Clinical Hematology
Pre-Test Questions
Course Introduction
Clinical Hematology is a comprehensive course that explores the principles and practices of diagnosing and managing disorders of the blood and blood-forming tissues. Students will study the structure and function of blood components, the pathophysiology of hematological diseases such as anemia, leukemias, lymphomas, and clotting disorders, and the methodologies used in laboratory hematology, including blood counts, bone marrow examination, and specialized diagnostic techniques. Emphasis is placed on correlating laboratory findings with clinical presentations, interpreting hematological data, and understanding therapeutic approaches, including transfusions and novel treatments, to prepare students for clinical decision-making in hematology.
Recommended Textbook
Clinical Laboratory Blood Banking and Transfusion Medicine Practices 1st Edition by Gretchen Johns
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Chapter 1: The Immune Process: the Origin and Interaction
Between Antigens and Antibodies
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Q1) Which of the following statements is true about the lectin pathway?
A)Involves a recognition unit and an activation phase
B)Is activated in an antibody-independent fashion
C)Is usually triggered by an immunoglobulin-antigen complex
D)Primarily responds to charged and neutral sugars
Answer: B
Q2) Optimal pH has not been determined for immunohematologic testing,but it is generally believed that testing should be performed within what pH range?
A)4.2-5.8
B)5.8-7.5
C)6.8-7.2
D)7.0-8.8
Answer: C
Q3) Immunoglobulins are roughly _____ -shaped molecules.
A)V
B)W
C)X
D)Y
Answer: D
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Chapter 2: Immunogenetics: the Origin of Antigens
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Q1) Which term refers to the fact that human cells,except for sexual cells,contain two sets of chromosomes?
A)Diploid
B)Karyotype
C)Mitosis
D)Polymerase
Answer: A
Q2) Which of the following is the method used for predicting genotype frequencies of offspring?
A)Combination grouping
B)Dominant grouping
C)Dosage effect
D)Punnett square
Answer: D
Q3) DNA is made up of nucleotides.How many bases do nucleotides have?
A)Two
B)Three
C)Four
D)Five
Answer: C
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Chapter 3: Blood Bank Applications of Antigenantibody Reactions
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Q1) Antihuman globulin (AHG)reagent must contain anti-_____ when used for antibody detection.
A)C3d
B)IgA
C)IgG
D)IgM
Answer: C
Q2) When the body first encounters a foreign antigen,a primary immune response is stimulated.One of the residual effects of the primary response is the retention of which memory cells?
A)B
B)D
C)X
D)Y
Answer: A
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Page 5
Chapter 4: Abo and Hh Blood Group Systems
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Q1) Cold-reactive alloantibodies can be identified by testing plasma against panels of cells with known
A)antibodies
B)genes
C)microorganisms
D)phenotypes
Q2) ABO discrepancies are categorized into ____ groups.
A)two
B)three
C)four
D)five
Q3) Antibodies that develop without any apparent stimulus are called
A)Actively occurring
B)Innately occurring
C)Naturally occurring
D)Passively occurring
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Page 6
Chapter 5: Rh, Rhag, and Lw Blood Group Systems
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Q1) Molecular studies have shown that most ____ D phenotypes are due to an exchange of genetic information between RHD and RHCE genes.
A)modified
B)null
C)partial
D)weak
Q2) Which of the following is not true about Rh proteins?
A)One amino acid is responsible for the difference between the C and c antigens.
B)RhD and RhCE proteins have the same composition except for 33-35 amino acids.
C)Rh proteins are nonglycosylated.
D)There is one carbohydrate molecule attached to the Rh proteins.
Q3) Rh antibodies may develop in response to transfusion of which of the following blood products?
A)Cryoprecipitate
B)Platelets
C)Rh-immune globulin
D)Thawed plasma
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Chapter 6: Other Blood Group Systems
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Q1) The full expression of Lewis antigens is not reached until around ___ years of age.
A)3
B)5
C)7
D)9
Q2) A gene,XK,carried on the X chromosome results in production of the high-incidence antigen
A)Jsb
B)KEL
C)Kpb
D)Kx
Q3) The Xg antigen results from a gene on the ____ chromosome.
A)X
B)Y
C)XG
D)YG
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Page 8
Chapter 7: Pretransfusion and Compatibility Testing
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Q1) In order for patients to give informed consent,they must first
A)be educated about the risks and benefits
B)be scheduled for an appointment
C)have a diagnosis
D)sign a waiver
Q2) Which of the following should be performed if the current antibody screen is positive and/or the patient has a history of clinically significant antibodies?
A)Computer-assisted crossmatch (CAC)
B)Direct antiglobulin test (DAT)crossmatch
C)Immediate spin (IS)crossmatch
D)Indirect antiglobulin test (IAT)crossmatch
Q3) What is the purpose of a reflex test?
A)Detect unexpected red blood cell antibodies
B)Identify red blood cell phenotype
C)Increase sensitivity of pretransfusion testing
D)Investigate an inconclusive or unexpected result
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Chapter 8: Identification of Unexpected Antibodies
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Q1) If the patient has been transfused within the previous ___ month(s),donor cells may still be circulating in the patient's bloodstream.
A)1
B)2
C)3
D)6
Q2) What equation is used to calculate the frequency of alleles and genotypes within a population?
A)Fisher-Test
B)Hardy-Weinberg
C)Hyde-Park
D)Landsteiner-Wiener
Q3) An antibody screen cell with the following phenotype,dce/dec,Fy (a-b+),Jk (a+b+),could be used to exclude or rule out which of the following antibodies?
A)Anti-Fy
B)Anti-Fy
C)Anti-Jk
D)Anti-Jk
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Chapter 9: Donor Selection, Phlebotomy, and Required Testing
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Q1) How many categories of deferrals are there?
A)Two
B)Three
C)Four
D)Five
Q2) During the informed consent process,a donor must be made aware of which of the following?
A)Hemoglobin or hematocrit result
B)Foreseeable risks of donation
C)Potential benefits to the recipient
D)Transmissible disease testing methods
Q3) Which document was developed to ensure that the donor gets a consistent message and that the questions asked are thorough and meet AABB Standards as well as FDA regulations?
A)DDD
B)DDR
C)DHQ
D)DHR
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Chapter 10: Blood Products: Preparation, Storage, and Shipment
of Blood Components
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Q1) What is the approved shelf-life in days of red blood cell components that use one of the three additive solutions currently licensed in the United States?
A)7
B)21
C)35
D)42
Q2) What temperature must be maintained for shipping platelets and granulocytes?
A)33.8-50° F (1-6° C)
B)33.8-50° F (1-10° C)
C)68-75.2° F (20-24° C)
D)75.2-89.6° F (24-32° C)
Q3) Plasma fractionation produces what three categories of protein concentrates?
A)Albumin,beta globulins,and coagulation factors
B)Albumin,immune globulins,and coagulation factors
C)Haptoglobin,immune globulins,and coagulation factors
D)Haptoglobin,immune globulins,and complement factors
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Chapter 11: Component Therapy and Massive Transfusion
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Q1) Which of the following modifications can help to prevent the formation of antibodies to HLA antigens?
A)Freezing
B)Irradiation
C)Leukoreduction
D)Washing
Q2) Which of the following is most commonly used as a volume replacement in trauma,shock,burns,and therapeutic plasma exchange?
A)Albumin
B)Fibrinogen
C)Globulin
D)Lipoprotein
Q3) A platelet count of less than _____ is often used as a trigger to initiate prophylactic platelet transfusions to prevent intracranial hemorrhage.
A)10 × 10³ / µL (10 x 10 /L)
B)20 × 10³ / µL (20 x 10 /L)
C)30 × 10³ / µL (30 x 10 /L)
D)40 × 10³ / µL (40 x 10 /L)
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Chapter 12: Adverse Reactions to Transfusion
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Q1) According to the 2005 UK SHOT data,the risk of a patient receiving an incorrect blood component is 1 in ____ blood components transfused.
A)100
B)5,000
C)15,000
D)100,000
Q2) In the United States,transfusion-associated fatalities must be reported to which regulatory agency?
A)American Medical Association
B)Centre for Biologics EvaLuation and Research
C)Food and Drug Administration
D)Haemovigilance network
Q3) Fever is a common symptom in which types of transfusion reactions?
A)Acute hemolytic,allergic,febrile nonhemolytic
B)Acute hemolytic,febrile nonhemolytic,transfusion-related acute lung injury
C)Allergic,febrile nonhemolytic,transfusion-associated circulatory overload
D)Anaphylactic,febrile nonhemolytic,transfusion-related immunomodulation
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Page 14
Chapter 13: Transfusion-Transmitted Infections
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Q1) Leukoreduction can reduce the risk of which transfusion-associated virus?
A)CMV (cytomegalovirus)
B)HBV (hepatitis B virus)
C)HCV (hepatitis C virus)
D)HIV (human immunodeficiency virus)
Q2) When was acquired immunodeficiency syndrome (AIDS)first reported as an infectious disease?
A)1940
B)1976
C)1981
D)1999
Q3) Which of the following transfusion-transmitted viruses does not have an envelope?
A)Hepatitis B
B)Hepatitis C
C)Human immunodeficiency virus
D)Parvovirus B19
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Chapter 14: Perinatal and Neonatal Transfusion Issues
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Q1) The most common cause of hemolytic disease of the newborn is incompatibility between the mother and the infant in which blood group system?
A)ABO
B)Kell
C)MNS
D)Rh
Q2) How does phototherapy reduce the blood bilirubin level?
A)Conjugates bilirubin in the liver to a form that can be excreted in the urine
B)Conjugates bilirubin in the skin to a form that can be excreted in the bile
C)Converts unconjugated bilirubin in the skin to a form that can be excreted by the lungs
D)Converts unconjugated bilirubin in the skin to a form that can be excreted in the urine
Q3) Which of the following is the condition where bilirubin crosses the blood-brain barrier and is deposited in the cells of the basal ganglia and hippocampus?
A)Anemia
B)Hepatosplenomegaly
C)Jaundice
D)Kernicterus
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Page 16
Chapter 15: Autoimmune and Drug-Induced Immune
Hemolytic Anemias
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Q1) Which term refers to the destruction of autologous red blood cells during a hemolytic transfusion reaction that is destroying allogeneic cells?
A)Hemagglutination
B)Hemostasis
C)Hemoglobinuria
D)Hyperhemolysis
Q2) Which of the following is defined as the process of removing antibodies bound to red blood cells?
A)Adsorption
B)Alloadsorption
C)Autoadsorption
D)Elution
Q3) All of the following can be symptoms of anemia except
A)Brachycardia
B)Fatigue
C)Pallor
D)Tachycardia
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Page 17
Chapter 16: Platelet Refractory Patients
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Q1) Which of the following mechanisms results in immune-mediated platelet refractoriness?
A)Alloimmunization
B)Consumption
C)Sequestration
D)Thrombosis
Q2) The antibodies most commonly implicated in immune platelet refractoriness are directed against which group of antigens?
A)ABO
B)HLA
C)HPA
D)Rh
Q3) Which condition is not considered prothrombotic?
A)Graft versus host disease (GVHD)
B)Heparin-induced thrombocytopenia (HIT)
C)Hemolytic uremic syndrome (HUS)
D)Thrombotic thrombocytopenia purpura (TTP)
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Chapter 17: Transfusion Support of Selected Patient
Populations
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Q1) Which of the following is an oral iron chelator?
A)Deferasirox
B)Deferoxamine
C)Dexamethasone
D)Dimercaprol
Q2) Which of the following is a self-limited process that subsides with donor lymphocyte death?
A)Graft versus host disease
B)Hyperacute rejection
C)Iron overload
D)Passenger lymphocyte syndrome
Q3) Transfusion-associated graft versus host disease (TA-GVHD)is
A)prevented through leukoreduction
B)almost universally fatal
C)caused by engraftment of donor B lymphoctyes
D)most often diagnosed in immunocompetent patients
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Chapter 18: Human Histocompatibility
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Q1) All of the following are true about HLA class I molecules except
A)Are expressed only on antigen presenting cells
B)Includes a 45 kDa glycoprotein heavy chain
C)Includes a 12 kDa -2 microglobulin light chain
D)Has a peptide-binding cleft that reacts with short peptides
Q2) A crossmatch using autologous lymphocytes can indicate if which of the following is present?
A)Alloantibodies
B)Autoantibodies
C)IgG
D)IgM
Q3) The SSO (sequence-specific oligonucleotide)probe hybridization method
A)begins with amplification of the target DNA
B)determines the nucleotide sequence of the entire exon
C)employs primer pairs that are specific for unique sequences within an exon
D)uses two rounds of polymerase chain reaction (PCR)
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Chapter 19: Methods in Parentage Testing
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Q1) In what year were DNA typing procedures incorporated into parentage testing standards?
A)1953
B)1967
C)1985
D)1992
Q2) Although DNA testing can be used to predict or exclude other relationships,the most common use is to assess the probability that a particular
A)child is a descendant within a distinct ethnic group
B)man and woman are the biological parents of a child
C)man is the biological father of a child
D)woman is the biological mother of a child
Q3) VNTR refers to
A)variable nucleotide test result in DNA testing
B)variable number of tandem repeats in a DNA sequence
C)venous nucleotide type repeat in DNA sequence
D)very neutral transition reactions in DNA synthesis
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Chapter 20: Transfusion Safety and Regulatory Issues
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Q1) Which organization enforces CLIA?
A)AMA
B)CBER
C)CMS
D)FDA
Q2) All of the following organizations offer certification for clinical laboratory scientists except
A)American Association of Bioanalysts
B)American Association of Blood Banks
C)Board of Certification of the American Society of Clinical Pathologists
D)College of American Pathologists
Q3) Which organization represents one of the most common voluntary accreditations that apply to medical laboratories?
A)American Association of Bioanalysts
B)American Medical Technologists
C)Board of Certification of the American Society of Clinical Pathologists
D)College of American Pathologists
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Page 22
Chapter 21: Quality Assurance
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Q1) All of the following are goals of a quality program except
A)Adversarial relationship with regulatory agencies
B)Cost containment
C)Knowledgeable and well-trained employees
D)Safe work environment
Q2) The definition for policy would be which of the following?
A)Document used to record data
B)Information that provides objective evidence that an activity was completed
C)Principle that guides decision making
D)Set of related steps that achieve a goal
Q3) Regulation grants the authority to stop production of blood products in a blood manufacturing organization when a problem is detected to which group of people?
A)Executive members
B)Leadership administrators
C)Production managers
D)Quality assurance unit
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