Hematology
Exam Answer Key
Course Introduction
Hematology is a comprehensive course that explores the physiology, pathology, and clinical significance of blood and blood-forming tissues. The curriculum covers topics such as blood cell development, function, and morphology, as well as the mechanisms and diagnosis of common hematological disorders including anemia, leukemias, lymphomas, bleeding and coagulation disorders. Students will also gain exposure to laboratory procedures, diagnostic techniques, and the interpretation of hematological test results, laying a strong foundation for both clinical practice and further study in the biomedical sciences.
Recommended Textbook
Modern Blood Banking and Transfusion Practices 6th Edition by Denise M. Harmening
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27 Chapters
1413 Verified Questions
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Chapter 1: Red Blood Cells and Platelet Preservation:
Historical Perspectives and Current Trends
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44 Verified Questions
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Sample Questions
Q1) What cryoprotective agent is added to red blood cells upon freezing?
A) Dextrose
B) Adsol
C) Glycerol
D) All of the above
Answer: C
Q2) If platelets are to be stored for 5 days on a rotator, what is the optimal storage temperature?
A) 1°C to 6°C
B) 20°C to 24°C
C) 35°C to 37°C
D) 1°C to 10°C
Answer: B
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
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Chapter 2: Basic Genetics
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Sample Questions
Q1) What blood group is the best example of codominantly inherited blood group genes?
A) Rh
B) MN
C) Lewis
D) ABO
Answer: B
Q2) A human gamete (egg or sperm) contains how many chromosomes?
A) 23 pairs
B) 46 pairs
C) 23 chromosomes
D) 46 chromosomes
Answer: C
Q3) What amino acid initiates translation by attaching to tRNA?
A) Glycine
B) Alanine
C) Methionine
D) Lysine
Answer: C
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Page 4
Chapter 3: Fundamentals of Immunology
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Sample Questions
Q1) In an immune response, what is the time called during which no antibody is detected in the test serum?
A) Secondary response time
B) Primary response time
C) Latency period
D) Amnestic response time
Answer: C
Q2) What is a possible explanation for a weak reaction (1+) in a reverse ABO grouping test?
A) Elderly patient
B) Immunocompromised patient
C) IgM deficiency
D) All of the above
Answer: D
Q3) What class of immunoglobulin is capable of crossing the placenta?
A) IgM
B) IgG
C) IgE
D) IgD
Answer: B
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Chapter 4: Concepts in Molecular Biology
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Sample Questions
Q1) Which of the following is false regarding the Southern blotting technique?
A) DNA is digested with one or more restriction endonucleases, and the fragments are separated by gel electrophoresis.
B) Gel is placed over a nitrocellulose membrane.
C) A labeled probe is used to detect bands of interest.
D) Membrane-bound fragments have different positions as the fragments seperated by size on the gel electrophoresis.
Q2) Restriction Fragment Length Polymorphism (RFLP) can be used for all but which of the following purposes?
A) In paternity cases to determine the source of a DNA sample
B) To measure recombination rates, which can lead to a genetic map with the distance between RFLP loci measured in centimorgans
C) In criminal cases to determine the source of a DNA sample
D) To determine the Rh status of an individual
Q3) 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
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Page 6
Chapter 5: The Antiglobulin Test
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Sample Questions
Q1) What is a possible consequence of incubating tubes too long with LISS when performing the IAT?
A) Increased sensitivity
B) Hemolysis
C) Elution of antibody from red blood cells
D) All of the above
Q2) All of the following statements regarding the AHG test are true except:
A) when washing cells, all saline should be removed completely.
B) centrifugation should provide a firm pellet.
C) incubation time with LISS should be a minimum of 30 minutes.
D) Coombs' control cells should be added to all negative tubes.
Q3) How is a 40:1 ratio of serum to cells prepared for the AHG test?
A) 5 drops of serum + 1 drop of a 5% v/v RBC suspension
B) 1 drop of serum + 1 drop of a 5% v/v RBC suspension
C) 2 drops of serum + 1 drop of a 5% v/v RBC suspension
D) 1 drop of serum + 5 drops of a 5% v/v RBC suspension
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Chapter 6: The Abo Blood Group System
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Sample Questions
Q1) Reverse grouping was performed on an AB person. The technologist observed a very weak agglutination macroscopically. The cells appeared as "stacked coins" under a microscope. Which reagent should be added to the tube before recentrifugation in an attempt to resolve the discrepancy?
A) Serum
B) Saline
C) Water
D) LISS
Q2) What substances are found in a group A secretor?
A) AH
B) H
C) BH
D) ABH
Q3) What does the <i>hh </i>genotype refer to?
A) Lewis
B) Sid
C) Bombay
D) Kell
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8
Chapter 7: The RH Blood Group System
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Sample Questions
Q1) In the Fisher-Race nomenclature what does "d" refer to?
A) Amorph
B) Silent allele
C) Absence of D
D) All of the above
Q2) G antigen is present on all of which type of red blood cells?
A) D-positive
B) C-positive
C) E-positive
D) e-positive
Q3) When a patient has Rh-null<sub> </sub>syndrome, what kind of packed RBCs need to be transfused?
A) ABO compatible Rh-positive blood
B) ABO compatible Rh-negative blood
C) ABO compatible Rh-null blood
D) O-negative PRBCs
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Chapter 8: Blood Group Terminology and the Other Blood Groups
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Sample Questions
Q1) What is the ISBT designation for the Lutheran blood group system?
A) LN
B) LU
C) LT
D) LR
Q2) What Kidd antibody will react with all panel cells and phenotype as Jk(a-b-)?
A) Anti-Jk<sup>a</sup>
B) Anti-Jk<sup>b</sup>
C) Anti-Jk3
D) None of the above
Q3) Which of the following statements about the Lewis system is not true?
A) The Lewis phenotype depends on whether the Se gene is present.
B) The system is composed of antigen found in secretions
C) Genes of the Lewis system are indicated by LE and le.
D) Secretion of Lewis substance is controlled by the Se gene
Q4) The Di<sup>a</sup> and Di<sup>b</sup> antigens are located on:
A) complement receptor one (CRI).
B) erythrocyte acetylcholinesterase.
C) the anion exchange molecule (AE-1).
D) channel-forming integral protein (CHIP).
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Chapter 9: Detection and Identification of Antibodies
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Sample Questions
Q1) What effect does ZZAP reagent have on sensitized red blood cells?
A) Removes antibody from red blood cells
B) Enzyme treats red blood cells
C) Increases adsorption capability of red blood cells
D) All of the above
Q2) What is the most common use of adsorption?
A) Removal of plasma protein from patient serum
B) Removal of alloantibody from patient serum
C) Removal of autoantibody from patient serum
D) Removal of drug-induced antibody from patient serum
Q3) A doctor has ordered 4 units of red blood cells for a patient with anti-E in his serum. How many units would have to be screened to yield 4 E-negative units?
A) 10
B) 15
C) 6
D) 12
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Chapter 10: Pre-Transfusion Testing
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Sample Questions
Q1) Which tests must be performed on the donor sample?
A) ABO, Rh, Du, antibody screen
B) ABO, Rh, antibody screen
C) ABO, Rh, DAT
D) All of the above
Q2) What does MSBOS stand for?
A) Monetary surgical blood order supply
B) Minimum surgical blood order schedule
C) Military surgical blood order supply
D) Maximum surgical blood order schedule
Q3) What blood-banking research product hopes to provide oxygen-carrying capacity without the need for compatibility testing?
A) Red blood cell stroma
B) Hemoglobin substitutes
C) Liquid agglutination
D) Solid phase adherence
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Chapter 11: Overview of the Routine Blood Bank Laboratory
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Sample Questions
Q1) Which cells are used for a donor's antibody screen?
A) Screening cells (2 vials)
B) Pooled screening cells (2 donors)
C) Screening cells (3 vials)
D) Autologous cells
Q2) It is December 1, 2012, and you irradiate an O-negative packed RBC that you have in inventory, which outdates January 5, 2013. What will the new outdate be for that unit?
A) December 2, 2012
B) December 3, 2012
C) December 29, 2012
D) January 5, 2013
Q3) Which of the following options are suitability requirements for product labeling?
A) Absence of detectable antibodies
B) No discrepancies in ABO and Rh testing
C) Nonreactive viral marker tests
D) All of the above
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13
Chapter 12: Other Technologies and Automation
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Sample Questions
Q1) The washing procedure is applicable to which of the following serologic methods?
A) Solid phase and tube system
B) Gel technology and solid phase
C) Solid phase and affinity column
D) Gel technology and tube system
Q2) After completing an antibody screen using the gel testing method, results after centrifugation yield a pellet of unagglutinated cells at the bottom of the microtube and a thin layer of cells at the top gel column. This situation commonly indicates:
A) a cold agglutinin.
B) a warm autoantibody.
C) that fibrin from serum that has not clotted completely.
D) a contaminated patient specimen.
Q3) In performing an antibody screen by the solid phase technique, a monolayer of red blood cells is formed at the top of the microplate wells following the addition of indicator cells. This result should be interpreted as:
A) negative.
B) mixed-field.
C) positive.
D) weak positive.
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Page 14
Chapter 13: Donor Screening and Component Preparation
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Sample Questions
Q1) A unit of red blood cells has an expiration date of 11/15/12. A patient currently on a fludarabine regimen requires irradiated packed red blood cells. The unit is irradiated for this patient on 11/02/12. What is the correct expiration date post-irradiation?
A) 11/15/12
B) 11/30/12
C) 11/28/12
D) 11/02/12
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) What is the deferral period for a donor who has received a live attenuated vaccine for rubella?
A) 2 weeks
B) 4 weeks
C) no deferral period
D) 8 weeks
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15
Chapter 14: Apheresis
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Sample Questions
Q1) 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
Q2) What is the primary anticoagulant used in pheresis procedures?
A) CPDA-1
B) Heparin
C) Citrate
D) EDTA
Q3) What effect do steroids have on leukapheresis?
A) Decrease the vascular pool of granulocytes
B) Increase the vascular pool of granulocytes
C) Help to separate red blood cells from white blood cells, using specific gravity properties
D) Neutralize the effect of toxic granulation in neutrophils
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16
Chapter 15: Transfusion Therapy
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Sample Questions
Q1) What is the expiration on washed red blood cells?
A) 35 days
B) 24 hours
C) 42 days
D) 6 hours
Q2) 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.
Q3) How are RBC aliquots prepared for a neonate transfusion?
A) Blood is withdrawn from collection bag using a syringe and diluted 1:2 with saline.
B) Blood is withdrawn from collection bag using a syringe and diluted 1:2 with glycerol.
C) Blood is transferred from collection bag to satellite bag and withdrawn using a syringe.
D) None of the above
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17
Chapter 17: Cellular Therapy
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Sample Questions
Q1) Which of the following results when large excesses of free hemoglobin are released into the blood?
A) Hemosiderinuria
B) Hematuria
C) Hemoglobinuria
D) Hemoglobinemia
Q2) What measure can be taken to prevent transfusion-associated hypothermia?
A) Prudent use of platelet concentrates
B) Close monitoring of patient vital signs
C) Transfusion of product using a blood warmer
D) Premedication with calcium gluconate
Q3) Upon investigation of a DHTR, what should be included in the medical history?
A) Previous transfusion
B) Pregnancies
C) Transfusion reactions
D) All of the above
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Chapter 18: Transfusion-Transmitted Diseases
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Sample Questions
Q1) HIV belongs to which family?
A) Flaviviridae
B) Retroviridae
C) Hepadnaviridae
D) Picornaviridae
Q2) What marker usually is not detected when the hepatitis B-infected patient enters the convalescent phase?
A) Anti-HBc
B) HBsAg
C) HBeAg
D) Anti-HBe
Q3) What is the source of hepatitis B immune globulin (HBIG)?
A) Persons with a high titer of anti-HBc(IgG)
B) Persons with a high titer of anti-HBe
C) Persons with a high titer of anti-HBs
D) Persons with a high titer of anti-HBc(IgM)
Q4) A person with acute hepatitis B infection is immune to infection from other hepatitis viruses.
A)True
B)False
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Chapter 19: Hemolytic Disease of the Fetus and Newborn
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Sample Questions
Q1) Which of the following treatments uses ultraviolet light to treat hyperbilirubinemia after the infant is delivered?
A) Phototherapy
B) Plasma exchange
C) Amniocentesis
D) Electrophoresis
Q2) A cord blood specimen from a jaundiced infant should be tested for which of the following?
A) ABO
B) Rh
C) DAT
D) All of the above
Q3) All of the following are goals of an exchange transfusion except:
A) to remove high levels of unconjugated bilirubin.
B) to correct anemia.
C) to remove high levels of conjugated bilirubin.
D) to remove high levels of maternal antibody.
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Chapter 20: Autoimmune Hemolytic Anemias
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Sample Questions
Q1) A patient with a positive DAT needs to be phenotyped for Jk<sup>a</sup>. What reagent can be used on red blood cells to ensure accurate typing?
A) DTT
B) Chloroquine diphosphate
C) Ficin
D) Digitonin
Q2) What is the most frequent antibody specificity in CHD?
A) Anti-IH
B) Anti-i
C) Anti-I
D) Anti-P
Q3) All of the following are clinical manifestations of cold hemagglutinin disease (CHD) except:
A) agglutination of red blood cells in skin capillaries.
B) acrocyanosis of the hands and feet.
C) hepatosplenomegaly.
D) Raynaud's phenomena.
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21
Chapter 21: The Hla System
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Sample Questions
Q1) Why is histocompatibility testing negated in both lung and heart transplants?
A) The donor must be living to perform HLA testing.
B) The cold ischemic time is too short.
C) The cold ischemic time is too long.
D) None of the above.
Q2) What is the most important step for increasing the number of bone marrow transplants performed?
A) Expand the donor pool to include related individuals.
B) Expand the donor pool to include unrelated individuals.
C) Expand the donor pool to include both related and unrelated individuals.
D) None of the above
Q3) All of the following diseases have been associated with a significant HLA correlation except:
A) narcolepsy.
B) ankylosing spondylitis.
C) Fanconi's anemia.
D) Goodpasture's syndrome.
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22
Chapter 22: Relationship Testing
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Sample Questions
Q1) Apparent opposite homozygosity is also known as:
A) direct exclusion.
B) apparent exclusion.
C) indirect exclusion.
D) direct homozygous transition.
Q2) A newborn is typed as Group O; her mother is Group A. Determine the maximum number of theoretical blood types that the father could be to produce a child of this ABO type.
A) A, B, AB, O
B) A, AB, O
C) A, B, O
D) B, O
E) O
Q3) 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
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Page 23
Chapter 23: Quality Management
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Sample Questions
Q1) A physician complains that she has not received a test report from the blood bank. The remedial action is to:
A) complete the occurrence report form.
B) prepare a copy of the report for the physician.
C) locate the original report.
D) determine why the report was not delivered.
Q2) Employee training takes place:
A) before procedures are validated.
B) after competence assessments.
C) before flowcharting the process.
D) after hiring and after implementing new procedures.
Q3) All of the following are transfusion service quality assurance indicators used to monitor patient care except:
A) labeling errors on specimens sent to the blood bank.
B) reason for return of blood products.
C) number of therapeutic units drawn.
D) turnaround time on antibody identification.
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Chapter 24: Transfusion Safety and Federal Regulatory Requirements
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Sample Questions
Q1) According to federal law, what organization must be contacted when a biological deviation occurs in a blood bank and the error has the potential to affect the safety of the product or patient?
A) Joint Commission
B) AABB
C) CAP
D) CBER
Q2) One change that occurred under the FDA for oversight of biologics was that the FD&C Act now labeled biologics as:
A) blood products.
B) drugs.
C) reagents.
D) growth factors.
Q3) What is the primary focus of quality assurance?
A) To place blame on employees who make recurring errors
B) To amend the system, procedure, or standard operating procedures, if deemed faulty
C) To analyze post-market stability
D) To rewrite employee job descriptions as needed
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Chapter 24: Utilization Management
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Sample Questions
Q1) An example of direct behavior influence when implementing intervention strategies would be:
A) discussion with a physician about his ordering practice.
B) an e-mail to the nursing staff about their roles in transfusing.
C) a communication tree to all med techs about new protocols of issuing a product.
D) All of the above
Q2) Which of the following is not part of a blood utilization review?
A) Retrospective review
B) Concurrent review
C) Interpreted review
D) Prospective review
Q3) Which statement is false?
A) There is zero inherent risk of transfusing blood if all protocols are followed.
B) Following quality assurance guidelines for transfusion increases the safety to the patient.
C) You must follow a physician's order no matter what.
D) All of the above statements are true.
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26
Chapter 25: Laboratory Information Systems
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Sample Questions
Q1) What kind of software allows the interchange of information between two different computer systems?
A) Application
B) Interface
C) Operating system
D) HIS
Q2) Blood bank information systems should perform all of the following except:
A) verify donor testing results to ensure units are suitable for transfusion.
B) identify the location of all units at any given time.
C) recognize units that are outdated.
D) verify the accuracy of input demographic data.
Q3) A transfusion service employee proceeds to issue blood to an O-positive patient. She enters the unit number via the keyboard. The unit is typed as A-positive. What should appear on the CRT screen at this point?
A) A prompt message asking what printer should print the compatibility tags
B) A message that the issue process is complete
C) A warning message signaling incompatibility between patient and donor
D) None of the above
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Chapter 26: Medicolegal and Ethical Aspects of Providing
Blood Collection and Transfusion Services
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Q1) Liability for negligence includes all of the following except:
A) there was a duty owed to the injured party.
B) the duty was not met; the injured party was harmed.
C) failure to meet the duty was indirectly responsible for harm suffered by injured party.
D) some measurable (compensable) harm occurred (called damage).
Q2) What is the meaning of tort reform?
A) Prospective immunity for hospitals from excess liability because of charitable acts
B) Revision of transfusion-associated litigation to include licensed registered nurses as defendants
C) Protection of specialty practices from punitive or excessive awards by state legislatures
D) None of the above
Q3) Which of the following species of organisms are known to infect red blood cells in storage?
A) Escherichia coli
B) Enterobacter species
C) Yersinia species
D) All of the above
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Chapter 27: Tissue Banking: A New Role for the Transfusion Service
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Sample Questions
Q1) If your facility is a member of and accredited by the Eye Bank Associates of America, there is no need to be monitored by the FDA.
Multiple Choice
Identify the choice that best completes the statement or answers the question.
A)True
B)False
Q2) Which Joint Commission standard has to do with storage of tissues?
A) PC.17.10
B) PC.17.20
C) PC.17.30
D) all of the above
Q3) 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.
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Page 29