Hematology Transfusion 4

Front 1

400. An 18-year-old female involved in a motor vehicle accident is brought to the emergency room in shock. She is transfused with 10 units of type O, Rh-negative whole blood over 30 minutes. After infusion of the first 5 units, bleeding is controlled & her blood pressure rises to 85/51 mm Hg. During the next 15 minutes, as the remaining 5 units are infused, her blood pressure slowly falls to 60 mm Hg. The patient remains in sinus tachycardia at 120 beats/min, but the QT interval is noted to increase from 310 to 470 msec, & the central venous pressure increases from 9 to 20 mm Hg. Her breathing is rapid & shallow. The most likely cause of this scenario is
...A. Citrate toxicity
...B. Hyperkalemia
...C. Hemolytic transfusion reaction
...D. Cardiac tamponade
...E. Tension pneumothorax

Back 1

400. (A)

Front 2

401. A 20-kg, 5-year-old child with a hematocrit of 40% could lose how much blood & still maintain a hematocrit of 30%?
...A. 140 mL
...B. 250 mL
...C. 350 mL
...D. 450 mL
...E. 550 mL

Back 2

401. (C)

Front 3

402. A 100-kg male patient has a measured serum sodium concentration of 105 mEq/L. How much sodium would be needed to bring the serum sodium to 120 mEq/L?
...A. 600 mEq
...B. 900 mEq
...C. 1200 mEq
...D. 2400 mEq
...E. 3600 mEq

Back 3

402. (B)

Front 4

403. The likelihood of a clinically significant hemolytic transfusion reaction resulting from administration of erythrocytes to a patient with a negative antibody screen is less than
...A. 1 in 100
...B. 1 in 1000
...C. 1 in 10,000
...D. 1 in 100,000
...E. 1 in 1,000,000

Back 4

403. (C)

Front 5

404. A 23-year-old female who has been receiving total parenteral nutrition (15% dextrose, 5% amino acids, & intralipids) for 3 weeks is scheduled for surgery for severe Crohn’s disease. Induction of anesthesia & tracheal intubation are uneventful. After establishing peripheral intravenous access, the old central line is removed & a new central line is placed at a different site. At the end of the operation, a large volume of fluid is discovered in the chest cavity on chest x-ray film. Arterial blood pressure is 105/70 mm Hg, heart rate is 150 beats/min, & Sao2 is 96% (pulse oximeter). The most appropriate initial step in the management of this patient is to
...A. Place a chest tube
...B. Change the single-lumen to a double-lumen endotracheal tube
...C. Start a dopamine infusion
...D. Check a blood glucose level
...E. Administer esmolol intravenously

Back 5

404. (D)

Front 6

405. In an emergency when there is a limited supply of type O-negative RBCs, type O-positive RBCs are reasonable for transfusion for each of the following patients EXCEPT
...A. A 60-year-old woman with diabetes who was involved in a motor vehicle accident
...B. A 23-year-old man who sustained a gunshot wound to the upper abdomen
...C. An 84-year-old man with a ruptured abdominal aortic aneurysm
...D. A 5-year-old boy involved in a pedestrian-automobile accident
...E. A 21-year-old, gravida 2, para 1 woman with placenta previa who is bleeding profusely

Back 6

405. (E)

Front 7

406. Hetastarch interferes with coagulating through interacting with
...A. Antithrombin III
...B. Factor VIII
...C. Fibrinogen
...D. Protein S
...E. Prostacyclin

Back 7

406. (B)

Front 8

407. All of the following characterize packed RBCs that have been stored for 35 days at 4° C in citrate phosphate dextrose adenine-1 (i.e., CPDA-1) anticoagulant preservative EXCEPT
...A. Serum potassium greater than 70 mEq/L
...B. pH less than 7.0
...C. Blood glucose less than 100 mg/dL
...D. P50 of 28
...E. 2,3-diphosphoglycerate (2,3-DPG) less than 1 μM/L

Back 8

407. (D)

Front 9

408. What is the storage life of whole blood stored with citrate phosphate dextrose (CPD)?
...A. 14 days
...B. 21 days
...C. 35 days
...D. 42 days
...E. 49 days

Back 9

408. (B)

Front 10

409. What is the storage life of RBCs stored with Adsol?
...A. 14 days
...B. 21 days
...C. 35 days
...D. 42 days
...E. 49 days

Back 10

409. (D)

Front 11

410. Anticoagulation with low-molecular-weight heparin (LMWH) can be best monitored through which of the following laboratory tests?
...A. Activated partial thromboplastin time (aPTT)
...B. Prothrombin time (PT)
...C. Thrombin time
...D. Reptilase test
...E. Anti-Xa assay

Back 11

410. (E)

Front 12

411. Heparin resistance is likely in patients with which of the following heritable conditions?...A. Factor V Leiden mutation
...B. Protein C deficiency
...C. Protein S deficiency
...D. Antithrombin or antithrombin III (AT3) deficiency
...E. Prothrombin G20210A gene mutation

Back 12

411. (D)

Front 13

412. von Willebrand’s disease could be treated by any of the following EXCEPT
...A. Cryoprecipitate
...B. Fresh frozen plasma
...C. Factor VIII concentrates
...D. Recombinant factor VIII
...E. Desmopressin (DDAVP)

Back 13

412. (D)

Front 14

413. The significance of IgA antibodies in transfusion medicine is related to
...A. Allergic reaction
...B. Immediate hemolytic reaction
...C. Febrile reaction
...D. Delayed hemolytic reaction (immune extravascular reaction)
...E. Diagnosis of transfusion-related acute lung injury (TRALI) reaction

Back 14

413. (A)

Front 15

414. The No. 1 cause of mortality associated with administration of blood is:
...A. ABO hemolytic transfusion reaction
...B. Non-ABO hemolytic transfusion reaction
...C. Microbial infection
...D. Transfusion associated circulatory overload (TACO)
...E. Transfusion related acute lung injury (TRALI)

Back 15

414. (E)

Front 16

415. Fluid resuscitation during major abdominal surgery with which of the following agents is associated with the best survival data?
...A. 5% Albumin
...B. 6% Hydroxyethyl starch
...C. Dextran 70
...D. Hypertonic saline
...E. None of the above

Back 16

415. (E)

Front 17

416. Which of the following processes reduces the possibility of transmission of CMV to a susceptible recipient via red cell transfusion?

DIRECTIONS (questions 416 & 417) Choose the correct response below for the following questions:

Back 17

416. (B)

Front 18

417. Process aimed at reducing graft versus host disease in transfusion recipients
...A. Washing erythrocytes
...B. Leukocyte reduction
...C. Irradiation
...D. Storage in ADSOL
...E. Treatment with ultraviolet light

DIRECTIONS (questions 416 & 417) Choose the correct response below for the following questions:

Back 18

417. (C)