BOC Blood Bank
c. L-fucosyl transferase (Fucose is the immunodominant sugar for H.)
89) The enzyme responsible for conferring H activity on the red cell membrane is alpha_: a. galactosyl transferase b. n-acetylgalactosaminyl tranferase c. L-fucosyl transferase d. N-acetylglucosaminyl transferase
46) Which of the following is proper procedure for preparation of platelets from Whole Blood: a. light spin followed by hard spin b. light spin followed by 2 hard spins c. 2 light spins d. hard spin followed by a light spin
a. light spin followed by hard spin (Whole blood-derived Platelets are prepared by a light spin to separate the Red Blood Cells from the platelet-rich plasma [PRP], followed by a heavy spin of the PRP to concentrate the platelets.)
111) The antibodies of the Kidd blood group system: a. react best at the IAT b. are predominately IgM c. often cause allergic transfusion reactions d. do not generally react with antigen-positive, enzyme-treated RBC's
a. react best at the IAT (Antibodies in the Kidd blood group system are IgG and react best at the antiglobulin phase. These antibodies are associated with delayed hemolytic transfusion reactions and reactivity can be enhanced by testing with enzyme pretreated cells.)
71) Which of the following phenotype will react with anti-f: a. rr b. R1R1 c. R2R2 d. R1R2
a. rr (Anti-f will react with cells that carry c and e on the same Rh polypeptide. No other listed genotypes produce an Rh polypeptide that carries both c and e.)
173) A group B, Rh-neg patient has a positive DAT. Which of the following situations would occur? a. all major crossmatches would be incompatible b. the weak D test and control would be positive c. the antibody screen test would be positive d. the forward and reverse ABO groupings would not agree
b (A positive DAT will interfere with weak D testing, causing both the patient and control to demonstrate positive results. Any positive result in the control tube invalidates any results.)
143) To prevent graft vs host disease, RBCs prepared for infants who have received intrauterine transfusions should be: a. saline washed b. irradiated c. frozen and deglycerolized d. group-and Rh-compatible with the mother
b (Blood selected for intrauterine transfusion and transfusion to premature infants should be irradiated to prevent graft-vs-host disease.)
171) Granulocytes for transfusion should: a. be administered through a micro aggregate filter b. be ABO compatible with the recipients serum c. be infused within 72 hrs. of collection d. never be transfused to patients with a history of febrile transfusion reaction.
b (Granulocytes must be compatible with recipient's plasma. Granulocyte products have an expiration of 24 hours.)
163) HLA antigen typing is important in screening for: a. ABO incompatibility b. a kidney donor c. Rh incompatibility d. a blood donor
b (HLA antigen typing is important to consider before organ transplantation.)
150) The results of a Kleihauer-Butke stain indicate a fetomaternal hemorrhage of 35 mL of WHOLE BLOOD. How many vials of Rh immune globulin would be required. a. 1 b. 2 c. 3 d. 4
b (One dose of RhIg will protect the mother from a bleed of 30 mL. The bleed was 35 mL, 2 vials of RhIg will be needed)
179) Which of the following is a characteristic of polyagglutinable red cells? a. can be classified by reactivity with Ulex europaeus b. are agglutinated by most adult sera c. are always an acquired condition d. autocontrol is always positive
b (Polyagglutination is a property of the cells. Most adult plasma agglutinate the cells due to naturally occurring antibodies directed towards the crypt antigens.)
155) A Kleihauer-Betke stain of a postpartum blood film revealed 0.3 fetal cells. What is the estimated volume of the fetomaternal hemorrhage expressed as whole blood: a. 5 b. 15 c. 25 d. 35
b (The formula to calculate the percentage assumes the mother's blood volume as 5,000 mL. 0.003 x 5,000 mL = l5 mL.)
156) Based upon Kleihauer-Betke test results, which of the following formulas is used to determine the volume of fetomaternal hemorrhage expressed in mL of whole blood. a. % of fetal cell present x 30 b. % of fetal cell present x 50 c. % of maternal cells x 30 d. % of maternal cells x 50
b (The percentage of fetal cells/100, the mother's volume is assumed to be 5,000 mL. The percentage must be multiplied by 50 to determine total volume.)
147) What is the most appropriate interpretation for the laboratory data given below when an Rh-neg woman has an Rh-pos child? mother: 1 rosette/3 fields Positive Control.: 5 rosettes/3 fields Negative Control: no rosettes a. mother is not a candidate for RhIg b. mother need 1 vial RhIg c. mother need 2 vials RhIg d. the fetal maternal hemorrhage needs to be quantified
b (The rosette test is a qualitative test. When enzyme-treated cells are used as indicator cells, a negative test [indicating there was not an excessive bleed] can have up to 1 rosette per 3 fields. The mother needs to receive 1 vial of RhIg for a normal bleed.)
6) Below are the results of the history obtained from a prospective female blood donor: - age: 16 - temperature: 99.0F (37.2C) - Hct: 36% - history: tetanus toxoid immunization 1 week previously How many of the above results excludes this donor from giving blood for a routine transfusion? a. none b. 1 c. 2 d. 3
b. 1 (The Hct must be >38%. A donor may be 16 unless state law differs. Temperature must not exceed 99.5F/37.5C, blood pressure must be <180 mmHg systolic and <100 mmHg diastolic, pulse 50-100 unless an athlete [which can be lower]. Toxoids and vaccines from synthetic or killed sources have no deferral.)
1) The minimum Hgb concentration in a fingerstick from a male blood donor is: a. 12.0 g/dL (120 g/L) b. 12.5 g/dL (125 g/L) c. 13.5 g/dL (135 g/L) d. 15.0 g/dL (150 g/L)
b. 12.5 g/dL (125 g/L) (All donors, regardless of sex, require a minimum hemoglobin of 12.5 g/dL [125 g/L]. The value must not be performed on an earlobe stick.)
23) If the seal is entered on a unit of RBCs stored at 1 C to 6 C, what is the maximum allowable storage period in hours? a. 6 b. 24 c. 48 d. 72
b. 24 (If the seal is broken during processing, components are considered to be prepared in an open system, rather than a dosed system. The expiration time for Red Blood Cells in an open system is 24 hours)
42) A blood component prepared by thawing FFP at refrigerator temp and removing the fluid portion is: a. Plasma Protein Fraction b. Cryo AHF c. Factor IX Complex d. FP24
b. Cryo AHF (Cryoprecipitate is the fraction of plasma proteins that precipitate when FFP is slowly thawed at 1-6 C.)
38) Which of the following blood components must be prepared within 8 hrs. after phlebotomy: a. RBCs b. FFP c. Frozen rbcs d. Cryo AHF
b. FFP (Fresh Frozen Plasma [FFP] must be separated and frozen within 8 hours of Whole Blood collection.)
19) Which of the following is the correct storage temp for the component listed: a. Cryo AHF = 4 C b. FFP = -20 C c. Frozen RBC = -40 C d. Platelets = 37 C
b. FFP = -20 C (Fresh Frozen Plasma is stored at -18 C or below for 12 months.)
12) The western blot is a confirmatory test for: a. CMV antibody b. anti-HIV-1 c. HbsAg d. serum protein abnormality
b. anti-HIV-1 (Western blot uses purified HIV proteins to confirm reactivity in samples whose screening test for anti-HIV is positive.)
13) The test that is currently used to detect donors who are infected with the AIDS virus is: a. anti-HBc b. anti-HIV-1,2 c. HbsAg d. ALT
b. anti-HIV-1,2 (The causative agent for AIDS is the human immunodeficiency virus types 1 and 2.)
c (A serological test to confirm the ABO on all RBC units and Rh on units labeled as Rh-negative must be performed prior to transfusion. Any errors in labeling must be reported to the collection facility.)
169) The following test results are noted for a unit of blood labeled group A, Rh-neg, anti-A 4+ anti-B 0 anti-D 3+ What should be done next? a. transfuse as a group A, Rh-neg b. transfuse as a group A, Rh-pos c. notify the collecting facility d. discard the unit
134) The Liley method of predicting the severity of HDFN is based on the amniotic fluid: a. bilirubin concentration by standard methods b. change in optical density measured at 450nm c. Rh determination d. ratio of lecithin to sphingomyelin
b. change in optical density measured at 450nm (The change in optical density [absorbance] of amniotic fluid measured spectrophotometrically at 450 nm is calculated and plotted on the Liley graph according to the weeks gestation. The graph is divided into 3 zones, which predict the severity of HDFN and the need for intervention and treatment.)
10) During the preparation of Platelet Concentrates from whole blood, the blood should be: a. cooled towards 6 C b. cooled towards 20-24 C c. warmed to 37 C d. heated to 57 C
b. cooled towards 20-24 C (Platelets are prepared and stored at 20-24 C for optimum function.)
85) In a relationship testing case the child has a genetic marker that is absent in the mother and cannot be demonstrated in the alleged father. What type of paternity exclusion is this: a. indirect b. direct c. prior probability d. Hardy-Weinbery
b. direct (Direct exclusion of paternity is established when a genetic marker is present in the child but is absent from the mother and the alleged father.)
105) Which of the following is a characteristic of anti-i? a. associated with warm autoimmune hemolytic anemia b. found in the serum of patients with infectious mononucleosis c. detected at lower temps in the serum of normal individuals d. found only in the serum of group O individuals
b. found in the serum of patients with infectious mononucleosis (Patients with infectious mononucleosis often demonstrate potent examples of anti-i that are transient in nature.)
94) HLA antibodies are: a. naturally occurring b. induced by multiple transfusions c. directed against granulocyte antigen only d. frequently cause hemolytic transfusion reactions.
b. induced by multiple transfusions (HLA antibodies are formed in response to pregnancy, transfusion or transplantation and are therefore not naturally occurring. They are associated with febrile nonhemolytic transfusion reactions and TRALI. They are directed against antigens found on granulocytes and other cells such as platelets.)
36) Irradiation of a unit of RBC's is done to prevent the replication of donor: a. granulocytes b. lymphocytes c. red cells d. platelets
b. lymphocytes (Irradiation inhibits proliferation of T lymphocytes.)
108) Which of the following is a characteristic of anti-i? a. often associated with HDFN b. reacts best at room temp or 4 C c. reacts best at 37 C d. is usually IgG
b. reacts best at room temp or 4 C (Anti-i is an IgM antibody that reacts with cord cells and i adult cells. It is not associated with hemolytic disease of the newborn since IgM antibodies do not cross the placenta.)
109) The Kell antigen is: a. absent from the red cells of neonates b. strongly immunogenic c. destroyed by enzymes d. has a frequency of 50% in the random population
b. strongly immunogenic (The Kell antigen is highly immunogenic. It is present on the red cells of up to 9% of adults and neonates, and is not affected by enzymes.)
93) Anti-Sda is strongly suspected if: a. the patient has been previously transfused b. the agglutinates are mixed field and refractile c. the patient is group A or B d. only a small number of panel cells are reactive
b. the agglutinates are mixed field and refractile (Anti-Sda is an antibody to a high-prevalence antigen, which varies in strength from person to person. Most examples of anti-Sda characteristically present as small, mixed-field, retractile agglutinates that may have a shiny appearance when observed microscopically after the antiglobulin test.)
135) These lab results were obtained on maternal and cord blood samples: Mother: A- baby: AB+ DAT 3+ cord hemoglobin 10 g/dL Does the baby have HDFN? a. no, as indicated by the cord hemoglobin b. yes, although the cord hemoglobin is normal, the DAT indicates HDFN c. yes, the DAT and cord hemoglobin level both support HDFN d. no, a diagnosis of HDN cannot be established without cord bilirubin levels
c (A positive DAT on cord blood demonstrates the presence of maternal antibody coating the baby's red cells and indicates hemolytic disease of the newborn. Normal cord hemoglobin in newborns ranges from 14-20 g/L. A cord hemoglobin value of 10 g/L indicates anemia and supports the diagnosis of HDFN.)
67) The mating of an Xg(a+) man and a Xg(a-) women will only produce: a. Xg(a-)sons + Xg(a-) daughters b. Xg(a+)sons + Xg(a+)daughters c. Xg(a-) sons + Xg(a+) daughters d. Xg(a+) sons + Xg(a-) daughters
c. Xg(a-) sons + Xg(a+) daughters (The Xg blood group system is unique in that the gene encodes on the X chromosome. A negative mother would not have the Xg[a] to pass on. A positive father would, however, transmit the Xg[a] to all his daughters.)
106) In a case of cold autoimmune hemolytic anemia, the patient's serum would most likely react 4+ at immediate spin with: a. group A cells, B cells and O cells, but not his own cells b. cord cells but not his own or other adult cells c. all cells of a group O cell panel and his own cells d. only penicillin treated panel cells, not his own
c. all cells of a group O cell panel and his own cells (Anti-I is commonly found in all individuals, but when it causes hemolysis, the titer may be high and react at all temperatures. Cold agglutinin syndrome is mainly found in lymphoproliferative diseases.)
154) Rh immune globulin administration would not be indicated in an Rh-neg woman who has a: a. first trimester abortion b. husband who is Rh-pos c. anti-D titer of 1:4,096 d. mother having a positive DAT
c. anti-D titer of 1:4,096 (RhIg is of no benefit once a person has been actively immunized and has formed anti-D)
113) Anti-Fya is: a. usually a cold reactive agglutinin b. more reactive when tested with enzyme treated RBCs c. capable of causing hemolytic transfusion reactions d. often an auto agglutinin
c. capable of causing hemolytic transfusion reactions (Anti-Fya is an IgG antibody that reacts best at the AHG phase, does not react with enzyme-treated red cells, is capable of causing hemolytic disease of the newborn, and is not known to be an auto agglutinin.)
18) When platelets are stored on a rotator set on an open bench top, the ambient air temps. must be recorded: a. once a day b. twice a day c. every 4 hours d. every hour
c. every 4 hours (If storage devices do not have automated temperature recording, temperature must he manually monitored every 4 hours.)
88) Cells of the A3 subgroup will: a. react with Dolichos biflorus b. bE-with anti-A c. have a mixed field reaction with anti-A,B d. bE- with anti-H
c. have a mixed field reaction with anti-A,B (Mixed-field reactivity with anti-A and anti-A,B is a typical finding for A3 subgroups.)
37) Plastic bag overwraps are recommended when thawing FFP in a 37 C water bath. because they prevent: a. FFP bag from cracking b. water from slowly dialyzing across the bag membrane c. the entry ports from being contaminated with water d. the label from peeling
c. the entry ports from being contaminated with water (FFP thawed in a water bath should be protected so that entry ports are not contaminated with water. One can may use a plastic overwrap or keep ports above the water level.)
175) What is the most likely cause of the following ABO discrepancy? Cells: anti-A = 0 | anti-B = 0 serum: A1 cells = 0 | B cells= 0 a. recent transfusion with group O blood b. antigen depression due to leukemia c. false-neg cell typing due to rouleaux d. obtained from the heel stick of a 2 month old baby
d (ABO immunoglobulins develop at approximately 3 months of age, attain adult levels by age 10, and may, but not always, decline in titer in the elderly)
162) A patient in the immediate post bone marrow transplant period has a hematocrit of 21%. The red cell product of choice for this patient would be: a. packed b. saline washed c. micro aggregate filtered d. irradiated
d (Bone marrow transplant patients are at risk for transfusion-associated graft-vs-host disease [TA-GVHD] and therefore should receive irradiated blood products.)
151) A fetal maternal hemorrhage of 35 mL of fetal Rh-pos PACKED RBCs has been detected in an Rh-neg woman. How many vials of Rh immune globulin should be given a. 0 b. 1 c. 2 d. 3
d (One vial of Rh immune globulin protects against a fetomaternal hemorrhage of 15 mL of red cells, or 30 mL of Whole Blood. Divide the volume of fetomaternal hemorrhage [35 mL] by 15; round down to 2, then add 1 extra vial = 3 vials total.)
161) A 40 year old man with autoimmune hemolytic anemia due to anti-E has a hemoglobin level of 10.8 g/dL. This patient will most likely be treated with: a. whole blood b. RBCs c. FFP d. no transfusion
d (Transfusion should generally be avoided except in cases of life-threatening anemia. A hemoglobin of 10.8 g/dL [108 g/L] is not life-threatening, especially if the patient is not actively bleeding.)
27) Optimum storage temperature for platelets: a. -20 C b. -12 C c. 4 C d. 22 C
d. 22 C (The required temperature for storage of platelets is 20-24 C.)
30) Once thawed, FFP must be transfused within: a. 4 hrs. b. 8 hrs. c. 12 hrs. d. 24 hrs.
d. 24 hrs. (Once thawed, FFP is stored at 1-6C for up to 24 hours.)
22) Optimum storage temperature for RBCs: a. -80 C b. -20 C c. -12 C d. 4 C
d. 4 C (Red Blood Cells are stored at 1-6C.)
26) Platelets prepared in a polyolefin type container, stored at 22-24 C in 50 mL of plasma and gently agitated can be used for up to: a. 24 hrs. b. 48 hrs. c. 3 days d. 5 days
d. 5 days (Whole Blood-derived platelets are stored at 20-24 C with continuous gentle agitation. Platelets prepared by the PRP method may be stored for up to 5 days.)
114) Resistance to malaria is best associated with which of the following blood groups: a. Rh b. I/i c. P d. Duffy
d. Duffy (The Duffy glycoprotein on red cells is a receptor for the malarial parasite Plasmodium vivax. Red cells with the phenotype Fy[a-b-] are resistant to invasion by P vivax.)
14) A commonly used screening method for anti-HIV detection is: a. latex agglutination b. RIA c. TLC d. ELISA
d. ELISA (The enzyme-labeled immunosorbent assay [ELISA] method is a very sensitive method employed to screen donors for markers of transfusion-transmitted viruses.)
129) Which of the following antigens in most likely to be involved in HDFN. a. Lea b. P1 c. M d. Kell
d. Kell (HDFN is caused by maternal IgG antibodies. Outside the Rh system, the most clinically significant antibody for HDFN is anti-K. IgM antibodies do not cross the placenta.)
8) Prior to blood donation, the intended venipuncture site must be cleaned with a scrub solution of: a. hypochlorite b. isopropyl alcohol c. 10% acetone d. PVP iodine complex
d. PVP iodine complex (The scrub must use iodine, eg, PVP iodine complex. Donors who are sensitive to iodine can have the area cleaned with a preparation of 2% chlorhexidine and 70% isopropyl alcohol.)
126) An obstetrical patient has had 3 previous pregnancies. her 1st baby was healthy, the 2nd was jaundiced at birth and required and exchange transfusion, while the 3rd was stillborn. Which of the following is the most likely cause: a. ABO incompatibility b. immune deficiency disease c. congenital spherocytic anemia d. Rh incompatibility
d. Rh incompatibility (HDFN is caused by maternal antibody crossing the placenta and destroying fetal antigen-positive red cells. Unlike ABO antibodies, which are naturally-occurring and can affect the first pregnancy, Rh antibodies are not produced until the mother has been exposed to Rh-positive red cells, usually during delivery of the first Rh-positive child Once immunized, subsequent pregnancies with Rh-positive infants are affected, usually with increasing severity.)
90) Even in the absence of prior transfusion or pregnancy, individuals with the Bombay phenotype will always have naturally occurring: a. anti-Rh b. anti-K0 c. anti-U d. anti-H
d. anti-H (Bombay phenotypes [Oh] lack H antigen on their red cells, and produce naturally occurring anti-H in their serum.)
66) Most blood group systems are inherited as: a. sex-linked dominant b. sex-linked recessive c. autosomal recessive d. autosomal codominant
d. autosomal codominant (Blood group genes are autosomal; they are not carried on the sex gene. Whenever the gene is inherited, the antigen is expressed on the red blood cells, which is known as codominant.)
4) Which of the following constitutes permanent rejection status of a donor? a. a tattoo 5 months ago b. recent close contact with a patient with viral hepatitis c. 2 units of blood transfused 4 months previously d. confirmed positive test for HbsAg 10 yrs. earlier
d. confirmed positive test for HbsAg 10 yrs. earlier (A positive test for HbsAg at any time is an indefinite deferral.)
95) Genes of the major histocompatibility complex: a. code for HLA-A,HLA-B, and HLA-C antigens only b. are linked to genes in the ABO system c. are the primary genetic sex-determinants d. contribute to the coordination of cellular and humoral immunity
d. contribute to the coordination of cellular and humoral immunity (MHC consists of both class I and class II HLA antigens. Discrimination of self from nonself is the primary function of the HLA system and involves many immune responses.)
99) Which of the following Rh antigens has the highest frequency in Caucasians: a. D b. E c. c d. e
d. e (The overall incidence of the e antigen is 98%. The overall incidence of c is 80%, D is 85% and E is 30%.)
97) Saliva from which of the following individuals would neutralize an auto anti-H in the serum of a group A, Le(a-b+) patient: a. group A, Le(a-b-) b. group A, Le(a+b-) c. group O, Le(a+b-) d. group O, Le(a-b+)
d. group O, Le(a-b+) (Group O have the most H substance in their saliva. The person must also be a secretor of ABH substances. Due to gene interaction between the secretor gene and Lewis gene, people who are Le[a-b+] assures H in their saliva.)
59) The linked HLA genes on each chromosome constitutes a (an): a. allele b. trait c. phenotype d. haplotype
d. haplotype (The entire set of HLA antigens located on one chromosome is a haplotype.)
128) ABO hemolytic disease of the newborn: a. usually requires an exchange transfusion b. most often occurs in 1st born children c. frequently results in stillbirth d. is usually seen only in the newborn of group O mothers
d. is usually seen only in the newborn of group O mothers (ABO HDFN is a mild disease, not usually requiring transfusion. It may occur in any pregnancy in which there is ABO incompatibility. High-titered IgG antibodies are more frequently seen in group O mothers than in A or B mothers.)
83) In relationship testing a "Direct exclusion" is established when a genetic marker is: a. absent in child, present in mother and alleged father b. absent in child, present in mother and absent in alleged father c. present in child, absent in mother and present in father alleged father d. present in child, absent in the mother and alleged father
d. present in child, absent in the mother and alleged father (When a marker is in a child that the mother and alleged father do not have the alleged father cannot be the biological father of the child. This is a direct exclusion.)
43) Upon inspection, a unit of platelets is noted to have visible clots, but otherwise appears normal. the tech should: a. issue without concern b. filter to remove clots c. centrifuge to express off the clots d. quarantine for gram stain and culture
d. quarantine for gram stain and culture (Clots in the unit may indicate contamination.)
137) Which unit should be selected for exchange transfusion if the newborn is group A, Rh pos. and the mother is Group A, Rh pos. with anti-c? a. A, CDe/CDe b. A, cDE/cDE c. O, cde/cde d. A, cde/cde
a (Blood for an exchange transfusion should lack the antigen to any maternal antibodies that have entered the infant's circulation and are reactive at 37 C or AHG.)
140) A blood specimen from a pregnant woman is found to be group B, Rh neg. and the serum contains anti-D with a titer of 512. What would be the most appropriate type of blood to have available for a possible exchange transfusion for her infant? a. O, Rh-neg b. O, Rh-pos c. B, Rh-neg d. B, Rh-pos
a (Blood selected for exchange transfusion should be ABO-compatible with the mother and baby, and antigen-negative. Prenatal antibody titers above 16 or 32 are considered significant, and the condition of the fetus should be monitored.)
141) Blood selected for exchange transfusion must: a. lack RBC antigens corresponding to maternal antibodies b. be <3 days old c. be the same Rh as the baby d. be ABO compatible with the father
a (Blood selected for exchange transfusion should be antigen-negative and ABO compatible with the mother and baby. Red Blood Cells are usually less than 7 days old, CMV-, hemoglobin S-, and irradiated.)
165) Anti-E is identified in a panel at the antiglobulin phase. When check cells are added to the tubes no agglutination is seen. The most appropriate course of action would be to: a. quality control the AHG reagent and check cells and repeat the panel b. open a new vial of check cells for subsequent testing that day c. open a new vial of AHG for subsequent testing that day d. record the check cell reactions and report the antibody panel result
a (Negative check cells means the results of tubes with the negative reactions are invalid. The reactivity of the check cells should be verified with anti-IgG since anti-E was detected, indicating the anti-IgG was reactive. All tests that were nonreactive with the check cells requires repeat test performance.)
167) Which of the following represents an acceptably identified patient for sample collection and transfusion a. a handwritten band with patients name and hospital identification number is affixed to the patients leg b. the addressographed hospital band is taped to the patients bed c. an unbanded patient responds positively when his name is called d. the chart transported with the patient contains his armband not yet attached
a (Samples must be labeled with 2 independent patient identifiers and the date of collection. This information should be identical to that on the patient's identification band and request.)
158) The rosette test will detect a fetomaternal hemorrhage as small as: a. 10 mL b. 15 mL c. 20 mL d. 30 mL
a (The rosette test is a sensitive method to detect FMH of 10 mL or more.)
177) Which of the following is characteristic of Tn polyagglutinable red cells? a. if group O, they may appear to have acquired a group A antigen b. they show strong reactions when the cells are enzyme treated c. they react with Arachis hypogaea lectin d. the polyagglutination is a transient condition
a (Tn is caused from a somatic mutation and the phenomenon is persistent. Resolution of the red cell typing can be performed with enzyme-treated patient cells, since Tn is denatured by enzymes. Although the reactivity with anti-A may be weak, testing with anti-A1 lectin gives strong reactivity, unlike subgroups of A, which are weakly reacting with anti-A and nonreactive with A1 lectin.)
24) Optimum storage for Cryo AHF is: a. -20 C b. -12 C c. 4 C d. 22 C
a. -20 C (Cryoprecipitated AHF is stored at -18C or lower.)
32) In the liquid state, plasma must be stored at: a. 1 - 6 C b. 22 C c. 37 C d. 56 C
a. 1 - 6 C (The required temperature for storage of thawed plasma is 1-6C.)
28) According to AABB standards FFP must be infused within what period of time following thawing: a. 24 hrs. b. 36 hrs. c. 48 hrs. d. 72 hrs.
a. 24 hrs. (Per AABB standards, thawed FFP should be stored at 1-6 C for no more than 24 hours.)
25) Cryo AHF must be transfused within what period of time following thawing and pooling? a. 4 hrs. b. 8 hrs. c. 12 hrs. d. 24 hrs.
a. 4 hrs. (Cryoprecipitate must be transfused within 4 hours of pooling.)
132) A group A, Rh positive infant of a group O, Rh positive mother has a weakly positive DAT and moderately elevated bilirubin 12 hours after birth. the most likely cause is: a. ABO incompatibility b. Rh incompatibility c. blood group incompatibility due to and antibody to a low frequency antigen d. neonatal jaundice not associated with blood group
a. ABO incompatibility (ABO HDFN occurs most commonly in group A babies born to group O mothers and usually has a mild course. The DAT is typically weak or negative and jaundice develops 12-48 hours after birth. The mother and baby are both Rh-positive.)
63) Given the following typing results, what is the donors racial ethnicity: Le(a-b-) Fy(a-b-) Js(a+b+) a. African American b. Asian American c. Native American d. Caucasian
a. African American (Fy[a-b-] individuals are very rare with all populations other than the individual of African descent. 68% of African Americans are Fy[a-b-].)
121) A blood component used in the treatment of hemophilia A is: a. Factor VIII concentrate b. FFP c. Platelets d. Whole Blood
a. Factor VIII concentrate (Patients with severe hemophilia A may have spontaneous hemorrhages that are treated with Factor VIII concentrate.)
62) An individual has been sensitized to the k antigen and has produced anti-k. What is her most probable Kell system genotype: a. KK b. Kk c. kk d. K0K0
a. KK (This individual cannot have the k antigen on their cells. KOKO is rare and no Ken system antigens are detected on the red blood cells. Those individuals usually produce antibodies that are reactive with all normal cells. KK is the most probable genotype.)
103) Which of the following red cell antigens are found on glycophorin-A: a. M,N b. Lea, Leb c. S, s d. P, P1,pk
a. M,N (The M and N antigens are found on glycophorin A.)
130) ABO HDFN differs from Rh HDFN in that: a. Rh HDFN is clinically more severe that ABO HDFN b. the DAT test is weaker in Rh HDFN than ABO c. Rh HDFN occurs in the 1st pregnancy d. the mother's antibody screen is positive in ABO HDFN
a. Rh HDFN is clinically more severe that ABO HDFN (ABO HDFN is a mild disease that may occur in any ABO-incompatible pregnancy, including the first, since the antibodies are naturally occurring Rh HDFN does not occur until the mother has become immunized. Once this happens, subsequent pregnancies may be quite severely affected. The DAT is typically weak or even negative in ABO HDFN, and strongly positive in Rh HDFN.)
91) The antibody in the Lutheran system that is best detected at lower temps: a. anti-Lua b. anti-Lub c. anti-Lu3 d. anti-Luab
a. anti-Lua (Most examples of anti-Lua agglutinate saline suspended cells. Most examples of anti-Lub are IgG and reacts at 37 C. Anti-Lu3 usually reacts at the AHG phase as does anti- Luab.)
65) In an emergency situation, Rh-neg. red cells are transfused into a Rh-pos person of the genotype CDe/CDe. the first antibody most likely to develop is: a. anti-c b. anti-d c. anti-e d. anti- E
a. anti-c ( The most common genotype in Rh-negative individuals is rr. Anti-e would not be formed because the recipient's red cells contain the e antigen. The first antibody most likely to develop would be anti-c.)
172) A neonate will be transfused for the first time with group O Red Blood Cells. Which of the following is appropriate compatibility testing? a. crossmatch with mothers serum b. crossmatch with baby's serum c. no crossmatch is necessary if initial plasma screening is negative d. no screening or crossmatching is necessary for neonates
c (Because neonates are immunologically immature, alloimmunization to red cell antigens is very rare during the neonatal period. No crossmatching is required if the initial antibody screen performed with either the baby's or mother's plasma is negative.)
142) When the main objective of an exchange transfusion is to remove the infant's antibody-sensitized RBCs and to control hyperbilirubinemia, the blood product of choice is ABO compatible: a. FFP b. RBCs washed c. RBC suspended in FFP d. heparinized RBCs
c (For exchange transfusion, antigen- negative Red Blood Cells are typically resuspended in ABO-compatible thawed Fresh Frozen Plasma.)
174) The following reaction were obtained: cells tested: anti-A = 4+| anti-B = 3+| anti-A,B = 4+ serum test: A1 cells = 2+ | B cells = 4+ The technologist washed the patients cells with saline and repeated the forward typing. A saline replacement technique was used with the reverse typing. the following results were obtained: cells tested: anti-A = 4+ | anti-B = 0 | anti-A,B = 4+ serum test: A1 cells = 0 | B cells = 4+ the results are consistent with: a. acquired immunodeficiency disease b. Bruton agammaglobulinemia c. multiple myeloma d. acquired "B" antigen
c (Patients with multiple myeloma demonstrate rouleaux formation, which can cause the appearance of agglutination. If the cells are washed to remove residual plasma, and tests repeated, an accurate red cell typing is obtained. By performing a saline replacement with the reverse typing, true agglutination will remain when the cell buttons of the reverse cells are resuspended in saline.)
152) Criteria determining Rh immune globulin eligibility include: a. mother is Rh-pos b. mother is Rh-neg c. mother has not been previously immunized to the D antigen d. infant has a positive DAT
c (RhIg should be given to nonimmunized D- females who are pregnant or have delivered a D+ infant.)
170) What information is essential on patient blood sample labels drawn for compatibility testing? a. biohazard sticker for AIDS patients b. patients room number c. unique patient medical # d. phlebotomist initials
c (Samples must be labeled with 2 independent patient identifiers and the date of collection. This information should be identical to that on the patients identification band and request. There must be a mechanism to identify the phlebotomist, but initialing the sample tubes is not required.)
29) Cryo AHF, if maintained in the frozen state at -18 C or below, has a shelf life of: a. 42 days b. 6 months c. 12 months d. 36 months
c. 12 months (Cryoprecipitate has a shelf life of 12 months in the frozen state.)
178) Mixed field agglutination encountered in ABO grouping with no history of transfusion would most likely be due to: a. Bombay phenotype (Oh) b. T activation c. A3 red cells d. positive IAT
c. A3 red cells (Mixed-field reactivity is a characteristic of the A3 subgroup. Transfusion history would be important to be sure it is not 2 cell populations.)
75) Which of the following red cell typings are most commonly found in the African Americans: a. Lu(a-b-) b. Jk(a-b-) c. Fy(a-b-) d. K-k-
c. Fy(a-b-) (the Fy[a-b-] phenotype occurs in 68% of the population of African descent, but is extremely rare in the other ethnic backgrounds. Lu[a-b-], Jk[a-b-] and K-k- are very rare in all ethnic backgrounds.)
112) Proteolytic enzyme treatment of red cells usually destroys which antigen? a. Jka b. E c. Fya d. k
c. Fya (The Fya and Fyb antigens are sensitive to denaturation by proteolytic enzymes. Serum containing anti-Fya reacts with untreated Fy[a+] cells, but not with enzyme treated Fy[a+] cells.)
107) Cold agglutinin syndrome is associated with an antibody specificity toward which of the following: a. Fy:3 b. P c. I d. Rh:1
c. I (Anti-I is associated with cold agglutinin syndrome.)
87) Human blood groups were discovered around 1900 by: a. Jules Bordet b. Louis Pasteur c. Karl Landsteiner d. PL Mollison
c. Karl Landsteiner (The ABO blood group system was discovered by Karl Landsteiner.)
70) The red cells of a nonsecretor will most likely type as: a. Le(a-b-) b. Le(a+b+) c. Le(a+b-) d. Le(a-b+)
c. Le(a+b-) (The Lewis antigens are developed by gene interaction. Both the Lewis and Secretor gene are required for red cells to type as Le[a-b+]. If a person has a Lewis gene, but not Secretor gene, then the cells type as Le[a+b-]. The Le[a-b-] phenotype is derived when the Lewis gene is absent and the Secretor gene may or may not be present. The Le[a+b-] phenotype occurs in 22% of the population, and Le[a-b-] occurs in 6%, so the most likely phenotype of a nonsecretor [se/se] is Le[a+b-].)
61) A blood donor has the genotype: hh, AB. what is his RBC phenotype? a. A b. B c. O d. AB
c. O (The A and B structures cannot be developed since there is no H precursor substance due to the lack of the H gene in the blood donor.)
104) Paroxysmal cold hemoglobinuria is associated with antibody specificity toward which of the following: a. Kell system antigens b. Duffy system antigens c. P antigen d. I antigen
c. P antigen (Autoanti-P, a cold-reactive IgG autoantibody described as a biphasic hemolysin, is associated with paroxysmal cold hemoglobinuria.)
74) A women types as Rh-pos. She has an anti-c titer of 32 at AHG. Her baby has a negative DAT and is not affected by HDFN. What is the fathers most likely Rh phenotype. a. rr b. r"r c. R1r d. R2r
c. R1r (The baby appears to lack c since no HDFN was evident. The mom is most likely R1R1, so had to pass R1 onto the baby. The father must have passed on an Rh gene that also did not produce c, Given the choices, the father has to be R1r.)
76) 4 units of blood are needed for elective surgery. the patient serum contains anti-C, anti-e, anti-Fya and anti-Jkb. Which of the following would be the best source of donor blood: a. test all units in current stock b. test 100 group O Rh-neg c. test 100 group compatible donors d. rare donor file
d. rare donor file (The frequency of compatible donors for this patient can be calculated by multiplying the percentage of the population that is e-C- x Fy[a-] x Jk[b-]. The blood supplier's immunohematology reference laboratory may have units in stock or can request blood from other IRLs through the American Rare Donor Program.)
20) A unit of RBCs is issued at 9 am and at 9:10 am it is returned to the blood bank. the container has NOT been entered but the unit has NOT been refrigerated during this time span. the best course of action for the tech is to: a. culture the unit for bacteria b. discard the unit if not used within 24 hrs. c. store the unit at room temp d. record the return and place the unit back into inventory
d. record the return and place the unit back into inventory (Blood may be returned to the blood bank after issue provided that 1] the container has not been entered, 2] at least 1 sealed segment is attached to the container, 3] visual inspection of the unit is satisfactory and documented, and 4] the unit has been maintained at the appropriate storage or transport temperature. Studies have shown that refrigerated components retain an acceptable temperature of <10 C for up to 30 minutes after removal from the refrigerator.)
9) All donors blood testing must include: a. complete Rh phenotype b. anti-CMV testing c. DAT d. serological test for syphilis
d. serological test for syphilis (Testing tor syphilis was the first mandated donor screening test for infectious disease and is still part of donor screening.)
16) A unit of packed cells is split into 2 aliquots under closed sterile conditions at 8 am. The expiration time for each aliquot is: a. 4 pm the same day b. 8 pm the same say c. 8 am the next morning d. the original date of the unsplit unit
d. the original date of the unsplit unit (Sterile docking devices allow entry into donor units without affecting the expiration date of the product.)
