Final Exam Flashcards by Stacy Silver

Which of the following activities is considered an external quality assessment?
a) Participating in accreditation
b) Reviewing a quality indicator
c) Performing daily QC
d) Performing a scheduled calibration

a) Participating in accreditation

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Which TAT should be monitored to assess the effectiveness of a change to a specimen transport process?
a) Analytical
b) Total Analytical
c) Post-analytical
d) Pre-analytical

d) Pre-analytical

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Which of the following is NOT a basic component of a QA program?
a) Calibration
b) Preventative maintenance
c) Record keeping
d) Keeping the hallways in the hospital clean

d) Keeping the hallways in the hospital clean

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Manual records can be corrected if:
a) Original entry is not deleted
b) The person making corrections includes initials
c) The item to be corrected is crossed off with a single line
d) All statements are true

d) All statements are true

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Which quality system essential guides managing test results and other data entered into laboratory recordkeeping systems?
a) Documents and Records Management
b) Information management
c) Non-conforming event management
d) Process management

a) Documents and Records Management

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All the following statements are true about SOPs except:
a) Step-by-step instructions
b) Used to monitor accuracy and precision
c) Written in compliance with manufacturing instructions
d) May refer to the operator manual for more specific troubleshooting recommendations

b) Used to monitor accuracy and precision

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What is the purpose of a competency assessment?
a) Identify employees in need of training
b) Identify employees who need to be fired
c) Identify employees who are not following SOPs
d) All of the above

a) Identify employees in need of training

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The following is (are) successful indicator(s) of a Quality Assurance and Quality Improvement programs in a clinical laboratory:
a) A log of incident reports and solutions attained
b) Emergency department and STAT turnaround times
c) Positive patient identification wristbands for blood bank operations
d) All of the above

d) All of the above

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Continuous Quality Improvement (CQI) is team effort approach for clinical laboratories to:
a) Identify potential problems and correct them
b) Set lab financial benchmarks for the year
c) Make up new LIS codes
d) Improve overall wages for lab employees

a) Identify potential problems and correct them

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Leukocytes are removed from transfusable blood components by a process called:
a) Leukoextraction
b) Leukorebation
c) Leukoreduction
d) Leukotransference

c) Leukoreduction

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While separating the components of a blood donation, you notice an unusual green colour in the plasma bag. Which of these could be the cause of the green colour?
a) The donor ate a fatty meal before the donation
b) The donor ate a large number of carrots before the donation
c) The donor is taking a vitamin A supplement
d) The donor is on a contraceptive pill

d) The donor is on a contraceptive pill

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Which process is used to decrease the risk of transmitting skin-borne infections during blood donation?
a) Scrubbing the IV site with 70% isopropyl alcohol
b) Preparing the IV site with 2% chlorhexidine
c) The first few mL of blood is directed into a diversion pouch before filling the main collection bag
d) All of the above

d) All of the above

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A patient refuses to have his blood drawn for a routine laboratory test request made by his physician. What is the most appropriate course of action?
a) Perform the venipuncture against the patient’s will
b) Do not attempt the venipuncture and file an incident report
c) Request that the patient be sedated, then collect the sample
d) Request for assistance from the legal department

b) Do not attempt the venipuncture and file an incident report

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What is the next step when an inpatient specimen arrives in blood bank with a spelling error in the name?
a) Ask the collector to sign a waiver
b) Reject the specimen
c) Use if the other identifiers are correct
d) Call the ward to confirm spelling

b) Reject the specimen

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Panel cells and screening cells may be used beyond their expiry dates:
a) For antibody screening
b) When in-date cells are not available
c) Without a policy that outlines the criteria for usage
d) To perform selected cells (antibody ID) as long as controls are used and working

d) To perform selected cells (antibody ID) as long as controls are used and working

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Phenotyping antisera may be used beyond their expiry dates, true or false?

True. They can be frozen and then used up to 6 months after expiry. You would have to do QC everytime you want to use them.

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An O Rh-negative mother with no record of any previous pregnancies gives birth to her first child, a B Rh positive baby. The baby’s DAT is weakly positive and the saline control for DAT testing is negative. The antibody screens are negative. The baby appears healthy but develops mild jaundice after 2 days. What is the most likely explanation for the weakly positive DAT?
a) Technical error
b) A low titer of Anti-D
c) Immune Anti-A,B from the mother
d) A maternal antibody against a low-incidence antigen

c) Immune Anti-A,B from the mother

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A patient was previously typed as blood group O. Forward grouping was negative with Anti-A and Anti-B. Reverse grouping showed reactivity with A1 cells and B cells. The technologist reported this patient’s type as A. What technical error occurred?
a) LIS error
b) Failure to add reagents
c) Clerical error
d) Reagent mix up

c) Clerical error

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Why is incubation omitted in the direct antiglobulin test?
a) Incubation will cause hemolysis
b) The antigen-antibody complex has already formed in vivo
c) The direct antiglobulin test is used if there is not enough time to perform the indirect test
d) The direct antiglobulin test only detects IgM antibodies

b) The antigen-antibody complex has already formed in vivo

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The technician adds Coombs control cells to the test to verify the result. When the Coombs control cells are added, no agglutination is observed. Which of these is the correct interpretation?
a) The original negative test results are valid
b) The patient has antibodies against their own red blood cells
c) The saline washings were adequate
d) The test needs to be repeated

d) The test needs to be repeated

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In compatibility testing, it is important to:
a) Take all crossmatches through to IAT when there is an antibody present in the recipient’s serum
b) Choose only ABO-compatible red cells, regardless of alloantibodies in the recipient’s serum
c) Use pre-transfusion group and screen for all crossmatches done after a transfusion reaction has taken place
d) None of the above

a) Take all crossmatches through to IAT when there is an antibody present in the recipient’s serum

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Why is the transfusion product tagged before it is used and transfused?
a) To identify the patient
b) To verify compatibility results
c) To verify the donor number
d) All are correct

d) All are correct

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Before a unit is issued, donor units should be observed for?
a) Blood clots
b) Correct labelling
c) Abnormal colour
d) All of the above

d) All of the above

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One of the best ways to protect and keep a safe laboratory environment is to provide employees with
a) Health benefits
b) Rest breaks
c) Safety education
d) Fluid-repellent laboratory coats

c) Safety education

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One of the most economical disinfectants to use is a) 1:10 fresh solution of sodium hypochlorite b) 1:5 solution of household Lysol c) 1:15 solution of sodium hydroxide d) Detergent and water mixture

a) 1:10 fresh solution of sodium hypochlorite

The material safety data sheets for hazardous chemicals address which of the following conditions? a) Physical characteristics of the chemical b) Safe handling and storage of the chemical c) Specific health hazards associated with the chemical d) All of the above

d) All of the above

Which of the following represents the final clerical check before transfusion? a) Phlebotomist asks patient to state their name and hospital number and compares with the requisition b) Medical Lab tech compares specimen label with LIS info c) Nurse and another individual use the patient's armband to compare patient ID with patient crossmatch tags and slips d) Two individuals verify affixing the proper labels to the selected blood products

c) Nurse and another individual use the patient's armband to compare patient ID with patient crossmatch tags and slips

Blood components may be returned to the transfusion services if which of the following conditions have been met and documented? a) At least one of the ports or closures are intact b) At least three sealed segments on the donor unit are attached c) Visual inspection of the components is satisfactory d) The temperature of the blood component is acceptable, and the component has been out of the controlled environment for less than 60 minutes from the time of issue

d) The temperature of the blood component is acceptable, and the component has been out of the controlled environment for less than 60 minutes from the time of issue

In a delayed transfusion reaction, all are false except: a) Symptom usually occurs after the 24 hours up to 10 days post transfusion b) Usually involves IgM antibodies c) Antibodies are present in high titre at the time of transfusion d) Is usually not clinically significant to the patient

d) The temperature of the blood component is acceptable, and the component has been out of the controlled environment for less than 60 minutes from the time of issue

What may be found in the serum of a person who is exhibiting signs of TRALI? a) Red blood cell alloantibody b) IgA antibody c) Leukocyte antibodies d) Allergen

c) Leukocyte antibodies

If a donor notifies CBS they develop a fever 2 days following a donation, what action is CBS required to take? a) Initiate a lookback b) Initiate a recall c) Initiate a traceback d) No action is required

a) Initiate a lookback

A patient experiences chills and lower back pain after 10 mL of blood. To rule out AHTR, one should immediately: a) Perform DAT and compare pre/post sample b) Measure serum haptoglobin c) Repeat crossmatches d) Perform Gram stain and culture unit

a) Perform DAT and compare pre/post sample

What is the common cause of a febrile non-hemolytic transfusion reaction? a) Recipient is allergic to donor's plasma proteins b) Donor unit is cold c) Donor unit has a positive DAT d) Recipient has antibodies to the donor's HLA antigens

d) Recipient has antibodies to the donor's HLA antigens

Which of the following adverse complications of transfusion is prevented by the irradiation of blood components: a) Allergies b) Hyperkalemia c) TACO d) GVHD

d) GVHD

Which of the following characteristics is associated with delayed serological transfusion reactions? a) Hives b) Hemosiderosis c) Positive antibody screen in post transfusion sample d) ABO incompatibility between donor unit and recipient

c) Positive antibody screen in post transfusion sample

Which of the following patients' histories might suggest future transfusions with saline-washed RBCs? a) History of multiple allo antibodies b) History of congestive heart failure c) IgA negative recipient with anti-IgA antibodies d) Transfusion-associated sepsis

c) IgA negative recipient with anti-IgA antibodies

A decrease in a recipient's platelet count after a transfusion is associated with? a) Circulatory overload b) Citrate toxicity c) Factor VIII deficiency d) PTP

d) PTP

The use of plasma from only male donors for transfusion is the preventative method for which type of transfusion reaction? a) Febrile b) TRALI c) Allergic d) TACO

b) TRALI

5 Days after a transfusion, patient returned or postsurgical CBC. Hemoglobin decreased from 110 to 90 g/L. To rule out DHTR what tests are performed? a) DAT on current sample, elution if positive b) Antibody screen on the current sample c) Blood smear to check for spherocytes d) All the above

d) All the above

Three victims of an automobile accident arrive at the trauma centre at the same time. An 18-year-old female, a54-year-old male, and a 76-year-old female. All require blood. All are O Rh negative, and the 76 year old has Anti-D. The blood bank inventory includes only two units of O Rh negative. Which patient should receive it?

The 76 year old female because she has Anti-D and transfusions with Rh-positive blood would lead to a transfusion reaction (if she didn't have Anti-D, we should give it to the 18 year old female to prevent immunization of D and the possibility of HDFN).

When a transfusion of Rh-positive blood is given to an Rh-negative recipient (unavoidable), what can be administered to prevent immunization?

RhIg

How might a transfusion of non-group-specific blood affect subsequent blood grouping results?

Donor cells are detectable in the recipient for up to 3 months (the life span of an RBC). Forward grouping reactions may be weaker and display mixed field reactions if Group O PRBCs have been transfused to a non-Group O patient.

Why do some hospital policies require you to perform a DAT before switching back to the recipient’s blood group?

Passive Anti-A and Anti-B might be detected in the reverse grouping in large volumes of Group O RBCs that have been transferred to a patient of another group

Warming blood components is indicated for: a) Autologous transfusion b) Massive Transfusions c) Cold Agglutinin disease d) Both b) and c)

d) Both b) and c)

In Adults, one unit of red blood cells will increase the hemoglobin by approximately: a) 50 g/L b) 1 g/L c) 10 g/L d) 20 g/L

c) 10 g/L

Which antibody are we testing for to investigate Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT)?

Anti-HPA

Which antibody are we testing for to investigate Post Transfusion Purpura (PTP)?

Anti-HPA

Which antibody are we testing for to investigate Platelet Refractoriness?

Anti-HPA and Anti-HLA

Which antibody are we testing for to investigate TRALI?

Anti-HLA

Which antibody are we testing for to investigate organ transplant?

Anti-HLA

If the donor notifies CBS that they developed a fever two days after the donation of apheresis platelets, what action is CBS required to take? a) Initiate a Lookback b) Initiate a Recall c) Initiate a Traceback d) No action is required

a) Initiate a Lookback

What is the average volume in a unit of pooled buffy coat platelets? a) 45 mL b) 60 mL c) 184 mL d) 150 mL

c) 184 mL

Why do platelets require continuous agitation during storage? a) To prevent aggregation and to prime the platelets b) To facilitate gas exchange and prevent bacterial growth c) To prevent aggregation and keep the plastic supple d) To facilitate gas exchange and prevent aggregation

d) To facilitate gas exchange and prevent aggregation

Which of the following is not usually considered when selecting platelets for transfusion? a) ABO/Rh compatible b) ABO/Rh specific c) Visually acceptable for transfusion d) Serologically crossmatched

d) Serologically crossmatched

Which anticoagulant is currently used in Canada for routine whole blood donation for buffy coat blood component production? a) SAGM b) CPD c) AS3 d) EDTA

b) CPD

What term describes a poor platelet response to transfused platelets because of the presence of HLA or platelet antibodies? a) Haplotype b) Refractory c) Vasoactive d) Thrombocytopenia

b) Refractory

How do patients become sensitized to HLA a) Pregnancies b) Blood Transfusions c) Organ Transplant d) All of the Above

d) All of the Above

In the Platelet inventory below, what would you select for a Group A Rh Rh negative male patient requiring a platelet transfusion? a) Group A Neg apheresis expiring at midnight b) Group O Pos apheresis expiring at midnight c) Group AB Neg pool expiring in 3 days d) Order Group A Neg from CBS

a) Group A Neg apheresis expiring at midnight

What are the key benefits of automation in transfusion practices?

Fewer steps, better traceability, and standardization. Error reduction (sample ID, reagent dispensing). Improved turnaround time and unbiased interpretation.

What are the three main companies mentioned for automated blood grouping/screening technology?

Ortho (ProVue, Vision) Immucor (Echo Lumena, Neo Iris) Bio-Rad (Tango)

What is the purpose of validation in automated systems?

Ensure instrument accuracy by testing 100 samples (normal/abnormal). Compare results with manual methods and calculate % error. Requires freeze/purchased samples for consistency.

What are common pitfalls when implementing automation?

Validation challenges. Training demands. High initial cost. LIS interfacing issues. Staff perception (gold standard adjustment).

How does MTS (Gel) technology work in Ortho’s ProVue/Vision systems?

Uses gel cards with 0.8% cell suspension. Internal incubator/centrifuge. Camera reads reactions; software grades results. Tests: ABO/Rh, screens, panels, DATs, IATs.

What is solid-phase technology (e.g., Immucor’s Echo Lumena)?

Uses microplate wells coated with antigens/antibodies. Red cells adhere to wells; agglutination is measured. Automated interpretation via built-in centrifuge.

What are critical training tips for automation implementation?

Train superusers early. Avoid peak holiday months (Dec/Jan, Jul/Aug). Overlap old/new systems for supply chain backup.

How does automation improve reagent management?

Pre-dispensed antisera (no human error). Barcode tracking for lot numbers/expiry. Minimal dead volume/reagent waste.

What is the role of LIS interfacing in automation?

Transfers results directly to LIS. Requires IT/vendor collaboration. Positive screens auto-graded and logged.

What are the levels of automation for lab test menus?

Workhorse analyzer: High volume, minimal tech attention. Bench-top analyzer: Mid-size labs, more tech involvement. Semi-automated: Incubator/centrifuge + computer.

Why is unbiased interpretation a benefit of automation?

Standardizes grading (reduces tech-to-tech variability). Clear protocols (e.g., repeat tests only if grading increases by 1+).

What troubleshooting steps are recommended for automated systems?

Document errors, then call vendor hotline. Use remote dial-in (IT firewall checks). Fill "Out of Service" forms and notify affected departments.

Compare MTS (gel) vs. solid-phase technology.

MTS: Gel cards, camera-based grading (Ortho). Solid-phase: Microplate wells, antigen/antibody binding (Immucor).

What are key SOP tips for automation?

Use manufacturer’s manuals/job aids. Include diagrams/examples in SOPs. Keep logs visible; involve superusers in writing.

How does Tango by Bio-Rad function?

Uses microplate wells pre-coated with antisera. Performs ABD, phenotyping, hemagglutination. Built-in centrifuge and automated interpretation.

What are the three main components of a Quality System?

Quality System: Organizational framework covering all operations. Quality Assurance (QA): Planned activities to assess and ensure quality. Quality Control (QC): Operational techniques to maintain quality.

How many Quality System Essentials (QSEs) are included in a Quality Management System?

12 QSEs (e.g., document control, personnel competency, non-conforming event management).

What is the difference between a Policy and a Procedure?

Policy: "What & Why" (e.g., "Perform KLH to assess FMH for RhIg dosage"). Procedure: "How to do it" (step-by-step instructions, e.g., SOP for issuing RhIg).

What are the 3 phases of workflow in QA?

Pre-examination: Test selection, sample collection. Examination: Laboratory analysis. Post-examination: Result interpretation, reporting.

What is the purpose of leukoreduction in blood components?

To reduce febrile non-hemolytic transfusion reactions (FNHTRs) and improve patient outcomes.

Name 3 QA measures during blood donation.

Donor questionnaire. Sterile equipment/arm cleaning. Diversion pouch for skin-borne infection risk.

What checks are done when receiving blood products in the hospital?

Tamper-proof seals intact. Proper storage temperature (e.g., PRBCs at 1–6°C, platelets agitated at 20–24°C). Revised expiry dates if modified.

Why are irradiated RBCs stored separately?

To prevent accidental transfusion to non-eligible patients (e.g., immunocompromised).

What are the "8 Rights of Transfusion"?

Right patient Right product Right reason Right dose Right time Right site Right documentation Right response

What must be done if a transfusion reaction is suspected?

Stop transfusion immediately. Notify physician and blood bank. Draw post-transfusion sample. Return bag for culture/investigation.

What is the difference between Traceback and Lookback?

Traceback: Hospital reports infection → CBS traces donor/recipients. Lookback: CBS informs hospital of donor infection → hospital notifies recipients.

Which agencies perform external audits in Canadian labs?

Accreditation Canada, IQMH (Institute for Quality Management in Healthcare).

What do CBS, ORBCON, and TTISS stand for?

CBS: Canadian Blood Services. ORBCON: Ontario Regional Blood Coordinating Network. TTISS: Transfusion Transmitted Injuries Surveillance System.