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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5565_Библиотеки_им_академика_М_И_Перельмана.pdf
46 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
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Question 2: Which of the following is NOT a member of the MNS antigen system?
A. M antigen.
B. N antigen.
C. S antigen.
D. n antigen.
E. s antigen.
D. There is no “n” antigen. The MNS group of red cell antigens includes the major
antigens M, N, S, s, U, and u.
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_____________________________
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Question 3: Which of the following antigens are present on glycophorin A?
A. S antigen.
B. s antigen.
C. M antigen.
D. U antigen.
E. u antigen.
C. The M and N antigens can be found on the glycophorin A molecule; the other
antigens (S, s, U, and u) are on glycophorin B.
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_____________________________
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Question 4: Which of the following is true about anti-M?
A. Occur naturally, non-RBC-stimulated.
B. Uncommon alloantibody specificity.
C. IgM only.
D. Frequent cause of HDFN.
E. Clinically significant.
A. Anti-M is a naturally occurring common alloantibody of either IgM or IgM with
IgG isotype. Anti-M is usually clinically insignificant, only rarely causing HDFN.
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Question 5: What is the most important distinction between patients with anti-M
and patients with anti-S?
POLYPEPTIDE BLOOD GROUP SYSTEMS 47
A. Unlike anti-M, anti-S is rare.
B. Anti-S is similar to anti-M in that they only occur naturally.
C. Patients with anti-S must receive antigen-negative blood, unlike those with
anti-M, who can often safely receive crossmatch-compatible blood.
D. Anti-S is active only when warm; anti-M when cold.
E. Anti-S is never clinically significant.
C. Both anti-M and anti-S are common and can occur naturally. However, anti-S
can also be produced in an immune fashion after exposure to S antigen. Anti-S can
be clinically significant and usually acts below body temperature. The most impor-
tant distinction from patients with anti-M is that patients with anti-S should receive
S-negative blood to avoid a potential reaction, while patients with anti-M can be
transfused with crossmatch-compatible (IAT at 37 C) red cells.
________________________________
_____________________________
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Question 6: Which of the following antibodies is described as of immune origin
solely, IgG only, may be clinically significant, and is extremely rare?
A. Anti-M.
B. Anti-N.
C. Anti-S.
D. Anti-n.
E. Anti-s.
E. Anti-s can be described as such. Because the s antigen is extremely common on
red cells it is unusual for anti-s to be produced. Similar to patients with anti-S,
patients with anti-s must be transfused with antigen-negative blood.
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_____________________________
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Question 7: Which of the following is NOT part of the Rh blood group system?
A. D antigen.
B. d antigen.
C. C antigen.
D. c antigen.
E. E antigen.
B. There is no d antigen, only the presence (85% of people) or the absence (the
remaining 15%) of the D antigen.
48 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
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Question 8: Which of the following statements is true?
A. The RhCE protein is encoded by the same gene as RhD protein.
B. The C antigen is the most immunogenic of the Rh antigens.
C. Anti-D causes intravascular hemolysis.
D. Partial D is a recombinant RhD-RhCE protein.
E. Anti-f is a rare compound alloantibody.
D. RhD and RhCE are encoded by separate related genes, most likely produced by a
duplication event on chromosome 1. The most immunogenic antigen of the Rh sys-
tem is the D antigen, which causes extravascular hemolysis. Anti-f is the most com-
mon compound alloantibody encountered clinically.
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Question 9: Which of the following describes the Rh
null
phenotype?
A. All Rh antigens are expressed on the red cell surface.
B. Red cells exhibit stomatocytosis.
C. Red cells display decreased osmotic fragility.
D. The phenotype is fairly common.
E. The cells demonstrate extended red cell survival.
B. Rh
null
red cells are stomatocytic and associated with mild anemia, suggesting that
the Rh proteins have an important structural role in the red cell membrane.
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Question 10: What is the main difference between “weak D” and “partial D” indi-
viduals?
A. Weak D phenotype results from a decreased number of epitopes on D antigen.
B. Partial D phenotype results from a decreased level of expression of D antigen.
C. Donors with weak D phenotype, but not partial D, should be categorized Rh-
positive.
D. Donors with partial D phenotype, but not weak D, should be categorized Rh-
positive.
E. Individuals with partial D phenotype, but not weak D, can make alloantibodies
to the D antigen when receiving D-positive RBCs.
E. Because partial D phenotype individuals lack D antigen epitopes, they can make
alloantibodies to those “missing” epitopes if exposed to normal D-positive RBCs.
POLYPEPTIDE BLOOD GROUP SYSTEMS 49
Choices A and B are reversed. Choices C and D are incorrect because both weak D
and partial D donors should be categorized as Rh positive.
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Question 11: Which statement is true about the compound Rh antigens, “ce” (also
known as “f”), Ce, CE, and cE?
A. Compound antigens must be in cis configuration (on the same chromosome) to
be expressed.
B. Antibodies to compound antigens are not clinically significant.
C. A recipient who has anti-ce should not receive blood from a donor who has the
cE haplotype.
D. Compound antigens are the result of multiple amino acid polymorphisms.
E. Anti-c has been shown not to cause hemolytic transfusion reactions.
A. C/c and E/e antigens reside on the same protein.
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Question 12: Which statement about the G antigen is true?
A. It is found only on Rh
null
red cells.
B. Anti-G does not react with red cells that express C and/or D antigens.
C. G antibodies may cause severe neonatal alloimmune thrombocytopenia.
D. Recipients with G antibodies should not receive C-negative or D-negative
RBCs.
E. Current methods of antibody identification testing cannot distinguish anti-G
from a mixture of anti-C and anti-D.
E. Anti-G can be identified by selective adsorption of anti-D and anti-C. It is impor-
tant to be able to distinguish anti-G from a mixture of anti-D and anti-C in young
women because females who have anti-G should receive Rh Immune Globulin,
whereas females with anti-D and anti-C would not.
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Question 13: Which statement about the Kell blood group system is true?
A. Consists of 10 antigens found on a single transmembrane protein.
B. K antigen is the most potent immunogen of the non-ABO antigens.
C. K antigen is present on 90% of donated red cells, so it can be difficult to find K
antigen-negative RBC units.
50 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
D. Anti-K, -k, -Kp
a/b
, -Js
a/b
are typically immune-stimulated IgG antibodies detected
by the antiglobulin test that have been associated with hemolytic transfusion
reactions and HDFN.
E. Anti-K is an infrequent cause of HDFN.
D. Hemolytic transfusion reactions, both acute and delayed have been associated
with anti-K. In addition, anti-K can cause HDFN, most likely through the suppres-
sion of erythroid precursors rather than through hemolysis.
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Question 14: McLeod syndrome is caused by the absence of Kx antigen. In the
absence of Kx antigen, levels of Kell antigens are greatly reduced on red cells and
granulocytes. Which of the following is not associated with the McLeod syndrome?
A. Duchenne muscular dystrophy.
B. Chronic granulomatous disease.
C. Retinitis pigmentosa.
D. Stomatocytosis and decreased red cell production.
E. Acanthocytosis
D. McLeod syndrome is an X-linked recessive condition indirectly associated with
decreased Kell antigens. The XK protein product deficient in McLeod syndrome may
function to stabilize Kell expression. McLeod syndrome is associated with other X-
linked conditions, such as chronic granulomatous disease, Duchenne muscular dys-
trophy, and some forms of retinitis pigmentosa. Patients with McLeod syndrome
often have abnormal red cells with acanthocytosis and decreased red cell survival.
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Question 15: Which of the following is true about the Kidd blood group system?
A. The Jk
null
phenotype is seen predominantly in those of African ethnicity.
B. Kidd antibodies are complement-fixing IgG.
C. JKA is a dominant allele, while JKB is recessive.
D. Jk
null
phenotype red cells are lysed by 2M urea.
E. Only anti-Jk
a
can cause hemolytic disease of the fetus and newborn.
B. Anti-Jk
a
and Jk
b
are clinically significant complement-fixing IgG antibodies that
are capable of causing intravascular and extravascular hemolysis.
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Question 16: Which of the following is true about Kidd antibodies?
POLYPEPTIDE BLOOD GROUP SYSTEMS 51
A. A positive history of Kidd antibodies is not clinically significant if there is no
current evidence of Kidd antibodies.
B. Kidd antibodies are persistent and once detected in a patient they will be able
to be detected from that point on.
C. Crossmatch alone is sufficient to identify units to transfuse to patients with Kidd
antibodies.
D. Anti-Jk
a
is clinically significant; anti-Jk
b
is not.
E. Kidd antibodies can cause delayed hemolytic transfusion reactions.
E. Kidd antibodies (both anti-Jk
a
and anti-Jk
b
) are notorious for being evanescent (dis-
appearing after initial detection) and reappearing when patients are re-exposed
(anamnestic response). For this reason patients with a history, however remote, of
Kidd antibody should receive not only crossmatch-compatible, but also antigen-
negative blood.
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Question 17: Which of the following about the Duffy blood group system is NOT
true?
A. The Duffy carrier protein is a chemokine receptor.
B. Anti-Fy
b
is more common than the anti-Fy
a
.
C. The Duffy carrier protein is the receptor for P. vivax.
D. Duffy antibodies can cause hemolytic transfusion reactions.
E. All of the above are true.
B. Anti-Fy
a
is more common than anti-Fy
b
and is clinically significant. Antibodies to
Duffy antigens have been associated with hemolytic transfusion reactions. Lack of
both FYA and FYB alleles [Fy(a−b−)] provides resistance to both P. vivax and P.
knowlesi infection and is found in up to two-thirds of Africans.
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SUGGESTED READING
Beadling WV, Cooling L. Immunohematology. In: McPherson RA, Pincus MR, eds.
Henry’s clinical diagnosis and management by laboratory methods. 21st ed. Phila-
delphia: Saunders, 2007:618-69.
Daniels G. Human blood groups. 2nd ed. Oxford, UK: Blackwell, 2002.
Issitt PD, Anstee DJ. Applied blood group serology. 4th ed. Durham, NC: Montgom-
ery Scientific Publications, 1998.
Klein HG, Anstee D. Mollison’s blood transfusion in clinical medicine. 12th ed.
Oxford, UK: Wiley-Blackwell, 2011.
52 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
Poole J, Daniels G. Blood group antibodies and their significance in transfusion
medicine. Transfus Med Rev 2007;21:58-71.
Reid ME, Lomas-Francis C, Olsson M. The blood group antigen factsbook. 3rd ed.
San Diego, CA: Academic Press, 2012 (in press).
In: Leonard G, Licata M.
Practical Self-Assessment for Transfusion Medicine Professionals
Bethesda, MD: AABB Press, 2012
6
Administration of Blood Components
QUESTIONS
Question 1: Which statement about the administration of blood components is true?
A. Errors in patient identification account for only a fraction of transfusion inci-
dents.
B. Most fatal hemolytic transfusions reactions are due to the inadvertent adminis-
tration of ABO-incompatible RBCs.
C. Mislabeled samples for compatibility testing should be returned to the person
who delivered the sample for correction.
D. A mislabeled sample is twice as likely to be ABO mismatched with the
patient’s blood type.
E. Transfusion of blood components must be completed within 4 hours of issue; a
unit that has been out of the blood bank for less than 60 minutes may be
returned and reissued to another patient.
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Question 2: For pretransfusion compatibility testing, which of the following is NOT
required for the proper identification of a sample?
A. First and last name of patient.
B. Unique identifying number.
C. Date of draw.
D. A method to identify the drawer.
E. A method to identify the facility.
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Question 3: Which statement about blood product filters is NOT true?
A. All blood components must be transfused through a filter capable of removing
clots, fibrin strands, and other potentially harmful particles.
54 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
B. Leukocyte reduction filters have a pore size that is small enough to remove par-
ticulate matter greater than 170 microns.
C. Leukocyte reduction filters are designed so that their performance is not
affected by the position of, or the pressure within the filter.
D. Leukocyte reduction filters are designed to be used once and then discarded.
E. Leukocyte reduction filters should not be flushed following infusion.
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Question 4: Which statement about blood component transfusions is true?
A. A 21-gauge needle is the minimum size required for most patient populations.
B. The only IV fluid that should be used to transfuse RBCs is normal saline,
although some other fluids, such as 5% albumin, may be used.
C. Lactated Ringer’s solution contains citrate, which promotes clotting, and there-
fore should not be used to transfuse RBCs.
D. Medications can be infused safely through the same line that is being used to
transfuse RBCs.
E. Because cold blood can cause arrhythmias and even cardiac arrest, the blood
warmers must be used even for routine infusions.
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Question 5: Regarding blood component transfusion, which statement is true?
A. Patients should be premedicated to prevent fever and allergic reactions.
B. A full set of vital signs should be obtained immediately before transfusion, after
15 minutes, and then hourly until completion of the transfusion.
C. The last 15 minutes of a transfusion is the best time to closely monitor the
recipient because that is when most major hemolytic reactions become appar-
ent.
D. Washing all blood components can help minimize the risk of transfusion reac-
tions.
E. A full set of vital signs should be obtained exactly 24 hours following the com-
pletion of transfusion.
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Question 6: In the event of a possible transfusion reaction, which of the following
should take place?
A. The transfusion should be stopped and reported to the transfusion service.
B. The transfused unit, all associated tubing, and a sample of venous blood should
be taken to the transfusion service.
ADMINISTRATION OF BLOOD COMPONENTS 55
C. The transfusion service should do a clerical check.
D. The transfusion service should visually inspect and perform a DAT on the
recipient’s pre- and posttransfusion venous blood samples.
E. All of the above.
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Question 7: Transfusions for neonates (less than 4 months old) differ from transfu-
sions in children and adults in several ways. Which statement is true regarding the
recommendations for neonatal transfusions?
A. Transfusion-associated graft-vs-host disease can be fatal, so platelets and RBCs
should be leukocyte-reduced.
B. CMV transmission can cause serious illness, so platelets and RBCs should be
CMV-reduced.
C. Potassium and anti-A or anti-B often cause severe illness, so platelets and RBCs
should be washed.
D. The RBC transfusion “threshold” is lower for newborns with cardiac or pulmo-
nary disease compared to adults.
E. Reference ranges for PT and PTT are lower in neonates.
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ANSWERS
Question 1: Which statement about the administration of blood components is true?
A. Errors in patient identification account for only a fraction of transfusion inci-
dents.
B. Most fatal hemolytic transfusions reactions are due to the inadvertent adminis-
tration of ABO-incompatible RBCs.
C. Mislabeled samples for compatibility testing should be returned to the person
who delivered the sample for correction.
D. A mislabeled sample is twice as likely to be ABO mismatched with the
patient’s blood type.
E. Transfusion of blood components must be completed within 4 hours of issue; a
unit that has been out of the blood bank for less than 60 minutes may be
returned and reissued to another patient.
B. By far the most common cause of transfusion accidents is an error in patient iden-
tification. Most of the cases of fatal transfusion reactions are due to the administra-
tion of ABO-incompatible blood to a patient, commonly associated with errors in