SECTION A: MULTPLE CHOICE QUESTONS (20 MARKS)

INSTRUCTIONS:
 This section consists of twenty (20) questions.
 Encircle a letter of the most correct answer.
 There is only one correct answer which carries one (1) mark.

1. Adult haemoglobin (HBA) is differentiated from fetal haemoglobin based on the following
facts:-
A. Adult haemoglobin has two beta globin chains.
B. Adult haemoglobinhas two delta globin chains.
C. Adult haemoglobinhas three existing molecular forms.
D. Adult haemoglobinhas alpha chains with 141 amino acids.
E. Adult haemoglobinhas two delta and two gamma globin chains.
2. Anaemia due to glucose-6-phosphate dehydrogenase deficiency is classified as:-
A. Iron deficient anaemia.
B. Inherited hemolytic anaemia.
C. Erythroporietic disorder anaemia.
D. Immune acquired hemolytic anaemia.
E. Non immune acquired haemolytic anaemia.
3. Which of the following result to haemoglobinS (HbS) in an individual?
A. Excess number of amino acids in the haemoglobin beta chain.
B. Polymerization resulted from high concentration of Featalhaemoglobin in adult age.
C. Replacement of glutamic acid with lysine in the sixth (6th) position of beta globin chain.
D. Replacement of lysine with glutamic acid in the sixth (6th) position of beta globin chain.
E. Replacement of glutamic acid with valine in the sixth (6th) position of beta globin chain.
4. Acondition whereby an individual is heterozygous of haemoglobin S is called:-
A. Sickle cell trait.
B. Sickle cell disease.
C. Erythroidhypeplasia.
D. Thalassemia syndrome.
E. Paroxysmal haemoglobinuria.
5. Increase number of total white blood cell count above normal range is termed:-
A. Pinocytosis.
B. Leptocytosis.
C. Monocytosis.
D. Leukocytosis.
E. Lymphocytosis.

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6. Which of the following is possible cause of isolating red blood cells of smaller size than
normal RBCs in stained blood film?
A. Iron deficiency.
B. Protein deficiency.
C. Folic acid deficiency.
D. Vitamin B 12 deficiency.
E. Folic acid kinase deficiency.
7. Combination of globin chains of haemoglobin molecules in adult results to how many forms
of heamoglobin?
A. Two forms.
B. Three forms.
C. Four forms.
D. Five forms.
E. Six forms.
8. The cluster of differentiation antigen found in all mature T-cells is known as:-
A. CD4
B. CD3
C. CD8
D. CD16
E. CD45
9. Which of the following means checkinghow close several results from the same specimen
are to each other?
A. Precision check.
B. Carry over check.
C. Calibration check.
D. Standard deviation check.
E. Coefficient of variation check.
10. Minimum recommended haemoglobin concentration for female donor is:-
A. 10.5g/dL
B. 11.5g/dL
C. 12.5g/dL
D. 13.5g/dL
E. 14.5g/dL
11. The process that involves labelling and tracking carefully blood units and their test results
required is referred to:-
A. History taking.
B. Blood units check.
C. Record management.
D. Pre-donation counseling.
E. Post donation counseling.

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12. Best blood product to be used for patients with severe bleeding due to dysfunction of clotting
mechanism is:-
A. Whole blood.
B. Packed red cells.
C. Packed white cells.
D. Fresh frozen plasma.
E. Frozen plasma blood.
13. The number of antigenic determinants that an individual antibody molecule can bind is
referred to as:-
A. Antibody valency.
B. Antibody domains.
C. Antigen determinant.
D. Antigen heavy chains.
E. Antibody binding sets.
14. Which of the following maternal antibodies are associated with Hemolytic disease of the
newborn:-
A. Immunoglobulin A
B. ImmunoglobulinD
C. Immunoglobulin E
D. Immunoglobulin G
E. Immunoglobulin M
15. For quality Blood and Blood product storage, which one is property of Blood transfusion
refrigerator?
A. Should have occasionally temperature recorder.
B. Should be connected to an audible alarm system.
C. Temperature control chat should be kept inside Blood transfusion refrigerator.
D. Any thermometer can be used to monitor minimum and maximum temperature.
E. Temperature rises or falls outside the prescribed limit should be controlled by Quality
officer.
16. Genes which are not expressed phenotypically but can be passed from parents to offspring’s
are termed as:-
A. Recessive genes.
B. Dominant genes.
C. Homozygous genes.
D. Co-dominant genes.
E. Heterozygous genes.

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17. Which of the following is suitable specimen for blood grouping of foetus at birth?
A. Cord blood.
B. Venous blood.
C. Capillary blood.
D. Serum from venous blood.
E. Serumfrom capillary blood.
18. The following number of antibodies are found in the ABO blood group system:-
A. One antibody.
B. Two antibodies.
C. Three antibodies.
D. Four antibodies.
E. Five antibodies.
19. Among the following which one is Rhesus antigen but cannot stimulate formation of specific
antibody.
A. d antigen
B. D antigen
C. C antigen
D. e antigen
E. E antigen
20. Process that allows someone to electronically identify a population of cells for further
analysis without the need of physically separating the cell population in flow
cytometryis termed as:
A. Gating.
B. Excitation.
C. Fluorescent.
D. Forward scatter.
E. Spectral dispersion.

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 MULTIPLE TRUE/FALSE QUESTIONS
1. Regarding Reticulocytes:-
Answer
A. Its normal count is the same as Erythrocytes.
B. They possess an irregular cytoplasmic border.
C. They retain mitochondria and other cells organelles.
D. They are slightly smaller than the mature erythrocytes.
E. They are retained in the bone marrow for 2 to 3 days before appearing in
theperipheral blood.
2. Regarding staining of thin blood film by using Leishman stain.
Answer
A. Tap water can be used as a buffer
B. Diluted Leishman stain can be used for several days.
C. Staining time is adjusted as requires for new batches of stain
D. The acidic parts of the cell is stained pink in colour and the basic part blue
incolour
E. Comparison of the staining reaction for the old and newly prepared stock
can act as the method of quality control
3. Concerning compatibility test:-
Answer
A. Compatibility is signified by hemolytic reaction.
B. It detects mistakes in ABO and Rhesus grouping.
C. Other antibodies will not be visible until centrifugation is applied
D. It is necessaryto wash patient cells three times by using physiological
saline.
E. Centrifugation hinders agglutination by decreasing the force between red
blood cell antigen and serum antibodies.
4. Regarding Echinocytes:-
Answer
A. Associated with artifact.
B. Associated with Liver disease.
C. Associated with Post-splenectomy.
D. Associated with Uremia (renal failure).
E. Associated with Iron deficiency anemia.

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SECTION C: SHORT ANSWER QUESTIONS: (30 MARKS)
INSTRUCTIONS
 This section consists of six (6) questions
 Answer all questions.
 Write the answer in space provided.
1. Mention five (5) associated factors of increased MCHC. (5 Marks)
Answer
2. Enumerate five (5) abnormal morphology of red blood cell. (5 Marks)
ANSWER:
3. Outline five (5) causes of non-immune acquired haemolyticanaemia. (5 Marks)
ANSWERS:
4. Pinpoint atlist five (5) risks behaviors that can disqualify individual to be good donor.
(5Marks)
ANSWERS:

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5. Enumerate five (5) blood products which can be transfused to patients. (5 Marks)
ANSWERS:
6. Enlist at list five (5) blood group systems of clinical significance apart from ABO and
Rhesus. (5 Marks)
ANSWERS

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SECTION D: ESSAY QUESTIONS: (30 MARKS)
INSTRUCTIONS:
 This section consists of 3 questions
 Each question carries 10 marks
 Answer all questions
1. DescribeHaemoglobin pigments

2. Describesickle-cell anemia. Answer

Introduction (1 Mark)
The term sickle cell disease is used to describe sickle cell anaemia (HbSS) and the range of HbS
disorders related to clinical severity, eg When HbS is inherited with HbC, HbD Punjab, or HbO
Arab.

Main body (8 Marks)

Clinical Features of Sickle Cell Disease
These include, haemolyticanaemia, jaundice, fever, painful swelling of hands and feet, skeletal
changes due to erythroid hyperplasia, pulmonary complication, kidney damage.

Mechanism of Sickle Cell Disease

HbS is formed when valine replaces glutamic acid in the beta globin chain ( 6th amino acid
position). In the deoxygenated state, HbS has poor solubility, forming polymers (long fibres) in
red cells. Polymerization leads to change in red cells membrane and metabolism, causing the
cells to become rigid and destorted with a sickle shape.The sickle cell adhere to vascular
endothelium and to one another, broking small blood vessels. They become traped in the spleene
and haemolyse easily.
When the abnormal beta cell gene is inherted from one parent and a normal beta gene from other
parent (heterozygoes state) the disorder is mainly refered to as the sickle cell trait.
Whe the person inherits the abnormal beta gene from both parenta (homozygoes state) these is
called sickle cell disease or sickle cell anaemia.
Complications of Sickle-cell anaemia
Most cases of anemia are mild, including those that occur as a result of chronic disease.
 Mild anemia can reduce oxygen transport in the blood, causing fatigue and a diminished
physical capacity.
 Because a reduction in red blood cells decreases the ability to absorb oxygen from the lungs,
serious problems can occur in prolonged and severe anemia that is not treated.
 Anemia can lead to secondary organ dysfunction or damage, including heart arrhythmia and
heart failure.
Specific complication for Sickle-cell anemia
 Priapism, Gallstones, Skin ulcers, Blindness, Organ damage, Pulmonary hypertension, Acute
chest syndrome, Stroke
Conclusion (1 Mark)
Sickle-cell anemia, can be life threatening. It affect children and are particularly devastating.

3. Explain principle of Compatibility test in respect to blood transfusion. (10 Marks)

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Introduction (1 Mark)
Compatibility test is the test used to detect or to demonstrate ABO incompatibility and clinical
significant antibodies to red cell antigens.
Main body (8 Marks)
 The known red cells (antigen) from donor are mixed with known serum (antibody) from the
patient to detect if there is any incompatibility caused by ABO, Rhesus and Other blood
group antibody.
 Centrifugation will enhance the reaction in vitro by enhancing the combining of antigen and
antibody in a short period of time.
 Other enhancement such as 37 C, bovine albumin and anti-human globulin are used to allow
the in vitro antibody-antigen reaction to occur more readily, if the antibody is present.
 The most important phase of compatibility testing is the immediate spin reaction will will
detect naturally occurring anti-A, anti-B or anti-A,B which would react with ABO
incompatible donor blood cells.
 Using reagents that have been verified with known positive and negative control cells is
important to provide reliable laboratory results. In addition, the centrifuge, waterbath and
refrigerator should have regularly scheduled maintenance and verify function as part of
good laboratory practice. Temperatures, PPM, QC results should all be properly recorded
and records maintained. In addition, patient and donor results are maintained in order to
track the appearance of unexpected antibodies and to prevent, if possible, adverse
transfusion reactions.
Conclusion (1 Mark)
This test is important for blood transfusion services unless there is an urgent need for blood,
Compatibility test must be done in order to avoid transfusion reaction.

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