IMMUNOLOGY SEROLOGY AND BLOOD BANKING

 Group B secretors have ___ antigen/s in their secretions. B and H

 Which of the following enhancement media decreases the zeta potential, allowing antibody and antigen to come closer
together? LISS
 004004:___:___ hr’; c; Rh4
 What does a minor crossmatch consist of? Recipient red cells and donor plasma
 In haemoglobin determination using copper sulphate test, a drop of blood is allowed to fell gently at a height of about
___ above the surface of the solution. 1 cm
 A unit of whole blood is collected at 10:00 a.m. and stored at 20°C–24°C. What is the last hour platelet concentrates may
be made from this unit? 4:00 p.m.
 What is the component of choice for a patient with chronic granulomatous disease (CGD)? Granulocytes
 Cryoprecipitate may be used to treat all of the following: von Willebrand’s disease; Hypofibrinogenemia; Factor XIII
deficiency
 What component(s) is (are) indicated for patients who have anti-IgA antibodies? Washed or deglycerolized RBCs
 What is a special condition for the storage of platelets? Platelets require constant agitation at 20°C-24°C
 Which of the following is TRUE about ACD (acid citrate dextrose)?
o Acts as an anticoagulant by binding calcium
o To prevent the clotting of 100 ml of blood 15 ml ACD is required
o With a shelf life of 75% survival after 21 days of storage
 Which component has the longest expiration date? Frozen RBCs
 A blood donor had an Avodart intake on January 2017. He is deferred to donate blood until: June 2017
 Which of the following blood group system is decribed to be strongly associated with delayed haemolytic transfusion
reactions and with intravascular hemolysis? Jk
 What phenotype is most commonly observed and exclusively in blacks? U-
 This is the most serious and potentially lethal and it occurs during or immediately after blood has been transfused. acute
 It is a cold-reacting antibody associated with paroxysmal cold hemoglobinuria (PCH). Autoanti-P
 These antigens reside on erythrocyte membrane-associated protein (ERMAP). Sc
 Hodgkin’s lymphoma (Sternberg-Reed cells): Lex
 Which phenotype could not result from the mating of a Sc(a+b+) female and a Sc(a+b+) male? Sc(a-b-)
 Which method is used to test for HIV infection in infants who are born to HIV-positive mothers? Polymerase chain
reaction
 An antibody formed in response to antigens from individuals of same species is called: Alloantibody
 Which disease may be expected to show an IgM spike on an electrophoretic pattern? Waldenström’s macroglobulinemia
 A positive DAT may be found in in which of the following situations? HDN
 What do Coomb’s control cells consist of? Type O-positive cells coated with Anti-D
 An example of a technical error that can result in an ABO discrepancy is: Cell suspension that is too heavy
 The immunodominant sugar responsible for blood group A specificity is: N-acetyl-D-galactosamine
 Rh antibodies are primarily of which immunoglobulin class? IgG
 The Rh system was first recognized in a case report about what disorder? Hemolytic transfusion reaction
 What is Rh null cells lack? Rh antigens
 Which of the following blood group systems is known for showing dosage? Kidd
 Raymhon, a 23-year old patient prevails a Mycoplasma pneumonia infection. What antigen will most likely develop a cold
autoantibody with specificity? I
 Which blood group system is associated with resistance to Plasmodium vivax malaria? P
 Changes of RBC shape in the forms of elliptocytes, acanthocytes, or ovalocytes are evident to: D
 Based on RBC surface antigens, “I” stands for: Individuality
 Lewis antibodies are frequently encountered in pregnant women. It is not considered significant in transfusion medicine.
 Platelet concentrates prepared by apheresis should contain how many platelets? 3.0 x 10 11
 The haematocrit level of an allogeneic blood donor should be at least ___%. 38
 Quality for RBCs requires a maximum haematocrit level of: 80%
 The purpose of the antibody screen is to detect: unexpected antibodies
 Screening cells are commercially prepared group ___ cell suspension obtained from individual donors. O
 The endpoint of the gel test is detected by: agglutination
 Solid phase reactions are stable for observation or review for ___ days. 2
 Which type of transplantation requires all cellular blood components to be irradiated? bone marrow
 The minimum interval allowed between plateletpheresis component collection procedure is: 48 hours
 Therapeutic cytapheresis is used in patients with: Sickle cell disease
 Patients at greatest risk of developing Transfusion-Associated Circulatory Overload (TACO) may include:
o Children
o elderly people
o Patients with chronic normovolemic anemia
o Patients with sickle cell disease
 The first retrovirus to be associated with human disease was: HTLV-1

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  What is the most common parasitic complication of transfusion? Plasmodium species
 Which of the following is the most frequently transmitted virus from mother to fetus? CMV
 The main difference between the fetus and the newborn is: bilirubin metabolism
 RhIg is indicated for: mothers who are Rh-negative
 Paternity Index (PI) is a likelihood ratio. It is calculated one genetic system at a time and is sometimes referred to as the
system index.
 A positive DAT is expected in association with: warm reactive autoantibodies
 Kernicterus is caused by the effects of: unconjugated bilirubin
 It has been implicated in severe haemolytic transfusion reactions. anti-K
 The interval between whole blood donation is: 56 days
 Antibody screen: ___
o Maternal’s serum
o Infant’s serum
 The anticoagulant most often used for neonate transfusion is: CPDA-1
 These antigens are produced by the same Rh gene complexes that produce C and D antigens. G
 Serological testing does the blood bank technologist perform when determining the blood group of a patient.
Genotyping
 Which of the following describes the expression of most blood group antigens? Codominant
 A mating between AO and BO persons can result in an offspring with a blood type of:
1. A 3. O
2. B 4. AB
 Based on Grading System of Agglutination, 3+ is interpreted as: Several large aggregates; Few free cells with clear
supernatant
 Which antibodies to a component of complement are contained in the rabbit polyspecific anti-human globulin reagent
for detection of in vivo sensitization? Anti-IgG and anti-C3d
 What antibodies are formed by a Bombay individual? Anti-A, B, and H
 Increasing the ionic strength of the medium, it ___ the rate of agglutination of antibody with antigen. decreases
 The acquired B phenomenon is only seen in group ___ persons. A; O
 What should be done if all forward and reverse ABO results as well as the autocontrol are positive? Wash the cells with
warm saline, autoadsorb the serum at 4°C
 A person in need of an RBC transfusion who is an A2 with anti-A1 can be transfused ___ cells. A and O
 The color of Rh tying sera is: white
 In the Anomalous Results in ABO Testing, Group II is described as: Missing weak antigens
 A female patient at 28 weeks’ gestation yields the following results:
*Patient cells: Anti-A: 3+; Anti-B: 4+
*Patient serum: A1 cells, negative; B cells: 1+; O cells: 1+
Which of the following could be causing the ABO discrepancy? Alloantibody in patient serum
 When cord blood is used, reverse grouping may be affected by Wharton’s jelly which causes rouleaux formation, what
is the best resolution to be done? 6-8 times of washing with NSS
 These antigens are almost as immunogenic as D antigens. c
 Which of the following statements is FALSE about plasma derivatives? Plasma derivatives have a shelf life of 10 years
when stored between 1◦C and 6◦C
 A patient has a hemolytic reaction to blood transfused 8 days ago. What is the most likely cause? Delayed
immunologic, probably due to an antibody such as anti-Jka
 Which of the following individuals is acceptable as a blood donor? A 29-year-old man who received the hepatitis B
vaccine last week
 Rh antibodies generally develop from ___ months after the initial immunization by red cells. 4
 Immunoglobulin found in secretions (tears): IgA
 Pentameric immunoglobulin: IgM
 Population of NK cells: 5-10%
 Cytokines are released by: macrophages, T cells, B cells
 This dengue antigen has been detected in the serum of dengue virus infected patients as early as 1-day post
onset of symptoms (DPO), and up to 18 DPO. NS1
 The most common fungal infection for AIDS patients is caused by: Cryptococcus neoformans
 Restriction Fragment Length Polymorphism (RFLP) is a/an ___ assay. Molecular
 Large granular lymphocytes: NK cells
 CD 34: HSC
 RPR positive blood bag, what to do next? Discard blood bag
 CEA is a tumor marker associated with: Colorectal cancer
 Which of the following is the antigen determinant? Epitope
 CYFRA 21-1 is a maker for ___ cancer. Lungs
 Which hepatitis marker is present during active infection and indicates that patient is highly infectious? HBeAg
 Which virus does NOT cause transfusion-transmitted hepatitis? HAV

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  Anti-smooth muscle antibodies (ASMA) are primarily seen in: Chronic active hepatitis
 Who received a Nobel prize because of discovering phagocytosis? Ellie Metchnikoff
 Which of the following constitutes the membrane attack complex of the complement system? C5b678
 Major advantage of gel technology: Standardization
 Anti-smooth muscle antibodies (ASMA) are primarily seen in: Chronic active hepatitis
 What is the most common bacterial contaminant in blood products? Y. enterocolitica
 The first recorded blood transfusion in history is between this head of state and three donor. Pope Innocent VII
 Blood group Lutheran is derived from: 1 donor named Luteran
 This is known as the marker Hepatitis B infectivity. HBeAg
 Temperature of BB refrigerator: 2-6 OC
 Which of the following is the most common immunodeficiency? Selective IgA deficiency
 The presence of HLA B27 is highly associated with what disease? Arthritic spondylitis
 These are expressed in the developing fetus and in rapidly dividing tissue, such as that associated with tumors,
but that are absent in normal adult tissue: Oncofetal antigens
 It is used as the receptor for the sheep red blood cells (sRBC) for e-rosette assay: CD2
 Which of the following activates both T and B cells? Pokeweed mitogen
 Size of pore in leukoreduction filter. 10um
 Function of IL-8: Inflammation

 HISTORICAL PERSPECTIVES
430 B.C. Early concept of immunity Karl Landsteiner Human Blood Group
11th century Smallpox in China antigens
1718: Lady Mary Variolation (“vacca” means Alexander Flemming Penicillin
Montagu cow) Robert Kaus Precipitin
1774: Benjamin Jesty Cowpox to protect against Susumu Tonegawa Antibody diversity
smallpox Luc Montagnier & HIV virus
1798: Edward Jenner Smallpox vaccination Francoise Barre-
(cellular immunity) Sinoussi
1880-1881: Louis Chicken cholera, anthrax, Burton Hypogammaglobulinemia
Pasteur rabies and therapeutic
vaccines
Elie Metchnikoff Cellular theory of immunity
through PHAGOCYTOSIS
Jules Bordet Complement
Macfarlane Burnet Clonal Selection Theory
Georges Kohler 1st Monoclonal Antibodies
Porter and Edelman Structure of Antibodies
Robert Koch Type IV Hypersensitivity
Reaction
1900: Paul Ehrlich Antibody Formation
Emil Von Behring and Humoral theory of immunity
Kitasata
Roux Passive immunization
Marrack Hypothesis of antigen-
antibody binding
Salk and Sabin Polio vaccine
Reed Yellow fever vaccine
1958-1962 HLA
1972 Antibody molecule
identification
George Snell Existence of gene control
graft rejection
Jean Dausset Human cells (Decrease graft
rejection)
Baruj Benacerraf Antigen resistance and
susceptibility
Mosmann Th 1 versus Th 2 model
Edward Donnall Thomas Bone marrow transplant
Joseph Murray Kidney transplant
FOXP3 Gene directing regulatory T-
cell
Frazer HPV vaccine
Charles Richet Anaphylaxis
Von Behring Serum Anti-toxins and
therapy
Rosalyn Yalow Radioimmunoassay
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CLASSIFICATION OF IMMUNOGLOBULINS
CONSIDERATIONS/ IgG IgA IgM IgD IgE

PARTICULARS

Heavy Chain Gamma Alpha Mu Delta Epsilon

Structure Monomer Monomer/Dimer Pentamer Monomer Monomer

% serum 70-75 10-15 Approximately 0.2 0.002

10

Sedimentation 7S 7S 19 S 7S 8S
coefficient

Half-life in serum 23 days 5 days 6 days 1-3 days 2-3 days

MW (Daltons) 150,000 350,000 900,000 180,000 190,000

Complement All except NO BEST NO NO

fixation IgG4

Crosses placenta All except NO NO NO NO

IgG2

J chain NO YES YES NO NO

Function/s Protects Decreases Activates Unknown; Prevents

bacteria and stress, complement; however, it parasitic worm
viruses resistance to causes lysis of helps in infection;
through infection microbes and activation Hypersensitivity
phagocytosis agglutination of B-cells reaction

Clusters of Differentiation (CD)

CD Leukocytes
CD2 T lymphocytes
CD4 T lymphocytes
CD8 T lymphocytes
CD10 Pre-B lymphocytes, common ALL
CD12 Monocytes, granulocytes, platelets
CD15 Granulocytes
CD19 B lymphocytes
CD24 B lymphocytes, granulocytes
CD27 T lymphocytes, plasma cells
CD33 Myeloid leukemia
CD34 Hematopoietic stem cells
CD39 B lymphocytes, macrophages
CD41a Glycoprotein IIb/IIIa
CD45 Leukocytes
CD47 Leukocytes, platelets
CD68 Macrophages
CD69 Activated Lymphocytes
CDw70 Reed-Sternberg cells
4 CD77
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SUMMARY OF THE CELLS OF THE IMMUNE SYSTEM
Cells of the Natural Immune System
CELL FUNCTION
Granulocytes
Neutrophil Phagocytosis, inflammatory
response
Eosinophil Neutralization of basophil & mast
cell products
Destruction of some helminths
Basophil Hypersensitivity reaction
Mononuclears
Monocyte Phagocytosis
Tissue cells
Mast cells Hypersensitivity reaction
Macrophages Phagocytosis; elimination of
bacteria, intra – cellular parasites,
tumor cells; secretion of cell
mediators; antigen presentation
Phagocytosis, presentation of
antigen to helper T lymphs in blood
& lymphoid organs
Lymphocyte
Natural Killer (NK) cells 1st line of defense against tumor
cells & cells infected with viruses
Cells of the Acquired Immune System
CELL FUNCTION
T lymphs Cell-mediated immunity.
Helper/inducer T cells Orchestrate cell-mediated
immunity. Activate B cells,
cytotoxic cells, & NK cells.
Cytotoxic/suppressor T cells Suppressor cells inhibit helper T
cells. Cytotoxic cells kill other cells.
T regulatory cells Suppress immune response to self.
B lymphs After antigenic challenge,
transform into blasts that give rise
to plasma cells & memory cells.
Plasma cells Antibody production.
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COMMENTS/CONSIDERATIONS/PARTICULARS
Respond to chemotaxins.
Granules contain bactericidal enzymes.
Some phagocytic ability.
Granules contain histamine, heparin, eosinophil
chemotactic factor A.
In allergic reaction, bind IgE.
Granules release contents in presence of antigen.
Migrate to tissues, become macrophages.
Respond to chemotaxins.
Connective tissue cells.
Resemble basophils but larger & more granules.
Bind IgE.
Activated by contact with microorganisms
Activated by contact with microorganisms or
cytokines from T lymphocytes (lymphs)
LOCATION OF MACROPHAGES
1. connective tissue: histiocytes
2. lungs: alveolar macrophages
3. liver: Kupffer cells
4. kidneys: mesanglial cells
5. brain: microglial cells
6. bone: osteoclasts
7. joints: synovial A cells
Initiate acquired immune response.
Lymphs without T or B markers.
No unique surface antigens, but CD16+ & CD56+.
Bridge between innate & acquired immunity.
Lack of specificity.
Stimulated by cytokines.
Respond early in infection.
Provide time for T & B cells to be activated. <20%
of lymphs.
COMMENTS/CONSIDERATIONS/PARTICULARS
Derived from cells in bone marrow.
Develop T-cell– specific surface antigens in
thymus. 60%–80% of lymphocytes.
CD4+; 2/3 of peripheral T cells.
Normal CD4 = 1,000/μL.
In AIDS, <200/μL.
CD8+ 1/3 of peripheral T cells.
Normal CD4:CD8 ratio of 2:1. In AIDS, <0.5:1.0.
CD4+ & CD25+.
Develop in bone marrow.
When mature, have surface Igs (IgM, IgD) that act
as receptors for antigens.
10%–20% of lymphocytes.
In peripheral lymphoid organs.
 Non-dividing.
Die in a few days.
Memory cells Respond to antigen when Present in the peripheral lymphoid organs.
encountered again with↑ speed & Live months to years.
intensity.

Hypersensitivity Reaction
Is an enhanced immune reaction to an antigen
POINT OF TYPE I: TYPE II: CYTOTOXIC TYPE III: COMPLEX TYPE IV: T-CELL
DIFFERENTIATION ANAPHYLACTIC DEPENDENT
Key reactant(s) IgE (reactions can be IgG, IgM, complement, IgG, IgM, CD4+ T cells,
systemic but most cellular antigens complement, macrophages,
are localized) (complement-fixing IgG soluble antigens monocytes (these cells
or IgM antibodies are deposits of Ag-Ab release substances
directed against cellular complexes such as proteases,
or tissue antigens such (complexes may be collagenases,
as those found on the deposited in cathepsins, and TNF)
surface of white blood extravascular tissues,
cells (WBCs) and which results in
platelets) infiltration by
neutrophils and local
tissue damage)
Mechanism Release of mediators Cytolysis due to Ab & Deposits of Ag-Ab Release of cytokines
from mast cells & complement complexes
basophils (release of in tissues
histamines and the
synthesis of
leukotrienes)
Onset of Immediate Immediate Immediate Sensitization after
symptoms 1st contact with
antigen, symptoms
upon re-exposure
Examples Anaphylaxis, hay Transfusion reactions, Arthus reaction, Contact dermatitis,
fever, bronchial Hemolytic disease of the serum sickness, hypersensitivity
asthma, food allergies, newborn, autoimmune systemic lupus pneumonitis,
urticaria (hives) haemolytic anemia, erythematosus (SLE), tuberculin skin test
certain drug allergies, rheumatoid arthritis
immune (RA)
thrombocytopenia

Types of MHC
POINT OF MHC I MHC II MHC III
DIFFERENTIATION
Gene Products HLA-A DP Complement
HLA-B DQ TNF
HLA-C DR Heat Shock Proteins
Steroid Enzymes
Cellular Expression Platelets TH cells (species variable) None
TC-cells B-cells
B-cells Macrophages (weak)
Macrophages Dendritic cells
Dendritic cells Some tumor cells
Endothelial cells
Hepatocytes (weak)
Antigen Specificity 8–10 amino acid peptides 13–18 amino acid peptides N/A
Antigen Presentation CD8+ T-cells CD4+ T-cells None
Cellular Location of Endogenous (endoplasmic Exogenous (membrane Membrane Receptor
Recognition reticulum) receptor)

SUMMARY OF OTHER IMMUNOLOGICAL AND SEROLOGICAL TESTS

SDSD Oudin’s Test Overlaid on the bottom of the tube

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 SDSD Rocket –Laurel Presence of cone
SDDD Ressler’s Test Arc formation
SDDD Radial Immunodiffusion Precipitin Ring/Disc
DDSD Oakley & Fulthrope (Modified Oudin) Precipitin Band or line
DDSD CIE pH: 8.2-8.3 (migration of line/band)
DDDD Outcherlony Precipitin line
*SDSD- single diffusion single dimension; SDDD- single diffusion double dimension; DDSD- double diffusion single dimension; DDDD- double diffusion double dimension

ANA PATTERN
1. homogenous/diffuse Anti-DNA Often SLE
Anti-DNP Usually RA
Anti-histone

2. peripheral/rim Anti-DNA Severe SLE

3. nucleolar Anti-nucleolar Scleroderma

4. speckled Anti-RNA Mixed Connective Tissue

ENA Disease (MCTD), and
Anti-Sm
40% of Scleroderma patients
5. centromere Anti-centromere CREST

Hepatitis Profile
CONSIDERATION/ HEPATITIS A HEPATITIS B HEPATITIS C HEPATITIS D HEPATITIS E
DESCRIPTION
INCUBATION 15-45 30-180 15-150 X X
(days)
ONSET Acute Insidious Insidious Replication Sporadic and
Epidemic
MODE OF Feco-oral Parenteral, Parenteral, Sexual Parenteral Feco-oral
TRANSMISSION Sexual, Perinatal
PROGNOSIS Good/Not Chronic Chronic Moderate Co-infection & Good
Superinfection
with HBV
OTHER Infectious hepatitis Serum hepatitis; Non-A, Non-B Seen most Clinically
PARTICULARS Post-transfusion hepatitis; Majority commonly in resembles HAV
hepatitis of post-transfusion intravenous infections; Is
non-A, non-B drug users and not associated
hepatitis cases are hemophiliacs with
caused by HCV hepatocellular
carcinoma

RPR/VDRL (Non-treponemal Serologic Tests)

CONSIDERATIONS/PARTICULARS VDRL RPR
Visualization Flocculation (Microscopically) Flocculation (Macroscopically)
Antigen Cardiolipin & Lecithin Cardiolipin & Charcoal
Antibody Reagin Sample
Heat Activation YES NO
Presence of Clumping (POSITIVE) YES YES

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