Blood Bank Exam 2

Question 1

Which of the following antigens is part of an antithetical pair?

a. P1
b. D
c. M
d. Leb

Answer 1

c. M

Question 2

Some blood group antibodies may react stronger with the red cells of individuals who inherited 2 identical alleles for the antigen. This phenomenon is known as:

a. post zone affect
b. dosage affect
c. prozone affect
d. equivalence affect

Answer 2

b. dosage affect

Question 3

Kell is an antigen attached to the cell by a cysteine bond which makes it

a. Susceptible to DTT treatment
b. Susceptible to papain treatment
c. Susceptible to ficin treatment
d. Resistent to all chemical and enzymatic treatment

Answer 3

a. Susceptible to DTT treatment

Question 4

Match the following neutralizing substances with their antibody:

HYDATID CYST FLUID

a. P
b. Chido/Rodgers
c. I
d. Lewis

Answer 4

a. P

Question 5

Match the following neutralizing substances with their antibody:

Breast Milk

a. P
b. Chido/Rodgers
c. I
d. Lewis

Answer 5

c. I

Question 6

Match the following neutralizing substances with their antibody:

Normal Human Plasma

a. P
b. Chido/Rodgers
c. I
d. Lewis

Answer 6

b. Chido/Rodgers

Question 7

Match the following neutralizing substances with their antibody:

Saliva

a. P
b. Chido/Rodgers
c. I
d. Lewis

Answer 7

d. Lewis

Question 8

Which phenotype is heterozygous?

a. M+N-S-s-
b. K-k+
c. Fya (a-b+)
d. Js(a+b+)

Answer 8

d. Js(a+b+)

Question 9

Though Diego antigens are not listed on the antigram, they are considered clinically significant for HDN and HTR. Why are you unlikely to encounter them?

a. antigens are high incidence/low incidence
b. there is no test for them
c. they are chemical and enzyme resistant
d. they are imaginary

Answer 9

a. antigens are high incidence/low incidence

Question 10

(Choose all that apply) Which of the following antigens is NOT significantly different (<20% different) in frequency between Caucasian and black populations?

Fyb
Jsa
N
e

Answer 10

N and e

Question 11

If your patient has a history of anti-Lua and a current negative antibody screen, how many units would you need to crossmatch to find compatible unit?

a. 1
b. 10
c. 15
d. 20

Answer 11

a. 1

Question 12

The physician has requested 3 units of RBCs for patient DB who has two antibodies, anti-K and anti-Jka. The frequency of K in the donor population is 9%. The frequency of Jka in donor population is 77%. How many units will need to be antigen typed for K and Jka to fill the request?

a. 2
b. 5
c. 10
d. 15

Answer 12

d. 15

Question 13

If your facility has a rule of ordering rather than testing antigen negative blood for antibody combinations compatible with less than 20% of the population, what is the maximum number of units you would statistically be expected to phenotype in your facility for a single unit for a single patient?

a. 2
b. 5
c. 10
d. 15

Answer 13

b. 5 ( 100/20 = 5 bc it already says compatible)

Question 14

Given the rule mentioned above (testing for antigens that have compatibility with greater than 20% of the population only) which antisera would routinely be maintained in house?

a. anti-K
b. anti-Jka
c. anti-s
d. anti- e

Answer 14

b. anti-Jka

Question 15

The first antigen group assigned to a specific chromosome was the Duffy group. Which other antigen group shares this chromosome?

a. Rh
b. P
c. Glob
d. Kell

Answer 15

a. Rh

Question 16

The genes of antigen systems typically either transcribe a product that is intrinsic to the red cell membrane or a transferase that builds a carbohydrate chain on the cellular surface. Which of the following antigens systems are created by transferase?

a. lutheran
b. duffy
c. MNS
d. P/Glob

Answer 16

d. P/Glob

Question 17

Which antibody activity is enhanced by enzymatic treatment of panel cells?

a. Jka
b. Jsa
c. Fya
d. Lua

Answer 17

a. Jka

Question 18

How would you use serology to differentiate between anti-e and anti-s?

a. e reacts with more cells on the antigram than s
b. e is warm acting while s is cold acting
c. e fixes compliment while s does not
d. e is enhanced by enzymes where s is destroyed by enzymes

Answer 18

d. e is enhanced by enzymes where s is destroyed by enzymes

Question 19

Name the FALSE statement regarding antibodies in the Kidd system

a. they fix compliment
b. they are IgG
c. They do NOT cause HDn or transfusion reaction
d. they are notorious for disappearing

Answer 19

c. They do NOT cause HDN or transfusion reaction

Question 20

Antibodies of which blood group are typically NOT known to interfere in reverse typing?

a. P
b. MNS
c. I
d. Kell

Answer 20

d. Kell

Question 21

Which of the following is generally detected at the antiglobulin phase of testing?

a. anti-Fya
b. anti-P1
c. anti-M
d. anti-I

Answer 21

a. anti-Fya

Question 22

Antibodies of which blood group are typically known to cause hemolytic transfusion reaction but NOT severe HDN?

a. Kell
b. Rh
c. ABO
d. Lewis

Answer 22

c. ABO

Question 23

Which antigen is STRONGLY expressed at birth?

a. K
b. Lub
c. A
d. I

Answer 23

a. K

Question 24

Which characteristics are true of ALL THREE of the following antibodies: anti-K, anti-Fya, and anti-Jka

a. detected at IAT but not known to cause HDN or transfusion reaction
b. may demonstrate dosage and cause HDN
c. not detected with enzyme treated cells, may cause delayed transfusion reactions
d. detectible at RT and causes hemolytic transfusion reaction

Answer 24

b. may demonstrate dosage and cause HDN

Question 25

Which of the following antibodies are known to fix compliment?

a. anti-Jka
b. anti-Kpa
c. anti- Leb
d. anti-P1

Answer 25

a. anti-Jka

Question 26

Patients that are serologically type as Jk(a-b-) make cells that:

a. are resistant to P. vivax
b. are stomatocytes
c. are acanthocytes
d. are resistant to lysis in 2M urea

Answer 26

d. are resistant to lysis in 2M urea

Question 27

Nulls of which blood group provide protection from plasmodium vivax?

a. P
b. MNS
c. Duffy
d. Kidd

Answer 27

c. Duffy

Question 28

If you had an antibody demonstrating unexplained mixed field reactivity, which antibody do you suspect?

a. anti-s
b. anti-fab
c. anti-N
d. anti-Lua

Answer 28

d. anti-Lua

Question 29

A patient has this phenotype: Fy(a+b-) M+ N+ S+ s- R1R2, which antibody is NOT ruled out as a potential alloantibody?

a. anti-U
b. anti- K
c. anti-c
d. anti-s

Answer 29

d. anti-s

Question 30

An AB positive patient with a negative antibody screen that was transfused five days ago is collected today for a new type and screen because the hemoglobin did not increase as much as the physicians wanted after transfusion. The new type and screen specimen appears to be hemolyses, recollection of the sample is not any better. You preform a DAT and find that the patient has compliment mediated hemolysis and the antibody screen is now positive in the AHG phase. Which antibody do you suspect you will identify?

a. anti-Lua
b. anti-Jkb
c. anti-K
d. anti-P1

Answer 30

b. anti-Jkb

Question 31

The Rh system demonstrates population disequilibrium with the interference of certain genes together more often than mendelian genetics would calculate. Which other antigen group demonstrates this phenomenon?

a. MNS
b. Kidd
c. Duffy
d. P

Answer 31

a. MNS

Question 32

MN and Ss are similar in all of the following ways except:

a. their genes are on the same chromosome
b. they are both glycophorin chains
c. they are susceptible to enzyme treatment
d. their antibodies prefer colder temperatures

Answer 32

d. their antibodies prefer colder temperatures

Question 33

Being on chromosome 19, the lutheran genes have been shown to be autosomally linked to all of the following EXCEPT:

a. P
b. Se
c. H
d. Le

Answer 33

a. P

Question 34

Which of the following antigens appear on the antigram but does not need to be ruled out unless suspected because it is low incidence?

a. K
b. Kpa
c. Ina
d. Xga

Answer 34

b. Kpa

Question 35

Which pair of antithetical antigens is considered to be a low incidence/high incidence pair?

a. Jka/Jkb
b. Lea/Leb
c. K/k
d. M/N

Answer 35

c. K/k

Question 36

TRUE or FALSE. A rule out is counted when an antigen is not present on a cell reactive when tested with patient plasma

Answer 36

FALSE

Question 37

In which of the following procedures would a positive agglutination reaction complete your workup?

a. Rule in
b. Rule out
c. Phenotype testing of a donor cell
d. Phenotype testing of a patient cell

Answer 37

a. Rule in

Question 38

Anti-Ch is considered to be high titer low avidity (HTLA) antibody. This antibody serologically tests as:

a. reactive strongly after multiple dilutions
b. reactive weakly after multiple dilutions
c. reactive strongly but disappears after a few dilutions
d. reactive weakly and then disappears after a few dilutions

Answer 38

b. reactive weakly after multiple dilutions

Question 39

Utilizing the provided antigram for Mary Poppins, which clinically significant antibodies do not have at least one rule out?

anti-P1
anti-E
anti-M
anti-K

Answer 39

anti-M & anti-K

Question 40

Utilizing the antigram for Mary Poppins: assuming only one antibody is present in the patient serum, what activity is the antibody demonstrating?

a. enzyme resistance
b. dosage
c. low incidence
d. compliment activation

Answer 40

b. dosage

• (the weaker reactions are occurring on cells that are heterozygous for the antigen)

Question 41

Utilize the panel for Mary Poppins to answer the following question: What does the auto control result mean?

a. the patient results are invalid
b. the patient has likely been transfused within the previous month
c. the antibody identified is an autoantibody
d. there is more than one antibody acting

Answer 41

b. the patient has likely been transfused within the previous month

• (MF reaction indicates the presence of two cell lines which would be perfectly reasonable for a patient who has been transfused. The patient cells are in the sample as well as the transfused cells)

Question 42

Check all that apply: Using the Mary Poppins antigram to answer the following question: What additional steps need to be taken in order to complete the workup?

• rule out anti-K
• rule out anti-M
• phenotype the patient for the suspected antigen(s)
  -investigate the positive auto control

Answer 42

• rule out anti-K
  -investigate the positive auto control

Question 43

Utilizing the antigram for Mary Poppins: Which antibody is most likely acting in the patient’s serum?

a. anti-M
b. anti-K
c. anti-S
d. anti- Leb

Answer 43

a. anti-M

Question 44

Utilizing the Mary Poppins: The physical wants 1 unit on hold for Mary Poppins. Statistically, how many units would you expect to phenotype to find compatible blood?

a. 1
b. 3
c. 7
d. 5

Answer 44

c. 5
M frequency: 78-80%
100 - 80= 20%. 20/100 = 1/5

Question 45

Which two cells on the antigram would you choose for a positive and negative control for M phenotyping?

a. 12 & 13
b. 13 & 17
c. 13 & 15
d. 12 & 15

Answer 45

a. 12 & 13

(a cell that is positive for M antigen heterozygously should be used for positive control. A cell that is negative for the M antigen should be used as the negative control)