EXAMINATION COUNCIL OF HEALTH SCIENCES

Diploma in Biomedical Sciences

INTERMIDIATE EXAMINATION

PAPER: BLOOD TRANSFUSION SCIENCE 1 – THEORY

DATE: 21-Nov-03

SERIES: NOVEMBER/DECEMBER 2003

Student number:…………………………………………………………………

Centre:……………………………………………………………………………

INSTRUCTIONS TO CANDIDATES

1. Time allowed: THREE (3) hours

2. This paper consists of two sections, A and B.

3. Section A has 60 multiple choice questions (MCQS) and section B has 6 essay questions

4. Answer all the questions in section A, and answer ANY four (4) from Section B.

5. Total mark allowed is 100%. 50% is the pass mark.

SECTION A ( 60 Multiple choice questions) Answer all

1.This blood group has naturally occurring IgM antibodies in serum.

a) Duffy
b) Kell
c) Rhesus
d) ABO
2. In indirect blood grouping the following is employed as a reagent.
a) Plasma
b) Serum
c) Red cells
d) White Blood cells
3. These genotypes could apply to someone who is ABO group A and is able to secrete A into
tissue fluids.
a) AO and SeSe
b) AA and sese
c) BB and Sese
d) OO and seSe
4. One of these statements is true about anti-D.
a) It is a naturally occurring antibody.
b) Its class is always IgG
c) It is never the cause of a transfusion reaction
d) It may be present in serum of Rh (D) males
5. These blood group substances are naturally present both on cells and in serum.
a) ABO
b) Lewis
c) Kiddy
d) MNS
6. Which blood group below would receive AB blood in transfusion?
a) O
b) A
c) B
d) AB
7. What precursor substance are A and B antigens formed from?
a) Ceramide
b) H
c) P
d) M
8. What antisera is obtained after absorbing anti-A with A2 cells
a) Anti-A1
b) Anti-H
c) Lectin anti-A1
d) Anti-D
9. The optimum temperature for ABO testing is ……..
a) 5C
b) 22C
c) 37C
d) 57C
10. Serum from a person who is group O positive normally contains…
a) Anti-A
b) Anti-B
c) Both anti-A and anti-B
d) Neither anti-A nor anti-B
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11. At what temperature is complement normally inactivated?
a) 30C
b) 100C
c) 56C
d) 37C
12. A father with genotype OA+ and a mother with genotype AB  cannot have an offspring of
blood group …..
a) O+
b) A+
c) B+
d) AB+
13. Which of the following accounts for the zeta potential on the membrane surface of a
red cell?
a) D antigen
b) Sialic acid
c) DNA
d) Haemoglobin
14. The terminal sugar responsible for determining blood group B specificity is..
a) Galactose
b) N-acetylgalactosamine
c) Fucose
d) Glucose
15. Which of the following is NOT a complement factor?
a) C1
b) C5
c) C7
d) C10
16. The commonest subgroup of group A is
a) Ax
b) A1
c) Am
d) AB
17. The anticoagulant used for collection of blood meant for transfusion is…
a) Heparin
b) Citrate Phosphate Dextrose
c) Ammonium Oxalate
d) Sodium Fluoride
18. Only one statement below is true about ABO agglutinins in infants.
a) They are present at birth
b) They are formed by immunization
c) They are inactive at birth
d) They are formed three months after birth
19. Reagent red cells contaminated with bacteria may show the following when reacted with
several test sera.
a) True agglutination
b) Rouleaux formation
c) Polyagglutination
d) Swelling

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20. Dolicos biflorus seeds produce a lectin which is able to react specifically with A1 red cells.
What is the chemical nature of the lectin?
a) Lipid
b) Protein
c) Steroid
d) Carbohydrate

21. Blood groups MN and P are not likely to cause a transfusion reaction or HDN. Why?
a) They are extremely rare
b) They produce cold antibodies
c) They are only found in rats
d) Their antibodies have an IgM class
22. The average shelf life of blood stored in Citrate Phosphate Dextrose (CPD) is..
a) 21 days
b) 35 days
c) 46 days
d) 64 days
23. Sensitized rhesus negative mother has ……… in the plasma.
a) Anti-c
b) Anti-E
c) Anti-D
d) Anti-d
24. Which class of antibodies is incriminated in Haemolytic Disease of Newborn (HDN)?
a) IgA
b) IgM
c) IgE
d) IgG
25. H antigen is present on all red cells except…
a) O+ Bombay cells
b) B+ cells
c) O+ cells
d) A+ cells
26. The commonest ABO blood group in Zambia is….
a) A
b) B
c) O
d) AB
27. Which of the following would produce a positive Direct Coombs Test (DAT)?
a) Plain red cells
b) Red cells digested with papain
c) Red cells washed in LISS
d) Red cells coated with complement
28. This amino acid is an ingredient of LISS
a) Alanine
b) Glycine
c) Methionine
d) Phenylalanine
29. Which blood group antigens serve as receptors for the entry of Plasmodium vivax
into red cells.
a) ABO antigens
b) Kell antigens
c) Duffy antigens
d) Kidd antigens
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30. MNS are seen as one blood group genetically. What is the difference between MN and S
blood groups serologically speaking then?
a) There is no genetic linkage between MN and S
b) MN produce cold antibodies where as S produce warm antibodies
c) MN is found in serum, and S on red cells
d) MN has soluble antigens, and S has insoluble antigens.
31. As a BTS officer how would you treat donor blood tested positive with VDRL.
a) Store at 22C for 72 hours before release for crossmatch
b) Store at 2 - 6C for 72 hours before release for crossmatch
c) Discard it right away
d) Issue it for cross-matching right away
32. In HIV infection, what best describes ‘window period’?
a) Time interval between appearance of anti-HIV and AIDS
b) Time interval between HIV infection and AIDS
c) Time interval between ARC and AIDS
d) Time interval between HIV infection and appearance of anti-HIV
33. How can one best describe the term ‘Complement Fixation’?
a) Consumption of compliment factors in serum by activation
b) Addition of compliment factors to serum
c) Inactivation of compliment factors in serum
d) Heamolysis of indicator red cells
34. A mother with rhesus genotype Cde/CDe and a father cDe/CdE are unlikely to have a
child with the following genotype.
a) Cde/CdE
b) CDe/cDe
c) Cde/cDe
d) CDe/Cde
35. Other than agglutination which phenomenon would render a cross match incompatible?
a) Rouleaux formation
b) Pan agglutination
c) Polyagglutination
d) Haemolysis
36. Fresh blood should not be older than 72 hours at 2 – 8C after collection. One of the
following clinical condition would warrant transfusion with fresh blood.
a) Hypo chromic microcytic anaemia (Hb 5.6g/l)
b) Bleeding due to intrauterine foetal death (PT 68 sec, APTT 150 sec)
c) Severe malarial infestation (B/S numerous)
d) Advanced Protein Calorie Malnutrition (Albumin 13g/l)
37. One of these transfusion reactions can be prevented by a cross match
a) Fever due to transfused incompatible MHC molecules
b) Urticaria caused by transfused allergens
c) Fever due to transfused cytokines such as TNF.
d) Intravascular haemolysis of donor cells
38. In ABO the expression of A gene will not affect the expression of B gene if
concurrently present at the same locus. Therefore, in group AB both anti-A and anti-B
bring about agglutination. What is this genetic feature called?
a) Recessiveness
b) Dominance
c) Penetrance
d) Codominace

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 39. One of the antibodies below would not cause HDN or haemolytic transfusion reaction
being a cold antibody.
a) Anti-M
b) Anti-D
c) Anti-A
d) Anti-B
40. What does the term Du imply?
a) Strongly reacting D antigen
b) D negative
c) Defective D antigen
d) Weakly reacting D antigen
41. The first blood group to be discovered was….
a) Rh
b) ABO
c) Kidd
d) Kell
42. Which blood group was discovered in macacus monkey?
a) Rh
b) ABO
c) Kidd
d) Kell
43. The best way of extracting an antibody from a mixture is…
a) Absorption technique
b) Elution technique
c) Membrane fusion
d) Differential centrifugation
44. During monoclonal antibody preparation membrane fusion between splenocytes and
myeloma cells is achieved by use of this chemical.
a) Aminopterin
b) Polyethylene glycol
c) Propanol
d) Hypoxanthine
45. The system below is responsible for intravascular haemolysis of red cells in haemolytic
transfusion reaction.
a) Alternative complement
b) Classical complement
c) Coagulation
d) Phagocytosis
46. One of these is a light chain of a typical antibody.
a) -chain
b) -chain
c) -chain
d) -chain
47. How many light chains are present on IgM?
a) 5
b) 6
c) 10
d) 2
48. This chemical is often used to colour the anti-A grouping sera yellow.
a) Eosin
b) Tartrazine
c) Methylene blue
d) Methyl violet
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49. One of the following would exclude a prospective blood donor from donation panel
a) Fever characterising malaria
b) Infestation with round worms (Ascaris lumbricoides)
c) Colour blindness
d) Dental caries

50. What do you understand by the titre of an antibody?

a) The isotype of an antibody
b) The shelf life of an antibody
c) The purity of an antibody
d) The concentration of an antibody
51. After stimulation B-cells are transformed into….
a) Plasma cells
b) T-cells
c) Macrophages
d) Natural Killer cells
52. Cytotoxic T-cells would destroy tissue cells displaying…
a) Host MHC I –antigen complex
b) Host MHC II –antigen complex
c) Host MHC I
d) Host MHC II
53. This method is best suited to screen Hb levels of prospective blood donors.
a) Cyanmethaemoglobin
b) Copper (II) sulphate solution
c) Sali’s method
d) Oxyhaemoglobin
54. Individuals are histocompatible when they have identical..
a) T-Cell receptors
b) MHC II and MHC I molecules
c) MHC II
d) MHC I molecules
55. Someone who is Kidd a postive and kidd b positive will have this phenotype.
a) Jk (a+b+)
b) Fy (a+b+)
c) K
d) k
56. One of these methods is not ideal for reducing zeta potential of red cells.
a) Polyethylene glycol
b) Albumin
c) LISS
d) Antihuman Globulin (AHG)
57. Which of the following ABO genotypes is heterozygous?
a) AA
b) BB
c) AB
d) OO
58. This antibiotic is the commonly used preservative in grouping antisera.
a) Sodium azide
b) Ampicilin
c) Cefotaxim
d) Bacitracin

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 59. One of these substances below is able to opsonise red cells to enhance phagocytosis.
a) C4b
b) C3b
c) Interleukin –2 (IL2)
d) Tumour Necrosis Factor (TNF)
60. The reaction below would result from transfusing blood with incompatible MHC
molecules
a) Fever
b) Haemolysis
c) Blood pressure
d) Bleeding

SECTION B: ESSAY QUESTIONS

Answer any four (4) questions

1. Write short notes on any FOUR of the following:- (20 marks)

a) Clonal Expansion
b) Monoclonal antibodies
c) Elution technique
d) The principle of antiglobulin test
e) Cytotoxic T-cells

2. Answer any FOUR of the following: (20 marks)

a)Compare and contrast between IgG and IgM antibodies
b) Briefly describe the MNS blood group system
c)Briefly describe screening tests done on transfusion blood
d) Zeta potential
e)Secretor phenomenon

3. Briefly explain any FOUR of the following:- (20 marks)

a)Pan agglutination
b) CD4 helper cells
c)A1 Subgroup
d) Titre
e)Red cell sensitisation

4. Give a detailed account on how monoclonal antibodies are produced

using hybridoma technology. (20 marks)

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5. Explain the cascade of reactions that occur in classical complement
activation. What is the role of classical complement in haemolytic
transfusion reaction? (20 marks)

6. How would one use blood groups in paternity tests? Give examples and
state limitations. (20 marks)

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 EXAMINATION COUNCIL OF HEALTH SCIENCES

INTERMEDIATE EXAMINATIONS
Diploma in Biomedical Sciences

SUBJECT: BLOOD TRANSFUSION SCIENCE 1 - PRACTICAL

DATE:13-Nov-03

SERIES: NOVEMBER/DECEMBER 2003

Student Number ………………………………………..

Centre …………………………………………………..

INSTRUCTIONS TO CANDIDATES

1. TIME ALLOWED: THREE (3) HOURS

2. Part A of this question paper has THREE (3) questions
3. Attempt ALL the questions
4. Marks will be awarded for correct technique, accurate results and
good presentation

5. Maximum number of marks obtainable is 100

Pass mark is 50%

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PART A - PRACTICAL PAPER

1. You are provided with Whole blood samples. QV and W.

Prepare Anti-A and Anti-B

2. Sample M is group AB Rh negative, and is from a sensitised mother

with a high titre of anti-D. Prepare anti-D from the sample.

3. Perform a X-match using serum sample Z obtained from patient in need

of blood transfusion. You are provided with donor samples A,B,C and D.
Select a suitable donor and proceed with crossmatch.

Comment on your findings.

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