Test Bank For Basic & Applied Concepts of Blood Banking and Transfusion Practices 5th Edition by Pau

Test Bank For Basic & Applied Concepts of Blood Banking and Transfusion Practices 5th Edition – By Paula Howard ISBN: 9780323697392

Table of Contents Part I: Quality and Safety Issues 1. Quality Assurance and Regulation of the Blood Industry: Safety Issues in the Blood Bank

Part II: Foundations: Basic Sciences and Reagents 2. Immunology: Basic Principles and Applications in the Blood Bank 3. Blood Banking Reagents: Overview and Applications 4. Genetic Principles in Blood Banking

Part III: Overview of the Major Blood Groups 5. ABO and H Blood Group Systems and Secretor Status 6. Rh Blood Group System 7. Other Red Cell Blood Group Systems, Human Leukocyte Antigens, and Platelet Antigens

Part IV: Essentials of Pretransfusion Testing 8. Antibody Detection and Identification 9. Compatibility Testing

10. Blood Bank Automation for Transfusion Services

Part V: Clinical Considerations in Immunohematology 11. Adverse Complications of Transfusions 12. Hemolytic Disease of the Fetus and Newborn

Part VI: Blood Collecting and Testing 13. Donor Selection and Phlebotomy 14. Testing of Donor Blood

Part VII: Blood Component Preparation and Transfusion Therapy 15. Blood Component Preparation and Therapy 16. Transfusion Therapy in Selected Patients

Chapter 01: Quality Assurance and Regulation of the Blood Industry and Safety Issues in the Blood Bank Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following agencies administers the Clinical Laboratory Improvement

Amendments?

AABB Centers for Medicare and Medicaid Services OSHA Food and Drug Administration

a. b. c. d.

ANS: B

The Centers for Medicare and Medicaid Services administers CLIA, Medicare, Medicaid, and HIPAA. DIF: Level 1

REF: p. 3

2. A laboratory technologist decided she would like to bring her lab coat home for laundering

because it had too many wrinkles when returned by the laboratory’s laundry service. Is this practice acceptable? a. Yes, if she uses 10% bleach b. Yes, if she clears it with her supervisor c. Yes, as long as she removes the coat and does not wear it home d. No, because the laboratory is a biosafety level 2, and lab coats may not be removed ANS: D

Methods of transporting the lab coat and the risk of contamination do not permit health care workers to bring lab coats home for cleaning.

DIF: Level 2

REF: p. 14

3. Personal protective equipment includes: a. safety glasses. b. splash barriers. c. masks. d. All of the above ANS: D

Safety glasses, splash barriers, and masks are types of personal protective devices.

DIF: Level 1

REF: p. 14

4. At what point in the employment process should safety training take place? a. During orientation and training b. Following lab training when employees are more familiar with their

responsibilities

c. Following the employees’ first evaluation d. Before independent work is permitted and annually thereafter ANS: D

The Occupation Safety and Health Administration requires safety training before independent work is permitted and annually thereafter.

DIF: Level 1

REF: p. 17

5. In safety training, employees must become familiar with all of the following except: a. tasks that have an infectious risk. b. limits of protective clothing and equipment. c. the appropriate action to take if exposure occurs. d. how to perform cardiopulmonary resuscitation on a donor or other employee.

ANS: D

The Occupational Safety and Health Administration requirements include all of those listed except cardiopulmonary resuscitation.

DIF: Level 1

REF: p. 13

6. Blood irradiators require all of the following safety procedures except: a. proper training. b. that the user have a degree in radiology. c. equipment leak detection. d. personal protective equipment.

ANS: B

Blood bank and transfusion service technologists require training but not a degree to use a blood irradiator.

DIF: Level 2

REF: p. 16

7. Which of the following is true regarding good manufacturing practices (GMPs)? a. GMPs are legal requirements established by the Food and Drug Administration. b. GMPs are optional guidelines written by the AABB. c. GMPs are required only by pharmaceutical companies. d. GMPs are part of the quality control requirements for blood products.

ANS: A

Good manufacturing practices are requirements established by the Food and Drug Administration.

DIF: Level 1

REF: p. 5

8. Which of the following is an example of an unacceptable record-keeping procedure? a. Using dittos in columns to save time b. Recording the date and initials next to a correction c. Not deleting the original entry when making a correction d. Always using permanent ink on all records ANS: A

All records must be clearly written. Dittos are unacceptable.

DIF: Level 1

REF: p. 7

9. A technologist in training noticed that the person training her had not recorded the results of a

test. To be helpful, she carefully recorded the results she saw at a later time, using the technologist’s initials. Is this an acceptable procedure? a. Yes; all results must be recorded regardless of who did the test. b. No; she should have brought the error to the technologist’s attention. c. Yes; because she used the other technologist’s initials. d. Yes; as long as she records the result in pencil.

ANS: B

This is an example of poor record keeping; results must be recorded when the test is performed and by the person doing the test.

DIF: Level 3

REF: p. 8

10. Unacceptable quality control results for the antiglobulin test performed in test tubes may be

noticed if: preventive maintenance has not been performed on the cell washer. the technologist performing the test was never trained. the reagents used were improperly stored.

All of the above

a. b. c. d.

ANS: D

Training, equipment maintenance, and reagent quality can affect quality control.

DIF: Level 2

REF: p. 5

11. All of the following are true regarding competency testing except: a. it must be performed following training. b. it must be performed on an annual basis. c. it is required only if the technologist has no experience. d. retraining is required if there is a failure in competency testing.

ANS: C

All employees must have competency testing following training and annually thereafter. If there is a failure in competency testing, retraining is required.

DIF: Level 2

REF: p. 10

12. Which of the following organizations are involved in the regulation of blood banks? a. The Joint Commission b. AABB c. College of American Pathologists d. Food and Drug Administration ANS: D

The Food and Drug Administration regulates blood banks, whereas the other organizations are involved in accreditation.

DIF: Level 1

REF: p. 2

13. All of the following are responsibilities of the quality assurance department of a blood bank

except: performing internal audits. performing quality control. reviewing standard operating procedures. reviewing and approving training programs.

a. b. c. d.

ANS: B

Quality control is performed in the laboratory, not by the quality assurance department.

DIF: Level 2

REF: p. 5

14. The standard operating procedure is a document that: a. helps achieve consistency of results. b. may be substituted with package inserts. c. is necessary only for training new employees. d. must be very detailed to be accurate.

ANS: A

Standard operating procedures are written procedures that help achieve consistency and should be clear and concise.

DIF: Level 2

REF: p. 8

15. Employee training takes place: a. after hiring and following implementation of new procedures. b. following competency assessment. c. only for new inexperienced employees. d. as procedures are validated.

ANS: A

Training occurs with all new employees regardless of their experience and following implementation of new procedures.

DIF: Level 1

REF: p. 10

16. Plans that provide the framework for establishing quality assurance in an organization are: a. current good manufacturing practices. b. standard operating procedures. c. change control plan. d. continuous quality improvement plan.

ANS: D

The total quality management or continuous quality improvement plan are part of the quality assurance program in an organization.

DIF: Level 1

REF: p. 4

17. A facility does not validate a refrigerator before use. What is a potential outcome? a. The facility is in violation of current good manufacturing practices and could be

cited by the Food and Drug Administration.

b. The facility is in compliance if the equipment functions properly. c. The facility is in compliance if the blood products stored in it are not transfused. d. The facility is in violation of AABB and may no longer be members.

ANS: A

Validation of equipment is a current good manufacturing practice, which is a legal requirement established by the Food and Drug Administration.

DIF: Level 2

REF: p. 12

18. In a routine audit of a facilities blood collection area, the quality assurance department found

that the blood bags used on that particular day had expired. What is the appropriate course of action? a. Initiate a root cause analysis and quarantine the blood collected in the expired bags. b. Call the Food and Drug Administration to report the incident. c. Change the expiration date on the bags to avoid legal issues. d. Fire the donor room supervisor, and discard the blood collected in the expired bags.

ANS: A

A root cause analysis will determine the factors that contributed to the error and result in a plan to prevent further errors.

DIF: Level 3

REF: p. 11

19. Several units were released to a hospital by mistake before all viral marker testing was

completed. What is the appropriate course of action? a. The error is reportable, and the Food and Drug Administration must be contacted. b. Ask the hospital to avoid transfusion and quickly complete the testing. c. Perform a root cause analysis and, if the units are found to be negative, report the

test result to the hospital. d. Recall only the units that are positive for viral markers.

ANS: A

Release of untested units is a reportable error to the Food and Drug Administration.

DIF: Level 3

REF: p. 11

MATCHING

Match the government or accrediting agencies with the description that best fits their purpose. a. Ensures safe and healthful working conditions b. Ensures the safety and efficacy of biologics, drugs, and devices c. Provides peer-reviewed accreditation for hospital laboratories d. Professional organization that accredits blood banks and transfusion services e. Makes recommendations to the Occupational Safety and Health Administration regarding the prevention of disease transmission 1. FDA

2.

3.

4.

5.

OSHA CDC AABB CAP

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS:

B A E D C

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Match the following descriptions with the appropriate terms.

The CAP survey is an example Systematic evaluations to determine whether procedures are being followed Testing to determine the accuracy and precision of reagents and equipment Process of standardizing an instrument against a known value Removal of products from the market that might compromise the safety of the recipient f. Degree to which a measurement represents the true value g. Establishing that a specific process produces an expected result h. Evaluation of an employee’s ability to perform a specific skill i. Investigation and identification of the factors that contributed to an error j. Maximizes the duration of equipment and increases the reliability of the equipment k. System to plan and implement changes to prevent problems a. b. c. d. e.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Root cause analysis Recall Accuracy Validation Calibration Quality control Proficiency test Competency assessment Change control Audit Preventive maintenance

6. ANS: I 7. ANS: E 8. ANS: F 9. ANS: G 10. ANS: D 11. ANS: C 12. ANS: A 13. ANS: H 14. ANS: K 15. ANS: B 16. ANS: J

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1

TRUE/FALSE 1. The Occupation Safety and Health Administration does not require the routine use of gloves

by phlebotomists working with healthy prescreened donors or changing unsoiled gloves between donors.

ANS: T

Because the risk of exposure is minimal with blood donors, the Occupation Safety and Health Administration (OSHA) does not require gloves, or if gloves are worn, OSHA does not require that unsoiled gloves be changed between donors.

DIF: Level 1

REF: p. 15

2. All accidents, even minor ones, must be reported to a supervisor.

ANS: T

The Occupational Safety and Health Administration, workers’ compensation, and other regulatory agencies require reporting all accidents, and an investigation to avoid other injuries is mandatory.

DIF: Level 1

REF: p. 16

3. Quality control is the same as quality assurance.

ANS: F

Quality control is performed on reagents and equipment; quality assurance is a system to ensure safe and effective products.

DIF: Level 1

REF: p. 5

Chapter 02: Immunology: Basic Principles and Applications in the Blood Bank Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Select the cell involved in humoral immunity. a. Neutrophils b. T lymphocytes c. B lymphocytes d. Monocytes ANS: C

B lymphocytes have the ability to transform into plasma cells to produce antibodies, which is considered a humoral response.

DIF: Level 2

REF: p. 23

2. What process is described by opsonization? a. Lysis of cells b. Binding to cells or antigens c. Ingestion of cells d. Phagocytosis ANS: B

Opsonization promotes phagocytosis by binding to cells or antigens.

DIF: Level 1

REF: p. 35

3. Select the term that describes cells or tissue from a genetically different individual within the

same species.

Allogeneic Autologous Xenogeneic Autograft

a. b. c. d.

ANS: A

Allogeneic cells or tissue come from a genetically different individual within the same species.

DIF: Level 1

REF: p. 33

4. Select the substance that regulates the activity of other cells by binding to specific receptors. a. Cytokines b. Complement c. Immunoglobulins d. Anaphylatoxin ANS: A

Cytokines are proteins secreted by cells that regulate the activity of other cells by binding to specific receptors.

DIF: Level 1

REF: p. 23

5. Which of the following is responsible for the activation of the classic pathway of

complement?

Bacteria Foreign proteins Virus Antibody bound to antigen

a. b. c. d.

ANS: D

An antigen-antibody complex activates the classical complement cascade, whereas bacterial membranes activate the alternative pathway.

DIF: Level 1

REF: p. 33

6. What biological molecules are considered the most immunogenic? a. Carbohydrates b. Lipids c. Proteins d. Enzymes ANS: C

Protein molecules are the most immunogenic, followed by carbohydrates and lipids, which tend to be immunologically inert.

DIF: Level 2

REF: p. 24

7. What part of the immunoglobulin molecule distinguishes the isotype? a. Light chain b. Heavy chain c. Kappa chain d. Lambda chain ANS: B

The five distinctive heavy-chain molecules distinguish the class or isotype. Each heavy chain imparts characteristic features, which permit them to have unique biological functions.

DIF: Level 2

REF: p. 24

8. Select the immunoglobulin class produced first in the primary immune response. a. IgG b. IgE c. IgA d. IgM ANS: D

IgM antibodies are produced first, followed by the production of IgG antibodies.

DIF: Level 1

REF: p. 28

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

a. b. c. d.

equivalence. antigen excess. antibody excess. serum-to-cell ratio.

ANS: C

Antibody excess is termed prozone, often leading to a false-negative reaction.

DIF: Level 1

REF: p. 38

10. What is the potential effect in a tube agglutination test if a red cell suspension with a

concentration greater than 5% is used?

False negatives False positives Hemolysis No effect

a. b. c. d.

ANS: A

Antigen excess is termed postzone and will lessen the reaction, causing a false-negative.

DIF: Level 3

REF: p. 38

11. After adding antigen and antibody to a test tube, one large agglutinate was observed. How

should this reaction be graded? a. 2+ b. 3+ c. 4+ d. 0 ANS: C

One large agglutinate is graded a 4+ reaction.

DIF: Level 2

REF: p. 39

12. Select the portion of the antibody molecule that imparts the antibody’s unique class function. a. Constant region of the heavy chain b. Constant region of the light chain c. Variable region of the heavy chain d. Variable region of the light chain ANS: A

The heavy-chain constant region has the function of the class.

DIF: Level 1

REF: p. 26

13. What portion of the antibody molecule binds to receptors on macrophages and assists in the

removal of antibody bound to red cells?

Fab fragment Hinge region Fc fragment J chain

a. b. c. d.

ANS: C

The Fc portion of the antibody binds to the macrophage, which then carries the antigenantibody complex to the spleen for removal.

DIF: Level 1

REF: p. 26

14. Select the region of the antibody molecule responsible for imparting unique antibody

specificity.

Variable region Constant region Hinge region Fc fragment

a. b. c. d.

ANS: A

The variable region is the unique antigen-binding site that gives each antibody its specificity.

DIF: Level 1

REF: p. 26

15. What immunoglobulin class is capable of crossing the placenta? a. IgM b. IgA c. IgE d. IgG ANS: D

Only IgG can cross the placenta as a result of IgG receptor binding sites on placental cells.

DIF: Level 1

REF: p. 26

16. What immunoglobulin class reacts best at room temperature at immediate-spin? a. IgM b. IgA c. IgE d. IgG ANS: A

IgM is a large immunoglobulin with multiple binding sites that is detectable at room temperature and the immediate-spin phase.

DIF: Level 2

REF: p. 27

17. An antigen that originates from the individual is termed: a. autologous. b. allogeneic. c. hapten. d. immunogen.

ANS: A

Autologous is a term that refers to cells or tissue from self.

DIF: Level 1

REF: p. 33

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

a. b. c. d.

Small antigen size Composed largely of carbohydrates Size greater than 10,000 daltons Similarity to the host

ANS: C

Antigens will elicit a better immune response if they are larger than 10,000 daltons, are foreign to the host, and are made of proteins.

DIF: Level 1

REF: p. 25

19. Extravascular destruction of blood cells occurs in the: a. blood vessels. b. lymph nodes. c. spleen. d. thymus.

ANS: C

Extravascular destruction of blood cells is initiated by macrophage interaction with IgG molecules attached to red cells that transport the red cells to the spleen for clearance.

DIF: Level 2

REF: p. 35

20. An antibody identified in the transfusion service appeared to be reacting stronger following

the second exposure to an antigen from a transfusion. The most likely explanation of this observation is: a. affinity maturation of the immunoglobulin molecule. b. anamnestic response. c. isotype switching. d. All of the above ANS: D

Genetic changes in the variable region, stimulation of memory B cells, and class switching contribute to the increased strength and specificity of an antibody following the second exposure to an antigen.

DIF: Level 3

REF: p. 29

21. Which of the following components in the complement cascade mediates the lysis of the

target cells?

C1qrs C4a, C3a, and C5a C5 to C9 C3a and C3b

a. b. c. d.

ANS: C

The membrane attack complex includes the C5 to C9 proteins that mediate lysis of the target cell.

DIF: Level 2

REF: p. 34

22. Which of the following requires adjustment in order to enhance the reaction of an antibody in

vitro?

Temperature above 37° C Speed of the centrifuge above the calibrated settings Increase the concentration of red cells in the test system Increase the incubation time in the incubator

a. b. c. d.

ANS: D

Increasing incubation time is effective in increasing antibody reactions; however, optimal temperatures, centrifugation, and antigen concentrations are normally not altered when performing routine transfusion service testing.

DIF: Level 3

REF: p. 37

23. Hemolysis was observed at room temperature when testing a patient’s serum with reagent red

cells used for screening. When this test was repeated using the patient’s plasma, no hemolysis was observed. What was the most likely explanation for the different reactions? a. The plasma sample was collected incorrectly. b. The serum sample was contaminated. c. Complement activation was inhibited by calcium in the plasma sample. d. The serum sample was fresher.

ANS: C

Complement can be activated by some red cell antibodies; however, fresh serum samples are necessary to observe this reaction. Plasma samples contain calcium to inhibit the coagulation cascade, which also will inhibit complement activation.

DIF: Level 3

REF: p. 33

24. Which immunoglobulin class is impacted by the zeta potential in a hemagglutination test? a. IgM b. IgG c. IgA d. IgE ANS: B IgG is a small molecule that cannot span the distance between red cells suspended in saline. The zeta potential prevents direct agglutination with IgG molecules.

DIF: Level 2

REF: p. 37

25. When testing for the A antigen in a patient, what would you use to perform the test? a. Patient’s plasma and commercial A red cells b. Commercial A cells and anti-A c. Patient’s red cells and anti-A d. None of the above ANS: C

For antigen testing, antigens are on the red cell; antibodies are in the antisera (commercial antibodies).

DIF: Level 2

REF: p. 40

26. A technologist added 4 drops of a 5% red cell suspension instead of the required 1 drop to a

hemagglutination test. What is the potential consequence to the test results?

False-positive False-negative Hemolysis due to complement activation Test results are not affected

a. b. c. d.

ANS: B

Postzone occurs when the concentration of antigen exceeds the number of antibodies present.

The amount of agglutinates formed under these circumstances is also suboptimal and diminished.

DIF: Level 3

REF: p. 38

MATCHING

Select the immunoglobulin class from the list below that best fits the characteristic described.

Each class can be used more than once. a. IgA b. IgM c. IgG d. IgE 1.

2.

3.

4.

5.

6.

7.

8.

Found in secretions, such as breast milk Able to cross the placenta Associated with intravascular cell destruction Associated with allergic reactions and mast cell activation Efficient in activation of the complement cascade Has the highest serum concentration Associated with immediate-spin in vitro reactions Has the highest number of antigen binding sites

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS:

A C B D B C B B

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2 Level 2 Level 2 Level 2 Level 2

Select the term from the list below that best fits the definitions. a. Kappa b. Epitope c. Hinge region d. Isotype e. Idiotype 9. Variable region of an immunoglobulin

10.

11.

12.

13.

Imparts flexibility to the immunoglobulin molecule Part of the antigen that the immunoglobulin binds to The type of immunoglobulins determined by the heavy chain One of the two types of light chains

9. ANS: E 10. ANS: C 11. ANS: B 12. ANS: D 13. ANS: A

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Chapter 03: Blood Banking Reagents: Overview and Applications Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Select the test that uses IgG-sensitized red cells (check cells). a. Antiglobulin test b. D-antigen typing c. Rh-antigen typing d. B-antigen detection ANS: A

The antiglobulin test requires the use of IgG-sensitized cells to verify a negative reaction was not caused by improper washing, omitting the antiglobulin reagent, or reagent problems.

DIF: Level 1

REF: p. 62

2. Select the method that uses a dextran-acrylamide matrix. a. Solid-phase red cell adherence b. Microplate c. Gel technology d. Tube techniques ANS: C

The dextran-acrylamide gel matrix traps agglutinated cells, making antigen-antibody reactions visible.

DIF: Level 1

REF: p. 66

3. What reagent contains antibodies to multiple antigenic epitopes? a. Polyclonal-based b. Monoclonal-based c. Heterophile antibody-based d. Alloantibody-based ANS: A

Polyclonal reagents contain antibodies to more than one antigen specificity.

DIF: Level 1

REF: p. 50

4. Which of the following items provides evidence for reagent red cell deterioration? a. Spontaneous agglutination b. Significant hemolysis c. Loss of agglutination strength over time d. All of the above ANS: D

Each observation listed may indicate a reagent red cell problem that could lead to false reactions.

DIF: Level 2

REF: p. 49

5. Reagent antibodies prepared from human sources are: a. unsafe. b. too low in potency to be effective. c. polyclonal in specificity. d. preferred because of their lower cost.

ANS: C

Human-derived antisera have antibodies to multiple specificities and meet Food and Drug Administration guidelines for potency and safety.

DIF: Level 1

REF: p. 49

6. Monoclonal antibodies are prepared in: a. vitro. b. vivo. c. laboratory animals. d. humans.

ANS: A

Monoclonal antibodies are prepared from antibody-producing B-lymphocytes and myeloma cells in a hybridoma, which is cultured in vitro.

DIF: Level 1

REF: p. 51

7. Which of the following is not an advantage of using a monoclonal antibody over a polyclonal

antibody?

There are very few variations between lots.

There are no contaminating antibodies.

Direct agglutination is usually faster.

All variations of the antigen can be detected.

a. b. c. d.

ANS: D

Some monoclonal D antibodies may miss antigen variations, such as the partial D phenotype.

DIF: Level 2

REF: p. 51

8. Where are product limitations and technical considerations for each reagent located? a. Standard operating procedure b. Product insert c. Food and Drug Administration code of regulations d. AABB standards ANS: B

The product insert outlines the technical considerations, procedural guidelines, and product limitations for each reagent.

DIF: Level 1

REF: p. 49

9. Solid-phase red cell adherence used for antibody detection has an advantage over tube testing

because:

a. b. c. d.

there is no washing involved. incubation time is not necessary. the endpoint is more clearly defined. indicator cells (IgG-coated cells) are not necessary.

ANS: C

Well-defined endpoints make reading results more consistent and reliable.

DIF: Level 2

REF: p. 67

10. Which of the following statements is true regarding IgG-sensitized red cells? a. They must be used to confirm a negative antiglobulin tube test. b. They must be used to confirm a positive antiglobulin test. c. They must be used to confirm a direct antiglobulin test that was negative with

anti-C3d. d. They should be used only with the indirect antiglobulin test.

ANS: A

IgG-sensitized red cells are used as a control for false-negative antiglobulin tests.

DIF: Level 2

REF: p. 62

11. What method displays a positive reaction as a compact red cell button? a. Gel test b. Microtiter plate c. Solid-phase red cell adherence d. Molecular testing ANS: B The microtiter plate method displays a positive reaction as a compact red cell button in the bottom of the well. Negative reactions will stream when tilted on an angle.

DIF: Level 1

REF: p. 68

12. The antiglobulin test was performed using gel technology. A button of cells was observed at

the bottom of the microtube following centrifugation. How do you interpret this result?

There is a problem with the card.

The result is a negative reaction.

The result is a strong positive reaction.

The test was not washed correctly.

a. b. c. d.

ANS: B

Red cells that are not trapped by the antihuman globulin reagent will travel unimpeded through the length of the tube.

DIF: Level 3

REF: p. 67

13. Which of the following statements is true regarding high-protein anti-D reagents? a. They have been largely replaced with low-protein monoclonal reagents. b. They contain high concentrations of bovine albumin. c. They may increase the possibility of a false-positive reaction, requiring the use of

a control.

d. All of the above are true.

ANS: D

High-protein anti-D reagent requires the use of a control to verify that positive reactions are the result of an antigen-antibody reaction and not agglutination caused by the reagent additive.

For this reason, the use of monoclonal anti-D is more commonly used.

DIF: Level 2

REF: p. 54

14. How would you interpret the results if both the anti-D reagent and the Rh control were 2+

agglutination reactions?

D-positive D-negative Unable to determine without further testing Depends on whether the sample was from a patient or a blood donor

a. b. c. d.

ANS: C

The Rh control should be negative for the test to be valid.

DIF: Level 2

REF: p. 54

15. Which red cells are used to screen for antibodies in donor samples? a. Screening cells (two vials) b. Pooled screening cells c. Panel cells d. Screening cells (three vials) ANS: B

Pooled screening cells are acceptable for screening antibodies in donor samples.

DIF: Level 2

REF: p. 56

16. What specificities does polyspecific antihuman globulin contain? a. Anti-IgG. b. Anti-C3b and anti-C3d. c. Anti-IgG and anti-C3d. d. Anti-IgG and anti-IgM. ANS: C

Polyspecific antihuman globulin contains specificities to the heavy chain IgG and complement component, C3d.

DIF: Level 1

REF: p. 60

17. What temperature is used for incubation in the indirect antihuman globulin test? a. 22° C b. 37° C c. 4° C d. 56° C ANS: B

Incubation takes place at body temperature, which is 37° C.

DIF: Level 1

REF: p. 59

18. Why is incubation omitted in the direct antihuman globulin test? a. The direct antiglobulin test can be used in an emergency to replace the indirect

test. b. Incubation will cause hemolysis. c. The antigen-antibody complex has already formed in vivo. d. IgM antibodies are detected in the direct antiglobulin test.

ANS: C

Incubation of the antigen-antibody complex essentially has taken place within the patient (or donor), making additional incubation in the tube unnecessary.

DIF: Level 2

REF: p. 58

19. In the solid-phase red cell adherence test, how does a negative test appear? a. A button of cells on the bottom of the well b. Adherence of cells along the sides and bottom of the wells c. Hemolysis of red cells d. A line of cells along the top of the well ANS: A

Indicator cells, which are added in the final step, do not adhere to the wells and have not reacted with the antibody. Therefore, a button will form on the bottom of the well.

DIF: Level 1

REF: p. 67

20. Following centrifugation of the gel card, red cells are evenly dispersed throughout one of the

microtubes. This reaction could be graded as a: 4+.

3+.

2+.

1+.

a. b. c. d.

ANS: C

A 2+ reaction is demonstrated with red cells throughout the microtube.

DIF: Level 2

REF: p. 67

21. What immunoglobulin class reacts best by antiglobulin testing? a. IgM b. IgA c. IgE d. IgG ANS: D

The antiglobulin test detects IgG antibodies on red cells.

DIF: Level 1

REF: p. 60

22. Which of the following red cell antigens do proteolytic enzymes destroy? a. Rh system antigens

b. Antigens Fya and Fyb in the Duffy system c. Antigens in the Kidd system d. Lewis system antigens ANS: B

Proteolytic enzymes, such as ficin, will destroy some antigens on red cells such as Fya and Fyb, M, N, and S. DIF: Level 1

REF: p. 65

23. What is the purpose of adding antibody-sensitized red cells following the antiglobulin test? a. Ensure a weak antibody reaction was not missed b. Confirm positive reactions c. Check that the wash procedure was sufficient to remove unbound antibodies d. Check that sufficient incubation took place ANS: C

Antibody-sensitized red cells (check cells) are IgG-coated cells that will detect unbound antihuman globulin following proper washing techniques.

DIF: Level 2

REF: p. 62

24. Why is polyethylene glycol reagent added to the screen or panel? a. Enhance detection of IgM antibodies. b. Eliminate the reactivity of certain antigens. c. Increase the avidity of IgG antibodies. d. Eliminate the need for washing in the indirect antiglobulin test.

ANS: C

Polyethylene glycol (PEG) concentrates antibodies and increases the rate of antibody uptake, increasing the avidity of IgG antibody reactions.

DIF: Level 2

REF: p. 65

25. Rouleaux is a false-positive reaction caused by elevated serum protein levels. Which of the

following tests would not likely be affected by an elevated protein level? a. Immediate-spin antibody screen b. Direct antiglobulin test c. Reverse typing in the ABO test d. ABO forward typing ANS: B

Rouleaux are caused by an elevated protein level or IV solutions and cause cells to appear agglutinated. A procedure involving washing, such as the direct or indirect antiglobulin test, would not be affected by this because saline would eliminate the excess proteins.

DIF: Level 3

REF: p. 58

MATCHING

Select the reagent from the list below and match it to the routine blood banking procedure. a. Panel cells

b. c. d. e.

1.

2.

3.

4.

5.

Screening cells A1 and B cells ABO antisera Lectins

Reagent derived from plants used to distinguish group A1 from group A2 red cells Reagent used to determine the ABO antigenic composition of a patient’s red cells Reagent used to detect the presence of red cell antibodies Reagent used to identify the specificity of a red cell antibody Reagent used in the identification of ABO antibodies

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS:

E D B A C

DIF: DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2 Level 2

Select the antiglobulin test that best fits the descriptions below. A selection may be used more than once. a. Indirect antiglobulin test b. Direct antiglobulin test c. Both the direct and indirect antiglobulin test 6. Incubation step is not necessary 7. Requires washing the cells several times before the addition of antihuman globulin reagent 8. Tests for certain clinical conditions such as hemolytic disease of the newborn and autoimmune

hemolytic anemia 9. Detects IgG or complement-coated red cells 6. ANS: 7. ANS: 8. ANS: 9. ANS:

B C B C

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Chapter 04: Genetic Principles in Blood Banking Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. A person whose red cells type as M+N+ with antisera would be: a. a homozygote. b. a heterozygote. c. unable to be determined without family studies. d. linked.

ANS: B

Because M and N are alleles, the inheritance of both alleles makes the individual a heterozygote.

DIF: Level 2

REF: p. 79

2. The children of a group AB mother and a group B father could phenotype as all of the

following except: O. A. B. AB.

a. b. c. d.

ANS: A

Unless there was a rare cis AB inheritance pattern, a group AB parent would not likely have a group O child.

DIF: Level 3

REF: p. 78

3. In a family study, all four siblings in the family had a different blood type: A, B, O, and AB.

What is the most likely genotypes of the parents?

AA and BB AO and BB OO and AB AO and BO

a. b. c. d.

ANS: D

Performing a Punnett square demonstrates that a cross between genotypes AO and BO could yield four offspring with different phenotypes.

DIF: Level 3

REF: p. 76

4. If anti-M was reacted with red cells that are M+N+, how would they compare with red cells

that are M+N–? a. Stronger b. Weaker c. The same d. Varies with the method

ANS: B

Because M+N+ cells are heterozygous, the “dosage” of the M antigen is less and would therefore be weaker in reaction strength.

DIF: Level 2

REF: p. 80

5. A father carries the Xga blood group trait and passes it on to all of his daughters but to none of

his sons. What type of inheritance pattern does this demonstrate?

X-linked dominant X-linked recessive Autosomal dominant Autosomal recessive

a. b. c. d.

ANS: A

Because the father passed the trait to only his daughters, it was carried on the X chromosome.

Because only one allele is needed for expression, this is a dominant genetic trait.

DIF: Level 2

REF: p. 79

6. Of the following markers used to test for paternity, which marker provides the most useful

statistical value?

Human leukocyte antigen typing D antigens ABO system antigens The Kidd system (Jka, Jkb)

a. b. c. d.

ANS: A

Human leukocyte antigen typing provides most statistical value because of the polymorphism of the major histocompatibility complex.

DIF: Level 2

REF: p. 83

7. Mitosis results in a. four cells with half as many b. two cells with the same number of c. four cells with the same number of d. two cells with half as many

chromosomes as the original.

ANS: B

Mitosis is cell division of somatic cells, resulting in two cells with the same number of chromosomes as the original cell.

DIF: Level 1

REF: p. 71

8. When does crossing over occur? a. Meiosis b. Mitosis c. Somatic cell division d. Zygote formation ANS: A

Crossing over is the sharing of chromosomal material during meiosis and contributes to greater genetic variation among offspring.

DIF: Level 1

REF: p. 81

9. When an individual is group A, which of the following genetic terms applies? a. Alleles b. Haplotype c. Genotype d. Phenotype ANS: D

The genetic expression, or trait, that can be determined by typing red cells is called the phenotype.

DIF: Level 1

REF: p. 75

10. What is an advantage of Nucleic Acid Testing (NAT) for viral marker testing? a. Quicker to perform than most other tests b. More cost effective than traditional test methods c. A small amount of DNA or RNA can be detected d. No problem with cross-contamination of samples ANS: C

Polymerase chain reaction is used for viral marker testing in the blood bank because it can detect very small quantities of viral material in donor samples.

DIF: Level 1

REF: p. 84

11. What is the meaning of the term autosomal? a. A trait that is not carried on the sex chromosomes b. A trait that is carried on the sex chromosome c. A trait that is expressed only in the parents d. A gene that does not express a characteristic ANS: A

Autosomal genetic expression is demonstrated in somatic cells, that is, cells in the body that are not gametes.

DIF: Level 1

REF: p. 75

12. How is RNA different from DNA? a. RNA usually exists as a single strand. b. The sugar ribose is substituted for deoxyribose. c. The base uracil exists only in RNA. d. All of the above are true.

ANS: D

RNA differs in its structural and chemical composition as well as its role in the cell function.

DIF: Level 1

REF: p. 84

13. When using the Hardy-Weinberg equation to calculate genetic frequencies, which of the

following must be TRUE? The population statistics must be large.

Mutations cannot occur.

Mating must be random.

All of the above are true.

a. b. c. d.

ANS: D

The Hardy-Weinberg formula is used to predict gene frequencies in populations where genetic variations are stable and random populations are large enough that statistics are reliable.

DIF: Level 1

REF: p. 83

14. If two traits occur higher in a population together than each occurs separately, they may be

linked. What does this fact suggest?

They are found far apart on the same chromosome.

They are inherited on different chromosomes.

Crossover has occurred.

The genes are close together on the same chromosome.

a. b. c. d.

ANS: D

Linkage disequilibrium refers to the phenomenon of traits occurring at a different frequency in the population depending on whether they are inherited on linked or unlinked genes.

DIF: Level 2

REF: p. 81

15. What is the approximate probability of finding a compatible unit of blood for a D-positive

patient with antibodies to C, E, and K, if the frequency of C is 70%, E is 30%, and K is 10%?

2 out of 10 units 4 out of 10 units 2 out of 100 units 4 out of 100 units

a. b. c. d.

ANS: A

Multiply the negative frequencies for each antigen: C × E × K or 0.30 × 0.70 × 0.90 =0.19, which is about 2 out of 10 units.

DIF: Level 3

REF: p. 82

16. In relationship testing, a “direct exclusion” is established when a genetic marker is: a. present in the child but absent in both the mother and alleged father. b. present in the child, absent in the mother, and present in the alleged father. c. absent in the child, present in the mother, and the alleged father. d. absent in the child, present in the mother, and absent in the alleged father.

ANS: A

A direct exclusion is determined when a genetic marker is present in the child but absent in both the mother and alleged father.

DIF: Level 2

REF: p. 83

17. In a random population, 16% of the population is homozygous for a particular trait. What

percentage of the same population is heterozygous for that particular trait?

32% 64% 48% 84%

a. b. c. d.

ANS: C

Using the Hardy Weinberg formula, (p + q)2 = 1.0 therefore the square root of 16 is 4 and 4 + 6 = 1. Since the expanded formula is p2 + 2pq + q2 = 1.0, then 2pq is the heterozygous population, which is 2 × 4 × 6 = 48.

DIF: Level 3

REF: p. 83

18. How are most blood group systems inherited? a. Autosomal recessive b. Autosomal dominant c. Sex-linked recessive d. Autosomal codominant ANS: D

Most blood groups systems are inherited as autosomal codominant, which means each inherited allele is equally expressed.

DIF: Level 1

REF: p. 77

19. The linked HLA genes on each chromosome are inherited as a: a. haplotype. b. phenotype. c. genotype. d. antithetical pair.

ANS: A

Closely linked genes on a chromosome such as the HLA genes are inherited as a group or haplotype.

DIF: Level 1

REF: p. 80

20. In the PCR reaction, what is the term for the short pieces of single-stranded DNA that are

complementary and mark the sequence to be amplified?

Nucleotides Polymerases Primers Amplicons

a. b. c. d.

ANS: C

Complementary strands of DNA that mark the target DNA for the initiation of replication during PCR are called primers.

DIF: Level 1

REF: p. 84

21. Which of the following clinical applications applies to molecular testing for blood group

antigens?

Confirm the D type of blood donors Identify fetus at risk for HDFN Predict the phenotype of a patient with autoimmune hemolytic anemia All of the above

a. b. c. d.

ANS: D

Molecular testing for blood group antigens is becoming more common and useful. The technique can predict a red cell phenotype, identify an at risk fetus, confirm a D typing and identify antigen-negative blood donors.

DIF: Level 2

REF: p. 84

MATCHING

Match the terms below with the definition that best fits. a. Haplotypes b. Recessive c. Amorphic genes d. Codominant genes e. Polymorphic 1. When two genes are close together on the same chromosome and are inherited as a “group” or 2.

3.

4.

5.

“bundle” A gene that does not express a detectable product Equal expression of two different inherited genes as in most blood group systems Having two or more alleles at a given gene locus When a gene product is expressed only when it is inherited by both parents

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS:

A C D E B

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Match the term with the definition that best fits.

Primer Polymerase chain reaction Hybridization Probe Amplicon DNA sequence

a. b. c. d. e.

6.

7.

8.

9.

10.

The binding of two complementary pairs of DNA Marks the sequence to be amplified during PCR Amplified target sequences of DNA produced by polymerase chain reaction Short segment of DNA with a known sequence that can be labeled with a marker Technique used to replicate a specific DNA sequences

6. ANS: C

DIF:

Level 1

7. ANS: A 8. ANS: E 9. ANS: D 10. ANS: B

DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1

TRUE/FALSE 1. Parents, who both phenotype as group A, cannot have a group O child.

ANS: F

If the parents are both heterozygous (AO), two O genes can be inherited by the offspring.

DIF: Level 3

REF: p. 77

Chapter 05: ABO and H Blood Group Systems and Secretor Status Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. What ABO phenotype would agglutinate in the presence of anti-A,B produced by group O

individuals?

A only B only A and B O only

a. b. c. d.

ANS: C

Group O individuals make anti-A,B, an antibody with a specificity to both the A and B antigens.

DIF: Level 2

REF: p. 106

2. Which ABO phenotype selection contains the most H antigen and the least H antigen,

respectively, on the red cell’s surface?

O, A1B A2, A1B B, A A1B, O

a. b. c. d.

ANS: A

Group O blood cells are high in unconverted H antigens because the O gene produces no detectable product and A1B cells have the lowest number of H unconverted antigen sites.

DIF: Level 1

REF: p. 101

3. A recipient with group A phenotype requires a transfusion of 2 units of frozen plasma. Which

of the following types are appropriate to select for transfusion? a. AB and B b. B and A c. O and A d. AB and A ANS: D

Group AB plasma contains no ABO system antibodies, and group A plasma contains anti-B, which would be compatible with the recipient’s red cells.

DIF: Level 3

REF: p. 106

4. A patient’s red cells are agglutinated by anti-B, but not by anti-A. What is this patient’s ABO

phenotype? a. Group B b. Group O c. Group AB

d. Group A ANS: A

Anti-B reacts with the B antigen, which is the blood type identified.

DIF: Level 2

REF: p. 106

5. What is the test procedure that combines patient’s serum with commercial A1 and B reagent

red cells?

ABO forward grouping ABO reverse grouping Antibody screen Antibody panel

a. b. c. d.

ANS: B

Testing the serum for ABO antibodies requires combining it with cells with known antigen specificities. Agglutination indicates that an antigen-antibody reaction took place, thereby identifying the unknown antibody.

DIF: Level 1

REF: p. 106

6. A group A man marries a group AB woman. The father of the group A man was group O.

What possible ABO phenotypes could be expected in the offspring?

Groups A, B, AB, and O Groups A and B Groups A, B, and AB Groups A and AB

a. b. c. d.

ANS: C

The group A man must be genotype AO because the O gene was inherited from his father. A Punnett square with a group AB yields three potential phenotypes for the children: A, B, and AB. DIF: Level 3

REF: p. 103

7. According to Landsteiner’s rule (law), what ABO antibody will be detected in a group A

individual’s serum?

Anti-A Anti-B Anti-A,B None

a. b. c. d.

ANS: B

According to Landsteiner, a person is expected to demonstrate the ABO antibody to the antigen he or she lacks on the red cells.

DIF: Level 1

REF: p. 97

8. Select the appropriate strategy if the results of red cell and serum testing in the ABO typing

procedure have negative agglutination reactions. a. Wash patient cells with warm saline. b. Use polyclonal typing reagents.

c. Perform an autocontrol. d. Incubate tubes at room temperature or 4° C with an autocontrol.

ANS: D

ABO antibodies are stronger at room temperature or lower. The autocontrol determines whether the enhanced antibody reaction was due to the ABO antibodies or to a cold reacting antibody. The autocontrol should be negative for the ABO typing to be valid.

DIF: Level 3

REF: p. 117

9. Predict the agglutination reaction of red cells from a Bombay phenotype when combined with

anti-H lectin.

Strong 4+ Mixed field Weak 1+ Negative

a. b. c. d.

ANS: D

Bombay phenotypes have not inherited the H gene and therefore are negative with anti-H lectin.

DIF: Level 2

REF: p. 118

10. Given the following ABO phenotyping data:

FORWARD REVERSE Anti-A: 2+mf A1 cells: 0 Anti-B: 0 B cells: 3+ What could be a plausible explanation for this discrepancy? a. T-activation of red cells b. Group O blood products given to group A c. Rouleaux formation d. Positive direct antiglobulin test ANS: B

Mixed-field reactions are often caused by transfusion of group O red cells, which may take place during an emergency or inventory issue.

DIF: Level 3

REF: p. 113

11. What forward typing reagent can be used to confirm group O units before placing them in

inventory? a. Anti-A b. Anti-B c. Anti-A,B d. Anti-H ANS: C

A common use of anti-A,B is to test group O red cells to confirm the blood type before putting them in inventory.

DIF: Level 1

REF: p. 106

12. Which of the following situations is most likely to cause intravascular hemolysis when an

incompatible transfusion is given?

Group B packed cells to a group O recipient Group A packed red cells to a group AB recipient Group AB plasma to a group A recipient Group AB plasma to a group O recipient

a. b. c. d.

ANS: A

A group O recipient has anti-B that could potentially cause intravascular hemolysis if group B blood were transfused.

DIF: Level 2

REF: p. 106

13. A blood sample from a 90-year-old man was submitted to the blood bank for a type and screen

before surgery. The forward type demonstrates as a group A, whereas the reverse type appears to be group AB. What is the most likely cause of the discrepancy? a. Contaminated reagent antisera b. Rouleaux formation c. That the patient has autoantibodies d. That patient has low-titer isoagglutinins ANS: D

In patients who are older, the level of ABO isoagglutinins can be below detectable levels.

DIF: Level 3

REF: p. 117

14. Most “naturally occurring” ABO system antibodies fall into which immunoglobulin class? a. IgA b. IgM c. IgE d. IgG ANS: B

ABO system antibodies are in the IgM class, which can agglutinate at immediate-spin and activate the complement cascade.

DIF: Level 1

REF: p. 105

15. What substances are found in the saliva of a group A person who also inherited the secretor

gene?

A, H H A, Se A, B, H

a. b. c. d.

ANS: A

The secretor gene codes for the secretion of H in secretions, allowing the expression of H, as well as the ABO antigens.

DIF: Level 2

REF: p. 118

16. What percentage of the group A population are type as A2?

a. b. c. d.

1% 10% 20% 35%

ANS: C

The A2 subgroup is coded by the A2 gene and is essentially a less branched version of the A antigen.

DIF: Level 1

REF: p. 102

17. Approximately what is the percentage of individuals who demonstrate H in their saliva? a. 15% b. 50% c. 80% d. 98% ANS: C

Finding the H antigen in secretions indicates that a secretor gene was inherited.

DIF: Level 1

REF: p. 118

18. To distinguish between an A1 and A2 blood type, which reagent is used? a. Ulex europeaus lectin b. Anti-A,B c. Monoclonal anti-A d. Dolichos biflorus lectin ANS: D

Anti-A1 lectin will agglutinate A1 red cells, not A2 red cells.

DIF: Level 1 19.

REF: p. 102

Why is it sometimes necessary to distinguish A1 and A2 blood types? a. To resolve a discrepancy between the forward and reverse typing b. To prevent A1 recipients from receiving A2 blood c. To determine the secretor status of group A individuals d. To prevent hemolytic disease of the newborn ANS: A

Routine testing with anti-A1 lectin is necessary to resolve a discrepancy between the forward and reverse typing. Individuals who possess the A2 antigen can make anti-A1 antibody.

DIF: Level 2

REF: p. 102

20. What subgroup of A possesses the least amount of A antigen? a. A3 b. Ax c. A2 d. Ael ANS: D

The Ael subgroup requires adsorption and elution procedures to detect the A antigen on the red cells.

DIF: Level 1

REF: p. 101

MATCHING

Match the immunodominant sugar that corresponds to the ABO system group or antigen.

D-galactose L-fucose N-acetylgalactosamine None of the above

a. b. c. d.

1.

2.

3.

4.

5.

Group A Group B Group O H antigen Bombay

1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS:

C A B B D

DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1

Chapter 06: Rh Blood Group System Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following phenotypes will react with anti-f? a. rr b. R1R1 c. R2R2 d. R1R2 ANS: A

The f antigen is the expression of the c and e gene complex when they are inherited on the same chromosome. Because the Weiner nomenclature “r” indicates that the ce gene was inherited together, it will express the f antigen.

DIF: Level 3

REF: p. 136

2. Each of the following genotypes is possible for an individual whose red cells react as

indicated below except: ANTISERA REACTIONS anti-C + anti-D + anti-E + anti-c + anti-e + a. b. c. d.

R1R2.

R1r".

Rzr. R0r'.

ANS: D

The R0r' genotype expresses the C, c, D, and e antigens, but it does not express the E antigen.

DIF: Level 3

REF: p. 130

3. The weak D test detects: a. the Du antigen. b. the missing D mosaic. c. a weak D antibody. d. a weak D antigen.

ANS: D

The weak D test is the antiglobulin test for the D antigen, which is more sensitive and better able to detect weak D antigen expression.

DIF: Level 1

REF: p. 132

4. How would you label a donor who tested negative with anti-D reagent upon immediate-spin

and positive in antihuman globulin test? a. D-positive b. D-negative c. Cannot label; more testing needed ANS: A

Donor testing is required for the weaker D expression by the antihuman globulin test with the unit labeled as D-positive.

DIF: Level 1

REF: p. 132

5. A patient phenotypes as D+C+E-c-e+. Predict the most likely genotype. a. R1r b. R1R1 c. R1r' d. R1R0 ANS: B

R1R1 fits the phenotype and is also the more common of the choices given.

DIF: Level 2

REF: p. 130

6. How is it genetically possible for a child to phenotype as D-negative? a. Both parents are heterozygous D-positive. b. Both parents are homozygous D-positive. c. Mom is homozygous D-positive, and Dad is heterozygous D-positive. d. The sibling is D-positive.

ANS: A

The heterozygous expression for both parents would allow the D-negative expression to be passed on to the child.

DIF: Level 2

REF: p. 131

7. Current theory regarding the genetics of the Rh system suggests that: a. each Rh system antigen is coded by its own gene locus. b. Rh system antigens are coded by two closely linked genes. c. one gene locus with multiple alleles codes for the protein antigens. d. the Rh system genes are a haplotype that codes for three sets of alleles.

ANS: B

Two closely linked genes, RHD and RHCE, code for the Rh system antigens.

DIF: Level 1

REF: p. 128

8. Red cells that phenotype as D-negative indicate that: a. they inherited two D genes. b. there is no genetic material inherited from the RHD gene from both parents. c. a suppressor gene was inherited that is turning off the D gene expression. d. reagents currently in use are not detecting the D antigen.

ANS: B

The D-negative phenotype is the absence of genetic material at the RHD gene locus. This lack of genetic material must be inherited from both parents to result in a negative expression.

DIF: Level 1

REF: p. 126

9. Anti-D reagent and the D control were tested with patient’s red cells. Both tests were 2+

agglutination reactions. What is the interpretation of the results? a. D-positive b. D-negative c. Unable to interpret without further testing d. D-positive if the sample is from a patient ANS: C

The D control should be negative for the test to be valid.

DIF: Level 2

REF: p. 54

10. All of the following can cause the D antigen expression to be weaker except: a. inheriting the G gene. b. inheriting the C antigen in trans to the D antigen. c. an RHD gene that is genetically weaker. d. partial D expression.

ANS: A

The G gene is always inherited when the D or C gene is inherited and has no effect on the strength of the D gene.

DIF: Level 1

REF: p. 133

11. An anti-E was identified in a patient who recently received a transfusion. What other Rh

system antibody should be investigated?

Anti-G Anti-f Anti-D Anti-c

a. b. c. d.

ANS: D

Anti-c is often found in patients who make anti-E. Anti-c is often weaker and shows dosage when the patient is developing the antibody from the first exposure to the antigen.

DIF: Level 1

REF: p. 137

12. The frequency of the D-negative phenotype in the population is: a. 15%. b. 85%. c. 50%. d. 35%.

ANS: A

Fifteen percent of the population is D-negative.

DIF: Level 1

REF: p. 126

13. Testing for the weak D expression is performed by: a. using anti-Du antisera with an extended incubation. b. using monoclonal anti-D. c. performing the indirect antiglobulin test with anti-D. d. performing the direct antiglobulin test with anti-D. ANS: C

The weak D test (previously called the Du test) involves the indirect antiglobulin test using anti-D reagent.

DIF: Level 1

REF: p. 132

14. The numeric Rh4 nomenclature refers to which antigen in the Rosenfield notation? a. C b. c c. e d. E ANS: B

The more common Rh system antigens are Rh1 = D, Rh2 = C, Rh3 = E, Rh4 = c, Rh5 = e.

DIF: Level 1

REF: p. 128

15. The LW antigen expression is typically stronger on a. D-positive b. D-negative c. Rh null d. D-variant

red cells.

ANS: A

The original anti-D found by experiments with rhesus monkeys was actually anti-LW that reacts best with D-positive cells.

DIF: Level 1

REF: p. 138

16. Why is the determination of the D antigen important for women during pregnancy? a. A D-positive mother can form anti-D during pregnancy that may destroy the D-

positive red cells of the fetus. b. A D-negative mother should be given Rh immune globulin to prevent potential formation of anti-D during delivery of a D-positive infant. c. A D-negative mother may form anti-D if the father of the child is also D-negative. d. A D-positive mother may pass her red cells to the D-negative fetus and cause hemolytic disease of the fetus and newborn.

ANS: B

D-negative females who are pregnant should be given Rh immune globulin at 28 weeks to prevent the formation of anti-D, which may cause hemolytic disease of the fetus and newborn on subsequent pregnancies. The exposure to the D antigen on delivery of a D-positive fetus triggers the formation of anti-D. DIF: Level 1

REF: p. 138

17. The inheritance of the Rh antigens are: a. X-linked recessive. b. X-linked dominant. c. autosomal recessive. d. codominant.

ANS: D

As with most blood group systems, inheritance patterns follow a codominant expression, meaning that both genes from the parents are expressed equally.

DIF: Level 1

REF: p. 126

18. What is the immunoglobulin class of most Rh system antibodies? a. IgM b. IgG c. IgA d. IgE ANS: B

Rh system antibodies are IgG, requiring the indirect antiglobulin test to detect.

DIF: Level 1

REF: p. 137

19. An individual’s red cells gave the following reactions with antisera:

Anti-D Anti-C Anti-E 4+ 3+ 0 The most probable genotype is: a. R1R2. b. R2r. c. R0r. d. R1r.

Anti-c 3+

Anti-e 3+

Rh control 0

ANS: D

The most probable genotype is based on the antigens present and the frequency of each allele in the population; thus since red cells that have this phenotype are most likely CDe/ce, the type is also expressed as R1r.

DIF: Level 2

REF: p. 130

20. If D-negative red cells are transfused to an R1R1 individual, what is the most likely Rh

antibody that could develop? a. Anti-E b. Anti-d c. Anti-D d. Anti-c ANS: D

Anti-c could develop since the recipient is c-negative and the donor is most likely rr or ce/ce.

DIF: Level 2

REF: p. 128

21. If a D-positive person appears to have anti-D in their serum, what is the most likely

explanation?

D-deletion phenotype Compound antigen Partial D antigen Transposition effect

a. b. c. d.

ANS: C

A person with a partial D antigen, who is exposed by pregnancy or transfusion to the complete D antigen, could potentially make an antibody that appears to be anti-D because it reacts with all D-positive cells on a panel, but not with D-negative cells. The antibody is actually directed to the part of the D epitope missing on the red cells.

DIF: Level 2

REF: p. 134

22. Which of the following is associated with the Rhnull phenotype? a. Membrane abnormalities b. Immunized Rhnull individuals may produce anti-Rh29 c. Mutation of the RhAG regulator gene d. All of the above ANS: D

The Rhnull phenotype lacks all Rh system antigens and is associated with membrane abnormalities. An antibody to all other Rh antigens can be produced if a null person becomes immunized and Rhnull blood would be required for transfusion. One of the mechanisms for inheritance of this phenotype is a mutation in the regulator gene called RhAG. DIF: Level 1

REF: p. 137

MATCHING

Match the following phenotypes with the most probable genotype in the Weiner nomenclature. a. R1r b. R1R1 c. R2R2 d. rr 1.

2.

3.

4.

DCce ce DCe DcE

1.

2.

3.

4.

ANS: A ANS: D ANS: B ANS: C

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Match the Fisher-Race notation with the correct Weiner notation for the following: a. Ce b. CE c. DCE

d. Dce 5.

6.

7.

8.

Rz ry r' R0

5. ANS: 6. ANS: 7. ANS: 8. ANS:

C B A D

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Chapter 07: Other Red Cell Blood Group Systems, Human Leukocyte Antigens, and Platelet Antigens Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. Which of the following facts is not a characteristic of Kell system antibodies? a. Usually clinically significant IgG antibodies b. Best detected in indirect antiglobulin test phases c. Lose reactivity with proteolytic enzyme reagents d. Do not bind complement proteins ANS: C

Proteolytic enzymes do not affect the Kell system antigens.

DIF: Level 1

REF: p. 151

2. Antibodies to Kidd, Kell, and Duffy blood group antigens share all the following

characteristics except: can cause hemolytic disease of the newborn. usually detected only by the indirect antiglobulin test. enhanced with enzyme treatment. can cause transfusion reactions.

a. b. c. d.

ANS: C

The Duffy system antibodies do not react with enzyme-treated cells.

DIF: Level 1

REF: p. 157

3. K-positive donor red cells were mistakenly transfused to a recipient with anti-K. The patient’s

posttransfusion blood sample has a positive direct antiglobulin test with polyspecific antihuman globulin. The direct antiglobulin test is positive because anti-K is an antibody that has sensitized the cells in vivo. a. IgG, donor’s b. IgM, donor’s c. IgG, recipient’s d. IgM, recipient’s ANS: A

The anti-K in the recipient attached to the K antigen on the transfused donor red cells, which will cause them to be prematurely cleared by the spleen.

DIF: Level 2

REF: p. 151

4. Which of the following phenotypes is heterozygous? a. Fy(a–b+) b. Jk(a+b–) c. Fy(a+b+) d. Le(a+b–)

ANS: C

If both alleles Fya and Fyb are present on the red cell, the genetic expression is heterozygous.

DIF: Level 2

REF: p. 154

5. Antibodies to which of the following blood group system show dosage (i.e., are stronger with

homozygous expression of the antigen)?

Lutheran P Duffy Kell

a. b. c. d.

ANS: C

Stronger reactions are typically seen with red cells that have a “double dose” of the antigen in the Duffy system.

DIF: Level 1

REF: p. 155

6. Why are antibodies to Lub antigen not commonly detected? a. Lub antigen is of high incidence. b. The antibodies do not cause transfusion reactions. c. Lub antigen is not present on screening cells. d. The antibodies react best at 4° C. ANS: A

Lub antigen occurs at an incidence of greater than 99%.

DIF: Level 1

REF: p. 158

7. Why have Lewis system antibodies not been implicated in hemolytic disease of the fetus and

newborn? a. The antigens are not fully developed at birth. b. Lewis system antibodies do not cross the placenta. c. The antibodies are not clinically significant. d. All of the above are correct.

ANS: D

Lewis antibodies are often found during pregnancy but do not cross the placenta because they are IgM. The antigens are not well developed at birth.

DIF: Level 2

REF: p. 160

8. All the following statements are true regarding Lewis system antibodies except antibodies: a. may be observed at the immediate-spin, 37° C, and antihuman globulin phases. b. can be neutralized by Lewis substance. c. may cause hemolysis in vitro. d. do not react following enzyme treatment of cells.

ANS: D

Anti-Leb may be enhanced with enzyme treatment.

DIF: Level 1

REF: p. 160

9. What phenotype will be expressed when the Le, Se, and H genes are inherited? a. Le(a+b+) b. Le(a–b+) c. Le(a–b–) d. Le(a+b–) ANS: B

Inheriting H, Se, and Le genes will allow the Lewis transferase to convert H to Leb antigen and to be absorbed onto the red cells.

DIF: Level 2

REF: p. 161

10. Predict the probable antibody’s identity if all red cells tested at room temperature are positive

with a patient’s serum except for cord cells.

Anti-Lu Anti-Lea Anti-I Anti-M

a. b. c. d.

ANS: C

The I antigen is found on adult red cells, not on cord red cells. Anti-I reacts best at colder temperatures.

DIF: Level 2

REF: p. 162

11. Which condition is often associated with the presence of anti-I? a. Infectious mononucleosis b. Mycoplasma pneumoniae infection c. Pregnancy d. Colon cancer ANS: B

High-titer auto anti-I is often found in patients with Mycoplasma pneumoniae infections.

DIF: Level 1

REF: p. 162

12. Which of the following blood group systems are structurally related to antigens of the P

system? a. MNS b. ABH c. Kell d. Duffy ANS: B

The P system antigens are formed by the action of glycosyltransferases, similar to the ABO system genes and antigen products.

DIF: Level 1

REF: p. 164

13. What characterizes the Donath-Landsteiner antibody? a. An IgG auto anti-P.

b. An IgM auto anti-I. c. Anti-IH that reacts at cold temperatures. d. An IgG anti-Pk. ANS: A

The Donath-Landsteiner antibody is a biphasic hemolysin that binds at colder temperatures in the body (extremities) and activates complement to cause hemolysis at warmer temperatures.

DIF: Level 1

REF: p. 165

14. Red cells that phenotype as S–s– are also: a. M-negative. b. N-negative. c. Tja-negative. d. U-negative.

ANS: D

When S and s are absent from the membrane, the high-frequency antigen U is also absent.

DIF: Level 1

REF: p. 168

15. Select the statement that is FALSE regarding anti-P1. a. Anti-P1 will not react with enzyme-treated P1 positive red cells. b. P2 individuals can make anti-P1. c. Anti-P1 is clinically not significant. d. Anti-P1 reacts best at room temperature.

ANS: A

Anti-P1 is an IgM alloantibody that is made by P2 individuals and reacts best at colder temperatures.

DIF: Level 1

REF: p. 165

16. Anti-Jsb was identified in a patient scheduled for elective surgery later. What is the best

approach to finding compatible blood? a. Contact the rare donor registry since Js(b-) units are rare. b. Request that family members be tested to determine if they share the same

phenotype. c. Screen donors from the black population because Js(b-) phenotype is common. d. A and B are correct.

ANS: D

Js(b-) individuals are less than 1% of the black population and even rarer in the white donor population. The rare donor registry is the most likely source of units; however, they would probably be stored as frozen red cells. Since the units are not required urgently, family members should be typed to locate potentially compatible blood.

DIF: Level 2

REF: p. 151

17. A patient’s antibody history listed an anti-Cellano. This antigen is also known as: a. c in the Rh system. b. k in the Kell system.

c. Cs in the Cost system. d. SC in the Scianna system.

ANS: B

Cellano is the original name of the k antigen (KEL2) in the Kell system, a high-frequency antigen that is antithetical to K (KEL1).

DIF: Level 1

REF: p. 149

18. The major histocompatibility complex is located on chromosome 6 and is important in all the

following immune functions except: recognition of nonself. graft rejection. hemolysis. coordination of cellular and humoral immunity.

a. b. c. d.

ANS: C

The major histocompatibility complex codes for molecules on all nucleated tissues and cells to allow for immune recognition and response to foreign antigens.

DIF: Level 2

REF: p. 172

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

determine: a. class I HLA antigen determination. b. class II HLA antigen determination. c. HLA antibody identification. d. compatibility testing for tissue typing. e. B and D. ANS: E

The mixed lymphocyte culture (MLC) was an in vitro procedure used to determine tissue compatibility and D (class II) typing that has been largely replaced by molecular typing and flow cytometry techniques.

DIF: Level 2

REF: p. 175

20. HLA matching between the donor and recipient is important for progenitor cell transplantation

to avoid: graft versus host disease (GVHD). graft rejection. transfusion reactions.

A and B.

a. b. c. d.

ANS: D

HLA typing is essential to avoid GVHD and rejection in HPC transplants.

DIF: Level 2 MATCHING

REF: p. 174

Match each characteristic with the appropriate blood group system. A selection may be used more than once. a. Cartwright b. MNSs c. Kidd d. Vel e. Xga f. Sda antigen g. Chido/Rodgers h. Kell i. Duffy Antigen has a higher frequency in females Antigen of high incidence; its antibody can cause hemolytic transfusion reactions Antibodies are sensitive to enzymes and have high-titer low-avidity characteristics System associated with McLeod phenotype Antigens Yta and Ytb are in this system System associated with glycophorin A and B Antibodies in this system often fall below detectable levels and are associated with delayed transfusion reactions 8. Antibody to this antigen demonstrates weak mixed field reaction 9. System associated with chronic granulomatous disease 10. System associated with resistance to malaria 1.

2.

3.

4.

5.

6.

7.

1. ANS: E 2. ANS: D 3. ANS: G 4. ANS: H 5. ANS: A 6. ANS: B 7. ANS: C 8. ANS: F 9. ANS: H 10. ANS: I

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 1

Chapter 08: Antibody Detection and Identification Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th Edition MULTIPLE CHOICE 1. In the process of identifying an antibody, the technologist observed 2+ reactions with 3 of the

10 cells in a panel at the immediate-spin phase. These reactions disappeared following incubation at 37° C and the antihuman globulin phase of testing. What is the most likely responsible antibody? a. Anti-E b. Anti-D c. Anti-I d. Anti-Lea ANS: D

The Lea antigen is typically found on three to four cells in a panel, and the antibody reacts best at the immediate-spin phase of testing.

DIF: Level 3

REF: p. 184

2. What is a characteristic of Rh system antibodies? a. Mixed-field reactions on panels b. Weak reactions with panel cells c. Strong reactions with panel cells when read at immediate-spin phase d. Reactions that are enhanced with enzymes ANS: D

Rh system antibodies are typically strong and are enhanced with enzyme treatment.

DIF: Level 1

REF: p. 193

3. Which of the following situations can be found in a classic case of autoimmune hemolytic

anemia? a. Positive direct antiglobulin test b. False-positive Fya phenotyping c. Crossmatch incompatibility at antihuman globulin d. All of the above ANS: D

Red cells of a patient with this condition are coated with IgG antibodies that are signaling premature destruction in the spleen. Because the red cells are coated, attempts to test them with antiglobulin reagent results in positive reactions. The antibody in the serum will react with all normal cells tested at the antihuman globulin phase.

DIF: Level 2

REF: p. 199

4. What is the next step in the investigation of a positive direct antiglobulin test with

polyspecific antihuman globulin reagent? a. Repeat the direct antiglobulin test using warm saline.

b. Perform an eluate. c. Add IgG-sensitized red cells to verify positive reaction. d. Repeat the direct antiglobulin test using monospecific anti-IgG and anti-C3

reagents.

ANS: D

Polyspecific antihuman globulin contains both a complement and IgG component. To determine which caused the positive reaction, red cells should be tested separately using monospecific anti-IgG and anti-C3 reagents.

DIF: Level 2

REF: p. 199

5. Antibody screening cells are positive at the antihuman globulin phase of testing. What is the

first step in this investigation?

Check transfusion and pregnancy history.

Perform a direct antiglobulin test using anti-C3.

Repeat the ABO typing.

Crossmatch units until one is compatible.

a. b. c. d.

ANS: A

A positive screen indicates the presence of unexpected antibody. Patient history can aid in the investigation.

DIF: Level 2

REF: p. 187

6. Why is the agglutination reaction phase important in the interpretation of the antibody screen

or antibody identification panel?

Determines whether there is a delayed transfusion reaction Provides clues on antibody dosage Indicates the class of the antibody Determines whether an autoantibody is present

a. b. c. d.

ANS: C

IgM antibodies typically react at room temperature. IgG antibodies require the antiglobulin phase to detect.

DIF: Level 2

REF: p. 184

7. In an antibody identification panel, only one red cell was negative at the antihuman globulin

phase. On ruling out and matching the pattern, an anti-k was identified. What further testing is necessary to confirm the antibody? a. Two more k-negative cells should be tested. b. Two more K-negative cells should be tested. c. Treat the panel cells with enzymes and perform the panel again. d. Perform an adsorption using “k”-positive cells.

ANS: A

To satisfy the “rule of three,” three negative and three positive reactions for the antigen should be observed to rule in an antibody.

DIF: Level 3

REF: p. 190

8. Anti-Fya was identified in a patient’s serum. The patient’s red cells phenotyped as Fy(a+)

using commercial antisera. What is the next step?

Repeat the panel to confirm the antibody.

Report the antibody because this result is normal.

Investigate a recent transfusion history.

Wash the cells and use monoclonal anti-Fya antibodies.

a. b. c. d.

ANS: C

The patient’s red cells should be Fy(a-) to make anti-Fya unless a recent transfusion was given of Fy(a+) red cells. If no Fy(a+) red cells were recently transfused, the antibody identified may be incorrect or the patient may have a positive direct antiglobulin test.

DIF: Level 3

REF: p. 191

9. If all antibody identification panel cells were reactive at the same strength at the antihuman

globulin phase, no negative reactions were observed, and the autocontrol was negative, what antibody should be suspected? a. Multiple antibody specificities b. Warm autoantibody c. Antibody to a low-frequency antigen d. Antibody to a high-frequency antigen ANS: D

Reactions of similar strength suggest one specificity; a negative autocontrol rules out an autoantibody, and all panel cells reactive suggest an antibody to an antigen that is of high frequency in the population.

DIF: Level 3

REF: p. 194

10. Select the antibody that is not produced against a low-incidence antigen. a. Anti-Vel b. Anti-Cw c. Anti-V d. Anti-Lua ANS: A

Vel is an antigen found in high frequency in the population.

DIF: Level 1

REF: p. 196

11. What is the typical specificity of cold autoantibodies? a. M b. N c. I d. Leb ANS: C

Cold autoantibodies are typically of the specificity anti-I. I is a high-frequency antigen found on all adult red cells but is absent on cord red cells.

DIF: Level 1

REF: p. 200

12. If an anti-I is suspected in a patient’s sample that requires a transfusion, what is the most

acceptable course of action?

Call the rare donor registry.

Crossmatch cord blood.

Perform a cold autoadsorption.

Perform the prewarm technique.

a. b. c. d.

ANS: D

Prewarming the patient’s serum and panel cells separately and then mixing at 37° C to avoid cold temperatures usually avoids the reactivity of the anti-I, which is not clinically significant but may mask other antibodies.

DIF: Level 2

REF: p. 200

13. What is the most important concern when trying to identify antibodies in a patient with a

warm autoantibody? a. Identifying the specificity of the autoantibody b. Determining whether there are underlying alloantibodies c. Identifying the antibody found in the eluate d. Determining whether complement is binding to the autologous red cells ANS: B

Autoantibodies in the serum can mask underlying alloantibodies.

DIF: Level 2

REF: p. 203

14. An autoadsorption may be performed to investigate underlying autoantibodies. When is this

procedure acceptable?

When the autoantibody is reactive at 4° C When the patient has not been recently transfused Only if complement is coating the red cells When the eluate is negative

a. b. c. d.

ANS: B

If an autoadsorption is performed (using the patient’s red cells) and the patient has been recently transfused, the adsorbing red cells may remove developing alloantibodies to the transfused cells.

DIF: Level 2

REF: p. 206

15. Why are proteolytic enzymes not used in the routine screening for antibodies? a. The reagent is too expensive for routine use. b. Clinically insignificant antibodies are enhanced. c. Red cells must be treated with enzymes first, which makes this technique

impractical. d. Some antigens are destroyed by enzymes, which would cause the antibodies to be missed.

ANS: D

Proteolytic enzymes destroy some antigens in the Duffy and MNS system. Antibody screens using enzymes would not detect antibodies to these antigens.

DIF: Level 1

REF: p. 186

16. High-titer, low-avidity antibodies typically: a. react with antigens of high frequency in the population. b. react with antigens of low frequency in the population. c. are clinically significant. d. react best at colder temperatures.

ANS: A

High-titer, low-avidity antibodies are typically reactive with most panel cells at the antihuman globulin phase and are not clinically significant. They may mask clinically significant reactions.

DIF: Level 1

REF: p. 194

17. Select the example of a cold alloantibody. a. Anti-M. b. Anti-I. c. Anti-Lub. d. Anti-k.

ANS: A

Alloantibodies to anti-M react best at room temperature but can also demonstrate reactions at 37° C and antihuman globulin phases.

DIF: Level 1

REF: p. 197

18. Select the best description of the elution technique. a. Technique that disassociates IgM antibodies from red cells for further

identification b. Technique that disassociates IgG antibodies from red cells for further

identification c. Technique that adsorbs IgG antibodies from serum d. Technique that separates IgG and IgM antibodies in serum ANS: B

Elution procedures remove IgG antibodies from sensitized red cells to be used for identification using panel cells.

DIF: Level 2

REF: p. 204

19. Which of the following antigens is not commonly used on screening cells? a. D b. k c. Kpa d. C ANS: C

Kpa is a low-frequency antigen in the Kell system that is typically not present on screening cells.

DIF: Level 1

REF: p. 184

20. What type of red cells is used in an autoadsorption to remove antibody from the serum? a. Antibody screening cells b. Donor red cells c. Patient red cells d. Antibody identification panel cells ANS: C

Patient red cells are treated to remove IgG antibody and then are incubated with the patient’s serum to remove more autoantibodies that are interfering with alloantibody identification.

DIF: Level 1

REF: p. 206

21. Anti-D, anti-K, and anti-Jka are the antibodies that are tentatively identified on a panel after

initially ruling out on negative cells. What selected cell from another panel should be chosen to confirm the presence of anti-K? a. K–, D+, Jk(a+) b. K+, D+, Jk(a+) c. K+, D–, Jk(a+) d. K+, D–, Jk(a–) ANS: D

To confirm the presence of a anti-K, a cell positive for K antigen and antigen negative for the other two suspected antibodies will confirm anti-K if it is reactive against it.

DIF: Level 2

REF: p. 193

22. Select the antibody where DTT (dithiothreitol) would be useful in the identification

investigation. a. Anti-Jsa b. Anti-Kpb c. Anti-Vel d. Anti-K ANS: B

Anti-Kpb is a high-frequency antigen in the Kell system. If an anti-Kpb is suspected, the panel cells could be treated with DTT and the sample retested. If all reactions are eliminated, the anti-Kpb is confirmed and other underlying alloantibodies are ruled out. Although K would also be destroyed by DTT, there are sufficient negative cells on the panel to determine if underlying antibodies exist and confirm the specificity.

DIF: Level 1

REF: p. 195

23. When should anti-Sda be suspected? a. Weak reactions at the antiglobulin phase occur with several panel cells b. Reactions are stronger with enzymes at the immediate-spin phase c. Antibody reacts with most panel cells and are mixed field and refractile

microscopically d. Weak reactions at the AHG phase titer out to high dilutions ANS: C

Anti-Sda antibodies are characteristically mixed field and refractile when observed under the microscope. Sda is a high-frequency antigen; therefore, these reactions will be observed with most cells tested.

DIF: Level 2

REF: p. 196

24. A patient’s serum reacted weakly with all panel cells tested at the antiglobulin phase using

LISS and were not enhanced using PEG. The autocontrol was negative. Ficin-treated panel cells were nonreactive. What is the most likely specificity of the antibody? a. Anti-I b. Anti-U c. Anti-Ch d. Anti-Jsb ANS: C

Anti-Ch (anti-Chido) is an antibody to a high-frequency antigen in the high-titer low-avidity category of antibodies that demonstrate weak reactions that are not normally enhanced with potentiators. Anti-Ch reactions may be eliminated when testing with ficin-treated cells.

DIF: Level 2

REF: p. 195

25. Which of the following medications is most likely to cause the production of autoantibodies? a. Tetracycline b. Cephalothin c. Methyldopa d. Acutane ANS: C

Methyldopa is a medication often associated with autoantibody formation. The autoantibody can be observed in the serum and the eluate without the presence of the drug (drugindependent mechanism).

DIF: Level 2

REF: p. 207

26. An antibody was detected at immediate-spin and 37° C that appeared to have anti-Leb

specificity. To confirm the antibody identity and determine if there were other antibodies in the serum, a Lewis neutralization technique was performed.

Patient serum + Lewis substance = 0 Patient serum + saline control = 1+ Neutralized serum + Fy(a+b+) red cell = 0 What conclusion can be made from these results? a. Anti-Leb is confirmed. b. Antibody was diluted, therefore no conclusion can be made. c. Antibody was not neutralized, therefore anti-Leb has not been identified. d. Antibody other than anti-Leb is most likely in the serum.

ANS: A

Since the saline control demonstrated a positive reaction, the antibody was not diluted by the neutralization procedure. The antibody to the Lewis antigen was neutralized, since it did not react with the Lewis positive cells.

DIF: Level 3

REF: p. 198

MATCHING

Match the tentative interpretation of antibody screen and direct antiglobulin test (DAT) with the results given below. a. Alloantibody, IgG b. Alloantibody, IgM c. Autoantibody, IgM d. Autoantibody or transfusion reaction, IgG 1.

2.

3.

4.

All screening cells 2+ at antihuman globulin phase, DAT positive, IgG 2+ One screening cell 1+ at antihuman globulin phase, DAT negative All screening cells positive 1+ at IS, DAT positive, C3 1+ All screening cells positive 1+ at IS, DAT negative

1. ANS: 2. ANS: 3. ANS: 4. ANS:

D A C B

DIF: DIF: DIF: DIF:

Level 2 Level 2 Level 2 Level 2

Chapter 9. Compatibility Testing

if investigating possible antibodies that bind compliment when is a serum sample preferred over and EDTA sample?

if the pre-transfusion testing is to be done on automated instruments when is an EDTA sample preferred?

two independent patient identifiers, date of collection, collectors identification what is required on the label of a patients sample?

drawn within 3 days of the expected transfusion due to the possibility of antibody production from the recent transfusion if the patient has been transfused in the past 3 months then the sample must be...

patients on a heart bypass pump because these patients hemolyze their red cells hemolyzed samples should be avoided and recollected if possible.

what is the exception and why?

so that IV fluids do not contaminate testing why do all specimens collected for lab testing have to be drawn below the IV?

ABO/Rh of patient and blood donor, antibody screen of patient and crossmatch between patient plasma and donor cells list the blood bank procedures required for compatibility testing

prevent ABO incompatibility and prevent IgG alloantibody incompatibility

what is the purpose of a full crossmatch (coombs, AHG)

positive antibody screen on current sample or documentation of clinically significant antibody in patients medical record a full crossmatch is performed when patient needs RBCs and the patient either has a.....

prevent ABO incompatibility purpose of immediate spin crossmatch (modified)

negative antibody screen on current sample and no history of clinically significant antibodies an immediate spin crossmatch is performed when both of the following criteria are met:

antibodies present in the recipients plasma against antigens on donor cells, some errors in ABO grouping, labeling, identification and positive DAT of donor serological crossmatch will detect the following:

all ABO and/or Rh typing errors and all unexpected antibodies in recipients plasma serological crossmatch will not detect the following:

Chapter 10. Blood Bank Automation for Transfusion Services

What laboratory component in automation is essential to flag discrepancies with previous results?

LIS

What term is defined as productivity of a machine, procedure, process, or system over a unit time period?

Throughput

How does a 2+ reaction appear in the MTS gel test?

Cells evenly distributed throughout the microtube

A compact button of red cells in the bottom of the well is interpreted as a/an when solid-phase testing is used for the antiglobulin test.

reaction

negative

Identify the forces driving the need for automation in the transfusion service. (Select all that apply.)

Compliance with increased regulations, Higher testing volumes as a result of consolidation, Financial environment encouraging new economies

Identify the benefit(s) for converting to automation testing. (Select all that apply.)

Save operating funds, Opportunity to question and examine work processes and identify areas for improvement, Increase in productivity, Improve total quality of testing

Select the challenges(s) for converting to automation testing. (Select all that apply.)

Initial capital investment for equipment, Investment of time for validation protocols, training, and procedures

The solid-phase red cell adherence procedure for antibody screen does not require a washing step.

False

The foundation of any automated platform begins with a proven technology. The performance of the base technology requires investigation.

True

Automation should make it easier to do things the right way and more difficult to do the wrong things.

True

Chapter 11. Adverse Complications of Transfusions

What are the symptoms to look for in recognizing a transfusion reaction either acute (<24 hrs) or delayed (>24hrs) Fever Chills/rigors Respiratory distress Hyper or hypotension Pain- flank or back Skin - urticaria, rash, flushing, edema Hemoglobinuria Nausea/emesis (vomiting) Oliguria/anuria Abnormal bleeding

What are examples of hemolytic transfusion reactions? destruction of transfused RBC Intravascular or extravascular acute or delayed - immune or non- immune

What are symptoms of acute hemolytic transfusion reaction (AHTR) Fever Chills Pain Oozing at infusion site Back or flank pain Hypotension Epistaxis

Hemoglobinuria DIC Oliguria/anuria Renal failure

Immune mediated AHTR Ab binding to RBC

Activation of complement

Activation of mononuclear phagocytes

Release of cytokines

Activation of coagulation

Shock and renal failure

What causes AHTR? Usually ABO incompatibility

How do ab influence severity of clinical manifestation in AHTR? the density of rbc antigens or the distribution of antigens

IgM activates complement free hemoglobin/ rbc stroma

IgG

interacts with Fc receptors on monocytes

What happens during complement?

-Opsonization -Anaphylatoxin -Red Cell lysis

What happens during opsonization?

Membrane bound complement

mononuclear phagocytes

What happens during anaphylatoxin?

Mast cell/smooth muscle/neutrophils

Vascular dilation and bronchospasm

C3a/C5a - mast cells release serotonin/histamine -Increased vascular permeability -Bradykinin - vasodilation and hypotension -Ab-Ag complexes deposition and thrombus formation vascular compromise in kidneys

What happens during red cell lysis? free hemoglobin (haptoglobin)

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What happens during DIC? Consumption of clotting factors

Fibrinogen, FV and FVIII, platelets

Diffuse uncontrolled microvascular bleeding

Fibrin degradation products -D-dimer

What happens during shock?

Systemic hypotension

Reactive renal vasoconstriction

Deposition of intravascular thrombi

Compromise of renal blood flow

Release of norepinephrine -Vasoconstriction in kidneys and lungs -Renal ischemia - acute tubular necrosis/renal loss

Renal failure

Errors known to cause AHTR -Collection of blood from incorrect patient -incorrect labeling of blood samples

-misidentification of sample at blood bank -Issuance of wrong unit from blood black -transfusion of blood to incorrect patient

Most common clinical presentation of an AHTR fever with or without chills hemoglobinuria (hemoglobin in the urine)

What causes DHTR? IgG antibody from previous exposure (sensitized)

Antibody below detectable levels -Sensitivity of test method

Antibody to low frequency -Not on screening cells -Expect incompatible crossmatch

Newly developed alloantibodies within 24 hrs to 28 days

Common blood group antibodies supected in DHTR Kidd- Most common Duffy Kell MNS- least common

Symptoms of DHTR under the microscope Little or no increase in post transfusion HGB

Rapid HGB decrease to pre-transfusion levels

Unexplained appearance of spherocytes

How does Immune delayed DHTR occur?

Extravascular hemolysis -Coated with Ig or C3 -Fever -Hypotension

Activation of T and B cells

Activation of endothelial cells - procoagulant

AHTR febrile non-hemolytic transfusion reaction Temperature elevation >1oC -Cytokines in response to transfused WBC -Premedication with acetaminophen

Not life-threatening

-give Tylenol prior to transfusion

Allergic Transfusion Reaction of AHTR Ranges from Urticaria to fulminant anaphylaxis

Seconds to minutes of start of transfusion

Hypersensitivity type I

Upgrade to remove adverts Only US$35.99/year Ranges from Urticaria to fulminant anaphylaxis Soluble allergens in donor plasma

Hypersensitivity type I -Preformed IgE in recipient -Allergen from donor -Activates mast cells Degranulation Histamine, proteases and chemotactic factors

Symptoms of an AHTR allergic transfusion rxn within 4 hours -Urticaria (hives) -Pruritis (itching) -Maculopapular rash -Generalized flushing -Localized angioedema -Edema of lips/tongue

More issues from AHTR allergic transfusion rxn within 4 hours Erythema and edema of periorbital area

Conjunctival edema

Respiratory distress

Hypotension

Treatment with antihistamines

History: premedication

Only type of transfusion reaction where component may continue to be administered after treatment administration

Anaphylactic (anaphylactoid) Transfusion Reaction, Non-IgE mechanisms of AHTR -IgA ab deficient patients

-Make anti-IgA antibody

-Receive plasma with IgA -Give washed RBC or platelets (why not washed FFP?)

-Give IgA deficient plasma

-Severe cases, treat with: Prednisone, epinephrine

What are symptoms of AHTR of Transfusion related acute lung injury (TRALI) -Respiratory distress/pulmonary edema within

1-2 hrs

-Severe hypoxemia

-Tachycardia

-Cyanosis (blue color due to lack of O2)

-Hypotension

-Fever

TRALI consist of...

-Donor HLA antibodies to recipient HLA antigens

Activates neutrophils in pulmonary microvasculature -Pulmonary endothelial damage -Capillary leakage -Pulmonary edema

Multiparous women - HLA-Aby in donated plasma -Male donors preferred

Transfusion Associated Graft-Versus-Host Disease (TA-GVHD) in DHTR Rare but highly lethal - 90% mortality -Immunocompetent donor lymphocytes -Immunocompromised recipient

3 days to 6 weeks -Maculopapular rash -Fever -Diarrhea -Elevated liver enzymes

What is required for TA-GVHD? Donor lymphocytes engraft -Proliferate

Immune response against host

T-Cells react to non-shared HLA antigens on host cells

Irradiation is required

Leukocyte reduction is NOT sufficient

Posttransfusion Purpura in DHTR Platelet count falls 5-12 days post transfusion -Anamnestic response to platelet ag HPA-1a

98% ag frequency

Multiparous women HPA-1a negative -Make anti HPA-1a -Ab destroys HPA-1a positive

platelets and own platelets

Upgrade to remove adverts Only US$35.99/year Bacterial contamination of AHTR-non immune mediated Bacterial proliferation in donor units -Transient bacteremia in asymptomatic donor -Improper cleansing of donor skin

Bacterial toxins

Rapid shock

-*Fatalities linked to platelet transfusions*

What temperature destroys several bacteria?

Storage at 4o C destroys many bacteria

Gram- negative cold tolerant bacteria Yersinia enterocolitica Serratia liquifaciens Pseudomonal fluorescens

Gram positive in platelets Staphylococcus species Bacillus cereus

Additional info on bacterial contamination Symptoms mimic AHTR

Treatment with broad spectrum antibiotics

Blood cultures from patient and donor units

Visual inspection -Discoloration -Clots -Cloudiness -Hemolysis

Transfusion-Associated Circulatory Overload (TACO) in AHTR- non immune Cardiopulmonary system exceeds volume capacity

What are elderly (>70) and infants at risk with TACO Dyspnea Severe headache Peripheral edema Signs of congestive heart failure

-aggressive oxygen thearpy and diuretics

-packed RBC- slow rate of infusion in small volume aliquots (3-4 hrs)

What are the normal transfusion rates for TACO -1 ml/ min for first 15 minutes

-If no reaction, up to 4 ml/min

Usual infusion time -RBC - can be divided to 2 , each transfused in3- 4 hours -Platelets, plasma - 10 ml/min (30 min)

Hemolysis (RBC Destruction) AHTR non immune Examine segments or remaining blood in unit

Questioning of transfusion process personnel

Hemolyzed unit -Free hgb and red cell stroma --RBC stroma may stimulate complement, procoagulant

What are causes of RBC hemolysis?

-exposure to extreme temperature -improper deglycerolization -mechanical destruction -Osmotic rupture -Bacterially contaminated unit -Intrinsic RBC defect (donor)

Upgrade to remove adverts Only US$35.99/year Exposure to extreme temperatures -Less than 0oC or above 50oC -Malfunctioning warming devices -Warming during storage -Frozen units

Mechanical destruction -Small bore needles -Mechanical valves -Excess pressure -Blood salvage units

Osmotic rupture -Nonphysiologic solutions Half-strength saline 5% dextrose in 0.18% saline Ringer's lactate

-Medication

Citrate toxicity of AHTR non immune Lg quantities of blood in short time frame it binds oxidized calcium

patients with impaired liver function

transfusion of preterm infants with liver or renal insufficiency

How do we treat citrate toxicity? calcium chloride or calcium gluconate

What is transfusion hemosiderosis?

Accumulation of excess iron in macrophages -Long term transfusion therapy -Thalassemia/sickle cell disease

Iron excretion = 1 mg/day

One unit packed RBC = 250mg/unit

Deposition of iron in liver, lungs and kidney

Iron chelators: bind and excrete

Initiation of transfusion for Delayed non immune mediated -Check all identifying information -Document informed consent -Date and time of start -Patient's pretransfusion vital signs Temperature Blood pressure Pulse Respiration rate -Remain with patient 15 minutes

-Recheck vitals at 15 minutes -Observe periodically up to 1 hours after completion

What do you do if suspected transfusion reaction?

STOP transfusion -keep line open w/saline -inform physician -sent blood unit to transfusion service -draw patient for post transfusion work up

What are the transfusion services?

-Check for clerical errors -Visual check of unit -ABO/D phenotyping -DAT - microscopic (ratio of pt cells/donor cells) Mixed field reaction Positive: recipient ab to donor cells May be negative: rapid clearance of coated cells

What are other serologic test that can be done?

-antibody screen -crossmatch -hgb/hct -haptoglobin -bilrubin -urine hemoglobin -gram stain and blood culture

Upgrade to remove adverts Only US$35.99/year What is the hemovigilance model?

-National Healthcare Safety Network (NHSN) -In cooperation with AABB and CDC -Track, analyze and improve transfusion outcomes -Confidential and voluntary reporting system from participating hospitals of transfusion reactions to CDC -CDC publishes results to assist quality improvement activities

How do you report out the hemovigilance component?

-Presence of a transfusion reaction Definitive, probable or possible

-Severity 1-4, (1 is least severe, 4 is death)

-Relationship of reaction to transfusion Definitive, probable, or possible

Records retained indefinitely

Transfusion-transmitted disease or bacterial contamination reported to donor facility

Chapter 12. Hemolytic Disease of the Fetus and Newborn

HDFN

hemolysis of fetal/infant red blood cells

How does HDFN happen?

trans placental passage of maternal group antibodies

specific for fetal/infant RBC antigens

What causes severity of HDFN

mild anemia to neonatal death

1: dependent on the magnitude of rbc DESTRUCTION

2: ability of infant to compensate by increased rbc PRODUCTION

What are the 4 kinds of HDFN?

ABO

Rh

Due to other antibodies

Alloimmune Neonatal Thrombocytopenia

How does ABO HDFN happen?

most common cause of HDFN

mom has ABO ab directed against ABO antigen on fetal cells

What is most common ABO HDFN? Anti-A,B in group O mothers

Naturally occuring IgG antibody

babies of group A or B and B moms?

rarely occurs due to Anti-A or Anti-B

Other ABO HDFN characteristics

can occur w/ first or subsequent pregnancies

cannot be predicted/diagnosed during pregnancy

What are symptoms of ABO HDFN?

mild, rarely symptomatic @ birth

Why is ABO HDFN mild?

A and B ags on tissues and cells not fully developed at birth

not full antigen expression

What is treatment for ABO HDFN?

rare, solves on its own

phototherapy

exchange transfusion

Phototherapy

destroys bilirubin in skin & lowers bilirubin levels

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(Ex: Anti-A,B, baby gets O blood)

What do you see on blood smear of ABO HDFN?

spherocytes

dark & round (covered w/ antibody)

Detection and Diagnosis of ABO HDFN

DAT-weak + or neg

Cord serum test-->A1, B, O cells at AHG

A1 + B + O 0

Monitor bilirubin levels

Not exceed 12 mg/dl

Rh HDFN Most severe form of HDFN.

Mother is Rh neg

Baby is Rh pos or weak D pos

D antigen inherited from father

When do Rh pos cells enter mother's circulation?

3rd trimester

delivery (more common)

placental membrane ruptured at delivery. exposure mom to produce Anti-D

Why does Rh HDFN happen after 1st pregnancy?

Anti-D crosses placenta and attaches to D pos fetal red cells after 1st exposure

*1st pregnancy unaffected*

Why is 1st pregnancy not affected?

time

IgM switches to IgG

2nd pregnancy has high tittered Anti-D

What is different from ABO HDFN and Rh HDFN?

Rh HDFN can be predicted & diagnosed during pregnancy

Diagnosing Rh HDFN

ABO/Rh

Antibody screen

Antibody ID

Rh HDFN can occur if

Ab is IgG

corresponding ags are fully developed on fetal cells

Symptoms of Rh HDFN

anemia to still birth

Why is Rh HDFN worse than ABO HDFN?

antigens FULLY DEVELOPED at birth

Rh antigens ONLY found on RBCs

How does anemia occur w/ Rh HDFN?

Anti-D (IgG) ab crosses & attaches to infant's cells (Rh pos cells)

coated cells removed from infant by RE system

indirect bilirubin by-product of hgb catabolism *before birth, moms liver removes bilirubin*

Levels of anemia in Rh HDFN

cord hgb > 14 gm/dL =mild

cord hgb 11-14 gm/dL =moderate

cord hgb < 11 gm/dL =severe

Hepatosplenomegaly

enlargement of the liver and spleen

production of RBC in liver/spleen

increased reticulocytes & nRBCs

Hydrops fetalis cardiac insufficiency result in edema & respiratory distress

Icterus gravis neonatorum

severe jaundice of newborns

due to accelerated RBC destruction

Kernicterus deposition of bilirubin in the brain and spinal cord

results in permanent brain damage

What level of bilirubin does Kernicterus happen?

over 20 mg/dL

70% of infants die within 5 days

Stillbirth depends on titer of Anti-D

magnitude of RBC destruction

16-20 weeks can cause intrauterine death

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before birth focus on alleviating anemia

maternal history (other stillbirths)

antigen type of father

Titer of maternal antibody

maternal serum (ab) tested against RBCs homozygous for corresponding ag

What is a critical titer?

greater or equal to 32

Indicates MCA-PSV and/or amniocentesis should be performed

What antibody can cause affect infant or stillbirth with titer below 32?

Anti-K

MCA-PSV Middle cerebral artery peak systolic velocity

watch blood flow from cerebral artery

know hematocrit

PUBS percutaneous umbilical blood sampling

Cordocentesis

infant blood drawn

When can PUBS be done?

16-18 weeks

Tests can be done w/ PUBS

· blood type

· hemoglobin and hematocrit

· platelet count

· DAT

· antigen type the fetus

· DNA typing

Amniocentesis indirect prediction of severity of fetal anemia

Procedure for Amniocentesis

needle is inserted through the abdominal wall into the amniotic sac and fluid is withdrawn

cannot be performed until 18-20 week gestation

How do they read bilirubin in amniocentesis?

Bili at 450 nm

Correlates to magnitude of red cell destruction

When would you do antigen testing on the father?

see if father has antigen to corresponding maternal antibody

can predict likelihood of fetus being antigen positive

Blood type for exchange transfusion

ABO/Rh compatible

Packed RBCs and ABO compatible plasma (FFP)

Antigen neg for corresponding maternal antibody

Special preparation for exchange transfusions?

Fresh (less than 5 days old)

CMV neg

Irradiated

CPDA-1

Leukofiltered

Hgb S neg

What kind of blood do you use for IUT? Antigen negative for maternal antibody

O Negative

What is a clinically significant rise of bilirubin?

10 mg/dL in first 24 hrs

How are intrauterine transfusion blood prepared?

1. Washed

2. Fresh: less than 5 days old

3. CMV neg

4. Irradiated

5. Leukofiltered

6. Hemoglobin S neg

Some requirements of exchange transfusion?

double volume required

monitor bilrubin

What are benefits of exchange transfusions?

remove:

sensitized cells

circulating antibody

some bilirubin

What do you see on blood smear of Rh HDFN?

nRBC

Retics

Schistocytes

Rh Immune Globulin (RhIG)

300 ug of IgG Anti-D

administered intramuscularly

What is the maternal criteria for RhIG?

Rh neg

Has not been immunized to D ag

Infant is Rh pos or weak D pos

When do you give RhIG?

28 weeks gestation

give within 72 hrs of delivery

RhIG important information

passive immunization to prevent active immunization

counteracts immunizing potential of 15ml packed rbc or 30ml whole blood

What test results are affected by RhIG?

Maternal antibody screen

Infant DAT

Infant antibody screen

RhIG workup

Type and Screen

Fetal bleed screen

*Do not do weak D testing for typing*

protective effect ABO incompatible fetal cells cleared more rapidly from maternal circulation

Anti-D doesn't have time to form

Mom less likely become immunized by D

Blocking D

Mom has high titer Anti-D

Infant red cells falsely neg due to mother's Anti-D blocking all D antigen sites

What are infants type with Blocking D?

Rh negative

DAT 4+

HDFN due to other antibodies

Infant inherits father ag which mother lacks

ag positive fetal cells enter mom's circulation

Mother immunized and produces antibody

IgG crosses placenta in other pregnancies and attaches to fetal antigen positive cells

HDFN due to other antibodies special notes

1st pregnancy unaffected

can be predicted/diagnosed

symptoms: same as Rh HDN but not as severe

What is treatment for HDFN due to other antibodies?

same as Rh HDN

prevent kernicterus, exchange if needed

alloimmune neonatal thrombocytopenia due to maternal Anti-HPA-1a

98% have antigen on platelets

infant inherits from father. mother lacks antigen and is immunized when fetal cells cross placenta

maternal antibody attaches to infants antigen positive RBCs

Chapter 13. Donor Selection and Phlebotomy

8 weeks Time between WB donations

16 weeks Time between double red cell donations

00:05 01:21

4 weeks Time between infrequent plasmapheresis

2 days Time between plasmapheresis, plateletpheresis, or leukapheresis

Indefinite/permanent deferrals Hx of viral hepatitis after 11th Bday HbsAg+ confirmed test Anti-Hbc+ more than once HCV, HTLV, HIV, babesiosis, Chagas, CJD Recipient of dura mater or human pituitary GH Risk of vCJD Use of needles for nonprescription drugs Tegison or Bovine insulin

3 year deferral History of malaria or lived in endemic area for 5 consecutive years

1 year deferral Travel to malarial endemic area Travel to Iraq (Leishmaniasis) Hep B immune globulin Tattoo/permanent makeup not in state facility Mucous membrane/skin penetration with blood Sex with high risk HIV person Incarceration >72 hours Syphilis therapy completion Transfusion Human diploid cell-rabies vaccine after bite

Risk of vCJD (permanent deferral) -Rec'd blood in UK or lived 5+ years in Europe from 1980-present -Lived 3+ months in UK or member of US military from 1980-1996

1 month deferral Finasteride (Proscar/Propecia), Accutane, Amnesteem, Claravis, Sotret

6 month deferral Dutasteride (Avodart/Jalyn)

3 year deferral Soriatane

1 week deferral Warfarin/Coumadin

00:02 01:21

Upgrade to remove adverts Only US$35.99/year 2 day deferral (PLTs) Aspirin and piroxicam (Feldene)

2 week deferral Plavix and Ticlid (PLTs) Measles (rubeola) vaccine Mumps vaccine Polio oral vaccine Typhoid oral vaccine Yellow fever vaccine

4 week deferral Rubella vaccine Chickenpox vaccine

6 week deferral Conclusion of pregnancy

Hgb/Hct Allogeneic Males 13 g/dL 39% Females 12.5 g/dL 38% (12 with variance)

Temperature Allogeneic Should not exceed 37.5C (99.5F)

BP Allogeneic < or = 180/100 mm Hg

Pulse Allogeneic 50-100 bpm

Weight Allogeneic 110 pounds for 525 mL. Donors who weigh less can still donate but a smaller amount of blood should be removed at 10.5 mL of blood per kg of body weight.

History of viral hepatitis after 11th birthday Permanent deferral

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Anti-Hbc+ more than once Permanent deferral

HCV Permanent deferral

HTLV Permanent deferral

HIV Permanent deferral

Babesiosis Permanent deferral

Chagas Permanent deferral

CJD or family history of CJD Permanent deferral

Recipient of dura mater or human pituitary growth hormone Permanent deferral

Risk of vCJD Permanent deferral

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Use of needles to administer nonprescription drugs Permanent deferral

Measles (Rubeola) vaccine 2 week deferral

Mumps vaccine 2 week deferral

Polio oral vaccine 2 week deferral

Typhoid oral vaccine 2 week deferral

Yellow fever vaccine 2 week deferral

Rubella vaccine 4 week deferral

Chickenpox vaccine 4 week deferral

Tattoos or permanent makeup (unless applied by a state-regulated facility with sterile needles and ink that is not reused) 1 year deferral

Mucous membranes or skin penetration exposure to blood

1 year deferral

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Incarceration > 72 hours 1 year deferral

Completion of therapy for syphilis 1 year deferral

Transfusion of blood, components, human tissue, or plasma-derived clotting factor concentrates 1 year deferral

Human diploid cell-rabies vaccine after animal bite 1 year deferral

Hgb/Hct Autologous 11 g/dL 33%

Time frame Autologous >72 hours before surgery

Plateletpheresis

At least 48 hours must elapse between donations. Should not donate more than twice per week or 24 times per year. Must have PLT count of at least 150k if the interval between donations is <4 weeks. Donors donating a triple platelet product are deferred from donating for 7 days.

Plasmapheresis (frequent) Donation occurs more often than once every four weeks. Total plasma protein, IgG, and IgM must be monitored at 4 month intervals. Total serum protein must be 6-9 g/dL before each apheresis procedure. Donors 110-175 lbs can lose 12 L plasma in 12 months. Donors >175 lbs can lose 14.4 L. There must be 2 days between donations and no more than twice a week.

Malaria risk is not a cause for deferral.

Double red cell pheresis Males must be 5'1" and 130 lbs Females must be 5'5" and 150 lbs Must have Hct of 40%

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Time to obtain additional donor info 24 hours

Hep B vaccine causes +HbsAg for how long?

18 days

How long does the donor center have to notify a donor of a positive result?

8 weeks

Difference between Allogeneic and directed donors For frequent directed donors the FDA permits infectious disease testing with only the first donation in a 30 day period

Which donors can use the abbreviated DHQ? Donors who have completed the full DHQ at least twice and have donated at least once in the past 6 months

Maximum time to collect WB for plasma and PLTs 15-20 minutes

When a low volume donation is collected which components can be used?

Red Cells - Low Volume. Discard plasma and PLTs.

Diseases treated with therapeutic phlebotomy PV, PCT, EPO receptor mutations, high O2 affinity Hgb mutations, Polycythemia due to high altitude, cyanosis congenital heart disease, respiratory disease, EPO-producing neoplasms, and hereditary hemochromatosis.

Vasovagal reaction Symptoms are pallor, lightheadedness, anxiety, diaphoresis, hyperventilation, irregular breathing, weakness, nausea, vomiting, hypotension, and bradycardia. Risk factors include young age, first time donor, low weight, epidemic fainting, and inattentive phlebotomist. Caused by excessive parasympathetic outflow trying to counteract sympathetic activation from hypovolemia.

Arterial Puncture Complications Characterized by severe pain, rapid filling of the bag, bright red blood, and movement of the needle with each heartbeat. Causes hematoma. Risk factor is inexperienced phlebotomist.

Discontinue donation and apply pressure for 10 minutes, then bandage 3-4 hours. Should be evaluated for pseudo aneurysm by ultrasound. (Or fistula formation or compartment syndrome)

Nerve injury complication Risk factors include hematoma, female, younger. Treatment is time.

ANH (Acute Normovolemic Hemodilution) Remove blood from patient in OR. Replace with crytalloid 3:1 or colloid 1:1. Store WB in standard blood bag at RT. Reinfuse in the reverse order of draw to reinfuse lower concentrations of red cells first. Storage should not exceed 8 hours. Blood must be labeled with name, MRN, D/T of collection, and autologous. Patient criteria includes likelihood of txn >10%, preop Hgb >=12 g/dL, no coronary artery/pulmonary/renal/liver disease, no severe hypertension, no risk of bacteremia.

Intraoperative Blood Recovery Vacuum settings usually 150 torr to prevent hemolysis. To be cost effective usually 2 or more units should be collected and processed.

Chapter 14. Testing of Donor Blood

Donor selection importance prevent presence of transmissible disease identify donors with potential exposure to infectious agents - malaria, prions defer donors with exposure during infectious period

Donor blood tests must be licensed by FDA results are confidential - only released by donor's consent positive infectious agent test must be reported to public health agency

Required donor blood tests RBC antigens clinically significant RBC antibodies hepatitis -HBsAg -anti-HCV -anti-HBc -HCV NAT HIV 1 and 2 syphilis WNV Trypanosoma cruzi

Allogenic testing immunohematologic -ABO/Rh -Ab screen

infectious disease screening

Autologous testing immunohematologic -ABO/Rh -Ab screen

infectious disease screening NOT required - unless blood is shipped to different facility

ABO testing methods: tube, microplate, solid phase adherence, gel test compared to previous results if available discrepancy between forward and reverse resolved

Rh testing if RH is neg in IS --> weak D MUST be performed

Antibody screen required only with history of pregnancy or transfusion - most center tests all donors anyway separately or in pools

if pos --> plasma and platelets NOT used antibody ID required on RBC label

Syphilis venereal disease caused by Treponema pallidum transmitted thru sexual contact and blood donation FDA mandated in 1950 usually storing at 4C will kill the pathogen - platelets kept at RT

Rapid Plasma Reagin (RPR) Syphilis screening test reagin - cardiolipin antibody donor serum + cardiolipin-coated charcoal particles if POS --> go to confirmatory test - not specific for syphilis

Hemagglutination test for T. pallidum antibodies Syphilis screening test fixed chicken RBC sensitized with T. pallidum antigens looking for antibodies not indicative of an active infection

Fluorescent Treponemal Ab Absorption testing (FTA-Abs) confirmatory test for syphilis donor serum absorbed with non-T. pallidum antigen - reduces nonspecific cross reactivity add lyophilized (killed) suspension of T. pallidum

add labeled AHG looking for antibodies

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unit may be used if labeled POS screen and NEG confirmatory for Syphilis

defer donor for 12 months POS screen and POS confirmatory for Syphilis

Methods used to detect viral ab and ag enzyme-linked immunosorbent assay (ELISA) nucleic acid testing (NAT) chemiluminescence

Types of ELISA Ag or Ab adsorbed to plastic microplate/bead

indirect - detects antibodies

sandwich - detects antigen

competitive - either ab or ag

ELISA results < cutoff value --> nonreactive can use unit

> cutoff value --> initally reactive repeat twice

both repeats neg --> nonreactive

one or both repeats pos --> reactive discard unit

confirmatory test, if available, after all 3 runs

Nucleic Acid Testing amplification of RNA or DNA of infectious agents can detect low numbers of the viral DNA can detect before antibodies can be detected

minipools approved by FDA 6-16 donors all tested at once HIV RNA HCV RNA WNV RNA

HBV DNA (not required) if POS, have to test each individually

Internal controls positive and negative control provided by manufacturer

External controls high and low controls must be within acceptable range facility makes own

Upgrade to remove adverts Only US$35.99/year Analytic Sensitivity ability of assay to ID samples from infected individuals as POS probability of a POS test given that a patient is ill

100 x # POS detected / total # of infected

Analytic Specificity ability of an assay to ID samples from non-infected individuals as NEG probability of a NEG test given that the patient is well

100 x # NEG detected / total # of infected

Viral Hepatitis

highest potential for transmission through transfusion leading cause of liver cancer liver transplant 4.4 million Americans with chronic hepatitis 80,000 new infections every year A and E not usually because fecal-oral route and too sick to donate anyway

Hepatitis that are tested for B and C

Hepatitis that are NOT tested for A, D, and E

Human Retroviruses has reverse transcriptase copies own viral RNA into DNA and inserts into host genome HIV 1 and 2 Human T-cell Lymphotropic Virus (HTLV) I, II, and V Spumavirus - not associated with human infection

HIV 1 infects CD4 helper T cells viremia 10 days - 3 weeks post infection antibodies show up in clinically latent stage

HIV 2 clinically less severe HIV more common in Africa than US

HIV Serologic testing looking for anti-HIV1 and anti-HIV2 22-25 day window for antibody to be detectable high sensitivity to low titer antibody

HIV NAT testing looking for RNA for HIV1 9 day window reduced number of false positives - highly sensitive

Upgrade to remove adverts Only US$35.99/year HTLV I transmitted by cellular blood products, breast milk, sexual contact, contaminated needles causes: adult T-cell leukemia neoplasm tropical spastic paraparesis myelopathy - semiprogressive neurologic

HTLV II transmitted by cellular blood products, breast milk, sexual contact, contaminated needles causes: atypical T cell variant of Hairy Cell leukemia large granular lymphocytic leukemia

leukopenic chromic T cell leukemia

Western Blot confirmatory test for HIV 1 and 2 and HTLV I and II if 2 bands present --> POS p24 gp41 gp120/160 no bands --> NEG bands with no identified pattern --> indeterminate

WNV testing mosquito-borne flavivirus causes mild febrile illness to encephalitis, coma, death test with NAT

CMV testing infects WBCs 70-80% adults POS asymptomatic to mono-like symptoms problem for children and IC NOT regular testing, unless requested by physician - all products are leukoreduced now

Chaga Disease testing American trypanosomiasis caused by Trypanosoma cruzi infection from feces of infected reduviid bug

test for antibodies with ELISA or chemiluminescent assay

Bacterial Contamination 2004 - testing required on apheresis platelets and platelet concentrates BacT/ALERT - platelets stored 24 hrs then samples - NEG --> released for transfusion - POS --> recall unit

call donor if not normal flora

Chapter 15. Blood Component Preparation and Therapy

reason for separation of whole blood more appropriate patient therapy allows optimal storage for each part - each part has different storage temp

have to adhere to: FDA cGMP Cod of Federal Regulations "safety, purity, and potency" of blood products ISBT 128 - everything same format for label

00:06 01:21

Collection of Whole blood closed system - satellite bags already connected allows for maximum expiration date - 35 days anticoag-preservative mixture already in bag if open system - 24 hour expiration

63 mLs of anticoag can hold up to 450 +/- 45 mL of blood

70 mLs of anticoag can hold up to 500 +/- 50 mLs of blood

adjust anti-coag volume donor <110 lbs

adjusting anticoag formula weight of patient/110 lbs = A

A x 70 mL = B (amount of anticoag)

70 - B = amount of anticoag removed

A x 500 mL = amount of blood that should be drawn

function of preservatives minimize effects of biochemical changes maximize shelf life

things that go up during storage plasma hgb - some cells dying plasma K+

things that go down during storage viable cells plasma pH plasma Na+

glucose RBC ATP 2,3 DPG

citrate-phosphate-dextrose (CPD) anticoag 21 days 1-6C

citrate-phosphate-2-dextrose (CP2D) anticoag 21 days 1-6C

00:03 01:21

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additive solutions

AS-1, AS-3, AS-5 enhance RBC survival and function minimize hemolysis during storage to <10% must be added within 72 hours of collection extends storage to 42 days

add 100 mL of AS 450 mL of whole blood collected

add 110 mL of AS 500 mL of whole blood collected

AS-1 dextrose adenine mannitol sodium chloride

AS-3 dextrose adenine monobasic sodium phosphate sodium chloride sodium citrate citric acid

AS-5 dextrose

adenine mannitol sodium chloride

Rejuvenation solution helps RBCs with nutrients during storage restores ATP and 2,3DPG pyruvate inosine phosphate adenine extends expiration date for freezing rare or autologous units must be washed when thawed to remove the inosine

variables effecting product preparation centrifugation speed (RPM) length calibration (light vs. heavy)

light spin short time, low RPM used for whole unit separates RBCs (bottom) from plasma and platelets (top) compress the platelet rich plasma (PRP) into satellite bag heat seal

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platelets need to rest for 1 hour have heavy spin centrifugation leave 50-70 mL of plasma with them to maintain pH of 6.2 or higher stored at RT on rotator only valid for 5 days (contamination)

5.5 x 10^10 plts/unit one unit = 5,000 uL increase no need to crossmatch circulate for 3-4 days

fresh frozen plasma (FFP) frozen within 8 hours of collection stored at -18C for one year or below -65C for 7 years (rare) has all coag factors

PF24 plasma frozen within 24 hours of collection stored at -18C for one year

some factors do not tolerate RT for very long and deterioriate VIII reduced V reduced or normal

cryoprecipitate let FFP thaw in fridge at 1-6C (slowly) use heavy spin - cryo precipitates to bottom, plasma on top (plasma cryo reduced) plasma compressed into satellite bag, cryo in original bag keep 10-15 mL of plasma with cryo refreeze within 1 hour at -18C for one year

sterile connecting device connects tubing to maintain closed system

whole blood contains RBC, WBC, platelets, plasma proteins, anticoag stored at 1-6C for 21 days (CPD) or 35 days (CPDA-1) viable platelets lost (like RT) labile coag factors decrease within 24 hours used in patients who are actively blooding and lost >25% of their blood volume must be ABO identical and crossmatched limits donor exposure

patients who get components chemotherapy or irradiation trauma victims cardiac, orthopedic, or other surgeries

end-stage renal disease premature infants sickle cell patients

need crossmatching reduces total volume of transfusion

leukocyte reduction should filter out within 3 days of collection and before storage - final unit should have < 5 x 10^6 WBCs and 85% of original RBCs - reduces cytokine release during storage - reduces fragments from apoptotic WBCs

implications of WBCs immediate febrile adverse transfusion reactions - cytokines immunization to leukocyte antigen CMV exposure GVHD

Upgrade to remove adverts Only US$35.99/year automated apheresis 1 unit every 8 weeks 2 units every 16 weeks (double RBCs) saline replaces lost fluid for donor ACD anticoag - 21 day storage

final component should should: - 51 g/dL hgb - 153 mL volume

can be leukocyte reduced AS increases to 42 day storage

high-glycerol method for freezing RBCs 40% glycerol concentration prevents ice formation prevents dehydration store at -65C for 10 years lay flat

more commonly used used for rare units or autologous

low-glycerol method for freezing RBCs 20% glycerol concentration use liquid nitrogen to freeze store at -120C for 10 years lay flat

deglycerolization thaw RBCs at 37C dry warmer for 20-25 min wash in a series of decreasing osmolar saline solutions - critical

- 12%, 1.6%, 0.9% draw glycerol out of RBC do hemolysis check on last wash supernatant

automated instrument - open system have 24 hours for transfuse

wash RBC protocol need to remove all plasma from RBCs used for: infants or intrauterine transfusion IgA deficient patients

automated instrument uses 1000 mL of 0.9% saline can lose 10-20% of RBCs

irradiated RBCs destroys WBCs, specifically T cells uses gamma radiation avoids GVHD - WBC or APC transfused with RBCs and attack host - patient immune system too weak to fight back - 90% fatal

gamma radiation stops T cells from proliferating required by AABB for:

blood relatives because MHC close to relative - donor WBC recognizes MHC of patient and activates

gamma irradiator machine Cesium-137 or cobalt-60 need to be fingerprinted by homeland security to use but unit inside cylinder put cylinder inside machine beam points 2500 cGy at middle of canister periodic verification required

can impact RBC membrane: increased K decreased ATP decreased 2,3DPG

goes down to 28 days expiration

reasons for platelet transfusion platelet deficient disease leukemia cancer patients (chemo) posthematopoietic progenitor cell transplant postoperative bleeding

pooled platelets platelets from 6-10 donors in one bag open system - expires in 4 hours

- contamination at RT type specific or type compatible unique number assigned (original unit #s recorded)

Upgrade to remove adverts Only US$35.99/year apheresis platelets at least 3 x 10^11 plts/unit can donate 2 times a week - interval of 48 hours - only 24 times a year leukoreduced may require HLA match

corrected count increment (CCI) [post-transfusion plt count - pre-transfusion plt count] / # of plts transfused (10^11) x BSA

> 7500 indicates adequate plt count increment 10 min - 1 hr following transfusion

use nomogram for BSA

immune causes of platelet destruction HLA alloantibodies platelet antibodies autoantibodies

adding fuel to the fire

nonimmune causes of platelet destruction splenomegaly - large spleen holds more platelets, shows a low plt count medications sepsis active bleeding DIC fever

reasons for FFP transfusion coag factor deficiencies when concentrates are not available abnormal coag assays warfarin patients replacement solution for therapeutic plasmapheresis liver disease DIC

thawing of FFP water bath at 30-37C for 30-45 min or FDA approved microwave store at 1-6C tranfuse within 24 hours can be re-labeled as "thawed plasma" and stored 1-6C for 5 days (probably won't have FVIII)

ABO compatible

crossmatching not necessary 10-20 mL/kg (3-6 units) for factor replacement

cryoprecipitate antihemophilic factor contains most coag factors von Willebrand factor Fibronectin FVIII

Fibrinogen and FXIII main deficiencies treated with this

must contain 150 mg of fibrinogen/unit or 80 IU of FVIII/unit

Plasma, Cryoprecipitate reduced refrozen within 24 hours stored at -18C for one year still contains: albumin factors II, V, VII, IX, X, and XI ADAMTS13

used to treat TTP

pooled cryo thawed 30-37C for 15 minutes rinse with 10-15 mLs of 0.9% saline pooled and stored at RT until transfused

- must be transfused within 4 hours

thrombin fibrin sealant or fibrin glue we do NOT mix it send cryo to floor surgeon mixes to control to control surface bleeding during surgery

Upgrade to remove adverts Only US$35.99/year apheresis granulocytes 1.0 x 10^10 WBCs stored at RT W/O agitation - do NOT refridgerate transfuse within 24 hours must be irradiated should be crossmatched - usually contains a lot of RBCs still

reasons for granulocyte transfusion neutropenia (< 0.5 x 10^9/L) documented infection (GN or fungi) lack of response to antibiotics

not usually done anymore more effective antibiotics

ISBT 128

AABB standard requirement in 2008 component name unique ID # manufacturer name with license/registration expiration date (or time) amount of blood/anticoag ABO/Rh selected testing donor category (volunteer or paid)

additional labeling irradiated - name of facility pooled - final volume and name of facility autologous - "For Autologous Use Only"

storage incubators should have: recording devices audible alarms alarm checks emergency backup procedures calibrated thermometers

transportation of units whole blood/RBCs: 1-10C

frozen:

on dry ice

platelets: RT

should be validated periodically

checklist for receiving blood temp appearance (clots, color, hemolysis) container closure attached segments intact expiration date and time shipping list correct intact labels

summary of liquid RBCs stored: 1-6C CPD and CP2D: 21 days CPDA-1: 35 days AS: 42 days transportation: 1-10C on ice

summary of frozen RBCs stored: -65 to -80C 10 years transportation: on dry ice

summary of liquid FFP stored: 1-6C 24 hours

summary of frozen FFP stored: -18 to -20C 1 year transportation: on dry ice

summary of liquid cryo stored: 20-24C (RT) 4 hours

summary of frozen cryo stored: -18 to -20C 1 year

transportation: on dry ice

summary of platelets stored: 20-24C (RT) 5 days transportation: RT with gel packs

summary of pooled platelets stored: 20-24C (RT) 4 hours transportation: RT with gel packs

summary of granulocytes stored: RT 24 hours transportation: RT with gel packs

Chapter 16. Transfusion Therapy in Selected Patients

What is the normal rate of RBC transfusion?

2-4 hours

How many units of blood product are issued at one time?

1-2 units at at time to 1 patient at a time

How soon can blood products be returned to inventory after issuing and assuming there were no issues?

30 minutes

If request is made for multiple units (>4) on the SAME patient, then what must you do?

Prepare a transport container

What is the only acceptable solution (substance) that can be administered along with a unit of blood?

0.9% physiologic saline

The seal has been broken on a unit of RBCs. What is the new expiration date?

24 hours

For leuko-reduced RBCs and platelets, what percentage of WBCs are removed? What is the estimated number of WBCs? >99% removal of WBCs <5x10^6 WBCs remaining

What are the 3 uses for leuko-reduced RBCs and platelets?

1. Reduces risk of alloimmunization

2. Reduces Febrile non-hemolytic reactions (FNH) 3. Reduces risk of CMV transmission

True or false?

Universal leukocyte-reduction can occur at collection and at beside.

True

What are the 3 uses for washed RBCs? 1. Removes plasma proteins 2. Prevents anaphylactic reactions 3. Prevents allergic reactions

What is Graft vs Host Disease?

Donor T lymphocytes take over recipient bone marrow leading to pancytopenia and bleeding

What special protocol prevents Graft vs Host Disease?

Irradiation

How does irradiation prevent Graft vs Host Disease?

Irradiation prevents DNA in donor T lymphocytes from reproducing

What is the new expiration date for RBCs that have been through irradiation?

28 days from date of collection

What products are irradiated?

RBCs and platlets

What is the dose for Gamma Irradiiation?

25 Gy

What are 2 target populations that would benefit from irradiated blood products?

Immunodeficient and transplant patients

What is the minimum temperature to store frozen red blood cells?

-65 degrees Celsius

What is the cyropreservative for frozen red blood cells? glycerol

What is the shelf life for frozen red blood cells?

10 years

After frozen red blood cells have been thawed, what is the new expiration date?

24 hours

Why is it required to wash frozen RBCs? It is required to remove glycerol from frozen RBCs

"Deglycerolization"

What is the use for blood warming blood products?

Rapid transfusion of large volumes of blood

Why do we not warm blood products higher than 42 degrees Celsius?

This would cause hemolysis

What is one of the benefits to pediatric aliquots?

Limits exposure to one donor

What is the target population for Factor VIII Concentrate?

Hemophilia A patients

Which blood product is used to target Hemophilia A patients?

Factor VIII Concentrate

What is the target population for Factor IX Concentrate?

Hemophilia B patients

Which blood product is used to target Hemophilia B patients?

Factor IX Concentrate

What is the target population for Factor VIIa Concentrate?

Patients who are Factor VII deficient and have Factor VIII or IX inhibitors

Which factors are contained in FEIBA or Prothrombin Complex Concentrates?

Factor II, VII, IX, and X

Which is the only product NOT administered through a blood filter?

Albumin

What is the purpose of 5% and 20% albumin?

It is a volume expander that expands and restores blood volume

Who are the 3 target patients for cryoprecipitate transfusion?

1. Hypofibrinogenemia 2. Massive transfusion 3. von Willebrand's Disease

What is the storage temperature for cryoprecipitate?

Less than -18 degrees Celsius

How long after separation must plasma be frozen for cryoprecipitate?

1 hour

How is cryoprecipitate thawed?

In 37 degrees Celsius in a water bath

After cryoprecipitate has been thawed, at what temperature is it stored at?

Room temperature (20 degrees Celsius)

What is the shelf life of frozen cryoprecipitate?

1 year

What is the shelf life of 1 unit of thawed cryoprecipitate?

6 hours

What is the shelf life of 1 dose (pooled) thawed cryoprecipitate?

4 hours

What are the coagulation factors in cryoprecipitate?

Factors I, VIII, XIII, and vWF

What is the minimum contents of cryoprecipitate?

80 IU of Factor VIII 150 mg of Factor I

Who are the target population for red blood cell transfusions?

Patients with acute and chronic blood loss

What is the Hgb and Hct transfusion trigger value?

Hgb <7 g/dL Hct <21%

How much does transfusing one RBC unit increase Hgb and Hct? Hgb increases by 1 g/dL Hct increases by 2-3%

What is the half life of transfused red cells?

56 days

Anti-A , B reagent is used for which ABO group(s)?

Group O units

Anti-A and Anti-B reagents are used for which ABO group(s)?

Group A, B, and AB units

Rh confirmation testing on packed red blood cells are used on which RBCs? ALL Rh-negative RBCs only

What is the shelf life for CDPA-1?

35 days

What is the shelf life of CDP AS-1?

42 days

What is the shipping temperature for packed red blood cells?

1-10 degrees Celsius

What is the minimum number of platelets in plateletphersis product?

3.0x10^11

What is the advantage to plateletpheresis products?

Exposure to only one donor

If a patient becomes refractory to platelet transfusion, what type of platelet products are recommended for future transfusions?

1. HLA matched 2. Platelet crossmatch compatible

What is the shelf life for random platelet concentrates?

5 days

What is the minimum number of platelets in random platelet concentrates?

5.5x10^10

Who are target patients for fresh frozen plasma?

1. To correct warfarin effect/overdose 2. Active bleeding patients

3. To correct prolonged PT/PTT 4. Liver disease with coagulation problems 5. Single or multiple coagulation deficiency 6. Massive transfusion

What is the storage temperature of fresh frozen plasma?

Less than 18 degrees Celsius

What is the storage temperature of thawed fresh frozen plasma?

1-6 degrees Celsius

What is the shelf life of fresh frozen plasma?

1 year

What is the shelf life of thawed fresh frozen plasma?

24 hours

What is the contents of fresh frozen plasma?

All 13 coagulation factors