Final Exam Flashcards
What red cell morphology is indicative of globin denaturation caused by increased intracellular oxidants?
a) bite cells
b) spherocytes
c) Heinz bodies
d) target cells
C) Heinz bodies
What would the hemoglobin (oxygen dissociation curve depict in a patient exhibiting clinical signs of alkalosis?
Question 2 options:
a) normal
b) shift to the left
c) shift to the right
d) none of the above
B) Shift to the left
Which of the following best describes the process of mitosis?
Question 3 options:
a) cell division by which only half of the daughter cells produced are identical to the parent cell
b) cell division of germ cells by which two successive divisions of the nucleus produce cells that contain half the number of chromosomes of somatic cells
c) cell division that produces four daughter cells (4n)
d) cell division that produces two daughter cells having the same number of chromosomes as the parent
D) Cell division that produces two daughter cells having the same number of chromosomes as the parent
Which of the following best describes the principle of polymerase chain reaction (PCR)?
Question 4 options:
a) migration of proteins in an electrical field
b) amplification of RNA using two oligonucleotide primers that hybridize to opposite DNA strands
c) amplification of DNA using two oligonucleotide primers that hybridize to opposite DNA strands, isolating a particular segment
d) enzymatic cleavage of proteins for DNA sequencing
C) Amplification of DNA using two oligonucleotide primers that hybridize to opposite DNA strands, isolating a particular segment
Gel electrophoresis is a useful tool in DNA cloning. At a neutral pH when voltage is applied DNA fragments will migrate toward the anode because:
Question 6 options:
a) DNA is positively charged due to its phosphate backbone.
b) DNA is positively charged due to its glycine backbone.
c) DNA is negatively charged due to its glycine backbone.
d) DNA is negatively charged due to its phosphate backbone.
D) DNA is negatively charged due to its phosphate backbone
These are described as bacterial circular genetic elements that replicate independently from the chromosome and are capable of conferring bacterial resistance to certain antibiotics in DNA cloning.
Question 7 options:
a) extrons
b) plasmids
c) codons
d) introns
B) Plasmids
All of the following are examples of recombinant proteins used in transfusion medicine, except:
Question 8 options:
a) G-CSF
b) Stem cell factor
c) Epoetin-alpha
d) Factor VIII
B) Stem cell factor
Extravascular hemolysis occurs when red cells are coated with antibody; what organ sequesters these cells?
Question 9 options:
a) thymus
b) reticuloendothelial system
c) bone marrow
d) all of the above
B) Reticuloendothelial system
Which IgG subclass primarily comprises antibodies to the Rh blood group system? Question 10 options:
a) IgG2, IgG4
b) IgG1, IgG3
c) IgG3, IgG4
d) IgG1, IgG2
B) IgG1, IgG3
What does hemolysis represent in an antigen-antibody reaction?
a) a negative result
b) a positive result
c) an inconclusive result
d) none of the above
b) a positive result
All of the following are factors of antigens that affect the type and extent of immune response except:
a) genetic locus
b) solubility
c) molecular weight
d) charge
a.) genetic locus
How is the classical pathway of complement activated?
a) by binding of antigen with antibody
b) by polysaccharides on the surface of bacteria
c) by enzyme catalysis
d) by lipopolysaccharides on surface of red cells
a) by binding of antigen with antibody
Which metabolic pathway permits the accumulation of 2,3 DPG?
Question 4 options:
a) glycolysis
b) Luebering-Rapoport shunt
c) methemoglobin reductase
d) pentose phosphate shunt
b) Luebering-Rapoport shunt
What is the definition of an immunoglobulin?
a) a protein molecule produced in response to an antigen
b) a protein molecule produced in response to an antibody
c) a substance that aids in the growth and proliferation of leukocytes
d) a substance that aids in the primary immune response
a) a protein molecule produced in response to an antigen
How would a negative IAT be demonstrated in solid phase methodology?
a) cells form a monolayer
b) pellet at bottom of well
c) small agglutinins at bottom of well
d) well turns orange
b) pellet at bottom of well
Why is the 37øC reading omitted when using PEG additive?
a) Antibodies detected by PEG do not react at 37°C.
b) PEG may cause aggregation of RBCs at 37°C
c) Unwanted reactions due to C3b will be detected at 37°C.
d) Warm-reacting antibodies are not clinically significant.
b) PEG may cause aggregation of RBCs at 37°C
An antibody screen is performed, and all three tubes are negative after adding AHG. Check cells are added, and the tubes are centrifuged. No agglutination occurs after the addition of check cells. What is the next course of action?
a) recentrifuge tubes
b) addition of one drop of AHG
c) repeat the antibody screen
d) addition of one drop of control cells
c) repeat the antibody screen
Why does anti-C3d activity require standardization in AHG reagents?
a) Low activity will fix anti-H and other clinically insignificant antibodies.
b) High activity will fix anti-I and other clinically insignificant antibodies.
c) It eliminates false negative reactions.
d) two of the above
b) High activity will fix anti-I and other clinically insignificant antibodies.
What percentage of the type A population are A1?
a) 20%
b) 80%
c) 10%
d) 50%
b) 80%
All of the following are tests performed in the blood bank to classify subgroups of A except:
a) elution
b) anti-H Lectin reactivity
c) absorption
d) LISS enhancement
d) LISS enhancement
An AB male mates with another AB female. What could be the genotype of the offspring?
a) AB
b) AA
c) BB
d) all of the above
d) all of the above
Forward grouping is defined as:
a) detecting antigen(s) on an individual’s red cells via reagent antisera
b) detecting antibody on an individual’s red cells via reagent antisera
c) detecting ABO group antigen via reagent red cells
d) detecting ABO group antibody via reagent red cells
a) detecting antigen(s) on an individual’s red cells via reagent antisera
What does the term “exalted D” refer to?
a) deletion of the D antigen
b) stronger expression of Ee antigens when D is missing
c) stronger expression of D antigens when Cc and Ee are missing
d) stronger expression of Cc antigens when D is missing
c) stronger expression of D antigens when Cc and Ee are missing
All of the following are true regarding Rh antibodies except:
a) An individual with a low titer Rh antibody may experience a secondary immune response on antigen exposure.
b) Rh antibodies can bind complement on the red cell membrane.
c) Red cell destruction is usually extravascular.
d) Rh antibodies may cause a delayed hemolytic transfusion reaction.
b) Rh antibodies can bind complement on the red cell membrane.
A gene, such as the O gene, that produces no detectable product is called:
a) an amorph
b) an allele
c) recessive
d) a trait
a) an amorph
Which red cell preservative has a storage time of 35 days?
a) CPDA-1
b) ACD
c) CPD
d) AS-1
a) CPDA-1
What would the hemoglobin (oxygen dissociation curve depict in a patient exhibiting clinical signs of alkalosis?
a) normal
b) shift to the left
c) shift to the right
d) none of the above
b) shift to the left
Alternate forms of a gene that can occur at a single chromosome locus are referred to as:
a) amorph
b) alleles
c) recessive
d) trait
b) alleles
Which of the following must be true when using the Hardy-Weinberg equation?
a) the population must be large
b) mutations cannot occur
c) mating must occur randomly
d) all of the above
d) all of the above
When an individual is said to have blood group A, it refers to the individual’s:
a) haplotype
b) genotype
c) phenotype
d) alleles on the chromosome
c) phenotype
What is responsible for recognition of the antibody-binding site to homologous antigen?
a) variable region of light/heavy chain
b) complementarity
c) solubility of antigen
d) phenotype
a) variable region of light/heavy chain
Which metabolic pathway is responsible for generating 90% of the ATP for the RBC?
a) pentose phosphate shunt
b) Luebering-Rapoport shunt
c) methemoglobin reductase
d) glycolysis
d) glycolysis
Which of the following metabolic pathways is responsible for maintaining heme iron in the ferrous (Fe) state?
a) methemoglobin reductase
b) glycolysis
c) Luebering-Rapoport shunt
d) pentose phosphate shunt
a) methemoglobin reductase
Which of the following statements are false concerning the structure of immunoglobulins?
a) The enzyme papain splits the antibody molecule at the hinge region to give three fragments (2 Fab + 1Fc).
b) The Fc portion is responsible for complement fixation, monocyte binding, and placental transfer.
c) The Fab portion is the region responsible for antigen binding.
d) IgM participates in placental transfer.
d) IgM participates in placental transfer
What is the function of helicases and gyrases in the polymerase chain reaction?
a) to anneal to cDNA sequences
b) to unwind the DNA
c) to generate blunt-ended double-stranded products
d) to extend the primer sequence
b) to unwind the DNA
What MHC Class encodes complement components?
a) Class I
b) Class II
c) Class III
d) all of the above
c) Class III
The portion of the immunoglobulin molecule which determine class:
a) light chain
b) heavy chain
c) kappa chain
d) lambda chain
b) heavy chain
When 1000 donors were tested, 75% were positive for C and 25% were negative for C; the gene frequency of C is:
a) 25
b) 10
c) 1
d) 0.5
d) 0.5
A woman with blood group A marries a man with blood group O. Their first born child has blood group O. The mother’s most probable genotype is:
a) AO
b) OO
c) AB
d) AA
a) AO
In an immune response, what is the time called in which no antibody is detected in test serum?
a) latency period
b) amnestic response
c) secondary response
d) primary response
a) latency period
In an immune response, __________ antibodies are formed before _______.
a) IgM, IgA
b) IgM, IgG
c) IgG, IgM
d) IgG, IgA
b) IgM, IgG
A human gamete (egg or sperm) contains how many chromosomes?
a) 23 pairs
b) 46 pairs
c) 46 chromosomes
d) 23 chromosomes
d) 23 chromosomes
In the MN blood group system, a person who inherits an “M” allele and “N” allele expresses both M and N antigens on the red blood cells. Which of the following is true?
a) M and N are located on the same chromosome
b) N is dominant to M
c) M an N are codominant alleles
d) M is dominant to N
c) M an N are codominant alleles
In Mendel’s law of separation, the first-filial generation is:
a) autologous
b) homozygous
c) recessive
d) heterozygous
d) heterozygous
Which of the following is representative of the “central dogma” of molecular biology?
a) The basic information of life flows from proteins to genes.
b) The basic information of life flows from DNA through RNA to proteins.
c) The basic information of life flows from RNA through DNA to proteins.
d) The basic information of life flows from amino acids to proteins.
b) The basic information of life flows from DNA through RNA to proteins
A father carries the Xga trait and passes it on to all of his daughters, but none of his sons. What type of inheritance does this represent?
a) autosomal dominant
b) X-linked recessive
c) autosomal recessive
d) X-linked dominant
d) X-linked dominant
All of the following are functions performed by the complement system except:
a) decreased vascular permeability
b) direct lysis of bacteria
c) promoter of phagocytosis
d) smooth muscle contraction
a) decreased vascular permeability
What is a vector?
a) extrachromosomal genetic element that can carry a recombinant DNA molecule into a host bacterial cell
b) substance that can carry an electric current in solution
c) substance capable of catalyzing a reaction
d) sequence of three bases in a strand of DNA
a) extrachromosomal genetic element that can carry a recombinant DNA molecule into a host bacterial cell
IgG-coated red cells will be phagocytized by what effector cells?
a) monocytes/macrophages
b) basophils
c) eosinophils
d) T cells
a) monocytes/macrophages
What is the function of mononuclear phagocytes?
a) produce antibody
b) present processed antigen to lymphocytes
c) release histamine released
d) present processed antibody to lymphocytes
b) present processed antigen to lymphocytes
All of the following biochemical changes are associated with loss of red cell viability upon storage except:
a) loss of red cell function
b) increased ATP level
c) decreased pH
d) decreased glucose consumption
b) increased ATP level
All of the following are consistent with a “shift to the right” of the hemoglobin (oxygen dissociation curve except:
a) decreased 2,3 DPG
b) 50% O2 saturation to tissues
c) decreased hemoglobin affinity for O2
d) increased 2,3 DPG
a) decreased 2,3 DPG
How is RNA different from DNA?
a) RNA usually exists as one strand
b) Ribose is substituted for deoxyribose.
c) RNA incorporates uracil.
d) all of the above
d) all of the above
How do restriction endonucleases function?
a) disrupt hydrogen bonding in DNA structure
b) cut DNA into smaller fragments
c) promote digestion of RNA
d) terminate translation of mRNA
b) cut DNA into smaller fragments
Which of the following corresponds to the basic structure of immunoglobulin?
a) two light chains held together with an interlink disulfide bond
b) two light chains and two heavy chains held together by covalent disulfide bonds
c) one light chain and one heavy chain held together by covalent disulfide bonds
d) two heavy chains held together with an interlink disulfide bond
b) two light chains and two heavy chains held together by covalent disulfide bonds
The diploid chromosomes number in humans is:
a) 23
b) 12
c) 92
d) 46
d) 46
Only 5% of Kell-negative individuals will develop antibodies to Kell if exposed to the Kell antigen, whereas 50% to 70% of Rh (D) negative individuals would produce antibodies to D upon exposure. What is the reason for this?
a) difference in ABO type
b) difference in immunogenicity
c) phenotype
d) all of the above
b) difference in immunogenicity
How is it genetically possible for a child to type Rh negative?
a) both parents are (DD)
b) mom is DD and Dad is Dd
c) both parents are (Dd)
d) sibling is Rh positive
c) both parents are (Dd)
In the normal hemoglobin–oxygen dissociation curve, what percentage of oxygen is released to the tissues when PO2 averages 40 mmHg?
a) 25%
b) 75%
c) 100%
d) 50%
a) 25%
Which immunoglobulin is found in greatest concentration in serum?
a) IgA
b) IgE
c) IgG
d) IgM
c) IgG
At what temperature do IgM antibodies react?
a) 22°C
b) 37°C
c) 42°C
d) 56°C
a) 22°C
Which blood group antibodies are known to activate complement leading to intravascular hemolysis?
a) Lewis
b) ABO
c) Duffy
d) Rh
b) ABO
What does polyspecific AHG contain?
a) IgG
b) C3b
c) C3d
d) all of the above
d) all of the above
At what temperature do IgG antibodies react optimally?
a) 22°C
b) 56°C
c) 4°C
d) 37°C
d) 37°C
What class of immunoglobulin is capable of crossing the placenta?
a) IgE
b) IgG
c) IgM
d) IgD
b) IgG
Which immunoglobulin exists in a pentameric configuration?
a) IgG
b) IgM
c) IgA
d) IgE
b) IgM
What is meant by the term “autosomal”?
a) Organism possesses different alleles for a given characteristic.
b) Trait is not expressed in the parents.
c) Trait is not carried on the sex chromosomes.
d) Trait is carried on sex chromosomes.
c) Trait is not carried on the sex chromosomes.
If not labeled “gamma heavy chain specific,” monospecific anti-IgG may contain antibodies to:
a) alpha heavy chains
b) C3d
c) immunoglobulin light chains
d) mu heavy chains
c) immunoglobulin light chains
How is a 40:1 ratio of serum to cells prepared for the AHG test?
a) 1 drop serum + 5 drops of a 5% v/v red cell suspension
b) 2 drops serum + 1 drop of a 5% v/v red cell suspension
c) 1 drop of serum + 1 drop of a 5%v/v red cell suspension
d) 5 drops of serum + 1 drop of a 5% v/v red cell suspension
b) 2 drops serum + 1 drop of a 5% v/v red cell suspension
Why is incubation omitted in the direct AHG test?
a) Incubation will cause lysis of red cells.
b) In vivo antigen (antibody complex is already formed.
c) Polyspecific AHG contains a higher dose of anti-IgG.
d) Incubation elutes complement components from red cells.
b) In vivo antigen (antibody complex is already formed.
What is the incubation time for the IAT when saline is used instead of LISS?
a) 10 minutes
b) 1 hour
c) 15 minutes
d) 30 minutes
d) 30 minutes
A patient came in for a routine type and screen prior to surgery. The antibody screen was negative at 37°C and AHG phase. Check cells did not produce agglutination often. What is a possible explanation for this result?
a) inadequate washing
b) dirty glassware
c) overcentrifugation
d) use of positive DAT cells
a) inadequate washing
At what temperature is the incubation phase of the AHG test?
a) 22°C
b) 56°C
c) 37°C
d) 4°C
c) 37°C
What is a possible consequence of incubating tubes too long with LISS when performing the IAT?
a) increased sensitivity
b) hemolysis
c) elution of antibody from red cell
d) all of the above
c) elution of antibody from red cell
Most clinically significant blood group antibodies are of what IgG subclass?
a) IgG1 and IgG2
b) IgG2 and IgG3
c) IgG2 and IgG4
d) IgG1 and IgG3
d) IgG1 and IgG3
Polyspecific AHG contains:
a) anti-IgG and anti-C3b-C3d
b) anti-IgG
c) anti-IgG and anti-IgM
d) anti-C3b-C3d
a) anti-IgG and anti-C3b-C3d
What do “check cells” contain?
a) Rh(D)- red cells coated with anti-D
b) A+ red cell coated with anti-D
c) Rh(D)+ red cells coated with anti-D
d) B+ red cells coated with anti-D
c) Rh(D)+ red cells coated with anti-D
All of the following are important in evaluating a positive DAT except:
a) drug therapy
b) transfusion history
c) patient diagnosis
d) donation history
d) donation history
The indirect antiglobulin test detects which antigen-antibody reactions?
a) in vivo
b) in vitro
c) both in vivo and in vitro
d) none of the above
b) in vitro
Why was anticomplement introduced into AHG sera?
a) Certain clinically significant antibodies demonstrate complement activity.
b) Complement components enhance Kell antibodies.
c) It provides additional information into transfusion reaction work-ups.
d) all of the above
d) all of the above
How many IgG molecules must be present on the red cell for a positive IAT to occur?
a) 50
b) 500
c) 10
d) 100
d) 100
All of the following conditions may produce a positive DAT except:
a) drug-induced hemolytic anemia
b) hemolytic transfusion reaction
c) hemolytic disease of the newborn
d) lymphoma
d) lymphoma
A patient is discovered to have anti-Fya in their serum. The medical technologist needs to phenotype the patient cells for the corresponding antigen. What test is appropriate for phenotyping?
a) IAT
b) absorption
c) DAT
d) elution
a) IAT
Why are “check cells” added to all negative reactions in the AHG test?
a) to increase the cell-to-serum ratio
b) to wash away any unbound antibody
c) to ensure AHG was not neutralized by free globulin molecules
d) to bring the antibody closer to the antigen in the test system
c) to ensure AHG was not neutralized by free globulin molecules
What type of globulin does the antiglobulin test detect?
a) IgG alloantibodies
b) IgG autoantibodies
c) C3b complement components
d) all of the above
d) all of the above
All of the following is true regarding the AHG test except:
a) Centrifugation should provide a firm pellet.
b) Coombs control cells should be added to all negative tubes.
c) When washing cells, all saline should be removed completely.
d) Incubation time with LISS is a minimum of 30 minutes.
d) Incubation time with LISS is a minimum of 30 minutes.
An antibody screen is performed, and all three tubes are negative after adding AHG. Check cells are added, and the tubes are centrifuged. No agglutination occurs after the addition of check cells. What is the next course of action?
a) recentrifuge tubes
b) addition of one drop of AHG
c) repeat the antibody screen
d) addition of one drop of control cells
c) repeat the antibody screen
Anti-IgG is specific for what part of the IgG molecule?
a) Fc fragment
b) kappa light chain
c) constant region of Fab fragment
d) hypervariable region of Fab fragment
a) Fc fragment
What is the purpose of washing cells in the AHG test?
a) to dilute serum
b) to remove all bound protein
c) to remove all unbound protein
d) to exclude a low affinity antibody
c) to remove all unbound protein
Saline used for blood banking tests should have a pH of _________.
a) 5.0 to 5.5
b) 7.5 to 8.0
c) 6.8 to 7.2
d) 7.2 to 7.4
d) 7.2 to 7.4
How would a negative IAT be demonstrated in solid phase methodology?
a) well turns orange
b) cells form a monolayer
c) pellet at bottom of well
d) small agglutinins at bottom of well
c) pellet at bottom of well
Anti-A from a group B individual is primarily what class of immunoglobulin?
a) IgM
b) IgG
c) IgA
d) all of the above
a) IgM
Which of the following criteria is used to classify the B subgroups?
a) agglutination patterns with anti-B, anti-AB, and anti-H
b) presence of ABH isoagglutinins in serum
c) absorption studies with anti-B
d) all of the above
d) all of the above
What substances are found in a group A secretor?
a) H
b) A,B,H
c) A,H
d) B,H
c) A,H
What is a “lectin”?
a) a protein produced from immunized rabbits and cloned for specificity
b) a foreign protein that will elicit an immune response in most individuals
c) a substance that will agglutinate sensitized cells in the presence of complement
d) seed extracts that agglutinate human cells with moderate specificity
d) seed extracts that agglutinate human cells with moderate specificity
What ABO group contains the least amount of H substance?
a) A1
b) A2
c) A2B
d) A1B
d) A1B
What is the source of anti-A1 lectin?
a) Bandeiraea simplicifolia
b) Dolichos biflorus
c) Ulex europaeus
d) all of the above
b) Dolichos biflorus
Secretor studies were performed on a person who expressed weak reactions in forward grouping. Only B and H substance were present in saliva. What is this person’s ABO group?
a) AB
b) B
c) O
d) A
b) B
Why can anti-H sometimes be found in an A1B individual?
a) H gene is not inherited.
b) The specific immunodominant sugar blocks the presence of H antigen.
c) The individual does not secrete H substance in secretions.
d) L-Fucose does not attach to precursor substance.
b) The specific immunodominant sugar blocks the presence of H antigen.
All of the following may result in weak or missing antigens except:
a) hypogammaglobulinemia
b) Hodgkin’s disease
c) intestinal infection with Escherichia coli
d) presence of blood group specific substances (BGSS)
a) hypogammaglobulinemia
What is the biochemical structure of secreted A,B, and H substances?
a) glycoprotein
b) glycolipid
c) sphingolipid
d) ceramide
a) glycoprotein
All of the following statements are true concerning ABH soluble substances except:
a) The precursor chain is type 2 (beta 1-4 linkage).
b) The first sugar in the precursor substance is N-acetylgalactosamine.
c) ABH structures are glycoproteins.
d) L-Fucosyltransferase production is regulated by the Se system.
a) The precursor chain is type 2 (beta 1-4 linkage).
All of the following may result in rouleaux formation except:
a) Waldenstrom’s macroglobulinemia
b) leukemia
c) Wharton’s jelly in cord blood
d) dextran
b) leukemia
What percentage of the type A population are A1?
a) 20%
b) 80%
c) 50%
d) 10%
b) 80%
Persons who inherit the h allele do not produce ___________ transferase necessary for formation of the H structure.
a) N-acetylgalactosaminyl
b) D-glucosyl
c) L-fucosyl
d) D-galactosyl
c) L-fucosyl
All of the following may depress antigen expression except:
a) Hodgkin’s disease
b) leukemia
c) lymphoma
d) coronary heart disease
d) coronary heart disease
What immunodominant sugar is responsible for B specificity?
a) D-glucose
b) D-galactose
c) L-fucose
d) N-acetyl-D-galactosamine
b) D-galactose
What percentage of A2 individuals produce anti-A1?
a) 5%
b) 80%
c) 20%
d) 50%
a) 5%
How are ABH antigens formed?
a) production of specific glycosyltransferases add sugars to precursor substances
b) recombinant gene technology
c) ABO genes code for production of antigens
d) all of the above
a) production of specific glycosyltransferases add sugars to precursor substances
Reverse grouping was performed on an AB person. The technologist observed a very weak agglutination macroscopically. The cells appeared as “stacked coins” under a microscope. Which reagent should be added to the tube and recentrifuged in an attempt to resolve the discrepancy?
a) saline
b) LISS
c) serum
d) water
a) saline
Which substance must be formed first before A or B specificity is determined?
a) O
b) H
c) Bombay
d) I
b) H
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) sample misidentified
b) failure to add reagents
c) clerical error
d) sample mix-up
c) clerical error
A patient who was recently diagnosed with an obstructed bowel became septic from Proteus vulgaris. Prior to surgery, a routine type and screen was performed. Though this person typed as an A two years ago, his forward type is consistent with an AB individual, albeit weaker in strength with anti-B. What is the reason for this discrepancy?
a) acquired “B”
b) technical error
c) patient history is incorrect
d) anti-A is contaminated
a) acquired “B”
What does the hh genotype refer to?
a) Bombay
b) Kell
c) Lewis
d) Sid
a) Bombay
Which blood group contains the highest concentration of H antigen?
a) B
b) AB
c) A2
d) O
d) O
What are the advantages of using chemically modified anti-D?
a) few false negative results obtained
b) Rh control not necessary
c) Du testing eliminated
d) provides a low-protein medium
d) provides a low-protein medium
The Rh antibody agglutinates what percentage of red cells.
a) 35%
b) 50%
c) 15%
d) 85%
d) 85%
Why is determination of Rh status crucial for obstetric patients?
a) All Rh positive mothers are possible candidates for Rh immune globulin.
b) All Rh negative mothers are possible candidates for Rh immune globulin.
c) An Rh negative mother can form anti-D if she gives birth to an Rh negative baby.
d) An Rh positive mother can form anti-D that will destroy D-positive red cells of fetus.
b) All Rh negative mothers are possible candidates for Rh immune globulin.
Which antigen represents Rh3 in Rosenfield terminology?
a) e
b) D
c) C
d) E
d) E
G antigen is present on all of which type of red cells?
a) e positive
b) C positive
c) E positive
d) D positive
b) C positive
Where is the Rh antigen located relative to the red cell membrane?
a) integrally
b) peripherally
c) centrally
d) none of the above
a) integrally
Which of the following is true regarding anti-LW?
a) It reacts poorly with cord cells.
b) It appears frequently as an auto antibody.
c) It reacts stronger with D-negative cells than D-positive cells.
d) Alloanti-LW is occasionally seen in autoimmune hemolytic anemia.
b) It appears frequently as an auto antibody.
Why is it acceptable for “C Trans” individuals to receive D-positive red cells?
a) The structure of the D antigen is complete.
b) The Du is a result of steric complications.
c) The Rh antigen on the red cell is normal.
d) all of the above
d) all of the above
A cord blood sample was sent to the blood bank for a type and DAT. Cells were washed six times with saline before testing. The forward grouping typed as an O. There was no agglutination with anti-D and washed cord cells. The DAT was 3+ with polyspecific AHG. What is the Rh type of the baby?
a) Rh negative
b) Rh positive
c) Rh type cannot be determined
d) none of the above
c) Rh type cannot be determined
Which of the following genotypes is consistent with f antigen expression?
a) DCe/DcE
b) DcE/DCe
c) Dce/DCE
d) DCe/dCE
c) Dce/DCE
How are the Rh antigens inherited?
a) X-linked recessive
b) codominant alleles
c) X-linked dominant
d) none of the above
b) codominant alleles
Most Rh antibodies are of what immunoglobulin class?
a) IgG
b) IgA
c) IgE
d) IgM
a) IgG
Which IgG subclasses carry the most significance with regard to Rh antibodies?
a) IgG1/IgG4
b) IgG2/IgG4
c) IgG3/IgG4
d) IgG1/IgG3
d) IgG1/IgG3
All of the following are true regarding Rh antibodies except:
a) Rh antibodies can bind complement on the red cell membrane.
b) Rh antibodies may cause a delayed hemolytic transfusion reaction.
c) An individual with a low titer Rh antibody may experience a secondary immune response on antigen exposure.
d) Red cell destruction is usually extravascular.
a) Rh antibodies can bind complement on the red cell membrane.
What is the principle of the Rh-Hr (Weiner) terminology?
a) The Rh gene produces at least 3 factors within an agglutinin.
b) The Rh gene produces at least 3 factors within an agglutinogen.
c) Each gene (D,C,c,E,e) produces one product or antigen.
d) Each gene is independent of the other.
b) The Rh gene produces at least 3 factors within an agglutinogen.
The Rh gene is located on which chromosome?
a) 11
b) 7
c) 9
d) 1
d) 1
Which of the following Rh antigens is the most immunogenic?
a) E
b) C
c) D
d) e
c) D
What is the basis of Rosenfield Rh terminology?
a) Each gene produces one product or antigen.
b) The Rh gene produces at least five factors within an agglutinogen.
c) The Rh gene produces at least three factors within an agglutinogen.
d) (+) or (–) sign demonstrates the presence or absence of antigen on a red cell.
d) (+) or (–) sign demonstrates the presence or absence of antigen on a red cell.
What class of antibody is found in AHG?
a) IgG
b) IgM
c) IgA
d) all of the above
d) all of the above
Red blood cells that phenotyped as [Le(a-b-)] are incubated with plasma containing Lea substance. The red blood cells convert to the phenotype [Le(a+b-)]. Whereas the same red blood cells incubated with saliva containing Lea substance do not convert. Why?
a) Other enzymes found in the saliva interfere with the conversion from Le(a-b-) to Le (a+b-).
b) Only Leb substance in saliva can convert phenotypes.
c) Biochemically, Lewis substances in saliva are glycolipids.
d) Glycoproteins are not absorbed onto red blood cell membranes.
d) Glycoproteins are not absorbed onto red blood cell membranes.
What is the most critical step in blood transfusion?
a) Phenotyping units to ensure compatibility with alloantibody
b) Following quality control procedures
c) Checking patient identification and compatibility of donor unit
d) Monitoring the temperature control of donor units
c) Checking patient identification and compatibility of donor unit
Recipient serum that reacted with one out of five donor units in the AHG phase and where the antibody screen was negative is probably due to:
a) an alloantibody directed against a high-frequency antigen.
b) an alloantibody directed against a low-frequency antigen.
c) an alloantibody coating the recipient cellS
d) an ABO mismatch.
b) an alloantibody directed against a low-frequency antigen.
Lewis cell-bound antigens absorbed from plasma onto the red cell membranes are:
a) ceramides
b) glycolipids
c) sphingolipids
d) glycoproteins
b) glycolipids
Why is anti-i implicated in hemolytic disease of the newborn?
a) The i antigen is well expressed on cord cells.
b) Anti-i can be either IgM or IgG.
c) The i antigen has weak antigen expression in adults.
d) two of the above
d) two of the above
What alternative type can be given to an O-positive person when group O blood is not available?
a) A packed cells
b) B packed cells
c) AB packed cells
d) None of the above
d) None of the above
Why are the M and N antigens important for paternity testing?
a) Antigens are well developed at birth.
b) Antigens are well developed on father’s red cells.
c) Antigens are fully developed at 2 years of age.
d) Antigens are poorly developed on mother’s cells.
a) Antigens are well developed at birth.
Autoantibodies to U antigen may be found in patients with:
a) cold autoimmune hemolytic anemia
b) warm autoimmune hemolytic anemia
c) drug-induced hemolytic anemia
d) paroxysmal cold hemoglobinuria
b) warm autoimmune hemolytic anemia
Antigens in the CH/RG blood group system are described as:
a) well developed on cord cells
b) resistant to ficin treatment
c) adsorbed on to the red cell membrane
d) antithetical partners
c) adsorbed on to the red cell membrane
Which antigen is expressed on C4B complement fragments?
a) Kna
b) Gya
c) Yka
d) Cha
d) Cha
Why are Lewis antibodies not generally implicated in hemolytic disease of the newborn (HDN)?
a) Lewis antigens can readily dissociate from the red cell upon transfusion of Lewis-positive cells.
b) Lewis antigens are well developed at birth.
c) Lewis antibodies do not bind complement.
d) Lewis antibodies are IgM and cannot cross the placenta.
d) Lewis antibodies are IgM and cannot cross the placenta.
Which of the following may be a possible cause for the lack of expression of Lewis antigens during pregnancy:
a) antigenic sites are blocked by IgG antibody
b) decreased ratio of plasma lipoproteins to red cell mass
c) increased ratio of plasma lipoproteins to red cell mass
d) antigenic sites are blocked by IgM antibody
c) increased ratio of plasma lipoproteins to red cell mass
At which phase are Lewis antibodies usually detected?
a) immediate spin
b) 37°C
c) Coombs
d) all of the above
a) immediate spin
Why is the Le system not implicated in hemolytic disease of the newborn (HDN)?
a) Lewis antibodies do not bind complement.
b) HDN Lewis antibodies are IgG and cannot cross the placenta and cause.
c) Lewis antigens are not well developed at birth.
d) Lewis antigens can readily dissociate from the red cell upon transfusion of Lewis-positive cells.
c) Lewis antigens are not well developed at birth.
How is Leb substance formed?
a) Leb is secreted into plasma in the absence of fucosyltransferase.
b) L-Fucose is added to subterminal N-acetylglucosamine of type 2 H substance.
c) L-Fucose is added to subterminal N-acetylglucosamine of type 1 H substance.
d) Lea and Leb are codominant alleles located on chromosome 19.
c) L-Fucose is added to subterminal N-acetylglucosamine of type 1 H substance.
Where are Lewis antigens found?
a) plasma
b) saliva
c) milk
d) all of the above
d) all of the above
Lewis antibodies are of what immunoglobulin class?
a) IgM
b) IgA
c) IgG
d) IgE
a) IgM
Lewis cell-bound antigens absorbed from plasma onto the red cell membranes are:
a) sphingolipids
b) glycoproteins
c) ceramides
d) glycolipids
d) glycolipids
Persons who inherit the Se and Le gene will have _______ A or B glycolipids in plasma than persons who are Se le.
a) more
b) less
c) inactive
d) none of the above
b) less
Pregnant women usually express which phenotype?
a) Le(a-b+)
b) Le(a+b-)
c) Le(a+b+)
d) Le(a-b-)
d) Le(a-b-)
In order for an individual to express Leb antigen on their red cells, they must have inherited which gene?
a) Le
b) Se
c) H
d) all of the above
d) all of the above
A Bombay individual who has inherited the Le gene will have a phenotype of:
a) Le(a-b-)
b) Le(a+b+)
c) Le(a+b-)
d) Le(a-b+)
Le(a+b-)
Why is anti-i implicated in hemolytic disease of the newborn?
a) The i antigen is well expressed on cord cells.
b) Anti-i can be either IgM or IgG.
c) The i antigen has weak antigen expression in adults.
d) two of the above
d) two of the above
Which of the following is not involved in the Kell blood group system?
a) Jka
b) Jsa
c) Kpb
d) K
a) Jka
Where are the Duffy antigens found?
a) red cells
b) platelets
c) lymphocytes
d) all of the above
a) red cells
Why is it relatively easy to find compatible units for a patient with anti-K?
a) Kell is a low-frequency antigen
b) anti-K has a low avidity for its respective antigen
c) anti-K does not react at 37°C
d) Kell is a high-frequency antigen
a) Kell is a low-frequency antigen
Red cells were ficin treated to help rule in anti-M from a panel study. Cells not treated reacted at 2+ at immediate spin and 1+ at 37°C. There was no reactivity in the Coombs phase. Ficin-treated cells demonstrated a _______ reaction with patient serum containing anti-M.
a) 4+
b) negative
c) 2+
d) 3+
b) negative
A blood bank technologist needed to confirm the presence of anti-P1 in a patient specimen. Fresh cells were not available for use, so an old panel that contained cells positive for P1 was used. No cells positive for the antigen reacted at any phase of the antiglobulin test, whereas cells from the screening cells showed specificity for the presence of anti-P1. What is a possible explanation for this?
a) Patient expresses the p phenotype.
b) P1 antigen deteriorates rapidly upon storage.
c) Technician omitted LISS.
d) Technician forgot to add AHG.
b) P1 antigen deteriorates rapidly upon storage.
Anti-M was detected in a 27-year-old man before surgery. Units negative for M antigen were not available; however, the units were approved for transfusion when major crossmatch using M+N+ donor cells and patient serum resulted in:
a) IS = 1+, 37 = 0, AHG = 0
b) IS = 3+, 37 = 2+, AHG = 1+
c) IS = 2+, 37 = 1+, AHG = 0
d) IS = 1+, 37 = 1+, AHG = 0
a) IS = 1+, 37 = 0, AHG = 0
Anti-Lua reacts at what temperature?
a) room temperature
b) 37°C
c) AHG
d) all of the above
a) room temperature
Persons who phenotype negative for U antigen lack Ss-SGP because of a partial or complete deletion of __________________.
a) GPB
b) N-acetylgalactosamine
c) GPA
d) N-acetylneuraminic acid
a) GPB
The M and N antigens are found in which glycoprotein?
a) band 3
b) glycophorin A
c) glycophorin B
d) glycophorin C
b) glycophorin A
How can pathologic anti-I be differentiated from benign anti-I?
a) immunoglobulin class
b) binding of complement
c) broad thermal range of reactivity
d) all of the above
c) broad thermal range of reactivity
Which of the following distinguishes the recessive LuLu gene from the dominant In(Lu) gene?
a) expression of trace amounts of i antigen
b) abnormal expression of P1
c) expression of the Lu(a-b-) phenotype
d) normal expression of P1
d) normal expression of P1
All of the following are characteristics of Kidd antibodies except:
a) IgG immunoglobulins
b) ability to bind complement
c) exhibit dosage
d) naturally occurring
d) naturally occurring
When red cells are placed in a solution of 2M urea, the red cells will lyse. However, it has been shown that which red cells are resistant to lysis?
a) Jk(a-b+)
b) Jk(a+b+)
c) Jk(a-b-)
d) Jk(a+b-)
c) Jk(a-b-)
The M and N antigens exhibit dosage. Therefore, if a person inherits the homozygous genotype MM their red cells will react _______ with anti-M than a person with a heterozygous genotype of MN.
a) stronger
b) weaker
c) mixed field
d) none of the above
a) stronger
The homozygous phenotype Fy(a+b-) has _______ antigenic Fy“ sites than heterozygous cells, Fy(a+b+).
a) more
b) less
c) weaker
d) none of the above
a) more
At what age does I antigen become detectable on infant cells?
a) 1 year
b) 4 years
c) 18 months
d) 1 month
c) 18 months
What characteristic differentiates Ss antigens from MN antigens?
a) antigens well developed at birth
b) enzyme degradation
c) biochemical structure rich in sialic acid
d) S and s exhibit dosage
b) enzyme degradation
Persons who express the phenotype P2 are at risk for developing anti-P1 when handling what animal species?
a) dogs
b) pigeons
c) mice
d) cats
b) pigeons
What abnormal blood cell morphology is associated with the McLeod phenotype?
a) acanthocytes
b) sickle cells
c) spherocytes
d) ovalocytes
a) acanthocytes
What type of hemolytic transfusion reaction occurs more frequently in patients with Jk antibodies?
a) bacterial
b) delayed
c) febrile
d) immediate
b) delayed
Anti-I is found in association with what microorganism?
a) Proteus vulgaris
b) Treponema pallidum
c) Mycoplasma pneumoniae
d) Escherichia coli
c) Mycoplasma pneumoniae
Units that were positive for P² antigen had to be crossmatched with serum of a patient containing the corresponding antibody because of a short supply of blood. Which of the following crossmatch results would be considered acceptable for transfusion?
a) IS=0, 37=2+, AHG=3+
b) IS=1+, 37=0, AHG=0
c) IS=2+, 37=1+, AHG=0
d) IS=0, 37=2+, AHG=1+
b) IS=1+, 37=0, AHG=0
What Kidd antibody will react with all panel cells and phenotype as Jk(a-b-)?
a) anti-Jka
b) anti-Jkb
c) anti-Jk3
d) none of the above
c) anti-Jk3
All of the following are characteristics of Duffy antibodies except:
a) destroyed by enzymes
b) may or may not show dosage
c) not implicated in hemolytic disease of the newborn (HDN)
d) IgG
c) not implicated in hemolytic disease of the newborn (HDN)
Anti-Jka was identified in a previously transfused patient. Five cells that were homozygous for Jka yielded 2+ reactions in the AHG phase. The same cells were treated with ficin and yielded 3+ reactions in AHG. Therefore, Jka is _________ by enzyme treatment.
a) destroyed
b) enhanced
c) unaffected
d) none of the above
b) enhanced
What sequence of antigens coincides with strongest immunogen to weakest immunogen?
a) D, K, Fya, Fyb
b) Fya, Fyb, D, K
c) D, Fya, Fyb, K
d) K, Fya, Fyb, D
a) D, K, Fya, Fyb
Anti-N will react stronger with which phenotype?
a) M-N-
b) M+N+
c) M+N-
d) M-N+
d) M-N+
Anti-N is known to occur in ___________ patients undergoing dialysis with equipment sterilized by formaldehyde?
a) thyroid
b) immunocompromised
c) renal
d) cancer
c) renal
What fatal disease is associated with the McLeod phenotype?
a) chronic granulomatous disease
b) Fanconi’s syndrome
c) Graves’ disease
d) lymphoma
a) chronic granulomatous disease
Why is it strongly recommended to use only homozygous cells when ruling out Kidd antibodies?
a) Anti-Jka may appear compatible with homozygous cells [Jk(a+b-)].
b) Anti-Jka may appear compatible with heterozygous cells [Jk(a+b+)].
c) It will reduce the number of false positive results.
d) two of the above
b) Anti-Jka may appear compatible with heterozygous cells [Jk(a+b+)].
A woman undergoing a hysterectomy requires 2 units of blood. The antibody screen was negative. One unit was incompatible in the Coombs phase (2+), the other unit was compatible. Give a reason why this antibody was not detected in the antibody screen.
a) a high-frequency antigen
b) a low-frequency antigen
c) antibody has low avidity to cell receptor
d) two of the above
b) a low-frequency antigen
Persons who are genetically P1 may serologically type as P2 because of:
a) presence of anti-P1 in their serum
b) depressed antigen expression
c) inheritance of the In(Lu) gene
d) inheritance of the p gene
c) inheritance of the In(Lu) gene
Persons who phenotype as Fy(a-b-) are resistant to infection by which organism?
a) Plasmodium malariae
b) Plasmodium falciparum
c) Plasmodium vivax
d) Plasmodium ovale
c) Plasmodium vivax
At birth, infant cells are rich in ______, and ______ is nearly undetectable.
a) I/i
b) I/H
c) i/I
d) none of the above
c) i/I
Why is hemolytic disease of the newborn (HDN) not a consideration when the mother possesses anti-P1 in her serum?
a) Anti-P1 is a naturally occurring antibody.
b) Anti-P1 is an IgM antibody.
c) Anti-P1 does not react at 37°C.
d) P1 antigen is poorly expressed at birth.
d) P1 antigen is poorly expressed at birth.
All of the following is true regarding the Kell antigen except:
a) strongly immunogenic
b) exhibits dosage
c) destroyed by ficin treatment
d) well developed at birth
c) destroyed by ficin treatment
What amino acid is specific for S antigen?
a) methionine
b) glycine
c) threonine
d) aspartic acid
a) methionine
Why does anti-Lua go undetected in routine testing?
a) Anti-Lua demonstrates low avidity.
b) Most reagent cells are Lu(a+).
c) Most reagent cells are Lu(a-).
d) two of the above
c) Most reagent cells are Lu(a-).
Why was U antigen included in the MNSs blood group system?
a) All U-negative red cells were also S-s-.
b) All U-positive red cells were also S+s+.
c) All U-negative red cells were also M-N-.
d) U is enhanced by enzyme treatment.
a) All U-negative red cells were also S-s-.
Duffy antigens are destroyed by:
a) AET
b) ficin
c) neuraminidase
d) two of the above
b) ficin
All of the following is consistent with Benign anti-I except:
a) do not bind complement
b) naturally occurring
c) IgM
d) reactive at 4°C
a) do not bind complement
What effect do enzyme treated cells have on anti-I detection?
a) enhances reactivity
b) destroys reactivity
c) no effect
d) none of the above
a) enhances reactivity
A woman came in for a cesarean section. The antibody screen was positive with a 3+ reaction in the AHG phase using screening cell I. Screening cells II and III were negative in all phases. An 8-cell panel was performed that paralleled the antibody screen where 3 cells reacted 3+ at AHG and 5 cells were negative at all phases of reactivity. The antibody identified was anti-Kell. What procedure might be helpful in predicting the infant’s susceptibility to hemolytic disease of the newborn (HDN)?
a) a fetal screen (rosette test) on the mother
b) determination of the father’s phenotype
c) plasmapherese of the mother’s plasma
d) determination of the mother’s phenotype
b) determination of the father’s phenotype
Antigens in the CH/RG blood group system are described as:
a) resistant to ficin treatment
b) well developed on cord cells
c) antithetical partners
d) adsorbed on to the red cell membrane
d) adsorbed on to the red cell membrane
Which antigen is expressed on C4B complement fragments?
a) Cha
b) Kna
c) Gya
d) Yka
a) Cha
The Dia and Dib antigens are located on:
a) erythrocyte acetylcholinesterase
b) complement receptor one (CRI)
c) the anion exchange molecule (AE-1)
d) channel-forming integral protein (CHIP)
c) the anion exchange molecule (AE-1)
The gene for which blood group antigen is located on the petite arm of the X chromosome.
a) Doa
b) Sc1
c) Coa
d) Xga
d) Xga
The seven Gerbich antigens are located on:
a) glycophorins A and B
b) glycophorins C and D
c) glycophorins A and D
d) glycophorins B and C
b) glycophorins C and D
