Blood Bank Final Exam Review

Front 1

A technologist in training noticed that the person training her had not recorded the results of a test. To be helpful, she carefully recorded the results she saw at a later time, using the technologist's initials. Is this an acceptable procedure?

Back 1

No, she should have brought the error to the technologist's attention

Front 2

All of the following are true regarding competency testing except____

Back 2

It is required only if the technologist has no experience

Front 3

Plans that provide the framework for establishing quality assurance in an organization are:

Back 3

Continous quality imorovement

Front 4

Select the term that describes cells or tissue from a genetically different individual within the same species

Back 4

Allogeneic

Front 5

What biological molecules are considered the most immunogenic?

Back 5

Proteins

Front 6

In a serologic test, the term prozone is also known as:

Back 6

Antibody excess

Front 7

What is the potential effect in a tube agglutination test if a red cell suspension with a concentration greater than 5% used?

Back 7

False negatives

Front 8

Select the portion of the antibody molecule that imparts the antibody's unique class function

Back 8

Variable region

Front 9

What portion of the antibody molecule binds to receptors on macrophages and assists in the removal of antibody boind to red cells?

Back 9

FC fragment

Front 10

Which of the following will cause an antigen to elicit a greater immune response?

Back 10

Size greater than 10,000 Daltons >10,000 D

Front 11

Extravascular destruction of blood cells occurs in the _______

Back 11

Liver and spleen

Front 12

An antibody identified in the transfusion service appeared to be reacting stronger following the second exposure to an antigen from a transfusion. The most likely explanation of this observation is:

A. Affinity maturation of the immunoglobulin

B. Anamnestic response

C. Isotype switching

D. All of the above

Back 12

All of the above

Front 13

When testing for the A antigen in a patient, what would you use to perform the test?

Back 13

Patient red cells and anti-a

Front 14

Select the method that uses a dextran-acrylamide matrix

Back 14

Gel technology

Front 15

Which of the following provides evidence for reagent red cell deterioration?

Back 15

If they spontaneously agglutinate, significant hemolysis, loss of agglutination strength

Front 16

What method displays a positive reaction as a compact red cell button?

Back 16

Microtiter plate

Front 17

The antiglobulin test was performed using gel technology. A button of cells was observed at the bottom of the microtube following centrifugation. How do you interpret this result?

Back 17

Negative

Front 18

How would you interpret the results if both the anti-D reagent and the Rh control were 2+ agglutination reactions?

Back 18

Invalid, unable to determine without further testing

Front 19

What immunoglobulin class reacts best by antiglobulin testing?

Back 19

IgG

Front 20

Why is polyethylene glycol reagent added to the screen or panel?

Back 20

It increases the avidity of IgG antibodies

Front 21

A person whose red cells type as M+N+ with antisera would be heterozygous or homozygous?

Back 21

Homozygous

Front 22

What is an advantage of Nucleic Acid Testing (NAT) for viral marker testing?

Back 22

Takes small amounts

Front 23

How is RNA different from DNA?

A. RNA usually exists as a single strand

B. Base uracil exists only in RNA

C. The sugar ribose is substituted for deoxyribose

D. All of the above

Back 23

All of the above

Front 24

When using the Hardy-Weinberg equation to calculate genetic frequencies, what must be TRUE?

Back 24

Population statistics have to be large, mutations cant occur, and mating has to be random

Front 25

If two traits occur higher in a population together than occurs separately, they may be linked. What does this fact suggest?

Back 25

The genes are close together on the same chromosome

Front 26

Which of the following clinical applications applies to molecular testing for blood group antigens?

A. Confirm the D type of blood donors

B. Identify fetus at risk for HDFN

C. Predict the phenotype of a patient with autoimmune hemolytic anemia

D. All of the above

Back 26

All of the above

Front 27

What is the test procedure that combines patient's serum with commercial A1 and B reagent red cells?

Back 27

ABO reverse grouping

Front 28

According to Landsteiners rule (law), what ABO antibody will be detected in a group A individual's serum?

Back 28

Anti-B

Front 29

Given the following ABO phenotype data:

FORWARD. REVERSE

Anti-A: 2+mf. A1 cells: 0

Anti-B: 0. B cells: 3+

What could be a plausible explanation for this discrepancy?

Back 29

Group-O blood products given to group A

Front 30

Most "naturally occurring" ABO system antibodies fall into which immunoglobulin class?

Back 30

IgM

Front 31

An anti-E was identified in a patient who recently received a transfusion. What other Rh system antibody should be investigated?

Back 31

Anti-c (little c)

Front 32

The frequency of D-negative phenotype in the population is:

Back 32

15%

Front 33

The numeric Rh4 nomenclature refers to which antigen in the Rosenfield notation?

Back 33

Little c

Front 34

Why is the determination of the D antigen important for women during pregnancy?

Back 34

A D-negative mother should be given Rh immune globin to prevent potential formation of anti-D during delivery of a D-positive infant

Front 35

What is the immunoglobulin class of most Rh system antibodies?

Back 35

IgG

Front 36

An individual's red cells gave the following reactions with antisera:

Anti-D. Anti-C. Anti-E. Anti-c. Anti-e. Rh cont.

4+ 3+ 0. 3+ 3+ 0

The most probable genotype is:

Back 36

R°r

Front 37

If D-negative red cells are transfused to an R1R1 individual, what is the most likely Rh antibody that could develop?

Back 37

Anti-c

Front 38

K-positive donor red cells were mistakenly transfixed to a recipient with anti-K. The patient's posttransfusion blood sample has a positive direct antiglobulin test with polyspecific antihuman globulin. The direct antiglobulin test is positive because anti-K is an ________ antibody that has sensitized the (recipient or donor) ________ cells in vivo.

Back 38

IgG, donor's

Front 39

Which phenotypes are heterozygous?

Back 39

Fy (a+b+)

Front 40

Antibodies to which of the following blood group system show dosage (i.e., are stronger with homozygous expression of the antigen)?

Back 40

Duffy

Hint 40

Front 41

What phenotype will be expressed when the Le, Se, and H genes are inherited?

Back 41

Le (a-b+)

Front 42

Which condition is often associated with the presence of anti-I?

Back 42

Mycoplasma pneumoniae infection

Front 43

What characterizes the Donath-Landsteiner antibody?

Back 43

An IgG auto anti-P

Front 44

A patient's antibody history listed an anti-Cellano. This antigen is also known as:

Back 44

k (Kell)

Front 45

The mixed lymphocyte culture (MLC) is a procedure that has been used in HLA testing to determine:

Back 45

Class 1 HLA antigen determination and Class 2 HLA determination

Front 46

HLA matching between the donor and recipient is important for progenitor cell transplantation to avoid:

Back 46

Graft vs. Host Disease (GVHD) and graft rejection

Front 47

In the process of identifying an antibody, the technologist observed 2+ reactions with 3 of the 10 cells in a panel at the immediate-spin phase. These reactions disappeared following incubation at 37°C and the antihuman globulin phase of testing. Given a list of antibodies, which one is most likely responsible?

Back 47

Le

Front 48

If all antibody identification panel cells were reactive at the same strength at the antihuman globulin phase, no negative reactions were observed, and the autocontrol was negative, what antibody should be suspected?

Back 48

Antibody to a high frequency antigen

Front 49

What is the most important concern when trying to identify antibodies in a patient with a warm autoantibody?

Back 49

Determine whether there are underlying antibodies

Front 50

High-titer, low avidity antibodies typically

Back 50

React with antigens of high frequency in the population.

Front 51

Describe the elution technique.

Back 51

Technique that disassociated IgG antibodies from red cells fir further identification.

Front 52

What is the immunoglobulin class of antibodies detected in the immediate spin crossmatch?

Back 52

IgM

Front 53

Select the correct statement regarding the collection of a blood sample for compatibility testing

Back 53

Sample must be labeled at bedside

Front 54

What are two components of the major crossmatch?

Back 54

Donor reds, recipient serum.

Front 55

A group O patient was crossmatched with group B red blood cells. What phase of the crossmatch will first detect this incompatibility?

Back 55

Immediate-spin

Front 56

If not stored in a monitored refrigerator, how long can RBC units remain outside the transfusion service to allow reissue?

Back 56

30 minutes

Front 57

How long following transfusion must the recipient's sample be stored?

Back 57

7 days

Front 58

A 29-year-old female was admitted to the emergency room with severe bleeding. The blood type was group AB, D-negative. Six units of RBC's are ordered STAT. What blood type would bebthe most preferable for crossmatch?

Back 58

A, D-

Front 59

Which of the following instruments performs assays using gel technology?

Back 59

ProVue

Front 60

A smooth layer of cells in the bottom of tye well is interpreted as a/an __________ reaction when the solid-phase red cell adherence method is completed for the antiglobulin test:

Back 60

Positive

Front 61

What items are required before implementing new automation technology into the transfusion service setting?

Back 61

Validation, training, and written procedures.

Front 62

A patient has a rise in temperature and chills during a transfusion. The transfusion is stopped, and a posttransfusion blood sample is carefully drawn. What should the transfusion service immediately perform upon receipt of this postreaction sample?

Back 62

Perform a clerical check, observe the color of the serum, and perform a direct antiglobulin test.

Front 63

What clinical signs are associated with a hemolytic transfusion reaction?

Back 63

Disseminated intravascular coagulation, renal failure, and shock

Front 64

Under what circumstances would a direct antiglobulin test be negative in the presence of a hemolytic process?

A. Bacterial contamination of unit

B. Medications administered within RBC unit

C. Transfused quickly through leukocyte reduction filter

D. All of the above

Back 64

All of the above

Front 65

A patient is diagnosed with cardiac insufficiency and needs a red,blood cell transfusion. How should the transfusion be administered?

Back 65

The red blood cell unit should be transfused slowly over a 4-hour period

Front 66

Antibodies to which blood group system is often implicated in delayed transfusion reactions?

Back 66

Kidd

Front 67

In a delayed hemolytic transfusion reaction, what is a typical DAT result?

Back 67

Mixed-field positive

Front 68

The Kleihauer-Betke test was performed using a 1-hour post-delivery maternal blood sample. It is the policy to add 1 vial of Rh immune globulin to the calculated dose when the estimated volume of the hemorrhage exceeds 20 mL of whole blood. Calculate the number of vials of Rh immune globulin that would be indicated under these circumstances when given the number of fetal cells counted /total cells counted.

Back 68

3 (she may give different values!)

Front 69

Which elution method is ideal in the investigation of ABO hemolytic disease of the fetus and newborn?

Back 69

Lui freeze-thaw

Front 70

A group O, D-positive mother gave birth to a group A, D-negative infant. After 24 hours, the newborn's bilirubin level rose to 19 mg/dL. A direct antiglobulin test performed on the cord blood specimen was positive with anti-IgG. What antibody is most likely implicated?

Back 70

ABO anti-A, B

Front 71

What is the principle behind the rosette test? Is it qualitative or quantitative?

Back 71

Rh- mom with Rh+ infant. Qualitative.

Front 72

During a first-trimester prenatal examination, a pregnant group A, D-negative woman had an anti-D tiger of 8. What isnthe most likely course of action?

Back 72

Repeat the titer in 4 weeks if significant rise is detected

Front 73

The rosette test will detect a fetomaternal hemorrhage as small as:

Back 73

10mL

Front 74

A 0.3% fetomaternal bleed was determined by a Kleihauer-Betke stain of postpartum blood. What is the estimated volume of the fetomaternal blood expressed as whole blood?

Back 74

15mL

Front 75

Which history represents an acceptable male donor?

Back 75

Hematocrit: 39%

BP: 90/60

Temp: 98.9

Pulse: 65

Age: 65

Front 76

Autologous donors may not donate if they:

Back 76

Are on antibiotics for an infection

Front 77

How long must a donor wait to donate red blood cells again following a 2-unit red blood cell apheresis donation?

Back 77

16 weeks

Front 78

What is the minimum hemoglobin level for a potential female allogeneic donor?

Back 78

12.5

Front 79

Below are the results of the medical screening for a prospective female donor:

Age: 16Hematocrit: 35%Temperature: 37.2°CHemoglobin: 12.0 g/dLHistory: HPV immunization 1 week agoHow many of the above results would exclude this donor from donating?

Back 79

2

2

2

2

2

2

Front 80

Why is Hepatitis A virus transmission in blood unusual?

A. Transmitted by the enteric route

B. Acute hepatitis

C. Only 2 weeks

D. All of the above

Back 80

All of the above

Front 81

Define a hepatitis B carrier.

Back 81

Person who can transmit hepatitis B, but may not be outwardly effected

Front 82

Transfusion-associated hepatitis can be caused by which hepatitis viruses?

Back 82

Hep B, Hep C, and Hep D

Front 83

What is the significance of a positive RPR test for syphilis?

Back 83

Possibility of Treponema pallidum infection

Front 84

What diseases are currently screened using nucleic acid tests?

Back 84

Hep B, Hep C, WNV, and HIV

Front 85

If a donor is positive for hepatitis C virus by nucleic acid testing, why is the process of "look-back" initiated?

Back 85

To quarantine units that existed from prior donations, notify recipients, and to locate and quarantine units sent to transfusion facilities

Front 86

What is the organism that causes Chagas disease?

Back 86

Trypanosoma cruzi

Front 87

Some donor centers have implemented the practice of diverting the first few milliliters of blood collected into a pouch attached to the collection bag. What is the purpose of this procedure?

Back 87

To reduce the risk of contamination.

Front 88

When are surrogate marker tests useful?

Back 88

Used when direct testing is not available

Front 89

What happens if clinically significant red cell antibodies are found in donor units?

Back 89

Nothing, RBC antibodies don't affect units

Front 90

Addition of what solution will increase the shelf life of red blood cells?

Back 90

AS-3

Front 91

What patient population needs leukocyte reduced red blood cells?

Back 91

Anyone with a history of febrile reactions

Front 92

What is the minimum acceptable storage temperature for frozen red blood cells?

Back 92

-65°C

Front 93

What is the correct storage temperature and time limit for pooled platelets?

Back 93

20-24°C for 4 hours

Front 94

Platelet concentrates that are prepared from whole blood have a minimum quality control limit of ___________ platelets in _______ of the units tested.

Back 94

5.5x10^10, 75%

Front 95

Plasma, frozen within 24 hours of collection (PF24), has similar coagulation factors as what plasma product?

Back 95

FFP

Front 96

Why are plastic overwraps recommended when thawing FFP and CRYO?

Back 96

To prevent entry ports from being contaminated.

Front 97

Select an important determination of platelet viability following the recommended storage interval

Back 97

pH

Front 98

What is the most effective component to treat a patient with von Willebrand disease?

Back 98

Cryoprecipitated AHF

Front 99

What term describes the replacement of one or more blood volumes within 24 hours whether an infant or in an adult patient?

Back 99

Massive transfusion

Front 100

Massive transfusion replaces 1 blood volume. In a 70-kg adult, how many units of whole blood would be needed?

Back 100

10 units