Practice questions Blood transfusion I
Practice questions
Blood transfusion I
© Jun Wang, MD, PhD
1. Use this case for the next three questions. A 21-year-old man is brought to the emergency department after being involved in a motor vehicle accident. His blood pressure is 90/60 mmHg, and heart rate is 120 beats per minute. Physical examination reveals pale skin and mucosa and a 15 cm laceration on the left leg with active bleeding. His CBC reveals a hemoglobin of 8 g/dL. His white cell count, platelet count and coagulation panels are within normal ranges. Forward typing reveals agglutination with anti-B but not anti-A reagent. Reverse typing reveals agglutination with A cells, but not B cells. Antibody screening test is negative. What is his blood type?
A. AB. AB
C. B
D. Bombay
E. O
2. A 21-year-old man is brought to the emergency department after being involved in a motor vehicle accident. His blood pressure is 90/60 mmHg, and heart rate is 120 beats per minute. Physical examination reveals pale skin and mucosa and a 15 cm laceration on the left leg with active bleeding. His CBC reveals a hemoglobin of 8 g/dL. His white cell count, platelet count and coagulation panels are within normal ranges. Forward typing reveals agglutination with anti-B but not anti-A reagent. Reverse typing reveals agglutination with A cells, but not B cells. Antibody screening test is negative. What blood product is needed for him?
B. Type A fresh frozen plasma
C. Type B platelets
D. Type B red cells
E. Type O red cells
3. A 21-year-old man is brought to the emergency department after being involved in a motor vehicle accident. His blood pressure is 90/60 mmHg, and heart rate is 120 beats per minute. Physical examination reveals pale skin and mucosa and a 15 cm laceration on the left leg with active bleeding. His CBC reveals a hemoglobin of 8 g/dL. His white cell count, platelet count and coagulation panels are within normal ranges. Forward typing reveals agglutination with anti-B but not anti-A reagent. Reverse typing reveals agglutination with A cells, but not B cells. Antibody screening tests are negative. His father is type O. What is the blood type of his mother?
B. AB or B
C. AB or O
D. B or Bombay
E. B or O
4. Use this case for the next three questions. A 65-year-old man is diagnosed with colon cancer and colectomy is arranged. He has a history of alcoholic hepatitis. His CBC reveals a hemoglobin of 12g/dL (14-18 g/dL). White cells and platelets are within normal range. His PT is 15 second (11-13.5 s) and aPTT is 41 second (25-35s). Mixing with pooled normal plasma results in a PT of 11.5 second and aPTT of 28 seconds. Forward typing reveals no agglutination with anti-A or anti-B reagent. Reverse typing reveals agglutination with both A and B cells. Antibody screening tests are negative. What is his blood type?
B. AB
C. B
D. Bombay
E. O
5. A 65-year-old man is diagnosed with colon cancer and colectomy is arranged. He has a history of alcoholic hepatitis. His CBC reveals a hemoglobin of 12g/dL (14-18 g/dL). White cells and platelets are within normal range. His PT is 18 second (11-13.5 s) and aPTT is 51 second (25-35s). Mixing with pooled normal plasma results in a PT of 12.5 second and aPTT of 32 seconds. Forward typing reveals no agglutination with anti-A or anti-B reagent. Reverse typing reveals agglutination with both A and B cells. Antibody screening tests are negative. What blood product is needed for him?
B. Type B red cells
C. Type AB platelets
D. Type AB fresh frozen plasma
E. Type O fresh frozen plasma
F. Type O red cells
6. A 65-year-old man is diagnosed with colon cancer and colectomy is arranged. He has a history of alcoholic hepatitis. His CBC reveals a hemoglobin of 12g/dL (14-18 g/dL). White cells and platelets are within normal range. His PT is 15 second (11-13.5 s) and aPTT is 41 second (25-35s). Mixing with pooled normal plasma results in a PT of 11.5 second and aPTT of 28 seconds. Forward typing reveals no agglutination with anti-A or anti-B reagent. Reverse typing reveals agglutination with both A and B cells. Antibody screening tests are negative. What can be the blood types of his parents?
B. AB and B
C. AB and O
D. AB and Bombay
E. O and O
7. Use this case for the next four questions. A 25-year-old G1P0 woman presents to the clinic for prenatal visit. Her past medical history is unremarkable. Physical examination reveals no significant abnormalities. Her CBC, liver and renal function tests are within normal range. Screening for infections are all negative. What additional tests need to be performed?
B. Direct Coombs test
C. Hemoglobin electrophoresis
D. Iron studies
E. Serum lead levels
8. A 25-year-old G1P0 woman presents to the clinic for prenatal visit. Her past medical history is unremarkable. Physical examination reveals no significant abnormalities. Her CBC, liver and renal function tests are within normal range. Screening for infections are all negative.
Forward typing reveals agglutination with anti-A or anti-B reagent. Reverse typing reveals no agglutination with both A and B cells. Rh factor testing is negative. The father of the baby is O+. What is her blood type?
B. AB-
C. B+
D. Bombay-
E. O-
9. A 25-year-old G1P0 woman presents to the clinic for prenatal visit. Her past medical history is unremarkable. Physical examination reveals no significant abnormalities. Her CBC, liver and renal function tests are within normal range. Screening for infections are all negative.
Forward typing reveals agglutination with anti-A or anti-B reagent. Reverse typing reveals no agglutination with both A and B cells. Rh factor testing is negative. The father of the baby is O+. What additional tests need to be performed?
B. Anti-Lutheran
C. Anti-A
D. Anti-B
E. Direct Coombs test
10. A 25-year-old G1P0 woman presents to the clinic for prenatal visit. Her past medical history is unremarkable. Physical examination reveals no significant abnormalities. Her CBC, liver and renal function tests are within normal range. Screening for infections are all negative.
Forward typing reveals agglutination with anti-A or anti-B reagent. Reverse typing reveals no agglutination with both A and B cells. Rh factor testing is negative. The father of the baby is O+.
Rh antibody is identified at 28th week of gestation. What is likely happen to her subsequent gestations?
B. Maternal anti-D IgG antibodies causing fetal red cell destruction
C. Fetal anti-D antibodies causing maternal hemolysis
D. ABO incompatibility causing mild fetal hemolysis
E. Maternal anti-D IgM antibodies activating complement in fetal circulation
11. A 25-year-old G1P0 woman presents to the clinic for prenatal visit. Her past medical history is unremarkable. Physical examination reveals no significant abnormalities. Her CBC, liver and renal function tests are within normal range. Screening for infections are all negative.
Forward typing reveals agglutination with anti-A or anti-B reagent. Reverse typing reveals no agglutination with both A and B cells. Rh factor testing is negative. The father of the baby is O+.
Rh antibody screening is negative at 28th week of gestation. What is needed for the mother?
B. Iron supplementation
C. Rhogam
D. Type AB plasma
12. Use this case for the next four questions. A 28-year-old man is brought to the emergency department for multiple stab wounds to the chest and abdomen. Upon arrival, he is pale, diaphoretic, and unresponsive. Vital signs reveal a blood pressure of 60/40 mmHg, heart rate of 140/min, and respiratory rate of 30/min. His CBC reveals a hemoglobin of 6 g/dL (14-18 g/dL). His coagulation panel and platelet count are within normal ranges. Forward typing reveals no agglutination with anti-A and anti-B reagents. Reverse typing reveals agglutination with A and B cells. Rh-factor test is negative. Antibody screening reveals agglutination with all reagent cells. What test should be performed next?
B. Direct antiglobulin test
C. Indirect Coombs test
D. Repeat ABO typing
E. Titer of anti-A
13. A 28-year-old man is brought to the emergency department for multiple stab wounds to the chest and abdomen. Upon arrival, he is pale, diaphoretic, and unresponsive. Vital signs reveal a blood pressure of 60/40 mmHg, heart rate of 140/min, and respiratory rate of 30/min. His CBC reveals a hemoglobin of 6 g/dL (14-18 g/dL). His coagulation panel and platelet count are within normal ranges. Forward typing reveals no agglutination with anti-A and anti-B reagents. Reverse typing reveals agglutination with A and B cells. Rh-factor test is negative. Antibody screening reveals agglutination with all reagent cells. No agglutination is seen when anti-H lectin is mixed with his blood. What is his blood type?
B. A positive
C. Bombay negative
D. Bombay positive
E. O negative
F. O positive
14. A 28-year-old man is brought to the emergency department for multiple stab wounds to the chest and abdomen. Upon arrival, he is pale, diaphoretic, and unresponsive. Vital signs reveal a blood pressure of 60/40 mmHg, heart rate of 140/min, and respiratory rate of 30/min. His CBC reveals a hemoglobin of 6 g/dL (14-18 g/dL). His coagulation panel and platelet count are within normal ranges. Forward typing reveals no agglutination with anti-A and anti-B reagents. Reverse typing reveals agglutination with A and B cells. Rh-factor test is negative. Antibody screening reveals agglutination with all reagent cells. No agglutination is seen when anti-H lectin is mixed with his blood. What blood product is needed for him?
B. AB positive plasma
C. Bombay negative plasma
D. Bombay negative RBCs
E. O negative RBCs
F. O positive plasma
15. A 28-year-old man is brought to the emergency department for multiple stab wounds to the chest and abdomen. Upon arrival, he is pale, diaphoretic, and unresponsive. Vital signs reveal a blood pressure of 60/40 mmHg, heart rate of 140/min, and respiratory rate of 30/min. His CBC reveals a hemoglobin of 6 g/dL (14-18 g/dL). His coagulation panel and platelet count are within normal ranges. Forward typing reveals no agglutination with anti-A and anti-B reagents. Reverse typing reveals agglutination with A and B cells. Rh-factor test is negative. Antibody screening reveals agglutination with all reagent cells. No agglutination is seen when anti-H lectin is mixed with his blood. What is causing agglutination with all antibody screening test reagent cells?
B. Anti-B
C. Anti-D
D. Anti-H
E. Anti-k
16. Use this case for the next two questions. A newborn boy is noted to have yellowish skin with the first 12 hours of life. The mother is 25-year-old G1P0 woman with no significant medical history. The pregnancy and delivery are uneventful. The mother is O negative with negative antibody screening. The newborn is A negative. Laboratory tests of the newborn reveal a hemoglobin of 12.5 g/dL (14-24 g/dL) and a bilirubin of 7.5 mg/dL (<5 mg/dL). Peripheral blood smears reveals many red cells without central pallor area. Direct Coombs test of the newborn is positive. What is most likely the cause of this newborn’s presentations?
B. Maternal anti-A IgG
C. Maternal anti-A IgM
D. Maternal anti-D IgG
E. Maternal anti-D IgM
F. Parvovirus infection of the newborn
17. A newborn boy is noted to have yellowish skin with the first 12 hours of life. The mother is 25-year-old G1P0 woman with no significant medical history. The pregnancy and delivery are uneventful. The mother is O negative with negative antibody screening. The newborn is A negative. Laboratory tests of the newborn reveal a hemoglobin of 11.5 g/dL (14-24 g/dL) and a bilirubin of 8.5 mg/dL (<5 mg/dL). Peripheral blood smears reveals many red cells without central pallor area. Direct Coombs test of the newborn is positive. What is the diagnosis?
B. Fetal viral hepatitis
C. Hemolytic disease of newborn
D. Hereditary spherocytosis
E. Paroxysmal nocturnal hemoglobinuria
18. Use this case for the next three questions. A 24-year-old G2P1 woman delivers a male newborn at 39 weeks of gestation. The newborn is pale and lethargic with generalized edema. The mother’s medical history is unremarkable. She does not smoke cigarette, but drinks wines occasionally. The pregnancy and delivery are uneventful. The mother is O negative. The newborn is A positive. Laboratory tests of the newborn reveal a hemoglobin of 7.5 g/dL (14-24 g/dL) and a bilirubin of 10.5 mg/dL (<5 mg/dL) right after delivery. Peripheral blood smears reveals many red cells without central pallor area. Direct Coombs test of the newborn is positive. What is most likely the cause of this newborn’s presentations?
B. Maternal anti-A IgG
C. Maternal anti-A IgM
D. Maternal anti-D IgG
E. Maternal anti-D IgM
F. Parvovirus infection of the newborn
19. A 24-year-old G2P1 woman delivers a male newborn at 39 weeks of gestation. The newborn is pale and lethargic with generalized edema. The mother’s medical history is unremarkable. She does not smoke cigarette, but drinks wines occasionally. The pregnancy and delivery are uneventful. The mother is O negative. The newborn is A positive. Laboratory tests of the newborn reveal a hemoglobin of 7.5 g/dL (14-24 g/dL) and a bilirubin of 10.5 mg/dL (<5 mg/dL) right after delivery. Peripheral blood smears reveals many red cells without central pallor area. Direct Coombs test of the newborn is positive. What is the diagnosis?
B. Hemoglobin SC disease
C. Hemolytic disease of newborn
D. Hereditary spherocytosis
E. Paroxysmal nocturnal hemoglobinuria
20. A 24-year-old G2P1 woman delivers a male newborn at 39 weeks of gestation. The newborn is pale and lethargic with generalized edema. The mother’s medical history is unremarkable. She does not smoke cigarette, but drinks wines occasionally. The pregnancy and delivery are uneventful. The mother is O negative. The newborn is A positive. Laboratory tests of the newborn reveal a hemoglobin of 7.5 g/dL (14-24 g/dL) and a bilirubin of 10.5 mg/dL (<5 mg/dL) right after delivery. Peripheral blood smears reveals many red cells without central pallor area. Direct Coombs test of the newborn is positive. What can be done to prevent the condition of this newborn?
B. Iron supplementation
C. Prenatal hemoglobin studies
D. Prenatal infectious disease screening
E. Rhogam during her first pregnancy
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