Blood Bank - Transfusion practices

8. All of the following are appropriate indications for the use of fresh frozen plasma (FFP) EXCEPT? A. Volume expansion B. Severe bleeding in the presence of significantly elevated PT secondary to vitamin K deficiency C. Replacement component after plasma exchange in patients with TTP or HUS D. Dilutional coagulopathy with significant active bleeding, and PT and PTT twice normal

A

60. One risk associated with patients that require chronic transfusions is: A. Iron overload B. Fear of needles C. Transfusion associated graft-versus-host disease (TA-GVHD) D. Increased antigen production

A

12. All of the following serological test results may occur in a patient experiencing a hemolytic transfusion reaction due to the presence of a clinically significant Rh antibody such as anti-c EXCEPT: A. Optimal reaction at 37°C or AHG phase. B. Preference to react with RBCs possessing a double-dose of Rh antigen. C. Binding complement. D. Positive DAT result.

C

3. Which one of the following blood components would be MOST appropriate for a 9-yr old girl who is suspected of having idiopathic thrombocytopenic purpura (ITP), including a low platelet count and bleeding gums? A. Packed red blood cells B. Cryoprecipitate C. Platelets D. Fresh frozen plasma

C

32. An urticarial transfusion reaction is characterized by which of the following? A. Rapid rise in temperature B. Difficulty breathing C. Rash and hives D. Blood in the urine

C

37. Delayed hemolytic transfusion reactions (DHTR) usually occur within which time period? A. 1 hour after transfusion B. 24 hours after transfusion C. 3-7 days after transfusion D. One year after transfusion

C

42. Antibodies to which of the following blood components is the most frequent cause of febrile nonhemolytic transfusion reactions? A. Platelets B. Packed red blood cells C. Granulocytes D. Plasma

C

43. The presence of hemolysis in a post-transfusion blood sample is best associated with which of the following? A. Rh incompatibility B. Circulatory overload C. ABO incompatibility D. Dehydration

C

6. A 47-year old man is hemorrhaging severely. He is group AB, Rh (D) negative. Ten units of packed red blood cells are requested STAT. One group-specific unit is available. Which other units that are available in the blood bank would be most appropriate to choose for crossmatch? A. B, Rh(D) - positive B. A, Rh(D) - negative C. A, Rh (D) - positive D. O, Rh (D) - positive

B

1. In an extreme emergency, if the ABO and Rh type are unknown, which of the following should be given to the patient? A. Group O, Rh positive blood B. Group AB, Rh negative blood C. Group O, Rh negative blood D. Any blood type is OK

C

10. Which of the following fresh frozen plasma ABO types would be suitable for transfusion to an AB negative patient? A. AB negative only. B. O negative only. C. AB negative and AB positive only. D. O negative and O positive only.

C

19. When performing a transfusion reaction investigation, what is the clerical check used to detect? A. The type of reaction that occurred B. The patient's hemoglobin and hematocrit C. Errors that may cause an ABO-incompatibility due to patient or donor unit mix up D. Medication errors

C

52. A patient experiences a mild allergic reaction to a transfusion, including urticaria, erythema (skin redness), and itching. What is the most likely source of the allergen? A. IgA on mast cells B. Drugs or food consumed by the blood donor C. Insoluble allergens D. Donor red blood cells

B

53. The antigen marker most closely associated with transmission of HBV infections is: A. HBsAg B. HBeAg C. HBcAg D. HBiAg

B

54. What is the MOST common cause of acute hemolytic transfusion reactions? A. Testing errors B. Clerical errors C. Donor IgG immune antibodies D. Blood administration errors

B

56. What is the increase in the risk percentage for developing antibodies against red cell antigens (RBC alloimmunization) for patients who are characterized as chronically transfused patients? A. 1% - 4% B. 2% - 8% C. 5% - 10% D. 20% - 50%

B

15. A patient with a documented history of febrile nonhemolytic transfusion reactions (FNHTRs) should receive __________ blood components. A. Leukoreduced B. Irradiated C. Cytomegalovirus (CMV) negative D. Hemoglobin S negative

A

16. Acute intravascular hemolysis as the result of a blood transfusion is most often associated with which of the following causes? A. Transfusion of ABO incompatible red blood cells B. Allergic reaction C. Passively transfused antibodies to HLA antigens D. Transfusion-associated graft-versus-host disease

A

2. Which of the following patients are at risk for transfusion-associated graft versus host disease (TA-GVHD) and require irradiated cellular blood products? A. Immunocompromised patients including neonates less than 4 months of age and patients receiving chemotherapy. B. Post-surgical recipients of pre-operatively donated autologous blood products. C. Patients with chronic anemias who are frequently transfused cellular blood products. D. Patients with a history of urticarial (allergic) reactions to transfused blood products.

A

23. Which organism is MOST likely responsible for septic reactions associated with red blood cell transfusions? A. Yersinia enterocolitica B. Escherichia coli C. Enterobacter species D. Streptococcus species

A

24. A febrile nonhemolytic transfusion reaction is characterized by which of the following? A. An increase in temperature of >1oC above 37oC during transfusion B. Appearance of hives C. Fever above 37oC which develops 24 hours later D. A decrease in temperature of < 2oC below 37oC following transfusion

A

31. What is the MOST common infective agent to be transmitted through blood transfusion that results in morbidity and mortality? A. Bacteria B. Human immunodeficiency virus (HIV) C. Hepatitis A virus (HAV) D. Malarial parasites

A

35. Which term listed below refers to the process that must be followed when notification is received that a donor of a unit transfused now tests positive for an infectious disease? A. Look-back B. Donor notification C. Minor crossmatch D. Major crossmatch

A

34. A 40-year-old female receives two units of Red Blood Cells during a surgical procedure. The patient has no prior history of transfusions. Seven days later, she presents with extensive bruising of the extremities and bleeding of the gums, with no additional symptoms. Her platelet count is 5 x 109/L (reference interval 150 - 400 x 109/L). What is the most likely diagnosis? A. Post transfusion purpura (PTP) B. Acute hemolytic transfusion reaction (AHTR) C. Transfusion-related acute lung injury (TRALI) D. Allergic reaction

A

36. Which of the following transfusion reactions can a diagnosis be more firmly established by evaluating B-type natriuretic peptide (BNP) levels before and after transfusion? A. Transfusion Associated Circulatory Overload (TACO) B. Delayed Hemolytic Transfusion Reactions C. Transfusion Associated Sepsis D. Allergic Transfusion Reactions

A

5. Which of the following packed red blood cell ABO types would be appropriate for transfusion to an O negative patient of child-bearing age? A. O negative only. B. AB negative and O negative only. C. AB negative, A negative and B negative only. D. AB negative, A negative, B negative and O negative only.

A

55. Which of the following best describes a transfusion reaction: A. Any adverse event associated with the transfusion of blood components B. A fever associated with a transfusion C. The destruction of transfused red cells D. The development of a rash after transfusion

A

57. What procedure utilizes leukapheresis to collect the buffy coat from whole blood? A. Photopheresis B. Plasmapheresis C. Therapeutic apheresis D. Erythrocytapheresis

A

14. Which of the following signs and symptoms may be associated with immediate transfusion reaction, but is NOT usually associated with delayed hemolytic transfusion reaction? A. Fever and chills B. Unexplained bleeding from surgical site C. Unexplained drop in hemoglobin D. Transient jaundice

B

21. An exchange transfusion has been ordered for a low birth weight infant. The physician has ordered irradiated Red Blood Cells for this purpose. Why is it necessary to irradiate the blood products for this patient? A. To prevent alloimmunization of the patient B. To prevent transfusion-associated graft-versus-host disease (TA-GVHD) C. To kill bacteria and viruses present in the Red Blood Cells D. To allow the cells to have a longer half-life

B

22. You receive a call in the blood bank, reporting a transfusion reaction. You ask the nurse to stop the red blood cell transfusion immediately and return the unit of blood and all related forms to the blood bank. You also ask for a new patient blood specimen to be drawn and sent to the blood bank. You receive the requested items 15 minutes later. What will you do FIRST as part of your investigation? A. Perform an antibody screen and DAT on the pre-transfusion and post-transfusion specimens. B. Perform a clerical check, centrifuge the pre-transfusion and post-transfusion patient specimens and examine the plasma for hemolysis and icterus. C. Issue a different unit of blood to this patient but only after the original unit has been returned to blood bank. D. Do nothing, as you issued an O Negative red blood cell unit to the patient and that proves that the unit is compatible.

B

25. Which of the following is the most commonly encountered presenting sign of a delayed hemolytic transfusion reaction (DHTR)? A. Active bleeding B. Unexplained decrease in hemoglobin or hematocrit C. Renal failure D. Abnormal liver function

B

27. Both hemoglobinuria and hemoglobinemia will be present in what type of reactions? A. Delayed hemolytic transfusion reactions B. Acute hemolytic transfusion reactions C. Transfusion related acute lung injury D. Anaphylactic transfusion reactions

B

28. All of the following would be included in a hemolytic transfusion reaction investigation, EXCEPT: A. ABO/Rh check of post-transfusion sample B. Leukocyte antigen studies C. Direct antiglobulin test (DAT) on post-transfusion sample D. Clerical check

B

33. What is the cause of MOST severe acute hemolytic transfusions reactions? A. Rh incompatibility B. ABO incompatibility C. Cold agglutinins D. Delayed hypersensitivity

B

38. Acute transfusion reactions are divided into categories based on all of the following symptoms EXCEPT: A. Fever B. Liver failure C. Allergic reaction D. Pulmonary involvement

B

46. Which listed transfusion reaction is MOST OFTEN associated with transfused patient's lacking IgA? A. Hemolytic B. Anaphylaxis C. Febrile D. Transfusion-associated circulatory overload (TACO)

B

48. Delayed hemolytic transfusion reactions are usually caused by antibodies directed against what blood group system? A. MNS B. Kidd C. Kell D. ABO

B

9. What is the first line treatment for moderate to severe hemophilia A? A. Platelets B. Lyophilized Factor VIII concentrate C. Factor IX complex D. Cryoprecipitated AHF

B

45. For transfusion services in the United States, which of the following incidents must be reported to the Food and Drug Administration (FDA) because of a biological product deviation? A. Incident A: A unit was issued with an incorrect expiration date. The expiration date was incorrectly marked as one day earlier than the actual expiration date. B. Incident B: A nurse in ICU misidentified the patient and initiated the transfusion of Rh positive blood to an Rh negative patient. C. Incident C: The wrong specimen was used to crossmatch a unit and the unit was issued D. Incident D: Donor reports information that is disqualifying based on revised questions. Previous collected units were distributed.

C

49. What is the MOST frequent disease complication of blood transfusions? A. Cytomegalovirus (CMV) B. Syphilis C. Hepatitis D. HIV

C

50. Which of the following is the cause of the most severe life-threatening hemolytic transfusion reactions? A. Anti-D B. Anti-M C. Anti-A, Anti-B, Anti-A, B D. Anti-Fya

C

59. It's a busy Friday evening in the blood bank and you have been receiving a steady stream of Type & Screen specimens from the emergency room. Several of them have positive antibody screens which require further workup. One of these patients is a 46-year-old male whose hemoglobin has dropped from 8.4 g/dL to 4.6 g/dL in the previous 8 hours (normal Hgb for this patient demographic would be ~14 g/dL). Your workup reveals a group O patient with the following antibodies: anti-K, anti-Fya. The prevalence of K negative donors in your donor population is 91% while the prevalence of Fya negative donors is 37%. Two units of cross-matched RBCs are requested by the physician. How many units of group O RBC units should you phenotype in order to fulfill the request for two cross-matched units? A. 2 units of type O RBC units B. 3 units of type O RBC units C. 6 units of type O RBC units D. 12 units of type O RBC units

C

62. If an average-weight adult male patient with a 7 g/dL hemoglobin is given two units of packed cells, what would be the approximate new hemoglobin value (assuming there is no active bleeding or other predisposing factors that would shorten the survival of the blood cells)? A. 7.5 g/dL B. 8.0 g/dL C. 9.0 g/dL D. 11.0 g/dL

C

Which of the following is/are considered an accrediting agency(ies) for quality and safety in the blood industry? A. FDA B. CMS C. AABB D. ASCP

C

11. All of the following steps should be taken in the IMMEDIATE investigation of a potential hemolytic transfusion reaction EXCEPT for what? A. DAT on the post-transfusion patient sample. B. Check for clerical errors. C. Visual examination of the post-reaction and pre-reaction plasma for hemolysis. D. A gram-stain on the patient's plasma.

D

13. Which blood group is most frequently associated with Cold Agglutinin Disease (CAD)? A. Kell B. Kidd C. Duffy D. I

D

17. Which of the following antibodies is most often implicated as a cause of a delayed hemolytic transfusion reaction (DHTR)? A. Anti-S B. Anti-M C. Anti-Fya D. Anti-Jka

D

18. Certain clinical conditions such as Hemolytic Disease of the Fetus and Newborn (HDFN), Hemolytic Transfusion Reaction (HTR), and Autoimmune Hemolytic Anemia (AIHA) result from the attachment of antibodies or complement to human RBCs. What is this process called? A. Desensitization B. Non-sensitization C. In vitro sensitization D. In vivo sensitization

D

20. A patient transfused with two units of packed cells spiked a fever of 99.5oF and complained of chills five days after transfusion. The direct antiglobulin test (DAT) was positive with anti-IgG, but negative with anti-C3d. Compatibility testing was performed on the pre- and post-transfusion specimens. The post-transfusion specimen was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion specimens. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jka. This transfusion reaction is most: A. Post-transfusion purpura B. An anaphylactic response C. An acute hemolytic transfusion reaction D. A delayed hemolytic transfusion reaction

D

26. During routine inspection, a unit of unexpired blood was noticed to have a black color with numerous small clots. What is the likely cause for this observation? A. The unit was frozen B. Donor had DIC C. Viral contamination D. Bacterial contamination

D

29. What is the first step a transfusionist should take when a transfusion reaction is suspected? A. Slow the transfusion and notify the physician. B. Administer medication to stop the reaction. C. Notify the laboratory of the reaction D. Stop the transfusion, but keep the intravenous line open with saline.

D

30. Which of the following is responsible for causing transfusion associated graft-versus-host disease? A. Platelets B. Granulocytes C. Monocytes D. Lymphocytes

D

39. Which of the following clinical findings characterizes post-transfusion purpura (PTP)? A. Increased hemoglobin B. Pancytopenia C. High ferritin levels D. Thrombocytopenia

D

4. Which of the following D variants has the best likelihood to receive D-positive RBCs without any adverse effects? A. Del B. Partial D C. Partial weak D D. C in Trans to RHD

D

40. HLA antibodies are responsible for which of the following transfusion reactions? A. Allergic transfusion reactions B. Transfusion-associated sepsis C. Transfusion-associated circulatory overload D. Transfusion-related acute lung injury (TRALI)

D

41. Which of the following is a common cause of febrile non-hemolytic transfusion reactions? A. Bacterial contamination of the blood B. Antibody to a platelet antigen C. Reaction to plasma proteins D. Immune response to leukocytes

D

44. Transfusion-related acute lung injury (TRALI) is a serious blood transfusion complication that can be characterized by all of the following EXCEPT: A. Respiratory distress B. Pulmonary edema C. Acute onset D. Increased central venous pressure

D

47. What is considered the cause of urticarial transfusion reactions? A. IgA deficient individuals receiving plasma products containing IgA B. IgG or IgM antibody along with complement C. Tissue damage from the formation of immune complexes D. Transfusion of certain food allergens or drugs in plasma products

D

51. Which of the following statements is correct regarding blood bank adverse event reporting to the FDA? A. All patient deaths while being transfused must be reported to the FDA, even when it has been confirmed that the death was not related to the transfusion. B. When a transfusion reaction is the result of an error it must be reported to the FDA in writing. C. A transfusion-related death must be reported to the FDA within 24 hours of the patient's death. D. The initial notification to the FDA of a transfusion-related death must be made by fax, telephone, express mail, or electronically as soon as possible after the death is confirmed to be associated with the transfusion.

D

61. Which of the following is the MOST IMPORTANT first step to take when a patient is transfused with un-crossmatched RBCs that turn out to be incompatible? A. Order new blood specimens for the investigation. B. Identify the antibody. C. Perform an immediate spin crossmatch to rapidly determine incompatibility. D. Stop any transfusion in progress.

D

63. At many hospitals, patients with sickle cell disease are given phenotypically matched units of blood. This policy is often used to help prevent alloimmunization to common RBC antigens in patients who are regularly transfused. A patient who regularly comes to your hospital demonstrates the following phenotype on her RBCs: C antigen positive; E antigen negative; K antigen positive. The patient's doctor requests a single unit of crossmatched packed RBCs. Based on the antigen prevalence indicated below, how many units of ABO compatible packed RBCs will you phenotype to find one to transfuse to this patient? Antigen frequencies C antigen positive: 68% E antigen positive: 22% K antigen positive: 9% A. 7 units B. 77 units C. 4 units D. 1 unit

D

7. Which of the following is generally considered equivalent to CMV seronegative RBCs for use in an exchange transfusion to a newborn? A. Fresh RBC less than 7 days old B. Hemoglobin S negative RBC C. Frozen RBC D. Leukoreduced RBC

D