Deck 7: The RH Blood Group System

Question 1

Which IgG subclasses carry the most significance with regard to Rh antibodies?

A) IgG₁/IgG₄
B) IgG₂/IgG₄
C) IgG₃/IgG₄
D) IgG₁/IgG₃

Answer 1

D

Question 2

Which of the following statements regarding anti-LW is true?

A) Anti-LW reacts poorly with cord cells.
B) Anti-LW reacts stronger with Rh-positive cells than with Rh-negative cells.
C) Rh-null individuals lack the LW gene.
D) The gene coding for LW is located on the same chromosome as the Rh genes.

Answer 2

B

Question 3

A cord blood sample was sent to the blood bank for a type and DAT. Cells were washed six times with saline before testing. The forward grouping typed as an O. There was no agglutination with anti-D and washed cord cells. The DAT was 3+ with polyspecific AHG. What is the Rh type of the baby?

A) Rh-negative
B) Rh-positive
C) Rh type cannot be determined
D) None of the above

Answer 3

C

Question 4

In which population is the genetic Du usually found?

A) White
B) Asian
C) Black
D) Native American

Question 5

What does Rh genotype refer to?

A) Antigens detected on a red blood cell by serologic methods
B) Antibodies detected in serum by serologic methods
C) Rh genes inherited from both parents
D) Rh genes inherited from the mother

Question 6

Which antigen represents Rh3 in Rosenfield terminology?

A) D
B) E
C) C
D) e

Question 7

All of the following may cause a false-negative reaction in Rh typing except:

A) omission of reagent.
B) immunoglobulin coating cells.
C) rouleaux.
D) cell suspension that is too heavy.

Question 8

The Rh antibody agglutinates what percentage of RBCs?

A) 15%
B) 85%
C) 50%
D) 35%

Question 9

Which of the following genotypes is consistent with f antigen expression?

A) DcE/DCe
B) Dce/DCE
C) DCe/DcE
D) DCe/dCE

Question 10

In the Fisher-Race nomenclature what does "d" refer to?

A) Amorph
B) Silent allele
C) Absence of D
D) All of the above

Question 11

Which of the following genotypes would demonstrate the strongest expression of D antigen?

A) Dce/dCE
B) DCe/dce
C) dce/dce
D) dCe/dcE

Question 12

Of the three following categories of altered D antigen, in which variation of D antigen expression are you more likely to encounter an allo-anti-D?

A) C in Trans to RhD
B) Weak D
C) Partial D
D) None of the above

Question 13

Which gene combination is expressed in the greatest frequency in the black population?

A) DCe
B) dce
C) Dce
D) DCE

Question 14

What is an advantage of using chemically modified anti-D?

A) It provides a low-protein medium.
B) Rh control is not necessary.
C) Few false-negative results are obtained.
D) Du testing is eliminated.

Question 15

Where is the Rh antigen located relative to the red blood cell membrane?

A) Integrally
B) Peripherally
C) Centrally
D) None of the above

Question 16

What clinical manifestation may be associated with the Rh-null syndrome?

A) Reticulocytosis
B) Stomatocytosis
C) Low hemoglobin
D) All of the above

Question 17

G antigen is present on all of which type of red blood cells?

A) D-positive
B) C-positive
C) E-positive
D) e-positive

Question 18

How are the Rh antigens inherited?

A) X-linked recessive
B) Codominant alleles
C) X-linked dominant
D) None of the above

Question 19

Why is determination of Rh status crucial for obstetric patients?

A) An Rh-positive mother can form anti-D, which will destroy D-positive red blood cells of the fetus.
B) All Rh-positive mothers are possible candidates for Rh immune globulin.
C) All Rh-negative mothers are possible candidates for Rh immune globulin.
D) An Rh-negative mother can form anti-D if she gives birth to an Rh-negative baby.

Question 20

Most Rh antibodies are of what immunoglobulin class?

A) IgM
B) IgG
C) IgA
D) IgE

Question 21

What protocol is put in place to validate Rh testing when high-protein reagents are used, especially when the patient types as an AB-positive?

A) Wash cells before testing
B) Run a control with Rh test
C) Add LISS to test system
D) Use only saline reactive anti-D

Question 22

What is the basis of Rosenfield Rh terminology?

A) Each gene produces one product or antigen.
B) The positive (+) or negative (-) sign demonstrates the presence or absence of antigen on a red blood cell.
C) The Rh gene produces at least three factors within an agglutinogen.
D) The Rh gene produces at least five factors within an agglutinogen.

Question 23

All of the following are consistent with International Society of Blood Transfusion (ISBT) terminology except:

A) A six-digit number specifies each blood group antigen.
B) 004 represents Rh group.
C) D is written as "R1."
D) All genes are written in bold print.

Question 24

On which chromosome are the genes that code for RH proteins, namely, RHD and RHCE located?

A) Chromosome 1
B) Chromosome 19
C) Chromosome 20
D) Chromosome 9

Question 25

What does the term exalted D refer to?

A) Deletion of the D antigen
B) Stronger expression of Cc antigens when D is missing
C) Stronger expression of Ee antigens when D is missing
D) Stronger expression of D antigens when Cc and Ee are missing

Question 26

The Rh testing on a blood donor was negative at immediate spin. The tube was incubated at 37°C for 15 minutes. The tube was centrifuged and read macroscopically. The test was negative at 37°C. The tube was washed three times with saline, and two drops of AHG were added. After centrifugation, the tube yielded a 2+ reaction. How is this Rh type reported on the donor unit?

A) Rh-positive
B) Rh-negative
C) Du-positive
D) Rh-variable

Question 27

Why must there be alpha designations in the Rosenfield system?

A) Nomenclature applies to other blood group systems besides Rh.
B) Rosenfield nomenclature is only used in the Rh blood system.
C) Weiner and Fisher-Race use alpha designations.
D) None of the above

Question 28

What is the principle of the Rh-Hr (Weiner) terminology?

A) The Rh gene produces at least three factors within an agglutinogen.
B) Each gene (D, C, c, E, e) produces one product or antigen.
C) The Rh gene produces at least three factors within an agglutinin.
D) Each gene is independent of the others.

Question 29

What is the frequency of E antigen in the general population?

A) 85%
B) 15%
C) 98%
D) 30%

Question 30

Which of the following reagents or methods is best for categorizing partial D types?

A) Saline based anti-D
B) High protein anti-D
C) A combination of serological typing and molecular analysis
D) Monoclonal anti-D reagents

Question 31

All of the following are true regarding Rh antibodies except:

A) Rh antibodies can bind complement on the red blood cell membrane.
B) An individual with a low titer Rh antibody may experience a secondary immune response on antigen exposure.
C) Rh antibodies may cause a delayed hemolytic transfusion reaction.
D) Red blood cell destruction is usually extravascular.

Question 32

The D_el phenotype is most commonly found in individuals of which ethnicity?

A) Asian
B) Whites
C) Native American
D) African

Question 33

Rh-immune globulin is effective is preventing which type of hemolytic disease of the newborn (HDN)?

A) Anti-c
B) Anti-E
C) Anti-D
D) Anti-C

Question 34

What does the "R" represent in Rh-Hr terminology?

A) Absence of D antigen
B) Presence of D antigen
C) Presence of C antigen
D) Presence of e antigen

Question 35

All of the following may occur following an Rh-mediated hemolytic transfusion reaction except:

A) elevated fever.
B) increased bilirubin.
C) intravascular hemolysis.
D) positive DAT.

Question 36

In the black population, a mosaic form of which antigen may be found?

A) c
B) E
C) e
D) C

Question 37

What does hr' refer to in the Weiner nomenclature?

A) c
B) e
C) C
D) E

Question 38

Which of the following Rh antigens is the most immunogenic?

A) D
B) C
C) e
D) E

Question 39

The Rh gene is located on which chromosome?

A) 1
B) 7
C) 9
D) 11

Question 40

The biochemical structure of the Rh antigens is a nonglycosylated protein, meaning:

A) lipids are not attached to protein structure.
B) carbohydrates are not attached to protein structure.
C) glucose is attached to protein.
D) glycerol is attached to protein.

Question 41

Anti-LW will react most strongly with:

A) adult Rh-positive RBCs.
B) Rh-negative RBCs.
C) Rh-null RBCs.
D) Rh-negative cord blood.

Question 42

The antigen ceCF is known as:

A) Wrights antigen
B) Crawford antigen
C) D mosaic
D) V antigen

Question 43

When one or more D epitopes within the entire D protein is missing it is termed_______________.

A) weak D
B) C in trans to Rh(D)
C) D_el
D) partial D

Question 44

What are the dangers of transfusing donor Rh-negative RBCs to an Rh-positive patient?

A) There are no dangers.
B) A hemolytic transfusion reaction will occur.
C) A patient will be sensitized and will develop an Anti-D.
D) Most Rh-negative blood is c- and e-positive, and because of their immunogenicity the patient may form an antibody to those antigens.

Question 45

Which of the following Rh phenotypes invites C^w antigen testing?

A) C+c+
B) E+e-
C) E-e+
D) C+c-

Question 46

Why do false-negative Rh testing results occur in babies with severe hemolytic disease of the newborn due to anti-D?

A) The cord cells may be contaminated with Wharton's jelly.
B) All D sites are covered by maternal anti-D, which blocks the reagent.
C) Antigens are not expressed yet.
D) None of the above

Question 47

Which of the following statements is false?

A) Anti-D usually stimulates complement.
B) Anti-D is mostly IgG.
C) Anti-D can cause hemolytic disease of the newborn.
D) None of the above

Question 48

A male patient was seen in the emergency room with an acute bleed. The recommendation from the blood supplier is to give O-positive RBCs as uncrossmatched blood. This patient has already been exposed to Rh-positive blood after a previous accident. What is a possible outcome?

A) The patient may have a hemolytic transfusion reaction from an allo immunized anti-D.
B) Anti-D is not immunogenic, and the patient probably would not have formed an anti-D.
C) Anti-D is not hemolytic, and even with the circulating antibody there would be no danger to the patient.
D) The anti-D would activate complement, and a strong intravascular transfusion reaction would occur.

Question 49

An individuals of the dce/dce genotype given dCe/dce blood has an antibody response that appears to be anti-C and anti-D. The most likely explanation for this is:

A) The antibody is anti-G.
B) The antibody is anti-partial D.
C) The antibody is anti-Cw.
D) There was an incorrect reading of the agglutination reactions.

Question 50

When a patient has Rh-null syndrome, what kind of packed RBCs need to be transfused?

A) ABO compatible Rh-positive blood
B) ABO compatible Rh-negative blood
C) ABO compatible Rh-null blood
D) O-negative PRBCs

Question 51

If an individual with a partial D expression is transfused with a normal Rh-positive unit of blood, a likely result will be:

A) the patient will develop an anti-D antibody.
B) the patient will form an antibody to the portion of Rh(D) protein that they are missing.
C) the patient will have an acute hemolytic transfusion reaction.
D) the patient will experience no consequence of receiving Rh-positive blood.