Ch. 13

A Donath-Landsteiner test is performed to determine the presence of antibodies with biphasic activity. The results show no hemolysis in the control sample and hemolysis in the test sample. These test results should be reported as: A) Positive B) Negative C) Inconclusive D) Borderline E) None of the above

A

A blood transfusion for a patient with cold agglutinin syndrome will require: A) Irradiation B) Transfusion with a warming coil C) HbS negative D) CMV negative E) Washing of red cells

A

A patient received a blood transfusion that contained a foreign red cell antigen. The patient developed antibody to this foreign antigen. In this case a/an __________ response has occurred. A) Alloimmune B) Autoimmune C) Drug-induced D) Non-immune E) Allergic

A

A patient who has been taking quinidine presents with hemoglobinemia and hemoglobinuria. His DAT shows specificity with anti-complement reagents but not with anti-IgG. His eluate is nonreactive. Which drug mechanism is responsible? A) Immune complex B) Drug absorption C) Membrane modification D) Methyldopa-induced E) Autoimmune

A

Activation of the classical pathway is initiated by what immune complexes? A) IgG or IgM B) IgM or IgA C) IgE or IgM D) IgD or IgE E) IgG or IgA

A

Anti-K was detected in a patient's serum 1 year ago in a routine antibody screen. This patient was transfused red cells containing antigen specific for anti-K. Forty-eight hours later the patient began exhibiting signs of a hemolytic anemia. What type of transfusion reaction is present? A) Delayed B) Acute C) Immediate D) Allergic E) Febrile

A

Autoantibody in warm autoimmune hemolytic anemia (WAIHA) usually mimics __________ specifically. A) Rh B) Lewis C) Duffy D) Kell E) Kidd

A

In alloimmune hemolytic anemia, hemolysis results from: A) Patient antibody to a foreign antigen coating the red cell B) Patient antigen coating red cell C) Patient antibody coating native red cell antigen D) Drug in the patient serum coating red cells E) None of the above

A

Intravascular hemolysis due to mechanical etiologies is usually accompanied by the presence of __________ on the peripheral blood smear. A) Schistocytes B) Target cells C) Sickle cells D) Ovalocytes E) Spherocytes

A

Microangiopathic hemolytic anemia is usually characterized by the presence of: A) Schistocytes B) Increased platelets C) Leukocytosis D) Normocytes E) Target cells

A

The main site of destruction for cells coated with complement alone is the __________. A) Liver B) Spleen C) Kidney D) Marrow E) None of the above

A

What pathological cold antibody disease is found in children in association with infectious mononucleosis, mumps, measles, and chicken pox? A) Paroxysmal cold hemoglobinuria B) Mycoplasma pneumoniae associated disease C) Cold agglutinin syndrome D) Secondary cold AIHA E) Paroxysmal nocturnal hemoglobinuria

A

What type of transfusion reaction would result from an incompatible mismatch in the ABO blood group? A) Acute hemolytic B) Hemolytic C) Xenophobic D) Delayed hemolytic E) Allergic

A

Where does extravascular phagocytosis of red cells occur? A) Spleen and liver B) Liver and lymph nodes C) Kidney and liver D) Lungs and liver E) Bone marrow and lymph nodes

A

Which is a characteristic red blood cell morphology in patients with abetalipoproteinemia? A) Acanthocytes B) Target cells C) Spherocytes D) Helmet cells E) None of the above

A

An autohemolysin can be defined as: A) A warm autoantibody that binds a patient's red cells at low temperatures and fixes complement B) A cold autoantibody that binds a patient's red cells at low temperatures and fixes complement C) A cold autoantibody that binds a patient's red cells at warm temperatures and fixes complement D) A cold autoantibody that binds a patient's red cells at low temperatures but does not fix complement E) All of the above

B

An immune hemolytic disorder in which red cells of the fetus and newborn are destroyed by maternal IgG antibody is: A) Warm autoimmune hemolytic anemia B) Hemolytic disease of the newborn (HDN) C) Hydrops fetalis D) Hereditary persistence of fetal hemoglobin E) Cold autoimmune hemolytic anemia

B

Autoimmune hemolytic anemia represents an abnormality in which: A) Hemolysis results from antigen sensitization through blood transfusion. B) Self-recognition of an individual's own red cell antigens is lost. C) Hemolysis results from patient's antibodies binding to blood groups other than ABO. D) Hemolysis is always drug induced. E) All of the above

B

Cold hemagglutinin disease represents __________ of all cases of autoimmune hemolytic anemia. A) 70% B) 16% C) 2% D) 12% E) 50%

B

Complement is a group of serum proteins that interact with each other to bring about: A) Complement-independent cell-mediated lysis B) Complement-dependent cell-mediated lysis C) Antibody-independent cell-mediated lysis D) Extravascular hemolysis E) None of the above

B

Drug-induced immune hemolytic anemia represents ____ of autoimmune hemolytic anemias. A) 16% B) 12% C) 70% D) 2% E) 40%

B

In HDN, when extramedullary hematopoiesis takes over for the fetal bone marrow to compensate for increased red cell destruction, this results in: A) A hypocellular bone marrow B) Hepatosplenomegaly C) Decrease in bilirubin D) Aplastic anemia E) Spherocytosis

B

In the case of partial phagocytosis, the red cell membrane reforms to form what type of red cell? A) Target cell B) Spherocyte C) Schistocyte D) Macrocyte E) Drepanocyte

B

In two-thirds of cases of warm autoimmune hemolytic anemia (WAIHA), the direct antiglobulin test (DAT) will result in reactivity with: A) IgG only B) IgG and C3d C) C3d only D) IgA E) IgE

B

The presence of these cells in the peripheral blood suggests that the patient is in the hemolytic phase of bartonellosis: A) Spherocytes B) Nucleated red cells C) Acanthocytes D) Schistocytes E) Target cells

B

To illustrate the presence of a malarial parasite in a blood smear, which stain is suggested? A) Methylene blue B) Giemsa C) Prussian blue D) Eosin E) Crystal violet

B

Warm autoimmune hemolytic anemia accounts for __________ of all cases of autoimmune hemolytic anemia. A) 12% B) 70% C) 16% D) 4% E) 40%

B

What hemolytic anemia is a common occurrence in joggers and marathon runners? A) Cardiac prosthesis B) March hemoglobinuria C) Hemolytic uremia syndrome D) Thrombotic thrombocytopenic purpura E) Idiopathic thrombocytopenic purpura

B

On a peripheral blood smear of a newborn suspected of HDN, one morphological abnormality that would help distinguish ABO HDN from Rh HDN is: A) Reticulocytosis B) Leukocytosis C) Spherocytes D) Nucleated red cells E) Target cells

C

The mechanism of direct lysis resulting from the release of lytic enzymes from effector cells that act on the red cell membrane is referred to as: A) Antigen-dependent cellular cytotoxicity B) Antibody-independent cellular cytotoxicity C) Antibody-dependent cellular cytotoxicity D) Antigen-independent cellular cytotoxicity E) None of the above

C

The spherocyte is indicative of: A) Liver damage B) Intravascular hemolysis C) Extravascular hemolysis D) Non-immune-mediated hemolysis E) None of the above

C

What pathological cold antibody disease occurs in persons older than 50 years of age and demonstrates acrocyanosis of the hands and feet and the presence of a lymphoproliferative disorder? A) Paroxysmal cold hemoglobinuria B) Mycoplasma pneumoniae associated disease C) Cold agglutinin syndrome D) Secondary cold AIHA E) Paroxysmal nocturnal hemoglobinuria

C

Which drug is primarily associated with the drug absorption (hapten) mechanism? A) Aldomet B) Streptomycins C) Penicillin D) Acetaminophen E) Primaquine

C

Which drug mechanism functions by modifying the red cell membrane so that normal plasma proteins are absorbed non-immunologically? A) Immune complex B) Drug absorption C) Membrane modification D) Methyldopa-induced E) Autoimmune

C

Which type of HDN is the most frequent? A) Rh HDN B) Duffy HDN C) ABO HDN D) Kidd HDN E) Kell HDN

C

A drug mechanism that results in a positive DAT with IgG specificity and a reactive eluate that usually mimics anti-e specificity is: A) Immune complex B) Drug absorption C) Membrane modification D) Methyldopa-induced (Autoimmune) E) None of the above

D

Alloimmune hemolytic anemia may result from: A) Pregnancy B) Blood transfusion C) Organ transplant D) All of the above E) None of the above

D

Chemicals or drugs that induce oxidative stress in red cells may result in hemoglobin being denatured and the formation of which type of inclusion? A) Hemoglobin H inclusions B) Siderocytes C) Howell-Jolly bodies D) Heinz bodies E) Pappenheimer bodies

D

Evaluate the course of infection that can occur in a splenectomized patient with babesiosis: A) Acute intravascular hemolysis B) Hemoglobinemia C) Renal failure D) All of the above E) None of the above

D

Plasmodium __________ has proven to be the most fatal of species of malaria presenting with massive intravascular hemolysis, jaundice, and hypotension. A) vivax B) ovale C) malariae D) falciparum E) hemolytica

D

The alternate pathway may be triggered by: A) Microorganisms B) Polysaccharides C) Lipopolysaccharides D) All of the above E) None of the above

D

What cold autoantibodies are found in the serum of normal, healthy individuals? A) Anti-H B) Anti-I C) Anti-IH D) All of the above E) None of the above

D

Which IgG subclass cannot activate complement in immune hemolysis? A) IgG1 B) IgG2 C) IgG3 D) IgG4 E) IgG1 and IgG2

D

Which of the following are classifications of immune hemolytic anemias? A) Alloimmune B) Autoimmune C) Drug-induced D) All of the above E) None of the above

D

Which of the following clinical features suggests a delayed hemolytic transfusion reaction has occurred? A) Mild fever B) Mild jaundice C) Unexpected fall in hemoglobin D) All of the above E) None of the above

D

A unit of blood transfused to a WAIHA patient should be: A) Least incompatible in the crossmatch B) Negative for antigens for clinically significant antibodies present in the patient C) Transfused slowly D) Transfused in small volumes E) All of the above

E

Laboratory features that suggest paroxysmal cold hemoglobinuria include: A) Polychromasia B) Poikilocytosis C) Hemoglobinuria is present D) Nucleated red blood cells E) All of the above

E

Laboratory findings that support a diagnosis of a malaria infection include: A) Normochromic/normocytic anemia B) Leukopenia C) Thrombocytopenia D) Presence of schizont on smear E) All of the above

E

The peripheral blood smear of a patient with warm autoimmune hemolytic anemia will show: A) Marked polychromasia B) Reticulocytosis C) Spherocytosis D) Nucleated RBCs E) All of the above

E

Which clinical feature suggests an acute hemolytic transfusion reaction? A) Fever B) Chills C) Hypotension D) Nausea E) All of the above

E

Which of the following antibodies do not cause a delayed hemolytic transfusion reaction? A) Anti-E B) Anti-K C) Anti-e D) Anti-C E) Anti-M

E