Exam C Flashcards by Erin Polley

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

1 g/dl
3%

How well did you know this?

Not at all

Perfectly

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

Post transfusion purpura

How well did you know this?

Not at all

Perfectly

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

T-cell lymphocytes derived from the donor blood

How well did you know this?

Not at all

Perfectly

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

Platelets

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

Group B negative apheresed platelets, HLA “B” matched

How well did you know this?

Not at all

Perfectly

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

28 weeks

How well did you know this?

Not at all

Perfectly

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

3.3 x 1011/bag

How well did you know this?

Not at all

Perfectly

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.

The woman was probably Rh positive.

How well did you know this?

Not at all

Perfectly

1 apheresis
2 apheresis
4 apheresis
6 apheresis

1 apheresis

How well did you know this?

Not at all

Perfectly

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

Group B

How well did you know this?

Not at all

Perfectly

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

Make packed red blood cells only

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

DAT on the post-transfusion sample

How well did you know this?

Not at all

Perfectly

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

elevated fever.
increased bilirubin.
intravascular hemolysis
positive DAT

intravascular hemolysis

How well did you know this?

Not at all

Perfectly

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

Rh-positive

How well did you know this?

Not at all

Perfectly

. 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.

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

How well did you know this?

Not at all

Perfectly

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

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

a DAT.

How well did you know this?

Not at all

Perfectly

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

d. All of the above

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

30 mL

How well did you know this?

Not at all

Perfectly

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

b. Rh-negative/Rh-positive

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is the most common clinical manifestation of ABO HDFN?

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

b. Hyperbilirubinemia

How well did you know this?

Not at all

Perfectly

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

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

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

b. 2

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

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

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

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

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

c. 28 weeks

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

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

Urticarial

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

Anti-PLA1

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

Goodpaster's syndrome

Which of the following is an indicator of acute immune hemolytic transfusion reaction? Increased haptoglobin Decreased LDH Increased hemoglobin Increased bilirubin

Increased bilirubin

. 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

Acute immune hemolytic transfusion reaction

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

Stop the transfusion

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

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

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

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

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

One vial

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

Immediate HTR

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

72 hours post delivery

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

Anti-P

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

The eluting solution was not at the correct pH

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

Antenatal RhIG

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

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

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

Examine it for free hemoglobin

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

Group O red cells coated with the drug in question

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

Perform a KBT to determine the amount of RhIG is needed

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

300 micrograms of IgG anti-D

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

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

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

Leukoreduce the plateletpheresis product

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

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

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

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

DAT on the post-transfusion sample

Stop the transfusion

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

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

A positive DAT

Urticarial

Anti-PLA1

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

Leukocyte antibodies in donor plasma or in patient plasma

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

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

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

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

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

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