Blood Banking
All donor blood testing must include:
A. complete Rh phenotyping
B. anti-CMV testing
C. direct antiglobulin test
D. serological test for syphilis
What is D. serological test for syphilis?
Syphilis is the first test performed on donated blood for infectious diseases decades ago and remains a required test.
Complete Rh phenotyping means typing for all Rh antigens; donated blood must be phenotyped for the Rh(D) antigen.
Anti-CMV testing is typically performed on some percentage of donated blood to meet the needs of specific patients.
Direct antiglobulin test is only performed if the donor has a positive antibody screening requiring an ABID, and the auto control is positive.
Kernicterus is an abnormal accumulation of bilirubin in:
A. heart tissue
B. brain tissue
C. liver tissue
D. kidney tissue
What is B. brain tissue?
Definition of kernicterus - high concentrations of unconjugated bilirubin that passes the immature blood-brain barrier of the newborn.
In order for hemoglobin to combine irreversibly with oxygen, the iron must be:
A. complexed with haptoglobin
B. freely circulating in the cytoplasm
C. attached to transferrin
D. in the ferrous state
What is D. The functional form of iron is the reduced state.
Which one of the following anaerobes is inhibited by sodium polyanethol sulfonate (SPS)?
A. Bacteroides fragilis
B. Cutibacterium acnes
C. Peptostreptococcus anaerobius
D. Veillonella parvula
What is C. what is Peptostreptococcus anaerobius?
SPS in blood culture media enhances recovery of most bacteria, including anaerobes. However, Peptostreptococcus anaerobius is inhibited by SPS.
A clean-catch urine is submitted to the laboratory in a plain sterile urine cup for routine urinalysis and culture. The routine urinalysis is performed first. Three hours later, the specimen is sent to the microbiology department for culture. The specimen should:
A. be centrifuged, and the supernatant cultured
B. be rejected due to the time delay
C. not be cultured if no bacteria are seen
D. be processed for culture only if the nitrate is positive
What is B. be rejected due to the time delay?
It is common practice to share samples between the microbiology department and urinalysis. Ideally, the culture is set up first to prevent contamination. If that is not feasible, the sample should be aliquotted using aseptic technique, and refrigerated until it can be cultured.
These results are obtained on a blood donor sample tested at immediate spin:
Anti-A Anti-B Anti-D Rh control A1 cells B cells
0 4+ 0 0 4+ 0
Before labeling blood components from this donation, what additional testing must be completed?
A. Test donor RBCs with Anti-A,B
B. Test donor RBCs with Anti-H
C. Perform weak D testing on donor RBCs
D. Test donor serum with A1 cells
What is C. Perform weak D testing on donor RBCs?
All donor blood collected that tests D Neg (Rh Control Neg) at immediate spin requires a weak D test prior to labeling. If the weak D test is positive, the blood components are labeled D Pos. If the weak D test is negative, the blood components are labeled D Neg. Anti-A,B testing is not required per AABB standards, but is often used to resolve ABO discrepancies. Anti-H lectin is used to confirm a Bombay phenotype. Testing donor serum with Anti-A1 lectin is used to resolve ABO discrepancies appearing as the presence of anti-A1.
The biuret reaction for the analysis of serum protein depends on the number of:
A. free amino groups
B. free carboxyl groups
C. peptide bonds
D. tyrosine residues
What is C. peptide bonds?
Principle of the biuret reaction: copper ions form complexes with peptide bonds in proteins.
Which of the following ions is bound to hemoglobin in methemoglobin?
A. Ca2+
B. Fe3+
C. Fe2+
D. Mg2+
What is B. Fe3+?
Methemoglobin results when iron is in the ferric (Fe3+) state.
A patient has a suspected diagnosis of subacute bacterial endocarditis. His blood cultures grow non-spore-forming pleomorphic gram-positive bacilli only in the anaerobic bottle. What test(s) will give a presumptive identification of this microorganism?
A. beta-hemolysis and oxidase
B. catalase and spot indole
C. esculin hydrolysis
D. hydrolysis of gelatin
What is B. catalase and spot indole?
Cutibacterium acnes is part of the normal flora on the skin and is a common blood culture contaminant. The Gram stain given is typical for C. acnes, and it is catalase and indole-positive.
The following data are calculated on a series of 30 determinations of a serum uric acid control: mean = 5.8 mg/dL, 1 standard deviation = 0.15 mg/dL. If confidence limits are set at +/- 2 standard deviations, which of these ranges represents the allowable limits for the control?
A. 5.65 - 5.95 mg/dL
B. 5.35 - 6.25 mg/dL
C. 5.50 - 6.10 mg/dL
D. 5.70 - 5.90 mg/dL
What is C. 5.50 - 6.10 mg/dL?
Standard deviation is a measure of the dispersion of data around the mean.
An individual has been sensitized to the k antigen, and has produced anti-k (little k/cellano). What is the most probable KEL (Kell) system genotype for this individual?
A. KK
B. Kk
C. kk
D. K0K0
What is A. KK?
The individual must lack the k antigen (not present on their RBCs), therefore KK is the most probably genotype. K0K0 is rare and no KEL (Kell) system antigens are detected on the RBCs. These individuals usually produce antibodies that react with all normal cells (anti-Ku)
The serum protein electrophoresis pattern shown is obtained on cellulose acetate at pH 8.6. Identify the serum protein fraction on the left of the illustration:
A. gamma globulin
B. albumin
C. alpha-1 globulin
D. alpha-2 globulin
What is B. albumin?
Concentration of albumin in serum: represents >50% of the total mass of protein.
An increased amount of cytoplasmic basophilia in a blood cell indicates:
A. increased cytoplasmic maturation
B. decreased cytoplasmic maturation
C. reduction in size of the cell
D. decreased nuclear maturation
What is B. decreased cytoplasmic maturation?
An increased amount of cytoplasmic basophilia in a blood cell indicates decreased cytoplasmic maturation.
A. rheumatic fever, undulant fever
B. glomerulonephritis, rheumatic fever
C. rheumatic fever, tularemia
D. glomerulonephritis, undulant fever
What is B. glomerulonephritis, rheumatic fever?
Noninfectious sequelae associated with infection with Streptococcus pyogenes are glomerulonephritis and rheumatic fever.
Which of the following organizations was formed to encourage the voluntary attainment of uniformly high standards in institutional medical care?
A. Centers for Disease Control and Prevention (CDC)
B. Health Care Finance Administration (HCFA)
C. The Joint Commission (TJC), formerly known as JCAHO
D. Federal Drug Administration (FDA)
What is C. The Joint Commission (TJC), formerly known as JCAHO?
The CDC, HCFA, and FDA are organizations created by the US federal government. The American College of Surgeons (ACS) adopted a one page document titled "The Minimum Standard for Hospitals" in 1919. In 1950 multiple medical professional organizations joined ACS as corporate members to create the Joint Commission on Accreditation of Hospitals to provide voluntary accreditation. Today "The Joint Commission" sets standards by which healthcare is measured and accredits institutions and laboratories worldwide.
In chronic granulomatous disease (CGD), granulocyte function is impaired. An association exists between this clinical condition and a depression of (an) antigen(s) from which of the following blood group systems?
A. Rh
B. P
C. KEL (Kell)
D. Duffy
What is C. KEL (Kell)?
Red blood cells of individuals with the MacLeod phenotype lack Kx and Km and have significant depression of other KEL antigens. The McLeod phenotype has been found in patients with chronic granulomatous disease (CGD).
The principle excretory form of nitrogen is:
A. amino acids
B. creatinine
C. urea
D. uric acid
What is C. urea?
Nitrogen, a metabolic product of protein catabolism is converted to urea for excretion.
The reactive lymphocyte seen in the peripheral blood smear of patients with infectious mononucleosis is probably derived from which of these cell types?
A. T lymphocytes
B. B lymphocytes
C. monocytes
D. mast cells
What is A. T lymphocytes?
Most reactive lymphocytes in infectious mononucleosis are cytotoxic, CD8 positive T cells.
A common cause of acute exudative pharyngitis is:
A. Staphylococcus aureus (beta-hemolytic)
B. Streptococcus pneumoniae
C. Streptococcus agalactiae
D. Streptococcus pyogenes
What is D. Streptococcus pyogenes
Streptococcus pyogenes is the cause of streptococcal pharyngitis, which commonly afflicts school age children during the winter and spring months, with a lower percentage of adults contracting the infection.
Test precision is verified by:
A. comparing results from analyzing the same specimens on multiple analyzers over time
B. repeat measurements of samples of multiple concentrations within run and between runs performed over a period of time
C. comparing results to a definitive or reference method for the same analyte
D. comparing results of multiple specimens analyzed by multiple individuals and multiple instruments
What is A. comparing results from analyzing the same specimens on multiple analyzers over time?
Precision refers to the reproducibility of a result. Precision is verified by replicating measurements on the same specimens, both simultaneously (within run precision) and consecutively (between run precision)
Which of the following antibodies is neutralizable by pooled human plasma/serum?
A. Anti-Lea
B. Anti-Ch (Chido)
C. Anti-Sda
D. Anti-P1
What is B. Anti-Ch (Chido)?
Anti-Ch and anti-Rg react at the AHG phase with trace amounts of C4 (a component of complement) found as a soluble substance in plasma and capable of attaching to the surface of RBCs. Neutralization studies with pooled plasma containing CH/RG substance can help confirm the antibody reactivity in a patient's sample. If test procedures are performed to coat cells with C4, a patient with anti-Ch or anti-Rg may agglutinate the cells directly.
In an assay of LD levels, 10 uL of sample is added to reagent to make a total volume of 1 mL. What is the dilution?
A. 1/10
B. 1/90
C. 1/100
D. 1/1000
What is C. 1/100?
First convert both volumes to the same unit. 1 milliliter - 1000 microliters. A dilution = sample volume/total volume where total volume = sample volume + diluent volume. 10/1000 = 1/100.
Pluripotent hematopoietic stem cells are capable of producing:
A. daughter cells of only one cell line
B. only T lymphocytes and B lymphocytes
C. erythropoietin, thrombopoietin, and leukopoietin
D. lymphoid and myeloid stem cells.
What is D. lymphoid and myeloid stem cells?
Pluripotential hematopoietic stem cells are capable of producing cells of more than one lineage, specifically both lymphoid and myeloid.
A Gram stain performed on a sinus aspirate reveals gram-negative diplococci and PMNs. Oxidase testing is positive and carbohydrate degradation tests are inert. The organism most likely is:
A. Neisseria lactamica
B. Moraxella catarrhalis
C. Neisseria meningitidis
D. Neisseria sicca
What is B. Moraxella catarrhalis?
The Neisseria species listed all ferment several carbohydrates. Moraxella catarrhalis is biochemically inert and does not ferment carbohydrates.
An HPLC operator notes that the column pressure is too high, is rising too rapidly and the recorder output is not producing normal peaks. The most probably cause of this problem is:
A. not enough sample injected
B. bad sample detector
C. effluent line obstructed
D. strip chart motor hanging up
What is C. effluent line obstructed?
Backflow causes increased pressure and bad chromatography.