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Chapter 07: Other Red Cell Blood Group Systems, Human Leukocyte Antigens, and
Platelet Antigens
Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices, 4th
Edition
MULTIPLE CHOICE
2. Antibodies to Kidd, Kell, and Duffy blood group antigens share all the following
characteristics except:
a. can cause hemolytic disease of the newborn.
b. usually detected only by the indirect antiglobulin test.
c. enhanced with enzyme treatment.
d. can cause transfusion reactions.
ANS: C
The Duffy system antibodies do not react with enzyme-treated cells.
3. K-positive donor red cells were mistakenly transfused to a recipient with anti-K. The patient’s
posttransfusion blood sample has a positive direct antiglobulin test with polyspecific
antihuman globulin. The direct antiglobulin test is positive because anti-K is an __________
antibody that has sensitized the __________ cells in vivo.
a. IgG, donor’s
b. IgM, donor’s
c. IgG, recipient’s
d. IgM, recipient’s
ANS: A
The anti-K in the recipient attached to the K antigen on the transfused donor red cells, which
will cause them to be prematurely cleared by the spleen.
5. Antibodies to which of the following blood group system show dosage (i.e., are stronger with
homozygous expression of the antigen)?
a. Lutheran
b. P
c. Duffy
d. Kell
ANS: C
Stronger reactions are typically seen with red cells that have a “double dose” of the antigen in
the Duffy system.
ANS: A
Lub antigen occurs at an incidence of greater than 99%.
7. Why have Lewis system antibodies not been implicated in hemolytic disease of the fetus and
newborn?
a. The antigens are not fully developed at birth.
b. Lewis system antibodies do not cross the placenta.
c. The antibodies are not clinically significant.
d. All of the above are correct.
ANS: D
Lewis antibodies are often found during pregnancy but do not cross the placenta because they
are IgM. The antigens are not well developed at birth.
8. All the following statements are true regarding Lewis system antibodies except antibodies:
a. may be observed at the immediate-spin, 37 C, and antihuman globulin phases.
b. can be neutralized by Lewis substance.
c. may cause hemolysis in vitro.
d. do not react following enzyme treatment of cells.
ANS: D
Anti-Leb may be enhanced with enzyme treatment.
10. Predict the probable antibody’s identity if all red cells tested at room temperature are positive
with a patient’s serum except for cord cells.
a. Anti-Lu
b. Anti-Lea
c. Anti-I
d. Anti-M
ANS: C
The I antigen is found on adult red cells, not on cord red cells. Anti-I reacts best at colder
temperatures.
12. Which of the following blood group systems are structurally related to antigens of the P
system?
a. MNS
b. ABH
c. Kell
d. Duffy
ANS: B
The P system antigens are formed by the action of glycosyltransferases, similar to the ABO
system genes and antigen products.
16. Anti-Jsb was identified in a patient scheduled for elective surgery later. What is the best
approach to finding compatible blood?
a. Contact the rare donor registry since Js(b-) units are rare.
b. Request that family members be tested to determine if they share the same
phenotype.
c. Screen donors from the black population because Js(b-) phenotype is common.
d. A and B are correct.
ANS: D
Js(b-) individuals are less than 1% of the black population and even rarer in the white donor
population. The rare donor registry is the most likely source of units; however, they would
probably be stored as frozen red cells. Since the units are not required urgently, family
members should be typed to locate potentially compatible blood.
17. A patient’s antibody history listed an anti-Cellano. This antigen is also known as:
a. c in the Rh system.
b. k in the Kell system.
c. Cs in the Cost system.
d. SC in the Scianna system.
ANS: B
Cellano is the original name of the k antigen (KEL2) in the Kell system, a high-frequency
antigen that is antithetical to K (KEL1).
18. The major histocompatibility complex is located on chromosome 6 and is important in all the
following immune functions except:
a. recognition of nonself.
b. graft rejection.
c. hemolysis.
d. coordination of cellular and humoral immunity.
ANS: C
The major histocompatibility complex codes for molecules on all nucleated tissues and cells
to allow for immune recognition and response to foreign antigens.
19. The mixed lymphocyte culture (MLC) is a procedure that has been used in HLA testing to
determine:
a. class I HLA antigen determination.
b. class II HLA antigen determination.
c. HLA antibody identification.
d. compatibility testing for tissue typing.
e. B and D.
ANS: E
The mixed lymphocyte culture (MLC) was an in vitro procedure used to determine tissue
compatibility and D (class II) typing that has been largely replaced by molecular typing and
flow cytometry techniques.
20. HLA matching between the donor and recipient is important for progenitor cell
transplantation to avoid:
a. graft versus host disease (GVHD).
b. graft rejection.
c. transfusion reactions.
d. A and B.
ANS: D
HLA typing is essential to avoid GVHD and rejection in HPC transplants.
MATCHING
Match each characteristic with the appropriate blood group system. A selection may be used
more than once.
a. Cartwright
b. MNSs
c. Kidd
d. Vel
e. Xga
f. Sda antigen
g. Chido/Rodgers
h. Kell
i. Duffy
ACT II
The White House
LOEB:
O Mr. President, depress your ear
Till it enfold me, so that you may hear
Strange news of one departed—one that you
Have done to death: old Nelson Miles.
ROOSEVELT:
Go to!
There is no news of him; he’s dead as nails.
LOEB:
About him, though, they tell alarming tales.
’Tis said that he has moved an inch or so.
ROOSEVELT:
Go put a heavier stone upon him—go!
Confound the fellow! will he ne’er stay dead?
LOEB:
The worst is yet to come: they say his head
Is half-protruded from the tomb!
ROOSEVELT:
Quick, quick!
Go rap it roundly with the big, big stick.
LOEB:
Nay, that’s a weapon I’m too weak to wield.
(aside)
For anything I know, the corpse is “heeled.”
ROOSEVELT:
Where’s Colonel Hull? Command him to attack.
He’s brave and generous enough to crack
The skull of any dead man living. Take the stick.
[Exit Loeb.]
That rogue’s obedient, but he makes me sick.
[An hour elapses. Enter Hull.]
HULL:
The work is done: again he is no more—
He was half out. These red stains are his gore.
ROOSEVELT:
I trust you gave him a conclusive whack.
HULL:
Well, not exactly, but—I bit his back!
A STRAINED RELATION
The President. Root, Secretary of State. Taft, Secretary of War.
Bonaparte, Secretary of the Navy. Metcalf, Secretary of Commerce
and Labor. Dewey, an Admiral. Loeb, Private Secretary to the
President.
ACT I
The White House, October, 1906.
Root—Mr. President, the Japanese Minister complains that the
children of his countrymen in California are denied admittance to the
public schools.
President—That will be bad for their education.
Root—He regards this as an unfriendly discrimination.
Pres.—I should suppose that would be a painful conviction.
Root—He says his countrymen in Japan are greatly excited about
it.
Pres.—What a jabbering they must make.
Root—He is making a good deal of noise himself.
Pres.—Dare say. Let’s ask Metcalf about it; he’s from California.
[Taps the bell nine times—enter Secretary Metcalf.] Mr. Secretary,
how about the exclusion of Japs from the Californian public schools,
poor little things!
Metcalf—There are separate schools for them. The average age of
the poor little things is about thirty years.
Pres.—How affecting! Many of them must be orphans. I was once
an orphan.
Root (aside)—His levity fatigues. (To the President) Among the
Japanese there are no orphans: those of them that have lost their
parents have an official father in the Minister of War.
Pres.—What’s that?
Root—Their actual guardian is the ranking admiral of the navy.
Pres.—The devil!
Root—No; Togo.
Pres.—This is a mighty serious matter, as I said. Go at once to the
Japanese Minister and disavow everything. [Exit Secretary Root,
smiling aside.] Metcalf, tell Loeb to prepare apologies for Japan, for
publication in the newspapers. Take the first train to California, and
——
[Exit Secretary Metcalf. Enter Secretary Bonaparte, breathless.]
Bonaparte—Mr. President, the J-J—the Mapanese Jinister is in the
offing with all his s-suite! He is sailing up the gravel walk this very
m-minute! For heaven’s sake, go to the window and show your
teeth.
[Exit Secretary Bonaparte, running. Tumult within: “Banzai!
Banzai!”]
Pres. (solus)—What under the sun can I say to appease the
pirates? This is what comes of the Peace of Portsmouth! It is this to
be a world power with a contumacious province.
[Has had a bad half-hour.]
ACT II
The Same, August, 1907.
Pres.—Mr. Secretary, it is reported that the Japanese in Hawaii are
rising.
Met.—You don’t say so! Why, it is hardly six o’clock by their time.
They are early risers.
Pres.—I learn from Secretary Root that Admiral Togo’s battleships
are coaling. Now, what can that mean?
Met.—Let us ask Dewey. [Enter, thoughtfully, Admiral Dewey.]
Admiral, the President has learned that the Japanese battleships at
Tokio are taking on coal. What, in your judgment as a sailor, are they
going to do with it?
Dewey—Burn it.
[Enter Secretary Root.]
Root—Mr. President, California is about to secede—we shall lose
Metcalf! The entire Pacific Coast will follow. I go to glory or the
grave!
[Exit Secretary Root. Enter Secretary Taft, with bottle.]
Taft—In this supreme crisis of the nation let us fortify our souls
(filling glasses) for any trial.
Pres. (lifting glass)—Here’s confusion to the memory of the late
Commodore Matthew Perry!
[They drink. Tumult within: “Banzai! Banzai!” Enter Loeb.]
Loeb—Mr. President——
Pres.—Where’s Root?
Loeb—In the East Room, playing draw poker with the Japanese
Minister. [Renewed tumult within: “Banzai Nippon!”] The Jap seems
to be winning.
A WIRELESS ANTEPENULTIMATUM
The President. Hay, Secretary of State. Bowen, Minister to
Venezuela.
PRESIDENT:
John Hay, where are you on the great, gray sea?
I beg you will at once return to me.
This wireless business is the devil’s own,
And Castro’s playing him with me alone!
Venezuela sneering at my threat;
Santo Domingo more and more in debt;
Their foreign creditors dispatching fleets
With duns and guns and sons of guns—it beats
The Dutch, the devil and the band! I swear
From sheer distraction I could pull your hair!
’Twixt Castro and the Doctrine of Monroe,
My fears are nimble and my wits are slow.
I know not where to go nor how to stop—
Stand fast or, like old Saul of Tarsus, “flop.”
Nothing I know, and everything I doubt—
Dear John, in God’s name put your prow about!
HAY:
Though the skies fall upon the hills beneath
Be resolute. If needful show your teeth.
PRESIDENT:
Dear Bowen, go to Castro. Tell him straight
He must make up his mind to arbitrate.
Say if he won’t—here swing the big, big stick—
We’ll do a little stunt to make him sick.
BOWEN:
Your words I’ve put into his ear. Said he:
“I’m sick already—to the mountains, me.”
PRESIDENT:
Tell him again; then if he won’t, why, add
We’ll give him ninety days to wish he had.
BOWEN
BOWEN:
I’ve told him that, sir, and he says if you
Are pressed for time a single day will do,
For he’s a rapid wisher. What shall I
Say further, to provoke a coarse reply?
PRESIDENT:
Tell him that when the time allowed is up
We’ll press against his lips the bitter cup.
We’ll waste no further words in this. Don’t fail
To send the scalawag’s reply—by mail.
A PRESIDENTIAL PROGRESS
First American Sovereign—Hurrah! Hooray! Hurroo!
Second American Sovereign—What’s the matter with you?
F. A. S.—What’s the matter with me? What’s the matter with all of
us? Don’t you see the President’s train? Don’t you hear him speaking
from the rear platform?
S. A. S.—What’s to prevent?
F. A. S.—Nothing could prevent—not all the crowned heads of
Europe, nor all their sycophant courtiers and servile subjects!
S. A. S.—No, nothing—just nothing at all—excepting personal self-
respect and a decent sense of the dignity of American citizenship.
F. A. S.—What! You think it base and undignified to pay honor to
the President’s great office?
S. A. S.—It is easy to call it “honoring his great office.” I believe
we commonly do give the name of some virtue to our besetting vice.
I observe that the President, too, honors our own great office by the
most sickening flattery of the people every time he opens his mouth.
His reasons are better than ours, for we really rank him: his great
office is of our own making and bestowal. But I wish he wouldn’t lick
my boots.
F. A. S.—Sir, you have no right to use such language of the ruler of
the nation!
S. A. S.—It is “ruler” when you want an excuse to grovel; in your
more austere moods it is “servant of the people”—and that is his
own name for the thing that he has the distinction to be. I don’t
cheer my butler, nor throw flowers at my coachman, nor crush the
hand of my cook.
F. A. S. (aside)—This must be a millionaire! (Aloud) I see great
wisdom, sir, in what you say. I’ll never again abase myself before
any one. Listen to the senseless applause! (Aside, as loud as he can
bawl) Hooray! Hooray!
S. A. S.—Ah, that was the fellow’s expiring platitude. He has
finished waving the red flag and is coming this way.
[President passes, shaking hands with both.]
F. A. S. (gazing at his hand with deep emotion)—God bless him!
S. A. S.—Hooray! Hooray! Hooray!
MISCELLANEOUS
THE SAMPLE COUNTER
From “Clarisse.”
He gazed into her beautiful eyes for a considerable period, during
which he did not converse; then he said, with an effort to be
sociable: “It has been represented to me that you are a lady of great
wealth. May I inquire if I have been rightly informed?”
Blushing energetically at the compliment, she replied in silence,
and for a few minutes there was an embarrassing hiatus in the
exchange of thought and feeling.
Fearing that he had offended her, the duke arose, and striding to
the grand piano began to improvise diligently. At that moment there
came in through the open window a sound of wheels on the gravel
outside.
He ceased in the middle of a nocturne and would have left the
room, but she restrained him:
“It is only my father returning from India,” smiled she; “I shall be
so glad to introduce you.”
The full horror of the situation burst upon him like a thunderbolt
out of a clean sky.
“Madam,” he thundered, “your father is dead! He died of the
plague in Bombay, and I attended the funeral, although he had
cursed me with his last breath. I cannot—cannot meet him!”
With those words falling from his white lips he flung himself out of
the room. A servant entered and handed Clarisse the visiting card of
Mrs. Delahanty.
From “Ideals.”
Where the grand old Hudson river rolls its floods seaward between
the rugged Palisades and the agricultural country of its eastern bank
Janey Sewell dwelt in a little vine-covered cottage in one of the most
picturesque spots of the latter.
Janey was beautiful all day long. Her hair was as dark as the
pinion of a crow, and her brown eyes rivaled in lustre the sheen of
the sunlight on the bosom of the river. She was also a fine French
scholar.
Janey’s parents had dwelt in Yonkers from time immemorial, and
sweet to her was her native environment, whence no proffers of a
marriage into the aristocracy or nobility of England could entice her.
Many coroneted hearts had been flung at her feet—many were the
impassionate pleas that ducal lips had poured into her ear; she
remained fancy free, determined to bestow her affection upon some
worthy member of an American labor union or die a maid. We shall
see with what indomitable tenacity she adhered through
disheartening trials to that commendable policy.
New York, July 3.—Rioting was renewed last night in front of the
boycotted publishing house of Charles Scribner’s Sons, 153–157 Fifth
avenue. Though frequently driven back by charges of the police,
who used their clubs freely, the striking authors succeeded in
demolishing all the front windows by stone-throwing. One shot was
fired into the interior, narrowly missing a young lady typewriter. Mr.
William D. Howells, a member of the Guild’s board of managers,
declares that he has irrefragable proof that this outrage was
committed by some one connected with the Publishers’ Protective
League for the purpose of creating public sympathy.
It has been learned that the non-union author so severely beaten
yesterday died of his injuries last night. His name is said to have
been Richard Henry (or Hengist) Stoddard, formerly a member of
the Guild, but expelled for denouncing the action of President
Brander Matthews in ordering the strike.
Later.—Matters look more and more threatening. A crowd of ten
thousand authors, headed by Col. Thomas Wentworth Higginson, is