BLOOD TRANSFUSION SCIENCE BSc .

MCQ 20 MARKS

Q1. “H” and “A” genes, code for the addition of:

A) D-galactose

B) N-acetylgalactosamine and L-fructose

C) Fructose

D) L-fructose and Nacetylglucosamine

Summary of Transferase Enzymes

for ABH Antigen Production1

GENE TRANSFERASE

H α-L -fucosyltransferase

A α-3-N-acetyl-D-galactosaminyl

Transferase

B α-3-D-acetyl-D-galactosyl

Transferase

O No Transferase Produced1

Q2. Given the phenotype as DcE. The following are possible genotype:

A) R2 r2

B) R1R2

C) R2 r1

D) R2R1
Rh-blood group system is governed by two theories
 Fisher – Race theory

 Weiner theory2

FISHER – RACE THEORY:

States that antigens of Rh system are determined by three pairs of genes which occupy closely

linked loci2.D-C-E

WEINERS THEORY:

Postulates that two genes are on each chromosome of the pair controls the entire expression of

the Rh system in one individual

Fisher race Weiner's

Dce R°

DCe R¹

DcE R2

DCE. Rz

dce. r

dCe. r¹

dcE. r¹¹

dCE rh y

Q3. The potion of immunoglobulin which plays the role of complement fixation is the:
 A) Disulphide bond portion

B) Fab Fragment

C) Light chain

D) F.C. Portion

Fab fragments

Antigen binding - These fragments were called the Fab fragments because
they contained the antigen binding sites of the antibody. Each Fab fragment is
monovalent whereas the original molecule was divalent. The combining site
of the antibody is created by both VH and VL. An antibody is able to bind a
particular antigenic determinant because it has a particular combination of VH
and VL. Different combinations of a VH and VL result in antibodies that can
bind a different antigenic determinants.

Fc

Effector functions - The effector functions of immunoglobulins are mediated

by this part of the molecule. Different functions are mediated by the different
domains in this fragment. Normally the ability of an antibody to carry out an
effector function requires the prior binding of an antigen in complement
binding.

Q5. The following is a/are light chain(s) of an immunoglobulin:

A) Gamma

B) Kappa

C) Delta

D) Mu

The immunoglobulins can be divided into five different classes, based on differences in the
amino acid sequences in the constant region of the heavy chains. All immunoglobulins within a
given class will have very similar heavy chain constant regions. These differences can be
detected by sequence studies or more commonly by serological means (i.e. by the use of
antibodies directed to these differences).

1. IgG - Gamma  heavy chains

2. IgM - Mu  heavy chains

3. IgA - Alpha heavy chains

4. IgD - Delta  heavy chains

5. IgE - Epsilon  heavy chains

Immunoglobulins can also be classified by the type of light chain that they have. Light chain
types are based on differences in the amino acid sequence in the constant region of the light
chain. These differences are detected by serological means.

1. Kappa light chains 

2. Lambda light chains 

Q6. The following blood group(s) is/are referred to as “minus-minus” phenotype:

A) Bombay blood group

B) Group O rhesus positive

C) Rhesue negative

D) Rhesus null phenotype

Rhesus null phenotype (-/-) these are individuals lacking all presentations of
rhesus antigen on the surface of red blood cells.

Q7. Examples of adjuvants used in the preparation of coombs serum are:-

A) Sodium chloride

B) Sulphiric acid
 C) Freund’s adjuvant

D) Sam’s adjuvant

E) Ammonium chloride

Adjuvants are the compounds used to increase the production of A.H.G.

Examples of adjuvants5

Ammonium sulphate (saturated or 40%)-

 Freud’s Adjuvant,

 Sodium alignate.5

Q8. The following are indirect Anti-Humanglobulin (Coombs) techniques EXCEPT:-

A) Major cross-match

B) Du test

C) Antibody screening

D) Reverse grouping

E) Minor cross-match

INDIRECT COOMB’S TEST:

The test is used to detect the presence of sensitized cells in vitro. Therefore it is used to detect
antibodies in serum using known antigens e.g. O-positive pooled cells or panel cells or reagent
cells.

Significance

Cross –match to detect incompatibility

Du test

Detection and identification of irregular antibodies (immune antibodies)5

Q9. What is responsible for the negative electrical charge of the RBC’s

A) Cell size

B) Sensitization by IgG antibodies

 C) Sialic acid content

D) Sentization by IgM antibodies

E) Cell shape

Zeta potential theory

The net ve charge of the red cell surface is due to ionization of carboxyl group of sialic acid

The average minimum distance between the cells can be reduced by reducing the force of
repulsion.

Much of the negative charge between cells is contributed by sialic acid residues on the cell
membrane.

The red cells in solution are in constant random motion. The minimum distance between cells is
maintained by the strong net negative surface charge of the red cells.

Q12. The terminal sugar that determines specificity of A antigen is:-

A) D-Galactose

B) L-fucose

C) N-Acetylmuramic acid

D) N-acetylusamine

E) N-Acetylgalctosamine

Summary of Transferase Enzymes

for ABH Antigen Production

GENE TRANSFERASE

H α-L -fucosyltransferase

A α-3-N-acetyl-D-galactosaminyl

Transferase
B α-3-D-acetyl-D-galactosyl

Transferase

O No Transferase Produced

Q13. Haptens:-

A) Are soluble antigens

B) Insoluble antigens

C) Have specificity but no antigenicity

D) Have antigenicity but no specificity

E) Are blood group antibodies

HAPTEN:

A substance that combines specifically with an antibody but does not

stimulate the production of

antibodies.

They are antigens with little antigenicity.

Thus it has specificity but does not have antigenicity.

A hapten is a small molecule that can elicit immune response only when
attached to a large carrier such as a protein.

Q14. Routine pre-transfusion test include:-

A) ABO and Rh typing of the donor

B) Major crossmatch

C) Urinalysis

D) Direct Coombs test

E) Direct antiglobulin test

 Whenever adverse reaction experienced by a patient in

association with a transfusion it should be regarded as a

suspected transfusion reaction, and the following lab.

investigations must be performed.

- Check the identification of the patient and transfused unit

- Obtain a post transfusion specimen from the patient and

visually examine it for hemolysis

- Direct Antiglobulin test from post transfusion sample,

taken as soon as possible after the reaction has taken

place.

- Re-type the red cells of both donor and recipient for ABO

and Rh grouping.

- Re-cross match blood from each unit transfused using

serum from both pre-and post-transfusion specimens from

the patient. 8

Q15. Febrile transfusion reaction may be caused by

A) Pyogens

B) Leucocytes antibodies

C) Dextran
 D) Sterile saline

E) Micro embolism

FEBRILE REACTIONS:

Due to bacteria products / toxins.

It is brought about by pyogens –bacteria.

The pt feels unwell and has fever and chills temperature rises rapidly in the patient.

They are caused by:

-Anti leukocyte and antiplatelet antibodies

-Use of unclean tube9

Q16. Which antibody is frequently used when saliva is tested for secretor status:-

A) Anti E

B) Anti-se

C) Anti-D

D) Anti-C

E) Anti-H

Secretor are individuals having soluble antigen in their body fluids and posses the secretor
gene( Se ) and gene H.

. Persons with soluble ABH antigen (SeSe or Sese) in their secretions are secretors. While those
with no A or B antigens in secretions (sese) are nonsecretors9

Q17. When Haemolytic Disease of the Newborn is suspected:-

A) Blood grouping is performed on the baby and the father

B) Blood grouping is performed on the baby and the mother

C) Blood grouping is performed on the father

D) Rhesus grouping is performed on the baby only

 E) Cross match useful

HDNB(hemolytic disease of new born)

The mechanism of HDNB involves the sensitization of the mother to the foreign antigen of child
on red blood cells.

prenatal testing for prediction of HDFN has

focused on the mother. ABO and RhD testing, as well as

antibody screen and identification, comprise the panel

of prenatal tests10

The purpose of testing, however, has not changed. The laboratory is still focused on:

1. Identifying RhD negative women to determine

women who are candidates for Rh immune globulin.

2. Determining the presence of an antibody that may

place the fetus at risk for HDFN.

3. In the presence of a potentially harmful antibody,

testing the father for the presence of antigens that

could place the fetus at risk for HDFN10

Q18. One purpose of accidents reporting in the laboratory is:-

A) Disciplinary action against the employee

B) Dispciplinary action against the employer

C) To ensure that appropriate protective equipment was used

D) To ensure that the victim receives appropriate action

 E) To make the workers scared

Quality Assurance is employed in the laboratory to support

error- free performance to ensure the highest quality of patient

care. Important factors in a routine quality assurance program

include evaluation of reagents, equipment, and personnel qualification. 11

Q19. Neutralization test:-

A) Is used to detect leukocyte antibodies

B) Detect immune antibodies

C) Confirm if an individual is a secretor or not

D) Is used in Rhesus blood grouping

E) Is not applicable in disputed paternity or maternity

NEUTRALIZATION TEST

Immune antibodies are not usually neutralized by blood group specific, while
Natural antibodies are neutralized by blood group specific substances, so that
when A cells or B cells are added there is no agglutination.

Also use to confirm one as secretor or non secretor.

11
SECTION B: ESSAY 30MARKS

1. Discuss on Haemolytic Disease of the Newborn(HDNB) due to rhesus D

factor incompatibility (10 MARKS)

2. Write in details on the systematic investigation of blood transfusion reactions

(10 MARKS)

3. Briefly Outline the Classical pathway of compliment activation (10MARKS)