lOMoARcPSD|19783995

Immunohema- Prelims- Question BANK

Immunology & Serology (University of Perpetual Help System DALTA)

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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

TOPIC 1: INTRODUCTION (BLANEY) c. irradiation of the blood product
1. Antibodies are produced by: d. providing HLA-matched blood products
a. natural killer cells
b. T cells 12. Complement activation can result in:
c. macrophages a. cell lysis
d. plasma cells b. enhanced cell clearance
2. Which of the following cells expresses HLA class II c. neutrophil activation
antigens? d. generation of vasoactive amines
a. B cells e. all of the above
b. platelets
c. erythrocytes 13. The mixed lymphocyte culture (MLC) is an older
d. T cells technique in the HLA laboratory used to
3. Select the term that describes the unique part of determine:
the antigen that is recognized by a corresponding a. HLA-A antigens
antibody. b. HLA-C antigens
a. immunogen c. HLA antibody identification
b. epitope d. HLA-D antigens and compatibility
c. avidity
d. clone Match the characteristic with the correct
4. _____ molecules are usually not good immunoglobulin
immunogenic substances. Class
a. protein a. IgA - 16
b. carbohydrate b. IgG – 17, 18, 23
c. lipid c. IgM – 14, 15, 19, 20, 22, 24, 25
d. glycoprotein d. IgE - 21

5. The chemical composition of an antibody is: 14. contains 10 antigen-binding sites

a. protein 15. produced early in an immune response
b. lipid 16. found in mucosal linings
c. carbohydrate 17. able to cross the placenta
d. glycoprotein 18. highest plasma/serum concentration
19. pentameter shape
6. In a hemagglutination test, the antigen is: 20. activates the complement cascade most
a. on the red cell membrane efficiently
b. secreted by the red cell 21. can initiate allergic reactions
c. in the red cell nucleus 22. associated with intravascular cell destruction
d. in the plasma or serum 23. detected with the antiglobulin test
24. detected in the immediate-spin phase of the
7. Hemagglutination can be enhanced by agglutination test
increasing: 25. reacts best at room temperature
a. the temperature higher than 37° C
b. the incubation time TOPIC 1: INTRODUCTION (HARMENING)
c. increasing the antigen concentration 1. Which of the following is not involved in the
d. pH greater than 7 acquired
(adaptive) immune response?
8. Molecules that bind to an antigen to increase a. Phagocytosis
phagocytosis are: b. Production of antibody or complement
a. opsonins c. Induction of immunologic memory
b. cytokines d. Accelerated immune response upon subsequent
c. haptens exposure to antigen
d. isotypes
2. Which cells are involved in the production of
9. An epitope is also termed a(n): antibodies?
a. binding site a. Dendritic cells
b. allotype b. T lymphocytes
c. antigenic determinant c. B lymphocytes
d. immunogen d. Macrophages

10. Agglutination reactions characterized by many 3. Which of the following cells is involved in antigen
small agglutinates in a background of free cells recognition following phagocytosis?
would be graded in tube testing as: a. B lymphocytes
a. 1+ b. T lymphocytes
b. 2+ c. Macrophages
c. 3+ d. Granulocytes
d. 4+
4. The role of the macrophage during an antibody
11. An order for blood products for a recent recipient response
of a bone marrow graft was received in the is to:
transfusion service. Because these patients are a. Make antibody.
especially susceptible to GVHD from a b. Lyse virus-infected target cells.
transfusion, which blood product would best c. Activate cytotoxic T cells.
prevent GVHD? d. Process antigen and present it.
a. leukocyte reduction of the unit
b. washing the unit with normal saline

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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

5. Which of the following immunoglobulins is a. Postzone
produced in b. Prozone
the primary immune response? c. Zone of equivalence
a. IgA d. Endzone
b. IgE
c. IgG 15. Which of the following refers to the presence of
d. IgM an
excess amount of antibody present in a test system?
6. Which of the following immunoglobulins is a. Postzone
produced in b. Prozone
the secondary immune response? c. Zone of equivalence
a. IgA d. Endzone
b. IgE
c. IgG 16. Which one of the following properties of
d. IgM antibodies is NOT dependent on the structure of the
heavy chain constant region?
7. Which of the following MHC classes encodes a. Ability to cross the placenta
complement b. Isotype (class)
components? c. Ability to fix complement
a. Class I d. Affinity for antigen
b. Class II
c. Class III 17. Molecules that promote the update of bacteria
d. Class IV for phagocytosis are:
a. Opsonins.
8. Which of the following immunoglobulins is most b. Cytokines.
efficient c. Haptens.
at binding complement? d. Isotypes.
a. IgA
b. IgE 18. Select the term that describes the unique
c. IgG confirmation
d. IgM of the antigen that allows recognition by a
corresponding antibody.
9. Which portion of the immunoglobulin molecules a. Immunogen
contains b. Epitope
complement binding sites? c. Avidity
a. Heavy chain variable region d. Clone
b. Light chain variable region
c. Heavy chain constant region 19. Which of the following terms refers to the net
d. Light chain constant region negative
charge surrounding red blood cells?
10. Which complement pathway is activated by the a. Dielectric constant
formation of antigen-antibody complexes? b. Van der Waals forces
a. Classical c. Hydrogen bonding
b. Alternative d. Zeta potential
c. Lectin
d. Retro TOPIC 2: INTRODUCTION TO ROUTINE TESTING
IN IMMUNOHEMATOLOGY (BLANEY)
11. Which of the following is known as the 1. What is the purpose of including a reagent control
“recognition unit” in the classical complement when interpreting group AB, D-positive red cells after
pathway? testing with a low-protein anti-D reagent?
a. C1q a. to detect false-positive agglutination reactions
b. C3a b. to detect false-negative agglutination reactions
c. C4 c. to identify a mix up with patient’s sample
d. C5 d. to confirm ABO typing results
12. Which of the following is known as the 2. Monospecific AHG reagents:
“membrane attack complex” in the classical a. increase the dielectric constant in-vitro
complement pathway? b. contain either anti-IgG or anti-C3d antibody
a. C1 specificities
b. C3 c. are not useful in identifying the molecule causing a
c. C4, C2, C3 positive DAT
d. C5b, C6, C7, C8, C9 d. contain human IgG or complement molecules
13. Which of the following immunoglobulin classes is 3. You have added IgG-sensitized red cells to a
capable of crossing the placenta and causing negative indirect antiglobulin test. You observe
hemolytic agglutination in the tube. What situation was not
disease of the newborn? controlled for in testing by adding these control cells?
a. IgA a. the addition of patient serum
b. IgE b. the addition of AHG reagent
c. IgG c. adequate washing of cell suspension
d. IgM d. adequate potency of AHG reagent
14. Which of the following refers to the effect of an 4. Part of the daily quality control in the blood bank
excess laboratory is the testing of reagent antisera with
amount of antigen present in a test system?
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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

corresponding antigen positive and antigen-negative
red cells. What does this procedure ensure? 14. To determine the presence of a red cell antibody
a. antibody class in a patient sample, what source of antigen is
b. antibody titer selected?
c. antibody specificity a. commercial reagent red cells
d. antibody sensitivity b. commercial antisera
c. patient serum
5. Group O red cells are used as a source for d. patient’s red cells
commercial screening cells because:
a. anti-A is detected using group O cells 15. What reagents are derived from plant extracts?
b. anti-D reacts with most group O cells a. panel cells
c. weak subgroups of A react with group O cells b. commercial anti-B
d. ABO antibodies do not react with group O cells c. lectins
d. antiglobulin reagents
6. Information regarding reagent limitations is
located in the:
a. SOPs TOPIC 2: INTRODUCTION TO ROUTINE TESTING
b. blood bank computer system IN IMMUNOHEMATOLOGY (HARMENING)
c. product inserts 1. A description of the antiglobulin test is:
d. product catalogs a. IgG and C3d are required for RBC sensitization.
b. Human globulin is completely eluted from RBCs
7. What regulatory agency provides licensure for during saline washings.
blood banking reagents? c. Human globulin is injected into an animal.
a. AABB d. AHG reacts with human globulin molecules bound
b. FDA to RBCs.
c. American Red Cross
d. College of American Pathologists 2. Polyspecific AHG reagent contains:
a. Anti-IgG and anti-IgA.
8. What antibodies are present in polyspecific AHG b. Anti-IgG and anti-IgM.
reagent? c. Anti-IgG and anti-C3d.
a. anti-IgG d. Anti-IgA and Anti-C3d.
b. anti-IgM and anti-IgG
c. anti-IgG and anti-C3d 3. Monoclonal anti-C3d is:
d. anti-C3d a. Derived from one clone of plasma cells.
b. Derived from multiple clones of plasma cells.
9. In which source are the regulations regarding the c. Derived from immunization of rabbits.
manufacturing of blood banking reagents published? d. Reactive with C3b and C3d.
a. Code of Federal Regulations
b. AABB Standards for Blood Banks 4. Which of the following is a clinically significant
and Transfusion Services antibody whose detection has been reported in some
c. AABB Technical Manual instances to be dependent on anticomplement
d. AABB Accreditation Requirements activity in polyspecific AHG?
Manual a. Anti-Jka
10. After the addition of anti-D reagent to a patient’s b. Anti-Lea
red cell suspension, agglutination was observed. The c. Anti-P1
result with anti-A reagent was negative. What is the d. Anti-H
interpretation of this patient’s D typing?
a. patient is D-negative 5. After the addition of IgG-coated RBCs (check cells)
b. patient is D-positive to a negative AHG reaction during an antibody
c. cannot interpret the test screen, a negative result is observed. Which of the
d. invalid result following is a correct interpretation based on these
findings?
11. What reagent would be selected to detect the a. The antibody screen is negative.
presence of unexpected red cell antibodies in a b. The antibody screen cannot be interpreted.
patient’s serum sample? c. The saline washings were adequate.
a. A1 and B cells d. AHG reagent was added.
b. panel cells
c. IgG-sensitized cells 6. RBCs must be washed in saline at least three
d. screening cells times before the addition of AHG reagent to:
a. Wash away any hemolyzed cells.
12. Select the method that uses the principle of b. Remove traces of free serum globulins.
sieving to separate larger agglutinates from smaller c. Neutralize any excess AHG reagent.
agglutinates in Ag-Ab reactions. d. Increase the antibody binding to antigen.
a. gel technology
b. solid-phase adherence 7. An in vivo phenomenon associated with a positive
c. microplate DAT is:
d. none of the above a. Passive anti-D detected in the maternal sample.
b. Positive antibody screen tested by LISS.
13. To determine the specificity of a red cell antigen c. Identification of alloantibody specificity using a
in a patient sample, what source of antibody is panel of reagent RBCs.
selected? d. Maternal antibody coating fetal RBCs.
a. commercial reagent red cells
b. commercial antisera 8. False-positive DAT results are most often
c. patient serum associated
d. patient plasma
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with: TOPIC 3: ABO BLOOD GROUP (BLANEY)
a. Use of refrigerated, clotted blood samples in which 1. Given the following ABO typing results, what
complement components coat RBCs in vitro. conclusion can be drawn from these results?
b. A recipient of a recent transfusion manifesting an
immune response to recently transfused RBCs.
c. Presence of antispecies antibodies from
administration
of immune globulin (IVIG). a. expected results for a group O individual
d. A positive autocontrol caused by b. expected results for a group AB individual
polyagglutination. c. discrepant results; patient has A antigen on red
cells with anti-A in serum
9. Polyethylene glycol (PEG) enhances d. discrepant results; patient has B antigen on red
antigenantibody cells with no anti-B in serum
reactions by:
a. Decreasing zeta potential. 2. What are the gene products of the A and B genes?
b. Concentrating antibody by removing water. a. glycolipids
c. Increasing antibody affinity for antigen. b. glycoproteins
d. Increasing antibody specificity for antigen. c. oligosaccharides
d. transferase enzymes
10. Solid-phase antibody screening is based on:
a. Adherence. For questions 3 through 5, use the following
b. Agglutination. ABO typing results:
c. Hemolysis.
d. Precipitation.

11. A positive DAT may be found in which of the

following 3. What is the ABO interpretation?
situations? a. group O
a. A weak D-positive patient b. group A
b. A patient with anti-M c. group B
c. HDFN d. group AB
d. An incompatible crossmatch
4. What ABO phenotypes would be compatible if the
12. What do Coombs’ check cells consist of? patient required a transfusion of RBCs?
a. Type A-positive cells coated with anti-IgG a. group AB, O, A, or B
b. Type A-negative cells coated with anti-IgG b. group O or B
c. Type O-positive cells coated with anti-D c. group AB or O
d. Type B-negative cells coated with anti-D d. only group O

13. Which of the following IAT methods requires the 5. What ABO phenotypes would be compatible if the
use of patient required a transfusion of fresh frozen plasma?
check cells? a. group AB, O, A, or B
a. Manual tube method with albumin b. group O or B
b. Gel c. group AB or O
c. Automated solid-phase analyzer d. only group O
d. Enzyme-linked
6. Using known sources of reagent antisera (known
14. Which uncontrollable factor can affect AHG antibodies) to detect ABO antigens on a patient’s red
testing? cells is known as:
a. Temperature a. Rh typing
b. Antibody affinity b. reverse grouping
c. Gravitational force in the centrifuge c. direct antiglobulin test
d. Incubation time d. forward grouping

15. Which would be the most efficient method for a 7. Which result is discrepant if the red cell typing
laboratory shown in the following chart is correct?
staffed by medical laboratory technicians?
a. LISS
b. Polybrene
c. Solid-phase or gel
d. Enzyme-linked a. negative reaction with group B cells
b. positive reaction with anti-B
16. A 27-year-old group O mother has just given c. negative reaction with group A1 cells
birth to a d. no discrepancies in these results
group A baby. Since the mother has IgG anti-A, anti-B
and anti-A, B in her plasma, which of the following 8. What ABO antibody is expected in this patient’s
methods and tests would be most effective at serum based on the following information?
detecting
the anti-A on the baby’s RBCs?
a. DAT using common tube technique
b. DAT using gel a. anti-B
c. IAT using common tube technique b. anti-A
d. IAT using gel c. anti-A and anti-B
d. none

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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

9. According to Landsteiner’s rule, if a patient has no 19. What soluble antigen forms are detectable in
ABO antibodies after serum testing, what ABO saliva based on the following genotype: AB, HH,
antigens are present on the patient’s red cells? SeSe?
a. A a. none (nonsecretor)
b. B b. only H
c. both A and B c. A, B, and H
d. none d. A and B

10. Select the ABO phenotypes, in order from most 20. Which ABO discrepancy is the best explanation
frequent to least frequent, that occur in whites: for the results shown in the following chart?
a. A, B, O, AB
b. O, A, B, AB
c. B, A, AB, O
d. AB, O, B, A
a. an elderly patient
11. Which of the following statements is true about b. subgroup of A
ABO antibody production? c. deterioration of reagents
a. ABO antibodies are present in newborns. d. hypogammaglobulinemia
b. ABO titers remain at constant levels throughout
life.
TOPIC 3: ABO BLOOD GROUP (HARMENING)
c. ABO antibodies are stimulated by bacteria and
other environmental factors. 1. An ABO type on a patient gives the following
d. All of these statements are true. reactions:

12. What immunoglobulin class is primarily

associated with ABO antibodies?
a. IgA
b. IgG What is the patient’s blood type?
c. IgE a. O
d. IgM b. A
c. B
13. What immunodominant sugar confers B blood d. AB
group specificity?
a. D-galactose 2. The major immunoglobulin class(es) of anti-B in a
b. L-fucose group A individual is (are):
c. N-acetylgalactosamine a. IgM.
d. L-glucose b. IgG.
c. IgM and IgG.
14. An individual has the genotype of AO, hh. What d. IgM and IgA.
antigens would be present on the red cells of this
individual? 3. What are the possible ABO phenotypes of the
a. A only offspring
b. A and H from the mating of a group A to a group B individual?
c. A and O a. O, A, B
d. none of the above b. A, B
c. A, B, AB
15. What gene controls the presence of soluble H d. O, A, B, AB
substance in saliva?
a. H 4. The immunodominant sugar responsible for blood
b. A group A specificity is:
c. Se a. L-fucose.
d. B b. N-acetyl-D-galactosamine.
c. D-galactose.
16. Which lectin agglutinates A1 red cells? d. Uridine diphosphate-N-acetyl-D-galactose.
a. Dolichos biflorus
b. Ulex europaeus 5. What ABH substance(s) would be found in the
c. Dolichos europaeus saliva of
d. Ulex biflorus a group B secretor?
a. H
17. What immunodominant sugar determines the b. H and A
specificity of H antigens? c. H and B
a. D-galactose d. H, A, and B
b. L-fucose
c. N-acetylgalactosamine 6. An ABO type on a patient gives the following
d. L-glucose reactions:
18. Which of the following situations may produce
ABO discrepancies in the serum testing?
a. newborn
b. patient with
The reactions above may be seen in a patient who is:
hypogammaglobulinemia
a. A1 with acquired B.
c. cold alloantibody
b. A2B with anti-A1.
d. all of the above
c. AB with increased concentrations of protein in the
serum.
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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

d. AB with an autoantibody.

7. Which of the following ABO blood groups contains

the
least amount of H substance?
a. A1B
b. A2
c. B
d. O

8. You are working on a specimen in the laboratory

that you believe to be a Bombay phenotype. Which
of the following reactions would you expect to see?
a. Patient’s cells + Ulex europaeus = no
agglutination
b. Patient’s cells + Ulex europaeus = agglutination
c. Patient’s serum + group O donor RBCs = no
agglutination
d. Patient’s serum + A1 and B cells = no
agglutination

9. An example of a technical error that can result in

an
ABO discrepancy is:
a. Acquired B phenomenon.
b. Missing isoagglutinins.
c. Cell suspension that is too heavy.
d. Acriflavine antibodies.

10. An ABO type on a patient gives the following

reactions:

These results are most likely due to:

a. ABO alloantibody.
b. Non-ABO alloantibody.
c. Rouleaux.
d. Cold autoantibody.

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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

TOPIC 4: RBC AND PLATELET PRESERVATION a. 21
(HARMENING) b. 42
1. What is the maximum volume of blood that can be c. 35
collected from a 110-lb donor, including samples for d. 7
processing?
a. 450 mL 10. One criterion used by the FDA for approval of
b. 500 mL new
c. 525 mL preservation solutions and storage containers is an
d. 550 mL average
24-hour post-transfusion RBC survival of more than:
2. How often can a blood donor donate whole blood? a. 50%.
a. Every 24 hours b. 60%.
b. Once a month c. 65%.
c. Every 8 weeks d. 75%.
d. Twice a year
11. What is the lowest allowable pH for a platelet
3. When RBCs are stored, there is a “shift to the left.” component
This at outdate?
means: a. 6
a. Hemoglobin-oxygen affinity increases, owing to an b. 5.9
increase in 2,3-DPG. c. 6.8
b. Hemoglobin-oxygen affinity increases, owing to a d. 6.2
decrease in 2,3-DPG.
c. Hemoglobin-oxygen affinity decreases, owing to a 12. Which of the following occurs during storage of
decrease in 2,3-DPG. red
d. Hemoglobin-oxygen affinity decreases, owing to an blood cells?
increase in 2,3-DPG. a. pH decreases
b. 2,3-DPG increases
4. The majority of platelets transfused in the United c. ATP increases
States d. plasma K+ decreases
today are:
a. Whole blood–derived platelets prepared by the 13. Which of the following is approved for bacterial
platelet-rich plasma method. detection specific to extending the expiration of
b. Whole blood–derived platelets prepared by the apheresed platelets to 7 days?
buffy coat method. a. BacT/ALERT
c. Apheresis platelets. b. eBDS
d. Prestorage-pooled platelets. c. Gram stain
d. Pan Genera Detection (PGD) test
5. Which of the following anticoagulant preservatives
provides a storage time of 35 days at 1°C to 6°C for 14. Which of the following is the most common
units cause of
of whole blood and prepared RBCs if an additive bacterial contamination of platelet products?
solution a. Entry of skin plugs into the collection bag
is not added? b. Environmental contamination during processing
a. ACD-A c. T in the donor
b. CP2D d. Incorrect storage temperature
c. CPD
d. CPDA-1 15. The INTERCEPT pathogen reduction system uses
which of the following methods?
6. What are the current storage time and storage a. Riboflavin and UV light
temperature b. Amotosalen and UV light
for platelet concentrates and apheresis platelet c. Solvent/detergent treatment
components? d. Irradiation
a. 5 days at 1°C to 6°C
b. 5 days at 24°C to 27°C
c. 5 days at 20°C to 24°C
d. 7 days at 22°C to 24°C

7. RBCs can be frozen for:

a. 12 months.
b. 1 year.
c. 5 years.
d. 10 years.

8. Whole blood and RBC units are stored at what

temperature?
a. 1°C to 6°C
b. 20°C to 24°C
c. 37°C
d. 24°C to 27°C

9. Additive solutions are approved for storage of red

blood
cells for how many days?

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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

TOPIC 5: RH BLOOD GROUP (BLANEY) 11. Which offspring is not possible from a mother
1. The Rh genotype CDE/cDE is written in Wiener who is R2r and a father who is R1r?
notation as: a. DcE/DcE
a. R0R1 b. DCe/DcE
b. RyR2 c. DcE/ce
c. R2R1 d. ce/ce
d. RzR2
12. Antibodies to the Rh blood group system antigens
2. In Rosenfield notation, the phenotype of a donor are usually characterized as:
may be written as Rh:1,−2,−3,4,5. What is the a. naturally occurring IgM
correct phenotype in Fisher-Race (CDE) notation? b. immune IgG
a. cDe c. immune IgM
b. CcDe d. naturally occurring IgG and IgM
c. CcDE
d. CDEe 13. Which of the following genotypes is heterozygous
for the C antigen?
3. Anti-f was identified in a patient. Because a. R1r
commercial antisera are not available, what is the b. R2R2
best course of action to locate compatible RBC units? c. R1R1
a. crossmatch E-negative units d. r′r′
b. contact the rare donor registry
c. release O, D-negative units 14. What is the likelihood that two heterozygous D-
d. crossmatch c-negative units positive parents will have a D-negative child?
a. less than 1%
4. A patient’s Rh phenotype was determined to be b. not possible
D+, c+, e+, C−, E−. The race of this donor is most c. 25%
likely: d. 75%
a. black
b. white 15. Which of the following genotypes could make
c. Asian anti-Ce (Rh7)?
d. Native American a. R2R2
b. R1R0
5. The test for the weak D antigen involves: c. R1R2
a. the IAT d. r′r
b. The DAT
c. anti-Du typing sera 16. Which of the following phenotypes would react
d. anti-D antisera with a LISS potentiator with anti-f?
a. rr
6. The anti-G antibody would be negative with which b. R1R1
of the following red cell genotypes? c. R2R2
a. R0r d. R1R2
b. rr
c. R2r 17. A donor is tested with Rh antisera; given the
d. r′r following results, what is the most probable Rh
genotype?
7. Results of a weak D test on a patient with a
positive direct antiglobulin test would be:
a. accurate as long as the check cells were positive
b. unreliable because of immunoglobulins already on
the cell
c. reliable if a high-albumin anti-D was used
d. false-negative because of antibody neutralization
a. R1R1
b. R1r
8. The Rhnull phenotype is associated with:
c. R0r
a. elevated D antigen expression
d. R2r
b. increased LW antigen expression
c. the Bombay phenotype
18. Anti-D was detected in the serum of a D-positive
d. red cell membrane abnormalities
person. What is a possible explanation?
a. the antibody is really anti-G
9. The blood group system that was originally
b. compound antibody was formed
identified as the Rh blood group system is now
c. regulator gene failure
called:
d. missing antigen epitope
a. Kell
b. Lutheran
19. An antibody to the E antigen was identified in a
c. Lewis
patient who received multiple transfusions. What is
d. LW
the most likely phenotype of the patient’s red cells?
a. R1R1
10. A donor tested D-negative using commercial anti-
b. R2R2
D reagent. The weak D test was positive. How should
c. R1r
the RBC unit be labeled?
d. r′r′
a. D-positive
b. D-negative
c. D variant
d. varies with blood bank policy
20. The regulator gene RHAG:
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IMMUNOHEMATOLOGY – QUESTION BANK PRELIMS

a. is inherited on chromosome 1 a. Lewis antigens
b. is responsible for the Rhmod phenotype b. Normal oxygen-carrying capacity
c. must be inherited to express LW antigens c. Rh antigens
d. is responsible for the D-deletion phenotype d. Hemoglobin

TOPIC 5: RH BLOOD GROUP (HARMENING) 11. Convert the following genotypes from Wiener
1. The Rh system genes are: nomenclature to Fisher-Race and Rosenfield
a. RHD and RHCE. nomenclatures, and list the antigens present in each
b. RHD and LW. haplotype.
c. RHD and RHAG. a. R1r
d. RHCE and RHAG. b. R2R0
c. RzR1
2. What Rh antigen is found in 85% of the Caucasian d. r_r
population
and is always significant for transfusion purposes?
a. d
b. c
c. D
d. E

3. How are weaker-than-expected reactions with anti-

D
typing reagents categorized?
a. Rhmod 12. Which Rh phenotype has the strongest
b. Weak D expression of D?
c. DAT positive a. DCe/ce
d. Dw b. DCe/DCe
c. DcE/DcE
4. Cells carrying a weak D antigen require the use of d. D–
what
test to demonstrate its presence? 13. An individual has the following serologic
a. Indirect antiglobulin test reactions:
b. Direct antiglobulin test D+C+E+c+e+f–. What is the most probable
c. Microplate test genotype?
d. Warm autoadsorption test a. R1R2
b. Rory
5. How are Rh antigens inherited? c. Rzr
a. Autosomal recessive alleles d. R1r_
b. Sex-linked genes
c. Codominant alleles 14. Which of the following is the most common
d. X-linked haplotype
in the African American population?
6. Biochemically speaking, what type of molecules a. DCe
are Rh b. DcE
antigens? c. Dce
a. Glycophorins d. ce
b. Simple sugars
c. Proteins 15. If a patient who is R1R1 is transfused with RBCs
d. Lipids that are Ror, which antibody is he most likely to
produce?
7. Rh antibodies react best at what temperature a. Anti-D
(°C)? b. Anti-c
a. 15 c. Anti-e
b. 18 d. Anti-G
c. 22
d. 37

8. Rh antibodies are primarily of which

immunoglobulin
class?
a. IgA
b. IgD
c. IgG
d. IgM

9. Rh antibodies have been associated with which

clinical
condition?
a. Hemolytic disease of the fetus and newborn
b. Thrombocytopenia
c. Hemophilia A
d. Stomatocytosis

10. What do Rhnull cells lack?

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ELSEVIER
1. Which immunodominant sugar confers A antigen
specificity? 28. An end-point of tube testing other than
a. D-Galactose agglutination
b. L-Fucose that must also be considered a positive reaction is
c. N-Acetylgalactosamine called:
d. Both A and C a. Clumping
b. Mixed field
2. If a patient has an A2 ABO type, which of the c. Hemolysis
following d. Microscopic
statements is true?
a. The patient’s red cells will react with anti-A1 lectin 30. In which situation(s) may the ABO serum
b. The patient’s serum will react with A2 cells grouping
c. The patient’s red cells will react with anti-A2 lectin not be valid?
d. The patient’s serum will react with A1 cells if anti- a. The patient has hypogammaglobulinemia
A1 is present b. IgM antibodies are present
c. Cold autoantibodies are present
3. Which genotype confers the Bombay blood type? d. All of the above
a. Hh
b. hh 32. How can IgG antibodies be removed from red
c. Sese cells?
d. Lele a. Elution
b. Adsorption
4. Which genes encode for Rh antigens? c. Prewarming
a. RHDCE d. Neutralization
b. RHD
c. RHCE 36. Group O red blood cells are used as a source of
d. Both b and c commercial
screening cells because:
5. Testing for the D antigen was conducted at the IAT a. Anti-A is detected using group O cells
phase. A control was included in the testing. Both the b. Anti-D reacts with most group O cells
patient’s red cells and the control tube reacted at 4+. c. Weak subgroups of A react with group O cells
How would you interpret this test? d. ABO antibodies do not react with group O cells
a. The test is invalid because the control tube was
positive 37. The use of EDTA samples for the direct
b. The patient is D positive antiglobulin test prevents activation of the classical
c. The patient is D negative complement pathway by:
d. The test should be repeated and the control tube a. Causing rapid decay of complement proteins
omitted b. Chelating Mg2+ ions, preventing assembly of C6
c. Chelating Ca2+ ions, preventing assembly of C1
6. Of the red cells listed, which has the most D d. Preventing chemotaxis
antigen present?
a. Rh null 39. What type(s) of red cells is(are) acceptable to
b. D positive transfuse
c. dce/dce to an AB-negative patient?
d. D__ a. A negative, B negative, AB negative, O negative
b. O negative only
21. A patient’s ABO blood type is determined by c. AB negative only
which d. AB negative, A negative, B negative only
of the following?
a. Genetic inheritance and environmental factors 49. A white female’s RBCs gave the following
b. Genetic inheritance reactions: D+, C+, E-, c+, e+. The most probable
c. Environmental factors Rh genotype is:
d. Immune function a. DCe/Dce
e. Maternal blood type b. DCe/dce
c. DCe/DcE
22. A trauma patient with type AB is seen at a rural d. Dce/dCe
hospital.
The hospital only has 3 units of type AB RBCs. What 66. What should be done first if a mother types as O
blood type of RBCs can the patient receive as an and
alternative? the baby types as AB?
a. Type O a. Report the results with no further testing
b. Type B b. Try to get a sample from the father
c. Type A c. Recheck all labels, get new samples, if necessary,
d. None of the above and retest
e. All of the above d. Retype using all new reagents

26. What blood type is not possible for the offspring 67. A newborn has a positive DAT.What is the best
of AO and BO parents? procedure
a. AB to determine the antibody causing a positive DAT in
b. A or B this newborn?
c. O a. An antibody titer on the mother’s serum
d. All are possible b. An antibody panel on the mother’s serum
c. An antibody panel performed on the eluate of the
mother’s cells
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d. An antibody panel performed on the eluate of the B. IgM antibodies tend to clump together more
baby’s cells readily to bind more antigen
C. IgM antibodies are found in greater concentrations
than IgG antibodies
68. Which of the following is(are) an example(s) of a D. IgM antibodies are not limited by subclass
record-keeping error? specificity
a. Use of correction fluid or tape
b. Using pencil 3. Which of the following distinguishes A1 from
c. Documentation after the fact A2 blood groups?
d. All of the above A. A2 antigen will not react with anti-A, A1 will react
strongly (4+)
71. In performing tube testing, you see many B. An A2 person may form anti-A1; an A1 person will
medium sized agglutinates in a clear background. not form anti-A1
How would you grade this reaction? C. An A1 person may form anti-A2, an A2 person will
a. 2+ not form anti-A1
b. 1+ D. A2 antigen will not react with anti-A from a
c. 4+ nonimmunized donor; A1 will react with any anti-A
d. 3+
4. What antibodies are formed by a Bombay
73. How would you interpret the following reactions? individual?
Forward Type Reverse Type A. Anti-A and anti-B
Anti-A Anti-B A1 Cells B B. Anti-H
Cells C. Anti-A,B
0 0 4+ 4+ D. Anti-A, B, and H
a. Blood type A
b. Blood type O 5. Acquired B antigens have been found in:
c. Blood type B A. Bombay individuals
d. Blood type AB B. Group O persons
C. All blood groups
74. Noting these reactions, if they patient needed D. Group A persons
blood
now, what type of blood should be transfused? 6. A patient’s red cells forward as group O,
Forward Type Reverse Type serum agglutinates B cells (4+) only. Your next
Anti-A Anti-B A1 Cells B step would be:
Cells A. Extend reverse typing for 15 minutes
4+ 0 1+ B. Perform an antibody screen including a room
4+ temperature incubation
a. Blood type A C. Incubate washed red cells with anti-A1 and anti-
b. Blood type O A,B for 30 minutes at room temperature
c. Blood type A2 D. Test patient’s red cells with Dolichos biflorus
d. Blood type A
7. Which typing results are most likely to occur
75. Blood group antibodies made by type A and type when a patient has an acquired B antigen?
B A. Anti-A 4+, anti-B-3+, A1 cells neg, B cells neg
people are predominantly which class? B. Anti-A 3+, anti-B neg, A1 cells neg, B cells neg
a. IgE C. Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+
b. IgA D. Anti-A 4+, anti-B 4+, A1 cells 2+, B cells neg
c. IgG
d. IgM 8. Which blood group has the least amount of H
antigen?
100. When should quality control be performed on A. A1B
routine B. A2
blood typing reagents? C. B
a. At the beginning of each shift D. A1
b. Once daily
c. Weekly 9. What should be done if all forward and
d. Only when opening a new vial reverse ABO results as well as the autocontrol
are positive?
HARR A. Wash the cells with warm saline, autoadsorb the
1. What type of serological testing does the serum at 4°C
blood bank technologist perform when B. Retype the sample using a different lot number of
determining the blood group of a patient? reagents
A. Genotyping C. Use polyclonal typing reagents
B. Phenotyping D. Report the sample as group AB
C. Both genotyping and phenotyping
D. Polymerase chain reaction 10. What should be done if all forward and
reverse ABO results are negative?
2. Why do IgM antibodies, such as those A. Perform additional testing such as typing with
formed against the ABO antigens, have the anti-A1 lectin and anti-A,B
ability to directly agglutinate red blood cells B. Incubate at 22°C or 4°C to enhance weak
(RBCs) and cause visible agglutination? expression
A. IgM antibodies are larger molecules and have the C. Repeat the test with new reagents
ability to bind more antigen D. Run an antibody identification panel

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11. A 61-year-old male with a history of
multiple myeloma had a stem cell transplant 3 18. Testing reveals a weak D that reacts 1+
years ago. The donor was O positive and the after
recipient was B positive. He is admitted to a indirect antiglobulin testing (IAT). How is this
community hospital for fatigue and nausea. result classified?
Typing results reveal the following: A. Rh-positive
Anti-A = 0 B. Rh-negative, Du positive
Anti-B =0 C. Rh-negative
Anti-A,B = 0 D. Rh-positive, Du positive
Anti-D = 4+
A1 cells = 4+ 19. What is one possible genotype for a patient
B cells = 0 who develops anti-C antibody?
How would you report this type? A. R1r
A. O positive B. R1R1
B. B positive C. r´r
C. A positive D. rr
D. Undetermined

12. A complete Rh typing for antigens C, c, D,

E, and e revealed negative results for C, D, and 20. A patient developed a combination of Rh
E. How is the individual designated? antibodies: anti-C, anti-E, and anti-D. Can
A. Rh positive compatible blood be found for this patient?
B. Rh negative A. It is almost impossible to find blood lacking the
C. Positive for c and e C, E, and D antigens
D. Impossible to determine B. rr blood could be used without causing a problem
C. R0R0 may be used because it lacks all three
13. How is an individual with genotype Dce/dce antigens
classified? D. Although rare, ryr blood may be obtained from
A. Rh positive close relatives of the patient
B. Rh negative
C. Rhnull 21. A patient tests positive for weak D but also
D. Total Rh appears to have anti-D in his serum. What may
be the problem?
14. If a patient has a positive direct A. Mixup of samples or testing error
antiglobulin test, should you perform a weak D B. Most weak D individuals make anti-D
test on the cells? C. The problem could be due to a disease state
A. No, the cells are already coated with antibody D. A D mosaic may make antibodies to missing
B. No, the cells are Rhnull antigen parts
C. Yes, the immunoglobulin will not interfere with the
test 22. Which offspring is not possible from a
D. Yes, Rh reagents are enhanced in protein media mother who is R1R2 and a father who is R1r?
A. DcE/DcE
15. Which donor unit is selected for a recipient B. Dce/DCe
with anti-c? C. DcE/DCe
A. r´r D. Dce/dce
B. R0R1
C. R2r´ 23. Why is testing a pregnant woman for weak
D. r´ry D not
required?
16. Which genotype usually shows the A. An Rh-negative fetus may yield false positive
strongest reaction with anti-D? results in a fetal maternal bleed
A. DCE/DCE B. An Rh-positive fetus may yield false positive
B. Dce/dCe results in a fetal maternal bleed
C. D–/D– C. D antigen strength decreases during pregnancy
D. -CE/-ce D. D antigen strength increases during pregnancy

17. Why is testing for Rh antigens and 24. A patient types as AB and appears to be Rh
antibodies different from ABO testing? positive on slide typing. What additional tests
A. ABO reactions are primarily due to IgM should be performed for tube typing?
antibodies and usually occur at room A. Rh negative control
temperature; Rh antibodies are IgG and B. Direct antiglobulin test (DAT)
agglutination usually requires a 37°C incubation C. Low-protein Rh antisera
and enhancement media D. No additional testing is needed
B. ABO antigens are attached to receptors on the
outside of the red cell and do not require any 25. According to the Wiener nomenclature
special enhancement for testing; Rh antigens are and/or genetic theory of Rh inheritance:
loosely attached to the red cell membrane and A. There are three closely linked loci, each with a
require enhancement for detection primary set of allelic genes
C. Both ABO and Rh antigens and antibodies have B. The alleles are named R1, R2, R0, r, r´, r˝, Rz, and
similar structures, but Rh antibodies are ry
configured so that special techniques are needed C. There are multiple alleles at a single complex
to facilitate binding to Rh antigens locus that determine each Rh antigen
D. There is no difference in ABO and Rh testing; D. The antigens are named D, C, E, c, and e
both may be conducted at room temperature
with no special enhancement needed for reaction
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26. The Wiener nomenclature for the E antigen
is:
A. hr´
B. hrv´
C. rh˝
D. Rh0

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