Summative Exam #2 PDF

CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED. CASSIE P a g e | 1 SUMMATIVE EXAM #2 170.What antibodies are present in polyspecific AHG 161. The key structural difference that distinguishes...

CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED. CASSIE P a g e | 1 SUMMATIVE EXAM #2 170.What antibodies are present in polyspecific AHG 161. The key structural difference that distinguishes reagent? immunoglobulin subclasses is the: A. Anti-IgG A. Number of domains B. Anti-IgM and anti-IgG B. Stereometry of the hypervariable region C. Anti-IgG and anti-C3d C. The sequence of the constant regions D. Anti-C3d D. Covalent linkage of the light chains 171. Which of the following medications is most likely to 162. lmmunoglobulin classes are differentiated according cause production of AUTOANTIBODIES? to the molecular structure of: A. Penicillin A. Light chains B. Cephalosporin B. Heavy chains isotype C. Methyldopa C. Fab fragment D. Tetracycline D. Fc fragment DRUG ADSORPTION Penicillin MEMBRANE MODIFICATION Cephalosporin lg classes are differentiated based on their amino acid IMMUNE COMPLEX Rifampin, phenacetin, sequences of the constant region of the heavy chains. stibophen 163.A 54-year-old female previous smoker presents with a AUTOANTIBODY Methyldopa (Aldomet) recent history of fever, swollen joints, and morning FORMATION Mefenamic acid (Ponstel) stiffness. 172. Red cells from a recently transfused patient were DAT § Laboratory results indicate elevated C-reactive positive when tested with anti-IgG. Screen cells and a protein, positive cyclic citrullinated peptide of 205 panel performed on a patient’s serum showed very units (cut-off: 20 units), speckled ANA pattern (titer weak reactions with inconclusive results. What 1:320), and negative rheumatoid factor. procedure could help to identify the antibody? What is the most likely diagnosis? A. Elution followed by a panel on the eluate A. Reactive arthritis B. Adsorption followed by a panel on the adsorbed B. Rheumatoid arthritis serum C. Systemic sclerosis C. Enzyme panel D. Sjogren syndrome D. Antigen typing the patient’s red cells 164. Which of the following is used for the confirmation of 173. The procedure that removes intact antibodies from infection with HIV-1? the red cell membranes is: A. Western blot (immunoblot) assay A. Autoadsorption B. ELISA B. Enzyme pretreatment C. Complement fixation C. Neutralization D. p24 Antigen testing D. Elution 165.Which technique is used for the confirmation of ADSORPTION Removing the antibody from the serum infection with HIV-1 and HIV-2? ELUTION Cells that are coated with antibody are A. Western blot (immunoblot) assay treated in such a manner as to disrupt the B. ELISA bonds between the antigen and antibody C. FDA-approved NAT Mechanism to free the antibody may be: D. p24 Antigen testing § Physical (heating, shaking) 166. Clinical assays for tumor markers are most important § Chemical (ether, acid) for: 174. A56-year-old female with cold agglutinin disease has A. Screening for the presence of cancer a positive direct antiglobulin test (DAT). When the B. Monitoring the course of a known cancer DAT is repeated using monospecific antiglobulin sera, C. Confirming the absence of disease which of the following is most likely to be detected? D. Identifying patients at risk for cancer A. lgM 167. In general, in which of the following situations is the B. lgG analysis of a tumor marker most useful? C. C3d A. Testing for recurrence D. C4a B. Prognosis 175. A crossmatch is positive at AHG phase with C. Screening polyspecific AHG reagent but is negative with D. Diagnosis monospecific anti-IgG AHG reagent. This may 168.The chemical composition of an antibody is: indicate the antibody: A. Protein protein - turgeon A. Is a weak anti-D B. Lipid B. Is a clinically insignificant Lewis antibody C. Carbohydrate C. Can cause decreased survival of transfused RBCs D. Glycoprotein D. Is a Duffy antibody 169. What is the most common clinical incident that INTERPRETATION Anti-IgG Anti-C3d results in alloantibody production? Patient red cells sensitized with IgG only + 0 A. Viral infection Patient red cells sensitized + + B. Solid tumor with IgG and C3d C. Red cell transfusion Patient red cells sensitized with C3d only 0 + D. Autoimmune disease CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED. CASSIE P a g e | 2 176. Crossmatch results at the antiglobulin phase were 185.Which of the following describes the expression of negative. When 1 drop of check cells was added, NO most blood group inheritance? AGGLUTINATION was seen. The most likely A. Dominant explanation is that the: B. Sex-linked A. Red cells were overwashed C. Recessive B. Residual patient serum inactivated the AHG reagent D. Codominant C. Centrifuge speed was set too high 186. Which genotype(s) will give rise to the Bombay D. Laboratorian did not add enough check cells phenotype? 177. Autoantibodies demonstrating blood group A. HH only specificity in warm autoimmune hemolytic anemia B. HH and Hh are associated more often with which blood group C. Hh and hh system? D. hh only A. Rh 187. What should be done if all forward and reverse ABO B. I results as well as the autocontrol are positive? C. P A. Wash the cells with warm saline, autoadsorb the D. Fy serum at 4°C 178. Which antibody is frequently seen in patients with B. Retype the sample using a different lot number warm autoimmune hemolytic anemia? of reagents A. Anti-Jka C. Use polyclonal typing reagents B. Anti-e D. Report the sample as group AB C. Anti-K 188. A patient types as AB positive. Two units of blood D. Anti-Fyb have been ordered by the physician. Currently, the 179. Many enhancement media used in the blood bank inventory shows no AB units, 10 A-positive units, 1 A- promote hemagglutination in the presence of lgG negative unit, 5 B-positive units, and 20 O-positive antibodies by reducing which of the following? units. Which should be set up for the major A. Hydrophilic forces crossmatch? B. Low ionic potential A. A-positive units C. van der Waals forces B. O-positive units D. Zeta potential liss C. B-positive units 180. Low ionic strength saline (LISS) acts as an D. Call another blood supplier for type-specific blood enhancement medium and facilitates antibody 189. A physician orders 2 units of leukocyte-reduced red uptake by: blood cells. The patient is a 55-year-old male with A. Activating complement anemia. He types as an AB negative, and his antibody B. Increasing flexibility in hinge region screen is negative. There is only 1 unit of AB negative C. Removing water molecules in inventory. What is the next blood type that should D. Reducing zeta potential be given? 181. Which antibody would not be detected by group O A. AB positive (patient is male) screening cells? B. A negative A. Anti-N C. B negative B. Anti-A1 D. O negative C. Anti-Dia 190. In an emergency situation, Rh-negative red cells are D. Anti-k transfused into an Rh-positive person of the 182. Screening cells, major crossmatch, and patient genotype CDe/CDe. The first antibody most likely to autocontrol are positive in all phases. Identify the develop is: problem. A. Anti-c A. Specific cold alloantibody B. Anti-d B. Specific cold autoantibody C. Anti-e C. Abnormal protein or nonspecific autoantibody D. Anti-E D. Cold and warm alloantibody mixture 191. What antibodies could an R1R1 make if exposed to 183. What corrective action should be taken when R2R2 blood? rouleaux causes positive test results? A. Anti-e and anti-C A. Perform a saline replacement technique B. Anti-E and anti-c B. Perform an autoabsorption C. Anti-E and anti-C C. Run a panel D. Anti-e and anti-c D. Perform an elution 192. What techniques are necessary for weak D testing? 184. Screening cells and major crossmatch are positive on A. Saline + 22°C incubation IS only, and the autocontrol is negative. Identify the B. Albumin or LISS + 37°C incubation problem. C. Saline + 37°C incubation A. Cold alloantibody D. 37°C incubation + IAT B. Cold autoantibody 193. RhIg (Rhogam) is indicated for: C. Abnormal protein A. Mothers who have anti-D D. Antibody mixture B. Infants who are Rh-negative C. Infants who have anti-D D. Mothers who are Rh-negative CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED. CASSIE P a g e | 3 CRITERIA FOR ADMINISTERING RHIG This individual cannot have the k antigen on their cells. K0K0 is 1. Mother must be D-negative; D-negative, Du positive rare and no Kell system antigens are detected on the red blood patients are not usually given RhIg. cells. Those individuals usually produce antibodies that are 2. Mother must have no detectable anti-D in her serum. reactive with all normal cells. KK is the most probable genotype 3. Infant must be D-positive. 203. An antibody commonly associated with delayed 4. The DAT on the cord blood must be NEGATIVE. transfusion reactions is: 194.RhIG should be administered within how many hours A. Anti-Lua of delivery? B. Anti-S A. 4 C. Anti-Jkb B. 48 D. Anti-M C. 72 204.What blood group system antibodies are commonly D. 96 associated with delayed hemolytic transfusion 195.Which of the following antigens is poorly expressed reactions? on cord blood cells? A. Rh c A. K B. MNS B. M C. ABO C. Leb D. Kidd D. D 205.What procedure would help to distinguish between 196. Which of the following is characteristic of anti-i? an anti-Fya and anti-Jka in an antibody mixture? A. Often associated with hemolytic disease of the A. Lowering the pH of the patient’s serum newborn B. Using a thiol reagent B. Reacts best at 37ºC C. Testing at colder temperatures C. Reacts best at room temperature or 4ºC D. Ficin-treated panel cells D. Is usually IgG 206. Which of the following antibodies characteristically 197. PAROXYSMAL COLD HEMOGLOBINURIA (PCH) is gives a refractile mixed-field appearance? associated with antibody specificity toward which of A. Anti-K the following? B. Anti-Dia A. Kell system antigens C. Anti-Sda B. Duffy system antigens D. Anti-s C. P antigen 207. A patient has symptoms indicating a possible hemolytic D. I antigen transfusion reaction. What should be done immediately? 198. In the DONATH-LANDSTEINER TEST, patient’s serum A. Stop the transfusion and discard the unit are incubated at various temperatures with: B. Contact the patient's doctor to ask if the A. Group O RBCs that express the P antigen transfusion should be stopped B. Group O RBCs that express the P1 antigen C. Stop the transfusion and call the patient's doctor to C. Group AB RBCs that express the P antigen report the reaction D. Group AB RBCs that express the P1 antigen D. Have patient blood samples sent to the lab to 199. Excluding ABO, __ is rated second only to D in investigate the reaction immunogenicity. 208. FATAL TRANSFUSION reactions are mostly caused by? A. Kell A. Serologic errors B. Cellano B. Improper storage of blood C. Duffy C. Clerical errors D. Kidd D. Improper handling of the product 200. The K (KEL1) antigen is: 209. Some blood group antibodies characteristically A. Absent from the red cells of neonates hemolyze appropriate red cells in the presence of: B. Strongly immunogenic A. Complement C. Destroyed by enzymes B. Anticoagulants D. Has a frequency of 50% in the random population C. Preservatives 201. The k (Cellano) antigen is a high-frequency antigen D. Penicillin and is found on most red cells. How often would one 210. PAIN AT INFUSION SITE and hypotension are observed expect to find the corresponding antibody? with what type of reaction? A. Often A. Acute hemolytic transfusion reaction B. Rarely B. Allergic reaction C. It depends upon the population C. Delayed hemolytic transfusion reaction D. Impossible to determine without consulting D. Febrile nonhemolytic reaction regional blood group antigen charts Red or dark urine or DIFFUSE OOZING may be the only sign 202. An individual has been sensitized to the k antigen and in the anesthetized patient. has produced anti-k. What is her most probable Kell 211. Hypotension, nausea, flushing, fever and chills are system genotype? symptoms of which of the following transfusion A. KK reactions? B. Kk A. Allergic C. kk B. Circulatory overload D. K0K0 C. Hemolytic D. Anaphylactic CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED. CASSIE P a g e | 4 212. Hemoglobinuria, hypotension and generalized 220. What may be found in the serum of a person who is bleeding are symptoms of which of the following exhibiting signs of TRALI (transfusion-related acute transfusion reactions? lung injury)? A. Allergic A. Red blood cell alloantibody B. Circulatory overload B. IgA antibody C. Hemolytic C. Anti-leukocyte antibody D. Anaphylactic D. Allergen 213. The most serious hemolytic transfusion reactions are 221. Hives and itching are symptoms of which of the due to incompatibility in which of the following blood following transfusion reactions? group systems? A. Febrile A. ABO htr B. Allergic B. Rh hdn C. Circulatory overload C. MN D. Bacterial D. Duffy 222. Which of the following transfusion reactions occurs The severity of symptoms is closely related to the amount after infusion of only a few milliliters of blood and and rate of incompatible blood transfused. gives no history of fever? 214. What would be the result of group A blood given to an A. Febrile O patient? B. Circulatory overload A. Nonimmune transfusion reaction C. Anaphylactic B. Immediate hemolytic transfusion reaction D. Hemolytic C. Delayed hemolytic transfusion reaction 223. Anaphylactic reactions to transfusion are usually D. Febrile nonhemolytic transfusion reaction caused by: 215. A patient has a hemolytic reaction to blood transfused A. Anti-IgA in an IgA-deficient recipient 8 days ago. What is the most likely cause? B. Anti-IgG in an IgA-deficient A. Immediate, nonimmunologic probably due to C. IgA deficiency volume overload D. IgG deficiency B. Delayed immunologic, probably due to an antibody 224. Which of the following transfusion reactions is such as anti-Jka characterized by high fever, shock, hemoglobinuria, C. Delayed nonimmunologic, probably due to iron DIC and renal failure? overload A. Bacterial contamination D. Immediate, immunologic, probably due to clerical B. Circulatory overload error, ABO incompatibility C. Febrile 216. In a DELAYED TRANSFUSION REACTION, the causative D. Anaphylactic antibody is generally too weak to be detected in routine 225. Coughing, hypoxemia and difficult breathing are compatibility testing and antibody screening tests, but is symptoms of which of the following transfusion typically detectable at what point after transfusion? reactions? A. 3 - 6 hours A. Febrile B. 3 - 7 days B. Allergic C. 60 - 90 days C. TACO D. After 120 days D. Hemolytic 217. An unexplained fall in hemoglobin and mild jaundice 226. Congestive heart failure, severe headache and/or in a patient transfused with Red Blood Cells 1 week peripheral edema occurring soon after transfusion is previously would most likely indicate: indicative of which type of transfusion reaction? A. Paroxysmal nocturnal hemoglobinuria A. Hemolytic B. Posttransfusion hepatitis infection B. Febrile C. Presence of HLA antibodies C. Anaphylactic D. Delayed hemolytic transfusion reaction D. TACO 218. Fever and chills are symptoms of which of the 227. Which of the following patient groups is at risk of following transfusion reactions? developing graft-versus-host disease? A. Citrate toxicity A. Full-term infants B. Circulatory overload B. Patients with history of febrile transfusion C. Allergic reactions D. Febrile C. Patients with a positive direct antiglobulin test 219. Symptoms of dyspnea, hypoxemia, and pulmonary D. Recipients of blood donated by immediate family edema within 6 hours of transfusion is most likely members which type of reaction? 228. The most frequent transfusion-associated disease A. Anaphylactic complication of blood transfusions is: B. Hemolytic A. Cytomegalovirus (CMV) C. Febrile B. Syphilis D. TRALI C. Hepatitis D. HIV-1/2 CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED. CASSIE P a g e | 5 229. When evaluating a possible delayed hemolytic 237. A donor who has just donated 2 units of Apheresis reaction, what is the best sample to use for bilirubin Red Blood Cells will be deferred from further blood determination? donation for a minimum of how many weeks? A. 6 hours posttransfusion A. 8 B. 12 hours posttransfusion B. 12 C. 24 hours posttransfusion C. 16 D. 48 hours posttransfusion D. 24 230. What is the primary reason that infectious agents can 238. All of the following apply to a double red cell unit be transmitted following blood transfusion? apheresis collection except: A. Pathogen reduction technology failure A. The hematocrit must be at least 38% B. Donor in the window period of early infection B. The weight for a female is at least 150 lbs C. Leukocyte-reduction failure C. The height for a male is at least 5 ft 1 in. D. Donor history questionnaire not completed D. The deferral period following collection is 16 weeks 231. What may be done to RBCs before transfusion to a 239. To qualify as a donor for autologous transfusion a patient with cold agglutinin disease in order to reduce patient’s hemoglobin should be at least: the possibility of a transfusion reaction? A. 8 g/dL A. Irradiate to prevent graft-versus-host-disease B. 11 g/dL (GVHD) C. 13 g/dL B. Wash with 0.9% percent saline D. 15 g/dL C. Warm to 37°C with a blood warmer 240. Which one of the following constitutes permanent D. Transport so that temperature is maintained at 20 deferral status of a donor? to 24°C A. A tattoo 5 months previously 232. Which of the following is an acceptable time in which B. Recent close contact with a patient with viral a unit of whole blood is collected? hepatitis A. 33 minutes C. 2 units of blood transfused 4 months previously B. 25 minutes D. Confirmed positive test for HBsAg 10 years C. 20 minutes previously D. 13 minutes 241. Donors who have received HBIG must wait ___ 233. How much anticoagulant would have to be removed months to donate blood to be sure they were not from the collection bag given a donor who weighs 90 infected since hepatitis B can be transmitted through lb? transfusion to a patient. A. 12 mL A. 2 weeks B. 15 mL B. 1 month C. 20 mL C. 3 months D. 23 mL D. 12 months Donors who weigh less are not restricted from donating, but 242. Which of the following vaccinations carries no deferral a proportionally smaller amount of blood should be removed period? A. VOLUME OF BLOOD TO BE DRAWN (mL) A. Rubella Donor’s weight x 450 mL = A B. Varicella zoster Ideal weight C. Recombinant HPV B. VOLUME OF ANTICOAGULANT NEEDED (mL) D. Smallpox Answer in A x 63 = B 243. A donor bag is half filled during donation when the 450 C. VOLUME OF ANTICOAGULANT TO BE REMOVED FROM blood flow stops. Select the correct course of action. THE BLOOD BAG (mL) A. Closely observe the bag for at least 3 minutes; if 63 mL – answer in B = C blood flow does not resume, withdraw the needle 234. The minimum hemoglobin concentration in a finger B. Remove the needle immediately and discontinue stick from a female blood donor is: the donation A. 12.0 g/dL (120 g/L) C. Check and reposition the needle if necessary; if B. 12.5 g/dL (125 g/L) blood flow does not resume, withdraw the needle C. 13.0 g/dL (135 g/L) D. Withdraw the needle and perform a second D. 15.0 g/dL (150 g/L) venipuncture in the other arm 235. Which of the following donors could be accepted for 244. A woman begins to breathe rapidly while donating whole-blood donation? blood. Choose the correct course of action. A. A construction worker who was incarcerated for A. Continue the donation; rapid breathing is not a opiate abuse reason to discontinue a donation B. A triathlete with a pulse of 45 B. Withdraw the needle, raise her feet, and administer C. A man who is currently taking finasteride ammonia (Propecia) C. Discontinue the donation and provide a paper bag D. A woman in her 14th week of pregnancy D. Tell her to sit upright and apply a cold compress to 236. How often can a blood donor donate whole blood? her forehead A. Every 24 hours 245. A unit tests positive for syphilis using the rapid plasma B. Once a month reagin test (RPR). The microhemagglutinin assay- C. Every 8 weeks Treponema pallidum (MHA-TP) on the same unit is D. Twice a year negative. What is the disposition of the unit? CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED. CASSIE P a g e | 6 A. The unit may be used to prepare components C. CPD B. The donor must be contacted and questioned D. CPDA-1 further; if the RPR result is most likely a false 253. Appropriate preservative for modified whole blood: positive, then the unit may be used A. ACD C. The unit must be discarded B. CPD D. Cellular components may be prepared but must be C. CPDA-1 irradiated before issue D. All of these 246. John Smith donated a unit of whole blood in May. Red When cryoprecipitated AHF has been removed for the unit blood cells made from the whole blood were transfused to of whole blood, WB is referred to as whole blood modified. a recipient of a community hospital in June with no 254.All of the following are requirements for the tag on the apparent complications. The blood supplier notified the medical director of the hospital that the donor reported crossmatched donor unit, EXCEPT: HIGH-RISK BEHAVIOR with another male in April, although A. ABO and Rh type viral tests remain negative and the donor is healthy. What B. Name of the donor course of action should be taken? C. Unit expiration date A. No action should be taken D. Interpretation of the crossmatch B. The recipient’s physician should be notified REQUIREMENTS FOR THE TAG ON THE C. The recipient’s physician and the recipient should be CROSSMATCHED DONOR UNIT notified § Patient’s full name and second independent D. The recipient should be notified identifier 247. Rejuvenation of a unit of Red Blood Cells is a method § Name of blood product used to: § Unique donor unit number or pool number A. Remove antibody attached to RBCs § Unit expiration date and ABO and D phenotype B. Restore 2,3-DPG and ATP to normal levels § Interpretation of crossmatch C. Inactivate viruses and bacteria § Technologist’s identification D. Filter blood clots and other debris 255.What is the expected therapeutic effect in the 248. A technologist removed 4 units of blood from the blood bank refrigerator and placed them on the counter. A recipient’s hematocrit after the transfusion of 1 unit clerk was waiting to take the units for transfusion. As she of RBCs? checked the paperwork, she noticed that one of the units A. Increase of 0.5% was leaking onto the counter. What should she do? B. Increase of 1% A. Issue the unit if the red cells appear normal C. Increase of 2% B. Reseal the unit D. Increase of 3% C. Discard the unit 256. How many units of red blood cells are required to raise D. Call the medical director and ask for an opinion the hematocrit of a 70 kg nonbleeding man from 24% 249. What should be done if a noticeable clot is found in an to 30%? RBC unit? A. 1 A. Issue the unit; the blood will be filtered B. 2 B. Issue the unit; note the presence of a clot on the C. 3 release form D. 4 C. Filter the unit in the blood bank before issue 257. A 42-year-old male of average body mass has a history of D. Do not issue the unit chronic anemia requiring transfusion support. Two units 250. Upon inspection, a unit of Apheresis Platelets is noted of red blood cells are transfused. If the pretransfusion hemoglobin was 7.0 g/dL, the expected posttransfusion to have visible clots, but otherwise appears normal. hemoglobin concentration should be: The technologist should: A. 8.0 g/dL A. Issue without concern B. 9.0 g/dL B. Filter to remove the clots C. 10.0 g/dL C. Centrifuge to express off the clots D. 11.0 g/dL D. Quarantine for Gram stain and culture 258.Washed Red Blood Cells are indicated in which of the 251. Plastic bag overwraps are recommended when following situations? thawing units of FFP in 37°C water baths because they A. An IgA-deficient patient with a history of prevent: transfusion-associated anaphylaxis A. The FFP bag from cracking when it contacts the B. A pregnant woman with a history of hemolytic warm water disease of the newborn B. Water from slowly dialyzing across the bag C. A patient with a positive DAT and red cell membrane autoantibody C. The entry ports from becoming contaminated with D. A newborn with a hematocrit of