IMMUNOHEMATOLOGY / BLOOD BANKING
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CFR
Code of Federal Regulations
How would you label a donor who tested negative with anti D reagent upon immediate spin and positive in AHG?
D Pos
Match the immunodominant sugar that corresponds to the ABO system group or antigen. group B
D-galactose
Math the Fisher Race notation with the correct Weiner notation. Rz
DCE
R0
Dce
Immunohematology tests utilize:
Direct Agglutination
Tests for certain clinical conditions such as hemolytic disease of the newborn and autoimmune hemolytic anemia
Direct Antiglobulin test
incubation step is not necessary
Direct antiglobulin test
To distinguish between an A1 and A2 blood type, which reagent is used?
Dolichos biflorus lectin
Antibodies in which of the following blood group system show dosage? Kell P Duffy Lutheran
Duffy
What is the potential effect in a tube agglutination test if a red cell suspension with a concentration greater than 5% is used?
False Negative Result
Which of the following organizations are involved in the regulation of blood banks? Food and Drug Administration AABB The Joint Commission College of American Pathologists
Food and Drug Administration
Which of the following phenotypes is heterozygous? Jk(a+b-) Fy(a+b+) Fy(a-b-) Le(a+b-)
Fy(a+b+)
What part of the immunoglobulin molecule distinguishes the isotype?
Heavy Chain
What immunoglobulin class reacts best by antiglobulin testing?
IgG
What is the immunoglobulin class of most Rh system antibodies?
IgG
Which immunoglobulin class is impacted by the zeta potential in a hemagglutination test?
IgG
What characteristics the Donath-Lansteiner antibody?
IgG auto Anti P
K positive donor red cells were mistakenly transfused to a recipient with anti K. The patient's posttransfusion blood sample has a positive direct antiglobulin test with polyspecific antihuman globulin. The direct antiglobulin test is positive because anti K is an ___________ antibody that has sensitized the ________cells.
IgG, donor's
Most "naturally occurring" ABO system antibodies fall into which immunoglobulin class?
IgM
What immunoglobulin class reacts best at room temperature at immediate-spin?
IgM
In Vivo
In body
In vitro
In lab
All of the following can cause the D antigen expression to be weaker except: an RHD gene that is genetically weaker inheriting the G gene partial D expression inheriting the C antigen in trans to the D antigen
Inheriting the G gene
Match the immunodominant sugar that corresponds to the ABO system group or antigen. H antigen
L-fucose
Match the immunodominant sugar that corresponds to the ABO system group or antigen. group O
L-fucose
What phenotype will be expressed when the Le, Se. and H genes are inherited?
Le(a-b+)
reagent derived from plants used to distinguish group A1 from group A2 red cells
Lectins
Why are antibodies to Lub antigen not commonly detected?
Lub antigen is of high incidence
What condition is often associated with the presence of anti I?
Mycoplasma pneumoniae infection
Match the immunodominant sugar that corresponds to the ABO system group or antigen. Group A
N acetylgalactosamine
Predict the agglutination reaction of red cells from a Bombay phenotype when combined with anti H lectin.
Negative Bombay phenotypes have not inherited the H gene and therefore are negative with anti H lectin.
The laboratory technologist decided she would like to bring her lab coat home for laundering because it had too many wrinkles when returned by the laboratory's laundry service. Is this practice acceptable?
No, because the laboratory is a biosafety level 2, and lab coats may not be removed
Match the immunodominant sugar that corresponds to the ABO system group or antigen. Bombay
Non of the above
If a child is group B and the mother is group A, which of the following may be excluded as possible groups of the father?
O
What ABO phenotype would agglutinate in the presence of anti A,B produced by group O individuals? A only O only B only
O only Correct! A and B Group O individuals make anti A,B, an antibody with a specificity to both the A and B antigents
Which ABO phenotype contains the most H antigen and the least H antigen, respectively, on the red cell surface? A2, A1B A1B , O B, A O, A1B
O, A1B Group O blood cells are high in unconverted H antigens because the O gene produces no detectable product and A1B cells have the lowest number of H unconverted antigen sites.
Antigens are located where?
On viruses, fungi, protozoa, bacteria, blood cells, tissues, organs
reagent used to identify the specificity of a red cell antibody
Panels Cells
When testing for the A antigen in a patient, what would you use to perform the test?
Patients Red Cells and Anti A
The observable appearance of an object is known as the:
Phenotype
When an individual is group A, which of the following genetic terms applies? alleles phenotype haplotype genotype
Phenotype
What is the Wiener allele that corresponds to DCe?
R1
A patient phenotypes as D+C+E-c-e+. Predict the most likely phenotype.
R1R1
DCe
R1R1
Match the phenotypes with the most probably genotype in the Weiner nomenclature. DCce
R1r
DcE
R2R2
Current theory regarding the genetics of the Rh system suggests that:
Rh system antigens are coded by two closely linked genes
Each of the following genotypes is possible for an individual whose red cells react as indicated below except: Antisera reaction anti C positive anti D positive anti E positive anti c positive anti e positive
Ror'
reagent used to detect the presence of red cell antibodies
Screening cells
Briefly explain the difference between DAT and IAT testing.
The DAT is looing for antibody or complement coating on the red cells that happened in the body (in Vivo). The IAT is looking to see if antibodies will coat the donor red blood cells in vitro, in the lab in a test tube. It is seeing if there are antibodys in the patients serum or plasma
Why is incubation omitted in the direct antihuman globulin test? The antigen-antibody complex has already formed in vivo
The antigen-antibody complex has already formed in vivo
A facility does not validate a refrigerator before use. What is a potential outcome? #The facility is in compliance if the equipment functions properly #The facility is in violation of AABB and may no long be members #The facility is in violation of current good manufacturing practices and could be cited by the FDA #The facility is in compliance if the blood products stored in it are not transfused
The facility is in violation of current good manufacturing practices and could be cited by the FDA
A group A man marries a group AB woman. The father of the group A man was group O. What possible ABO phenotypes could be expected in the offspring? groups A, B and AB groups A and AB groups A. B. AB and O groups A and B
The groups A man must be genotype AO because the O gene was inherited from his father. A Punnett square with a group AB yields three potential phenotypes for the children: A, B and AB.
Which of the following statements is true regarding IgG sensitized red cells? #They must used to confirm a negative antiglobulin tube test #They must be used to confirm a positive antiglobulin test #They must be used to confirm a direct antiglobulin test that was negative with anti C3d #The should be used only with the indirect antiglobulin test
They must used to confirm a negative antiglobulin tube test
Red cells that phenotype as S-s- are also:
U-negative
Anti D reagent and the D control were tested with patient's red cells. Both tests were 2+ agglutination reactions. What is the interpretation of the results?
Unable to interpret without further testing
Select the region of the antibody molecule responsible for imparting unique antibody specificity.
Variable Region
Which of the following is not a technique used to enhance ABO agglutination reactions?
Warm the reactions
A father carries the Xga blood group trait and passes it on to all of his daughters but to none of his sons. What type of inheritance pattern does this demonstrate?
X Linked Dominant
A person whose red cells type as M+N+ with antisera would be
a heterozygote
Antigen
a molecule that binds to an antibody or T-cell Receptor
Which of the following items provides evidence for reagent red cell deterioration? spontaneous agglutination loss of agglutination strength over time significant hemolysis all of the above
all of the above
Which of the following statements is true regarding high protein anti D reagents? #they have been largely replaced with low protein monoclonal reagents #they contain high concentrations of bovine albumin #they may increase the possibility of a false positive reaction requiring the use of a control
all of the above
What specificities does polyspecific antihuman globulin contain?
anti IgG and anti C3d
Select the test that uses IgG sensitized red cells (check cells): #Rh antigen typing #antiglobulin test #D antigen typing #B antigen detection
antiglobulin test
How is it genetically possible for a child to phenotype as D negative?
both parents are heterozygous D positive
Detects IgG or complement-coated red cells
both the direct and indirect antiglobulin test
The numeric Rh4 nomenclature refers to which antigen in the Rosenfield notation?
c
What is the purpose of adding antibody sensitized red cells following the antiglobulin test?
check that the wash procedure was sufficient to remove unbound antibodies
The inheritance of the Rh antigens are:
codominant
Anti Jsb was identified in a patient scheduled for elective surgery later. What is the best approach in finding compatible blood?
contact the rare donor registry since Js(-) units are rare or request the family members be tested to determine if they share the same phenotype
All of the following statements are true regarding Lewis system antibodies except antibodies: can be neutralized by Lewis substance do not react following enzyme treament of cells may be observed at the immediate spin, 37C and AHG phases may cause hemolysis in vitro
do not react following enzyme treament of cells
Antibodies to the Kidd, Kell and Duffy blood group antigens share all of the following except: enhance with enzymes can cause transfusion reactions can cause hemolytic disease of the newborn usually detected only the the IAT
enhance with enzymes
Blood irradiators require all of the following safety procedures
equipment leak detection personal protective equipment proper training
Which of the following situations is most likely to cause intravascular hemolysis when an incompatible transfusion is given? group AB plasma to a group O recipient group A packed red cells to a group AB recipient group AB plasma to a group A recipient group B packed cells to a group O recipient
group B packed cells to a group O recipient A group O recipient has anti B that could potentially cause intravascular hemolysis if group B blood were transfusted.
Given the following ABO phenotyping data: Forward anti A: 2+ mf anti B: 0 Reverse A1 cells: 0 B cells 3+
group O blood products given to a group A
Select the appropriate strategy if the results of red cell and serum testing in the ABO typing procedure have negative agglutination reactions.
incubate tubes at room temperature or 4C with an autocontrol ABO antibodies are stronger at room temperature or lower. The autocontrol determines whether the enhanced antibody reaction was due to ABO antibodies or to a cold reacting antibody. The autocontrol should be negative for the ABO typing to be valid.
A patient's antibody history listed an anti Cellano. This antigen is also known as:
k in the Kell system
Which of the following facts is NOT a characteristic of Kell system anti bodies? usually clinically significant IgG antibodies best detected in indirect antiglobulin test phase lose reactivity with proteolytic enzymes reagents do not bind complement proteins
lose reactivity with proteolytic enzymes reagents
If a D positive person appears to have anti D in their serum, what is the most likely explanation?
partial D antigen
Testing for the weak D expression is performed by:
performing the indirect antiglobulin test with anti-D
Where are product limitations and technical considerations for each reagent located? #product insert #standard operating procedure #FDA code of regulations #AABB standards
product insert
Which of the following phenotypes will react with anti f?
rr
ce
rr
Hapten
small molecule that has to bind to a larger molecule to trigger an immune response
A blood sample from a 90 year old man was submitted to the blood bank for a type and screen before surgery. The forward type demonstrates as a group A, whereas the reverse type appears to be group AB. What is the most likely cause of the discrepancy?
the patient has low titer isoagglutinins
Red cells that phenotype as D negative indicate that:
there is no genetic material inherited from the RHD gene from both parents
Why is it sometimes necessary to distinguish A1 and A2 blood types?
to resolve a discrpancy between the forward and reverse typing
How would you interpret the results if both the anti D reagent and the Rh control were 2+ agglutination reactions? #unable to determine without further testing #depends on whether the samples was from a patient of a blood donor #D negative #D positive
unable to determine without further testing
Which of the following is true regarding good manufacturing practices (GMP)? *GMPs are required only by pharmaceutical companies *GMPs are optional guidelines written by the AABB *GMPs are legal requirements established by the Food and Drug Administration *GMPs are part of the quality control requirements for blood products
*GMPs are legal requirements established by the Food and Drug Administration
Elements of Quality assurance
- Records and SOPs -Personnel selection and training - Validations, calibrations, preventative maintenance, proficiency testing -supplier qualifications -error managment -process improvement -process control -label control -internal auditing
The frequency of the D negative phenotype in the population is:
15%
What percentage of the group A population type as A2?
20%
What temperature is used for incubation in the indirect antiglobulin test?
37 degrees
Approximately what is the percentage of individuals who demonstrate H in their saliva?
80%
What is the meaning of the term autosomal
A trait that is not carried on the sex chromosomes
The weak D test detects:
A weak D antigen
What subgroup of A possesses the least amount of A antigen?
A(el)
What substances are found in the saliva of a group A person who also inherited the secretor gene?
A, H
reagent used in the identification of ABO antibodies
A1 and B cells
The frequency of anti A1 is highest in type:
A2B
A recipient with group A phenotype requires a transfusion of 2 units of frozen plasma. Which of the following types are appropriate to select for transfusion? AB and B B and A AB and A O and A
AB and A
Which of the following blood group systems are structurally related to antigens of the P system?
ABH
reagent used to determine the ABO antigenic composition of a patient's red cells
ABO Antisera
What is the test procedure that combines patient's serum with commercial A1 and B reagent red cells?
ABO Reverse Typing
Which of the following is associated with the Rh null phenotype? immunized Rh null individuals may produce anti Rh29 mutation of the RhAG regulator gene membrane abnormalities All of the above
All of the above
Why have Lewis system antibodies not been implicated in hemolytic disease of the fetus and newborn? Lewis system antibodies do not cross the placenta the antigens are not fully developed at birth the antibodies are not clinically significant all of the above
All of the above
Select the term that describes cells or tissue from a genetically different individual within the same species.
Allogeneic
According to Lansteiner's rule, what ABO antibody will be detected in a group A individual's serum?
Anti B
Predict the probably antibody's identity if all red cells tested at room temperature are positive with a patients serum except for cord cells.
Anti I
Select the statement that is FALSE regarding anti P1. Anti P1 is clinically not significant Anti P1 will not react with enzyme reated P1 positive cells anti P1 reacts best at room temperature P2 individuals can make anti P1
Anti P1 will not react with enzyme reated P1 positive cells
An anti-E was identified in a patient who recently received a transfusion. What other Rh system antibody should be investigated?
Anti c
What forward typing reagent can be used to confirm group O units before placing them in inventory?
Anti-A and Anti-B
Which of the following is responsible for the activation of the classic pathway of complement?
Antibody Bound to Antigen
In a serologic test, the term prozone is also known a:
Antibody Excess
How are most blood group systems inherited?
Autosomal codominate
A patient's red cells are agglutinated by anti B but not by anti A. What is the patient's ABO phenotype?
B
Agglutination only with anti B typing serum indicates the blood is group:
B
requires washing the cells several times before the addition of antihuman globulin reagent
Both direct and Indirect Antiglobulin test
Which of the following components in the complement cascade mediates the lysis of the target cells?
C5 to C9