LESSON 7 - THE ANTIGLOBULIN TEST immune response to recently transfused RBCs.

c. Presence of antispecies antibodies from adminis

1. A description of the antiglobulin test is: tration of immune globulin (IVIG).
a. IgG and C3d are required for RBC sensitization. d. A positive autocontrol caused by polyagglutination.
b. Human globulin is completely eluted from RBCs
during saline washings. 9. Polyethylene glycol (PEG) enhances antigen antibody
c. Human globulin is injected into an animal. reactions by:
d. AHG reacts with human globulin molecules bound to a. Decreasing zeta potential.
RBCs. b. Concentrating antibody by removing water.
c. Increasing antibody affinity for antigen.
2. Polyspecific AHG reagent contains: d. Increasing antibody specificity for antigen.
a. Anti-IgG and anti-IgA.
b. Anti-IgG and anti-IgM. 10. Solid-phase antibody screening is based on:
c. Anti-IgG and anti-C3d. a. Adherence.
d. Anti-IgA and Anti-C3d. b. Agglutination.
c. Hemolysis.
3. Monoclonal anti-C3d is: d. Precipitation.
a. Derived from one clone of plasma cells.
b. Derived from multiple clones of plasma cells. 11. A positive DAT may be found in which of the
c. Derived from immunization of rabbits. following situations?
d. Reactive with C3b and C3d. a. A weak D-positive patient
b. A patient with anti-M
4. Which of the following is a clinically significant c. HDFN
antibody whose detection has been reported in some d. An incompatible crossmatch
instances to be dependent on anticomplement activity in
polyspecific AHG? 12. What do Coombs’ check cells consist of?
a. Anti-Jka a. Type A-positive cells coated with anti-IgG
b. Anti-Lea b. Type A-negative cells coated with anti-IgG
c. Anti-P1 c. Type O-positive cells coated with anti-D
d. Anti-H d. Type B-negative cells coated with anti-D

5. After the addition of IgG-coated RBCs (check cells) 13. Which of the following IAT methods requires the
to a negative AHG reaction during an antibody screen, a use of check cells?
negative result is observed. Which of the following is a a. Manual tube method with albumin
correct interpretation based on these findings? b. Gel
a. The antibody screen is negative. c. Automated solid-phase analyzer
b. The antibody screen cannot be interpreted. d. Enzyme-linked
c. The saline washings were adequate.
d. AHG reagent was added. 14. Which uncontrollable factor can affect AHG testing?
a. Temperature
6. RBCs must be washed in saline at least three times b. Antibody affinity
before the addition of AHG reagent to: c. Gravitational force in the centrifuge
a. Wash away any hemolyzed cells. d. Incubation time
b. Remove traces of free serum globulins.
c. Neutralize any excess AHG reagent. 15. Which would be the most efficient method for a
d. Increase the antibody binding to antigen. laboratory staffed by medical laboratory technicians?
a. LISS
7. An in vivo phenomenon associated with a positive b. Polybrene
DAT is: c. Solid-phase or gel
a. Passive anti-D detected in the maternal sample. d. Enzyme-linked
b. Positive antibody screen tested by LISS.
c. Identification of alloantibody specificity using a 16. A 27-year-old group O mother has just given birth to
panel of reagent RBCs. a group A baby. Since the mother has IgG anti-A, anti-B
d. Maternal antibody coating fetal RBCs. and anti-A, B in her plasma, which of the following
methods and tests would be most effective at detecting
8. False-positive DAT results are most often associated the anti-A on the baby’s RBCs?
with: a. DAT using common tube technique
a. Use of refrigerated, clotted blood samples in which b. DAT using gel
complement components coat RBCs in vitro. c. IAT using common tube technique
b. A recipient of a recent transfusion manifesting an d. IAT using gel
LESSON 8 - DETECTION AND IDENTIFICATION 6. Patient JM appears to have a warm autoantibody. She
OF ANTIBODIES was transfused 2 weeks ago. What would be the next
step performed to identify any alloantibodies that might
1. Based on the following phenotypes, which pair of be in her serum?
cells would make the best screening cells? a. Acid elution
a. Cell 1: Group A, D+C+c–E–e+, K+, Fy(a+b–), b. Warm autoadsorption using autologous cells
Jk(a+b–), M+N–S+s– c. Warm differential adsorption
Cell 2: Group O, D+C–c+E+e–, K–, Fy(a–b+), Jk(a–b+), d. RESt adsorption
M–N+S–s+
7. What is the titer and score for this prenatal anti-D
b. Cell 1: Group O, D–C–c+E–e+, K–, Fy(a–b+), titer?
Jk(a+b+), M+N–S+s+ (Refer to Fig. 10–17.)
Cell 2: Group O, D+C+c–E–e+, K–, Fy(a+b–), Jk(a+b–), a. Titer = 64; score = 52
M–N+S–s+ b. Titer = 1:32; score = 15
c. Titer = 64; score = 21
c. Cell 1: Group O, D+C+c+E+e+, K+, Fy(a+b+), d. Titer = 32; score = 52
Jk(a+b+), M+N–S+s+
Cell 2: Group O, D–C–c+E–e+, K–, Fy(a+b–), Jk(a+b+),
M+N+S–s+

d. Cell 1: Group O, D+C+c–E–e+, K+, Fy(a–b+), For Questions 8 through 10, refer to Figure 10–18.
Jk(a–b+), M–N+S–s+ 8. Select the antibody(ies) most likely responsible for
Cell 2: Group O, D- C–c+E+e–, K–, Fy(a+b–), Jk(a+b–), the reactions observed.
M+N–S+s– a. Anti-E and anti-K
b. Anti-Fya
2. Antibodies are excluded using RBCs that are c. Anti-e
homozygous for the corresponding antigen because: d. Anti-Jkb
a. Antibodies may show dosage
b. Multiple antibodies may be present 9. What additional cells need to be tested to be 95%
c. It results in a P value of 0.05 for proper identification confident that the identification is correct?
of the antibody a. Three e-negative cells that react negatively and one
d. All of the above additional e-positive cell that reacts positively
b. One additional E-positive, K-negative cell to react
3. A request for 8 units of RBCs was received for patient positively and one additional K-positive, E-negative cell
LF. The patient has a negative antibody screen, but 1 of to react positively
the 8 units was 3+ incompatible at the AHG phase. c. Two Jkb homozygous positive cells to react positively
Which of the following antibodies may be the cause? and one Jkb heterozygous positive cell to react
a. Anti-K negatively
b. Anti-Lea d. No additional cells are needed
c. Anti-Kpa
d. Anti-Fyb 10. Using the panel (Fig. 10–18), select cells that would
make appropriate controls when typing for the C
4. The physician has requested 2 units of RBCs for antigen.
patient DB, who has two antibodies, anti-L and anti-Q. a. Cell number 1 for the positive control and cell number
The frequency of antigen L is 45%, and the frequency of 2 for the negative control
antigen Q is 70% in the donor population. b. Cell number 1 for the positive control and cell number
Approximately how many units will need to be 6 for the negative control
antigen-typed for L and Q to fill the request? c. Cell number 2 for the positive control and cell number
a. 8 4 for the negative control
b. 12 d. Cell number 4 for the positive control and cell number
c. 2 5 for the negative control
d. 7

5. Anti-Sda has been identified in patient ALF. What

substance would neutralize this antibody and allow
detection of other alloantibodies?
a. Saliva
b. Hydatid cyst fluid
c. Urine
d. Human breast milk
11. Which of the following methods may be employed
to remove IgG antibodies that are coating a patient’s red
blood cells?
a. Adsorption
b. Elution
c. Neutralization
d. Titration

12. A technologist has decided to test an enzyme-treated

panel of RBCs against a patient’s serum. Which of the
following antibody pairs could be separated using this
technique?
a. Anti-Jka and anti-Jkb
b. Anti-S and anti-Fya
c. Anti-D and anti-C
d. Anti-Jka and anti-Fya

13. An antibody demonstrates weak reactivity at the

AHG phase when the tube method is used with no
enhancement reagent and monospecific anti-IgG AHG
reagent. When repeating the test, which of the following
actions may increase the strength of the positive
reactions?
a. Adding an enhancement reagent, such as LISS or PEG
b. Decreasing the incubation time from 30 minutes to 10
minutes
c. Employing the prewarm technique
d. Decreasing the incubation temperature to 18°C
LESSON 9 - PRETRANSFUSION TESTING
9. A patient requires 15 units of thawed plasma for an
1. Which is not included on a properly labeled apheresis procedure. The patient’s blood type is
specimen? O-negative. What donor units could be selected?
a. Two unique patient identifiers a. O-negative
b. Date and time of draw b. AB-positive
c. Phlebotomist’s initials c. A-negative
d. Patient’s home address d. All of the above

2. How many days before a pretransfusion specimen 10. The American College of Surgeons recommends
expires? transfusion of red blood cells, thawed plasma, and
a. 3 days platelets in what ratio for a massive transfusion?
b. 7 days a. 2 units of red blood cells for every unit of platelets
c. 14 days b. 1 unit of red blood cells to 1 unit of thawed plasma
d. 1 month to 1 unit of platelets
c. 1 unit of red blood cells to 3 units of thawed plasma
3. How many days must a pretransfusion specimen and d. It’s an emergency. Give the surgeon whatever she
donor unit segments be retained post-transfusion? wants
a. 3 days
b. 7 days 11. A patient’s antibody screen was positive and an
c. 14 days anti-c was identified. Antiglobulin crossmatches were
d. 1 month performed with c-negative units and 1 of the 6 units
was incompatible. What should be performed to
4. If a blood type cannot be resolved, what ABO group resolve the incompatible crossmatch?
should be selected for a red blood cell transfusion? a. Give O-negative red blood cells
a. Group A b. Retype the incompatible unit for the c antigen
b. Group B c. Perform a DAT on the incompatible unit
c. Group O d. Perform additional identification testing to include
d. Group AB low-specificity antigens
e. b, c, and d
5. Which antibody specificity is not required in
antibody detection tests? 12. A mother, 30 weeks’ pregnant, has anti-K with a
a. K titer of 32. An intrauterine red blood cell transfusion is
b. Cw indicated. The donor unit selected should be all of the
c. Fya following except:
d. S a. O-negative
b. K-negative
6. A patient has a history of anti-Jka. The antibody c. Positive for sickling hemoglobin
screen is currently negative. Which red blood cell unit d. Irradiated
should be selected, and what type of crossmatch should
be performed? 13. A patient with sickle cell disease is B-positive with
a. Jk(a-) red blood cells, computer crossmatch a positive antibody screen. The antibody identified is
b. Jk(a-) red blood cells, antiglobulin crossmatch anti-D, and the autocontrol is negative. What is a
c. Jk(a-) red blood cells, immediate spin crossmatch possible explanation?
d. ABO-compatible because the antibody screen is a. The patient is weak D-positive
negative b. Autoantibody is present
c. Patient possesses the partial D phenotype
7. Which is not true of rouleaux formation? d. The patient has a positive DAT
a. Mimics agglutination
b. Appears like a “stacking of coins”
c. Can be seen in the antiglobulin test
d. Can be dispersed by saline

8. A patient’s blood type is AB-negative, but there are

no AB-negative red blood cell units available. What
donor units could be selected?
a. A-negative
b. O-positive
c. B-positive
d. All of the above
LESSON 10 - DONOR SELECTION b. 1 month after last dose
c. 12 months after last dose
1. Which of the following information is not required d. 48 hours after last dose
for whole blood donation?
a. Name 9. All of the following records must be kept for 10
b. Address years, except:
c. Transfusion history a. Unique ID of each unit.
d. Sex b. Donor consent.
e. Date of Birth c. Request for blood or blood component.
d. A signed statement from requesting physician for
2. Which of the following would be cause for deferral emergency release.
for a male donor?
a. Temperature of 99.2°F 10. What is the causative agent of Chagas disease?
b. Hematocrit of 37% a. Trypanosoma cruzi
c. Spent 2 weeks in the United Kingdom in 1998 b. Yersinia pestis
d. Weighs 80 kg c. Treponema pallidum
e. Received a blood transfusion 2 years ago d. Plasmodium falciparum

3. Which of the following would be cause for a 11. Which of the following donors would be rejected
permanent deferral? for whole blood donation?
a. Received a dura mater graft 9 months ago a. A male who had sex with another male in 1977
b. Received hepatitis B immune globulin b. A female who had sex with a male in 1992
c. Is currently on warfarin c. A male who had sex with another male last month
d. Diagnosis of babesiosis d. A female who had sex with a male 9 months ago
e. Traveled to Senegal 2 years ago
12. What does “infrequent” refer to when talking about
4. Immunization for rubella would result in a a plasmapheresis program?
temporary deferral for: a. Donating no more frequently than once every 4
a. 4 weeks. weeks
b. 8 weeks. b. Donating once a year
c. 6 months. c. Donating once every 6 months
d. 1 year. d. Donating no more frequently than once every 8
e. 3 years. weeks

5. Which of the following donors is acceptable? 13. A patient is having an exploratory laparotomy
a. Donor who had a first-trimester abortion 4 weeks performed and donated blood for use in the patient’s
ago upcoming surgery. Three units were collected, with the
b. Donor whose husband is a hemophiliac who last unit collected 2 days before surgery. Given this
regularly received cryoprecipitate before 1989 information, can the patient undergo surgery as planned?
c. Donor who was treated for gonorrhea 6 months ago a. Yes
d. Donor who had a needle-stick injury 10 months ago b. No

6. Which of the following tests is not required as part 14. Which of the following refers to a temporary
of the donor-processing procedure for allogeneic deferral?
donation? a. Donor received varicella zoster live attenuated
a. ABO vaccine
b. Rh b. Donor had a confirmed positive test for HBsAg
c. STS c. Donor has a history of CJD
d. Anti-HTLV-I d. Donor was diagnosed with babesiosis
e. Anti-CMV
15. Which of the following carries a 12-month deferral?
7. How long must a 2-unit RBC donor wait before a. Donor received Hepatitis B immune globulin
donating red blood cells again? b. Donor received pituitary growth hormone from
a. 8 weeks another human
b. 16 weeks c. Donor received the MMR vaccine
c. 6 months d. Donor spent 10 years in Africa
d. 12 months

8. What is the deferral period for Plavix?

a. 14 days after last dose
LESSON 11 - TTIs a. By needle sharing among IV drug users
b. Through blood transfusions
1. The fecal-oral route is common in transmitting c. By unknown methods
which of these hepatitis viruses? d. By sexual activity
a. HAV and HEV
b. HBV and HCV 10. Which of the following is the most common cause
c. HDV of chronic hepatitis, cirrhosis, and hepatocellular
d. HGV carcinoma in the United States?
a. HAV
2. Which of the following is the component of choice b. HBV
for a low-birth-weight infant with a hemoglobin of 8 c. HCV
g/dL if the mother is anti-CMV negative? d. HDV
a. Whole blood from a donor with anti-CMV
b. RBCs from a donor who is anti-CMV negative 11. The first retrovirus to be associated with human
c. Leukoreduced platelets disease was:
d. Solvent detergent–treated plasma a. HCV
b. HIV
3. Which of the following is an FDA-licensed c. HTLV-I
screening test for HCV? d. WNV
a. NAT + anti-HBc
b. RIBA 12. All of the following statements are true concerning
c. Lymph node biopsy WNV except:
d. HCV RNA a. 1 in 150 infections results in severe neurological
disease
4. Currently, which of the following does the AABB b. Severe disease occurs most frequently in the over-50
consider to be the most significant infectious threat age group
from transfusion? c. Deaths occur more often in those over 65 years who
a. Bacterial contamination present with encephalitis
b. CMV d. Fatalities occur in approximately 38% of infected
c. Hepatitis individuals
d. HIV
13. The primary host for WNV is:
5. Which of the following is the most frequently a. Birds
transmitted virus from mother to fetus? b. Horses
a. HIV c. Humans
b. Hepatitis d. Bats
c. CMV
d. EBV 14. Tests for WNV include all of the following except:
a. ELISA
6. Jaundice due to HAV is seen most often in the: b. NAT
a. Adolescent c. Plaque reduction neutralization test
b. Adult d. Immunofluorescent antibody assay
c. Child younger than 6 years old
d. Newborn 15. Individuals exposed to EBV maintain an
asymptomatic latent infection in:
7. Currently, steps taken to reduce a. B cells
transfusion-transmitted CMV include: b. T cells
a. Plaque reduction neutralization test c. All lymphocytes
b. NAT testing d. Monocytes
c. Leukoreduction
d. Minipool screening 16. Fifth disease is caused by:
a. CMV
8. HBV remains infectious on environmental surfaces b. EBV
for 1: c. Parvovirus B19
a. Day d. HTLV-II
b. Week
c. Month 17. Transient aplastic crisis can occur with:
d. Year a. Parvovirus B19
b. WNV
9. HBV is transmitted most frequently: c. CMV
d. EBV

18. Reasons why syphilis is so rare in the U.S. blood

supply include all of the following except:
a. 4°C storage conditions
b. Donor questionnaire
c. Short spirochetemia
d. NAT testing

19. Nucleic acid amplification testing for HIV was

instituted in donor testing protocols to:
a. Identify donors with late-stage HIV who lack
antibodies
b. Confirm the presence of anti-HIV in asymptomatic
HIV-infected donors
c. Reduce the window period by detecting the virus
earlier than other available tests
d. Detect antibodies to specific HIV viral proteins,
including anti-p24, anti-gp41, and anti-gp120

20. Screening for HIV is performed using the following

technique:
a. Radio immunoassay
b. WB
c. Immunofluorescent antibody assay
d. NAT

21. The first form of pathogen inactivation was:

a. Chemical
b. Heat
c. Cold-ethanol fractionation
d. Anion-exchange chromatography

22. What is the most common parasitic complication of

transfusion?
a. Babesia microti
b. Trypanosoma cruzi
c. Plasmodium species
d. Toxoplasma gondii

23. Which organism has a characteristic C- or U-shape

on stained blood smears?
a. Trypanosoma cruzi
b. Plasmodium vivax
c. Plasmodium falciparum
d. Babesia microti

24. Which transfusion-associated parasite may have

asymptomatic carriers?
a. Babesia microti
b. Trypanosoma cruzi
c. Plasmodium species
d. All of the above

25. Which disease is naturally caused by the bite of a

deer tick?
a. Chagas disease
b. Babesiosis
c. Malaria
d. Leishmaniasis