Advanced Clinical Hematology
Chapter Exam Questions
Course Introduction
Advanced Clinical Hematology explores the intricate mechanisms underlying blood disorders and the latest diagnostic, therapeutic, and management approaches in hematological practice. The course delves into advanced topics such as leukemias, lymphomas, anemias, coagulation disorders, and transfusion medicine, emphasizing current research findings, evidence-based clinical guidelines, and the interpretation of laboratory data. Students gain hands-on experience with advanced diagnostic techniques, critical evaluation of clinical cases, and multidisciplinary approaches to patient care, preparing them to address complex hematological challenges in clinical settings.
Recommended Textbook
Basic and Applied Concepts of Immunohematology 2nd Edition by Kathy D. Blaney
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16 Chapters
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2
Chapter 1: Immunology: Basic Principles and Applications in the Blood Bank
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Sample Questions
Q1) The major histocompatibility complex is located on chromosome 6 and is important in all the following immune functions except:
A) recognition of nonself.
B) graft rejection.
C) hemolysis.
D) coordination of cellular and humoral immunity.
Answer: C
Q2) What immunoglobulin class reacts best at room temperature at immediate spin?
A) IgM
B) IgA
C) IgE
D) IgG
Answer: A
Q3) In a lymphocytotoxicity test, cells that take on the dye:
A) do not recognize a human leukocyte antigen.
B) recognize a red cell antibody.
C) are not affected by complement.
D) are recognized by a specific antibody.
Answer: D
Page 3
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Chapter 2: Blood Banking Reagents: Overview and Applications
in Immunohematology
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Sample Questions
Q1) The evidence for reagent red cell deterioration may include which of the following?
A) Spontaneous agglutination
B) Significant hemolysis
C) Loss of agglutination strength over time
D) All of the above
Answer: D
Q2) Which of the following statements is true regarding IgG-sensitized red cells?
A) They must be used to confirm a negative antiglobulin tube test.
B) They must be used to confirm a positive antiglobulin test.
C) They must be used to confirm a direct antiglobulin test that was negative with anti-C3d.
D) They should be used only with the indirect antiglobulin test.
Answer: A
Q3) Monoclonal antibodies are prepared in:
A) vitro.
B) vivo.
C) laboratory animals.
D) humans.
Answer: A
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Chapter 3: Genetic Principles in Blood Banking
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Sample Questions
Q1) Equal expression of two different inherited genes as in most blood group systems
A)Haplotypes
B)Recessive
C)Amorphic genes
D)Codominant genes
E)Polymorphic
Answer: D
Q2) When a gene product is expressed only when it is inherited by both parents
A)Haplotypes
B)Recessive
C)Amorphic genes
D)Codominant genes
E)Polymorphic
Answer: B
Q3) What is meant by the term autosomal?
A) A trait that is not carried on the sex chromosomes
B) A trait that is carried on the sex chromosome
C) A trait that is expressed only in the parents
D) A gene that does not express a characteristic
Answer: A
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Chapter 4: Abo and H Blood Group Systems and Secretor
Status
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Sample Questions
Q1) Approximately what is the percentage of individuals who demonstrate H in their saliva?
A) 15%
B) 50%
C) 80%
D) 98%
Q2) What substances are found in the saliva of a group A person who also inherited the secretor gene?
A) A, H
B) H
C) A, Se
D) A, B, H
Q3) Why is it sometimes necessary to distinguish A<sub>1</sub> and A<sub>2</sub> blood types?
A) To resolve a discrepancy between the forward and reverse typing
B) To prevent A<sub>1</sub> recipients from receiving A<sub>2</sub> blood
C) To determine the secretor status of group A individuals
D) To prevent hemolytic disease of the newborn
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Chapter 5: Rh Blood Group System
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Sample Questions
Q1) Anti-D reagent and the Rh control were tested with red cells. Both tests were 2+ agglutination reactions. What is the interpretation of the results?
A) D-positive
B) D-negative
C) Unable to interpret without further testing
D) D-positive if the sample is from a patient
Q2) A patient phenotypes as D+C+E-c-e+. The most likely genotype is:
A) R<sup>1</sup>r.
B) R<sup>1</sup>R<sup>1</sup>.
C) R<sup>1</sup>r'.
D) R<sup>1</sup>R<sup>0</sup>.
Q3) DcE
A)R<sub>1</sub>r
B)R<sub>1</sub>R<sub>1</sub>
C)R<sub>2</sub>R<sub>2</sub>
D)rr
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Page 7
Chapter 6: Other Blood Group Systems
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Q1) System associated with chronic granulomatous disease
A)Cartwright
B)MNSs
C)Kidd
D)Bg
E)Xg<sup>a</sup>
F)Sd<sup>a</sup> antigen
G)Chido
H)Knops
I)Duffy
J)Vel
Q2) Which of the following facts is not a characteristic of Kell system antibodies?
A) Usually clinically significant IgG antibodies
B) Best detected in indirect antiglobulin test phases
C) Lose reactivity with proteolytic enzyme reagents
D) Do not bind complement proteins
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Chapter 7: Antibody Detection and Identification
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Q1) Both screening cells 2+ at antihuman globulin phase, DAT positive, IgG 2+
A)Alloantibody, IgG
B)Alloantibody, IgM
C)Autoantibody, IgM
D)Autoantibody or transfusion reaction, IgG
Q2) Cold autoantibodies are typically of which specificity?
A) M
B) N
C) I
D) Le<sup>b</sup>
Q3) In the process of identifying an antibody, the technologist observed 2+ reactions with 3 of the 10 cells in a panel at the immediate spin phase. These reactions disappeared following incubation at 37<sup>\(\circ\)</sup> C and the antihuman globulin phase of testing. The antibody most likely to be responsible is:
A) anti-E.
B) anti-D.
C) anti-I.
D) anti-Le<sup>a</sup>.
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Chapter 8: Compatibility Testing
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Sample Questions
Q1) A group O patient was crossmatched with group B red blood cells. What phase of the crossmatch will first detect this incompatibility?
A) Immediate spin
B) 37<sup>\(\circ\)</sup> C low-ionic strength solution
C) Indirect antiglobulin
D) None of them; unit is compatible
Q2) When group O blood is not available for transfusion, what is the next alternative?
A) Group A red blood cells
B) Group AB red blood cells
C) Washed group B red blood cells
D) None
Q3) To what does the abbreviation "MSBOS" refer?
A) Monthly surgical blood order schedule
B) Minimum surgical blood order staffing
C) Maximum blood order schedule
D) Minimum safe blood order schedule
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Chapter 9: Donor Selection and Phlebotomy
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Sample Questions
Q1) Autologous donors may not donate if they:
A) have a positive test for syphilis.
B) are on antibiotics for an infection.
C) are taking aspirin.
D) are over 65 years old.
Q2) How long must a donor wait to donate red blood cells again following a 2-unit red blood cell apheresis donation?
A) 56 days
B) 4 weeks
C) 10 weeks
D) 16 weeks
Q3) Which type of autologous donation procedure is the most common for most types of surgery?
A) Preoperative hemodilution
B) Postoperative salvage
C) Intraoperative blood salvage
D) Preoperative donation
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11
Chapter 10: Testing of Donor Blood
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Sample Questions
Q1) What is the true statement regarding West Nile virus testing?
A) Testing for West Nile virus is required only in New York and California.
B) Testing for West Nile virus is necessary only in the warmer months of the year.
C) West Nile virus testing is performed using nucleic acid testing on all donor units.
D) West Nile virus testing is optional.
Q2) What is the advantage of testing donor blood using nucleic acid test methods?
A) Detection of small amounts of the virus
B) Reduction of costs involved in testing
C) Quicker and easier to perform than other methods
D) All of the above
Q3) A thorough donor history is the only way to prevent:
A) syphilis.
B) human T-cell lymphotropic virus-I.
C) cytomegalovirus.
D) malaria.
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Chapter 11: Blood Component Preparation and Therapy
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Sample Questions
Q1) Cryoprecipitated AHF, pooled
A)20° to 24° C, 4 hours
B)1° to 6° C, 24 hours
C)20° to 24° C, 6 hours
D)< -18° C, 1 year from collection
E)1° to 6° C, < 5 days
F)< -65° C, 7 years
G)20° to 24° C, 48 hours
Q2) CPDA-1
A)21 days
B)35 days
C)42 days
D)10 years
E)28 days
F)24 hours
G)48 hours
H)72 hours
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Chapter 12: Adverse Complications of Transfusions
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Sample Questions
Q1) The clinical sequelae of a hemolytic transfusion reaction may include all of the following except:
A) disseminated intravascular coagulation.
B) renal failure.
C) shock.
D) graft-versus-host disease.
Q2) Acute hemolytic
A)Prevented by leukoreduced components
B)Prevented by irradiation of components
C)Symptoms include hives and itching
D)Associated with ABO incompatibilities
E)Caused by donor white cell antibodies
F)Alloantibodies to red cell antigens
G)Can be prevented by transfusion slowly
Q3) An anaphylactic transfusion reaction is caused by __________ antibodies.
A) IgA
B) IgG
C) IgE
D) All of the above
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Page 14
Chapter 13: Hemolytic Disease of the Fetus and Newborn
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Sample Questions
Q1) Amniotic fluid analysis showed a marked increase into zone III of the Liley graph. Lecithin-sphingomyelin ratios indicated that the fetal lungs were not mature. Select the most appropriate decision regarding medical intervention.
A) No immediate need for intervention
B) An intrauterine transfusion
C) Delivery by cesarean section
D) None of the above
Q2) Which elution method is ideal in the investigation of ABO hemolytic disease of the fetus and newborn?
A) Glycine-acid
B) Freeze-thaw
C) Xylene
D) Chloroform
Q3) A 300-\(\mu\)g dose of Rh immune globulin contains sufficient anti-D to protect against how much whole blood?
A) 25 mL
B) 30 mL
C) 50 mL
D) 100 mL
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Page 15
Chapter 14: Transfusion Therapy in Selected Patients
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Q1) Which of the following contributes to the high blood use in a liver transplant surgery?
A) The liver is a very large organ.
B) It is difficult to find close human leukocyte antigen matches for liver transplants.
C) Platelets are stored in the liver.
D) The liver produces the vitamin K-dependent coagulation factors.
Q2) Avoid graft-versus-host disease
A)Cryoprecipitated AHF
B)Fresh frozen plasma
C)Red blood cells
D)Platelets
E)Leukoreduced blood components
F)Washed red blood cells
G)Albumin/plasma protein fraction
H)Factor concentrates
I)Plasma, cryoprecipitate reduced
J)Irradiated blood products
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16
Chapter 15: Quality Assurance and Regulation of the Blood Industry
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Q1) Quality control is the same as quality assurance.
A) True
B) False
Q2) Employee training takes place:
A) after hiring and following implementation of new procedures.
B) following competency assessment.
C) only for new inexperienced employees.
D) as procedures are validated.
Q3) Which of the following is true regarding good manufacturing practices (GMPs)?
A) GMPs are legal requirements established by the Food and Drug Administration.
B) GMPs are optional guidelines written by the AABB.
C) GMPs are required only by pharmaceutical companies.
D) GMPs are part of the quality control requirements for blood products.
Q4) Which of the following is an example of an unacceptable record-keeping procedure?
A) Using dittos in columns to save time
B) Recording the date and initials next to a correction
C) Not deleting the original entry when making a correction
D) Always using permanent ink on all records
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Chapter 16: Safety Issues in the Blood Bank
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Q1) All accidents, even minor ones, must be reported to a supervisor.
A) True
B) False
Q2) HCFA
A)Ensures safe and healthful working conditions
B)Government agency that determines whether a health facility meets standards for reimbursement for Medicare
C)Assessment of medical wastes
D)Ensures the safety and efficacy of biologics, drugs, and devices
E)Voluntary accrediting agency for hospitals
F)Writes fire safety standards
G)Provides peer-reviewed accreditation for hospital laboratories
H)Professional organization that accredits blood banks and transfusion services
I)Makes recommendations to the Occupational Safety and Health Administration regarding the prevention of disease transmission
J)Governs all transportation except by mail
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