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Immunology, Serology and Blood Banking

1. Incorrect statement about naturally occurring antibodies:

a. React best in saline
b. React best at room temperature or at 4OC
c. They are usually IgG
d. Do not usually cross the placenta

2. Which antibody is most likely to be involved in hemolytic disease of

the newborn?
a. Anti-E
b. Anti-Lea
c. Anti-M
d. Anti-Jsa

3. What blood type is not possible for an offspring of AO and BO persons?

a. AB
b. A or B
c. O
d. All are possible

4. Nature of ABO antibodies:

a. IgM
b. IgG and IgM
c. IgA
d. IgG, IgM and IgA

5. Waldenström’s macroglobulinemia, multiple myeloma and increased levels

of fibrinogen is associated with what ABO discrepancy?
a. Group I
b. Group II
c. Group III
d. Group IV

6. In which of the following blood group systems may the RBC typing change
during pregnancy?
a. Kidd
b. Lewis
c. MNS
d. Kell

7. Which of the following are the RBC equivalents of human leukocyte

antigens (HLA)?
a. Kpa, Kpb, Kpc
b. Jsa, Jsb
c. Doa, Dob
d. Bga, Bgb, Bgc

8. Which of the following does not belong to the high titer low avidity
antibodies?
a. Anti-Ch
b. Anti-Yka
c. Anti-Co
d. Anti-JMH
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9. Incorrect statement about Kell blood group:

a. 90% of the population is Kell negative
b. Anti-K reacts best in saline at room temperature
c. Anti-K can cause hemolytic disease of the newborn
d. Next to Rh (D), the Kell (K) antigen is the most immunogenic

10. Adults who have the Le, Se, and H genes will exhibit which Lewis
antigen on their red cells?
a. Lea
b. Leb
c. Lea and Leb
d. None

11. Given the following reactions, identify the cause of discrepancy:

Cell Typing: Serum Typing:
Anti-A = 4+ A1 cells = 0
Anti-B = 2+ B cells = 4+
a. Hypogammaglobulinemia
b. Hodgkin’s lymphoma
c. Cold agglutinins
d. Acquired B phenomenon

12. Which of the following is a contraindication for accepting a donor for

plateletpheresis?
a. 72 hours since the last apheresis
b. Plasmapheresis of 800mL 1 week ago
c. Platelet count of 100 x 109/L
d. Aspirin ingestion 7 days ago

13. Which of the following donors could be accepted for blood donation?
a. 18-year old woman with a hematocrit value of 38%
b. 45-year old man with a blood pressure of 180/100
c. 60-year old man with history of Babesiosis
d. 30-year old man who had been vaccinated for rabies 6 months ago

14. All of the following donors can be accepted for donating blood EXCEPT:
a. 30-year old female who had a rubella vaccination 6 weeks ago
b. 20-year old male with a body temperature of 99.4OF
c. 50-year old man with night sweats and skin lesions
d. 45-year old woman who was a recipient of recombinant growth
hormone

15. A man turns pale and complains of dizziness while donating blood. What
is the best course of action?
a. Continue the donation
b. Withdraw the needle, raise his feet and administer ammonia spirits
c. Discontinue the donation and provide a paper bag
d. Tell him to sit upright and not have a reaction until the donation
is finished

16. What would be the cause of jet-like pulsating bleeding with bright red
blood during blood donation?
a. Increased vacuum from the blood bag
b. The donor is hypertensive
c. Brachial artery was punctured
d. The donor is a chronic smoker
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17. Red blood cells stored in CPDA-2 blood bag would have a shelf-life of:
a. 21 days
b. 35 days
c. 2 days
d. 42 days

18. What is the proper storage protocol for granulocyte concentrates?

a. 1-6OC
b. -18OC
c. Room temperature with agitation
d. Room temperature without agitation

19. Cryoprecipitated antihemophilic factor is not recommended for the

treatment:
a. Hemophilia A
b. von Willebrand’s disease
c. Hemophilia B
d. Hypofibrinogenemia

20. What is the purpose of adding rejuvenating solutions to RBC products?

a. To restore ATP and 2,3-DPG
b. To stabilize RBC membrane
c. To prevent lysis of RBCs during storage at cold temperature
d. To increase the harvest of WBCs

21. Prothrombin complex concentrates are used to treat which of the

following?
a. Hemophilia A
b. Hemophilia B
c. Hemophilia C
d. von Willebrand’s disease

22. What is the purpose of adding citric acid to blood bag preservatives?
a. To prevent coagulation
b. To restore ATP levels
c. To improve survival of red cells
d. To prevent caramelization

23. Fresh frozen plasma stored at -65OC would have a shelf-life of:
a. 1 year
b. 5 years
c. 7 years
d. 10 years

24. Each unit of cryoprecipitate prepared from whole blood should contain
approximately how many units of factor VIII?
a. 40
b. 80
c. 150
d. 200

25. Quality control for RBCs requires a maximum hematocrit level of:
a. 75%
b. 80%
c. 85%
d. 90%
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26. Cryoprecipitate that has been thawed must be transfused within ___
hours
a. 6
b. 8
c. 4
d. 24

27. Platelets prepared from a whole blood donation require which of the
following?
a. A light spin followed by a heavy spin
b. Two light spins
c. A hard spin followed by a light spin
d. Two heavy spins

28. A single unit of granulocyte concentrate should contain at least ____

WBCs
a. 1.0 x 109
b. 1.0 x 1010
c. 3.0 x 1011
d. 5.5 x 1010

29. Which of the following antibodies is most responsible for immediate

hemolytic transfusion reactions?
a. Anti-N
b. Anti-D
c. Anti-B
d. Anti-Leb
30. When a suspected hemolytic transfusion reaction occurs, the first
thing to do is:
a. Slow the transfusion rate and call the physician
b. Administer medication to stop the reaction
c. First inform the laboratory to begin an investigation
d. Stop the transfusion but keep the intravenous line open with
saline

31. Transfusion reactions can be caused by:

1. Overheated donor blood 3. Hypokalemia
2. Bacterial contamination 4. Citrate toxicity
a. 1, 2 and 4
b. 2, 3 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4

32. Hepatitis B virus remains infectious on environmental surfaces for:

a. 7 days
b. 1 month
c. 1 year
d. 3 days

33. HBV is transmitted most frequently:

a. By unknown methods
b. Through blood transfusion
c. By needle sharing among IV drug abusers
d. By sexual activity
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34. Which of the following blood-borne pathogens is destroyed under

prolonged cold temperature storage?
a. Babesia microti
b. Trypanosoma cruzi
c. Treponema pallidum
d. Plasmodium falciparum

35. What procedure would help to distinguish between an anti-C and anti-Fyb
in an antibody mixture?
a. Use a thiol reagent
b. Run an enzyme panel
c. Lower the pH of test serum
d. Run a regular panel

36. What samples are required to perform compatibility testing?

a. Patient serum and donor serum
b. Patient serum and donor cells
c. Donor serum and patient cells
d. Donor cells and patient cells
37. What is the minimum testing required for a massively transfused
patient?
a. Immediate spin crossmatch or forward typing ABO
b. ABO, Rh, crossmatch
c. ABO, forward and reverse typing
d. Antibody screen and ABO typing

38. What is the major advantage of gel technology?

a. No cell washing steps
b. Specialized equipments
c. Standardization
d. Use of IgG-coated control cells

39. The purpose of immediate spin crossmatch is:

a. To ensure survival of transfused RBCs
b. To determine ABO compatibility between donor and recipient
c. Detect cold-reacting unexpected antibodies
d. Meet computer crossmatch requirements

40. Blood donor and recipient samples used in crossmatching must be stored
for a minimum of how many days following transfusion?
a. 2
b. 5
c. 7
d. 10

41. After the addition of IgG-coated RBCs to a negative AHG reaction

during an antibody screen, a negative result is observed. Which of the
following is a correct interpretation?
a. The antibody screen is negative
b. Reactive AHG reagent was added
c. The saline washings were adequate
d. AHG reagent was neutralized
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42. RBCs must be washed in saline at least three times before the addition
of AHG reagent to:
a. Wash away any hemolyzed cells
b. Neutralize any excess AHG reagent
c. Increase the antibody binding to antigen
d. Remove traces of free serum globulins

43. Blood for intrauterine transfusion should be all of the following

EXCEPT:
a. Compatible with maternal serum
b. Screened for CMV
c. Gamma-irradiated
d. More than 7 days old
44. What should be done if Wharton’s jelly cannot be removed from cord
cells?
a. Collect a heelstick sample
b. Wash cells with 0.6N HCl
c. Obtain another cord sample
d. Test cells using saline typing reagents

45. Cold AIHA is sometimes associated with infection by:

a. Staphylococcus aureus
b. Mycoplasma pneumoniae
c. Escherichia coli
d. Streptococcus pyogenes

46. Cephalosporin given in massive doses has been associated with RBC
hemolysis. Which of the classic mechanisms is involved in the hemolytic
process?
a. Membrane modification
b. Drug adsorption
c. Immune complex formation
d. Autoantibody formation

47. Backup copies of the information system:

a. Can be used to restore the information system data and software
b. Are used to maintain hardware components
c. Are performed once a month
d. Are created any time changes are made to the system

48. User passwords should be:

a. Shared with others
b. Never changed
c. Kept confidential
d. Posted at each terminal

49. All of the following items should be checked quarterly EXCEPT:

a. Cell washers
b. Centrifuge timers
c. Blood warmers
d. Platelet incubators

50. What is the principle involved in the gel technology?

a. Hemadsorption
b. Hemagglutination-inhibition
c. Hemagglutination
d. Precipitation
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51. Which of these match(es) is(are) correct?

1. Karl Landsteiner – ABO blood group 3. Rosalyn Yallow - ELISA
2. Elie Metchnikoff – Phagocytosis 4. Jules Bordet – Complement
fixation
a. 1, 2 and 3
b. 1, 2 and 4
c. 2, 3 and 4
d. 1, 2, 3 and 4

52. When was T cell receptor gene discovered?

a. 1979
b. 1987
c. 1984
d. 1981

53. Cytokine produced mainly by macrophages:

a. IL-1
b. IL-2
c. IL-6
d. IL-12

54. It is a non-specific indicator of inflammation believed to be an

antibody to the C-polysaccharide of pneumococci:
a. Alpha1-antitrypsin
b. C-reactive protein
c. Serum amyloid A
d. Ceruloplasmin

55. Acquired immunodeficiency syndrome (AIDS) shows a change in the ratio

of:
a. T/B cells
b. B1/B2 cells
c. Albumin/Globulin
d. CD4+/CD8+ cells

56. Hybridomas are formed from:

a. Antibodies
b. B lymphocytes
c. T lymphocytes
d. Phagocytes

57. T cells are involved in:

a. Humoral immunity
b. Wheal and flare reaction
c. Cell-mediated immunity
d. Antibody production

58. What is the major component of natural humoral immunity?

a. Immunoglobulins
b. Complement
c. B cells
d. Cytokines
59. Interferon can be produced by which of the following?
1. Macrophages 3. Virus-infected cells
2. T lymphocytes 4. All of these
a. 1 and 2 c. 2 and 3
b. 1 and 3 d. 4
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60. Which of the following IgG subclasses does not cross the placenta?
a. IgG1
b. IgG2
c. IgG3
d. IgG4

61. What is the major amino acid component of the hinge region of an
immunoglobulin molecule?
a. Lysine
b. Glutamine
c. Proline
d. Tryptophan

62. What region determines the immunoglobulin class?

a. Fc
b. CH
c. VL
d. CL

63. Marker for NK cells:

a. CD19
b. CD45
c. CD34
d. CD56

64. How are cytotoxic T cells and NK cells similar?

a. Effective against virally infected cells
b. Recognize antigen in association with HLA Class II markers
c. Do not bind to infected cells
d. Require antibody to be present

65. Which immunology cross-links mast cells to release histamine?

a. IgG
b. IgM
c. IgE
d. IgA

66. Humoral immunity is due to:

a. Macrophage activity
b. Suppressor T lymphocytes
c. B lymphocytes that transform into plasma cells
d. Lymphokines

67. The predominant antibody in an anamnestic response is:

a. IgG
b. IgM
c. IgA
d. IgD

68. The binding strength of an antibody for an antigen is referred to as

its:
a. Specificity
b. Affinity
c. Avidity
d. Titer
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69. The HLA complex is located primarily on:

a. Chromosome 3
b. Chromosome 6
c. Chromosome 9
d. Chromosome 17

70. For an antibody-coated antigen to be phagocytized, what part of the

antibody molecule fits into a receptor on the phagocytic cell?
a. Fab region
b. Hinge region
c. Variable region
d. Fc region

71. These are substances added to a vaccine to enhance the immune

response:
a. Haptens
b. Mitogens
c. Adjuvants
d. Immunogens

72. The alternative pathway of the complement cascade is initiated by:

1. IgG and IgM 3. Yeast cell wall 5. Lipopolysaccharides
2. Aggregates of IgA 4. Mannose group 6. Cobra venom factor
a. 1, 2 and 3
b. 2, 3, 5 and 6
c. 3, 4, 5 and 6
d. 1, 2, 3 and 5

73. Deficiency of C3 complement component is associated with:

a. Paroxysmal nocturnal hemoglobinuria
b. Hereditary angioneurotic edema
c. Gonococcal or meningococcal infection
d. Severe recurrent bacterial infection

74. Fetus in a mother’s womb is considered a(n):

a. Allograft
b. Autograft
c. Heterograft
d. Syngeneic graft

75. HLA-B27 is most commonly associated with:

a. Systemic lupus erythematosus
b. Rheumatoid arthritis
c. Ankylosing spondylitis
d. Graves’ disease

76. If the interval between heating the serum for the VDRL test and
testing exceeds 4 hours, the serum should be reheated at:
a. 37OC for 30 minutes
b. 37OC for 10 minutes
c. 56OC for 30 minutes
d. 56OC for 10 minutes
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77. Patients with syphilis develop an antibody response to a substance

known as:
a. Reagin
b. Complement
c. Cardiolipin
d. Hemolysin

78. The fluorescein-antihuman gamma globulin used in the FTA-ABS test:

a. Makes the antigen-antibody reaction visible
b. Is added to the serum before the antigen is added
c. Is added to the antigen before the serum is added
d. Makes the antibody visible

79. The reactions on DNA-methyl green substrates when testing for the
presence of anti-DNase are:
a. (+) Blue, (-) Yellow
b. (+) Red, (-) Orange
c. (+) Green, (-) Colorless
d. (+) Purple, (-) Yellow

80. The Widal and Weil-Felix reactions are examples of techniques to

detect:
a. Heterophil antibodies
b. Febrile agglutinins
c. Reagin
d. Forssman antigen

81. Forssman antibodies are adsorbed by:

a. Beef erythrocytes
b. Guinea pig kidney cells
c. Both
d. Neither

82. What is the first antibody to be produced in a patient with hepatitis

B virus infection?
a. Anti-HBs
b. Total anti-HBc
c. IgM anti-HBc
d. Anti-HBe

83. What is the first antibody to be produced in a patient with HIV

infection?
a. Antibody to p24
b. Antibody to gp41
c. Antibody to gp120
d. Antibody to p15

84. Among the following congenital infections, which one is the most
common?
a. Congenital syphilis
b. Rubella infection
c. Cytomegalovirus infection
d. Herpes virus infection
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85. In the exoantigen test for Histoplasma capsulatum, which bands are
present in a positive result?
a. A
b. H and/or M
c. 1, 2, 3
d. HS, HL, F

86. If only anti-HBs is positive, which of the following can be ruled out?
a. HBV vaccination
b. Distant past infection with HBV
c. HBIG injection
d. Chronic HBV infection

87. This test will detect parasitic lactate dehydrogenase enzyme present
in malarial organisms:
a. Optimal
b. Malaquick
c. Monospot
d. Streptozyme

88. Which is most likely a positive Western blot result for infection with
HIV?
a. Band at p24
b. Bands at gp160
c. Bands at p24 and p31
d. Band at p24 and gp120

89. Which disease might be indicated by antibodies to smooth muscle?

a. Myasthenia gravis
b. Primary biliary cirrhosis
c. Chronic active hepatitis
d. Hashimoto’s thyroiditis

90. Which immunofluorescent pattern indicates the need for further testing
by Ouchterlony double diffusion?
a. Solid
b. Mottled
c. Rim
d. Nucleolar

91. What disease is indicated by a high titer of anti-centromere

antibodies?
a. Scleroderma
b. Sclerodactyly
c. MCTD
d. SLE

92. Which of the following is a sialylated Lewis blood group antigen

associated with colorectal carcinoma?
a. CA 19-9
b. CEA
c. CA 549
d. CA 15-3
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93. Associated with increased serum alpha1-fetoprotein level:

1. Testicular cancer 3. Pancreatic carcinoma
2. Hepatocellular carcinoma 4. Prostatic carcinoma
a. 1 and 2
b. 1, 2 and 3
c. 3 and 4
d. 1, 2 and 4

94. Not true regarding hCG:

a. Beta subunit confers immunogenic specificity
b. Used to confirm pregnancy
c. Used as a tumor marker
d. Found in hepatoma

95. What immune elements are involved in a reaction to poison ivy?

a. IgE antibodies
b. NK cells and IgG antibody
c. B cells and IgM antibody
d. T cells and macrophages

96. Needles used to deliver VDRL antigen should be checked:

a. Monthly
b. Bimonthly
c. Daily or every time tests are performed
d. Weekly

97. When preparing monoclonal antibodies:

a. Inject an animal with an antigen
b. Fuse B lymphocytes with a malignant cell
c. Remove the B lymphocytes
d. All of the above

98. The air temperature throughout the serology laboratory is 20OC. How
will this affect RPR test result?
a. No effect – the acceptable test range is 20-24OC
b. Weaken reactions so that false negatives occur
c. Strengthen reactions so that positive titers appear elevated
d. Increase the number of false positives from spontaneous clumping

99. A device used to measure radioactivity in radioimmunoassay:

a. Spectrophotometer
b. Scintillation counter
c. Fluorometer
d. None of these

100. Most commonly used label in ELISA:

a. HRP
b. FITC
c. Tritiated hydrogen
d. G6PD
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ANSWER KEY: ISBB

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1. C 21. B 41. D 61. C 81. B

2. A 22. D 42. D 62. B 82. C
3. D 23. C 43. D 63. D 83. A
4. D 24. B 44. A 64. A 84. C
5. C 25. B 45. B 65. C 85. B
6. B 26. A 46. A 66. C 86. D
7. D 27. A 47. A 67. A 87. A
8. C 28. B 48. C 68. C 88. D
9. B 29. C 49. D 69. B 89. C
10. B 30. D 50. C 70. D 90. B
11. D 31. A 51. B 71. C 91. B
12. C 32. A 52. C 72. B 92. A
13. A 33. D 53. A 73. D 93. B
14. C 34. C 54. B 74. A 94. D
15. B 35. B 55. D 75. C 95. D
16. C 36. B 56. B 76. D 96. C
17. D 37. A 57. C 77. C 97. B
18. D 38. C 58. B 78. A 98. B
19. C 39. B 59. D 79. C 99. B
20. A 40. C 60. B 80. B 100. A
ANSWER KEY: ISBB