Chapter 15 Flashcards
All of the following are characteristics of blood donations and transfusions that enable their extensive use for transplantation purposes except _____.
a. individuals can donate on a regular basis without any deleterious effects
b. erythrocytes do not express MHC class I or class II molecules
c. the blood components only need to function for a few weeks
d. only the ABO antigens need to be compatible between donor and recipient
e. blood transfusion is a straight forward and inexpensive process
d. only the ABO antigens need to be compatible between donor and recipient
In routine blood transfusions, which of the following must be matched correctly?
a. A and B antigens and Rhesus D antigen
b. O antigens
c. MHC class I molecules
d. MHC class II molecules
e. None of the above
a. A and B antigens and Rhesus D antigen
The underlying molecular basis for distinguishing blood-group antigens A, B and O is _____ at the erythrocyte surface.
a. the presence or absence of fucose in glycolipids
b. differences in the oligosaccharide attached to the lipid ceramide
c. structural polymorphisms in the Rhesus D antigen the levels of MHC class I and class II molecules.
d. differences in the peptide attached to the lipid ceramide
b. differences in the oligosaccharide attached to the lipid ceramide
_____ results from alloreactions mediated by donor T cells in the graft subsequent to hematopoietic stem-cell transplantation.
a. Acute rejection
b. Chronic rejection
c. Graft-versus-host disease (GVHD)
d. Serum sickness
e. Hyperacute rejection
c. Graft-versus-host disease (GVHD)
Alloantibodies to blood-vessel endothelium on solid organ grafts _____.
a. are specific for HLA class I and class II antigens
b. cause hyperacute rejection
c. cause acute rejection
d. target endothelium for attack by NK cells
e. are IgA and do not fix complement
b. cause hyperacute rejection
Which of the following is a permissible match between a blood donor and a recipient (donor: recipient)?
a. O - : AB +
b. O + : AB -
c. AB + : O -
d. A + : A -
e. AB - : O +
a. O - : AB +
The direct pathway of allorecognition involves interaction of _____, whereas the indirect pathway of alloreaction involves interaction of _____.
a. donor T cells with allogeneic HLA molecule on recipient dendritic cells; recipient T cells with allogeneic HLA molecules on donor dendritic cells
b. recipient T cells with allogeneic HLA molecules on donor dendritic cells; donor T cells with allogeneic HLA molecule on recipient dendritic cells
c. recipient T cells with allogeneic HLA molecules on donor dendritic cells; recipient T cells with peptides of allogeneic HLA molecules on recipient dendritic cells
d. recipient T cells with peptides of allogeneic HLA molecules on recipient dendritic cells; donor T cells with peptides of allogeneic HLA molecules on donor dendritic cells
c. recipient T cells with allogeneic HLA molecules on donor dendritic cells; recipient T cells with peptides of allogeneic HLA molecules on recipient dendritic cells
_____ is a monoclonal antibody administered to transplant patients before and after transplantation in order to induce lymphopenia.
a. Rabbit anti-thymocyte globulin (rATG)
b. Tacrolimus
c. Alemtuzumab
d. Belatacept
e. Basiliximab
c. Alemtuzumab
In the context of allogeneic transplantation, identify the mismatched pair.
a. inhibition of inflammation: prednisone
b. inhibition of co-stimulation: daclizumab
c. inhibition of cytokine signaling: basiliximab
d. inhibition of calcineurin: tacrolimus (FK506)
e. inhibition of T-cell proliferation: azathioprine
b. inhibition of co-stimulation: daclizumab
Hematopoietic stem cell transplantation is appropriate for all of the following conditions except _____.
a. thalassemia major
b. Wiskott-Aldrich syndrome
c. Fanconi anemia
d. cirrhosis of the liver
e. sickle-cell anemia
d. cirrhosis of the liver
_____ describes the process by which transplanted pluripotent stem cells find their way to the bone marrow spaces in the bones of the body and begin to produce new blood cells.
a. Myeloablation
b. Engraftment
c. Relapse
d. Graft-vesus-leukemia
e. Chemotherapy
b. Engraftment
The risk of _____ is the primary complication in bone marrow transplants.
a. acute host-versus-graft disease
b. hyperacute rejection
c. chronic rejection
d. acute graft-versus-host disease
e. cancer
d. acute graft-versus-host disease
_____ from a bone marrow transplant facilitate alloreactive responses, causing the condition defined as acute graft-versus-host disease.
a. Natural killer cells
b. Mature T cells
c. Dendritic cells
thymocytes
Mature B cells
b. Mature T cells
Autologous bone marrow transplantation used to treat cancer patients involves reinfusing a(n) _____-depleted stem-cell population into the patient after their cancer treatment has been completed.
a. mature T cell
b. antibody
c. tumor cell
d. dendritic cell
e. NK cell
c. tumor cell
Leukapheresis is used in hematopoietic stem-cell transplantation where stem cells from a suitable donor are fractionated on the basis of their expression of _____.
a. CD3
b. the same major histocompatibility antigens as the recipient
c. the same minor histocompatibility antigens as the recipient
d. the same inhibitory KIR receptors as the recipient
e. CD34
e. CD34
Males engrafted with HLA-identical bone marrow from their sisters develop graft-versus-host disease because _____.
a. T cells develop in the male thymus that are not tolerant to minor histocompatibility antigens expressed by the sister
b. mature T cells in the graft have specificity for male-specific minor histocompatibility antigens
c. there are differences between the sexes in how self proteins are modified post-translationally
d. NK-cell alloreactions occur
e. residual female hormones in the graft cause upregulation of HLA class I on male dendritic cells presenting minor histocompatibility antigens
b. mature T cells in the graft have specificity for male-specific minor histocompatibility antigens
Family members who donate their bone marrow to a transplant patient and who share one out of the two HLA haplotypes are providing a(n) _____ transplant.
a. autologous
b. HLA-matched
c. haploidentical
d. chimeric
e. cross-matched
c. haploidentical
George Cunningham was diagnosed with Crohn s disease when 23 years old. He was experiencing acute abdominal pain, diarrhea, rectal bleeding, anemia and weight loss. He did not respond to conventional immunosuppressive therapies and was given a course of infliximab, an anti-TNF-alpha monoclonal antibody that suppresses inflammation by blocking TNF-alpha activity. On day 12 after receiving his first infusion, he developed a mild fever, generalized vasculitis, swollen lymph glands, swollen joints and joint pain. Traces of blood and protein were detected in his urine. Which of the following is the most likely cause of these recent symptoms?
a. Type I hypersensitivity involving anaphylaxis.
b. Type II hypersensitivity leading to hemolytic anemia.
c. Type III hypersensitivity caused by immune complex deposition in blood vessels.
d. Type IV hypersensitivity involving CD8 T-cell cytotoxicity.
e. Type II hypersensitivity leading to thrombocytopenia
c. Type III hypersensitivity caused by immune complex deposition in blood vessels.
The term _____ is used to describe polymorphic antigens that vary between individuals of the same species.
a. xenoantigens
b. immunoantigens
c. alloantigens
d. Histoantigens
e. autoantigens
c. alloantigens
Graft-versus-host disease (GVHD) is a consequence of _____.
a. mature T lymphocytes from the donor mounting an immune response against tissue of the recipient
b. mature T lymphocytes from the recipient mounting an immune response against tissue of the donor
c. mismatching A, B, and O antigens between donor and recipient
d. mismatching Rhesus antigen between donor and recipient
e. antibodies of the donor stimulating NK cell antibody-dependent cell-mediated cytotoxicity (ADCC) of tissues of the recipient
a. mature T lymphocytes from the donor mounting an immune response against tissue of the recipient
Which of the following best explains why a bone marrow donor needs to be HLA-matched to the recipient?
a. The bone marrow transplant contains enough mature T cells to reconstitute the recipient and the recipient provides the antigen-presenting cells.
b. The recipient s MHC molecules mediate positive selection of thymocytes in the thymus that interact with donor-derived MHC molecules in the periphery.
c. Reconstituted T cells are restricted by donor, not recipient, HLA allotypes.
d. Without an HLA match, the donor-derived thymocytes undergo negative selection.
e. If the donor is not HLA matched, the reconstituted T cells will be autoreactive.
b. The recipient s MHC molecules mediate positive selection of thymocytes in the thymus that interact with donor-derived MHC molecules in the periphery.
Richard French, 53 years old, was diagnosed with chronic myelogenous leukemia. His elder brother Don is HLA-haploidentical and will donate bone marrow. The oncologist has recommended him to a medical center that favors using bone marrow depleted of mature T cells prior to infusion. The most likely rationale for employing the practice of T-cell depletion is that _____.
a. T-cell depletion will remove alloreactive T cells from the donor and prevent the potential for graft-versus-host disease (GVHD)
b. mature T-cell chimerism is required to establish long-term tolerance
c. because Don is HLA-haploidentical and male, there is no risk of alloreactivity toward major or minor histocompatibility antigens
d. because of Don s age, the expected bone marrow harvest is already marginal for successful engraftment, and depletion measures would compromise the yield of stem cells
e. the benefit of using a cocktail of immunosuppressive drugs outweighs the risk of contaminating the bone marrow during T-cell depletion
a. T-cell depletion will remove alloreactive T cells from the donor and prevent the potential for graft-versus-host disease (GVHD)
Forty-four-year old Danielle Bouvier is on the waiting list for a kidney transplant and is receiving weekly dialysis. Her HLA type is: HLA-A: 0101/0301; HLA-B: 0702/0801; HLA-DRB1: 0301/0701. Today, Danielle s physician informed her that several potential kidney donors are available. Which of the following would be the most suitable?
a. A: 0301/0201; B: 4402/0801; DRB1: 0301/0403
b. A: 0301/2902; B: 1801/0801; DRB1: 0301/0701
c. A: 2902/0201; B: 0702/0801; DRB1: 0301/13011
d. A: 0101/0101; B: 5701/0801; DRB1: 0701/0701
e. A: 0101/0301; B: 0702/5701; DRBA: 0403/0301
d. A: 0101/0101; B: 5701/0801; DRB1: 0701/0701
What type of hypersensitivity reaction would result from a mismatched blood transfusion?
a. Type I
b. Type II
c. Type III
d. Type IV
b. Type II
