Transfusion Medicine: Module 4-5

You have a patient who has a positive antibody screen. What is the next step you should take in pretransfusion testing?

Perform an electronic crossmatch

Perform an antibody panel

Identify the antibody that present using the antibody screen antigram.

Perform a major crossmatch

Perform an antibody panel

AB Negative patients can receive B Negative donor blood.

True

False

True

You have an AB Neg patient and need to crossmatch 6 units of compatible blood. Your blood supply is getting low, and you do not have enough type specific blood to give tha patient all AB Hevative units. It is perfectly fine to cross match 1 AB Negative, 2 A Negative, 2 B Negative, and 1 O Negative units for transfusion. True or false?

True

All positive antibody screens must have an ______   _______performed to identify the allo- or autoantibody present. 

Antibody panel

When you perform an antibody panel, you can also use the antibody screen cells to help rule in and rule out the antibody that is present.
True

False

True

Select all of the following that are true about crossmatching an AB Negative patient who has anti-E.

Only AB Negative, E negative units should be used.

Only AB Negative or A Negative blood should be crossmatched

Any Rh negative blood type can be used as long as the unit is E negative.

O Negative blood should be used for this because all O Negative blood is D negative.

Any Rh negative blood type can be used as long as the unit is E negative.

When crossmatching a patient sample that has an antibody, you only need to test the crossmatch through 37C; IgG phase is not needed. True or false?           

False

Testing recipient red blood cells with donor plasma

Minor crossmatch

Used when patient has a current antibody screen that is negative and has NO history of previously identified antibodies - relies on a a system of barcode scanning

Electronic crossmatch

Correct match:

Crossmatching patient sample and donor RBCs through the IgG phase of testing

Coomb's crossmatch

Correct match:

Testing recipient plasma with donor red blood cells

Major Crossmatch

Which of many of the following that could be a symptom of a transfusion reaction.

Lower Back Pain and Chest pain

Tachycardia (high resting heart rate)

Increased Blood Pressure (unexpected and sharp increase)

Anaphylaxis (fever, itching, rash/hives)

All of the above

Select any of the following that is a part of a transfusion reaction workup.

ABO Rh on the pretransfusion sample

Blood culture of the patient

Testing the patient's blood glucose level

Testing the glucose level of the unit of blood

Clerical check of the pre and post transfusion samples.

Urinalysis for the presence of hemoglobin

Examination of the transfused component

DAT on post-transfusion sample

DAT on post-transfusion sample

Urinalysis for the presence of hemoglobin

Clerical check of the pre and post transfusion samples.

ABO Rh on the pretransfusion sample

Examination of the transfused component

Which combination of patient and blood component would result in a delayed transfusion reaction? (Meaning there is EXTRAvascular hemolysis, primarily)

Patient is B Negative with an anti-D antibody at 4+ strength, receiving 2 units of B Positive blood

The emergence of anti-Jka after transfusion with Jka positive blood

Patient is O positive  and received A positive blood

Patient is A positive and received AB plasma

The emergence of anti-Jka after transfusion with Jka positive blood

Choose the correct response to this scenario.

A nurse calls you for advice on whether or not her patient is having a transfusion reaction. She states that the patient is complaining of severe lower back pain (kidney area), heart rate is elevated, and urine in the foley cath bag is pink. Which of the following is the best advice to give the nurse from a blood banker?

I would not worry about it. This happens frequently and the patient typically just gets some Benadryl and the rate of the transfusion is slowed. But you may want to touch base with the physician or at least have day shift check with her.

I have no clue. Consult with someone on the floor or call the physician. More than likely the patient is okay but I cannot state that without seeing the patient.

Stop the transfusion NOW and order a transfusion reaction workup. You also want to give the patient 2 bags of normal saline immediately and 150mg of IV Benadryl. This patient is having a severe transfusion reaction.

The symptoms sound suspicious. My recommendation is to consult the physician and your nursing manual immediately. Although the blood bank cannot advise you on calling a reaction, I can state you have 4 hours to complete the transfusion, so stopping it now, for a few minutes to consult with someone, will be okay. 

The symptoms sound suspicious. My recommendation is to consult the physician and your nursing manual immediately. Although the blood bank cannot advise you on calling a reaction, I can state you have 4 hours to complete the transfusion, so stopping it now, for a few minutes to consult with someone, will be okay. 

When working up a transfusion reaction, the only time a Pathologist needs to review the completed work is if there has been a reaction.

True

False

False

You issued a unit of blood to ICU 32 minutes ago. The nurse called down to ask if she can bring it back because the patient refused the transfusion. You tell her she can and that you can place it back into your inventory. 

This was correct.

True

False

An open system is one that has never been entered since the donation was made.

True

False

A patient with a previous history of alloantibodies should receive antigen negative units crossmatched at immediate spin only.

True

False

All pRBC units should be transfused with a filter to remove microclots, if present.

True

False

Thawed cryo has a closed expiration of 4 hours.

True

False

There is not as much Fibrinogen in cryo as there is in FFP.

True

False

False

If a patient is bleeding and will not stop, even after multiple FFP transfusions, cryo would likely be the best component to transfuse to aid in stopping the bleed.

True

False

As a pRBC ages, the amount of 2,3 DPG increases.

True

False

Increase in K is an example of a pRBC storage lesion.

True

False

pRBCs should be stored at 1-6C and transported at 1-8C.

True

False

A nurse calls you and asks what size filter is needed when transfusing platelets. You tell her a 170 micro filter is to be used.

This is correct.

True

False

Platelet rich plasma is made from the hard spin.

True

False

Cryo can be stored at <-18C for one year from collection.

True

False

Platelets should be refrigerated prior to transfusion.

True

False

Platelets have a 5 day expiration from the date of processing.

True

False