TEST BANK for Modern Blood Banking & Transfusion Practices 7th Edition by Denise M. Harmening

Modern Blood Banking & Transfusion Practices 7th Edition Harmening Test Bank Chapter 1. Red Blood Cells and Platelet Preservation: Historical Perspectives and Current Trends Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Which metabolic pathway is responsible for generating 90% of the ATP for the RBC? a. Pentose phosphate shunt c. Glycolysis b. Luebering-Rapoport shunt d. Methemoglobin reductase 2. A unit of blood was returned to the blood bank before it was spiked. Apparently the patient’s IV failed. The unit of blood was outside the blood bank for 35 minutes. Which of the statements below is most accurate? a. The unit of blood should be discarded immediately. b. The unit of blood can be returned to inventory. c. The unit of blood must be transfused within 4 hours or be discarded at the end of that time. d. The unit of blood must be transfused with 24 hours.

3. What effect does storage have on platelets? a. Shrinking b. Lysis

c. Repulsion d. All of these.

4. In the normal hemoglobin-oxygen dissociation curve, what percentage of oxygen is released to the tissues when PO2 averages 40 mm Hg? a. 75% c. 100% b. 25% d. 50% 5. What factors are known to influence platelet metabolism and function? a. Storage temperature c. Platelet count b. Initial pH d. All of the above 6. Which of the following red blood cell morphologies may be present on the peripheral blood smear as a result of loss of RBC membrane? a. Spherocytes c. Burr cells b. Target cells d. Schistocytes 7. What does the term autologous transfusion refer to? a. A parent donating blood for his or her child b. An individual donating blood for a friend c. An individual donating blood for a relative d. An individual donating blood for his or her own transfusion 8. What is the primary function of hemoglobin? a. Iron metabolism b. Porphyrin synthesis

c. Oxygen transport d. Signal transduction

9. All of the following areas of red blood cell biology are crucial for normal erythrocyte survival except: a. cellular metabolism. c. site of the ABO antigen attachment. b. RBC membrane. d. hemoglobin structure.

10. What is the correct biochemical composition of the RBC membrane? a. 52% protein, 40% lipid, 8% carbohydrate b. 40% protein, 8% lipid, 52% carbohydrate

c. 8% protein, 52% lipid, 40% carbohydrate d. 8% lipid, 40% carbohydrate, 52% protein 11. All of the following biochemical changes are associated with loss of red blood cell viability upon storage except: a. decreased pH. c. increased ATP level. b. loss of red blood cell function. d. decreased glucose consumption.

12. Which red blood cell preservative has a storage time of 35 days? a. ACD c. AS-1 b. CPDA-1 d. CPD 13. The RBC membrane is relatively permeable to all of the following except: a. chloride. c. bicarbonate. b. sodium. d. water.

14. Red blood cells frozen using the high-concentration glycerol technique are usually stored at a. 0oC c. -65oC o b. -20 C d. -80oC 15. What is the major biochemical consideration in platelet storage? a. Glucose metabolism c. Production of carbon dioxide b. Oxygen supply d. Regulation of pH 16. What would the hemoglobin-oxygen dissociation curve depict in a patient exhibiting clinical signs of alkalosis? a. Normal c. Shift to the right NKS E L L E R . d. None ofCthOeMabove b. Shift to the left 17. Name the main lipid components of a red blood cell membrane. a. Phospholipid c. Glycolipid b. Sphingomyelin d. Glycophorin A 18. The ABO blood groups were discovered in 1901 by whom? a. Charles Drew c. Loutit and Mollison b. Karl Landsteiner d. Edward Lindeman 19. A standing order of platelets was shipped to your facility by your supplier. It was inadvertently left in the corner of the department until discovered 36 hours later. What would the appropriate action be for the blood banker? a. If the temperature in the box was 22 ± 2°C and the platelet swirl seemed OK, it would be OK to accept the unit into inventory. b. The platelets have fallen outside the supplier’s quality assurance. The unit should be discarded because the pH has probably dropped too low and platelet activation has been compromised. c. If the temperature was 1°C to 6°C and the platelet swirl seemed OK, it would be OK to accept the unit into inventory. d. If the platelets appeared OK and passed the platelet swirl test after being placed on the agitator, they could be accepted into the inventory.

20. Which metabolic pathway permits the accumulation of 2,3 diphosphoglycerate (2,3-DPG)? a. Glycolysis c. Pentose phosphate shunt b. Luebering-Rapoport shunt d. Methemoglobin reductase

21. All of the following are consistent with a "shift to the right" of the hemoglobin-oxygen dissociation curve except: a. increased 2,3-DPG. b. 50% O2 saturation to tissues. c. decreased 2,3-DPG. d. decreased hemoglobin affinity for O2.

22. Why are platelet transfusions performed? a. Therapeutically to stop bleeding b. Prophylactically to prevent bleeding

c. Both reasons. d. Neither reason.

23. What cryoprotective agent is added to red blood cells upon freezing? a. Dextrose c. Glycerol b. Adsol d. All of the above 24. If platelets are to be stored for 5 days on a rotator, what is the optimal storage temperature? a. 1°C to 6°C c. 35°C to 37°C b. 20°C to 24°C d. 1°C to 10°C 25. Platelets are transfused to play which role in hemostasis? a. Maintenance of vascular integrity b. Initial arrest of bleeding by platelet plug formation c. Stabilization of the hemostatic plug d. All of the above 26. Which of the following best describes "integral" membrane proteins? a. Reside at the cytoplasmic surface of membrane b. Span the entire membrane surface c. Form the red blood cell cytoskeleton d. None of the above 27. How is stroma-free hemoglobin solution prepared? a. Outdated red blood cells are concentrated, and stroma is removed. b. Outdated red blood cells are diluted with saline, and stroma is removed. c. Outdated red blood cells are lysed, and stroma is removed. d. None of the above 28. What is the normal life span of an RBC? a. 100 days b. 120 days

c. 120 hours d. 2 days

29. Regarding loss of RBC membrane deformability, all of the following are true except: a. increase in ATP level. b. decrease in ATP level. c. increase in calcium level. d. decrease in spectrin phosphorylation level.

30. One of the most important controls of hemoglobin's affinity for oxygen is: a. glucose. c. K+. b. 2,3-diphosphoglycerate (2,3-DPG). d. Ca++.

31. The normal position of the oxygen dissociation curve depends on three ligands normally found within the RBC. Which one of the following is not one of these ligands?

a. H+ ions b. CO2

c. 2,3-diphosphoglycerate (2,3-DPG) d. Na+

32. Which of the following events does not occur while RBCs are stored? a. 2,3-DPG levels increase. b. Potassium levels increase. c. Hgb has a decreased affinity for oxygen carrying capacity. d. 2,3-DPG and potassium levels increase.

33. In order to maintain ATP levels in stored blood, can be added to CPD to extend the shelflife of stored RBCs from 21 days to 35 days. This new preservative is designated as CPDA-1. a. mannitol c. adenine and glucose b. adenine saline d. Rejuvenix 34. Which type of blood storage container is no longer available for use in the United States because it may limit the viability of RBCs? a. Glass bottles c. DEHP-free polyolefin containers b. PVC plastic bags with DEHP d. Latex-free plastic containers 35. A rare unit of blood became outdated 48 hours ago but is needed for a patient. Which of the following concepts applies to this situation? a. The blood could be rejuvenated by adding Rejuvesol, being washed appropriately, and being transfused within 48 hours. b. The blood could be rejuvenated with Rejuvesol, washed, and given immediately to the patient. c. Once a unit is outdated, it is no longer available for use. d. The unit can be rejuvenatedTim mT edB iaA teN lyK ,w d,EanRd.sC toO reM d in the appropriate ES SaEshLeL refrigerator until needed later in the week.

36. FDA-approved rejuvenation solution contains all of the following EXCEPT: a. adenine c. inosine b. glycerin d. phosphate 37. Rejuvenated RBCs may be prepared up to three days after expiration when stored in all of these

EXCEPT: a. b. c. d.

ACD AS-1 CPD CPDA-1

38. When is the corrected count increment (CCI) of platelets is usually determined? a. Immediately prior to transfusion. c. Ten to 60 minutes after transfusion. b. During the transfusion procedure. d. One to two days after transfusion.

39. Generally, the quality control measurements required by various accreditation organizations for platelet concentrates include: a. platelet concentrate volume and platelet count. b. leukocyte count if claims of leukoreduction are made. c. pH of the unit. d. All of the above 40. Which of the following is not a major factor that influences platelet shape and activation while the platelet is in storage?

a. pH b. Volume

c. Agitation d. Temperature

41. Proper agitation of platelets while they are being stored is: a. important because when not agitated properly the platelets will stick together and not perform properly when transfused. b. important because the pH of the stored platelets will increase and the platelets will lose functionality. c. important because the pH of the stored platelets will decrease and the platelets will lose functionality. d. not important because it has been deemed unnecessary by the FDA. 42. Which of the following is not a commercial system approved by the FDA for screening for bacterial contamination in platelet collections? a. BacT/ALERT c. BACTEC b. eBDS d. Scansytems 43. Which of the following is a possible future method in pathogen reduction to treat platelet components? a. UV light and amotosalen c. Vitamin B12 and UV light b. Amphotericin B d. Penicillin 44. Which of the following is licensed additive solutions approved for the storage of red blood cells for 42 days? a. Adsol (AS-1) c. Optisol (AS-5) b. Nutricel (AS-3) d. All of the above

Chapter 1. Red Blood Cells and Platelet Preservation: Historical Perspectives and Current Trends Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: C 3. ANS: B 4. ANS: B 5. ANS: D 6. ANS: A 7. ANS: D 8. ANS: C 9. ANS: C 10. ANS: A 11. ANS: C 12. ANS: B 13. ANS: B 14. ANS: C 15. ANS: D 16. ANS: B 17. ANS: A 18. ANS: B 19. ANS: B 20. ANS: B 21. ANS: C 22. ANS: C 23. ANS: C 24. ANS: B 25. ANS: D 26. ANS: B 27. ANS: C 28. ANS: B 29. ANS: A 30. ANS: B 31. ANS: D 32. ANS: A 33. ANS: C 34. ANS: A 35. ANS: B 36. ANS: B 37. ANS: A 38. ANS: C 39. ANS: D 40. ANS: B

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1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 TESTBANKEY: KSELTaxonomy LER.COLevel: M 1 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 1-3 LO: 1-6 LO: 1-14 LO: 1-4 LO: 1-14 LO: 1-7 LO: 1-1 LO: 1-2 LO: 1-2 LO: 1-2 LO: 1-7 LO: 1-9 LO: 1-2 LO: 1-6 LO: 1-14 LO: 1-5 LO: 1-2 LO: 1-1 LO: 1-16 LO: 1-8 LO: 1-4 LO: 1-15 LO: 1-11 LO: 1-16 LO: 1-15 LO: 1-2 LO: 1-10 LO: 1-2 LO: 1-3 LO: 1-4 LO: 1-4 LO: 1-5 LO: 1-5 LO: 1-9 LO: 1-12 LO: 1-13 LO: 1-13 LO: 1-15 LO: 1-19 LO: 1-18

41.

42.

43.

44.

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

PTS: PTS: PTS: PTS:

1 1 1 1

KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2

LO: 1-17 LO: 1-19 LO: 1-19 LO: 1-20

Chapter 2. Basic Genetics Multiple Choice Identify the choice that best completes the statement or answers the question.

1. When 1,000 donors were tested, 75% were positive for C and 25% were negative for C; the gene frequency of C is: a. 10. c. 0.5. b. 1. d. 25.

2. All of the following may cause an alteration in DNA, except: a. ultraviolet light. c. antibodies. b. alkylating agents. d. enzymes.

3. How is it genetically possible for a child to type Rh-negative? a. Both parents are Dd. c. Mom is DD and Dad is Dd. b. Both parents are DD. d. Sibling is Rh-positive.

4. All of the following are included in transcription except: a. mRNA terminates at the 5' end. b. RNA polymerase II binds to a promoter. c. it proceeds from the 3' end to the 5' end. d. the 5' end is capped with a methyl residue.

5. Which of the following best describes the structure of human chromosomes? a. Linear strands of DNA wound around histones b. Linear strands of RNA wrapped around histones c. Tertiary structure of DNA wound around histones d. Quaternary structure of DNA wound around histones 6. In Mendel's law of separation, the first-filial generation is: a. recessive. c. heterozygous. b. homozygous. d. autologous.

7. A father carries the Xga trait and passes it on to all of his daughters but none of his sons. What type of inheritance does this represent? a. Autosomal dominant c. X-linked recessive b. X-linked dominant d. Autosomal recessive 8. Methods to isolate intact DNA in order for it to be studied include all of the following except: a. pH changes. c. detergent lysis. b. enzyme activation. d. heat treatment.

9. Point mutations include which of the following? a. Substitutions b. Insertions c. Deletions d. Substitutions, insertions, and deletions 10. Which of the following best describes the process of mitosis? a. Cell division by which only one-half of the daughter cells produced are identical to the parent cell

b. Cell division of germ cells by which two successive divisions of the nucleus produce cells that contain half the number of chromosomes of somatic cells c. Cell division that produces two daughter cells having the same number of chromosomes as the parent d. Cell division that produces four daughter cells (4n) 11. All of the following processes occur in replication, except: a. the two DNA strands separate via helicase. b. DNA polymerase acts on the 5' to 3' parent strand to produce an anticomplementary duplicate strand. c. DNA polymerase acts on the 3' to 5' parent strand to produce an anticomplementary duplicate strand. d. replication of the 3' to 5' parent strand is initiated by the enzyme primase, which anneals to the parent strand.

12. Which type of genetic change (mutation) is incapable of reverting back to the original phenotype? a. Duplication c. Recombination b. Deletion d. Insertion 13. In the MN blood group system, a person who inherits an "M" allele and an "N" allele expresses both M and N antigens on the RBCs. Which of the following is true? a. M is dominant to N. b. N is dominant to M. c. M an N are codominant alleles. d. M and N are located on the same chromosome.

14. A gene, such as the O gene, thatTpE roS duTcB esAnN oK deSteEctL abLleEpRro.dC ucOt M is called: a. an amorph. c. an allele. b. a trait. d. recessive.

15. What blood group is the best example of codominantly inherited blood group genes? a. Rh c. Lewis b. MN d. ABO 16. When an individual is said to have blood group A, it refers to the individual's: a. alleles on the chromosome. c. phenotype. b. genotype. d. haplotype.

17. The two strands of DNA are: direction. a. parallel b. antiparallel

; one runs in a 5' to 3' direction, and the other runs in a 3' to 5' c. somatic d. zigzag

18. In what stage of mitosis is DNA not actively dividing? a. Interphase c. Metaphase b. Prophase d. Anaphase 19. How many chromosomes do somatic cells of humans have? a. 46 c. 23 b. 50 d. 100 20. The diploid chromosome number in humans is: a. 12 c. 46

b. 23

d. 92

21. Which constituent in the Hardy-Weinberg equation represents the total number of alleles? a. q c. 2pq b. p d. q2 22. In which of the following circumstances will Hardy-Weinberg’s principle fail? a. Mutation c. Nonrandom mating b. Genetic drift d. All the above 23. What amino acid initiates translation by attaching to tRNA? a. Glycine c. Methionine b. Alanine d. Lysine 24. What is meant by the term autosomal? a. Trait is not carried on the sex chromosomes b. Trait is carried on sex chromosomes c. Trait is not expressed in the parents d. Organism possesses different alleles for a given characteristic 25. Which of the following best describes classical genetics? a. DNA alteration that is caused by a physical or chemical agent b. Transmission of characteristics from parents to offspring c. Possessing a pair of identical alleles d. The synthesis of RNA from DNA requiring RNA polymerase 26. How is RNA different from DNA? LNEAR. a. RNA usually exists as one sTtrE anSdTBANKScE. LR inC coO rpMorates uracil b. Ribose is substituted for deoxyribose d. All of the above 27. Using the Hardy-Weinberg equation, if a total random population carried the dominant allele E and 20% carried the recessive allele e, what would the total percentage be for the recessive trait ee? a. 64% c. 16% b. 4% d. 0.4% 28. A triple set of nucleotides is a: a. helix. b. base.

c. codon. d. template.

29. A human gamete (egg or sperm) contains how many chromosomes? a. 23 pairs c. 23 chromosomes b. 46 pairs d. 46 chromosomes 30. How do restriction endonucleases function? a. Disrupt hydrogen bonding in DNA structure b. Promote digestion of RNA c. Cut DNA into smaller fragments d. Terminate translation of mRNA 31. DNA is composed of all of the following except: a. adenine. c. cytosine. b. guanine. d. uracil.

32. A woman with blood group A marries a man with blood group O. Their firstborn child has blood group O. The mother's most probable genotype is: a. OO c. AB b. AA d. AO 33. A structural alteration of DNA in an organism that is caused by a physical or chemical agent is called: a. transcription. c. mutation. b. translation. d. cloning.

34. In a pedigree analysis, what do vertical lines indicate? a. Consanguineous mating c. Stillbirth b. Offspring d. Deceased sibling 35. What is a vector? a. Substance capable of catalyzing a reaction b. Sequence of three bases in a strand of DNA c. Extrachromosomal genetic element that can carry a recombinant DNA molecule into a host bacterial cell d. Substance that can carry an electric current in solution 36. Which of the following must be true when using the Hardy-Weinberg equation? a. The population must be large c. Mating must occur randomly b. Mutations cannot occur d. All of the above 37. Alternate forms of a gene that can occur at a single chromosome locus are referred to as: a. amorphs. c. alleles. b. traits. d. recessive.

TESTBANKSELLER.COM

38. The condition in which one chromosome has a copy of the gene and the other chromosome has that gene deleted or absent is referred to as: a. homozygous. c. hemizygous. b. heterozygous. d. recessive.

39. Most antigens in the various blood group systems follow what kind of inheritance patterns? a. Codominant c. Dominant b. Homozygous d. Autosomal 40. All of the following are consistent with Mendel's basic rules of inheritance except: a. the gene is transmitted through generations intact. b. a pair of genes is always found in the same gamete. c. different pairs of genes are assorted independently of each other. d. a pair of genes is rarely found in the same gamete.

Chapter 2. Basic Genetics Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: D 3. ANS: A 4. ANS: A 5. ANS: A 6. ANS: C 7. ANS: B 8. ANS: D 9. ANS: D 10. ANS: C 11. ANS: C 12. ANS: B 13. ANS: C 14. ANS: A 15. ANS: B 16. ANS: C 17. ANS: B 18. ANS: A 19. ANS: A 20. ANS: C 21. ANS: B 22. ANS: D 23. ANS: C 24. ANS: A 25. ANS: B 26. ANS: D 27. ANS: B 28. ANS: C 29. ANS: C 30. ANS: C 31. ANS: D 32. ANS: D 33. ANS: C 34. ANS: B 35. ANS: C 36. ANS: D 37. ANS: C 38. ANS: C 39. ANS: A 40. ANS: B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 TESTBANKEY: KSELTaxonomy LER.COLevel: M 1 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2

LO: 2-4 LO: 2-9 LO: 2-2 LO: 2-8 LO: 2-8 LO: 2-1 LO: 2-2 LO: 2-11 LO: 2-9 LO: 2-6 LO: 2-8 LO: 2-9 LO: 2-2 LO: 2-2 LO: 2-2 LO: 2-2 LO: 2-8 LO: 2-6 LO: 2-7 LO: 2-7 LO: 2-3 LO: 2-3 LO: 2-8 LO: 2-7 LO: 2-8 LO: 2-8 LO: 2-4 LO: 2-8 LO: 2-8 LO: 2-12 LO: 2-8 LO: 2-5 LO: 2-9 LO: 2-5 LO: 2-12 LO: 2-3 LO: 2-10 LO: 2-9 LO: 2-11 LO: 2-1

Chapter 3. Fundamentals of Immunology Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Only 5% of Kell-negative individuals will develop antibodies to Kell if exposed to the Kell antigen, whereas 50% to 70% of Rh(D)-negative individuals would produce antibodies to D upon exposure. What is the reason for this? a. Difference in ABO type c. Phenotype b. Difference in immunogenicity d. All of the above 2. What is the definition of an immunoglobulin? a. A protein molecule produced in response to an antigen b. A protein molecule produced in response to an antibody c. A substance that aids in the primary immune response d. A substance that aids in the growth and proliferation of leukocytes 3. IgG-coated RBCs will be phagocytized by what effector cells? a. Monocytes/macrophages c. Eosinophils b. T cells d. Basophils 4. What class of immunoglobulin is capable of crossing the placenta? a. IgM c. IgE b. IgG d. IgD 5. What is responsible for recognitT ioE nS ofTthBeAaN ntK ibS odEyL -bL inE diR ng.sC itO e tM o homologous antigen? a. Phenotype b. Solubility of antigen c. Variable region of light/heavy chain d. Complementarity 6. Which of the following is not true of monoclonal reagents? a. Monoclonal reagents are produced for single antigens with more than one epitope. b. Monoclonal reagents are highly specific. c. Monoclonal reagents are highly characterized and are uniformly reactive. d. Monoclonal reagents are produced by hybridoma technology.

7. At what temperature do IgM antibodies react? a. 22°C b. 37°C

c. 56°C d. 42°C

8. What is a possible explanation for a weak reaction (1+) in a reverse ABO grouping test? a. Elderly patient c. IgM deficiency b. Immunocompromised patient d. All of the above 9. An agglutination inhibition test is performed on a person whose blood type is A+. The person's saliva is mixed with type A antisera. After incubation, the solution is mixed with reagent A cells and no agglutination occurs. What can be deduced from this finding? a. The person is a nonsecretor of A substance. b. The person is a nonsecretor of O substance. c. The person is a secretor of A substance. d. The person is a secretor of O substance.

10. How can T cells be differentiated from B cells? a. Secretion of interleukin-2 b. CD2 marker c. Agglutination of sheep erythrocytes d. All of the above 11. Which of the following statements is true concerning immunoglobulin variations? a. Allotypic variations occur primarily in the variable region. b. Isotypic refers to all members of a species. c. Idiotypic variation occurs in the constant region. d. Isotypic variation is associated with organ transplantation and paternity testing.

12. What test is used to remove autoantibodies from test serum? a. Adsorption c. Elution b. Direct Coombs’ d. Indirect Coombs’ 13. A person with the genotype MM shows a 3+ reaction when red blood cells are mixed with M antisera, whereas a person with the genotype MN shows a 1+ reaction. What phenomenon is occurring here? a. Dosage c. Zeta potential b. Prozone d. Hemolysis 14. Name a lymphoid organ in which cells of the immune system can be found. a. Thymus c. Spleen b. Bone marrow d. All of the above 15. At what age do infants begin to produce their own antibodies?

TESTBANKScE. L6Lm EoRn.thCs OM a. 1 week b. 2 months d. 1 year 16. Which of the following blood group systems is not likely to cause HDN? a. Kell c. MN b. ABO d. Rh 17. What is the purpose of the antihuman globulin (AHG) test in blood banking? a. It detects red blood cells coated with antibody by bridging the gap between red blood cells. b. It detects white blood cells coated with antibody by bridging the gap between red blood cells. c. It detects red blood cells coated with antigen. d. All of the above 18. Extravascular hemolysis occurs when red blood cells are coated with antibody; what organ sequesters these cells? a. Thymus c. Bone marrow b. Reticuloendothelial system d. All of the above 19. Which IgG subclass primarily comprises antibodies to the Rh blood group system? a. IgG1, IgG2 c. IgG3, IgG4 b. IgG2, IgG4 d. IgG1, IgG3 20. Which immunoglobulin exists in a pentameric configuration? a. IgG c. IgA b. IgM d. IgE

21. All of the following are characteristics of monoclonal reagents except: a. an absence of batch variation. b. antibodies directed against a single epitope. c. undetectable subgroups of A. d. monoclonal antibodies with high affinities.

22. All of the following are characteristics of a secondary immune response except: a. quickly formed antibodies. b. higher avidity for antigen. c. higher dose of antigen required to form antibodies. d. lower dose of antigen required to form antibodies.

23. Which of the following antibodies is considered the most significant in blood banking because it reacts at body temperature? a. IgG c. IgA b. IgM d. IgE 24. What does hemolysis represent in an antigen-antibody reaction? a. A negative result c. An inconclusive result b. A positive result d. None of the above 25. What function does chemically modified IgG serve? a. It creates a pentameric structure to enhance binding. b. Disulfide bonds are reduced in the hinge region of IgG, which promotes flexibility of Fab portions. c. It alters the light chain variability portion of molecule. d. It dissociates the IgG molecules from surface of sensitized red blood cells.

26. When antigen and antibody combine, they are held together by noncovalent forces. With the absence of a visible lattice, this stage is called . a. adhesion c. agglutination b. sensitization d. inhibition 27. What Rh type does a mother have to be to produce antibodies to Rh(D) from an Rh-positive infant? a. O-positive c. Rh-negative b. Rh-positive d. Kell-negative 28. Which immunoglobulin is found in greatest concentration in serum? a. IgE c. IgG b. IgM d. IgA 29. Which antibodies characteristically demonstrate a decreased avidity for antigen? a. Rh c. Lewis b. HTLA d. ABO 30. Why are enzymes used in blood banking? a. Enzymes enhance reactivity of MNS antigens. b. Sialic acid is released from red blood cells, which helps to reduce the zeta potential. c. Hydrophobic glycoproteins are removed from the red blood cell membrane, rendering the membrane hydrophilic (water loving), thereby allowing the red blood cells to move closer. d. All of the above 31. When there is an excess of antigen in a serologic test system, what course of action should be followed?

a. Dilute the serum b. Add complement

c. Decrease the serum-to-cell ratio d. Increase the serum-to-cell ratio

32. At what temperature do IgG antibodies react optimally? a. 22°C c. 56°C b. 37°C d. 4°C 33. What cells are responsible for mounting a secondary response when exposure to the same antigen occurs? a. Memory T/B cells c. Plasma cells b. Neutrophils d. Myeloblasts 34. In an immune response, what is the time called during which no antibody is detected in the test serum? a. Secondary response time c. Latency period b. Primary response time d. Amnestic response time 35. How is the classical pathway of complement activated? a. By polysaccharides on the surface of bacteria b. By enzyme catalysis c. By binding of antigen with antibody d. By lipopolysaccharides on surface of red blood cells 36. What cells are considered polymorphonuclear granulocytes? a. Monocytes c. Lymphocytes b. Eosinophils d. None of the above 37. Which is a characteristic of natural killer (NK) cells? a. They bind to and lyse antibody-coated cells in ADCC. b. They require the presence oT fE MS HT CBtoArN esK poSnE dL toLaE ntR ig. enC. OM c. They produce antibody to act on foreign antigens. d. They possess the TCR on their membrane surface.

38. In an immune response, a. IgG, IgA b. IgM, IgG

antibodies are formed before c. IgG, IgM d. IgM, IgA

.

39. All of the following are true regarding IgM antibodies except: a. IgM antibodies form against Kell. b. IgM can bind to up to 10 antigens on a red cell. c. IgM is 160 Å larger than IgG. d. IgM is a pentamer.

40. What does the term zeta potential mean? a. The ability of antigen to react with antibody b. The attraction of positive charges on the red blood cell surface to negative charges in an ionic cloud c. The attraction of negative charges on the surface of red blood cells to positive charges in an ionic cloud d. The repulsion between red blood cells caused by noncovalent forces 41. What is the equivalent of Factor D (alternative pathway) in the classic complement pathway? a. C1q c. C1r b. C1s d. C4 42. Which of the following corresponds to the basic structure of immunoglobulin?

a. b. c. d.

Two light chains held together with an interlink disulfide bond Two heavy chains held together with an interlink disulfide bond One light chain and one heavy chain held together by covalent disulfide bonds Two light chains and two heavy chains held together by covalent disulfide bonds

43. Which of the following are produced after exposure to genetically different nonself antigens of the same species? a. Alloantibodies c. Drug-induced antibodies b. Autoantibodies d. All of the above 44. An immunogenic substance that reacts with an antibody is: a. immunoglobulin. c. chromogen. b. antigen. d. agglutinin.

45. All of the following are functions performed by the complement system except: a. direct lysis of bacteria. c. decreased vascular permeability. b. promotion of phagocytosis. d. smooth muscle contraction.

46. What MHC Class encodes complement components? a. Class I c. Class III b. Class II d. All of the above 47. What does polyspecific AHG contain? a. IgG b. C3b

c. C3d d. All of the above

48. Which blood group antibodies are known to activate complement, leading to intravascular hemolysis?

TESTBANKScE. LD LuEffRy.COM a. Lewis b. Rh d. ABO 49. Why is EDTA not conducive to complement activation? a. Antigens are destroyed c. Calcium is inactivated b. Antibodies are neutralized d. It dilutes plasma 50. All of the following techniques are used in the laboratory to detect blood group antigens or antibodies except: a. agglutination. c. ELISA. b. precipitation. d. hemolysis.

51. The portion of the immunoglobulin molecule that determines class is the: a. light chain. c. lambda chain. b. kappa chain. d. heavy chain.

52. All of the following are included in the actions of cytokines except: a. regulation of growth and mobility and differentiation of leukocytes. b. possible production of a synergistic effect when used together. c. decrease in the number of cell receptors when going from a resting to a reactive state. d. binding to target cell receptors.

53. What are the principle receptors for the FC portion of immunoglobulin and the CR1 complement component, respectively? a. IgM, C3b c. IgG, C3d b. IgG, C3b d. IgM, C3d 54. What substances are responsible for the activation of the alternate complement pathway?

a. Enzymes b. Polysaccharides

c. Proteins d. All of the above

55. A patient with multiple myeloma exhibits rouleaux formation in an immediate spin crossmatch. What procedure is recommended to distinguish true red blood cell agglutination from nonspecific agglutination? a. Secretor studies c. Enzyme treatment b. Saline dilution d. Polyethylene glycol enhancement 56. All of the following are characteristics of antigens that affect the type and extent of immune response except: a. solubility. c. molecular weight. b. charge. d. genetic locus.

57. What happens to the target cell after the cytokine has bound? a. The contents of the cell are expelled. b. The target cell is programmed to produce biological responses. c. The host exhibits a hypersensitivity reaction. d. ABO antigens are stripped from the membrane.

58. What is the function of mononuclear phagocytes? a. They present processed antigen to lymphocytes. b. They present processed antibody to lymphocytes. c. They release histamine. d. They produce antibodies.

59. Why is low ionic strength solution (LISS) used in blood banking? a. It reduces the incubation time. b. It reduces the net negative surface charge on the RBC. c. It increases the zeta potential. d. It enhances aggregation.

60. Which of the following statements concerning the structure of immunoglobulins is false? a. The enzyme papain splits the antibody molecule at the hinge region to give three fragments (2 Fab + 1FC). b. The FC portion is responsible for complement fixation, monocyte binding, and placental transfer. c. IgM participates in placental transfer. d. The Fab portion is the region responsible for antigen binding.

61. The immune response that consists of physical barriers, biochemical effectors, and immune cells is the immune response. a. autoc. localized b. innate d. primary 62. Opsonization is: a. the coating of pathogens with factors that facilitate phagocytosis. b. a major role of complement in immunity. c. the binding of an opsonin, such as an antibody, to a receptor on the pathogen's cell membrane. d. all of the above.

63. Which of the following statements is not true? a. T-cell receptors do not recognize foreign antigen on their own like B cells do. b. Major histocompatibility complex (MHC) molecules are cell membrane proteins.

c. MHC molecules are required for T cells to recognize foreign antigens. d. MHC molecules are required for B cells to recognize foreign antigens.

64.

are produced by monocytes and lymphocytes to help regulate growth, mobility, and differentiation of leukocytes. a. Monokines c. Cytokines b. Lymphokines d. Optikines

65. HLA proteins are coded by what complex? a. Major histocompatibility complex b. Human leukocyte compatibility complex c. Complement d. Innate immune response 66. Anti JK (Kidd) antibodies are of what class of antibody? a. IgG1 c. IgG3 b. IgG2 d. IgM 67. HDN is most often associated with what class of antibody? a. IgG1 c. IgE d. IgG4 b. IgM 68. The four unique serum proteins of the alternate pathway of complement include all but which of the following? a. Factor B b. X factor c. Factor D d. Initiating factor e. Factor P

69. The organ in which lymphocytes are formed is the a. bone marrow b. liver c. thymus d. spleen

70. The organs in which lymphocytes differentiate include a. bone marrow b. thymus c. both d. neither

.

.

Chapter 3. Fundamentals of Immunology Answer Section MULTIPLE CHOICE 1. ANS: B 2. ANS: A 3. ANS: A 4. ANS: B 5. ANS: C 6. ANS: A 7. ANS: A 8. ANS: D 9. ANS: C 10. ANS: D 11. ANS: B 12. ANS: A 13. ANS: A 14. ANS: D 15. ANS: C 16. ANS: C 17. ANS: A 18. ANS: B 19. ANS: D 20. ANS: B 21. ANS: C 22. ANS: C 23. ANS: A 24. ANS: B 25. ANS: B 26. ANS: B 27. ANS: C 28. ANS: C 29. ANS: B 30. ANS: B 31. ANS: D 32. ANS: B 33. ANS: A 34. ANS: C 35. ANS: C 36. ANS: B 37. ANS: A 38. ANS: B 39. ANS: A 40. ANS: C 41. ANS: B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 TESTBANKEY: KSELTaxonomy LER.COLevel: M 2 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 3-12 LO: 3-1 LO: 3-9 LO: 3-2 LO: 3-9 LO: 3-10 LO: 3-8 LO: 3-12 LO: 3-11 LO: 3-2 LO: 3-6 LO: 3-10 LO: 3-8 LO: 3-1 LO: 3-1 LO: 3-12 LO: 3-8 LO: 3-1 LO: 3-6 LO: 3-6 LO: 3-8 LO: 3-9 LO: 3-6 LO: 3-10 LO: 3-11 LO: 3-9 LO: 3-1 LO: 3-6 LO: 3-6 LO: 3-10 LO: 3-11 LO: 3-11 LO: 3-2 LO: 3-9 LO: 3-7 LO: 3-2 LO: 3-2 LO: 3-3 LO: 3-3 LO: 3-11 LO: 3-7

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 3-3 LO: 3-9 LO: 3-9 LO: 3-7 LO: 3-5 LO: 3-8 LO: 3-8 LO: 3-8 LO: 3-10 LO: 3-6 LO: 3-3 LO: 3-3 LO: 3-7 LO: 3-12 LO: 3-9 LO: 3-3 LO: 3-2 LO: 3-10 LO: 3-6 LO: 3-9 LO: 3-9 LO: 3-5 LO: 3-2 LO: 3-5 LO: 3-6 LO: 3-6 LO: 3-7 LO: 3-4 LO: 3-4

Chapter 4. Concepts in Molecular Biology Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Which of the following is representative of the “central dogma” of molecular biology? a. The basic information of life flows from DNA through RNA to proteins. b. The basic information of life flows from RNA through DNA to proteins. c. The basic information of life flows from proteins to genes. d. The basic information of life flows from amino acids to proteins.

2. All of the following make up three branches of molecular biology related to transfusion medicine except: a. molecular genetics. c. molecular diagnostics. b. biotechnology. d. paternity.

3. Which of the following is not consistent with the structure of DNA? a. The double helix consists of two strands of nucleotides, which are antiparallel. b. At each turn of the helix, 10 base pairs are stacked on top of each other. c. The double helix consists of two strands of nucleotides, which are parallel. d. The helical ladder is built from alternating units of deoxyribose and phosphate.

4. Which of the following statements regarding the DNA molecule is false? a. Cytosine always pairs with guanine. b. Adenine always pairs with thymine. c. Adenine always pairs with uracil. d. Options A and B 5. Which of the following is representative of the lagging strand in DNA replication? a. RNA polymerase catalyzes a primer that provides the 3'OH to which DNA polymerase III can add nucleotides. b. DNA polymerase catalyzes a primer that provides the 5'OH to which RNA polymerase can add nucleotides. c. DNA telomerase catalyzes a primer that provides the 3'OH to which RNA polymerase can add nucleotides. d. DNA ligase catalyzes a primer that provides the 5'OH to which RNA polymerase can add nucleotides.

6. A codon consists of how many nucleotides? a. 1 b. 2

c. 3 d. 4

7. In DNA cloning, the DNA fragment of interest carried by the is introduced into a host cell. a. plasmid c. protein b. vector d. restriction endonucleases 8. Restriction endonucleases are characterized as being palindromic. What is meant by this term? a. The recognition sequence is read in the same 5' to 3' direction on both strands of the double helix. b. The recognition sequence is read in the same 3' to 5' direction on both strands of the double helix. c. The recognition sequence is read in the same 5' to 3' direction on one side of the double helix.

d. The recognition sequence is read in the same 3' to 5' direction on one side of the double helix.

9. Which of the following sequences is recognized by ecoRI? a. 5'GAATTC3' c. 5'CGCG3' b. 5'CTCTTG3' d. 5'AGCT3' 10. Gel electrophoresis is a useful tool in DNA cloning. At a neutral pH, when voltage is applied, DNA fragments will migrate toward the anode because: a. DNA is negatively charged due to its glycine backbone. b. DNA is negatively charged due to its phosphate backbone. c. DNA is positively charged due to its glycine backbone. d. DNA is positively charged due to its phosphate backbone.

11. Which of the following are described as bacterial circular genetic elements that replicate independently from the chromosome and are capable of conferring bacterial resistance to certain antibiotics in DNA cloning? a. Introns c. Codons b. Extrons d. Plasmids 12. All of the following are examples of recombinant proteins used in transfusion medicine except: a. G-CSF. c. epoetin alpha. b. stem cell factor. d. factor VIII. 13. What is the function of helicases and gyrases in the polymerase chain reaction? a. To unwind the DNA b. To anneal to cDNA sequences c. To extend the primer sequence d. To generate blunt-ended, double-stranded products 14. What are ddNTPs? a. Deoxyribonucleoside triphosphates b. Dideoxyribonucleoside triphosphates c. Deaminase deoxyribonucleoside triphosphates d. Dodecyl deoxyribonucleoside triphosphates 15. Which of the following is false regarding the Southern blotting technique? a. DNA is digested with one or more restriction endonucleases, and the fragments are separated by gel electrophoresis. b. Gel is placed over a nitrocellulose membrane. c. A labeled probe is used to detect bands of interest. d. Membrane-bound fragments have different positions as the fragments separated by size on the gel electrophoresis.

16. How does the Northern blotting technique differ from the Southern blotting technique? a. In the Northern blotting technique, RNA is detected instead of DNA. b. Gel electrophoresis is not used in the Northern blotting technique. c. In the Northern blotting technique, cDNAs are used in place of restriction endonucleases. d. All of the above 17. In this technique, fluorescent probes are used to detect homologous DNA or RNA sequences in chromosomes or intact cells. a. PCR c. RFLP b. FISH d. DNA sequencing

18.

are regions of DNA interspersed in the human genome formed by variable tandem repeats of short nucleotide sequences used in DNA fingerprinting. a. Minisatellites c. Platelet satellites b. Macrosatellites d. Chromatids

19. In this procedure, PCR products are blotted in a nylon filter and hybridized with specific probes that allow the distinction of the different known alleles. a. Sequence-specific PCR b. Sequence-specific oligonucleotide probe c. Sequence-specific RFLP d. Allele-specific PCR 20. How can genomic DNA be obtained? a. Lysis of peripheral blood mononuclear cells with a hypotonic solution and proteinase K b. Lysis of bone marrow mononuclear cells with a hypertonic solution and proteinase K c. Lysis of peripheral blood mononuclear cells with an isotonic solution and proteinase K d. Lysis of bone marrow mononuclear cells with an isotonic solution and proteinase K 21. The process of translation and transcription is referred to as: a. the genetic code. c. gene expression. b. central dogma. d. spectral analysis.

22. Biotechnology is important in blood banking because of: a. its production of growth factors. c. its production of clotting factors. b. its production of erythropoietin. d. all of the above.

LpEleRo.f:COM 23. Gene transfer between two bacteTriE alSsT traBinAsN isKaS nE exL am a. Mendel’s law. b. Griffith’s transformation. c. Oswald's principle of heredity transformation. d. Chargaff's rules.

24. During protein biosynthesis a. DNA b. tRNA

combines the codons of mRNA with its anticodons. c. uracil d. reverse transcriptase

25. Single-stranded RNA can be transcribed into single-stranded DNA by what enzyme? a. Polymerase c. Reverse transcriptase b. DNAse d. Endonuclease 26. Restriction Fragment Length Polymorphism (RFLP) can be used for all but which of the following purposes? a. In paternity cases to determine the source of a DNA sample b. To measure recombination rates, which can lead to a genetic map with the distance between RFLP loci measured in centimorgans c. In criminal cases to determine the source of a DNA sample d. To determine the Rh status of an individual 27. Gel electrophoresis allows for: a. isolation of DNA fragments. b. purification of DNA fragments. c. visual examination of a defined-length DNA fragment. d. all of the above.

28. What is a disadvantage of using ethidium bromide (EB) as a dye in electrophoresis studies? a. It is expensive. c. It is rare and difficult to obtain. b. It is mutagenic. d. It fades quickly after use.

29. All of the following are examples of vectors except: a. plasmids. c. cosmids. b. lambdas. d. chirons.

30. E. coli was inserted with a plasmid vector with a gene resistant to ampicillin. This bacterium was then inoculated into a medium treated with ampicillin. After 24 hours of incubation what would be seen? a. No growth b. DNA clone of ampicillin-resistant bacterium c. DNA clone of the original E. coli specimen d. Two populations of bacterium 31. Risks for using retroviruses, adenoviruses, and lentiviruses as vectors in gene therapy include all of the following except: a. the exogenous gene may cause disease if overexpressed or expressed in certain cell types. b. contaminants may be introduced during vector manufacture. c. antitumor responses by overexpression of cytokines may occur. d. there is a potential for recombination of gene therapy vectors with human endogenous sequences.

32. An advantage to cloning using the polymerase chain reaction is that it can be done completely a. in vitro c. in situ b. in vivo d. in utero

TESTBANKSELLER.COM

33. In nucleic acid hybridization, nucleic acid hybrids can be formed between a. two strands of DNA b. two strands of RNA c. one strand of RNA and one strand of DNA d. all of the above 34. Southern blotting techniques are mostly being replaced by a. Northern blotting techniques b. Eastern blotting techniques c. polymerase chain reaction-based methods d. all of the above

.

.

35. Which of the following statements is false? a. Transcription mediated amplification is a form of NAT. b. Serological testing for antibodies shortens the preconversion window period for testing the safety of donor units for the national blood supply. c. PCR and ligase chain reaction are both examples of NAT. d. NAT allows the detection of pathogens before the appearance of testable immune response.

36. Which of the following blood groups is coded by variants of a single gene? a. Rh b. Xg c. MNS d. Chido/Rodgers e. Lutheran

.

37. Molecular RBC antigen typing is used: a. to confirm serological testing. b. when serology is not possible. c. when serology is not sensitive enough or discrepancies occur. d. for all of the above.

38. Which of the following best describes the principle of polymerase chain reaction (PCR)? a. Migration of proteins in an electrical field b. Amplification of RNA using two oligonucleotide primers that hybridize to opposite DNA strands c. Amplification of DNA using two oligonucleotide primers that hybridize to opposite DNA strands, isolating a particular segment d. Enzymatic cleavage of proteins for DNA sequencing 39. What is a major advantage of PCR? a. Primers can be reused. b. It uses a small amount of DNA. c. Probes can come from several sources. d. DNA can be single stranded.

40. All of the following are sources of DNA for performing Southern blot analysis except: a. bone marrow. c. cell cultures. b. leukocytes. d. pericardial fluid.

41. In performing gene cloning for blood group genes, possible source of RNA? c. what Neutisroaph ils a. Lymphocytes TESTBANKSELLER.COM b. Reticulocytes d. Platelets 42. What blood grouping information can be ascertained from RFLP analysis? a. Rh factor c. Sda b. HLA phenotype d. Polyagglutination 43. In the science of trans-blotting techniques, Southern is to DNA as Western is to: a. carbohydrates. c. lipids. b. enzymes. d. proteins.

44. Which formula demonstrates Chargaff’s rule? a. A + G = T + C b. A + T = G + C c. A + C = G + T 45. What technique did Rosalind Franklin use to show the helical structure of DNA? a. Gas chromatography b. Infrared spectrum c. Mass spectrometry d. X-ray diffraction 46. Transcription-mediated amplification is currently being used to test donor blood for a. bacteria.

b. fungi. c. parasites. d. viruses.

e.

47. Which statement is true concerning transcription-mediated amplification methods? a. The starting material DNA. b. Reverse transcriptase synthesizes complementary DNA. c. DNA is amplified in this assay. d. RNA is transcribed to hundreds of DNA molecules.

True/False Indicate whether the statement is true or false.

1. Each type of tRNA molecule can be attached to only one type of amino acid, but because the genetic code contains multiple codons that specify the same amino acid, tRNA molecules bearing different anticodons may also carry the same amino acid.

Chapter 4. Concepts in Molecular Biology Answer Section MULTIPLE CHOICE 1. ANS: A 2. ANS: D 3. ANS: C 4. ANS: C 5. ANS: A 6. ANS: C 7. ANS: B 8. ANS: A 9. ANS: A 10. ANS: B 11. ANS: D 12. ANS: B 13. ANS: A 14. ANS: B 15. ANS: D 16. ANS: A 17. ANS: B 18. ANS: A 19. ANS: B 20. ANS: A 21. ANS: C 22. ANS: D 23. ANS: B 24. ANS: B 25. ANS: C 26. ANS: D 27. ANS: D 28. ANS: B 29. ANS: D 30. ANS: B 31. ANS: C 32. ANS: A 33. ANS: D 34. ANS: C 35. ANS: B 36. ANS: E 37. ANS: D 38. ANS: C 4

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2

LO: 4-4 LO: 4-4 LO: 4-3 LO: 4-3 LO: 4-5 LO: 4-4 LO: 4-4 LO: 4-5 LO: 4-7 LO: 4-7 LO: 4-7 LO: 4-7 LO: 4-6 LO: 4-8 LO: 4-8 LO: 4-12 LO: 4-12 LO: 4-12 LO: 4-11 LO: 4-13 LO: 4-13 LO: 4-4 LO: 4-5 LO: 4-1 LO: 4-4 LO: 4-9 LO: 4-13 LO: 4-7 LO: 4-7 LO: 4-7 LO: 4-7 LO: 4-9 LO: 4-12 LO: 4-12 LO: 4-14 LO: 4-15 LO: 4-15 LO: 4-13

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1

LO: 4-13 LO: 4-12 LO: 4-15 LO: 4-15 LO: 4-12 LO: 4-2 LO: 4-2 LO: 4-10 LO: 4-10

PTS: 1

KEY: Taxonomy Level: 3

LO: 4-4

TRUE/FALSE 1. ANS: T

Chapter 5. The Antiglobulin Test Multiple Choice Identify the choice that best completes the statement or answers the question.

1. If not labeled "gamma heavy chain-specific," monospecific anti-IgG may contain antibodies to: a. immunoglobulin light chains. c. mu heavy chains. b. alpha heavy chains. d. C3d.

2. In preparing anti-IgG, how is excess antibody removed for titer adjustment? a. Elution c. Block titration b. Adsorption d. Dilution 3. An advantage of polyclonal anti-IgG over monoclonal anti-IgG is: a. AHG produced in rabbits is more specific than AHG produced in mice. b. polyclonal anti-IgG will recognize IgG variants. c. polyclonal anti-IgG also has anticomplement activity. d. polyclonal anti-IgG recognizes only one IgG epitope.

4. How is a 40:1 ratio of serum to cells prepared for the AHG test? a. 5 drops of serum + 1 drop of a 5% v/v RBC suspension b. 1 drop of serum + 1 drop of a 5% v/v RBC suspension c. 2 drops of serum + 1 drop of a 5% v/v RBC suspension d. 1 drop of serum + 5 drops of a 5% v/v RBC suspension 5. Why is incubation omitted in the direct AHG test? a. Polyspecific AHG contains a higher dose of anti-IgG. b. Incubation will cause lysis of red blood cells. c. Incubation elutes complement components from red blood cells. d. In vivo antigen antibody complex is already formed.

6. Which of the following is consistent with hemolytic disease of the newborn (HDN)? a. Recipient antibody coating donor red blood cells b. Maternal antibody coating fetal red blood cells c. Fetal antibody coating maternal red blood cells d. Autoantibody coating individual's own red blood cells 7. What is the incubation time for the IAT when saline is used instead of LISS? a. 10 minutes c. 30 minutes b. 15 minutes d. 1 hour 8. The antihuman globulin (AHG) test was discovered in 1945 by whom? a. Landsteiner c. Coombs b. Mollison d. Sanger 9. A patient came in for a routine type and screen prior to surgery. The antibody screen was negative at 37°C and at the AHG phase. Check cells did not produce agglutination often. What is a possible explanation for this result? a. Dirty glassware c. Inadequate washing b. Use of positive DAT cells d. Overcentrifugation 10. What effect does a low pH have on a saline AHG test?

a. b. c. d.

Enhances antibody elution Enhances the antigen-antibody complex Increases hydrogen bonding Increases bacterial contamination

11. At what temperature is the incubation phase of the AHG test? a. 22°C c. 4°C b. 37°C d. 56°C 12. What is a possible consequence of incubating tubes too long with LISS when performing the IAT? a. Increased sensitivity b. Hemolysis c. Elution of antibody from red blood cells d. All of the above 13. Most clinically significant blood group antibodies are of which IgG subclasses? a. IgG1 and IgG2 c. IgG2 and IgG3 b. IgG1 and IgG3 d. IgG2 and IgG4 14. Polyspecific AHG contains: a. anti-IgG. b. anti-C3b-C3d.

c. anti-IgG and anti- C3d. d. anti-IgG and anti-IgM.

15. "Complete" agglutinins that agglutinate red blood cells in saline are of which immunoglobulin class? a. IgG c. IgA b. IgM d. IgE 16. What do "check cells" contain? a. A+ red blood cell coated with anti-D b. Rh(D)+ red blood cells coated with anti-D c. Rh(D)- red blood cells coated with anti-D d. B+ red blood cells coated with anti-D 17. All of the following are important in evaluating a positive DAT except: a. patient diagnosis. c. transfusion history. b. drug therapy. d. donation history.

18. The indirect antiglobulin test detects which antigen-antibody reactions? a. In vivo c. Both in vivo and in vitro b. In vitro d. None of the above 19. What is the action of PEG? a. Reduces ionic strength to allow for faster antibody uptake b. Its macromolecules allow for closer contact of antibody-coated RBCs c. Increases the serum-to-cell ratio d. Removes water molecules, thereby concentrating antibody 20. Why was anticomplement introduced into AHG sera? a. Certain clinically significant antibodies demonstrate complement activity. b. Complement components enhance Kell antibodies. c. It provides additional information for transfusion reaction workups. d. All of the above 21. How many IgG molecules must be present on the red blood cell for a positive IAT to occur?

a. 10 b. 100

c. 50 d. 500

22. All of the following conditions may produce a positive DAT except: a. hemolytic disease of the newborn. c. lymphoma. b. hemolytic transfusion reaction. d. drug-induced hemolytic anemia.

23. Which IgG antibodies are contained in polyspecific AHG? a. High titer, high avidity b. High titer, low avidity c. Chemically modified d. Those that are pentameric in structure 24. All of the following complement proteins can be found on the red blood cell membrane except: a. C3d c. C4a b. C4b d. C4d 25. A patient is discovered to have anti-Fya in their serum. The medical technologist needs to phenotype the patient’s cells for the corresponding antigen. What test is appropriate for phenotyping? a. Absorption c. DAT b. Elution d. IAT 26. Why are check cells added to all negative reactions in the AHG test? a. To ensure AHG was not neutralized by free globulin molecules b. To wash away any unbound antibody c. To increase the cell-to-serum ratio d. To bring the antibody closer to the antigen in the test system

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27. What type of globulin does the antiglobulin test detect? a. IgG alloantibodies c. C3b complement components b. IgG autoantibodies d. All of the above 28. In the production of polyspecific AHG, why are IgG and complement antibodies absorbed with A1, B, and O cells? a. To eliminate the possibility of prozone b. To remove heterospecific antibody c. To eliminate false-negative results d. To standardize dilutions of antibody 29. How is polyclonal antiglobulin serum made? a. Serum from one human is injected into another human, and an antibody is produced. b. Human serum is injected into rabbits, and an immune response triggers the production of an antibody. c. Murine serum is injected into rabbits, and an immune response triggers the production of an antibody. d. Murine serum is injected into mice, and an immune response triggers the production of an antibody.

30. All of the following statements regarding the AHG test are true except: a. when washing cells, all saline should be removed completely. b. centrifugation should provide a firm pellet. c. incubation time with LISS should be a minimum of 30 minutes. d. Coombs’ control cells should be added to all negative tubes.

31. What class of antibody can be present in AHG? a. IgG c. IgA b. IgM d. All of the above 32. An antibody screen is performed, and all three tubes are negative after adding AHG. Check cells are added, and the tubes are centrifuged. No agglutination occurs after the addition of check cells. What is the next course of action? a. Recentrifuging the tubes c. Repeating the antibody screen b. Adding one drop of control cells d. Adding one drop of AHG 33. Conventional tube testing in AHG testing has one distinct advantage over gel testing. Identify the advantage. a. Sensitivity c. Time savings b. Cost d. Automation 34. An advantage of monoclonal anti-C3 over polyclonal anti-C3 is: a. with monoclonal anti-C3, the antibody potency can be controlled. b. contamination with anti-IgG is avoided with anti-C3. c. with monoclonal anti-C3, antibody to immunoglobulin light chains are eliminated. d. false-positives caused by cold agglutinins are avoided with anti-C3.

35. Why is the 37°C reading omitted when using PEG additive? a. PEG may cause aggregation of RBCs at 37°C. b. Antibodies detected by PEG do not react at 37°C. c. Warm-reacting antibodies are not clinically significant. d. Unwanted reactions due to C3b will be detected at 37°C.

KoSleEcL 36. Anti-IgG is specific for what paT rt E ofSthTeBIgAGNm ulL e?ER.COM a. FC fragment b. Constant region of Fab fragment c. Hypervariable region of Fab fragment d. Kappa light chain 37. What is the purpose of washing cells in the AHG test? a. To dilute serum b. To remove all unbound protein c. To remove all bound protein d. To exclude a low-affinity antibody 38. Saline used for blood banking tests should have a pH of a. 5.0 to 5.5 c. 7.2 to 7.4 b. 6.8 to 7.2 d. 7.5 to 8.0

.

39. How would a negative IAT be demonstrated in solid phase methodology? a. The cells form a monolayer. b. There is a pellet at the bottom of the well. c. The well turns orange. d. Small agglutinins appear at the bottom of the well.

40. The inability to determine the polyclonal reagents. a. potency b. titer

of anti-C3b and anti-C3d individually is one of the difficulties with c. presence d. volume

41. False-negative results in antihuman globulin testing can be caused by: a. overcentrifugation. b. undercentrifugation. c. cell suspensions that are too weak or too heavy. d. all of the above.

42. Which of the following antibodies is least likely to bind complement? a. Jka c. ABO b. Kell d. P 43. Which of the following is not a clinical application for a direct antiglobulin test? a. HDN c. AIHA b. HTR d. Heterophile detection 44. You are performing an IAT, and you are suspicious of the results. It appears there may be a weak alloantibody present. You decide to repeat the test, and at the LISS stage you decide to add an extra two drops of serum to each tube being tested. What can you expect to happen? a. There would be no effect. b. The additional serum increases reaction strengths, because more possible antibody is added to the reaction. c. Sensitivity of the test decreases, because you increased the ionic strength of the mixture. d. You lowered the zeta potential, thus enhancing your results.

45. What is the optimal temperature for complement activation? a. 58°C c. 4°C b. 37°C d. 22°C

46. Why is it important to use polyspecific AHG rather than monospecific? a. Polyspecific AHG costs less than monospecific AHG. b. Polyspecific AHG is easier to use than monospecific AHG. c. Polyspecific AHG is better at detecting IgG antibodies. d. Polyspecific AHG is less sensitive to IgG antibodies.

Chapter 5. The Antiglobulin Test Answer Section MULTIPLE CHOICE 1. ANS: A 2. ANS: C 3. ANS: B 4. ANS: C 5. ANS: D 6. ANS: B 7. ANS: C 8. ANS: C 9. ANS: C 10. ANS: A 11. ANS: B 12. ANS: C 13. ANS: B 14. ANS: C 15. ANS: B 16. ANS: B 17. ANS: D 18. ANS: B 19. ANS: D 20. ANS: D 21. ANS: B 22. ANS: C 23. ANS: A 24. ANS: C 25. ANS: D 26. ANS: A 27. ANS: D 28. ANS: B 29. ANS: B 30. ANS: C 31. ANS: D 32. ANS: C 33. ANS: B 34. ANS: A 35. ANS: A 36. ANS: A 37. ANS: B 38. ANS: C 39. ANS: B 40. ANS: A 41. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 TESTBAKEY: NKSETaxonomy LLER.CLevel: OM 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1

LO: 5-4 LO: 5-3 LO: 5-2 LO: 5-3 LO: 5-9 LO: 5-10 LO: 5-7 LO: 5-1 LO: 5-10 LO: 5-11 LO: 5-9 LO: 5-11 LO: 5-4 LO: 5-2 LO: 5-2 LO: 5-8 LO: 5-9 LO: 5-7 LO: 5-11 LO: 5-6 LO: 5-7 LO: 5-10 LO: 5-2 LO: 5-3 LO: 5-12 LO: 5-9 LO: 5-8 LO: 5-3 LO: 5-3 LO: 5-7 LO: 5-1 LO: 5-12 LO: 5-13 LO: 5-11 LO: 5-9 LO: 5-2 LO: 5-8 LO: 5-11 LO: 5-10 LO: 5-6 LO: 5-11

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

PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1

KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2

LO: 5-6 LO: 5-1 LO: 5-12 LO: 5-11 LO: 5-5

Chapter 6. The ABO Blood Group System Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Anti-A from a group B individual is primarily what class of immunoglobulin? a. IgM c. IgA b. IgG d. All of the above 2. Cord blood was sent to the laboratory for blood type determination on twins A and B. Baby A demonstrated mixed-field reactions with anti-A and anti-AB and no reactivity with anti-B. Reverse grouping was not performed. Baby B showed a 1+ reaction with anti-A and anti-AB. What could be the reason for the variable reactions? a. Chimerism c. Dispermy b. A dimorphic cell population d. All of the above 3. Which of the following criteria is used to classify the B subgroups? a. Agglutination patterns with anti-B, anti-AB, and anti-H b. Presence of ABH isoagglutinins in serum c. Absorption studies with anti-B d. All of the above 4. Approximately how many antigen sites exist on a type-A1 individual's RBC? a. 1 million c. 1,000 b. 600,000 d. 5 million

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5. What substances are found in a group A secretor? a. AH c. BH b. H d. ABH

6. Where are ABH substances detected in secretors? a. Tears c. Milk b. Saliva d. All of the above 7. Which of the following is not characteristic of antibodies within the ABO system? a. Antibodies are of IgM Class. b. Antibodies are naturally occurring. c. ABO antibodies do not activate complement. d. ABO antibodies may cause immediate intravascular hemolysis.

8. A group O person with warm autoimmune hemolytic anemia may demonstrate weak reactions in the forward grouping due to: a. red blood cells being coated with antigen. b. red blood cells being coated with antibody. c. exposure of T antigen. d. acquired B-like syndrome.

9. What is a lectin? a. A protein produced from immunized rabbits and cloned for specificity b. A foreign protein that will elicit an immune response in most individuals c. Seed extracts that agglutinate human cells with moderate specificity d. A substance that will agglutinate sensitized cells in the presence of complement

10. What ABO group contains the least amount of H substance? a. A1 c. A1B b. A2 d. A2B 11. What testing is available that will differentiate between a true B and an acquired B? a. Anti-B lectin c. Secretor studies b. Acidification of anti-B reagent d. All of the above 12. What is the source of anti-A1 lectin? a. Bandeiraea simplicifolia b. Dolichos biflorus

c. Ulex europaeus d. All of the above

13. Secretor studies were performed on a person who expressed weak reactions in forward grouping. Only B and H substance were present in the saliva. What is this person's ABO group? a. O c. B b. A d. AB 14. How is polyagglutination resolved? a. Absorption of Tn antigen with anti-T b. Patient serum is tested with a lectin panel c. Patient cells are tested with a lectin panel d. Elution of Tn antigen with chloroquine 15. Serum from a group B individual contains anti-A. When A2 cells are added to serum and centrifuged, the cells with attached anti-A are removed from serum. What is the name of this technique? a. Elution c. Glycerolization TESTBANKS dE . LDLeE glR yc.eC roO lizMation b. Absorption 16. What other consideration should be made before beginning a subgroup investigation? a. Patient demographics b. ABH alteration caused by malignancy c. Chromosomal aberration d. Immunization record of patient 17. Why can anti-H sometimes be found in an A1B individual? a. L-fucose does not attach to precursor substance. b. The H gene is not inherited. c. The specific immunodominant sugar blocks the presence of H antigen. d. The individual does not secrete H substance in secretions.

18. All of the following may result in weak or missing antigens except: a. presence of blood-group–specific soluble substances (BGSS). b. Hodgkin's disease. c. hypogammaglobulinemia. d. intestinal infection with Escherichia coli.

19. What is the biochemical structure of secreted A, B, and H substances? a. Glycolipid c. Sphingolipid b. Glycoprotein d. Ceramide 20. Where will the ABO discrepancy occur in cis-AB individuals? a. Forward grouping with anti-A c. Forward grouping with anti-AB d. Reverse grouping with A1 cells b. Reverse grouping with B cells

21. Which ABO group’s reaction will be the weakest with anti-H lectin? a. A1 c. A2B b. B d. AB 22. All of the following statements are true concerning ABH soluble substances except: a. the first sugar in the precursor substance is N-acetylgalactosamine. b. the precursor chain is type 2 (beta 1-4 linkage). c. ABH structures are glycoproteins. d. L-fucosyltransferase production is regulated by the Se system.

23. All of the following is true regarding formation of the ABH antigens except: a. H gene inheritance is independent of ABO gene inheritance. b. A, B, and H antigens are formed from the same precursor material. c. A type 1 structure refers to a beta 1-2 linkage. d. A type 2 structure refers to a beta 1-4 linkage.

24. When performing secretor studies, what is omitted in the control tube but present in the patient tube? a. Antiserum c. Saliva b. 5% B cells d. 5% O cells 25. Two drops of serum are added to one drop of A1 cells, and two drops are added to one drop of B cells; the two tubes are centrifuged. The tubes show reactivity when read macroscopically. This is an example of: a. forward grouping. c. antibody screen. b. reverse grouping. d. crossmatch.

26. Why is reverse grouping not performed on cord blood specimens? a. Antigens are not present at bTirE thS . TBANKSELLER.COM b. Antibodies are generally not present at birth. c. Antibody titer is too high. d. Antigens are too weak.

27. If a group O mother gives birth to a group A baby, which of the following antibodies is usually responsible for crossing the placenta and causing hemolytic disease of the newborn (HDN)? a. Anti-AB c. Anti-A b. Anti-B d. Anti-H 28. What immunodominant sugar is responsible for H specificity? a. D-galactose c. N-acetyl-D-galactosamine b. L-fucose d. D-glucose 29. What percentage of the type A population is A2? a. 1% c. 20% b. 10% d. 80% 30. An elderly patient is documented as being type O. The forward grouping is negative with anti-A and anti-B. The reverse grouping shows no reactivity with A1 cells and B cells. What can be done to correct the discrepancy? a. Incubate the patient’s serum and reagent cells for 15 minutes at room temperature. b. Incubate the patient’s serum and reagent cells for 15 minutes at 37°C. c. Perform an antibody screen. d. Incubate the patient’s cells and serum for 15 minutes at room temperature.

31. Mixed-field agglutination encountered in ABO forward grouping may be caused by:

a. b. c. d.

A3. cold reactive autoagglutinins. abnormal concentrations of serum proteins. para-Bombay.

32. What is used to stimulate saliva secretion in secretor studies? a. Tongue depressor c. Chewing gum b. Paraffin wax d. Water 33. The ABO group antibodies are primarily: a. alloantibodies. b. autoantibodies.

c. naturally occurring. d. drug induced.

34. What percentage of the white population has type-O blood? a. 45% c. 4% b. 10% d. 32% 35. All of the following are technical errors that could result in ABO discrepancies except: a. a misidentified sample. c. failure to add reagents. b. failure to warm reagents. d. clerical errors.

36. If a type-A person contains anti-M in his or her serum, what might the reverse grouping type as? a. A c. AB b. B d. O 37. Reverse grouping showed negative reactions with A1 and B cells. Forward grouping showed positive reactions with A, B, and AB antisera. What blood type is consistent with these results?

TESTBANKScE . LALBER.COM a. A b. B d. O 38. A type-A person demonstrates a 3+ reactivity with A1 cells (reverse grouping). The forward grouping with anti-A is 4+. Therefore, the possibility of a subgroup is excluded. B cells demonstrate a 4+ reaction. The antibody screen is weakly positive at 37°C but shows no reactivity at the AHG phase. An antibody panel is performed and anti-M is identified. The patient phenotypes negative for M antigen. How is the ABO discrepancy resolved? a. Perform reverse grouping at 4°C. b. Perform reverse grouping with A1 cells negative for M antigen. c. Perform reverse grouping with A1 cells positive for M antigen. d. Perform forward grouping at 4°C. 39. What is the source of anti-B lectin? a. Bandeiraea simplicifolia b. Ulex europaeus

c. Dolichos biflorus d. All of the above

40. What is the cause of polyagglutination in most cases? a. Exposure of anti-T caused by bacterial contamination b. Exposure of T antigen caused by bacterial contamination c. Hypergammaglobulinemia d. Exposure of I antigen caused by bacterial contamination 41. Which blood group contains the highest concentration of H antigen? a. A2 c. AB b. B d. O

42. What is the only possible phenotype of an offspring produced from two group O parents? a. A c. AB b. B d. O 43. All of the following is consistent with A3 individuals except: a. "A" substance in saliva. b. mixed field agglutination with anti-A. c. 4,000 antigenic sites on red blood cells. d. a variable amount of "A" transferase in serum.

44. The forward grouping of a patient showed no agglutination of patient cells with anti-A, anti-B, or anti-AB reagent antisera. The reverse grouping showed agglutination with A1 and B cells. What is this person's ABO group? a. A c. AB b. B d. O 45. Forward grouping is defined as: a. detecting antibody on an individual's red blood cells via reagent antisera. b. detecting antigen(s) on an individual's red blood cells via reagent antisera. c. detecting ABO group antibody via reagent red blood cells. d. detecting ABO group antigen via reagent red blood cells.

46. What does the hh genotype refer to? a. Lewis b. Sid

c. Bombay d. Kell

47. Approximately how many antigen sites can be found on A2 cells? a. 1 million c. 260,000 b. 10,000 d. 500,000 48. Which of the following indicates secretor gene control overproduction of H substance? a. L-fucosyltransferase is found in the saliva of secretors. b. D-galactosyltransferase is found in saliva of secretors. c. N-acetylgalactosaminyltransferase is found in saliva of secretors. d. D-glycosyltransferase is found in saliva of secretors.

49. Individuals with group B blood are more common among which populations? a. Black/Asian c. White/black b. Asian/white d. Hispanic/white 50. A patient who was recently diagnosed with an obstructed bowel became septic from Proteus vulgaris. Prior to surgery, a routine type and screen was performed. Though this person typed as an A 2 years ago, his forward type is consistent with an AB individual, albeit weaker in strength with anti-B. What is the reason for this discrepancy? a. Acquired "B" c. Incorrect patient history b. Technical error d. Contaminated anti-A 51. A patient was previously typed as blood group O. Forward grouping was negative with anti-A and anti-B. Reverse grouping showed reactivity with A1 cells and B cells. The technologist reported this patient's type as A. What technical error occurred? a. Sample misidentified c. Clerical error b. Failure to add reagents d. Sample mix-up

52. Which substance must be formed first before A or B specificity is determined? a. I c. Bombay b. O d. H 53. Reverse grouping was performed on an AB person. The technologist observed a very weak agglutination macroscopically. The cells appeared as "stacked coins" under a microscope. Which reagent should be added to the tube before recentrifugation in an attempt to resolve the discrepancy? a. Serum c. Water b. Saline d. LISS 54. How are ABH antigens formed? a. Production of specific glycosyltransferases add sugars to precursor substances b. Recombinant gene technology c. ABO genes code for production of antigens d. All of the above 55. What percentage of A2 individuals produce anti-A1? a. 5% c. 50% b. 20% d. 80% 56. What would be a possible genotype of an A2B individual? a. A1B c. A2O b. A2B d. A2A2 57. What percentage of individuals inherit the secretor gene? a. 15% c. 80% b. 50% d. 98%

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58. What immunodominant sugar is responsible for B specificity? a. D-galactose c. N-acetyl-D-galactosamine b. L-fucose d. D-glucose 59. What is the most important use for anti-B lectin? a. Differentiating B1 from B2 b. Differentiating secretors from nonsecretors c. Differentiating a true B from an acquired-like B d. All of the above 60. What is the source of anti-H lectin? a. Bandeiraea simplicifolia b. Ulex europaeus

c. Dolichos biflorus d. All of the above

61. An AB male mates with an AB female. What could be the genotype of the offspring? a. AB c. BB b. AA d. All of the above 62. The state in which an individual's red blood cells are agglutinated by all sera regardless of blood type is called: a. panagglutination. c. sensitization. b. polyagglutination. d. leukoagglutination.

63. All of the following are tests performed in the blood bank to classify subgroups of A except: a. anti-H lectin reactivity. c. LISS enhancement. b. absorption. d. elution.

64. All of the following may depress antigen expression except: a. leukemia. c. coronary heart disease. b. lymphoma. d. Hodgkin's disease.

65. Persons who inherit the h allele do not produce transferase necessary for formation of the H structure. a. L-fucosyl c. D-galactosyl b. N-acetylgalactosaminyl d. D-glucosyl 66. What percentage of the type-A population are A1? a. 80% c. 20% b. 50% d. 10% 67. All of the following may result in rouleaux formation except: a. Waldenstrom's macroglobulinemia. c. leukemia. b. Wharton's jelly in cord blood. d. dextran.

68. Weak agglutination with anti-A typing sera is to be expected with which of the following blood groups? a. A1 b. A2 c. A3 D A2B 69. Antibody titers specific to antigens from the ABO system are typically highest: a. when the patient is a newborn. b. when the patient is around 10 years old. c. when the patient is around 3T 0E yeSaT rsB olAdN . KSELLER.COM d. when the patient is around 60 years old.

70. A1 lectin agglutinates: a. all cells except A2. b. all subgroups of A. c. cells not agglutinated by absorbed anti-A. d. only A1 cells.

Chapter 6. The ABO Blood Group System Answer Section MULTIPLE CHOICE 1. ANS: A 2. ANS: D 3. ANS: D 4. ANS: A 5. ANS: A 6. ANS: D 7. ANS: C 8. ANS: B 9. ANS: C 10. ANS: C 11. ANS: D 12. ANS: B 13. ANS: C 14. ANS: C 15. ANS: B 16. ANS: B 17. ANS: C 18. ANS: C 19. ANS: B 20. ANS: B 21. ANS: D 22. ANS: B 23. ANS: C 24. ANS: C 25. ANS: B 26. ANS: B 27. ANS: A 28. ANS: B 29. ANS: C 30. ANS: A 31. ANS: A 32. ANS: B 33. ANS: C 34. ANS: A 35. ANS: B 36. ANS: D 37. ANS: C 38. ANS: B 39. ANS: A 40. ANS: B 41. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 TESTBANKEY: KSELTaxonomy LER.COLevel: M 1 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1

LO: 6-4 LO: 6-14 LO: 6-4 LO: 6-9 LO: 6-7 LO: 6-7 LO: 6-4 LO: 6-1 LO: 6-9 LO: 6-7 LO: 6-13 LO: 6-10 LO: 6-8 LO: 6-14 LO: 6-14 LO: 6-2 LO: 6-6 LO: 6-13 LO: 6-7 LO: 6-5 LO: 6-10 LO: 6-7 LO: 6-6 LO: 6-8 LO: 6-14 LO: 6-3 LO: 6-5 LO: 6-7 LO: 6-2 LO: 6-14 LO: 6-8 LO: 6-6 LO: 6-1 LO: 6-1 LO: 6-14 LO: 6-14 LO: 6-1 LO: 6-14 LO: 6-10 LO: 6-13 LO: 6-6

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 : LTL axEoR no.mCyOLM evel: 1 1 TESTBANKKESYE 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2

LO: 6-5 LO: 6-11 LO: 6-1 LO: 6-1 LO: 6-12 LO: 6-9 LO: 6-6 LO: 6-2 LO: 6-13 LO: 6-14 LO: 6-6 LO: 6-14 LO: 6-6 LO: 6-9 LO: 6-5 LO: 6-7 LO: 6-6 LO: 6-14 LO: 6-10 LO: 6-5 LO: 6-8 LO: 6-11 LO: 6-13 LO: 6-6 LO: 6-9 LO: 6-13 LO: 6-11 LO: 6-3 LO: 6-9

Chapter 7. The Rh Blood Group System Multiple Choice Identify the choice that best completes the statement or answers the question.

1. What is an advantage of using chemically modified anti-D? a. It provides a low-protein medium. b. Rh control is not necessary. c. Few false-negative results are obtained. d. Du testing is eliminated.

2. The Rh antibody agglutinates what percentage of RBCs? a. 15% c. 50% b. 85% d. 35% 3. Why is determination of Rh status crucial for obstetric patients? a. An Rh-positive mother can form anti-D, which will destroy D-positive red blood cells of the fetus. b. All Rh-positive mothers are possible candidates for Rh immune globulin. c. All Rh-negative mothers are possible candidates for Rh immune globulin. d. An Rh-negative mother can form anti-D if she gives birth to an Rh-negative baby.

4. Which antigen represents Rh3 in Rosenfield terminology? a. D c. C b. E d. e

TESTBANKSELLER.COM

5. G antigen is present on all of which type of red blood cells? a. D-positive c. E-positive b. C-positive d. e-positive

6. What does Rh genotype refer to? a. Antigens detected on a red blood cell by serologic methods b. Antibodies detected in serum by serologic methods c. Rh genes inherited from both parents d. Rh genes inherited from the mother 7. Where is the Rh antigen located relative to the red blood cell membrane? a. Integrally c. Centrally b. Peripherally d. None of the above 8. Which of the following statements regarding anti-LW is true? a. Anti-LW reacts poorly with cord cells. b. Anti-LW reacts stronger with Rh-positive cells than with Rh-negative cells. c. Rh-null individuals lack the LW gene. d. The gene coding for LW is located on the same chromosome as the Rh genes.

9. Of the three following categories of altered D antigen, in which variation of D antigen expression are you more likely to encounter an allo-anti-D? a. C in Trans to RhD c. Partial D b. Weak D d. None of the above

10. A cord blood sample was sent to the blood bank for a type and DAT. Cells were washed six times with saline before testing. The forward grouping typed as an O. There was no agglutination with anti-D and washed cord cells. The DAT was 3+ with polyspecific AHG. What is the Rh type of the baby? a. Rh-negative c. Rh type cannot be determined b. Rh-positive d. None of the above 11. Which gene combination is expressed in the greatest frequency in the black population? a. DCe c. Dce b. dce d. DCE 12. Which of the following genotypes is consistent with f antigen expression? a. DcE/DCe c. DCe/DcE b. Dce/DCE d. DCe/dCE 13. How are the Rh antigens inherited? a. X-linked recessive b. Codominant alleles

c. X-linked dominant d. None of the above

14. All of the following may cause a false-negative reaction in Rh typing except: a. omission of reagent. c. rouleaux. b. immunoglobulin coating cells. d. cell suspension that is too heavy.

15. In the Fisher-Race nomenclature what does "d" refer to? a. Amorph c. Absence of D b. Silent allele d. All of the above 16. Which of the following genotypes would demonstrate the strongest expression of D antigen?

TESTBANKScE . LdL ceE/dRc. e COM a. Dce/dCE b. DCe/dce d. dCe/dcE 17. Most Rh antibodies are of what immunoglobulin class? a. IgM c. IgA b. IgG d. IgE 18. What clinical manifestation may be associated with the Rh-null syndrome? a. Reticulocytosis c. Low hemoglobin b. Stomatocytosis d. All of the above 19. Which IgG subclasses carry the most significance with regard to Rh antibodies? a. IgG1/IgG4 c. IgG3/IgG4 b. IgG2/IgG4 d. IgG1/IgG3 20. In which population is the genetic Du usually found? a. White c. Black b. Asian d. Native American 21. What does hr' refer to in the Weiner nomenclature? a. c c. C b. e d. E 22. All of the following may occur following an Rh-mediated hemolytic transfusion reaction except: a. elevated fever. c. intravascular hemolysis. b. increased bilirubin. d. positive DAT.

23. All of the following are consistent with International Society of Blood Transfusion (ISBT) terminology except: a. A six-digit number specifies each blood group antigen. b. 004 represents Rh group. c. D is written as "R1." d. All genes are written in bold print.

24. Rh-immune globulin is effective is preventing which type of hemolytic disease of the newborn (HDN)? a. Anti-c c. Anti-D b. Anti-E d. Anti-C 25. The biochemical structure of the Rh antigens is a nonglycosylated protein, meaning: a. lipids are not attached to protein structure. b. carbohydrates are not attached to protein structure. c. glucose is attached to protein. d. glycerol is attached to protein.

26. The Rh testing on a blood donor was negative at immediate spin. The tube was incubated at 37°C for 15 minutes. The tube was centrifuged and read macroscopically. The test was negative at 37°C. The tube was washed three times with saline, and two drops of AHG were added. After centrifugation, the tube yielded a 2+ reaction. How is this Rh type reported on the donor unit? a. Rh-positive c. Du-positive b. Rh-negative d. Rh-variable 27. What does the term exalted D refer to? a. Deletion of the D antigen b. Stronger expression of Cc an igS enT sB wA heN nK DSisEm ssE inR g .COM TtE LiL c. Stronger expression of Ee antigens when D is missing d. Stronger expression of D antigens when Cc and Ee are missing 28. What does the "R" represent in Rh-Hr terminology? a. Absence of D antigen c. Presence of C antigen b. Presence of D antigen d. Presence of e antigen 29. What is the basis of Rosenfield Rh terminology? a. Each gene produces one product or antigen. b. The positive (+) or negative (–) sign demonstrates the presence or absence of antigen on a red blood cell. c. The Rh gene produces at least three factors within an agglutinogen. d. The Rh gene produces at least five factors within an agglutinogen.

30. In the black population, a mosaic form of which antigen may be found? a. c c. e b. E d. C 31. Which of the following Rh antigens is the most immunogenic? a. D c. e b. C d. E 32. What protocol is put in place to validate Rh testing when high-protein reagents are used, especially when the patient types as an AB-positive? a. Wash cells before testing c. Add LISS to test system b. Run a control with Rh test d. Use only saline reactive anti-D

33. The Del phenotype is most commonly found in individuals of which ethnicity? a. Asian c. Native American b. Whites d. African 34. Why must there be alpha designations in the Rosenfield system? a. Nomenclature applies to other blood group systems besides Rh. b. Rosenfield nomenclature is only used in the Rh blood system. c. Weiner and Fisher-Race use alpha designations. d. None of the above 35. What is the frequency of E antigen in the general population? a. 85% c. 98% b. 15% d. 30% 36. The Rh gene is located on which chromosome? a. 1 c. 9 b. 7 d. 11 37. What is the principle of the Rh-Hr (Weiner) terminology? a. The Rh gene produces at least three factors within an agglutinogen. b. Each gene (D, C, c, E, e) produces one product or antigen. c. The Rh gene produces at least three factors within an agglutinin. d. Each gene is independent of the others.

38. Which of the following reagents or methods is best for categorizing partial D types? a. Saline based anti-D b. High protein anti-D c. A combination of serological typing and molecular analysis d. Monoclonal anti-D reagents 39. All of the following are true regarding Rh antibodies except: a. Rh antibodies can bind complement on the red blood cell membrane. b. An individual with a low titer Rh antibody may experience a secondary immune response on antigen exposure. c. Rh antibodies may cause a delayed hemolytic transfusion reaction. d. Red blood cell destruction is usually extravascular.

40. On which chromosome are the genes that code for RH proteins, namely, RHD and RHCE located? a. Chromosome 1 c. Chromosome 20 b. Chromosome 19 d. Chromosome 9 41. When one or more D epitopes within the entire D protein is missing it is termed a. weak D c. Del b. C in trans to Rh(D) d. partial D

.

42. If an individual with a partial D expression is transfused with a normal Rh-positive unit of blood, a likely result will be: a. the patient will develop an anti-D antibody. b. the patient will form an antibody to the portion of Rh(D) protein that they are missing. c. the patient will have an acute hemolytic transfusion reaction. d. the patient will experience no consequence of receiving Rh-positive blood.

43. A male patient was seen in the emergency room with an acute bleed. The recommendation from the blood supplier is to give O-positive RBCs as uncrossmatched blood. This patient has already been exposed to Rh-positive blood after a previous accident. What is a possible outcome? a. The patient may have a hemolytic transfusion reaction from an allo-immunized anti-D. b. Anti-D is not immunogenic, and the patient probably would not have formed an anti-D. c. Anti-D is not hemolytic, and even with the circulating antibody there would be no danger to the patient. d. The anti-D would activate complement, and a strong intravascular transfusion reaction would occur.

44. Anti-LW will react most strongly with: a. adult Rh-positive RBCs. b. Rh-negative RBCs.

c. Rh-null RBCs. d. Rh-negative cord blood.

45. Which of the following statements is false? a. Anti-D usually stimulates complement. b. Anti-D is mostly IgG. c. Anti-D can cause hemolytic disease of the newborn. d. None of the above 46. When a patient has Rh-null syndrome, what kind of packed RBCs need to be transfused? a. ABO compatible Rh-positive blood c. ABO compatible Rh-null blood b. ABO compatible Rh-negative blood d. O-negative PRBCs 47. What are the dangers of transfusing donor Rh-negative RBCs to an Rh-positive patient? a. There are no dangers. b. A hemolytic transfusion reaT ctiEoS nw ccK urS . ELLER.COM TiBllAoN c. A patient will be sensitized and will develop an Anti-D. d. Most Rh-negative blood is c- and e-positive, and because of their immunogenicity the patient may form an antibody to those antigens.

48. The antigen ceCF is known as: a. Wrights antigen b. Crawford antigen

c. D mosaic d. V antigen

49. An individuals of the dce/dce genotype given dCe/dce blood has an antibody response that appears to be anti-C and anti-D. The most likely explanation for this is: a. The antibody is anti-G. b. The antibody is anti-partial D. c. The antibody is anti-Cw. d. There was an incorrect reading of the agglutination reactions.

50. Why do false-negative Rh testing results occur in babies with severe hemolytic disease of the newborn due to anti-D? a. The cord cells may be contaminated with Wharton's jelly. b. All D sites are covered by maternal anti-D, which blocks the reagent. c. Antigens are not expressed yet. d. None of the above 51. Which of the following Rh phenotypes invites Cw antigen testing? a. C+c+ c. E-e+ b. E+ed. C+c-

Chapter 7. The Rh Blood Group System Answer Section MULTIPLE CHOICE 1. ANS: A 2. ANS: B 3. ANS: C 4. ANS: B 5. ANS: B 6. ANS: C 7. ANS: A 8. ANS: B 9. ANS: C 10. ANS: C 11. ANS: C 12. ANS: B 13. ANS: B 14. ANS: C 15. ANS: D 16. ANS: B 17. ANS: B 18. ANS: D 19. ANS: D 20. ANS: C 21. ANS: A 22. ANS: C 23. ANS: D 24. ANS: C 25. ANS: B 26. ANS: A 27. ANS: D 28. ANS: B 29. ANS: B 30. ANS: C 31. ANS: A 32. ANS: B 33. ANS: A 34. ANS: A 35. ANS: D 36. ANS: A 37. ANS: A 38. ANS: C 39. ANS: A 40. ANS: A 41. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 7-8 LO: 7-12 LO: 7-9 LO: 7-3 LO: 7-4 LO: 7-12 LO: 7-5 LO: 7-5 LO: 7-8 LO: 7-15 LO: 7-2 LO: 7-2 LO: 7-2 LO: 7-10 LO: 7-2 LO: 7-2 LO: 7-12 LO: 7-6 LO: 7-12 LO: 7-15 LO: 7-2 LO: 7-14 LO: 7-1 LO: 7-13 LO: 7-5 LO: 7-11 LO: 7-4 LO: 7-3 LO: 7-3 LO: 7-15 LO: 7-5 LO: 7-10 LO: 7-13 LO: 7-3 LO: 7-15 LO: 7-7 LO: 7-2 LO: 7-10 LO: 7-5 LO: 7-7 LO: 7-7

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2

LO: 7-14 LO: 7-14 LO: 7-12 LO: 7-12 LO: 7-6 LO: 7-14 LO: 7-3 LO: 7-14 LO: 7-13 LO: 7-9

Chapter 8. Blood Group Terminology and Common Blood Groups Multiple Choice Identify the choice that best completes the statement or answers the question.

1. An individual from Bombay who has inherited the Le gene will have a phenotype of: a. Le(a-b-). c. Le(a+b-). b. Le(a+b+). d. Le(a-b+).

2. Individuals who are Le(a-b-) and can develop Lewis antibodies without exposure to Lewis antigens are called: a. immune mediated. c. naturally occurring. b. biphasic. d. autoantibodies.

3. Which of the following may be a possible cause for the lack of expression of Lewis antigens during pregnancy? a. Increased ratio of plasma lipoproteins to RBC mass b. Decreased ratio of plasma lipoproteins to RBC mass c. Antigenic sites blocked by IgG antibody d. Antigenic sites blocked by IgM antibody 4. A patient was phenotyped for the presence of Lewis antigens (Lea and Leb). A 3+ reaction was observed when patient cells were incubated with anti-Lea. No reaction was observed with anti-Leb. Based on these results, the patient's phenotype is and the patient is a of ABH substances. a. Le(a+b-)/secretor c. Le(a+b-)/nonsecretor b. Le(a-b+)/secretor d. Le(a-b+)/nonsecretor 5. What percentage of the white poTpE ulS atio n in heK riS ts E thL eL LeEgRe. neC ? OM TB AN a. 50% c. 10% b. 90% d. 25% 6. Approximately what percentage of the black population is [Le(a-b-)]? a. 78% c. 15% b. 22% d. 35% 7. In order for an individual to express Leb antigen on their red blood cells, they must have inherited which gene? a. Le c. H b. Se d. All of the above 8. Pregnant women usually express which phenotype? a. Le(a+b-) c. Le(a-b-) b. Le(a+b+) d. Le(a-b+) 9. Why is anti-LebL the antibody of choice when phenotyping red blood cells? a. It reacts best with O and A2 cells. b. It is dependent on the ABH antigens. c. It is neutralized by H substance. d. It recognizes any Leb antigen independent of ABO type.

10. Persons who inherit the Se and Le genes will have A or B glycolipids in plasma than persons who are Se le. a. more c. inactive b. fewer d. none of the above

11. All of the following statements are representative of Lewis antibodies except: a. they occur frequently in pregnant women. b. they occur more often in group O persons than A or B. c. they are destroyed by enzymes. d. they can be neutralized by Lewis substances.

12. Anti-Lea, which is reactive at the Coombs phase, may cause what kind of hemolysis? a. In vivo c. Intravascular b. In vitro d. None of the above 13. Red blood cells that phenotyped as [Le(a-b-)] are incubated with plasma containing Lea substance. The red blood cells convert to the phenotype [Le(a+b-)]. Whereas the same red blood cells incubated with saliva containing Lea substance do not convert. Why? a. Glycoproteins are not absorbed onto red blood cell membranes. b. Biochemically, Lewis substances in saliva are glycolipids. c. Only Leb substance in saliva can convert phenotypes. d. Other enzymes found in the saliva interfere with the conversion from Le(a-b-) to Le (a+b-).

14. What does the type 1 chain refer to? a. Alpha linkage of the number 1 carbon of galactose to the number 3 carbon of N-acetylglucosamine residue of precursor structure b. Beta linkage of the number 2 carbon of galactose to the number 4 carbon of N-acetylglucosamine residue of precursor structure c. Beta linkage of the number 1 carbon of galactose to the number 3 carbon of N-acetylglucosamine residue of precursor structure d. Alpha linkage of the number 1 carbon of galactose to the number 4 carbon of N-acetylglucosamine residuT e tE oS prTecBuA rsN orKsS truEcL tuL reER.COM 15. Lewis cell-bound antigens absorbed from plasma onto the red blood cell membranes are: a. glycoproteins. c. sphingolipids. b. glycolipids. d. ceramides.

16. Lewis antibodies are of what immunoglobulin class? a. IgM c. IgA b. IgG d. IgE 17. Which enzyme is responsible for Lewis specificity? a. L-fucosyltransferase c. D-galactosyltransferase b. N-acetylglycosyltransferase d. N-acetylgalactosyltransferase 18. Where are Lewis antigens found? a. Plasma b. Saliva

c. Milk d. All of the above

19. What substances would be present in the saliva of a person with the LeLe HH SeSe AA genotype? a. A, H c. H, B, Lea, Leb b. A, B, H d. A, H, Lea, Leb 20. How is Leb substance formed? a. L-fucose is added to subterminal N-acetylglucosamine of type 1 H substance. b. L-fucose is added to subterminal N-acetylglucosamine of type 2 H substance. c. Lea and Leb are codominant alleles located on chromosome 19. d. Leb is secreted into plasma in the absence of fucosyltransferase.

21. Which of the following statements is false? a. Lewis antibodies do not bind complement. b. Lewis antibodies may cause hemolytic reactions if detectable at 37°C. c. Lewis antibodies are IgM; therefore, they cannot cross the placenta and cause hemolytic disease of the newborn. d. Lewis antigens are finally developed around age 6.

22. What would be the probable genotype of a patient who phenotypes as ABLe (a-b-)? a. LeLe sese hh AB c. lele sese HH AB b. lele sese Hh OO d. Lele Sese hh OO 23. What is found in secretions of Le(a-b-) individuals? a. Lea c. Both a and b b. Leb d. None of the above 24. At which phase are Lewis antibodies usually detected? a. Immediate spin c. Coombs b. 37°C d. All of the above 25. How does anti-Lea differ from anti-Leb? a. Only anti-Lea will be produced in Le(a-b-) individuals. b. Anti-Lea can bind complement more efficiently. c. Anti-Leb is an IgG antibody. d. Anti-Lea is an IgM antibody.

26. Why are Lewis antibodies not generally implicated in hemolytic disease of the newborn? a. Lewis antigens are well devT elE opSedTaBt A biN rthK.SELLER.COM b. Lewis antibodies are IgM and cannot cross the placenta. c. Lewis antigens can readily dissociate from the red blood cell upon transfusion of Lewis-positive cells. d. Lewis antibodies do not bind complement.

27. Which blood group system is not based on carbohydrates? a. Lewis c. P b. Rh d. ABO 28. How is Le(y) formed? a. Fucose-B(1-4) GlcNAc is added to type 1 chain oligosaccharide. b. Fucose-A(1-3) GlcNAc is added to type 2H precursor substance. c. Fucose-A(1-4) GlcNAc is added to type 2H precursor substance. d. Fucose-B(1-3) GlcNAc is added to type 2 chain oligosaccharide.

29. It was discovered that a patient who was to receive two units of packed RBCs had an anti-Lea circulating in his system. What would be the proper procedure? a. Anti- Lea is clinically insignificant, and two units could be issued without further workup. b. Multiple units should be screened for Lea antigen, and only two of the units negative for that antigen should be transfused. c. The two units do not necessarily need to be Lea-negative but should be crossmatched through at least 37 degrees and crossmatch compatible before given d. The transfusion should be halted until specially screened units are flown in

30. The true Lewis phenotype will normally be detected at what age? a. Birth b. 10 days c. 6 years d. Not necessarily ever, as circumstances such as pregnancy may alter or mask an individual’s true Lewis phenotype 31. Which of the following statements about the Lewis system is not true? a. The Lewis phenotype depends on whether the Se gene is present. b. The system is composed of antigen found in secretions c. Genes of the Lewis system are indicated by LE and le. d. Secretion of Lewis substance is controlled by the Se gene 32. P1 antigens: a. are fully developed at birth. b. are fully developed at 6 months.

c. take up to 6 or 7 years to develop. d. none of the above.

33. I and i antigens are found in plasma, serum, and what other possible source? a. Breast milk c. Saliva b. Urine d. All of the above 34. Persons with the Kidd-null phenotype have been found in: a. Russia. c. North America. b. New Zealand. d. Saudi Arabia.

35. Lutheran antibodies are rarely associated with causing hemolytic disease of the newborn (HDN) for which of the following reasons? a. Lutheran antigens are poorly developed at birth. b. Maternal Lutheran antibodies are absorbed onto glycoproteins on the placenta, decreasing the likelihood of HDN. c. Lutheran antibodies are generally IgM class and normally do not cross the placenta. d. All of the above 36. Which of the following is not involved in the Kell blood group system? a. Jsa c. Kpb b. K d. Jka 37. Where are the Duffy antigens found? a. Red blood cells b. Platelets

c. Lymphocytes d. All of the above

38. What is the most common Kidd phenotype in the black population? a. Jk(a+b-) c. Jk(a-b+) b. Jk(a+b+) d. Jk(a-b-) 39. Why is dosage inconsistent in the Duffy blood group? a. The genotype could be inherited as FyaFyb or FyaFy for Fy(a+b-) red blood cells. b. Antigen expression is depressed in low ionic strength media. c. The genotype could be inherited as FyaFya or FyaFy for Fy(a+b-) red blood cells. d. All of the above

40. Why is it relatively easy to find compatible units for a patient with anti-K? a. Kell is a low-frequency antigen. b. Kell is a high-frequency antigen. c. Anti-K does not react at 37°C. d. Anti-K has a low avidity for its respective antigen.

41. Red blood cells were treated with ficin to help rule in anti-M from a panel study. Cells not treated reacted at 2+ at immediate spin and 1+ at 37°C. There was no reactivity in the Coombs phase. Ficin-treated cells demonstrated a reaction with patient serum containing anti-M. a. negative c. 3+ b. 2+ d. 4+ 42. The Fy5 antigen has been shown to be the result of an interaction between Duffy genes and: a. Lewis c. Rh b. ABO d. Kidd 43. A blood bank technologist needed to confirm the presence of anti-P1 in a patient specimen. Fresh cells were not available for use, so an old panel that contained cells positive for P1 was used. No cells positive for the antigen reacted at any phase of the antiglobulin test, whereas cells from the screening cells showed specificity for the presence of anti-P1. What is a possible explanation for this? a. Technician omitted LISS b. Patient expresses the p phenotype c. P1 antigen deteriorates rapidly upon storage d. Technician forgot to add AHG 44. What will happen to I antigen expression when ABH sugars are removed from red blood cells? . LNLoEeR ff. ecC t OM a. Increased expression TESTBANKScE b. Decreased expression d. None of the above 45. What is the International Society of Blood Transfusion (ISBT) assignment for the antigen P²? a. 003001 c. 003100 b. 004001 d. 005001 46. What is the definition of a blood group system? a. A group of antibodies produced by alleles at a single gene locus b. A group of antigens produced by alleles at a single gene locus c. A group of antibodies produced by alleles at multiple genetic loci d. A group of antigens produced by alleles at multiple genetic loci 47. Where are the Kell blood group antigens found? a. Red blood cells c. Lymphocytes b. Platelets d. All of the above 48. Anti-M was detected in a 27-year-old man before surgery. Units negative for M antigen were not available; however, the units were approved for transfusion when major crossmatch using M+N+ donor cells and patient serum resulted in: a. IS = 1+, 37 = 1+, AHG = 0 c. IS = 3+, 37 = 2+, AHG = 1+ b. IS = 1+, 37 = 0, AHG = 0 d. IS = 2+, 37 = 1+, AHG = 0 49. Which of the following is known to enhance K antigen expression in the antihuman globulin test? a. LISS c. Albumin b. DTT d. Polyethylene glycol

50. Anti-Lua reacts at what temperature? a. Room temperature b. 37°C

c. AHG d. All of the above

51. At what phase of the antihuman globulin test will anti-Kell be detected? a. IS c. AHG b. 37°C d. All of the above 52. What is the function of a GPB-GPA hybrid (anti-Lepore type)? a. Encodes normal GPA c. Encodes the COOH end of GPB d. Encodes the NH2 end of GPB b. Encodes altered GPB 53. Persons who phenotype negative for U antigen lack Ss-SGP because of a partial or complete deletion of . a. GPA c. N-acetylneuraminic acid b. GPB d. N-acetylgalactosamine 54. What sample requirement is essential for identification of a Kidd antibody? a. Fresh whole blood c. Fasting sample b. Fresh serum or plasma d. Sample on ice 55. What does the U in U antigen stand for? a. unusual b. universal

c. uniform d. unique

56. Infection with which organism is associated with naturally occurring IgM anti-K. a. Escherichia coli c. Campylobacter coli TESTBANKS dE . LALllEoR f. thC eO abM ove b. Mycobacterium species 57. The M and N antigens are found in which glycoprotein? a. Glycophorin A c. Glycophorin C b. Glycophorin B d. Band 3 58. How can pathologic anti-I be differentiated from benign anti-I? a. Immunoglobulin class c. Broad thermal range of reactivity b. Binding of complement d. All of the above 59. Which of the following distinguishes the recessive LuLu gene from the dominant In(Lu) gene? a. Normal expression of P1 b. Abnormal expression of P1 c. Expression of the Lu(a-b-) phenotype d. Expression of trace amounts of i antigen 60. All of the following are characteristics of Kidd antibodies except: a. IgG immunoglobulins. c. naturally occurring. b. ability to bind complement. d. exhibit dosage.

61. When red blood cells are placed in a solution of 2M urea, the red blood cells will lyse. However, it has been shown that which red blood cells are resistant to lysis? a. Jk(a+b-) c. Jk(a-b-) b. Jk(a+b+) d. Jk(a-b+)

62. What MN phenotype is found in highest frequency in the white population? a. M+N+ c. M-Nb. M+Nd. M-N+ 63. The M and N antigens exhibit dosage. Therefore, if a person inherits the homozygous genotype MM, their red blood cells will react with anti-M than/as those of a person with a heterozygous genotype of MN. a. stronger c. the same b. weaker d. none of the above 64. Anti-M will react strongest with which cells? a. M+Nb. M+N+

c. M-Nd. M-N+

65. The Lu gene shares chromosome 19 with what other blood group gene? a. H c. LW b. Le d. All of the above 66. The homozygous phenotype Fy(a+b-) has a. more b. fewer

antigenic Fy sites than heterozygous cells, Fy(a+b+). c. weaker d. none of the above

67. What is the source of anti-M lectin? a. Bauhinia candicans b. Dolichos biflorus

c. Iberis amara d. Bandeiraea simplicifolia

68. All of the following are grouped with the para-Kell antigens except: a. K18. c. K22.

TESTBANKS dE . LKL1E 4.R.COM b. K11.

69. What anemia will result in an increased expression of i antigen, which exceeds that found on control cord cells? a. Sideroblastic anemia c. CDA type II b. CDA type I d. CDA type III 70. The Kell gene is located on the long arm of which chromosome? a. 5 c. 9 b. 7 d. 11 71. At what age does I antigen become detectable on infant cells? a. 1 year c. 4 years b. 18 months d. 1 month 72. What red blood cell antigens do McLeod individuals express? a. TracekKpbJsbK11 c. None b. KmKx d. KkKpbJsa 73. What characteristic differentiates Ss antigens from MN antigens? a. Antigens well developed at birth b. S and s exhibit dosage c. Enzyme degradation d. Biochemical structure rich in sialic acid 74. A person who inherits alleles Fya and Fyb will carry which antigens on their red blood cells? a. Only Fya antigen c. Both Fya and Fyb antigen b b. Only Fy antigen d. Neither Fya or Fyb antigen

75. What is the ISBT designation for the Ii blood groups? a. 200 c. 300 b. 207 d. 310 76. On which malaria receptor site is Duffy antigen dependent? a. Attachment receptor c. Ligand receptor b. Junction receptor d. None of the above 77. The structures that carry the P antigens also carry which determinants? a. A c. B b. I d. All of the above 78. A patient who has a pathologic autoanti-I must be transfused with: a. a leukocyte filter. b. a cold pack. c. a blood warmer d. none of the above 79. What is the etiology of dialysis-associated anti-N? a. Formaldehyde alters the N antigen so that it is recognized as foreign. b. Most renal patients express the phenotype M+N-S-s- where most potent forms of anti-N are found. c. Treatment of renal patients depresses N-antigen expression. d. None of the above 80. The genes that code for GPA and GPB are closely linked on the long arm of which chromosome?

TESTBANKScE . L4LER.COM a. 9 b. 11 d. 15 81. Persons who express the phenotype P2 are at risk for developing anti-P1 when handling what animal species? a. Dogs c. Pigeons b. Cats d. Mice 82. Persons who inherit the In(Lu) gene will exhibit: a. Jk(a-b+) red blood cells that can elute anti-Jk3. b. Jk(a+b-) red blood cells that can elute anti-Jka. c. Jk(a+b-) red blood cells that can absorb anti-Jk3. d. Jk(a-b-) red blood cells that can absorb anti-Jka. 83. What abnormal blood cell morphology is associated with the McLeod phenotype? a. Spherocytes c. Sickle cells b. Ovalocytes d. Acanthocytes 84. What organism is capable of converting Jk(b-) red blood cells to Jk(b+)? a. Escherichia coli c. Proteus vulgaris b. Micrococcus species d. Streptococcus pneumoniae 85. What is the ISBT designation for the Lutheran blood group system? a. LN c. LT b. LU d. LR

86. How are lipids dissociated from the red blood cell membrane for biochemical studies? a. Increased pH c. Sodium dodecyl sulfate b. Ion exchange d. Organic solvents 87. Persons who are negative for Duffy antigens are less likely to contract which of the following diseases? a. Chicken pox c. Malaria b. Influenza d. Polio 88. What type of hemolytic transfusion reaction (HTR) occurs more frequently in patients with Jk antibodies? a. Febrile c. Immediate b. Delayed d. Bacterial 89. Anti-I is found in association with what microorganism? a. Mycoplasma pneumoniae c. Escherichia coli b. Treponema pallidum d. Proteus vulgaris 90. Autoantibodies to Jka have been found in patients taking: a. ibuprofen. c. methyldopa. b. penicillin. d. none of the above.

91. What adult phenotype is rich in i antigen and common to the white population? a. I1 c. i1 b. I2 d. i2 92. Units that were positive for P² antigen had to be crossmatched with serum of a patient containing the corresponding antibody because of a short supply of blood. Which of the following crossmatch results would be considered acceptable for transfusion?

TESTBANKScE O0M, AHG=0 . LIL S=E1R +,.3C 7= a. IS=2+, 37=1+, AHG=0 b. IS=0, 37=2+, AHG=1+ d. IS=0, 37=2+, AHG=3+ 93. Most blood group alleles are: a. X-linked dominant. b. X-linked recessive.

c. codominant. d. none of the above.

94. What Kidd antibody will react with all panel cells and phenotype as Jk(a-b-)? a. Anti-Jka c. Anti-Jk3 b. Anti-Jkb d. None of the above 95. What is the most common genetic combination in the Kell blood group system? a. kKKpbJsb c. kKpbJsbK11 b. kKpbJsaK11 d. KKpbJsbK11 96. All of the following are characteristics of Duffy antibodies except: a. they are IgG in nature. c. they are destroyed by enzymes. b. they may or may not show dosage. d. they are not implicated in HDN. 97. Anti-Jka was identified in a previously transfused patient. Five cells that were homozygous for Jka yielded 2+ reactions in the AHG phase. The same cells were treated with ficin and yielded 3+ reactions in AHG. Therefore, Jka is by enzyme treatment. a. destroyed c. unaffected b. enhanced d. none of the above

98. All of the following are characteristics of the Ena antigen except: a. it is a high-frequency antigen. b. it is a low-frequency antigen. c. individuals negative for Ena lack MN-SGP. d. most Ena-negative individuals produce anti-Ena. 99. What sequence of antigens coincides with strongest immunogen to weakest immunogen? a. D, Fya, Fyb, K c. Fya, Fyb, D, K a b b. D, K, Fy , Fy d. K, Fya, Fyb, D 100. Anti-N will react stronger with which phenotype? a. M+N+ c. M+Nb. M-N+ d. M-N101. The Ii antigens are found on the membranes of which structures? a. Platelets c. Red blood cells b. Leukocytes d. All of the above 102. Where are the Kidd antigens found? a. Red blood cells b. Platelets

c. Lymphocytes d. Monocytes

103. Why do En(a-) individuals have a reduced chance of infection with Plasmodium falciparum? a. There is a reduction in N-acetylneuraminic acid. b. There is an increase in N-acetylneuraminic acid. c. GPB is in an altered state. d. There is a reduction in N-acetylgalactosamine.

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a

104. How is the En antigen related to the Wr(a-b-) phenotype? a. En(a-) red blood cells are all Wr(a-b-) b. En(a+) red blood cells are all Wr(a-b-) c. All Wr(a-b-) red blood cells are also M-Nd. En(a-) individuals lack MN-SGP 105. Anti-N is known to occur in formaldehyde? a. cancer b. thyroid

patients undergoing dialysis with equipment sterilized by c. renal d. immunocompromised

106. Anti-Anton recognizes the same specificity as: a. anti-Wj. c. anti-Lu3. b. anti-Aua. d. anti-Lub. 107. Approximately what percentage of the black population are s-? a. 70% c. 3% b. 98% d. 25% 108. What can be done to rule in anti-M when only M+N+ red blood cells are available? a. Decrease the 37°C incubation time. b. Use potentiating agents such as LISS. c. Decrease the serum-to-cell ratio. d. Use plasma anticoagulated in an acidic medium.

109. What fatal disease is associated with the McLeod phenotype? a. Graves' disease c. Lymphoma b. Chronic granulomatous disease d. Fanconi's syndrome 110. Which of the following statements regarding individuals who are Fy(a-b-) is true? a. The presence of Fyb in the tissue of individuals who are black who are Fy(a-b-) prevents those individuals from forming Anti-Fyb. b. The presence of Fya substance in individuals who are white who are Fy(a-b-) prevents those individuals from forming Anti-Fya. c. All individuals that are Fy(a-b-) are likely to form anti Fyb if exposed to the Fyb antigen. d. Anti Fyb can only be produced from individuals that have inherited the Duffy gene.

111. Why is it strongly recommended that only homozygous cells be used when ruling out Kidd antibodies? a. Anti-Jka may appear compatible with homozygous cells [Jk(a+b-)]. b. Anti-Jka may appear compatible with heterozygous cells [Jk(a+b+)]. c. It will reduce the number of false-positive results. d. Options A and C 112. A woman undergoing a hysterectomy requires two units of blood. The antibody screen was negative. One unit was incompatible in the Coombs phase (2+), the other unit was compatible. Give a reason why this antibody was not detected in the antibody screen. a. Existence of a high-frequency antigen b. Existence of a low-frequency antigen c. Antibody has low avidity to cell receptor d. Options A and C 113. What is the etiology of chronic gTraEnS ulT om diE seL asL eE (CRG.DC )?OM BaAtoNuKs S a. Muscular degeneration caused by a mutated X gene b. Phagocytes are unable to generate hydrogen peroxide, which is used to kill invading bacteria. c. Alteration in red blood cell membrane, allowing passage by bacteria d. Inability to generate leukocytes from the bone marrow 114. What are the antibody characteristics of Fy3, Fy4, and Fy5? a. Immunogenic c. Reactive at AHG b. IgG d. All of the above 115. What finding may protect individuals from making alloanti-Lub in dominant In(Lu) genotypes? a. The ability to neutralize anti-Lub b. The ability to absorb and elute anti-Lub c. Trace amounts of Lua on red blood cells d. The ability to secrete Lub substance in plasma 116. Persons who are genetically P1 may serologically type as P2 because of: a. inheritance of the In(Lu) gene. c. presence of anti-P1 in their serum. b. inheritance of the p gene. d. depressed antigen expression.

117. What biochemical observations signify a protein composition to the Kell antigens? a. Degradation with formaldehyde c. Cell-membrane orientation b. Inactivation at 56°C d. None of the above

118. Most Kell autoantibodies are directed against which antigens that are usually undefined? a. Low-frequency c. Soluble b. High-frequency d. Leukocyte 119. Black persons who genotype as Fy4Fy4 will phenotype as: a. Fy(a+b+) c. Fy(a-b-) b. Fy(a+b-) d. Fy(a-b+) 120. What is the ISBT designation for the Kell system? a. 001 c. 006 b. 009 d. 100 121. The Duffy antigens have mobility characteristics similar to what other antigenic structure? a. Ss-SGP c. H precursor structure b. MN-SGP d. Jka protein 122. What Kell phenotype is found in highest frequency in the white population? a. K+k+ c. K-k+ b. K+kd. K0 123. All of the following are characteristics of anti-M except: a. they are naturally occurring antibodies. b. they do not bind complement. c. they react stronger with enzyme-treated cells. d. antibodies may exhibit an IgG component.

124. Anti-i is found in association with what disease?

TESTBANKScE . LSLyE phRil. isCOM a. Pneumonia b. Infectious mononucleosis d. Gonorrhea 125. What is the ISBT designation for the Kidd blood group system? a. 101 c. 002 b. 009 d. 107 126. What biochemical substituent is responsible for the i determinant? a. Two repeating N-acetyllactosamine units on H3 structures b. Two repeating N-acetyllactosamine units on H4 structures c. Two repeating N-acetyllactosamine units on H2 structures d. Two repeating N-acetyllactosamine units on H1 structures 127. What serologic factor distinguishes anti-Fy3 from anti-Fya or anti-Fyb? a. It is not destroyed by enzymes. c. It does not bind complement. b. It is an IgM antibody. d. It does show dosage.

128. What portion of GPA reacts with anti- EnaFR? a. Phenylalanine resistant c. Ficin resistant b. Phenylalanine sensitive d. Ficin sensitive 129. Persons who phenotype as Fy(a-b-) are resistant to infection by which organism? a. Plasmodium falciparum c. Plasmodium ovale b. Plasmodium vivax d. Plasmodium malariae

130. Alloanti-Lub will react a. stronger b. weaker

with Lu(a+b+) cells than/as with Lu(a-b+) cells. c. the same d. none of the above

131. How is the Luke (LKE) system related to the P blood group system? a. Anti-LKE reacts with all p individuals. b. Anti-LKE reacts with all P1 and P2 individuals. c. Persons who do not express the Luke antigen lack neuraminic acid. d. Luke-positive individuals occur more in persons who are group O. 132. At birth, infant cells are rich in a. I/i b. I/H

, and

is nearly undetectable. c. i/I d. H/i

133. Why is HDN not a consideration when the mother possesses anti-P1 in her serum? a. Anti-P1 is an IgM antibody. b. P1 antigen is poorly expressed at birth. c. Anti-P1 does not react at 37°C. d. Anti-P1 is a naturally occurring antibody.

134. All of the following characteristics regarding the Kell antigen are true except: a. it is well-developed at birth. c. it is destroyed by ficin treatment. b. it exhibits dosage. d. it is strongly immunogenic.

135. What is the biochemical structure of the P system antigens? a. Phospholipid c. Glycosphingolipids b. Glycophorin B d. Glycophorin A

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136. Which of the following is TRUE concerning the I and i antigens? a. I and i antigens are antithetical. b. I and i antigens have a reciprocal relationship. c. Adult RBCs i antigen positive and I antigen negative. d. Infant’s RBCs convert from I to i antigen in 18 months.

137. Anti-Lu3 will be compatible with donor blood from individuals with which of the following phenotypes? a. Lu(a-b+) c. Lu (a-b-) b. Lu (a+b-) d. Lu (a+b+) 138. Where are the P antigens found? a. Red blood cells b. Platelets

c. Tissue fibroblasts d. All of the above

139. What amino acid is specific for S antigen? a. Glycine b. Threonine

c. Methionine d. Aspartic acid

140. Why does anti-Lua go undetected in routine testing? a. Anti-Lua demonstrates low avidity c. Most reagent cells are Lu(a-) b. Most reagent cells are Lu(a+) d. None of the above 141. Why was U antigen included in the MNSs blood group system? a. U is enhanced by enzyme treatment. b. All U-negative red blood cells were also S-s-.

c. All U-positive red blood cells were also S+s+. d. All U-negative red blood cells were also M-N-.

142. Duffy antigens are destroyed by: a. AET. b. ficin.

c. neuraminidase. d. neuraminidase and AET.

143. A person who inherits the In(Lu) gene will not express which antigens? a. Lua c. c b. K d. S 144. Dithiothreitol (DTT), when used alone, can destroy antigens in which blood group system? a. Duffy b. Kell c. Kidd d. Lewis 145. The gene that codes for P1 is located on which chromosome? a. 22 c. 9 b. 12 d. 4 146. What class of immunoglobulin makes up anti-Lua? a. IgA c. IgG b. IgM d. All of the above 147. Which population has the greatest frequency of the Fy(a-b-) phenotype? a. White c. Asian b. Black rican TESTBANKSdE. LNLaEtivRe.ACmOeM 148. Anti-Fs is more likely to react with which cells? a. Fy(a+b-) c. Fy(a+b-) b. Fy(a-b-) d. Fy(a-b+) 149. The Miltenberger subsystem is related to what major blood group system? a. Rh c. P b. Kell d. MNSs 150. How were Aua and Aub initially linked to the Lutheran system? a. Enhanced by enzymes (trysin) b. Well-expressed on cord cells c. Suppression by In(Lu) gene d. Antigens active on H precursor substance 151. Patients diagnosed with , where the autoantibody is directed against the K antigen, may exhibit a diminished expression of antigen. a. autoimmune hemolytic anemia c. rheumatoid arthritis b. lupus erythematosus d. chronic granulomatous disease 152. What is the most common Lutheran phenotype in the white population? a. Lu(a+b-) c. Lu(a-b+) b. Lu(a-b-) d. Lu(a+b+) 153. How do MN antigens differ in their biochemical protein structure? a. M contains serine at position 1 and N contains glycine. b. N contains glutamic acid at position 5 and M contains glycine.

c. N contains glycine at position 5 and M contains arginine. d. M contains serine at position 1 and N contains lysine.

154. Anti-Lua is destroyed by what enzyme? a. Trypsin b. Ficin

c. Papain d. All of the above

155. Which organ removes cells coated with Jk antibodies from circulation? a. Spleen c. Kidneys b. Liver d. Bone marrow 156. All of the following are characteristic of anti-P1 except: a. the antibody is IgM. b. the antibody reacts strongly at room temperature. c. the antibody is not neutralized by soluble P1 substance. d. the antibody may be detected in AHG phase of antiglobulin test if polyspecific antiserum is used.

157. What is Kell's antithetical partner? a. Penney b. Cellano

c. Sutter d. Rautenberg

158. Autoantibodies to U antigen may be found in patients with: a. paroxysmal cold hemoglobinuria. b. cold autoimmune hemolytic anemia. c. warm autoimmune hemolytic anemia. d. drug-induced hemolytic aneT mE iaS . TBANKSELLER.COM 159. What name is attached to the Ena antigen? a. Envelope b. Enterprise

c. Envision d. Epitope

160. Which has been shown to define the Duffy receptor that Plasmodium vivax uses to penetrate red blood cells? a. Anti-Fy3 c. Anti-Fy6 b. Anti-Fy5 d. Anti-Fy4 161. What is unique about the Kpa antigen? a. It occurs in as high a frequency as its antithetical partner, Kpb. b. It suppresses the expression of k and Jsb. c. It enhances the expression of k and Jsb. d. Its inheritance is most often a result of a consanguineous marriage.

162. All of the following characteristics are consistent with benign anti-I except: a. it is naturally occurring. c. it does not bind complement. b. it is IgM. d. it is reactive at 4°C. 163. Why are the M and N antigens important for paternity testing? a. Antigens are well developed on father's red blood cells. b. Antigens are poorly developed on mother's cells. c. Antigens are well developed at birth. d. Antigens are fully developed at 2 years of age.

164. Hemolysis associated with ficin-treated cells is more common with which red blood cells? a. Jk(a+b+) c. Jk(a+b-) b. Jk(a-b+) d. All of the above 165. Why are P1 individuals susceptible to urinary tract infections by Escherichia coli? a. E. coli attach to antigen glycolipids on uroepithelial cells. b. Polysaccharides from bacteria coat antigens on red blood cells. c. P1 individuals have a decreased amount of immunoglobulins. d. The fimbriae of E. coli have receptor sites for sialic acid.

166. Serologic tests determine a person's: a. genotype. b. haplotype.

c. phenotype. d. all of the above.

167. What effect do enzyme-treated cells have on anti-I detection? a. Enhances reactivity c. No effect b. Destroys reactivity d. None of the above 168. A cold antibody panel was performed to help identify an antibody that reacted at room temperature. The results of the panel are as follows: A1 cells = 0, A2 cells = 2+, B cells = 3+, O adult cells = 4+, Cord O cells = 1+. This is consistent with which antibody? a. Anti-IH c. Anti-i b. Anti-I d. Aanti-H 169. A patient who had a viral infection suspected to be Infectious mononucleosis may develop which antibody? a. Anti-I c. Anti-P b. Anti-i d. Anti-p

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170. A woman came in for a cesarean section. The antibody screen was positive with a 3+ reaction in the AHG phase using screening cell I. Screening cells II and III were negative in all phases. An 8-cell panel was performed that paralleled the antibody screen, where three cells reacted 3+ at AHG and five cells were negative at all phases of reactivity. The antibody identified was anti-Kell. What procedure might be helpful in predicting the infant's susceptibility to HDN? a. Determination of the mother's phenotype b. Determination of the father's phenotype c. Plasmapheresis of the mother's plasma d. A fetal screen (rosette test) on the mother 171. Type I H antigen in secretions is a product of which of the following genes? a. H c. Se b. Le d. le 172. A patient who recently recovered from a Mycoplasma pneumoniae infection may develop which antibody? a. Anti-I c. Anti-P b. Anti-i d. Anti-p 173. Antibodies to the blood groups below exhibit dosage EXCEPT: a. Duffy c. Kidd b. Kell d. MNS 174. Red blood cell antigens are written using which of these conventions? a. Genes are written in italics. b. Genes are written using all capitals.

c. Genes are written using bolded font. d. Genes are written with super and subscripts.

175. Which of the following techniques/reagents may be useful in increasing the reactivity of anti-M? a. Papain pretreated cells c. Acidified serum techniques b. Anticomplement AHG reagents d. Heterozygous MN Cells 176. Name the substance used to neutralize antibodies to P1. a. Papain c. Dolichos biflorus b. Hydatid cyst fluid d. Milk 177. You have a patient with Anti-P1. Theoretically, how many units would be compatible if you set up 10 units of blood? a. 2 c. 6 b. 4 d. 9 178. Enzymes destroy the antigens of which of the following blood groups? a. N c. M b. Fya d. All of the above 179. Which antigen(s) is/are antithetical partner(s) to s? a. MN c. U b. E d. f 180. What antibody gives a 1+ reaction in undiluted and diluted samples? a. High incidence c. High titer, low avidity b. Low incidence d. Low titer, high avidity

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181. Which group of antigens below best represents the definition of high-frequency antigens? a. Jsb, Kpb c. Kpa, Jsa b. K, k d. Jka, K 182. A patient presented in the emergency room needing to be transfused ASAP. According to the computer, the patient had a Kell antibody 5 years ago. The antibody screen is negative now. Of the following, the best procedure to obtain suitable blood for transfusion is: a. to use immediate spin crossmatch compatible blood. b. to take the time to crossmatch the units of blood through the AHG phase. c. to antigen type the units for Kell and completely crossmatch the negative ones. d. to assume the electronic crossmatch is acceptable.

183. Which of the following blood groups is inherited from the parents but absent at birth? a. P1 c. Lutheran b. Lewis d. Fya 184. Which of the following are written in the order of allele, antigen, and phenotype? a. A1, A1, A1 b. A1, A1, A1 c. A1, A1, A1 d. A1, A1, A1

185. Which of the follow lists of phenotypes is written correctly? a. S+s+, K–; Fy(a+b–) b. S+s+ / K– / Fy(a+b–) c. S+s+; K–; Fy(a+b–) d. S+s+: K–: Fy(a+b–) 186. RBCs from an adult are suspected of having a rare i-antigen. Which of the follow reactions is expected with these cells? a. Anti-I strong; Anti-I weak; Anti-IT- weak b. Anti-I weak; Anti-I strong; Anti-IT- strong c. Anti-I weak; Anti-I strong; Anti-IT- weak d. Anti-I weak; Anti-I weak; Anti-IT- strong 187. Cord blood cells and adult cells that have the rare i phenotype will both demonstrate which reaction? a. Strong with Anti-I and weak with Anti-i b. Strong with both Anti-I and Anti-i c. Weak with both Anti-I and Anti-i d. Weak with Anti-I and strong with Anti-i

Chapter 8. Blood Group Terminology and the Other Blood Groups Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: C 3. ANS: A 4. ANS: C 5. ANS: B 6. ANS: B 7. ANS: D 8. ANS: C 9. ANS: D 10. ANS: B 11. ANS: C 12. ANS: A 13. ANS: A 14. ANS: C 15. ANS: B 16. ANS: A 17. ANS: A 18. ANS: D 19. ANS: D 20. ANS: A 21. ANS: A 22. ANS: C 23. ANS: D 24. ANS: A 25. ANS: B 26. ANS: B 27. ANS: B 28. ANS: B 29. ANS: C 30. ANS: D 31. ANS: D 32. ANS: C 33. ANS: D 34. ANS: B 35. ANS: D 36. ANS: D 37. ANS: A 38. ANS: A 39. ANS: C 40. ANS: A 41. ANS: A

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 TESTBANKEY: KSELTaxonomy LER.COLevel: M 3 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3

LO: 8-4 LO: 8-18 LO: 8-4 LO: 8-5 LO: 8-4 LO: 8-4 LO: 8-5 LO: 8-6 LO: 8-5 LO: 8-6 LO: 8-18 LO: 8-3 LO: 8-4 LO: 8-4 LO: 8-4 LO: 8-18 LO: 8-3 LO: 8-4 LO: 8-6 LO: 8-6 LO: 8-18 LO: 8-5 LO: 8-6 LO: 8-18 LO: 8-18 LO: 8-18 LO: 8-3 LO: 8-4 LO: 8-3 LO: 8-3 LO: 8-5 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-11 LO: 8-21 LO: 8-8 LO: 8-3

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 8-3 LO: 8-16 LO: 8-16 LO: 8-2 LO: 8-3 LO: 8-3 LO: 8-19 LO: 8-20 LO: 8-3 LO: 8-3 LO: 8-10 LO: 8-10 LO: 8-3 LO: 8-11 LO: 8-3 LO: 8-10 LO: 8-3 LO: 8-9 LO: 8-3 LO: 8-27 LO: 8-8 LO: 8-21 LO: 8-3 LO: 8-3 LO: 8-11 LO: 8-19 LO: 8-3 LO: 8-14 LO: 8-3 LO: 8-3 LO: 8-22 LO: 8-3 LO: 8-3 LO: 8-2 LO: 8-26 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-10 LO: 8-19 LO: 8-3 LO: 8-25 LO: 8-3 LO: 8-2 LO: 8-3 LO: 8-23 LO: 8-23

89.

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134.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 : LTL axEoR no.mCyOLM evel: 3 1 TESTBANKKESYE 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 8-24 LO: 8-23 LO: 8-8 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-16 LO: 8-3 LO: 8-3 LO: 8-10 LO: 8-3 LO: 8-3 LO: 8-26 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-11 LO: 8-3 LO: 8-25 LO: 8-11 LO: 8-12 LO: 8-3 LO: 8-25 LO: 8-3 LO: 8-12 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-11 LO: 8-2 LO: 8-3 LO: 8-9 LO: 8-3 LO: 8-24 LO: 8-2 LO: 8-3 LO: 8-3 LO: 8-10 LO: 8-26 LO: 8-13 LO: 8-3 LO: 8-14 LO: 8-14 LO: 8-3

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2

LO: 8-3 LO: 8-7 LO: 8-12 LO: 8-3 LO: 8-3 LO: 8-12 LO: 8-3 LO: 8-16 LO: 8-9 LO: 8-17 LO: 8-3 LO: 8-3 LO: 8-11 LO: 8-3 LO: 8-3 LO: 8-12 LO: 8-20 LO: 8-9 LO: 8-3 LO: 8-16 LO: 8-3 LO: 8-3 LO: 8-3 LO: 8-11 LO: 8-3 LO: 8-26 LO: 8-9 LO: 8-3 LO: 8-19 LO: 8-16 LO: 8-3 LO: 8-3 LO: 8-16 LO: 8-14 LO: 8-24 LO: 8-22 LO: 8-3 LO: 8-24 LO: 8-21 LO: 8-1 LO: 8-3 LO: 8-16 LO: 8-8 LO: 8-16 LO: 8-8 LO: 8-3

181. ANS: A 182. ANS: C 183. ANS: D 184. ANS: B 185. ANS: C 186. ANS: C 187. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1

KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1

LO: 8-8 LO: 8-20 LO: 8-3 LO: 8-1 LO: 8-1 LO: 8-15 LO: 8-15

Chapter 9. Uncommon Blood Groups Multiple Choice Identify the choice that best completes the statement or answers the question.

1. ISBT nomenclature for the Xg System is a. 002 b. 006

c. 012 d. 024

2. Antigens in the CH/RG blood group system are described as: a. resistant to ficin treatment. b. antithetical partners. c. well developed on cord cells. d. adsorbed onto the red blood cell membrane.

3. Which antigen is expressed on C4B complement fragments? a. Cha c. Yka b. Kna d. Gya 4. A plasma inhibition study was performed on a patient whose serum sample reacted +/– on all panel cells at AHG. Three sets of A, B, C tubes were set up according to the following scheme: Tube A had 2 drops of patient serum and 1 drop of Ch(a+) Rg(a-) plasma.

Tube B had 2 drops of patient serum and 1 drop of Ch(a-) Rg(a+) plasma.

Tube C had 2 drops of patient serum and 1 drop of Ch(a+) Rg(a+) plasma.

Screening cells were added in trT ipE licSatTe B anAdNinKcS ubEatL edLfE orR6.0CmOinMutes at 37°C. The antiglobulin test was performed. All three A tubes reacted at 2+, and the B and C tubes were negative. What antibody is indicated? a. Anti-Cha c. Another alloantibody b. Anti-Rga d. None of the above 5. The Dia and Dib antigens are located on: a. complement receptor one (CRI). b. erythrocyte acetylcholinesterase. c. the anion exchange molecule (AE-1). d. channel-forming integral protein (CHIP).

6. Which of the following is true concerning Colton antibodies? a. Encountered frequently b. Destroyed by enzymes c. React at immediate spin d. Stimulated by red blood cell exposure 7. Anti-Sc3 will react with which Scianna phenotype? a. Sc: -1, +2 c. Sc: +1, -2 b. Sc: +1, +2 d. All of the above 8. An antibody that reacts in the IAT phase of the antiglobulin test and whose antigen expression is depressed by the In (Lu) gene is: a. anti-Xga. c. anti-Inb. b. anti-Ytb . d. anti-Sc1.

9. The gene for which blood group antigen is located on the petite arm of the X chromosome? a. Sc1 c. Coa a b. Xg d. Doa 10. The seven Gerbich antigens are located on: a. glycophorins A and B. b. glycophorins C and D.

c. glycophorins A and D. d. glycophorins B and C.

11. The high-incidence Gya, Hy, and Joa antigens belong to which blood group system? a. Wr c. DO b. DI d. Sc 12. Knops antigens are present in most populations at a rate of: a. 10% c. 60% b. 30% d. 90% 13. The following is true regarding anti-Doa and anti-Dob. a. They are destroyed by enzymes. b. They are frequently naturally occurring. c. They are known to cause HTRs. d. They are known to cause clinical HDN.

b.

14. What blood group antigens are involved in the regulation of complement because they are located on decoy accelerating factor? a. CO c. CROM DO TESTBANKSdE. LILNER.COM 15. Where might you expect anti-Ytb to react in antibody screening? a. Immediate spin phase c. IAT phase b. 37°C phase d. All of the above 16. How does complement aid in the identification of alloantibodies masked by anti-Cha? a. C4d in plasma will absorb anti-Cha. c. C3d in plasma will absorb anti-Cha. a b. C3b in serum will absorb anti-Ch . d. C4a in plasma will absorb anti-Cha. 17. Anti-Wrb has been frequently observed in patients: a. with paroxysmal cold hemoglobinuria. b. with warm autoimmune hemolytic anemia. c. taking penicillin. d. with paroxysmal nocturnal hemoglobinuria.

18. Bg antibodies are primarily directed toward antigenic determinants present on: a. white blood cells. c. platelets. b. red blood cells. d. meso cells.

19. The Wright blood group antigens belong to which blood group system? a. Wr c. DO b. DI d. SC 20. LW has a phenotypic relationship with the a. D b. P1

antigen. c. M d. Wra

21. Both anti-Dia and anti-Dib are known to: a. cause severe HDN. b. bind complement. c. occur as a result of red blood cell stimulation. d. react at the 37°C and IgG phases.

22. What percentage of the female population is Xg(a+)? a. 50% c. 89% b. 66% d. 40% 23. What criteria must be met for an antigen to be assigned to a blood group system? a. Must be a red blood cell antigen b. Must be assigned to a unique chromosomal locus c. Must be controlled by a single gene or two closely linked genes d. All of the above 24. The rarely encountered Scianna antibodies react in which phase of the antibody screen? a. Immediate spin c. AHG b. 37°C d. All of the above 25. Which antibody is viewed to be clinically significant because of its association with HTR and HDN? a. Anti-Bga c. Anti-Dib a b. Anti-Kn d. Anti-Cha 26. All of the following are inconsistent with Xga antibody characteristics except: a. reactive at the IAT phase. c. resistant to enzymes. b. IgM immunoglobulins. d. known to cause HTRs.

TESTBANKSELLER.COM

27. The Sc1 antigen occurs in approximately what percentage of the random population? a. 100% c. 10% b. 50% d. 35% 28. Which statement is true concerning the Cartwright antigens? a. The Ytb antigen is a strong immunogen. b. Cord blood tests as Yta negative. c. The Yta is inherited as a dominant allele. d. Ytb is a high-frequency antigen.

29. Which antigen in the high-incidence series (901) is usually IgM and occasionally causes hemolysis? a. Vel c. Lan b. JMH d. Sda 30. Disease associations have linked which Colton phenotype with monosomy-7? a. Co(a+b-) c. Co(a-b+) b. Co(a+b+) d. Co(a-b-) 31.

is an antigen in the high-prevalence series (901) that is found in saliva and urine. The corresponding antibody typically reacts at the AHG phase and produces a characteristic refractile, mixed-field reaction. a. Vel c. Lan b. JMH d. Sda

32. Which antigen is useful as a genetic marker for Mongolian derivation and anthropologic studies? a. Yta c. Sda

b. Dia

d. Xga

33. Which population is most likely to exhibit the Di(b-) phenotype? a. Central America b. Native Americans

c. South America d. All of these

34. The Hu antigen is present in the highest prevalence in which people group? a. African Americas c. West Africans b. Native Americans d. Southeast Asians 35. The presence of normal GPA (MNS system) is required for the expression of: a. Coa c. Wrb b b. Do d. Yta 36. Which antigen is associated with Dombrock null? a. Gy c. Jo b. Hy d. None of these 37. Gy(a–) RBCs are also a. Do(a–b–). b. Do(a–b+).

c. Do(a+b–). d. Do(a+b+).

38. Most the antigens in the blood group collections are a. high frequency. c. BotT h.ESTBANKSELLER.COM b. low frequency. d. Neither.

39. Which of these is the Gerbich null phenotype? a. Gerbich b. Leach

c. Yus d. None of these

40. Low prevalence Gerbich-negative phenotypes include all of these EXCEPT a. Ana c. Lsa b. Ge2 d. Wb

41. High prevalence Gerbich-negative phenotypes include all of these EXCEPT a. GEAT c. GEPL b. GEIS d. GETI

42. Which antigen is denatured by enzymes? a. ABTI b. Cromer

c. LW d. All of these

43. Which antigen is resistant to DTT? a. Chido

c. Knops

b. Dombrock

d. All of these

44. Which antigen is destroyed by DTT? a. Dombrock b. JMH

c. Knops d. All of these

45. Which antibody is enhanced with enzymes? a. Colton b. Gill

c. Forssman d. All of these

46. In testing blood cells for the Knops antigen, which would most likely be positive? a. Cord blood c. Fresh units from West Africans b. Fresh units from Caucasians d. Older units from any population 47. Which of the following is a characteristic of the Rh-associated glycoprotein (RhAG) ? a. RhAG does not have Rh blood group antigens. b. RhAG is present in a complex with the Rh proteins. c. RhAG is essential for Rh antigen expression. d. These are all characteristics of RhAG. 48. Which of the following antigens is NOT part of the Rh-Associated Glycoprotein System? a. b. c. d.

DCE DSLK Duclos Ola

49. Why was the Forssman system originally thought to be an A subgroup? a. b. c. d.

Cross-reactivity with monoclonal anti-A1 Cross-reactivity with monoclonal anti-A2 Cross-reactivity with polycolonal anti-A No cross-reactivity with polycolonal anti-A

50. Why are the antibodies to the COST collection antigens difficult to identify? a. b. c. d.

The COST antigens are located on carried on the same CR1 receptor as Knop antigens.

The COST antigens are only expressed on cord blood cells.

The COST antigens are expressed with a high degree of variability.

The COST antigens are present in a very low frequency in most populations.

51. RBC antigen studies on a family prone to E. coli infections are most likely to reveal which antigen? a. b. c. d.

DISK FORS1 GLOB MER2

52. End-stage renal disease may be present in persons with alloanti-MER2 because: a. MER2- persons who have MER2 on cells other than RBCs will make alloanti-MER2.

b. MER2 is essential for assembly of basement membranes in the kidneys. c. persons who have made anti-MER2 do not exhibit CD151 mutations. d. persons who have made alloanti-MER2 are MER2+.

53. Anti-JMH is found mostly in patients who: a. lack the JMH protein from birth. b. form the antibody early in life c. lost the JMH antigen later in life. d. show autoimmune RBC destruction.

54. Which statements are true of Anti-Lan? a. b. c. d.

Anti-Lan is formed during transfusion or pregnancy.

Anti-Lan is naturally occurring IgM antibodies.

Transfusion reactions are rarely caused by Anti-Lan. Severe HDFN can occur because of Anti-Lan.

55. Anti-Lan is able to cause a. b. c. d.

Severe hemolytic transfusion reactions.

Hemolytic disease of the fetus and newborn.

Both of these Neither of these.

56. Anti-Vel is able to cause: a. b. c. d.

in vitro but not in vivo hemolysis. in vivo but not in vitro hemolysis. both in vitro and in vivo hemolysis. neither in vitro nor in vivo hemolysis.

57. Anti-Vel antibody is usually: a. b. c. d.

IgG IgM Both Neither

58. Anti-Vel is able to cause: a. b. c. d.

severe immediate hemolytic transfusion reactions. hemolytic disease of the fetus and newborn. both of these neither of these

59. Anti-Indian is able to cause: a. hemolytic transfusion reactions. b. hemolytic disease of the fetus and newborn. c. both of these

d. neither of these.

60.

Haemophilus influenza is able to gain entry in to red blood cells via which antigen? a. b. c. d.

Anton Emm Sid Vel

61. Cromer system antibodies: a. b. c. d.

are usually IgG. do not cause HDFN. are expressed on placentas. are all of these.

62. Placental tissue will absorb antibodies from which blood group? a. b. c. d.

Augustine Cromer Forssman Gerbich

63. How does Anti-LW usually react? a. b. c. d.

Weakly with D+ RBCs Strongly with D– RBCs from adults Weakly with D– RBCs from cord blood Negatively with Rhnull RBCs

64. Cord blood can be used to differentiate anti-LW and anti-D antibodies because: a. anti-LW reacts equally well with cord RBCs regardless of their D type. b. anti-LW reacts only with D+ cord blood and not D- cord blood. c. anti-LW reacts only with D- cord blood and not with D+ cord blood. d. anti-LW reacts only with adult cells and not with cord blood.

65. Which statement describes the role of Knops (CR1) in immunity? a. CR1 binds the complement component fragments C3b and C4b. b. CR1 functions as a receptor for several pathogenic organisms. c. CR1 processes immune complexes for transportation to the liver and spleen. d. CR1 performs all these roles.

Chapter 9. Uncommon Blood Groups Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: D 3. ANS: A 4. ANS: B 5. ANS: C 6. ANS: D 7. ANS: D 8. ANS: C 9. ANS: B 10. ANS: B 11. ANS: C 12. ANS: D 13. ANS: C 14. ANS: C 15. ANS: C 16. ANS: A 17. ANS: B 18. ANS: A 19. ANS: B 20. ANS: A 21. ANS: C 22. ANS: C 23. ANS: D 24. ANS: C 25. ANS: C 26. ANS: A 27. ANS: A 28. ANS: B 29. ANS: D 30. ANS: D 31. ANS: D 32. ANS: B 33. ANS: D 34. ANS: C 35. ANS: C 36. ANS: A 37. ANS: A 38. ANS: C 39. ANS: B 40. ANS: B 41. ANS: B 42. ANS: B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 9-1 LO: 9-1 LO: 9-20 LO: 9-20 LO: 9-5 LO: 9-17 LO: 9-17 LO: 9-24 LO: 9-1 LO: 9-1 LO: 9-1 LO: 9-4 LO: 9-18 LO: 9-7 LO: 9-7 LO: 9-20 LO: 9-17 LO: 9-17 LO: 9-1 LO: 9-9 LO: 9-17 LO: 9-1 LO: 9-1 LO: 9-17 LO: 9-25 LO: 9-17 LO: 9-1 LO: 9-1 LO: 9-3 LO: 9-1 LO: 9-3 LO: 9-1 LO: 9-4 LO: 9-4 LO: 9-6 LO: 9-8 LO: 9-8 LO: 9-2 LO: 9-1 LO: 9-10 LO: 9-10 LO: 9-11

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

57.

58.

59.

60.

61.

62.

63.

64.

65.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2

LO: 9-12 LO: 9-12 LO: 9-11 LO: 9-13 LO: 9-14 LO: 9-14 LO: 9-15 LO: 9-16 LO: 9-30 LO: 9-28 LO: 9-21 and 9-29 LO: 9-22 LO: 9-25 LO: 9-23 LO: 9-23 LO: 9-25 LO: 9-25 LO: 9-31 LO: 9-26 LO: 9-26 LO: 9-19 LO: 9-19 LO: 9-27

Chapter 10. Detection and Identification of Antibodies Multiple Choice Identify the choice that best completes the statement or answers the question.

1. All of the following antigens are found on reagent screening cells except: a. D. c. C. a b. Js . d. Fyb. 2. Which of the following statements concerning acid eluates is false? a. Citric acid is an example of an acid eluate. b. The pH is reduced to 3 or less to disrupt the antigen-antibody complex. c. The pH of the eluate remains at 3 before testing against a panel. d. None of the above 3. What screening cells are used primarily for testing donor units for unexpected antibodies? a. Pooled c. 3-vial b. 2-vial d. 4-vial 4. When performing the elution procedure, the solution containing the recovered antibody is called: a. neutralized serum. c. the eluate. b. the buffer. d. absorbed serum.

5. What is the purpose of Coombs’ control cells? a. To ensure that AHG tests with negative results are not false-negatives b. To ensure that washing removed all unbound antibody c. To ensure that AHG was not omitted or inactivated d. All of the above 6. In what test might rouleaux cause an interference? a. DAT c. Reverse ABO grouping b. Forward ABO grouping d. Rh control 7. What is an elution? a. A technique used to dissociate IgM antibodies from sensitized RBCs b. A technique used to dissociate IgG antibodies from sensitized RBCs c. A technique used to reduce the zeta potential enhancing antigen binding d. None of the above 8. A patient with a warm autoantibody has a positive DAT. The antibody screen was negative, but the eluate reacted uniformly with all normal cells and patient cells. Why was the antibody screen negative? a. Reagent red blood cells were saturated with warm autoantibody from patient serum. b. No alloantibodies were present. c. The warm autoantibody has bound to patient RBCs in circulation. d. Polyspecific AHG was used instead of monospecific IgG. 9. The process of removing antibody from serum by combining a serum sample with appropriate red blood cells under optimal conditions is called: a. elution. c. enzyme treatment. b. absorption. d. sensitization.

10. How does LISS enhance antibody detection in the antibody screen?

a. b. c. d.

Increases the incubation times, which increases the sensitivity of the test Increases the zeta potential, promoting agglutination of sensitized red blood cells Increases the rate at which antibody binds to red blood cell antigens None of the above

11. Which cells are employed to remove autoantibody from patient serum without removing any alloantibody from serum? a. Coombs’ control red blood cells c. Patient red blood cells b. Screening red blood cells d. Panel red blood cells 12. What would be a realistic source of finding compatible units for a person with an antibody to a high-frequency antigen? a. Random donor units b. A donor of similar ethnic background c. Siblings d. Apheresis donors 13. Why is it important to match the lot number on the panel sheet with the lot number on the panel cells? a. The ABO group will change from lot to lot. b. Pattern of reactions will change from lot to lot. c. It is a requirement of the FDA. d. All of the above

b.

14. Which of the following high-frequency antigens do not cause in vivo red blood cell destruction when complexed with corresponding antibody? a. k c. Cha b b Js TESTBANKSdE. LLLuE R.COM 15. A person has developed an antibody to the LISS reagent. What test will not be affected by this circumstance? a. Major ACT crossmatch c. DAT b. IAT d. Antibody screen 16. Which of the following statements is correct concerning cold antibody screens? a. Patient serum is incubated with group O adult and cord red blood cells at 4°C. b. Patient serum is incubated with group O cord cells at 37°C. c. Patient serum is incubated with check cells at 18°C. d. Patient serum is incubated with group A cord cells at room temperature.

17. Routine pretransfusion testing consists of all of the following except: a. ABO typing. c. an antibody screen. b. Rh typing. d. a DAT. 18. A positive autocontrol in antibody detection procedures is usually indicative of: a. inadequate washing. c. positive IAT. b. positive DAT. d. none of the above.

19. In interpreting an antibody screen, which of the following questions might be asked to decipher the class of antibody? a. Is the autologous control positive or negative? b. Is hemolysis present? c. In what phase did the reaction occur? d. Is rouleaux present?

20. Why is an enzyme treatment used in antibody identification? a. Enzymes aid in the dissociation of antibody from antigen in a positive DAT. b. Enzymes aid in the separation and identification of multiple antibodies. c. Enzymes aid in the absorption of autoantibody from patient serum. d. Enzymes aid in the separation and identification of multiple antibodies and the absorption of autoantibody from patient serum.

21. Which of the following is a mechanism of an elution procedure? a. Disruption of structural complementarity of antigen and antibody b. Enhancement of structural complementarity of antigen and antibody c. Exchange of one immunoglobulin class for another d. Denaturation of membrane epitopes by chemical means 22. Neutralization of antibody is applicable to all of the following blood groups except: a. Lewis. c. P1. b. Rh. d. Chido.

23. What determines if a red blood cell antibody is clinically significant? a. Class of antibody (IgG or IgM) b. Shortened red blood cell survival c. Shortened white blood cell survival d. Shortened platelet survival 24. Why are screening cells group O? a. To prevent interference with anti-A and anti-B in patient serum b. To prevent interference with A and B antigens on patient cells c. Because group O cells are eT asE ieS r tT oB acAqN uiK reSinErL anLdE om poCpO ulM ations R. d. Because group O cells contain antigens to clinically significant antibodies 25. Cold-reactive autoantibodies can be selectively removed from patient serum by adsorption with autologous red blood cells (RBCs). What other cells can be used? a. Mouse RBCs c. Rabbit RBCs b. Goat RBCs d. Donor RBCs 26. Why is rouleaux not usually found in the AHG phase of antibody screens? a. High protein molecules are not reactive at 37°C. b. Patient cells are washed away before adding AHG. c. Patient serum is washed away before adding AHG. d. None of the above 27. What is the most common use of adsorption? a. Removal of plasma protein from patient serum b. Removal of alloantibody from patient serum c. Removal of autoantibody from patient serum d. Removal of drug-induced antibody from patient serum 28. What is a positive DAT? a. In vitro sensitization of RBC with antigen b. In vitro sensitization of RBC with antibody c. In vivo sensitization of RBC with antibody d. In vivo sensitization of RBC with antigen 29. Which is the second phase of a hemagglutination reaction?

a. Immunodiffusion b. Precipitation

c. Sensitization d. Agglutination

30. What test is used to confirm the efficacy of chloroquine treatment? a. IAT c. ABO grouping b. DAT d. Neutralization test 31. What antibody is associated with a mixed-field reaction? a. Lea c. Sda b. K d. E 32. Why is it important for screening cells to be from individuals who have a homozygous expression of antigens? a. Homozygous expression is directly related to clinically significant antibodies. b. Stronger reactions are seen with heterozygous cells than with homozygous cells. c. Weakly reacting antibodies may not agglutinate heterozygous cells. d. All of the above 33. How is an antibody ruled in? a. Two RBC samples positive for antigen show reactivity; two RBC samples negative for the antigen show no reactivity. b. Three RBC samples positive for antigen show reactivity; three RBC samples negative for the antigen show no reactivity. c. One homozygous RBC sample shows reactivity. d. None of the above 34. What can be concluded in a patiT enEt S who KLidLenEtR ifi. edCiO nM his serum but phenotypes positive for K TBhAasNaKntSi-E antigen? a. Kell antiserum was omitted. b. Patient was recently transfused with K-positive blood. c. Anti-K was misidentified d. Patient was recently transfused with K-positive blood and Anti-K was misidentified 35. What is tested in an antibody screen? a. Patient red blood cells are tested against group O reagent screening cells. b. Patient serum is tested against group AB reagent screening cells. c. Patient serum is tested against group O reagent screening cells. d. Patient serum is tested against group A reagent screening cells.

36. What effect does ZZAP reagent have on sensitized red blood cells? a. Removes antibody from red blood cells b. Enzyme treats red blood cells c. Increases adsorption capability of red blood cells d. All of the above 37. What is a possible explanation for a nonreactive eluate? a. Hemolytic disease of the newborn (HDN) b. Positive DAT due to drugs c. A warm autoantibody d. All of the above 38. Why are antibodies to high-frequency antigens, such as cellano (k), rarely seen in patient samples? a. Most persons are not antigenically stimulated to produce the antibody, because their red

blood cells are negative for the antigen. b. Most persons are not antigenically stimulated to produce the antibody, because their red blood cells are positive for the antigen. c. Anti-k has low avidity. d. Most reagent cells are heterozygous for cellano.

39. What might a positive antibody screen and a negative auto control indicate? a. An alloantibody is coating donor cells after a transfusion b. An autoantibody has been detected c. An alloantibody has been detected d. Drug-induced antibody reacting with patient cells 40. When might you suspect multiple antibodies in a patient's serum? a. Pattern of reactivity not fitting a single antibody b. Variation in phase of reactivity c. Variation in antibody reactivity strength d. All of the above 41. In what circumstance would an alloadsorption be performed? a. Warm autoantibody in serum c. Multiple antibodies in serum b. HDN d. Hemolytic transfusion reaction 42. One drop of Coombs’ control cells was added to a negative antibody screen. No agglutination was observed after centrifugation. What course of action is taken? a. Report negative result b. Report inconclusive result c. Repeat the test d. Add one more drop of check cells and re-centrifuge 43. When are antibody titration studies warranted? a. During a gastrointestinal bleed c. After bone marrow transplantation b. During pregnancy d. During chemotherapy 44. What is the simplest way of reducing the interferences from benign cold autoantibodies in antibody screening procedures? a. Use polyspecific AHG c. Use prewarming techniques b. Use monospecific IgG d. Use cold autoabsorption techniques 45. A 2-unit crossmatch was ordered on a patient in the emergency room. The patient's antibody screen was negative. One unit was compatible and the other was incompatible at AHG. If the patient's antibody screen was negative and the donor had no history of antibodies, what could be the reason for this reaction? a. The patient's serum has an antibody to a low-frequency antigen not present on screening cells. b. The donor has a positive DAT. c. The patient's serum has an HTLA antibody. d. Options A and B 46. What test must be performed on a patient with a warm autoantibody in their serum before transfusing? a. Prewarming c. Elution b. Warm autoadsorption d. DAT

47. During an antibody ID, there was 1+ reaction at AHG with donor cells with the antigen profile Fya(+), Fyb(-).

All other donor cells on the panel were negative, including those that were Fya(+), Fyb(+). Given these results, what might be the conclusion? a. Single antibody (showing dosage) b. Probably an antibody not represented on the antigen profile c. An antibody to a high-frequency antigen d. IgM antibody 48. What is the purpose of treating serum containing cold autoantibodies with dithiothreitol (DTT) or 2-mercaptoethanol (2-ME)? a. To denature IgG alloantibody and test serum for presence of IgM autoantibody b. To denature IgM cold autoantibody and test serum for presence of IgM alloantibody c. To denature IgM cold autoantibody and test serum for presence of IgG alloantibody d. To denature IgM drug-induced antibody and test serum for presence of IgG alloantibody 49. What is the first step in reading hemagglutination reactions? a. Resuspension of red blood cells c. Grading agglutination b. Checking supernatant for hemolysis d. None of the above 50. How many units would you likely have to screen to find two compatible units for someone with the following antibodies: anti-C, anti-Lea, anti-Jkb? a. 10 c. 32 b. 15 d. 35 51. Why might some blood banking facilities prefer the use of monospecific IgG over polyspecifiic antihuman globulin (AHG) in their antibody screens? a. Interference from naturally oTcE cuSrrT inB gA wN arK mSaE ntL ibL odEieRs. inCpO atM ient serum is reduced. b. Interference from naturally occurring cold antibodies in patient serum is reduced. c. There is more IgG in monospecific antisera than in polyspecific reagents. d. Monospecific IgG has been standardized.

52. What is the purpose of saline washing in the antibody screen procedure? a. Removal of bound IgG that would otherwise neutralize the AHG reagent b. Removal of unbound IgG that would neutralize the AHG reagent c. Stripping of the red blood cell membrane for alloantibody binding d. Removal of unbound IgM that would neutralize AHG reagent 53. Why can't autoadsorption be performed on a patient who was transfused 1 month before? a. Only IgM antibody would be present at 1 month. b. Donor cells might adsorb out autoantibody in serum. c. Patient cells might adsorb out alloantibody in serum. d. Donor cells might adsorb out alloantibody in serum.

54. All of the following antigens are interacted by proteolytic enzymes except: a. C. c. M. b. Fya. d. S. 55. When should multiple antibodies be suspected in a positive antibody screen? a. The autocontrol was positive. b. Cells react at different phases and strengths. c. Only the AHG phase is reactive. d. None of the above

56. How is chloroquine diphosphate used in blood banking? a. To accurately phenotype patient cells when IAT is positive b. To enhance antigen-antibody binding in IAT c. To accurately phenotype patient cells when the DAT is positive d. To be used as an Rh control when DAT is positive 57. Tests with which AHG reagents can determine if IgG, complement, or both are coating red blood cells? a. Monospecific c. Standardized b. Polyspecific d. Irradiated 58. Which of the following is known as the "sensitization phase" in the antibody screen? a. Immediate spin c. 37°C incubation b. AHG d. None of the above 59. What is an antigen profile sheet? a. An insert listing the antibodies present in each vial of screening cells b. An insert listing the antigenic makeup of each vial of screening cells c. A statistical comparison of 200 blood banks' results of antigenic reactions with various antisera d. An insert listing the antigenic makeup of check cells 60. What makes up an autologous control? a. Patient serum and patient cells b. Patient serum and screening cells

c. Patient cells and Rh control d. None of the above

61. Why should only homozygous cells be used to rule out an antibody? a. Homozygous cells carry a double dose of antibody. R.COM TESTBANKSELLE b. Weakly reacting antibody may not react with heterozygous cells. c. Strong reacting antibodies may not react with heterozygous cells. d. All of the above 62. In the autoabsorption procedure for the removal of cold autoagglutinins from serum, pretreatment of the patient's RBCs with which of the following reagents is helpful: a. Ficin c. LISS b. Phosphate buffered saline d. Albumin 63. In which scenario can an antibody be ruled out? a. Patient serum does not react with a cell known to carry the corresponding antigen. b. Patient serum does react with a cell known to carry the corresponding antigen. c. Patient cells do not react with a cell known to carry the corresponding antibody d. Patient cells do react with a cell known to carry the corresponding antibody.

64. What is done with a patient’s serum after an autoadsorption technique has been performed? a. Alloantibodies are identified. b. The serum is discarded. c. Autoantibody is identified. d. Alloantibodies are identified, and the serum can be used for compatibility testing.

65. What is the final step in antibody identification? a. Phenotype donor's RBC units for corresponding antigen b. Phenotype patient's RBCs for corresponding antibody c. Phenotype patient's RBCs for corresponding antigen d. Phenotype RBC units for corresponding antibody

66. A doctor has ordered 4 units of red blood cells for a patient with anti-E in his serum. How many units would have to be screened to yield 4 E-negative units? a. 10 c. 6 b. 15 d. 12 67. How can neutralization aid in the identification of multiple antibodies? a. Once antibody has been neutralized serum can be further tested in panel studies. b. Neutralization inhibits all warm autoantibodies. c. Neutralized serum can be used to phenotype patient cells. d. All of the above 68. What does a panel of reagent red blood cells consist of? a. 1 to 5 group O red blood cell suspensions b. 3-vial screening cells c. 11 to 20 group O red blood cell suspensions d. Pooled screening cells 69. If you suspect anti-C is present in a patient's serum, and anti-Fya still has to be ruled out using other reagent cells, what would the phenotype of the rule out cell have to be? a. Fy(a+), C–, Fy(b+) c. Fy(a+), C+, Fy(b-) b. Fy(a+), C–, Fy(b-) d. Fy(a+), C+, Fy(b+) 70. Cells that have antibody attached to them but are still separated from one another are: a. agglutinated. c. phagocytized. b. sensitized. d. hemolyzed.

71. What is the advantage of havingTaE3S -cT elB l pAaN neK l sScE reL enLvE erR su.sC aO 2-M cell panel screen? a. More cells in the homozygous state that show dosage b. You can narrow down the specificity of the AB better. c. You might detect more rare antibodies. d. All of the above 72. Name a disease in which your positive D control might be positive. a. PCH c. Huntington's disease b. Multiple myeloma d. Epstein-Barr virus 73. The electrical force that exists between red blood cells is: a. called the zeta potential. b. due to the net negative charge of the red blood cell membrane. c. related to the voltage or potential that exists at the surface of the RBC and the outer layer of the ionic cloud. d. all of the above.

74. Pseudoagglutination: a. is frequently associated with alterations in serum proteins. b. occurs when serum viscosity is increased. c. can be confused with panagglutination. d. all of the above.

75. While performing an antibody screen, a test reaction is observed that is suspected to be rouleaux. A saline replacement test is done, and the reaction remains. What is the best interpretation? a. The original reaction was rouleaux and may be ignored. b. The replacement test is invalid and should be repeated.

c. The original reaction was due to true agglutination. d. The antibody screen is negative.

76.

Of the antibodies listed below, which does NOT fit with the others in terms of the optimal temperature of reactivity?

Anti-P1 c. Anti-A1 Anti-I d. Anti-E

77.

Antibodies formed as the result of RBC stimulation in the patient are known as: a. active. c. naturally occurring. b. immune. d. passive.

78. Antibodies resulting from exposure to pollen, fungus, or bacteria are known as: a. active. c. naturally occurring. b. immune. d. passive.

79.

A laboratory employee who previously tested negative in a donor antibody screen is now testing positive after having had an intravenous immunoglobulin treatment for needle-stick exposure. Which type of antibody has this person formed? a. active c. naturally occurring b. immune d. passive

80.

The AABB’s Standards for Blood Banks and Transfusion Services requires antibody screen of all populations listed below EXCEPT: a. allogeneic blood donors c. patients receiving WBCs b. patients receiving RBCs d. prenatal patients

Chapter 10. Detection and Identification of Antibodies Answer Section MULTIPLE CHOICE 1. ANS: B 2. ANS: C 3. ANS: A 4. ANS: C 5. ANS: D 6. ANS: C 7. ANS: B 8. ANS: C 9. ANS: B 10. ANS: C 11. ANS: C 12. ANS: C 13. ANS: B 14. ANS: C 15. ANS: C 16. ANS: A 17. ANS: D 18. ANS: B 19. ANS: C 20. ANS: D 21. ANS: A 22. ANS: B 23. ANS: B 24. ANS: A 25. ANS: C 26. ANS: C 27. ANS: C 28. ANS: C 29. ANS: D 30. ANS: B 31. ANS: C 32. ANS: C 33. ANS: B 34. ANS: D 35. ANS: C 36. ANS: D 37. ANS: B 38. ANS: B 39. ANS: C 40. ANS: D 41. ANS: C

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 TESTBANKEY: KSELTaxonomy LER.COLevel: M 3 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 10-4 LO: 10-15 LO: 10-4 LO: 10-15 LO: 10-8 LO: 10-6 LO: 10-15 LO: 10-17 LO: 10-14 LO: 10-13 LO: 10-15 LO: 10-12 LO: 10-6 LO: 10-2 LO: 10-9 LO: 10-5 LO: 10-3 LO: 10-5 LO: 10-5 LO: 10-13 LO: 10-15 LO: 10-13 LO: 10-2 LO: 10-4 LO: 10-8 LO: 10-8 LO: 10-13 LO: 10-11 LO: 10-8 LO: 10-8 LO: 10-5 LO: 10-6 LO: 10-11 LO: 10-9 LO: 10-5 LO: 10-13 LO: 10-15 LO: 10-2 LO: 10-5 LO: 10-5 LO: 10-14

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 10-5 LO: 10-16 LO: 10-8 LO: 10-17 LO: 10-10 LO: 10-7 LO: 10-8 LO: 10-8 LO: 10-12 LO: 10-6 LO: 10-8 LO: 10-14 LO: 10-13 LO: 10-5 LO: 10-11 LO: 10-11 LO: 10-5 LO: 10-4 LO: 10-4 LO: 10-4 LO: 10-8 LO: 10-7 LO: 10-14 LO: 10-7 LO: 10-12 LO: 10-13 LO: 10-4 LO: 10-10 LO: 10-9 LO: 10-4 LO: 10-5 LO: 10-11 LO: 10-8 LO: 10-5 LO: 10-1 LO: 10-1 LO: 10-1 LO: 10-1 LO: 10-3

Chapter 11. Pre-Transfusion Testing Multiple Choice Identify the choice that best completes the statement or answers the question.

1. In which section of the blood bank laboratory would blood be issued for transfusion? a. Component preparation and storage b. Donor processing c. Main laboratory d. Reference laboratory 2. Electronic crossmatching a. does not eliminate the need for a serologic crossmatch. b. must confirm current with historical recipient’s ABO group. c. disregards discrepancies between recipient and donor unit. d. allows the antibody screening to be eliminated.

3. What test(s) are involved when a physician orders a 4-unit crossmatch on a patient? a. IS crossmatch b. AHG crossmatch c. ABO, Rh, antibody screen, IS crossmatch d. ABO, Rh, DAT, IS crossmatch 4. Which patient information is NOT acceptable as one of the two identifiers? a. Assigned fictitious name b. Date of birth c. Hair and skin color d. Medical record number 5. Which of the following might be used to investigate a cold autoantibody? a. Titration b. Rabbit erythrocyte stroma c. Elution d. A2 cells 6. A positive DAT may be seen in: a. warm autoimmune hemolytic anemia. b. cold agglutinin syndrome. c. hemolytic transfusion reaction. d. all of the above.

7. Why are monoclonal anti-D reagents preferred over the slide test reagents? a. They contain a low protein concentration and are not prone to false-positive reactions. b. They contain a high protein concentration and are not prone to false-negative reactions. c. They contain albumin, which acts as a potentiator. d. None of the above 8. If an intrauterine transfusion is indicated, which of the following is acceptable? a. Red blood cells typing the same the mother b. Nonirradiated units of blood are preferred. c. Only type O red blood cells d. Units with concentrated white blood cells

9. Immediate spin resulting in agglutination may be caused by a. matching ABO groups between donor and recipient. b. cold reacting allo- or autoantibodies. c. too much saline in the reagents used. d. prewarming the specimens.

10. Why is reviewing a potential recipient’s historical data important? a. Antibodies from previous transfusions can decrease to undetectable levels. b. Current medications may produce unusual results. c. Donor units must be negative antigens to previous antibodies even if none are currently present. d. All of these are reasons to review patient historical data.

11. Which cells are used for a donor's antibody screen? a. Screening cells (2 vials) b. Pooled screening cells (2 donors) c. Screening cells (3 vials) d. Autologous cells 12. Which of the following would prolong labeling of the packed red blood cell unit? a. Nonreactive STS b. Anti-K in donor plasma c. ALT = 31 U/L d. None of the above 13. What one forward-typing reagent can be used to confirm O units collected from another facility? a. Anti-A b. Anti-B c. Anti-A,B d. Anti-H 14. All of the following procedures might be done in an investigation of an ABO discrepancy except: a. increasing incubation time for reverse grouping. b. secretor studies. c. neutralization studies with urine. d. testing with anti-A1 lectin.

15. The label on the recipient’s pretransfusion specimen a. cannot be a barcode. b. need not include phlebotomist ID. c. must duplicate patient wristband information. d. must be affixed prior to collection.

16. Where can an identification band be placed on a double arm amputee? a. Ankle b. Head c. Torso d. All of these 17. Blood is collected Saturday in the emergency room for possible transfusion. The patient is admitted to the hospital and on Wednesday it is determined that the transfusion is truly needed. a. The specimen can be used for a crossmatch because the patient did not yet receive blood. b. The specimen must be recollected because the patient’s location at the facility has changed. c. The specimen must be recollected because more than 3 days have passed.

d. The specimen must be recollected because it must be collected the same day as the crossmatch.

18. How are 8 units of cryoprecipitate usually issued? a. As eight individual units b. As one pooled unit c. As four multiple units of two d. None of the above 19. A three-cell antibody screening set provides except Kell. a. homozygous b. heterozygous c. homogenous d. heterogenous

antigen expression in all major blood group systems

20. A 40-year-old male presented in the ER with acute bleeding. The technologist received a specimen but was unable to resolve a typing discrepancy between the forward and reverse typings. What blood type should the patient receive for emergency transfusion? a. Type-specific uncrossmatched packed RBCs b. O-negative crossmatched packed RBCs c. O-negative uncrossmatched packed RBCs d. Electronic crossmatched blood 21. All of the following viral tests are required for donor processing except: a. HBsAg b. CMV c. anti-HIV d. anti–HTLV-I 22. What is the main concern for obstetric patients in prenatal testing? a. Antibody that causes hemolytic transfusion reaction b. Drug-induced antibody c. Antibody that causes hemolytic disease of the newborn (HDN) d. Autoantibodies 23. In which department of the blood bank laboratory would an ABO discrepancy be resolved? a. Component preparation and storage b. Donor processing c. Main laboratory d. Reference laboratory 24. A proper blood bank specimen is good for how many days after it is drawn from a patient that has had a prior transfusion within 90 days? a. 24 hours b. 3 days c. 7 days d. 14 days 25. Which of the following options are suitability requirements for product labeling? a. Absence of detectable antibodies b. No discrepancies in ABO and Rh testing c. Nonreactive viral marker tests

d. All of the above 26. Why would an Rh type be ordered on a cord blood sample? a. To determine mother's candidacy for RhIG if she is Rh-negative b. To determine mother's candidacy for RhIG if she is Rh-positive c. Because the mother had a spontaneous abortion d. None of the above 27. Which of the following would lead to nonacceptance of a blood bank specimen? a. Initials of phlebotomist not on specimen b. A patient name spelled incorrectly c. An erroneous Social Security number d. All of the above 28. The advantages of electronic crossmatching as compared to serologic crossmatch include a. less specimen is required. b. less time is required. c. automatic alters of discrepancy. d. all of these.

29. Why can the Rh-hr control be eliminated from donor processing? a. An Rh-positive unit of blood typed as an Rh-negative would only be transfused to an Rh-positive patient. b. An Rh-negative unit of blood typed as an Rh-positive would only be transfused to an Rh-negative patient. c. An Rh-negative unit of blood typed as an Rh-positive would only be transfused to an Rh-positive patient. d. None of the above 30. Patient blood management programs: a. are based on patient evidence. b. ensure an increasing demand for blood components. c. prevent the detection and treatment of anemia. d. restrict the use of transfusion triggers.

31. Personalized medicine involves: a. individualized treatment for patients. b. prevention of alloimmunization. c. the use of a national database. d. all of these. .

32. Which patient is most likely to require irradiated products? a. Patient undergoing a bone marrow transplant b. Patient undergoing open heart surgery c. Newborn d. Geriatric patient 33. It is December 1, 2017, and you irradiate an O-negative packed RBC that you have in inventory, which outdates January 5, 2018. What will the new outdate be for that unit? a. December 2, 2017

b. December 3, 2017 c. December 29, 20172 d. January 5, 2018 34. A STAT type and screen comes from surgery. Your institution uses a blood bank band ID bracelet system.

The nurse who obtained specimens did not label them with the blood bank number before she handed them to transport to take to the laboratory. What would be the most appropriate action to take? a. Call surgery and have the nurse come down and properly label the specimens. b. Accept the specimen as is. c. Reject the specimen and have it recollected. d. Label the specimen yourself and continue with testing.

35. Possible reasons for incompatibilities after initial spin during a crossmatch include: a. new alloantibody in recipient’s plasma. b. alloantibody to a low-incidence present is on the donor unit red blood cells. c. warm-reactive autoantibody is present in the recipient’s plasma. d. all of these reasons.

Chapter 11. Pre-Transfusion Testing Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: B 3. ANS: C 4. ANS: C 5. ANS: B 6. ANS: D 7. ANS: A 8. ANS: C 9. ANS: B 10. ANS: D 11. ANS: B 12. ANS: D 13. ANS: C 14. ANS: C 15. ANS: C 16. ANS: D 17. ANS: C 18. ANS: B 19. ANS: A 20. ANS: C 21. ANS: B 22. ANS: C 23. ANS: D 24. ANS: B 25. ANS: D 26. ANS: A 27. ANS: D 28. ANS: D 29. ANS: C 30. ANS: A 31. ANS: D 32. ANS: A 33. ANS: C 34. ANS: C 35. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 1 TESTBANKEY: KSELTaxonomy LER.COLevel: M 2 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1

LO: 11-9 LO: 11-6 LO: 11-4 LO: 11-1 LO: 11-4 LO: 11-4 LO: 11-4 LO: 11-8 LO: 11-7 LO: 11-3 LO: 11-4 LO: 11-9 LO: 11-8 LO: 11-7 LO: 11-2 LO: 11-1 LO: 11-2 LO: 11-9 LO: 11-4 LO: 11-8 LO: 11-5 LO: 11-8 LO: 11-2 LO: 11-3 LO: 11-9 LO: 11-8 LO: 11-2 LO: 11-6 LO: 11-5 LO: 11-10 LO: 11-10 LO: 11-5 LO: 11-9 LO: 11-1 LO: 11-7

Chapter 12. Blood Bank Technologies and Automation Multiple Choice Identify the choice that best completes the statement or answers the question.

1. After completing an antibody screen using the gel testing method, results after centrifugation yield a pellet of unagglutinated cells at the bottom of the microtube and a thin layer of cells at the top gel column. This situation commonly indicates: a. a cold agglutinin. b. a warm autoantibody. c. that fibrin from serum that has not clotted completely. d. a contaminated patient specimen.

2. The indicator cells used to detect antibodies in a solid phase technology are: a. anti-D coated RBCs. b. AHG-coated RBCs. c. plain RBC suspension. d. antibody screen cell I. 3. Which of the following factors are likely to cause false-positive results while using gel technology? a. Lipemia b. Icteric sample c. Rouleaux d. All of the above 4. Upon centrifugation of an antibody screen procedure done by the gel system, the red blood cell agglutinates are dispersed throughout the gel column with a few agglutinates at the bottom of the microtubes. This reaction should be graded as a: a. 4+ reaction. b. 3+ reaction. c. 2+ reaction. d. 1+ reaction.

5. The FDA has approved the for application of gel technology. a. ABO, Rh, DAT, antibody screen and identification, as well as crossmatching b. ABO, antibody screen, and DAT c. Antibody screen, antibody identification, and crossmatching d. ABO, Rh, DAT, and antibody screen 6. When performing an antibody screen by gel technology, the following steps are eliminated: a. the AHG reagent and control checked cells. b. the saline wash and control check cells. c. the cells I and II and saline wash. d. the centrifugation and saline wash.

7. The gel system has all of the following advantages over the traditional tube procedure except: a. standardization in reading technique. b. stability of the test reaction. c. replicability of the test results. d. different grading system.

8. Which of the following tests is not available for both the gel testing method and solid phase technology?

a. b. c. d.

AHG ABO DAT None of the above

9. If you had a lipemic and icteric sample that needed to have an antibody screen done, which of the following would obtain the best results? a. Tube method b. Gel c. Solid phase d. SPRCA 10. In a gel-based technology, the solid band at the top of the gel indicates a pellet at the bottom of the microtubes indicates . a. 4+ reaction/a negative reaction b. negative reaction/a 4+ reaction c. 3+ reaction/a negative reaction d. mixed field reaction/subgroups

, whereas formation of a

11. Using the affinity column technique, a serologic reaction that forms a fine red blood cell band at the top of the gel column and a red blood cell button at the bottom of the gel column is interpreted as: a. mixed-field. b. weak positive. c. strong positive. d. negative 12. Low ionic strength saline (LISST ) iE sS adT deBdAtoNaKnS tibEoL dyLsE crR ee.nC inO gM methods for which of the following test systems? a. Gel b. SPRCA c. Solid phase d. None of the above 13. The washing procedure is applicable to which of the following serologic methods? a. Solid phase and tube system b. Gel technology and solid phase c. Solid phase and affinity column d. Gel technology and tube system 14. A layer of red blood cells agglutinates at the top of the gel media, and a pellet of unagglutinated red blood cells forms at the bottom. These findings are comparable to which of the following reactions in the test tube? a. Negative b. Weak positive c. Mixed-field d. Invalid 15. In performing an antibody screen by the solid phase technique, a monolayer of red blood cells is formed at the top of the microplate wells following the addition of indicator cells. This result should be interpreted as: a. negative. b. mixed-field. c. positive. d. weak positive.

16. Using the gel test system, the technologist used a 3% cell solution. What would be the probable outcome? a. Normal b. Weaker results because of the increase in antigen/antibody ratio c. Stronger results because of the increase in antigen/antibody ratio d. None of the above 17. Which of the following is a factor in possible false-negative or false-positive results when using the gel system to screen for antibodies? a. Bacterial contamination b. Temperature c. Time d. All of the above 18. Which of the following statements is the most accurate? A mixed-field in the gel system: a. can be ignored without further workup. b. can be caused by fibrin found in plasma and can be corrected by using fresh serum. c. needs to have further testing performed. d. can be resolved by respinning the gel card.

19. Which of the following substances may interfere with gel technology but not SPRCA technology? a. Hemolysis b. Lipemia c. Icteric samples d. All of the above 20. SPRCA testing requires the use of all of these specialized microplate equipment EXCEPT: a. centrifuge. b. incubator. c. thermal cycler. d. washer.

21. Manufacturers Grifols and Ortho both produce automated blood bank equipment that uses a. Column Agglutination Technology b. Erytype S methods c. Protein A methods d. Solid-Phase Technology 22. Special pipettes are required for this method. a. Column Agglutination Technology b. Erytype S methods c. Protein A methods d. Solid-Phase Technology True/False Indicate whether the statement is true or false.

1. An anti-M detected by using gel AHG antibody screening cards is considered clinically insignificant.

Chapter 12. Other Technologies and Automation Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: B 3. ANS: D 4. ANS: C 5. ANS: A 6. ANS: B 7. ANS: D 8. ANS: C 9. ANS: D 10. ANS: A 11. ANS: A 12. ANS: B 13. ANS: A 14. ANS: C 15. ANS: C 16. ANS: B 17. ANS: D 18. ANS: C 19. ANS: D 20. ANS: C 21. ANS: A 22. ANS: A

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 : LTL 1 TESTBANKKESYE axEoR no.mCyOLM evel: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 12-2 LO: 12-1 LO: 12-2 LO: 12-2 LO: 12-1 LO: 12-1 LO: 12-3 LO: 12-5 LO: 12-5 LO: 12-1 LO: 12-2 LO: 12-1 LO: 12-1 LO: 12-2 LO: 12-2 LO: 12-2 LO: 12-3 LO: 12-2 LO: 12-3 LO: 12-4 LO: 12-4 LO: 12-4

TRUE/FALSE 1. ANS: F

PTS: 1

KEY: Taxonomy Level: 2

LO: 12-2

Chapter 13. Donor Selection Multiple Choice Identify the choice that best completes the statement or answers the question.

1. If a prospective blood donor has participated in a pheresis donation (platelets, plasma, granulocytes), at least how much time must pass before he or she can donate whole blood? a. 56 days c. 24 hours b. 48 hours d. 4 weeks 2. A whole blood donor who has taken Tegison should be: a. accepted. c. permanently deferred. b. deferred for 3 months. d. deferred for 6 months.

3. What is the deferral period for a donor who has received a live attenuated vaccine for rubella? a. 2 weeks c. no deferral period b. 4 weeks d. 8 weeks 4. A woman received a transfusion of packed RBCs while delivering her baby. Six months later she wanted to donate a unit of blood back to the American Red Cross. If the woman meets all other criteria for donation, is she allowed to donate at this time? a. Yes, she can donate at this time. b. No, she needs to wait 3 more months. c. No, she needs to wait 6 more months. d. No, she should be on permanent deferral.

TESTBANKSELLER.COM

5. A patient who recently stopped taking clopidogrel (Plavix) needs to donate platelets. How long must the patient defer donation after completing the medication? a. 24 hours c. 7 days b. 48 hours d. 14 days 6. What is the minimum hemoglobin level for a potential allogeneic donor? a. 11 g/dL c. 12.5 g/dL b. 12 g/dL d. 14 g/dL 7. What is the minimum hemoglobin level for a potential autologous donor? a. 11 g/dL c. 12.5 g/dL b. 12 g/dL d. 14 g/dL 8. Which of the following is the only pheresis procedure that requires administration of a growth factor to the donor? a. Plasmapheresis c. Leukopheresis b. Plateletpheresis d. Erythrocytapheresis 9. A blood donor with a history of hepatitis B should be excluded: a. only if he or she is jaundiced. b. only if the disease has been active for the last 5 years. c. permanently. d. only if liver function tests are abnormal.

10. An autologous unit should be donated what time period prior to the patients surgery/need? a. 72 hours c. 1 week

b. 48 hours

d. 24 hours

11. The following blood donors regularly give blood. Which donor may donate on September 11th? a. A 40-year-old woman who last donated on July 25th b. A 28-year-old man who had plateletpheresis on August 24th c. A 52-year-old man who made an autologous donation on September 9th d. A 23-year-old woman who made a direct donation for her aunt on August 14th 12. How many times can a person meeting all the optimal criteria donate an apheresis unit of platelets per year? a. 56 times c. 24 times b. 112 times d. 48 times 13. A world traveler came in to do a directed donation for his sister when he found out she needed surgery for her hip. After spending 5 weeks in Europe, he traveled extensively throughout Africa. How should his case be handled? a. Because he is donating to his sister, and she signed consent, he may donate for her. b. He meets all the criteria for being a directed donor, so he would be able to donate without any problem. c. He would not be able to donate, because all directed donors must meet the same criteria as allogeneic donors. d. He could donate, but only with the consent of the medical director and physician.

14.

Autologous blood donations may occur as: a. preoperative collection b. intraoperative collection c. postoperative collection. d. all of these

15. Who is NOT included in the documentation process in the decision to use preoperative autologous blood? a. Blood Bank medical director b. Blood Bank staff c. Patient d. Patient’s physician 16. What is the last time a patient can donate for an autologous unit before surgery? a. 1 day before the scheduled surgery b. 3 days before the scheduled surgery c. 1 week before the scheduled surgery d. 3 weeks before the scheduled surgery 17. Which of the following tests is optional for the collecting facility for an autologous donation? a. ABO group b. Rh type c. Antibody screen d. Viral studies 18. Which of the following tests is not optional for the transfusing facility for an autologous donation? a. Group & type b. Antibody screen c. Crossmatch d. Viral studies

19. There is a decreased risk of each of these when using autologous donations EXCEPT: a. alloimmunization. b. bacterial contamination. c. disease transmission. d. transfusion reactions.

20. For which of the following cases would intraoperative autologous collection NOT be contraindicated? a. Abdominal surgery where there is potential for contamination of the surgical site by bowel contents. b. Surgery on a pregnant mother where there is potential for contamination of the surgical site by amniotic fluid. c. Orthopedic surgery where there is a risk of bacterial contamination. d. Cardiac surgery where there is no risk of contamination with clotting agents.

21. Blood product collections and component manufacturing, but not donor selection, is regulated by the: a. AABB. b. CBER. c. CLIA. d. FDA. 22. Which of the following accredits blood banks? a. CAP b. CBER c. CLIA d. CMS 23. A blood transfusion service is scheduled for an inspection. Which of the following agencies may be conducting the inspection? a. AABB b. CAP c. FDA d. Any of these 24. Which of the following statement is true regarding directed donations? a. Only a family member can donate as a directed donor. b. The usual viral studies can be skipped in directed donation. c. Directed donations may need irradiation to prevent GVHD. d. None of these statements is true.

25. Which of the following serologic tests is required for directed donations? a. HepB b. HIV c. FTA d. All of these 26. Donor arm preparation must be repeated if which of the following occurs? a. The donor bends the arm. b. The prepared site is touched with the fingers. c. A nonsterile object comes in contact with the prepared site. d. All of these occurrences

27. When should mixing of the blood bag be performed? a. After the bag is fully collected b. Periodically during collection c. Constantly d. Never 28. How are pilot tubes for donor serologic testing collected? a. A separate blood collection is performed prior to donation. b. A separate blood collection is performed after donation. c. Blood is collected from tubing connected to a needle in the donor’s arm. d. Blood is collected from the tubing coming out of the blood bag.

29. Nausea, twitching, and muscle spasm during blood donations are categorized as: a. b. c. d.

severe reactions. moderate reactions. mild reactions. normal reactions.

30. Which of the following may be a sign of a potential fainting event? a. Sweating b. Dizziness c. Pallor d. All of these

31. A donor has fainted during blood collection. Which of the following is NOT an appropriate action? a. Remove the tourniquet and withdraw needle. b. Place warm compresses on the donor’s forehead. c. Raise the donor’s legs above the level of the head. d. Loosen tight clothing and secure airway.

32. In addition to signs experienced during a mild reaction to blood donation, a moderate reaction includes which of the following? a. Loss of consciousness b. Increased pulse rate c. Hypoventilation d. Rise in blood pressure 33. Convulsions may occur during blood donation as a result of: a. cerebral ischemia. b. epilepsy. c. marked hyperventilation. d. any of these 34. Ensuring the presence of an adequate airway is most important in which type of blood donation reaction? a. Severe reactions b. Moderate reactions

c. Mild reactions d. All of these 35. Which statement concerning a hematoma is true? a. A hematoma is a localized collection of blood under the skin. b. A hematoma is reddish in color because of all the blood pooling. c. A hematoma is caused by not inserting the needle deep enough to go through the vein. d. If a hematoma develops, stop blood collection only if the bag is full.

36. Treating an occurrence of hematoma development during blood donation involves: a. removing the tourniquet and needle from donor’s arm. b. keeping the donor’s arm lowered. c. ensuring no pressure is placed on the site. d. applying a warm compress to the site.

37. A 4-week deferral is required of donors exposed to which of these organisms? a. Babesia b. Ebola c. Zika d. All of these

38. An 8-week deferral is required of donors exposed to which of these organisms? a. Babesia b. Ebola c. Zika d. All of these 39. A donor exposed to which of these organisms may be able to donate in as soon as 2 weeks? a. Babesia b. Ebola c. Zika d. All of these 40. In order for a donor to be infected with West Nile Virus he/she must be bitten by a mosquito that has first bitten which reservoir host? a. Birds b. Humans c. Small mammals d. Any of these 41. Which is the most economical way to test for West Nile Virus? a. ID-NAT with follow-up by MP-NAT on positives b. MP-NAT with follow-up by ID-NAT on positives c. Either method d. Neither method

42. A donor who was repeatedly reactive with anti-HBc may be considered for reentry if after 8 weeks if which of these tests are negative? a. HBsAg b. anti-HBc c. HBV NAT d. All of these must be negative.

43. Prions are: a. bacteria that are deactivated by heat. b. protozoan parasites that hide in brain tissue. c. spongiform organisms that resist deactivation. d. viruses that are deactivated by ultraviolet light.

44. Donors must be screened for which virus that causes a neurological disorder of myelopathy? a. HTLV b. HIV c. HCV d. HBV 45. Donors must be screened for which virus that causes a neurological disorder of myelopathy? a. HTLV b. HIV c. HCV d. HBV

ShEoLviLsiEt m Ra.laCriOa-Mendemic countries?

46. How long is the donation deferrT alEfS orTpB erA soN nsKw a. 1 year b. 2 years c. 3 years d. Indefinitely 47. Which of these countries is NOT a malaria-endemic country? a. Afghanistan b. Angola c. Argentina d. Austria 48. A U.S. military officer was deployed to Belgium from 1982 to 1985. How long is his deferment from blood donations once returning to the United States? a. 1 year b. 2 years c. 3 years d. Indefinitely 49. A 25-year-old patient who had travelled to Ireland in the last year has been experiencing neurological abnormalities since returning to the United States several months ago. Which of the following is most likely? a. Creutzfeldt-Jakob disease with no accumulation of prion proteins b. Creutzfeldt-Jakob disease with an accumulation of prion proteins c. Variant Creutzfeldt-Jakob disease with no accumulation of prion proteins

d. Variant Creutzfeldt-Jakob disease with an accumulation of prion proteins 50. A 75-year-old patient who had recently undergone a cornea transplant 6 months ago is suddenly experiencing neurological abnormalities. Which of the following is most likely? a. Creutzfeldt-Jakob disease with no accumulation of prion proteins b. Creutzfeldt-Jakob disease with an accumulation of prion proteins c. Variant Creutzfeldt-Jakob disease with no accumulation of prion proteins d. Variant Creutzfeldt-Jakob disease with an accumulation of prion proteins

Chapter 13. Donor Screening and Component Preparation Answer Section MULTIPLE CHOICE 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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16.

17.

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22.

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29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 axEoR no.mCyOLM evel: 2 1 TES TBANKKESYE : LTL 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1

LO: 13-3 LO: 13-3 LO: 13-3 LO: 13-3 LO: 13-3 LO: 13-2 LO: 13-2 LO: 13-7 LO: 13-10 LO: 13-8 LO: 13-8 LO: 13-8 LO: 13-16 LO: 13-4 LO: 13-9 LO: 13-3 LO: 13-7 LO: 13-7 LO: 13-18 LO: 13-18 LO: 13-1 LO: 13-1 LO: 13-1 LO: 13-19 LO: 13-19 LO: 13-5 LO: 13-5 LO: 13-5 LO: 13-6 LO: 13-6 LO: 13-6 LO: 13-6 LO: 13-6 LO: 13-6 LO: 13-11 LO: 13-11 LO: 13-16 LO: 13-16 LO: 13-16 LO: 13-12 LO: 13-12 LO: 13-10 LO: 13-14

44.

45.

46.

47.

48.

49.

50.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 3

LO: 13-17 LO: 13-17 LO: 13-15 LO: 13-15 LO: 13-15 LO: 13-13 LO: 13-13

Chapter 14. Transfusion-Transmitted Diseases Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A person infected with HIV-1 is diagnosed with AIDS-related condition (ARC). What antibodies will be present in the patient's serum at this stage? a. Anti-p24 c. Anti-p26 b. Anti-gp41 d. Anti-p24 and anti-gp41 2. The cytomegalovirus and Epstein-Barr virus belong to which family of viruses? a. Flaviviridae c. Herpesviridae b. Retroviridae d. Picornaviridae 3. American Association of Blood Banks (AABB) Standards mandate the donor of blood or a component given to a recipient who develops clinical or laboratory evidence of transfusion-associated hepatitis (TAH), HIV infection, or HTLV-I/II infection must be permanently deferred if the unit was: a. a directed donation. b. the only unit transfused. c. one of four transfused to the recipient. d. positive for cytomegalovirus.

4. The hepatitis C virus is thought to be included in which family? a. Hepadnaviridae c. Flaviviridae b. Retroviridae d. Picornaviridae 5. HIV belongs to which family? a. Flaviviridae b. Retroviridae

c. Hepadnaviridae d. Picornaviridae

6. Why is transmission of cytomegalovirus (CMV) through blood components not a significant risk to most recipients? a. Most recipients are CMV-positive. b. Most recipients are CMV-negative. c. The CMV cannot tolerate cold storage temperatures. d. None of the above 7. How is the hepatitis A virus usually spread? a. Oral-fecal route b. Blood transfusion

c. Sexual transmission d. None of the above

8. A blood donor's serologic tests were reactive for HIV-1/2 antibodies. The test was repeated, and both were reactive. A Western blot confirmatory test was done and was negative. What is the protocol for this donor? a. Unit is discarded. c. Unit is OK to use. b. Health department is notified. d. Donor is permanently deferred.

9. This disease can be transmitted through blood transfusion and is characterized by sponge-like lesions of the brain. a. Cytomegalovirus c. Creutzfeldt-Jakob disease b. Epstein-Barr virus d. Chagas’ disease

10. According to the Centers for Disease Control (CDC), an HIV-positive person is considered to have AIDS according to what criterion? a. Presence of anti-p24 b. Presence of anti-gp41 c. Fewer than 200 CD8+ T cells per µL d. Fewer than 200 CD4+ T cells per µL 11. Which two infectious agents share the same vector? a. Rickettsia and Leishmania c. Borrelia and Plasmodium b. Babesia and Borrelia d. Babesia and Trypanosoma 12. All of the following viruses have been associated with TAH except: a. hepatitis A. c. hepatitis D. b. hepatitis B. d. hepatitis E. 13. HBsAg is what part of the hepatitis B virus? a. Core protein b. Coat protein

c. Dane particle d. Capsid protein

14. Which of the following parasites has not been associated with transmission via blood transfusion? a. Trypanosoma cruzi c. Leishmania b. Plasmodium spp. d. None of the above 15. In the HIV-1 virus a. gp41 b. p24

is a core protein. c. p55 d. p16

ToEckSyTMBoAuN 16. What is the causative agent for R ntK aiS nE spL otL teE dR fe. veCr?OM a. Rickettsia rickettsii c. Dolichos biflorus b. Borrelia burgdorferi d. Ehrlichia 17. The hepatitis B virus belongs to which family? a. Picornaviridae c. Flaviviridae b. Hepadnaviridae d. Retroviridae 18. Which test can reveal an asymptomatic patient with TAH? a. BUN c. ALT b. AST d. Amylase 19. What treatment is recommended for chronic liver disease due to hepatitis C virus infection? a. Gamma globulin c. Alpha interferon b. Prednisone d. Gamma interferon 20. Which test for HIV infection depends on amplification of HIV integrated in the DNA of infected cells? a. Western blot b. Polymerase chain reaction c. Immunofluorescence d. Enzyme-linked immunosorbent assay 21. What is the incubation period of hepatitis A virus in transfusion-associated hepatitis? a. 40 to 60 days c. 20 to 40 days b. 90 to 180 days d. 1 to 20 days 22. The hepatitis A virus belongs to which family of viruses?

a. Retroviridae b. Flaviviridae

c. Hepadnaviridae d. Picornaviridae

23. Persons infected with the hepatitis C virus may develop what disease? a. Chronic liver disease c. Hepatocellular carcinoma b. Cirrhosis d. All of the above 24. Which of the following findings is not part of the typical pattern of hepatitis A infection? a. Anti-HAV IgM antibodies c. Virus in stool b. Anti-HAV IgG antibodies d. Elevated ALT 25. The most sensitive test for the detection of HIV infection is the: a. polymerase chain reaction. c. immunofluorescence. b. Western blot. d. Southern blot.

26. Why are donors deferred for 6 months following receipt of blood products? a. To permit adequate screening for transfusion-acquired viral infections b. Because donation may cause recurrence of the condition that required transfusion c. To allow clearance of all transfused cells in the donor d. To allow donor recovery from the condition that required transfusion 27. Which of the following statements regarding the Western blot confirmation test for HIV infection is false? a. Viral components are distributed according to molecular weights. b. Most persons with AIDS show bands to p24 and gp41. c. Interpretation of test depends upon degree of immunofluorescence. d. A purified viral lysate is dissolved in SDS and separated by PAGE electrophoresis.

28. What marker usually is not deteT cteEdSwThB enAtN heKhS epEaL titL isEBR –i. nfCecOteMd patient enters the convalescent phase? a. Anti-HBc c. HBeAg b. HBsAg d. Anti-HBe 29. Which of the following is indicated when a recipient of blood or blood components develops a viral disease? a. Transfusion-reaction investigation c. Incident report b. Donor look-back d. Type and screen 30. Which of the following patients would be at a greater risk for CMV infection? a. An autologous transplant recipient b. A low-birth-weight infant transfused with CMV-negative blood c. An allogenic bone marrow transplant recipient d. None of the above 31. How can hepatitis A infection be prevented? a. Plasma protein fraction (PPF) b. Normal serum albumin (NSA)

c. Immune serum globulin (ISG) d. Fresh frozen plasma (FPP)

32. Which of the following viral infections poses a severe threat to chronically transfused individuals who carry the hepatitis B virus (HBV)? a. Superinfection by hepatitis C virus (HCV) b. Infection with hepatitis G virus (HGV) c. Superinfection by hepatitis D virus (HDV) d. Non-A, non-B, non-C virus (NANBNC virus) 33. Which cell is invaded by the HIV viruses? a. Monocyte

c. Lymphocyte

b. Neutrophil

d. Basophil

34. What is the source of hepatitis B immune globulin (HBIG)? a. Persons with a high titer of anti-HBc(IgG) b. Persons with a high titer of anti-HBe c. Persons with a high titer of anti-HBs d. Persons with a high titer of anti-HBc(IgM) 35. The “look-back” process includes notifying donors of abnormality with: a. predonation evaluation. b. laboratory testing. c. recipient follow-up. d. all of these.

36. Which of the following is not included in the signs and symptoms of TAH? a. Jaundice c. Dark urine b. Splenomegaly d. Acholic stools 37. In an individual infected with hepatitis B virus, which of the following is detected first? a. HBsAg c. anti-HBc b. HBeAg d. anti-HBs 38. Which statement regarding HDV is true? a. The HDV is a DNA virus. b. A carrier of hepatitis B virus cannot contract HDV infection. c. Most HDV infections occur via blood transfusion. d. HDV can occur simultaneously with hepatitis B virus.

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39. Pathogen inactivation intervention includes all of these EXCEPT: a. albumin’s pasteurization. b. anion-exchange chromatography. c. cold-ethanol fractionation. d. millipore filtration.

40. A single donor tested positive for HIV-1 via enzyme immunoassay screening techniques. The blood was retested and found to be nonreactive. What is the status of the donor whole blood unit? a. A confirmatory test should be performed. b. Blood and components are okay for use. c. The unit should be discarded. d. The donor should be placed on the re-entry list.

41.

42.

Which test is now used in the processing of all source plasmas for pathogen inactivation verification? a. DAT b. ELISA c. HPLC d. NAT Lipid-enveloped viruses are inactivated by use of: alcohol. cold. detergents. heat.

a. b. c. d.

43.

44.

The current risk of enveloped virus transmission is very low because of: a. heat treatment. b. detergent treatment. c. nanofiltration methods. d. a combination of all of these.

Pathogen inactivation using psoralen activated by ultraviolet light is most effective in: whole blood. plasma.

RBC concentrates. platelet concentrates.

a. b. c. d.

45. Pathogen reduction systems may not be effective against which agents? a. Prions b. Low-titer viruses c. Enveloped viruses d. Bacteria without spores True/False Indicate whether the statement is true or false.

1. A person with acute hepatitis B infection is immune to infection from other hepatitis viruses.

Chapter 14. Transfusion-Transmitted Diseases Answer Section MULTIPLE CHOICE 1. ANS: D 2. ANS: C 3. ANS: B 4. ANS: C 5. ANS: B 6. ANS: A 7. ANS: A 8. ANS: A 9. ANS: C 10. ANS: D 11. ANS: B 12. ANS: D 13. ANS: B 14. ANS: D 15. ANS: B 16. ANS: A 17. ANS: B 18. ANS: C 19. ANS: C 20. ANS: B 21. ANS: A 22. ANS: D 23. ANS: D 24. ANS: D 25. ANS: A 26. ANS: A 27. ANS: C 28. ANS: C 29. ANS: B 30. ANS: C 31. ANS: C 32. ANS: C 33. ANS: C 34. ANS: C 35. ANS: D 36. ANS: B 37. ANS: A 38. ANS: D 39. ANS: D 40. ANS: B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 TESTBANKEY: KSELTaxonomy LER.COLevel: M 1 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3

LO: 14-1 LO: 14-1 LO: 14-2 LO: 14-1 LO: 14-1 LO: 14-2 LO: 14-1 LO: 14-3 LO: 14-2 LO: 14-2 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-2 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-2 LO: 14-1 LO: 14-1 LO: 14-3 LO: 14-1 LO: 14-1 LO: 14-2 LO: 14-1 LO: 14-1 LO: 14-3 LO: 14-1 LO: 14-1 LO: 14-1 LO: 14-4 LO: 14-2

41. ANS: D 42. ANS: C 43. ANS: D 44. ANS: D 45. ANS: A

PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2

LO: 14-4 LO: 14-4 LO: 14-4 LO: 14-4 LO: 14-4

PTS: 1

KEY: Taxonomy Level: 2

LO: 14-1

TRUE/FALSE 1. ANS: F

Chapter 15. Component Preparation Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A whole blood donation contains a volume of 350 mL. Which of the following is true regarding this unit? a. Packed red blood cells cannot be made from this unit. b. FFP cannot be made from this unit. c. Cryoprecipitate can be made from this unit. d. Platelets cannot be made from this unit.

2. A unit of red blood cells has an expiration date of 11/15/12. A patient currently on a fludarabine regimen requires irradiated packed red blood cells. The unit is irradiated for this patient on 11/02/12. What is the correct expiration date postirradiation? a. 11/15/12 c. 11/28/12 b. 11/30/12 d. 11/02/12 3. Packed RBCs must have a final hematocrit of less than or equal to: a. 85%. c. 80%. b. 38%. d. 70%.

4. Leukoreduced packed RBCs must have an absolute white blood cell count of less than and contain at least what percent of original RBC mass? a. 5  108/85 c. 5  108/80 6/8 TESTBANKSdE. L5LE1R0.

C0OM b. 5  106/85 5. All of the following statements are characteristic of a penetrating cryoprotective agent except: a. it consists of generally small molecules. b. osmotic force prevents migration of water outside of the cell, preventing dehydration. c. large molecules form a shell around the cell, preventing loss of water and dehydration. d. none of the above.

6. What is the minimal pH required for platelets? a. 6.0 c. 7.0 b. 6.2 d. 7.2 7. Cryoprecipitate is indicated for all of the following disorders except: a. hypofibrinogenemia. c. Von Willebrand's disease. b. hemophilia A. d. hemophilia B. 8. What dose of RhIG would be appropriate for a D-negative woman who has had a miscarriage at 11 weeks’ gestation? a. 300 µg c. 50 µg b. 120 µg d. All of the above 9. A patient has a baseline platelet count of 30,000/µL. Upon receiving a platelet pool of 4 random platelets, what would you expect the post-transfusion platelet count to be? a. 35,000/µL c. 80,000/µL b. 50,000/µL d. 100,000/µL 10. What is the expiration time for platelet concentrates that have been pooled?

a. 24 hours b. 6 hours

c. 4 hours d. 48 hours

11. Which of the following are approved preservative solutions for blood storage at 1°C to 6°C for 21 days? a. ACD c. CP2D b. CPD d. All of the above 12. Methods of preparation of platelet concentrates from single units of whole blood must produce a product that yields a minimum of: a. 5.5  1011 platelets per unit in 50% of units tested. b. 5.5  1011 platelets per unit in 75% of units tested. c. 5.5  1010 platelets per unit in 75% of units tested. d. none of the above.

13. Normally what percentage of 35-day-old red blood cells should be circulating 24 hours after transfusion? a. 100% c. 65% b. 50% d. 70% 14. Which of the following statements explains why bacterial contamination of blood is rarely a problem? a. Regulated procedures for arm preparation prevent most bacterial contamination from occurring during collection. b. Citrate in the anticoagulant is not conducive to bacterial growth. c. The cold storage of blood is not conducive to bacterial growth. d. All of the above 15. What is the ratio of anticoagulantT toEw it R of.wChO olM e blood?

ShTolBe AblNooKdSinEaLuLnE a. 8 mL of anticoagulant-preservative for every 100 mL of whole blood collected b. 14 mL of anticoagulant-preservative for every 100 mL of whole blood collected c. 22 mL of anticoagulant-preservative for every 100 mL of whole blood collected d. 30 mL of anticoagulant-preservative for every 100 mL of whole blood collected 16. A unit of whole blood must be stored at what temperature? a. -65° to -20°C b. - 10° to 2°C c. 1° to 6°C d. 8° to 20°C 17.

What is the shelf life of whole blood collected in acid-citrate-dextrose? a. 10 days b. 21 days c. 35 days d. 50 days

18.

What is the shelf life of whole blood collected in citrate-phosphate-double dextrose? a. 10 days b. 21 days c. 35 days d. 50 days

19.

What is the shelf life of whole blood collected in citrate-phosphate-dextrose-adenine? a. 10 days b. 21 days c. 35 days d. 50 days

20. How are RBCs separated from whole blood? a. Apheresis b. Centrifugation c. Sedimentation d. All of these 21. Within what time after collection of whole blood must RBCs be separated from whole blood in order for platelet and plasma components to be prepared? a. Immediately b. 2 to 5 hours c. 8 to 24 hours d. Any time 22. A unit of packed RBCs must be stored at what temperature? a. -65° to -20°C b. - 10° to 2°C c. 1° to 6°C d. 8° to 20°C 23.

What is the shelf life of packed RTBECSs T coBllA ecN teK dS inEaL ciL d-E ciR tra.teC-dOeM xtrose? a. 10 days b. 21 days c. 35 days d. 50 days

24. What are platelets obtained from apheresis donations called? a. Random-donor platelets (RDPs) b. Single-donor platelets (SDPs) c. Targeted-donor platelets (TDPs) d. None of these 25. Manufacturing RDPs is accomplished by using all of the following methods EXCEPT: a. apheresis collection. b. buffy coat aspiration. c. centrifuge on high d. centrifuge on low.

26. A unit of packed platelets must be stored at what temperature? a. 1° to 6°C b. 8° to 20°C c. 20° to 24°C d. 32° to 45°C 27. Units of platelets are stored under which of these conditions? a. Constant agitation

b. Darkened chamber c. Hanging from a hook d. None of these 28.

What is the shelf-life of platelets if the unit is tested for bacterial contamination just prior to issuing? a. 2 days b. 5 days c. 7 days d. 10 days

29.

What is the shelf-life of frozen RBCs? a. 1 year b. 5 years c. 10 years d. Indefinite

30. Which of the following is/are an example of a penetrating cryoprotective agent? a. Dimethylsulfoxide b. Glycerol c. Hydroxyethyl starch d. All of these 31. A unit of cryopreserved RBCs must be stored below what temperature? a. -80°C b. -65°C c. -20°C d. 0°C 32. What is the expiration date of a deglycerolized unit of RBCs? a. 10 hours b. 24 hours c. 36 hours d. 72 hours 33. Which statement about frozen plasma is correct? a. The expiration of frozen plasma stored at -18°C is 10 years. b. The expiration of frozen plasma stored at -65°C is 7 years. c. The expiration of frozen plasma stored at -10° to 0°C is 5 years. d. All of these are correct.

34. Frozen plasma is thawed at what temperature? a. 2° to 4°C b. 18° to 22°C c. 30° to 37°C d. 45° to 56°C 35. Which statement about liquid plasma is correct? a. Liquid plasma is a product from whole blood donations. b. The expiration of liquid plasma is 5 days after its whole blood shelf-life. c. Liquid plasma is stored at 1° to 6°C.

d. All of these are correct.

36. Liquid plasma is prepared from a unit of whole blood collected in CPDA-1 on July 28th.

What is the expiration date of this plasma? a. August 18th b. August 23rd c. September 2nd d. September 7th 37. A unit of granulocyte should contain at least what concentration of granulocytes? a. 1  1010 b. 4  1010 c. 6  1010 d. 10  1010 38. A unit of granulocytes prepared on April 13th at 10:00 am and is irradiated at 2:00 pm the same day.

What is the expiration date? a. April 13th 3:00 pm. b. April 13th 10:00 pm. c. April 14th 10:00 am. d. April 14th 2:00 pm.

39. Plasma factor concentrates are separated into various proteins by manipulating which variable? a. pH b. Alcohol content c. Temperature d. All of these 40. Viruses are inactivated in units of plasma factor concentrate by all of these methods EXCEPT: a. freezing. b. heating. c. solvent-detergent. d. nanofiltration.

41. Which factor concentrate has almost completely replaced cryoprecipitate as the product of choice to treat patients with hemophilia A? a. FVIIa b. rFVIIa c. FVIII d. FVIX 42. Xenographic forms of factor VIII are made from which source of plasma? a. Bovine plasma b. Human plasma c. Porcine plasma d. Reptilian plasma 43. Which of the follow is NOT considered in the preparation of Rho immunoglobulin? a. Donors are Rh-(D) positive.

b. Donors have been hyperimmunized. c. Donor plasmas contain IgG anti-D. d. Donor human plasmas are pooled.

44. Which of the follow does NOT describe the preparation of NSA? a. Plasma is salvaged and pooled. b. Plasma is fractionated using a warm alcohol process. c. HIV and hepatitis are inactivated with heat inactivation. d. NSA composition includes of 96% albumin and 4% globulin.

45. Which of the follow does NOT describe the preparation of immune serum globulin? a. Immune serum globulin is a concentrate of plasma gamma globulins. b. It is prepared from pooled plasma by cold ethanol fractionation. c. Preparations include intravenous (IV) or intramuscular (IM) forms. d. The solution of immune serum globulin is dehydrated state and must be reconstituted with saline.

46. What is the half-life of immune serum globulin? a. 3 to 7 days b. 10 to 15 days c. 18 to 32 days d. 40 to 45 days 47. How is the preparation of PPF different than that of NSA? a. PPF is salvaged and pooled; NSA is not pooled. b. PPF is cold ethanol fractionated; NSA is warm alcohol fractionated. c. PPF uses heat inactivation of viruses; NSA does not. d. PPF contains less albumin and more globulins than NSA. 48. What is the storage temperature for normal serum albumin? a. -80° to -65°C b. -20° to 0°C c. 2° to 10°C d. 20° to 25°C 49. What is the shelf-life for normal serum albumin? a. 1 year b. 3 years c. 5 years d. 10 years 50. What is the storage temperature for plasma protein fraction? a. -80° to -65°C b. -20° to 0°C c. 2° to 10°C d. 20° to 25°C 51. What is the shelf-life for plasma protein fraction? a. 3 years b. 5 years c. 10 years

d. 15 years 52. Which of the follow does NOT describe the preparation of antithrombin? a. Apheresis of a single donor sensitized donor b. Prepared from pooled human plasma c. Viral inactivation using heat treatment d. Purification of milk from transgenic goats.

53. In which animal has transgenic methods produced rAT in the milk? a. Cows b. Goats c. Pigs d. Sheep

Chapter 15. Component Preparation Answer Section MULTIPLE CHOICE 1. ANS: B 2. ANS: A 3. ANS: C 4. ANS: B 5. ANS: C 6. ANS: B 7. ANS: D 8. ANS: C 9. ANS: B 10. ANS: C 11. ANS: D 12. ANS: C 13. ANS: D 14. ANS: D 15. ANS: B 16. ANS: C 17. ANS: B 18. ANS: B 19. ANS: C 20. ANS: D 21. ANS: C 22. ANS: C 23. ANS: B 24. ANS: B 25. ANS: A 26. ANS: C 27. ANS: A 28. ANS: C 29. ANS: C 30. ANS: A 31. ANS: B 32. ANS: B 33. ANS: B 34. ANS: C 35. ANS: D 36. ANS: D 37. ANS: A 38. ANS: C 39. ANS: D 40. ANS: A 41. ANS: C

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1

LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1 LO: 15-1

Chapter 16. Transfusion Therapy Multiple Choice Identify the choice that best completes the statement or answers the question.

1. What is the purpose of dialysis in uremic patients? a. Release of functional von Willebrand factor (vWF) from endothelial cells b. Removal of by-products of protein metabolism that renders vWF and platelets nonfunctional c. Release of platelets from the bone marrow d. All of the above 2. Which of the following is not an indication for fresh frozen plasma (FFP) transfusion? a. Disseminated intravascular coagulation (DIC) b. Vitamin K deficiency c. Factor VIII deficiency d. Massive transfusion 3. The rejection of the transplantation of platelets from one individual to another is termed or defined as: a. a hemolytic transfusion reaction. c. graft-versus-host disease. b. platelet refractoriness. d. none of the above.

4. Which of the following may be a serious manifestation of FFP transfusion in congenital factor deficiencies? a. Tachycardia c. Hypogammaglobulinemia b. Pleurisy d. Pulmonary edema

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5. All coagulation factors are produced in the liver except: a. antihemophilic factor (AHF). c. vWF. b. factor I. d. factor VII.

6. What is the advantage of performing a type and screen for patients scheduled for surgery instead of crossmatching units for possible transfusion? a. Increases the amount of crossmatch performed b. Increases the availability of donor units in the inventory c. Contributes to outdating of blood products d. Decreases the number of panel studies done on positive antibody screens 7. How are RBC aliquots prepared for a neonate transfusion? a. Blood is withdrawn from collection bag using a syringe and diluted 1:2 with saline. b. Blood is withdrawn from collection bag using a syringe and diluted 1:2 with glycerol. c. Blood is transferred from collection bag to satellite bag and withdrawn using a syringe. d. None of the above 8. Which of the following is an indication for immunoglobulin administration? a. Cytomegalovirus b. Hepatitis A c. Infectious mononucleosis d. Congenital hypergammaglobulinemia 9. Deglycerolized red blood cells can be used interchangeably with washed red blood cells, because both procedures: a. remove white blood cells. c. have 24-hour outdate.

b. remove plasma.

d. all of the above

10. Oncology patients usually receive repeated red blood cell and platelet transfusions because of: a. radiation therapy. c. chemotherapy. b. tumor infiltration of bone marrow. d. all of the above.

11. Which of the following is not a function of the hospital transfusion committee? a. FDA certification b. Reviewing transfusion reactions c. Submitting reports of committee recommendations to medical staff d. Ensuring proper procedures are upheld by hospital personnel 12. Liquid plasma is not indicated for factor a. XI b. V

deficiency. c. II d. X

13. Why are fresh blood units (less than 7 days old) preferred for a neonate transfusion? a. They reduce the risk of hyperkalemia. b. They minimize 2,3 DPG levels. c. They reduce the risk of hypokalemia. d. They reduce the risk of hypernatremia.

14. All of the following are consistent with graft-versus-host disease (GVHD) except: a. transplantation of immunocompetent T lymphocytes. b. HLA incompatibility between graft and recipient. c. transplantation of "immunologically naive" T lymphocytes. d. an immunocompromised recipient.

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15. The pathological cause of a decreased red blood cell mass include(s): a. compromised bone marrow production. b. decreased red blood cell survival. c. bleeding as a result of trauma. d. all of the above 16. Bleeding disorders may be caused by: a. dysfunction of lymphocytes. b. dysfunction of neutrophils.

c. dysfunction of platelets. d. dysfunction of erythrocytes.

17. Which of the following are not at risk for developing cytomegalovirus (CMV) via CMV-positive blood products? a. CMV-positive heart transplant recipients b. CMV-negative pregnant women c. CMV-negative bone marrow transplant recipients d. CMV-negative premature infants 18. Which platelet pheresis product should be irradiated? a. Autologous unit collected prior to surgery b. Random stock unit going to a patient with disseminated intravascular coagulation (DIC) c. A directed donation given by a mother to her son d. A directed donation given by an unrelated family friend 19. Why is whole blood contraindicated for patients with severe chronic anemia? a. These patients have a reduced number of red blood cells.

b. The plasma volume of these patients is decreased. c. The plasma volume of these patients is increased. d. These patients have an increased number of red blood cells.

20. How is donor platelet survival determined in the recipient? a. Platelet count increment (1 hour after transfusion) b. Radiolabeled metals c. Antiplatelet antibody detection d. None of the above 21. Immunoglobulin prepared from pooled plasma is primarily: a. IgG c. IgA b. IgM d. IgE 22. A blood component should be transfused within: a. 1 hour. c. 3 hours. b. 2 hours. d. 4 hours.

23. Cryoprecipitated AHF can be used in the treatment of: a. Bernard-Soulier syndrome. b. von Willebrand's disease (vWD). c. antithrombin III deficiency. d. hemolytic uremic syndrome.

24. Why is it recommended that factor VIII concentrates be used in patients with von Willebrand's disease? a. Because of the variability in vWF content b. Because of factor VIII’s short half-life c. Factor VIII concentrates are reserved for hemophiliacs. d. All of the above 25. What whole blood component contained in pheresed granulocyte concentrate warrants crossmatching of this product? a. White blood cells c. Platelets b. Red blood cells d. Plasma 26. How is the whole blood that is collected from a donor different from whole blood circulating in someone's blood vessels? a. The anticoagulant in donor blood prevents activation of the coagulation system. b. The citrate mixed with donor blood serves as substrate for red blood cell metabolism. c. The pH of whole blood is higher in collected units than in blood vessels. d. Immunogenicity is diminished in collected units.

27. What is the corrected platelet increment for a patient with a body surface area of 2.7 m 2, an initial count of 15,000 per µL, and a 1-hour post-transfusion platelet count of 80,000 per µL given one apheresed platelet component? a. 53,182 per µL c. 31,900 per µL b. 58,500 per µL d. 5,000 per µL 28. In addition to nonhemolytic febrile transfusion reactions, what other indication exists for washed red blood cells? a. IgM-deficient patients with anti-IgM b. IgE-deficient patients with anti-IgE c. IgA-deficient patients with anti-IgA

d. IgG-deficient patients with anti-IgG 29. How does 25% albumin induce diuresis in liver disease patients? a. Albumin inactivates antidiuretic hormone in diabetics. b. Albumin solution acts with diuretic drugs to concentrate plasma, driving water into extravascular spaces. c. Albumin solution acts with diuretics and brings extravascular water into vascular space to dilute albumin. d. None of the above 30. Which of the following is an indication for plasma transfusion in a patient who has been massively transfused? a. PT = 12 seconds c. Fibrinogen = 120 mg/dL b. PTT greater than 60 seconds d. Platelets = 25,000/µL 31. In what disease state is acquired antithrombin III deficiency manifested? a. DIC c. Liver disease b. von Willebrand's disease d. Lupus erythematosus 32. Who is at risk for transfusion-associated graft-versus-host disease (TAGVHD)? a. Hodgkin's lymphoma patients b. Bone marrow transplant recipients c. Persons receiving nonirradiated directed donations d. All of the above 33. Which class of vWD provides the least amount of vWF? e III a. Type I TESTBANKScE. LTLyEpR .COM b. Type IIB d. Type IIA 34. Which of the following methods provides the purest factor VIII concentrates? a. Anion exchange chromatography c. DNA technology b. Monoclonal antibody purification d. Pasteurization 35. What is the expiration on washed red blood cells? a. 35 days c. 42 days b. 24 hours d. 6 hours 36. What is used to anticoagulate the shed blood obtained from intraoperative salvage? a. EDTA c. Heparin b. Citrate d. Citrate and heparin 37. Why is it essential that irradiated blood components be used in bone marrow transplant recipients? a. Irradiation counteracts the effects of neutrophil toxicity. b. Bone marrow recipients demonstrate hyperimmunity to lymphocytes. c. Bone marrow recipients are on immunosuppressive therapy. d. None of the above 38. Persons making predeposit donations for planned surgery will take iron supplements to replenish iron and stimulate: a. myelopoiesis. c. thrombopoiesis. b. erythropoiesis. d. lymphopoiesis.

39. Platelets prepared from a. recovered plasma

are referred to as random donor platelets. c. whole blood units

b. pheresis products

d. red blood cells

40. Hemophilia A is clinically apparent when the factor VIII level is less than: a. 20% c. 50% b. 10% d. 60% 41. Which of the following is not an indication for transfusing platelets? a. Thrombocytopenia with bleeding or invasive procedure b. Disseminated intravascular coagulation c. Chemotherapy for malignancy d. Massive transfusion, platelet count 250,000/µL 42. Which type of filter is used in routine blood administration sets to remove gross clots from all blood products? a. Leukopoor c. 100 µm b. 170 µm d. 50 µm 43. Which type of autologous transfusion, successful in liver transplants, involves collecting 1 to 2 units from the patient before surgery, using crystalloid to replace blood volume and reinfusing blood at the end of surgery? a. Intraoperative hemodilution c. Intraoperative salvage b. Predeposit donation d. Postoperative salvage 44. Factor VIII is treated by which of the following to ensure sterility for HIV and hepatitis B and C? a. Pasteurization c. Solvent detergent b. Nanofiltration d. All of the above 45. Which of the following should be done when selecting units for a hypoxic neonate?

TESTBANKScE. LH LgEbRS.teCsO tinMg a. Irradiation b. Cytomegalovirus testing d. Epstein-Barr virus testing 46. Why is red blood cell transfusion contraindicated in a stable patient with chronic renal failure who has no symptoms except after climbing three flights of stairs? a. The anemia is compensated. b. The anemia is a "nutritional anemia." c. Whole blood is recommended because the plasma volume is decreased in these patients. d. None of the above 47. What is the source of hyperimmune globulins used in the prevention of hepatitis B? a. Recombinant hepatitis B purified protein b. Plasma donors whose sera are devoid of hepatitis B antibody c. Plasma donors whose sera demonstrate a high titer of hepatitis B antibody d. None of the above 48. Why is the increase in hemoglobin and hematocrit evident more quickly in red blood cell transfusions than in whole blood transfusions? a. Blood volume adjustment is less when red blood cells are transfused. b. Blood volume adjustment is greater when red blood cells are transfused. c. Whole blood takes longer to mix. d. Whole blood is usually transfused through a porous filter.

49. Factor IX concentrates contain which factors (otherwise known as "prothrombin complex")? a. I, V, VII, IX c. II, VII, IX, X b. II, V, VII, IX d. V, VII, IX, XII

50. What is suspected when the hematocrit has decreased by 4% and the total bilirubin level is increased 5 days after transfusion? a. Acute hemolytic transfusion reaction b. Volume overload c. Delayed hemolytic transfusion reaction d. Urticarial reaction 51. The rejection of platelets in multiply transfused patients is called: a. platelet satellitism. c. refractoriness. b. stimulation. d. urticaria.

52. Which of the following statements concerning red blood cells prepared with additive solution 1 (AS-1) is true? a. The shelf life is 35 days. b. The AS-1 unit contains more plasma than the CPDA-1 red blood cells. c. Red blood cell mass is lower than that of CPDA-1 red blood cells. d. The hematocrit is lower than CPDA-1 red blood cells.

53. What is the immunologic principle of RhIG administration? a. Anti-D attaches to Rh-positive cells of mother and are subsequently removed by cells of the reticuloendothelial system, preventing sensitization. b. Anti-D attaches to Rh-positive cells of the infant in maternal circulation and are subsequently removed by cells of the reticuloendothelial system, preventing sensitization. c. Anti-D attaches to Rh-negative cells of the infant in maternal circulation and are subsequently removed by cells of the reticuloendothelial system, preventing sensitization. d. None of the above 54. Vitamin K is essential for the carboxylation of which coagulation factors? a. I, VII, IX, X c. II, VII, IX, X b. I, V, IX, X d. II, VII, XI, XII 55. Leukoreduction filters are used in the transfusion of red blood cells and platelets to prevent: a. nonfebrile hemolytic transfusion reactions. b. febrile hemolytic transfusion reactions. c. febrile nonhemolytic transfusion reactions. d. nonfebrile nonhemolytic transfusion reactions.

56. How would the hematocrit of a patient with chronic anemia be affected by transfusion of 2 units of whole blood versus transfusion with 3 units of packed RBCs? a. Patient's hematocrit would be equally affected. b. The packed RBCs would increase the hematocrit more than the whole blood. c. The whole blood would increase the hematocrit more than the packed RBCs. d. The hematocrit would not change at all with the whole blood because of the plasma in the unit.

57. Which of the following factors are found in therapeutic levels in fresh frozen plasma? a. Factor VIII c. Factor XI b. Factor V d. All of the above 58. A patient with severe hemolytic anemia had a pulse of 120 beats per minute and a respiratory rate of 37 breaths per minute. What blood component is indicated for this patient? a. Plasma c. Red blood cells b. Whole blood d. Platelets

59. Which of the following Rh-negative patients may be transfused with Rh-positive units when few O-negative units are available in an emergency? a. Pregnant woman c. 25-year-old female b. Middle-aged male d. Neonate 60. What is the recommended treatment for mild von Willebrand's disease? a. VIII concentrate b. Fresh frozen plasma c. Cryoprecipitate d. DDAVP (1-Deamino-8-arginine vasopressin) 61. Neonatal exchange transfusion is performed using which blood preservative? a. AS-1 b. Citrate-phosphate-dextrose (CPD) c. Citrate-phosphate-dextrose adenine (CPDA-1) d. Both B and C can be safely used 62. A patient with hypofibrinogenemia is receiving cryoprecipitate on an outpatient basis. His plasma volume is 4,000 mL, and his physician wants to increase factor I from 40 mg/dL to 120 mg/dL. How many bags of cryoprecipitate are needed? a. 8 c. 15 b. 13 d. 21 63. Why is thrombocytopenia a manifestation of a massive transfusion? a. Platelets are diluted by resuscitation fluids and stored blood. b. Platelets are refractory to infused blood. c. Platelets are sequestered in the spleen due to abnormal hemodynamics. d. None of the above 64. Which blood product is used in the treatment of DIC? a. Plasma c. Cryoprecipitate b. Platelets d. All of the above 65. All of the following are characteristics of protein C except: a. it has a vitamin K dependent factor. b. it has a serine protease inhibitor. c. it enhances factors V and VIII. d. it produces a hypercoagulable state.

66. Cryoprecipitate is not used to treat which condition? a. Hemophilia A c. Hemophilia B b. von Willebrand's disease d. Hypofibrinogenemia 67. A 160-pound man was transfused with 1 unit of whole blood after being rescued from a burning apartment building. His hematocrit was determined to be 27% before transfusion. What would you expect his hematocrit to be in 48 hours? a. 28% c. 40% b. 30% d. 45% 68. What is the only blood component that provides high concentrations of vWF? a. FFP c. Platelets b. Whole blood d. Cryoprecipitated AHF

69. How is cryoprecipitated AHF used with prosthetic vascular grafts? a. Bovine thrombin activates factor XIII, which acts as a fibrin solvent to prime grafts. b. Bovine thrombin activates factor VIII, which acts as a fibrin glue to seal gaps. c. Bovine thrombin activates fibrinogen, which acts as a fibrin glue to seal gaps. d. None of the above 70. Antithrombin III concentrates are used in the treatment of: a. dysfibrinogenemia. b. acquired antithrombin III deficiency caused by DIC. c. hereditary antithrombin III deficiency caused by venous thrombosis. d. all of the above 71. Which intravenous solution is not recommended for dilution of blood components because of red blood cell damage? a. 0.9% saline c. 5% albumin b. Dextrose d. Plasma 72. How can GVHD be prevented in transplant recipients? a. Filtering of cellular components b. Irradiation of cellular components c. Deglycerolizing of cellular components d. None of the above 73. Which of the following represents the final clerical check of a transfusion? a. The phlebotomist asks the patient to state his name and Social Security number and compares that information with the patient requisition. b. The medical technologist coTmEpS arT esBtA heNsK peS ciE mL enLlE abRe. lw thMcomputer information.

CiO c. The nurse uses the patient’s armband to compare patient identification with the patient crossmatch report and tags attached to the unit. d. Two individuals verify affixing of proper labels to selected blood products.

74. A patient with paroxysmal cold hemoglobinuria (PCH) would require transfusion. a. irradiation c. a blood warmer b. cytomegalovirus-negative units d. Hgb S-negative units

in the event of a blood

75. What disease state may require exogenous fibrinogen replacement? a. Disseminated intravascular coagulation b. Liver failure c. Congenital fibrinogen deficiency d. All of the above 76. All blood components should be transfused within what time period to avoid bacterial contamination issues? a. 4 hours c. 8 hours b. 6 hours d. 24 hours 77. Cryoprecipitate AHF contains how much fibrinogen? a. 500 to 750 mg c. 150 to 250 mg b. 50 to 100 mg d. 250 to 400 mg 78. Which of the following criteria warrants a granulocyte concentrate transfusion? a. A neutrophil count greater than 1,000 per µL b. A septic patient unresponsive to antibiotics

c. Bone marrow hyperplasia d. None of the above 79. Each cryoprecipitate unit contains at least how much factor VIII? a. 80 units c. 30 units b. 50 units d. 100 units 80. What is the most efficient way to remove leukocytes from red blood cell units? a. Leukoreduction filters c. Deglycerolizing b. Centrifugation d. Washing 81. What blood component is responsible for most allergic reactions? a. Platelets c. Red blood cells b. Plasma d. White blood cells 82. Why is plasma not recommended for the treatment of hemophilia B? a. Hypervolemia limits factor IX efficacy. b. Hypovolemia limits factor IX efficacy. c. Plasma is devoid of factor IX. d. None of the above 83. What plasma product is used to replace fluid in patients undergoing plasmapheresis procedures? a. Albumin c. Immune globulin b. Plasma protein fraction d. Cryoprecipitate 84. What is the best-tolerated form of transplantation in humans? a. Red blood cells c. Bone marrow TESTBANKS LiE dE. LL veR r .COM b. Platelets 85. What transfusion therapy is indicated for a patient who is found to be refractory to random platelets? a. Irradiated random donor platelets b. Random platelets from other donors c. Apheresis platelets from an HLA-compatible donor d. Neutralization of antiplatelet antibodies by type-specific platelets 86. What hemoglobin level is considered critical and may warrant a red blood cell transfusion? a. 10 g/dL c. 12 g/dL b. 7 g/dL d. 9 g/dL 87. Cryoprecipitated AHF can be used to treat von Willebrand's disease by providing has failed to release adequate amounts of endogenous vWF. a. exogenous/DDAVP b. endogenous/DDAVP c. exogenous/factor VIII concentrates d. endogenous/factor VIII concentrates 88. How is a coagulation factor unit defined? a. Activity in 1 mL of pooled plasma b. 100% activity in 1 unit/L

c. Activity in 100 units/mL d. All of the above

89. Cryoprecipitate AHF contains factor VIII. What other coagulation factor is present? a. I c. VII b. V d. XII

vWF after

90. Four units of packed RBCs were used in the operating room at 3 p.m. Can the remaining 2 units be returned to the blood bank at 5 p.m.? a. Yes, if the 2 units have been kept under the proper storage conditions b. Yes, but only if the units are to be used for the same patient c. No, units may have been out of blood bank for more than 4 hours d. No, units have been out of the blood bank for longer than 30 minutes 91. What component is indicated for patients who have had moderate to severe allergic transfusion reactions and have anti-IgA antibodies because of IgA deficiency? a. Whole blood c. Washed RBCs b. Packed RBCs d. Granulocyte preparations 92. Which component(s) provide(s) a concentrated source of fibrinogen? a. Fresh or frozen RBCs and FFP c. Cryoprecipitate b. FFP and cryoprecipitate d. Random donor platelets and plasma 93. The most important step in the safe administration of blood is to: a. perform compatibility testing accurately. b. get an accurate patient history. c. exclude disqualified donors. d. accurately identify the donor unit and intended recipient.

94. Poor increment in the platelet count 1 hour following platelet transfusion is most commonly caused by: a. splenomegaly. b. alloimmunization to HLA antigens. c. disseminated intravascular coagulation. d. defective platelets.

95. Granulocytes for transfusion should: a. be administered through a microaggregate filter. b. be ABO- and Rh-compatible with the recipient's serum. c. be infused within 72 hours of collection. d. never be transfused to patients with a history of febrile transfusion reaction.

96. In anemia uncomplicated by low plasma proteins or shock, the transfusion of: a. whole blood is most desirable. b. plasma is desirable. c. packed red blood cells is most desirable. d. fresh frozen plasma is most desirable.

97. For which of the following transfusion candidates would CMV-negative blood be most likely indicated? a. Renal dialysis patients c. Transplant candidates b. Pregnant women d. CMV seropositive patients 98. What are the requirements for a transfusion to be classified as massive in an adult? a. 5 units within 24 hours c. 5 units within 1 week b. 10 units within 24 hours d. 10 units within 1 week

99. In the case of a need for massive transfusion in which a shortage of Rh-negative blood exists, which of these patients must not be switched to administration of Rh-positive blood if at all possible? a. 35 year old male c. 35 year old female b. 85 year old male d. 85 year old female 100. What does the first transfusion in a massive transfusion protocol consist of?

a. b. c. d.

2 units uncrossmatched group O whole blood 2 units uncrossmatched type-specific whole blood 2 units crossmatched group O whole blood 2 units crossmatched type-specific whole blood

Chapter 16. Transfusion Therapy Answer Section MULTIPLE CHOICE 1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS: 9. ANS: 10. ANS: 11. ANS: 12. ANS: 13. ANS: 14. ANS: 15. ANS: 16. ANS: 17. ANS: 18. ANS: 19. ANS: 20. ANS: 21. ANS: 22. ANS: 23. ANS: 24. ANS: 25. ANS: 26. ANS: 27. ANS: 7

B C B D C B C B D D A B A C D C A C C A A D B A B A B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 LLER.COM TES TBAN 1 KKESYE : Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3

LO: 16-13 LO: 16-2 LO: 16-7 LO: 16-3 LO: 16-1 LO: 16-8 LO: 16-5 LO: 16-2 LO: 16-2 LO: 16-12 LO: 16-15 LO: 16-2 LO: 16-3 LO: 16-7 LO: 16-3 LO: 16-2 LO: 16-6 LO: 16-5 LO: 16-2 LO: 16-4 LO: 16-1 LO: 16-15 LO: 16-2 LO: 16-14 LO: 16-5 LO: 16-1 LO: 16-4

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 16-2 LO: 16-2 LO: 16-2 LO: 16-2 LO: 16-7 LO: 16-13 LO: 16-5 LO: 16-15 LO: 16-5 LO: 16-7 LO: 16-9 LO: 16-5 LO: 16-13 LO: 16-2 LO: 16-15 LO: 16-9 LO: 16-5 LO: 16-5 LO: 16-3 LO: 16-5 LO: 16-4 LO: 16-1 LO: 16-4 LO: 16-2 LO: 16-5 LO: 16-2 LO: 16-1 LO: 16-15 LO: 16-4 LO: 16-1 LO: 16-3 LO: 16-10 LO: 16-3 LO: 16-3 LO: 16-2 LO: 16-10 LO: 16-3 LO: 16-1 LO: 16-2 LO: 16-4 LO: 16-1 LO: 16-2 LO: 16-2

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1

LO: 16-5 LO: 16-7 LO: 16-15 LO: 16-3 LO: 16-3 LO: 16-15 LO: 16-1 LO: 16-2 LO: 16-1 LO: 16-5 LO: 16-1 LO: 16-3 LO: 16-2 LO: 16-2 LO: 16-2 LO: 16-2 LO: 16-3 LO: 16-1 LO: 16-1 LO: 16-15 LO: 16-3 LO: 16-1 LO: 16-15 LO: 16-4 LO: 16-15 LO: 16-2 LO: 16-3 LO: 16-11 LO: 16-11 LO: 16-11

Chapter 17. Adverse Effects of Blood Transfusion Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Treatment of post-transfusion purpura (PTP) with is not advocated in medical practice. a. plasmapheresis c. platelet transfusions b. prednisone d. exchange transfusions 2. A transfusion reaction investigation should include all of the following except: a. diagnosis. c. neocyte transfusion. b. current medication. d. washed RBCs. 3. What should be done in the transfusion process when the patient temperature spikes from 37.5°C to 38.5°C within 30 minutes of transfusion? a. Continue the transfusion. b. Stop the transfusion and keep the intravenous line open. c. Treat with diphenhydramine (Benadryl). d. Affix a leukocyte filter to transfusion line.

4. What groups are at risk for graft-versus-host disease (GVHD) as a result of transfusion? a. Polycythemia vera patients undergoing a therapeutic phlebotomy b. Fetuses receiving an intrauterine transfusion c. Patients receiving a directed donation from a first-degree relative d. Options B and C

TESTBANKSELLER.COM

5. A 41-year-old multiparous woman was rushed to the emergency room after being shot in the chest. She received 8 units of packed red blood cells and 5 units of platelets. The hemoglobin and hematocrit determinations stabilized after 6 hours in surgery, but the platelet counts remained less than 50,000 per µL. She had received additional units of platelets at 48-hour intervals with little efficacy. Her serum was tested for platelet antibodies. She was placed on corticosteroids to control chest wound bleeding. Anti-PLA1 was identified in the patient's serum. This case is representative of what type of transfusion reaction? a. Post-transfusion purpura c. Graft-versus-host disease b. Circulatory overload d. Alloimmunization 6. A patient with two or more documented febrile nonhemolytic transfusion reactions (FNHTRs) should receive blood components. a. irradiated c. cytomegalovirus-negative b. leukopoor d. hemoglobin S-negative 7. Which of the following questions should be asked when investigating a transfusion reaction? a. How many milliliters of red blood cells were transfused? b. What time of day was the donor unit collected? c. What methodology was used for serologic testing? d. What was the donor unit hematocrit?

8. What measure can be taken to prevent transfusion-associated hypothermia? a. Prudent use of platelet concentrates b. Close monitoring of patient vital signs c. Transfusion of product using a blood warmer d. Premedication with calcium gluconate

9. Which of the following products may lead to sepsis in a patient when contaminated with Escherichia coli? a. Packed red blood cells c. Platelets b. Normal saline d. All of the above 10. All of the following are diseases that can mimic a transfusion reaction except: a. AML. c. G6PD deficiency. b. hemoglobin C disease. d. PNH. 11. Persons with a documented history of anaphylactic reactions should be transfused with products. a. IgE-deficient c. washed b. leukodepleted d. irradiated

blood

12. A postpartum woman was crossmatched for 2 units of packed red blood cells. The first unit was issued at 3:15 a.m. At 3:45 a.m., the nurse called the blood bank and stated the patient was developing red hives and pruritus (itching). The transfusion was stopped and a post-transfusion specimen was drawn. The unit and identification tags were returned to the blood bank. The DAT on the specimen was negative, and hemolysis was absent. All visual and clerical checks were satisfactory. The pathologist ordered the treatment of diphenhydramine (Benadryl) for all subsequent transfusions. What type of transfusion reaction has occurred in this patient? a. Anaphylactic c. Alloimmunization b. Urticarial d. Post-transfusion purpura 13. What would be the result of group B blood given to a group O patient? a. Nonimmune transfusion reaction b. Immediate hemolytic transfusion reaction c. Delayed hemolytic transfusion reaction d. No reaction 14. For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to: a. prevent alloimmunization. b. diminish chills and fever and make the patient comfortable. c. prevent hemoglobinemia. d. reverse hypotension and minimize renal damage.

15. The plasma level of unconjugated bilirubin is elevated in: a. intravascular hemolysis. b. extravascular hemolysis. c. intravascular and extravascular hemolysis. d. none of the above.

16. Which of the following is an indicator of acute immune hemolytic transfusion reaction? a. Increased haptoglobin c. Decreased LDH b. Increased hemoglobin d. Increased bilirubin 17. A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except: a. Acute nonimmune hemolytic transfusion reaction b. Febrile nonhemolytic transfusion reaction c. Acute immune hemolytic transfusion reaction d. Transfusion-associated sepsis 18. Which of the following statements is false? a. Intravascular transfusion reactions require complete complement activation.

b. Intravascular transfusion reactions can have immediate clinical signs. c. Red blood cells are phagocytized by macrophages in the spleen and liver in intravascular reactions. d. Intravascular reactions usually involve IgM antibodies.

19. A patient transfused with 2 units of packed cells spiked a fever of 99.5°F and complained of chills 3 days after transfusion. The DAT was positive with polyspecific antisera and anti-IgG but negative with anti-C3d.

Compatibility testing was performed on the pre- and post-transfusion specimens. The latter was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion specimens. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jka. This transfusion reaction is most likely caused by: a. an anaphylactic response. b. delayed hemolytic transfusion reaction (DHTR) caused by anamnestic response. c. DHTR caused by primary alloimmunization. d. post-transfusion purpura.

20. A 35-year-old woman was transfused with 1 unit of packed red blood cells. The nurse monitoring the transfusion noticed hives on the patient’s arm and an increase in body temperature. What is the choice of treatment for this patient? a. Leukopoor blood products c. Premedication with aspirin b. Antihistamines d. None of the above 21. Why is an FNHTR said to be a "diagnosis of exclusion"? a. A spiked fever can only be the result of a blood transfusion. b. FNHTR should not be suspected when fever is the sole symptom exhibited by the patient. c. Fever can be the result of many other underlying maladies. d. None of the above 22. Which of the following results when large excesses of free hemoglobin are released into the blood? a. Hemosiderinuria c. Hemoglobinuria b. Hematuria d. Hemoglobinemia 23. What is a cause of death in GVHD? a. Anemia b. Infection

c. Cardiac arrest d. Renal failure

24. The principle clinical signs of extravascular hemolysis include: a. bilirubinemia mostly of the direct type. b. hemoglobinuria. c. positive DAT. d. bilirubinemia and positive DAT. 25. All of the following are symptoms of an allergic reaction except: a. pruritus. c. anemia. b. local erythema. d. hives.

26. What treatment is recommended following a bacterial contamination reaction? a. Plasma protein fraction (PPF) c. Aspirin b. Broad-spectrum antibiotics d. Epinephrine 27. In the United States, fatalities associated with transfusion are required to be reported to which organization? a. AMA b. CDC

c. FDA d. NHSN 28. Which of the following is not a finding associated with intravascular hemolytic reaction? a. Methemalbumin decreases b. Haptoglobin decreases c. Increased free hemoglobin in the plasma d. Increased free hemoglobin in the urine 29. Which of the following is the most common transfusion reaction reported to blood banks? a. Anaphylactic reaction b. Febrile reaction c. Intravascular hemolytic reaction d. Extravascular hemolytic reaction 30. Treatment in the event of an anaphylactic or anaphylactoid reaction should include all of the following except: a. stopping the transfusion. b. immediately administering PPF. c. keeping the intravenous line open with normal saline. d. immediately administering epinephrine.

31. Hypothermia as a result of cold fluid replacement can result in all of the following except: a. hemolysis. c. coagulopathy. b. abnormal electrocardiogram. d. citrate toxicity.

32. Which of the following organisms have been implicated in bacterial contamination reactions? a. Corynebacterium flavescens c. Enterobacter aerogenes b. Yersinia enterocolitica d. Clostridium perfringens 33. What is the team of medical officers who investigate all reported cases of transfusion related fatalities? a. AMA b. CBER c. FDA d. NHSN 34. What is the physiologic mechanism of histamine? a. Histamine is released when the allergen-reagin complex attaches to the surface of basophils, increasing vascular dilation and permeability b. Histamine is released when the allergen-reagin complex attaches to the surface of tissue mast cells, increasing vascular dilation and permeability c. Histamine is released when the allergen-reagin complex attaches to the surface of eosinophils, increasing vascular dilation and permeability d. Histamine is released when the allergen-reagin complex attaches to the surface of tissue mast cells, decreasing vascular dilation and permeability 35. How can depletion and dilution of coagulation factors be avoided in a massively transfused patient? a. Prudent use of colloid replacement solutions b. Prudent use of platelets and fresh frozen plasma (FFP) c. Whole blood infusions d. None of the above 36. A delayed hemolytic transfusion reaction is most often the result of: a. bacterial-contaminated red blood cells.

b. a unit of packed cells infected with hepatitis B virus. c. an anamnestic response in a patient who has been previously sensitized by transfusion or pregnancy. d. hemosiderosis in a massively transfused patient.

37. Who developed the imputability criteria for reporting cases of transfusion fatalities? a. AMA c. FDA b. CBER d. NHSN 38. Which of the following is consistent with bacterial contamination reactions? a. The organism is a fastidious anaerobe. b. The organism thrives in warm temperatures. c. The organism thrives in cold temperatures. d. The organism exhibits motility.

39. What is the most common preventable error occurring among the nursing and medical staff that results in a transfusion-related death? a. Alloantibody misidentified c. Specimen mislabeled b. Improper patient identification d. Incorrect crossmatch procedure 40. A delta check was noted for potassium after a surgical patient was transfused with 2 units of packed red blood cells. The pre-transfusion potassium was 3.1 mmol/L and the post-transfusion specimen was 6.2 mmol/L. What could be the reason for this sudden increase? a. Coagulation factors were diluted out of patient plasma. b. Red blood cells were washed prior to infusion. c. Red blood cells spent maximum time in storage. d. None of the above 41. Which mechanism may play a role in fever development in an FNHTR? a. Release of pyrogens from transfused white blood cells b. The production of interleukin-6 by the complement system c. Synthesis of prostaglandins (PGE±) in hypothalamic cells by interleukin-6 d. None of the above 42. How could a potential alloimmunizaton due to anti-K be prevented? a. Matching of donor and recipient red blood cell phenotype b. Use of third-generation bedside leukocyte filters c. Use of washed red blood cells d. Use of apheresed platelets 43. Which of these is/are involved in hemovigilance? a. Collecting information on transfusion c. Improving transfusion practices based on complications. transfusion complications data analysis. b. Analyzing transfusion complication data. d. All of these.

44. What is the most frequent cause of circulatory overload? a. Transfusion of a unit at too slow a rate b. Massive transfusion of blood components c. Transfusion of a unit at too fast a rate d. Transfusion of a partially deglycerolized unit 45. What is meant by the term iatrogenic? a. Generic treatment

c. Physician-caused

b. Underlying disease

d. Hospital-contracted

46. What is the purpose of performing serial hemoglobin and hematocrit after a blood transfusion? a. To detect the presence of hemoglobinemia b. To monitor platelet refractoriness c. To monitor the therapeutic or nontherapeutic response d. To monitor the efficacy of clotting factors 47. Upon investigation of a DHTR, what should be included in the medical history? a. Previous transfusion c. Transfusion reactions b. Pregnancies d. All of the above 48. Which of the following clinical manifestations is not included in the physically or chemically induced transfusion reactions? a. Citrate toxicity c. Hemosiderosis b. Hyperkalemia d. Factor VIII depletion 49. All of the following are immediate nonhemolytic transfusion reactions, except: a. being febrile. c. anaphylaxis. b. PTP. d. an allergic response.

50. Which of the following is indicative of GVHD? a. Thrombocytopenia c. Pancytopenia b. Anemia d. Hematuria 51. What is a possible mechanism for noncardiogenic pulmonary edema reactions? a. Antileukocyte antibody reacts with leukocytes and activates the reticuloendothelial system b. Histamine is released from T mE asS t cTeB llsA ,N inK crS eaE siL ngLvEasRc. ulC arOdM ilation and fluidity to tissues c. Antileukocyte antibody reacts in donor or patient plasma, initiating complement-mediated pulmonary capillary endothelial injury d. None of the above 52. A patient transfused with 2 units of packed red blood cells demonstrated signs of a transfusion reaction just before the second unit was completely infused. Hypotension, fever, and back pain are the immediate symptoms. Blood work reveals a 3% drop in hematocrit and prolonged PT. What therapy is given to correct the PT? a. FFP c. Platelet concentrates b. Dopamine d. Mannitol 53. Which of the following is not a symptom of noncardiogenic pulmonary edema? a. Hypervolemia c. Hypotension b. Fever d. Coughing 54. Which of the following may be a factor in a nonimmune transfusion reaction? a. Post-transfusion purpura b. Circulatory overload c. Allergic reaction d. Immediate hemolytic transfusion reaction 55. Which of the following urinalysis results represents hemolysis? a. Reagent strip is negative for blood in presence of intact red blood cells (RBCs) (microscopic) b. Reagent strip is positive for blood in presence of intact RBCs (microscopic)

c. Reagent strip is positive for blood in absence of intact RBCs (microscopic) d. Reagent strip is negative for blood and positive for urobilinogen 56. Physical or chemical damage of the transfused red blood cells can result in: a. intravascular hemolysis. c. sepsis. b. extravascular hemolysis. d. pulmonary edema.

57. An O-positive patient transfused with A-positive red blood cells would experience which of the following clinical manifestations? a. Acute hemolysis b. Delayed hemolytic transfusion reaction c. Anaphylaxis d. External hemolysis 58. What is the primary mediator of an allergic response? a. Melatonin c. Histamine b. Lysozyme d. Pyrimidine 59. The presence of intact red blood cells in microscopic urinalysis examination indicates: a. bleeding. c. hemosiderinuria. b. hemolysis. d. bilirubinemia.

60. Immediate transfusion reaction procedures consist of all of the following except: a. clerical check. c. serum haptoglobin. b. DAT. d. visual check.

61. What symptom would not usually be found in a bacterial contamination reaction?

TESTBANKScE. LH LeEmRo. glC obOinMuria a. Tachycardia b. Hypotension d. Fever 62. What test is indicated for the detection of HLA antibodies? a. Direct Coombs’ c. Lymphocyte panels b. Antibody screen d. Cold antibody panel 63. What may be found in the serum of a person who is exhibiting signs of a noncardiogenic pulmonary edema reaction? a. Red blood cell alloantibody c. Antileukocyte antibody b. IgA antibody d. Allergen 64. Which of the following describes the etiology of GVHD? a. Anti-PLA1 attaches to platelet surface, permitting extravascular destruction by RES b. B lymphocytes from donor blood react with major and minor histocompatibility antigens in the patient c. T lymphocytes from donor blood react with major and minor histocompatibility antigens in the patient d. Alloantibody in patient serum reacts with donor red blood cells 65. A severe manifestation of alloimmunization might include: a. renal failure. c. platelet refractoriness. b. rising hemoglobin and hematocrit. d. cyanosis.

66. Which patients are not at risk for circulatory overload? a. Patients with iron-deficiency anemia b. Pediatric patients

c. Geriatric patients d. Persons homozygous for hemoglobin S 67. What type of hemolysis accompanies an anaphylactic reaction? a. Intravascular c. Acute b. Extravascular d. None of the above 68. Which of the following therapies is not advocated in circulatory overload? a. Whole blood units c. Therapeutic phlebotomy b. Transfusing at too fast a rate d. Washed red blood cells 69. Which of the following should be collected immediately from a patient exhibiting signs of a septic reaction to blood products? a. DAT c. Urine sample b. Complete blood count (CBC) d. Blood cultures 70. Changes that occur to RBCs upon storage include an increase in a. ATP. b. calcium. c. glucose. d. all of these.

71. Which of the following indicates a hemolytic process? a. Pre-transfusion plasma is yellow; post-transfusion plasma is red. b. Pre-transfusion plasma is yellow; post-transfusion plasma is yellow. c. Pre-transfusion plasma is red; post-transfusion plasma is yellow. d. None of the above.

72. What is a common finding in a DHTR? a. DIC b. Jaundice

c. Renal failure d. Hypotension

73. Persons with PTP exhibit thrombocytopenia with platelet counts as low as 10,000 per µL. What other complications might be present? a. Hematuria c. Fever b. Hypotension d. DIC 74. Which of the following is not characteristic of an anaphylactic reaction? a. Hypotension c. Electrophoretic levels of IgA b. Abdominal cramps d. Loss of consciousness 75. What type of hemolysis is implicated in a DHTR caused by primary alloimmunization? a. Extravascular c. Nonimmune b. Intravascular d. None of the above 76. Which of the following best describes a transfusion reaction? a. An urticarial response to blood products occurring 1 to 2 hours after infusion b. A physiologic response to a blood product transfused 5 to 10 days before host symptoms c. Any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components d. None of the above 77. In a DHTR, patient antibody attaches to the specific foreign donor red blood cell antigen, causing sensitization of red blood cells, which are removed by the:

a. b. c. d.

complement system. kidneys. reticuloendothelial system (RES).

MHC complex.

78. Which of the following is characterized by a rapid onset of thrombocytopenia due to anamnestic production of platelet antibody? a. GVHD c. PTP b. Alloimmunization d. Iron overload 79. What is the length of time required for production of antibody in a DHTR caused by an anamnestic immune response? a. 7 to 14 days c. 1 to 2 hours b. 5 to 10 days d. 3 to 7 days 80. All of the following signs are consistent with circulatory overload except: a. orthopnea. c. dyspnea. b. fever. d. tachycardia.

81. The most important initial step in evaluating a suspected hemolytic transfusion reaction is to: a. perform a CBC and urinalysis. b. perform a DAT. c. recheck the compatibility testing, using a pre- and post-sample. d. reconfirm the patient’s identity and reexamine all pre-transfusion testing.

82. How is a febrile nonhemolytic transfusion reaction FNHTR best defined? a. A 1°C temperature rise associated with transfusion that has no medical explanation other than blood component transfusion b. A 1°C temperature rise associated with transfusion and inflammation of the colon c. A 2°C temperature rise associated with transfusion that has no medical explanation other than component transfusion d. A 2°C temperature rise associated with transfusion and pneumonia 83. Besides hemoglobin, what other protein can cause a pink discoloration of serum or plasma in association with muscle trauma? a. Myosin c. Haptoglobin b. Albumin d. Myoglobin 84. Alloimmunization may result from which of the following? a. Bacterial-contaminated red blood cells b. Prior exposure to donor blood components c. Transfusing an O-positive recipient with A-negative packed cells d. Circulatory overload 85. A patient undergoing transfusion of packed red blood cells became hypotensive and cyanotic 30 minutes into the transfusion. The nurse also noted a 0.8°C increase in temperature. The transfusion was stopped and postblood specimens were sent down to the laboratory for a transfusion reaction investigation. The donor serum was tested against screening cells (3-vials) and was reactive at AHG in all vials. A panel was performed, and anti-Bga was identified. What special blood component should this patient now receive? a. Leukopoor c. Deglycerolized b. Washed d. None of the above 86. Circulatory overload is cause by which of the following?

a. Excessive transfused fluid b. Rapid rate of infusion

c. decreased cardiac capacity d. All of these

87. Alloimmunization is categorized as what type of transfusion reaction? a. Immediate nonhemolytic c. Delayed nonhemolytic b. Immediate hemolytic d. Delayed hemolytic 88. Which of the following should be collected 5 to 7 hours after transfusion for unconjugated bilirubin determination? a. EDTA blood specimen c. Post-transfusion urine specimen b. Clotted blood specimen d. Heparinized blood specimen 89. What is the pathophysiological cause surrounding anaphylactic and anaphylactoid reactions? a. Antibody in patient serum is detected 3 to 7 days after transfusion, reacting with donor red blood cells b. Donor plasma has reagins (IgE or IgA) that combine with allergens in patient plasma c. A patient who is deficient in IgE develops IgE antibodies via sensitization from transfusion or pregnancy d. A patient who is deficient in IgA develops IgA antibodies via sensitization from transfusion or pregnancy

Chapter 17. Adverse Effects of Blood Transfusion Answer Section MULTIPLE CHOICE

1

1. ANS: C 2. ANS: C 3. ANS: B 4. ANS: D 5. ANS: A 6. ANS: B 7. ANS: A 8. ANS: C 9. ANS: D 10. ANS: A 11. ANS: C 12. ANS: B 13. ANS: B 14. ANS: D 15. ANS: C 16. ANS: D 17. ANS: C 18. ANS: C 19. ANS: B 20. ANS: B 21. ANS: C 22. ANS: D 23. ANS: B 24. ANS: C 25. ANS: C 26. ANS: B 27. ANS: B 28. ANS: A 29. ANS: B 30. ANS: B 31. ANS: D 32. ANS: B 33. ANS: B 34. ANS: B 35. ANS: B 36. ANS: C 37. ANS: D 38. ANS: C

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3

LO: 17-2 LO: 17-3 LO: 17-11 LO: 17-13 LO: 17-2 LO: 17-11 LO: 17-3 LO: 17-10 LO: 17-15 LO: 17-3 LO: 17-12 LO: 17-6 LO: 17-2 LO: 17-8 LO: 17-8 LO: 17-8 LO: 17-3 LO: 17-8 LO: 17-6 LO: 17-12 LO: 17-11 LO: 17-8 LO: 17-2 LO: 17-8 LO: 17-12 LO: 17-15 LO: 17-4 LO: 17-8 LO: 17-2 LO: 17-12 LO: 17-1 LO: 17-15 LO: 17-4 LO: 17-12 LO: 17-1 LO: 17-8 LO: 17-4 LO: 17-15

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2

LO: 17-2 LO: 17-14 LO: 17-11 LO: 17-7 LO: 17-5 LO: 17-2 LO: 17-1 LO: 17-3 LO: 17-8 LO: 17-3 LO: 17-3 LO: 17-13 LO: 17-10 LO: 17-11 LO: 17-10 LO: 17-9 LO: 17-3 LO: 17-14 LO: 17-8 LO: 17-12 LO: 17-3 LO: 17-3 LO: 17-15 LO: 17-3 LO: 17-10 LO: 17-13 LO: 17-7 LO: 17-1 LO: 17-12 LO: 17-2 LO: 17-6 LO: 17-14 LO: 17-8 LO: 17-8 LO: 17-15 LO: 17-12 LO: 17-8 LO: 17-3 LO: 17-8 LO: 17-1 LO: 17-9 LO: 17-2 LO: 17-3

82.

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89.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2

LO: 17-11 LO: 17-3 LO: 17-9 LO: 17-3 LO: 17-10 LO: 17-9 LO: 17-3 LO: 17-9

Chapter 18. Apheresis Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The specific cell product used for treating sepsis is the: a. lymphocyte. c. monocyte. b. granulocyte. d. plasmacyte.

2. Photopheresis is effective against what malignant disorder? a. Hairy cell leukemia c. Hodgkin's lymphoma b. Cutaneous T-cell lymphoma d. Acute lymphocytic leukemia 3. Plasma exchange is most effective when a. IgG b. IgM

is considered the pathological substance. c. IgA d. IgE

4. What is an example of a continuous flow centrifugation (CFC) instrument? a. Haemonetics V50 c. Fenwal Autopheresis-C b. COBE Spectra d. Haemonetics V30 5. What effect does aspirin have on platelets? a. Prevents release of ATP b. Prevents platelet adhesion

c. Prevents platelet aggregation d. Inhibits antigen expression

6. Which of the following incorporates membrane filtration technology with intermittent flow centrifugation (IFC) apheresis? a. Haemonetics V50 b. COBE Spectra

c. Fenwal Autopheresis-C d. Haemonetics V30

7. What is the definition of apheresis? a. The process of freezing RBCs in liquid nitrogen b. Separation or removal of a blood component from whole blood c. The addition of EPO to red blood cells to increase 2,3 DPG levels d. The extraction of plasma from a whole blood unit 8. Which cell type is densest in the white blood cell layer when anticoagulated blood is centrifuged? a. Granulocyte c. Lymphocyte b. Monocyte d. Platelets 9. When a sample of whole blood is spun, distinct layers form. What cell line or lines make up the

buffy coat? a. White blood cells only b. White blood cells and platelets

c. Red blood cells d. Cellular fragments

10. A child undergoing apheresis may require CFC to minimize: a. extracorporeal volume. c. intracorporeal volume. b. extravascular volume. d. extramedullary volume.

11. A normal healthy donor undergoes a procedure to obtain platelets that will be transfused to a patient is representative of: a. therapeutic apheresis collection. c. whole blood donation.

b. component apheresis collection.

d. None of the above.

12. In what circumstance is a plasmapheresis donor rejected from donation? a. Blood pressure = 140/95 c. Serum protein = 5.0 g/dL b. Temperature = 99.5°F d. Hematocrit = 40% 13. What other technique is available for neonates with sepsis when apheresis is unavailable? a. A buffy coat prepared from plasma less than 12 hours old b. A buffy coat prepared from red blood cells less than 12 hours old c. A buffy coat prepared from a whole blood unit less than 12 hours old d. A buffy coat prepared from platelets less than 12 hours old 14. Which of the following is an indication for therapeutic apheresis? a. Collection of neocytes to reduce the number of transfusions in patient with thalassemia major b. A pathogenic substance exists in the blood that contributes to a disease process. c. A substance can be more effectively removed by apheresis than by the body's own homeostatic mechanisms. d. Options B and C 15. Which of the following factors influenced the need for apheresis technology? a. Marked increase in the number of exchange transfusions b. Amputee patients c. The blood component needs of patients on chemotherapy d. AIDS epidemic 16. Which of the following terms is defined as the removal of white blood cells with the return of red blood cells, plasma, and platelets? a. Leukapheresis c. Plasmapheresis b. Erythrocytapheresis d. Plateletpheresis 17. All of the following statements are consistent with photopheresis except: a. the patient is given an oral dose of psoralen, which binds to the DNA of all nucleated cells. b. collected white blood cells are exposed to ultraviolet light, which activates psoralen, preventing replication. c. the patient is given an oral dose of piroxicam, which binds to the RNA of all nucleated cells. d. treated cells are returned to the patient, inducing an immune response against the abnormal lymphocyte clone.

18. Which of the following statements best describes the apheresis concept? a. Blood is removed from an individual and separated, the desired component is retained, and the remaining portions are returned to the donor/patient. b. Blood is removed from an individual, the desired component is retained, anticoagulated, and separated, and the remaining portion is returned to the donor/patient. c. Blood is removed from an individual, anticoagulated, and separated, the desired component is retained, and the remaining portions are returned to the donor/patient. d. None of the above 19. What is the physiological cause of citrate toxicity in cytapheresis procedures? a. The extracorporeal blood volume leaks citrate into the reinfusion site of the donor. b. The anticoagulant in plasma contains citrate, which binds calcium, lowering the body's ionized calcium.

c. The anticoagulant in plasma contains citrate, which binds chloride, lowering the anion gap. d. None of the above.

20. Fresh frozen plasma (FFP) is not the optimal product for replacement fluids for a therapeutic plasma exchange procedure. For which patient is FFP the optimal product of choice? a. Patient with liver disease b. Patient with thrombotic thrombocytopenic purpura (TTP) c. Patient scheduled to undergo an invasive procedure d. All of the above 21. What possible risk exists when hydroxyethyl starch (HES) concentration has exceeded the renal threshold and excretion is retarded? a. Blockage of the reticuloendothelial system b. Blockage of the spleen c. Citrate toxicity d. Infiltration of the liver by activated macrophages 22. All of the following statements are consistent with CFC except: a. blood is drawn from one phlebotomy site and returned through another. b. reinfusion to the patient completes one cycle. c. the process of phlebotomy, separation, and reinfusion is uninterrupted. d. separation of components is achieved through centrifugation.

23. Currently, the immunoaffinity column has FDA licensure for treating what disease state? a. Hemolytic uremic syndrome b. TTP c. AIDS d. Idiopathic thrombocytopenic purpura (ITP) 24. What is a disadvantage of choosing fresh frozen plasma for fluid replacement in persons undergoing therapeutic plasmapheresis? a. Citrate toxicity c. ABO incompatibility b. Disease transmission d. All of the above 25. The platelet count of the plateletpheresis donor must be prior to the procedure. a. >100  109 per L c. >150  109 per L b. >50  109 per L d. >20  109 per L 26. A donor’s estimated total blood volume was determined to be 4,500 mL before a plasmapheresis procedure.

The extracorporeal blood volume should not exceed: a. 675 mL. c. 187 mL. b. 335 mL. d. 50 mL. 27. In plateletpheresis, which blood component is returned to the donor? a. Red blood cells c. White blood cells b. Platelets d. Options A and C 28. Antiplatelet medications have differing deferral time periods. Which of the following does not match? a. Aspirin—48 hours c. Feldene—7 days b. Plavix—14 days d. Ticlid—14 days

29.

testing is performed on platelet apheresis products to make sure that HIV, WNV, and hepatitis C are not present. a. Serological c. Electrophoretic b. Nucleic acid d. Rapid

30. Plasmapheresis is synonymous with what term? a. Plasma exchange c. Plasma dilution b. Antibody exchange d. Antibody dilution 31. Erythrocytapheresis is successful in which of the following conditions? a. Leukemia c. Malaria b. Colon/rectal cancer d. Waldenstrom's macroglobulinemia 32. The removal of red blood cells in a hemapheresis procedure is called: a. thrombocytapheresis. c. erythrocytapheresis. b. plasmapheresis. d. leukapheresis.

33. What is the primary anticoagulant used in pheresis procedures? a. CPDA-1 c. Citrate b. Heparin d. EDTA 34. What variables are necessary to calculate the donor’s total blood volume? a. Height c. Sex b. Weight d. All of the above 35. Fatalities that result from therapeutic apheresis have primarily been caused by: a. cardiac arrest and arrhythmia. c. seizure.

TESTBANKS dE. LrLenEaR l f. aiC luO reM . b. stroke.

36. Leukopheresis may be indicated when the white blood cell count exceeds a. 50,000 per µL c. 75,000 per µL b. 100,000 per µL d. 25,000 per µL

.

37. Which apheresis method carries the additional risk of returning red blood cells to the wrong individual and yielding the smallest volume of selected blood component? a. IFC c. CFC b. Manual apheresis d. Membrane filtration 38. Which immunoadsorbent has an affinity for IgG classes 1, 2, and 4 and their immune complexes? a. Charcoal c. DNA b. Staphylococcal protein A d. A antigen 39. What can be done to prevent the development of HLA alloimmunization and platelet refractoriness? a. Test the donor for the presence of platelet antibodies. b. Issue only cytomegalovirus-negative platelets. c. Irradiate the platelet concentrate. d. Reduce the number of leukocytes in the platelet product.

40. Which of the following is not an indication for plasmapheresis? a. To decrease iron deposition in tissues in chronically transfused patients b. To collect rare red blood cell antibodies c. To increase the inventory of AB plasma d. To manufacture Rh-immune globulin

41. All of the following constitute variables of apheresis procedures except: a. centrifuge speed. c. length of blood dwell time in centrifuge. b. anticoagulant. d. blood type.

42. What is therapeutic plasmapheresis? a. The removal of large volumes of patient plasma b. The removal of minute volumes of patient plasma c. The removal of plasma containing anti-D d. The removal of plasma containing immunoglobulin 43. The hematopoietic progenitor cells that eventually repopulate the bone marrow and also circulate in the blood are called: a. peripheral blood stem cells (PBSC). c. myeloid stem cells (MSC). b. hematopoietic stem cells (HSC). d. lymphoid stem cells.

44. A person participating in a serial apheresis program would not: a. donate more frequently than every 4 weeks. b. lose more than 25 mL of red blood cells per week. c. be monitored for weight loss. d. donate every 72 hours.

45. How is HES used in apheresis procedures? a. As a chelation agent to bind calcium b. As a sedimenting agent to separate white blood cells from red blood cells c. As a primer to keep infusion lines open d. As a hemolysin to lyse red blood cells

TESTBANKSELLER.COM

46. While undergoing plasmapheresis, the donor experienced numbness around his mouth, which is indicative of citrate toxicity. How can this be treated? a. Administering exogenous sodium c. Administering exogenous calcium b. Administering exogenous potassium d. Decreasing the extracorporeal volume 47. The concentrate obtained from plateletpheresis via a closed system is stored for 5 days at room temperature.

What must the pH be at the end of storage? a. >=5.0 c. >=4.0 b. >=6.0 d. >=8.0 48. When is isolation of PBSCs via apheresis equipment indicated? a. The bone marrow contains malignant cells b. The bone marrow has been irradiated c. The patient cannot tolerate general anesthesia d. All of the above 49. The method in which a specific ligand is bound to an insoluble matrix in a column and plasma is perfused over the column with select removal of pathogenic substance and return of patient's plasma is known as: a. immunoinhibition. c. immunoadsorption. b. plasma exchange. d. elution.

50. Which of the following conditions would necessitate a plasmapheresis procedure? a. Sickle-cell anemia c. CML b. Barbiturate poisoning d. Polycythemia vera

51. During a plasmapheresis procedure, the red blood cells must be returned within how many hours of phlebotomy? a. 2 hours c. 6 hours b. 4 hours d. 8 hours 52. Citrate used as an anticoagulant in apheresis procedures is removed from the body by: a. the kidneys. c. sweating. b. being metabolized in the liver. d. none of the above.

53. What effect do steroids have on leukapheresis? a. Decrease the vascular pool of granulocytes b. Increase the vascular pool of granulocytes c. Help to separate red blood cells from white blood cells, using specific gravity properties d. Neutralize the effect of toxic granulation in neutrophils 54. Which patients are at the most risk for platelet refractoriness where they become alloimmunized to HLA antigens on platelets? a. Patients with liver disease c. Leukemic patients b. Cardiac patients d. Kidney transplant patients 55. One unit of apheresed platelets should increase the platelet count . a. 5,000 to 10,000 per µL c. 80,000 to 100,000 per µL b. 20,000 to 60,000 per µL d. 15,000 to 30,000 per µL 56. Compatibility testing is required for granulocyte concentration if the red blood cell contamination is greater than: a. 20 mL. TESTBANKScE. L5Lm ELR..COM b. 10 mL. d. 15 mL. 57. What does the hematocrit need to be (regardless of gender) for a double red blood cell collection? a. 25% c. 40% b. 45% d. 35%

58. The removal of bile acids from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures? a. Cellulose acetate b. Charcoal c. Polymyxin B d. Any of these.

59. The removal of endotoxin from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures? a. Cellulose acetate b. Charcoal c. Polymyxin B d. Any of these.

60. The removal of granulocytic cells from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures? a. Cellulose acetate b. Charcoal

c. Polymyxin B d. Any of these.

Chapter 14. Apheresis Answer Section MULTIPLE CHOICE 1. ANS: B 2. ANS: B 3. ANS: B 4. ANS: B 5. ANS: C 6. ANS: C 7. ANS: B 8. ANS: A 9. ANS: B 10. ANS: A 11. ANS: B 12. ANS: C 13. ANS: C 14. ANS: D 15. ANS: C 16. ANS: A 17. ANS: C 18. ANS: C 19. ANS: B 20. ANS: D 21. ANS: A 22. ANS: B 23. ANS: D 24. ANS: D 25. ANS: C 26. ANS: A 27. ANS: D 28. ANS: C 29. ANS: B 30. ANS: A 31. ANS: C 32. ANS: C 33. ANS: C 34. ANS: D 35. ANS: A 36. ANS: B 37. ANS: B 38. ANS: B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2

LO: 18-5 LO: 18-8 LO: 18-8 LO: 18-3 LO: 18-2 LO: 18-4 LO: 18-1 LO: 18-5 LO: 18-5 LO: 18-12 LO: 18-2 LO: 18-6 LO: 18-8 LO: 18-7 LO: 18-1 LO: 18-2 LO: 18-7 LO: 18-1 LO: 18-11 LO: 18-7 LO: 18-12 LO: 18-3 LO: 18-7 LO: 18-12 LO: 18-6 LO: 18-6 LO: 18-2 LO: 18-6 LO: 18-6 LO: 18-2 LO: 18-7 LO: 18-2 LO: 18-1 LO: 18-6 LO: 18-12 LO: 18-8 LO: 18-12 LO: 18-9

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2

LO: 18-12 LO: 18-10 LO: 18-1 LO: 18-2 LO: 18-11 LO: 18-6 LO: 18-5 LO: 18-12 LO: 18-2 LO: 18-8 LO: 18-9 LO: 18-10 LO: 18-2 LO: 18-1 LO: 18-2 LO: 18-12 LO: 18-7 LO: 18-2 LO: 18-6 LO: 18-9 LO: 18-9 LO: 18-9

Chapter 19. Cellular Therapy in the Transplant Setting Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The use of one’s own HPCs for transplantation is referred to as: a. Allogeneic b. Autologous c. Syngeneic d. None of these 2. An identical twin donating to his or her twin sibling is an example of what kind of hematopoietic progenitor cell donation? a. Autologous c. Allogeneic b. Syngeneic d. Philogeneic e.

3. HPC transplantation using HPCs from another individual is referred to as: a. Allogeneic b. Autologous c. Syngeneic d. None of these 4. What term is used if an HPC donor is an identical twin? a. Allogeneic b. Autologous c. Syngeneic d. None of these 5. Donors of allogeneic HPC products have to be carefully screened for which of these? a. Sickle cell disease b. Human leukocyte antigen (HLA) type c. Congenital immune deficiencies d. All of these 6. Which of these infectious diseases is not included in screening tests for donors of allogeneic HPC products? a. Hepatitis B virus (HBV) b. Hepatitis C virus (HCV) c. Human immunodeficiency virus (HIV) d. Human papilloma virus (HPV)

7. Which of these infectious diseases is not included in screening tests for donors of allogeneic HPC products? a. cytomegalovirus (CMV) b. human T-cell lymphotrophic virus (HTLV) c. respiratory syncytial virus (RSV) d. syphilis 8. Donors of autologous HPC products have to be carefully screened for which of these? a. Congenital immune deficiencies b. Human leukocyte antigen (HLA) type c. Infectious diseases d. Sickle cell disease 9. Donor screening for HPC products includes: a. a physical examination. b. completion of screening questionnaire. c. review of relevant medical records. d. all of these.

10. HPC-M collections are performed: a. using a needle to access the marrow space of the posterior iliac crest. b. employing apheresis technology. c. with an automated device to process blood and collect peripheral blood. d. by all of these methods.

11. HPC-A collections are performed: a. using a needle to access the marrow space of the posterior iliac crest. b. employing apheresis technology. c. with an automated device to process blood and collect peripheral blood. d. by all of these methods.

12. What is the first cell in the formation of all blood cells? a. Hematopoietic stem cell b. Hematopoietic progenitor cell c. Multipotent progenitor cell d. Pluripotent progenitor cell 13. What cells are produced as a result of hematopoiesis? a. Red blood cells b. Platelets c. White blood cells d. All of these 14. The myeloid line of hematopoietic progenitor cells (HPC-M) includes all but which of the following? a. Erythrocytes c. Dendritic cells b. Monocytes d. Basophils

15. Which of the following is a cytokine used to stimulate hematopoietic progenitor cell production for harvest by apheresis? a. Filgrastrim c. Progesterone b. Naproxen d. Erythropoietin 16. Which protein surface marker is used to assess the concentration of HPCs? a. CD 16 b. CD 34 c. FMC-7 d. HLA-DR 17. Bone marrow transplants and peripheral blood stem cell transplantation (PBSCT) are most commonly used in the treatment of which of the following diseases? a. Lymphoma c. Neuroblastoma b. Multiple myeloma d. All of the above 18. Hematopoietic progenitor cell transplantation has been used to treat which of the following diseases? a. Adrenoleukodystrophy b. Aplastic anemia c. Lysosomal disorders d. All of the above 19. Autologous HPC donation is used to treat all of the following EXCEPT: a. b. c. d.

Lymphoproliferative Malignant myeloproliferative processes Plasma cell disorders Solid tumors

20.

Allogeneic HPC donation is commonly used to treat which of the following? a. Lymphoproliferative b. Malignant myeloproliferative processes c. Plasma cell disorders d. Solid tumors ANS: B PTS: 1 KEY: Taxonomy Level: 2

21.

The final bacterial culture was positive for hematopoietic progenitor cell batch. What must be done with this batch? a. The batch must be discarded. b. Broad spectrum antibiotics can be given to the patient and the batch infused. c. Have a sensitivity done on the culture and administer the batch, as well as provide antibiotics to which the bacteria are sensitive to the patient. d. The batch can be irradiated and then transfused.

22.

What is the target collection goal for CD34 positive cells in an HPC products? a. CD34 enumeration b. Complete blood count c. White blood cell differential d. All of these

23. Laboratory tests performed on HPC products include the enumeration of all of these EXCEPT: a. Plasma cells b. Progenitors c. Viable cells d. WBC percentages 24. What is the target collection goal for CD34 positive cells in an HPC product? a. 1 × 106 to 2 × 106 CD34 positive cells per kilogram of recipient body weight b. 2 × 106 to 6 × 106 CD34 positive cells per kilogram of recipient body weight c. 6 × 106 to 10 × 106 CD34 positive cells per kilogram of recipient body weight d. 10 × 106 to 15 × 106 CD34 positive cells per kilogram of recipient body weight 25.

What is involved in the cryopreservation of HPCs? a. addition of a cryoprotectant to the HPC product b. freezing in a controlled-rate freezer c. long-term storage in a liquid nitrogen freezer d. All of these

26.

Which of the following statements about dimethyl sulfoxide (DMSO) is true? a. DMSO is nontoxic. b. DMSO prevents damage to HPCs during the freezing process. c. DMSO destroys non-HPC white blood cells. d. All of the above

27. Dimethyl sulfoxide (DMSO) is used to wash HPC product in order to remove which cells? a. Progenitor cells b. Red blood cells c. White blood cells d. None of these.

28. What concentration of dimethyl sulfoxide (DMSO) is used to wash HPC product?

a. 1% b. 2% c. 5% d. 10% 29. What is the purpose of recipient conditioning? a. b. c. d.

Destroys tumor cells Creates a niche for donor HPC to occupy Ensures engraftment of allogeneic product All of these

30. Myeloablative conditioning means a. intervention uses reduced amounts of chemotherapy and/or radiation. b. without intervention the bone marrow would not recover without HPC transplantation. c. without intervention immune function is able to recover without HPC transplantation. d. none of these.

31. Nonmyeloablative conditioning means: a. intervention uses reduced amounts of chemotherapy and/or radiation. b. without intervention the bone marrow would not recover without HPC transplantation. c. without intervention immune function would not recover without HPC transplantation. d. none of these.

32. When not all of the recipient's hematopoietic progenitor cells are destroyed prior to transplantation, it is called: a. myeloablative conditioning. c. syngeneic conditioning. b. nonmyeloablative conditioning. d. xerographic conditioning.

ANS: B PTS: 1 KEY: Taxonomy Level: 2 33. What percent of HPC transplants have a bidirectional ABO incompatibility? a. 1% to 5 % b. 6% to 14 % c. 15% to 19 % d. 20% to 25 % 34. What percent of HPC transplants have major ABO incompatibility? a. 1% to 5 % b. 6% to 14 % c. 15% to 19 % e. 20% to 25 % 35. What percent of HPC transplants have a minor ABO incompatibility? a. 1% to 5 % b. 6% to 14 % c. 15% to 19 % d. 20% to 25 % 36. HPC products are typically manipulated to reduce the total number of contaminating red blood cells (RBCs) for recipients with which ABO incompatibility? a. Bidirectional b. Major c. Minor d. All of these 37. Plasma content of HPC products is reduced for recipients with which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. All of these 38. HPC transplant recipients can be at risk for delayed red blood cell production in which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. none of these 39. HPC transplant recipients can be at risk for delayed granulocyte production in which ABO incompatibility?

a. b. c. d.

Bidirectional ABO incompatibility Major ABO incompatibility Minor ABO incompatibility None of these

40. HPC transplant recipients can be at risk for delayed platelet production in which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. None of these 41. Donor plasma antibodies can bind to and cause destruction of recipient RBCs in which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. None of these 42. Acute hemolysis of recipient RBCs may occur by ABO-incompatible antibodies in the transplant product, in which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. None of these

SaTyBoA CpOatMible antibodies in the recipient that lyse 43. Acute hemolysis of recipient RBT CsEm ccN urKbS yE AL BL O-EinRc. om donor red blood, in which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. None of these 44. Minor hemolysis of recipient RBCs due to passenger lymphocyte syndrome can be seen in which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. None of these 45. Delayed hemolysis of recipient RBCs due to passenger lymphocyte syndrome can be seen in which ABO incompatibility? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. None of these 46. Which of the following statement concerning graft-versus-host disease (GVHD) is TRUE? a. GVHD can be avoided by using leuko-reduced HPC product. b. GVHD is a nonimmune-mediated disease. c. GVHD results from a failure of the autologous HPC to engraft.

d. GVHD results from mismatches in HLA types between the donor and recipient.

47. What is the overall incidence of graft-versus-host disease? a. 0% to 10% b. 10% to 30 % c. 30% to 50 % d. 60% to 80 % 48. Which symptom is NOT likely to have been caused by acute GVHD? a. Gastroenteritis b. Reduced mobility c. Skin rash d. Transaminitis 49. Which symptom is NOT likely to have been caused by chronic GVHD? a. Dry mouth b. Gastroenteritis c. Joint contractures d. Lung damage 50. A transplant recipient has developed pancytopenia, with an elevation in liver enzymes and is experiencing bouts of diarrhea. This patient has most likely developed which form of GVHD? a. Acute b. Chronic c. Transfusion-associated d. None of these 51. Transfused lymphocytes escape detection and are able to divide and harm the recipient’s tissues, resulting in which type of graft-versus-host disease? a. Acute b. Chronic c. Transfusion-associated d. None of these 52. Which type of graft-versus-host disease is usually fatal? a. Acute b. Chronic c. Transfusion-associated d. All of these 53. Both autologous and allogeneic HPC transplant recipients are at an increased risk for which type of graft-versus-host disease? a. Acute b. Chronic c. Transfusion-associated d. None of these 54. Which type of graft-versus-host disease results if contaminating donor lymphocytes are not recognized and destroyed by the recipient’s immune system?

a. Acute

b. Chronic c. Transfusion-associated d. All of these 55. Reduction of TA-GVHD risk is accomplished through all of the following EXCEPT: a. damaging donor lymphocyte DNA. b. irradiation of blood products. c. leukocyte reduction d. pathogen-reduction techniques.

a. b. c. d.

56. Which of these conditions may develop in HPC transplant recipients?

ABO incompatibility complications Passenger lymphocyte syndrome Platelet refractoriness All of these

a. b. c. d.

57. Which incompatibility complication is most common in HPC transplant recipients?

ABO HLA Rh None of these

58. HPC transplant recipients require significant blood product support because they: a. often have a period of hypoproliferative cytopenia. b. are experiencing complications of refractoriness.

TESTBANKSELLER.COM c. either of these d. neither or these 59. Which of these techniques best helps to reduce infections with cytomegalovirus? a. Collection from CMV seronegative donors b. Leukoreduction c. A combination of both of these d. Neither of these can reduce CMV.

a. b. c. d.

60. For a recipients with a major mismatch, HPC products of which group are usually selected until the recipien antibodies that are incompatible with HPC product are no longer detected?

O A B AB

61. For recipients with a minor mismatch, HPC products of which group are usually selected until the recipien antibodies that are incompatible with HPC product are no longer detected? a. O b. A c. B d. AB

62. For recipients with a bidirectional incompatibility, HPC products of which group are usually selected until the recipient antibodies that are incompatible with HPC product are no longer detected? a. O b. A c. B d. AB 63. Group O hematopoietic progenitor cell products are best used for which type of mismatch situation? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. All of these 64. Group AB plasma is best used for which type of mismatch situation? a. Bidirectional ABO incompatibility b. Major ABO incompatibility c. Minor ABO incompatibility d. All of these

Chapter 19. Cellular Therapy Answer Section MULTIPLE CHOICE 1.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 E:LTLaExR CyOLMevel: 2 1TESTBANK KS EY on. om 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 19-1 LO: 19-1 LO: 19-1 LO: 19-1 LO: 19-2 LO: 19-2 LO: 19-2 LO: 19-2 LO: 19-2 LO: 19-5 LO: 19-5 LO: 19-5 LO: 19-5 LO: 19-5 LO: 19-5 LO: 19-6 LO: 19-7 LO: 19-7 LO: 19-7 LO: 19-7 LO: 19-8 LO: 19-8 LO: 19-8 LO: 19-8 LO: 19-9 LO: 19-10 LO: 19-10 LO: 19-10 LO: 19-11 LO: 19-11 LO: 19-11 LO: 19-11 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12 LO: 19-12

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2

LO: 19-12 LO: 19-13 LO: 19-13 LO: 19-14 LO: 19-14 LO: 19-14 LO: 19-15 LO: 19-15 LO: 19-15 LO: 19-15 LO: 19-15 LO: 19-15 LO: 19-15 LO: 19-15 LO: 19-15 LO: 19-16 LO: 19-16 LO: 19-16 LO: 19-16 LO: 19-16

Chapter 20. Hemolytic Disease of the Fetus and Newborn Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Which of the following best describes the principle of the Kleihauer-Betke test? a. D-positive indicator cells form rosettes around maternal Rh-positive RBCs. b. D-positive indicator cells form rosettes around fetal Rh-positive red blood cells. c. Maternal hemoglobin is resistant to acid (alkali), appearing pink, whereas fetal cells appear as ghost cells. d. Fetal hemoglobin is resistant to acid (alkali) and appears pink, whereas maternal red blood cells appear as ghost cells.

2. What tests are indicated for cord blood specimens if the mother has made anti-K? a. ABO, Rh, antibody screen c. ABO, Rh, cold autoabsorption b. ABO, Rh, DAT d. Kleihauer-Betke 3. Which severe outcome can be caused by indirect bilirubin levels greater than 18 mg/dL in the newborn? a. Hydrops fetalis c. Bilirubinemia b. Kernicterus d. Bilirubinuria 4. All of the following are goals of an exchange transfusion except: a. to remove high levels of unconjugated bilirubin. b. to correct anemia. c. to remove high levels of conjugated bilirubin. d. to remove high levels of maTteE rnSaT l aB ntA ibN odKyS . ELLER.COM 5. Why is suppression of erythropoiesis an advantage of exchange transfusions? a. Reduces the production of compatible RBCs b. Reduces the production of incompatible RBCs c. Decreases the risk of iron overload d. Clears nucleated RBCs from circulation 6. Why is reverse grouping omitted in neonate ABO grouping? a. Maternal ABO antibody is identical to newborn ABO antibody. b. Maternal antibodies mask the ABO antibodies of the neonate. c. Newborns do not produce isoagglutinins of their own. d. None of the above 7. A cord blood specimen from a jaundiced infant should be tested for which of the following? a. ABO c. DAT b. Rh d. All of the above 8. Why is the immediate spin eliminated in the prenatal antibody screen? a. To reduce the detection of autoantibodies b. To reduce the detection of IgG antibodies c. To reduce the detection of IgM antibodies d. None of the above 9. Which of the following reagents can be used to determine the immunoglobulin class of anti-M? a. PEG c. 2-mercaptoethanol b. Chloroquine d. Ficin

10. All of the following are characteristic of ABO hemolytic disease of the fetus and newborn (HDFN) except: a. the mother is group O. c. the antibody is IgM. b. the mother has anti-A, B. d. the infant has mild HDFN. 11. What is the physiological mechanism of Rh-immune globulin? a. Attachment of fetal Rh-positive red blood cells in fetal circulation, inhibiting production of anti-D b. Attachment of maternal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D c. Attachment of fetal Rh-positive red blood cells in maternal circulation, inhibiting production of anti-D d. Attachment of fetal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D 12. Which of the following treatments uses ultraviolet light to treat hyperbilirubinemia after the infant is delivered? a. Phototherapy c. Amniocentesis b. Plasma exchange d. Electrophoresis 13. A 300-µg dose of Rh-immune globulin contains sufficient anti-D to protect against how much whole blood? a. 15 mL c. 50 mL b. 30 mL d. 100 mL 14. In HDFN, the IgG antibodies are directed against which antigen on the fetal red blood cells? a. Maternal c. Bacterial d. Viral b. Paternal

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15. An O-positive mother gave birth to an A- negative baby. After 24 hours the newborn's bilirubin level rose to 18 mg/dL. A DAT performed on the cord blood specimen was positive with polyspecific AHG and anti-IgG reagents. It is probable that from maternal circulation is coating the newborn's red blood cells. a. anti-A, B c. anti-A b. anti-B d. anti-D 16. Which red blood cell morphology is most characteristic in ABO HDFN and absent in Rh HDFN? a. Target cells c. Microspherocytes b. Teardrop cells d. Burr cells 17. How is an intrauterine transfusion performed? a. RBCs are injected into the placenta. b. RBCs are injected into the fetal peritoneal cavity. c. RBCs are injected into the maternal peritoneal cavity. d. RBCs are injected into the mother and diffused through the placenta to the fetus.

18. Immunization of the mother can be caused by as little as a. 10 mL c. 50 mL b. 1 mL d. 20 mL

D-positive fetal cells.

19. Active immunization induced by Rh(D) antigen can be prevented by the concurrent administration of: a. gamma globulin. c. alpha-1 protease inhibitor. b. Rh immunoglobulin. d. immune serum globulin.

20. Due to a short supply of O-negative packed cells, an Rh-negative patient was transfused with 1 unit of Rhpositive red blood cells. Calculate the number of Rh-immune globulin vials needed to protect against 250 mL of Rh-positive packed cells. a. 5 c. 10 b. 17 d. 23 21. In order for the mother to be considered for Rh-immune globulin, her Rh type must be newborn must be . a. Du-positive/Rh-positive c. Du-negative/Du-negative b. Rh-negative/Rh-positive d. Rh-positive/Rh-negative

, and her

22. What is the most common clinical manifestation of ABO HDFN? a. Severe anemia c. Hyperkalemia b. Hyperbilirubinemia d. Hypotension 23. Which of the following red blood cells is appropriate for neonatal transfusions? a. Group A, CMV-negative c. Group O, CMV+ b. Group AB, CMV-negative d. Group O, CMV-negative 24. The laboratory is presented with a case of HDFN due to ABO incompatibility. The mother is Group O and the infant is Group B. The most appropriate type of blood to use for an exchange transfusion for this infant is: a. A c. O b. B d. AB

b.

25. The most important serologic test for the diagnosis of HDFN is the a. elution c. DAT IAT d. fetal screen

with anti-IgG reagents.

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26. Which of the following antibodies have not been known to cause HDFN? a. Anti-C c. Anti-D b. Anti-S d. Anti-Lea 27. What is the physiological path of indirect bilirubin produced as a result of red blood cell destruction in HDFN? a. Indirect bilirubin is transported across the placenta and excreted via maternal kidneys. b. Indirect bilirubin is conjugated in the fetal liver to direct bilirubin. c. Indirect bilirubin crosses the placenta and is conjugated in the maternal liver to direct bilirubin. d. None of the above 28. All of the following are true regarding antibody titration of maternal IgG antibodies except: a. the method must include the indirect antiglobulin test. b. the difference of two or more dilutions between titrations is considered significant. c. red blood cells should consist of the same genotype for each titration. d. the first serum specimen should be run in parallel with all subsequent titrations.

29. The D-positive fetal cells in Rh-HDN are a. homozygous b. heterozygous

. c. amorphic d. homologous

30. Why is the Rh-positive firstborn of an Rh-negative mother unaffected by Rh hemolytic disease of the fetus and newborn (Rh HDFN)?

a. The plasma volume of the mother is tripled during the first pregnancy which dilutes antiD. b. The titer of anti-D is too low to cause destruction of fetal antigens. c. The mother has not been immunized to the D antigen before placental separation. d. None of the above 31. Besides the Rh antibodies, what other red blood cell antibody is common to cause severe HDFN? a. Anti-M c. Anti-K b. Anti-Lea d. Anti-Fyb 32. The results of a Kleihauer-Betke stain indicate a fetomaternal bleed of 40 ml of whole blood. How many vials of Rh-immune globulin would be required? a. 1 c. 3 b. 2 d. 4 33. What effect does ABO incompatibility between mother and fetus have on maternal sensitization to Rh antigen? a. The chance of maternal sensitization to Rh antigen is increased. b. The chance of maternal sensitization to Rh antigen is decreased. c. It has no effect. d. None of the above 34. Which of the following assays is used to calculate the amount of fetomaternal hemorrhage in a postpartum specimen? a. Antibody specimen c. Rosette test b. Kleihauer-Betke test d. Solid-phase adherence test

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35. In the event of a clinically significant antibody found in the mother's serum, which of the following must be performed to determine its concentration? a. Fetal screen c. Antibody titer b. Antibody screen d. Elution 36. What is the cause of HDFN? a. Destruction of the mother’s RBCs by autoantibody b. Destruction of the fetus’s RBCs by antibody produced by the mother c. Destruction of the fetus’s RBCs by autoantibody d. Destruction of the mother’s RBCs by antibody produced by the fetus 37. What immunoglobulin is capable of crossing the placenta? a. IgG c. IgA b. IgM d. All of the above 38. What life-threatening disorder is characterized by a severe anemia, effusions, and ascites from hepatomegaly and splenomegaly? a. Thalassemia b. Sickle cell anemia c. Hereditary persistence of fetal hemoglobin d. Hydrops fetalis 39. What physiological phenomenon associates erythroblastosis fetalis with HDFN? a. Release of nucleated red blood cells (RBC) into circulation of mother inflicted with HDFN b. Release of mature RBCs into circulation of neonate inflicted with HDFN c. Release of nucleated RBCs into circulation of neonate inflicted with HDFN

d. None of the above 40. In which type of HDFN is the firstborn affected? a. ABO c. Lewis b. Rh d. P 41. Cannulation of the umbilical vein under ultrasound guidance is known as: a. cordocentesis. c. apheresis. b. amniocentesis. d. pericardiocentesis.

42. Why are premature newborns more likely to require exchange transfusions than full-term infants? a. Premature newborns are deficient in carrier protein (albumin) for bilirubin transport. b. Premature newborns have excess indirect bilirubin due to placental transfer of maternal bilirubin. c. Premature newborn livers are too underdeveloped to conjugate bilirubin. d. None of the above 43. Blood transfusions to the fetus and premature infants should be to prevent graft-versus-host disease. a. gamma irradiated c. less than 7 days old b. negative for hemoglobin S d. beta irradiated 44. Which IgG subclass carries more potency in red blood cell hemolysis? a. IgG2 c. IgG4 b. IgG3 d. None of the above 45. Which of the following mother/infant blood types would be considered at risk for ABO hemolytic disease of the fetus and newborn? a. Mother is group O; baby is group B. b. Mother is group O; baby is group O. c. Mother is group AB; baby is group B. d. Mother is group A; baby is group O. 46. When is the antenatal dose of Rh-immune globulin given? a. 20 weeks c. 28 weeks b. 13 weeks d. 36 weeks 47. Rh-immune globulin should be given within how many hours after delivery? a. 24 c. 36 b. 48 d. 72 48. Which prenatal serologic tests are recommended during the first trimester? a. ABO c. Antibody screen b. Rh d. All of the above 49. Anti-D in the serum of a third trimester pregnant woman with a titer of 16 is indicative of: a. Rh-immune globulin. c. passive immunization. b. active immunization. d. none of the above.

50. How are units for exchange transfusion prepared? a. Group O red blood cells and group O plasma b. Group O red blood cells and group A plasma c. Group O red blood cells and group AB plasma d. Group O red blood cells and group B plasma

51. Why does the rate of RBC destruction after birth decrease in an infant diagnosed with HDFN? a. Maternal antibody is no longer entering infant circulation via the placenta. b. Reticuloendothelial system of the neonate reaches an equilibrium with the rate of RBC destruction. c. The bone marrow of the neonate compensates for sequestered RBCs. d. None of the above 52. What is done to prevent HDFN caused by maternal anti-Jka antibody formation? a. Give Jka immune globulin. b. Monitor the mother's antibody level. c. Prevent formation of Jka-positive cells in the fetus. d. No action is necessary; anti-Jka will not cause HDFN.

53. What is the role of the technologist in the diagnosis and clinical management of HDFN? a. Perform exchange transfusions b. Serological diagnosis of maternal alloimunization

c. Ultrasonography, Doppler assessment d. All of these

True/False Indicate whether the statement is true or false.

1. Rh-immune globulin is of no benefit after a person has been actively immunized and formed anti-D. 2. The antibody titer of maternal antibody is directly proportional to severity of HDFN. 3. All Rh-negative recipients who are transfused with as little as 1 mL of Rh-positive cells will develop anti-D.

Chapter 19. Hemolytic Disease of the Fetus and Answer Section MULTIPLE CHOICE 1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS: 9. ANS: 10. ANS: 11. ANS: 12. ANS: 13. ANS: 14. ANS: 15.

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D B B C B C D C C C C A B B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

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KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1

LO: 20-6 LO: 20-7 LO: 20-3 LO: 20-8 LO: 20-8 LO: 20-3 LO: 20-3 LO: 20-7 LO: 20-7 LO: 20-1 LO: 20-4 LO: 20-3 LO: 20-5 LO: 20-1

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1

LO: 20-3 LO: 20-1 LO: 20-8 LO: 20-3 LO: 20-3 LO: 20-5 LO: 20-5 LO: 20-3 LO: 20-8 LO: 20-8 LO: 20-6 LO: 20-3 LO: 20-3 LO: 20-7 LO: 20-3 LO: 20-3 LO: 20-1 LO: 20-5 LO: 20-3 LO: 20-6 LO: 20-7

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1

LO: 20-1 LO: 20-3 LO: 20-3 LO: 20-3 LO: 20-3 LO: 20-3 LO: 20-3 LO: 20-8 LO: 20-3 LO: 20-3 LO: 20-5 LO: 20-5 LO: 20-6 LO: 20-3 LO: 20-8 LO: 20-3 LO: 20-3 LO: 20-2

PTS: 1 PTS: 1 PTS: 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1

LO: 20-4 LO: 20-3 LO: 20-3

TRUE/FALSE 1. ANS: T 2. ANS: F 3. ANS: F

Chapter 21. Autoimmune Hemolytic Anemias Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Which of the following can be found in warm autoimmune hemolytic anemia in the presence of hypoplastic marrow? a. Reticulocytopenia c. Reticulocytosis b. Polychromasia d. Thrombocytopenia 2. Most cases of warm autoimmune hemolytic anemia will be DAT-positive with which of the following? a. Anti-IgG only c. Both anti-IgG and Anti-C3d b. Anti-C3d only d. None of the above 3. Cold autoanti-H is more prevalent in which blood group? a. A2 c. A1B b. O d. B 4. RBCs sensitized in which drug-induced hemolytic anemia mechanism act as "innocent bystanders"? a. Membrane modification c. Drug absorption b. Immune complex d. Autoantibody formation 5. Which drug can cause production of autoantibody? a. Ibuprofen c. Methyldopa b. Isoniazid d. Tetracycline

EeLthLylEdoRp.a-CinOduMced mechanism of immune hemolytic 6. Which of the following is a propToE seS dT thB eoAryNfK orSm anemia? a. Normal red blood cell antigens are altered by the drug and are no longer recognized as "self," resulting in production of alloantibody to these red blood cell antigens. b. The drug affects the synthesis of IgG, exerting a direct effect on T lymphocytes, which results in a loss of suppressor function and subsequent proliferation of autoantibodies by B lymphocytes. c. The drug produces aberrations in the proliferation of normal lymphocytes, producing clones of normal immunologically competent cells, which produces antibody against foreign red blood cell antigens. d. The drug modifies the red blood cells so that plasma proteins bind to the membrane.

7. In warm autoimmune hemolytic anemia, the autoantibody will frequently demonstrate specificity. a. Fya c. Rh b. K d. Jkb

-like

8. All of the following are clinical manifestations of cold hemagglutinin disease (CHD) except: a. agglutination of red blood cells in skin capillaries. b. acrocyanosis of the hands and feet. c. hepatosplenomegaly. d. Raynaud's phenomena.

9. A patient with a positive DAT needs to be phenotyped for Jka. What reagent can be used on red blood cells to ensure accurate typing? a. DTT c. Ficin

b. Chloroquine diphosphate

d. Digitonin

10. In which of the following is the DAT reactive with anti-C3d only? a. Drug adsorption mechanism b. Warm autoimmune hemolytic anemia c. Cold hemagglutinin disease d. Membrane modification 11. Which of the following characterizes an alloimmune response in immune hemolytic anemia? a. The patient produces an antibody reactive with her own red blood cells. b. The patient produces an antibody to a prescribed antibiotic. c. The patient produces anti-K to transfused red blood cells. d. None of the above 12. How can persons with CHD avoid hemolytic episodes? a. Have a splenectomy c. Corticosteroid therapy b. Move to a warm climate d. None of the above 13. The onset of warm autoimmune hemolytic anemia (WAIHA) may be precipitated by: a. pregnancy. c. trauma. b. bacterial infection. d. all of the above.

14. In the digitonin-acid elution procedure, what is the purpose of adding phosphate buffer to the eluate solution? a. To disperse any debris left in the eluate b. To protect against hemolysis c. To restore neutrality to the eluate d. To elute antibody from red blood cell membrane

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15. If a false-positive reaction was suspected with anti-D in the forward grouping due to the presence of a cold autoantibody, which of the following would show reactivity? a. Du test c. Rh control b. DAT d. All of the above 16. Which of the following factors distinguishes a cold autoantibody produced in a patient with infectious mononucleosis from that produced in a patient with pneumonia? a. A titer greater than 64 c. A wide thermal range b. An IgM class of antibody d. Anti-i specificity 17. Cold hemagglutinin disease represents what percentage of autoimmune hemolytic anemia (AIHA) cases? a. 18 c. 12 b. 70 d. 25 18. In the case of an AB-positive individual, what test must be performed to ensure that a warm-reacting autoantibody is not causing false-positive reactions? a. Rh control c. IAT b. DAT d. Rosette test 19. Which of the following procedures can be used to resolve interference due to anti-I? a. Cold autoadsorption b. Prewarm technique c. Warm adsorption d. Cold autoadsorption and prewarm technique 20. How might a technologist detect a patient with drug-induced hemolytic anemia?

a. Positive rosette test b. Positive antibody screen

c. Positive DAT d. ABO discrepancy

21. In a patient who has been recently transfused, a positive DAT may be due to: a. alloantibody coating patient cells. b. alloantibody coating transfused donor cells. c. antibodies to a drug coating donor cells. d. none of the above.

22. How is RBC destruction characterized in drug-induced immune hemolytic anemia via immune complex mechanism? a. Extravascular hemolysis via macrophage ingestion of drug complex b. Red blood cell death due to toxic granules released by neutrophils c. Intravascular hemolysis precipitated by complement activation d. None of the above 23. Anti-K was identified in absorbed serum of a patient with warm autoimmune hemolytic anemia. If a red blood cell phenotype was performed using an indirect antiglobulin test to ensure the patient was negative for K antigen, what would the technologist find? a. A negative result after cells were treated with ficin b. A positive result due to IgM coating cells c. Patient would type negative for K antigen d. A positive result due to IgG coating cells 24. What technique can be used to identify an alloantibody in the presence of a cold autoagglutinin? a. Prewarming c. Chloroquine treatment b. Enzyme treatment TESTBANKSdE. LPLoElyRet.hyCleOnMe glycol 25. A patient with a warm reacting autoantibody needs 2 units of compatible, packed cells. Medical history reveals a blood transfusion 2 months ago. A homologous absorption is performed using the following red blood cell phenotype: R2R2, ss, Fy(a-b+), Jk(a+b-), kk. What alloantibody would remain in the serum after absorption? a. anti-Jka c. anti-S b. anti-E d. anti-Fyb 26. Which of the following describes the drug-adsorption (hapten) mechanism? a. Drugs bind firmly to proteins of the RBC membrane. b. A soluble drug-antidrug complex absorbs nonspecifically to red blood cell membrane. c. Drugs alter the red blood cell membrane so that plasma proteins then bind to the membrane. d. The drug induces production of an autoantibody that recognizes red blood cell antigens.

27. What is the most common drug associated with the drug-adsorption mechanism? a. Erythromycin c. Methyldopa b. Penicillin d. Insulin 28. What percentage of AIHA cases are caused by warm reacting autoantibodies? a. 18% c. 12% b. 70% d. 25% 29. Why do clotted specimens yield positive DAT results with anti-C3 in the presence of a benign cold autoagglutinin? a. Complement is inhibited due to calcium chelation.

b. Complement can be activated in vivo. c. Complement can be activated in vitro. d. Complement is activated in the absence of fibrinogen.

30. Approximately what percentage of AIHA cases are due to paroxysmal cold hemoglobinuria (PCH)? a. 70% c. 1% to 2% b. 12% d. 18% 31. All of the following are classifications of immune hemolytic anemia except: a. hyperimmune. c. autoimmune. b. alloimmune. d. drug-induced.

32. What is one indication a positive DAT might be due to alloantibody coating donor red blood cells? a. Positive eluate b. Positive rosette test c. Microscopic mixed-field appearance d. Panagglutinin reaction in panel studies 33. What is the primary goal for treatment in patients with warm autoimmune hemolytic anemia? a. Reduce neoplastic tumors c. Treat the underlying disease b. Treat coexisting anemia d. None of the above 34. Autoanti-I was identified in a patient transfused 1 month ago. Which technique is advocated to detect alloantibodies in this patient? a. Cold autoabsorption c. Warm autoabsorption b. Prewarming d. Enzyme treatment 35. A cold antibody titer greater thaT n ESTBAN at K 4°SCEiL s cLhE arR ac. teC risOtiM c of pathological CHD. a. 64 c. 256 b. 1,000 d. 128 36. Persons diagnosed with pneumonia caused by Mycoplasma pneumoniae may produce a cold autoantibody with specificity. a. anti-H c. anti-I b. anti-i d. anti-P 37. Which alloantibody is frequently present in the serum of i adults? a. Anti-IH c. Anti-I b. Anti-H d. All of the above 38. A benign cold autoagglutinin may cause interference in antibody screening procedures when: a. anti-IgG AHG reagents are used in the test procedure. b. polyspecific AHG reagents are used in the test procedure. c. the immediate spin phase is omitted. d. LISS is used as a potentiator at 37°C incubation.

39. Which of the following is a characteristic red blood cell morphology seen on a peripheral blood smear from a patient with warm autoimmune hemolytic anemia? a. Stomatocytes c. Spherocytes b. Teardrop cells d. Target cells 40. How is the serology workup for an autoantibody produced by a drug-induced hemolytic anemia different from other autoantibody workups? a. The antibody will only be reactive with red blood cells in the presence of the drug.

b. The antibody is not detected in the presence of the drug. c. Eluate is detectable when drug-coated red blood cells are present. d. Complement will be detected on red blood cells.

41. Which of the following describes a cold autologous absorption procedure? a. An aliquot of patient cells is incubated with an equal aliquot of patient serum at 37°C; autoantibody is removed and alloantibody remains in the serum. b. An aliquot of patient cells is incubated with an equal aliquot of patient serum at 37°C; alloantibody is removed while autoantibody remains in the serum. c. An aliquot of patient cells is incubated with an equal aliquot of patient serum at 4°C; alloantibody is removed while autoantibody remains in the serum. d. An aliquot of patient cells is incubated with an equal aliquot of patient serum at 4°C; autoantibody is removed while alloantibody remains in the serum.

42. What treatment for warm autoimmune hemolytic anemia aids in the reduction of antibody and removes a potent site of red blood cell damage and destruction? a. Corticosteroids c. Immunosuppressive drugs b. Splenectomy d. Transfusion 43. Which of the following signifies intravascular hemolysis in AIHA? a. Increased haptoglobin c. Hemoglobinuria b. Bilirubinemia d. Spherocytosis 44. A 5-year-old boy suffering from the measles complained of back pain, chills, and stomach pain. A visit to the doctor revealed hemoglobinuria, bilirubinemia, and hemoglobinemia. The child's hemoglobin level had fallen to 6 g/dL. A Donath- Landsteiner test was performed and showed the following: control sample = no hemolysis; test sample = hemolyTsE is.STThB e rAesNuK ltsSaE reLcL onEsiRst. enCt O wM ith what disorder? a. Warm autoimmune hemolytic anemia b. Cold hemagglutinin disease c. Paroxysmal cold hemoglobinuria d. Secondary cold AIHA 45. In which case might you see an anti-i? a. Mononucleosis b. Viral hepatitis c. Paroxysmal nocturnal hemoglobinuria d. None of the above 46. Which of the following forward-typing reagents may generate false-positive results in a patient with a warmreacting autoantibody? a. Anti-A c. Anti-A, B b. Anti-B d. Anti-D 47. What is the recommended treatment for drug-induced hemolytic anemia caused by the immune complex mechanism? a. Splenectomy c. Cessation of drug administration b. Immunosuppressive therapy d. Transfusion 48. Immune hemolytic anemia is defined as: a. an increased RBC destruction caused by radiation exposure. b. a shortened RBC survival caused by defective DNA synthesis. c. a shortened RBC survival mediated through humoral antibody production. d. an increased RBC destruction caused by enzyme defects.

49. What reagent cell type is used in the immune complex formation test to detect drug-antidrug interaction? a. Group A c. Group AB b. Group B d. Group O 50. What is the most frequent antibody specificity in CHD? a. Anti-IH c. Anti-I b. Anti-i d. Anti-P 51. Chemically modified anti-D reacted negatively in a patient with a warm-reacting autoantibody. A Du test was performed using monospecific IgG, which was positive in Coombs’ phase. A fetal screen (rosette test) was also performed on this patient and showed no rosettes when viewed microscopically. Based on these results, what is the correct Rh type of this patient? a. Rh-positive c. Rh-unknown b. Rh-negative d. Du-positive 52. Which of the following is a characteristic of autoantibodies? a. The DAT is only reactive with anti-C3d. b. Antibody consists of IgM immunoglobulin. c. Antibody reacts with low-incidence antigens. d. Antibody reacts with high-incidence antigens.

53. All of the following are characteristics of benign cold autoagglutinins except: a. Antibodies react best with ficin-treated cells. b. Autoantibodies are of the IgM class. c. Antibodies have a titer greater than 64 at 4°C.. d. Autoantibodies can activate complement in vitro

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54. Which cells contain the most i antigen? a. Lymphocytes b. Cord blood

c. Adult red blood cells d. Platelets

55. Which theory supports production of autoantibodies? a. Loss of T-cell suppressor activity upon self-antigens leads to production of autoantibody. b. Helper T cells assist immunocompetent B cells in making antibody against foreign antigens. c. T suppressor cells prevent overproduction of antibody by B cells. d. Loss of T helper cell activity upon self-antigens leads to production of autoantibodies.

56. How can cold autoantibody interference with ABO grouping be avoided? a. Washing cells with normal saline cooled to 4°C b. Washing cells with normal saline warmed to 37°C c. Treating red blood cells with ficin prior to testing d. Washing cells with normal saline (room temperature) 57. In cases of warm autoimmune hemolytic anemia, what subclass of IgG is most efficient in binding complement? a. IgG2 c. IgG3 b. IgG1 d. IgG4 58. Which of the following regarding the immune complex mechanism in serologic testing is true? a. The antibody is directed against a red blood cell antigen. b. The antibody screen will be positive in Coombs' phase. c. The DAT will be positive with monospecific C3 but negative with IgG.

d. The eluate will be positive.

59. Which drug-induced mechanism does not result in a hemolytic episode? a. Immune complex formation c. Membrane modification b. Drug adsorption d. Methyldopa-induced autoantibody 60. What is the mechanism by which thiol reagents, such as dithiothreitol (DTT), disperse agglutination caused by cold-reactive autoantibody? a. Dissociation of IgG molecules from the red blood cell with no damage to the membrane b. Cleavage of the intersubunit disulfide bonds of dimeric IgG molecules c. Cleavage of the intersubunit disulfide bonds of pentameric IgM molecules d. Dissociation of IgM molecules from the red blood cell with no damage to the membrane 61. A 28-year-old female with cold hemagglutinin disease has a positive DAT. When the DAT is repeated using monospecific reagent, which of the following is most likely to be detected? a. IgM c. C3d b. IgG d. C4d 62. The antigen I is often: a. found on all cord cells. b. absent on all cord cells.

c. a rare antigen. d. only found in the white population.

63. An EDTA sample is preferred over a clotted sample for performing DAT testing because: a. hemolysis is less likely to occur in a smaller EDTA tube. b. complement coating is better detected in an EDTA tube. c. the EDTA prevents complement binding in-vitro. d. there is less likely to be fibrin in the EDTA tube.

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64. A DAT was performed on a patient suspected of having autoimmune hemolytic anemia. The following results were obtained: PS AHG 3+, Anti-IgG 2+, Anti-C3d-negative. These results mean: a. the test is invalid. b. the patient's cells are coated with IgG. c. the patient's cells are coated with C3d. d. the patient's cells are coated with both IgG and C3d.

65. Cold panel results obtained are: A1 cells: 4+ A2 cells: 4+ O cells: 4+ O cord cells: 0 These results suggest which antibody? a. H b. IH

c. I d. i

66. Approximately what percentage of warm autoimmune hemolytic anemia will produce a positive DAT with both IgG and C3d antibodies? a. 20% c. 10% b. 67% d. 13%

Chapter 21. Autoimmune Hemolytic Anemias Answer Section MULTIPLE CHOICE 1. ANS: A 2. ANS: C 3. ANS: C 4. ANS: B 5. ANS: C 6. ANS: B 7. ANS: C 8. ANS: C 9. ANS: B 10. ANS: C 11. ANS: C 12. ANS: B 13. ANS: D 14. ANS: C 15. ANS: D 16. ANS: D 17. ANS: A 18. ANS: A 19. ANS: D 20. ANS: C 21. ANS: B 22. ANS: C 23. ANS: D 24. ANS: A 25. ANS: C 26. ANS: A 27. ANS: B 28. ANS: B 29. ANS: C 30. ANS: C 31. ANS: A 32. ANS: C 33. ANS: C 34. ANS: B 35. ANS: B 36. ANS: C 37. ANS: C 38. ANS: B 39. ANS: C 40. ANS: A 41. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 TESTBANKEY: KSELTaxonomy LER.COLevel: M 2 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO: 21-7 LO: 21-7 LO: 21-2 LO: 21-9 LO: 21-9 LO: 21-9 LO: 21-7 LO: 21-5 LO: 21-8 LO: 21-5 LO: 21-1 LO: 21-5 LO: 21-7 LO: 21-8 LO: 21-3 LO: 21-4 LO: 21-5 LO: 21-7 LO: 21-4 LO: 21-9 LO: 21-8 LO: 21-9 LO: 21-8 LO: 21-3 LO: 21-8 LO: 21-9 LO: 21-9 LO: 21-7 LO: 21-3 LO: 21-5 LO: 21-1 LO: 21-8 LO: 21-7 LO: 21-4 LO: 21-2 LO: 21-2 LO: 21-5 LO: 21-3 LO: 21-7 LO: 21-6 LO: 21-10

42.

43.

44.

45.

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47.

48.

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9

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 3 1 KEY: Taxonomy Level: 1

LO: 21-7 LO: 21-1 LO: 21-10 LO: 21-5 LO: 21-7 LO: 21-9 LO: 21-1 LO: 21-9 LO: 21-2 LO: 21-7 LO: 21-1 LO: 21-2 LO: 21-5 LO: 21-1 LO: 21-3 LO: 21-7 LO: 21-9 LO: 21-9 LO: 21-4 LO: 21-5 LO: 21-2 LO: 21-1 LO: 21-1 LO: 21-5 LO: 21-7

Chapter 22. Tissue Banking as Part of the Transfusion Service True/False Indicate whether the statement is true or false.

1. If your facility is a member of and accredited by the Eye Bank Associates of America, there is no need to be monitored by the FDA. Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Which of the following statements is false? a. Bone can be sterilized and all living tissue removed prior to its use. b. Bone must be HLA typed to the recipient prior to implantation. c. ABO/RH is not relative to be bone transplantation. d. Bone can be made into screws, chips, spacers, and wedges for patient use.

2. Which of the following is generally excluded from the tissue bank? a. Corneas b. Liver c. Heart valves d. Skin 3. At a minimum, all but which of the following must be included on the tissue receipt records? a. Tissue Identification NumbT erE(T ) ANKSELLER.COM SITNB b. Expiration date (if applicable) c. Condition of the tissue and who received it/inspected it upon arrival d. Donor’s birth date 4. Records of tissue must be kept at least a. 2 years b. 5 years c. 10 years d. indefinitely

after expiration.

5. A bone flap is harvested by a physician for a patient at hospital X. The patient has an issue with hospital X and requests to go to hospital Y. The patient is transferred, but the physician wants to continue with the treatment. Which of the following scenarios is possible? a. Hospital X would need to be registered with the FDA as a tissue vendor in order to transfer the bone flap to hospital Y. b. The patient is allowed to take the bone flap with him to hospital Y because it is autologous. c. The physician is licensed to practice at both hospitals, so he is allowed to transfer the bone flap. d. There is no tissue with transfer from one hospital to the next, because the material being transferred is bone.

6. Which statement about autologous is true? a. Autologous tissue has a different outdate than allogeneic tissue. b. Autologous tissue is not regulated by the AATB.

c. The medical director can have autologous tissue reassigned to an allogeneic donor if it is not used by the autologous donor. d. Autologous tissue should have the same shelf-life as allogeneic tissue under the same storage.

7. The 21 in 21 CFR 1271 refers to: a. the region from which the tissue was collected, thus falling under the general provisions of that area. b. the title established for food and drugs in the Code of Federal Regulations. c. the category of FDA laws that govern all blood bank regulation. d. none of the above.

8. Donors for cornea transplants must be tested for all but which of the following diseases prior to transplant? a. HIV-1 and -2 b. Hepatitis B c. Hepatitis C d. Chlamydia trachomatis 9. Which Joint Commission standard has to do with storage of tissues? a. PC.17.10 b. PC.17.20 c. PC.17.30 d. All of the above 10. The Joint Commission’s standard states that a. hospitals are required to establish a specific tissue bank. b. hospital tissue banks must bT eE loS caT teB dA wN ithKinStE heLbLloEoR d. baC nkO.M c. oversight of the tissue bank must be assigned. d. all of these must be followed.

11. The AABB Tissue Committee’s recommended model for a centralized tissue bank includes: a. allowing surgeons to maintain their own inventories. b. validating vendor qualifications being handled by the purchasing department. c. the infectious diseases department investigation of adverse events. d. none of these.

12. From which organization would a newly established tissue bank seek accreditation? a. American Association of Tissue Banks b. The Food and Drug Administration c. The Joint Commission d. Any of these 13. Which of these organizations is NOT involved with tissue bank regulating? a. American Association of Tissue Banks b. American Society of Clinical Pathology c. The Food and Drug Administration d. The Joint Commission

14. According to the AABB, what is the function of the medical director with regard to tissue banks? a. Must obtain special education and approves standard operating procedures b. Investigates adverse outcomes and participates in look-back investigations

c. Communicates with the physicians using the procured tissue or end product d. All of these 15. Tissue receipt records do not require which of the following data? a. Date of tissue collection of tissue b. Name and address of tissue supplier c. Description of tissue and quantity d. Date of tissue received at the facility 16. What aspect of tissue banking is especially important during product recalls? a. Accreditation of the tissue bank b. Qualifications of the medical director c. Traceability of the tissue to donor d. Vendor validation

17. What steps can be taken to minimize adverse events due to transplantation? a. Ensuring contaminated tissues are not used for transplantation b. Preventing improper handling that may contaminate or damage tissue c. Demonstration of safety and effectiveness of tissue products d. All of these 18. Which of these steps is NOT part of the transplant adverse events investigation process? a. All of the tissues that originated from that donor must be investigated. b. Communications between tissue bank and supplier to initiate a recall. c. Additional tissue is trackeTdEdS ow oN prK evSeE ntL trL anEsm TnBtA Ri.ssCioOnMof disease to other recipients. d. Vendor validation of transport containers 19. Which of the following does NOT describe an adverse event. a. A patient contracts Creutzfeldt-Jakob disease a year after tissue transplantation. b. An allograft is failing to function as expected and appears to be rejected. c. An irregularity with the handling of a particular tissue is discovered in an FDA inspection 3 months after the tissue was processed. d. An infection may have been caused by an improperly handled tissue for transplantation.

20. How is an adverse transplant event defined? a. A negative change in the tissue recipient b. The patient has a reaction to tissue implant c. There is an unexpected outcome after tissue implant d. All of these 21. Which of these events are classified as adverse? a. Infectious disease transmission. b. Failure of the allograft to function as expected c. Transmission of malignancy d. All of these 22. Which of these occurrences might initiate a recall? a. An error in tissue processing is discovered b. FDA inspection uncovers an irregularity in tissue processing. c. A doctor discovers a tissue handling problem.

23. Upon periodic inspection of tissue products, a violation of an FDA labeling regulation is discovered. What class of recall would this initiate? a. Class I b. Class II c. Class III d. None 24. Who among the following is NOT usually part of the committee that selects tissue vendors? a. Blood bank staff technologist b. Head surgeon of transplant staff c. Laboratory/ tissue bank medical director d. Would care physician using tissues 25. What must be considered when selecting a qualified tissue vendor? a. Tissues supplied must be high in quality, safe and effective for the intended use. b. The tissue must be readily available in a useful time frame c. Cost of tissue must fall within budgetary guidelines and customary price range. d. All of these 26. The following are of concern when selecting a qualified tissue vendor EXCEPT: a. the transparency and willingness of the vendor to provide information. b. the method of processing and disinfecting the tissue. c. the supplier’s medical director staying out of the communication loop. d. the ability of the supplier to meet special needs.

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27. The first step in qualifying any vendor is to: a. determine the number of FDA recalls by this vendor. b. have your medical director establish communication with the vendor’s medical director. c. order a sample tissue on which to perform quality checks. d. verify the supplier’s FDA registration.

Chapter 22. Tissue Banking as Part of Transfusion Service Answer Section TRUE/FALSE 1. ANS: F

PTS: 1

KEY: Taxonomy Level: 1

LO: 22-5

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 : LTL axEoR no.mCyOLM evel: 1 1 TESTBANKKESYE 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1

LO: 22-2 LO: 22-2 LO: 22-4 LO: 22-3 LO: 22-2 LO: 22-4 LO: 22-2 LO: 22-2 LO: 22-1 LO: 22-5 LO: 22-5 LO: 22-5 LO: 22-1 LO: 22-5 LO: 22-4 LO: 22-6 LO: 22-6 LO: 22-6 LO: 22-6 LO: 22-6 LO: 22-6 LO: 22-6 LO: 22-6 LO: 22-3 LO: 22-3 LO: 22-3 LO: 22-3

MULTIPLE CHOICE 1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS: 9. ANS: 10. ANS: 11. ANS: 12. ANS: 13. ANS: 14. ANS: 15. ANS: 16. ANS: 17. ANS: 18. ANS: 19. ANS: 20. ANS: 21. ANS: 22. ANS: 23. ANS: 24. ANS: 25. ANS: 24. ANS: 27. ANS:

B D D C A D B D A C D A B D A C D D C D D D C A D C D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

Chapter 23. The HLA System Multiple Choice Identify the choice that best completes the statement or answers the question.

1. What is the purpose of washing the cells after the initial cell-serum incubation in the Amos-modified antibody screen procedure? a. To identify previously undefined alleles b. To identify antibodies in the serum of the donor c. To remove aggregated immunoglobulin in the serum d. None of the above 2. How is induction of tolerance achieved in kidney transplantation? a. Administration of cytokines prior to transplant b. Blood transfusions after transplant c. Blood transfusions before transplant d. None of the above 3. How are the heavy chains of major histocompatibility complex (MHC) classes I and II molecules transported into the cell membrane? a. Heavy chains are transported via extracellular fluid. b. Heavy chains are inserted through the membrane via hydrophobic residues. c. Heavy chains are inserted through the membrane via hydrophilic residues. d. Heavy chains are adsorbed onto the membrane via semipermeable methods.

4. Which of the following is a phenToE mS enToB nA inNwKhS icE h aLnLaE ntR is. erC um directed against one HLA determinant reacts OM with other HLA antigenic determinants? a. Cross reactivity c. Recombination b. Linkage disequilibrium d. Conversion 5. HLA-DR typing requires a a. T-lymphocyte b. B-lymphocyte

suspension. c. granulocyte d. platelet

6. HLA testing is useful in what other area of study? a. Paternity testing c. Anthropology b. Disease correlation d. All of the above 7. All of the following diseases have been associated with a significant HLA correlation except: a. narcolepsy. c. Fanconi's anemia. b. ankylosing spondylitis. d. Goodpasture's syndrome.

8. What is the linkage disequilibrium in reference to the HLA antigens? a. Occurrence of HLA genes more frequently in the same haplotype than would be expected by chance alone b. Displacement of HLA genes on different chromosomes c. Occurrence of HLA genes less frequently in the same haplotype than would be expected by chance alone d. Crossover of HLA genes 9. Why is histocompatibility testing negated in both lung and heart transplants? a. The donor must be living to perform HLA testing.

b. The cold ischemic time is too short. c. The cold ischemic time is too long. d. None of the above 10. What is the most important step for increasing the number of bone marrow transplants performed? a. Expand the donor pool to include related individuals. b. Expand the donor pool to include unrelated individuals. c. Expand the donor pool to include both related and unrelated individuals. d. None of the above 11. What is meant by the term public as applied to HLA antibodies? a. Antibodies that detect a single HLA gene product b. Binding to an epitope unique to one HLA gene product c. Binding to epitopes shared by more than one HLA gene product d. All of the above 12. What is the definition of total ischemic time in heart transplantation? a. The amount of time there is not blood flow through the organ b. The time it takes to perform the transplant c. The time it takes for PO2 levels to normalize after transplant d. The time it takes for CO2 levels to normalize after transplant 13. The MHC class I region encodes for all of the following genes except: a. HLA-A c. HLA-DR b. HLA-B d. HLA-C 14. Which of the following is an example of linkage disequilibrium? a. The actual occurrence of haplotype HLA-B7 and HLA-Cw5 is 6%; the expected occurrence based on gene frequencies is 5%. b. The actual occurrence of haplotype HLA-C4 and HLA-B37 is 3%; the expected occurrence based on gene frequencies is 4%. c. The actual occurrence of haplotype HLA-A1 and HLA-B8 is 8%; the expected occurrence based on gene frequencies is 2%. d. The actual occurrence of haplotype HLA-A11 and HLA-DR4 is 8%; the expected occurrence based on gene frequencies is 7%.

15. What does "HLA" stand for? a. Human lymphodenapathy b. Human lymphocyte antibody

c. Human leukocyte antigen d. Human liver antigen

16. Why are monoclonal antibodies able to detect a broad range of epitopes? a. They are derived through alloimmunization. b. They are derived through xenoimmunization. c. They have both IgM and IgG specificity. d. None of the above 17. How is complement detected in HLA testing? a. Agglutination b. Hemolysis

c. Uptake of trypan blue dye d. Uptake of mitomycin-C

18. The majority of HLA alloantibodies are a. IgM b. IgG

immunoglobulins. c. IgE d. IgA

19. How is histocompatibility testing different from RBC testing? a. Known serum is used to type antigens on test cells. b. Recipient serum is screened for the presence of antibodies. c. Crossmatch of donor cells and recipient serum is performed to determine compatibility. d. None of the above 20. The surface marker, or antigen, detected in histocompatibility testing of a single individual is referred to as HLA: a. phenotype. c. haplotype. b. genotype. d. karyotype.

21. Which of the following is acceptable for cytotoxicity techniques? a. EDTA c. Serum b. ACD d. CPDA-1 22. What is the main purpose of crossmatching before transplantation? a. To identify antibody in the potential donor to antigen present on recipient cells b. To identify antibody in the serum of the potential recipient to antigens present on donor tissues c. To identify antigen in the recipient cells to antibody present in donor serum d. To identify antigen present on donor tissues to antibody present in recipient serum 23. Recipient lymphocytotoxic HLA-antibody to donor antigens is associated with: a. accelerated graft rejection. c. respiratory distress. b. platelet refractoriness. d. both A and B.

TRE,SDTQB, aAnN 24. When the entire set of A, B, C, D dK DS PE anLtiL geE nsRa.reClO ocM ated on one chromosome, it is called a: a. phenotype. c. haplotype. b. genotype. d. karyotype.

25. The genetic region that contains surface antigens or receptors responsible for the recognition and elimination of foreign tissues is referred to as: a. D-related locus. b. major histocompatibility complex. c. deoxyribonucleic acid. d. complement-dependent microlymphocytotoxicity.

26. How many targets are required for HLA antibody screening? a. 10 c. 30 b. 20 d. 40 27. How might platelet survival be improved in a patient receiving platelets despite a near perfect HLA match between recipient and donor? a. Wash the platelets before transfusion b. Remove red blood cells from the donor unit c. Remove leukocytes from the donor unit d. Transfuse using a blood warmer 28. In HLA testing, what is the purpose of mineral oil contained in the testing well? a. To prevent evaporation of antisera during incubation b. To create a viscous microenvironment c. To act as an antigen-antibody complex potentiator d. To provide height to the testing well

29. A platelet recipient whose HLA phenotype includes A3, B7; A11, B42 is transfused from a A1, B7; A3, B13 donor. Given the following CREG (Cross-Reactive Groups), what would you expect the outcome of this transfusion to be? A1-CREG: A1,36,3,9(23,24),10(25,26,34,66),11, 19(29,30,31,32,33)28 B7-CREG: B7,42,22(54,55,56),27,40(60,61)13,41,47,48 a. The donor would experience platelet refractoriness because A3 and A11 and B13 and B42 are not cross-reactive. b. The donor would benefit from this transfusion because A3 and A11 and B13 and B42 are cross-reactive. c. The recipient would experience platelet refractoriness because A3 and A11 and B13 and B42 are not cross-reactive. d. The recipient would benefit from this transfusion because A3 and A11 and B13 and B42 are cross-reactive.

30. Kidney transplants are used to treat which disease? a. Di Guglielmo's syndrome c. Graves' disease b. End-stage renal disease d. Erythropoietin deficiency 31. Which MHC region encodes for complement proteins? a. Class I c. Class III b. Class II d. None of the above 32. Between which two loci are recombination (crossing over) most likely to occur? a. HLA-A and HLA-B c. HLA-B and HLA-C b. HLA-DR and HLA-DP d. HLA-A and HLA-DP 33. What does the "R" signify in the HLA-DR locus? a. Recessive gene c. RNA b. Red cell predominance d. Subregion of D 34. MHC class II molecules are expressed on all of the following except: a. monocytes. c. B lymphocytes. b. endothelial cells. d. platelets.

35. A common technique used for HLA class II typing that involves amplification of specific DNA sequences for hybridization is called: a. complement-dependent cytotoxicity (CDC). b. mixed lymphocyte reaction (MLR). c. polymerase chain reaction (PCR). d. lymphocytotoxicity.

36. In testing for the HLA-D antigens (DR, DP, DQ, etc.) typing cells of each phenotype are set up in an MLR as against the test cells. a. heterozygous/responders c. heterozygous/stimulators b. homozygous/stimulators d. homozygous/responders 37. What is the most important pretransplant test performed on the recipient in a heart transplantation? a. HLA-crossmatch c. HLA-antibody screen b. Red blood cell antibody screen d. Red blood cell-crossmatch 38. How are monoclonal HLA antibodies (MoAbs) produced? a. The fusion of HLA antibody, producing B cells with plasmacytoma lines b. The fusion of HLA antibody, producing T cells with plasmacytoma lines

c. The fusion of HLA antibody, producing B cells with neuroblastoma lines d. The fusion of HLA antibody, producing T cells with neuroblastoma lines 39. Why are T cells unacceptable for cytotoxicity testing using fluorescent labeling? a. T cells are not involved in cytotoxicity testing. b. T cells do not adhere to nylon wool. c. T cells lack immunoglobulin on their surface. d. The suppressor activity of T cells renders the membrane protein inaccessible to the label antibody 40. What kidney transplant strategy is satisfied through matching of the donor and recipient antigens? a. Use of immunosuppressive agents c. Induction of tolerance b. Reduction of graft "foreignness" d. None of the above 41. A double-lung transplant is indicated in which of the following disorders? a. Pneumonia c. Primary hypertension b. Pulmonary fibrosis d. Cystic fibrosis 42. A patient who has been presensitized to foreign HLA antigens will demonstrate expresses the same antigens. a. graft survival c. chimerism b. graft rejection d. ABO conversion

if the donor tissue

43. The primary indication for pancreas transplantation is: a. Fabry's disease. c. diabetes. b. Karposi’s sarcoma. d. Crohn's disease.

LaEkR 44. The HLA-A locus antigens A2, T AE 23S, T A2B4A , aNnK dS AE 28Lm e u.pCthOeM : a. A4-CREG c. A2-CREG b. A3-CREG d. A8-CREG 45. Which of the following specificities designates the HLA-C gene? a. Cd c. Cp b. Ci d. Cw 46. Which of the following is NOT a rule for HLA nomenclature? a. Capital letters indicate a specific gene. c. The allele group is designated by the

fourth numeric field. b. All class II genes are prefixed by the

letter D

d. The second numeric field defines the

specific allele protein.

47. What is placed between the gene name and the numerical identifier for the allele to differentiate between the gene nomenclature and HLA serologic reactivity? a. Asterisk c. Colon b. Comma d. Dash

48. Which of these is NOT the purpose of the virtual crossmatch? a. Selecting donor-recipient pairs b. Finding a match based on known HLA types c. Eliminating the serologic testing process d. Directing organs to the most likely compatible matches

49. Which of these is not a concern in the virtual crossmatch? a. Full knowledge for donor HLA type b. Recent alloantibody profile of the recipient c. Full knowledge for recipient HLA type d. The type of organ that is being transplanted

True/False Indicate whether the statement is true or false.

1. Patients who have been presensitized to HLA antigens have a much higher graft survival rate in liver transplantation than nonsensitized patients.

2. The majority of cross-reactive alloantibodies detect HLA specificities of allelic molecules coded by the same locus.

Chapter 23. The HLA System Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: C 3. ANS: B 4. ANS: A 5. ANS: B 6. ANS: D 7. ANS: C 8. ANS: A 9. ANS: B 10. ANS: C 11. ANS: C 12. ANS: A 13. ANS: C 14. ANS: C 15. ANS: C 16. ANS: B 17. ANS: C 18. ANS: B 19. ANS: D 20. ANS: A 21. ANS: B 22. ANS: B 23. ANS: D 24. ANS: C 25. ANS: B 26. ANS: C 27. ANS: C 28. ANS: A 29. ANS: D 30. ANS: B 31. ANS: C 32. ANS: D 33. ANS: D 34. ANS: D 35. ANS: C 36. ANS: B 37. ANS: C 38. ANS: A

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 23-8 LO: 23-10 LO: 23-6 LO: 23-7 LO: 23-7 LO: 23-10 LO: 23-6 LO: 23-4 LO: 23-10 LO: 23-10 LO: 23-8 LO: 23-10 LO: 23-2 LO: 23-4 LO: 23-1 LO: 23-7 LO: 23-7 LO: 23-8 LO: 23-9 LO: 23-5 LO: 23-7 LO: 23-9 LO: 23-8 LO: 23-5 LO: 23-2 LO: 23-8 LO: 23-10 LO: 23-7 LO: 23-9 LO: 23-10 LO: 23-6 LO: 23-2 LO: 23-2 LO: 23-6 LO: 23-6 LO: 23-7 LO: 23-9 LO: 23-8

39.

40.

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49.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2

LO: 23-7 LO: 23-10 LO: 23-10 LO: 23-6 LO: 23-10 LO: 23-3 LO: 23-3 LO: 23-3 LO: 23-3 LO: 23-11 LO: 23-11

PTS: 1 PTS: 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1

LO: 23-10 LO: 23-8

TRUE/FALSE 1. ANS: F 2. ANS: T

Chapter 24. Relationship Testing Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The goals of relationship testing of inherited genetic markers include all of these EXCEPT: a. confirm an alleged biological relationship between two or more individuals whose relationship is in question. b. refute an alleged biological relationship between two or more individuals whose relationship is in question. c. include all falsely accused men of being related to a child in question. d. provide compelling inclusionary evidence if a man is not excluded from being related to a child in question.

2. Which offspring scenario could not be the result of the marriage shown? a. Father: MM/Mother: NN—Child: MN b. Father: MN/Mother: NN—Child: NN c. Father: MN/Mother: MM—Child: NN d. Father: NN/Mother: NN—Child: NN 3. Which of these is not one of the classic systems used for parentage testing? a. ABO b. DNA c. Human leukocyte antigens d. Polymorphic proteins 4. The inclusionary calculations arT eE deS em alS idE ifLwLhE icR h. ofCthOeMfollowing possible subjects is to be ruled out TeBdAinNvK as the alleged father of the child? a. Brother c. Father b. Uncle d. All of the above 5. Apparent opposite homozygosity is also known as: a. direct exclusion. c. indirect exclusion. b. apparent exclusion. d. direct homozygous transition.

6. CODIS stands for: a. Convicted Offender Digital Identifying System b. Combined Offender DNA Index System c. Combined Operation Digital Index System d. None of the above 7. What test systems are used in the ascertainment of paternity? a. Endocrine, RBC, serum protein, enzymes b. RBC, HLA, enzymes, serum proteins c. RBC, enzymes, HLA, hormones d. Viral antigens, RBC, HLA, serum proteins 8. Which of the following is consistent with a low probability of paternity? a. Only 1 POG and 1 MOG were found to exist in the Rh system. b. More than 3 POGs were found in the HLA and MNS groups. c. The POG had a gene frequency of 0.0004 in the random population. d. None of the above

9. How is DNA testing advantageous to paternity cases? a. It provides cloning capabilities in xenographic studies. b. It provides visual insight into genetically inherited differences among individuals. c. It provides insight into approximate time of conception. d. It establishes a means of stem cell transplantation for related individuals.

10. What technology is used to demonstrate the presence of allelic variants of red blood cell enzymes and serum proteins? a. Electrophoresis c. Ion-exchange chromatography b. Polymerase chain reaction d. Fluorescence polarization 11. Which of the following AABB standards must be met in paternity testing? a. DNA testing using double-locus probes b. Independent reading of electrophoretograms by two technologists c. HLA and red blood cell antigen testing performed by two independent laboratories d. All of the above 12. Which of these is not a type of DNA polymorphism? a. PCR b. SNP c. STR d. VNTR 13. What component of the Hardy-Weinberg equation (p2 + 2pq + q2) signifies heterozygotes? a. p2 c. q2 b. 2pq d. None of the above

TESTBANKSELLER.COM

14. A child was found to express the M+N+ phenotype. The mother's phenotype was M+N-, as was the father's.

What type of exclusion is evident in this case? a. Direct c. No exclusion b. Indirect d. None of the above 15. How is HLA serologic testing performed? a. T lymphocytes are harvested and introduced to a panel of test sera specific for antigens of the HLA system. b. B lymphocytes are harvested and introduced to a panel of test sera specific for antigens of the HLA system. c. HLA antigens move through a limited pH gradient and are immobilized, complexed with antibody, and stained. d. DNA is isolated from peripheral white blood cells, fragmented, and hybridized.

16. In paternity testing, which of the following systems is the first to be tested against samples drawn from the mother, alleged father, and child? a. Rh c. ABO b. Red blood cell enzymes d. Kell 17. What technology NOT is used to demonstrate the presence of DNA polymorphisms? a. Ion-exchange chromatography c. Restriction fragment length b. Polymerase chain reaction d. Southern blot

18. When does direct exclusion exist? a. The child possesses a marker that is present in either the mother or the alleged father. b. The alleged father demonstrates heterozygosity for two different alleles in the same system and the child does not demonstrate either. c. The child demonstrates only one marker and the alleged father demonstrates a different single marker. d. A single DNA mismatch is demonstrated between alleged parent and child.

19. In HLA serologic testing, how are cytotoxic effects of antigen-antibody interactions detected? a. There is visible agglutination, or clumping. b. The cells remain clear. c. Trypan blue or eosin stains the cells because of loss of membrane integrity. d. There is hemolysis.

20. What is the statistical basis of the Hardy-Weinberg principle? a. Selection of mates is dependent on blood types and therefore is random. b. Selection of mates is dependent on blood types and therefore is biased. c. Selection of mates is independent of blood types and therefore is random. d. Selection of mates is independent of blood types and therefore is biased.

21. Calculate the paternity index, given the X and Y probabilities: Child MOG MS a. 0.999 b. 0.301

POG Ms

X = 0.0628

Y = 0.1389

c. 0.452 d. 0.002

22. What is the basic unit of inheritance that determines the production or nonproduction of specific markers? a. Antigen c. Gene b. Chromosome d. Locus 23. Which of the following factors are considered when selecting genetic systems to use for relationship testing? a. The system should be monomorphic. b. Genotypes should be readily deducible from the phenotype. c. Mutation rates should be high. d. Testing methodology should only be available at the State laboratory.

24. All of the following factors are considered when selecting genetic systems to use for relationship testing EXCEPT: a. Inheritance patterns should be well established. b. The mutation rate should be known and should be low. c. Multiethnic databases of allele frequencies should be available. d. Each genetic system should be known to be genetically dependent.

25. In the case below, which father is being falsely accused of paternity?

Phenotype Mother A19,x B13, B21

Child Alleged Father #1 Alleged Father #2

A9, A19 B14, B21 A1, A19 B5, B35 A9, A28 B18, B14

a. Alleged father #1 b. Alleged father #2

c. Both are being falsely accused. d. Neither is being falsely accused.

26. Which of the following factors are considered when selecting genetic systems to use for relationship testing? a. Testing methodology should be reliable, reproducible, and available in more than one laboratory. b. Markers tested should be stable and not affected by environmental factors, age, disease, reagents, or methodology employed. c. Allelic distributions should provide a high probability of excluding an alleged father. d. All of these 27. Which of these is NOT one of the classic systems used for parentage testing? a. Duffy b. Kell c. Kidd d. Lewis 28. Which system has the highest probability of exclusion? a. ABO b. HLA c. MNSs d. Rh 29. Which system has the highest probability of exclusion? a. RFLP b. SNP c. STR d. These systems have the same PE. 30. Which statement defines the probability of exclusion (PE)? a. The probability of excluding one who is falsely accused of being related to someone in a given way. b. The PE reflects the probability of including one who is alleged to be the parent. c. The probability of exclusion requires knowledge of the alleged parent’s phenotype. d. The PE compares two mutually exclusive hypotheses that are expressed as a likelihood ratio.

31. Which of these is a restatement of the weight of the evidence for relatedness, expressed in percentage form? a. The probability of exclusion (PE) b. The posterior probability of parentage (PP) c. The relationship index (RI) d. None of these 32. When can false direct exclusions occur? a. Mutations occur that alter the final product. b. There is a lack of precursor substance. c. There is suppressor activity at a locus unlinked to the one tested.

d.

All of these

33. When can false indirect exclusions occur? a. Secondarily in the presence of silent alleles. b. Mutations occur that alter the final product. c. There is a lack of precursor substance. d. All of these 34. A chimeric state exists in one of the individuals being tested in a paternity case.

This can contribute to which type of exclusion? a. Direct b. Indirect c. False direct d. False indirect 35. Which of these is NOT one of the immunoglobulin allotypes used in classic parentage testing? a. Am b. Gm c. Km d. Pm

Chapter 24. Relationship Testing Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: C 3. ANS: B 4. ANS: D 5. ANS: C 6. ANS: B 7. ANS: B 8. ANS: B 9. ANS: B 10. ANS: A 11. ANS: B 12. ANS: A 13. ANS: B 14. ANS: A 15. ANS: A 16. ANS: C 17. ANS: A 18. ANS: B 19. ANS: C 20. ANS: C 21. ANS: C 22. ANS: C 23. ANS: B 24. ANS: D 25. ANS: A 26. ANS: D 27. ANS: D 28. ANS: A 29. ANS: A 30. ANS: A 31. ANS: B 32. ANS: D 33. ANS: A 34. ANS: C 35. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: TS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1

LO: 24-1 LO: 24-5 LO: 24-2 LO: 24-5 LO: 24-5 LO: 24-8 LO: 24-2 LO: 24-7 LO: 24-4 LO: 24-3 LO: 24-2 LO: 24-2 LO: 24-2 LO: 24-5 LO: 24-3 LO: 24-3 LO: 24-3 LO: 24-5 LO: 24-3 LO: 24-2 LO: 24-7 LO: 24-2 LO: 24-2 LO: 24-2 LO: 24-5 LO: 24-2 LO: 24-2 LO: 24-4 LO: 24-4 LO: 24-7 LO: 24-7 LO: 24-6 LO: 24-6 LO: 24-6 LO: 24-2

Chapter 25. Quality Management Multiple Choice Identify the choice that best completes the statement or answers the question.

1. How do internal assessments differ from compliance inspections? a. Compliance inspections assess performance on quality indicators. b. Internal assessments focus on meeting regulations. c. Internal assessments are more frequent than compliance inspections. d. Compliance inspections seek underlying causes of problems.

2. Why might a laboratory adopt an individualized quality control plan (IQCP)? a. To customize its QC program to its specific needs b. To demonstrate where costs can be saved c. To eliminate the need to perform daily quality control d. To do all of these 3. Employee training takes place: a. before procedures are validated. b. after competence assessments. c. before flowcharting the process. d. after hiring and after implementing new procedures.

4. What is a function of the quality committee or quality council? a. To provide solutions to recurring clerical errors b. To provide counseling for dT epE arS tm iziL ngER.COM TeBntAalNdKow SnEsL c. To set priorities for quality improvements d. To focus on computer upgrades and software implementation 5. What is the main purpose of linking Current Good Manufacturing Practices (CGMPs) to process control? a. To comply with the regulations b. To build quality into the manufacturing process from the beginning to the end c. To review and approve training programs and employee position descriptions d. To approve raw test materials and in-house reagents 6. A physician complains that she has not received a test report from the blood bank. The remedial action is to: a. complete the occurrence report form. b. prepare a copy of the report for the physician. c. locate the original report. d. determine why the report was not delivered.

7. When a new shipment of reagents is received, what measure is taken to determine equivalency? a. Lot-to-lot testing of new and old lot numbers of reagent b. Work-flow reorientation c. Daily quality control d. Calibration 8. Which of the following is not regarded as an instrument? a. Automated analyzer c. Washer b. Pipette d. Cuvette 9. Which of the following might lead to unacceptable quality control results?

a. b. c. d.

A technician who has not worked in the area for several months A deteriorated "anti-A" An uncalibrated serofuge All of the above

10. Which of the following is an example of an external customer? a. A night-shift medical technologist c. An intravenous nurse b. A blood donor d. Housekeeping employee 11. Blood collected in a red-top tube and a lavender tube was sent through a tube system to the STAT laboratory.

The blood specimens were not labeled with any type of patient identification. The medical technologist called the emergency room (ER) to notify them of the problem. The ER nurse stated she wanted the tubes sent back to the ER and that she would label them. The stat laboratory technologist related the laboratory's policy on unlabeled specimens, saying that they would be discarded. At that point the disgruntled nurse said she would write up a(n) for the laboratory's refusal to analyze blood on an emergency patient. a. employee evaluation c. patient report b. incident report d. flow chart 12. Which statement concerning compliance programs is false? a. Programs are designed to evaluate effectiveness of blood bank laboratories. b. Programs provide an occasional opportunity to expose new and different problems. c. Compliance is synonymous with organization-wide quality assurance. d. Compliance inspections are conducted every 1 to 2 years.

13. A standard operating procedure (SOP) is: a. a statement of intent or course of action. b. a description of resources anTdEaS ctiT viB tiA esNthKaS t tE raL nsL foErm R.inCpuOtsMinto outputs. c. a set of directions for how to perform a particular task. d. a form on which to record results.

14. What phase is synonymous with "quality management?" a. Good manufacturing practice b. Organization-wide quality assurance c. Process improvement team d. Quality control 15. All of the following are transfusion service quality assurance indicators used to monitor patient care except: a. labeling errors on specimens sent to the blood bank. b. reason for return of blood products. c. number of therapeutic units drawn. d. turnaround time on antibody identification.

16. Which of the following statements concerning equipment is true? a. Requires software to function b. Quality control is not needed for critical steps. c. Frequency of testing is determined by manufacturer recommendations. d. All equipment must be purchased from the manufacturer.

17. Which continuous improvement cycle component ensures the finished product has met required specifications? a. Improve c. Implement b. Assess d. Plan

18. As part of postemployment departmental training, a medical technologist was given 10 known blood samples to analyze for ABO specificity. This is referred to as: a. recertification. c. education. b. a competence assessment. d. a proficiency test.

19. Process improvement teams address all of the following issues except: a. becoming "team players." c. filing a grievance. b. quality and reliability of service. d. interdepartmental communication.

20. Calibrating equipment prior to use is considered which function of quality? a. Quality assurance b. Quality control c. Quality improvement d. Quality management 21. Daily testing the reactivity of blood typing reagents is considered which function of quality? a. Quality assurance b. Quality control c. Quality improvement d. Quality management 22. Which of the following is not part of an individualized quality control plan (IQCP)? a. New instrument validation b. Quality control plan c. Quality assessment d. Risk assessment 23. Which of these need NOT be evaluated during a risk assessment? a. Patient opinion survey b. Reagent storage conditions c. Specimen labeling d. Transmission of data to LIS 24. Which of these should be evaluated during a risk assessment? a. Airflow/ventilation b. Competency of testing personnel c. Equipment functioning d. All of these 25. Quality assessment monitors include reviews of all of these EXCEPT: a. Corrected report communications. b. Personnel competency records. c. Turnaround time reports. d. Vendor selection process.

26. Which of the following provides a framework for applying quality principles and practices in the blood bank? a. Quality assurance program b. Quality control and correction c. Quality improvement process d. Quality management system

27. A quality framework in the blood bank ensures all of the following EXCEPT: a. Application of quality principles and practices. b. Blood bank operations are customized to individual staff preferences. c. Compliance with regulatory body requirements d. Review of each step from donor selection through transfusion outcomes.

28. Which of the following relationships is NOT considered a quality essential of an organization? a. Blood bank personnel links to their families b. Blood bank’s link to the laboratory c. Blood bank’s link to the hospital. d. Blood bank links to the hospital’s quality function 29. Which of the following is NOT an internal customer for the transfusion service? a. Nurse administering blood products b. Patient receiving blood products c. Nursing assistant transporting blood products d. Physician ordering blood products 30. Laboratory safety training must include which of these for blood bank personnel? a. Chemical hygiene b. Emergency preparedness c. Radiation safety d. All of these 31. Competency assessment for blood bank personnel includes all of these EXCEPT: a. direct observation of patienTt E teS st T peBrfA orNmKaS ncE e.LLER.COM b. cross-training into other areas of the laboratory. c. monitoring the recording and reporting of test results. d. review of test results or worksheets.

32. Which of these records may be reviewed during competency assessment for blood bank personnel? a. Quality control records b. Proficiency testing results c. Maintenance records d. All of these 33. What is a flowchart? a. A tool that displays all the elements involved in a process b. A tool that allows for greater understanding of specific steps in a process c. A tool that explains the sequence of activities in a process in paragraph for d. All of these.

34. What is the purpose of a flowchart? a. Facilitates understanding of resources when planning a new process b. Reveals problems (i.e., missing actions) in a current process c. Shows how process inputs are converted into outputs d. All of these 35. Which of these does NOT describe a flowchart?

a. b. c. d.

Can be created on paper or with commercially available software programs Displays actions required in a process using graphic symbols for ease of understanding Is useless in obtaining better control of a process.

Shows where decision points are located within a process

36. Testing all activities in a new process to ensure that the process will work in the live environment is a function of: a. quality control. b. standard operating procedures. c. validation studies. d. none of these.

37. The use of different colored sera for blood bank reagents is an example of: a. process control. b. quality control. c. standard operating procedures. d. validation studies.

38. Which of these is part of process control? a. Performing routine QC of test methods and reagents b. Performing proficiency testing and personnel competency checks c. Using a manual or automated action to prevent the occurrence of errors d. All of these.

39. An outcomes of performing procedures and testing is called a: a. document. b. form. c. result. d. none of these.

40. Copies of regulations and accreditation requirements are examples of: a. documents. b. forms. c. results. d. none of these.

41. Examples of documents include: a. written policies, procedures and instructions. b. process flowcharts and forms. c. manufacturers’ package inserts and operator manuals. d. all of these.

42. Examples of forms include: a. instrument printouts. b. manual or electronic worksheets. c. tags, stickers, or labels.

d. all of these.

43. An error has occurred during a test procedure, which was found to be caused by the technologist using a copy of the procedure that was being used at the time of her training. What should be put in place to ensure this type of mistake is not made again. a. Corrective disciplinary action b. Document control process c. Instrument validation d. Quality control checks 44. A good document control process does all of these EXCEPT: a. eliminates the need to document all changes or corrections to procedures. b. ensures that only the latest approved copies of documents are available for use. c. links a facility’s policies, processes, and procedures to each other. d. notifies appropriate parties of the change and document the notification.

45. Which of the following statements is true? a. Remedial action occurs over time. b. Remedial action does not uncover the real cause of the nonconformance. c. Remedial action does not require further investigation. d. All of these are true.

46. An action taken to identify and eliminate the cause of a nonconformance is what type of action? a. Corrective b. Disciplinary c. Preventive d. Remedial 47. An action taken to reduce or eliminate the potential for a nonconformance is what type of action? a. Corrective b. Disciplinary c. Preventive d. Remedial 48. The process of define, measure, analyze, improve, and control (DMAIC) is known as which process? a. IOS System b. FQM System c. LEAN d. Six Sigma 49. A Pareto chart is used at what stage of the DMAIC process? a. Analyze b. Control c. Define d. Measure

50. Using a SIPOC diagram occurs at what stage of the DMAIC process? a. Analyze b. Control c. Define d. Measure 51. Understanding the cause and effect relationships occurs at what stage of the DMAIC process? a. Analyze b. Control c. Define d. Improve 52, Using the DOE tool occurs at what stage of the DMAIC process? a. Analyze b. Control c. Define d. Improve 53. Ensuring that the implemented changes are sustained occurs at what stage of the DMAIC process? a. Analyze b. Control c. Define d. Improve 54. The cost of good quality (COGQ) does NOT include which of these? a. Appraisal costs b. Conformance costs c. Nonconformance costs d. Prevention costs 55. Conformance costs may include: a. preventive maintenance. b. quality management activities. c. validation activities. d. all of these.

56. The cost incurred for calibration materials and reagents is an example of what type of cost? a. b. c. d.

Internal evaluation costs External evaluation costs Internal failure costs External failure costs

57. The cost incurred for proficiency testing and periodic licensure or accreditation inspections is what type of cost? a. Internal evaluation costs

b. External evaluation costs c. Internal failure costs d. External failure costs 58. Which of these costs is a cost of poor quality (COPQ)? a. Appraisal costs b. Conformance costs c. Nonconformance costs d. Prevention costs 59. The cost incurred when discarding donated blood units is an example of what type of cost? a. Internal evaluation costs b. External evaluation costs c. Internal failure costs d. External failure costs 60. The cost incurred with customer product recalls is an example of what type of cost? a. Internal evaluation costs b. External evaluation costs c. Internal failure costs d. External failure costs 61. Both the blood bank and the entire medical laboratory use which of the following? a. Quality management syTsE teS mTs BANKSELLER.COM b. Continuous improvement systems c. Essentials quality indicators d. All of these

Chapter 25. Quality Management

Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: D 3. ANS: D 4. ANS: C 5. ANS: B 6. ANS: B 7. ANS: A 8. ANS: D 9. ANS: D 10. ANS: B 11. ANS: B 12. ANS: A 13. ANS: C 14. ANS: B 15. ANS: C 16. ANS: C 17. ANS: B 18. ANS: B 19. ANS: C 20. ANS: B 21. ANS: B 22. ANS: A 23. ANS: A 24. ANS: D 25. ANS: D 26. ANS: D 27. ANS: B 28. ANS: A 29. ANS: B 30. ANS: D 31. ANS: B 32. ANS: D 33. ANS: A 34. ANS: D 35. ANS: C 36. ANS: C 37. ANS: A 38. ANS: D 39. ANS: C 40. ANS: A 41. ANS: D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 25-1 LO: 25-3 LO: 25-3 LO: 25-5 LO: 25-5 LO: 25-11 LO: 25-7 LO: 25-2 LO: 25-2 LO: 25-5 LO: 25-11 LO: 25-1 LO: 25-5 LO: 25-1 LO: 25-3 LO: 25-3 LO: 25-12 LO: 25-5 LO: 25-13 LO: 25-2 LO: 25-2 LO: 25-3 LO: 25-3 LO: 25-3 LO: 25-3 LO: 25-4 LO: 25-4 LO: 25-5 LO: 25-5 LO: 25-5 LO: 25-5 LO: 25-5 LO: 25-6 LO: 25-6 LO: 25-6 LO: 25-7 LO: 25-8 LO: 25-8 LO: 25-9 LO: 25-9 LO: 25-9

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59.

60.

61.

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

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1

LO: 25-9 LO: 25-10 LO: 25-10 LO: 25-11 LO: 25-11 LO: 25-11 LO: 25-13 LO: 25-13 LO: 25-13 LO: 25-13 LO: 25-13 LO: 25-13 LO: 25-14 LO: 25-14 LO: 25-14 LO: 25-14 LO: 25-14 LO: 25-14 LO: 25-14 LO: 25-15

Chapter 26. Patient Blood Management Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Blood utilization management programs are designed to do all but which of the following? a. Increase safety c. Reduce expenditure b. Decrease component availability d. Manage limited blood resources 2. A physician has ordered a 2-unit transfusion on an outpatient. When the outpatient arrives, the patient's hemoglobin is 12. What is the most appropriate action? a. Cancel the transfusion and send the patient home. b. Call the physician’s office and inform them of their mistake. c. Inform the pathologist or medical director and allow him to contact the physician. d. Transfuse. A physicians order should not be questioned.

3. Which statement is false? a. There is zero inherent risk of transfusing blood if all protocols are followed. b. Following quality assurance guidelines for transfusion increases the safety to the patient. c. You must follow a physician’s order no matter what. d. All of the above statements are true.

4. The focus of most blood utilization programs is: a. the underutilization of blood products of a facility. b. the overutilization of blood products by a facility. c. to reduce cost. d. to evaluate the need for ordering more product.

5. Which of the following is not part of a blood utilization review? a. Retrospective review c. Interpreted review b. Concurrent review d. Prospective review 6. Targeted and discontinuous are subtypes of what review system? a. Retrospective c. Interpreted b. Concurrent d. Prospective 7. Upon review at the end of the quarter, you note that one physician’s C/T ratio was high. You discuss this with the medical director, and he has you draft a letter to this physician. This is an example of what kind of review? a. Retrospective c. Interpreted b. Concurrent d. Prospective 8. An example of direct behavior influence when implementing intervention strategies would be: a. discussion with a physician about his ordering practice. b. an e-mail to the nursing staff about their roles in transfusing. c. a communication tree to all med techs about new protocols of issuing a product. d. All of the above

9. Which if the following is NOT a duty of the transfusion safety officer? a. Administering blood products b. Auditing transfusion records c. Reviewing blood utilization d. Tracking and reporting transfusion metrics 10. What educational functions must a transfusion safety officer be able to perform? a. Developing educational materials b. Coordinating education for clinical staff c. Lecturing to physicians and nurses d. All of these.

11. Which administrative function is NOT normally that of a transfusion safety officer? a. Developing transfusion guidelines. b. Educating laboratory and medical staff c. Hiring qualified transfusion personnel d. Writing transfusion policies and procedures 12. Which of the following is NOT a patient blood management tool? a. Blood order sets b. Computerized algorithms c. Maximum surgical blood order schedule d. Training phlebotomists in donor collection 13. Which patient blood management tool has no other goals besides safety and quality improvement? a. Auditing and review of blood utilization SoTnB b. Benchmarking continuoT usEm itoAriN ngKSELLER.COM c. Maximum surgical blood order schedule d. Preoperative anemia clinics 14. Which patient blood management tool has the least effect on resource conservation? a. Blood order sets b. Blood-sparing or salvage techniques c. Computerized algorithms d. Preoperative anemia clinics 15. Transfusion guidelines are intended to be a. a burden on clinicians and their patients in making decisions related to transfusion. b. prescriptive in nature when dealing with the topic of transfusion therapy. c. prohibitive in nature when dealing with the topic of transfusion therapy. d. systematically developed statements relevant to transfusion therapy.

16. Transfusion guidelines should contain which of the following? a. Indications for transfusion b. Incorporation of current best practices c. Thresholds used in screening and auditing of transfusion records d. All of these 17.

A patient has a platelet count of 10,000/cumm. This value may be used by transfusion service to: a. establish the patient’s normal range. b. place scheduled transfusion on hold.

c. proceed with transfusion therapy. d. None of the above 18. Which of the following scenarios serves the purpose of providing needed hemotherapy without transfusing more blood than is necessary? a. Single-unit transfusion of RBCs, with reassessment prior to ordering additional units b. Continuation of RBC transfusion until normal levels are reached c. Transfusing one extra RBC unit after normal level is reached to avoid relapse d. None of these 19. Transfusion guidelines typically contain which of the following? a. Contraindications for transfusion b. Indications for transfusion c. Dosage recommendations d. All of these 20. Proper blood utilization audits should review which types of records from transfused patients? a. Retrospective sample of records b. Representative sample of records c. Both d. Neither 21. The blood utilization review audit should compare which of these? a. Indications used for actual transfusions against the transfusion guideline b. Number of units ordered from regional blood banks versus those used and those wasted c. Number of units transfuT seE dS byToBnA eN phKyS sicEiaLnLpE raR ct. iceCgOroMup with another physician practice group d. All of these 22. Why should a blood utilization review give special attention to each type of blood component? a. They all have the same risk factors. b. Their costs are basically the same. c. Wastage may vary according to component. d. All of these 23. Which of the following is an undesired result of blood utilization review audits? a. Establishing lower transfusion thresholds b. Increasing underutilization of blood c. Reducing blood overutilization d. None of these 24. Which of these is NOT one of the thee pillars of patient-focused blood management? a. Minimizing the effects of leukemia. b. Minimization of blood loss and bleeding c. Optimizing the physiological reserve of anemia d. Optimization of erythropoiesis 25. Which of the following drugs is NOT a hematinic. a. B12 b. Erythropoietin c. Folate

d. Iron 26. Presurgical autologous blood donation (PAD) is NOT recommended patients with anemia unless the patient has which of the following? a. A rare blood type b. Alloantibodies to high-frequency antigens c. Multiple antigens that require very rare phenotype-matched products d. Any of these 27. Which of the following can be a significant contributor to anemia developed as a result of hospitalization? a. Iron deficiency b. Iatrogenic blood loss c. Viscoelastic testing d. Vitamin deficiency

Chapter 26. Patient Blood Management Answer Section MULTIPLE CHOICE 1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS: 9. ANS: 10. ANS: 11. ANS: 12. ANS: 13. ANS: 14. ANS: 15. ANS: 16. ANS: 17. ANS: 18. ANS: 19. ANS: 20. ANS: 21. ANS: 22. ANS: 23. ANS: 24. ANS: 25. ANS: 26. ANS: 27. ANS:

B C A B C D A D A D C D A A D D C A D C D C B A B D B

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 : LTL axEoR no.mCyOLM evel: 3 1 TESTBANKKESYE 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2

LO:26-1 LO:26-7 LO:26-1 LO:26-1 LO:26-6 LO:26-6 LO:26-6 LO:26-7 LO:26-3 LO:26-3 LO:26-3 LO:26-2 LO:26-2 LO:26-2 LO:26-4 LO:26-4 LO:26-4 LO:26-4 LO:26-4 LO:26-5 LO:26-5 LO:26-5 LO:26-5 LO:26-8 LO:26-8 LO:26-8 LO:26-8

Chapter 27. Transfusion Safety and Federal Regulatory Requirements Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Why is the Center for Biologics Evaluation and Research (CBER) notified in the case of a transfusion-related fatality? a. To recall all banked units b. To disclose the name of the deceased c. To determine if appropriate corrective action has been taken to prevent recurrence d. To report all reagent lot numbers used in typing deceased patient 2. Establishments that hold U.S. licenses for a biological product can: a. ship products interstate and internationally for sale or exchange. b. only ship and sell products interstate. c. market multiple trademark for their product. d. All of the above 3. In what year did the FDA take over biologics regulation? a. 1976 c. 1972 b. 1980 d. 1985 4. Which of the following would constitute short supply and an exemption from licensure? a. RBCs used in the manufacturing of check cells b. Recovered plasma used in the making of platelets c. Recovered plasma used in tT heEm acN tuK riS ngEoL fL faE ctR or.VCIIO IM SaTnuBfA d. Whole blood used in the manufacturing of hemoglobin substitute 5. According to federal law, what organization must be contacted when a biological deviation occurs in a blood bank and the error has the potential to affect the safety of the product or patient? a. Joint Commission c. CAP b. AABB d. CBER 6. What is the primary focus of quality assurance? a. To place blame on employees who make recurring errors b. To amend the system, procedure, or standard operating procedures, if deemed faulty c. To analyze postmarket stability d. To rewrite employee job descriptions as needed 7. In 1970, the Public Health Service Act was expanded to include: a. provisions for licensing products. b. blood and blood components and derivatives. c. guidelines for suspending licenses for violations. d. authorization for facility inspection.

8. One change that occurred under the FDA for oversight of biologics was that the FD&C Act now labeled biologics as: a. blood products. c. reagents. b. drugs. d. growth factors.

9. What protocol is followed for licensed products generated at a different site from the original licensed site or establishment?

a. b. c. d.

Product license is automatically transferred from site to site.

An amendment is filed to the product license application.

A separate product license must be issued for each additional site.

None of the above

10. Which of the following provides just cause for a product recall by the FDA? a. The donor blood pressure reading was omitted in donor screening. b. An A-positive packed red blood cell unit was labeled as an A-negative packed red blood cell unit. c. An autologous unit was found reactive for anti-HBc. d. A therapeutic whole blood unit had a hematocrit of greater than 80%.

11. The law that began and mandated regulation of biological products in the United States was called: a. PHS Act of 1902. c. Biologics Control Act of 1902. b. Product Safety Act of 1902. d. none of the above.

12. The short supply agreement is between the blood establishment and: a. the broker. c. the donor. b. the final product manufacturer. d. none of the above.

13. All of the following is correct regarding recovered plasma except: a. it is derived from single units of expired whole blood. b. it is derived from single units of unexpired whole blood. c. it is a licensed source material used in the manufacturing of licensed products. d. it is an unlicensed source material used in the manufacturing of licensed products.

14. What is contained in Form FDA-483? a. Objectionable conditions noted by an FDA inspector b. An FDA checklist used by inspectors c. A list of blood banks that perform in-house viral testing d. A list of certified FDA inspectors 15. What is the function of the CBER? a. To monitor continuing education at designated facilities b. To issue federal licenses to establishments that are manufacturing biological products c. To issue certification to medical technologists d. None of the above 16. Which of the following prevents interstate shipment of biological products by an establishment? a. An FDA warning letter c. FDA form 483 b. An FDA suspension d. Short supply 17. Which part of quality assurance ensures that products are consistently manufactured according to, and controlled by, the quality standards appropriate for their intended use? a. Quality control c. Delta check b. Reproducibility d. Good manufacturing practices 18. Biological products are defined as any virus, therapeutic serum, toxin, antitoxin, vaccine, blood, blood component (or derivative allergenic products) or analogous product applicable to the prevention, treatment, or cure of disease or injuries of man. Which specific product was missing in the original PHS statute? a. Vaccine c. Antitoxin b. Blood component d. Virus

19. FDA proposed regulations are published in a. Transfusion Medicine b. The Federal Register

. c. AABB Standards d. Immunohematology

20. The FDA-directed civil action that calls for removal of products from distribution channels is known as: a. injunction. c. prosecution. b. seizure. d. quarantine.

21. All of the following is covered under the PHS Act except: a. penalty for violation. c. inspection requirements. b. labeling requirements. d. budget control.

22. What is the purpose of a prelicense inspection by the CBER? a. To order mandatory injunctions b. To determine the firm's readiness for an unannounced inspection c. To determine the firm's ability to operate in compliance with applicable regulations d. None of the above 23. Upon the event of an adverse reaction that results in a transfusion-related fatality, the CBER must be notified within what time frame? a. 24 hours b. 7 days c. 30 days d. Not necessary to contact the CBER but must contact the FDA 24. Which of the following is NOT included in the FDA’s five layers of safety? a. Competency testing of persoTnE neSl TBANKSELLER.COM b. Donor screening and blood testing c. Reviewing records of donor deferral d. Quarantine of donor blood 25. Which of the following is are included in the FDA’s five layers of safety? a. Donor screening and review of deferral records b. Blood testing and quarantine of donor unit c. Investigation of all problems and deficiencies d. All of these 26. Which of the following is true concerning a contract manufacturer? a. Contract manufacturers are employed by another manufacturer to perform some part of the product’s manufacturing. b. Contract manufacturer is under the direct control of the original product manufacturer. c. Contract manufacturers do not need to register with the FDA because they are not the originating manufacture. d. All of these 27. Under the regulated products section 21 CFR 607.20(a), who needs to register with the FDA? a. The originating manufacturer b. Contract manufacturers who produce the product for the originating manufacturer c. Contract manufacturers who only perform one step of the manufacturing process d. All of these

28. Which FDA center regulates therapeutic biological products? a. CBER b. CDER c. OBRR d. OCBQ 29. Which FDA center regulates biological and related devices? a. CBER b. CDER c. OBRR d. OCBQ 30. Which office performs FDA postmarket inspections of blood and blood component manufacturing facilities? a. OBRR b. OCBQ c. ORA d. None of these 31. In a situation where it is thought a product will cause serious adverse health consequences or death, what type of recall will be issued? a. Class I b. Class II c. Class III d. None of these

EoSteTcBhA 32. In a situation where there is a rT em anN ceKtS haEt L aL prE odRu. ctCwOilM l cause temporary or medically reversible adverse health consequences, what type of recall will be issued? a. Class I b. Class II c. Class III d. None of these 33. In a situation where exposure to a product is not likely to cause adverse health consequences, what type of recall will be issued? a. Class I b. Class II c. Class III d. None of these True/False Indicate whether the statement is true or false.

1. Blood grouping reagents are considered medical devices according to the CBER. 2. A drug is considered adulterated if the methods used to manufacture it do not conform with current good manufacturing processes.

3. The establishment license and one product license are issued simultaneously by the CBER.

Chapter 27. Transfusion Safety and Federal Regulatory Requirements Answer Section MULTIPLE CHOICE 1. ANS: C 2. ANS: A 3. ANS: C 4. ANS: C 5. ANS: D 6. ANS: B 7. ANS: B 8. ANS: B 9. ANS: B 10. ANS: B 11. ANS: C 12. ANS: B 13. ANS: D 14. ANS: A 15. ANS: B 16. ANS: B 17. ANS: D 18. ANS: B 19. ANS: B 20. ANS: B 21. ANS: D 22. ANS: C 23. ANS: B 24. ANS: A 25. ANS: D 26. ANS: A 27. ANS: D 28. ANS: B 29. ANS: A 30. ANS: C 31. ANS: A 32. ANS: B 33. ANS: C 3

5

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 TESTBANKKESYE : LTL axEoR no.mCyOLM evel: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 27-9 LO: 27-2 LO: 27-3 LO: 27-5 LO: 27-1 LO: 27-10 LO: 27-1 LO: 27-6 LO: 27-7 LO: 27-8 LO: 27-1 LO: 27-5 LO: 27-5 LO: 27-6 LO: 27-3 LO: 27-3 LO: 27-6 LO: 27-2 LO: 27-6 LO: 27-3 LO: 27-1 LO: 27-5 LO: 27-9 LO: 27-10 LO: 27-10 LO: 27-4 LO: 27-4 LO: 27-8 LO: 27-8 LO: 27-8 LO: 27-9 LO: 27-9 LO: 27-9

TRUE/FALSE 1. ANS: T 2. ANS: T 3. ANS: T

PTS: 1 PTS: 1 PTS: 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1

LO: 27-2 LO: 27-9 LO: 27-3

Chapter 28. Laboratory Information Systems in the Blood Bank Multiple Choice Identify the choice that best completes the statement or answers the question.

1. When does computer software for the laboratory need to be validated? a. Before sale by the vendor c. Both of these b. After installation at the laboratory. d. Neither of these 2. What are the two components of computer terminals? a. Central receiving terminal/keyboard c. Cathode ray tube/disk b. Monitor/keyboard d. Central processing unit/keyboard 3. Software is the establishment of documented evidence that provides a high degree of assurance that the information system will consistently function as expected. a. regulation c. validation b. application d. maintenance 4. The final label verification step performed at the donation facility will prevent: a. the release of blood that tests positive for hepatitis markers. b. transfusion reactions. c. the release of ABO incompatible blood. d. donor reactions.

5. During the morning run, the computer system went offline for maintenance. This situation is appropriately referred to as , and there should be a backup system in place. a. break time c. a disaster b. downtime d. backload 6. What information might be found in a blood bank computer system? a. Inventory of blood components b. Antibodies identified in a patient c. The last date of donation for a blood donor d. All of the above 7. What is the overall purpose of a blood bank information system? a. To track a blood product from the time of donation to the point of final disposition b. To store donor history information c. To assist blood bank personnel in selection of appropriate components for transfusion d. To keep a daily inventory of all blood components 8. A blood bank wishes to upgrade its computer system so that it will automatically interpret the ABO group based on the results of the forward and reverse grouping tests. This upgrade would be achieved through the: a. applications software. c. interface software. b. operating system software. d. none of the above.

9. What hardware device controls the interpretation and execution of software instructions? a. Modem c. Central ray tube b. Central processing unit d. File server 10. Data from donor history cards would be stored in what type of file? a. Static file c. Dynamic file

b. Antibody file

d. Review file

11. Computer technical support personnel would need the use of a system to troubleshoot system problems. a. cathode ray tube c. modem b. laser d. tape drive

to access the blood bank information

12. How can information systems in a blood center assist the managerial staff? a. By isolating the HIV-positive donor population b. By tabulating deficiencies in cap surveys c. By monitoring the number of donors deferred d. None of the above 13. A unit of blood was irradiated for a patient. It had 29 days before it expired. The unit's original expiration date was January 1, 2012. What expiration date should the LIS have given it when the modification was recorded? a. January 1, 2012 c. December 31, 2012 b. January 2, 2012 d. 24-hour expiration 14. A transfusion service employee proceeds to issue blood to an O-positive patient. She enters the unit number via the keyboard. The unit is typed as A-positive. What should appear on the CRT screen at this point? a. A prompt message asking what printer should print the compatibility tags b. A message that the issue process is complete c. A warning message signaling incompatibility between patient and donor d. None of the above 15. When a new hospital patient is registered through admissions, the demographic information is entered into the hospital information system (HIS). Blood bank technologists are able to access the patient information through which of the following? a. Operating system software c. Interface software b. Database d. None of the above 16. Many accreditation agencies have checklist items that emphasize the responsibilities of operating an information system. Which of the following is not a volunteer accreditation agency? a. CAP c. FDA b. AABB d. Joint Commission 17. Which of the following best describes software? a. Physical pieces of equipment that can be seen and touched b. The "core" of the information system c. Programmed instructions that tell computer how to operate and manipulate the data d. A mechanism for connecting one computer system to another through a telephone line 18. What information is accessed from a component barcode sticker? a. Blood type c. Expiration date b. Unit number d. All of the above 19. Blood bank information systems should perform all of the following except: a. verify donor testing results to ensure units are suitable for transfusion. b. identify the location of all units at any given time. c. recognize units that are outdated. d. verify the accuracy of input demographic data.

20. How does the blood bank information system aid the technologist in selecting RBCs for a patient who had previously developed anti-Jka, but whose current antibody screen is negative? a. Alerts the tech to previous phenotyping results b. Reveals a history of anti-Jka c. Reveals a history of anti-Jkb d. None of the above 21. What kind of software allows the interchange of information between two different computer systems? a. Application c. Operating system b. Interface d. HIS 22. What is the function of a system manager? a. To implement new software updates b. To assign access codes to new users c. To add new data items to the database d. All of the above 23. One way for mobile or satellite blood-collecting facilities to access donor histories is to donor records from the blood bank information system to portable computers. a. purge c. download b. upload d. barcode

a copy of

24. A warning message displayed to alert the user of invalid ABO grouping test results is a function of the: a. operating system. c. static database files. b. truth tables. d. dynamic database records.

25. Through what mechanism is security of computer applications maintained? a. User name c. User keys b. User combination d. User password 26. For ready access by its processor, where does the computer hold information such as the operating system, application programs, and data? a. In its archive c. In RAM b. In ROM d. On the hard disk 27. Which of the following is a function of the operating system software? a. Result entry of serologic tests b. Transfer of information from the blood bank system to the HIS c. Transfer of data onto a disk d. Storage of data in the information system 28. In a computerized transfusion service with six terminals: two terminals are used to crossmatch RBCs for a patient with gastrointestinal bleeding, one terminal is used to enter blood products recently delivered by the blood supplier, one is used to enter type and screen results, and one is used to enter patient test orders. This is an example of a validation test case. a. normal c. stress b. boundary d. special 29. A 17-mL aliquot of CMV-negative RBCs is requested for a newborn. The mother's antibody screen was positive and anti-Fya was identified. A sample from the aliquot was tested with anti-Fya and found to be negative for the antigen. This information should be documented on which of the following? a. Aliquot unit c. Donor file b. Original unit d. All of the above

30. Documentation of previous antigen typing results in donor files is beneficial when: a. there is a patient with gastrointestinal bleeding in the emergency room. b. specific antigen-positive units are needed for a future surgery. c. specific antigen-negative units are needed for a future surgery. d. fresh frozen plasma is needed on a factor IX-deficient patient.

31. Which of the following should be included in the construction of a truth table for the blood bank? a. Forward grouping reactions c. Interpretation of the grouping reactions b. Reverse grouping reactions d. All of these 32. Decisions made by a computer system without human intervention is what type of control? a. Decision support b. Process c. Quality d. None of these 33. Decisions made by a user based on computer displayed information is what type of control? a. Decision support b. Process c. Quality d. None of these 34. When entering an expiration date into the computer that exceeds the possible shelf life of a blood component you receive a warning box. This is what type of control?

a. b. c. d.

Decision support Process Quality None of these

35. A computer validation test plan should include which of the following? a. Control functions and documentation methods b. Data entry methods and results review c. Specific test cases and acceptance criteria d. All of these 36. Which of these is NOT included in a computer validation test plan? a. Analysis of the cost of the software b. Determination of documentation methods c. Review of results and corrective actions d. Validation using specific test cases

37. During a validation of a blood bank computer system, a zero is entered for an O in an ABO result field. This type of validation is an example of which test? a. Boundary testing b. Normal testing c. Invalid test cases d. Special test cases 38. Special test cases when validating a laboratory computer system do which of the following? a. Assess the system’s ability to recognize and reject incorrect inputs. b. Force the evaluation of data that are slightly below or slightly above valid ranges. c. Make the system react to unusual inputs. d. Use typical blood bank inputs to produce normal or routine outputs.

True/False Indicate whether the statement is true or false.

1. Standard operating procedures must include computer functions that are part of the blood bank's technical procedures, such as the issuance of blood components.

Chapter 28. Laboratory Information Systems Answer Section MULTIPLE CHOICE 1. ANS: 2. ANS: 3. ANS: 4. ANS: 5. ANS: 6. ANS: 7. ANS: 8. ANS: 9. ANS: 10. ANS: 11. ANS: 12. ANS: 13. ANS: 14. ANS: 15. ANS: 16. ANS: 17. ANS: 18. ANS: 19. ANS: 20. ANS: 21. ANS: 22. ANS:

C B C A B D A A B C C C C C C C C D D B B D

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1

LO: 28-13 LO: 28-3 LO: 28-11 LO: 28-11 LO: 28-5 LO: 28-1 LO: 28-1 LO: 28-4 LO: 28-2 LO: 28-7 LO: 28-2 LO: 28-1 LO: 28-12 LO: 28-8 LO: 28-4 LO: 28-6 LO: 28-4 LO: 28-7 LO: 28-1 LO: 28-8 LO: 28-7 LO: 28-5

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

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

TRUE/FALSE 1. ANS: T

PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS:

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 2 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 1 KEY: Taxonomy Level: 3 KEY: Taxonomy Level: 2

LO: 28-5 LO: 28-8 LO: 28-5 LO: 28-2 LO: 28-4 LO: 28-15 LO: 28-10 LO: 28-10 LO: 28-9 LO: 28-14 LO: 28-14 LO: 28-14 LO: 28-15 LO: 28-15 LO: 28-15 LO: 28-15

PTS: 1

KEY: Taxonomy Level: 1

LO: 28-10

Chapter 29. Medicolegal and Ethical Aspects of Providing Blood Collection and Transfusion Services Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Many transfusion-transmitted acquired immunodeficiency syndrome (TTAIDS) lawsuits have been dismissed because of: a. inability to prove negligence. c. blood shield statutes. b. lack of precedence. d. statute of limitations.

2. What is the meaning of tort reform? a. Prospective immunity for hospitals from excess liability because of charitable acts b. Revision of transfusion-associated litigation to include licensed registered nurses as defendants c. Protection of specialty practices from punitive or excessive awards by state legislatures d. None of the above 3. What kind of cases stimulated state legislatures to enact protection for blood banks through so-called blood shield statutes? a. TTAIDS c. TT syphilis b. TTH d. TT sepsis 4. What body of government is authorized to pass laws? a. U.S. Congress c. State courts TESTBANKS LlEl oRf.thCeOabMove b. U.S. Supreme Court dE. LA 5. Why are physicians selected as the "respondent superior" in negligent cases? a. Physicians give the order to transfuse. b. Physicians are considered expert witnesses in transfusion-related deaths. c. Federal regulations can be applied to medical malpractice. d. None of the above 6. A blood bank technologist working in an Army medical center discovers that a colleague from boot camp who donated blood is HIV-positive. While at a nightclub on base, the technologist discloses this information to his sergeant. Within 24 hours the donor's commander confronts the donor with this rumor. By law the donor can file suit against the donor center for . a. battery c. tort b. negligence d. loss of privacy 7. Which of the following situations is grounds for a plaintiff claim under invasion of privacy? a. Public disclosure of embarrassing facts b. Placement of plaintiff in a "false light" in public c. Intrusion on plaintiff's seclusion d. All of the above 8. What is the rationale surrounding the Doctrine of Charitable Immunity? a. State legislatures are more lenient toward select specialty areas of medicine with regard to excessive legal damages. b. Courts provide immunity from excess liability for nonprofit organizations. c. Blood collecting facilities entice donors by agreeing to donate 5% of plasma revenues to their favorite charity.

d. None of the above 9. Liability for negligence includes all of the following except: a. there was a duty owed to the injured party. b. the duty was not met; the injured party was harmed. c. failure to meet the duty was indirectly responsible for harm suffered by injured party. d. some measurable (compensable) harm occurred (called damage).

10. What was the reason for the negligence verdict in the district case Belle Bonfils Memorial Blood Bank v.

Denver District Court (1988)? a. Lack of an HIV-confirmatory test for specific unit transfused b. Clerical error by reference laboratory (site of testing) c. Lack of standard protocol for implementing new HIV testing on available components d. Lack of quality control for HIV test kit 11. How does the doctrine of informed consent protect the donor? a. By providing a pamphlet of donor risks to the donor on his or her way out the door b. By not requiring his or her signature c. By requiring that information be provided to the donor in a manner that he or she can understand and ask questions about, if so desired d. None of the above 12. What would be the effect of redefining blood banking outside the realm of medical practice in litigation cases? a. Physicians would no longer serve as the respondent superior. b. Blood bank personnel would take the role of the defendant. c. Expert medical testimony wToE ulS dT noBt A beNnKeeSdE edLtL oE esR ta. blC ishOsMtandard of care. d. Transfusion facilities would be excluded from the blood shield statute.

13. How is battery conceptualized in transfusion medicine? a. A patient develops a fever after being transfused. b. A donor claims never to have agreed to be stuck by a needle. c. A donor develops a hematoma after phlebotomy. d. A patient develops an antibody 2 months after being transfused.

14. In regard to donor histories, the federal government has put an emphasis on acquiring more descriptive information from persons who may be infected with HIV. a. self-administration of questionnaires c. humiliation tactics b. face-to-face oral questions d. none of the above

in the hope of

15. What would be the plaintiff's claim for a case involving a donor or defendant who intentionally donated HIVpositive blood for transfusion purposes? a. Wrongful death c. Tort b. Battery d. Manslaughter 16. All of the following are emerging concerns of transfusion medicine except: a. red blood cell substitute. b. standards of preoperative blood collection and reinfusion. c. crossover of autologous (unused) units. d. antibody testing procedures.

17. Blood banks are federally regulated by which of the following? a. AABB

b. Commission on Laboratory Accreditation c. American Medical Association d. FDA 18. In transfusion services, who is liable for the actions of employees as determined by federal law? a. Chief technologist c. Laboratory director b. Blood bank supervisor d. Physician 19. In the case of Kozup v. Georgetown University Hospital (1987), what were the circumstances surrounding the court's decision to rule in favor of the defendant? a. The death of an infant was not transfusion related. b. Parents did not object to transfusion at the time of infusion. c. Parents had signed a transfusion consent form. d. The District of Columbia courts had a blood shield statute in effect.

20. The is an example of a voluntary standard, as related to transfusion medicine. a. Clinical Laboratory Improvement Amendments of 1988 b. Journal of the American Medical Association c. AABB Standards d. Code of Federal Regulations 21. Who determines the professional standard of care in negligence lawsuits? a. Jury c. Expert witnesses b. Judge d. Defendant 22. Plaintiffs have prevailed in TTAIDS multimillion-dollar medical malpractice suits against physicians for which of the following arguments? a. There is a lack of standard protocol for implementing new HIV test kits. b. The patient did not need a transfusion based on clinical data. c. The patient did not give informed consent. d. The patient was health illiterate and therefore could not comprehend the need for transfusion.

23. Which of the following best describes strict liability? a. Manufacturers are liable when it can be proven the consumer did not misuse the product. b. Manufacturers are legally liable for all harm that occurs through use of a product. c. Manufacturers are legally liable for the duration of the warranty period. d. None of the above 24. Which of the following species of organisms are known to infect red blood cells in storage? a. Escherichia coli c. Yersinia species b. Enterobacter species d. All of the above 25. What is the legal basis for lawsuits filed as a result of a transfusion? a. Civil actions for tort and tort liability b. Criminal actions for tort and tort liability c. Civil actions for manslaughter d. None of the above 26. All of the following injuries from component collection may be grounds for a civil suit except: a. a hematoma. c. a sudden fall. b. nerve damage. d. severe donor reaction.

27. Civil cases involving TTAIDS in the 1980s, when plaintiffs argued infected patients were insufficiently warned of the hazards of transfusion, were unsuccessful in their litigation efforts because: a. patients gave verbal consent. b. the statute of limitations was in effect. c. scientific knowledge was limited, as stated by experts. d. hospitals were protected by blood shield statutes.

28. Lawsuits against blood collection agencies for improper donor screening can be ruled in favor of the blood center if which of the following occurs? a. Facilities could show that they had implemented written procedures. b. Facilities could show that they and had properly trained employees. c. Facilities could show that employees followed standard procedures and that proper documentation of each screen occurred. d. All of these.

29. Lawsuits against blood collection agencies for improper donor screening can be ruled in favor of the plaintiff if which of the following occurs? a. Facilities cannot show that they had implemented written procedures. b. Facilities cannot show that they and had properly trained employees. c. Facilities cannot document that employees followed procedures for proper documentation of each screen. d. Any of these 30. How must a standard operating procedure (SOP) be written in order to stand up against legal scrutiny? a. SOPs must be consistent with quality principles b. SOPs must comply with recToE gnS izT edBaAuN thK orS itiE esL, L reE guR la. tiC onO s,Mand statutes. c. SOPs must include a method of measuring and recording how persons actually follow those procedures. d. All of these 31. In the absence of federal law, what justification can provide precedence for future decisions. a. State b. City c. Either of these d. None of these 32. Donors who were protected in the past from subpoena in cases of transfusion-transmitted diseases now may be questioned by the court. How might the donors identity be handled? a. Completely protected b. Partially protected c. Must appear in open court d. Any of these

Chapter 29. Medicolegal and Ethical Aspects of Providing Blood Collection and Transfusion Services Answer Section

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1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 LLER.COM TES TBAN 1 KKESYE : Taxonomy Level: 2 1 KEY: Taxonomy Level: 3 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 2 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1 1 KEY: Taxonomy Level: 1

LO: 29-2 LO: 29-6 LO: 29-6 LO: 29-1 LO: 29-2 LO: 29-5 LO: 29-2 LO: 29-1 LO: 29-1 LO: 29-5 LO: 29-1 LO: 29-4 LO: 29-1 LO: 29-3 LO: 29-2 LO: 29-4 LO: 29-6 LO: 29-2 LO: 29-5 LO: 29-6 LO: 29-1 LO: 29-5 LO: 29-2 LO: 29-3 LO: 29-2 LO: 29-5 LO: 29-6 LO: 29-3 LO: 29-3 LO: 29-3 LO: 29-4 LO: 29-4