ISBB - Chapter 4.9

Question 1

All of the following are reasons for a positive DAT on cord blood cells of a newborn except:
A. High concentrations of Wharton jelly on cord blood cells
B. Immune anti-A from an O mother on the cells of an A baby
C. Immune anti-D from an Rh (-) mother on the cells of Rh (+) baby
D. Immune anti-K from a K (-) mother on the cells of a K (-) baby

Answer 1

D. Immune anti-K from a K (-) mother on the cells of a K (-) baby

Question 2

A fetal screen yielded negative results on a mother who is O negative and infant who is O positive. What course of action should be taken?
A. Perform a Kleihauer-Betke test
B. Issue one full dose of RhIg
C. Perform a DAT on the infant
D. Perform an antibody screen on the mother

Answer 2

B. Issue one full dose of RhIg

Question 3

What should be done when a woman who is 24 weeks pregnant has a positive antibody screen?
A. Perform an antibody identification panel; titer, if necessary
B. No need to do anything until 30 weeks’ gestation
C. Administer RhIg
D. Adsorb the antibody onto antigen-positive cells

Answer 3

A. Perform an antibody identification panel; titer, if necessary

Question 4

All of the following are interventions for fetal distress caused by maternal antibodies attacking fetal cells except:
A. Intrauterine transfusion
B. Plasmapheresis on the mother
C. Transfusion of antigen-positive cells to the mother
D. Middle cerebral artery peak systolic velocity (MCA-PSV)

Answer 4

C. Transfusion of antigen-positive cells to the mother

Question 5

Cord blood cells are washed six times with saline, and the DAT result and negative control are still positive. What should be done next?
A. Obtain a heelstick sample
B. Record the DAT result as positive
C. Obtain another cord blood sample
D. Perform elution on the cord blood cells

Answer 5

A. Obtain a heelstick sample

Question 6

What can be done if HDFN is caused by maternal anti-K?
A. Give Kell immune globulin
B. Monitor the mother’s antibody level
C. Prevent formation of K-positive cells in the fetus
D. Not a problem; anti-K is not known to cause HDFN

Answer 6

B. Monitor the mother’s antibody level

Question 7

Should an O-negative mother receive RhIg if a positive DAT on the newborn is caused by immune anti-A?
A. No, the mother is not a candidate for RhIg because of the positive DAT result
B. Yes, if the baby’s type is Rh negative
C. Yes, if the baby’s type is Rh positive
D. No, the baby’s problem is unrelated to Rh blood group antibodies

Answer 7

C. Yes, if the baby’s type is Rh positive

Question 8

Should an A-negative woman who has just had a miscarriage receive RhIg?
A. Yes, but only if she does not have evidence of active anti-D
B. No, the type of the baby is unknown
C. Yes, but only a minidose regardless of trimester
D. No, RhIg is given to women at full-term pregnancies only

Answer 8

A. Yes, but only if she does not have evidence of active anti-D

Question 9

SITUATION:. The automated blood bank analyzer reports a type of O negative on a woman who is 6 weeks pregnant with vaginal bleeding. The woman tells the emergency department physician she is O positive and presents a blood donor card. The MLS performs a test for weak D and observes a 1+ reaction in the AHG phase. The Kleihauer-Betke test result is negative. Is this woman a candidate for RhIg?
A. Molecular testing is indicated to ascertain the type of weak D
B. Yes, she is Rh positive
C. No, there is no evidence of a fetal bleed
D. Yes, based on the automated typing results

Answer 9

A. Molecular testing is indicated to ascertain the type of weak D

Question 10

Which of the following patients would be a candidate for RhIg?
A. B-positive mother; B-negative baby; first pregnancy; no anti-D in mother
B. O-negative mother; A-positive baby; second pregnancy; no anti-D in mother
C. A-negative mother; O-negative baby; fourth pregnancy; anti-D in mother
D. AB-negative mother; B-positive baby; second pregnancy; anti-D in mother

Answer 10

B. O-negative mother; A-positive baby; second pregnancy; no anti-D in mother

Question 11

The Kleihauer-Betke acid elution test identifies 40 fetal cells in 2,000 maternal RBCs. How many full doses of RhIg are indicated?
A. 1
B. 2
C. 3
D. 4

Answer 11

D. 4

Question 12

Kernicterus is caused by the effects of:
A. Anemia
B. Unconjugated bilirubin
C. Antibody specificity
D. Antibody titer

Answer 12

B. Unconjugated bilirubin

Question 13

Anti-E is detected in the serum of a woman in the first trimester of pregnancy. The first titer for anti-E is 32. Two weeks later, the antibody titer is 64 and then 128 after another 2 weeks. Clinically, there are beginning signs of fetal distress. What may be done?
A. Induce labor for early delivery
B. Perform plasmapheresis to remove anti-E from the mother
C. Administer RhIg to the mother
D. Perform an intrauterine transfusion using E-negative cells

Answer 13

B. Perform plasmapheresis to remove anti-E from the mother

Question 14

What testing is done for exchange transfusion when the mother’s serum contains an alloantibody?
A. Crossmatching and antibody screen
B. ABO, Rh, antibody screen, and crossmatching
C. ABO, Rh, antibody screen
D. ABO and Rh only

Answer 14

B. ABO, Rh, antibody screen, and crossmatching

Question 15

Which blood type may be transfused to an AB-positive baby who has HDFN caused by anti-D?
A. AB negative, CMV negative, Hgb S negative; irradiated or O negative, CMV negative, Hgb S negative
B. AB positive, CMV negative; irradiated or O positive, CMV negative
C. AB negative only
D. O negative only

Answer 15

A. AB negative, CMV negative, Hgb S negative; irradiated or O negative, CMV negative, Hgb S negative

Question 16

All of the following are routinely performed on a cord blood sample except:
A. Forward ABO typing
B. Antibody screen
C. Rh typing
D. DAT

Answer 16

B. Antibody screen

Question 17

Why do Rh-negative women tend to have a positive antibody screen compared with Rhpositive women of childbearing age?
A. They have formed active anti-D
B. They have received RhIg
C. They have formed anti-K
D. They have a higher rate of transfusion

Answer 17

B. They have received RhIg

Question 18

SITUATION: An O-negative mother gave birth to a B-positive infant. The mother had no history of antibodies or transfusion. This was her first child. The baby was mildly jaundiced, and the DAT result was weakly positive with polyspecific antisera. What could have caused the positive DAT result?
A. Anti-D from the mother coating the infant RBCs
B. An alloantibody, such as anti-K, coating the infant RBCs
C. Maternal anti-B coating the infant RBCs
D. Maternal anti-A, B coating the infant RBCs

Answer 18

D. Maternal anti-A, B coating the infant RBCs

Question 19

SITUATION: RhIg is requested on a 28-year-old woman with suspected abortion. When the nurse arrives in the blood bank to pick up the RhIg, she asks the MLS if it is a minidose. The MLS replies that it is a full dose, not a minidose. The nurse then requests to take 50 μg from the 300 μg syringe to satisfy the physician’s orders. What course of action should the MLS take?
A. Let the nurse take the syringe of RhIg, so that she may withdraw 50 μg
B. Call a supervisor or pathologist
C. Instruct the nurse that the blood bank does not stock minidoses of RhIg and manipulating the full dose will compromise the purity of the product
D. Instruct the nurse that the blood bank does not stock minidoses of RhIg, and relay this information to the patient’s physician

Answer 19

D. Instruct the nurse that the blood bank does not stock minidoses of RhIg, and relay this information to the patient’s physician