TEST BANK FOR IMMUNOHEMATOL OGY 4TH EDITION BY HOWARD | VERIFIED 2023/2024

Donor records are legal documents and permanent medical records. How are errors properly corrected? a. Erasing the error and correcting the information in red ink b. Drawing many lines through the error and dating the error c. Drawing a single line through the error, correcting and dating the error, and initialing the correction d. Write over the error and date the correction  Good documentation requires the drawing of a single line through the error, correcting and dating the error, and initialing the correction. Some policies also require the reason for the correction to be documented. 3. What area does the Centers for Medicare and Medicaid Services (CMS) regulate? a. Donor testing only b. All laboratory testing c. All laboratory testing including research d. Recipient testing only  CMS regulates all laboratory testing (except research) performed on humans in the United States. The Clinical Laboratory Improvement Amendments of 1988 were enacted to ensure safe and accurate laboratory work. CMS issues a certification to laboratories or other test sites performing clinical tests on human samples. 4. Select the statement that BEST describes Good Manufacturing Practices (GMPs). a. Apply to the blood bank and not the transfusion service b. Include SOP and written record guidelines but not computerized record guidelines c. Do not apply to supplier qualifications d. Regulations that itemize what needs to be done without specifying how  Good Manufacturing Practices are performed in blood banks and transfusion services as part of QA and are legal requirements established by the FDA. These regulations itemize “what” needs to be done without necessarily specifying “how.” In other words, each organization must determine the best way to implement all these practices. HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 2 | P a g e 5. A new technologist reported to work in her regulation scrubs with her long hair neatly tied back. She was wearing her new large hoop earrings and gold bangles. Her shoes were new leather sneakers for comfort. Did she violate any safety rules for personal attire? a. No, she met all safety requirements. b. Yes, her hair was too long to work in the lab. c. Yes, her shoes were not made of nylon. d. Yes, she had excessive jewelry that could be a problem.  Hair should be secured away from the face and off the shoulders. Jewelry should be kept to a minimum, and rings that could perforate gloves should not be worn. Open-toed shoes are not permitted in areas where blood exposure exists. Cosmetics should not be applied in the laboratory. 6. What is the minimum personal protective equipment needed when splashes are likely to occur in the laboratory? a. Lab coat, gloves, safety glasses b. Lab coat, gloves, protective apron c. Lab coat and gloves d. None of the above  Safety glasses or goggles should be worn when splashes are likely to occur during a task. Face shields offer greater protection because they protect the mouth, nose, and eyes. Face shields are made of shatterproof plastic and wrap around the face. 7. Where should biohazardous needles and glass materials be disposed? a. Biohazardous waste red plastic bag b. Regular trash can c. Leakproof solid plastic container (“sharps”) d. Any of the above  Needles and glass need a special hard plastic container for disposal called a sharps container. 8. A technologist in training noticed that the person training her had some food and water stored in her reagent refrigerator. Is this an acceptable practice? a. Yes b. No Food or drink should not be allowed in the blood storage or testing areas. TRUE/FALSE 1. The Food and Drug Administration classifies blood as a drug. ANS: T  Yes, the FDA classifies blood as a drug and requires all blood banks and transfusion services to follow its legally required standards. HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 3 | P a g e 2. Proper glove techniques require that gloves are washed with soap after handling blood samples so they can be used again. ANS: F  A prudent part of the safety procedure of the blood bank includes the policy that all employees must wear gloves when tasks are likely to involve exposure to blood. Gloves used in a contaminated area should not be worn to a “clean” area or when using or touching telephones, doorknobs, or computer terminals. Gloves should be discarded after use and never washed. HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 4 | P a g e Chapter 02 Immunology: Basic Principles and Applications in the Blood Bank Review Questions 1. Select the cells that will undergo transformation to become plasma cells. a. Neutrophils b. T lymphocytes c. B lymphocytes d. Monocytes  B lymphocytes have the ability to transform into plasma cells and produce antibodies, which is considered a humoral response. 2. What process is described by the engulfment of antibody-coated red cells? a. Lysis of cells b. Binding to cells or antigens c. Agglutination d. Phagocytosis  Phagocytosis removes antibody-coated red cells from the circulation through the mononuclear phagocyte system (also known as reticuloendothelial system). 3. Select the sources of antigen for immunohematology testing. a. Patient red cells and plasma b. Commercial and patient red cells c. Patient plasma and commercial red cells d. Commercial antisera and red cells  For antigen testing, antigens are on patient and commercial red cells; antibodies are in patient plasma and commercial antisera. 4. In transfusion medicine, what is the name of the process whereby antibodies attached to red cell antigens signal clearance in the liver and spleen? a. Classical complement pathway b. Intravascular hemolysis c. Alternative complement pathway d. Extravascular hemolysis  Extravascular hemolysis: red cell destruction by phagocytes residing in the liver and spleen, usually facilitated by IgG opsonization. 5. What antibodies are best detected at 37° C and can cause immune-mediated destruction of transfused red cells possessing the corresponding antigen? a. IgM b. IgG c. Both IgM and IgG d. Neither IgM nor IgG  Most clinically important antibodies react at body temperature (37° C), are IgG, and can cause immune destruction of transfused red cells possessing the corresponding antigen. HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 5 | P a g e 6. What type of immune response occurs within 1 to 3 days of exposure and contains a significant production of memory B cells? a. Primary b. Secondary c. Tertiary d. None of the above  The second contact with the identical antigen initiates a secondary immune response, or anamnestic response, within 1 to 3 days of exposure. Because of the significant production of memory B cells from the initial exposure, the concentrations of circulating antibody are much higher and sustained for a much longer period. 7. What is the classification of red cell antibodies produced in response to transfusion and pregnancies? a. Naturally occurring antibodies b. HLA antibodies c. Alloantibodies d. Autoantibodies  The antibodies produced in response to transfusion and pregnancies are classified as alloantibodies. 8. What is the potential effect in a tube agglutination result if a red cell suspension with a concentration less than 5% is used? a. False negatives b. False positives c. Hemolysis d. No effect  Antibody excess is termed prozone and will lessen the reaction, causing a false-negative result. 9. After adding antigen and antibody to a test tube, small agglutinates with many unagglutinated cells were observed. How should this reaction be graded? a. 1+ b. 2+ c. 3+ d. 4+ Small agglutinates with many unagglutinated red cells are a 1+ reaction. TRUE/FALSE 1. An antibody molecule can possess one kappa and one lambda light chain. FALSE  There are two types of light chains: kappa chains and lambda chains. Antibodies possess either two kappa or two lambda chains but never one of each. HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 6 | P a g e Chapter 03 Blood Banking Reagents: Overview and Applications Review Questions 1. The FDA has established minimum standards relating to product quality for use in blood banks and transfusion services before assignment of license to a commercial reagent. What term relates to the strength of the product? a. Potency b. Specificity  Potency addresses the strength of the Ag-Ab reaction in commercially formulated products. For example, commercial anti-A reagents are manufactured to agglutinate strongly (3+ to 4+) with red cells possessing the A antigen. 2. Select the test method that may use a rabbit polyclonal anti-IgG. a. D phenotype b. Reverse ABO grouping c. Forward ABO grouping d. Antiglobulin test  The antiglobulin test uses a reagent that has been prepared by injecting animals (e.g., rabbits) with human antibody molecules (human IgG) and complement proteins. In these animals, the injected proteins are recognized as foreign antigens, stimulating the animal’s immune system to produce antibodies to human antibody molecules and complement proteins. 3. What term describes technical procedures to determine whether the analytic testing phase is working properly? a. Quality assurance b. Specificity testing c. Quality control d. Reference standards  Quality control is the term assigned to technical procedures to determine whether the analytic testing phase is working properly. Quality control includes checks on blood banking reagents and equipment before their use in tests on patient or donor samples. 4. Commercial antibody screening and panel cells always use group O. What is the reason for this choice? a. To avoid spontaneous agglutination b. To avoid significant hemolysis over time c. To prevent loss of agglutination strength over time d. To prevent reactions with anti-A and anti-B  Group O donors are selected because the group O phenotype lacks A and B antigens, and so these red cells do not react with ABO antibodies present in patient or donor serum or plasma. Serum or plasma from any ABO type may be used in the antibody screen or antibody identification test without interference from the ABO antibodies. HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 7 | P a g e 5. You have added IgG-sensitized red cells to the negative indirect antiglobulin test result in the antibody screen procedure. You observe no agglutination in the tube. What is the interpretation for this antibody screen? a. Positive b. Negative c. Cannot determine  IgG-sensitized red cells were designed as an additive system for negative antiglobulin tests to detect false-negative results. When added to a negative AHG test, the IgG-sensitized red cells should react with the AHG reagent and show agglutination. 6. Select a source of a potential false-positive result in antiglobulin testing. a. Improper centrifugation b. Failure to identify weak positive reactions c. Failure to incubate at 37° C d. Contamination of reagent with human serum  Not following the recommended centrifugation time and speed can produce false-positive reactions, especially if overcentrifugation occurs. 7. What potentiator works by increasing the rate of antibody uptake? a. Bovine serum albumin b. Polyethylene glycol c. LISS d. Ficin  The incubation of serum and red cells in a reduced ionic environment increases the rate of antibody binding to specific antigen receptor sites on red cells. 8. What lectin possesses the specificity for the H antigen? a. Iberis amara b. Dolichos biflorus c. Ulex europaeus d. Vicia graminea  Lectins: plant extracts useful as blood banking reagents; they bind to carbohydrate portions of certain red cell antigens and agglutinate the red cells. Ulex europaeus will react with H antigens. 9. Can you accurately interpret a patient’s group AB, Dpositive result in ABO and D typing tests using monoclonal antibody reagents without additional testing? a. Yes b. No  No. If red cells agglutinate with anti-A, anti-B, and anti-D, a reagent control is required to confirm the results are due to true agglutination, and not due to spontaneous polyagglutination. The reagent control should HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 8 | P a g e be performed as described by the reagent manufacturer. 10. What document provides the antigen phenotypes for each donor used in the manufacture of commercially supplied screening and panel cells? a. Product insert b. Antigram c. Red cell profiles d. Donor phenotypes  Antigram: profile of antigen phenotypes for each donor used in the manufacture of commercially supplied screening and panel cells. Antigrams will differ with each lot of commercial red cells. HOWARD – IMMUNOHEMATOLOGY 4TH EDITION STUDY QUESTIONS 9 | P a g e Chapter 04 Genetic Principles in Blood Banking Review Questions 1. Which of the following red cell phenotypes would react most strongly with anti-M? a. M+N+ b. M+N− c. M−N+ d. M−N−  M+N− is a homozygote and contains more M antigen than an M+N+ heterozygote. 2. The patient’s red cell _____________ is determined by hemagglutination of red cell antigens using specific antisera. a. phenotype b. genotype c. haplotype d. idiotype  The phenotype, or the physical expression of inherited traits, is determined by reacting red cells with known antisera and observing for the presence or absence of hemagglutination. 3. When Ce is inherited in trans to D gene, what happens to the D antigen expression on the red cell? a. Stronger b. Weaker c. The same d. Varies with the method  Sometimes genes can interact with each other, depending on whether they are inherited on the same chromosome (cis) or on the opposite chromosome (trans). Inheritance of the Ce gene in trans to the D gene may weaken the expression of the D antigen encoded by the gene. 4. What term is defined as the phenomenon of antigens occurring at a different frequency in the population, depending on whether they were inherited by linked or unlinked genes? a. X-linked dominant b. X-linked recessive c. Linkage disequilibrium d. Autosomal recessive