BOC: BB
A D-negative mother gives birth to a D-positive child. The result of the fetal-maternal hemorrhage (FMH) test is positive. The Kleihauer-Betke test is performed next to quantify the volume of the fetal bleed. The result of this test indicates that the mother has been exposed to 20 mL of fetal blood. How many 300 microgram vials of RhIG should the mother receive?
2 vials fetal volume mL / 30 add 1 for overkill 20/30 = 0.67 + 1
Tube-based agglutination reactions in the blood bank are graded from negative (0) to 4+. A reaction that has numerous small clumps in a cloudy, red background is:
1+ A 2+ has many medium-sized clumps and clear supernatant. A 3+ has several large clumps and clear supernatant. A 4+ has one solid clump, no free cells, and clear supernatant.
Which of the following is the deferral period following the collection of double red blood cell units?
16 wks standard unit is deferred for 8 wks
Red blood cell units that contain CPD (citrate-phosphate-dextrose) can be stored for up to how many days?
21 days -CPD / CP2D stored for 21 days -irradiated stored for 28 days / original exp date -CPDA1 stored for 35 days -additive solution stored 42 days
Unless an alternative has been approved by the FDA, what is the expiration and storage temperature of rejuvenated (non-frozen) RBC's?
24 hours; 1 °C to 6 °C -also be frozen and maintained at -65 °C -if frozen: expiration date is 10 years in CPD / CPDA1 -If w/ AS1: 3 years
A rejuvenation solution may be used up to how many days following expiration of a red cell unit?
3 days
How long after potential donors have been diagnosed with malaria should they be deferred from doing a blood donation?
3 years potential transfusion transmitted disease
Approximately how many out of 1,000,000 Caucasians will have the following phenotype?Group 0, K+, Jk(a+)
30,000 Group O - 45% 450,000 / 1,000,000 K+ - 9% 40,500 / 450,000 Jka - 77% 31,185 / 40,500
Donated red blood cells that contain the anticoagulant CPDA-1 (citrate-phosphate-dextrose-adenine) may be stored up to how many days?
35 days CPD / CP2D - 21 days Irradiated RBC - 28 days / expiration Additive solutions - 42 days
In a closed system, thawed FFP and PF24 blood components may be labeled as "Thawed Plasma" 24 hours after the original thaw time and given a shelf life of?
5 days
Which best describes an A1 individual?
A and A1 antigens on RBCs and anti-B antibodies in serum. Group A2 - A ag on RBC and anti B (maybe anti A1) ab in serum Group A1B - A and B ag on RBC w/ none in serum Group B - B ag on RBC and anti A in serum
Which one of these physical exam results would cause a donor to be deferred?
A diastolic blood pressure of 110 mm Hg diastolic blood pressure - <100 mm Hg. Hgb >12.5 g/dL. pulse between 50-100 BPM. temperature <37.5°C (99.5°F).
Which of the following group B antigens is generally associated with a mixed field reaction?
B3 B3 - weaker than usual reaction w/ anti B B - strong reaction w/ anti B Bm and Bx - weaker reaction w/ anti B but no MF
What is the MOST common infective agent to be transmitted through blood transfusion that results in morbidity and mortality?
Bacteria storing RBC >6C and plts 20-24C increases growth presence of clots, darker purple-black color, cloudy, hemolysis HAV rarely transmitted through blood; feco-oral route HIV: rare through blood transfusion Malaria pts deferred for 3 years+
Which is in the correct order from the lowest concentration of H antigen to the highest concentration of H antigen?
Bombay, A1B, A1, A2B, B, A2, O
The major crossmatch is performed using:
Donor's red cells and recipient's serum or plasma
All of the following RBC antigens are high-frequency EXCEPT:
E (big E) Little k (k), Lub, and Kpb - 99% of pop.
When performing the rosette test to screen for Fetal Maternal Hemorrhage, what is considered the correct combination to avoid false positives and/or false negatives?
Fetal cells D positive & mother is D negative False pos when mother is weak D pos False neg when fetus is pos for weak D
The Rh nomenclature which uses the letters DCE is found in which of the following genetic models?
Fisher -Race Wiener: R0, R1, R2, Rz Rosenfield: Rh1(D), Rh2(C), Rh3(E), Rh4(c), RH5(e) Tippett: RHd, RHD, RHCE, RHCe
All of the following represent a 2 week temporary deferral from donating blood or blood products EXCEPT:
German measles (rubella) vaccine 4wks Measles (rubeola) vaccine Mumps vaccine Polio vaccine
The antigen marker most closely associated with transmission of HBV infections is:
HBeAg Hepatitis B - high infectivity HBsAg - first marker to appear, active infection - initial infection HBcAg - determine the course of HBV infections. HBiAg is not an actual component of HBV
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 and anti-HIV-2 - required screening tests HCV NAT - detects Hepatitis c
What blood system is often tested to either establish or dispute paternity?
HLA High polymorphic nature ABO - not polymorphic, can be used to predict parents and offspring, can't prove or disprove paternity Rh - highly polymorphic, can't prove or disprove paternity Duffy - not useful, can't prove or disprove paternity
Recombinant Factor IX is indicated for which of the following?
Hemophilia B Factor Vlll - hemophilia A and VWD with no inhibitors; cryo Factor Vlla - hemophilia a or b with inhibitors Factor IX - hemophilia B with no inhibitors. Factor X - Factor X deficiency
What is the MOST frequent disease complication of blood transfusions?
Hepatitis Hepatitis B and C transmitted parenterally CMV, syphilis, and HIV transmitted through blood transfusion but lover incidence
Which of the following antigen groups is closely related to the ABO antigens on the red cell membrane?
I, i exist on the precursor A, B, and H I - branched chains i - linear chains Rh - nonglycosylated proteins (no carbs), transmembrane proteins Kell - only on RBC Duffy - on fetal RBC
What additional information is required on a label or tie tag of an autologous unit?
Identification of the recipient -labeling of the autologous blood bag, the name of the donor, the recipient, the blood group, and the name of the hospital
Transfusion-related acute lung injury (TRALI) is a serious blood transfusion complication that can be characterized by all of the following EXCEPT:
Increased central venous pressure In TACO not TRALI respiratory distress, hypotension, and pulmonary edema
In theory, how difficult is it to find a compatible blood unit and to identify the antibody in a patient with an antibody to a low-frequency antigen, such as Kpa or Jsa?
It is not difficult to find compatible blood but difficult to identify the antibody
Washing red cells may be performed to remove what from the unit?
Proteins light spin to separate the red blood cells from the plasma and platelets
Rejuvenation solutions for donated red blood cell units may be used to improve what factor that is affected by storage lesion?
2,3 DPG also ATP - decreases storage A red blood cells age and lyse during storage - increase hemolysis, increase K, decreased Na
What is the increase in the risk for developing antibodies against red cell antigens (RBC alloimmunization) for patients who are characterized as chronically transfused patients?
30% or greater like thalassemia, autoimmune hemolytic anemia, and sickle cell disease
The primary antibody response takes an average of how many days?
5-10 days
What is the maximum number of white blood cells that may be present in 95% apheresis platelet units that have been leukocyte-reduced?
5.0 x 10^6 apheresis granulocyte - >1.0 x 10^10 in 90% - 3.0 x 10^11 in 90% plts - 5.5 x 10^10
A platelet component prepared from a unit of whole blood (random donor platelet) must contain at least how many platelets?
5.5 x 1010 platelets/unit
One of these patients is a 46-year-old male whose hemoglobin has dropped from 8.4 g/dL to 4.6 g/dL in the previous 8 hours (normal Hgb for this patient demographic would be ~14 g/dL). Your workup reveals a group O patient with the following antibodies: anti-K, anti-Fya. The prevalence of K negative donors in your donor population is 91%, while the prevalence of Fya negative donors is 37%. Two units of cross-matched RBCs are requested by the physician. How many units of group O RBC units should you phenotype in order to fulfill the request for two cross-matched units?
6 units of type O RBC units XM 2 units / neg ag prevalence x neg ag prevalence 2/0.91x0.37 = 6.06
In order to prevent a loss of viability in platelet concentrates during storage, the pH must be maintained at or above what level?
6.2
How long after collection can a patient's sample be used for compatibility testing?
72 hours 7 days for donor / pt following transfusion
Platelets that are not collected by an apheresis method must be prepared within ________ of the collection of whole blood.
8 hours WB and apheresis-derived platelets are stored at 20 -24C.
A unit of leukocyte-reduced red blood cells must retain at least what percentage of red blood cells following leukoreduction?
85%
If an average-weight adult male patient with a 7 g/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)?
9.0 g/dL 1 unit pRBC > Hgb by 1g/dL
Leukocyte-reduced blood products may be administered to reduce the risk of febrile reactions and what disease or condition?
Cytomegalovirus in cytoplasm of WBC reducing WBC in red cell unit reduces viral load graft-vs-host disease - transmitted through allogenic bone marrow transplantation Malaria - extracellularly / in RBC Bacteremia - extracellularly, leukocyte reduction cannot filter bacteria
A D-positive mother with a D-negative fetus eliminates the possibility of HDFN due to the
D antigen mother must be D-negative with a D-positive fetus.
What would be the best way to determine how much RhIg should be given to a postpartum female who received RhIG antenatally and demonstrates the anti-D antibody at delivery?
Flow cytometry Antibody titration: differentiate between passive anti-D or active anti-D rosette test: identify not quantify Kleihauer-Betke acid elution: highly subjective
Antibodies to which of the following blood components is the most frequent cause of febrile nonhemolytic transfusion reactions?
Granulocytes collected WBC in treatment of pt w/ severe neutropenia cytotoxic antibodies or leukoagglutinins (leukocyte antibodies) formed against WBC in donor unit perform a prestorage leukocyte reduction for whole blood, plt, and pRBC
A delayed hemolytic transfusion reaction is most likely to be the result of which of the following antibodies?
Jka disappear from circulation quickly false-negative antibody screen Lea antibodies: acute hemolytic transfusion reactions, not delayed
Which of the following best describes reverse typing?
Known antigen used to detect ABO antibodies Uses known reagent red cells (ag) A1c and Bc in serum
A patient with a documented history of febrile nonhemolytic transfusion reactions (FNHTRs) should receive __________ blood components.
Leukoreduced cytokine and intact fragmented membrane accumulation during storage Irradiation: Graft vs host; unit is from a blood relative of the recipient or the donor unit is HLA-matched for the recipient CMV-negative units: immunosuppressed pts; premature infants or recipients of organ or hematopoietic stem cell transplants, not prevent a febrile reaction
Acute transfusion reactions are divided into categories based on all of the following symptoms EXCEPT:
Liver failure presenting key clinical symptom: fever: TAS (bacterial), AHTR, FNHTR (febrile) allergic pulmonary: TACO, TRALI
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 identify recipients who were at risk of receiving an infectious blood product before the donor was testing positive for a particular infectious disease Donor notification: regulations for notification of donors that they currently test positive for an infectious disease Minor crossmatch: testing donor serum and recipient red blood cells for compatibility Major crossmatch: testing donor red blood cells and recipient serum for compatibility
An antibody screen demonstrates a mixed field agglutination pattern. To which blood group system will this antibody most likely belong?
Lutheran - Lua Lewis - no dosage / MF Kell - react strong Kidd - react weakly
For granulocyte concentrations, all of the following laboratory tests must be performed on the unit by the donor center EXCEPT?
Lymphocyte enumeration ABO, Rh, red cell antibodies, and infectious disease markers should be performed
What is the first line treatment for moderate to severe hemophilia A?
Lyophilized Factor VIII concentrate if not that, cryoprecipitated AHF can be administered
A newborn presents with neonatal alloimmune thrombocytopenia. What is the most likely cause of this condition?
Maternal antibodies to neonatal platelet antigens neonate inherited from father destroy the neonate's platelets Maternal antibodies against neonatal ABO antigens: mild jaundice, elevated bilirubin, phototherapy Maternal antibodies to the D antigen: HDN, moderate to severe hemolysis, fetal demise Maternal antibodies to neonatal white blood cells: neonatal alloimmune neutropenia; ab attach to and destroy the WBC
In an emergency release, why do blood bankers seldom encounter patients who have experienced hemolytic transfusion reactions (HTR) from transfusion of uncrossmatched packed RBCs? Select the best response.
The incidence of unexpected red blood cell antibodies is relatively low.
You perform a gel ABO/Rh test on a 94-year-old woman and receive the following results. You recognize a discrepancy between the front and back types. Which one of the following reasons is most likely for this discrepancy?
The patient is O POS with depressed ABO antibody production Elderly, newborn, and immunocompromised patients may demonstrate false negative reactions in the reverse type compromised ability to produce antibodies
If an autologous blood component is shipped from the donor center without the completion of infectious disease testing, the unit must be labeled with:
The phrase "Donor Untested" Not required to be tested should not be used for allogeneic donation purposes
Which of the following transfusion reactions can a diagnosis be more firmly established by evaluating B-type natriuretic peptide (BNP) levels before and after transfusion?
Transfusion Associated Circulatory Overload (TACO) difficult to distinguish from TRALI DHTR: involve DAT, free plasma hemoglobin, hemoglobin, LDH, total and direct bilirubin, haptoglobin, free urine hemoglobin, and hemosiderin testing TAS: testing blood cultures, gram stain, culture component Allergic Transfusion Reactions: anaphylactic symptoms
Which of the following is the cause of the most severe life-threatening hemolytic transfusion reactions?
Anti-A, Anti-B, Anti-A, B Incompatibility involving the ABO blood group transfusion reaction (acute, hemolytic) Immediate
If an R1r patient received R2R2 blood, which of these antibodies could be produced?
Anti-E R1r patient = DCe/ce R2R2 = DcE/DcE E antigen is not present in the R1r
All of the following are the reacting substances that may be in the Coombs sera (antihuman globulin) EXCEPT?
Anti-IgM sources Monoclonal antibody sources Polyclonal antibody sources Complement antibodies (e.g. anti-C3b)
If detected in antibody screen testing, which of the following antibodies is NOT considered clinically significant in prenatal patients?
Anti-Leb not indicated causing HDN anti M and N could rarely cause HDN Clinically significant ab: anti-Fya, anti-K, anti-D, anti-E, anti-e, anti-C, and anti-c (IgG)
A patient demonstrates an antibody that reacts at the immediate spin phase, shows variable dosage, and has increased reactivity after treatment with enzymes. Which antibody does the patient most likely have?
Anti-P2 clinically significant IgM - colder variable dosage enhanced enzymes
How can a hematoma from venipuncture be prevented?
Apply pressure to venipuncture site immediately after drawing blood hematoma can result from blood leaking into the surrounding tissue Needle can penetrate upper wall but not completely tourniquet should be removed before the needle Mixing the tubes after blood collection has no effect
Leukocyte reduction may be performed at the same time as which step in blood component collection?
At the same time the additive solution is added
A 9-year-old male in Alaska presents with hemolysis and hematuria. The patient history reveals that he recently recovered from a flu-like virus. The ABO type is A+, and the DAT reacts at 1+. What blood group antibody should be suspected?
Autoanti-P Donath-Landsteiner antibody IgG following viral infection children biphasic hemolysin autoanti i: CAD, RT reaction, in vivo antiM: IgM, natural, insig antiH: bombay, sig, hemolysis
What is considered the cause of urticarial transfusion reactions?
Transfusion of certain food allergens or drugs in plasma products type 1: anaphylaxis or immediate hypersensitivity, histamine release by mast or basophil cells, surface IgE, in IgA deficient who recieved IgA Type 2: IgG or IgM with complement, phagocytes, and proteolytic enzymes type 3: tissue damage, formation of immune complexes
Following the treatment of an IgG molecule with papain, which of the following will remain?
Two Fab fragments each with a light chain and a partial heavy chain attached with a disulfide bond Digestion with urea and mercaptoethanol: remove all disulfide bonds Digestion with pepsin: one unit of two partial heavy chains and two light chains no enzyme: 8 units
Which of the following signs and symptoms may be associated with immediate transfusion reaction, but is NOT usually associated with delayed hemolytic transfusion reaction?
Unexplained bleeding from surgical site DIC: activated by the antigen-antibody-complement complexes Fever, chills, transient jaundice and a drop in hemoglobin in delayed
All of the following are appropriate indications for the use of fresh frozen plasma (FFP) EXCEPT?
Volume expansion FFP needed: Elevated PT or PTT results, with bleeding or coagulopathy needs replacement of clotting proteins plasma exchange
Which blood group is considered the universal recipient for transfusion of red blood cells?
AB universal donor: O
Units of A-negative, B-negative, and O-negative red blood cells are shipped to your transfusion service. What testing MUST be performed by your facility before placing these units into your inventory?
ABO and Rh Ab screen and weak d are not done
A febrile nonhemolytic transfusion reaction is characterized by which of the following?
An increase in temperature of >1oC above 37oC during transfusion chills, rigors, headaches and vomiting. allergic transfusion reactions - hives and itching within 15-20 minutes of transfusion. delayed hemolytic transfusion reaction - >24 hours to 28 days.
All of the following are cause for donor deferral EXCEPT?
An individual weighs 115 pounds at the time of donor screening. Potential donor is currently pregnant in her second trimester. Donated a whole blood product within the last 30 days. He/she lived in the United Kingdom (UK) for a consecutive 12-month period between 1980 - 1996.
A 27-year-old female presents to her physician after suffering a spontaneous abortion. Though rare, which antibody may be the etiological agent?
Anti P causes spontaneous abortions Rare Anti p1 - cold, not significant Anti PP1Pk - significant, hemolysis Anti p1 and p2 - similar to A1 and A2
For which of the following antibodies is the DAT most likely to be NEGATIVE when testing a newborn for possible HDFN?
Anti-A,B Anti D, c, or K most likely yield pos DAT
Which of the following statements are true about anti-H?
Anti-H reacts more strongly with group A2 cells than with group A1 cells O>A2>B>A2B>A1>A1B (O has the most H and A1B has the least)
Which Rh antibody might be produced if a unit of blood with Rh genotype DCe/dce is given to a patient with Rh genotype DCe/DCe?
Anti-c c antigen is not present on the cells of the recipient
What is the most prudent step to follow to select units for crossmatch after recipient antibodies have been identified?
Antigen type patient cells and any donor cells to be crossmatched DAT: RBC; Ab; in vivo IAT: serum; Ab; in vitro
The following statements are true regarding the Lewis blood group EXCEPT:
Antigens are a structural component of the red cell membrane not a component of the red cell membrane; not produced by red cell Expression of Lewis antigens is influence by secretor status passively adsorbed onto the red cells from the plasma ABO grouping does affect antigen expression
A blood donor shows signs of syncope, or fainting, shortly after donating. What should be done to treat the patient?
Apply a cold compress to the back of the neck also should sit or lie down airway shouldn't be closing except if convulsions occur shouldn't have to cough unless muscle spasms shouldn't need chest compressions unless cardiac arrest
Which of the following is NOT considered a characteristic of paroxysmal cold hemoglobinuria (PCH)?
Autoantibody class: IgM IgG children and young adults following viral infection intravascular
The "recognition unit" of the classical complement pathway refers to which of the following?
C1q C5b, C6, C7, C8, and C9 make up the membrane attack complex. C3a works as a natural substrate on C4b2a. C4, along with C2, are part of the classical complement pathway.
Which of the following genotypes is found with the highest frequency in the Caucasian population?
CDe/ce
Which procedure used to obtain a fetal blood sample to monitor severity of hemolytic disease of the fetus and newborn (HDFN) can also be used to deliver intrauterine transfusions?
Cordocentesis spinal needle is inserted into the umbilical vein injecting donor red blood cells directly into the vein
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?
Creutzfeldt-Jakob (CJD) disease and variant CJD (vCJD) Leishmaniasis - parasite - sand fly Chagas disease - Trypanosoma cruzi
Which of the following blood components will provide the best source of fibrinogen for a patient with hypofibrinogenemia?
Cryoprecipitate Whole blood is used to increase red cells mass and plasma volume. FFP is used to replace stable and labile coagulation factors. Plts are used to treat bleeding caused by thrombocytopenia or thrombocytopathy.
The McLeod phenotype is associated with which of the following antigen systems?
Kell decreased expression of kell Absence of Kx, reduced expression of Kell
Which of the following antigens are well developed on fetal cells?
Kell lewis and I - poorly developed on fetal cells ABO - expressed 25 - 50%
Antibodies within which of the following blood group systems are known to result in severe hemolytic transfusion reactions, but are not always detected during pre-transfusion testing in the blood bank?
Kidd delayed or anamnestic response resistant to lysis in 2 M urea enhanced w/ ficin IgG, AHG drop in titer in vivo Duffy: HTR and DHTR, IgG, clinically significant, dosage, denatured enzymes Kell: severe HTR, acute transfusion reaction Lewis: naturally occurring, IgM, rare HTR, during pregnancy their expression is diminished on the mother's red blood cells M and N: not clinically significant, rare HDN IgM, dosage, decreased enzyme
Which of the following tests is suitable for quantifying the size of fetomaternal hemorrhage (FMH)?
Kleihauer-Betke test also flow cytometry for dosage rosette test is suitable to screen
Which of the following viruses or diseases is screened for in blood donors only using questions asked during the donor screening and selection process?
Malaria -no FDA-approved test available
Platelet specific antigens, also referred to as human platelet antigens (HPAs), are expressed on which of the following?
Membrane glycoproteins GPIIb, GPIIIa, GPIba, GPIbß, GPIa, and CD109
Compared to the primary immune response, the secondary immune response typically demonstrates:
More antibodies produced primary - less ab secondary - shorter lag time (1-3 days), ab w/ higher affinity
Which patient population benefits from HLA matching to provide patients with the best outcomes?
Organ transplant recipients
All of the following are required to be in a machine-readable format on a blood component label, EXCEPT:
Outdate Should have: A unique collection facility identifier, Lot number relating to the donor, Product code, ABO and Rh of the donor
Which of the following might cause a false positive indirect antiglobulin test (IAT)?
Over-centrifugation false pos - clumps cannot be removed false neg - too much afitation Failure to adequately wash cells and High concentration of IgG paraprotein can leave unbound IgG - neutralize the antiglobulin reagent and cause a false negative Delay in the addition of antiglobulin reagent may allow previously bound IgG antibody to dissociate from red cells and cause a false negative result.
Which subset of effector lymphocytes is predominantly responsible for regulation of antibody production?
TH2 against parasites, asthma, allergic inflammatory disorders TH1 - secrete interferon on macrophages to increase phagocytosis , stimulate IgG TH17 - agains bacteria and fungi, organ specific autoimmune disorders, activate neutrophils CD8 - in PB, destroying virally infected target cells, apoptosis
Mother types as O pos and neg DAT. Her newborn types as group A Rh positive with a (1+) positive direct antiglobulin test (DAT) Which of the following investigative tests would be most useful to resolve the cause of the positive DAT and should be done FIRST?
Test newborn's plasma against group A1 red cells and group O antibody screen cells by IAT. Possible case of ABO HDFN (usually A or B infants of group O mothers)
What step must be performed before a rejuvenated blood unit may be transfused to the patient?
The unit must be washed. remove inosine because it's toxic to the patient not frozen 1-6C
All of the following regarding Anti-A and Anti-B reagents used in forward typing for ABO typing are true EXCEPT?
The antibodies are IgG. IgM monoclonal antibodies highly specific expected 3+ / 4+
What must be true for the antiglobulin phase of the serologic crossmatch to be omitted (i.e., immediate spin crossmatch is done)?
The antibody screen must be negative and there is not history of detection of unexpected antibodies.
After irradiating a unit of packed red blood cells, how is the expiration date affected?
The expiration date shortens to 28 days from the date of irradiation or the original expiration date, whichever is first plasma potassium level in irradiated units is higher, and ATP and 2,3-DPG levels are lower
Phenotype refers to:
The expression of traits routine blood bank testing detects phenotype Ex: AA / AO Antithetical genes are opposing genes Polymorphic genes will have two or more alleles
The qualitative differences between A1 and A2 phenotypes includes all of the following EXCEPT:
The lack of agglutination of patient red cells with anti-A reagent. Differences: differences in the precursor oligosaccharide chains (in length and complexity of branching) small differences in transferase enzymes (decreased in A2 subgroup) formation of anti-A1 in the serum of A2 Dolichos biflorus or anti-A1 lectin
What is the correct description for Group II ABO discrepancies?
These discrepancies between forward and reverse groupings are due to weakly reacting or missing antigens. Forward subgroups of A or B, Leukemia (weakened A or B antigens) acquired B l: reverse, weakly reacting or missing antibodies, (newborns, elderly, congenital or acquired agammaglobulinemia or immunodeficiency diseases) lll: protein or plasma abnormalities, multiple myeloma, Waldenström's macroglobulinemia, (+) fibrinogen, Wharton's jelly lV: miscellaneous problems, cold autoAb, transfusion, isoagglutinins, unexpected non-ABO alloantibodies
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 Remove IgG bound to red cells that were detected from pos DAT Then can be used for autologous adsorption / RBC phenotype
Which of the following can be used to confirm if someone has the Bombay phenotype?
Ulex europaeus specificity to H ag anti H in serum pos in ab detection and ID cause neg agglutination reaction Type O has pos reaction Bandeiraea simplicifolia - B antigen. Iberis amara has specificity - M antigen
When processing umbilical cord blood samples for hematopoietic progenitor cells (HPC), what tests are performed on both the mother's blood and cord blood?
ABO and Rh Needs special processing Cord blood tested for CMV Maternal sample will have ab screen, HIV 1, HIV2, HBV, HCV, HBsAg, anti HBc, HTLV1, HTLV2, and syphilis
A false-negative reaction while performing the DAT technique may be the result of:
AHG addition delayed for 40 or more minutes previously bound globulins may dissociate from red cells - leaves insufficient ab coating red cells / free ab directly neutralize AHG False pos - over centrifugation, tubes containing silicone gel, and use of saline stored in glass or metal container
After birth, which of the following is the biggest concern for a newborn infant suffering from hemolytic disease of the fetus and newborn?
Accumulation of bilirubin destruction of fetal red blood cells cause by a maternal antibody (IgG) able to cross the placenta baby's liver is unable to conjugate the indirect bilirubin efficiently - bilirubin is not excreted Toxic levels can damage brain - kernicterus Anemia is also a concern
Which group of conditions increases the risk of HbS polymerization?
Acid pH, dehydration, increased level of 2,3-DPG (+) temp
Which of the following genotypes are known to be resistant to P. vivax (malaria) merozoites?
Fy(a-b-)
What sugar configuration is necessary as a base for attachment of other sugars to produce ABO antigens?
Galactose plus fucose also n acetyl glucosamine A ag: N-acetylgalactosamine B ag: D-galactose
Lewis Blood Group System is a human blood group unlike most others. The antigen is produced and secreted by exocrine glands, eventually adsorbing to the surface of red blood cells. Its expression is based on the genetic expression of the Lewis and Secretor genes. Based on the following genotype (Le) (Se), what would you predict the Lewis antigen phenotypic expression to be?
Le(a- b+) Le (a+b-) Le sese Le (a-b-) lele sese / Se
Which one of the following blood group antigens is not expressed, or only weakly expressed on cord blood cells?
Leb Newborns are phenotypically Le(a-b-) ABO are present but reduced amounts K and M are well developed
A ficin (enzyme) treated panel can be a useful tool for determining the identity of an antibody. On a ficin-treated panel, reactions with which system would be enhanced?
Rh also lewis, kidd MNS and duffy destroyed Kell unaffected
A solution of gamma globulins containing anti-Rh(D) is given to an Rh(D) negative mother to:
Prevent fetal cells from initially sensitizing the mother anti-D will bind to fetal Rh-positive red blood cells in vivo - mother will not produce anti-D herself and preventing sensitization
Compared to plasma frozen within 8 hours of collection, plasma frozen within 24 hours of collection will likely have reduced levels of Factor:
Vlll also reduced V
A patient who demonstrates a history of an allergic reaction from red blood cell transfusions will benefit from receiving which red cell component?
Washed RBCs Plasma proteins cause allergic / anaphylactic response freezing RBCs - maintains units w/ rare ag or increase shelf life Irradiating RBC - prevents donor t lymphs from multiplying, TA GVHD Leukocyte reduction RBCS - prevents febrile reactions
When performing an anti-human globulin (AHG) test, it is important to completely wash the red cells because:
Washing prevents neutralization of the anti-human globulin (AHG) serum. Inadequate cell washing will lead to unbound antibody remaining in the red cell suspension should not remove cell-bound antibody should not prevent bound ab from eluting from ag Washing removes protein from the test system - rouleaux not a cause
A 300 µg dose of RhIg (Rh immune globulin) can suppress immunization to how many mL of D-positive whole blood?
30 mL 1 vial is 300 µg calculation is: fetal volume mL / 30
What is the acceptable temperature range for maintaining red blood cell components during transport?
1 - 10ºC RBC stored: 1-6C Plt transported: 20-24C once opened: 24hrs
The proper storage requirements for granulocyte concentrates is:
20 - 24 degrees Celsius, 24 hours severe neutropenic
What is the maximum interval during which a recipient sample may be used for compatibility testing if the patient has recently been transfused or was pregnant within the past 3 months?
3 days Donor and recipient samples: 7 days
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?
Adding IgG sensitized red cells. should be pos
Red blood cells with a positive DAT cannot be tested accurately with blood typing reagents that require an indirect antiglobulin technique unless they have been treated with all of the following (to dissociate IgG from the RBC membrane) EXCEPT:
Albumin not effective to remove IgG bound to RBCs chloroquine diphosphate, ZZAP, or ficin treatment dissociates IgG from RBC membrane
Which of the following statements regarding the ABO phenotype A2 is true?
A2 antigens are linear while A1 antigens are branched. A1 cells will agglutinate with anti-A1 lectin A1 and A2 RBCs will agglutinate with anti-A antisera A1 cells have more antigens on the surface of their RBC's
Which of the following is/are considered an accrediting agency(ies) for quality and safety in the blood industry?
AABB voluntary and evaluated by peer review; industry association FDA and CMS is enforced by law, regulatory agency
Which of the following fresh frozen plasma ABO types would be suitable for transfusion to an AB negative patient?
AB negative and AB positive only FFP should be ABO compatible, Rh type doesnt matter
The direct antiglobulin test (DAT) is most unreliable when diagnosing hemolytic disease of the fetus and newborn due to which blood group system?
ABO good for duffy, rh, and kidd
Which of the following is the most important factor in determining the immediate outcomes of kidney transplants?
ABO compatibility
Which one of the following blood components contains the MOST factor VIII concentration per mL?
Cryoprecipitate Plasma and Fresh Frozen Plasma: contain clotting factors by not preferred choice for factor Vlll plt conc: restore plt levels but not provide clotting factors
A 28 year old female patient is experiencing disseminated intravascular coagulation (DIC) following the delivery of her newborn. Her Complete Blood Count (CBC) results are normal. What would be the best blood product for this patient to receive?
Cryoprecipitated antihemophilic factor cry - contains concentrated coagulation factors, minimizes risk of TACO pooled or apheresis plt should be given when decreased plt count / function pRBC - CBC was normal, could cause TACO FFP - contains coag factors but not as high as cryo
Which cluster of differentiation (CD) is used for the quantification of hematopoietic progenitor cells (HPC) after an HPC-apheresis collection?
CD34 CD4, CD8, and CD2 are all lymphocyte surface markers
Which of the following describes the main function of hemoglobin?
Carry oxygen Platelets: hemostasis WBC: fight infection fibroblasts: Support bone marrow stroma
In the ABO blood group system, the A antigen is inherited in what relation to the B antigen?
Codominant person who inherits the A antigen from one parent and the B antigen from the other will demonstrate both the A and B antigens dominant: if inherit a or b ag from one and o ag from another, a or b ag will be demonstrated O antigen is recessive to the A and B antigen O antigen is amorphic: does not produce any demonstrable antigen
Which of the following methods are a non-invasive way to reliably predict anemia in the fetus?
Color Doppler middle cerebral artery peak systolic velocity (MCA-PSV) blood velocity ultrasound maternal antibody titer: not good for severity and anemia Cordocentesis and Amniocentesis: invasive
Which one of the following tests BEST correlates with the severity of hemolytic disease of the fetus and newborn (HDFN)?
Color Doppler ultrasonography Fetal anemia caused by hemolysis of red cells during pregnancy determine the severity of fetal anemia ab screen: use screen cells to detect IgG alloab (significant), then use ab ID Amniotic fluid bilirubin: increased w/ severity of HDN, RBC lyse and bilirubin builds up
Which of the following is used as a source for irradiation of blood products?
Cs137 or Co60 radiochromic film label is affixed to the component before it is placed into the metal canister of the irradiator
What is the most common Rh haplotype among whites?
DCe 42% whites, 70% asians Dce: 44% blacks DcE: 21% asians dce: 37% whites, 26% blacks
What is the fundamental purpose of the full, pre-transfusion crossmatch?
Detect antibodies in recipient serum/plasma that react with donor red blood cells. Alloab can potentially react with donor RBCs crossmatch is a final check of ABO compatibility
What is the Kleihauer-Betke test used for?
Differentiate between maternal and fetal red cells fetal hemoglobin is resistant to acid elution smear of maternal treated with acid, rinsed, counterstained fetal cells stain and appear pink maternal cells are ghost cells Usually for maternal blood volume: 5,000 ml Usually for number of maternal cells: 2,000 ml (# fetal cells x 5000 / 2000)
When AHG or Coombs serum is used to demonstrate that red blood cells are antibody coated in vivo, the procedure is termed:
Direct technique AIHA, HDN, HTR indirect: in vitro, antibody screening and compatibility testing purposes hemagglutination and hemolysis techniques: in vitro, detection of ag/ab
For which of these reasons would a molecular method not be used?
Donor antibody screening should be donor ag screening Determine blood type when the DAT is positive Complex Rh genotypes (weak D expression) Type fetal blood
Which type of antibodies are known to cause transfusion-related acute lung injury (TRALI) reactions?
HLA antibodies
In which system are DR antigens are found?
HLA system is an MHC class II
An antibody to which platelet antigen is most commonly encountered in blood bank?
HPA-1a Antibodies to platelet antigens are not commonly found HPA-2a, HPA-3a, and HPA-4a are all platelet antigens - usually ab not produced
What section of an immunoglobulin molecule is responsible for the differences between immunoglobulin classes?
Heavy chains Fc: defines class and subclass Fab: Ag binding Light: Kappa and Lambda
Which one of the physical examination results below may be cause to reject a donor from blood donation?
Hemoglobin of 12.0 g/dL Age: >16 Hgb: >12.5 Hct: >39% Pulse: 50-100 Temp: <37.5C (99.5F) BP: <180/110
Which of the following statements about high-frequency antigens is correct?
High-frequency antigens are common, but it is difficult to identify their corresponding antibodies. >98% for ag, <2% for ab
The chief purpose of performing a serologic crossmatch is to:
Identify recipient antibodies against donor cells Ab in donor and recipient checked w/ ab screen
Which symptom of hemolytic disease of the fetus and newborn (HDFN) is associated with low levels of glucuronyl transferase?
Jaundice glucuronyl transferase - conjugates bilirubin anemia in utero - maternal IgG ab cross placenta and bind to ag compensate for anemia - increase erythropoiesis = increased reticulocyte red cell destruction by macrophages in liver and spleen Cardiac failure b/c untreated anemia
Which of the following is the predominant immunoglobulin class for anti-A and anti-B antibodies in group B and group A individuals?
IgM
Which of the following is a common cause of febrile non-hemolytic transfusion reactions?
Immune response to leukocytes ATR >1C within 24 hrs chills, nausea, tachycardia, hypertension, and tachypnea Contamination of a blood product cause: TAS antibody to a platelet antigen cause: PTP reaction to plasma proteins: allergic reactions
Which of the following statements best describes Rh antibodies?
Immune, IgG pregnancy or transfusion clinically significant dosage enhanced enzymes
Which of the following patients are at risk for transfusion-associated graft versus host disease (TA-GVHD) and require irradiated cellular blood products?
Immunocompromised patients including neonates less than 4 months of age and patients receiving chemotherapy. Neonates less than 4 months of age Recipients with a congenital or acquired immunodeficiency, such as bone marrow or stem cell recipients, and patients receiving chemotherapy Recipients of directed donor units from a blood relative Recipients of HLA matched or crossmatched platelets or granulocytes
Certain clinical conditions such as Hemolytic Disease of the Fetus and Newborn (HDFN), Hemolytic Transfusion Reaction (HTR), and Autoimmune Hemolytic Anemia (AIHA) result from the attachment of antibodies or complement to human RBCs.
In vivo sensitization within the living already taken place in vitro: within the glass, predict potential for successful transfusion Desensitization and Non-sensitization: goal of reducing allergy/allergen reactions
For transfusion services in the United States, which of the following incidents must be reported to the Food and Drug Administration (FDA) because of a biological product deviation?
Incident C: The wrong specimen was used to crossmatch a unit and the unit was issued. reportable if occurred while the product was under the control of the transfusion service; affects the safety, purity, or potency of the product, and if the unit was issued
One risk associated with patients that require chronic transfusions is:
Iron overload each unit contains 225mg iron TA-GVHD: rare
What is the purpose of adding citrate to donated red cell units?
It prevents coagulation stabilizes the red cell membrane Sodium biphosphate: stabilize the pH of the unit during storage Adenine: substrate for ATP synthesis Dextrose: helps in ATP generation by the glycolytic pathway
What is the rare phenotype found exclusively in male patients that is caused by X-linked inheritance from a carrier mother, often demonstrating a chronic but well-compensated anemia as well as muscle and nerve disorders?
McLeod lack of Kx and Km X-linked chronic granulomatous disease Fy (a- b-): african americans, resistance to malaria, p vivax Jk (a- b-): very rare, polynesian U-: very rare, both S-s-
An Rh-negative pregnant female has produced anti-D, and the physician has decided to use molecular typing to determine if the fetus is at risk. Which of the following test results makes fetal DNA testing a recommended second step?
Molecular genotyping demonstrates that the father is heterozygous for the RHD allele. 50% chance of inheriting d gene if homozygous - baby will be Rh pos, don't have to be tested, risk of HDN
Which of the following is the most prevalent blood type found in the United States?
O pos then A and B AB neg is rarest
If a father carried the Xga allele, to which of his children will he pass it along?
Only to his daughters on x chromosome
Which of the following is considered an indication for Rh immune globulin (RhIG) administration in postpartum women?
Passive protection administered within 72 hours after delivery effective against formation of anti-D no long term protection against the development of Rh antibodies RhIG therapy does not block antibody: attaches to the fetal Rh-positive RBCs and removed by macrophages in the maternal spleen Active: Rh-negative non-immunized mothers expecting Rh-positive infant(s) should receive Rh immune globulin (RhIG) in the third trimester or at 28 weeks, Postpartum Rh-negative non-immunized mothers should receive RhIG immediately after delivery of an Rh-positive newborn
A2B is suspected when a patient's ABO typing has the following results:
Patient's red cells forward types as AB with anti-A1 present in the patient's serum A2 individuals forward types as A, and may demonstrate anti-A1 in their serum do not react with either Anti-A nor Anti-B, and have anti-A1 and anti-B are present in the their serum is type O A3 subgroup will ahve MF of agglutination w/ anti a
What procedure utilizes leukapheresis to collect the buffy coat from whole blood?
Photopheresis treatment of cutaneous T-cell lymphoma treated with 8-methoxypsoralen, exposed to ultraviolet A light and then reinfused Plasmapheresis: removal and retention of the plasma Therapeutic apheresis (TA): removal of a specific blood component, pathological Erythrocytapheresis: red cell exchange, removes many RBC from pt plasma and plts
Donation of which apheresis blood product more than once every four weeks requires monitoring of total plasma protein and antibody levels?
Plasmapheresis red cell apheresis, plateletpheresis, and leukapheresis: dont contain enough plasma
Which one of the following blood components would be MOST appropriate for a 9-yr old girl who is suspected of having immune thrombocytopenic purpura (ITP)?
Platelets in TTP: give FFP / cryo
A patient, who recently received a transfusion of three units of red cells, is DAT-positive with an IgG specificity. What would be the best method to identify the patient's phenotype?
Polymerase chain reaction-based assay determine a patient's phenotype Adsorption and elution: use of chemicals that may denature antigens Type and Screen: presence of an antibody Antigen typing: tedious process
Why is Rh immune globulin (RhIg) administered within 72 hours of delivery to an Rh negative mother if the newborn is found to be D-positive or weak-D positive?
Prevent fetal cells from initially sensitizing the mother prevents alloimmunization in D negative mothers exposed to D positive red cells
Anti-U antibodies can be produced by which of the following genotypes?
S-s- absence or altered glyocyphorin B result in lacking S, s, and U ag
Donated red cell units contain which substance to stabilize the pH of the unit during storage?
Sodium biphosphate preventing the pH from excessively becoming more acidic Dextrose: ATP generation. Adenine: ATP synthesis. Citrate chelates calcium to prevent coagulation.
What is the MOST likely explanation for the following results? Anti-A = 1+ Anti-B = negative A1 Cells = 1+ B Cells = 4+
Subgroup of A with anti-A1 forward ABO group appears as a group A, but the reverse grouping appears as a group O Subgroups of A often have weaker reactions in the forward due to less antigens on the cells anti-A1 is causing the additional reaction in the reverse grouping Group A with acquired B antigen would have a forward grouping that looks like AB and a reverse grouping that looks like A Group O with hypogammaglobulinemia would have a forward grouping that looks like O and a reverse grouping that looks like AB
Which of the following steps must be followed to prepare a platelet concentrate?
Whole blood centrifuged at low speed - plasma separated then centrifuged at high speed low first separates RBC from PRP PRP at high speed separates plasma from plts (settles at bottom) Centrifuging whole blood at high speed causes hemolysis
Which organism is MOST likely responsible for septic reactions associated with red blood cell transfusions?
Yersinia enterocolitica thrive at 4C promote transfusion reactions Organisms unable to survive at 4C and die GP and GN organisms linked to plts stored at 20-24C (Escherichia coli, Enterobacter species, and Streptococcus species) Red cells stored at 1-6C frozen plasma and cryo stored at <-18C
Based on the following results obtained against a patient's red cells, what will the genotype look like in this example? Anti-C = 4+ Anti-c = 4+ Anti-E = 0 Anti-e = 4+ Anti-D = 0
r'r Cce R0 - Dce R1 - DCe R2 - DcE Rz - DCE r - ce r' - Ce r" - cE ry - CE
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?
4 vials KB% x blood volume = volume of baby blood 1.9 x 5000 = 95 mL 95 / 30 = 3.17 + 1
When would unexpected positive reactions be encountered during ABO forward typing?
Acquired B antigen -usually found in group A individuals with intestinal diseases -produce a deacetylating enzyme that can alter the A antigen to resemble the B antigen -A and B subgroups: Ag depression, leukemia, unexpected neg reactions forward typing -Hypogammaglobulinemia: unexpected neg reaction reverse typing
Both hemoglobinuria and hemoglobinemia will be present in what type of reactions?
Acute hemolytic transfusion reactions Acute - hypotension delayed - jaundice, hemoglobinuria transfusion-related acute lung injury and anaphylactic transfusion reactions - no hemolysis
Antibodies directed against granulocyte antigens have been implicated for all of the following EXCEPT?
Acute hemolytic transfusion reactions implicated in NAN, TRALI, febrile transfusion reactions
Which listed transfusion reaction is MOST OFTEN associated with transfused patient's lacking IgA?
Anaphylaxis Hemolytic reactions - presence of recipient autoantibodies or alloantibodies reacting with donor antigens. Febrile reactions - recipient white cell Ab causing the release of pyrogens or to donor platelet release of cytokines. TACO - patient's cardiovascular system unable to handle the additional volume from the transfusion - CHF
A patient presents with platelet refractoriness, or poor response to platelet transfusions. What can be performed to help ensure platelet transfusions will be therapeutic?
HLA typing Transfusing the platelets with a warmer: cold agglutinins or are receiving a massive transfusion Administering an antihistamine: history of having mild allergic reactions to transfusions
Which of the following antigens is classified as a Major Histocompatibility Complex Class II antigen (MHCII)?
HLA-DR HLA-A, HLA-B, and HLA-C are all class I MHC - found on plts, leukocytes, most nucleated cells
Marcus had a transfusion of packed RBC's 8 months ago following a surgery after a car accident. He is fully recovered and is otherwise healthy. How soon can Marcus donate a unit of blood?
He can donate in 4 months. Total deferral time is 12 months
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 could be neutralized in a manner using these fluids or other natural sources?
Lewis Kel, Rh, MN do not exist in body fluids Anti M and N do exist in plant sources but not helpful in neutralizing Ab
Which of the following sources of error will give a false negative result in antihuman globulin testing?
Low pH of saline Dirty glassware, samples collected in gel separator tubes, and refrigerated specimens - false pos
Which of the following is responsible for causing transfusion associated graft-versus-host disease?
Lymphocytes engrafting of immunocompetent T lymphocytes into a severely immunosuppressed recipient prevented by gamma irradiation
Which adsorption technique removes cold (IgM) antibodies, particularly anti-I specificities?
Rabbit erythrocyte stroma (RESt) Cold autoadsorption: remove cold autoantibodies to determine alloAb Warm autoadsorption: remove warm autoantibodies to determine alloAb Allogeneic adsorption: warm autoantibodies from alloantibodies, alloantibodies with several specificities
Which of the following antibodies are enhanced using enzyme panels during antibody identification in the blood bank?
Rh Enhanced: Lewis, Kidd, ABO, I, P, Rh Destroyed: MNS, Duffy No effect: Kell, Lutheran
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? Anti A - neg Anti B - neg A1c - neg Bc - 3+
Weak subgroup of A patient is healthy due to be eligible to donate blood adsorption and elution studies can be performed Leukemia can cause decrease ag expression Acquired b - additional reaction in forward, digestive tract low immunoglobulin - strong 3+ reaction with Bc in reverse