Blood Bank- unit 3 quizzes and ICA questions
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A patient with a positive DAT is being antigen typed using the indirect antiglobulin technique. Why might this produce a false-positive result?
-The patient's own IgG-coated red cells can agglutinate with the AHG reagent regardless of true antigen status
-AHG reagent cannot be used on any patient sample with a positive DAT
-A positive DAT always indicates the antigen is present
-The antisera used in AHG testing is never quality-controlled
The patient's own IgG-coated red cells can agglutinate with the AHG reagent regardless of true antigen status
A 6-year-old child arrives in hemorrhagic shock after a motor vehicle collision, and the blood type is not yet known. Which RBC units should blood bank issue?
-Group AB, D-positive
-Group O, D-negative
-Group O, D-positive
-Group A, D-negative
Group O, D-negative
A massively bleeding D-negative male patient is switched to D-positive RBC units because D-negative inventory is limited. What should happen once his bleeding is controlled?
-Nothing further is needed; he can remain on D-positive units permanently
-He should be switched back to D-negative units, and RhIG administration should be considered
-He should receive a double dose of RhIG regardless of antibody status
-He must be switched to group AB units to avoid further complications
He should be switched back to D-negative units, and RhIG administration should be considered
A patient with a documented history of severe allergic/anaphylactic transfusion reactions (e.g., IgA deficiency) should receive which special product modification?
-Irradiated units
-CMV-negative units
-Washed units
-Hemoglobin S-negative units
Washed units
Which blood component is the primary concentrated source of fibrinogen, and is tied to an MTP target goal of fibrinogen > 100 mg/dL?
-Fresh frozen plasma
-Platelets
-Cryoprecipitate
-Recombinant Factor VIIa
Cryoprecipitate
A 70-year-old postmenopausal woman requires emergency-released RBC units for surgical hemorrhage before her blood type is known. Which of the following is an acceptable unit to issue if necessary?
-Group O, D-negative only - D-positive units must never be given to any female patient
-Group O, D-positive
-Group AB, D-positive
-Any ABO group, as long as it is D-negative
Group O, D-positive
Which of the following is commonly used as a criterion to define a massive transfusion protocol (MTP) situation?
-Transfusion of 2 RBC units over 8 hours in a stable patient
-Transfusion of more than 4 RBC units within 4 hours in an actively hemorrhaging patient
-Transfusion of any plasma product regardless of volume
-Replacement of 10% of the patient's blood volume over 24 hours
Transfusion of more than 4 RBC units within 4 hours in an actively hemorrhaging patient
Which of the following best defines an "emergency (urgent) release" of blood?
-Release of blood only after a full crossmatch is completed and documented
-Release of blood components to a patient before pretransfusion compatibility testing is complete, because delaying transfusion poses a greater risk
-Release of autologous units that were donated by the patient prior to a scheduled surgery
-Release of blood that has already expired but is still within an extended-use exception
Release of blood components to a patient before pretransfusion compatibility testing is complete, because delaying transfusion poses a greater risk
Under what specific condition would a pooled platelet unit require a crossmatch before transfusion?
- Pooled platelets never require a crossmatch, regardless of content
-If the unit contains more than 2 mL of red cells
-If the recipient is group O
-If the unit is more than 3 days old
If the unit contains more than 2 mL of red cells
Per AABB Standards and FDA 21 CFR 606.151, which of the following must be retained or documented for every emergency-released unit?
-A segment from the issued unit must be retained
-The patient's insurance information must be recorded on the unit tag
-The patient must be retyped using a minimum of three independent samples
-The unit must be re-crossmatched within 24 hours regardless of outcome
A segment from the issued unit must be retained
Why are red cells, plasma, and platelets transfused in a fixed, balanced ratio during MTP rather than waiting for lab results between rounds?
-To reduce the total number of units needed overall
-To replace coagulation capacity along with red cell mass and prevent dilutional coagulopathy
-Because AABB Standards require exactly equal volumes of every component at all times
-To avoid the need for blood warmers during rapid infusion
To replace coagulation capacity along with red cell mass and prevent dilutional coagulopathy
Which ABO group is considered the "universal donor" for plasma, and why?
-Group O, because it lacks A and B antigens
-Group AB, because AB plasma contains neither anti-A nor anti-B antibodies
-Group A, because anti-B is the most clinically significant antibody
-Group B, because it is the least common blood type
Group AB, because AB plasma contains neither anti-A nor anti-B antibodies
A patient's current antibody screen is negative, but she has a documented history of anti-Jka. What type of RBC units must she still receive?
-Jka-negative units, because the antibody could reappear rapidly on re-exposure
-Any ABO/Rh-compatible units, since the antibody is no longer detectable
-Units that have been washed and irradiated only
-Jka-positive units, to prevent further sensitization
Jka-negative units, because the antibody could reappear rapidly on re-exposure
A recently transfused patient's antigen typing result shows a mixed-field reaction. What does this most likely indicate?
-A technical error that requires the test to be discarded
-A mixture of the patient's own red cells and transfused donor red cells
-The presence of a cold-reacting autoantibody
-An invalid antisera lot that failed quality control
A mixture of the patient's own red cells and transfused donor red cells
A massively transfused patient develops a low ionized calcium level. What is the most likely cause?
- Citrate anticoagulant from the transfused units chelating ionized calcium
-Excess potassium released from stored red cells
-Dilution of clotting factors from crystalloid fluids
-An acute hemolytic transfusion reaction
Citrate anticoagulant from the transfused units chelating ionized calcium
According to Landsteiner's law, what result would you expect when antigen typing the red cells of a patient with a TRUE alloantibody against that antigen?
-The patient's cells should test positive for that antigen
-The patient's cells should test negative for that antigen
-The result will always be a mixed-field reaction
-The result cannot be predicted without a DAT
The patient's cells should test negative for that antigen
A patient has been receiving group O, D-negative emergency-released RBCs. Two hours later, her current sample confirms she is group A, D-positive with a negative antibody screen. What should the transfusion service do next?
-Switch to group AB units since her antibody screen is negative
-Continue issuing group O, D-negative units for the remainder of the admission
-Switch immediately to crossmatch-compatible units without waiting for the antibody screen to finalize
-Switch to group A, D-positive, type-specific units now that her type is confirmed
Switch to group A, D-positive, type-specific units now that her type is confirmed
A patient receiving massive transfusion develops acidosis. Which downstream electrolyte complication is this most likely to worsen?
-Hyponatremia
-Hyperkalemia, as hydrogen ions enter cells and potassium shifts into the plasma
-Hypercalcemia
-Hypophosphatemia
Hyperkalemia, as hydrogen ions enter cells and potassium shifts into the plasma
A patient with a history of a severe allergic/anaphylactic transfusion reaction related to IgA deficiency requires a cellular component. Which special modification directly addresses this patient's specific risk?
-CMV-negative units, to prevent viral transmission
-Hemoglobin S-negative units, to avoid sickle hemoglobin
-Washed units, to remove residual plasma proteins including IgA
-Irradiated units, to inactivate donor lymphocytes
Washed units, to remove residual plasma proteins including IgA
A patient with a positive DAT is antigen typed using the indirect antiglobulin (Coombs) technique and shows a positive result. Which typing approach would be more reliable for confirming this patient's true phenotype?
- Diluting the patient's plasma before retesting
-Increasing the incubation time for the AHG phase
-Repeating the same AHG-based technique a second time
-Molecular (genotype) typing, which is unaffected by circulating IgG on the patient's cells
Molecular (genotype) typing, which is unaffected by circulating IgG on the patient's cells
A trauma patient receives 5 RBC units within 3 hours and continues to hemorrhage actively. Based on common MTP criteria, is this patient a candidate for massive transfusion protocol activation?
-Yes, because more than 4 RBC units have been transfused within 4 hours in an actively bleeding patient
-Yes, but only if the patient has also received plasma
-No, because MTP only applies to pediatric patients
-No, because MTP requires at least 10 units before activation
Yes, because more than 4 RBC units have been transfused within 4 hours in an actively bleeding patient
During MTP, a patient receives RBCs, plasma, and platelets in a fixed, balanced ratio rather than RBCs alone. What complication is this ratio-based approach primarily designed to prevent?
-Hyperkalemia from stored red cells
-Hypothermia from rapid component infusion
-ABO-antibody-mediated hemolysis
-Dilutional coagulopathy from replacing red cell mass without replacing coagulation factors and platelets
Dilutional coagulopathy from replacing red cell mass without replacing coagulation factors and platelets
A 19-year-old pregnant trauma patient needs emergency-released RBCs before her blood type is known. Which unit should be issued, and why?
-Group AB, D-negative, because AB is the universal recipient type
-Group O, D-negative, to avoid alloimmunization to D that could cause HDFN in this or a future pregnancy
-Group O, D-positive, because D-positive inventory is more plentiful
-Group O, D-positive, because Rh type does not matter in a true emergency
Group O, D-negative, to avoid alloimmunization to D that could cause HDFN in this or a future pregnancy
Before reporting any antigen typing result, the MLS confirms that the day's positive and negative antisera controls reacted as expected. Why is this step performed before every typing run and/or day of use?
- To determine the patient's ABO group simultaneously
-Because AABB only requires control testing once per antisera lot number, not daily
-To calibrate the centrifuge before use
-To confirm the antisera is reacting correctly before patient or donor results can be trusted and reported
To confirm the antisera is reacting correctly before patient or donor results can be trusted and reported
A male trauma patient of unknown blood type requires immediate transfusion. The blood bank issues group O, D-positive RBCs rather than D-negative. What is the most likely reason for this choice?
-D-positive units are tested more thoroughly than D-negative units
-He has no risk of forming anti-D causing HDFN in a future pregnancy, so issuing D-positive conserves the limited D-negative inventory
-Group O, D-positive units are safer for all patients regardless of sex
-Group O, D-positive units do not require a physician's release statement
He has no risk of forming anti-D causing HDFN in a future pregnancy, so issuing D-positive conserves the limited D-negative inventory
A pooled platelet unit is being prepared for transfusion. Under which condition would this unit require a crossmatch before issue?
- If the unit contains more than 2 mL of red cells
-If the unit is being transfused outside of an MTP setting
-Pooled platelet units never require a crossmatch under any circumstance
-If the recipient is group O
If the unit contains more than 2 mL of red cells
Why do plasma, platelets, and cryoprecipitate typically not require a crossmatch before transfusion, unlike RBC units?
-Crossmatch is only required for group O recipients
-They contain little to no red cells for antibody-mediated reactions to target
-They are tested more extensively at the donor center
-They are always leukoreduced, which eliminates the need for crossmatch
They contain little to no red cells for antibody-mediated reactions to target
A massively transfusing patient's labs show worsening acidosis and a falling ionized calcium simultaneously. Which underlying process links both findings?
-Both are caused exclusively by hypothermia
-Both result from ABO incompatibility between donor and recipient
-Both are prevented entirely by using leukoreduced components
-Both result from citrate in the transfused components, which is metabolized to bicarbonate but also chelates calcium, and impaired metabolism during shock worsens both
Both result from citrate in the transfused components, which is metabolized to bicarbonate but also chelates calcium, and impaired metabolism during shock worsens both
A MLS is validating a new lot of anti-K antisera. Which of the following would correctly confirm the antisera is functioning as expected before it is used on patient samples?
-It is approved for use once it passes testing on a single patient sample
-It agglutinates all red cells tested, regardless of K status
-It produces a mixed-field reaction with K-positive cells
-It agglutinates known K-positive control cells and does not react with known K-negative control cells
It agglutinates known K-positive control cells and does not react with known K-negative control cells
An MTP patient nearing the end of a large-volume transfusion of RBC units close to their outdate develops a cardiac arrhythmia. Which electrolyte disturbance is the most likely cause?
-Hypocalcemia from citrate toxicity
-Hyperkalemia from potassium that has leaked from older stored red cells
-Hypomagnesemia from dilution
-Hypernatremia from excess saline
Hyperkalemia from potassium that has leaked from older stored red cells
A patient was transfused 2 units of RBCs four days ago. Her antigen typing for the K antigen today shows a mixed-field reaction. What is the best interpretation of this result?
-Her true phenotype is K-positive
-Mixed-field reactions always indicate a technical error in cell suspension preparation
-The antisera used has failed quality control and must be discarded
-The result reflects a mixture of her own red cells and the transfused donor red cells, and is not reliable for determining her true phenotype
The result reflects a mixture of her own red cells and the transfused donor red cells, and is not reliable for determining her true phenotype
Which of the following scenarios would most appropriately justify an emergency release of blood?
-A stable patient scheduled for elective surgery in two weeks
- A patient whose antibody screen was already completed and is negative
-A patient in hemorrhagic shock from a ruptured aneurysm with no time to complete routine pretransfusion testing
-A patient requesting blood be held in reserve for a future procedure
A patient in hemorrhagic shock from a ruptured aneurysm with no time to complete routine pretransfusion testing
A physician requests recombinant Factor VIIa for a massively bleeding patient whose bleeding has not responded to component replacement alone. Which statement correctly describes this product?
-It is a blood bank component that replaces fibrinogen
-It is the first-line component for all MTP activations
-It eliminates the need for RBC transfusion
-It is an adjunct hemostatic agent from pharmacy, used when bleeding isn't controlled by component replacement alone
It is an adjunct hemostatic agent from pharmacy, used when bleeding isn't controlled by component replacement alone
A patient with a history of anti-Fya currently has a negative antibody screen. Why must antigen-negative units still be selected for her, rather than relying on the current negative screen result?
-A negative antibody screen is never accurate and must always be disregarded
-Antibody levels can fall below detectable thresholds over time but reappear rapidly upon re-exposure to the antigen
-Fya-negative units are required for all patients regardless of history
-The original antibody identification must have been a laboratory error
Antibody levels can fall below detectable thresholds over time but reappear rapidly upon re-exposure to the antigen
A trauma surgeon activates MTP for a patient with an initial hemoglobin of 6.0 g/dL and ongoing hemorrhage. Based on the goals of massive transfusion, why might more RBC units ultimately be needed than a simple blood-volume calculation would suggest?
-Because stored RBC units have reduced 2,3-DPG, which impairs how readily oxygen is released to the tissues
-Because MTP requires doubling all calculated component volumes as a safety margin
-Because hemoglobin values are not accurate during active hemorrhage
-Because RBC units are routinely underfilled by manufacturers
Because stored RBC units have reduced 2,3-DPG, which impairs how readily oxygen is released to the tissues
A patient with a history of anti-K (91% of random donors are K-negative) and anti-Fya (34% of random donors are Fya-negative) needs 2 units of RBCs for a scheduled procedure. Approximately how many donor units should be screened to find 2 units negative for both antigens?
-Approximately 15 units
-Approximately 2 units
-Approximately 7 units
-Approximately 4 units
Approximately 7 units
What is the proposed underlying mechanism of TRALI?
-Volume/hydrostatic overload exceeding the patient's cardiopulmonary capacity
-Donor anti-HLA/HNA antibodies activating neutrophils in the pulmonary microvasculature (a "two-hit" model)
-IgE-mediated mast cell degranulation in the lungs
-Bradykinin accumulation combined with reduced ACE-mediated degradation
Donor anti-HLA/HNA antibodies activating neutrophils in the pulmonary microvasculature (a "two-hit" model)
Which antibody class is classically responsible for the intravascular hemolysis seen in an ABO-incompatible AHTR?
- IgA
-IgE
-IgG
-IgM
IgM
For future transfusions, a patient with a confirmed history of anaphylactic transfusion reactions and anti-IgA should receive which blood products?
-Irradiated RBCs and platelets only
-Washed RBCs and platelets, with plasma/cryoprecipitate from IgA-deficient donors
-Leukoreduced RBCs and standard-issue plasma
-CMV-negative RBCs and platelets
Washed RBCs and platelets, with plasma/cryoprecipitate from IgA-deficient donors
In the workup of a suspected septic transfusion reaction, what finding is considered key to confirming the diagnosis of transfusion-associated sepsis?
-positive DAT on the postreaction sample
-Isolation of the same organism from both the implicated donor unit and the patient's blood culture
-A decrease in plasma haptoglobin
-An elevated BNP
Isolation of the same organism from both the implicated donor unit and the patient's blood culture
Why does prestorage leukoreduction reduce the incidence of FNHTR with RBC transfusions but remain less effective for platelet transfusions?
-Platelets are never leukoreduced
-Platelet storage requires constant agitation, which activates complement and releases cytokines independent of leukocyte content
-FNHTR with platelets is caused exclusively by bacterial contamination
-Leukoreduction removes plasma proteins, not leukocytes
Platelet storage requires constant agitation, which activates complement and releases cytokines independent of leukocyte content
Which of the following is a recognized nonimmune cause of red cell hemolysis that should be investigated once an immune-mediated cause has been ruled out?
-A newly positive post-transfusion DAT
-A malfunctioning blood warmer that overheated the transfused red cells
-Formation of a new Kidd alloantibody
-A positive antibody screen using an enhancement technique
A malfunctioning blood warmer that overheated the transfused red cells
A patient develops acute dyspnea during transfusion. Chest x-ray shows bilateral patchy infiltrates in a noncardiogenic pattern, and the patient's temperature has risen 1.5 C. Which reaction is most consistent with this presentation?
-TACO
-TRALI
-Hypotensive transfusion reaction
-FNHTR
TRALI
A patient experiencing a severe AHTR develops hypotension, disseminated intravascular coagulation (DIC), and acute renal failure. What is the primary substance responsible for these downstream complications?
-Free plasma hemoglobin released by intravascular hemolysis
-Bilirubin released from extravascular hemolysis
-Histamine released from mast cell degranulation
-B-type natriuretic peptide (BNP)
Free plasma hemoglobin released by intravascular hemolysis
A patient's post-transfusion sample shows visible hemolysis, but the DAT is negative. Which of the following is the best explanation for this combination of findings?
-The reaction cannot be hemolytic if the DAT is negative
-Sensitized donor cells may already have been destroyed and cleared from the circulation, or the hemolysis may be due to a nonimmune cause
-A negative DAT confirms transfusion-associated sepsis
-The patient must have an undiagnosed hemoglobinopathy
Sensitized donor cells may already have been destroyed and cleared from the circulation, or the hemolysis may be due to a nonimmune cause
What are the three tests that make up the INITIAL transfusion service workup performed on virtually every suspected acute transfusion reaction?
-Elution, antibody screen, and crossmatch
-Clerical check, visual check, and DAT
-Gram stain, blood culture, and procalcitonin
-Haptoglobin, LDH, and bilirubin
Clerical check, visual check, and DAT
An acute hemolytic transfusion reaction (AHTR) is most often caused by which of the following?
-ABO incompatibility
-An anamnestic IgG alloantibody response
-Leukocyte-derived cytokine accumulation in stored components
-Donor anti-HLA antibodies
ABO incompatibility
Which finding is characteristic of TRALI but NOT typically seen in TACO?
- Hypertension
-Elevated BNP
-Hypotension
-Improvement with diuretics
Hypotension
Which of the following best defines a febrile nonhemolytic transfusion reaction (FNHTR)?
- A rise in temperature of greater than or equal to 1 C that exceeds 38 C associated with transfusion, not explained by any other cause
-Any fever occurring within 24 hours of transfusion regardless of magnitude
-A temperature rise accompanied by a positive DAT
-A temperature rise of greater than or equal to 0.5 C occurring more than 24 hours post-transfusion
A rise in temperature of greater than or equal to 1 C that exceeds 38 C associated with transfusion, not explained by any other cause
Which AABB donor-eligibility requirement specifically targets reducing the risk of TRALI?
-Deferral of all platelet donors for 7 days after any illness
-Mandatory bacterial detection testing of apheresis platelets
-Sourcing plasma, apheresis platelets, and whole blood from donors who have never been pregnant or have tested negative for HLA antibodies since their most recent pregnancy
-Irradiation of all plasma-containing components
Sourcing plasma, apheresis platelets, and whole blood from donors who have never been pregnant or have tested negative for HLA antibodies since their most recent pregnancy
A patient develops wheezing, severe hypotension, urticaria, and angioedema within minutes of starting an FFP transfusion. After the transfusion is stopped and the physician is notified, what laboratory testing should be pursued for this patient?
-Testing for IgA deficiency and, if deficient, for anti-IgA antibody
-Testing for HLA antibodies in the donor unit
-Bacterial culture of the donor unit only
-Repeat ABO/Rh typing only
Testing for IgA deficiency and, if deficient, for anti-IgA antibody
Which practice helps reduce the risk of bacterial contamination at the time of blood collection?
Collecting the donor sample into an EDTA tube
Diverting the first 10+ mL of collected blood away from the final component
Storing the collected unit at room temperature for the first hour
Performing an immediate-spin crossmatch before component preparation
Diverting the first 10+ mL of collected blood away from the final component
An allergic transfusion reaction is classified as which type of hypersensitivity reaction?
-Type I
-Type II
-Type III
-Type IV
Type I
A nurse reports that a patient is experiencing shortness of breath and chills during a transfusion. What is the FIRST action that should be taken?
-Draw a blood culture from the patient
-Stop the transfusion immediately and keep the IV line open with 0.9% normal saline
-Administer an antihistamine and continue the transfusion at a slower rate
-Notify the FDA Office of Compliance
Stop the transfusion immediately and keep the IV line open with 0.9% normal saline
What is the single most common preventable cause of ABO-incompatible acute hemolytic transfusion reactions?
-Failure to leukoreduce the component
-Clerical/patient identification error
-Inadequate donor skin disinfection
-Use of an expired blood warmer
Clerical/patient identification error
Which blood component is most frequently implicated in transfusion-associated bacterial sepsis, and why?
-Platelets, because they are stored at room temperature, which favors bacterial growth
-RBCs, because they are stored the longest
-Plasma, because it is thawed at room temperature before use
-Cryoprecipitate, because it is pooled from multiple donors
Platelets, because they are stored at room temperature, which favors bacterial growth
Why is retaining a segment from every emergency-released unit an important part of the documentation process?
-It allows the segment to be used for confirmatory ABO/Rh and compatibility testing after the fact if needed
-It is required only for units that expire within 24 hours
-It allows the unit to be reissued to a different patient later
-It eliminates the need for a physician's release statement
It allows the segment to be used for confirmatory ABO/Rh and compatibility testing after the fact if needed
A physician requests recombinant Factor VIIa for a massively bleeding patient whose bleeding has not responded to component replacement alone. Which statement correctly describes this product?
- It is a blood bank component that replaces fibrinogen
-It is an adjunct hemostatic agent from pharmacy, used when bleeding isn't controlled by component replacement alone
-It eliminates the need for RBC transfusion
-It is the first-line component for all MTP activations
It is an adjunct hemostatic agent from pharmacy, used when bleeding isn't controlled by component replacement alone
Which of the following scenarios would most appropriately justify an emergency release of blood?
- A patient whose antibody screen was already completed and is negative
-A stable patient scheduled for elective surgery in two weeks
-A patient in hemorrhagic shock from a ruptured aneurysm with no time to complete routine pretransfusion testing
-A patient requesting blood be held in reserve for a future procedure
A patient in hemorrhagic shock from a ruptured aneurysm with no time to complete routine pretransfusion testing
A 19-year-old pregnant trauma patient needs emergency-released RBCs before her blood type is known. Which unit should be issued, and why?
-O, D-positive, because D-positive inventory is more plentiful
-Group AB, D-negative, because AB is the universal recipient type
-Group O, D-positive, because Rh type does not matter in a true emergency
-Group O, D-negative, to avoid alloimmunization to D that could cause HDFN in this or a future pregnancy
Group O, D-negative, to avoid alloimmunization to D that could cause HDFN in this or a future pregnancy
A patient with a positive DAT is antigen typed using the indirect antiglobulin (Coombs) technique and shows a positive result. Which typing approach would be more reliable for confirming this patient's true phenotype?
-Repeating the same AHG-based technique a second time
-Diluting the patient's plasma before retesting
-Molecular (genotype) typing, which is unaffected by circulating IgG on the patient's cells
-Increasing the incubation time for the AHG phase
Molecular (genotype) typing, which is unaffected by circulating IgG on the patient's cells
A male trauma patient of unknown blood type requires immediate transfusion. The blood bank issues group O, D-positive RBCs rather than D-negative. What is the most likely reason for this choice?
-Group O, D-positive units do not require a physician's release statement
-D-positive units are tested more thoroughly than D-negative units
-He has no risk of forming anti-D causing HDFN in a future pregnancy, so issuing D-positive conserves the limited D-negative inventory
-Group O, D-positive units are safer for all patients regardless of sex
He has no risk of forming anti-D causing HDFN in a future pregnancy, so issuing D-positive conserves the limited D-negative inventory
Which of the following best explains why plasma is transfused in a ratio close to 1:1 with RBCs during many MTP protocols, rather than being reserved until coagulation lab results return?
- Plasma is given first because it does not require ABO compatibility
-Waiting for lab results would delay replacement of coagulation factors that are being consumed and diluted during ongoing hemorrhage
-Plasma has a longer shelf life than RBCs, so it is given first to avoid waste
-Plasma must always be given before RBCs per FDA regulation
Waiting for lab results would delay replacement of coagulation factors that are being consumed and diluted during ongoing hemorrhage
During MTP, a patient receives RBCs, plasma, and platelets in a fixed, balanced ratio rather than RBCs alone. What complication is this ratio-based approach primarily designed to prevent?
-ABO-antibody-mediated hemolysis
-Hyperkalemia from stored red cells
-Hypothermia from rapid component infusion
-Dilutional coagulopathy from replacing red cell mass without replacing coagulation factors and platelets
Dilutional coagulopathy from replacing red cell mass without replacing coagulation factors and platelets
A patient with a history of anti-K (91% of random donors are K-negative) and anti-Fya (34% of random donors are Fya-negative) needs 2 units of RBCs for a scheduled procedure. Approximately how many donor units should be screened to find 2 units negative for both antigens?
-Approximately 2 units
-Approximately 7 units
-Approximately 15 units
-Approximately 4 units
Approximately 7 units
A patient requires platelet transfusion for active bleeding with thrombocytopenia. Which statement about ABO compatibility for platelets is most accurate?
-Platelet ABO compatibility is determined the same way as red cell compatibility, by antigen content
-Platelets have no plasma content and therefore have no ABO considerations
-ABO-compatible platelets are preferred when available, since residual plasma can contain anti-A/anti-B, though ABO-identical matching is typically not required
-Platelets must always be type-specific or they cannot be transfused
ABO-compatible platelets are preferred when available, since residual plasma can contain anti-A/anti-B, though ABO-identical matching is typically not required
A trauma patient receives 5 RBC units within 3 hours and continues to hemorrhage actively. Based on common MTP criteria, is this patient a candidate for massive transfusion protocol activation?
-Yes, because more than 4 RBC units have been transfused within 4 hours in an actively bleeding patient
-Yes, but only if the patient has also received plasma
-No, because MTP only applies to pediatric patients
-No, because MTP requires at least 10 units before activation
Yes, because more than 4 RBC units have been transfused within 4 hours in an actively bleeding patient
A D-negative male patient is switched to D-positive RBC units during an MTP due to limited D-negative inventory. Once his bleeding is controlled, which follow-up step should the transfusion service take?
-Administer a double dose of RhIG regardless of whether he was previously sensitized
-Switch him back to D-negative units and consider RhIG administration to help prevent anti-D formation
-No follow-up is needed since he is male
-Permanently document him as group D-positive going forward
Switch him back to D-negative units and consider RhIG administration to help prevent anti-D formation
A patient receiving massive transfusion develops acidosis. Which downstream electrolyte complication is this most likely to worsen?
-Hypophosphatemia
-Hyponatremia
-Hyperkalemia, as hydrogen ions enter cells and potassium shifts into the plasma
-Hypercalcemia
Hyperkalemia, as hydrogen ions enter cells and potassium shifts into the plasma
A trauma surgeon activates MTP for a patient with an initial hemoglobin of 6.0 g/dL and ongoing hemorrhage. Based on the goals of massive transfusion, why might more RBC units ultimately be needed than a simple blood-volume calculation would suggest?
-Because RBC units are routinely underfilled by manufacturers
-Because hemoglobin values are not accurate during active hemorrhage
-Because MTP requires doubling all calculated component volumes as a safety margin
-Because stored RBC units have reduced 2,3-DPG, which impairs how readily oxygen is released to the tissues
Because stored RBC units have reduced 2,3-DPG, which impairs how readily oxygen is released to the tissues
An MTP patient nearing the end of a large-volume transfusion of RBC units close to their outdate develops a cardiac arrhythmia. Which electrolyte disturbance is the most likely cause?
-Hypomagnesemia from dilution
-Hypernatremia from excess saline
-Hyperkalemia from potassium that has leaked from older stored red cells
-Hypocalcemia from citrate toxicity
Hyperkalemia from potassium that has leaked from older stored red cells
A hospital's emergency-release log shows a unit issued to a patient without a physician's signed release statement on file. What is the most appropriate corrective action?
-Report the incident only if the patient develops a reaction
-Discard the unit and bill the physician for the loss
-Obtain and document the required release statement as soon as possible, since this is a required element of the emergency-release record
-No action is needed, since the patient survived the transfusion
Obtain and document the required release statement as soon as possible, since this is a required element of the emergency-release record
A trauma patient of unknown ABO type urgently needs plasma before his type can be confirmed. Which group of plasma can be safely given to a recipient of any ABO group?
-Group O
-Group B
-Group AB, because it contains neither anti-A nor anti-B antibodies
-Group A
Group AB, because it contains neither anti-A nor anti-B antibodies
A MLS is validating a new lot of anti-K antisera. Which of the following would correctly confirm the antisera is functioning as expected before it is used on patient samples?
-It agglutinates all red cells tested, regardless of K status
-It agglutinates known K-positive control cells and does not react with known K-negative control cells
-It is approved for use once it passes testing on a single patient sample
-It produces a mixed-field reaction with K-positive cells
It agglutinates known K-positive control cells and does not react with known K-negative control cells
A patient has been receiving group O, D-negative emergency-released RBCs. Two hours later, her current sample confirms she is group A, D-positive with a negative antibody screen. What should the transfusion service do next?
-Switch immediately to crossmatch-compatible units without waiting for the antibody screen to finalize
-Switch to group A, D-positive, type-specific units now that her type is confirmed
-Continue issuing group O, D-negative units for the remainder of the admission
-Switch to group AB units since her antibody screen is negative
Switch to group A, D-positive, type-specific units now that her type is confirmed
A massively transfused patient develops hypothermia. What is the most appropriate intervention to help prevent cardiac arrhythmias in this situation?
-Switching to group AB plasma
-Using blood warmers for rapidly infused components
-Increasing the RBC:plasma ratio
-Administering intravenous calcium
Using blood warmers for rapidly infused components
A patient's initial transfusion reaction workup (clerical check, visual check, and DAT) is entirely unremarkable, yet the patient had a brief episode of hypotension that resolved within 10 minutes of stopping the transfusion, with no other symptoms. Which reaction should be considered?
-Posttransfusion purpura
-A hypotensive transfusion reaction (HyTR), particularly in a patient taking an ACE inhibitor
-TA-GVHD
-AHTR
A hypotensive transfusion reaction (HyTR), particularly in a patient taking an ACE inhibitor
A physician orders diuretics for a patient with acute dyspnea during transfusion, before TRALI and TACO have been distinguished. Why could this decision be harmful if the patient actually has TRALI?
-Diuretics would convert TRALI into TACO
-Diuretics have no effect on patients with TRALI
-Diuretics do not improve TRALI and may worsen the hypotension already associated with it
-Diuretics would cure TRALI just as effectively as TACO
Diuretics do not improve TRALI and may worsen the hypotension already associated with it
A patient develops hypotension, oliguria, and laboratory evidence of DIC shortly after starting a transfusion. Applying your understanding of AHTR pathophysiology, which mediator is most directly responsible for triggering this cascade of complications?
-B-type natriuretic peptide
-Donor anti-HLA antibody
-IgE bound to mast cells
-Free hemoglobin released into the plasma from intravascular hemolysis
Free hemoglobin released into the plasma from intravascular hemolysis
Which of the following peripheral blood smear findings would best support intravascular, rather than extravascular, red cell destruction?
-Schistocytes
-Howell-Jolly bodies
-Spherocytes
-Target cells
Schistocytes
Why should blood cultures for a suspected septic transfusion reaction be drawn from a venous site different from (or in addition to) the transfusion catheter?
-This practice has no diagnostic value and is done only by convention
-Peripheral draws are required for ABO confirmation testing
-To distinguish catheter-related infection from true contamination of the transfused unit itself
-Because the transfusion catheter cannot be used to draw any blood sample
To distinguish catheter-related infection from true contamination of the transfused unit itself
A patient who experienced a prior anaphylactic transfusion reaction is found to be IgA-deficient with anti-IgA. Applying this information, which component selection would best reduce the risk of a recurrent reaction?
-Standard-issue, unmodified RBCs and platelets
-CMV-negative, non-washed cellular components
-Irradiated, non-washed cellular components
-Washed RBCs and platelets, with plasma/cryoprecipitate sourced from IgA-deficient donors
Washed RBCs and platelets, with plasma/cryoprecipitate sourced from IgA-deficient donors
Which statement correctly explains why strict bedside patient identification is considered the single most important safeguard against AHTR?
-Clerical and identification errors are the most common preventable cause of ABO-incompatible AHTRs
-Bedside identification eliminates the need for a DAT after transfusion
-Most AHTRs are caused by undetectable antibodies that cannot be prevented through testing
-AHTRs are primarily caused by donor-related clerical errors at the blood center
Clerical and identification errors are the most common preventable cause of ABO-incompatible AHTRs
A newly POSITIVE post-transfusion DAT, compared against a negative pretransfusion DAT, is most consistent with which process?
-An immune-mediated reaction, in which antibody has coated the transfused donor cells
-Transfusion-associated circulatory overload
-A citrate toxicity reaction
-A nonimmune mechanical cause of hemolysis
An immune-mediated reaction, in which antibody has coated the transfused donor cells
A patient develops dyspnea 2 hours into a plasma transfusion. Vital signs show hypotension and a 1.5 C temperature rise; chest x-ray shows bilateral patchy infiltrates. BNP is normal. Which reaction best fits this presentation?
-TRALI
-FNHTR
-Hypotensive transfusion reaction
-TACO
TRALI
Why is FNHTR considered a diagnosis of exclusion rather than an immediate conclusion when a patient becomes febrile during transfusion?
-AHTR, TRALI, and septic reactions can all present with fever, and some of these are life-threatening if missed
-FNHTR can only be diagnosed after the patient is discharged
-FNHTR is extremely rare and therefore unlikely
-A fever during transfusion is never clinically significant
AHTR, TRALI, and septic reactions can all present with fever, and some of these are life-threatening if missed
A patient's temperature rises from 37.0 C to 38.3 C near the end of an RBC transfusion, with no other symptoms and a negative hemolytic workup. Which diagnosis best fits this clinical picture?
-FNHTR
-Transfusion-associated sepsis
-TRALI
-AHTR
FNHTR
Which pathophysiologic model best describes the mechanism of TRALI?
-A bradykinin-accumulation model related to ACE inhibitor use
-A "two-hit" model in which donor anti-HLA/HNA antibodies activate neutrophils in the pulmonary microvasculature of a recipient with an underlying risk factor
-A pure volume/hydrostatic overload model
-An IgE-mediated type I hypersensitivity model
A "two-hit" model in which donor anti-HLA/HNA antibodies activate neutrophils in the pulmonary microvasculature of a recipient with an underlying risk factor
An elderly patient with a history of congestive heart failure receives a large-volume plasma transfusion at a rapid rate and develops dyspnea without fever. Which transfusion reaction should be most strongly suspected given this patient's risk profile?
-Posttransfusion purpura
-TRALI
-TACO
-FNHTR
TACO
A patient becomes febrile, hypotensive, and tachycardic shortly after a platelet transfusion begins, and transfusion-associated sepsis is suspected. What finding, if obtained, would most strongly CONFIRM this diagnosis rather than simply support it?
-A decreased haptoglobin
-An elevated indirect bilirubin
-Isolation of the same organism from both the implicated donor unit and the patient's blood culture
-A positive DAT on the postreaction sample
Isolation of the same organism from both the implicated donor unit and the patient's blood culture
A patient on an ACE inhibitor develops a sudden, isolated drop in blood pressure during transfusion that resolves quickly once the transfusion is stopped. Applying your understanding of hypotensive transfusion reactions, what is the proposed mechanism?
-Volume overload exceeding cardiac capacity
-IgE-mediated mast cell degranulation
-Complement activation by IgM antibody
-Bradykinin accumulation in the component combined with reduced bradykinin degradation due to ACE inhibition
Bradykinin accumulation in the component combined with reduced bradykinin degradation due to ACE inhibition
A patient with sickle cell disease develops signs of hemolysis after a transfusion, but the DAT is negative and no new alloantibody is detected. Applying your understanding of nonimmune hemolysis, what is the most likely explanation?
-Transfusion-associated graft-versus-host disease
-An intrinsic red cell defect unrelated to the transfusion itself contributing to the hemolysis
-A hypotensive transfusion reaction
-An undetected ABO incompatibility
An intrinsic red cell defect unrelated to the transfusion itself contributing to the hemolysis
Why are platelet units more frequently implicated in bacterial contamination than RBC units?
-Platelets undergo irradiation, which increases bacterial growth
-Platelets are stored at room temperature (20-24 C), which favors bacterial growth, particularly gram-positive skin flora
-Platelets are refrigerated, which favors gram-negative organism growth
-Platelet units are stored for a shorter time than RBC units
Platelets are stored at room temperature (20-24 C), which favors bacterial growth, particularly gram-positive skin flora
A unit of RBCs implicated in a suspected septic reaction appears visually normal with no discoloration or clots. Based on your understanding of bacterial contamination, what is the correct interpretation of this visual finding?
-A normal appearance confirms the reaction is due to TRALI instead
-A normal appearance does NOT rule out contamination, so further testing (Gram stain and culture) is still warranted if clinically indicated
-A normal appearance rules out bacterial contamination
-A normal appearance means the reaction must be an allergic reaction
A normal appearance does NOT rule out contamination, so further testing (Gram stain and culture) is still warranted if clinically indicated
A patient receiving an ABO-incompatible RBC unit develops fever, flank pain, and dark urine within the first few minutes of transfusion. Which combination of laboratory findings would you expect if this reaction is due to intravascular hemolysis?
-Normal haptoglobin with isolated thrombocytosis
-Decreased indirect bilirubin and a markedly elevated haptoglobin
-A positive direct antiglobulin test with spherocytes and no hemoglobinuria
-Increased plasma free hemoglobin, decreased haptoglobin, and hemoglobinuria
Increased plasma free hemoglobin, decreased haptoglobin, and hemoglobinuria
Which of the following mechanisms contributes to FNHTR?
- Donor anti-HLA antibody activating recipient neutrophils in the lungs
-Pyrogenic cytokines (such as IL-6, IL-8, and TNF-alpha) that accumulate in stored cellular components
-IgE-mediated mast cell degranulation
-Volume overload exceeding cardiopulmonary capacity
Pyrogenic cytokines (such as IL-6, IL-8, and TNF-alpha) that accumulate in stored cellular components
A patient receiving RBCs through a malfunctioning blood warmer develops signs of hemolysis, but the DAT is negative and no new antibody is identified. Which category of cause best explains this presentation?
-A delayed hemolytic transfusion reaction
-An immune-mediated cause requiring an updated antibody screen
-A nonimmune cause of red cell destruction related to thermal injury from the device
-Transfusion-associated circulatory overload
A nonimmune cause of red cell destruction related to thermal injury from the device
A patient's initial transfusion reaction workup (clerical check, visual check, and DAT) is entirely unremarkable, yet the patient had a brief episode of hypotension that resolved within 10 minutes of stopping the transfusion, with no other symptoms. Which reaction should be considered?
-Posttransfusion purpura
-AHTR
-TA-GVHD
-A hypotensive transfusion reaction (HyTR), particularly in a patient taking an ACE inhibitor
A hypotensive transfusion reaction (HyTR), particularly in a patient taking an ACE inhibitor
A patient's temperature rises from 37.0 C to 38.3 C near the end of an RBC transfusion, with no other symptoms and a negative hemolytic workup. Which diagnosis best fits this clinical picture?
-AHTR
-FNHTR
-TRALI
-Transfusion-associated sepsis
FNHTR
A patient's postreaction labs show elevated indirect bilirubin, elevated LDH, decreased haptoglobin, and hemoglobinuria. These findings, taken together, are most consistent with which process?
-A hypotensive transfusion reaction unrelated to hemolysis
-Circulatory overload
-An allergic reaction
-Active hemolysis
Active hemolysis