Transfusion Medicine Final Review

the B gene is responsible for adding which sugar to the H antigen

Galactose

Which of the antigens is fully developed at birth

ABO

Rh

I

Lewis

Rh

which of the following reduces steric hinderance to promote antibody uptake

Albumin

Liss

Enzyme

all of the above

Enzyme

Which of the following is not responsible for mixed field reactions in the forward ABO blood typing?

a. A3 blood group

b. Bone Marrow Transplant

c. Transfusion with non-type specific RBCs

d. Lutheran blood group

Lutheran blood group

An A positive individual possessing the Lewis gene (Le) but lacking the secretor gene (sese), would have which phenotype?

a. Le(a-b+) b. Le(a+b-) c. Le(a-b-) d. None of the above

Le(a+b-)

In which of the following would the saline replacement technique NOT be utilized?

a. ABO grouping b. Antibody Screening c. Immediate Spin Crossmatch d. AHG Crossmatch e. Auto Control

AHG crossmatch

A patient has anti-E. A compatible AHG crossmatch is obtained. The unit types as E positive using commercial antisera. Should the unit be used for transfusion? a. Yes b. No

NO

Which of the following blood group systems is not affected by enzyme treatment? a. Rh b. Kell c. Duffy d. Kidd e. MNS

kell

Which of the following blood group systems does not show dosage? a. Rh b. Lewis c. Duffy d. Kidd e. MNS

lewis

A patient with an antibody to the enhancement media will not show reactivity in: a. Antibody screen b. Panel c. Auto Control d. DAT

DAT

Screening cells are what ABO group? a. A b. B c. AB d. O

O

When performing an antibody screen, what occurs during the incubation phase?

a. Anti-human globulin reagent crosslinks to make visible agglutination b. Antibodies are neutralized c. Antibodies attach to the antigens on the RBCs d. Both a. and c. e. None of the above

c. Antibodies attach to the antigens on the RBCs

Which special technique is used to investigate a positive DAT? a. Elution b. Adsorption c. Titration d. Enzyme

Elution

A crossmatch order is received for a patient with a prior history of anti-Fya. The patient currently has a negative antibody screen. What testing needs to be done?

a. Perform only an immediate spin crossmatch to detect ABO incompatibility b. Send to the reference laboratory since the antibody screen appears negative. c. AHG crossmatch Fy(a-) units since there is a prior history of anti-Fya d. All of the above

AHG crossmatch Fy(a-) units since there is a prior history of anti-Fya

Which of the following patients qualifies for a transfusion?

a. Cardiac patient with hemoglobin of 8.5g/dl b. Patient with platelet function defect going to surgery with platelet count of 150,000 c. Non-bleeding patient with fibrinogen of 150mg/dl d. Patient going for total knee replacement with INR of 1.2

Patient with platelet function defect going to surgery with platelet count of 150,000

Death is unlikely to occur from which of the following adverse reactions to transfusion?

a. Allergic transfusion reaction b. Febrile transfusion reaction c. TRALI d. Transfusion related sepsis e. Acute hemolytic transfusion reaction

Febrile transfusion reaction

Which adverse reaction to transfusion is not typically experienced during the infusion?

a. Febrile b. Allergic c. Acute hemolytic d. Transfusion associated sepsis e. Transfusion associated graft vs host disease

e. Transfusion associated graft vs host disease

Most blood group antigens express what mode of inheritance?

A. Autosomal Dominant B. Autosomal Codominant C. Autosomal Recessive D. Sex linked

Autosomal codominant

Which word describes an individual having two different antigens at a given allele: A. Homozygous B. Heterozygous C. Hemizygous

Heterozygous

• At which phase do antigens cross-link to cause visible agglutination? A. Sensitization B. Agglutination

sensitization

• Zone of antigen excess is known as: A. Prozone B. Equivalence C. Postzone

Postzone

Which immunoglobulin classes cross the placenta? A. IgG B. IgM C. IgA D. IgD

IgG

Which immunoglobulin class is most effective at activating complement: A. IgG B. IgM C. IgA D. IgD E. IgE

IgM

Do babies have ABO antigens at birth? • Yes • No

Yes

Do babies have ABO antibodies at birth? • Yes • No

NO

Most ABO antibodies belong to which class of immunoglobulin? •IgG •IgM •IgD •IgE

IgM

Which blood type possesses the most H antigen? • A • B • AB •O

O

Most group A individuals belong to which subgroup? • A1 • A2 • A3 • Ax

A1

Commercial antisera is used in which part of the blood typing assay? • Forward typing • Reverse typing

Forward typing

What is the most common black Rh phenotype? • R1 r • R0r • rr • R1R1

R0r

Which Rh phenotype results in the formation of stomatocytes? • Weak D • Partial D • Rh null

Rh null

How many identifiers are required to ID a patient for a blood bank sample? • One • Two • Three • Four

two

Which additive solutions act to decrease zeta potential? • Albumin • LISS • PEG • Ficin

Albumin

LISS

Which of the following antigens are missing from the cells of newborns? A. ABO B. Rh C. H D. I E. Le

I

Le

Someone with the secretor gene and Lewis gene would have which of the following in their saliva? A. ABH B. Lea C. Leb

all

Which antibody in the P blood group system causes spontaneous abortion and is IgG? A. P B. P1 C. p D. PP1P k

PP1P k

Which of the following antigens are destroyed by enzyme treatment? A. MNSs B. Kell C. Duffy D. Kidd E. Lutheran

MNSs

Duffy

Which blood group system is known for antibodies that deteriorate and become undetectable? A. Duffy B. Kidd C. Kell D. MNS

Kidd

Which of the following antigens result in RBC morphology changes? A. Rhnull B. K0 C. Kx

Rh null

Kx null

% chance of HLA matching a sibling? A. 20% B. 25% C. 40% D. 50%

25%

Platelets express which HLA antigens? A. HLA-A B. HLA-B C. HLA-C D. HLA-DRB1

HLA-A

HLA-B

What immunizing events can cause formation of clinically significant alloantibodies?

Pregnancy

Passive antibody transfer

Transfusion

Needle sharing

Transfusion of donor plasma

Pregnancy

Transfusion

needle sharing

Patient has history of anti-Jka, but currently has a negative antibody screen. •

Do Jka- units need to be supplied? • Yes • No •

What type of crossmatch must you perform? • Only IS • Electronic • AHG

Yes

AHG

Saline replacement technique is used to resolve which phenomenon? • Cold agglutinin • Warm autoantibody • Rouleaux

Rouleaux

DAT detects in vivo or in vitro bound antibody? • In vivo • In vitro

in vivo

Name three lab tests results that are indicative of hemolysis? • Reticulocytes • Spherocytes • Hemoglobinemia • Decreased serum haptoglobin • Elevated bilirubin • Elevated LDH

all of them

What processing step is performed to prevent TA-GVHD?

• Leukoreduction

• Washing

• Irradiation

• Volume reduction

• Irradiation

Criteria for accepting a unit back into the bank after issued inthe hospital?

• Within temperature

• Ports unopened

• Segment attached (RBC)

• Less than 30 minutes outside of BB

• No returns allowed

Within temperature

• Ports unopened

• Segment attached (RBC)

What component is indicated for transfusion if the patienthas an INR >1.5 and is scheduled for surgery?

• RBC

• FFP

• Platelets

• Cryoprecipitate

FFP

What component is indicated for transfusion if the patienthas a fibrinogen of 80mg/dl?

• RBC

• FFP

• Platelets

• Cryoprecipitate

Cryoprecipitate

What is the transfusion trigger for an RBC transfusion in anon-cardiac patient?

• 6g/dl

• 7 g/dl

• 8g/dl

• 10g/dl

• 7 g/dl

Lactated Ringers is an RBC transfusion compatible infusionfluid ?- True- False

False

How long must the RN remain with the patient after starting ablood transfusion?- 5 minutes- 15 minutes- 30 minutes- Not required to stay with patient

15 minutes

What is the maximum amount of time a unit of bloodmay be infused?- 2 hours- 4 hours- 8 hours- 24 hours

4 hours

Two reasons for mixed field reaction in forward blood typing?

- A2 subgroup

- A3 subgroup

- Transfusion with non type specific RBCs

- Transfusion with non type specific plasma

A3 subgroup

Transfusion with non type specific RBCs

What can cause an incompatible IS crossmatch in a patient with a negativeantibody screen?

- Wrong donor ABO group selected

- Cold reactive allo or auto antibody

- Rouleaux

- Donor unit with positive DAT

- Transfusion with non type specific RBC

- Wrong donor ABO group selected

- Cold reactive allo or auto antibody

- Rouleaux

What can cause an incompatible AHG phase crossmatch in apatient with a negative antibody screen?

- Allo antibody where donor unit has more antigen sites than screening cells

- Donor unit with positive DAT

- Cold reacting allo antibody

- Rouleaux

- Patient has antibody to low incidence antigen present ondonor cells

- Allo antibody where donor unit has more antigen sites than screening cells

- Donor unit with positive DAT

- Patient has antibody to low incidence antigen present on donor cells

Steps RN takes upon recognition of a reaction?

• Stop transfusion

• Perform clerical check

• Call physician

• Call blood bank

• Draw post transfusion sample only if doctor instructs

• Stop transfusion

• Perform clerical check

• Call physician

• Call blood bank

What testing is done on the post transfusion blood sample in a reaction workup?

• Visual check for hemolysis/icterus

• ABO/Rh

• DAT using anti-IgG

• Crossmatch

• Visual check for hemolysis/icterus

• ABO/Rh

Allergic reactions are not life threatening• True• False

False

Which adverse recipient event is nearly always fatal?

• Acute hemolytic

• TRALI

• Febrile

• Transfusion Associated Graft vs Host Disease

• Transfusion Associated Graft vs Host Disease

Which two transfusion reactions usually appear early in the transfusion?

• Febrile

• TRALI

• Acute hemolytic

• Allergic

• Acute hemolytic

• Allergic

Which transfusion reaction manifests itself with very high fever?

• Febrile

• TRALI

• Transfusion related sepsis

• Allergic

• Transfusion related sepsis

Give reasons for extraneous plasma reactivity in an ABO discrepancy.

• Elderly

• Rouleaux

• Very recent BMT

• Cold reacting auto or allo antibody

• Warm reacting auto antibody

• Rouleaux

• Very recent BMT

• Cold reacting auto or allo antibody

There are systems available on the market that makeblood transfusion risk free?• True• False

False