transfusion medicine exam 1 Part 1

After adding antigen and antibody to a test tube, one large agglutinate was observed. How should this reaction be graded? a. 2+ b. 3+ c. 4+ d. 0

c. 4+

Plans that provide the framework for establishing quality assurance in an organization are: a. standard operating procedures. b. current good manufacturing practices. c. continuous quality improvement plan. d. change control plan.

c. continuous quality improvement plan.

An antigen that originates from the individual is termed: a. autologous b. allogeneic c. hapten d. immunogen

A. Autologous

Degree to which a measurement represents the true value

Accuracy

Systematic evaluation to determine whether procedures are being followed

Audit

Part of the antigen that the immunoglobulin binds to

Epitope

Ensure the safety and efficacy of biologics, drugs, and devices

FDA

Quality control is the same as quality assurance. True False

False

Variable region of an immunoglobulin

Idiotype

Found in secretions, such as breast milk

IgA

Associated with allergic reactions and mast cell activation

IgE

Able to cross the placenta

IgG

Has the highest serum concentration

IgG

Has the highest number of antigen binding sites

IgM

Ensure safe and healthful working conditions

OSHA

Maximizes the duration of equipment and increases the reliability of the equipment

Preventive maintenance

Removal of products from the market that might compromise the safety of the recipient

Recall

The Occupation Safety and Health Administration does not require the routine use of gloves by phlebotomists working with healthy prescreened donors or changing unsoiled gloves between donors. True False

True

Establishing that a specific process produces an expected result

Validation

Which of the following is an example of an unacceptable record-keeping procedure? a. Using dittos in columns to save time b. Not deleting the original entry when making a correction c. Always using permanent ink on all records d. Recording the date and initials next to a correction

a. Using dittos in columns to save time

Which of the following organizations are involved in the regulation of blood banks? a. College of American Pathologists b. Food and Drug Administration c. The Joint Commission d. AABB

b. Food and Drug Administration

Professional organization that accredits blood banks and transfusion services

AABB

Provides peer-reviewed accreditation for hospital laboratories

CAP

Makes recommendations to the Occupational safety and health administration regarding the prevention of disease transmission

CDC

Process of standardizing an instrument against a known value

Calibration

system to plan and implement changes to prevent problems

Change control

Evaluation of an employee's ability to perform a specific skill

Competency assessment

Imparts flexibility to the immunoglobulin molecule

Hinge region

Associated with immediate-spin in vitro reactions

IgM

Associated with intravascular cell destruction

IgM

Efficient in activation of the complement cascade

IgM

The type of immunoglobulins determined by the heavy chain

Isotype

One of the two types of light chains

Kappa

The CAP survey is an example

Proficiency test

testing to determine the accuracy and precision of reagents and equipment

Quality Control

Investigation and identification of the factors that contributed to an error

Root cause analysis

At what point in the employment process should safety training take place? a. Before independent work is permitted and annually thereafter b. During orientation and training c. Following the employees' first evaluation d. Following lab training when employees are more familiar with their responsibilities

a. Before independent work is permitted and annually thereafter

Which class of HLA antigens would be typed when matching patient and donors for platelet transfusion? a. Class I only b. Class II only c. Class I and II d. Classes I, II, and III

a. Class I only

Select the substance that regulates the activity of other cells by binding to specific receptors. a. Cytokines b. Complement c. Immunoglobulins d. Anaphylatoxin

a. Cytokines

What is the potential effect in a tube agglutination test if a red cell suspension with a concentration greater than 5% is used? a. False negatives b. False positives c. Hemolysis d. No effect

a. False negatives

Select the term that is associated with the B-cell response to antigens. a. Humoral immunity b. Cellular immunity c. Innate immunity d. Nonspecific immunity

a. Humoral immunity

In a routine audit of a facilities blood collection area, the quality assurance department found that the blood bags used on that particular day had expired. What is the appropriate course of action? a. Initiate a root cause analysis and quarantine the blood collected in the expired bags. b. Fire the donor room supervisor, and discard the blood collected in the expired bags. c. Call the Food and Drug Administration to report the incident. d. Change the expiration date on the bags to avoid legal issues.

a. Initiate a root cause analysis and quarantine the blood collected in the expired bags.

A technologist 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 technologist's initials. Is this an acceptable procedure? a. No; she should have brought the error to the technologist's attention. b. Yes; as long as she records the result in pencil. c. Yes; all results must be recorded regardless of who did the test. d. Yes; because she used the other technologist's initials.

a. No; she should have brought the error to the technologist's attention.

A patient's record indicated that he had a history of an antibody to HPA-1a. What is the significance of this antibody if this patient requires a platelet transfusion? a. The patient would require HPA-1a negative platelets, which are relatively rare. b. Transfusion of HLA-matched platelet donors would yield a better response. c. Washed platelets are necessary to avoid antibody interference. d. No testing is necessary because the frequency of HPA-1a positive donors is very rare.

a. The patient would require HPA-1a negative platelets, which are relatively rare.

Select the region of the antibody molecule responsible for imparting unique antibody specificity. a. Variable region b. Constant region c. Hinge region d. Fc fragment

a. Variable region

Select the portion of the antibody molecule that imparts the antibody's unique class function. a. Constant region of the heavy chain b. Constant region of the light chain c. Variable region of the heavy chain d. Variable region of the light chain

b. Constant region of the light chain

Which of the following is true regarding good manufacturing practices (GMPs)? a. GMPs are optional guidelines written by the AABB. b. GMPs are legal requirements established by the Food and Drug Administration. c. GMPs are required only by pharmaceutical companies. d. GMPs are part of the quality control requirements for blood products.

b. GMPs are legal requirements established by the Food and Drug Administration.

Several units were released to a hospital by mistake before all viral marker testing was completed. What is the appropriate course of action? a. Ask the hospital to avoid transfusion and quickly complete the testing. b. The error is reportable, and the Food and Drug Administration must be contacted. c. Recall only the units that are positive for viral markers. d. Perform a root cause analysis and, if the units are found to be negative, report the test result to the hospital.

b. The error is reportable, and the Food and Drug Administration must be contacted.

A facility does not validate a refrigerator before use. What is a potential outcome? a. The facility is in compliance if the equipment functions properly. b. The facility is in violation of current good manufacturing practices and could be cited by the Food and Drug Administration. c. The facility is in violation of AABB and may no longer be members. d. The facility is in compliance if the blood products stored in it are not transfused.

b. The facility is in violation of current good manufacturing practices and could be cited by the Food and Drug Administration.

In safety training, employees must become familiar with all of the following except: a. tasks that have an infectious risk. b. how to perform cardiopulmonary resuscitation on a donor or other employee. c. limits of protective clothing and equipment. d. the appropriate action to take if exposure occurs.

b. how to perform cardiopulmonary resuscitation on a donor or other employee.

All of the following are responsibilities of the quality assurance department of a blood bank except: a. reviewing standard operating procedures. b. performing quality control. c. performing internal audits. d. reviewing and approving training programs.

b. performing quality control.

A poor response to platelet transfusion that can be caused by antibodies to human leukocyte antigens is known as: a. nonresponders. b. refractoriness. c. immune activation. d. responders.

b. refractoriness.

Select the cell involved in humoral immunity. a. Neutrophils b. T lymphocytes c. B lymphocytes d. Monocytes

c. B lymphocytes

In the complement cascade, lysis of the target cell is mediated by which of the following components? a. C1qrs b. C4a, C3a, and C5a c. C5 to C9 d. C3a and C3b

c. C5 to C9

Hemolysis was observed at room temperature when testing a patient's serum with reagent red cells used for screening. When this test was repeated using the patient's plasma, no hemolysis was observed. What was the most likely explanation for the different reactions? a. The plasma sample was collected incorrectly. b. The serum sample was contaminated. c. Complement activation was inhibited by calcium in the plasma sample. d. The serum sample was fresher.

c. Complement activation was inhibited by calcium in the plasma sample.

What portion of the antibody molecule binds to receptors on macrophages and assists in the removal of antibody bound to red cells? a. Fab fragment b. Hinge region c. Fc fragment d. J chain

c. Fc fragment

Which of the following will cause an antigen to elicit a greater immune response? a. Small antigen size b. Composed largely of carbohydrates c. Size greater than 10,000 daltons d. Similarity to the host

c. Size greater than 10,000 daltons

In a serologic test, the term prozone is also known as: a. equivalence. b. antigen excess. c. antibody excess. d. serum-to-cell ratio.

c. antibody excess.

The major histocompatibility complex is located on chromosome 6 and is important in all the following immune functions except: a. recognition of nonself. b. graft rejection. c. hemolysis. d. coordination of cellular and humoral immunity.

c. hemolysis.

Extravascular destruction of blood cells occurs in the: a. blood vessels. b. lymph nodes. c. spleen. d. thymus.

c. spleen.

HLA matching between the donor and recipient is important for progenitor cell transplantation to avoid: a. graft versus host disease (GVHD). b. graft rejection. c. transfusion reactions. d. A and B.

d. A and B.

Personal protective equipment includes: a. safety glasses. b. splash barriers. c. masks. d. All of the above

d. All of the above

Unacceptable quality control results for the antiglobulin test performed in test tubes may be noticed if: a. preventive maintenance has not been performed on the cell washer. b. the technologist performing the test was never trained. c. the reagents used were improperly stored. d. All of the above

d. All of the above

When using the Hardy-Weinberg equation to calculate genetic frequencies, which of the following must be TRUE? a. The population statistics must be large. b. Mutations cannot occur. c. Mating must be random. d. All of the above are true.

d. All of the above are true.

Which of the following is responsible for the activation of the classic pathway of complement? a. Bacteria b. Foreign proteins c. Virus d. Antibody bound to antigen

d. Antibody bound to antigen

Which of the following agencies administers the Clinical Laboratory Improvement Amendments? a. AABB b. OSHA c. Food and Drug Administration d. Centers for Medicare and Medicaid Services

d. Centers for Medicare and Medicaid Services

What immunoglobulin class is capable of crossing the placenta? a. IgM b. IgA c. IgE d. IgG

d. IgG

In order to enhance the reaction of an antibody in vitro, it may be necessary to adjust which of the following? a. Temperature above 37° C b. Speed of the centrifuge above the calibrated settings c. Increase the concentration of red cells in the test system d. Increase the incubation time in the incubator

d. Increase the incubation time in the incubator

A laboratory technologist decided she would like to bring her lab coat home for laundering because it had too many wrinkles when returned by the laboratory's laundry service. Is this practice acceptable? a. Yes, as long as she removes the coat and does not wear it home b. Yes, if she uses 10% bleach c. Yes, if she clears it with her supervisor d. No, because the laboratory is a biosafety level 2, and lab coats may not be removed

d. No, because the laboratory is a biosafety level 2, and lab coats may not be removed

What reagent contains antibodies to multiple antigenic epitopes? a. Alloantibody-based b. Monoclonal-based c. Heterophile antibody-based d. Polyclonal-based

d. Polyclonal-based

A person whose red cells type as M+N+ with antisera would be: a. linked. b. unable to be determined without family studies. c. a homozygote. d. a heterozygote.

d. a heterozygote.

Employee training takes place: a. as procedures are validated. b. following competency assessment. c. only for new inexperienced employees. d. after hiring and following implementation of new procedures.

d. after hiring and following implementation of new procedures.

It was observed that 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 is: a. affinity maturation of the immunoglobulin molecule. b. anamnestic response. c. isotype switching. d. all of the above.

d. all of the above.

In a lymphocytotoxicity test, cells that take on the dye: a. do not recognize a human leukocyte antigen. b. recognize a red cell antibody. c. are not affected by complement. d. are recognized by a specific antibody

d. are recognized by a specific antibody

In a lymphocytotoxicity test, cells that take on the dye: a. do not recognize a human leukocyte antigen. b. recognize a red cell antibody. c. are not affected by complement. d. are recognized by a specific antibody.

d. are recognized by a specific antibody.

The standard operating procedure is a document that: a. is necessary only for training new employees. b. must be very detailed to be accurate. c. may be substituted with package inserts. d. helps achieve consistency of results.

d. helps achieve consistency of results.

All of the following are true regarding competency testing except: a. it must be performed following training. b. it must be performed on an annual basis. c. retraining is required if there is a failure in competency testing. d. it is required only if the technologist has no experience.

d. it is required only if the technologist has no experience.

Blood irradiators require all of the following safety procedures except: a. proper training. b. equipment leak detection. c. personal protective equipment. d. that the user have a degree in radiology.

d. that the user have a degree in radiology.

The mixed lymphocyte culture (MLC) is a procedure that has been used in HLA testing to determine: a. Class I HLA antigen determination. b. Class II HLA antigen determination. c. HLA antibody identification. d. compatibility testing for tissue typing. e. B and D.

e. B and D.