Exam C

Question 1

Hemoglobin will increase _____ and hematocrit will increase _____ per unit of whole blood

Answer 1

1 g/dl
3%

Question 2

will see bruising on the extremities and bleeding gums and platelet count will be extremely low

Answer 2

Post transfusion purpura

Question 3

Transfusion-Associated Graft-Versus-Host Disease is caused by

T-cell lymphocytes derived from the donor blood

B-cell lymphocytes derived from the patient

T-cell lymphocytes derived from the patient

B-cell lymphocytes derived from the donor blood

Answer 3

T-cell lymphocytes derived from the donor blood

Question 4

A 22 year old women presents with easy bruising and fatigue. A complete blood count reveals hemoglobin 8 g/dL, hematocrit of 24%, WBC 15,000/uL, and a platelet count of 5,000/uL. The hematologist plans to perform a bone marrow transplant biopsy and aspiration. Which of the following components should be given?

Packed RBCs
Cryoprecipitate
Platelets
Fresh frozen plasma

Answer 4

Platelets

Question 5

For a massive transfusion what is the appropriate blood group for the packed cells, fresh frozen plasma and platelets?

O red blood cells, platelets and plasma

O red blood cells, AB platelets and any blood group of plasma

O red blood cells, AB plasma and any blood group of plasma

O red blood cells, AB plasma and platelets

Answer 5

O red blood cells, AB plasma and platelets

Question 6

A group O negative patient with anti-D needs platelets. He has become refractory to random donor platelets. Which of the following platelets should he receive?

Group O positive apheresed platelets, HLA “A” matched,

Group A negative apheresed platelets, HLA “C” matched

Group B negative apheresed platelets, HLA “B” matched

Group AB positive apheresed platelets, HLA “C” matched.

Answer 6

Group B negative apheresed platelets, HLA “B” matched

Question 7

When is antenatal Rh Immune Globulin given?
16 weeks
20 weeks
28 weeks
36 weeks

Answer 7

28 weeks

Question 8

What is the amount of platelets that should be in a bag of platelets obtained by apheresis procedures?

5.5 x 1010 /bag
80 to 120 /bag
3.3 x 1011/bag
150 / bag

Answer 8

3.3 x 1011/bag

Question 9

A Kleihauer-Betke (K-B) stain was done on a sample of blood from a pregnant woman who had been in a motor vehicle accident. The screen to detect a feto-maternal bleed was 4+ positive. All controls reacted as expected. The positive and negative control slides for the K-B stain, which were stained concurrently with the patient’s slide, were appropriately stained. The patient’s slide had all “ghost” cells. Choose from the following:

The eosin stain in the K-B stain procedure was too diluted.

The screen test was yielding false positives.

The woman was probably Rh positive.

The eluting solution in the K-B stain procedure was too acidic.

Answer 9

The woman was probably Rh positive.

Question 10

A 22 year old women presents with easy bruising and fatigue. A complete blood count reveals hemoglobin 8 g/dL, hematocrit of 24%, WBC 15,000/uL, and a platelet count of 5,000/uL. The hematologist plans to perform a bone marrow transplant biopsy and aspiration. If platelets are given to the patient, how many units should be given?

1 apheresis
2 apheresis
4 apheresis
6 apheresis

Answer 10

1 apheresis

Question 11

A massive transfusion protocol is initiated on a 45 year old male patient that is B negative and has a positive antibody screen. What is the appropriate blood group that should be given?

Group O
Group B
Group AB
Group A

Answer 11

Group B

Question 12

A 55 year old male is contemplating surgery for severe arthritis in the right hip. He has been approved to donate an autologous unit of blood for his surgery. Upon donation, only 390 mls of blood was drawn. What should be done with the blood?

Use it as whole blood

Make platelets only
Make fresh frozen plasma only

Make packed red blood cells only

Nothing, 390 mLs is sufficient

Answer 12

Make packed red blood cells only

Question 13

What is the immunologic of Rh immune globulin administration?

Anti-D attaches to Rh positive cells of the mother and these cells are subsequently removed by cells of the mothers reticuloendothelial system preventing sensitization of the mother

Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Anti-D attaches to Rh negative cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Anti-D crosses the placenta and attaches to Rh positive cells of the infant. The cells are subsequently removed by cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Answer 13

Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Question 14

Which of the following is one of the immediate procedures in the laboratory investigation of a transfusion reaction?

DAT on the post-transfusion sample

Repeat the crossmatch on the transfused unit using a post-sample

Measure the amount of free hemoglobin in the first voided sample

Repeat the antibody screen on the pre- and post- transfusion samples

Answer 14

DAT on the post-transfusion sample

Question 15

2. All of the following may occur following an Rh-mediated hemolytic transfusion reaction except:

elevated fever.
increased bilirubin.
intravascular hemolysis
positive DAT

Answer 15

intravascular hemolysis

Question 16

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?

Rh-positive
Rh-negative
Du-positive
Rh-variable

Answer 16

Rh-positive

Question 17

. 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?

The patient may have a hemolytic transfusion reaction from an allo immunized anti-D.

Anti-D is not immunogenic, and the patient probably would not have formed an anti-D.

Anti-D is not hemolytic, and even with the circulating antibody there would be no danger
to the patient.

The anti-D would activate complement, and a strong intravascular transfusion reaction
would occur.

Answer 17

The patient may have a hemolytic transfusion reaction from an allo immunized anti-D.

Question 18

Routine pre-transfusion testing consists of all of the following except:

ABO typing.
an antibody screen.
Rh typing
a DAT.

Answer 18

a DAT.

Question 19

A cord blood specimen from a jaundiced infant should be tested for which of the following?
a. ABO
b. Rh
c. DAT
d. All of the above

Answer 19

d. All of the above

Question 20

What is the physiological mechanism of Rh-immune globulin?

Attachment of fetal Rh-positive red blood cells in fetal circulation, inhibiting production of anti-D

Attachment of maternal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D

Attachment of fetal Rh-positive red blood cells in maternal circulation, inhibiting production of anti-D

Attachment of fetal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D

Answer 20

Attachment of fetal Rh-positive red blood cells in maternal circulation, inhibiting production of anti-D

Question 21

A 300-µg dose of Rh-immune globulin contains sufficient anti-D to protect against how much whole blood?
15 mL
30 mL
50 mL
100 mL

Answer 21

30 mL

Question 22

In order for the mother to be considered for Rh-immune globulin, her Rh type must be _________, and her newborn must be __________.

a. Du-positive/Rh-positive

b. Rh-negative/Rh-positive

c. Du-negative/Du-negative

d. Rh-positive/Rh-negative

Answer 22

b. Rh-negative/Rh-positive

Question 23

Due to a short supply of O-negative packed cells, an Rh-negative patient was transfused with 1 unit of Rh-positive red blood cells. Calculate the number of Rh-immune globulin vials needed to protect against 250 mL of Rh-positive packed cells.

a. 5
b. 17
c. 10
d. 23

Answer 23

17

Question 24

What is the most common clinical manifestation of ABO HDFN?

a. Severe anemia
b. Hyperbilirubinemia
c. Hyperkalemia
d. Hypotension

Answer 24

b. Hyperbilirubinemia

Question 25

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 anti-D.

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

Answer 25

c. The mother has not been immunized to the D antigen before placental separation

Question 26

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
b. 2
c. 3
d. 4

Answer 26

b. 2

Question 27

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

Answer 27

b. The chance of maternal sensitization to Rh antigen is decreased.

Question 28

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

Answer 28

b. Destruction of the fetus’s RBCs by antibody produced by the mother

Question 29

When is the antenatal dose of Rh-immune globulin given?
a. 20 weeks
b. 13 weeks
c. 28 weeks
d. 36 weeks

Answer 29

c. 28 weeks

Question 30

Rh-immune globulin should be given within how many hours after delivery?
a. 24
b. 48
c. 36
d. 72

Answer 30

72

Question 31

A postpartum woman was crossmatched for two units of leukoreduced 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 that the patient was developing red hives and pruritis. 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 from the plasma. All visual and clerical checks were satisfactory. The pathologist ordered the treatment of diphenhydramine for all subsequent transfusions. What type of transfusion reaction has occurred in this patient?

Urticarial
Anaphylactic
Alloimmunization
Febrile

Answer 31

Urticarial

Question 32

A multiparous patient received two units of platelets obtained by apheresis following open heart surgery. Within seven days her platelet count was 9000/mm3. Purpura was clearly evident on her body. All tests for coagulation factors were normal. Which of the following antibodies could cause this?

Anti-Bg(a)
Anti-A,B
Anti-Jk(a)
Anti-PLA1

Answer 32

Anti-PLA1

Question 33

A 16-year-old male goes to his physician for an annual checkup. A routine urinalysis indicates the presence of blood, an increase in protein and an increase in urea. The young man reports he has been feeling tired and has a persistent cough. The doctor orders additional laboratory testing, including a serum test for rheumatoid factor, antinuclear antibody testing, anti-streptolysin O testing, and testing for the presence of anti-basement membrane antibodies. Only the latter was positive. What disease is most likely the cause of the symptoms?

SLE
Goodpaster’s syndrome
MS
Rheumatoid arthritis

Answer 33

Goodpaster’s syndrome

Question 34

Which of the following is an indicator of acute immune hemolytic transfusion reaction?

Increased haptoglobin
Decreased LDH
Increased hemoglobin
Increased bilirubin

Answer 34

Increased bilirubin

Question 35

. A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except:

Acute non immune hemolytic transfusion reaction
Febrile nonhemolytic transfusion reaction
Acute immune hemolytic transfusion reaction
Transfusion-associated sepsis

Answer 35

Acute immune hemolytic transfusion reaction

Question 36

If a patient shows any adverse reaction while receiving a blood component, what is the first action that must be taken by the person overseeing the transfusion?

Notify the patients physician
Start an IV line to administer saline
Perform bedside clerical checks
Stop the transfusion

Answer 36

Stop the transfusion

Question 37

A newborn is in need of an exchange transfusion. Whole blood is not available; however, a reconstituted unit of blood can be prepared. How is this prepapred?

Combine leukoreduced red blood cells of the infants ABO and Rh type with thawed FFP of the same ABO type

Combine group O, Rh negative, leukoreduced red blood cells with group O thawed FFP

Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP

Combine group AB, Rh negative, leukoreduced red blood cells, less than 7 days old and CMV negative with group O FFP

Answer 37

Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP

Question 38

The D antigen is not detectable on platelets; therefore, why do some Rh negative people get Rh immune globulin when they are exposed to a unit of Rh positive platelets?

Units of platelets have numerous white blood cells which have the D antigen

Although the D antigen is not detectable, there is a G antigen on the platelets which has a D component

There are small numbers of red blood cells in the unit of platelets

Rh immune globulin is given prophylactically in case there is a lawsuit

Answer 38

There are small numbers of red blood cells in the unit of platelets

Question 39

A patient has a 2.0 mL feto-maternal whole blood bleed and meets all the criteria for receiving Rh immune globulin (RHIG). Her baby was born at 40 weeks gestation without any complications. How many vials of RHIG should the mother receive?

One vial
Two vials
One micro dose
None, the bleed is so small

Answer 39

One vial

Question 40

A group O patient started to receive a unit of group B packed RBCs. Within minutes he experienced fever, chills, hypotension and facial flushing. Ultimately, he went into shock and renal failure. What type of transfusion reaction is this?

Immediate HTR

Delayed HTR

Febrile nonhemolytic TR

Anaphylactic TR

Answer 40

Immediate HTR

Question 41

An Rh-negative mother delivered an Rh-positive baby. The mother’s antibody screen was negative, When is the latest that the mother should receive Rh immune globulin?

24 hours post-delivery

48 hours post delivery

72 hours post delivery

She’s not a candidate for RhIG

Answer 41

72 hours post delivery

Question 42

In cold autoimmune hemolytic anemia the antibody may show specificity. Which of the following could be the specificity?

Anti-e
Anti-Jk(a)
Anti-P
Anti-I

Answer 42

Anti-P

Question 43

A Keilhauer-Betke stain was performed on the sample from a mom. A negative control slide and a positive control slide were stained with it. Upon examination all of the cells on every slide were darkly stained with a bright pink color. What is the explanation for this?

The slides were not properly fixed with 80% ethanol

The eluting solution was not at the correct pH

The slides were not properly dried to the start of the staining procedure

The staining solution was too strong

Answer 43

The eluting solution was not at the correct pH

Question 44

An Rh negative mother was admitted to the labor room. As a part of the customary procedure, a type and screen was ordered. She was tested as group B, Rh negative and anti-D was identified in her serum. The titer of the anti-D was four. What is the source of the anti-D?

Previous pregnancy
Antenatal RhIG
Previously transfusion
Technical error

Answer 44

Antenatal RhIG

Question 45

If a patient’s cells are coated with cold antibodies and spontaneous agglutination is observed, what can be done to resolve the spontaneous agglutination of the patient’s own cells?

Place the patient’s cells with his own serum at 4C so that the serum will remove the antibody from the patient’s cells, then test the patient’s cells with commercial antisera

Enzyme treat the patients cells to remove the cold antibody that is coating them, then test them with commercial antisera

incubate the commercial antisera and the patients cells at 4C prior to centrifugation and reading the results

Prewarm the patient’s cells and the commercial antisera at 37 C prior to making them together in the tube, centrifuging and reading with caution

Answer 45

Prewarm the patient’s cells and the commercial antisera at 37 C prior to making them together in the tube, centrifuging and reading with caution

Question 46

A tech received a first voided urine sample after a transfusion reaction workup was ordered on a patient. What test should be done on this urine sample?

Examine it for free hemoglobin

examine it for intact RBCs

Test for hemosiderin

Test for myoglobin

Answer 46

Examine it for free hemoglobin

Question 47

What is needed for the detection of drug induced antibodies?

Group O red cells coated with the drug in question

Group B red cells treated with an enzyme

Commercially prepared panel cells

Commercially prepared A1 and B cells

Answer 47

Group O red cells coated with the drug in question

Question 48

An Rh negative mom miscarried at ten weeks gestation (first trimester). The antibody screen on her serum was negative at all phases. The Rh type could not be determined on the products of conception. How much Rh immune globulin should the mom receive?

One vial of RhIG containing 300 micrograms of anti-D

Two vials of RhIG containing 300 micrograms of anti-D

Perform a KBT to determine the amount of RhIG is needed

No RhIG is necessary

Answer 48

Perform a KBT to determine the amount of RhIG is needed

Question 49

What is Rh immune globulin?

300 micrograms of IgG anti-D

200 micrograms of IgM anti-D

300 micrograms of IgM anti-D

100 micrograms of IgG anti-D

Answer 49

300 micrograms of IgG anti-D

Question 50

A group O, Rh negative mom entered labor and delivery. Her type and screen was positive. The panel showed anti-D that was weakly positive (1+) at the AHG phase of testing. No prenatal records were readily available since she was visiting from another state. How can it be determined if the anti-D is passive or immune?

Titer the anti-D against R2R2 cells. If the titer is four or less, this is from Rh immune globulin

Test the anti-D against enzyme treated R2R2 cells. If the reaction is greater than 1+, this is immune anti-D

Titer the anti-D against its cell. If the result is positive, this is from Rh immune globulin

Titer the anti-D against the fathers cells. If the titer is greater than 64, this is Rh immune globulin

Answer 50

Titer the anti-D against R2R2 cells. If the titer is four or less, this is from Rh immune globulin

Question 51

It is documented on a patient’s chart that he has a pyrogenic transfusion reaction. The doctor has ordered the transfusion of a unit of platelets obtained by apheresis technology. How can the pyrogenic transfusion reaction be avoided?

Wash the platelets to remove the plasma and some of the leukocytes

Pretreat the patients with an antihistamine

Transfuse HLA matched platelets

Leukoreduce the plateletpheresis product

Answer 51

Leukoreduce the plateletpheresis product

Question 52

Unwashed red blood cells from a cord sample were ABO/Rh typed. Which of the following could be expected?

The cells would type as expected with the Rh control negative. No problems.

The cells would type negative with all reagents except the Rh control would be positive

The cells would be positive with all reagents including the Rh control

None of the above

Answer 52

The cells would be positive with all reagents including the Rh control

Question 53

What is the immunologic mechanism of Rh immune globulin administration?

Anti-D attaches to Rh positive cells of the mother and these cells are subsequently removed by cells of the mothers reticuloendothelial system preventing sensitization of the mother

Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Anti-D attaches to Rh negative cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Anti-D crosses the placenta and attaches to Rh positive cells of the infant. The cells are subsequently removed by cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Answer 53

Anti-D attaches to Rh positive cells of the infant in the maternal circulation. These cells are subsequently removed by the cells of the reticuloendothelial system of the mother preventing sensitization of the mother

Question 54

Which of the following is one of the immediate procedures in the laboratory investigation of a transfusion reaction?

DAT on the post-transfusion sample

Repeat the crossmatch on the transfused unit using a post-sample

Measure the amount of free hemoglobin in the first voided sample

Repeat the antibody screen on the pre- and post- transfusion samples

Answer 54

DAT on the post-transfusion sample

Question 55

If a patient shows any adverse reaction while receiving a blood component, what is the first action that must be taken by the person overseeing the transfusion?

Notify the patients physician

Start an IV line to administer saline

Perform bedside clerical checks

Stop the transfusion

Answer 55

Stop the transfusion

Question 56

A newborn is in need of an exchange transfusion. Whole blood is not available; however, a reconstituted unit of blood can be prepared. How is this prepapred?

Combine leukoreduced red blood cells of the infants ABO and Rh type with thawed FFP of the same ABO type

Combine group O, Rh negative, leukoreduced red blood cells with group O thawed FFP

Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP

Combine group AB, Rh negative, leukoreduced red blood cells, less than 7 days old and CMV negative with group O FFP

Answer 56

Combine group O, Rh negative, leukoreduced red blood cells, less than 7 days old, with Group AB thawed FFP

Question 57

How might a technologist detect a patient with drug induced hemolytic anemia?

A positive rosette test

Positive antibody screen

A positive DAT

An ABO discrepancy

Answer 57

A positive DAT

Question 58

A postpartum woman was crossmatched for two units of leukoreduced 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 that the patient was developing red hives and pruritis. 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 from the plasma. All visual and clerical checks were satisfactory. The pathologist ordered the treatment of diphenhydramine for all subsequent transfusions. What type of transfusion reaction has occurred in this patient?

Urticarial
Anaphylactic
Alloimmunization
Febrile

Answer 58

Urticarial

Question 59

A multiparous patient received two units of platelets obtained by apheresis following open heart surgery. Within seven days her platelet count was 9000/mm3. Purpura was clearly evident on her body. All tests for coagulation factors were normal. Which of the following antibodies could cause this?

Anti-Bg(a)
Anti-A,B
Anti-Jk(a)
Anti-PLA1

Answer 59

Anti-PLA1

Question 60

The clinical picture of transfusion related acute lung injury (TRALI) is similar to adult respiratory distress syndrome (ARDS). In TRALI the mechanisms for the lung injury are

Leukocyte antibodies in donor plasma or in patient plasma

Platelet antibodies in the patients plasma

Red blood cell antibodies in the donors plasma

Antibodies to thee lung tissue in the donors plasma

Answer 60

Leukocyte antibodies in donor plasma or in patient plasma

Question 61

The following cell typing and serum typing results were obtained on a cord blood from a child to a group AB mom with a negative antibody screen.

Report the newborns blood type as group O

Wash the cells and repeat the cell typing. Wharton’s jelly may be interfering

Perform a DAT on the cells to determine if an elution is needed

Repeat a heel stick on the newborn and repeat the test

Answer 61

Wash the cells and repeat the cell typing. Wharton’s jelly may be interfering

Question 62

There are two processes by which the body can dispose of sensitized red blood cells: intravascular and extravascular. Choose the correct answer below

Both processes begin with the formation of an immune complex on the red blood cell membrane. Extravascular cell destruction causes the release of hemoglobin, RBC stomata and intracellular enzymes.
Intravascular destruction does not cause lysis of red blood cells.

Intravascular destruction can result in damage to the sclera of the glomerulus, cortex, and tubules of the kidney and damage to the hepatic ports and hepatocytes.
Extravascular destruction only affects the liver

Intravascular destruction results in hematuria and extravascular destruction results in complement coated RBCs

An immune complex binds to the red blood cell membrane in intravascular destruction; however, the complex does not bind to the membrane in extravascular destruction

Answer 62

Intravascular destruction can result in damage to the sclera of the glomerulus, cortex, and tubules of the kidney and damage to the hepatic ports and hepatocytes.
Extravascular destruction only affects the liver

Question 63

The fetal screen test using a rosetting technique is used to detect feto-maternal bleeds. Choose the correct answer below.

The test uses chemically modified anti-D for the purpose of spanning the distance between Rh(D) positive cells

The test can only be used if the mother is Rh(D) positive and the baby is Rh(D) negative

The mothers cells must be treated with enzyme to enhance the Rh(D) antigen

Because the anti-D is a low protein product, the test can be done at immediate spin without a 37 to AHG phase

Answer 63

The test uses chemically modified anti-D for the purpose of spanning the distance between Rh(D) positive cells