BOC Blood Bank_4

a (Febrile nonhemolytic transfusion reactions are defined as fever of 1C or greater [over baseline temperature] during or after transfusion, with no other reason for the elevation than transfusion, and no evidence of hemolysis in the transfusion reaction investigation.)

310) A temperature rise of 1 C or more occurring in association with a transfusion, with no abnormal results in the transfusion reaction investigation. usually indicates which of the following reactions? a. febrile b. circulatory overload c. hemolytic d. anaphylactic

c (Apheresis [single donor] Platelets should contain at least 3.0 x 10^11 platelets, be stored with continuous agitation at 20-24 C, and have a pH of 6.2 or higher when tested at the end of the storage period.)

50) Platelets prepared by apheresis should contain at least: a. 1 x 10^10 platelets b. 3 x 10^10 platelets c. 3 x 10^11 platelets d. 5 x 10^11 platelets

c (Two distinguishing features or anaphylactic transfusion reactions are that symptoms occur with transfusion of only small amounts of blood, and the patient has no fever.)

307) Which of the following transfusion reactions occurs after infusion of only a few milliliters of blood and gives no history of fever? a. febrile b. circulatory overload c. anaphylactic d. hemolytic

d (Febrile nonhemolytic transfusion reactions are defined as fever of 1C or greater [over baseline temperature] during or after transfusion, with no other reason for the elevation than transfusion, and no evidence of hemolysis in the transfusion reaction investigation. Allergic reactions, citrate toxicity, and circulatory overload are not characterized by fever.)

308) Fever and chills are symptoms of which of the following transfusion reactions? a. citrate toxicity b. circulatory overload c. allergic d. febrile

b (Allergic reactions are a type 1 immediate hypersensitivity reaction to an allergen in plasma. Most are mild reactions shown by urticaria [hives, swollen red wheals] which may cause itching.)

309) Hives and itching are symptoms of which of the following transfusion reactions? a. febrile b. allergic c. circulatory overload d. bacterial

d (After performing rule outs, the most likely antibody is anti-c. To form anti-c, the patient would need to inherit a gene from both parents that does not produce the c antigen. The most common gene that codes for no antigen is denoted as R1.)

118) A 25-year-old Caucasian woman, gravida 3, para 2, required 2 units of Red Blood Cells. The antibody screen was positive and the results of the antibody panel are shown below: What is the most probable genotype of this patient? a. rr b. r'r' c. R0r d. R1R1

b (Care must be taken so that fetal Rh-positive RBCs in the maternal circulation are not interpreted as maternal, because the mother would be assumed erroneously to be weak D+.)

145) Rh-Immune Globulin is requested for an Rh-negative mother who has the following results: What is the most likely explanation? a. mother is a genetic weak D b. mother had a fetomaternal hemorrhage of D+ cells c. mother's red cells are coated weakly with IgG d. anti-D reagent is contaminated with an atypical antibody

d (The presence of D+ infant's red cells in the mother's circulation can cause the weak D test to show mixed-field agglutination. Care must be taken so that fetal Rh-positive RBCs in the maternal circulation are not interpreted as maternal, because the mother would be assumed erroneously to be weak D+.)

146) The following results are seen on a maternal postpartum sample: The most appropriate course of action is to: a. report the mother as Rh-negative b. report the mother as Rh-positive c. perform an elution on mother's RBCs d. investigate for a fetomaternal hemorrhage

c (The weak D result is most likely due to excessive bleed of fetal cells. Rosette results indicate a quantitative test for approximate volume of fetal-maternal bleed should be performed.)

148) What is the best interpretation for the laboratory data given above? a. mother is Rh-positive b. mother is weak D+ c. mother has had a fetal-maternal hemorrhage d. mother has a positive DAT

c (Use the formula: [fetal cells counted/ cells counted] x [maternal blood volume]. Assume the mother's blood volume is 5,000 mL. In this example, 30 fetal cells/2,000 cells counted x 5,000 mL = 75 mL. RhIg protects against 30 mL. So 2.5 vials are needed, rounded up to 3 full vials. Add 1 vial for hospital policy and 4 vials are needed.)

157) An acid elution stain was made using a 1-hour post-delivery maternal blood sample. Out of 2,000 cells that were counted, 30 of them appeared to contain fetal hemoglobin. It is the policy of the medical center to add 1 vial of Rh immune globulin to the calculated dose when the estimated volume of the hemorrhage exceeds 20 mL of whole blood. Calculate the number of vials of Rh immune globulin that would be indicated under these circumstances. a. 2 b. 3 c. 4 d. 5

d (The major cause of transfusion associated fatalities is transfusion of blood to the wrong patient.)

330) The most important step in the safe administration of blood is to: a. perform compatibility testing accurately b. get an accurate patient history c. exclude disqualified donors d. accurately identify the donor unit and recipient

d (Results of ABO and Rh testing on a current specimen must always be compared to that of a previous transfusion record. Errors in typing or patient identification may be detected when discrepancies are found. Collection of a new sample allows determination of which sample was incorrectly collected.)

168) Samples from the same patient were received on 2 consecutive days. Test results are summarized below: How should the request for crossmatch be handled? a. crossmatch A, Rh-positive units with sample from day 1 b. crossmatch B, Rh-positive units with sample from day 2 c. crossmatch AB, Rh-positive units with both samples d. collect a new sample and repeat the tests

d (Sterile docking devices allow entry into donor units without affecting the expiration date of the product.)

17) A unit of Red Blood Cells expiring in 35 days is split into 5 small aliquots using a sterile pediatric quad set and a sterile connecting device. Each aliquot must be labeled as expiring in: a. 6 hours b. 12 hours c. 5 days d. 35 days

b (Acquired B occurs in group A individuals and is due to deacetylation of the A antigen by bacterial enzymes. Detection of acquired B is dependent upon the source of anti-B used.)

176) Which of the following patient data best reflects the discrepancy seen when a person's red cells demonstrate the acquired-B phenotype? a. A b. B c. C d. D

c (Presence of agglutination with A1 cells, screening cells and autocontrol at IS and RT is indicative of a cold autoantibody.)

180) Consider the following ABO typing results: What is the most likely cause of this discrepancy? a. A2 with anti-A1 b. cold alloantibody c. cold autoantibody d. acquired-A phenomenon

d (Unexpected reactivity with reverse cells should include a test with screen cells at immediate spin to determine if alloantibodies are present. Resolution of the ABO discrepancy can be performed with group B cells that lack the corresponding antigen for the identified alloantibody.)

182) The following results were obtained on a patient's blood sample during routine ABO and Rh testing: Select the course of action to resolve this problem: a. draw a new blood sample from the patient and repeat all test procedures b. test the patient's serum with A2 cells and the patient's red cells with anti-Al lectin c. repeat the ABO antigen grouping using 3x washed saline-suspended cells d. perform antibody screening procedure at immediate spin using group 0 cells

b (Reaction with anti-IgG in the DAT and with both screening cells and autocontrol at the AHG phase is indicative of a warm autoantibody.)

192) Refer to the following data: - hemoglobin: 7.4 g/dL (74 g/L) - reticulocyte count: 22% Which clinical condition is consistent with the lab results shown above? a. cold hemagglutinin disease b. warm autoimmune hemolytic anemia c. penicillin-induced hemolytic anemia d. delayed hemolytic transfusion reaction

a (The patient has a negative antibody screen, but one unit is found to be incompatible. The antibody is most likely directed towards a low-incidence antigen.)

196) A 42-year-old female is undergoing surgery tomorrow and her physician requests that 4 units of Red Blood Cells be crossmatched. The following results were obtained: What is the most likely cause of the incompatibility of donor 1? a. single alloantibody b. multiple alloantibodies c. Rh incompatibilities d. donor 1 has a positive DAT

a (Antibodies to antigens on cells 2, 3, 4, and 5 can be ruled out in tubes II and III, in which there was no reaction between patient serum and cells.)

209) An antibody identification study is performed with the 5-cell panel shown below: An antibody against which of the following antigens could not be excluded? a. 1 b. 2 c. 3 d. 4

c (An ABO discrepancy in an A1 individual, manifested by agglutination in the serum grouping with A2 cells, is most likely due to anti-H. The greatest concentration of H substance is found on O cells, followed by A2 cells. The least amount of H substance is found on Al and AIB cells.)

215) The ABO discrepancy seen above is most likely due to: a. anti-A1 b. rouleaux c. anti-H d. unexpected IgG antibody present

b (Reactivity at 37C and AHG indicate the presence of an IgG antibody. Anti-M, although usually IgM, may be partly or wholly IgG. Anti-M is ruled out on cell4. Anti-Leb is usually IgM and can be ruled out on cells 4 and 8. This leaves anti-E, anti-Fya and anti-K.)

216) Based on the results of the above panel, the most likely antibodies are: a. anti-M and anti-K b. anti-E, anti-Jka and anti-K c. anti-Jka and anti-M d. anti-E and anti-Leb

b (In cold agglutinin syndrome, anti-I acts as a complement binding antibody with a high titer and high thermal amplitude. the complement cascade is activated and C3d remains on the red cell membrane of circulating cells.)

221) Anti-I may cause a positive direct antiglobulin test (DAT) because of: a. anti-I agglutinating the cells b. C3d bound to the red cells c. T-activation d. C3c remaining on the red cells after cleavage of C3b

c (Methyldopa is frequently listed as the prototype for drug-independent antibody mechanism where autoantibody is present on the red cells and may also be present in the plasma.)

230) Which of the following medications is most likely to cause production of autoantibodies? a. penicillin b. cephalothin c. methyldopa d. tetracycline

b (Patients may have antibodies to components of reagents. Washing the patient's cells prior to testing to remove their plasma from the cell suspension will resolve the reactivity with anti-B.)

238) In a prenatal workup, the following results were obtained: ABO discrepancy was thought to be due to an antibody directed against a component of the typing sera. Which test would resolve this discrepancy? a. A1 lectin b. wash patient's RBCs and repeat testing c. anti-A,B and extend incubation of the reverse group d. repeat reverse group using A2 cells

a (Enzyme treatment would allow for differentiation of the remaining antibodies after rule outs. The Fya antigen would be denatured, allowing determination of whether anti-Jka and -K are present, and to confirm anti-E.)

239) Based on the results of the above panel, which technique would be most helpful in determining antibody specificity? a. proteolytic enzyme treatment b. urine neutralization c. autoadsorption d. saliva inhibition

b (Anti-Leb is confirmed because the tubes with Lewis substance are negative. Nonreactivity of the serum with Le[b+] cells indicates the anti-Leb in the serum was neutralized by the Lewis substance. The test is valid since the patient's serum with saline rather than substance added is still able to react with the Le[b+] cells.)

243) To confirm the specificity of anti-Leb, an inhibition study using Lewis substance was performed with the following results: What conclusion can be made from these results? a. a second antibody is suspected due to the positive control b. anti-Leb is confirmed because the tubes with Lewis substance are negative c. anti-Leb is not confirmed because the tubes with Lewis substance are negative d. anti-Leb cannot be confirmed because the saline positive is control

d (Polyagglutination is a property of the red blood cells. Structures on the red cells are altered due to bacterial enzymes or a somatic mutation, so crypt antigens not normally exposed on cells are now present. Antibodies to the exposed structures are naturally occurring in adult plasma.)

248) Which one of the following is an indicator of polyagglutination? a. RBCs typing as weak D+ b. presence of red cell autoantibody c. decreased serum bilirubin d. agglutination with normal adult ABO compatible sera

d (Since the auto control is positive after the AHG phase and no reactivity was detected at immediate spin, the serology is most consistent with a warm autoantibody. An adsorption with autologous cells to remove the antibody to used the adsorbed plasma for alloantibody detection is the next step.)

255) A 26-year-old female is admitted with anemia of undetermined origin. Blood samples are received with a crossmatch request for 6 units of Red Blood Cells, The patient is group A, Rh-negative and has no history of transfusion or pregnancy. The following results were obtained in pretransfusion testing: The best way to find compatible blood is to: a. do an antibody identification panel b. use the saline replacement technique c. use the pre-warm technique d. perform a warm autoadsorption

c (Lack of expected rise in hemoglobin after transfusion may be a sign of a delayed hemolytic transfusion reaction. If the DAT is positive, an elution should be performed to remove and identify the antibody coating the transfused donor red cells. In this case, the antibody is not detectable in the antibody screen, so a routine cell panel on the serum would not be helpful. Since the transfusion occurred 3 weeks previously, donor samples are not available for testing.)

299) A patient is readmitted to the hospital with a hemoglobin level of 7 g/dL (70 g/L) 3 weeks after receiving 2 units of red cells. The initial serological tests are: Which test should be performed next? a. antibody identification panel on the patient's serum b. repeat the ABO type on the donor units c. perform an elution and identify the antibody in the eluate d. crossmatch the post reaction serum with the 3 donor units

c (Leukocyte-Reduced RBCS and Platelets can be used to prevent further nonhemolytic transfusion reactions.)

304) The use of Leukocyte-Reduced Red Blood Cells and Platelets is indicated for which of the following patient groups? a. CMV-seropositive postpartum mothers b. victims of acute trauma with massive bleeding c. patients with history of febrile transfusion reactions d. burn victims with anemia and low serum protein

d (Febrile nonhemolytic transfusion reactions occur in about 1% of transfusions, making it one of the most common types of reaction. Neither transfusion-associated circulatory overload [TACO] or anaphylactic transfusion reactions are characterized by fever. Bacterially contaminated Red Blood Cells are rare, and rapidly produce severe symptoms upon transfusion.)

311) A 65 yr. old woman experienced shaking, chill, and a fever of 102 F (38.9 C) approximately 40 minutes following the transfusion of a second unit of RBCs. The most likely explanation for the patient's symptoms is: a. transfusion of bacterial contaminated blood b. congestive heart failure c. anaphylactic transfusion reaction d. febrile transfusion reaction

d (Febrile nonhemolytic transfusion reactions are caused by leukoagglutinins in the patient or cytokines released from donor leukocytes during storage. Since these reactions are not caused by red cell antibodies, transfusion investigation studies show no hemolysis or abnormal test results.)

312) A sickle cell patient who has been multiply transfused experiences fever and chills after receiving a unit of RBCs. Transfusion investigation studies show: DAT: neg Plasma hemolysis: none The patient is most likely reacting to: a. IgA b. plasma protein c. red cells d. white cells or cytokines

d (Noncardiogenic pulmonary edema, dyspnea, hypotension, and hypoxemia occurring within 6 hours of transfusion are clinical symptoms of TRALI.)

315) Symptoms of dyspnea, cough, hypoxemia, and pulmonary edema within 6 hrs. of transfusion is most likely which type of reaction? a. anaphylactic b. hemolytic c. febrile d. TRALI

a (Anaphylactic transfusion reactions are severe reactions that occur after infusion of a small amount of donor blood. Symptoms are hypotension, shock, respiratory distress dyspnea, and substernal pain. Anaphylactic reactions are usually caused by anti-IgA.)

316) A patient with a coagulopathy was transfused with FP24 (FFP within 24 hrs. of collection). After infusion of 15 mL, the patient experienced hypotension, shock, chest pain and difficulty in breathing. The most likely cause of the reaction is: a. anti-IgA b. bacterial contamination c. intravascular hemolysis d. leukoagglutinins

c (Leukoreduction of blood products reduces the risk of febrile nonhemolytic transfusion reactions, which are caused by leukoagglutinins or cytokines from white cells.)

317) To prevent febrile transfusion reactions, which RBC product should be transfused? a. RBCs irradiated b. CMV-neg RBC's c. RBCs, leukocyte reduced d. IgA-deficient donor blood

d (One reason to quarantine blood components before transfusion is hemolysis of the red cells. Hemolysis of red cells is an indication of contamination or improper storage.)

318) During the issue of an autologous unit of Whole Blood, the supernatant plasma is observed to be dark red in color. What would be the best course of action? a. the unit may be issued only for autologous use b. remove the plasma and issue the unit as RBC's c. issue the unit only as washed RBC's d. quarantine the unit for further testing

c (Transfusion-associated circulatory overload [TACO] is hypervolemia manifested by coughing, cyanosis, and pulmonary edema.)

319) Coughing, cyanosis and difficult breathing are symptoms of which of the following transfusion reactions? a. febrile b. allergic c. circulatory overload d. hemolytic

c (Transfusion-associated circulatory overload [TACO] is hypervolemia caused by blood transfusion in susceptible patients. Hemolytic [antibody to red cell antigen], febrile NHTR [leukoagglutinins or cytokines], and allergic [reaction to allergens in plasma] are immunologic reactions.)

320) Which of the following is a nonimmunologic adverse effect of a transfusion? a. hemolytic reaction b. febrile nonhemolytic reaction c. congestive heart failure d. urticaria

d (Transfusion-induced hypervolemia causing edema and congestive heart failure is a feature of transfusion-associated circulatory overload [TACO]. Hypervolemia is not a complication of a hemolytic, febrile, or anaphylactic transfusion reaction.)

321) Congestive heart failure, severe headache and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion reaction? a. hemolytic b. febrile c. anaphylactic d. circulatory overload

b (Hypervolemia due to transfusion in susceptible patients, such as cardiac, elderly, infants, or severely anemic, causes circulatory overload [TACO] and associated respiratory and cardiac problems)

322) A patient with severe anemia became cyanotic and developed tachycardia, hypertension, and difficulty breathing after receiving 3 units of blood. No fever or other symptoms were evident. this is most likely what type of reaction? a. febrile b. transfusion-associated circulatory overload (TACO) c. anaphylactic d. hemolytic

a (Septic transfusion reactions due to contaminated blood products are manifested by high fever, chills, hypotension, shock, nausea, diarrhea, renal failure, and DIC. Symptoms usually appear rapidly. Transfusion reaction investigation shows no evidence of unexpected blood group antibodies. A Gram stain and blood culture of the donor unit may detect the presence of aerobic or anaerobic organisms.)

323) A patient became hypotensive and went into shock after receiving 50 mL of a unit of RBCs. She had a shaking chill and her temperature rose to 104.8 F (40.0 C). A transfusion reaction investigation was initiated but no abnormal results were seen. What additional testing should be performed? a. gram stain and culture of the donor unit b. lymphocytotoxicity tests for leukoagglutinins c. plasma IgA levels d. elution and antibody screen

c (Hepatitis transmission is unlikely, but has a higher risk of transmission through blood transfusion than CMV [rare], syphilis [no transfusion-transmitted cases reported in >30 years], or HIV [1:2,300,000 units].)

324) The most frequent transfusion-associated disease complication of blood transfusion is: a. cytomegalovirus (CMV) b. syphilis c. hepatitis d. AIDS

b (Irradiation inhibits proliferation of T cells and subsequent GVHD.)

325) The purpose of a low-dose irradiation of blood components is to: a. prevent posttransfusion purpura b. prevent graft-vs-host disease c. sterilize components d. prevent noncardiogenic pulmonary edema

c (Gamma irradiation of blood products prevents donor lymphocytes from replicating after transfusion and causing transfusion associated graft-vs-host disease in susceptible patients.)

327) Irradiation of donor blood is done to prevent which of the following adverse effects of transfusion? a. febrile transfusion reaction b. CMV c. transfusion associated graft-vs-host disease d. transfusion related acute lung injury (TRALI)

b (Whole blood-derived [random donor] Platelets should contain at least 5.5 x 10^10 platelets, be stored with continuous agitation at 20-24 C, and have a pH of 6.2 or higher when tested at the end of the storage period.)

49) A unit of Whole Blood-derived (random donor) Platelets should contain at least: a. 1.0 x 10^10 platelets b. 5.5 x 10^10 platelets c. 5.5 x 10^11 platelets d. 90% of the platelets from the original unit of Whole Blood

a (The apheresis process is to remove whole blood, the desired component removed, and the remaining portion of blood returned to the donor/patient.)

53) A father donating platelets for his son is connected to a continuous flow machine, which uses the principle of centrifugation to separate platelets from whole blood. As the platelets are harvested, all other remaining elements are returned to the donor. This method of platelet collection is known as: a. apheresis b. autologous c. homologous d. fractionation

b (Autologous donors have less stringent criteria than allogeneic donors. Donations must be collected at least 72 hours prior to surgery.)

54) To qualify as a donor for autologous transfusion a patient's hemoglobin should be at least: a. 8 g/dL (80 g/L) b. 11 g/dL (110 g/L) c. 13 g/dL (130 g/L) d. 15 g/dL (150 g/L)

a (Only ABO and Rh is required with the patient's sample. Each autologous unit must be confirmed for ABO and Rh from an integrally attached segment.)

55) What is/are the minimum pretransfusion testing requirement(s) for autologous donations collected and transfused by the same facility? a. ABO and Rh typing only b. ABO/Rh type, antibody screen c. ABO/Rh type, antibody screen, crossmatch d. no pretransfusion testing is required for autologous donations

a (The mother has a 50% chance of passing on R1 and 50% chance of passing on r. The father will always pass on R1. Statistically, 50% of the children will be R1r and 50% of them will be R1R1.)

58) Given the most probable genotypes of the parents, which of the following statements best describes the most probable Rh genotypes of the 4 children? a. 2 are R1r, 2 are R1R1 b. 3 are R1r, 1 is rr c. 1 is R0r, 1 is R1r, 2 are R1R1 d. 1 is R0r', 1 is R1R1, 2 are R1r

d (The patient lacks E. Since C and c are alleles, C is inherited from one parent and c from the other. Since the person is homozygous for e, one of the genes needs to code for ce [RHce] and the other Ce [RHCe]. The RHD gene is more likely inherited with Ce than ce, so the person's most probable genotype is DCe/dce. This genotype is found in 31% of the white and 15% of the black populations.)

60) An individual's red blood cells give the following reactions with Rh antisera: The individual's most probable genotype is: a. DCe/DcE b. DcE/dce c. Dce/dce d. DCe/dce

a (The baby is Rh-negative and lacks c, since there is no evidence of HDFN. Inheritance of no D and no c is denoted as r'. The baby must have inherited this gene from both parents, and is homozygous r'r'.)

64) A mother has the red cell phenotype D+C+E-c-e+ with anti-c (titer of 32 at AHG) in her serum. The father has the phenotype D+C+E-c+e+. The baby is Rh-negative and not affected with hemolytic disease of the newborn. What is the baby's most probable Rh genotype? a. r'r' b. r'r c. R1R1 d. R1r

d (All common Rh antigens are present on the red blood cells. R1 [DCe] and R2 [DcE] are frequent genotypes.)

68) Refer to the following data: Given the reactions above, which is the most probable genotype? a. R1R1 b. R1r' c. R0r" d. R1R2

a (R0R0 is the only correct choice here. R0 = D+C-E-c+e+.)

69) A patient's red cells type as follows: Which of the following genotype would be consistent with these results? a. R0R0 b. R1r c. R1R2 d. Rzr

b (The most likely haplotype is DCe/dce.)

77) A donor is tested with Rh antisera with the following results: What is his most probable Rh genotype? a. R1R1 b. R1r c. R0r d. R2r

d (From the first 2 children it can be determined the mom has the haplotypes A2B12 and A23F18. The dad has the haplotypes Al B3 and A3B35. The expected B antigen in child #3 is B35.)

78) A family has been typed for HLA because 1 of the children needs a stem cell donor. Typing results are listed below: father: A1,3;B8,35 mother: A2,23;B12,18 child #1: A1,2;B8,12 child #2: A1,23;B8,18 child #3: A3,23;B18,? What is the expected B antigen in child #3? a. A1 b. A2 c. B12 d. B35

c (The child's genotype does not include E. The alleged father is homozygous for E. If he was the father the child would also have E. The father can be excluded from paternity.)

84) Relationship testing produces the following red cell phenotyping results: alleged father: ABO = B | Rh = D+C-c+E+e- mother: ABO = O | Rh = D+C+E-c-e+ child: ABO = O | Rh = D+C+E-c+e+ What conclusions may be made? a. there is no exclusion of paternity b. paternity may be excluded on the basis of ABO typing c. paternity may be excluded on the basis of Rh typing d. paternity may be excluded on the basis of both ABO and Rh typing

c (Ax cells are more strongly reactive with anti-A,B than with anti-A and the plasma frequently has anti-Al present.)

86) A patient is typed with the following results: The most probable reason for these findings is that the patient is group: a. O; confusion due to faulty group O antiserum b. O; with an anti-A1 c. Ax; with an anti-A1 d. A1; with an anti-A

c (Lewis antigens are found soluble in saliva. If saliva containing Lewis substance is added to a sample with anti-Lea, then neutralization occurs. Le[a+] indicator cells added to the test system would be nonreactive. A proper control system is required whenever neutralization studies are performed.)

98) Inhibition testing can be used to confirm antibody specificity for which of the following antibodies? a. anti-Lua b. anti-M c. anti-Lea d. anti-Fya