LATEST PATHOLOGY - BLOOD
BANKING/TRANSFUSION MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PATHOLOGY |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 45-year-old woman with a history of multiple
pregnancies presents for preoperative blood typing.
Her forward typing shows no reactivity with anti-A or
anti-B. Reverse typing shows 4+ reactivity with A1
cells and 4+ reactivity with B cells. What is her ABO
blood type?
A) A
B) B
C) AB
D) O
Correct answer: D
Rationale: Group O individuals lack A and B antigens
on red cells (forward typing negative) and have both
anti-A and anti-B antibodies in serum (reverse typing
positive with A1 and B cells). This is the most
common ABO type.
,2. A 30-year-old man is brought to the emergency
department after a motor vehicle accident with
massive hemorrhage. He requires an emergency
transfusion. Which blood component should be
transfused first before the type and screen is
complete?
A) Whole blood
B) O negative packed red blood cells
C) AB positive packed red blood cells
D) Fresh frozen plasma
Correct answer: B
Rationale: O negative red blood cells are the
universal donor for RBCs and can be given
emergently before blood typing is complete. O
negative lacks A and B antigens, minimizing risk of
hemolytic transfusion reaction. ABO-specific blood
should be used once type is known.
3. A 55-year-old man with sickle cell disease receives
a chronic transfusion program. His pre-transfusion
workup now shows a new alloantibody that reacts
with all panel cells except those lacking the Duffy
antigen. The antibody is IgG and shows dosage. What
is the most likely antibody specificity?
A) Anti-K
,B) Anti-Fy(a)
C) Anti-Jk(a)
D) Anti-S
Correct answer: B
Rationale: Anti-Fy(a) is a common alloantibody in
multiply transfused patients. It shows dosage
(stronger reactivity with homozygous Fy(a+b-) cells)
and is typically IgG. Duffy antibodies can cause
delayed hemolytic transfusion reactions.
4. A 68-year-old man with cold agglutinin disease
requires a type and screen. His sample shows 4+
agglutination at immediate spin and room
temperature that resolves after warming to 37°C.
What is the most appropriate next step?
A) Report the patient as ABO incompatible
B) Wash the red cells with warm saline and repeat
testing at 37°C
C) Perform an electronic crossmatch
D) Issue O negative blood without further testing
Correct answer: B
Rationale: Cold agglutinins (usually IgM anti-I) cause
in vitro agglutination at room temperature. Washing
red cells with warm saline and performing all testing
, at 37°C removes the interference. The ABO type is
still reliable after warm washing.
5. A 32-year-old pregnant woman at 28 weeks
gestation has a positive antibody screen. Antibody
identification reveals anti-D with a titer of 1:16. She is
Rh-negative and her partner is Rh-positive. What is
the most appropriate next step?
A) No intervention needed; titer is low
B) Administer Rh immune globulin at 28 weeks
C) Perform amniocentesis for fetal genotyping
D) Serial Doppler ultrasound of the middle cerebral
artery
Correct answer: D
Rationale: Anti-D titer ≥1:16 (or 1:8 depending on lab)
indicates risk for fetal hemolytic disease. Serial MCA
Doppler (peak systolic velocity) is the non-invasive
standard to detect fetal anemia. Amniocentesis (C) is
invasive and used only when Doppler is abnormal.
6. A 25-year-old woman with idiopathic
thrombocytopenic purpura requires platelet
transfusion. Her platelet count is 5,000/μL with active
bleeding. What is the most appropriate platelet
product?
BANKING/TRANSFUSION MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PATHOLOGY |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 45-year-old woman with a history of multiple
pregnancies presents for preoperative blood typing.
Her forward typing shows no reactivity with anti-A or
anti-B. Reverse typing shows 4+ reactivity with A1
cells and 4+ reactivity with B cells. What is her ABO
blood type?
A) A
B) B
C) AB
D) O
Correct answer: D
Rationale: Group O individuals lack A and B antigens
on red cells (forward typing negative) and have both
anti-A and anti-B antibodies in serum (reverse typing
positive with A1 and B cells). This is the most
common ABO type.
,2. A 30-year-old man is brought to the emergency
department after a motor vehicle accident with
massive hemorrhage. He requires an emergency
transfusion. Which blood component should be
transfused first before the type and screen is
complete?
A) Whole blood
B) O negative packed red blood cells
C) AB positive packed red blood cells
D) Fresh frozen plasma
Correct answer: B
Rationale: O negative red blood cells are the
universal donor for RBCs and can be given
emergently before blood typing is complete. O
negative lacks A and B antigens, minimizing risk of
hemolytic transfusion reaction. ABO-specific blood
should be used once type is known.
3. A 55-year-old man with sickle cell disease receives
a chronic transfusion program. His pre-transfusion
workup now shows a new alloantibody that reacts
with all panel cells except those lacking the Duffy
antigen. The antibody is IgG and shows dosage. What
is the most likely antibody specificity?
A) Anti-K
,B) Anti-Fy(a)
C) Anti-Jk(a)
D) Anti-S
Correct answer: B
Rationale: Anti-Fy(a) is a common alloantibody in
multiply transfused patients. It shows dosage
(stronger reactivity with homozygous Fy(a+b-) cells)
and is typically IgG. Duffy antibodies can cause
delayed hemolytic transfusion reactions.
4. A 68-year-old man with cold agglutinin disease
requires a type and screen. His sample shows 4+
agglutination at immediate spin and room
temperature that resolves after warming to 37°C.
What is the most appropriate next step?
A) Report the patient as ABO incompatible
B) Wash the red cells with warm saline and repeat
testing at 37°C
C) Perform an electronic crossmatch
D) Issue O negative blood without further testing
Correct answer: B
Rationale: Cold agglutinins (usually IgM anti-I) cause
in vitro agglutination at room temperature. Washing
red cells with warm saline and performing all testing
, at 37°C removes the interference. The ABO type is
still reliable after warm washing.
5. A 32-year-old pregnant woman at 28 weeks
gestation has a positive antibody screen. Antibody
identification reveals anti-D with a titer of 1:16. She is
Rh-negative and her partner is Rh-positive. What is
the most appropriate next step?
A) No intervention needed; titer is low
B) Administer Rh immune globulin at 28 weeks
C) Perform amniocentesis for fetal genotyping
D) Serial Doppler ultrasound of the middle cerebral
artery
Correct answer: D
Rationale: Anti-D titer ≥1:16 (or 1:8 depending on lab)
indicates risk for fetal hemolytic disease. Serial MCA
Doppler (peak systolic velocity) is the non-invasive
standard to detect fetal anemia. Amniocentesis (C) is
invasive and used only when Doppler is abnormal.
6. A 25-year-old woman with idiopathic
thrombocytopenic purpura requires platelet
transfusion. Her platelet count is 5,000/μL with active
bleeding. What is the most appropriate platelet
product?
