Blood bank final
rule of three
need 3- and 3+ cells to react with the Ab
errors
never erase, white out, etc. Draw a straight line through error, correct, initial
temporarily deferred
25 yr old man treated for syphillis 3 months ago 27 yr old woman returning from the peace corps in Nigeria who was vaccinated for typhoid 6 months ago 18 yr old woman currently taking accutane for acne 22 yr old who returned from Iraq 3 months ago and was vaccinated for tetanus and yellow fever befor being deployed 48 yr old man taking Propecia for baldness
acceptable
28 yr old man who was incarcerated overnight for unspecified reason 2 months ago 53 yr old woman taking a beta-blocker for hypertension 65 yr old woman taking sleep meds at night 19 yr old woman who recently finished the three-part vaccination for hep B surface antigen
indefinate
50 yr old woman on vacation in the US who currently lives in England
no height requirement, 110lbs
A 21-yr old college student wishes to participate in a double red program at the local blood center by donating red blood cells collected by apheresis. What is the minimum height and weight requirement that she must meet?
urticarial
A 44 yr old woman has a hemoglobin level of 6.1g/dL. WBC and platelet counts are w/in normal levels. The patient is group O D-neg w/ a neg antibody screen. Crossmatches are compatible, however 15 mins after first transfusion, she experiences erythema and hives. What type of transfusion reaction is occuring?
X-linked dominant
A father carries the Xga blood group trait and passes it on to all of his daughters but to none of his sons. What type of inheritance pattern does this demonstrate?
Group A, B, and AB
A group A man marries a group AB woman. The father of the group A man was group O. What possible ABO phenotypes could be expected in the offspring?
Immediate spin
A group O patient was crossmatched with group B red blood cells. What phase of the crossmatch will first detect this incompatibility?
pellet of cells at the bottom of the column.
A negative reaction in the MTS GEl test would appear as a:
hypovolemic shock
A patient demonstrated the following symptoms: hypotension, tachycardia, cold or clammy skin, and cyanosis. What is the most likely cause?
R1R1
A patient phenotypes as D+C+E-c-e+. The most likely genotype is:
k in the Kell system
A patient's antibody history listed an anti-cellano. This antigen is also known as:
Group B
A patient's red cells are agglutinated by anti-B, but not by anti-A. What is this patient's ABO phenotype?
heterozygote
A person whose red cells type as M+N+ with antisera would be:
Anti-c
A recipient is group O with the following Rh phenotype: D+, C+, c-, E+, e+. If this recipient is transfused with red blood cells from six random group O D positve donors, what Rh alloantibody could this patient produce as a result of transfusion?
AB and A
A recipient with group A phenotype requires a transfusion of 2 units of frozen plasma. Which of the following types are appropriate to select for transfusion?
false-negative
A tech added 4 drops of a 5% red cell suspension instead of the required 1 drop to a hemagglutination test. What is the potential consequence to the test results?
No; she should have brought the error to the tech's attention
A tech in training noticed that the person training her had not recorded the results of a test. To be helpful, she carefully recorded the results she saw at a later time, using the tech's initials. Is this an acceptable procedure?
IgG
Able to cross the placenta
Anti-B
According to Landsteiner's rule (law), what ABO antibody will be detected in a group A individual's serum?
AS-3
Addition of which of the following will increase the shelf life of red blood cells?
4+
After adding antigen and antibody to a test tube, one large agglutinate was observed. How should this reaction be graded?
2
Age-16 Hct-35% temp-37.2 hgb-12.0 g/dL history-HPV imm, 1 wk ago How many of the above results would exclude this donor from donating?
restore platelet count
All of the following are goals of an exchange transfusion except to:
it is required only if the tech has no experience
All of the following are true regarding competency testing except:
56
Allogenic whole blood donors may donate every ________ days
ALL OF THE ABOVE affinity maturation of the immunoglobulin molecule anamnestic response isotope switching
An antibody identified in the transfusion service appeared to be reacting stronger following the second exposure to an antigen from a transfusion. The most likely explanation of this observation is:
Perform a direct antiglobulin test on the incompatible unit
An antibody screed on a patient with a prior history of transfusion was neg. The crossmatch was incompatible with one unit selected at AHG phase. What is the next step in the investigation?
autologous
An antigen that originates from the individual is termed:
R1r
An individual's blood cells gave the following reactions with antisera: Anti-D Anti-C Anti-E Anti-c Anti-e Rh control 4+ 3+ 0 3+ 3+ 0 The most probable genotype is:
K+, D-, Jk(a-)
Anti-D, anti-K, and anti-Jka are the antibodies that are tentatively identified on a panel after initially ruling out on negative cells. What selected cell from another panel should be chosen to confirm the presence of anti-K?
Kidd
Antibodies to which blood group sys is often implicated in delayed transfusion reactions?
IgE
Associated with allergic reactions and mast cell activation
IgM
Associated with immediate-spin in vitro reactions
IgM
Associated with intravascular cell distruction
ry
CE
r'
Ce
Rz
DCE
R0
Dce
Human Leukocyte Antigen (HLA) typing
Documentation of a transfusion reaction investigation should include all of the following except:
IgM
Efficient in activation of the complement cascade
6 weeks
Following delivery, what is the deferral time for donating a unit of whole blood?
72 hours
Following delivery, when should Rh immune globulin be given?
72 hours
Following donation, how long does it take to replace the fluid lost from giving whole blood?
IgA
Found in secretions, such as breast milk
A and B graft vs host disease graft rejection
HLA matching between the donor and recipient is important for progenitor cel transplantation to avoid
IgM
Has the highest number of antigen binding sites
IgG
Has the highest serum concentration
Both parents are heterozygous D-positive
How it is genetically possible for a child to phenotype as D-negative?
7 days
How long following transfusion must the recipient's sample be stored?
16 weeks
How long must a donor wait to donate red blood cells again following a 2-unit red blood cell apheresis donation?
2
How many units of red blood cells are required to raise the hematocrit of a 70kg nonbleeding adult man from 24% to 30%?
8 weeks
How often can a person donate a unit of whole blood for a directed donation?
D-positive
How would a donor who tested negative with anti-D reagent upon immediate-spin and positive in antihuman globulin test be labeled?
48 hours
If a prospective donor has participated in a plasmapheresis program, how long must he or she wait to donate whole blood?
Release group O, D-negative RBC units
If an emergency exists and there is not enough time to perform a crossmatch for red cells, what is the correct procedure?
recollect
If discrepancies are found in specimen labeling or if current records do not match patient history what must be done?
3 days
If the recipients was transfused within the last 3 months, how long from the time of collection can sample be used for the crossmatch?
expiration date, color/appearance, records/clerical
Important aspects of blood "signout" are:
Vital signs, patient ID, education & consent, y tubing if needed for .9% saline, observe pt periodically
Important aspects of blood administration
known is rgt RBCs (antigen) unknown is pt serum (antibodies)
In Ab screen and ID what is the known and what is the unknown
AO and BO
In a family study, all four siblings in the family had different blood type: A, B, O, and AB. What is the most likely genotypes of the parents?
antibody excess
In a serologic test, the term prozone is also known as:
Two more k-negative cells should be tested
In an antibody identification panel only one red cell was negative at the antihuman globulin phase. On ruling out and matching the pattern, an anti-k was identified. What further testing is necessary to confirm the antibody
Anti-Lea
In the process of identifying an antibody, the technologist observed 2+ reactions with 3 of the 10 cells in a panel at the immediate spin phase. These reactions disappeared following incubation at 37° C and the antihuman globulin phase of testing. The antibody most likely to be responsible is:
ALL OF THE ABOVE recognizing errors in sample ID flagging discrepancies with previous test results providing a mechanism for the electronic crossmatch
LIS interfaces are an important component in automation because of its potential in:
vitro
Monoclonal antibodies are prepared in:
IgM
Most "naturally occuring" ABO system antibodies fall into which immunoglobulin class?
clerical
Number one cause of problems with transfusion
human leukocyte antigen typing
Of the following markers used to test for paternity, which marker provides the most useful statistical value?
Safety glasses splash barriers masks ALL OF THE ABOVE
Personal protective equipment includes
Creutzfeldt-Jakob disease
Persons who have had injections of human growth hormone are permanently deferred as blood donors. What disease is associated with the injections?
continuous quality improvement plans
Plans that provide the framework for establishing quality assurance in an organization are:
fibrin can interfere with agglutination interpretation
Plasma is not the preferred specimen for tube test methods because:
polyclonal in specificity
Reagent antibodies prepared from human sources are:
IgG anti-D
Rh immune globulin contains
30 minutes
Safe time blood can be out of the blood bank
Technique that disassociated IgG antibodies from red cells for further identification
Select the best description of the elution technique
The sample must be labeled at the bedside
Select the correct statement regarding the collection of a blood sample for compatibility testing.
IgM
Select the immunoglobulin class produced first in the primary immune response
paternal serum
Select the item that cannot be used to perform an antibody screen for an infant less than 4 months old.
Prevent formation of all red cell antibodies
Select the item that compatibility procedures will not address
r"r; 4+ anti D detected (mother); R2r: DAT pos (newborn)
Select the situation where the administration of Rh immune globulin would be contraindicated
allogenic
Select the term that describes cells or tissue from a genetically different individual within the same species
O
The children of a group AB mother and group B father could phenotype as all of the following except:
15%
The frequency of the D-negative phenotype in the population is
IS, 37deg, AHG
The full crossmatch involves what phases?
helps achieve consistency of results
The standard operating procedure is a document that:
place units in inventory bc the temp is acceptable
The temp of a RBC unit shipment from the local blood center was recorded as 8deg C upon arrival at the hospital. What is the correct course of action?
TRALI (transfusion related acute lung injury)
The use of only male donors as a source of plasma for transfusion is a method to reduce the risk of:
D neg, D pos
To be considered a candidate for Rh immune globulin, the mother is _______ and the infant is ____________
Dolichos biflorus lectin
To distinguish between an A1 and A2 blood type, which reagent is used?
irradiated
To prevent graft vs host disease, blood components prepared for a fetus that needs an intrauterine transfusion should be:
A and B
What ABO phenotype would agglutinated in the presence of anti-A,B produced by group O individuals?
Donor red cells and recipient serum
What are the two components of the major crossmatch?
irradiated red blood cells
What component is indicated for patients who recieve directed donations from immediate family members to prevent graft vs host transfusion reactions
anti- A,B
What forward typing reagent can be used to confirm group O units before placing them in inventory?
IgG
What immunoglobulin class is capable of crossing the placenta?
IgM
What immunoglobulin class reacts best at room temp at immediate spin?
Computer program must have the logic to detect discrepancies and aler user
What is required for a computer to crossmatch?
Detection of small amounts of the virus
What is the advantage of testing donors' blood using nucleic acid test methods?
2 out of 10 units
What is the approximate probability of finding a compatible unit of blood for a D-positive patient with antibodies to C, E, and K, if the frequency of C is 70%, E is 30%, and K is 10%?
20-24deg C, 4 hours
What is the correct storage temp and time limit for pooled platelets?
ALL OF THE ABOVE reduce a high antibody level replace cellular elements clear immune complexes
What is the goal of therapeutic apheresis?
IgM
What is the immunoglobulin class of antibodies detected in the immediate-spin crossmatch?
IgG
What is the immunoglobulin class of most Rh system antibodies?
65deg C
What is the minimum acceptable storage temperature for frozen red blood cells?
12.5 g/dL
What is the minimum hemoglobin level for a potential female allogeneic donor?
2 unique IDs (name and med record #, DOB, or SS#) date and time, collector ID (name or tech #)
What is the minimum requirement information when labeling a patient sample for blood bank?
Repeat the direct antiglobulin test using monospecific anti-IgG and anti-C3 reagents
What is the next step in the investigation of a positive direct antiglobulin test with polyspecific antihuman globulin reagent?
Trypanasoma cruzi
What is the organism that causes Chagas disease
false negatives
What is the potential effect in the tube agglutination test if a red cell suspension with a concentration greater than 5% is used?
Check that the wash procedure was sufficient to remove unbound antibodies
What is the purpose of adding antibody-sensitized red cells following the antiglobulin test?
ABO reverse grouping
What is the test procedure that combines patient's serum with commercial A1 and B reagent cells?
lung
What organ of the recipient's body is involved in a TRALI?
37deg C
What temperature is used for incubation in the indirect antihuman globulin test?
massive transfusion
What term is described as the replacement of one or more blood volumes within 24 hrs whether in an infant or in an adult patient
store and reissue later
What to do with units of blood
If you have a sample on pt and know type... type specific. If you do not know type or no sample, O neg
What type of blood to give in emergency when no time for antibody screen?
Rows where pt is negative, non reactive cells is same as neg rows
When "ruling" out Abs we start with which reaction rows?
pregnant women, newborns (cord blood), donor blood
When do we perform the weak D or Du procedure?
No prior or existing clinically significant antibodies
When is the immediate-spin or abbreviated crossmatch an acceptable procedure for the recipient?
Patient's red cells and anti-A
When testing for the A antigen in a patient, what would you use to perform the test?
ALL OF THE ABOVE The population statistics must be large Mutations cannot occur Mating must be random
When using the Hardy-Weinberg equation to calculate genetic frequencies, which of the following must be TRUE?
Product insert
Where are product limitations and technical considerations for each reagent located?
Leukocyte reduced RBCs
Which blood product is recomended for transfusions to individuals with a history of febrile nonhemolytic transfusion reactions
Mycoplasma pneumoniae infection
Which condition is often associated with the presence of anti-I?
fetal hemoglobin is resistant to acid elution and remains in the cell to stain pink, whereas adult cells appear as ghost cells
Which of the following best describes the principle of the Kleinhauer-Betke test?
ABH
Which of the following blood group systems are structurally related to antigens of the P system?
ABO
Which of the following blood group systems has been implicated in transfusion reactions on the first exposure to incompatible red blood cells?
Platelets
Which of the following blood products is tested for bacterial contamination following storage?
Lose reactivity with proteolytic enzyme reagents
Which of the following facts is not a characteristic of Kell system antibodies?
aspirin ingestion 12 hrs previously
Which of the following is not a cause for temporary deferment of a whole blood donor?
antibody bound to antigen
Which of the following is responsible for the activation of the classic pathway of complement?
Factor VIII concentrate
Which of the following is used in the treatment of hemophilia A
ALL OF THE ABOVE premature infants HIV pos pts bone marrow recipients unborn infants of pregnant women who are seronegative
Which of the following patients should not receive cytomegalovirus (CMV)- pos blood?
Antigens Fya and Fyb in the Duffy system
Which of the following red cell antigens do proteolytic enzymes destroy?
confirmed pos test for hepatitis B surface antigen 10 yrs previously
Which of the following statements contributes to permanent rejection status for a donor?
direct antiglobulin test
Which of the following tests is not included in routine compatibility testing?
TRALI
Which of the following transfusion reactions demonstrates with coughing, cyanosis, and difficulty breathing?
Transfusion Associated Circulatory Overload (TACO)
Which of the following transfusion reactions has the highed incidence?
hematocrit 39 BP 90/60mmHg Pulse (beats/min) 65 Age 65
Which one of the following histories represents an acceptable male donor?
ALL OF THE ABOVE ABO group D testing Direct antiglobulin test
Which tests are performed to identify the cause of suspected hemolytic disease of the fetus and newborn?
To prevent entry ports from being contaminated with water
Why are plastice overwraps recommended when the thawing FFP and CRYO?
Some antigens are destroyed by enzymes, which would cause the antibodies to be missed
Why are proteolytic enzymes not used in the routine screening for antibodies?
ALL OF THE ABOVE Iatrogenic blood loss hemoglobin F is being changed to hemoglobin A insufficient erythropoiesis
Why do premature neonated require red blood cell transfusions?
Increase the avidity of IgG antibodies
Why is polyethylene glycol reagent added to the screen or panel?
Indicated the class of the antibody
Why is the agglutination reaction phase important in the interpretation of the antibody screen or antibody identification panel?
A D-negative mother should be given Rh immune globulin to prevent potential formation of anti-D during delivery of a D-positive infant.
Why is the determination of the D antigen important for women during pregnancy?
newborns do not produce their own antibody until about 4 months
Why is the reverse grouping omitted in the neonatal period for ABO testing?
for antibodies that show dosage
Why should homozygous cells be included in the panel and what is their effect?
donor
Write in indelible ink, keep records indefinitely
immediately available
abo/Rh typing for past 12 mnths and any problems
