Blood Bank2

You answered the question correctly.
Based on the phenotype of the RBC screening cells, and patient results shown on the
right, which of the following antibodies CANNOT be ruled out?
The correct answers are highlighted below
Anti-C
Anti-Jka
Anti-M
Anti-Fya
Feedback
Rule-out is a process by which antibodies are identified as being unlikely in a given

sample because of the absence of an expected antigen-antibody reaction. In other
words, the absence of a reaction is noted with a cell that is positive for the
corresponding antigen.
Although rule-out procedures may vary somewhat from institution to institution, the
following general principles apply:
1. Non-reactive cells are selected for rule-out. To be classified as non-reactive, a

cell must NOT have reacted at any phase of testing in a given panel or screen.
2. Using the logic that if the rule-out cell is positive for a given antigen, it should
have reacted with the corresponding antibody, you can rule-out antibodies that
correspond to antigen positive cells.
3. To increase the probability that rule-out will not mistakenly eliminate a
weakly-reacting antibody that exhibits dosage*, use only cells that are
homozygous for the corresponding antigen for those systems that generally
show dosage. Generally these include: C, c, E, e, Fya, Fyb, Jka, Jkb, M, N, S,
and s.
In this case, it is only possible to rule out on screening cell 2 since it demonstrates a
negative reaction with the patient serum. Anti-C cannot be ruled out since the C
antigen is heterozygous on screening cell 2 with c. Anti-Fya cannot be ruled out since
this antigen is not present on screening cell 2. Anti-M and anti-Jka can be ruled out
since the antigens are homozyous while demonstrating a negative reaction on
screening cell 2.
Rule-out, while very useful, can lead to error. Ruling out an antibody should be
combined with other supporting data to increase confidence in the solution; the more
data collected, the higher the probability that the final solution is correct.
*Dosage means that there are two "doses" of the same antigen present on the red cells
. Antibodies that exhibit dosage react more strongly with homozygous cells (e.g., Jka
Jka) than with heterozygous cells (e.g., Jka Jkb) .
Question Difficulty: Level 7
You answered the question incorrectly.
The proper storage requirements for granulocyte concentrates is:
The correct answer is highlighted below
1 - 6 degrees Celsius, < 12 hours

- 20 degrees Celsius, 48 hours
Feedback
Granulocytes may be stored at 20-24 degrees Celsius for up to 24 hours, but should be
transfused as soon as possible.
The most definite indication that a patient has been sensitized to a specific red cell
antigen is:
Hives and rash

A positive posttransfusion DAT in a patient with a previously negative DAT
A positive posttransfusion DAT in a patient with a previously positive DAT
Hemoglobinuria
Feedback
Hives and rash usually indicate an allergic reaction. Hematuria is due to a variety of
causes. Fever and chills usually indicate a febrile reaction. Positive DAT due to
conditions other than sensitization to red cell alloantigens is not uncommon.
Therefore a positive DAT in the posttransfusion specimen with a negative DAT in the
pretransfusion specimen is more likely to indicate alloimmunization.
A patient has a probable anti-Fya but anti-c and anti-K have not been excluded. Which
of the following cells would be the one most useful cell to exclude both anti-c and
anti-K efficiently in this patient?
Fya-; Fyb+; C+c+; K+k+

Fya-; Fyb+; C-c+; K+k-
Fya-; Fyb+; C+c+; K+k-
Fya+; Fyb-; C-c+; K+k-
Feedback
The ideal red cell to exclude both antibodies efficiently is one that is Fy(a-) and
homozygous positive for both c and K: Fy(a-b+)C-c+K+k-
The other red cells exclude only anti-c or anti-K (not both) or are Fy(a+).
Below is a listing of two commonly used terminology systems for genes and antigens.
Use this information to answer this question:
If a recipient has anti-c, which donor unit should be selected?
Wiener Fisher-Race (haplotype)
Ro Dce
R1 DCe
R2 DcE
R DCE
r dce
r dCe
r dcE
ry dCE
r'r
RoR1
R2ry
r'ry
RoRo
Feedback
It is necessary to convert Wiener system shorthand nomenclature to Fisher-Race

nomenclature in order to make this determination.
We can also combine the designations into genotypes. For example, rry would
correspond to dCe/dCE. Therefore, this donor unit would not have the little c
antigen(hr) and would be the correct answer.
NOTE#1: blood bankers know that there is NO little d antigen, but they like to
write it as a place-holder for big D.
NOTE #2: When referring specifically to an antigen: Rho = D; rh = C; rh = E; hr

= c and hr = e.
Which one of the following blood group systems may show a cell typing change
during pregnancy?
Rh
MNS
Lewis
Duffy
D mosaic
Feedback
The Lewis group antigen, Lea may disappear during pregnancy, resulting in the
formation of anti-Lea antibodies. The majority of these antibodies are IgM and
clinically insignificant.
When performing an antibody panel, which one of the following antigens will be
rendered inactive by enzyme treatment?
anti-Fya
anti-Jka
anti-E
anti-Lua
Feedback
Duffy antigens are rendered inactive by enzyme treatments since the enzyme will
remove the sialic acid from the RBC membrane. This process destroys: M, N, S, s,
and Duffy antigens. The process enhances the reactions for Rh, Kidd, Lewis, I, and P
antigens.
What is the purpose of a major crossmatch?
Prevent immunization
Prevent delayed transfusion reactions
Guarantee normal survival of the red blood cells
Verify donor ABO packed-cell compatibility
Feedback
The purpose of the major crossmatch is to determine compatibility between the

donor's red cells and the recipient's plasma. A negative antibody screen coupled with
a patient's historical record are used to prevent immunization, prevent delayed
transfusion reactions, and guarantee normal survival of the red blood cells by
detecting or alerting to clinically significant antibodies.
Which symptom of HDFN does phototherapy help prevent?
Anemia
Enlarged heart
Enlarged spleen
Hydrops
Kernicterus
Feedback
Phototherapy helps prevent kernicterus by chemically altering the bilirubin in the

surface capillaries to harmless substances that can be excreted. Kernicterus is
associated with severe cases of jaundice.
A patient with two or more documented febrile nonhemolytic transfusion reactions

(FNHTRs) should receive __________ blood components.
Leukoreduced
Irradiated
Cytomegalovirus (CMV) negative
Hemoglobin S negative
Feedback
Pre-storage leukocyte reduction prevents febrile non-hemolytic transfusion reactions

that occur due to cytokine accumulation during storage.
What should be the first step performed to resolve a case where all forward and
reverse ABO typing results are negative on a patient?
Wash the patient cells and retest.

Get a new sample and retest.
Test the patient cells with Anti-H Lectin.
Incubate all testing tubes at 22c
Feedback
If all results for a patient's forward and reverse type are negative, it is suggested that
the reactions incubate at room temperature for at least 15 minutes to help strengthen
any reactions to become observable.
When antigen typing, mixed-field agglutination (MFA) due to red cell transfusion
indicates RECENT transfusion, specifically transfusion within the past three months.
True
False
Feedback
MFA due to transfusion does not occur in patients transfused more than three months
ago because the maximum life span of red cells is 120 days.
Transfused donor cells will have an even shorter life span in vivo because some of
them will have died during storage of the blood component.

An antibody screen utilizing PEG was performed. Reaction readings of this antibody
screen are analyzed after immediate spin and again at 37 incubation with subsequent
centrifugation. How will the centrifugation of the tubes affect the patient's results?
Reactions will be enhanced

No effect will be seen
False positives may be seen
False negatives may be seen
Feedback
False positives would be seen with the test serum and cells if PEG is added before
centrifugation. PEG can cause non-specific aggregation of cells, thus eliminating the
necessity for centrifugation after 37C incubation. PEG causes red blood cells to
aggregate forming nonspecific aggregates which may not disperse with washing.
These aggregates will appear as agglutination. This agglutination is not due to an
antibody-antigen reaction.
Which of the following statements best describes Rh antibodies:
Naturally occurring, IgM

Immune, IgG
Naturally occurring, IgG
Immune, IgM
Feedback
Rh antibodies are of the IgG class of immunoglobulins, and occur as a result of

exposure to the corresponding antigens, through pregnancy or transfusion.
Which of the following is the proper storage temperature for fresh frozen plasma:
37 degrees Celsius
4 degrees Celsius
- 20 degrees Celsius
Feedback
FFP must be separated from RBCs and frozen solid at less than or equal to -18
degrees Celsius within 8 hours of collection.
Match the following antibodies to their appropriate immunities:
Your answers are on the left. The correct answers are on the right and highlighted.
IgM Anti-I
IgG Anti-K
IgG Anti-Jka
IgM Anti-M
Feedback
IgM Antibodies: anti-M, anti-I
IgG Antibodies: anti-K, anti-Jka
Delayed hemolytic transfusion reactions (DHTR) usually occur within which time
period?
5 hours after transfusion

24 hours after transfusion
3-10 days after transfusion
one year after transfusion
Feedback
Delayed hemolytic transfusion reactions (DHTR) are usually caused by a secondary

(anamnestic) response. It takes about 3-10 days from the time of transfusion for
enough antibody to be produced to cause clinical symptoms.
Which of the following is NOT required to be in a machine-readable format on a
blood component label?
ABO & Rh of the donor

Product code
Collection facility
Outdate
Feedback
The correct answer is D. The outdate may be handwritten.

21 CFR 606.121 requires this information be machine-readable:
A unique collection facility identifier

Lot number relating to the donor
Product code
ABO and Rh of the donor
Which of the following is most commonly associated with febrile non-hemolytic

transfusion reactions:
Bacterial contamination of the blood

I.V. tubing contaminants
Reaction to plasma proteins
Immune response to leukocytes
Feedback
The immune response in the recipient to donor leukocytes present in a blood product
is most commonly associated with febrile, non-hemolytic transfusion reactions.
Which one of the following blood group antigens is not expressed, or only
weakly expressed on cord blood cells?
K
Jka
M
Leb
ABO
Feedback
Newborns are phenotypically Le(a-b-).
Can an autologous donor donate blood at 4 PM on Monday if she is having surgery at

10 AM on Wednesday?
.
No, the minimal allowable time between the last donation and surgery is 72
hours.
No, the minimal allowable time between the last donation and surgery is two
weeks.
Yes, the patient can donate, but only half a unit.
Yes, an autologous donor can donate up to 24 hours prior to surgery.
Feedback
Although it is generally accepted that the minimal allowable time between the last
autologous donation and surgery is 72 hours, it is highly unlikely that there will be an
appreciable increase in red blood cell mass in this short of a time. Therefore, some
facilities may have a cutoff time that is further out than 72 hours.
Approximately what percent of the overall population is Rh negative:
10 %
15 %
25 %
35 %
Feedback
Approximately 15% of individuals are Rh negative, will approximately 85% of

individuals are Rh positive.

The condition most likely associated with the peripheral blood picture in the
photograph is:
Hereditary spherocytosis
Lead poisoning
Transfusion dimorphism
Folic acid deficiency
Feedback
The intended response is "transfusion dimorphism". The microcytic, hypochromic

erythrocytes suggests iron deficiency anemia. Interspersed among these cells are
normocytic, normochromic erythrocytes suggesting two populations of red cells
following transfusion. This was a case of severe iron deficiency treated with red cell
transfusions and iron supplement.
Which of the following serological test results may occur in a patient experiencing a
hemolytic transfusion reaction due to antibodies such as anti-c and anti-K? (Select all
that apply.)
Patient's antibody strength may initially decrease.

Patient may develop a positive DAT with mixed-field agglutination.
Patient's antibody becomes undetectable.
Patient's antibody increases in titer weeks later.
Feedback
All are possible.
The patient's antibody strength can initially decrease due to adsorbing to transfused
antigen-positive donor red cells.
This results in a positive DAT with mixed-field agglutination, since only the
transfused donor cells are antibody-sensitized.
The patient's antibody may even become undetectable at the stage when most of it has
adsorbed to the donor cells.
Eventually, the patient's antibody increases in strength. This may become apparent
weeks later, depending on the relative amount of antibody compared to donor red
cells present in the patient's circulation.
At least three antigen-positive red cells that react and three antigen-negative cells
that do not react are required to identify an antibody with acceptable statistical
significance despite how many cells are included in the panel.
True
False
Feedback
This statement is false. Three positives and three negatives are required to identify an
antibody with acceptable statistical significance (a p value of <0.05) ONLY if you
have a panel of only 6 cells.
For example, a 10-cell panel with eight antigen-positive cells that react and two
antigen-negative cells that do not react, will generate acceptable statistical
significance (a p value of <0.05). In this case the p value is 0.02.
An outcome of statistical significance is an outcome that is more than what you could
reasonably attribute to chance. The shorthand way of stating statistical significance is
p < 0.05, where p represents probability. This literally means that the probability is
less than 5 out of 100, or less than 1 out of 20, that the results were due to chance.
In antibody identification, a p value of <0.05 can be interpreted as meaning that the
same results produced by another antibody or cause would be expected to occur by
chance alone less than one in 20 times, or less than 5% of the time (p<0.05), given the
number of cells tested. By scientific tradition, this is an acceptable level of
uncertainty.
Statistical significance begins when the threshold of 0.05 is crossed. Therefore a p
value of 0.02 is statistically significant, as it suggests the likelihood is 2 out of 100 (1
out of 50) that the findings were due to chance. In the 10-cell panel example, the
results were statistically significant, even though only two antigen-negative cells did
not react.
The seeds of the Dolichos biflorus plant will agglutinate A2 cells but not A1 cells.
True
False
Feedback
Anti-A1 lectin is extracted from the seeds of Dolichos biflorus. This reagent will
agglutinate A1 cells, but not A2 cells.
Which unit contains the proper number of platelets from a random donor?
3.8 x 1010
4.0 x 1010
4.5 x 1010
5.8 x 1010
Feedback
Platelet concentrates are required to have a minimum of 5.5 x 1010 platelets/unit.

Random donor platelet concentrates typically contains between 5.5 and 8.5 X 1010
platelets suspended in about 50 mL of plasma. This is approximately 70% of the
platelets which were present in the original unit of whole blood collected by the
donor.

Which of the following blood group antigen-antibody reactions is enhanced by using

enzymes:
Fya
Fyb
M
Jka
Feedback
Duffy antigens (Fya and Fyb) and M,N,S antigens are denatured by enzymes. Kidd
antigens (Jka, Jkb) are enhanced by enzymes.

Acute intravascular hemolysis as the result of a blood transfusion is most often

associated with which of the following causes?
Transfusion of ABO incompatible red cells

Allergies
Passively transfused antibodies to HLA antigens
Transfusion-associated graft-versus-host disease
Feedback
Acute hemolytic transfusion reactions are most commonly due to ABO-incompatible

blood being transfused to a recipient with naturally occurring ABO alloantibodies
(anti-A, anti-B, anti A,B).
Patients with which of the following conditions would benefit most from washed red
cells:
Warm autoimmune hemolytic anemia

Cold autoimmune hemolytic anemia
Elevated serum potassium
Multiple red cell alloantibodies
Feedback
Washing not only reduces the number of leukocytes and platelets that are often
responsible for febrile reactions, but also eliminates anticoagulants, ammonia, lactic
acid, and potassium.
Your screen cells are 3+ at immediate spin and weak (W)+ at AHG. Your auto control
is negative for both phases. Some of your antibody panel cells are 3+ at immediate
spin and negative at AHG. What should you suspect?
A warm autoantibody is present

A cold antibody may be present
Bad specimen draw
Feedback
If your reactions are strong at immediate spin (3+) and then get weaker at AHG (w+),
it could mean the presence of a strong cold antibody.
Cold antibodies tend to be IgM and their optimum phase for reactivity is immediate
spin. Incubation and washing of the sample may cause the agglutination that occurred
at room temperature to break down. This would appear as a weaker reaction at AHG.
If the reaction strengths varied in each panel cell then that could be an indication that
there are multiple antibodies present.
After the second spin in the preparation of platelets from whole blood, the platelet
products should be:
Allowed to rest for 1-2 hours.

Agitated vigorously for 3 hours
Pooled immediately and microwaved
Frozen
Feedback
After the second spin in the preparation of platelets, the platelet bag should be
allowed to rest at room temperature for 1 - 2 hours. The platelet component is placed
on a rotator to resuspend the platelets that have aggregated during the centrifugation
process, but should not be vigorously agitated. They should remain at room
temperature, not pooled and heated in a microwave, and not frozen.
What are the possible ABO genotypes of offspring of parents whose genotype is OA
and OB:

OO
OA
OB
AB
Feedback
The offspring from this set of parents can yeild each blood type: OO, OA, OB, AB.
This can be determined by the utilization of a simple punnett sqaure. There is a 25%
chance for inheritance of each blood type.
Granulocyte Concentrates MUST be administered within ______ of collection.
12 hours
24 hours
3 days
30 days
35 days
Feedback
Granulocytes should be transfused as soon as possible and always within 24 hours.

A unit of Red Blood Cells that was collected on 15 June 2009 and frozen with
glycerol at -80 degrees C on 21 June 2009 will expire on what date?
14 June 2019.
15 June 2019.
20 June 2019.
21 June 2019.
22 June 2020
Feedback
Red Blood Cell units with the addition of a cryoprotectaive agent, such as glycerol,
may be frozen for up to 10 years from day of collection. Frozen red blood cells must
be stored at least -65 degrees C or colder.
Unexpected positive reactions encountered during forward ABO typing may be due
to:
A or B subgroups
Antigen depression due to leukemia
Hypogammaglobulinemia
Acquired B antigen due to intestinal cancer
Feedback
A and B subgroups, and antigen depression due to leukemia may cause unexpected
negative reactions during forward typing. Hypogammaglobulinemia may cause an
unexpected negative reaction during reverse typing. Acquired B antigen due to
intestinal cancer is the only option listed that can cause an unexpected positive
reaction during forward ABO typing.
Which D variant has a qualitative difference in the D antigen that allows individuals
with the D variant to produce anti-D? Select all that apply.
weak D
partial D
partial weak D
None of the listed D variants have a qualitative difference in the D antigen
Feedback
Both partial D and partial weak D have a qualitative difference in the D antigen that
allows individuals with the D variant to produce anti-D to the D epitopes that they
lack.
Which of the following blood groups reacts least strongly with Anti-H:
O
A2
A1
A1B
Feedback
The amount of H antigen present on red cells varies by blood group: O > A2 > B >
A2B > A1 > A1B.
Using an exclusion protocol that requires only one homozygous cell to exclude antibodies,
three antibodies have not been excluded in the panel shown below. Two of the antibodies
are anti-E and anti-K, what is the third antibody that is possible (has not been excluded)?
Cel Result Cel

Rh Rhesus Kell Duffy Kidd MNSs P Lewis Lu l
l s
C Kp Fy Fy Jk Jk P Le Le Lu Gel
CDEc e w Kk a a b a b MNS s a b a IAT*
1
+
1 rr 0 0 0 ++ 0 0 + 0 + 0 0 + 0 + ++ S + 0 0 2+ 1
+
2 rr 0 0 0 ++ 0 0 + 0 0 + + 0 0 + ++ S + 0 0 0 2
3 rr 0 0 0 ++ 0 0 + 0 + + 0 + 0 + +0 + 0 + 0 2+ 3
4 r"r 0 0 + + + 0 0 + 0 + + 0 + 0 + 0+ + + 0 0 3+ 4
R2 R
5 0 + ++0 0 + 0 0 + + + 0 + 0 +0 + 0 + 0 3+ 5
2
R2 R
6 0 + ++0 0 + + 0 + + + 0 + 0 +0 + 0 + 0 3+ 6
2
R1 R +
7 + + 0 0+ 0 0 + 0 + 0 + + + 0 +0 S 0 + + 0 7
1
R1 R
8 + + 0 0+ 0 0 + 0 0 + + 0 + 0 0+ + + 0 0 0 8
1
RZR
9 + + +0+ 0 + + 0 + 0 0 + + 0 0+ + + 0 0 3+ 9
1
+ 1
10 r''r + 0 + + + 0 0 + 0 + 0 + + + 0 +0 S 0 + 0 1+
0
11 Aut 0 1
o 1
Anti-c
Anti-Jka
Anti-Jkb
Feedback
Anti-Jkb,in addition to anti-E, anti-K, has not been excluded. Non-reacting cells are
either negative or only heterozygous positive (i.e., from donors heterozygous for the
gene).
Anti-c is excluded by panel cell 2 (C-c+) and anti-Jka is excluded by cells 2 and 8,
both of which are Jk(a+b-).

Which of the following antibodies can be enhanced using enzyme panels during
antibody identification in the blood bank?
Rh
Lewis
Kidd
Duffy
Lutheran
Kell
Feedback
The Rh system antibodies along with Lewis and Kidd blood group antibodies can
show an enhanced reaction when analyzed with enzyme treated panels. The antibodies
which can be destroyed or weakened by enzyme treated panels are: the MNS group
(though s can be variable), Duffy, and Xga.
Which of the following Fresh Frozen Plasma ABO types would be suitable for
transfusion to an AB negative patient?
AB negative only.
O negative only.
AB negative and AB positive only.
O negative and O positive only.
A or B
Feedback
FFP should be ABO compatible with the patient's red blood cells. It can be given
without regard to Rh type because it does not contain cells.
What must be true for the antiglobulin phase of the serologic crossmatch to be omitted
(i.e., immediate spin crossmatch is done)?
The antibody screen must be negative.

The patient has not been transfused within the past 24 hours.
There is no history of detection of unexpected antibodies
The blood is needed for surgery
Feedback
The antiglobulin test may be omitted from the serological crossmatch if the patient's
antibody screen is negative and there is no history of detection of unexpected
antibodies.
At what phase of antibody screen testing is it most important to read the reactions in
order to detect clinically significant antibodies?
AHG
Immediate spin
37
any of the above
Feedback
A reading must be done at AHG in the antibody screen procedure. The purpose of this
is to detect clinically significant antibodies which could cause hemolytic transfusion
reactions or hemolytic disease of the newborn.
Immediate spin readings during the antibody screen would detect IgM antibodies
primarily. These are not considered clinically significant if reacting at IS phase only.
A reading at 37 may show if a clinically significant antibody is causing hemolysis.
Transfusion related acute lung injury (TRALI) is a serious blood transfusion

complication that can be characterized by:
Respiratory distress
Hypotension
Hypertension
Non-cardiogenic pulmonary edema
All of the above
Feedback
TRALI is an acute, often life-threatening reaction characterized by respiratory

distress, hypotension or hypertension, and non-cardiogenic pulmonary edema that
generally occurs within 2 hours of a transfusion of a plasma-containing component.
The serum of some group A individuals may agglutinate group A1 cells.
True
False
Feedback
Approximately 4% of individuals with A2 blood type will have Anti-A1 antibodies in

their serum. Individuals with some rarer A subgroups may also have Anti-A1 in their
serum. Agglutination will occur if the serum from any of these individuals is mixed
with A1 red cells.

Which of the following group B antigens is generally associated with a mixed field
reaction:
B
B3
Bm
Bx
Feedback
B3 is characterized by a weaker than usual reaction with anti-B and by a mixed field
reaction with the same reagent.
If a pregnant female who was injected with RhIg antenatally has anti-D at delivery,
routine antibody titration to determine the titer of the anti-D is considered a good
practice.
True
False
Feedback
Routine antibody titration is not considered a good practice.
If the antibody strength is weak (e.g., 2+ or less, consistent with RhIg administration),
titer cannot differentiate between passive and immune anti-D.

For which of the following antibodies is the DAT most likely to be negative when
testing a newborn for possible HDFN?
anti-A
anti-c
anti-D
anti-K
anti-Fya
Feedback
The DAT is most likely to be negative in ABO HDFN. It's possible that the washing
done as part of the DAT may break the bonds between anti-A (or anti-B) and the
newborn's poorly developed A (or B) antigens.
For transfusion services in the United States, which of the following incidents must be
reported to the Food and Drug Administration (FDA) because of a biological product
deviation?
Incident A: A unit was issued with an incorrect expiration date. The expiration
date was incorrectly marked as one day earlier than the actual expiration date.
Incident B: A nurse in ICU misidentified the patient and initiated the transfusion
of Rh positive blood to an Rh negative patient.
Incident C: The wrong specimen was used to crossmatch a unit and the unit was
issued.
Feedback
According to 21 CFR 606.171, an event is reportable, if it occurred while the product

was under the control of the transfusion service, is a deviation of standard practice
that affects the safety, purity or potency of the product, and if the unit was issued.
Incident C is reportable to the FDA because of a biological product deviation. In this
case, an error was made in the blood bank and the unit was issued. It is reportable
regardless of the harm to the patient.
In Incident A, the outdate was shortened; therefore, there is no concern for the safety,
purity or potency of the product. This is not reportable.
Incident B did not occur within the jurisdiction of the blood bank and is not reportable
as a biological product deviation. There was no safety, purity or potency issue related
to the product issued by the transfusion service.
However, if the patient dies as a result of a transfusion reaction, the FDA must be
notified, but not through the biological product deviation reporting process.
Which of the following is generally considered equivalent to CMV seronegative RBC

for use in an exchange transfusion to a newborn?
Fresh RBC less than 7 days old

Hemoglobin S negative RBC
Irradiated RBC
Leukoreduced RBC
Feedback
Leukoreduced RBC are generally considered equivalent to CMV seronegative RBC

because CMV is carried intracellularly within leukocytes.

A Rh positive individual has produced an anti-D antibody. Which D variant possesses
the ability to stimulate this production of anti-D? (Choose all that apply.)
Weak D
Partial D
Partial weak D
None of the listed D variants can produce anti-D
Feedback
Both partial D and partial weak D can produce anti-D to the D epitopes that they
lack.
A sample has reactions occurring at immediate spin and AHG in a panel that show
varying reaction strengths. There is no obvious pattern that matches a particular panel
cell or single antigen profile and the auto-control was negative. Which of the
following is the most likely cause?
An IgM and an IgG antibody

A warm autoantibody
An antibody to a low-frequency antigen
An antibody to a high-frequency antigen
Feedback
The cause would be the presence of both an IgM and an IgG antibody.
Antibodies to high-frequency antigens would be positive with all of the panel cells in
the AHG phase. Reactions would be the same strength.
If the antibody is a warm autoantibody, then reactions would all be positive at AHG at
the same strength and the auto control would also be positive.
Antibodies to low-frequency antigens would probably not be detected at immediate

spin and there would be very few if any reactions at AHG due to low-frequency
antigens not being present on panel cells.
Think multiple antibodies when reactions are occurring at two different phases (IS
and AHG), varying strengths in reactions and no definite pattern. Patterns can
sometimes be recognized if you look at each phase individually. For example:
reactions at immediate spin may match an M antibody and reactions at AHG may
match a D antibody. Varying strengths in reaction could also indicate dosage
occurring.
Which of the following methods is MOST reliable for determining the appropriate
dosage of Rh immune globulin to give to an identified Rh immune globulin candidate
after delivery?
Kleihauer-Betke method
Flow cytometry
Rosette test
No test is needed, the same dosage is given to all Rh immune globulin
candidates
Feedback
Flow cytometry is the most reliable method of those listed. It is a quantitative method,
whereas Keihauer-Betke and the rosette test are very subjective tests.

Gamma irradiation of cellular blood components is required in which of the following

situations:
Prevent post-transfusion purpura

Prevent Graft-Versus-Host (GVH) disease
Sterile components
Prevent non-cardiogenic pulmonary edema
Feedback
Transfusion related Graft-Versus-Host disease is a rare condition usually following

transfusion of patients whose immune system is severely compromised. It occurs
when T lymphocytes present in the transfused unit replicate and attack the tissues of
the recipient. Gamma irradiation prevents this condition by inactivating T
lymphocytes in the donor unit. Gamma irradiation of cellular blood components is
required when: 1.The donor is a blood relative of the recipient, 2. Intrauterine
transfusions, 3. The recipient has a selected immunodeficiency condition, 4. The
recipient has received a bone marrow transplant.
The appropriate dosage of Rh immune globulin (RhIg) to administer post-delivery to

an Rh-negative mother delivering an Rh-positive child is calculated based on the
estimated volume of fetal bleed.
What is the value of x in the formula given below that is used to calculate RhIg
dosage?
Number of vials of 300 g RhIg = volume of fetal bleed/x mL
Enter the number in the box below that is represented by x in the formula; do not spell
out the number.(e.g., use "5" and not "five").
30
30
Feedback
A 300 g vial of RhIg can prevent immunization to a fetomaternal hemorrhage

(FMH) of 30 mL of D-positive whole blood.
Using the estimated volume of fetal bleed determined by the Kleihauer-Betke test or
flow cytometry, the number of vials of RhIg (300 g) to inject is calculated as
follows:
Number of vials of 300 g RhIg = volume of fetal bleed/30 mL. In the interests of
safety some American organizations recommend the following to deal with decimal
points:
If the number to the right of the decimal point is <5, round down and add 1 vial (e.g.,
1.4 = 1 +1 = 2 vials)
If the number to the right of the decimal point is greater than or equal to 5, round up
and add 1 vial (e.g., 1.7 = 2 +1 = 3 vials).
Why is Rh immune globulin (RhIG) administered within 72 hours of delivery or

miscarriage to an Rh-negative mother if the newborn is found to be D-positive or
weak-D positive?
prevent future children from producing antibodies

prevent fetal cells from initially sensitizing the mother
prevent antibody response in a previously sensitized mother
neutralize any natural maternal antibodies present
Feedback
All Rh-negative women should receive at least one full dose of RhIG at 28 weeks
gestation and another full dose after birth (assuming that the newborn is found to be
D-positive or weak D-positive).
What is the MINIMUM number of days that samples from blood donor and recipient
be kept following blood transfusion?
2
5
7
10
14
Feedback
Samples must be kept for at least 7 days when used for pre-transfusion component
testing. The main reason is to have the samples available in case transfusion reaction
work-ups need to be performed.
A patient's serum reacts with all reagent red cell samples. The autocontrol is negative.
An alloantibody to a high incidence antigen is suspected. Which of the following
would be most likely to be a compatible donor:
Parents
Siblings
Children
Husband
Feedback
Patients with an alloantibody to a high incidence antigen are, of course, missing the
corresponding high incidence antigen on their red cells. In most cases, this results
from inheritance of the same rare blood group gene from both parents. Siblings are
much more likely to have inherited two doses of this same gene than the random
donor population. Parents and children of the patient will more likely only have a
single dose of the rare blood group gene in question, and are less likely to be a source
of compatible blood.
A delayed hemolytic reaction occurring a week later is MOST likely caused by:
Volume overload
Kidd system antibodies
Iron overload
ABO incompatibility
Feedback
Of the causes that are listed, the most likely cause of a delayed hemolytic reaction is
Kidd system antibodies. Both jka and jkb are often responsible for delayed hemolytic
transfusion reactions.
Volume overload may cause an immediate, nonimmunological reaction.
Iron overload may cause a delayed, nonimmunological reaction.
ABO incompatibility would cause an immediate immunological reaction.

How long may blood be stored using CPDA-1 preservative prior to transfusion?
5 days
15 days
25 days
35 days
Feedback
Blood collected in CPDA-1 may be stored at 1 - 6 oC for up to 35 days.
Which of the procedures listed below will increase the platelet concentration in the
preparation of platelets?
Centrifuge the blood at a low speed, remove the plasma and spin the plasma
again at a low speed.
Centrifuge the blood at a low speed, remove the plasma and spin the plasma
again at a high speed.
Centrifuge the blood at a high speed, remove the plasma and spin the plasma
again at a high speed.
Increase the duration of rotation
Feedback
Preparation of platelets is a two step process. The whole blood unit should be
centrifuged at a low speed on the first spin. The platelets will then remain in the
plasma portion of the bag (platelet-rich plasma). The platelet-rich plasma is then
centrifuged again at a higher speed, forcing the platelets to the bottom of the
container.
A primary immune response is generally associated with which antibody?
IgG
IgA
IgM
IgD
Feedback
IgM is a pentamer which is the predominant antibody produced during the primary
immune response. Secondary antibodies are usually IgG.
Which of the following is the most common reagent source for Anti-A1 (a reagent that
is used to differentiate subgroup A1 from subgroup A2)?
Group A1
Dolichos biflorous seeds
Group O
Arachis hypogea
Feedback
The lectin from Dolichos biflorous seeds is used as a source of anti-A1.
Which one of the following blood groups usually reacts LEAST strongly with anti-H?
0
B
A2
A1
Feedback
Of the blood groups that are listed, A1 has the least amount of H antigen and therefore
would react least strongly with anti-H.
If Jka is showing dosage, how might reactions on an antibody panel appear?
Weaker if homozygous for Jka

Stronger if heterozygous for Jka and Jkb
Weaker if heterozygous for Jka and Jkb
Both heterozygous and homozygous reactions would always be of equal strength
Feedback
Strength of reaction can be due to the number of antigens present on the red cells that
can bind with the antibody present. Inheritance of antigens can be in the homozygous
or heterozygous state. If the antigen is in the homozygous state, there is a double dose
of the antigen present on the red cell.
Antigen-antibody reactions will be stronger if in the homozygous state since there is

more antigen to bind with the antibody.
Which is in the correct order from the lowest concentration of H to the highest
concentration of H?
Bombay, A1B, A1, A2B, B, A2, O

A1, O, B, A2, Bombay, A1B, A2B
Bombay, O, A1B, A2, A1, B, A2B
A1B, A2B, A2, O, B, A1, Bombay
Feedback
The H antigen is an essential precursor to the ABO blood group antigens. Individuals
with the rare Bombay phenotype (hh) do not express antigen H on their red blood
cells; therefore this type would contain the least amount of H antigen. Those which
are type A1B would then have the second to least amount of H antigen since the
precursor H antigens have been formed into A1 and B antigens instead. The remaining
order of the H concentration from lowest to highest in the blood types given is: A1,
A2B, B, A2, and O. O patients produce the most H antigen since they do not convert
the H antigen into A or B antigens on their cell surface.

Reverse typing is done using known antisera to detect ABO antigens present on the
patient's red blood cells.
True
False
Feedback
Reverse typing is performed using reagent red cells with known antigens to detect
ABO antibodies present in the patient's serum.
The accepted interval between blood donations is:
12 weeks
8 weeks
6 weeks
Depends on hematocrit level
Feedback
The mandatory waiting period between blood donations is 56 days, or eight weeks.

Below are results of a mini-panel chosen to confirm anti-D and exclude other
antibodies in an Rh negative woman at delivery who received antenatal RhIg and who
has a positive antibody screen consistent with passive anti-D.
Cell Rh Rhesus Kell Duffy Kidd
C D E c e K k Fya Fyb Jka Jkb M
1 rr 0 0 0 + + + + + 0 + 0 0
2 rr 0 0 0 + + 0 + 0 + + 0 +
3 r'r + 0 0 + + 0 + + 0 0 + +
4 r'r + 0 0 + + + + + + + + +
5 r"r 0 0 + + + 0 + 0 + 0 + +
6 r"r 0 0 + + + 0 + + + + + +
o
7 Rr 0 + + + + 0 + + + + + +
8 Auto
Mini-Panel Results
* IAT = indirect antiglobulin test
Anti-? is the most likely cause of the mini-panel test results with screen cells #1 and
#4.
Enter one letter to designate the most likely antibody, e.g., D or C, etc.
Feedback
Anti-K is the most likely cause of the reactions with cells #1 and #4, which are the
only cells that are K+. Cell #7 reacts since it is D+.
However, other causes are possible. An antibody identification would be done to

identify the antibody or antibodies.
What should be done with a box of 10 Red Blood Cell units that was received with a
measured temperature inside the box at 15C.
Quarantine and destroy the products.

Quarantine and observe for bacterial growth
Add ice to the box and bring temperature to 6 C
Process and use the units as normal
Feedback
The interior of the transport container cannot exceed 10oC during transport of Red
Blood Cells.
In blood bank agglutination reactions, the zeta potential (a force exerted by ions in the
saline solution that causes repulsion between red blood cells in the saline suspension)
can be reduced by treating the sensitized cells with:
Polyclonal antibody reagents

Polyethylene glycol (PEG), albumin, or proteolyic enzymes
Monoclonal antiglobulin reagents
Coombs serum reagents
distilled water
Feedback
Antigen-antibody reactions will not occur, or will be weak, if a force exerted by ions
in the saline solution cause repulsion between two adjacent red blood cells. The zeta
potential can be reduced by treating the red blood cells with proteolytic enzymes such
as papain and ficin, or using various colloidal diluents such as albumin or PEG.
Which type of blood component is most implicated in bacterial contamination?
platelets
red cells
plasma
cryoprecipitate
all of the above
Feedback
Platelets are the most common product implicated in bacterial contamination cases.
This is because the room temperature storage requirement provides an adequate
environment for bacterial growth.
All of the following are reasons for conducting compatibility testing EXCEPT:
prevent recipient alloimmunization

verify ABO and Rh
select proper blood products
detect antibodies against donor cells
avoid hemolytic transfusion reactions
Feedback
Compatibility testing is performed by the blood bank laboratory to detect serologic

incompatibilities that might result in decreased survival of donor red cells in the
transfused patient. The term compatibility testing, also known as pretransfusion
testing, describes a set of procedures required before blood is issued as being
compatible. Compatibility testing includes verification of ABO and Rh, selecting the
proper blood products for transfusion, detecting antibodies against donor cells, and to
avoiding transfusion reactions. It does not include the prevention of recipient
alloimmunization since patients and donor units are not phenotyped for every antigen
to prevent alloimmunization.
During routine inspection, a unit of unexpired blood was noticed to have a black color
with numerous small clots. What is the likely cause for this observation?
the unit was frozen

donor had DIC
viral contamination
bacterial contamination
Feedback
Bacterial contamination can manifest itself in several ways including: the presence of
clots, darker purple-black color of blood unit, unit can appear cloudy, hemolysis may
be present.

Feedback

Evaluate the panel shown on the right. Which antibody(ies) are most likely causing
this reaction?
Note: Use the reaction patterns to identify the most likely antibody(ies). There may be
additional antibodies present that cannot be ruled out.
A PDF of the panel is also available on this page to enhance viewing, if necessary.
Anti-C
Anti-D
Anti-E
Anti-c
Feedback
The answer for this panel is anti-D. The pattern of reactivity exactly matches the
expression on the panel cells. Anti-D occurs most commonly in Rh negative mothers
who have been exposed to the D antigen through the birth of Rh positive children.
Anti-D can also be present due to the administration of RhIg (Rh immune globulin).

In HDN which of the following antigen-antibody reactions is occurring:
Maternal antibody against fetal antibody

Maternal antigen against fetal antibody
Maternal antibody against fetal antigen
Maternal antigen against fetal antigen
Feedback
In hemolytic disease of the newborn (HDN), maternal antibodies are directed against
fetal red blood cells. This condition can cause red cell lysis in the infant and can be
dangerous for the health of the fetus.
Group O blood cannot be transfused to a person with Bombay blood" type because
the Bombay individual has:
Anti-H
Anti-A
Anti-B
H substance on his cells
Anti-i
Feedback
Group O blood has the most H substance of all blood types; therfore, in a patient who
has the Bombay phenotype (hh), the anti-H can react and cause incompatibility issues.
FFP that has been thawed at 30 - 37oC and maintained at 1 - 6oC must be transfused
within ___________ after it has been thawed.
24 hours
8 hours
12 hours
5 days
10 days
Feedback
within 24 hours. In contrast, "Thawed Plasma" can be used for up to 5 days as a
replacement therapy for patients requiring stable clotting factors. Keep in mind that
these are two different component types and you are asked about FFP.
Which of the following is the proper storage temperature for whole blood:
12 degrees Celsius
4 degrees Celsius
Feedback
Whole Blood should be stored between 1 - 6 degrees Celsius.
Which blood component is the most commonly used component for the replacement
of multiple coagulation factor deficiencies?
Fresh Frozen Plasma

Red Blood Cells
Cryoprecipitate
Whole Blood
Feedback
Fresh Frozen Plasma (FFP) is indicated for bleeding patients with multiple
coagulation factor deficiencies due to inadequate production, as in liver disease;
excessive consumption, as in disseminated intravascular coagulation (DIC); or
dilution, as in massive transfusion, generally defined as the replacement of one or
more blood volumes in a period of 24 hours or less.
FFP is also indicated for non-bleeding patients with multiple deficiencies who are
undergoing invasive procedures. FFP is also used for reversal of warfarin therapy in
bleeding patients and for patients with congenital factor deficiencies for which no
concentrates are available.

IgM antibodies directed against red cells generally:
React best at 37 degrees Celsius

Appear after heated incubation
Are identified using the AHG test
React best at room temperature
Feedback
IgM antibodies typically react best at room temperature. The other choices listed
including: reacting best at 37oC, appearing after heated incubation, and identification
using the AHG test, are all characteristics of most IgG immunoglobulins, but not IgM
immunoglobulins.
What are the cells that are indicated by the arrows in this image?
codocytes (target cells)

acanthocytes
spherocytes
tear drop cells
Feedback
The cells depicted in the image are codocytes, also known as target cells. Target cells
typically are a bit larger than a normal red blood cell, and have a "bull's eye"
appearance.
The Kleihauer-Betke test used to quantitate FMH has poor reproducibility.
True
False
Feedback
Despite its widespread use, the Kleihauer-Betke test has poor reproducibility (as well
as poor sensitivity).
Which one of the following blood components contains the MOST factor VIII
concentration per ml?
plasma
cryoprecipitate
fresh frozen plasma
platelet concentrate
leuko-reduced red cells
Feedback
The most factor VIII, approximately 100 IU, is found in cryoprecipitate compared to
the other blood component choices listed.
A false-negative reaction while performing the DAT technique may be the result of:
Red cell/AHG tube is over centrifuged

Blood collected in tube containing silicon gel
Saline used for wash stored in glass or metal container
AHG addition delayed for 40 or more minutes
Feedback
AHG must be added immediately after washing to prevent the possibility of a false
negative; a false negative can occur in this situation because previously bound
globulins may dissociate from red cells, leaving insufficient antibody coating on the
red cells to produce a reaction, or free antibody may directly neutralize antiglobulin
reagent.
A confirmatory test for HIV in patients who are positive by ELISA is the:
Latex agglutination
Western blot
Thin layer chromatography
ELISA
Feedback
Western blot for HIV is performed by reacting antibodies in the patients serum with
HIV antigenic material separated into bands by molecular weight on a nitrocellulose
membrane.
What is the MOST likely cause of the ABO discrepancy when the following results
were obtained from a first-time 29-year old, blood donor?
Forward Group
Anti-A = Negative
Anti-B= Negative
Reverse Group
A1 Cells = Negative
B Cells = 3+
Loss of antigen due to disease

Acquired B
Bombay phenotype
Weak subgroup of A
Contaminated reagents
Feedback
It is important to recognize that a weak subgroup of A may be present if this blood is

from a donor. If the blood were transfused as a group O to a group O recipient, a
transfusion reaction would occur.
A positive Coombs control test in a cross match BEST indicates that the:
negative antiglobulin test was actually negative

patient's RBCs were not washed thoroughly
Coombs control cells are contaminated
Coombs reagent is contaminated
Feedback
The Coombs control should be positive in order to confirm that a negative

antiglobulin test is actually negative, and not showing a negative result due to missing
reagent.
Which one of the following types of transfusion reactions caused the highest number
of transfusion-related fatalities that were reported to the U.S. Food and Drug
Administration (FDA) from 2005 - 2009?

Anaphylactic reactions
Febrile non-hemolytic reactions
Transfusion-related acute lung injury (TRALI)
Transfusion-associated graft versus host disease (TA-GVHD)
Feedback
In combined fiscal years 2005 through 2009, transfusion-related acute lung injury
(TRALI) caused the higest number of reported fatalities (48%), followed by
hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%)
incompatibilities. Complications of microbial infection, transfusion-associated
circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller
number of reported fatalities.
Reference: U.S. Food and Drug Administration Website. Fatalities reported to FDA
following blood collection and transfusion: Annual summary for fiscal year 2009.
Available at:
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/Tra
nsfusionDonationFatalities/ucm204763.htm. Accessed Janary 7, 2011.
The term used to describe patients with absence of Rh antigens is:
Rhd
Rhnull
Rhmod
Rho
Feedback
Rhnull individuals have no Rh antigens. Rhmod individuals show reduced and varied
reactivity with Rh antigens.

Red Cells Tested With Serum Tested With
Interpretation of ABO
Known Antisera Known Red Cells
Group
Anti-A Anti-B Anti-A,B A1 Cells B Cells
0 0 0 4+ 4+ ?
Using the information provided above, select the correct ABO group.
A
O
Results are inconclusive; retesting required.
Feedback
In this case, the forward type shows no agglutination; the patient's red blood cells do
not contain the A or B antigens. In the reverse type, the patient demonstrates the
presence of anti-A and anti-B, which correlates with the results obtained from the
forward typing. The blood is type O.
Which of the following red blood cells contain the most H antigen:
Group A cells
Group B cells
Group O cells
Bombay phenotype
Feedback
O cells contain only H antigen, while cells of the other ABO groups contain varying
amount of H antigen in addition to their group specific antigen(s). The classic
Bombay phenotype is characterized by the absence of A, B, and H antigens.
Which Lewis antigen(s) will be exhibited on the red cells of adults who have the Le,
Se, and H genes?
Lea
Leb
both Lea and Leb
neither Lea or Leb
Se and H
Feedback
Inheritance of both Le and Se genes produces the Leb antigen on red blood cells. The
Se gene codes for the enzyme, a-2-L-fucosyltransferase which adds L-fucose to the
type 1 precursor H (type 1). The Le gene codes for another L-fucose which forms the
Leb antigen. Some of the precursor chains are not affected by the Se gene and,
therefore, form the Lea antigen. Hence, it is possible to see both Lea and Leb in the
plasma and secretory fluids. However, only Leb adsorbs onto the red cells of adults
(most likely due to competitive binding), causing them to phenotype Le(a-b+).

A pregnant female who received RhIg at 28 weeks gestation has a positive antibody
screen at delivery. If the antibody has been confirmed as anti-D alone and reacts 1+ in
the indirect antiglobulin test with D+ red cells, performing a titration to investigate if
the anti-D is immune is good practice.
True
False
Feedback
Because lower titers could be due to both passive and immune anti-D, in the absence
of results that suggest immune anti-D, routine antibody titration is not a good use of
time compared to assuming that anti-D is passive.
Best practice guidelines do NOT recommend routine titration for women known to be
injected with RhIg and exhibiting a 2+ or less reaction with D+ red cells consistent
with passive anti-D from RhIg.
What should be done FIRST if a donor unit is found to be incompatible at the

antiglobulin phase with several different recipients?
Repeat the ABO grouping on the incompatible unit using different sera
Do a panel made up of red cells having all low-frequency antigens
Perform a direct antiglobulin test (DAT) on the donor unit
Obtain a new specimen and repeat the minor cross match
Feedback
If a donor unit is found to be incompatible at the antiglobulin phase with several

recipients, the possibility of antibody coating the red blood cells is likely. A DAT
should be performed on the donor unit.
Which of the following combination of globin chains comprise Hemoglobin H?
2 alpha, 2 beta
2 alpha, 2 gamma
4 beta chains
4 alpha chains
Feedback
Hemoglobin H is a tetramer made of four beta globin chains. Hemoglobin H occurs

when there is very limited alpha chain availability used to make normal hemoglobin
A. Hemoglobin H forms in those affected with alpha thalassemia major as well as in
people with the combination of two-gene deletion alpha thalassemia and hemoglobin
Constant Spring.
Based on the reactions below, indicate the correct blood group for each patient:
Patient #1
Forward (Cell) Typing Reverse (Serum) Typing

4+ 4+ 4+ 0 0
Patient #2

0 0 0 4+ 4+
Patient #3

4+ 0 4+ 0 4+
Patient #4

0 4+ 4+ 4+ 0
Your answers are on the left. The correct answers are on the right and highlighted.
Group AB Patient #1
Group O Patient #2
Group A Patient #3
Group B Patient #4
Feedback
The correct matching of the blood types and forward + reverse type reactions are as
follows:
Group A patients:

4+ 0 4+ 0 4+
Group B patients:

0 4+ 4+ 4+ 0
Group AB patients:
4+ 4+ 4+ 0 0
Group O patients:

0 0 0 4+ 4+
Avidity is best described by which of the following statements:
The strength with which red cells agglutinate

The strength with which multivalent antigens and antibodies bind
The strength with which univalent antigens and antibodies bind
The speed with which an antigen-antibody reaction occurs
Feedback
The term affinity refers to the strength of attraction between a single antigenic
determinant and a corresponding antigen binding site. The term avidity refers to the
total strength of the attraction between an antibody and a multivalent antigen. The
reaction between an IgM molecule (which has 10 antigen binding sites), and a
multivalent antigen is therefore much stronger than that of an IgG antibody (which
has only 2 antigen binding sites).

A2B patients have or may have which of the following:
Serum containing anti-A1.

Serum containing anti-B.
Red cells that react with anti-A and anti-B.
Feedback
A2 and A2B individuals can produce anti-A1. In fact, about 25% of A2B individuals
may have anti-A1 in their serum. Approximately 4% of all A2 individuals have
naturally occurring anti-A1 in their serum.
Which symptom of HDFN is associated with low levels of glucuronyl transferase?
Anemia
Increased reticulocyte count
Hydrops
Jaundice
Enlarged heart
Feedback
Jaundice in a newborn suffering from HDFN is associated with low levels of

glucuronyl transferase, a liver enzyme that conjugates bilirubin into its water-soluble,
excretable form.

If the mother is a Rh immune globulin (RhIg) candidate, blood safety standards

mandate that a test for weak D is compulsory when initial D typing shows a newborn
to be Rh negative.
True
False
Feedback
Weak D red cells can stimulate production of anti-D. Therefore, infants born to
mothers who are RhIg candidates must be tested for weak D.
RhIg is given to Rh negative women who deliver infants who are Rh positive or weak
D.
Which is the first marker (antigen or antibody) which will become positive after
exposure to Hepatitis B:
HBsAg
Anti-Hbs
Anti-Hbe
Anti-HBc
Feedback
HBsAg is the first hepatitis antigen to appear after infection. The first antibody
produced after infection with HBV is anti-Hbc; used to detectpresent or past infection.
Anti-Hbe is present in individuals who have recovered from acute hepatitis B
infection. Anti-HBs becomes positive later, during the recovery period.
In order to detect the presence of antibodies fixed on the RBCs of newborns one
should:
Perform a direct antiglobulin test (DAT) on the cord blood

Perform an indirect antiglobulin test (IAT) on the cord blood
Test the babys cells with typing antiserum
Look for agglutination in a mixture of mothers serum and babys cells
Feedback
A positive DAT is consistent with a diagnosis of hemolytic disease of the newborn. A

hemoglobin performed on the cord blood serves as an indicator of the severity of the
disease.
Which of the following antibodies is detected primarily in the antiglobulin phase of

the crossmatch:
Anti-Fya
Anti-M
Anti-B
Anti-P1
Feedback
The Duffy system consists of Fya and Fyb. Antibodies to these antigens are IgG and
are detected in the antiglobulin phase. Anti-M, Anti-B and Anti-P1 are typically IgM
antibodies and may agglutinate saline suspended cells at room temperature.
What is the cause of neonatal alloimmune thrombocytopenia (NAIT)?
Destruction of a neonate's platelets by alloantibodies crossing the placenta from

the mother.
Destruction of a neonate's platelets by an antibody that is produced by the
neonate's own immune system.
Decreased platelet production in the neonate.
Feedback
Neonatal alloimmune thrombocytopenia (NAIT) is caused by platelet destruction that

is the result of alloantibodies stimulated by foreign antigens during pregnancy or
blood transfusions. Platelet destruction by alloantibodies may occur in neonates if the
mother lacks the platelet-specific antigen but the baby has inherited the antigen from
its father. When maternal IgG antiplatelet antibodies cross the placenta, immune
destruction of the neonate's platelets occurs.
The antibodies that are produced are maternal and not neonatal.
NAIT is a thrombocytopenia that is caused by increased destruction of platelets and

not by decreased platelet production.
within ___________ after it has been thawed.
24 hours
8 hours
12 hours
5 days
10 days
Feedback
within 24 hours. In contrast, "Thawed Plasma" can be used for up to 5 days as a
replacement therapy for patients requiring stable clotting factors. Keep in mind that
these are two different component types and you are asked about FFP.
A positive Coombs control test in a cross match BEST indicates that the:
negative antiglobulin test was actually negative

patient's RBCs were not washed thoroughly
Coombs control cells are contaminated
Coombs reagent is contaminated
Feedback
The Coombs control should be positive in order to confirm that a negative

antiglobulin test is actually negative, and not showing a negative result due to missing
reagent.

Which of the following set of conditions would NOT allow HDN to occur as a result
of Rh incompatibility:
Mother Rh-negative, father Rh-positive

Mother Rh-negative, baby Rh-positive
Mother Rh-negative, father Rh-negative
Mother Rh unknown, baby Rh-positive
Feedback
If both parents are Rh negative, the baby would also be Rh negative.
When administering Fresh Frozen Plasma, which one of the following is considered
standard blood bank practice?
Should be ABO compatible with the recipient's red blood cells

Must be the same Rh type as the recipient
Is appropriate as a volume expander
Component should remain frozen when it is issued
Feedback
FFP should be ABO compatible with the recipient's red blood cells, but does not need
to be the same Rh type as the recipient because it is a cell-free product. FFP should
not be used as a volume expander. It should be thawed prior to issue.
Which is the first marker (antigen or antibody) which will become positive after
exposure to Hepatitis B:
HBsAg
Anti-Hbs
Anti-Hbe
Anti-HBc
Feedback
HBsAg is the first hepatitis antigen to appear after infection. The first antibody
produced after infection with HBV is anti-Hbc; used to detectpresent or past infection.
Anti-Hbe is present in individuals who have recovered from acute hepatitis B
infection. Anti-HBs becomes positive later, during the recovery period.
For infants born to Rh negative females, a test for weak D is optional when initial D
typing shows the newborn to be Rh negative.
True
False
Feedback
The statement is false. For such infants, the weak D test is mandatory when initial D
typing shows the newborn to be Rh negative.
Which D variant has a qualitative difference in the D antigen that allows individuals with the D variant to produce anti-D? Select all that apply.
weak D
partial D
partial weak D
None of the listed D variants have a qualitative difference in the D antigen
Feedback
Both partial D and partial weak D have a qualitative difference in the D antigen that allows individuals with the D variant to produce anti-D to
the D epitopes that they lack.
During routine inspection, a unit of unexpired blood was noticed to have a black color
with numerous small clots. What is the likely cause for this observation?

the unit was frozen
donor had DIC
viral contamination
bacterial contamination
Feedback
Bacterial contamination can manifest itself in several ways including: the presence of
clots, darker purple-black color of blood unit, unit can appear cloudy, hemolysis may
be present.

An Rh negative mother has just given birth to an Rh positive baby. Her physician suspects that she has
experienced a fetal-maternal hemmorhage since her rosette test was positive. Upon performing the
Kleihauer-Betke stain procedure, the percentage of fetal cells is found to be 0.85%. The mother's total
blood volume is 4,565 mL. What dose of Rh Ig (RhoGam) should be administered to the mother?
1 vial
2 vials
3 vials
4 vials
Feedback
Rh immune globulin, also known as Rh Ig or RhoGam, is used to help prevent an Rh negative mother
from becoming sensitized to the D antigen from an Rh positive baby. To do this, vials of Rh Ig must be
administered correctly. One full dose vial (300g or equivalent) per 30 ml of D+ whole blood (15 ml
D+ packed RBCs).
To calculate how many vials are needed, the following formula can be employed:
KB% x blood volume = volume of baby blood
In this case: 0.85% (0.0085) x 4,565mL= 38.8 mL baby blood in maternal circulation
38.8mL / 30 mL per Rh Ig vial = 1.29 vials
1.29 vials can be rounded to 1 vial. In addition, an extra vial is always added. Therefore, 2 vials is the
correct answer.
Platelets should be stored at what temperature:
1-6 degrees Celsius

10-16 degrees Celsius
Feedback
Platelets should be stored at 20-24 degrees Celsius with continuous gentle agitation.
They should be infused within 4 hours after the seal on a platelet unit is broken.
An Rh negative pregnant female has produced anti-D and the physician has decided to
use molecular typing to determine if the fetus is at risk. Is the following statement true
or false?
If molecular genotyping demonstrates that the father is homozygous for the

RHD allele, molecular typing of the fetus is also indicated.
True
False
Feedback
If the father is homozygous for the RHD allele, all offspring will be Rh positive and
do not need to be tested for D. The fetus will be at risk for HDFN and should be
monitored.
Antibody identification interpretations would be considered correct 95% of the time

or have a P value of 0.05 if you have:
2 positive reactions to rule in an antibody and 2 negative reactions to rule out an

antibody
1 positive reaction to rule in an antibody and 3 negative reactions to rule out an
antibody
3 positive reactions to rule in an antibody and 3 negative reactions to rule out an
antibody
3 positive reactions to rule in an antibody and 1 negative reaction to rule out an
antibody
Feedback
Based on Fisher's exact method, the probability of having reliable results increases if
you are able to have more rule out and rule in cells. So 3 to rule in and 3 to rule out
would give the highest probability. By comparing the patterns of reactivity and non-
reactivity, we can more safely assume that an observed pattern is not the result of
chance alone.
If an average-weight adult male patient with a 7 gram/dL hemoglobin is given two

units of packed cells, what would be the approximate new hemoglobin value
(assuming there is no active bleeding or other predisposing factors that would shorten
the survival of the blood cells)?
7.5 gm/dL
9.0 gm/dL
10.5 gm/dL
12.0 gm/dL
15.0 gm/dL
Feedback
One unit of Red Blood Cells increases the hemoglobin level by approximately 1g/dL
in an adult who is not actively bleeding and has no other predisposing factors that
would shorten the survival of the transfused blood cells.

Feedback

Tiny volumes of D+ red cells (e.g., as little as 0.1 mL) can stimulate production of
anti-D in some individuals.
True
False
Feedback
Although the D antigen is very immunogenic, the ability to produce anti-D varies
greatly among individuals.
Some people will make anti-D after exposure to exceedingly small volumes of Rh
positive red cells such as 0.1 mL.
HLA-A and HLA-B antigens can be detected using which of the following
techniques?
Standard crossmatch
Lymphocyte cytotoxicity
Immunofluorescent staining
Mixed lymphocyte cultures
Feedback
HLA-A and B antigens are detected by mixing the lymphocytes being tested with
known HLA antisera and complement and then measuring the cell lysis
(leukocytoxicity) that occurs.

Which of the following kappa / lambda ratios is found in normal serum:
4:1
3:1
2:1
1:1
Feedback
The normal kappa/lambda ratio in serum is 2:1. A kappa/lambda ratio outside of 2:1 is
an indication of monoclonal gammopathies.
The use of the direct antiglobulin test is indicated in all the following except:
Transfusion reactions
Autoimmune hemolytic anemia
Hemolytic disease of the newborn
Detection of alloantibodies in serum
Feedback
The direct antiglobulin test (DAT) detects antibodies coating RBCs. Alloantibodies
are primarily detected in the serum, although they may also sometimes be eluted from
previously transfused RBCs in the patient's blood.
Based on the phenotype of the RBC screening cells, and patient results shown on the
right, which of the following antibodies CANNOT be ruled out?
Anti-C
Anti-Jka
Anti-M
Anti-Fya
Feedback
Rule-out is a process by which antibodies are identified as being unlikely in a given

sample because of the absence of an expected antigen-antibody reaction. In other
words, the absence of a reaction is noted with a cell that is positive for the
corresponding antigen.
Although rule-out procedures may vary somewhat from institution to institution, the
following general principles apply:
1. Non-reactive cells are selected for rule-out. To be classified as non-reactive, a

cell must NOT have reacted at any phase of testing in a given panel or screen.
2. Using the logic that if the rule-out cell is positive for a given antigen, it should
have reacted with the corresponding antibody, you can rule-out antibodies that
correspond to antigen positive cells.
3. To increase the probability that rule-out will not mistakenly eliminate a
weakly-reacting antibody that exhibits dosage*, use only cells that are
homozygous for the corresponding antigen for those systems that generally
show dosage. Generally these include: C, c, E, e, Fya, Fyb, Jka, Jkb, M, N, S,
and s.
In this case, it is only possible to rule out on screening cell 2 since it demonstrates a
negative reaction with the patient serum. Anti-C cannot be ruled out since the C
antigen is heterozygous on screening cell 2 with c. Anti-Fya cannot be ruled out since
this antigen is not present on screening cell 2. Anti-M and anti-Jka can be ruled out
since the antigens are homozyous while demonstrating a negative reaction on
screening cell 2.
Rule-out, while very useful, can lead to error. Ruling out an antibody should be
combined with other supporting data to increase confidence in the solution; the more
data collected, the higher the probability that the final solution is correct.
*Dosage means that there are two "doses" of the same antigen present on the red cells
. Antibodies that exhibit dosage react more strongly with homozygous cells (e.g., Jka
Jka) than with heterozygous cells (e.g., Jka Jkb) .
Agglutination reactions in blood bank are graded from negative (0) to 4+. A reaction
that has numerous small clumps in a cloudy, red background is:
1+
2+
3+
4+
Feedback
1+ reaction has numerous small clumps and cloudy red supernatant
2+ has many medium-sized clumps and clear supernatant.
3+ has several large clumps and clear supernatant
4+ has one solid clump, no free cells, and clear supernatant

Which of the following is the most prevalent blood type found in the United States:
O positive
A positive
B positive
O negative
Feedback
O positive is the most prevalent followed by A positive.
Granulocyte Concentrates MUST be administered within ______ of collection.
12 hours
24 hours
3 days
30 days
35 days
Feedback
Granulocytes should be transfused as soon as possible and always within 24 hours.

Which one of the following types of transfusion reactions caused the highest number
of transfusion-related fatalities that were reported to the U.S. Food and Drug
Administration (FDA) from 2005 - 2009?
Anaphylactic reactions
Febrile non-hemolytic reactions
Transfusion-related acute lung injury (TRALI)
Transfusion-associated graft versus host disease (TA-GVHD)
Feedback
In combined fiscal years 2005 through 2009, transfusion-related acute lung injury
(TRALI) caused the higest number of reported fatalities (48%), followed by
hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%)
incompatibilities. Complications of microbial infection, transfusion-associated
circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller
number of reported fatalities.
Reference: U.S. Food and Drug Administration Website. Fatalities reported to FDA
following blood collection and transfusion: Annual summary for fiscal year 2009.
Available at:
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/Tra
nsfusionDonationFatalities/ucm204763.htm. Accessed Janary 7, 2011.
A rosette test to screen for Fetal Maternal Hemorrhage should not be performed if the
newborn has a weak D antigen.
True
False
Feedback
The statement is true. A rosette test cannot be done to screen for FMH if the fetus is
weak D because false negatives may result.
A rosette test to screen for FMH is contraindicated if the newborn is weak-D positive.
True
False
Feedback
The statement is true. A rosette test cannot be done to screen for FMH if the fetus is
weak-D positive because false negatives may result. In this test, a sample of maternal
blood is incubated with Rho(D) immune globulin, which will bind to fetal Rh positive
cells. When a weak D antigen is expressed, the Rho(D) immune globulin may not
bind entirely, which will not allow for rosetting to form once the indicator cells have
been added.
Given the following commonly used nomenclature systems, which one of the Rh
genotypes listed below is heterozygous for the C antigen?
WienerFisher-Race (haplotype)
RoDce
R1 DCe
R2DcE
RzDCE
rdce
rdCe
rdcE
rydCE
R1r
R1R1
R2r"
r"r
Feedback
R1r is the only genotype listed that is heterozygous for the C antigen.
Weiner Fisher-Race
R1r DCe/dce
R1R1 DCe/DCe
rr dce/dce
R1R2 DCe/DcE
R2r DcE/dce
R2R2 DcE/DcE
rr dCe/dce
rr dCe/dCe
rr dcE/dce
rr dcE/dcE
R0r Dce/dce
Type B blood is found in higher frequency in:
African Americans
Caucasians
Asians
Hispanics
Feedback
According to the Red Cross, the mix of the different blood types in the U.S. population is:
Caucasians African American Hispanic Asian
O+ 37% 47% 53% 39%
O- 8% 4% 4% 1%
A+ 33% 24% 29% 27%
A- 7% 2% 2% 0.5%
B+ 9% 18% 9% 25%
B- 2% 1% 1% 0.4%
AB + 3% 4% 2% 7%
AB - 1% 0.3% 0.2% 0.1%
b You answered the question incorrectly.

Evaluate the panel shown on the right. Which antibody(ies) are most likely causing
this reaction?
Note: Use the reaction patterns to identify the most likely antibody(ies). There may be
additional antibodies present that cannot be ruled out.
A PDF of the panel is also available on this page to enhance viewing, if necessary.
Anti-k
Anti-C
Anti-Fyb
Anti-Fya
Anti-Lea
Anti-M
Feedback
Anti-Fyb and anti-Lea are the correct answers. Judging by the difference in reactions at
different phases, it is very likely that more than one antibody is present. Since some
reactions are only present during IS and others only show up during 37o and AHG,
there may be a warm and cold antibody present together. Other antibodies such as
anti-C, for example, may not be ruled out; however, the pattern of reactivity does not
match- leaving us with Anti-Fyb and anti-Lea.

Which of the following is NOT required to be in a machine-readable format on a
blood component label?
ABO & Rh of the donor

Product code
Collection facility
Outdate
Feedback
The correct answer is D. The outdate may be handwritten.

21 CFR 606.121 requires this information be machine-readable:
A unique collection facility identifier

Lot number relating to the donor
Product code
ABO and Rh of the donor
Which of the following blood groups reacts least strongly with Anti-H:
O
A2
A1
A1B
Feedback
The amount of H antigen present on red cells varies by blood group: O > A2 > B >
A2B > A1 > A1B.

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The correct answers are highlighted below

Rule-out is a process by which antibodies are identified as being unlikely in a given

1. Non-reactive cells are selected for rule-out. To be classified as non-reactive, a

Question Difficulty: Level 7

You answered the question incorrectly.

The proper storage requirements for granulocyte concentrates is:

The correct answer is highlighted below

1 - 6 degrees Celsius, < 12 hours

Question Difficulty: Level 7

You answered the question correctly.

The correct answer is highlighted below

Hives and rash

You answered the question incorrectly.

The correct answer is highlighted below

Fya-; Fyb+; C+c+; K+k+

You answered the question incorrectly.

If a recipient has anti-c, which donor unit should be selected?

Wiener Fisher-Race (haplotype)

The correct answer is highlighted below

It is necessary to convert Wiener system shorthand nomenclature to Fisher-Race

NOTE #2: When referring specifically to an antigen: Rho = D; rh = C; rh = E; hr

You answered the question incorrectly.

You answered the question correctly.

The correct answer is highlighted below

You answered the question incorrectly.

What is the purpose of a major crossmatch?

The correct answer is highlighted below

The purpose of the major crossmatch is to determine compatibility between the

You answered the question correctly.

Which symptom of HDFN does phototherapy help prevent?

The correct answer is highlighted below

Phototherapy helps prevent kernicterus by chemically altering the bilirubin in the

You answered the question incorrectly.

A patient with two or more documented febrile nonhemolytic transfusion reactions

The correct answer is highlighted below

Pre-storage leukocyte reduction prevents febrile non-hemolytic transfusion reactions

You answered the question correctly.

The correct answer is highlighted below

Wash the patient cells and retest.

You answered the question incorrectly.

The correct answer is highlighted below

You answered the question correctly.

The correct answer is highlighted below

Reactions will be enhanced

You answered the question correctly.

Which of the following statements best describes Rh antibodies:

The correct answer is highlighted below

Naturally occurring, IgM

Rh antibodies are of the IgG class of immunoglobulins, and occur as a result of

You answered the question incorrectly.

The correct answer is highlighted below

You answered the question correctly.

Match the following antibodies to their appropriate immunities:

IgM Antibodies: anti-M, anti-I

IgG Antibodies: anti-K, anti-Jka

You answered the question correctly.

The correct answer is highlighted below

5 hours after transfusion

Delayed hemolytic transfusion reactions (DHTR) are usually caused by a secondary

The correct answer is highlighted below

ABO & Rh of the donor

The correct answer is D. The outdate may be handwritten.

A unique collection facility identifier