BB: Transfusion Practice
A patient became hypotensive and went into shock after receiving 50 mL of a unit of RBC. She had a shaking chill and her temperature rose to 104.8*F (40.4*C). A transfusion reaction investigation was initiated but no abnormal results were seen. What additional testing should be performed? a) Gram stain and culture of the donor unit b) lymphocytotoxicity tests for leukoagglutinins c) plasma IgA level d) elution and antibody identification
A
A patient has had massive trauma involving replacement of 1 blood volume with RBC and crystalloid. She is currently experiencing oozing from mucous membranes and surgical incisions. Laboratory values are as follows: PT: normal; aPTT: normal; bleeding time: prolonged; platelet count: 20x10^3/uL; hemoglobin: 11.4 g/dL What is the blood component of choice for this patient? a) Platelets b) Cryoprecipitated AHF c) FFP d) Prothrombin Complex
A
A patient with a coagulopathy was transfused with FP24. After infusion of 15 mL, the patient experienced hypotension, shock, chest pain and difficulty in breathing. The most likely cause of the reaction is: a) anti-IgA b) bacterial contamination c) intravascular hemolysis d) leukoagglutinins
A
A temperature rise of 1*C or more occurring in association with a transfusion, with no abnormal results in the transfusion reaction investigation, usually indicates which of the following reactions? a) febrile b) circulatory overload c) hemolytic d) anaphylactic
A
After receiving a unit of RBC, a patient immediately developed flushing, nervousness, fever spike of 102*F, shaking, chills, and back pain. The plasma hemoglobin was elevated and there was hemoglobinuria. Laboratory investigation of this adverse reaction would most likely show: a) an error in ABO grouping b) an error in Rh typing c) presence of anti-FyA antibody in patient's serum d) presence of gram-negative bacteria in blood bag
A
FFP from a group A, Rh-positive donor may be safely transfused to a patient who is group: a) A b) B c) AB d) O
A
Leukocyte-Poor RBC would most likely be indicated for patients with a history of: a) febrile transfusion reaction b) iron deficiency anemia c) hemophilia A d) von Willebrand disease
A
Severe intravascular hemolysis is most likely caused by antibodies of which blood group system? a) ABO b) Rh c) Kell d) Duffy
A
The most appropriate laboratory test for early detection of acute posttransfusion hemolysis is: a) a visual inspection for free plasma hemoglobin b) plasma haptoglobin concentration c) examination for hematuria d) serum bilirubin concentration
A
The most serious hemolytic transfusion reactions are due to incompatibility in which of the following blood group systems? a) ABO b) Rh c) MN d) Duffy
A
Washed RBC indicated in which of the following situations? a) an IgA-deficient patient with a history of transfusion-associated anaphylaxis b) a pregannt woman with a history of HDN c) a patient with a positive DAT and red cell autoantibody d) a newborn with a hematocrit <30%
A
When evaluating a suspected transfusion reaction, which of the following is the ideal sample collection time for a bilirubin determination? a) 6 hours posttransfusion b) 12 hours posttransfusion c) 24 hours posttransfusion d) 48 hours posttransfusion
A
Which of the following transfusion reactions is characterized by high fever, shock, hemoglobinuria, DIC and renal failure? a) bacterial contamination b) circulatory overload c) febrile d) anaphylactic
A
How would the hematocrit of a patient with chronic anemia be affected by the transfusion of a unit of Whole Blood containing 475 mL of blood, vs 2 units of RBC each with a total volume of 250 ml? a) patient's hematocrit would be equally affected by the WB or the RBC b) RBC would provide twice the increment in hematocrit as the WB c) WB would provide twice the increment in hematocrit as the RBC d) WB would provide a change in hematocrit slightly less than the RBC
B
In a delayed hemolytic transfusion reaction, the DAT test is typically: a) negative b) mixed-field positive c) positive due to complement d) negative with the antibody screen is negative
B
In a delayed transfusion reaction, the causative antibody is generally too weak to be detected in routine compatibility testing and antibody screening tests, but is typically detectable at what point after transfusion? a) 3-6 hours b) 3-7 days c) 60-90 days d) after 120 days
B
Plasma exchange is recommended in the treatment of patients with macroglobulinemia in order to remove: a) antigen b) excess IgM c) excess IgG d) abnormal platelets
B
The purpose of a low-dose irradiation of blood components is to: a) prevent posttransfusion purpura b) prevent GVHD c) sterilize components d) prevent noncardiogenic pulmonary edema
B
Use of only male donors as a source of plasma intended for transfusion is advocated to reduce which type of reaction? a) allergic b) TRALI c) hemolytic d) TACO (circulatory overload)
B
What increment of platelets/uL, in the typical 70 kg human, is expected to result from each single unit of Platelets transfused to a non-HLA-sensitized recipient? a) 3,000- 5,000 b) 5,000- 10,000 c) 20,000- 25,000 d) 25,000- 30,000
B
Which of the following blood group systems is most commonly associated with delayed hemolytic transfusion reactions? a) Lewis b) Kidd c) MNS d) I
B
A patient admitted to the trauma unit requires emergency release of FFP. His blood donor card states that he is group AB, Rh-positive. Which of the following blood groups of FFP should be issued? a) A b) B c) AB d) O
C
A patient is readmitted to the hospital with a hemoglobin level of 7 g/dL 3 weeks after receiving 2 units of red cells. The initial serological tests are: ABO/Rh: A+; antibody screen: negative; DAT: 1+ mixed field Which test should be performed next? a) antibody identification panel on the patient's serum b) repeat the ABO type on the donor units c) perform an elution and identify the antibody in the eluate d) crossmatch the post reaction serum with the 3 donor units
C
A patient multiply transfused with RBC developed a headache, nausea, fever and chills during his last transfusion. What component is most appropriate to prevent this reaction in the future? a) RBC b) RBC, Irradiated c) RBC, Leukocyte-Reduced d) RBC selected as CMV-reduced risk
C
After checking the inventory, it was noted that there were no units on the shelf marked "May Issue as Uncrossmatched: For Emergency Only." Which of the following should be placed on this shelf? a) 1 unit of each of the ABO blood groups b) units of group O, Rh-positive WB c) units of group O, Rh-negative RBC d) any units that are expiring at midnight
C
Coughing, cyanosis and difficult breathing are symptoms of which of the following transfusion reactions? a) febrile b) allergic c) circulatory overload d) hemolytic
C
FFP: a) contains all labile coagulative factors except cryoprecipitated AHF b) has a higher risk of transmitting hepatitis than does WB c) should be transfused within 24 hours of thawing d) need not be ABO-compatible
C
For which of the following transfusion candidates would CMV-seronegative blood be most likely indicated? a) renal dialysis patients b) sickle cell patient c) bone marrow and hematopoietic cell transplant recipients d) CMV-seropositive patients
C
Hemoglobinuria, hypotension and generalized bleeding are symptoms of which of the following transfusion reactions? a) allergic b) circulatory overload c) hemolytic d) anaphylactic
C
Hypotension, nausea, flushing, fever, and chills are symptoms of which of the following transfusion reactions: a) allergic b) circulatory overload c) hemolytic d) anaphylactic
C
Irradiation of donor blood is done to prevent which of the following adverse effects of transfusion? a) febrile transfusion reaction b) cytomegalovirus infection c) transfusion associated GVHD d) TRALI
C
Platelet transfusions are of most value in treating: a) hemolytic transfusion reaction b) posttransfusion purpura c) functional platelet abnormalities d) immune thrombocytopenic purpura
C
Posttransfusion anaphylactic reactions occur most often in patients with: a) leukocyte antibodies b) erythrocyte antibodies c) IgA deficiency d) Factor VIII deficiency
C
Posttransfusion purpura is usually caused by: a) anti-A b) white cell antibodies c) anti-HPA-1a (Pl^A1) d) platelet wash-out
C
Ten units of group A platelets were transfused to a group AB patient. The pretransfusion platelet count was 12x10^3/uL and the posttransfusion count was 18x10^3/uL. From this information, the technologist would most likely conclude that the patient: a) needs group AB platelets to be effective b) clinical data does not suggest a need for platelets c) has developed antibodies to the transfused platelets d) should receive irradiated platelets
C
The most frequent transfusion-associated disease complication of blood transfusions is: a) CMV b) syphilis c) hepatitis d) AIDS
C
The use of Leukocyte-Reduced RBC and Platelets is indicated for which of the following patient groups? a) CMV-seropositive postpartum mothers b) victims of acute trauma with massive bleeding c) patients with history of febrile transfusion reactions d) burn victims with anemia and low serum protein
C
To prevent febrile transfusion reactions, which RBC product should be transfused? a) RBC, Irradiated b) CMV-negative RBC c) RBC, Leukocyte-Reduced d) IgA-deficient donor blood
C
Which of the following is a nonimmunologic adverse effect of a transfusion? a) hemolytic reaction b) febrile nonhemolytic reation c) congestive heart failure d) urticaria
C
Which of the following transfusion reactions occurs after infusion of only a few mL of blood and gives no history of fever? a) febrile b) circulatory overload c) anaphylactic d) hemolytic
C
A 65 year old woman experience shaking, chills, and a fever of 102*F (38.9*C) approximately 40 minutes following the transfusion of a second unit of RBC. The most likely explanation for the patient's symptoms is: a) transfusion of bacterially contaminated blood b) congestive heart failure c) anaphylactic transfusion reaction d) febrile transfusion reaction
D
A patient has become refractory to platelet transfusion. Which of the following are probable causes? a) transfusion of Rh-incompatible platelets b) decreased pH of the platelets c) development of an alloantibody with anti-D specificity d) development of antibodies to HLA antigen
D
A patient who is group AB, Rh-negative needs 2 units of FFP. Which of the following units of plasma would be most acceptable for transfusion? a) group O, Rh-negative b) group A, Rh-negative c) group B, Rh-positive d) group AB, Rh-positive
D
A patient's record shows a previous anti-Jk^b, but the current antibody screen is negative. What further testing should be done before transfusion? a) phenotype the patient's red cells for the Jk^b antigen b) perform a cell panel on the patient's serum c) crossmatch type specific units and release only compatible units for transfusion d) give Jk^b negative crossmatch compatible blood
D
A sickle cell patient who has been multiply transfused experiences fever and chills after receiving a unit of RBC. Transfusion investigation studies show: DAT: negative; Plasma hemolysis: no hemolysis observed The patient is most likely reacting to: a) IgA b) plasma protein c) red cells d) white cells or cytokines
D
A trauma patient who has just received ten units of blood may develop: a) anemia b) polycythemia c) leukocytosis d) thrombocytopenia
D
An unexplained fall in hemoglobin and mild jaundice in a patient transfused with RBC 1 week previously would most likely indicate: a) paroxysmal nocturnal hemoglobinuria b) posttransfusion hepatitis infection c) presence of HLA antibodies d) delayed hemolytic transfusion reaction
D
Congestive heart failure, severe headache and/or peripheral edemia ocurring soon after transfusion is indicative of which type of transfusion reaction? a) hemolytic b) febrile c) anaphylactic d) circulatory overload
D
During initial investigation of a suspected hemolytic transfusion reaction, it was observed that the posttransfusion serum was yellow in color and DAT was negative. Repeat ABO typing on the posttransfusion sample confirmed the pretransfusion results. What is the next step in this investigation? a) repeat compatibility testing on suspected unit(s) b) perform plasma hemoglobin and haptoglobin determinations c) use enhancement media to repeat the antibody screen d) no further serological testing is necessary
D
During the issue of an autologous unit of WB, the supernatant plasma is observed to be dark red in color. What would be the best course of action? a) the unit may be issued only for autologous use b) remove the plasma and issue the unit as RBC c) issue the unit only as washed RBC d) quarantine the unit for further testing
D
Fever and chills are symptoms of which of the following transfusion reactions? a) citrate toxicity b) circulatory overload c) allergic d) febrile
D
Five days after transfusion, a patient becomes mildly jaundiced and experiences a drop in hemoglobin and hematocrit with no apparent hemorrhage. Below are the results of the transfusion reaction workup: In order to reach a conclusion, the technician should first: a) retype the pre- and post- transfusion patient samples and donor#1 b) request an EDTA tube drawn on the patient and repeat the DAT c) repeat the pretransfusion antibody screen on the patient's sample d) identify the antibody in the serum and eluate from the posttransfusion sample
D
For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to: a) prevent alloimmunization b) diminish chills and fever c) prevent hemoglobinemia d) reverse hypotension and minimize renal damage
D
Platelets are ordered for a patient who has a history of febrile reactions following red cell transfusions. What should be done to reduce the risk of another febrile reaction? a) pretransfusion administration of Benadryl b) transfuse Irradiated Platelets c) give Platelets from IgA-deficient donors d) give Leukocyte-Reduced Platelets
D
Symptoms of dyspnea, cough, hypoxemia, and pulmonary edema within 6 hours of transfusion is most likely which type of reaction? a) anaphylactic b) hemolytic c) febrile d) TRALI
D
The most important step in the safe administration of blood is to: a) perform compatibility testing accurately b) get an accurate patient history c) exclude disqualified donors d) accurately identify the donor unit and recipient
D
The primary indication for granulocyte transfusion is: a) prophylactic treatment for infection b) additional supportive therapy in those patients who are responsive to antibiotic therapy c) clinical situations where bone marrow recovery is not anticipated d) severe neutropenia with an infection that is nonresponsive to antibiotic therapy
D
Therapeutic plasmapheresis is performed in order to: a) harvent granulocytes b) harvest platelets c) treat patients with polycythemia d) treat patient with plasma abnormalities
D
Transfusion of plateletpheresis products from HLA-compatible donors is the preferred treatment for: a) recently diagnosed cases of TTP with severe thrombocytopenia b) acute leukemia in relapse with neutropenia, thrombocytopenia and sepsis c) immune thrombocytopenic purpura d) severely thrombocytopenic patients, known to be refractory to random donor platelets
D
Washed RBC would be the product of choice for a patient with: a) multiple red cell alloantibodies b) an increased risk of hepatitis infection c) warm autoimmune hemolytic anemia d) anti-IgA antibodies
D
Which of the following is consistent with standard blood bank procedure governing the infusion of FFP? a) only blood group-specific plasma may be administered b) group O may be administered to recipients of all blood groups c) group AB may be administered to AB recipients only d) group A may be administered to both A and O recipients
D
Which of the following patient groups is at risk of developing GVHD? a) full term infants b) patients with history of febrile transfusion reactions c) patients with a positive DAT d) recipients of blood donated by immediate family members
D
A 42 year old male of average body mass has a history of chronic anemia requiring transfusion support. Two RBC are transfused. If the pretransfusion hemoglobin was 7.0 g/dL, the expected posttransfusion hemoglobin concentration should be: a) 8.0 g/dL b) 9.0 g/dL c) 10.0 g/dL d) 11.0 g/dL
B
A patient received about 15 mL of compatible blood and developed severe shock, but no fever. If the patient needs another transfusion, what kind of RBC component should be given? a) RBC b) RBC, Washed c) RBC, Irradiated d) RBC, Leukocyte-Reduced
B
A patient with severe anemia became cyanotic and developed tachycardia, hypertension and difficulty breathing after received 3 units of blood. No fever or other symptoms were evident. This is most likely what type of reaction? a) febrile reaction b) transfusion-associated circulatory overload (TACO) c) anaphylactic reaction d) hemolytic reation
B
A poor increment in the platelet count 1 hour following platelet transfusion is most commonly caused by: a) splenomegaly b) alloimmunization to HLA antigens c) DIC d) defective platelets
B
A posttransfusion blood sample from a patient experiencing chills and fever shows distinct hemolysis. The DAT is positive (mixed field). What would be most helpful to determine the cause of the reaction? a) auto control b) elution and antibody identification c) repeat antibody screen on the donor unit d) bacteriologic smear and culture
B
Although ABO compatibility is preferred, ABO incompatible product may be administered when transfusing: a) Single-Donor plasma b) Cryoprecipitated AHF c) FFP d) Granulocytes
B
Hives and itching are symptoms of which of the following transfusion reactions? a) febrile b) allergic c) circulatory overload d) bacterial
B
How many units of RBC are required to raise the hematocrit of a 70 kg nonbleeding man from 24% to 30%? a) 1 b) 2 c) 3 d) 4
B
