Blood bank
Which of the following is the proper storage temperature for fresh frozen plasma (FFP)? Please select the single best answer 37 degrees Celsius 4 degrees Celsius - 20 degrees Celsius - 10 degrees Celsius
- 20 degrees Celsius
How soon must granulocyte concentrates be administered after donation? Please select the single best answer 12 hours 24 hours 3 days 30 days
24 hours
How many milliliters of Rh positive whole blood is one dose of Rh immune globulin capable of neutralizing? Please select the single best answer 15 30 45 450
30
Units of A-negative, B-negative, and O-negative red blood cells are shipped to your transfusion service. What testing MUST be performed by your facility before placing these units into your inventory? Please select the single best answer ABO ABO and Rh ABO, Rh and antibody screen ABO, Rh and Weak D to confirm negative status
ABO and Rh
What is the increase in the risk for developing antibodies against red cell antigens (RBC alloimmunization) for patients who are characterized as chronically transfused patients? Please select the single best answer 1% - 4% 2% - 8% 5% - 10% 30% or greater
In chronically transfused patients, such as those with thalassemia, autoimmune hemolytic anemia, and sickle cell disease, the risk of developing antibodies against red cell antigens (RBC alloimmunization) increases by 30% or more.
What two things are put together for the testing known as forward grouping (testing)? Please select the single best answer Patient red cells and patient serum Reagent red cells and patient serum Reagent antisera and patient red cells Patient serum and donor red cells
In the forward grouping, patient's red cells are combined with reagent antisera to detect antigens present on the patient's red cells
Lewis Blood Group System is a human blood group unlike most others. The antigen is produced and secreted by exocrine glands, eventually adsorbing to the surface of red blood cells. Its expression is based on the genetic expression of the Lewis and Secretor genes. Based on the following genotype (Le) (Se), what would you predict the Lewis antigen phenotypic expression to be? The correct answer is highlighted below Le(a- b-) Le(a+ b+) Le(a- b+) Le(a+ b-)
Le(a- b+)
Which of the following blood group antigen-antibody reactions is enhanced by using enzymes: The correct answer is highlighted below Fya Fyb M Jka
Jka
The majority of Lewis antibodies are of which immunoglobulin class? The correct answer is highlighted below IgM IgG IgA IgE
Lewis antibodies are often naturally occurring and they occur without red blood cell stimulus. They are generally IgM and do not cross the placenta. Anti-Lea is the most commonly encountered of the Lewis antibodies.
Platelet specific antigens, also referred to as human platelet antigens (HPAs), are expressed on which of the following? Please select the single best answer Membrane glycoproteins Membrane lipids Nucleus surface Nucleus nucleolus
Membrane glycoproteins Human platelet antigens (HPA's) are expressed on six different platelet membrane glycoproteins. These include GPIIb, GPIIIa, GPIba, GPIbß, GPIa, and CD109.
What is the acceptable temperature range for maintaining red blood cell components during transport? Please select the single best answer 1 - 6ºC 1 - 10ºC 10 - 15ºC 20 - 24ºC
Red blood cell components must be maintained between 1 - 10°C during shipping. Red blood cell components (with the exception of frozen RBC units) are stored refrigerated between 1 - 6ºC.
What percentage of glycerol is most commonly used when freezing red blood cell units? Please select the single best answer 70% 40% 10% 20%
The correct answer is 40%. This is called the high glycerol method, and it is often used because the equipment is fairly simple, and frozen products require less delicate handling.
In order to prevent a loss of viability in platelet concentrates during storage, the pH must be maintained at or above what level? Please select the single best answer 7.5 6.2 5.0 4.5
The correct answer is 6.2. The proper pH for a unit of platelets must be at or above 6.2.
A rosette test to screen for fetomaternal hemorrhage (FMH) is indicated in all of the following situations, EXCEPT: The correct answer is highlighted below A weak D-positive infant A D-positive infant A D-positive mother A D-negative mother
A D-positive mother
Essential components of compatibility testing include all of the following EXCEPT: Please select the single best answer Antibody screen on recipient's serum Major crossmatch or computer crossmatch ABO and Rh typing of recipient Direct Antiglobulin Test (DAT)
A direct antiglobulin test (DAT) is used to detect in-vivo sensitization of red blood cells with IgG or complement components. Cases in which this test is used include hemolytic disease of the fetus and newborn, hemolytic transfusion reaction, and autoimmune or drug-induced hemolytic anemia. AABB Standards do not require a DAT for pretransfusion testing. Studies have looked into whether or not a routine DAT would benefit patient outcomes and have shown that they do not have a positive impact on the patients.
All of the following steps should be taken in the IMMEDIATE investigation of a potential hemolytic transfusion reaction EXCEPT: Please select the single best answer DAT on the post-transfusion patient sample. Check for clerical errors. Visual examination of the post-reaction and pre-reaction plasma for hemolysis. A gram-stain on the patient's plasma.
A gram-stain on the patient's plasma.
Phenotype refers to: The correct answer is highlighted below The genes inherited from each parent Opposing antigens produced by genes The presence of two or more alleles at a locus The expression of traits
A phenotype refers to the traits that are expressed; routine blood bank testing detects phenotype. For example, a person may possess the A phenotype.
A rejuvenation solution may be used up to how many days following expiration of a red cell unit? Please select the single best answer 1 day 3 days 7 days 10 days
A rejuvenation solution may be added to a unit of donated red blood cells up to 3 days after the unit has expired. A rejuvenation solution may be used within 1 day of the red cell unit's expiration, but that is not the maximum amount of time.
Which of the following donors could be accepted for blood donation? Please select the single best answer 22-year female who is currently pregnant 40-year-old female who lived in London from 1988 - 1995 44-year-old male who used a needle to administer nonprescription drugs 24-year-old man who had a tooth extraction two months ago
A tooth extraction that occurred two months ago would not be a reason for rejection as a blood donor.
A delayed hemolytic reaction occurring a week later is MOST likely caused by: Please select the single best answer Volume overload Kidd system antibodies Iron overload ABO incompatibility
Delayed hemolytic transfusion reactions occur more than 24 hours after a transfusion and result in the hemolysis of red blood cells. Of the causes that are listed, the most likely cause of a delayed hemolytic reaction is Kidd system antibodies. Both Jka and Jkb are often responsible for delayed hemolytic transfusion reactions.
A blood donor shows signs of syncope, or fainting, shortly after donating. What should be done to treat the patient? Please select the single best answer Ensure the donor's airway is open Perform chest compressions Ask the donor to cough Apply a cold compress to the back of the neck
The blood donor should sit or lie down and have a cold compress applied to the back of the neck.
Delayed hemolytic transfusion reactions (DHTR) usually occur within which time period? The correct answer is highlighted below 1 hour after transfusion 24 hours after transfusion 3-7 days after transfusion One year after transfusion
The correct answer is 3 - 7 days after transfusion. Delayed hemolytic transfusion reactions (DHTR) are usually caused by a secondary (anamnestic) response. It takes about 3-7 days from the time of transfusion for enough antibody to be produced to cause clinical symptoms.
Which of the following genotypes are known to be resistant to P. vivax (malaria) merozoites? Please select the single best answer Fy(a+b+) Fy(a-b-) Jk(a-b-) Jk(a+b+)
The correct answer is Fy(a-b-). In the mid-70s, it was observed that Duffy (Fy) (a-b-) RBCs resist infection by Plasmodium knowlesi and Plasmodium vivax. This provides an explanation for the high frequency of Fy(a-b-) persons originating from West Africa.
As a student in a blood bank laboratory, you are tasked with determining the identification of an antibody as part of your practical exam. You are asked to use an enzyme treated red cell panel during the process of antibody identification. Which of the following antibodies is enhanced by enzyme treatment of red cells? Please select the single best answer MN and Duffy antibodies Rh, Lewis, and Kidd antibodies Rh, A, B, and S antibodies Duffy, A, and B antibodies
The correct answer is Rh, Lewis, Kidd antibodies. Antibodies from these blood group systems will be enhanced (react more strongly) when tested against enzyme-treated reagent red blood cells.
Antibodies directed against granulocyte antigens have been implicated for all of the following EXCEPT? Please select the single best answer Febrile transfusion reactions Acute hemolytic transfusion reactions Transfusion-related acute lung injury (TRALI) Neonatal alloimmune neutropenia (NAN)
The correct answer is acute hemolytic transfusion reactions. Antibodies against granulocytes have not been suggested as a cause of acute hemolytic transfusion reactions.
Which one of the physical examination results below may be cause to reject a donor from blood donation? The correct answer is highlighted below Hemoglobin of 12.0 g/dL Pulse of 80 beats per minute Temperature of 98.3ºF (36.8ºC) Blood pressure of 100/75 mm Hg
The correct answer is hemoglobin of 12.0 g/dL. The hemoglobin level of a donor should be greater than or equal to 12.5 g/dL
Lewis Blood Group System is a human blood group unlike most others. The antigen is produced and secreted by exocrine glands, eventually adsorbing to the surface of red blood cells. Its expression is based on the genetic expression of the Lewis and Secretor genes. Based on the following genotype (Le) (sese), what would you predict the Lewis antigen phenotypic expression to be? Please select the single best answer Le(a- b-) Le(a+ b+) Le(a+ b-) Le(a- b+)
The correct answer is: Le(a+ b-) Phenotype Lewis Genotype Secretor Genotype Le(a+b-): Le sese Le(a-b+): Le Se Le(a-b-): lele sese or Se
How long after potential donors have been diagnosed with malaria should they be deferred from doing a blood donation? The correct answer is highlighted below 6 months 1 year 2 years 3 years
The deferral period for malaria, since it is considered a potential transfusion transmitted disease, is 3 years following treatment with no symptoms.
What is the first line treatment for moderate to severe hemophilia A? The correct answer is highlighted below Platelets Lyophilized Factor VIII concentrate Factor IX complex Cryoprecipitated AHF
The first line treatment for moderate to severe hemophilia A is commercial factor concentrates. If factor concentrates are not available and treatment cannot be safely delayed, cryoprecipitated AHF can be administered.
Which of the following is the most prevalent blood type found in the United States? Please select the single best answer O positive A positive B positive O negative
Type O phenotype is the most frequent among all ethnic groups in the United States, followed by Type A, Type B, and Type AB. The D antigen is present in 85% Whites, and 92% Blacks.
All of the following are appropriate indications for the use of fresh frozen plasma (FFP) EXCEPT? Please select the single best answer Volume expansion Severe bleeding in the presence of significantly elevated PT secondary to vitamin K deficiency Replacement component after plasma exchange in patients with TTP or HUS Dilutional coagulopathy with significant active bleeding, and PT and PTT twice normal
Volume expansion
Washing red cells may be performed to remove what from the unit? Please select the single best answer White blood cells Platelets Plasma Proteins
Washing red cells removes remaining plasma proteins that are present in the unit.
If an Rh group (DCe/dce) man marries an Rh group (dce/dce) woman, what is the probability that their offspring will be D negative? The correct answer is highlighted below 25% 50% 75% 100%
50%
What is the minimum hemoglobin concentration required for autologous blood donation? Please select the single best answer 11 g/dL 10 g/dL 13 g/dL 12.5 g/dL
Autologous blood donors are required to have a minimum hemoglobin concentration of 11 g/dL (or hematocrit of 33%).
A patient's serum reacts with all reagent red cell samples. The autocontrol is negative. An alloantibody to a high incidence antigen is suspected. Which of the following would most likely be a compatible donor? Please select the single best answer Patient's parents Patient's siblings Patient's children Autologous donation
Autologous donation
Rh Immune Globulin (RhIG) is used to prevent the active immunization to the D antigen in women who are Rh negative carrying an Rh positive fetus. One dose of RhIG (equal to 300 µg of World Health Organization reference material) contains enough anti-D to protect against: Please select the single best answer 50 mL of whole blood 50 mL of packed red cells 30 mL of whole blood 20 mL of packed red cells
30 mL of whole blood Rh Immune Globulin is used to help prevent pregnant women from becoming actively immunized to the D antigen. During pregnancy and delivery fetal blood can enter maternal circulation. This exposure to the D antigen puts the mother at risk for becoming sensitized and making an anti-D. Women who are Rh negative carrying an Rh positive fetus now receive RhIG at 28 weeks and at delivery (within 72 hours of delivery) to clear fetal red blood cells from maternal circulation. The RhIG can attach to fetal red blood cells which are then cleared by macrophages.
Donated red blood cells that contain the anticoagulant CPDA-1 (citrate-phosphate-dextrose-adenine) may be stored up to how many days? Please select the single best answer 21 days 28 days 35 days 42 days
35 days The addition of adenine to the anticoagulant-preservative solution allows the red blood cell unit to be stored for up to 35 days rather than 21 days. CPD or CP2D blood can be stored for up to 21 days. Irradiated red blood cells expire either after 28 days from irradiation or on the original expiration date, based on which date occurs first. Additive solutions increase the shelf life of donated blood products to 42 days.
A potential apheresis platelet donor must be deferred for how long following the use of aspirin? Please select the single best answer 4 weeks 2 weeks 48 hours No deferral - can donate immediately given they meet all other requirements.
48 hours The correct answer is 48 hours. Because aspirin inhibits platelet function, a potential apheresis platelet donor must be deferred for a minimum of 48 hours after taking aspirin. An apheresis unit of platelets is usually the sole source of platelets when transfused to a patient.
It's a busy Friday evening in the blood bank, and you have been receiving a steady stream of Type & Screen specimens from the emergency room. Several of them have positive antibody screens, which require further workup. One of these patients is a 46-year-old male whose hemoglobin has dropped from 8.4 g/dL to 4.6 g/dL in the previous 8 hours (normal Hgb for this patient demographic would be ~14 g/dL). Your workup reveals a group O patient with the following antibodies: anti-K, anti-Fya. The prevalence of K negative donors in your donor population is 91%, while the prevalence of Fya negative donors is 37%. Two units of cross-matched RBCs are requested by the physician. How many units of group O RBC units should you phenotype in order to fulfill the request for two cross-matched units? Please select the single best answer 2 units of type O RBC units 3 units of type O RBC units 6 units of type O RBC units 12 units of type O RBC units
6 units of type O RBC units 2/(0.37x0.91)
The accepted interval between whole blood donations is: Please select the single best answer 2 days 4 weeks 8 weeks 16 weeks
8 weeks The mandatory waiting period between whole blood donations is 56 days, or eight weeks.
Which of the following is the most important factor in determining the immediate outcomes of kidney transplants? Please select the single best answer ABO compatibility HLA compatibility Rh compatibility Other blood group system compatibility (Kell, Kidd, and Duffy)
ABO compatibility When determining the immediate outcomes of kidney transplants, ABO compatibility is the most important factor. Transplanted ABO-incompatible tissue comes into continuous contact with the recipient's ABO antibodies.
If the unit is going to be transfused within the collection facility, autologous blood must always be tested for which of the following before transfusion? The correct answer is highlighted below ABO, Rh ABO, Rh, HBsAg ABO, Rh, HIV ABO, Rh, HBsAg, HIV
ABO, Rh
A patient experiences a mild allergic reaction to a transfusion, including urticaria, erythema (skin redness), and itching. What is the most likely source of the allergen? Please select the single best answer IgA on mast cells Drugs or food consumed by the blood donor Insoluble allergens Donor red blood cells
Allergen substances may be drugs or food consumed by the blood donor. The blood recipient forms antibodies to these allergens bound to IgE on mast cells and causes the release of histamines. Mild allergic reactions result from a patient's hypersensitivity to soluble allergens in the plasma of the donor unit. Reactions against donor red blood cells would cause acute or delayed hemolytic transfusion reactions.
A sample has reactions occurring at immediate spin and AHG in a panel that show varying reaction strengths. There is no obvious pattern that matches a particular panel cell or single antigen profile and the auto-control was negative. Which of the following is the most likely cause? Please select the single best answer An IgM and an IgG antibody An IgG antibody only An IgM antibody only An autoantibody
An IgM and an IgG antibody The cause would be the presence of both an IgM and an IgG antibody. Laboratorians should think of multiple antibodies when reactions are occurring at two different phases (IS and AHG), varying strengths in reactions, and no definite pattern. Patterns can sometimes be recognized if you look at each phase individually. For example reactions at immediate spin may match an M antibody, and reactions at AHG may match a D antibody. Varying strengths in reaction could also indicate dosage occurring
What is the minimum acceptable hematocrit value for a female who wants to donate an autologous unit of blood for an upcoming surgery? Please select the single best answer 39% 38% 33% 25%
An autologous donor, whether female or male, needs to have a minimum hematocrit of 33% to qualify to donate. This is equivalent to an 11 g/dL hemoglobin.
All of the following are cause for donor deferral EXCEPT? Please select the single best answer An individual weighs 115 pounds at the time of donor screening. Potential donor is currently pregnant in her second trimester. Donated a whole blood product within the last 30 days. He/she lived in the United Kingdom (UK) for a consecutive 12-month period between 1980 - 1996.
An individual weighs 115 pounds at the time of donor screening. Physical examination requirements include weighing donors prior to donation. To donate a standard unit of blood, an individual must weigh at least 100 pounds. A current pregnancy and recent blood donation within the last 30 days may be deemed as temporary deferrals. An individual that has resided in the United Kingdom (UK) between 1980 through 1996 for more than 3 months (consecutively) may be deferred indefinitely.
An individual with group AB blood does not have which of the following antigens present on their red blood cells? The correct answer is highlighted below A B H O
An individual who has group AB blood has genes for H, A, and B antigens. Therefore, A and B antigens are present on the red cells of this individual. The H antigen is a precursor to the ABO antigens so this individual would also have the H antigen present. The O gene is an amorph. This means that this gene does not code for a gene product, so there is no O antigen. Individuals who are group AB do not carry a copy of the O gene since their two ABO genes present are A and B.
Lectin from the seeds of Dolichos biflorus is a source of which of the following? The correct answer is highlighted below Anti-A1 Anti-A2 Anti-B Anti-H
Anti-A1
If a patient is determined to have type A blood, what antibody would be found in his/her serum? Please select the single best answer Anti-A Anti-B Anti-A and Anti-B Anti-O
Anti-B
Which of the following antibodies is the MOST common cause of severe hemolytic disease of the newborn? Please select the single best answer Anti-A Anti-B Anti-E Anti-D
Anti-D
Which of the following antibodies causes the MOST severe cases of hemolytic disease of the fetus and newborn (HDFN)? Please select the single best answer Anti-I Anti-N Anti-A,B Anti-D
Anti-D Anti-D is the most common cause of severe HDFN.
Which of the following antibodies usually show enhanced agglutination with the use of proteolytic enzymes? Please select the single best answer Anti-M,-N, and -S Anti-Jka, -Jkb, -C, and -E Anti-Fya and -Fyb Anti-K
Anti-Jka, -Jkb, -C, and -E
Which of the following conditions is MOST frequently associated with anti-I? The correct answer is highlighted below Cold agglutinin disease Hemolytic transfusion reaction Delayed transfusion reaction Infectious mononucleosis
Autoanti-I is an insignificant IgM cold agglutinin found in many individuals. It can rarely be the cause of cold autoimmune hemolytic anemia. It is also seen in many patients with Mycoplasma Pneumoniae infection. Alloanti-I is very rare, since there are so few I-negative adults, and is therefore not a frequent cause of hemolytic and/or delayed transfusion reactions. Infectious mononucleosis is associated with production of autoanti-i.
From the IgG molecule illustration, which region is the heavy chain? The correct answer is highlighted below A B C D
CD
Which component can be shipped with fresh frozen plasma (FFP)? Please select the single best answer Cryoprecipitate Platelets Packed red blood cells Whole blood
Cryoprecipitate The correct answer is cryoprecipitate. FFP and cryoprecipitate must be shipped on dry ice.
Which is the best component to treat a patient with fibrinogen deficiency? The correct answer is highlighted below Red Blood Cells Platelet Concentrate Fresh Whole Blood Cryoprecipitated AHF
Cryoprecipitated AHF Cryoprecipitated AHF is the only product that contains a concentrated amount of fibrinogen. Cryoprecipitate contains a minimum of 150 mg of fibrinogen in each unit. It is primarily used for fibrinogen replacement in patients diagnosed with a congenital fibrinogen deficiency.
What is the fundamental purpose of the full, pre-transfusion crossmatch? Please select the single best answer Detect antibodies in recipient serum/plasma that react with donor red blood cells. Discover HLA antibodies in graft-versus-host situations. Verify that the donor and recipient are the same blood type. Prevent hemolytic destruction of the recipient red blood cells.
Detect antibodies in recipient serum/plasma that react with donor red blood cells. The purpose of performing a crossmatch is to determine whether or not donor RBCs are compatible for transfusion by testing the donors' RBCs against the recipient serum (or plasma) which may contain alloantibodies that can potentially react with these donor RBCs. The crossmatch is a final check of ABO compatibility between both donor and the recipient. The donor and recipient may not have the same blood type based on product selection and inventory.
Which is NOT a requirement for information on the donor tag once the appropriate compatibility testing has been completed and the unit or units are suitable for transfusion? Please select the single best answer Patient's full name and identification number Name of the product and donor number ABO & D phenotype of the unit Doctor's name and patient room number
Doctor's name and patient room number
Which of the prospective donors below would be an acceptable blood donor? Please select the single best answer Donor number 1: Blood pressure: 90/55 Pulse: 105 Temperature: 36.4ºC (97.6 ºF) Donor number 2: Blood pressure: 200/90 Pulse: 72 Temperature: 37ºC (98.6 ºF) Donor number 3: Blood pressure: 110/72 Pulse:66 Temperature: 37.2ºC (99.0 ºF) Donor number 4: Blood pressure: 100/70 Pulse: 98 Temperature: 38.3 (101.0 ºF)
Donor number 3: Blood pressure: 110/72 Pulse:66 Temperature: 37.2ºC (99.0 ºF)
What is the BEST technique for monitoring the severity of hemolytic disease of the fetus and newborn (HDFN)? Please select the single best answer Amniocentesis Doppler ultrasound Antibody titration Cordocentesis
Doppler ultrasonography can measure blood flow velocity, which allows for the severity of fetal anemia to be determined without invasive methods. This creates a safer alternative than amniocentesis for fetal monitoring and has largely replaced serial amniocentesis for predicting severity of HDFN.
When performing a transfusion reaction investigation, what is the clerical check used to detect? Please select the single best answer The type of reaction that occurred The patient's hemoglobin and hematocrit Errors that may cause an ABO-incompatibility due to patient or donor unit mix up Medication errors
Errors that may cause an ABO-incompatibility due to patient or donor unit mix up
A severe hemophiliac, with a Factor VIII activity of less than 1%, is actively bleeding due to a serious accident. The blood product of choice is: Please select the single best answer Single-donor plasma Factor VIII concentrate Factor IX concentrate Cryoprecipitate
Factor VIII concentrate can be administered to a hemophiliac patient (hemophilia A) during active bleeds. The administered factor VIII will aid in the coagulation process to cease active bleeding in the patient. Factor VIII concentrate can be made from pooled plasma and recombinant DNA technology. The more commonly used method is recombinant DNA technology, which does not pose the risk of viral contamination.
Persons with hemophilia A or hemophilia B that demonstrate inhibitors should be given which of the following products? The correct answer is highlighted below: Factor VIII concentrates Factor IX concentrates Factor VIIa Factor X
Factor VIIa is used for persons with hemophilia A or hemophilia B that demonstrate inhibitors. Factor VIII is used for persons with hemophilia A with no inhibitors. Factor IX is used for persons with hemophilia B with no inhibitors. Factor X could be used for persons demonstrating Factor X deficiency.
IgG coated red cells are added to negative antiglobulin tests to detect which of the following sources of error? Please select the single best answer Delay in washing procedure Improper resuspension of the red cells Failure to add AHG Improper incubation time or temperature
Failure to add AHG IgG-coated red cells will agglutinate in the presence of free human antiglobulin. They will not agglutinate in the absence of AHG reagent, such as might occur with the failure of addition of AHG or its neutralization by unbound globulins present with inadequately washed red cells.
When performing the rosette test to screen for Fetal Maternal Hemorrhage, what is considered the correct combination to avoid false positives and/or false negatives? The correct answer is highlighted below Fetal cells D positive & mother is D negative Fetal cells D positive & mother is weak D positive Fetal cells weak D positive & mother is D negative Any combinations could cause false positive and/or false negative results with the rosette test
Fetal cells D positive & mother is D negative
Which of the following is considered an indication for Rh immune globulin (RhIG) administration in postpartum women? Please select the single best answer Long term protection Antibody blocking Passive protection Active immunity
For passive protection, RhIG therapy can be administered within 72 hours after delivery as it may be effective against formation of anti-D.
Which of the following is an example of proper transfusion practices regarding fresh frozen plasma (FFP)? The correct answer is highlighted below Contains all labile coagulation factors except cryoprecipitate Has a higher risk of transmitting hepatitis than whole blood Should be transfused within 24 hours of thawing ABO-compatible units are not required for transfusion purposes
Fresh Frozen Plasma (FFP) should be thawed at 37°C and transfused within 24 hours when stored at 1 to 6°C. Indications for transfusion therapy include bleeding related to coagulation factor deficiency if specific concentrates are not appropriate, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome
When testing for the quality of platelet concentrates, all of the following must be included EXCEPT? The correct answer is highlighted below pH Platelet count Bacterial detection Gas production
Gas production is the correct answer. While gas production may be used in one of the FDA approved methods to detect bacterial contamination, gas production, in and of itself, is not one of the mandatory quality testing methods. pH is incorrect, as it is one of the required items for testing platelet concentrate quality. The pH must be at 6.2 or greater. A platelet count is incorrect, as it is one of the required items for testing quality of a unit of platelets. Bacterial detection is incorrect, as it is one of the newer standards for testing the quality of platelet concentrates.
Antibodies to which of the following blood components is the most frequent cause of febrile nonhemolytic transfusion reactions? Please select the single best answer Platelets Packed red blood cells Granulocytes Plasma
Granulocytes The most common type of febrile nonhemolytic transfusion reaction (FNHTR) occurs as the result of cytotoxic antibodies or leukoagglutinins (leukocyte antibodies) formed against the white blood cells present in the donor unit. Granulocyte concentrates are collected white blood cells used in the treatment of patients diagnosed with severe neutropenia. Due to this component type being comprised of primarily white blood cells, leukocyte depletion filters cannot be used. A standard blood administration filter may be used with this component.
Recombinant Factor IX is indicated for which of the following? The correct answer is highlighted below Hemophilia A Hemophilia B Hemophiliacs with inhibitors Persons with acquired Factor VII deficiency
Hemophilia B Persons with hemophilia B are lacking Factor IX. Recombinant Factor IX is used to treat patients with hemophilia B.
What is the MOST frequent disease complication of blood transfusions? Please select the single best answer Cytomegalovirus (CMV) Syphilis Hepatitis HIV
Hepatitis (Hepatitis B and C can be transmitted parenterally) is the most common disease transmitted by blood transfusions
Which class of antibody can agglutinate erythrocytes (RBCs) after anti-human globulin (AHG) is added to the test tube? Please select the single best answer IgA IgE IgG IgM
IgG Some antibodies, such as IgG, do not directly agglutinate erythrocytes (RBCs). This incomplete or blocking type of antibody may be detected by an enhancement medium, such as anti-human globulin (AHG) reagent. If AHG is added, a second antibody binds to the antibody present on the erythrocytes. AHG is created to bind with IgG antibodies at the Fc portion of these antibodies. AHG will bind to both bound and unbound IgG antibodies. When IgG is bound to red blood cells, AHG produces visible agglutination in a test tube.
Which of the following immunoglobulins are capable of fixing complement by the classical pathway? The correct answer is highlighted below IgG and IgA IgM and IgA IgG and IgM IgG and IgD
IgG and IgM
What red blood cell component is indicated for patients who receive directed donations from immediate family members to prevent transfusion-associated graft versus host disease (TA-GVHD)? Please select the single best answer Irradiated Red Blood Cells Washed Red Blood Cells Leukocyte-reduced Red Blood Cells HLA matched Red Blood Cells
Irradiated Red Blood Cells Gamma-irradiation of blood components containing viable lymphocytes is very effective in preventing TA-GVHD. Irradiation is recommended for all Whole Blood, Red Blood Cell, Platelets, and Granulocyte transfusions to patients at risk. Patients at risk include neonates less than 4 months, patients with an acquired or congenital immunodeficiency, or patients receiving a directed donation from a family member. Irradiation prevents the proliferation of donor lymphocytes with a required dose of 25 Gy to the midplane of the blood container and a minimum of 15 Gy elsewhere.
An antibody screen demonstrates a mixed field agglutination pattern. To which blood group system will this antibody most likely belong? The correct answer is highlighted below Lewis Lutheran Kell Kidd
Lutheran antibodies, particularly Anti-Lua, typically demonstrate a mixed field pattern of reactivity. Lewis antibodies do not show dosage or mixed field agglutination. Kell antibodies typically react very strongly, 3+ or 4+. They do not demonstrate a mixed field pattern. Though Kidd antibodies may demonstrate a 1+ or 2+ reaction strength, they do not demonstrate a mixed field pattern of reactivity.
Most antibodies present in cord blood are of ________ origin. The correct answer is highlighted below Fetal Maternal Paternal Maternal and paternal
Maternal Infants who are less than 6 months old usually do not produce alloantibodies. Newborns may have passive antibodies of maternal origin that crossed the placental, but they do not have passive antibodies of paternal origin.
Many red blood cell (RBC) processes, such as binding, transporting, and releasing oxygen, do NOT require energy. Energy however, is required for cellular viability. How does the RBC obtain most of it's energy? Please select the single best answer Glycolytic pathways Hexose-monophosphate shunt Rapoport-Luebering pathway Methemoglobin reductase pathway
Most of the energy needed for RBC viability is obtained through the glycolytic pathway. About 90 to 95% of the cells' glucose is metabolized in this pathway, which in turn produces ATP. One glucose molecule produces a net gain of 2 moles of ATP via this pathway.
Plasma exchange is the current treatment for all of these conditions, EXCEPT: The correct answer is highlighted below Warm autoimmune hemolytic anemia (WAIHA) Diarrhea-associated hemolytic uremic syndrome (HUS) Thrombotic thrombocytopenic purpura (TTP) Pernicious anemia
Pernicious anemia is treated with monthly parenteral does of hydroxycobalamin not by plasma exchange.
Which of the following situations warrants postpartum administration of Rh immune globulin (RhIg)? Please select the single best answer Mother: D positive; Cord: D negative Mother: D negative; Cord: D negative Mother: D negative; Cord: D positive Mother: D positive; Cord: D positive
Mother: D negative; Cord: D positive A non-immunized D negative woman who delivers a D positive infant should receive a full dose of RhIg within 72 hours of delivery. RhIg prevents alloimmunization in D negative mothers exposed to D positive cells. Therefore, it is not needed if the mother is D positive or when the mother and baby are both D negative.
Which test is NOT used as a screen for retroviruses in donated blood? Please select the single best answer Antibody to HIV type 1 or type 2 Nucleic acid testing to detect HIV-1 RNA Antibody to HTLV types I and II Nucleic acid testing for HCV
Nucleic acid testing for HCV Three tests are currently used as a screen for retroviruses in donated blood: antibody to HIV type 1 or type 2 (anti-HIV-1/2), nucleic acid testing (NAT) to detect HIV-1 RNA, and antibody to HTLV types I and II (anti-HTLV-I/II). Positive results using NAT for HCV are approved by the FDA to confirm a reactive HCV antibody test. Also, hepatitis C is not considered a retrovirus.
What is the deferral period from donating blood for someone who is or has taken Tegison© for severe psoriasis? Please select the single best answer Permanent deferral 1 month following last dose 2 weeks No deferral
Persons taking or who have ever taken Tegison© are permanently deferred. Blood or blood products from persons who have ever taken Tegison© can cause birth defects if transfused to a pregnant woman.
What procedure utilizes leukapheresis to collect the buffy coat from whole blood? Please select the single best answer Photopheresis Plasmapheresis Therapeutic apheresis Erythrocytapheresis
Photopheresis utilizes leukapheresis to collect the buffy coat layer from whole blood. These cells are treated with 8-methoxypsoralen, exposed to ultraviolet A light and then reinfused into the patient. Photopheresis has been shown to be efficacious and has been approved by the Food and Drug Administration for the treatment of cutaneous T-cell lymphoma.
Which type of blood component is most implicated in bacterial contamination? The correct answer is highlighted below Platelets Packed red cells Fresh frozen plasma Cryoprecipitate
Platelets are the most common product implicated in bacterial contamination cases. This is because the room temperature storage requirement provides an adequate environment for bacterial growth. Contamination rates in the United States has been estimated to be 0.2% for red blood cells and as high as 10% for platelets.
Which finding best distinguishes immune hemolytic anemia from other hemolytic anemias? Please select the single best answer Rouleaux Positive DAT Splenomegaly Increased erythrocyte count
Positive DAT In the group of disorders referred to as immune hemolytic anemias, erythrocytes are destroyed too early by an immune-mediated process that results from antibodies, complement, or both attaching to the red cell membrane. The presence of immune hemolytic anemia is confirmed by a positive DAT (direct antiglobulin test).
Red blood cell units that contain CPD (citrate-phosphate-dextrose) can be stored for up to how many days? Please select the single best answer 21 days 28 days 35 days 42 days
Red blood cell units that contain CPD or CP2D may be stored for up to 21 days
False negative results may occur with indirect antiglobulin tests as a result of all of the following EXCEPT: Please select the single best answer Undercentrifugation Delay in adding antiglobulin reagent Failure to adequately wash cells Red blood cells have a positive DAT
Red blood cells have a positive DAT Undercentrifugation will reduce antigen-antibody binding, causing a false negative result. Delaying the addition of AHG means that the antibody may no longer be bound to the antigen (binding is reversible) on the red cells causing a false negative result. Lastly, not washing well would mean that proteins may be present that can neutralize the AHG, causing a false negative result.
In the evaluation of a positive DAT result, all of the below techniques can be used to dissociate the antibody(ies) form the RBCs EXCEPT: Please select the single best answer EDTA-glycine Saline replacement Chloroquine diphosphate Murine monoclonal antibodies
Saline replacement In the saline replacement technique, saline is used to free RBCs clumped in rouleaux (coin-like stacking of RBCs) formation. If it is pseudo-agglutination, then the RBC clumps will disperse after the addition of saline. If true agglutination is present, then the RBCs will remain clumped together after the addition of saline
Storage lesion, or the biochemical changes in red blood cells during storage, will result in: Please select the single best answer Decreased hemoglobin Increased plasma sodium Decreased plasma potassium Decreased plasma pH
Storage lesion will cause a decrease in plasma pH levels as lactic acid levels increase during storage. The free hemoglobin levels will increase as red blood cells lyse. The plasma sodium levels will decrease as a dilutional effect of hemolysis. The plasma potassium levels will increase due to hemolysis within the unit.
When is testing for weak D optional (not required)? The correct answer is highlighted below Testing for weak D on potential transfusion recipient samples. Testing on donor red blood cells. Testing cord blood on infants born to Rh-negative moms Testing for Rh immune globulin workups
Testing for weak D on potential transfusion recipient samples is not required. However, some facilities will test for weak D on recipient samples. If the initial testing (immediate spin) is the only testing performed on the weak D individual, they would be considered Rh-negative and would receive Rh-negative blood
In a closed system, thawed FFP and PF24 blood components may be labeled as "Thawed Plasma" 24 hours after the original thaw time and given a shelf life of? Please select the single best answer 5 days 60 minutes 24 hours 2 days
Thawed FFP and PF24 components expire within 24 hours from the date and time thawed. After 24 hours have elapsed from the date of thawing, thawed FFP and PF24 components may be labeled as "Thawed Plasma" and allowed a 5-day shelf life.
A patient with a historical type of AB positive requires a routine type and screen test. You perform the ABO/Rh type using the gel methodology and note the results below. How would you interpret the results? The back type is correct. The front type is incorrect and probably due to a manufacturing defect at the gel card production facility. An elderly group O patient with a weak reaction in the back type due to compromised anti-A and anti-B production. The front type is correct. The discrepancy in the back type can be ignored because it is not strong. The front type is correct and the back type may due to cold agglutinins. You could prewarm the patient serum and repeat the back type to see if the discrepancy is resolved.
The front type is correct and the back type may due to cold agglutinins. You could prewarm the patient serum and repeat the back type to see if the discrepancy is resolved. The patient forward types as group AB positive, and this is consistent with the historical type. The back type shows extra reactivity. Extra reactivity in the back type may be caused by alloantibodies, autoantibodies, or rouleaux. Warming the serum before repeating the back type is one method to help solve the discrepancy in the back type
What is the minimum acceptable hematocrit level for a male that wants to donate double RBC units through RBC apheresis? Please select the single best answer 40% 39% 38% 33%
The minimum acceptable hematocrit level for a male or female to participate in a double RBC apheresis program is 40%. The hematocrit level can't be determined using a copper sulfate method, and MUST be a quantitative method.
A standard blood donation of 450-500 mL requires a minimum anticoagulant-preservative solution volume of: Please select the single best answer 57 mL 63 mL 70 mL 82 mL
The minimum volume of 63 mL of anticoagulant-preservative ensures that the donated blood product contains an appropriate anticoagulant-to-blood ratio.
A tech is performing an antibody screen. The reaction is negative when reading at the AHG (anti-human globulin) phase, so the tech then adds Coombs' control cells. Agglutination is now observed. What does this indicate? Please select the single best answer The negative reaction at AHG phase is valid The patient's RBCs were not washed thoroughly Coombs' control cells are contaminated Coombs' control cells were not added
The negative reaction at AHG phase is valid
Which of the following choices best describes the primary function of antibodies? Please select the single best answer Protection of B-lymphocytes Binds with antigen Fixes complement Stimulates the immune response
The primary function of an antibody is to bind with its specific antigen to facilitate clearance of that antigen.
When giving a whole blood donation to a patient, what consideration must be made in regards to the ABO/Rh compatibility between the recipient and the donor? Please select the single best answer The recipient and the donor ABO or Rh compatibilities are not a concern. The recipient and donor ABO and Rh types must be compatible. The recipient and donor ABO and Rh types must be identical. The recipient and donor ABO types must be identical, but the Rh does not matter.
The recipient and donor ABO and Rh types must be identical. Because whole blood donations contain all blood products, including plasma and red blood cells, the donor and recipient ABO and RH must be identical to prevent a transfusion reaction or the development of Anti-D antibodies
What action should be taken if a large clot is noticed in a red blood cell unit while the product is being prepared for release to the patient? Please select the single best answer Issue the product as you normally would but with a filter. Issue the product, but note the presence of the clot in the computer records. Filter the product prior to issue and record the process. Do not issue the product.
This integrity of this product is compromised. The unit cannot be used even with a filter and should be quarantined and returned to the blood supplier for investigation.
Which of the following transfusion reactions can a diagnosis be more firmly established by evaluating B-type natriuretic peptide (BNP) levels before and after transfusion? Please select the single best answer Transfusion Associated Circulatory Overload (TACO) Delayed Hemolytic Transfusion Reactions Transfusion Associated Sepsis Allergic Transfusion Reactions
Transfusion Associated Circulatory Overload (TACO) is difficult to distinguish from Transfusion Related Acute Lung Injury (TRALI). A post-transfusion to pretransfusion BNP ratio of 1.5 points is diagnostic of TACO. Delayed Hemolytic Transfusion Reactions testing includes the DAT, free plasma hemoglobin, hemoglobin, LDH, total and direct bilirubin, haptoglobin, free urine hemoglobin, and hemosiderin in urine. Transfusion Associated Sepsis testing includes blood cultures on the recipient and a gram stain and culture on the transfused component. Allergic transfusion reactions are diagnosed based on anaphylactic symptoms of the patient during transfusion of the component.
Acute intravascular hemolysis as the result of a blood transfusion is most often associated with which of the following causes? The correct answer is highlighted below Transfusion of ABO incompatible red blood cells Allergic reaction Passively transfused antibodies to HLA antigens Transfusion-associated graft-versus-host disease
Transfusion of ABO incompatible red blood cells
A patient has a probable anti-Fya; however, anti-c and anti-K have not been excluded. Which of the following cells would be the most useful cell to exclude both anti-c and anti-K efficiently in this patient? The correct answer is highlighted below Fya-; Fyb+; C+c+; K+k+ Fya-; Fyb+; C-c+; K+k- Fya-; Fyb+; C+c+; K+k- Fya+; Fyb-; C-c+; K+k-
When multiple antibodies remain after the exclusion ("rule out") process, then additional antibody identification testing is necessary. In a selected cell panel, the ideal red blood cell selected will exclude the presence of all three antibodies efficiently is one that is Fya antigen negative and homozygous positive for both c and K antigens: Fy(a-b+)C-c+K+k-
Which of the following consequences of severe hemolytic disease of the fetus and newborn (HDFN) is most associated with neonatal death before or shortly after birth? The correct answer is highlighted below Enlarged liver Enlarged spleen Cardiac failure Hyperbilirubinemia
While the other consequences of HDFN can be severe in and of themselves, cardiac failure is the greatest threat to the fetus. In HDFN, the antibodies bind to the fetal antigens, which ends in red cell destruction by macrophages in the fetal liver and spleen. As red cell destruction continues, the fetus becomes increasingly anemic. The fetal liver and spleen enlarge as erythropoiesis increases to compensate for the red cell destruction. Hemoglobin is liberated from the damaged cells, metabolized to indirect bilirubin and is transported across the placenta where it is conjugated by the maternal liver and excreted. As the red cell destruction continues, cardiac failure resulting from uncompensated anemia will occur.
Whole blood or red blood cell units will be shipped from the American Red Cross to the transfusion facility. At what temperature should the units be kept during transportation? Please select the single best answer 1-4 °C 1-10 °C 2-6 °C 2-8 °C
Whole blood or red blood cell units must be maintained between 1 and 10 °C during transportation. Blood in storage should be kept between 1 and 6 °C.
Which of the following is the proper storage temperature for whole blood? Please select the single best answer - 20 degrees Celsius - 12 degrees Celsius 12 degrees Celsius 4 degrees Celsius
Whole blood transfusions can be used to increase oxygen carrying capacity and provide volume expansion. When used whole blood should be stored between 1 - 6 degrees Celsius. All other temperatures listed are outside of this acceptable range.
A D-negative mother gives birth to a D-positive child. The result of the fetal-maternal hemorrhage (FMH) test is positive. The Kleihauer-Betke test is performed next to quantify the volume of the fetal bleed. The result of this test indicates that the mother has been exposed to 20 mL of fetal blood. How many 300 microgram vials of RhIG should the mother receive? Please select the single best answer 1 vial 2 vials 3 vials RhIG is not indicated for this mother.
A single 300 microgram vial of RhIG provides protection of up to 30 mL of fetal blood. Since a 20 mL fetal bleed occurred, 0.67 vials of RhIG are needed (20mL/30mL = 0.67). Round this number up to 1 (as it is greater than or equal to 0.5) and add 1 more vial (as is the convention). Thus, 2 vials are needed.
A D-negative mother gives birth to a baby that tests as D-negative in the immediate spin phase. What step should be performed next? The correct answer is highlighted below Calculate dose for RhIg Perform a weak D test Administer one dose of RhIg Perform a Kleihauer-Betke stain
A weak D test must be performed to ensure that the neonate is D-negative instead of weak D-positive due to the potential for the mother to form anti-D to any D-positive neonate.
If an Rh negative patient is administered a unit of R1R1 packed red cells, which one of the following antibodies would be most likely to develop: Please select the single best answer Anti-c Anti-E Anti-e Anti-D
Anti-D R1R1 (DCe/DCe) cells are positive for the D antigen, which is the most immunogenic antigen of the Rh system, followed by c and E. An Rh negative individual would lack the D antigen and could potentially develop anti-D if transfused red blood cells that contain the D antigen.
Which symptom of hemolytic disease of the fetus and newborn (HDFN) is associated with low levels of glucuronyl transferase? Please select the single best answer Anemia Increased reticulocyte count Jaundice Cardiac failure
Jaundice Jaundice in a newborn suffering from HDFN is associated with low levels of glucuronyl transferase, a liver enzyme that conjugates bilirubin into its water-soluble, excretable form. Cardiac failure may occur because of untreated, uncompensated anemia.
Following a major trauma event, a family of four walks into your donor center hoping to donate blood. Which one of the following individuals may donate blood today? Please select the single best answer A 14-year-old girl who received an ear piercing 6 weeks ago. A 53-year-old man who worked and resided in the United Kingdom from 1983-1989. A 49-year-old woman who donated whole blood 5 weeks ago. A 22-year-old woman using oral contraceptives.
The 22-year-old female is the only one who may donate blood based on the information provided because there are no restrictions on women using oral contraceptives or other birth control methods.
Marcus had a transfusion of packed RBC's 8 months ago following a surgery after a car accident. He is fully recovered and is otherwise healthy. How soon can Marcus donate a unit of blood? Please select the single best answer He can never donate a unit of blood. He can donate in 12 months. He can donate in 4 months. He can donate today.
The correct answer is, "he can donate today". The total deferral time following a blood transfusion is 3 months, as long as the donor meets all of the other requirements.
A patient who demonstrates a history of an allergic reaction from red blood cell transfusions will benefit from receiving which red cell component? Please select the single best answer Frozen red blood cells Washed red blood cells Irradiated red blood cells Leukocyte-reduced red blood cells
Washed red blood cells Patients who demonstrate an allergic or anaphylactic response following transfusion with red cells typically do so against plasma proteins present in the unit. Washing the red cells will remove the excess plasma proteins to decrease or prevent the reaction.
When preparing platelet concentrates from whole blood, after the second spin and excess plasma has been expressed from the platelets, what is the next step in platelet preparation? Please select the single best answer Allow the platelets to rest for 1-2 hours at 20-24°C. Agitate the platelets vigorously for 1-2 hours at 20-24°C. Pool several platelet concentrates together immediately and irradiate. Freeze the platelet concentrate immediately at < 18°C.
Allow the platelets to rest for 1-2 hours at 20-24°C. After the second spin in the preparation of platelets, the excess plasma is expressed, leaving approximately 50-70 mL of plasma on the packed platelet concentrate. The platelet bag should be allowed to rest at 20-24°C for 1 - 2 hours. After resting, the platelet component can be gently massaged if needed to resuspend the platelets, and the bag is placed on a rotator for gentle agitation.
Leukocyte-reduced blood products may be administered to reduce the risk of febrile reactions and what disease or condition? The correct answer is highlighted below Graft-vs-host disease Cytomegalovirus Malaria Bacteremia
Cytomegalovirus (CMV) is present in the cytoplasm of white blood cells. Reducing the number of white blood cells that are present in a donated red cell unit reduces the viral load of cytomegalovirus.
Which of the following blood group antigens are most susceptible to destruction by the action of enzymes? Please select the single best answer D Jka Lea Fya
Duffy, or Fya and Fyb antigens, are most sensitive to enzyme treatment since they will be destroyed during this process. Enzyme panels can be helpful when multiple antibodies, including Duffy, are present in a patient sample. With the Duffy antigens destroyed, the panel can be performed to identify the remaining antibodies present. Other antigens that are sensitive to enzyme treatment include those of the MNS system and Xga.
The antigen marker most closely associated with transmission of HBV infections is: Please select the single best answer HBsAg HBeAg HBcAg HBiAg
HBeAg The presence of HBeAg connotes active replication of hepatitis B virus, with a high degree of infectivity. HBsAg is the first marker to appear in HBV infection and indicates active infection. It is an important marker in detecting initial infection and is a required donor test. HBcAg is tested to determine the course of HBV infections. HBiAg is not an actual component of HBV, nor is it tested for to determine the course of HBV infection.
What blood system is often tested to either establish or dispute paternity? Please select the single best answer HLA ABO Rh Duffy
HLA Due to the highly polymorphic nature of HLA, or human leukocyte antigens, this system is often used to prove or disprove paternity cases
Can an autologous donor donate blood at 4 PM on Monday if she is having surgery at 10 AM on Wednesday? The correct answer is highlighted below No, the minimal allowable time between the last donation and surgery is 72 hours. No, the minimal allowable time between the last donation and surgery is eight weeks. Yes, the patient can donate, but only half a unit. Yes, an autologous donor can donate up to 24 hours prior to surgery.
It is generally accepted that the minimal allowable time between the last autologous donation and surgery is 72 hours, though some facilities may have a cutoff time that is further out than 72 hours.
Which term listed below refers to the process that must be followed when notification is received that a donor of a unit transfused now tests positive for an infectious disease? Please select the single best answer Look-back Donor notification Minor crossmatch Major crossmatch
The "look-back" process involves the donation facility looking back at previous donations to identify recipients who received a blood product from a donor that is newly testing positive for an infectious disease. The time frame for "look-backs" vary by infectious disease. The goal is to identify recipients who were at risk of receiving an infectious blood product before the donor was testing positive for a particular infectious disease (ex. HIV).
Tube-based agglutination reactions in the blood bank are graded from negative (0) to 4+. A reaction that has numerous small clumps in a cloudy, red background is: The correct answer is highlighted below 1+ 2+ 3+ 4+
The correct answer is 1+. A 1+ reaction has numerous small clumps and cloudy red supernatant. A 2+ has many medium-sized clumps and clear supernatant. A 3+ has several large clumps and clear supernatant. A 4+ has one solid clump, no free cells, and clear supernatant.
An exchange transfusion has been ordered for a low birth weight infant. The physician has ordered irradiated Red Blood Cells for this purpose. Why is it necessary to irradiate the blood products for this patient? The correct answer is highlighted below To prevent alloimmunization of the patient To prevent transfusion-associated graft-versus-host disease (TA-GVHD) To kill bacteria and viruses present in the Red Blood Cells To allow the cells to have a longer half-life
The correct answer is to prevent TA-GVHD. This occurs when donor lymphocytes from transfused blood engraft in the recipient and cause disease. Usually TA-GVHD occurs 3 to 30 days post transfusion with clinical features of fever, skin rash, hepatitis, diarrhea and pancytopenia. It is associated with a 90% mortality rate. Irradiation is indicated for patients who are at high-risk for TA-GVHD, including premature, low birth weight infants, directed donations from related donors, newborns with erythroblastosis fetalis, transplant recipients, and recipients with congenital immunodeficiencies.
Antibodies within which of the following blood group systems are known to result in severe hemolytic transfusion reactions, but are not always detected during pre-transfusion testing in the blood bank? Please select the single best answer Duffy Kell Lewis Kidd
The correct answer is: Kidd. Kidd is the most common cause of delayed transfusion reactions. The antibody titer for Kidd can drop to undetectable levels several months after primary exposure to the antigen. Upon subsequent exposure to the antigen, a robust antibody response and hemolysis of the offending donor red cells occurs. This is also referred to as an anamnestic response.
After irradiating a unit of packed red blood cells, how is the expiration date affected? Please select the single best answer The expiration date is changed to 28 days from the date of irradiation regardless of the original expiration date. The expiration date shortens to 28 days from the date of irradiation or the original expiration date, whichever is first. The expiration date is shortened to 24 hours from time of irradiation. The expiration date is not affected.
The expiration date of irradiated packed red blood cells is changed to 28 days from the date of irradiation. However, if the original expiration date is sooner, the unit retains the original expiration date. Irradiation causes damage to the red cell membrane. Subsequently, the plasma potassium level in irradiated units is higher, and ATP and 2,3-DPG levels are lower. These effects necessitate a shorter expiration date for the safety of a potential recipient.
If Jka is showing dosage, how might reactions on an antibody panel appear? Please select the single best answer Weaker if homozygous for Jka Stronger if heterozygous for Jka and Jkb Weaker if heterozygous for Jka and Jkb Both heterozygous and homozygous reactions would always be of equal strength
Weaker if heterozygous for Jka and Jkb The strength of reaction can be due to the number of antigens present on the red cells that can bind with the antibody present. Inheritance of antigens can be in the homozygous or heterozygous state. If the antigen is in the homozygous state, there is a double dose of the antigen present on the red cell. For antibody reactions showing dosage, antigen-antibody reactions will be stronger if in the homozygous state since there is more antigen to bind with the antibody. The antigen-antibody reactions will be weaker if in the heterozygous state since there is less antigen to bind with the antibody.
For transfusion services in the United States, which of the following incidents must be reported to the Food and Drug Administration (FDA) because of a biological product deviation? Please select the single best answer Incident A: A unit was issued with an incorrect expiration date. The expiration date was incorrectly marked as one day earlier than the actual expiration date. Incident B: A nurse in ICU misidentified the patient and initiated the transfusion of Rh positive blood to an Rh negative patient. Incident C: The wrong specimen was used to crossmatch a unit and the unit was issued. Incident D: Donor reports information that is disqualifying based on revised questions. Previous collected units were distributed.
ncident C: The wrong specimen was used to crossmatch a unit and the unit was issued. According to 21 CFR 606.171, an event is reportable if it occurred while the product was under the control of the transfusion service, is a deviation of standard practice that affects the safety, purity, or potency of the product, and if the unit was issued. Incident C is reportable to the FDA because of a biological product deviation. In this case, an error was made in the blood bank, and the unit was issued. It is reportable regardless of the harm to the patient.
Delayed hemolytic transfusion reactions are usually caused by antibodies directed against what blood group system? Please select the single best answer MNS Kidd Kell ABO
kidd The most likely causes of delayed hemolytic reactions are Kidd system antibodies. Both Jka and Jkb are often responsible for delayed hemolytic transfusion reactions. The antibody titers for Kidd increase and then quickly decrease after immune stimulation, making detection and identification difficult in some patients.
What is the appropriate deferral period from donating blood for a 34-year-old female who miscarried in her first trimester? Please select the single best answer 8 weeks 6 weeks 2 weeks No deferral
A miscarriage or abortion in the first or second trimester is not cause for deferral from donating blood or blood products in an otherwise healthy woman. Female donors whose pregnancy terminated in the third trimester or who delivered should be deferred for a minimum of 6 weeks. Some exceptions can be made for autologous donors. Additionally, deferral may be longer than 6 weeks under certain circumstances such as receipt of a blood transfusion after delivery.
Which listed transfusion reaction is MOST OFTEN associated with transfused patient's lacking IgA? Please select the single best answer Hemolytic Anaphylaxis Febrile Transfusion-associated circulatory overload (TACO)
Anaphylaxis Anaphylactoid and anaphylactic reactions (collectively referred to as anaphylaxis) result from the recipient's forming anti-IgA, which targets IgA proteins in the donor plasma. Recipients have a genetic IgA deficiency and have developed anti-IgA from sensitization during a previous transfusion or pregnancy. Patients experience IgA deficiency-related anaphylactic reactions.
If a patient is determined to have type B blood, what antibody would be found in his/her serum? Please select the single best answer Anti-A Anti-B Anti-A and Anti-B Anti-O
Anti-A
Of the following blood group antibodies, which has been most frequently associated with severe cases of hemolytic disease of the fetus and newborn (HDFN)? Please select the single best answer Anti-A,B Anti-Lea Anti-K Anti-M
Anti-K Of those listed, anti-K is most frequently associated with severe forms of HDFN. Anti-K is considered the most clinically significant antibody outside of the Rh system. Kell antigens are found on both immature and mature red blood cells leading to destruction of precursor and circulating red blood cells.
A 28 year old female patient is experiencing disseminated intravascular coagulation (DIC) following the delivery of her newborn. Her Complete Blood Count (CBC) results are normal. What would be the best blood product for this patient to receive? Please select the single best answer Apheresis platelets Leukocyte-reduced packed red blood cells Cryoprecipitated antihemophilic factor Fresh frozen plasma
Cryoprecipitated antihemophilic factor, often called cryo or cryo AHF, contains concentrated coagulation factors. Since the coagulation factors are concentrated in this blood product, its administration does not also add additional cells or volume, which minimizes the risk of transfusion-related conditions such as transfusion-associated circulatory overload (TACO). Though fresh frozen plasma contains coagulation factors, it is not the best option. The concentration of coagulation factors in fresh frozen plasma is not as high as in cryoprecipitated AHF, and the plasma itself could cause adverse reactions to the patient due to the fluid volume.
A 40-year-old female receives two units of Red Blood Cells during a surgical procedure. The patient has no prior history of transfusions. Seven days later, she presents with extensive bruising of the extremities and bleeding of the gums, with no additional symptoms. Her platelet count is 5 x 109/L (reference interval 150 - 400 x 109/L). What is the most likely diagnosis? Please select the single best answer Post transfusion purpura (PTP) Acute hemolytic transfusion reaction (AHTR) Transfusion-related acute lung injury (TRALI) Allergic reaction
Her symptoms, including severe thrombocytopenia one week after transfusion, are most consistent with post-transfusion purpura (PTP). PTP results as an anamnestic response to a platelet antigen. PTP presents 1 to 24 days after a transfusion. PTP is caused by platelet-specific antibodies in a patient who has been previously exposed to platelet antigens through pregnancy or transfusion. The most frequently identified antibody is Anti-PLA1, which reacts with platelet antigen HPA-1a. The platelet antibody binds to the platelet surface, which allows for extravascular removal through the liver or the spleen. The patient's own platelets are destroyed as well, thus aggravating the thrombocytopenia.
Polyspecific antihuman globulin (AHG) reagent used in antiglobulin testing should react with which one of the following? Please select the single best answer IgG and IgA IgM and IgA IgG and C3d IgM and C3d
IgG and C3d Polyspecific antihuman globulin (AHG) reagent contains both anti-IgG activity and anti-C3d activity. Most clinically significant antibodies detected during antibody screening (IAT) are IgG. Polyspecific antihuman AHG was developed for the detection of IgG antibodies, not IgA antibodies or clinically insignificant IgM antibodies.
Which one of these physical exam results would cause a donor to be deferred? Please select the single best answer A hemoglobin of 13.0 g/dL. A pulse of 75 A diastolic blood pressure of 110 mm Hg A temperature of 99.3 ºF
The correct answer is a diastolic blood pressure of 110 mm Hg. Donors must have a diastolic blood pressure must be less than 100 mm Hg.
When performing an antibody screen, both the screen cells are 4+ at immediate spin and W+ at AHG. The antibody panel shows 4+ reactions at immediate spin and W+ reactions at AHG and there is no specific match to the reaction pattern. The auto control is negative. What would be a logical next step? Please select the single best answer Have patient redrawn Repeat testing using warmed patient sample/reagent and just do AHG reading Run an enzyme panel Use acidified reagents
Phase of reactivity is primarily at immediate spin (4+) and reactions get weaker at AHG (w+). There is no specific pattern of reactivity and the auto control is negative which rules out an autoantibody. This is a strong cold antibody which is still slightly present after incubation and washing. Activation and binding of the antibody takes place at room temperature or colder. Warming the sample/reagents and eliminating this phase will prevent the antibody from binding. Cold antibodies usually are more of a nuisance to blood bankers and are not clinically significant
Compared to plasma frozen within 8 hours of collection, plasma frozen within 24 hours of collection will likely have reduced levels of Factor: Please select the single best answer II VIII X XI
Plasma that is frozen within 24 hours of collection, often abbreviated as PF24 or FP24, contains the same clotting factors as plasma frozen within 8 hours of collection, but it often contains reduced levels of Factor V and Factor VIII.
A platelet component prepared from a unit of whole blood (random donor platelet) must contain at least how many platelets? Please select the single best answer 3.8 x 10^10 platelets/unit 4.0 x 10^10 platelets/unit 4.5 x 10^10 platelets/unit 5.5 x 10^10 platelets/unit
Platelet concentrates are required to have a minimum of 5.5 x 10^10 platelets/unit. Random donor platelet concentrates typically contain between 5.5 and 8.5 X 10^10 platelets suspended in about 50 mL of plasma. This is approximately 70% of the platelets present in the original unit of whole blood collected by the donor.
When administering fresh frozen plasma (FFP), which one of the following is considered standard blood bank practice? The correct answer is highlighted below Should be ABO compatible with the recipient's red blood cells Must be the same Rh type as the recipient Is appropriate for use as a volume expander Component should remain frozen when it is issued
Should be ABO compatible with the recipient's red blood cells FFP should be ABO-compatible with the recipient's red blood cells, but does not need to be the same Rh type as the recipient because it is a cell-free product. FFP should not be used as a volume expander; preferably, use a safer product such as serum albumin. This limits the exposure to transfusion-transmitted diseases and lowers the risk of transfusion reactions. FFP is indicated for patients that are actively bleeding or to treat clotting factor deficiencies. It may be used as a replacement fluid during plasma exchange procedures. FFP must be thawed prior to being issued for transfusion purposes.
In which of the following sections of CFR Title 21, Good manufacturing practices, would you find requirements for quality control testing of donor units of platelets? Please select the single best answer 21 CFR 211.22 Responsibilities of a Quality Control Unit 21 CFR 211.80 Control of Components, Drug Product Containers and Closures 21 CFR 606.140 Laboratory Controls 21 CFR 640.25 Platelets - General Requirements
The correct answer is 21 CFR 640.25. This section contains the requirement to test a minimum of 4 units per month. The pH must be at least 6.2 at the end of the dating period. The plasma volume and the platelet count must also be measured. The minimum platelet count in a whole blood derived Platelet is 5.5 x 1010 in 75% of the units tested.
Frozen red blood cells that have been thawed, deglycerolized and reconstituted in an open system must be used within _______. Please select the single best answer 1 hour 24 hours 14 days 7 days
The correct answer is 24 hours. Frozen red blood cells that have been thawed, deglycerolized and reconstituted in an open system must be used within 24 hours.
A person who lived in the United Kingdom between the years of 1980 and 1996 for 3 or more months is indefinitely deferred from donating blood or blood products based on an increased risk of which of the following? Please select the single best answer Malaria Leishmaniasis Creutzfeldt-Jakob disease (CJD) and/or variant Creutzfeldt-Jakob disease (vCJD) Chagas disease
The correct answer is CJD and/or vCJD. If a potential blood donor spent more than 3 months in the United Kingdom between 1980 and 1996, or 5 or more years in France from 1980 to the present, they are indefinitely deferred due to an increased risk of CJD and/or vCJD. If they have ever been diagnosed with CJD or vCJD, they are permanently deferred.
Red blood cells with a positive DAT cannot be tested accurately with blood typing reagents that require an indirect antiglobulin technique unless they have been treated with all of the following (to dissociate IgG from the RBC membrane) EXCEPT: The correct answer is highlighted below Chloroquine diphosphate Ficin ZZAP Albumin
The correct answer is albumin. Albumin would not be an effective way to remove IgG bound to the RBC's so that further testing could be performed. Red blood cells with a positive DAT cannot be testws accurately with blood typing reagents that require an indirect antiglobulin technique unless they have been treated with chloroquine diphosphate, ZZAP, or ficin to dissociate IgG from the RBC membrane.
What is the MOST common cause of acute hemolytic transfusion reactions? The correct answer is highlighted below Testing errors Clerical errors Donor IgG immune antibodies Blood administration errors
The correct answer is clerical errors. Improper patient identification at the time of sample collection or transfusion is the most common cause of an acute immune hemolytic transfusion reaction.
Which of the following statements about high-frequency antigens is correct? Please select the single best answer High-frequency antigens are common and it is easy to identify their corresponding antibodies. High-frequency antigens are common, but it is difficult to identify their corresponding antibodies. High-frequency antigens are rare and it is difficult to identify their corresponding antibodies. High-frequency antigens are rare, but it is east to identify their corresponding antibodies.
The correct answer is high-frequency antigens are common, but it's difficult to identify their corresponding antibodies. High-frequency antigens are present in >98% of all individuals. Occurrence of an antibody to these antigens is rare because most individuals have these antigens on their red cells.
A patient with multiple myeloma has the following reactions in the ABO typing: Anti-A= w+ Anti-B = w+ Anti-A,B = w+ Auto control = w+ A1 Cells = 4+ B cells = 4+ What is probably causing these results? The correct answer is highlighted below Rouleaux Subgroup of A Patient has hypogammaglobulinemia Patient has selective IgA deficiency
The correct answer is rouleaux. Rouleaux is the stacking of red blood cells and it occurs when patients have abnormal globulins such as in Multiple Myeloma. This is most likely causing false agglutination in the ABO typing.
Which of the following statements is correct regarding blood bank adverse event reporting to the FDA? Please select the single best answer All patient deaths while being transfused must be reported to the FDA, even when it has been confirmed that the death was not related to the transfusion. When a transfusion reaction is the result of an error it must be reported to the FDA in writing. A transfusion-related death must be reported to the FDA within 24 hours of the patient's death. The initial notification to the FDA of a transfusion-related death must be made by fax, telephone, express mail, or electronically as soon as possible after the death is confirmed to be associated with the transfusion.
The initial notification to the FDA of a transfusion-related death must be made by fax, telephone, express mail, or electronically as soon as possible after the death is confirmed to be associated with the transfusion.
What step must be performed before a rejuvenated blood unit may be transfused to the patient? Please select the single best answer The unit must be thawed. The unit must be warmed to room temperature. The unit must be washed. The unit must be agitated.
The unit must be washed. The unit must be washed to remove inosine because it's toxic to the patient. Rejuvenated red cells are not frozen, so they do not need to be thawed. The unit must be stored at 1-6 C and should not be warmed to room temperature. The unit should not be agitated.
