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Test Bank For Basic & Applied Concepts of Blood Banking and Transfusion
Practices 5th Edition – By Paula Howard ISBN: 9780323697392

Table of Contents

Part I: Quality and Safety Issues

1. Quality Assurance and Regulation of the Blood Industry: Safety Issues in the Blood
Bank

Part II: Foundations: Basic Sciences and Reagents

2. Immunology: Basic Principles and Applications in the Blood Bank

3. Blood Banking Reagents: Overview and Applications

4. Genetic Principles in Blood Banking

Part III: Overview of the Major Blood Groups

5. ABO and H Blood Group Systems and Secretor Status

6. Rh Blood Group System

7. Other Red Cell Blood Group Systems, Human Leukocyte Antigens, and Platelet
Antigens
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Part IV: Essentials of Pretransfusion Testing

8. Antibody Detection and Identification

9. Compatibility Testing
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10. Blood Bank Automation for Transfusion Services

Part V: Clinical Considerations in Immunohematology

11. Adverse Complications of Transfusions

12. Hemolytic Disease of the Fetus and Newborn

Part VI: Blood Collecting and Testing

13. Donor Selection and Phlebotomy

14. Testing of Donor Blood

Part VII: Blood Component Preparation and Transfusion Therapy

15. Blood Component Preparation and Therapy

16. Transfusion Therapy in Selected Patients

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Chapter 01: Quality Assurance and Regulation of the Blood Industry and Safety
Issues in the Blood Bank
Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices,
4th Edition

MULTIPLE CHOICE

1. Which of the following agencies administers the Clinical Laboratory

Improvement Amendments?
a. AABB
b. Centers for Medicare and Medicaid Services
c. OSHA
d. Food and Drug Administration
ANS: B
The Centers for Medicare and Medicaid Services administers CLIA, Medicare,
Medicaid, and HIPAA.

DIF: Level 1 REF: p. 3

2. A laboratory technologist decided she would like to bring her lab coat home for
laundering because it had too many wrinkles when returned by the laboratory’s
laundry service. Is this practice acceptable?
a. Yes, if she uses 10% bleach
b. Yes, if she clears it with her supervisor
c. Yes, as long as she removes the coat and does not wear it home
d. No, because the laboratory is a biosafety level 2, and lab coats may
not be removed
ANS: D
Methods of transporting the lab coat and the risk of contamination do not permit
health care workers to bring lab coats home for cleaning.

DIF: Level 2 REF: p. 14

3. Personal protective equipment includes:

a. safety glasses.
b. splash barriers.
c. masks.
d. All of the above

ANS: D
Safety glasses, splash barriers, and masks are types of personal protective devices.

DIF: Level 1 REF: p. 14

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4. At what point in the employment process should safety training take place?
a. During orientation and training
b. Following lab training when employees are more familiar with
their responsibilities
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c. Following the employees’ first evaluation

d. Before independent work is permitted and annually thereafter
ANS: D
The Occupation Safety and Health Administration requires safety training before
independent work is permitted and annually thereafter.

DIF: Level 1 REF: p. 17

5. In safety training, employees must become familiar with all of the following except:
a. tasks that have an infectious risk.
b. limits of protective clothing and equipment.
c. the appropriate action to take if exposure occurs.
d. how to perform cardiopulmonary resuscitation on a donor or other employee.
ANS: D
The Occupational Safety and Health Administration requirements include all of
those listed except cardiopulmonary resuscitation.

DIF: Level 1 REF: p. 13

6. Blood irradiators require all of the following safety procedures except:

a. proper training.
b. that the user have a degree in radiology.
c. equipment leak detection.
d. personal protective equipment.
ANS: B
Blood bank and transfusion service technologists require training but not a degree to
use a blood irradiator.

DIF: Level 2 REF: p. 16

7. Which of the following is true regarding good manufacturing practices (GMPs)?

a. GMPs are legal requirements established by the Food and Drug Administration.
b. GMPs are optional guidelines written by the AABB.
c. GMPs are required only by pharmaceutical companies.
d. GMPs are part of the quality control requirements for blood products.
ANS: A
Good manufacturing practices are requirements established by the Food and Drug
Administration.

DIF: Level 1 REF: p. 5

8. Which of the following is an example of an unacceptable record-keeping procedure?

a. Using dittos in columns to save time
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b. Recording the date and initials next to a correction
c. Not deleting the original entry when making a correction
d. Always using permanent ink on all records
ANS: A
All records must be clearly written. Dittos are unacceptable.
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DIF: Level 1 REF: p. 7

9. A technologist in training noticed that the person training her had not recorded the
results of a test. To be helpful, she carefully recorded the results she saw at a later
time, using the technologist’s initials. Is this an acceptable procedure?
a. Yes; all results must be recorded regardless of who did the test.
b. No; she should have brought the error to the technologist’s attention.
c. Yes; because she used the other technologist’s initials.
d. Yes; as long as she records the result in pencil.
ANS: B
This is an example of poor record keeping; results must be recorded when the test is
performed and by the person doing the test.

DIF: Level 3 REF: p. 8

10. Unacceptable quality control results for the antiglobulin test performed in test
tubes may be noticed if:
a. preventive maintenance has not been performed on the cell washer.
b. the technologist performing the test was never trained.
c. the reagents used were improperly stored.
d. All of the above
ANS: D
Training, equipment maintenance, and reagent quality can affect quality control.

DIF: Level 2 REF: p. 5

11. All of the following are true regarding competency testing except:
a. it must be performed following training.
b. it must be performed on an annual basis.
c. it is required only if the technologist has no experience.
d. retraining is required if there is a failure in competency testing.
ANS: C
All employees must have competency testing following training and annually
thereafter. If there is a failure in competency testing, retraining is required.

DIF: Level 2 REF: p. 10

12. Which of the following organizations are involved in the regulation of blood banks?
a. The Joint Commission
b. AABB
c. College of American Pathologists
d. Food and Drug Administration
ANS: D
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The Food and Drug Administration regulates blood banks, whereas the other
organizations are involved in accreditation.

DIF: Level 1 REF: p. 2

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13. All of the following are responsibilities of the quality assurance department of a
blood bank
except:
a. performing internal audits.
b. performing quality control.
c. reviewing standard operating procedures.
d. reviewing and approving training programs.
ANS: B
Quality control is performed in the laboratory, not by the quality assurance
department.

DIF: Level 2 REF: p. 5

14. The standard operating procedure is a document that:

a. helps achieve consistency of results.
b. may be substituted with package inserts.
c. is necessary only for training new employees.
d. must be very detailed to be accurate.

ANS: A
Standard operating procedures are written procedures that help achieve consistency
and should be clear and concise.

DIF: Level 2 REF: p. 8

15. Employee training takes place:

a. after hiring and following implementation of new procedures.
b. following competency assessment.
c. only for new inexperienced employees.
d. as procedures are validated.
ANS: A
Training occurs with all new employees regardless of their experience and following
implementation of new procedures.

DIF: Level 1 REF: p. 10

16. Plans that provide the framework for establishing quality assurance in an organization
are:
a. current good manufacturing practices.
b. standard operating procedures.
c. change control plan.
d. continuous quality improvement plan.
ANS: D
The total quality management or continuous quality improvement plan are part of
the quality assurance program in an organization.
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DIF: Level 1 REF: p. 4

17. A facility does not validate a refrigerator before use. What is a potential outcome?
a. The facility is in violation of current good manufacturing practices and
could be cited by the Food and Drug Administration.
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b. The facility is in compliance if the equipment functions properly.

c. The facility is in compliance if the blood products stored in it are not transfused.
d. The facility is in violation of AABB and may no longer be members.
ANS: A
Validation of equipment is a current good manufacturing practice, which is a legal
requirement established by the Food and Drug Administration.

DIF: Level 2 REF: p. 12

18. In a routine audit of a facilities blood collection area, the quality assurance
department found that the blood bags used on that particular day had expired.
What is the appropriate course of action?
a. Initiate a root cause analysis and quarantine the blood collected in the
expired bags.
b. Call the Food and Drug Administration to report the incident.
c. Change the expiration date on the bags to avoid legal issues.
d. Fire the donor room supervisor, and discard the blood collected in the
expired bags.
ANS: A
A root cause analysis will determine the factors that contributed to the error and
result in a plan to prevent further errors.

DIF: Level 3 REF: p. 11

19. Several units were released to a hospital by mistake before all viral marker
testing was completed. What is the appropriate course of action?
a. The error is reportable, and the Food and Drug Administration must be contacted.
b. Ask the hospital to avoid transfusion and quickly complete the testing.
c. Perform a root cause analysis and, if the units are found to be negative,
report the test result to the hospital.
d. Recall only the units that are positive for viral markers.
ANS: A
Release of untested units is a reportable error to the Food and Drug Administration.

DIF: Level 3 REF: p. 11

MATCHING

Match the government or accrediting agencies with the description that best fits
their purpose.
a. Ensures safe and healthful working conditions
b. Ensures the safety and efficacy of biologics, drugs, and devices
c. Provides peer-reviewed accreditation for hospital laboratories
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d. Professional organization that accredits blood banks and transfusion services
e. Makes recommendations to the Occupational Safety and Health
Administration regarding the prevention of disease transmission

1. FDA
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2. OSHA
3. CDC
4. AABB
5. CAP

1. ANS: B DIF: Level 1

2. ANS: A DIF: Level 1
3. ANS: E DIF: Level 1
4. ANS: D DIF: Level 1
5. ANS: C DIF: Level 1

Match the following descriptions with the appropriate terms.

a. The CAP survey is an example
b. Systematic evaluations to determine whether procedures are being followed
c. Testing to determine the accuracy and precision of reagents and equipment
d. Process of standardizing an instrument against a known value
e. Removal of products from the market that might compromise the
safety of the recipient
f. Degree to which a measurement represents the true value
g. Establishing that a specific process produces an expected result
h. Evaluation of an employee’s ability to perform a specific skill
i. Investigation and identification of the factors that contributed to an error
j. Maximizes the duration of equipment and increases the reliability
of the equipment
k. System to plan and implement changes to prevent problems
6. Root cause analysis
7. Recall
8. Accuracy
9. Validation
10. Calibration
11. Quality control
12. Proficiency test
13. Competency assessment
14. Change control
15. Audit
16. Preventive maintenance

6. ANS: I DIF: Level 1

7. ANS: E DIF: Level 1
8. ANS: F DIF: Level 1
9. ANS: G DIF: Level 1
10. ANS: D DIF: Level 1
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11. ANS: C DIF: Level 1

12. ANS: A DIF: Level 1
13. ANS: H DIF: Level 1
14. ANS: K DIF: Level 1
15. ANS: B DIF: Level 1
16. ANS: J DIF: Level 1
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TRUE/FALSE

1. The Occupation Safety and Health Administration does not require the routine use
of gloves by phlebotomists working with healthy prescreened donors or changing
unsoiled gloves between donors.

ANS: T
Because the risk of exposure is minimal with blood donors, the Occupation Safety
and Health Administration (OSHA) does not require gloves, or if gloves are worn,
OSHA does not require that unsoiled gloves be changed between donors.

DIF: Level 1 REF: p. 15

2. All accidents, even minor ones, must be reported to a supervisor.

ANS: T
The Occupational Safety and Health Administration, workers’ compensation, and
other regulatory agencies require reporting all accidents, and an investigation to
avoid other injuries is mandatory.

DIF: Level 1 REF: p. 16

3. Quality control is the same as quality assurance.

ANS: F
Quality control is performed on reagents and equipment; quality assurance is a
system to ensure safe and effective products.

DIF: Level 1 REF: p. 5

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Chapter 02: Immunology: Basic Principles and Applications in the Blood Bank
Howard: Basic & Applied Concepts of Blood Banking and Transfusion Practices,
4th Edition

MULTIPLE CHOICE

1. Select the cell involved in humoral immunity.

a. Neutrophils
b. T lymphocytes
c. B lymphocytes
d. Monocytes
ANS: C
B lymphocytes have the ability to transform into plasma cells to produce antibodies,
which is considered a humoral response.

DIF: Level 2 REF: p. 23

2. What process is described by opsonization?

a. Lysis of cells
b. Binding to cells or antigens
c. Ingestion of cells
d. Phagocytosis
ANS: B
Opsonization promotes phagocytosis by binding to cells or antigens.

DIF: Level 1 REF: p. 35

3. Select the term that describes cells or tissue from a genetically different individual
within the same species.
a. Allogeneic
b. Autologous
c. Xenogeneic
d. Autograft
ANS: A
Allogeneic cells or tissue come from a genetically different individual within the same
species.

DIF: Level 1 REF: p. 33

4. Select the substance that regulates the activity of other cells by binding to specific receptors.
a. Cytokines
b. Complement
c. Immunoglobulins
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d. Anaphylatoxin
ANS: A
Cytokines are proteins secreted by cells that regulate the activity of other cells by
binding to specific receptors.
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DIF: Level 1 REF: p. 23

5. Which of the following is responsible for the activation of the classic

pathway of complement?
a. Bacteria
b. Foreign proteins
c. Virus
d. Antibody bound to antigen
ANS: D
An antigen-antibody complex activates the classical complement cascade, whereas
bacterial membranes activate the alternative pathway.

DIF: Level 1 REF: p. 33

6. What biological molecules are considered the most immunogenic?

a. Carbohydrates
b. Lipids
c. Proteins
d. Enzymes
ANS: C
Protein molecules are the most immunogenic, followed by carbohydrates and lipids,
which tend to be immunologically inert.

DIF: Level 2 REF: p. 24

7. What part of the immunoglobulin molecule distinguishes the isotype?

a. Light chain
b. Heavy chain
c. Kappa chain
d. Lambda chain
ANS: B
The five distinctive heavy-chain molecules distinguish the class or isotype. Each heavy
chain imparts characteristic features, which permit them to have unique biological
functions.

DIF: Level 2 REF: p. 24

8. Select the immunoglobulin class produced first in the primary immune response.
a. IgG
b. IgE
c. IgA
d. IgM
ANS: D
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IgM antibodies are produced first, followed by the production of IgG antibodies.

DIF: Level 1 REF: p. 28

9. In a serologic test, the term prozone is also known as:

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a. equivalence.
b. antigen excess.
c. antibody excess.
d. serum-to-cell ratio.
ANS: C
Antibody excess is termed prozone, often leading to a false-negative reaction.

DIF: Level 1 REF: p. 38

10. What is the potential effect in a tube agglutination test if a red cell
suspension with a concentration greater than 5% is used?
a. False negatives
b. False positives
c. Hemolysis
d. No effect
ANS: A
Antigen excess is termed postzone and will lessen the reaction, causing a false-
negative.

DIF: Level 3 REF: p. 38

11. After adding antigen and antibody to a test tube, one large agglutinate was
observed. How should this reaction be graded?
a. 2+
b. 3+
c. 4+
d. 0

ANS: C
One large agglutinate is graded a 4+ reaction.

DIF: Level 2 REF: p. 39

12. Select the portion of the antibody molecule that imparts the antibody’s unique class
function.
a. Constant region of the heavy chain
b. Constant region of the light chain
c. Variable region of the heavy chain
d. Variable region of the light chain
ANS: A
The heavy-chain constant region has the function of the class.

DIF: Level 1 REF: p. 26

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13. What portion of the antibody molecule binds to receptors on macrophages and
assists in the removal of antibody bound to red cells?
a. Fab fragment
b. Hinge region
c. Fc fragment
d. J chain
ANS: C
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The Fc portion of the antibody binds to the macrophage, which then carries the
antigen- antibody complex to the spleen for removal.

DIF: Level 1 REF: p. 26

14. Select the region of the antibody molecule responsible for imparting unique
antibody specificity.
a. Variable region
b. Constant region
c. Hinge region
d. Fc fragment

ANS: A
The variable region is the unique antigen-binding site that gives each antibody its
specificity.

DIF: Level 1 REF: p. 26

15. What immunoglobulin class is capable of crossing the placenta?

a. IgM
b. IgA
c. IgE
d. IgG
ANS: D
Only IgG can cross the placenta as a result of IgG receptor binding sites on placental
cells.

DIF: Level 1 REF: p. 26

16. What immunoglobulin class reacts best at room temperature at immediate-spin?

a. IgM
b. IgA
c. IgE
d. IgG
ANS: A
IgM is a large immunoglobulin with multiple binding sites that is detectable
at room temperature and the immediate-spin phase.

DIF: Level 2 REF: p. 27

17. An antigen that originates from the individual is termed:

a. autologous.
b. allogeneic.
c. hapten.
d. immunogen.
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ANS: A
Autologous is a term that refers to cells or tissue from self.

DIF: Level 1 REF: p. 33

18. Which of the following will cause an antigen to elicit a greater immune response?
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a. Small antigen size

b. Composed largely of carbohydrates
c. Size greater than 10,000 daltons
d. Similarity to the host
ANS: C
Antigens will elicit a better immune response if they are larger than 10,000 daltons,
are foreign to the host, and are made of proteins.

DIF: Level 1 REF: p. 25

19. Extravascular destruction of blood cells occurs in the:

a. blood vessels.
b. lymph nodes.
c. spleen.
d. thymus.
ANS: C
Extravascular destruction of blood cells is initiated by macrophage interaction with
IgG molecules attached to red cells that transport the red cells to the spleen for
clearance.

DIF: Level 2 REF: p. 35

20. An antibody identified in the transfusion service appeared to be reacting stronger

following the second exposure to an antigen from a transfusion. The most likely
explanation of this observation is:
a. affinity maturation of the immunoglobulin molecule.
b. anamnestic response.
c. isotype switching.
d. All of the above
ANS: D
Genetic changes in the variable region, stimulation of memory B cells, and class
switching contribute to the increased strength and specificity of an antibody
following the second exposure to an antigen.

DIF: Level 3 REF: p. 29

21. Which of the following components in the complement cascade mediates the
lysis of the target cells?
a. C1qrs
b. C4a, C3a, and C5a
c. C5 to C9
d. C3a and C3b
ANS: C
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The membrane attack complex includes the C5 to C9 proteins that mediate lysis of
the target cell.

DIF: Level 2 REF: p. 34

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22. Which of the following requires adjustment in order to enhance the reaction of an
antibody in vitro?
a. Temperature above 37° C
b. Speed of the centrifuge above the calibrated settings
c. Increase the concentration of red cells in the test system
d. Increase the incubation time in the incubator

ANS: D
Increasing incubation time is effective in increasing antibody reactions; however,
optimal temperatures, centrifugation, and antigen concentrations are normally not
altered when performing routine transfusion service testing.

DIF: Level 3 REF: p. 37

23. Hemolysis was observed at room temperature when testing a patient’s serum with
reagent red cells used for screening. When this test was repeated using the patient’s
plasma, no hemolysis was observed. What was the most likely explanation for the
different reactions?
a. The plasma sample was collected incorrectly.
b. The serum sample was contaminated.
c. Complement activation was inhibited by calcium in the plasma sample.
d. The serum sample was fresher.
ANS: C
Complement can be activated by some red cell antibodies; however, fresh serum
samples are necessary to observe this reaction. Plasma samples contain calcium to
inhibit the coagulation cascade, which also will inhibit complement activation.

DIF: Level 3 REF: p. 33

24. Which immunoglobulin class is impacted by the zeta potential in a hemagglutination

test?
a. IgM
b. IgG
c. IgA
d. IgE
ANS: B
IgG is a small molecule that cannot span the distance between red cells suspended in saline.
The zeta potential prevents direct agglutination with IgG molecules.

DIF: Level 2 REF: p. 37

25. When testing for the A antigen in a patient, what would you use to perform the test?
a. Patient’s plasma and commercial A red cells
b. Commercial A cells and anti-A
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c. Patient’s red cells and anti-A
d. None of the above
ANS: C
For antigen testing, antigens are on the red cell; antibodies are in the antisera
(commercial antibodies).

DIF: Level 2 REF: p. 40