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30 Cards in this Set
- Front
- Back
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Which of the following red blood cell units would be the most difficult to find in donated blood? |
C. Jk (a-b-).
Of the major antigens associated with hemolysis, Kidd (Jk) is one of the more difficult to deal with. The Jk (a-b-) phenotype is rare. Jka is most commonly associated with hemolysis and luckily ~20% of the donor population is Jka-. QCCP2, T2.19, Frequency of antigens in USA donor population |
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What is the purpose of rapid plasmin reagent testing on donated whole blood?
A. detection of N. gonorrheae infection B. detection of syphilis infection C. marker of Chagas disease D. detection of past CMV infection E. surrogate marker of high-risk behavior |
E. surrogate marker of high-risk behavior.RPR is a confirmatory test for Treponema infections, but is a very poor screening test (low PPV). Instead, RPR positivity is used as a marker for other diseases associated with high-risk behavior (HIV, HCV).
QCCP2, Infections |
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Which of the following viruses is a patient at the highest risk of acquiring through a blood transfusion?
A. hepatitis B virus B. hepatitis C virus C. hepatitis A virus D. human immunodeficiency virus E. West Nile virus |
A. hepatitis B virus.
The viruses are presented in the order of risk of infection. HBV risk is at 1:100000, while HCV risk is 10 times lower and HAV mildly lower than HCV. HIV rates vary wildly but are in the same range as HCV and HAV. West Nile virus-associated infection has been reported in case reports. QCCP2, Infections |
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Which of the following factors involved with the degree of platelet refractoriness is the most important?
A. gender B. spleen status (present or absent) C. age D. height and weight E. active bleeding |
B. spleen status (present or absent).
The absence of a spleen is associated with the greatest platelet increments following transfusion. All of the other factors, with the exception of patient age, are associated with platelet refractoriness. To prevent the occurrence of refractoriness, one must try to prevent alloimmunization. QCCP2, Platelet refractoriness |
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What feature of allergic transfusion reactions makes them unique?
A. the patient does not have to be treated; continue transfusion B. patient serum does not exhibit a positive DAT C. the reaction does not need to be reported D. the transfusion can be restarted after treating the patient E. they cause hemolysis |
D. the transfusion can be restarted after treating the patient.
Allergic transfusion reactions are unique because once it is determined that the patient is experiencing urticaria due to the transfusion, the patient can be treated with anti-histamines and the transfusion restarted. All of the other choices are either untrue or not unique. QCCP2, Allergic transfusion reactions |
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All of the following are associated with transfusion-related acute lung injury, except:
A. patients on induction chemotherapy for lymphoma B. bypass patients C. blood stored for long periods of time D. multiparous female donors E. patients post-op from lung surgery |
E. patients post-op from lung surgery.
In addition, products containing plasma are more commonly associated with TRALI, perhaps due to anti-HLA antibodies from the donor unit. The diagnosis of TRALI is one of exclusion, after volume overload, sepsis, anaphylaxis, hemolysis, etc. have been ruled out. QCCP2, TRALI |
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Why are most cases of transfusion-associated graft v. host disease seen in transfusions between related individuals?
A. common disease exposures B. HLA similarity, not identity C. shared non-genetic environmental exposures D. less compatibility E. less stringent donor requirements |
B. HLA similarity, not identity.TAGVHD occurs most often when the recipient has an antigen that the donor does not, while all the donor's antigens are present in the recipient. This means that the
recipient's white blood cells don't see the donor as foreign, however the donor's white blood cells react to the foreign antigen on the recipient's cells. QCCP2, TAGVHD |
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All of the following are illness-causing bacteria most commonly associated with red blood cell transfusions, except:
A. Yersinia enterocolitica B. Serratia liquifaciens C. Citrobacter spp. D. Staphylococcus aureus E. Pseudomonas spp. |
D. S .
While platelet products are associated with contamination from gram-positive cocci, red blood cells are associated with gram-negative organisms, especially those listed in the choices (except Staph). Remember that red blood cells are refrigerated so organisms that grow in the cold will be favored. QCCP2, Bacterial contamination |
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What is the most common antibody associated with acute hemolytic transfusion reactions?
A. anti-D B. anti-Kidd C. anti-A/anti-B D. anti-Kell E. anti-Duffy |
C. anti-A/anti-B.
Intravascular acute hemolysis is most commonly due to anti-A or anti-B in cases of ABO incompatibility. The only other antibody of significance associated with acute intravascular hemolysis is anti-Kidd. All the other antibodies presented as choices are more commonly associated with extravascular hemolysis, either acute or delayed. QCCP2, Acute hemolytic transfusion reactions |
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Which of the following is the most common type of transfusion reaction?
A. febrile nonhemolytic transfusion reaction B. acute hemolytic transfusion reaction C. delayed hemolytic transfusion reaction D. transfusion-associated graft v. host disease E. transfusion-related acute lung injury |
A. febrile nonhemolytic transfusion reaction.
Luckily, the least severe reaction is the most common, reportedly seen in 0.5% of all transfusions. The most common cause of FNHTRs is cytokines elaborated from white blood cells while the unit is stored. A decreased incidence can be achieved with filtration of red blood cells at the time of collection as well as pretransfusion administration of acetaminophen to patients. QCCP2, FNHTRs |
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Which of the following is the most common cause of hemolytic transfusion reactions?
A. ABO incompatibility B. Rh incompatibility C. paperwork errors D. anti-Kidd alloantibodies E. mechanical hemolysis due to faulty packaging |
C. paperwork errors.
Unfortunately, clerical errors still account for a significant number of hemolytic transfusion reactions - patient ID, sample mislabeling, etc. QCCP2, Transfusion complications |
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Which is the first step in the workup of a suspected transfusion reaction?
A. call the blood bank B. stop the transfusion C. infuse a bolus of normal saline D. paperwork and bag check E. check urine for hemoglobin |
B. Stop the transfusion.The first step in all transfusion reactions should be always be the same. STOP THE REACTION. Always, every time, always, always. The most important factor in
determining the severity of reactions is the amount of product that is delivered to the patient. QCCP2, Transfusion complications |
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All of the following products would be useful in the treatment of symptomatic anemia in a patient that you wish to remain CMV negative, except:
A. red blood cells, CMV(-) by serology B. frozen, thawed, and deglycerolized red blood cells C. washed red blood cells D. red blood cells leukoreduced to <5 × 108 white blood cells E. all of the above are acceptable |
D. red blood cells leukoreduced to <5 × 10 8 white blood cells.
Red cell unit can contain up to 5 × 109 white blood cells/unit and should be reduced one order of magnitude in order to prevent febrile nonhemolytic transfusion reactions and three orders of magnitude to prevent CMV transmission or alloimmunization. Washed red blood cells are considered leukoreduced. Most experts believe that leukoreduced and CMV negative by serology units are equivalent in prevention of CMV transmission. QCCP2, Leukoreduced products |
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Which of the following indications is an appropriate usage of irradiated products?
A. cellular products to immunocompromised hosts B. granulocyte concentrates for neutropenic sepsis C. prevention of alloimmunization in platelets D. red blood cells to prevent CMV transmission E. red blood cells to prevent recurrent febrile nonhemolytic transfusion reactions |
A. cellular products to immunocompromised hosts.
The only clear indication for irradiation is to prevent transfusion-associated graft v. host disease. By irradiating white blood cells, they are rendered incapable of engrafting in an immunocompromised host. Irradiated products do not prevent CMV transmission, alloimmunization, or recurrent febrile non-hemolytic transfusion reactions, like leukoreduction does. Furthermore, irradiating granulocytes would destroy your product. Don't do that. QCCP2, Irradiated products |
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What is the minimum dose of irradiation that must be delivered to any portion of a product for it to be considered adequately irradiated?
A. 5 Gy B. 25 Gy C. 100 Gy D. 50 Gy E. 15 Gy |
E. 15 Gy.
At least 15 Gy must be delivered to any point of the product while at least 25 Gy must be delivered to the middle of the product. After irradiation, it must be noted that the expiration date cannot exceed 28 days. QCCP2, Irradiated products |
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Cryoprecipitated plasma contains appreciable amounts of all of the following factors, except:
A. Factor VIII B. von Willebrand factor C. Factor XIII D. Factor V E. fibrinogen |
D. Factor V.
More numbers to remember. Each unit of cryo must contain at least 150 mg of fibrinogen and 80IU of Factor VIII. This is the same amount as in FFP (cryo is made from FFP), but instead of a volume of 200 mL, cryo has the factors in 15 mL. Cryo can be used to treat hemophilia, though for a number of reasons, recombinant Factor VIII is the preferred treatment. QCCP2, Cryoprecipitated anti-hemophilic factor |
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All of the following are preferred uses of fresh frozen plasma, except:
A. multiple factor deficiencies in disseminated intravascular coagulation B. reversal of warfarin therapy C. massive transfusion D. replacement solution in plasmapheresis for thrombotic thrombocytopenic purpura E. hemophilia A |
E. hemophilia A.
FFP is best used in the situation of coagulopathy that results from the loss of multiple coagulation factors. Loss of single factors, such as Factor VIII in hemophilia A, is better treated with recombinant Factor VIII, or if needed, cryoprecipitate/FFP is also useful in TTP to return ADAMTS-13, in hereditary angioedema, to replace C1q, and in antithrombin deficiency. QCCP2, FFP |
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After thawing, what is the time frame within which fresh frozen plasma must be used?
A. 8 hours B. 24 hours C. 2 days D. 7 days E. 30 days |
B. 24 hours.
There are a lot of numbers to remember with FFP preparation, storage, and use. The plasma separated from platelets by a hard spin must be frozen within 8 hours of collection to be considered “fresh frozen plasma.” The frozen product can be stored for up to 1 year as such, but then must be used within 24 hours of thawing. The product can be refrigerated and stored for 5 days, but it must be relabeled as thawed plasma with the expectation that it contains lower levels of coagulation factors, especially Factor V and VIII. QCCP2, FFP |
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What is the appropriate storage temperature for granulocyte concentrates?
A. 37°C B. 20-24°C C. 1-6°C D. -20°C E. -80°C |
B. 20-24°C.
Granulocyte concentrates must be collected and used within 24 hours. For that reason, the product is not routinely collected until it is needed. The optimal temperature at which to keep the product is 20-24°C (room temperature). QCCP2, Granulocyte concentrates |
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What is the minimum amount of platelets required in an apheresis platelet unit?
A. 3 × 1011 B. 3 × 1010 C. 1 × 1011 D. 1 × 1010 E. 1 × 108 |
A. 3 ×10 11.
An apheresis platelet unit is approximately equal to 6 single whole blood-collected units (the “6 pack”). Each individual platelet unit must contain at least 5.5 × 1010 platelets in at least 75% of the units tested. It makes sense that a “6 pack” would contain 6x more platelets than a single unit. QCCP2, Platelets |
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Which of the following fluids may be transfused simultaneously through an infusion line with red blood cells?
A. antibiotics B. 0.45% (1/2 normal) salineC. 0.9% (isotonic) saline D. lactated Ringer's solution E. heparin |
C. 0.9% (isotonic) saline.
Only isotonic saline (without medications) may be infused through the same line as red blood cells. Many products, such as lactated Ringer solution, affect the red blood cells (hemolysis, anticoagulation, etc.). QCCP2, Red blood cell products |
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What is the approximate amount of iron in a single red blood cell unit?
A. 200 mg B. 100 mg C. 200 mg D. 100 mg E. 10 mg |
A. 200 mg.
Each red blood cell unit contains approximately 200 mL red blood cells, with each mL of red blood cells containing 1mg of iron. This means that each RBC unit has 200mg of iron. QCCP2, Red blood cell products |
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What is the shelf life of washed red blood cells?
A. 4 hours B. 24 hours C. 48 hours D. 1 week E. 28 days |
B. 24 hours.
The process of washing cells involves opening the closed system of the unit, washing, and resuspending in normal saline. As a result of opening the system, the shelf life is reduced to 24 hours. QCCP2, Red blood cell products |
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In order to qualify as “leukocyte-reduced” for the purpose of avoiding CMV transmission, what must the final white blood cell count not exceed?
A. <5 × 106 B. <5 × 107 C. <5 × 108 D. <5 × 109 E. <5 × 1010 |
A. <5 × 10 6.
At least a 3 log reduction of the white cell count (from 5 × 109) must be achieved in order for a unit to qualify to prevent HLA alloimmunization or CMV transmission. Only a single log reduction is required to prevent febrile non-hemolytic transfusion reactions. QCCP2, Red blood cell products |
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The final hematocrit of packed red cells must be no more than:
A. 50% B. 75% C. 80% D. 90% E. 95% |
C. 80%.
The final hematocrit of the red blood cells after centrifugation of whole blood must be no greater than 80%. Above that, the viscosity is too great. The prepared RBCs must be stored at 4°C within 8 hours of being collected. Additive solutions can increase the storage life (see question 66). QCCP2, Red cell components |
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Which of the following clotting factors is/are most labile in stored blood?
A. Factor V B. Factor VIIIC. Factor VII D. A & B E. A, B, C |
D. A & B.
While both Factor V and Factor VII are labile in vitro, Factor VII is most labile in vivo. QCCP2, Red cell components |
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Which of the following additive solutions extends the shelf life of blood the most?
A. citrate B. heparin C. CPD D. AS-1 E. CPDA-1 |
D. AS-1.
Citrate by itself is not used as a preservative, but rather as an anticoagulant. Heparin, too. Heparin, however, has been used in the past to extend the shelf life of blood by a few days. CPD (citrate phosphate dextrose) and CPDA-1 (CPD + adenine) extend to 21 and 35 days, respectively. AS-1 is similar to CPDA-1, but instead of citrate, there is mannitol and sodium chloride, and it extends the most to 42 days. QCCP2, T2.15, Additive solutions |
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Which of the following blood products has the shortest allowable storage time?
A. whole blood B. fresh frozen plasma C. apheresis platelets D. cryoprecipitate E. granulocyte concentrate |
E. granulocyte concentrate.
Frozen products, such as cryoprecipitate and fresh frozen plasma have the longest storage life - around one year. They are followed by refrigerated products, like whole blood or packed red cells, whose lifetime varies with the preservative used, but is in the neighborhood of 1-2 months. Finally, the room temperature-stored products, platelets, and granulocytes have the shortest life-span - 5 days in the case of platelets and 1 day for granulocyte concentrate. QCCP2, T2.14 |
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What percentage of viable RBCs present in the circulation 24 hours after transfusion is considered in the determination of allowable storage time?
A. 100% B. 90% C. 75% D. 50% E. 25% |
C. 75%.
This figure is used for the calculation of allowable storage time for different storage media and additives. QCCP2, RBC components |
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All of the following are associated with massive transfusion, except:
A. anti-D development B. decreased oxygen-carrying capacity C. dilutional coagulopathy D. raised body temperature E. raised serum potassium |
D. raised body temperature.
The exposure of an individual to massive amounts of blood, whether cross-matched or not, is associated with a number of potential adverse outcomes. If an Rh-negative patient receives Rh (D) + blood without prophylaxis, there is a significant risk of developing anti-D. The use of large amounts of blood is known to cause dilution of many serum proteins and substances, such as coagulation factors, ATP, and 2,3 DPG. Also, there is the risk of transfusing older blood, which can result in increased potassium. Overall, the risk of decreased body temperature is more likely than increased body temperature, which suggests a transfusion reaction in the absence of any other potential source of fever. QCCP2, Emergency and massive transfusion |
