American Society for Clinical PathologyBOC Study Guide 5th edition Clinical Laboratory Certification Examinations Oversight Editors Patricia A. Tanabe, MPA, MLS(ASCP)™ Director, Examination Activities E. Blair Holladay, PhD, SCT(ASCP)™ Vice President for Scientific Activities, ASCP Executive Director, Board of Certification and the ASCP Board of Certification Staff @B a mesican Soccry for Clinical PachofogyPublishing Team Erik N Tanck & Tae W Moon (design/production) Joshua Weikersheimer (publishing direction) Notice ‘Trade names for equipment and supplies desceibed are included as suggestic inclusion constitute an endorsement of preference by the Author or the ASCP. The Author and ASCP urge all readers to read and follow all manufacturers’ instructions and package insert warnings concerning the proper and safe use of products. The American Society for Clinical Pathology, having exercised appropriate and reasonable effort to research material current as of publication date, does not assume any liability for any loss or damage caused by errors and omissions in this publication, Readers must assume responsibility for complete and thorough research of any hazardous conditions they encounter, as this publication is not intended to be all-inclusive, and recommendations and regulations change only. In no way does their over time, ‘American Society for Clinical Pathology Press Copyright © 2009 by the American Society for Clinical Pathology. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. Printed in Hong Kong 1413121110 ii. The Board of Certification Study GuideTable of Contents vi vii ix xi ‘Acknowledgments Preface ‘The Importance of Certification, CMP, Licensure and Qualification Preparing for and Taking the BOC Certification Examination 1 Blood Bank Questions 1 Blood Products 8 Blood Group Systems 17 Physiology and Pathophysiology 24 Serology 42 Transfusion Practice Answers 53 Blood Products 55 Blood Group Systems 59 Physiology and Pathophysiology 62 Serology 69 Transfusion Practice 75 Chemistry Questions 75 Carbohydrates 78 Acid-Base Balance 81 Electrolytes 85 Proteins and Other Nitrogen- Containing Compounds 95 Heme Derivatives 99 Enzymes 104 Lipids and Lipoproteins 107 Endocrinology and Tumor Markers 113 TDM and Toxicology 115 Quality Assessment 117 Laboratory Mathematics 121 Instrumentation Answers 129 Carbohydrates 129 Acid-Base Balance 130 130 132 133 136 137 139 140 141 142 145 145 149 155 166 168 178 187 189 191 194 202 211 211 213 215 216 219 220 221 222 Electrolytes Proteins and Other Nitrogen- Containing Compounds Heme Derivatives Enzymes Lipids and Lipoproteins Endocrinoiogy and Tumor Markers TDM and Toxicology Quality Assessment Laboratory Mathematics Instrumentation Hematology Questions Erythrocytes: Physiology Erythrocytes: Disease States Erythrocytes: Laboratory Determinations Leukocytes: Physiology Leukocytes: Disease States Leukocytes: Laboratory Determinations Platelets: Physiology Platelets: Disease States Platelets: Laboratory Determinations Hemostasis Hematology Laboratory Operations Answers Erythrocytes: Physiology Erythrocytes: Disease States Erythrocytes: Laboratory Determinations Leukocytes: Physiology Leukocytes: Disease States Leukocytes: Laboratory Determinations Platelets: Physiology Platelets: Disease States Platelets: Laboratory Determinations Clinical Laboratory Certification Examinations iti‘Table of Contents 222 226 229 229 240 248 258 265 268 271 275 279 279 294 300 313 315 317 321 328 334 337 345, 352 354 358 359 Hemostasis Hematology Laboratory Operations Immunology > Questions Autoantibody Evaluation Infectious Disease Serology Protein Analysis Cellular Immunity and Histocompatibility Techniques Answers Autoantibody Evaluation Infectious Disease Serology Protein Analysis Cellular Immunity and Histocompatibility Techniques Microbiology Questions Preanalytical and Susceptibility Testing Aerobic Gram-Positive Cocci Gram-Negative Bacilli Aerobic Gram-Negative Cocci Aerobic or Facultative Gram-Positive Bacilli Anaerobes Fungi Mycobacteria Viruses and Other Microorganisms Parasites Answers Preanalytical and Susceptibility Testing Aerobic Gram-Positive Cocci Gram-Negative Bacilli Aerobic Gram-Negative Cocci Aerobic or Facultative Gram-Positive Bacilli iv The Board of Certification Study Guide 359 361 363 365 367 369 369 370 374 378 378 379 381 381 383 386 390 399 403 405 413 414 415 417 420 421 423 Anaerobes Fungi Mycobacteria Viruses and Other Microorganisms Parasites Molecular Biology Questions Molecular Science Molecular Techniques Applications of Molecular Testing Answers Molecular Science Molecular Techniques Applications of Molecular Testing Urinalysis and Body Fluids Questions Urinalysis: Pre-Analytical Examination Urinalysis: Physical Examination Urinalysis: Chemical Examination Urinalysis: Microscopic Examination Urinalysis: Complete Examination Urine Physiology Other Body Fluids Answers Urinalysis: Pre-Analytical Examination Urinalysis: Physical Examination Urinalysis: Chemical Examination Urinalysis: Microscopic Examination Urinalysis: Complete Examination Urine Physiology Other Body Fluids‘Table of Contents 427 Laboratory Operations 481 Reading & References 427 433 442 445 453 459 462 465 467 472 473 476 478 479 Questions Quality Assessment Safety Management Laboratory Mathematics Instrumentation and General Laboratory Principles Education and Communication Laboratory Information Systems Answers Quality Assessment Safety Management Laboratory Mathematics Instrumentation and General Laboratory Principles Education and Communication Laboratory Information Systems Clinical Laboratory Certification Examinations VAcknowledgments The editors would like to thank Melissa Meeks and Edith Miller for their painstaking efforts in combining and reviewing this body of work in accordance with the ASCP Press and production staff Special thanks are also extended to all our volunteers (former examination committee members and recently recruited volunteers) for their commitment laboratory science students and theit professors. sisting us on this essential resource for ‘Thank you to my family - Adam, Peter and Joe, for their support and understanding during this project. ~Patricia A. Tanabe, MPA, MLS(ASCP)“ Good luck with your hoard examination—my best to each of you as you embark on an exciting career in laboratory medicine. -B. Blair Holladay, PhD, SCT(ASCP)™ Vi The Board of Certification Study GuidePreface The Sth edition of the Board of Certification Study Guide for Clinical Laboratory Certification Examinations contains over 2000 multiple choice questions. Unique to this study guide is the differentiation of questions appropriate for both the Medical Laboratory Technician and Medical Laboratory Scientist levels from questions that are appropriate for the Medical Laboratory Scientist level only (clearly marked MLS ONLY). The questions in this edition are arranged in chapters which correspond to the major content areas on the examination, Within each chapter, the questions are further grouped by topic. New to this edition are short answer explanations and references for each practice question. Questions with images will appear as they would on the certification examination. Laboratory results will be presented in both conventional and SI units. ‘The practice questions are presented in a format and style similar to the questions included on the Board of Certification certification examinations. Please note: None of these questions will appear on any Board of Certification examination. ‘These practice questions were compiled from previously published materials and submitted questions from recruited reviewers, (Note: ‘These reviewers do not currently serve on any Examination Committee.) This book is not a product of the Board of Certification, rather it is a product of the ASCP Press, the independent publishing arm of the American Society for Clinical Pathology. Use of this book does not ensure passing of an examination. The Board of Certification’s evaluation and credentialing processes are entirely independent of this study guide; however, this book should significantly help you prepare for your BOC examination. Clinical Laboratory Certification ExaminationsQuestion Editors and Reviewers Our thanks to those who edited/ reviewed questions for this book. Blood Bank Margaret G. Fritsma, MA, MT(ASCP) SBB, retired (co-Editor) Formerly, Associate Professor University of Alabarna at Birrsingham Birmingham, AL Joanne Kosanke, MT(ASCP)SBB" (co-Editer) (Manager, Immunohematology Reference Laboratory ‘American Red Cross Central Ohio Blood Services Region Columbus, OF Patricia J llinger, MSEA, MASCP, MLS(asce) space Laboratory Education and Training Consultant Minneapolis, Minnesota Deborah T, Firestone, EdD, MT(ASCP) SBB Associate Dean Stony Brook Univesity Stony Brook, NY Carol McConnell, MS, MLS(ASCP)* Chemistry Polly Cathcart, MMSe, MT(ASCP)SC, retited Formetly, Chemistry Supervisor Piedmone Hospital ‘Aulanta, GA, Vicki. Freeman, PhD, FACB, MLSascP)sC Department Cha and Distinguished Teaching Professor University of Texas Medical Branch Galveston, TX Ross J. Molinaro, PRD, MT(ASCP), (ABCC), FACB Medical Director, Core Laboratory, Emory University Fospital Midtown & Assistant Professor, Pathology and Lab Medicine, mory University School of Medicine nory University Atlanta, GA Christine Papadea, PRD, MTKASCPISC, retired Formerly, Professor Pathology and Laboratory Medicine Medical University of South Carolina Charleston, SC Diane Wilson, PhD, MT(ASCP) Progrant Director- Medical Technology Morgan State University Bakimore. MD Hematology Donna D.Castllone, MS, MT(ASCP)SH Eaton) Clinkal Project Manager/Hematology & Hemostasis Siemens Healthcare Dingostics Tanytoun, NY Sandra DiFalco, MS, MT(ASCP) Baeston Coordinator “The Colorado Center for Medical Laboratory Scien Denver, CO) Kathy W. Jones, MS, MLS(ASCP)<™ Faculty Clinical Laboratory Science Program ‘Auburn University Montgomery Montgomery, Al Linda L. Myers, MEd, MT(ASCP)S#H Assistant Director Clinical Laboratory St. Joseph Medical Center Houston, TX John K. Scariano, PhD, MT(ASCP) ‘Assistant Professor, Pathology & Internal Medicine University of New Mi Medicine Albuquerque, NM. Ruth Scheib, MT(ASCP)SH. Medical Technologist Cleveland Clinic Cleveland, OH co School of Immunology Barbara Anne Maier, MPA, MI(ASCP)SI retied (Edi Formely, Technical Specialist Ienmanology Seology& Flow Cyrometry Geisinger Medical enter Damvile, Linda E. Miller, PhD, SASCE)MB™ Profesor of Cinival Laboratory Science SUNY Upstate Medical Driversity Syracuse. NY Kate Rittenhouse-Olson, PhD, SIASCP) bxofessor, Director Biotechnology Program University at Buta, The State University cof New York Buffalo, NY Laboratory Operations Ellen Boswell, MBA, MT(ASC?)SH Director of Clinical Pathology Laboratory Operations Univesity of Virginia Medical Center Charlotervile,VA Cynthia S. Johns, MSA, MLS(ASCP)"MSH™ Se 1PTechnical Specialist oratory Corporation of Ameria talelond, FL Ross J. Molinaro, hD, MTASCP), D(ABCC), FACB Medical Decor, Core Laboratory. Ernory Univesity Hospital Midtown Assibtant Profesor Pathology and Lab Medicine, Emory Univesity Schoel ot Medicine Emory University Adants, GA Patricia A Myers, MTCASCP)SMSLS Lead Technologist, Microbiology Lancaster General Hospital Uaneaster PA Lymn Schwabe, MBA, CHE, MT(ASCP) Caitor Safety) Senior necro, Lab Services Northshore University HealthSystem, Evanston Hospital vil The Board of Certification Study Guide anton, IL Peggy Simpson, MS, MT(ASCP) -Adiministrative Diector of Laboratories Danville Regional Medical Center Danville, VA Microbiology ‘Yvette S, McCarter, PRD, D(ABMM) GEditor) Director, Clinical Microbiology Laboratory University of Florida Health Science Center - Jacksonville Sacksonvile, FL JoAnn P. Fenn, M8, MT(ASCP) Professor and Associate Division Head, Medical Laboratory Science, Depa of Pathology University 0 Salt Lake Ci Dawn S. Lumpkin, BA, MTYASCP)SM,SV Manager of Microbiology Services HCA Midwest Division, Research Medical Center Kansas City, MO Karen Myers, MA, MTASCP)SC ‘The Colorado Center for Medical Laboratory Science Denver, CO Patty Newcomb-Gayman, MT(ASCE)SM. Point of Care Testing Coordinator Swedish Medical Center Seattle, WA Molecular Pathology Stephen T: Koury, PhD, MT(ASCE) (Editor) Research Assistant Professor Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo Buffalo, NY Urinalysis and Body Fluids Kristina Jackson Behan, PhD, MT(ASCP) Associate Professor and Program Director University of West Florida Clinical Laboratory Scienc Pensacola, FL Susan Strasinger, DA, MT(ASCP), retited formerly, Vis University o Pensacola, FL ting Assistant Professor West FloridaCertification, Certification Maintainance Program (CMP), Licensure and Qualification The Importance of Certification, CMP, Licensure and Qualification ‘The practice of modern medicine would be impossible without the tests performed in the laboratory. Ahighly skilled medical teaa of pathologists, specialists, laboratory scientists, technologists, and technicians works together to determine the presence or absence of disease and provides valuable data needed to determine the course of treatment. Today's laboratory uses many complex, precision instruments and a variety of automated and electronic equipment. However, the success of the laboratory begins with the laboratorians’ dedication to their profession and willingness to help others. Laboratorians must produce accurate and reliable test results, have an interest in science, and be able to recognize their responsibility for affecting human lives. Role of the ASCP Board of Certification Founded in 1928 by the American Society of Clinical Pathologists (ASCP—now, the American Society for Clinical Pathology), the Board of Certification is considered the preeminent certification agency in the US and abroad within the field of laboratory medicine. Composed of representatives of professional organizations and the public, the Board's mission is to: “Provide excellence in certification of laboratory professionals on behalf of patients worldwide.” ‘The Board of Certification consists of more than 100 volunteer technologists, technicians, laboratory scientists, physicians, and professional researchers. These volunteers contribute their time and, expertise to the Board of Governors and the Examination Committees. They allow the BOC to achieve the goal of excellence in credentialing medical laboratory personnel in the US and abroad. The Board of Governors is the policy-making governing body for the Board of Certification and is composed of 25 members. These 25 members include technologists, technicians, and pathologists nominated by the ASCP and representatives from the general public as well as from the following societies: the American Association for Clinical Chemistry, the AABB, American College of Microbiology, American Society for Clinical Laboratory Science, the American Society of Cytopathology, the American Society of Hematology, the American Association of Pathologists’ Assistants, Association of Genetic Technology, the National Society for Histotechnology, and the Clinical Laboratory Management Association (CLMA). ‘The Examination Committees are responsible for the planning, development, and review of the examination databases; determining the accuracy and relevancy of the test items; confirming the standards for each examination and performing job or practice analyses. Certification http://wwwascp.org/certification Certification is the process by which a nongovernmental agency ot association grants recognition of competency to an individual who has met certain predetermined qualifications, as specified by that agency or association. Certification affirms that an individual has demonstrated that he or she possesses the knowledge and skills to perform essential tasks in the medical laboratory. The ASCP Board of Certification certifies those individuals who meet academic and clinical prerequisites and who achieve acceptable performance levels on examinations. In 2004, the ASCP Board of Certification implemented the Certification Maintenance Program (CMP), which mandates participation every 3 years for newly certified individuals in the US. The goal of this program is to demonstrate to the public that laboratory professionals are performing the appropriate and relevant activities to Keep current in their practice. Please follow the steps outlined on the website to apply for CMP and retain your certification. (http://www.ascp.org/CMP) Clinical Laboratory Certification Examinations ixCertification, Certification Maintainance Program (CMP), Licensure and Qualification United States Certification http://www-ascp.org/certification To apply for a Certification Examination follow these step-by-step instructions: 1 {dentify the examination you are applying for and determine your eligibility. 2 Gather your required education and experience documentation. 3. Apply for the examination. We offer 2 options: a. Apply online and pay by credit card b. Ordownload an application, pay by credit card, check or money order and mail to [ASCP Board of Certification 3336 Eagle Way Chicago, 1L 60678-1033, 4 Schedule your examination at a Pearson Professional Center. Visit the Pearson site (http://www.pearsonvue. com/ascp) to identify a location and time that is convenient for you to take your ASCP examination, International Certification http://www.asep.org/certification/International ASC? offers its gold standard credentials in the form of international certification (ASCP!) to eligible individuals. The ASCP* credential certifies professional competency among new and practicing laboratory personnel in an effort to contribute globally to the highest standards of patient safety. Graduates of medical laboratory science programs outside the United States are challenged with content that mirrors the standards of excellence established by the US ASCP exams. The ASCP’ credential carries the weight of 80 years of expertise in clinical laboratory professional certification. Please visit the website to view the following: 1 Website information translated into a specific language. Current listing of international certifications 2 3 Bligibility guidelines. 4 step-by-step instructions to apply or international certification State Licensure hetp://www.ascp.org/licensure State Licensure is the process by which a state grants a license to an individual to practice their profession in the specified state. The individual must meet the state's licensing requirements, which may include examination and/or experience. It is important to identify the state and exarnination to determine your eligibility and view the steps for licensure and/or certification. For a list of states that require licensure, please go to the website. (http://www-ascp.org/statelicensureagencies) “The ASCP Board of Certification (BOC) examinations have been approved for licensure purposes by the states of California and New York. The BOC examinations also meet the requirements for all other states that require licensure. Qualification http:/www.ascp.org/qualification Aqualification from the Board of Certification recognizes the competence of individuals in specific technical areas. Qualifications are available in laboratory informatics, immunohistochemistry and flow cytometry. To receive this credential, candidates must meet the eligibility requirements and successfully complete an examination (QCYM, QIHC) or a work sample project (QLI). Candidates who complete the Qualification process will receive a Certificate of Qualification, which is valid for 5 years. The Qualification may be revalidated every 5 years upon receipt of completed application and fee, (Documentation of acceptable continuing education may be requested.) X The Board of Certification Study GuideAbout the Examination Preparing for and Taking the BOC Certification Examination Begin early to prepare for the Certification Examination. Because of the broad range of knowledge and skills tested by the examination, even applicants with college education and those completing formal laboratory education training programs will find that review is necessary, although the exact amount will vary from applicant to applicant. Generally, last-minute cramming is the least effective method for preparing for the examination. The earlier you begin, the more time you will have to prepare; and the more you prepare, the better your chance of successfully passing the examination and scoring well. Study for the Test Plan a course of study that allows more time for your weaker areas. Although it is important to study your areas of weakness, be sure to allow enough time to review all areas. It is better to spend a short time studying every day than to spend several hours every week or 2. Setting aside a regular time and a special place to study will help ensure studying becomes a part of your daily routine. Study Resources hetp://www.ascp.org/studymaterials Competency Statements and Content Guidelines http://www.ascp.org/contentguidelines The Board of Certification has developed competency statements and content guidelines to delineate the content and tasks included in its tests. Current Content Guidelines for the Medical Laboratory Scientist (MLS) and Medical Laboratory Technician (MLT) examinations as well as other certification examinations offered by the ASCP BOC are available. Study Guide ‘The questions in this study guide are in a format and style similar to the questions on the Board of Certification examinations. The questions are in a multiple choice format with 1 best answer. Work through each chapter and answer all the questions as presented. Next, review your answers against the answer key. Review the answer explanation for those questions, that you answered incorrectly. Lastly, each question is referenced if you require further explanation Textbooks The references cited in this study guide (see pp 481-484) identify many useful textbooks. The most current reading lists for most of the examinations are available on the ASCP's website (http://www. ascp.org/readinglists). Textbooks tend to cover a broad range of knowledge in a given field, An added benefit is that textbooks frequently have questions at the end of the chapters that you can use to test yourself should you need further clarification on specific subject matter. Online practice tests hittp://www.ascp-practice.com ‘The online practice test is a subscription product. It includes 90-day online access to the practice tests, comprehensive diagnostic scores, and discussion boards. If you are an institutional purchaser that would like to pay by check or purchase order (minimum of 20 tests to use a check or purchase order), please download the order form frora the website. Content-specific online practice tests can be purchased online. Clinical Laboratory Certification Examinations xiAbout the Examination Taking the Certification Examination ‘The ASCP Board of Certification (BOC) uses computer adaptive testing (CAT), which is criterion referenced, With CAT, provided you answer the question correctly, the next examination question has a slightly higher level of difficulty. The difficulty level of the questions presented to the exarninee continues to increase until a question is answered incorrectly. At this point, a slightly easier question is presented. The importance of testing in an adaptive format is that each test is individually tailored to your ability level. Each question in the examination pool is calibrated for difficulty and categorized into a subtest area, which corresponds to the content guideline for a particular examination. The weight (value) given to each question is determined by the level of difficulty. All examinations (with the exception of phlebotomy (PBT) and donor phlebotomy (DPT) are scheduled for 2 hours and 30 minutes and have 100 questions. The PBT and DPT examinations are scheduled for 2 hours and have 80 questions. Your preliminary test results (pass/fail) will appear on the computer screen immediately upon completion of your examination. Detailed examination scores will be mailed within 10 business days after your examination, provided that the BOC has received all required application documents. Examination results cannot be released by telephone under any circumstances. Your official detailed examination score report will indicate a “pass” or “fail” status and the specific scaled score on the total examination, A scaled score is statistically derived (in part) from the raw score (number of correctly answered questions) and the difficulty level of the questions. Because each examinee has taken an individualized examination, scaled scores are used so that all examinations may be compared on the same scale. The minimum passing score is 400. The highest attainable score is 999. If you were unsuccessful in passing the examination, your scaled scores on each of the subtests will be indicated on the report as well. These subtest scores cannot be calculated to obtain your total score, ‘These scores are provided as a means of demonstrating your areas of strengths and weaknesses in comparison to the minimum pass score. adi. The Board of Certification Study Guide1: Blood Bank | Blood Products Questions Blood Bank ‘The following items have been identified generally as appropriate for both entry level medical laboratory scientists and medical laboratory technicians. Items that are appropriate for medical laboratory scientists only are marked with an “MLS ONLY.” 1 Questions 52 Answers with Explanations 1 Blood Products 53 Blood Products 8 Blood Group Systems 55 Blood Group Systems 17 Physiology and Pathophysiology 59. Physiology and Pathophysiology 24 Serology 62 Serology 42 Transfusion Practice 69 Transfusion Practice Blood Products 1 The minimum hemoglobin concentration in a fingerstick from a male blood donor is: a 12.0 g/dl. (120 g/L) b 12.5 g/dL (125 g/L) ¢ 13.5 g/dL (135 g/L) 15.0 g/dL (150 g/L) 2_ A cause for permanent deferral of blood donation is: a diabetes b residence in an endemic malaria region history of jaundice of uncertain cause history of therapeutic rabies vaccine 3 Which of the following prospective donors would be accepted for donation? Ny a 32-year-old woman who received a transfusion in a complicated delivery 5 months previously & 19-year-old sailor who has been stateside for 9 months and stopped taking his anti-malarial medication 9 months previously € 22-year-old college student who has a temperature of 99,2°F (37.3°C) and states thar he feels, well, but is nervous about donating 45-year-old woman who has just recovered from a bladder infection and is still taking antibiotics 4 Which one of the following constitutes permanent rejection status of a donor? a a tattoo 5 months previously b recent close contact with a patient with viral hepatitis 2units of blood transfused 4 months previously confirmed positive test for HBsAg 10 years previously 5 According to AABB standards, which of the following donors may be accepted as a blood donor? us © a traveled to an area endemic for malaria 9 months previously spontaneous abortion at 2 months of pregnancy, 3 months previously resides with a known hepatitis patient received a blood transfusion 22 weeks previously ane (Clinical Laboratory Certification Examinations 11: Blood Bank | Blood Products Questions 6 Below are the results of the history obtained from a prospective female blood donor: age: 16 temperature: 99.0°F (972°C) Het 36% history tetanus toxoid immunization 1 week previously How many of the above results excludes this donor from giving blood for a routine transfusion? a none bi «2 a3 7 For apheresis donars who donate platelets more frequently than every 4 weeks, a platelet count Gkiy must be performed prior to the procedure and be at least: 150 x 103/uL (150 x 102/L) 200 x 103/pL (200 x 10°/L) 250 x 10°/L (250 x 10°/L) 300 x 103/j:L (300 x 10°/L) aoee 8 Prior to blood donation, the intended venipuncture site must be cleaned with a scrub solution containing: a hypochlorite b isopropyl alcohol € 10% acetone @ PVP iodine complex 9 All donor blood testing must include a complete Rh phenotyping b anti-CMV testing € direct antiglobulin test 4 serological test for syphilis 10 During the preparation of Platelet Concentrates from Whole Blood, the blood should be: cooled towards 6°C cooled towards 20°-24°C warmed to 37°C heated to 57°C noe 11 The most common cause of posttransfusion hepatitis can be detected in donors by testing for: ony anti-HCV HBsAg anti-HAV IgM anti-HBe nose 12 The Western blot is a confirmatory test for the presence of a CMV antibody b anti-HIV-1 HBsAg d serum protein abnormalities 13° The tes at is currently used to detect donors who are infected with the AIDS virus is: a anti-HBc b anti-HIV 1,2 ¢ HBsAg 4 ALT 2 The Board of Certification Study Guide1: Blood Bank | Blood Products Questions 14 A commonly used screening method for anti-HIV-1 detection is: a latex agglutination b radioimmunoassay (RIA) ¢ thin-layer-chromatography (TLC) 4 enzyme labeled immunosorbent assay (ELISA) 15 Rejuvenation of a unit of Red Blood Cells is a method used to: oN 4 remove antibody attached to RBCs inactivate viruses and bacteria restore 2,3-DPG and ATP to normal levels filter blood clots and other debris, neo 16 A.unit of packed cells is split into 2 aliquots under closed sterile conditions at 8 AM. The expiration time for each aliquot is now: a 4pmon the same day b BPmon the same day © 8am the next morning 4 the original date of the unsplit unit 17 Aunit of Red Blood Celis expiring in 35 days is split into 5 small aliquots using a sterile pediatric quad set and a sterile connecting device. Each aliquot must be labeled as expiring in: a Ghours b 12hours © Sdays 35 days 18 When platelets are stored on a rotator set on an open bench top, the ambient aiv temperature must be recorded: once a day twice a day every 4 hours every hour aooe 19 Which of the following is the correct storage temperature for the component li a Cryoprecipitated AHF, 4°C b Fresh Frozen Plasma (BFP), -20°C € Red Blood Cells, Frozen, ~40° d Platelets, 37°C 20 Aunit of Red Blood Cells is issued at 9:00 AM. At 9:10 aM the unit is returned to the Blood Bank. ‘The container has not been entered, but the unit has not been refrigerated during this time span. ‘The best course of action for the technologist is to: a. culture the unit for bacterial contamination ‘b discard the unit if not used within 24 hours € store the unit at room temperature record the return and place the unit back into inventory 21 The optimum storage temperature for Red Blood Cells, Frozen is: ewer a 80°C b -20°C © 12°C aac tinical Laboratory Certification Examinations 31: Blood Bank | Blood Products Questions 22 ‘The optimum storage temperature for Red Blood Cells is: a -80°C b -20°C © 12°C a ac 23 If the seal is entered on a unit of Red Blood Cells stored at 1°C to 6°C, what is the maximum. allowable storage period, in hours? a 6 b 24 © 48 d 72 24 The optimum storage temperature for cryoprecipitated AHE is: a 20°C b -12°C © ac d@ 22°C 25. Cryoprecipitated AHF must be transfused within what period of time following thawing and pooling? a 4hours b 8hours © i2hours d 24 hours 26 Platelets prepared in a polyolefin type container, stored at 22°-24°C in 50 ml. of plasma, and gently agitated can be used for up to: a 24 hours b 48 hours © 3days d Sdays 27 The optimum storage temperature for platelets is a -20°C b -12°C c ac a 22°C 28 According to ABB standards, Fresh Frozen Plasma must be infused within what period of time following thawing? a 24 hours b 36 hours © 48 hours d 72 hours 29 Cryoprecipitated AHE, if maintained in the frozen state at -18°C or below, has a shelf life of: a 42 days b 6months © 12 months 4.36 months 4 The Board of Certification Stady Guide: Blood Bank | Blood Products Questions 30 31 32 33 34 35 36 37 38 Once thawed, Fresh Frozen Plasma must be transfused within: Abours Bhours 12 hours 24 hours anos An important determinant of platelet viability following storage is: a plasma potassium concentration b plasma pH prothrombin time 4 activated partial thromboplastin time In the liquid state, plasma must be stored at: a 16°C b 22°C © 37°C d 56°C During storage, the concentration of 2,3-diphosphoglycerate (2,3-DPG) decreases in a unit of Platelets Fresh Frozen Plasma Red Blood Cells Cryoprecipitated AHE aoe Cryoprecipitated AHF a is indicated for fibrinogen deficiencies b should be stored at 4°C prior to administration € will not transmit hepatitis B virus is indicated for the treatment of hemophilia B Which apheresis platelets product should be irradiated? autologous unit collected prior to surgery random stock unit going to a patient with DIC a directed donation given by a mother for her son a directed donation given by an unrelated family friend aoe Irradiation of a unit of Red Blood Cells is done to prevent the replication of donor: a. granulocytes b lymphocytes € red cells d platelets Plastic bag overwraps are recommended when thawing units of FFP in 37°C water baths because they prevent: a. the FFP bag from cracking when it contacts the warm water b water from slowly dialyzing across the bag membrane € the entry ports from becoming contaminated with water 4 the label from peeling off as the water circulates in the bath Which of the following blood components must be prepared within 8 hours after phlebotomy? Red Blood Cells Fresh Frozen Plasma Red Blood Cells, Frozen Cryoprecipitated AHE noose Clinical Laboratory Certification Examinations 51: Blood Bank | Blood Products Questions 39 Cryoprecipitated AHF contains how many units of Factor VIII? oily a 40 b 80 © 130 a 250 40 Which of the following blood components contains the most Factor VIII concentration relative My to volume? a Single-Donor Plasma b Cryoprecipitated AHF € Fresh Frozen Plasma d Platelets 41 The most effective component to treat a patient with fibrinogen deficiency is: osty a Fresh Frozen Plasma b Platelets € Fresh Whole Blood dd Cryoprecipitated AHF 42 Ablood component prepared by thawing Fresh Frozen Plasma at refrigerator temperature and removing the fluid portion is: a Plasma Protein Fraction b Cryoprecipitated AHF ¢ Factor IX Complex d FP24 43 Upon inspection, a unit of platelets is noted to have visible clots, but otherwise appears normal. ‘The technologist should: issue without concern filter to remove the dots centrifuge to express off the clots quarantine for Gram stain and culture moge 44 According to ABB Standards, at least 90% of all Apheresis Platelets units tested shall contain a MS. minimum of how many platelets? a 55x1010 b 65x10 © 3.0x10" d 5.0x 1012 45 According to AABB Standards, Platelets prepared from Whole Blood shall have at least: a 5.5 x 10! platelets per unit in at least 90% of the units tested b 6.5 x 112 platelets per unit in 90% of the units tested € 7.5 x 10% platelets per unit in 100% of the units tested d 85x 10% platelets per unit in 95% of the units tested 46 Which of the following is proper procedure for preparation of Platelets from Whole Blood? alight spin followed by a hard spin D light spin followed by 2 hard spins ¢ 2light spins hard spin followed by a light spin © The Board of Certification Study Guide1: Blood Bank | Blood Products Questions 47 According to AABB standards, what is the minimum pH required for Platelets at the end of the Ully. storage period? a 60 b 62 © 68 47.0 48 According to ABB standards, Platelets must be: NY gently agitated if stored at room temperature b separated within 12 hours of Whole Blood collection € suspended in sufficient plasma to maintain a pH of 5.0 or lower d_ prepared only from Whole Blood units that have been stored at 4°C for 6 hours 49 Aunit of Whole Blood-derived (random donor) Platelets should contain at least: a 1.0 102 platelets b 55x10! platelets © 5.5.x 10" platelets d_ 90% of the platelets from the original unit of Whole Blood 50 _ Platelets prepared by apheresis should contain at least: a 1x10" platelets b 3x 10" platelets ¢ 3x10" platelets 4 5x10! piatelets 51 Leukocyte-Reduced Red Blood Cells are ordered for a newly diagnosed bone marrow candidate. 3, What is the best way to prepare this product? czossmatch only CMV-seronegative units irradiate the unit with 1,500 rads wash the unit with saline prior to infusion transfuse through a Log? leukocyte-removing filter anoe 52 Of the following blood components, which one should be used to prevent HLA alloimmunization 5, of the recipient? a Red Blood Cells b Granulocytes Irradiated Red Blood Cells 4 Leukocyte-Reduced Red Blood Cells 53 A father donating Platelets for his son is connected to a continuous flow machine, which uses the principle of centrifugation to separate Platelets from Whole Blood. As the Platelets are harvested, all other remaining elements are returned to the donor. This method of Platelet collection is known as: a apheresis B autologous homologous 4 fractionation 54 To qualify as a donor for autologous transfusion a patient’s hemoglobin should be at least: a 8 g/dL (80 g/L) b 11 g/dL (110 g/L) ¢ 13 g/dL (130 g/L) ad 15 g/dL (150 g/L) (Clinical Laboratory Certification Examinations 71: Blood Bank | Blood Group Systems Questions 55 What is/are the minimum pretransfusion testing requirement(s) for autologous donations collected and transfused by the same facility? a ABO and Rh typing only b ABO/Rh type, antibody screen ¢ ABO/Rh type, antibody screen, crossmatch d_ no pretransfusion testing is required for autologous donations 56 ina quality assurance program, Cryoprecipitated AHF must contain a minimum of how many 385, international units of Factor VIII? a 60 b 70 « 80 a 90 57 An assay of plasma from a bag of Cryoprecipitated AHF yields a concentration of 9 international ‘Sux Units (U) of Factor VIII per mL of Cryoprecipitated AHF If the volume is 9 mL, what is the Factor VIII content of the bag in IU? a Qo b 18 © 27 d 81 Blood Group Systems 58 Refer to the following table Antigens 1 234 5 Test results Slo+ 00 ++ + Zuo o+ 0% o She IS wo + + oF + v + Sas auto 0 Given the most probable genotypes of the parents, which of the following statements best describes the most probable Rh genotypes of the 4 children? a 2are Ryr, 2are RyRy b Bare Ryr, Lis rr ¢ Lis Ror, Lis Ryr, 2 are RyRy d Lis Ror’, Lis RyRy, 2 are Ryr 59 The linked HLA genes on each chromosome constitute a(n): a allele b trait ¢ phenotype 4 haplotype 8 The Board of Certification Study Guide1: Blood Bank | Blood Group Systems Questions 60 An individual's red blood cells give the following reactions with Rh antisera anti-D anti-C anti-E antic antie Rhcontrol ae 3s 0 Be an) ‘The individual's most probable genotype is: a DCe/DeE b DcE/dce © Dee/dee d DCe/dce 61 Ablood donor has the genotype: hh, AB. What is his red blood cell phenotype? aA bB <0 a AB 62 An individual has been sensitized to the k antigen and has produced anti-k. What is her most probable Kell system genotype? a KK b Kk c kk d Koko 63 Given the following typing results, what is this donor's racial ethnicity? Lefa-b3) Fy(a-b-); Jsfaxb+) a African American b Asian American © Native American @ Caucasian 64 Amother has the red cell phenotype D+C+E-c-e+ with anti-c (titer of 32 at AHG) in her serum. The father has the phenotype D+C+E-c+e+. The baby is Rh-negative and not affected with hemolytic disease of the newborn. What is the baby's most probable Rh genotype? brr © RR; aRy 65 _ Inan emergency situation, Rh-negative red cells are transfused into an Rh-positive person of the genotype CDe/CDe. ‘Ihe first antibody most likely to develop is: a antic b anti-d © antie d anti-£ 66 Most blood group systems are inherited as: sex-linked dominant sex-linked recessive autosomal recessive aooe autosomal codominant 67 ‘The mating of an Xg(a+) man and an Xg(a-) woman will only produce a Xg(a-) sons and Xg(a-) daughters b Xg(a+) sons and Xg(a+) daughters ¢ Xg(a-) sons and Xg(a+) daughters d Xg(a+) sons and Xg(a-) daughters Clinical Laboratory Certification Examinations 91: Blood Bank | Blood Group Systems Questions 68 Refer to the following data: anti-C anti-D anti-€ antic antte Given the reactions above, which is the most probable genotype? a RoR; b Ry’ © Ro” @ RR 69 A patient's red cells type as follows: anti-D anti-c anti-E 4s 0 ° Which of the following genotype would be consistent with these results? a Roky b Rr © RiRy a Rr 70 ‘The red cells of a nonsecretor (se/se) will most likely type as: a Le(a-b-) b Le(arbs) « Lelarb-) d Le(a-b+) 71 Which of the following phenotypes will react with anti-f? arr b RR, © RoRp @ RR A 72 Apatient’s ved blood cells gave the following reactions anti-D anti-C = amtiE = antic = antieg = antinf + + + * + ° The most probable genotype of this patient is: a RyRy b Ror” © Rr a RR, 73 Antic is identified in a patient’s serum. If random crossmatches are performed on 10 donor Mis units, how many would be expected to be compatible? a 0 b 3 <7 a 10 74 A woman types as Rh-positive. She has an anti-c titer of 32 at AHG. Her baby has a negative DAT and is not affected by hemolytic disease of the newborn. What is the father’s most likely Rh phenotype? ar bir © Ry d Ror 10 The Board of Certification Study Guide1: Blood Bank | Blood Group Systems Questions 75 Which of the following red cell typings are most commonly found in the African American donor population? a Lula-b-) b Jk(a-b-) © Fy(a-b-) a Kk 76 Four units of blood are needed for elective surgery. The patient's serum contains anti-C, anti-e, anti-Fy* and anti-Jk®. Which of the following would be the best source of donor blood? a test all units in current stock b test 100 group O, Rh-negative donors € test 100 group-compatible donors rare donor file 77 A donoris tested with Rh antisera with the following results: anti-D antic anti-E antic. ~—antie. ~—Rhcontrol + + 0 + * ° What is his most probable Rh genotype? a RR; b Ry © Ror a Ry 78 A family has been typed for HLA because 1 of the children needs a stem cell donor. Typing results are listed below: father: 8,95 mother, A2,28:812,18 child #1: A1,2;08,12 child #2: A1,23:88,18 child #3: A3,23:618,7 What is the expected B antigen in child #3? a Al b Az «© B12 B35 79 Which of the following is the best source of HLA-compatible platelets? ONY a mother b father € siblings 4 cousins 80 A patient is group O, Rh-negative with anti-D and anti-K in her serum. What percentage of the MS general Caucasian donor population would be compatible with this patient? a 0S b 2.0 © 3.0 d 6.0 Clinical Laboratory Certification Examinations 111: Blood Bank | Blood Group Systems Questions 81 The observed phenotypes in a particular population are: ky Phenotype Number of persons Jklarb-) 12 dk(a+b+) 194 uk(a-b+) 84 What is the gene frequency of Jk* in this population? a 031 b 0.45 © 055 4 0.60 82 Ina random population, 16% of the people are Rh-negative (rr). What percentage of the ws Rh-positive population is heterozygous for r? a 36% b 48% € 57% a 66% 83. Invelationship testing, a “direct exclusion’ is established when a genetic marker is a absent in the child, but present in the mother and alleged father b absent in the child, present in the mother and absent in the alleged father € present in the child, absent in the mother and present in the alleged father present in the child, but absent in the mother and alleged father 84 Reiationship testing produces the following red cell phenotyping results: ‘ABO Rh alleged father: B OsC-crEse mother: ° DiC+E-c-e+ child ° D+C+E-cres What conclusions may be made? a there is no exclusion of paternity b paternity may be excluded on the basis of ABO typing € paternity may be excluded on the basis of Rh typing paternity may be excluded on the basis of both ABO and Rh typing 85 Ina relationship testing case, the child has a genetic marker that is absent in the mother and cannot be demonstrated ia the alleged father. What type of paternity exclusion is this known as? a indirect b direct © prior probability @ Hardy-Weinberg A 86 A patient is typed with the following results: Patient's cells with Patient's serum with anticA 0 Ayredcells 2+ anti-B 0 Bredcells 4+ anhAB 2+ Apscreen 0 ‘The most probable reason for these findings is that the patient is group: a 0; confusion due to faulty group O antiserum b O; with an anti-A, © Agwith an anti-Ay @ Ajwith an anti-A 12 The Board of Certification Study Guide1: Blood Bank | Blood Group Systems Questions 87 Human blood groups were discovered around 1900 by: a Jules Bordet b Louis Pasteur ¢ Karl Landsteiner @ PL Mollison 88 Cells of the Ay subgroup will a react with Dolichos biftorus b bE- with anti-A © give a mixed-field reaction with anti-A,B @_ bE- with anti-H 89 The enzyme responsible for conferring H activity on the red cell membrane is alpha galactosyl transferase N-acetylgalactosaminyl transferase 1.-fucosy! transferase N-acetylglucosaminyl transferase meee 90 Even in the absence of prior transfusion or pregnancy, individuals with the Bombay phenotype (Os) will always have naturally occurring: a anti Rh b antik, © anti-U anti-H 91 The antibody in the Lutheran system that is best detected at lower temperatures is: anti-Lu® anti-Lu® anti-Lu3 anti-Lut ane 92 Which of the following antibodies is neutralizable by pooled human plasma? en a anti-Kn" anti-Ch anti-Yké anti-Cs* nee 93 Anti-Sd* is strongly suspected if: a. the patient has been previously transfused b the agglutinates are mixed-field and refractile € the patient is group A or B only a small number of panel cells are reactive 94 HLA antibodies are a naturally occurring b induced by multiple transfusions € directed against granulocyte antigens only d frequently cause hemolytic transfusion reactions 95 Genes of the major histocompatibility complex (MHC): a code for HLA-A, HLA-B, and HLA-C antigens only b are linked to genes in the ABO system € are the primary genetic sex-determinants 4 contribute to the coordination of cellular and humoral immunity Clinical Laboratory Certification Examinations 13: Blood Bank | Blood Group Systems Questions 96 _Isoimmunization to platelet antigen HPA-1a and the placental transfer of maternal antibodies Oney Would be expected to cause newborn: a erythroblastosis B leukocytosis ¢ leukopenia d_ thrombocytopenia 97 Saliva from which of the following individuals would neutralize an auto anti-H in the serum of a group A, Le(a-b+) patient? a group A, Le(a-b-) b group A, Le(a+b-) © group O, Le(a+b-) @ group O, Le(a-b+) 98 Inhibition testing can be used to confirm antibody specificity for which of the following antibodies? anti-Lu* anti-M anti-Le* anti-Fy* aoe 99 Which of the following Rh antigens has the highest frequency in Caucasians? D £ ane 100 Anti-D and anti-C are identified in the serum of a transfused pregnant woman, gravida 2, para &iiy 1. Nine months previously she received Rh immune globulin (RhIG) after delivery. Tests of the patient, her husband, and the child revealed the following: anti-D anti-C anti-€ antic anti-e patient 0 0 0 + + father + 0 0 + + chile . 0 0 + + ‘The most likely explanation for the presence of anti-C is that this antibody is: actually anti-C” b from the RhIG dose © actually anti-G naturally occurring 101 The phenomenon of an Rh-positive person whose serum contains anti-D is best explained by: es" a gene deletion 1b missing antigen epitopes © trans position effect 4 gene inhibition 102. When the red cells of an individual fail to react with anti-U, they usually fail to react with: esty a anti-M anti-Le? anti-S anti-Py ane 14 The Board of Certification Study Guide1: Blood Bank | Blood Group Systems Questions 103 Which of the following red cell antigens are found on glycophorin-A? a M,N b Le®, Le? « S,s PP, Pk 104. Paroxysmal cold hemoglobinuria (PCH) is associated with antibody specificity toward which of the following? a Kell system antigens b Duffy system antigens Pantigen a Tantigen 105 Which of the following is a characteristic of anti-i? a associated with warm autoimmune hemolytic anemia } found in the serum of patients with infectious mononucleosis « detected at lower temperatures in the serum of normal individuals found only in the serum of group O individuals 106 Ina case of cold autoimmune hemolytic anemia, the patient's serum would most likely react 4+ at immediate spin with: group A cells, B cells and O cells, but not his own cells cord cells but not his own or other adult cells all cells of a group O cel} panel and his own cells only penicilfin-treated panel cells, not his own celis, anon 107 Cold agglutinin syndrome is associated with an antibody specificity toward which of the following? a Fy3 bP el d Rb: 108 Which of the following is a characteristic of anti-i? often associated with hemolytic disease of the newborn reacts best at room temperature or 4°C reacts best at 37°C is usually IgG 109 ‘he Kell (K1) antigen is: ance absent from the red cells of neonates b strongly immunogenic € destroyed by enzymes d has a frequency of 50% in the random population 110 In chronic granulomatous disease (CGD), granulocyte function is impaired. An association exists M3, between this clinical condition and a depression of which of the following antigens? a Rh bP © Kell d Duffy Clinical Laboratory Certification Examinations 151: Blood Bank | Blood Group Systems Questions 112 The antibodies of the Kidd blood group system: a. react best by the indirect antiglobulin est. b are predominantly IgM ¢ often cause allergic transfusion reactions do not generally react with antigen-positive, enzyme-treated RBCs 112 Proteolytic enzyme treatment of red cells usually destroys which antigen? a Jk bE © Fy ak 113 Anti-Fy* is usually a cold-reactive agglutinin more reactive when tested with enzyme-treated red blood cells capable of causing hemolytic transfusion reactions often an autoagglutinin aco 114 Resistance to malaria is best associated with which of the following blood groups? a Rh bi

at anti-D 3 3 Ax cells a Ay B cells ae ° Ab screen ° 0 How should the request for crossmatch be handled? a crossmatch A, Rh-positive units with sample from day 1 b crossmatch B, Rh-positive units with sample from day 2 € crossmatch AB, Rh-positive units with both samples collect a new sample and repeat the tests The following test results are noted for a unit of blood labeled group A, Rh-negative: Cells tested with: anti-A anti-B anti-D 4% 0 34 What should be done next? a. transfuse as a group A, Rh-negative b transfuse asa group A, Rh-positive € notify the collecting facility d discard the unit What information is essential on patient blood sample labels drawn for compatibility testing? biohazard sticker for AIDS patients patient's room number unique patient medical number phiebotomist initials anos Granulocytes for transfusion should: a be administered through a microaggregate filter be ABO compatible with the recipient's serum be infused within 72 hours of collection never be transfused to patients with a history of febrile transfusion reactions Anneonate will be transfused for the first time with group O Red Blood Cells. Which of the following is appropriate compatibility testing? crossmatch with mother's serum B crossmatch with baby's serum. € no crossmatch is necessary if initial plasma screening is negative dno screening or crossmatching is necessary for neanates A group B, Rh-negative patient has a positive DAT. Which of the following situations would occur? a all major crossmatches would be incompatible b the weak D test and control would be positive € the antibody screening test would be positive the forward and reverse ABO groupings would not agree Clinical Laboratory Certification Examinations 251: Blood Bank | Serology Questions 174. The following reactions were obtained: Cells tested with: ‘Serum tested with: ani anti-B anti-A8 — A;cells Beet's 3 4s 2 4 The technologist washed the patient's cells with saline, and repeated the forward typing. A saline replacement technique was used with the reverse typing. The following results were obtained: Cells tested with: Serum tested with: anti-A anti-B antiAB — A;cells B cells 400 4 0 4 The results are consistent with: acquired immunodeficiency disease b Bruton agarnmaglobulinemia © multiple myeloma acquired “B” antigen 175 What is the most likely cause of the following ABO discrepancy? Patient's cells vs: Patient's serum vs: anti-A anti-B Arcelis Bells o o 0 ° a recent transfusion with group O blood b antigen depression due to leukemia € false-negative cell typing due to rouleaux obtained from a heel stick of a 2-month old baby 176 Which of the following patient data best reflects the discrepancy seen when a person's red cells demonstrate the acquired-B phenotype? Forward grouping Reverse grouping patient A, B ° patient B AB A patient C o B patient D B AB aA bB eC aD 177 Which of the following is characteristic of Tn polyagglutinable red cells? a_ if group O, they may appear to have acquired a group A antigen b they show strong reactions when the cells are enzyme-treated € they react with Arachis hypogaea lectin 4 the polyagglutination is a transient condition 178 Mixed field agglutination encouncered in ABO grouping with no history of transfusion would most likely be due to: a Bombay phenotype (O;) b Tactivation © Agred cells 4. positive indirect antiglobulin test 179 Which of the following is a characteristic of polyagglutinable red cells? a can be classified by reactivity with Ulex europaeus b are agglutinated by most adult sera © are always an acquired condition d_autocontrol is always positive 26 The Board of Certification Study GuideBlood Bank | Serology Questions 180 Consider the following ABO typing results: Patient's cells vs: Patient’s serum vs: anti-A anti-B Aycelis Bcells 4 0 1 a Additional testing was performed using patient serum: Is RT screening cell! 1+ 2+ screening coll] 1 2+ autocontrol or What is the most likely cause of this discrepancy? a A; with anti-A b cold alloantibody € cold autoantibody d_acquired-A phenomenon 181 Consider the following ABO typing results: Skiy Patient's cells vss Patient's serum vs: anti-A anti-B Aycells B cells 4+ 0 + 4s Additional testing was performed using patient serum: 1s RT screening cell! 1+ De screening cellll 1+ 2+ autocontrol ts What should be done next? a test serum against a panel of group 0 cells b neutralization € perform serum type at 37°C di elution 182 ‘Ihe following results were obtained on a patient's blood sample during routine ABO and Rh testing: Cell testing: Serum testing: ania: 0 Avcolls; 4 anti-B ae Boells; 2+ anti-D: 0 aytocontrol: 0 Select the course of action to resalve this problem: a draw a new blood sample from the patient and repeat all test procedures b test the patient's serum with Ay cells and the patient's red cells with anti-A, lectin ¢ repeat the ABO antigen grouping using 3x washed saline-suspended cells 4_ perform antibody screening procedure at immediate spin using group O cells 183 Which of the following explains an ABO discrepancy caused by problems with the patient's red 32, blood cells? an unexpected antibody rouleaux agammaglobulinemia Tn activation aeoe (Clinical Laboratory Certification Examinations 271: Blood Bank | Serology Questions 184 The test for weak D is performed by incubating patient's red cells with several different dilutions of anti-D serum anti-D serum followed by washing and antiglobulin serum anti-D" serum antiglobulin serum ane 185 Refer to the following data: Ssty Forward group: Reverse group: anti-A anti-B anti-A, lectin Aycells Az cells B cells ay ° 44 0 2 4 Which of the following antibody screen results would you expect with the ABO discrepancy seen above? a negative b positive with all screen cells at the 37°C phase © positive with all screen cells at the RT phase; autocontrol is negative 4 positive with all screen cells and the autocontrol cells at the RT phase 186 The following results were obtained when testing a sample from a 20-year-old, first-time blood donor Forward group: Reverse group: anti-A anti-B Avcells Bcells 0 0 0 St What is the most likely cause of this ABO discrepancy? a loss of antigen due to disease b acquired B ¢ phenotype 0, “Bombay” weak subgroup of A 187 A mother is Rh-negative and the father Rh-positive. Their baby is Rh-negative. It may be concluded that: the father is homozygous for D b the mother is heterozygous for D € the father is heterozygous for D atleast 1 of the 3 Rh typings must be incorre. 188. Some blood group antibodies characteristically hemolyze appropriate red cells in the presence of: a complement B anticoagulants € preservatives 4 penicillin 189. Review the following schematic diagram: PATIENT SERUM + REAGENT GROUP “O” CELLS INCUBATE —y READ FOR AGGLUTINATION WASH — ADD AHG — AGGLUTINATION OBSERVED. The next step would be to: add “check cells” as a confirmatory measure b identify the cause of the agglutination ¢ perform an elution technique 4 perform a direct antiglobulin test 28 the Board of Certification Study Guide1: Blood Bank | Serology Questions 190 The following results were obtained in pretransfusion testing: 37°C lat screening celll 0 3+ screening cellll 0 Be autocontro! 0 3+ The most probable cause of these results is: a rouleaux 1b a warm autoantibody © acold autoantibody 4 multiple alloantibo dies 191 A patient is typed as group O, Rh-positive and crossmatched with 6 units of blood. At the indirect antiglobulin (IAT) phase of testing, both antibody screening cells and 2 crossmatched units are incompatible. What is the most likely cause of the incompatibility? a recipient alloantibody b recipient autoantibody «donors have positive DATs 4 rouleaux 192 Refer to the following data’ hemoglobin: 7.4 gf. (74 g/L) reticulocyte count, 22% Direct Antigtobulin Test ‘Ab Screen - IAT polyspecitic: 3+ 8 36 9G 3 SCI: 3+ ca: 0 auto: 34 ‘Which clinical condition is consistent with the lab results shown above? a cold hemagglutinin disease Bb warm autoimmune hemolytic anemia © penicillin-induced hemolytic anemia 4 delayed hemolytic transfusion reaction 193A patient received 2 units of Red Blood Cells and had 4 delayed transfusion reaction. Pretransfusion antibody screening records indicate no agglutination except after the addition of IgG sensitized cells. Repeat testing of the pretransfusion specimen detected an antibody at the antiglobulin phase. What is the most likely explanation for the original results? a red cells were overwashed b centrifugation time was prolonged © patient's serum was omitted from the original testing, 4 antiglobulin reagent was neutralized 194 At the indirect antiglobulin phase of testing, there is no agglutination between patient serum and screening cells. One of 3 donor units was incompatible. The most probable explanation for these findings is that the: patient has an antibody directed against a high incidence antigen 'b patient has an antibody divected against a low incidence antigen ¢ donor has an antibody directed against donor cells donor has a positive antibody screen 195 The major crossmatch will detect a(n): group A patient mistyped as group 0 unexpected red ceil antibady in the donor unit Rh-negative donor unit misiabeled as Kh-positive recipient antibody directed against antigens on the donor red cells ano Clinical Laboratory Certification Examir1: Blood Bank | serology Questions 196 197 198 199 200 201 b « a ‘A 42-year-old female is undergoing surgery tomorrow and her physician requests that 4 units of Red Blood Cells be crossmatched. The following results were obtained: Is 3r°c iat screening ceil! 0 0 ° screening cell iI 0 0 0 screening cellill 0 0 o Crossmatch IS wat donor 1 2 1 4 donors 2.3,4: 0 ° 0 What is the most likely cause of the incompatibility of donor 1? & single alloantibody multiple alloantibodies Rh incompatibilities donor 1 has a positive DAT Which of the following would most likely be responsible for an incompatible antiglobulin crossmatch? 2 recipient's red cells possess a low frequency antigen b anti-K antibody in donor serum € recipient's red cells are polyagglutinable d donor red cells have a positive direct antiglobulin test A reason why a patient's crossmatch may be incompatible while the antibody screen is negative is: a the patient has an antibody against a high-incidence antigen b the incompatible donor unit has a positive direct antiglobulin test cold agglutinins are interfering in the crossmatch 4 the patient's serum contains warm autoantibody A blood specimen types as A, Rh-positive with a negative antibody screen. 6 units of group A, Rh-positive Red Blood Cells were ctossmatched and 1 unit was incompatible in the antiglobulin phase. The same result was obtained when the test was repeated. Which should be done first? repeat the ABO grouping on the incompatible unit using a more sensitive technique b test a panel of red cells that possesses low-incidence antigens ¢ perform a direct antiglobulin test on the donor unit obtain a mew specimen and repeat the crossmatch During emergency situations when there is no time to determine ABO group and Rh type on a current sample for transfusion, the patient is known to be A, Rh-negative. The technologist should: refuse to release any blood until ¢he patient's sample has been typed release A Rh-negative Red Blood Cells release O Rh-negative Red Blood Cells, release O Rh-positive Red Blood Cells aooe A.29-year-old male is hemorrhaging severely. He is AB, Rh-negative. 6 anits of blood are required STAT. Of the following types available in the blood bank, which would be most preferable for crossmatch? a AB, Rh-positive b A, Rh-negative © A, Rh-positive dO, Rh-negative 30 ‘The Board of Certification Study Guide1: Blood Bank | Serology Questions 202 A patient is group ApB, Rh-positive and has an antiglobulin- reacting anti-A, in his serum. He is in the operating room bleeding profusely and group AzB Red Blood Cells are not available. Which of the following blood types is first choice for crossmatching? B, Rh-positive B, Rh-negative A,B, Rh-positive O, Rh-negative 203 A 10% red cell most likely occur? ane ension in saline is used in a compatibility test. Which of the following would a a false-positive result due to antigen excess b a false-positive result due to the prozone phenomenon ¢ a false-negative result due to the prozone phenomenon da false-negative result due to antigen excess 204 A patient serum reacts with 2 of the 3 antibody screening cells at the AHG phase. 8 of the 10 Nify units crossmatched were incompatible at the AHG phase. All reactions are markedly enhanced by enzymes. These results are most consistent with: antiM anti anti-c anti-Fy* anos 205 A patient received 4 units of blood 2 years previously and now has multiple antibodies. He has not been transfused since that time. It would be most helpful to: phenotype his cells to determine which additional alloantibodies may be produced recommend the use of directed donors, which are more likely to be compatible use proteolytic enzymes to destroy the “in vitro” activity of some of the antibodies freeze the patient's serum to use for antigen typing of compatible units aa 206 Autoantibodies demonstrating blood group specificity in warm autoimmune hemolytic anemia are associated more often with which blood group system? a Rh bi

Let Le? M NP; AHG AHG 1 4 + Cee o) 1 Pieay 2 + +00 0+ 0 0 + +00 & w& anemone Caeeeeoe 2 Senor a 4 4 #4 O 4 0 0 + GH FO + & 8 Oe sees 0) 0) 6 0 0+ + + 0 + 0 + 0 + + 0 0 0 eesloh 0 20) ee 0 - gerne coco 8 0 0 +0 +00 + 0 + 0+ + 0 0 aio 0 0 Based on these results, which of the following antibodies is most likely present? a anti-C b antic ¢ anti-D d anti-K 219 A pregnant woman has a positive antibody screen and the panel results are given below: EM Enzyme Cell D C c E e K Jk* Jk Fy* Fy> Le® Le? M N P; 37°C AHG AHG Meera CON + er; Ocoee aol oyna) 2 4+ +00+0+ 0 + 0 0 + +00 % B& 0 Sess he) Rea 4 + + +0400 + GO + GO + + 8 0 0 oO £6 o) «2 0 + Cee +O Oe ae + 0 6 0o+++0+ 0 00 + 0 ++0 0 0 9 PAO BS ae + + Oe ee o o B 0o+0+0 + + 0 0 + OF + tH B& O auto 0 oO nhancement media What is the association of the antibody(ies) with hemolytic disease of the newborn (HDN)? usually fatal HDEN b may cause HDFN € is not associated with HDEN d_ HDEN cannot be determined 220 Which of the following tests is most commonly used to detect antibodies attached to a patient's red blood cells in vivo? a direct antiglobulin b complement fixation € indirect antiglobulin d_immunofluorescence Clinical Laboratory Certification Examinations 353: Blood Bank | Serology Questions 221 Anti-I may cause a positive direct antiglobulin test (DAT) because of: a. anti-[ agglutinating the cells, b C3d bound to the red cells Tactivation a C3c remaining on the red cells after cleavage of C3b 222 Which direct antighobulin test results are associated with an anamnestic antibody response in a Mify recently transfused patient? Test result Polyspecific Ig ay Controt result A +m om 0 9 result 8 + 0 * 0 result C Es 24 ° result D ae 4 ae 0 iWfemied fold a result A b result B © result C @ resultD 223. In the direct (DAT) and indirect (LAT) antiglobulin tests, false-negative reactions may result if the: patient's blood specimen was contaminated with bacteria patient's blood specimen was collected into tubes containing silicon gel saline used for washing the serum/cell mixture has been stored in glass or metal containers addition of AHG is delayed for 40 minutes or more after washing the serum/cell mixture ome 224 Polyspecific reagents used in the direct antiglobulin test should have specificity for: a IgG and Iga b IgG and C3d ¢ IgM and IgA IgM and C3d 225 In the direct antiglobulin test, the antiglobulin reagent is used to: a mediate hemolysis of indicator red blood cells by providing complement b precipitate anti-erythrocyte antibodies € measure antibodies in a test serum by fixing complement 4 detect preexisting antibodies on erythrocytes 226 AHG (Coombs) control cells: can be used as a positive control for anti-C3 reagents can be used only for the indirect antiglobulin test are coated only with IgG antibody must be used to confirm all positive antiglobulin reactions aan 227 A'56-year-old female with cold agglutinin disease has a positive direct antiglobulin test (DAT). When the DAT is repeated using monospecific antiglobulin sera, which of the following is most likely to be devected? a IgM b IgG < Cd d Céa 228 The mechanism that best explains hemalytic anemia due to penicillin is: ws’ a drug-dependent antibodies reacting with drug-treated cells b drug-dependent antibodies reacting in the presence of drug € drug-independent with autoantibody production d_ nonimmunologic protein adsorption with positive DAT 36. The Board of Certification Study Guide: Blood Bank | Serology Questions 229 230 231 232 233 234 235 236 Use of EDTA plasma prevents activation of the classical complement pathway by. causing rapid decay of complement components chelating Mg"? ions, which prevents the assembly of C6 chelating Ca** ions, which prevents assembly of Cl preventing chemotaxis or Which of the following medications is most likely to cause production of autoantibodies? a penicillin b cephalothin methyldopa 4 tetracycline Serological results on an untransfused patient were: antibody sereen: negative at AHG direct antiglobulin test: 3+ with anti-C3d eluate: negative Trese results are most likely due to: a warm autoimmune hemolytic anemia b cold agglutinin syndrome € paroxysmal cold hemoglobinura 4. drug induced hemolytic anemia The drug cephalosporin can cause a positive direct antiglobulin test with hemolysis by which of the following mechanisms? drug-dependent antibodies reacting with drug-treated cells drug-dependent antibodies reacting in the presence of a drug drug-independent with autoantibody production nonimmunoiogic protein adsorption with positive DAT aes Crossmatch results at the antiglobulin phase were negative. When 1 drop of check cells was added, no agglutination was seen. The most likely explanation is that the: a. red cells were overwashed b centrifuge speed was set too high ¢ residual patient serum inactivated the AHG reagent d laboratorian did not add enough check cells Wi hich of the following might cause a false negative indirect antiglobulin test (IAT)? over-reading IgG-coated screening cells addition of an extra drop of serum too heavy a cell suspension nooe ‘The purpose of testing with anti-A,B is to detect: anti-A, anti-A subgroups of A subgroups of B aooe What is the most appropriate diluent for preparing a solution of 8% bovine albumin for a red cell control reagent? deionized water distilled water normal saline anoe Alsever solution Clinical Laboratory Certification Examinations 374: Blooa Bank | Serology Questions 237 238 239 240 Which of the following antigens gives enhanced reactions with its corresponding antibody following treatment of the red cells with proteolytic enzymes? Ina prenatal workup, the following results were obtained: Forward Group: Reverse Group: anticA anti-B anti-D Rh control Avcolis Bells 4 ae o en DAT: negative antibody screen: negative ABO discrepancy was thought to be due to an antibody directed against a component of the typing sera. Which test would resolve this discrepancy? a Ajlectin b wash patient's RBCs and repeat testing, ¢ anti-A,B and extend incubation of the reverse group repeat reverse group using Ap cells Refer to the following panel: EM Cell D C c E e© K Jkt Jko Fy® Fy 37°C ANG 1 + + 0 0 + + &# 4 + + 0 2+ 2 + £ 0 0 * 0 + O # 4 0 24 B+ 0 # + 0 0 BO 4 F & tH BF 4 + 0 0 + 0 0 * O + 6 0 5 0 0 + 0 O + + # # 0 2+ 6 0 0 + + oO + 0 + o 4 3+ 7 0 0 + 0 + 4+ O + # 0 0 2s 8 0 0 + © + 0 GO + GO + 0 0 auto 0 ° Eii= enhancement media Based on the results of the above panel, which technique would be most helpful in determining antibody specificity? a proteolytic enzyme treatment b urine neutralization © autoadsorption d saliva inhibition Of the following, the most useful technique(s) in the identification and classification of high-titer, low-avidity (HTLA) antibodies is/are: reagent red cell panels adsorption and elution titration and inhibition cold autoadsorption aoe 38. The Board of Certification Study Guide1: Blood Bank | Serology Questions 241 To confirm a serum antibody specificity identified as anti-P,, a neutralization study was performed and the following results obtained: Pit RBCS. serum +P, substance: negative serum + saline: negative What conclusion can be made from these results? a anti:P; is confirmed b antisP; is ruled out asecond antibody is suspected due to the results of the negative contro! _anti-P, cannot be confirmed due to the results of the negative control 242. What happens to an antibody in neutralization study when a soluble antigen is added to the test? mus °¥ a inhibition b dilution © complement fixation hemolysis 243 To confirm the specificity of anti-Le®, an inhibition study using Lewis substance was performed with the following results: Le(b+) cells tubes with patient serum + Lewis substance: 0 tubes with patient serum + saline contro: ‘ What conclusion can be made from these results? a a second antibody is suspected due to the positive control b anti-Le? is confirmed because the tubes with Lewis substance are negative € anti-Le® is not confirmed because the tubes with Lewis substance are negative anti-Le? cannot be confirmed because the saline positive is control 244 Which of the following is the correct interpretation of this saliva neutralization testing? Shty Indicator cells, Sample A B ° saliva plus anti + 6 ° saliva plus anti 0 + ° saliva plus anti 0 ° 0 a group A secretor b group B secretor © group AB secretor group O secretor 245 A person's saliva incubated with the following antibodies and tested with the appropriate Ap, O, Me, and B indicator cells, gives the following test results: Antibody specificity Test results anti-A, reactive anti-B inhibited anti-H inhibited “The person's red cells ABO phenotype is: aA B nee Orm Clinical Laboratory Certification Examinations 391: Blood Bank | Serology Questions 246 An antibody screen performed using solid phase technology revealed a diffuse layer of red blood cells on the bottom of the well. These results indicate: a positive reaction a negative reaction serum was not added red cells have a positive direct antiglobulin test anos 247 On Monday, a patient's K antigen typing result was positive. Two days later, the patient's K typing was negative. The patient was transfused with 2 units of Fresh Frozen Plasma. The tech might conclude that the transfusion of FEP affected the K typing wrong patient was drawn results are normal anti-K reagent was omitted on Monday noose 248 Which one of the following is an indicator of polyagglutination? a RBCs typing as weak D+ b presence of red cell autoantibody decreased serum bilirubin agglutination with normal adult ABO compatible sera 249 While performing an antibody screen, a test reaction is suspected to be rouleaux. A saline replacement test is performed and the reaction remains, What is the best interpretation? original reaction of rouleaux is confirmed xeplacement test is invalid and should be repeated original reaction was due to true agglutination antibody screen is negative aoe 250 A 10-year-old girl was hospitalized because her urine had a distinct red color. The patient had Uy recently recovered from an upper respiratory infection and appeared very pale and lethargic. Tests were performed with the following results hemoglobin: 5 g/dL (50 g/L) reticulocyte count: 15% Dar: ‘weak reactivity with poly-specitic and anti-C3d; anti-IgG was negative antibody sereen negative Donath-Landsteiner test: positive; P-cells showed no hemolysis ‘Ihe patient probably has: a. paroxysmal cold hemoglobinuria (PCH) b paroxysmal nocturnal hemoglobinuria (PNH) € warm autoimmune hemolytic anemia d hereditary erythroblastic multinuclearity with a positive acidified serum test (HEMPAS) 251 Which of the following is useful for removing IgG from red blood cells with a positive DAT to perform a phenotype? a bromelin b chloroquine ¢ LISS d DIT 252 Apatient’s serum contains a mixture of antibodies. One of the antibodies is identified as anti-D. Anti-Jk, anti-Fy? and possibly another antibody are present, What technique(s) may be helpful to. identify the other antibody(ies)? a enzyme panel; select cell panel b thiol reagents ¢ lowering the pH and increasing the incubation time 4 using albumin as an enhancement media in combination with selective adsorption 40 ‘the Board of Certification Study Guide1: Blood Bank | Serology Questions 253 A sample gives the following results: Colts with: ‘Serum with: 3+ Aycells 2+ 44 Beolls 0 Which lectin should be used first to resolve this discrepancy? a Ulex europaeus b Arachis hypogaea € Dolichos biftores Vicia graminea 254 The serum of a group O, Cde/Cde donor contains anti-D. In order to prepare a suitable anti-D reagent from this donor's serum, which of the following cells would be suitable for the adsorption? a group O, cde/ede cells b group 0, Cde/ede cells © group ApB, CDe/cde cells group A,B, cde/cde cells a 255 A 26-year-old female is admitted with anemia of undetermined origin. Blood samples are received with a crossmatch request for 6 units of Red Blood Cells. The patient is group A, Rh-negative and has no history of transfusion or pregnancy. The following results were obtaine pretransfusion testing: Is are wr screening celli 0 a 3 screening cell ll 0 0 3 autocontro} ° 0 34 al 8 donors ° 0 3+ ‘The best way to find compatible blood is to: a do an antibody identification panel b use the saline replacement technique use the pre-warm technique d perform a warm autoadsorption 256 A patient's serum was reactive 2+ in the antiglobulin phase of testing with all cells on a routine Ngy panel including their own. Transfusion was performed 6 months previously. The optimal adsorption method to remove the autoantibody is: autoadsorption using the patient's 22AP-treated red cells, autoadsorption using the patient's LISS-treated red cells adsorption using enzyme-treated red cells from a normal donor adsorption using methyldopa-treated red cells aoe 257 Ina cold autoadsorption procedure, pretreatment of the patient's red cells with which of the MG. following reagents is helpful? a ficin b phosphate-buffered saline at pH 9.0 ¢ low ionic strength saline (LISS) albumin 258 ‘The process of separation of antibody from its antigen is known as: a diffusion b adsorption © neutralization 4 clation Clinical Laboratory Certification Examinations 41