Exam C Flashcards
Hemoglobin will increase _____ and hematocrit will increase _____ per unit of whole blood
1 g/dl
3%
will see bruising on the extremities and bleeding gums and platelet count will be extremely low
Post transfusion purpura
Transfusion-Associated Graft-Versus-Host Disease is caused by
T-cell lymphocytes derived from the donor blood
B-cell lymphocytes derived from the patient
T-cell lymphocytes derived from the patient
B-cell lymphocytes derived from the donor blood
T-cell lymphocytes derived from the donor blood
A 22 year old women presents with easy bruising and fatigue. A complete blood count reveals hemoglobin 8 g/dL, hematocrit of 24%, WBC 15,000/uL, and a platelet count of 5,000/uL. The hematologist plans to perform a bone marrow transplant biopsy and aspiration. Which of the following components should be given?
Packed RBCs
Cryoprecipitate
Platelets
Fresh frozen plasma
Platelets
For a massive transfusion what is the appropriate blood group for the packed cells, fresh frozen plasma and platelets?
O red blood cells, platelets and plasma
O red blood cells, AB platelets and any blood group of plasma
O red blood cells, AB plasma and any blood group of plasma
O red blood cells, AB plasma and platelets
O red blood cells, AB plasma and platelets
A group O negative patient with anti-D needs platelets. He has become refractory to random donor platelets. Which of the following platelets should he receive?
Group O positive apheresed platelets, HLA “A” matched,
Group A negative apheresed platelets, HLA “C” matched
Group B negative apheresed platelets, HLA “B” matched
Group AB positive apheresed platelets, HLA “C” matched.
Group B negative apheresed platelets, HLA “B” matched
When is antenatal Rh Immune Globulin given?
16 weeks
20 weeks
28 weeks
36 weeks
28 weeks
What is the amount of platelets that should be in a bag of platelets obtained by apheresis procedures?
5.5 x 1010 /bag
80 to 120 /bag
3.3 x 1011/bag
150 / bag
3.3 x 1011/bag
A Kleihauer-Betke (K-B) stain was done on a sample of blood from a pregnant woman who had been in a motor vehicle accident. The screen to detect a feto-maternal bleed was 4+ positive. All controls reacted as expected. The positive and negative control slides for the K-B stain, which were stained concurrently with the patient’s slide, were appropriately stained. The patient’s slide had all “ghost” cells. Choose from the following:
The eosin stain in the K-B stain procedure was too diluted.
The screen test was yielding false positives.
The woman was probably Rh positive.
The eluting solution in the K-B stain procedure was too acidic.
The woman was probably Rh positive.
A 22 year old women presents with easy bruising and fatigue. A complete blood count reveals hemoglobin 8 g/dL, hematocrit of 24%, WBC 15,000/uL, and a platelet count of 5,000/uL. The hematologist plans to perform a bone marrow transplant biopsy and aspiration. If platelets are given to the patient, how many units should be given?
1 apheresis
2 apheresis
4 apheresis
6 apheresis
1 apheresis
A massive transfusion protocol is initiated on a 45 year old male patient that is B negative and has a positive antibody screen. What is the appropriate blood group that should be given?
Group O
Group B
Group AB
Group A
Group B
A 55 year old male is contemplating surgery for severe arthritis in the right hip. He has been approved to donate an autologous unit of blood for his surgery. Upon donation, only 390 mls of blood was drawn. What should be done with the blood?
Use it as whole blood
Make platelets only
Make fresh frozen plasma only
Make packed red blood cells only
Nothing, 390 mLs is sufficient
Make packed red blood cells only
What is the immunologic of Rh immune globulin administration?
Anti-D attaches to Rh positive cells of the mother and these cells are subsequently removed by cells of the mothers reticuloendothelial system preventing sensitization of the mother
Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Anti-D attaches to Rh negative cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Anti-D crosses the placenta and attaches to Rh positive cells of the infant. The cells are subsequently removed by cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Which of the following is one of the immediate procedures in the laboratory investigation of a transfusion reaction?
DAT on the post-transfusion sample
Repeat the crossmatch on the transfused unit using a post-sample
Measure the amount of free hemoglobin in the first voided sample
Repeat the antibody screen on the pre- and post- transfusion samples
DAT on the post-transfusion sample
- All of the following may occur following an Rh-mediated hemolytic transfusion reaction except:
elevated fever.
increased bilirubin.
intravascular hemolysis
positive DAT
intravascular hemolysis
The Rh testing on a blood donor was negative at immediate spin. The tube was incubated at 37°C for 15 minutes. The tube was centrifuged and read macroscopically. The test was negative at 37°C. The tube was washed three times with saline, and two drops of AHG were added. After centrifugation, the tube yielded a 2+ reaction. How is this Rh type reported on the donor unit?
Rh-positive
Rh-negative
Du-positive
Rh-variable
Rh-positive
. A male patient was seen in the emergency room with an acute bleed. The recommendation from the blood supplier is to give O-positive RBCs as uncrossmatched blood. This patient has already been exposed to Rh-positive blood after a previous accident. What is a possible outcome?
The patient may have a hemolytic transfusion reaction from an allo immunized anti-D.
Anti-D is not immunogenic, and the patient probably would not have formed an anti-D.
Anti-D is not hemolytic, and even with the circulating antibody there would be no danger
to the patient.
The anti-D would activate complement, and a strong intravascular transfusion reaction
would occur.
The patient may have a hemolytic transfusion reaction from an allo immunized anti-D.
Routine pre-transfusion testing consists of all of the following except:
ABO typing.
an antibody screen.
Rh typing
a DAT.
a DAT.
A cord blood specimen from a jaundiced infant should be tested for which of the following?
a. ABO
b. Rh
c. DAT
d. All of the above
d. All of the above
What is the physiological mechanism of Rh-immune globulin?
Attachment of fetal Rh-positive red blood cells in fetal circulation, inhibiting production of anti-D
Attachment of maternal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D
Attachment of fetal Rh-positive red blood cells in maternal circulation, inhibiting production of anti-D
Attachment of fetal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D
Attachment of fetal Rh-positive red blood cells in maternal circulation, inhibiting production of anti-D
A 300-µg dose of Rh-immune globulin contains sufficient anti-D to protect against how much whole blood?
15 mL
30 mL
50 mL
100 mL
30 mL
In order for the mother to be considered for Rh-immune globulin, her Rh type must be _________, and her newborn must be __________.
a. Du-positive/Rh-positive
b. Rh-negative/Rh-positive
c. Du-negative/Du-negative
d. Rh-positive/Rh-negative
b. Rh-negative/Rh-positive
Due to a short supply of O-negative packed cells, an Rh-negative patient was transfused with 1 unit of Rh-positive red blood cells. Calculate the number of Rh-immune globulin vials needed to protect against 250 mL of Rh-positive packed cells.
a. 5
b. 17
c. 10
d. 23
17
What is the most common clinical manifestation of ABO HDFN?
a. Severe anemia
b. Hyperbilirubinemia
c. Hyperkalemia
d. Hypotension
b. Hyperbilirubinemia
Why is the Rh-positive firstborn of an Rh-negative mother unaffected by Rh hemolytic disease of the fetus and newborn (Rh HDFN)?
a. The plasma volume of the mother is tripled during the first pregnancy which dilutes anti-D.
b. The titer of anti-D is too low to cause destruction of fetal antigens.
c. The mother has not been immunized to the D antigen before placental separation
.
d. None of the above
c. The mother has not been immunized to the D antigen before placental separation
The results of a Kleihauer-Betke stain indicate a fetomaternal bleed of 40 ml of whole blood. How many vials of Rh-immune globulin would be required?
a. 1
b. 2
c. 3
d. 4
b. 2
What effect does ABO incompatibility between mother and fetus have on maternal sensitization to Rh antigen?
a. The chance of maternal sensitization to Rh antigen is increased.
b. The chance of maternal sensitization to Rh antigen is decreased.
c. It has no effect.
d. None of the above
b. The chance of maternal sensitization to Rh antigen is decreased.
What is the cause of HDFN?
a. Destruction of the mother’s RBCs by autoantibody
b. Destruction of the fetus’s RBCs by antibody produced by the mother
c. Destruction of the fetus’s RBCs by autoantibody
d. Destruction of the mother’s RBCs by antibody produced by the fetus
b. Destruction of the fetus’s RBCs by antibody produced by the mother
When is the antenatal dose of Rh-immune globulin given?
a. 20 weeks
b. 13 weeks
c. 28 weeks
d. 36 weeks
c. 28 weeks
Rh-immune globulin should be given within how many hours after delivery?
a. 24
b. 48
c. 36
d. 72
72
A postpartum woman was crossmatched for two units of leukoreduced packed red blood cells. The first unit was issued at 3:15 A.M. At 3:45 A.M., the nurse called the blood bank and stated that the patient was developing red hives and pruritis. The transfusion was stopped and a post-transfusion specimen was drawn. The unit and identification tags were returned to the blood bank. The DAT on the specimen was negative and hemolysis was absent from the plasma. All visual and clerical checks were satisfactory. The pathologist ordered the treatment of diphenhydramine for all subsequent transfusions. What type of transfusion reaction has occurred in this patient?
Urticarial
Anaphylactic
Alloimmunization
Febrile
Urticarial
A multiparous patient received two units of platelets obtained by apheresis following open heart surgery. Within seven days her platelet count was 9000/mm3. Purpura was clearly evident on her body. All tests for coagulation factors were normal. Which of the following antibodies could cause this?
Anti-Bg(a)
Anti-A,B
Anti-Jk(a)
Anti-PLA1
Anti-PLA1
A 16-year-old male goes to his physician for an annual checkup. A routine urinalysis indicates the presence of blood, an increase in protein and an increase in urea. The young man reports he has been feeling tired and has a persistent cough. The doctor orders additional laboratory testing, including a serum test for rheumatoid factor, antinuclear antibody testing, anti-streptolysin O testing, and testing for the presence of anti-basement membrane antibodies. Only the latter was positive. What disease is most likely the cause of the symptoms?
SLE
Goodpaster’s syndrome
MS
Rheumatoid arthritis
Goodpaster’s syndrome
Which of the following is an indicator of acute immune hemolytic transfusion reaction?
Increased haptoglobin
Decreased LDH
Increased hemoglobin
Increased bilirubin
Increased bilirubin
. A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except:
Acute non immune hemolytic transfusion reaction
Febrile nonhemolytic transfusion reaction
Acute immune hemolytic transfusion reaction
Transfusion-associated sepsis
Acute immune hemolytic transfusion reaction
If a patient shows any adverse reaction while receiving a blood component, what is the first action that must be taken by the person overseeing the transfusion?
Notify the patients physician
Start an IV line to administer saline
Perform bedside clerical checks
Stop the transfusion
Stop the transfusion
A newborn is in need of an exchange transfusion. Whole blood is not available; however, a reconstituted unit of blood can be prepared. How is this prepapred?
Combine leukoreduced red blood cells of the infants ABO and Rh type with thawed FFP of the same ABO type
Combine group O, Rh negative, leukoreduced red blood cells with group O thawed FFP
Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP
Combine group AB, Rh negative, leukoreduced red blood cells, less than 7 days old and CMV negative with group O FFP
Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP
The D antigen is not detectable on platelets; therefore, why do some Rh negative people get Rh immune globulin when they are exposed to a unit of Rh positive platelets?
Units of platelets have numerous white blood cells which have the D antigen
Although the D antigen is not detectable, there is a G antigen on the platelets which has a D component
There are small numbers of red blood cells in the unit of platelets
Rh immune globulin is given prophylactically in case there is a lawsuit
There are small numbers of red blood cells in the unit of platelets
A patient has a 2.0 mL feto-maternal whole blood bleed and meets all the criteria for receiving Rh immune globulin (RHIG). Her baby was born at 40 weeks gestation without any complications. How many vials of RHIG should the mother receive?
One vial
Two vials
One micro dose
None, the bleed is so small
One vial
A group O patient started to receive a unit of group B packed RBCs. Within minutes he experienced fever, chills, hypotension and facial flushing. Ultimately, he went into shock and renal failure. What type of transfusion reaction is this?
Immediate HTR
Delayed HTR
Febrile nonhemolytic TR
Anaphylactic TR
Immediate HTR
An Rh-negative mother delivered an Rh-positive baby. The mother’s antibody screen was negative, When is the latest that the mother should receive Rh immune globulin?
24 hours post-delivery
48 hours post delivery
72 hours post delivery
She’s not a candidate for RhIG
72 hours post delivery
In cold autoimmune hemolytic anemia the antibody may show specificity. Which of the following could be the specificity?
Anti-e
Anti-Jk(a)
Anti-P
Anti-I
Anti-P
A Keilhauer-Betke stain was performed on the sample from a mom. A negative control slide and a positive control slide were stained with it. Upon examination all of the cells on every slide were darkly stained with a bright pink color. What is the explanation for this?
The slides were not properly fixed with 80% ethanol
The eluting solution was not at the correct pH
The slides were not properly dried to the start of the staining procedure
The staining solution was too strong
The eluting solution was not at the correct pH
An Rh negative mother was admitted to the labor room. As a part of the customary procedure, a type and screen was ordered. She was tested as group B, Rh negative and anti-D was identified in her serum. The titer of the anti-D was four. What is the source of the anti-D?
Previous pregnancy
Antenatal RhIG
Previously transfusion
Technical error
Antenatal RhIG
If a patient’s cells are coated with cold antibodies and spontaneous agglutination is observed, what can be done to resolve the spontaneous agglutination of the patient’s own cells?
Place the patient’s cells with his own serum at 4C so that the serum will remove the antibody from the patient’s cells, then test the patient’s cells with commercial antisera
Enzyme treat the patients cells to remove the cold antibody that is coating them, then test them with commercial antisera
incubate the commercial antisera and the patients cells at 4C prior to centrifugation and reading the results
Prewarm the patient’s cells and the commercial antisera at 37 C prior to making them together in the tube, centrifuging and reading with caution
Prewarm the patient’s cells and the commercial antisera at 37 C prior to making them together in the tube, centrifuging and reading with caution
A tech received a first voided urine sample after a transfusion reaction workup was ordered on a patient. What test should be done on this urine sample?
Examine it for free hemoglobin
examine it for intact RBCs
Test for hemosiderin
Test for myoglobin
Examine it for free hemoglobin
What is needed for the detection of drug induced antibodies?
Group O red cells coated with the drug in question
Group B red cells treated with an enzyme
Commercially prepared panel cells
Commercially prepared A1 and B cells
Group O red cells coated with the drug in question
An Rh negative mom miscarried at ten weeks gestation (first trimester). The antibody screen on her serum was negative at all phases. The Rh type could not be determined on the products of conception. How much Rh immune globulin should the mom receive?
One vial of RhIG containing 300 micrograms of anti-D
Two vials of RhIG containing 300 micrograms of anti-D
Perform a KBT to determine the amount of RhIG is needed
No RhIG is necessary
Perform a KBT to determine the amount of RhIG is needed
What is Rh immune globulin?
300 micrograms of IgG anti-D
200 micrograms of IgM anti-D
300 micrograms of IgM anti-D
100 micrograms of IgG anti-D
300 micrograms of IgG anti-D
A group O, Rh negative mom entered labor and delivery. Her type and screen was positive. The panel showed anti-D that was weakly positive (1+) at the AHG phase of testing. No prenatal records were readily available since she was visiting from another state. How can it be determined if the anti-D is passive or immune?
Titer the anti-D against R2R2 cells. If the titer is four or less, this is from Rh immune globulin
Test the anti-D against enzyme treated R2R2 cells. If the reaction is greater than 1+, this is immune anti-D
Titer the anti-D against its cell. If the result is positive, this is from Rh immune globulin
Titer the anti-D against the fathers cells. If the titer is greater than 64, this is Rh immune globulin
Titer the anti-D against R2R2 cells. If the titer is four or less, this is from Rh immune globulin
It is documented on a patient’s chart that he has a pyrogenic transfusion reaction. The doctor has ordered the transfusion of a unit of platelets obtained by apheresis technology. How can the pyrogenic transfusion reaction be avoided?
Wash the platelets to remove the plasma and some of the leukocytes
Pretreat the patients with an antihistamine
Transfuse HLA matched platelets
Leukoreduce the plateletpheresis product
Leukoreduce the plateletpheresis product
Unwashed red blood cells from a cord sample were ABO/Rh typed. Which of the following could be expected?
The cells would type as expected with the Rh control negative. No problems.
The cells would type negative with all reagents except the Rh control would be positive
The cells would be positive with all reagents including the Rh control
None of the above
The cells would be positive with all reagents including the Rh control
What is the immunologic mechanism of Rh immune globulin administration?
Anti-D attaches to Rh positive cells of the mother and these cells are subsequently removed by cells of the mothers reticuloendothelial system preventing sensitization of the mother
Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Anti-D attaches to Rh negative cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Anti-D crosses the placenta and attaches to Rh positive cells of the infant. The cells are subsequently removed by cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother
Which of the following is one of the immediate procedures in the laboratory investigation of a transfusion reaction?
DAT on the post-transfusion sample
Repeat the crossmatch on the transfused unit using a post-sample
Measure the amount of free hemoglobin in the first voided sample
Repeat the antibody screen on the pre- and post- transfusion samples
DAT on the post-transfusion sample
If a patient shows any adverse reaction while receiving a blood component, what is the first action that must be taken by the person overseeing the transfusion?
Notify the patients physician
Start an IV line to administer saline
Perform bedside clerical checks
Stop the transfusion
Stop the transfusion
A newborn is in need of an exchange transfusion. Whole blood is not available; however, a reconstituted unit of blood can be prepared. How is this prepapred?
Combine leukoreduced red blood cells of the infants ABO and Rh type with thawed FFP of the same ABO type
Combine group O, Rh negative, leukoreduced red blood cells with group O thawed FFP
Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP
Combine group AB, Rh negative, leukoreduced red blood cells, less than 7 days old and CMV negative with group O FFP
Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP
How might a technologist detect a patient with drug induced hemolytic anemia?
A positive rosette test
Positive antibody screen
A positive DAT
An ABO discrepancy
A positive DAT
A postpartum woman was crossmatched for two units of leukoreduced packed red blood cells. The first unit was issued at 3:15 A.M. At 3:45 A.M., the nurse called the blood bank and stated that the patient was developing red hives and pruritis. The transfusion was stopped and a post-transfusion specimen was drawn. The unit and identification tags were returned to the blood bank. The DAT on the specimen was negative and hemolysis was absent from the plasma. All visual and clerical checks were satisfactory. The pathologist ordered the treatment of diphenhydramine for all subsequent transfusions. What type of transfusion reaction has occurred in this patient?
Urticarial
Anaphylactic
Alloimmunization
Febrile
Urticarial
A multiparous patient received two units of platelets obtained by apheresis following open heart surgery. Within seven days her platelet count was 9000/mm3. Purpura was clearly evident on her body. All tests for coagulation factors were normal. Which of the following antibodies could cause this?
Anti-Bg(a)
Anti-A,B
Anti-Jk(a)
Anti-PLA1
Anti-PLA1
The clinical picture of transfusion related acute lung injury (TRALI) is similar to adult respiratory distress syndrome (ARDS). In TRALI the mechanisms for the lung injury are
Leukocyte antibodies in donor plasma or in patient plasma
Platelet antibodies in the patients plasma
Red blood cell antibodies in the donors plasma
Antibodies to thee lung tissue in the donors plasma
Leukocyte antibodies in donor plasma or in patient plasma
The following cell typing and serum typing results were obtained on a cord blood from a child to a group AB mom with a negative antibody screen.
Report the newborns blood type as group O
Wash the cells and repeat the cell typing. Wharton’s jelly may be interfering
Perform a DAT on the cells to determine if an elution is needed
Repeat a heel stick on the newborn and repeat the test
Wash the cells and repeat the cell typing. Wharton’s jelly may be interfering
There are two processes by which the body can dispose of sensitized red blood cells: intravascular and extravascular. Choose the correct answer below
Both processes begin with the formation of an immune complex on the red blood cell membrane. Extravascular cell destruction causes the release of hemoglobin, RBC stomata and intracellular enzymes.
Intravascular destruction does not cause lysis of red blood cells.
Intravascular destruction can result in damage to the sclera of the glomerulus, cortex, and tubules of the kidney and damage to the hepatic ports and hepatocytes.
Extravascular destruction only affects the liver
Intravascular destruction results in hematuria and extravascular destruction results in complement coated RBCs
An immune complex binds to the red blood cell membrane in intravascular destruction; however, the complex does not bind to the membrane in extravascular destruction
Intravascular destruction can result in damage to the sclera of the glomerulus, cortex, and tubules of the kidney and damage to the hepatic ports and hepatocytes.
Extravascular destruction only affects the liver
The fetal screen test using a rosetting technique is used to detect feto-maternal bleeds. Choose the correct answer below.
The test uses chemically modified anti-D for the purpose of spanning the distance between Rh(D) positive cells
The test can only be used if the mother is Rh(D) positive and the baby is Rh(D) negative
The mothers cells must be treated with enzyme to enhance the Rh(D) antigen
Because the anti-D is a low protein product, the test can be done at immediate spin without a 37 to AHG phase
The test uses chemically modified anti-D for the purpose of spanning the distance between Rh(D) positive cells
