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03-2023 > ISBB > Flashcards

ISBB Flashcards

1
Q

Cells known to be actively phagocytic include:

Neutrophils, monocytes, basophils
Monocytes, lymphocytes, neutrophils
Neutrophils, eosinophils, monocytes
Lymphocytes, eosinophils, monocytes

A

Neutrophils, eosinophils, monocytes

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2
Q

Which of the following can be attributed to IL-1?

Mediator of the innate immune response
Differentiation of stem cells
Halts growth of virally infected cells
Stimulation of mast cells

A

Mediator of the innate immune response

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3
Q

Interferons (IFN) have been demonstrated to act as:

Immunomodulators
Antiviral agents
Antineoplastic agents
All of these

A

All of these

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4
Q

Why might a COLONY STIMULATING FACTOR (CSF) be given to a cancer patient?

Stimulate activity of NK cells
Increase production of certain types of leukocytes
Decrease the production of TNF
Increase production of mast cells

A

Increase production of certain types of leukocytes

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5
Q

Acute-phase reactants are produced primarily by:

Endothelial cells
Epithelial cells
Fibroblasts
Hepatocytes (liver parenchymal cells)

A

Hepatocytes (liver parenchymal cells)

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6
Q

In plasma, this acute phase reactant is associated with HDL cholesterol, and it is thought to play a role in metabolism of cholesterol:

CRP
Ceruloplasmin
Haptoglobin
Serum amyloid

A

Serum amyloid

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7
Q

Of the circulating lymphocytes in peripheral blood, which are in the greatest percentages (60-80%)?

Natural killer cells
Null lymphocytes
B lymphocytes
T lymphocytes

A

T lymphocytes

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8
Q

Antigen receptors on T lymphocytes bind HLA class II molecules with the help of which accessory molecule?

CD2
CD3
CD4
CD8

A

CD4

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9
Q

The main function of T cells in the immune response is to:

Produce cytokines that regulate both innate and adaptive immunity
Produce antibodies
Participate actively in phagocytosis
Respond to target cells without prior exposure

A

Produce cytokines that regulate both innate and adaptive immunity

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10
Q

How do cytotoxic T cells kill target cells?

They produce antibodies that bind to the cell
They engulf the cell by phagocytosis
They stop protein synthesis in the target cell
They produce granzymes that stimulate apoptosis

A

They produce granzymes that stimulate apoptosis

CD8+ T cells are cytotoxic cells that are able to destroy cancer cells or virally infected host cells by producing PERFORINS and GRANZYMES.

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11
Q

Which of the following best describes a HAPTEN?

Not able to react with antibody
Antigenic only when coupled to a carrier
Has multiple determinant sites
A large chemically complex molecule

A

Antigenic only when coupled to a carrier

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12
Q

UNIQUE AMINO ACID SEQUENCE THAT IS COMMON TO ALL IMMUNOGLOBULIN MOLECULES of a given class in a given species:

Isotype
Allotype
Idiotype

A

Isotype

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13
Q

Antibody ALLOTYPE is determined by the:

Constant region of heavy chain
Variable regions of heavy and light chains
Constant region of light chain
Constant regions of heavy and light chains

A

Constant regions of heavy and light chains

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14
Q

Antibody IDIOTYPE is dictated by the:

Constant region of heavy chain
Variable regions of heavy and light chains
Constant region of light chain
Constant regions of heavy and light chains

A

Variable regions of heavy and light chains

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15
Q

Treatment of IgG with papain results in how many fragments from each immunoglobulin molecule

2
3
4
5

A

3

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16
Q

Which of the following immunoglobulins is present in the highest concentration in normal human serum?

IgM
IgG
IgA
IgE

A

IgG

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17
Q

The SUBCLASSES of IgG differ mainly in:

Type of L chain
Arrangement of disulfide bonds
Ability to act as opsonins
Molecular weight

A

Arrangement of disulfide bonds

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18
Q

Which antibody is best at agglutination and complement fixation?

IgA
IgG
IgD
IgM

A

IgM

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19
Q

The immunoglobulin class typically found to be present in saliva, tears and other secretions is:

IgG
IgA
IgM
IgD

A

IgA

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20
Q

Measurement of serum levels of which of the following immunoglobulins can serve as a screening test for multiple allergies?

IgA
IgE
IgG
IgM

A

IgE

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21
Q

Which complement component is present in the greatest quantity in plasma?

C2
C3
C4
C8

A

C3

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22
Q

The three complement activation pathways converge at the point of cleavage of complement component _____.

C3
C5
C7
C8

A

C3

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23
Q

Which of the following complement components is a strong CHEMOTACTIC FACTOR as well as a strong ANAPHYLATOXIN?

C3a
C3b
C5a
C4a

A

C5a

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24
Q

Which of the following activities is associated with C3b?

Opsonization
Anaphylaxis
Vasoconstriction
Chemotaxis

A

Opsonization

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25
Q

Which immunologic mechanism is usually involved in BRONCHIAL ASTHMA?

Immediate hypersensitivity
Immune complex
Antibody mediated cytotoxicity
Delayed hypersensitivity

A

Immediate hypersensitivity

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26
Q

The BASIC STRUCTURE OF IMMUNOGLOBULINS was elucidated in the 1950s and 1960s by:

Georges Kohler and Cesar Milstein
Gerald Edelman, Rodney Porter
Susumu Tonegawa
Rosalyn Yalow

A

Gerald Edelman, Rodney Porter

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27
Q

Recipient of the Nobel Prize for Physiology or Medicine in 1987, for his discovery of the genetic mechanism that produces ANTIBODY DIVERSITY:

Georges Kohler and Cesar Milstein
Gerald Edelman, Rodney Porter
Susumu Tonegawa
Rosalyn Yalow

A

Susumu Tonegawa

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28
Q

Which of the following is true of NK cells?

They rely upon memory for antigen recognition
They have the same CD groups as B cells
They are found mainly in lymph nodes
They kill target cells without prior exposure to them

A

They kill target cells without prior exposure to them

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29
Q

Which cell is the most potent phagocytic cell in tissue?

Neutrophil
Dendritic cell
Eosinophil
Basophil

A

Dendritic cell

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30
Q

The HLA complex is located primarily on:

Chromosome 3
Chromosome 6
Chromosome 9
Chromosome 17

A

Chromosome 6

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31
Q

Antigenic groups identified by different sets of antibodies reacting in a manner to certain standard cell lines best describes:

Cytokines
Clusters of differentiation (CD)
Neutrophilic granules
Opsonins

A

Clusters of differentiation (CD)

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32
Q

An HLA specimen is collected in a tube containing:

ACD
EDTA
Silica
Thrombin

A

ACD

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33
Q

Of the following diseases, which one has the HIGHEST RELATIVE RISK IN ASSOCIATION WITH AN HLA ANTIGEN?

Ankylosing spondylitis
Dermatitis herpetiformis
Juvenile diabetes
Rheumatoid arthritis

A

Ankylosing spondylitis

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34
Q

Which of these are found on a mature B cell?

IgG and IgD
IgM and IgD
Alpha and beta chains
CD 3

A

IgM and IgD

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35
Q

All the following are a function of T cells except:

Mediation of delayed-hypersensitivity reactions
Mediation of cytolytic reactions
Regulation of the immune response
Synthesis of antibody

A

Synthesis of antibody

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36
Q

Which T cell expresses the CD8 marker and acts specifically to kill tumors or virally infected cells?

Helper T
T suppressor
T cytotoxic
T inducer/suppressor

A

T cytotoxic

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37
Q

How are cytotoxic T cells (TC cells) and natural killer (NK) cells similar?

Require antibody to be present
Effective against virally infected cells
Recognize antigen in association with HLA class II markers
Do not bind to infected cells

A

Effective against virally infected cells

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38
Q

Select the term that describes the unique part of the antigen that is recognized by a corresponding antibody.

Immunogen
Epitope
Paratope
Clone

A

Epitope

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39
Q

Which immunoglobulin cross links mast cells to release histamine?

IgG
IgM
IgA
IgE

A

IgE

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40
Q

Which immunoglobulin class(es) has (have) a J chain?

IgM
IgE and IgD
IgM and sIgA
IgG3 and IgA

A

IgM and sIgA

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41
Q

Which immunoglobulin(s) help(s) initiate the classic complement pathway?

IgA and IgD
IgM only
IgG and IgM
IgG only

A

IgG and IgM

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42
Q

What is MOST SERIOUS complement deficiency?

C1
C2
C3
C4

A

C3

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43
Q

What is the MOST COMMON complement component deficiency?

C1
C2
C3
C4

A

C2

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44
Q

Type IV hypersensitivity reactions are responsible for all the following EXCEPT:

Contact sensitivity
Elimination of tumor cells
Rejection of foreign tissue grafts
Serum sickness

A

Serum sickness

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45
Q

Anti-CCP (cyclic citrullinated proteins) is specifically associated with which autoimmune disease?

Rheumatoid arthritis
Myasthenia gravis
Autoimmune hepatitis
Goodpasture’s syndrome

A

Rheumatoid arthritis

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46
Q

Anti-mitochondrial antibodies are strongly associated with which disease?

Autoimmune hepatitis
Celiac disease
Primary biliary cirrhosis
Goodpasture’s syndrome

A

Primary biliary cirrhosis

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47
Q

Which disease might be indicated by antibodies to smooth muscle?

Atrophic gastritis
Chronic active hepatitis
Myasthenia gravis
Sjögren’s syndrome

A

Chronic active hepatitis

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48
Q

A lack of C1 INHIBITOR might result in which of the following conditions?

Paroxysmal nocturnal hemoglobinuria
Hemolytic uremic syndrome
Hereditary angioedema
Increased bacterial infections

A

Hereditary angioedema

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49
Q

Increased up to 1000x in inflammation:

Alpha1-antitrypsin and CRP
Ceruloplasmin and C3
CRP and serum amyloid A
Fibrinogen and haptoglobin

A

CRP and serum amyloid A

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50
Q

Anti-dsDNA antibodies are associated with which of the following?

Syphilis
CMV infection
Systemic lupus erythematosus
Hemolytic anemia

A

Systemic lupus erythematosus

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51
Q

The flexible portion of the heavy chain of an immunoglobulin molecule that is located between the first and second constant regions.

Heavy chain
Hinge region
Light chain
Disulfide bonds

A

Hinge region

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52
Q

Father of Immunology:

Edward Jenner
Louis Pasteur
Gerald Edelman
Paul Ehrlich

A

Louis Pasteur

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53
Q

Most potent phagocytic cell:

Dendritic cell
Eosinophil
Macrophage
Neutrophil

A

Dendritic cell

Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

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54
Q

Most efficient antigen-presenting cell (APC):

B cell
T cell
Dendritic cell
Macrophage

A

Dendritic cell

Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

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55
Q

Which of the following is characteristic of B cells?

Phagocytic
Participate in antibody-dependent cellular cytotoxicity (ADCC) reactions
Contain surface immunoglobulins
Secrete the C5 component of complement

A

Contain surface immunoglobulins

B cells carry surface immunoglobulins that react to a specific antigen. The antigen can then be internalized processed and presented to an appropriate T helper cell. B cells are not phagocytic, nor do they participate in antibody-dependent cellular cytotoxicity (ADCC) reactions. Complement proteins are secreted by hepatocytes.

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56
Q

What is the predominant type of antibody found in the serum of neonates born after full-term gestation?

Infant IgA
Infant IgG
Infant IgM
Maternal IgG

A

Maternal IgG

Antibody production is immunogen induced. Because the fetus develops in a sequestered site, it makes very little immunoglobulin. Maternal IgG crosses the placenta and is the primary antibody found in infant’s circulation.

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57
Q

The major class of immunoglobulin found in adult human serum is:

IgA
IgE
IgG
IgM

A

IgG

Immunoglobulin G is Ihe predominant class of immunoglobulin found in serum. It accounts for approximately 80% of the total serum immunoglobulin. The normal range is 800-1600 mg/dL.

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58
Q

Which class of immunoglobulin possesses 10 antigenic binding sites?

IgA
IgD
IgG
IgM

A

IgM

The IgM molecule is a pentamer that contains 10 binding sites. However, the actual valence falls to 5 with larger antigen molecules, probably because of steric restrictions. IgA, IgG, IgD, and IgE monomers each have two antigenic binding sites.

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59
Q

Type I hypersensitivity is:

Associated with complement-mediated cell lysis
Due to immune complex deposition
Mediated by activated macrophages
An immediate allergic reaction

A

An immediate allergic reaction

Type I hypersensitivity reactions occur immediately after second exposure to an allergen. On the first, or primary, exposure, IgE specific to the allergen is produced. The IgE binds to Fc receptors on the surface of basophils and mast cells. Immune complexes and complement are not involved in the response.

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60
Q

Severe combined immunodeficiency(SCID) is an:

Immunodeficiency with decreased B cells and neutrophils
Immunodeficiency with lymphocytopenia and eosinophilia
Immunodeficiency with decreased or dysfunctional T and B cells
Immunodeficiency with decreased lymphocytes and decreased complement concentration

A

Immunodeficiency with decreased or dysfunctional T and B cells

SCID is defined as a condition in which adaptive immune responses (i.e., cell-mediated and humoral-mediated immune responses) do not occur because of a lack of T and B cell activity. A number of genetic defects can lead to this condition. Children born with SCID need to live in a sterile environment, and they have a short life expectancy.

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61
Q

After exposure to antigen, the first antibodies that can be detected belong to the class:

IgA
IgE
IgG
IgM

A

IgM

The first B cells to respond to antigen differentiate into plasma cells that produce IgM antibody. Later in the immune response, stimulated B cells undergo a phenomenon called “class switching” and begin to produce antibodies of the IgG, IgA, and IgE classes. High concentration of IgM in patient serum is indicative of a recent infection.

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62
Q

A kidney transplant from one identical twin to another is an example of a(n):

Allograft
Autograft
Isograft
Xenograft

A

Isograft

Identical twins have the same genetic makeup. Grafts between them would be isografts or syngeneic grafts.

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63
Q

In Bruton disease, measurement of serum immunoglobulins would show:

Elevated levels of IgE
Elevated levels of IgG
Normal levels of IgG and IgM but reduced levels of IgA
The absence of all immunoglobulins

A

The absence of all immunoglobulins

Bruton disease is a congenital form of agammaglobulinemia. It is a sex-linked phenomenon that affects males. Because B cells are not produced, affected males have levels of IgA, IgD, IgE, and IgM undetectable by routine assays. IgG may be absent or present at very low levels.

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64
Q

The type of immunity that follows the injection of an immunogen is termed:

Artificial active
Natural active
Artificial passive
Innate

A

Artificial active

Active immunity follows exposure to an antigen that stimulates the recipient to develop his or her own immune response. Vaccines are an example of artificial immunity in that the animal was exposed to the immunogen by the actions of a healthcare provider (unnatural).

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65
Q

The type of immunity that follows the injection of antibodies synthesized by another individual or animal is termed:

Artificial active
Natural adaptive
Artificial passive
Natural passive

A

Artificial passive

Artificial passive immunity results following the injection of antibody synthesized by another individual or animal. This type of immunity is only temporary but may be very important in providing “instant” protection from an infectious agent before the recipient would have time to actively synthesize antibody.

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66
Q

Innate immunity includes:

Anamnestic response
Antibody production
Cytotoxic T cell activity
Phagocytosis by polymorphonuclear cells

A

Phagocytosis by polymorphonuclear cells

Innate, or nonspecific, immunity refers to host defenses that are in general present at birth and do not require immunogen stimulation. Phagocytosis of bacteria by polymorphonuclear cells is an example.

Cytotoxic T cell activity is part of the adaptive cell-mediated immune response, and antibody production is the mechanism of protection in the adaptive humoral-mediated immune response.

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67
Q

The antibody most frequently present in systemic lupus erythematosus is directed against:

Surface antigens of bone marrow stem cells
Surface antigens of renal cells
Nuclear antigen
Myelin

A

Nuclear antigen

Antinuclear antibody (ANA) is the most consistent feature of systemic lupus erythematosus (SLE).

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68
Q

Elevated IgE levels are typically found in:

Type I hypersensitivity reactions
Type II hypersensitivity reactions
Type III hypersensitivity reactions
Type IV hypersensitivity reactions

A

Type I hypersensitivity reactions

Elevated IgE levels are found in type I hypersensitivity reactions. The antibody binds via the Fc portion of the molecule to Fc receptors on mast cells and basophils. When the attached antibody binds its specific allergen, the cell degranulates.

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69
Q

Loss of self-tolerance results in:

Autoimmune disease
Graft-versus-host disease
Immunodeficiency
Tumors

A

Autoimmune disease

The immune system recognizes host cells as self and is tolerant to antigens on those cells. The loss of tolerance will result in an autoimmune disease in which the immune system mounts an immune response against self cells.

Graft-versus-host disease occurs when a bone marrow graft is incompatible with the host tissue and attacks the host.

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70
Q

The activity of natural killer (NK) cells:

Does not require previous exposure to an antigen
Involves phagocytosis and killing of bacteria
Requires interaction with cytotoxic T cells
Requires interaction with B cells

A

Does not require previous exposure to an antigen

The natural killer (NK) cells destroy target cells through an extracellular nonphagocytic mechanism. NK cells are part of the host’s innate resistance and, therefore, do not need previous exposure to an antigen to be active.

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71
Q

An autoimmune disease causing destruction of pancreatic cells can result in:

Hashimoto disease
Multiple sclerosis
Myasthenia gravis
Type 1 diabetes

A

Type 1 diabetes

Destruction of the beta cells in the pancreas results in type 1 diabetes. An autoimmune response destroys the insulin-producing cells.

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72
Q

Which of the following complement proteins is part of the membrane attack complex (MAC)?

Cl
C3
C4
C5

A

C5

The membrane attack complex forms following the binding of C5 to a biologic membrane. The complex is formed by the sequential addition of C6, C7, C8, and C9. When C5-C8 complex with C9, a tubule is formed that bridges the cell membrane.

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73
Q

A cut on a person’s finger becomes contaminated with the bacterium Staphylococcus aureus. The first response by the immune system consists of activity of:

B cells
Monocytes
Neutrophils
T cells

A

Neutrophils

The first response by the innate immune system consists of an influx of neutrophils into the tissue invaded by bacteria. Monocytes and macrophages, although they are phagocytic cells and part of the innate immune system, play only a minor role in the initial response to bacterial invasion.

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74
Q

Incompatible blood transfusions are examples of:

Type I hypersensitivity reactions
Type II hypersensitivity reactions
Type III hypersensitivity reactions
Type IV hypersensitivity reactions

A

Type II hypersensitivity reactions

Incompatible blood transfusions are examples of a type II hypersensitivity reaction. These reactions are characterized as the antigen being a part of a cell. Antibody binds to the antigen, complement is activated, and the red blood cells are lysed.

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75
Q

Hashimoto disease is an autoimmune disease primarily involving the:

Kidneys
Liver
Lungs
Thyroid gland

A

Thyroid gland

Hashimoto disease is a type of thyroiditis due to an autoimmune disease. Patients produce autoantibodies and T cells that respond to thyroid antigens. This results in inflammation and swelling of the thyroid gland (goiter). The autoantibody blocks the uptake of iodine, which results in a decrease in the production of thyroid hormones (hypothyroidism).

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76
Q

Contact dermatitis is mediated by:

B lymphocytes
T lymphocytes
Macrophages
Polymorphonuclear cells

A

T lymphocytes

Contact dermatitis is a delayed-type hypersensitivity reaction mediated by T cells.

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77
Q

Which of the following is characteristic of DiGeorge syndrome?

Defective T lymphocyte production
Depressed B cell development
Suppressed intracellular killing by polymorphonuclear cells
Suppressed complement levels

A

Defective T lymphocyte production

Congenital thymic hypoplasia (DiGeorge syndrome)

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78
Q

Which of the following frequently functions as an antigen-presenting cell?

Dendritic cell
Cytotoxic T lymphocyte
Natural killer cell
T helper cell

A

Dendritic cell

Dendritic cells are considered the most effective APC in the body, as well as the most potent phagocytic cell.

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79
Q

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?

Anti-CCP
ANA testing
Flow cytometry
Complement levels

A

Anti-CCP

Antibodies to cyclic citrullinated peptide are often found in RF-negative patients with rheumatoid arthritis.

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80
Q

Which of the following is the best analyte to monitor for recurrence of ovarian cancer?

CA 15-3
CA 19-9
CA 125
CEA

A

CA 125

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81
Q

Which tumor marker is associated with cancer of the urinary bladder?

CA 19-9
CA 72-4
Nuclear matrix protein
Cathepsin-D

A

Nuclear matrix protein

Nuclear matrix proteins (NMPs) are RNA-protein complexes. NMP-22 is shed into the urine in persons with bladder carcinoma and is about 25-fold higher than normal in this condition.

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82
Q

Which of the following tumor markers is used to monitor persons with breast cancer for RECURRENCE of disease?

Cathepsin-D
CA 15-3
Retinoblastoma gene
Estrogen receptor (ER)

A

CA 15-3

CA 15-3 shares the same antigenic determinant as CA 27.29. The markers are used to monitor treatment and recurrence of breast cancer.

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83
Q

Which tumor marker is used to determine the usefulness of trastuzumab (Herceptin) therapy for breast cancer?

PR
CEA
HER-2/neu
Myc

A

HER-2/neu

Trastuzumab is an antibody to the HER-2/neu gene product, a tyrosine kinase receptor protein. HER- 2/neu is an oncogene that is overexpressed in some breast cancers. Overexpression is associated with a more aggressive clinical course but responds to treatment with trastuzumab, which blocks the attachment of growth factor to the receptor.

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84
Q

Which type of cancer is associated with the highest level of AFP?

Hepatoma
Ovarian cancer
Testicular cancer
Breast cancer

A

Hepatoma

AFP is increased in all persons with yolk sac tumors and over 80% of those with hepatoma. Levels above 1000 ng/mL are diagnostic of hepatoma.

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85
Q

Immunoglobulin IDIOTYPES are antibodies with variations in the domains of which of the following?

CH1 and CH2
VH and VL
VH and CL
CH1, CH2 and CH3

A

VH and VL

Variations in the variable regions of the heavy and light chains of an immunoglobulin molecule define the idiotype.

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86
Q

Mannose-binding lectin is similar to which component of the classical pathway?

C3
C2
C1q
C5a

A

C1q

Mannose-binding lectin (MBL) of the lectin pathway of complement activation is found in circulation complexed with proteinases. It is considered to be similar in structure to C1q of the classical pathway. The MBL-proteinase complex does not require antibody for complement activation.

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87
Q

In Grave’s disease, one of the main autoantibodies is:

Anti-CCP
Antibody to islet cells of pancreas
Antibody to thyroid-stimulating hormone receptor
Anti-dsDNA

A

Antibody to thyroid-stimulating hormone receptor

Autoantibody to the thyroid-stimulating hormone receptor ultimately causes release of thyroid hormones and a hyperthyroid condition.

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88
Q

Skin testing for exposure to tuberculosis is an example of which type of hypersensitivity?

Type I
Type II
Type III
Type IV

A

Type IV

Type IV hypersensitivity is the delayed-type hypersensitivity. Skin testing for tuberculosis causes a delayed-type hypersensitivity to intradermally injected antigens in individuals previously exposed to the organism.

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89
Q

A 1-year-old boy is seen for having many recurrent infections with Streptococcus pneumoniae. Laboratory tests revealed a normal quantity of T cells, but no B cells and no immunoglobulins were seen on electrophoresis. Which of the following would most likely be the cause?

Chronic granulotomatous disease
Bruton’s agammaglobulinemia
DiGeorge’s syndrome
Wiskott-Aldrich syndrome

A

Bruton’s agammaglobulinemia

Bruton’s agammaglobulinemia is typically seen in infancy. These patients present with frequent recurring infections, especially after protective maternal antibody is gone and normal levels of circulating T cells. The syndrome is a genetic B cell enzyme deficiency in which the B cells fail to differentiate and mature to antibody-producing plasma cells.

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90
Q

A patient with hereditary angiodema has which of the following deficiencies?

C5-9
Phagocytic cell function
Mature B cells
C1 Inhibitor

A

C1 Inhibitor

Hereditary angioedema is characterized by recurrent swelling. The condition is genetic or can be acquired and is the result of a deficiency of the complement protein C1 Inhibitor.

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91
Q

A radiograph of a 1-year-old boy indicates the lack of a thymus. Complete blood count and flow cytometry confirm a below-normal lymphocyte count and a lack of T cells. Which of the following would most likely be the cause?

DiGeorge’s syndrome
Wiskott-Aldrich syndrome
Bare lymphocyte syndrome
Bruton’s agammaglobulinemia

A

DiGeorge’s syndrome

DiGeorge syndrome is the most likely cause. In this syndrome the thymus fails to develop before birth. These patients also show a marked decrease in T cells.

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92
Q

A 3-year-old boy is seen by his physician because of many recent bacterial infections. Flow cytometery indicates normal levels of T and B cells. The nitroblue tetrazolium test for oxidative reduction is negative. The most likely cause is:

Wegener’s syndrome
Chronic granulomatous disease
Bruton’s agammaglobulinemia
Diabetes mellitus

A

Chronic granulomatous disease

Chronic granulomatous disease is an inherited disease that impairs the neutrophil’s ability to kill certain bacteria. The neutrophils lack the enzyme nicotinamide adenine dinucleotide phosphate oxidase, easily demonstrated by the failure to reduce nitroblue tetrazolium or produce a blue end result. These patients have normal levels of lymphocytes.

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93
Q

The type of graft rejection that occurs within minutes of a tissue transplant is ____________.

Acute
Chronic
Hyperacute
Accelerated

A

Hyperacute

The hyperacute tissue graft reject occurs within minutes to hours of a transplant and is typically associated with transplantation across ABO blood groups and anti-ABO antibodies.

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94
Q

A biomarker that exhibits greater specificity than other proinflammatory markers in identifying patients with sepsis and can be used in the DIAGNOSIS OF BACTERIAL INFECTIONS:

Ceruloplasmin
Cytokines
CEA
Procalcitonin

A

Procalcitonin

Procalcitonin (PCT) is a biomarker that exhibits greater specificity than other proinflammatory markers (e.g., cytokines) in identifying patients with sepsis and can be used in the diagnosis of bacterial infections.

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95
Q

Macrophages have specific names according to their tissue location. Macrophages in the liver are:

Alveolar macrophages
Microglial cells
Kupffer cells
Histiocytes

A

Kupffer cells

MACROPHAGES NOMENCLATURE IN DIFFERENTTISSUES
CNS - Microglial cells
Kidney - Mesangial cells
Liver - Kupffer cells
Lung - Alveolar macrophage
Lymph node - Lymph node macrophage
Spleen - Splenic macrophage

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96
Q

Skin pH keeps most microorganisms from growing:

pH 5.6
pH 6.5
pH 7.2
pH 8.0

A

pH 5.6

Lactic acid in sweat, for instance, and fatty acids from sebaceous glands maintain the skin at a pH of approximately 5.6. This acidic pH keeps most microorganisms from growing.

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97
Q

C1 consists of three subunits: C1q, C1r and C1s, which are bound together by:

Magnesium
Calcium
Iron
Chloride

A

Calcium

C1 forms the recognition unit of the complement pathway. It consists of three subunits stabilized by calcium.

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98
Q

High titers of antimicrosomal antibodies are most often found in:

RA
SLE
Chronic active hepatitis
Hashimoto’s thyroiditis

A

Hashimoto’s thyroiditis

Hashimoto’s thyroiditis is an autoimmune disorder that results in hypothyroidism. More than 80% of the patients with the disease have serum anti-thyroglobulin and anti-microsomal antibodies.

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99
Q

Which autoantibodies are strongly associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)?

ANA
ANCA
AMA
ASMA

A

ANCA

ANCA: ANTINEUTROPHILIC CYTOPLASMIC ANTIBODY

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100
Q

The immunoglobulin classes most commonly found on the surface of circulating B lymphocytes in the peripheral blood of normal persons are:

IgM, IgA
IgM, IgG
IgM, IgD
IgM, IgE

A

IgM, IgD

IgM and IgD are the classes of immunoglobulin that are found on most circulating B cells. They are in effect the B cell receptor.

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101
Q

Immunodeficiency with thrombocytopenia and eczema is often referred to as:

DiGeorge syndrome
Bruton agammaglobulinemia
Ataxia telangiectasia
Wiskott-Aldrich syndrome

A

Wiskott-Aldrich syndrome

Wiskott Aldrich syndrome is an X-linked recessive defect that exhibits immunodeficiency, eczema and thrombocytopenia.

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102
Q

The prozone phenomenon can result in a (an):

False-positive reaction
False-negative reaction
Enhanced agglutination
Diminished antigen response

A

False-negative reaction

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103
Q

Which of the following is the most common application of IMMUNOELECTROPHORESIS (IEP)?

Identification of the absence of a normal serum protein
Structural abnormalities of proteins
Screening for circulating immune complexes
Diagnosis of monoclonal gammopathies

A

Diagnosis of monoclonal gammopathies

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104
Q

In a ____ immunofluorescent assay, ANTIBODY THAT IS CONJUGATED WITH A FLUORESCENT TAG is added directly to unknown antigen that is fixed to a microscope slide:

Direct immunofluorescent assay
Indirect immunofluorescent assay
Inhibition immunofluorescent assay

A

Direct immunofluorescent assay

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105
Q

A substrate is first exposed to a patient’s serum, then after washing, ANTI-HUMAN IMMUNOGLOBULIN LABELED WITH A FLUOROCHROME is added. The procedure described is:

Fluorescent quenching
Indirect fluorescence
Direct fluorescence
Fluorescence inhibition

A

Indirect fluorescence

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106
Q

BLOCKING TEST in which an antigen is first exposed to unlabeled antibody and then to labeled antibody, and is finally washed and examined:

Direct immunofluorescent assay
Indirect immunofluorescent assay
Inhibition immunofluorescent assay

A

Inhibition immunofluorescent assay

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107
Q

In FLUORESCENCE POLARIZATION IMMUNOASSAY (FPIA), the degree of fluorescence polarization is ____ proportional to concentration of the analyte.

Direct
Inverse
Variable
No effect

A

Inverse

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108
Q

In FLUORESCENCE POLARIZATION IMMUNOASSAY (FPIA), labeled antigens compete with unlabeled antigen in the patient sample for a limited number of antibody binding sites. The MORE antigen that is present in the patient sample:

Less fluorescence
Greater fluorescence
Less fluorescence polarization
Greater fluorescence polarization

A

Less fluorescence polarization

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109
Q

The polymerase chain reaction (PCR) involves three processes. Select the order in which these occur.

Extension→Annealing→Denaturation
Annealing→Denaturation→Extension
Denaturation→Annealing→Extension
Denaturation→Extension→Annealing

A

Denaturation→Annealing→Extension

The PCR process results in identical copies of a piece of double-stranded DNA. The process involves three steps that are repeated to double the number of copies produced with each cycle.

The first step is denaturation to separate the complementary strands.

Annealing occurs when a primer binds upstream to the segment of interest on each strand, called the template.

Extension involves the enzymatic addition of nucleotides to the primer to complete the new strand.

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110
Q

In the PCR cycle, how is denaturation accomplished?

Heat
Alkali treatment
Addition of sulfonylurea
Formamide

A

Heat

In PCR, the separation of dsDNA occurs by heating the sample. This breaks the double bonds between the base pairs and is reversible by lowering the temperature.

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111
Q

What temperature is used to achieve DNA denaturation to a single strand?

74 °C
92 °C
94 °C
102 °C

A

94 °C

DENATURATION: 94C
ANNEALING: 50 to 58C or higher
EXTENSION: 72C

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112
Q

The Australia antigen is now called:

Dane particle
Long-incubation hepatitis
Hepatitis B surface antigen (HBsAg)
Hepatitis B core antigen (HBcAg)

A

Hepatitis B surface antigen (HBsAg)

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113
Q

The FIRST SEROLOGIC MARKER to appear in patients with acute hepatitis B virus infection is:

Anti-HBs
Anti-HBc
Anti-HBe
HBsAg

A

HBsAg

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114
Q

Which surface marker is a reliable marker for the presence of high levels of hepatitis B virus (HBV) and a high degree of infectivity?

HBeAg
HBsAg
HBcAg
Anti-HBsAg

A

HBeAg

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115
Q

Which of the following tests is positive during the WINDOW PERIOD of infection with hepatitis B?

Hepatitis B surface antigen
Hepatitis B surface antibody
Hepatitis B core antibody
Hepatitis C antibody

A

Hepatitis B core antibody

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116
Q

Which hepatitis antibody confers immunity against reinfection with hepatitis B virus?

Anti-HBc IgM
Anti-HBc IgG
Anti-HBe
Anti-HBs

A

Anti-HBs

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117
Q

If only anti-HBs is positive, which of the following can be ruled out?

Hepatitis B virus vaccination
Distant past infection with hepatitis B virus
Hepatitis B immune globulin (HBIG) injection
Chronic hepatitis B virus infection

A

Chronic hepatitis B virus infection

Persons with chronic HBV infection show a positive test result for anti-HBc (IgG or total) and HBsAg but not anti-HBs. Patients with active chronic hepatitis have not become immune to the virus.

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118
Q

Risk factors for hepatitis C virus (HCV) include:

Illegal IV drug use
Occupational exposure
Multiple sexual partners
All of the above

A

All of the above

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119
Q

The specific diagnostic test for hepatitis C is:

Absence of anti-HAV and anti-HBsAg
Increase in liver serum enzyme levels
Detection of non-A, non-B antibodies
Anti-HCV

A

Anti-HCV

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120
Q

As AIDS progresses, the quantity of _______ diminishes and the risk of opportunistic infection increases.

HIV antigen
HIV antibody
CD4+ T lymphocytes
CD8+ T lymphocytes

A

CD4+ T lymphocytes

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121
Q

The most frequent malignancy observed in AIDS patients is:

Pneumocystis jiroveci (P. carinii)
Kaposi’s sarcoma
Toxoplasmosis
Non-Hodgkin’s lymphoma

A

Kaposi’s sarcoma

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122
Q

Antibodies to which of the following viral antigens are usually the first to be detected in HIV infection?

gp120
gp160
gp41
p24

A

p24

In HIV-1 infection, antibodies to the gag proteins p24 and p55 appear relatively early after exposure to the virus, but tend to decrease or become undetectable as clinical symptoms of AIDS appear.

Antibodies to the envelope proteins gp41, gp120, and gp160 appear slightly later but remain throughout all disease stages in an HIV-infected individual, making them a more reliable indicator of the presence of HIV.

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123
Q

The fourth-generation ELISA tests for HIV detect:

HIV-1 and HIV-2 antigens
HIV-1 and HIV-2 antibodies
p24 antigen
HIV-1 and HIV-2 antibodies and p24 antigen

A

HIV-1 and HIV-2 antibodies and p24 antigen

FIRST GENERATION
Solid-phase, indirect
Anti-HIV1

SECOND GENERATION
Indirect binding
Anti-HIV1, anti-HIV2

THIRD GENERATION
Sandwich technique
Anti-HIV1, anti-HIV2
Simultaneously detecting HIV antibodies of different immunoglobulin classes, including IgM

FOURTH GENERATION
Detects anti-HIV1, anti-HIV2 and p24

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124
Q

Which is most likely a positive Western blot result for infection with HIV?

Band at p24
Band at gp60
Bands at p24 and p31
Bands at p24 and gp120

A

Bands at p24 and gp120

Criteria for determining a positive test result have been published by the Association of State and Territorial Public Health Laboratory Directors and CDC, the Consortium for Retrovirus Serology Standardization, the American Red Cross, and the FDA.

According to these criteria, a result should be reported as positive if at least two of the following three bands are present: p24, gp41, and gp120/gp160.

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125
Q

Which part of the radial immunodiffusion (RID) test system contains the antisera?

Center well
Outer wells
Gel
Antisera may be added to any well

A

Gel

In an RID test system, for example, one measuring hemopexin concentration, the gel would contain the antihemopexin. A standardized volume of serum containing the antigen is added to each well. Antigen diffuses from the well into the gel and forms a precipitin ring by reaction with antibody. At equivalence, the area of the ring is proportional to antigen concentration.

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126
Q

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)?

No reaction between wells 1 and 2
Partial identity between wells 1 and 2
Nonidentity between wells 1 and 2
Identity between wells 1 and 2

A

Nonidentity between wells 1 and 2

Crossed lines indicate nonidentity between wells 1 and 2. The antibody from well 1 recognizes a different antigenic determinant than the antibody from well 2.

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127
Q

What outcome results from improper washing of a tube or well after adding the enzyme–antibody conjugate in an ELISA system?

Result will be falsely decreased
Result will be falsely increased
Result will be unaffected
Result is impossible to determine

A

Result will be falsely increased

If unbound enzyme-conjugated anti-immunoglobulin is not washed away, it will catalyze conversion of substrate to colored product, yielding a falsely elevated result.

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128
Q

What would happen if the color reaction phase is prolonged in one tube or well of an ELISA test?

Result will be falsely decreased
Result will be falsely increased
Result will be unaffected
Impossible to determine

A

Result will be falsely increased

If the color reaction is not stopped within the time limits specified by the procedure, the enzyme will continue to act on the substrate, producing a falsely elevated test result.

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129
Q

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?

Possible false-positive result
Possible false-negative result
No effect
Depends on the amount of antibody present in the sample

A

Possible false-positive result

Failure to follow directions, as in this case where the reaction was allowed to proceed beyond the recommended time, may result in a false-positive reading. Drying on the slide may lead to a possible erroneous positive reading.

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130
Q

The characteristic laboratory finding in HIV infection is:

Decreased numbers of CD4 T cells.
Decreased numbers of CD8 T cells.
Decreased numbers of CD20 B cells.
Decreased immunoglobulins.

A

Decreased numbers of CD4 T cells.

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131
Q

Which CD4:CD8 ratio is most likely in a patient with acquired immunodeficiency syndrome (AIDS)?

2:1
3:1
2:3
1:2

A

1:2

An inverted CD4:CD8 ratio (less than 1.0) is a common finding in an AIDS patient. The Centers for Disease Control and Prevention requires a CD4-positive (helper T) cell count of less than 200/μL or 14% in the absence of an AIDS-defining illness (e.g., Pneumocystis carinii pneumonia) in the case surveillance definition of AIDS.

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132
Q

All of the following hepatitis viruses are spread through blood or blood products except:

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D

A

Hepatitis A

Hepatitis A is spread through the fecal–oral route and is the cause of infectious hepatitis. Hepatitis A virus has a shorter incubation period (2–7 weeks) than hepatitis B virus (1–6 months). Epidemics of hepatitis A virus can occur, especially when food and water become contaminated with raw sewage.

Hepatitis E virus is also spread via the oral–fecal route and, like hepatitis A virus, has a short incubation period.

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133
Q

Which hepatitis B marker is the best indicator of early acute infection?

HBsAg
HBeAg
Anti-HBc
Anti-HBs

A

HBsAg

Hepatitis B surface antigen (HBsAg) is the first marker to appear in hepatitis B virus infection. It is usually detected within 4 weeks of exposure (prior to the rise in transaminases) and persists for about 3 months after serum enzyme levels return to normal.

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134
Q

Which is the first antibody detected in serum after infection with hepatitis B virus (HBV)?

Anti-HBs
Anti-HBc IgM
Anti-HBe
All are detectable at the same time

A

Anti-HBc IgM

Antibody to the hepatitis B core antigen (anti-HBc) is the first detectable hepatitis B antibody. It persists in the serum for 1–2 years post-infection and is found in the serum of asymptomatic carriers of HBV.

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135
Q

Which test, other than serological markers, is most consistently elevated in viral hepatitis?

Antinuclear antibodies
Alanine aminotransferase (ALT)
Absolute lymphocyte count
Lactate dehydrogenase

A

Alanine aminotransferase (ALT)

ALT is a liver enzyme and may be increased in hepatic disease. Highest levels occur in acute viral hepatitis, reaching 20–50 times the upper limit of normal.

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136
Q

In monitoring an HIV-infected patient, which parameter may be expected to be the most sensitive indicator of the effectiveness of antiretroviral treatment?

HIV antibody titer
CD4:CD8 ratio
HIV viral load
Absolute total T-cell count

A

HIV viral load

The HIV viral load will rise or fall in response to treatment more quickly than any of the other listed parameters. The absolute CD4 count is also an indicator of treatment effectiveness and is used in resource-poor areas that might not have facilities for molecular testing available. Note that the absolute CD4 count is not one of the choices, however.

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137
Q

When soluble antigens diffuse in a gel that contains antibody, in which zone does OPTIMUM precipitation occur?

Prozone
Zone of equivalence
Postzone
Prezone

A

Zone of equivalence

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138
Q

Which technique represents a SINGLE-diffusion reaction?

Radial immunodiffusion
Ouchterlony diffusion
Immunoelectrophoresis
Immunofixation electrophoresis

A

Radial immunodiffusion

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139
Q

Reactions involving IgG may need to be enhanced for which reason?

It is only active at 25°C.
It may be too small to produce lattice formation.
It has only one antigen-binding site.
It is only able to produce visible precipitation reactions.

A

It may be too small to produce lattice formation.

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140
Q

For which of the following tests is a lack of agglutination a positive reaction?

Hemagglutination
Passive agglutination
Reverse passive agglutination
Agglutination inhibition

A

Agglutination inhibition

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141
Q

Typing of RBCs with reagent antiserum represents which type of reaction?

Direct hemagglutination
Passive hemagglutination
Hemagglutination inhibition
Reverse passive hemagglutination

A

Direct hemagglutination

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142
Q

The serum of an individual who received all doses of the hepatitis B vaccine should contain:

Anti-HBs
Anti-HBe
Anti-HBc
All of the above

A

Anti-HBs

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143
Q

The most common means of HIV transmission worldwide is through:

Blood transfusions
Intimate sexual contact.
Sharing of needles in intravenous drug use.
Transplacental passage of the virus.

A

Intimate sexual contact.

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144
Q

False-negative test results in a laboratory test for HIV antibody may occur because of:

Heat inactivation of the serum before testing.
Collection of the test sample before seroconversion.
Interference by autoantibodies.
Recent exposure to certain vaccines

A

Collection of the test sample before seroconversion.

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145
Q

What is the main difference between agglutination and precipitation reactions?

Agglutination occurs between a soluble antigen and antibody
Agglutination occurs when the antigen is particulate
Precipitation occurs when the antigen is particulate
Precipitation occurs when both antigen and antibody are particulate

A

Agglutination occurs when the antigen is particulate

Precipitation reactions occur between soluble antigen and soluble antibody that produce a visible end result typically in the form of a visible line of precipitate.

Agglutination reactions occur when the antigen is particulate or coated on a particulate such as latex beads.

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146
Q

Postzone causes false-negative reactions in antibody titers as a result of which of the following?

Too much diluent added to test
Excess antibody in test
Excess antigen in test
Incorrect diluent added to test

A

Excess antigen in test

PROZONE
Antibody excess, false negative
Remedy: serum dilution

POSTZONE
Antigen excess, false negative
Remedy: repeat test after a week to give time for antibody production

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147
Q

Serum tested positive for HBsAg and anti-HBc IgM. The patient most likely has which of the following?

Acute hepatitis C
Chronic hepatitis B
Acute hepatitis B
Acute hepatitis A

A

Acute hepatitis B

The most likely answer is acute hepatitis B because of the presence of IgM anti-HBc in combination with the hepatitis surface antigen. Typically the presence of IgM indicates the presence of an acute phase of a disease.

148
Q

What is the difference between nephelometry and turbidimetry?

There is no difference between the two assays, only in name
Nephlometry is a newer example of turbidimetry
Nephlometry measures light transmitted through a solution, and turbidimetry measures light scattered in a solution
Nephlometry measures light scattered in a solution, and turbidimetry measures light transmitted through a solution

A

Nephlometry measures light scattered in a solution, and turbidimetry measures light transmitted through a solution

Nepholometry measures light at angles. The light source used for detection is placed at an angle from the detection device.

Turbidometry detection devices are placed directly across from the light source and measures the intensity of the light as it passes through solution.

149
Q

HIV can infect all of the following cells except:

CD4+ subset of lymphocytes
Macrophages
Monocytes
Polymorphonuclear leukocytes

A

Polymorphonuclear leukocytes

In addition to T lymphocytes, macrophages, peripheral blood monocytes, and cells in the lymph nodes, skin, and other organs also express measurable amounts of CD4 and can be infected by HIV-1.

150
Q

A bacterial protein used to bind human immunoglobulins is:

HAV antibody, IgA type
Escherichia coli protein C
Staphylococcal protein A
HAV antibody, IgG type

A

Staphylococcal protein A

Protein A, found in the cell walls of Staphylococcus aureus bacteria, has high affinity for the Fc region of IgG and can be used to bind IgG in some laboratory assays.

151
Q

Which of the following is used to detect allergen specific IgE?

RIST
RAST
IEP
CRP

A

RAST

RIST - measures TOTAL IgE
RAST - measures SPECIFIC IgE

152
Q

Initial force of attraction that exists between A SINGLE FAB SITE ON AN ANTIBODY MOLECULE AND A SINGLE EPITOPE OR DETERMINANT SITE on the corresponding antigen:

Affinity
Avidity

A

Affinity

153
Q

It represents the sum of all the attractive forces between an antigen and an antibody:

Affinity
Avidity

A

Avidity

154
Q

The antigen used in the precipitation test is:

Soluble
Insoluble
Particulate
Cellular

A

Soluble

155
Q

Inactivation of sera for serological tests is performed for what purpose?

Destruction of complement
Increasing sensitivity of test
Removal of particulate matter
Restoration of refrigerated sera to appropriate temperature for testing

A

Destruction of complement

156
Q

In ELISA, either antigen or antibody may be bound to ____ phase.

Liquid phase
Semi-solid phase
Solid phase

A

Solid phase

A variety of solid-phase supports are used, including microtiter plates, nitrocellulose membranes, and magnetic latex beads.

157
Q

In the enzyme-linked immunosorbent assay (ELISA), which of the following can be attached to a solid-phase support (e.g. polystyrene)?

Antigen anzyme
Antibody and albumin
Antigen and antibody
Antigen and albumin

A

Antigen and antibody

158
Q

In the enzyme-linked immunosorbent assay (ELISA), the antihuman globulin is:

Fluorochrome-conjugated
Auramine-conjugated
Hormone-conjugated
Enzyme-conjugated

A

Enzyme-conjugated

159
Q

Rapid plasma reagin (RPR) antigen contain cardiolipin with:

10% saline
Lipoteichoic acid
Charcoal particles
Fluorescein isothiocyanate

A

Charcoal particles

160
Q

The rapid plasma reagin (RPR) test is rotated at what speed for which length of time?

200 RPM for 10 minutes
100 RPM for 8 minutes
180 RPM for 4 minutes
125 RPM for 2 minutes

A

100 RPM for 8 minutes

161
Q

FTA-ABS is used to identify which of the following in the patient’s serum?

Treponemal antibody
Treponemes
Reagin
Cardiolipin

A

Treponemal antibody

162
Q

The serum titer in the ASO tube test is reported in:

Highest dilution that gives a positive result
Lowest dilution that gives a negative result
ASO units
Todd or International Units

A

Todd or International Units

163
Q

The Weil-Felix test is used for the detection of which type of antibodies:

Salmonella
Mycoplasma
Rickettsial
Viral

A

Rickettsial

164
Q

God standard for detecting rickettsial antibodies:

Weil-Felix test
ELISA
Immunoblot
IFA and micro-IF

A

IFA and micro-IF

IFA - indirect fluorescent assays
Micro-IF - microimmunofluorescent assay
The IFA test and the micro-IF are currently considered the gold standard for detecting rickettsial antibodies.

165
Q

OX-19 and OX-2 refer to:

Strains of Proteus vulgaris
Antigens of Rickettsia prowazeki
Serotypes of Brucella abortus
Antibodies to Salmonella typhi

A

Strains of Proteus vulgaris

166
Q

The presence of C-reactive protein in a patient’s serum indicates:

Inflammation
Pneumococcal pneumonia
Group A Strep infection
Typhoid or paratyphoid

A

Inflammation

167
Q

Cold agglutinins may develop after infection with:

Klebsiella pneumoniae
Mycoplasma pneumoniae
Streptococcus pneumoniae
Haemophilus influenzae

A

Mycoplasma pneumoniae

168
Q

A positive ANA with the pattern of ANTI-CENTROMERE ANTIBODIES is most frequently seen in patients with:

Rheumatoid arthritis
CREST syndrome
Systemic lupus erythematosus
Sjogren syndrome

A

CREST syndrome

Most patients with CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) demonstrate anti-centromere antibody.

169
Q

In the anti-dsDNA procedure, the antigen most commonly utilized is:

Rat stomach liver
Mouse kidney tissue
Crithidia luciliae
Toxoplasma gondii

A

Crithidia luciliae

One particularly sensitive assay for ds-DNA is an immunofluorescent test using Crithidia luciliae, a hemoflagellate, as the substrate. This trypanosome has circular ds-DNA in the kinetoplast. A positive test is indicated by a brightly stained KINETOPLAST with patient serum and an antibody conjugate.

170
Q

Rheumatoid factor is typically an IgM autoantibody with specificity for which of the following?

SS-B
Double-stranded DNA
Ribonucleoprotein
Fc portion of IgG

A

Fc portion of IgG

171
Q

What substance is detected by the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests for syphilis?

Cardiolipin
Anticardiolipin antibody
Anti-T. pallidum antibody
Treponema pallidum

A

Anticardiolipin antibody

Reagin is the name for a nontreponemal antibody that appears in the serum of syphilis-infected persons and is detected by the RPR and VDRL assays. Reagin reacts with cardiolipin, a lipid-rich extract of beef heart and other animal tissues.

172
Q

What type of antigen is used in the RPR card test?

Live treponemal organisms
Killed suspension of treponemal organisms
Cardiolipin
Tanned sheep cells

A

Cardiolipin

Cardiolipin is extracted from animal tissues, such as beef hearts, and attached to carbon particles. In the presence of reagin, the particles will agglutinate.

173
Q

A biological false-positive reaction is LEAST likely with which test for syphilis?

VDRL
Fluorescent T. pallidum antibody absorption test (FTA-ABS)
RPR
All are equally likely to detect a false-positive result

A

Fluorescent T. pallidum antibody absorption test (FTA-ABS)

The FTA-ABS test is more specific for T. pallidum than nontreponemal tests such as the VDRL and RPR and would be least likely to detect a biological false-positive result.

The FTA-ABS test uses heat-inactivated serum that has been absorbed with the Reiter strain of T. pallidum to remove nonspecific antibodies.

174
Q

Which specimen is the sample of choice to evaluate latent or tertiary syphilis?

Serum sample
Chancre fluid
CSF
Joint fluid

A

CSF

If neurosyphilis is present, cerebrospinal fluid serology will be positive and the CSF will display increased protein and pleocytosis characteristic of central nervous system infection.

175
Q

What criteria constitute the classification system for HIV infection?

CD4-positive T-cell count and clinical symptoms
Clinical symptoms, condition, duration, and number of positive bands on Western blot
Presence or absence of lymphadenopathy
Positive bands on Western blot and CD8-positive T-cell count

A

CD4-positive T-cell count and clinical symptoms

The classification system for HIV infection is based upon a combination of CD4-positive T-cell count (helper T cells) and various categories of clinical symptoms. Classification is important in determining treatment options and the progression of the disease.

176
Q

Which of the following statements regarding infection with hepatitis D virus is true?

Occurs in patients with HIV infection
Does not progress to chronic hepatitis
Occurs in patients with hepatitis B
Is not spread through blood or sexual contact

A

Occurs in patients with hepatitis B

Hepatitis D virus is an RNA virus that requires the surface antigen or envelope of the hepatitis B virus for entry into the hepatocyte. Consequently, hepatitis D virus can infect only patients who are coinfected with hepatitis B.

177
Q

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?

Only IgG antibodies positive
Only IgM antibodies positive
Both IgG and IgM antibodies positive
Fourfold rise in titer for IgG antibodies

A

Only IgM antibodies positive

If only IgM antibodies are positive, this result indicates a recent vaccination or an early primary infection.

178
Q

The serologically detectable antibody produced in rheumatoid arthritis (RA) is primarily of the class:

IgA
IgE
IgG
IgM

A

IgM

Rheumatoid factor (RF) is an immunoglobulin that reacts with antigenic determinants on an IgG molecule.

Although they may be of several types, the one that is easily serologically detectable is IgM. This is because of the agglutination activity of the molecule.

RF tests are commonly used in the diagnosis of rheumatoid arthritis.

179
Q

Diagnosis of group A streptococci (Streptococcus pyogenes) infection is indicated by the presence of:

Anti-protein A
Anti-DNase B
Anti-beta-toxin
C-reactive protein

A

Anti-DNase B

The serological diagnosis of group A streptococcal infection can be made by demonstrating anti-DNase B.

The antistreptolysin O (ASO) assay can also be used; however, ASO response is poor in skin infections.

180
Q

Diagnostic reagents useful for detecting antigen by the COAGGLUTINATION reaction may be prepared by binding antibody to killed staphylococcal cells via the Fc receptor of staphylococcal protein A. The class of antibody bound by this protein is:

IgA
IgD
IgG
IgM

A

IgG

Staphylococcal protein A binds only the IgG class (subclasses IgG1, IgG2, and IgG4) of immunoglobulin.

Binding occurs via the Fc portion of the antibody molecule, leaving the Fab portion available to bind antigen in an immunologic assay.

181
Q

The rapid plasma reagin assay for syphilis does not need to be read microscopically because the antigen is:

Cardiolipin
Complexed with latex
Complexed with charcoal
Inactivated bacterial cells

A

Complexed with charcoal

The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests use a cardiolipin antigen.

However, in the RPR test, charcoal particles are included with the antigen. When antibody in the patient sample combines with the antigen, the charcoal is trapped in the immune complex, allowing the reaction to be read macroscopically.

182
Q

The Venereal Disease Research Laboratory (VDRL) test for syphilis is classified as a(n):

Agglutination reaction
Flocculation reaction
Hemagglutination reaction
Precipitation reaction

A

Flocculation reaction

The cardiolipin antigen is particulate, not soluble, in the VDRL test. However, the particles are too small to make macroscopic agglutinates when combined with antibody.

This type of reaction is called a flocculation reaction and needs to be read with low-power microscopy.

183
Q

The Venereal Disease Research Laboratory (VDRL) test for syphilis is classified as a(n):

Agglutination reaction
Flocculation reaction
Hemagglutination reaction
Precipitation reaction

A

Flocculation reaction

The cardiolipin antigen is particulate, not soluble, in the VDRL test. However, the particles are too small to make macroscopic agglutinates when combined with antibody.

This type of reaction is called a flocculation reaction and needs to be read with low-power microscopy.

184
Q

One cause of a FALSE-POSITIVE VDRL test is:

Brucellosis
Treponema pallidum infection
Rocky Mountain spotted fever
Systemic lupus erythematosus

A

Systemic lupus erythematosus

Patients with connective tissue disorders such as systemic lupus erythematosus may show a false positive reaction in the VDRL test.

Other causes of false positives include rheumatic fever, infectious mononucleosis, malaria, and pregnancy.

185
Q

Which of the following serologic tests is commonly performed by an immunofluorescence method?

Anti-HBs
Antinuclear antibody (ANA)
Antistreptolysin O (ASO)
C-reactive protein (CRP)

A

Antinuclear antibody (ANA)

Testing for antinuclear antibodies (ANAs) is commonly performed by the immunofluorescence method—using fluorescein-conjugated antihuman antibody to detect patient antibody bound to nuclear components of test cells.

186
Q

Which of the following statements about the test for C-reactive protein (CRP) is true?

It correlates with neutrophil phagocytic function.
It is an indicator of ongoing inflammation.
It is diagnostic for rheumatic fever.
Levels decrease during heart disease.

A

It is an indicator of ongoing inflammation.

CRP is an acute-phase reactant. Although it is elevated in inflammation, its presence is not diagnostic for any one disease, such as rheumatic fever. It does not correlate with antibody levels or with neutrophil phagocytic function. CRP levels are sometimes elevated during heart disease.

187
Q

A SOLUBLE antigen and soluble antibody reacting to form an insoluble product describes:

Agglutination reactions
Heterophile reactions
Labeled reactions
Precipitation reactions

A

Precipitation reactions

Precipitation reactions involve both soluble antigens and antibodies.

With agglutination reactions, one of the reactants is soluble and the other is insoluble. A reactant is made insoluble by combining with a carrier particle such as latex beads.

188
Q

Which of the following is an example of a TREPONEMAL antigen test used for the diagnosis of syphilis?

CRP
RPR
VDRL
FTA-ABS

A

FTA-ABS

The fluorescent treponemal antibody absorbance (FTA-ABS) test is often used as a confirmatory test for syphilis. Treponema pallidum subsp. pallidum, the causative agent of syphilis, is the source of the antigen.

The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) are diagnostic tests for syphilis that use nontreponemal antigen.

189
Q

A patient report states the presence of serum antibodies to OspC. What disease does the patient most likely have? - IMPORTANT

Syphilis
Strep throat
Lyme disease
Rubella

A

Lyme disease

IMPORTANT!
IgM antibody to OspC is an important early marker in the diagnosis of Lyme disease.

190
Q

Patient serum is mixed with a suspension of guinea pig antigen. When the sample is then mixed with horse red blood cells, agglutination occurs. This is suggestive of an infection caused by:

Borrelia burgdorferi
Hepatitis B virus
Hepatitis C virus
Epstein-Barr virus

A

Epstein-Barr virus

INFECTIOUS MONONUCLEOSIS (EBV)
The Davidsohn differential test can be used to detect heterophile antibodies produced during infectious mononucleosis. These antibodies are not adsorbed by guinea pig antigens. Therefore, the antibodies are available to agglutinate horse red blood cells.

191
Q

A living donor is being sought for a child who requires a kidney transplant. The best odds of finding an MHC-compatible donor occur between the child and:

A sibling (brother or sister)
An unrelated individual
The child’s father
The child’s mother

A

A sibling (brother or sister)

Because the human leukocyte antigen (HLA) system is extremely polymorphic, the odds are greatly against finding an HLA-compatible donor in unrelated individuals. The genes coding for HLA antigens are inherited from one’s parents and are expressed co-dominantly. Between an offspring and either parent, there is, statistically, a 25% chance of an HLA match. Between siblings, there is a 50% chance of an HLA match.

192
Q

Which of the following serologic tests detects the polysaccharide capsule ANTIGEN in serum and CSF of patients with suspected infection with Cryptococcus neoformans?

Complement fixation
India ink test
Latex agglutination
Hemagglutination test

A

Latex agglutination

193
Q

What is the immunologic method utilized in the FLOW CYTOMETER?

Latex agglutination
Immunofluorescence
Enzyme linked immunoassay
Radioimmunoassay

A

Immunofluorescence

194
Q

This disease was endemic in Haiti and was subsequently contracted and CARRIED TO EUROPE by COLUMBUS CREW:

Gonorrhea
Syphilis
Typhoid
Hepatitis

A

Syphilis

195
Q

Which of the following is considered to be nonsuppurative complication of streptococcal infection?

Acute rheumatic fever
Scarlet fever
Impetigo
Pharyngitis

A

Acute rheumatic fever

196
Q

A widely used HEMAGGLUTINATION test for detecting antibody to Treponema pallidum is:

MHA-TP test
FTA-ABS test
VDRL test
RPR test

A

MHA-TP test

197
Q

HTLV-I and HTLV-II can be transmitted by:

Bloodborne (transfusion, IV drug abuse)
Sexual contact (commonly from men to women)
Mother-to-child (mainly through breastfeeding)
All of these

A

All of these

198
Q

Two cross-reacting antigen types of herpes simplex virus have been identified:

EBV and CMV
HHV6 and HHV7
VZV and CMV
HSV1 and HSV2

A

HSV1 and HSV2

199
Q

Which of the following stages of infectious mononucleosis infection is characterized by ANTIBODY TO EPSTEIN-BARR NUCLEAR ANTIGEN (EBNA)?

Recent (acute) infection
Past infection (convalescent) period
Reactivation of latent infection
Past infection, reactivation of latent infection

A

Past infection, reactivation of latent infection

VCA - VIRAL CAPSID ANTIGEN
EBNA - EBV NUCLEAR ANTIGEN
EA - EARLY ANTIGEN

CHARACTERISTICS DIAGNOSTIC PROFILE OF EBV

SUSCEPTIBILITY
If the patient is seronegative (lacks antibody to VCA)

PRIMARY INFECTION
Antibody (IgM) to VCA is present; EBNA is absent.

PAST INFECTION
Antibodies to VCA and EBNA are present.

REACTIVATION
If antibody to EBNA and increased antibodies to EA are present, patient may be experiencing reactivation.

200
Q

Serological testing provides the most practical and reliable means of confirming a measles diagnosis. Samples collected before ___ may yield false-negative results, and repeat testing on a later sample is recommended in that situation.

72 hours
5 days
6 days
9 days

A

72 hours

IgM antibodies become detectable 3 to 4 days after appearance of symptoms and persist for 8 to 12 weeks.

201
Q

The most commonly used method to detect VZV antibodies in the clinical laboratory is:

ELISA
PCR
FAMA
All of these

A

ELISA

Varicella-Zoster virus (VZV) Antibodies

ELISA - most common, easiest
Automated, provides objective results, and does not require viral culture

FAMA - reference method
Considered to be the reference method for VZV antibody, it requires live, virus-infected cells and is not suitable for large-scale routine testing

FAMA (fluorescent antibody to membrane antigen)

202
Q

ACUTE HEPATITIS A is routinely diagnosed in symptomatic patients by demonstrating the:

HAV antigen
IgM anti-HAV
IgG anti-HAV

A

IgM anti-HAV

203
Q

Which technique is used to detect DNA containing a specific base sequence by applying a labeled probe to DNA bands immobilized onto nitrocellulose paper following electrophoresis?

Southern blot
Northern blot
Western blot

A

Southern blot

SNOW DROP
S - Southern Blot = D - DNA
N - Northern Blot = R - RNA
W - Western Blot = P - PROTEINS

204
Q

Rapid antigen detection for HISTIDINE-RICH PROTEIN II (HRP-II) is specific for:

Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium vivax

A

Plasmodium falciparum

HRP-II: Plasmodium falciparu

pLDH AND ALDOLASE TESTS: All four Plasmodium spp.

205
Q

Karl Landsteiner’s book The Specificity of Serological Reactions, published in 1917, detailed the results of an exhaustive study of haptens that has contributed greatly to our knowledge of antigen–antibody reactions.

A

FOUR DIFFERENT FORMS OF ANTIGENS. Two of which are unbranched straight chains (H1 and H2) and two of which are complex branched chains (H3 and H4).

206
Q

What type of serological testing does the blood bank technologist perform when determining the blood group of a patient?

Genotyping
Phenotyping
Both genotyping and phenotyping
Polymerase chain reaction

A

Phenotyping

Phenotyping, or the physical expression of a genotype, is the type of testing routinely performed in the blood bank. An individual, for example, may have the AO genotype but phenotypes as group A.

207
Q

Which genotype(s) will give rise to the Bombay phenotype?

HH only
HH and Hh
Hh and hh
hh only

A

hh only

The Bombay phenotype will be expressed only when no H substance is present. The Oh type is expressed by the genotype hh. Bombays produce naturally occurring anti-H, and their serum agglutinates group O red cells in addition to red cells from groups A, B, and AB persons.

208
Q

Which of the following describes the expression of most blood group antigens?

Dominant
Recessive
Codominant
Corecessive

A

Codominant

The inheritance of most blood group genes is codominant, meaning that no gene or allele is dominant over another. For example, a person who is group AB expresses both the A and B antigen on his or her red cells.

209
Q

What blood type is not possible for an offspring of an AO and BO mating?

AB
A or B
O
All are possible

A

All are possible

A mating between AO and BO persons can result in an offspring with a blood type of A, B, AB, or O.

210
Q

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?

The patient may be a subgroup of A
The patient may have an immunodeficiency
The patient may be a Bombay
The patient may have developed alloantibodies

A

The patient may be a Bombay

211
Q

What antibodies are formed by a Bombay individual?

Anti-A and anti-B
Anti-H
Anti-AB
Anti-A, anti-B and anti-H

A

Anti-A, anti-B and anti-H

A Bombay individual does not express A, B, or H antigens; therefore anti-A, B, and H are formed. Because a Bombay individual has three antibodies, the only compatible blood must be from another Bombay donor.

212
Q

Acquired B antigens have been found in:

Bombay individuals
Group O persons
All blood groups
Group A persons

A

Group A persons

The acquired B phenomenon is only seen in group A persons.

213
Q

Which typing results are most likely to occur when a patient has an acquired B antigen?

Anti-A 4+, anti-B-3+, A1 cells neg, B cells neg
Anti-A 3+, anti-B neg, A1 cells neg, B cells neg
Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+
Anti-A 4+, anti-B 4+, A1 cells 2+, B cells neg

A

Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+

In forward typing, a 1+ reaction with anti-B is suspicious because of the weak reaction and the normal reverse grouping that appears to be group A. This may be indicative of an acquired antigen. In the case of an acquired B, the reverse grouping is the same for a group A person.

214
Q

Which blood group has the LEAST amount of H antigen?

A1B
A2
B
A1
O

A

A1B

The A1B blood group has the least amount of H antigen. This is due to both A and B epitopes present on red cells compromising the availability of H epitopes. A1B cells will yield weak reactions with anti-H lectin.

215
Q

What should be done if all forward and reverse ABO results are negative?

Perform additional testing such as typing with anti-A1 lectin and anti-A,B
Incubate at 22°C or 4°C to enhance weak expression
Repeat the test with new reagents
Run an antibody identification panel

A

Incubate at 22°C or 4°C to enhance weak expression

All negative results may be due to weakened antigens or antibodies. Room temperature or lower incubation temperature may enhance expression of weakened antigens or antibodies.

216
Q

N-acetyl-D-galactosamine is the immunodominant carbohydrate that reacts with:

Arachis hypogaea
Salvia sclarea
Dolichos biflorus
Ulex europeaus

A

Dolichos biflorus

The immunodominant sugar N-acetyl-galactosamine confers A antigen specificity when present at the terminus of the type 2 precursor chain on the RBC membrane. Therefore, its presence would cause RBCs to react with anti-A1 lectin, Dolichos biflorus.

217
Q

A stem cell transplant patient was retyped when she was transferred from another hospital. What is the most likely cause of the following results?

Patient cells: Anti-A neg, Anti-B 4+
Patient serum: A1 cells neg, B cells neg

Viral infection
Alloantibodies
Immunodeficiency
Autoimmune hemolytic anemia

A

Immunodeficiency

WEAK OR MISSING ANTIBODIES
A transplant patient is probably taking immunosuppressive medication to increase graft survival. This can contribute to the loss of normal blood group antibodies as well as other types of antibodies.

218
Q

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?

Rh positive
Rh negative
Positive for c and e
Impossible to determine

A

Rh negative

Rh positive refers to the presence of D antigen; Rh negative refers to the absence of the D antigen. These designations are for D antigen only and do not involve other Rh antigens.

219
Q

A patient tests positive for weak D but also appears to have anti-D in his serum. What may be the problem?

Mixup of samples or testing error
Most weak D individuals make anti-D
The problem could be due to a disease state
A D mosaic may make antibodies to missing antigen parts

A

A D mosaic may make antibodies to missing antigen parts

The D antigen is comprised of different parts designated as a mosaic. If an individual lacks parts of the antigen, he or she may make antibodies to the missing parts if exposed to the whole D antigen.

220
Q

What does the genotype —/— represent in the Rh system?

Rh negative
D mosaic
Rh null
Total Rh

A

Rh null

A person who is Rh null shows no Rh antigens on his or her RBCs.

221
Q

What techniques are necessary for weak D testing?

Saline + 22°C incubation
Albumin or LISS + 37°C incubation
Saline + 37°C incubation
37°C incubation + indirect antiglobulin test

A

37°C incubation + indirect antiglobulin test

Weak D testing requires both 37°C incubation and the IAT procedure.

222
Q

Which of the following sugars must be present on a precursor substance for A and B antigenic activity to be expressed?

D-Galactose
N-Acetylgalactosamine
Glucose
L-Fucose

A

L-Fucose

Without H substance present, the sugars giving A or B antigenic activity cannot attach.

223
Q

Lectins are useful in determining the cause of abnormal reactions in blood bank serology. These lectins are frequently labeled as anti-H, anti-A1 etc. The nature of these lectins is explained by which of the following?

An early form of monoclonal antibody produced in nonvertebrates
A plant substance that chemically reacts with certain RBC antigens
Naturally occurring antibodies in certain plants
The ability of plants to respond to RBC antigens by antibody production

A

A plant substance that chemically reacts with certain RBC antigens

Lectins are proteins present in plants, often derived from the seeds of plants.

224
Q

If a patient has the Rh genotype DCe/DCe and receives a unit of red blood cells from a DCe/dce individual, what Rh antibody might the patient develop?

Anti-C
Anti-c
Anti-d
Anti-E

A

Anti-c

The unit from the DCe/dce donor has the c antigen that the patient lacks.

225
Q

Which of the blood group systems is associated with antibodies that are generally IgM?

Rh
Duffy
Kell
Lewis

A

Lewis

Lewis system antibodies are generally IgM.

226
Q

In which of the following blood group systems may the red blood cell typing change during pregnancy?

P
MNS
Lewis
Duffy

A

Lewis

The Lewis typings of a pregnant woman may appear to be Le(a-b-), even though the original typing may have been Le(a-b+).

227
Q

All are associated with Group I ABO discrepancies, except:

Newborns and elderly patients
Patients with congenital immunodeficiency diseases
Patients using immunosuppressive drugs
Subgroups of A or B

A

Subgroups of A or B

228
Q

An antigen present on most D-positive and all C-positive RBCs:

G
f
rhi
Cw

A

G

229
Q

From the following ABO mating, what are the probabilities of the ABO PHENOTYPES of potential offspring? Mother: Group O; Father: Group B (heterozygous).

50% BO, 50% OO
100% BO
50% B, 50% O
50% B, 50% A

A

50% B, 50% O

230
Q

Rh antibodies are predominantly:

IgM
IgG
IgD
IgA

A

IgG

231
Q

Rh immune globulin provides ____ protection against fetal D antigen.

Active
Passive
Antigen-stimulated
Antibody-stimulated

A

Passive

232
Q

If an Rh negative woman recently delivered an Rh positive baby and the Kleihauer-Betke test result is 5%, how many vials of Rh Ig should be administered?

6
7
8
9

A

9

233
Q

The glass surface of an Rh viewbox should be _____ C.

Between 45 and 50C
Between 26 and 39C
Between 16 and 25C
Between 0 and 15C

A

Between 45 and 50C

234
Q

Anti-c can be formed by persons with the genotype:

R1R2
R1R1
R2r
rr

A

R1R1

235
Q

The results of a Kleihauer-Betke stain indicate a feto-maternal hemorrhage of 35 mL of whole blood. How many vials of Rh immune globulin would be required?

1
2
3
4

A

2

236
Q

ABH substances would be found in the saliva of a group B secretor:

H
A and H
B and H
A, B and H

A

B and H

237
Q

ABH substances would be found in the saliva of a group B secretor:

H
A and H
B and H
A, B and H

A

B and H

238
Q

The immunogenicity of the common Rh antigens may be described from greatest to least:

D>C>E>c>e
D>c>E>e>C
c>D>C>E>e
D>c>E>C>e

A

D>c>E>C>e

239
Q

An individual with genes A, H, Se and lele has which of the following phenotypes?

ABH, Le (a-b-)
ABH, Le (a+b-)
AH, Le (a-b-)
AH, Le (a+b-)

A

AH, Le (a-b-)

240
Q

The antigen system closely associated phenotypically with Rh is known as:

McCoy
Lutheran
Duffy
LW

A

LW

241
Q

“O” secretor person would demonstrate what substance/s in his saliva:

A
B
H
A and B

A

H

242
Q

Which of the following is NOT true about the anti-A and anti-B?

They are well-developed at birth
They are “naturally occurring”
They are IgM isoagglutinins
They are reactive at cold temperature

A

They are well-developed at birth

243
Q

What chain is formed when the terminal galactose on the ABH precursor substance is attached to the N-acetylglucosamine in beta 1, 4 linkage?

Type 1 precursor chain
Type 2 precursor chain

A

Type 2 precursor chain

Type 1 precursor substance
Beta 1 → 3 linkage between galactose and N-acetylglucosamine

Type 2 precursor substance
Beta 1 → 4 linkage between galactose and N-acetylglucosamine

244
Q

Rh-HDN occurs in what type of mother and child:

Mother and child are both Rh (-)
Mother and child are both Rh (+)
Mother is Rh (+), child is Rh (-)
Mother is Rh (-), child is Rh (+)

A

Mother is Rh (-), child is Rh (+)

245
Q

BO antibodies in infants are detected in serum:

At birth in cord blood
2 to 4 weeks after birth
1 to 2 months after birth
3 to 6 months after birth

A

3 to 6 months after birth

246
Q

Which cells agglutinate most strongly with Ulex europaeus lectin?

O
A1
A1B
A2B
Oh (Bombay phenotype)

A

O

247
Q

If a patient has an A2 ABO type, which of the following statements is true?

The patient’s red cells will react with anti-A1 lectin
The patient’s serum will react with A2 cells
The patient’s red cells will react with anti-A2 lectin
The patient’s serum will react with A1 cells if anti-A1 is present

A

The patient’s serum will react with A1 cells if anti-A1 is present

The A2 subgroup is described as having both qualitative and quantitative differences when compared to the A1 subgroup. This means that there is less A antigen found on the red cells of people with A2, and their A antigen looks “different” when compared to that of people with type A1.

Therefore the red cells from those with type A2 will not react with anti-A1 lectin. Approximately 20% of those with type A have the A2 phenotype, and between 1% and 8% of those individuals make anti-A1. There is no anti-A2 reagent, and people with the A2 phenotype would not react with A2 cells, because that would imply an autoantibody is present.

248
Q

Of the red cells listed, which has the most D antigen present?

Rh null
D positive
dce/dce
D- - / D - -

A

D- - / D - -

Individuals with the D - - phenotype may possess more D antigen because they have inherited a nonfunctioning RHCE gene.

249
Q

A trauma patient with type AB is seen at a rural hospital. The hospital only has 3 units of type AB RBCs. What blood type of RBCs can the patient receive as an alternative?

Type O
Type B
Type A
None of the above
All of the above

A

All of the above

The patient can receive all of the blood types listed, but good blood management would dictate the order in which they were transfused. Generally, the best course of action would be to transfuse type A first because it is usually more plentiful than type B. Patients with O type can receive only type O blood, so it is best to conserve type O when possible. If type A is not plentiful, type B can be given.

Once either type A or type B is given, types should not be mixed, to help avoid potential reactions. If type A or B is exhausted, it is then appropriate to move to type O.

250
Q

If a person has the genetic makeup Hh, AO, LeLe, sese, what substance will be found in the secretions?

A substance
H Substance
Lea substance
Leb substance

A

Lea substance

Le and secretor gene interaction:
If Le is inherited without Se, only Lea will be found on red cells and in saliva. Because this person is a nonsecretor, only Lea antigen will be present in the secretions.

251
Q

Anti-E will react with which of the following cells?

RoRo
R1R1
R2R2
rr

A

R2R2

  • RoRo Dce/Dce
  • R1R1 DCe/DCe
  • R2R2 DcE/DcE
  • rr dce/dce

Therefore anti-E will react only with R2R2 cells because they are the only ones in this list that possess the corresponding E antigen

252
Q

Rh antibodies react best at what temperature (°C)?

15
18
22
37

A

37

253
Q

Which of the following is the most common haplotype in the ASIAN population?

DCe
DcE
Dce
ce

A

DCe

R1 (DCe) - Whites, Asians and Native Americans
R0 (Dce) - Blacks

254
Q

If a patient who is R1R1 is transfused with RBCs that are Ror, which antibody is he most likely to produce?

Anti-D
Anti-c
Anti-e
Anti-G

A

Anti-c

255
Q

Which of the following characteristics best describes Lewis antibodies?

IgM, naturally occurring, cause HDN
IgM, naturally occurring, do not cause HDN
IgG, in vitro hemolysis, cause hemolytic transfusion reactions
IgG, in vitro hemolysis, do not cause hemolytic transfusions

A

IgM, naturally occurring, do not cause HDN

256
Q

Transformation to Leb phenotype after birth may be as follows:

Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+)
Le(a+b–) to Le(a–b–) to Le(a–b+) to Le(a+b+)
Le(a–b+) to Le(a+b–) to Le(a+b+) to Le(a–b–)
Le(a+b+) to Le(a+b–) to Le(a–b–) to Le(a–b+)

A

Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+)

In children who inherit both Le and Se genes, the transformation can be followed from the Le(a–b–) phenotype at birth to Le(a+b–) after 10 days to Le(a+ b+) and finally to Le(a–b+), the true Lewis phenotype, after about 6 years.

257
Q

What is the component of choice for someone who needs a RBC transfusion when there is a history of febrile transfusion reactions?

RBCs less than 5 days old
Leukocyte-reduced RBCs
RBCs 30 to 35 days old
Frozen RBCs that have been thawed and deglycerolized

A

Leukocyte-reduced RBCs

Febrile reactions are brought about by the interaction of antibodies in the recipient directed against antigens on donor leukocytes or by cytokines secreted by leukocytes. The antigens involved are both the HLA and granulocyte-specific antigens. Leukocyte-reduced RBCs are the component of choice for a patient with repeated febrile transfusion reactions.

Although frozen RBCs that have been thawed and deglycerolized are considered leukocyte reduced, the cost and time involved in preparation make them an unpractical choice.

258
Q

Which of the following is acceptable to be given intravenously with a blood transfusion?

5% dextrose in water
Physiologic saline
Ringer’s solution
Potassium chloride in saline

A

Physiologic saline

Physiologic saline (NSS) is the only generally acceptable solution that is allowed to be added to blood or blood components.

259
Q

Hemolytic transfusion reactions are the most serious type of reactions to blood transfusion. The majority of hemolytic transfusion reactions are caused by ____ errors.

Blood typing
Antibody identification
Clerical
Crossmatching

A

Clerical

The majority of deaths due to hemolytic transfusion reactions are caused by clerical errors, not laboratory errors. Patients, blood samples, and lab records, if misidentified, may lead to the wrong ABO type blood being administered to the patient.

These deaths most often occur in areas of high stress, such as in emergency departments and surgical suites.

260
Q

Occasionally, patients have an anaphylactic reaction to a specific immunoglobulin class during a transfusion. Which immunoglobulin class is most often implicated?

IgA
IgD
IgE
IgG

A

IgA

Some people are genetically deficient in IgA. If these individuals have anti-IgA in their plasma, they may suffer a severe anaphylactic reaction when subsequently exposed to IgA in donor plasma. Once these people are identified, they must receive IgA-deficient components such as multiple-washed or frozen-thawed RBC or components drawn from IgA-deficient donors.

261
Q

A transfusion reaction is reported by the nursing unit on patient. The nurse reports that the patient had chills, fever, and back pain within a few minutes of starting the unit. The nurse asks what s/he should do.

Collect posttransfusion blood samples
Monitor the pulse and blood pressure
Discontinue the unit, keep the line open
Page the patient’s physician for instructions

A

Discontinue the unit, keep the line open

The transfusion of the unit should be stopped, and the transfusionist should keep the patient’s intravenous (IV) line open with physiologic saline in case medications must be given quickly to counteract the transfusion reaction.

262
Q

All paperwork checks on this transfusion reaction are OK. The pretransfusion sample has straw-colored plasma. The post-transfusion sample has RED-tinged plasma. This is indicative of a(an):

Uncomplicated transfusion
Intravascular transfusion reaction
Error in which drugs have been infused with the blood
Febrile transfusion reaction

A

Intravascular transfusion reaction

Red-tinged plasma is indicative of hemolysis. When this is seen in the posttransfusion sample but not in the pretransfusion sample, it is evidence that an intravascular hemolytic transfusion reaction has occurred.

263
Q

A patient experiences severe rigors and goes into shock after receiving part of a unit of RBC. The patient’s temperature, which was 37.5°C pretransfusion, is now 40.0°C. Which of the following is the most likely type of reaction?

Hemolytic
Anaphylactic
Septic
Embolic

A

Septic

Although rigors and shock may be caused by hemolytic or anaphylactic reactions, bacterial sepsis is the most likely cause in this case. The sudden rise of the patient’s temperature from normal to 40°C or above is typical of such an infection.

264
Q

Which is the class of immunoglobulin uniquely associated with hemolytic disease of the newborn (HDN)?

IgA
IgD
IgE
IgG

A

IgG

IgG is the only immunoglobulin that is transported across the placenta.

IgG molecules are actively transported via the Fc portion beginning in the second trimester. Therefore, potentially any IgG blood group antibody produced by the mother could cause HDN, if the fetus possesses a well-developed corresponding antigen.

265
Q

What is the principle of the Kleihauer-Betke stain?

Fetal hemoglobin is more resistant to alkaline buffer than adult hemoglobin.
Adult hemoglobin is more resistant to alkaline buffer than fetal hemoglobin.
Fetal hemoglobin is more resistant to erythrosin and hematoxylin staining than adult hemoglobin.
Adult hemoglobin is more soluble in acid buffer than fetal hemoglobin.

A

Adult hemoglobin is more soluble in acid buffer than fetal hemoglobin.

The Kleihauer-Betke acid elution stain is used to quantify the amount of fetal cells present in the maternal circulation postpartum to calculate the correct dose of RhIG to administer.

Adult hemoglobin is soluble in acid buffer, whereas fetal hemoglobin is resistant to acid elution.

266
Q

The temperature of a blood refrigerator without a continuous recording device should be recorded:

Daily
Every 4 hours
Once every 24 hours
Every 30 minutes

A

Every 4 hours

Per AABB Standards, if an automated temperature recording device is not used, then temperatures of the blood component storage environment must be measured manually every 4 hours.

267
Q

The temperature of a blood refrigerator without a continuous recording device should be recorded:

Daily
Every 4 hours
Once every 24 hours
Every 30 minutes

A

Every 4 hours

Per AABB Standards, if an automated temperature recording device is not used, then temperatures of the blood component storage environment must be measured manually every 4 hours.

268
Q

When should quality control be performed on routine blood typing reagents?

At the beginning of each shift
Once daily
Weekly
Only when opening a new vial

A

Once daily

As suggested by AABB, red cell reagents, antisera, and antiglobulin serum should have quality control performed each day of use.

269
Q

Kernicterus is caused by the effects of:

Anemia
Unconjugated bilirubin
Antibody specificity
Antibody titer

A

Unconjugated bilirubin

Kernicterus occurs because of high levels of unconjugated bilirubin. High levels of this pigment cross into the central nervous system, causing brain damage to the infant.

270
Q

All of the following are routinely performed on a cord blood sample except:

Forward ABO typing
Antibody screen
Rh typing
DAT

A

Antibody screen

An antibody screen is not performed routinely on a cord blood sample because a baby does not make antibodies until about 6 months of age. Any antibodies detected in a cord blood sample come from the mother.

271
Q

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?

Perform a DAT on the post-transfusion sample
Check for a clerical error(s)
Repeat ABO and Rh typing of patient and donor unit
Perform an antibody screen on the post-transfusion sample

A

Check for a clerical error(s)

Over 90% of transfusion reactions are due to some type of clerical error. The most time-saving approach would be to check all paperwork before performing any laboratory testing.

272
Q

What may be found in the serum of a person who is exhibiting signs of TRALI (transfusion-related acute lung injury)?

Red blood cell alloantibody
IgA antibody
Antileukocyte antibody
Allergen

A

Antileukocyte antibody

TRALI is associated with antibodies to human leukocyte antigens or neutrophil antigens, which react with patient granulocytes and cause acute respiratory insufficiency.

273
Q

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?

Immediate hemolytic
Delayed hemolytic
Febrile nonhemolytic reaction
Transfusion-related acute lung injury

A

Febrile nonhemolytic reaction

A febrile nonhemolytic transfusion reaction (FNHTR) is defined by a rise in temperature of 1°C or higher within 24 hours post-transfusion, and unexplained by other causes. The patient has formed antibodies to HLA, which react with donor cells and result in release of pyrogens.

274
Q

What would be the result of group A blood given to an O patient?

Nonimmune transfusion reaction
Immediate hemolytic transfusion reaction
Delayed hemolytic transfusion reaction
Febrile nonhemolytic transfusion reaction

A

Immediate hemolytic transfusion reaction

Group A blood given to a group O patient would cause an immediate hemolytic transfusion reaction because a group O patient has anti-A and anti-B antibodies and would destroy A cells.

275
Q

What component is most frequently involved with transfusion-associated sepsis?

Plasma
Packed red blood cells
Platelets
Whole blood

A

Platelets

276
Q

Fatal transfusion reactions are mostly caused by?

Serologic errors
Improper storage of blood
Clerical errors
Improper handling of the product

A

Clerical errors

277
Q

Pain at infusion site and hypotension are observed with what type of reaction?

Delayed hemolytic transfusion reaction
Acute hemolytic transfusion reaction
Allergic reaction
Febrile nonhemolytic reaction

A

Acute hemolytic transfusion reaction

In the immune mediated acute hemolytic transfusion reaction, accompanying signs and symptoms include abdominal, chest, flank, or back pain; pain at infusion site; feeling of impending doom; hemoglobinemia; hemoglobinuria; hypotension; renal failure; shock; and diffuse intravascular coagulopathy. Red or dark urine or diffuse oozing may be the only sign in the anesthetized patient.

278
Q

Irradiation of blood is performed to prevent?

Febrile nonhemolytic transfusion reaction
Delayed hemolytic transfusion reaction
Transfusion-associated graft-versus-host disease
Transfusion-associated circulatory overload

A

Transfusion-associated graft-versus-host disease

279
Q

The only presenting sign most often accompanying a delayed hemolytic transfusion reaction is?

Renal failure
Unexplained decrease in hemoglobin
Active bleeding
Hives

A

Unexplained decrease in hemoglobin

280
Q

Which transfusion reaction presents with fever, maculopapular rash, watery diarrhea, abnormal liver function, and pancytopenia?

Transfusion-associated sepsis
Transfusion-related acute lung injury
Transfusion-associated graft-versus-host disease
Transfusion-associated allergic reaction

A

Transfusion-associated graft-versus-host disease

281
Q

Which transfusion reaction presents with fever, maculopapular rash, watery diarrhea, abnormal liver function, and pancytopenia?

Transfusion-associated sepsis
Transfusion-related acute lung injury
Transfusion-associated graft-versus-host disease
Transfusion-associated allergic reaction

A

Transfusion-associated graft-versus-host disease

282
Q

Which of the following is characteristic of iron overload?

Delayed, nonimmune complication
Chelating agents are used
Multiorgan damage may occur
All of the above

A

All of the above

283
Q

Which of the following tests is useful to confirm that a patient or donor is infected with HCV?

ALT + anti-HBc
Anti-HIV 1/2
Lymph node biopsy
RIBA

A

RIBA

Recombinant immunoblot assays (RIBA) can be used to confirm anti-HCV tests.

284
Q

The first retrovirus to be associated with human disease was:

HCV
HIV
HTLV-I
WNV

A

HTLV-I

285
Q

What is the most common parasitic complication of transfusion?

Babesia microti
Trypanosoma cruzi
Plasmodium species
Toxoplasma gondii

A

Plasmodium species

286
Q

The endpoint of the gel test is detected by:

Agglutination
Hemolysis
Precipitation
Attachment of indicator cells

A

Agglutination

287
Q

The endpoint of the SPRCA test is detected by:

Agglutination
Hemolysis
Precipitation
Attachment of indicator cells

A

Attachment of indicator cells

SPRCA: Solid-Phase Red Cell Adherence

288
Q

An advantage for both gel and solid-phase technology is:

No cell washing steps
Standardization
Use of IgG-coated control cells
Specialized equipment

A

Standardization

289
Q

Incubation period for the gel test:

5 minutes
10 minutes
15 minutes
20 minutes

A

15 minutes

290
Q

Centrifugation time for the test:

5 minutes
10 minutes
15 minutes
20 minutes

A

10 minutes

291
Q

An important determinant of platelet viability following storage is:

Plasma potassium concentration
Plasma pH
PT
APTT

A

Plasma pH

The pH of platelets should be maintained at 6.2 or above throughout the storage period.

292
Q

Irradiation of a unit of Red Blood Cells is done to prevent the replication of donor:

Granulocytes
Lymphocytes
Red cells
Platelets

A

Lymphocytes

Irradiation inhibits proliferation of T lymphocytes.

293
Q

The Liley method of predicting the severity of hemolytic disease of the newborn is based on the amniotic fluid:

Bilirubin concentration by standard methods
Change in optical density measured to 450 nm
Rh determination
Ratio of lecithin to sphingomyelin

A

Change in optical density measured to 450 nm

The change in optical density (absorbance) of amniotic fluid measure spectrophotometrically at 450nm is calculated and plotted on a Liley graph according to the weeks of gestation. The graph is divided into 3 zones, which predict the severity of HDFN and the need for intervention and treatment.

294
Q

Kernicterus is caused by the effects of:

Anemia
Unconjugated bilirubin
Antibody specificity
Antibody titer

A

Unconjugated bilirubin

295
Q

Blood for intrauterine transfusion should be all of the following, EXCEPT:

More than 7 days old
Screened for CMV
Gamma-irradiated
Compatible with maternal serum

A

More than 7 days old

296
Q

RhIG is indicated for:

Mothers who have anti-D
Infants who are Rh-negative
Infants who have anti-D
Mothers who are Rh-negative

A

Mothers who are Rh-negative

297
Q

Which of the following is the preferred specimen for the initial compatibility testing in exchange transfusion therapy?

Maternal serum
Paternal serum
Infant’s post-exchange serum
Eluate prepared from infant’s red blood cells

A

Maternal serum

298
Q

Posttransfusion purpura (PTP) is usually caused by:

Anti-A
White cell antibodies
Anti-HPA
Platelet wash out

A

Anti-HPA

Antibodies to human platelet antigen (HPA)

299
Q

In a delayed transfusion reaction, the causative antibody is generally too weak to be detected in routine compatibility testing and antibody screening tests, but is typically detectable at what point after transfusion?

3 to 6 hours
3 to 7 days
60 to 90 days
After 120 days

A

3 to 7 days

Delayed hemolytic transfusion reactions are caused by a secondary anamnestic response in a previously alloimmunized recipient. Unlike a primary response, a secondary response is rapid. Antibody may be detectable 3 to 7 days from the time of transfusion.

300
Q

Which of the following transfusion reactions is characterized by high fever, shock, hemoglobinuria, DIC and renal failure?

Bacterial contamination
Circulatory overload
Febrile
Anaphylactic

A

Bacterial contamination

In septic transfusion reactions patient experience fever >101˚F (38.3˚C), shaking chills and hypotension. In severe reactions, patients develop shock, renal failure, hemoglobinuria and DIC.

301
Q

Hemoglobinuria, hypotension and generalized bleeding are symptoms of which of the following transfusion reactions?

Allergic
Circulatory overload
Hemolytic
Anaphylactic

A

Hemolytic

Clinical signs of a hemolytic transfusion reaction include fever and chills, and in severe cases, DIC. Circulatory overload, allergic and anaphylactic tractions are not characterized by fever and DIC.

302
Q

The MOST COMMON INITIAL clinical manifestation of a hemolytic transfusion reaction is:

Shock
Shortness of breath
Fever
Bleeding

A

Fever

FEVER is the MOST COMMON initial manifestation of an cute transfusion reaction and is frequently accompanied by chills.

303
Q

Leukocyte-poor red blood cells would most likely be indicated for patients with a history of:

Febrile nonhemolytic transfusion reaction
Iron deficiency anemia
Hemophilia A
von Willebrand disease

A

Febrile nonhemolytic transfusion reaction

Leukocyte antibodies are a primary cause of febrile transfusion reactions. Leukocyte reduced blood components reduce the risk of febrile non-hemolytic reactions.

304
Q

Hives and itching are symptoms of which of the following transfusion reactions?

Citrate toxicity
Circulatory overload
Allergic
Febrile

A

Allergic

Allergic reactions are a Type I immediate hypersensitivity reaction to an allergen in plasma. Most are mild reactions shown by urticaria (hives, swollen red wheals) which mat cause itching.

305
Q

The laboratory assay of brain natriuretic peptide (BNP) may be used to aid in the diagnosis of:

TRALI
FNHTR
TACO
Iron overload

A

TACO

TACO: Transfusion-associated circulatory overload

The laboratory assay of brain natriuretic peptide (BNP), consisting of the measurement of a peptide secreted from the ventricles in response to increased filling pressures and a marker of congestive heart failure, may be used to aid in the diagnosis of TACO.

306
Q

The most common isolate found in RBC units:

Pseudomonas species
Yersinia enterocolitca
Staphylococcus epidermidis
Bacillus cereus

A

Yersinia enterocolitca

According to the CDC, Yersinia enterocolitica is the most common isolate found in RBC units, followed by the Pseudomonas species. Together, these two account for more than 80% of all bacterial infections transmitted by RBCs.

307
Q

Organisms most frequently recovered from donated blood and contamination of platelets:

Yersinia enterocolitica, Pseudomonas species
Yersinia enterocolitica, Serratia marcescens
Staphylococcus aureus, Bacillus cereus
Staphylococcus epidermidis, Bacillus cereus

A

Staphylococcus epidermidis, Bacillus cereus

Staphylococcus epidermidis, and Bacillus cereus (both gram-positive) are the organisms most frequently recovered from donated blood and contamination of platelets.

308
Q

Congestive heart failure, severe headache and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion reaction?

Hemolytic
Febrile
Anaphylactic
Circulatory overload

A

Circulatory overload

Transfusion-induced hypervolemia causing edema and congestive heart failure is a feature of transfusion-associated circulatory overload (TACO). Hypervolemia is not a complication of hemolytic, febrile or anaphylactic transfusion reaction.

309
Q

The most frequent transfusion-associated disease complication of blood transfusion is:

Cytomegalovirus
Syphilis
Hepatitis
AIDS

A

Hepatitis

Hepatitis transmission is unlikely, but a higher risk of transmission through blood transfusion than CMV (rare), syphilis (no transfusion transmitted cases reported in >30 years), or HIV (1:2,300,000 units).

310
Q

PLATELET AGITATION has been shown to FACILITATE OXYGEN TRANSFER into the platelet bag and oxygen consumption by the platelets. The positive role for oxygen has been associated with the maintenance of platelet component pH. Maintaining pH was determined to be a key parameter for retaining platelet viability in vivo when platelets were stored at 20°C to 24°C.

A

Noted

311
Q

Which of the following information is not required for whole blood donors?

Name
Address
Occupation
Sex
Date of birth

A

Occupation

312
Q

Which of the following would be cause for deferral for a male donor?

Temperature of 99.2°F
Hematocrit of 37%
Received a blood transfusion 2 years ago
Pulse rate 60 bpm

A

Hematocrit of 37%

313
Q

Which of the following would be cause for permanent deferral?

History of hepatitis after 11th birthday
Positive hepatitis C test result
Positive HTLV-I antibody
Positive anti-HBc test result
All of the above

A

All of the above

314
Q

Immunization for rubella would result in a temporary deferral for:

2 weeks
4 weeks
8 weeks
6 months
1 year

A

4 weeks

315
Q

Which of the following donors is acceptable?

Donor who had a first-trimester abortion 4 weeks ago
Donor whose husband is a hemophiliac who regularly received cryoprecipitate before 1989
Donor who was treated for gonorrhea 6 months ago
Donor who had a needle-stick injury 10 months ago

A

Donor who had a first-trimester abortion 4 weeks ago

First-trimester or second-trimester abortion or miscarriage is not cause for deferral.

316
Q

Which of the following tests is not required as part of the donor processing procedure for allogeneic donation?

ABO
Rh
Serologic test for syphilis (STS)
Anti-CMV

A

Anti-CMV

317
Q

Which of the following lists the correct shelf-life for the component?

Deglycerolized RBCs—24 hours
RBCs (CPD)—35 days
Platelet concentrate—7 days
FFP—5 years
RBCs (CPDA-1)—21 days

A

Deglycerolized RBCs—24 hours

318
Q

Each unit of cryoprecipitate prepared from whole blood should contain approximately how many units of AHF activity?

40 IU
80 IU
120 IU
160 IU
180 IU

A

80 IU

319
Q

Platelet concentrates prepared by apheresis should contain how many platelets?

5.5 × 10 10th
6 × 10 10th
3 × 10 11th
5.5 × 10 11th
6 × 10 11th

A

3 × 10 11th

320
Q

The required storage temperature for frozen RBCs using the HIGH GLYCEROL method is:

4°C
–20°C
–18°C
–120°C
–65°C

A

–65°C

321
Q

Once thawed, FFP must be transfused within:

4 hours
6 hours
8 hours
12 hours
24 hours

A

24 hours

322
Q

Quality control for packed RBCs requires a maximum hematocrit level of:

75%
80%
85%
90%
95%

A

80%

323
Q

Prothrombin complex concentrates are used to treat which of the following?

Factor IX deficiency
Factor VIII deficiency
Factor XII deficiency
Factor XIII deficiency
Factor V deficiency

A

Factor IX deficiency

324
Q

RBCs that have been LEUKOREDUCED must contain less than ______ and retain at least ______ of original RBCs.

8 × 10 6th /85%
8 × 10 6th /90%
5 × 10 6th /85%
5 × 10 6th /80%

A

5 × 10 6th /85%

325
Q

Cryoprecipitate that has been pooled must be transfused within ______ hours.

24
6
4
8

A

4

326
Q

The most common anticoagulant used for apheresis procedures is:

Heparin
Sodium fluoride
Warfarin
Citrate

A

Citrate

327
Q

The minimum interval allowed between plateletpheresis component collection procedures is:

1 day
2 days
7 days
8 weeks

A

2 days

328
Q

Which of the following can be given to an apheresis donor to increase the number of circulating granulocytes?

DDAVP
Hydroxyethyl starch (HES)
Immune globulin
G-CSF

A

G-CSF

The administration of granulocyte colony-stimulating factor (GCSF), a recombinant hematopoietic growth factor, to granulocyte donors has resulted in marked increases in granulocyte yield.

Although mild side effects, such as muscle and skeletal pain, have been reported with the use of these growth factors, they are usually well tolerated by donors.

329
Q

Leukocyte-reduced filters can do all of the following EXCEPT:

Reduce the risk of CMV infection
Prevent or reduce the risk of HLA alloimmunization
Prevent febrile, nonhemolytic transfusion reactions
Prevent TA-GVHD

A

Prevent TA-GVHD

330
Q

Albumin should NOT be given for:

Burns
Shock
Nutrition
Plasmapheresis

A

Nutrition

331
Q

Of the following, which blood type is selected when a patient cannot wait for ABO-matched RBCs?

A
B
O
AB

A

O

332
Q

Which type of transplantation requires all cellular blood components to be irradiated?

Bone marrow
Heart
Liver
Kidney

A

Bone marrow

333
Q

Select the appropriate product for a bone marrow transplant patient with anemia:

RBCs
Irradiated RBCs
Leukoreduced RBCs
Washed RBCs

A

Irradiated RBCs

334
Q

What is the maximum volume of blood that can be collected from a 110-lb donor, including samples for processing?

450 mL
500 mL
525 mL
550 mL

A

525 mL

335
Q

When RBCs are stored, there is a “shift to the left.” This means:

Hemoglobin oxygen affinity increases, owing to an increase in 2,3-DPG.
Hemoglobin oxygen affinity increases, owing to a decrease in 2,3-DPG.
Hemoglobin oxygen affinity decreases, owing to a decrease in 2,3-DPG.
Hemoglobin oxygen affinity decreases, owing to an increase in 2,3-DPG.

A

Hemoglobin oxygen affinity increases, owing to a decrease in 2,3-DPG.

336
Q

Which of the following anticoagulant preservatives provides a storage time of 35 days at 1°C to 6°C for units of whole blood and prepared RBCs if an additive solution is not added?

ACD
CP2D
CPD
CPDA-1

A

CPDA-1

337
Q

What are the current storage time and storage temperature for platelet concentrates and apheresis platelet components?

5 days at 1°C to 6°C
5 days at 24°C to 27°C
5 days at 20°C to 24°C
7 days at 22°C to 24°C

A

5 days at 20°C to 24°C

338
Q

What is the minimum number of platelets required in a platelet concentrate prepared from whole blood by centrifugation (90% of sampled units)?

5.5 x 10 11th
3 x 10 10th
3 x 10 11th
5.5 x 10 10th

A

5.5 x 10 10th

339
Q

RBCs can be frozen for:

12 months
1 year
5 years
10 years

A

10 years

340
Q

Whole blood and RBC units are stored at what temperature?

1°C to 6°C
20°C to 24°C
37°C
24°C to 27°C

A

1°C to 6°C

341
Q

Additive solutions (AS) are approved for storage of red blood cells for how many days?

21 days
42 days
35 days
7 days

A

42 days

342
Q

What is the lowest allowable pH for a platelet component at outdate?

6
5.9
6.8
6.2

A

6.2

343
Q

Frozen and thawed RBCs processed in an open system can be stored for how many days/hours?

3 days
6 hours
24 hours
15 days

A

24 hours

344
Q

Which of the following occurs during storage of red blood cells?

pH decreases
2,3-DPG increases
ATP increases
Plasma K+ decreases

A

pH decreases

345
Q

What is the component of choice for a patient with chronic granulomatous disease (CGD)?

FFP
Granulocytes
Cryoprecipitate
RBCs

A

Granulocytes

Patients with CGD cannot fight bacterial infections due to dysfunctional phagocytic enzymes; granulocyte concentrates are the product of choice for these patients.

346
Q

What method can be employed to detect bacteria in random donor platelets?

pH
Glucose
Pan genera detection (PGD) assay
Gram stain

A

Pan genera detection (PGD) assay

The FDA has mandated that pH and glucose can no longer be used as a screening test for platelets. The Verax PGD assay has been FDA approved for both single-donor platelets and random-donor platelets for bacteria screening.

347
Q

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?

Must be issued within 24 hours
Must be issued within 48 hours
Must be irradiated
Must retain the original expiration date

A

Must be issued within 24 hours

The other half unit must be issued within 24 hours, if an open system is used to split the unit.

348
Q

How does irradiation prevent transfusion associated graft-versus-host disease (TA-GVHD)?

Gamma rays and x-rays destroy the lymphocytes’ ability to divide
X-rays cause lysis of the lymphocytes
Gamma rays enhance lymphocyte reactivity
Ultraviolet radiation induces apoptosis of lymphocytes

A

Gamma rays and x-rays destroy the lymphocytes’ ability to divide

Gamma rays or x-rays have the ability to prohibit a lymphocyte’s ability to divide, preventing TA-GVHD.

349
Q

Which component has the longest expiration date?

Cryoprecipitate
FFP
Frozen RBCs
Platelet concentrates

A

Frozen RBCs

Frozen RBCs may be kept for up to 10 years.

FFP and cryoprecipitate stored at -18°C or lower expire in 1 year.

If FFP is kept at -65°C or lower, the expiration time is 7 years.

Platelet concentrates expire in 5 days.

350
Q

Deferral period for Hepatitis B Ig (HBIg) immunization:

6 months
12 months
3 years
No deferral

A

12 months

Deferral for HBIG injection is 12 months.

351
Q

A whole-blood donor currently on clopidogrel (Plavix) is precluded from donating which product?

Platelets
Red blood cells
FFP
Cryoprecipitate

A

Platelets

Clopidogrel renders platelets nonfunctional and therefore potential donors on this medication cannot donate platelets.

352
Q

A woman begins to breathe rapidly while donating blood. Choose the correct course of action.

Continue the donation; rapid breathing is not a reason to discontinue a donation
Withdraw the needle, raise her feet, and administer ammonia
Discontinue the donation and provide a paper bag
Tell her to sit upright and apply a cold compress to her forehead

A

Discontinue the donation and provide a paper bag

This woman is HYPERVENTILATING; therefore, the donation should be discontinued. A paper bag should be provided for the donor to breathe into in order to increase the carbon dioxide in the donor’s air.

353
Q

Minimum weight of female donor for double RBC pheresis:

90 lbs
100 lbs
130 lbs
150 lbs

A

150 lbs

354
Q

Minimum weight of male donor for double RBC pheresis:

90 lbs
100 lbs
130 lbs
150 lbs

A

130 lbs

355
Q

Donors who have received blood or blood products within 12 months of when they desire to donate are deferred to protect the recipient because the

Blood could have transmitted hepatitis (HBV or HCV) or HIV
Blood may have two cell populations
Donor may not be able to tolerate the blood loss
Donor red cell hemoglobin level may be too low

A

Blood could have transmitted hepatitis (HBV or HCV) or HIV

Hepatitis viruses and HIV have extended incubation periods in which exposure has occurred but neither serological nor clinical manifestations of the disease are evident. The current screening tests, although quite sensitive, are unable to detect the viruses if testing is performed during this incubation period.

To safeguard against the possibility that the donor received blood or blood products collected during the incubation period, a 12-month deferral is incurred to allow for fulmination of the disease.

356
Q

Which of the following viruses resides exclusively in leukocytes?

CMV
HIV
HBV
HCV

A

CMV

Of the viruses listed, CMV is the only one that resides exclusively in leukocytes.

357
Q

Even though it is properly collected and stored, which of the following will fresh frozen plasma (FFP) not provide?

Factor V
Factor VIII
Factor IX
Platelets

A

Platelets

FFP contains all the plasma clotting factors. FFP’s primary use is for patients with clotting factor deficiencies for which no concentrate is available and patients who present multiple factor deficiencies such as in liver disease.

Platelets are CELLULAR elements, not a plasma clotting factor, and they must be maintained at 20-24°C with continuous gentle agitation to maintain their viability.

358
Q

The last unit of autologous blood for an elective surgery patient should be collected no later than __ hours before surgery.

24 hours
36 hours
48 hours
72 hours

A

72 hours

Autologous blood should not be drawn later than 72 hours prior to surgery. The reason is to allow time for adequate volume repletion. However, the medical director may decrease this time if the patient’s condition warrants it.

359
Q

For preparation of packed RBCs: if CPDA-1 is used, _____ mL of plasma can be removed, leaving the RBC product with a hematocrit of 65% to 80%.

100 to 150 mL plasma removed
150 to 200 mL plasma removed
200 to 250 mL plasma removed
250 to 300 mL plasma removed

A

200 to 250 mL plasma removed

If CPDA-1 is used, 200 to 250 mL of plasma can be removed, leaving the RBC product with a hematocrit of 65% to 80%. If additive solutions (AS) are employed, an additional 50 mL of plasma can be removed, because 150 mL of adenine-saline is added back to the cells, achieving the desired hematocrit level of less than 80%.

360
Q

For preparation of packed RBCs: if CPDA-1 is used, _____ mL of plasma can be removed, leaving the RBC product with a hematocrit of 65% to 80%.

100 to 150 mL plasma removed
150 to 200 mL plasma removed
200 to 250 mL plasma removed
250 to 300 mL plasma removed

A

200 to 250 mL plasma removed

If CPDA-1 is used, 200 to 250 mL of plasma can be removed, leaving the RBC product with a hematocrit of 65% to 80%. If additive solutions (AS) are employed, an additional 50 mL of plasma can be removed, because 150 mL of adenine-saline is added back to the cells, achieving the desired hematocrit level of less than 80%.

361
Q

For apheresis donors who donate platelets more frequently than every 4 weeks, a platelet count must be performed prior to the procedure and be at least:

At least 50,000/uL
At least 100, 000/uL
At least 150, 000/uL
At least 400,000/uL

A

At least 150, 000/uL

The minimum platelet count required for a frequent repeat donor is 150 X 10 9th/L).

362
Q

For apheresis donors who donate platelets more frequently than every 4 weeks, a platelet count must be performed prior to the procedure and be at least:

At least 50,000/uL
At least 100, 000/uL
At least 150, 000/uL
At least 400,000/uL

A

At least 150, 000/uL

The minimum platelet count required for a frequent repeat donor is 150 X 10 9th/L).

363
Q

For apheresis donors who donate platelets more frequently than every 4 weeks, a platelet count must be performed prior to the procedure and be at least:

At least 50,000/uL
At least 100, 000/uL
At least 150, 000/uL
At least 400,000/uL

A

At least 150, 000/uL

The minimum platelet count required for a frequent repeat donor is 150 X 10 9th/L).

364
Q

Heavy spin centrifugation:

1,000 x g for 5 minutes
2, 000 x g for 2 to 3 minutes
3,000 x g for 2 to 3 minutes
5, 000 x g for 5 minutes

A

5, 000 x g for 5 minutes

HEAVY SPIN
3, 600 RPM
5,000 x g
5 minutes

LIGHT SPIN
3, 200 RPM
2,000 x g
2-3 minutes

365
Q

Plasmapheresis donors must have a serum total protein of at least ___ g/dL.

3 g/dL
4 g/dL
5 g/dL
6 g/dL

A

6 g/dL

Plasmapheresis donors must have a serum total protein of at least 6 g/dL.

03-2023 (14 decks)

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