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Immunohematology > Final Exam: Old Exam Questions > Flashcards

Final Exam: Old Exam Questions Flashcards

1
Q

What blood type is the universal donor of plasma?

A

AB

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2
Q

What blood type is universal recipient of red cells

A

AB

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3
Q

What do Landsteiner’s laws state

A

If you have the antigen, you do not have the antibody
If you have the antibody, you do not have the antigen
You can not have both

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3
Q

Why is the ABO blood type the most significant

A

It has naturally occurring antibodies that are primarily IgM that react at body temperature

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4
Q

Donor has the phenotype hh AB. What is the red cell phenotype in forward type?

A

O

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4
Q

What lectin is used to determine A subgroups?

A

Dolichos biflorus

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5
Q

What immune globulin levels characterize a secondary immune response

A

higher total antibody, slower decline

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6
Q

What do we call the net negative charge on the surface of the RBCs

A

Zeta potential

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7
Q

What are immunoglobulin functions

A

Binding to antigens, facilitates phagocytosis, fix complement.

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8
Q

Phenotype is

A

the physical expression produced by the genotype

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9
Q

LISS reagent is used to

A

reduce the zeta potential

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10
Q

Which immunoglobulin class has 10 antigen binding sites and can’t cross placenta

A

IgM

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11
Q

Which of the following sugars must be present on the precursor chain for the A and B immunodominant sugars to be added

A

L-fucose

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12
Q

Acquired B may occur in patients with which disorders?

A

Disorder of the lower intestinal tract

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13
Q

If a person as the genotype SeSe, AA what antigens would be in their secretions

A

A and H

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14
Q

Phenomenon in which a false-negative result is obtained in an agglutination based assay because of an excessively increased ration of antigen to antibody

A

Postzone

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15
Q

Which of the following ABO blood groups contains the most amount of H antigen

A

A2

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16
Q

An example of a technical error that could result in ABO discrepancy

A

Reagent was not added in correct amounts

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17
Q

What is the best definition of avidity when talking about antigen-antibody interaction

A

sum of all attractive forces

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18
Q

What is the first step in agglutination reactions

A

sensitization

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19
Q

What corrective action should be taken when rouleaux causes positive test results

A

Perform a saline replacement technique

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20
Q

Which immunodominant sugar is for the B blood type

A

D-galactose

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21
Q

What is in the adaptive immune response that is not in the acquired?

A

Memory

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22
Q

What does reverse typing tell you?

A

The antibodies in the patient’s plasma

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23
Q

Lattice formation of antigen and antibody…

A

will not occur in prozone and postzone

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24
Q

Genetic material in the order from largest to smallest

A

Chromosomes, genes, DNA, nucleic acids

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25
Q

The most common blood type in the US is

A

type O

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26
Q

The class of antibody is usually clinically significant in the blood banking lab usually at 37 degrees and is small enough to cross the placenta

A

IgG

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27
Q

Which is the immunodominant sugar confers A antigens

A

N-Acetylgalactosamine

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28
Q

The lectin Ulex europeaus agglutinates what RBC

A

Most cells except Bombays

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29
Q

What is the inheritance pattern for the ABO and Rh blood groups

A

Autosomal co-dominant

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30
Q

The O gene has no detectable product and is termed…

A

Amorph

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31
Q

The products of genes inherited at the ABO locus are

A

transferases

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32
Q

Processes of the adaptive immune system include…

A

production of antibody on exposure to foreign antigens

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33
Q

What is not part of the innate immune system

A

memory B-cells

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34
Q

What is true about prozone and postzone

A

they both result in a false negative

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35
Q

What cells are involved in the production of antibodies

A

B lymphocytes

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36
Q

A person who has the A2 phenotype will have which antigens on their red cells

A

A antigens only

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37
Q

What antibody is present when patient serum agglutinates with a panel of adult red cells

A

Anti-I

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38
Q

What groups of antigens are destroyed by enzymes?

A

M, N, S and Duffy

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39
Q

Which antibody disappears rapidly in vivo, making it difficult to detect in vitro

A

Kidd

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40
Q

What test method is most efficient for a short staff lab

A

Solid phase or gel testing

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41
Q

What can proteolytic enzymes do to red cell antigens

A

Enhance, destroy or not affect reactivity

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42
Q

A patient is suspected of having PCH. Which pattern of reactivity is characteristic of the antibody that causes the condition?

A

Attaches to RBCs at 4C, and causes hemolysis at 37C

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43
Q

Which antigen is notorious for deteriorating rapidly in storage

A

P1 antigen

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44
Q

Polyspecific AHG reagent contains

A

Anti-IgG and Anti C3d

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45
Q

Anti-N like antibodies may be formed in individuals…

A

requiring renal dialysis

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46
Q

How is the principle of the antiglobulin test best described

A

AHG reacts with human globulin molecules that can be bound to RBCs or free in serum

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47
Q

CAD is associated with antibody specificity towards which of the following

A

I

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48
Q

If there is no agglutination when check cells are added then the results are…

A

invalid

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49
Q

What is the substance that prevents the allogeneic production of anti-D in pregnant women

A

Rh-immune globulin (RhIg)

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50
Q

Where does antihuman globulin AHG bind

A

To the Fc receptor of IgG molecule

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51
Q

What type of RBCs do Rhnull individuals have on a peripheral blood smear

A

Stomatocytes

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52
Q

What antigen is the 3rd most immunogenic after the D antigen and well developed at birth

A

K

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53
Q

The endpoint reaction of gel testing technology is

A

agglutination

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54
Q

The indirect antiglobulin test detects…

A

in vitro sensitation

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55
Q

The direct antiglobulin test detects

A

in vivo sensitation

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56
Q

Antibodies to Kpa and Jsa are…

A

rare because few people are exposed to them

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57
Q

What does the RHAG gene do

A

it must be present for the expression of Rh antigens

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58
Q

The D antibody will agglutinate with what percentage of the populations RBCs

A

85%

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59
Q

What does the term exalted D refer to

A

Stronger expression of D antigens when Cc and Ee are missing

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60
Q

What makes up an autocontrol

A

patient serum and patient cells

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61
Q

Which of the following is NOT a reagent used in the lab to enhance the reactions of antibodies

A

Distilled water

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62
Q

Which of the following is an example of weakened expression of a trait due to position effect

A

Weakened expression of D when C is trans

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63
Q

Le(a-b-) individuals may develop Lewis antibodies without exposure to lewis antigens. These antibodies are referred to as being

A

naturally occuring

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64
Q

AHG reagent that is monospecific for IgG contains…

A

Anti-IgG only

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65
Q

Sold-phase antibody testing is based on

A

adherence

66
Q

When an individual inherits both the lewis gene and the secretor gene which of the following RBC phenotypes will be observed

A

Le (a-b+)

67
Q

The Fy(a-b-) phenotype is seen largely in what population

A

African

68
Q

In the indirect antiglobulin test IAT, which phase of testing is IgM antibodies

A

IS

69
Q

Which of the following would give you a false negative antiglobulin test

A

incorrect plasma to cell ratio

70
Q

When one or more D epitopes within the entire D protein is missing it is termed

A

Partial D

71
Q

Most Rh antibodies are of what immunoglobulin class

A

IgG

72
Q

Which of the following lists the three phases of the IAT in the correct order

A

IS, 37C, AHG

73
Q

Which microbial disease is associated with the development of an auto-anti-I in older adults

A

mycoplasma pneumonia

74
Q

Rh system genes are

A

RHD and RHCE

75
Q

AHG (Coombs) control cells

A

are coated with IgG antibodies

76
Q

What are weak D donors typed as

A

Rh positive

77
Q

What liquid is not able to inhibit or neutralize any antibody

A

PEG

78
Q

The lack of Kx expression of RBCs has been associated with

A

the McLeod phenotype and CGD

79
Q

Why should specimens be used no more than 3 days after collections in patients who have been recently transfused or pregnant.

A

Recent pregnancy or transfusion may stimulate antibodies that are not detectable at the time of collection

80
Q

What is being tested in an antibody screen

A

patient serum against group O reagent cells

81
Q

When would you suspect multiple antibodies in a patients serum?

A

Patterns of reactions not fitting a single antibody, variation in reactivity phase, and variation in reactivity strength

82
Q

What does the rule of 3 determine

A

95% confidence that the correct antibody has been detected

83
Q

Which of the following best describes the principle of absorption

A

The process of removing antibodies from serum by incubating with the corresponding antigen

84
Q

What compatibility testing is preformed on plasma products

A

No compatibility testing is required

85
Q

Once a donor unit arrives to the transfusion facility, donor units should be observed for

A

blood clots, correct labeling and abnormal color

86
Q

An autologous donation of blood is

A

a donation from yourself for future surgery or medical needs

87
Q

For an autologous donation the Hb and Hct must be at least

A

11g/dl and 33%

88
Q

Which of the following microorganisms poses the greatest risk of infection by transfusion

A

Bacteria

89
Q

Washed RBCs are particularly important for which patient population

A

IgA deficient patients

90
Q

After transfusion the donor sample and pre transfusion recipient sample must be kept for

A

7 days

91
Q

Which is the most appropriate product for a person with multi-coag factor deficiency

A

FFP

92
Q

Irradiation of donor blood is done to prevent which of the following adverse effects of transfusion

A

Transfusion associated graft vs host disease

93
Q

Pre-transfusion testing for a patient with a newly detected clinically significant Ab must include

A

an AHG phase crossmatch

94
Q

Pre-transfusion orders for a type and screen includes

A

ABO group, Rh type and antibody screen

95
Q

A donor unit shipped to a transfusion facility from a collection facility must be retyped for ABO group and

A

Rh typed if D neg

96
Q

A patient that has every had a serologic positive test for Hep B would be deferred from donating for how long

A

permanently

97
Q

In a left shift…

A

Hb O2 affinity increases, owing to a decrease in 2,3 DPG

98
Q

What is considered a massive transfusion

A

8-10 units of RBC in less than 24 hours

99
Q

If the collection and transfusion facilities are the same what testing is required before transfusion

A

ABO/Rh & Ab screen

100
Q

What type of testing has decreased window period

A

Nucleic acid testing of donated blood products

101
Q

What can donation centers do on the Donor history questionaire

A

Add additional questions at the end to make criteria more stringent

102
Q

What happens in a computer crossmatch

A

Compares patients blood type to a database of units to find a match

103
Q

What is part of pre donation screening

A

Registration, medical history questionnaire, physical exam

104
Q

Antibodies are excluded using RBCs that are homozygous for the antigen because

A

antibodies may show dosage

105
Q

What is one way to restore 2,3 DPG and ATP levels in a unit of packed RBCs

A

Rejuvenate the RBCs with rejuvisol

106
Q

How long does someone donating platelets wait after taking aspirin

A

2 days

107
Q

Directed donation from a first degree relative increases the risk of

A

transfusion associated graft vs host disease

108
Q

You perform an IS crossmatch and see no Agg. What does that mean

A

unit is compatible and can be transfused

109
Q

What type of crossmatch is done if there is history of an Ab

A

AHG crossmatch

110
Q

What is the europe/canada technique to make plts from whole blood

A

Buffy coat method

111
Q

when performing AHG crossmatch what procedure do we use

A

IAT

112
Q

The min Hb concentration for male to donate is

A

13g/dl

113
Q

What is it called when a donor tests positive for a bloodborne pathogen

A

donor lookback

114
Q

A RBC unit is considered uncross matched when it is issued

A

prior to lab test completion

115
Q

Therapeutic apheresis can be used to remove pathologic substances from a patients blood. This could include removal of…

A

platelets, plasma, WBC, RBC

116
Q

What crossmatch is equivalent to a computer crossmatch

A

IS crossmatch

117
Q

What is the expected outcome of a transfusion of 1 unit of packed RBCs

A

Inc Hb by 1g/dl and Hct by 3%

118
Q

What is the window period

A

The period between infection and detection of Ab

119
Q

What acute transfusion reaction would be least likely to cause an inc in temperature

A

Transfusion associated circulatory overload (TACO)

120
Q

What acute transfusion reactions have pulmonary effects

A

TACO and TRALI

121
Q

What happens in the blood within the first hours of an intravascular hemolytic event

A

Haptoglobin decreases and free hemoglobin increases

122
Q

T/F is malaria screened for in all donated units of blood int he US

A

False

123
Q

Which transfusion would likely not exhibit hypotension

A

Febrile non-hemolytic transfusion reaction

124
Q

Which transfusion reaction would likely have a + DAT

A

Acute hemolytic

125
Q

What reaction would decrease the most if we only used male donors

A

TRALI

126
Q

What are the results of someone with a delayed HTR

A

Dec Hb and inc total bilirubin

127
Q

What component is most frequently involved in transfusion associated sepsis

A

Platelets

128
Q

Fatal TR are most often caused by

A

clerical errors

129
Q

Fever, maculopapular rash, watery diarrhea, abnormal liver function, pancytopenia after first degree relative

A

TA-GVHD

130
Q

How are mild allergic TR with isolated symptoms or hives treated

A

Transfusion is stopped, anti-histamine is administered, when symptoms improve transfusion is restarted.

131
Q

Patient has respiratory distress, severe hypoxemia and hypotension and fever. What reaction

A

TRALI

132
Q

What is a characteristic of iron overload

A

Multi organ damage

133
Q

Hepatosplenomegaly in a fetus with HDFN is caused by…

A

erythropoiesis in the liver and spleen

134
Q

What is performed at 28 weeks in a Rh neg mother

A

RhIG dose

135
Q

What is the most important serologic test for HDFN diagnosis

A

DAT

136
Q

Besides Keilhaur betke test what is another method to determine fetal hemorrhage volume

A

Flow cytometry

137
Q

What causes fifths disease and enters RBCs via the P antigen

A

Parvovirus B-19

138
Q

What diseases are caused by mosquito bites

A

Malaria, West Nile Virus, Dengue Fever

139
Q

Babesiosis is common in what geographical area

A

Northeastern and midwestern US

140
Q

What is responsible for the decrease in the window period

A

Nucleic amplification testing

141
Q

What poses the greatest risk of infection by transfusion in an immunocompetent individual

A

Bacteria due to contaminated skin or septic donor

142
Q

Which disease is not tested in donated units in the US

A

vCJD

143
Q

Why do we rarely see syphilis transmitted via RBC donation

A

The organism can not survive at fridge temperatures for very long

144
Q

Antibodies that are common causes of HDFN can be IDed in prenatal specimens include

A

Rh and Anti-K

145
Q

What is the principle of the kleihauer-betke test

A

Fetal cells resist acid elution and stain pink. Adult cells are not resistant and will not stain

146
Q

Why is Rh HDFN more severe than ABO

A

Both involve IgG, but ABO antigens are not well developed at birth

147
Q

Kernicterus is caused by

A

Unconjugated bilirubin

148
Q

When determining RhIg dosage it is better to under or over estimate

A

over

149
Q

50% or greater of the adult population has been exposed to which viruses

A

CMV, EBV, parvovirus

150
Q

HLA antibodies are induced by:

A

Multiple pregnancies or transfusions

151
Q

Which method of pathogen inactivation can not be used on cellular products

A

Heat and solvent/detergent

152
Q

Maternal IgG antibodies that enter the fetus can remain in the circulation at significant levels for what length of time after birth

A

several weeks

153
Q

The most important and easiest step in the safe administration of blood products is

A

accurate identification of the donor unit and recipient

154
Q

Severe allergic reactions in plasma products are most likely to happen with…

A

IgA deficient patients

155
Q

Which of the transfusion reactions is not associated with HLA antibodies

A

TACO

156
Q

Rh immune globulin is administered to mothers to prevent

A

maternal antibody production

157
Q

Which of the following best describes pathogen inactivation using Psoralen and UV light

A

Crosslinks the nucleic acid of pathogens so they can not reproduce

158
Q

The prion disease that is most concerning for transfusion transmittance in the US is

A

vCJD

159
Q

What is the most common treatment for ABO HDFN

A

UV light

160
Q

300ug dose of RhIg can suppress immunization to how many mls of D-pos whole blood

A

30

161
Q

The most helpful lab test for early detection of acute HTR is

A

a visual inspection of plasma for hemolysis

162
Q

Compensated anemia

A

RBC production > RBC destruction

163
Q

Uncompensated anemia

A

RBC production < destruction
Decreased Hb, Hct, Haptoglobin
Inc retics, unconjugated bilirubin

164
Q

Conditions that cause secondary AIHA

A

Lymphoproliferative (CLL) and SLE = warm
Epstein barr, pnemonia, lymphoproliferative=cold

165
Q

What antibodies are commonly seen in warm autos?

A

Rh, Kell, Kidd

Immunohematology (2 decks)

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