7.

What is the minimum number of platelets required in a platelet

MODERN BLOOD BANKING & concentrate prepared from whole blood by centrifugation (90% of
TRANSFUSION PRACTICES: HARMENING sampled units)?
a. 5.5 1011
CHAPTER 1
b. 3 1010
c. 3 1011
1. What is the maximum volume of blood that can be collected from
d. 5.5 1010
a 110-lb donor, including samples for
ANSWER: D
processing?
a. 450 mL
8. RBCs can be frozen for:
b. 500 mL
a. 12 months.
c. 525 mL
b. 1 year.
d. 550 mL
c. 5 years.
ANSWER: C
d. 10 years.
ANSWER: D
2. How often can a blood donor donate whole blood?
a. Every 24 hours
9. What is the minimum number of platelets required in
b. Once a month
an apheresis component (90% of the sampled units)?
c. Every 8 weeks
a. 3 1011
d. Twice a year
b. 4 1011
ANSWER: C
c. 2 1011
d. 3.5 1011
3. When RBCs are stored, there is a “shift to the left.” This means:
ANSWER: A
a. Hemoglobin oxygen affinity increases, owing to an
increase in 2,3-DPG.
10. Whole blood and RBC units are stored at what
b. Hemoglobin oxygen affinity increases, owing to a decrease in 2,3-
temperature?
DPG.
a. 1°C to 6°C
c. Hemoglobin oxygen affinity decreases, owing to a decrease in 2,3-
b. 20°C to 24°C
DPG.
c. 37°C
d. Hemoglobin oxygen affinity decreases, owing to an
d. 24°C to 27°C
increase in 2,3-DPG.
ANSWER: A
ANSWER: B
11. Additive solutions are approved for storage of red blood cells for
4. The majority of platelets transfused in the United States today are:
how many days?
a. Whole blood–derived platelets prepared by the
a. 21
platelet-rich plasma method.
b. 42
b. Whole blood–derived platelets prepared by the buffy
c. 35
coat method.
d. 7
c. Apheresis platelets.
ANSWER: B
d. Prestorage pooled platelets.
ANSWER: C
12. One criterion used by the FDA for approval of new preservation
solutions and storage containers is an average 24-hour post-
5. Which of the following anticoagulant preservatives provides a
transfusion RBC survival of more than:
storage time of 35 days at 1°C to 6°C for units of whole blood and
a. 50%.
prepared RBCs if an additive solution is not added?
b. 60%.
a. ACD-A
c. 65%.
b. CP2D
d. 75%.
c. CPD
ANSWER: D
d. CPDA-1
ANSWER: D
13. What is the lowest allowable pH for a platelet component at
outdate?
6. What are the current storage time and storage temperature for
a. 6
platelet concentrates and apheresis platelet components?
b. 5.9
a. 5 days at 1°C to 6°C
c. 6.8
b. 5 days at 24°C to 27°C
d. 6.2
c. 5 days at 20°C to 24°C
ANSWER: D
d. 7 days at 22°C to 24°C
ANSWER: C
14. Frozen and thawed RBCs processed in an open system can be
stored for how many days/hours?
a. 3 days

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b. 6 hours between three daughter cells
c. 24 hours d. Genetic material is halved, doubled, then equally
d. 15 days divided between two daughter cells
ANSWER: C ANSWER: B

15. What is the hemoglobin source for hemoglobin-based oxygen 2. When a recessive trait is expressed, it means that:
carriers in advanced clinical testing? a. One gene carrying the trait was present.
a. Only bovine hemoglobin b. Two genes carrying the trait were present.
b. Only human hemoglobin c. No gene carrying the trait was present.
c. Both bovine and human hemoglobins d. The trait is present but difficult to observe.
d. None of the above ANSWER: B
ANSWER: C 3. In a pedigree, the “index case” is another name for:
a. Stillbirth.
16. Which of the following occurs during storage of red b. Consanguineous mating.
blood cells? c. Propositus.
a. pH decreases d. Monozygotic twins.
b. 2,3-DPG increases ANSWER: C
c. ATP increases
d. plasma K+ decreases 4. Which of the following nitrogenous bases make up DNA?
ANSWER: A a. Adenine, leucine, guanine, thymine
b. Alanine, cytosine, guanine, purine
17. Nucleic acid amplification testing is used to test donor blood for c. Isoleucine, lysine, uracil, leucine
which of the following infectious diseases? d. Adenine, cytosine, guanine, thymine
a. Hepatitis C virus ANSWER: D
b. Human immunodeficiency virus
c. West Nile virus 5. Proteins and peptides are composed of:
d. All of the above a. Golgi bodies grouped together.
ANSWER: D b. Paired nitrogenous bases.
c. Nuclear basic particles.
18. Which of the following is NOT an FDA-approved test d. Linear arrangements of amino acids.
for quality control of platelets? ANSWER: D
a. BacT/ALERT
b. eBDS 6. Which phenotype(s) could not result from the mating
c. Gram stain of a Jk(a+b+) female and a Jk(a-b+) male?
d. Pan Genera Detection (PGD) test a. Jk(a+b–)
ANSWER: C b. Jk(a+b+)
c. Jk(a–b+)
19. Prestorage pooled platelets can be stored for: d. Jk(a–b-)
a. 4 hours. ANSWER: D
b. 24 hours.
c. 5 days. 7. Exon refers to:
d. 7 days. a. The part of a gene that contains nonsense mutations.
ANSWER: C b. The coding region of a gene.
c. The noncoding region of a gene.
20. Which of the following is the most common cause of d. The enzymes used to cut DNA into fragments.
bacterial contamination of platelet products? ANSWER: B
a. Entry of skin plugs into the collection bag
b. Environmental contamination during processing 8. PCR technology can be used to:
c. Bacteremia in the donor a. Amplify small amounts of DNA.
d. Incorrect storage temperature b. Isolate intact nuclear RNA.
ANSWER: A c. Digest genomic DNA into small fragments.
d. Repair broken pieces of DNA.
CHAPTER 2 ANSWER: A

1. Which of the following statements best describes mitosis?
a. Genetic material is quadruplicated, equally divided
between four daughter cells
b. Genetic material is duplicated, equally divided
between two daughter cells
c. Genetic material is triplicated, equally divided
9. Transcription can be defined as:
a. Introduction of DNA into cultured cells.
b. Reading of mRNA by the ribosome.
c. Synthesis of RNA using DNA as a template.
d. Removal of external sequences to form a mature RNA
molecule.

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ANSWER: C 2. Which cells are involved in the production of antibodies?
a. Dendritic cells
10. When a male possesses a phenotypic trait that he passes to all b. T lymphocytes
his daughters and none of his sons, the trait is said to be: c. B lymphocytes
a. X-linked dominant. d. Macrophages
b. X-linked recessive. ANSWER: C
c. Autosomal dominant.
d. Autosomal recessive. 3. Which of the following cells is involved in antigen recognition
ANSWER: A following phagocytosis?
a. B lymphocytes
11. When a female possesses a phenotypic trait that she b. T lymphocytes
passes to all of her sons and none of her daughters, the c. Macrophages
trait is said to be: d. Granulocytes
a. X-linked dominant. ANSWER: B
b. X-linked recessive.
c. Autosomal dominant. 4. The role of the macrophage during an antibody response is to:
d. Autosomal recessive. a. Make antibody
ANSWER: B b. Lyse virus-infected target cells
c. Activate cytotoxic T cells
12. DNA is replicated: d. Process antigen and present it
a. Semiconservatively from DNA. ANSWER: D
b. In a random manner from RNA.
c. By copying protein sequences from RNA. 5. Which of the following immunoglobulins is produced in the
d. By first copying RNA from protein. primary immune response?
ANSWER: A a. IgA
b. IgE
13. RNA is processed: c. IgG
a. After RNA is copied from DNA template. d. IgM
b. After protein folding and unfolding on the ribosome. ANSWER: D
c. Before DNA is copied from DNA template.
d. After RNA is copied from protein on ribosomes. 6. Which of the following immunoglobulins is produced in the
ANSWER: A secondary immune response?
a. IgA
14. Translation of proteins from RNA takes place: b. IgE
a. On the ribosomes in the cytoplasm of the cell. c. IgG
b. On the nuclear membrane. d. IgM
c. Usually while attached to nuclear pores. ANSWER: C
d. Inside the nucleolus of the cell. 7. Which of the following MHC classes are found on
ANSWER: A antigen presenting cells?
a. Class I
15. Meiosis is necessary to: b. Class II
a. Keep the N number of the cell consistent within c. Class III
populations. d. Class IV
b. Prepare RNA for transcription. ANSWER: B
c. Generate new DNA sequences in daughter cells.
d. Stabilize proteins being translated on the ribosome. 8. Which of the following MHC classes encodes complement
ANSWER: C components?
a. Class I
CHAPTER 3 b. Class II
1. Which of the following is not involved in the acquired or adaptive c. Class III
immune response? d. Class IV
a. Phagocytosis ANSWER: C
b. Production of antibody or complement
c. Induction of immunologic memory 9. Which of the following immunoglobulins is most efficient at
d. Accelerated immune response upon subsequent exposure to binding complement?
antigen a. IgA
ANSWER: A b. IgE
c. IgG
d. IgM
ANSWER: D

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 17. Which of the following refers to a state of equilibrium in antigen-
10. Which portion of the immunoglobulin molecules antibody reactions?
contains complement binding sites? a. Postzone
a. Heavy chain variable region b. Prozone
b. Light chain variable region c. Zone of equivalence
c. Heavy chain constant region d. Endzone
d. Light chain constant region ANSWER: C
ANSWER: A
18. Which one of the following properties of antibodies is NOT
11. Which complement pathway is activated by the formation of dependent on the structure of the heavy chain constant region?
antigen-antibody complexes? a. Ability to cross the placenta
a. Classical b. Isotype (class)
b. Alternative c. Ability to fix complement
c. Lectin d. Affinity for antigen
d. Retro ANSWER: D
ANSWER: A
19. Molecules that promote the update of bacteria for
12. Which of the following is known as the “recognition phagocytosis are:
unit” in the classical complement pathway? a. Opsonins
a. C1q b. Cytokines
b. C3a c. Haptens
c. C4 d. Isotypes
d. C5 ANSWER: A
ANSWER: A
20. Select the term that describes the unique confirmation of the
antigen that allows recognition by a corresponding antibody:
13. Which of the following is known as the “membrane a. Immunogen
attack complex” in the classical complement pathway? b. Epitope
a. C1 c. Avidity
b. C3 d. Clone
c. C4, C2, C3 ANSWER: B
d. C5b, C6, C7, C8, C9
ANSWER: D 21. Which of the following terms refers to the net negative charge
surrounding red blood cells?
14. Which of the following immunoglobulin classes is a. Dielectric constant
capable of crossing the placenta and causing hemolytic b. Van der Waals forces
disease of the newborn? c. Hydrogen bonding
a. IgA d. Zeta potential
b. IgE ANSWER: D
c. IgG
d. IgM CHAPTER 4
ANSWER: D
1. The central dogma of molecular biology states that:
15. Which of the following refers to the effect of an excess amount a. DNA is the genetic material
of antigen present in a test system? b. RNA is the genetic material
a. Postzone c. DNA is translated to mRNA
b. Prozone d. Proteins are transcribed from mRNA
c. Zone of equivalence ANSWER: A
d. Endzone
ANSWER: A 2. Recombinant-DNA technology is possible because:
a. Restriction endonucleases cut RNA
16. Which of the following refers to the presence of an b. Restriction endonucleases cut proteins
excess amount of antibody present in a test system? c. The genetic code is universal
a. Postzone d. Bacteria are difficult to culture
b. Prozone ANSWER: C
c. Zone of equivalence
d. Endzone
ANSWER: B

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3. Agarose gel electrophoresis is a technique used for: 11. Transcription mediated amplification:
a. DNA synthesis a. Requires thermostable DNA polymerase
b. RNA synthesis b. Is an isothermal procedure
c. Separation of DNA molecules by size c. Is an obsolete method currently replaced by SSOP
d. Oligonucleotide synthesis d. Utilizes probes labeled with fluorescent tags
ANSWER: C ANSWER: B

4. Restriction fragment length polymorphism (RFLP) is 12. Preseroconversion window:

based on the use of the enzymes: a. Is the time when donors can be infected but do not
a. Reverse transcriptases yet test positive by serologic methods
b. Bacterial endonucleases b. May be narrowed by using molecular methods
c. DNA polymerases c. Refers mainly to viral pathogens
d. RNA polymerases d. All of the above
ANSWER: B ANSWER: D

5. The polymerase chain reaction (PCR): 13. Red blood cell molecular antigen typing is useful in all listed
a. Is carried out in vivo situations except:
b. Is used for peptide synthesis a. In screening RBC inventory for antigen-negative units
c. Requires RNA polymerase b. When reagent antibodies are weak or unavailable
d. Is used for the amplification of DNA c. In quantitative gene expression analysis
ANSWER: D d. When resolving ABO discrepancies
ANSWER: C
6. Plasmids are:
a. Vectors used for molecular cloning CHAPTER 5
b. Antibiotics
c. Enzymes 1. A principle of the antiglobulin test is:
d. Part of chromosomes a. IgG and C3d are required for RBC sensitization.
ANSWER: A b. Human globulin is eluted from RBCs during saline
washings.
7. Some model organisms: c. Injection of human globulin into an animal engenders
a. Simplify the study of human disease passive immunity.
b. Are used to produce recombinant proteins d. AHG reacts with human globulin molecules bound to
c. Are prokaryotes and some are eukaryotes RBCs or free in serum.
d. All of the above ANSWER: D
ANSWER: D
2. Polyspecific AHG reagent contains:
8. DNA sequencing: a. Anti-IgG.
a. Is more difficult than peptide sequencing b. Anti-IgG and anti-IgM.
b. Requires the use of RNA polymerase c. Anti-IgG and anti-C3d.
c. Can never be automated d. Anti-C3d.
d. Is an enzymatic in vitro reaction ANSWER: C
ANSWER: D
3. Monoclonal anti-C3d is:
9. RFLP and SSP are techniques used for: a. Derived from one clone of plasma cells.
a. Protein isolation b. Derived from multiple clones of plasma cells.
b. RNA isolation c. Derived from immunization of rabbits.
c. DNA typing d. Reactive with C3b and C3d.
d. Protein typing ANSWER: A
ANSWER: C
4. Which of the following is a clinically significant antibody whose
10. Recombinant DNA techniques: detection has been reported in some instances to be dependent on
a. Are not used in a clinical setting anticomplement activity in polyspecific AHG?
b. Are useful research tools a. Anti-Jka
c. Are not used in blood banking b. Anti-Lea
d. Are useful only for research c. Anti-P1
ANSWER: B d. Anti-H
ANSWER: A

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5. After the addition of IgG-coated RBCs (check cells) to a negative a. Type A-positive cells coated with anti-D
AHG reaction during an antibody screen, a b. Type A-negative cells coated with anti-D
negative result is observed. Which of the following is a c. Type O-positive cells coated with anti-D
correct interpretation? d. Type O-negative cells coated with anti-D
a. The antibody screen is negative. ANSWER: C
b. The antibody screen needs to be repeated.
c. The saline washings were adequate. 13. Which of the following methods requires the use of
d. Reactive AHG reagent was added. check cells?
ANSWER: B a. LISS
b. Gel
6. RBCs must be washed in saline at least three times before the c. Solid-phase
addition of AHG reagent to: d. Enzyme-linked
a. Wash away any hemolyzed cells ANSWER: A
b. Remove traces of free serum globulins
c. Neutralize any excess AHG reagent 14. Which factor can affect AHG testing, yet is uncontrollable in the
d. Increase the antibody binding to antigen lab?
ANSWER: B a. Temperature
b. Antibody affinity
7. An in vitro phenomenon associated with a positive c. Gravitational force in the centrifuge
IAT is: d. Incubation time
a. Maternal antibody coating fetal RBCs ANSWER: B
b. Patient antibody coating patient RBCs
c. Recipient antibody coating transfused donor RBCs
d. Identification of alloantibody specificity using a panel
of reagent RBCs 15. If you had the authority to decide which primary AHG
ANSWER: D methodology to utilize at your lab, which method would you choose
based on the knowledge that the majority of the staff are
8. False-positive DAT results are most often associated with: generalists?
a. Use of refrigerated, clotted blood samples in which a. LISS
complement components coat RBCs in vitro. b. Polybrene
b. A recipient of a recent transfusion manifesting an c. Solid phase or gel
immune response to recently transfused RBCs. d. Enzyme-linked
c. Presence of heterophile antibodies from administration of ANSWER: C
globulin.
d. A positive autocontrol caused by polyagglutination. 16. A 27-year-old group O mother has just given birth to a beautiful,
ANSWER: A group A baby girl. Since the mother has IgG
anti-A in her plasma, it is likely that the baby is experiencing some in
9. Polyethylene glycol enhances antigen-antibody reactions by: vivo red cell destruction. Which of the following methods and tests
a. Decreasing zeta potential. would be most effective at detecting the anti-A on the baby’s RBCs?
b. Concentrating antibody by removing water. a. DAT using common tube technique
c. Increasing antibody affinity for antigen. b. DAT using gel
d. Increasing antibody specificity for antigen. c. IAT using common tube technique
ANSWER: B d. IAT using gel
ANSWER: B
10. Solid-phase antibody screening is based on:
a. Adherence.
b. Agglutination. CHAPTER 6
c. Hemolysis.
d. Precipitation. 1. An ABO type on a patient gives the following reactions:
ANSWER: A Patient Cells With Patient Serum With
Anti-A Anti-B A1 cells B cells
11. A positive DAT may be found in which of the following situations? 4+ 4+ Neg Neg
a. A weak D-positive patient What is the patient’s blood type?
b. A patient with anti-K a. O
c. HDN b. A
d. An incompatible crossmatch c. B
ANSWER: C d. AB
ANSWER: D

12. What do Coombs’ control cells consist of?

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2. The major immunoglobulin class(es) of anti-B in a group A ANSWER: A
individual is (are):
a. IgM 9. An example of a technical error that can result in an
b. IgG ABO discrepancy is:
c. IgM and IgG a. Acquired B phenomenon.
d. IgM and IgA b. Missing isoagglutinins.
ANSWER: A c. Cell suspension that is too heavy.
d. Acriflavine antibodies.
3. What are the possible ABO phenotypes of the offspring from the ANSWER: C
mating of a group A to a group B individual?
a. O, A, B 10. An ABO type on a patient gives the following reactions:
b. A, B Patient Cells With Patient Serum With
c. A, B, AB Anti-A Anti-B A1 cells B cells O cells Autocontrol
d. O, A, B, AB 4+ Neg 2+ 4+ 2+ Neg
ANSWER: D These results are most likely due to:
a. ABO alloantibody.
4. The immunodominant sugar responsible for blood group A b. Non-ABO alloantibody.
specificity is: c. Rouleaux.
a. L-fucose d. Cold autoantibody
b. N-acetyl-D-galactosamine ANSWER: B
c. D-galactose
d. Uridine diphosphate-N-acetyl-D-galactose CHAPTER 7
ANSWER: B
1. The Rh system was first recognized in a case report of:
5. What ABH substance(s) would be found in the saliva of a group B a. A hemolytic transfusion reaction.
secretor? b. Hemolytic disease of the fetus and newborn.
a. H c. Circulatory overload.
b. H and A d. Autoimmune hemolytic anemia.
c. H and B ANSWER: A
d. H, A, and B
ANSWER: C 2. What antigen is found in 85% of the white population
and is always significant for transfusion purposes?
6. An ABO type on a patient gives the following reactions: a. d
Patient Cells With Patient Serum With b. c
Anti-A Anti-B Anti-A1 A1 cells B cells c. D
4+ 4+ Neg 2+ Neg d. E
The reactions above may be seen in a patient who is: ANSWER: C
a. A1 with acquired B
b. A2B with anti-A1 3. How are weaker-than-expected reactions with anti-D
c. AB with increased concentrations of protein in the typing reagents categorized?
serum a. Rhmod
d. AB with an autoantibody b. Weak D
ANSWER: B c. DAT positive
d. Dw
7. Which of the following ABO blood groups contains the least ANSWER: B
amount of H substance?
a. A1B 4. Cells carrying a weak-D antigen require the use of what test to
b. A2 demonstrate its presence?
c. B a. Indirect antiglobulin test
d. O b. Direct antiglobulin test
ANSWER: A c. Microplate test
d. Warm autoadsorption test
8. You are working on a specimen in the laboratory that ANSWER: A
you believe to be a Bombay phenotype. Which of the
following reactions would you expect to see? 5. How are Rh antigens inherited?
a. Patient’s cells + Ulex europaeus = no agglutination a. Autosomal recessive alleles
b. Patient’s cells + Ulex europaeus = agglutination b. Sex-linked genes
c. Patient’s serum + group O donor RBCs = no c. Codominant alleles
agglutination d. X-linked
d. Patient’s serum + A1 and B cells = no agglutination ANSWER: C

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 d. ryr
6. Biochemically speaking, what type of molecules are Rh antigens? R1r DCe/dce Rh:1,2,-3,4,5
a. Glycophorins R2R0 DcE/Dce Rh:1,-2,3,4,5
b. Simple sugars RzR1 DCE/DCe Rh:1,2,3,-4,5
c. Proteins ryr dCE/dce RH:-1,2,3,4,5
d. Lipids
ANSWER: C
14. Which Rh phenotype has the strongest expression of D?
7. Rh antibodies react best at what temperature (°C)? a. R1r
a. 22 b. R1R1
b. 18 c. R2R2
c. 15 d. D–
d. 37 ANSWER: D
ANSWER: D
15. Which of the following most commonly causes an
8. Rh antibodies are primarily of which immunoglobulin individual to type RhD positive yet possess anti-D?
class? a. Genetic weak D
a. IgA b. Partial D
b. IgM c. C in trans to RHD
c. IgG d. D epitopes on RhCE protein
d. IgD ANSWER: B
ANSWER: C
16. An individual has the following Rh phenotype:
9. Rh antibodies have been associated with which of the D+C+E+c+e+. Using Fisher-Race terminology, what is
following clinical conditions? their most likely Rh genotype?
a. Erythroblastosis fetalis a. DCE/Dce
b. Thrombocytopenia b. DCE/dce
c. Hemophilia A c. DCe/dcE
d. Stomatocytosis d. DCe/DcE
ANSWER: E ANSWER: D

17. Which of the following is the most common Rh phenotype in

10. What do Rhnull cells lack? African Americans?
a. Lewis antigens a. Dce/dce
b. Normal oxygen-carrying capacity b. DcE/dce
c. Rh antigens c. DCe/dce
d. MNSs antigens d. Dce/dC
ANSWER: C ANSWER: A

11. What antigen system is closely associated phenotypically with

Rh? CHAPTER 8
a. McCoy
b. Lutheran 1. The following phenotypes are written incorrectly
c. Duffy except for:
d. LW a. Jka+
ANSWER: C b. Jka+
c. Jka(+)
12. Anti-LW will not react with which of the following? d. Jk(a+)
a. Rh-positive RBCs ANSWER: D
b. Rh-negative RBCs
c. Rhnull RBCs 2. Which of the following characteristics best describes
d. Rh:33 RBCs Lewis antibodies?
ANSWER: C a. IgM, naturally occurring, cause HDFN
b. IgM, naturally occurring, do not cause HDFN
13. Convert the following genotypes from Wiener nomenclature to c. IgG, in vitro hemolysis, cause hemolytic transfusion
Fisher-Race and Rosenfield nomenclatures, and list the antigens reactions
present in each haplotype. d. IgG, in vitro hemolysis, do not cause hemolytic transfusion
a. R1r reactions
b. R2R0 ANSWER: B
c. RzR1

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3. The Le gene codes for a specific glycosyltransferase that transfers 10. Anti-LebH will not react or will react more weakly with which of
a fucose to the N-acetylglucosamine on: the following RBCs?
a. Type 1 precursor chain. a. Group O Le(b+)
b. Type 2 precursor chain. b. Group A2 Le(b+)
c. Types 1 and 2 precursor chain. c. Group A1 Le(b+)
d. Either type 1 or type 2 in any one individual but not d. None of the above
both. ANSWER: C
ANSWER: A
4. What substances would be found in the saliva of a 11. Which of the following best describes MN antigens and
group B secretor who also has Lele genes? antibodies?
a. H, Lea a. Well developed at birth, susceptible to enzymes,
b. H, B, Lea generally saline reactive
c. H, B, Lea, Leb b. Not well developed at birth, susceptible to enzymes,
d. H, B, Leb generally saline reactive
ANSWER: C c. Well developed at birth, not susceptible to enzymes,
generally saline reactive
5. Transformation to Leb phenotype after birth may be as follows: d. Well developed at birth, susceptible to enzymes,
a. Le(a–b–) to Le(a+b–) to Le(a+b+) to Le(a–b+) generally antiglobulin reactive
b. Le(a+b–) to Le(a–b–) to Le(a–b+) to Le(a+b+) ANSWER: A
c. Le(a–b+) to Le(a+b–) to Le(a+b+) to Le(a–b–)
d. Le(a+b+) to Le(a+b–) to Le(a–b–) to Le(a–b+) 12. Which autoantibody specificity is found in patients with
ANSWER: A paroxysmal cold hemoglobinuria?
a. Anti-I
6. In what way do the Lewis antigens change during b. Anti-i
pregnancy? c. Anti-P
a. Lea antigen increases only d. Anti-P1
b. Leb antigen increases only ANSWER: C
c. Lea and Leb both increase
d. Lea and Leb both decrease 13. Which of the following is the most common antibody seen in the
ANSWER: D blood bank after ABO and Rh antibodies?
a. Anti-Fya
7. A type 1 chain has: b. Anti-k
a. The terminal galactose in a 1-3 linkage to subterminal c. Anti-Jsa
N-acetylglucosamine. d. Anti-K
b. The terminal galactose in a 1-4 linkage to subterminal ANSWER: D
N-acetylglucosamine.
c. The terminal galactose in a 1-3 linkage to subterminal 14. Which blood group system is associated with resistance to P.
N-acetylgalactosamine. vivax malaria?
d. The terminal galactose in a 1-4 linkage to subterminal a. P
N-acetylgalactosamine. b. Kell
ANSWER: A c. Duffy
d. Kidd
8. Which of the following best describes Lewis antigens? ANSWER: C
a. The antigens are integral membrane glycolipids
b. Lea and Leb are antithetical antigens 15. The null Ko RBC can be artificially prepared by which
c. The Le(a+b–) phenotype is found in secretors of the following treatments?
d. None of the above a. Ficin and DTT
ANSWER: D b. Ficin and glycine-acid EDTA
c. DTT and glycine-acid EDTA
9. Which of the following genotypes would explain RBCs d. Glycine-acid EDTA and sialidase
typed as group A Le(a+b–)? ANSWER: C
a. A/O Lele HH Sese
b. A/A Lele HH sese 16. Which antibody does not fit with the others with respect to
c. A/O LeLe hh SeSe optimum phase of reactivity?
d. A/A LeLe hh sese a. Anti-S
ANSWER: B b. Anti-P1
c. Anti-Fya
d. Anti-Jkb
ANSWER: B

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17. Which of the following Duffy phenotypes is prevalent in blacks c. Jra
but virtually nonexistent in whites? d. Sda
a. Fy(a+b+) ANSWER: D
b. Fy(a–b+)
c. Fy(a–b–) 25. Which of the following has been associated with causing severe
d. Fy(a+b–) immediate HTRs?
ANSWER: C a. Anti-JMH
b. Anti-Lub
18. Antibody detection cells will not routinely detect which antibody c. Anti-Vel
specificity? d. Anti-Sda
a. Anti-M ANSWER: C
b. Anti-Kpa
c. Anti-Fya 26. Which of the following antibodies would more likely be found in
d. Anti-Lub a black patient?
ANSWER: B a. Anti-Cra
b. Anti-Ata
19. Antibodies to antigens in which of the following blood groups are c. Anti-Hy
known for showing dosage? d. All of the above
a. I ANSWER: D
b. P
c. Kidd 27. Which of the following antigens is not in a blood group system?
d. Lutheran a. Doa
ANSWER: C b. Vel
c. JMH
20. Which antibody is most commonly associated with d. Kx
delayed hemolytic transfusion reactions? ANSWER: B
a. Anti-s
b. Anti-k 28. A weakly reactive antibody with a titer of 128 is neutralized by
c. Anti-Lua plasma. Which of the following could be the specificity?
d. Anti-Jka a. Anti-JMH
ANSWER: D b. Anti-Ch
c. Anti-Kna
21. Anti-U will not react with which of the following RBCs? d. Anti-Kpa
a. M+N+S+s– ANSWER: B
b. M+N–S–s–
c. M–N+S–s+ 29. An antibody reacted with untreated RBCs and DTTtreated RBCs
d. M+N–S+s+ but not with ficin-treated RBCs. Which of the following antibodies
ANSWER: B could explain this pattern of
reactivity?
22. A patient with an M. pneumoniae infection will most a. Anti-JMH
likely develop a cold autoantibody with specificity to b. Anti-Yta
which antigen? c. Anti-Kpb
a. I d. Anti-Ch
b. i ANSWER: D
c. P
d. P1 30. The following antibodies are generally considered clinically
ANSWER: A insignificant because they have not been associated with causing
increased destruction of RBCs, HDFN, or HTRs.
23. Which antigen is destroyed by enzymes? a. Anti-Doa and anti-Coa
a. P1 b. Anti-Ge3 and anti-Wra
b. Jsa c. Anti-Ch and anti-Kna
c. Fya d. Anti-Dib and anti-Yt
d. Jka ANSWER: C
ANSWER: C

24. The antibody to this high-prevalence antigen demonstrates CHAPTER 9

mixed-field agglutination that appears shiny and refractile under the
microscope: 1. Based on the following phenotypes, which pair of cells would
a. Vel make the best screening cells?
b. JMH a. Cell 1: Group A, D+C+c–E–e+, K+, Fy(a+b–),

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Jk(a+b–), M+N–S+s– 6. Patient JM appears to have a warm autoantibody. She was
Cell 2: Group O, D+C–c+E+e–, K–, Fy(a–b+), transfused 2 weeks ago. What would be the next step performed to
Jk(a–b+), M–N+S–s+ identify any alloantibodies that might be in her serum?
b. Cell 1: Group O, D–C–c+E–e+, K–, Fy(a–b+), a. Acid elution
Jk(a+b+), M+N–S+s+ b. Warm autoadsorption using autologous cells
Cell 2: Group O, D+C+c–E–e+, K–, Fy(a+b–), c. Warm differential adsorption
Jk(a+b–), M–N+S–s+ d. RESt™ adsorption
c. Cell 1: Group O, D+C+c+E+e+, K+, Fy(a+b+), ANSWER: C
Jk(a+b+), M+N–S+s+
Cell 2: Group O, D–C–c+E–e+, K–, Fy(a+b–), 7. What is the titer and score for this prenatal anti-D titer? (Refer to
Jk(a+b+), M+N+S–s+ Figure 9–20.)
d. Cell 1: Group O, D+C+c–E–e+, K+, Fy(a–b+), a. Titer = 64; score = 52
Jk(a–b+), M–N+S–s+ b. Titer = 1:32; score = 15
Cell 2: Group O, D- C–c+E+e–, K–, Fy(a+b–), c. Titer = 64; score = 21
Jk(a+b–), M+N–S+s– d. Titer = 32; score = 52
ANSWER: D ANSWER: D

2. Antibodies are excluded using RBCs that are homozygous for the For Questions 8 through 10, refer to Figure 9–21.
corresponding antigen because: 8. Select the antibody(ies) most likely responsible for the reactions
a. Antibodies may show dosage observed:
b. Multiple antibodies may be present a. Anti-E and anti-K
c. It results in a P value of .05 for proper identification b. Anti-Fya
of the antibody c. Anti-e
d. All of the above d. Anti-Jkb
ANSWER: A ANSWER: A

3. A request for 8 units of packed RBCs was received for 9. What additional cells need to be tested to be 95% confident that
patient LF. The patient has a negative antibody screen, the identification is correct?
but one of the 8 units was 3+ incompatible at the AHG a. Three e-negative cells that react negatively and one
phase. Which of the following antibodies may be the additional e-positive cell that reacts positively
cause? b. One additional E-positive cell to react positively and
a. Anti-K one additional K-positive cell to react positively
b. Anti-Lea c. Two Jkb homozygous positive cells to react positively and one Jkb
c. Anti-Kpa heterozygous positive cell to react
d. Anti-Fyb negatively
ANSWER: C d. No additional cells are needed
ANSWER: B
4. The physician has requested 2 units of RBCs for patient DB, who
has two antibodies, anti-L and anti-Q. The frequency of antigen L is 10. Using the panel in Figure 9–21, select cells that would make
45%, and the frequency of antigen Q is 70% in the donor population. appropriate controls when typing for the C antigen.
Approximately how many units will need to be antigen-typed for L a. Cell number 1 for the positive control and cell number 2 for the
and Q to fill the request? negative control
a. 8 b. Cell number 1 for the positive control and cell number 6 for the
b. 12 negative control
c. 2 c. Cell number 2 for the positive control and cell number 4 for the
d. 7 negative control
ANSWER: B d. Cell number 4 for the positive control and cell number 5 for the
negative control
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
ANSWER: C

ANSWER: C

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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
ANSWER: B
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
ANSWER: D
13. An antibody demonstrates weak reactivity at the AHG phase
when using a tube method 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
ANSWER: A
CHAPTER 10
1. Pretransfusion testing:
a. Proves that the donor’s plasma is free of all irregular
antibodies
b. Detects most irregular antibodies on the donor’s RBCs that are
reactive with patient’s serum
c. Detects most errors in the ABO groupings
d. Ensures complete safety of the transfusion
ANSWER: C
2. Which is not true of rouleaux formation?
a. It is a stacking of RBCs to form aggregates.
b. It can usually be dispersed by adding saline.
c. It can appear as an ABO incompatibility.
d. It cannot cause a false-positive immediate spin
crossmatch.
ANSWER: D
3. What type of blood should be given in an emergency
transfusion when there is no time to type the recipient’s
sample?
a. O Rh0 (D)-negative, whole blood
b. O Rh0 (D)-positive, whole blood
c. O Rh0 (D)-positive, packed cells
d. O Rh0 (D)-negative, packed cells
ANSWER: D
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4. A patient developed an anti-Jka antibody 5 years ago. The
antibody screen is currently negative. To obtain suitable blood for
transfusion, which procedures apply?
a. Type the patient for the Jkb antigen as an added part to the
crossmatch procedure.
b. Crossmatch random donors with the patient’s serum,
and release the compatible units for transfusion to the
patient.
c. Type the patient and donor units for the Jka antigen,
and then crossmatch the Jka negative units with the
patient serum.
d. Computer-crossmatch Jka negative donor units.
ANSWER: C
5. A 26-year-old B Rh0 (D)-negative female patient requires a
transfusion. No B Rh0 (D)-negative donor units are available. Which
should be chosen for transfusion?
a. B Rh0 (D)-positive RBCs
b. O Rh0 (D)-negative RBCs
c. AB Rh0 (D)-negative RBCs
d. A Rh0 (D)-negative RBCs
ANSWER: B
6. Having checked the patient’s prior history after having received
the specimen and request, you:
a. Do not have to repeat the ABO and Rh if the name and hospital
number agree
b. Do not have to repeat the indirect antiglobulin test
(IAT) if the previous IAT was negative
c. Have to perform a crossmatch only if one has not been done
within the last 2 weeks
d. Have to compare the results of your ABO, Rh, and IAT
with the previous results
ANSWER: D
7. The purpose of the immediate spin crossmatch is to:
a. Ensure survival of transfused RBCs
b. Determine ABO compatibility between donor and
recipient
c. Detect cold-reacting unexpected antibodies
d. Meet computer crossmatch requirements
ANSWER: B
8. Which does not represent requirements set forth by the AABB for
the performance of a computer crossmatch?
a. Computer system must be validated on-site.
b. Recipient antibody screen must be positive.
c. Two determinations of the recipient ABO and Rh
must be performed.
d. Computer system must have logic.
ANSWER: B
9. You have just received a request and sample for pretransfusion
testing. Which is the most appropriate to do first?
a. Perform the ABO grouping and Rh typing
b. Complete the crossmatch
c. Perform the IAT to see if the patient is going to be a
problem
d. Check the records for prior type and screen results
on the patient
ANSWER: D b. Technologist enters results of patient A testing into
patient B field
10. Blood donor and recipient samples used in crossmatching must c. Wrong RBC unit is tagged for transfusion
be stored for a minimum of how many days following transfusion? d. Antibody below detectable levels during pretransfusion
a. 2 testing
b. 5 ANSWER: D
c. 7
d. 10
ANSWER: C CHAPTER 11

11. Which is true regarding compatibility testing for the infant 1. What is the shipping temperature requirement for
younger than 4 months old? plasma?
a. A DAT is required. a. 1°F to 6°F or higher
b. A crossmatch is not needed with the infant’s blood b. 1°C to 6°C or lower
when unexpected antibodies are present. c. 18°F or higher
c. Maternal serum cannot be used for antibody d. 18°C or lower
detection. ANSWER: D
d. To determine the infant’s ABO group, RBCs must be
tested with reagent anti-A, anti-B, and anti-A,B. 2. Antibody serial titration studies are most often associated
ANSWER: B with which of the following blood bank test groupings?
a. Prenatal evaluation
12. A nurse just called to request additional RBC units for a patient b. Type and screen
for whom you performed compatibility testing 4 days ago. She would c. Type and crossmatch
like you to use the original specimen, as you keep it for 7 days d. Blood unit processing
anyway. Your most appropriate course of action would be to: ANSWER: A
a. Check to see if there is enough of the original
specimen 3. The prewarm technique is most useful in investigating which types
b. Perform the compatibility testing on the original of blood bank problems?
specimen a. ABO discrepancies
c. Request more information in case the patient has developed a b. Rh discrepancies
clinically significant unexpected antibody c. Warm antibodies
d. Indicate that a new specimen is necessary because the patient has d. Cold antibodies
been recently transfused ANSWER: D
ANSWER: D
4. It is most important to perform weak-D testing in which of the
13. A crossmatch is positive at AHG phase with polyspecific AHG following blood bank test groupings?
reagent but is negative with monospecific anti-IgG AHG reagent. This a. Type and screen
may indicate the antibody: b. Type and crossmatch
a. Is a weak anti-D c. Cord blood evaluation
b. Is a clinically insignificant Lewis antibody d. Prenatal evaluation
c. Can cause decreased survival of transfused RBCs ANSWER: C
d. Is a Duffy antibody
ANSWER: B 5. Which of the following is a method for determining
approximate volume of fetal-maternal bleed?
14. The emergency room requests 6 units of packed RBCs for a a. Kleihauer-Betke test
trauma patient prior to collection of the patient’s specimen. The b. Eluate testing
most appropriate course of action is to: c. Nucleic acid amplification testing
a. Release group O RBCs to ER with trauma patient d. Antibody screening
identification on each unit sent ANSWER: A
b. Refuse to release units until you get a patient sample
c. Indicate necessity for signed patient waiver for 6. Which of the following may not be used as a patient
incomplete pretransfusion testing identifier?
d. Explain need of patient’s ABO group prior to issuing a. Patient’s full name
blood b. Patient’s date of birth
ANSWER: A c. Patient’s medical record number
d. Patient’s room number
15. Which is not an example of the most common form of error ANSWER: D
associated with fatal transfusion reactions?
a. Phlebotomist labels patient A tubes with patient B
information

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7. Which of the following is not an enhancement media that may be 7. The endpoint of the luminex assay is change of:
used in antibody screening and identification? a. Electrical charge on the RBCs
a. Albumin b. Color of the liquid substrate
b. Low ionic strength solution (LISS) c. Color of indicator on beads
c. Normal saline d. Density of the indicator substrate
d. Polyethylene glycol ANSWER: C
ANSWER: C
8. An advantage for both gel and solid-phase technology is:
8. Which of the following methods may be useful in a. No cell washing steps
investigating a positive DAT? b. Standardization
a. Elution techniques c. Use of IgG-coated control cells
b. Removal of cell-bound antibody using chloroquine d. Specialized equipment
diphosphate ANSWER: B
c. Drug studies
d. All of the above 9. A disadvantage for both gel and solid-phase technology is:
ANSWER: D a. Decreased sensitivity
b. Inability to test hemolyzed, lipemic, or icteric samples
CHAPTER 12 c. Inability to detect C3d complement–coated cells
d. Large sample requirement
1. The endpoint of the gel test is detected by: ANSWER: C
a. Agglutination
b. Hemolysis 10. A safety feature in the SPRCA test is:
c. Precipitation a. Air bubble barrier
d. Attachment of indicator cells b. Viscous barrier
ANSWER: A c. Color change of the LISS
d. Use of IgG-coated control cells
2. The endpoint of the SPRCA test is detected by: ANSWER: C
a. Agglutination
b. Hemolysis CHAPTER 13
c. Precipitation
d. Attachment of indicator cells 1. Which of the following information is not required for
ANSWER: D whole blood donors?
a. Name
3. The endpoint of the solid-phase protein A assay is: b. Address
a. Agglutination c. Occupation
b. Hemolysis d. Sex
c. Precipitation e. Date of birth
d. Attachment of cells to microwell ANSWER: C
ANSWER: D
2. Which of the following would be cause for deferral?
4. Protein A captures antibodies by binding to: a. Temperature of 99.2°F
a. Fab portion of immunoglobulin b. Pulse of 90 beats per minute
b. Fc portion of immunoglobulin c. Blood pressure of 110/70 mm Hg
c. Surface of test cells d. Hematocrit level of 37%
d. Surface of indicator cells e. None of the above
ANSWER: B ANSWER: D

5. The endpoint of the solid-phase immunosorbent assay (ELISA) is: 3. Which of the following would be cause for permanent deferral?
a. Agglutination a. History of hepatitis after 11th birthday
b. Hemolysis b. Positive hepatitis C test result
c. Color change in the substrate c. Positive HTLV-I antibody
d. Attachment of indicator cells d. Positive anti-HBc test result
ANSWER: C e. All of the above
ANSWER: E
6. Mixed-field reactions can be observed in:
a. Gel 4. Immunization for rubella would result in a temporary
b. SPRCA deferral for:
c. Protein A technology a. 4 weeks
d. Luminex b. 8 weeks
ANSWER: A c. 6 months

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d. 1 year 11. How does irradiation affect the shelf-life of red blood cells?
e. no deferral required a. Irradiation has no effect on the shelf-life.
ANSWER: A b. The expiration date is 28 days from the date of irradiation or the
original outdate, whichever is later.
5. Which of the following donors is acceptable? c. The expiration date is 28 days from the date of irradiation or the
a. Donor who had a first-trimester therapeutic abortion original outdate, whichever is sooner.
4 weeks ago d. The expiration date is 25 days from the date of irradiation or the
b. Donor whose husband is a hemophiliac who regularly original outdate, whichever is later.
received cryoprecipitate before 1989 e. The expiration date is 25 days from the date of irradiation or the
c. Donor who was treated for gonorrhea 6 months ago original outdate, whichever is sooner.
d. Donor who had a needlestick injury 10 months ago ANSWER: A
ANSWER: A
12. Once thawed, FFP must be transfused within:
6. Which of the following tests is not required as part of the donor a. 4 hours
processing procedure for allogeneic donation? b. 6 hours
a. ABO c. 8 hours
b. Rh d. 12 hours
c. STS e. 24 hours
d. Anti-HTLV I ANSWER: E
e. Anti-CMV
ANSWER: E 13. Quality control for RBCs requires a maximum hematocrit level of:
a. 75%
7. Which of the following lists the correct shelf-life for the b. 80%
component? c. 85%
a. Deglycerolized RBCs—24 hours d. 90%
b. RBCs (CPD)—35 days e. 95%
c. Platelet concentrate—7 days ANSWER: B
d. FFP—5 years
e. RBCs (CPDA-1)—21 days 14. AHF concentrates are used to treat:
ANSWER: A a. Thrombocytopenia
b. Hemophilia A
8. Each unit of cryoprecipitate prepared from whole blood should c. Hemophilia B
contain approximately how many units of AHF activity? d. von Willebrand disease
a. 40 IU e. Factor XIII deficiency
b. 80 IU ANSWER: B
c. 120 IU
d. 160 IU 15. Prothrombin complex concentrates are used to treat which of
e. 180 IU the following?
ANSWER: B a. actor IX deficiency
b. Factor VIII deficiency
9. Platelet concentrates prepared by apheresis should contain how c. Factor XII deficiency
many platelets? d. Factor XIII deficiency
a. 5.5 × 1010 e. Factor V deficiency
b. 6 × 1010 ANSWER: A
c. 3 × 1011
d. 5.5 × 1011 16. How is the antibody screen test different for donors than for
e. 6 × 1011 patients?
ANSWER: C a. In donors, a 2-cell screen is used.
10. The required storage temperature for frozen RBCs using the high- b. In donors, a 3-cell screen is used.
glycerol method is: c. In donors, a pooled cell is used.
a. 4°C d. There is no difference in testing.
b. –20°C ANSWER: D
c. –18°C
d. –120°C 17. RBCs that have been leukoreduced must contain less than
e. –65°C ______ and retain at least ______ of original
ANSWER: E RBCs.
a. 8 × 106/85%
b. 8 × 106/90%
c. 5 × 106/85%
d. 5 × 106/80%

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ANSWER: C
5. The replacement fluid indicated during plasma exchange for TTP
18. Random-donor platelets that have been leukoreduced must is:
contain less than ______ leukocytes. a. Normal (0.9%) saline.
a. 8.3 × 105 b. Hydroxyethyl starch (HES).
b. 8 × 106 c. FFP.
c. 5 × 106 d. Albumin (human) 5%.
d. 3 × 1011 ANSWER: C
ANSWER: A
6. The most common adverse effect of plateletpheresis
19. A single unit of FFP or PF24 should contain ______ mL of plasma. collection is:
a. 100–150 a. Allergic reaction.
b. 200–400 b. Hepatitis.
c. 150–250 c. Hemolysis.
d. 50–150 d. Citrate effect.
ANSWER: C ANSWER: D

20. Cryoprecipitate that has been pooled must be transfused within 7. Apheresis technology can be used to collect each of the following
______ hours. components except:
a. 24 a. Leukocytes.
b. 6 b. Macrophages.
c. 4 c. Hematopoietic progenitor cells.
d. 8 d. Platelets.
ANSWER: C ANSWER: B

CHAPTER 14 8. The anticoagulant added to blood as it is removed

from a donor or patient during an apheresis procedure
1. The most common anticoagulant used for apheresis acts by:
procedures is: a. Binding calcium ions.
a. Heparin. b. Increasing intracellular potassium.
b. Sodium fluoride. c. Binding to antithrombin III.
c. Warfarin. d. Inactivating factor V.
d. Citrate. ANSWER: A
ANSWER: D
9. Peripheral blood stem cells are:
2. Therapeutic cytapheresis has a primary role in treatment of a. Responsible for phagocytosis of bacteria.
patients with: b. Removed during erythrocytapheresis.
a. Sickle cell disease and acute chest syndrome. c. Pluripotential hematopoietic precursors that circulate
b. Systemic lupus erythematosus to remove immune in the peripheral blood.
complexes. d. Lymphocytes involved with the immune response.
c. Leukemia to help increase granulocyte production. ANSWER: C
d. Myasthenia gravis to increase antibody production.
ANSWER: A 10. Which of the following can be given to an apheresis donor
to increase the number of circulating granulocytes?
3. The minimum interval allowed between plateletpheresis a. DDAVP
component collection procedures is: b. Hydroxyethyl starch (HES)
a. 1 day. c. Immune globulin
b. 2 days. d. G-CSF
c. 7 days. ANSWER: D
d. 8 weeks.
ANSWER: B CHAPTER 15

4. In plasma exchange, the therapeutic effectiveness is: 1. Leukocyte-reduced filters can do all of the following
a. Greatest with the first plasma volume removed except:
b. Affected by the type of replacement fluid used a. Reduce the risk of CMV infection
c. Enhanced if the unwanted antibody is IgG rather b. Prevent or reduce the risk of HLA alloimmunization
than IgM c. Prevent febrile, nonhemolytic transfusion reactions
d. Independent of the use of concomitant immunosuppressive d. Prevent TA-GVHD
therapy ANSWER: D
ANSWER: A

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2. Albumin should not be given for: d. Plasma
a. Burns ANSWER: D
b. Shock
c. Nutrition 10. Which fluid should be used to dilute RBCs?
d. Plasmapheresis a. 0.9% saline
ANSWER: C b. 5% dextrose and water
c. Immune globulin
3. Of the following, which blood type is selected when a d. Lactated Ringers solution
patient cannot wait for ABO-matched RBCs? ANSWER: A
a. A
b. B
c. O CHAPTER 16
d. AB
ANSWER: C 1. What component is most frequently involved with
transfusion-associated sepsis?
4. Which patient does not need an irradiated component? a. Plasma
a. Bone marrow transplant recipient b. Packed red blood cells
b. Neonate weighing less than 1,200 g c. Platelets
c. Adult receiving an RBC transfusion d. Whole blood
d. Adult receiving an RBC transfusion from a blood ANSWER: C
relative
ANSWER: C 2. Fatal transfusion reactions are mostly caused by?
a. Serologic errors
5. RBC transfusions should be given: b. Improper storage of blood
a. Within 4 hours c. Clerical errors
b. With lactated Ringer’s solution d. Improper handling of the product
c. With dextrose and water ANSWER: C
d. With cryoprecipitate
ANSWER: A 3. Early manifestation of an acute hemolytic transfusion
reaction can be confused with?
6. Which type of transplantation requires all cellular blood a. Allergic reaction
components to be irradiated? b. Febrile nonhemolytic reaction
a. Bone marrow c. Anaphylactic shock
b. Heart d. Sepsis
c. Liver ANSWER: B
d. Kidney
ANSWER: A 4. Pain at infusion site and hypotension are observed with what type
of reaction?
7. Characteristics of deglycerolized RBCs include the a. Delayed hemolytic transfusion reaction
following except: b. Acute hemolytic transfusion reaction
a. Inexpensive c. Allergic reaction
b. 24-hour expiration date after thawing d. Febrile nonhemolytic reaction
c. Used for rare antigen-type donor blood ANSWER: B
d. Used for IgA-deficient recipient with history of severe
reaction 5. Irradiation of blood is performed to prevent?
ANSWER: A a. Febrile nonhemolytic transfusion reaction
b. Delayed hemolytic transfusion reaction
8. Select the appropriate product for a bone marrow transplant c. Transfusion-associated graft-versus-host disease
patient with anemia: d. Transfusion-associated circulatory overload
a. BCs ANSWER: C
b. Irradiated RBCs
c. Leukoreduced RBCs 6. The only presenting sign most often accompanying a
d. Washed RBCs delayed hemolytic transfusion reaction is?
ANSWER: B a. Renal failure
b. Unexplained decrease in hemoglobin
9. Which blood product should be selected for vitamin K c. Active bleeding
deficiency? d. Hives
a. Cryoprecipitate ANSWER: B
b. Factor VIII
c. Factor IX

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7. Which transfusion reaction presents with fever, maculopapular 14. TRALI presents with the following symptoms:
rash, watery diarrhea, abnormal liver function and pancytopenia? a. Respiratory distress
a. Transfusion-associated sepsis b. Severe hypoxemia and hypotension
b. Transfusion-related acute lung injury c. Fever
c. Transfusion-associated graft-versus-host disease d. All of the above
d. Transfusion-associated allergic reaction ANSWER: D
ANSWER: C
15. Which of the following is characteristic of iron overload?
8. A suspected transfusion-related death must be a. Delayed, nonimmune complication
reported to? b. Chelating agents are used
a. AABB c. Multiorgan damage may occur
b. Federal and Drug Administration (FDA) d. All of the above
c. College of American Pathologists (CAP) ANSWER: D
d. The Joint Commission (TJC)
ANSWER: B
CHAPTER 17
9. Nonimmune hemolysis can be caused during transfusion by:
a. Use of small bore size needle. 1. Which of the following terms describe an HPC transplant
b. Use of an infusion pump. where the donor and recipient may be unrelated?
c. Improper use of a blood warmer. a. Allogeneic
d. All of the above b. Autologous
ANSWER: D c. Syngeneic
d. Hematopoietic
ANSWER: A
10. Transfusion reactions are classified according to:
a. Signs or symptoms presenting during or after 2. Stem cells from HPC donors may be mobilized with:
24 hours. a. Plerixafor.
b. Immune or nonimmune. b. Granulocyte colony-stimulating factor (G-CSF).
c. Infectious or noninfectious. c. Chemotherapy.
d. All of the above d. All of the above
ANSWER: D ANSWER: E

11. With febrile nonhemolytic transfusion reactions: 3. Which choice is an advantage of an HPC transplant using
a. They are self-limited. umbilical cord blood?
b. Fever resolves within 2 to 3 hours. a. Recipient weight of no concern
c. Treatment is required. b. Donor screening and testing abbreviated
d. A and B are correct c. Higher risk of GVHD
e. All of the above d. No significant risk to the donor or mother
ANSWER: D ANSWER: D

12. Absolute IgA deficiency is a classic example of a severe 4. Graft-versus-host disease (GVHD) is primarily caused by:
allergic reaction. Results indicating an absolute IgA a. Neutrophils.
deficiency: b. T lymphocytes.
a. < 0.05 mg/dL c. B lymphocytes.
b. < 0.50 mg/dL d. Monocytes.
c. < 0.50 gm/dL ANSWER: B
d. < 5 mg/dL
ANSWER: A 5. The minimum number of CD34+ cells required in an
HPC-apheresis collection to ensure timely engraftment is:
13. How are mild allergic transfusion reactions with isolated a. 2 × 102 CD34+ cells/kg.
symptoms or hives and urticaria treated? b. 2 × 104 CD34+ cells/kg.
a. Transfusion is stopped and transfusion reaction c. 2 × 106 CD34+ cells/kg.
workup is initiated. d. 2 × 108 CD34+ cells/kg.
b. Transfusion is stopped and antihistamines administrated; when ANSWER: C
symptoms improve, transfusion is
restarted. 6. The mother of a cord blood donor is tested for:
c. Stop transfusion and prepare washed red cells. a. ABO.
d. Continue transfusion with a slower infusion rate. b. HIV.
ANSWER: B c. Antibody screen.
d. All of the above

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ANSWER: D 2. Which of the following is the component of choice for a
low-birth-weight infant with a hemoglobin of 8 g/dL if
7. The cellular marker used to quantify the collection of the mother is anti-CMV negative?
HPCs is: a. Whole blood from a donor with anti-CMV
a. CD4. b. RBCs from a donor who is anti-CMV negative
b. CD33. c. Leukoreduced platelets
c. CD34. d. Solvent detergent–treated plasma
d. CD59. ANSWER: B
ANSWER: C
3. Which of the following tests is useful to confirm that a
8. The recommended dose of gamma radiation administered patient or donor is infected with HCV?
to a blood product to reduce the risk of graft-versus-host a. ALT + anti-HBc
disease is: b. Anti-HIV 1/2
a. 1,500 cGy to any point within the canister. c. Lymph node biopsy
b. 1,500 cGy to the midplane of the canister. d. RIBA
c. 2,500 cGy to the midplane of the canister. ANSWER: D
d. 2,500 cGy to any point within the canister.
ANSWER: C 4. Currently, which of the following does the AABB consider
to be the most significant infectious threat from transfusion?
9. During HPC processing, cultures must be performed: a. Bacterial contamination
a. At initial testing. b. CMV
b. Before freezing. c. Hepatitis
c. After thawing. d. HIV
d. After infusion. ANSWER: A
ANSWER: C
5. Which of the following is the most frequently transmitted
10. HPC products are required to be tested for: virus from mother to fetus?
a. Hepatitis C. a. HIV
b. Epstein-Barr virus. b. Hepatitis
c. Variant CJD. c. CMV
d. Herpes simplex virus. d. EBV
ANSWER: A ANSWER: C

11. Which of the following terms describe an HPC transplant where 6. Jaundice due to HAV is seen most often in the:
donor and recipient are the same person? a. Adolescent.
a. Allogeneic b. Adult.
b. Autologous c. Child younger than 6 years old.
c. Syngeneic d. Newborn.
d. Hematopoietic ANSWER: B
ANSWER: B
7. Currently, steps taken to reduce transfusion-transmitted
12. Which of the following terms describe an HPC transplant where CMV include:
donor and recipient are identical twins? a. Plaque reduction neutralization test.
a. Allogeneic b. NAT testing.
b. Autologous c. Leukoreduction.
c. Syngeneic d. Minipool screening.
d. Hematopoietic ANSWER: C
ANSWER: C
8. HBV remains infectious on environmental surfaces for 1:
CHAPTER 18 a. Day.
b. Week.
1. The fecal-oral route is common in transmitting which of c. Month.
these hepatitis viruses? d. Year.
a. HAV ANSWER: B
b. HBV
c. HDV 9. HBV is transmitted most frequently:
d. HCV a. By needle sharing among IV drug users.
ANSWER: A b. Through blood transfusions.
c. By unknown methods
d. By sexual activity

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ANSWER: D 17. Transient aplastic crisis can occur with:
a. Parvovirus B19.
10. Which of the following is the most common cause of b. WNV.
chronic hepatitis, cirrhosis, and hepatocellular carcinoma in the c. CMV.
United States? d. EBV.
a. HAV ANSWER: A
b. HBV
c. HCV 18. Reasons why syphilis is so rare in the United States
d. HDV blood supply include all of the following except:
ANSWER: C a. 4°C storage conditions.
b. Donor questionnaire.
11. The first retrovirus to be associated with human disease c. Short spirochetemia.
was: d. NAT testing.
a. HCV ANSWER: D
b. HIV
c. HTLV-I 19. Nucleic acid amplification testing for HIV was instituted
d. WNV in donor testing protocols to:
ANSWER: C a. Identify donors with late-stage HIV who lack antibodies.
b. Confirm the presence of anti-HIV in asymptomatic
12. All of the following statements are true concerning HIV-infected donors.
WNV except: c. Reduce the window period by detecting the virus
a. 1 in 150 infections results in severe neurologic earlier than other available tests.
disease. d. Detect antibodies to specific HIV viral proteins,
b. Severe disease occurs most frequently in the over-50 including anti-p24, anti-gp41, and anti-gp120.
age group. ANSWER: C
c. Deaths occur more often in those over 65 years who
present with encephalitis. 20. Screening for HIV is performed using the following
d. Fatalities occur in approximately 38% of infected technique:
individuals. a. Radio immunoassay
ANSWER: D b. WB
c. Immunofluorescent antibody assay
13. The primary host for WNV is: d. NAT
a. Birds. ANSWER: D
b. Horses.
c. Humans. 21. The first form of pathogen inactivation was:
d. Bats. a. Chemical.
ANSWER: A b. Heat.
c. Cold-ethanol fractionation.
14. Tests for WNV include all of the following except: d. Anion-exchange chromatography.
a. ELISA. ANSWER: B
b. NAT.
c. Plaque reduction neutralization test. 22. What is the most common parasitic complication of
d. Immunofluorescent antibody assay. transfusion?
ANSWER: D a. Babesia microti
b. Trypanosoma cruzi
15. Individuals exposed to EBV maintain an asymptomatic c. Plasmodium species
latent infection in: d. Toxoplasma gondii
a. B cells. ANSWER: C
b. T cells.
c. All lymphocytes. 23. Which organism has a characteristic C- or U-shape on
d. Monocytes. stained blood smears?
ANSWER: A a. Trypanosoma cruzi
b. Plasmodium vivax
16. Fifth disease is caused by: c. Plasmodium falciparum
a. CMV. d. Babesia microti
b. EBV. ANSWER: A
c. Parvovirus B19.
d. HTLV-II.
ANSWER: C

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24. Which transfusion-associated parasite may have asymptomatic 7. RhIG is indicated for:
carriers? a. Mothers who have anti-D.
a. Babesia microti b. Infants who are Rh-negative.
b. Trypanosoma cruzi c. Infants who have anti-D.
c. Plasmodium species d. Mothers who are Rh-negative.
d. All of the above ANSWER: D
ANSWER: D
8. RhIG is given without regard for fetal Rh type in all of
25. Which disease is naturally caused by the bite of a deer tick? the following conditions except:
a. Chagas’ disease a. Ectopic pregnancy rupture.
b. Babesiosis b. Amniocentesis.
c. Malaria c. Induced abortion.
d. Leishmaniasis d. Full-term delivery.
ANSWER: B ANSWER: D

CHAPTER 19 9. A Kleihauer-Betke test or flow cytometry indicates

10 fetal cells per 1,000 adult cells. For a woman with
1. HDFN is characterized by: 5,000 mL blood volume, the proper dose of RhIG is:
a. IgM antibody. a. One regular-dose vial.
b. Nearly always anti-D. b. Two regular-dose vials, plus one.
c. Different RBC antigens between mother and father. c. One regular-dose vial, plus one.
d. Antibody titer less than 32. d. Two microdose vials.
ANSWER: C ANSWER: B

2. The main difference between the fetus and the newborn is: 10. RhIG is indicated in which of the following circumstances?
a. Bilirubin metabolism. a. Mother D-positive, infant D-positive
b. Maternal antibody level. b. Mother D-negative, infant D-positive
c. Presence of anemia. c. Mother D-positive, infant D-negative
d. Size of RBCs. d. Mother D-negative, infant D-negative
ANSWER: A ANSWER: B

3. Kernicterus is caused by the effects of: 11. ABO HDFN is usually mild because:
a. Anemia. a. ABO antigens are poorly developed in the fetus.
b. Unconjugated bilirubin. b. ABO antibodies prevent the disease.
c. Antibody specificity. c. ABO antibodies readily cross the placenta.
d. Antibody titer. d. ABO incompatibility is rare.
ANSWER: B ANSWER: A

4. The advantages of cordocentesis include all of the following 12. A woman without prenatal care delivers a healthy
except: term infant. A cord blood sample shows the infant is
a. Allows measurement of fetal hemoglobin and hematocrit levels A-positive with a positive DAT. The workup of the
b. Allows antigen typing of fetal blood unexpected finding should include:
c. Allows direct transfusion of fetal circulation a. Anti-C3 antiglobulin test.
d. Decreases risk of trauma to the placenta b. ABO testing of the mother.
ANSWER: D c. Direct antiglobulin testing of the mother’s specimen.
d. ABO and Rh typing of the father.
5. Middle cerebral artery-peak systolic velocity is used to: ANSWER: C
a. Measure bilirubin.
b. Determine fetal blood type.
c. Determine change in optical density. CHAPTER 20
d. Assess for anemia.
ANSWER: D 1. Immune hemolytic anemias may be classified in which
of the following categories?
6. Blood for intrauterine transfusion should be all of the a. Alloimmune
following except: b. Autoimmune
a. More than 7 days old. c. Drug-induced
b. Screened for CMV. d. All of the above
c. Gamma-irradiated. ANSWER: D
d. Compatible with maternal serum.
ANSWER: A

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2. When preparing cells for a cold autoadsorption procedure, it is 9. Many warm reactive autoantibodies have a broad specificity
helpful to pretreat the cells with which of the within which of the following blood groups?
following? a. Kell
a. Dithiothreitol b. Duffy
b. Ficin c. Rh
c. Phosphate-buffered saline at pH 9 d. Kidd
d. Bovine albumin ANSWER: C
ANSWER: B
10. Valid Rh typing can usually be obtained on a patient
3. The blood group involved in the autoantibody specificity with WAIHA using all of the following reagents or
in PCH is: techniques except:
a. P a. Slide and modified tube anti-D
b. ABO b. Chloroquine-treated RBCs
c. Rh c. Rosette test
d. Lewis d. Monoclonal anti-D
ANSWER: A ANSWER: A

4. Which of the following blood groups reacts best with an 11. In pretransfusion testing for a patient with WAIHA, the
anti-H or anti-IH? primary concern is:
a. O a. Treating the patient’s cells with chloroquine for
b. B reliable antigen typing
c. A2 b. Adsorbing out all antibodies in the patient’s serum to
d. A1 be able to provide compatible RBCs
ANSWER: A c. Determining the exact specificity of the autoantibody
so that compatible RBCs can be found
5. With cold reactive autoantibodies, the protein coating the d. Discovering any existing significant alloantibodies in
patient’s cells and detected in the DAT is: the patient’s circulation
a. C3 ANSWER: D
b. IgG
c. C4 12. Penicillin given in massive doses has been associated
d. IgM with RBC hemolysis. Which of the classic mechanisms
ANSWER: A is typically involved in the hemolytic process?
a. Immune complex
6. Problems in routine testing caused by cold reactive b. Drug adsorption
autoantibodies can usually be resolved by all of the c. Membrane modification
following except: d. Autoantibody formation
a. Prewarming ANSWER: B
b. Washing with warm saline
c. Using anti-IgG antiglobulin serum 13. Which of the following drugs has been associated with
d. Testing clotted blood specimens complement activation and rapid intravascular hemolysis?
ANSWER: D a. Penicillins
b. Quinidine
7. Pathological cold autoagglutinins differ from common c. Alpha-methyldopa
cold autoagglutinins in: d. Cephalosporins
a. Immunoglobulin class ANSWER: D
b. Thermal amplitude
c. Antibody specificity 14. A patient is admitted with a hemoglobin of 5.6 g/dL.
d. DAT results on EDTA specimen Initial pretransfusion workup appears to indicate the
ANSWER: B presence of a warm autoantibody in the serum and coating his RBCs.
His transfusion history indicates that he received 6 units of RBCs 2
8. Cold AIHA is sometimes associated with infection by: years ago after an automobile accident. Which of the following
a. Staphylococcus aureus would be most helpful in performing antibody detection and
b. Mycoplasma pneumoniae compatibility testing procedures?
c. Escherichia coli a. Adsorb the autoantibody using the patient’s enzymetreated cells.
d. Group A Streptococcus b. Perform an elution and use the eluate for compatibility testing.
ANSWER: B c. Crossmatch random units until compatible units are
found.
d. Collect blood from relatives who are more likely to
be compatible.
ANSWER: A

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15. A patient who is taking Aldomet has a positive DAT. An 4. Of the following diseases, which one has the highest relative risk
eluate prepared from his RBCs would be expected to: in association with an HLA antigen?
a. React only with Aldomet-coated cells a. Ankylosing spondylitis
b. Be neutralized by a suspension of Aldomet b. Juvenile diabetes
c. React with all normal cells c. Narcolepsy
d. React only with Rhnull cells d. Rheumatoid arthritis
ANSWER: C ANSWER: A

16. One method that can be used to separate a patient’s 5. Why is HLA matching not feasible in cardiac transplantation?
RBCs from recently transfused donor RBCs is: a. No HLAs are present on cardiac cells
a. Chloroquine diphosphate treatment of the RBCs b. No donors ever have HLA antibodies
b. Reticulocyte harvesting c. Total ischemic time is too long
c. EGA treatment d. Total ischemic time is too short
d. Donath-Landsteiner testing ANSWER: D
ANSWER: B
6. DR52 molecules are the product of which alleles?
17. Monoclonal antisera is valuable in phenotyping RBCs a. DRA and DRB1
with positive DATs because: b. DRA and DRB3
a. Both polyspecific and monospecific antihuman serum c. DRA and DRB4
can be used in antiglobulin testing d. DRA and DRB5
b. Anti-C3 serum can be used in antiglobulin testing ANSWER: B
c. It usually does not require antiglobulin testing
d. It does not require enzyme treatment of the cells prior 7. What is the molecular technique that detects undefined
to antiglobulin testing alleles?
ANSWER: C a. Restriction fragment length polymorphism
b. Sequence-specific primer typing
18. Autoadsorption procedures to remove either warm or c. Sequence-specific oligonucleotide typing
cold autoantibodies should not be used with a recently d. Direct nucleotide sequencing
transfused patient. Recently means: ANSWER: D
a. 3 days
b. 3 weeks 8. What represents the association of the alleles on the two
c. 6 weeks C6 chromosomes as determined by family studies?
d. 3 months a. Haplotype
ANSWER: D b. Genotype
c. Phenotype
d. Xenotype
CHAPTER 21 ANSWER: A

1. The HLA genes are located on which chromosome? CHAPTER 22: Relationship Testing
a. 2
b. 4 1. Among the combinations of attributes described below,
c. 6 select the one that would not be suitable for a genetic
d. 8 system used in parentage testing analysis.
ANSWER: C a. The system has multiple alleles in Hardy-Weinberg
equilibrium.
2. The majority of HLA antibodies belongs to what immunoglobulin b. The system has a high mutation rate.
class? c. Databases of allele frequencies are available for all
a. IgD ethnic groups tested by the laboratory.
b. IgE d. All systems selected are genetically independent from
c. IgG each other.
d. IgM ANSWER: B
ANSWER: C
2. In which of the following genetic systems is the allele
3. What is the test of choice for HLA antigen testing? frequency distribution continuous (not discrete)?
a. Agglutination a. DNA polymorphisms by RFLP
b. Molecular b. DNA polymorphisms by PCR
c. Cytotoxicity c. RBC antigens
d. ELISA d. RBC enzymes
ANSWER: B ANSWER: A

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3. A false direct exclusion in RBC antigen genetic systems
can be caused by: 7. An example of a remedial action is:
a. A silent allele a. Applying the problem-solving process.
b. A lack of precursor substance b. Starting a process improvement team.
c. An alternate untested allele c. Resolving the immediate problem.
d. Weak reagents d. Performing an internal audit.
ANSWER: B ANSWER: C

4. Among the following organizations, which one offers an 8. The PDCA cycle is used for:
accreditation program for parentage testing laboratories? a. Problem resolution.
a. AABB b. Process control.
b. ASCP c. Validation.
c. FDA d. Auditing.
d. HCFA ANSWER: A
ANSWER: A
9. The difference between the blood bank and laboratory
QMSs is that:
CHAPTER 23: Quality Management a. The laboratory has a different path of workflow.
b. The blood bank does not include computer systems.
1. A QMS is: c. The QSEs are different.
a. Synonymous with compliance. d. The blood bank excludes testing.
b. Active and continuous. ANSWER: A
c. Part of quality control.
d. An evaluation of efficiency. 10. The QSEs for the blood bank QMS can be used for the
ANSWER: B laboratory because:
a. The paths of workflow are identical.
2. QSEs are applied to: b. Both the laboratory and blood bank experience
a. Just the blood bank’s management staff. accreditation inspections.
b. Blood bank quality control activities. c. The QSEs are universal.
c. Only blood component manufacturing. d. The QSEs are required by international standards.
d. The blood bank’s path of workflow. ANSWER: C
ANSWER: D

3. cGMP refers to: CHAPTER 24: Utilization Management

a. Regulations pertaining to laboratory safety.
b. Validation of testing. 1. Which type of review does not require direct discussion between
c. Nonconformance reporting. the ordering clinician and transfusion service personnel?
d. Manufacturing blood components. a. Discontinuous prospective
ANSWER: D b. Targeted prospective
c. Concurrent
4. Internal and external failure costs are: d. Retrospective
a. Readily identifiable in facility reports. ANSWER: D
b. Controlled through prevention and appraisal.
c. Built into the facility’s operating budget. 2. Improper specimen labeling contributes to waste (muda)
d. Part of prevention and appraisal. within the system by requiring rework and prolonging
ANSWER: B turnaround time.
a. True
5. Which one statement below is correct? b. False
a. A process describes how to perform a task. ANSWER: A
b. A procedure simply states what the facility will do.
c. A procedure informs the reader how to perform a task. 3. There is no value in a transfusion if the patient suffers
d. A policy can be flowcharted. any transfusion-related adverse event.
ANSWER: C a. True
b. False
6. A blank form is a: ANSWER: B
a. Record.
b. Procedure. 4. To receive benefit from a transfusion the patient must
c. Flowchart. have:
d. Document. a. A hemoglobin level less than 8 g/dL.
ANSWER: D b. An invasive procedure planned.

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c. A pathological lesion or deficiency that can be remedied by
functioning stored components. 2. Where are the regulations for blood and blood components
d. A blood order signed by the attending physician. published?
ANSWER: C a. The AABB Technical Manual
b. CAP inspection checklist
5. All of the following regarding the transfusion medicine c. The Code of Federal Regulations
value stream are true except: d. State Inspectional Guidance Documents
a. The patient is the customer. ANSWER: C
b. Waste can be generated in any department.
c. Transfusion guidelines are a form of standardization. 3. What was an important tragedy that prompted Congress
d. Value is decreased when waste and peril are decreased. to enact the Public Health Service Act?
ANSWER: D a. Three patients contracted hepatitis C following
transfusion
6. Continuous improvement (kaizen) is important only when b. A child died following transfusion of hemolyzed red
targeted or discontinuous prospective review is utilized. blood cells
a. True c. A group O patient received group A blood
b. False d. Thirteen children died after receiving diphtheria antitoxin
ANSWER: B contaminated with tetanus
ANSWER: D
7. All interventions are compatible with all utilization review
methods, and they can be utilized in any combination. 4. What is required to ship blood and blood components
a. True across state lines (interstate)?
b. False a. AABB accreditation
ANSWER: B b. State license
c. CMS certification
8. The blood utilization management program planning d. Approved Biologics License Application
team should include: ANSWER: D
a. Nursing representatives.
b. Representatives from the facility’s practicing clinicians. 5. Which of the following government organizations inspect blood
c. The blood bank medical director. and blood component manufacturers?
d. All of the above. a. CBER
ANSWER: D b. ORA
c. CMS
9. Metrics should be: d. All of the above
a. Chosen to indicate progress during the process of ANSWER: C
continuous improvement.
b. Tracked and disseminated only to members of the 6. Which of the following is true about CGMP?
blood utilization management team. a. CGMP is the minimum current practice for methods
c. The same for all institutions. and facilities used to manufacture a drug to ensure
d. Selected only by the transfusion service leadership. that it is safe, pure, and potent.
ANSWER: A b. The FDA will approve a Biologics License Application
if the manufacturer does not have a quality control
10. Perfect value with zero risk and no peril is attainable plan.
for any facility willing to invest in a blood utilization c. The quality control unit must perform all the quality
management program. functions.
a. True d. Blood and blood components do not have to be in
b. False compliance with the drug CGMP regulations.
ANSWER: B ANSWER: A

CHAPTER 25: Transfusion Safety and Federal Regulatory
Requirements
1. Which of the following is responsible for overseeing the
safety of the nation’s blood supply?
a. Joint Commission on Accreditation of Healthcare
Organizations
b. Food and Drug Administration
c. College of American Pathologists (CAP)
d. Occupational Safety and Health Administration
ANSWER: B
7. A donor calls the blood bank and informs them that
within a year prior to his donation, he had intimate
contact with a person diagnosed with HIV. Which of the
following action is NOT required by the FDA?
a. Identify and quarantine all blood and blood components produced
from the blood supplied by the
donor
b. Report the biological product deviation to CBER if
the product has already been distributed
c. Enter the donor in a record so that he can be identified and his
product not be distributed while he is

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deferred into the blood bank system
d. Notify the AABB c. The printing of a workload report
ANSWER: D d. Preventing access to the system by an unauthorized
user
8. A patient dies following transfusion of ABO-incompatible ANSWER: B
blood. To whom should this event be reported?
a. The Center for Biologics Evaluation and Research 5. Backup copies of the information system:
b. Center for Medicare and Medicaid Services a. Can be used to restore the information system data and
c. The AABB central office software if the production system is damaged.
d. The Occupational Safety and Health Administration b. Are used to maintain hardware components.
ANSWER: A c. Are performed once a month.
d. Are created any time changes are made to the system.
9. Which federal agency has the responsibility to routinely ANSWER: A
inspect an unregistered transfusion service that does not
collect blood? 6. User passwords should be:
a. Food and Drug Administration a. Shared with others.
b. Centers for Medicare and Medicaid Services b. Kept confidential.
c. Occupational Safety and Health Administration c. Posted at each terminal.
d. State health department d. Never changed.
ANSWER: B ANSWER: B

10. Which of the following is NOT one of the FDA layers of safety? 7. Preventing the issue of an incompatible blood component is an
a. Donor screening example of:
b. Biologics License Application a. Inventory management.
c. Investigation of manufacturing problems b. Utilization review.
d. Infectious disease testing c. System security.
ANSWER: B d. Control function.
ANSWER: D
CHAPTER 26: Laboratory Information Systems
8. Information is stored in a collection of many different
1. Components of an information system consist of all of the files called the:
following except: a. Database.
a. Hardware b. Configuration.
b. Software c. Hardware.
c. Validation d. Disk drive.
d. People ANSWER: A
ANSWER: C
9. Application software communicates with this type of
2. To be in compliance with regulatory and accreditation software to retrieve data from the system disks:
agency requirements for blood bank information systems, a. Interface
blood banks must maintain SOPs for all of the following b. Operating system
except: c. Security
a. Vendor validation testing d. Program
b. Computer downtime ANSWER: B
c. System maintenance
d. Personnel training 10. Validation testing for software should consider all of the
ANSWER: A following items except:
a. Data entry methods
3. A validation test case that assesses the system’s ability to b. Control functions
recognize an erroneous input is called: c. Performance of testing in production database
a. Normal d. Invalid data
b. Boundary ANSWER: C
c. Stress
d. Invalid 11. Complete the truth table below for a negative antibody
ANSWER: D screen using two screening cells (SCI, SCII) at the
immediate spin (IS), 37°C (37), and antihuman globulin
4. An example of interface software functionality is: (AHG) phases.
a. The entry of blood components into the blood bank
database
b. The transmission of patient information from the HIS

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ANSWER:
12. During validation testing, a computer user entered the following
results for an antibody screen test:
After the user verified the entries, the monitor displayed
the following message: “Invalid test results.” What
caused the error message to display?
a. An invalid entry was made in the check cells (CC)
column.
b. The truth table was set up incorrectly.
c. The interpretation does not correlate with the test
entries.
d. The interface to the laboratory computer system is
down.
ANSWER: B
13. The following test plan has been created to validate
the blood bank computer function used to update the
status of blood units that have been transfused. The
test plan contains each of the sections, lettered A through H,
required for a thorough test plan. Evaluate each section and, using
the list below, assign a name to each section.
Test Plan Function: Assigning Transfused Status
Section A
Description: This function is used to change the status of
issued units to a transfused status. All records pertaining
to the unit and patient will be updated:
Name of Section A. ________________________________
Section B
1. Preventing the assignment of transfused status to a
quarantined blood unit.
2. Preventing the assignment of transfused status to a
blood unit that has already been transfused.
3. Preventing the assignment of transfused status to a
blood component that has not been issued.
Name of Section B. ________________________________
Section C
1. The computer will beep and display **Unit Has Not
Been Issued** when a blood unit number that has not
been issued is entered.
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2. The computer will beep and display **Unit Is in
Quarantined Status** when a blood component that
is in quarantine status is entered.
3. The computer will beep and display **Unit Has Been
Transfused** when a blood component that has already
been transfused is entered.
4. The Transfusion History screen display will indicate the
patient has been transfused and will display the date of
the last transfusion.
5. Printed reports will indicate relevant units were
assigned transfused status
Name of Section C. ________________________________
Section D
1. Attempt to assign transfused status to the following
units:
a. Quarantined blood component
b. Selected (but not issued) blood component
c. Transfused blood component
2. Selection of units from issued inventory list
3. Manual entry of issued blood components
Name of Section D. ________________________________
Section E
1. Operator will input blood component information and
select blood components.
2. Operator will input selected patient information.
3. Blood bank computer will update the patient and unit
record.
Name of Section E. ________________________________
Section F
The following screen displays and printed reports will be
verified for accuracy:
Screen Displays Printed Reports
Patient Information Patient History Report
Unit Information Transfusion Listing
Unit History
Transfusion History
Name of Section F. _________________________________
Section G
The acceptability of the results of each test case will be
determined by the blood bank manager and documented
on the validation documentation form.
Name of Section G. ________________________________
Section H
If the software does not perform as expected, the problem
must be recorded on a computer problem report and the
supervisor alerted. A remedial action plan will be devised
with the assistance of the blood bank computer system
vendor.
Name of Section H. ________________________________
Blood bank director signature:____ Date:_____________
Comments: _____________________________________
13. ANSWERS:
A. Control functions
B. Acceptance Criteria
C. Test Cases
D. Data entry methods
E. Documentation methods
F. Result review
G. Corrective action
H. Acceptance
CHAPTER 27: Medicolegal and Ethical Aspects of Providing Blood 2. Where are the regulations for blood and blood components
Collection and Transfusion Services published?
a. The AABB Technical Manual
1. Transfusion-transmitted diseases can result in lawsuits b. CAP inspection checklist
claiming: c. The Code of Federal Regulations
a. Battery. d. State Inspectional Guidance Documents
b. Invasion of privacy. ANSWER: C
c. Negligence.
d. A, B, and C 3. What was the important tragedy that led to the regulation
ANSWER: D of biological products?
a. Three patients contracted hepatitis C following transfusion
2. Laws applicable to blood banking and transfusion b. A child died following transfusion of hemolyzed red
medicine can arise: blood cells
a. In state and federal courts. c. A group O patient received group A blood
b. In the U.S. Congress, state legislatures, and state and d. Thirteen children died after receiving diphtheria antitoxin
federal courts. contaminated with tetanus
c. In state legislatures and courts. ANSWER: D
d. In state legislatures and the U.S. Congress.
ANSWER: B 4. What is required to ship blood and blood components
across state lines (interstate)?
3. The reasons patients have sued for transfusion injury a. AABB accreditation
include: b. State license
a. Failure to perform surrogate testing. c. CMS certification
b. Failure to properly test blood components. d. Approved biologics license application
c. Failure to properly screen donors. ANSWER: D
d. All of the above
ANSWER: D 5. Which of the following government organizations inspect blood
and blood component manufacturers?
4. Blood banking professionals may increase the threat of a. CBER
litigation by: b. ORA
a. Following published regulations and guidelines. c. CMS
b. Knowing the legal bases for liability. d. All of the above
c. Disclosing all information about patients and donors. ANSWER: C
d. Practicing good medicine.
ANSWER: C 6. Which of the following is true about CGMP?
a. CGMP is the minimum current practice for methods
5. Issues about transfusion-transmitted diseases: and facilities used to manufacture a drug to ensure
a. Are evolving and will continue to result in litigation in that it is safe, pure, and potent
the foreseeable future. b. The FDA will approve a biologics license application
b. Frequently result in plaintiff verdicts. if the manufacturer does not have a quality control
c. Have all been litigated. plan
d. Are known and avoidable. c. The quality control unit must perform all the quality
ANSWER: A functions
d. Blood and blood components do not have to be in
compliance with the drug CGMP regulations
CHAPTER 27 (7th edition): Transfusion Safety and Federal Regulatory ANSWER: A
Requirements
7. A donor calls the blood bank and informs them that
1. Which of the following is responsible for overseeing the within a year prior to his donation, he had intimate contact with a
safety of the nation’s blood supply? person diagnosed with HIV. Which of the following actions is not
a. Joint Commission on Accreditation of Healthcare required by the FDA?
Organizations a. Identify and quarantine all blood and blood components produced
b. Food and Drug Administration from the blood supplied by the
c. College of American Pathologists (CAP) donor
d. Occupational Safety and Health Administration b. Report the biological product deviation to CBER if
ANSWER: B the product has been distributed
c. Enter the donor in a record so that he can be identified and his
product not be distributed while he is
deferred
d. Notify the AABB

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ANSWER: D
8. A patient dies following transfusion of ABO-incompatible
blood. To whom should this event be reported?
a. The Center for Biologics Evaluation and Research
b. Center for Medicare and Medicaid Services
c. The AABB central office
d. The Occupational Safety and Health Administration
ANSWER: A
9. Which federal agency has the responsibility to routinely
inspect an unregistered transfusion service that does not
collect blood?
a. Food and Drug Administration
b. Centers for Medicare and Medicaid Services
c. Occupational Safety and Health Administration
d. State health department
ANSWER: B
10. Which of the following is not one of the FDA layers of safety?
a. Donor screening
b. Biologics License Application
c. Investigation of manufacturing problems
d. Testing for relevant transfusion-transmitted infections
ANSWER: B
CHAPTER 28: . Tissue Banking: A New Role for the Transfusion
Service
1. Implant records must be kept for what duration?
a. Ten years after the tissue has been harvested
b. Indefinitely
c. For a reasonable time to ensure that the recipient is
not still alive when records are destroyed
d. Ten years following the expiration of the tissue
ANSWER: D
2. FDA CFR 1270 and 1271 include all of the following
tissues EXCEPT:
a. Cancellous bone chips.
b. Blood vessels associated with vascular organs for
transplant.
c. Cornea.
d. Heart valve.
ANSWER: B
3. Hospital tissue banks must register with the FDA if:
a. Tissue for transplant is stored.
b. Autologous tissue is stored and issued.
c. Tissue is transferred to another facility.
d. The tissue bank is located outside the blood bank.
ANSWER: C
4. The Joint Commission requires all of the following
EXCEPT:
a. Hospital tissue banks must ensure that suppliers are
complying with applicable state laws.
b. Tissue manufacturing establishments must register
with the FDA.
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c. Hospitals must assign responsibility for overseeing the
tissue program throughout the organization.
d. Hospital tissue banks must verify supplier’s registration with the
FDA yearly.
ANSWER: B
5. The American Association of Tissue Banks (AATB) is:
a. A mandatory accrediting agency for all tissue banks.
b. A voluntary accrediting agency for tissue-manufacturing
establishments.
c. An historic name for the U.S. Navy Tissue Bank.
d. A subdivision within the AABB.
ANSWER: B
6. Transmission of malignancy in tissue:
a. Is most likely to occur with the use of bone.
b. Is relatively common (1/10,000 cases)
c. Is more likely to occur in whole organ transplant.
d. Has never been reported in cornea transplant.
ANSWER: C
7. The medical director for the tissue bank can be:
a. Any individual appointed by the hospital medical
director.
b. The lead supervisor in the blood bank.
c. The head nurse/transplant coordinator from surgical
nursing.
d. A qualified physician involved in tissue transplant or
blood banking.
ANSWER: D
8. Notification of a recipient of tissue that has been
recalled because of possible contamination should be
conducted by:
a. The tissue bank director only.
b. The patient’s transplanting surgeon.
c. The patient does not need to be told unless he develops an
infection.
d. The informed consent covers this contingency and
no further notification is necessary.
ANSWER: B
9. Tissue receipt records must include all of the following
EXCEPT:
a. Unique tissue identification number.
b. Name and address of tissue supplier.
c. Expiration date.
d. Tissue supplier’s FDA registration number.
ANSWER: D
10. Records that must be reviewed to determine donor
eligibility by the tissue manufacturer include:
a. Donor family history.
b. Records from any source pertaining to risk factors for
communicable diseases.
c. Interview of next-of-kin.
d. Consent to harvest tissue.
ANSWER: D
CHAPTER 28 (7th edi): Laboratory Information Systems in the Blood
Bank 8. Information is stored in a collection of many different
1. Components of an information system consist of all of files called the:
the following except: a. Database
a. Hardware b. Configuration
b. Software c. Hardware
c. Validation d. Disk drive
d. People ANSWER: A
ANSWER: C
9. Application software communicates with this type of
2. To be in compliance with regulatory and accreditation software to retrieve data from the system disks:
agency requirements for blood bank information systems, a. Interface
blood banks must maintain SOPs for all of the following b. Operating system
except: c. Security
a. Vendor validation testing d. Program
b. Computer downtime ANSWER: B
c. System maintenance
d. Personnel training
ANSWER: A
10. Validation testing for software should consider all of the
3. A validation test case that assesses the system’s ability to following items except:
recognize an erroneous input is called: a. Data entry methods
a. Normal b. Control functions
b. Boundary c. Performance of testing in production database
c. Stress d. Invalid data
d. Invalid ANSWER: C
ANSWER: D
11. Complete the truth table below for a negative antibody
4. An example of interface software functionality is: screen using two screening cells (SCI, SCII) at the immediate spin (IS),
a. The entry of blood components into the blood bank 37°C (37), and antihuman globulin
database (AHG) phases.
b. The transmission of patient information from the HIS
into the blood bank system
c. The printing of a workload report
d. Preventing access to the system by an unauthorized
user
ANSWER: B

5. Backup copies of the information system:

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

6. User passwords should be:

a. Shared with others
b. Kept confidential
c. Posted at each terminal
d. Never changed
ANSWER: B 12. During validation testing, a computer user entered the
following results for an antibody screen test:
7. Preventing the issue of an incompatible blood component is an SCI IS 37 AHG CC Interpretation
example of: Result 0 0 0 + Negative
a. Inventory management After the user verified the entries, the monitor displayed
b. Utilization review the following message: “Invalid test results.” What
c. System security caused the error message to display?
d. Control function a. An invalid entry was made in the check cells (CC)
ANSWER: D column

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b. The truth table was set up incorrectly 2. Selection of units from issued inventory list
c. The interpretation does not correlate with the test 3. Manual entry of issued blood components
entries Name of Section D. ________________________________
d. The interface to the laboratory computer system is Section E
down 1. Operator will input blood component information and
ANSWER: B select blood components.
2. Operator will input selected patient information.
13. The following test plan has been created to validate 3. Blood bank computer will update the patient and unit
• Corrective action record.
the Name of Section E. ________________________________
blood bank computer function used to update the status Section F
of blood units that have been transfused. The test plan The following screen displays and printed reports will be
contains each of the sections, lettered A through H, required for a verified for accuracy:
thorough test plan. Evaluate each section Screen Displays Printed Reports
and, using the list below, assign a name to each section. Patient Information Patient History Report
Unit Information Transfusion Listing
Section Names Unit History
• Acceptance Transfusion History
• Acceptance criteria
• Control functions Name of Section F. _________________________________
• Data entry methods Section G
• Documentation methods The acceptability of the results of each test case will be determined
• Result review by the blood bank manager and documented on
• Test cases the validation documentation form. If the software does not perform
as expected, the problem must be recorded on a computer problem
Test Plan Function: Assigning Transfused Status report and the supervisor alerted. A remedial action plan will be
Section A devised with the assistance of the
Description: This function is used to change the status of issued units blood bank computer system vendor.
to a transfused status. All records pertaining to Name of Section G. _________________________________
the unit and patient will be updated: Section H
Name of Section A. ________________________________ Blood bank director signature: ____ Date:
Section B _____________
1. Preventing the assignment of transfused status to a quarantined Comments: _______________________________________
blood unit. Name of Section H. _______________________________
2. Preventing the assignment of transfused status to a blood
unit that has already been transfused. 13.ANSWER;
3. Preventing the assignment of transfused status to a blood A. Control functions
component that has not been issued. B. Acceptance criteria
Name of Section B. ________________________________ C. Test cases
Section C D. Data entry methods
1. The computer will beep and display **Unit Has Not Been E. Documentation methods
Issued** when a blood unit number that has not been issued is F. Result review
entered. G. Corrective action
2. The computer will beep and display **Unit Is in Quarantined H. Acceptance
Status** when a blood component that is in quarantine status is
entered. CHAPTER 29 (7th edi): Medicolegal and Ethical Aspects of Providing
3. The computer will beep and display **Unit Has Been Blood Collection and Transfusion Services
Transfused** when a blood component that has already
been transfused is entered. 1. Transfusion-transmitted diseases can result in lawsuits
4. The Transfusion History screen display will indicate the claiming:
patient has been transfused and will display the date of a. Battery
the last transfusion. b. Invasion of privacy
5. Printed reports will indicate relevant units were assigned c. Negligence
transfused status. d. a, b, and c
Name of Section C. ________________________________ ANSWER: D
Section D
1. Attempt to assign transfused status to the following units: 2. Laws applicable to blood banking and transfusion medicine can
a. Quarantined blood component arise:
b. Selected (but not issued) blood component a. In state and federal courts
c. Transfused blood component b. In the U.S. Congress, state legislatures, and state and

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federal courts
c. In state legislatures and courts
d. In state legislatures and the U.S. Congress
ANSWER: B

3. The reasons patients have sued for transfusion injury

include:
a. Failure to perform surrogate testing
b. Failure to properly test blood components
c. Failure to properly screen donors
d. All of the above
ANSWER: D

4. Blood banking professionals may increase the threat of

litigation by:
a. Following published regulations and guidelines
b. Knowing the legal bases for liability
c. Disclosing all information about patients and donors
d. Practicing good medicine
ANSWER: C

5. Issues about transfusion-transmitted diseases:

a. Are evolving and will continue to result in litigation in
the foreseeable future
b. Frequently result in plaintiff verdicts
c. Have all been litigated
d. Are known and avoidable
ANSWER: A

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