BOC Blood Bank part 2

*diagram - pg. 36, #239*

A

*diagram - pg. 38, #247*

A

*diagram - pg. 34, #227*

B

*diagram - pg. 36, #240*

B

*diagram - pg. 38, #242*

B

*diagram - pg. 38, #245*

B

*diagram - pg. 39, #248*

B

*diagram - pg. 41, #260*

B

*diagram - pg. 44, #277*

B

*diagram - pg. 49, #305*

B

357.) Hives and itching are symptoms of which of the following transfusion reactions? A. febrile B. allergic C. circulatory overload D. bacterial

B. allergic

370.) which of the following disease states is treated with therapeutic plasma exchange (TPE)? A. gout B. myasthenia gravis C. intrahepatic cholestasis D. Chron disease

B. myasthenia gravis

282.) a male patient's sample demonstrates a pattern most consistent with anti-D. The patient is Rh-negative and was transfused with Rh-positive blood emergently after a motor vehicle accident 2 years previously. The anti-D shows variable reactivity when tested with D-positive cells. What test would be appropriate to enhance the anti-D reactivity and verify specificity? A. ficin-AHG B. DTT-AHG C. trypsin-AHG D. albumin-AHG

A. ficin-AHG

364.) a patient became hypotensive and went into shock after receiving 50 mL of a unit of RBC. She had a shaking chill and her temperature rose to 104.8 oF (40.4 oC). A transfusion reaction investigation was initiated but no abnormal results were seen. What additional testing should be performed? A. gram stain and culture of the donor unit B. lymphocytotoxicity tests for leukoagglutinins C. plasma IgA level D. elution and antibody identification

A. gram stain and culture of the donor unit

*diagram - pg. 41, #262*

A

*diagram - pg.39, #251*

A

*diagram - pg.46, #286*

A

368.) which viral diseases have a lower incidence of transfusion-associated infections due to nucleic acid testing (NAT)? A. HIV-1, HCV, WNV B. HIV-2, HBV, CMV C. HTLV I/II, HCV, WNV D. CMV, WNV, HCV

A HIV-1, HCV, WNV

278.) based on these reactions, what is the patient's ABO type? anti-A = 4+ anti-B = 0 Ulex europaeus = 0 Dolichos biflorus = 4+ A. A1 B. A2 C. Amod D. Ax

A. A1

338.) Severe intravascular hemolysis is most likely caused by antibodies of which blood group system? A. ABO B. Rh C. Kell D. Duffy

A. ABO

223.) Some blood group antibodies characteristically hemolyze appropriate red cells in the presence of: A. complement B. anticoagulants C. preservatives D. penicillin

A. complement

246.) which characteristics are true of ALL 3 of the following antibodies: anti-Fy^a, anti-Jk^a, and anti-K? A. detected at IAT phase and may cause hemolytic disease of the fetus and newborn (HDFN) and transfusion reactions B. not detected with enzyme treated cells; may cause delayed transfusion reactions C. requires the IAT technique for detection; usually not responsible for ausing HDFN D. may show dosage effect; may cause severe hemolytic transfusion reactions

A. detected at IAT phase and may cause hemolytic disease of the fetus and newborn and transfusion reactions

249.) which of the following tests is most commonly used to detect antibodies attached to a patient's red blood cells in vivo? A. direct antiglobulin B. complement fixation C. indirect antiglobulin D. immunofluorescence

A. direct antiglobulin

254.) the mechanism that best explains hemolytic anemia due to penicillin is: A. drug-dependent antibodies reacting with drug-treated cells B. drug-dependent antibodies reacting in the presence of drug C. drug-independent with autoantibody production D. nonimmunologic protein adsorption with positive DAT

A. drug-dependent antibodies reacting with drug-treated cells

295.) a patient's serum contains a mixture of antibodies. One of the antibodies is identified as anti-D. Anti-Jk^a, anti-Fy^a and possibly another antibody are present. What technique(s) may be helpful to identify the other antibody(ies)? A. enzyme panel; select cell panel B. thiol reactions C. lowering the pH and increasing the incubation time D. using albumin as an enhancement media in combination with selective adsorption

A. enzyme panel; select cell panel

299.) in a cold autoadsorption procedure, pretreatment of the patient's red cells with which of the following reagents is helpful? A. ficin B. phosphate-buffered saline at pH 9.0 C. low ionic strength saline (LISS) D. albumin

A. ficin

194.) based upon Kelihauer-Betke test results, which of the following formulas is used to determine the volume of fetomaternal hemorrhage expressed in mL of whole blood? A. % of fetal cells present x 30 B. % of fetal cells present x 50 C. % of maternal cells present x 30 D. % of maternal cells present x 50

B. % of fetal cells present x 50

193.) A Kleihauer-Betke stain of a postpartum blood film revealed 0.3% fetal cells. What is the estimated volume (mL) of the fetomaternal hemorrhage expressed as whole bLood? A. 5 B. 15 C. 25 D. 35

B. 15

312.)how many units of RBC are required to raise the hematocrit of a 70 kg nonbleeding man from 24% to 30%? A. 1 B. 2 C. 3 D. 4

B. 2

336.) In a delayed transfusion reaction, the causative antibody is generally too weak to be detected in routine compatibility testing and antibody screening tests but is typically detectable at what point after transfusion? A. 3-6 hours B. 2 days - 2 weeks C. 60-90 days D. after 120 days

B. 2 days-2 weeks

315.) What increment of platelets/uL in the typical 70-kg human is expected to result from each single unit of platelets transfused to a non-HLA sensitized recipient? A. 3,000 - 5,000 / uL B. 5,000 - 10,000 / uL C. 20,000 - 25,000 / uL D. 25,000 - 30.000 / uL

B. 5,000-10,000/uL

311.) a 42 yo male of average body mass has a history of chronic anemia requiring transfusion support. 2 units of RBC are transfused. If the pretransfusion hemoglobin was 7.0 g/dL (70 g/L), the expected posttransfusion hemoglobin concentration should be: A. 8.0 g/dL B. 9.0 g/dL C. 10.0 g/dL D. 11.0 g/dL

B. 9.0 g/dL

233.) a 29-yo male is hemorrhaging severely. He is AB, Rh-negative. Six units of blood are required STAT. Of the following types available in the blood bank, which would be most preferable for crossmatch? A. AB, Rh-positive B. A, Rh-negative C. A, Rh-positive D. O, Rh-negative

B. A, Rh-negative

250.) anti-I in cold agglutination disease may cause a positive direct antiglobulin test (DAT) because of: A. anti-I agglutinating the cells B. C3d bound to the red cells C. T-activation D. C3c remaining on the red cells after cleavage of C3b

B. C3d bound to the red cells

285.) which of the following antigens gives enhanced reactions with its corresponding antibody following treatment of the red cells with proteolytic enzymes? A. Fy^a B. E C. S D. M

B. E

270.) inheritance of the rare M^k gene resutls in the deletion of both GYPA and GYPB. Which of the following blood group antigens is not expressed on red cells in the presence of a M^k gene? A. Kx B. En^a C. f D. G

B. En^a

206.) which of the following systems plays an important role in Transfusion-Related Acute Lung Injury (TRALI), transfusion-associated graft vs. host disease (TA-GVHD), platelet refractoriness, and Febrile Nonhemolytic Transfusion Reactions (FNHTR) as well as in hematopoietic stem and organ transplantation rejection? A. Rh B. HLA C. Lewis D. Diego

B. HLA

268.) Polyspecific reagents used in the direct antiglobulin test should have specificity for: A. IgG and IgA B. IgG and C3d C. IgM and IgA D. IgM and C3d

B. IgG and C3d

339.) which of the following blood group systems is most commonly associated with delayed hemolytic transfusion reactions? A. Lewis B. Kidd C. Lu D. I

B. Kidd

274.) in a group O individual with Le and Se genes, what ABH and Lewis antigens are present in their secretions? A. Le^a, Le^b B. Le^a, Le^b, H C. Le^a, H D. Le^b, H

B. Le^a, Le^b, H

195.) An acid elution stain was made using a 1-hour postdelivery maternal blood sample. Two thousand cells were counted and thirty of these cells appeared to contain fetal hemoglobin. It is the policy of the medical center to add one vial of Rh immune globulin to the calculated dose when the estimated volume of the hemorrhage exceeds 20 mL of whole blood. Calculate the number of vials of Rh immune globulin that would be indicated under these circumstances. A. 2 B. 3 C. 4 D. 5

C. 4

263.) Mixed field agglutination encountered in ABO grouping with no history of transfusion would most likely be due to: A. Bombay phenotype (Oh) B. T activation C. A3 red cells D. positive indirect antiglobulin test

C. A3 red cells

326.) a patient admitted to the trauma unit requires emergency release of Fresh Frozen Plasma (FFP). Which of the following blood groups of FFP should be issued? A. A B. B C. AB D. O

C. AB

291.) a person's saliva incubated with the following antibodies and tested with the appropriate A2, O, and B indicator cells, gives the following test results: anti-A = reactive anti-B = inhibited anti-H = inhibited the person's red cells ABO phenotype is: A. A B. AB C. B D. O

C. B

269.) a 56-yo female with cold agglutinin disease has a positive direct antiglobulin test (DAT). When the DAT is repeated using monospecific antiglobulin sera, which of the following is most likely to be detected? A. IgM B. IgG C. C3d D. C4a

C. C3d

296.) a sample gives the following results: cells with: anti-A = 3+ anti-B = 4+ serum with: A1 cells = 2+ B cells = 0 which lectin should be used first to resolve this discrepancy? A. Ulex europaeus B. Arachis hypogaea C. Dolichos biflorus D. Vicia graminea

C. Dolichos biflorus

207.) Which of the following statements is true about Class II HLA antigens? A. they are found on the surface of most nucleated cells B. Bg antigens are part of HLA Class II C. HLA-DR, HLA-DQ, and HLA-DP are all Class II D. they are only located on neurons and platelets

C. HLA-DR, HLA-DQ, HLA-DP are all class II

252.) a patient's antibody identification panel demonstrated anti-M. The antibody was most reactive with homozygous M+ cells compared to heterozygous M+ cells. Which of the following cells would demonstrate the strongest reaction? A. M-N+S-s+ B. M+N+S+s+ C. M+N-S-s+ D. M+N+S-s-

C. M+N-S-s+

212.) in what patient population may we observe the following results? anti-A = 4+ anti-B = 0 anti-D = 4+ A1 cells = 0 B cells = 1+ A. labor and delivery patient B. 30 yo GI bleed patient C. 2 yo pre-surgical patient D. 16 yo ACL repair surgery patient

C. 2 yo pre-surgical patient

265.) using the antigen typing results below, what is the patient's likely phenotype? D + C 0 E + c + e + f + G + A. R1R1 B. R2R2 C. R2r D. R1R2

C. R2r

218.) the Rh-negative phenotype results from the complete deletion of what gene(s)? A. RHD and RHce B. RHCE C. RHD D. RHD and RHCE

C. RHD

313.) for which of the following transfusion candidates would CMV-safe blood be MOST likely indicated? A. renal dialysis patients B. sickle cell patient C. bone marrow and hematopoietic cell transplant recipients D. CMV-seropositive patients

C. bone marrow and hematopoietic cell transplant recipients

255.) Use of EDTA plasma prevents activation of the classical complement pathway by: A. causing rapid decay of complement components B. chelating Mg++ ions, which prevents assembly of C6 C. chelating Ca++ions, which prevents assembly of C1 D. preventing chemotaxis

C. chelating Ca++ions, which prevents assembly of C1

362.) coughing, hypoxiema and difficult breathing are symptoms of which of the following transfusion reactions? A. febrile B. allergic C. circulatory overload D. hemolytic

C. circulatory overload

371.) a 50 yo patient with acute lymphocytic leukemia has symptoms of dyspnea, visual abnormalities, and headache. The blast count is greater than 100,000 /uL. What type of apheresis is indicated to treat this patient? A. extracorporeal photopheresis (ECP) to remove immature lymphocytes B. selective absorption apheresis to remove immature lymphocytes C. cytapheresis to remove immature lymphocytes D. therapeutic plasma exchange to remove antibodies

C. cytapheresis to remove immature lymphocytes

200.) what is the most important consideration for a patient requiring red cell transfusion due to severe anemia when their serum contains a warm autoantibody? A. determine specificity of autoantibody B. determine the immunoglobulin class of the autoantibody C. determine the presence of underlying alloantibody(ies) D. avoid transfusion therapy

C. determine the presence of underlying alloantibody(ies)

316.) platelet transfusions are of most value in treating: A. hemolytic transfusion reaction B. posttransfusion purpura C. functional platelet abnormalities D. immune thrombocytopenia

C. functional platelet abnormalities

354.) nine days after being transfused with an HLA-matched platelet transfusion a patient develops a fever, watery diarrhea, skin rash and demonstrates increased liver enzymes. this patient may have transfusion-associated: A. allergic urticaria reaction B. hepatitis C C. graft vs. host disease D. septicemia with endocarditis

C. graft vs host disease

*diagram - pg. 32, #219*

D

*diagram - pg. 37, #241*

D

*diagram - pg. 44, #276*

D

*diagram - pg. 54, #342*

D

*diagram - pg.47, #290*

D

230.) which of the following would most likely be responsible for an incompatible antiglobulin crossmatch? A. recipient's red cells possess a low frequency antigen B. anti-K antibody in donor serum C. recipient's red cells are polyagglutinable D. donor red cells have a positive direct antiglobulin test

D. donor red cells have a positive direct antiglobulin test

300.) the process of separation of antibody from its antigen is known as: A. diffusion B. adsorption C. neutralization D. elution

D. elution

353.) for a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to: A. prevent alloimmunization B. diminish chills and fever C. prevent hemoglobinemia D. reverse hypotension and minimize renal damage

D. reverse hypotension and minimize renal damage

196.) The rosette test will detect a fetomaternal hemorrhage (FMH) as small as: A. 10 mL B. 15 mL C. 20 mL D. 30 mL

A. 10 mL

213.) a patient is a subgroup of A (Asub), Rh-positive with anti-A1 in their serum. How many units would you have to screen to find 1 unit that is compatible with the patient's anti-A? A. 5 B. 10 C. 15 D. 20

A. 5

325.) fresh frozen plasma from a group A, Rh-positive donor may be safely transfusion to a patient who is group: A. A, Rh-negative B. B, Rh-negative C. AB, Rh-positive D. AB, Rh-positive

A. A, Rh-negative

234.) A patient is group A2B, Rh-positive and has an antiglobulin-reacting anti-A1 in his serum. He is bleeding profusely in the operating room and group A2B Red Blood Cells are NOT available. Which of the following types of blood should be given as a first choice for crossmatching? A. B, Rh-positive B. B, Rh-negative C. A1B, Rh-positive D. O, Rh-negative

A. B, Rh-positive

284.) which of the following blood bank chemicals produce Kell null cells? A. DTT B. ficin C. formaldehyde D. chloroquine diphosphate

A. DTT

203.) indications for an autologous hematopoietic progenitor cell (HPC) transplant include patients who have: A. Hodgkin lymphoma with high-dose chemotherapy B. congenital hemoglobinopathies C. congenital immunodeficiency disorders D. inborn errors of metabolism

A. Hodgkin lymphoma with high-dose chemotherapy

279.) a patient has a variable reacting anti-P1 pattern in antibody identification studies. What test can be used to verify the specificity of anti-P1? A. P1 neutralization B. PEG-AHG C. cloroquine-AHG D. DTT-AHG

A. P1 neutralization

237.) autoantibodies demonstrating blood group specificity in warm autoimmune hemolytic anemia are associated more often with which blood group system? A. Rh B. I C. P D. Duffy

A. Rh

292.) an antibody screen performed using solid phase technology revealed a diffuse layer of red blood cells on the bottom of the well. These results indicate: A. a positive reaction B. a negative reaction C. serum was not added D. red cells have a positive direct antiglobulin test

A. a positive reaction

217.) what ABO type is found in group A1 individuals following deacetylation of their A antigens? A. acquired B B. B(A) C. Amod D. Aint

A. acquired B

301.) which of the following is most helpful to confirm a weak ABO subgroup? A. adsorption-elution B. neutralization C. testing with A1 lectin D. use of anti-A,B

A. adsorption-elution

314.) washed RBC are indicated in which of the following situations? A. an IgA-deficient patient with a history of transfusion-associated anaphylaxis B. a pregnant woman with a history of hemolytic disease of the newborn C. a patient with a positive DAT and red cell autoantibody D. a newborn with a hematocrit of <30%

A. an IgA-deficient patient with a history of transfusion-associated anaphylaxis

309.) deglycerolized RBC are used to transfuse patients with: A. an antibody to a high-incidence red cell antigen B. anti-c and anti-K alloantibodies C. chronic anemia D. increased risk of CMV infection

A. an antibody to a high-incidence red cell antigen

340.) after receiving a unit of RBC, a patient immediately developed flushing, nervousness, fever spike of 102 oF (38.9 oC), shaking, chills, and back pain. The plasma hemoglobin was elevated and there was hemoglobinuria. Laboratory investigation of this adverse reaction would most likely show: A. an error in ABO grouping B. an error in Rh typing C. presence of anti-Fya antibody in patient's serum D. presence of gram-negative bacteria in blood bag

A. an error in ABO grouping

281.) a patient's serum reacted weakly positive (1+^W) with 16 of 16 group O panel cells at the AHG test phase. The autocontrol was negative. Tests with ficin-treated panel cells demonstrated no reactivity at the AHG phase. Which antibody is most likely responsible for these results? A. anti-Ch B. anti-k C. anti-e D. anti-Js^b

A. anti-Ch

238.) an antibody that causes in vitro hemolysis and reacts with the red cells of 3 out of 10 AHG-crossmatched donor units is most likely: A. anti-Le^a B. anti-s C. anti-k D. anti-E

A. anti-Le^a

298.) a patient's serum was reactive 2+ in the antiglobulin phase of testing with all cells on a routine panel including their own. Transfusion was performed 6 months previously. The optimal adsorption method to remove the autoantibody is: A. autoadsorption using the patient's ZZAP-treated red cells B. autoadsorption using the patient's LISS-treated red cells C. adsorption using enzyme treated red cells from a normal donor D. adsorption using methyldopa-treated red cells

A. autoadsorption using the patient's ZZAP-treated red cells

345.) which of the following transfusion reactions is characterized by high fever, shock, hemoglobinuria, DIC, and renal failure? A. bacterial contamination B. circulatory overload C. febrile D. anaphylactic

A. bacterial contamination

377.) which of the following must be performed on a patient before and after receiving a blood transfusion? A. blood pressure, pulse, respiration rate and temperature B. blood pressure, pulse, temperature and urine occult blood C. blood pressure, temperature, respiration rate and hematocrit D. blood pressure, temperature, pulse and hematocrit

A. blood pressure, pulse, respiration rate, and temperature

358.) a temperature rise of 1 oC or more occurring in association with a transfusion, with no abnormal resuts in the transfusion reaction investigation, usually indicates which of the following reactions? A. febrile B. circulatory overload C. hemolytic D. anaphylactic

A. circulatory overload

202.) the autoantibody most often implicated in Paroxysmal Cold Hemoglobinuria (PCH) is: A. cold-reactive, IgG, anti-P B. cold-reactive, IgM, anti-P C. cold-reactive, IgG, anti-I D. cold-reactive, IgM, anti-I

A. cold-reactive, IgG, anti-P

306.) which of the following represents an acceptably identified patient for sample collection and transfusion? A. handwritten band with patient's name and hospital ID number is affixed to the patient's leg B. the addressographed hospital band is taped to the patient's bed C. an unbanded patient responds positively when his name is called D. the chart transported with the patient contains his armband not yet attached

A. handwritten band with patient's name and hospital ID number is affixed to the patient's leg

347.) patients who are chronically transfused with red cell components can develop: A. iron overload B. low ferritin C. hypokalemia D. hypertensive reaction

A. iron overload

374.) prior to initiating a blood transfusion, the transfusionist and another qualified individual must: A. match the blood component to the recipient using 2 independent identifiers B. verify that the recipient's vital signs are within normal limits C. review the patient's medical record to verify the need for a transfusion D. order a baseline hemoglobin and hematocrit before the transfusion is started

A. match the blood component to the recipient using 2 independent identifiers

259.) a group O, Rh-negative pregnant female has anti-Vel in her serum. If needed, how might blood be provided for her infant? A. maternal donation B. paternal donation C. random ABO-identical unit D. random group O, Rh-negative unit

A. maternal donation

244.) Transfusion of Ch+ (Chido-positive) red cells to a patient with anti-Ch has been reported to cause: A. no clinically significant red cell destruction B. clinically significant immune red cell destruction C. decreased ^51 Cr red cell survivals D. febrile transfusion reactions

A. no clinically significant red cell destruction

236.) a patient received 4 units of blood 2 years previously and now has multiple antibodies. He has not been transfused since that time. It would be most helpful to: A. phenotype his cells to determine which additional alloantibodies may be produced B. recommend the use of directed donors, which are more likely to be compatible C. use proteolytic enzymes to destroy the "in vitro" activity of some of the antibodies D. freeze the patient's serum to use for antigen typing of compatible units

A. phenotype his cells to determine which additional alloantibodies may be produced

201.) a drug-induced immune hemolytic anemia caused by a drug-independent antibody would have which of the following results? A. positive DAT with IgG; positive antibody screen B. positive DAT with IgG; negative eluate C. positive DAT with C3d; negative antibody screen D. negative DAT; positive antibody screen

A. positive DAT with IgG; positive antibody screen

304.) anti-E is identified in a panel at the antiglobulin phase. When check cells are added to the tubes, no agglutination is seen. The most appropriate course of action would be to: A. quality control the AHG reagent and check cells and repeat the panel B. open a new vial of check cells for subsequent testing that day C. open a new vial of AHG for subsequent testing that day D. record the check cell reactions and report the antibody panel result

A. quality control of AHG reagent and check cells and repeat the panel

226.) a patient is typed as group O, Rh-positive and crossmatched with 6 units of blood. At the indirect antiglobulin (IAT) phase of testing, both antibody screening cells and 2 crossmatched units are incompatible. What is the most likely cause of the incompatibility? A. recipient alloantibody B. recipient autoantibody C. donors have positive DATs D. rouleaux

A. recipient alloantibody

343.) the most appropriate laboratory test for early detection of acute posttransfusion hemolysis is: A. visual inspection for free plasma hemoglobin B. plasma haptoglobin concentration C. examination for hematuria D. serum bilirubin concentration

A. visual inspection for free plasma hemoglobin

283.) which of the following genes on chromosome 1 encodes for the 4 common antigen combinations ce, cE, Ce, and CE? A. RHD B. RHCE C. RHD and RHCE D. RHd and RHce

B. RHCE

360.) use of only male donors as a source of plasma intended for transfusion is advocated to reduce which type of reaction? A. allergic B. TRALI C. hemolytic D. TACO (circulatory overload)

B. TRALI

225.) the following results were obtained in pretransfusion testing: (37 oC then IAT) screening cell I = 0 3+ screening cell II= 0 3+ autocontrol = 0 3+ the most probable cause of these results is: A. rouleaux B. a warm autoantibody C. cold autoantibody D. multiple alloantibodies

B. a warm autoantibody

191.) while performing routine postpartum testing for an Rh immune globulin (RhIG) candidate, a weakly positive antibody screening test was found. Anti-D was identified. This antibody is most likely the result of: A. massive fetomaternal hemorrhage occurring at the time of this delivery B. antenatal administration of Rh immune globulin at 28 weeks gestation C. contamination of the blood sample with Wharton jelly D. mother having a positive direct antiglobulin test

B. antenatal administration of Rh immune globulin at 28 weeks gestation

220.) The test for weak D is performed by incubating a patients red cells with: A. different dilutions of anti-D B. anti-D antiserum C.anti-D^u antiserum D. antiglobulin antiserum

B. anti-D antiserum

231.) in the process of identifying an antibody, the technologist observes 2+ reactions with 3 of 10 cells at immediate spin (IS) and room temperature (RT). There were no reactions at 37 oC or AHG. What is the most likely antibody? A. anti-Jk^b B. anti-Le^a C. anti-C D. anti-Fy^a

B. anti-Le^a

243.) in the process of identifying an antibody, the technologist observed 2+ reactions with 3 of the 10 cells in a panel after the immediate spin phase. There was no reactivity after incubation at 37 oC and after the anti-human globulin test phase. The antibody most likely is: A. anti-P1 B. anti-Le^a C. anti-C D. anti-Fy^a

B. anti-Le^a

289.) to confirm the specificity of anti-Le^b, an inhibition study using Lewis substance was performed with the following results: (sample, result with Le(b+) cells) tubes w/patient serum + Lewis substance = 0 tubes w/patient serum + saline control = + what conclusion can be made from these results? A. second antibody is suspected due to the positive control B. anti-Le^b is confirmed because the tubes with Lewis substance are negative C. anti-Le^b is not confirmed because the tubes with Lewis substance are negative D. anti-Le^b cannot be confirmed because the saline positive is control

B. anti-Le^b is confirmed because the tubes with Lewis substance are negative

294.) which of the following is useful for removing IgG from red blood cells with a positive DAT to perform a phenotype? A. bromelin B. chloroquine C. LISS D. DTT

B. chloroquine

321.) Although ABO compatibility is preferred, ABO incompatible product may be administered when transfusing: A. single-donor plasma B. cryoprecipitated AHF C. fresh frozen plasma D. granulocytes

B. cryoprecipitated AHF

349.) which of the following is associated with a risk of developing transfusion-associated graft versus host disease (TA-GVHD)? A. patients receiving leukocyte reduced blood components B. directed donation from 1st-degree family member C. patients transfused with irradiated blood components D. autologous blood donation prior to surgery

B. directed donation from 1st degree family member

373.) plasma exchange is recommended in the treatment of patients with macroglobulinemia in order to remove: A. antigen B. excess IgM C. excess IgG D. abnormal platelets

B. excess IgM

319.) which of the following statements regarding red cell transfusion to infants less than 4 months old is correct? A. only phenotype identical units should be issued B. fresher units (generally <7 days) should be issued C. irradiated blood components are contraindicated D. crossmatching with a current sample is required for each transfusion

B. fresher units (generally <7 days) should be issued

318.) in an emergency situation, what type of blood should be given to a female patient of child-bearing age if the ABO group and Rh type are unknown? A. group O, Whole Blood should be given B. group O, Rh-negative red cells should be given C. group O, Rh-positive red cells should be given D. group O, Washed RBC should be given

B. group O, Rh-negative red cells should be given

224.) review the following schematic diagram: PATIENT SERUM + REAGENT GROUP "O" CELLS INCUBATE -> READ FOR AGGLUTINATION WASH -> ADD AHG -> AGGLUTINATION OBSERVED the next step would be to: A. add "check cells" as a confirmatory measure B. identify the cause of the agglutination C. perform an elution technique D. perform a direct antiglobulin test

B. identify the cause of the agglutination

351.) in a delayed hemolytic transfusion reaction, the direct antiglobulin test on the posttransfusion sample can be: A. negative B. mixed-field positive C. positive due to complement D. negative when the antibody screen is negative

B. mixed-field positive

369.) the preferred replacement fluid to maintain normal oncotic pressure and intravascular fluid levels for patients who have therapeutic plasma exchange (TPE) for thrombotic thrombocytopenic purpura is: A. IVIg B. plasma C. crystalloid solutions D. isotonic saline

B. plasma

328.) the purpose of irradiation of blood components is to: A. prevent posttransfusion purpura B. prevent graft-vs-host disease (GVH) C. sterilize components D. prevent noncardiogenic pulmonary edema

B. prevent graft-vs-host disease (GVH)

267.) Results of a serum sample tested against a panel of reagent red cells gives presumptive evidence of an alloantibody directed against a high incidence antigen. Further investigation to confirm the specificity should include which of the following? A. serum testing against red cells from random donors B. serum testing against red cells known to lack high incidence antigens C. serum testing against enzyme treated autologous red cells D. testing of an eluate prepared from the patient's red cells

B. serum testing against red cells known lack high incidence antigens

204.) which of the following statements is correct about hematopoietic progenitor cell (HPC) transplantation? A. successful allogeneic transplantation requires that at least 5 out of 10 HLA loci match B. sources for HPC collection include BM, umbilical cord blood (UCB), and mobilized peripheral blood C. bone marrow collection of HPC is preferred to apheresis collection because of fewer side effects D. HPC products are infused into the patient over a period of at least 6 hours

B. sources for HPC collection include bone marrow, umbilical cord blood, and mobilized peripheral blood

215.) A group B, Rh-negative patient has a positive DAT. Which of the following situations would occur? A. all major crossmatches would be incompatible B. the weak D test and control would be positive C. the antibody screening test would be positive D. the forward and reverse ABO groupings would not agree

B. the weak D test and control would be positive

303.) testing blood donors for the presence of antibodies to human neutrophil antigens (HNAs) can help prevent which of the following adverse events associated with transfusion? A. transfusion-associated circulatory overload (TACO) B. transfusion-related acute lung injury (TRALI) C. anaphylaxis D. citrate toxicity

B. transfusion-related acute lung injury (TRALI)

*diagram - pg. 32, #216*

C

*diagram - pg. 43, #275*

C

378.) an intraoperative strategy for patient blood management is: A. anemia assessment and treatment B. autologous blood donation C. acute normovolemic hemodilution D. limiting phlebotomy-related blood loss

C. acute normovolemic hemodilution

355.) which of the following transfusion reactions occurs after infusion of only a few milliliters of blood and gives no history of fever? A. febrile B. circulatory overload C. anaphylactic D. hemolytic

C. anaphylactic

273.) reagent antibody screening cells may not detect all antibodies. Which of the following antibodies is most likely to go undetected? A. anti-Co^a B. anti-S C. anti-C^W D. anti-Xg^a

C. anti-C^W

288.) plasma neutralization is best used to verify which of the following antibodies? A. anti-Lub B. anti-M C. anti-Ch/Rg D. anti-V

C. anti-Ch/Rg

192.) Rh immune globulin administration would NOT be indicated in an Rh-negative woman who has a(n): A. first trimester abortion B. husband who is Rh-positive C. anti-D titer of 1:4,096 D. positive direct antiglobulin test

C. anti-D titer of 1:4,096

334.) posttransfusion purpura is usually caused by: A. anti-A B. white cell antibodies C. anti-HPA-1a D. platelet wash-out

C. anti-HPA-1a

264.) a patient demonstrates 4+ reactivity with all red cells tested and the autocontrol is nonreactive. This high incidence antibody was suspected to be related to the P1PK blood group system as the patient is the rare p phenotype. What antibody specificity should be suspected? A. anti-IP1 B. anti-P2 C. anti-PP1P^k D. anti-P1

C. anti-PP1P^k

280.) a patient serum reacts with 2 of the 3 antibody screening cells at the AHG phase. Eight of the 10 units crossmatched were incompatible at the AHG phase. All reactions are markedly enhanced by enzymes. These results are most consistent with: A. anti-M B. anti-E C. anti-c D. anti-Fy^a

C. anti-c

198.) pathologic cold autoantibodies differ from benign cold autoantibodies in: A. antibody specificity B. imunoglobulin class C. antibody titer D. ability to bind complement

C. antibody titer

307.) AHG (Coombs) control cells: A. can be used as a positive control for anti-C3 reagents B. can be used only for the indirect antiglobulin test C. are coated only with IgG antibody D. must be used to confirm all positive antiglobulin reactions

C. are coated only with IgG antibody

209.) the following blood typing results were noted on a patient's sample: anti-A = 0 anti-B = 4+ anti-D = 4+ A1 cells = 4+ B cells = 0 Rh typing results = C-E-c+-e+ what is the patient's likely ethnicity? A. Asian B. Hispanic C. Black D. White

C. black

330.) four units of group A platelets were transfused to a group AB patient as group AB platelets were not available. The patient's pretransfusion platelet count was 10,000 /uL and the posttransfusion count was 16,000 /uL. From this information, the laboratorian would most likely conclude that the patient: A. needs group AB platelets to be more effective B. clinical data does not suggest a need for platelet transfusion C. has developed antibodies to the transfused platelets D. should receive irradiated platelets

C. has developed antibodies to the transfused platelets

331.) hypotension, nausea, flushing, fever and chills are symptoms of which of the following transfusion reactions? A. allergic B. circulatory overload C. hemolytic D. anaphylactic

C. hemolytic

346.) hemoglobinuria, hypotension, and generalized bleeding are symptoms of which of the following transfusion reactions? A. allergic B. circulatory overload C. hemolytic D. anaphylactic

C. hemolytic

365.) the most frequent transfusion-associated disease complication of blood transfusions is: A. cytomegalovirus (CMV) B. syphilis C. hepatitis D. AIDS

C. hepatitis

337.) which of the following is a potential complication of massive transfusions? A. citrate toxicity with hypercalcemia B. heparin-induced thrombocytopenia C. hypothermia due to 1-6 oC storage temperature of red cells D. iron overload from donor cells leaking intracellular iron

C. hypothermia due to 1-6C storage temperature of red cells

208.) the most widely accepted QC test to measure probable Hematopoietic Progenitor Cell (HPC) engraftment is: A. clonogenic assay B. cell viability C. CD34+ cell enumeration D. manual differential

C. manual differential

211.) the following test results are noted for a unit of blood labeled group A, Rh-negative: cells tested with anti-A = 4+ anti-B = 0 anti-D = 3+ what should be done next? A. transfuse as a group A, Rh-negative B. transfuse as a group A, Rh-positive C. notify the collecting facility D. discard the unit

C. notify the collecting facility

261.) while performing an antibody screen, a test reaction is suspected to be rouleaux. A saline replacement test is performed and the reaction remains. What is the best interpretation? A. original reaction of roleaux is confirmed B. replacement test is invalid and should be repeated C. original reaction was due to true agglutination D. antibody screen is negative

C. orginal reaction was due to true agglutination

266.) a patient received 2 units of RBC and had a delayed transfusion reaction. Pretransfusion antibody screening records indicate no agglutination except after the addition of IgG-sensitized cells. Repeat testing of the pretransfusion specimen detected an antibody at the antiglobulin phase. What is the most likely explanation for the original results? A. red cells were overwashed B. centrifugation time was prolonged C. patient's serum was omitted from the original testing D. antiglobulin reagent was neutralized

C. patient's serum was omitted from the original testing

350.) a patient is readmitted to the hospital with a hemoglobin level of 7 g/dL (70 g/L) 3 weeks after receiving 2 units of red cells. The initial serological tests are: ABO/Rh = A+ antibody screen = negative DAT = 1+ mixed field which test should be performed next? A. antibody identification panel on the patient's serum B. repeat the ABO type on the donor units C. perform an elution and identify the antibody in the eluate D. crossmatch the post reaction serum with the 2 donor units

C. perform an elution and identify the antibody in the eluate

302.) in solid phase red cell adherence assays (SPRCA) to detect platelet specific antibodies, the wells of the microtiter plates are coated with immobilized: A. red blood cells B. granulocytes C. platelets D. patient serum

C. platelets

232.) during an emergency situation with no time to determine ABO group and Rh type on a current sample for transfusion, it is noted that previous records state the patient is known to be A, Rh-negative. The technologist should: A. refuse to release any blood until the patient's sample has been typed B. release A, Rh-negative RBC C. release O Rh-negative RBC D. release O Rh-positive RBC

C. release O Rh-negative RBC

228.) based on the results below, what is the next step in determination of the patient's ABO/Rh type? anti-A = 4+ anti-B = 4+ anti-D = 4+ A1 cells= 0 B cells = 0 A. interpret at AB, D-positive B. interpret at AsubB, D-positive C. repeat ABO red cell typing and include a control D. add room temperature incubation with ABO red cell typing

C. repeat ABO red cell typing and include control

308.) Crossmatch results at the antiglobulin phase were negative. When 1 drop of check cells was added, no agglutination was seen. The MOST likely explanation is that the? A. red cells were overwashed B. centrifuge speed was set too high C. residual patient serum inactivated the AHG reagent D. laboratorian did not add enough check cells

C. residual patient serum inactivated the AHG reagent

327.) Fresh Frozen Plasma: A. contains all labile coagulative factors except cryoprecipitated AHF B. has a higher risk of transmitting hepatitis than does Whole Blood C. should be transfused within 24 hours of thawing D. need not be ABO-compatible

C. should be transfused within 24 hours of thawing

333.) a patient has symptoms indicating a possible hemolytic transfusion reaction. What should be done immediately? A. stop the transfusion and discard the unit B. contact the patient's doctor to ask if the transfusion should be stopped C. stop the transfusion and call the patient's doctor to report the reaction D. have patient blood samples sent to the lab to investigate the reaction

C. stop the transfusion and call the patient's doctor to report the reaction

258.) the purpose of testing with anti-A,B is to detect: A. anti-A1 B. anti-A2 C. subgroups of A D. subgroups of O

C. subgroups of A

222.) a mother is Rh-negative and the father is Rh-positive. Their baby is Rh-negative. It may be concluded that: A. the father is homozygous for D B. the mother is heterozygous for D C. the father is heterozygous for D D. at least 1 of the 3 Rh typings must be incorrect

C. the father is heterozygous for D

257.) during prenatal studies, a woman is noted to have a positive antibody screen and anti-Kp^a is identified. What percentage of units will be compatible for this patient if transfusion is necessary? A. <2% B. 50% C. 85% D. >98%

D. >98%

293.) which of the following genes on chromosome 1 is made up of 2 exons, leading to the expression of the Duffy glycoprotein and its antigens? A. DAF B. FYAB C. FY D. ACKR1

D. ACKR1

329.) a common strategy to reduce alloimmunization in chronically transfused patients with Sickle Cell Disease (SCD) is to provide red cell units matched for which of the following antigens? A. Fy^a, Fy^b, and Di^a B. M, N, and S C. Jk^a, Jk^b and s D. C, E, and K

D. C, E, K

320.) cryoprecipitated AHF transfusion is recommended as a treatment for patients with: A. type 1 vWF disorder B. factor V coagulation deficiency C. factor VII coagulation deficiency D. DIC with hypofibrinogenemia

D. DIC with hypofibrinogenemia

199.) the DAT in a patient with WAIHA is most often positive for: A. IgG only B. C3 only C. IgM only D. IgG and C3

D. IgG and C3

361.) symptoms of dyspnea, hypoxemia, and pulmonary edema within 6 hours of transfusion is most likely which type of reaction? A. anaphylactic B. hemolytic C. febrile D. TRALI

D. TRALI

272.) a patient's serum sample was reactive with all cells except the autocontrol when tested by PEG-AHG. The patient's phenotype was confirmed as C-E+c+e+; K-k+, Kp(a-b+), Js(a-b+); Fy(a-b+); Jk(a-b-); M+N+S+s+. Phenotypically similar cells were tested and found to be nonreactive. In what population of donors are we most likely to find a compatible donor for this patient? A. African B. Middle Eastern C. South American D. Tahitian

D. Tahitian

379.) the most important step in the safe administration of blood is to: A. perform compatibility testing accurately B. get an accurate patient history C. exclude disqualified donors D. accurately identify the donor unit and recipient

D. accurately identify the donor unit and recipient

287.) to confirm a serum antibody specificity identified as anti-P1, a neutralization study was performed and the following results obtained: (sample, P1+ RBCs) serum + P1 substance = negative serum + saline = negative what conclusion can be made from these results? A. anti-P1 is confirmed B. anti-P1 is ruled out C. a second antibody is suspected due to the results of the negative control D. anti-P1 cannot be confirmed due to the results of the negative control

D. anti-P1 cannot be confirmed due to results of the negative control

363.) congestive heart failure, severe headache, and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion reaction? A. hemolytic B. febrile C. anaphylactic D. circulatory overload

D. circulatory overload

210.) samples from the same patient were received on 2 consecutive days. test results summarized: (1 then 2) anti-A = 4+ 0 anti-B = 0 4+ anti-D = 3+ 3+ A1 cells= 0 4+ B cells= 4+ 0 Ab screen= 0 0 how should the request for crossmatch be handled? A. crossmatch A, Rh-positive units with sample from day 1 B. crossmatch B, Rh-positive unites with sample from day 2 C. crossmatch AB, Rh-positive units with both samples D. collect a new sample and repeat the tests

D. collect a new sample and repeat the tests

335.) An unexplained fall in hemoglobin and mild jaundice in a patient transfused with RBC's 1 week previously would most likely indicate: A. paroxysmal nocturnal hemoglobinuria B. posttransfusion hepatitis infection C. presence of HLA antibodies D. delayed hemolytic transfusion reaction

D. delayed hemolytic transfusion reaction

253.) in the direct antigloulin test, the antiglobulin reagent is used to: A. mediate hemolysis of indicator RBC by providing complement B. precipitate anti-erythrocyte antibodies C. measure antibodies in a test serum by fixing complement D. detect preexisting antibodies on erythrocytes

D. detect preexisting antibodies on erythrocytes

332.) a patient has become refractory to platelet transfusion. Which of the following are probable causes? A. transfusion of Rh-incompatible platelets B. decreased pH of the platelets C. development of an alloantibody with anti-D specificity D. development of antibodies to HLA antigen

D. development of antibodies to HLA antigen

375.) which of the following must be verified in the transfusion service prior to the issue of blood products? A. antibody detection test result B. date and time when the patient's blood sample was drawn C. name of the transfusionist administering the blood product D. expiration date and, if applicable, expiration time of the blood product

D. expiration date and if applicable, expiration time of the blood product

235.) A 10% red cell suspension in saline is used in a compatibility test. Which of the following would most likely occur? A. false-positive result due to antigen excess B. false-positive result due to the prozone phenomenon C. false-negative result due to the prozone phenomenon D. false-negative result due to antigen excess

D. false-negative results due to antigen excess

356.) fever and chills are symptoms of which of the following transfusion reactions? A. citrate toxicity B. circulatory overload C. allergic D. febrile

D. febrile

359.) a 65-yo woman experienced shaking, chills, and a fever of 102 oF (38.9 oC) approximately 40 mins following the transfusion of a second unit of RBC. The most likely explanation for the patient's symptoms is: A. transfusion of bacterially contaminated blood B. congestive heart failure C. anaphylactic transfusion reaction D. febrile transfusion reaction

D. febrile transfusion reaction

348.) a patient's record shows a previous anti-Jkb, but the current antibody screen is negative. What further testing should be done before transfusion? A. phenotype the patient's red cells for the Jkb antigen B. perform a cell panel on the patient's serum C. crossmatch type specific units and release only compatible units for transfusion D. give Jk(b-), crossmatch compatible blood

D. give Jk(b-), crossmatch compatible blood

323.) which of the following is consistent with standard blood bank procedure governing the infusion of fresh frozen plasma? A. only blood group-specific plasma may be administered B. group O may be administered to recipients of all blood groups C. group AB may be administered to AB recipients only D. group A may be administered to both A and O recipients

D. group A may be administered to both A and O recipients

324.) a patient who is group AB, Rh-negative needs 2 units of fresh frozen plasma. Which of the following units of plasma would be MOST acceptable for transfusion? A. group O, Rh-negative B. group A, Rh-negative C. group B, Rh-positive D. group AB, Rh-positive

D. group AB, Rh-positive

367.) transfusion-associated HTLV I/II incidence is low due to the following laboratory testing: A. nucleic acid testing for HTLV I/II B. HTLV I core antibody testing by ELISA C. HTLV II surface antigen testing by chemiluminescent immunoassay (ChLIA) D. IgG antibody testing for HTLV I/II by ELISA or ChLIA

D. igG antibody testing for HTLV I/II by ELISA or ChLIA

205.) a patient in the immediate post bone marrow transplant period has a hematocrit of 21%. The red cell product of choice for this patient would be: A. packed B. saline washed C. microaggregate filtered D. irradiated

D. irradiated

352.) to prevent donor lymphocytes from engraftment in the bone marrow of an immunosuppressed patient, all transfusion products must be: A. washed B. leukocyte-reduced C. treated with UV light D. irradiated

D. irradiated

214.) a patient is group A, Rh-positive but is receiving a group O, bone marrow transplant (BMT) on Friday. After the transplant, what hemagglutination pattern will the patient demonstrate when the patient's red cells are tested with anti-A? A. rouleaux B. aggregation C. polyagglutination D. mixed-field

D. mixed-field

344.) during initial investigation of a suspected hemolytic transfusion reaction, it was observed that Blood Bank paperwork and patient sample and blood component labels were correct, the posttransfusion reaction plasma was yellow as was the pretransfusion sample, and the direct antiglobulin test was negative. Repeat ABO typing on the posttransfusion sample confirmed the pretransfusion results. What is the next step in this investigation? A. repeat compatibility testing on the suspected unit(s) B. perform plasma hemoglobin and haptoglobin determinations C. use enhancement media to repeat the antibody screen D. no further serological testing is necessary

D. no further serological testing is necessary

197.) a 40 yo man with autoimmune hemolytic anemia due to anti-E has a hemoglobin level of 10.8 g/dL (108 g/L). This patient will most likely be treated with: A. whole blood B. RBC C. fresh frozen plasma D. no transfusion

D. no transfusion

256.) the drug cephalosporin can cause a positive direct antiglobulin test due to modification of the RBC membrane by the drug which is independent of antibody production. This mechanism related to the drug cephalosporin is best described as: A. drug-dependent B. complement related drug-dependent C. drug-autoantibody D. nonimmunologic protein adsorption

D. nonimmunologic protein adsorption

297.) a 26 yo female is admitted with anemia of undetermined origin. Blood samples are received with a crossmatch request for 1 units of RBC. the patient is group A, Rh-negative and has no history of transfusion or pregnancy. the following results were obtained in pretransfusion testing: (sample, IS, 37 oC, IAT) screening cell I = 0 0 3+ screening cell II = 0 0 3+ autocontrol = 0 0 3+ donor unit = 0 0 3+ the next step to continue this investigation would be: A. do an antibody identification panel B. use the saline replacement technique C. use the pre-warm technique D. perform a warm autoadsorption

D. perform a warm autoadsorption

376.) during the issue of an autologous unit of Whole Blood, the supernatant plasma is observed to be dark red. What would be the best course of action? A. the unit may be issued only for autologous use B. remove the plasma and issue the unit as RBC C. issue the unit only as washed RBC D. quarantine the unit for further testing

D. quarantine the unit for further testing

229.) the major crossmatch will detect a(n): A. group A patient mistyped as O B. unexpected red cell antibody in the donor unit C. Rh-negative donor unit mislabeled as Rh-positive D. recipient antibody directed against antigens on the donor red cells

D. recipient antibody directed against antigens on the donor red cells

366.) which of the following patient groups is at risk of developing graft-vs-host disease? A. full term infants B. patients with history of febrile transfusion reactions C. patients with a positive direct antiglobulin test D. recipients of blood donated by immediate family members

D. recipients of blood donated by immediate family members

310.) the primary indication for granulocyte transfusion is: A. prophylactic treatment for infection B. additional supportive therapy in those patients who are responsive to antibiotic therapy C. clinical situations where bone marrow recovery is not anticipated D. severe neutropenia with an infection that is nonresponsive to antibiotic therapy

D. severe neutropenia with an infection that is nonresponsive to antibiotic therapy

322.) transfusion of plateletpheresis products from HLA-compatible donors is the preferred treatment for: A. recently diagnosed cases of TTP with severe thrombocytopenia B. acute leukemia in relapse with neutropenia, thrombocytopenia and sepsis C. immune thrombocytopenic purpura D. severely thrombocytopenic patients, known to be refractory to random donor platelets

D. severely thrombocytopenic patients, known to be refractory to random donor platelets

317.) guidelines for emergency release of blood require that: A. ABO group and Rh typing of recipient be performed before the unit is released B. only group O Whole Blood be issued C. only Rh-negative blood is used for Rh-negative patients D. the physician signs a document authorizing the emergency release

D. the physician signs a document authorizing the emergency release

341.) a trauma patient who has just received 10 units of blood may develop: A. anemia B. polycythemia C. leukocytosis D. thrombocytopenia

D. thrombocytopenia

271.) which of the following might cause a false negative indirect antiglobulin test (IAT)? A. over-reading B. IgG-coated screening cells C. addition of an extra drop of serum D. too heavy a cell suspension

D. too heavy a cell suspension

372.) therapeutic plasmapheresis is performed in order to: A. harvest granulocytes B. harvest platelets C. treat patients with polycythemia D. treat patients with plasma abnormalities

D. treat patients with plasma abnormalities

221.) the following results were obtained when testing a sample from a 20 yo, first time blood donor: forward group: anti-A=0, anti-B=0 reverse group: A1 cells=0, B cells= 3+ what is the most likely cause of this ABO discrepancy? A. loss of antigen due to disease B. acquired B C. phenotype Oh "Bombay" D. weak subgroup of A

D. weak subgroup of A