Single Antibody Identification PANEL #1

Question 1
Review the findings of the preliminary panel.
In routine practice, which of the following processes is best for INITIALLY interpreting the
serological results of a panel?
1. Rule out the antibody if homozygous cells fail to react with it. This completes the serum in
all phases.
2. Consider reactions important only if they remain positive at the AHG phase.
3. If a panel cell reacts with the serum, rule out all antigens that the cell lacks.
4. Rule out the antibody if heterozygous cells fail to react with serum in all phases.
Question 2
The reactions of the patient's serum with the patient's own cells (the autocontrol) noted in the last
row of the panel indicate:
1. The presence of an autoantibody.
2. The presence of an alloantibody only.
3. The presence of BOTH alloantibody and autoantibody.
4. Invalid test results caused by antiglobulin reagent.
Question 3
After reviewing the phase and pattern of reactivity, the alloantibody most likely belongs to
which of the following blood group systems?
1. MN
2. Rh
3. Lewis
4. Kidd
Question 4
Which of the following antibodies are NOT excluded after performing the recommended rule-out
procedure?
1. Anti-E, anti-c, anti-f, and anti-M
2. Anti-Fy(a), anti-Fy(b), and anti-Jk(a)
3. Anti-K, anti-Xg(a), and anti-V
4. Anti-Le(a), anti-Le(b), and anti-s
Question 5
On the basis of the patient's red cell phenotype, which Rh antibodies are NOT likely?
Question 6
Assuming that only one unexpected alloantibody is present, what is the most likely specificity?
1. Anti-c
2. Anti-E
3. Anti-f
4. Anti-Le(b)
Single Antibody Identification Panel #2
Question 1
70-year old male with renal failure is admitted for transfusion therapy due to a low hemoglobin.
He is group A, Rh negative and has a history of multiple transfusions. His antibody screen is
positive at AHG only. The results of the panel indicate the presence of:
1. A single warm alloantibody
2. Multiple warm alloantibodies
3. Both warm and cold alloantibodies
4. Both alloantibodies and autoantibodies
Question 2
After performing the recommended rule-out procedure and evaluating the pattern and phase of
reactivity, the most likely specificity of the alloantibody present is:
1. Anti-Jk(a)
2. Anti-Le(b)
3. Anti-E
4. Anti-S
Question 3
Panel cells #4 and #6 show a 1+ strength of agglutination, while panel cells #2 and #8 reveal 2+
reactivity. What best explains this variation in agglutination strength?
1. Over-shaking of the cell button
2. Antigen dosage
3. Postzone phenomenon
4. Multiple antibodies
Resolution of Indeterminate Results Antibody Enhancement PANEL # 3
Question 1
A patient requires transfusion due to a bleeding ulcer. Using three antibody screening cells,
weakly positive (w+) reactions are noted with cells II and III at AHG. A routine panel shows
similar weak agglutination at AHG, and no specific agglutination pattern. The patient's
autocontrol is negative. A panel demonstrates weak agglutination at AHG and shows no specific
agglutination pattern. Select an appropriate technique for investigating these findings.
1. Enzyme treatment with ficin
2. Increasing the serum to cell ratio
3. Polyethylene glycol (PEG) potentiator
4. All of the above
Question 2
A panel was performed using PEG to enhance the indeterminate agglutination reactions. After
reviewing the results of the PEG panel only, which of the following antibodies may NOT be
ruled out?
1. Anti-Le(a), anti-N, and anti- Fy(a)
2. Anti-K, anti-Fy(b), and anti-Xg(a)
3. Anti-E, anti-N, anti-s, anti-K, anti-Jk(b), and anti-Fy(a)
4. Anti-E, anti-s, anti-Jk(a), and H
Question 3
After reviewing the phase and pattern of reactivity, the alloantibody(s) present is (are):
1. Anti-M
2. Anti-s
3. Anti-E and anti-K
4. Anti-Jk(b)
Antibody Enhancement 2 PANEL #4
Question 1
Routine blood bank testing of a preoperative patient reveals a weakly positive reaction (w+) with
antibody screen cell I. The results of a routine panel indicate:
1. The presence of multiple alloantibodies
2. Indeterminate findings - enhancement technique recommended
3. Invalid panel results caused by poor washing technique
4. The presence of a cold-reacting autoantibody
Question 2
The panel was repeated using four drops of the patient's serum for testing instead of two drops as
used in the routine procedure. These results suggest the presence of:
1. Anti-Le(a)
2. Anti-E
3. Anti-Fy(a)
4. Anti-K

Enzyme Treatment in Antibody Identification PANEL #5
Question 1
A 32-year old male with aplastic anemia and a history of multiple transfusions is admitted with a
hemoglobin of 5.4 g/dL . Three units of RBCs are ordered for transfusion. The antibody screen
is weakly positive at the AHG phase only. The results of the initial antibody panel suggest:
1. The presence of a single warm-reacting alloantibody
2. The presence of a warm-reacting autoantibody
3. Indeterminate findings - enhancement technique recommended
4. The presence of multiple alloantibodies
Question 2
To investigate the findings of the preliminary panel, enzyme treatment is performed with ficin.
Which is the most likely interpretation of the panel results?
1. Enhanced reactivity of anti-C with ficin treated cells
2. Decreased reactivity of anti-Jk(a) with ficin treated cells
3. Enhanced reactivity of anti-D with ficin treated cells
4. Decreased reactivity of anti-E with ficin treated cells
Enzyme Treatment in Antibody Identification 2 PANEL #6
Question 1
A black male, group B, Rh positive, is admitted for thoracic surgery. The antibody screen is
positive, and a panel is performed. After reviewing the reactions in the first panel, all of the
following antibodies may be excluded EXCEPT:
1. Anti-c, anti-Le(b), and anti-Jk(b)
2. Anti-D, anti-N, and anti-Le(a)
3. Anti-e, anti-Fy(b), and anti-Xg(a)
4. Anti-E, anti-Fy(a), and anti-Jk(a)
Question 2
To investigate the findings of the preliminary panel, enzyme treatment is performed with ficin.
What is the best interpretation of the ficin panel?
1. Enhanced reactivity of anti-Jk(a);depressed reactivity of another antibody
2. Enhanced reactivity of anti-E; depressed reactivity of another antibody
3. Decreased reactivity of anti-Jk(a); enhanced activity of another antibody
4. Enhanced reactivity of anti-Fy(a); enhanced reactivity of another antibody
Question 3
Review of the preliminary panel results indicates the presence of:
1. A second antibody reactive against the Fy(a) antigen
2. A second antibody against the c antigen
3. An antibody against the E antigen only
4. A nonspecific warm antibody in addition to anti-E
Resolution of Indeterminate Results PANEL #7
Question 1
After reviewing the results of the preliminary panel, the most likely explanation is the presence
of:
1. A potent warm alloantibody directed against a high frequency antigen
2. Multiple cold and warm-reacting alloantibodies
3. A potent cold autoantibody with a possible underlying warm alloantibody
4. A cold alloantibody and a warm reacting autoantibody
Question 2
Prewarmed technique is performed to remove interfering cold autoantibody and facilitate the
detection of any underlying alloantibody. The findings of the prewarmed panel suggest:
1. Incomplete removal of the cold autoantibody - repeat prewarming recommended
2. The presence of underlying anti-Jk(b)
3. Indeterminate findings - enhancement technique recommended
4. The presence of underlying anti-K
Multiple Antibody Identification PANEL # 8
Question 1
After performing the rule-out procedure, give the most likely explanation for the variation in
reaction strength noted at the immediate spin phase for panel cells #1, #5, #6, #8, and #9.
1. Antigen dosage effect
2. Presence of multiple antibodies reacting
3. Poor avidity due to variation in tube "shaking" technique
4. Potent autoantibody
Question 2
The positive agglutination reactions of panel cells #3 and #7 at the antiglobulin phase
most likely indicate
1. Contamination of the test system
2. The presence of an additional alloantibody
3. Carry-over reactions from immediate spin testing
4. The presence of cold alloantibody and warm autoantibody
Question 3
The findings of the panel and the autocontrol reactions indicate:
1. The presence of autoantibody only
2. The presence of both alloantibody and autoantibody
3. The presence of multiple alloantibodies
4. Invalid testing due to antiglobulin reagent failure
Question 4
On the basis of the patient's phenotype, which alloantibodies may be ruled out?
2. Antibodies to both Duffy antigens
3. Antibodies to M and K antigens
4. Antibodies to Le(a) and Le(b) antigens
Question 5
What is the patient's most probable Rh genotype?
1. R1Rz
2. R1R2
3. RoR1
4. R1R1
Multiple Antibody Identification 2 PANEL # 9
Question 1
A 20-year old female with thalassemia major and a history of multiple transfusions is admitted
for transfusion therapy. Her hemoglobin is 6.4 g/dL, and her antibody screen is positive. The
panel indicates the presence of:
1. A single warm-reacting alloantibody.
2. Multiple warm-reacting alloantibodies.
3. Multiple warm and cold alloantibodies.
4. Both alloantibody and autoantibody.
Question 2
After performing the recommended rule-out procedure, the most likely specificities of the
antibodies present are:
1. Anti-K and anti-Jk(b)
2. Anti-C and anti-Fy(a)
3. Anti-D and anti-s
4. Anti-C and anti-Jk(a)
Question 3
Donor units for this patient must be C and Jk(a) antigen negative. How many RBC units per 100
random donors are expected to be negative for the C and Jk(a) antigens?
1. One unit per 100 donor units
2. Three units per 100 donor units
3. Seven units per 100 donor units
4. Ten units per 100 donor units
Multiple Antibody Identification 3 PANEL #10
Question 1
Three units of RBCs are ordered ASAP for a 36-year old female admitted to the ER due to
multiple trauma and blood loss caused by an auto accident. The type and screen results reveal
that she is group B, Rh negative, with a positive antibody screen at 37C and AHG phases. The
patient's history reveals multiple pregnancies. The findings of the panel suggest:
1. A single warm alloantibody
2. Multiple warm alloantibodies
3. Multiple warm and cold alloantibodies
4. Both alloantibody and autoantibody
Question 2
Results of the recommended rule-out procedure indicate the most likely specificities of the
antibodies present are:
1. Anti-C and anti-S
2. Anti-C and anti-E
3. Anti-D and anti-K
4. Anti-D and anti-Jk(b)
Transfusion Reaction Investigation PANEL # 11
Question 1
A 63-year old female GI bleeder is admitted to the hospital with a hemoglobin of 7.4 g/dL. She
is group O, Rh negative, with a negative antibody screen. Subsequently, she is transfused with
three units of group specific RBCs. Three days post transfusion, her hemoglobin falls and more
blood is requested. A new sample of the patient's blood reveals a positive antibody screen,
positive DAT, and slightly icteric serum. The pretransfusion sample shows a negative DAT, and
normal serum color. No clerical errors are found. Evaluation of this patient's post transfusion
blood results suggests:
1. A possible delayed transfusion reaction.
2. Warm autoimmune hemolytic anemia induced by drug therapy.
3. A possible immediate transfusion reaction.
4. A febrile non-hemolytic transfusion reaction
Question 2
Follow-up testing is performed to investigate the cause of the positive DAT and the icterus in the
post transfusion sample. An acid elution is performed on the post transfusion sample, and the
eluate is tested against the panel cells. What is the most likely specificity of the alloantibody
present?
1. Anti-K
2. Anti-Jk(b)
3. Anti-Fy(b)
4. Anti-Le(a)
Question 3
Given the pre- and post transfusion results, what is the best interpretation?
1. The pretransfusion sample was collected from the wrong patient.
2. The donor samples used were not from the units that were transfused.
3. An alloantibody was missed in the pretransfusion antibody screen.
4. The pretransfusion sample was diluted with IV fluid.
Warm Antibody Identification PANEL # 12
Question 1
Two units of RBCs are ordered to relieve anemia in a 69-year old female on levodopa therapy
for Parkinson's disease. The patient is group O, Rh positive with a positive antibody screen. The
reactions on the panel suggest the presence of:
1. Multiple warm-reacting alloantibodies.
2. A warm autoantibody.
3. An alloantibody against a high frequency antigen.
4. Multiple alloantibodies.
Question 2
Assuming that the patient has not been transfused within the last four months, what technique
would be most useful for investigating these findings?
1. Repeat the panel after treatment with ficin.
2. Repeat the panel after treatment with DTT.
3. Repeat the panel according to prewarmed technique.
4. Repeat the panel on autoadsorbed serum.
Question 3
After reviewing the autoadsorption studies in this case, what is the most likely interpretation of
these results?
1. An autoantibody with a specificity mimicking anti-e
2. An alloantibody with anti-e specificity
3. Multiple alloantibodies - probable anti-c and anti-Jk(a)
4. Autoantibody reacting as a panagglutinin
Question 4
What is the best approach to providing a suitable red cell product for this patient?
1. Select Rh negative units and perform an immediate spin crossmatch.
2. Perform an immediate spin crossmatch using the autoadsorbed serum.
3. Phenotype the patient's RBCs and provide units that are negative for the major antigens
lacking in the patient; perform a complete AHG crossmatch using autoadsorbed serum.
4. No further serological testing is required - provide ABO and Rh specific units.
Incompatible Crossmatch PANEL #13
Question 1
Four units of RBCs are crossmatched, and one unit is incompatible at the AHG phase of testing.
One possible explanation of these findings is:
1. Incorrect ABO grouping of the incompatible donor unit.
2. Patient has a positive direct antiglobulin test.
3. LH
4. The presence of an antibody to a low frequency antigen.
Question 2
An antibody identification panel is performed. The results suggest the presence of:
1. Anti-Le(a)
2. Anti-E
3. Anti-K
4. Anti-V
Question 3
Other than an antibody to a low frequency antigen, which of the following is associated with a
negative antibody screen but an incompatible crossmatch only at the AHG phase of testing?
1. Incorrect ABO grouping of the donor unit
2. Incorrect ABO grouping of the patient
3. Positive direct antiglobulin test (DAT) of the donor unit
4. Positive direct antiglobulin test (DAT) of the patient's red cells
Rh Immune Globulin PANEL # 14
Question 1
A 34-year old pregnant female is seen by her physician for prenatal evaluation. Review of the
panel results suggests the presence of:
Question 2
The potential exists for this infant to develop hemolytic disease of the newborn due to anti-Fy(a).
What would be the next step for investigating this case?
1. Enhancement technique to detect anti-D
2. Amniocentesis with follow-up bilirubin assay
3. Antibody titration
4. No further investigation is indicated
Question 3
Maternal titration studies are performed. Review of the findings suggests:
1. Hemolytic disease of the newborn is likely but is not severe
2. Hemolytic disease of the newborn has developed and is severe
3. Amniocentesis is needed to determine the risk to the fetus
4. There is no evidence of hemolytic disease of the newborn at this time
Question 4
At birth, the newborn is determined to be group O, Rh positive. The direct antiglobulin test is
negative. Which of the following statements is correct?
1. The mother is a candidate for Rh immune globulin (RhIG) administration.
2. The mother is NOT a candidate for RhIG because she has a positive antibody screen.
3. Further testing is needed to determine whether RhIG should be given.
4. The mother is considered a candidate only if subsequent pregnancies are planned.
Question 5
A fetal screen test is positive, suggesting that a fetal to maternal bleed has occurred. The
Kleihauer-Betke acid elution is performed to determine the volume of this bleed, and the results
show that 1.1% of the cells are of fetal origin. Based on this information, calculate the number
of vials of RhIG needed for this patient.
1. One dose
2. Two doses
3. Three doses
4. Four