Transfusion Science
Mock Exam
Course Introduction
Transfusion Science explores the principles and practices involved in the collection, processing, testing, storage, and transfusion of blood and blood components. The course covers immunohematology, blood group systems, compatibility testing, transfusion reactions, and the management of transfusion therapies. Students will gain an understanding of quality assurance, safety protocols, donor recruitment, and the ethical and legal considerations in transfusion medicine. Emphasis is placed on both the laboratory techniques and the clinical decision-making processes essential for safe and effective blood transfusion practices.
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 cryoprotective agent is added to red blood cells upon freezing?
A) Dextrose
B) Adsol
C) Glycerol
D) All of the above
Answer: C
Q2) How is stroma-free hemoglobin solution prepared?
A) Outdated red blood cells are concentrated, and stroma is removed.
B) Outdated red blood cells are diluted with saline, and stroma is removed.
C) Outdated red blood cells are lysed, and stroma is removed.
D) None of the above
Answer: C
Q3) What does the term autologous transfusion refer to?
A) A parent donating blood for his or her child
B) An individual donating blood for a friend
C) An individual donating blood for a relative
D) An individual donating blood for his or her own transfusion
Answer: D
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Chapter 2: Basic Genetics
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Sample Questions
Q1) In the MN blood group system, a person who inherits an "M" allele and an "N" allele expresses both M and N antigens on the RBCs. Which of the following is true?
A) M is dominant to N.
B) N is dominant to M.
C) M an N are codominant alleles.
D) M and N are located on the same chromosome.
Answer: C
Q2) Which type of genetic change (mutation) is incapable of reverting back to the original phenotype?
A) Duplication
B) Deletion
C) Recombination
D) Insertion
Answer: B
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Chapter 3: Fundamentals of Immunology
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Sample Questions
Q1) In an immune response,______________ antibodies are formed before______________ .
A) IgG, IgA
B) IgM, IgG
C) IgG, IgM
D) IgM, IgA
Answer: B
Q2) A patient with multiple myeloma exhibits rouleaux formation in an immediate spin crossmatch. What procedure is recommended to distinguish true red blood cell agglutination from nonspecific agglutination?
A) Secretor studies
B) Saline dilution
C) Enzyme treatment
D) Polyethylene glycol enhancement
Answer: B
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Chapter 4: Concepts in Molecular Biology
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Sample Questions
Q1) All of the following make up three branches of molecular biology related to transfusion medicine except:
A) molecular genetics.
B) biotechnology.
C) molecular diagnostics.
D) paternity.
Q2) How does the Northern blotting technique differ from the Southern blotting technique?
A) In the Northern blotting technique, RNA is detected instead of DNA.
B) Gel electrophoresis is not used in the Northern blotting technique.
C) In the Northern blotting technique, cDNAs are used in place of restriction endonucleases.
D) All of the above
Q3) In performing gene cloning for blood group genes, what is a possible source of RNA?
A) Lymphocytes
B) Reticulocytes
C) Neutrophils
D) Platelets
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6
Chapter 5: The Antiglobulin Test
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Sample Questions
Q1) What class of antibody can be present in AHG?
A) IgG
B) IgM
C) IgA
D) All of the above
Q2) Polyspecific AHG contains:
A) anti-IgG.
B) anti-C3b-C3d.
C) anti-IgG and anti- C3d.
D) anti-IgG and anti-IgM.
Q3) Anti-IgG is specific for what part of the IgG molecule?
A) FC fragment
B) Constant region of Fab fragment
C) Hypervariable region of Fab fragment
D) Kappa light chain
Q4) 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.
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Chapter 6: The Abo Blood Group System
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Sample Questions
Q1) If a group O mother gives birth to a group A baby, which of the following antibodies is usually responsible for crossing the placenta and causing hemolytic disease of the newborn (HDN)?
A) Anti-AB
B) Anti-B
C) Anti-A
D) Anti-H
Q2) The state in which an individual's red blood cells are agglutinated by all sera regardless of blood type is called:
A) panagglutination.
B) polyagglutination.
C) sensitization.
D) leukoagglutination.
Q3) Why is reverse grouping not performed on cord blood specimens?
A) Antigens are not present at birth.
B) Antibodies are generally not present at birth.
C) Antibody titer is too high.
D) Antigens are too weak.
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8
Chapter 7: The RH Blood Group System
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Sample Questions
Q1) On which chromosome are the genes that code for RH proteins, namely, RHD and RHCE located?
A) Chromosome 1
B) Chromosome 19
C) Chromosome 20
D) Chromosome 9
Q2) What protocol is put in place to validate Rh testing when high-protein reagents are used, especially when the patient types as an AB-positive?
A) Wash cells before testing
B) Run a control with Rh test
C) Add LISS to test system
D) Use only saline reactive anti-D
Q3) The Rh gene is located on which chromosome?
A) 1
B) 7
C) 9
D) 11
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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 etiology of chronic granulomatous disease (CGD)?
A) Muscular degeneration caused by a mutated X gene
B) Phagocytes are unable to generate hydrogen peroxide, which is used to kill invading bacteria.
C) Alteration in red blood cell membrane, allowing passage by bacteria
D) Inability to generate leukocytes from the bone marrow
Q2) What is the definition of a blood group system?
A) A group of antibodies produced by alleles at a single gene locus
B) A group of antigens produced by alleles at a single gene locus
C) A group of antibodies produced by alleles at multiple genetic loci
D) A group of antigens produced by alleles at multiple genetic loci
Q3) Which blood group system is not based on carbohydrates?
A) Lewis
B) Rh
C) P
D) ABO
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Chapter 9: Detection and Identification of Antibodies
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Sample Questions
Q1) What antibody is associated with a mixed-field reaction?
A) Le<sup>a</sup>
B) K
C) Sd<sup>a</sup>
D) E
Q2) Which of the following statements is correct concerning cold antibody screens?
A) Patient serum is incubated with group O adult and cord red blood cells at 4°C.
B) Patient serum is incubated with group O cord cells at 37°C.
C) Patient serum is incubated with check cells at 18°C.
D) Patient serum is incubated with group A cord cells at room temperature.
Q3) What is a positive DAT?
A) In vitro sensitization of RBC with antigen
B) In vitro sensitization of RBC with antibody
C) In vivo sensitization of RBC with antibody
D) In vivo sensitization of RBC with antigen
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Chapter 10: Pre-Transfusion Testing
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Sample Questions
Q1) What is the most critical step in blood transfusion?
A) Phenotyping units to ensure compatibility with alloantibody
B) Following quality control procedures
C) Checking patient identification and compatibility of donor unit
D) Monitoring the temperature control of donor units
Q2) 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.
Q3) A patient with anti-K and anti-Jk<sup>a</sup> needs two units of RBCs for surgery. How many group-specific units would need to be screened to find two that are compatible?
A) 6
B) 10
C) 20
D) 36
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12
Chapter 11: Overview of the Routine Blood Bank Laboratory
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Sample Questions
Q1) Why can the Rh-hr control be eliminated from donor processing?
A) An Rh-positive unit of blood typed as an Rh-negative would only be transfused to an Rh-positive patient.
B) An Rh-negative unit of blood typed as an Rh-positive would only be transfused to an Rh-negative patient.
C) An Rh-negative unit of blood typed as an Rh-positive would only be transfused to an Rh-positive patient.
D) None of the above
Q2) All of the following procedures might be done in an investigation of an ABO discrepancy except:
A) increasing incubation time for reverse grouping.
B) secretor studies.
C) neutralization studies with urine.
D) testing with anti-A<sub>1</sub> lectin.
Q3) Why would A<sub>2</sub> cells be used in the reverse group in donor processing?
A) To differentiate an A subgroup from a group AB
B) To differentiate an A subgroup from a group B
C) To differentiate an A subgroup from a group O
D) None of the above
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Page 13
Chapter 12: Other Technologies and Automation
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Sample Questions
Q1) Using the affinity column technique, a serologic reaction that forms a fine red blood cell band at the top of the gel column and a red blood cell button at the bottom of the gel column is interpreted as:
A) mixed-field
B) weak positive
C) strong positive
D) negative
Q2) Low ionic strength saline (LISS) is added to antibody screening methods for which of the following test systems?
A) Gel
B) SPRCA
C) Solid phase
D) None of the above
Q3) The gel system has all of the following advantages over the traditional tube procedure except:
A) standardization in reading technique.
B) stability of the test reaction.
C) replicability of the test results.
D) different grading system.
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Page 14
Chapter 13: Donor Screening and Component Preparation
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Sample Questions
Q1) A patient who recently stopped taking clopidogrel (Plavix) needs to donate platelets. How long must the patient defer donation after completing the medication?
A) 24 hours
B) 48 hours
C) 7 days
D) 14 days
Q2) Which of the following products does not necessarily need to be ABO-compatible in order to be transfused?
A) Cryoprecipitate
B) FFP
C) Granulocytes
D) Deglycerolized RBCs
Q3) What is the minimum hemoglobin level for a potential allogeneic donor?
A) 11 g/dL
B) 12 g/dL
C) 12.5 g/dL
D) 14 g/dL
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15
Chapter 14: Apheresis
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Sample Questions
Q1) Antiplatelet medications have differing deferral time periods. Which of the following does not match?
A) Aspirin-48 hours
B) Plavix-14 days
C) Feldene-7 days
D) Ticlid-14 days
Q2) 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
Q3) Which of the following incorporates membrane filtration technology with intermittent flow centrifugation (IFC) apheresis?
A) Haemonetics V50
B) COBE Spectra
C) Fenwal Autopheresis-C
D) Haemonetics V30
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16
Chapter 15: Transfusion Therapy
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Sample Questions
Q1) Which of the following criteria warrants a granulocyte concentrate transfusion?
A) A neutrophil count greater than 1,000 per µL
B) A septic patient unresponsive to antibiotics
C) Bone marrow hyperplasia
D) None of the above
Q2) Four units of packed RBCs were used in the operating room at 3 p.m. Can the remaining 2 units be returned to the blood bank at 5 p.m.?
A) Yes, if the 2 units have been kept under the proper storage conditions
B) Yes, but only if the units are to be used for the same patient
C) No, units may have been out of blood bank for more than 4 hours
D) No, units have been out of the blood bank for longer than 30 minutes
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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Chapter 17: Cellular Therapy
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Sample Questions
Q1) Which of the following indicates a hemolytic process?
A) Pre-transfusion plasma is yellow; post-transfusion plasma is red.
B) Pre-transfusion plasma is yellow; post-transfusion plasma is yellow.
C) Pre-transfusion plasma is red; post-transfusion plasma is yellow.
D) None of the above.
Q2) Which of the following statements is true?
A) Dimethyl sulfoxide is toxic.
B) Dimethyl sulfoxide is the preservative used to prevent damage to hematopoietic progenitor cells during the freezing process.
C) 5% to 10% dimethyl sulfoxide is the final concentration allowed before freezing.
D) All of the above
Q3) What is the purpose of performing serial hemoglobin and hematocrit after a blood transfusion?
A) To detect the presence of hemoglobinemia
B) To monitor platelet refractoriness
C) To monitor the therapeutic or nontherapeutic response
D) To monitor the efficacy of clotting factors
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18
Chapter 18: Transfusion-Transmitted Diseases
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Sample Questions
Q1) This disease can be transmitted through blood transfusion and is characterized by sponge-like lesions of the brain.
A) Cytomegalovirus
B) Epstein-Barr virus
C) Creutzfeldt-Jakob disease
D) Chagas disease
Q2) Which of the following patients would be at a greater risk for CMV infection?
A) An autologous transplant recipient
B) A low-birth-weight infant transfused with CMV-negative blood
C) An allogenic bone marrow transplant recipient
D) None of the above
Q3) The cytomegalovirus and Epstein-Barr virus belong to which family of viruses?
A) Flaviviridae
B) Retroviridae
C) Herpesviridae
D) Picornaviridae
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 severe outcome can be caused by indirect bilirubin levels greater than 18 mg/dL in the newborn?
A) Hydrops fetalis
B) Kernicterus
C) Bilirubinemia
D) Bilirubinuria
Q2) What is the cause of HDFN?
A) Destruction of the mother's RBCs by autoantibody
B) Destruction of the fetus's RBCs by antibody produced by the mother
C) Destruction of the fetus's RBCs by autoantibody
D) Destruction of the mother's RBCs by antibody produced by the fetus
Q3) The D-positive fetal cells in Rh-HDN are___________ .
A) homozygous
B) heterozygous
C) amorphic
D) homologous
Q4) All Rh-negative recipients who are transfused with as little as 1 mL of Rh-positive cells will develop anti-D.
A)True
B)False
Page 20
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Chapter 20: Autoimmune Hemolytic Anemias
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Sample Questions
Q1) The antigen I is often:
A) found on all cord cells.
B) absent on all cord cells.
C) a rare antigen.
D) only found in the white population.
Q2) Which of the following characterizes an alloimmune response in immune hemolytic anemia?
A) The patient produces an antibody reactive with her own red blood cells.
B) The patient produces an antibody to a prescribed antibiotic.
C) The patient produces anti-K to transfused red blood cells.
D) None of the above
Q3) Which theory supports production of autoantibodies?
A) Loss of T-cell suppressor activity upon self-antigens leads to production of autoantibody
B) Helper T cells assist immunocompetent B cells in making antibody against foreign antigens
C) T suppressor cells prevent overproduction of antibody by B cells
D) Loss of T helper cell activity upon self-antigens leads to production of autoantibodies
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21
Chapter 21: The Hla System
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Sample Questions
Q1) What is the linkage disequilibrium in reference to the HLA antigens?
A) Occurrence of HLA genes more frequently in the same haplotype than would be expected by chance alone
B) Displacement of HLA genes on different chromosomes
C) Occurrence of HLA genes less frequently in the same haplotype than would be expected by chance alone
D) Crossover of HLA genes
Q2) What is the most important pre-transplant test performed on the recipient in a heart transplantation?
A) HLA-crossmatch
B) Red blood cell antibody screen
C) HLA-antibody screen
D) Red blood cell-crossmatch
Q3) Between which two loci are recombination (crossing over) most likely to occur?
A) HLA-A and HLA-B
B) HLA-DR and HLA-DP
C) HLA-B and HLA-C
D) HLA-A and HLA-DP
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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) How many chromosomes does the developing child normally carry?
A) 23
B) 46
C) 16
D) 32
Q3) Given the gene frequencies of MS and NS, what is the genotype frequency (MS/NS), assuming the genotype could occur in two different ways: MS: 0.2578 or NS: 0.0628.
A) 0.0004
B) 0.0625
C) 0.0324
D) 0.0054
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Page 23
Chapter 23: Quality Management
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Q1) What is the main purpose of linking Current Good Manufacturing Practices (CGMPs) to process control?
A) To comply with the regulations
B) To build quality into the manufacturing process from the beginning to the end
C) To review and approve training programs and employee position descriptions
D) To approve raw test materials and in-house reagents
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) What is a function of the quality committee or quality council?
A) To provide solutions to recurring clerical errors
B) To provide counseling for departmental downsizing
C) To set priorities for quality improvements
D) To focus on computer upgrades and software implementation
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24
Chapter 24: Transfusion Safety and Federal Regulatory Requirements
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Q1) 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.
Q2) 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
Q3) Upon the event of an adverse reaction that results in a transfusion-related fatality, the CBER must be notified within what time frame ?
A) 24 hours
B) 7 days
C) 30 days
D) not necessary to contact the CBER, but must contact the FDA
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Page 25
Chapter 24: Utilization Management
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Q1) 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.
Q2) Blood utilization management programs are designed to do all but which of the following?
A) Increase safety
B) Decrease component availability
C) Reduce expenditure
D) Manage limited blood resources
Q3) A physician has ordered a 2-unit transfusion on an outpatient. When the outpatient arrives, the patient's hemoglobin is 12. What is the most appropriate action?
A) Cancel the transfusion and send the patient home.
B) Call the physician's office and inform them of their mistake.
C) Inform the pathologist or medical director and allow him to contact the physician.
D) Transfuse. A physicians order should not be questioned.
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Chapter 25: Laboratory Information Systems
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Sample Questions
Q1) Which of the following could be considered a final disposition of a unit?
A) Issued
B) Transfused
C) Available
D) Reserved
Q2) A unit of blood was irradiated for a patient. It had 29 days before it expired. The unit's original expiration date was January 1, 2012. What expiration date should the LIS have given it when the modification was recorded?
A) January 1, 2012
B) January 2, 2012
C) December 31, 2012
D) 24-hour expiration
Q3) What information might be found in a blood bank computer system?
A) Inventory of blood components
B) Antibodies identified in a patient
C) The last date of donation for a blood donor
D) All 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) In the case of Kozup v. Georgetown University Hospital (1987), what were the circumstances surrounding the court's decision to rule in favor of the defendant?
A) The death of an infant was not transfusion-related.
B) Parents did not object to transfusion at the time of infusion.
C) Parents had signed a transfusion consent form.
D) The District of Columbia courts had a blood shield statute in effect.
Q2) Blood banks are federally regulated by which of the following?
A) AABB
B) Commission on Laboratory Accreditation
C) American Medical Association
D) FDA
Q3) What is the rationale surrounding the Doctrine of Charitable Immunity?
A) State legislatures are more lenient toward select specialty areas of medicine with regard to excessive legal damages.
B) Courts provide immunity from excess liability for nonprofit organizations.
C) Blood collecting facilities entice donors by agreeing to donate 5% of plasma revenues to their favorite charity.
D) None of the above
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Chapter 27: Tissue Banking: A New Role for the Transfusion Service
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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 of the following is generally excluded from the tissue bank?
A) Corneas
B) Liver
C) Heart valves
D) Skin
Q3) 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
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