Immunohematology
Exam Answer Key
Course Introduction
Immunohematology is the study of the immunologic and genetic aspects of blood, particularly as they relate to blood group antigens and antibodies, transfusion medicine, and the diagnosis and management of hemolytic disease. This course covers the principles of blood group serology, antibody screening and identification, compatibility testing, and the selection of appropriate blood components for transfusion. Students will also explore the mechanisms behind transfusion reactions, hemolytic diseases of the newborn, and autoimmune hemolytic anemias, alongside learning laboratory techniques used for detecting and resolving blood type discrepancies. The course also discusses the clinical significance of various blood group systems and the implementation of safety and quality assurance measures in transfusion services.
Recommended Textbook
Clinical Laboratory Blood Banking and Transfusion Medicine Practices 1st Edition by Gretchen Johns
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21 Chapters
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Page 2
Chapter 1: The Immune Process: the Origin and Interaction
Between Antigens and Antibodies
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Sample Questions
Q1) Which is the principal isotype found in mucosal secretions?
A)IgA
B)IgD
C)IgE
D)IgM
Answer: A
Q2) What is the best description of cytokines?
A)Glycoproteins bound to red blood cell membranes
B)Proteins reLe sed by cells that affect the behavior of other cells
C)Small proteins that attract and cause the migration of cells
D)Substances that evoke an immune response
Answer: B
Q3) All of the following statements about agglutination are true except
A)Is defined as the aggregation of particulate matter caused by combination with a specific antibody
B)Is the visible endpoint of antigen-antibody reactions for blood bank testing
C)Is an irreversible reaction between antigen and antibody
D)Is thought to be a two-step process
Answer: C
Page 3
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Chapter 2: Immunogenetics: the Origin of Antigens
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Q1) DNA is defined as
A)Deoxyribonucleic acid
B)Deoxyribonucleic alkali
C)Digoxin neural assessment
D)Diploid nucleotide analysis
Answer: A
Q2) All of the following statements are true except
A)The null phenotype is the inheritance of genes that code for no expression of the usual blood group antigens for that system.
B)An amorphic gene expresses a phenotype and can be called the silent gene.
C)Interaction among alleles or the products of different genes may modify the expression of a trait.
D)The HLA genes are linked and are inherited as haplotypes.
Answer: B
Q3) What term is used to describe an allele present on the same chromosome?
A)Amorph
B)Cis
C)Genotype
D)Karyotype
Answer: B
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Chapter 3: Blood Bank Applications of Antigenantibody
Reactions
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Sample Questions
Q1) During the incubation phase of an antibody screen test,how long should the test tubes be incubated?
A)5-10 minutes
B)10-30 minutes
C)Depends on the temperature of incubation
D)Depends on the enhancement reagent added
Answer: D
Q2) The most common cause for the check cells not reacting is
A)Incorrect use of tubes
B)Improper washing
C)Malfunctioning equipment
D)Too much time in the centrifuge
Answer: B
Q3) All of the following can cause false results in both an indirect (IAT)or direct (DAT)antiglobulin test except
A)Contaminated saline
B)Inadequate incubation
C)Interruption in testing
D)Improper centrifugation
Answer: B
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Chapter 4: Abo and Hh Blood Group Systems
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Sample Questions
Q1) The most common ABO blood group is group
A)A
B)B
C)AB
D)O
Q2) Alloantibodies that cause problems in ABO typing include
A)anti-Jk
B)anti-P1
C)A lectin
D)A lectin
Q3) How many nucleotide differences are there between the A and B genes?
A)3
B)4
C)6
D)7
Q4) What is the immunodominant sugar of the A antigen?
A)D-galactose
B)D-glucose
C)N-acetyl-D-galactosamine
D)L-fucose
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Chapter 5: Rh, Rhag, and Lw Blood Group Systems
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Q1) Clonal reagent anti-D may be
A)IgD or IgG
B)IgE or IgG
C)IgE or IgM or blend of both
D)IgG or IgM or blend of both
Q2) When both c and e antigens are present on the red blood cell membrane and the respective genes are in the cis position or on the same chromosome,which antigen is expressed?
A)Ce
B)d
C)f
D)G
Q3) When testing for weak D using an indirect antigblobulin test (IAT),cells that are already coated with _____ can give a false-positive reaction in the antiglobulin phase.
A)IgA
B)IgD
C)IgE
D)IgG
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Chapter 6: Other Blood Group Systems
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Q1) The antigens of the Chido/Rodgers system are located on the _____ complement component.
A)C1
B)C2
C)C3
D)C4
Q2) How many antigens are in the Kidd system?
A)3
B)9
C)12
D)19
Q3) The antigens of the Kell system are found on a ________ that passes through the red blood cell membrane.
A)glycogen
B)glycolipid
C)glycophorin
D)glycoprotein
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Chapter 7: Pretransfusion and Compatibility Testing
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Q1) 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
Q2) The majority of hemolytic transfusion reactions that occur are due to
A)errors in sample or patient identification
B)errors in written orders
C)illegible handwriting on the order
D)miscommunication of verbal orders
Q3) Crossmatch is also known as
A)Compatibility testing
B)Donor cell antigen typing
C)Immediate spin phase testing
D)Patient cell antigen typing
Q4) Another term for the electronic crossmatch is
A)computer-aided crossmatch
B)computer-assisted crossmatch
C)computer-enhanced crossmatch
D)computer-generated crossmatch
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Chapter 8: Identification of Unexpected Antibodies
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Sample Questions
Q1) Which method is preferred for removing autoantibodies?
A)Autologous absorption
B)Allogenic absorption
C)Cutaneous absorption
D)Pathologic absorption
Q2) The elution methods best suited for cold-reactive antibodies include all of the following except
A)Digitonin acid
B)Landsteiner and Wiener heat
C)Lui's freeze-thaw
D)Sonication
Q3) In transfusion medicine,what is the definition of neutralization?
A)Inactivation of an antibody by adsorption onto red blood cells
B)Inactivation of an antibody by combination with a soLu le antigen
C)Inactivation of an antigen by a genetic mutation
D)Inactivation of an antigen by combination with a plasma antibody
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Chapter 9: Donor Selection, Phlebotomy, and Required Testing
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Q1) What would be the deferral period for an individual who has been taking insulin from cows (bovine or beef insulin)?
A)6 months
B)3 years
C)Indefinite
D)Permanent
Q2) The AABB Standards require a donor's temperature to be less than or equal to
A)98.0° F (36.7° C)
B)98.7° F (37.0° C)
C)99.0° F (37.2° C)
D)99.5° F (37.5° C)
Q3) The minimum hemoglobin level for an allogeneic whole blood donation is
A)10.5 g/dL (105 g/L)
B)12.5 g/dL (125 g/L)
C)13.3 g/dL (133 g/L)
D)13.6 g/dL (136 g/L)
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Chapter 10: Blood Products: Preparation, Storage, and Shipment of
Blood Components
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Sample Questions
Q1) Which of the following statements is true about granulocyte component production?
A)A whole blood unit generally yields 5 × 106 granulocytes.
B)Apheresis collection is used more often than whole blood separation.
C)Granulocyte units are stored at 68-75.2° F (20-24° C)for up to 5 days.
D)Hydroxyethel starch is added and then the blood is centrifuged.
Q2) All of the following are true about platelet storage containers except A)Are made from nonpolyvinylchloride plastic
B)Contain plasticizers that stabilize the platelet membrane
C)Decrease carbon dioxide buildup
D)Have high gas permeability
Q3) 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
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Chapter 11: Component Therapy and Massive Transfusion
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Q1) All of the following statements are true of intraoperative blood salvage except
A)Bacteria at the site of the surgery are washed out of the blood before reinfusion.
B)Blood can be collected during or after surgery.
C)Collected blood can be reinfused as either whole blood or red blood cells.
D)Collected blood is mixed with anticoagulant.
Q2) Patients rarely need red blood cell transfusions if the hemoglobin concentration is
A)Below 7 g/dL (70 g/L)and the patient has a low oxygen saturation level
B)Below 10 g/dL (100 g/L)and the patient is bleeding
C)Between 7 and 10 g/dL (70 and 100 g/L)and the patient has underlying cardiac disease
D)Above 10 g/dL (100 g/L)and the patient is hemodynamically stable
Q3) Which of the following modifications can help to prevent the formation of antibodies to HLA antigens?
A)Freezing
B)Irradiation
C)Leukoreduction
D)Washing
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Page 13
Chapter 12: Adverse Reactions to Transfusion
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Q1) Which of the following statements is true of delayed hemolytic reactions?
A)Are associated with complement-mediated intravascular hemolysis.
B)Are associated with extravascular hemolysis.
C)Are the most common reactions to occur during blood transfusion.
D)Occur immediately after exposure to a transfused component.
Q2) What can be done to prevent transfusion-associated circulatory overload (TACO)in at-risk patients?
A)Irradiate blood products before transfusion
B)Split a red blood cell product in half and transfuse each half over 4 hours
C)Transfuse only leukoreduced blood products
D)Wait several hours after medication is given before starting a transfusion
Q3) Approximately how many milligrams of iron does a single red blood cell unit contain?
A)50
B)150
C)200
D)250
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Chapter 13: Transfusion-Transmitted Infections
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Q1) Chronic infection is most common with which of the following types of viral hepatitis?
A)Hepatitis A
B)Hepatitis B
C)Hepatitis C
D)Hepatitis D
Q2) Which disease is associated with a parasite that can be potentially transmitted by blood transfusion?
A)Cruetzfeld-Jakob disease
B)Lyme disease
C)Malaria
D)Syphilis
Q3) All of the following transfusion-transmitted infections are also considered to be sexually transmitted diseases except
A)Hepatitis C
B)Human immunodeficiency virus
C)Syphilis
D)Toxoplasmosis
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15
Chapter 14: Perinatal and Neonatal Transfusion Issues
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Q1) Which donor red blood cells would be chosen to use in an intrauterine transfusion?
A)Group AB,Rh(D)negative that lack the offending antigen
B)Group AB,Rh(E)negative that lack the offending antigen
C)Group O,Rh(C)negative that lack the offending antigen
D)Group O,Rh(D)negative that lack the offending antigen
Q2) 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
Q3) Amniocentesis can be performed as early as
A)10 weeks gestation
B)15 weeks gestation
C)20 weeks gestation
D)25 weeks gestation
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Chapter 15: Autoimmune and Drug-Induced Immune
Hemolytic Anemias
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Sample Questions
Q1) Which of the following is the most common autoimmune hemolytic anemia?
A)DAT-negative autoimmune hemolytic anemia
B)Drug-induced immune hemolytic anemia (DIIHA)
C)Mixed autoimmune hemolytic anemia (MAIHA)
D)Warm autoimmune hemolytic anemia (WAIHA)
Q2) Typical antihuman globulin reagents used in the direct antiglobulin test (DAT)may be directed against all of the following except
A)IgG only
B)IgM only
C)C3b and C3d
D)IgG,C3b,and C3d
Q3) Which of the following describes alloadsorption?
A)Removal of antibody from plasma by incubation with donor or reagent red blood cells with specific phenotypes
B)Removal of autoantibody from plasma by incubation with the patient's own red blood cells
C)Removal of antibody bound to red blood cells by incubation with chloroquine
D)Removal of autoantibody bound to red blood cells by incubation with glycine
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Chapter 16: Platelet Refractory Patients
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Q1) Transfusion of which blood component is most often associated with post-transfusion purpura (PTP)?
A)Plasma
B)Platelets
C)Red blood cells
D)White blood cells (granulocytes)
Q2) Which of the following mechanisms results in immune-mediated platelet refractoriness?
A)Alloimmunization
B)Consumption
C)Sequestration
D)Thrombosis
Q3) What is the match called when one human leukocyte antigen (HLA)is mismatched?
A)A
B)BU
C)C
D)D
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Chapter 17: Transfusion Support of Selected Patient
Populations
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Q1) Which of the following best describes an exchange transfusion?
A)Removal of patient's plasma and replacement with normal saline
B)Removal of patient's red blood cells and replacement with donor red blood cells
C)Transfusion of phenotype-matched donor red blood cells
D)Transfusion of irradiated donor red blood cells
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) Hemophilia B is due to deficiency in what coagulation factor?
A)VII
B)VIII
C)IX
D)X
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Chapter 18: Human Histocompatibility
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Q1) Which chromosome carries the genes for the HLA system?
A)1
B)3
C)6
D)9
Q2) 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)
Q3) Which of the following are molecules produced and secreted by activated cells?
A)Cytokines
B)Cytometries
C)Cytosines
D)Cytosols
Q4) All of the following describe the adaptive immune system except
A)Also known as the natural immune system
B)Consists of antigen presenting cells
C)Displays an anamnestic response
D)Is involved in allograft rejection
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Chapter 19: Methods in Parentage Testing
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Q1) Which of the following is typically referred to as the parentage index?
A)DR
B)LI
C)LR
D)PEx
Q2) Which of the following reflects the ability of a genetic marker to distinguish two samples coming from different sources?
A)Discriminatory power
B)Likelihood ratio
C)Power of exclusion
D)Short tandem repeat loci
Q3) Mendel's laws of genetics requires ________ of the alleles in the child's sample to be traceable to each parent.
A)one-half
B)one-third
C)one-quarter
D)one-sixth
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21
Chapter 20: Transfusion Safety and Regulatory Issues
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Q1) Most laboratory tests performed in blood banks and transfusion services are _________ tests.
A)nonwaived
B)waived
C)centralized
D)point-of-collection
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) Under which class of medical devices would reagents for diagnostic tests for HIV,HCV,and HBV fall?
A)Class I
B)Class II
C)Class III
D)Class IV
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Chapter 21: Quality Assurance
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Q1) Which of the following explains document control?
A)A system that standardizes facility documents
B)Activities used to create a controlled environment for processes and procedures
C)Documented evidence that provides a high degree of assurance that a specific process will consistently produce a product meeting predetermined specifications
D)Standardization of an analytic instrument
Q2) Calibration is defined as
A)conformance of a product or process with pre-established specifications
B)documented evidence that provides a high degree of assurance that a specific process will consistently produce a product meeting predetermined specifications
C)monitoring performed to ensure that the quality system is being adhered to and is effective
D)standardization of an analytic instrument
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