BOC Immunohematology Practice Questions
How many doses of RhIG should be administered if the calculated amount of fetal whole blood volume in maternal circulation was 28 mL? - 1 dose - 2 doses - 3 doses - 4 doses
2 doses
An Rh-negative mother has just given birth to an Rh-positive baby. Her physician suspects that she has experienced a fetal-maternal hemorrhage since her rosette test was positive. Upon performing the Kleihauer-Betke stain procedure, the percentage of fetal cells is found to be 0.85%. The mother's total blood volume is 4565 mL. What dose of RhIG should be administered to the mother? - 1 vial - 2 vials - 3 vials - 4 vials
2 vials
Which of the following changes in titers would be considered significant when monitoring maternal antibodies using a doubling dilution? - 16 to 32 - 4 to 8 - 8 to 32 - 8 to 16
8 to 32
The accepted interval between whole blood donations is: - 2 days - 4 weeks - 8 weeks - 16 weeks
8 weeks
Which of the following antigen groups is closely related to the ABO antigens on the red cell membrane? - Rh - Kell - I, i - Duffy
I, i
Screen cells and crossmatch are positive at IS only with a negative autocontrol. What could be the cause? - Antibody mixture - Cold alloantibody - Abnormal protein - Cold autoantibody
Cold alloantibody
Which one of the following blood components contains the most Factor VIII concentration per mL? - Plasma - Cryoprecipitate - FFP - Platelet concentrate
Cryoprecipitate
An antibody titer is ordered on a prenatal-immunized female. What is the purpose of this? - Decide if the baby needs an intrauterine transfusion - Determine the identification of the antibody - Determine if early labor induction is indicated - Identify candidates for amniocentesis or percutaneous umbilical blood sampling
Identify candidates for amniocentesis or percutaneous umbilical blood sampling
A specimen from a 23-year-old female patient who is a Bombay Phenotype arrives in the blood bank. You observe the following reactions upon tube testing: Anti-A = 0, Anti-B = 0, A cells = 4+, B cells = 4+ - Type AB red cells can be transfused to this patient - Type O red cells can be transfused to this patient in an emergency - Type O neg blood can be transfused to this patient - Patient can only receive Bombay phenotype blood
Patient can only receive Bombay phenotype blood
What red cell component is indicated for patients who receive directed donations from immediate family members to prevent TA-GVHD? - Irradiated red cells - Washed red cells - Leukocyte-reduced red cells - HLA-matched red cells
Irradiated red cells
The addition of LISS to the testing environment when performing an indirect antiglobulin test is designed to do what? - Lowering the zeta potential - Increasing the zeta potential - Bind IgG antibodies attached to patient red cells - Bind IgM antibodies found in patient serum or plasma
Lowering the zeta potential
Almost all individuals possess which Lutheran antigen profile? - Lu(a-b-) - Lu(a+b-) - Lu(a-b+) - Lu(a+b+)
Lu(a-b+)
Which of the following is true regarding the Lutheran blood group system? - anti-Lu^a most often is IgG - anti-Lu^b is always IgM - Lu^a is a high frequency antigen - Lu^b is a high frequency antigen
Lu^b is a high frequency antigen
Which specific immunodominant sugar is responsible for A (blood group A) antigenic specificity? - L-fucose - D-galactose - N-acetyl-D-galactosamine - Glucose
N-acetyl-D-galactosamine
Screen cells, crossmatch, and autocontrol are positive at all phases of testing. What is the most likely cause: - Nonspecific autoantibody or abnormal protein - Cold + warm alloantibody mixture - Specific cold alloantibody - Specific cold autoantibody
Nonspecific autoantibody or abnormal protein
Anti-A = 0, Anti-B = 0, A1 cells = 4+, B cells = 4+ What is the correct ABO group? - Unable to interpret - O - AB - Either A or B
O
Paroxysmal cold hemoglobinuria is associated with: - P antigen - Kell system antigens - Duffy system antigens - I antigen
P antigen
Which genotype(s) is/are possible for a mating of an AB mother and an AB father? - AB only - AA and BB - AB, AA, and BB - All genotypes are possible
AB, AA, and BB
Which best describes an A1 individual? - A antigens on red cells and anti-B in serum, which may also contain anti-A1 - A, A1, and B antigens on red cells and no antibodies in serum - A and A1 antigens on red cells and anti-B in serum
A and A1 antigens on red cells and anti-B in serum
Which of the following is the most important factor in determining the immediate outcomes of kidney transplants? - ABO compatibility - HLA compatibility - Rh compatibility - Other blood group system compatibility (Kell, Kidd, and Duffy)
ABO compatibility
What is the cause of most severed acute hemolytic transfusion reactions? - Rh incompatibility - ABO incompatibility - Cold agglutinins - Delayed hypersensitivity
ABO incompatibility
In transfusion-associated acute lung injury (TRALI): - Red cell alloantibodies may be found in the recipient's serum - IgA antibodies may be found in the recipient's serum - Allergens may be found in the recipient's serum - Antileukocyte antibodies may be found in the recipient's serum
Antileukocyte antibodies may be found in the recipient's serum
A patient's red cells do not react with anti-A or anti-B but react weakly with anti-A,B from group O persons. The patient's serum agglutinates both A1 and B cells, but not O cells. The patient's blood group is most likely: - Ax - Am - O - A3
Ax
A D-positive mother with a D-negative fetus eliminates the possibility of HDFN due to the: - D antigen - ABO antigen system - Lewis antigen system - Rh antigen system
D antigen
What is an explanation for patient positive for weak D with an anti-D in their serum? - Most weak D individuals make weak D - D mosaic patients may make antibodies to the missing antigen parts - Due to the patient's disease state - Mixup of samples or a testing error
D mosaic patients may make antibodies to the missing antigen parts
A blood bank work up indicates positive screen cells, crossmatch, autocontrol, and DAT. What should be done next? - Antigen typing of patient cells - Eluate; cell panel on eluate - Adsorption using rabbit stroma - Selected cell panel
Eluate; cell panel on eluate
After performing an antibody panel and a selected cell panel, you still can't rule out S and Fy^b. It appears that the patient has anti-e and anti-Jk^b, but they are only reacting microscopically. What technique would be the best way to strengthen the suspected antibodies? - Lui freeze thaw technique - Prewarm panel - Enzyme panel - Saline replacement technique
Enzyme panel
A patient comes in with multiple antibodies in their serum. One is anti-D. The technologist determines anti-Fy^a, anti-Jk^a, and possibly a fourth antibody present. What should the technologist do next to identify the remaining antibody(ies)? - Enzyme panel; select cell panel - Thiol reagents - Albumin as enhancing media in combination with selective adsorption - Lowed the pH and increase incubation time
Enzyme panel; select cell panel
Which blood product should be shipped on dry ice? - FFP - Whole blood - Leukocyte-reduced red cells - Apheresis granulocytes
FFP
Jennifer expresses Fy^a, Fy^b, and Xg^a. Dylan does not show expression of any of these. Which factor(s) may be responsible for these absences? - Race - Prescription medication - Gender and race - Gender
Gender and race
Which of the following types of whole blood is the only one to be transfused to a type AB patient? - Group O - Group A - Group B - Group AB
Group AB
All of the following cellular antigens are important to an immunohematologist except: - Blood group antigens - Histocompatibility antigens - Haptens - Autoantigens
Haptens
Which would not be a reason to perform an adsorption? - Identification of antibodies causing a positive DAT - Separation of a mixture of antibodies - Removal of interfering antibodies - Confirmation of weak antigen on red cells
Identification of antibodies causing a positive DAT
Which of the following cannot be treated with cryoprecipitate? - Hypofibrinogemia - Factor XIII deficiency - Idiopathic thrombocytopenic purpura - von Willebrand's disease
Idiopathic thrombocytopenic purpura
Which of the following would not be causative of a positive DAT on cord cells of a newborn? - Immune anti-D from an Rh- mother on the cells of an Rh+ baby - Immune anti-K form a K- mother on the cells of a K- baby - High concentrations of Wharton's jelly on cord cells - Immune anti-A from a group O mother on a group A baby
Immune anti-K form a K- mother on the cells of a K- baby
Transfusion of which blood product is most likely to cause circulatory overload in patients? - Platelets - FFP - Red cells - Whole blood
Whole blood
If a patient is determined to have type B blood, what antibody would be found in his/her serum? - anti-A - anti-B - anti-A and anti-B - anti-O
anti-A
If a patient is determined to have type O blood, what antibody would be found in his/her serum? - anti-A - anti-B - anti-O - anti-A and anti-B
anti-A and anti-B
If a patient is determined to have type A blood, what antibody would be found in his/her serum? - anti-A - anti-B - anti-A and anti-B - anti-O
anti-B
What would not be detected by group O screen cells? - anti-B - anti-Di^a - anti-N - anti-k
anti-B
Which of the following antibodies is the most common cause of severe HDFN? - anti-A - anti-B - anti-E - anti-D
anti-D
Tests reveals an antibody that is strongly reactive in all test phases. Screen cells and panel cells are positive, but the serum is negative against cord red cells. What antibody could this be? - anti-i - anti-I - anti-H - anti-P
anti-I
Which antibody identified in prenatal specimens is never a cause of HDFN? - anti-D - anti-c - anti-E - anti-I
anti-I
Which of the following is true of the classic Bombay phenotype? - Two h genes are inherited at the H locus - H substance is present - A antigen is present - B antigen is present
Two h genes are inherited at the H locus
Which does not require the use of irradiated product for transfusion? - Bone marrow transplant - Exchange transfusion - Severe combined immunodeficiency syndrome (SCIDS) - Warm autoimmune hemolytic anemia
Warm autoimmune hemolytic anemia
Anti-Fy^a: - Is capable of causing hemolytic transfusion reactions - Is often an autoagglutinin - Is usually a cold-reactive agglutinin - Is more reactive when tested with enzyme-treated red cells
Is capable of causing hemolytic transfusion reactions
Some soluble blood group antigens exist in fluids such as saliva, urine, and plasma. These antigens can be used to neutralize corresponding antibodies that could mask the presence of other non-neutralizable antibodies. Of the following blood group system antibodies, which one Ould be neutralized in a manner using these fluids or other natural sources? - Lewis - Kell - Rh - MN
Lewis
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? - Look-back - Donor notification - Minor crossmatch - Major crossmatch
Look-back
Which of the following cells are capable of producing antibodies? - Thrombocytes - Macrophages - Lymphocytes - Neutrophils
Lymphocytes
What is the first line treatment for moderate to severe hemophilia A? - Platelets - Lyophilized Factor VIII concentrates - Factor IX complex - Cryoprecipitated AHF
Lyophilized Factor VIII concentrates
Most antibodies present in cord blood are of ___________ origin. - Fetal - Maternal - Paternal - Maternal and paternal
Maternal
In HDFN which of the following antigen-antibody reactions is occurring? - Maternal antibody is directed against fetal antibody - Maternal antigen is directed against fetal antibody - Maternal antibody is directed against fetal antigen - Maternal antigen is directed against fetal antigen
Maternal antibody is directed against fetal antigen
Which of the following set of conditions would not allow HDFN to occur as a result of Rh incompatibility? - Mother Rh-negative, father Rh-positive - Mother Rh-negative, baby Rh-positive - Mother Rh-negative, father Rh-negative - Mother Rh-negative, father Rh-unknown
Mother Rh-negative, father Rh-negative
In immunohematology, an antithetical relationship exists between M antigen and which of these antigens? - K antigen - S antigen - Lu6 antigen - N antigen
N antigen
What is the appropriate deferral period from donating blood for a 34-year-old female who miscarried in her first trimester? - 8 weeks - 6 weeks - 2 weeks - No deferral
No deferral
With the Bombay phenotype: - Patient serum contains anti-A, anti-B, and anti-H - It is compatible with all group O cells - It may express acquired B antigens - The red cells express A, B, and H antigens
Patient serum contains anti-A, anti-B, and anti-H
In order to detect the presence of antibodies fixed on the red cells of a newborn, one should: - Perform a DAT on cord blood - Perform an IAT on cord blood - Test the baby's cells with typing antiserum - Look for agglutination in a mixture of mother's serum and baby's cells
Perform a DAT on cord blood
Which procedure should be followed when one cross-matched unit out of five is incompatible at the AHG phase? - Perform a DAT on the incompatible unit - Check for high-frequency antigens - Wash the donor cells and use the washed cells for testing - Perform an antibody panel using donor serum
Perform a DAT on the incompatible unit
All of the following could explain why screening cell #2 has a stronger reaction than screening cell #1 except: - The patient has more than one antibody and all corresponding antigens are on screen cell #2 but not on screen cell #1 - The patient has an antibody other than anti-D and screen cell #2 has a double dose of the antigen, whereas cell #1 has only a single dose - Operator variability - when dislodging the cells buttons during reading, the technologist shook screen cell #1's test more vigorously than cell #2's test - Screening cell #1 has homozygous antigen for the reacting antibody whereas screening cell #2 is heterozygous
Screening cell #1 has homozygous antigen for the reacting antibody whereas screening cell #2 is heterozygous
Antibodies of the Kidd system: - React best at IAT (AHG) - Often cause allergic reactions - Are predominantly IgM - Do not generally react with antigen positive, enzyme-treated red cells
React best at IAT (AHG)
What characteristic is usually associated with IgM antibodies directed against red cells? - React best at 37C - Appear after heated incubation - Are identified using the AHG test - React best at room temperature
React best at room temperature
Antibodies in the Rh system typically exhibit which one of the following characteristics? - Reacts best at 37C and AHG - Reacts best at room temperature - Shows hemolysis better than agglutination - Reacts best at 4C
Reacts best at 37C and AHG
Which of the following is characteristic of anti-i? - Reacts best at room temperature or 4C - Reacts best at 37C - Is usually IgG - Often associated with HDFN
Reacts best at room temperature or 4C
All of the following are benefits of autologous donation except: - Reduces exposure to infectious diseases - Readily available in case of an unexpected emergency - Reduces demand for homologous blood transfusions - Eliminates sensitization to cellular blood components
Readily available in case of an unexpected emergency
Complement-dependent antibodies would be best preserved in: - Serum heated to 56C for 30 minutes - Serum/plasma stored at 20-24C for no longer than 48 hours - Serum stored at 4C for no longer than 48 hours - Plasma stored at 4C for not longer than 24 hours
Serum stored at 4C for no longer than 48 hours
When administering FFP, which one of the following is considered standard blood bank practice? - Should be ABO compatible with the recipient's red cells - Must be the same Rh type as the recipient - Is appropriate for use as a volume expander - Complement should remain frozen when it is issued
Should be ABO compatible with the recipient's red cells
Enzyme panel reactions cannot be used as the only source of rule-outs during antibody identification. Why is this? - Enzyme panels only detect warm autoantibodies - Enzyme panels only detect IgM antibodies - All antigens on the panel cells are destroyed by enzymes - Some antigens are destroyed and may not detect an antibody that is present
Some antigens are destroyed and may not detect an antibody that is present
The following reactions occurred in an ABO type: Anti-A = mf, Anti-B = 0, A1 cells = 1+, B cells = 4+ What should be done next? - Nothing, this is normal typing - Type with Dolichos biflorus and A2 cells - Retype patient cells with anti-H and anti-A,B; use screen cells and A2 cells on serum; run an autocontrol - Wash cells 4 times with saline and repeat forward type
Retype patient cells with anti-H and anti-A,B; use screen cells and A2 cells on serum; run an autocontrol
In cases of HDFN: - DAT is weaker in Rh HDFN than ABO HDFN - Rh HDFN can occur in the first pregnancy - The mother will demonstrate a positive antibody screen in ABO HDFN - Rh HDFN is clinically more severe than ABO HDFN
Rh HDFN is clinically more severe than ABO HDFN
All of the following are indications for administering Rh immune globulin (RhIG) to an Rh-negative woman, except? - Therapeutic abortion - Ectopic pregnancy - Rh-positive fetus - Rh-negative fetus
Rh-negative fetus
The Rh nomenclature which uses the letters DCE is found in which of the following genetic models? - Wiener - Shorthand - Fisher-Race - Rosenfield
Fisher-Race
Platelet transfusion is most beneficial when used to treat: - Post-transfusion purpura - Hemolytic transfusion reaction - Functional platelet abnormalities - Immune thrombocytopenia purpura
Functional platelet abnormalities
Which of the following blood group antigens are most susceptible to destruction by the action of enzymes? - D - Jk^a - Le^a - Fy^a
Fy^a
A patient has anti-c. Which phenotype should be given if the patient required a transfusion? - R0R1 - r'r^y - r'r - R2r'
r'r^y
The expression of most blood group antigens can be classified as: - Codominant - Dominant - Recessive - Corecessive
Codominant
Frozen red cells that have been prepared with high glycerol methods (40% glycerol) can be stored up to 10 years if held at which of the following temperatures? - -65C or lower - -20C or lower - -10C or lower - 0C or lower
-65C or lower
Whole blood or red cell units will be shipped from the American Red Cross to the transfusion facility. At what temperature should the units be kept during transportation? - 1-4C - 1-10C - 2-6C - 2-8C
1-10C
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? - 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
21 CFR 640.25 Platelets - General Requirements
An oncology patient has a positive antibody screen. The work up indicates that anti-K and anti-c are present. How many units of RBCs would need to be screened to find 4 compatible units for the patient? - 22 units - 6 units - 12 units - 30 units
22 units # units requested / % compatibility Compatibility is the percent of blood compatible with known antibody. If there is more than one antibody, multiply percentages together. If you are given the frequency of the antigen, subtract frequency from 100 to get the percent compatible
Frozen red cells that have been thawed, deglycerolized, and reconstituted in an open system must be used within: - 1 hour - 24 hours - 14 days - 7 days
24 hours
What is the minimum number of reactive antigen-positive and non-reactive antigen-negative panel cells that must be present in order to identify a red cell antibody with statistical confidence? - 2 - 3 - 5 - 10
3
A rejuvenation solution may be used up to how many days following expiration of a red cell unit? - 1 day - 3 days - 7 days - 10 days
3 days
The appropriate dosage of RhIG to administer post-delivery to an Rh negative mother delivering an Rh positive child is calculated based on the estimated volume of fetal bleed. What is the value of x in the formula given below that is used to calculate RhIG dosage? Number of vials of 300 ug RhIG = volume of fetal bleed/x mL - 10 - 30 - 100 - 300
30
A 300 ug dose of RhIg can suppress immunization to how many mL of D-positive whole blood? - 15 mL - 20 mL - 25 mL - 30 mL
30 mL
What is the minimum acceptable hematocrit value for a female who wants to donate an autologous unit of blood for an upcoming surgery? - 39% - 38% - 33% - 25%
33%
Which of the following is the proper temperature to use when crossmatching in the presence of a cold antibody? - 37C - 25C - 15C - 4C
37C
A Kleinbauer-Betke acid elution test identifies 30 fetal red cells in 2000 maternal red cells. How many RhIG doses are indicated? - 3 vials - 4 vials - 2 vials - 1 vials
4 vials % KB x 5000 ml (maternal) red cells = fetal red cells (ml) fetal red cells (ml) / 30 ml per vial = dosage < .5 round down >/= .5 round up ALWAYS add 1 vial to calculation
A potential apheresis platelet donor must be deferred for how long following the use of aspirin? - 4 weeks - 2 weeks - 48 hours - No deferral - can donate immediately given they meet all other requirements
48 hours
In a closed system, thawed FFP and PF24 components may be labeled as "Thawed Plasma" 24 hours after the original thaw time and given a shelf life of? - 5 days - 60 minutes - 24 hours - 2 days
5 days
What is the maximum number of white cells allowed in a leukocyte-reduced unit of red cells? - 5 x 10^6 - 1 x 10^10 - 5.5 x 10^10 - 3 x 10^11
5 x 10^6
In order to prevent a loss of viability in platelet concentrations during storage, the pH must be maintained at or above what level? - 7.5 - 6.2 - 5.0 - 4.5
6.2
The serum of which of the following individuals may agglutinate group A1 cells? - A2 individual - A1B individual - A1 individual - Newborn
A2 individual
What is the correct blood group for the patient based on the reactions below? Anti-A = 4+, Anti-B = 4+, A1 cells = 0, B cells = 0 - AB - O - A - B
AB
If a child's phenotype is Group O, the phenotype of the mother of the child is Group A and the phenotype of the father is Group B, what are the possible genotypes of both parents? - AA and BO - AO and BB - AO and BO - AA and BB
AO and BO
Which of the following will not result in indefinite donor deferral? - Accidental needle stick 1 year ago; negative for infectious diseases - Former drug addict that has been drug-free for 5 years - Man that is in remission for lymphoma - Recipient of human growth hormone 30 years ago
Accidental needle stick 1 year ago; negative for infectious diseases
The AABB Standards for Blood Banks and Transfusion Services requires a control system for antiglobulin tests interpreted as negative. What is done for this control system? - Running tests in duplicate - Adding an extra incubation - Adding IgG sensitized red cells - Performing a minimum of 3 extra washes
Adding IgG sensitized red cells
Weak ABO subgroup can be best confirmed by: - Immunodiffusion-precipitation - Adsorption-elution - Elution-diffusion - Neutralization
Adsorption-elution
A female at 27 weeks gestation comes into the hospital and is ABO typed: Anti-A = 3+, Anti-B = 4+, A1 cells = 0, B cells = 1+, O cells = 1+ What is likely the cause of the ABO discrepancy? - Weak subgroup - Hypogammaglobulinemia - Alloantibody in patient serum - Acquired B
Alloantibody in patient serum
A patient has a weakly positive antibody screen during postpartum testing, which was identified as anti-D. Most likely the result of: - Massive fetomaternal hemorrhage occurring at the time of delivery - Antenatal administration of RhIG at 28 weeks - Mother having a positive DAT - Contamination of blood sample
Antenatal administration of RhIG at 28 weeks
Acquired B blood type results would look like: - Anti-A = 4+, Anti-B = 3+, A1 cells = 0, B cells = 0 - Anti-A = 4+, Anti-B = 4+, A1 cells = 2+, B cells = 0 - Anti-A = 4+, Anti-B = 1+, A1 cells = 0, B cells = 4+ - Anti-A = 3+, Anti-B = 0, A1 cells = 0, B cells = 0
Anti-A = 4+, Anti-B = 1+, A1 cells = 0, B cells = 4+
A pregnant patient with fetal distress possesses an antibody that reacts at IAT (AHG), is non-reactive with DTT-treated cells, and causes in vitro hemolysis. What is the likely specificity? - Anti-Le^a - Anti-Lu^a - Anti-Lu^b - Anti-Xg^a
Anti-Lu^b
What is the indirect anti globulin test (IAT) usually used to detect? - Antibodies coating red cells - Antibodies in the plasma - Antigens coating red cells - Antigens in the plasma
Antibodies in the plasma
Persons who have received a dura mater transplant are not eligible to donate blood and are permanently deferred. This is due to an increased risk of which of the following? - HIV - Leishmaniasis - Chagas disease - CJD or vCJD
CJD or vCJD
A patient comes in with anti-C, anti-D, and anti-E. Is it possible to find compatible blood? - Blood from a donor with rr genotype could be used without causing problem - r^yr (rare) blood from close relatives - R0R0 because it lacks these 3 antigens - Nearly impossible to find blood lacking C, D, and E antigens
Blood from a donor with rr genotype could be used without causing problem
Which of the following consequences of severe HDFN is most associated with neonatal death before or shortly after birth? - Enlarged liver - Enlarged spleen - Cardiac failure - Hyperbilirubinemia
Cardiac failure
Which of the procedures listed below will increase the platelet concentration in the preparation of platelets? - Centrifuge the blood at a low speed, remove the plasma and spin the plasma again at a low speed - Centrifuge the blood at a low speed, remove the plasma and spin the plasma again at a high speed - Centrifuge the blood at a high speed, remove the plasma and spin the plasma again at a high speed - Decrease the duration of rotation of the initial spin
Centrifuge the blood at a low speed, remove the plasma and spin the plasma again at a high speed
An aliquot of AS-1 red cells is being prepared from an intact packed cell unit using a sterile connection device. During the process of preparing an aliquot, the sterile device fails and blood drips onto the counter from the product tubing. What should be done with the primary unit? - Destroy the unit - Keep the original expiration date - Change the expiration date to 24 hours - Change the expiration date to 48 hours
Change the expiration date to 24 hours
What genotype is homozygous for D? - DCe/dce - dCE/dCE - DCE/DCE - Dce/dce
DCE/DCE
LISS enhancement media: - Decreases the rate of antibody uptake - Requires increased incubation time - Decreases zeta potential which allows antibodies and antigens to come closer together - Denatures some red cell antigens
Decreases zeta potential which allows antibodies and antigens to come closer together
Antibodies to the Kidd blood group system are most commonly associated with: - Delayed hemolytic transfusion reactions - Postpartum depression - Hives and rashes - Immediate spin, cold antibody reactions
Delayed hemolytic transfusion reactions
A patient was transfused 7 days ago and has a hemolytic transfusion reaction. The most likely cause of this is: - Delayed, immunological; due to an antibody such as anti-Jk^a - Immediate, nonimmunological; due to volume overload - Immediate, immunological; due to clerical error or ABO incompatibility - Delayed, nonimmunological; due to iron overload
Delayed, immunological; due to an antibody such as anti-Jk^a
What is the cause of neonatal alloimmune thrombocytopenia (NAIT)? - Destruction of a neonate's platelets by alloantibodies crossing the placenta from the mother - Destruction of a neonate's platelets by an antibody that is produced by the neonate's own immune system - Decreased platelet production in the neonate - Destruction of a mother's platelets by alloantibodies crossing the placenta from the neonate
Destruction of a neonate's platelets by alloantibodies crossing the placenta from the mother
Platelet refractoriness in a patient is most likely caused by: - Transfusion of Rh-incompatible platelets - Development of antibodies to HLA antigen - Decreased pH of platelets - Development of alloantibody with anti-D specificity
Development of antibodies to HLA antigen
Which one of the following is the most common reagent source for anti-A1? - Group A1 plasma - Dolichos biflorus seed extracts (lectins) - Bandeiraea simplicifolia seed extracts (lectins) - Ulex europaeus seed extracts (lectins)
Dolichos biflorus seed extracts (lectins)
John Doe received 2 A, Rh positive red cell units 2 days ago. 2 days later, he presents with fever and jaundice. The transfusion work up indicates he is A, Rh positive and that no clerical errors were made. Post-transfusion specimen testing reveals a positive DAT with monospecific IgG, specimen hemolysis, and a positive antibody screen determined the antibody to be anti-Jk^b. The pretransfusion antibody screen was negative. The DAT can be explained by: - Donor cells were polyagglutinable - Donor cells were likely positive for Jk^b antigen - Recipient cells were likely positive for Jk^b antigen - Donor cells had a positive DAT
Donor cells were likely positive for Jk^b antigen
The major crossmatch is performed using: - Donor's serum and recipient's red cells - Donor's serum and recipient's serum or plasma - Donor's red cells and recipient's serum or plasma - Donor's red cells and recipient's red cells
Donor's red cells and recipient's serum or plasma
What blood group are the RBCs screening cells for antibody screens? - Group O - Group A - Group B - Group AB
Group O
Which is the first marker (antigen or antibody) which will become positive after exposure to Hepatitis B? - HBsAg - anti-HBs - anti-Hbe - IgG anti-HBc
HBsAg
Which test is performed on donor units to identify the most common cause of posttransfusion hepatitis? - Anti-HCV - Anti-HAV IgM - HBsAg - Anti-HBe
HBsAg
Antibody screen reacts at IAT (AHG) with all screen cells but the autocontrol is negative. This can be best explained by: - Cold alloantibody - Cold and warm alloantibodies - Warm autoantibody - High-frequency alloantibody or mixture of alloantibodies
High-frequency alloantibody or mixture of alloantibodies
Which of the following would result in permanent donor deferral? - History of therapeutic rabies vaccine - Diabetes - Residence in endemic malaria region - History of jaundice of uncertain cause
History of jaundice of uncertain cause
Which of the following patients should be transfused using washed red cells? - Pregnant woman with history of HDFN - IgA-deficient patient with history of transfusion associated anaphylaxis - Newborn with hematocrit of < 30% - Patient with positive DAT and red cell antibody
IgA-deficient patient with history of transfusion associated anaphylaxis
Which class of antibody can agglutinate red cells after AHG is added to the test tube? - IgA - IgE - IgG - IgM
IgG
Polyspecific antihuman globulin reagent used in antiglobulin testing should react with which one of the following? - IgG and IgA - IgM and IgA - IgG and C3d - IgM and C3d
IgG and C3d
The most significant blood group antibodies belong to which immunoglobulin classes? - IgA and IgD - IgA and IgM - IgE and IgD - IgG and IgM
IgG and IgM
What kind of immunoglobulins are predominantly found in Rh immune globulin? - IgM anti-D - IgG anti-D - IgM anti-A,B - IgG anti-A,B
IgG anti-D
Which occurrence is a medical error? - Technologist drops and breaks a bottle of chemistry reagent - Patient is tested and diagnosed with acute leukemia - Analyzer malfunctions and test results are rejected as invalid - Incompatible blood is transfused into a patient during surgery
Incompatible blood is transfused into a patient during surgery
Select the correct ABO group based on the following: Anti-A = 4+, Anti-B = 4+, Anti-A,B = 4+, A1 cells = 1+, B cells = 0 - Group AB - Group O - Group B - Inconclusive; could be A2B with anti-A1 in serum; further testing is necessary
Inconclusive; could be A2B with anti-A1 in serum; further testing is necessary
Consider the following reactions: Anti-A = 0, Anti-B = 0, A1 cells = 0, B cells = 0 What should be done next? - Repeat test with new reagents - Perform antibody identification panel - Perform additional testing like A1 lectin and anti-A,B - Incubate at 22C or 4C to enhance weak expression
Incubate at 22C or 4C to enhance weak expression
What is the purpose of adding citrate to donated red cell units? - It stabilizes the pH of the unit during storage - It is a substrate in ATP synthesis - It supports ATP generation by the glycolytic pathway - It prevents coagulation
It prevents coagulation
The McLeod phenotype is associated with which of the following antigen systems? - Rh - P - Kell - MNSs
Kell
Which of the following best describes reverse typing? - Known antisera used to detect ABO antigens - Known antigen used to detect ABO antibodies - Known antigen used to detect ABO antigens - Known antisera used to detect ABO antibodies
Known antigen used to detect ABO antibodies
ABO blood groups were discovered by: - Drew - Lindemann - Hicks - Landsteiner
Landsteiner
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? - Le(a-b-) - Le(a+b+) - Le(a+b-) - Le(a-b+)
Le(a+b-)
Which of these Lewis blood group system phenotypes usually produces anti-Le^a? - Le(a+b+) - Le(a+b-) - Le(a-b+) - Le(a-b-)
Le(a-b-)
Which Lewis antigen(s) would be detected when phenotyping the red cells of an adult who has the Le, Se, and H genes? - Le^a - Le^b - Both Le^a and Le^b - Neither Le^a and Le^b
Le^b
Which one of the following blood group antigens is not expressed, or only weakly expressed on cord blood cells? - K - ABO - M - Le^b
Le^b
All of the following would be included in a hemolytic transfusion reaction investigation, except: - ABO/Rh check on post-transfusion sample - Leukocyte antigen studies - DAT on post-transfusion sample - Clerical check
Leukocyte antigen studies
Which blood component prevents HLA alloimmunization of the recipient? - RBCs - Leukocyte-reduced rbcs - Granulocytes - Irradiated rbcs
Leukocyte-reduced rbcs
Can an autologous donor donate blood at 4PM on Monday if she is having surgery at 10AM on Wednesday? - 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 8 weeks - Yes, the patient can donate, but only half a unit - Yes, an autologous donor can donated up to 24 hours prior to surgery
No, the minimal allowable time between the last donation and surgery is 72 hours
Which one of the ABO groups listed below has the MOST H-antigen? - A1 - A1B - B - O
O
Maternal blood: O, Rh negative, with anti-E in the serum; cord blood: A, Rh positive, DAT = 2+, with anti-E in eluate What is the best choice of blood for exchange transfusion? - O, Rh positive, E- - O, Rh positive, E+ - O, Rh negative, E- - A, Rh positive, E-
O, Rh positive, E-
You receive a call in the blood bank, reporting a transfusion reaction. You ask the nurse to stop the red cell transfusion immediately and return the unit of blood and all related forms to the blood bank. You also ask for a new patient blood specimen to be drawn and sent to the blood bank. You receive the requested items 15 minutes later. What will you do first as part of your investigation? - Perform an antibody screen and DAT on the pre-transfusion and post-transfusion specimens - Perform a clerical check, centrifuge the pre-transfusion and post-transfusion patient specimens and examine the plasma for hemolysis and icterus - Issue a different unit of blood to this patient but only after the original unit has been returned to blood bank - Do nothing, as you issued an O negative red cell unit to the patient and that proves that the unit is compatible
Perform a clerical check, centrifuge the pre-transfusion and post-transfusion patient specimens and examine the plasma for hemolysis and icterus
While working at a blood bank lab, you hear chimes over the hospital loudspeaker system announcing the birth of a baby. Thirty minutes later, you receive a cord blood specimen that you identify as O positive. You previously received the mother's specimen and she was O negative with a negative antibody screen. What is the next action? - Issue one vial of RhIG - Perform a Kleinbauer Bete stain - Nothing - mom is not at risk for anti-D - Perform a fetal bleed screen
Perform a fetal bleed screen
What corrective action should be taken by a technologist in the event that rouleaux causes positive test results? - Perform an autoadsorption - Perform a saline replacement procedure - Perform an eluate - Run a panel
Perform a saline replacement procedure
A blood bank technologist performing testing to determine the blood group of a patient is: - Genotyping - Polymerase chain reaction - Phenotyping - Phenotyping and genotyping
Phenotyping
In blood bank agglutination reactions, the zeta potential (a force exerted by ions in the saline solution that causes repulsion between red blood cells in the saline suspension) can be reduced by treating the sensitized cells with: - Polyclonal antibody reagents - Polyethylene glycol (PEG), albumin, or proteolytic enzymes - Monoclonal antiglobulin reagents - Coombs check cells
Polyethylene glycol (PEG), albumin, or proteolytic enzymes
A patient types as: Anti-A = 4+, Anti-B = 0, Anti-A1 lectin = 4+, A1 cells = 0, A2 cells = 2+, B cells = 4+ What would you expect to see on the antibody screen? - Negative screen - Positive with all cells at 37C - Positive with all cells at RT, with negative autocontrol - Positive will all cells and positive autocontrol at RT
Positive with all cells at RT, with negative autocontrol
In which situation is gamma irradiation of cellular blood components required? - Prevention of post-transfusion purpura - Prevention of GVHD - Sterile components - Prevention of non-cardiogenic pulmonary edema
Prevention of GVHD
When is testing for weak D optional (not required)? - Testing for weak D on potential transfusion recipient samples - Testing on donor red cells - Testing cord blood on infants born to Rh-negative moms - Testing for RhIG workups
Testing for weak D on potential transfusion recipient samples
How are antibodies to the ABO blood group system antigens unique? - Laboratory tests are available for their identification - The antibodies are naturally occurring to antigens that are absent from the red cell membrane - The antibodies are formed after the individual has been immunized - The antibodies are IgM
The antibodies are naturally occurring to antigens that are absent from the red cell membrane
After irradiating a unit of packed red cells, how is the expiration date affected? - 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 is not affected
The expiration date shortens to 28 days from the date of irradiation or the original expiration date, whichever is first
Phenotype refers to: - 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
The expression of traits
If an autologous blood component is shipped from the donor center without the completion of infectious disease testing, the unit must be labeled with: - A blue sticker indicating which tests are in process - The phrase "Donor Untested" - A statement from the ordering physician requesting the release - A red warning tag
The phrase "Donor Untested"
What step must be performed before a rejuvenated blood unit may be transfused to the patient? - 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
What is the correct description for Group II discrepancies? - These discrepancies between forward and reverse groupings are due to miscellaneous problems - These discrepancies between forward and reverse groupings are caused by protein or plasma abnormalities - These discrepancies between forward and reverse groupings are due to weakly reacting or missing antigens - These discrepancies between forward and reverse groupings are due to weakly reacting or missing antibodies
These discrepancies between forward and reverse groupings are due to weakly reacting or missing antigens
Which one of the following statements about directed donations is true? - They are safer than random donor units - The will never cause GVHD - They do not cause logistical problems for blood banks - They are often perceived by the recipient as safer than random donor units
They are often perceived by the recipient as safer than random donor units
An elution is a technique that is used to release, concentrate, and purify antibodies that are bound to red cells. In preparing red cells for any elution method, one must be particularly careful to: - Leave a small amount of serum in the test system so complement will be present - Add albumin to decrease zeta potential - Pretreat the cells with enzymes - Thoroughly wash sensitized red cells
Thoroughly wash sensitized red cells
Chloroquine diphosphate can be used in blood banking for which of the following methodologies? - To remove antibody bound to red cells so that cells can be further tested - To remove a specific antibody in serum or plasma - To remove ABO antigens from cells - To remove Rh antigens from cells
To remove antibody bound to red cells so that cells can be further tested
Of the following blood group antibodies, which has been most frequently associated with several cases of HDFN? - anti-A,B - anti-Le^a - anti-K - anti-M
anti-K
The serum from a patient of African-American descent is reactive with all screening and panel cells. Which antibody directed to a high incidence antigen is most likely to be present? - anti-Lu^b - anti-Jk3 - anti-U - anti-Ku
anti-U
Which of the following donors could be accepted for blood donation? - 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
24-year-old man who had a tooth extraction two months ago
Which is the best component to treat a patient with fibrinogen deficiency? - RBCs - Platelet concentrate - Fresh whole blood - Cryoprecipitated AHF
Cryoprecipitated AHF
Which of the following may result in a false negative reaction when performing Rh typing? - Rouleaux - Centrifuging for too long - Cold agglutinins - Failure to follow manufacturer's directions precisely
Failure to follow manufacturer's directions precisely
Hemolytic anemias are diagnosed by clinical findings and laboratory test results. All of the following are lab values that are relied on to help diagnose hemolytic anemia except? - Hemoglobin and/or hematocrit - Retic count and red cell morphology - Bilirubin and haptoglobin - Fibrinogen and C-reactive protein
Fibrinogen and C-reactive protein
Which of the following is beneficial when pretreating patient red cells in a cold autoadsorption procedure? - Phosphate-buffered saline at pH of 9.0 - Low ionic strength saline (LISS) - Ficin - Albumin
Ficin
Which of the following is generally considered equivalent to CMV-seronegative red cells for use in an exchange transfusion to a newborn? - Fresh red cells less than 7 days old - Hemoglobin S negative red cells - Frozen red cells - Leukoreduced red cells
Leukoreduced red cells
A blood bank technologist suspects positive antibody screen is due to rouleaux. Saline replacement technique is applied and the results remain positive. The best interpretation of this is: - Original positive antibody screen is caused by true agglutination - Confirms original reaction is due to rouleaux - Antibody screen is negative - Saline replacement is invalid and should be repeated
Original positive antibody screen is caused by true agglutination
HLA antibodies are responsible for which of the following transfusion reactions? - Allergic transfusion reactions - Transfusion-associated sepsis - Transfusion-associated circulatory overload - Transfusion-related acute lung injury (TRALI)
Transfusion-related acute lung injury (TRALI)
A patient with a cold agglutinin needs a transfusion. What can we do to decrease the risk of a transfusion reaction? - Transport and maintain temperature of 20-24C - Irradiated to prevent GVHD - Wash with 0.9% saline - Warm to 37C with a blood warmer
Warm to 37C with a blood warmer
When performing an anti-human globulin test, it is important to completely wash the red cells because: - Washing eliminates concentrations of unbound antigens - Washing prevents elution of cell-bound antibody - Washing promotes false positive effects of rouleaux - Washing prevents neutralization of the AHG serum
Washing prevents neutralization of the AHG serum
A patient that is an ABO nonsecretor: - Will have negative indicator cells for anti-A and anti-B, but positive indicator cells for anti-H - Will have positive indicator cells for anti-A and anti-B, but negative indicator cells for anti-H - Will have negative indicator cells for anti-A, anti-B, and anti-H - Will have positive indicator cells for anti-A, anti-B, and anti-H
Will have positive indicator cells for anti-A, anti-B, and anti-H (Think opposite of what you would expect. Reagent neutralizes soluble antigens if secretor, resulting in negative reaction with indicator cells)
