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ABO Blood group system
 Rh System

• The second most significant blood group system for blood transfusion
• Involves 50 antigens
• The D antigen is the most likely to trigger an immune response
• If you have D antigen, there's a "+" after your ABO blood type
• If you don't have D antigen, there's a "-" after your ABO blood type
 Weak D Antigen

• Weak D antigen is a phenotype where the D antigen is weakly

expressed on red blood cells

• Three Mechanisms for Weak D

1. Genetic
2. Position effect
3. Mosaic
 Anti-human globulin (AHG)

• Purpose: To detect IgG antibodies and complement proteins that have

bound to red cells either in vitro or in vivo but do not produce visible
agglutination.

• Types:
• Direct antiglobulin test, DAT (in vivo)
• Indirect antiglobulin test, IAT (in vitro)
DAT
IAT
 IAT DAT

IgG attachment to red cells has occurred during - IgG attachment to red cells has occurred within -
the incubation steps the patient body
Two- stage step procedure - One- stage procedure -
:Application - : Application -
Antibody screening -1 Hemolytic disease of the fetus and newborn -1
Antibody identification -2 HDFN
Cross-hatching -3 Hemolytic transfusion reaction HTR -2
Titration of incomplete Abs -4 Autoimmune hemolytic anemia -3
Drug-induced hemolytic anemia -4
 HDFN

Is an immune-mediated red blood cell (RBC) disorder in

which maternal antibodies attack fetal or newborn RBCs.

-Rh negative mother has a baby with Rh-positive father.

- Symptoms of HDN are:

• pale skin
• yellowing of the amniotic fluid
• enlarged liver or spleen
• severe swelling of the body
• Hyperbilirubinemia and jaundice
• Anemia
 Diagnoses

Newborn Mother Diagnosis

Positive Negative Rh-D
DAT IAT Anti-globulin test

Amniocentesis CBC
 Treatment

Phototherapy -
Exchange transfusion -

Prevention
RhoGAM -
First dose at 28 weeks of gestation -
Second dose when mother delivers an Rh + baby -
01. What is considered to be a "mature" L/S ratio?

A. 1:2
B. <1:5
C. 1:1
D. >2:1

The lecithin–sphingomyelin ratio is a test of fetal amniotic

fluid to assess for fetal lung immaturity.
02.
What additional lung surfactant appears at the end of term as a final indicator and
accurate predictor of fetal lung maturity?

A. Phosphatidyl glycerol
B. Phosphoric acid
C. Choline
D. Stearic acid

Phosphatidylglycerol (PG) in amniotic fluid is recognized as a good indicator of

fetal lung maturity 
03.
If the fetus is suffering from Hemolytic disease of the newborn, what
chemistry analyte will be detected in high levels in the amniotic fluid?

A. Myoglobin
B. Bilirubin
C. Urobilinogen
D. Porphobilinogen
 04. At what wavelength will this analyte (see previous question) cause a
characteristic increase in absorbance on spectrophotometry?

A. 325 nm
B. 395 nm
C. 410 nm
D. 450 nm
 Mother's Hematology

Parameter Mother’s results Normal range

WBC 3.8 X 103 /uL 4,500 to 11,000
RBC 1.90 X 106 /uL 3.93 to 5.69
HGB 8.1gm/dL 11.6 to 15
HCT 22 % 36% to 48%
PLT 94 X 103 /uL 150.000 to 450.000
Segmented neutrophils 78% (20 hypersegmented) 50-65%
Lymphs 12 % 20% to 40%
Monos 10% 2% to 8%
Folate 0.8 ng/mL 2.5 to 20 ng/mL
Vitamin B 12 540 pg/mL 160 to 950 pg/mL
Blood film: Marked anisocytosis with macroovalocytes
 05. Given the calculated indices, classify this anemia morphologically:

A. Normochromic, normocytic
B. Hypochromic, microcytic
C. Macrocytic
D. Reduced production
06. Hypersegmented neutrophils are associated with which of the
following?
A. Iron deficiency
B. Megaloblastic anemia (B12, folate deficiency)
C. Aplastic anemia
D. Hemoglobinopathies
 07. What is the most likely cause of this woman’s anemia?
A. Pernicious anemia
B. Folate deficiency secondary to increased need and probable poordiet
C. Vitamin B12 deficiency secondary to a tapeworm
D. Folate deficiency secondary to chronic hemolysis
 Mother's Blood Bank
Anti A Anti B A Cell B Cell
3+ = 1+ 4+

Anti D Rh control
RT 37 AHG RT 37 AHG

= = = = = =

RT 37 AHG

Screening Cell l = 1+ 4+

Screening Cell ll = 1+ 4+

Auto Control = = 4+

Panel: Anti D
Antibody titer: 1:1024 A-
 08. What is the most likely reason for the ABO typing
discrepancy?
A. A2 with Anti A1
B. Bombay
C. Weakened antibodies secondary to immune disorder
D. Positive DAT
 09. Which of the following would be a likely confirmation test on
this patient?
A. No reaction with either Anti A1 lectin or A2 cells
B. No reaction with A,B antisera
C. Positive reaction with polyspecific AGH
D. No reaction with anti A1 lectin and positive reaction with A2 cells
 10. The IAT, panel and antibody titer probably indicate:

A. The woman was given RhIG at 28 weeks

B. The woman has an anti D and the baby is likely D+
C. The woman has an anti D but the baby is likely D=
D. An error was made
The baby was delivered early and had the following
results:
Parameter Mother’s results Normal range
WBC 85 X 103 /uL 4,500 to 11,000
RBC 2.93 X 106 /ML 3.93 to 5.69
HGB 12.5 gm/dL 11.6 to 15
HCT 37 % 36% to 48%
MCV 126 fL 80 to 100 femtoliter
MCH 42.6 pg 27 to 31 picograms/cell
MCHC 33.8% 32 to 34%
PLT 157 X 103 /pL 150.000 to 450.000
Segmented neutrophils 90% 50-65%
Lymphs 5% 20% to 40%
Monos 5% 2% to 8%
650 n-RBCs per 100 WBCs
Marked polychromasia
 11. Corrected for the nucleated red cells, what is white blood count?

A. 1130 /μL
B. 11,300 /μL
C. 23,000 /μL
D. 113,000 /μL

Corrected WBC = observed WBC count x (100 ÷ [nRBC + 100])

12. Which of the baby’s CBC results are normal for a newborn infant?

A. Red cell morphology

B. Hematocrit
C. MCV
D. Differential
 Baby's Blood Bank

Anti A Anti B A Cell B Cell

= = = =

Anti D Rh control

RT 37 AHG RT 37 AHG

= = 3+ = = 3+
13. What ABO type is this baby?
A. Cannot determine
B. A
C. AB
D. O
14. What Rh type is the baby?
E. Rh +
F. Weak D +
G. Rh =
H. Rh indeterminate
15. It would be expected that the baby type Rh+ at room temperature with
anti D if the mother's anti D titer is 1:1024. Which of the following is the best
explanation for the results given?
A. A mistake was probably made on the titer
B. The baby's D antigen sites are covered by maternal antibody
C. The mother's antibody is not really anti D
D. A premature infant does not have developed Rh antigens yet
16. What is the most common reason for the Rh control reacting at
AHG?

A. Expired reagent
B. Positive DAT
C. Detecting complement
D. Using polyspecific AHG instead of monospecific
17. How can the correct Rh type be determined on the baby?
A. Auto absorption
B. Prewarm all reagents and skip immediate spin
C. Omit the Rh control
D. Elute the maternal antibody off the infant red cells and retest
18. if the baby needs an exchange transfusion, what blood
type should be used?

A. O+
B. O=
C. AB=
D. At
19. All of the following are required for units for exchange
transfusionEXCEPT?

A. CMV =
B. Blood must be less than 7 days old
C. Hemoglobin S negative
D. Compatible with father’s blood type
E. Irradiated
20. The fetal screen on the mom was negative. How much RhIG
(Rhogam)should she get?

A. None
B. One vial
C. Two vials
D. Five vials
21. How many vials of RhIG (Rhogam) should a woman receive
who had 9fetal cells (stained dark pink) out of 500 cells on the
Kleihauer-Betke test?

A. 1
B. 2
C. 4
D. 10
22. Why do premature infants, even without HDN, frequently
require blood transfusions?

A. Inherited hemolytic disorders are common in preemies

B. Replace blood taken for lab tests
C. The bili lights used break red cells
D. Iron deficiency is common in preemies
 Baby's Chemistry

Normal Range :
1h : Less than 1 mg/dL
2h: Less than 5 mg/dL
24h : Less than 10 mg/dL
23. Interpret the baby's 1 hour post delivery total bilirubin.

A. Increased
B. Normal
C. Decreased
24. At what age should a baby's bilirubin level become
consistent with adult levels?

A. 1 week
B. 1 month
C. 6 months
D. 12 months
25. Which of the following best explains the cause for the continual
rise seenin the 8 hour and 24 hour post delivery bilirubin samples?

A. These results are normal for a newborn and will resolve within 5
days
B. The baby's liver is unable to metabolize the bilirubin from
destroyed RBCs
C. The baby is suffering from renal disease and is unable to
excretethe excess bilirubin into the urine
26. What type(s) of bilirubin is (are) contributing to the elevated total
bilirubin in this baby?

A. Conjugated
B. Unconjugated
C. Both conjugated and unconjugated