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Blood Bank 2 > final exam review > Flashcards

final exam review Flashcards

1
Q

Which serological match between father and mother might result in HDFN?

a. Mother is negative for anti-K while father is positive for anti-K
b. Mother is Rh positive while father is Rh negative
c. Mother is positive for anti-Fya while father is positive for Fya antigen
d. Mother is negative for Lea antigen while father is positive for Leb antigen

A

c. Mother is positive for anti-Fya while father is positive for Fya antigen

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2
Q

Which of the following features of an antibody increases the risk of HDFN?

a. Compliment fixing
b. IgM
c. Antigens present on the placenta
d. Antigens fully developed at 16 weeks gestation

A

d. Antigens fully developed at 16 weeks gestation

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3
Q

Which of the following is the most common cause of HDFN?

a. Anti-A,B
b. Anti-D
c. Anti-K
d. Anti-C

A

a. Anti-A,B

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4
Q

What is the Rh type of a newborn with the following serological results:
Anti-D: IS:0 37:0 AHG: 0 CC: 2+
Saline: IS:0 37:0 AHG: 0 CC: 2+
(Weak D test)

a. Rh positive
b. Weak D positive
c. Rh negative
d. DAT positive

A

c. Rh negative

No reaction with Anti-D

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5
Q

What follow up testing should be performed on a newborn with the following serological results:
Anti-D: IS:0 37:0 AHG: 2+ CC: NT
Saline: IS:0 37:0 AHG: 2+ CC: NT

a. Eluate
b. DAT
c. Maternal Antibody screen
d. Wash the cells & repeat the Weak D test

A

b. DAT

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6
Q

Which other test is invalidated by the following serological results on a maternal sample?
Anti-D: IS:0 37:0 AHG: 2+ CC: NT
Saline: IS:0 37:0 AHG: 0 CC: 2+

a. KLB
b. FMH/fetal screen
c. Rhogam
d. Maternal Rh type

A

b. FMH/fetal screen

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7
Q

Under what circumstances would the fetal screen be skipped in favor of a KLB?

a. Trauma
b. STAT Rhogam order
c. When the mother is Rh positive
d. When the mother’s antibody is not anti-D

A

a. Trauma

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8
Q

Which of the following cells would you choose as a titer cell when evaluating HDF caused by anti-Jka?

a. R0r,K-/k,Fy(a-b+)Jk(a-b+)S+s+M-N+
b. R1R1,K+/k,Fy(a+b-)Jk(a-b+)S+s+M+N+
c. rr,K-/k,Fy(a+b-)Jk(a+b-)S-s+M-N+
d. R2r,K+/k,Fy(a-b+)Jk(a+b+)S+s-M+N-

A

c. rr,K-/k,Fy(a+b-)Jk(a+b-)S-s+M-N+

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9
Q

Which HDFN test does the Flow Cytometry test replace?

a. KLB
b. Fetal Screen
c. Cord blood Workup
d. Antibody Titer

A

a. KLB

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10
Q

Which patient is disqualified from receiving Rhogam?

a. Mary who is O negative Weak D positive with a negative antibody screen in her 2nd Trimester
b. Sonya who is A negative with a positive antibody screen for anti-Lea in her 1st trimester
c. June who is B negative with a negative antibody screen is newly delivered of an Rh negative set of twins
d. Candace is O negative with a positive antibody screen for anti-E is newly delivered of an O positive baby

A

c. June who is B negative with a negative antibody screen is newly delivered of an Rh negative set of twins

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11
Q

The MLS has found 34 fetal cells/1000 on Sunny’s KLB slide. How many doses of Rhogam does she require?

a. 1
b. 3
c. 5
d. 7

A

d. 7

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12
Q

Hydrops fetalis is caused by:

a. Unconjugated bilirubin deposits
b. Anemia/edema
c. Maternal Antibody Titer
d. Maternal Kidney compensation

A

b. Anemia/edema

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13
Q

A cordblood workup is performed on Baby girl Springfield. According to her results, does she have HDN?
Anti-A: 4+
Anti-B: 2+
Anti-D 2+
Poly: 2+
Saline: 2+

a. Yes
b. No
c. Invalid

A

c. Invalid

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14
Q

Anti-E is detected in the serum of a woman in the first trimester of pregnancy. The first titer for anti-E is 32. Two weeks later, the antibody titer is 64 and then 128 after another 2 weeks. Clinically there are beginning to be signs of fetal distress. What can be done?

a. Induce labor for early delivery
b. Perform plasmapheresis
c. Administer Rhogam
d. Intrauterine exchange transfusion

A

b. Perform plasmapheresis

Too early for inducing labor and Rhogam won’t help. Intrauterine exchange transfusion is the last resort

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15
Q

What testing is performed on maternal plasma in preparation for a neonate exchange transfusion?

a. ABO Rh only
b. Crossmatch and Antibody screen
c. Type and Screen
d. Type and DAT

A

b. Crossmatch and Antibody screen

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16
Q

What type of blood product would you provide for a newborn suffering from alloimmune thrombocytopenia?

a. HLA matched platelets
b. CMV neg, Sickle Cell neg fresh RBCs
c. Crossmatched platelets
d. Irradiated platelets

A

c. Crossmatched platelets

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17
Q

Which of the following is NOT a symptom of acute hemolytic transfusion reaction?

a. Back pain
b. Shortness of breath
c. Fever
d. Watery stool

A

d. Watery stool

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18
Q

Delayed transfusion reactions tend to be associated with antibodies that:

a. Cause Extravascular hemolysis
b. Cause Intravascular hemolysis
c. Are IgM
d. Appear within 24 hours

A

a. Cause Extravascular hemolysis

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19
Q

Febrile transfusion reactions can be prevented by which of the following actions?

a. Transfusing irradiated products
b. Pre treatment with Benadryl
c. Pre treatment with Tylenol
d. Transfusing HLA matched products

A

c. Pre treatment with Tylenol

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20
Q

Urticarial reactions are usually caused by what?

a. IgM antibodies in red cells
b. IgA antibodies in plasma products
c. Leukocytes in non-irradiated products
d. Protein allergens in platelets

A

d. Protein allergens in platelets

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21
Q

Patients most at risk of anaphylactic reactions to blood component transfusion are:

a. Allergic to IgA antibodies
b. Allergic to shellfish
c. Receiving blood products from relatives
d. Cardiovascularly limited

A

a. Allergic to IgA antibodies

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22
Q

Shortness of breath can be a symptom of all of the following transfusion reactions except:

a. TRALI
b. TACO
c. Acute Hemolytic
d. Febrile

A

d. Febrile

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23
Q

Which of the following transfusion reactions is associated with an increase in blood pressure?

a. Sepsis
b. TACO
c. TRALI
d. Delayed Hemolytic

A

b. TACO

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24
Q

Which lab result would lead you to believe the blood product has been bacterially contaminated?

a. Positive DAT on post transfusion specimen
b. Positive hemolysis on the post transfusion specimen
c. Positive gram stain on the post patient specimen
d. Positive gram stain on the transfused unit

A

d. Positive gram stain on the transfused unit

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25
Q

Which of the following is treated through chelation therapy?

a. Citrate toxicity
b. Hemosiderosis
c. Post transfusion purpura
d. Graft vs Host

A

b. Hemosiderosis

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26
Q

Which is the first step of the transfusion reaction workup?

a. Clerical Check
b. Blood Type on post specimen
c. DAT on the pre specimen
d. Gram stain of the transfused product

A

a. Clerical Check

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27
Q

Which chemical marker is expected to increase if a patient has experienced a hemolytic transfusion reaction?

a. Ferritin
b. Haptoglobin
c. pH
d. Hemoglobin A1C

A

a. Ferritin

Haptoglobin and pH expected to decrease, A1c not affected

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28
Q

A patient became hypotensive and went into shock after receiving 50mL of a unit of platelets. She had shaking and chills and her temp spiked up to 103F. A transfusion reaction investigation was initiated. Gram stain results found GPCs in the patient that matched the unit. Should this be reported to the FDA?

a. Yes
b. No

A

a. Yes

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29
Q

A 52 yo male quadriplegic has a history of A positive with anti-Fya in his plasma. Current specimen demonstrated in ABO discrepancy in the reverse type that was attributed to a nonspecific cold agglutinin. Two units of A positive RBCS were phenotyped for Fya and found negative. They were crossmatched. The first unit was transfused with no problems, the second unit was transfused and stopped after 20 minutes when brown tinged urine was noticed in the patient’s catheter bag. Post transfusion specimen was grossly hemolyzed with a positive DAT eluate confirmed anti-E. What transfusion reaction occurred?

a. Acute Hemolytic
b. Symptoms not related to transfusion
c. TACO
d. FNHTR

A

a. Acute Hemolytic

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30
Q

A 76 yo female oncology patient was in for urosepsis. Her history indicates that she is AB negative with a negative antibody screen. Her current type matches and she is crossmatched 2 units of A negative blood. Upon receiving the first blood product, she becomes hypoxic so the unit is stopped after 35mL are infused. Her blood temperature falls from 38C to 36C, her BP fell from 120/80 to 110/69. Serological workup shows no evidence of clerical error or hemolysis. She died 12 hours after the transfusion reaction occurred. What type of reaction was this?

a. Acute Hemolytic
b. Symptoms not related to transfusion
c. TACO
d. FNHTR

A

b. Symptoms not related to transfusion

31
Q

True or False: FDA is responsible for inspecting both registered and unregistered laboratories performing Transfusions.

A

False

32
Q

CBER is the department of which agency responsible for overseeing the nation’s blood supply?

a. FDA
b. CDC
c. AABB
d. JCAHO

A

a. FDA

33
Q

Which of the following is NOT defined as a manufacturer?

a. Transfusion service that serves a NICU by making aliquots for neonate transfusions.
b. Donor collection center where apheresis platelets are collected and processed
c. Offsite NTL where viral testing on Donor products is performed
d. Courier service for blood products from the Donor Processing Center to the Transfusion Service

A

d. Courier service for blood products from the Donor Processing Center to the Transfusion Service

34
Q

Which of the following Quality Assurance activities should NOT be performed by the manufacturer?

a. Inspection of Transfusion Service’s written SOPs
b. Product purity and potency Quality Control
c. Label inspection for license
d. Short Supply Arrangements

A

a. Inspection of Transfusion Service’s written SOPs

35
Q

How long should Donor deferral records be maintained by the Blood Donor Center?

a. 2 years
b. 5 years
c. 10 years
d. Indefinitely

A

d. Indefinitely

36
Q

A platelet is returned from surgery 1 hour after issue unused on ice, what do you do?

a. Discard, it has been out of the blood bank too long
b. Discard, it has been stored improperly
c. Return to inventory, platelets are fine up to 24 hours
d. Return to inventory, platelets are rare and must be preserved until expiration

A

b. Discard, it has been stored improperly

37
Q

Which of the following tests counts as QC not QA?

a. Lookback activities
b. Direct observation of test performance by a seasoned tech
c. Parallel testing of kit components from a new Fetal Screen Kit
d. Validation of a new automated blood banking analyzer

A

c. Parallel testing of kit components from a new Fetal Screen Kit

38
Q

Which Quality Assurance activity is considered process improvement?

a. Competency Performance for a new employee
b. Lookback Activities
c. Update of SOPs
d. Quarterly Review of Preventive maintenance records

A

c. Update of SOPs

39
Q

According to Patient Blood Management Guidelines what is the transfusion Threshold for a patient about to undergo cardiothoracic surgery?

a. 6 g/dL
b. 6-7 g/dL
c. 8-10 g/dL
d. >10 g/dL

A

c. 8-10 g/dL

40
Q

According to Patient blood management guidelines, what test should be ordered between transfusions of RBCs?

a. Blood Type
b. Bilirubin
c. Hemoglobin
d. INR

A

c. Hemoglobin

41
Q

Who manages physician education regarding patient blood management activities?

a. The Blood Bank Staff
b. The Blood Bank Manager
c. The Laboratory Director
d. Other physicians

A

d. Other physicians

42
Q

What is an expected outcome of a patient blood management program implementation at a hospital?

a. The hospital will pass JCAHO inspection
b. Better patient outcomes from lower transfusion thresholds
c. Better interaction amongst transfusion staff and physicians
d. More reimbursement from CMS

A

b. Better patient outcomes from lower transfusion thresholds

43
Q

Which patient is matched correctly with the crossmatch they should be getting?

a. B pos with 2 ABO types that match and an anti-E ; Electronic
b. A neg with no previous history and a negative antibody screen; Immediate spin
c. O positive with 2 ABO types that match and negative antibody history; AHG

A

b. A neg with no previous history and a negative antibody screen; Immediate spin

44
Q

Which follow up test might you perform for a multiple myeloma patient with the following results?
Anti-A: 0
Anti-B: 4+
Anti-D: 4+
A1 cell: 2+
B cell: 2+

a. Wash cells
b. PreWarm Technique
c. Saline Replacement
d. Cool to 4C

A

c. Saline Replacement

45
Q

Your patient is A negative and has anti-Fyb in their plasma. 2 units of RBCs are ordered for a morning surgery. You have tested all 3 A negative units in inventory for the antigen and they are all positive. What do you do next?

a. Crossmatch 2 of the A negative units that you phenotyped
b. Phenotype the O negative units in inventory for Fyb antigen
c. Crossmatch 2 O negative units in inventory for the patient
d. Phenotype the AB negative units in inventory for Fyb antigen
d. Cancel the surgery

A

c. Crossmatch 2 O negative units in inventory for the patient

46
Q

Which surgical patient would require the use of irradiated blood products?

a. Jehovah’s witness heart surgery patient
b. 7th day Adventist orthopedic patient
c. AIDS patient undergoing kidney transplant
d. 5 year old sickle cell patient undergoing splenectomy

A

c. AIDS patient undergoing kidney transplant

47
Q

Which procedure is not utilized in bloodless medicine?

a. Plasmapheresis
b. Cell Salvage
c. Hemodilution
d. Vitamin K administration

A

a. Plasmapheresis

48
Q

A patient has a history of A positive blood type. The current sample is O positive. What should be done regarding transfusion?

a. Crossmatch O negative blood to the current sample.
b. Have the patient recollected STAT.
c. Change the record to match the current blood type.
d. Offer Emergency release O negative blood.

A

b. Have the patient recollected STAT.

49
Q

Which is the TRUE statement?

a. Emergency releases are always massive transfusions.
b. Massive transfusions always have emergency releases.
c. Both emergency release and massive transfusion waive the necessity of performing a crossmatch on a patient.
d. A crossmatch must complete the workup for both emergency release and massive transfusions.

A

d. A crossmatch must complete the workup for both emergency release and massive transfusions.

50
Q

Plasma transfusion instead of cellular products would be indicated for which of the following patients?

a. Sickle cell patient not in crisis
b. TTP patient
c. Warm Autoantibody patient
d. A mother at risk of causing HDFN
e. All of the above
f. None of the above

A

b. TTP patient

51
Q

What is a possible explanation for the following serological results?
Anti-A: 4+
Anti-B: 3+mf
Anti-D: 2+mf
A1 cell: 0
B cell: 0

a. Multiple Myeloma
b. WAIHA
c. Immunocompromized
d. Massive Transfusion

A

d. Massive Transfusion

52
Q

What is the most likely possible explanation for the following serological results?
Anti-A: 0
Anti-B : 0
Anti-D: 4+
A1 cell: 4+
B cell: 4+
Type: Opos
IS: 2+

a. CAD
b. Pos DAT in Donor cell
c. Pos DAT in patient cells
d. Low incidence antibody

A

a. CAD (cold agglutinins disease)

53
Q

Which of the following is acceptable as a donor?

a. 29 yo who received flu vacc last month.
b. 21 yo who got nose pierced last week.
c. 30 yo who used to live in Zambia and returned last year.
d. 54 yo tested pos for HepC last year but no active symptoms

A

a. 29 yo who received flu vacc last month.

54
Q

Which vaccine has the longest deferral period?

a. Hep B Ig
b. Rubella
c. Influenza
d. Yellow fever

A

a. Hep B Ig

55
Q

Which of the following donors are qualified to donate on September 10?

a. 40 yo who donated RBCs on July 23
b. 28 yo who donated platelets on Aug 24
c. 52 yo who made an autologous donation 2 days ago
d. 23 yo who donated blood for her aunt on Aug 14

A

b. 28 yo who donated platelets on Aug 24

56
Q

Which donor would NOT be acceptable for whole blood donation?

a. Former drug addict who has been clean for 3 years
b. Triathlete with a pulse of 45 beats/min
c. A man who is currently in remission for multiple myeloma
d. A woman treated for gonorrhea 8 months ago

A

c. A man who is currently in remission for multiple myeloma

57
Q

Which physical exam result is cause for rejecting a whole blood donor?

a. Weight 105 lbs
b. Pulse 75 beats/min
c. Temperature of 99.3F
d. Diastolic blood pressure of 110 mm Hg

A

a. Weight 105 lbs
d. Diastolic blood pressure of 110mmHg

58
Q

Which donor is acceptable for blood donation today?

a. Donor who had an abortion 4 weeks ago
b. Donor who’s husband is a hemophiliac who received cryo in the 1980s
c. Donor treated for gonorrhea 6 months ago
d. Donor who had a needlestick 9 months ago

A

c. Donor treated for gonorrhea 6 months ago
d. Donor who had a needlestick 9 months ago

3-month deferral for these

59
Q

Which test is NOT required for allogenic donation testing?

a. Rh
b. STS
c. Anti-HTLV
d. Anti-CMV

A

d. Anti-CMV

60
Q

What is the difference between allogenic donor and autologous donor?

a. There is not a minimum age for autologous donors.
b. Hemoglobin value has a lower threshold for autologous than allogenic
c. The autologous donor unit will not be rejected for viral testing results.
d. All of the above

A

d. All of the above

61
Q

Which of the following lists the correct shelf life for the product?

a. Deglycerolized RBCs- 24 hours
b. CPD RBCs – 35 days
c. Platelet concentrate – 7 days
d. FFP – 5 years

A

a. Deglycerolized RBCs- 24 hours

CPD RBCS is 21 days
Plt concentrate is 24 hrs
FFP is 24 hours

62
Q

What cells are HLA antigens typically on?

a. Red cells
b. White cells
c. Platelets
d. 2 of these

A

d. 2 of these

WBCs and plts

63
Q

What is the test of choice for HLA antigen testing?

a. Agglutination
b. Molecular
c. Cytotoxicity
d. ELISA

A

b. Molecular

64
Q

Which coagulation factors are diminished in products labeled “thawed plasma”

a. XIII & VWF
b. V & VIII
c. Fibrinogen & VIII
d. VII & Fibrinogen

A

b. V & VIII

65
Q

Which of the following is true regarding apheresis platelets?

a. Minimum platelet count in a unit must be 3.0 x 10^11 PH<6.0
b. Minimum platelet count in a unit must be 3.0 x 10^10 PH<6.2
c. Minimum platelet count in a unit must be 3.0 x 10^11 PH>6.2
d. Minimum platelet count in a unit must be 5.5 x 10^10 PH>6.0

A

c. Minimum platelet count in a unit must be 3.0 x 10^11 PH>6.2

66
Q

A shipment of packed red blood cells and platelets arrived together in the same box stored at 1-6C. What should be done?

a. Place all units in 1-6C refrigerator.
b. Reject the entire shipment.
c. Accept the red cells, discard the platelets.
d. Accept the platelets, discard the red cells.

A

c. Accept the red cells, discard the platelets.

67
Q

A cold screen giving the following results helps identify which antibody in patient plasma?
4C:
SC1: 4+ SC2: 4+ SC3: 4+ Auto: 4+ Cord: 0
IS:
SC1: 3+ SC2: 3+ SC3: 3+ Auto: 3+ Cord: 0
37C:
SC1: 0 SC2: 0 SC3: 0 Auto: 1+ Cord: 0
AHG:
SC1: 0 SC2: 0 SC3: 0 Auto: 0 Cord: 0
CC:
SC1: 2+ SC2: 2+ SC3: 2+ Auto: 2+ Cord: 2+

a. Anti-P
b. Anti-A1
c. Anti-M
d. Anti-I

A

d. Anti-I

look at the cord cells, only Anti-I in baby blood

68
Q

Which statement is true for alloadsorption procedure?

a. It is utilized when patients have been recently transfused
b. It removes antibody from patient cells
c. QC for this procedure involves testing of the last wash
d. Patient cells are used to remove autoantibody from their own plasma

A

a. It is utilized when patients have been recently transfused

69
Q

What type of reaction gives a positive interpretation on the Donath Landsteiner test?

a. 4+ agglutination
b. Hemolysis after addition of compliment
c. Hemolysis after cooling and heating of patient specimen
d. Negative agglutination

A

c. Hemolysis after cooling and heating of patient specimen

70
Q

Which DAT results would implicate WAIHA over CAD?

a. Poly 3+ IgG 3+ C3d 0
b. Poly 1+ IgG 0 C3d 0
c. Poly 0 IgG 0 C3d 0
d. Poly 3+ IgG 0 C3d 3+

A

a. Poly 3+ IgG 3+ C3d 0

71
Q

Warm autoimmune anemias tend to mask alloantibody activity in patient plasma. Which test is LEAST useful in the serological workup?

a. Phenotype of patient cells
b. Eluate
c. Adsorption
d. Non enhanced antibody screen

A

b. Eluate

72
Q

Which drug is commonly associated with the Autoantibody formation mechanism of Drug Induced Anemia?

a. Penicillin
b. Quinidine
c. Ceptosporin
d. Aldomet

A

d. Aldomet

73
Q

A patient gives the following results on work up, what followup testing should you do?
Anti-A: 3+
Anti-B: 3+
Anti-D: 3+
A1 cell: 3+
B cell: 3+
Poly: 2+ IgG: 0 C3d: 3+ Saline: 0

a. Wash patient cells
b. Eluate
c. Adsorption
d. Nothing

A

d. Nothing

Blood Bank 2 (2 decks)

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