Clinical Pathology(Tranfusion Medicine)

Front 1

Transfusion-associated graft versus host disease has been identified in each of the following recipients after receiving nonirradiated cellular blood transfusion EXCEPT:
a. Hodgkin lymphoma
b. DiGeorge syndrome
c. Directed blood donation from blood relative
d. Neuroblastoma
e. AIDS secondary to HIV

Back 1

e.
HIV/AIDS does not cause TAGVHD due to dysfunction of T cells. It suggested that the virus infects the donor T cells and becomes dysfunctional.

Front 2

Which of the following would result in the permanent deferral of a prospective blood donor?
a. Visited a malaria area
b. Received a tattoo
c. Intranasal use of cocaine
d. Positive test for syphilis but received treatment
e. Intake of etretinate (Tegison) for psoriasis

Back 2

e. Etretinate
(Tegison) is a medication for psoriasis and may cause fetal malformation. The user is permanently deferred.

Front 3

What is the expected hematocrit when a 70 kg nonbleeding patient with a hematocrit of 25% receives two units of packed red cells?
a. 28%
b. 31%
c. 34%
d. 36%
e. 38%

Back 3

b.
In a 70 kg non-bleeding person, each unit of packed red cell should raise the hematocrit by
3%or 1 gm
of hemoglobin.

Front 4

A woman who is Rh (D) negative delivered a Rh (D) positive newborn. A Kleihauer-Betke acid elution test is performed and shows that 1.2% of red cells are positive. How
many 300-!g doses of Rh immunoglobulin are recommended for administration?
a. 1 dose
b. 2 doses
c. 3 doses
d. 4 doses
e. 5 doses

Back 4

c.
The 1.2% red cells acid resistance containing HbF is equivalent to 60 cc red cells. In an average pregnant female, 60 ml of whole blood needs 2 doses of anti-D antibody,
and another dose is added (i.e., 3 of 300 !g doses are required).

Front 5

What is the fluid permitted by FDA and AABB to be administered simultaneously with blood or blood components within the same IV line?
a. Lactated Ringer solution
b. 0.45% sodium chloride
c. 0.9% sodium chloride
d. Any medication
e. IVIG

Back 5

c. 0.9% sodium chloride
(normal saline) is the only fluid permitted by FDA and AABB to be used simultaneously with blood products.

Front 6

The majority of transfusion associated acute lung injury (TRALI) cases are caused by:
a. Clerical or managerial error
b. Platelets specific antibody HPA-1
c. Undetected anti red cell antigen in donor plasma
d. Anti HLA/granulocytes antibody in donor plasma
e. Fluid overload

Back 6

d. TRALI
in most cases is caused by granulocyte agglutination in lung capillaries due to presence of anti-HLA/granulocytes antibodies in donor plasma.

Front 7

A patient with sickle cell disease is found to have an anti-G antibody. What other antibody might this patient have?
a. Anti-M and N
b. Anti-S and S
c. Anti-Jka and Jkb
d. Anti-D and C
e. Anti-c and e

Back 7

d.
The G antigen is present on red cells possessing either C or D antigens. Antibodies against G may be present with anti-C and D.

Front 8

Newborn red blood cells differ from those in the adult. Which antigens are present on newborn red blood cells?
a. Lea Leb
b. Lea only
c. Leb only
d. Lea, Leb, and I
e. None of the above

Back 8

e.
Lea, Leb, and I are not produced at birth.

Front 9

A white female, blood type A, Rh positive, received two units of compatible red cells postpartum. During
her second pregnancy, the prenatal screening tests for red cell antibodies are positive with all of the screening cells and panels. Her direct antiglobulin test is negative. Her red
cell Rh phenotype is D positive and negative for the other Rh antigens. What is her red cell Rh phenotype?
a. R1r
b. RzRy
c. D- -
d. Rr
e. R1R2

Back 9

c.
This patient Rh type is D- - (Rh17); patient is not producing E, e, C, c antigens.

Front 10

In Fisher and Race CDE terminology, if patient phenotype is D positive, c negative and E negative, the haplotype is:
a. R1r'
b. R2r
c. Rzr
d. R2R1
e. R1R1

Back 10

e.
A patient who is CDe is also designated
R1R1

Front 11

The McLeod phenotype lacks which of the following red cell antigen system?
a. Kidd system
b. Duffy system
c. MNS system
d. Kell system
e. Rh system

Back 11

d. McLeod
phenotype lacks the Kell system and may show specific changes in red cell morphology such as shortened survival, reduced deformability, decreased permeability to
water, and acanthocytic morphology.

Front 12

A person who lacks Ss antigens may lack the U antigen and may develop anti-U following a red blood cell transfusion. The person is a member of which ethnicity?
a. White
b. Hispanic
c. Black
d. Asian
e. Arabic

Back 12

c.
The U antigen is a high-frequency antigen present in 100% of white population and present in 99% of black population. Blacks who are negative for U may develop anti-U
antibody if they receive a U positive red blood cell unit. This antibody is capable of causing hemolytic transfusion reaction and hemolytic reaction of fetus and newborn.

Front 13

Antigens of the MNS system are carried on:
a. Glycophorins A and B
b. Glycophorin A
c. Glycophorin B
d. Rh system
e. Kell system

Back 13

a.
MNS system is located on glycophorins A and B which are single-pass transmembrane glycoproteins.

Front 14

The Rh system is complex blood group phenotype controlled by:
a. One gene
b. Two genes
c. Three genes
d. Four genes
e. Five genes

Back 14

b.
There are two genes which control the production of Rh system, one gene for D and one gene for CE antigens.

Front 15

The genes encoding the glycosyltransferases that produce A and B red cell antigens are located on which chromosome?
a. Chromosome 6
b. Chromosome 1
c. Chromosome 9
d. Chromosome 4
e. Chromosome 2

Back 15

c.
The genes are located at
chromosome 9 (9q34.2).

Front 16

In Fisher and Race CDE terminology, if a patient's phenotype is D positive, C negative, and e negative the type is:
a. R1r
b. R0r
c. Rr
d. R2R1
e. R2R2

Back 16

e.
In Fisher and Race system, the phenotype is
R2R2

Front 17

Rh genes encode nonglycosylated polypeptides on what chromosome?
a. Chromosome 6 large arm
b. Chromosome 1 short arm
c. Chromosome 9 short arm
d. Chromosome 4 long arm
e. Chromosome X

Back 17

b.
The two highly homologous Rh genes are located on the short arm of
chromosome 1

Front 18

In Fisher and Race CDE terminology, if a patient phenotype is D negative, C negative, and E negative, the haplotype is:
a. R1r'
b. R2r''
c. R0r
d. r'r
e. rr

Back 18

e.
In Fisher and Race system, D-negative, C-negative and E-negative phenotypes are designated as rr

Front 19

The quality of platelets collected by apheresis and labeled as leukocytes-reduced follow which FDA-mandated criterion?
a. Less than 5 ! 106 leukocytes
b. Less than 5 ! 107 leukocytes
c. Less than 5 ! 109 leukocytes
d. Less than 5 ! 102 leukocytes

Back 19

a.
FDA requires that apheresis platelet unit may contain equal or less than
5 ! 106 leukocytes

Front 20

The quality of platelet concentrates derived from whole blood follow which FDA-mandated criterion?
a. Platelet counts >5.5 !1010 in 95% of the tested units
b. Platelet counts >5.5 ! 1010 in 100% of the tested units
c. Platelet counts >5.5 ! 106 in 75% of the tested units
d. Platelets count >5.5 ! 106 in 100% of the tested units

Back 20

a.
FDA requires that whole blood platelet units contain
5.5 x 1010 or more in 75% of the units tested

Front 21

Plasma transfusion is indicated for each of the following conditions EXCEPT:
a. Deficiency of vitamin K depending coagulation factors
b. Liver disease with elevated coagulation screening tests
c. Warfarin reversal
d. Plasma albumin low
e. Fluid replacement for thrombotic thrombocytopenic purpura during apheresis

Back 21

d.
Plasma transfusion is used to replace coagulation factors in case of vitamin K-dependent coagulation factors deficiencies include liver disease and warfarin medication,
and to increase ADAMTS13 in thrombotic thrombocytopenic purpura. It is not used to increase plasma albumin or as fluid replacement.

Front 22

Justifications for transfusion of red blood cells are derived from:
a. AABB Standards
b. FDA CFR
c. The hospital code of conduct
d. CAP survey documents
e. The clinical condition of the patient based on medical record review

Back 22

e.
The combination of clinical evidence and hemoglobin concentration is the best tool to judge the need for red cell transfusion.

Front 23

Red blood cell products used for intrauterine exchange transfusions have all the following characteristics EXCEPT:
a. Leukocyte-reduced
b. Irradiated
c. Rh negative
d. CMV safe
e. Washed

Back 23

e.
With the advancement of leukocyte-reduced filters and other methods of removing most of the white cells,
washed red cells
are not required for intrauterine exchange transfusion.

Front 24

The FDA drafts guidance for industry to provide Look Back policies for donors at risk for transmission of what disease?
a. Malaria
b. Parvovirus infection
c. Creutzfeldt-Jakob disease
d. HCV infection
e. Hepatitis B infection

Back 24

d.
Donors with increased risk of transmitting Hepatitis C virus (HCV) or HIV infection are included in Look Back policies. However, recent concern over vCJD and TRALI may
result in change in those policies.

Front 25

Records of patient with clinically significant antibodies must be retained for a minimum of:
a. Indefinite
b. 10 years
c. 5 years
d. 2 years
e. 1 year

Back 25

a.
Patient records with clinically significant antibody must be retained
indefinitely

Front 26

Information on severe adverse reactions to transfusion in adults should be retained for a minimum of:
a. 60 years
b. 10 years
c. 5 years
d. 2 years
e. 1 year

Back 26

c.
Severe adverse reaction for patient or donor may be retained for
5 years or more. In cases of infants and children, some hospitals require longer retention period.

Front 27

The Standards for Blood Banks and Transfusion Services require that a patients' sample must be labeled with which of the following?
a. Patient name and date of admission
b. Two independent unique identifications of the patient and the identification of the phlebotomist
c. Two independent identifications of the patient include patient name, time of the sample drawing, and the phlebotomist ID
d. Patient name, location, bed number, and ID of the phlebotomist
e. Patient name and home address

Back 27

b.
Two independent unique identifiers and a method to identify the phlebotomist are required by AABB standard. These two unique identifiers may include patient's name,
medical record, or social security number. Addresses and patient hospital room numbers are not unique identifiers.

Front 28

Which of the following statements about the computer crossmatch is true?
a. Serologic crossmatch must be recorded in computer permanent file.
b. All Blood Bank services must use FDA approved software.
c. Patient who has two ABO and Rh typing with negative antibody screen and no transfusion or pregnancy during last 90 days may transfuse blood with no serologic crossmatch.
d. Patient computer data must be accessed by the Blood Bank personnel only.
e. FDA may have an access to the patient's crossmatch in case of acute hemolytic transfusion reaction.

Back 28

c.
Computer crossmatch does not require serologic crossmatch; the patient must have two ABO and Rh types performed in advance with negative antibody screen and no
transfusion or pregnancy during the last 90 days.

Front 29

The Standards for Blood Banks and Transfusion Services are issued by:
a. FDA
b. AABB
c. American Red Cross
d. America's Blood Centers
e. FDA, AABB, America's Blood Centers

Back 29

b.
The AABB publishes the
Standards for Blood Banks and Transfusion Services.

Front 30

A 57-year-old white man with history of myelodysplastic syndrome and multiple red cell transfusion was found to have anti-Jka, E, and S antibodies. What is the probability of
finding compatible red cell units? (Incidence of positive red cells for Jka 77%, E 29%, and S 55% in white population.)
a. 12%
b. 9%
c. 50%
d. 7%
e. 29%

Back 30

d.
Only 7% compatible units will be negative for Jka, E, and S (0.23 x 0.71x 0.45).

Front 31

Anaphylactic reactions associated with blood transfusions may occur in patients who are IgA deficient. Which of the following statements about IgA deficiency in populations
of European descent is correct?
a. IgA deficiency is very rare in this populations.
b. IgA deficiency is the most common congenital immunodeficiency.
c. It affects 1 in 7000-8000 persons.
d. It affects 1 in 70,000-80,000 persons.
e. It affects 1 in 100,000-200,000 persons.

Back 31

b. IgA deficiency
is the most common congenital immunodeficiency affecting 1 in 700-800 persons of European descent. The production of IgE and anti-IgA may occur in these patients
when receiving transfusion. Anaphylactic reaction may occur if these patients receive blood containing IgA. The cellular blood products must be washed to remove the
plasma IgA or obtained from IgA-deficient donor.

Front 32

A newborn presents with petechia on the trunk. The baby is diagnosed with neonatal associated thrombocytopenia purpura. The mother is found to have antibodies against
rare platelet antigens. The maternal aunt's platelets are transfused to the newborn. Ten days later the baby presents with fever, hepatitis, diarrhea, and dermatitis. The cause of
these symptoms is:
a. Posttransfusion hepatitis C disease
b. Budd-Chiari syndrome
c. Hemolytic disease of newborn (HDN)
d. Transfusion-associated graft host disease
e. Bacterial infection due to bacterial contamination of platelets

Back 32

d.
Transfusion-associated graft versus host disease may occur when nonirradiated blood is transfused from one relative to a related recipient due to similarities in the HLA
of the donor and recipient. In homogenous populations such as the Japanese or Israelis, sharing of HLA is reported.

Front 33

A 62-year-old woman who received multiple blood transfusions due to chemotherapy-associated anemia, presents with petechia and bleeding eight days post red cell
transfusion. The CBC shows hemoglobin of 9.5 gm/dl, hematocrit of 38%, white count of 8.5 ! 109/l with 70 % segmented neutrophils, 24% lymphocytes,
5% monocytes and 1% eosinophils, and platelet count of 8.500x109/l.What is the diagnosis?
a. Immune thrombocytopenia purpura
b. Chemotherapy associated thrombocytopenia purpura
c. Viral associated thrombocytopenia purpura
d. Posttransfusion purpura
e. Malignancy associated thrombocytopenia purpura

Back 33

d.
Posttransfusion purpura is a rare post-red cell transfusion complication. It is characterized by severe thrombocytopenia occurring within an average 9 days (range of 1-24 days) after red cell
transfusion. Most affected patients have been pregnant or transfused.

Front 34

Plant-derived lectins are chemically composed of:
a. Complex carbohydrates
b. Proteins
c. Glycoproteins
d. Lipoproteins
e. Small peptides

Back 34

c. Lectins are glycoproteins that may be bound to specific monosaccharides; either free monosaccharides or as part of glycoproteins.

Front 35

Which of the following lectins are used to differentiate between A1 and A2 red cells?
a. Arachis hypogaea
b. Glycine max (soja)
c. Dolichos biflorus
d. Ulex europaeus
e. Saliva horminium

Back 35

c. Dolichos biflorus
is a lectin which agglutinates A1 but not A2 red cells and may be used to differentiate between them.

Front 36

Pooled units of thawed pooled cryoprecipitated antihemophilic factor (AHF) stored at 20-24°C should be transfused within:
a. 24 hours
b. 6 hours
c. 4 hours
d. 3 days
e. 5 days

Back 36

c.
Pooled cryoprecipitated AHF
expires within 4 hours
if kept at room temperature or 6 hours for a single unit.

Front 37

A single unit of thawed cryoprecipitated AHF if not transfused immediately should be stored under what conditions?
a. Eight hours at -20°C
b. One hour at 4°C
c. Six hours at 20-24°C
d. Refreeze the unit
e. Eight hours at 20-24°C

Back 37

c.
Single unit of cryoprecipitated AHF may be, if not transfused immediately, stored for
6 hours at 20-24°C

Front 38

Routine infectious disease testing for blood donors includes the following EXCEPT:
a. HIV by NAT testing
b. HCV by NAT testing
c. Cytomegalovirus by PCR
d. West Nile Virus by PCR
e. HTLV I/II by enzyme immune assay

Back 38

c.
Screening for Cytomegalovirus by PCR is not a routine test for donor screening. It is not done routinely but upon request for patients whose immune system is
suppressed such as in congenital immune deficiency, intrauterine blood exchange, or in those receiving highdose immunosuppression.

Front 39

A transfusion-dependent patient received two units of packed red cells. Approximately 8 days posttransfusion, the patient developed severe thrombocytopenia. The probable
cause of the thrombocytopenia is:
a. Idiopathic thrombocytopenia purpura
b. Thrombotic thrombocytopenia purpura
c. Acute renal failure
d. Splenomegaly
e. Posttransfusion purpura

Back 39

e. Post transfusion purpura
is a rare thrombocytopenia secondary to blood transfusion occurring 1 week to 9 days after red cell transfusion. It is characterized by abrupt onset of severe
thrombocytopenia. Most patients have been previously transfused or pregnant. Fatal intracranial hemorrhage may occur. The mechanism of patient's platelets
destruction by what appears to be platelets alloantibody is controversial. Treatment with IVIG or plasmapheresis is often helpful.

Front 40

Which one of the following is an indication for blood donation deferral?
a. Return from traveling to a malaria endemic area less than a year ago
b. Tattoo performed less than three weeks ago
c. Receiving recombinant growth factor
d. Receiving rabies vaccine within the last two weeks
e. Receiving the flu vaccine two days ago

Back 40

c.
All the mentioned criteria cause donor deferral except receiving recombinant growth factor. Donors who in the past received animal source growth factor are permanently
deferred.