What type of serological testing does the blood bank technologist perform when determining the blood group of a patient? A. Genotyping B. Phenotyping C. Both genotyping and phenotyping D. Polymerase chain reaction

If anti-K reacts 3+ with a donor cell with a genotype KK and 2+ with a Kk cell, the antibody is demonstrating: A. Dosage B. Linkage disequilibrium C. Homozygosity D. Heterozygosity

Carla expresses the blood group antigens Fya, Fyb, and Xga. James shows expressions of none of these antigens. What factor(s) may account for the absence of these antigens in James? A. Gender B. Race C. Gender and race D. Medication

Which of the following statements is true? A. An individual with the BO genotype is homozygous for B antigen B. An individual with the BB genotype is homozygous for B antigen C. An individual with the OO genotype is heterozygous for O antigen D. An individual with the AB phenotype is homozygous for A and B antigens

Which genotype is heterozygous for C? A. DCe/dce B. DCE/DCE C. Dce/dce D. DCE/dCe

Which genotype(s) will give rise to the Bombay phenotype? A. HH only B. HH and Hh C. Hh and hh D. hh only

Meiosis in cell division is limited to the ova and sperm producing four gametes containing what complement of DNA? A. 1N B. 2N C. 3N D. 4N

A cell that is not actively dividing is said to be in: A. Interphase B. Prophase C. Anaphase D. Telophase

Which of the following describes the expression of most blood group antigens? A. Dominant B. Recessive C. Codominant D. Corecessive

What blood type is not possible for an offspring of an AO and BO mating? A. AB B. A or B C. O D. All are possible

The alleged father of a child in a disputed case of paternity is blood group AB. The mother is group O and the child is group O. What type of exclusion is this? A. Direct/primary/first order B. Probability C. Random D. Indirect/secondary/second order

If the frequency of gene Y is 0.4 and the frequency of gene Z is 0.5, one would expect that they should occur together 0.2 (20%) of the time. In actuality, they are found together 32% of the time. This is an example of: A. Crossing over B. Linkage disequilibrium C. Polymorphism D. Chimerism

In the Hardy–Weinberg formula, p2 represents: A. The heterozygous population of one allele B. The homozygous population of one allele C. The recessive allele D. The dominant allele

In this type of inheritance, the father carries the trait on his X chromosome. He has no sons with the trait because he passed his Y chromosome to his sons; however, all his daughters will express the trait. A. Autosomal dominant B. Autosomal recessive C. X-linked dominant D. X-linked recessive

Why do IgM antibodies, such as those formed against the ABO antigens, have the ability to directly agglutinate red blood cells (RBCs) and cause visible agglutination? A. IgM antibodies are larger molecules and have the ability to bind more antigen B. IgM antibodies tend to clump together more readily to bind more antigen C. IgM antibodies are found in greater concentrations than IgG antibodies D. IgM antibodies are not limited by subclass specificity

Which of the following enhancement mediums decreases the zeta potential, allowing antibody and antigen to come closer together? A. LISS B. Polyethylene glycol C. Polybrene D. ZZAP

This type of antibody response is analogous to an anamnestic antibody reaction. A. Primary B. Secondary C. Tertiary D. Anaphylactic

Which antibodies to a component of complement are contained in the rabbit polyspecific antihuman globulin reagent for detection of in vivo sensitization? A. Anti-IgG and anti-C3a B. Anti-IgG and anti-C3d C. Anti-IgG and anti-IgM D. All of these options

Which of the following distinguishes A1 from A2 blood groups? A. A2 antigen will not react with anti-A, A1 will react strongly (4+) B. An A2 person may form anti-A1; an A1 person will not form anti-A1 C. An A1 person may form anti-A2, an A2 person will not form anti-A1 D. A2 antigen will not react with anti-A from a nonimmunized donor; A1 will react with any anti-A

A patient’s serum is incompatible with O cells. The patient RBCs give a negative reaction to anti-H lectin. What is the most likely cause of these results? A. The patient may be a subgroup of A B. The patient may have an immunodeficiency C. The patient may be a Bombay D. The patient may have developed alloantibodies

What antibodies are formed by a Bombay individual? A. Anti-A and anti-B B. Anti-H C. Anti-A,B D. Anti-A, B, and H

Acquired B antigens have been found in: A. Bombay individuals B. Group O persons C. All blood groups D. Group A persons

Blood is crossmatched on an A positive person with a negative antibody screen. The patient received a transfusion of A positive RBCs 3 years ago. The donors chosen for crossmatch were A positive. The crossmatch was run on the Ortho Provue and yielded 3+ incompatibility. How can these results be explained? A. The patient has an antibody to a low-frequency antigen B. The patient has an antibody to a high-frequency antigen C. The patient is an A2 with anti-A1 D. The patient is an A1 with anti-A2

A patient’s red cells forward as group O, serum agglutinates B cells (4+) only. Your next step would be: A. Extend reverse typing for 15 minutes B. Perform an antibody screen including a roomtemperature incubation C. Incubate washed red cells with anti-A1 and anti-A,B for 30 minutes at room temperature D. Test patient’s red cells with Dolichos biflorus

Which typing results are most likely to occur when a patient has an acquired B antigen? A. Anti-A 4+, anti-B-3+, A1 cells neg, B cells neg B. Anti-A 3+, anti-B neg, A1 cells neg, B cells neg C. Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+ D. Anti-A 4+, anti-B 4+, A1 cells 2+, B cells neg

Which blood group has the least amount of H antigen? A. A1B B. A2 C. B D. A1

What type RBCs can be transfused to an A2 person with anti-A1? A. A only B. A or O C. B D. AB

What should be done if all forward and reverse ABO results as well as the autocontrol are positive? A. Wash the cells with warm saline, autoadsorb the serum at 4°C B. Retype the sample using a different lot number of reagents C. Use polyclonal typing reagents D. Report the sample as group AB

What should be done if all forward and reverse ABO results are negative? A. Perform additional testing such as typing with anti-A1 lectin and anti-A,B B. Incubate at 22°C or 4°C to enhance weak expression C. Repeat the test with new reagents D. Run an antibody identification panel

N-acetyl-D-galactosamine is the immunodominant carbohydrate that reacts with: A. Arachis hypogaea B. Salvia sclarea C. Dolichos biflorus D. Ulex europeaus

A stem cell transplant patient was retyped when she was transferred from another hospital. What is the most likely cause of the following results? Patient cells: Anti-A, neg Anti-B, 4+ Patient serum: A1 cells, neg B cells, neg A. Viral infection B. Alloantibodies C. Immunodeficiency D. Autoimmune hemolytic anemia

What reaction would be the same for an A1 and an A2 person? A. Positive reaction with anti-A1 lectin B. Positive reaction with A1 cells C. Equal reaction with anti-H D. Positive reaction with anti-A,B

A female patient at 28 weeks’ gestation yields the following results: Patient cells: Anti-A, 3+ Anti-B, 4+ Patient serum: A1 cells, neg B cells, 1+ O cells, 1+ Which of the following could be causing the ABO discrepancy? A. Hypogammaglobulinemia B. Alloantibody in patient serum C. Acquired B D. Weak subgroup

Which condition would most likely be responsible for the following typing results? Patient cells: Anti-A, neg Anti-B, neg Patient serum: A1 cells, neg B cells, 4+ A. Immunodeficiency B. Masking of antigens by the presence of massive amounts of antibody C. Weak or excessive antigen(s) D. Impossible to determine

Which of the following results is most likely discrepant? Anti-A, neg Anti-B, 4+ A1 cells, neg B cells, neg A. Negative B cells B. Positive reaction with anti-B C. Negative A1 cells D. No problem with this typing

A 61-year-old male with a history of multiple myeloma had a stem cell transplant 3 years ago. The donor was O positive and the recipient was B positive. He is admitted to a community hospital for fatigue and nausea. Typing results reveal the following: Anti-A = 0 Anti-B =0 Anti-A,B = 0 Anti-D = 4+ A1 cells = 4+ B cells = 0 How would you report this type? A. O positive B. B positive C. A positive D. Undetermined

A complete Rh typing for antigens C, c, D, E, and e revealed negative results for C, D, and E. How is the individual designated? A. Rh positive B. Rh negative C. Positive for c and e D. Impossible to determine

How is an individual with genotype Dce/dce classified? A. Rh positive B. Rh negative C. Rhnull D. Total Rh

If a patient has a positive direct antiglobulin test, should you perform a weak D test on the cells? A. No, the cells are already coated with antibody B. No, the cells are Rhnull C. Yes, the immunoglobulin will not interfere with the test D. Yes, Rh reagents are enhanced in protein media

Which donor unit is selected for a recipient with anti-c? A. r´r B. R0R1 C. R2r´ D. r´ry

Which genotype usually shows the strongest reaction with anti-D? A. DCE/DCE B. Dce/dCe C. D–/D– D. -CE/-ce

Why is testing for Rh antigens and antibodies different from ABO testing? A. ABO reactions are primarily due to IgM antibodies and usually occur at room temperature; Rh antibodies are IgG and agglutination usually requires a 37°C incubation and enhancement media B. ABO antigens are attached to receptors on the outside of the red cell and do not require any special enhancement for testing; Rh antigens are loosely attached to the red cell membrane and require enhancement for detection C. Both ABO and Rh antigens and antibodies have similar structures, but Rh antibodies are configured so that special techniques are needed to facilitate binding to Rh antigens D. There is no difference in ABO and Rh testing; both may be conducted at room temperature with no special enhancement needed for reaction

Testing reveals a weak D that reacts 1+ after indirect antiglobulin testing (IAT). How is this result classified? A. Rh-positive B. Rh-negative, Du positive C. Rh-negative D. Rh-positive, Du positive

What is one possible genotype for a patient who develops anti-C antibody? A. R1r B. R1R1 C. r´r D. rr

A patient developed a combination of Rh antibodies: anti-C, anti-E, and anti-D. Can compatible blood be found for this patient? A. It is almost impossible to find blood lacking the C, E, and D antigens B. rr blood could be used without causing a problem C. R0R0 may be used because it lacks all three antigens D. Although rare, ryr blood may be obtained from close relatives of the patient

A patient tests positive for weak D but also appears to have anti-D in his serum. What may be the problem? A. Mixup of samples or testing error B. Most weak D individuals make anti-D C. The problem could be due to a disease state D. A D mosaic may make antibodies to missing antigen parts

Which offspring is not possible from a mother who is R1R2 and a father who is R1r? A. DcE/DcE B. Dce/DCe C. DcE/DCe D. Dce/dce

Why is testing a pregnant woman for weak D not required? A. An Rh-negative fetus may yield false positive results in a fetal maternal bleed B. An Rh-positive fetus may yield false positive results in a fetal maternal bleed C. D antigen strength decreases during pregnancy D. D antigen strength increases during pregnancy

What antibodies could an R1R1 make if exposed to R2R2 blood? A. Anti-e and anti-C B. Anti-E and anti-c C. Anti-E and anti-C D. Anti-e and anti-c

What does the genotype —/— represent in the Rh system? A. Rh negative B. D mosaic C. Rhnull D. Total Rh

What techniques are necessary for weak D testing? A. Saline + 22°C incubation B. Albumin or LISS + 37°C incubation C. Saline + 37°C incubation D. 37°C incubation + IAT

A patient types as AB and appears to be Rh positive on slide typing. What additional tests should be performed for tube typing? A. Rh negative control B. Direct antiglobulin test (DAT) C. Low-protein Rh antisera D. No additional testing is needed

According to the Wiener nomenclature and/or genetic theory of Rh inheritance: A. There are three closely linked loci, each with a primary set of allelic genes B. The alleles are named R1, R2, R0, r, r´, r?, Rz, and ry C. There are multiple alleles at a single complex locus that determine each Rh antigen D. The antigens are named D, C, E, c, and e

The Wiener nomenclature for the E antigen is: A. hr´ B. hrv´ C. rh˝ D. Rh0

A physician orders 2 units of leukocyte-reduced red blood cells. The patient is a 55-year-old male with anemia. He types as an AB negative, and his antibody screen is negative. There is only 1 unit of AB negative in inventory. What is the next blood type that should be given? A. AB positive (patient is male) B. A negative C. B negative D. O negative

Which technology may report an Rh-weak D positive as Rh negative? A. Gel System B. Solid Phase C. Tube Testing D. None of these options

A patient has the Lewis phenotype Le(a−b−). An antibody panel reveals the presence of anti-Lea. Another patient with the phenotype Le(a−b+) has a positive antibody screen; however, a panel reveals no conclusive antibody. Should anti-Lea be considered as a possibility for the patient with the Le(a−b+) phenotype? A. Anti-Lea should be considered as a possible antibody B. Anti-Lea may be a possible antibody, but further studies are needed C. Anti-Lea is not a likely antibody because even Leb individuals secrete some Lea D. Anti-Lea may be found in saliva but not detectable in serum

A technologist is having great difficulty resolving an antibody mixture. One of the antibodies is antiLea. This antibody is not clinically significant in this situation, but it needs to be removed to reveal the possible presence of an underlying antibody of clinical significance. What can be done? A. Perform an enzyme panel B. Neutralize the serum with saliva C. Neutralize the serum with hydatid cyst fluid D. Use DTT (dithiothreitol) to treat the panel cells

What type of blood should be given to an individual who has an anti-Leb that reacts 1+ at the IAT phase? A. Blood that is negative for the Leb antigen B. Blood that is negative for both the Lea and Leb antigens C. Blood that is positive for the Leb antigen D. Lewis antibodies are not clinically significant, so any type of blood may be given

Which of the following statements is true concerning the MN genotype? A. Antigens are destroyed using bleach-treated cells B. Dosage effect may be seen for both M and N antigens C. Both M and N antigens are impossible to detect because of cross-interference D. MN is a rare phenotype seldom found in routine antigen typing

Anti-M is sometimes found with reactivity detected at the immediate spin (IS) phase that persists in strength to the IAT phase. What is the main testing problem with a strong anti-M? A. Anti-M may not allow detection of a clinically significant antibody B. Compatible blood may not be found for the patient with a strongly reacting anti-M C. The anti-M cannot be removed from the serum D. The anti-M may react with the patient’s own cells, causing a positive autocontrol

A patient is suspected of having paroxysmal cold hemoglobinuria (PCH). Which pattern of reactivity is characteristic of the Donath– Landsteiner antibody, which causes this condition? A. The antibody attaches to RBCs at 4°C and causes hemolysis at 37°C B. The antibody attaches to RBCs at 37°C and causes agglutination at the IAT phase C. The antibody attaches to RBCs at 22°C and causes hemolysis at 37°C D. The antibody attaches to RBCs and causes agglutination at the IAT phase

How can interfering anti-P1 antibody be removed from a mixture of antibodies? A. Neutralization with saliva B. Agglutination with human milk C. Combination with urine D. Neutralization with hydatid cyst fluid

Which antibody is frequently seen in patients with warm autoimmune hemolytic anemia? A. Anti-Jka B. Anti-e C. Anti-K D. Anti-Fyb

An antibody shows strong reactions in all test phases. All screen and panel cells are positive. The serum is then tested with a cord cell and the reaction is negative. What antibody is suspected? A. Anti-I B. Anti-i C. Anti-H D. Anti-p

Which group of antibodies is commonly found as cold agglutinins? A. Anti-K, anti-k, anti-Jsb B. Anti-D, anti-e, anti-C C. Anti-M, anti-N D. Anti-Fya, anti-Fyb

Which of the following antibodies characteristically gives a refractile mixed-field appearance? A. Anti-K B. Anti-Dia C. Anti-Sda D. Anti-s

What does the 3+3 rule ascertain? A. An antibody is ruled in B. An antibody is ruled out C. 95% confidence that the correct antibody has been identified D. 95% confidence that the correct antibody has not been identified

The k (Cellano) antigen is a high-frequency antigen and is found on most red cells. How often would one expect to find the corresponding antibody? A. Often, because it is a high frequency antibody B. Rarely, because most individuals have the antigen and therefore would not develop the antibody C. It depends upon the population, because certain racial and ethnic groups show a higher frequency of anti-k D. Impossible to determine without consulting regional blood group antigen charts

Which procedure would help to distinguish between an anti-e and anti-Fya in an antibody mixture? A. Lower the pH of test serum B. Run an enzyme panel C. Use a thiol reagent D. Run a LISS panel

Which characteristics are true of all three of the following antibodies: anti-Fya, anti-Jka, and anti-K? A. Detected at the IAT phase; may cause hemolytic disease of the newborn and hemolytic transfusion reactions B. Not detected with enzyme-treated cells C. Requires the IAT technique for detection; usually not associated with HDN D. Enhanced reactivity with enzyme-treated cells; may cause severe hemolytic transfusion reactions

A patient is admitted to the hospital. Medical records indicate that the patient has a history of anti-Jka. When you performed the type and screen, the type was O positive and screen was negative. You should: A. Crossmatch using units negative for Jka antigen B. Crossmatch random units, since the antibody is not demonstrating C. Request a new sample D. Repeat the screen with enzyme-treated screening cells

A technologist performs an antibody study and finds 1+ and weak positive reactions for several of the panel cells. The reactions do not fit a pattern. Several selected panels and a patient phenotype do not reveal any additional information. The serum is diluted and retested, but the same reactions persist. What type of antibody may be causing these results? A. Antibody to a high-frequency antigen B. Antibody to a low-frequency antigen C. High titer low avidity (HTLA) D. Anti-HLA

An antibody is detected in a pregnant woman and is suspected of being the cause of fetal distress. The antibody reacts at the IAT phase but does not react with DTT-treated cells. This antibody causes in vitro hemolysis. What is the most likely antibody specificity? A. Anti-Lea B. Anti-Lua C. Anti-Lub D. Anti-Xga

What sample is best for detecting complementdependent antibodies? A. Plasma stored at 4°C for no longer than 24 hours B. Serum stored at 4°C for no longer than 48 hours C. Either serum or plasma stored at 20°C–24°C no longer than 6 hours D. Serum heated at 56°C for 30 minutes

Which antibody would not be detected by group O screening cells? A. Anti-N B. Anti-A1 C. Anti-Dia D. Anti-k

Refer to Panel 1. Which antibody is most likely implicated? A. Anti-Fyb B. Anti-Jkb C. Anti-e D. Anti-c and anti-K

Refer to Panel 2. Which antibody specificity is most likely present? A. Anti-S and anti-E B. Anti-E and anti-K C. Anti-Lea and anti-Fyb D. Anti-C and anti-K

On Panel 2, which of the following antibodies could not be ruled out? A. Anti-Jkb B. Anti-C C. Anti-M D. Anti-Fyb

On Panel 2, which cells are homozygous for C? A. 1, 2, 3 B. 1, 2, 9 C. 3, 4, 7 D. 7, 8, 10

A 77-year-old female is admitted to a community hospital after a cardiac arrest. History includes an abdominal aortic aneurysm 2 years ago in which she received 6 units of packed cells. Her blood type is A positive and antibody screen is positive at AHG phase in screening cells II and III. A panel is performed using LISS. Referring to panel 3, which antibodies are likely implicated? A. C and K B. Jka and c C. E and c D. Fya and M

What observation is apparent with one of the antibodies present on Panel 3? A. One antibody is only reacting with heterozygous cells B. Both antibodies are only reacting with homozygous cells C. One antibody is only reacting with homozygous cells D. Both antibodies are exhibiting dosage

SITUATION: An emergency trauma patient requires transfusion. Six units of blood are ordered stat. There is no time to draw a patient sample. O-negative blood is released. When will compatibility testing be performed? A. Compatibility testing must be performed before blood is issued B. Compatibility testing will be performed when a patient sample is available C. Compatibility testing may be performed immediately using donor serum D. Compatibility testing is not necessary when blood is released in emergency situations

How would autoantibodies affect compatibility testing? A. No effect B. The DAT would be positive C. ABO, Rh, antibody screen, and crossmatch may show abnormal results D. Results would depend on the specificity of autoantibody

An antibody screen is reactive at IAT phase of testing using a three-cell screen and the autocontrol is negative. What is a possible explanation for these results? A. A cold alloantibody B. High-frequency alloantibody or a mixture of alloantibodies C. A warm autoantibody D. A cold and warm alloantibody

What does a minor crossmatch consist of? A. Recipient plasma and recipient red cells B. Recipient plasma and donor red cells C. Recipient red cells and donor plasma D. Donor plasma and donor red cells

Can crossmatching be performed on October 14th using a patient sample drawn on October 12th? A. Yes, a new sample would not be needed B. Yes, but only if the previous sample has no alloantibodies C. No, a new sample is needed because the 2-day limit has expired D. No, a new sample is needed for each testing

A type and screen was performed on a 32-year-old woman, and the patient was typed as AB negative. There are no AB-negative units in the blood bank. What should be done? A. Order AB-negative units from a blood supplier B. Check inventory of A-, B-, and O-negative units C. Ask the patient to make a preoperative autologous donation D. Nothing—the blood will probably not be used

What ABO types may donate to any other ABO type? A. A negative, B negative, AB negative, O negative B. O negative C. AB negative D. AB negative, A negative, B negative

What type(s) of red cells is (are) acceptable to transfuse to an O-negative patient? A. A negative, B negative, AB negative, or O negative B. O negative C. AB negative D. AB negative, A negative, B negative

A technologist removed 4 units of blood from the blood bank refrigerator and placed them on the counter. A clerk was waiting to take the units for transfusion. As she checked the paperwork, she noticed that one of the units was leaking onto the counter. What should she do? A. Issue the unit if the red cells appear normal B. Reseal the unit C. Discard the unit D. Call the medical director and ask for an opinion

A donor was found to contain anti-K using pilot tubes from the collection procedure. How would this affect the compatibility test? A. The AHG major crossmatch would be positive B. The IS (immediate spin) major crossmatch would be positive C. The recipient’s antibody screen would be positive for anti-K D. Compatibility testing would not be affected

Which of the following is not a requirement for the electronic crossmatch? A. The computer system contains logic to prevent assignment and release of ABO incompatible blood B. There are concordant results of at least two determinations of the recipient’s ABO type on record, one of which is from the current sample C. Critical elements of the system have been validated on site D. There are concordant results of at least one determination of the recipient’s ABO type on file

A patient showed positive results with screening cells and 4 donor units. The patient autocontrol was negative. What is the most likely antibody? A. Anti-H B. Anti-S C. Anti-Kpa D. Anti-k

Screening cells and major crossmatch are positive on IS only, and the autocontrol is negative. Identify the problem. A. Cold alloantibody B. Cold autoantibody C. Abnormal protein D. Antibody mixture

Six units are crossmatched. Five units are compatible, one unit is incompatible, and the recipient’s antibody screen is negative. Identify the problem: A. Patient may have an alloantibody to a high-frequency antigen B. Patient may have an abnormal protein C. Donor unit may have a positive DAT D. Donor may have a high-frequency antigen

An incompatible donor unit is found to have a positive DAT. What should be done with the donor unit? A. Discard the unit B. Antigen type the unit for high-frequency antigens C. Wash the donor cells and use the washed cells for testing D. Perform a panel on the incompatible unit

Screening cells, major crossmatch, and patient autocontrol are positive in all phases. Identify the problem. A. Specific cold alloantibody B. Specific cold autoantibody C. Abnormal protein or nonspecific autoantibody D. Cold and warm alloantibody mixture

A panel study has revealed the presence of patient alloantibodies. What is the first step in a major crossmatch? A. Perform a DAT on patient cells and donor units B. Antigen type patient cells and any donor cells to be crossmatched C. Adsorb any antibodies from the patient serum D. Obtain a different enhancement medium for testing

What is the disposition of a donor red blood cell unit that contains an antibody? A. The unit must be discarded B. Only the plasma may be used to make components C. The antibody must be adsorbed from the unit D. The unit may be labeled indicating it contains antibody and released into inventory