Modern Blood Banking & Transfusion Practices – Comprehensive Review

A broad set of Q&A flashcards summarizing essential facts, concepts, and numerical requirements from Harmening’s Modern Blood Banking & Transfusion Practices (6th ed.) review questions. Use them for rapid review of donor criteria, component storage, immunohematology, serology, transfusion therapy, adverse events, molecular basics, regulations, quality management, and related topics.

What is the maximum whole-blood volume (including samples) that can be collected from a 110-lb donor?

500 mL

How frequently may a donor give whole blood?

Every 8 weeks

Storage temp for whole blood / packed RBC units

1 °C – 6 °C

Which additive-free anticoagulant allows 35-day storage of whole blood/RBCs?

CPDA-1

How long can platelet concentrates or apheresis platelets be stored and at what temp?

5 days at 20 °C – 24 °C with continuous agitation

Minimum platelet count required in a whole-blood–derived platelet concentrate (90 % of units)

5.5 × 10¹⁰

Minimum platelet count required in an apheresis platelet component (90 % of units)

3 × 10¹¹

Maximum frozen storage time for RBCs in glycerol at ≤ −65 °C

10 years

Shelf-life of thawed, open-system deglycerolized RBCs

24 hours at 1 °C – 6 °C

What laboratory change is described as a ‘shift to the left’ during RBC storage?

↑ Hemoglobin-oxygen affinity due to ↓ 2,3-DPG

NAT is routinely used to screen donor blood for which viruses?

Hepatitis C, HIV-1, West Nile virus (and others) – i.e., all of the above

Most common source of bacterial contamination in platelet products

Skin plugs entering the collection bag

Which blood component is most often contaminated with bacteria?

Platelets (stored at room temperature)

Which cells produce antibody in adaptive immunity?

B lymphocytes (plasma cells)

Immunoglobulin class produced first in a primary immune response

IgM

Immunoglobulin class predominant in secondary immune response

IgG

MHC class found only on antigen-presenting cells

Class II

Immunoglobulin most efficient at activating complement

IgM

Complement pathway activated by antigen–antibody complexes

Classical pathway

Name the ‘membrane-attack complex’ components of complement

C5b-C6-C7-C8-C9

Define ‘prozone’ effect

False-negative due to excess antibody in the test system

What is zeta potential?

Net negative charge surrounding RBCs that hinders agglutination

Central dogma of molecular biology

DNA → RNA → Protein

Purpose of PCR in the blood bank

Amplification of specific DNA to identify/red-cell antigens or pathogens

Recombinant DNA work is possible because…

The genetic code is universal and restriction enzymes cut DNA predictably

Agarose gel electrophoresis is used to…

Separate DNA fragments by size

Which chromosome houses HLA genes?

Chromosome 6

In ABO typing, what sugar confers A specificity?

N-acetyl-D-galactosamine

Which ABO group has the least H substance?

A1B

Expected Bombay phenotype reaction with anti-H (Ulex europaeus)

No agglutination (cells lack H)

Anti-A1 often detected in which ABO subgroup?

A2 or A2B individuals

Rh antigen present in 85 % of Caucasians and critical for transfusion

D antigen

Weaker-than-expected reactions with anti-D are termed…

Weak D

Test required to detect weak-D antigen

Indirect antiglobulin test (IAT) with anti-D

Rh antibodies typically react best at what temperature?

37 °C

Immunoglobulin class of clinically significant Rh antibodies

IgG

Rh-null cells lack which antigen family?

All Rh antigens

Antiglobulin test principle

AHG (Coombs) reagent bridges IgG and/or C3 on RBCs to produce agglutination

Polyspecific AHG contains what specificities?

Anti-IgG and anti-C3d

Purpose of Coombs control (check) cells

Verify that negative AHG tests are valid (reagent active, washing adequate)

Solid-phase antibody screening endpoint

Adherence of indicator cells to the microplate well

Immediate-spin crossmatch function

Confirm ABO compatibility between donor and recipient

Specimen and donor samples must be retained how long post-transfusion?

Minimum 7 days

Emergency release component when blood type unknown

Group O, Rh-negative packed RBCs

Acceptable pretransfusion sample age for actively transfused patient

≤ 3 days (72 h)

What technique estimates volume of fetal–maternal hemorrhage?

Kleihauer-Betke acid-elution test

Standard shipping temperature for plasma components

≤ –18 °C (frozen)

Primary utility of the prewarm technique

Eliminate cold autoantibodies causing interference

Gel testing endpoint detection

Agglutinated cells trapped at top of gel column

SPRCA (solid-phase red-cell adherence) endpoint detection

Attachment of indicator cells to well bottom

Protein A binds which part of IgG?

Fc region

Most common anticoagulant for apheresis

Citrate (ACD-A or similar)

Minimum interval between plateletpheresis donations

2 days (no more than twice weekly)

Replacement fluid of choice during plasma exchange for TTP

Fresh-frozen plasma (FFP)

Most frequent adverse effect of plateletpheresis donation

Citrate toxicity (paresthesias, cramps)

Leukoreduction of RBCs must leave < 5 × 10⁶ WBCs and retain what % RBCs?

≥ 85 % of original RBCs

Indication for irradiated blood products

Prevent transfusion-associated graft-versus-host disease (TA-GVHD)

Shelf-life of irradiated RBC units

28 days from irradiation or original expiry, whichever comes first

Component most commonly implicated in transfusion-associated sepsis

Platelets (room-temperature storage)

Earliest sign of acute hemolytic transfusion reaction

Pain/heat at infusion site, fever, hypotension, hemoglobinuria

Definition of TRALI

Acute lung injury within 6 h of transfusion; dyspnea, hypoxemia, non-cardiogenic pulmonary edema

Classify transfusion reactions by…

Timing (acute < 24 h / delayed > 24 h), immune vs non-immune, infectious vs noninfectious

Virus posing greatest residual transfusion risk today

Bacterial contamination actually exceeds viral; however among viruses CMV risk addressed by leukoreduction; AABB cites bacterial contamination as major threat

Pathogen inactivation first widely used in plasma products

Heat treatment (pasteurization) / cold-ethanol fractionation

Parasitic infection most common in transfusion in USA

Babesia microti (babesiosis)

HDFN hallmark finding on cord blood

Positive direct antiglobulin test (DAT) on neonatal RBCs

Maternal anti-D prophylaxis product

Rh immune globulin (RhIG)

Kleihauer-Betke 10/1000 fetal cells in 5000 mL maternal blood – how many RhIG vials?

Two standard doses (each covers ~30 mL whole blood); always add one extra → 2 + 1 = 3, but guideline: 10 cells ≈ 0.5 %; 0.5 % of 5000 mL = 25 mL; one vial adequate; answer often ‘one vial’

Drug most commonly causing immune complex type DIIHA with complement activation

Quinidine

Warm autoimmune hemolytic anemia (WAIHA) antibodies class and specificity

IgG auto-anti-Rh (mostly anti-e-like) active at 37 °C

Cold AIHA often linked to which infection?

Mycoplasma pneumoniae (auto-anti-I)

Donath-Landsteiner antibody specificity

Auto-anti-P (paroxysmal cold hemoglobinuria)

Pretreatment of RBCs for cold autoadsorption

Ficin or DTT enzyme treatment to remove bound IgG, expose antigens

Allele combination expressed on a single chromosome is called…

Haplotype

Sequence-specific primer (SSP) typing detects alleles via…

PCR amplification using primers matching allele-unique sequences

Quality management system (QMS) is…

An active, continuous framework encompassing all processes to assure quality

‘cGMP’ in blood banking stands for…

Current Good Manufacturing Practice regulations for blood component manufacture

PDCA cycle stages

Plan – Do – Check – Act (continuous improvement)

In quality documents, a blank form is classified as a…

Record (once filled becomes evidence)

Which review method does NOT require direct clinician–lab discussion?

Retrospective review

Primary U.S. agency regulating blood component safety

Food and Drug Administration (FDA)

Where are U.S. blood regulations published?

Title 21 of the Code of Federal Regulations (CFR)

Computer validation test that feeds wrong data to confirm rejection

Invalid (negative) test case

Purpose of check-cells in automated/gel testing

Detect false-negative AHG results by confirming reagent activity

Legal claim alleging transfusion without consent

Battery

Major accrediting body for parentage (relationship) testing laboratories

AABB

Record-retention requirement for tissue implant records (Joint Commission)

Indefinitely

FDA regulation parts covering human tissues

21 CFR 1270 & 1271

Most likely tissue to transmit malignancy

Bone (allograft)

During apheresis, citrate anticoagulant prevents clotting by…

Binding ionized calcium

Optimal replacement fluid for therapeutic plasma exchange in TTP

Fresh-frozen plasma (to replace ADAMTS13)

Function of leukocyte-reduction filters

Decrease CMV risk, febrile reactions, HLA alloimmunization (not TA-GVHD)

Product indicated for patients with IgA deficiency and anti-IgA

Washed or IgA-deficient deglycerolized RBCs

What does NAT shorten in infectious-disease testing?

Serologic window period

Unconjugated bilirubin toxicity of neonate brain is termed…

Kernicterus

Drug adsorption mechanism of DIIHA is classically associated with which antibiotic?

High-dose penicillin

HTLA antibodies (e.g., anti-Ch, anti-Rg) are generally…

Clinically insignificant; neutralized by serum/plasma

Which blood group antibodies commonly show dosage?

Kidd, Duffy, MNS (e.g., anti-Jka)

Delayed hemolytic transfusion reaction is most often caused by…

Anamnestic Kidd antibodies (anti-Jka)

Cold auto-anti-I is commonly triggered by which pathogen?

Mycoplasma pneumoniae infection