemoglobinuria. D. Drug-induced immune hemolytic anemia.
A
71. If possible, what is the recommended time interval for Rh immune globulin administration to the Rh negative mother following the delivery of an Rh positive or weak-D positive infant? A. 72 hours B. One week C. Two weeks D. Prior to another pregnancy
A
73. What is the cause of neonatal alloimmune thrombocytopenia (NAIT)? A. Destruction of a neonate's platelets by alloantibodies crossing the placenta from the mother. B. Destruction of a neonate's platelets by an antibody that is produced by the neonate's own immune system. C. Decreased platelet production in the neonate. D. Destruction of a mother's platelets by alloantibodies crossing the placenta from the neonate.
A
77. In the Kleihauer-Betke test, a maternal blood smear is treated with acid and then stained with counterstain. The fetal cells contain fetal hemoglobin, which is resistant to acid and will remain pink. Since the calculated volume of fetomaternal hemorrhage is an estimate, how many additional RhIg vials need to be added for the dose? A. 1 B. 1.5 C. 2 D. 3
A
78. What is the expected life span of a normal red blood cell? A. 3-4 months B. 1-2 months C. 3-6 weeks D. 1-3 weeks
A
87. How does RhIg prevent anti-D production? A. Mainly by suppressing the immune response after exposure to D positive cells. B. Mainly by clearing antibody sensitized D negative RBCs from maternal circulation. C. Mainly by clearing IgG fetal antibodies from maternal circulation. D. Mainly by clearing maternal IgM antibodies from fetal circulation. Feedback
A
88. Many red blood cell (RBC) processes, such as binding, transporting, and releasing oxygen, do NOT require energy. Energy however, is required for cellular viability. How does the RBC obtain most of it's energy? A. Glycolytic pathways B. Hexose-monophosphate shunt C. Rapoport-Luebering pathway D. Methemoglobin reductase pathway
A
89. Which cluster of differentiation (CD) is used for the quantification of hematopoietic progenitor cells (HPC) after an HPC-apheresis collection? A. CD34 B. CD4 C. CD8 D. CD2
A
93. The direct antiglobulin test (DAT) is most unreliable when diagnosing hemolytic disease of the fetus and newborn due to which blood group system? A. ABO B. Duffy C. Rh D. Kidd
A
95. When performing the rosette test to screen for Fetal Maternal Hemorrhage, what is considered the correct combination to avoid false positives and/or false negatives? A. Fetal cells D positive & mother is D negative B. Fetal cells D positive & mother is weak D positive C. Fetal cells weak D positive & mother is D negative D. Any combinations could cause false positive and/or false negative results with the rosette test
A
96. Which type of antibody can cause HDFN in any pregnancy (first or subsequent), but is usually limited to less severe symptoms? A. Anti-A,B B. Anti-D C. Anti-E D. Anti-K
A
98. For which of the following antibodies is the DAT most likely to be NEGATIVE when testing a newborn for possible HDFN? A. Anti-A,B B. Anti-c C. Anti-D D. Anti-K
A
10. A primary immune response typically presents with which class of antibody? A. IgG B. IgM C. IgA D. IgD
B
16. Most antibodies present in cord blood are of ________ origin. A. Fetal B. Maternal C. Paternal D. Maternal and paternal
B
17. Which of the following choices best describes the primary function of antibodies? A. Protection of B-lymphocytes B. Binds with antigen C. Fixes complement D. Stimulates the immune response
B
19. Which subset of effector lymphocytes is predominantly responsible for regulation of antibody production? A. TH1 B. TH2 C. TH17 D. CD8+
B
2. The immunoglobulin class responsible for the etiology of Hemolytic Disease of the Fetus and Newborn (HDFN) is: A. IgM B. IgG C. IgD D. IgE
B
22. How are antibodies to the ABO blood group antigens unique? A. Laboratory tests are available for their identification B. The antibodies are naturally occurring to antigens that are absent from the red cell membrane C. The antibodies are formed after the individual has been immunized D. The antibodies are IgM
B
23. What kind of immunoglobulins are predominantly found in Rh immune globulin? A. IgM anti-D B. IgG anti-D C. IgM anti-A,B D. IgG anti-A,B
B
30. What is the principle of the Kleihauer-Betke test? A. Fetal cells present in the mother's blood smear contain fetal hemoglobin (Hgb F). When treated with acid the fetal cells are sensitive and become ghost cells. B. Fetal cells present in the mother's blood smear contain fetal hemoglobin (Hgb F). When treated with acid the fetal cells are resistant and will stain pink with the counter stain. C. Maternal red blood cells contain fetal hemoglobin (Hgb F). When treated with acid the maternal cells are resistant and will stain pink with the counter stain. D. Paternal cells present in the mother's blood smear are stained pink with an acid treatment.
B
32. The appropriate dosage of Rh immune globulin (RhIg) to administer post-delivery to an Rh negative mother delivering an Rh positive child is calculated based on the estimated volume of fetal bleed. What is the value of x in the formula given below that is used to calculate RhIg dosage? Number of vials of 300 µg RhIg = volume of fetal bleed/x mL A.10 B. 30 C. 100 D. 300
B
44. One standard 300 µg vial of RhIg contains enough anti-D to protect against what amount of whole blood exposure? A. 15 mL B. 30 mL C. 1 L D. 5 mL
B
47. Which of the following methods are a non-invasive way to reliably predict anemia in the fetus? A. Antibody titer C. Color Doppler middle cerebral artery peak systolic velocity (MCA-PSV) C. Cordocentesis D. Aminocentesis
B
48. The MOST reliable method for determining the appropriate dosage of Rh immune globulin to give to an identified Rh immune globulin candidate after delivery is: A. Kleihauer-Betke method B. Flow cytometry C. Rosette test D. Panel cells
B
50. In blood banking, the Direct Antiglobulin Test (DAT) is used in the investigation of which of the following clinical conditions? 1. Hemolytic Disease of the Fetus and Newborn (HDFN) 2. IgA deficiency 3. Hemolytic Transfusion Reaction (HTR) 4. Zika virus infection A. 1, 2, 3 B. 1, 3 C. 2, 4 D. 2, 3, 4
B
52. A D-negative mother gives birth to a baby that tests as D-negative in the immediate spin phase. What step should be performed next? A. Calculate dose for RhIg B. Perform a weak D test C. Administer one dose of RhIg D. Perform a Kleihauer-Betke stain
B
53. Which symptom of HDFN does phototherapy help prevent? A. Anemia B. Kernicterus C. Enlarged spleen D. Hydrops
B
61. Why is Rh immune globulin (RhIg) administered within 72 hours of delivery to an Rh negative mother if the newborn is found to be D-positive or weak-D positive? A. Prevent future children from producing antibodies B. Prevent fetal cells from initially sensitizing the mother C. Prevent antibody response in a previously sensitized mother D. Neutralize any natural maternal antibodies present
B
63. An Rh negative mother has just given birth to an Rh positive baby. Her physician suspects that she has experienced a fetal-maternal hemmorhage since her rosette test was positive. Upon performing the Kleihauer-Betke stain procedure, the percentage of fetal cells is found to be 0.85%. The mother's total blood volume is 4,565 mL. What dose of Rh Immune Globulin (RhIG or RhoGam) should be administered to the mother? A. 1 vial B. 2 vials C. 3 vials D. 4 vials
B
68. A pregnant female has been injected with Rh Immune Globulin (RhIG) antenatally (28 weeks gestation) and has a positive antibody screen at delivery. The antibody has been confirmed as anti-D alone and reacts only weakly (1+ in the indirect antiglobulin test). This antibody may be the result of: A. Massive fetomaternal hemorrhage at delivery B. Passive anti-D (RhIg) received at 28 weeks. C. Wharton's jelly contaminating the sample D. Patient has an autoantibody
B
69. What would be the best way to determine how much RhIg should be given to a postpartum female who received RhIG antenatally and demonstrates the anti-D antibody at delivery? A. Antibody titration B. Flow cytometry C. Rosette test D. Kleihauer-Betke acid elution
B
7. The "recognition unit" of the classical complement pathway refers to which of the following? A. C5b, C6, C7, C8, C9 B. C1q C. C3a D. C4
B
76. What is the BEST technique for monitoring the severity of hemolytic disease of the fetus and newborn (HDFN)? A. Amniocentesis B. Doppler ultrasound C. Antibody titration D. Cordocentesis
B
79. How many doses of RhIG should be administered if the calculated amount of fetal whole blood volume in maternal circulation was 28 mL? A. 1 dose B. 2 doses C. 3 doses D. 4 doses
B
82. Which of the following tests is suitable for quantifying the size of fetomaternal hemorrhage (FMH)? A. DAT B. Kleihauer-Betke test C. Rosette test D. IAT
B
84. What kind of immunoglobulins are predominantly found in Rh immune globulin? A. IgM anti-D B. IgG anti-D C. IgM anti-A,B D. IgG anti-A,B
B
91. Which of the following individuals is a candidate to receive RhIg? A. An Rh positive mother upon delivery of her 3rd child. B. An Rh negative mother upon delivery of her first child. C. An Rh negative mother who had previously developed anti-D. D. An Rh positive mother who miscarried after 2 months.
B
94. Which finding best distinguishes immune hemolytic anemia from other hemolytic anemias? A. Rouleaux B. Positive DAT C. Splenomegaly D. Increased erythrocyte count
B
11. Which class of antibody can agglutinate erythrocytes (RBCs) after anti-human globulin (AHG) is added to the test tube? A. IgA B. IgE C. IgG D. IgM
C
13. What would be considered a common characteristic of anti-Jka and anti-Jkb? A. The immunoglobulin class is IgM. B. Agglutination reactions are best observed by DAT. C. The antibodies show dosage of Kidd antigens on red cells. D. The antibodies are naturally occurring.
C
14. What section of an immunoglobulin molecule is responsible for the differences between immunoglobulin classes? A. Fc B. Fab C. Heavy chains D. Light chains
C
20. Which of the following immunoglobulins are capable of fixing complement by the classical pathway? A. IgG and IgA B. IgM and IgA C. IgG and IgM D. IgG and IgD
C
21. The primary antibody response takes an average of how many days? A. 1-3 days B. 3-4 days C. 5-10 days D. 14-21 days
C
24. A primary immune response is generally associated with which antibody? A. IgG B. IgA C. IgM D. IgD
C
25. What is the explanation for a discrepancy in the following front type and back type in a newborn? Anti-A = neg Anti-B = neg A1 cells = neg B cells = neg A. Red cells are totally coated with antibody. B. The newborn is missing antigens. C. The baby's antibodies are undeveloped. D. Unable to determine.
C
29. How does hydroxyurea aid in the treatment of sickle cell disease? A. Acts as an analgesic in pain management. B. Prevents sickle cells from clumping together. C. Induces increased production of HbF. D. Reduces the number of sickle cells that form.
C
33. In the interest of safety, it is the policy at XYZ hospital to always add one extra 300 µg vial of RhIG, regardless if the dosage calculation is rounded up or rounded down. After performing a Kleihauer-Betke test, a technologist in the laboratory at XYZ hospital calculates the fetomaternal hemorrhage to be 45 mL of fetal whole blood. How many 300 µg vials of RhIG should be administered to this woman? A. One B. Two C. Three D. Four
C
38. A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions: A. Neural tube defects B. Maternal hypertension C. Hemolytic disease of the newborn D. Maternal diabetes
C
43. Which of the following set of conditions would NOT allow HDFN to occur as a result of Rh incompatibility? A. Mother Rh-negative, father Rh-positive B. Mother Rh-negative, baby Rh-positive C. Mother Rh-negative, father Rh-negative D. Mother Rh-negative, father Rh-unknown
C
45. In HDFN which of the following antigen-antibody reactions is occurring? A. Maternal antibody is directed against fetal antibody. B. Maternal antigen is directed against fetal antibody. C. Maternal antibody is directed against fetal antigen. D. Maternal antigen is directed against fetal antigen.
C
49. A rosette test to screen for fetomaternal hemorrhage (FMH) is indicated in all of the following situations, EXCEPT: A. A weak D-positive infant B. A D-positive infant C. A D-positive mother D. A D-negative mother
C
5. Which of the following cells are capable of producing antibodies? A. Thrombocytes B. Macrophages C. Lymphocytes D. Neutrophils
C
54. Which symptom of hemolytic disease of the fetus and newborn (HDFN) is associated with low levels of glucuronyl transferase? A. Anemia B. Increased reticulocyte count C. Jaundice D. Cardiac failure
C
56. To prevent Rh alloimmunization in pregnancy between mother and fetus, it is recommended to initiate RhIG prophylaxis when? A. Rh-positive pregnant females, postpartum. B. Rh-negative pregnant females, antenatal in the first trimester. C. Rh-negative pregnant females, antenatal in the third trimester. D. Rh-positive pregnant females after delivery of an Rh-positive infant.
C
57. Which of these methods measures fetal hemoglobin or D positive red cells or both to evaluate fetomaternal hemorrhage? A. Rosette test B. Kleihauer-Betke test C. Flow cytometry D. AHG testing
C
58. Which of the following describes the main function of hemoglobin? A. Hemostasis B. Fight infection C. Carry oxygen D. Support bone marrow stroma
C
59. All of the following cellular antigens are important to an immunohematologist EXCEPT: A. Blood group antigens B. Histocompatibility antigens C. Haptens D. Autoantigens
C
60. Which of the following characteristics of hemolytic disease of the fetus and newborn (HDFN) is NOT different for ABO and Rh HDFN? A. Disease predicted in titers B. Anemia at birth C. Antibody is IgG D. Bilirubin at birth
C
66. If detected in antibody screen testing, which of the following antibodies is NOT considered clinically significant in prenatal patients? A. Anti-M B. Anti-N C. Anti-Leb D. Anti-Fya
C
70. What is a common difference between paroxysmal cold hemoglobinuria (PCH) and cold hemagglutinin disease (CHD)? A. PCH is a cold autoimmune anemia while CHD is acquired B. PCH is a warm autoimmune anemia while CHD is room temperature C. PCH is caused by an IgG antibody while CHD is usually caused by an IgM antibody D. PCH is typically an IgM antibody while CHD is usually caused by an IgE
C
75. An Rh negative pregnant female has produced anti-D and the physician has decided to use molecular typing to determine if the fetus is at risk. Which of the following test results makes fetal DNA testing a recommended second step? A. Molecular genotyping demonstrates that the father lacks the RHD allele. B. Molecular genotyping demonstrates that the father is homozygous for the RHD allele. C. Molecular genotyping demonstrates that the father is heterozygous for the RHD allele. D. Molecular genotyping demonstrates that the father is heterozygous for the RHCE allele.
C
8. Compared to the primary immune response, the secondary immune response typically demonstrates: A. Less antibodies produced B. A longer lag time C. More antibodies produced D. A lower affinity
C
81. Which group of conditions increases the risk of HbS polymerization? A. Acid pH, dehydration, decreased level of 2,3-DPG B. Alkaline pH, dehydration, increased level of 2,3-DPG C. Acid pH, dehydration, increased level of 2,3-DPG D. Alkaline pH, dehydration, decreased level of 2,3-DPG
C
83. What is the most common treatment for hemolytic disease of the fetus and newborn (HDFN) due to ABO incompatibility? A. Intravenous immune globulin (IVIG) B. Intrauterine transfusion C. Phototherapy D. Exchange transfusion
C
85. What is the Kleihauer-Betke test used for? A. Screen for sickle cell anemia B. Screen for fetal hemoglobin C. Differentiate between maternal and fetal red cells D. Screen for hemoglobin A1c
C
86. Which of the following consequences of severe hemolytic disease of the fetus and newborn (HDFN) is most associated with neonatal death before or shortly after birth? A. Enlarged liver B. Enlarged spleen C. Cardiac failure D. Hyperbilirubinemia
C
92. Severe blood loss causing circulatory collapse and shock usually first occurs when what percentage of blood is lost? A. 5 to 10% B. 20% C. 30 to 40% D. 60%
C
12. The most significant blood group antibodies belong to which immunoglobulin classes? A. IgA and IgD B. IgA and IgM C. IgE and IgD D. IgG and IgM
D
15. Which class of immunoglobulins is implicated in hemolytic disease of the fetus and newborn (HDFN)? A. IgA B. IgM C. IgE D. IgG
D
31. Hemolytic anemias are diagnosed by clinical findings and laboratory test results. All of the following are lab values that are relied on to help diagnose hemolytic anemia EXCEPT? A. Hemoglobin and/or hematocrit B. Retic count and RBC morphology C. Bilirubin and haptoglobin D. Fibrinogen and C-reactive protein
D
36. An Rh negative mother has just given birth to an Rh positive baby after 18 hours of strenuous labor. Her rosette test was positive. Upon performing the Kleihauer-Betke stain procedure, the percentage of fetal cells is found to be 1.9%. The mother's total blood volume is 5,000 mL. What dose of Rh Ig (RhoGam) should be administered to the mother? A. 1 vial B. 2 vials C. 3 vials D. 4 vials
D
4. Which characteristic best describes IgG antibodies produced against red blood cells? A. Are naturally occurring B. Cannot be identified using the AHG test C. React best at room temperature D. React best at 37o Celsius
D
40. Which of the following criteria for donor RBC should be used for an exchange transfusion related to both HDFN due to anti-D and ABO HDFN? A. Reconstituted with group O fresh frozen plasma B. Negative for hemoglobin F C. Reconstituted with cryoprecipitate D. Irradiated
D
42. All of the following can be indications of anemia and the potential need for a transfusion of packed red cells EXCEPT? A. Pulse rate greater than 100 beats per minute B. Respiration rate greater than 30 breaths per minute C. Hemoglobin of 7 g/dL or less D. Increased haptoglobin
D
55. While working at a blood bank laboratory, you hear chimes over the hospital loudspeaker system announcing the birth of a baby. Thirty minutes later, you receive a cord blood specimen that you identify as O positive. You previously received the mother's specimen and she was O negative with a negative antibody screen. What is the next action? A. Issue one vial of RhIg B. Perform a Kleihauer Betke stain C. Nothing - Mom is not at risk for anti-D D. Perform a fetal bleed screen
D
6. The immediate spin phase of an indirect antiglobulin test (antibody screen and antibody identification) could most likely lead to the detection of which of the following? A. Clinically significant warm antibodies B. Clinically significant cold antibodies C. Clinically insignificant warm antibodies D. Clinically insignificant cold antibodies
D
65. All of the following are indications for administering Rh immune globulin (RhIg) to an Rh negative woman, EXCEPT? A. Therapeutic abortion B. Ectopic pregnancy C. Rh positive fetus D. Rh negative fetus
D
72. Who would be a candidate, at 28 weeks gestation and had a negative antibody screen, to be injected with Rh immune globulin (RhIg)? A. Rh positive mother with Rh negative fetus B. Rh positive mother with Rh positive fetus C. Rh negative mother with Rh negative fetus D. Rh negative mother with Rh positive fetus
D
74. Certain clinical conditions such as Hemolytic Disease of the Fetus and Newborn (HDFN), Hemolytic Transfusion Reaction (HTR), and Autoimmune Hemolytic Anemia (AIHA) result from the attachment of antibodies or complement to human RBCs. What is this process called? A. Desensitization B. Non-sensitization C. In vitro sensitization D. In vivo sensitization
D
80. In order to avoid repeating pretransfusion testing on a neonate during one hospital admission, all of the following must be true, EXCEPT? A. Received only ABO-compatible blood B. Received only Rh-compatible blood C. No unexpected antibodies in the serum or plasma D. Has only received formula for nourishment
D
9. Why is it dangerous to transfuse a blood group O person with a unit of blood group A? A. The patient will make antibodies to the type A blood. B. The group A blood may become the prominent blood group. C. The patient's Anti-O would destroy the donor's cells with severe consequences to the patient. D. The patient's anti-A would destroy the donor's cells with severe consequences to the patient
D
90. Of the following, what is the recommended routine testing to be performed on a newborn of a group B Rh positive female? A. ABO and Rh testing would routinely be performed in this scenario. B. ABO, Rh and DAT would routinely be performed in this scenario. C. ABO, Rh and antibody screening would routinely be performed in this scenario. D. ABO/Rh, DAT and/or antibody screening are NOT routinely performed in this scenario.
D
