TGO2 May 2025

Question 1

Compassion

Answer 1

• Kindness
• Empathy
• Sympathy
• Concern
  Help others without judgement or expectation

Question 2

Excellence

Answer 2

• Dependable
• Accurate
  Exceed client’s expectation

Question 3

Accountable

Answer 3

• Reliable (do what we say we’ll do)
  Work efficiently individually to work towards shared goals

Question 4

Respect

Answer 4

• Polite
• Careful
  Accept and embrace our differences

Question 5

Integrity

Answer 5

• Consistent
• Honest
  Own your mistakes and successes

Question 6

Transfusion Reaction: Fever

Answer 6

• Acute haemolytic (ABO incompatible)
• Bacterial contamination
• Febrile non-haemolytic (cytokine release from donor WBC)
• TRALI

Question 7

Transfusion Reaction: Short of Breath

Answer 7

• Anaphylaxis
• Bacterial contamination
• TACO
• TRALI
• Acute haemolytic transfusion reaction

Question 8

Transfusion Reaction: Rash/Itch

Answer 8

• Minor allergic reaction
• Anaphylaxis

Question 9

Transfusion Reaction: Hypotension

Answer 9

• Bacterial Contamination
• Acute haemolytic transfusion reaction
• Anaphylaxis

Question 10

Transfusion Reaction: Hypertension

Answer 10

• Circulatory Overload

Question 11

Transfusion Reaction: Tachycardia

Answer 11

• Bacterial Contamination

Question 12

Not all antibodies can be excluded on a complex ABID. How would you provide blood for that patient?

Answer 12

1. Phenotype the units as negative for the antigens unable to be excluded
2. In conjunction with senior scientist/haematologist, explore provision “most suitable” phenotyped blood

Question 13

A patient has a complex ABID and ARCBS can’t find pheno matched units. How would you provide blood for them?

Answer 13

1. See if we have blood suitable for them at other sites, including private pathology providers
2. See if there are any units assigned to other patients who may be able to share for the time being
3. With senior scientist/haematologist approval, drop phenotype requirements to see if we can find blood that may be incompatible and issue least reactive.

Question 14

Screen + panel = positive, but they are few, weak reactions. How would you continue?

Answer 14

Consider changing the phase to enhance reactivity (enzyme enhancement, PEG, room temperature)

Could also be an HLA reactor; if all clinically significant antibodies are excluded refer to senior scientist.

Question 15

Screen + panel = non-specific panagglutination. How would you continue?

Answer 15

1. Warm auto
   * DAT would be up, Elution would show panagglutination, adsorb to ensure no underlying alloantibodies
2. Additive
   * Change phase; glass for gel card, no potentiator (NISS), change cells or wash and resuspend with a neutral red cell diluent
3. Drug interference (mAb)
   * Test with DTT treated cells, check with nurse for clinical information
4. Multiple antibodies
   * Consider differentiation with different testing phases (RT, Enz)
5. High incidence antibodies
   * Try to find negative red cells for testing, or consider neutralisation or adsorption if the protocol is supported

Question 16

A patient has a history of [RhK, Fy, Jk, Ss] antibody. Do you need to serologically crossmatch?

Answer 16

Yes, whether reactive or not. Also phenotype the unit as negative.

Question 17

A patient has a history of [M, N, Lea, Leb, P1]. Do you need to serologically crossmatch?

Answer 17

Only if currently reactive.

Provision of Rx- typed units is best practice, but random units are fine.

Question 18

A patient has a history of a low incidence antigen [Cob, Kpa, Lua, Wra, Cw]. Do you need to serologically crossmatch?

Answer 18

Yes.

Question 19

A patient has a history of A1 antibody. Do you need to serologically crossmatch?

Answer 19

Only if currently reactive at 37*C.

Question 20

A patient has a history of HTLA antibodies. Do you need to serologically crossmatch?

Answer 20

Yes. Phenotype matched if currently reactive.

Question 21

A patient has a history of anti-HI. Do you need to serologically crossmatch?

Answer 21

Only if its currently reactive. Technically only if A1 or A1B but I would probably err on the side of caution if its not urgent and serocrossmatch for A2 and B.

Question 22

What blood group do you select for a patient with anti-A1 antibodies reactive at 37*C?

Answer 22

Group O can be given to everyone.
Group A2 can be given to A/AB patients.
Group B can be given to AB patients.

Question 23

What’s the difference between a Quality Control program and a Quality Assurance program.

Answer 23

QC = TER
T echniques,
E quipment,
R eagents are in working order.

QA = accuracy
T echniques,
E quipment and
K nowledge is sufficient to ensure accurate results.

Question 24

How do you ensure attention to detail?

Answer 24

• Only work on one specimen at a time.
• If interrupted, start again.
• Ensure QC is read first ahead of patients (e.g. phenotyping)
• Do not trust your memory. Write down every well/test tube is read.

Question 25

Blood is requested for a patient who has antibodies

Answer 25

- Assess degree of urgency - What stage is the G+H at? Is it running, can they wait for .sero? - Do we have blood on hand for them? Do they have additional requirements that may complicate e.g. irradiated - Ask for location of patient, doctor requesting units, whether the doctor is willing to accept the risk of uncrossmatched - If so, choose Rx- for clinically significant antibodies and keep unit segments for retrospective crossmatching/phenotyping

Question 26

Reverse group anomalies (up)

Answer 26

1. Cold reacting alloantibody - Prove antibody is present - Run at strictly 37* - If possible, run a different reverse cell phenotyped negative for that antibody (e.g. donor unit) 2. Cold reacting autoantbody - Strictly 37 3. ABO subgroup - Prove the subgroup through phenotyping or referral to red cross 4. Rouleaux - Saline replacement/dispersal 5. Bone Marrow - Check history. 6. Drug interference - Are they on magrolimab?

Question 27

What is the most important test in blood bank?

Answer 27

Blood group. - ABO/D is the most immunogenic, can cause acute haemolytic reactions. Other antibodies can cause delayed reactions that can be managed clinically. - Sometimes a patient may not have a positive screen: chemo or old age reduces antibody reactivity.

Question 28

You're experiencing a blood shortage. How do you tackle the situation?

Answer 28

- Prioritise trauma patients - Relay information to manager/hospital and ward - Manage hospital/ward expectations (Tx/or surgeries might be rescheduled or told no) - Convert patients to iron infusions where possible Is it local (RAH? SA? Australia?) Is it one blood type or all? What is the ETA on the next delivery? - Are you low because you had multiple traumas depleting your O stock but FMC/Clinpath are fine or are you low because ARCBS Melbourne exploded

Question 29

Do you understand the role? What can you offer/add to it?

Answer 29

- The role is quite similar to one I backfilled for 2 years prior to taking on my current position. Specimen reception duties - Customer service - Triaging and logging specimens for testing - Issuing/dispatching blood within and external to the hospital Automated and manual processing of specimens - Identification of routine and complex and atypical antibodies - Receipt of complex ID from other locations within the company and from private companies - I have experience across BioVue, BioRad and manual techniques as well as complex testing methods from my time on the reference bench such as alloabsorption and complex patient pictures including BMT and multiple concurrent antibodies I have 4 years at a regional location, so experience with the remote aspect of ABID and blood stock management, as well as experience in the 2 largest trauma hospitals in South Australia. Beyond that, I have a systematic and proactive approach to my work.

Question 30

Tell us about a time when you anticipated the future and ammended operations to meet future needs?

Answer 30

Multidisciplinary - Could see the results before the doctors - Low PLT or Hb make sure you have enough/place an order with red cross/ask Wollongong Public if they could loan us some - Potentially even call another staff member for help before the doctor/nurse called for an MTP; in Wollongong the security guard for the hospital sometimes took the car over to the public hospital to get us stock

Question 31

Can you think of a difficult clinical situation you had to face and how you tackled it?

Answer 31

Amira Soliman - Patient with multiple Abs, ARCBS couldn't provide blood - Deteriorated, required urgent surgery - All her blood was in one tray with her name on it, but it varied between "compatible", "most suitable" and "least incompatible" - Drawing from experience at another hospital, I separated them into trays, so that we could clearly identify which order we draw from - I also familiarised myself with her case and her transfusion protocol, as it was something I'd never experienced in my experience today. 5 Ps: Prior planning prevents poor performance.

Question 32

Can you give an example of a time where you were faced with a decision with no clear solution?

Answer 32

- ED patient with multiple antibodies, requirement for phenotype specific - Tx dependent outpatient booked for 8 hours from now who matched ED patients phenotype, but had a history of non-compliance - I took the outpatients blood for the ED patient, ordered ASAP to replace and the outpatient had to reschedule. - I had to consider both Hb and clinical picture, whether other locations could help with assisting with provision of blood and whether disadvantaging the outpatient could affect care

Question 33

Tell me about a situation in which you had to adjust to changes over which you had no control. How did you handle it?

Answer 33

Working during an LIS communication outage (not quite downtime) - Triage specimens - Notify wards of delay - Do what you can, leave what you can't and try not to let it get to you.

Question 34

How do you deal with pressure?

Answer 34

Assess the situation Ask for help where needed Be realistic with yourself and others

Question 35

How do you deal with stressful situations?

Answer 35

Stress management on shift and outside of work helps prevent carrying it over to future shifts/taking it home with you AT WORK - I triage the most time critical work - I chip away at it bit by bit - I ask for help where necessary - Regular breaks to return refreshed; I like to listen to podcasts on my break. OUTSIDE OF WORK - Bingewatch TV (e.g. Ted Lasso) - Bushwalks (Belair) - Home improvements

Question 36

Would you consider yourself a good communicator?

Answer 36

Yes - I try to understand my audience and adapt my communication to convey the message e.g. - A clinician calling in a critical situation needs confident, concise responses - Large handover for next shift might not be able to take a lot of information on, so a stickynote will relay - A phone call from another site might need calm, patient explanation to work through and troubleshoot a situation together

Question 37

Tell us about a work error you felt guilty about at your current or former worklace?

Answer 37

Dara Patient - Busy shift, I issued blood that didn't meet 100% of their transfusion requirements (only RhK) - I realised hours later, after hours so didn't do anything - Next shift I saw that the patient had a transfusion reaction implicated to that unit - I couldn't speak with my line manager about it that day, I panicked and stressed myself sick. I did speak with them at the next convenience though and we spoke it over, they encouraged me to talk to them ASAP if anything like that happened again and I refamiliarised myself with the protocol

Question 38

How would you handle multiple people giving you tasks at the same time?

Answer 38

- Be honest with them; let them know that you have a lot on their plate. - Help set their expectations to avoid disappointment. - If I really didn’t think I could do it , I would let them know so that they make other arrangements.

Question 39

Give an example of how you have successfully managed conflict in a professional context. How did you work through issues, what was the outcome? Would you take the same approach now?

Answer 39

Raj - Demanding haematologist - I built a rapport with him, by learning to anticipate his expectations provide clear communication - Outcome was that Kathys mother received good care - Would I do it again? Yeah probably

Question 40

What does team work mean to you/how important is teamwork

Answer 40

-Recognising and valuing the skills each person brings - Collaboration with one another (maybe another department) - Morale is a big factor in quality teamwork, productivity - Best way to good morale is to get along with your team

Question 41

How do you handle conflicts with a coworker

Answer 41

- Talk to the other person - Listen to what they have to say - Identify points of agreement/disagreement - Develop a plan to work on each area of conflict Try to understand others perspective, not everyone thinks the same as you or interprets situation. Big step to avoiding conflict.