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WorksheetsBB FINAL EXAM
Total questions: 102
Worksheet time: 2hrs 42mins
American Association of Blood Bank Standards requires
that plateletpheresis products:
Prepared in a closed system be transfused within 24 hours
Contain 3x1011 platelets in ≥ 90% of the units teste
Have a compatibility test performed before transfusion
Have a pH of 6.2 or greater on the day of collection
Therapeutic cytapheresis is used in patients with:
Sickle cell disease to reduce the number of crises
Systemic lupus erythematosus to remove immune complexes
Leukemia to help increase granulocyte production
Myasthenia gravis to increase antibody production
The minimum interval allowed between plateletpheresis
component collection procedures is
24 hours
48 hours
7 days
8 weeks
In plasma exchange, the therapeutic effectiveness is:
Greatest with the first plasma volume removed
Affected by the type of replacement fluid used
Enhanced if the unwanted antibody is IgG rather than IgM
Independent of the use of concomitant immunosuppressive therapy
The most common adverse effect of plateletpheresis collection is
Allergic reactions
Hepatitis
Hemolysis
Citrate effect
Air embolism
Apheresis can be used to collect all of the following except:
Leukocytes
Macrophages
Hematopoetic progenitor cells
Platelets
Lymphocytes
Transfused plasma constituents resulting in immediate erythema, itching, and hives best typify which of the following transfusion reactions
HTR
DHTR
Allergic
Iron overload
Alloimmunization
Which listed transfusion reaction may result from an anamnestic response following a secondary exposure to
donor RBCs?
IHTR
Alloimmunization
Anaphylactoid reaction
TACO
TA-GVHD
Patients at greatest risk of developing TACO may include:
Children
Elderly people
Patients with chronic normovolemic anemia
Patients with sickle cell disease
All of the above
Which listed transfusion reaction is most associated with transfused patients lacking IgA immunoglobulin?
Anaphylactic
Hemolytic
Febrile
TACO
A transfusion reaction that usually appears rapidly during the transfusion termed “warm” and that may result in fever, shock, or death is which of the following?
Hemolytic
Bacterial contamination
TACO
Allergic
FNHTR
After an IHTR, the recipient’s serum bilirubin may return to normal in:
5 hours
12 hours
48 hours
3 hours
24 hours
Which of the following antibodies is most responsible for IHTR?
Anti-Lea
Anti-N
Anti-A
Anti-M
Anti-D
When a suspected hemolytic reaction occurs, the first
thing to do is:
Slow the transfusion rate and call the physician
Administer medication to stop the reaction
Stop the transfusion but keep the intravenous line open with saline
First inform the laboratory to begin an investigation
Begin technical checks
Which of the following are symptoms of Febrile Nonhemolytic Transfusion Reaction?
Shock, hemoglobinuria, hypotension
Respiratory distress, vascular instability, shock
DIC, renal failure, hemoglobinuria
Temperature rise of 1C with transfusion
Temperature rise of 2C or more with transfusion
DHTRs from anamnestic responses usually occur within which time period?
5 hours
24 hours
Several weeks after transfusion
3–7 days after transfusion
48 hours post-transfusion
Pretransfusion irradiation of all blood products in certain patients is done to prevent which of the following?
CMV
TA-GVHD
FNHTR
PNH
HTR
A patient was suspected of having TA-GVHD as a result of transfusion therapy. What may cause TA-GVHD?
Transfused contaminated blood components
Functional T lymphocytes in cellular blood component
Hypersensitivity reaction
Results from platelet-specific antibody following transfusion
Results from transfused serum proteins (IgE) reacting
with recipient antibodies
Currently, which of the following does the AABB consider to be the most significant infectious threat from transfusion?
Bacterial contamination
CMV
Hepatitis
HIV
Which transfusion-associated parasite may have asymptomatic carriers?
Babesia microti
Trypanosoma cruzi
Plasmodium species
All of the above
Reasons why syphilis is so rare in the United States blood supply include all of the following except
4C storage conditions
donor questionnaire
short spirochetemia
NAT testing
What is the shipping temperature requirement for plasma?
1–6F or higher
1–6C or lower
-18F or higher
-18C or lower
A shipment of platelets has been received, but transfusion is delayed for 1 hour. What is the best course of action to ensure optimal viability of the product?
Refrigerate the units subsequent to confirmation of ABO and Rh type
Incubate at 37C and perform compatibility testing
Store at room temperature on a flatbed agitation
Place the platelets in the 18C freezer until transfused
Under what circumstances must the Rh type be confirmed
Donor unit previously typed as Rh-positive
Donor unit previously typed as Rh-negative
Donor unit previously typed as A-, B-, or O-negative
Donor unit previously typed as A-, B- or O-positive
What factors determine the maximum number of components that may be derived from one unit of whole
blood
Time and anticoagulant
Time and collection container composition
Temperature and collection container size
Container composition and anticoagulant
Which of the following presents with depressed or absent antigen expression due to the In(Lu) regulator gene?
GE and DI
KN and IN
CROM and CH/RG
IN and GE
Mutations in the carrier molecule for this blood group system may result in changes of RBC shape in the forms of elliptocytosis, acanthocytosis, or ovalocytosis.
DI
DO
CO
SC
According to the RBC surface antigen terminology by ISBT, all authenticated antigens may be assigned to a blood group system, provided they are:
Controlled by a single gene or by two closely linked genes
Inherited from multiple regulator genes
Shown not to follow mendelian principles
Shown to share serologic characteristics with other members of the blood group system
The antibody to this RBC antigen in the 901 series demonstrates mixed-field agglutination that appears shiny and refractile under the microscope.
Vel
JMH
Lan
Sda
The antibody to this RBC antigen in the 901 series has
been associated with causing severe immediate HTR
Anti-JMH
Anti-Bga
Anti-Vel
Anti-Sda
The following antibodies are generally considered clinically insignificant because they have not been associated with causing increased destruction of RBCs, HDN, or HTR
Anti-Doa and anti-Coa
Anti-Ge3 and anti-Wra
Anti-Ch2 and anti-Kna
Anti-Dib and anti-Yta
A woman wants to donate blood. Her physical examination reveals the following:
weight—110 Ib, pulse—73 bpm,
blood pressure—125/75 mm Hg,
hematocrit—35%. Which of the following exclusions applies to the prospective donor?
Pulse too high
Weight too low
Hematocrit too low
Blood pressure too low
A potential donor has no exclusions, but she weighs only 95 pounds. What is the allowable amount of blood (including samples) that can be drawn?
367 mL
378 mL
454 mL
473 mL
Donors who have received blood or blood products within 12 months of when they desire to donate are deferred to protect the recipient because the
Blood could have transmitted hepatitis (HBV or HCV) orHIV
Blood may have two cell populations
Donor may not be able to tolerate the
blood loss
Donor red cell hemoglobin level may
be too low
Which of the following conditions would contraindicate autologous presurgical donation?
Weight of 100 pounds
Age of 14 years
Hemoglobin of 12 g/dL
Mild bacteremia
Which of the following donors would be deferred indefinitely?
History of syphilis
History of gonorrhea
Accutane® treatment
Recipient of human growth hormone
Which of the following viruses resides exclusively in leukocytes
CMV
HIV
HBV
HCV
A donor indicates that he has taken two aspirin tablets per day for the last 36 hours. The unit of blood
May not be used for pooled platelet concentrate preparation
Should not be drawn until 36 hours after cessation of aspirin ingestion
May be used for pooled platelet concentrate preparation
May be used for red blood cells and fresh-frozen plasma production, but the platelets should be discarded
Which of the following best describes what must be done with a unit of blood drawn from a donor who is found to be at high risk of contracting acquired immune deficiency syndrome (AIDS)?
Hold unit in quarantine until donor diagnosis is clarified.
Use the blood for research dealing with AIDS.
Properly dispose of unit by autoclaving or incineration
Use the plasma and destroy the red blood cells
Which of the following is least likely to transmit hepatitis?
Cryoprecipitate
RBC
Plasma protein fraction (PPF
Platelets
Although Cryoprecipitate has primarily been used for treatment of hypofibrinogenemia and hemophilia A, it contains other blood proteins useful in the treatment of coagulopathies. Which of the following is not found in Cryoprecipitate?
Fibronectin
Factor XIII
Factor VIILvW
Antithrombin III
Even though it is properly collected and stored, which of the following will freshfrozen plasma (FFP) not provide?
Factor V
FactorVIII
Factor IX
Platelets
Blood needs to be prepared for intrauterine transfusion of a fetus with severe HDN. The red blood cell unit selected is compatible with the mother's serum and
has been leuko-depleted. An additional step that must be taken before transfusion is to
Add pooled platelets and fresh-frozen plasma
Check that the RBC group is consistent with the father's
Irradiate the RBCs before infusion
Test the RBC unit with the neonate's eluate
The addition of adenine in an anticoagulant- preservative formulation aids in
Maintaining ATP levels for red cell viability
Maintaining platelet function in stored blood
Reducing the plasma K+ levels during storage
Maintaining 2,3-BPG levels for oxygen release to the tissues
When 2,3-BPG levels drop in stored blood, which of the following occurs as a result?
Red blood cell K+ increases
Red blood cell ability to release O2 decreases
Plasma hemoglobin is stabilized.
ATP synthesis increases
The last unit of autologous blood for an elective surgery patient should be collected no later than _______________hours before surgery.
24
36
48
72
For which of the following patients would autologous donation not be advisable?
Patients with an antibody against a high-incidence antigen
Patients with uncompensated anemia
Open heart surgery patients
Patients with multiple antibodies
It is generally asymptomatic but has a very high carrier rate (70-80% have chronic infections). About 10% of the carriers develop cirrhosis or hepatocellular carcinoma. These statements are most typical of which of the following transfusion-transmitted infections?
HAV
HBV
HCV
HEV
Biochemical changes occur during the shelf life of stored blood. Which of the following is a result of this "storage lesion"?
Increase in pH
Increase in plasma K+
Increase in plasma Na+
Decrease in plasma hemoglobin
It has been determined that a patient has posttransfusion hepatitis and received blood from eight donors. There is nothing to indicate that these donors may have been likely to transmit hepatitis. What action must be taken initially?
Defer all donors indefinitely from further donations
Repeat all hepatitis testing on a fresh sample from each donor
Notify the donor center that collected the blood.
Interview all implicated donors
The temperature range for maintaining red blood cells and whole blood during shipping is
0-4°C
1-6°C
1-10°C
5-15°C
Platelets play an important role in maintaining hemostasis. One unit of donor platelets derived from whole blood should yield platelets.
5.5 X 106
5 X 108
5.5 X 1010
5 X 1010
The pH of four platelet concentrates is measured on the day of expiration. The pH and plasma volumes of the four units are as follows: pH 6.0, 45 mL; pH 5.5, 38 mL; pH 5.8, 40 mL; pH 5.7, 41 mL. What corrective action is needed in product preparation to meet AABB Standards for platelet production?
No corrective action is necessary
Recalibrate pH meter
Increase final plasma volume of platelet concentrates
Decrease final plasma volume of platelet concentrates
During preparation of platelet concentrate, the hermetic seal of the primary bag is broken. The red blood cells
Must be discarded
May be labeled with a 21-day expiration date if collected in CPD
Must be labeled with a 24-hour expiration date
May be glycerolized within 6 days and stored frozen
The blood bank procedures manual must be
Revised annually
Revised after publication of each new edition of AABB Standards
Reviewed prior to a scheduled inspection
Reviewed annually by an authorized individual
Previous records of patients' ABO and Rh types must be immediately available for comparison with current test results
For 6 months
For 12 months
For 10 years
Indefinitely
Which of the following weak D donor units should be labeled Rh-positive?
Weak D due to transmissible genes
Weak D as position effect
Weak partial D
All the above
None of the above
In order to meet the current A ABB Standards for leukocyte reduction to prevent HLA alloimmunization or CMV transmission, the donor unit must retain at least of the original red cells and leukocytes must be reduced to
less than
85%, 5 X 108
80%, 5 X 106
75%, 5 X 105
70%, 5 X 104
Which of the following tests is/are not performed during donor processing?
ABO and Rh grouping
HBsAg
HIV-l-Ag
HBsAb
A 70-kg man has a platelet count of 15,000/uL, and there are no complicating factors such as fever or HLA sensitization. If he is given a platelet pool of 6 units, what would you expect his posttransfusion count to be?
21,000-27,000/uL
25,000-35,000/uL
45,000-75,000/uL
75,000-125,000/uL
Which of the following tests on donor red blood cells must be repeated by the transfusing facility when the blood was collected and processed by a different facility?
Confirmation of ABO group and Rh type of blood labeled D-negative
Confirmation of ABO group and Rh type
Weak D on D-negatives
Antibody screening
What is the required storage temperature of this component: Red blood cells (RBCs), liquid
1-6°C
20-24°C
-18°C or colder
-65°C or colder
What is the required storage temperature of this component: Fresh-frozen plasma
1-6°C
20-24°C
-18°C or colder
-65°C or colder
What is the required storage temperature of this component: Cryoprecipitate
1-6°C
20-24°C
-18°C or colder
-65°C or colder
What is the shelf-life for this component: Fresh-frozen plasma, thawed
24 hours
5 days
35 days
1 year
What is the shelf-life for this component: Fresh-frozen plasma
24 hours
5 days
35 days
1 year
What is the component of choice for the patient based on the given situation: Patients with normovolemic anemia
Platelet concentrate
Packed RBC
Leukocyte-reduced RBC
Transfusion not indicated
What is the component of choice for the patient based on the given situation: Patients requiring transfusion with RBC that will not transmit cytomegalovirus (CMV)
Platelet concentrate
Packed RBC
Leukocyte-reduced RBC
Transfusion not indicated
What is the component of choice for the patient based on the given situation: Patients who are thrombocytopenic
secondary to the treatment of acute leukemia
Platelet concentrate
Packed RBC
Leukocyte-reduced RBC
Cryoprecipitate
Most blood group antibodies are of what immunoglobulin classes?
IgA and IgD
IgA and lgM
IgE and lgD
IgG and lgM
Which of the following blood groups reacts least strongly with an anti-H produced in an AjB individual?
Group O
Group A2B
Group A2
Group A1
How many genes encode the following Rh antigens: D, C, E, c, e?
One
Two
Three
Four
If a person has the genetic makeup Hh, AO, LeLe, sese, what substance will be found in the secretions?
A substance
H substance
Lea substance
Leb substance
Lectins are useful in determining the cause of abnormal reactions in blood bank serology. These lectins are frequently labeled as anti-H, anti-Ap etc. The nature of these lectins is explained by which of the following?
An early form of monoclonal antibody produced in nonvertebrates
A plant substance that chemically reacts with certain RBC antigens
Naturally occurring antibodies in certain plants
The ability of plants to respond to RBC antigens by antibody production
Which of the following sugars must be present on a precursor substance for A and B antigenic activity to be expressed?
D-Galactose
./V-Acetylgalactosamine
Glucose
L-Fucose
An antigen-antibody reaction alone does not cause hemolysis. Which of the following is required for red blood cell lysis?
Albumin
Complement
Glucose-6-phosphate dehydrogenase (G6PD)
Antihuman globulin (AHG)
A white female's red blood cells gave the following reactions upon phenotyping: D+ C+ E- c+ e+. Which of the
following is the most probable Rh genotype?
DCe/Dce
DCe/dce
DCe/DcE
Dce/dCe
A black patient has the following Rh phenotype: D+ C+ E+ c+ e+. Which of the following genotypes is the least
probable?
DCE/dce
DCe/DcE
DCe/dcE
DcE/dCe
If a patient has the Rh genotype DCe/DCe and receives a unit of red blood cells from a DCe/dce individual, what Rh antibody might the patient develop
Anti-C
Anti-c
Anti-d
Anti-E
If a D-positive person makes an anti-D, this person is probably
Partial D
D-negative
Weak D as position effec
Weak D due to transmissible genes
Which of the following is a characteristic of Kidd system antibodies?
Usually IgM antibodies
Corresponding antigens are destroyed by enzymes
Usually strong and stable during storage
Often implicated in delayed hemolytic transfusion reactions
Which of the following statements is not true of anti-Fya and anti-Fyb?
Are clinically significant
React well with enzyme-treated panel cells
Cause hemolytic transfusion reactions
Cause a generally mild hemolytic disease of the newborn
Which of the following antibodies can be neutralized with pooled human plasma
Anti-Hy and anti-Ge: 1
Anti-Cha and anti-Rga
Anti-Coa and anti-Cob
Anti-Doa and anti-Jsb
Which of the following statements is not true about anti-U?
Is clinically significant
Is only found in black individuals
Only occurs in S-s- individuals
Only occurs in Fy(a-b-) individuals
A patient's red blood cells are being typed for the Fya antigen. Which of the following is the proper cell type of choice for a positive control of the anti-Fya reagent?
Fy(a+b-)
Fy(a+b+)
Fy(a-b+)
Fy(a-b-)
Which of the following antibodies has been clearly implicated in transfusion reactions and hemolytic disease of the newborn?
Anti-I
Anti-K
Anti-Lea
Anti-N
Which of the following antibodies does not match the others in terms of optimal reactive temperature?
Anti-Fya
Anti-Jkb
Anti-N
Anti-U
Which set of antibodies could you possibly find in a patient with no history of transfusion or pregnancy?
Anti-I, anti-s, anti-P1
Anti-Leb, anti-A1 anti-D
Anti-M, anti-c, anti-B
Anti-P1 anti-Lea, anti-I
A group A, D-negative obstetric patient with anti-D (titer 256) is carrying a fetus who needs an intrauterine transfusion. Which of the following units should be chosen?
Group A, D-negative RBC
Group A, D-negative whole blood
Group O, D-negative RBC
Group O, D-negative whole blood
Which of the following is generally detected at the antiglobulin phase of testing?
Anti-Jka
Anti-M
Anti-P1
Anti-I
Which of the blood group systems is associated with antibodies that are generally IgM?
Rh
Duffy
Kell
Lewis
Some antigens that are primarily found on white blood cells can occur on erythrocytes. Which of the following are the redblood cell equivalents of human leukocyte antigens (HLAs)?
Lea,Leb
Bga,Bgb,Bgc
Kpa, Kpb, Kpc
Doa,Dob
The antibody that reacts at immediate spin is most likely
Anti-D
Anti-P1
Anti-Lea
Anti-Leb
The antibody that reacts at 37°C and with AHG is
Anti-C
Anti-D
Anti-CD
Anti-K
The crossmatch is performed using
Donor's serum and recipient's red cells
Donor's red cells and recipient's serum
Donor's serum and reagent red cells
Recipient's serum and reagent red cells
Which of the following will the crossmatch do?
Prevent immunization
Prevent delayed transfusion reaction
Guarantee normal survival of the red blood cells
Frequently verify donor ABO compatibility
Given that a patient's antibody screening test is negative, which of the following may cause a false positive result in a compatibility test?
Incorrect ABO typing of the donor or patient
An alloantibody against a low frequency antigen on the donor cells
Prior coating of IgG antibody on the donor cells
All the above
The patient is group A. Which cryoprecipitate units would most appropriately be used to treat this patient?
Group A only
Group AB only
Group A and Group O
Group A and Group AB
What is the component of choice for someone who needs a RBC transfusion when there is a history of febrile transfusion reactions?
RBCs less than 5 days old
Leukocyte-reduced RBCs
RBCs 30 to 35 days old
Frozen RBCs that have been thawed and deglycerolized
Four units of fresh-frozen plasma have been ordered to correct factor V deficiency in a group O patient. One should thaw and _______________issue plasma.
Group O only
Group O and/or group A
Group O and/or group AB
Any blood group available
A transfusion of which of the following is least likely to transmit HIV, HCV, or HBV?
Pooled plasma, solvent/detergent treated
Cryoprecipitate
Leukocyte-reduced RBCs
Platelets
What antibody, labile both in stored serum and the patient's plasma, is a frequent cause of delayed hemolytic transfusion reactions?
Anti-A
Anti-D
Anti-Jka
Anti-K
