WorksheetsBB-4
Total questions: 121
Worksheet time: 1hrs 1mins
Name
Class
Date
1.
Unexpected MISSING reactions in REVERSE GROUPING due to weakly reacting or missing antibodies
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
2.
CAUSE: DECREASED ANTIBODY
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
3.
Unexpected MISSING reactions in FORWARD GROUPING due to weakly reacting or missing antigen
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
4.
Discrepancies between forward and reverse groupings are caused by PROTEIN OR PLASMA ABNORMALITIES and rouleaux formation or pseudoagglutination
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
5.
Discrepancies between forward and reverse grouping due to MISCELLANEOUS PROBLEMS
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
6.
An A₂ individual forming anti-A₁ antibody represents which type of discrepancy?
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
7.
Which discrepancy type may be caused by recent RBC transfusion from a different ABO group?
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
8.
A sample showing polyagglutination due to bacterial enzyme exposure is classified as:
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
9.
Which type of discrepancy may involve RBCs expressing the rare “cis-AB phenotype”?
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
10.
Which group of ABO discrepancy is the most common?
a)
Group I ABO discrepancy
b)
Group II ABO discrepancy
c)
Group III ABO discrepancy
d)
Group IV ABO discrepancy
11.
Group I discrepancies are characterized by:
a)
Unexpected reactions in forward grouping
b)
Unexpected missing reactions in reverse grouping
c)
Pseudoagglutination due to plasma abnormalities
d)
Polyagglutination due to bacterial contamination
12.
The most frequent cause of Group I discrepancy is:
a)
Hypogammaglobulinemia
b)
Excess blood group–specific substances
c)
Rouleaux formation
d)
Cold autoantibodies
13.
Which of the following patient conditions can cause Group I discrepancies?
a)
Newborn infants
b)
Elderly patients
c)
Leukemia or immunodeficiency
d)
Bone marrow transplant recipients
e)
All of the above
14.
True chimerism is most likely seen in which condition?
a)
Post-transfusion
b)
Twin pregnancy
c)
Bone marrow transplantation
d)
Fetal-maternal hemorrhage
15.
Artificial chimerism may result from:
a)
Leukemia
b)
Transfusion or bone marrow transplant
c)
Immunosuppressive therapy
d)
Malnutrition
16.
To resolve Group I discrepancies, which approach is most appropriate?
a)
Repeat forward grouping with enzyme-treated RBCs
b)
Warm incubation of serum with A₁ and B cells for 15–30 minutes
c)
Washing RBCs multiple times with saline
d)
Saline replacement technique
17.
What control must always be included when resolving Group I discrepancies?
a)
Positive and negative control
b)
Autocontrol and O-cell control
c)
Saline blank
d)
QC plasma control
18.
Group II discrepancies are due to:
a)
Missing or weak antibodies
b)
Missing or weak antigens
c)
Rouleaux formation
d)
Unexpected alloantibodies
19.
Which of the following can cause a Group II discrepancy?
a)
Subgroups of A or B
b)
Leukemias or Hodgkin’s disease
c)
Excess blood group–specific substances (BGSS)
d)
Acquired B phenomenon
e)
All of the above
20.
Excess blood group–specific substances (BGSS) may lead to false-negative forward typing due to:
a)
Hemolysis
b)
Neutralization of anti-A or anti-B reagent
c)
Agglutination of serum proteins
d)
Adsorption of antibodies onto cells
21.
Excess BGSS substances are commonly seen in caner diseases involving:
a)
Heart
b)
Liver
c)
Stomach or pancreas
d)
Bone marrow
22.
How can weakly reactive antigens in Group II discrepancies be enhanced?
a)
Incubate the test at room temperature for up to 30 minutes
b)
Add more reagent antisera
c)
Wash RBCs with saline
d)
Perform saline replacement technique
23.
In Group II discrepancies, what can be done to increase reactivity?
a)
Pretreat RBCs with enzymes
b)
Add albumin
c)
Add EDTA
d)
Decrease incubation time
24.
Which of the following distinguishes acquired B antigen from true B antigen?
a)
Reactivity with anti-B at all pH levels
b)
Reactivity removed by acetic anhydride treatment
c)
Reaction with anti-A₁ lectin
d)
Positive secretor test for B substance
25.
In acquired B, only which soluble substance is secreted?
a)
A substance
b)
B substance
c)
H substance
d)
Either
e)
Neither
26.
Antibodies to low-incidence antigens may cause a Group II discrepancy. How can this be resolved?
a)
Repeat with antisera from a different lot
b)
Pretreat with enzymes
c)
Add anti-human globulin
d)
Incubate at 37°C
27.
Group III discrepancies are caused by:
a)
Plasma protein abnormalities or rouleaux formation
b)
Missing antibodies
c)
Weak antigens
d)
Cold autoantibodies
28.
Which of the following may cause a Group III discrepancy?
a)
Wharton’s jelly in cord blood
b)
High fibrinogen
c)
Plasma expanders like Dextran
d)
Multiple myeloma or Waldenström macroglobulinemia
e)
All of the above
29.
Wharton’s jelly–related discrepancies are corrected by:
a)
Incubation
b)
Washing the RBCs 6–8 times
c)
Saline replacement
d)
Enzyme pretreatment
30.
Rouleaux formation can be eliminated by which confirmatory step?
a)
Enzyme pretreatment
b)
Saline replacement technique
c)
Absorption-elution
d)
Plasma removal
31.
In the saline replacement technique, what happens to rouleaux?
a)
Cells remain clumped
b)
Cells disperse after saline addition
c)
Either
d)
Neither
32.
Group IV discrepancies result from:
a)
Weak antigens
b)
Missing antibodies
c)
Miscellaneous causes
d)
Plasma protein abnormalities
33.
Causes of Group IV discrepancies include all EXCEPT:
a)
Polyagglutination
b)
Cold autoantibodies
c)
Rouleaux formation
d)
Unexpected alloantibodies
34.
Cold reactive autoantibodies are often associated with:
a)
False-positive agglutination in forward typing
b)
Weak reactions in reverse typing
c)
Hypogammaglobulinemia
d)
Rouleaux formation
35.
A patient’s forward typing shows unexpected agglutination at room temperature that disappears after warming to 37 °C. What is the most appropriate corrective step?
a)
Wash RBCs 6–8 times with saline
b)
Incubate RBCs at 37 °C, then wash with 37 °C saline three times
c)
Pretreat RBCs with enzymes before testing
d)
Add one or two extra drops of patient serum
36.
Which chemical can be used to disperse IgM-related agglutination in cold autoantibody interference?
a)
EDTA
b)
Dithiothreitol (DTT)
c)
Acetic anhydride
d)
Sodium azide
37.
If warming the patient’s RBCs does not resolve a cold autoantibody discrepancy, what next procedure may be performed?
a)
Cold autoabsorption using patient cells and serum
b)
Saline replacement technique
c)
Incubation with A₁ and B cells at room temperature
d)
Treat RBCs with papain enzyme
38.
How can the presence of an unexpected ABO isoagglutinin such as anti-A₁ be confirmed?
a)
Perform antibody identification panel
b)
Test patient RBCs with Dolichos biflorus lectin
c)
Wash patient cells with saline three times
d)
Perform DAT test
39.
What is the correct next step when unexpected ABO isoagglutinins are suspected in reverse typing?
a)
Repeat reverse typing using multiple A₁, A₂, B, O cells and an autologous control
b)
Pretreat patient RBCs with DTT
c)
Perform cold autoabsorption
d)
Add extra serum to the reverse typing tube
40.
An antibody against acriflavine (a yellow dye in anti-B reagents) can cause false agglutination in forward typing. How should this be corrected?
a)
Warm the patient serum and reagent cells at 37 °C
b)
Wash the patient’s cells three times with saline and retype
c)
Use a different lot of anti-B reagent
d)
Incubate the sample at room temperature for 30 minutes
41.
Which test should be performed first to confirm the presence of cold autoantibodies causing a Group IV discrepancy?
a)
DAT
b)
IAT
c)
Antibody identification panel
d)
Crossmatching
42.
It is based on the theory that antigen of the system was produced by three closely linked set of alleles, each gene was responsible for producing a product (or antigen on the red cells surface)
a)
Fisher-Race
b)
Wiener
c)
Rosenfield
d)
ISBT
43.
DCE
a)
Fisher-Race
b)
Wiener
c)
Rosenfield
d)
ISBT
44.
It is postulated that gene responsible for defining Rh actually produced an agglutinogen that contained a series of blood factors in which each is an antigen recognized by an antibody
a)
Fisher-Race
b)
Wiener
c)
Rosenfield
d)
ISBT
45.
Rh-Hr
a)
Fisher-Race
b)
Wiener
c)
Rosenfield
d)
ISBT
46.
Number is assigned to each antigen of the Rh system in order of its discovery
▪ It has no genetic basis, only indicates absence or presence of Rh antigens
▪ A (-) minus preceding a number designates the absence of the antigen
▪ If the antigen has not been phenotyped, its number will not appear in the sequence
a)
Fisher-Race
b)
Wiener
c)
Rosenfield
d)
ISBT
47.
Alpha-numeric
a)
Fisher-Race
b)
Wiener
c)
Rosenfield
d)
ISBT
48.
Numeric terminology
a)
Fisher-Race
b)
Wiener
c)
Rosenfield
d)
ISBT
49.
In ISBT, which of the ff. represent the system?
a)
First three numbers
b)
Last three numbers
50.
In ISBT, which of the ff. represent the antigenic specificity?
a)
First three numbers
b)
Last three numbers
51.
Gene important to Rh antigen expression
a)
RHD gene
b)
RHCE gene
c)
Rh-Associated glycoprotein
52.
It is termed as a coexpressor and must be present for successful expression of the Rh antigens
a)
RHD gene
b)
RHCE gene
c)
Rh-Associated glycoprotein
53.
described a hemolytic transfusion reaction in obstetrical patient
a)
Levine and Mullis
b)
Levine and Stetson
c)
Levine and Sheldon
d)
Levine and Leeuwenhoek
54.
It is the second most important blood group system in terms of transfusion
a)
ABO Blood group
b)
Rh Blood group
c)
Other blood group
55.
Very immunogenic
a)
ABO Blood group
b)
Rh Blood group
c)
Other blood group
56.
Order of immunogenicity of Rh blood group
a)
D>C>E>c>e
b)
D>c>E>C>e
c)
D>C>e>c>E
d)
All of the above
57.
The Rh antigen on the RBC is normal, but the steric arrangement of the C antigen in relationship to the D antigen appears to interfere with the expression of D antigen
a)
Position effect
b)
Quantitative
c)
Partial D antigen
58.
Inheritance of RHD genes that code for a weakened expression of the D antigen
a)
Position effect
b)
Quantitative
c)
Partial D antigen
59.
Antigens expressed appear to be complete but fewer in number
a)
Position effect
b)
Quantitative
c)
Partial D antigen
60.
• Del extremely low number of D antigen sites that most reagent antiD are unable to detect
a)
Position effect
b)
Quantitative
c)
Partial D antigen
61.
Wiener and Unger postulated that the D antigen is made of antigenic subparts, genetically determined, that could be absent in rare instances
a)
Position effect
b)
Quantitative
c)
Partial D antigen
62.
Individual lacks one or more pieces or epitopes of the total D antigen, alloantibody can be made to the missing epitope(s) if exposed to RBCs that possess the complete D antigen
a)
Position effect
b)
Quantitative
c)
Partial D antigen
63.
What test principle is used in the detection of weak D antigen?
a)
Direct Antiglobulin Test
b)
Indirect Antiglobulin Test
c)
Saline Replacement Technique
d)
Antibody Identification Panel
64.
In weak D testing, what indicates a positive result after adding AHG reagent?
a)
Precipitation
b)
Agglutination
c)
Flocculation
d)
Hemagglutination
65.
During weak D testing, the RBCs and anti-D are first incubated at what temperature?
a)
Room temperature (25°C)
b)
4°C
c)
37°C
d)
45°C
66.
In Rh slide typing using a viewbox, at what temperature should the test be performed?
a)
4°C
b)
37°C
c)
20–25°C
d)
45–50°C
67.
In weak D testing, how long should the agglutination be read in slide typing?
a)
Immediately
b)
Within 1 minute
c)
Within 2 minutes
d)
Within 5 minutes
68.
How should a patient with weak D expression be typed for transfusion purposes?
a)
Rh positive
b)
Rh negative
c)
Indeterminate
d)
Weak D positive but Rh negative
69.
How should a donor with weak D antigen expression be labeled?
a)
Rh positive
b)
Rh negative
c)
Indeterminate
d)
Weak D positive but Rh negative
70.
Most Rh antibodies belong to which immunoglobulin class?
a)
IgA
b)
IgM
c)
IgG
d)
IgE
71.
At what temperature do Rh antibodies react optimally?
a)
4°C
b)
25°C
c)
37°C
d)
56°C
72.
Rh antibodies are usually detected after what type of exposure?
a)
Exposure to bacterial antigens
b)
Exposure to foreign RBC antigens
c)
Exposure to viral antigens
d)
Natural environmental exposure
73.
Which statement best describes complement binding by Rh antibodies?
a)
Strongly binds complement, causing intravascular lysis
b)
Weakly binds complement, causing partial lysis
c)
Does not bind complement; causes extravascular destruction
d)
Binds complement only in presence of enzyme-treated cells
74.
What type of hemolysis is primarily caused by Rh antibodies?
a)
Intravascular
b)
Extravascular
c)
Mixed-type hemolysis
d)
No hemolysis
75.
▪ Individuals who lack all Rh antigens on their RBCs
a)
Rh null
b)
Rh mod
c)
Rh deleted
d)
Cw
76.
Either a mutation in the RHAG gene which results in no RhAG protein expression and subsequently no RhD or RHCE protein or mutation in each of the RHCE genes inherited from each parent and the common deletion of the RHD gene while the RHAG gene is normal
a)
Rh null
b)
Rh mod
c)
Rh deleted
d)
Cw
77.
Partial suppression of RH gene expression caused by mutations in the RHAG gene
a)
Rh null
b)
Rh mod
c)
Rh deleted
d)
Cw
78.
aka Exalted D
a)
Rh null
b)
Rh mod
c)
Rh deleted
d)
Cw
79.
▪ It has the greatest amount of D antigen
a)
Rh null
b)
Rh mod
c)
Rh deleted
d)
Cw
80.
Only phenotypic and antithetical to the high-prevalence antigen MAR
a)
Rh null
b)
Rh mod
c)
Rh deleted
d)
Cw
81.
Results in a single amino acid change most often found on the RhCe protein
a)
Rh null
b)
Rh mod
c)
Rh deleted
d)
Cw
82.
Compound antigen present when C and e are on the RhCe protein
a)
Rh i
b)
G
c)
f
83.
It is the antigen present on most D positive and all C positive RBCs
a)
Rh i
b)
G
c)
f
84.
expressed on the RBC when both c and e are present on the same haplotype
a)
Rh i
b)
G
c)
f
85.
HDFN is caused by the destruction of fetal red blood cells due to:
a)
Maternal IgM antibodies
b)
Maternal IgG antibodies
c)
Fetal IgM antibodies
d)
Fetal complement activation
86.
As little as how many milliliters of fetal blood can stimulate maternal production of anti-D?
a)
0.1 mL
b)
1 mL
c)
5 mL
d)
10 mL
87.
Which of the following is not a required condition for HDFN to occur?
a)
Fetus possesses an antigen lacking in the mother
b)
Maternal antibody is IgG
c)
Fetal antigen is poorly developed at birth
d)
Antigen must be well-developed at birth
88.
The generalized edema, effusions, and ascites in severe HDFN are collectively known as:
a)
Erythroblastosis fetalis
b)
Hydrops fetalis
c)
Kernicterus
d)
Rh incompatibility
89.
What is the main site of removal for antibody-coated fetal RBCs in HDFN?
a)
Liver macrophages
b)
Bone marrow macrophages
c)
Spleen macrophages
d)
Kidney macrophages
90.
When the bone marrow cannot keep up with RBC destruction in HDFN, extramedullary erythropoiesis occurs primarily in the:
a)
Spleen and liver
b)
Lungs and thymus
c)
Kidney and adrenal glands
d)
Placenta and cord blood
91.
Hemoglobin released from destroyed RBCs in HDFN is converted to:
a)
Biliverdin
b)
Bilirubin
c)
Urobilinogen
d)
Hemosiderin
92.
The goal of intrauterine transfusion in HDFN is to maintain fetal hemoglobin above:
a)
5 g/dL
b)
7 g/dL
c)
10 g/dL
d)
12 g/dL
93.
A standard 300 µg vial of RhIG protects against how much whole blood?
a)
5 mL
b)
15 mL
c)
30 mL
d)
45 mL
94.
The first dose of RhIG is administered at:
a)
12 weeks’ gestation
b)
20 weeks’ gestation
c)
28 weeks’ gestation
d)
After delivery only (Within 72 hours)
95.
The second dose of RhIG is administered at:
a)
12 weeks’ gestation
b)
20 weeks’ gestation
c)
28 weeks’ gestation
d)
After delivery only (Within 72 hours)
96.
RhIG works by:
a)
Neutralizing anti-D antibodies in the maternal circulation
b)
Destroying fetal RBCs in maternal circulation directly
c)
Coating fetal Rh-positive RBCs for removal by the maternal spleen
d)
Inhibiting fetal RBC production
97.
Which test is qualitative for fetomaternal hemorrhage detection?
a)
Coombs test
b)
Rosette test
c)
Kleihauer-Betke test
d)
Flow cytometry
98.
Which test is quantitative for fetomaternal hemorrhage?
a)
Coombs test
b)
Rosette test
c)
Kleihauer-Betke test
d)
Flow cytometry
99.
The Kleihauer-Betke test is based on what principle?
a)
Acid elution resistance of fetal hemoglobin
b)
Complement fixation
c)
Agglutination inhibition
d)
Hemoglobin denaturation by alkali
100.
In Kleihauer-Betke test results, maternal cells appear as
a)
Darkly stained cells
b)
Ghost cells
c)
Blue-stained cells
d)
Reticulated cells
101.
Formula for calculating the % fetal cells in Kleihauer-Betke test:
a)
(Fetal cells / 1,000) × 100
b)
(Fetal cells / 2,000) × 100
c)
(Fetal cells / 5,000) × 100
d)
(Fetal cells / 10,000) × 100
102.
Formula for calculating volume of fetomaternal hemorrhage (FMH):
a)
% Fetal cells × 30
b)
% Fetal cells × 50
c)
% Fetal cells × 60
d)
% Fetal cells × 70
103.
Formula for determining vials of RhIG needed:
a)
(Volume of FMH ÷ 15) + 1
b)
(Volume of FMH ÷ 20) + 1
c)
(Volume of FMH ÷ 30) + 1
d)
(Volume of FMH ÷ 50) + 1
104.
More common
a)
ABO HDFN
b)
RH HDFN
105.
First pregnancy: yes
a)
ABO HDFN
b)
RH HDFN
106.
Disease predicted by titers: no
a)
ABO HDFN
b)
RH HDFN
107.
Antibody IgG: Yes, (anti-A,B)
a)
ABO HDFN
b)
RH HDFN
108.
Bilirubin at birth if within normal range
a)
ABO HDFN
b)
RH HDFN
109.
Anemia at birth is not present
a)
ABO HDFN
b)
RH HDFN
110.
Exchange transfusion is rarely done
a)
ABO HDFN
b)
RH HDFN
111.
No intrauterine transfusion
a)
ABO HDFN
b)
RH HDFN
112.
Sometimes intrauterine transfusion
a)
ABO HDFN
b)
RH HDFN
113.
Exchange transfusion is uncommon
a)
ABO HDFN
b)
RH HDFN
114.
Rare in first pregnancy
a)
ABO HDFN
b)
RH HDFN
115.
Disease is predicted by titers (yes)
a)
ABO HDFN
b)
RH HDFN
116.
Antibody is IgG
a)
ABO HDFN
b)
RH HDFN
117.
Bilirubin at birth is elevated
a)
ABO HDFN
b)
RH HDFN
118.
Anemia at birth is present
a)
ABO HDFN
b)
RH HDFN
119.
Phototherapy
a)
ABO HDFN
b)
RH HDFN
120.
First pregnancy: rare
a)
ABO HDFN
b)
RH HDFN
121.
More severe
a)
ABO HDFN
b)
RH HDFN
100 %
