Blood Banking and Transfusion Medicine
Chapter Exam Questions
Course Introduction
This course provides an in-depth exploration of blood banking and transfusion medicine, focusing on the principles and practices critical to the collection, testing, processing, storage, and distribution of blood and blood components. Students will study blood group systems, compatibility testing, donor selection, and transfusion reactions, as well as safety guidelines and quality assurance processes. The course also examines advances in transfusion therapy, immunohematology, and the management of transfusion-transmitted diseases, preparing students to apply this dynamic field's concepts in clinical laboratory settings.
Recommended Textbook
Modern Blood Banking and Transfusion Practices 6th Edition by Denise M. Harmening
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Chapter 1: Red Blood Cells and Platelet Preservation:
Historical Perspectives and Current Trends
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Sample Questions
Q1) What is the normal platelet count range per cubic millimeter?
A) 100 to 350
B) 150,000 to 350,000
C) 50,000 to 200,000
D) 350,000 to 500,000
Answer: B
Q2) In order to maintain ATP levels in stored blood, _____________can be added to CPD to extend the shelf-life of stored RBCs from 21 days to 35 days. This new preservative is designated as CPDA-1.
A) mannitol
B) adenine saline
C) adenine and glucose
D) Rejuvenix
Answer: C
Q3) What is the major biochemical consideration in platelet storage?
A) Glucose metabolism
B) Oxygen supply
C) Production of carbon dioxide
D) Regulation of pH
Answer: D
Page 3
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Chapter 2: Basic Genetics
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Sample Questions
Q1) A father carries the Xg<sup>a</sup> trait and passes it on to all of his daughters but none of his sons. What type of inheritance does this represent?
A) Autosomal dominant
B) X-linked dominant
C) X-linked recessive
D) Autosomal recessive
Answer: B
Q2) How is it genetically possible for a child to type Rh-negative?
A) Both parents are Dd.
B) Both parents are DD.
C) Mom is DD and Dad is Dd.
D) Sibling is Rh-positive.
Answer: A
Q3) In what stage of mitosis is DNA not actively dividing?
A) Interphase
B) Prophase
C) Metaphase
D) Anaphase
Answer: A
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Chapter 3: Fundamentals of Immunology
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Sample Questions
Q1) All of the following are true regarding IgM antibodies except:
A) IgM antibodies form against Kell.
B) IgM can bind to up to 10 antigens on a red cell.
C) IgM is 160 Å larger than IgG.
D) IgM is a pentamer.
Answer: A
Q2) All of the following techniques are used in the laboratory to detect blood group antigens or antibodies except:
A) agglutination.
B) precipitation.
C) ELISA.
D) hemolysis.
Answer: C
Q3) Which of the following blood group systems is not likely to cause HDN?
A) Kell
B) ABO
C) MN
D) Rh
Answer: C
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Page 5
Chapter 4: Concepts in Molecular Biology
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Q1) All of the following are examples of vectors except:
A) plasmids.
B) lambdas.
C) cosmids.
D) chirons.
Q2) Biotechnology is important in blood banking because of:
A) its production of growth factors.
B) its production of erythropoietin.
C) its production of clotting factors.
D) all of the above.
Q3) What is a major advantage of PCR?
A) Primers can be reused.
B) It uses a small amount of DNA.
C) Probes can come from several sources.
D) DNA can be single stranded.
Q4) Which of the following statements regarding the DNA molecule is false?
A) Cytosine always pairs with guanine.
B) Adenine always pairs with thymine.
C) Adenine always pairs with uracil.
D) Options A and B
6
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Chapter 5: The Antiglobulin Test
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Q1) In the production of polyspecific AHG, why are IgG and complement antibodies absorbed with A<sub>1</sub>, B, and O cells?
A) To eliminate the possibility of prozone
B) To remove heterospecific antibody
C) To eliminate false-negative results
D) To standardize dilutions of antibody
Q2) All of the following complement proteins can be found on the red blood cell membrane except:
A) C3d
B) C4b
C) C4a
D) C4d
Q3) What is the optimal temperature for complement activation?
A) 58°C
B) 37°C
C) 4°C
D) 22°C
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Chapter 6: The Abo Blood Group System
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Sample Questions
Q1) What is the only possible phenotype of an offspring produced from two group O parents?
A) A
B) B
C) AB
D) O
Q2) What percentage of A<sub>2</sub> individuals produce anti-A<sub>1</sub>?
A) 5%
B) 20%
C) 50%
D) 80%
Q3) Two drops of serum are added to one drop of A<sub>1</sub> cells, and two drops are added to one drop of B cells; the two tubes are centrifuged. The tubes show reactivity when read macroscopically. This is an example of:
A) forward grouping.
B) reverse grouping.
C) antibody screen.
D) crossmatch.
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Chapter 7: The RH Blood Group System
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Sample Questions
Q1) The antigen ceCF is known as:
A) Wrights antigen
B) Crawford antigen
C) D mosaic
D) V antigen
Q2) Of the three following categories of altered D antigen, in which variation of D antigen expression are you more likely to encounter an allo-anti-D?
A) C in Trans to RhD
B) Weak D
C) Partial D
D) None of the above
Q3) An individuals of the dce/dce genotype given dCe/dce blood has an antibody response that appears to be anti-C and anti-D. The most likely explanation for this is:
A) The antibody is anti-G.
B) The antibody is anti-partial D.
C) The antibody is anti-Cw.
D) There was an incorrect reading of the agglutination reactions.
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9
Chapter 8: Blood Group Terminology and the Other Blood Groups
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Sample Questions
Q1) What is the ISBT designation for the Kell system?
A) 001
B) 009
C) 006
D) 100
Q2) The true Lewis phenotype will normally be detected at what age?
A) Birth
B) 10 days
C) 6 years
D) Not necessarily ever, as circumstances such as pregnancy may alter or mask an individual's true Lewis phenotype
Q3) All of the following are characteristics of Duffy antibodies except:
A) they are IgG in nature.
B) they may or may not show dosage.
C) they are destroyed by enzymes.
D) they are not implicated in HDN.
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Page 10
Chapter 9: Detection and Identification of Antibodies
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Sample Questions
Q1) What is a possible explanation for a nonreactive eluate?
A) Hemolytic disease of the newborn (HDN)
B) Positive DAT due to drugs
C) A warm autoantibody
D) All of the above
Q2) The process of removing antibody from serum by combining a serum sample with appropriate red blood cells under optimal conditions is called:
A) elution.
B) absorption.
C) enzyme treatment.
D) sensitization.
Q3) What is the advantage of having a 3-cell panel screen versus a 2-cell panel screen?
A) More cells in the homozygous state that show dosage
B) You can narrow down the specificity of the AB better.
C) You might detect more rare antibodies.
D) All of the above
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11
Chapter 10: Pre-Transfusion Testing
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Q1) Mixing patient serum and donor red blood cells together and observing for direct cell lysis or agglutination is known as:
A) the Donath-Landsteiner test.
B) a minor crossmatch.
C) a major crossmatch.
D) an autohemolysis test.
Q2) A 4-unit crossmatch is ordered on a patient for emergency surgery. The patient's blood type is group B-positive. The blood bank inventory only contains two B positive packed cells. What other type is ABO compatible with this patient?
A) A-positive
B) A-negative
C) AB-positive
D) O-negative
Q3) What is the most common cause of clerical errors in transfusion therapy?
A) Entering an erroneous ABO type
B) Misidentification of the patient
C) Entering an erroneous crossmatch result
D) Labeling units as antigen-positive instead of antigen-negative when phenotyping
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Chapter 11: Overview of the Routine Blood Bank Laboratory
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Q1) In which department of the blood bank laboratory would an ABO discrepancy be resolved?
A) Component preparation and storage
B) Donor processing
C) Main laboratory
D) Reference laboratory
Q2) How are 8 units of cryoprecipitate usually issued?
A) As eight individual units
B) As one pooled unit
C) As four multiple units of two
D) None of the above
Q3) What additive is used to freeze blood for long-term storage at -65°C?
A) Glycerol
B) Glycine
C) Glutamic acid
D) Dextran
Q4) Granulocyte concentrates follow the same compatibility protocol as packed red blood cells.
A)True
B)False
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Chapter 12: Other Technologies and Automation
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Q1) Which of the following tests is not available for both the gel testing method and solid phase technology?
A) AHG
B) ABO
C) DAT
D) None of the above
Q2) Which of the following is a factor in possible false-negative or false-positive results when using the gel system to screen for antibodies?
A) Bacterial contamination
B) Temperature
C) Time
D) All of the above
Q3) An anti-M detected by using gel AHG antibody screening cards is considered clinically insignificant.
A)True
B)False
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Chapter 13: Donor Screening and Component Preparation
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Q1) Which of the following statements explains why bacterial contamination of blood is rarely a problem?
A) Regulated procedures for arm preparation prevent most bacteria contamination from occurring during collection.
B) Citrate in the anticoagulant is not conducive to bacterial growth.
C) The cold storage of blood is not conducive to bacterial growth.
D) All of the above
Q2) Nucleic acid amplification testing (NAT) is performed for which of the following?
A) HIV, WNV, HCV
B) HIV, HCV, HBV
C) HIV, HBV, WNV
D) HIV, HTLV I,II, HCV
Q3) Methods of preparation of platelet concentrates from single units of whole blood must produce a product that yields a minimum of:
A) 5.5 \(\times\) 10<sup>11</sup> platelets per unit in 50% of units tested.
B) 5.5 \(\times\) 10<sup>11</sup> platelets per unit in 75% of units tested.
C) 5.5 \(\times\) 10<sup>10</sup> platelets per unit in 75% of units tested.
D) none of the above.
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Chapter 14: Apheresis
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Sample Questions
Q1) Which immunoadsorbent has an affinity for IgG classes 1, 2, and 4 and their immune complexes?
A) Charcoal
B) Staphylococcal protein A
C) DNA
D) A antigen
Q2) Fresh frozen plasma (FFP) is not the optimal product for replacement fluids for a therapeutic plasma exchange procedure. For which patient is FFP the optimal product of choice?
A) Patient with liver disease
B) Patient with thrombotic thrombocytopenic purpura (TTP)
C) Patient scheduled to undergo an invasive procedure
D) All of the above
Q3) What does the hematocrit need to be (regardless of gender) for a double red blood cell collection?
A) 25%
B) 45%
C) 40%
D) 35%
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Page 16
Chapter 15: Transfusion Therapy
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Sample Questions
Q1) How is the whole blood that is collected from a donor different from whole blood circulating in someone's blood vessels?
A) The anticoagulant in donor blood prevents activation of the coagulation system.
B) The citrate mixed with donor blood serves as substrate for red blood cell metabolism.
C) The pH of whole blood is higher in collected units than in blood vessels.
D) Immunogenicity is diminished in collected units.
Q2) Vitamin K is essential for the carboxylation of which coagulation factors?
A) I, VII, IX, X
B) I, V, IX, X
C) II, VII, IX, X
D) II, VII, XI, XII
Q3) Granulocytes for transfusion should:
A) be administered through a microaggregate filter.
B) be ABO- and Rh-compatible with the recipient's serum.
C) be infused within 72 hours of collection.
D) never be transfused to patients with a history of febrile transfusion reaction.
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Chapter 17: Cellular Therapy
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Q1) What is a common finding in a DHTR?
A) DIC
B) Jaundice
C) Renal failure
D) Hypotension
Q2) When not all of the recipient's hematopoietic progenitor cells are destroyed prior to transplantation, it is called:
A) myeloablative conditioning.
B) nonmyeloablative conditioning.
C) syngeneic conditioning.
D) chimerism.
Q3) Which of the following is compromised by iron overload?
A) Heart
B) Liver
C) Endocrine glands
D) All of the above
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Chapter 18: Transfusion-Transmitted Diseases
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Q1) Which of the following is indicated when a recipient of blood or blood components develops a viral disease?
A) Transfusion-reaction investigation
B) Donor look-back
C) Incident report
D) Type and screen
Q2) Why is transmission of cytomegalovirus (CMV) through blood components not a significant risk to most recipients?
A) Most recipients are CMV-positive.
B) Most recipients are CMV-negative.
C) The CMV cannot tolerate cold storage temperatures.
D) None of the above.
Q3) A blood donor's serologic tests were reactive for HIV-1/2 antibodies. The test was repeated, and both were reactive. A Western blot confirmatory test was done and was negative. What is the protocol for this donor?
A) Unit is discarded.
B) Health department is notified.
C) Unit is OK to use.
D) Donor is permanently deferred.
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Page 19
Chapter 19: Hemolytic Disease of the Fetus and Newborn
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Q1) What is the physiological mechanism of Rh-immune globulin?
A) Attachment of fetal Rh-positive red blood cells in fetal circulation, inhibiting production of anti-D
B) Attachment of maternal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D
C) Attachment of fetal Rh-positive red blood cells in maternal circulation, inhibiting production of anti-D
D) Attachment of fetal Rh-negative red blood cells in maternal circulation, inhibiting production of anti-D
Q2) Which of the following best describes the principle of the Kleihauer-Betke test?
A) D-positive indicator cells form rosettes around maternal Rh-positive RBCs
B) D-positive indicator cells form rosettes around fetal Rh-positive red blood cells
C) Maternal hemoglobin is resistant to acid (alkali), appearing pink, whereas fetal cells appear as ghost cells
D) Fetal hemoglobin is resistant to acid (alkali) and appears pink, whereas maternal red blood cells appear as ghost cells
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Chapter 20: Autoimmune Hemolytic Anemias
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Q1) Autoanti-I was identified in a patient transfused 1 month ago. Which technique is advocated to detect alloantibodies in this patient?
A) Cold autoabsorption
B) Prewarming
C) Warm autoabsorption
D) Enzyme treatment
Q2) Chemically modified anti-D reacted negatively in a patient with a warm-reacting autoantibody. A Du test was performed using monospecific IgG, which was positive in Coombs phase. A fetal screen (rosette test) was also performed on this patient and showed no rosettes when viewed microscopically. Based on these results, what is the correct Rh type of this patient?
A) Rh-positive
B) Rh-negative
C) Rh-unknown
D) Du-positive
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21
Chapter 21: The Hla System
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Q1) Why are monoclonal antibodies able to detect a broad range of epitopes?
A) They are derived through alloimmunization
B) They are derived through xenoimmunization
C) They have both IgM and IgG specificity
D) None of the above
Q2) What does "HLA" stand for?
A) Human lymphodenapathy
B) Human lymphocyte antibody
C) Human leukocyte antigen
D) Human liver antigen
Q3) The primary indication for pancreas transplantation is:
A) Fabry's disease.
B) Karposi's sarcoma.
C) diabetes.
D) Crohn's disease.
Q4) A double-lung transplant is indicated in which of the following disorders?
A) Pneumonia
B) Pulmonary fibrosis
C) Primary hypertension
D) Cystic fibrosis
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Chapter 22: Relationship Testing
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Q1) CODIS stands for:
A) Convicted Offender Digital Identifying System
B) Combined Offender DNA Index System
C) Combined Operation Digital Index System
D) None of the above
Q2) Which of the following is a structure located within the cell nucleus that carries genes in a linear order as a part of the DNA molecule?
A) Antigen
B) Karyosome
C) Chromosome
D) Locus
Q3) Samples for paternity testing have arrived at Forensic Laboratories, Inc. What documentation should the shipping container contain?
A) Social Security number
B) Date of birth
C) Initials
D) Department code
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Chapter 23: Quality Management
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Q1) As part of postemployment departmental training, a medical technologist was given 10 known blood samples to analyze for ABO specificity. This is referred to as:
A) recertification.
B) a competence assessment.
C) education.
D) a proficiency test.
Q2) What phase is synonymous with "quality management"?
A) Good manufacturing practice
B) Organization-wide quality assurance
C) Process improvement team
D) Quality control
Q3) Which of the following statements concerning equipment is true?
A) Requires software to function
B) Quality control is not needed for critical steps.
C) Frequency of testing is determined by manufacturer recommendations.
D) All equipment must be purchased from the manufacturer.
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Chapter 24: Transfusion Safety and Federal Regulatory Requirements
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Q1) Which of the following would constitute short supply and an exemption from licensure?
A) RBCs used in the manufacturing of check cells
B) Recovered plasma used in the making of platelets
C) Recovered plasma used in the manufacturing of factor VIII
D) Whole blood used in the manufacturing of hemoglobin substitute
Q2) The FDA-directed civil action that calls for removal of products from distribution channels is known as:
A) injunction.
B) seizure.
C) prosecution.
D) quarantine.
Q3) The law that began and mandated regulation of biological products in the United States was called:
A) PHS Act of 1902.
B) Product Safety Act of 1902.
C) Biologics Control Act of 1902.
D) None of the above.
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Chapter 24: Utilization Management
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Q1) Targeted and discontinuous are subtypes of what review system?
A) Retrospective
B) Concurrent
C) Interpreted
D) Prospective
Q2) The focus of most blood utilization programs is:
A) the underutilization of blood products of a facility.
B) the overutilization of blood products by a facility.
C) to reduce cost.
D) to evaluate the need for ordering more product.
Q3) Which of the following is not part of a blood utilization review?
A) Retrospective review
B) Concurrent review
C) Interpreted review
D) Prospective review
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Chapter 25: Laboratory Information Systems
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Q1) What are the two components of computer terminals?
A) central receiving terminal/keyboard
B) monitor/keyboard
C) cathode ray tube/disk
D) central processing unit/keyboard
Q2) A warning message displayed to alert the user of invalid ABO grouping test results is a function of the:
A) operating system.
B) truth tables.
C) static database files.
D) dynamic database records.
Q3) A 17-mL aliquot of CMV-negative RBCs is requested for a newborn. The mother's antibody screen was positive and anti-Fy<sup>a</sup> was identified. A sample from the aliquot was tested with anti-Fy<sup>a</sup> and found to be negative for the antigen. This information should be documented on which of the following?
A) Aliquot unit
B) Original unit
C) Donor file
D) All of the above
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Page 27
Chapter 26: Medicolegal and Ethical Aspects of Providing
Blood Collection and Transfusion Services
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Q1) What kind of cases stimulated state legislature to enact protection for blood banks through so-called blood shield statutes?
A) TTAIDS
B) TTH
C) TT syphilis
D) TT sepsis
Q2) What would be the plaintiff's claim for a case involving a donor or defendant who intentionally donated HIV-positive blood for transfusion purposes?
A) Wrongful death
B) Battery
C) Tort
D) Manslaughter
Q3) What would be the effect of redefining blood banking outside the realm of medical practice in litigation cases?
A) Physicians would no longer serve as the respondent superior.
B) Blood bank personnel would take the role of the defendant.
C) Expert medical testimony would not be needed to establish standard of care.
D) Transfusion facilities would be excluded from the blood shield statute.
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Chapter 27: Tissue Banking: A New Role for the Transfusion Service
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Q1) The 21 in 21 CFR 1271 refers to:
A) the region from which the tissue was collected, thus falling under the general provisions of that area.
B) the title established for food and drugs in the Code of Federal Regulations.
C) the category of FDA laws that govern all blood bank regulation.
D) none of the above.
Q2) A bone flap is harvested by a physician for a patient at hospital X. The patient has an issue with hospital X and requests to go to hospital Y. The patient is transferred, but the physician wants to continue with the treatment. Which of the following scenarios is possible?
A) Hospital X would need to be registered with the FDA as a tissue vendor in order to transfer the bone flap to hospital Y.
B) The patient is allowed to take the bone flap with him to hospital Y, because it is autologous.
C) The physician is licensed to practice at both hospitals, so he is allowed to transfer the bone flap.
D) There is no tissue with transfer from one hospital to the next, because the material being transferred is bone.
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