Exam D

Question 1

A unit of fresh frozen plasma was thawed between 1 and 6 C for the purpose of precipitating the cold-insoluble portion of the plasma. What is the minimum amount of fibrinogen in this newly harvested component?

150 mg/dL
160 mg/dL
170 mg/dL
180 mg/dL

Answer 1

150 mg/dL

Question 2

The antibody screen on a unit of blood included which of the following phases of testing?

Only the 37 C to the AHG is required to detect IgG antibodies

Immediate spin, room temperature phases only are required to detect IgM antibodies

All phases of testing are required to detect every possible antibody present

Only the 37 C phase is required since this is body temperature

Answer 2

All phases of testing are required to detect every possible antibody present

Question 3

A tech noticed that the cell button in a tube has been centrifuged in an old serological centrifuge wasn’t not clearly delineated on the bottom. Also, the button seemed to dislodge after only one or two shakes. What does this mean?

The tech probably shook the tube as he removed it from the centrifuge

The tech is shaking too hard that the bottom button breaks up in one or two shakes

The centrifuge needs to be recalibrated to determine the optimal spin time

The revolutions per minute are probably too fast for the time of centrifugation

Answer 3

The centrifuge needs to be recalibrated to determine the optimal spin time

Question 4

Four units of blood Group O, Rh negative packed cells were signed out to the emergency room at 0300. At 0800 a custodian discovered two of the units on the crash cart. He told the charge nurse, who returned them to the blood bank. What can be done with them?

Place them in the refrigerator to cool and use as needed

The units must be destroyed, they were out of the refrigerator too long

Wash prior to using to remove any hemolysis created by old, dying cells

Freeze the unit to preserve whatever cells are still viable

Answer 4

The units must be destroyed, they were out of the refrigerator too long

Question 5

Nucleic acid testing (NAT) is used to detect viral markers for HIV and HCV. Select the correct answer below.

This test can be used by pooling sera to decrease the cost

Although this is a very expensive test, it reduces the exposure window by detecting very low numbers of viral copies after they appear in the blood stream

The advantage of using this test is the relative lack of false-positive results as long as sample and laboratory cross-contamination are controlled

All of the above are correct

Answer 5

All of the above are correct

Question 6

This product is indicated in the treatment of classic hemophilia (Hemophilia A). The doctor ordered ten bags of this product be thawed and pooled prior to its being infused. What is the storage temperature for this thawed, pooled product?

Six hours from the start of the pooling; stored at 1 to 6 C

24 hours from the completion of the pooling; stored at 1 to 4 C

Four hours from the start of the pooling; stored at 20 to 24 C

24 hours from the start of pooling; stored at 20 to 24 C

Answer 6

Four hours from the start of the pooling; stored at 20 to 24 C

Question 7

A patient had anti-vel and was in critical need of transfusion. After many phone calls by the rare donor center, a liquid unit was found in another state. The blood bank shipped it, and it arrived within six hours. When the box was unpacked and dry ice removed, the tech noticed that the blood was almost pure hemolysate. What could have happened?

The blood was packed beneath the bag of dry ice, and it reached temperatures colder than 10 degrees centigrade

The ice was dry ice rather than wet ice and it reached temperatures less than one degree centigrade

There was no protectant such as newspaper between the bag of blood and the ice

The blood was packed above the ice, and it reached temperature above ten degrees centigrade

Answer 7

The blood was packed beneath the bag of dry ice, and it reached temperatures colder than 10 degrees centigrade

Question 8

The lab had just purchased a new serological centrifuge. Before it could be placed into service, what validation testing had to be done on it?

Optimum spin times for all mediums used in the lab, the revolutions per minute (rpm) and the timer check must be done on the new centrifuge

Only the rpm and the timer check need to be tested. Optimum spin times as used on other centrifuges

On most centrifuges the rpms are not adjustable; so rpms do not have to be measured. The timer and optimum spin time for each medium must be done

Answer 8

Only the rpm and the timer check need to be tested. Optimum spin times as used on other centrifuges

Question 9

A unit of fresh frozen plasma was thawed between 1 and 6 C for the purpose of precipitating the cold-insoluble portion of the plasma. What is the storage time and temperature for this new harvested component?

Twelve months from the date of preparation at minus 18 C or colder

Five years from the date drawn at minus 65 C or colder

Twelve months from the date drawn at minus 18C or colder

Two years from the date prepared at minus 18 or colder

Answer 9

Twelve months from the date drawn at minus 18C or colder

Question 10

A very excited eighteen-year-old came to the donor center to donate for the first time. He had about 100 mls left before the bag was full and the needle could be pulled when he started to show symptoms of nausea, pallor, and perspiration. Despite efforts to calm him, he went into vasovagal syncope (he fainted). What should be done?

Pull the needle and administer CPR

Pull the needle when the bag is full and fan the donor

Pull the needle when the bag is full and raise his legs above the level of his head

Pull the needle and apply cold compress to the donor’s forehead

Answer 10

Pull the needle and apply cold compress to the donor’s forehead

Question 11

Plasma from a unit of whole blood must be frozen within 8 hours of collection. If it is frozen after the 8 hours, what is the problem?

It only contains coagulation factors I, VIII, an XIII

The albumin becomes too concentrated

The stable coagulation factors have deteriorated

The labile coagulation factors have deteriorated

Answer 11

The labile coagulation factors have deteriorated

Question 12

Aspirin containing products affect which of the following components

Red blood cells
Platelets
Fresh frozen plasma
cryoprecipitate

Answer 12

Platelets

Question 13

Plasma cryoprecipitate reduced (also called “cryo free frozen plasma”) is indicated for which of the following?

Liver cancer
Hypofibrinogenemia
Hemophilia A
TTP

Answer 13

TTP

Question 14

During a plateletpheresis procedure the hermetic seal on the bag broke. What should be done with the bag of platelets?

The bag must be destroyed because it won’t be processed prior to the 24 hour expiration

The bag can be stored for 7 hours in the refrigerator to kill any bacteria that may have entered during the breakage. Then it can be transfused within the following 48 hours

The bag can be stored for five days with continuous shaking. It can be transfused during that time period

The bag will expire within 72 hours because of the breakage, it can be transfused when needed during that time period

Answer 14

The bag must be destroyed because it won’t be processed prior to the 24 hour expiration

Question 15

A unit of blood tested positive for hepaitis B surface antigen. Two more samples on the same unit were also positive. The confirmation test, a neutralization procedure was positive. How long must the donor wait until he can donate allogenic blood sample?

He can donate in 56 days
He can donate in 120 days
He can donate in 12 months
He is indefinitely deferred

Answer 15

He is indefinitely deferred

Question 16

An immunocompromised patient needed leukoreduced red blood cells that were negative for the cytomegalovirus. No CMV negative blood was available. What is an acceptable alternative?

Leukoreduced red blood cells filtered prior to storage

Washed red blood cells less than five days old

Irradiated red blood cells

There is no alternative

Answer 16

Leukoreduced red blood cells filtered prior to storage

Question 17

How frequently should the temperature be read and recorded on a freezer or refrigerator that contains blood products for transfusion?

Every 4 hours
Every 6 hours
Every 12 hours
Every 24 hours

Answer 17

Every 4 hours

Question 18

A person was in the military and desired to donate blood at the local blood drive. He had never left the US since he enlisted; however, he was not about to be deployed overseas. He last donated blood six weeks age. His hemoglobin was 13.6 gm/dL, his blood pressure was 110/70, his temperature was 98.3 F, his pulse was 60 beats per minute. He was deferred from donating. Why?

His hemoglobin was too high

His blood pressure was too low

He was about to be deployed overseas

There should be eight weeks between donations

Answer 18

There should be eight weeks between donations

Question 19

A phlebotomist was scrubbing a donor’s arms with iodine when a red rash began to appear. Immediately the iodine was washed off. In the future, what should be used to scrub the patient’s arm prior to phlebotomy.

Green soap

Chlorhexidine and 70% alcohol

An across the counter product containing an antimicrobial substance

Povidone iodine

Answer 19

Povidone iodine

Question 20

A unit of blood was drawn on Jul 1 of this year. Within six hours of being drawn, fresh frozen plasma was made. If properly stored, when does the FFP expire?

One year from the date that the unit of blood expires

One year from the date that the unit of blood was drawn

Thirsty days from the date that the unit of blood was drawn

Five years from the date that the fresh frozen plasma was made

Answer 20

One year from the date that the unit of blood was drawn

Question 21

Both the Fy(a) and P1 antigen deteriorate in storage before any of the other antigens deteriorate; however, of the two, the Fy(a) is monitored rather than the P1. Why?

The antibody to the Fy(a) antigen is IgG and we are more interested in checking that a clinically significant antigen is present rather than a clinically significant antigen

The antibody to the P1 antigen is IgG and we are more interested in checking that a clinically significant antigen is present rather than a clinically insignificant antigen.

Anti-Fy(a) is more readily available than anti-P1

Anti-P1 has a longer incubation period than anti-Fy(a) and we elect to test by the most efficient method possible

Answer 21

The antibody to the Fy(a) antigen is IgG and we are more interested in checking that a clinically significant antigen is present rather than a clinically significant antigen

Question 22

A unit of blood was found to be Jk(a-b-); therefore, the lab director requested that it be frozen. The tech quickly added the glycerol to the unit before it warmed above six degrees Centigrade. Promptly the unit was placed at minus sixty-five degrees centigrade for storage. Two years later the unit was needed. The unit was thawed at 37 degrees C and solutions of saline in decreasing concentration were used to wash the cells. To everyone’s dismay, the unit was grossly hemolyzed. Why?

The unit should have been allowed to thaw at room temperature rather than 37 degrees C

The deglycerolization procedure should have used increasing concentrations of saline rather than decreasing concentrations

The Jk(a-b-) phenotype withstand freezing

Two years ago the glycerol should have been added slowly with continuous shaking after the bag has warmed to room temperature

Answer 22

The deglycerolization procedure should have used increasing concentrations of saline rather than decreasing concentrations

Question 23

An adult average sized patient received one bag of platelets obtained by apheresis. What is the expected rise in his platelet count?

5000 to 10,000/uL
15,000 to 25,000/uL
30,000 to 60,000/uL
80,000 to 100,000/uL

Answer 23

30,000 to 60,000/uL

Question 24

Viruses can invade host defenses by:

Maintaining a stable genetic identity

Inducing increased expression of MHC class I

Inducing increased expression of MCH class II

Hiding from the immune system in a latent state

Answer 24

Hiding from the immune system in a latent state

Question 25

In the western blot test for HIV antibody, a positive test result is indicated by the bands p24 and p55

Answer 25

False

Question 26

A complement fixation test for histoplasma antibodies shows a 1:32 titer. This means the patient is negative for histoplasma infection

Answer 26

False

Question 27

Serology is performed on a patient with a rash and fever. Results are rubella IgM = positive; rubella IgG = positive; measles IgM = negative; measles IgG = positive; varicella-zoster IgM = negative; varicella-zoster IgG= negative. What is the interpretation of these results?

Answer 27

Acute infection with rubella virus

Question 28

Which of the following serologic test results indicate that a patient is a chronic carrier of hepatitis B?

Answer 28

HbsAb negative; HBsAg positive for 12 months

Question 29

Pt has liver cancer and the result of PT and APTT was abnormally long. Which components should he receive

Recovered plasma, thaw
Cryo
Fresh WB
Thaw FFP

Answer 29

Thaw FFP

Question 30

A unit of leukoreduced red blood cells was drawn on December 1 in CPD and frozen by the high glycerol method on December 21. At what temperature is the unit stored and when does it expire?

Store at –18 C for ten years from the date frozen

Store at –65 C for ten years from the date drawn

Store at –65 C for ten years from the date frozen

Store at –65 C for ten years from the CPD expiration date

Answer 30

Store at –65 C for ten years from the date drawn

Question 31

A unit of red blood cells was washed prior to its being transfused with documented urticarial transfusion reactions. At what temperature and for what period of time can the washed cells be stored?

1 C to 6C for 24 hours
1 C to 10 C for 6 hours
20 C to 24 C for 24 hours
20 C to 24 C for 4 hours

Answer 31

1 C to 6C for 24 hours

Question 32

A child received a bone marrow transplant and soon had a fungal infection and required a granulocyte transfusion. After the granulocytes were obtained by apheresis, what manipulation and testing were done before the child could receive them?

Sickle cell negative and irradiated

HLA matched and leukoreduced

ABO and Rh matched and washed

Irradiated and crossmatched, unless collected by a method known to result in a component with less than 2 mL of red cells

Answer 32

Irradiated and crossmatched, unless collected by a method known to result in a component with less than 2 mL of red cells

Question 33

What is the disadvantage of choosing FFP over plasma protein fraction (PPF) for fluid replacement in persons?

FFP can transmit hepatitis and HIV, whereas PPP has been treated and there Is no documentation of its transmitting the aforementioned diseases

FFP lacks the labile coagulation factors; whereas, PPF has all coagulation factors

FFP is more likely to cause potassium toxicity than PPF

FFP contains only stable coagulation factors; whereas, PPF has the labile coagulation

Answer 33

FFP is more likely to cause potassium toxicity than PPF

Question 34

The doctor desired to raise the hemoglobin of his patient by 4 gm/dL. How many compatible units of red blood cells must be transfused to obtain this?

2 units
4 units
6 units
8 units

Answer 34

4 units

Question 35

The antibody screen on a unit of blood included which of the following phases of testing?

Only the 37 C to the AHG is required to detect IgG antibodies

Immediate spin, room temperature phases only are required to detect IgM antibodies

All phases of testing are required to detect every possible antibody present

Only the 37 C phase is required since this is body temperature

Answer 35

All phases of testing are required to detect every possible antibody present

Question 36

Thawed FFP Expiration

Answer 36

24 hours

Question 37

Thawed PF24 expiration

Answer 37

24 hours