Blood bank and immunology

40-year-old female receives two units of Red Blood Cells during a surgical procedure. The patient has no prior history of transfusions. Seven days later, she presents with extensive bruising of the extremities and bleeding of the gums, with no additional symptoms. Her platelet count is 5X109/L (reference interval 150-400 X 109 /L). What is the most likely diagnosis?

Post transfusion purpura (PTP)

The reaction that occurs when a soluble antigen is mixed with its specific antibody is termed:

Precipitation

A hapten is only antigenic when it is coupled with which of the following:

Proteins

The primary purpose of neutrophil granules is to:

Provide microbicidal action

What has happened in an antibody titer, if tubes # 5-7 show a stronger reaction than tubes #1-4?

Prozone reaction

The assay which is most helpful in identifying specific allergens is:

RAST

IgM antibodies produced against red blood cells generally:

React best at room temperature

Antibodies in the Rh system typically exhibit which one of the following characteristics?

Reacts best at 37 ˚C and AHG

The prozone effect can be described by all of the following EXCEPT: a. Results in a false negative reaction b. The result of antibody excess c. Dilution of antibody can help prevent its occurrence d. Results in a false positive reaction

Results in a false positive reaction

As a student in a blood bank laboratory, you are tasked with determining the identification of an antibody as part of your practical exam. You are asked to use an enzyme treated red cell panel during the process of antibody identification.Which of the following antibodies is enhanced by enzyme treatment of red cells?

Rh, Lewis, Kidd

Which of the following would be considered most significant as it relates to serological testing:

Rise of antibody titers is diagnostic

If an antinuclear antibody indirect immunofluorescence test shows a positive, speckled pattern, which would be the MOST appropriate additional test to perform?

Screen for Sm and RNP antibodies

Lewis antigen is a human blood group unlike most others. The antigen is produced and secreted by exocrine glands, eventually absorbing 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 information, predict the Lewis Antigen phenotypic expression based on the following genotype: (Le) (Se)

Le (a-b+)

Which of the following would NOT be included in a hemolytic transfusion reaction investigation? a. ABO/Rh check of post transfusion sample b. Leukocyte antigen studies c. Direct antiglobulin test (DAT) on post-transfusion sample d. Clerical check

Leukocyte antigen studies

The part of the immunoglobulin molecule that may be kappa or lambda chains is:

Light chains

HLA-A and HLA-B antigens can be detected using which of the following techniquest?

Lymphocyte cytotoxicity

Which of the following is responsible for causing graft-versus-host reactions:

Lymphocytes

What is the first line treatment for moderate to severe hemophilia A?

Lyophilized Factor VIII concentrate

Antigen processing is primarily accomplished by which cell type?

Macrophages

When testing a patient with a warm autoantibody, which of the following is the most important concern?

Masking of other clinically significant antibodies

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:

Polyethylene glycol (PEG), albumin, or proteolytic enzymes

The immunoglobulin molecule is made up of both heavy and light chains-the light chains can be comprised of which of the following:

Kappa or lambda

A ficin (enzyme) treated panel can be a useful tool for determining the identity of an antibody. On a ficin-treated panel, reactions with systems are enhanced, while reactions with systems are degraded and reactions with stay the same (unaffected).

(Rh, Lewis, Kidd) (MN, Duffy) (Kell)

Which of the following are indicators of sepsis? (Choose all that apply.) a. Erythrocytosis b. Increased heart rate c. Leukocytosis d. Increased body temperature

Increased heart rate Leukocytosis Increased body temperature

Which of the following is not a feature of systemic lupus erythematosus (SLE):

Increased serum complement

The vast MAJORITY of would-be invaders are killed or inactivated primarily by which part of the immune system?

Innate

Which two stages of cell division are the most important for reading ANAs?

Interphase and metaphase

Transfusion- associated graft versus host disease (TA-GVHD) may be prevented by which of the following?

Irradiation of cellular products

While ABO, Rh, Kell, Duffy, Kidd, SsU are clinically significant, which of the following antibodies generally react at ONLY the Coombs phase (also knowns as Antihuman Globulin phase):

Kell, Duffy, Kidd

Which symptom of hemolytic disease of the fetus and newborn (HDFN) does phototherapy help prevent?

Kernicterus

A delayed hemolytic reaction occurring a week later is MOST likely caused by:

Kidd system antibodies

Which of the following is NOT true about hybridization in PCR procedures? a. Hybridization cannot happen between a strand of DNA and a strand of RNA b. Hybridization is the process of single strands of nucleic acid bonding together to form double strands c. Hybridization can also be called annealing d. Complementary bases link together with hydrogen bonds

Hybridization cannot happen between a strand of DNA and a strand of RNA

The serum hemolytic complement level (CH50): A.Is a measure of total complement activity B. provides the same information as a serum factor B level C. is detectable when any component of the classical system is congenitally absent D. can be calculated from the serum concentrations of the individual components

Is a measure of total complement activity

Given the following results, what is the immune status of the patient? HBsAg: negative HBeAg: negative Anti-HBc: positive Anti-HBs: positive

recovery

In what way are the ABO serum antibodies unique among blood group systems?

the antibodies are naturally occurring.

In order to detect the presence of antibodies fixed on the RBC's of newborns one should:

Perform a direct antiglobulin test (DAT) on the cord blood

Why are ANA positive samples titered?

- To determine how much antibody is present in the sample.

Match the names of the PCR stages to their definitions. 1 The DNA is heated to break the hydrogen bonds resulting in single stranded DNA 2 The DNA primers attach to the DNA strands 3 The DNA polymerase synthesize new strands of DNA

1 The DNA is heated to break the hydrogen bonds resulting in single stranded DNA= Denature 2 The DNA primers attach to the DNA strands= Annealing 3 The DNA polymerase synthesize new strands of DNA= Extension

Approximately what percent of the overall population is Rh negative:

15%

Platelets should be stored at what temperature:

20-24 degrees Celsius

When a unit of packed RBC's is split using the open system, each half-unit must be issued within:

24 hours

Which of the following kappa / lambda ratios is found in normal serum:

2:1

Delayed hemolytic transfusion reactions (DHTR) usually occur within which time period?

3-10 days after transfusion

How many micrograms (ug) of IgG anti-D are in a 1500 IU vial of Rhlg?

300

It's a busy Friday evening in the blood bank and you have been receiving a steady stream of Type & Screen specimens from the emergency room and several of them have positive antibody screens which require further workup. One of these patients is a 46-year-old male whose hemoglobin has dropped from 8.4 g/dL to 4.6 g/dL in the previous 8 hours (normal Hgb for this patient demographic would be ̴ 14 g/dL).Your workup reveals a Type O patient with the following antibodies:Anti - K , anti Fya. The prevalence of K negative donors in your donor population is 91% while the prevalence of Fya negative donors is 37%. Two units of crossmatched RBCs are requested by the physician. How many units of group O RBC units should you phenotype, in order to fulfill the request for two cross matched units?

6 units of type O RBC units

Which of the following represents the approximate percentage of the population that is Rh positive:

85%

For the ANA test to be positive what must be present in the nucleus of the interphase cell?

A clearly discernible pattern

Your screen cells are 3+ at immediate spin and weak (W) + at AHG. Your auto control is negative for both phases. Some of your antibody panel cells are 3+ at immediate spin and negative at AHG. What should you suspect?

A cold antibody may be present

A hapten can BEST be described as:

A nonimmunogenic material capable of stimulating an immune response only when bound to a carrier protein

The most definite indication that a patient has been sensitized to a specific red cell antigen is:

A positive posttransfusion DAT in a patient with a previously negative DAT

A lymphokine can BEST be described as:

A soluble mediator produced by lymphocytes

Autologous blood must be tested for which of the following before transfusion:

ABO, Rh

The Hepatitis B virus vaccine was administered to MLS students during Orientation. Which type of immunity is expected and provide long-term protection?

Active

Given the following results, what is the immune status for the patient? HbsAg: positive HbeAg: positive Anti-HBc IgM: positive Anti-HBs: negative

Acute infection

How does the secondary immune response differ from the primary immune response? a. IgG is the predominant antibody class produced in the secondary immune response b. The antibody levels produced are higher in the secondary immune response c. The lag phase (the time between exposure to antigen and production of antibody) is shorter in the secondary d. All of the above

All of the above

Which of the following antibodies is the most common cause of severe hemolytic disease of the new born:

Anti-D

Twelve weeks after onset of the disease, patients with uncomplicated acute hepatitis B usually will demonstrate which of the following in their serum?

Anti-HBe

Which of the following would you expect to find in the serum of a patient who has recovered from Hepatitis B infection within 6 months after infection?

Anti-HBs

The Western Blot Assay was used as a confirmatory test for which of the following?

Anti-HIV-1

Match these autoimmune diseases with their corresponding serological markers: Antimitochondrial Anticentromere Antineutrophilic Antimyocardial

Antimitochondrial= Primary biliary cirrhosis Anticentromere= CREST syndrome Antineutrophilic =Wegener's granulomatosis Antimyocardial = Rheumatic fever

All of the following are considered benefits of automated isolation and extraction equipment EXCEPT: a. Automated isolation equipment is cheaper and more practical b. Automated isolation equipment requires less manipulation c. Automated isolation equipment is considered moderate complexity d. Automated isolation equipment provides consistent results

Automated isolation equipment is cheaper and more practica

Which of the following is responsible for humoral response:

B lymphocytes

Which complement component is found in both classical and alternative pathways?

C3

The mediator cells that bind MOST to IgE antibodies are:

Basophils

Which of the following best describes the primary function of antibodies:

Bind with antigen

The hh genotype gives rise to:

Bombay phenotype

Which of the following is the "activation unit" in the classical complement pathway?

C4, C2, C3

A decrease in which of the following in a AIDS patient are associated with increased susceptibility to infection:

CD4 + cells

Which of the following is used as an indicator of inflammation?

C-Reactive Protein (CRP)

Which one of the following statements concerning phagocytosis is FALSE? a. Cells are only capable of phagocytizing bacteria. b. Membrane "reaches" out and surrounds the material to be internalized. c. Once internalized the material is surrounded by phagosomes. d. Only specialized cells are capable of phagocytosis e. Whole pathogenic organisms can be ingested.

Cells are only capable of phagocytizing bacteria.

The mechanism responsible for pathology in autoimmune diseases is:

Circulating immune complexes

Fresh frozen plasma should be used for which of the following:

Coagulation deficiencies

Which real-time PCR quantification method is only effective if the amplification efficiency of both target and reference samples are equal?

Comparative Threshold Method

Which is the best component to treat a patient with fibrinogen deficiency?

Cryoprecipitated AHF

The Kidd antibody is MOST commonly associated with:

Delayed hemolytic transfusion reactions

The Kleihauer-Betke test is used to:

Differentiate between maternal and fetal red cells

A traveler is being evaluated at a local hospital for gastrointestinal pain, fever and diarrhea. The patient has recently returned from a month-long visit to Southeast Asia. The patient has no recent history of sexual activity or IV drug use but did describe conditions of poor sanitation where they were visiting. If liver function test results were elevated and bilirubinuria was noted, which of the following would be the next logical test to order?

ELISA testing for Hepatitis A antigens in the stool

You are working at a blood donor center; the date is July 1st. A unit of packed RBCs expires on August 4th. If the unit of blood is irradiated, what will be the new expiration date?

July 29th - because after irradiation, the expiration date shortens to 28 days from the date of expirations, or the original expiration date, whichever is first

When performing a transfusion reaction investigation, what is the clerical check used to detect?

Errors that may cause an ABO-incompatibility due to patient or donor unit mix up

During which stage in real-time PCR can the fluorescent signal start to be recorded?

Exponential stage

The use of non-specific fluorescent dyes is the most specific method of measuring amplicons in real-time PCR. True or False?

False

Which part of the immunoglobulin molecule is responsible for activating complement?

Fc

Match antibody group with corresponding descriptor: Fixes complement via classical Largest antibody, pentamer Crosses placental barrier Immediate hypersensitivity

Fixes complement via classical=IgG IgM Largest antibody, pentamer= IgM Crosses placental barrier= IgG Immediate hypersensitivity= IgE

Which one of the following red blood cell phenotypes will NOT react with Anti-Fy3?

Fy (a-b-)

When performing an antibody panel, which one of the following antigens will be rendered inactive by enzyme treatment? a. Fya b. Jka c. E d. Lua

Fya

Diseases associated with dysfunctions of polymorphonuclear neutrophils (PMNs) include all of the following EXCEPT: a. CHediak-Higashi syndrome (CH) b. Chronic granulomatous disease (CGD) c. Gaucher's Disease d. Myeloperoxidase deficiency (MPO)

Gaucher's Disease

The parents' blood types were AB and O. The blood group of any of their children could ONLY be:

Group A or B only

In an extreme emergency, if the ABO and Rh type are unknown which of the following should be given to the patient?

Group O, Rh negative blood

Which is the first marker (antigen or antibody) which will become positive after exposure to Hepatitis B:

HBsAg

In blood banking, the Direct Antiglobulin Test (DAT) is used in the investigation of which of the following clinical conditions? 1. HDFN 2. Compatibility testing 3. HTR 4. Zika virus testing

HDNF, and HTR

The most recent algorithm for HIV confirmatory testing in patients who are positive by HIV-1/2 antigen/antibody combination immunoassay is the:

HIV-1/HIV-2 antibody differentiation immunoassay

Which of the following diseases is NOT associated with autoantibodies? a. Wegener's granulomatosis b. Rheumatoid arthritis c. Lupus erythematosus d. Hemolytic disease of the newborn

Hemolytic disease of the newborn

A phlebotomist at a local hospital recently had an accidental needle stick while drawing from a patient being treated for acute hepatitis B. Which serological marker from the patient would be of most value to the physician evaluating the phlebotomist's possible infection status?

Hepatitis B e Antigen (HBeAg)

What is the most common combination of ANA patterns?

Homogeneous and speckled

Which of the following immunoglobulin classes is chiefly responsible for the degranulation of mast cells and basophils:

IgE

Which class of antibody is able to agglutinate RBC's after anti-human globulin is added?

IgG

Which class of immunoglobulins is implicated in hemolytic disease of the fetus and newborn (HDFN)?

IgG

ABO antibodies are classified as which of the following two immunoglobulin classes? Select all that apply.

IgG IgM

Most blood group antibodies belong to which immunoglobulin classes?

IgG and IgM

Which of the following immunoglobulins is capable of fixing complement by the classical pathway:

IgG, IgM

The rheumatoid factor in rheumatoid arthritis is PRIMARILY which type of immunoglobulin?

IgM

In skin tests for allergy, a wheal and flare development is indicative of:

Immediate hypersensitivity

Certain clinical conditions such as Hemolytic Disease of the Newborn (HDN), Hemolytic Transfusion Reaction (HTR), and Autoimmune Hemolytic Anemia (AIHA) result from the attachment of antibodies or complement to human RBCs. What is this process called?

In vivo sensitization

Which is the main limitation of standard PCR that is not a limitation of real-time PCR?

Inability to quantitate DNA product due to endpoint analysis only

In HDN which of the following antigen-antibody reactions is occurring:

Maternal antibody against fetal antigen

Match each characteristic listed below to either standard or real-time PCR. Measures PCR product of the exponential Measures PCR product at the plateau Is followed by agarose gel electrophoresis All cycles, including detection, can be completed in the same tube

Measures PCR product of the exponential= real time pcr Measures PCR product at the plateau =standard pcr Is followed by agarose gel electrophoresis=standard pcr All cycles, including detection, can be completed in the same tube= Real time pcr

MOST pathogens enter the body through:

Mucous membranes

Which of these is NOT a Systemic Autoimmune Rheumatic Disease (SARD)?a. Systemic sclerosis b. Lupus erythematosus c. Rheumatoid arthritis d. Multiple sclerosis

Multiple sclerosis

An individual with type AB blood will demonstrate the complete absence of which of the following antigen sites? a. A b. B c. H d. None of the above

None of the above

The antibody MOST frequently present in systemic lupus erythematosus (SLE) is directed against:

Nuclear antigen

Which of the following packed red blood cell ABO types would be appropriate for transfusion to an O negative patient?

O neg

hat are the possible ABO genotypes of offspring from parents whose genotypes are OO and AB:

OA and OB

Which of the following is/are NOT associated with immediate hypersensitivity? a. Hay fever b. Serum sickness c. Arthus reaction d. Anaphylactic shock e. Tuberculin reaction

Serum sickness Tuberculin reaction

A 2 month old infant presented with history of chronic diarrhea and failure to thrive. The child's mother also revealed that the baby has suffered from thrush (Candida infections) since birth. Preliminary finding showed lymphopenia (<2,000), hypogammaglobulinemia, and physical findings showed a small thymus, no tonsils or lymph nodes. Which of the following immune deficiencies DOES the patient present.

Severe combined immunodeficiency syndrome

Which method remains the "gold standard" for ANA detection?

Slide-based immunofluorescent assay (IFA) or Colorzyme

What is the first step a transfusionist should take when a transfusion reaction is suspected?

Stop the transfusion, but keep the intravenous line open with saline.

Patients with antibody to the following antigen are immune to hepatitis B:

Surface antigen

Jane Doe is a 39-year-old female who felt tired for several months, had pain in the joints of her fingers, and recently developed a dermatitis following exposure to the sun. The following test results were obtained on a blood sample drawn during the initial evaluation:Total Protein = 8.4 gm/dL (N = 6.0-8.0 gm/dL) ANA > 1:2560; speckled pattern CRP = positive C3 = 40 mg/dL (N = 80-180 mg/dL) C4 = 5 mg/dL (N=15-45 mg/dL) Based on the clinical and laboratory findings, what disease should be suspected?

Systemic Lupus Erythematosus (SLE)

Which immune elements are involved in a POSITIVE TB skin test?

T cells and macrophages

Which T cell expresses the CD8 marker and acts specifically to kill tumor or virally infected cells?

T cytotoxic

Which one of the following would not be considered an anatomic barrier of the innate immune system?

T lymphocytes

What type of the follow - up testing is recommended for a Speckled ANA pattern ?

Testing for antibodies to the extractable nuclear antigens (ENA)

Avidity is best described by which of the following statements:

The strength with which multivalent antigens and antibodies bind

Homogeneous Speckled

There are two patterns present in this microscopic field from an antinuclear antibody (ANA) test. The test is viewed using fluorescent microscopy. One pattern can be seen in the interphase cells (a) and the area outside of the chromosomal area of the mitotics (b). The other pattern is recognizable in the chromosomal area of the metaphase mitotic cells (c). What are these two patterns?

Nucleolar

This antinuclear antibody (ANA) test is viewed using fluorescent microscopy. The pattern is characterized by staining of the nucleoli in the nuclei of the interphase cells (a). Which pattern is this?Note: (a) points to the nuclei of the interphase cells, the primary consideration for discerning the ANA pattern and (b) indicates a metaphase mitotic cell. Observing the chromosomal area and cytoplasm of the metaphase cell may assist in identification of the ANA pattern.

Centromere

This antinuclear antibody (ANA) test pattern is characterized by staining to discrete speckles in the nucleus of the interphase cells (a) and discrete speckling also in the chromosomal area of the metaphase mitotics (b) when viewed using fluorescent microscopy. This image represents which of the following patterns?

Which of these nitrogenous bases is present in deoxyribonucleic acid (DNA), but not in ribonucleic acid (RNA)?

Thymine

Why are ANA positive samples titered?

To determine how much antibody is present in the sample. To look for multiple ANA patterns

All of the following criteria for donor RBC to be used for an exchange transfusion relate to both ABO hemolytic disease of the fetus and newborn (HDFN) and HDFN due to anti-D: Less than or equal to 7 days old Reconstituted with AB FFP CMV Negative Negative for Hemoglobin S Irradiated

True

Evaluating B-type natriuretic peptide (BNP) levels can be helpful in distinguishing transfusion- related acute lung injuries (TRALI) from cardiopulmonary edemas.

True

For those facilities that in the interest of safety use a special calculation for Rhlg dosage, regardless if they round up or round down, they always add one vial. True or False?

True

If the mother is a Rh immune globulin (Rhlg) 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 or False?

True

In real-time PCR procedures, fluorescence resonance energy transfer (FRET) is the process that allows for probes to emit fluorescence only after hybridization. True or False?

True

Kernicterus due to high levels of unconjugated bilirubin can cause brain damage in newborns suffering from severe HDFN. True or false?

True

The DNA strand ending with a phosphate group is the 5' end. True or False?

True

The best way to evaluate single nucleotide polymorphism (SNP) is by melting curve analysis. True or False?

True

Tiny volumes of D+ red cells (e.g., as little as 0.1 mL) can stimulate production of anti-D in some individuals. True or false?

True

True or False: When antigen typing, mixed-field agglutination (MFA) due to red cell transfusion indicates RECENT transfusion, specifically transfusion within the past three months.

True

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

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?

Warm autoantibody

Anti-Fya

Which is the probable antibody reacting in the panel below? Select the one antibody that can account for all reactions.

Elderly Type O POS patient whose production of ABO antibodies is depressed

You perform a gel ABO/Rh test on a 94 - year- old woman and this is the result. You recognize a discrepancy between the front and back types. Which one of the following descriptions is most likely?

Patient 1234 has a positive antinuclear antibody (ANA) test with a centromere pattern at a 1:1280 titer.Surprised by the result, the clinician calls and says the patient is only having mild stiffness of her fingers and asks your opinion of the result. Which is your best reply?

You point out that centromere antibodies have been known to occur years prior to the onset of the disease and the patient should be carefully examined and monitored for the development of other symptoms.

Following an infection with mycoplasma pneumoniae, a patient may demonstrate a strong cold agglutinin response against .

anti-I

During routine inspection, a unit of unexpired blood was noticed to have a black color with numerous small clots. What is the likely cause for this observation?

bacterial contamination

The greatest risk for the manifestation of anomalies in maternal rubella infection during gestation is the:

first trimester

Corneal tissue may be transplanted successfully from one patient to another because:

he absence of class II transplantation antigens

Generally speaking, infant RBCs demonstrate the presence of the antigen, which gradually decreases as one ages. Conversely, the phenotype is not expressed at birth, but increases in frequency as one ages.

i and I

Given the following results, what is the immune status of the patient? HbsAg - neg HbeAg - neg Anti-Hbc - neg Anti-HBs - pos Anti-HBe - neg

immunization

Which of the following mediators is released during T-cell activation?

lymphokines

A positive Coombs control test (check cells) in a cross match BEST indicates that the:

negative antiglobulin test was actually negative

What is the MOST likely cause when clinical signs indicated HIV infections, but antibody tests are negative?

patient is in the "window phase" before antibody production