ASCP MT Blood Bank
The concentration of sodium chloride in an isotonic solution is : 8.5 % 0.85 % 0.08 % 1 molar -BB
0.85 % Isotonic or normal saline is a 0.85 % solution of sodium chloride in water.
The parents' blood types were AB and O. The blood group of any of their children could ONLY be: Group A only Group B only Group O only Group A or B only Group AB, A, B, or O -BB
Group A or B only If the parents' have AB and O blood types, then the child could have only AO or BO inheritance patterns resulting in a group A or group B baby.
Group O blood cannot be transfused to a person with "Bombay blood" type because the Bombay individual has: Anti-H Anti-A Anti-B H substance on his cells Anti-i -BB
Group O blood has the most H substance of all blood types; therfore, in a patient who has the Bombay phenotype (hh), the anti-H can react and cause incompatibility issues.
How many out of 1,000,000 Caucasians will have the following phenotype: Group 0, K+, Jk(a+) 10,000 30,000 100,000 600,000 750,000 -BB
Group O blood types comprise about 44% of the caucasian population. Out of 1,000,000 people, this leaves us with about 440,000 people. Approximately 9% of caucasians have the K antigen, leaving us with 39,600 individuals who are group O, K+. Approximately 77% of caucasians are positive for the Jka antigen. 77% of 39,600 individuals leaves us with 30,492 or approximately 30,000 individuals that are group O, K+ and Jk(a+).
Which of the following antigens is classified as a Major Histocompatibility Complex Class II antigen (MHCII)? HLA-A HLA-B HLA-C HLA-DR -BB
HLA-DR is a class II MHC. HLA-A, HLA-B, and HLA-C are all class I MHC.
Which of the following is the most probable explanation for the results below? The following results were obtained: ABO/Rh Type DAT Ab. Screen and ID Mother A negative NT Positive anti-D Infant O positive 4+ IgG NT NT = not tested Hemolytic disease of the newborn due to antibody against a high frequency antigen Baby has an autoimmune syndrome Hemolytic disease of the newborn due to anti-D -BB
Hemolytic disease of the newborn due to anti-D The results indicate hemolytic disease of the newborn due to anti-D.
Which of the following groups of antibodies generally reacts most strongly at 4o C: Anti-A, Anti-P1 , Anti-Leb , Anti-M Anti-B, Anti-K, Anti-Lua , Anti-Fya Anti-H, Anti-S, Anti-Jkb , Anti-Leb Anti-A, Anti-K, Anti-Lub , Anti-s -BB
Anti-A, anti-P, anti-Leb, and anti-M all react best at 4o C as they are predominantly IgM antibodies. Other antibody group choices above include IgG antibodies such as anti-K, anti-s, anti-S, and anti-Fya, anti-Lub, etc. which react best at 37o C.
Why would a unit of group O blood never be administered to a Bombay patient: Anti-A in donor Anti-B in donor Anti-H in donor Anti-H in recipient -BB
Anti-H in recipient The classic Bombay phenotype (Oh) is characterized by the absence of A, B and H antigens, and the presence of anti-H, which will react from 4o to 37o C. Bombay patients must therefore be transfused only with blood from donors of the Bombay phenotype.
Lectin from the seeds of Dolichos biflorus is a source of which of the following? anti-A1 anti-A2 anti-B -BB
anti-A1 The lectin from the seeds of Dolichos biflorus is used as a source of anti-A1.
In performing an AHG test it is important to completely wash the red cells in order to: eliminate concentrations of unbound antigens prevent elution of cell-bound antibody eliminate false positive effects of Rouleaux avoid neutralization of the anti-human globulin serum -BB
avoid neutralization of the anti-human globulin serum Inadequate cell washing will lead to unbound antibody remaining in the red cell suspension. This residual unbound antibody would be available to neutralize the AHG (Coombs serum) so it will not react with red cells bound with antibody.
A positive Coombs control test in a cross match BEST indicates that the: negative antiglobulin test was actually negative patient's RBCs were not washed thoroughly Coombs control cells are contaminated Coombs reagent is contaminated -BB
negative antiglobulin test was actually negative The Coombs control should be positive in order to confirm that a negative antiglobulin test is actually negative, and not showing a negative result due to missing reagent.
Premedication with antihistamines may prevent an allergic reaction in patients with a history of multiple urticarial transfusion reactions. True False -BB
Premedication with antihistamines 30 minutes prior to transfusion may be helpful in preventing an allergic reaction in patients with a history of multiple urticarial transfusion reactions.
Red Blood Cells, Frozen 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? - 65o C or lower - 20 o C or lower - 10 o C or lower 0 o C or lower -BB
Red Blood Cells, Frozen that are prepared using the high-glycerol technique (40%) can be stored up to 10 years at - 65o degrees Celsius or lower.
The temperature range for maintaining red blood cell units (or whole blood units) during shipping is what? 0 - 4 ºC 1 - 10 ºC 10 - 15 ºC 20 - 25 ºC -BB
Red blood cell units must be maintained between 1 - 10oC during shipping.
Which of the following actions should take place if a donor experiences numbness in the mouth during an apheresis procedure? Reduce the flow rate Elevate the donor's head Have the donor breathe into a paper bag Stop the procedure and elevate the feet -BB
Reducing the flow rate will help to alleviate the symptom of numbness in the mouth during an apheresis procedure.
For which of the following antibodies is the DAT most likely to be negative when testing a newborn for possible HDFN? anti-A anti-c anti-D anti-K anti-Fya -BB
The DAT is most likely to be negative in ABO HDFN. It's possible that the washing done as part of the DAT may break the bonds between anti-A (or anti-B) and the newborn's poorly developed A (or B) antigens
Which of the following antibodies is detected primarily in the antiglobulin phase of the crossmatch: Anti-Fya Anti-M Anti-B Anti-P1 -BB
The Duffy system consists of Fya and Fyb. Antibodies to these antigens are IgG and are detected in the antiglobulin phase. Anti-M, Anti-B and Anti-P1 are typically IgM antibodies and may agglutinate saline suspended cells at room temperature.
Which of the following tests has been recommended by the FDA to replace the HIV-1 p24 antigen test in the screening of donated blood for infectious diseases? HIV-1 NAT Anti-HIV-1 Anti-HIV-2 HCV NAT -BB
The FDA recommends that HIV-1 nucleic acid testing (NAT) be done in place of HIV-1 p24. Anti-HIV-1 and anti-HIV-2 are still required screening tests. HCV NAT is recommended as part of the battery of tests, but is not a replacement for HIV-1 p24 testing.
The McLeod phenotype is associated with which of the following antigen systems? Rh P Kell Duffy MNSs -BB
The McLeod phenotype is associated with a decreased expression of Kell antigens on red cells.
Which of the following is NOT required to be in a machine-readable format on a blood component label? ABO & Rh of the donor Product code Collection facility Outdate -BB
The correct answer is D. The outdate may be handwritten. 21 CFR 606.121 requires this information be machine-readable: A unique collection facility identifier Lot number relating to the donor Product code ABO and Rh of the donor
For which of these reasons would a molecular method be used to determine a pregnant woman's Rh type? To determine if she is homozygous or heterozygous for D To determine if she is Rh negative To differentiate between weak D or partial D -BB
To differentiate between weak D or partial D Differentiating between weak D and partial D is useful because women with partial D, but not usually weak D, may make anti-D and should be considered Rh negative for purposes of administering RhIg. Anti-D reagents cannot distinguish between the two D variants.
Tiny volumes of D+ red cells (e.g., as little as 0.1 mL) can stimulate production of anti-D in some individuals. True False -BB
True Although the D antigen is very immunogenic, the ability to produce anti-D varies greatly among individuals. Some people will make anti-D after exposure to exceedingly small volumes of Rh positive red cells such as 0.1 mL.
When given during pregnancy, RhIg may cross the placenta and cause a positive DAT in the newborn. True False -BB
True Because RhIg contains IgG anti-D, it can cross the placenta and sensitize fetal Rh positive red cells. Affected infants may be born with a weakly positive DAT, but significant hemolysis does not occur.
Evaluating B-type natriuretic peptide (BNP) levels can be helpful in distinguishing transfusion-related acute lung injuries (TRALI) from cardiopulmonary edemas. True False -BB
True It is important to rule out cardiac causes of pulmonary edema. One way of differentiating is evaluating the BNP level, which is known to be elevated in congestive heart failure and not TRALI.
Ectopic pregnancy is an indication for administering RhIg to an Rh negative woman. True False -BB
True RhIg is indicated in any circumstance in which D-positive fetal red cells may enter the circulation of an Rh-negative female, including ectopic pregnancy.
Which of the following contains all the possible phenotypes that could be the result of parents who are type O and type A: Type A or type O only Type A only Type O only All possible blood types -BB
Type A or type O only The group O parent can only supply an O gene to the offspring (OO) but the A parent could provide either an A or an O (AO). Therefore the only two possible combinations is OO or AO.
Match each blood type with the corresponding antibody you would find in its serum: 1) B 2) O 3) A 4) AB __Anti-A __Anti-B __Anti-A, Anti-B __none -BB
1 Anti-A 3 Anti-B 2 Anti-A, Anti-B 4 none In type O patients, both anti-A and anti-B will be present since the patient does not have A or B antigens on their red cells. Individuals who are type A, will have anti-B and will not have anti-A. The reverse is true for type B individuals. Finally, type AB individuals will have neither anti-A or anti-B in their plasma.
Agglutination reactions in blood bank are graded from negative (0) to 4+. A reaction that has numerous small clumps in a cloudy, red background is: 1+ 2+ 3+ 4+ -BB
1+ reaction has numerous small clumps and cloudy red supernatant 2+ has many medium-sized clumps and clear supernatant. 3+ has several large clumps and clear supernatant 4+ has one solid clump, no free cells, and clear supernatant
Match substance(s) secreted with their respective blood groups: 1) A 2) O 3) AB 4) B __A, B, & H __B & H __A & H __H -BB
3 A, B, & H 4 B & H 1 A & H 2 H Type A patients will have both A and H substances secreted. B patients will have both B and H substances secreted. AB patients will have A, B, and H substances secreted. Type O patients will only secrete H substance.
Match appropriate genotype to its corresponding phenotype : 1) OO 2) AA, AO 3) AB 4) BB, BO __AB __O __A __B -BB
3 AB 1 O 2 A 4 B In the first genotype (BB, BO) the interpretation is a B phenotype since BB = B and BO = B. In the second genotype (AA, AO) the interpretation is an A phenotype since AA = A and AO = A. In the third genotype (OO), the interpretation is an O phenotype since there is neither an inherited A or B antigen. Finally, in the fourth genotype (AB), the phenotypic interpretation is AB since both the A and B antigens have been inherited.
What is the maximum interval during which a recipient sample may be used for crossmatching if the patient has been recently transfused, has been pregnant within the past 3 months, or if relevant medical/transfusion history is unknown? 1 day 3 days 1 week 1 month 31 days -BB
3 days Generally, 3 days is used as the maximum interval for all recipient samples in most blood banks.
In the interest of safety, it is the policy at XYZ hospital to always add one extra 300 µg vial of RhIG, regardless if the dosage calculation is rounded up or rounded down. After performing a Kleihauer-Betke test, a technologist in the laboratory at XYZ hospital calculates the fetomaternal hemorrhage to be 45 mL of fetal whole blood. How many 300 µg vials of RhIG should be administered to this woman? One Two Three Four -BB
3 vials The calculated bleed was 45 mL of fetal whole blood, the dosage calculations would yield 1.5 vials (45 mL fetal whole blood / 30 mL) = 1.5. One vial of Rh immunoglobulin (RhIG) is used for every 30 mL of fetal whole blood (or 15mL of fetal packed cells). This number, 1.5, would be rounded to 2 and an additional vial added. Thus, the final dosage would be 3 vials (900 µg or 4500 IU). In the interests of safety, if the number to the right of the decimal point is <5, round down and add 1 vial (e.g., 1.4 = 1 +1 = 2 vials) If the number to the right of the decimal point is greater than or equal to 5, round up and add 1 vial (e.g., 1.5 = 2 +1 = 3 vials).
Match the blood types from the drop-down boxes with the appropriate descriptions: 1)O 2)B 3)A1 4)A2 5)A2B 6)A1B A antigens on RBCs and Anti-B antibodies in serum, which may also contain Anti A1 antibodies. A, A1 and B antigens on RBCs and no antibodies in serum. B antigens on RBCs and Anti-A antibodies in serum. No antigens on RBCs and Anti-A, Anti-B, and Anti-AB antibodies in serum. A and B antigens on RBCs and either Anti-A1 antibodies or no antibodies in serum. A1 and A antigens on RBCs and Anti-B antibodies in serum. -BB
4 A antigens on RBCs and Anti-B antibodies in serum, which may also contain Anti A1 antibodies. 6 A, A1 and B antigens on RBCs and no antibodies in serum. 2 B antigens on RBCs and Anti-A antibodies in serum. 1 No antigens on RBCs and Anti-A, Anti-B, and Anti-AB antibodies in serum. 5 A and B antigens on RBCs and either Anti-A1 antibodies or no antibodies in serum. 3 A1 and A antigens on RBCs and Anti-B antibodies in serum. Type A2 has A antigens on the red blood cells with anti-B and possibly anti-A1 antibodies in the serum. Type A1B has A and B antigens on the red blood cells with neither anti-A nor anti-B in the serum. Type B has B antigens on the red blood cells and anti-A in the serum. Type O has no A or B antigens on the red blood cells, and anti-A, anti-B, and anti-AB antibodies in serum. Type A1 has A antigens on the red blood cells and anti-B in the serum.
A 300 µg dose of RhIg can suppress immunization to _____ mL of D-positive whole blood. 15 mL 20 mL 25 mL 30 mL 35 mL -BB
A 300 µg dose of RhIG can suppress immunization to approximately 30 mL of D-positive whole blood.
An Rh negative mother has just given birth to an Rh positive baby after 18 hours of strenuous labor. Her rosette test was positive. Upon performing the Kleihauer-Betke stain procedure, the percentage of fetal cells is found to be 1.9%. The mother's total blood volume is 5,000 mL. What dose of Rh Ig (RhoGam) should be administered to the mother? 1 vial 2 vials 3 vials 4 vials -BB
4 vials Rh immune globulin, also known as Rh Ig or RhoGam, is used to help prevent an Rh negative mother from becoming sensitized to the D antigen from an Rh positive baby. To do this, vials of Rh Ig must be administered correctly. One full dose vial (300µg or equivalent) per 30 ml of D+ whole blood (15 ml D+ RBCs). To calculate how many vials are needed, the following formula can be employed: KB% x blood volume = volume of baby blood In this case: 1.9% x 5,000mL = 95 mL baby blood in maternal circulation 95mL / 30 mL per Rh Ig vial = 3.17 vials This equals 3 vials (after rounding), with the addition of 1 extra vial = the mother should have 4 vials of Rh Ig administered.
The most definite indication that a patient has been sensitized to a specific red cell antigen is: Hives and rash A positive posttransfusion DAT in a patient with a previously negative DAT A positive posttransfusion DAT in a patient with a previously positive DAT Hemoglobinuria -BB
A positive posttransfusion DAT in a patient with a previously negative DAT Hives and rash usually indicate an allergic reaction. Hematuria is due to a variety of causes. Fever and chills usually indicate a febrile reaction. Positive DAT due to conditions other than sensitization to red cell alloantigens is not uncommon. Therefore a positive DAT in the posttransfusion specimen with a negative DAT in the pretransfusion specimen is more likely to indicate alloimmunization.
Which one of the following statements about anti-A1 is false: Anti-A1 is a naturally occurring antibody Anti-A1 reactive at 37o C can sometimes destroy transfused A1 positive cells A1 and A2 occur in 80 and 20 percent of the blood type A population, respectively A2 cells react with Dolichos biflorus lectin -BB
A2 cells react with Dolichos biflorus lectin Dolichos biflorus lectin has anti-A1 specificity.
Which of the following steps should be taken in the IMMEDIATE investigation of a potential hemolytic transfusion reaction? (choose all that apply) ABO and DAT on the post-transfusion patient sample Check for a clerical error Serum bilirubin test Gram stain the recipient's supernatant plasma Visual examination of the post-reaction and pre-reaction (if available) plasma for hemolysis -BB
ABO and DAT on the post-transfusion patient sample Check for a clerical error Visual examination of the post-reaction and pre-reaction (if available) plasma for hemolysis Serum bilirubin testing would not be done as part of the immediate investigation of a possible hemolytic transfusion reaction. Peak levels of bilirubin occur 5 to 7 hours after transfusion. Gram stain would be useful if bacterial contamination of the donor blood were suspected. This would not be a hemolytic transfusion reaction.
The most severe acute hemolytic transfusions reactions are the result of which of the following: Rh incompatibility ABO incompatibility Cold agglutinins Delayed hypersensitivity -BB
ABO incompatibility Incompatibility in blood groups other then ABO may also cause acute hemolysis, but the reactions are rarely as severe.
Which of the following tests must be repeated by the lab on homologous blood received from the Red Cross or other community blood sources: ABO, Rh, HBsAg ABO, Rh, HBsAg, HIV ABO, Rh, HIV ABO, Rh
ABO, Rh The Red Cross and the community blood centers have already performed serological testing for infectious agents.
A false-negative reaction while performing the DAT technique may be the result of: Red cell/AHG tube is over centrifuged Blood collected in tube containing silicon gel Saline used for wash stored in glass or metal container AHG addition delayed for 40 or more minutes -BB
AHG addition delayed for 40 or more minutes AHG must be added immediately after washing to prevent the possibility of a false negative; a false negative can occur in this situation because previously bound globulins may dissociate from red cells, leaving insufficient antibody coating on the red cells to produce a reaction, or free antibody may directly neutralize antiglobulin reagent.
Which of the following is the MOST likely discrepancy seen when a person demonstrates an "acquired B-like" phenomenon? Forward typing appears to be B, but reverse groups like O Forward typing appears to be AB, but reverse groups like A Forward typing appears to be O, but reverse groups like B Forward typing appears to be B, but reverse groups like AB Forward typing appears to be AB, but reverse groups like B -BB
Acquired B is seen only in a subpopulation of group A1 individuals. The individuals that demonstrate acquired B possess anti-B, but this anti-B does not react with the acquired B antigen; consequently, the auto control is negative. These patients should be transfused with group A or O blood.
After the second spin in the preparation of platelets from whole blood, the platelet products should be: Allowed to rest for 1-2 hours. Agitated vigorously for 3 hours Pooled immediately and microwaved Frozen -BB
After the second spin in the preparation of platelets, the platelet bag should be allowed to rest at room temperature for 1 - 2 hours. The platelet component is placed on a rotator to resuspend the platelets that have aggregated during the centrifugation process, but should not be vigorously agitated. They should remain at room temperature, not pooled and heated in a microwave, and not frozen.
False negative results may occur with both the direct and indirect antiglobulin tests as a result of all of the following except: Undercentrifugation Delay in adding antiglobulin reagent Failure to adequately wash cells Agglutination of red cells prior to addition of antiglobulin reagent
Agglutination of red cells prior to addition of antiglobulin reagent due to cold autoantibodies would give a "false" positive result, not a false negative. In this case, the washed red cell sample will agglutinate prior to addition of antiglobulin.
A group A Rh positive infant born to a group O Rh negative woman has a 1+ positive DAT. The mother had a negative antibody screen at delivery and received antenatal RhIg. Which of the following are possible causes of the newborn's positive DAT? Anti-A Passive anti-D Antibody to a low frequency antigen All of the above are possible causes None of the above are possible causes -BB
All are possible causes. Anti-A is possible because the mother is group O and the newborn is group A. Passive anti-D is possible because the mother received antenatal RhIg and the infant is D+. An antibody to a low frequency antigen is possible because the mother's antibody screen is negative and antibody screen cells are not usually positive for rare antigens.
Which of the following refers to the most common procedure for donating whole blood for use by the general population: Autologous donation Hemapheresis Directed donation Allogenic donation -BB
Allogenic donation is also known as homologous donation. In this procedure, donor blood products are collected for transfusion and given to a random (non-directed) patient in need
Which one of the following tests BEST correlates with the severity of hemolytic disease of the newborn (HDN). Rh antibody titer of baby's blood L/S ratio amniotic fluid bilirubin antibody titer of mother's blood -BB
Amniotic fluid bilirubin is increased in association with the severity of hemolytic diseases of the newborn. As red blood cells lyse during these conditions, bilirubin builds up as a byproduct of the red cell destruction. The more red blood cells that are being destroyed in the baby, the more increased the bilirubin level will become.
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? An IgM and an IgG antibody A warm autoantibody An antibody to a low-frequency antigen An antibody to a high-frequency antigen -BB
An IgM and an IgG antibody The cause would be the presence of both an IgM and an IgG antibody. Antibodies to high-frequency antigens would be positive with all of the panel cells in the AHG phase. Reactions would be the same strength. If the antibody is a warm autoantibody, then reactions would all be positive at AHG at the same strength and the auto control would also be positive. Antibodies to low-frequency antigens would probably not be detected at immediate spin and there would be very few if any reactions at AHG due to low-frequency antigens not being present on panel cells. Think 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.
An antithetical relationship exists between M antigen and which of these antigens? K S Vw N -BB
An antithetical relationship exists between the antigens M and N.
A febrile nonhemolytic transfusion reaction is characterized by which of the following? An increase in temperature of >1 degree C above 37 degrees during transfusion appearance of rash fever above 37 degrees which develops 24 hours later An increase in temperature of >5 degrees C above 37 degrees following transfusion. -BB
An increase in temperature of >1 degree C above 37 degrees during transfusion Febrile nonhemolytic transfusion reactions (FNHTR) is defined as a >1oC rise in temperature above 37oC, associated with transfusion. Fever usually appears during the transfusion, but may develop 1-2 hours later.
Which of the following Rh antigens is found the highest frequency in the Caucasian population: C E c e -BB
Antigen frequency in whites: D = 84%, C = 70%, E = 30%. c = 80%, e = 98%.
What is Coombs sera comprised of: Complement Indicator red cells Anti-human globulins Anti-red cell globulins -BB
Antiglobulin testing was first described by Coombs in 1945. The direct method is used to demonstrate the in-vivo coating of red cells by antibody, and the indirect method is used to determine the presence of antibody in serum.
What is a transfusion reaction? Any adverse event associated with the transfusion of blood components A fever associated with a transfusion The destruction of transfused red cells none of the above -BB
Any adverse event associated with the transfusion of blood components A transfusion reaction can be defined as any adverse event occurring during or after the transfusion of blood components. Adverse events can range from fever and hives to renal failure, shock, and death. Some adverse events can be prevented, but others cannot.
An error was made in a handwritten blood bank record. Which of the following methods is acceptable for correcting the error to remain in compliance with current good manufacturing practices requirements? A. Use white correction fluid to completely cover the error. B. Draw a single line through the error so that it can still be read. C. Erase the error as much as possible and write the correction on top of the obliterated result. -BB
B. Draw a single line through the error so that it can still be read. The correct answer is B. 21 CFR 600.12 requires records to be legible and indelible. Records cannot be covered up with correction fluid or tape, or be obliterated. Corrections to a record should be made in a manner that allows the error to still be read so that it can be reviewed. The correction should also include the date the correction was made and the person who made the correction.
Antibody identification interpretations would be considered correct 95% of the time or have a P value of 0.05 if you have: 2 positive reactions to rule in an antibody and 2 negative reactions to rule out an antibody 1 positive reaction to rule in an antibody and 3 negative reactions to rule out an antibody 3 positive reactions to rule in an antibody and 3 negative reactions to rule out an antibody 3 positive reactions to rule in an antibody and 1 negative reaction to rule out an antibody -BB
Based on Fisher's exact method, the probability of having reliable results increases if you are able to have more rule out and rule in cells. So 3 to rule in and 3 to rule out would give the highest probability. By comparing the patterns of reactivity and non-reactivity, we can more safely assume that an observed pattern is not the result of chance alone.
A pregnant female who received RhIg at 28 weeks gestation has a positive antibody screen at delivery. If the antibody has been confirmed as anti-D alone and reacts 1+ in the indirect antiglobulin test with D+ red cells, performing a titration to investigate if the anti-D is immune is good practice. True False -BB
Because lower titers could be due to both passive and immune anti-D, in the absence of results that suggest immune anti-D, routine antibody titration is not a good use of time compared to assuming that anti-D is passive. Best practice guidelines do NOT recommend routine titration for women known to be injected with RhIg and exhibiting a 2+ or less reaction with D+ red cells consistent with passive anti-D from RhIg.
Which is the best component to treat a patient with fibrinogen deficiency? Red Blood Cells Platelet Concentrate Fresh Whole Blood Cryoprecipitated AHF -BB
Crypoprecipitated AHF is the only product that contains a concentrated amount of fibrinogen.
The Kidd antibody is MOST commonly associated with: Delayed hemolytic transfusion reactions Post partum depression Hives and rashes with Shingles Immediate spin, cold antibody reactions -BB
Delayed hemolytic transfusion reactions The Kidd group antibodies typically cause delayed hemolytic transfusion reactions as opposed to post partum depression, hives or rashes with shingles, or cold antibody reactions.
The use of the direct antiglobulin test is indicated in all the following except: Transfusion reactions Autoimmune hemolytic anemia Hemolytic disease of the newborn Detection of alloantibodies in serum -BB
Detection of alloantibodies in serumThe direct antiglobulin test (DAT) detects antibodies coating RBCs. Alloantibodies are primarily detected in the serum, although they may also sometimes be eluted from previously transfused RBCs in the patient's blood.
Which of the following tests are suitable for quantifying the size of fetomaternal hemorrhage (FMH)? Select all that apply. Flow cytometry Kleihauer-Betke test Rosette test Weak D (microscopic Du)test -BB
Flow cytometry Kleihauer-Betke test Of these methods, only flow cytometry and the Kleihauer-Betke test can quantify the size of a FMH. The rosette test (but not the weak D test) is suitable to screen for FMH.
Which blood component is the most commonly used component for the replacement of multiple coagulation factor deficiencies? Fresh Frozen Plasma Red Blood Cells Cryoprecipitate Whole Blood -BB
Fresh Frozen Plasma (FFP) is indicated for bleeding patients with multiple coagulation factor deficiencies due to inadequate production, as in liver disease; excessive consumption, as in disseminated intravascular coagulation (DIC); or dilution, as in massive transfusion, generally defined as the replacement of one or more blood volumes in a period of 24 hours or less. FFP is also indicated for non-bleeding patients with multiple deficiencies who are undergoing invasive procedures. FFP is also used for reversal of warfarin therapy in bleeding patients and for patients with congenital factor deficiencies for which no concentrates are available.
Fresh frozen plasma : Contains all labile coagulation factors except cryoprecipitate Has a higher risk of transmitting hepatitis than does whole blood Should be transfused within 24 hours of thawing Need not be ABO-compatible -BB
Fresh Frozen Plasma (FFP) should be thawed at 37 degrees Celsius and transfused within 24 hours when stored at 1 to 6 degrees Celsius. Indications include bleeding related to coagulation factor deficiency if specific concentrates are not appropriate, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome. FFP should not be used as a volume expander, since there is a risk of transfusing bloodborne pathogens.
What other component(s) can be shipped together with Fresh Frozen Plasma (FFP)? frozen RBC's and cryoprecipitate platelets packed RBC's and granulocytes whole blood none -BB
Frozen red blood cell units and cryoprecipitate can be shipped together with FFP.
A patient has a probable anti-Fya but anti-c and anti-K have not been excluded. Which of the following cells would be the one most useful cell to exclude both anti-c and anti-K efficiently in this patient? Fya-; Fyb+; C+c+; K+k+ Fya-; Fyb+; C-c+; K+k- Fya-; Fyb+; C+c+; K+k- Fya+; Fyb-; C-c+; K+k- -BB
Fya-; Fyb+; C-c+; K+k- The ideal red cell to exclude both antibodies efficiently is one that is Fy(a-) and homozygous positive for both c and K: Fy(a-b+)C-c+K+k- The other red cells exclude only anti-c or anti-K (not both) or are Fy(a+).
When a unit of packed RBC's is split using the open system, each half-unit must be issued within: 24 hours 48 hours 30 days the original expiration date 72 hours -BB
If a unit is entered without use of a sterile connection device (open system) it must be used within 24 hours of entry. Closed systems retain the same expiration date as the original whole blood unit.
Which of the following set of conditions would NOT allow HDN 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 unknown, baby Rh-positive -BB
If both parents are Rh negative, the baby would also be Rh negative.
Which one of the following blood components would be MOST appropriate for a 9-yr old girl, with a low hemoglobin and low platelet count, who has bleeding gums? Packed red blood cells Cryoprecipitate Platelet Concentrate Fresh Frozen Plasma -BB
If the patient has a low platelet count and is actively bleeding, a transfusion of platelet concentrate would be recommended to potentially control bleeding due to thrombocytopenia.
Once the seal on a unit of packed red cells is broken, how long can the unit be stored refrigerated prior to administration: 4 hours 12 hours 24 hours 48 hours -BB
If the seal on a unit of blood is broken, it must then be used within 24 hours and stored between 1 and 6 degrees C.
An issued unit of blood may be returned to blood bank inventory if it has not been outside a monitored refrigerator for longer than: 30 minutes 60 minutes 2 hours 3 hours 6 hours -BB
If, for instance, transfusion is delayed, a unit of blood must be returned to a temperature-monitored refrigerator within 30 minutes to maintain the integrity of the blood cells.
Which of the following statements best describes Rh antibodies: Naturally occurring, IgM Immune, IgG Naturally occurring, IgG Immune, IgM -BB
Immune, IgG Rh antibodies are of the IgG class of immunoglobulins, and occur as a result of exposure to the corresponding antigens, through pregnancy or transfusion.
Forward/Red Cells: Anti- A = 0 Anti- B = 0 Anti- A,B = 4+ Reverse/Serum: A1 = 4+ B = 4+ Using the information provided above, select the correct ABO group. A O Results are inconclusive; retesting required. -BB
In this case, the forward type shows no agglutination; the patient's red blood cells do not contain the A or B antigens. In the reverse type, the patient demonstrates the presence of anti-A and anti-B, which correlates with the results obtained from the forward typing. The blood is type O.
FALSE-NEGATIVE results at the indirect antiglobulin phase of an antibody screening test using a tube method (i.e., not a Gel-method) are usually caused by which of the following? Excessive washing of the red cells Inadequate washing of the red cells Warm autoantibody present in the patient's serum Failure to allow the blood to clot properly Cold acting antibody -BB
Inadequate washing of the red cells If an antigen-antibody reaction has occurred, but washing is inadequate, free antibodies that have not attached to antigens on the red blood cells remain when the anti-human globulin (AHG) is added. The AHG is bound by the free antibody rather than attaching to the antibody on the red blood cells, causing a false-negative result. This false-negative result is detected by using Check Cells as a control. If the free antibody has already been bound by the AHG, there is no free AHG serum to react with the Check Cells, and no agglutination will occur.
What is the basic technique employed to detect antibodies with a commercial set of panel cells? Albumin enhanced technique Direct antiglobulin test Enzyme technique Indirect antiglobulin test Direct hemolysis of red cells -BB
Indirect antiglobulin testAn antibody panel utilizes the IAT principle as the reagent red blood cells are detecting antibodies present in the patient serum or plasma for identification.
What component is indicated for patients who receive directed donations from immediate family members to prevent transfusion-associated graft versus host disease (TA-GVHD)? Irradiated Red Blood Cells Washed Red Blood Cells IgA-deficient products HLA matched products -BB
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 proliferation of donor lymphocytes with a required dose of 25 Gy to the mid plane of the blood container and a minimum of 15 Gy elsewhere.
What is the MOST likely cause of the ABO discrepancy when the following results were obtained from a first-time 29-year old, blood donor? Forward Group Anti-A = Negative Anti-B= Negative Reverse Group A1 Cells = Negative B Cells = 3+ Loss of antigen due to disease Acquired B "Bombay" phenotype Weak subgroup of A Contaminated reagents -BB
It is important to recognize that a weak subgroup of A may be present if this blood is from a donor. If the blood were transfused as a group O to a group O recipient, a transfusion reaction would occur.
Which Lewis antigen(s) will be exhibited on the red cells of adults who have the Le, Se, and H genes? Le a Le b both Le a and Le b neither Le a or Le b Se and H -BB
Leb Inheritance of both Le and Se genes produces the Leb antigen on red blood cells. The Se gene codes for the enzyme, a-2-L-fucosyltransferase which adds L-fucose to the type 1 precursor H (type 1). The Le gene codes for another L-fucose which forms the Leb antigen. Some of the precursor chains are not affected by the Se gene and, therefore, form the Lea antigen. Hence, it is possible to see both Lea and Leb in the plasma and secretory fluids. However, only Leb adsorbs onto the red cells of adults (most likely due to competitive binding), causing them to phenotype Le(a-b+).
In HDN which of the following antigen-antibody reactions is occurring: Maternal antibody against fetal antibody Maternal antigen against fetal antibody Maternal antibody against fetal antigen Maternal antigen against fetal antigen -BB
Maternal antibody against fetal antigen In hemolytic disease of the newborn (HDN), maternal antibodies are directed against fetal red blood cells. This condition can cause red cell lysis in the infant and can be dangerous for the health of the fetus.
Which of the following is the proper temperature to use when crossmatching in the presence of a cold antibody: 37 degrees Celsius 25 degrees Celsius 15 degrees Celsius 4 degrees Celsius -BB
Most antibodies that are inactive at 37 degrees Celsius, and active only below 37 degrees Celsius (i.e. cold reactive antibodies), are of little clinical significance.
If an average-weight adult male patient with a 7 gram/dL hemoglobin is given two units of packed cells, what would be the approximate new hemoglobin value (assuming there is no active bleeding or other predisposing factors that would shorten the survival of the blood cells)? 7.5 gm/dL 9.0 gm/dL 10.5 gm/dL 12.0 gm/dL 15.0 gm/dL -BB
One unit of Red Blood Cells increases the hemoglobin level by approximately 1g/dL in an adult who is not actively bleeding and has no other predisposing factors that would shorten the survival of the transfused blood cells.
A Rh positive individual has produced an anti-D antibody. Which D variant possesses the ability to stimulate this production of anti-D? (Choose all that apply.) Weak D Partial D Partial weak D None of the listed D variants can produce anti-D -BB
Partial D Partial weak D Both partial D and partial weak D can produce anti-D to the D epitopes that they lack.
Patients with diseases that require chronic transfusions are at risk for iron overload. True False -BB
Patient's with diseases such as congential hemolytic anemias and aplastic anemias require frequent transfusions. Each unit of red cells contains 225 mg of iron, which puts these patients at risk for iron overload.
What should be done FIRST if a donor unit is found to be incompatible at the antiglobulin phase with several different recipients? Repeat the ABO grouping on the incompatible unit using different sera Do a panel made up of red cells having all low-frequency antigens Perform a direct antiglobulin test (DAT) on the donor unit Obtain a new specimen and repeat the minor cross match -BB
Perform a direct antiglobulin test (DAT) on the donor unit If a donor unit is found to be incompatible at the antiglobulin phase with several recipients, the possibility of antibody coating the red blood cells is likely. A DAT should be performed on the donor unit.
Antibodies in the Rh system typically exhibit which one of the following characteristics? Reacts best at 37ºC and AHG Reacts best at room temperature Shows hemolysis better than agglutination -BB
Rh antibodies typically react the strongest at 37 degree temperatures and during the AHG phase of typing.
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? Rouleaux Subgroup of A Patient has hypogammaglobulinemia Patient has selective IgA deficiency -BB
Rouleaux The stacking of red blood cells known as Rouleaux formation occurs when patients have abnormal globulins such as in Multiple Myeloma. This is most likely causing false agglutination in the ABO typing. Saline replacement should resolve these discrepancies.
If parents have the blood group genotypes AA and BO, what is the possibility of having a child with a blood type of A? 25% 50% 75% 100% none of them -BB
The parents will each give one of their ABO genes, so the possibilities are as follows: AB, AO, AB, AO = 50% chance of A blood type, 50% chance of AB blood type
Which of the following candidates would be an acceptable blood donor? Blood pressure / Pulse / Temperature 90/55 105 36.4ºC ( 97.6 ºF) 200/90 72 37ºC (98.6 ºF) 110/72 66 37.2ºC (99.0 ºF) 100/70 98 38.3 (101.0 ºF) 180/110 90 35.6ºC (96 ºF) -BB
Systolic blood pressure should be no higher than 180, which eliminates candidate #2. Diastolic pressure should be no higher than 100, which eliminates candidate #5. Pulse should be between 50 and 100 beats/minute, which eliminates candidate #1. Temperature above 37.5oC (99.5oF) requires that the donor be temporarily rejected, which eliminates candidate #4. The only candidate that meets all of the requirements for blood donation is candidate #3.
Transfusion related acute lung injury (TRALI) is a serious blood transfusion complication that can be characterized by: Respiratory distress Hypotension Hypertension Non-cardiogenic pulmonary edema All of the above -BB
TRALI is an acute, often life-threatening reaction characterized by respiratory distress, hypotension or hypertension, and non-cardiogenic pulmonary edema that generally occurs within 2 hours of a transfusion of a plasma-containing component.
Once Fresh Frozen Plasma has been thawed at 30 - 37oC, it should be stored at what temperature? 1-6 ºC 30 - 37 ºC 20 - 24º C 45- 56º C -BB
Thawed Fresh Frozen Plasma can be stored at 1 - 6oC for 1 to 5 days. It should be relabeled as "Thawed Plasma" and used for replacement therapy only in patients requiring stable clotting factors.
An individual with type AB blood will demonstrate the complete absence of which of the following antigen sites? A B H None of the above -BB
The A and B antigens are present on the red cells of an AB patient. H antigen is a precursor to the ABO antigens.
Why do so few patients transfused with un-crossmatched red cells in an emergency experience a hemolytic transfusion reaction? Select the one best reason. The incidence of unexpected red cell antibodies is relatively low. They usually receive group O Rh negative red cells; a hemolytic transfusion reaction will never occur if O Rh-negative red cells are transfused. They hemorrhage so severely that incompatible donor red cells "bleed out" before a reaction occurs. Some patients have cold-reactive antibodies that will not react at body temperature. -BB
The incidence of unexpected red cell antibodies is relatively low.Hemolytic transfusion reactions seldom occur because the incidence of unexpected antibodies in random patients is relatively low, e.g., 3-5% is sometimes cited. Being transfused with O Rh negative RBC is irrelvant if you have an unexpected antibody like anti-K or anti-c. Incompatible red cells may "bleed out" but only if bleeding is brisk. Even then, a hemolytic reaction may occur later once the patient's antibody rebounds and destroys remaining antigen-positive donor red cells. It's true that some patients have only cold-reactive antibodies that will not react at body temperature. But this does not explain why warm-reactive red cell antibodies cause few reactions.
The majority of anti-Lea antibodies are of which immunoglobulin class? IgM IgG IgA -BB
The majority of Lea antibodies are IgM.
Why is it dangerous to transfuse a person with type O blood with a unit of A blood? The patient will make antibodies to the type A blood. The type A blood may become the prominent blood group. The patient's Anti-O would destroy the donor's cells with severe consequences to the patient. The patient's anti-A would destroy the donor's cells with severe consequences to the patient. -BB
The patient's anti-A would destroy the donor's cells with severe consequences to the patient. Transfusing type A blood cells into a patient who is type O will result in a hemolytic transfusion reaction where the body would mount an immune response with anti-A against the foreign cells entering the body. The consequences of such a reaction can be very dangerous for the patient.
Before testing all cord cells should be thoroughly washed in order to: Remove Lea substances Remove H substances Remove Wharton's jelly Hemolyze contaminating maternal cells -BB
The proteins found in Wharton's jelly can interfere with blood typing.
The shelf-life of whole blood collected in CPDA-1 is: 7 days 28 days 35 days 48 days -BB
The shelf life of whole blood collected with CPDA-1, or citrate-phosphate-dextrose-adenine, has a storage life of 35 days.
Blood safety standards such as AABB Standards directly specify that an electronic crossmatch cannot be done when an Rh negative female has an anti-D consistent with antenatal RhIg administration. True False -BB
The statement is false. Current blood safety standards do not directly address whether an electronic crossmatch is contraindicated when anti-D consistent with antenatal RhIg administration is present. Laboratories are left to develop their own policies.
A rosette test to screen for FMH is contraindicated if the newborn is weak D. True False -BB
The statement is true. A rosette test cannot be done to screen for FMH if the fetus is weak D because false negatives may result.
An O pos patient has no reactions at immediate spin but both screen cells are positive and all antibody panel cells are reacting 1+ at AHG. The auto control is 1+. What would you suspect to be the cause? Cold autoantibody Warm autoantibody -BB
Warm autoantibody There is no reaction at the immediate spin phase so the cold autoantibody can be eliminated. Reactivity is occurring at AHG with all panel cells and the auto control is positive which can indicate a warm autoantibody. An elution may be beneficial to determine if other clinically significant antibodies are present or to help identify the warm autoantibody.
Which of the following is the most common type of autoimmune hemolytic anemia? Warm autoimmune hemolytic anemia. Cold agglutinin disease. Paroxysmal cold hemoglobinuria. Drug-induced immune hemolytic anemia -BB
Warm autoimmune hemolytic anemia accounts for 60 - 70% of the cases of immune hemolytic anemias.
If the mother is a Rh immune globulin (RhIg) candidate, blood safety standards mandate that a test for weak D is compulsory when initial D typing shows a newborn to be Rh negative. True False -BB
Weak D red cells can stimulate production of anti-D. Therefore, infants born to mothers who are RhIg candidates must be tested for weak D. RhIg is given to Rh negative women who deliver infants who are Rh positive or weak D.
Which of the following is the proper storage temperature for whole blood: - 20 degrees Celsius - 12 degrees Celsius 12 degrees Celsius 4 degrees Celsius -BB
Whole Blood should be stored between 1 - 6 degrees Celsius.
