Blood bank ASCP MLT medialab exams

When performing an antibody screen, both the screen cells are 4+ at immediate spin and W+ at AHG. The antibody panel shows 4+ reactions at immediate spin and W+ reactions at AHG and there is no specific match to the reaction pattern. The auto control is negative. What would be a logical next step?

- Have patient redrawn

- Repeat testing using warmed patient sample/reagent and just do AHG reading

- Run an enzyme panel

- Use acidified reagents

- Repeat testing using warmed patient sample/reagent and just do AHG reading

Phase of reactivity is primarily at immediate spin (4+) and reactions get weaker at AHG (w+). There is no specific pattern of reactivity and the auto control is negative which rules out an autoantibody. This is a strong cold antibody which is still slightly present after incubation and washing. Activation and binding of the antibody takes place at room temperature or colder. Warming the sample/reagents and eliminating this phase will prevent the antibody from binding. Cold antibodies usually are more of a nuisance to blood bankers and are not clinically significant.

There does not seem to a problem with the sample so the patient does not need to be redrawn.

Enzymes can be used to enhance reactions of certain antibodies but in this case the antibody present appears to be one that may not be clinically significant so enhancement is not needed.

Acidified reagents can be used as a way to enhance certain antibodies as well.

Donor and recipient blood samples must be kept for at least how long after transfusion?

- 10 days

- 7 days

- 3 days

- 24 hours

- 7 days

The correct answer is 7 days.

Donor and recipient samples must be available to investigate a transfusion reaction, if necessary.

Samples used for antibody screening and serological crossmatches must be less than 72 hours (3 days) old, but the sample must be kept the full 7 days.

5 days is not long enough to retain a sample in case of a transfusion reaction workup.

10 days is in excess of the required retention time of 7 days.

Which of the following consequences of severe hemolytic disease of the fetus and newborn (HDFN) is most associated with neonatal death before or shortly after birth?

- Enlarged liver

- Enlarged spleen

- Cardiac failure

- Hyperbilirubinemia

- Cardiac failure

While the other consequences of HDFN can be severe in and of themselves, cardiac failure is the greatest threat to the fetus.

In HDFN, the antibodies bind to the fetal antigens, which ends in red cell destruction by macrophages in the fetal liver and spleen. As red cell destruction continues, the fetus becomes increasingly anemic. The fetal liver and spleen enlarge as erythropoiesis increases to compensate for the red cell destruction. Hemoglobin is liberated from the damaged cells, metabolized to indirect bilirubin and is transported across the placenta where it is conjugated by the maternal liver and excreted. As the red cell destruction continues, cardiac failure resulting from uncompensated anemia will occur.

Which of the following best describes a transfusion reaction:

- Any adverse event associated with the transfusion of blood components

- A fever associated with a transfusion

- The destruction of transfused red cells

- The development of a rash after transfusion

- Any adverse event associated with the transfusion of blood components

A transfusion reaction can be defined as any adverse event occurring during or after the transfusion of blood components. This event may or may not include a fever, the destruction of transfused red cells, or the development of a rash.

Which situation will cause a positive DAT (direct antiglobulin test) in the newborn?

- Hemolytic disease of the fetus and newborn

- Mother is group AB and newborn is group O

- Mother is Rh positive and newborn is Rh positive

- Mother is Rh positive and newborn in Rh negative

- Hemolytic disease of the fetus and newborn

The DAT is ordered to detect IgG or complement proteins bound to patient cells. This can be from autoimmune hemolytic anemia, hemolytic disease of the fetus and newborn (HDFN), a drug-related mechanism, or an antibody reaction to transfused red cells.

In HDFN, the fetal cells are coated with IgG that has crossed the placenta from the mother's circulation.

With the mother being AB, there would not be any ABO antibodies present to cross the placenta.

With the mother being Rh positive, there would not be any antibodies formed from exposure of the fetal red cells, whether the fetus is Rh positive or Rh negative.

In an extreme emergency, if the ABO and Rh type are unknown, which of the following should be given to the patient?

- Group O, Rh positive blood

- Group AB, Rh negative blood

- Group O, Rh negative blood

- Any blood type is OK

- Group O, Rh negative blood

"Universal donor" is usually applied to group O, Rh negative blood. It lacks ABO and D antigens, so it can be transfused to any ABO and/or Rh type recipient. It does not guarantee complete compatibility due other potential allo-antiboidies in the recipient.

An exchange transfusion has been ordered for a low birth weight infant. The physician has ordered irradiated Red Blood Cells for this purpose. Why is it necessary to irradiate the blood products for this patient?

- To prevent alloimmunization of the patient

- To prevent transfusion-associated graft-versus-host disease (TA-GVHD)

- To kill bacteria and viruses present in the Red Blood Cells

- To allow the cells to have a longer half-life

- To prevent transfusion-associated graft-versus-host disease (TA-GVHD)

The correct answer is to prevent TA-GVHD. This occurs when donor lymphocytes from transfused blood engraft in the recipient and cause disease. Usually TA-GVHD occurs 3 to 30 days post transfusion with clinical features of fever, skin rash, hepatitis, diarrhea and pancytopenia. It is associated with a 90% mortality rate. Irradiation is indicated for patients who are at high-risk for TA-GVHD, including premature, low birth weight infants, directed donations from related donors, newborns with erythroblastosis fetalis, transplant recipients, and recipients with congenital immunodeficiencies.

Which of the following genotypes are known to be resistant to P. vivax (malaria) merozoites?

- Fy(a+b+)

- Fy(a-b-)

- Jk(a-b-)

- Jk(a+b+)

- Fy(a-b-)

The correct answer is Fy(a-b-). In the mid-70s, it was observed that Duffy (Fy) (a-b-) RBCs resist infection by Plasmodium knowlesi and Plasmodium vivax. This provides an explanation for the high frequency of Fy(a-b-) persons originating from West Africa.

All of the other genotypes (Fy(a+b+), Jk(a-b-), and Jk(a+b+)) are not known to cause this type of resistance.

An 82-year-old male is a long-time resident of a local nursing facility. He has been to your hospital multiple times over the years and has historically demonstrated antibodies against the K and Fya antigens. He has returned to your hospital following a 2-year absence, and his antibody screen is as follows.

Which of the following red blood cells would you crossmatch for this patient?

Cell D C E c e K k Fya Fyb Jka Jkb Lea Leb S s M N Lua Lub Cell IgG

Phage

1 + + 0 0 + 0 + + 0 + + 0 0 + + + + + + 1 0

2 + + 0 0 + + 0 + 0 + 0 0 + + + + 0 0 + 2 0

3 + 0 + + 0 + 0 0 + + + 0 + 0 + 0 + 0 + 3 0

- K negative

- Fya negative

- K negative; Fya negative

- As long as you perform a full crossmatch and it is compatible, you can use any unit of red cells

- K negative; Fya negative

This patient does not currently demonstrate any antibodies, but his historical clinically significant unexpected antibodies cannot be ignored. He must receive units that lack the K and Fya antigens.

If the patient is transfused with red cells positive for antigens for which he has made the corresponding antibody, this could lead to a hemolytic transfusion reaction. Any patient with a history of unexpected clinically significant antibodies requires antigen-negative units, even if the corresponding antibodies are not currently reacting in routine testing.

A standard blood donation of 450-500 mL requires a minimum anticoagulant-preservative solution volume of:

- 57 mL

- 63 mL

- 70 mL

- 82 mL

- 63 mL

The minimum volume of 63 mL of anticoagulant-preservative ensures that the donated blood product contains an appropriate anticoagulant-to-blood ratio.

57 mL of anticoagulant-preservative will not allow the donated blood unit to have enough anticoagulant to ensure a proper anticoagulant-to-blood ratio.

70 mL of anticoagulant-preservative is the maximum volume allowed to ensure proper anticoagulant-to-blood ratio.

82 mL of anticoagulant-preservative is too high and will result in an improper anticoagulant-to-blood ratio.

How many milliliters of Rh positive whole blood is one dose of Rh immune globulin capable of neutralizing?

- 15

- 30

- 45

- 450

- 30

One dose of Rh immune globulin, also known as RhoGAM, can neutralize approximately 30 mL of Rh positive fetal whole blood (or 15 mL of Rh positive blood cells). Additional doses may be necessary if the amount of Rh positive whole blood exposure is determined to be greater than 30 mL.

A low-incidence antigen is one that occurs in less than 10% of the population. Which of the following is a low-incidence antigen?

- D

- c (little c)

- Fyb

- Cw

- Cw

Of those listed, Cw is the only low-incidence antigen.

- The D antigen occurs on approximately 85% of the population. Therefore, it is not a low-incidence antigen.

- The c (little c) antigen occurs on approximately 80% of the white population and approximately 97% of the black population. It is not a low-incidence antigen.

- The Fyb (Duffy b) antigen occurs in approximately 83% of the white population and approximately 23% of the black population. It is not a low-incidence antigen.

A patient presents with platelet refractoriness, or poor response to platelet transfusions. What can be performed to help ensure platelet transfusions will be therapeutic?

- ABO matching

- HLA typing

- Transfusing the platelets with a warmer

- Administering an antihistamine before the transfusion

- HLA typing

Antibodies to human leukocyte antigens, or HLA, can often cause platelet refractoriness. To prevent this, HLA typing may be performed on the donor platelets to match them to the recipient.

ABO matching is typically not performed on platelets.

Transfusing the platelets with a warmer will not increase the viability of the platelets or decrease the potential for refractoriness. Using a warmer may be used in patients who have cold agglutinins or are receiving a massive transfusion.

Administering an antihistamine may be done when the patient has a history of having mild allergic reactions to transfusions. This will not improve the refractoriness.

What kind of immunoglobulins are predominantly found in Rh immune globulin?

- IgM anti-D

- IgG anti-D

- IgM anti-A,B

- IgG anti-A,B

- IgG anti-D

Rh immune globulin is a solution of concentrated anti-D. It is prepared from pooled human plasma of patients who have been hyperimmunized and contains predominantly IgG anti-D. Because RhIg contains IgG anti-D, it can cross the placenta and sensitize fetal Rh positive red cells. Affected infants may be born with a weakly positive DAT, but significant hemolysis does not occur.

Which of the prospective donors below would be an acceptable blood donor?

- Donor number 1:

Blood pressure: 90/55

Pulse: 105

Temperature: 36.4ºC (97.6 ºF)

- Donor number 2:

Blood pressure: 200/90

Pulse: 72

Temperature: 37ºC (98.6 ºF)

- Donor number 3:

Blood pressure: 110/72

Pulse:66

Temperature: 37.2ºC (99.0 ºF)

- Donor number 4:

Blood pressure: 100/70

Pulse: 98

Temperature: 38.3 (101.0 ºF)

- Donor number 3:

Blood pressure: 110/72

Pulse:66

Temperature: 37.2ºC (99.0 ºF)

The correct answer is donor number 3.

Systolic blood pressure must be less than or equal to 180; diastolic blood pressure must be less than or equal to 100; pulse must be within 50-100 beats per minute; temperature must be less than or equal to 37.5oC (99.5oF).

Donor number 1 has a pulse above 100.

Donor number 2 has a systolic blood pressure above 180.

Donor number 4 has a temperature above 37.5oC (99.5oF).

The serum from a patient of African-American descent is reactive with all screening and panel cells. Which antibody directed to a high incidence antigen is most likely to be present?

- Anti-Lub

- Anti-Jk3

- Anti-U

- Anti-Ku

- Anti-U

The U antigen is located on glycophorin B, a glycoprotein that carries the S, s, and U antigens in the MNS blood group system. Individuals who are U-negative are also S-s- and are of black descent. This phenotype is never found in the white population. The U antigen is present in more than 99% of the population.

Anti-Lub is rarely seen because of the high prevalence of the antigen. The presence of anti-Lub is not associated with a specific ethnicity.

Individuals who are Jk(a-b-) can make anti-Jk3. The Jk(a-b-) phenotype is most commonly seen in individuals of Polynesian, Filipino, or Chinese descent.

Anti-Ku may be found in immunized individuals who have the Kell null (K0) phenotype. The K0 phenotype is not associated with a specific ethnicity.

Which of the following characteristics is consistent with the Kidd blood group system?

- Jk(a-b-) red cells are resistant to lysis in 2 M urea

- Kidd antigens are destroyed by ficin

- Antibodies to Kidd antigens react best at immediate spin

- Anti-Jka activity may not react well in a LISS test system

- Jk(a-b-) red cells are resistant to lysis in 2 M urea

Kidd antigens are located on the red cell urea transporter. Red cells that lack Kidd antigens resist lysis by 2M urea.

Antibodies to Kidd system antigens are enhanced with ficin treated cells. Most antibodies to Kidd antigens are IgG and prefer to react at AHG phase. Antibodies to the Kidd system may be difficult to detect because they can drop in titer in vivo; however, their detection is aided by the use of potentiators such as LISS and PEG.

Which blood group is most frequently associated with Cold Agglutinin Disease (CAD)?

- Kell

- Kidd

- Duffy

- I

- I

Cold Agglutinin Disease (CAD) presents when red cells agglutinate at room temperature. In vivo, a cold autoantibody attaches to red cells in the colder extremities and activates the complement cascade. As the blood warms closer to the core of the body, the autoantibodies dissociate from the red cells, and more complement is activated. This is often associated with autoanti-I or autoanti-i.

Kell is a warm antibody and does not activate complement.

Kidd can bind complement but is not activated at colder temperatures.

Duffy is a warm antibody and does not activate complement.

Severe blood loss causing circulatory collapse and shock usually first occurs when what percentage of blood is lost?

- 5 to 10%

- 20%

- 30 to 40%

- 60%

- 30 to 40%

According to McKenzie and Williams (2015), severe blood loss of 30 to 40% of total blood volume leads to circulatory collapse and shock.

Acute blood loss of 20% or less, in many cases, doesn't cause clinical symptoms at rest. Because of this 5 to 10% and 20% are not the correct answers.

Acute blood loss of 50% or more is not compatible with life, therefore, 60% is not the correct answer.

When blood is lost over a longer period of time, the body can develop compensatory mechanisms to accommodate for the loss. Because of this, circulatory collapse and shock may not develop when 30 to 40% of blood is lost over an extended period of time.

What is the first step a transfusionist should take when a transfusion reaction is suspected?

- Slow the transfusion and notify the physician.

- Administer medication to stop the reaction.

- Notify the laboratory of the reaction

- Stop the transfusion, but keep the intravenous line open with saline.

- Stop the transfusion, but keep the intravenous line open with saline.

The first critical step is to stop the transfusion immediately, but keep the patient's line open with saline.

Once the transfusion is stopped, the tranfusionist notifies the physician. The transfusion needs to be stopped, no slowed, immediately.

Notification of the laboratory or administration of medications, such as antihistamines for mild allergic transfusion reactions, are follow-up steps in the process of a transfusion reaction workup.

The parents' blood types are AB and O. What could be the only possible blood type(s) of their children?

- Group A only

- Group B only

- Group O only

- Group A or B only

- Group A or B only

If the parents' have AB and O blood types, then the child could have only AO or BO inheritance patterns resulting in a group A or group B baby.

A B

O AO BO

O AO BO

If the unit is going to be transfused within the collection facility, autologous blood must always be tested for which of the following before transfusion?

- ABO, Rh

- ABO, Rh, HBsAg

- ABO, Rh, HIV

- ABO, Rh, HBsAg, HIV

- ABO, Rh

Autologous units must have ABO and Rh grouping determined by the collection facility. Additional testing (unexpected antibodies and infectious disease testing) are not required if the unit is going to be transfused within the collection facility. If the unit gets shipped outside of the collection facility the additional testing will be required.

In this question the HBsAg and HIV tests will only be required if the unit is being used outside of the collection facility.

Which of the following immunoglobulins are capable of fixing complement by the classical pathway?

- IgG and IgA

- IgM and IgA

- IgG and IgM

- IgG and IgD

- IgG and IgM

The correct answer is IgG and IgM.

IgG and IgM can fix complement via the classical pathway.

IgA can fix complement via the alternative pathway.

IgD is not able to fix complement.

What is considered the definition of allogeneic blood?

- Donated by the donor for self-use

- Donated by a donor for a recipient other than the donor to use

- Blood salvaged during surgery

- Blood collected through normovolemic hemodilution

- Donated by a donor for a recipient other than the donor to use

A voluntary donation of blood for use by the general patient population is called allogeneic. Allogeneic blood is blood that is transfused to someone other than the blood donor.

All the other choices are considered sources of autologous blood. Blood that is transfused to the person who donated the blood is referred to as autologous blood. If blood is salvaged during surgery, recycled, and transfused back to the donor during surgery, the term that is applied is perioperative blood collection. During normovolemic hemodilution, blood is collected at the beginning of surgery, and the volume is restored with crystalloid or colloid solutions. The blood will be transfused back to the patient during or at the end of the surgery.

Units of A-negative, B-negative, and O-negative red blood cells are shipped to your transfusion service. What testing MUST be performed by your facility before placing these units into your inventory?

- ABO

- ABO and Rh

- ABO, Rh and antibody screen

- ABO, Rh and Weak D to confirm negative status

- ABO and Rh

All donor Red Blood Cell units must have the ABO group re-confirmed. Units that are labeled as "Rh-negative" must also be tested and re-confirmed for Rh negativity.

Antibody screen testing is not performed on donor units upon receipt to inventory.

Tests for weak D are not required upon unit type reconfirmation/receipt to inventory.

Which of the following would be a possible cause of a positive direct antiglobulin test (DAT)?

- Transfusion reaction and warm autoimmune disease only

- Warm autoimmune disease and clot tube stored at 4°C only

- Clot tube stored at 4°C and transfusion reaction only

- Clot tube stored at 4°C, transfusion reaction, and warm autoimmune disease.

- Clot tube stored at 4°C, transfusion reaction, and warm autoimmune disease.

A positive DAT is associated with transfusion reactions, warm autoimmune disease, clot tube stored at 4oC, cold autoimmune disease, drug interactions, and hemolytic disease of the fetus and newborn.

A patient with a historical type of AB positive requires a routine type and screen test. You perform the ABO/Rh type using the gel methodology and note the results below.

How would you interpret the results?

- The back type is correct. The front type is incorrect and probably due to a manufacturing defect at the gel card production facility.

- An elderly group O patient with a weak reaction in the back type due to compromised anti-A and anti-B production.

- The front type is correct. The discrepancy in the back type can be ignored because it is not strong.

- The front type is correct and the back type may due to cold agglutinins. You could prewarm the patient serum and repeat the back type to see if the discrepancy is resolved.

- The front type is correct and the back type may due to cold agglutinins. You could prewarm the patient serum and repeat the back type to see if the discrepancy is resolved.

The patient forward types as group AB positive, and this is consistent with the historical type. The back type shows extra reactivity. Extra reactivity in the back type may be caused by alloantibodies, autoantibodies, or rouleaux. Warming the serum before repeating the back type is one method to help solve the discrepancy in the back type.

Any discrepancies between the forward and back type should be investigated and resolved before finalizing ABO/D typing results and should not be reasoned away as problems with the testing system. These results show strong reactions in the forward type. These reactions along with the patient history indicate AB pos is most likely the correct type, so resolution steps should focus on the cause of the extra reactivity in the back type.

All of the following steps should be taken in the IMMEDIATE investigation of a potential hemolytic transfusion reaction EXCEPT:

- DAT on the post-transfusion patient sample.

- Check for clerical errors.

- Visual examination of the post-reaction and pre-reaction plasma for hemolysis.

- A gram-stain on the patient's plasma.

- A gram-stain on the patient's plasma.

For the investigation of a hemolytic transfusion reaction, a clerical check, visual check for hemolysis, and a DAT are indicated. If any of these yields a discrepancy or evidence of hemolysis/serologic incompatibility, further testing will be performed.

A gram-stain on the patient's plasma is not indicated. If sepsis is suspected, a gram-stain and culture of the donor unit may be performed.

Which one of the following procedures is used for the proper preparation of platelet concentrate from random whole-blood donors?

- Light spin followed by a hard spin

- Light spin followed by two hard spins

- Two light spins

- Hard spin followed by a light spin

- Light spin followed by a hard spin

The correct answer is a light spin followed by a hard spin.

The first step in the preparation of platelets from random whole blood donors is low-speed centrifugation (light spin). This allows the platelets to remain in the plasma portion of the collection container. The plasma (dubbed "platelet-rich plasma") is then centrifuged at a higher velocity (hard spin) that forces the platelets to the bottom of the satellite bag. The platelet-poor plasma is expressed into another container, and the residual platelets that remain in the bag are resuspended in a small volume of plasma.

Which of the following group B antigens is generally associated with a mixed field reaction?

- B

- B3

- Bm

- Bx

- B3

B3 is characterized by a weaker than usual reaction with anti-B and by a mixed field reaction with the same reagent.

B is characterized by a strong reaction with anti-B.

Bm and Bx are characterized by a weaker than usual reaction with anti-B but no mixed field reactions.

How many doses of RhIG should be administered if the calculated amount of fetal whole blood volume in maternal circulation was 28 mL?

- 1 dose

- 2 doses

- 3 doses

- 4 doses

- 2 doses

When calculating RhIG dosage, facilities always add one extra dose to the calculated dose for an added margin of safety.

Each dose is effective in treating 30 mL fetal whole blood. Therefore, 28 mL fetal whole blood would require one dose, plus one additional dose.

The addition of Low Ionic Strength Solution (LISS) to the testing environment when performing an indirect antiglobulin test is designed to do what?

- Lowering the zeta potential

- Increasing the zeta potential

- Bind IgG antibodies attached to patient RBC's

- Bind IgM antibodies found in patient serum or plasma

- Lowering the zeta potential

The correct answer is that LISS lowers the zeta potential.

- The addition of LISS does not increase the zeta potential.

- LISS does not bind IgG antibodies attached to patient RBC's. That is accomplished by the addition of antihuman globulin.

- LISS does not bind IgM antibodies found in the patient serum or plasma. Because IgM is a pentamer, lattice formation naturally occurs when it binds in a solution with antigens to which it has specificity.

Frozen red blood cells that have been thawed, deglycerolized and reconstituted in an open system must be used within _______.

- 1 hour

- 24 hours

- 14 days

- 7 days

- 24 hours

The correct answer is 24 hours.

Frozen red blood cells that have been thawed, deglycerolized and reconstituted in an open system must be used within 24 hours.

1 hour is an unreasonable amount of time for a unit to be used.

If prepared in a functionally closed, FDA-approved system, post-thaw storage would be allowed up to 14 days, but this statement indicates that an open system was used.

7 days is inappropriate since the cells were prepared in an open system.

Polyspecific antihuman globulin (AHG) reagent used in antiglobulin testing should react with which one of the following?

- IgG and IgA

- IgM and IgA

- IgG and C3d

- IgM and C3d

- IgG and C3d

Polyspecific antihuman globulin (AHG) reagent contains both anti-IgG activity and anti-C3d activity. Most clinically significant antibodies detected during antibody screening (IAT) are IgG. Polyspecific antihuman AHG was developed for the detection of IgG antibodies, not IgA antibodies or clinically insignificant IgM antibodies.

Many red blood cell (RBC) processes, such as binding, transporting, and releasing oxygen, do NOT require energy. Energy however, is required for cellular viability. How does the RBC obtain most of it's energy?

- Glycolytic pathways

- Hexose-monophosphate shunt

- Rapoport-Luebering pathway

- Methemoglobin reductase pathway

- Glycolytic pathways

Most of the energy needed for RBC viability is obtained through the glycolytic pathway. About 90 to 95% of the cells' glucose is metabolized in this pathway, which in turn produces ATP. One glucose molecule produces a net gain of 2 moles of ATP via this pathway.

The main function of the hexose-monophosphate shunt is to provide NADPH and glutathione to reduce oxidants, essentially minimizing the amount of oxyhemoglobin that would convert to methemoglobin.

The Rapoport-Luebbering pathway controls the amount of 2,3-BPG that gets produced.

The methemoglobin reductase pathway functions to protect hemoglobin from oxidation by NADH and methemoglobin reductase.

Red blood cell units that contain CPD (citrate-phosphate-dextrose) can be stored for up to how many days?

- 21 days

- 28 days

- 35 days

- 42 days

- 21 days

Red blood cell units that contain CPD or CP2D may be stored for up to 21 days.

Irradiated red cell units may be stored for up to 28 days or the original expiration date, whichever occurs first.

Red cell units that contain CPDA-1 may be stored for up to 35 days.

Red cell units that contain an additive solution may be stored up to 42 days.

Which of the following antibodies is most often implicated as a cause of a delayed hemolytic transfusion reaction (DHTR)?

- Anti-S

- Anti-M

- Anti-Fya

- Anti-Jka

- Anti-Jka

Of the antibodies that are listed, anti-Jka is most often reported as the cause of DHTR. Anti-Jkb is also well documented as a cause of DHTR. The antibody titer of these two antibodies commonly decreases rapidly in vivo, which contributes to the higher incidence of DHTRs.

Anti-S has been implicated in severe Hemolytic Transfusion Reactions (HTRs) but less often in DHTRs.

Anti-M is more commonly an IgM antibody and even when it reacts at 37°C it rarely causes HTRs.

Antibodies that are also implicated in a DHTR include Kell, Rh, and Duffy system antibodies.

Unless an alternative has been approved by the FDA, what is the expiration and storage temperature of rejuvenated (non-frozen) RBC's?

- 24 hours; 1 °C to 6 °C

- 48 hours; 1 °C to 10 °C

- 72 hours; 1 °C to 6 °C

- 24 hours; Room temperature

- 24 hours; 1 °C to 6 °C

The correct expiration date/time after rejuvenation is 24 hours, although rejuvenated RBCs can also be frozen and maintained at -65 °C. If the product is not frozen, it should be stored like other packed RBCs at 1 °C up to 6 °C.

In cases where the rejuvenated cells are frozen, the expiration date is 10 years if collected in CPD or CPDA-1. If rejuvenated cells are frozen and collected with AS-1, the expiration date is 3 years.

A 47-year old man is hemorrhaging severely. He is group AB, Rh (D) negative. Ten units of packed red blood cells are requested STAT. One group-specific unit is available. Which other units that are available in the blood bank would be most appropriate to choose for crossmatching?

- B, Rh(D) - positive

- A, Rh(D) - negative

- A, Rh (D) - positive

- O, Rh (D) - positive

- A, Rh(D) - negative

Rh-negative recipients should receive Rh-negative Red Blood Cells. A group AB patient can receive Group AB, A, B, or O blood. If AB negative blood is not available, the next units selected should be A negative because A is the second most common ABO blood type. The second choice should be B negative. O negative should be used last because it is the only blood type available for an O negative recipient and is used as the 'emergency' blood type. Therefore, the best choice would be units that are A negative.

Transfusion of Rh-positive blood to Rh-negative male patients is possible IF the patient has NO preformed anti-D in their serum. Nearly 80% of Rh-negative patients transfused with 200 mL or more of Rh-positive blood will produce anti-D. This should only occur when Rh-negative units are not available, and the risk of not transfusing is greater than the risk of transfusing.

Whole blood or red blood cell units will be shipped from the American Red Cross to the transfusion facility. At what temperature should the units be kept during transportation?

- 1-4 °C

- 1-10 °C

- 2-6 °C

- 2-8 °C

- 1-10 °C

Whole blood or red blood cell units must be maintained between 1 and 10 °C during transportation. Blood in storage should be kept between 1 and 6 °C.

All other answer choices have temperature ranges that are too restrictive.

Which one of the following tests BEST correlates with the severity of hemolytic disease of the fetus and newborn (HDFN)?

- Color Doppler ultrasonography

- An antibody screen of mother's blood

- Amniotic fluid bilirubin

- Antibody titer of mother's blood

- Color Doppler ultrasonography

Fetal anemia caused by hemolysis of red cells during pregnancy can be detected by color Doppler ultrasonography. This can determine the severity of fetal anemia. Before the development of this technology, the severity of HDFN was measured by amniocentesis.

An antibody screen using separate screening cells to detect clinically significant IgG alloantibodies can be performed. If the antibody screen is positive, an identification panel should be performed. Laboratory testing for the corresponding paternal red blood cell antigens can predict the future risk of HDFN.

Amniotic fluid bilirubin is increased in association with the severity of hemolytic diseases of the newborn. As red blood cells lyse during these conditions, bilirubin builds up as a byproduct of red cell destruction. As more red blood cells are destroyed in the baby, the bilirubin level will become more increased. However, this uses a graph to estimate the severity of the HDFN.

Once the critical titer for the given antibody is met, assessments for the possibility of fetal anemia must be undertaken using amniocentesis or middle cerebral artery Doppler ultrasound.

A person who lived in the United Kingdom between the years of 1980 and 1996 for 3 or more months is indefinitely deferred from donating blood or blood products based on an increased risk of which of the following?

- Malaria

- Leishmaniasis

- Creutzfeldt-Jakob disease (CJD) and/or variant Creutzfeldt-Jakob disease (vCJD)

- Chagas disease

- Creutzfeldt-Jakob disease (CJD) and/or variant Creutzfeldt-Jakob disease (vCJD)

The correct answer is CJD and/or vCJD. If a potential blood donor spent more than 3 months in the United Kingdom between 1980 and 1996, or 5 or more years in France from 1980 to the present, they are indefinitely deferred due to an increased risk of CJD and/or vCJD. If they have ever been diagnosed with CJD or vCJD, they are permanently deferred.

Persons with malaria or who have been infected with malaria are deferred for a period of 3 years after they are asymptomatic. The United Kingdom (UK) is not a malaria-endemic area and traveling to the UK in and of itself, would not be cause for deferral based on a potential malaria infection.

Traveling to an area that is endemic for Leishmaniasis may be cause for a 12-month deferral from the time you left the area. The UK is not an Leishmaniasis endemic area. It is endemic in tropical and subtropical areas of the Middle East, Mediterranean, Africa, Central and South America, and Asia.

Chagas disease is endemic in parts of Central and South America and Mexico. The UK is not an endemic area of Chagas disease. All potential donors are tested one time for Trypanosoma cruzi, the causative agent of Chagas disease. If the potential donor tests nonreactive for Chagas disease, the donor doesn't need to be retested. The rational for this is that most persons with Chagas disease have a chronic infection that was acquired while in a endemic area.

One risk associated with patients that require chronic transfusions is:

- Iron overload

- Fear of needles

- Transfusion associated graft-versus-host disease (TA-GVHD)

- Increased antigen production

- Iron overload

The correct answer is iron overload.

A long-term complication of RBC transfusion is iron overload. Each unit of red cells contains 225 mg of iron, which puts these patients at risk for iron overload.

Fear of needles is not induced by chronic transfusions.

TA-GVHD is a rare complication that is more likely in certain populations, but not associated with patients that receive chronic transfusions.

Increased antigen production is not something that can be associated with chronic transfusions, but increased antibody production would be.

What is the shelf-life of whole blood collected in CPDA-1?

- 21 days

- 28 days

- 35 days

- 48 days

- 35 days

Whole blood collected with CPDA-1, or citrate-phosphate-dextrose-adenine, has a storage (shelf) life of 35 days from the date of collection.

Whole blood collected with CPD (citrate-phosphate-dextrose), CP2D (citrate-phosphate-dextrose-dextrose), or ACD (acid-citrate-dextrose) has a storage (shelf) life of 21 days from the date of collection.

Which term listed below refers to the process that must be followed when notification is received that a donor of a unit transfused now tests positive for an infectious disease?

- Look-back

- Donor notification

- Minor crossmatch

- Major crossmatch

- Look-back

The "look-back" process involves the donation facility looking back at previous donations to identify recipients who received a blood product from a donor that is newly testing positive for an infectious disease. The time frame for "look-backs" vary by infectious disease. The goal is to identify recipients who were at risk of receiving an infectious blood product before the donor was testing positive for a particular infectious disease (ex. HIV).

Donor notification includes regulations for notification of donors that they currently test positive for an infectious disease.

Minor crossmatch involves testing donor serum and recipient red blood cells for compatibility.

Major crossmatch involves testing donor red blood cells and recipient serum for compatibility.

Marcus had a transfusion of packed RBC's 8 months ago following a surgery after a car accident. He is fully recovered and is otherwise healthy. How soon can Marcus donate a unit of blood?

- He can never donate a unit of blood.

- He can donate in 12 months.

- He can donate in 4 months.

- He can donate today.

- He can donate in 4 months.

The correct answer is, "he can donate in 4 months". The total deferral time following a blood transfusion is 12 months, as long as the donor meets all of the other requirements. Given Marcus received his transfusion 8 months ago, he would need to wait an additional 4 months before he would be eligible to donate a unit of blood.

Cold agglutinin disease (CAD) is most often associated with which antibody?

- Anti-D

- Anti-M

- Autoanti-I

- Autoanti-i

- Autoanti-I

In CAD, patients may have a history of mild anemia, Mycoplasma pneumoniae infection, or infectious mononucleosis. The autoantibody specificity in CAD is most often autoanti-I and less commonly autoanti-i.

What is the MOST common cause of acute hemolytic transfusion reactions?

- Testing errors

- Clerical errors

- Donor IgG immune antibodies

- Blood administration errors

- Clerical errors

The correct answer is clerical errors.

Improper patient identification at the time of sample collection or transfusion is the most common cause of an acute immune hemolytic transfusion reaction.

Testing errors can cause acute hemolytic transfusion reactions, but they are not the most common cause.

Donor IgG antibodies should not be transmitted to a patient, as patients with a positive antibody screen are generally deferred.

Blood administration errors can cause acute hemolytic transfusion reactions, but they are not the most common cause.

An elution is a technique that is used to release, concentrate, and purify antibodies that are bound to red blood cells. In preparing red cells for any elution method, one must be particularly careful to:

- Leave a small amount of serum in the test system so complement will be present

- Add albumin to decrease zeta potential

- Pretreat the cells with enzymes

- Thoroughly wash sensitized red cells

- Thoroughly wash sensitized red cells

Elutions are commonly used when a patient has a positive direct antiglobulin test (DAT), indicating that there are antibodies coating the patient's red blood cells. Performing an elution releases the antibodies from the surface of the red blood cells, concentrates the antibodies, and purifies the antibodies. Elution methods include changing the temperature, changing the pH, and use of organic solvents. The most important step in an elution is the washing of the sensitized red blood cells. The washing removes immunoglobulins that are not bound to the cells. If washing is incomplete the unbound immunoglobulins will contaminate the final eluate and lead to a false-positive result.

Leaving serum in the test serum will lead to contaminating immunoglobulins in the eluate interfering with the results (false-positive). Albumin can be used to reduce the zeta potential to enhance antigen-antibody binding. Enzymes are used to enhance expression of certain antigens (ABO, Rh, I, P, Kidd, Lewis) and destroy expression of other antigens (Duffy, MNS, Xga).

Which is the best component to treat a patient with fibrinogen deficiency?

- Red Blood Cells

- Platelet Concentrate

- Fresh Whole Blood

- Cryoprecipitated AHF

- Cryoprecipitated AHF

Cryoprecipitated AHF is the only product that contains a concentrated amount of fibrinogen. Cryoprecipitate contains a minimum of 150 mg of fibrinogen in each unit. It is primarily used for fibrinogen replacement in patients diagnosed with a congenital fibrinogen deficiency.

Red blood cells, platelet concentrate, and fresh whole blood do not contain enough concentrated fibrinogen to be adequate in treating patients with fibrinogen deficiency.

All of the following RBC antigens are high-frequency EXCEPT:

- k (little k)

- E (big E)

- Lub

- Kpb

- E (big E)

Of the RBC antigens listed, only E is NOT a high-frequency antigen. A high-incidence antigen occurs in 98% or more of the population. E occurs in 29% of the white population and 22% of the black population.

Little k (k), Lub, and Kpb all occur in approximately 99% or more of the population.

Which of the following antibodies usually show enhanced agglutination with the use of proteolytic enzymes?

- Anti-M,-N, and -S

- Anti-Jka, -Jkb, -C, and -E

- Anti-Fya and -Fyb

- Anti-K

- Anti-Jka, -Jkb, -C, and -E

Enzyme techniques are particularly useful in the identification of antibodies in the Rh system (e.g., anti-C and -E) and in the Kidd system (e.g., anti-Jka and -Jkb).

Enzymes destroy some antigens, such as M, N, S, Fya, and Fyb. Therefore the corresponding antibodies would not be detected.

Enzymes do not affect the K antigen or antibodies against the K antigen.

Red Cells Tested With Serum Tested With Interpretation of ABO

Known Antisera Known Red Cells Group

Anti-A 4+ A1 Cells 1+

Anti-B 4+ B Cells 0 ?

Anti-A,B 4+

Using the information provided above, select the correct ABO group.

- Group AB

- Group O

- Group B

- Inconclusive; could be A2B with anti-A1in the serum; further testing is necessary.

- Inconclusive; could be A2B with anti-A1in the serum; further testing is necessary.

The forward type in this case suggests group AB; however, there is an unexpected reaction with the A1 cells\in the reverse type.

Group O is not the correct answer because the forward typing indicates the presence of A and B antigens on the red cells, and the reverse typing is not consistent with group O reactivity.

While the reverse typing results are consistent with reactivity noted in group B people, the forward type indicates A antigen is present, so group B cannot be the correct answer.

Because the forward and reverse typing results do not agree, more testing must be performed to identify why the A1 cells are reacting in the reverse type. One possible reason is the patient has a subgroup of A. In ABO typing, reactions with reagent antisera and red cells are generally strong (3 - 4+); weak reactions (less than 3+) should be investigated.

Transfusion-related acute lung injury (TRALI) is a serious blood transfusion complication that can be characterized by all of the following EXCEPT:

- Respiratory distress

- Pulmonary edema

- Acute onset

- Increased central venous pressure

- Increased central venous pressure

TRALI is an acute, often life-threatening reaction characterized by respiratory distress, hypotension, and pulmonary edema that generally occurs within 2 hours of a transfusion. TRALI must be distinguished from anaphylactic transfusion reactions, transfusion-associated circulatory overload (TACO), and transfusion-related sepsis.

Increased central venous pressure is a characteristic finding in TACO, not TRALI.

At what temperature should whole blood be stored?

- < -65 C

- < -18 C

- 1-6 C

- 20-24 C

- 1-6 C

Whole blood must be stored at 1-6 C to maintain viability of the red blood cells.

Red blood cells that are frozen without glycerolization, such as whole blood, will lyse. Temperatures < - 18 C and < -65 C would not produce viable red blood cells.

Whole blood storage at room temperature increases the storage lesion effects caused by biochemical reactions within the unit and also increases the chance of bacterial contamination.

All of the following are appropriate indications for the use of fresh frozen plasma (FFP) EXCEPT?

- Volume expansion

- Severe bleeding in the presence of significantly elevated PT secondary to vitamin K deficiency

- Replacement component after plasma exchange in patients with TTP or HUS

- Dilutional coagulopathy with significant active bleeding, and PT and PTT twice normal

- Volume expansion

Since each unit of fresh frozen plasma (FFP) carries with it the risk of transmitting blood-borne pathogens, and other products (such as normal saline or albumin) which do not carry this risk are available, FFP should not be used as a volume expander.

Elevated PT or PTT results, with bleeding or coagulopathy, would require the replacement of clotting proteins, and FFP would be indicated.

FFP would be a necessary replacement component in cases of plasma exchange.

Which of the following activities would require that a label be added to the blood label indicating the name and location of a second manufacturer?

- Irradiating a unit of red cells or platelets

- Shipping a unit to another facility

- Thawing a unit of plasma

- Receiving a unit from another facility

- Irradiating a unit of red cells or platelets

The correct answer is irradiating a unit of red cells or platelets. Irradiating a unit is considered manufacturing and the second manufacturer (name of the facility performing the irradiation) must be listed on the label.

Shipping components, thawing plasma, and receiving components are not considered manufacturing and an additional label would not be required.

What should be done FIRST if a donor unit of red blood cells is found to be incompatible at the antiglobulin phase but compatible at immediate spin with several different recipients?

- Repeat the ABO grouping on the incompatible unit using different sera

- Do a panel made up of red cells having all low-frequency antigens

- Perform a direct antiglobulin test (DAT) on the donor unit

- Obtain a new specimen and repeat the minor crossmatch

- Perform a direct antiglobulin test (DAT) on the donor unit

If a donor unit of red blood cells is found to be incompatible at the antiglobulin phase with several recipients, the possibility of antibody coating the red blood cells is likely. A DAT should be performed on the donor unit. The antiglobulin phase of a crossmatch involves the addition of anti-human globulin (AHG). If donor cells are coated with antibody from a positive DAT the AHG will crosslink the donor cells and the crossmatch with be incompatible.

ABO grouping does not need to be repeated since ABO incompatibility would be seen at immediate spin.

It is unlikely that multiple recipients have alloantibodies to a low frequency antigen present on the donor unit. Antibodies to low frequency antigens are uncommon due to the low percent of patients stimulated (since not many donor cells have the antigen) to produce antibodies during a transfusion.

Lastly, a new specimen is not needed for a minor crossmatch since plasma is not being transfused.

Which of the following patients is eligible for RhIG?

- D-positive woman, 28 weeks gestation, no unexpected antibodies

- D-negative woman, 28 weeks gestation, no unexpected antibodies

- D-negative woman, 28 weeks gestation, immune anti-D present in serum

- D-positive woman, 28 weeks gestation, anti-K present in serum

- D-negative woman, 28 weeks gestation, no unexpected antibodies

A D-negative woman at 28 weeks gestation with no unexpected antibodies present in her serum is eligible for RhIG administration to help protect her from making immune anti-D if she is carrying a D-positive fetus.

D-positive women cannot make immune anti-D and are not eligible for RhIG regardless of any other unexpected antibodies present. RhIG only prevents immunization to the D antigen. D-negative women who have already made immune anti-D would not be eligible for RhIG.

Phenotype refers to:

- The genes inherited from each parent

- Opposing antigens produced by genes

- The presence of two or more alleles at a locus

- The expression of traits

- The expression of traits

A phenotype refers to the traits that are expressed; routine blood bank testing detects phenotype. For example, a person may possess the A phenotype.

A genotype is what is inherited from each parent. For example, a person who is the A phenotype may be AA or AO.

Antithetical genes are opposing genes that are inherited at a given locus.

Polymorphic genes will have two or more alleles at a locus.

The following results were obtained at delivery for a pregnant woman who received antenatal RhIg.

ABO and Rh typing

ABO Forward Group ABO Reverse Group Rh

anti-A anti-B A1 cells B cells anti-D*

0 0 4+ 4+ 0

Antibody screen

Cells Gel IAT*

Screen cell l (R1R1) w+

Screen cell ll (R2R2) 1+

Screen cell lll (rr) 0

* IAT = indirect antiglobulin test

Which of the following are possible causes of the positive antibody screen?

- Anti-D (passive, from RhIg administration) or an antibody other than anti-D

- Anti-D (immune) or Anti-D (passive, from RhIg administration)

- Antibody other than anti-D

- Anti-D (immune) or Anti-D (passive, from RhIg administration) or an antibody other than anti-D

- Anti-D (immune) or Anti-D (passive, from RhIg administration) or an antibody other than anti-D

All causes are possible, although given the history of antenatal RhIg administration, passive anti-D alone is the most likely cause. The screening cells I & II are D positive and screening cell III is D negative, so it could be anti-D (either passive or immune). However, there are other antigens present on the both screening cells I & II, and the corresponding antibodies could give the same results.

Anti-U antibodies can be produced by which of the following genotypes?

- M-N-

- S+s+

- S+s-

- S-s-

- S-s-

Absence of or an altered glyocyphorin B can result in red cells lacking the S, s, and U antigens. These individuals, if exposed to blood with S antigens, s antigens, or both will also be exposed to the U antigen and have the potential to produce anti-U. In this same scenario, the person receiving blood could also produce anti-S and/or anti-s.

The U antigen is present on red cells when a person has S antigens, s antigens, or both.

A Bombay individual's blood specimen can be differentiated from a blood specimen of a group O person by which of the following?

- Cells giving a negative reaction with anti-A,B

- Testing with anti-H lectin (Ulex europaeus)

- Reverse typing with A1 and B cells would be give different reactions

- Testing with Dolichos biflorus

- Testing with anti-H lectin (Ulex europaeus)

Testing with anti-H is the correct answer. Bombay individuals lack A, B, and H antigens and would test negative with anti-H lectin whereas an Type O individual has H antigens on their red cells and would test positive with anti-H lectin.

Both a Bombay phenotype and a group O would test negative with anti-A,B as both blood types lack A and B antigens.

Both a Bombay phenotype and a group O person possess anti-A and anti-B and would both test positive with A1 and B cells on the reverse typing.

Testing with Dolichos biflorus (anti-A1 lectin) would not help differentiate a Bombay phenotype and a type O person as both blood types lack the A antigen on the surface of their red cells.

Which of the following is used as a source for irradiation of blood products?

- Cs137

- I131

- C14

- P51

- Cs137

Irradiation is performed using cesium-137 or cobalt-60. To confirm a product was irradiated, a radiochromic film label is affixed to the component before it is placed into the metal canister of the irradiator. Darkening of the film confirms irradiation requirements.

Once Fresh Frozen Plasma (FFP) has been thawed, it should be stored at what temperature?

- 1 - 6 ºC

- 30 - 37 ºC

- 20 - 24º C

- 45 - 56º C

- 1 - 6 ºC

Thawed FFP is stored at 1 - 6oC and should be transfused within 24 hours of thawing.

FFP is thawed in a 30 - 37o C water bath prior to administration but is not stored at this temperature. Platelets are stored at 20 - 24º C. Currently, no blood components are stored at 45 - 56º C.

Which of the following statements is correct regarding blood bank adverse event reporting to the FDA?

- All patient deaths while being transfused must be reported to the FDA, even when it has been confirmed that the death was not related to the transfusion.

- When a transfusion reaction is the result of an error it must be reported to the FDA in writing.

- A transfusion-related death must be reported to the FDA within 24 hours of the patient's death.

- The initial notification to the FDA of a transfusion-related death must be made by fax, telephone, express mail, or electronically as soon as possible after the death is confirmed to be associated with the transfusion.

- The initial notification to the FDA of a transfusion-related death must be made by fax, telephone, express mail, or electronically as soon as possible after the death is confirmed to be associated with the transfusion.

According to 21 CFR 606.170, a death must be reported to the FDA as soon as possible after the death is confirmed to be associated with the transfusion. The initial notification to the FDA of a transfusion-related death may be made by fax, telephone, express mail, or electronically.

If it is confirmed that the transfusion is not the cause of their death, the death does not need to be reported to the FDA.

Unless there is a death, it is not necessary to report the transfusion reaction to the FDA even if there was an error outside the blood bank.

If the error was made outside the blood bank, it would not be reportable unless there was a transfusion related death.

All of the following regarding Anti-A and Anti-B reagents used in forward typing for ABO typing are true EXCEPT?

- They contain monoclonal antibodies.

- The antibodies are highly specific.

- The antibodies are IgG.

- They produce an expected 3+ or 4+ reaction with the corresponding antigens.

- The antibodies are IgG.

The correct answer is "The antibodies are IgG". This is the only statement about Anti-A and Anti-B reagents for forward typing that is NOT true. The antibodies in these reagents are IgM.

All of the other choices are true of the reagents. The antibodies in the reagents are monoclonal, they are highly specific, and the reagents are designed to produce an expected 3+ or 4+ reaction with the corresponding antigens (Anti-A with A antigen and Anti-B with B antigen).

In order to prevent a loss of viability in platelet concentrates during storage, the pH must be maintained at or above what level?

- 7.5

- 6.2

- 5.0

- 4.5

- 6.2

The correct answer is 6.2.

The proper pH for a unit of platelets must be at or above 6.2.

7.5 is incorrect because all of the pH values between 6.2 - 7.5 are also acceptable.

5.0 and 4.5 are incorrect because they are values below the lower cutoff of 6.2.

In immunohematology, an antithetical relationship exists between M antigen and which of these antigens?

- K antigen

- S antigen

- Lu6 antigen

- N antigen

- N antigen

The correct answer is N antigen.

The M antigen has an antithetical relationship with N antigen. Antithetical is the term used to describe a pair of antigens that are coded by different alleles on a single gene.

The K antigen has an antithetical relationship with k antigen.

The S antigen has an antithetical relationship with s antigen.

The Lu6 antigen has an antithetical relationship with Lu9.

A newborn presents with neonatal alloimmune thrombocytopenia. What is the most likely cause of this condition?

- Maternal antibodies to neonatal platelet antigens

- Maternal antibodies to neonatal ABO antigens

- Maternal antibodies to neonatal white cell antigens

- Maternal antibodies to neonatal D antigen

- Maternal antibodies to neonatal platelet antigens

Neonatal alloimmune thrombocytopenia can occur when maternal antibodies attack fetal platelet antigens the neonate inherited from the father. This will destroy the neonate's platelets, causing the thrombocytopenia.

Maternal antibodies against neonatal ABO antigens typically causes a mild jaundice as the antibodies lyse the neonatal red blood cells. This is a common condition that will result in elevated bilirubin levels, but the bilirubin levels typically either return to normal on their own or with phototherapy.

Maternal antibodies to neonatal white blood cells will present with neonatal alloimmune neutropenia as the antibodies will attach to and destroy the white blood cells.

Maternal antibodies to the D antigen result in hemolytic disease of the fetus and newborn, which is a condition that causes moderate to severe hemolysis. This hemolysis can result in fetal demise.

Can an autologous donor donate blood at 4 PM on Monday if she is having surgery at 10 AM on Wednesday?

- No, the minimal allowable time between the last donation and surgery is 72 hours.

- No, the minimal allowable time between the last donation and surgery is eight weeks.

- Yes, the patient can donate, but only half a unit.

- Yes, an autologous donor can donate up to 24 hours prior to surgery.

- No, the minimal allowable time between the last donation and surgery is 72 hours.

It is generally accepted that the minimal allowable time between the last autologous donation and surgery is 72 hours, though some facilities may have a cutoff time that is further out than 72 hours.

If an autologous blood donation was made 8 weeks before surgery, the donated blood would expire before the surgery date.

Less than the normal blood donation volumes are only taken if the donor is less than 110 pounds.

An autologous blood donation made 24 hours prior to surgery would not allow enough time for the patient's bone marrow to replace the blood that was lost during donation.

Which of the following is a possible type for an offspring from the mating of an O and an AB (non-cis) individual?

- AB

- AO

- BB

- OO

- AO

AO and BO genotypes are the only possible types for the offspring. In this case, the parents' genotypes are OO and AB, therefore one parent can only pass on the O gene and the other parent can either pass the A or the B gene, but not both. This is illustrated below with the use of the Punnett square. Thus, the heterozygous genotype AB is not possible and the homozygous BB and OO genotypes are not possible.

OO x AB

O O

A AO AO

B BO BO

Leukocyte-reduced blood products may be administered to reduce the risk of febrile reactions and what disease or condition?

- Graft-vs-host disease

- Cytomegalovirus

- Malaria

- Bacteremia

- Cytomegalovirus

Cytomegalovirus (CMV) is present in the cytoplasm of white blood cells. Reducing the number of white blood cells that are present in a donated red cell unit reduces the viral load of cytomegalovirus.

Leukoreduction is not successful at preventing transfusion-associated graft-vs-host disease (TA-GVHD). However, this is an uncommon route for graft-vs-host disease as it is typically transmitted through allogenic bone marrow transplantation.

Malaria is found extracellularly or in red blood cells, so leukoreduction would not affect any Plasmodium species that may be present in donated red blood cells.

Bacteremia exists extracellularly, so leukoreduction would not affect any bacteria present in donated red cells. The filter used in leukocyte reduction cannot filter bacteria.

Which of the following is considered an indication for Rh immune globulin (RhIG) administration in postpartum women?

- Long term protection

- Antibody blocking

- Passive protection

- Active immunity

- Passive protection

Active immunization induced by the D antigen can be prevented by the concurrent administration of the corresponding RBC antibody (anti-D). Rh-negative non-immunized mothers expecting Rh-positive infant(s) should receive Rh immune globulin (RhIG) in the third trimester or at 28 weeks' gestation. Postpartum Rh-negative non-immunized mothers should receive RhIG immediately after delivery of an Rh-positive newborn.

For passive protection, RhIG therapy can be administered within 72 hours after delivery as it may be effective against formation of anti-D.

There is no long term protection against the development of Rh antibodies due to potential for patient exposure in subsequent pregnancies.

The mechanism for RhIG therapy does not block antibody; it attaches to the fetal Rh-positive RBCs and removed by macrophages in the maternal spleen.

If the parents are group A and B respectively, what are the possible blood groups of their children?

- A and B only

- A and B and AB only

- A and B and O only

- A and B and AB and O

- A and B and AB and O

If the parents are phenotypes A and B, then their possible allele combinations are genotypes AA or AO and type BB or BO. The following blood types are possible when one allele from each parent is passed to the child:

AO and BO parents = possibility of phenotypes (and genotypes) AB (AB), A (AO), B(BO), or O(OO) children

AO and BB parents = possibility of phenotypes (and genotypes) AB(AB) or B(BO) children

AA and BO parents = possibility of phenotypes (and genotypes) AB(AB) or A(AO) children

AA and BB parents = possibility of phenotypes (and genotypes) AB(AB) only children

Since we do not know the parents' allele combination, the best answer choice is A and B and AB and O.

The Direct Antiglobulin Test (DAT) is used to detect:

- Antibodies sensitizing red cells

- Antibodies in the plasma

- Antigens coating red cells

- Antigens in the plasma

- Antibodies sensitizing red cells

The DAT, or direct antiglobulin test, is used to detect antibodies sensitizing RBC's in vivo.

Antibodies in the plasma are primarily detected by IAT (Indirect antiglobulin test) methods.

Antigens are typically found on the red cells and are detected using specific anti-sera testing.

The accepted interval between whole blood donations is:

- 2 days

- 4 weeks

- 8 weeks

- 16 weeks

- 8 weeks

The mandatory waiting period between whole blood donations is 56 days, or eight weeks.

Donors must wait at least two days between plasmapheresis, plateletpheresis, or leukopheresis.

Infrequent plasmapheresis has a waiting period of four weeks between donations.

The waiting period for double, or two-unit, donations of red cells is 16 weeks.

When a unit of packed RBC's is split using the open system, each portion of the unit must be issued:

- Within 24 hours

- Within 48 hours

- Within 30 days

- By the original expiration date

- Within 24 hours

The correct answer is within 24 hours.

If a unit is entered without use of a sterile connection device (open system) it must be used within 24 hours of entry. Closed systems retain the same expiration date as the original whole blood unit.

Which is NOT a requirement for information on the donor tag once the appropriate compatibility testing has been completed and the unit or units are suitable for transfusion?

- Patient's full name and identification number

- Name of the product and donor number

- ABO & D phenotype of the unit

- Doctor's name and patient room number

- Doctor's name and patient room number

The doctor's name and the patient's room number are not required to be on the tag attached to the donor unit.

When the appropriate compatibility testing has been completed, and the unit or units are suitable for transfusion, a tag is produced and attached to each donor unit. The donor unit tag must clearly state the patient's full name and identification number, name of the product, donor number, expiration date, ABO and D phenotype of the unit, interpretation of the crossmatching test (if performed), and identity of the person doing the testing or selection of the unit.

Which characteristic best describes IgG antibodies produced against red blood cells?

- Are naturally occurring

- Cannot be identified using the AHG test

- React best at room temperature

- React best at 37o Celsius

- React best at 37o Celsius

There are two types of antibodies that concern blood banking: one is naturally occurring and the other is immune. Most immune red blood cell antibodies are IgG antibodies that react best at 37oC and require the use of antihuman globulin for detection. Most naturally occurring antibodies are IgM cold agglutinins which react best at room temperature or lower.

If Jka is showing dosage, how might reactions on an antibody panel appear?

- Weaker if homozygous for Jka

- Stronger if heterozygous for Jka and Jkb

- Weaker if heterozygous for Jka and Jkb

- Both heterozygous and homozygous reactions would always be of equal strength

- Weaker if heterozygous for Jka and Jkb

The strength of reaction can be due to the number of antigens present on the red cells that can bind with the antibody present. Inheritance of antigens can be in the homozygous or heterozygous state.

-----> If the antigen is in the homozygous state, there is a double dose of the antigen present on the red cell.

For antibody reactions showing dosage, antigen-antibody reactions will be stronger if in the homozygous state since there is more antigen to bind with the antibody. The antigen-antibody reactions will be weaker if in the heterozygous state since there is less antigen to bind with the antibody.

Based on the evaluation of hematocrit (Hct), blood pressure (BP), pulse, age, and gender, which of the following individuals represents an acceptable allogeneic donor?

- Hct is 39%, BP is 160/105, Temp is 99.8, Pulse is 75, Age is 40, and Sex is female

- Hct is 37%, BP is 135/85, Temp is 98.6, Pulse is 80, Age is 15, and Sex is male

- Hct is 41%, BP is 110/80, Temp is 99.4, Pulse is 65, Age is 65, and Sex is male

- Hct is 32%, BP is 120/80, Temp is 98.9, Pulse is 70, Age is 22, and Sex is female

- Hct is 41%, BP is 110/80, Temp is 99.4, Pulse is 65, Age is 65, and Sex is male

With certain exceptions, allogeneic blood donors must be at least 17 years of age. The minimum hemoglobin/hematocrit levels for females are 12.5 g/dL or 39%; for males, 13.0 g/dL or 39%. The donor's blood pressure must be no greater than 180 mm Hg (systolic), and no greater than 100 mm Hg (diastolic). The donor's pulse must be regular and fall between 50 to100 beats per minute. Donor's body temperature must not exceed 99.5°F (37.5°C).

Exceptions to these donor criteria should be evaluated by the blood bank physician on a case by case basis.

An antibody to which platelet antigen is most commonly encountered in blood bank?

- HPA-1a

- HPA-2a

- HPA-3a

- HPA-4a

- HPA-1a

Currently, only 33 human platelet antigens have been identified. Antibodies to platelet antigens are not commonly found since there is low variability among the antigens. However, antibodies to the HPA-1a antigens are the most commonly found in blood bank tests.

HPA-2a, HPA-3a, and HPA-4a are all platelet antigens, but patients do not typically produce antibodies against these antigens.

When is a computer crossmatch acceptable?

- Patient has a history of anti-Jka but the antibody screen on the current sample is negative

- Patient has a positive antibody screen and anti-D is detected

- Patient has no history of clinically significant antibodies detected and the antibody screen on the current sample is negative

- Patient has a history of anti-Fya but the antibody screen on the current sample is negative

- Patient has no history of clinically significant antibodies detected and the antibody screen on the current sample is negative

Crossmatching allows for a final check of ABO compatibility and can be used to detect antibodies that would otherwise be missed using an antibody screen (antibodies to low incidence antigens). Studies have shown that computer crossmatches are as safe as serologic immediate spin testing. The requirements for a computer or electronic crossmatch include:

Current testing for unexpected antibodies must be negative and the patient cannot have a history of any such antibodies. Other criteria include at least two matching ABO/Rh types on file (one must be from current sample).

A history of anti-Jka or anti-Fya would disqualify a patient for a computer crossmatch. Additionally, positive antibody screen and anti-D identified would also rule out the use of a computer crossmatch.

What is the deferral period from donating blood for someone who is or has taken Tegison© for severe psoriasis?

- Permanent deferral

- 1 month following last dose

- 2 weeks

- No deferral

- Permanent deferral

Persons taking or who have ever taken Tegison© are permanently deferred. Blood or blood products from persons who have ever taken Tegison© can cause birth defects if transfused to a pregnant woman.

Other medications such as Proscar© and Avodart © (both used to treat enlarged prostates), Propecia© (used to treat bladness), Accutane© (used to treat severe acne), and Soriatane© (used to treat severe psoriasis) are all cause for deferral.

Proscar©, Propecia©, and Accutane© users are deferred for one month following the last dose.

Persons who have used Avodart © are deferred for six months following the last dose.

Persons who have used Soriatane© are deferred for three years following the last dose.

A potential apheresis platelet donor must be deferred for how long following the use of aspirin?

- 4 weeks

- 2 weeks

- 48 hours

- No deferral - can donate immediately given they meet all other requirements.

- 48 hours

The correct answer is 48 hours. Because aspirin inhibits platelet function, a potential apheresis platelet donor must be deferred for a minimum of 48 hours after taking aspirin. An apheresis unit of platelets is usually the sole source of platelets when transfused to a patient.4 weeks is incorrect. Certain vaccinations may be cause for a 4-week deferral from donating whole blood and/or other blood products.2 weeks is incorrect. The use of certain antiplatelet function medications such as clopidogrel and ticlopidine may be cause for a 2-week deferral from donating apheresis platelets.

When donating a unit of whole blood, there is no restriction due to aspirin ingestion.

What is the most prudent step to follow to select units for crossmatch after recipient antibodies have been identified?

- Perform DAT on patient serum and donor units

- Antigen type patient cells and any donor cells to be crossmatched

- Perform IAT on patient cells and donor units

- Obtain a different sample for repeat antibody panel testing

- Antigen type patient cells and any donor cells to be crossmatched

After any significant antibodies have been identified, the technologist must antigen type any blood cell units for the recipient along with a cross-match to prevent transfusion reactions.

The DAT is for the detection of in vivo sensitization of red blood cells.

The IAT was already performed on the patient's serum through the screen to detect unusual antibodies and the antibody identification panel.

There is no need to repeat the antibody panel testing since the antibody has been identified.

A unit of leukocyte-reduced red blood cells must retain at least what percentage of red blood cells following leukoreduction?

- 65%

- 75%

- 85%

- 95%

- 85%

The American Association of Blood Banks (AABB) standards state that a unit of leukocyte-reduced red blood cells must contain at least 85% of the red cells as the original unit.

Units containing 65% or 75% of red blood cells would not meet this standard of quality.

Units containing 95% of red blood cells exceed the minimum standard, not the minimum percentage required for red blood cells following leukoreduction.

Which class of antibody can agglutinate erythrocytes (RBCs) after anti-human globulin (AHG) is added to the test tube?

- IgA

- IgE

- IgG

- IgM

- IgG

Some antibodies, such as IgG, do not directly agglutinate erythrocytes (RBCs). This incomplete or blocking type of antibody may be detected by an enhancement medium, such as anti-human globulin (AHG) reagent. If AHG is added, a second antibody binds to the antibody present on the erythrocytes. AHG is created to bind with IgG antibodies at the Fc portion of these antibodies. AHG will bind to both bound and unbound IgG antibodies. When IgG is bound to red blood cells, AHG produces visible agglutination in a test tube.

IgA is the predominant immunoglobulin in secretions, such as tears and saliva. IgA forms a complex molecule termed secretory IgG, which is critical in protecting body surfaces against invading microorganisms because of its presence in seromucous secretions.

IgE is unique in that it binds strongly to a receptor on mast cells and basophils. Together with antigen, IgE mediates the release of histamines and heparin from mast cells and basophils.

IgM is a pentamer with multiple binding sites that enable higher avidity. IgM antibodies, such as anti-A and anti-B, readily agglutinate erythrocytes with the corresponding antigen, A or B, optimally at a colder temperature than IgG without any enhancement agent, such as anti-human globulin (AHG).

Which of the following criteria for donor RBC should be used for an exchange transfusion related to both HDFN due to anti-D and ABO HDFN?

- Reconstituted with group O fresh frozen plasma

- Negative for hemoglobin F

- Reconstituted with cryoprecipitate

- Irradiated

- Irradiated

One of the criterium to consider when selecting blood for exchange transfusion would be the use of irradiated blood to prevent graft versus host disease. Other criteria include using red blood cells < 7 days old resuspended in group AB fresh frozen plasma, hemoglobin S negative blood, group O (or ABO compatible) Rh negative blood, CMV reduced risk products, blood that lacks antigens corresponding to maternal antibody, and compatible crossmatch with maternal serum.

Which one of the physical examination results below may be cause to reject a donor from blood donation?

- Hemoglobin of 12.0 g/dL

- Pulse of 80 beats per minute

- Temperature of 98.3ºF (36.8ºC)

- Blood pressure of 100/75 mm Hg

- Hemoglobin of 12.0 g/dL

The correct answer is hemoglobin of 12.0 g/dL.

The hemoglobin level of a donor should be greater than or equal to 12.5 g/dL.

The pulse of a donor should be between 50 to 100 beats per minute.

The donors temperature must be less than or equal to 99.5ºF (37.5ºC).

A donors blood pressure must be less than or equal to 180/110 mm Hg.

What are the possible ABO genotypes of offspring of parents whose genotype is AO and BO?

- OO, AO, BO, AB

- AO and BO

- OO and AB

- AB, AO, and BO

- OO, AO, BO, AB

The offspring from this set of parents can yield each of these genotypes OO, AO, BO, AB, which can lead to group O, group A, group B, and group AB offspring. This can be determined by the utilization of a simple Punnett square. There is a 25% chance for inheritance of each of the possible genotypes. The only genotypes this mating would not produce are AA and BB.

For which of these reasons would a molecular method not be used?

- Determine blood type when the DAT is positive

- Complex Rh genotypes (weak D expression)

- Donor antibody screening

- Type fetal blood

- Donor antibody screening

Applications of molecular testing in blood bank include donor antigen screening not donor antibody screening. Other applications include determining blood type when the DAT is positive, identifying complex Rh genotypes, and typing fetal blood.

What is the appropriate deferral period from donating blood for a 34-year-old female who miscarried in her first trimester?

- 8 weeks

- 6 weeks

- 2 weeks

- No deferral

- No deferral

A miscarriage or abortion in the first or second trimester is not cause for deferral from donating blood or blood products in an otherwise healthy woman.

Female donors whose pregnancy terminated in the third trimester or who delivered should be deferred for a minimum of 6 weeks. Some exceptions can be made for autologous donors. Additionally, deferral may be longer than 6 weeks under certain circumstances such as receipt of a blood transfusion after delivery.

When processing umbilical cord blood samples for hematopoietic progenitor cells (HPC), what tests are performed on both the mother's blood and cord blood?

- ABO & Rh

- HIV-1 & HIV-2

- HBV & HCV

- HTLV-I & HTLV-II

- ABO & Rh

Umbilical cord blood requires special processing. Both the mother's blood sample and the cord blood are tested for ABO and Rh.

The maternal sample will have an antibody screen performed along with testing for HIV-1 & HIV-2, HBV & HCV, and HTLV-I & HTLV-II. Also, HBsAg, anti-HBc, and syphilis status is determined.

The cord blood is cultured for cytomegalovirus.

Which of the following transfusion reactions can a diagnosis be more firmly established by evaluating B-type natriuretic peptide (BNP) levels before and after transfusion?

- Transfusion Associated Circulatory Overload (TACO)

- Delayed Hemolytic Transfusion Reactions

- Transfusion Associated Sepsis

- Allergic Transfusion Reactions

- Transfusion Associated Circulatory Overload (TACO)

Transfusion Associated Circulatory Overload (TACO) is difficult to distinguish from Transfusion Related Acute Lung Injury (TRALI). A post-transfusion to pretransfusion BNP ratio of 1.5 points is diagnostic of TACO.

Delayed Hemolytic Transfusion Reactions testing includes the DAT, free plasma hemoglobin, hemoglobin, LDH, total and direct bilirubin, haptoglobin, free urine hemoglobin, and hemosiderin in urine.

Transfusion Associated Sepsis testing includes blood cultures on the recipient and a gram stain and culture on the transfused component.

Allergic transfusion reactions are diagnosed based on anaphylactic symptoms of the patient during transfusion of the component.

Which patient population benefits from HLA matching to provide patients with the best outcomes?

- Transfusion recipients

- Organ transplant recipients

- Neonates

- Patients with high-incidence antibodies

- Organ transplant recipients

Patients who receive organ and hematopoietic progenitor cell transplants respond best if the HLA antigens are matched between the donor and the recipient.

Routine transfusion recipients do not require HLA matching. For patients who experience allergic or anaphylactic reactions from transfusions, blood unit irradiation would be helpful.

There is no indication that HLA typing would be beneficial for neonates.

Human leukocyte antigens are present on white blood cells, so a patient with antibodies to high-incidence red cell antigens should not have a reaction with the HLA.

Which antibody identified in prenatal specimens is never a cause of hemolytic disease of the fetus and newborn?

- Anti-D

- Anti-c

- Anti-E

- Anti-I

- Anti-I

Anti-I is a common autoantibody that can be found in virtually all sera. It is benign (not associated with in vivo red blood cell destruction). It is usually a weak, naturally occurring, saline-reactive IgM agglutinin.

Rh antibodies are primarily IgG and Rh antigens are well developed early in fetal life. While the D antigen is the most immunogenic, c antigen is the next most likely Rh antigen to elicit an immune response, followed by E, C, and e. Rh antibodies formed by the Rh negative pregnant women coat the fetal red blood cells that carry the corresponding antigens. The coated fetal cells are removed from the fetal circulation (hemolytic disease of the fetus and newborn).

In which situation is gamma irradiation of cellular blood components required?

- Prevention of post-transfusion purpura

- Prevention of Graft-Versus-Host (GVH) disease

- Sterile components

- Prevention of non-cardiogenic pulmonary edema

- Prevention of Graft-Versus-Host (GVH) disease

Transfusion related Graft-Versus-Host disease is a rare condition usually following transfusion of patients whose immune system is severely compromised. It occurs when T lymphocytes present in the transfused unit replicate and attack the tissues of the recipient. Gamma irradiation prevents this condition by inactivating T lymphocytes in the donor unit. Gamma irradiation of cellular blood components is required when: 1.The donor is a blood relative of the recipient, 2. Intrauterine transfusions, 3. The recipient has a selected immunodeficiency condition, 4. The recipient has received a bone marrow transplant.

Post transfusion purpura and pulmonary edema are adverse effects of transfusion not related to irradiation of blood components.

All blood components are considered sterile unless the unit has been compromised or becomes an open system.

What is the principle of the Kleihauer-Betke test?

- The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to alkaline treatment.

- The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to acid treatment.

- The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to enzymatic treatment.

- The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to radiation treatment.

- The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to acid treatment.

The Kleihauer-Betke test is based on the principle that red cells containing adult hemoglobin are more susceptible to acid elution than those containing fetal hemoglobin. A thin smear of maternal blood is treated with acid, rinsed, and counterstained. The maternal red cells, predominately adult hemoglobin, appear as pale 'ghost' cells, and the fetal red cells, predominately fetal hemoglobin, are pink.

The principle of the Kleihauer-Betke is not based upon fetal hemoglobin resistance to alkaline treatment, enzymatic treatment, or radiation treatment.