Transfusion Science MCQS

FINALS 

Section A

1. Antibody

Proteins produced by lymphocytes as a result of stimulation by an antigen which can then interact specifically with that particular antigen 

Structure

• Heavy chains=alpha, gamma, delta, mu, or epsilon chains
• Light chains=kappa or lambda
• Disulfide bonds hold chains 
• Hinge regions allows antibody flex to reach more antigen sites
• Fab frag contains variable portion of antibody, antigen binding sites 
• Fc frag contains constant portion of antibody, site of complement activation

IgG monomer (80~85%)

• can cross placenta
• smallest Ab
• found in all body fluids, colostrum
• responsible for protection of newborn 
• secondary immune response
• 2 binding sites
• 37°C (optimum temp of reactivity)
• cause in vivo hemolysis which in turn cause transfusion reaction or HDN
• half life of 7~23 days
• Fc portion activate classical complement pathway, bind to macrophage and neutrophils for enhanced phagocytosis, bind to NK for ADCC

IgM pentamer (5~13%)

• first Ab secreted by B 
• largest Ab
• found in blood, lymph fluid 
• responsible for neutralize Ag and controls bloodstream infection
• primary immune response
• can bind to B cell surface
• 10 binding sites
• 4°C or room temp (optimum temp of reactivity)
• no in vivo hemolysis except for ABO antibodies, anti-A and B
• half life of about 5 days
• Fc portion activate classical complement pathway

IgA dimer (10~13%)

• produced in mucous lining, found in mucous secretions 
• prevents colonization by pathogens 
• 2 subclasses: IgA1, IgA2
• present in large quantities in breast milk 

IgE monomer 

• found in mammals 
• defends against parasitic invasion
• responsible for allergic reactions 
• mediates release of histamine and heparin 

IgD monomer (1%)

• produced in secreted form in small amount 
• unknown functions 
• can bind to B cell surface 

Antibody production

2. Perform blood bank

wrap an elastic band around upper arm to stop blood flow

makes veins below band larger 

easier to insert needle

clean needle site with alcohol

insert

attach a tube to the needle to fit it with blood

remove band

apply gauze pad or cotton ball over needle site

apply pressure to the site and bandage 

3. Blood processing 

a single donation=PRBC + platelets + FFP, benefits 3 patients

whole blood 

PRBC for anemia (70% plasma removed) 

store >42d at 2~6 C

anticoagulant Citrate Phosphate Dextrose Adenine 

done by light centrifugation 

plasma → centrifuge 2nd time → platelet rich plasma

supernatant plasma → fresh frozen plasma (3rd bag)

remaining platelet rich plasma → platelet pack

Donor inspection 

4. Blood group

5. ABO

Indications

• blood donors
• transfusion recipients
• transplant candidates and donors
• prenatal patients
• newborns
• paternity testing 

ABO & Rh Blood System

6. Transfusion transmitted disease

Mode of transmission

• intravascular drug user 
• sexual exposure
• perinatal infection
• needle prick
• infected blood 

Virus

• CMV
• immunocompromised, low-birth weight infants, BM and organ transplant at risk 
• filter blood, decrease WBC carrying CMV
• CMV lies dominant in peripheral blood lymphocytes
• HAV
• acute disease, rare in TTI
• spread by contaminated food and water
• prophylaxis: immune serum globulin, decrease severity of symptoms
• HBV
• chronic course, TTI
• acute and chronic hepatitis
• screening Enzyme Immuno Assay 
• confirmation Neutralization 
• reagent used specific antibody neutralize HB Ag in serum/plasma
• neutralization ≥50%
• 25% ppl carry active hepatitis progressing to liver cirrhosis
• 4000/yr die HB liver cirrhosis, >800 die HB liver cancer
• HCV
• chronic course, TTI
• non HAV, HBV
• ppl unaware 
• screening EIA
• confirmation RIBA-3
• HIV
• cause AIDS
• HIV antibody tests used on every blood donation
• Nucleic Acid Amplification Testing (NAT) detect genetic material of HIV 
• screening EIA
• confirmation PCR
• Human T Lymphotropic Virus I & II
• West Nile Virus
• Human Parvovirus B19
• Sen Virus
• Human Herpes Virus 8
• Hepatitis G Virus 
• SARS

Parasite

• Babesiosis
• carried by white-footed mouse
• transmitted by tick bites 
• immunocompromised ppl or no spleen at risk of serious illness
• Chaga's disease
• Trypanosoma cruzi
• blood sucking bugs (Triatomine)
• life long
• die of heart and digestive problems
• Malaria
• Plasmodium
• Anopheles mosquito
• Screening done by preparing one thick and one thin smear with Giemsa stain

Bacteria

• Syphilis
• Treponema pallidum
• VDRL, RPR, TPHA
• Lyme disease caused by Borrelia sp
• bite of deer tick
• may affects brain, nerves, heart, joints, eyes 
• E coli
• Pseudomonas

Minimize TTI

• donor selection
• appropriate screening 
• judicious use of blood
• fractionated product
• viral inactionated products 

7. T lymphocyte

Section B 

1. Blood group

2. ABO Discrepancy 

• Problems with technique
• Clerical
• Mislabel tubes, using wrong serum
• Expired reagents 
• increase in potency 
• Incorrect reaction condition
• temperature (RT)
• time of reaction (5~30 min)
• Incorrect cell suspension strength
• too weak, hard to read
• too strong, false negative
• Problems with RBC cells
• Presence of protein coating pseudo agglutination
• Whartons Jelly 
• Loss or weakening of antigen
• Leukemia, weak A Ag 
• Hodgkin's
• Elderly
• Group O on forward, A on reverse 
• Acquiring of antigen on RBC
• B like Ag attach E coli
• A like Ag at Proteus mirabilis 
• Mixed field agglutination
• due to e.g. transfused group O red cells to a non-O patient 
• Problems with serum
• Increased protein 
• form Rouleaux 
• Hemolysis
• Serum contaminated with hemolyzed cells should not use as significant hemolytic reaction may be mixed
• Hemolytic sera should not use
• Weakened Ig
• CLL
• elderly
• Hypogammaglobulinemia in newborn or marrow transplant patient
• Presence of anti-A1 in A2 ppl
• Presence of anti-H in Bombay group and some A1 and A1B patients
• High titer cold agglutination
• Blood Group Specific Soluble 

3. HDN

• HDN is also called as erythroblastosis fetalis
• HDN occurs when the blood types of the mother and infant are incompatible, which resulting in hemolysis
• ABO and Rh incompatibility can cause HDN
• Rh D is the most common cause of HDN. Antibody combination such as Anti-Rh C and E occurring together can be severe. Mechanisms of Rh HDN include antibody absorption and fetal maternal hemorrhage.

	Rh HDN	ABO HDN
Frequency	Less common	More common
Mother	Rh negative	Group O
Infant	Rh positive	Group A or B
Occurrence in first born	5%	40~50%
Severe anemia	Frequent	Rare
Stillbirth or hydrops	Frequent	Rare
DAT	Strongly positive	Weakly positive or negative
Blood smear	Erythroblastosis	Spherocytosis
Exchange transfusion	Frequent	Infrequent
Bilirubinemia	Yes	No
Increase in antibody titer	Yes	No
Microscopic examination	Polychromasia Increased nucleated RBC Normal WBC Thrombocytopenia Increased reticulocyte count	Polychromasia Increased nucleated RBC Micro spherocytes
Prophylaxis	Anti-D globulin given within 72 hours of abortion	-
Phototherapy	Adjunct to exchange	Often only treatment
Signs and symptoms	Anemia Fetal heart failure Kernicterus Hepatosplenomegaly Oedema Hydrops fetalis	Mild anemia Jaundice Kernicterus
Diagnosis	Doppler ultrasound -degree of anemia Amniocentesis -bilirubin Obstetric ultrasonography -hydrops fetalis Antenatal assessment of severity -titer of Anti-D Cordocentesis percutaneous umbilical cord blood sampling DAT & IAT	ABO typing Rh typing DAT & IAT

4. Rhesus phenotyping 

• Fisher-Race
• States that there are 3 closely linked loci
• Each with one of the sets of allelic gene (D, d; C, c; E, e)
• These 3 genes are inherited as complex
• Complex Rh genes control Rh antigens
• Antigen d does not exist
• Complex genes can be assembled in: Dce, DCe, DcE, DCE, dce, dCe, dce, dCE
• All individuals who lack D antigen are Rh negative regardless of whether C or E antigen or both are present  
• Useful to describe antigens and antibodies

• Weiner
• States one gene produces one complex antigen which made up of 3 factors
• 8 genes: R₀, R₁, R₂, R_z, r, r’, r”, r_y
• Useful to describe phenotypes

• Rosenfield
• In 1962 proposed a nomenclature based only on serologic reactions
• Antigens are numbered in the order of their discovery and recognition
• No genetic assumption made

5. Simple case (table & possible symptoms)

http://www.referencelab.ir/Asset/userfiles/file/Bahman02.pdf

Anti-B 2+mf

A1 cells 3+

problem: mf reactivity

cause: recent-out of group transfusion, BM transplant, subgroup A, fetal hemorrhage, chimerism

resolution: check patient history, serology, reticulocyte separation method

Anti-A 4+

Anti-B 4+

B cells 1+

problem:

cause

resolution:

All -

problems: missing antibody

cause: group O newborn or elderly, hypogammaglobulinemia, agammaglobulinemia, immunosuppressive drugs

resolution: repeat reverse grouping using 4 drops of serum, incubate at RT for 30 mins or at 4℃ (run auto-control and Sc)

https://www.studystack.com/flashcard-688797

https://quizlet.com/86675386/abo-discrepancies-flash-cards/

https://quizlet.com/292486827/abo-discrepancies-flash-cards/

November 2019

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Discuss the differences of direct and indirect coomb test. (10 Marks)

DAT

• in vivo
• detects antibodies on RBC
• self antibody attack self antigen 
• use RBC
• AIHA

IAT

• in vitro
• detects antibodies in serum
• foreign antigen attack self antibody
• use serum
• blood transfusion and prenatal test

2. a. What is the aim of compatibility test? (3 Marks)

give every patient blood which will give them max benefit from transfusion with the min risk of side effects

maximize survival rate of RBC

patient safety

b. Write down the procedure of major crossmatch. (7 Marks)

immediate spin detects presence of cold antibody IgM in patient serum against donor cells (anti-M)

37℃ incubation detects presence of Rh antibody IgG in patient serum against donor cells (anti-C, c, E, e)

AHG detects presence of warm antibody IgG in patient serum against donor cells (anti-S)

2 patient serum +1 donor RBC 5%

incubate 37℃ 10 min

wash x3

centrifuge 1 min high speed

2 AHG

centrifuge 20 sec low speed

1 CCC

centrifuge 20 sec low speed

3. a. Define safe donor (2 Marks)

no negative health effects, eligible

b. Describe the physical examination for safe donor. (4 Marks)

blood pressure and pulse rate: 120/80 mmHg 60~100 BPM

hemoglobin male 13~18 g/dL female 12~16 g/dL

iron bearing protein 60~160 ug/dL

blood cell volume 

c. Describe the donor inspection for potential donor. (4 Marks)

donor education

medical history interview 

heart, lung or blood disease, heart valve conditions, irregular heartbeat, disease of blood vessels in the brain

other medical conditions

no seizures for past 12 months

recent surgery, not permitted until complete healing and resumed full activity

pregnancy, not permitted during pregnancy and for 6 weeks after delivery

age >17

weight >50 kg, lesser weight greater likelihood of reaction (dizziness or fainting) 

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Write down in detail the procedure of direct antiglobulin test in blood transfusion. (20 Marks)

1 tube DAT, 1 tube Control

2 RBC 5% into DAT and Control

wash x3

centrifuge 1 min high speed

2 AHG and patient serum into DAT

2 saline into Control

centrifuge 20 sec low speed

1 CCC into DAT 

centrifuge 20 sec low speed

Question 2

Discuss the significant types of weak D antigen in Rhesus blood group. (20 marks)

Donors

• labeled as D+
• weak D substantially less immunogenic than normal D
• weak D has caused severe HTR in patient with anti-D

Patients

• if weak D due to partial D can make antibody to portion they lack
• if weak D due to suppression or genetic expression theoretically could give D+
• standard practice to transfuse with D- 

Weak D testing on donors by transfusion service not required

Weak D testing on patients not required except in certain situations

Question 3

Explain the pathogenesis of Rhesus Hemolytic Disease of newborn. (20 Marks)

Rh D is the most common

Rh E is mild condition

Rh C 3rd common, range from mild to severe 

antibody combinations can be severe (anti-Rh C & E occurring together)

mechanisms include antibody absorption and fetal maternal hemorrhage

occurs when Rh +ve RBCs of the fetus cross placenta of a Rh -ve mother

induce formation of anti-IgG in the mother

IgG antibodies lyse RBCs of fetus 

usually occur in 2nd pregnancy, rare in 1st

in subsequent pregnancies, mother become sensitized (make Rh anti-D IgG antibodies)

formed IgG antibodies cross placenta, cause agglutination and coat fetal hemolysis 

baby become anemic

doppler ultrasound determine degree of anemia measuring speed of blood flow in fetal vessel 

fetal heart compensate, lead to fetal heart failure 

fetal jaundice, high unconjugated bilirubin

bilirubin toxic to neurological tissue, resulting in kernicterus

secondary to hemolysis, hepatosplenomegaly

less albumin produced, reduce liver function

albumin is responsible for intravascular oncotic pressure, fetal become edematous 

amniocentesis measure fetal bilirubin

hydrops fetalis, obstetric ultrasonography 

antenatal assessment of severity can be made by determining the titre of anti-D in the mother every 4 weeks until 28 weeks, then every 2 weeks

at the time of delivery, 20 mL of cord blood collected (both EDTA and clotted specimens) and subjected to Direct Coombs Test

if positive, subjected to Indirect Coombs to assess anti-D levels

for prophylaxis (tx), anti-D given to Rh -ve mother within 72 hours of delivery/abortion

fetal maternal hemorrhage occur due to trauma, abortion, childbirth, ruptures in placenta during pregnancy, or medical procedures carried out during pregnancy that breach the uterine wall

in subsequent pregnancies, if there is similar incompatibility in fetus, antibodies are then able to cross placenta into fetal bloodstream to attach RBCs and cause hemolysis

if a mother is sensitized, the antibodies will only affect fetus with Rh D +ve blood 

paternal Rh typing test father's blood carried corresponding antigen

cordocentesis percutaneous umbilical cord blood sampling, Hb, bilirubin, ABO, DAT

https://www.studocu.com/my/document/lancaster-university/medicine-and-surgery/rhesus-haemolytic-disease-of-the-newborn/14196255

https://studylib.net/doc/7038670/hemolytic-disease-of-abo-incompatibility

https://www.scribd.com/presentation/91318840/Haemolytic-Disease-of-the-Newborn

ABO incompatibility

less severe

arises when a pregnant mother with blood type O with a fetus of different blood type

mother's serum contains naturally occurring anti-A and B without previous immunization that is usually in form of IgM cannot cross placenta

during 1st pregnancy, mother expose to A or B antigen leading to maternal sensitization and formation of IgG cross placenta cause fetal hemolysis in 2nd pregnancy

some mother has anti-A or B of IgG type 

ABO incompatibility can occur in 1st pregnancy

occur in 20~25% of pregnancies HD, develop in only 10% of such

increase TSB, reticulocyte count

Hb usually normal but may be as low as 10~12 mg/dL

Coombs -ve 

polychromasia

nucleated RBCs

micro spherocyte

April 2019

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. List the tests required prior to blood transfusion (3 Marks)

ABO

Rh 

antibody 

b. Describe the donor inspection in blood transfusion. (7 Marks)

donor education

medical history interview 

heart, lung or blood disease, heart valve conditions, irregular heartbeat, disease of blood vessels in the brain

other medical conditions

no seizures for past 12 months

recent surgery, not permitted until complete healing and resumed full activity

pregnancy, not permitted during pregnancy and for 6 weeks after delivery

age >17

weight >50 kg, lesser weight greater likelihood of reaction (dizziness or fainting) 

2. a. What is the aim of compatibility test. (3 Marks)

give every patient blood which will give them max benefit from transfusion with the min risk of side effects

maximize survival rate of RBC

patient safety

b. List TWO (2) types of compatibility test. (2 Marks)

ABO & Rh typing

antibody screening 

crossmatch

c. Why major crossmatching is important? (2 Marks)

antibodies of most concern is in patients, they are only ones in dynamic state

antigens of importance is in donor blood

d. List THREE (3) phases involved during crossmatching. (3 Marks)

immediate spin 

37℃ incubation

AHG 

3. a. Discuss the discrepancy in ABO typing. (10 Marks)

• Problems with technique
• Clerical
• Mislabel tubes, using wrong serum
• Expired reagents 
• increase in potency 
• Incorrect reaction condition
• temperature (RT)
• time of reaction (5~30 min)
• Incorrect cell suspension strength
• too weak, hard to read
• too strong, false negative
• Problems with RBC cells
• Presence of protein coating pseudo agglutination
• Whartons Jelly 
• Loss or weakening of antigen
• Leukemia, weak A Ag 
• Acquiring of antigen on RBC
• B like Ag attach E coli
• A like Ag at Proteus mirabilis 
• Mixed field agglutination
• due to e.g. transfused group O red cells to a non-O patient 
• Problems with serum
• Increased protein 
• form Rouleaux 
• Hemolysis
• Serum contaminated with hemolyzed cells should not use as significant hemolytic reaction may be mixed
• Hemolytic sera should not use
• Weakened Ig
• CLL
• elderly
• Hypogammaglobulinemia in newborn or marrow transplant patient
• Presence of anti-A1 in A2 ppl
• Presence of anti-H in Bombay group and some A1 and A1B patients
• High titer cold agglutination
• Blood Group Specific Soluble 

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss in detail the differences between direct and indirect coomb test. (20 Marks)

DAT

• in vivo
• detects antibodies on RBC
• self antibody attack self antigen 
• use RBC
• AIHA

IAT

• in vitro
• detects antibodies in serum
• foreign antigen attack self antibody
• use serum
• blood transfusion and prenatal test

Question 2

Discuss the mechanism of weak D antigen and its significance. (20 marks)

not all D+ cells react equally well with anti-D

RBCs not immediately agglutinated by anti-D must be tested

Genetic

• low densities of D antigens on RBCs membrane, gene codes for less D

Position effect 

• C trans 
• D and C in opposite site 
• cause steric hindrance results in weak D expression 

D mosaic or partial D

• absence of a portion or portions of total material that compromises D antigen
• if patient is transfused with D+ RBCs, may develop anti-D alloantibody to the epitope that is missing

Question 3

Explain in detail the principle, interpretation of result and advantages of gel card technique. (20 Marks)

Principle

• antibodies + RBC antigens coat RBC = agglutination
• AHG 
• agglutinates are centrifuged thro gel the rate of travel thro column is inversely proportional to size of agglutinates
• difference in SG between RBC and serum 
• results in RBC pass into column 
• serum is excluded (less dense)
• eliminates wash step 

Interpretation

Advantages

• standardization of procedure
• less subjectivity in interpretation
• simplification of testing
• increased safety

September 2018

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Explain the differences between Immunoglobulin M (IgM) and Immunoglobulin G (IgG). (10 Marks)

IgG monomer (80~85%)

• can cross placenta
• smallest Ab
• found in all body fluids, colostrum
• responsible for protection of newborn 
• secondary immune response
• 2 binding sites
• 37°C (optimum temp of reactivity)
• cause in vivo hemolysis which in turn cause transfusion reaction or HDN
• half life of 7~23 days
• Fc portion activate classical complement pathway, bind to macrophage and neutrophils for enhanced phagocytosis, bind to NK for ADCC

IgM pentamer (5~13%)

• first Ab secreted by B 
• largest Ab
• found in blood, lymph fluid 
• responsible for neutralize Ag and controls bloodstream infection
• primary immune response
• can bind to B cell surface
• 10 binding sites
• 4°C or room temp (optimum temp of reactivity)
• no in vivo hemolysis except for ABO antibodies, anti-A and B
• half life of about 5 days
• Fc portion activate classical complement pathway

2. a. Discuss the cryoprecipitate component used in transfusion science. (10 Marks)

3. a. What is the aim of antibody screening? (1 Mark)

detect unexpected antibodies in serum of an individual

b, List FOUR (4) uses of antibody screening. (4 Marks)

patients needing a transfusion

pregnant women

cases of transfusion reactions 

blood and plasma donors

c. Describe briefly the characteristic of screening cells used in antibody screening. (5 Marks)

must be O

representative of all important blood antigens 

homozygous for antigen with dosage effect

optimally preserved for antigenicity 

obtain from 2 or 3 individuals

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss in detail the procedure of antibody screening should be performed before donor’s blood can be transfused. (20 Marks)

label Sc I and Sc II

2 patient serum + 1 Sc I and II

centrifuge 15 sec high speed

2 LISS

incubate 10 min

wash x3

centrifuge 1 min high speed

2 AHG

centrifuge 20 sec low speed

1 CCC

centrifuge 20 sec low speed

Question 2

Discuss in detail the ABO antigens and their antibody characteristics. (20 marks)

Question 3

Explain the pathogenesis and diagnosis of erythroblastosis fetalis condition. (20 marks)

February 2018

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Describe the conditions that would disqualify a potential blood donor. (10 Marks)

heart and lung disease

other medical conditions

seizures in past 12 months

recent surgery

pregnancy

age <16/17

<50 kg

infectious diseases

• HIV
• HBV
• HCV
• Syphilis
• Malaria

2. a. Briefly describe the indications of packed red blood cells. (5 Marks)

70% plasma removed (Hct)

store for patient with anemia

CPDA

increase oxygen-carrying capacity

exchange transfusion for HDN

b. What is the important precaution when handling the packed rbc for transfusion? (4 Marks)

label

preserve

volume

store

c. State the BEST storage for packed rbc. (1 Mark)

2~6°C, 42 days

3. a. Define transfusion reaction ( 2 Marks)

any adverse event which occurs because of blood transfusion

allergy, infection, hemolysis, alteration of immune system

b. Briefly describe TWO (2) types of transfusion reaction (6 Marks)

Acute 

• <24h
• most common
• release Hb in circulation 
• RBC rapidly destroyed
• immunologic (fever, chills, allergy)
• non immunologic (bacterial infection)

Delayed

• >24h 
• in patient previously sensitized by transfusion, pregnancy, transplant
• mild
• unexpected decrease Hb 
• alloimmunization
• immunologic (post transfusion purpura)
• non immunologic (viral infection)

c. State TWO (2) immunologic acute transfusion reactions. (2 Marks)

fever, chills, allergy, anaphylactic shock

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Compare and contrast the differences between direct and indirect coomb test. (20 Marks)

Question 2

Discuss the pathogenesis of fetal-maternal hemorrhage Rhesus D Hemolytic Disease of Newborn (HDN). (20 marks)

Question 3

Explain the secretor status and Bombay phenotype based on your study. (20 Marks)

secretor genes consists 2 alleles (Se, se)

Se responsible for expression of H antigen on glycoprotein structures located in body secretions (plasma, saliva, synovial fluid)

if Se allele is inherited as SeSe or Sese, secretor 80% 

express soluble forms of H antigen in secretions that can be converted to A or B antigens by transferases 

sese, non secretor 

se is an amorph

September 2017

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Define the principle of antibody human globulin (AHG) testing (2 Marks)

antibodies are gamma globulins, an antibody to gamma globulin can form bridges between red cells sensitized with antibody and cause them to agglutinate

b. Tabulate the differences of direct and indirect coomb test. (8 Marks)

2. a. State the Kell system phenotyping (5 Marks)

b. State the characteristics of Kell system antibodies. (5 Marks)

3. a. Define safe donor (2 Marks)

b. Describe briefly the physical examination for safe donor. (4 Marks)

c. Describe the donor inspection for potential donor. (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss the various transfusion transmitted infection associated problems in blood transfusion. (20 Marks)

Virus

• CMV
• immunocompromised, low-birth weight infants, BM and organ transplant at risk 
• filter blood, decrease WBC carrying CMV
• CMV lies dominant in peripheral blood lymphocytes
• HAV
• acute disease, rare in TTI
• spread by contaminated food and water
• prophylaxis: immune serum globulin, decrease severity of symptoms
• HBV
• chronic course, TTI
• acute and chronic hepatitis
• screening Enzyme Immuno Assay 
• confirmation Neutralization 
• reagent used specific antibody neutralize HB Ag in serum/plasma
• neutralization ≥50%
• 25% ppl carry active hepatitis progressing to liver cirrhosis
• 4000/yr die HB liver cirrhosis, >800 die HB liver cancer
• HCV
• chronic course, TTI
• non HAV, HBV
• ppl unaware 
• screening EIA
• confirmation RIBA-3
• HIV
• cause AIDS
• HIV antibody tests used on every blood donation
• Nucleic Acid Amplification Testing (NAT) detect genetic material of HIV 
• screening EIA
• confirmation PCR
• Human T Lymphotropic Virus I & II
• West Nile Virus
• Human Parvovirus B19
• Sen Virus
• Human Herpes Virus 8
• Hepatitis G Virus 
• SARS

Parasite

• Babesiosis
• carried by white-footed mouse
• transmitted by tick bites 
• immunocompromised ppl or no spleen at risk of serious illness
• Chaga's disease
• Trypanosoma cruzi
• blood sucking bugs (Triatomine)
• life long
• die of heart and digestive problems
• Malaria
• Plasmodium
• Anopheles mosquito
• Screening done by preparing one thick and one thin smear with Giemsa stain

Bacteria

• Syphilis
• Treponema pallidum
• VDRL, RPR, TPHA
• Lyme disease caused by Borrelia sp
• bite of deer tick
• may affects brain, nerves, heart, joints, eyes 
• E coli
• Pseudomonas

Question 2

Discuss the diagnosis of Hemolytic Disease of Newborn (HDN). (20 marks)

Question 3

Discuss the ABO blood group system. (20 Marks)

January 2017

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Describe in general Rhesus (Rh) antibodies. (5 Marks)

naturally occurring

most IgG 

can cross placenta

HDN

Rh D more immunogenic

b. List FIVE (5) Rh antigens based on the strength of immunogenicity. (5 Marks)

D, c, E, C, e

2. a. List FOUR (4) phenotypes of ABO with its appropriate antigen and antibody. (4 Marks)

A (A antigen, anti-B), B (B antigen, anti-A), O (no antigen, anti-A and B), AB (A and B antigen, no Ab)

b. State the characteristics of KIDD system antibodies. (4 Marks)

antibody type IgG IgM

react best at 37

can cause HDN

can cause HTR

activate complement cause intravascular HTR

c. Briefly Describe about anti-S. (2 Marks)

3. a. State the used of antibody screens (2 Marks)

patients needing a transfusion 

pregnant women

cases transfusion reactions

blood and plasma donors 

b. Differentiate between antibody screening and antibody identification. (4 Marks)

antibody screening 

• test recipient's plasma against RBC of 2 or 3 reagent screening cells 
• detect unexpected antibodies in serum

antibody identification

• performed after positive results of antibody screening 

c. State the criteria of screening cells (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss the various types of blood component including the indication of use and storage. (20 Marks)

Question 2

Discuss the pathogenesis and diagnosis of Rhesus D Hemolytic Disease of Newborn (HDN). (20 marks)

Question 1

Discuss the possibilities of transfusion reaction might happen during blood transfusion. (20 marks)

January 2016

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS.

1.a. Describe in general I and i antibodies (5 Marks)

b. Describe in general M alloantibodies (5 Marks)

2.a. Describe in general Rh antibodies. (5 Marks)

b. List FIVE (5) Rh antigens starting with the highest strength of immunogenicity. (5 Marks)

3.a. State phases of direct antiglobulin testing. (6 Marks)

b. List FOUR (4) Fisher-Race types of Rh positive. (4 Marks)

Dce (R0), DCe (R1), DcE (R2), DCE (RZ)

Rh negative: dce (r), dCe (r'), dcE (r''), dCE (ry)

https://arup.utah.edu/media/RHbloodGroup/Introduction%20to%20the%20Rh%20Blood%20Group.pdf

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY.

Question1

In your own words, summarize blood preservative solutions in blood collection. (20 marks)

blood is collected as whole blood

anticoagulant used is citrate phosphate dextrose adenine

blood can be stored as whole blood (all plasma present) or packed red blood cells (70% of plasma has been removed) which is done by light centrifugation

both can be stored up to 42 days at 2~6 °C

the plasma can be centrifuged heavily a second time to separate platelet rich plasma

supernatant plasma can be expressed into a third bag and stored as fresh frozen plasma 

the remaining platelet rich plasma is utilized as platelet pack

a single donation of whole blood supplies 3 separated components (PRBCs, platelets, FFP) that can potentially benefit 3 different patients 

Question 2

In your own words, explain the antibody-antigen reaction which covers the nature of the reactions, affinity, avidity, specificity and cross-reactivity. (20 marks)

Antibody affinity is the strength of the reaction between a single antigenic determinant and a single combining site on the antibody. It is the sum of the attractive and repulsive forces operating between the antigenic determinant and the combining site of the antibody as illustrated in Figure 2.

Affinity is the equilibrium constant that describes the antigen-antibody reaction as illustrated in Figure 3. Most antibodies have a high affinity for their antigens.

Avidity is a measure of the overall strength of binding of an antigen with many antigenic determinants and multivalent antibodies. Avidity is influenced by both the valence of the antibody and the valence of the antigen. Avidity is more than the sum of the individual affinities. This is illustrated in Figure 4.

To repeat, affinity refers to the strength of binding between a single antigenic determinant and an individual antibody combining site whereas avidity refers to the overall strength of binding between multivalent antigens and antibodies.

Specificity refers to the ability of an individual antibody combining site to react with only one antigenic determinant or the ability of a population of antibody molecules to react with only one antigen. In general, there is a high degree of specificity in antigen-antibody reactions. Antibodies can distinguish differences in:

• The primary structure of an antigen
• Isomeric forms of an antigen
• Secondary and tertiary structure of an antigen

Cross reactivity refers to the ability of an individual antibody combining site to react with more than one antigenic determinant or the ability of a population of antibody molecules to react with more than one antigen. Figure 5 illustrates how cross reactions can arise. Cross reactions arise because the cross reacting antigen shares an epitope in common with the immunizing antigen or because it has an epitope which is structurally similar to one on the immunizing antigen (multi-specificity).

https://www.microbiologybook.org/mayer/ab-ag-rx.htm

Question 3

Illustrate and explain haemolytic disease of newborn. (20 marks)

August 2015

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. State TWO (2) other blood groups than can cause HDN. (2 Marks)

Kell, Kidd

b. Describe on O blood group antibodies. (4 Marks)

no antigen 

anti-A and B in serum 

naturally occurring antibodies

respective antibodies are predominantly smaller IgG molecules that can cross placenta

c. Briefly describe the error that will lead to transfusion reaction. (4 Marks)

improper specimen and patient identification

antibody identification error

crossmatch error

2. Describe the possible offspring’s genotype and phenotype if Adam’s genotype is AO and his wife Eve’s genotype is BO with illustration. (10 Marks)

3. a. Name the procedure that allows the donor to donate platelet only. (2 Marks)

apheresis

b. List FOUR (4) criteria on the temporary deferral for platelet donor.(4 Marks)

recent viral infection

tattoo

STD

vaccination

c. State FOUR (4) criteria on the permanent deferral criteria for platelet donor. (4 Marks)

HIV

heart, lung, kidney disease

hypertension

epilepsy

diabetes

SECTION C : ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Elaborate on coomb’s test. (20 Marks)

Question 2

Discuss on Bombay blood group system in term of antigen, antibody, and the match blood group cross match for blood transfusion. (20 Marks)

phenotype that result from lack of H gene 

H antigen is the precursor to A and B antigens

A or B allele must be present to produce the A or B enzyme that modifies the H antigen to become A or B antigen 

if only recessive alleles for H antigen are inherited (hh), antigen will not be produced

safe donor for Bombay is from Bombay phenotype 

detection of Bombay by determining absence of H antigen by Ulex europaeus extract and plant Lectin 

Bombay phenotype (hh) do not express substance H on RBC

Bombay do not agglutinate with A or B antigens 

instead, Bombay produce antibodies to H substance as well as both A and B antigens

therefore compatible only with other hh donors 

Question 3

Elaborate the hemolytic disease of newborn (HDN) in term of pathogenesis, lab diagnosis, and its effect on baby and mother. (20 Marks)

January 2015

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. State the importance of compatibility testing. (4 Marks)

b. Define minor compatibility testing. (2 Marks)

c. Briefly describe the error that will lead to transfusion reaction. (4 Marks)

2. Describe the possible offspring’s genotype and phenotype if Adam’s genotype is AO and his wife Eve’s genotype is BO with illustration (10 Marks)

3. a. Name the procedure that allows the donor to donate platelet only. (2 Marks)

b. Briefly describe on the temporary deferral for platelet donor. (4 Marks)

c. Briefly describe on the permanent deferral criteria for platelet donor. (4 Marks)

SECTION C : ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Elaborate on abnormal result for coomb’s test (20 Marks)

Question 2

Discuss on ABO blood group system including antigen, antibody, and the match blood group to be transfused (20 Marks)

ABO antibody

naturally occurring

found in certain bacteria, E coli, stimulate antibody production in individuals lack of specific A and B antigens 

predominant IgM

react in saline and readily agglutinate

IgM not necessary overcome zeta potential due to position of antigen 

optimum temp <30℃ or body temp

present  in high titre 1/128 or 1/256

absent at birth

appear around 3~6 months 

newborn only forward typing

Question 3

Elaborate the hemolytic disease of newborn (HDN) in term of pathogenesis, lab diagnosis, and its effect on baby and mother. (20 Marks)

August 2014

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Name the TWO (2) types of compatibility testing. (2 Marks)

b. Briefly explain in general on cross matching test. (4 Marks)

c. List the cause of transfusion reaction. (4 Marks)

acute hemolysis (ABO mismatch)

acute pulmonary edema

bacterial contamination

acute hemolysis (damage blood component)

2. a. What are the preliminary evaluations of a transfusion reaction? (3 Marks)

b. Briefly explain why wrongly transfused group A blood to group O patient may cause the most severe transfusion reaction? (3 Marks)

c. Briefly describe the delayed haemolytic transfusion reaction. (4 marks)

3. a. Name the organization that is responsible for blood management at national level in Malaysia. (2 Marks)

National Blood Center

b. Briefly describe on the temporary deferral blood donor criteria. (4 Marks)

c. Briefly describe on the permanent deferral blood criteria. (4 Marks)

SECTION C : ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Elaborate on direct and indirect coombs test and the disease associated for negative result. (20 Marks)

Question 2

By using illustration, describe the ABO blood group system. (20 Marks)

Question 3

Elaboration on haemolytic disease of newborn. (20 Marks)

January 2014

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. Rhesus blood group system is one of the major blood group in blood banking.

a) What are the antigens of rhesus blood group system? (2 Marks)

D/d, C/c, E/e

b) Briefly discuss antibody characteristics of Rhesus blood group system. (8 Marks)

2. Duffy blood group system is one of the major blood group in blood banking.

a) What are the possible phenotypes of Duffy blood group? (4 Marks)

b) Briefly discuss about Duffy blood group system. (6 Marks)

3. Explain the grading system that have been used in blood grouping. (10 Marks)

SECTION C : ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only.

Question 1

Discuss on the compatibility testing in transfusion science. (20 Marks)

Question 2

Discuss on ABO discrepancy. (20 Marks)

Question 3

Outline the biochemistry of ABO Antigen. (20 Marks)

August 2013

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1.a. Describe in general I and i antibodies (5 Marks)

1.b. Describe in general P alloantibodies (5 Marks)

2.a. Describe in general Rh antibodies. (5 Marks)

2.b. List FIVE (5) Rh antigens based on the strength of immunogenicity. (5 Marks)

3.a. State phases of direct antiglobulin testing. (6 Marks)

3.b. List FOUR (4) Fisher-Race types of Rh positive. (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only.

Question1

In your own words, summarize blood preservative solutions in blood collection. (20 Marks)

Question 2

In your own words, explain the antibody-antigen reaction which covers the nature of the reactions, affinity, avidity, specificity and cross-reactivity. (20 Marks)

Question 3

Illustrate and explain the process of blood donation. (20 Marks)

January 2013

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. Duffy blood group system is one of the major blood groups in blood banking.

a. What are the possible phenotypes of the Duffy blood group system. (4 Marks)

b. Briefly discuss Duffy blood group system. (6 Marks)

2. A donor center has recruited donors for a blood mobile visit at a shopping mall. A male donor tells the technician that he has been tested positive for hepatitis B. He insists that his blood was accepted on his last visit and that he wants to donate.

a. What information should this technician give to the donor? (5 Marks)

b. Will the blood from this donor be used for transfusion? Explain. (5 Marks)

3. Several products related to blood in transfusion science can be obtained from donated blood.

a. List FOUR (4) blood products from a single unit of donor’s whole blood. (2 Marks)

PRBCs, platelets, FFP, serum, cryoprecipitate 

b. Briefly explain the storage and life span of FOUR (4) of blood products. (8 Marks)

SECTION C : ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only

Question 1

Discuss the compatibility testing in transfusion science. (20 Marks)

Question 2

Discuss ABO discrepancies. (20 Marks)

Question 3

Discuss immune hemolytic transfusion reactions and their investigations. (20 Marks)

July 2011

PART B : SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. Rhesus blood group system is one of major blood group in blood banking.

a. What are the antigens of rhesus blood group system? (2 Marks)

b. Briefly discuss antibody characteristic of Rhesus blood group system. (8 Marks)

2. A donor center has recruited donors for a blood mobile visit at a shopping mall. One female donor tells the technician that her previous tests showed positive test for hepatitis C. She insists that her blood was accepted for transfusion on her last visit and that she wants to donate.

a. What information should this technician give to the donor? (5 Marks)

b. Will the blood from this donor be used for transfusion? Explain. (5 Marks)

3. A patient has been tested to determine the blood group in case a transfusion is necessary during surgery. The results of the ABO grouping are as follows:

Anti A Anti B A1 cells B cells

2+ 2+ 0 0

a. What is the ABO group of this patient? Explain your answer. (5 Marks)

A2B

b. Are there any discrepancies noted in these results? Explain. (5 Marks)

4. Several products related to blood in transfusion science can be obtained from donated blood.

a. List FOUR (4) blood products from a single unit of whole blood donation. (2 Marks)

b. Briefly explain the storage and life time FOUR (4) of blood product. (8 Marks)

PART C : ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only

Question 1

Explain the steps in blood cross-matching. Include purpose of each steps and reagent used. (20 Marks)

Question 2

Outline the biochemistry of ABO Antigen (20 Marks)

Question 3

Discuss immune hemolytic transfusion reaction and their investigation. (20 Marks)