Only $2.99/month

Purple book

Terms in this set (897)

List several blood group antigens of low incidence.

Kp(a)
Js(a)
Lu(a)
C(w)
These antigens are found in less than 1% of the population

List several high incidence blood group antigens

Kp(b)
k
Js(b)
Lu(b)
I
U
These antigens are found in 99% of the population

What 4 RBC antigens are not fully expressed at birth

A
B
I
P(1)
Lewis
Lutheran

What is sensitization?

Attachment of antibodies to antigen on a red cell

Why should serum separator tubes not be used for blood bank testing?

The gel can contaminate the red blood cells during sampling and can cause false-positive test results.

What is the terminal sugar on the B antigen?

D-galactose

What is the terminal sugar on the A antigen?

N-acetylgalactosamine.

Which races have the higher percentage of group B?

Blacks and Chinese.

When might anti-A,B be used?

Anti-A,B is no longer used for routine typing but some labs use it for confirmatory typing of Group 0 red cell units.

What might cause the naturally-occurring isoagglutinins to be decreased in titer or missing?

Hypo- or agammaglobulinemia, leukemia, or the age of the patient.
Babies do not have detectable levels of naturally-occurring isoagglutinins in their plasma/serum until 3-6 months of age and titers decrease in the elderly.

What are lectins?

Extracts from plant seeds or animals that have antibody-like activity. For example, Dolichos biflorus agglutinates A1 cells and Ulex europeus reacts with the H determinant.

Why is anti-A1 not detected in an antibody screen?

Antibody screening cells are group 0. Anti-A1 only reacts with A1 cells.

How is anti-A1 usually discovered?

By an ABO discrepancy in which there is unexpected agglutination of Ai cells in the reverse grouping of a group A.

What group of blood should be transfused to a patient with anti-A1?

If the antibody is reactive at 37°C, cells lacking the A1 antigen (subgroup of A or group 0) should be transfused.
Anti-A1 that only reacts below 30°C is not considered clinically significant. In actual practice, some blood banks would provide subgroup of A or group 0 blood without testing the thermal range of the Anti-A1. The laboratory's
standard operating procedures (SOP) should be followed.

How can rouleaux interfere with blood bank tests?

Rouleaux cause false-positive reactions with all cells mixed witth the serum. Rouleaux are due to a serum protein abnormality and are usually seen in patients with multiple myeloma.

While retyping a group B trauma patient, the technologist observes mixed field agglutination with anti-B. Typing at the lime of admission showed 4+ agglutination with anti-B. What might have caused this change in
reactivity?

The patient might have been transfused with a large volume of group 0 ABCs. The transfusion history should be
checked.

How does the acquired B antigen usually react?

It typically agglutinates strongly with anti-A and weakly with anti-B, and the serum contains strong anti-B.

How might transfusion of non-group specific blood affect subsequent blood grouping result?

Donor cells are detectable in the recipient for up to 4 months, the life span of the RBC. Front grouping reactions may be weak or mixed-field if group 0 cells have been transfused to a patient of another group. Passive anti-A
and/or anti-B might be detected in the reverse grouping if large volumes of group 0 RBCs or platelets have been transfused to a patient of another group. These products contain some plasma and naturally-occurring isoagglutinins

How might agammaglobulinemia or leukemia affect a patient's blood grouping?

The naturally-occurring isoagglutinins might be weak or missing. With leukemia, certain antigens may also be
weak or missing.

Which blood groups are most likely to have anti-H?

Al and AIR (Bombays also have very string anti-H.)

What type of antibody is anti-H?

A naturally-occurring cold antibody

Which Rh antigen determines Rh type?

D (Rho). The presence of the D antigen denotes Rh-positive blood.

Why is an Rh control included when using high-protein Rh typing sera?

To detect false-positive reactions. If the Rh typing and the Rh control are both positive, the test is invalid.

Which Rh typing sera do not require use of an Rh control?

Saline anti-D,
chemically modified anti-D,
or anti-D monoclonal/polyclonal blend.

These reagents have a low
protein content. Manufacturers frequently recommend the ABO front type as a suitable control. For group AB patients, a 6-8% albumin control or a saline control should be run. The manufacturer's instructions should always
be followed.

How is testing for weak D performed and when is it required?

The Rh typing is carried through an indirect antiglobulin phase. Weak D testing is required on blood donors who
type Rh negative.

A unit of Rh-positive blood is erroneously typed as Rh negative. Will this mistake be caught in the
crossmatch?

Not unless the Rh-negative recipient has anti-D and a complete crossmatch is performed.

A donor's RBCs fail to react with anti-D typing serum during routine testing. When the tubes are carried through the indirect antiglobulin phase, agglutination is observed with anti-D, but not with the control. How should this blood be classified for transfusion purposes?

The donor is a weak D, therefore, the unit is labeled Rh positive.

What Rh type should a weak D patient receive?

A weak D recipient may be transfused with either Rh positive or Rh negative.

Since the test for weak D is not routinely performed on recipients, Rh-negative blood is usually provided.

What are the consequences of infusing D positive RBCs into an Rh-negative recipient with a negative antibody screen?

There would not be a transfusion reaction, but the recipient might develop anti-D.

Which Rh gene complexes are most common in Caucasians?

RI, R2, and r. (The frequencies are 42%, 14%, and 26% respectively.)

Which Rh gene complex is common in Blacks and uncommon in Caucasians?

R°. (The frequency is 44% for Blacks and 4% for Caucasians.)
Which Rh gene complexes are present in only 2% or less of Caucasians

What is the most common genotype for Rh negatives?

What is the most common genotype for Rh positives?

R1r

What is the most common Rh antigen in Caucasians?

98% of Caucasians are positive for e.

What percentage of Rh-negative children would be expected from an R'R' mother and an R1r father?

None. All offspring would be Rh positive

A patient's RBCs react with anti-D, anti-C, anti-c, and anti-e. They do not react with anti-E. Which of the
following might be the patient's Rh genotype: R1r, RIR2, rr, r'r?

R1r

Which of the following Rh genotypes could develop anti-C: RIr, R'R', r'r, rr?

Which antibody could an RIRI individual make if exposed to R2R2 blood?

anti-E

If a patient has anti-e, which of the following units could he receive: R2R2, R1R1, RIR2, R2R2, R1r?

R2R2 (DcE/DcE). All of the others have the e antigen.

b (All donors, regardless of sex, require a minimum hemoglobin of 12.5 g/dL [125 g/L]. The value must not be performed on an earlobe stick.)

1) The minimum Hgb concentration in a fingerstick from a male blood donor is:
a. 12.0 g/dL (120 g/L)
b. 12.5 g/dL (125 g/L)
c. 13.5 g/dL (135 g/L)
d. 15.0 g/dL (150 g/L)

d (A positive test for HbsAg at any time is an indefinite deferral.)

4) Which of the following constitutes permanent rejection status of a donor?
a. a tattoo 5 months ago
b. recent close contact with a patient with viral hepatitis
c. 2 units of blood transfused 4 months previously
d. confirmed positive test for HbsAg 10 yrs. earlier

b (The Hct must be >38%. A donor may be 16 unless state law differs. Temperature must not exceed 99.5F/37.5C, blood pressure must be <180 mmHg systolic and <100 mmHg diastolic, pulse 50-100 unless an athlete [which can be lower]. Toxoids and vaccines from synthetic or killed sources have no deferral.)

6) Below are the results of the history obtained from a prospective female blood donor:
- age: 16
- temperature: 99.0F (37.2C)
- Hct: 36%
- history: tetanus toxoid immunization 1 week previously
How many of the above results excludes this donor from giving blood for a routine transfusion?
a. none
b. 1
c. 2
d. 3

d (The scrub must use iodine, eg, PVP iodine complex. Donors who are sensitive to iodine can have the area cleaned with a preparation of 2% chlorhexidine and 70% isopropyl alcohol.)

8) Prior to blood donation, the intended venipuncture site must be cleaned with a scrub solution of:
a. hypochlorite
b. isopropyl alcohol
c. 10% acetone
d. PVP iodine complex

d (Testing tor syphilis was the first mandated donor screening test for infectious disease and is still part of donor screening.)

9) All donors blood testing must include:
a. complete Rh phenotype
b. anti-CMV testing
c. DAT
d. serological test for syphilis

b (Platelets are prepared and stored at 20-24 C for optimum function.)

10) During the preparation of Platelet Concentrates from whole blood, the blood should be:
a. cooled towards 6 C
b. cooled towards 20-24 C
c. warmed to 37 C
d. heated to 57 C

b (Western blot uses purified HIV proteins to confirm reactivity in samples whose screening test for anti-HIV is positive.)

12) The western blot is a confirmatory test for:
a. CMV antibody
b. anti-HIV-1
c. HbsAg
d. serum protein abnormality

b (The causative agent for AIDS is the human immunodeficiency virus types 1 and 2.)

13) The test that is currently used to detect donors who are infected with the AIDS virus is:
a. anti-HBc
b. anti-HIV-1,2
c. HbsAg
d. ALT

d (The enzyme-labeled immunosorbent assay [ELISA] method is a very sensitive method employed to screen donors for markers of transfusion-transmitted viruses.)

14) A commonly used screening method for anti-HIV detection is:
a. latex agglutination
b. RIA
c. TLC
d. ELISA

d (Sterile docking devices allow entry into donor units without affecting the expiration date of the product.)

16) A unit of packed cells is split into 2 aliquots under closed sterile conditions at 8 am. The expiration time for each aliquot is:
a. 4 pm the same day
b. 8 pm the same say
c. 8 am the next morning
d. the original date of the unsplit unit

c (If storage devices do not have automated temperature recording, temperature must he manually monitored every 4 hours.)

18) When platelets are stored on a rotator set on an open bench top, the ambient air temps. must be recorded:
a. once a day
b. twice a day
c. every 4 hours
d. every hour

b (Fresh Frozen Plasma is stored at -18 C or below for 12 months.)

19) Which of the following is the correct storage temp for the component listed:
a. Cryo AHF = 4 C
b. FFP = -20 C
c. Frozen RBC = -40 C
d. Platelets = 37 C

d (Blood may be returned to the blood bank after issue provided that 1] the container has not been entered, 2] at least 1 sealed segment is attached to the container, 3] visual inspection of the unit is satisfactory and documented, and 4] the unit has been maintained at the appropriate storage or transport temperature. Studies have shown that refrigerated components retain an acceptable temperature of <10 C for up to 30 minutes after removal from the refrigerator.)

20) A unit of RBCs is issued at 9 am and at 9:10 am it is returned to the blood bank. the container has NOT been entered but the unit has NOT been refrigerated during this time span. the best course of action for the tech is to:
a. culture the unit for bacteria
b. discard the unit if not used within 24 hrs.
c. store the unit at room temp
d. record the return and place the unit back into inventory

d (Red Blood Cells are stored at 1-6C.)

22) Optimum storage temperature for RBCs:
a. -80 C
b. -20 C
c. -12 C
d. 4 C

b (If the seal is broken during processing, components are considered to be prepared in an open system, rather than a dosed system. The expiration time for Red Blood Cells in an open system is 24 hours)

23) If the seal is entered on a unit of RBCs stored at 1 C to 6 C, what is the maximum allowable storage period in hours?
a. 6
b. 24
c. 48
d. 72

a (Cryoprecipitated AHF is stored at -18C or lower.)

24) Optimum storage for Cryo AHF is:
a. -20 C
b. -12 C
c. 4 C
d. 22 C

a (Cryoprecipitate must be transfused within 4 hours of pooling.)

25) Cryo AHF must be transfused within what period of time following thawing and pooling?
a. 4 hrs.
b. 8 hrs.
c. 12 hrs.
d. 24 hrs.

d (Whole Blood-derived platelets are stored at 20-24 C with continuous gentle agitation. Platelets prepared by the PRP method may be stored for up to 5 days.)

26) Platelets prepared in a polyolefin type container, stored at 22-24 C in 50 mL of plasma and gently agitated can be used for up to:
a. 24 hrs.
b. 48 hrs.
c. 3 days
d. 5 days

d (The required temperature for storage of platelets is 20-24 C.)

27) Optimum storage temperature for platelets:
a. -20 C
b. -12 C
c. 4 C
d. 22 C

a (Per AABB standards, thawed FFP should be stored at 1-6 C for no more than 24 hours.)

28) According to AABB standards FFP must be infused within what period of time following thawing:
a. 24 hrs.
b. 36 hrs.
c. 48 hrs.
d. 72 hrs.

c (Cryoprecipitate has a shelf life of 12 months in the frozen state.)

29) Cryo AHF, if maintained in the frozen state at -18 C or below, has a shelf life of:
a. 42 days
b. 6 months
c. 12 months
d. 36 months

d (Once thawed, FFP is stored at 1-6C for up to 24 hours.)

30) Once thawed, FFP must be transfused within:
a. 4 hrs.
b. 8 hrs.
c. 12 hrs.
d. 24 hrs.

a (The required temperature for storage of thawed plasma is 1-6C.)

32) In the liquid state, plasma must be stored at:
a. 1 - 6 C
b. 22 C
c. 37 C
d. 56 C

b (Irradiation inhibits proliferation of T lymphocytes.)

36) Irradiation of a unit of RBC's is done to prevent the replication of donor:
a. granulocytes
b. lymphocytes
c. red cells
d. platelets

c (FFP thawed in a water bath should be protected so that entry ports are not contaminated with water. One can may use a plastic overwrap or keep ports above the water level.)

37) Plastic bag overwraps are recommended when thawing FFP in a 37 C water bath. because they prevent:
a. FFP bag from cracking
b. water from slowly dialyzing across the bag membrane
c. the entry ports from being contaminated with water
d. the label from peeling

b (Fresh Frozen Plasma [FFP] must be separated and frozen within 8 hours of Whole Blood collection.)

38) Which of the following blood components must be prepared within 8 hrs. after phlebotomy:
a. RBCs
b. FFP
c. Frozen rbcs
d. Cryo AHF

b (Cryoprecipitate is the fraction of plasma proteins that precipitate when FFP is slowly thawed at 1-6 C.)

42) A blood component prepared by thawing FFP at refrigerator temp and removing the fluid portion is:
a. Plasma Protein Fraction
b. Cryo AHF
c. Factor IX Complex
d. FP24

d (Clots in the unit may indicate contamination.)

43) Upon inspection, a unit of platelets is noted to have visible clots, but otherwise appears normal. the tech should:
a. issue without concern
b. filter to remove clots
c. centrifuge to express off the clots
d. quarantine for gram stain and culture

a (Whole blood-derived Platelets are prepared by a light spin to separate the Red Blood Cells from the platelet-rich plasma [PRP], followed by a heavy spin of the PRP to concentrate the platelets.)

46) Which of the following is proper procedure for preparation of platelets from Whole Blood:
a. light spin followed by hard spin
b. light spin followed by 2 hard spins
c. 2 light spins
d. hard spin followed by a light spin

d (The entire set of HLA antigens located on one chromosome is a haplotype.)

59) The linked HLA genes on each chromosome constitutes a (an):
a. allele
b. trait
c. phenotype
d. haplotype

c (The A and B structures cannot be developed since there is no H precursor substance due to the lack of the H gene in the blood donor.)

61) A blood donor has the genotype: hh, AB. what is his RBC phenotype?
a. A
b. B
c. O
d. AB

a (This individual cannot have the k antigen on their cells. KOKO is rare and no Ken system antigens are detected on the red blood cells. Those individuals usually produce antibodies that are reactive with all normal cells. KK is the most probable genotype.)

62) An individual has been sensitized to the k antigen and has produced anti-k. What is her most probable Kell system genotype:
a. KK
b. Kk
c. kk
d. K0K0

a (Fy[a-b-] individuals are very rare with all populations other than the individual of African descent. 68% of African Americans are Fy[a-b-].)

63) Given the following typing results, what is the donors racial ethnicity:
Le(a-b-)
Fy(a-b-)
Js(a+b+)
a. African American
b. Asian American
c. Native American
d. Caucasian

a ( The most common genotype in Rh-negative individuals is rr. Anti-e would not be formed because the recipient's red cells contain the e antigen. The first antibody most likely to develop would be anti-c.)

65) In an emergency situation, Rh-neg. red cells are transfused into a Rh-pos person of the genotype CDe/CDe. the first antibody most likely to develop is:
a. anti-c
b. anti-d
c. anti-e
d. anti- E

d (Blood group genes are autosomal; they are not carried on the sex gene. Whenever the gene is inherited, the antigen is expressed on the red blood cells, which is known as codominant.)

66) Most blood group systems are inherited as:
a. sex-linked dominant
b. sex-linked recessive
c. autosomal recessive
d. autosomal codominant

c (The Xg blood group system is unique in that the gene encodes on the X chromosome. A negative mother would not have the Xg[a] to pass on. A positive father would, however, transmit the Xg[a] to all his daughters.)

67) The mating of an Xg(a+) man and a Xg(a-) women will only produce:
a. Xg(a-)sons + Xg(a-) daughters
b. Xg(a+)sons + Xg(a+)daughters
c. Xg(a-) sons + Xg(a+) daughters
d. Xg(a+) sons + Xg(a-) daughters

c (The Lewis antigens are developed by gene interaction. Both the Lewis and Secretor gene are required for red cells to type as Le[a-b+]. If a person has a Lewis gene, but not Secretor gene, then the cells type as Le[a+b-]. The Le[a-b-] phenotype is derived when the Lewis gene is absent and the Secretor gene may or may not be present. The Le[a+b-] phenotype occurs in 22% of the population, and Le[a-b-] occurs in 6%, so the most likely phenotype of a nonsecretor [se/se] is Le[a+b-].)

70) The red cells of a nonsecretor will most likely type as:
a. Le(a-b-)
b. Le(a+b+)
c. Le(a+b-)
d. Le(a-b+)

a (Anti-f will react with cells that carry c and e on the same Rh polypeptide. No other listed genotypes produce an Rh polypeptide that carries both c and e.)

71) Which of the following phenotype will react with anti-f:
a. rr
b. R1R1
c. R2R2
d. R1R2

c (The baby appears to lack c since no HDFN was evident. The mom is most likely R1R1, so had to pass R1 onto the baby. The father must have passed on an Rh gene that also did not produce c, Given the choices, the father has to be R1r.)

74) A women types as Rh-pos. She has an anti-c titer of 32 at AHG. Her baby has a negative DAT and is not affected by HDFN. What is the fathers most likely Rh phenotype.
a. rr
b. r"r
c. R1r
d. R2r

c (the Fy[a-b-] phenotype occurs in 68% of the population of African descent, but is extremely rare in the other ethnic backgrounds. Lu[a-b-], Jk[a-b-] and K-k- are very rare in all ethnic backgrounds.)

75) Which of the following red cell typings are most commonly found in the African Americans:
a. Lu(a-b-)
b. Jk(a-b-)
c. Fy(a-b-)
d. K-k-

d (The frequency of compatible donors for this patient can be calculated by multiplying the percentage of the population that is e-C- x Fy[a-] x Jk[b-]. The blood supplier's immunohematology reference laboratory may have units in stock or can request blood from other IRLs through the American Rare Donor Program.)

76) 4 units of blood are needed for elective surgery. the patient serum contains anti-C, anti-e, anti-Fya and anti-Jkb. Which of the following would be the best source of donor blood:
a. test all units in current stock
b. test 100 group O Rh-neg
c. test 100 group compatible donors
d. rare donor file

d (When a marker is in a child that the mother and alleged father do not have the alleged father cannot be the biological father of the child. This is a direct exclusion.)

83) In relationship testing a "Direct exclusion" is established when a genetic marker is:
a. absent in child, present in mother and alleged father
b. absent in child, present in mother and absent in alleged father
c. present in child, absent in mother and present in father alleged father
d. present in child, absent in the mother and alleged father

b (Direct exclusion of paternity is established when a genetic marker is present in the child but is absent from the mother and the alleged father.)

85) In a relationship testing case the child has a genetic marker that is absent in the mother and cannot be demonstrated in the alleged father. What type of paternity exclusion is this:
a. indirect
b. direct
c. prior probability
d. Hardy-Weinbery

c (The ABO blood group system was discovered by Karl Landsteiner.)

87) Human blood groups were discovered around 1900 by:
a. Jules Bordet
b. Louis Pasteur
c. Karl Landsteiner
d. PL Mollison

c (Mixed-field reactivity with anti-A and anti-A,B is a typical finding for A3 subgroups.)

88) Cells of the A3 subgroup will:
a. react with Dolichos biflorus
b. bE-with anti-A
c. have a mixed field reaction with anti-A,B
d. bE- with anti-H

c (Fucose is the immunodominant sugar for H.)

89) The enzyme responsible for conferring H activity on the red cell membrane is alpha_:
a. galactosyl transferase
b. n-acetylgalactosaminyl tranferase
c. L-fucosyl transferase
d. N-acetylglucosaminyl transferase

d (Bombay phenotypes [Oh] lack H antigen on their red cells, and produce naturally occurring anti-H in their serum.)

90) Even in the absence of prior transfusion or pregnancy, individuals with the Bombay phenotype will always have naturally occurring:
a. anti-Rh
b. anti-K0
c. anti-U
d. anti-H

a (Most examples of anti-Lua agglutinate saline suspended cells. Most examples of anti-Lub are IgG and reacts at 37 C. Anti-Lu3 usually reacts at the AHG phase as does anti- Luab.)

91) The antibody in the Lutheran system that is best detected at lower temps:
a. anti-Lua
b. anti-Lub
c. anti-Lu3
d. anti-Luab

b (Anti-Sda is an antibody to a high-prevalence antigen, which varies in strength from person to person. Most examples of anti-Sda characteristically present as small, mixed-field, retractile agglutinates that may have a shiny appearance when observed microscopically after the antiglobulin test.)

93) Anti-Sda is strongly suspected if:
a. the patient has been previously transfused
b. the agglutinates are mixed field and refractile
c. the patient is group A or B
d. only a small number of panel cells are reactive

b (HLA antibodies are formed in response to pregnancy, transfusion or transplantation and are therefore not naturally occurring. They are associated with febrile nonhemolytic transfusion reactions and TRALI. They are directed against antigens found on granulocytes and other cells such as platelets.)

94) HLA antibodies are:
a. naturally occurring
b. induced by multiple transfusions
c. directed against granulocyte antigen only
d. frequently cause hemolytic transfusion reactions.

d (MHC consists of both class I and class II HLA antigens. Discrimination of self from nonself is the primary function of the HLA system and involves many immune responses.)

95) Genes of the major histocompatibility complex:
a. code for HLA-A,HLA-B, and HLA-C antigens only
b. are linked to genes in the ABO system
c. are the primary genetic sex-determinants
d. contribute to the coordination of cellular and humoral immunity

d (Group O have the most H substance in their saliva. The person must also be a secretor of ABH substances. Due to gene interaction between the secretor gene and Lewis gene, people who are Le[a-b+] assures H in their saliva.)

97) Saliva from which of the following individuals would neutralize an auto anti-H in the serum of a group A, Le(a-b+) patient:
a. group A, Le(a-b-)
b. group A, Le(a+b-)
c. group O, Le(a+b-)
d. group O, Le(a-b+)

d (The overall incidence of the e antigen is 98%. The overall incidence of c is 80%, D is 85% and E is 30%.)

99) Which of the following Rh antigens has the highest frequency in Caucasians:
a. D
b. E
c. c
d. e

a (The M and N antigens are found on glycophorin A.)

103) Which of the following red cell antigens are found on glycophorin-A:
a. M,N
b. Lea, Leb
c. S, s
d. P, P1,pk

b (Patients with infectious mononucleosis often demonstrate potent examples of anti-i that are transient in nature.)

105) Which of the following is a characteristic of anti-i?
a. associated with warm autoimmune hemolytic anemia
b. found in the serum of patients with infectious mononucleosis
c. detected at lower temps in the serum of normal individuals
d. found only in the serum of group O individuals

c (Autoanti-P, a cold-reactive IgG autoantibody described as a biphasic hemolysin, is associated with paroxysmal cold hemoglobinuria.)

104) Paroxysmal cold hemoglobinuria is associated with antibody specificity toward which of the following:
a. Kell system antigens
b. Duffy system antigens
c. P antigen
d. I antigen

c (Anti-I is commonly found in all individuals, but when it causes hemolysis, the titer may be high and react at all temperatures. Cold agglutinin syndrome is mainly found in lymphoproliferative diseases.)

106) In a case of cold autoimmune hemolytic anemia, the patient's serum would most likely react 4+ at immediate spin with:
a. group A cells, B cells and O cells, but not his own cells
b. cord cells but not his own or other adult cells
c. all cells of a group O cell panel and his own cells
d. only penicillin treated panel cells, not his own

c (Anti-I is associated with cold agglutinin syndrome.)

107) Cold agglutinin syndrome is associated with an antibody specificity toward which of the following:
a. Fy:3
b. P
c. I
d. Rh:1

b (Anti-i is an IgM antibody that reacts with cord cells and i adult cells. It is not associated with hemolytic disease of the newborn since IgM antibodies do not cross the placenta.)

108) Which of the following is a characteristic of anti-i?
a. often associated with HDFN
b. reacts best at room temp or 4 C
c. reacts best at 37 C
d. is usually IgG

b (The Kell antigen is highly immunogenic. It is present on the red cells of up to 9% of adults and neonates, and is not affected by enzymes.)

109) The Kell antigen is:
a. absent from the red cells of neonates
b. strongly immunogenic
c. destroyed by enzymes
d. has a frequency of 50% in the random population

a (Antibodies in the Kidd blood group system are IgG and react best at the antiglobulin phase. These antibodies are associated with delayed hemolytic transfusion reactions and reactivity can be enhanced by testing with enzyme pretreated cells.)

111) The antibodies of the Kidd blood group system:
a. react best at the IAT
b. are predominately IgM
c. often cause allergic transfusion reactions
d. do not generally react with antigen-positive, enzyme-treated RBC's

c (The Fya and Fyb antigens are sensitive to denaturation by proteolytic enzymes. Serum containing anti-Fya reacts with untreated Fy[a+] cells, but not with enzyme treated Fy[a+] cells.)

112) Proteolytic enzyme treatment of red cells usually destroys which antigen?
a. Jka
b. E
c. Fya
d. k

c (Anti-Fya is an IgG antibody that reacts best at the AHG phase, does not react with enzyme-treated red cells, is capable of causing hemolytic disease of the newborn, and is not known to be an auto agglutinin.)

113) Anti-Fya is:
a. usually a cold reactive agglutinin
b. more reactive when tested with enzyme treated RBCs
c. capable of causing hemolytic transfusion reactions
d. often an auto agglutinin

d (The Duffy glycoprotein on red cells is a receptor for the malarial parasite Plasmodium vivax. Red cells with the phenotype Fy[a-b-] are resistant to invasion by P vivax.)

114) Resistance to malaria is best associated with which of the following blood groups:
a. Rh
b. I/i
c. P
d. Duffy

a (Patients with severe hemophilia A may have spontaneous hemorrhages that are treated with Factor VIII concentrate.)

121) A blood component used in the treatment of hemophilia A is:
a. Factor VIII concentrate
b. FFP
c. Platelets
d. Whole Blood

d (HDFN is caused by maternal antibody crossing the placenta and destroying fetal antigen-positive red cells. Unlike ABO antibodies, which are naturally-occurring and can affect the first pregnancy, Rh antibodies are not produced until the mother has been exposed to Rh-positive red cells, usually during delivery of the first Rh-positive child Once immunized, subsequent pregnancies with Rh-positive infants are affected, usually with increasing severity.)

126) An obstetrical patient has had 3 previous pregnancies. her 1st baby was healthy, the 2nd was jaundiced at birth and required and exchange transfusion, while the 3rd was stillborn. Which of the following is the most likely cause:
a. ABO incompatibility
b. immune deficiency disease
c. congenital spherocytic anemia
d. Rh incompatibility

d (ABO HDFN is a mild disease, not usually requiring transfusion. It may occur in any pregnancy in which there is ABO incompatibility. High-titered IgG antibodies are more frequently seen in group O mothers than in A or B mothers.)

128) ABO hemolytic disease of the newborn:
a. usually requires an exchange transfusion
b. most often occurs in 1st born children
c. frequently results in stillbirth
d. is usually seen only in the newborn of group O mothers

d (HDFN is caused by maternal IgG antibodies. Outside the Rh system, the most clinically significant antibody for HDFN is anti-K. IgM antibodies do not cross the placenta.)

129) Which of the following antigens in most likely to be involved in HDFN.
a. Lea
b. P1
c. M
d. Kell

a (ABO HDFN is a mild disease that may occur in any ABO-incompatible pregnancy, including the first, since the antibodies are naturally occurring Rh HDFN does not occur until the mother has become immunized. Once this happens, subsequent pregnancies may be quite severely affected. The DAT is typically weak or even negative in ABO HDFN, and strongly positive in Rh HDFN.)

130) ABO HDFN differs from Rh HDFN in that:
a. Rh HDFN is clinically more severe that ABO HDFN
b. the DAT test is weaker in Rh HDFN than ABO
c. Rh HDFN occurs in the 1st pregnancy
d. the mother's antibody screen is positive in ABO HDFN

a (ABO HDFN occurs most commonly in group A babies born to group O mothers and usually has a mild course. The DAT is typically weak or negative and jaundice develops 12-48 hours after birth. The mother and baby are both Rh-positive.)

132) A group A, Rh positive infant of a group O, Rh positive mother has a weakly positive DAT and moderately elevated bilirubin 12 hours after birth. the most likely cause is:
a. ABO incompatibility
b. Rh incompatibility
c. blood group incompatibility due to and antibody to a low frequency antigen
d. neonatal jaundice not associated with blood group

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

134) The Liley method of predicting the severity of HDFN is based on the amniotic fluid:
a. bilirubin concentration by standard methods
b. change in optical density measured at 450nm
c. Rh determination
d. ratio of lecithin to sphingomyelin

c (A positive DAT on cord blood demonstrates the presence of maternal antibody coating the baby's red cells and indicates hemolytic disease of the newborn. Normal cord hemoglobin in newborns ranges from 14-20 g/L. A cord hemoglobin value of 10 g/L indicates anemia and supports the diagnosis of HDFN.)

135) These lab results were obtained on maternal and cord blood samples:
Mother: A-
baby: AB+ DAT 3+
cord hemoglobin 10 g/dL
Does the baby have HDFN?
a. no, as indicated by the cord hemoglobin
b. yes, although the cord hemoglobin is normal, the DAT indicates HDFN
c. yes, the DAT and cord hemoglobin level both support HDFN
d. no, a diagnosis of HDN cannot be established without cord bilirubin levels

a (Blood for an exchange transfusion should lack the antigen to any maternal antibodies that have entered the infant's circulation and are reactive at 37 C or AHG.)

137) Which unit should be selected for exchange transfusion if the newborn is group A, Rh pos. and the mother is Group A, Rh pos. with anti-c?
a. A, CDe/CDe
b. A, cDE/cDE
c. O, cde/cde
d. A, cde/cde

a (Blood selected for exchange transfusion should be ABO-compatible with the mother and baby, and antigen-negative. Prenatal antibody titers above 16 or 32 are considered significant, and the condition of the fetus should be monitored.)

140) A blood specimen from a pregnant woman is found to be group B, Rh neg. and the serum contains anti-D with a titer of 512. What would be the most appropriate type of blood to have available for a possible exchange transfusion for her infant?
a. O, Rh-neg
b. O, Rh-pos
c. B, Rh-neg
d. B, Rh-pos

a (Blood selected for exchange transfusion should be antigen-negative and ABO compatible with the mother and baby. Red Blood Cells are usually less than 7 days old, CMV-, hemoglobin S-, and irradiated.)

141) Blood selected for exchange transfusion must:
a. lack RBC antigens corresponding to maternal antibodies
b. be <3 days old
c. be the same Rh as the baby
d. be ABO compatible with the father

c (For exchange transfusion, antigen- negative Red Blood Cells are typically resuspended in ABO-compatible thawed Fresh Frozen Plasma.)

142) When the main objective of an exchange transfusion is to remove the infant's antibody-sensitized RBCs and to control hyperbilirubinemia, the blood product of choice is ABO compatible:
a. FFP
b. RBCs washed
c. RBC suspended in FFP
d. heparinized RBCs

b (Blood selected for intrauterine transfusion and transfusion to premature infants should be irradiated to prevent graft-vs-host disease.)

143) To prevent graft vs host disease, RBCs prepared for infants who have received intrauterine transfusions should be:
a. saline washed
b. irradiated
c. frozen and deglycerolized
d. group-and Rh-compatible with the mother

b (The rosette test is a qualitative test. When enzyme-treated cells are used as indicator cells, a negative test [indicating there was not an excessive bleed] can have up to 1 rosette per 3 fields. The mother needs to receive 1 vial of RhIg for a normal bleed.)

147) What is the most appropriate interpretation for the laboratory data given below when an Rh-neg woman has an Rh-pos child?
mother: 1 rosette/3 fields
Positive Control.: 5 rosettes/3 fields
Negative Control: no rosettes
a. mother is not a candidate for RhIg
b. mother need 1 vial RhIg
c. mother need 2 vials RhIg
d. the fetal maternal hemorrhage needs to be quantified

b (One dose of RhIg will protect the mother from a bleed of 30 mL. The bleed was 35 mL, 2 vials of RhIg will be needed)

150) The results of a Kleihauer-Butke stain indicate a fetomaternal hemorrhage of 35 mL of WHOLE BLOOD. How many vials of Rh immune globulin would be required.
a. 1
b. 2
c. 3
d. 4

d (One vial of Rh immune globulin protects against a fetomaternal hemorrhage of 15 mL of red cells, or 30 mL of Whole Blood. Divide the volume of fetomaternal hemorrhage [35 mL] by 15; round down to 2, then add 1 extra vial = 3 vials total.)

151) A fetal maternal hemorrhage of 35 mL of fetal Rh-pos PACKED RBCs has been detected in an Rh-neg woman. How many vials of Rh immune globulin should be given
a. 0
b. 1
c. 2
d. 3

c (RhIg should be given to nonimmunized D- females who are pregnant or have delivered a D+ infant.)

152) Criteria determining Rh immune globulin eligibility include:
a. mother is Rh-pos
b. mother is Rh-neg
c. mother has not been previously immunized to the D antigen
d. infant has a positive DAT

c (RhIg is of no benefit once a person has been actively immunized and has formed anti-D)

154) Rh immune globulin administration would not be indicated in an Rh-neg woman who has a:
a. first trimester abortion
b. husband who is Rh-pos
c. anti-D titer of 1:4,096
d. mother having a positive DAT

b (The formula to calculate the percentage assumes the mother's blood volume as 5,000 mL. 0.003 x 5,000 mL = l5 mL.)

155) A Kleihauer-Betke stain of a postpartum blood film revealed 0.3 fetal cells. What is the estimated volume of the fetomaternal hemorrhage expressed as whole blood:
a. 5
b. 15
c. 25
d. 35

b (The percentage of fetal cells/100, the mother's volume is assumed to be 5,000 mL. The percentage must be multiplied by 50 to determine total volume.)

156) Based upon Kleihauer-Betke test results, which of the following formulas is used to determine the volume of fetomaternal hemorrhage expressed in mL of whole blood.
a. % of fetal cell present x 30
b. % of fetal cell present x 50
c. % of maternal cells x 30
d. % of maternal cells x 50

a (The rosette test is a sensitive method to detect FMH of 10 mL or more.)

158) The rosette test will detect a fetomaternal hemorrhage as small as:
a. 10 mL
b. 15 mL
c. 20 mL
d. 30 mL

d (Transfusion should generally be avoided except in cases of life-threatening anemia. A hemoglobin of 10.8 g/dL [108 g/L] is not life-threatening, especially if the patient is not actively bleeding.)

161) A 40 year old man with autoimmune hemolytic anemia due to anti-E has a hemoglobin level of 10.8 g/dL. This patient will most likely be treated with:
a. whole blood
b. RBCs
c. FFP
d. no transfusion

d (Bone marrow transplant patients are at risk for transfusion-associated graft-vs-host disease [TA-GVHD] and therefore should receive irradiated blood products.)

162) A patient in the immediate post bone marrow transplant period has a hematocrit of 21%. The red cell product of choice for this patient would be:
a. packed
b. saline washed
c. micro aggregate filtered
d. irradiated

b (HLA antigen typing is important to consider before organ transplantation.)

163) HLA antigen typing is important in screening for:
a. ABO incompatibility
b. a kidney donor
c. Rh incompatibility
d. a blood donor

a (Negative check cells means the results of tubes with the negative reactions are invalid. The reactivity of the check cells should be verified with anti-IgG since anti-E was detected, indicating the anti-IgG was reactive. All tests that were nonreactive with the check cells requires repeat test performance.)

165) Anti-E is identified in a panel at the antiglobulin phase. When check cells are added to the tubes no agglutination is seen. The most appropriate course of action would be to:
a. quality control the AHG reagent and check cells and repeat the panel
b. open a new vial of check cells for subsequent testing that day
c. open a new vial of AHG for subsequent testing that day
d. record the check cell reactions and report the antibody panel result

a (Samples must be labeled with 2 independent patient identifiers and the date of collection. This information should be identical to that on the patient's identification band and request.)

167) Which of the following represents an acceptably identified patient for sample collection and transfusion
a. a handwritten band with patients name and hospital identification number is affixed to the patients leg
b. the addressographed hospital band is taped to the patients bed
c. an unbanded patient responds positively when his name is called
d. the chart transported with the patient contains his armband not yet attached

c (A serological test to confirm the ABO on all RBC units and Rh on units labeled as Rh-negative must be performed prior to transfusion. Any errors in labeling must be reported to the collection facility.)

169) The following test results are noted for a unit of blood labeled group A, Rh-neg,
anti-A 4+
anti-B 0
anti-D 3+
What should be done next?
a. transfuse as a group A, Rh-neg
b. transfuse as a group A, Rh-pos
c. notify the collecting facility
d. discard the unit

c (Samples must be labeled with 2 independent patient identifiers and the date of collection. This information should be identical to that on the patients identification band and request. There must be a mechanism to identify the phlebotomist, but initialing the sample tubes is not required.)

170) What information is essential on patient blood sample labels drawn for compatibility testing?
a. biohazard sticker for AIDS patients
b. patients room number
c. unique patient medical #
d. phlebotomist initials

b (Granulocytes must be compatible with recipient's plasma. Granulocyte products have an expiration of 24 hours.)

171) Granulocytes for transfusion should:
a. be administered through a micro aggregate filter
b. be ABO compatible with the recipients serum
c. be infused within 72 hrs. of collection
d. never be transfused to patients with a history of febrile transfusion reaction.

c (Because neonates are immunologically immature, alloimmunization to red cell antigens is very rare during the neonatal period. No crossmatching is required if the initial antibody screen performed with either the baby's or mother's plasma is negative.)

172) A neonate will be transfused for the first time with group O Red Blood Cells. Which of the following is appropriate compatibility testing?
a. crossmatch with mothers serum
b. crossmatch with baby's serum
c. no crossmatch is necessary if initial plasma screening is negative
d. no screening or crossmatching is necessary for neonates

b (A positive DAT will interfere with weak D testing, causing both the patient and control to demonstrate positive results. Any positive result in the control tube invalidates any results.)

173) A group B, Rh-neg patient has a positive DAT. Which of the following situations would occur?
a. all major crossmatches would be incompatible
b. the weak D test and control would be positive
c. the antibody screen test would be positive
d. the forward and reverse ABO groupings would not agree

c (Patients with multiple myeloma demonstrate rouleaux formation, which can cause the appearance of agglutination. If the cells are washed to remove residual plasma, and tests repeated, an accurate red cell typing is obtained. By performing a saline replacement with the reverse typing, true agglutination will remain when the cell buttons of the reverse cells are resuspended in saline.)

174) The following reaction were obtained:
cells tested: anti-A = 4+| anti-B = 3+| anti-A,B = 4+
serum test: A1 cells = 2+ | B cells = 4+
The technologist washed the patients cells with saline and repeated the forward typing. A saline replacement technique was used with the reverse typing. the following results were obtained:
cells tested: anti-A = 4+ | anti-B = 0 | anti-A,B = 4+
serum test: A1 cells = 0 | B cells = 4+
the results are consistent with:
a. acquired immunodeficiency disease
b. Bruton agammaglobulinemia
c. multiple myeloma
d. acquired "B" antigen

d (ABO immunoglobulins develop at approximately 3 months of age, attain adult levels by age 10, and may, but not always, decline in titer in the elderly)

175) What is the most likely cause of the following ABO discrepancy?
Cells: anti-A = 0 | anti-B = 0
serum: A1 cells = 0 | B cells= 0
a. recent transfusion with group O blood
b. antigen depression due to leukemia
c. false-neg cell typing due to rouleaux
d. obtained from the heel stick of a 2 month old baby

a (Tn is caused from a somatic mutation and the phenomenon is persistent. Resolution of the red cell typing can be performed with enzyme-treated patient cells, since Tn is denatured by enzymes. Although the reactivity with anti-A may be weak, testing with anti-A1 lectin gives strong reactivity, unlike subgroups of A, which are weakly reacting with anti-A and nonreactive with A1 lectin.)

177) Which of the following is characteristic of Tn polyagglutinable red cells?
a. if group O, they may appear to have acquired a group A antigen
b. they show strong reactions when the cells are enzyme treated
c. they react with Arachis hypogaea lectin
d. the polyagglutination is a transient condition

c (Mixed-field reactivity is a characteristic of the A3 subgroup. Transfusion history would be important to be sure it is not 2 cell populations.)

178) Mixed field agglutination encountered in ABO grouping with no history of transfusion would most likely be due to:
a. Bombay phenotype (Oh)
b. T activation
c. A3 red cells
d. positive IAT

b (Polyagglutination is a property of the cells. Most adult plasma agglutinate the cells due to naturally occurring antibodies directed towards the crypt antigens.)

179) Which of the following is a characteristic of polyagglutinable red cells?
a. can be classified by reactivity with Ulex europaeus
b. are agglutinated by most adult sera
c. are always an acquired condition
d. autocontrol is always positive

b (Although monoclonal anti-D react with most D+ red blood cells, cells with fewer antigen sites requires testing after the antiglobulin test. The test is referred to as a test for weak D.)

184) The test for weak D is performed by incubating patients red cells with:
a. several different dilutions of anti-D serum
b. anti-D serum followed by washing and antiglobulin serum
c. anti-Du serum
d. antiglobulin serum

d (Some subgroups of A are only recognized because of their lack of anti-A in the reverse typing. Often, the donors are confirmed as subgroups of A by an adsorption-elution technique.)

186) The following results were obtained when testing a sample from a 20 year old first time blood donor
Forward: anti-A = 0 | anti-B = 0
Reverse: A1 cells = 0 | B cells = 3+
What is the most likely cause of this ABO discrepancy?
a. loss of antigen due to disease
b. acquired B
C. phenotype Oh (Bombay)
d. weak subgroup of A

c (The mom does not have the D gene. The father would have to have inherited one gene that produces D and another gene that does not produce D. The mom and dad both passed on genes that do not produce D.)

187) A mother is Rh neg. and the father is Rh pos. their baby is Rh neg. It may be concluded that:
a. the father is homozygous for D
b. the mother is heterozygous for D
c. the father is heterozygous for D
d. at least 1 of the 3 Rh typings must be incorrect

a (Some blood group antibodies, in the presence of their corresponding antigen and complement, activate the complement cascade and demonstrate in-vitro hemolysis.)

188) Some blood group antibodies characteristically hemolyze appropriate red cells in the presence of:
a. complement
b. anticoagulants
c. preservatives
d. penicillin

b (Agglutination at AHG phase indicates the presence of clinically significant antibody, indicating the need for antibody identification.)

189) Review the following schematic diagram:
patient serum + reagent group O cells --> incubate --> read for agglutination --> wash --> add AHG --> agglutination observed --> ?
The next step would be:
a. add check cells as a confirmatory measure
b. identify the cause of the agglutination
c. perform an elution technique
d. perform a DAT

b (Presence of agglutination at AHG phase with both screening cells and autocontrol is indicative of warm autoantibody.)

190) The following results were obtained in pre-transfusion testing:
screen cell 1: @37 C = 0 | @IAT = 3+
screen cell 2: @37 C = 0 | @IAT = 3+
autocontrol: @37 C = 0 | @IAT = 3+
The most probable cause of these results are:
a. rouleaux
b. a warm autoantibody
c. a cold autoantibody
d. multiple alloantibodies

a (Presence of agglutination at AHG phase with screening cells and 2 out of 6 donor units indicates antibody in patient serum to antigen[s] on screening cells and donor cells. The presence of an autoantibody would most likely react with all cells, including the autologous control or DAT.)

191) A patient is typed as group O, Rh pos. and crossmatched with 6 units of blood. At the IAT phase of testing, both antibody screening cells and 2 crossmatched units are incompatible. What is the most likely cause of the incompatibility?
a. recipient alloantibody
b. recipient autoantibody
c. donors have pos. DAT's
d. rouleaux

c (Initial result was most likely a false-negative result due to the omission of patient serum. This would explain the initial negative result followed by the subsequent positive result.)

193) a patient received 2 units of RBCs and had a delayed transfusion reaction. Pretransfusion antibody screening records indicate no agglutination except after the addition of IgG sensitized cells. Repeat testing of the pretransfusion specimen detected an antibody at the antiglobulin phase. what is the most likely explanation for the original results?
a. red cell were overwashed
b. centrifuge time was prolonged
c. patient's serum was omitted from the original test
d. antiglobulin reagent was neutralized

b (The absence of agglutination at the AHG phase with screening cells and agglutination with one of 3 donor units is most likely due to an antibody to a low-incidence antigen.)

194) At the indirect antiglobulin phase of testing there is no agglutination between patient serum and screening cells. One of 3 donor units was incompatible. The most probable explanation for these findings is that the:
a. patient has an antibody directed against a high incidence antigen
b. patient has an antibody directed against a low incidence antigen
c. donor has an antibody directed against donor cells
d. donor has a positive antibody screen

d (The major crossmatch tests the recipient's plasma with donor's cells. This would detect any antibody in the recipient that would react with antigens on the donor's RBCs. If a patient were mistyped as a group O rather than group A, then group O cells would be selected for crossmatch and no incompatibility would be found.)

195) The major crossmatch will detect a (an):
a. group A patient mistyped as a group O
b. unexpected red cell antibody in the donor unit
c. Rh-neg donor unit mislabeled as Rh-pos
d. recipient antibody directed against antigens on the donor red cells

d (Since crossmatching is a test between the patient's plasma and donor's cells, any incompatibility is due to the donor's red cells. If a patient is negative for clinically significant antibodies to common antigens, an incompatible unit by the antiglobulin test is due to either a positive DAT on the donors red cells or the patient has an antibody to a low-incidence antigen that the donor's cells possess.)

197) Which of the following would most likely be responsible for an incompatible antiglobulin crossmatch?
a recipients red cells possess a low frequency antigen
b. anti-K antibody in donor serum
c. recipients red cells are polyagglutinable
d. donor red cells have a positive DAT

b (If a patient is negative for clinically significant antibodies, and a single crossmatch is incompatible, the incompatibility is either due to donor cells with a positive DAT or the patient has an antibody to a low-incidence antigen that the donor's cells possess.)

198) A reason why a patient's crossmatch may be incompatible while the antibody screen is negative is:
a. the patient has an antibody against a high incidence antigen
b. the incompatible donor unit has a positive DAT
c. cold agglutinins are interfering in the crossmatch
d. the patient's serum contains warm autoantibody

c (It a patient is negative tor clinically significant antibodies, and a single crossmatch is incompatible, the incompatibility is either due to donor cells with a positive DAT or the patient has an antibody to a low-incidence antigen that the donor's cells possess.)

199) A blood specimen types as A, Rh-pos with a negative antibody screen. 6 units of group A, Rh-pos RBCs were crossmatched and 1 unit was incompatible in the antiglobulin phase. The same result was obtained when the test was repeated. Which should be done first?
a. repeat the ABO grouping on the incompatible unit using a more sensitive technique
b. test a panel of red cells that possesses low incidence antigens
c. perform a DAT on the donor unit
d. obtain a new specimen and repeat the crossmatch

c (Emergency release of blood cannot use previous records. Blood typing must be performed on the current sample. In this case, group O Rh-negative is the best choice since there is evidence the patient is Rh-negative.)

200) During emergency situations when there is no time to determine ABO group and Rh type on a current sample for transfusion, the patient is known to be A, Rh-neg. the technologist should:
a. refuse to release any blood until the patient's sample has been typed
b. release A Rh-neg RBC's
c. release O Rh-neg RBC's
d. release O Rh-pos RBC's

b (When group specific units of Red Blood Cells are not available, group compatible units are selected. Since the patient is AB, group A would be selected to conserve group O units for group O patients. Rh-negative patients should receive Rh-negative units of red blood cells.)

201) A 29 year old male is hemorrhaging severely. He is AB, Rh-neg. 6 units of blood are required STAT. Of the following types available in the blood bank, which would be most preferable for crossmatch?
a. AB, Rh-pos
b. A, Rh-neg
c. A, Rh-pos
d. O, Rh-neg

a (This patient has an anti-A1, which eliminates A1B cells immediately. Rh-negative units should be conserved for Rh-negative patients when Rh-positive units are available. Selection of group B units provides compatible units quickly.)

202) A patient is group A2B, Rh-pos and has an antiglobulin reacting anti-A1 in his serum. He is in the operating room bleeding profusely and group A2B RBCs are not available. Which of the following blood types is first choice for crossmatching?
a. B, Rh-pos
b. B, Rh-neg
c. A1B, Rh-pos
d. O, Rh-neg

d (The strength of agglutination is dependent upon optimal antigen to antibody ratio. Excessive amount of antigen does not allow maximal uptake of antibody per red cell and therefore agglutination is negatively affected leading to weaker or negative results.)

203) A 10% red cell suspension in saline is used in a compatibility test. Which of the following would most likely occur?
a. a false-positive result due to antigen excess
b. a false-positive result due to the prozone phenomenon
c. a false-negative result due to the prozone phenomenon
d. a false-negative result due to antigen excess

a (Determining the patients phenotype allows focusing identification procedures toward antibodies the patient can develop.)

205) A patient received 4 units of blood 2 years previously and now has multiple antibodies. He has not been transfused since that time. It would be most helpful to:
a. phenotype his cells to determine which additional alloantibodies may be produced
b. recommend the use of directed donors, which are more likely to be compatible
c. use proteolytic enzymes to destroy the "in vitro" activity of some of the antibodies
d. freeze the patient's serum to use for antigen typing of compatible units

a (Warm autoantibodies often exhibit Rh specificity.)

206) Autoantibodies demonstrating blood group specificity in warm autoimmune hemolytic anemia are associated more often with which blood group system.
a. Rh
b. I
c. P
d. Duffy

a (Lewis antibodies may bind complement and fresh serum that contains anti-Lea may hemolyze Le[a+] red cells in vitro. Approximately 22% of the population is Le[a+].)

207) An antibody that causes in-vitro hemolysis and reacts with the red cells of 3 out of 10 crossmatched donor units is most likely:
a. anti-Lea
b. anti-s
c. anti-k
d. anti-E

b (Lewis antibodies are usually IgM and agglutinate saline suspended cells. Approximately 22% of the population is Le[a+], which would account for 3 out of 10 donor units being incompatible. Anti-P1 is also an antibody that may react at immediate spin, but 79% of the white population and 94% of the black population are P1 +. Anti-C and anti-Fya are IgG antibodies that react at the antiglobulin phase.)

212) In the process of identifying an antibody, the technologist observed 2+ reactions with 3 out of the 10 cells in a panel after the immediate spin phase. There was no reactivity after incubation at 37 C and after the anti-human globulin test phase. The antibody most likely is:
a. anti-P1
b. anti-Lea
c. anti-C
d. anti-Fya

a (Chido antibodies are considered clinically insignificant)

213) Transfusion of Ch+ (Chido-positive) red cells to a patient with anti-Ch has been reported to cause:
a. no clinically significant red cell destruction
b. clinically significant immune red cell destruction
c. decreased 51Cr red cell survivals
d. febrile transfusion reactions

a (All 3 antibodies can cause HDFN and delayed transfusion reactions. Anti-Jka is associated with showing dosage.)

217) Which characteristics are true of all 3 of the following antibodies: anti-Fya, anti-Jka and anti-K?
a. detected at IAT phase and may cause HDFN and transfusion reactions
b. not detected with enzyme treated cells; may cause delayed transfusion reactions
c. requires the IAT technique for detection; usually not responsible for causing HDFN
d. may show dosage effect; may cause severe hemolytic transfusion reactions

a ( The direct antiglobulin test [DAT] is used to identify red blood cells that have been coated with antibody in vivo.)

220) Which of the following tests is most commonly used to detect antibodies attached to a patient's red blood cells in-vivo?
a. DAT
b. complement fixation
c. IAT
d. immunofluorescence

d (After washing cells for the DAT or IAT procedure, the AHG should be added immediately and read. Delay can cause a weakened or negative result due to dissociation of the bound IgG in the prolonged time before reagent is added.)

223) In DAT and IAT tests, false-negative reactions may result if the:
a. patient's blood specimen was contaminated with bacteria
b. patient's blood specimen was collected into tubes containing silicon gel
c. saline used for washing the serum/cell mixture has been stored in glass or metal containers
d. addition of AHG is delayed for 40 minutes or more after washing the serum/cell mixture.

b (Polyspecific AHG contains anti-IgG and anti-C3d.)

224) Polyspecific reagents used in the DAT test should have specificity for:
a. IgG and IgA
b. IgG and C3d
c. IgM and IgA
d. IgM and C3d

d (Antiglobulin reagent is used to detect the presence of red cells which have been coated in-vivo with IgG and/or C3d. Antiglobulin reagent may be polyspecific [contains an anti-IgG and anti-C3d] or monospecific [anti-IgG or anti- C3d].)

225) In the direct antiglobulin test, the antiglobulin reagent is used to:
a. mediate hemolysis of indicator red cells by providing complement
b. precipitate anti-erythrocyte antibodies
c. measure antibodies in a test serum by fixing complement
d. detect preexisting antibodies on erythrocytes

c (AHG control cells are IgG-sensitized cells that react with the anti-IgG in the AHG reagent to demonstrate AHG was added and not neutralized by insufficient washing of the tests prior to its addition.)

226) AHG control cells:
a. can be used as a positive control for anti-C3d reagents
b. can be used only for the IAT
c. are coated only with IgG antibody
d. must be used to confirm all positive antiglobulin reactions

c (Cold agglutinin disease is associated with cold reactive antibodies that typically activate complement. Cells that do not undergo lysis due to complement activation have C3d attached to the red blood cells.)

227) A 56 year old female with cold agglutinin disease has a positive DAT. When the DAT is repeated using monospecific antiglobulin sera, which of the following is most likely to be detected?
a. IgM
b. IgG
c. C3d
d. C4a

c (EDTA chelates calcium preventing blood to clot. This chelation of calcium also will stop the complement cascade. Calcium ions are necessary for C1 to attach to IgG on the red blood cells.)

229) Use of EDTA plasma prevents activation of the classical complement pathway by:
a. causing rapid decay of complement components
b. chelating Mg++ ions, which prevents the assembly of C6
c. chelating Ca++ ions, which prevents assembly of C1
d. preventing chemotaxis

b (Second and third generation cephalosporins react when the drug is present in vitro. When serum, drug, and red cells are present, direct or indirect agglutination or lysis may be observed.)

232) The drug cephalosporin can cause a positive DAT with hemolysis by which of the following mechanisms?
a. drug dependent antibodies reacting with drug treated cells.
b. drug dependent antibodies reacting in the presence of a drug
c. drug independent with autoantibody production
d. nonimmunologic protein adsorption with positive DAT

c (A negative reaction after the addition of check cells indicates AHG serum was not present. Inadequate washing of red cells may leave residual patient serum behind, which can neutralize AHG serum.)

233) Crossmatch results at the antiglobulin phase were negative. When 1 drop of check cells was added, no agglutination was seen. The most likely explanation is that the:
a. red cells were over washed
b. centrifuge speed was to high
c. residual patient serum inactivated the AHG reagent
d. laboratorian did not add enough check cells

d (Weak antibodies may be missed if there are excess RBC antigens as there may be too few antibodies to bind to red cell antigens.)

234) Which of the following might cause a false-negative IAT?
a. over-reading
b. IgG coated screen cells
c. addition of an extra drop of serum
d. too heavy a cell suspension

c (Ax cells react more strongly with anti-A,B than with anti-A. If anti-A is nonreactive, Ax cells may be detected with anti-A,B.)

235) The purpose of testing with anti-A,B is to detect:
a. anti-A1
b. anti-A2
c. subgroups of A
d. subgroups of B

c (A solution of 8% bovine albumin can be prepared by diluting the more concentrated solution with normal saline. The formula to be used is: [volume 1 x concentration 1] = [volume 2 x concentration 2]. A solution of 6%-8% albumin is used with some anti-D reagents as a control for spontaneous agglutination.)

236) What is the most appropriate diluent for preparing a solution of 8% bovine albumin for red cell control reagent?
a. deionized water
b. distilled water
c. normal saline
d. Alsever solution

b (Rh antibodies show enhanced reactivity with enzyme pretreated cells. Treatment of red cells with enzymes weakens reactivity with antibodies in the MNS and Duffy systems.)

237) Which of the following antigens gives enhanced reactions with its corresponding antibody following treatment of the red cells with proteolytic enzymes?
a. Fya
b. E
c. S
d. M

c (Soluble forms of some blood group antigens can be prepared from other sources and used to inhibit reactivity of the corresponding antibody, such as the HTLA antibodies anti-Ch and anti-Rg. Most HTLA antibodies, although weakly reactive in undiluted serum, will continue to react weakly at higher dilutions.)

240) Of the following, the most useful technique in the identification and classification of high-titer, low-avidity antibodies is/are:
a. reagent red cell panels
b. adsorption and elution
c. titration and inhibition
d. cold autoadsorption

d (For neutralization studies to be valid, the saline dilutional control must be reactive. Since neutralization studies involve adding a substance to the patient's plasma, nonreactivity in test tubes may be due to simple dilution. The saline control acts as the dilutional control and must be reactive. When the saline control is reactive, then if the tube with the substance is nonreactive, the interpretation that neutralization has occurred is made. If it is reactive, neutralization did not occur.)

241) To confirm a serum antibody specificity identified as anti-P1, a neutralization study was performed and the following results obtained:
serum + P1 substance = NEGATIVE
serum + saline = NEGATIVE
What conclusion can be made from these results.
a. anti-P1 is confirmed
b. anti-P1 is ruled out
c. a second antibody is suspected due to the results of the negative control
d. anti-P1 cannot be confirmed due to the results of the negative control

a (In the solid phase technology, the antibody screening cells are bound to the surface of the well. Antibody specific for antigen on the red blood cells attaches, resulting in a diffuse pattern of red blood cells in the well. A negative reaction would have manifested as a pellet of red blood cells in the bottom of the well.)

246) An antibody screen performed using solid phase technology revealed a diffuse layer of RBCs on the bottom of the well. these results indicate:
a. a positive reaction
b. a negative reaction
c. serum was not added
d. red cells have a positive DAT

b ( The K antigen is integral to the red cell membrane and would not change in a patient. Errors in typing or patient identification may be detected when discrepancies are found when comparing historical records.)

247) On Monday a patient's K antigen typing result was positive. 2 days later the patient's K typing was negative. The patient was transfused with 2 units of FFP. The tech might conclude that the:
a. transfusion of FFP affected the K typing
b. wrong patient was drawn
c. decreased serum bilirubin
d. agglutination with normal adult ABO compatible sera

c (Rouleaux will readily disperse in saline whereas true agglutination will remain after saline replacement.)

249) While performing an antibody screen, a test reaction is suspected to be rouleaux. A saline replacement test is performed and the reaction remains. What is the best interpretation:
a. original reaction of rouleaux is confirmed
b. replacement test is invalid and should be repeated
c. original reaction was due to true agglutination
d. antibody screen is negative

b (Two reagents used for removing IgG from red blood cells are chloroquine diphosphate [CDP] and EDTA glycine acid [EGA]. Using either of these procedures is useful to reduce a patient's DAT and allow phenotyping with IAT reactive antisera.)

251) Which of the following is useful for removing IgG from RBCs with a positive DAT to perform a phenotype?
a. bromelin
b. chloroquine
c. LISS
d. DTT

a (Anti-Fya would not react with enzyme pretreated cells; a select cell panel would allow for individual reactivity of the remaining 2 antibodies. Thiol reagents would be used to disperse agglutination of IgM antibodies; the antibodies in question are IgG.)

252) A patient's serum contains a mixture of antibodies. One of the antibodies is identified as anti-D. Anti-Jka, Fya, and possibly another antibody are present. What technique may be helpful to identify the other antibody?
a. enzyme panel: select cell panel
b. thiol reagents
c. lowering the pH and increasing the incubation time
d. using albumin as an enhancement media in combination with selective adsorption

c (Dolichos biflorus plant seed extract forms complexes with N-acetylgalactosamine. When properly diluted, it can distinguish between A1 donor cells and all other subgroups of A)

253) A sample gave the following results:
cells: anti-A = 3+ | anti-B = 4+
serum: A1 cells = 2+ | B cells = 0
Which lectin should be used first to resolve the discrepancy?
a. Ulex europaeus
b. Arachis hypogaea
c. Dolichos biflorus
d. Vicia graminea

d (The serum of a group O individual contains anti-A, anti-B and anti-A,B. To prepare a suitable reagent, the ABO antibodies must be removed and anti-D left in the serum. The serum would need to be adsorbed with cells of the A1R cde/ cde phenotype.)

254) The serum of a group O, Cde/Cde donor contains anti-D. In order to prepare a suitable anti-D reagent from this donor's serum, which of the following cells would be suitable for the adsorption?
a. group O. Cde/Cde
b. group O, Cde/cde
c. group A2B, CDe/cde
d. groupA1B, cde/cde

d (An elution is the process of removal of antibody from red blood cells. The product of the elution method is an eluate. The eluate contains the antibody and can be used in antibody identification methods.)

258) The process of separation of antibody from its antigen is known as:
a. diffusion
b. adsorption
c. neutralization
d. elution

c (Antibody-antigen complexes are dependent upon a neutral pH. Extremes in pH causes dissociation. Both auto and alloantibodies are recovered in eluates prepared by reagent kits that alter the pH.)

260) One of the most effective methods for the elution of warm autoantibodies from RBCs utilizes:
a. 10% sucrose
b. LISS
c. change in pH
d. distilled water

b (Each unit of Whole Blood or RBCs will increase the hematocrit by 3%-5%, so 2 units of RBCs will increase the hematocrit by twice as much as 1 unit of Whole Blood.)

261) How would the hematocrit of a patient with chronic anemia be affected by the transfusion of a unit of Whole Blood containing 475 mL of blood versus 2 units of RBCs, each with a total volume of 250 mL?
a. patient's hematocrit would be equally affected by the Whole Blood or the RBC's
b. RBC's would provide twice the increment in hematocrit as the Whole Blood
c. Whole Blood would provide twice the increment in hematocrit as the RBC's
d. Whole Blood would provide a change in hematocrit slightly less than the RBC's

c (For emergency transfusions, group O- RBC units should be used.)

262) After checking the inventory, it was noted that there were no units on the shelf marked "May Issue Uncrossmatched: For Emergency Only"
Which of the following should be place on this shelf?
a. 1 unit of each of the ABO blood groups
b. units of group O, Rh-pos Whole Blood
c. units of group O, Rh-neg RBC's
d. any units that are expiring at midnight

b (Each unit of RBCs is expected to increase the hemoglobin level by 1-1.5 g/dL [10-15 g/L].)

264) A 42 year old male of average body mass has a history of chronic anemia requiring transfusion support. 2 units of RBCs are transfused. If the pretransfusion hemoglobin was 7.0 g/dL, the expected posttransfusion hemoglobin concentration should be:
a. 8.0 g/dL (80 g/L)
b. 9.0 g/dL (90 g/L)
c. 10.0 g/dL (100 g/L)
d. 11.0 g/dL (110 g/L)

b (Each unit of RBCs is expected to increase the hematocrit level by 3%-5%, so it would take 2 units to raise the level 6%.)

265) How many units of RBCs are required to raise the hematocrit of a 70 kg nonbleeding man from 24% to 30%
a. 1
b. 2
c. 3
d. 4

d (Class I HLA antigens on platelets are a known cause for platelet refractoriness. Leukoreduction of blood products is used as a mechanism to reduce or prevent patients from developing antibodies.)

268) Transfusion of plateletpheresis products for HLA-compatible donors is the preferred treatment for:
a. recently diagnosed cases of TTP with severe thrombocytopenia
b. acute leukemia in relapse with neutropenia, thrombocytopenia and sepsis
c. immune thrombocytopenic purpura
d. severely thrombocytopenic patients, known to be refractory to random donor platelets

d (FFP should be ABO compatible with the recipient's RBCs. Avoid FFP with antibodies to A or B antigens the patient may have. Group A plasma has anti-B, and should only be transfused to A or O recipients.)

270) Which of the following is consistent with standard blood bank procedure governing the infusion of FFP?
a. only blood group specific plasma may be administered
b. group O may be administered to recipients of all blood groups
c. group AB may be administered to AB recipients only
d. group A may be administered to both A and O recipients

d (FFP should be ABO compatible with the recipient's RBCs. Avoid FFP with ABO antibodies to A or B antigens the patient may have.)

271) A patient who is group AB, Rh-neg needs 2 units of FFP. Which of the following units of plasma would be most acceptable for transfusion?
a. group O, Rh-neg
b. group A, Rh-neg
c. group B, Rh-pos
d. group AB, Rh-pos

b (Each unit of platelets should increase the count 5,000-10,000/uL [5,000-10,000/L].)

272) What increment of platelets/uL in the typical 70-kg human, is expected to result from each single unit of platelets transfused to a non-HLA sensitized recipient?
a. 3,000 - 5,000
b. 5,000 - 10,000
c. 20,000 - 25,000
d. 25,000 - 30.000

b (Anaphylactic transfusion reactions are distinguished from other types of reactions by 1] the absence of fever, and 2] the reactions are sudden in onset after infusion of only a few mL of blood. Since the reaction is due to anti-IgA, washing the donor red blood cells to remove all plasma protein is indicated. Alternatively, blood products from IgA-deficient donors may be used.)

275) A patient received about 15 mL of compatible blood and developed severe shock, but no fever. If the patient needs another transfusion, what kind of RBC component should be given?
a. RBCs
b. RBCs, washed
c. RBCs, Irradiated
d. RBCs, leukocyte reduced

a (FFP should be ABO compatible with the recipient's RBCs. Avoid FFP with ABO antibodies to A or B antigens the patient may have. Rh type is not significant.)

276) FFP from a group A, Rh-pos donor may be safely transfused to a patient who is group:
a. A, Rh-neg
b. B, Rh-neg
c. AB, Rh-pos
d. AB, Rh-neg

c (FFP should be ABO compatible with the recipient's RBCs. If patient's type has not been determined [currently], plasma lacking anti-A and anti-B should be given.)

277) A patient admitted to the trauma unit requires the emergency release of FFP. His blood donor card states that he is group AB, Rh-pos. Which of the following blood groups of FFP should be issued?
a. A
b. B
c. AB
d. O

c (FFP contains all factors, including cryoprecipitate. It does not have a higher risk of transmitting hepatitis than Whole Blood. It must be transfused within 24 hours of thawing and must be ABO compatible.)

278) Fresh Frozen Plasma:
a. contains all labile coagulative factors except cryo AHF
b. has a higher risk of transmitting hepatitis than does Whole Blood
c. should be transfused within 24 hours of thawing
d. need not be ABO compatible

c (Each unit of platelets should increase the count 5,000-10,000 platelets/uL [5,000- 10,000/L]. Platelet antibodies can diminish this expected increment.)

279) 10 units of group A platelets were transfused to a group AB patient. The pretransfusion platelet count was 12 x 10^3/uL and the posttransfusion count was 18 x 10^3/uL. From this information the laboratorian would most likely conclude that the patient:
a. needs group AB platelets to be effective
b. clinical data does not suggest a need for platelets
c. has developed antibodies to the transfused platelets
d. should receive irradiated platelets

c (Symptoms of hemolytic transfusion reactions are fever, chills, flushing, chest and back pain, hypotension, nausea, dyspnea, shock, renal failure, and DIC. Circulatory overload, allergic, and anaphylactic reactions are not characterized by fever.)

280) Hypotension, nausea, flushing, fever and chills are symptoms of which of the following transfusion reactions?
a. allergic
b. circulatory overload
c. hemolytic
d. anaphylactic

d (Previously immunized patients may have an undetectable level of antibody. Transfusion of antigen-positive donor red cells may cause an anamnestic response and result in a delayed hemolytic transfusion reaction. Symptoms may be mild, and present only as jaundice and unexplained anemia.)

284) An unexplained fall in hemoglobin and mild jaundice in a patient transfused with RBCs 1 week previously would most likely indicate:
a. paroxysmal nocturnal hemoglobinuria
b. posttransfusion hepatitis infection
c. presence of HLA antibodies
d. delayed hemolytic transfusion reaction

b (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 3-7 days from the time of transfusion.)

285) 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?
a. 3-6 hours
b. 3-7 days
c. 60-90 days
d. after 120 days

a (Antibodies in the ABO system may activate complement and cause immediate intravascular hemolysis if incompatible blood is transfused. Antibodies in the Rh, Duffy, and MN systems typically cause extravascular hemolysis, which is usually less severe.)

286) The most serious hemolytic transfusion reactions are due to incompatibility in which of the following blood group systems?
a. ABO
b. Rh
c. MN
d. Duffy

a (ABO antibodies activate complement and may cause intravascular hemolysis. Rh, Kell, and Duffy antibodies are primarily associated with extravascular hemolysis.)

287) Severe intravascular hemolysis is most likely caused by antibodies of which blood group system?
a. ABO
b. Rh
c. Kell
d. Duffy

b (Antibodies in the Kidd system activate complement and may cause intravascular hemolysis. The antibodies often decline in vivo, are weak, show dosage, and are difficult to detect in vitro, making them prime candidates for causing anamnestic delayed hemolytic transfusion reactions.)

288) Which of the following blood group systems is most commonly associated with delayed hemolytic transfusion reactions?
a. Lewis
b. Kidd
c. MNS
d. I

a (ABO antibodies activate complement and may cause intravascular hemolysis. The antibodies are naturally occurring against A and B antigens that the recipient lacks. Rh and Duffy antibodies may also cause hemolytic transfusion reactions, but the antibodies are the results of alloimmunization and not naturally present in recipients who lack the antigen. The incidence of septic transfusion reactions from bacterial contamination of Red Blood Cells is rare, about 1:500,000.)

289) After receiving a unit of RBCs, a patient immediately developed flushing, nervousness, fever spike of 102*F, shaking, chills and back pain. The plasma hemoglobin was elevated and there was hemoglobinuria. Laboratory investigation of this adverse reaction would most likely show:
a. an error in ABO grouping
b. an error in Rh typing
c. presence of anti-Fya in patient's serum
d. presence of gram-neg bacteria in blood bag

d (Patients receiving >1 blood volume replacement often develop thrombocytopenia and require platelet transfusion.)

290) A trauma patient who has just received 10 units of blood may develop:
a. anemia
b. polycythemia
c. leukocytosis
d. thrombocytopenia

a (Free hemoglobin released from destruction of transfused donor red cells will impart a distinct pink or red color in the posttransfusion sample plasma.)

292) The most appropriate laboratory test for early detection of acute posttransfusion hemolysis is:
a. a visual inspection for free plasma hemoglobin
b. plasma haptoglobin concentration
c. examination for hematuria
d. serum bilirubin concentration

d (The immediate steps required to investigate a transfusion reaction include a clerical check of records and labels, visual inspection of postreaction plasma for hemolysis, and direct antiglobulin test and repeat ABO typing on the postreaction sample. Additional investigation is performed when there is evidence of hemolysis, bacterial contamination, TRALI, or other serious adverse event.)

293) During initial investigation of a suspected hemolytic transfusion reaction, it was observed that the posttransfusion serum was yellow in color and the DAT was negative. Repeat ABO typing on the posttransfusion sample confirmed the pretransfusion results. What is the next step in this investigation?
a. repeat compatibility testing on suspected units
b. perform plasma hemoglobin and haptoglobin determinations
c. use enhancement media to repeat the antibody screen
d. no further serological testing is necessary

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

294) Which of the following transfusion reactions is characterized by high fever, shock, hemoglobinuria, DIC, and renal failure?
a. bacterial contamination
b. circulatory overload
c. febrile
d. anaphylactic

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

295) Hemoglobinuria, hypotension and generalized bleeding are symptoms of which of the following transfusion reactions?
a. allergic
b. circulatory overload
c. hemolytic
d. anaphylactic

a (Bilirubin is a marker for red cell hemolysis. Bilirubin peaks at 5-7 hours after transfusion and is back to pretransfusion levels at 24 hours if liver function is normal.)

296) When evaluating a suspected transfusion reaction, which of the following is the ideal sample collection time for a bilirubin determination?
a. 6 hrs. posttransfusion
b. 12 hrs. posttransfusion
c. 24 hrs. posttransfusion
d. 48 hrs. posttransfusion

d (Delayed hemolytic transfusion reactions may occur in recipients who are previously immunized but who do not have detectable antibody, if they receive blood with the corresponding antigen. When there is a history of clinically significant antibodies, donor red cells should be phenotyped and antigen-negative blood selected. A complete antiglobulin crossmatch must be performed.)

297) A patient's records show a previous anti-Jkb, but the current antibody screen is negative. What further testing should be done before transfusion?
a. phenotype the patient's red cells for Jkb antigen
b. perform a cell panel on the patient's serum
c. crossmatch type specific units and release only compatible units for transfusion
d. give Jkb neg crossmatch compatible blood

b (If the direct antiglobulin test is positive in a transfusion reaction investigation, the antibody should be eluted from the red cells and identified.)

298) A posttransfusion blood sample from a patient experiencing chills and fever show distinct hemolysis. The DAT is positive (mixed field). What would be the most helpful to determine the cause of the reaction?
a. auto control
b. elution and antibody ID
c. repeat antibody screen on the donor unit
d. bacteriologic smear and culture

b (Delayed hemolytic transfusion reactions are associated with extravascular hemolysis, rather than intravascular. Alloantibody coats the transfused antigen-positive donor cells in the recipient's circulation, producing a mixed-field positive reaction in the DAT.)

300) In a delayed hemolytic transfusion reaction, the DAT is typically:
a. negative
b. mixed-field positive
c. positive due to complement
d. negative when the antibody screen is negative

d (Treatment of acute hemolytic transfusion reactions focuses on supportive measures and control of DIC, hypotension, and acute renal failure.)

302) For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to:
a. prevent alloimmunization
b. diminish chills and fever
c. prevent hemoglobinemia
d. reverse hypotension and minimize renal disease

c (Red Blood Cells, Leukocyte-Reduced should be chosen, because febrile nonhemolytic transfusion reactions are either due to chemokines released from leukocytes in nonleukoreduced blood components or to patient antibodies directed towards donor HLA antigens on the leukocytes.)

303) A patient multiply transfused with RBCs developed a headache, nausea, fever and chills during his last transfusion. What component is most appropriate to prevent this reaction in the future?
a. RBCs
b. RBCs, irradiated
c. RBCs, leukocyte reduced
d. RBCs selected as CMV-reduced-risk

a (Leukocyte antibodies are a primary cause of febrile transfusion reactions. Leukocyte-reduced blood components reduce the risk of febrile nonhemolytic reactions.)

305) Leukocyte-poor RBCs would most likely be indicated for patients with a history of :
a. febrile transfusion reaction
b. iron deficiency anemia
c. hemophilia A
d. von Willebrand disease

c (Anaphylactic transfusion reactions are attributed to anti-IgA in IgA- deficient recipients.)

306) Posttransfusion anaphylactic reactions occur most often in patients with:
a. leukocyte antibodies
b. erythrocyte antibodies
c. IgA deficiency
d. Factor VIII deficiency

c (Two distinguishing features or anaphylactic transfusion reactions are that symptoms occur with transfusion of only small amounts of blood, and the patient has no fever.)

307) Which of the following transfusion reactions occurs after infusion of only a few milliliters of blood and gives no history of fever?
a. febrile
b. circulatory overload
c. anaphylactic
d. hemolytic

d (Febrile nonhemolytic transfusion reactions are defined as fever of 1C or greater [over baseline temperature] during or after transfusion, with no other reason for the elevation than transfusion, and no evidence of hemolysis in the transfusion reaction investigation. Allergic reactions, citrate toxicity, and circulatory overload are not characterized by fever.)

308) Fever and chills are symptoms of which of the following transfusion reactions?
a. citrate toxicity
b. circulatory overload
c. allergic
d. febrile

b (Allergic reactions are a type 1 immediate hypersensitivity reaction to an allergen in plasma. Most are mild reactions shown by urticaria [hives, swollen red wheals] which may cause itching.)

309) Hives and itching are symptoms of which of the following transfusion reactions?
a. febrile
b. allergic
c. circulatory overload
d. bacterial

a (Febrile nonhemolytic transfusion reactions are defined as fever of 1C or greater [over baseline temperature] during or after transfusion, with no other reason for the elevation than transfusion, and no evidence of hemolysis in the transfusion reaction investigation.)

310) A temperature rise of 1 C or more occurring in association with a transfusion, with no abnormal results in the transfusion reaction investigation. usually indicates which of the following reactions?
a. febrile
b. circulatory overload
c. hemolytic
d. anaphylactic

d (Febrile nonhemolytic transfusion reactions occur in about 1% of transfusions, making it one of the most common types of reaction. Neither transfusion-associated circulatory overload [TACO] or anaphylactic transfusion reactions are characterized by fever. Bacterially contaminated Red Blood Cells are rare, and rapidly produce severe symptoms upon transfusion.)

311) A 65 yr. old woman experienced shaking, chill, and a fever of 102 F (38.9 C) approximately 40 minutes following the transfusion of a second unit of RBCs. The most likely explanation for the patient's symptoms is:
a. transfusion of bacterial contaminated blood
b. congestive heart failure
c. anaphylactic transfusion reaction
d. febrile transfusion reaction

d (Febrile nonhemolytic transfusion reactions are caused by leukoagglutinins in the patient or cytokines released from donor leukocytes during storage. Since these reactions are not caused by red cell antibodies, transfusion investigation studies show no hemolysis or abnormal test results.)

312) A sickle cell patient who has been multiply transfused experiences fever and chills after receiving a unit of RBCs. Transfusion investigation studies show:
DAT: neg
Plasma hemolysis: none
The patient is most likely reacting to:
a. IgA
b. plasma protein
c. red cells
d. white cells or cytokines

d (Noncardiogenic pulmonary edema, dyspnea, hypotension, and hypoxemia occurring within 6 hours of transfusion are clinical symptoms of TRALI.)

315) Symptoms of dyspnea, cough, hypoxemia, and pulmonary edema within 6 hrs. of transfusion is most likely which type of reaction?
a. anaphylactic
b. hemolytic
c. febrile
d. TRALI

a (Anaphylactic transfusion reactions are severe reactions that occur after infusion of a small amount of donor blood. Symptoms are hypotension, shock, respiratory distress dyspnea, and substernal pain. Anaphylactic reactions are usually caused by anti-IgA.)

316) A patient with a coagulopathy was transfused with FP24 (FFP within 24 hrs. of collection). After infusion of 15 mL, the patient experienced hypotension, shock, chest pain and difficulty in breathing. The most likely cause of the reaction is:
a. anti-IgA
b. bacterial contamination
c. intravascular hemolysis
d. leukoagglutinins

c (Leukoreduction of blood products reduces the risk of febrile nonhemolytic transfusion reactions, which are caused by leukoagglutinins or cytokines from white cells.)

317) To prevent febrile transfusion reactions, which RBC product should be transfused?
a. RBCs irradiated
b. CMV-neg RBC's
c. RBCs, leukocyte reduced
d. IgA-deficient donor blood

d (One reason to quarantine blood components before transfusion is hemolysis of the red cells. Hemolysis of red cells is an indication of contamination or improper storage.)

318) During the issue of an autologous unit of Whole Blood, the supernatant plasma is observed to be dark red in color. What would be the best course of action?
a. the unit may be issued only for autologous use
b. remove the plasma and issue the unit as RBC's
c. issue the unit only as washed RBC's
d. quarantine the unit for further testing

c (Transfusion-associated circulatory overload [TACO] is hypervolemia manifested by coughing, cyanosis, and pulmonary edema.)

319) Coughing, cyanosis and difficult breathing are symptoms of which of the following transfusion reactions?
a. febrile
b. allergic
c. circulatory overload
d. hemolytic

c (Transfusion-associated circulatory overload [TACO] is hypervolemia caused by blood transfusion in susceptible patients. Hemolytic [antibody to red cell antigen], febrile NHTR [leukoagglutinins or cytokines], and allergic [reaction to allergens in plasma] are immunologic reactions.)

320) Which of the following is a nonimmunologic adverse effect of a transfusion?
a. hemolytic reaction
b. febrile nonhemolytic reaction
c. congestive heart failure
d. urticaria

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

321) Congestive heart failure, severe headache and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion reaction?
a. hemolytic
b. febrile
c. anaphylactic
d. circulatory overload

b (Hypervolemia due to transfusion in susceptible patients, such as cardiac, elderly, infants, or severely anemic, causes circulatory overload [TACO] and associated respiratory and cardiac problems)

322) A patient with severe anemia became cyanotic and developed tachycardia, hypertension, and difficulty breathing after receiving 3 units of blood. No fever or other symptoms were evident. this is most likely what type of reaction?
a. febrile
b. transfusion-associated circulatory overload (TACO)
c. anaphylactic
d. hemolytic

a (Septic transfusion reactions due to contaminated blood products are manifested by high fever, chills, hypotension, shock, nausea, diarrhea, renal failure, and DIC. Symptoms usually appear rapidly. Transfusion reaction investigation shows no evidence of unexpected blood group antibodies. A Gram stain and blood culture of the donor unit may detect the presence of aerobic or anaerobic organisms.)

323) A patient became hypotensive and went into shock after receiving 50 mL of a unit of RBCs. She had a shaking chill and her temperature rose to 104.8 F (40.0 C). A transfusion reaction investigation was initiated but no abnormal results were seen. What additional testing should be performed?
a. gram stain and culture of the donor unit
b. lymphocytotoxicity tests for leukoagglutinins
c. plasma IgA levels
d. elution and antibody screen

c (Hepatitis transmission is unlikely, but has 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].)

324) The most frequent transfusion-associated disease complication of blood transfusion is:
a. cytomegalovirus (CMV)
b. syphilis
c. hepatitis
d. AIDS

b (Irradiation inhibits proliferation of T cells and subsequent GVHD.)

325) The purpose of a low-dose irradiation of blood components is to:
a. prevent posttransfusion purpura
b. prevent graft-vs-host disease
c. sterilize components
d. prevent noncardiogenic pulmonary edema

c (Gamma irradiation of blood products prevents donor lymphocytes from replicating after transfusion and causing transfusion associated graft-vs-host disease in susceptible patients.)

327) Irradiation of donor blood is done to prevent which of the following adverse effects of transfusion?
a. febrile transfusion reaction
b. CMV
c. transfusion associated graft-vs-host disease
d. transfusion related acute lung injury (TRALI)

d (The major cause of transfusion associated fatalities is transfusion of blood to the wrong patient.)

330) The most important step in the safe administration of blood is to:
a. perform compatibility testing accurately
b. get an accurate patient history
c. exclude disqualified donors
d. accurately identify the donor unit and recipient

d (Sterile docking devices allow entry into donor units without affecting the expiration date of the product.)

17) A unit of Red Blood Cells expiring in 35 days is split into 5 small aliquots using a sterile pediatric quad set and a sterile connecting device. Each aliquot must be labeled as expiring in:
a. 6 hours
b. 12 hours
c. 5 days
d. 35 days

b (Whole blood-derived [random donor] Platelets should contain at least 5.5 x 10^10 platelets, be stored with continuous agitation at 20-24 C, and have a pH of 6.2 or higher when tested at the end of the storage period.)

49) A unit of Whole Blood-derived (random donor) Platelets should contain at least:
a. 1.0 x 10^10 platelets
b. 5.5 x 10^10 platelets
c. 5.5 x 10^11 platelets
d. 90% of the platelets from the original unit of Whole Blood

c (Apheresis [single donor] Platelets should contain at least 3.0 x 10^11 platelets, be stored with continuous agitation at 20-24 C, and have a pH of 6.2 or higher when tested at the end of the storage period.)

50) Platelets prepared by apheresis should contain at least:
a. 1 x 10^10 platelets
b. 3 x 10^10 platelets
c. 3 x 10^11 platelets
d. 5 x 10^11 platelets

a (The apheresis process is to remove whole blood, the desired component removed, and the remaining portion of blood returned to the donor/patient.)

53) A father donating platelets for his son is connected to a continuous flow machine, which uses the principle of centrifugation to separate platelets from whole blood. As the platelets are harvested, all other remaining elements are returned to the donor. This method of platelet collection is known as:
a. apheresis
b. autologous
c. homologous
d. fractionation

b (Autologous donors have less stringent criteria than allogeneic donors. Donations must be collected at least 72 hours prior to surgery.)

54) To qualify as a donor for autologous transfusion a patient's hemoglobin should be at least:
a. 8 g/dL (80 g/L)
b. 11 g/dL (110 g/L)
c. 13 g/dL (130 g/L)
d. 15 g/dL (150 g/L)

a (Only ABO and Rh is required with the patient's sample. Each autologous unit must be confirmed for ABO and Rh from an integrally attached segment.)

55) What is/are the minimum pretransfusion testing requirement(s) for autologous donations collected and transfused by the same facility?
a. ABO and Rh typing only
b. ABO/Rh type, antibody screen
c. ABO/Rh type, antibody screen, crossmatch
d. no pretransfusion testing is required for autologous donations

a (The mother has a 50% chance of passing on R1 and 50% chance of passing on r. The father will always pass on R1. Statistically, 50% of the children will be R1r and 50% of them will be R1R1.)

58) Given the most probable genotypes of the parents, which of the following statements best describes the most probable Rh genotypes of the 4 children?
a. 2 are R1r, 2 are R1R1
b. 3 are R1r, 1 is rr
c. 1 is R0r, 1 is R1r, 2 are R1R1
d. 1 is R0r', 1 is R1R1, 2 are R1r

d (The patient lacks E. Since C and c are alleles, C is inherited from one parent and c from the other. Since the person is homozygous for e, one of the genes needs to code for ce [RHce] and the other Ce [RHCe]. The RHD gene is more likely inherited with Ce than ce, so the person's most probable genotype is DCe/dce. This genotype is found in 31% of the white and 15% of the black populations.)

60) An individual's red blood cells give the following reactions with Rh antisera:
The individual's most probable genotype is:
a. DCe/DcE
b. DcE/dce
c. Dce/dce
d. DCe/dce

a (The baby is Rh-negative and lacks c, since there is no evidence of HDFN. Inheritance of no D and no c is denoted as r'. The baby must have inherited this gene from both parents, and is homozygous r'r'.)

64) A mother has the red cell phenotype D+C+E-c-e+ with anti-c (titer of 32 at AHG) in her serum. The father has the phenotype D+C+E-c+e+. The baby is Rh-negative and not affected with hemolytic disease of the newborn. What is the baby's most probable Rh genotype?
a. r'r'
b. r'r
c. R1R1
d. R1r

d (All common Rh antigens are present on the red blood cells. R1 [DCe] and R2 [DcE] are frequent genotypes.)

68) Refer to the following data:
Given the reactions above, which is the most probable genotype?
a. R1R1
b. R1r'
c. R0r"
d. R1R2

a (R0R0 is the only correct choice here. R0 = D+C-E-c+e+.)

69) A patient's red cells type as follows:
Which of the following genotype would be consistent with these results?
a. R0R0
b. R1r
c. R1R2
d. Rzr

b (The most likely haplotype is DCe/dce.)

77) A donor is tested with Rh antisera with the following results:
What is his most probable Rh genotype?
a. R1R1
b. R1r
c. R0r
d. R2r

d (From the first 2 children it can be determined the mom has the haplotypes A2B12 and A23F18. The dad has the haplotypes Al B3 and A3B35. The expected B antigen in child #3 is B35.)

78) A family has been typed for HLA because 1 of the children needs a stem cell donor. Typing results are listed below:
father: A1,3;B8,35
mother: A2,23;B12,18
child #1: A1,2;B8,12
child #2: A1,23;B8,18
child #3: A3,23;B18,?
What is the expected B antigen in child #3?
a. A1
b. A2
c. B12
d. B35

c (The child's genotype does not include E. The alleged father is homozygous for E. If he was the father the child would also have E. The father can be excluded from paternity.)

84) Relationship testing produces the following red cell phenotyping results:
alleged father: ABO = B | Rh = D+C-c+E+e-
mother: ABO = O | Rh = D+C+E-c-e+
child: ABO = O | Rh = D+C+E-c+e+
What conclusions may be made?
a. there is no exclusion of paternity
b. paternity may be excluded on the basis of ABO typing
c. paternity may be excluded on the basis of Rh typing
d. paternity may be excluded on the basis of both ABO and Rh typing

c (Ax cells are more strongly reactive with anti-A,B than with anti-A and the plasma frequently has anti-Al present.)

86) A patient is typed with the following results:
The most probable reason for these findings is that the patient is group:
a. O; confusion due to faulty group O antiserum
b. O; with an anti-A1
c. Ax; with an anti-A1
d. A1; with an anti-A

c (Lewis antigens are found soluble in saliva. If saliva containing Lewis substance is added to a sample with anti-Lea, then neutralization occurs. Le[a+] indicator cells added to the test system would be nonreactive. A proper control system is required whenever neutralization studies are performed.)

98) Inhibition testing can be used to confirm antibody specificity for which of the following antibodies?
a. anti-Lua
b. anti-M
c. anti-Lea
d. anti-Fya

d (After performing rule outs, the most likely antibody is anti-c. To form anti-c, the patient would need to inherit a gene from both parents that does not produce the c antigen. The most common gene that codes for no antigen is denoted as R1.)

118) A 25-year-old Caucasian woman, gravida 3, para 2, required 2 units of Red Blood Cells. The antibody screen was positive and the results of the antibody panel are shown below:
What is the most probable genotype of this patient?
a. rr
b. r'r'
c. R0r
d. R1R1

b (Care must be taken so that fetal Rh-positive RBCs in the maternal circulation are not interpreted as maternal, because the mother would be assumed erroneously to be weak D+.)

145) Rh-Immune Globulin is requested for an Rh-negative mother who has the following results:
What is the most likely explanation?
a. mother is a genetic weak D
b. mother had a fetomaternal hemorrhage of D+ cells
c. mother's red cells are coated weakly with IgG
d. anti-D reagent is contaminated with an atypical antibody

d (The presence of D+ infant's red cells in the mother's circulation can cause the weak D test to show mixed-field agglutination. Care must be taken so that fetal Rh-positive RBCs in the maternal circulation are not interpreted as maternal, because the mother would be assumed erroneously to be weak D+.)

146) The following results are seen on a maternal postpartum sample:
The most appropriate course of action is to:
a. report the mother as Rh-negative
b. report the mother as Rh-positive
c. perform an elution on mother's RBCs
d. investigate for a fetomaternal hemorrhage

c (The weak D result is most likely due to excessive bleed of fetal cells. Rosette results indicate a quantitative test for approximate volume of fetal-maternal bleed should be performed.)

148) What is the best interpretation for the laboratory data given above?
a. mother is Rh-positive
b. mother is weak D+
c. mother has had a fetal-maternal hemorrhage
d. mother has a positive DAT

c (Use the formula: [fetal cells counted/ cells counted] x [maternal blood volume]. Assume the mother's blood volume is 5,000 mL. In this example, 30 fetal cells/2,000 cells counted x 5,000 mL = 75 mL. RhIg protects against 30 mL. So 2.5 vials are needed, rounded up to 3 full vials. Add 1 vial for hospital policy and 4 vials are needed.)

157) An acid elution stain was made using a 1-hour post-delivery maternal blood sample. Out of 2,000 cells that were counted, 30 of them appeared to contain fetal hemoglobin. It is the policy of the medical center 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.
a. 2
b. 3
c. 4
d. 5

d (Results of ABO and Rh testing on a current specimen must always be compared to that of a previous transfusion record. Errors in typing or patient identification may be detected when discrepancies are found. Collection of a new sample allows determination of which sample was incorrectly collected.)

168) Samples from the same patient were received on 2 consecutive days. Test results are summarized below:
How should the request for crossmatch be handled?
a. crossmatch A, Rh-positive units with sample from day 1
b. crossmatch B, Rh-positive units with sample from day 2
c. crossmatch AB, Rh-positive units with both samples
d. collect a new sample and repeat the tests

b (Acquired B occurs in group A individuals and is due to deacetylation of the A antigen by bacterial enzymes. Detection of acquired B is dependent upon the source of anti-B used.)

176) Which of the following patient data best reflects the discrepancy seen when a person's red cells demonstrate the acquired-B phenotype?
a. A
b. B
c. C
d. D

c (Presence of agglutination with A1 cells, screening cells and autocontrol at IS and RT is indicative of a cold autoantibody.)

180) Consider the following ABO typing results:
What is the most likely cause of this discrepancy?
a. A2 with anti-A1
b. cold alloantibody
c. cold autoantibody
d. acquired-A phenomenon

d (Unexpected reactivity with reverse cells should include a test with screen cells at immediate spin to determine if alloantibodies are present. Resolution of the ABO discrepancy can be performed with group B cells that lack the corresponding antigen for the identified alloantibody.)

182) The following results were obtained on a patient's blood sample during routine ABO and Rh testing:
Select the course of action to resolve this problem:
a. draw a new blood sample from the patient and repeat all test procedures
b. test the patient's serum with A2 cells and the patient's red cells with anti-Al lectin
c. repeat the ABO antigen grouping using 3x washed saline-suspended cells
d. perform antibody screening procedure at immediate spin using group 0 cells

b (Reaction with anti-IgG in the DAT and with both screening cells and autocontrol at the AHG phase is indicative of a warm autoantibody.)

192) Refer to the following data:
- hemoglobin: 7.4 g/dL (74 g/L)
- reticulocyte count: 22%
Which clinical condition is consistent with the lab results shown above?
a. cold hemagglutinin disease
b. warm autoimmune hemolytic anemia
c. penicillin-induced hemolytic anemia
d. delayed hemolytic transfusion reaction

a (The patient has a negative antibody screen, but one unit is found to be incompatible. The antibody is most likely directed towards a low-incidence antigen.)

196) A 42-year-old female is undergoing surgery tomorrow and her physician requests that 4 units of Red Blood Cells be crossmatched. The following results were obtained:
What is the most likely cause of the incompatibility of donor 1?
a. single alloantibody
b. multiple alloantibodies
c. Rh incompatibilities
d. donor 1 has a positive DAT

a (Antibodies to antigens on cells 2, 3, 4, and 5 can be ruled out in tubes II and III, in which there was no reaction between patient serum and cells.)

209) An antibody identification study is performed with the 5-cell panel shown below:
An antibody against which of the following antigens could not be excluded?
a. 1
b. 2
c. 3
d. 4

c (An ABO discrepancy in an A1 individual, manifested by agglutination in the serum grouping with A2 cells, is most likely due to anti-H. The greatest concentration of H substance is found on O cells, followed by A2 cells. The least amount of H substance is found on Al and AIB cells.)

215) The ABO discrepancy seen above is most likely due to:
a. anti-A1
b. rouleaux
c. anti-H
d. unexpected IgG antibody present

b (Reactivity at 37C and AHG indicate the presence of an IgG antibody. Anti-M, although usually IgM, may be partly or wholly IgG. Anti-M is ruled out on cell4. Anti-Leb is usually IgM and can be ruled out on cells 4 and 8. This leaves anti-E, anti-Fya and anti-K.)

216) Based on the results of the above panel, the most likely antibodies are:
a. anti-M and anti-K
b. anti-E, anti-Jka and anti-K
c. anti-Jka and anti-M
d. anti-E and anti-Leb

b (In cold agglutinin syndrome, anti-I acts as a complement binding antibody with a high titer and high thermal amplitude. the complement cascade is activated and C3d remains on the red cell membrane of circulating cells.)

221) Anti-I may cause a positive direct antiglobulin test (DAT) because of:
a. anti-I agglutinating the cells
b. C3d bound to the red cells
c. T-activation
d. C3c remaining on the red cells after cleavage of C3b

c (Methyldopa is frequently listed as the prototype for drug-independent antibody mechanism where autoantibody is present on the red cells and may also be present in the plasma.)

230) Which of the following medications is most likely to cause production of autoantibodies?
a. penicillin
b. cephalothin
c. methyldopa
d. tetracycline

b (Patients may have antibodies to components of reagents. Washing the patient's cells prior to testing to remove their plasma from the cell suspension will resolve the reactivity with anti-B.)

238) In a prenatal workup, the following results were obtained:
ABO discrepancy was thought to be due to an antibody directed against a component of the typing sera. Which test would resolve this discrepancy?
a. A1 lectin
b. wash patient's RBCs and repeat testing
c. anti-A,B and extend incubation of the reverse group
d. repeat reverse group using A2 cells

a (Enzyme treatment would allow for differentiation of the remaining antibodies after rule outs. The Fya antigen would be denatured, allowing determination of whether anti-Jka and -K are present, and to confirm anti-E.)

239) Based on the results of the above panel, which technique would be most helpful in determining antibody specificity?
a. proteolytic enzyme treatment
b. urine neutralization
c. autoadsorption
d. saliva inhibition

b (Anti-Leb is confirmed because the tubes with Lewis substance are negative. Nonreactivity of the serum with Le[b+] cells indicates the anti-Leb in the serum was neutralized by the Lewis substance. The test is valid since the patient's serum with saline rather than substance added is still able to react with the Le[b+] cells.)

243) To confirm the specificity of anti-Leb, an inhibition study using Lewis substance was performed with the following results:
What conclusion can be made from these results?
a. a second antibody is suspected due to the positive control
b. anti-Leb is confirmed because the tubes with Lewis substance are negative
c. anti-Leb is not confirmed because the tubes with Lewis substance are negative
d. anti-Leb cannot be confirmed because the saline positive is control

d (Polyagglutination is a property of the red blood cells. Structures on the red cells are altered due to bacterial enzymes or a somatic mutation, so crypt antigens not normally exposed on cells are now present. Antibodies to the exposed structures are naturally occurring in adult plasma.)

248) Which one of the following is an indicator of polyagglutination?
a. RBCs typing as weak D+
b. presence of red cell autoantibody
c. decreased serum bilirubin
d. agglutination with normal adult ABO compatible sera

d (Since the auto control is positive after the AHG phase and no reactivity was detected at immediate spin, the serology is most consistent with a warm autoantibody. An adsorption with autologous cells to remove the antibody to used the adsorbed plasma for alloantibody detection is the next step.)

255) A 26-year-old female is admitted with anemia of undetermined origin. Blood samples are received with a crossmatch request for 6 units of Red Blood Cells, The patient is group A, Rh-negative and has no history of transfusion or pregnancy. The following results were obtained in pretransfusion testing:
The best way to find compatible blood is to:
a. do an antibody identification panel
b. use the saline replacement technique
c. use the pre-warm technique
d. perform a warm autoadsorption

c (Lack of expected rise in hemoglobin after transfusion may be a sign of a delayed hemolytic transfusion reaction. If the DAT is positive, an elution should be performed to remove and identify the antibody coating the transfused donor red cells. In this case, the antibody is not detectable in the antibody screen, so a routine cell panel on the serum would not be helpful. Since the transfusion occurred 3 weeks previously, donor samples are not available for testing.)

299) A patient is readmitted to the hospital with a hemoglobin level of 7 g/dL (70 g/L) 3 weeks after receiving 2 units of red cells. The initial serological tests are:
Which test should be performed next?
a. antibody identification panel on the patient's serum
b. repeat the ABO type on the donor units
c. perform an elution and identify the antibody in the eluate
d. crossmatch the post reaction serum with the 3 donor units

c (Leukocyte-Reduced RBCS and Platelets can be used to prevent further nonhemolytic transfusion reactions.)

304) The use of Leukocyte-Reduced Red Blood Cells and Platelets is indicated for which of the following patient groups?
a. CMV-seropositive postpartum mothers
b. victims of acute trauma with massive bleeding
c. patients with history of febrile transfusion reactions
d. burn victims with anemia and low serum protein

What are minimum requirements for a preservative? An additive?

-Preservative: based on FDA requirement that 70% of RBC survive 24 hrs post transfusion
-Additive- Must ensure 75% of RBCs survive 24 hrs post transfusion

What are the basic components of preservatives?

-Has a slightly acidic pH
-contains sodium citrate, citric acid, dextrose, and monobasic sodium phosphate

What is CPD/CP2D also known as? What is its FDA approved shelf life?

-Aka citrate-phosphate-dextrose/CP-dextrose-dextrose
-FDA approved shelf life: 21 days; contain no adenine

What is CPDA-1 also known as? What is its FDA approved shelf life?

-Aka citrate-phosphate-dextrose-adenine
-FDA approved shelf life: 35 days; contains adenine

What are the names of additives? What is their shelf life?

-AS-1, 3 and 5
- Shelf life: 42 days

List the information required to appear on the label of a unit of whole blood or other component

-Component name and ID to trace back to blood donor
-Manufacturer's name and registration/license number
-Amount of blood and anticoag/preservative
-ABO and Rh type; Selected tests: CMV antigen or AB ID
-Donor: paid or volunteer
-Autologous use only = add name of donor
-Statements regarding recipient ID, reference to circular of information, infectious disease risk, and prescription requirements

Platelet rich plasma and red blood cells are expressed after ___ centrifuge spin, while platelet poor plasma is expressed after ___ spin

Light; heavy

Platelets are frozen at __C, while RBCs are frozen at __C, and these must be frozen ___ hrs after collection

-15; -65; 8 hours

Cryoprecipitate contains...

vWF, fibrinogen, fibronectin, factor VII and XII in 10-15 mL of plasma

Describe the procedure for preparing cryoprecipitate from a unit of whole blood

-First thaw FFP at 1-6C for 24 hrs
-Give a hard spin to get a button at the bottom
-Smush everything into another bag except for 10-15mL of plasma and the cryo

What is the difference between fresh frozen plasma and PF24?

Fresh frozen plasma is plasma frozen within 8 hrs while FP24 is frozen within 24 hrs

Platelet poor plasma can be used to make ___, which contains what factors?

FFP; V and VIII

Frozen RBCs need to be stored at __C and are good for ___ YEARS

-65; 10 yrs

RBCs in an open system need to be stored at __C and are good for __ hrs

1-6; 24 hrs

Irradiated RBCs need to be stored at __C and are good for __ days

1-6; 28 days

Plasma and cryoprecipitate need to be stored at __C and are good for __ year

-18; 1 year

FFP needs to be stored at __C and are good for __ years

-18; 1 year or
-65; 7 years

Thawed plasma needs to be stored at __C and are good for __ hrs

1-6; 24

Pooled cryo needs to be stored at __C and are good for __ hrs

20-24; 4 hrs

Platelets need to be stored at __C and are good for __ days

20-24; 5 days

Pooled platelets need to be stored at __C and are good for __ hrs

20-24; 4 hrs

Apheresis platelets need to be stored at __C and are good for __ days

20-24 hrs; 5 days

Apheresis granulocytes need to be stored at __C and are good for __ hrs

20-24; 24 hrs

As blood sits out (blood storage lesion), what happens to the glucose levels? Why?

Glucose decreases as RBC metabolizes glucose

As blood sits out (blood storage lesion), what happens to the ATP levels? Why?

Decreases b/c RBC uses ATP for glycolysis

As blood sits out (blood storage lesion), what happens to the lactic acid levels?

Increases

As blood sits out (blood storage lesion), what happens to the pH levels? Why?

Decreases b/c of the inc in [H+] as RBC metabolizes glucose

As blood sits out (blood storage lesion), what happens to the 2,3 DPG levels?

Decreases

As blood sits out (blood storage lesion), what happens to the O2 affinity?

Increases, resulting in decreased release of O2 to tissues

As blood sits out (blood storage lesion), what happens to the plasma K+ levels? Why?

Increases b/c of red cell lysis

As blood sits out (blood storage lesion), what happens to the plasma hemoglobin levels? Why?

Increases b/c of RBC lysis

As blood sits out (blood storage lesion), is there a left shift or a right shift in the O2 dissociation curve?

Left

Anti-I

***Anti-I reacts most strongly with adult cells, negative or weakly with cord RBCs
***Strength of I antigen varies on adult cells

________ is associated with cold agglutinin hemagglutinin disease

Anti-I

Associated with atypical pneumonia caused by M. pneumoniae, and cold agglutinin titers are used to monitor the disease

I antibodies

anti-i

associated with infectious mononucleosis, epstein-barr virus, cytomegalovirus.

this antibody is rarely encountered

clinical significance of Anti-I

Cannot cause HDN or HTR
Clinical significant examples are seen in cold agglutinin syndrome which will cause hemolytic anemia (transfuse blood through blood warmer)
IgM
antigen not well developed on fetal RBCs

Lewis

Le^a
Le^b
NOT intrinsic to RBC and are absorbed from the plasma and inserted into the rbc membrane
Lewis antigens cannot be used for paternity testing on infants are they are extremely weak at birth
May produce Lewis antibodies during pregnancy then antigens will reappear after birth and then antibodies disappear

80% secretors
20% nonsecretors

clinical significance of Lewis antibodies

Not implicated in HDN
Can bind complement and may cause in vitro hemolysis usually with enzyme treated cells
usually reacts at RT but may be seen at 37C but is weaker and may be weakly reactive at AHG
IgM antibodies
Can be neutralized invitro by adding Lewis substance

Clinical significance anti-P1

Rarely causes invitro hemoolysis
Does not cause HDFN
Little clinical significance unless reactive at 37C
If reactive at 37C or AHG select crossmatch compatible blood

S, s, U

Clinically significant
IgG
Causes HDN and HTR

The U antigen is always present when S and s are inherited
Suspect anti-U when a pregnant or previously transfused black person reacts with ALL cells tested and has a negative auto control

Lutheran

poorly developed at birth
RT
Rare mild HDN

anti-Lub

Lutheran
clinically significant IgG
Causes mild Hdn
Rare because Lub is high incident antigen
finding compatible blood is difficult as 99% of population is positive

Kell

K (Kell)
k (cellano)
Very immunogenic (2nd to the D antigen)
IgG
Anti-K most common
HTR
Cause of severe HDN
kp^a
kp^b
js^a
js^b
McLeod has weakened expression of kell system antigens

McLeod Syndrome

Kell
Phenotype has weakened expression of Kell system antigens

Associated with structural and functional abnormalities of RBCs and leukocytes with abnormal red cell morphologies and decreased red cell survival: acanthocytes and reticulocytes

associataed with chronic granulomatous disease (WBCs engulf microorganisms but cannot kill them)

Kidd

jk^a
jk^b
shows dosage
well developed at birth
enhanced by enzymes
not very accessible on the RBC membrane
IgG
implicated in HTR and HDN
common cause of delayed HTR
usually appears with other antibodies when detected

Duffy

shows dosage
IgG

does not bind complement

clinically significant

stimulated by transufion or pregnancy but not a common cause of hdfn

Most african/americans are Fy(a-b-)

Certain malarial parasites cannot invade fy^a and fy^b negative cells (Plasmodium knowlesi and P. vivax)

Cold antibodies (IgM)

Anti-Le^a
Anti-Le^b
Anti-I
Anti-P1
Anti-M
Anti-A, -B, -H
Anti-N

Warm Antibodies (IgG)

Rh antibodies
Kidd
Kell
Duffy
S,s

Enhanced by enzymes

Kidd
Rh
Lewis
I
P

Destroyed by enzymes

Fy^a and Fy^b
M
N
S
s

Shows Dosage

Kidd (Jka and Jkb)
Duffy (Fya and Fyb)
Rh (not D)
M, N, S, s

Which of the following Rh antigens is found in the highest frequency in the Caucasian population:

a. C
b. E
c. c
d. e

d. e

The e antigen is present in 98% of the Caucasian population.

Which one of these Lewis blood group phenotypes usually produces anti-Lea

a. Le(a+b+)
b. Le(a+b-)
c. Le(a--b+)
d. Le(a--b-)

d. Le(a--b-)

This antibody is found in the serum of Le(a-b-) secretors.

When testing a patient with a warm autoantibody, which of the following is the most important concern?

a. Masking of other clinically significant antibodies
b. Interference of plasma protein with detection methods
c. Detection of donor antibodies
d. Interference of rouleaux

a. Masking of other clinically significant antibodies

Reactivity of a warm autoantibody may mask the presence of other clinically significant antibodies which adds to the possibility of a transfusion reaction. Further testing should be performed on the sample to determine if other antibodies are present.

Which unit contains the proper number of platelets from a random donor?

a. 3.8 x 10^10
b. 4.0 x 10^10
c. 4.5 x 10^10
d. 5.8 x 10^10

d. 5.8 x 10^10

Platelet concentrates are required to have a minimum of 5.5 x 10^10 platelets/unit. Random donor platelet concentrates typically contains between 5.5 and 8.5 X 10^10 platelets suspended in about 50 mL of plasma. This is approximately 70% of the platelets which were present in the original unit of whole blood collected by the donor.

Which of the following patients are at risk for transfusion-associated graft versus host disease (TA-GVHD) and require irradiated cellular blood products? (Choose all that apply)

a. Neonates less than 4 months of age
b. Recipients of donor units known to be from a blood relative.
c. Patients with chronic anemias.
d. Patient receiving chemotherapy who are immunocompromised.
e. Patients with a history of allergic reactions.

a.
b.
d.

Certain recipients have increased risk for developing TA-GVHD. They are:

**Neonates less than 4 months of age
**Fetuses
**Recipients with a congenital or acquired immunodeficiency, such as bone marrow or stem cell recipients, and patients receiving chemotherapy
**recipients of donor units from a blood relative

The Kleihauer-Betke test used to quantitate FMH has poor reproducibility.

a. True
b. False

a. true

Despite its widespread use, the Kleihauer-Betke test has poor reproducibility (as well as poor sensitivity).

The Kleihauer-Betke test is used to:

a. Screen for sickle cell anemia
b. Screen for fetal hemoglobin
c. Differentiate between maternal and fetal red cells
d. Screen for hemoglobin A1c

c. Differentiate between maternal and fetal red cells

The Kleihauer-Betke test allows the differentiation of fetal and maternal red cells.

The Kleihauer-Braun-Betke stain is based on the principle that fetal hemoglobin is resistant to acid elution, while adult hemoglobin is not. A smear of maternal blood is treated with acid, rinsed and counterstained. Fetal cells will stain and appear pink. Maternal cells appear as ghost cells. Generally, 2000 cells are counted and the number of fetal cells determined. The hemorrhage is estimated using the following formula:

Fetal cells X maternal blood volume* / Total cells counted = Fetomaternal hemorrhage (mL of whole blood)

* Maternal blood volume is estimated at 5000 mL

If an Rh group (DCe/dce) man marries an Rh group (dce/dce) woman, what is the probablitiy that their first child will be D-negative?

a. 0%
b. 25%
c. 50%
d. 75%
e. 100%

c. 50%

Since the inheritance pattern of the D-antigen is determined equally from the mother's and father's genotypes, the chances of producing a D-negative offspring is 50%.

DCe (father) + dce (mother) = D positive

dce (father) + dce (mother) = D negative

An issued unit of blood may be returned to blood bank inventory if it has not been outside a monitored refrigerator for longer than:

a. 30 minutes
b. 60 minutes
c. 2 hours
d. 3 hours
e. 6 hours

a. 30 minutes

If, for instance, transfusion is delayed, a unit of blood must be returned to a temperature-monitored refrigerator within 30 minutes to maintain the integrity of the blood cells.

The McLeod phenotype is associated with which of the following antigen systems?

a. Rh
b. P
c. Kell
d. Duffy
e. MNSs

c. Kell

The McLeod phenotype is associated with a decreased expression of Kell antigens on red cells.

Patients with which of the following conditions would benefit most from washed red cells:

a. Warm autoimmune hemolytic anemia
b. Cold autoimmune hemolytic anemia
c. Elevated serum potassium
d. Multiple red cell alloantibodies

c. Elevated serum potassium

Washing not only reduces the number of leukocytes and platelets that are often responsible for febrile reactions, but also eliminates anticoagulants, ammonia, lactic acid, and potassium.

If a pregnant female who was injected with RhIg antenatally has anti-D at delivery, routine antibody titration to determine the titer of the anti-D is considered a good practice.

a. True
b. False

b. False

Routine antibody titration is not considered a good practice.

If the antibody strength is weak (e.g., 2+ or less, consistent with RhIg administration), titer cannot differentiate between passive and immune anti-D.

The accepted interval between blood donations is:

The correct answer is highlighted below

a. 12 weeks
b. 8 weeks
c. 6 weeks
d. Depends on hematocrit level

b. 8 weeks

The mandatory waiting period between blood donations is 56 days, or eight weeks.

Rh immune globulin is manufactured to be capable of neutralizing _____________ milliliters of Rh positive whole blood.

a. 15
b. 30
c. 45
d. 450
e. 1000

b. 30

Rh immune globulin, also known as RhoGAM, can neutralize approximately 30 mL of Rh positive whole blood.

A patient with a positive DAT due to IgG cannot be reliably antigen-phenotyped using antisera that reacts by the indirect antiglobulin test (IAT).

a. True
b. False

a. True

A positive DAT precludes antigen phenotyping by IAT. IgG-sensitized red cells will react with the antiglobuin serum whether the cells are antigen positive or negative.

Which of the following represents the approximate percentage of the population that is Rh positive:

a. 35 %
b. 65 %
c. 85 %
d. 95 %

c. 85 %

For which of the following antibodies is the DAT most likely to be negative when testing a newborn for possible HDFN?

a. anti-A
b. anti-c
c. anti-D
d. anti-K
e. anti-Fya

a. anti-A

The DAT is most likely to be negative in ABO HDFN. It's possible that the washing done as part of the DAT may break the bonds between anti-A (or anti-B) and the newborn's poorly developed A (or B) antigens.

What is the proper storage temperature for thawed Cryoprecipitate?

a. 4 - 8 ºC.
b. 20 - 24 ºC.
c. 35 - 37 ºC.
d. -20 ºC or colder

b. 20 - 24 ºC.

Once thawed, cryoprecipitate must be kept at room temperature (20 - 24oC) and used within 6 hours after thawing.

The proper storage requirements for granulocyte concentrates is:

a. 1 - 6 degrees Celsius, < 12 hours
b. - 20 degrees Celsius, 48 hours
c. 1 - 6 degrees Celsius, < 24 hours
d. 20 - 24 degrees Celsius, < 24 hours

d. 20 - 24 degrees Celsius, < 24 hours

Granulocytes may be stored at 20-24 degrees Celsius for up to 24 hours, but should be transfused as soon as possible.

An urticarial transfusion reaction is characterized by:

a. Rapid rise in temperature
b. Difficulty breathing
c. Rash and hives
d. Blood in the urine

c. Rash and hives

Urticarial transfusion reactions occur in up to 1% of transfusions. They are manifested by hives, rash, and itching. The transfusion may be resumed after successful administration of antihistamines.

Which of the following antibodies usually show enhanced agglutination with the use of proteolytic enzymes?

a. anti-M,N, and S
b. anti-Jka, Jkb, C, and E
c. anti-Fya and Fyb

b. anti-Jka, Jkb, C, and E

Enzyme techniques are particularly useful in the identification of antibodies in the Rh system (e.g., anti-C and E) and in the Kidd system (e.g., anti-Jka and Jkb).

Enzymes destroy some antigens, such as M, N, S, Fya, and Fyb. Therefore the corresponding antibodies would not be detected.

Given the following commonly used nomenclature systems, which one of the Rh genotypes listed below is heterozygous for the C antigen?

WienerFisher-Race (haplotype)

RoDce

R1 DCe

R2DcE

RzDCE

rdce

r'dCe

r"dcE

rydCE

The correct answer is highlighted below

a. R1r
b. R1R1
c. R2r"
d. r"r

a. R1r

R1r is the only genotype listed that is heterozygous for the C antigen.

Weiner = Fisher-Race
R1r = DCe/dce

R1R1 = DCe/DCe

rr = dce/dce

R1R2 = DCe/DcE

R2r = DcE/dce

R2R2 = DcE/DcE

r'r = dCe/dce

r'r' = dCe/dCe

r"r = dcE/dce

r"r" = dcE/dcE

R0r =Dce/dce

Which of the following is the MOST likely discrepancy seen when a person demonstrates an "acquired B-like" phenomenon

a. Forward typing appears to be B, but reverse groups like O
b. Forward typing appears to be AB, but reverse groups like A
c. Forward typing appears to be O, but reverse groups like B
d. Forward typing appears to be B, but reverse groups like AB
e. Forward typing appears to be AB, but reverse groups like B

b. Forward typing appears to be AB, but reverse groups like A

Acquired B is seen only in a subpopulation of group A1 individuals. The individuals that demonstrate acquired B possess anti-B, but this anti-B does not react with the acquired B antigen; consequently, the auto control is negative. These patients should be transfused with group A or O blood.

Which one of the following types of transfusion reactions caused the highest number of transfusion-related fatalities that were reported to the U.S. Food and Drug Administration (FDA) from 2005 - 2009?

a. Anaphylactic reactions
b. Febrile non-hemolytic reactions
c. Transfusion-related acute lung injury (TRALI)
d. Transfusion-associated graft versus host disease (TA-GVHD)

c. Transfusion-related acute lung injury (TRALI)

In combined fiscal years 2005 through 2009, transfusion-related acute lung injury (TRALI) caused the higest number of reported fatalities (48%), followed by hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%) incompatibilities. Complications of microbial infection, transfusion-associated circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller number of reported fatalities.

Which one of the following blood group systems may show a cell typing change during pregnancy?

a. Rh
b. MNS
c. Lewis
d. Duffy
e. D mosaic

c. Lewis

The Lewis group antigen, Le^a may disappear during pregnancy, resulting in the formation of anti-Le^a antibodies. The majority of these antibodies are IgM and clinically insignificant.

When monitoring maternal antibody strength using a doubling dilution, an increase in titer from 16 to 32 is considered a significant rise in titer.

a. True
b. False

b. False

The statement is false. To be significant, a rise in titer needs to be a two tube increase or more. A rise in titer from 16 to 32 in a doubling dilution is only a one tube difference.

The most recent algorithm for HIV confirmatory testing in patients who are positive by ELISA is the:

a. Latex agglutination for HIV-1/HIV-2 antigen
b. HIV-1/HIV-2 antibody differentiation immunoassay
c. Thin layer chromatography
d. ELISA

b. HIV-1/HIV-2 antibody differentiation immunoassay

According to the CDC, specimens with a reactive 4th generation immunoassay (or repeatedly reactive, if repeat testing is recommended by the manufacturer) should be tested with an FDA-approved 2nd generation antibody immunoassay that differentiates HIV-1 antibodies from HIV-2 antibodies (such as the Multispot© assay).

Which of the following refers to the most common procedure for donating whole blood for use by the general population:

The correct answer is highlighted below

a. Autologous donation
b. Hemapheresis
c. Directed donation
d. Allogenic donation

d. Allogenic donation

Allogenic donation is also known as homologous donation. In this procedure, donor blood products are collected for transfusion and given to a random (non-directed) patient in need.

Which one of the following procedures is used for the proper preparation of Platelet concentrate from random whole-blood donors?

a. Light spin followed by a hard spin
b. Light spin followed by two hard spins
c. Two light spins
d. Hard spin followed by a light spin
e. Two hard spins

a. Light spin followed by a hard spin

The first step in preparation of Platelets from random whole blood donors is a low-speed centrifugation (light spin). This allows the platelets to remain in the plasma portion of the collection container. The plasma (dubbed "platelet-rich plasma") is then centrifuged at a higher velocity (hard spin) that forces the platelets to the bottom of the satellite bag. The platelet-poor plasma is expressed into another container and the residual platelets that remain in the bag are resuspended in a small volume of plasma.

RhIg prevents anti-D production mainly by clearing antibody-sensitized D-positive rbc from maternal circulation.

a. True
b. False

b. False

Initially researchers thought that RhIg prevented anti-D production by clearing the infant's D-positive rbc sensitized with maternal anti-D, but we now know this is not true.

Currently, the mechanism by which RhIg prevents immunization to the D antigen is poorly defined. However, research shows that it likely involves down-regulation of antigen-specific B cells, ie., the B cells do not differentiate into antibody-excreting plasma cells as they normally would when presented with foreign antigens.

A pregnant female who received RhIg at 28 weeks gestation has a positive antibody screen at delivery. If the antibody has been confirmed as anti-D alone and reacts 1+ in the indirect antiglobulin test with D+ red cells, performing a titration to investigate if the anti-D is immune is good practice.

a. True
b. False

b. False

Because lower titers could be due to both passive and immune anti-D, in the absence of results that suggest immune anti-D, routine antibody titration is not a good use of time compared to assuming that anti-D is passive.

Best practice guidelines do NOT recommend routine titration for women known to be injected with RhIg and exhibiting a 2+ or less reaction with D+ red cells consistent with passive anti-D from RhIg.

Whole Blood or RBCs Storage Temperature

1 - 6C

Whole Blood or RBCs Shipping Temperature

1 - 10 C

Whole Blood or RBCs Storage Limit with CPD or CP2D

21 days

Whole Blood Storage Limit with CPDA-1

35 days

RBCs Storage limit with AS-1, AS-3, or AS-5

42 days

Platelet concentrates storage temperature

20 - 24 C

Platelet concentrates expiration time

5 days

FFP Storage temperatures and expiration times

<= -18C 1 year
<= -65C 7 year

CRYO storage temperatures and expiration times

<= -18C 1 year

RBC frozen storage temp and expiration

<= -65C 10 year

RBC deglycerolized or washed (open system)

1 - 6 C 24 hour

What temperature should whole blood collected from a donor should remain at before the separation and preparation of platelet concentrates

20-24

What would be added RBCs to increase their shelf life

AS3 or Adenine

What patients need to receive Leukocyte-reduced red blood cell

Patients with history of febrile transfusion reactions

What is the maximum acceptable storage temperature for frozen red blood cells

-65

To prevent graft-versus-host disease, blood components prepared for a fetus that needs an intrauterine transfusion should be

irradiated

The temperature of a shipment of red blood cell units that was received from the local blood center was recorded as 8° C. What is the best course of action

Place units in inventory because the temperature is acceptable

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

20-24 and 4 days

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

5.5 x 10(10), 75%

Following a platelet concentrate transfusion, a patient did not obtain the calculated corrected count increment that was expected. What is a possible reason(s) this did not occur

HLA alloantibodies, Platelet allonantibodies, Autoantibodies, Splenomegaly, Medications, Sepsis, Active Bleeding, DIC, Fever.

Once the cryoprecipitate has been removed from fresh frozen plasma, the remaining plasma can be refrozen and stored at -18° C for 1 year from collection. What condition is this product is useful for

Treatment for thrombotic thrombocytopenic purpura

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

FFP

A unit of CPDA-1 RBCs, expiring in 35 days, is split using a sterile collection device to prepare pediatric units. Each unit can be relabeled with an expiration date as __________days.

What does rejuvenation of a unit of RBCs do

restores the 2, 3 DPG and ATP levels

Why are plastic overwraps are recommended for thawing FFP and CRYO

they prevent the entry ports from becoming contaminated with water

What is an important determination of platelet viability following the recommended storage interval

Expiration limit with each red blood cell product: Irradiated

28 days

Expiration limit with each red blood cell product: Frozen

10 Years

Expiration limit with each red blood cell product: CPDA-1

35 days

Expiration limit with each red blood cell product: AS-3 or AS-2

42 days

Expiration limit with each red blood cell product: CPA

21 days

Expiration limit with each red blood cell product: Deglycerolized

24 hours

Expiration limit with each red blood cell product: Pheresis (ACD)

21 days

Expiration limit with each red blood cell product: Leukoreduced (AS-3)

42 days

Storage Temp and expiration Limit: Cryoprecipitated AHF (thawed)

20° to 24° C, 6 hours

Storage Temp and expiration Limit: Cryoprecipitated AHF (frozen)

< 18° C, 1 year from collection

Storage Temp and expiration Limit: Fresh frozen plasma (thawed)

1-6 C, 24 hours

Storage Temp and expiration Limit: Liquid plasma from whole blood

1° to 6° C, < 5 days

Storage Temp and expiration Limit: Plasma, cryoprecipitate reduced thawed

1° to 6° C, < 5 days

Storage Temp and expiration Limit: Cryoprecipitated AHF, pooled

20° to 24° C, 4 hours

Describe antigen development in a newborn

ABO antigens are weaker in cord blood samples and may result in weaker ABO phenotyping reactions.
Antigen development slowly occurs until the full expression of adult levels is reached at about 2 to 4 years of age.

Sugar for H angtigen

L-fucose

Genetic control of A and B antigens is mapped to chromosome ___

H antigens by phenotype (highest to lowest concentration

O>A2>B>A2B>A1>A1B

Which phenotype possesses the lowest number of unconverted H sites

Group A1B

The anti-A1 lectin is______ in the routine ABO testing of donors and recipients because it is unnecessary to distinguish between the A1 and A2 phenotypes for transfusion purposes.

not used

Adsorption

immunohematologic technique that uses red cells (known antigens) to remove red cell antibodies from a solution (plasma or antisera); group A red cells can remove anti-A from solution.

Elution

process that dissociates antigen-antibody complexes on red cells; freed IgG antibody is tested for specificity.

Ulex europaeus

Plant lectin with specificity for the H antigen

ABO antibodies are not detected in the serum of newborns until they are _____

3 to 6 months of age

Maximal ABO titers have been reported in children from __________

5 to 10 years of age.

The anti-A produced in group B individuals and the anti-B produced in group A individuals contain primarily antibodies of the ___

immunoglobulin M (IgM) immunoglobulin class along with small amounts of IgG.

Anti-A and anti-B antibodies found in the serum of group O individuals are composed

primarily of IgG class.

Anti-A1 becomes a concern when it causes problems with ABO phenotyping results and incompatible crossmatches on immediate spin.

...

Red cell suspensions prepared from patient samples can be washed three times before repeated testing

...

Daily quality control on ABO typing reagents is satisfactory

...

Acquired B phenotype

group A1 individual with disease of the lower gastrointestinal tract, cancer of the colon and rectum, intestinal obstruction, or gram-negative septicemia who acquires reactivity with anti-B reagents in ABO red cell testing and appears as group AB.

B(A) phenotype

group B individual who acquires reactivity with anti-A reagents in ABO red cell testing; in these individuals the B gene transfers trace amounts of the immunodominant sugar for the A antigen and the immunodominant sugar for the B antigen

Acquired B phenotype

1. The agglutination of the patient's red cells with anti-A is strong (4+).

2. The agglutination of the patient's red cells with anti-B is weaker (1+) than usually expected (3+ to 4+). These red cells react as the phenotype group AB.

3. The results of serum testing reactions are typical of a group A individual.

Resolution of ABO discrepancy pertaining to "acquired B phenotype"

1. Obtain more information about the patient.
2. Test the patient's serum against autologous red cells. Anti-B in the patient's serum does not agglutinate autologous red cells with the acquired B antigen.
3. Test red cells with additional monoclonal anti-B reagents from other manufacturers that are documented not to react with the acquired B antigen or a source of human polyclonal anti-B.

Resolution of B(A) phenotype

1. Determine the patient's diagnosis and transfusion history.

2. Test red cells with additional monoclonal antibody anti-A reagents from other manufacturers or a source of human polyclonal anti-A.

______ of red cells by most human sera as a result of the exposure of a hidden T antigen on the red cell membrane because of a bacterial infection

Polyagglutination

Nonspecific aggregation of serum-suspended red cells because of ________

abnormal concentrations of serum proteins or Wharton's jelly in cord blood samples (false agglutination)

Missing or weakly expressed antigens may be associated with:

ABO subgroups OR
weaked A and B antigen expression in patients with leukemia or Hodgkin's disease

No agglutination of patient's red cells with both anti A and anti B reagents. The person appears to be group O phenotype (forward grouping)
The results of serum testing are typical of a group A individual. Agglutination with anti-B with reagent B cells is strong 3+

These results are characteristic of a missing antigen in the red cell testing. The serum testing results are those expected in a group A individual. Anti-A, found in group O individuals, is absent in the serum testing.
Repeat the red cell testing with extended incubation times, and include human polyclonal anti-A,B or monoclonal blend anti-A,B. The extended incubation time may enhance the antigen-antibody reaction.

Mixed field reactions

Usually a mixed field reaction is due to the presence of two distinct cell populations. For example, testing red cells from a patient recently transfused with non-ABO-identical RBCs (group O donor RBCs to a group AB recipient) can yield mixed field observations. In addition to the transfusion of group O RBCs to group A, B, or AB individuals, recipients of recent bone marrow transplant and stem cell transplant, individuals with the A3 phenotype, and patients with Tn-polyagglutinable red blood cells can demonstrate mixed field reactions.

1. Strong agglutination reactions are observed in the red cell testing and are consistent with a group AB individual.

2. The results of serum testing with reagent B cells demonstrate a weaker extra reaction (1+). This serum testing appears to be consistent with a group A individual.

Cold Autoantibody and Cold Alloantibody in Serum Testing

Alloantibodies may appear as additional serum antibodies in ABO typing as one of the following

anti-P1, anti-M, anti-N, anti-Lea, and anti-Leb
Any serum reactivity caused by an existing ABO antibody would be eliminated in the reaction with group O cells. It is logical to conclude that screening cells are valuable in distinguishing between ABO antibodies and alloantibodies.

Cold autoantibodies usually possess the specificity of

anti-I or anti-IH and react against all adult red cells, including screening cells, A1 and B cells, and autologous cells. An autocontrol (autologous control) is tested to differentiate a cold autoantibody from a cold alloantibody. If the autocontrol is positive, the reactions observed with the A1 and B cells and screening cells are probably the result of autoantibodies.

Resolution of Cold Autoantibody and Cold Alloantibody in Serum Testing

Test the patient's serum with screening cells and an autocontrol at room temperature. This strategy helps distinguish whether cold alloantibody or cold autoantibody is present.

RESOLUTION OF Rouleaux

2. Wash an red cell suspension and repeat the phenotyping.

3. Perform the saline replacement technique to help distinguish true agglutination from rouleaux

Resolution of Missing or Weak Antibodies in Serum Testing

Incubate serum testing for 15 minutes at room temperature, and then centrifuge and examine for agglutination. This simple incubation step often solves the problem. If the results are still negative, place the serum testing at 4° C for 5 minutes with an autologous control. The autologous control validates the test by ensuring that positive reactions are not attributable to a cold autoantibody.

A antigen sugar

N-acetylgalactosamine

B antigen sugar

D-galactose

ABO system is on Chromosome _____

H system is on chromosome ___

Crossmatch

procedure that combines donor's RBCs and patient's serum to determine the serologic compatibility between donor and patient.

Monoclonal antibody ABO typing reagents are tested to meet FDA potency and specificity requirements before licensure. The antibodies are suspended in a diluent that usually does not exceed a

6% bovine albumin concentration and is considered a low-protein medium.

enzymes that denature certain proteins

Antibody potentiators

reagents or methods that enhance or speed up the antibody-antigen reaction.

Low-ionic strength solution

Increases rate of antibody uptake

Polyethylene glycol

Concentrates the antibody in the test environment in a low-ionic strength solution

Because PEG can directly effect the aggregation of red cells the reagent can be used only in indirect antiglobulin testing. Only anti-IgG specific AHG reagent is suitable for use with PEG because of reports of nonspecific agglutination with polyspecific AHG reagents

Proteolytic enzymes (papain and ficin)

Removes negative charges from the red blood cell membrane, which reduces the zeta potential; denatures some red cell antigens.

if platelets are prepared from the whole blood, the unit must

, the unit must not be allowed to cool below room temperature or 20° C, and the platelets must be separated from the whole blood within 8 hours.

If platelets are not to be separated from the whole blood, units are stored at

1° to 6° C before component preparation.

What is the purpose of an antibody screen?

To detect unexpected antibodies to red cell antigens.

What does a negative antibody screen indicate?

That there are no detectable antibodies in that sample

At what phase do Rh antibodies react best at?

IgG 37/AHG

At what phase do anti-Lewis ab react best at?

IgM 24 degrees C

At what phase does anti-P1 react at?

IGM 24 degrees C

At what phase do I ab react at?

IgM 24 degrees C

At what phase do M and N ab react?

IgM RT

At what phase do S,s and U antibodies react at?

IgG 37

At what phase do Kell ab react at?

IgG 37

At what phase do Kidd ab react?

IgG 37

At what phase do Duffy ab react?

IgG 37

At what phase do lutheran ab react?

Lua - mostly IgM
Lub- mostly IgG

what is required by the AABB standards for ab screening?

AHG testing
Cells must contain antigens to challenge 18 Ags
D,C,E,c,e,M, N, S, s, K,k,Fya,Fyb,Jka,Jkb,P1,Lea,Leb

what is not required by the AABB standards for ab screening?

Autocontrol - only for pos ab screen
testing, Jsa,Jsb,f,V,Cw, Kpa,Kpb,Lua,Lub
IS and read at 37 degrees before AHG

what type of cells are chosen as a pos ctl for ag typing?

heterozygous cells for that ag

What would results look like if you tried to do an antigen type on a recently transfused pt?

mixed field agglutination

What is the Ag freq for D?

85% W

What is the Ag freq for C?

70% W

What is the Ag freq for c?

80% W

What is the ag freq for E?

30%

What is the ag freq for e?

98%

What is the ag freq for Cw?

What is the ag freq for Le a+b-?

22%

What is the Ag freq for a-b+?

70%

what is the Ag freq for Le a-b-

What is the Ag freq for Lea+b+?

rare

What is the ag freq for P1?

79%

What is the ag freq for M?

78%

what is the ag freq for N?

72%

what is the ag freq for K?

what is the ag freq for k

99.8%

What is the ag freq for Kpa?

what is the ag freq for Kpb?

99%

what is the ag freq for Jsa?

<1%

What is the ag freq for Jsb?

99.9%

what is the ag freq of Jka?

77%

What is the ag freq of Jkb?

72%

what is the ag freq of Fya?

66%

What is the ag freq of Fyb?

83%

what is the ag freq of Lua?

7.7%

What is the ag freq of Lub?

99.9%

What are the low freq ags?

Lua, Jsa, Kpa, K, Cw, V

What are the High freq ags?

k, Lub, Jsb, Kpb, e, U

Where is an antibody to a low incidince ag usually detected?

in the crossmatch?

Which ags have no antithetical partner?

V, Cw,f,D, P, Xga

Antibodies toward which blood groups are clinically significant?

Rh, Kell, Kidd, Duffy, anti-I, S,s, U

Which antibodies aren't significant?

M,N, Lutheran, Lewis?, P

What ag is enhanced by a low ph?

Why use enzymes?

To help deal with multiple abs or a high freq ab

Which ags are destroyed by enzymes?

Duffy, M,N,

Which ags are enhanced by enzymes?

Rh, Kidd, P, Lewis, I

Which ags are unaffected by enzymes?

Kell

Which ags are variable with enzymes?

S,s

Do you read enzyme treated rxns under microscope?

Do you run ctls with enzyme treated cells?

yes

What are the two uses of Chloroquine?

To remove a pos DAT and to remove Bg Ag (HLA ag - not clinically significant)

What is one disadvantage to chloroquine?

It takes longer than EGA

What is the purpose of using PeG?

To enhance weak reactivity more than NHance

What are two precautions to take with PeG?

Never spin after incubation - wash immediately
Never read under microscope can = false pos

When would you use Dolichos biflorus?

If you suspect and anti-A1, test the pt red cells with it

When would you use EGA?

To remove a pos DAT to do a weak D test
To remove a pos DAT to do antigen typing in the aHG phase

What are the 3 uses for Ab titrations?

Prenatal studies -give insight into a possible ab that could cause hdn
Ab id - some abs react with all cells undiluted, diluting can give an indication of a possible id
HTLA ab - high titer low avidity, reactive in undiluted, but reat at a high titer with out dec. strength.

What antibodies can be neutralized?

Lewis, P, Sda

What is the source of P 1 substance?

avian

What is the source of Lewis substance?

saliva

What is the source of Sda substance?

urine but not from pregnant women because it is decreased due to pregnancy

In who is anti-Sda most common?

pregnant women

How does Sda appear under the microscope?

big, shiny clumps with free cells

How does neutralization work?

One tube with plasma and neutralizing substance and a ctl tube with plasma diluted with the same amount of saline
If the tube with the substance doesn't react and the ctl is pos that means the ab is present

What ags are destroyed by WARM?

Kell, M,N,S, Duffy

When should a Pre-warm technique be used?

If you suspect a cold Ab and it is interferring with the blood typing

How is the pre-warm technique performed?

Incubate the tubes, cells, pippette, plasma at 37 degrees C, drop plasma on cells and move into AHG phase

What additional thing should you do in a pre-warm technique if you suspect a cold ab?

Use 2 sets of tubes, one set, spin, read and throw and the other incubate, so there is no interference from the cold ab into the AHG phase

What should you watch out for in a pre-warm technique if the patient has been recently transfused?

Watch out for a newly forming ab that may be significant, but has an IgM component so it could easily be overlooked by moving straight to AHG phase

What antigens are destroyed by W.A.R.M.?

Kell system, M,N, S,s, Fya, Fyb

What is W.A.R.M. made up of?

dithiothreitol and cysteine-activated papain
resembles zzap

What does W.A.R.M. do?

It removes bound IgG if present and enzyme treats the RBCs to enhance adsorption of the cold or warm autoantibodies present in the patient's blood.
This allows the detection of clinically significant alloantibodies that may be underlying the autoantibodies

Describe a 4+ reaction.

One solid agglutinate

Describe a 3+ reaction.

several large agglutinates

Describe a 2+ reaction.

medium-sized agglutinates, clear background

Describe a 1+ reaction.

Small agglutinates, turbid background

Describe a 1+w.

Very small agglutinates, turbid background.

Describe a trace reaction.

Barely visible agglutination, turbid background.

Describe a microscopic reaction.

agglutination seen only with viewer or microscope

Describe a 0 reaction.

no agglutination

Describe a mf reaction.

a mixture of agglutinated and un-agglutinated cells.

what is the exclusion criteria for antibodies when evaluating the results of an antibod panel?

look at antigens on nonreactive panel cells that have a double dose expression.
Cross out because a dbl dose expression will be stronger and will react better, so if it is negative it can be excluded.
All others require 3 heterozygous expressions on nonreactive cells, except Lua, Lub, Kpa, Kpb, Jsa and JSb can be ruled out with 1 heterozygous.

Ig class, opt temp, effect of enzymes, optimal phase for detection, and does Rh ab cause HDN, HTR?

IgG, 37, enhanced, AHG, yes it causes HTR and HDN, no complement binding, and displays dosage

Ig class, opt temp, effect of enzymes, opt phase for detection, and does Kell ab cause HDN, HTR?

IgG, 37, unaffected by enzymes, destroyed by WARM, AHG, no complement binding, yes causes HDN and HTR, shows dosage.

Ig class, opt temp, effect of enzymes, opt phase for detection and does Duffy ab cause HDN, HTR?

IgG, 37, yes causes HDN and HTR, AHG phase, , no complement binding, destroyed by enzymes, may show dosage.

Ig class, opt temp, effect of enzymes, opt phase for detection, and does lewis ab cause HDN, HTR?

IgM, doesn't cause HTR, HDN, 24, saline, yes, binds complement, enhanced by enzymes, doesn't show dosage.

Ig Class, opt tmp, efect of enzymes, opt phase for detection and does Kidd ab cause hdn, htr?

IgG, AHG, causes htr, hdn and delayed htr, 37, binds complement,enhanced by enzymes, and shows dosage.

Ig Class, opt temp, effect of enzymes, opt hase for detection and does I antibody cause hdn, htr?

IgM, saline, 24, doesn't cause htr, hdn, doesn't bind complement, enhanced by enzymes, shows dosage.

Ig Class, opt temp, effect of enzymes, opt phase for detection and does M,N antibody cause hdn, htr?

Ig M, saline, 24, doesn't bind complement, no htr and hdn, destroyed by enzymes, yes it shows dosage.

Ig class, opt temp, effect of enzymes, opt phase for detection and does P antibody cause hdn, htr?

Ig M, saline, 24, doesn't bind complement, doesn't cause hdn and htr, enhanced by enzymes, doesn't show dosage.

Ig class, opt temp, effect of enzymes, opt phase for detection and does S abs cause hdn, htr?

IgG, yes it causes htr and hdn, AHG, 37, no binding complement, variably affected by enzymes, and shows dosage.

Ig class, opt temp, effect of enzymes, opt phase for dectection and does Lutheran A cause hdn, htr?

IgM usually, may cause mild htr, hdn, more likely to react at AHG and maybe saline, doesn't bind complement, unaffected to variable with enzymes, yes shows dosage.

Ig class, opt temp, effect of enzymes, opt phase for detection and does Lutheran B cause hdn, htr?

Ig G usually, causes mild htr, hdn, ahg, 37, doesn't bind complement, unaffected to variable with enzymes, yes shows dosage

What is the calculation to determine how many units would have to be screened to find a given number of antigen negative units for a patient?

multiply negative incidence times 100 = x
100 / x = # of units to screen to find 1 compatible unit.
If need more than 1 unit multiply the # of units to screen for 1 compatible by the number of units you need.

What are the uses for RBC's?

treatment for symptomatic or critical deficit of oxygen-carrying capacity, anemia, red cell exchange transfusion.

What are the uses for FFP?

Management of preop or bleeding patients who require replacement of multiple plasma coagulation factors(DIC or liver disease), pts undergoing massive transfusion who have clinically signigicant coag deficiencies, pts taking warfarin who are bleeding or need to undergo an invasive procedure before vitamin K can reverse the warfarin, for transfusion or plasma exchange in pts with TTP, manageent of patients with rare specific plasma protein deficiencies, when recombinant products are unavailable.

What are the uses for platelets?

treatment for thrombocytopenia,dysfunctional platelet disorders, active platelet-related bleeding, serious risk of bleeding, leukemia, myelodysplasia, aplastic anemia, solid tumors, congenital or acquired platelet dysfunction, cns trauma.

What are the uses for cryoppt?

to control bleeding associated with fibrinogen deficiency and to treat Factor XIII deficiency. Second line treatment for vWF disease and hemophilia A if no factor preps are available.

What are the uses of plasma frozen within 24hrs?

deficiency of stable coag factors

What is the use of cryoppt reduced plasma?

TTP?

What are the uses for thawed plasma?

bleeding pts, reversal of warfarin

What is the use for liquid plasma?

initial treatment of pts undergoing massive transfusion

What is the purpose of using leukoreduction?

To reduce febrile reactions and HLA alloimmunization.

What is the purpose of using apheresed granulocytes?

to treat neutropenia with infection that is unresponsive to appropriate antibiotics.

What are deglycerolized rbcs used for?

To treat IgA deficiency with anaphylactoid reaction.

What are washed rbcs used for?

IgA deficiency with anaphylactoid rxn, and recurrent severe allergic reactions to unwashed red cell products.

Who gets CMV negative units?

For CMV seronegative individuals who are at risk for severe CMV infections, this group includes pregnant women and their fetuses, low birthweight infants, hematopoietic progenitor cell transplant recipients, solid-organ transplant recipients, severely immunosuppressed recipients, and HIV infected patients.

Who gets irradiated units?

Those who are at risk for Transfusion associated graft vs host disease. fetal and neonatal recipients of intrauterine transfusions, selected immunocompromised recipients, recipients of cellular components known to be from a blood relative, recipients who have undergone marrow or peripheral blood progenitor cell transplantation and recipients of cellular components whose donor is selected for HLA compatibility.

What is the storage temp, expiration date of packed cells?

1-6 oC, varies from 21 to 35 to 42 days depending on the anticoagulant

What is the expiration date of deglycerolized cells?

24hrs from after thawing in an open system, or 2 weeks if a closed system.

What is the expiration and storage of FFP?

store at -18 oC or colder for 1 year.

what is the expiration date and storage temp after thawing of FFP?

24hr or 5 days after thawing and store at 1-6 oC

What is the expiration date and storage temp of cryoppt?

-18 oC and 1 yr

What is the expiration date and storage temp of cryoppt after thawing?

6hr for a single unit, 4hr for a pooled unit and store at room temp

What is the expiration date and storage temp of platelets?

room temp and 5 days

How are blood components shipped?

Box from red cross
styrofoam
packed cells need ice and gel pack - 1-6
plasma and cryo need dry ice - -18
platelets need gel packs to stabilize the temp - 24C

Who receives Rhogam?

D neg moms at 28 weeks and post partum.

Why do D neg moms need Rhogam?

To bind any D+ baby cells that get into the maternal blood stream in order to prevent the mom from becoming immunized to the D antigen

How much Rhogam should women get?

(the # of fetal cells or % found in KB x the maternal blood volume which is 5000)/30 ml per dose = # of doses of Rhogam needed.
for <or= to 0.5 round down and add 1 dose
for >0.5 round up and add 1 dose

What is the purpose of the Fetal Screen?

To determine if any fetal rbcs got into the maternal blood stream. It is qualitative. 1 rosette in every field is a definite positive (in at least 3-4 fields). If less than 1 rosette in each field, negative and means , 30ml of whole blood got in maternal blood stream so they get one dose.

What is the purpose of the Kleihauer-Betke?

To quantitate the fetal maternal bleed. Uses acid elution. Fetal cells resist acid. Count # of fetal cells and report as percent.

Which reagents are used to check typing of donor unit packed cells?

0 neg = anti A,B and anti-D
O pos = anti A,B
A pos = anti A anti B
A neg = anti A, Anti B and anti-D
B pos = anti-A, Anti-B
B neg = anti-A, Anti-B and anti-D
AB pos = anti-A, Anti-B
AB neg = anti-A, Anti-B, and anti-D

What are acceptable alternative blood groups for whole blood?

Must be type compatible

What are acceptable alternative blood groups for packed cells?

O is comp for all
A = O or A
B = B or O
AB = A,B or O
O=O

What are acceptable alternative blood groups for FFP and cryo?

AB = AB
A = AB or A
B = AB or B
O = AB, A, B or O

What are acceptable alternative blood groups for platelets?

Try to give type compatible, but may contain some plasma, so can also give plasma compatible.

_____ are derived from the injection of animals or humans with purified antigens

Polyclonal reagents

The polyclonal product contains _____

several clones of B cell Aantigens

Monoclonal antibody contains antibodies of ___

a defined specificity

Monoclonal antibodies are produced ____

in vitro

Commercial sera anti-A and anti-B are _____

monoclonal

Anti-A has ____ dye (color)

blue

Anti-B has ____ dye (color)

yellow

What are the three types of antiglobulin reagents

1. Polyspecific AHG reagents
2. Monospecific reagents
3. AHG

Polyspecific AHG reagent

1. Used mostly in DAT testing
2. Contain antibodies to both IgG and C3d

Monospecific reagent

Prepared by separating the polyspecific products into IgG AHG or C3d AHG

Check cells are also known as

Coombs cells

Check cells are ____

commercially prepared type O cell that have been sensitized with IgG

Check cells should always have a ____ reaction

positive

_______ requires a control system for all AHG tests that are interpreted as negative

AABB standards for blood banks and transfusion services

Group A1 and group B red cells are used to___

confirm the ABO typing performed on a patient's red cells

Group A1 and group B cells are known as ___

ABO reverse grouping

The ____ requires that Screening cells detect the most clinically significant antibodies

FDA

Screening cells are used in ____

antibody screen tests

_____ are alternatives to antisera for blood typing purposes

Lectins

Lectins can be useful in identifying ____

the antigens present on patient or donor red cells

Two common types of gel technology methods

1. Phenotyping cards - ABO, D and Rh typing
2. AHG cards - antibody screen, antibody id, compatability testing, and DAT

Describe microplate testing for detecting antigen-antibody reactions

Uses a plate with 96 wells that substitute for test tubes. Serum and red cells are added to wells and then incubated, and centrifuged. The red cell buttons can be read manually or with a photometric device

Describe a negative reaction in a microplate test

smooth suspension of rbc or a streaming pattern of rbcs when the plate is placed at an angle

_____ are units of inheritance that encode for certain traits or visible characteristics

Genes

Genetic information are carried on double strands of DNA known as ____

chromosomes

Humans have ____ pairs of chromosomes

The _____ is the physical expression of inherited genes

phenotype

A phenotype can be described as the _____ found on red cells

antigens

The term _____ refers to a genetic system that expresses two or more phenotypes

polymorphic

____ is the actual genes inherited from each parent

genotype

The genotype can only be inferred from the ++++

phenotpe

Family studies are required to determine the actual _____

genotype

Pedigree charts can illustrate the difference between ___ and ____

genotype and phenotype

A punnett square illustrates the probabilities of ____ from known or inferred ____

phenotype
genotype

A, B, and O are ____ on the ABO ____

alleles / gene

Codominant

the equal expression of both inherited alleles

In most cases, blood group antigens are expresses as ____

codominant

____ genes do not express any detectable product

amorphic

_____ is where both parents contribute the same gen giving a double dose of the antigen. This can result in stronger red cell antigen called the ____ effect

Homozygous expression dosage effect

_____ is where different blood system alleles from each parent

Herozygosity

____ and _____ are easily identifiable and are useful in paternity analysis

Red cell and Human leukocyte antigens

In routine testing, the sources of antigen include:

1. reagent
2. patient
3. donor red cells

In routine testiing, the source of antibody include:

1. commercial antisera containing known antibodies
2. Patient serum or plasma

In routine testing procedures: ABO and D testing tests for:

A, B, and D antigens

In routine testing procedures: ABO seru testing tests for

ABO antibodies

In routine testing procedures: Antigen testing in _____

patient and donor samples

In routine testing procedures: Antibody screen for _____

preformed antibody as a result of pregnancy or previous transfusions

Are antibodies made by the mother or the infant?

mother

Routine procedures also include the identification of ________ during the antibody screen procedure

antibodies

Crossmatch is the _____

serologic check of compatability between a donor unit and the patient before transfusion

What is the difference between plasma and serum

Plasma contains all unused clotting factors whereas serum has no clotting factors

A crossmatch is done between the _____ and _______

patient's serum and donor cells

Commercial antisera and reagent red cell products are licensed by the ______. Products must meet minimum standards for _____and _____

FDA / specificity and potency

specificity reflects the _____

the unique recognition of the antigenic dertminant and its corresponding antibody

Potency addresses the ______

strength of the Ag/Ab reaction

Laboratory standard operating procedures are written to reflect ______

manufacturer product inserts

Package inserts contain:

1. Criteria for acceptable reagent performance
2. Documentation of reagent use
3. Appropriate corrective actions for reagents that do not meet performance requirements

Polyclonal reagents are usually derived from the injection of _______ and the polyclonal product contains several clones of _____

animals or humans with purified antigens/ B-cell antibody

Monoclonal antibody is a _______

a created clone that contains antibodies of a defined specificity. (produced in vitro)

What is anti-A and anti-B?

Anti-A and Anti-B are commercial sera used to determine A or B antigens on donor or patient (unknown antigen) red cells

Anti-A is ______ for A _____

Anti-A is antibody for A antigen

D is most important ______

Rh antigen in routine blood bank testing. Determines whether positive or negative. O negative blood lacks D antigen

Polyspecific AHG reagents are used primarily in ______ testing

DAT testing

Polyspecific AHG reagents contain antibodies to both _____ and _____

IgG and C3d ( a different part of the complement protein)

Monospecific reagents are prepared by _____

separating the polyspecific products into either IgG AHG or C3d AHG

AHG is commercially available as either ____ or ______ serum based

polyclonal or monoclonal

Checks cells should give a _____ reaction every time

positive

Check cells are _____

commercially prepared type O cells that have been sensitized with IgG

Check cells are also known as _____

Coombs cells

The _______ requires a control system all AHG tests that are interpreted as ______

AABB Standards for Blood Banks and Transfusion Services / negative

AABB Standards for Blood Banks and Transfusion services ensures that all _______

negative AHG tests were performed correctly with sufficient cell washing

Check cells should give a ______ reaction every time

positive

_____ and _____cells are used to confirm the ABO typing performed on the patient's red cells

Group A1 and Group B cells

Group A1 and group B red cells are known as ____

ABO reverse grouping

Patients produce _____ in their serum directed against the ______ on their red cells

ABO antibodies / ABO antigens

People who have AB, do not have any _____

antibodies

_____ are the universal donor for plasma

People who have type O, have no ______

antigens on red cells (universal donor for blood)

_______ are used in antibody screen tests

Screening cells

Screening cells are obtained from ______

Type O individuals

Screening cells are available as _____

two- or three- vial sets

The _____ requirs that screening cells detect the most clinically significant antibodies

FDA

Panel cells determine ______

the specificity of an antibody when an antibody screen detects the presence of an unexpected antibody

Panel cells use type ____ donors and are packaged in sets of _____

O / 10 or more vials

A(n) ______ of each donor is included in the packaging of Panel Cells

antigenic profile

______ are useful alternaties to antisera for blood typing purposes. They are derived from _______. No ______ is contained in these reagents

Lectins/ plant extracts/ no antibody

Lectins can be useful in identifying _______

antigens present on patient or donor red cells

Gel technology methods uses ________ to ______

uses dextran acrylamide gel particles to trap agglutinated red cells (the cards are incubated and cetrifuged)

Two types of Gel Technology Methods:

1. Phenotyping cards: used for ABO, D, and other Rh typing
2. AHG card: Used for antibody screen, antibody identification, compatability testing, and DAT

Microplate testing for the detection of antigen-antibody reactions, uses...

a plate with 96 wells that substitute for test tubes

Explain Microplate testing for the detection of antigen-antibody reactions

1. Small quantities of serum and red cells are added to the wells and incubated, then centrifuged
2. The red cell buttons are resuspended and can be read manually or with a photometric device

How is a positive reaction determined in microplate testing

A concentrated button of red blood cells

How is a negative reaction determined in microplate testting

Smooth suspension of red blood cells or a streaming pattern of red blood cells when the plate is placed on an angle

Solid-phase methods use:

microplate test wells with immobilized red cells, which are bound to polystyrene and adhered to the microplate. These plates have low ionic solution added and are incubated, washed, and cetrifuged

Nonspecific and provides the first line of defense against invading pathogens

Innate immunity or natural immunity

The innate response includes (3 things)

1. phagocytic cells
2. chemical mediators
3. inflammatory response

Principal cells of innate immunity are (three things)

1. neutrophils
2. macrophages
3. natural killer cells

Three signs of inflammation

1. Vasodilation
2. Edema
3. Phagocyte migration into tissue (neutrophils)

Principal cells of acquired immunity are

T cells and B cells

Antibodies are products of the _____

adaptive immune system

_____ are in the blood

monocytes

____ are in the tissue

macrophages

_____ are antigen presenting cells (APCs)

macrophages

Why are macrophages antigen presenting cells?

Because they present foreign material to lymphocytes that will initiate the adaptive immune response

______ cells are a part of the innate immune system and act as a first line of defense

Phagocytic

Mononuclear phagocytes include:

monocytes (in blood) and macrophages (in tissues).

What are polymorphonuclear leukocytes?

Other phagocytic cells such as neutrophils. They are found in peripheral blood and migrate into tissues when signaled by inflammatory mediators

Neutrophils contain

lytic enzymes and bactericidal substances within their granules

Phagocytes include:

1. mononuclear phagocytes
2. antigen-presenting cells
3. Polymorphonuclear leukocytes

Antigen-presenting cells process and present antigenic peptides in association with

Class II MHC molecules and active T cells

T-cell activity is referred to as

cellular immunity

B cells (B lymphocytes) are a part of

the humoral immunity

T-cells ____

combat intracellular pathogens

B cells ____

recognize and clear extracellular material

Cytokines

Cytokines are secreted proteins that regulate the behavior of other cells.

_______ bind to specific receptors to mediate inflammation and immune reactions

Cytokines

Colony-stimulating factors

These are specific cytokines that direct differentiation of the stem cells to produce assorted blood cells such as platelets, erythrocytes, and different leukocytes in a process hematopoieses

B cells differentiate into

memory cells and plasma cells

Once a naive B cell encounters its matching antigen, it changes into an activated B cell or ______

plasma cell

What does a plasma cell do?

The plasma cell manufactures antibody molecules that recognize and bind to specific antigens

epitopes are also called

antigenic determinants

Antigenic determinant is

a site on an antigen that is recognized and bound by a particular antibody or T cell receptor

When are memory B cells created

They are created following the first encounter with an antigen

Antibodies made by B cells become more specific through a process called ____

affinity maturation

What is affinity maturation

the process that leads to an increase in the affinity between the antibody and an antigen following repeated exposures with the antigen

What is a B-cell clone

Groups of B cells or plasma cells that produce antibodies with the same specificity

Antibodies are found in

body fluids

T-cells two types

1. T-helper cells
2. T-cytotoxic cells

Purpose of Helper cells

recognize and interact with antigen and produce cytokines that activate other cells such as B cells, cytotoxic cells, and stimulate B cells to produce antibodies

T-cytotoxic cells ...

Involved in direct clearance of viral-infected cells, tumor cells, and cells of foreign tissue grafts

How do T cells recognize antigens

Unllike B cells, T cells recognize antigens ONLY when they are enclosed withing the peptide-bonding groove of the MHC of another cell

T-helper cells are stimulated by

antigen-presenting cells (APC) and B cells to produce cytokines

T cells are involved in the direct destruction of

1. viral infected cells
2. tumor cells
3. cells of foreign tissue

T cells also have a

memory response signaled by a secondary infection in a mechanism similar to that of a B cell

Lymphocytes are differentiated by cluster of differentiation (CD). How does this work

1. A lymphocyte with a CD4 marker functions as a T-helper cell
2. A lymphocyte with a CD8 marker functions as a cytotoxic cell

What is the ratio of CD4 to CD8 to cells and what can alter this

The ratio is 2:1 and can be altered by AIDS or an autoimmune disease

Name three things that cytokines can do

1. Regulate the intensity of a reaction
2. Initiate inflammation
3. Cause fever
4. Stimulate the bone marrow to produce more cells

What is MHC

Major histocompatibility complex - A group of genes located on chromosome 6 that determine the expression of the HLA and complement proteins

What is HLA

human leukocyte antigen

antigen presenting cells include (APCs)

macrophages found in the tissues and monocytes found in the blood

Blood containing leukocytes that are stored tend to have an increase in _____ that may cause febrile reaction

cytokines

Name 4 cytokines

1. Interleukin 1
2. Interferon alpha
3. Tumor necrosis factor
4. Interleukin 6 and colony-stimulating factors

Interleukin 1

Activates T-helper cells and promotes the inflammatory response and fever

Interferon alpha

inhibits viral replication

tumor necrosis factor

kills tumor cells

Interleukin 6 and colony-stimulating factors

promotes hematopoiesis

nine components of complement are

C1-C9

Activation of C1q creates ____

a cascade reaction that results in the final formation of a membrane attack complex that causes cell lysis

The classical pathway is activated by

antibody-bound antigen

Complement proteins normally circulate in an ____

inactive or proenzyme state

Upon activation, complement proteins ____

are converted to active enzymes that enhance the immunologic process

C1q, r, s complex splits _______ proteins into two parts

C4 and C2

Each protein is converted into an a or b protein fragment. ____ is the smaller fragment

What does the b fragment do

The larger b fragment binds to the cell

What does the a fragment do

The smaller a fragment enhances the inflammatory response

C4b and C2a fragments join to _____

form C3 convertase which splits C3 into C3a and C3b

The C3 convertase joins with _______ to form _______ which splits C5

C3b to form C5 convertase which splits C5

The final formation of a ________ causes lysis of various cells by disrupting the cell membrane

membrane attack complex

Three major biologic activities of the complement system:

1. opsonization
2. lysis of target cells
3. Stimulation of inflammatory mediators

C3a, C4a, and C5a assist in the ____

recruitment of phagocytic cells and promote the release of vasoactive amines that help make blood vessels permeable for fluid and cells to enter the area

The ______ protein is chemotactic for neutrophils and attracts these cells to the site of injury

C5a

Complement also functions as an _____

opsonin

What do opsonins do

A substance that binds to an antigen to promote phagocytosis. Phagocytic cells are inefficient unless they are coated with opsonin

Receptors on the surface of a phagocytic cell have a high affinity for _____

opsonin

What test is useful when red cell destruction is being investigated?

A test to determine whether the RBC is coated with complement components

Antigens combine with ____ or _____

antibody or T cell

____ are the most immunogenic followed by _____

Proteins / carbohydrates

_____ tend to be immunologically inert

lipids

Factors contributing to immunogenicity

1. chemical composition of antigen
2. Degree of foreignness
3. Size
4. Dosage and antigen density
5. route of administration

Within the immunogen, small regions of the molecule are called epitopes or _____

antigenic determinants

_____ is responsible for specificity

antigenic determinant

Every individual possesses a unique set of _____ determined through genetic inheritance

red cell antigens

______ is an alternative testing method which uses red cell adherence to a solid support rather than hemagglutination

Solid-phase testing

_______ is highly immunogenic compared with other antigens

The D antigen within the Rh blood group

Antibodies to platelet antigens are the major cause of _______ in which maternal alloantibodies against antigen inherited from the father can cause fetal platelet destruction

neonatal alloimmune thrombocytopenia

Alloantibodies are ____

antibodies with specifities other than self; stimulated by transfusion or pregnancy

HLA are

(Human leukocyte antigens) the nucleated cells such as leukocytes and tissue cells that possess many antigens on the cell surface. They will provoke an immune response if transferred into a genetically different or allogenic individual

The genes encoding the expression of HLAs are parts of the ______

MHC gene system

The MHC system is important in recognition of (three things)

1. nonself
2. coordination of cellular and humoral immunity
3. graft rejection

MHC is divided into ____ categories

3 categories (Class I, Class II, and Class III). Class III include the complement proteins

Antibodies produced by patients following repeated transfusions of platelets are often directed against _______

HLA antigens

Antibodies produced by patients following repeated transfusions can cause poor _____

platelet response or refractoriness

What is refractoriness

An unresponsiveness to platelet transfusions due to HLA or platelet-specific antibodies or platelet destruction from fever or sepsis

The risk of ______ increases if HLA matching is not close

Graft-verse-host disease (GVHD)

Clinical symptoms of GVHD

1. rash
2. diahrrhea
3. jaundice

_______ of blood components is performed to reduce the risk of leukocytes proliferating in the host

Irradiation

The lymphocytoxicity test is used for

identification of either HLA system antigens or antibodies

Three classes of antigens

1. red cell antigens
2. Human leukocyte antigens (HLA)
3. Platelet antigens

5 classes of antibodies

1. IgG
2. IgM
3. IgA
4. IgD
5. IgE

Antibody molecules are _____

glycoproteins

The five diffferent immunoglobulins are sometimes referred to as:

isotypes

The constant regions of the heavy chain impart_______

unique antibody class functions such as the activation of complement or the attachment to certain cells

The variable regions of the heavy and light chains are concerned with ____

antigen binding and constitutes the area of the antibody that contains the idiotype

____is the binding site into which the antigen fits

variable region

___ and ____ are used to cleave the antibody into Fab and FC regions

pepsin and papain

fab contains

the portion that binds to the antigenic determinant

___ consists of the remainder of the constant domains of the two heavy chains

_____ are the first class of antibody to be produced by B cells or plasma cells when an antigen is encountered

IgM

____ is capable of agglutination of red cells in saline

IgM

IgM constitutes ____% of total serum antibody

5 - 10%

One ____ IgM molecules is required for initiation of the classical pathway

one

Antibodies of the ABO blood group are typically _____ and can cause rapid hemolysis of red cells if an incompatible unit of blood is transfused

IgM

IgG is a monomer or pentamer

monomer

IgG possesses ____ antigen-combining sites

two

IgG is capable of activating the complement system but requires ___ molecules of IgG

two

___ subclasses of IgG exist

In a primary response, ____ antibodies are produced first

IgM

During the _____ phase of an immune response, no detectable circulating antibodies can be found

lag

Secondary response is also known as

anamnestic response (because there are memory cells)

Because of significant production of ______ from initial exposure, concentrations of circulating antibody is high and sustained longer in a ______ response

Memory B cells / secondary response

Detecting a higher level of the _____ form of an antibody may indicate an acute or early infection, whereas an increase in the _____ form may indicate a chronic or continued infection

IgM, IgG

Avidity depends on:

1. affinity of the antibody
2. valency of the antigen
3. noncovalent attractive forces

The binding of an antigen and antibody follows the:

law of mass action and is a reversible process

In vivo refers to a reaction ____

within the body

Antibody screen test determines ___

presence of alloantibodies

In vitro refers to a reaction ___

in a test tube

sensitization

binding of antibody or complement components to a red blood cell

lattice formation

combination of antibody and a multivalent antigen to form crosslinks and result in visible agglutination

allobodies

Antibodies produced in response to transfusion of blood products

The ______ test is performed on the patient before transfusion to detect any preformed red cell alloantibodies

antibody screen test

If a red cell alloantibody is detected then _____

a test is performed to identify the specificity of the antibody. Once the specificity is identified, donor units lacking the red cell antigen are selected for transfusion

Antigen-antibody complexes are removed from the body's circulation through the ________ in secondary lymphoid organs

mononuclear phagocyte system

Secondary lymphoid organs:

1. spleen
2. lymph nodes
3. liver
4. lungs

Red cells that have bound _______ are removed by the spleen

IgG or complement components

What are the two stages of hemagglutination:

1. sensitization
2. lattice formation

Serum-to-cell ratio

ratio of antigen on the red cell to antibody in the serum

How are antigen-antibody reactions occuring in vitro determined?

Detected by visible agglutination of red cells or through evidence of hemolysis at the completion of testing

Sensitization stage of antibody-binding to red blood cells

* No visible agglutination is visible at this stage
* In this stage the antibody binds to an antigen on the red cell membrane
* This stage requires an immunologic recognition between the antigen and antibody
* During this recognition stage, antigenic determinants on the red cell combine with the antigen-binding site of the antibody molecule

During the sensitization stage, increasing the _____ concentration will increase the probability of collision events for antigen-antibody binding

antibody (Increasing the amount of antigen will not enhance the first stage of agglutination reaction)

In addition to the serum to cell ratio, what are other events that may influence the first stage of agglutination (sensitization)

1. temperature of the reaction
2. Incubation time
3. Ph
4. Ionic strength

Most antibodies in transfusion are ____ antibodies reacting at approximately _____ degrees celsius

IgG/37 degrees Celsius
In contrast, IgM antibodies are more reactive at lower temperatures, at or below room temperature (22 degrees celsius)

Duriing incubation of the sensitization stage of antigen-antibody reactions, some test procedures may require an ______ that indicates a combination of test reagents and sample with no period of incubation

Immediate spin (interpretation of agglutination reactions immediately following centrifugation and without incubation)

Lattice formation is also known as

Cell-Cell interactions

______ form when red cells are in close proximity to promote the lattice formation of antibody-binding sites to antigenic determinants on adjacent red cells

Visible agglutinates

Zeta potential

is the electrostatic potential measured between the red cell membranes (the force of repulsion between red cells in saline solution)

The distance between red cells is _____ to the zeta potential

proportional

Agglutination is facilitated between adjacent red cells that have _____ attached to them

IgM (IgG antibody molecules are smaller and less able to span the distance between adjacent red cells generated by the zeta potential. Therefore, IgG molecules may attach, but visible agglutination might not occur)

Red cell preparations are diluted to _____% suspension in saline for optimal antigen concentrations. The use of red cell suspensions greater than ____ may affect the ability of the test reaction to fall within the zone of equivalence AND cause a negative reaction.

2% - 5% / 5%

The time and speed of centrifugation are important factors for the detection of agglutinated red cells. Centrifugation helps to facilitate the formation of a latticed network by _____

forcing the red cells closer together in the test environment.

Centrifuges are calibrated to _____

define the optimum speed and time for the best reactions

Antigen-antibody reactions are measured ____ (qualitative or quantitative)

qualitatively

In addition to agglutination, _____ is another indicator of antigen-antibody reaction

hemolysis

If the ________ is activated by an antibody, hemolysis of the red cells along with agglutination can occur.

complement system

As a consequence of red cell hemolysis, _____ is released into the reaction environment and imparts a slightly reddish tinge to the supernatant in the tube.

intracellular hemoglobin (this is how you can tell that hemolysis has occurred)

How is hemolysis in a test tube graded?

By placing an H on the tube

The antiglobulin test detects ______ and _____ that have attached to red cells either in vitro or in vivo but do NOT demonstrate visible agglutination in testing

IgG antibodies and complement proteins

Neutralization

blocking antibody sites thus causing a negative reaction in an antiglobulin test

If red cell washing is neglected during an antiglobulin test, what happens?

If the test red cells are not washed correctly, any unbound antibody or complement present in serum can bind to the AHG reagent and inhibit its reaction with antibody or complement molecules attached to the red cells. This is known as neutralization of the reagent and can create a FALSE negative result

The direct antiglobulin test is ordered to ____

detect IgG or complement proteins bound to patient cells in vivo. This is a consequence of certain clinical events

A positive DAT (direct antiglobulin test) is an indicator of

potential immune-mediated red cell destruction in the body

In immune-mediated red cell destruction _______ (as a consequence of IgG or complement attachment to red cells)

macrophages are signaled to clear the red cells using the mononuclear phagocytic system which often leads to anemia

Because complement can attach nonspecifically to red cells when samples are stored, it is imperative to use ________when performing a direct antiglobulin test

anticoagulated EDTA sample

Proteolytic enzymes are _____

enzymes that denature certain proteins

______ or ______ are reagents selected to adjust the in vitro test environment to promote agglutination

antibody potentiators or enhancement media

The incubation of serum and red cells in a _____ ionic environment _____ the rate of antibody binding to specific antigen receptor sites on red cells

reduced/ increases

In routine testing, the sources of antigen include:

1. reagent
2. patient
3. donor red cells

In routine testiing, the source of antibody include:

1. commercial antisera containing known antibodies
2. Patient serum or plasma

In routine testing procedures: ABO and D testing tests for:

A, B, and D antigens

In routine testing procedures: ABO seru testing tests for

ABO antibodies

In routine testing procedures: Antigen testing in _____

patient and donor samples

In routine testing procedures: Antibody screen for _____

preformed antibody as a result of pregnancy or previous transfusions

Are antibodies made by the mother or the infant?

mother

Routine procedures also include the identification of ________ during the antibody screen procedure

antibodies

Crossmatch is the _____

serologic check of compatability between a donor unit and the patient before transfusion

What is the difference between plasma and serum

Plasma contains all unused clotting factors whereas serum has no clotting factors

A crossmatch is done between the _____ and _______

patient's serum and donor cells

Commercial antisera and reagent red cell products are licensed by the ______. Products must meet minimum standards for _____and _____

FDA / specificity and potency

specificity reflects the _____

the unique recognition of the antigenic dertminant and its corresponding antibody

Potency addresses the ______

strength of the Ag/Ab reaction

Laboratory standard operating procedures are written to reflect ______

manufacturer product inserts

Package inserts contain:

1. Criteria for acceptable reagent performance
2. Documentation of reagent use
3. Appropriate corrective actions for reagents that do not meet performance requirements

Polyclonal reagents are usually derived from the injection of _______ and the polyclonal product contains several clones of _____

animals or humans with purified antigens/ B-cell antibody

Monoclonal antibody is a _______

a created clone that contains antibodies of a defined specificity. (produced in vitro)

What is anti-A and anti-B?

Anti-A and Anti-B are commercial sera used to determine A or B antigens on donor or patient (unknown antigen) red cells

Anti-A is ______ for A _____

Anti-A is antibody for A antigen

D is most important ______

Rh antigen in routine blood bank testing. Determines whether positive or negative. O negative blood lacks D antigen

Polyspecific AHG reagents are used primarily in ______ testing

DAT testing

Polyspecific AHG reagents contain antibodies to both _____ and _____

IgG and C3d ( a different part of the complement protein)

Monospecific reagents are prepared by _____

separating the polyspecific products into either IgG AHG or C3d AHG

AHG is commercially available as either ____ or ______ serum based

polyclonal or monoclonal

Checks cells should give a _____ reaction every time

positive

Check cells are _____

commercially prepared type O cells that have been sensitized with IgG

Check cells are also known as _____

Coombs cells

The _______ requires a control system all AHG tests that are interpreted as ______

AABB Standards for Blood Banks and Transfusion Services / negative

AABB Standards for Blood Banks and Transfusion services ensures that all _______

negative AHG tests were performed correctly with sufficient cell washing

Check cells should give a ______ reaction every time

positive

_____ and _____cells are used to confirm the ABO typing performed on the patient's red cells

Group A1 and Group B cells

Group A1 and group B red cells are known as ____

ABO reverse grouping

Patients produce _____ in their serum directed against the ______ on their red cells

ABO antibodies / ABO antigens

People who have AB, do not have any _____

antibodies

_____ are the universal donor for plasma

People who have type O, have no ______

antigens on red cells (universal donor for blood)

_______ are used in antibody screen tests

Screening cells

Screening cells are obtained from ______

Type O individuals

Screening cells are available as _____

two- or three- vial sets

The _____ requirs that screening cells detect the most clinically significant antibodies

FDA

Panel cells determine ______

the specificity of an antibody when an antibody screen detects the presence of an unexpected antibody

Panel cells use type ____ donors and are packaged in sets of _____

O / 10 or more vials

A(n) ______ of each donor is included in the packaging of Panel Cells

antigenic profile

______ are useful alternaties to antisera for blood typing purposes. They are derived from _______. No ______ is contained in these reagents

Lectins/ plant extracts/ no antibody

Lectins can be useful in identifying _______

antigens present on patient or donor red cells

Gel technology methods uses ________ to ______

uses dextran acrylamide gel particles to trap agglutinated red cells (the cards are incubated and cetrifuged)

Two types of Gel Technology Methods:

1. Phenotyping cards: used for ABO, D, and other Rh typing
2. AHG card: Used for antibody screen, antibody identification, compatability testing, and DAT

Explain Microplate testing for the detection of antigen-antibody reactions

1. Small quantities of serum and red cells are added to the wells and incubated, then centrifuged
2. The red cell buttons are resuspended and can be read manually or with a photometric device

THIS SET IS OFTEN IN FOLDERS WITH...

HASHBROWN

392 terms

28

69 terms

Specimen Collection, Media, and Methods

30 terms

CLINICAL MICROSCOPY

353 terms

OTHER SETS BY THIS CREATOR

27

163 terms

26

158 terms

25

115 terms

24

39 terms

OTHER QUIZLET SETS

Politics and Religion Quiz 1

23 terms

Oceanography Midterm 1

38 terms

HIST 201 Study Guide

58 terms

BDD

42 terms