Assessment BB Flashcards by Karl Dashley Atinen

What type of serological testing does the blood bank technologist perform when determining the blood group of a patient?

a. Genotyping
b. Phenotyping
c. Both genotyping and phenotyping
d. Polymerase chain reaction

b. Phenotyping

Phenotyping, or the physical expression of a genotype, is the type of testing routinely performed in the blood bank. An individual, for example, may have the AO genotype but phenotypes as group A.

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Which genotype(s) will give rise to the Bombay phenotype?

a. HH only
b. HH and Hh
c. Hh and hh
d. hh only

d. hh only

The Bombay phenotype will be expressed only when no H substance is present. The Oh type is expressed by the genotype hh. Bombays produce naturally occurring anti-H, and their serum agglutinates group O red cells in addition to red cells from groups A, B, and AB persons.

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Which of the following describes the expression of most blood group antigens?

a. Dominant
b. Recessive
c. Codominant
d. Corecessive

c. Codominant

The inheritance of most blood group genes is codominant, meaning that no gene or allele is dominant over another. For example, a person who is group AB expresses both the A and B antigen on his or her red cells.

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What blood type is not possible for an offspring of an AO and BO mating?

a. AB
b. A or B
c. O
d. All are possible

d. All are possible

A mating between AO and BO persons can result in an offspring with a blood type of A, B, AB, or O.

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A patient’s serum is incompatible with O cells. The patient RBCs give a negative reaction to anti-H lectin. What is the most likely cause of these results?

a. The patient may be a subgroup of A
b. The patient may have an immunodeficiency
c. The patient may be a Bombay
d. The patient may have developed alloantibodies

c. The patient may be a Bombay

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What antibodies are formed by a Bombay individual?

a. Anti-A and anti-B
b. Anti-H
c. Anti-AB
d. Anti-A, anti-B and anti-H

d. Anti-A, anti-B and anti-H

A Bombay individual does not express A, B, or H antigens; therefore anti-A, B, and H are formed. Because a Bombay individual has three antibodies, the only compatible blood must be from another Bombay donor.

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Acquired B antigens have been found in:

a. Bombay individuals
b. Group O persons
c. All blood groups
d. Group A persons

d. Group A persons

The acquired B phenomenon is only seen in group A persons.

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Which typing results are most likely to occur when a patient has an acquired B antigen?

a. Anti-A 4+, anti-B-3+, A1 cells neg, B cells neg
b. Anti-A 3+, anti-B neg, A1 cells neg, B cells neg
c. Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+
d. Anti-A 4+, anti-B 4+, A1 cells 2+, B cells neg

c. Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+

In forward typing, a 1+ reaction with anti-B is suspicious because of the weak reaction and the normal reverse grouping that appears to be group A. This may be indicative of an acquired antigen. In the case of an acquired B, the reverse grouping is the same for a group A person.

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Which blood group has the LEAST amount of H antigen?

a. A1B
b. A2
c. B
d. A1
e. O

a. A1B

The A1B blood group has the least amount of H antigen. This is due to both A and B epitopes present on red cells compromising the availability of H epitopes. A1B cells will yield weak reactions with anti-H lectin.

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What should be done if all forward and reverse ABO results are negative?

a. Perform additional testing such as typing with anti-A1 lectin and anti-A,B
b. Incubate at 22°C or 4°C to enhance weak expression
c. Repeat the test with new reagents
d. Run an antibody identification panel

b. Incubate at 22°C or 4°C to enhance weak expression

All negative results may be due to weakened antigens or antibodies. Room temperature or lower incubation temperature may enhance expression of weakened antigens or antibodies.

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N-acetyl-D-galactosamine is the immunodominant carbohydrate that reacts with:

Arachis hypogaea
Salvia sclarea
Dolichos biflorus
Ulex europaeus

Dolichos biflorus

The immunodominant sugar N-acetyl-galactosamine confers A antigen specificity when present at the terminus of the type 2 precursor chain on the RBC membrane. Therefore, its presence would cause RBCs to react with anti-A1 lectin, Dolichos biflorus.

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A stem cell transplant patient was retyped when she was transferred from another hospital. What is the most likely cause of the following results?
Patient cells: Anti-A, neg Anti-B, 4+
Patient serum: A1 cells, neg B cells, neg

a. Viral infection
b. Alloantibodies
c. Immunodeficiency
d. Autoimmune hemolytic anemia

c. Immunodeficiency

WEAK OR MISSING ANTIBODIES
A transplant patient is probably taking immunosuppressive medication to increase graft survival. This can contribute to the loss of normal blood group antibodies as well as other types of antibodies.

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A complete Rh typing for antigens C, c, D, E, and e revealed negative results for C, D, and E. How is the individual designated?

a. Rh positive
b. Rh negative
c. Positive for c and e
d. Impossible to determine

b. Rh negative

Rh positive refers to the presence of D antigen; Rh negative refers to the absence of the D antigen. These designations are for D antigen only and do not involve other Rh antigens.

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A patient tests positive for weak D but also appears to have anti-D in his serum. What may be the problem?

a. Mixup of samples or testing error
b. Most weak D individuals make anti-D
c. The problem could be due to a disease state
d. A D mosaic may make antibodies to missing antigen parts

d. A D mosaic may make antibodies to missing antigen parts

The D antigen is comprised of different parts designated as a mosaic. If an individual lacks parts of the antigen, he or she may make antibodies to the missing parts if exposed to the whole D antigen.

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What does the genotype —/— represent in the Rh system?

a. Rh negative
b. D mosaic
c. Rh null
d. Total Rh

c. Rh null

A person who is Rh null shows no Rh antigens on his or her RBCs.

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What techniques are necessary for weak D testing?

a. Saline + 22°C incubation
b. Albumin or LISS + 37°C incubation
c. Saline + 37°C incubation
d. 37°C incubation + indirect antiglobulin test

d. 37°C incubation + indirect antiglobulin test

Weak D testing requires both 37°C incubation and the IAT procedure.

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Which of the following sugars must be present on a precursor substance for A and B antigenic activity to be expressed?

a. D-Galactose
b. N-Acetylgalactosamine
c. Glucose
d. L-Fucose

d. L-Fucose

Without H substance present, the sugars giving A or B antigenic activity cannot attach.

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Lectins are useful in determining the cause of abnormal reactions in blood bank serology. These lectins are frequently labeled as anti-H, anti-A1 etc. The nature of these lectins is explained by which of the following?

a. An early form of monoclonal antibody produced in nonvertebrates
b. A plant substance that chemically reacts with certain RBC antigens
c. Naturally occurring antibodies in certain plants
d. The ability of plants to respond to RBC antigens by antibody production

b. A plant substance that chemically reacts with certain RBC antigens

Lectins are proteins present in plants, often derived from the seeds of plants.

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If a patient has the Rh genotype DCe/DCe and receives a unit of red blood cells from a DCe/dce individual, what Rh antibody might the patient develop?

a. Anti-C
b. Anti-c
c. Anti-d
d. Anti-E

b. Anti-c

The unit from the DCe/dce donor has the c antigen that the patient lacks.

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Which of the blood group systems is associated with antibodies that are generally IgM?

a. Rh
b. Duffy
c. Kell
d. Lewis

d. Lewis

Lewis system antibodies are generally IgM.

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In which of the following blood group systems may the red blood cell typing change during pregnancy?

a. P
b. MNS
c. Lewis
d. Duffy

c. Lewis

The Lewis typings of a pregnant woman may appear to be Le(a-b-), even though the original typing may have been Le(a-b+).

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All are associated with Group I ABO discrepancies, except:

a. Newborns and elderly patients
b. Patients with congenital immunodeficiency diseases
c. Patients using immunosuppressive drugs
d. Subgroups of A or B

d. Subgroups of A or B

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An antigen present on most D-positive and all C-positive RBCs:

a. G
b. f
c. rhi
d. Cw

a. G

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From the following ABO mating, what are the probabilities of the ABO PHENOTYPES of potential offspring? Mother: Group O; Father: Group B (heterozygous).

a. 50% BO, 50% OO
b. 100% BO
c. 50% B, 50% O
d. 50% B, 50% A

c. 50% B, 50% O

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Rh antibodies are predominantly: a. IgM b. IgG c. IgD d. IgA

b. IgG

Rh immune globulin provides ____ protection against fetal D antigen. a. Active b. Passive c. Antigen-stimulated d. Antibody-stimulated

b. Passive

If an Rh negative woman recently delivered an Rh positive baby and the Kleihauer-Betke test result is 5%, how many vials of Rh Ig should be administered? a. 6 b. 7 c. 8 d. 9

d. 9

The glass surface of an Rh viewbox should be _____ C. a. Between 45 and 50C b. Between 26 and 39C c. Between 16 and 25C d. Between 0 and 15C

a. Between 45 and 50C

Anti-c can be formed by persons with the genotype: a. R1R2 b. R1R1 c. R2r d. rr

b. R1R1

The results of a Kleihauer-Betke stain indicate a feto-maternal hemorrhage of 35 mL of whole blood. How many vials of Rh immune globulin would be required? a. 1 b. 2 c. 3 d. 4

b. 2

ABH substances would be found in the saliva of a group B secretor: a. H b. A and H c. B and H d. A, B and H

c. B and H

The immunogenicity of the common Rh antigens may be described from greatest to least: a. D>C>E>c>e b. D>c>E>e>C c. c>D>C>E>e d. D>c>E>C>e

d. D>c>E>C>e

An individual with genes A, H, Se and lele has which of the following phenotypes? a. ABH, Le (a-b-) b. ABH, Le (a+b-) c. AH, Le (a-b-) d. AH, Le (a+b-)

c. AH, Le (a-b-)

The antigen system closely associated phenotypically with Rh is known as: a. McCoy b. Lutheran c. Duffy d. LW

d. LW

“O” secretor person would demonstrate what substance/s in his saliva: a. A b. B c. H d. A and B

c. H

Which of the following is NOT true about the anti-A and anti-B? a. They are well-developed at birth b. They are “naturally occurring” c. They are IgM isoagglutinins d. They are reactive at cold temperature

a. They are well-developed at birth

What chain is formed when the terminal galactose on the ABH precursor substance is attached to the N-acetylglucosamine in beta 1, 4 linkage? a. Type 1 precursor chain b. Type 2 precursor chain

b. Type 2 precursor chain ## Footnote Type 1 precursor substance Beta 1 → 3 linkage between galactose and N-acetylglucosamine Type 2 precursor substance Beta 1 → 4 linkage between galactose and N-acetylglucosamine

Rh-HDN occurs in what type of mother and child: a. Mother and child are both Rh (-) b. Mother and child are both Rh (+) c. Mother is Rh (+), child is Rh (-) d. Mother is Rh (-), child is Rh (+)

d. Mother is Rh (-), child is Rh (+)

ABO antibodies in infants are detected in serum: a. At birth in cord blood b. 2 to 4 weeks after birth c. 1 to 2 months after birth d. 3 to 6 months after birth

d. 3 to 6 months after birth

Which cells agglutinate most strongly with Ulex europaeus lectin? a. O b. A1 c. A1B d. A2B e. Oh (Bombay phenotype)

a. O

If a patient has an A2 ABO type, which of the following statements is true? a. The patient’s red cells will react with anti-A1 lectin b. The patient’s serum will react with A2 cells c. The patient’s red cells will react with anti-A2 lectin d. The patient’s serum will react with A1 cells if anti-A1 is present

d. The patient’s serum will react with A1 cells if anti-A1 is present ## Footnote The A2 subgroup is described as having both qualitative and quantitative differences when compared to the A1 subgroup. This means that there is less A antigen found on the red cells of people with A2, and their A antigen looks “different” when compared to that of people with type A1. Therefore the red cells from those with type A2 will not react with anti-A1 lectin. Approximately 20% of those with type A have the A2 phenotype, and between 1% and 8% of those individuals make anti-A1. There is no anti-A2 reagent, and people with the A2 phenotype would not react with A2 cells, because that would imply an autoantibody is present.

Of the red cells listed, which has the most D antigen present? a. Rh null b. D positive c. dce/dce d. D- - / D - -

d. D- - / D - - ## Footnote Individuals with the D - - phenotype may possess more D antigen because they have inherited a nonfunctioning RHCE gene.

A trauma patient with type AB is seen at a rural hospital. The hospital only has 3 units of type AB RBCs. What blood type of RBCs can the patient receive as an alternative? a. Type O b. Type B c. Type A d. None of the above e. All of the above

e. All of the above ## Footnote The patient can receive all of the blood types listed, but good blood management would dictate the order in which they were transfused. Generally, the best course of action would be to transfuse type A first because it is usually more plentiful than type B. Patients with O type can receive only type O blood, so it is best to conserve type O when possible. If type A is not plentiful, type B can be given. Once either type A or type B is given, types should not be mixed, to help avoid potential reactions. If type A or B is exhausted, it is then appropriate to move to type O.

If a person has the genetic makeup Hh, AO, LeLe, sese, what substance will be found in the secretions? a. A substance b. H Substance c. Lea substance d. Leb substance

c. Lea substance ## Footnote Le and secretor gene interaction: If Le is inherited without Se, only Lea will be found on red cells and in saliva. Because this person is a nonsecretor, only Lea antigen will be present in the secretions.

Anti-E will react with which of the following cells? a. RoRo b. R1R1 c. R2R2 d. rr

c. R2R2 ## Footnote * RoRo Dce/Dce * R1R1 DCe/DCe * R2R2 DcE/DcE * rr dce/dce Therefore anti-E will react only with R2R2 cells because they are the only ones in this list that possess the corresponding E antigen

Rh antibodies react best at what temperature (°C)? a. 15 b. 18 c. 22 d. 37

d. 37

Which of the following is the most common haplotype in the ASIAN population? a. DCe b. DcE c. Dce d. ce

a. DCe ## Footnote R1 (DCe) - Whites, Asians and Native Americans R0 (Dce) - Blacks

If a patient who is R1R1 is transfused with RBCs that are Ror, which antibody is he most likely to produce? a. Anti-D b. Anti-c c. Anti-e d. Anti-G

b. Anti-c

Which of the following characteristics best describes Lewis antibodies? a. IgM, naturally occurring, cause HDN b. IgM, naturally occurring, do not cause HDN c. IgG, in vitro hemolysis, cause hemolytic transfusion reactions d. IgG, in vitro hemolysis, do not cause hemolytic transfusions

b. IgM, naturally occurring, do not cause HDN

Transformation to Leb phenotype after birth may be as follows: a. Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+) b. Le(a+b–) to Le(a–b–) to Le(a–b+) to Le(a+b+) c. Le(a–b+) to Le(a+b–) to Le(a+b+) to Le(a–b–) d. Le(a+b+) to Le(a+b–) to Le(a–b–) to Le(a–b+)

a. Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+) ## Footnote In children who inherit both Le and Se genes, the transformation can be followed from the Le(a–b–) phenotype at birth to Le(a+b–) after 10 days to Le(a+ b+) and finally to Le(a–b+), the true Lewis phenotype, after about 6 years.

Transfusion-transmissible infectious agents for which UNIVERSAL SCREENING of all donations in all countries is recommended. Check four (4) boxes. Cytomegalovirus (CMV) Plasmodium sp. (malaria) Human immunodeficiency virus (HIV) Hepatitis B virus (HBV) Hepatitis C virus (HCV) Treponema pallidum (syphilis)

Human immunodeficiency virus (HIV) Hepatitis B virus (HBV) Hepatitis C virus (HCV) Treponema pallidum (syphilis) ## Footnote Transfusion-transmissible infectious agents for which universal screening of all donations in all countries is recommended: Screening for the following four infections that are transmissible by transfusion is recommended as mandatory for the provision of a safe blood supply. These infections can cause chronic disease with possible serious consequences and present the greatest infection risk to recipients of transfusion: 1. Human immunodeficiency virus (HIV) 2. Hepatitis B virus (HBV) 3. Hepatitis C virus (HCV) 4. Treponema pallidum (syphilis)

What is the maximum volume of blood that can be collected from a 110-lb donor, including samples for processing? 450 mL 500 mL 525 mL 550 mL

525 mL

When RBCs are stored, there is a “shift to the left.” This means: Hemoglobin-oxygen affinity increases, owing to an increase in 2,3 -DPG Hemoglobin-oxygen affinity increases, owing to a decrease in 2,3-DPG Hemoglobin-oxygen affinity decreases, owing to a decrease in 2,3-DPG Hemoglobin-oxygen affinity decreases, owing to an increase in 2,3-DPG

Hemoglobin-oxygen affinity increases, owing to a decrease in 2,3-DPG

What are the current storage time and storage temperature for platelet concentrates and apheresis platelet components? 5 days at 1°C to 6°C 5 days at 24°C to 27°C 5 days at 20°C to 24°C 7 days at 22°C to 24°C

5 days at 20°C to 24°C

Prestorage pooled platelets can be stored for: 4 hours 24 hours 5 days 7 days

5 days ## Footnote Because they are produced in a CLOSED SYSTEM, they can be stored for 5 days from collection.

Additive solutions are approved for storage of red blood cells for how many days? 21 42 35 7

One criterion used by the FDA for approval of new preservation solutions and storage containers is an average 24-hour post-transfusion RBC survival of more than: 50% 60% 65% 75%

75%

What is the lowest allowable pH for a platelet component at outdate? 6 5.9 6.8 6.2

6.2

Which of the following occurs during storage of red blood cells? pH decreases 2,3-DPG increases ATP increases Plasma K+ decreases

pH decreases

Which of the following is approved for bacterial detection specific to extending the expiration of apheresed platelets to 7 days? BacT/ALERT eBDS Gram stain Pan Genera Detection (PGD) test

Pan Genera Detection (PGD) test ## Footnote In November 2009, the FDA approved the first rapid test to detect bacteria in platelets—the Pan Genera Detection (PGD) test (Verax Biomedical).

The pattern of inheritance most commonly expressed by blood group genes is: X-linked recessive Autosomal recessive Autosomal codominant X-linked codominant

Autosomal codominant

RBCs must be washed in saline at least three times before the addition of AHG reagent to: Wash away any hemolyzed cells Remove traces of free serum globulins Neutralize any excess AHG reagent Increase the antibody binding to antigen

Remove traces of free serum globulins

You are working on a specimen in the laboratory that you believe to be a Bombay phenotype. Which of the following reactions would you expect to see? Patient’s cells + Ulex europaeus = no agglutination Patient’s cells + Ulex europaeus = agglutination Patient’s serum + group O donor RBCs = no agglutination Patient’s serum + A1 and B cells = no agglutination

Patient’s cells + Ulex europaeus = no agglutination

Which of the following ABO blood groups contains the least amount of H substance? A1B A2 B O

A1B

Cells carrying a weak D antigen require the use of what test to demonstrate its presence? Indirect antiglobulin test Direct antiglobulin test Microplate test Warm autoadsorption test

Indirect antiglobulin test

Which of the following is the most common haplotype in the African American population? DCe DcE Dce ce

Dce ## Footnote R0 (Dce) Blacks R1 (DCe) Whites, Native Americans, Asians

If a patient who is R1R1 is transfused with RBCs that are R0r, which antibody is he most likely to produce? Anti-D Anti-c Anti-e Anti-G

Anti-c

The following results were obtained on a 51-year-old male with hepatitis C: Anti A: 4+ Anti B: 4+ Anti D: 3+ A1 cells: 0 B cells: 0 Retype the patient’s sample to confirm group AB positive Repeat the Rh typing Run a saline control in forward grouping Report the patient as group AB, Rh positive

Run a saline control in forward grouping ## Footnote In the case of an AB-positive person, a saline control must be run in forward grouping to obtain a negative reaction; this will ensure agglutination is specific in the other reactions. When samples test AB Rh-positive or when the Rh test is performed by itself, a separate saline control or 6% to 8% albumin control must be used to ensure the observed reactions are true agglutination and not a result of spontaneous agglutination.

What is the purpose of including a reagent control when interpreting group AB, D-positive red cells after testing with a low-protein anti-D reagent? To detect false-positive agglutination reactions To detect false-negative agglutination reactions To identify a mix up with patient’s sample To confirm ABO typing results

To detect false-positive agglutination reactions

Transformation to Leb phenotype after birth may be as follows: Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+) Le(a+b–) to Le(a–b–) to Le(a–b+) to Le(a+b+) Le(a–b+) to Le(a+b–) to Le(a+b+) to Le(a–b–) Le(a+b+) to Le(a+b–) to Le(a–b–) to Le(a–b+)

Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+)

In what way do the Lewis antigens change during pregnancy? Lea antigen increases only Leb antigen increases only Lea and Leb both increase Lea and Leb both decrease

Lea and Leb both decrease

The most commonly encountered of the Lewis antibodies: Anti-Le a Anti-Le b Anti-Le bH Anti-Le bL

Anti-Le a ## Footnote Anti-Lea is the most commonly encountered of the Lewis antibodies and is often detected in room temperature tests, but it sometimes reacts at 37°C and in the indirect antiglobulin test.

Which of the following best describes MN antigens and antibodies? -Well developed at birth, susceptible to enzymes, generally saline reactive -Not well developed at birth, susceptible to enzymes, generally saline reactive -Well developed at birth, not susceptible to enzymes, generally saline reactive -Well developed at birth, susceptible to enzymes, generally antiglobulin reactive

Well developed at birth, susceptible to enzymes, generally saline reactive

Which autoantibody specificity is found in patients with paroxysmal cold hemoglobinuria? Anti-I Anti-i Anti-P Anti-P1

Anti-P

Which of the following is the most common antibody seen in the blood bank after ABO and Rh antibodies? Anti-Fya Anti-k Anti-Jsa Anti-K

Anti-K

Which antibody is most commonly associated with delayed hemolytic transfusion reactions? Anti-s Anti-k Anti-Lu Anti-Jk

Anti-Jk

A patient with an M. pneumoniae infection will most likely develop a cold autoantibody with I i P P1

The antibody to this high-prevalence antigen demonstrates mixed-field agglutination that appears shiny and refractile under the microscope. Vel JMH Jr Sd

Sd ## Footnote Anti-Sda has characteristic shiny and refractile agglutinates under the microscope and is inhibited with urine from Sd(a+) individuals and guinea pigs.

What red blood cell treatment can be used to differentiate between anti-D and anti-LW? Ficin Trypsin Dithiothreitol (DTT) Papain

Dithiothreitol (DTT) ## Footnote Anti-LW does not react with DTT-treated D+ RBCs but anti-D does.

A weakly reactive antibody with a titer of 128 is neutralized by plasma. Which of the following could be the specificity? Anti-JMH Anti-Ch Anti-Kn Anti-Kp

Anti-Ch

The prevalence of ____ in Northern Europeans is 1% but is higher in the Mennonite population Diego a Diego b Scianna 1 Scianna 2

Scianna 2

Anti-Sda has been identified in a patient. What substance would neutralize this antibody and allow detection of other alloantibodies? Saliva Hydatid cyst fluid Urine Human breast milk

Urine

How many days must a pretransfusion specimen and donor unit segments be retained post-transfusion? 3 days 7 days 14 days 1 month

7 days ## Footnote The patient sample and a segment from the donor unit must be retained post-transfusion for at least 7 days. This allows for the investigation of any adverse events related to transfusion, such as a delayed hemolytic transfusion reaction.

How many days before a pretransfusion specimen expires? 3 days 7 days 14 days 1 month

3 days ## Footnote Pretransfusion specimens must be collected within 3 days of the scheduled transfusion.

Which is not true of rouleaux formation? Mimics agglutination Appears like a “stacking of coins” Can be seen in the antiglobulin test Can be dispersed by saline

Can be seen in the antiglobulin test

Protein A captures antibodies by binding to the: Fab portion of immunoglobulin Fc portion of immunoglobulin Surface of test cells Surface of indicator cells

Fc portion of immunoglobulin

Immunization for rubella (German measles) would result in a temporary deferral for: 4 weeks 2 weeks 1 year 3 years

4 weeks ## Footnote RUBELLA (GERMAN MEASLES) VACCINATION - 4 weeks deferral RUBEOLA (MEASLES) VACCINATION - 2 weeks deferral

Which of the following carries a 12-month deferral? Donor received Hepatitis B immune globulin Donor received pituitary growth hormone from another human Donor received the MMR vaccine Donor spent 10 years in Africa

Donor received Hepatitis B immune globulin

A first-trimester or second trimester abortion or miscarriage: 4 weeks deferral 6 weeks deferral 12 months deferral Not cause for deferral

Not cause for deferral ## Footnote A first-trimester or second trimester abortion or miscarriage is not cause for deferral. Female donors should be temporarily deferred for 6 weeks following termination of pregnancy. Exceptions can be made by the blood bank medical director for an autologous donation if complications are anticipated at delivery. A 12-month deferral would apply if the woman received a transfusion during her pregnancy.

Donors who have received a transfusion of blood or its components or other human tissues (organ, tissue, bone marrow transplant, or bone or skin graft) known to be possible sources of bloodborne pathogens should be deferred for _____ from the time of receiving the blood product or graft 4 weeks 6 weeks 12 months 3 years

12 months ## Footnote Donors who during the preceding 12 months have received a transfusion of blood or its components or other human tissues (organ, tissue, bone marrow transplant, or bone or skin graft) known to be possible sources of bloodborne pathogens should be deferred for 12 months from the time of receiving the blood product or graft.

Currently, steps taken to reduce transfusion-transmitted CMV include: Plaque reduction neutralization test NAT testing Leukoreduction Minipool screening

Leukoreduction

The first retrovirus to be associated with human disease was: HCV HIV-1 HTLV-1 WNV

HTLV-1

What is the most common parasitic complication of transfusion? Babesia microti Trypanosoma cruzi Plasmodium species Toxoplasma gondii

Plasmodium species

RBCs that have been leukoreduced must contain less than ______ leukocytes and retain at least ______ of original RBCs. 8 × 10 6th/ 85% 8 × 10 6th/ 90% 5 × 10 6th/ 85% 5 × 10 6th / 80%

5 × 10 6th/ 85%

Patient with APLASTIC ANEMIA should be transfused with: Fresh whole blood (FWB) Washed RBCs less than 7 days old Fresh frozen plasma and platelets Cryoprecipitated AHF

Washed RBCs less than 7 days old

Leukocyte-reduced filters can do all of the following except: Reduce the risk of CMV infection Prevent or reduce the risk of HLA alloimmunization Prevent febrile, nonhemolytic transfusion reactions Prevent TA-GVHD

Prevent TA-GVHD

Which patient does NOT need an irradiated component? Bone marrow transplant recipient Neonate weighing less than 1,200 g Adult receiving an RBC transfusion Adult receiving an RBC transfusion from a blood relative

Adult receiving an RBC transfusion

RBC transfusions should be given: Within 4 hours With lactated Ringer solution With dextrose and water With cryoprecipitate

Within 4 hours

Which type of transplantation requires all cellular blood components to be irradiated? Bone marrow Heart Liver Kidney

Bone marrow

Select the appropriate product for a bone marrow transplant patient with anemia: RBCs Irradiated RBCs Leukoreduced RBCs Washed RBCs

Irradiated RBCs

Which fluid should be used to dilute RBCs? 0.9% saline 5% dextrose and water Immune globulin Lactated Ringer solution

0.9% saline

Fatal transfusion reactions are mostly caused by: Serologic errors Improper storage of blood Improper handling of the product Clerical errors

Clerical errors

Pain at infusion site and hypotension are observed with what type of reaction? Delayed hemolytic transfusion reaction Acute hemolytic transfusion reaction Allergic reaction Febrile nonhemolytic reaction

Acute hemolytic transfusion reaction

The most common isolate found in RBC units: Bacillus cereus Propionobacterium acnes Staphylococcus epidermidis Yersinia enterocolitica

Yersinia enterocolitica ## Footnote According to the CDC, Yersinia enterocolitica is the most common isolate found in RBC units, followed by the Pseudomonas species. Together, these two account for more than 80% of all bacterial infections transmitted by RBCs.

The organisms most frequently recovered from donated blood and contamination of platelets: Yersinia enterocolitica and Pseudomonas species Yersinia enterocolitica and Propionobacterium acnes Staphylococcus aureus and Bacillus cereus Staphylococcus epidermidis and Bacilus cereus

Staphylococcus epidermidis and Bacilus cereus ## Footnote Staphylococcus epidermidis, and Bacillus cereus (both gram-positive) are the organisms most frequently recovered from donated blood and contamination of platelets.

The only presenting sign most often accompanying a delayed hemolytic transfusion reaction is: Renal failure Unexplained decrease in hemoglobin Active bleeding Hives

Unexplained decrease in hemoglobin

Which transfusion reaction presents with fever, maculopapular rash, watery diarrhea, abnormal liver function, and pancytopenia? Transfusion-associated sepsis Transfusion-related acute lung injury Transfusion-associated graft-versus-host disease Transfusion-associated allergic reaction

Transfusion-associated graft-versus-host disease

The most common anticoagulant used for apheresis procedures is: Heparin Sodium fluoride Warfarin Citrate

Citrate

The minimum interval allowed between plateletpheresis component collection procedures is: 1 day 2 days 7 days 8 weeks

2 days

Which of the following can be given to an apheresis donor to increase the number of circulating granulocytes? DDAVP Hydroxyethyl starch (HES) Immune globulin G-CSF

G-CSF ## Footnote Hematopoietic growth factors, in particular GCSF, are commonly used prior to the collection procedure to increase the number of circulating stem cells in the peripheral circulation.

Acute transfusion reactions: signs or symptoms presenting during or within ___ hours of transfusion Within 4 hours Within 24 hours Within 48 hours Within 72 hours

Within 24 hours ## Footnote A transfusion reaction with signs or symptoms presenting during or within 24 hours of transfusion is defined as an acute transfusion reaction. A transfusion reaction with signs or symptoms presenting after 24 hours of transfusion is defined as a delayed transfusion reaction.

In humans, there are ____ chromosomes. 2 chromosomes (1 pair) 22 chromosomes (11 pairs) 44 chromosomes (22 pairs) 46 chromosomes (23 pairs)

46 chromosomes (23 pairs) ## Footnote In humans, there are 46 chromosomes. These 46 chromosomes are arranged into pairs, with one of each being inherited from each parent. Humans have 22 autosomes and one set of sex chromosomes, XX in the female and XY in the male.

Humans have ___ autosomes and ____ of sex chromosomes, 1 pair of autosomes, 23 pairs sex chromosomes 22 pairs of autosomes, 2 pairs sex chromosomes 22 pairs of autosomes, 1 pair sex chromosomes 23 pairs of autosomes, 1 pair sex chromosomes

22 pairs of autosomes, 1 pair sex chromosomes ## Footnote Humans have 22 pairs of autosomes and one pair of sex chromosomes (the X and Y).

A1 individuals: A antigen A and A1 antigens Anti-A2 Production of only 240,000 to 290,000 antigen sites on the adult RBCs

A and A1 antigens ## Footnote A1: A and A1 antigens, produces Anti-H Potent gene A1 creates from 810,000 to 1,170,000 antigen sites on the adult RBCs A2: A antigen only, produces Anti-A1 Inheriting an A2 gene, results in the production of only 240,000 to 290,000 antigen sites on the adult A2 RBCs

The ultimate goal of biological safety is to: Provide safe and sterile working area Provide immunity to healthcare workers Prevent completion of the chain of infection by preventing transmission Prevent the spread of harmful aerosols

Prevent completion of the chain of infection by preventing transmission ## Footnote The ultimate goal of biological safety is to prevent completion of the chain by preventing transmission.

Which of the following includes an amorph? DcE DCE dce All of these

dce ## Footnote d is an amorph

A cause of indefinite deferral of blood donation is: German measles vaccination Residence in an endemic malaria region Positive test for Trypanosoma cruzi History of therapeutic rabies vaccine

Positive test for Trypanosoma cruzi ## Footnote Present or past clinical laboratory evidence of infection with Trypanosoma Cruz (Chagas disease) is cause for an indefinite deferral from blood donation.

Which one of the following constitutes permanent deferral status of a donor? Tattoo 5 months previously Recent close contact with a patient with viral hepatitis 2 units of blood transfused 4 months previously Confirmed positive test for HBsAg 10 years previously

Confirmed positive test for HBsAg 10 years previously ## Footnote A positive test for HBsAg at any time is a permanent deferral.

Which of the following donors may be accepted as a blood donor? Traveled to an area endemic for malaria 9 months previously Spontaneous abortion at 2 months, 3 months previously Resides with a known hepatitis B patient Received blood transfusion 22 weeks previously

Spontaneous abortion at 2 months, 3 months previously ## Footnote A first-trimester or second-trimester abortion or miscarriage is not cause for deferral.

In order to be a plateletpheresies donor, the platelet count must be at least: 150,000/uL 200,000/uL 250,000/uL 300,000/uL

150,000/uL

Prior to blood donation, the intended venipuncture site must be cleaned with a scrub solution containing: Hypochlorite Green soap 10% acetone Povidone iodine

Povidone iodine ## Footnote The scrub must used povidone-iodine. Donors who are sensitive to iodine can have the area cleaned with a preparation of 2% chlorhexidine and 70% isopropyl alcohol.

What is/are the minimum pretransfusion testing requirement(s) for autologous donations collected and transfused by the same facility? ABO and Rh typing only ABO/Rh type and antibody screen ABO/Rh type, antibody screen, crossmatch No pretransfusion testing is required for autologous donation

ABO and Rh typing only ## Footnote Only ABO and Rh typing are required with the patient's sample. Each autologous unit must be confirmed for ABO and RH from an integrally attached segment.

Upon inspection, a unit of aphaeresis platelets is noted to have visible clots, but otherwise appears normal. The technologist should: Issue without concern Filter to remove clots Centrifuge to express off the clots Quarantine for Gram stain and culture

Quarantine for Gram stain and culture ## Footnote Clots in the unit may indicate bacterial contamination.

An important determinant of platelet viability during storage is: Plasma potassium concentration Plasma pH Prothrombin time Partial thromboplastin time

Plasma pH ## Footnote The pH of platelets should be maintained at 6.2 or above throughout the storage period.

An individual's red blood cells give the following reactions with RH antisera: anti-D (4+), anti-C (3+), anti-E (neg), anti-c(3+) anti-e (3+). The individual's most probable GENOTYPE is: DCe/DcE DcE/dce Dce/dce DCe/dce

DCe/dce

An individual's red blood cells give the following reactions with RH antisera: anti-D (4+), anti-C (3+), anti-E (neg), anti-c(3+) anti-e (3+). The individual's PHENOTYPE is: Dce/dce DCe/dce DCce Dce

DCce

ABO hemolytic disease of the fetus and newborn (HDFN) differs from Rh HDFN in that: Rh HDFN is clinically more severe than ABO HDFN The direct antiglobulin test is weaker in Rh HDFN than ABO Rh HDFN occurs in the first pregnancy The mother's antibody screen is positive in ABO HDFN

Rh HDFN is clinically more severe than ABO HDFN ## Footnote ABO HDFN is a mild disease that may occur in any ABO-incompatible pregnancy including the first, since antibodies are naturally occurring. Rh HDFN does not occur until the mother has become immunized. Once this happens, subsequent pregnancies may be quite severely affected. The DAT is typically weak or even negative in ABO HDFN and strongly positive in Rh HDFN.

RBCs agglutinated by Dolichos biflorus: O red cells B and AB red cells A2 and A2B red cells A1 and A1B red cells

A1 and A1B red cells

Some blood group antibodies characteristically hemolyze appropriate antigen-positive red cells in the presence of : Complement Anticoagulants Preservatives Penicillin

Complement

The major crossmatch will detect a(an): Group A patient mistyped as O Unexpected red cell antibody in the donor unit Rh-negative donor unit mislabeled as Rh-positive Recipient antibody directed against antigens on the donor red cells

Recipient antibody directed against antigens on the donor red cells

In the Fisher-Race nomenclature, "d" represents: Presence of D antigen Absence of D antigen Elimination of D antigen Weak D antigen

Absence of D antigen

If the Du rosette test is positive, quantitation of the fetomaternal hemorrhage must be done by: Spectrophotometric technique Indirect antiglobulin test Flow cytometry Hemagglutination-inhibition test

Flow cytometry ## Footnote Massive fetomaternal hemorrhages of more than 30 mL of whole blood occur in less than 1% of deliveries. These massive hemorrhages can lead to immunization if adequate RhIG is not administered. A maternal sample should be obtained within 1 hour of delivery and screened—using a test such as the rosette technique—for massive fetomaternal hemorrhage. If positive, quantitation of the hemorrhage must be done by Kleihauer-Betke or by flow cytometry.

Performed as early as 10 to 12 weeks’ gestation to determine whether the FETUS has the gene for the D antigen: Amniocentesis Cordocentesis Peripheral blood sample None of these

Amniocentesis ## Footnote If the mother has anti-D and the father is likely to be heterozygous for the D antigen, amniocentesis or chorionic villous sampling can be performed as early as 10 to 12 weeks’ gestation to determine whether the fetus has the gene for the D antigen.

Defined as the proportion of cases with a specific disease or condition that give a positive test result: Sensitivity Specificity

Sensitivity

Defined as the proportion of cases with absence of the specific disease or condition that gives a negative test result: Sensitivity Specificity

Specificity

How are Rh antigens inherited? Autosomal recessive alleles Sex-linked genes Codominant alleles X-linked

Codominant alleles

Which animal was immunized that led to discovery of the Rh blood group? Mice Bats Guinea pigs and rabbits Rhesus macaque monkeys

Guinea pigs and rabbits ## Footnote Landsteiner and Wiener reported on an antibody made by guinea pigs and rabbits when they were transfused with Rhesus macaque monkey RBCs.

Agglutination with yellow anti-serum, no agglutination with blue anti-serum : A + B + A B

Reported the use of sodium citrate as an anticoagulant solutions for transfusions in 1914: Edward Lindemann Hustin Lewisohn Rous and Turner

Hustin

Introduced citrate-dextrose solution for preservation of blood in 1916: Edward Lindemann Hustin Lewisohn Rous and Turner

Rous and Turner

Prospective donors with a history of SYPHILIS or GONORRHEA, of treatment for either, or of a reactive screening test for syphilis, or where no confirmatory test was performed, should be deferred for ___months AFTER COMPLETION OF THERAPY. 3 months 6 months 12 months 36 months

12 months

Donor deferral after complete recovery from tuberculosis: 3 months 6 months 12 months 24 months

24 months ## Footnote Completion of therapy + 2 negative follow-up sputum exam.

For ABO grouping, mix red cell suspension and antiserum and centrifuge for approximately: 10 seconds 15 seconds 20 seconds 60 seconds

20 seconds

Centrifugation for the GEL TEST: 5 minutes 10 minutes 15 minutes 20 minutes

10 minutes

Shelf-life of FFP stored at -18C: 24 hours 1 year 2 years 7 years 10 years

1 year

Shelf-life of FFP stored at -65C: 24 hours 1 year 2 years 7 years 10 years

7 years

Fresh frozen plasma must be thawed at which temperature? 1 to 6C Room temperature 37C 40C or higher

37C

Once thawed, FFP must be transfused within: 4 hours 6 hours 12 hours 24 hours

24 hours

THAWED UNPOOLED cryoprecipitate must be transfused within: 4 hours 6 hours 12 hours 24 hours

6 hours

What is the expiration of cryoprecipitate once pooled? 4 hours 6 hours 8 hours 24 hours

4 hours

Incubation time for the GEL TEST and solid-phase red cell adherence test: 5 minutes 10 minutes 15 minutes 20 minutes

15 minutes

What component is indicated for patients who have anti-IgA antibodies? Whole blood Packed RBCs Washed RBCs Granulocytes

Washed RBCs

The blood warmer should have automatic temperature control with an ALARM that will sound if the blood is warmed: Over 37C Over 42C Over 50C Over 56C

Over 42C

STANDARD OPERATING PROCEDURE (SOP) manuals are integral components of any blood bank laboratory’s quality-assurance program. They are reviewed at least _____ and updated on a regular basis to reflect changes in operations and implementation of new regulations. Annually Every 2 years Every 5 years Every 10 years

Annually