MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND

CHILDREN
TANGANYIKA MEDICAL TRAINING BOARD
CERTIFICATE IN MEDICAL LABORATORY
(NTA LEVEL 5)
END OF SEMESTER II EXAMINATION
MODULE CODE: MLT05207
MODULE NAME: HAEMATOLOGY AND BLOOD TRANSFUSION
THEORY ANSWER GUIDE
AUGUST, 2017

GENERAL INSTRUCTIONS:
1. INTEGRITY, AUTHENTICITY and DEVOTION must be observed during the whole
process of marking
2. Read instructions given at each section carefully before marking.
3. Go through the answer guide carefully and if there are MAJOR changes which
contribute to the marks adjustment upon agreed by the marking panel must be
communicated with the Chief Marker
4. The final answer guide with adjustment of marks shall be submitted together with the
report to the DHRD-MOHCDGEC
5. Write your initial signature authorized by the chief marker on the space provided for
each Answer script you have marked.
6. Chief Marker will appoint Verifiers for each section among Markers
7. After marking process all Answer scripts must be packed, sealed and kept in a secured
place

MLT05207: Theory Answer Guide for End of Semester II Examination August, 201714-Jan-21 18:05:55 a1/p1 Page 1
 SECTION A: MULTIPLE CHOICE QUESTIONS 20 MARKS
Instructions:
 This section consists of Twenty (20) questions
 Encircle the most correct answer
 One (1) mark will be awarded for each correct answer
1. When a male possess a phenotypic trait that he passes to all his daughters and none of his
sons, the trait is said to be
A. Only dominant.
B. X- linked dominant.
C. X- linked recessive
D. Autosomal recessive.
E. Autosoumal dominant.
2. Which of the following produces antibodies?
A. Macrophages.
B. Dendritic cells.
C. B – Lymphocytes.
D. T – Cytotoxic cells.
E. Natural Killers cells.
3. Immunoglobulin produced as secondary body immune response:-
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
4. Which of the following is a reason for washing red blood cells in saline before performing
blood grouping test?
A. Improve complement fixation
B. Wash away any haemolysed cells
C. Increase antibody binding to antigen
D. Remove traces of free serum globulins
E. Neutralize any excess antihuman globulins present in the blood
5. Which of the following blood group contains the greatest amount of H substance:
A. Blood group O
B. Blood group B
C. Blood group A2
D. Blood group A1B
E. Blood group A2B
6. Which of the following antigen is not present on the surface of red blood cells of Rh null
individual?
A. Rh antigens
B. Duffy antigen
C. ABH antigens
D. Lewis antigens
E. MN53 antigens

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 7. Optimum temperature at which Rhesus antibodies react:-
A. 150C
B. 180C
C. 220C
D. 250C
E. 370C
8. Rhesus antigens are inherited as:-
A. X-linked
B. ABH Antigens
C. Sex-linked genes
D. Co-dominant alleles
E. Autosomal recessive alleles
9. Which of the following blood group can be given to patient as an emergency transfusion
when there is no time for cross matching?
A. O Rh positive whole cells
B. O Rh negative packed cells
C. O Rh positive whole blood
D. O Rh positive packed cells
E. O Rh negative whole blood
10. Pernicious anemia caused by which among the following?
A. B6 deficiency.
B. Iron deficiency.
C. B12 deficiency.
D. Severe hemolysis.
E. Severe hemorrhage.
11. ABO Haemolytic Disease of the New borne (HDN) is usually mild because:-
A. ABO incompatibility is rare.
B. ABO antibodies are of weak.
C. ABO antibodies prevent the disease.
D. ABO antibodies readily cross the placenta.
E. ABO antigens are poorly developed in the fetus.
12. CD4:CD8 ratio is calculated by dividing:-
A. Number of CD4-T cells by the number of CD8-T cells.
B. Number of CD4+ T cells by the number of CD8- T cells.
C. Number of CD4- T cells by the number of CD8+ T cells.
D. Number of CD4+ T cells by the number of CD8+ T cells.
E. Number of CD4+ T cells by the number of CD8+ B cells.
13. Which of the following is characteristic of hypochromia RBCs?
A. Any color change in the Red blood cells.
B. Variation in shape of the red blood cells.
C. Decreased concentration of red blood cell.
D. Decreased size variation of red blood cells.
E. Decreased haemoglobin content of red blood cell.

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 14. The morphological classification of anaemia is based on:-
A. Reticulocyte count.
B. Red blood cell shape.
C. Cause of the anaemia.
D. Red blood cell indices.
E. Red blood cell haemoglobin.
15. In ABO system the common blood group A subgroup are:-
A. A1 and A2
B. A2 and A3
C. A3 and A4
D. A4 and A5
E. A5 and A6
16. When an individual inherit Haemoglobin S from one parent and haemoglobin C from
another parent, the disorder is known as:
A. Sickle cell trait.
B. Sickle cell disease.
C. White blood disorder.
D. Heredity spherocytosis.
E. Systemic lupus erythematosus.
17. Which red blood cell inclusions are results of denatured haemoglobin?
A. Heinz bodies.
B. Malaria parasites.
C. Howell-Jolly bodies.
D. Basophilic stippling.
E. Pappenheimer bodies.
18. What is the function of glacial acetic acid in the CSF diluting fluid?
A. Stain Red Blood Cells.
B. Lysis Red Blood Cells.
C. Stain White Blood Cells.
D. Lysis White Blood Cells.
E. Stain both Red and White Blood Cells.
19. Which of the following method is used to estimate donor’s haemoglobin levels before blood
collection in the field?
A. Colorimetric
B. Copper II sulphite
C. Copper II sulphate
D. Cyanmethaemoglobin
E. Sodium metabisulphate
20. Acid Citrate Dextrose solution is composed of:-
A. Citric acid, adenine and dextrose in water.
B. Citric acid, adenine and sodium phosphate.
C. Citric acid, sodium citrate and dextrose in water.
D. Distilled water, Sodium phosphate and dextrose.
E. Citric acid, sodium phosphate and dextrose in water.

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 SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 20 MARKS
Instructions:
 This section consists of Four (4) questions with five (5) options each
 Write the word “TRUE” and NOT letter ‘T’ for a correct statement and the word “FALSE”
NOT letter ‘F’ for incorrect statement in the space provided before each option
 All responses should be in CAPITAL letters
 One (1) a mark will be awarded for each correct response
 Responses with letters ‘T’ and ‘F’ will not be awarded any mark
 There will be a penalty of half (½) of allocated marks for responses with small letters.
1. Factors required for optimal haemtopoiesis.
A. TRUE Iron
B. FALSE Oxygen
C. TRUE Folic Acid
D. TRUE Vitamin B12
E. FALSE Haemoglobin
2. Regarding features of haemoglobin:-
A. TRUE Haemoglobin A is above 90% in adults
B. TRUE Haemoglobin F combines more readily with oxygen than Hb A
C. FALSE Hb A consists of one alpha globin chains and two beta globin chains
D. TRUE Haemoglobin F has greater resistance to alkali denaturation than HbA
E. FALSE HbF consists of alpha, beta and gamma chains without the delta chains
3. Function of Immunoglobin G:-
A. TRUE Primarily found in serum.
B. Binds and neutralizes toxins.
C. Associated with type II hypersensitivity reaction.
D. TRUE Main type of antibody found in blood and extracellular fluid.
E. In the human body act as mportant secretory immunoglobulin.
4. Regarding ABO blood grouping system:-
A. FALSE ABO red blood cell antigens are lipoprotein.
B. TRUE ABO reverse grouping is done from cord blood.
C. FALSE ABO reverse grouping is omitted from cord blood.
D. TRUE ABO genes are inherited in a co-dominant manner.
E. TRUE ABO blood group has naturally occurring antibodies of 1gM type.

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 SECTION C: SHORT ANSWER QUESTIONS 30 MARKS
Instructions:
 This section consists of Six (6) questions.
 Write your answers in the space provided on each question.
 Write a readable handwrite; DIRTY WORK IS NOT ALLOWED
1. Enumerate five (5) samples to be submitted to the laboratory for investigation of Haemolytic
Transfusion reaction. (5 Marks)
ANSWER:
A. Recipient pre-transfusion sample
B. Recipient post transfusion sample clotted
C. Recipient post transfusion sample EDTA
D. Recipient post transfusion sample blood for culture
E. The unit being transfused when HTR was noted
F. Recipient post transfusion urine sample
G. Recipients 24 hour urine collection

2. List five (5) sources of Technical errors resulting in ABO grouping test. (5 Marks)
ANSWER:
A. Incorrect identification of blood specimen i.e. labeling
B. Cell suspension too heavy or too light
C. Clerical errors
D. Mix up of samples
E. Missed observation of haemolysis
F. nFailure to add reagents
G. Contaminated reagents
H. Failure to follow SOP

3. Mention five (5) sources of error when performing sickle cell screening test. (5 Marks)
ANSWER:
A. Not using the reducing agent at correct concentration
B. Using too much reagent to volume of blood
C. Using expired reagent (older than 8 hours)
D. Not using a clean slide
E. Not using a clean cover glass

4. Mention five (5) materials used to maintain or control cold blood chain in blood donation.
(5 Marks)
ANSWER:
A. Blood transfusion refrigerator
B. Temperature control chart
C. Thermometer
D. Alarm system
E. Ice packs
F. Cool box

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 5. List five (5) abnormal haemoglobin maybe found in blood. (5 Marks)
ANSWER
A. Haemoglobin S
B. Haemoglobin E
C. Haemoglobin D
D. Haemoglobin C
E. Haemoglobin H

6. List five (5) types of anaemia. (5 Marks)

ANSWER
A. Iron deficiency anaemia
B. Haemolytic anaemia
C. Sideroblastic anaemia
D. Megaloblastic anaemia
E. Pernicious anaemia

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 SECTION D: ESSAY QUESTIONS 30 MARKS
Instructions
 This section consists of three (3) questions which are supposed to be answered in a narrative
way.
 Write your answer on the empty pages of this question paper; each question should start on
a new page.
1. Describe any six (6) complication of hemolytic anaemia. (10 marks)
Answer
Introduction (0.5 Marks)
Main body (9 Marks)
Candidate should explain any six (6) complications @ score 1.5 marks
 Hemosiderosis
 Heart failure
 Liver failure
 Infection /Osteomyelitis
 Hemolytic cell crisis
 Renal failure
 Kenicterus
 Jaundice
 Respiratory distress
 Brain death.
Conclusion (0.5 Mark)
Should reflect the above explanation

2. Describe Rh system antigens (10 Marks)

ANSWER
Introduction: (1 Mark)
Rh system antigens are most important antigen which consists of 50 defined blood-group antigens,
among which the five antigens D, C, c, E, and e are the most important. The commonly used terms Rh
factor, Rh positive and Rh negative refer to the D antigen only.
Main Body (8 Marks)
 The proteins which carry the Rh antigens are transmembrane proteins, whose structure suggest that
they are ion channels.

 The main antigens are D, C, E, c and e, which are encoded by two adjacent gene loci.

 The RHD gene which encodes the RhD protein with the D antigen (and variants) and the RHCE
gene which encodes the RhCE protein with the C, E, c and e antigens (and variants).

 There is no d antigen. Lowercase "d" indicates the absence of the D antigen (the gene is usually
deleted or otherwise nonfunctional).

 Rh phenotypes are readily identified by identifying the presence or absence of the Rh surface
antigens.

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  Most of the Rh phenotypes can be produced by several different Rh genotypes.
 Regarding patient treatment, only the phenotype is usually of any clinical significance to ensure a
patient is not exposed to an antigen they are likely to develop antibodies against.
Conclusion (1 Mark)
Should reflect the above explanation
3. Describe maintenance of cold chain for blood and blood products. (10 Marks)
ANSWERS
Introduction (1 Mark)
Student should mention and explain the following point
Cold chain is the systematic process for storage and transportation of blood from the donor to its
administration to the patient who requires transfusion.
Main body (8 Marks)
Transportation
 Cool box with ice packs are used to transport blood from collection site to the transfusion center.
 They must also be used when transporting blood from the blood center to the individual hospital
blood bank.
 Special thermometers can be used to monitor the minimum and maximum temperature of the
blood.
Storage
 Use of blood transfusion refrigerators which are known as blood bank refrigerator.
 They should have an excellent thermal insulation properties and ability to maintain a temperature
of 2 oC -6oC.
 The refrigerator should have a continuous temperature recorder, an audible alarm system which is
triggered off when temperature rises or fall outside the limit, a temperature control chart and
thermometer placed inside.
 The cold chain can be managed by a quality management system.
 The cold chain should be analyzed, measured, controlled, documented and validated.
Conclusion (1 Mark)
Should reflect the above explanation

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