Blood Bank Final Exam

Clinical indications for transfusion of leukocyte reduced red blood cells include—

a. minimize febrile transfusion reactions

b. prevent HLA alloimmunization\

c. serve as a substitute for CMV sero-negative red blood cells

d. all of the above

d. all of the above

A patient has a positive antibody screen and panel. All tested cells are positive 3+ at AHG. The only tested cell that is negative is the autocontrol. You phenotype the patient and discover that he is negative for the following antigens: E, Fya, S, Jkb. You located a testing cell that has this antigen negative phenotype. The cell reacts 3+ at the AHG phase. Of the following choices, which is the most likely specificity of the antibody/antibodies?

a. allo-anti-E, Fya, S, Jkb

b. allo-anti E, Fya, S and auto anti-Jka

c. allo-anti-k

d. warm reacting autoantibody

c. allo-anti-k

Which of the following organisms grows well in the cold and especially like the iron-rich environment of stored blood?

a. Escherichia coli

b. Hepatitis B virus

c. Staph aureus

d. Yersinia enterocolitica

d. Yersinia enterocolitica

The greatest concern for a postpartum baby with severe HDFN is the—

a. buildup of conjugated bilirubin in the brain

b. buildup of unconjugated bilirubin in the brain

c. presence of a positive DAT

d. presence of a positive antibody screen

b. buildup of unconjugated bilirubin in the brain

The single most important participant in quality assurance is the—

a. QA department

b. medical director

c. individual employee

d. supervisor

c. individual employee

A hospital transfusion service received a shipment from a blood center. Included is a unit of A positive red blood cells that is labeled as O positive red blood cells. The hospital blood bank should—

a. discard the unit

b. correct the label

c. quarantine the unit until the error is confirmed by phone

d. return the unit to the shipping blood center

d. return the unit to the shipping blood center

The following are true for the prozone phenomenon except—

a. results from excessive antibody concentration

b. results in a false negative reaction

c. can be overcome by serially diluting the antibody containing plasma

d. can be influenced by the length of incubation

d. can be influenced by the length of incubation

A person with the genotype RzRz, if stimulated, could potentially produce antibodies of the following Rh specificity—

a. anti-D

b. anti-C

c. anti-E

d. anti-c

d. anti-c

Which Duffy phenotype offers the greatest resistance to invasion by Plasmodium vivax?

a. Fy (a+b=)

b. Fy (a+b+)

c. Fy (a=b+)

d. Fy (a=b=)

d. Fy (a=b=)

A patient who had a severe anaphylactic transfusion reaction and requires transfusion of blood for oxygen carrying capacity should be transfused with—

a. FFP

b. irradiated red blood cells

c. leukocyte reduced red blood cells

d. washed red blood cells

d. washed red blood cells

Which of the following is not a potential cause of false negative direct antiglobulin test?

a. incorrect red cell suspension

b. contaminated saline

c. delays in the testing process

d. omitting AHG from the test

b. contaminated saline

Which of the following is not a cause of mixed field agglutination?

a. Incompatibility from several donor units

b. fetal-maternal hemorrhage

c. weak IgM antibodies

d. chimerism

c. weak IgM antibodies

The following phenotype frequencies are noted:

Jk (a=b+) 20%; Le (a+b=) 22%

Jk (a+b=) 28%; Le (a=b+) 72%

Jk (a+b+) 52%; Le (a=b=) 6%

If donors were ABO and Rh specific with a recipient, it would be easiest to find compatible blood if the recipient’s unexpected antibody was—

a. anti-Jka

b. anti-Jkb

c. anti-Lea

d. anti-Leb

b. anti-Jkb

Currently FDA approved shelf life of whole blood drawn into CPDA-1 is ________ days.

a. 21

b. 28

c. 42

d. 35

d. 35

Donors who received blood or blood products within 3 months of when they desire to donate are deferred to protect the recipient because the—

a. blood could have transmitted hepatitis or HIV

b. blood may have two cell populations

c. donor may not be able to tolerate the blood loss

d. donor red cell hemoglobin level may be too low

b. blood may have two cell populations

Of the following, which of the following persons is most likely to develop anti-E as a result of transfusion with E + cells?

a. R1r”

b. R2r’

c. r”r

d. R1r

d. R1r

Pathologic cold autoagglutinins differ from common cold autoagglutinins in—

a. immunoglobulin class

b. thermal range

c. antibody specificity

d. DAT results on EDTA specimen

b. thermal range

Which of the following would not be necessary information to have before issuing Rh immune globulin to a postnatal OB patient?

a. group and Rh of the mother

b. identification of the antibody if the antibody screen were positive

c. weak D test result if the mother appears Rh negative at immediate spin

d. group and type of the infant

c. weak D test result if the mother appears Rh negative at immediate spin

Which of the following diseases may not be transmitted by blood transfusion?

a. malaria

b. hepatitis B

c. chickenpox

d. chaga’s disease

c. chickenpox

During an inspection of the blood bank, the following were noted by the inspector. Which is in conflict with acceptable standards?

a. anti-A and anti-B were used but not anti-A,B

b. the temperature variation in the blood inventory storage refrigerator was from -3 to +6 C

c. work records has documentation of serological reactions

d. tests for HBsAg were not repeated on units received from an outside source

b. the temperature variation in the blood inventory storage refrigerator was from -3 to +6 C

A patients RBCs are being typed for the Fya antigen. Which of the following is the proper cell type to use for the positive control?

a. Fya+b=

b. Fya=b=

c. Fya+b+

d. Fya=b+

c. Fya+b+

Results of a plasma sample tested against a panel of reagent red cells give presumptive evidence of an alloantibody directed against a high incidence antigen. Further investigation to confirm the specificity should include which of the following?

a. plasma testing against red cells from random donors

b. plasma testing against red cells known to lack high incidence antigens

c. plasma testing against enzyme treated autologous red cells

d. testing of an eluate prepare from the patient’s red cells

b. plasma testing against red cells known to lack high incidence antigens

A unit of packed RBCs was issued by the transfusion service. The blood was no longer needed, so the nurse returned it 20 minutes after it was issued. May the unit be placed back into inventory?

a. Yes, it may be returned as long as the unit was not out of the blood bank refrigerator longer than 30 minutes

b. Yes, it may be returned as long as the unit was properly inspected and the transfusion service SOP allowed return of a unit within that period of time

c. No, blood may not be returned to inventory once it has been distributed

d. No, there is a 15 minute time limit for returning blood to inventory

b. Yes, it may be returned as long as the unit was properly inspected and the transfusion service SOP allowed return of a unit within that period of time

Based upon Kleihauer-Betke test results, which of the following formulas is used to determine the volume of fetomaternal hemorrhage in mL of whole blood?

a. % of fetal cells x 30

b. % of fetal cells x 50

c. % of maternal cells x 30

d. % of maternal cells x 50

b. % of fetal cells x 50

A 65-year-old woman experienced shaking,. chills, and developed a fever of 103 F approximately 40 minutes following the transfusion of a second unit of red blood cells. The most likely explanation for the patient’s symptoms is—

a. transfusion of bacterially contaminated blood

c. congestive heart failure due to fluid overload

c. anaphylactic transfusion reaction

d. severe febrile transfusion reaction

d. severe febrile transfusion reaction

What percent of group O donors would be compatible with a plasma sample that contained anti-X and anti-Y if the X antigen is present of red cells of 5/20 donors and the Y antigen is present on red cells of 1/10 donors?

a. 2.5

b. 6.8

c. 25.0

d. 67.5

d. 67.5

Which of the following would be the best emergency source of platelets for transfusion in a case of neonatal alloimmune thrombocytopenia?

a. father

b. mother

c. pooled platelet rich plasma

d. polycythemic donor

b. mother

Antibodies involved in warm autoimmune hemolytic anemia are often associated with which blood group system?

a. Rh

b. I

c. P

d. Duffy

a. Rh

Which of the following is a characteristic of polyagglutinable red cells?

a. can be classified by reactivity with Ulex europaeus

b. are agglutinated by most adult sera

c. are always an acquired condition

d. autocontrol is always positive

b. are agglutinated by most adult sera

One week after birth, an infant with positive DAT and a bilirubin level of 18.5 mg/dL is in need of an exchange transfusion. Since the biological mother was not available, the next course of action would be to—

a. crossmatch blood using the baby’s plasma

b. crossmatch blood using an eluate from baby’s red blood cells

c. locate the father as a potential donor

d. use group O, Rh negative blood for the exchange

b. crossmatch blood using an eluate from baby’s red blood cells

Prior to transfusion, granulocytes must be—

a. washed to remove the plasma

b. retyped for Rh antigen only

c. crossmatched with the recipient’s plasma

d. filtered to remove RBCs and lymphocytes

c. crossmatched with the recipient’s plasma

All of the following are included in a routine cord blood evaluation except—

a. DAT

b. fetal screen

c. ABO

d. Rh

b. fetal screen

What is the most probably ethnicity of a donor with the following typing results: Lea=b=, Fya=b=, Jsa+b+?

a. black

b. oriental

c. american indian

d. caucasian

a. black

The anticoagulant CPDA-1 improved availability of red blood cells because it—

a. increases ATP synthesis

b. retards bacterial growth

c. allows shelf life of 21 days

d. allows better preservation of platelets

a. increases ATP synthesis

With which of the following would an anti-C showing dosage react most strongly?

a. A red cell of the genotype Cc

b. A red cell of the genotype cc

c. A red cell of the genotype CC

d. equal with all genotypes

c. A red cell of the genotype CC

The direct antiglobulin test is often negative in which of the following situations?

a. transfusion reaction due to anti-Jka

b. warm autoimmune hemolytic anemia due to anti-e

c. HDFN due to anti-D

d. HDFN due to anti-B

b. warm autoimmune hemolytic anemia due to anti-e

Proteolytic enzymes may enhance certain reactions. Which of the following groups of antigens show enhanced agglutination with the use of enzymes?

a. M, N, D, e

b. Jka, Jkb, C, E

c. Fya, Fyb, Lua, Lub

d. Fya, Jkb, Lua, S

b. Jka, Jkb, C, E

Red cells of which of the following genotypes have the least amount of LW antigen?

a. DCe/dCe

b. dCe/DcE

c. DcE/dce

d. dce/dce

d. dce/dce

Antibodies are produced by—

a. B cells differentiated into plasma cells

b. T cells under the influence of thymosin

c. B cells, T cells, and macrophages

d. the pluripotent stem cell

a. B cells differentiated into plasma cells

Given the following information, what conclusions can be drawn regarding paternity? All testing was performed with appropriate controls.

Mother - A, MN

Baby - O, NN

Alleged father - O, MN

a. the typing procedures are probably in error

b. paternity is not excluded

c. paternity is excluded based on ABO results

d. paternity is excluded based on MN results

b. paternity is not excluded

The gene that controls the presence or absence of the H substance in body secretions is the—

a. H gene

b. Se gene

c. h gene

d. B gene

b. Se gene

A male tested positive for the following antigens: D, C, c, E, e. What is his most probably genotype?

a. R1r

b. R1R2

c. Ror

d. R1r’

b. R1R2

All of the following are characteristics of cold agglutinins except that they—

a. react optimally at temperatures between 1 and 10C

b. can give a reversible reaction after warming

c. are strongly reactive with cord cells

d. agglutinate almost all adult human red cells, regardless of group

c. are strongly reactive with cord cells

Which of the following gives all the possible phenotypes of offspring that could result from the mating of a group A person with a group B person?

a. A and B only

b. A and B and AB only

c. A and B and O only

d. A and B and AB and O

d. A and B and AB and O

The greatest danger for the fetus affected by HDFN prior to birth is—

a. death due to build up of bilirubin

b. death due to anemia

c. Kernicterus

brain damage

b. death due to anemia

All of the following statements regarding FFP are true except—

a. FFP must be prepared within 24 hours of collection

b. after thawing FFP must be transfused within 24 hours

c. storage temperature for FFP with a 1 year shelf life is -18 or colder

d. when thawed FFP must be stored between 1 and 6 C

a. FFP must be prepared within 24 hours of collection

FDA regulation require that at least ______% of erythrocytes remain viable in an anticoagulant preservative solution at the end of the permitted storage period.

a. 50

b. 65

c. 70

d. 95

c. 70

Which patient is least likely to need an irradiated component?

a. bone marrow transplant recipient

b. neonate less than 1200g

c. healthy adult receiving a RBC transfusion

d. healthy adult receiving a RBC transfusion from a blood relative

c. healthy adult receiving a RBC transfusion

Which of the following is not a factor that influences antigen-antibody association?

a. the number of antibody molecules in relation to the number of antigen sites per cell

b. the subclass of IgG molecules

c. the temperature and length of time of incubation

d. ionic strength

b. the subclass of IgG molecules

Select the most appropriate characteristic of anti-K

a. usually IgM

b. stimulated by k antigen

c. second in immunogenicity to D antigen

d. usually not a cause of HTR

c. second in immunogenicity to D antigen

If a fatality results directly from a transfusion complication, which organization must be notified within 24 hours of the fatality?

a. FDA

b. CAP

c. AABB

d. CDC

a. FDA

Which of the following is not a potential cause of a false positive direct antiglobulin test?

a. use of EDTA anticoagulated blood

b. use of refrigerated clotted whole blood

c. dirty glassware

d. over centrifugation of erythrocytes

a. use of EDTA anticoagulated blood

What may be found in the plasma of a person who is exhibiting signs of TRALI?

a. RBC alloantibody

b. IgA antibody

c. anti-leukocyte antibody (HLA)

d. allergen

c. anti-leukocyte antibody (HLA)

A woman, group A (R2R2) delivers an infant with a positive DAT. Her husband is group O (rr) Of the following, which antibody is most likely causing the problem?

a. anti-D

b. anti-c

c. anti-e

d. anti-E

a. anti-D

Which of the following is a non-immunologic adverse effect of a transfusion?

a. hemolytic reaction

b. TRALI

c. TACO

d. urticaria

c. TACO

Paroxysmal cold hemoglobinuria (PCH) is best associated with which of the following blood groups?

a. Kell

b. Duffy

c. P

d. I/i

c. P

Laboratory studies of maternal and cord blood yield the following results:

Maternal - O=, anti-E in plasma

Cord - B+, DAT 2+, Anti-E in eluate

If exchange transfusion is necessary, the best choice of blood is—

a. B, Rh =, E +

b. B, Rh +, E +

c. O, Rh =, E =

d. O, Rh +, E =

d. O, Rh +, E =

Cryoprecipitated AHF, if maintained in the frozen state at -18 C or colder has a shelf life of—

a. 42 days

b. 6 months

c. 12 months

d. 36 months

c. 12 months

Anti-N is identified in a patient’s plasma. If random crossmatches were performed on 10 donor units, how many would be expected to be compatible?

a. 0

b. 3

c. 7

d. 10

b. 3

A neonate is to be transfused for the first time with group O red blood cells. Which of the following is appropriate when compatibility testing is performed?

a. screen and crossmatch with the mother’s plasma

b. screen and crossmatch with the baby’s plasma

c. crossmatch is not necessary if initial screening of mother’s or baby’s plasma was negative

d. screening or crossmatching is not necessary; issue group and Rh compatible blood

c. crossmatch is not necessary if initial screening of mother’s or baby’s plasma was negative

Which of the following mediations is most likely to cause production of autoantibodies?

a. penicillin

b. cephalothin

c. methyldopa

d. tetracycline

c. methyldopa

A patient has three plasma antibodies: anti-K, Fya, Jka. What percentage of ABO group specific blood would you expect to be compatible (antigen incidence K 9%, Fya 65%, Jka 75%)

a. 3%

b. 5%

c. 8%

d. 12%

c. 8%

Rh antibodies result in destruction of incompatible transfused red cells predominantly in the —

a. spleen

b. bone marrow

c. liver

d. intravascular space

a. spleen

A 37 year old female with systemic lupus erythematosus is admitted with anemia. Blood samples are received with a crossmatch request for four units of red blood cells. The patient is group B Rh =. The following results were obtained in pretransfusion testing

_____IS_37_IAT___

SC1 0 0 3+

SC2 0 0 3+

auto 0 0 3+

The most probable cause of these results is—

a. Rouleaux

b. Warm autoantibody

c. Cold autoantibody

d. Multiple antibodies

b. Warm autoantibody

Delayed hemolytic transfusion reactions are most commonly associated with antibodies of the—

a. Kell system

b. Kidd system

c. ABO system

d. Lewis system

b. Kidd system

Lewis antibodies have not been implicated in HDFN because the—

a. antibodies are not usually hemolytic

b. antibodies are 7S in form

c. antigens are not developed on the red cells of newborns

d. antigens are not soluble plasma substances

c. antigens are not developed on the red cells of newborns

The zeta potential of the red cell—

a. produces a positive ionic charge

b. results from a net negative red cell membrane charge

c. is measured at the membrane surface

d. attracts a negative charge

b. results from a net negative red cell membrane charge

A unit of random donor platelets should contain—

a. 3.0 × 10¹¹ in 75% of units tested

b. 5.5 × 10¹⁰ in 75% of units tested

c. 1.0 × 10¹⁰ in 50% of units tested

d. 2.5 × 10¹⁰ in 50% of units tested

b. 5.5 × 10¹⁰ in 75% of units tested

Any antibodies found in an infant’s sera at birth are probably—

a. produced by the infant’s lymphocytes

b. derived from the infant’s meconium

c. acquired from the maternal circulation

d. derived from the infant’s Wharton’s jelly

c. acquired from the maternal circulation

When anti-K is found in prenatal screening—

a. the infant’s father is definitely Kell +

b. 9 units of blood will have to be tested to find one compatible unit

c. the patient may have a history of previous transfusions

d. the infant will be erythroblastic

c. the patient may have a history of previous transfusions

Which two group systems are similar in that the red cell antigens are highly antigenic and may lead to formation of clinically significant antibodies, the lack of normal antigens leads to damaged red cells and resultant anemia conditions, and there is usually no problem finding antigen-negative blood for patients with antibodies to the most common antigens of the sytems?

a. Rh and Kell

b. P and I

c. MNSs and Lewis

d. Duffy and Kidd

a. Rh and Kell

Blood donor and recipient samples used in crossmatching must be stored for a minimum of how many days following transfusion?

a. 2

b. 5

c. 7

d. 10

c. 7

If a patient has an anti-c antibody, which of the following units of blood may he or she receive without an expected reaction due to this antibody?

a. R1R2

b. R1R1

c. R1r

d. rr

b. R1R1

A female blood donor is group A and possesses the secretor gene (Se). Her saliva will contain which of the following blood group substances?

a. H

b. O

c. A

d. a and c

d. a and c

The blood group that reacts the weakest with anti-H lectin is—

a. A2

b. B

c. O

d. A1B

d. A1B

A patient experiences chills and fever, nausea, flushing, and lower back pain following the infusion of 350 mL of blood. To quickly rule out a transfusion reaction due to acute hemolysis, one should immediately—

a. perform a DAT on the pretransfusion sample

b. culture the unit at 4 C, 22 C, and 32 C

c. compare visually pre- and post reaction plasma for hemolysis or bilirubin

d. measure serum haptoglobin on pre- and post reaction samples

c. compare visually pre- and post reaction plasma for hemolysis or bilirubin

Select the most likely cause for ABO forward and reverse reactions given below:

anti-A 4+ anti-B 0 anti-A,B 4+

A cells 0 B cells 0 O cells 0 auto 0

a. polyagglutinable cells

b. immunodeficiency

c. acquired A-like antigen

d. A subgroup

b. immunodeficiency

Which of the following antigens is considered to occur with the highest frequency?

a. D

b. Lea

c. k

d. M

c. k

A patient types as O+. All three screen cells and red cells from 2 O+ units show agglutination after incubation at 37 C and increase in reactivity at the IAT phase of testing. What action should be taken next?

a. perform an auto and DAT

b. perform an enzyme panel

c. perform an elution

d. choose another 2 units and repeat the crossmatch

d. choose another 2 units and repeat the crossmatch

A donor unit contains a warm reacting 37 C unexpected antibody. According to AABB standards what should be done with that unit?

a. treated as any other unit for transfusion

b. used only for purposes other than red cell transfusion

c. used only as frozen blood

d. used as red blood cells with the plasma removed

d. used as red blood cells with the plasma removed

The temperature of a refrigerator that contains stored blood should not exceed—

a. 4 C

b. 6 C

c. 8 C

d. 10 C

b. 6 C

Which of the following best reflects the discrepancy seen when a person demonstrates an acquired B like phenomenon?

a. forward typing appears to be B but reverse groups like O

b. forward typing appears to be AB but reverse groups like A

a. forward typing appears to be O but reverse groups like B

a. forward typing appears to be B but reverse groups like AB

b. forward typing appears to be AB but reverse groups like A

A patient is typed as group O+ and crossmatched with 5 units of blood. The patient’s antibody screening test and one compatibility test show agglutination in the antiglobulin phase. All other testing results are negative at room temperature and 37C. The most probable antibody is—

a. anti-I

b. anti-K

c. anti-M

d. anti-Vel

b. anti-K

Which of the following incompatibilities will the crossmatch not detect?

a. O patient, mistyped as A, donor is A

b. Rh= patient, mistyped as Rh+, but having no unexpected antibodies, donor is Rh+

c. patient with AHG reacting anti Jka donor is Jka+b=

d. A2 patient with anti A1, donor is A1

c. patient with AHG reacting anti Jka donor is Jka+b=