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Blood banking > Part 4 > Flashcards

Part 4 Flashcards

1
Q

Which of the following is true regarding acute normovolemic hemodilution?

A. One or more units of blood are withdrawn from the patient and replaced with FFP

B. Units removed may be stored in the operating room at room temperature for 8 hours

C. Units removed may be stored in the operating room at room temperature for 24 hours

D. Unused units can be added to the general donor blood inventory

A

B. Units removed may be stored in the operating room at room temperature for 8 hours

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2
Q

All of the following apply to a double red cell unit apheresis collection except:

A. The hematocrit must be at least 38%

B. The weight for a female is at least 150 lb

C. The height for a male is at least 5 ft 1 in.

D. The deferral period following collection is 16 weeks

A

A. The hematocrit must be at least 38%

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3
Q

An autologous unit of whole blood was collected on a 33-year-old woman in preparation for a knee replacement procedure in 3 weeks. The whole blood unit had her hyphenated last name, first name, and last four digits of her social security number for identification. The lab computer system, however, only had her married name and first name, medical record number, and social security number. What should be done with this blood product?

A. Discard the unit

B. Make the unit available for transfusion

C. Confirm the name with donor and have admissions make the correction in the computer system, then make the unit available for transfusion

D. Ensure that social security numbers match, confirm the name with donor and have admissions make the correction in the computer system with the medical director’s approval, then make the unit available for transfusion

A

D. Ensure that social security numbers match, confirm the name with donor and have admissions make the correction in the computer system with the medical director’s approval, then make the unit available for transfusion

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4
Q

What is the youngest age a person can make an allogeneic whole-blood donation?

A. 14

B. 15

C. 16

D. 17

A

C. 16

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5
Q

Which of the following vaccinations carries no deferral period?

A. Rubella

B. Varicella zoster

C. Recombinant HPV

D. Smallpox

A

C. Recombinant HPV

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6
Q

All of the following are reasons for a positive DAT on cord blood cells of a newborn except:

A. High concentrations of Wharton’s jelly on cord cells

B. Immune anti-A from an O mother on the cells of an A baby

C. Immune anti-D from an Rh negative mother on the cells of an Rh-positive baby

D. Immune anti-K from an K-negative mother on the cells of a K-negative baby

A

D. Immune anti-K from an K-negative mother on the cells of a K-negative baby

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7
Q

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

A

B. Issue one full dose of RhIg

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8
Q

What should be done when a woman who is 24 weeks pregnant has a positive antibody screen?

A. Perform an antibody identification panel; titer if necessary

B. No need to do anything until 30 weeks gestation

C. Administer Rh immune globulin (RhIg)

D. Adsorb the antibody onto antigen-positive cells

A

A. Perform an antibody identification panel; titer if necessary

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9
Q

All of the following are interventions for fetal distress caused by maternal antibodies attacking fetal cells except:

A. Intrauterine transfusion

B. Plasmapheresis on the mother

C. Transfusion of antigen-positive cells to the mother

D. Early induction of labor

A

C. Transfusion of antigen-positive cells to the mother

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10
Q

Cord cells are washed six times with saline and the DAT and negative control are still positive. What should be done next?

A. Obtain a heelstick sample

B. Record the DAT as positive

C. Obtain another cord sample

D. Perform an elution on the cord cells

A

A. Obtain a heelstick sample

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11
Q

What can be done if HDN is caused by maternal anti-K?

A. Give Kell immune globulin

B. Monitor the mother’s antibody level

C. Prevent formation of K-positive cells in the fetus

D. Not a problem; anti-K is not known to cause HDN

A

B. Monitor the mother’s antibody level

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12
Q

Should an O-negative mother receive RhIg if a positive DAT on the newborn is caused by immune anti-A?

A. No, the mother is not a candidate for RhIg because of the positive DAT

B. Yes, if the baby’s type is Rh negative

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

D. No, the baby’s problem is unrelated to Rh blood group antibodies

A

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

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13
Q

Should an A-negative woman who has just had a miscarriage receive RhIg?

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

B. No, the type of the baby is unknown

C. Yes, but only a minidose regardless of trimester

D. No, RhIg is given for term pregnancies only

A

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

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14
Q

SITUATION: The Ortho Provue reports a type on a woman who is 6 weeks pregnant with vaginal bleeding as O negative. The woman tells the emergency department physician she is O positive and presents a blood donor card. The medical laboratory scientist performs a test for weak D and observes a 1+ reaction in AHG phase. A Kleihauer-Betke test is negative. Is this woman a candidate for RhIg?

A. No, she is Rh positive

B. Yes, she is a genetic weak D

C. No, there is no evidence of a fetal bleed

D. Yes, based upon the Provue results

A

A. No, she is Rh positive

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15
Q

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

A

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

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16
Q

A Kleihauer-Betke acid elution test identifies 40 fetal cells in 2,000 maternal red cells. How many full doses of RhIg are indicated?

A. 1

B. 2

C. 3

D. 4

A

D. 4

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17
Q

Kernicterus is caused by the effects of:

A. Anemia

B. Unconjugated bilirubin

C. Antibody specificity

D. Antibody titer

A

B. Unconjugated bilirubin

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18
Q

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

A

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

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19
Q

What testing is done for exchange transfusion when the mother’s serum contains an alloantibody?

A. Crossmatch and antibody screen

B. ABO, Rh, antibody screen, and crossmatch

C. ABO, Rh, antibody screen

D. ABO and Rh only

A

B. ABO, Rh, antibody screen, and crossmatch

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20
Q

Which blood type may be transfused to an AB-positive baby who has HDN caused by anti-D?

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

B. AB positive, CMV negative; irradiated or O positive, CMV negative

C. AB negative only

D. O negative only

A

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

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21
Q

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

A

B. Antibody screen

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22
Q

Why do Rh-negative women tend to have a positive antibody screen compared to Rh-positive women of childbearing age?

A. They have formed active anti-D

B. They have received RhIg

C. They have formed anti-K

D. They have a higher rate of transfusion

A

B. They have received RhIg

23
Q

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 weakly positive with polyspecific antisera. What could have caused the positive DAT?

A. Anti-D from the mother coating the infant red cells

B. An alloantibody, such as anti-K, coating the infant red cells

C. Maternal anti-B coating the infant cells

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

A

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

24
Q

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 medical laboratory scientist (MLS) if it is a minidose. The MLS replies that it is a full dose, not a minidose. The nurse then requests to take 50 mcg from the 300 mcg syringe to satisfy the physician’s orders. What course of action should the MLS take?

A. Let the nurse take the syringe of RhIg, so that she may withdraw 50 mcg

B. Call a supervisor or pathologist

C. Instruct the nurse that the blood bank does not stock minidoses of RhIg and manipulating the full dose will compromise the purity of the product

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

A

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

25
Q

What protocol is followed when screening whole blood donors for HIV-1 RNA?

A. Pools of 10 are tested; if the pool is nonreactive, donors are accepted

B. Pools of 20 are tested; if the pool is reactive, samples are tested individually

C. Pools of up to 16 donors are tested; if pool is reactive, individual samples are screened

D. All donors are screened individually; if samples are reactive, blood is discarded

A

C. Pools of up to 16 donors are tested; if pool is reactive, individual samples are screened

26
Q

Currently, nucleic acid amplification testing (NAT) testing is performed to detect which viruses?

A. HIV and HTLV-1

B. HTLV I\II

C. HIV, HCV, and WNV

D. HIV, HBV, and WNV

A

C. HIV, HCV, and WNV

27
Q

John comes in to donate a unit of whole blood at the collection center of the community blood supplier. The EIA screen is reactive for anti-HIV-1\2. The test is repeated in duplicate and is nonreactive. John is:

A. Cleared for donation

B. Deferred for 6 months

C. Status is dependent on confirmatory test

D. Deferred for 12 months

A

A. Cleared for donation

28
Q

What marker is the first to appear in hepatitis B infection?

A. Anti-HBc (IgM)

B. HbsAg

C. Anti-HBs

D. Anti-HBc (IgG)

A

B. HbsAg

29
Q

What marker indicates immunity to hepatitis B infection?

A. Anti-HBc (IgM)

B. HBsAg

C. Anti-HBs

D. Anti-HBc (IgG)

A

C. Anti-HBs

30
Q

An EIA screening test for HTLV I\II was performed on a whole-blood donor. The results of the EIA were repeatedly reactive but the confirmatory test was negative. On the next donation, the screening test was negative by two different EIA tests. The donor should be:

A. Accepted

B. Deferred

C. Told that only plasma can be made from his donation

D. Told to come back in 6 months

A

A. Accepted

31
Q

A unit tests positive for syphilis using the rapid plasma reagin test (RPR). The microhemagglutinin assay-Treponema pallidum (MHA-TP) on the same unit is negative. What is the disposition of the unit?

A. The unit may be used to prepare components

B. The donor must be contacted and questioned further; if the RPR result is most likely a false positive, then the unit may be used

C. The unit must be discarded

D. Cellular components may be prepared but must be irradiated before issue

A

A. The unit may be used to prepare components

32
Q

SITUATION: John Smith donated a unit of whole blood in May. Red blood cells made from the whole blood were transfused to a recipient of a community hospital in June with no apparent complications. The blood supplier notified the medical director of the hospital that the donor reported high-risk behavior with another male in April, although viral tests remain negative and the donor is healthy. What course of action should be taken?

A. No action should be taken

B. The recipient’s physician should be notified

C. The recipient’s physician and the recipient should be notified

D. The recipient should be notified

A

B. The recipient’s physician should be notified

33
Q

All of the following are required tests on donor blood, except:

A. HBsAg

B. Anti-CMV

C. HIV-1

D. Anti-HTLV I\II

A

B. Anti-CMV

34
Q

Which of the following bands would constitute a positive Western Blot for HIV?

A. p24, gp41, p17

B. p55, gp120, p51

C. gp160, p31, p56

D. p24, p30, p55

A

A. p24, gp41, p17

35
Q

Is there a discrepancy between the following blood typing and secretor study results?

Blood typing results: Anti-A Anti-B A1 cells B cell 4+ 0 0 4+

Secretor results: Anti-A + saliva + A1 cells = 0, Anti-B + saliva + B cells = 4+, Anti-H + saliva + O cells = 0

A. No problem, the sample is from a group A secretor

B. Blood types as A and saliva types as B

C. Blood types as A, but the secretor study is inconclusive

D. No problem, the sample is from a group A nonsecretor

A

A. No problem, the sample is from a group A secretor

36
Q

What is the best course of action given the following test result? (Assume the patient has not been transfused recently.)

Anti-A Anti-B A1 cells B cells

Mixed field 0 1+ 4+

A. Nothing, typing is normal

B. Type patient cells with anti-A1 lectin and type serum with A2 cells

C. Retype patient cells; type with anti-H and anti-A,B; use screen cells or A2 cells on patient serum; run patient autocontrol

D. Wash patient cells four times with saline, then repeat the forward type

A

C. Retype patient cells; type with anti-H and anti-A,B; use screen cells or A2 cells on patient serum; run patient autocontrol

37
Q

The following results were obtained on a 41-year-old female:

Anti-A Anti-B A1 cells B cells O cells
4+ 0 3+ 4+ 3+

Due to the discrepant reverse grouping, a panel was performed on patient serum revealing the presence of anti-M. How can the reverse grouping be resolved?

A. Repeat the reverse grouping with a 10-minute incubation at room temperature

B. Repeat the reverse grouping using A1 cells that are negative for M antigen

C. Repeat the reverse grouping using A1 cells that are positive for M antigen

D. No further work is necessary

A

B. Repeat the reverse grouping using A1 cells that are negative for M antigen

38
Q

A 59-year-old male came through the emergency department of a community hospital complaining of dizziness and fatigue. History included no transfusions and a positive rheumatoid factor 1 year ago. His CBC confirmed anemia. A sample was sent to the blood bank for a type and crossmatch. Upon receipt of the sample in the blood bank, the MLS noticed the EDTA sample appeared very viscous. Fearing the sample would clog the ProVue, testing was performed using the tube method. Initial results revealed the following:

Anti-A Anti-B Anti-D Rh Control A1 cells B cells
0 0 4+ 2+ 4+ 4+

The patient’s red cells were washed eight times with saline, and testing was repeated giving the following results:

Anti-A Anti-B Anti-D Rh Control A1 cells B cells

0 0 4+ 0 4+ 4+
The antibody screen was negative at IS, 37°C, and AHG phases; check cells were positive. Crossmatch testing using two O-positive donor units revealed a 1+ at immediate spin, and negative results at 37°C and AHG phases. The check cells were positive. In light of the crossmatch results, what is the next course of action?

A. Use other donor cells for the crossmatch

B. Perform a saline replacement for the crossmatch

C. Run the crossmatch using the Gel system

D. Result the crossmatch as incompatible

A

B. Perform a saline replacement for the crossmatch

39
Q

The following results were obtained on a 51-year-old male with hepatitis C:

Anti-A Anti-B Anti-D A1 cells B cells
4+ 4+ 3+ 0 0

What should be done next?

A. Retype the patient’s sample to confirm group AB positive

B. Repeat the Rh typing

C. Run a saline control in forward grouping

D. Report the patient as group AB, Rh positive

A

C. Run a saline control in forward grouping

40
Q

An Rh phenotyping shows the following results:

Anti-D Anti-C Anti-E Anti-c Anti-e
4+ 2+ 0 0 3+

What is the most likely Rh genotype?

A. R1r ́

B. R0r

C. R1R1

D. R1r

A

C. R1R1

41
Q

An obstetric patient, 34 weeks pregnant, shows a positive antibody screen at the indirect antiglobulin phase of testing. She is group B, Rh negative. This is her first pregnancy. She has no prior history of transfusion. What is the most likely explanation for the positive antibody screen?

A. She has developed an antibody to fetal red cells

B. She probably does not have antibodies because this is her first pregnancy, and she has not been transfused; check for technical error

C. She received an antenatal dose of RhIg

D. Impossible to determine without further testing

A

C. She received an antenatal dose of RhIg

42
Q

A patient’s serum contains a mixture of antibodies. One of the antibodies is identified as anti-D. Anti-Jka or anti-Fya and possibly another antibody are present. What technique(s) may be helpful to identify the other antibody(s)?

A. Enzyme panel; select cell panel

B. Thio reagents

C. Lowering the pH and increasing the incubation time

D. Using albumin as an enhancement media in combination with selective adsorption

A

A. Enzyme panel; select cell panel

43
Q

An anti-M reacts strongly through all phases of testing. Which of the following techniques would not contribute to removing this reactivity so that more clinically significant antibodies may be revealed?

A. Acidifying the serum

B. Prewarmed technique

C. Adsorption with homozygous cells

D. Testing with enzyme-treated red cells

A

A. Acidifying the serum

44
Q

The reactivity of an unknown antibody could be anti-Jka, but the antibody identification panel does not fit this pattern conclusively. Which of the following would not be effective in determining if the specificity is anti-Jka?

A. Testing with enzyme-treated cells

B. Select panel of homozygous cells

C. Testing with AET-treated cells

D. Increased incubation time

A

C. Testing with AET-treated cells

45
Q

A cold-reacting antibody is found in the serum of a recently transfused patient and is suspected to be anti-I. The antibody identification panel shows reactions with all cells at room temperature, including the autocontrol. The reaction strength varies from 2+ to 4+. What procedure would help to distinguish this antibody from other cold-reacting antibodies?

A. Autoadsorption technique

B. Neutralization using saliva

C. Autocontrol using ZZAP reagent-treated cells

D. Reaction with cord cells

A

D. Reaction with cord cells

46
Q

An antibody identification panel reveals the presence of anti-Leb and a possible second specificity. Saliva from which person would best neutralize the Leb antibody?

Genes Lewis ABO Secretor

A. Le H sese

B. Le hh Se

C. Le H Se

D. lele hh sese

A

C. Le H Se

47
Q

The Ortho Provue does not detect weak forms of the D antigen. Why would running type and screens on the Provue prevent a patient with a weak D phenotype from forming anti-D?

A. Weak D persons cannot form anti-D

B. The Provue would result the sample as Rh negative; the patient would receive Rh-negative blood

C. The Provue would result the sample as Rh positive; the patient would receive Rh-positive blood

D. A and C

A

B. The Provue would result the sample as Rh negative; the patient would receive Rh-negative blood

48
Q

A cord blood workup was ordered on Baby Boy Jones. The mother is O negative. Results on the baby are as follows:

Anti-A Anti-B Anti-A, B Anti-D DAT (poly)
4+ 0 4+ 0 2+

The test for weak D was positive at AHG. Is the mother an RhIg candidate?

A. No, the baby is Rh positive

B. Yes, the baby’s Rh type cannot be determined due to the positive DAT

C. No, the baby is Rh negative

D. Yes, the mother is Rh negative

A

B. Yes, the baby’s Rh type cannot be determined due to the positive DAT

49
Q

Red cells from a recently transfused patient were DAT positive when tested with anti-IgG. Screen cells and a panel performed on a patient’s serum showed very weak reactions with inconclusive results. What procedure could help to identify the antibody?

A. Elution followed by a panel on the eluate

B. Adsorption followed by a panel on the adsorbed serum

C. Enzyme panel

D. Antigen typing the patient’s red cells

A

A. Elution followed by a panel on the eluate

50
Q

A patient types as O positive. All three screen and red cells from two O-positive donor units show agglutination after incubation at 37°C, and increase in reactivity at the IAT phase of testing. What action should be taken next?

A. Perform an autocontrol and direct antiglobulin test on the patient

B. Perform an enzyme panel

C. Perform an elution

D. Choose another 2 units and repeat the crossmatch

A

A. Perform an autocontrol and direct antiglobulin test on the patient

51
Q

Four units of blood are ordered for a patient. Blood bank records are checked and indicate that 5 years ago this patient had an anti-Jkb. What is the next course of action?

A. Antigen type units for the Jkb antigen and only crossmatch units positive for Jkb

B. Antigen type units for the Jkb antigen and only crossmatch units negative for Jkb

C. Randomly pull 4 units of blood that are ABO compatible and crossmatch

D. Perform an immediate spin crossmatch on 4 Jkb-negative units

A

B. Antigen type units for the Jkb antigen and only crossmatch units negative for Jkb

52
Q

A 56-year-old patient diagnosed with colon cancer demonstrates a positive antibody screen in all three screen cells at the antiglobulin phase. A panel study is done and shows 10 cells positive as well as the autocontrol at the antiglobulin phase. The reactions varied from 1+ to 3+. This patient had a history of receiving 2 units of blood approximately 1 month ago. What should be done next?

A. Perform a DAT on the patient cells

B. Perform an autoadsorption

C. Perform an alloadsorption

D. Issue O-negative cells

A

C. Perform an alloadsorption

53
Q

A 33-year-old maternity patient is drawn for a type and screen at 36 weeks’ gestation. The following results are found on the Ortho Provue:
Anti-A Anti-B Anti-A, B Anti-D A1 cells B cells
3+ 0 4+ 4+ 2+ 4+
SCI SCII SCIII A1 lectin
0 0 0 3+
The reference lab identified anti-P1 in the patient plasma using enzyme techniques. How could the ABO discrepancy be solved?

A. Wash the patient’s red cells and repeat the forward grouping
B. Test the patient’s plasma against A2 cells
C. Warm the patient plasma at 37°C for 10 minutes and repeat the reverse grouping
D. Treat the A1 cells with dithiothreitol and repeat the reverse grouping

A

C. Warm the patient plasma at 37°C for 10 minutes and repeat the reverse grouping

54
Q

An O-negative mother with no record of any previous pregnancies gives birth to her first child, a B-positive baby. The baby’s DAT is weakly positive and the negative control is negative. The antibody screen is also negative. The baby appears healthy but develops mild jaundice after 2 days, which is treated with phototherapy. The baby goes home after 4 days in the hospital without complications. What is the most likely explanation for the weakly positive DAT?

A. Technical error

B. A low titer anti-D

C. Immune anti-B from the mother

D. A maternal antibody against a low-incidence antigen

A

C. Immune anti-B from the mother

Blood banking (4 decks)

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