Success: Immunohematology

109. Some antigens that are primarily found on white blood cells can occur on erythrocytes. Which of the following are the red blood cells equivalents of HLAs? A. Lea, Leb B. Bga, Bgb, Bgc C. Kpa, kpb, kpc D. Doa, Dob

B. Bga, Bgb, Bgc

74. An antigen-antibody reaction alone does not cause hemolysis. Which of the following is required for red blood cell lysis? A. Albumin B. Complement C. Glucose-6-phosphate dehydrogenase (G6PD) D. Antihuman globulin (AHG)

B. Complement

75. A whit female's red blood cells gave the following reaction upon phenotyping: D+C+E-c+e+. Which of the following is the most probable Rh genotype? A. DCe/Dce B. DCe/dce C. DCe/DcE D. Dce/dCe

B. DCe/dce

92. A patient's red blood cells are being typed for the Fya antigen. Which of the following is the proper cell type of choice for a positive control of the anti-Fya reagent? A. Fy(a+b-) B. Fy(a+b+) C. Fy(a-b+) D. Fy(a-b-)

B. Fy(a+b+)

100. The antiglobulin test does not require washing or the addition of IgG-coated cells in which of the following antibody detection methods? A. Solid-phase red cell adherence assays B. Gel test C. Affinity column technology D. Polyethylene glycol (PEG) technique

B. Gel test

102. Lymphocytotoxicity testing can be used to detect the presence of antibodies to: A. Wra and Wrb B. HLA antigens C. Bga, Bgb, and Bgc D. JMH antigen

B. HLA antigens

99. A recently transfused patietn's serum has a positive antibody screen. The panel performed at IS, in LISS at 37 degrees C, and at AHG shows a strong anti-Fya and a weak possible anti-C. To confirm the anti-C, your would perform an: A. Elution B. Absorption C. Antigen typing D. Enzyme panel

D. Enzyme panel Fya antigen is destroyed by enzyme treatment

66. Which of the following blood groups reacts least strongly with an anti-H produced in an A1B individual? A. Group O B. Group A2B C. Group A2 D. Group A1

D. Group A1 O>A2>A2B>A1>A1B

36. Which of the following tests is/are not performed during donor processing? A. ABO and Rh grouping B. HBsAG C. HIV-1-Ag D. HBsAb

D. HBsAb

64. Most blood group antibodies are of what immunoglobulin classes? A. IgA and IgD B. IgA and IgM C. IgE and IgD D. IgG and IgM

D. IgG and IgM

73. Which of the following sugars must be present on a precursor substance for A and B antigenic activity to be expressed? A. D-Galactose B. N-Acetylgalactosamine C. Glucose D. L-Fucose

D. L-Fucose

108. Which of the blood group systems is associated with antibodies that are generally IgM? A. Rh B. Duffy C. Kell D. Lewis

D. Lewis

4. Which of the following conditions would contraindicate autologous pre-surgical donation? A. Weight of 100 lbs B. Age of 14 years C. Hemoglobin of 12 g/dL D. Mild bacteremia

D. Mild bacteremia

87. Which of the following is a characteristic of Kidd system antibodies? A. Usually IgM antibodies B. corresponding antigens are destroyed by enzymes C. Usually strong and stable during storage D. Often implicated in delayed hemolytic transfusion reactions

D. Often implicated in delayed hemolytic transfusion reactions

90. Which of the following statements is not true about anti-U? A. Is clinically significant B. Is only found in black individuals C. Only occurs in S-s-individuals D. Only occurs in Fy(a-b-)

D. Only occurs in Fy(a-b-)

12. Even though it is properly collected and stored, which of the following will fresh-frozen plasma (FFP) not provide? A. Factor V B. Factor VIII C. Factor IX D. Platelets

D. Platelets

26. Biochemical changes occur during the shelf life of stored blood. Which of the following is a results of this "storage lesion"? A. Increase in pH B. Increase in plasma K+ C. Increase in plasma Na+ D. Decrease in plasma hemoglobin

B. Increase in plasma K+

41. Fresh-frozen plasma Storage Temperature: A. 1-6 degrees C B. 20-24 degrees C C. -18 degrees C or colder D. -65 degrees C or colder

C. -18 degrees C or colder

42. Cryprecipitate Storage Temperature: A. 1-6 degrees C B. 20-24 degrees C C. -18 degrees C or colder D. -65 degrees C or colder

C. -18 degrees C or colder

28. The temperature range for maintaining red blood cells and whole blood during shipping is: A. 0-4 degrees C B. 1-6 degrees C C. 1-10 degrees C D. 5-15 degrees C

C. 1-10 degrees C

44.Shelf life: Red blood cells in CPDA-1 A. 24 hours B. 5 days C. 35 days D. 1 year

C. 35 days

51. Shelf life: AS-1 (Adsol) A. 21 days B. 35 days C. 42 days D. not an approved anticoagulant

C. 42 days

37. A 70 kg man has a platelet count of 15,000/uL, and there are no compliating factors such as fever of HLA sensitization. If he is given a platelet pool of 6 units, what would you expect his posttransfusion count to be? A. 21,000- 27,000/uL B. 25,000- 35,000/uL C. 45,000- 75,000/uL D. 75,000- 125,000/uL

C. 45,000- 75,000/uL

2. A potential donor has no exclusions, but she weights only 95 pounds. What is the allowable amount of blood (including samples) that can be drawn? A. 367 mL B. 378 mL C. 454 mL D. 473 mL

C. 454 mL 10.5mL/kg 95/2.2=43.2 43.2x10.5= 453.6mL

29. Platelets play an important role in maintaining hemostasis. One unit of donor platelets derived from whole blood should yield _________ platelets A. 5.5 x 10^6 B. 5 x 10 ^8 C. 5.5 x 10^10 D. 5 x 10^10

C. 5.5 x 10^10

84. A victim of an auto accident arrives in the ED as a transfer from a hospital in a rural area. The patient has been in that facility for several weeks and has received several units of red blood cells during that time. The ED resident orders 2 units of RBCs for transfusion. The sample sent to the blood bank is centrifuged and the cell-serum interface is not discernible. A subsequent sample produces the same appearance. You would suspect that the patient has: A. Autoimmune hemolytic anemia B. Anti-Fya C. Anti-Jka D. Paroxysmal nocturnal hemoglobinuria

C. Anti-Jka

97. Often when trying to identify a mixture of antibodies, it is useful to neutralize one of the known antibodies. Which one of the following antibodies is neutralizable? A. Anti-D B. Anti-Jka C. Anti-Lea D. Anti-M

C. Anti-Lea

98. Which of the following antibodies does not match the others in terms of optimal reactive temperature? A. Anti-Fya B. Anti-Jka C. Anti-N D. Anti-U

C. Anti-N

76. A black patient has the following Rh phenotype: D+, C+, E+, c+, e+. Which of the following genotypes is the least probable? A. DCE/dce B. DCe/DcE C. DCe/dcE D. DcE/dCe

C. DCe/dcE

55. Donor: A 50 year old man who had sex with another man in 1980: A. Defer Temporarily B. Defer for 12 months C. Defer indefinitely D. Accept

C. Defer indefinitely

8. Which of the following best describes what must be done with a unit of blood drawn from a donor who is found to be at high risk of contracting acquired immune deficiency syndrome (AIDS)? A. Hold unit in quarantine until donor diagnosis is clarified B. Use the blood for research dealing with AIDS C. Properly dispose of unit by autoclaving or incineration D. Use the plasma and destroy the red blood cells.

C. Properly dispose of unit by autoclaving or incineration

5. Which of the following donors would be deferred indefinitely? A. History of syphilis B. History of gonorrhea C. Accutane treatment D Recipient of human growth hormone

D Recipient of human growth hormone

40. Red blood cells, frozen Storage Temperature: A. 1-6 degrees C B. 20-24 degrees C C. -18 degrees C or colder D. -65 degrees C or colder

D. -65 degrees C or colder

45. Shelf life: Fresh-frozen plasma A. 24 hours B. 5 days C. 35 days D. 1 year

D. 1 year

46. Shelf life: Cryoprecipitate A. 24 hours B. 5 days C. 35 days D. 1 year

D. 1 year

23. The last unit of autologous blood for an elective surgery patient should be collected no later than _________ hours before surgery: A. 24 B. 36 C. 48 D. 72

D. 72

A satellite bag containing 250 mL of fresh plasma is selected for quality control of cryoprecipitate production. Cryoprecipitate is prepared according to standard operating procedures. The final product has a total volume of 10 mL. The factor VIII assays are I IU/mL before and 9IU/mL after preparation 16. What is the percent yield of factor VIII in the final cryoprecipitate? A. 11% B. 25% C. 36% D. 80% 17. Does this product meet AABB standards for cryoprecipitate production? A. Yes B. No; the percent recovery is too low C. No; the final factor VIII level is too low D. Data are insufficient to calculate

16. C. 36% 17. A. Yes

43. Platelet concentrate Storage Temperature: A. 1-6 degrees C B. 20-24 degrees C C. -18 degrees C or colder D. -65 degrees C or colder

B. 20-24 degrees C

50. Shelf life: CPDA-1 (citrate phosphate dextrose adenine) A. 21 days B. 35 days C. 42 days D. not an approved anticoagulant.

B. 35 days

48. Shelf life: Platelet concentrate in PL-732 (with agitation) A. 24 hours B. 5 days C. 35 days D. 1 year

B. 5 days

35. In order to meet the current AABB standards for leukocyte reduction to prevent HLA alloimmunization of CMV transmission, the donor unit must rretain at least _________ of the original red cells and leukocytes must be reduced to less than________________. A. 85%, 5 x 10^8 B. 80%, 5 x 10^6 C. 75%, 5 x 10^5 D. 70%, 5 x 10^4

B. 80%, 5 x 10^6

72. Lectins are useful in determining the cause of abnormal reactions in blood bank serology. These lectins are frequently labeled as anti-H, anti-A, etc. The nature of these lectins is explained by which of the following? A. An early form of monoclonal antibody produced in nonvertebrates B. A plant substance that chemically reacts with certain RBC antigens C. naturally occurring antibodies in certain plants D. The ability of plants to respond to RBC antigens by antibody production

B. A plant substance that chemically reacts with certain RBC antigens

89. Which of the following antibodies can be neutralized with pooled human plasma? A. Anti-Hy and anti-Ge: B. Anti-Cha and anti-Rga C. Anti-Coa and anti-Cob D. Anti-Doa and anti-Jsb

B. Anti-Cha and anti-Rga

93. Which of the following antibodies has been clearly implicated in transfusion reactions and hemolytic disease of the newborn? A. Anti-I B. Anti-K C. Anti-Lea D. Anti-N

B. Anti-K

78. If a patient has the Rh genotype DCe/DCe and receives a unit of red blood cells from a DCe/dce individual, what Rh antibody might the patient develop? A. Anti-C B. Anti-c C. Anti-d D. Anti-E

B. Anti-c

39. Red blood cells (RBCs), liquid Storage Temperature: A. 1-6 degrees C B. 20-24 degrees C C. -18 degrees C or colder D. -65 degrees C or colder

A. 1-6 degrees C

49. Shelf life: CPD (citrate phosphate dextrose): A. 21 days B. 35 days C. 42 days D. not an approved anticoagulant

A. 21 days

47. Shelf life: Fresh-frozen plasma, thawed A. 24 hours B. 5 days C. 35 days D. 1 year

A. 24 hours

107. Which of the following is generally detected at the antiglobulin phase of testing? A. Anti-Jka B. Anti-M C. Anti-P1 D. AntiI

A. Anti-Jka

3. Donors who have received blood or blood products within 12 months of when they desire to donate are deferred to protect the recipient because the: A. Blood could have transmitted hepatitis or HIV B. Blood may have two cell populations C. Donor May not be able to tolerate the blood loss D. Donor red cell hemoglobin level may be too low

A. Blood could have transmitted hepatitis or HIV

6. Which of the following viruses resides exclusively in leukocytes? A. CMV B. HIV C. HBV D. HCV

A. CMV

38. Which of the following tests on donor red blood cells must be repeated by the transfusing facility when the blood was collected and processed by a different facility? A. Confirmation of ABO group and Rh type of blood labeled D-negative B. Confirmation of ABO group and Rh type C. Weak D on D-negatives D. Antibody screening

A. Confirmation of ABO group and Rh type of blood labeled D-negative

54. Donor: A 45-year-old woman who donated a unit during a holiday appeal 54 days ago: A. Defer Temporarily B. Defer for 12 months C. Defer indefinitely D. Accept

A. Defer Temporarily

103. In which of the following instances my mixed-field (mf) agglutination be observed? A. Directed antiglobulin test (DAT) result of patient undergoing delayed hemolytic transfusion reaction B. Indirect antilobulin test (IAT) result of patient who has anti-Lea C. DAT result of patient on high doses of alpha-methyldopa D. Typing result with anti-A of patietn who is A2 subgroup

A. Directed antiglobulin test (DAT) result of patient undergoing delayed hemolytic transfusion reaction

14. The addition of adenine in an anticoagulant-preservative formulation aids in: A. Maintaining ATP levels for red cell viability B. Maintaining platelet funciton in stored blood C. Reducing the plasma K+ levels during storage D. Maintaining 2,3-PBG levels for oxygen release to the tissue

A. Maintaining ATP levels for red cell viability

82. If a D-positive person makes an anti-D, this person is probably: A. Partial D B. D-negative C. Weak D as position effect D. Weak D due to transmissible genes

A. Partial D

83. A serum containing anti-k is not frequently encountered. This is because: A. People who lack the k antigen are rare B. People who possess the k antigen are rare C. The k antigen is no a good immunogen D. Kell null people are rare

A. People who lack the k antigen are rare

Choice of Transfusion therapy: 63. Patients who are thrombocytopenic secondary to the treatment of acute leukemia: A. Platelet concentrate B. RBC C. Leukocyte-reduced D. Transfusion not indicated

A. Platelet concentrate

85. Which of the following is a characteristic of the Xga blood group system? A. The Xga antigen has a higher frequency in women than in men. B. The Xga antigen has a higher frequency in men than in women C. The Xga antigen is enhanced by enzymes D. Anti-Xga is usally a saline-reacting antibody

A. The Xga antigen has a higher frequency in women than in men.

77. An individual of the dce/dec genotype given dCe/dce blood has an antibody response that appears to be anti-C plus anti-D. What is the most likely explanation for this? A. The antibody is anti-G B. The antibody is anti-partial D C. The antibody is anti-Cw D. The reactions were read incorrectly

A. The antibody is anti-G

24. For which of the following patients would autologous donation not be advisable? A. Patients with an antibody against a high-incidence antigen B. Patients with uncompensated anemia C. Open heart surgery patients D. Patients with multiple antibodies

B. Patients with uncompensated anemia

Choice of Transfusion therapy: 62. Patients with normovolemic anemia: A. Platelet concentrate B. RBC C. Leukocyte-reduced D. Transfusion not indicated

B. RBC

88. Which of the following statements is not true of anti-Fya and anti-Fyb? A. Are clinically significant B. React well with enzyme-treated panel cells C. Cause hemolytic transfusion reactions D. Cause a generally mild hemolytic disease of the newborn

B. React well with enzyme-treated panel cells

22. When 2,3-BPG levels drop in stored blood, which of the following occurs as a result? A. Red blood cell K+ increases B. Red blood cell ability to release O2 decreases C. Plasma hemoglobin is stabilized D. ATP synthesis increases

B. Red blood cell ability to release O2 decreases

10. A pooled sera product from 16 donors has a repeatedly positive nucleic acid test (NAT) for HCV. The next action that should be taken is to: A. Permanently exclude all the donors in the pool B. Test each donor in the pool for HCV C. Label all the donors as HCV positive D. Confirm the positive using recombinant immunoblot assay (RIBA)

B. Test each donor in the pool for HCV

67. How many genes encode the following Rh antigens: D, C, E, c, e? A. One B. Two C. Three D. Four

B. Two

91. A patient had an anti-E identified in his serum 5 years ago. His antibody screening test is now negative. To obtain suitable blood for transfusion, what is the best procedure to use? A. Type the patient for teh E antigen as an added part to the crossmatch procedure B. Type the donor units for the E antigen and crossmatch the E-negative units C. Crossmatch donors with the patient's serum and release the compatible units for transfusion D. Perform the crossmatch with enzyme-treated donor cells, becuase enzyme- treated red cells react better with Rh antibodies

B. Type the donor units for the E antigen and crossmatch the E-negative units

33. Previous records of patients' ABO and Rh types must be immediately available for comparison with current test results: A. for 6 months B. for 12 months C. for 10 years D. indefinitely

B. for 12 months

106. A group A, D-negative obstetric patient with anti-D (titer 256) is carrying a fetus who need an intrauterine transfusion. Which of the following units should be chosen? A. Group A, D-negative RBC B. Group A, D-negative whole blood C. Group O, D-negative RBC D. Group O, D-negative whole blood

C. Group O, D-negative RBC

25. It is generally asymptomatic but has a very high carrier rate (70%-80% have chronic infections). About 10% of the carriers develop cirrhosis or hepatocellular carcinoma. These statements are most typical of which of the following transfusion-transmitted infection? A. HAV B. HBV C. HCV D. HEV

C. HCV

1. A woman wants to donate blood. Her physical examination reveals the following: weight-110 lbs, pulse- 73 bpm, blood pressure-125/75 mmHg, Hematocrit- 35%. Which of the following exclusions applies to the prospective donor? A. Pulse to high B. Weight too low C. Hematocrit too low D. Blood pressure too low

C. Hematocrit too low Acceptable hematocrit is above 38%

30. The pH of four platelet concentrates is measured on the day of expiration. The pH and plasma volumes of the four units are as follows: pH 6.0, 45 mL; pH 5.5, 38 mL; pH 5.8, 40 mL; pH 5.7, 41 mL. What corrective action is needed in product preparation to meet AABB standards for platelet production? A. No corrective action is necessary B. Recalibrate pH meter C. Increase final plasma volume of platelet concentrates D. Decrease final plasma volume of platelet concentrates

C. Increase final plasma volume of platelet concentrates

13. Blood needs to be prepared for intrauterine transfusion of a fetus with severe HDN. The red blood cell unit selected is compatible with the mother's serum and has been leuko-depleted. An additional step that must be taken before transfusion is to: A. Add pooled platelets and fresh-frozen plasma B. Check that the RBC group is consistent with the father's C. Irradiate the RBCs before infusion D. Test the RBC unit with the neonate's eluate

C. Irradiate the RBCs before infusion

70. If a person has the genetic makeup Hh, AO, LeLe, sese, what substance will be found in the secretions? A. A substance B. H substance C. LeA substance D. Leb substance

C. LeA substance

Choice of Transfusion therapy: 61. Patients requiring transfusion with RBC that will not transmit cytomegalovirus (CMV): A. Platelet concentrate B. RBC C. Leukocyte-reduced D. Transfusion not indicated

C. Leukocyte-reduced

7. A donor indicates that he has taken two aspirin tablets per day for the last 36 hours. The unit of blood: A. May not be used for pooled platelet concentrate preparation B. Should not be drawn until 36 hours after cesation of aspirin ingestion C. May be used for pooled platelet concentrate preparation D. May be used for red blood cells and fresh-frozen plasma production, but the platelets should be discarded

C. May be used for pooled platelet concentrate preparation

31. During preparation of platelet concentrate, the hermetic seal of the primary bag is broken. The red blood cells: A. Must be discarded B. may be labeled with a 21-day expiration date if collected in CPD C. Must be labeled with a 24 hour expiration date D. May be glycerolized within 6 days and stored frozen

C. Must be labeled with a 24 hour expiration date

27. It has been determined that a patient has posttransfusion hepatitis and received blood from eight donors. There is nothing to indicate that these donors may have been likely to transmit hepatitis. What action must be taken initially? A. Defer all donors indefinitely from further donations B. Repeat all hepatitis testing on a fresh sample from each donor C. Notify the donor center that collected the blood D. Interview all implicated odnors

C. Notify the donor center that collected the blood

9. Which of the following is least likely to transmit hepatitis? A. Cryoprecipiate B. RBC C. Plasma protein fraction (PPF) D. Platelets

C. Plasma protein fraction (PPF)

A centrifuge used for platelet preparation has been returned after major repair. A unit of whole blood (450 mL; platelet count 200,000/uL) is selected for calibration of platelet production. The platelet-rich plasma (PRP) contains 250 mL with a platelet count of 300,000/uL. The final platelet concentrate prepared from the PRP contains 50mL with a platelet count of 900,000/uL 18. What is the percent yield of platelets in the PRP from this unit? A. 33% B. 45% C. 66% D. 83% 19. What is the percent yield of platelets in the PRP from this unit? A. 30% B. 45% C. 50 % D. 60% 20. Does this product meet AABB standards for platelet concentrate production? A. Yes B. No; the count on the final product is too low C. No; the percentage recovery in the PRP is too low D. Data are insufficient to calculate 21. The final product was prepared with a PRP spin time of 2 minutes at 2500 rpm. To increase the percent platelet yield in the final product, one would: A. Increase the time and/or rpm for the first spin B. Increase the time and/or rpm for the second spin C. Decrease the time and/or rpm for the first spin D. Decrease the time and/or rpm for the second spin

D. 83% D. 60% B. No; the count on the final product is too low B. Increase the time and/or rpm for the second spin

53. Donor: A 65-year-old man whose birthday is tomorrow: A. Defer Temporarily B. Defer for 12 months C. Defer indefinitely D. Accept

D. Accept

56. Donor: A 25 year old man who says he had yellow jaundice right after he was born: A. Defer Temporarily B. Defer for 12 months C. Defer indefinitely D. Accept

D. Accept

57. Donor: An 18 year old with poison ivy on his hands and face: A. Defer Temporarily B. Defer for 12 months C. Defer indefinitely D. Accept

D. Accept

58. Donor: A woman who had a baby 2 months ago: A. Defer Temporarily B. Defer for 12 months C. Defer indefinitely D. Accept

D. Accept

59. A 35 year old runner (pulse 46 bpm) A. Defer Temporarily B. Defer for 12 months C. Defer indefinitely D. Accept

D. Accept

105. In which situation(s) may the ABO serum grouping not be valid? A. The patietn has hypogammaglobulinemia B. IgM alloantibodies are present C. Cold autoantibodies are present D. All of the above

D. All of the above

34. Which of the following weak D donor units should be labeled Rh-positive? A. Weak D due to transmissible genes B. Weak D as position effect C. Weak partial D D. All the above

D. All the above

101. Which set of antibodies could your possibly find in a patient with no history of transfusion or pregnancy? A. Anti-I, anti-s, anti-P1 B. Anti-Leb, anti-A1, anti-B C. Anti-M, anti-c, anti-B D. Anti-P1, anti-Lea, anti-I

D. Anti-P1, anti-Lea, anti-I

11. Allthough cryoprecipitate has primarily been used for treatment of hypofibrinogenemia and hemophilia A, it contains other blood proteins useful in the treatment of coagulopathies. Which of the following is not found in cryoprecipitate? A. Fibronectin B. Factor XIII C. Factor VIII:vW D. Antithrombin III

D. Antithrombin III

104. The antibody produced during the secondary response to a foreign antigen is usually: A. IgM B. A product of T lymphocytes C. Produced a month or more after the second stimulus D. Present at a higher titer than after a primary response

D. Present at a higher titer than after a primary response

15.The pilot tubes for donor unit #3276 break in the centrifuge. You should: A. Label the blood using the donor's previous records B. Discard the unit because processing procedures cannot be performed C. Discard the red cells and salvage the plasma for fractionation D. Remove sufficient segments to complete donor processing procedures

D. Remove sufficient segments to complete donor processing procedures

32. The blood bank procedures manual must be; A. Revised annually B. Revised after publication of each new edition of AABB standards C. Reviewed prior to a scheduled inspection D. Reviewed annually by an authorized individual

D. Reviewed annually by an authorized individual

86. Testing needs to be done with an anti-serum that is rarely used. The appropriate steps to take in using this antiserum include following the manufacturer's procedure and: A. Performing a cell panel to be sure that the antiserum is performing correctly B. Performing the testing on screen cells C. Testing in duplicate to ensure the repeatability of the results D. Testing a cell that is negative for the antigen and one that is heterozygous for the antigen

D. Testing a cell that is negative for the antigen and one that is heterozygous for the antigen

Choice of Transfusion therapy: 60. Patients with warm autoimmune hemolytic anemia (AIHA) due to alpha-methyldopa (aldomet) with hemoglobins of 8.5 g/dL or above: A. Platelet concentrate B. RBC C. Leukocyte-reduced D. Transfusion not indicated

D. Transfusion not indicated

52. Shelf life: EDTA A. 21 days B. 35 days C. 42 days D. not an approved anticoagulant

D. not an approved anticoagulant