TEST BANK for Basic & Applied Concepts of Blood Banking and Transfusion Practices 4th Edition.

Basic and Applied Concepts of Blood Banking and Transfusion Practices 4th Edition Howard Test Bank Chapter 01: Quality Assurance and Regulation of the Blood Industry and Safety Issues in the Blood Bank Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following agencies administers the Clinical Laboratory Improvement

Amendments? a. AABB b. Centers for Medicare and Medicaid Services c. OSHA d. Food and Drug Administration ANS: B

The Centers for Medicare and Medicaid Services administers CLIA, Medicare, Medicaid, and HIPAA. DIF: Level 1

REF: p. 3

2. A 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? a. Yes, if she uses 10% bleach b. Yes, if she clears it with her supervisor c. Yes, as long as she remToE veSsTthBeAcN oaKt SanEdLdLoE esRn.oC tw OeMar it home d. No, because the laboratory is a biosafety level 2, and lab coats may not be removed ANS: D

Methods of transporting the lab coat and the risk of contamination do not permit health care workers to bring lab coats home for cleaning.

DIF: Level 2

REF: p. 14

3. Personal protective equipment includes: a. safety glasses. b. splash barriers. c. masks. d. All of the above ANS: D

Safety glasses, splash barriers, and masks are types of personal protective devices.

DIF: Level 1

REF: p. 14

4. At what point in the employment process should safety training take place? a. During orientation and training b. Following lab training when employees are more familiar with their

responsibilities c. Following the employees’ first evaluation

d. Before independent work is permitted and annually thereafter ANS: D

The Occupation Safety and Health Administration requires safety training before independent work is permitted and annually thereafter.

DIF: Level 1

REF: p. 17

5. In safety training, employees must become familiar with all of the following except: a. tasks that have an infectious risk. b. limits of protective clothing and equipment. c. the appropriate action to take if exposure occurs. d. how to perform cardiopulmonary resuscitation on a donor or other employee.

ANS: D

The Occupational Safety and Health Administration requirements include all of those listed except cardiopulmonary resuscitation.

DIF: Level 1

REF: p. 13

6. Blood irradiators require all of the following safety procedures except: a. proper training. b. that the user have a degree in radiology. c. equipment leak detection. d. personal protective equipment.

ANS: B

Blood bank and transfusion service technologists require training but not a degree to use a TESTBANKSELLER.COM blood irradiator.

DIF: Level 2

REF: p. 16

7. Which of the following is true regarding good manufacturing practices (GMPs)? a. GMPs are legal requirements established by the Food and Drug Administration. b. GMPs are optional guidelines written by the AABB. c. GMPs are required only by pharmaceutical companies. d. GMPs are part of the quality control requirements for blood products.

ANS: A

Good manufacturing practices are requirements established by the Food and Drug Administration.

DIF: Level 1

REF: p. 5

8. Which of the following is an example of an unacceptable record-keeping procedure? a. Using dittos in columns to save time b. Recording the date and initials next to a correction c. Not deleting the original entry when making a correction d. Always using permanent ink on all records ANS: A

All records must be clearly written. Dittos are unacceptable.

DIF: Level 1

REF: p. 7

9. A technologist in training noticed that the person training her had not recorded the results of a

test. To be helpful, she carefully recorded the results she saw at a later time, using the technologist’s initials. Is this an acceptable procedure? a. Yes; all results must be recorded regardless of who did the test. b. No; she should have brought the error to the technologist’s attention. c. Yes; because she used the other technologist’s initials. d. Yes; as long as she records the result in pencil.

ANS: B

This is an example of poor record keeping; results must be recorded when the test is performed and by the person doing the test.

DIF: Level 3

REF: p. 8

10. Unacceptable quality control results for the antiglobulin test performed in test tubes may be

noticed if: a. preventive maintenance has not been performed on the cell washer. b. the technologist performing the test was never trained. c. the reagents used were improperly stored. d. All of the above ANS: D

Training, equipment maintenance, and reagent quality can affect quality control.

DIF: Level 2

REF: p. 5

11. All of the following are true regarding competency testing except: a. it must be performed following training. b. it must be performed on an annual basis. c. it is required only if the technologist has no experience. d. retraining is required if there is a failure in competency testing.

ANS: C

All employees must have competency testing following training and annually thereafter. If there is a failure in competency testing, retraining is required.

DIF: Level 2

REF: p. 10

12. Which of the following organizations are involved in the regulation of blood banks? a. The Joint Commission b. AABB c. College of American Pathologists d. Food and Drug Administration ANS: D

The Food and Drug Administration regulates blood banks, whereas the other organizations are involved in accreditation.

DIF: Level 1

REF: p. 2

13. All of the following are responsibilities of the quality assurance department of a blood bank

except: a. performing internal audits. b. performing quality control. c. reviewing standard operating procedures. d. reviewing and approving training programs.

ANS: B

Quality control is performed in the laboratory, not by the quality assurance department.

DIF: Level 2

REF: p. 5

14. The standard operating procedure is a document that: a. helps achieve consistency of results. b. may be substituted with package inserts. c. is necessary only for training new employees. d. must be very detailed to be accurate.

ANS: A

Standard operating procedures are written procedures that help achieve consistency and should be clear and concise.

DIF: Level 2

REF: p. 8

15. Employee training takes place: a. after hiring and following implementation of new procedures. b. following competency assessment. c. only for new inexperieT ncEeS dT em esE . LLER.COM BpAloNyKeS d. as procedures are validated.

ANS: A

Training occurs with all new employees regardless of their experience and following implementation of new procedures.

DIF: Level 1

REF: p. 10

16. Plans that provide the framework for establishing quality assurance in an organization are: a. current good manufacturing practices. b. standard operating procedures. c. change control plan. d. continuous quality improvement plan.

ANS: D

The total quality management or continuous quality improvement plan are part of the quality assurance program in an organization.

DIF: Level 1

REF: p. 4

17. A facility does not validate a refrigerator before use. What is a potential outcome? a. The facility is in violation of current good manufacturing practices and could be

cited by the Food and Drug Administration. b. The facility is in compliance if the equipment functions properly.

c. The facility is in compliance if the blood products stored in it are not transfused. d. The facility is in violation of AABB and may no longer be members.

ANS: A

Validation of equipment is a current good manufacturing practice, which is a legal requirement established by the Food and Drug Administration.

DIF: Level 2

REF: p. 12

18. In a routine audit of a facilities blood collection area, the quality assurance department found

that the blood bags used on that particular day had expired. What is the appropriate course of action? a. Initiate a root cause analysis and quarantine the blood collected in the expired bags. b. Call the Food and Drug Administration to report the incident. c. Change the expiration date on the bags to avoid legal issues. d. Fire the donor room supervisor, and discard the blood collected in the expired bags.

ANS: A

A root cause analysis will determine the factors that contributed to the error and result in a plan to prevent further errors.

DIF: Level 3

REF: p. 11

19. Several units were released to a hospital by mistake before all viral marker testing was

completed. What is the appropriate course of action? a. The error is reportable,TaE ndST thB eA FoNoKdSaE ndLD g.

AC dm LrEuR OiMnistration must be contacted. b. Ask the hospital to avoid transfusion and quickly complete the testing. c. Perform a root cause analysis and, if the units are found to be negative, report the test result to the hospital. d. Recall only the units that are positive for viral markers.

ANS: A

Release of untested units is a reportable error to the Food and Drug Administration.

DIF: Level 3

REF: p. 11

MATCHING

Match the government or accrediting agencies with the description that best fits their purpose. a. Ensures safe and healthful working conditions b. Ensures the safety and efficacy of biologics, drugs, and devices c. Provides peer-reviewed accreditation for hospital laboratories d. Professional organization that accredits blood banks and transfusion services e. Makes recommendations to the Occupational Safety and Health Administration regarding the prevention of disease transmission 1. FDA 2. OSHA

3. CDC 4. AABB 5. CAP 1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS:

B A E D C

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Match the following descriptions with the appropriate terms. a. The CAP survey is an example b. Systematic evaluations to determine whether procedures are being followed c. Testing to determine the accuracy and precision of reagents and equipment d. Process of standardizing an instrument against a known value e. Removal of products from the market that might compromise the safety of the recipient f. Degree to which a measurement represents the true value g. Establishing that a specific process produces an expected result h. Evaluation of an employee’s ability to perform a specific skill i. Investigation and identification of the factors that contributed to an error j. Maximizes the duration of equipment and increases the reliability of the equipment k. System to plan and implement changes to prevent problems 6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Root cause analysis Recall Accuracy Validation Calibration Quality control Proficiency test Competency assessment Change control Audit Preventive maintenance

6. ANS: I 7. ANS: E 8. ANS: F 9. ANS: G 10. ANS: D 11. ANS: C 12. ANS: A 13. ANS: H 14. ANS: K 15. ANS: B 16. ANS: J

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1

TRUE/FALSE 1. The Occupation Safety and Health Administration does not require the routine use of gloves

by phlebotomists working with healthy prescreened donors or changing unsoiled gloves between donors.

ANS: T

Because the risk of exposure is minimal with blood donors, the Occupation Safety and Health Administration (OSHA) does not require gloves, or if gloves are worn, OSHA does not require that unsoiled gloves be changed between donors.

DIF: Level 1

REF: p. 15

2. All accidents, even minor ones, must be reported to a supervisor.

ANS: T

The Occupational Safety and Health Administration, workers’ compensation, and other regulatory agencies require reporting all accidents, and an investigation to avoid other injuries is mandatory.

DIF: Level 1

REF: p. 16

3. Quality control is the same as quality assurance.

ANS: F

Quality control is performed on reagents and equipment; quality assurance is a system to ensure safe and effective products.

DIF: Level 1

REF: p. 5

Chapter 02: Immunology: Basic Principles and Applications in the Blood Bank Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Select the cell involved in humoral immunity. a. Neutrophils b. T lymphocytes c. B lymphocytes d. Monocytes ANS: C

B lymphocytes have the ability to transform into plasma cells to produce antibodies, which is considered a humoral response.

DIF: Level 2

REF: p. 23

2. What process is described by opsonization? a. Lysis of cells b. Binding to cells or antigens c. Ingestion of cells d. Phagocytosis ANS: B

Opsonization promotes phagocytosis by binding to cells or antigens.

DIF: Level 1

REF: p. 35

3. Select the term that describes cells or tissue from a genetically different individual within the

same species. a. Allogeneic b. Autologous c. Xenogeneic d. Autograft ANS: A

Allogeneic cells or tissue come from a genetically different individual within the same species.

DIF: Level 1

REF: p. 33

4. Select the substance that regulates the activity of other cells by binding to specific receptors. a. Cytokines b. Complement c. Immunoglobulins d. Anaphylatoxin ANS: A

Cytokines are proteins secreted by cells that regulate the activity of other cells by binding to specific receptors.

DIF: Level 1

REF: p. 23

5. Which of the following is responsible for the activation of the classic pathway of

complement? a. Bacteria b. Foreign proteins c. Virus d. Antibody bound to antigen ANS: D

An antigen-antibody complex activates the classical complement cascade, whereas bacterial membranes activate the alternative pathway.

DIF: Level 1

REF: p. 33

6. What biological molecules are considered the most immunogenic? a. Carbohydrates b. Lipids c. Proteins d. Enzymes ANS: C

Protein molecules are the most immunogenic, followed by carbohydrates and lipids, which tend to be immunologically inert.

DIF: Level 2

REF: p. 24

7. What part of the immunoglobulin molecule distinguishes the isotype? a. Light chain b. Heavy chain c. Kappa chain d. Lambda chain ANS: B

The five distinctive heavy-chain molecules distinguish the class or isotype. Each heavy chain imparts characteristic features, which permit them to have unique biological functions.

DIF: Level 2

REF: p. 24

8. Select the immunoglobulin class produced first in the primary immune response. a. IgG b. IgE c. IgA d. IgM ANS: D

IgM antibodies are produced first, followed by the production of IgG antibodies.

DIF: Level 1

REF: p. 28

9. In a serologic test, the term prozone is also known as:

a. b. c. d.

equivalence. antigen excess. antibody excess. serum-to-cell ratio.

ANS: C

Antibody excess is termed prozone, often leading to a false-negative reaction.

DIF: Level 1

REF: p. 38

10. What is the potential effect in a tube agglutination test if a red cell suspension with a

concentration greater than 5% is used? a. False negatives b. False positives c. Hemolysis d. No effect ANS: A

Antigen excess is termed postzone and will lessen the reaction, causing a false-negative.

DIF: Level 3

REF: p. 38

11. After adding antigen and antibody to a test tube, one large agglutinate was observed. How

should this reaction be graded? a. 2+ b. 3+ c. 4+ d. 0 ANS: C

One large agglutinate is graded a 4+ reaction.

DIF: Level 2

REF: p. 39

12. Select the portion of the antibody molecule that imparts the antibody’s unique class function. a. Constant region of the heavy chain b. Constant region of the light chain c. Variable region of the heavy chain d. Variable region of the light chain ANS: A

The heavy-chain constant region has the function of the class.

DIF: Level 1

REF: p. 26

13. What portion of the antibody molecule binds to receptors on macrophages and assists in the

removal of antibody bound to red cells? a. Fab fragment b. Hinge region c. Fc fragment d. J chain ANS: C

The Fc portion of the antibody binds to the macrophage, which then carries the antigen-antibody complex to the spleen for removal.

DIF: Level 1

REF: p. 26

14. Select the region of the antibody molecule responsible for imparting unique antibody

specificity. a. Variable region b. Constant region c. Hinge region d. Fc fragment ANS: A

The variable region is the unique antigen-binding site that gives each antibody its specificity.

DIF: Level 1

REF: p. 26

15. What immunoglobulin class is capable of crossing the placenta? a. IgM b. IgA c. IgE d. IgG ANS: D

Only IgG can cross the placenta as a result of IgG receptor binding sites on placental cells.

DIF: Level 1

REF: p. 26

16. What immunoglobulin class reacts best at room temperature at immediate-spin? a. IgM b. IgA c. IgE d. IgG ANS: A

IgM is a large immunoglobulin with multiple binding sites that is detectable at room temperature and the immediate-spin phase.

DIF: Level 2

REF: p. 27

17. An antigen that originates from the individual is termed: a. autologous. b. allogeneic. c. hapten. d. immunogen.

ANS: A

Autologous is a term that refers to cells or tissue from self.

DIF: Level 1

REF: p. 33

18. Which of the following will cause an antigen to elicit a greater immune response?

a. b. c. d.

Small antigen size Composed largely of carbohydrates Size greater than 10,000 daltons Similarity to the host

ANS: C

Antigens will elicit a better immune response if they are larger than 10,000 daltons, are foreign to the host, and are made of proteins.

DIF: Level 1

REF: p. 25

19. Extravascular destruction of blood cells occurs in the: a. blood vessels. b. lymph nodes. c. spleen. d. thymus.

ANS: C

Extravascular destruction of blood cells is initiated by macrophage interaction with IgG molecules attached to red cells that transport the red cells to the spleen for clearance.

DIF: Level 2

REF: p. 35

20. An antibody identified in the transfusion service appeared to be reacting stronger following

the second exposure to an antigen from a transfusion. The most likely explanation of this observation is: a. affinity maturation of the immunoglobulin molecule. b. anamnestic response. c. isotype switching. d. All of the above ANS: D

Genetic changes in the variable region, stimulation of memory B cells, and class switching contribute to the increased strength and specificity of an antibody following the second exposure to an antigen.

DIF: Level 3

REF: p. 29

21. Which of the following components in the complement cascade mediates the lysis of the

target cells? a. C1qrs b. C4a, C3a, and C5a c. C5 to C9 d. C3a and C3b ANS: C

The membrane attack complex includes the C5 to C9 proteins that mediate lysis of the target cell.

DIF: Level 2

REF: p. 34

22. Which of the following requires adjustment in order to enhance the reaction of an antibody in

vitro? a. Temperature above 37 C b. Speed of the centrifuge above the calibrated settings c. Increase the concentration of red cells in the test system d. Increase the incubation time in the incubator ANS: D

Increasing incubation time is effective in increasing antibody reactions; however, optimal temperatures, centrifugation, and antigen concentrations are normally not altered when performing routine transfusion service testing.

DIF: Level 3

REF: p. 37

23. Hemolysis was observed at room temperature when testing a patient’s serum with reagent red

cells used for screening. When this test was repeated using the patient’s plasma, no hemolysis was observed. What was the most likely explanation for the different reactions? a. The plasma sample was collected incorrectly. b. The serum sample was contaminated. c. Complement activation was inhibited by calcium in the plasma sample. d. The serum sample was fresher.

ANS: C

Complement can be activated by some red cell antibodies; however, fresh serum samples are necessary to observe this reaction. Plasma samples contain calcium to inhibit the coagulation cascade, which also will inhibit complement activation.

DIF: Level 3

. 3S3 REF: TpE

24. Which immunoglobulin class is impacted by the zeta potential in a hemagglutination test? a. IgM b. IgG c. IgA d. IgE ANS: B IgG is a small molecule that cannot span the distance between red cells suspended in saline. The zeta potential prevents direct agglutination with IgG molecules.

DIF: Level 2

REF: p. 37

25. When testing for the A antigen in a patient, what would you use to perform the test? a. Patient’s plasma and commercial A red cells b. Commercial A cells and anti-A c. Patient’s red cells and anti-A d. None of the above ANS: C

For antigen testing, antigens are on the red cell; antibodies are in the antisera (commercial antibodies).

DIF: Level 2

REF: p. 40

26. A technologist added 4 drops of a 5% red cell suspension instead of the required 1 drop to a

hemagglutination test. What is the potential consequence to the test results? a. False-positive b. False-negative c. Hemolysis due to complement activation d. Test results are not affected ANS: B

Postzone occurs when the concentration of antigen exceeds the number of antibodies present.

The amount of agglutinates formed under these circumstances is also suboptimal and diminished.

DIF: Level 3

REF: p. 38

MATCHING

Select the immunoglobulin class from the list below that best fits the characteristic described.

Each class can be used more than once. a. IgA b. IgM c. IgG d. IgE 1.

2.

3.

4.

5.

6.

7.

8.

Found in secretions, such as breast milk Able to cross the placenta Associated with intravascuTlaEr S ceTllBdAesNtrKuS ctE ioL n LER.COM Associated with allergic reactions and mast cell activation Efficient in activation of the complement cascade Has the highest serum concentration Associated with immediate-spin in vitro reactions Has the highest number of antigen binding sites

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS:

A C B D B C B B

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2 Level 2 Level 2 Level 2 Level 2

Select the term from the list below that best fits the definitions. a. Kappa b. Epitope c. Hinge region d. Isotype e. Idiotype 9. Variable region of an immunoglobulin

10.

11.

12.

13.

Imparts flexibility to the immunoglobulin molecule Part of the antigen that the immunoglobulin binds to The type of immunoglobulins determined by the heavy chain One of the two types of light chains

9. ANS: E 10. ANS: C 11. ANS: B 12. ANS: D 13. ANS: A

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Chapter 03: Blood Banking Reagents: Overview and Applications Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Select the test that uses IgG-sensitized red cells (check cells). a. Antiglobulin test b. D-antigen typing c. Rh-antigen typing d. B-antigen detection ANS: A

The antiglobulin test requires the use of IgG-sensitized cells to verify a negative reaction was not caused by improper washing, omitting the antiglobulin reagent, or reagent problems.

DIF: Level 1

REF: p. 62

2. Select the method that uses a dextran-acrylamide matrix. a. Solid-phase red cell adherence b. Microplate c. Gel technology d. Tube techniques ANS: C

The dextran-acrylamide gel matrix traps agglutinated cells, making antigen-antibody reactions visible.

DIF: Level 1

REF: p. 66

3. What reagent contains antibodies to multiple antigenic epitopes? a. Polyclonal-based b. Monoclonal-based c. Heterophile antibody-based d. Alloantibody-based ANS: A

Polyclonal reagents contain antibodies to more than one antigen specificity.

DIF: Level 1

REF: p. 50

4. Which of the following items provides evidence for reagent red cell deterioration? a. Spontaneous agglutination b. Significant hemolysis c. Loss of agglutination strength over time d. All of the above ANS: D

Each observation listed may indicate a reagent red cell problem that could lead to false reactions.

DIF: Level 2

REF: p. 49

5. Reagent antibodies prepared from human sources are: a. unsafe. b. too low in potency to be effective. c. polyclonal in specificity. d. preferred because of their lower cost.

ANS: C

Human-derived antisera have antibodies to multiple specificities and meet Food and Drug Administration guidelines for potency and safety.

DIF: Level 1

REF: p. 49

6. Monoclonal antibodies are prepared in: a. vitro. b. vivo. c. laboratory animals. d. humans.

ANS: A

Monoclonal antibodies are prepared from antibody-producing B-lymphocytes and myeloma cells in a hybridoma, which is cultured in vitro.

DIF: Level 1

REF: p. 51

7. Which of the following is not an advantage of using a monoclonal antibody over a polyclonal

antibody? a. There are very few variations between lots. b. There are no contaminating antibodies. c. Direct agglutination is usually faster. d. All variations of the antigen can be detected.

ANS: D

Some monoclonal D antibodies may miss antigen variations, such as the partial D phenotype.

DIF: Level 2

REF: p. 51

8. Where are product limitations and technical considerations for each reagent located? a. Standard operating procedure b. Product insert c. Food and Drug Administration code of regulations d. AABB standards ANS: B

The product insert outlines the technical considerations, procedural guidelines, and product limitations for each reagent.

DIF: Level 1

REF: p. 49

9. Solid-phase red cell adherence used for antibody detection has an advantage over tube testing

because:

a. b. c. d.

there is no washing involved. incubation time is not necessary. the endpoint is more clearly defined. indicator cells (IgG-coated cells) are not necessary.

ANS: C

Well-defined endpoints make reading results more consistent and reliable.

DIF: Level 2

REF: p. 67

10. Which of the following statements is true regarding IgG-sensitized red cells? a. They must be used to confirm a negative antiglobulin tube test. b. They must be used to confirm a positive antiglobulin test. c. They must be used to confirm a direct antiglobulin test that was negative with

anti-C3d. d. They should be used only with the indirect antiglobulin test.

ANS: A

IgG-sensitized red cells are used as a control for false-negative antiglobulin tests.

DIF: Level 2

REF: p. 62

11. What method displays a positive reaction as a compact red cell button? a. Gel test b. Microtiter plate c. Solid-phase red cell adherence d. Molecular testing ANS: B The microtiter plate method displays a positive reaction as a compact red cell button in the bottom of the well. Negative reactions will stream when tilted on an angle.

DIF: Level 1

REF: p. 68

12. The antiglobulin test was performed using gel technology. A button of cells was observed at

the bottom of the microtube following centrifugation. How do you interpret this result? a. There is a problem with the card. b. The result is a negative reaction. c. The result is a strong positive reaction. d. The test was not washed correctly.

ANS: B

Red cells that are not trapped by the antihuman globulin reagent will travel unimpeded through the length of the tube.

DIF: Level 3

REF: p. 67

13. Which of the following statements is true regarding high-protein anti-D reagents? a. They have been largely replaced with low-protein monoclonal reagents. b. They contain high concentrations of bovine albumin. c. They may increase the possibility of a false-positive reaction, requiring the use of a

control.

d. All of the above are true.

ANS: D

High-protein anti-D reagent requires the use of a control to verify that positive reactions are the result of an antigen-antibody reaction and not agglutination caused by the reagent additive.

For this reason, the use of monoclonal anti-D is more commonly used.

DIF: Level 2

REF: p. 54

14. How would you interpret the results if both the anti-D reagent and the Rh control were 2+

agglutination reactions? a. D-positive b. D-negative c. Unable to determine without further testing d. Depends on whether the sample was from a patient or a blood donor ANS: C

The Rh control should be negative for the test to be valid.

DIF: Level 2

REF: p. 54

15. Which red cells are used to screen for antibodies in donor samples? a. Screening cells (two vials) b. Pooled screening cells c. Panel cells d. Screening cells (three vials) ANS: B

Pooled screening cells are acceptable for screening antibodies in donor samples.

DIF: Level 2

REF: p. 56

16. What specificities does polyspecific antihuman globulin contain? a. Anti-IgG. b. Anti-C3b and anti-C3d. c. Anti-IgG and anti-C3d. d. Anti-IgG and anti-IgM. ANS: C

Polyspecific antihuman globulin contains specificities to the heavy chain IgG and complement component, C3d.

DIF: Level 1

REF: p. 60

17. What temperature is used for incubation in the indirect antihuman globulin test? a. 22° C b. 37° C c. 4° C d. 56° C ANS: B

Incubation takes place at body temperature, which is 37° C.

DIF: Level 1

REF: p. 59

18. Why is incubation omitted in the direct antihuman globulin test? a. The direct antiglobulin test can be used in an emergency to replace the indirect

test. b. Incubation will cause hemolysis. c. The antigen-antibody complex has already formed in vivo. d. IgM antibodies are detected in the direct antiglobulin test.

ANS: C

Incubation of the antigen-antibody complex essentially has taken place within the patient (or donor), making additional incubation in the tube unnecessary.

DIF: Level 2

REF: p. 58

19. In the solid-phase red cell adherence test, how does a negative test appear? a. A button of cells on the bottom of the well b. Adherence of cells along the sides and bottom of the wells c. Hemolysis of red cells d. A line of cells along the top of the well ANS: A

Indicator cells, which are added in the final step, do not adhere to the wells and have not reacted with the antibody. Therefore, a button will form on the bottom of the well.

DIF: Level 1

REF: p. 67

20. Following centrifugation oT fE thS eT geBl A caNrK d,SreEdLcL elE lsRa. reCeOvM enly dispersed throughout one of the

microtubes. This reaction could be graded as a: a. 4+. b. 3+. c. 2+. d. 1+.

ANS: C

A 2+ reaction is demonstrated with red cells throughout the microtube.

DIF: Level 2

REF: p. 67

21. What immunoglobulin class reacts best by antiglobulin testing? a. IgM b. IgA c. IgE d. IgG ANS: D

The antiglobulin test detects IgG antibodies on red cells.

DIF: Level 1

REF: p. 60

22. Which of the following red cell antigens do proteolytic enzymes destroy? a. Rh system antigens

b. Antigens Fya and Fyb in the Duffy system c. Antigens in the Kidd system d. Lewis system antigens ANS: B

Proteolytic enzymes, such as ficin, will destroy some antigens on red cells such as Fya and Fyb, M, N, and S. DIF: Level 1

REF: p. 65

23. What is the purpose of adding antibody-sensitized red cells following the antiglobulin test? a. Ensure a weak antibody reaction was not missed b. Confirm positive reactions c. Check that the wash procedure was sufficient to remove unbound antibodies d. Check that sufficient incubation took place ANS: C

Antibody-sensitized red cells (check cells) are IgG-coated cells that will detect unbound antihuman globulin following proper washing techniques.

DIF: Level 2

REF: p. 62

24. Why is polyethylene glycol reagent added to the screen or panel? a. Enhance detection of IgM antibodies. b. Eliminate the reactivity of certain antigens. c. Increase the avidity of IgG antibodies. d. Eliminate the need for washing in the indirect antiglobulin test.

ANS: C

Polyethylene glycol (PEG) concentrates antibodies and increases the rate of antibody uptake, increasing the avidity of IgG antibody reactions.

DIF: Level 2

REF: p. 65

25. Rouleaux is a false-positive reaction caused by elevated serum protein levels. Which of the

following tests would not likely be affected by an elevated protein level? a. Immediate-spin antibody screen b. Direct antiglobulin test c. Reverse typing in the ABO test d. ABO forward typing ANS: B

Rouleaux are caused by an elevated protein level or IV solutions and cause cells to appear agglutinated. A procedure involving washing, such as the direct or indirect antiglobulin test, would not be affected by this because saline would eliminate the excess proteins.

DIF: Level 3

REF: p. 58

MATCHING

Select the reagent from the list below and match it to the routine blood banking procedure. a. Panel cells

b. c. d. e.

1.

2.

3.

4.

5.

Screening cells A1 and B cells ABO antisera Lectins

Reagent derived from plants used to distinguish group A1 from group A2 red cells Reagent used to determine the ABO antigenic composition of a patient’s red cells Reagent used to detect the presence of red cell antibodies Reagent used to identify the specificity of a red cell antibody Reagent used in the identification of ABO antibodies

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS:

E D B A C

DIF: DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2 Level 2

Select the antiglobulin test that best fits the descriptions below. A selection may be used more than once. a. Indirect antiglobulin test b. Direct antiglobulin test c. Both the direct and indirect antiglobulin test 6. Incubation step is not necessary 7. Requires washing the cells several times before the addition of antihuman globulin reagent 8. Tests for certain clinical conditions such as hemolytic disease of the newborn and

autoimmune hemolytic aneTmEia 9. Detects IgG or complement-coated red cells 6. ANS: 7. ANS: 8. ANS: 9. ANS:

B C B C

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Chapter 04: Genetic Principles in Blood Banking Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. A person whose red cells type as M+N+ with antisera would be: a. a homozygote. b. a heterozygote. c. unable to be determined without family studies. d. linked.

ANS: B

Because M and N are alleles, the inheritance of both alleles makes the individual a heterozygote.

DIF: Level 2

REF: p. 79

2. The children of a group AB mother and a group B father could phenotype as all of the

following except: a. O. b. A. c. B. d. AB. ANS: A

Unless there was a rare cisTAEBSiT nhBeAriN taK ncSeEpL atL teErnR, . aC grOoM up AB parent would not likely have a group O child.

DIF: Level 3

REF: p. 78

3. In a family study, all four siblings in the family had a different blood type: A, B, O, and AB.

What is the most likely genotypes of the parents? a. AA and BB b. AO and BB c. OO and AB d. AO and BO ANS: D

Performing a Punnett square demonstrates that a cross between genotypes AO and BO could yield four offspring with different phenotypes.

DIF: Level 3

REF: p. 76

4. If anti-M was reacted with red cells that are M+N+, how would they compare with red cells

that are M+N–? a. Stronger b. Weaker c. The same d. Varies with the method

ANS: B

Because M+N+ cells are heterozygous, the “dosage” of the M antigen is less and would therefore be weaker in reaction strength.

DIF: Level 2

REF: p. 80

5. 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? a. X-linked dominant b. X-linked recessive c. Autosomal dominant d. Autosomal recessive ANS: A

Because the father passed the trait to only his daughters, it was carried on the X chromosome.

Because only one allele is needed for expression, this is a dominant genetic trait.

DIF: Level 2

REF: p. 79

6. Of the following markers used to test for paternity, which marker provides the most useful

statistical value? a. Human leukocyte antigen typing b. D antigens c. ABO system antigens d. The Kidd system (Jka, Jkb) ANS: A

Human leukocyte antigen tTyE piS ngTpBrA ovNiK deSs E mLoL stEstRat.isCtiO caMl value because of the polymorphism of the major histocompatibility complex.

DIF: Level 2

REF: p. 83

7. Mitosis results in a. four cells with half as many b. two cells with the same number of c. four cells with the same number of d. two cells with half as many

chromosomes as the original.

ANS: B

Mitosis is cell division of somatic cells, resulting in two cells with the same number of chromosomes as the original cell.

DIF: Level 1

REF: p. 71

8. When does crossing over occur? a. Meiosis b. Mitosis c. Somatic cell division d. Zygote formation ANS: A

Crossing over is the sharing of chromosomal material during meiosis and contributes to greater genetic variation among offspring.

DIF: Level 1

REF: p. 81

9. When an individual is group A, which of the following genetic terms applies? a. Alleles b. Haplotype c. Genotype d. Phenotype ANS: D

The genetic expression, or trait, that can be determined by typing red cells is called the phenotype.

DIF: Level 1

REF: p. 75

10. What is an advantage of Nucleic Acid Testing (NAT) for viral marker testing? a. Quicker to perform than most other tests b. More cost effective than traditional test methods c. A small amount of DNA or RNA can be detected d. No problem with cross-contamination of samples ANS: C

Polymerase chain reaction is used for viral marker testing in the blood bank because it can detect very small quantities of viral material in donor samples.

DIF: Level 1

REF: TpE . 8S4

11. What is the meaning of the term autosomal? a. A trait that is not carried on the sex chromosomes b. A trait that is carried on the sex chromosome c. A trait that is expressed only in the parents d. A gene that does not express a characteristic ANS: A

Autosomal genetic expression is demonstrated in somatic cells, that is, cells in the body that are not gametes.

DIF: Level 1

REF: p. 75

12. How is RNA different from DNA? a. RNA usually exists as a single strand. b. The sugar ribose is substituted for deoxyribose. c. The base uracil exists only in RNA. d. All of the above are true.

ANS: D

RNA differs in its structural and chemical composition as well as its role in the cell function.

DIF: Level 1

REF: p. 84

13. When using the Hardy-Weinberg equation to calculate genetic frequencies, which of the

following must be TRUE? a. The population statistics must be large. b. Mutations cannot occur. c. Mating must be random. d. All of the above are true.

ANS: D

The Hardy-Weinberg formula is used to predict gene frequencies in populations where genetic variations are stable and random populations are large enough that statistics are reliable.

DIF: Level 1

REF: p. 83

14. If two traits occur higher in a population together than each occurs separately, they may be

linked. What does this fact suggest? a. They are found far apart on the same chromosome. b. They are inherited on different chromosomes. c. Crossover has occurred. d. The genes are close together on the same chromosome.

ANS: D

Linkage disequilibrium refers to the phenomenon of traits occurring at a different frequency in the population depending on whether they are inherited on linked or unlinked genes.

DIF: Level 2

REF: p. 81

15. What is the approximate probability of finding a compatible unit of blood for a D-positive

patient with antibodies to C anBdAKN, K ifSthEeLfrLeE quRe. ncCyOoMf C is 70%, E is 30%, and K is 10%?

T,EES, T a. 2 out of 10 units b. 4 out of 10 units c. 2 out of 100 units d. 4 out of 100 units ANS: A

Multiply the negative frequencies for each antigen: C  E  K or 0.30  0.70  0.90 =0.19, which is about 2 out of 10 units.

DIF: Level 3

REF: p. 82

16. In relationship testing, a “direct exclusion” is established when a genetic marker is: a. present in the child but absent in both the mother and alleged father. b. present in the child, absent in the mother, and present in the alleged father. c. absent in the child, present in the mother, and the alleged father. d. absent in the child, present in the mother, and absent in the alleged father.

ANS: A

A direct exclusion is determined when a genetic marker is present in the child but absent in both the mother and alleged father.

DIF: Level 2

REF: p. 84

17. In a random population, 16% of the population is homozygous for a particular trait. What

percentage of the same population is heterozygous for that particular trait? a. 32% b. 64% c. 48% d. 84% ANS: C

Using the Hardy Weinberg formula, (p + q)2 = 1.0 therefore the square root of 16 is 4 and 4 + 6 = 1. Since the expanded formula is p2 + 2pq + q2 = 1.0, then 2pq is the heterozygous population, which is 2  4  6 = 48.

DIF: Level 3

REF: p. 83

18. How are most blood group systems inherited? a. Autosomal recessive b. Autosomal dominant c. Sex-linked recessive d. Autosomal codominant ANS: D

Most blood groups systems are inherited as autosomal codominant, which means each inherited allele is equally expressed.

DIF: Level 1

REF: p. 77

19. The linked HLA genes on each chromosome are inherited as a: a. haplotype. b. phenotype. c. genotype. d. antithetical pair.

ANS: A

Closely linked genes on a chromosome such as the HLA genes are inherited as a group or haplotype.

DIF: Level 1

REF: p. 80

20. In the PCR reaction, what is the term for the short pieces of single-stranded DNA that are

complementary and mark the sequence to be amplified? a. Nucleotides b. Polymerases c. Primers d. Amplicons ANS: C

Complementary strands of DNA that mark the target DNA for the initiation of replication during PCR are called primers.

DIF: Level 1

REF: p. 84

21. Which of the following clinical applications applies to molecular testing for blood group

antigens? a. Confirm the D type of blood donors b. Identify fetus at risk for HDFN c. Predict the phenotype of a patient with autoimmune hemolytic anemia d. All of the above ANS: D

Molecular testing for blood group antigens is becoming more common and useful. The technique can predict a red cell phenotype, identify an at risk fetus, confirm a D typing and identify antigen-negative blood donors.

DIF: Level 2

REF: p. 84

MATCHING

Match the terms below with the definition that best fits. a. Haplotypes b. Recessive c. Amorphic genes d. Codominant genes e. Polymorphic 1. When two genes are close together on the same chromosome and are inherited as a “group” or 2.

3.

4.

5.

“bundle” A gene that does not express a detectable product Equal expression of two diT ffE erSenTtBinAhN erKitS edEgLeL neEsRa. s iCnOmMost blood group systems Having two or more alleles at a given gene locus When a gene product is expressed only when it is inherited by both parents

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS:

A C D E B

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Match the term with the definition that best fits. a. Primer b. Polymerase chain reaction c. Hybridization d. Probe e. Amplicon DNA sequence 6.

7.

8.

9.

10.

The binding of two complementary pairs of DNA Marks the sequence to be amplified during PCR Amplified target sequences of DNA produced by polymerase chain reaction Short segment of DNA with a known sequence that can be labeled with a marker Technique used to replicate a specific DNA sequences

6. ANS: C

DIF:

Level 1

7. ANS: A 8. ANS: E 9. ANS: D 10. ANS: B

DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1

TRUE/FALSE 1. Parents, who both phenotype as group A, cannot have a group O child.

ANS: F

If the parents are both heterozygous (AO), two O genes can be inherited by the offspring.

DIF: Level 3

REF: p. 77

Chapter 05: ABO and H Blood Group Systems and Secretor Status Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. What ABO phenotype would agglutinate in the presence of anti-A,B produced by group O

individuals? a. A only b. B only c. A and B d. O only ANS: C

Group O individuals make anti-A,B, an antibody with a specificity to both the A and B antigens.

DIF: Level 2

REF: p. 106

2. Which ABO phenotype selection contains the most H antigen and the least H antigen,

respectively, on the red cell’s surface? a. O, A1B b. A2, A1B c. B, A d. A1B, O ANS: A

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.

DIF: Level 1

REF: p. 101

3. 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? a. AB and B b. B and A c. O and A d. AB and A ANS: D

Group AB plasma contains no ABO system antibodies, and group A plasma contains anti-B, which would be compatible with the recipient’s red cells.

DIF: Level 3

REF: p. 106

4. A patient’s red cells are agglutinated by anti-B, but not by anti-A. What is this patient’s ABO

phenotype? a. Group B b. Group O c. Group AB

d. Group A ANS: A

Anti-B reacts with the B antigen, which is the blood type identified.

DIF: Level 2

REF: p. 106

5. What is the test procedure that combines patient’s serum with commercial A1 and B reagent

red cells? a. ABO forward grouping b. ABO reverse grouping c. Antibody screen d. Antibody panel ANS: B

Testing the serum for ABO antibodies requires combining it with cells with known antigen specificities. Agglutination indicates that an antigen-antibody reaction took place, thereby identifying the unknown antibody.

DIF: Level 1

REF: p. 106

6. 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? a. Groups A, B, AB, and O b. Groups A and B c. Groups A, B, and AB d. Groups A and AB ANS: C

The group 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. DIF: Level 3

REF: p. 103

7. According to Landsteiner’s rule (law), what ABO antibody will be detected in a group A

individual’s serum? a. Anti-A b. Anti-B c. Anti-A,B d. None ANS: B

According to Landsteiner, a person is expected to demonstrate the ABO antibody to the antigen he or she lacks on the red cells.

DIF: Level 1

REF: p. 97

8. Select the appropriate strategy if the results of red cell and serum testing in the ABO typing

procedure have negative agglutination reactions. a. Wash patient cells with warm saline. b. Use polyclonal typing reagents.

c. Perform an autocontrol. d. Incubate tubes at room temperature or 4° C with an autocontrol.

ANS: D

ABO antibodies are stronger at room temperature or lower. The autocontrol determines whether the enhanced antibody reaction was due to the ABO antibodies or to a cold reacting antibody. The autocontrol should be negative for the ABO typing to be valid.

DIF: Level 3

REF: p. 117

9. Predict the agglutination reaction of red cells from a Bombay phenotype when combined with

anti-H lectin. a. Strong 4+ b. Mixed field c. Weak 1+ d. Negative ANS: D

Bombay phenotypes have not inherited the H gene and therefore are negative with anti-H lectin.

DIF: Level 2

REF: p. 118

10. Given the following ABO phenotyping data:

FORWARD REVERSE A1 cells: 0 Anti-A: 2+mf Anti-B: 0 B cells: 3+ What could be a plausible T exEpS laT naBtiAoN nK foSr E thL isLdEisR cr.epCaOnM cy? a. T-activation of red cells b. Group O blood products given to group A c. Rouleaux formation d. Positive direct antiglobulin test ANS: B

Mixed-field reactions are often caused by transfusion of group O red cells, which may take place during an emergency or inventory issue.

DIF: Level 3

REF: p. 113

11. What forward typing reagent can be used to confirm group O units before placing them in

inventory? a. Anti-A b. Anti-B c. Anti-A,B d. Anti-H ANS: C

A common use of anti-A,B is to test group O red cells to confirm the blood type before putting them in inventory.

DIF: Level 1

REF: p. 106

12. Which of the following situations is most likely to cause intravascular hemolysis when an

incompatible transfusion is given? a. Group B packed cells to a group O recipient b. Group A packed red cells to a group AB recipient c. Group AB plasma to a group A recipient d. Group AB plasma to a group O recipient ANS: A

A group O recipient has anti-B that could potentially cause intravascular hemolysis if group B blood were transfused.

DIF: Level 2

REF: p. 106

13. 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? a. Contaminated reagent antisera b. Rouleaux formation c. That the patient has autoantibodies d. That patient has low-titer isoagglutinins ANS: D

In patients who are older, the level of ABO isoagglutinins can be below detectable levels.

DIF: Level 3

REF: p. 117

14. Most “naturally occurring” ABO system antibodies fall into which immunoglobulin class? a. IgA b. IgM c. IgE d. IgG ANS: B

ABO system antibodies are in the IgM class, which can agglutinate at immediate-spin and activate the complement cascade.

DIF: Level 1

REF: p. 105

15. What substances are found in the saliva of a group A person who also inherited the secretor

gene? a. A, H b. H c. A, Se d. A, B, H ANS: A

The secretor gene codes for the secretion of H in secretions, allowing the expression of H, as well as the ABO antigens.

DIF: Level 2

REF: p. 118

16. What percentage of the group A population are type as A2?

a. b. c. d.

1% 10% 20% 35%

ANS: C

The A2 subgroup is coded by the A2 gene and is essentially a less branched version of the A antigen.

DIF: Level 1

REF: p. 102

17. Approximately what is the percentage of individuals who demonstrate H in their saliva? a. 15% b. 50% c. 80% d. 98% ANS: C

Finding the H antigen in secretions indicates that a secretor gene was inherited.

DIF: Level 1

REF: p. 118

18. To distinguish between an A1 and A2 blood type, which reagent is used? a. Ulex europeaus lectin b. Anti-A,B c. Monoclonal anti-A d. Dolichos biflorus lectin ANS: D

Anti-A1 lectin will agglutinate A1 red cells, not A2 red cells.

DIF: Level 1 19.

REF: p. 102

Why is it sometimes necessary to distinguish A1 and A2 blood types? a. To resolve a discrepancy between the forward and reverse typing b. To prevent A1 recipients from receiving A2 blood c. To determine the secretor status of group A individuals d. To prevent hemolytic disease of the newborn ANS: A

Routine testing with anti-A1 lectin is necessary to resolve a discrepancy between the forward and reverse typing. Individuals who possess the A2 antigen can make anti-A1 antibody.

DIF: Level 2

REF: p. 102

20. What subgroup of A possesses the least amount of A antigen? a. A3 b. Ax c. A2 d. Ael ANS: D

The Ael subgroup requires adsorption and elution procedures to detect the A antigen on the red cells.

DIF: Level 1

REF: p. 101

MATCHING

Match the immunodominant sugar that corresponds to the ABO system group or antigen. a. D-galactose b. L-fucose c. N-acetylgalactosamine d. None of the above 1.

2.

3.

4.

5.

Group A Group B Group O H antigen Bombay

1.

2.

3.

4.

5.

ANS: C ANS: A ANS: B ANS: B ANS: D

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Chapter 06: Rh Blood Group System Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following phenotypes will react with anti-f? a. rr b. R1R1 c. R2R2 d. R1R2 ANS: A

The f antigen is the expression of the c and e gene complex when they are inherited on the same chromosome. Because the Weiner nomenclature “r” indicates that the ce gene was inherited together, it will express the f antigen.

DIF: Level 3

REF: p. 136

2. Each of the following genotypes is possible for an individual whose red cells react as

indicated below except: ANTISERA REACTIONS anti-C + anti-D + anti-E + + TESTBA anti-c anti-e + a. b. c. d.

R1R2.

R1r".

Rzr. R0r'.

ANS: D

The R0r' genotype expresses the C, c, D, and e antigens, but it does not express the E antigen.

DIF: Level 3

REF: p. 130

3. The weak D test detects: a. the Du antigen. b. the missing D mosaic. c. a weak D antibody. d. a weak D antigen.

ANS: D

The weak D test is the antiglobulin test for the D antigen, which is more sensitive and better able to detect weak D antigen expression.

DIF: Level 1

REF: p. 132

4. How would you label a donor who tested negative with anti-D reagent upon immediate-spin

and positive in antihuman globulin test? a. D-positive b. D-negative c. Cannot label; more testing needed ANS: A

Donor testing is required for the weaker D expression by the antihuman globulin test with the unit labeled as D-positive.

DIF: Level 1

REF: p. 132

5. A patient phenotypes as D+C+E-c-e+. Predict the most likely genotype. a. R1r b. R1R1 c. R1r' d. R1R0 ANS: B

R1R1 fits the phenotype and is also the more common of the choices given.

DIF: Level 2

REF: p. 130

6. How is it genetically possible for a child to phenotype as D-negative? a. Both parents are heterozygous D-positive. b. Both parents are homozygous D-positive. c. Mom is homozygous D-positive, and Dad is heterozygous D-positive. d. The sibling is D-positivTeE .

ANS: A

The heterozygous expression for both parents would allow the D-negative expression to be passed on to the child.

DIF: Level 2

REF: p. 131

7. Current theory regarding the genetics of the Rh system suggests that: a. each Rh system antigen is coded by its own gene locus. b. Rh system antigens are coded by two closely linked genes. c. one gene locus with multiple alleles codes for the protein antigens. d. the Rh system genes are a haplotype that codes for three sets of alleles.

ANS: B

Two closely linked genes, RHD and RHCE, code for the Rh system antigens.

DIF: Level 1

REF: p. 128

8. Red cells that phenotype as D-negative indicate that: a. they inherited two D genes. b. there is no genetic material inherited from the RHD gene from both parents. c. a suppressor gene was inherited that is turning off the D gene expression. d. reagents currently in use are not detecting the D antigen.

ANS: B

The D-negative phenotype is the absence of genetic material at the RHD gene locus. This lack of genetic material must be inherited from both parents to result in a negative expression.

DIF: Level 1

REF: p. 126

9. 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? a. D-positive b. D-negative c. Unable to interpret without further testing d. D-positive if the sample is from a patient ANS: C

The D control should be negative for the test to be valid.

DIF: Level 2

REF: p. 54

10. All of the following can cause the D antigen expression to be weaker except: a. inheriting the G gene. b. inheriting the C antigen in trans to the D antigen. c. an RHD gene that is genetically weaker. d. partial D expression.

ANS: A

The G gene is always inherited when the D or C gene is inherited and has no effect on the strength of the D gene.

DIF: Level 1

REF: TpE . 1S3T 3

11. An anti-E was identified in a patient who recently received a transfusion. What other Rh

system antibody should be investigated? a. Anti-G b. Anti-f c. Anti-D d. Anti-c ANS: D

Anti-c is often found in patients who make anti-E. Anti-c is often weaker and shows dosage when the patient is developing the antibody from the first exposure to the antigen.

DIF: Level 1

REF: p. 137

12. The frequency of the D-negative phenotype in the population is: a. 15%. b. 85%. c. 50%. d. 35%.

ANS: A

Fifteen percent of the population is D-negative.

DIF: Level 1

REF: p. 126

13. Testing for the weak D expression is performed by: a. using anti-Du antisera with an extended incubation. b. using monoclonal anti-D. c. performing the indirect antiglobulin test with anti-D. d. performing the direct antiglobulin test with anti-D. ANS: C

The weak D test (previously called the Du test) involves the indirect antiglobulin test using anti-D reagent.

DIF: Level 1

REF: p. 132

14. The numeric Rh4 nomenclature refers to which antigen in the Rosenfield notation? a. C b. c c. e d. E ANS: B

The more common Rh system antigens are Rh1 = D, Rh2 = C, Rh3 = E, Rh4 = c, Rh5 = e.

DIF: Level 1

REF: p. 128

15. The LW antigen expression is typically stronger on a. D-positive b. D-negative c. Rh null d. D-variant

red cells.

ANS: A

The original anti-D found by experiments with rhesus monkeys was actually anti-LW that reacts best with D-positive cells.

DIF: Level 1

REF: p. 138

16. Why is the determination of the D antigen important for women during pregnancy? a. A D-positive mother can form anti-D during pregnancy that may destroy the

D-positive red cells of the fetus. b. A D-negative mother should be given Rh immune globulin to prevent potential

formation of anti-D during delivery of a D-positive infant. c. A D-negative mother may form anti-D if the father of the child is also D-negative. d. A D-positive mother may pass her red cells to the D-negative fetus and cause

hemolytic disease of the fetus and newborn.

ANS: B

D-negative females who are pregnant should be given Rh immune globulin at 28 weeks to prevent the formation of anti-D, which may cause hemolytic disease of the fetus and newborn on subsequent pregnancies. The exposure to the D antigen on delivery of a D-positive fetus triggers the formation of anti-D. DIF: Level 1

REF: p. 138

17. The inheritance of the Rh antigens are: a. X-linked recessive. b. X-linked dominant. c. autosomal recessive. d. codominant.

ANS: D

As with most blood group systems, inheritance patterns follow a codominant expression, meaning that both genes from the parents are expressed equally.

DIF: Level 1

REF: p. 126

18. What is the immunoglobulin class of most Rh system antibodies? a. IgM b. IgG c. IgA d. IgE ANS: B

Rh system antibodies are IgG, requiring the indirect antiglobulin test to detect.

DIF: Level 1

REF: p. 137

19. An individual’s red cells gave the following reactions with antisera:

Anti-D Anti-C Anti-E 4+ 3+ 0 The most probable genotypTeEisS: a. R1R2. b. R2r. c. R0r. d. R1r.

Anti-c 3+

Anti-e 3+

Rh control 0

ANS: D

The most probable genotype is based on the antigens present and the frequency of each allele in the population; thus since red cells that have this phenotype are most likely CDe/ce, the type is also expressed as R1r.

DIF: Level 2

REF: p. 130

20. If D-negative red cells are transfused to an R1R1 individual, what is the most likely Rh

antibody that could develop? a. Anti-E b. Anti-d c. Anti-D d. Anti-c ANS: D

Anti-c could develop since the recipient is c-negative and the donor is most likely rr or ce/ce.

DIF: Level 2

REF: p. 128

21. If a D-positive person appears to have anti-D in their serum, what is the most likely

explanation? a. D-deletion phenotype b. Compound antigen c. Partial D antigen d. Transposition effect ANS: C

A person with a partial D antigen, who is exposed by pregnancy or transfusion to the complete D antigen, could potentially make an antibody that appears to be anti-D because it reacts with all D-positive cells on a panel, but not with D-negative cells. The antibody is actually directed to the part of the D epitope missing on the red cells.

DIF: Level 2

REF: p. 134

22. Which of the following is associated with the Rhnull phenotype? a. Membrane abnormalities b. Immunized Rhnull individuals may produce anti-Rh29 c. Mutation of the RhAG regulator gene d. All of the above ANS: D

The Rhnull phenotype lacks all Rh system antigens and is associated with membrane abnormalities. An antibody to all other Rh antigens can be produced if a null person becomes immunized and Rhnull blood would be required for transfusion. One of the mechanisms for inheritance of this phenotype is a mutation in the regulator gene called RhAG. DIF: Level 1

REF: TpE . 1S3T 7

MATCHING

Match the following phenotypes with the most probable genotype in the Weiner nomenclature. a. R1r b. R1R1 c. R2R2 d. rr 1.

2.

3.

4.

DCce ce DCe DcE

1.

2.

3.

4.

ANS: A ANS: D ANS: B ANS: C

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Match the Fisher-Race notation with the correct Weiner notation for the following: a. Ce b. CE c. DCE

d. Dce 5.

6.

7.

8.

Rz ry r' R0

5. ANS: 6. ANS: 7. ANS: 8. ANS:

C B A D

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Chapter 07: Other Red Cell Blood Group Systems, Human Leukocyte Antigens, and Platelet Antigens Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following facts is not a characteristic of Kell system antibodies? a. Usually clinically significant IgG antibodies b. Best detected in indirect antiglobulin test phases c. Lose reactivity with proteolytic enzyme reagents d. Do not bind complement proteins ANS: C

Proteolytic enzymes do not affect the Kell system antigens.

DIF: Level 1

REF: p. 151

2. Antibodies to Kidd, Kell, and Duffy blood group antigens share all the following

characteristics except: a. can cause hemolytic disease of the newborn. b. usually detected only by the indirect antiglobulin test. c. enhanced with enzyme treatment. d. can cause transfusion reactions.

ANS: C

EiLthLeEnRzy.mCeO-tM The Duffy system antibodiTesEdSoTnBoA t rN eaKcS tw reated cells.

DIF: Level 1

REF: p. 157

3. 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 in vivo. a. IgG, donor’s b. IgM, donor’s c. IgG, recipient’s d. IgM, recipient’s ANS: A

The anti-K in the recipient attached to the K antigen on the transfused donor red cells, which will cause them to be prematurely cleared by the spleen.

DIF: Level 2

REF: p. 151

4. Which of the following phenotypes is heterozygous? a. Fy(a–b+) b. Jk(a+b–) c. Fy(a+b+) d. Le(a+b–)

ANS: C

If both alleles Fya and Fyb are present on the red cell, the genetic expression is heterozygous.

DIF: Level 2

REF: p. 154

5. Antibodies to which of the following blood group system show dosage (i.e., are stronger with

homozygous expression of the antigen)? a. Lutheran b. P c. Duffy d. Kell ANS: C

Stronger reactions are typically seen with red cells that have a “double dose” of the antigen in the Duffy system.

DIF: Level 1

REF: p. 155

6. Why are antibodies to Lub antigen not commonly detected? a. Lub antigen is of high incidence. b. The antibodies do not cause transfusion reactions. c. Lub antigen is not present on screening cells. d. The antibodies react best at 4 C. ANS: A

Lub antigen occurs at an incidence of greater than 99%.

DIF: Level 1

REF: TpE . 1S5T 8

7. Why have Lewis system antibodies not been implicated in hemolytic disease of the fetus and

newborn? a. The antigens are not fully developed at birth. b. Lewis system antibodies do not cross the placenta. c. The antibodies are not clinically significant. d. All of the above are correct.

ANS: D

Lewis antibodies are often found during pregnancy but do not cross the placenta because they are IgM. The antigens are not well developed at birth.

DIF: Level 2

REF: p. 160

8. All the following statements are true regarding Lewis system antibodies except antibodies: a. may be observed at the immediate-spin, 37 C, and antihuman globulin phases. b. can be neutralized by Lewis substance. c. may cause hemolysis in vitro. d. do not react following enzyme treatment of cells.

ANS: D

Anti-Leb may be enhanced with enzyme treatment.

DIF: Level 1

REF: p. 160

9. What phenotype will be expressed when the Le, Se, and H genes are inherited? a. Le(a+b+) b. Le(a–b+) c. Le(a–b–) d. Le(a+b–) ANS: B

Inheriting H, Se, and Le genes will allow the Lewis transferase to convert H to Leb antigen and to be absorbed onto the red cells.

DIF: Level 2

REF: p. 161

10. Predict the probable antibody’s identity if all red cells tested at room temperature are positive

with a patient’s serum except for cord cells. a. Anti-Lu b. Anti-Lea c. Anti-I d. Anti-M ANS: C

The I antigen is found on adult red cells, not on cord red cells. Anti-I reacts best at colder temperatures.

DIF: Level 2

REF: p. 162

11. Which condition is often associated with the presence of anti-I? a. Infectious mononucleoT siE s b. Mycoplasma pneumoniae infection c. Pregnancy d. Colon cancer ANS: B

High-titer auto anti-I is often found in patients with Mycoplasma pneumoniae infections.

DIF: Level 1

REF: p. 162

12. Which of the following blood group systems are structurally related to antigens of the P

system? a. MNS b. ABH c. Kell d. Duffy ANS: B

The P system antigens are formed by the action of glycosyltransferases, similar to the ABO system genes and antigen products.

DIF: Level 1

REF: p. 164

13. What characterizes the Donath-Landsteiner antibody? a. An IgG auto anti-P.

b. An IgM auto anti-I. c. Anti-IH that reacts at cold temperatures. d. An IgG anti-Pk. ANS: A

The Donath-Landsteiner antibody is a biphasic hemolysin that binds at colder temperatures in the body (extremities) and activates complement to cause hemolysis at warmer temperatures.

DIF: Level 1

REF: p. 165

14. Red cells that phenotype as S–s– are also: a. M-negative. b. N-negative. c. Tja-negative. d. U-negative.

ANS: D

When S and s are absent from the membrane, the high-frequency antigen U is also absent.

DIF: Level 1

REF: p. 168

15. Select the statement that is FALSE regarding anti-P1. a. Anti-P1 will not react with enzyme-treated P1 positive red cells. b. P2 individuals can make anti-P1. c. Anti-P1 is clinically not significant. d. Anti-P1 reacts best at room temperature.

ANS: A

Anti-P1 is an IgM alloantibody that is made by P2 individuals and reacts best at colder temperatures.

DIF: Level 1

REF: p. 165

16. Anti-Jsb was identified in a patient scheduled for elective surgery later. What is the best

approach to finding compatible blood? a. Contact the rare donor registry since Js(b-) units are rare. b. Request that family members be tested to determine if they share the same phenotype. c. Screen donors from the black population because Js(b-) phenotype is common. d. A and B are correct.

ANS: D

Js(b-) individuals are less than 1% of the black population and even rarer in the white donor population. The rare donor registry is the most likely source of units; however, they would probably be stored as frozen red cells. Since the units are not required urgently, family members should be typed to locate potentially compatible blood.

DIF: Level 2

REF: p. 151

17. A patient’s antibody history listed an anti-Cellano. This antigen is also known as: a. c in the Rh system. b. k in the Kell system.

c. Cs in the Cost system. d. SC in the Scianna system.

ANS: B

Cellano is the original name of the k antigen (KEL2) in the Kell system, a high-frequency antigen that is antithetical to K (KEL1).

DIF: Level 1

REF: p. 149

18. The major histocompatibility complex is located on chromosome 6 and is important in all the

following immune functions except: a. recognition of nonself. b. graft rejection. c. hemolysis. d. coordination of cellular and humoral immunity.

ANS: C

The major histocompatibility complex codes for molecules on all nucleated tissues and cells to allow for immune recognition and response to foreign antigens.

DIF: Level 2

REF: p. 172

19. The mixed lymphocyte culture (MLC) is a procedure that has been used in HLA testing to

determine: a. class I HLA antigen determination. b. class II HLA antigen determination. c. HLA antibody identification. d. compatibility testing foTr E tiS ssT ueBtA ypNiK ngS. ELLER.COM e. B and D. ANS: E

The mixed lymphocyte culture (MLC) was an in vitro procedure used to determine tissue compatibility and D (class II) typing that has been largely replaced by molecular typing and flow cytometry techniques.

DIF: Level 2

REF: p. 175

20. HLA matching between the donor and recipient is important for progenitor cell

transplantation to avoid: a. graft versus host disease (GVHD). b. graft rejection. c. transfusion reactions. d. A and B. ANS: D

HLA typing is essential to avoid GVHD and rejection in HPC transplants.

DIF: Level 2 MATCHING

REF: p. 174

Match each characteristic with the appropriate blood group system. A selection may be used more than once. a. Cartwright b. MNSs c. Kidd d. Vel e. Xga f. Sda antigen g. Chido/Rodgers h. Kell i. Duffy Antigen has a higher frequency in females Antigen of high incidence; its antibody can cause hemolytic transfusion reactions Antibodies are sensitive to enzymes and have high-titer low-avidity characteristics System associated with McLeod phenotype Antigens Yta and Ytb are in this system System associated with glycophorin A and B Antibodies in this system often fall below detectable levels and are associated with delayed transfusion reactions 8. Antibody to this antigen demonstrates weak mixed field reaction 9. System associated with chronic granulomatous disease 10. System associated with resistance to malaria 1.

2.

3.

4.

5.

6.

7.

1. ANS: E 2. ANS: D 3. ANS: G 4. ANS: H 5. ANS: A 6. ANS: B 7. ANS: C 8. ANS: F 9. ANS: H 10. ANS: I

DIF: Level 1 evel 1 DIF: TLE ST DIF: Level 1 DIF: Level 1 DIF: Level 1 DIF: Level 1 DIF: Level 1 DIF: Level 1 DIF: Level 1 DIF: Level 1

Chapter 08: Antibody Detection and Identification Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. In the process of identifying an antibody, the technologist observed 2+ reactions with 3 of the

10 cells in a panel at the immediate-spin phase. These reactions disappeared following incubation at 37° C and the antihuman globulin phase of testing. What is the most likely responsible antibody? a. Anti-E b. Anti-D c. Anti-I d. Anti-Lea ANS: D

The Lea antigen is typically found on three to four cells in a panel, and the antibody reacts best at the immediate-spin phase of testing.

DIF: Level 3

REF: p. 184

2. What is a characteristic of Rh system antibodies? a. Mixed-field reactions on panels b. Weak reactions with panel cells c. Strong reactions with panel cells when read at immediate-spin phase d. Reactions that are enhaTnE ceSdTwBitA h NenKzS ym esLER.COM EL ANS: D

Rh system antibodies are typically strong and are enhanced with enzyme treatment.

DIF: Level 1

REF: p. 193

3. Which of the following situations can be found in a classic case of autoimmune hemolytic

anemia? a. Positive direct antiglobulin test b. False-positive Fya phenotyping c. Crossmatch incompatibility at antihuman globulin d. All of the above ANS: D

Red cells of a patient with this condition are coated with IgG antibodies that are signaling premature destruction in the spleen. Because the red cells are coated, attempts to test them with antiglobulin reagent results in positive reactions. The antibody in the serum will react with all normal cells tested at the antihuman globulin phase.

DIF: Level 2

REF: p. 199

4. What is the next step in the investigation of a positive direct antiglobulin test with

polyspecific antihuman globulin reagent? a. Repeat the direct antiglobulin test using warm saline.

b. Perform an eluate. c. Add IgG-sensitized red cells to verify positive reaction. d. Repeat the direct antiglobulin test using monospecific anti-IgG and anti-C3

reagents.

ANS: D

Polyspecific antihuman globulin contains both a complement and IgG component. To determine which caused the positive reaction, red cells should be tested separately using monospecific anti-IgG and anti-C3 reagents.

DIF: Level 2

REF: p. 199

5. Antibody screening cells are positive at the antihuman globulin phase of testing. What is the

first step in this investigation? a. Check transfusion and pregnancy history. b. Perform a direct antiglobulin test using anti-C3. c. Repeat the ABO typing. d. Crossmatch units until one is compatible.

ANS: A

A positive screen indicates the presence of unexpected antibody. Patient history can aid in the investigation.

DIF: Level 2

REF: p. 187

6. Why is the agglutination reaction phase important in the interpretation of the antibody screen

or antibody identification panel? a. Determines whether thT erE eS isTaBdA elN ayKeS dE trL anLsE fuR si. onCO reM action b. Provides clues on antibody dosage c. Indicates the class of the antibody d. Determines whether an autoantibody is present ANS: C

IgM antibodies typically react at room temperature. IgG antibodies require the antiglobulin phase to detect.

DIF: Level 2

REF: p. 184

7. In an antibody identification panel, only one red cell was negative at the antihuman globulin

phase. On ruling out and matching the pattern, an anti-k was identified. What further testing is necessary to confirm the antibody? a. Two more k-negative cells should be tested. b. Two more K-negative cells should be tested. c. Treat the panel cells with enzymes and perform the panel again. d. Perform an adsorption using “k”-positive cells.

ANS: A

To satisfy the “rule of three,” three negative and three positive reactions for the antigen should be observed to rule in an antibody.

DIF: Level 3

REF: p. 190

8. Anti-Fya was identified in a patient’s serum. The patient’s red cells phenotyped as Fy(a+)

using commercial antisera. What is the next step? a. Repeat the panel to confirm the antibody. b. Report the antibody because this result is normal. c. Investigate a recent transfusion history. d. Wash the cells and use monoclonal anti-Fya antibodies.

ANS: C

The patient’s red cells should be Fy(a-) to make anti-Fya unless a recent transfusion was given of Fy(a+) red cells. If no Fy(a+) red cells were recently transfused, the antibody identified may be incorrect or the patient may have a positive direct antiglobulin test.

DIF: Level 3

REF: p. 191

9. If all antibody identification panel cells were reactive at the same strength at the antihuman

globulin phase, no negative reactions were observed, and the autocontrol was negative, what antibody should be suspected? a. Multiple antibody specificities b. Warm autoantibody c. Antibody to a low-frequency antigen d. Antibody to a high-frequency antigen ANS: D

Reactions of similar strength suggest one specificity; a negative autocontrol rules out an autoantibody, and all panel cells reactive suggest an antibody to an antigen that is of high frequency in the population.

DIF: Level 3

REF: TpE . 1S9T 4

10. Select the antibody that is not produced against a low-incidence antigen. a. Anti-Vel b. Anti-Cw c. Anti-V d. Anti-Lua ANS: A

Vel is an antigen found in high frequency in the population.

DIF: Level 1

REF: p. 196

11. What is the typical specificity of cold autoantibodies? a. M b. N c. I d. Leb ANS: C

Cold autoantibodies are typically of the specificity anti-I. I is a high-frequency antigen found on all adult red cells but is absent on cord red cells.

DIF: Level 1

REF: p. 200

12. If an anti-I is suspected in a patient’s sample that requires a transfusion, what is the most

acceptable course of action? a. Call the rare donor registry. b. Crossmatch cord blood. c. Perform a cold autoadsorption. d. Perform the prewarm technique.

ANS: D

Prewarming the patient’s serum and panel cells separately and then mixing at 37° C to avoid cold temperatures usually avoids the reactivity of the anti-I, which is not clinically significant but may mask other antibodies.

DIF: Level 2

REF: p. 200

13. What is the most important concern when trying to identify antibodies in a patient with a

warm autoantibody? a. Identifying the specificity of the autoantibody b. Determining whether there are underlying alloantibodies c. Identifying the antibody found in the eluate d. Determining whether complement is binding to the autologous red cells ANS: B

Autoantibodies in the serum can mask underlying alloantibodies.

DIF: Level 2

REF: p. 203

14. An autoadsorption may be performed to investigate underlying autoantibodies. When is this

procedure acceptable? a. When the autoantibody is reactive at 4° C b. When the patient has not been recently transfused c. Only if complement is coating the red cells d. When the eluate is negative ANS: B

If an autoadsorption is performed (using the patient’s red cells) and the patient has been recently transfused, the adsorbing red cells may remove developing alloantibodies to the transfused cells.

DIF: Level 2

REF: p. 206

15. Why are proteolytic enzymes not used in the routine screening for antibodies? a. The reagent is too expensive for routine use. b. Clinically insignificant antibodies are enhanced. c. Red cells must be treated with enzymes first, which makes this technique

impractical. d. Some antigens are destroyed by enzymes, which would cause the antibodies to be

missed.

ANS: D

Proteolytic enzymes destroy some antigens in the Duffy and MNS system. Antibody screens using enzymes would not detect antibodies to these antigens.

DIF: Level 1

REF: p. 186

16. High-titer, low-avidity antibodies typically: a. react with antigens of high frequency in the population. b. react with antigens of low frequency in the population. c. are clinically significant. d. react best at colder temperatures.

ANS: A

High-titer, low-avidity antibodies are typically reactive with most panel cells at the antihuman globulin phase and are not clinically significant. They may mask clinically significant reactions.

DIF: Level 1

REF: p. 194

17. Select the example of a cold alloantibody. a. Anti-M. b. Anti-I. c. Anti-Lub. d. Anti-k.

ANS: A

Alloantibodies to anti-M react best at room temperature but can also demonstrate reactions at 37° C and antihuman globulin phases.

DIF: Level 1

REF: p. 197

18. Select the best description T ofEtS heTeBluAtN ioK nS teE chLnLiqEuR e..COM a. Technique that disassociates IgM antibodies from red cells for further

identification b. Technique that disassociates IgG antibodies from red cells for further identification c. Technique that adsorbs IgG antibodies from serum d. Technique that separates IgG and IgM antibodies in serum ANS: B

Elution procedures remove IgG antibodies from sensitized red cells to be used for identification using panel cells.

DIF: Level 2

REF: p. 204

19. Which of the following antigens is not commonly used on screening cells? a. D b. k c. Kpa d. C ANS: C

Kpa is a low-frequency antigen in the Kell system that is typically not present on screening cells.

DIF: Level 1

REF: p. 184

20. What type of red cells is used in an autoadsorption to remove antibody from the serum? a. Antibody screening cells b. Donor red cells c. Patient red cells d. Antibody identification panel cells ANS: C

Patient red cells are treated to remove IgG antibody and then are incubated with the patient’s serum to remove more autoantibodies that are interfering with alloantibody identification.

DIF: Level 1

REF: p. 206

21. Anti-D, anti-K, and anti-Jka are the antibodies that are tentatively identified on a panel after

initially ruling out on negative cells. What selected cell from another panel should be chosen to confirm the presence of anti-K? a. K–, D+, Jk(a+) b. K+, D+, Jk(a+) c. K+, D–, Jk(a+) d. K+, D–, Jk(a–) ANS: D

To confirm the presence of a anti-K, a cell positive for K antigen and antigen negative for the other two suspected antibodies will confirm anti-K if it is reactive against it.

DIF: Level 2

REF: p. 193

22. Select the antibody where DTT (dithiothreitol) would be useful in the identification

investigation. a. Anti-Jsa b. Anti-Kpb c. Anti-Vel d. Anti-K ANS: B

Anti-Kpb is a high-frequency antigen in the Kell system. If an anti-Kpb is suspected, the panel cells could be treated with DTT and the sample retested. If all reactions are eliminated, the anti-Kpb is confirmed and other underlying alloantibodies are ruled out. Although K would also be destroyed by DTT, there are sufficient negative cells on the panel to determine if underlying antibodies exist and confirm the specificity.

DIF: Level 1

REF: p. 195

23. When should anti-Sda be suspected? a. Weak reactions at the antiglobulin phase occur with several panel cells b. Reactions are stronger with enzymes at the immediate-spin phase c. Antibody reacts with most panel cells and are mixed field and refractile

microscopically d. Weak reactions at the AHG phase titer out to high dilutions ANS: C

Anti-Sda antibodies are characteristically mixed field and refractile when observed under the microscope. Sda is a high-frequency antigen; therefore, these reactions will be observed with most cells tested.

DIF: Level 2

REF: p. 196

24. A patient’s serum reacted weakly with all panel cells tested at the antiglobulin phase using

LISS and were not enhanced using PEG. The autocontrol was negative. Ficin-treated panel cells were nonreactive. What is the most likely specificity of the antibody? a. Anti-I b. Anti-U c. Anti-Ch d. Anti-Jsb ANS: C

Anti-Ch (anti-Chido) is an antibody to a high-frequency antigen in the high-titer low-avidity category of antibodies that demonstrate weak reactions that are not normally enhanced with potentiators. Anti-Ch reactions may be eliminated when testing with ficin-treated cells.

DIF: Level 2

REF: p. 195

25. Which of the following medications is most likely to cause the production of autoantibodies? a. Tetracycline b. Cephalothin c. Methyldopa d. Acutane ANS: C

Methyldopa is a medication often associated with autoantibody formation. The autoantibody can be observed in the serum and the eluate without the presence of the drug (drug-independent mechanism).

DIF: Level 2

REF: p. 207

26. An antibody was detected at immediate-spin and 37° C that appeared to have anti-Leb

specificity. To confirm the antibody identity and determine if there were other antibodies in the serum, a Lewis neutralization technique was performed.

Patient serum + Lewis substance = 0 Patient serum + saline control = 1+ Neutralized serum + Fy(a+b+) red cell = 0 What conclusion can be made from these results? a. Anti-Leb is confirmed. b. Antibody was diluted, therefore no conclusion can be made. c. Antibody was not neutralized, therefore anti-Leb has not been identified. d. Antibody other than anti-Leb is most likely in the serum.

ANS: A

Since the saline control demonstrated a positive reaction, the antibody was not diluted by the neutralization procedure. The antibody to the Lewis antigen was neutralized, since it did not react with the Lewis positive cells.

DIF: Level 3

REF: p. 198

MATCHING

Match the tentative interpretation of antibody screen and direct antiglobulin test (DAT) with the results given below. a. Alloantibody, IgG b. Alloantibody, IgM c. Autoantibody, IgM d. Autoantibody or transfusion reaction, IgG 1.

2.

3.

4.

All screening cells 2+ at antihuman globulin phase, DAT positive, IgG 2+ One screening cell 1+ at antihuman globulin phase, DAT negative All screening cells positive 1+ at IS, DAT positive, C3 1+ All screening cells positive 1+ at IS, DAT negative

1. ANS: 2. ANS: 3. ANS: 4. ANS:

D A C B

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Chapter 09: Compatibility Testing Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Why is a recipient’s antibody screening performed as a component of compatibility testing? a. Detects red cell alloantibodies b. Detects irregular antigens on the recipient’s red cells c. Detects human leukocyte antigen antibodies d. Detects incompatibilities with the donor’s red cells ANS: A

The antibody screen detects alloantibodies that the recipient made to red cell exposure from pregnancy or prior transfusions.

DIF: Level 1

REF: p. 224

2. What is the immunoglobulin class of antibodies detected in the immediate-spin crossmatch? a. IgA b. IgM c. IgG d. IgD ANS: B

Immediate-spin reactions are typically due to antibodies of the IgM class.

DIF: Level 1

REF: p. 218

3. Select the correct statement regarding the collection of a blood sample for compatibility

testing. a. The sample must be labeled at the bedside. b. The sample requires a new numeric identifier for the patient for each admittance. c. The sample may be labeled at any time in an emergency. d. The sample does not require a means to identify the phlebotomist.

ANS: A

Samples must be labeled by the bedside following examination of the wristband and correctly identifying the patient. Identification of the phlebotomist and a unique ID number that does not change are also required.

DIF: Level 1

REF: p. 221

4. A patient was admitted to the hospital with acute bleeding. Anti-E was detected in the

patient’s serum. Four E-negative units of blood were crossmatched for the patient. The units were compatible at immediate-spin and following the antiglobulin test. After the antiglobulin test was performed, IgG-sensitized red cells gave a 2+-agglutination reaction. What is the proper interpretation of this 2+-agglutination reaction? a. Antihuman globulin washing procedure was adequate. b. IgG-sensitized red cells spontaneously agglutinated.

c. Crossmatch was incompatible. d. Patient’s anti-E reacted with the IgG-sensitized red cells.

ANS: A

IgG-sensitized red cells should be positive if adequate washing was performed and antihuman globulin reagent was added.

DIF: Level 3

REF: p. 219

5. Which of the following tests is not included in routine compatibility testing? a. ABO phenotyping b. Direct antiglobulin test c. D typing d. Antibody screen ANS: B

The direct antiglobulin test is not required as part of the compatibility test.

DIF: Level 1

REF: p. 221

6. What are the two components of the major crossmatch? a. Recipient red cells and donor serum b. Donor red cells and recipient serum c. Reverse ABO cells and recipient serum d. Screening cells and donor serum ANS: B

Donor red cells and patient serum are tested for reactivity.

TESTBANKSELLER.COM

DIF: Level 1

REF: p. 217

7. A group O patient was crossmatched with group B red blood cells. What phase of the

crossmatch will first detect this incompatibility? a. Immediate-spin b. 37° C low–ionic strength solution c. Indirect antiglobulin d. None of them; unit is compatible ANS: A

ABO incompatibilities should be detected on immediate-spin.

DIF: Level 2

REF: p. 218

8. Select the item that compatibility procedures will not address. a. Prevent formation of all red cell antibodies b. Prevent life-threatening transfusion reactions c. Maximize in vivo survival rate of red cells d. Check ABO compatibility ANS: A

The compatibility test may prevent the formation of anti-D, but not all other antigens are matched.

DIF: Level 2

REF: p. 220

9. A recipient is group O with the following Rh phenotype: D+C+c–E+e+.

If this recipient is transfused with red blood cells from six random group O D-positive donors, what Rh alloantibody could this patient produce as a result of transfusion? a. Anti-E b. Anti-C c. Anti-c d. Anti-D ANS: C

Although Rh phenotyping is not routinely performed, exposure to the c antigen may cause the recipient to make anti-c because the recipient is negative for the antigen.

DIF: Level 2

REF: p. 220

10. Given the following red cell antigen frequencies:

K 10% E 30% K 90% P1 80% Which of the following red cell alloantibodies would be responsible for incompatible crossmatches with one 1 of 10 random donor units? a. Anti-K b. Anti-E c. Anti-k d. Anti-P1 ANS: A

Anti-K is incompatible with 1 in 10 units of red blood cells.

DIF: Level 3

REF: p. 225

11. Your blood bank mistakenly released a D-positive red blood cell unit that subsequently

transfused to a patient who typed as D-negative. The patient had no history of a previous transfusion or pregnancy. Antibody detection testing was negative in pretransfusion testing.

Predict the crossmatch result in this case. a. Compatible at immediate-spin b. Incompatible at immediate-spin only c. Not necessary to perform d. Incompatible at antihuman globulin only ANS: A

The abbreviated or AHG crossmatch would not have detected this error because anti-D had not formed and the unit would have been compatible at IS and AHG phases.

DIF: Level 2

REF: p. 219

12. An antibody screen on a patient with a prior history of transfusion was negative. The patient

had an indication to perform an AHG crossmatch on file. The crossmatch was incompatible with 1 of 5 units selected at AHG phase. What is the next step in the investigation?

a. b. c. d.

Perform a prewarm procedure for crossmatching Perform a direct antiglobulin test on the incompatible unit Redraw the patient and begin a new crossmatch Crossmatch a new unit and discard the incompatible unit

ANS: B

The most likely reason for the incompatibility is that the blood unit has a positive direct antiglobulin test or the patient has developed an antibody to a low-frequency antibody. If the direct antiglobulin test is negative, testing the patient’s serum against a selected cell panel of low-frequency antigen-positive cells should be performed.

DIF: Level 3

REF: p. 220

13. Which of the following blood products requires a crossmatch before issuing? a. Group AB fresh frozen plasma that is transfused to a group O b. Human leukocyte antigen–matched platelets c. Cryoprecipitated AHF d. Granulocyte concentrates that have more than 2 mL of red blood cells ANS: D

Granulocytes may contain a significant amount of red blood cells because they are obtained from the “buffy coat” layer during apheresis. These units would require crossmatching before release.

DIF: Level 2

REF: p. 228

14. If not stored in a monitored refrigerator, how long can RBC units remain outside the

transfusion service to allowTE reS isT suBeA ? a. 15 minutes b. 30 minutes c. 45 minutes d. 60 minutes ANS: B

Reissuing of blood products can happen if the unit has not been entered and the unit has not exceeded 1-10C. RBCs must be returned to the transfusion service within 30 minutes if not stored in a monitored refrigerator.

DIF: Level 2

REF: p. 226

15. When is the immediate-spin or abbreviated crossmatch an acceptable procedure for the

recipient? a. No prior or existing clinically significant antibodies b. Never been pregnant or transfused c. Needs blood before a sample can be obtained d. Using blood from a directed donation ANS: A

An immediate-spin checks the ABO incompatibility only. It must only be used if no clinically significant antibodies are detected.

DIF: Level 2

REF: p. 219

16. If an emergency exists and there is not enough time to perform a crossmatch for red cells,

what is the correct procedure? a. Release group O, D-negative whole blood. b. Release group O, D-negative RBC units. c. Release group AB fresh frozen plasma until the blood type is performed. d. Release ABO-compatible blood based on the patient’s prior record in the computer.

ANS: B

Group O D-negative red blood cell units should be released and the crossmatch procedure completed as soon as possible.

DIF: Level 3

REF: p. 226

17. How long following transfusion must the recipient’s sample be stored? a. 5 days b. 7 days c. 10 days d. 14 days ANS: B

The recipient’s sample should be stored at 1° to 6° C for 7 days in case there is a transfusion reaction that requires investigation.

DIF: Level 1

REF: p. 223

18. When type O blood is not T avEaS ilaTbB leAfN orKtrSaE nsLfuLsE ioR n. foCr O aM type O recipient, what is the next

alternative? a. Group A red blood cells b. Group AB red blood cells c. Washed group B red blood cells d. None ANS: D

Group O individuals have both anti-A and anti-B present in serum, which is incompatible with all blood groups other than group O. DIF: Level 2

REF: p. 225

19. If the recipient was transfused within the last 3 months, how long from the time of collection

can a sample be used for the crossmatch? a. 3 days b. 5 days c. 7 days d. 10 days ANS: A

The sample can be used for 72 hours if additional crossmatches are required.

DIF: Level 1

REF: p. 222

20. To what does the abbreviation “MSBOS” refer? a. Monthly surgical blood order schedule b. Minimum surgical blood order staffing c. Maximum blood order schedule d. Minimum safe blood order schedule ANS: C

The maximum surgical blood order schedule outlines the typical number of blood units that should be set up for various surgical procedures.

DIF: Level 1

REF: p. 228

21. What can be done to increase the sensitivity of the antibody screen in a compatibility test? a. Extend the incubation time. b. Increase the serum-to-cell ratio. c. Use an enhancement such as polyethylene glycol. d. All of the above are correct.

ANS: D

Extending the incubation time, increasing the serum to cell ratio, and using an enhancement such as polyethylene glycol will all increase sensitivity.

DIF: Level 2

REF: p. 198

22. The use of the electronic (computer) crossmatch is restricted to recipients who: a. are group O. b. do not have a clinically significant antibody. c. have had successful traT nE sfS usTioBnA sN inKthSeEpLasLt.ER.COM d. have transfusion history that has been documented in the computer.

ANS: B

The electronic (computer) crossmatch may be performed only on patients who do not have or have a history of a clinically significant antibody.

DIF: Level 2

REF: p. 219

23. A tube was received in the blood bank for crossmatching. The label was torn and the only

information that was visible was the patient’s last name and the medical record number.

Which of the following is an acceptable procedure? a. Request a recollection of the specimen. b. Call the phlebotomist back to relabel the tube. c. Reprint a label using the MRI as the identifier. d. Use the tube since the MRI is visible.

ANS: A

Tubes used for crossmatching must have the patient’s name, unique number, date and time of collection and phlebotomist identifier at the minimum. Tubes that do not have proper labels should not be used and recollection is necessary.

DIF: Level 2

REF: p. 221

24. How many units of red blood cells are required to raise the hematocrit of a 70-kg nonbleeding

adult man from 24% to 30%? a. 1 b. 2 c. 3 d. 4 ANS: B

Each red cell unit should raise the hematocrit by 3%.

DIF: Level 2

REF: p. 218

25. A 29-year-old female was admitted to the emergency room with severe bleeding. The blood

type was group AB, D-negative. Six units of RBCs are ordered STAT. Of the following types available in the blood bank, which would be the most preferable for crossmatch? a. AB, D positive b. A, D negative c. A, D positive d. O, D negative ANS: B

Transfusion of RBCs to D-negative recipients should be D-negative when possible, especially in the case of females of childbearing age. Group AB recipients can receive AB, A, and B RBCs, as well as group O; group O, especially group O, D-negative blood should be reserved for emergencies when the blood type is not known and for group O, D-negative recipients.

DIF: Level 2

REF: p. 225

26. A donor unit with a positive DAT would cause reactions at what phase of the crossmatch? a. Immediate-spin b. Antiglobulin c. None; it would be compatible d. All phases ANS: B

The antiglobulin phase of the crossmatch would be positive because it would detect donor cells with attached IgG antibodies.

DIF: Level 2

REF: p. 219

Chapter 10: Blood Bank Automation for Transfusion Services Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Random access is an important feature in selecting an automated instrument for testing in the

transfusion service. What is random access? a. Ability of multiple users to sign into the system b. The recognition of various types of barcodes c. The need for minimal maintenance procedures d. The ability to accommodate STAT testing ANS: D

Random access provides the ability to stop the instrument to accommodate STAT tests without disrupting prior sample testing.

DIF: Level 2

REF: p. 238

2. LIS interfaces are an important component in automation because of its potential in: a. recognizing errors in sample ID. b. flagging discrepancies with previous test results. c. providing a mechanism for the electronic crossmatch. d. All of the above ANS: D

BAinNteKrfSacEeL(L The laboratory informationTsEyS stT em LIESR ) i.s C anOM essential component that provides for correct sample recognition and comparison with prior records; in this function, LIS meets some of the criteria for the electronic crossmatch.

DIF: Level 2

REF: p. 239

3. Which of the following instruments performs assays using gel technology? a. ECHO b. PROVUE c. NEO d. TANGO ANS: B

The Ortho PROVUE automated platform performs the MTS Gel Test.

DIF: Level 1

REF: p. 249

4. The TANGO, PROVUE, and NEO all use one of the following reagents or components in the

indirect antiglobulin test. a. Washing mechanism b. Centrifuge c. Indicator cells d. Antihuman globulin ANS: B

All systems require a centrifugation step. The gel technology does not require washing or the addition of AHG reagent. Indicator cells (red cells coated with anti-IgG) are used in the NEO and TANGO instruments to detect IgG binding.

DIF: Level 2

REF: p. 243

5. What is an advantage of the MTS gel technology over test tubes when performing panels? a. shorter centrifugation time. b. decreased reagent cost. c. reduced patient sample requirements. d. the incubation step is optional.

ANS: C

The patient sample requirement is less for the gel test compared to tube testing. Centrifugation time is longer with gel tests, incubation time is about the same, and the reagent cost associated with gel testing is higher.

DIF: Level 2

REF: p. 248

6. What does a negative reaction in the MTS Gel Test look like in the gel card? a. pellet of cells at the bottom of the column. b. layer of cells at the top of the column. c. cells evenly distributed throughout the column. d. cells distributed only in the bottom half of the column.

ANS: A

The cells at the bottom of the column indicate a negative reaction because no agglutination took place with the antibodTyEsS usTpB enAdN edKiS nEthLeLgE elR . .COM DIF: Level 2

REF: p. 250

7. A smooth layer of cells in the bottom of the well is interpreted as a/an

reaction

when the solid-phase red cell adherence method is completed for the antiglobulin test: a. positive b. negative c. indeterminate d. mixed field ANS: A

A smooth monolayer of cells indicates a positive reaction, while a compact button is a negative reaction.

DIF: Level 2

REF: p. 245

8. The PROVUE, TANGO, and NEO have the ability to perform all of the following tests

except: a. ABO/D typing. b. antibody ID panels. c. direct antiglobulin test. d. acid elution.

ANS: D

All instruments have the ability to perform ABO/D typing, antibody panels, and the DAT. DIF: Level 1

REF: p. 243

9. Which of the following items is required before implementing new automation technology

into the transfusion service setting? a. Validation b. Training c. Written procedures d. All of the above ANS: D

Before implementing a new instrument validation, training and written SOPs must be in place.

DIF: Level 2

REF: p. 241

TRUE/FALSE 1. The determination of the ABO and D type by the NEO and ECHO uses the same solid-phase

red cell adherence technique that is used for the antibody screen.

ANS: F

The screen uses the solid phase red cell adherence technique, while ABO and D typing uses the hemagglutination technique similar to tube typing.

DIF: Level 2

REF: p. 243

Chapter 11: Adverse Complications of Transfusions Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following blood group systems has been implicated in transfusion reactions on

the first exposure to incompatible red blood cells? a. Rh b. Kell c. Kidd d. ABO ANS: D

Antibodies to the ABO system antigens exist before exposure to blood products.

DIF: Level 1

REF: p. 258

2. A patient has a rise in temperature and chills during a transfusion. The transfusion is stopped,

and a posttransfusion blood sample is carefully drawn. What should the transfusion service immediately perform upon receipt of this postreaction sample? a. Perform a clerical check, observe the color of serum and perform an antibody screen b. Perform a clerical check, observe the color of serum and perform a direct antiglobulin test c. Perform an antibody scTreEeS nT anBdAaNdKirS ecEt L anLtiEgR lo. buCliOnMtest d. Perform an antibody screen and a crossmatch ANS: B

Ruling out a hemolytic transfusion reaction should be done immediately by performing a clerical check and looking for evidence of antibody-mediated red cell destruction.

DIF: Level 2

REF: p. 269

3. A 44-year-old woman has a hemoglobin level of 6.1 g/dL. White blood cell and platelet

counts are within normal levels. The patient is group O D-negative with a negative antibody screen. Crossmatches are compatible. However, 15 minutes after the start of the first transfusion, she experiences erythema and hives. What type of transfusion reaction is occurring? a. Urticarial b. Febrile nonhemolytic c. Delayed hemolytic d. Acute hemolytic ANS: A

Erythema and hives indicate an allergic reaction, which cannot be prevented by routine pretransfusion testing.

DIF: Level 2

REF: p. 262

4. Ten days after a 2-unit RBC transfusion, a patient experienced a 2 g/dL drop in hemoglobin

and appeared slightly jaundiced. No evidence of bleeding was observed. What tests would be helpful in determining whether the patient is experiencing a delayed hemolytic transfusion reaction? a. Culture the donor unit. b. Compare pretransfusion and posttransfusion ABO and D typing. c. Perform hepatitis B surface antigen test. d. Perform an antibody screen and DAT on the current posttransfusion sample.

ANS: D

A delayed transfusion reaction is due to alloantibodies that have developed from the red cells recently transfused or from antibodies made against prior red cell exposure.

DIF: Level 2

REF: p. 259

5. Select the clinical sign that is not associated with a hemolytic transfusion reaction. a. Disseminated intravascular coagulation b. Renal failure c. Shock d. Graft-versus-host disease ANS: D

Kidney failure, shock, and disseminated intravascular coagulation are clinical signs of hemolytic transfusion reactions. These signs are due to the presence of excessive hemoglobin breakdown products. Graft-versus-host disease is a result of leukocytes given to an immunocompromised patient.

DIF: Level 2

REF: TpE . 2S5T 6

6. Which blood product is recommended for transfusions to individuals with a history of febrile

nonhemolytic transfusion reactions? a. Leukocyte-reduced red blood cells b. Packed red blood cells c. Frozen red blood cells d. Whole blood ANS: A

Prestorage leukocyte removal has been shown to reduce the incidence of febrile reactions resulting from cytokines and white cells in transfused blood components.

DIF: Level 2

REF: p. 262

7. Which of the following transfusion reactions can be linked to the administration of whole

blood to a patient with cardiac insufficiency? a. Delayed hemolytic reaction b. Transfusion-related acute lung injury (TRALI) c. Circulatory overload (TACO) d. Febrile nonhemolytic reaction ANS: C

Excess fluids in the form of transfused blood products can increase stress on the circulatory system and heart.

DIF: Level 2

REF: p. 267

8. What component is indicated for patients who receive directed donations from immediate

family members to prevent graft-versus-host transfusion reactions? a. Irradiated red blood cells b. Packed red blood cells c. Washed red blood cells d. Cytomegalovirus-negative red blood cells ANS: A

Irradiation of blood products prevents leukocytes from replicating, which causes graft-versus-host disease.

DIF: Level 2

REF: p. 265

9. What organ of the recipient’s body is involved in a TRALI? a. Heart b. Lung c. Liver d. Brain ANS: B

Transfusion-related acute lung injury (TRALI) is a complication caused by white cell antibodies in blood products that damage lung tissue.

DIF: Level 1

REF: p. 264

10. Which of the following transfusion reactions has the highest incidence? a. Hemolytic reactions due to ABO incompatibility b. Urticarial c. Graft-versus-host disease d. Transfusion-related acute lung injury ANS: B

Because allergic reactions cannot be prevented or predicted, they are the most common reaction.

DIF: Level 1

REF: p. 262

11. Which of the following nonimmune mechanisms can lead to a hemolytic reaction to red blood

cells? a. Incompatible intravenous solutions mixed with the unit b. Improper storage of the unit c. Bacterial contamination of the unit d. All of the above ANS: D

Mechanisms for nonimmune hemolysis include incompatible intravenous solutions mixed with the unit, improper storage of the unit, or bacterial contamination of the unit. It should be considered if an antibody is not present in the prereaction or postreaction specimen.

DIF: Level 1

REF: p. 260

12. What is the cause of posttransfusion purpura? a. Red cell antibodies b. White cell antibodies c. Platelet antibodies d. Bacterial contamination ANS: C

Low platelet counts and bleeding following transfusion may be associated with platelet antibodies.

DIF: Level 1

REF: p. 269

13. Which of the following conditions can result from long-term red blood cell transfusions? a. Citrate toxicity b. Hemosiderosis c. Graft-versus-host disease d. Transfusion-related acute lung injury ANS: B

Hemosiderosis is the accumulation of excess iron in macrophages in various tissues.

DIF: Level 2

REF: p. 268

14. What antibodies cause an anaphylactic transfusion reaction? a. IgA b. IgG c. IgE d. All of the above ANS: A

An anaphylactic reaction is caused by preexisting patient’s antibodies to the IgA protein in transfused plasma.

DIF: Level 1

REF: p. 263

15. Which of the following is necessary to prevent an anaphylactic reaction due to a known IgA

antibody in a patient? a. All red blood cell units should be irradiated. b. Red blood cell units should be washed. c. All blood components should be leukocyte-reduced. d. Patient should be given antihistamine before transfusion.

ANS: B

Blood products should be washed or from a donor who is IgA deficient.

DIF: Level 2

REF: p. 263

16. Documentation of a transfusion reaction investigation should include all of the following

except: a. posttransfusion patient temperature.

b. human leukocyte antigen (HLA) typing. c. re-identification of the patient and transfused component. d. collection of a blood sample.

ANS: B

Human leukocyte antigen typing is not necessary in investigating a transfusion reaction.

DIF: Level 1

REF: p. 269

17. Under what circumstance would a direct antiglobulin test be negative in the presence of a

hemolytic process? a. Bacterial contamination of the unit b. Medications administered with the unit c. Red blood cell unit transfused quickly through a leukocyte reduction filter d. All of the above ANS: D

A direct antiglobulin test detects hemolysis caused by alloantibodies. The test would be negative if the red blood cell unit was hemolyzed before or during transfusion, due to bacteria, medications, or physical damage from a filter.

DIF: Level 2

REF: p. 260

18. A patient is diagnosed with cardiac insufficiency and needs a red blood cell transfusion. How

should the transfusion be administered? a. The red blood cell unit should be transfused slowly over a 4-hour period. b. The unit should be transfused as whole blood. c. Diuretics should be adm inS isT teB reA dN wKitS hE thL eL unEiR t. .COM TE d. Transfusion should be avoided.

ANS: A

Red blood cells are often necessary to increase oxygen-carrying capacity in patients with cardiac insufficiency. Circulatory overload can be avoided by transfusion slowly over a 4-hour period or by dividing the unit and administering it over a longer period.

DIF: Level 2

REF: p. 267

19. Antibodies to which blood group system is often implicated in delayed transfusion reactions? a. Kell b. ABO c. Duffy d. Kidd ANS: D

Kidd blood group antibodies often fall below detectable levels and may be missed, leading to the administration of antigen-positive red blood cells.

DIF: Level 2

REF: p. 261

20. Which one of the following transfusion reactions is associated with high fever, shock,

hemoglobinuria, and DIC? a. Anaphylactic

b. Sepsis c. Circulatory overload d. Allergic ANS: B

Bacterial contamination or sepsis is characterized by high fever and shock along with red cell destruction leading to DIC. DIF: Level 2

REF: p. 266

21. In a delayed hemolytic transfusion reaction, what is a typical DAT result? a. Negative b. Positive due to C3 c. Mixed field positive d. Very strongly positive ANS: C

Due to the small number of circulating donor cells that may be sensitized with the antibody, the DAT is often mixed field and weakly reacting.

DIF: Level 2

REF: p. 261

22. The use of only male donors as a source of plasma for transfusion is a method to reduce the

risk of: a. allergic reactions b. circulatory overload. c. TRALI. d. febrile reactions.

ANS: C

In order to avoid antibodies that can cause TRALI, male donors are used since female donors are more likely to have white cell antibodies from prior pregnancies.

DIF: Level 2

REF: p. 265

23. Which of the following transfusion reactions demonstrates with coughing, cyanosis, and

difficulty breathing? a. Allergic b. Febrile c. Hemolytic d. TRALI ANS: D

Transfusion-related acute lung injury is associated with difficulty breathing and pulmonary edema.

DIF: Level 2

REF: p. 264

MATCHING

Match the transfusion reaction with the description that best fits. a. Prevented by leukocyte-reduced components

b. c. d. e. f. g.

1.

2.

3.

4.

5.

6.

7.

Prevented by irradiation of components Symptoms include hives and itching Associated with ABO incompatibilities Caused by donor white cell antibodies Alloantibodies to red cell antigens Can be prevented by transfusion slowly

Febrile, nonhemolytic Urticarial Graft-versus-host disease Transfusion-related acute lung injury Delayed hemolytic Acute hemolytic Circulatory overload (TACO)

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS:

A C B E F D G

DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2 Level 2 Level 2 Level 2

Chapter 12: Hemolytic Disease of the Fetus and Newborn Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. A newborn phenotypes as group O, D-positive with a 1+ direct antiglobulin test. The mother’s

antibody screening test is negative. Assuming the antibody screen is valid; one should consider the reason for the positive DAT is due to an antibody against antigen. a. D b. A or B c. low-incidence d. high-incidence ANS: C

The screening cells might not have the low-incidence antigen to which the antibody is reacting.

DIF: Level 2

REF: p. 282

2. Select the situation where the administration of Rh immune globulin would be

contraindicated.

a. b. c. d.

MOTHER NEWBORN r"r; no antibody detecteTdESTBANKSELLER.R CoOr;MDAT negative rr; no antibody detected R1r; DAT negative Rr; anti-E detected R2r; DAT positive r"r; 4+ anti-D detected R2r: DAT positive

ANS: D

Rh immune globulin is not indicated if anti-D has already been formed.

DIF: Level 2

REF: p. 289

3. Select the true statement regarding ABO hemolytic disease of the fetus and newborn (HDFN). a. It is frequently seen in group A mothers with group O infants. b. It cannot occur during prima gravida (first pregnancy). c. Bilirubin levels often exceed 15 mg/dL in the affected infants. d. The frequency of ABO hemolytic disease of the fetus and newborn is greater than

Rh hemolytic disease of the fetus and newborn.

ANS: D

ABO system hemolytic disease of the fetus and newborn is more common because the occurrence of group O mothers having group A babies is more frequent.

DIF: Level 2

REF: p. 281

4. In testing amniotic fluid, the Liley method of predicting the severity of hemolytic disease of

the fetus and newborn is based on:

a. b. c. d.

colorimetric protein analysis. optical density of bilirubin at 450 nm. ratio of lecithin to sphingomyelin. titration of antibody.

ANS: B

In the Liley method, optical density reading at 450 nm determines the concentration of bilirubin.

DIF: Level 2

REF: p. 284

5. A large fetomaternal bleed in a D-negative woman who delivered a D-positive infant should

be suspected if the: a. direct antiglobulin test on the infant is positive. b. infant is premature. c. fetomaternal hemorrhage screen result is positive. d. maternal antibody screen is positive postpartum.

ANS: C

The fetal screen determines whether the mother has received a significant amount of D-positive cells from the baby during birth.

DIF: Level 2

REF: p. 289

6. Select the most common antibody specificity associated with hemolytic disease of the fetus

and newborn. a. Anti-A,B b. Anti-C c. Anti-D d. Anti-K ANS: A

Anti-A,B from a group O mother can cause mild hemolytic disease of the fetus and newborn if the baby is group A or B. DIF: Level 2

REF: p. 281

7. Amniotic fluid analysis showed a marked increase into zone III of the Liley graph.

Lecithin-sphingomyelin ratios indicated that the fetal lungs were not mature. Select the most appropriate decision regarding medical intervention. a. No immediate need for intervention b. An intrauterine transfusion c. Delivery by cesarean section d. None of the above ANS: B

Because fetal lung maturity is essential for early delivery, intrauterine transfusion is necessary to provide red cells to the fetus to replace those cells destroyed by the mother’s antibody.

DIF: Level 3

REF: p. 284

8. To prevent graft-versus-host disease, red blood cells prepared for intrauterine transfusions

should be: a. frozen and deglycerolized. b. saline washed. c. ABO and D-compatible with the mother. d. irradiated.

ANS: D

Because the fetal immune system is immature, providing components that are irradiated to prevent leukocyte replication is necessary.

DIF: Level 2

REF: p. 287

9. The Kleihauer Betke test was performed using a 1-hour post-delivery maternal blood sample.

Results: 10 fetal cells/1000 cells counted It is the policy 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 ANS: B

10/1000 = 1% bleed 1  50 = 50 (50 mL of fetal blood in the mother’s circulation) 50/30 = 1.66 (30 mL bleed is protected by 1 vial of Rh immune globulin) 1.66 → 2 (round up) 2 + 1 = 3 doses (one added for safety margin) DIF: Level 3

REF: p. 290

10. Which elution method is ideal in the investigation of ABO hemolytic disease of the fetus and

newborn? a. Glycine-acid b. Lui freeze-thaw c. Xylene d. Chloroform ANS: B

The Lui freeze-thaw elution method is a sensitive and fast method to determine whether ABO antibodies are coating the baby’s red cells.

DIF: Level 1

REF: p. 205

11. Which of the following best describes the principle of the Kleihauer-Betke test? a. Fetal hemoglobin is resistant to acid elution and remains in the cell to stain pink,

whereas adult cells appear as ghost cells. b. Adult hemoglobin is resistant to acid elution and remains in the cell to stain pink,

whereas fetal cells appear as ghost cells. c. D-positive cells from the fetus form rosettes around the IgG-coated mother’s cells.

d. Indicator cells form rosettes around the fetal D-positive cells.

ANS: A

The Kleihauer-Betke acid elution test is a stain that enables the quantification of fetal cells in the maternal circulation.

DIF: Level 2

REF: p. 290

12. All of the following are goals of an exchange transfusion except to: a. correct anemia. b. remove high levels of unconjugated bilirubin. c. remove high levels of maternal antibody. d. restore the platelet count.

ANS: D

An exchange transfusion increases the red cell count, reduces bilirubin levels, and lowers the amount of maternal antibody in the infant.

DIF: Level 2

REF: p. 292

13. Why is reverse grouping omitted in the neonatal period for ABO testing? a. The maternal antibody is identical to that of the newborn. b. Newborns do not produce their own antibody until about 4 months. c. The newborn’s antibody is the same as the paternal antibody. d. None of the above is correct.

ANS: B

The newborn does not produce ABO isoagglutinins until about 4 months. If antibodies are identified, they are often the mother’s and may be misleading.

DIF: Level 2

REF: p. 287

14. Which tests are performed to identify the cause of suspected hemolytic disease of the fetus

and newborn? a. ABO group b. D testing c. Direct antiglobulin test d. All of the above ANS: D

ABO group, D testing, and the direct antiglobulin test are initial screening tests for suspected hemolytic disease of the fetus and newborn.

DIF: Level 1

REF: p. 286

15. All of the following are common characteristics of ABO hemolytic disease of the fetus and

newborn except: a. weak positive direct antiglobulin test. b. the mother is group A. c. the antibody on the infant’s cells is anti-A,B. d. mild clinical symptoms.

ANS: B

Often the mother was group O and passed an IgG form of anti-A,B to the infant.

DIF: Level 1

REF: p. 281

16. Which one of the following antibodies is unlikely to cause hemolytic disease of the fetus and

newborn? a. Anti-C b. Anti-K c. Anti-Lea d. Anti-S ANS: C

Lewis system antibodies are IgM and therefore do not pass the placenta. The Lewis system antigens are not well developed at birth.

DIF: Level 1

REF: p. 282

17. A group O, D-positive mother gave birth to a group A, D-negative infant. After 24 hours, the

newborn’s bilirubin level rose to 19 mg/dL. A direct antiglobulin test performed on the cord blood specimen was positive with anti-IgG. What antibody is most likely implicated? a. Anti-D b. Anti-A c. Anti-B d. Anti-A,B ANS: D

ABO hemolytic disease of the fetus and newborn is typically seen in group O mothers with infants who are group A. DIF: Level 3

REF: p. 286

18. Anti-D in the serum of a third-trimester pregnant woman with a titer of 16 is indicative of: a. the presence of Rh immune globulin administered at 28 weeks. b. active immunization. c. passive immunization. d. None of the above ANS: B

Antibody titers of 16 or more suggest active immunization and not the presence of anti-D from Rh immune globulin.

DIF: Level 2

REF: p. 283

19. Following delivery, when should Rh immune globulin be administered? a. 12 hours b. 24 hours c. 48 hours d. 72 hours ANS: D

Clinical trials for Rh immune globulin established a 72-hour time for the administration of Rh immune globulin following delivery.

DIF: Level 1

REF: p. 289

20. A 300-µg dose of Rh immune globulin contains sufficient anti-D to protect against how much

whole blood? a. 25 mL b. 30 mL c. 50 mL d. 100 mL ANS: B

Rh immune globulin protects against a bleed of 30 mL of D-positive cells from the fetus or newborn to the mother before or during birth.

DIF: Level 1

REF: p. 289

21. Which of the following is true regarding the rosette test? a. The test is a staining procedure differentiating fetal and adult cells b. The test is valid only if the mother is D-negative and the infant is D-positive. c. Indicator cells bind to the D-positive maternal cells forming a rosette. d. The test is a quantitative test to determine how many vials of Rh immune globulin

to administer.

ANS: B

The rosette test is a qualitative test to determine D-positive infant’s cells in the D-negative maternal circulation.

DIF: Level 2

REF: TpE . 2S8T 9

22. To be considered a candidate for Rh immune globulin, the mother is

and the

infant is . a. D-positive, D-negative b. D-negative, D-positive c. D-negative, D-negative d. D-positive, D-positive ANS: B

Rh immune globulin protects only the formation of anti-D in a D-negative mother who has a D-positive infant.

DIF: Level 1

REF: p. 289

23. During a first-trimester prenatal examination, a pregnant group A, D-negative woman had an

anti-D titer of 8. What is the most likely course of action? a. The anti-D is probably from prenatal Rh immune globulin; another dose should be given at birth. b. Repeat the titer in 4 weeks to determine if significant rise in titer is detected. c. The pregnancy is considered high risk, and the mother should be followed up immediately with amniocentesis or percutaneous umbilical cord testing. d. None of the above is correct.

ANS: B

A change in titer suggests the need for more invasive tests.

DIF: Level 2

REF: p. 283

24. Rh immune globulin contains: a. IgG anti-D. b. immune serum globulin. c. IgM anti-D. d. gamma globulin.

ANS: A

Rh immune globulin is a pool of purified human plasma containing IgG anti-D. DIF: Level 1

REF: p. 288

25. What type of hemolytic disease of the fetus and newborn affects the first-born? a. ABO b. D c. E d. M ANS: A

Because ABO antibodies are present before red cell exposure, ABO antibodies can cause hemolytic disease of the fetus and newborn on the first pregnancy.

DIF: Level 1

REF: p. 281

26. What immunoglobulin is cT apEaS blTe B oA f cNroKsS siE ngLtLhE eR pl. acCeO ntM a? a. IgA b. IgG c. IgM d. IgE ANS: B

Receptor cells on the placenta allow the passage of IgG to the fetus, which protects the newborn for the first several months of life.

DIF: Level 1

REF: p. 279

27. The rosette test will detect a fetomaternal hemorrhage as small as: a. 5 mL b. 10 mL c. 15 mL d. 20 mL ANS: B

The rosette test will detect a bleed as low as 10 mL of D-positive cells.

DIF: Level 1

REF: p. 289

28. A 0.3% fetomaternal bleed was determined by a Kleihauer-Betke stain of postpartum blood.

What is the estimated volume of the fetomaternal bleed expressed as whole blood?

a. b. c. d.

10 mL 15 mL 20 mL 25 mL

ANS: B

0.003  5000 (average blood volume of an adult) = 15 mL DIF: Level 2

REF: p. 291

29. A weakly reactive anti-D was detected in a sample from a D-negative mother one day

following delivery of a D-negative baby. Based on these results, what is the next step? a. Titer the anti-D b. Perform a rosette test c. Review records for prenatal RhIG administration d. Administer RhIG ANS: C

Weak anti-D is often detected in samples obtained from D-negative mothers who received prenatal RhIG. No additional RhIG is necessary since the baby is D-negative.

DIF: Level 3

REF: p. 286

30. In a suspected case of ABO HDFN, what significant information is obtained from the baby’s

blood smear? a. The estimated platelet count b. Increase in nucleated red cells c. The presences of spherT ocEyS teTs d. Increase in monocytes ANS: C

Spherocytes are characteristic of ABO HDFN but not normally observed in Rh HDFN. DIF: Level 2

REF: p. 282

Chapter 13: Donor Selection and Phlebotomy Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which one of the following histories represents an acceptable male donor?

Hematocrit

Blood Pressure

Temperature

Pulse

Age (mm Hg) (beats/min) a. 39 40 b. 35 18 c. 39 65 d. 40 56

110/70

99.9° F

75

136/86

98.6° F

80

90/60

98.9° F

65

190/90

98.6° F

78

ANS: C

The others are unacceptable temperature, unacceptable hematocrit, and unacceptable blood pressure.

DIF: Level 2

REF: TpE . 3S0T 9

2. How often can a person donate a unit of whole blood for a directed donation? a. 8 weeks b. 2 weeks c. 48 hours d. 24 hours ANS: A

Directed donors must follow the same guidelines as allogeneic donors.

DIF: Level 1

REF: p. 315

3. Blood collected from a therapeutic phlebotomy is: a. acceptable for inventory under certain Food and Drug Administration guidelines. b. unacceptable for inventory. c. acceptable if the “volunteer donor” label is removed. d. acceptable if the patient meets all regular donor criteria.

ANS: A

The Food and Drug Administration requires a variance from the blood center to allow a blood unit (from a donor with genetic hemochromatosis) for placement into inventory.

DIF: Level 2

REF: p. 317

4. Which type of autologous donation procedure is most common for the majority of surgeries? a. Preoperative hemodilution b. Postoperative salvage c. Intraoperative blood salvage d. Preoperative donation ANS: D

Donating blood for surgery is typically a preoperative donation.

DIF: Level 1

REF: p. 314

5. Which of the following statements contributes to permanent rejection status for a donor? a. A tattoo 5 months previously b. Contact with a patient with viral hepatitis c. Two units of blood transfused 4 months previously d. Confirmed positive test for hepatitis B surface antigen 10 years previously ANS: D

A positive test for hepatitis B core antigen is a permanent deferral.

DIF: Level 2

REF: p. 305

6. Which of the following is not a cause for temporary deferment of a whole blood donor? a. Aspirin ingestion 12 hours previously b. Hepatitis B immunoglobulin taken 4 weeks previously c. Oral polio vaccine taken 1 week previously d. Rubella injection 1 week previously ANS: A

Aspirin is acceptable for whole blood donation. If platelets are prepared from the unit, they cannot be the sole source of platelets for a recipient (i.e., apheresis platelet).

DIF: Level 2

REF: p. 305

7. Autologous donors may not donate if they: a. have a positive test for syphilis. b. are on antibiotics for an infection. c. are taking aspirin. d. are over 65 years old.

ANS: B

A risk of bacteremia would cause the autologous donor to be deferred.

DIF: Level 1

REF: p. 314

8. Allogeneic whole blood donors may donate every a. 24 b. 36 c. 56 d. 72 ANS: C

Whole blood donation is restricted to every 56 days.

days.

DIF: Level 1

REF: p. 302

9. A male donor has a reactive nucleic acid test for hepatitis C. What kind of deferral is assigned

to this donor? a. Indefinite b. Permanent c. Temporary d. None of the above ANS: B

A permanent deferral is based on high-risk behavior or a positive test result.

DIF: Level 2

REF: p. 305

10. How long must a donor wait to donate red blood cells again following a 2-unit red blood cell

apheresis donation? a. 56 days b. 4 weeks c. 10 weeks d. 16 weeks ANS: D

A 16-week deferral period is required following a 2-unit red blood cell apheresis donation.

DIF: Level 1

REF: p. 302

11. A 58-year-old woman reveTale dT thB atAsN heKhSaE dL exLpEerRim ES .eCnOteMd with intravenous drugs as a

teenager. Is she an acceptable donor? a. She is an acceptable donor because testing will pick up evidence of hepatitis. b. She will need to be deferred for 12 months. c. She is an acceptable donor, if she has had the hepatitis B vaccine. d. She is deferred.

ANS: D

Use of a needle to administer nonprescription drugs is a permanent deferral.

DIF: Level 2

REF: p. 306

12. If a prospective donor has participated in a plasmapheresis program, how long must he or she

wait to donate whole blood? a. 56 days b. 48 hours c. 24 hours d. 4 weeks ANS: B

Following apheresis procedures, there is a 48-hour deferral period.

DIF: Level 1

REF: p. 302

13. Following donation, how long does it take to replace the fluid lost from giving whole blood?

a. b. c. d.

3 hours 12 hours 48 hours 72 hours

ANS: D

Fluid replacement takes about 3 days.

DIF: Level 1

REF: p. 314

14. Why is it necessary to mix the unit frequently during the donation process? a. Avoid blood clots by mixing the anticoagulant with the blood b. Suspend the platelets throughout the unit c. Determine whether the volume is acceptable d. Allow the donation process to go more quickly ANS: A

Mixing of the anticoagulant avoids clot formation in the unit.

DIF: Level 1

REF: p. 312

15. What is the minimum hemoglobin level for a potential female allogeneic donor? a. 11 g/dL b. 12 g/dL c. 12.5 g/dL d. 14 g/dL ANS: C

Minimum hemoglobin is 12.5 g/dL for female donors.

DIF: Level 1

REF: p. 309

16. What is the purpose of a “diversion pouch” used when collecting blood from a donor? a. Collect samples for viral marker testing b. Prime the line to remove air c. Determine if blood flow is sufficient d. Avoid bacterial contamination of the blood product ANS: D

A diversion pouch is used in order to avoid contamination of the blood product with the initial blood that may contain bacteria from the skin.

DIF: Level 2

REF: p. 312

17. A 21-year-old college student wishes to participate in the “double red” program at the local

blood center by donating red blood cells collected by apheresis. What is the minimum height and weight requirement that she must meet? a. Height: 5’1”, 130 lbs b. Height: 5’3”, 125 lbs c. Height: 5’5”, 150 lbs d. No height requirement, 110 lbs ANS: C

RBCs collected by apheresis must meet the FDA requirement of 5’5”, 150 lbs for women and 5’1”, 130 lbs for men.

DIF: Level 1

REF: p. 316

18. Below are the results of the medical screening for a prospective female donor:

Age: 16 Hematocrit: 35% Temperature: 37.2° C Hemoglobin: 12.0 g/dL History: HPV immunization, 1 week ago How many of the above results would exclude this donor from donating? a. None, she is acceptable. b. 1 c. 2 d. 3 ANS: C

Hematocrit level must be 38% or above. Hemoglobin must be 12.5 g/dL or above.

Temperature is acceptable (<37.5° C) and toxoid immunization has no deferral.

DIF: Level 2

REF: p. 309

19. Before donation, the intended venipuncture site must be cleaned with: a. PVP-iodine complex. b. alcohol. c. 10% acetone. d. green soap.

ANS: A

FDA guidelines require the arm to be cleaned with iodine compounds or, in the case of sensitivity to iodine, alternate solutions are suggested in the AABB technical manual.

DIF: Level 2

REF: p. 311

20. Following delivery, what is the deferral time for donating a unit of whole blood? a. 2 weeks b. 4 weeks c. 6 weeks d. 8 weeks ANS: C

Pregnancy has a 6-week deferral time.

DIF: Level 1

REF: p. 308

MATCHING

Indicate how the following allogeneic donors should be classified. a. Acceptable donors b. Temporarily deferred

c. Permanently deferred d. Indefinite deferral 1. 25-year-old man treated for syphilis 3 months ago 2. 27-year-old woman returning from the Peace Corps in Nigeria who was vaccinated for 3.

4.

5.

6.

7.

8.

9.

10.

typhoid 6 months ago 50-year-old woman on vacation in the United States who currently lives in England 28-year-old man who was incarcerated overnight for unspecified reason 2 months ago 53-year-old woman taking a beta-blocker for hypertension and over-the-counter low-dose aspirin for blood-clot prevention 22-year-old man who returned from Iraq 3 months ago and was vaccinated for tetanus and yellow fever before being deployed 18-year-old woman currently taking Accutane for acne 65-year-old woman taking sleep medication at night 48-year-old man taking Propecia for baldness 19-year-old woman who recently finished the three-part vaccination for hepatitis B surface antigen after starting a volunteer position at the hospital

1. ANS: B 2. ANS: B 3. ANS: D 4. ANS: A 5. ANS: A 6. ANS: B 7. ANS: B 8. ANS: A 9. ANS: B 10. ANS: A

DIF: Level 2 DIF: Level 2 DIF: Level 2 DIF: Level 2 DIF: Level 2 DIF: Level 2 DIF: Level 2 evSelT2 DIF: TLE DIF: Level 2 DIF: Level 2

Chapter 14: Testing of Donor Blood Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Why is Hepatitis A virus transmission in blood unusual? a. Hepatitis A virus is usually transmitted by the enteric route b. Hepatitis A virus is usually an acute hepatitis c. Infectivity after a hepatitis A virus infection is usually only 2 weeks d. All of the above ANS: D

Hepatitis A is not a blood-borne virus and is not chronic; therefore, it is not transmitted by transfusion.

DIF: Level 2

REF: p. 330

2. What is the most common mode of transmission for hepatitis C virus? a. Contaminated food and water b. Transfusion c. Sexual transmission d. Intravenous drug use ANS: D

Hepatitis C is most commonly transmitted by intravenous drug use.

DIF: Level 1

REF: p. 330

3. Define a hepatitis B virus carrier. a. Hepatitis B surface antigen–positive person who has liver disease because of a

previous hepatitis exposure b. Person who can transmit hepatitis B virus but may not be outwardly affected by it c. Hepatitis B surface antibody–positive person, negative for hepatitis B surface antigen d. Hepatitis B core antibody–positive person, negative for hepatitis B surface antigen ANS: B

A carrier can transmit the virus but often does not show symptoms; the carrier remains positive for the antigen marker.

DIF: Level 2

REF: p. 330

4. Transfusion-associated hepatitis can be caused by hepatitis a. B b. C c. D d. All of the above ANS: D

virus.

Hepatitis B, C, and D can be transmitted by blood transfusion. Because the hepatitis D virus requires co-infection with hepatitis B, hepatitis D is not tested for directly in donor testing.

DIF: Level 1

REF: p. 330

5. Which hepatitis virus is transmitted similar to hepatitis A? a. Hepatitis E virus b. Hepatitis B virus c. Hepatitis C virus d. Hepatitis D virus ANS: A

Both hepatitis A and hepatitis E are transmitted by the oral-fecal route.

DIF: Level 1

REF: p. 331

6. Which of the following patients should not receive cytomegalovirus (CMV)-positive blood? a. Premature infants b. HIV-positive patients c. Bone marrow recipients d. Unborn infants of pregnant women who are seronegative e. All of the above ANS: E

Cytomegalovirus is an opportunistic virus, affecting people with a lower-level immune response.

DIF: Level 2

REF: TpE . 3S3T 7

7. Which of the following diseases relies on obtaining a thorough donor history to reduce

potential transmission in blood donors? a. Syphilis b. Human T-cell lymphotropic virus-I c. Cytomegalovirus d. Malaria ANS: D

Because there is no screening test for malaria, the only way to prevent its transmission is through questions about donor history regarding potential exposure.

DIF: Level 2

REF: p. 323

8. Which of the following blood products is tested for bacterial contamination following

storage? a. Cryoprecipitated AHF b. Red blood cells, frozen c. Platelets d. Fresh frozen plasma ANS: C

Bacterial contamination of stored platelets is monitored by culture techniques as well as pH.

DIF: Level 1

REF: p. 337

9. Which of the following is the most common transfusion-transmitted infection? a. AIDS b. Syphilis c. Cytomegalovirus d. Hepatitis ANS: D

Hepatitis viruses are the most common cause of transfusion-transmitted infection.

DIF: Level 1

REF: p. 332

10. Which of the following characteristics is associated with human T-cell lymphotropic virus-I? a. It can be transmitted in blood products. b. It is found in patients with tropical spastic paraparesis. c. It is found in patients with adult T-cell leukemia. d. All of the above ANS: D

Human T-cell lymphotropic virus-I is associated with tropical spastic paraparesis and adult T-cell leukemia, and because it can be transmitted through blood transfusion, testing is required.

DIF: Level 1

REF: p. 334

11. Persons who have had injections of human growth hormone are indefinitely deferred as blood

donors. What disease is assToE ciS atTedBA wN ithKtShE eL inL jeE ctR io. nC s?OM a. Trypanosomiasis cruzi b. Babesia microti c. Borrelia burgdorferi d. Creutzfeldt-Jakob disease ANS: D

Human growth hormone has been associated with transmission of Creutzfeldt-Jakob disease.

DIF: Level 1

REF: p. 306

12. What is the advantage of testing donors’ blood using nucleic acid test methods? a. Detection of small amounts of the virus b. Reduction of costs involved in testing c. Quicker and easier to perform than other methods d. All of the above ANS: A

The advantage of nucleic acid testing is to be able to amplify small amounts of the virus and detect viruses before the antibody levels are measurable.

DIF: Level 2

REF: p. 329

13. What is the significance of a positive RPR test for syphilis? a. Antibodies to Treponema pallidum are present

b. Past or present venereal disease infection c. Possibility of an infection with Treponema pallidum d. Antigens associated with venereal disease are present ANS: C

A positive serological test for syphilis is often a false-positive result in volunteer donors because it is not specific for the presence of an infection with Treponema pallidum.

DIF: Level 2

REF: p. 325

14. What diseases are currently screened using nucleic acid tests? a. Hepatitis B and C viruses, West Nile virus, and HIV-1 b. Chagas disease, malaria, and syphilis c. Hepatitis B virus, hepatitis C virus, and HIV d. Human T-cell lymphotropic virus-I/human T-cell lymphotropic virus-II, HIV

1/HIV-2, and hepatitis C virus ANS: A

Nucleic acid tests detect hepatitis B and C viruses, HIV-1, and West Nile virus.

DIF: Level 1

REF: p. 329

15. How is the sensitivity of a viral marker assay described? a. True positives divided by difference between true positives and false negatives b. True negatives divided by sum of true negatives and false positives c. True positives divided by sum of true positives and false negatives d. True negatives divided by difference between true negatives and false positives ANS: C

Sensitivity is the ability of an assay to identify samples from infected individuals as positive.

DIF: Level 1

REF: p. 326

16. If a donor is positive for hepatitis C virus by nucleic acid testing, why is the process of

“look-back” initiated? a. To quarantine units in the blood center that may exist from prior donations from the inventory b. To notify recipients who may have previously received blood from this donor c. To locate and quarantine units sent to transfusion facilities from this donor in the past d. All of the above ANS: D

The purpose of look-back is to locate and quarantine current and previously donated units from a donor who tests positive for either hepatitis, HIV, West Nile virus, or Chagas disease.

It also notifies the recipients of units that were transfused. Because test methods have become more sensitive, viral contaminants in prior donations may not have been detected. The process of look-back avoids additional cases of viral transmission.

DIF: Level 1

REF: p. 326

17. What is the true statement regarding West Nile virus testing?

a. b. c. d.

Testing for West Nile virus is required only in New York and California.

Testing for West Nile virus is necessary only in the warmer months of the year.

West Nile virus testing is performed using nucleic acid testing on all donor units.

West Nile virus testing is optional.

ANS: C

West Nile virus testing is performed by nucleic acid testing on all donors since 2003.

DIF: Level 1

REF: p. 334

18. What is the organism that causes Chagas disease? a. Treponema pallidum b. Trypanosoma cruzi c. Cytomegalovirus d. Plasmodium vivax ANS: B

Chagas disease is caused by infection with the protozoal parasite Trypanosoma cruzi, which can be transmitted by blood transfusion.

DIF: Level 1

REF: p. 335

19. Some donor centers have implemented the practice of diverting the first few milliliters of

blood collected into a pouch attached to the collection bag. What is the purpose of this procedure? a. Reduce leukocyte contamination b. Prepare pedipacks for neonates c. Avoid bacterial contamTinEaS tiT on d. Collect blood for viral testing ANS: C

Bacterial contamination of blood units from the phlebotomy procedure can be avoided by diverting the first couple of milliliters of blood collected into a pouch.

DIF: Level 1

REF: p. 338

20. What of the following measures is taken to prevent cytomegalovirus infection from blood

units? a. Leukocyte reduction b. Washing c. Freezing and thawing d. Nucleic acid testing ANS: A

Because cytomegalovirus resides in white cells, leukoreduction has been documented to reduce the transmission of this virus through blood.

DIF: Level 1

REF: p. 337

21. What is the most sensitive test for HIV? a. Enzyme-linked assays b. Chemiluminescence

c. Western blot d. Nucleic acid ANS: D

The nucleic acid test for the virus is the most sensitive test. The others test for the presence of an antibody that might not always be at a detectable level.

DIF: Level 1

REF: p. 334

22. When are surrogate marker tests useful? a. When the required test is too expensive b. When direct testing is not yet available c. When the required test detects too many false-positive results d. When the internal controls are not valid ANS: B

Surrogate tests are sometimes used until direct testing becomes available and are usually no longer required when direct, more specific tests are licensed.

DIF: Level 2

REF: p. 332

23. What happens if clinically significant red cell antibodies are found in donor units? a. Platelet and fresh frozen plasma can be transfused. b. Red blood cells can be used if the antibody interpretation is indicated on the label. c. The red blood cells, plasma, and platelet products must be discarded. d. Red blood cells must be washed before transfusion.

ANS: B

Units found to contain clinically significant antibodies may be transfused with minimal amounts of plasma and are labeled with the antibody.

DIF: Level 1

REF: p. 325

Chapter 15: Blood Component Preparation and Therapy Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Whole blood collected from a donor should remain at what temperature before the separation

and preparation of platelet concentrates? a. 20° to 24° C b. 1° to 6° C c. 1° to 10° C d. Varies with the facility ANS: A

Platelets must be separated from whole blood units before storage at 1° to 6° C. DIF: Level 1

REF: p. 348

2. Addition of which of the following will increase the shelf life of red blood cells? a. Heparin b. AS-3 c. Lactated Ringer’s d. Citrate ANS: B

The additive solution increases the shelf life of RBC units to 42 days.

DIF: Level 1

REF: p. 345

3. What patient population needs leukocyte-reduced red blood cells? a. Patients with febrile transfusion reactions b. Patients with iron deficiency anemia c. Patients with hemophilia A d. Patients with cancer undergoing chemotherapy treatments ANS: A

Avoiding febrile transfusion reactions is an important reason in administering leukocyte-reduced blood products.

DIF: Level 2

REF: p. 351

4. What is the minimum acceptable storage temperature for frozen red blood cells? a. 4° C b. –12° C c. –20° C d. –65° C ANS: D

Frozen red blood cells must be stored at –65° C or lower.

DIF: Level 1

REF: p. 353

5. To prevent graft-versus-host disease, blood components prepared for a fetus that needs an

intrauterine transfusion should be: a. saline washed. b. irradiated. c. frozen and deglycerolized. d. human leukocyte antigen–matched.

ANS: B

Irradiation prevents the leukocytes from dividing and causing a graft-versus-host reaction.

DIF: Level 2

REF: p. 354

6. The temperature of a RBC unit shipment from the local blood center was recorded as 8° C

upon arrival at the hospital. What is the correct course of action? a. Place the units in inventory because the temperature is acceptable. b. Quarantine the units until approved by the supervisor. c. Send the units back to the blood center. d. Have the units tested for bacterial contamination before release.

ANS: A

The shipment temperature of red blood cells should be between 1° and 10° C, and these units are acceptable to use.

DIF: Level 3

REF: p. 362

7. What is the correct storage temperature and time limit for pooled platelets? a. 20° to 24° C, 5 days b. 1° to 6° C, 7 days c. 1° to 10° C, 24 hours d. 20° to 24° C, 4 hours ANS: D

Following pooling, products that are stored at room temperature must be transfused within 4 hours.

DIF: Level 2

REF: p. 356

8. Platelet concentrates that are prepared from whole blood have a minimum quality control limit

of

platelets in

a. 3  1011, 75% b. 1  1010, 75% c. 5.5  1010, all d. 5.5  1010, 75%

of the units tested.

ANS: D

Three-fourths of the units tested must meet the minimum platelet count of 5.5  1010.

DIF: Level 1

REF: p. 346

9. Following a platelet concentrate transfusion, a patient did not obtain the calculated corrected

count increment that was expected. Select the possible reason(s) the increment increase did not occur. a. Patient had a fever b. Patient was actively bleeding c. Patient has leukocyte antibodies d. All of the above are correct ANS: D

Refractoriness or poor response to platelet transfusions can be caused by fever, active bleeding, or leukocyte antibodies.

DIF: Level 2

REF: p. 356

10. Once the cryoprecipitate is removed from fresh frozen plasma, the remaining plasma can be

refrozen and stored at –18° C for 1 year from collection. Which of the following clinical conditions can use this product? a. Thrombotic thrombocytopenic purpura b. Hemophilia c. Warfarin overdose d. Volume replacement following surgery ANS: A

Without the factor VIII that is removed as cryoprecipitate, the plasma is useful in patients that have thrombotic thrombocytopenic purpura.

DIF: Level 2

REF: p. 359

11. Plasma, frozen within 24 hours of collection (PF24), has similar coagulation factors as which

of the following plasma products? a. FFP b. CRYO c. Thawed plasma d. Recovered plasma ANS: A

FFP contains both labile and stable coagulation factors. Labile factors may be somewhat reduced in PF24.

DIF: Level 1

REF: p. 357

12. A unit of CPDA-1 RBCs, expiring in 35 days, is split using a sterile collection device to

prepare pediatric units. What is the expiration date for each split unit? a. 4 days from collection b. 4 days from sterile docking c. 35 days from collection d. 28 days from collection ANS: C

The sterile docking device maintains the original expiration of the unit.

DIF: Level 2

REF: p. 352

13. Rejuvenation of a unit of RBCs is a method used to: a. inactivate viruses. b. restore 2, 3 DPG and ATP levels. c. increase the expiration date by 21 days. d. prepare a unit for freezing in high glycerol.

ANS: B

The additives in rejuvenation solutions increase the 2, 3 DPG and ATP levels of an expired unit and allow for freezing within 3 days.

DIF: Level 1

REF: p. 347

14. Why are plastic overwraps recommended when thawing FFP and CRYO? a. To prevent contamination of the water bath b. To prevent rapid thawing, which affects labile factors c. To prevent entry ports from becoming contaminated with water d. To prevent the label from peeling off when thawing ANS: C

A plastic overwrap or keeping ports above the water level are acceptable methods for prevention of bacterial contamination from the water bath.

DIF: Level 2

REF: p. 357

15. Select an important determination of platelet viability following the recommended storage

interval. a. Platelet count b. pH c. PTT d. Oxygen level ANS: B

The platelet pH should be 6.2 or above during the storage of platelets.

DIF: Level 1

REF: p. 346

MATCHING

Match the correct expiration limit with each red blood cell product. Each choice may be used more than once or not at all. a. 21 days b. 35 days c. 42 days d. 10 years e. 28 days f. 24 hours g. 48 hours h. 72 hours 1. Irradiated

2.

3.

4.

5.

6.

7.

8.

Frozen CPDA-1 AS-3 or AS-2 CPD Deglycerolized Apheresis (ACD) Leukoreduced (AS-3)

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS:

E D B C A F A C

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1

Match the blood component with the correct storage and expiration limit. Each choice may be used more than once or not at all. a. 20° to 24° C, 4 hours b. 1° to 6° C, 24 hours c. 20° to 24° C, 6 hours d. < –18° C, 1 year from collection e. 1° to 6° C, up to 5 days f. < –65° C, 7 years g. 20° to 24° C, 48 hours 9.

10.

11.

12.

13.

14.

Cryoprecipitated AHF (thawed) Cryoprecipitated AHF (frozen) Fresh frozen plasma (thawed) Liquid plasma from whole blood Plasma, cryoprecipitate reduced, thawed Cryoprecipitated AHF (thawed, pooled)

9. ANS: C 10. ANS: D 11. ANS: B 12. ANS: E 13. ANS: E 14. ANS: A

DIF: DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1 Level 1

Chapter 16: Transfusion Therapy in Selected Patients Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. What is the most effective component to treat a patient with von Willebrand disease? a. Fresh frozen plasma b. Red blood cells c. Platelets d. Cryoprecipitated AHF ANS: D

Cryoprecipitated AHF is the only product listed that contains von Willebrand factor.

DIF: Level 1

REF: p. 382

2. Which of the following is used in the treatment of hemophilia A? a. Factor VIII concentrate b. Factor XIII concentrate c. Platelets d. Fresh frozen plasma ANS: A

Factor VIII concentrate is used to treat hemophilia A. DIF: Level 1

. 3S8T 2 REF: TpE

3. What term is describes the replacement of one or more blood volumes within 24 hours

whether in an infant or in an adult patient? a. Acute hypovolemic shock b. Hemorrhage c. Intravascular shock d. Massive transfusion ANS: D

During massive transfusion, the blood products transfused in 24 hours approximate or exceed the recipient’s original blood volume. At that point, the recipient’s circulation contains almost entirely transfused blood and essentially no autologous blood.

DIF: Level 1

REF: p. 370

4. A patient, group AB, D-positive, has a bleeding aortic aneurysm. A massive transfusion is

undertaken for lifesaving measures. What ABO phenotype is recommended for transfusion to this patient? a. Group A b. Group B c. Group O d. Group AB ANS: A

Group AB recipients could receive group A or group B but not both; group A is routinely used because of its greater availability in comparison to group B or AB. DIF: Level 2

REF: p. 371

5. Why do premature neonates require red blood cell transfusions? a. Iatrogenic blood loss b. Hemoglobin F is being changed to hemoglobin A c. Insufficient erythropoiesis d. All of the above ANS: D

Premature neonates have unique blood requirements such as iatrogenic blood loss, insufficient erythropoiesis, and formation of new blood cells that can be corrected by red blood cell transfusions.

DIF: Level 2

REF: p. 373

6. Infants do not require crossmatching if they are less than: a. 6 months old. b. 5 months old. c. 4 months old. d. 12 months old.

ANS: C

Because infants do not make their own antibodies, crossmatching is not required until they are 4 months old.

DIF: Level 2

REF: p. 373

7. Identify the common complications of chemotherapy. a. Bleeding b. Infection c. Anemia d. All of the above ANS: D

Because chemotherapy reduces the rate of cell division of rapidly dividing cells, the ability of the bone marrow to replace cells is reduced, affecting leukocyte, erythrocyte, and platelet counts.

DIF: Level 2

REF: p. 379

8. What is the goal of therapeutic apheresis? a. Reduce a high antibody level b. Replace cellular elements c. Clear immune complexes d. All of the above are correct ANS: D

Therapeutic apheresis has been a successful treatment for conditions with elevated antibody levels, immune complexes, and platelet dysfunction.

DIF: Level 2

REF: p. 377

9. Select the clinical situation where iron chelation is recommended to prevent iron overload. a. Aplastic anemia b. Autoimmune hemolytic anemia c. Sickle cell anemia d. Anemia caused by trauma ANS: C

Iron chelation to prevent iron overload in sickle cell anemia is necessary due to repeated RBC transfusions.

DIF: Level 1

REF: p. 381

10. Which of the following situations contributes to red blood cell loss in chronic renal disease? a. Below normal erythropoietin levels b. Shearing of red cells from kidney dialysis c. Elevated uremia d. All of the above ANS: D

Patients with end stage renal disease undergoing kidney dialysis require erythropoietin, red blood cell transfusion support, or both because of uremia, cell loss from dialysis, and low levels of the colony-stimulating factor erythropoietin.

DIF: Level 2

REF: p. 379

11. Who needs the transfusion of CMV-negative blood products? a. Sickle cell b. Neonates c. Cardiac d. Trauma ANS: B

Because of the low immune system in a neonate, CMV-safe units should be given.

DIF: Level 1

REF: p. 373

12. Risk factors for bleeding during cardiac surgery include all of the following except: a. length of time on the pump. b. level of preoperative medications. c. presence of a red cell antibody. d. hypothermia.

ANS: C

The presence of a red cell antibody does not affect the risk of bleeding during or following cardiac surgery.

DIF: Level 2

REF: p. 371

13. Massive transfusion replaces 1 blood volume. In a 70-kg adult, how many units of whole

blood would be needed? a. 6 b. 8 c. 10 d. 14 ANS: C

A 70-kg adult’s blood volume is about 10 units of whole blood.

DIF: Level 1

REF: p. 371

14. A patient demonstrated the following symptoms: hypotension, tachycardia, cold or clammy

skin, and cyanosis. What is the most likely cause? a. Anaphylactic shock b. Graft-versus-host disease c. Congestive heart failure d. Hypovolemic shock ANS: D

Trauma with sudden blood loss leads to several physiological responses that demonstrate the symptoms listed above.

DIF: Level 2

REF: p. 370

15. Which of the following contributes to the high blood usage in a liver transplant surgery? a. The liver is a very large organ. b. It is difficult to find cloTseES huTmBaA nN leK ukSoEcL ytL eE anRti. geCnOm Matches for liver transplants. c. Platelets are stored in the liver. d. The liver produces the vitamin K–dependent coagulation factors.

ANS: D

The liver is essential in producing coagulation factors.

DIF: Level 2

REF: p. 374

MATCHING

Match the component with the indications for use. Each can be used more than once. a. Cryoprecipitated AHF b. Fresh frozen plasma c. Red blood cells d. Platelets e. Leukoreduced blood components f. Washed red blood cells g. Albumin/plasma protein fraction h. Factor concentrates i. Plasma, cryoprecipitate reduced j. Irradiated blood products 1. Intravascular volume expansion

2.

3.

4.

5.

6.

7.

8.

9.

10.

Bleeding due to thrombocytopenia Decreases immunization to leukocytes Reduce the risk of allergic reactions Treatment of symptomatic anemia Specific clotting deficiencies of factors VIII, V, and X Deficiency of factors II, V, X, and XI Thrombotic thrombocytopenic purpura Avoid graft-versus-host disease Deficiency of factor XIII and von Willebrand factor

1. ANS: G 2. ANS: D 3. ANS: E 4. ANS: F 5. ANS: C 6. ANS: H 7. ANS: B 8. ANS: I 9. ANS: J 10. ANS: A

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1