Chapter 16: Adverse Effects of Blood Transfusion
Which of the following clinical manifestations is not included in the physically or chemically induced transfusion reactions
Hemosiderosis
What test is indicated for the detection of HLA antibodies?
Lymphocyte panels
How could a potential alloimmunizaton due to Anti-K be prevented?
Matching of donor and recipient red blood cell phenotype
Which of the following is not a finding associated with intravascular hemolytic reaction?
Methemalbumin decreases
Which of the following should be collected immediately from a patient exhibiting signs of a septic reaction to blood products?
blood samples
What is a common finding in a DHTR?
Jaundice
What is the most frequent cause of circulatory overload?
Transfusion of a unit at too fast a rate
What measure can be taken to prevent transfusion-associated hypothermia?
Transfusion of product using a blood warmer
Persons with PTP exhibit thrombocytopenia with platelet counts as low as 10,000 per µL. What other complications might be present?
Hematuria
What type of hemolysis accompanies an anaphylactic reaction
. None of the above ( Intravascular c. Acute b. Extravascular )
Which of the following can be added to blood prior to or during transfusion?
0.85% sodium chloride solution (USP grade)
What is the length of time required for production of antibody in a DHTR caused by an anamnestic immune response?
3 to 7 days
How is an febrile nonhemolytic transfusion reaction FNHTR best defined?
A 1°C temperature rise associated with transfusion that has no medical explanation other than blood component transfusion
What is the pathophysiological cause surrounding anaphylactic and anaphylactoid reactions?
A patient who is deficient in IgA develops IgA antibodies via sensitization from transfusion or pregnancy
All of the following are diseases that can mimic a transfusion reaction except:
AML
An O-positive patient transfused with A-positive red blood cells would experience which of the following clinical manifestations?
Acute hemolysis
A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except:
Acute immune hemolytic transfusion reaction
Which mechanism may play a role in fever development in an FNHTR?
Release of pyrogens from transfused white blood cells
Which of the following products may lead to sepsis in a patient when contaminated with Escherichia coli?
All of the above (Packed red blood cells c. Platelets b. Normal saline )
Which of the following is compromised by iron overload?
All of the above (a. Heart c. Endocrine glands b. Liver)
Upon investigation of a DHTR, what should be included in the medical history?
All of the above (a. Previous transfusion c. Transfusion reactions b. Pregnancies)
When checking out a unit of blood to the floor:
All of the above (a. the nurse must provide a piece of paper with at least two patient identifiers and preferably, depending on the system, a unique blood bank band number b. you must visually check and document that the unit is free from hemolysis or possible bacterial contamination c. you must document who is checking out the blood and transporting it )
Which of the following symptoms are consistent with hemosiderosis?
Anemia, jaundice, fatigue, muscle weakness
A 35-year-old woman was transfused with 1 unit of packed red blood cells. The nurse monitoring the transfusion noticed hives on the patient's arm and an increase in body temperature. What is the choice of treatment for this patient?
Antihistamines
What may be found in the serum of a person who is exhibiting signs of a noncardiogenic pulmonary edema reaction?
Antileukocyte antibody
What is a possible mechanism for noncardiogenic pulmonary edema reactions?
Antileukocyte antibody reacts in donor or patient plasma, initiating complement mediated pulmonary capillary endothelial injury
Which of the following best describes a transfusion reaction?
Any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components
What treatment is recommended following a bacterial contamination reaction?
Broad-spectrum antibiotics
Which of the following may be a factor in a nonimmune transfusion reaction?
Circulatory overload
Which of the following should be collected 5 to 7 hours after transfusion for unconjugated bilirubin determination?
Clotted blood specimen
A patient transfused with 2 units of packed cells spiked a fever of 99.5°F and complained of chills 3 days after transfusion. The DAT was positive with polyspecific antisera and anti-IgG, but negative with anti-C3d. Compatibility testing was performed on the pre- and post-transfusion specimens. The latter 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 likely caused by:
DHTR caused by primary alloimmunization.
Alloimmunization is categorized as what type of transfusion reaction?
Delayed nonhemolytic
Which of the following is not characteristic of an anaphylactic reaction?
Electrophoretic levels of IgA
What type of hemolysis is implicated in a DHTR caused by primary alloimmunization?
Extravascular
A patient transfused with 2 units of packed red blood cells demonstrated signs of a transfusion reaction just before the second unit was completely infused. Hypotension, fever, and back pain are the immediate symptoms. Blood work reveals a 3% drop in hematocrit and prolonged PT. What therapy is given to correct the PT?
FFP
Which of the following is the most common transfusion reaction reported to blood banks?
Febrile reaction
Why is an FNHTR said to be a "diagnosis of exclusion"?
Fever can be the result of many other underlying maladies
Which of the following results when large excesses of free hemoglobin are released into the blood?
Hemoglobinemia
What is the primary mediator of an allergic response?
Histamine
What is the physiologic mechanism of histamine?
Histamine is released when the allergen-reagin complex attaches to the surface of tissue mast cells, increasing vascular dilation and permeability
Which of the following questions should be asked when investigating a transfusion reaction?
How many milliliters of red blood cells were transfused?
Which of the following is not a symptom of noncardiogenic pulmonary edema
Hypervolemia
What would be the result of group B blood given to a group O patient?
Immediate hemolytic transfusion reaction
What is the most common preventable error occurring among the nursing and medical staff that results in a transfusion-related death
Improper patient identification
Which of the following is an indicator of acute immune hemolytic transfusion reaction?
Increased bilirubin
What is a cause of death in GVHD?
Infection
Besides hemoglobin, what other protein can cause a pink discoloration of serum or plasma in association with muscle trauma?
Myoglobin
A patient undergoing transfusion of packed red blood cells became hypotensive and cyanotic 30 minutes into the transfusion. The nurse also noted a 0.8°C increase in temperature. The transfusion was stopped and postblood specimens were sent down to the laboratory for a transfusion reaction investigation. The donor serum was tested against screening cells (3-vials) and was reactive at AHG in all vials. A panel was performed, and anti-Bga was identified. What special blood component should this patient now receive?
None of the above (a. Leukopoor c. Deglycerolized b. Washed )
What groups are at risk for graft-versus-host disease (GVHD) as a result of transfusion?
Options B and C (b. Fetuses receiving an intrauterine transfusion c. Patients receiving a directed donation from a first-degree relative )
All of the following are immediate nonhemolytic transfusion reactions, except:
PTP
Which of the following is characterized by a rapid onset of thrombocytopenia due to anamnestic production of platelet antibody
PTP
Which of the following is indicative of GVHD?
Pancytopenia
Which patients are not at risk for circulatory overload?
Patients with iron-deficiency anemia
What is meant by the term iatrogenic?
Physician-caused
A 41-year-old multiparous woman was rushed to the emergency room after being shot in the chest. She received 8 units of packed red blood cells and 5 units of platelets. The hemoglobin and hematocrit determinations stabilized after 6 hours in surgery, but the platelet counts remained less than 50,000 per µL. She had received additional units of platelets at 48-hour intervals with little efficacy. Her serum was tested for platelet antibodies. She was placed on corticosteroids to control chest wound bleeding. Anti-PLA1 was identified in the patient's serum. This case is representative of what type of transfusion reaction?
Post-transfusion purpura
Which of the following indicates a hemolytic process?
Pre-transfusion plasma is yellow; post-transfusion plasma is red
Alloimmunization may result from which of the following?
Prior exposure to donor blood components
How can depletion and dilution of coagulation factors be avoided in a massively transfused patient?
Prudent use of platelets and fresh frozen plasma (FFP)
Which of the following urinalysis results represents hemolysis?
Reagent strip is positive for blood in absence of intact RBCs (microscopic)
Which of the following statements is false?
Red blood cells are phagocytized by macrophages in the spleen and liver in intravascular reactions
A delta check was noted for potassium after a surgical patient was transfused with 2 units of packed red blood cells. The pre-transfusion potassium was 3.1 mmol/L and the post-transfusion specimen was 6.2 mmol/L. What could be the reason for this sudden increase?
Red blood cells spent maximum time in storage.
What should be done in the transfusion process when the patient temperature spikes from 37.5°C to 38.5°C within 30 minutes of transfusion?
Stop the transfusion and keep the intravenous line open.
Which of the following describes the etiology of GVHD?
T lymphocytes from donor blood react with major and minor histocompatibility antigens in the patient
What symptom would not usually be found in a bacterial contamination reaction?
Tachycardia
Which of the following is consistent with bacterial contamination reactions?
The organism thrives in cold temperatures.
What is the purpose of performing serial hemoglobin and hematocrit after a blood transfusion?
To monitor the therapeutic or nontherapeutic response
Iron overload is synonymous with which of the following terms?
Transfusion hemosiderosis
A postpartum woman was crossmatched for 2 units of packed red blood cells. The first unit was issued at 3:15 a.m. At 3:45 a.m., the nurse called the blood bank and stated the patient was developing red hives and pruritus (itching). The transfusion was stopped and a post-transfusion specimen was drawn. The unit and identification tags were returned to the blood bank. The DAT on the specimen was negative, and hemolysis was absent. All visual and clerical checks were satisfactory. The pathologist ordered the treatment of diphenhydramine (Benadryl) for all subsequent transfusions. What type of transfusion reaction has occurred in this patient?
Urticarial
Which of the following therapies is not advocated in circulatory overload?
Whole blood units
Which of the following organisms have been implicated in bacterial contamination reactions?
Yersinia enterocolitica
A delayed hemolytic transfusion reaction is most often the result of:
an anamnestic response in a patient who has been previously sensitized by transfusion or pregnancy.
All of the following are symptoms of an allergic reaction except:
anemia
The presence of intact red blood cells in microscopic urinalysis examination indicates:
bleeding
Hypothermia as a result of cold fluid replacement can result in all of the following except:
citrate toxicity.
All of the following signs are consistent with circulatory overload except:
fever
Treatment in the event of an anaphylactic or anaphylactoid reaction should include all of the following except:
immediately administering PPF
The plasma level of unconjugated bilirubin is elevated in:
intravascular and extravascular hemolysis
Physical or chemical damage of the transfused red blood cells can result in:
intravascular hemolysis
A patient with two or more documented febrile nonhemolytic transfusion reactions (FNHTRs) should receive __________ blood components
leukopoor
A transfusion reaction investigation should include all of the following except:
neocyte transfusion
A severe manifestation of alloimmunization might include:
platelet refractoriness
Treatment of post-transfusion purpura (PTP) with _________is not advocated in medical practice.
platelet transfusions
The principle clinical signs of extravascular hemolysis include:
positive DAT
The most important initial step in evaluating a suspected hemolytic transfusion reaction is to:
reconfirm the patient's identity and reexamine all pre-transfusion testing
In a DHTR, patient antibody attaches to the specific foreign donor red blood cell antigen, causing sensitization of red blood cells, which are removed by the:
reticuloendothelial system (RES).
For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to:
reverse hypotension and minimize renal damage.
Immediate transfusion reaction procedures consist of all of the following except:
serum haptoglobin
Persons with a documented history of anaphylactic reactions should be transfused with _________ blood products
washed
Persons diagnosed with chronic renal failure and hemosiderosis should be treated with:
washed red blood cells