10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The BB/TM exam has 280 questions and runs 6 hours 22 minutes.
These 10 free BB/TM questions are organized by exam domain, so you can see how each part of the Certification in Pathology: Blood Banking/Transfusion Medicine (BB/TM) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Clinical Practice 14% of exam
Question 1
The transfusion service is called about a patient with warm autoimmune hemolytic anemia, hemoglobin 4.3 g/dL, new chest pain, and ischemic ECG changes. Corticosteroids have been started. ABO typing is verified, all antiglobulin crossmatches are incompatible because of a panreactive warm autoantibody, and adsorption studies will take several hours. No historical alloantibodies are documented; ABO-compatible RBCs matched to the available Rh and K profile are ready. What should the transfusion physician authorize now?
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Correct answer: A - Authorize immediate transfusion of the selected RBCs while adsorption studies continue.
Domain 2: Histocompatibility and Tissue Banking 1% of exam
Question 2
During evaluation of a previously HLA-sensitized transplant candidate, a single-antigen bead assay gives unexpectedly weak reactivity with one HLA antigen. Mean fluorescence intensity is 800 in undiluted serum, 11,500 at a 1:8 dilution, and 5,400 at a 1:32 dilution. Controls are acceptable, the same reagent lot is used throughout, and a second aliquot reproduces the pattern. Which conclusion is supported by these results?
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Correct answer: D - Inhibitory interference masking antibody reactivity in the undiluted specimen
Domain 3: RBCs and RBC Components 10% of exam
Question 3
A patient receiving daratumumab needs RBC transfusion for symptomatic anemia. ABO/RhD typing is concordant with prior records. Untreated screening cells react uniformly, but the antibody screen with 0.2 M DTT-treated cells is negative. Pretreatment genotyping documents a conventional K+k+ phenotype, and there is no history of clinically significant RBC alloantibodies. The available ABO/RhD-compatible units are K-positive; K-negative units would take several hours to obtain. Under a validated anti-CD38 testing protocol, which release decision is appropriate?
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Correct answer: B - Release the available K-positive units after a compatible immediate-spin crossmatch.
Domain 4: Apheresis 8% of exam
Question 4
A patient with confusion, thrombocytopenia, and microangiopathic hemolytic anemia has ADAMTS13 activity of 3% with a demonstrable inhibitor. Therapeutic plasma exchange is prescribed alongside disease-directed therapy. A proposed exchange order uses 5% albumin throughout. Which replacement strategy best addresses the underlying defect?
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Correct answer: D - Plasma, to replace ADAMTS13 as the inhibitor is removed.
Domain 5: Hazards of Transfusion: Specific Adverse Events 10% of exam
Question 5
Nine hours after completion of two RBC units, a 77-year-old patient with chronic kidney disease develops new orthopnea, hypoxemia, and bilateral pulmonary edema. Blood pressure has risen from 128/72 to 184/96 mm Hg, jugular venous pressure is elevated, and fluid balance is positive by 1.9 L. Echocardiography shows preserved left ventricular ejection fraction with elevated filling pressures. There is no fever or wheezing. Using the January 2026 NHSN surveillance framework, how should this pulmonary event be classified?
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Correct answer: D - Transfusion-associated circulatory overload
Domain 8: Blood Donors and Blood Collection 7% of exam
Question 6
At a U.S. blood center using FDA individual risk-based donor assessment, a prospective whole-blood donor reports stopping oral HIV pre-exposure prophylaxis six weeks ago after consultation with the prescribing clinician. The donor has never used injectable PrEP, has no history of HIV infection, and reports no other deferrable exposure. Recent clinical HIV antigen/antibody and nucleic acid tests were negative. How does the oral PrEP history affect eligibility today?
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Correct answer: C - Defer until three months have elapsed since the last oral dose.
Domain 10: Surgery Patients 7% of exam
Question 7
Diffuse oozing persists after cardiopulmonary bypass and initial protamine administration. Surgical inspection finds no focal bleeding source. Kaolin thromboelastography shows an R time of 24 minutes; the paired heparinase-treated sample has an R time of 7 minutes. The laboratory's R-time reference interval is 5-10 minutes for both assays. In the heparinase channel, maximum amplitude is 61 mm within a 50-70 mm reference interval, with no excess clot lysis. The paired R times localize the dominant clot-initiation abnormality to which cause?
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Correct answer: A - Residual heparin anticoagulation
Domain 12: Platelet and Platelet Components 6% of exam
Question 8
During induction chemotherapy, an adult receives two consecutive ABO-identical apheresis platelet transfusions. Each contains 3.0 × 10^11 platelets; body surface area is 1.8 m². Counts are 6,000/µL before and 9,000/µL 30 minutes after the first transfusion, then 7,000/µL before and 10,000/µL 30 minutes after the second. There is no fever, active bleeding, DIC, or splenomegaly. Testing detects HLA class I antibodies. The service defines refractoriness as an early corrected count increment below 5,000 on two consecutive transfusions. Which assessment should guide the next platelet selection?
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Correct answer: C - CCI 1,800; request HLA-compatible platelet support.
Domain 13: Obstetric and Pediatric Patients 7% of exam
Question 9
An adolescent with HbSS received RBCs for acute chest syndrome eight days ago. Hemoglobin rose from 7.6 to 9.8 g/dL but has now fallen to 5.2 g/dL. Hemoglobinuria and a marked LDH increase accompany a rapid fall in the posttransfusion HbA fraction. The reticulocyte count is lower than the patient's usual baseline. There is no bleeding, and both the DAT and current antibody screen are negative. Which process best accounts for the hemoglobin falling below its pretransfusion level?
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Correct answer: A - Accelerated destruction of both donor and recipient RBCs
Domain 14: Hematopoietic Progenitor Cell (HPC) Transplantation 11% of exam
Question 10
An allogeneic hematopoietic-cell transplant recipient requires RBCs and plasma during early engraftment. The recipient was group A and the donor is group B. Recipient anti-B remains detectable, and donor-type conversion has not been established. Support must remain compatible with both recipient and emerging donor hematopoiesis. Which ABO combination should be requested?
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Correct answer: B - Group O RBCs with group AB plasma