Blood Bank Rotation Final Exam 2025/2026 |
100% Verified Q&A | Transfusion Medicine,
Immunohematology & Hemolytic Anemia
Review.
Identify 3 categories of immune hemolytic anemia
1) Autoimmune
2) Alloimmune (patient's antibodies on donor's cells, mother's antibodies on babies' cells)
3) Drug-induced
What are 4 mechanisms of drug-induced hemolytic anemia?
1) Drug-Adsorption (Hapten) Mechanism
2) Drug-dependent or Immune Complex ("Innocent Bystander") Mechanism
3) Membrane Modification (Nonimmunologic Protein Adsorption)
4) Autoantibody Formation
What is the Drug-Adsorption (Hapten) Mechanism?
Drugs bind firmly to proteins, including proteins of the RBC membrane
What is the Drug-dependent or Immune Complex ("Innocent Bystander") Mechanism?
Drugs combine with plasma proteins to form immunogens
What is the Membrane Modification (Nonimmunologic Protein Adsorption) Mechanism?
Drugs modify RBCs so that plasma proteins (antibodies & complement) can bind to the
membrane
What are 5 techniques that can be used to decrease the likelihood of an interfering cold
autoantibody?
1) Pre-warm patient's sample
2) Wash patient RBCs with saline warmed to 37C
3) Patient's RBCs can be treated with dithiothreitol (DTT) to denature IgM autoantibodies
4) Cold autoadsorption
5) Use monospecific IgG instead of AHG
What are 4 causes of false positive reactions that may be seen in blood bank testing?
,1) Rouleaux --> false pos in forward and reverse type
2) Cold antibodies --> false pos in reverse type
3) Tech error --> used wrong reagent, centrifuged for too long
4) Wharton's Jelly --> false pos DAT when using infant cord blood
What are 4 immunological reasons a technologist may observe a positive DAT?
1) Hemolytic Transfusion Reaction (HTR) --> recipient antibody coating donor RBCs
2) Hemolytic Disease of the Newborn (HDN) --> maternal antibody coating baby RBCs
3) Autoimmune Hemolytic Anemia --> autoantibody coating individual's RBCs
4) Drug-induced
What are 3 types of Hemolytic Disease of the Newborn (HDN)?
1) ABO
2) Rh
3) Other blood groups (ex: Kell, Duffy)
What are 2 mechanisms to suppress maternal alloimmunization?
1) RhIg (RhoGam)
2) Plasma exchange
What are 2 common IgG antibodies that can cause HDN and transfusion reactions?
1) anti-A and anti-B from type "O" mothers
2) anti-D
Why is it important to quantify the fetal-maternal hemorrhage?
Because quantification allows you to calculate the number of vials of RhoGam that need to be
administered to the mother
How do you calculate the correct dose of RhoGam needed in the case of a fetal maternal
bleed
Step 1) Maternal Blood Volume (mL) = Pre-pregnant weight in kg X 70 mL/kg
Step 2) Kleihauer-Betke% X maternal BV = Baby mLs
Step 3) Baby mLs/30 mLs = # vials of RhoGam
Step 4) if # of vials has decimal of .0 to 0.4 then add 1
if # of vials has decimal of .5 to .9 then add 2
Step 5) round number of vials normally
What is a fetal maternal bleed?
baby's cells enter mom's circulation during delivery
, What are 4 tests used to detect fetal-maternal hemorrhage?
1) Rosette Test (Fetal Blood Screen) --> Qualitative
2) Kleihauer Betke --> Quantitative
3) ELAT (Enzyme Linked Antiglobulin Test) --> Quantitative
4) Flow Cytometry --> Quantitative
What are 6 indications for RBC transfusions in newborns?
1) HDN
2) Failure to thrive
3) Iatrogenic blood loss (caused by repeated phlebotomies)
4) Increasd bilirubin (bilirubin = byproduct of RBC breakdown)
5) Sepsis
6) Uridine diphosphate deficiency
What is RhIg?
anti-D that is given to D-negative mothers (once during pregnancy and once after delivery) who
are pregnant with a D-positive baby. It prevents alloimmunization of the mother (since D-
positive fetal cells may enter mom's circulation during birth).
What is HDFN
hemolytic disease of the fetus and newborn --> when maternal IgG antibodies cross the
placenta and attack fetal RBCs (caused by fetomaternal blood group incompatibility)
What is ECMO?
extracorporeal membrane oxygenation --> A short term life support system that circulates the
blood through an oxygenating system. Bypasses the heart and lungs.
What is Iatrogenic blood loss?
anemia from blood collection
What is autocontrol?
Tests the patient's plasma with their or RBCs. Detects in vivo sensitization, and is included as a
part of an antibody ID panel.
What is massive transfusion.
Equivalent to total body replacement within 24 hrs. (transfusion of 10 units of RBCs within 24
hrs)
What is a nonspecific reaction?
100% Verified Q&A | Transfusion Medicine,
Immunohematology & Hemolytic Anemia
Review.
Identify 3 categories of immune hemolytic anemia
1) Autoimmune
2) Alloimmune (patient's antibodies on donor's cells, mother's antibodies on babies' cells)
3) Drug-induced
What are 4 mechanisms of drug-induced hemolytic anemia?
1) Drug-Adsorption (Hapten) Mechanism
2) Drug-dependent or Immune Complex ("Innocent Bystander") Mechanism
3) Membrane Modification (Nonimmunologic Protein Adsorption)
4) Autoantibody Formation
What is the Drug-Adsorption (Hapten) Mechanism?
Drugs bind firmly to proteins, including proteins of the RBC membrane
What is the Drug-dependent or Immune Complex ("Innocent Bystander") Mechanism?
Drugs combine with plasma proteins to form immunogens
What is the Membrane Modification (Nonimmunologic Protein Adsorption) Mechanism?
Drugs modify RBCs so that plasma proteins (antibodies & complement) can bind to the
membrane
What are 5 techniques that can be used to decrease the likelihood of an interfering cold
autoantibody?
1) Pre-warm patient's sample
2) Wash patient RBCs with saline warmed to 37C
3) Patient's RBCs can be treated with dithiothreitol (DTT) to denature IgM autoantibodies
4) Cold autoadsorption
5) Use monospecific IgG instead of AHG
What are 4 causes of false positive reactions that may be seen in blood bank testing?
,1) Rouleaux --> false pos in forward and reverse type
2) Cold antibodies --> false pos in reverse type
3) Tech error --> used wrong reagent, centrifuged for too long
4) Wharton's Jelly --> false pos DAT when using infant cord blood
What are 4 immunological reasons a technologist may observe a positive DAT?
1) Hemolytic Transfusion Reaction (HTR) --> recipient antibody coating donor RBCs
2) Hemolytic Disease of the Newborn (HDN) --> maternal antibody coating baby RBCs
3) Autoimmune Hemolytic Anemia --> autoantibody coating individual's RBCs
4) Drug-induced
What are 3 types of Hemolytic Disease of the Newborn (HDN)?
1) ABO
2) Rh
3) Other blood groups (ex: Kell, Duffy)
What are 2 mechanisms to suppress maternal alloimmunization?
1) RhIg (RhoGam)
2) Plasma exchange
What are 2 common IgG antibodies that can cause HDN and transfusion reactions?
1) anti-A and anti-B from type "O" mothers
2) anti-D
Why is it important to quantify the fetal-maternal hemorrhage?
Because quantification allows you to calculate the number of vials of RhoGam that need to be
administered to the mother
How do you calculate the correct dose of RhoGam needed in the case of a fetal maternal
bleed
Step 1) Maternal Blood Volume (mL) = Pre-pregnant weight in kg X 70 mL/kg
Step 2) Kleihauer-Betke% X maternal BV = Baby mLs
Step 3) Baby mLs/30 mLs = # vials of RhoGam
Step 4) if # of vials has decimal of .0 to 0.4 then add 1
if # of vials has decimal of .5 to .9 then add 2
Step 5) round number of vials normally
What is a fetal maternal bleed?
baby's cells enter mom's circulation during delivery
, What are 4 tests used to detect fetal-maternal hemorrhage?
1) Rosette Test (Fetal Blood Screen) --> Qualitative
2) Kleihauer Betke --> Quantitative
3) ELAT (Enzyme Linked Antiglobulin Test) --> Quantitative
4) Flow Cytometry --> Quantitative
What are 6 indications for RBC transfusions in newborns?
1) HDN
2) Failure to thrive
3) Iatrogenic blood loss (caused by repeated phlebotomies)
4) Increasd bilirubin (bilirubin = byproduct of RBC breakdown)
5) Sepsis
6) Uridine diphosphate deficiency
What is RhIg?
anti-D that is given to D-negative mothers (once during pregnancy and once after delivery) who
are pregnant with a D-positive baby. It prevents alloimmunization of the mother (since D-
positive fetal cells may enter mom's circulation during birth).
What is HDFN
hemolytic disease of the fetus and newborn --> when maternal IgG antibodies cross the
placenta and attack fetal RBCs (caused by fetomaternal blood group incompatibility)
What is ECMO?
extracorporeal membrane oxygenation --> A short term life support system that circulates the
blood through an oxygenating system. Bypasses the heart and lungs.
What is Iatrogenic blood loss?
anemia from blood collection
What is autocontrol?
Tests the patient's plasma with their or RBCs. Detects in vivo sensitization, and is included as a
part of an antibody ID panel.
What is massive transfusion.
Equivalent to total body replacement within 24 hrs. (transfusion of 10 units of RBCs within 24
hrs)
What is a nonspecific reaction?
