Blood Bank Lecture Exam IV

MLS 4130

What component is most frequently involved with transfusion-associated sepsis?

Platelets

How are mild allergic transfusion reactions with isolated symptoms or hives and urticaria treated?

Transfusion is stopped and antihistamines administrated; when symptoms improve, transfusion is restarted

Nonimmune hemolysis can be caused during transfusion by:

All of the above

Pain at the infusion site and hypotension are observed with what type of reaction?

Acute hemolytic transfusion reaction

Which transfusion reaction presents with fever, maculopapular rash, watery diarrhea, abnormal liver function, and pancytopenia?

Transfusion-associated graft-vs-host disease

With febrile nonhemolytic reactions:

They tend to be self-limited

Fatal transfusion reactions are mostly caused by:

Clerical errors

Early manifestation of an acute hemolytic transfusion reaction can be confused with:

Febrile non-hemolytic reaction

Transfusion reactions are classified according to:

All of the above

Irradiation of blood is performed to prevent:

Transfusion-associated graft-vs-host disease

The advantage of middle cerebral artery peak systolic velocity doppler (MCA-PSV) is that it is:

Noninvasive and decreases risk of adverse events

Erythroblastosis fetalis primarily manifests in a fetus as:

Immature RBCs

Blood for intrauterine transfusion (IUT) should be:

Irradiated, leukocyte reduced, less than 7 days old, HbS negative

A patient without prenatal care delivers a healthy term infant. A cord blood sample shows the infant is A-positive with a positive DAT. The workup of the unexpected finding should include:

ABO testing of the birthing parent

ABO HDFN is usually mild because:

ABO antigens are poorly developed on fetal cells

Cold AIHA is sometimes associated with infection by:

Mycoplasma pneumoniae

A patient is admitted with a hemoglobin of 5.6 g/dL. Initial pre-transfusion workup appears to indicate the presence of a warm autoantibody in the serum and coating the RBCs. The transfusion history indicates that the patient received 6 units of RBCs 2 years ago after an automobile accident. Which of the following would be most helpful in performing antibody detection and compatibility testing procedures?

Adsorb the autoantibody using patient's enzyme treated cells

Immune hemolytic anemias may be classified in which of the following categories?

All of the above

A patient who is taking Aldomet has a positive DAT. An eluate prepared from his RBCs would be expected to:

React with all normal cells

A patient had a transfusion reaction to packed red blood cells. The medical laboratory scientist began the laboratory investigation of the transfusion reaction by assembling pre- and post-transfusion specimens and all paperwork and computer printouts. What should he do next?

Check for a clerical error

A patient has a hemolytic reaction to blood transfused 8 days ago. What is the most likely cause?

Delayed immunologic, probably due to an antibody such as anti-Jk^a

What may be found in the serum of a person who is exhibiting signs of TRALI?

Anti-leukocyte antibody

Which type of transfusion reaction occurs in about 1% of all transfusions, results in a temperature rise of 1°C or higher, is associated with blood component transfusion, and is not related to the patient’s medical condition?

Febrile nonhemolytic reaction

What would be the result of group A blood given to an O patient?

AHTR

All of the following are part of the preliminary evaluation of a transfusion reaction, except:

Panel on pre- and post-transfusion samples

A 68-year-old female diagnosed with neutropenia and inflammation of the left hand was typed as A positive, and received 1 packed red blood cell unit. The antibody screen was negative and crossmatch was compatible. During the transfusion, her pulse was 94, and blood pressure rose from 114/59 to 132/64. Her temperature rose from 37.1°C pretransfusion to 37.8°C 60 minutes after starting transfusion, then to 38.1°C upon completion. A post-transfusion specimen yielded plasma that was neither hemolyzed nor icteric, and a negative DAT. Post-transfusion urinalysis gave a 1+ blood and protein with 10 RBCs/hpf microscopically. The clerical check was acceptable.

What type of reaction most likely occurred as a result of transfusion?

Febrile nonhemolytic

All of the following are reasons for a positive DAT on cord blood cells of a newborn except:

Immune anti-K from an K-negative mother on the cells of a K-negative baby

A fetal screen yielded negative results on a mother who is O negative and infant who is O positive. What course of action should be taken?

Issue one full dose of RhIg

What can be done if HDN is caused by maternal anti-K?

Monitor maternal antibody titers

A woman who is 6 weeks pregnant with vaginal bleeding is reported as O negative. She tells the emergency department physician she is O positive and presents a blood donor card. The medical laboratory scientist performs a test for weak D and observes a 1+ reaction in AHG phase. A Kleihauer–Betke test is negative. Is this woman a candidate for RhIg?

No, she is Rh-positive.

Kernicterus is caused by the effects of:

Unconjugated bilirubin

Anti-E is detected in the serum of a woman in the first trimester of pregnancy. The first titer for anti-E is 32. Two weeks later, the antibody titer is 64 and then 128 after another 2 weeks. Clinically, there are beginning signs of fetal distress. What does this indicate?

Fetomaternal hemorrhage

An O-negative mother gave birth to a B-positive infant. The mother had no history of antibodies or transfusion. This was her first child. The baby was mildly jaundiced and the DAT weakly positive with polyspecific antisera. What could have caused the positive DAT?

Maternal anti-A, B coating the infant cells

Which mechanism of drug-induced red cell destruction closely mimics the serologic presentation of WAIHA?

Induction of autoimmunity

Which mechanism of drug-induced hemolytic anemia involves the formation of drug-antibody combinations that bind non-specifically to RBC membranes and activate complement?

Immune complex

Penicillin is responsible for which form of drug-induced immune hemolytic anemia?

Drug adsorption

A 50-year-old patient with systemic lupus erythematosus (SLE) is admitted to the hospital with evidence of hemolysis, including decreased hemoglobin and hematocrit, increased reticulocyte count, and increased indirect bilirubin. The patient has no recent history of transfusion. An antibody screen is ordered, and 3+ agglutination is observed at the AHG phase for all cells. An autologous control (autocontrol) is also tested, and 3+ agglutination is observed at the AHG phase in this test as well. 

Given the results of the antibody screen, other laboratory test results, and the patient's medical and transfusion history, which of the following is the most likely cause of the positive screen results?

Warm autoantibodies

What is/are the causative autoantibody(ies) in paroxysmal cold hemoglobinuria (PCH)?

IgG

In pre-transfusion testing for a patient with WAIHA, the primary concern is:

Discovering any existing significant alloantibodies in the patient sample

Which of the following reactions is characterized by rigors, rather than chills?

TTBI

A patient a little over a week after transfusion presents with maculopapular rash, diarrhea, high liver enzymes, and pancytopenia. What does this most closely resemble?

TA-GVHD

Increased ___ levels in blood products are hypothesized to cause hypotensive transfusion reactions.

Bradykinin

A transfusion medicine physician has eliminated the diagnoses of TRALI and TACO, thus the patient is diagnosed with ___.

TAD

The differentiating factor between DHTR and DSTR is:

DSTR is not associated with shortened RBC life span.

A provider has visualized bilateral “white out” on an X-ray. What is the next step to demonstrate transfusion-related acute lung injury?

Exclusion of circulatory overload or other causes of pulmonary edema

Deferring multiparous females from platelet donation intends to reduce the risk of…

TRALI

A patient post-transfusion has an elevated BNP, respiratory distress, and left ventricular failure. This presentation most closely resembles…

TACO

Which of the following is a delayed transfusion reaction?

TA-GVHD