Immunoserology and Bloodbanking Flashcards
Discovery of genetic principles underlying the generation of antibodies with different specificities:
a. Edward Jenner
b. Ellie Metchnikoff
c. Emil von Behring
d. Susumu Tonegawa
D.
The process of inflammation is characterized by all of the following except
a. Increased blood supply to the area
b. Migration of white blood cells.
c. Decreased capillary permeability
d. Appearance of acute-phase reactants.
C.
The acute phase protein that demonstrates the most dramatic rise during acute inflammation is
a. Fibrinogen
b. CRP
c. Haptoglobin
d. Alpha2-macroglobulin
B.
Which of the following refers to the force of
attraction between an antibody and a single
antigenic determinant?
a. Affinity
b. Avidity
c. Van der Waals attraction
d. Covalence
A.
Macrophages in the kidneys are:
a. Alveolar macrophages
b. Microglial cells
c. Mesangial cells
d. Histiocytes
C.
The major role of neutrophils is phagocytosis.
Which one of the following events is not associated with some aspect of neutrophil function?
a. Recognition of antigen via primitive pattern
receptor patterns
b. Recognition of opsonins on bacteria
c. Secretion of perforin
d. Activation of the NADPH oxidase
C. Perforin secreted by lymphocytes not neutrophils
Which cell is the most potent phagocytic cell in
the tissue?
a. Neutrophil
b. Dendritic cell
c. Eosinophil
d. Basophil
B.
What is the principal source of IL-2?
a. B cells
b. Tcells
c. Monocytes
d. Plasma cells
B.
HOT T BONE stEAK
HOT- IL 1 (fever)
T- IL 2 (T lymphocytes)
Bone- IL 3 (Bone marrow stimulation)
E- IL4 (IgE synthesis)
A- IL 5 (IgA synthesis)
K- IL 6 (aKute phase reactants)
The immunoglobulin classes most commonly
found on the surface of circulating B lymphocytes in the peripheral blood of normal persons are:
a. IGM, IgA
b. IgM, IgG
c. IgM, lgD
d. gM, lgE
C.
Which of the following antigens are found on the Tell subset known as helper/inducers?
a. CD3
b. CD4
c. CD8
d. CD11
B.
Antigen receptors on T lymphocytes bind HLA
class I+ peptide complexes with the help of which accessory molecule?
a. CD2
b. CD3
c. CD4
d. CD8
D.
Which of the following MC classes encodes
complement components?
a. Class I
b. Class Il
c. Class IlI
d. Class IV
C.
What type of cells would be found in a primary
follicle?
a. Unstimulated B cells
b. Germinal centers
c. Plasma cells
d. Memory cells
A.
Which of the following is a unique characteristic of adaptive immunity?
a. Ability to fight infection
b. Ability to remember a prior exposure to a
pathogen
c. A similar response encountered to all pathogens
d. Process of phagocytosis to pathogen destroy a pathogen
B.
Which of the following statements is FALSE about an anamnestic response versus a primary response?
a. Has a shorter lag phase
b. Antibodies decline more gradually
c. Has a longer plateau
d. IgM antibodies predominate
D.
The type of immunity that follows the injection of an immunogen is termed:
a. Artificial active
b. Natural active
c. Artificial passive
d. Innate
A.
Bence-Jones proteins are identical:
a. H chains
b. L chains
c. IgMmolecules
d. IgG molecules
B.
A complement which is strongly chemotactic for neutrophils:
a. C4a
b. C3b
c. C5a
d. C9
C.
C5a is the most potent anaphylatoxin. It increases inflammatory response thus gathering neutrophils to the site of inflammation
Which of the following complement proteins is
part of the membrane attack complex (MAC)?
a. C1
b. C3
c. C4
d. C5
D.
Which of the following would be most effective in preventing bystander lysis of red blood cells?
a. C1INH
b. Factor B
c. DAF
d. Factor H
C.
A patient with a deficiency in complement component C7 would likely present with:
a. Recurrent Staphylococcal infections
b. Recurrent Neisserial infections
c. Recurrent Escherichia coli infections
d. Recurrent Nocardia infections
B.
Complement can be inactivated in human serum by heating to
a. 25 C
b. 37 C
c. 45 C
d. 56 C
D.
In the complement fixation procedure, a negative result is manifested by:
a. Antigen-binding
b. Lysis of guinea pig cells
c. Lysis of sheep red blood cells
d. Agglutination of sheep red blood cells
C.
Which of the following is characteristic DiGeorge syndrome?
a. Defective T lymphocyte production
b. Depressed B cell development
c. Suppressed intracellular killing by polymorphonuclear cells
d. Suppressed complement levels
A.
A positive direct Coomb’s test could occur under which circumstances?
a. Hemolytic disease of the newborn
b. Autoimmune hemolytic anemia
c. Antibodies to drug that bind to red cells
d. Any of the above
D.
Antibodies are grouped into five classes based on differences in their
a. Kappa chains
b. Lambda chains
c. Heavy chains
d. Light chains
C.
IgG subclass most efficient at efficient at complement fixation but is not capable of binding the Fc portion of the molecule to staphylococcal protein A
a. lgG1
b. IgG3
c. lgG4
d. lgG2
B.
Which class of immunoglobulin possesses 10
antigenic binding sites?
a. lgA
b. lgD
c. lgG
d. IgM
D.
A 1:750 dilution of serum is needed to perform a serological test. Which of the following series of dilutions would be correct to use in this
situation?
a. 1:5, 1:15, 1:10
b. 1:5. 1:10. 1.5
c. 1:15, 1:10, 1:3
d. 1:15, 1:3, 1;5
A.
Protein can be separated into fractions by use of serum electrophoresis.
a. Three
b. Four
c. Five
d. Six
C.
What is the interpretation when an Ouchterlony plate shows crossed lines between wells 1 and 2 (antigen is placed in the center well and antisera in wells 1 and 2)?
a. No reaction between wells 1 and 2
b. Partial identity between wells 1 and 2
c. Nonidentity between wells 1 and 2
d. Identity between wells 1 and 2
C.
All of the following are benefits of automation except
a. Greater accuracy.
b. Increased turnaround time.
c. Savings on controls.
d. Less disposal of outdated reagents.
B.
Which of the following techniques uses signal
amplification?
a. bDNA
b. TMA
c. NASBA
d. RT-PCR
A.
What is the immune phenomenon associated
with Arthus reaction?
a. Tissue destruction by cytotoxic T cells
b. Removal of antibody-coated red blood cells
c. Deposition of immune complexes in blood vessels
d. Release of histamine from mast cells
C.
A few isolated aggregates; mostly free-floating
cells; supernatant appears red:
a. Negative
b. Mixed field
c. Weak
d. 1+
B.
Which of the following best describes agglutination?
a. A combination of soluble antigen with
soluble antibody
b. A combination of particulate antigen with
soluble antibody
c. A reaction that produces no visible end point
d. A reaction that requires instrumentation to
read
B.
The Mantoux test is an example of:
a. Type I Hypersensitivity
b. Type I hypersensitivity
c. Type Il1 hypersensitivity
d. Type IV hypersensitivity
D.
It is strongly suggestive, in a high titer, of primary biliary cirrhosis:
a. Anti-myelin antibody
b. Anti-intrinsic factor antibody
c. Anti-centromere antibody
d. Anti-mitochondrial antibody
D.
Individuals who are at risk for ankylosing
spondylitis have inherited which one of the
following alleles?
a. HLA-A3
b. HLA-B8
c. HLA-B27
d. HLA-B7
C.
The type of graft rejection that occurs within
minutes of a tissue transplant is
a. Acute
b.Chronic
c. Hyperacute
d. Accelerated
C.
Which surface marker is a reliable marker for the presence of high levels of hepatitis B virus (HBV) and a high degree of infectivity?
a. HBeAg
b. HBsAg
c. HBCAg
d. Anti-HBsAg
A.
Interpret Hepa B panel:
HBsAg: negative
Anti-HBc: positive
Anti-HBs: positive
a. Susceptible to HBV
b. Acutely infected
c. Immune because of natural infection
d. Immune because of HBV vaccination
C.
Which of the following combinations of bands
would represent a positive Western blot for HIV
antibody?
a. p24 and p55
b. p24 and p31
c. gp41 and gp120
d. p31 and p55
C.
What is the standard Screening test for HIV?
a. ELISA
b. Western blot
c. Immunofluorescence
d. RIPA
A.
The Epstein-Barr virus can cause all the following except:
a. Infectious mononucleosis
b. Burkitt’s lymphoma
c. Nasopharyngeal carcinoma
d. Neoplasms of the bone marrow
D.
Which of the following is not a strain of proteus
useful in diagnosing ricketssial disease?
a. Ox-2
b. Ox-1
c. OX-K
d. OX-4
D.
The least immunogenic transplant tissue:
a. Bone marrow
b. Cornea
c. Heart
d. Skin
B.
Monoclonal antibodies are produced by
a. Cultured T cells
b. Human plasma cells
c. Mouse plasma cells
d. Hybridomas
D.
Which type of cancer is associated with the
highest level of AFP?
a. Hepatoma
b. Ovarian cancer
c. Testicular cancer
d.Breast cancer
A.
The pope who was recorded to perform the first transfusion:
a. Pope John Paul
b. Pope Popius
C Pope Innocent VII
d. Pope Benedict
C.
When RBCs are stored, there is a “shift to the left.” This means:
a. Hemoglobin-oxygen affinity increases, owing to an increase in 2,3 -DPG
b. Hemoglobin-oxygen affinity increases, owing to a decrease in 2.3-DPG
C. Hemoglobin-oxygen affinity decreases, owing to a decrease in 2.3-DPG
d. Hemoglobin-oxygen affinity decreases, owing to an increase in 2,3-DPG
B.
What does a MAJOR crossmatch consist of?
a. Recipient plasma and recipient red cells
b. Recipient plasma and donor red cells
c. Recipient red cells and donor plasma
d. Donor plasma and donor red cells
B.
Determine what incompatibility is demonstrated: Group A (donor) with group O (patient):
a. Incompatible in minor crossmatch
b. Incompatible in major crossmatch
c. Both of these
d. None of these
B.
The immunodominant sugar responsible for blood group B specificity is:
a. L-fucose
b. N-acetyl-D-galactosamine
c. D-galactose
d. Uridine diphosphate-N-acety|-D-galactose
C.
Which of the following ABO blood groups
contains the least amount of H substance?
a. A1B
b. A2
c. B
d. O
A.
The most commonly encountered of the Lewis
antibodies:
a. Anti-Le a
b. Anti-Le b
c. Anti-Le bH
d. Anti-Le bL
A.
Which Duffy phenotype offers the greatest
resistance to invasion by malarial parasites?
a. Fy (a+b-)
b. Fy (a+b+)
c. Fy (a-b+)
d. Fy (a-b-).
D.
Which blood group system is associated with
resistanca to Plasmodium vivax malaria?
a. P
b. Kell
c. Duffy
d. Kidd
C.
A patient is suspected of having paroxysmal cold hemoglobinuria (PCH). Which pattern
of reactivity is characteristic of the Donath-
Landsteiner antibody, which causes this condition?
a. The antibody attaches to RBCs at 4°C and
causes hemolysis at 37°C
b. The antibody attaches to RBCs at 37°C and
causes agglutination at the AT phase
c. The antibody attaches to RBCs at 22°C and causes hemolysis at 37°C
d. The antibody attaches to RBCs and causes
agglutination at the AT phase
A.
Antibodies to antigens in which of the following blood groups are known for showing dosage?
a. I
b. P
c. Kidd
d. Lewis
C.
A low-incidence antigen that serves as a useful anthropologic marker for Mongolian ancestry:
a. Xga
b Do(a)
c. Dia
d. Yt(a)
C.
How can interfering anti-P1 antibody be removed from a mixture of antibodies?
a. Neutralization with saliva
b. Agglutination with human milk
c. Combination with urine
d. Neutralization with hydatid cyst fluid
D.
Rh antibodies are primarily of which immunoglobulin class?
a. lgA
b. lgM
c. IgG
d. lgD
C.
If a prospective allogeneic donor has received
blood or blood components known to be sources of hepatitis (e.g., surgery), the donor should be deferred from donating for after the transfusion.
a. 6 weeks
b. 3 months
c. 6 months
d. 12 months
D.
Immunization for rubella(German measles)
would result in a temporary deferral for:
a. 4 weeks
b. 2 weeks
c. 1 year
d. 3 years
A.
Which of the following donors is acceptable?
a. Donor who had a first-trimester abortion
b. Donor whose husband is a hemophiliac who regularly received cryoprecipitate before 1989
c. Donor who was treated for gonorrhea 6 months ago
d. Donor who had needle stick injury 10 months ago
A.
Frozen platelets can be stored for up to:
a. 48 hours
b. 5 days
c. 1 year
d. 2 years
D.
What are the current storage time and storage
for temperature for platelet concentrates and
apheresis platelet components?
a. 5 days at 1°C to 6°C
b. 5 days at 24°C to 27°C
c. 5 days at 20°C to 24°C.
d. 7 days at 22°C to 24°C
C.
Which component has the longest expiration
date?
a. Cryoprecipitate
b. FFP
c. Frozen RBCs
d. Platelet concentrates
C.
Minimum weight of male donor for double RBC
apheresis:
a. 90 Ibs
b. 100 Ibs
c. 130 Ibs
d. 150 Ibs
C.
The required storage temperature for frozen
RBs using the HIGH GLYCEROL method is:
a.-20 C
b. -18 C
c. -120°C
d. -65°C
D.
Additive solutions are approved for blood storage for how many days?
a. 21 days
b. 42 days
c. 35 days
d. 7 days
B.
The radiation source for irradiation of blood
products is:
a. 131I
b. 137Ce or Cobalt (60C)
c. 14C
d. 131Te
B.
Once thawed, FFP must be transfused within:
a. 4 hours
b. 6 hours
c. 8 hours
d. 24 hours
D.
The minimum hemoglobin concentration in g/dL in a fingerstick from a male blood donor is:
a. 12.0
b. 13.5
c. 12.5
d. 15.0
C.
The required hemoglobin and hematocrit for
autologous donation should be at least:
a. 11 g/dL Hgb, 33% Hct
b. 11 g/dL Hgb, 38% Hct
c. 12.5 g/dL Hgb, 33% Hct
d. 12.5 g/dL Hgb, 38% Hct
A.
Blood component most frequently associated
with transfusion reaction düe to bacterial contamination:
a. Red cells
b. Fresh frozen plasma
c. Cryoprecipitate
d. Platelet concentrate
D.
Of the deaths caused by bacterial contamination of blood components reported to Centers for Disease Control (CDC), most are caused by blood components contaminated by:
a. Escherichia coli
b. Pseudomonas species
c. Yersinia enterocolitica
d. None of these
C.
Polyspecific AHG reagent contains:
a. Anti-IgG or anti-C3d
b. Anti-IgG and anti-IgM
c. Anti-IgG and anti-C3d
d. Anti-C3d
C.
Anticoagulant used to collect blood samples for the direct AHG test (DAT) to avoid in vitro complement attachment associated with refrigerated, clotted specimens:
a. Heparin
b. EDTA
c. Citrate
d. Oxalate
B.
All of the following are enhancement media for
AHG testing, EXCEPT:
a. Albumin
b. Polyethylene glycol (PEG)
c. Normal saline
d. LISS
C.
Which of the following is the most common
haplotype in the African American population?
a. DCe
b. DcE
c. Dce
d. ce
C.
If a patient who is R1R1 is transfused with RBCs that are R0r, which antibody is he most likely to produce?
a. Anti-D
b. Anti-C
c. Anti-e
d. Anti-G
B.
RBCs that have been leukoreduced must contain less than leukocytes and retain at least of original RBCs.
a. 8 × 10 6th/ 85%
b. 8 × 10 6th/ 90%
c. 5 × 10 6th/ 85%
d. 5 × 10 6th / 80%
C.
Which of the following blood components is the best source of factor IX?
a. Prothrombin complex
b. Cryoprecipitated AHF
c. Fresh frozen plasma
d. Single-donor plasma
A.
A lectin with anti-N specificity can be made from:
a. Bandeirae simplicifolia
b. Dolichos biflorus
c. Iberis amara
d. Vicia graminea
D.
The mechanism that best explains hemolytic
anemia due to penicillin is:
a. Drug adsorption
b. Membrane modification
c. Immune complex formation
d. Autoantibody production
A.
Occasionally, patients have an anaphylactic
reaction to a specific immunoglobulin class
during a transfusion. Which immunoglobulin
class is most often implicated?
a. lgA
b. lgD
c. IgE
d.IgG
A.
What is the component of choice for a patient
with chronic granulomatous disease (CGD)?
a. FFP
b. Granulocytes
c. Cryoprecipitate
d. RBCS
B.
Cryoprecipitated antihemophilic factor (AHF) is not recommended for the treatment of:
a. Hemophilia A
b. Hemophilia B
c. VWD
d. Hypofibrinogenemia
B.
Which of the following is usually employed to
start an IV liner prior to blood transfusion?
1. Normal saline
2. Ringers Lactate
4. 5% Dextrose in water
5. Distilled water
a. 1 only
b. 1 and 3
c. 1, 2 and 3
d. 1, 2, 3 and 4
A.
What may be found in the serum of a person
who is exhibiting signs of TRALI (transfusion-
related acute lung injury)?
a. Red blood cell alloantibody
b. IgA antibody
c. Antileukocyte antibody
d. Allergen
C.
The laboratory assay of brain natriuretic peptide (BNP) may be used to aid in the diagnosis of:
a. TRALI
b. FNHTR
c. TACO
d. Iron overload
C.
T activation is a form of polyagglutination that is caused by microorganisms that produce
as a metabolic byproduct.
a. Deacetylase
b. Galactosidase
c. Glucosidase
d. Neuraminidase
D.
All of the following are routinely performed on
a cord blood sample except:
a. Forward AB typing
b. Antibody screen
c. Rh typing
d. DAT
B.
Blood banking Laboratory Information system
(LIS) password should be
a. Encrypted in small letters
b. Strictly kept confidential
c. At least 8 characters
d. Should be posted in the BB bulletin board
B.
Which is NOT a component of a BB information
system?
a. People
b Validation
C. Hardware
d. Software
B
What comprises the indicator system in an indirect ELISA for detecting antibody?
a. Enzyme conjugated antibody + chromogenic substrate
b. Enzyme conjugated antigen + chromogenic substrate
c. Enzyme + antigen
d. Substrate + antigen
A.
Rejuvenation of a unit of red blood cells is a method used to
a. Remove antibody attached to rbc
b. Inactivate viruses and bacteria
c. Restore 2,3 DPG and ATP to normal levels
d. Filter blood clots and other debris
C
From the following, identify a specific component of the adaptive immune system that is formed in response to antigenic stimulation:
A. Lysozyme
B. Complement
C. Commensal organisms
D. Immunoglobulin
D
Which two organs are considered the primary lymphoid organs in which immunocompetent cells originate and mature?
A. Thyroid and Peyer’s patches
B. Thymus and bone marrow
C. Spleen and mucosal-associated lymphoid tissue (MALT)
D. Lymph nodes and thoracic duct
B
What type of B cells are formed after antigen stimulation?
A. Plasma cells and memory B cells
B. Mature B cells
C. Antigen-dependent B cells
D. Receptor-activated B cells
A
T cells travel from the bone marrow to the thymus for maturation. What is the correct order of the maturation sequence for T cells in the thymus?
A. Bone marrow to the cortex; after thymic education, released back to peripheral circulation
B. Maturation and selection occur in the cortex; migration to the medulla; release of mature T cells to secondary lymphoid organs
C. Storage in either the cortex or medulla; release of T cells into the peripheral circulation
D. Activation and selection occur in the medulla; mature T cells are stored in the cortex until activated by antigen
B
Which cluster of differentiation (CD) marker appears during the first stage of T-cell development and remains present as an identifying marker for T cells?
A. CD1
B. CD2
C. CD3
D. CD4 or CD8
B
Which markers are found on mature, peripheral helper T cells?
A. CD1, CD2, CD4
B. CD2, CD3, CD8
C. CD1, CD3, CD4
D. CD2, CD3, CD4
D
Which T cell expresses the CD8 marker and acts specifically to kill tumors or virally infected cells?
A. Helper T
B. T suppressor
C. T cytotoxic
D. T inducer/suppressor
C
How are cytotoxic T cells (TC cells) and natural killer (NK) cells similar?
A. Require antibody to be present
B. Effective against virally infected cells
C. Recognize antigen in association with HLA class II markers
D. Do not bind to infected cells
B
What is the name of the process by which phagocytic cells are attracted to a substance such as a bacterial peptide?
A. Diapedesis
B. Degranulation
C. Chemotaxis
D. Phagotaxis
C
All of the following are immunologic functions of complement except:
A. Induction of an antiviral state
B. Opsonization
C. Chemotaxis
D. Anaphylatoxin formation
A
Which complement component is found in both the classic and alternative pathways?
A. C1
B. C4
C. Factor D
D. C3
D
Which immunoglobulin(s) help(s) initiate the classic complement pathway?
A. IgA and IgD
B. IgM only
C. IgG and IgM
D. IgG only
C
How is complement activity destroyed in vitro?
A. Heating serum at 56°C for 30 min
B. Keeping serum at room temperature of 22°C for 1 hour
C. Heating serum at 37°C for 45 min
D. Freezing serum at 0°C for 24 hours
A
What is the purpose of C3a, C4a, and C5a, the split products of the complement cascade?
A. To bind with specific membrane receptors of lymphocytes and cause release of cytotoxic substances
B. To cause increased vascular permeability, contraction of smooth muscle, and release of histamine from basophils
C. To bind with membrane receptors of macrophages to facilitate phagocytosis and the removal of debris and foreign substances
D. To regulate and degrade membrane cofactor protein after activation by C3 convertase
B
Which region of the immunoglobulin molecule can bind antigen?
A. Fab
B. Fc
C. CL
D. CH
A
Which region determines whether an immunoglobulin molecule can fix complement?
A. VH
B. CH
C. VL
D. CL
B
Which immunoglobulin class(es) has (have) a J chain?
A. IgM
B. IgE and IgD
C. IgM and sIgA
D. IgG3 and IgA
C
Which immunoglobulin appears first in the primary immune response?
A. IgG
B. IgM
C. IgA
D. IgE
B
Which immunoglobulin appears in highest titer in the secondary response?
A. IgG
B. IgM
C. IgA
D. IgE
A
Which immunoglobulin can cross the placenta?
A. IgG
B. IgM
C. IgA
D. IgE
A
Which immunoglobulin cross links mast cells to release histamine?
A. IgG
B. IgM
C. IgA
D. IgE
D
All of the following are functions of immunoglobulins except:
A. Neutralizing toxic substances
B. Facilitating phagocytosis through opsonization
C. Interacting with TC cells to lyse viruses
D. Combining with complement to destroy cellular antigens
C
Which of the following cell surface molecules is classified as an MHC class II antigen?
A. HLA-A
B. HLA-B
C. HLA-C
D. HLA-DR
D
Which MHC class of molecule is necessary for antigen recognition by CD4-positive T cells?
A. Class I
B. Class II
C. Class III
D. No MHC molecule is necessary for antigen recognition
B
Which of the following are products of HLA class III genes?
A. T-cell immune receptors
B. HLA-D antigens on immune cells
C. Complement proteins C2, C4, and Factor B
D. Immunoglobulin VL regions Immunology
C
What molecule on the surface of most T cells recognizes antigen?
A. IgT, a four-chain molecule that includes the tau heavy chain
B. MHC protein, a two-chain molecule encoded by the HLA region
C. CD3, consisting of six different chains
D. TcR, consisting of two chains, alpha and beta
D
The T-cell antigen receptor is similar to immunoglobulin molecules in that it:
A. Remains bound to the cell surface and is never secreted
B. Contains V and C regions on each of its chains
C. Binds complement
D. Can cross the placenta and provide protection to a fetus
B
Macrophages produce which of the following proteins during antigen processing?
A. IL-1 and IL-6
B. γ-Interferon
C. IL-4, IL-5, and IL-10
D. Complement components C1 and C3
A
A superantigen, such as toxic shock syndrome toxin-1 (TSST-1), bypasses the normal antigen processing stage by binding to and cross linking:
A. A portion of an immunoglobulin molecule and complement component C1
B. Toll-like receptors and an MHC class 1 molecule
C. A portion of an immunoglobulin and a portion of a T-cell receptor
D. A portion of a T-cell receptor and an MHC class II molecule
D
T regulator cells, responsible for controlling autoimmune antibody production, express which of the following phenotypes?
A. CD3, CD4, CD8
B. CD3, CD8, CD25
C. CD3, CD4, CD25
D. CD8, CD25, CD56
C
The interaction between an individual antigen and antibody molecule depends upon several types of bonds such as ionic bonds, hydrogen bonds, hydrophobic bonds, and van der Waals forces. How is the strength of this attraction characterized?
A. Avidity
B. Affinity
C. Reactivity
D. Valency
B
A laboratory is evaluating an enzyme-linked immunosorbent assay (ELISA) for detecting an antibody to cyclic citrullinated peptide (CCP), which is a marker for rheumatoid arthritis. The laboratory includes serum from healthy volunteers and patients with other connective tissue diseases in the evaluation. These specimens determine which factor of the assay?
A. Sensitivity
B. Precision
C. Bias
D. Specificity
D
Thedetectionofprecipitationreactions depends on the presence of optimal proportions of antigen and antibody. A patient’s sample contains a large amount of antibody, but the reaction in a test system containing antigen is negative. What has happened?
A. Performance error
B. Low specificity
C. A shift in the zone of equivalence
D. Prozone phenomenon
D
Which part of the radial immunodiffusion (RID) test system contains the antisera?
A. Center well
B. Outer wells
C. Gel
D. Antisera may be added to any well
C
What is the interpretation when an Ouchterlony plate shows crossed lines between wells 1 and 2 (antigen is placed in the center well and antisera in wells 1 and 2)?
A. No reaction between wells 1 and 2
B. Partial identity between wells 1 and 2
C. Nonidentity between wells 1 and 2
D. Identity between wells 1 and 2
C
Why is a chemiluminescent immunoassay (CIA) or enzyme immunoassay (EIA) the method of choice for detection of certain analytes, such as hormones, normally found in low concentrations?
A. Because of low cross reactivity
B. Because of high specificity
C. Because of high sensitivity
D. Because test systems may be designed as both competitive and noncompetitive assays
C
What comprises the indicator system in an indirect ELISA for detecting antibody?
A. Enzyme-conjugated antibody + chromogenic substrate
B. Enzymeconjugated antigen + chromogenic substrate
C. Enzyme + antigen
D. Substrate + antigen
A
What outcome results from improper washing of a tube or well after adding the enzyme–antibody conjugate in an ELISA system?
A. Result will be falsely decreased
B. Result will be falsely increased
C. Result will be unaffected
D. Result is impossible to determine
B
What would happen if the color reaction phase is prolonged in one tube or well of an ELISA test?
A. Result will be falsely decreased
B. Result will be falsely increased
C. Result will be unaffected
D. Impossible to determine
B
What is the interpretation when an Ouchterlony plate shows crossed lines between wells 1 and 2 (antigen is placed in the center well and antisera in wells 1 and 2)?
A. No reaction between wells 1 and 2
B. Partial identity between wells 1 and 2
C. Nonidentity between wells 1 and 2
D. Identity between wells 1 and 2
C
Why is a chemiluminescent immunoassay (CIA) or enzyme immunoassay (EIA) the method of choice for detection of certain analytes, such as hormones, normally found in low concentrations?
A. Because of low cross reactivity
B. Because of high specificity
C. Because of high sensitivity
D. Because test systems may be designed as both competitive and noncompetitive assays
C
What comprises the indicator system in an indirect ELISA for detecting antibody?
A. Enzyme-conjugated antibody + chromogenic substrate
B. Enzyme conjugated antigen + chromogenic substrate
C. Enzyme + antigen
D. Substrate + antigen
A
What outcome results from improper washing of a tube or well after adding the enzyme–antibody conjugate in an ELISA system?
A. Result will be falsely decreased
B. Result will be falsely increased
C. Result will be unaffected
D. Result is impossible to determine
B
What would happen if the color reaction phase is prolonged in one tube or well of an ELISA test?
A. Result will be falsely decreased
B. Result will be falsely increased
C. Result will be unaffected
D. Impossible to determine
B
A patient was suspected of having a lymphoproliferative disorder. After several laboratory tests were completed, the patient was found to have an IgMκ paraprotein. In what sequence should the laboratory tests leading to this diagnosis have been performed?
A. Serum protein electrophoresis (SPE) followed by immunofixation electrophoresis (IFE)
B. Immunoglobulin levels followed by SPE
C. Total lymphocyte count followed by immunoglobulin levels
D. Immunoglobulin levels followed by urine protein electrophoresis
A
An IFE performed on a serum sample showed a narrow dark band in the lanes containing anti-γ and anti-λ. How should this result be interpreted?
A. Abnormally decreased IgG concentration
B. Abnormal test result demonstrating monoclonal IgGλ
C. Normal test result
D. Impossible to determine without densitometric quantitation
B
Which type of nephelometry is used to measure immune complex formation almost immediately after reagent has been added?
A. Rate
B. Endpoint
C. Continuous
D. One dimensional
A
An immunofluorescence microscopy assay (IFA) was performed, and a significant antibody titer was reported. Positive and negative controls performed as expected. However, the clinical evaluation of the patient was not consistent with a positive finding. What is the most likely explanation of this situation?
A. The clinical condition of the patient changed since the sample was tested
B. The pattern of fluorescence was misinterpreted
C. The control results were misinterpreted
D. The wrong cell line was used for the test Immunology/Apply principles of basic laboratory
B
What corrective action should be taken when an indeterminate pattern occurs in an indirect IFA?
A. Repeat the test using a larger volume of sample
B. Call the physician
C. Have another medical laboratory scientist read the slide
D. Dilute the sample and retest
D
Which statement best describes passive agglutination reactions used for serodiagnosis?
A. Such agglutination reactions are more rapid because they are a single-step process
B. Reactions require the addition of a second antibody
C. Passive agglutination reactions require biphasic incubation
D. Carrier particles for antigen such as latex particles are used
D
What has happened in a titer, if tube Nos. 5–7 show a stronger reaction than tube Nos.1–4?
A. Prozone reaction
B. Postzone reaction
C. Equivalence reaction
D. Poor technique
A
What is the titer in tube No. 8 if tube No. 1 is undiluted and dilutions are doubled?
A. 64
B. 128
C. 256
D. 512
B
The directions for a slide agglutination test instruct that after mixing the patient’s serum and latex particles, the slide must be rotated for 2 minutes. What would happen if the slide were rotated for 10 minutes?
A. Possible false-positive result
B. Possible false-negative result
C. No effect
D. Depends on the amount of antibody present in the sample
A
Which outcome indicates a negative result in a complement fixation test?
A. Hemagglutination
B. Absence of hemagglutination
C. Hemolysis
D. Absence of hemolysis
C
What effect does selecting the wrong gate have on the results when cells are counted by flow cytometry?
A. No effect
B. Failure to count the desired cell population
C. Falsely elevated results
D. Impossible to determine
B
Which statement best describes immunophenotyping?
A. Lineage determination by detecting antigens on the surface of the gated cells using fluorescent
B. Identification of cell maturity using antibodies to detect antigens within the nucleus
C. Identification and sorting of cells by front and side-scatter of light from a laser
D. Analysis of cells collected by flow cytometry using traditional agglutination reactions
A
A flow cytometry scattergram of a bone marrow sample shows a dense population of cells located in-between normal lymphoid and normal myeloid cells. What is the most likely explanation?
A. The sample was improperly collected
B. An abnormal cell population is present
C. The laser optics are out of alignment
D. The cells are most likely not leukocytes
B
Which serum antibody response usually characterizes the primary (early) stage of syphilis?
A. Antibodies against syphilis are undetectable
B. Detected 1–3 weeks after appearance of the primary chancre
C. Detected in 50% of cases before the primary chancre disappears
D. Detected within 2 weeks after infection
B
What substance is detected by the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests for syphilis?
A. Cardiolipin
B. Anticardiolipin antibody
C. Anti-T. pallidum antibody
D. Treponema pallidum
B
What type of antigen is used in the RPR card test?
A. Live treponemal organisms
B. Killed suspension of treponemal organisms
C. Cardiolipin
D. Tanned sheep cells
C
Which of the following is the most sensitive test to detect congenital syphilis?
A. VDRL
B. RPR
C. Microhemagglutinin test for T. pallidum (MHA-TP)
D. Polymerase chain reaction (PCR)
D
A biological false-positive reaction is least likely with which test for syphilis?
A. VDRL
B. Fluorescent T. pallidum antibody absorption test (FTA-ABS)
C. RPR
D. All are equally likely to detect a false-positive result
B
A 12-year old girl has symptoms of fatigue and a localized lymphadenopathy. Laboratory tests reveal a peripheral blood lymphocytosis, a positive RPR, and a positive spot test for IM. What test should be performed next?
A. HIV test by ELISA
B. VDRL
C. Epstein–Barr virus (EBV) specific antigen test
D. Treponema pallidum particle agglutination (TP-PA) test
D
Which test is most likely to be positive in the tertiary stage of syphilis?
A. FTA-ABS
B. RPR
C. VDRL
D. Reagin screen test (RST)
A
What is the most likely interpretation of the following syphilis serological results?
RPR: reactive;
VDRL: reactive;
MHA-TP: nonreactive
A. Neurosyphilis
B. Secondary syphilis
C. Syphilis that has been successfully treated
D. Biological false positive
D
Which specimen is the sample of choice to evaluate latent or tertiary syphilis?
A. Serum sample
B. Chancre fluid
C. CSF
D. Joint fluid
C
Interpret the following quantitative RPR test results.
RPR titer: weakly reactive 1:8; reactive 1:8–1:64
A. Excess antibody, prozone effect
B. Excess antigen, postzone effect
C. Equivalence of antigen and antibody
D. Impossible to interpret; testing error
A
Tests to identify infection with HIV fall into which three general classification types of tests?
A. Tissue culture, antigen, and antibody tests
B. Tests for antigens, antibodies, and nucleic acid
C. DNA probe, DNA amplification, and Western blot tests
D. ELISA, Western blot, and Southern blot tests
B
Which tests are considered screening tests for HIV?
A. ELISA, 4th generation, and rapid antibody tests
B. Immunofluorescence, Western blot, radioimmuno-precipitation assay
C. Culture, antigen capture assay, DNA amplification
D. Reverse transcriptase and messenger RNA (mRNA) assay
A
Which tests are considered confirmatory tests for HIV?
A. ELISA and rapid antibody tests
B. Western blot test, HIC-1,2 differentiation assays, and polymerase chain reaction
C. Culture, antigen capture assay, polymerase chain reaction
D. Reverse transcriptase and mRNA assay
B
Which is most likely a positive Western blot result for infection with HIV?
A. Band at p24
B. Band at gp60
C. Bands at p24 and p31
D. Bands at p24 and gp120
D
A woman who has had five pregnancies subsequently tests positive for HIV by Western blot. What is the most likely reason for this result?
A. Possible cross-reaction with herpes or EBV antibodies
B. Interference from medication
C. Cross-reaction with HLA antigens in the antigen preparation
D. Possible technical error
C.
Interpret the following results for HIV infection. ELISA: positive; repeat ELISA: negative; Western blot:
no bands
A. Positive for HIV
B. Negative for HIV
C. Indeterminate
D. Further testing needed
B.
Interpret the following results for HIV infection. HIV 1,2 ELISA: positive; HIV-1 Western blot:
indeterminate; HIV-1 p24 antigen: negative
A. Positive for antibodies to human immunodeficiency virus, HIV-1
B. Positive for antibodies to human immunodeficiency virus, HIV-2
C. Cross reaction; biological false-positive result
D. Additional testing required
D.
What is the most likely explanation when antibody tests for HIV are negative but a polymerase chain reaction test performed 1 week later is positive?
A. Probably not HIV infection
B. Patient is in the “window phase” before antibody production
C. Tests were performed incorrectly
D. Clinical signs may be misinterpreted
B.
What criteria constitute the classification system for HIV infection?
A. CD4-positive T-cell count and clinical symptoms
B. Clinical symptoms, condition, duration, and number of positive bands on Western blot
C. Presence or absence of lymphadenopathy
D. Positive bands on Western blot and CD8-positive T-cell count
A
What is the main difficulty associated with the development of an HIV vaccine?
A. The virus has been difficult to culture; antigen extraction and concentration are extremely laborious
B. Human trials cannot be performed
C. Different strains of the virus are genetically diverse
D. Anti-idiotype antibodies cannot be developed
C
Which CD4:CD8 ratio is most likely in a patient with acquired immunodeficiency syndrome (AIDS)?
A. 2:1
B. 3:1
C. 2:3
D. 1:2
D
What is the advantage of 4th-generation rapid HIV tests over earlier rapid HIV tests?
A. They use recombinant antigens
B. They detect multiple strains of HIV
C. They detect p24 antigen
D. They are quantitative
C.
Which method is used to test for HIV infection in infants who are born to HIV-positive mothers?
A. ELISA
B. Western blot test
C. Polymerase chain reaction
D. Viral culture
C
What is the most likely cause when a Western blot or ELISA is positive for all controls and samples?
A. Improper pipetting
B. Improper washing
C. Improper addition of sample
D. Improper reading
B
What constitutes a diagnosis of viral hepatitis?
A. Abnormal test results for liver enzymes
B. Clinical signs and symptoms
C. Positive results for hepatitis markers
D. All of these options
D
Which of the following statements regarding infection with hepatitis D virus is true?
A. Occurs in patients with HIV infection
B. Does not progress to chronic hepatitis
C. Occurs in patients with hepatitis B
D. Is not spread through blood or sexual contact
C
All of the following hepatitis viruses are spread through blood or blood products except:
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
A
Which hepatitis B marker is the best indicator of early acute infection?
A. HBsAg
B. HBeAg
C. Anti-HBc
D. Anti-HBs
A
Which is the first antibody detected in serum after infection with hepatitis B virus (HBV)?
A. Anti-HBs
B. Anti-HBc IgM
C. Anti-HBe
D. All are detectable at the same time
B
Which antibody persists in low-level carriers of hepatitis B virus?
A. IgM anti-HBc
B. IgG anti-HBc
C. IgM anti-HBe
D. IgG anti-HBs
B
What is the most likely explanation when a patient has clinical signs of viral hepatitis but tests negative for hepatitis A IgM, hepatitis B surface antigen, and hepatitis C Ab?
A. Tests were performed improperly
B. The patient does not have hepatitis
C. The patient may be in the “core window”
D. Clinical evaluation was performed improperly
C
Which hepatitis B markers should be performed on blood products?
A. HBsAg and anti-HBc
B. Anti-HBs and anti-HBc
C. HBeAg and HBcAg
D. Anti-HBs and HBeAg
A
Which hepatitis antibody confers immunity against reinfection with hepatitis B virus?
A. Anti-HBc IgM
B. Anti-HBc IgG
C. Anti-HBe
D. Anti-HBs
D
Which test, other than serological markers, is most consistently elevated in viral hepatitis?
A. Antinuclear antibodies
B. Alanine aminotransferase (ALT)
C. Absolute lymphocyte count
D. Lactate dehydrogenase
B
If only anti-HBs is positive, which of the following can be ruled out?
A. Hepatitis B virus vaccination
B. Distant past infection with hepatitis B virus
C. Hepatitis B immune globulin (HBIG) injection
D. Chronic hepatitis B virus infection
D
Interpret the following results for EBV infection: IgG and IgM antibodies to viral capsid antigen (VCA) are positive.
A. Infection in the past
B. Infection with a mutual enhancer virus such as HIV
C. Current infection
D. Impossible to interpret; need more information
C
Which statement concerning non-Forssman heterophile antibody is true?
A. It is not absorbed by guinea pig antigen
B. It is absorbed by guinea pig antigen
C. It does not agglutinate horse RBCs
D. It does not agglutinate sheep RBCs
A
Blood products are tested for which virus before being transfused to newborns?
A. EBV
B. Human T-lymphotropic virus II (HTLV-II)
C. Cytomegalovirus (CMV)
D. Hepatitis D virus
C
What is the endpoint for the antistreptolysin O (ASO) latex agglutination assay?
A. Highest serum dilution that shows no agglutination
B. Highest serum dilution that shows agglutination
C. Lowest serum dilution that shows agglutination
D. Lowest serum dilution that shows no agglutination
B
Interpret the following ASO results:
Tube Nos. 1–4 (Todd unit 125): no hemolysis;
Tube No. 5 (Todd unit 166): hemolysis
A. Positive Todd unit 125
B. Positive Todd unit 166
C. No antistreptolysin O present
D. Impossible to interpret
A
Which control shows the correct result for a valid ASO test?
A. SLO control, no hemolysis
B. Red cell control, no hemolysis
C. Positive control, hemolysis in all tubes
D. Hemolysis in both SLO and red cell control
B
A streptozyme test was performed, but the result was negative, even though the patient showed clinical signs of a streptococcal throat infection. What should be done next?
A. Either ASO or anti-deoxyribonuclease B (anti-DNase B) testing
B. Another streptozyme test using diluted serum
C. Antihyaluronidase testing
D. Wait for 3–5 days and repeat the streptozyme test
A
Rapid assays for influenza that utilize specimens obtained from nasopharyngeal swabs detect:
A. IgM anti-influenza
B. IgA anti-influenza
C. IgA-influenza Ag immune complexes
D. Influenza antigen
D
How can interfering cold agglutinins be removed from a test sample?
A. Centrifuge the serum and remove the top layer
B. Incubate the clot at 1°C–4°C for several hours, then remove serum
C. Incubate the serum at 56°C in a water bath for 30 minutes
D. Use an anticoagulated sample
B
All tubes (dilutions) except the negative control are positive for cold agglutinins. This indicates:
A. Contaminated red cells
B. A rare antibody against red cell antigens
C. The sample was stored at 4°C prior to separating serum and cells
D. Further serial dilution is necessary
D
All positive cold agglutinin tubes remain positive after 37°C incubation except the positive control. What is the most likely explanation for this situation?
A. High titer cold agglutinins
B. Contamination of the test system
C. Antibody other than cold agglutinins
D. Faulty water bath
C
Which increase in antibody titer (dilution) best indicates an acute infection?
A. From 1:2 to 1:8
B. From 1:4 to 1:16
C. From 1:16 to 1:256
D. From 1:64 to 1:128
C
Which of the following positive antibody tests may be an indication of recent vaccination or early primary infection for rubella in a patient with no clinical symptoms?
A. Only IgG antibodies positive
B. Only IgM antibodies positive
C. Both IgG and IgM antibodies positive
D. Fourfold rise in titer for IgG antibodies
B
Why is laboratory diagnosis difficult in cases of Lyme disease?
A. Clinical response may not be apparent upon initial infection; IgM antibody may not be detected until 3–6 weeks after the infection
B. Laboratory tests may be designed to detect whole Borrelia burgdorferi, not flagellar antigen found early in infection
C. Most laboratory tests are technically demanding and lack specificity
D. Antibodies formed initially to B. burgdorferi may cross react in antigen tests for autoimmune diseases
A
Serological tests for which disease may give a false- positive result if the patient has Lyme disease?
A. AIDS
B. Syphilis
C. Cold agglutinins
D. Hepatitis C
B
In monitoring an HIV-infected patient, which parameter may be expected to be the most sensitive indicator of the effectiveness of antiretroviral treatment?
A. HIV antibody titer
B. CD4:CD8 ratio
C. HIV viral load
D. Absolute total T-cell count
C
A renal transplant recipient is found to have a rising creatinine level and reduced urine output. The physician orders a “Urine PCR” assay. When you call to find out what organism the physician wants to identify, you are told:
A. Hepatitis C virus
B. Legionella pneumophila
C. EBV
D. BK virus
D
A newborn is to be tested for a vertically transmitted HIV infection. Which of the following tests is most useful?
A. HIV PCR
B. CD4 count
C. Rapid HIV antibody test
D. HIV IgM antibody test
A
Which of the following methods used for HIV identification is considered a signal amplification technique?
A. Branched chain DNA analysis
B. DNA PCR
C. Reverse transcriptase PCR
D. Nucleic acid sequence based assay (NASBA)
A
Which of the following fungal organisms is best diagnosed by an antibody detection test as opposed to an antibody detection assay?
A. Histoplasma
B. Cryptococcus
C. Candida
D. Aspergillus
B
Your cytology laboratory refers a Papanicolaou smear specimen to you for an assay designed to detect the presence of a virus associated with cervical cancer. You perform:
A. An ELISA assay for anti-HSV-2 antibodies
B. A molecular assay for HSV-2
C. An ELISA assay for HPV antibodies
D. A molecular assay for HPV
D
An immunosuppressed patient has an unexplained anemia. The physician suspects a parvovirus
B19 infection. A parvovirus IgM test is negative. The next course of action is to tell the physician:
A. The patient does not have parvovirus
B. A convalescent specimen is recommended in 4 weeks to determine if a fourfold rise in titer has occurred
C. A parvovirus PCR is recommended
D. That a recent transfusion for the patient’s anemia may have resulted in a false-negative assay and the patient should be retested in 4 weeks
C
What is a general definition for autoimmunity?
A. Increase of tolerance to self-antigens
B. Loss of tolerance to self-antigens
C. Increase in clonal deletion of mutant cells
D. Manifestation of immunosuppression
B
An antinuclear antibody test is performed on a specimen from a 55-year-old woman who has unexplained joint pain. The IFA result is a titer of 40 and a homogeneous pattern. The appropriate follow-up for this patient is:
A. Anti-DNA assay
B. Extractable nuclear antigen (ENA) testing
C. Retest ANA in 3–6 months
D. CH50 complement assay
C. A patient with anti DNA positive SLE have a much higher titer(≥160). For ENA positive, the pattern would be speckled
Which disease is likely to show a rim (peripheral) pattern in an immunofluorescence (IF) microscopy test for ANA?
A. Mixed connective tissue disease (MCTD)
B. Rheumatoid arthritis
C. Systemic lupus erythematosus
D. Scleroderma
C
A patient’s specimen is strongly positive in an ANA ELISA. Which of the following would not be an appropriate follow up to this result?
A. Immunofluorescence test on HEp-2 cells
B. Specific ENA ELISA tests
C. Specific anti-DNA ELISA
D. Rheumatoid factor assay
D
What type of antibodies is represented by the solid or homogeneous pattern in the immunofluorescence test for antinuclear antibodies?
A. Antihistone antibodies
B. Anticentromere antibodies
C. Anti-ENA (anti-Sm and anti-RNP) antibodies
D. Anti-RNA antibodies
A
What disease is indicated by a high titer of anti-Sm (anti-Smith) antibody?
A. Mixed connective tissue disease (MCTD)
B. RA
C. SLE
D. Scleroderma
C
Which disease is least likely when a nucleolar pattern occurs in an immunofluorescence test for antinuclear antibodies?
A. MCTD
B. Sjögren’s syndrome
C. SLE
D. Scleroderma
A
What antibodies are represented by the nucleolar pattern in the immunofluorescence test for antinuclear antibodies?
A. Antihistone antibodies
B. Anti-dsDNA antibodies
C. Anti-ENA (anti-Sm and anti-RNP) antibodies
D. Anti-RNA antibodies
D
Which test would best distinguish between SLE and MCTD?
A. Multiplex or ELISA test for anti-SM and anti-RNP
B. Immunofluorescence testing using Crithidia as substrate
C. Slide agglutination testing
D. Laboratory tests cannot distinguish between these disorders
A
An ANA test on HEp-2 cells shows nucleolar staining in interphase cells and dense chromatin staining in mitotic cells. The most likely cause of this staining pattern is:
A. Antifibrillarin antibody
B. Antiribosomal p antibody
C. A serum with nucleolar and homogeneous patterns
D. Technical artifact
A
1Which immunofluorescence pattern indicates the need for ENA testing by Ouchterlony immunodiffusion, Multiplex, or ELISA assays?
A. Homogeneous or solid
B. Peripheral or rim
C. Speckled
D. Nucleolar
C
Which of the following is used in rapid slide tests for detection of rheumatoid factors?
A. Whole IgM molecules
B. Fc portion of the IgG molecule
C. Fab portion of the IgG molecule
D. Fc portion of the IgM molecule
B
Which of the following methods is least likely to give a definitive result for the diagnosis of RA?
A. Nephelometric measurement of anti-IgG
B. Agglutination testing for rheumatoid factor
C. Anti CCP
D. Immunofluorescence testing for antinuclear antibodies
D
Which disease might be indicated by antibodies to smooth muscle?
A. Atrophic gastritis
B. Autoimmune hepatitis
C. Myasthenia gravis
D. Sjögren’s syndrome
B
Antibodies to thyroid peroxidase can be detected by using agglutination assays. Which of the following diseases may show positive results with this type of assay?
A. Graves’ disease and Hashimoto’s thyroiditis
B. Myasthenia gravis
C. Granulomatous thyroid disease
D. Addison’s disease
A
What is the main use of laboratory tests to detect antibodies to islet cells and insulin in cases of insulin-dependent diabetes mellitus (IDDM)?
A. To regulate levels of injected insulin
B. To diagnose IDDM
C. To rule out the presence of other autoimmune diseases
D. To screen susceptible individuals prior to destruction of β cells
D
A patient presents with clinical symptoms of celiac disease. Tests for anti-tissue transglutaminase and antigliadin antibodies are negative. Which of the following tests should be ordered?
A. IgG level
B. HLA DQ typing
C. HLA DR typing
D. IgM level
B
A specimen appears to have a perinuclear staining pattern in an antineutrophil cytoplasmic antibody (ANCA) immunofluorescent assay using ethanol- fixed neutrophils, suggesting the possibility of a pANCA. On which of the following substrates would this specimen display cytoplasmic speckling?
A. Formalin-fixed neutrophils
B. Unfixed neutrophils
C. HEp-2 cells
D. Rabbit kidney tissue
A
Which of the following is a description of a type I hypersensitivity reaction?
A. Ragweed antigen cross links with IgE on the surface of mast cells, causing release of preformed mediators and resulting in symptoms of an allergic reaction
B. Anti-Fya from a pregnant woman crosses the placenta and attaches to the Fya antigen-positive red cells of the fetus, destroying the red cells
C. Immune complex deposition occurs on the glomerular basement membrane of the kidney, leading to renal failure
D. Exposure to poison ivy causes sensitized T cells to release lymphokines that cause a localized inflammatory reaction
A
Why is skin testing the most widely used method to test for a type I hypersensitivity reaction?
A. It causes less trauma and is more cost effective than other methods
B. It has greater sensitivity than in vitro measurements
C. It is more likely to be positive for IgE-specific allergens than other methods
D. It may be used to predict the development of further allergen sensitivity
B
Which in vitro test measures IgE levels against a specific allergen?
A. Histamine release assay
B. Radioimmunosorbent test (RIST)
C. Fluorescent allergosorbent test (FAST)
D. Precipitin radioimmunosorbent test (PRIST)
C
A patient who is blood group O is accidentally transfused with group A blood and develops a reaction during the transfusion. What antibody is involved in this type II reaction?
A. IgM
B. IgE
C. IgG and IgE
D. IgG
A
Which test would measure the coating of red cells by antibody as occurs in hemolytic transfusion reactions?
A. Indirect antiglobulin test (IAT)
B. Direct antiglobulin test (DAT)
C. ELISA
D. Hemagglutination
B
Which test detects antibodies that have attached to tissues, resulting in a type-II cytotoxic reaction?
A. Migration inhibition factor assay (MIF)
B. Direct immunofluorescence (IF)
C. Immunofixation electrophoresis (IFE)
D. Hemagglutination
B
Which of the following conditions will most likely result in a false-negative DAT test?
A. Insufficient washing of RBCs
B. Use of heavy chain–specific polyclonal anti-human Ig
C. Use of excessive centrifugal force
D. Use of a sample obtained by finger puncture
A
Which of the following tests is used to detect circulating immune complexes in the serum of some patients with systemic autoimmune diseases such as rheumatoid arthritis?
A. Direct immunofluorescence B. Enzyme immunoassay
C. Assay of cryoglobulins
D. Indirect antiglobulin test
C
All of the following tests may be abnormal in a type III immune complex reaction except:
A. C1q-binding assay by ELISA
B. Raji cell assay
C. CH50 level
D. Mitogen response
D
What immune elements are involved in a positive skin test for tuberculosis?
A. IgE antibodies
B. T cells and macrophages
C. NK cells and IgG antibody
D. B cells and IgM antibody
B
A patient receives a transfusion of packed red cells and fresh frozen plasma and develops an anaphylactic, nonhemolytic reaction. She reports receiving a transfusion 20 years earlier. She had
no reaction to the previous transfusion, but she did feel “poorly” a few weeks later. Which of the following transfused substances most likely elicited the reaction?
A. IgA
B. Group A antigen
C. Rho (D) antigen
D. An antigen belonging to the Duffy system
A
A patient deficient in the C3 complement component would be expected to mount a normal:
A. Type I and IV hypersensitivity response
B. Type II and IV hypersensitivity response
C. Type I and III hypersensitivity response
D. Type II and III hypersensitivity response
A
Which of the following symptoms in a young child may indicate an immunodeficiency syndrome?
A. Anaphylactic reactions
B. Severe rashes and myalgia
C. Recurrent bacterial, fungal, and viral infections
D. Weight loss, rapid heartbeat, breathlessness
C
What screening test should be performed first in a young patient suspected of having an immune dysfunction disorder?
A. Complete blood count (CBC) and white cell differential
B. Chemotaxis assay
C. Complement levels
D. Bone marrow biopsy
A
Which test should be performed when a patient has a reaction to transfused plasma products?
A. Immunoglobulin levels
B. T-cell count
C. Hemoglobin levels
D. Red cell enzymes
A
What is the “M” component in monoclonal gammopathies?
A. IgM produced in excess
B. μ Heavy chain produced in excess
C. Malignant proliferation of B cells
D. Monoclonal antibody or cell line
D
A child suspected of having an inherited humoral immunodeficiency disease is given diphtheria/ tetanus vaccine. Two weeks after the immunization, his level of antibody to the specific antigens is measured. Which result is expected for this patient if he/she indeed has a humoral deficiency?
A. Increased levels of specific antibody
B. No change in the level of specific antibody
C. An increase in IgG-specific antibody but not IgM-specific antibody
D. Increased levels of nonspecific antibody
B
Which disease may be expected to show an IgM spike on an electrophoretic pattern?
A. Hypogammaglobulinemia
B. Multicystic kidney disease
C. Waldenström’s macroglobulinemia
D. Wiskott–Aldrich syndrome
C
In testing for DiGeorge’s syndrome, what type of laboratory analysis would be most helpful in determining the number of mature T cells?
A. Complete blood count
B. Nitroblue tetrazolium (NBT) test
C. T-cell enzyme assays
D. Flow cytometry
D
Interpret the following description of an immunofixation electrophoresis assay of urine. Dense wide bands in both the κ and λ lanes. No bands present in the heavy-chain lanes.
A. Normal
B. Light chain disease
C. Increased polyclonal Fab fragments
D. Multiple myeloma
C
Free monoclonal light chains are often present in the serum of multiple myeloma patients, and may be useful for disease monitoring. Which of the following assays would be recommended to detect the presence of serum-free light chains?
A. Serum protein electrophoresis
B. Urine immunofixation
C. Nephelometry
D. ELISA
C
What is measured in the CH50 assay?
A. RBC quantity needed to agglutinate 50% of antibody
B. Complement needed to lyse 50% of RBCs
C. Complement needed to lyse 50% of antibody- sensitized RBCs
D. Antibody and complement needed to sensitize 50% of RBCs
C
What type of disorders would show a decrease in C3, C4, and CH50?
A. Autoimmune disorders such as SLE and RA
B. Immunodeficiency disorders such as common variable immunodeficiency
C. Tumors
D. Bacterial, viral, fungal, or parasitic infections
A
All of the following tests measure phagocyte function except:
A. Leukocyte adhesion molecule analysis
B. Di Hydro rhodamine reduction assay
C. NBT test
D. IL-2 (interleukin-2) assay
D
A patient had surgery for colorectal cancer, after which he received chemotherapy for 6 months. The test for carcinoembryonic antigen (CEA) was normal at this time. One year later, the bimonthly CEA was elevated (above 10 ng/mL). An examination and biopsy revealed the recurrence of a small tumor. What was the value of the results provided by the CEA test in this clinical situation?
A. Diagnostic information
B. Information for further treatment
C. Information on the immunologic response of the patient
D. No useful clinical information in this case
B
A carbohydrate antigen 125 assay (CA-125) was performed on a woman with ovarian cancer. After treatment, the levels fell significantly. An examination performed later revealed the recurrence of the tumor, but the CA 125 levels remained low. How can this finding be explained?
A. Test error
B. CA-125 was the wrong laboratory test; α-fetoprotein (AFP) is a better test to monitor ovarian cancer
C. CA-125 may not be sensitive enough when used alone to monitor tumor development
D. CA-125 is not specific enough to detect only one type of tumor
C
What is the correct procedure upon receipt of a test request for human chorionic gonadotropin (hCG) on the serum from a 60-year-old man?
A. Return the request; hCG is not performed on men
B. Perform a qualitative hCG test to see if hCG is present
C. Perform the test; hCG may be increased in testicular tumors
D. Perform the test but use different standards and controls
C
Would an hCG test using a monoclonal antibody against the β-subunit of hCG likely be affected by an increased level of follicle-stimulating hormone (FSH)?
A. Yes, the β-subunit of FSH is identical to that of hCG
B. No, the test would be specific for the β-subunit of hCG
C. Yes, a cross reaction would occur because of structural similarities
D. No, the structure of FSH and hCG are not at all similar
B
Which of the following substances, sometimes used as a tumor marker, is increased two- or threefold in a normal pregnancy?
A. Alkaline phosphatase (ALP)
B. Calcitonin
C. Adrenocortocotropic hormone (ACTH)
D. Neuron-specific enolase
A
Which method is the most sensitive for quantitation of AFP?
A. Double immunodiffusion
B. Electrophoresis
C. Enzyme immunoassay
D. Particle agglutination
A
How is HLA typing used in the investigation of genetic diseases?
A. For prediction of the severity of the disease
B. For genetic linkage studies
C. For direct diagnosis of disease
D. Is not useful in this situation
C
Select the best donor for a man, blood type AB, in need of a kidney transplant.
A. His brother, type AB, HLA matched for class II antigens
B. His mother, type B, HLA matched for class I antigens
C. His cousin, type O, HLA matched for major class II antigens
D. Cadaver donor, type O, HLA matched for some class I and II antigens
A
Interpret the following microcytotoxicity results: A9 and B12 cells damaged; A1 and Aw19 cells intact.
A. Positive for A1 and Aw19; negative for A9 and B12
B. Negative for A1 and Aw19; positive for A9 and B12
C. Error in test system; retest
D. Impossible to determine
B
Which method, classically used for HLA-D typing, is often used to determine the compatibility between a living organ donor and recipient?
A. Flow cytometry
B. Mixed lymphocyte culture (MLC)
C. Primed lymphocyte test (PLT)
D. Restriction fragment length polymorphism (RFLP)
B
SITUATION: Cells type negative for all HLA antigens in a complement-dependent cytotoxicity assay. What is the most likely cause?
A. Too much supravital dye was added
B. Rabbit complement is inactivated
C. All leukocytes are dead
D. Antisera is too concentrated
B
What method may be used for tissue typing instead of serological HLA typing?
A. PCR
B. Southern blotting
C. RFLP
D. All of these options
D
Which of the following serial dilutions contains an incorrect factor?
A. 1:4, 1:8, 1:16
B. 1:1, 1:2, 1:4
C. 1:5, 1:15, 1:45
D. 1:2, 1:6, 1:12
D
A patient was tested for syphilis by the RPR method and was reactive. An FTA-ABS test was performed and the result was negative. Subsequent testing showed the patient to have a high titer of anticardiolipin antibodies (ACAs) by the ELISA method. Which routine laboratory test is most likely to be abnormal for this patient?
A. Activated partial thromboplastin time (APTT)
B. Antismooth muscle antibodies
C. Aspartate aminotransferase (AST)
D. C3 assay by immunonephelometry Immunology/Apply knowledge to recognize sources of
A
Inflammation involves a variety of biochemical and cellular mediators. Which of the following may be increased within 72 hours after an initial infection?
A. Neutrophils, macrophages, antibody, complement, α1-antitrypsin
B. Macrophages, T cells, antibody, haptoglobin, fibrinogen
C. Neutrophils, macrophages, complement, fibrinogen, C-reactive protein
D. Macrophages, T cells, B cells, ceruloplasmin, complement
C
An 18-month-old boy has recurrent sinopulmonary infections and septicemia. Bruton’s X-linked immunodeficiency syndrome is suspected. Which test result would be markedly decreased?
A. Serum IgG, IgA, and IgM
B. Total T-cell count
C. Both B- and T-cell counts
D. Lymphocyte proliferation with phytohemagglutinin stimulation
A
A patient received 5 units of fresh frozen plasma (FFP) and developed a severe anaphylactic reaction. He has a history of respiratory and gastrointestinal infections. Post-transfusion studies showed all 5 units to be ABO-compatible. What immunologic test would help to determine the cause of this transfusion reaction?
A. Complement levels, particularly C3 and C4
B. Flow cytometry for T-cell counts
C. Measurement of immunoglobulins
D. NBT test for phagocytic function
C
An IFE revealed excessive amounts of polyclonal IgM and low concentrations of IgG and IgA. What is the most likely explanation of these findings and the best course of action?
A. Proper amounts of antisera were not added; repeat both tests
B. Test specimen was not added properly; repeat both procedures
C. Patient has common variable immunodeficiency; perform B-cell count
D. Patient has immunodeficiency with hyper-M; perform immunoglobulin levels
D
SITUATION: A 54-year-old man was admitted to the hospital after having a seizure. Many laboratory tests were performed, including an RPR, but none of the results were positive. The physician suspects a case of late (tertiary) syphilis. Which test should be performed next?
A. Repeat RPR, then perform VDRL
B. Treponemal test such as MHA-TP on serum
C. VDRL on CSF
D. No laboratory test is positive for late (tertiary) syphilis
B
A patient came to his physician complaining of a rash, severe headaches, stiff neck, and sleep problems. Laboratory tests of significance were an elevated sedimentation rate (ESR) and slightly increased liver enzymes. Further questioning of the patient revealed that he had returned from a hunting trip in upstate New York 4 weeks ago. His physician ordered a serological test for Lyme disease, and the assay was negative. What is the most likely explanation of these results?
A. The antibody response is not sufficient to be detected at this stage
B. The clinical symptoms and laboratory results are not characteristic of Lyme disease
C. The patient likely has an early infection with hepatitis B virus
D. Laboratory error has caused a false-negative result
A
A 19-year-old girl came to her physician complaining of a sore throat and fatigue. Upon physical examination, lymphadenopathy was noted. Reactive lymphocytes were noted on the differential, but a rapid test for IM antibodies was negative. Liver enzymes were only slightly elevated. What test(s) should be ordered next?
A. Hepatitis testing
B. EBV serological panel
C. HIV confirmatory testing
D. Bone marrow biopsy
B
A patient received 2 units of RBCs following surgery. Two weeks after the surgery, the patient was seen by his physician and exhibited mild jaundice and slightly elevated liver enzymes. Hepatitis testing, however, was negative. What should be done next?
A. Nothing until more severe or definitive clinical signs develop
B. Repeat hepatitis testing immediately
C. Repeat hepatitis testing in a few weeks
D. Check blood bank donor records and contact donor(s) of transfused units
C
A hospital employee received the final dose of the hepatitis B vaccine 3 weeks ago. She wants to donate blood. Which of the following results are expected from the hepatitis screen, and will she be allowed to donate blood?
A. HBsAg, positive; anti-HBc, negative—she may donate
B. HBsAg, negative; anti-HBc, positive—she may not donate
C. HBsAg, positive; anti-HBc, positive—she may not donate
D. HBsAg, negative; anti-HBc, negative—she may donate
D
A pregnant woman came to her physician with a maculopapular rash on her face and neck. Her temperature was 37.7°C (100°F). Rubella tests for both IgG and IgM antibody were positive. What positive test(s) would reveal a diagnosis of congenital rubella syndrome in her baby after birth?
A. Positive rubella tests for both IgG and IgM antibody
B. Positive rubella test for IgM
C. Positive rubella test for IgG
D. No positive test is revealed in congenital rubella syndrome
B
SITUATION: A patient with RA has acute pneumonia but a negative throat culture. The physician suspects an infection with Mycoplasma pneumoniae and requests an IgM-specific antibody test. The test is performed directly on serial dilutions of serum less than 4 hours old. The result is positive, giving a titer of 1:32. However, the test is repeated 3 weeks later, and the titer remains at 1:32. What best explains these results?
A. IgM-specific antibodies do not increase fourfold between acute and convalescent serum
B. The results are not significant because the initial titer was not accompanied by a positive test for cold agglutinins
C. Rheumatoid factor caused a false-positive test result
D. Insufficient time had elapsed between measurement of acute and convalescent samples
C
A patient has a prostate-specific antigen level of 60 ng/mL the day before surgery to remove a localized prostate tumor. One week following surgery, the serum PSA was determined to be
8 ng/mL by the same method. What is the most likely cause of these results?
A. Incomplete removal of the malignancy
B. Cross reactivity of the antibody with another tumor antigen
C. Testing too soon after surgery
D. Hook effect with the PSA assay
C
A patient with symptoms associated with SLE and scleroderma was evaluated by immunofluorescence microscopy for ANAs using the HEp-2 cell line as substrate. The cell line displayed a mixed pattern of fluorescence that could not be separated by serial dilutions of the serum. Which procedure would be most helpful in determining the antibody profile of this patient?
A. Use of a different tissue substrate
B. Absorption of the serum using the appropriate tissue extract
C. Ouchterlony technique
D. ELISA tests for specific antibodies
D
A patient with joint swelling and pain tested negative for serum RF by both latex agglutination and ELISA methods. What other test would help establish a diagnosis of RA in this patient?
A. Anti CCP
B. ANA testing
C. Flow cytometry
D. Complement levels
A
What is the main advantage of the recovery and reinfusion of autologous stem cells?
A. It slows the rate of rejection of transplanted cells
B. It prevents graft-versus-host disease
C. No HLA testing is required
D. Engraftment occurs in a more efficient sequence
B
A transplant patient began to show signs of rejection 8 days after receipt of the transplanted organ, and the organ was removed. What immune elements might be found in the rejected organ?
A. Antibody and complement
B. Primarily antibody
C. Macrophages
D. T cells
D
Apatientwithovariancancerwhohasbeentreated with chemotherapy is being monitored for recurrence using serum CA-125, CA-50, and CA 15–3. Six months after treatment the CA 15–3 is elevated, but the CA-125 and CA-50 remain low. What is the most likely explanation of these findings?
A. Ovarian malignancy has recurred
B. CA 15–3 is specific for breast cancer and indicates metastatic breast cancer
C. Testing error occurred in the measurement of CA 15–3 caused by poor analytical specificity
D. The CA 15–3 elevation is spurious and probably benign
A
An initial and repeat ELISA test for antibodies to HIV-1 are both positive. A Western blot shows a single band at gp160. The patient shows no clinical signs of HIV infection, and the patient’s CD4 T-cell count is normal. Based upon these results, which conclusion is correct?
A. Patient is diagnosed as HIV-1-positive
B. Patient is diagnosed as HIV-2-positive
C. Results are inconclusive
D. Patient is diagnosed as HIV-1-negative
C
A woman who has been pregnant for 12 weeks is tested for toxoplasmosis. Her IgM ELISA titer is 2.6 (reference range < 1.6), and her IgG ELISA value is 66 (reference range < 8). The physician asks you if these results indicated an infection during the past 12 weeks. Which of the following tests would you recommend to determine if the woman was infected during her pregnancy?
A. Toxo PCR on amniotic fluid
B. Toxo IgM on amniotic fluid
C. Toxo IgG avidity
D. Amniotic fluid culture
C
On January 4, a serum protein electrophoresis on a specimen obtained at your hospital in North Dakota from a 58-year-old patient shows a band at the β-γ junction. The specimen was also positive for rheumatoid factor. You recommend that an immunofixation test be performed to determine if the band represents a monoclonal immunoglobulin. Another specimen is obtained 2 weeks later by the physician in his office 30 miles away, and the whole blood is submitted to you for the IFE. The courier placed the whole blood specimen in an ice chest for transport. In this specimen, no β-γ band is seen in the serum protein lane, and the IgM lane is very faint. The rheumatoid factor on this specimen was negative. The physician wants to know what’s wrong with your laboratory. Your response is:
A. Nothing’s wrong with our laboratory; the patient had an infection 2 weeks ago that has cleared up
B. Something’s wrong with our laboratory—we likely mislabeled one of the specimens; please resubmit a new specimen and we will test it at no charge
C. You will run a second specimen using a 2-mercaptoethanol treatment that will eliminate IgM aggregates and allow for more sensitive monoclonal IgM detection
D. The physician should redraw another specimen from the patient and this time separate the serum from the clot in his office before sending the specimen in by courier
D
A dialysis patient is positive for both hepatitis B surface antigen and hepatitis B surface antibody. The physician suspects a laboratory error. Do you agree?
A. Yes; the patient should not test positive for both HBsAg and HBsAb
B. No; incomplete dialysis of a patient in the core window phase of hepatitis B infection will yield this result
C. No; it is likely the patient has recently received a hepatitis B booster vaccination and could have these results
D. Perhaps; a new specimen should be submitted to clear up the confusion
C
You are evaluating an ELISA assay as a replacement for your immunofluorescent antinuclear antibody test. You test 50 specimens in duplicate on each assay. The ELISA assay uses a HEp-2 extract as its antigen source. The correlation between the ELISA and the IFA tests is only 60% (30 of 50 specimens agree). Which of the following is the next best course of action?
A. Test another 50 specimens
B. Perform a competency check on the technologists who performed the tests
C. Order a new lot of both kits and then retest on the new lots
D. Refer the discrepant specimens for testing by another method
D
What type of serological testing does the blood bank technologist perform when determining the blood group of a patient?
A. Genotyping
B. Phenotyping
C. Both genotyping and phenotyping
D. Polymerase chain reaction
B
If anti-K reacts 3+ with a donor cell with a genotype KK and 2+ with a Kk cell, the antibody is demonstrating:
A. Dosage
B. Linkage disequilibrium
C. Homozygosity
D. Heterozygosity
A
Carla expresses the blood group antigens Fya, Fyb, and Xga. James shows expressions of none of these antigens. What factor(s) may account for the absence of these antigens in James?
A. Gender
B. Race
C. Gender and race
D. Medication
C
Which of the following statements is true?
A. An individual with the BO genotype is homozygous for B antigen
B. An individual with the BB genotype is homozygous for B antigen
C. An individual with the OO genotype is heterozygous for O antigen
D. An individual with the AB phenotype is homozygous for A and B antigens
B
Which genotype(s) will give rise to the Bombay phenotype?
A. HH only
B. HH and Hh
C. Hh and hh
D. hh only
D
Meiosis in cell division is limited to the ova and sperm producing four gametes containing what complement of DNA?
A. 1N
B. 2N
C. 3N
D. 4N
A
A cell that is not actively dividing is said to be in:
A. Interphase
B. Prophase
C. Anaphase
D. Telophase
A
Which of the following describes the expression of most blood group antigens?
A. Dominant
B. Recessive
C. Codominant
D. Corecessive
C
What blood type is not possible for an offspring of an AO and BO mating?
A. AB
B. A or B
C. O
D. All are possible
D
The alleged father of a child in a disputed case of paternity is blood group AB. The mother is group O and the child is group O. What type of exclusion is this?
A. Direct/primary/first order
B. Probability
C. Random
D. Indirect/secondary/second order
D
In the Hardy–Weinberg formula, p2 represents:
A. The heterozygous population of one allele
B. The homozygous population of one allele
C. The recessive allele
D. The dominant allele
B
In this type of inheritance, the father carries the trait on his X chromosome. He has no sons with the trait because he passed his Y chromosome to his sons; however, all his daughters will express the trait.
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
D. X-linked recessive
C
Why do IgM antibodies, such as those formed against the ABO antigens, have the ability to directly agglutinate red blood cells (RBCs) and cause visible agglutination?
A. IgM antibodies are larger molecules and have the ability to bind more antigen
B. IgM antibodies tend to clump together more readily to bind more antigen
C. IgM antibodies are found in greater concentrations than IgG antibodies
D. IgM antibodies are not limited by subclass specificity
A
Which of the following enhancement mediums decreases the zeta potential, allowing antibody and antigen to come closer together?
A. LISS
B. Polyethylene glycol
C. Polybrene
D. ZZAP
A
This type of antibody response is analogous to an anamnestic antibody reaction.
A. Primary
B. Secondary
C. Tertiary
D. Anaphylactic
B.
Which antibodies to a component of complement are contained in the rabbit polyspecific antihuman globulin reagent for detection of in vivo sensitization?
A. Anti-IgG and anti-C3a
B. Anti-IgG and anti-C3d
C. Anti-IgG and anti-IgM
D. All of these options
B
Which of the following distinguishes A1 from A2 blood groups?
A. A2 antigen will not react with anti-A, A1 will react strongly (4+)
B. An A2 person may form anti-A1; an A1 person will not form anti-A1
C. An A1 person may form anti-A2, an A2 person will not form anti-A1
D. A2 antigen will not react with anti-A from a nonimmunized donor; A1 will react with any anti-A
B
A patient’s serum is incompatible with O cells. The patient RBCs give a negative reaction to anti-H lectin. What is the most likely cause of these results?
A. The patient may be a subgroup of A
B. The patient may have an immunodeficiency
C. The patient may be a Bombay
D. The patient may have developed alloantibodies
C
What antibodies are formed by a Bombay individual?
A. Anti-A and anti-B
B. Anti-H
C. Anti-A,B
D. Anti-A, B, and H
D
Acquired B antigens have been found in:
A. Bombay individuals
B. Group O persons
C. All blood groups
D. Group A persons
D
Blood is crossmatched on an A positive person with a negative antibody screen. The patient received a transfusion of A positive RBCs 3 years ago. The donors chosen for crossmatch were A positive.
The crossmatch was run on the Ortho Provue and yielded 3+ incompatibility. How can these results be explained?
A. The patient has an antibody to a low-frequency antigen
B. The patient has an antibody to a high-frequency antigen
C. The patient is an A2 with anti-A1
D. The patient is an A1 with anti-A2
C
A patient’s red cells forward as group O, serum agglutinates B cells (4+) only. Your next step would be:
A. Extend reverse typing for 15 minutes
B. Perform an antibody screen including a room- temperature incubation
C. Incubate washed red cells with anti-A1 and anti-A,B for 30 minutes at room temperature
D. Test patient’s red cells with Dolichos biflorus
C
Which typing results are most likely to occur when a patient has an acquired B antigen?
A. Anti-A 4+, anti-B-3+, A1 cells neg, B cells neg
B. Anti-A 3+, anti-B neg, A1 cells neg, B cells neg
C. Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+
D. Anti-A 4+, anti-B 4+, A1 cells 2+, B cells neg
C
Which blood group has the least amount of H antigen?
A. A1B
B. A2
C. B
D. A1
A
What type RBCs can be transfused to an A2 person with anti-A1?
A. A only
B. A or O
C. B
D. AB
B
What should be done if all forward and reverse ABO results as well as the autocontrol are positive?
A. Wash the cells with warm saline, autoadsorb the serum at 4°C
B. Retype the sample using a different lot number of reagents
C. Use polyclonal typing reagents
D. Report the sample as group AB
A
What should be done if all forward and reverse ABO results are negative?
A. Perform additional testing such as typing with anti-A1 lectin and anti-A,B
B. Incubate at 22°C or 4°C to enhance weak expression
C. Repeat the test with new reagents
D. Run an antibody identification panel
B
What reaction would be the same for an A1 and an A2 person?
A. Positive reaction with anti-A1 lectin
B. Positive reaction with A1 cells
C. Equal reaction with anti-H
D. Positive reaction with anti-A,B
D
A female patient at 28 weeks’ gestation yields the following results:
Patient cells: Anti-A, 3+ Anti-B, 4+ Patient serum: A1 cells, neg B cells, 1+ O cells, 1+
Which of the following could be causing the ABO discrepancy?
A. Hypogammaglobulinemia
B. Alloantibody in patient serum
C. Acquired B
D. Weak subgroup
B
Which condition would most likely be responsible for the following typing results?
Patient cells: Anti-A, neg
Patient serum: A1 cells, neg
Anti-B, neg B cells, 4+
A. Immunodeficiency
B. Masking of antigens by the presence of massive amounts of antibody
C. Weak or excessive antigen(s)
D. Impossible to determine
C
- A 61-year-old male with a history of multiple myeloma had a stem cell transplant 3 years ago. The donor was O positive and the recipient was B positive. He is admitted to a community hospital for fatigue and nausea. Typing results reveal the following:
Anti-A = 0
Anti-B =0
Anti-A,B = 0
Anti-D = 4+
A1 cells = 4+
B cells = 0
How would you report this type?
A. O positive
B. B positive
C. A positive
D. Undetermined
D
A complete Rh typing for antigens C, c, D, E, and e revealed negative results for C, D, and E. How is the individual designated?
A. Rh positive
B. Rh negative
C. Positive for c and e
D. Impossible to determine
B
How is an individual with genotype Dce/dce classified?
A. Rh positive
B. Rh negative
C. Rhnull
D. Total Rh
A
If a patient has a positive direct antiglobulin test, should you perform a weak D test on the cells?
A. No, the cells are already coated with antibody
B. No, the cells are Rhnull
C. Yes, the immunoglobulin will not interfere with the test
D. Yes, Rh reagents are enhanced in protein media
A
Which donor unit is selected for a recipient with anti-c?
A. r ́r
B. R0R1
C. R2r ́
D. r ́ry
D
Which genotype usually shows the strongest reaction with anti-D?
A. DCE/DCE
B. Dce/dCe
C. D–/D–
D. -CE/-ce
C
Why is testing for Rh antigens and antibodies different from ABO testing?
A. ABO reactions are primarily due to IgM antibodies and usually occur at room temperature; Rh antibodies are IgG and agglutination usually requires a 37°C incubation and enhancement media
B. ABO antigens are attached to receptors on the outside of the red cell and do not require any special enhancement for testing; Rh antigens are loosely attached to the red cell membrane and require enhancement for detection
C. Both ABO and Rh antigens and antibodies have similar structures, but Rh antibodies are configured so that special techniques are needed to facilitate binding to Rh antigens
D. There is no difference in ABO and Rh testing; both may be conducted at room temperature with no special enhancement needed for reaction
A
Testing reveals a weak D that reacts 1+ after indirect antiglobulin testing (IAT). How is this result classified?
A. Rh-positive
B. Rh-negative, Du positive
C. Rh-negative
D. Rh-positive, Du positive
A
What is one possible genotype for a patient who develops anti-C antibody?
A. R1r
B. R1R1
C. r ́r
D. rr
D
A patient developed a combination of Rh antibodies: anti-C, anti-E, and anti-D. Can compatible blood be found for this patient?
A. It is almost impossible to find blood lacking the C, E, and D antigens
B. rr blood could be used without causing a problem
C. R0R0 may be used because it lacks all three antigens
D. Although rare, ryr blood may be obtained from close relatives of the patient
B
A patient tests positive for weak D but also appears to have anti-D in his serum. What may be the problem?
A. Mixup of samples or testing error
B. Most weak D individuals make anti-D
C. The problem could be due to a disease state
D. A D mosaic may make antibodies to missing antigen parts
D
Which offspring is not possible from a mother who is R1R2 and a father who is R1r?
A. DcE/DcE
B. Dce/DCe
C. DcE/DCe
D. Dce/dce
A
Why is testing a pregnant woman for weak D not
required?
A. An Rh-negative fetus may yield false positive results in a fetal maternal bleed
B. An Rh-positive fetus may yield false positive results in a fetal maternal bleed
C. D antigen strength decreases during pregnancy
D. D antigen strength increases during pregnancy
B
What antibodies could an R1R1 make if exposed to R2R2 blood?
A. Anti-e and anti-C
B. Anti-E and anti-c
C. Anti-E and anti-C
D. Anti-e and anti-c
B
What does the genotype —/— represent in the Rh system?
A. Rh negative
B. D mosaic
C. Rhnull
D. Total Rh
C
What techniques are necessary for weak D testing?
A. Saline + 22°C incubation
B. Albumin or LISS + 37°C incubation
C. Saline + 37°C incubation
D. 37°C incubation + IAT
D
A patient types as AB and appears to be Rh positive on slide typing. What additional tests should be performed for tube typing?
A. Rh negative control
B. Direct antiglobulin test (DAT)
C. Low-protein Rh antisera
D. No additional testing is needed
A
According to the Wiener nomenclature and/or genetic theory of Rh inheritance:
A. There are three closely linked loci, each with a primary set of allelic genes
B. The alleles are named R1, R2, R0, r, r ́, r ̋, Rz, and ry
C. There are multiple alleles at a single complex locus that determine each Rh antigen
D. The antigens are named D, C, E, c, and e
C
The Wiener nomenclature for the E antigen is:
A. hr ́
B. hrv ́
C. rh ̋
D. Rh0
C
A physician orders 2 units of leukocyte-reduced red blood cells. The patient is a 55-year-old male with anemia. He types as an AB negative, and his antibody screen is negative. There is only 1 unit of AB negative in inventory. What is the next blood type that should be given?
A. AB positive (patient is male)
B. A negative
C. B negative
D. O negative
B
Which technology may report an Rh-weak D positive as Rh negative?
A. Gel System
B. Solid Phase
C. Tube Testing
D. None of these options
A
A patient has the Lewis phenotype Le(a−b−). An antibody panel reveals the presence of anti-Lea. Another patient with the phenotype Le(a−b+) has a positive antibody screen; however, a panel reveals no conclusive antibody. Should anti-Lea be considered as a possibility for the patient with the Le(a−b+) phenotype?
A. Anti-Lea should be considered as a possible antibody
B. Anti-Lea may be a possible antibody, but further studies are needed
C. Anti-Lea is not a likely antibody because even Leb individuals secrete some Lea
D. Anti-Lea may be found in saliva but not detectable in serum
C
A technologist is having great difficulty resolving an antibody mixture. One of the antibodies is anti- Lea. This antibody is not clinically significant in this situation, but it needs to be removed to reveal the possible presence of an underlying antibody of clinical significance. What can be done?
A. Perform an enzyme panel
B. Neutralize the serum with saliva
C. Neutralize the serum with hydatid cyst fluid
D. Use DTT (dithiothreitol) to treat the panel cells
B
What type of blood should be given to an individual who has an anti-Leb that reacts 1+ at the IAT phase?
A. Blood that is negative for the Leb antigen
B. Blood that is negative for both the Lea and Leb antigens
C. Blood that is positive for the Leb antigen
D. Lewis antibodies are not clinically significant, so any type of blood may be given
A
Which of the following statements is true concerning the MN genotype?
A. Antigens are destroyed using bleach-treated cells
B. Dosage effect may be seen for both M and N antigens
C. Both M and N antigens are impossible to detect because of cross-interference
D. MN is a rare phenotype seldom found in routine antigen typing
B
Anti-M is sometimes found with reactivity detected at the immediate spin (IS) phase that persists in strength to the IAT phase. What is the main testing problem with a strong anti-M?
A. Anti-M may not allow detection of a clinically significant antibody
B. Compatible blood may not be found for the patient with a strongly reacting anti-M
C. The anti-M cannot be removed from the serum
D. The anti-M may react with the patient’s own cells, causing a positive autocontrol
A
A patient is suspected of having paroxysmal cold hemoglobinuria (PCH). Which pattern
of reactivity is characteristic of the Donath– Landsteiner antibody, which causes this condition?
A. The antibody attaches to RBCs at 4°C and causes hemolysis at 37°C
B. The antibody attaches to RBCs at 37°C and causes agglutination at the IAT phase
C. The antibody attaches to RBCs at 22°C and causes hemolysis at 37°C
D. The antibody attaches to RBCs and causes agglutination at the IAT phase
A
How can interfering anti-P1 antibody be removed from a mixture of antibodies?
A. Neutralization with saliva
B. Agglutination with human milk
C. Combination with urine
D. Neutralization with hydatid cyst fluid
D
Which antibody is frequently seen in patients with warm autoimmune hemolytic anemia?
A. Anti-Jka
B. Anti-e
C. Anti-K
D. Anti-Fyb
B
Which group of antibodies is commonly found as cold agglutinins?
A. Anti-K, anti-k, anti-Jsb
B. Anti-D, anti-e, anti-C
C. Anti-M, anti-N
D. Anti-Fya, anti-Fyb
C
Which of the following antibodies characteristically gives a refractile mixed-field appearance?
A. Anti-K
B. Anti-Dia
C. Anti-Sda
D. Anti-s
C
What does the 3+3 rule ascertain?
A. An antibody is ruled in
B. An antibody is ruled out
C. 95% confidence that the correct antibody has been identified
D. 95% confidence that the correct antibody has not been identified
C
The k (Cellano) antigen is a high-frequency antigen and is found on most red cells. How often would one expect to find the corresponding antibody?
A. Often, because it is a high frequency antibody
B. Rarely, because most individuals have the antigen and therefore would not develop the antibody
C. It depends upon the population, because certain racial and ethnic groups show a higher frequency of anti-k
B
Which procedure would help to distinguish between an anti-e and anti-Fya in an antibody mixture?
A. Lower the pH of test serum
B. Run an enzyme panel
C. Use a thiol reagent
D. Run a LISS panel
B
Which characteristics are true of all three of the following antibodies: anti-Fya, anti-Jka, and anti-K?
A. Detected at the IAT phase; may cause hemolytic disease of the newborn and hemolytic transfusion reactions
B. Not detected with enzyme-treated cells
C. Requires the IAT technique for detection; usually not associated with HDN
D. Enhanced reactivity with enzyme-treated cells; may cause severe hemolytic transfusion reactions
A
A patient is admitted to the hospital. Medical records indicate that the patient has a history of anti-Jka. When you performed the type and screen, the type was O positive and screen was negative. You should:
A. Crossmatch using units negative for Jka antigen
B. Crossmatch random units, since the antibody is not demonstrating
C. Request a new sample
D. Repeat the screen with enzyme-treated screening cells
A
A technologist performs an antibody study and finds 1+ and weak positive reactions for several of the panel cells. The reactions do not fit a pattern. Several selected panels and a patient phenotype do not reveal any additional information. The serum is diluted and retested, but the same reactions persist. What type of antibody may be causing these results?
A. Antibody to a high-frequency antigen
B. Antibody to a low-frequency antigen
C. High titer low avidity (HTLA)
D. Anti-HLA
C
An antibody is detected in a pregnant woman and is suspected of being the cause of fetal distress. The antibody reacts at the IAT phase but does not react with DTT-treated cells. This antibody causes in vitro hemolysis. What is the most likely antibody specificity?
A. Anti-Lea
B. Anti-Lua
C. Anti-Lub
D. Anti-Xga
C
What sample is best for detecting complement- dependent antibodies?
A. Plasma stored at 4°C for no longer than 24 hours
B. Serum stored at 4°C for no longer than 48 hours
C. Either serum or plasma stored at 20°C–24°C no longer than 6 hours
D. Serum heated at 56°C for 30 minutes
B
Which antibody would not be detected by group O screening cells?
A. Anti-N
B. Anti-A1
C. Anti-Dia
D. Anti-k
B
A 77-year-old female is admitted to a community hospital after a cardiac arrest. History includes an abdominal aortic aneurysm 2 years ago in which she received 6 units of packed cells. Her blood type is A positive and antibody screen is positive at AHG phase in screening cells II and III. A panel
is performed using LISS. Referring to panel 3, which antibodies are likely implicated?
A. C and K
B. Jka and c
C. E and c
D. Fya and M
C
An emergency trauma patient requires transfusion. Six units of blood are ordered stat. There is no time to draw a patient sample. O-negative blood is released. When will compatibility testing be performed?
A. Compatibility testing must be performed before blood is issued
B. Compatibility testing will be performed when a patient sample is available
C. Compatibility testing may be performed immediately using donor serum
D. Compatibility testing is not necessary when blood is released in emergency situations
B
How would autoantibodies affect compatibility testing?
A. No effect
B. The DAT would be positive
C. ABO, Rh, antibody screen, and crossmatch may show abnormal results
D. Results would depend on the specificity of autoantibody
C
An antibody screen is reactive at IAT phase of testing using a three-cell screen and the autocontrol is negative. What is a possible explanation for these results?
A. A cold alloantibody
B. High-frequency alloantibody or a mixture of alloantibodies
C. A warm autoantibody
D. A cold and warm alloantibody
B
What does a minor crossmatch consist of?
A. Recipient plasma and recipient red cells
B. Recipient plasma and donor red cells
C. Recipient red cells and donor plasma
D. Donor plasma and donor red cells
C
Can crossmatching be performed on October 14th using a patient sample drawn on October 12th?
A. Yes, a new sample would not be needed
B. Yes, but only if the previous sample has no alloantibodies
C. No, a new sample is needed because the 2-day limit has expired
D. No, a new sample is needed for each testing
A
A type and screen was performed on a 32-year-old woman, and the patient was typed as AB negative. There are no AB-negative units in the blood bank. What should be done?
A. Order AB-negative units from a blood supplier
B. Check inventory of A-, B-, and O-negative units
C. Ask the patient to make a preoperative autologous donation
D. Nothing—the blood will probably not be used
B
What ABO types may donate to any other ABO type?
A. A negative, B negative, AB negative, O negative
B. O negative
C. AB negative
D. AB negative, A negative, B negative
B
What type(s) of red cells is (are) acceptable to transfuse to an O-negative patient?
A. A negative, B negative, AB negative, or O negative
B. O negative
C. AB negative
D. AB negative, A negative, B negative
B
A technologist removed 4 units of blood from the blood bank refrigerator and placed them on the counter. A clerk was waiting to take the units for transfusion. As she checked the paperwork, she noticed that one of the units was leaking onto the counter. What should she do?
A. Issue the unit if the red cells appear normal
B. Reseal the unit
C. Discard the unit
D. Call the medical director and ask for an opinion
C
A donor was found to contain anti-K using pilot tubes from the collection procedure. How would this affect the compatibility test?
A. The AHG major crossmatch would be positive
B. The IS (immediate spin) major crossmatch would be positive
C. The recipient’s antibody screen would be positive for anti-K
D. Compatibility testing would not be affected
D
Which of the following is not a requirement for the electronic crossmatch?
A. The computer system contains logic to prevent assignment and release of ABO incompatible blood
B. There are concordant results of at least two determinations of the recipient’s ABO type on
record, one of which is from the current sample
C. Critical elements of the system have been validated on site
D. There are concordant results of at least one determination of the recipient’s ABO type on file
D
A patient showed positive results with screening cells and 4 donor units. The patient autocontrol was negative. What is the most likely antibody?
A. Anti-H
B. Anti-S
C. Anti-Kpa
D. Anti-k
D
Screening cells and major crossmatch are positive on IS only, and the autocontrol is negative. Identify the problem.
A. Cold alloantibody
B. Cold autoantibody
C. Abnormal protein
D. Antibody mixture
A
Six units are crossmatched. Five units are compatible, one unit is incompatible, and the recipient’s antibody screen is negative. Identify the problem:
A. Patient may have an alloantibody to a high-frequency antigen
B. Patient may have an abnormal protein
C. Donor unit may have a positive DAT
D. Donor may have a high-frequency antigen
C
An incompatible donor unit is found to have a positive DAT. What should be done with the donor unit?
A. Discard the unit
B. Antigen type the unit for high-frequency antigens
C. Wash the donor cells and use the washed cells for testing
D. Perform a panel on the incompatible unit
A
Screening cells, major crossmatch, and patient autocontrol are positive in all phases. Identify the problem.
A. Specific cold alloantibody
B. Specific cold autoantibody
C. Abnormal protein or nonspecific autoantibody
D. Cold and warm alloantibody mixture
C
A panel study has revealed the presence of patient alloantibodies. What is the first step in a major crossmatch?
A. Perform a DAT on patient cells and donor units
B. Antigen type patient cells and any donor cells to be crossmatched
C. Adsorb any antibodies from the patient serum
D. Obtain a different enhancement medium for testing
B
What is the disposition of a donor red blood cell unit that contains an antibody?
A. The unit must be discarded
B. Only the plasma may be used to make components
C. The antibody must be adsorbed from the unit
D. The unit may be labeled indicating it contains antibody and released into inventory
D
Given a situation where screening cells, major crossmatch, autocontrol, and DAT (anti-IgG) are all positive, what procedure should be performed next?
A. Adsorption using rabbit stroma
B. Antigen typing of patient cells
C. Elution followed by a cell panel on the eluate
D. Selected cell panel
C
A major crossmatch and screening cells are 2+ at IS, 1+ at 37°C, and negative at the IAT phase. Identify the most likely problem.
A. Combination of antibodies
B. Cold alloantibody
C. Rouleaux
D. Test error
B
What corrective action should be taken when rouleaux causes positive test results?
A. Perform a saline replacement technique
B. Perform an autoabsorption
C. Run a panel
D. Perform an elution
A
All of the following are reasons for performing an adsorption, except:
A. Separation of mixtures of antibodies
B. Removal of interfering substances
C. Confirmation of weak antigens on red cells
D. Identification of antibodies causing a positive DAT
D
How long must a recipient sample be kept in the blood bank for compatibility testing?
A. 3 days
B. 5 days
C. 7 days
D. 10 days
C
What is the crossmatching protocol for platelets and/or plasma?
A. Perform a reverse grouping on donor plasma
B. No testing is required
C. Perform a reverse grouping on recipient plasma
D. Platelets must be HLA compatible
B
What are the compatibility requirements for an autologous unit?
A. ABO and Rh typing
B. Type and screen
C. Major crossmatch
D. All of these options
A
A patient types as AB positive. Two units of blood have been ordered by the physician. Currently, the inventory shows no AB units, 10 A-positive units, 1 A-negative unit, 5 B-positive units, and 20 O-positive units. Which should be set up for the major crossmatch?
A. A-positive units
B. O-positive units
C. B-positive units
D. Call another blood supplier for type-specific blood
A
Which of the following comprises an abbreviated crossmatch?
A. ABO, Rh, and antibody screen
B. ABO, Rh, antibody screen, IS crossmatch
C. Type and screen
D. ABO, Rh, IS crossmatch
B
When may an IS crossmatch be performed?
A. When a patient is being massively transfused
B. When there is no history of antibodies and the current antibody screen is negative
C. When blood is being emergency released
D. When a patient has not been transfused in the past 3 months
B
A patient had a transfusion reaction to packed red blood cells. The medical laboratory scientist began the laboratory investigation of the transfusion reaction by assembling pre- and post-transfusion specimens and all paperwork and computer printouts.
What should he do next?
A. Perform a DAT on the post-transfusion sample
B. Check for a clerical error(s)
C. Repeat ABO and Rh typing of patient and donor unit
D. Perform an antibody screen on the post- transfusion sample
B
What is the pathophysiological cause surrounding anaphylactic and anaphylactoid reactions?
A. Antibody in patient serum is detected 3–7 days after transfusion, and is attached to donor red blood cells
B. Donor plasma has reagins (IgE or IgA) that combine with allergens in patient plasma
C. Patient is deficient in IgE and develops IgE antibodies via sensitization from transfusion or pregnancy
D. Patient is deficient in IgA and develops IgA antibodies via sensitization from transfusion or pregnancy
D
A patient has a hemolytic reaction to blood transfused 8 days ago. What is the most likely cause?
A. Immediate, nonimmunologic probably due to volume overload
B. Delayed immunologic, probably due to an antibody such as anti-Jka
C. Delayed nonimmunologic, probably due to iron overload
D. Immediate, immunologic, probably due to clerical error, ABO incompatibility
B
What may be found in the serum of a person who is exhibiting signs of TRALI (transfusion-related acute lung injury)?
A. Red blood cell alloantibody
B. IgA antibody
C. Antileukocyte antibody
D. Allergen
C
Which type of transfusion reaction occurs in about 1% of all transfusions, results in a temperature
rise of 1°C or higher, is associated with blood component transfusion, and is not related to the patient’s medical condition?
A. Immediate hemolytic
B. Delayed hemolytic
C. Febrile nonhemolytic reaction
D. Transfusion-related acute lung injury
C
What would be the result of group A blood given to an O patient?
A. Nonimmune transfusion reaction
B. Immediate hemolytic transfusion reaction
C. Delayed hemolytic transfusion reaction
D. Febrile nonhemolytic transfusion reaction
B
Patient DB received 2 units of group A-positive red cells 2 days ago. Two days later, he developed a fever and appeared jaundiced. His blood type was A positive. A transfusion reaction workup was ordered. There were no clerical errors detected. A post-transfusion specimen was collected and a DAT performed. The DAT was positive with monospecific anti-IgG. The plasma was also hemolyzed. An antibody screen and panel studies revealed the presence of anti-Jkb (postspecimen). The antibody screen on the pretransfusion specimen was negative. Which of the following explain the positive DAT?
A. The donor cells had a positive DAT
B. The donor cells were polyagglutinable
C. The donor cells were likely positive for the Jkb antigen
D. The recipient cells were likely positive for the Jkb antigen
C
All of the following are part of the preliminary evaluation of a transfusion reaction, except:
A. Check pre- and post-transfusion samples for color of serum
B. Perform ABO and Rh recheck
C. DAT on the post-transfusion sample
D. Panel on pre- and post-transfusion samples
D
A 68-year-old female diagnosed with neutropenia and inflammation of the left hand was typed as A positive, and received 1 packed red blood cell unit. The antibody screen was negative and crossmatch was compatible. During the transfusion, her pulse was 94, and blood pressure rose from 114/59 to 132/64. Her temperature rose from 37.1°C pretransfusion to 37.8°C 60 minutes after starting transfusion, then to 38.1°C upon completion. A post-transfusion specimen yielded plasma that was neither hemolyzed nor icteric, and a negative DAT. Post-transfusion urinalysis gave a 1+ blood and protein with 10 RBCs/hpf microscopically. The clerical check was acceptable. What type of reaction most likely occurred as a result of transfusion?
A. Allergic
B. Circulatory overload
C. Febrile nonhemolytic
D. Delayed hemolytic
C
A 92-year-old male diagnosed with anemia
and episodes of frequent falling was typed as
B negative and transfused 1 unit of packed red blood cells, also B negative. He was not recently transfused, and the antibody screen was negative. During the transfusion, his temperature rose from 36.2°C to 36.4°C, his pulse rose from 96 to 124, respirations from 18 to 20, and BP from 127/81 to 174/83. He was transfused with 205 mL before a reaction was called by the transfusionist. The postspecimen DAT was negative and clerical check acceptable. Urinalysis yielded 1+ blood with 5 RBCs microscopically. Other symptoms included tachycardia and flushing. What reaction had most likely taken place?
A. Febrile nonhemolytic
B. Acute hemolytic
C. Anaphylactic
D. Volume overload
D
A 76-year-old female diagnosed with urosepsis was transfused 2 units of packed red blood cells. Her type was AB positive with a negative antibody screen. The units transfused were AB positive. Upon receiving the second unit, the patient became hypoxic with tachypnea. The clerical check was acceptable and DAT negative. She received 269 mL from the second unit before a reaction was called. Her temperature fell from 38°C to 36.4°C, her pulse increased from 72 to 90, and respirations rose from 35 to 41. Her BP was 110/70. The patient expired approximately 12 hours from the time the reaction was called. What type of reaction was most likely present?
A. Febrile
B. Symptoms not related to transfusion
C. Allergic
D. TRALI
B
A 52-year-old male received 2 units of packed red blood cells as an outpatient in the IV therapy unit. He had a 20-year history of head trauma and was quadriplegic. He had recurrent pneumonia and hematuria due to removal of a Foley catheter.
His blood type was A positive with a previously identified anti-Fya. There was an ABO discrepancy in that the A1 cells were positive. The technologist attributed the reaction to the Fya antigen being present on the A1 cells. The patient also had a cold autoantibody. Two units of A-positive packed cells were crossmatched that were Fya negative, and were compatible. One unit was transfused at 11:30 a.m. without incident. The second unit was transfused at 2:16 p.m., and stopped at 3:55 p.m. due to reddish brown–tinged urine discovered in his collection bag. A post-transfusion specimen yielded a positive DAT, and plasma that was grossly hemolyzed. A prewarm crossmatch was incompatible in both the pre- and postspecimen. Anti-E and c were present in the postspecimen. What reaction was most likely present?
A. Acute hemolytic
B. Febrile
C. Allergic
D. TRALI
A
An 82-year-old male was admitted for renal failure. His type was B positive, and his antibody screen was negative. Two units of red cells were ordered. The first unit was transfused at 1:00 p.m. without incident. The second was started at 4:15 p.m. and stopped at 5:12 p.m., after the nurse observed the patient had expired. Vital signs were taken at 4:30 p.m. with no abnormalities.
A transfusion reaction was called and the blood unit, tubing, and paperwork sent to the blood bank. There were no clinical manifestations noted on the paperwork and no post-transfusion specimen was sent to the blood bank. What type of reaction most likely occurred?
A. Symptoms not related to transfusion
B. Acute hemolytic reaction
C. Anaphylactic reaction
D. Volume overload
A
A male cancer patient with a hemoglobin of 6 g/dL was admitted to the hospital with acute abdominal pain. Small bowel resection was indicated, but the attending physician wanted to raise the patient’s hemoglobin to 12 g/dL before surgery. How many units of RBCs would most likely be required to accomplish this?
A. 2
B. 3
C. 6
D. 8
C
Which of the following is not a viable method for removing leukocytes from red blood cells?
A. Prestorage filtration
B. Bedside filtration
C. Poststorage filtration
D. Buffy coat removal
D
Four units of packed RBCs were brought to the nurses’ station at 10:20 a.m. Two units were transfused immediately, and 1 unit was transfused at 10:40 a.m. The remaining unit was returned to the blood bank at 11:00 a.m. The units were not refrigerated after leaving the blood bank. What problem(s) is (are) present in this situation?
A. The only problem is with the returned unit; the 30-minute limit has expired and the unit cannot be used
B. The unit should not have been transfused at 10:40 a.m. because the time limit had expired; this unit and the remaining unit should have been returned to the blood bank
C. The returned unit may be held for this patient for 48 hours but cannot be used for another patient
D. No problems; all actions were performed within the allowable time limits
A
A unit of whole blood is collected at 10:00 a.m. and stored at 20°C–24°C. What is the last hour platelet concentrates may be made from this unit?
A. 4:00 p.m.
B. 6:00 p.m.
C. 7:00 p.m.
D. 8:00 p.m.
B
Which of the following is acceptable according to AABB standards?
A. Rejuvenated RBCs may be made within 3 days of outdate and transfused or frozen within 24 hours of rejuvenation
B. Frozen RBCs must be prepared within 30 minutes of collection and may be used within 10 years
C. Irradiated RBCs must be treated within 8 hours of collection and transfused within 6 hours
D. Leukocyte-reduced RBCs must be prepared within 6 hours of collection and transfused within 6 hours of preparation
A
Which of the following is true regarding apheresis platelets?
A. The minimum platelet count must be 3.0 × 1011, pH must be ≥6.0
B. The minimum platelet count must be 3.0 × 1010, pH must be ≤6.2
C. The minimum platelet count must be 3.0 × 1011, pH must be ≥6.2
D. The minimum platelet count must be 5.5 × 1010, pH must be ≤6.0
C
What is the component of choice for a patient with chronic granulomatous disease (CGD)?
A. FFP
B. Granulocytes
C. Cryoprecipitate
D. RBCs
B
What method can be employed to detect bacteria in random donor platelets?
A. pH
B. Glucose
C. Pan genera detection (PGD) assay
D. Gram stain
C
All of the following statements regarding FFP are true, except:
A. FFP must be prepared within 24 hours of collection
B. After thawing, FFP must be transfused within 24 hours
C. Storage temperature for FFP with a 1-year shelf life is ≤−18°C
D. When thawed, FFP must be stored between 1°C–6°C
A
What may be done to RBCs before transfusion to a patient with cold agglutinin disease in order to reduce the possibility of a transfusion reaction?
A. Irradiate to prevent graft-versus-host-disease (GVHD)
B. Wash with 0.9% percent saline
C. Warm to 37°C with a blood warmer
D. Transport so that temperature is maintained at 20°C–24°C
C
A unit of packed RBCs is split using the open system. One of the half units is used. What may be done with the second half unit?
A. Must be issued within 24 hours
B. Must be issued within 48 hours
C. Must be irradiated
D. Must retain the original expiration date
A
What should be done if a noticeable clot is found in an RBC unit?
A. Issue the unit; the blood will be filtered
B. Issue the unit; note the presence of a clot on the release form
C. Filter the unit in the blood bank before issue
D. Do not issue the unit
D
Cryoprecipitate may be used to treat all of the following, except:
A. von Willebrand’s disease
B. Hypofibrinogenemia
C. Idiopathic thrombocytopenic purpura (ITP)
D. Factor XIII deficiency
C
SITUATION: A transplant patient may receive only type A or AB platelets. There are only type O apheresis platelets available. What devices may be used to deplete the incompatible plasma and replace with sterile saline?
A. Cytospin/irradiator
B. Water bath/centrifuge
C. Centrifuge/sterile connecting device
D. Cell washer/heat sealer
C
What component(s) is (are) indicated for patients who have anti-IgA antibodies?
A. Whole blood
B. Packed RBCs
C. Washed or deglycerolized RBCs
D. Granulocytes
C
All of the following are true regarding washed RBCs, except:
A. RBCs are washed with 1–2 L of normal saline
B. Volume is 180 mL
C. Shelf life is extended
D. Leukocytes are removed
C
What is a special condition for the storage of platelets?
A. Room temperature, 20°C–24°C
B. No other components may be stored with platelets
C. Platelets must be stored upright in separate containers
D. Platelets require constant agitation at 20°C–24°C
D
Transfusion of an irradiated product is indicated in all of the following conditions except:
A. Exchange transfusion
B. Bone marrow transplant
C. Severe combined immunodeficiency syndrome (SCIDS)
D. Warm autoimmune hemolytic anemia (WAIHA)
D
What percentage of red cells must be retained in leukocyte-reduced red cells?
A. 75%
B. 80%
C. 85%
D. 100%
C
Which of the following is true regarding granulocyte concentrates?
A. The product must contain a maximum of 1.0 × 1010 granulocytes
B. The pH must be 6.0
C. The product must be crossmatched
D. The product must be irradiated
C
What course of action should be taken if a medical laboratory scientist inadvertently irradiates a unit of red cells twice?
A. Issue the unit
B. Discard the unit
C. Change the expiration date; then issue the unit
D. Note on the irradiation sticker that the unit was irradiated twice and issue
B
What components(s) may be shipped together with FFP?
A. Frozen RBCs and cryoprecipitate
B. Platelets
C. Packed RBCs and granulocytes
D. Double red cell
A
A blood supplier ships 3 units of pooled cryoprecipitate. Each pool consists of 5 units of cryoprecipitate. If one unit is thawed at 5:00 p.m., when must it be dispensed from the blood bank?
A. Before 9:00 p.m.
B. Before 11:00 p.m.
C. Before 12:00 a.m.
D. Before 5:00 p.m. the next day
A
How does irradiation prevent transfusion associated graft-versus-host disease (TA-GVHD)?
A. Gamma rays and x-rays destroy the lymphocytes ability to divide
B. X-rays cause lysis of the lymphocytes
C. Gamma rays enhance lymphocyte reactivity
D. Ultraviolet radiation induces apoptosis of lymphocytes
A
Which component has the longest expiration date?
A. Cryoprecipitate
B. FFP
C. Frozen RBCs
D. Platelet concentrates
C
All of the following are advantages of using single- donor platelets as opposed to random donor platelets, except:
A. Less preparation time
B. Less antigen exposure for patients
C. May be HLA matched
D. No pooling is required
A
What is the expiration of cryoprecipitate once pooled?
A. 4 hours
B. 6 hours
C. 8 hours
D. 24 hours
A
What is the number of white blood cells permitted in a unit of leukoreduced red cells?
A. <5 × 1010
B. <5 × 106
C. <8.3 × 105
D. <8.3 × 106
B
A cancer patient recently developed a severe infection. The patient’s hemoglobin is
8 g/dL owing to chemotherapy with a drug known to cause bone marrow depression and immunodeficiency. Which blood products are indicated for this patient?
A. Liquid plasma and cryoprecipitate
B. Crossmatched platelets and washed RBCs
C. Factor IX concentrates and FFP
D. Irradiated RBCs, platelets, and granulocytes
D
Which of the following individuals is acceptable as a blood donor?
A. A 29-year-old man who received the hepatitis B vaccine last week
B. A 21-year-old woman who had her nose pierced last week
C. A 30-year-old man who lived in Zambia for 3 years and returned last month
D. A 54-year-old man who tested positive for hepatitis C last year, but has no active symptoms of disease
A
SITUATION: A 53-year-old woman donates blood at her place of employment. She weighs 150 lb and has a hemoglobin of 13 g/dL. She is currently on warfarin and vitamin B12. Is she an acceptable donor?
A. Yes
B. No, she is on warfarin
C. Yes, for red cells only
D. No, her hemoglobin is too low
C
Which immunization has the longest deferral period?
A. HBIG
B. Rubella vaccine
C. Influenza vaccine
D. Yellow fever vaccine
A
Thefollowingwholeblooddonorsregularlygive blood. Which donor may donate on September 10th?
A. A 40-year-old woman who last donated on July 23rd
B. A 28-year-old man who had plateletpheresis on August 24th
C. A 52-year-old man who made an autologous donation 2 days ago
D. A 23-year-old woman who donated blood for her aunt on August 14th
B
Which of the following precludes acceptance of a plateletpheresis donor?
A. Platelet count of 75 × 109/L in a donor who is a frequent platelet donor
B. Plasma loss of 800 mL from plasmapheresis 1 week ago
C. Plateletpheresis performed 4 days ago
D. Aspirin ingested 7 days ago
A
Which of the following donors could be accepted for whole-blood donation?
A. A construction worker who was incarcerated for opiate abuse
B. A triathlete with a pulse of 45
C. A man who is currently taking finasteride (Propecia)
D. A woman in her 14th week of pregnancy
B
Which physical examination result is cause for rejecting a whole-blood donor?
A. Weight of 105 lb
B. Pulse of 75
C. Temperature of 99.3°F
D. Diastolic pressure of 110 mm Hg
D
Which situation is not a cause for indefinite deferral of a donor?
A. Male currently on dutasteride (Avodart)
B. Donation of a unit of blood that transmitted hepatitis B virus to a recipient
C. History of Creutzfeldt–Jacob disease
D. Accidental needle stick 1 year ago; negative for infectious disease
D
A whole-blood donor currently on clopidogrel (Plavix) is precluded from donating which product?
A. Platelets
B. Red blood cells
C. FFP
D. Cryoprecipitate
A
How much anticoagulant would have to be removed from the collection bag given a donor who weighs 90 lb?
A. 12 mL
B. 15 mL
C. 20 mL
D. 23 mL
A
A woman begins to breathe rapidly while donating blood. Choose the correct course of action.
A. Continue the donation; rapid breathing is not a reason to discontinue a donation
B. Withdraw the needle, raise her feet, and administer ammonia
C. Discontinue the donation and provide a paper bag
D. Tell her to sit upright and apply a cold compress to her forehead
C
A donor bag is half filled during donation when the blood flow stops. Select the correct course of action.
A. Closely observe the bag for at least 3 minutes; if blood flow does not resume, withdraw the needle
B. Remove the needle immediately and discontinue the donation
C. Check and reposition the needle if necessary; if blood flow does not resume, withdraw the needle
D. Withdraw the needle and perform a second venipuncture in the other arm
C
Can an autologous donor donate blood on Monday, if he is having surgery on Friday?
A. Yes, he or she can donate up to 72 hours before surgery
B. No, he or she cannot donate within 7 days of surgery
C. Yes, he or she can donate, but only a half a unit
D. No, he or she cannot donate within 5 days of surgery
A
Which of the following is an acceptable time in which a unit of whole blood is collected?
A. 33 minutes
B. 25 minutes
C. 20 minutes
D. 13 minutes
D
Which of the following is true regarding acute normovolemic hemodilution?
A. One or more units of blood are withdrawn from the patient and replaced with FFP
B. Units removed may be stored in the operating room at room temperature for 8 hours
C. Units removed may be stored in the operating room at room temperature for 24 hours
D. Unused units can be added to the general donor blood inventory
B
All of the following apply to a double red cell unit apheresis collection except:
A. The hematocrit must be at least 38%
B. The weight for a female is at least 150 lb
C. The height for a male is at least 5 ft 1 in.
D. The deferral period following collection is 16 weeks
A
An autologous unit of whole blood was collected on a 33-year-old woman in preparation for a knee replacement procedure in 3 weeks. The whole blood unit had her hyphenated last name, first name, and last four digits of her social security number for identification. The lab computer system, however, only had her married name and first name, medical record number, and social security number. What should be done with this blood product?
A. Discard the unit
B. Make the unit available for transfusion
C. Confirm the name with donor and have admissions make the correction in the computer system, then make the unit available for transfusion
D. Ensure that social security numbers match, confirm the name with donor and have admissions make the correction in the computer system with the medical director’s approval, then make the unit available for transfusion
D
What is the youngest age a person can make an allogeneic whole-blood donation?
A. 14
B. 15
C. 16
D. 17
C
Which of the following vaccinations carries no deferral period?
A. Rubella
B. Varicella zoster
C. Recombinant HPV
D. Smallpox
C
All of the following are reasons for a positive DAT on cord blood cells of a newborn except:
A. High concentrations of Wharton’s jelly on cord cells
B. Immune anti-A from an O mother on the cells of an A baby
C. Immune anti-D from an Rh negative mother on the cells of an Rh-positive baby
D. Immune anti-K from an K-negative mother on the cells of a K-negative baby
D
A fetal screen yielded negative results on a mother who is O negative and infant who is O positive. What course of action should be taken?
A. Perform a Kleihauer–Betke test
B. Issue one full dose of RhIg
C. Perform a DAT on the infant
D. Perform an antibody screen on the mother
B
What should be done when a woman who is 24 weeks pregnant has a positive antibody screen?
A. Perform an antibody identification panel; titer if necessary
B. No need to do anything until 30 weeks gestation
C. Administer Rh immune globulin (RhIg)
D. Adsorb the antibody onto antigen-positive cells
A
All of the following are interventions for fetal distress caused by maternal antibodies attacking fetal cells except:
A. Intrauterine transfusion
B. Plasmapheresis on the mother
C. Transfusion of antigen-positive cells to the mother
D. Early induction of labor
C
Cord cells are washed six times with saline and the DAT and negative control are still positive. What should be done next?
A. Obtain a heelstick sample
B. Record the DAT as positive
C. Obtain another cord sample
D. Perform an elution on the cord cells
A
What can be done if HDN is caused by maternal anti-K?
A. Give Kell immune globulin
B. Monitor the mother’s antibody level
C. Prevent formation of K-positive cells in the fetus
D. Not a problem; anti-K is not known to cause HDN
B
Should an O-negative mother receive RhIg if a positive DAT on the newborn is caused by immune anti-A?
A. No, the mother is not a candidate for RhIg because of the positive DAT
B. Yes, if the baby’s type is Rh negative
C. Yes, if the baby’s type is Rh positive
D. No, the baby’s problem is unrelated to Rh blood group antibodies
C
Should an A-negative woman who has just had a miscarriage receive RhIg?
A. Yes, but only if she does not have evidence of active Anti-D
B. No, the type of the baby is unknown
C. Yes, but only a minidose regardless of trimester
D. No, RhIg is given for term pregnancies only
A
The Ortho Provue reports a type on a woman who is 6 weeks pregnant with vaginal bleeding as O negative. The woman tells the emergency department physician she is O positive and presents a blood donor card. The medical laboratory scientist performs a test for weak D and observes a 1+ reaction in AHG phase. A Kleihauer–Betke test is negative. Is this woman a candidate for RhIg?
A. No, she is Rh positive
B. Yes, she is a genetic weak D
C. No, there is no evidence of a fetal bleed
D. Yes, based upon the Provue results
A
Which of the following patients would be a candidate for RhIg?
A. B-positive mother; B-negative baby; first pregnancy; no anti-D in mother
B. O-negative mother; A-positive baby; second pregnancy; no anti-D in mother
C. A-negative mother; O-negative baby; fourth pregnancy; anti-D in mother
D. AB-negative mother; B-positive baby; second pregnancy; anti-D in mother
B
A Kleihauer–Betke acid elution test identifies 40 fetal cells in 2,000 maternal red cells. How many full doses of RhIg are indicated?
A.1
B. 2
C. 3
D. 4
D
Kernicterus is caused by the effects of:
A. Anemia
B. Unconjugated bilirubin
C. Antibody specificity
D. Antibody titer
B
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 signs of fetal distress. What may be done?
A. Induce labor for early delivery
B. Perform plasmapheresis to remove anti-E from the mother
C. Administer RhIg to the mother
D. Perform an intrauterine transfusion using E-negative cells
B
What testing is done for exchange transfusion when the mother’s serum contains an alloantibody?
A. Crossmatch and antibody screen
B. ABO, Rh, antibody screen, and crossmatch
C. ABO, Rh, antibody screen
D. ABO and Rh only
B
Which blood type may be transfused to an AB-positive baby who has HDN caused by anti-D?
A. AB negative, CMV negative, Hgb S negative; irradiated or O negative, CMV negative,Hgb S negative
B. AB positive, CMV negative; irradiated or O positive, CMV negative
C. AB negative only
D. O negative only
A
All of the following are routinely performed on a cord blood sample except:
A. Forward ABO typing
B. Antibody screen
C. Rh typing
D. DAT
B
Why do Rh-negative women tend to have a positive antibody screen compared to Rh-positive women of childbearing age?
A. They have formed active anti-D
B. They have received RhIg
C. They have formed anti-K
D. They have a higher rate of transfusion
B
An O-negative mother gave birth to a B-positive infant. The mother had no history of antibodies or transfusion. This was her first child. The baby was mildly jaundiced and the DAT weakly positive with polyspecific antisera. What could have caused the positive DAT?
A. Anti-D from the mother coating the infant red cells
B. An alloantibody, such as anti-K, coating the infant red cells
C. Maternal anti-B coating the infant cells
D. Maternal anti-A, B coating the infant cells
D
RhIg is requested on a 28-year-old woman with suspected abortion. When the nurse arrives in the blood bank to pick up the RhIg, she asks the medical laboratory scientist (MLS) if it is a minidose. The MLS replies that it is a full dose, not a minidose. The nurse then requests to take 50 mcg from the 300 mcg syringe to satisfy the physician’s orders. What course of action should the MLS take?
A. Let the nurse take the syringe of RhIg, so that she may withdraw 50 mcg
B. Call a supervisor or pathologist
C. Instruct the nurse that the blood bank does not stock minidoses of RhIg and manipulating the full dose will compromise the purity of the product
D. Instruct the nurse that the blood bank does not stock minidoses of RhIg, and relay this information to the patient’s physician
D
What protocol is followed when screening whole blood donors for HIV-1 RNA?
A. Pools of 10 are tested; if the pool is nonreactive, donors are accepted
B. Pools of 20 are tested; if the pool is reactive, samples are tested individually
C. Pools of up to 16 donors are tested; if pool is reactive, individual samples are screened
D. All donors are screened individually; if samples are reactive, blood is discarded
C
Currently, nucleic acid amplification testing (NAT) testing is performed to detect which viruses?
A. HIV and HTLV-1
B. HTLV I/II
C. HIV, HCV, and WNV
D. HIV, HBV, and WNV
C
John comes in to donate a unit of whole blood at the collection center of the community blood supplier. The EIA screen is reactive for anti-HIV-1/2. The test is repeated in duplicate and is nonreactive. John is:
A. Cleared for donation
B. Deferred for 6 months
C. Status is dependent on confirmatory test
D. Deferred for 12 months
A
What marker is the first to appear in hepatitis B infection?
A. Anti-HBc (IgM)
B. HbsAg
C. Anti-HBs
D. Anti-HBc (IgG)
B
What marker indicates immunity to hepatitis B infection?
A. Anti-HBc (IgM)
B. HBsAg
C. Anti-HBs
D. Anti-HBc (IgG)
C
An EIA screening test for HTLV I/II was performed on a whole-blood donor. The results of the EIA were repeatedly reactive but the confirmatory test was negative. On the next donation, the screening test was negative by two different EIA tests. The donor should be:
A. Accepted
B. Deferred
C. Told that only plasma can be made from his donation
D. Told to come back in 6 months
A
A unit tests positive for syphilis using the rapid plasma reagin test (RPR). The microhemagglutinin assay-Treponema pallidum (MHA-TP) on the same unit is negative. What is the disposition of the unit?
A. The unit may be used to prepare components
B. The donor must be contacted and questioned further; if the RPR result is most likely a false positive, then the unit may be used
C. The unit must be discarded
D. Cellular components may be prepared but must be irradiated before issue
A
John Smith donated a unit of whole blood in May. Red blood cells made from the whole blood were transfused to a recipient of a community hospital in June with no apparent complications. The blood supplier notified the medical director of the hospital that the donor reported high-risk behavior with another male in April, although viral tests remain negative and the donor is healthy. What course of action should be taken?
A. No action should be taken
B. The recipient’s physician should be notified
C. The recipient’s physician and the recipient should be notified
D. The recipient should be notified
B
All of the following are required tests on donor blood, except:
A. HBsAg
B. Anti-CMV
C. HIV-1
D. Anti-HTLV I/II
B
Which of the following bands would constitute a positive Western Blot for HIV?
A. p24, gp41, p17
B. p55, gp120, p51
C. gp160, p31, p56
D. p24, p30, p55
A
An obstetric patient, 34 weeks pregnant, shows a positive antibody screen at the indirect antiglobulin phase of testing. She is group B, Rh negative. This is her first pregnancy. She has no prior history of transfusion. What is the most likely explanation for the positive antibody screen?
A. She has developed an antibody to fetal red cells
B. She probably does not have antibodies because this is her first pregnancy, and she has not been transfused; check for technical error
C. She received an antenatal dose of RhIg
D. Impossible to determine without further testing
C
A patient’s serum contains a mixture of antibodies. One of the antibodies is identified as anti-D. Anti-Jka or anti-Fya and possibly another antibody are present. What technique(s) may be helpful to identify the other antibody(s)?
A. Enzyme panel; select cell panel
B. Thio reagents
C. Lowering the pH and increasing the incubation time
D. Using albumin as an enhancement media in combination with selective adsorption
A
An anti-M reacts strongly through all phases of testing. Which of the following techniques would not contribute to removing this reactivity so that more clinically significant antibodies may be revealed?
A. Acidifying the serum
B. Prewarmed technique
C. Adsorption with homozygous cells
D. Testing with enzyme-treated red cells
A
The reactivity of an unknown antibody could be anti-Jka, but the antibody identification panel does not fit this pattern conclusively. Which of the following would not be effective in determining if the specificity is anti-Jka?
A. Testing with enzyme-treated cells
B. Select panel of homozygous cells
C. Testing with AET-treated cells
D. Increased incubation time
C
A cold-reacting antibody is found in the serum of a recently transfused patient and is suspected to be anti-I. The antibody identification panel shows reactions with all cells at room temperature, including the autocontrol. The reaction strength varies from 2+ to 4+. What procedure would
help to distinguish this antibody from other cold-reacting antibodies?
A. Autoadsorption technique
B. Neutralization using saliva
C. Autocontrol using ZZAP reagent-treated cells
D. Reaction with cord cells
D
The Ortho Provue does not detect weak forms of the D antigen. Why would running type and screens on the Provue prevent a patient with a weak D phenotype from forming anti-D?
A. Weak D persons cannot form anti-D
B. The Provue would result the sample as Rh negative; the patient would receive Rh-negative blood
C. The Provue would result the sample as Rh positive; the patient would receive Rh-positive blood
D. A and C
B
Red cells from a recently transfused patient were DAT positive when tested with anti-IgG. Screen cells and a panel performed on a patient’s serum showed very weak reactions with inconclusive results. What procedure could help to identify the antibody?
A. Elution followed by a panel on the eluate
B. Adsorption followed by a panel on the adsorbed serum
C. Enzyme panel
D. Antigen typing the patient’s red cells
A
A patient types as O positive. All three screen and red cells from two O-positive donor units show agglutination after incubation at 37°C, and increase in reactivity at the IAT phase of testing. What action should be taken next?
A. Perform an autocontrol and direct antiglobulin test on the patient
B. Perform an enzyme panel
C. Perform an elution
D. Choose another 2 units and repeat the crossmatch
A
Four units of blood are ordered for a patient. Blood bank records are checked and indicate that 5 years ago this patient had an anti-Jkb. What is the next course of action?
A. Antigen type units for the Jkb antigen and only crossmatch units positive for Jkb
B. Antigen type units for the Jkb antigen and only crossmatch units negative for Jkb
C. Randomly pull 4 units of blood that are ABO compatible and crossmatch
D. Perform an immediate spin crossmatch on 4 Jkb-negative units
B
A 56-year-old patient diagnosed with colon cancer demonstrates a positive antibody screen in all three screen cells at the antiglobulin phase. A panel study is done and shows 10 cells positive as well as the autocontrol at the antiglobulin phase. The reactions varied from 1+ to 3+. This patient had a history of receiving 2 units of blood approximately 1 month ago. What should be done next?
A. Perform a DAT on the patient cells
B. Perform an autoadsorption
C. Perform an alloadsorption
D. Issue O-negative cells
C
An O-negative mother with no record of any previous pregnancies gives birth to her first child, a B-positive baby. The baby’s DAT is weakly positive and the negative control is negative.
The antibody screen is also negative. The baby appears healthy but develops mild jaundice after 2 days, which is treated with phototherapy. The baby goes home after 4 days in the hospital without complications. What is the most likely explanation for the weakly positive DAT?
A. Technical error
B. A low titer anti-D
C. Immune anti-B from the mother
D. A maternal antibody against a low-incidence antigen
C
Toll-like receptors are found on which cells?
A. T cells
B. Dendritic cells
C. B cells
D. Large granular lymphocytes
B.
FFP can be transfused without regard for:
A. ABO type
B. Rh type
C. Antibody in product
D. All of these options
