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81 Cards in this Set
- Front
- Back
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What is the most common anticoagulant used in the blood bank? |
CPDA-1
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What is the storage temperature for the following components?
Red Blood Cells Platelets Fresh frozen plasma Granulocyte concentrates |
Red Blood Cells 1-6 C
Platelets 20-24 C 5 days Fresh frozen plasma frozen -18 C, thawed 1-6 C Granulocyte concentrates 20-24 C |
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What is the shelf life of the following?
CPDA-1 red blood cells Washed red blood cells Platelets Cryoprecipitate Immune serum globulin-Intravenous solution |
CPDA-1 red blood cells 35 days
Washed red blood cells 24 hours Platelets 5 days at 20-24 C Cryoprecipitate Frozen:1 year; thawed:6 hours; pooled:4 hours Immune serum globulin:1 year for intravenous solution; 3 years for IM injectable |
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What is the pH requirement for platelets?
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pH: > 6.2 or greater at end of storage
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What is the quality control requirement for a granulocyte concentrate?
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Minimum 1.0e10 granulocytes, total WBC count with differential
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What is the quality control requirement for Factor VIII in cryoprecipitate?
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Factor VIII:C (80 IU)
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The plasma volume of single donor platelets can not exceed ________ ml.
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60 ml
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The hematocrit of red blood cells can not exceed_____%.
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80%
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Name the 4 coagulation factors contained in Factor IX concentrate.
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Factors II, VII, IX, X
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Which of the following is the proper procedure for the preparation of platelets from whole blood?
A.Light spin followed by a hard spin B.Hard spin followed by a light spin C.Two hard spins D.Two light spins |
Light spin followed by a hard spin
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Following the second spin in the preparation of platelets from whole blood, the platelets should be:
A.Agitated immediately to resuspend the platelets. B.Allowed to resuspend by sitting undisturbed for 1 hour C.Allowed to resuspend by sitting undisturbed for 8 hours D.Allowed to sit undisturbed for 24 hours. |
Allowed to resuspend by sitting undisturbed for 1 hour
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The hematocrit of RBCs prepared from whole blood should not be higher than:
A. 60% B. 70% C. 80% D. 90% |
80%
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Once a unit of FFP is thawed it must be transfused within _____ hours if it is to be used as a source of labile coagulation factors.
A. 24 B. 36 C. 48 D. 72 |
24
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In preparation for transfusion, FFP and cryoprecipitate must be thawed at:
A. 1-6 C B. 22-24 C C. 30-37 C D. 37-45 C |
30-37 C
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Cryoprecipitate is prepared from:
A.Recovered plasma thawed at 370 C B.Recovered plasma thawed at 40 C C.FFP thawed at 370 C D.FFP thawed at 40 C |
FFP thawed at 40 C
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Eight units of cryoprecipitate are thawed and pooled together for transfusion; the pooled product must be transfused within:
A. 2 hours B. 4 hours C. 6 hours D. 24 hours |
4 hours
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Platelets prepared by either aphaeresis or from whole blood units have a maximum room temperature storage time of:
A. 24 hours B. 48 hours C. 5 days D. 7 days |
5 days
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According to AABB Standards, 75% of platelet concentrates prepared from whole blood must contain:
A.3.0 X 1011 platelets per unit. B.5.5 X 1011 platelets per unit. C.3.0 X 1010 platelets per unit. D.5.5 X 1010 platelets per unit. |
5.5 X 1e10 platelets per unit.
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The optimum storage temperature for platelet concentrates is:
A. 1-6 C B. 20-24 C C. 30-37 C D. -18 C |
20-24 C
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According to AABB Standards, platelets should be suspended in sufficient plasma to maintain a pH of _____ or higher at the end of storage.
A. 4.0 B. 5.0 C. 6.2 D. 7.0 |
6.2
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The cryoprotective agent added to RBCs prior to freezing is:
A. Rejuvesol B. Dextrose C. Glycerol D. 1.9% saline |
glycerol
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“High glycerol” frozen RBCs must be stored at _____ for up to _____.
A.-80 C or lower; 10 years B.-18 C or lower, 12 months C.-65 C or lower, 12 months D.-65 C or lower, 10 years |
-65 C or lower, 10 years
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Which of the following blood components contains the most Factor VIII and fibrinogen relative to volume?
A. Cryoprecipitate B. Recovered plasma C. FFP D. Platelets |
Cryoprecipitate
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Hemophilia A needs what product?
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Factor VIII concentrate
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Hemophilia B needs what product?
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Factor IX concentrate
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Fibrinogen deficiency needs what product?
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Cryoprecipitated AHF
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Bone marrow transplant patient with anemia unresponsive to iron and vitamin B12 therapy needs what?
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Irradiated RBCs
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Increasing oxygen carrying capacity needs what?
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RBCs
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Vitamin K deficiency and hemorrhaging need what?
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Fresh frozen plasma
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What is also called AHF?
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Cryoprecipitated AHF
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Directed donation from a first degree relative requires?
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Irradiated RBCs
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Repeated febrile transfusion reactions need what?
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Leukocyte-poor red cells
Washed or deglycerolized RBCs |
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Thrombocytopenia requires
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Platelet concentrates
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Which type of transfusion reaction is the most common?
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febrile
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Which types of transfusion reactions can result in death?
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Most often:
•Immediate transfusion reaction especially if ABO incompatible •Anaphylactic •Bacterial contamination Some others could lead to it if not treated |
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What are the most common errors that cause hemolytic transfusion reactions?
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Patient misidentification
Sample error Wrong blood issued Transcription error Administration error Technical error Storage error |
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List the most common symptoms of immediate hemolytic transfusion reaction.
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Fever, chills, pain at site, facial flushing, chest pain, back or flank pain are the most common, other symptoms include: hypotension, abdominal pain, nausea, dyspnea, vomiting, hemoglobinuria, hemoglobinemia, shock, anemia, oliguria or anuria, bleeding, hives, diarrhea and DIC
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List the most common symptoms of delayed hemolytic transfusion reaction.
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Mild fever, fever with chills, anemia and jaundice
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List the three immediate laboratory procedures performed when a transfusion reaction is reported.
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Pre and Post transfusion –
•Clerical check •Visual inspection of serum or plasma •DAT |
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What is the time period for delayed transfusion reactions?
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Usually 3-7 days, could go up to 14 days
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Irradiation of blood products is the best way to prevent which type of non-hemolytic transfusion reaction?
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GVH
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Which tests will always be positive if the patient's RBCs are sensitized with IgG or complement in vivo.
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DAT - yes, the DAT tests for in vivo sensitization
Antibody Screen - no, this is a test for serum antibody Auto Control - yes, the patient's sensitized cells are used in the autocontrol Crossmatch - no, the patient's serum is used in this test Weak D and Control- yes, the patient's sensitized cells are used in a AHG test |
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Why is an EDTA anticoagulated specimen the sample of choice when performing a DAT?
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Because it will prevent activation of the complement cascade in vitro ( in the test tube). The DAT is a measure of in vivo (in the body) sensitization. Using clotted samples can result in false positive results with anti-complement (anti-C3d).
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List the next test that should be performed in the following situations:
DAT positive with polyspecific AHG DAT positive with anti-IgG and C3d DAT positive only with C3d, anti-IgG is negative. |
test with anti-IgG and anti-C3d
an eluate to determine the specificity of the antibody coating the RBCs (may not be necessary if the patient shows no signs of hemolysis) None, eluates are not helpful when the RBC are coated only with complement. |
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List three techniques used in elutions to break the binding of RBC antibodies to RBC antigens. List the advantages and disadvantages for each technique.
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Change in Temperature
advantage - easy, cheap, not hazardous, good for ABO antibodies disadvantage - insensitive Organic Solvents advantage - sensitive, reagents are inexpensive disadvantage - time consuming, health hazardous Change in pH advantage - fast, sensitive, not hazardous disadvantage - reagents may be more costly |
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Are auto controls a required part of pretransfusion testing? Why or why not?
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No, because even if the auto control or the DAT is positive many positive DATs are clinically insignificant. In other words, many individuals with positive DATs show no signs of hemolysis. Investigation of these samples is meaningless to the patient's transfusion and treatment plans.
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Determine if you would do an eluate in the following situation. Briefly explain why.
DAT positive due to IgG. No recent transfusions. All chemistry and hematology tests are normal. |
No, Although the DAT is positive due to IgG, the patient show no signs of hemolysis.
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Determine if you would do an eluate in the following situation. Briefly explain why.
DAT positive due to IgG and Complement. Transfused 3 day ago and the DAT was negative then. All chemistry and hematology tests are normal. |
Yes, The recent transfusion and the change of the DAT from negative to positive indicates a transfusion reaction (extravascular hemolysis). Investigation of this sample may change the selection of blood for transfusion.
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Determine if you would do an eluate in the following situation. Briefly explain why.
DAT is positive due to Complement only. Transfused 2 weeks ago and the DAT was negative then. Patient is taking quinine. The patient has free serum hemoglobin and the hematocrit has decreased from 36 to 30 in the last 48 hours. |
Yes, even though the DAT is positive due to complement only, the evidence of hemolysis (dropping hematocrit) and the recent transfusions make an investigation necessary.
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Determine if you would do an eluate in the following situation. Briefly explain why.
DAT is positive due to IgG. Patient was transfused in 1990 and has an anti-E in the serum. All chemistry and hematology tests normal. |
No, No signs of hemolysis and no recent transfusions.
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Determine if you would do an eluate in the following situation. Briefly explain why.
DAT is positive due to IgG No transfusions Patient's total and unconjugated bilirubin is increased. The hematocrit is normal (40%) but the reticulocyte count is increased. |
Yes, the elevated bilirubin and increased reticulocyte count indicate hemolysis, an investigation is necessary.
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A 29 year old female patient with rheumatoid arthritis.
Transfusions = none Pregnancy = 2 Medications = Prednisone DAT = poly 2+ IgG 2+ C3d 0 Antibody Screen = SC 1 and SC 2 are negative at all phases. The autocontrol is 2+ at AHG. Eluate = reacts 1+ with all cells tested. Most likely cause of positive DAT________ Is there anything in the patient's history that supports your answer? Explain. |
A warm autoantibody (the eluate is reacting with all cells)
The diagnosis of Rheumatoid Arthritis points to autoimmune disease. |
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A 50 year old male post-op from open heart surgery.
Transfusions = 2 units 4 days ago, 2 units in 1980. Medications = none DAT= poly 2+mf IgG 1+mf C3d w+mf Antibody Screen = SC 1 and SC 2 are negative. Auto control is 2+mf at the AHG phase Eluate = anti-c is identified in the eluate. Why does this patient's DAT show mixed field agglutination? What type of blood would you transfuse to this patient? Is the transfusion history helpful in resolving this case? |
Because the donors c+ cells are coated with the patient's anti-c (+DAT) while the anti-c will not bind to the patient's c- RBCs (-DAT).
c negative RBCs Yes, it indicates that the patient may be having a transfusion reaction. |
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What is mixed field agglutination?
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Mixed field agglutination occurs when there are two cell populations. One population is giving a positive result (agglutination) and one is negative (no agglutination). It looks like agglutinins in a "sea of free cells".
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A 40 year old male patient with a mycoplasma pneumonia:
Transfusions = 2 in 1988 Medications = penicillin, large dose DAT= poly 1+ IgG 0 C3d 1+ Antibody screen: SC I 37 2+ AHG w+ SC II 37 2+ AHG w+ AUTO 37 2+ AHG 1+ Would you perform an elution? Why or why not? What is the most probable cause of the positive DAT? Why? |
No, because the DAT is positive due to complement. The anti-IgG is negative.
A cold autoantibody. The DAT is positive due to complement, the patient's serum is reacting with screening and auto cells at 37C and the reactions get weaker at AHG. The recent infection with mycoplasma is associated with autoanti-I. |
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A newborn baby who is group A Rh positive.
Transfusions = none Medications = none DAT= poly 1+ IgG 1+ C3d 0 Mother = O Rh positive with a negative antibody screen. What would be the most likely antibody to be recovered in an elution prepared from the baby's RBC? Explain. Fill in the reactions you would expect if you tested the eluate against the following RBCs: Test Cell: Expected results (+ or -) A Cell: B Cell: SC 1: SC 2: |
Anti-A,B because group O mothers often have an IgG component to their anti-A,B.
A Cell + B Cell + SC 1 neg SC 2 neg |
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Name the antibody that causes the most severe cases of HDN.
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D
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What is ABO HDN? What is the usual treatment?
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Hemolysis of fetal RBCs by maternal ABO antibodies.
None or UV lights |
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In which of the following cases might we encounter ABO HDN?
Mother: O; Baby A; ABO HDN:? Mother: A; Baby O; ABO HDN:? Mother: AB; Baby B; ABO HDN:? Mother: A; Baby B; ABO HDN:? |
Yes, maternal anti-A or -A,B may cause HDN
No, baby lacks the antigens No, mother is AB and lacks ABO antibodies Yes, maternal anti-B may cause HDN |
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What do we do when the prenatal antibody screen is positive?
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Antibody Identification - then determine if the antibody is capable of causing HDN
If it is perform an antibody titer If it is NOT no titer is necessary |
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How do we monitor the amount of maternal antibody?
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By performing titers over the course of the pregnancy
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What does it mean if the antibody titer increases during a pregnancy?
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That the child carries the corresponding antigen and may suffer from HDN.
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What do we do when a prenatal patient is Rh negative and they
Do not have an anti-D in their serum? Do have an anti-D in their serum? Do not have anti-D but they have an anti-K in the serum? |
Give antenatal RhIg at 28 weeks to prevent formation of anti-D. Type the child’s RBCs for D at delivery, if Rh + mother gets a 2nd dose of RhIg.
Perform titers over the course of the pregnancy to monitor the level of maternal anti-D. Give RhIg as described in a. Monitor the level of the anti-K by performing titers |
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What is RhIg and what does it do?
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Purified and concentrated anti-D. It prevents Rh negative individuals from becoming sensitized to the D antigen (prevents production of anti-D). It will NOT stop the production of anti-D if the patient have already become sensitized.
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How much Rh+ whole blood will one dose of RhIg cover?
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30 mls of whole blood or 15 mls of packed RBCs
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Should RhIg be given to this mother:
Mother: O Rh positive, Negative antibody screen. Baby: A Rh negative |
No, mother is Rh positive
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Should RhIg be given to this mother:
Mother: O Rh negative, Negative antibody screen. Baby: A Rh positive |
Yes, mother Rh negative, baby Rh positive, no anti-D in the maternal serum.
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Should RhIg be given to this mother:
Mother: A Rh negative, Anti-K titer 512. Baby: A Rh positive |
Yes, mother Rh negative, baby Rh positive, no anti-D in the maternal serum.
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Should RhIg be given to this mother:
Mother: AB Rh negative, Negative antibody screen Baby: A Rh negative |
No, baby is Rh negative
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Should RhIg be given to this mother:
Mother: B Rh negative, Anti-D titer 128. Baby: A Rh positive |
No, mother is already producing anti-D.
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Should RhIg be given to this mother:
Mother: O Rh negative, Negative antibody screen Baby: Unknown, spontaneous abortion. |
Yes, mother is Rh negative with no anti-D in her serum. Assume the child is Rh positive whenever the type is unknown.
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A Kleinhauer-Betke test indicates 10 fetal cells per 1000 adult cells. For a woman with 5000 mL blood volume, the proper dose of RhIg is:
a.One regular dose vial b.Two regular dose vials c.One microdose vial d.Two microdose vials |
Two regular dose vials
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In HDNB the greatest risk to the unborn fetus is ____________ .
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anemia
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In HDNB the greatest risk to the newborn is _______________ .
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elevated bilirubin levels
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What is kernicterus?
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a permanent brain damage caused by elevated bilirubin levels
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What is ABO HDNB? What is the usual treatment?
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HDNB caused by the IgG fractions of the anti-A,B (most common), anti-A, or anti-B None or Phototherapy
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Why is the high bilirubinemia level in HDNB more serious after birth than during the pregnancy?
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During the pregnancy the mother's liver conjugates the bilirubin. After birth the fetal liver is immature and can not handle the excess bilirubin conjugation.
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Select the proper blood for exchange transfusion
Mother O- Baby A+ Mother A+ Baby A- Mother AB+ Baby A+ Mother B- Baby A+ |
O Rh positive (unless the mother has anti-D in her serum)
A Rh negative A Rh positive O Rh positive (unless the mother has anti-D in her serum) |
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List three things that exchange transfusions accomplish.
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-reduces bilirubin levels
-removes antibody coated RBCs -reduces the level of maternal antibody -replacement with uncoated cells -suppression of red cell production |
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List the following requirements for blood used in exchange transfusions for the following case:
Mother: A Rh negative with anti-K in the serum. Baby: A Rh positive, DAT 3+, anti-Kell eluted from RBCs Age of blood ABO type Rh type Special antigen typings? Crossmatch compatible with who? Negative for antibody to CMV? Irradiated? |
less than 5 days old
A Rh positive K negative mother yes usually, however it is only required for low weight babies |
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List the following requirements for blood used in intrauterine transfusions for the following case.
Mother: A Rh negative with anti-K in the serum. Baby: unknown (not born yet) Age of blood ABO type Rh type Special antigen typings? Crossmatch compatible with who? Negative for antibody to CMV? Irradiated? |
less than 5 days old
O Rh negative K negative mother yes yes |
