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36 Cards in this Set

  • Front
  • Back
ANZCA July 2007 Q24

The estimated risk of infection following percutaneous exposure (needlestick injury) to human immunodeficiency virus (HIV) is approximately

A. 1 in 30

B. 1 in 300

C. 1 in 3,000

D. 1 in 30,000

E. 1 in 300,000

Hep C : 30% risk

Hep B : 3% risk

HIV : 0.3% risk
March 2006 Q101

Regarding perioperative use of processed salvaged red blood cells,

A. malignant cells are removed by the washing process

B. storage of salvaged cells should be limited to six hours

C. the high free haemoglobin levels are associated with renal failure

D. the salvaged cells have lower oxygen carrying capacity than banked blood

E. the survival of the salvaged red blood cells is significantly impaired
Answer : C

A – False. Some malignant cells are removed, but not all. Need irradiation and washing to guarantee removal, and even then controversial area

B – FALSE : if collected under aseptic conditions with a saline-wash device, blood may be stored at room temp for up to 4 hours or at 1-6deg for up to 24 hours (provided that storage at 1-6deg is begun within 4 hours of ending the collection).

Storage times are the same for recovered blood whether unwashed or washed.

C – True. Free Hb in cell salvage can cause renal failure, but most removed during separation and washing.

D – False. Banked blood has lower O2 carrying capacity due to depletion of 2,3-DPG over time.

E – False. No difference in survival times.
AB51[Jul06] [Apr07]

Patient (age 60s) having a total knee replacement; on antihypertensives incl. an ACE Inhibitor. You have started a blood transfusion via a leukocyte-depleting filter in PACU after rapid loss into drains. What complication occurs with THIS filter in THIS situation? 

A. Air embolism

B. Haemolysis 

C. Increased risk of postoperative infection

D. Consumption of coagulation factors

E. Severe hypotension
Relatively few adverse effects.

1. Profound hypotension :
Negatively charged surfaces of leukoctye reduction filters may vause contact activation with release of bradykinin-like vasoactive substances.

Profound hypotension has been reported in patients
taking angiotension-converting-enzyme (ACE) inhibitors and receiving pretransfusion leukocytereduced blood products—platelets in particular. Presumably, ACE inhibitors decrease bradykinin degradation thereby prolonging its intravascular half-life.

2. 'Red Eye' Syndrome
Allergic conjunctivitis linked to
recipients of prestorage leukocyte-reduced RBCs. This condition is characterized by erythema (100%),
periorbital edema (16%), eye pain (15%), and itching. In most patients, symptoms resolve within 48 hours, but erythema may require up to three weeks for complete resolution.

AB52 [Jul06] Q121

TRALI more likely if blood donor has been

A. diabetic?

B. multiparous woman

C. male over 50 years old

D. stayed in UK for few yrs 


TRALI is defined as acute onset of hypoxia and bilateral pulmonary infiltrates that is temporally related to a blood transfusion, it must occur within 6 hours following transfusion.

Typically associated with platelets and FFP.

Etiology is not currently understood, but it is thought to be immune mediated.

TRALI is more likily when blood donor is
1. Multiparous women : exposure to fetal blood
2. Previous transfusions
3. Previous transplantation

Reciept RF include
1. Duration of cardiopulmonary bypass (cardiac surgery)
2. older age
3. repeated FFP/Platelets
AB35a ANZCA version [2003-Apr] Q109 & [2004-Aug] Q73

In a Jehovah's Witness patient undergoing a revision of a total hip replacement, the most effective technique to minimise post-operative anaemia would be

A. epidural anaesthesia

B. induced hypotension

C. intra-operative cell saving

D. intra-operative intentional normovolaemic haemodilution

E. pre-operative administration of recombinant erythropoietin
Hard to say which one is the most effective.

* A. epidural anaesthesia - effective

* B. induced hypotension - effective

* C. intra-operative cell saving - effective if the patient allows its use

* D. intra-operative intentional normovolaemic haemodilution - false and the odd one out as the others are all mentioned in the CEACCP article: "Acute normovolaemic haemodilution is often unacceptable to Jehovah’s Witnesses, as it involves the removal and storage of blood before haemodilution." (Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 2 2004)

* E. pre-operative administration of recombinant erythropoietin - effective
AB35c ANZCA Version [Jul06] Q118

When providing anaesthesia for a patient who is a Jehovah's Witness, it is NOT acceptable to use

A. erythropoietin

B. albumin and clotting factors

C. cardio-pulmonary bypass

D. isovolaemic haemodilution

E. blood products for children, if parents insist that they be witheld

# A. erythropoietin - false

# B. albumin and clotting factors - true: These are blood products and often will be refused by JW patients. Always should be done on a case by case basis though as some JWs are more liberal than others.

# C. cardio-pulmonary bypass - false

# D. isovolaemic haemodilution - false

# E. blood products for children, if parents insist that they be witheld - false
From CEACCP 04 - Children under 16 yrs of age of Jehovah's Witness parents present a difficult legal management problem. For elective procedures, there should be full and frank discussion between the surgeon, anaesthetist, parents and child (if they are old enough to understand). Most parents will accept that while every attempt will be made to avoid blood, a doctor will not allow a child to die for lack of transfusion. Children under 16 can legally give consent themselves if they can understand the issues involved (Gillick Competence). However, the courts have proved willing to overrule the refusal of specific procedures by children.
ANZCA 2007 Q79.

The most common coagulopathy in trauma patients is

A. clotting factor inhibition and depletion

B. disseminated intravascular coagulation

C. citrate toxicity

D. hypofibrinogenaemia

E. thrombocytopaenia

Trauma Associated Coagulopathy

The causes of coagulopathy are multifactorial and interrelated, including consumption and dilution of coagulation factors and platelets, dysfunction of platelets and the coagulation system, increased fibrinolysis, compromise of the coagulation system by the infusion of colloid, hypocalcaemia, and disseminated intravascular coagulation like syndrome.

* Massive crystalloid infusion induces early coagulopathy

* Using more than 6 units packed cells → PT and APTT > 1.5 times normal

* > 10-30 units packed cells → platelets < 50 × 109

* Massive transfusion protocols aim to prevent rather than 'catch up' with coagulopathy

* Factors in trauma that lead to coagulopathy
o Clotting element loss, consumption and dilution
+ Small normal body stores ∴ easily lost
# 10g fibrinogen
# 15mls platelets
o Hypothermia
+ ↓ platelet activation and adhesion
+ Slows metabolic rates of coagulation enzymes
o Acidosis
+ Affects enzyme complex activity on lipid surfaces
+ DIC in trauma doubles the mortality rate
+ Embolisation of brain substance, marrow fat, amniotic fluid and other strong thromboplastins → DIC

* Thrombocytopenia may be the first cause of bleeding to treat in trauma, whereas correction of coagulation factor deficiency due to dilution may be undertaken first in elective surgery
ANZCA March 2007 Q84.

The administration of blood contaminated with Yersinia Enterocolitica will typically produce symptoms of infection

A. during the transfusion

B. within 6 hours

C. within 12 hours

D. within 24 hours

E. within a week

'Yersinia enterocolitica' is the most common organism found in RBCs, whereas Staphylococcus aureus, Klebsiella pneumoniae, Serratia marcescens, and Staphylococcus epidermidis are most common in platelets. Bacterial infection is probably underdiagnosed, and the possibility of bacterial infection (and antibiotic coverage) should be considered in any patient in whom fever develops within 6 hours of transfusion.

The onset of clinical symptoms typically occurs acutely during transfusion, with a mortality rate of 60% and a median time to death of only 25 hrs
ANZCA March 2007 Q86.

Cryoprecipitate contains each of the following clotting factors EXCEPT

A. factor VIII

B. factor IX

C. factor XIII

D. fibrinogen

E. von Willebrand factor

Cryoprecipitate is a human blood component obtained from fresh frozen plasma (FFP) prepared from
a unit of whole blood (WB). When FFP is thawed in the cold, a cryoprecipitate forms which is
rich in fibrinogen, factor VIII, von Willebrand factor, factor XIII, and fibronectin.

One unit of cryoprecipitate derived from a unit of whole blood contains:

* a volume of 10-20 mL,
* 80-100 units of factor VIII (which consists of both the procoagulant activity and the
von Willebrand factor),
* 150-250 mg of fibrinogen,
* 50-100 units of factor XIII, and
* 50-60 mg of fibronectin.

It can be stored at -18° C for a maximum of one year. When ordered, cryoprecipitate is thawed
in a 37° C waterbath and issued in individual bags or as a pooled product. Once thawed it must
be kept at room temperature and has an expiration time of 6 hours for unpooled cryoprecipitate,
and 4 hours for the pooled product.
BL18 [Jul99] [Mar02] [Mar03] [Jul03]

Which of the following statements about Fresh frozen plasma (FFP) is NOT true?

A. Must be group specific

B. Does not need to be cross matched

C. Contains all clotting factors except for platelets

D. Contains clotting factors except deficient in factors V and VIII

E. Is not useful in treating ?protein C deficiency/ coagulopathy

F. Does not contain albumin

G. Does not contain anticoagulant

H. Contains an anti-thrombotic protein

Fresh Frozen Plasma (FFP) is separated and frozen within eighteen hours after collection of whole blood.

A unit of FFP contains all coagulation factors, albumin, antocoagulant proteins C, S and thrombomodulin.

It is deficient in the liable plasma coagulation factors.

FFP has decreased levels of factor V (about 65%) and VIII (about 40%) as these deplete the most rapidly.
ANZCA March 2007 Q120.

Transfusion related acute lung injury (TRALI) occurs

A. almost immediately

B. within 4 hours

C. within 8 hours

D. within 24 hours

E. within 48 hours

TRALI is defined as acute onset of hypoxia and bilateral pulmonary infiltrates that is temporally related to a blood transfusion, it must occur within 6 hours following transfusion.
ANZCA March 2007 Q133

During a laparotomy for resection of a liver tumour, a 25 kg 8-year-old has received a rapid transfusion of one unit of packed cells. Her central venous pressure (CVP) is now 5mmHg. The most likely cause of haemodynamic instability related to this transfusion is

A. ABO incompatibility

B. coagulapathy

C. hyperkalaemia

D. hypocalcaemia

E. hypothermia

A. ABO incompatibility : FALSE

B. coagulapathy : FALSE

C. hyperkalaemia : TRUE, red cell lesion

D. hypocalcaemia : packed cell contain no citrate.
*PRBC contains dextrose, sodium chloride, mannitol and adenine
*Platelets contains Sodium chloride, Sodium acetate trihydrate, Sodium citrate dihydrate, sSodium dihydrogenophospate, Disodium hydrogenophosphate, Potassium chloride, Magnesium chloride

E. hypothermia: FALSE
ANZCA March 2007 Q140.

In a patient requiring fresh frozen plasma (FFP), where the patient's blood group is unknown, it is ideal to give FFP of group

A. A

B. B


D. O

E. blood group of FFP in this situation doesn't matter
ANZCA July 2007 Q24.

The estimated risk of infection following percutaneous exposure (needlestick injury) to human immunodeficiency virus (HIV) is approximately

A. 1 in 30

B. 1 in 300

C. 1 in 3,000

D. 1 in 30,000

E. 1 in 300,000

HIV 0.3%
HCV 3%
HBV 30%

Factors increasing risk of viral transmission:

* higher viral titres (for example higher HIV if terminal AIDS, higher HCV if coinfection with HIV)
* hollow bore rather than solid needle
* deeper puncture
* visible blood on needle
ANZCA July 2007 Q67

Post-transfusion hepatitis in Australia is associated with

A. jaundice in over 50% of patients

B. development of chronic disease in less than 10% of patients

C. hepatitis B in the majority of patients

D. the presence of antigen or antibody to hepatitis C

E. elevation of serum alkaline phosphatase

A. False : Less than one third

B. FALSE : 23% have chronic hepatitis, 51% have chronic active hepatits

HIV 1 in 5.4 million
Hepatitis C 1 in 2.7 million
Hepatitis B 1 in 739,000
HTLV Approx 1 in 17.5 million
Malaria 1 in 4.9 to 1 in 10.2 million
Variant CJD Possible and cannot be excluded


E. inc ALT and AST 400-4000
ANZCA July 2007 Q74.

The most frequently reported cause of mortality associated with transfusion of blood and blood products is

A. anaphylaxis

B. bacterial sepsis

C. haemolytic reaction

D. transfusion associated graft versus host disease

E. Transfusion Related Acute Lung Injury (TRALI)

The ARC handbook has mortality figures listed:

Bacterial sepsis 1: 4mill- 8mill

Hemolytic reactions acute 1:600000- 1.5mill

TRALI 1:5 mill

GVHD rare but 90% fatal

(CEACCP states "TRALI is the most common cause of major morbidity and death after transfusion. It presents as an acute respiratory distress syndrome (ARDS) either during or within 6 h of transfusion.3")
ANZCA 2007 Q75.

Which of the following statements is INCORRECT? Recombinant Factor VIla

A. directly activates Factors IX and X on the surface of activated platelets, leading to thrombin formation

B. has a half-life of three and a half hours

C. has been used "off-label" for bleeding in trauma patients

D. is best monitored by the prothrombin time, which is shortened in a dose-dependent manner at therapeutic doses

E. was developed for patients with haemophilia A and B who have inhibitors to Factors VIII and IX respectively

A-. TRUE : Factor VIIa is also involved in the "thrombin burst". This is a direct activation of factor VIII and IX on the platelet surface, in the absence of TF. This is thought to be the major mechanism of action in thrombus formation.

B. TRUE : The half life of Novoseven is 2-6 hrs depending on your source. 2.8-3.1 in Novoseven PI

C. TRUE : Recombinant factor VII (RF7, or Novoseven (TM)) has been used for major trauma cases. It was first documented for this use in 1999, when used on a soldier with coagulopathy. Its use in trauma is on a 'compassionate' basis, and so it is used off license.

D. FALSE : Whilst it is true that lab coagulation profiles can be used to monitor efficacy of treatment, these parameters have not shown a direct correlation to level of haemostasis that is achieved. TEG as well as clinical cessation of bleeding seems to be the most effective method at present but they both obviously also have limitations. See Novoseven web site for more information.

Licensed uses of Novoseven include:

* Congenital Haemophilia A or B
* Haemophilia with inhibitors
* Factor VII deficiency
* Glanzmanns thrombocytopaenia

Unlicensed uses of Novoseven

* Major trauma
* Bleeding post cardiac bypass
* Obstetric - major haemorrhage.
ANZCAJuly 2007 Q98.

During transfusion of platelets a patient develops fever, rigors and vomiting and becomes hypotensive and tachycardic. The most likely diagnosis is

A. ABO incompatibility

B. Anaphylaxis

C. bacterial contamination of the platelets

D. leukocyte mediated transfusion reaction

E. viral contamination of the platelets
AB50 ANZCA version [2005-Sep] Q120

Transfusion related acute lung injury (TRALI)

A. can be caused by all homologous blood components, but particularly FFP (fresh frozen plasma)

B. is associated with significantly elevated pulmonary artery pressure

C. is the commonest cause of morbidity associated with blood transfusion

D. should be treated with high dose steroids

E. typically presents 24 hours following transfusion

* A- True(answer) –SHOT report describes 13 reactions as follows: 6 to FFP, 4 to platelets, 2 to packed cells and 1 to whole blood. The preponderance of reactions with FFP and platelets is thought to result from their ‘high plasma component’
* B- ? False patients at autopsy have significant pulmonary capillary dilation ie a disease of pulmonary plasma leakage see Kam article --Kevin07 03:31, 10 Dec 2008 (EST)
* C- commonest cause of major morbidity
* D- False
* E- False 6 hours
149. Which of the following statements regarding anaphylactic and anaphylactoid reactions is FALSE

A. cross-sensitivity between latex and bananas, chest nuts and avocardo has been reported

B. cross-sensitivity of cephalosporins with penicillin is about 8%

C. gelatin solutions used for resuscitation can worsen any reaction

D. reactions to neuromuscular blocking agents are more common in females

E. vecuronium is more likely to cause an anaphylactoid rather than an anaphylactic reaction

Steroidal cause anaphylaxis, benzylisoquinoliums cause anaphylactoid.
AB60 ANZCA April 2008

Sepsis from Yersinia infection from blood transfusion, mortality?
A. <5%

B. 20%

C. 40%

D. 60%

E. 80%

Yersinia Contamination
-rapid onset, usually immediate but must be considered for any hypotension post 24hours after infusion
-high mortality (50%)
-Platelets >> PRBC = FFP=Cryo
-Caused by bacterimic donor at time of donation

-early recognition
-broad antibiotics

-visual inspection : cloudy/clots
-tranfusion rate <4 hours
AB58 ANZCA version [Jul07] Q141

A young woman with type 1 von Willebrand disease presents for a dilatation and curettage. She is a
Jehovah's Witness. You consider administering intravenous desmopressin in an attempt to reduce haemorrhage. Which of the following statements regarding desmopressin is FALSE?

A. it is a synthetic substance and is acceptable to Jehovah's Witnesses

B. it is likely to reduce haemorrhage in this patient

C. it should be given 30 minutes prior to surgery as an infusion

D. its duration of effect is approximately 5 days

E. the intravenous dose is 0.3 mcg.kg-1

* A - Clearly true, acceptable to JWs

* B - Useful for type 1 vWD, so it is likely to reduce bleeding

* C - Infuse in 50mL N saline over 30 min, 30 min prior to surgery sounds about right

* D - False - elimination half-time 2.5-4.4 hours

* E - Correct dose
AB59b ANZCA version [Jul07]

During transfusion of platelets a patient develops fever, rigors and vomiting and becomes hypotensive and tachycardic. The most likely diagnosis is

A. ABO incompatibility

B. anaphylaxis

C. bacterial contamination of the platelets

D. leukocyte mediated transfusion reaction

E. viral contamination of the platelets
AB54 Actual ANZCA version [2005-Apr] MCQ-103

In trauma patients, the main mechanism by which hypothermia exacerbates bleeding is by

A. altering blood viscosity

B. causing disseminated intravascular coagulation

C. inhibiting clotting factors

D. potentiating anticoagulants used for DVT (deep venous thrombosis) prophylaxis

E. reducing platelet function and number

Hypothermia impairs coagulation by two main mechanisms:
* impaired platelet function, and
* impaired clotting factor enzyme activity.

Note: Fibrinolytic activity is not affected by mild hypothermia, BUT is increased with HYPERthermia.
Fibrinolysis doe NOT contribute to increased bleeding with hypothermia.)

Hypothermia inhibits function but does not reduce the number.
AB49 ANZCA version [2005-Sep] Q97

Features of perfluorocarbon emulsions when used as blood substitutes include

A. a dose dependent half-life

B. a sigmoidal oxygen dissociation curve

C. liver dysfunction, which is a common side-effect

D. metabolism by the liver

E. prolongation of the the bleeding time

* A. a dose dependent half-life - true
o "After intravenous (i.v.) administration, perflubron (perfluoro-octyl bromide) is absorbed by the reticulo-endothelial (RES) system. This absorption determines its intravascular half-time, which is dose-dependent and is in the order of several hours." (Best Practice & Research Clinical Anaesthesiology Vol. 22, No. 1, pp. 63–80, 2008 doi:10.1016/j.bpa.2007.10.003)

* B. a sigmoidal oxygen dissociation curve - false
o " Unlike Hb solutions, the relationship between PaO 2 and PFC-transported O 2 is linear"

* C. liver dysfunction, which is a common side-effect - false
o "The side effects of perflubron are usually mild and without serious clinical consequences."

* D. metabolism by the liver - false
o See A. "In the RES, perflubron droplets are broken down then excreted back in to the bloodstream and transported to the lungs where they are exhaled, with- out any known metabolism."

* E. prolongation of the the bleeding time - false
o "Nevertheless, perflubron has no effect on coagulation tests, bleeding time and platelet aggregation."
AB46 ANZCA version [2002-Mar] Q64

Infusion of 1 litre of Hartmanns solution over 30 minutes in a healthy adult results in

A. hypercoagulability due to platelet activation

B. hypercoagulablity due to a fall in antithrombin III (ATIII) levels

C. hypocoagulablilty due to a fall in thrombin levels

D. hypocoagulablility due to a fall in platelet levels

E. no change in coagulation status

Crystalloid hemodilution was associated with hypercoagulability in in vitro and in vivo studies.

Increased thrombin activity due to dilutional effects on AT3.
AB43 ANZCA version [2001-Apr] Q87

A 30 year old female requires drainage of a large wound abscess following an abdominoplasty 1 week ago. She has been on enoxaparin (Clexane) 40 mg once a day for 8 days. She would probably have

A. a prolonged prothrombin time (PT)

B. a prolonged activated partial thromboplastin time (aPPT)

C. normal coagulation, 12 hours after the last dose of enoxaparin

D. a risk of bleeding, which would NOT be predicted by her antiXa activity

E. her haemostatic function restored to normal after administration of 6 units of FFP (fresh frozen plasma) preoperatively

* A. False (Mosby)

* B. False (Mosby + Rang and Dale)

* C. False - some residual (although minor) effects at 12hrs (t1/2 is 7hrs, longer in renal impairment). In fact, Factor Xa effects at 12hrs are 50% of peak [2] (http://www.ncbi.nlm.nih.gov/pubmed/17215700)

* D. Best answer - see below - Xa level is not predictive of bleeding complications unfortunately - see the above reference also.

* E. False - Partial reversal is by protamine (FFP indicated for warfarin reversal)
AB42 ANZCA version [2001-Aug] Q76 & [2004-Apr] Q8

The adverse effect of 6 units of Fresh frozen plasma LEAST likely to be a problem is

A. an allergic reaction

B. a febrile reaction

C. a haemolytic reaction

D. transmission of infectious disease (including hepatitis and HIV infection)

E. citrate toxicity

A * Anaphylaxis only 1/30,000. Minor allergy 1/2000.

B. a febrile reaction

* This actually seems to be extremely rare with FFP (1/5000), compared with platelets or RBCs. And not to mention quite a minor 'problem' when it does occur.

C. a haemolytic reaction

* Rare but it does occur and is very serious when it does. It is due to the direct transfer of donor antibodies into the recipient's circulation causing haemolysis of the recipient's RBCs(ie the opposite to what occurs with transfused RBC haemolytic reactions in which the donor RBCs lyse)

D. transmission of infectious disease (including hepatitis and HIV infection)

* Viruses are the same as in RBCs - ie very very rare. Bacteria virtually unheard of.

E. citrate toxicity

* This totally depends on the context. If in the anhepatic phase of a liver Tx, sure, every time! Usually not much of an issue.
All of the following are major complications of massive transfusion, except:

A. Hypokalemia

B. Hypothermia

C. Hypomagnesemia

D. Hypocalcemia
All of the following should be irradiated before they are given to an immunocompromised patient EXCEPT:

A. Whole Blood
B. Peripheral stem cell reinfusions

C. Granulocyte transfusions

D. Apheresis platelets

E. Leukocyte-reduced RBCs

Patients who are immunocompromised are at risk for Transfusion Associated Graft vs. Host Disease (TA-GVHD). Any product that contains viable lymphocytes should be irradiated prior to transfusion to a patient at risk. This would include all of the choices listed above, but stem cell reinfusions shouldn't be irradiated.

Granulocytes CAN be irradiated, because they still function OK following irradiation, and the incompatible lymphs can attack host tissues and cause TA-GVHD.

Granulocytes CANNOT be filtered .
From the following list, choose the factor that does NOT decrease the measurable response to platelet transfusion:

A. Fever

B. ABO incompatibility

C. Rh incompatibility

D. Recipient HLA antibodies

E. Splenomegaly

F. Amphotericin B therapy

Rh incompatibility does not affect how well a patient responds to a platelet transfusion, because there are no Rh antigens on platelets. This does not mean, however, that Rh incompatibility may not be an issue, as D-negative recipients can, in uncommon situations, develop anti-D when given D-positive platelet transfusions, as a result of a small number of red cells present in the platelet product. There are ABO antigens on platelets, so ABO incompatibility can decrease the response somewhat. All of the other factors have also been shown to decrease a patient's post-platelet transfusion response to at least some extent.
A 59-year-old male is admitted with major trauma following an automobile accident. His blood type is O-negative, but you are out of O-negative blood. Which of the following blood products would be UNACCEPTABLE to transfuse?

A. AB positive red cells

B. A negative platelets

C. O positive red cells

D. AB positive FFP

E. B positive FFP
What if the person described in the previous question had been AB-negative? Which of the following red cell types would be acceptable to give him? (CHOOSE ALL THAT APPLY)

A. AB positive

B. A negative

C. O positive

D. O negative

E. B positive

ABO compatibility is important and always should be matched.

Rh should be matched if possible
A 40 year old female loses 15% of her blood volume as a result of an accidental arterial laceration during a hysterectomy. The most appropriate immediate therapy is:

A. Crystalloids

B. Colloids

C. Crystalloids and packed red cells

D. FFP and packed red cells

E. Whole blood
A 55 year old male has a gastrointestinal hemorrhage and drops his hematocrit from 45% to 19%. A bleeding arteriovenous malformation is resected, and the patient stabilizes. The clinician calls you to ask what level he should expect the patient's hematocrit to rise to if he gives him 4 units of red blood cells. You say:

A. About 23%

B. About 25%

C. About 27%

D. About 31%

E. About 35%

absence of bleeding, each unit of red cells should raise the hematocrit approximately 3% in an average sized person (that translates to about a 1 g/dL per unit hemoglobin increase).
Leukocyte reduction is indicated for prevention of all of the following EXCEPT:

A. Febrile nonhemolytic transfusion reactions

B. Transfusion-associated Graft vs Host Disease

C. HLA alloimmunization

D. Transmission of Cytomegalovirus (CMV)

E. All of the above are prevented by leukocyte reduction

Reduction of the transfused white blood cell load is well accepted for prevention of recipient antibody formation vs. donor HLA antigens, and works well for prevention of febrile reactions. In recent years, prevention of CMV transmission has become a widely accepted use for leukocyte reduction, as well (though there remains some controversy about this). However, TA-GVHD is a brutal, usually fatal complication of blood transfusion that may NOT be prevented by leukocyte reduction. The big problem is that no one really knows the minimum white cell load required to cause this horrific complication. So, most everyone feels that it is better to just deactivate the transfused lymphs in cases where a patient is at risk. This is done with irradiation.