Deck 17: Adverse Effects of Blood Transfusion

Question 1

Which of the following products may lead to sepsis in a patient when contaminated with Escherichia coli?

A) Packed red blood cells
B) Normal saline
C) Platelets
D) All of the above

Answer 1

D

Question 2

Treatment of post-transfusion purpura (PTP) with is not advocated in medical practice.

A) plasmapheresis
B) prednisone
C) platelet transfusions
D) exchange transfusions

Answer 2

C

Question 3

A patient transfused with 2 units of packed cells spiked a fever of 99.5°F and complained of chills 3 days after transfusion. The DAT was positive with polyspecific antisera and anti-IgG but negative with anti-C3d. Compatibility testing was performed on the pre- and post-transfusion specimens. The latter was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion specimens. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jk^a. This transfusion reaction is most likely caused by:

A) an anaphylactic response.
B) delayed hemolytic transfusion reaction (DHTR) caused by anamnestic response.
C) DHTR caused by primary alloimmunization.
D) post-transfusion purpura.

Answer 3

B

Question 4

All of the following are diseases that can mimic a transfusion reaction except:

A) AML.
B) hemoglobin C disease.
C) G6PD deficiency.
D) PNH.

Question 5

The plasma level of unconjugated bilirubin is elevated in:

A) intravascular hemolysis.
B) extravascular hemolysis.
C) intravascular and extravascular hemolysis.
D) none of the above.

Question 6

A transfusion reaction investigation should include all of the following except:

A) diagnosis.
B) current medication.
C) neocyte transfusion.
D) washed RBCs.

Question 7

Why is an FNHTR said to be a "diagnosis of exclusion"?

A) A spiked fever can only be the result of a blood transfusion.
B) FNHTR should not be suspected when fever is the sole symptom exhibited by the patient.
C) Fever can be the result of many other underlying maladies.
D) None of the above

Question 8

For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to:

A) prevent alloimmunization.
B) diminish chills and fever and make the patient comfortable.
C) prevent hemoglobinemia.
D) reverse hypotension and minimize renal damage.

Question 9

A 41-year-old multiparous woman was rushed to the emergency room after being shot in the chest. She received 8 units of packed red blood cells and 5 units of platelets. The hemoglobin and hematocrit determinations stabilized after 6 hours in surgery, but the platelet counts remained less than 50,000 per µL. She had received additional units of platelets at 48-hour intervals with little efficacy. Her serum was tested for platelet antibodies. She was placed on corticosteroids to control chest wound bleeding. Anti-PL^A1 was identified in the patient's serum. This case is representative of what type of transfusion reaction?

A) Post-transfusion purpura
B) Circulatory overload
C) Graft-versus-host disease
D) Alloimmunization

Question 10

A 35-year-old woman was transfused with 1 unit of packed red blood cells. The nurse monitoring the transfusion noticed hives on the patient's arm and an increase in body temperature. What is the choice of treatment for this patient?

A) Leukopoor blood products
B) Antihistamines
C) Premedication with aspirin
D) None of the above

Question 11

Which of the following questions should be asked when investigating a transfusion reaction?

A) How many milliliters of red blood cells were transfused?
B) What time of day was the donor unit collected?
C) What methodology was used for serologic testing?
D) What was the donor unit hematocrit?

Question 12

What would be the result of group B blood given to a group O patient?

A) Nonimmune transfusion reaction
B) Immediate hemolytic transfusion reaction
C) Delayed hemolytic transfusion reaction
D) No reaction

Question 13

Which of the following statements is false?

A) Intravascular transfusion reactions require complete complement activation.
B) Intravascular transfusion reactions can have immediate clinical signs.
C) Red blood cells are phagocytized by macrophages in the spleen and liver in intravascular reactions.
D) Intravascular reactions usually involve IgM antibodies.

Question 14

What groups are at risk for graft-versus-host disease (GVHD) as a result of transfusion?

A) Polycythemia vera patients undergoing a therapeutic phlebotomy
B) Fetuses receiving an intrauterine transfusion
C) Patients receiving a directed donation from a first-degree relative
D) Options B and C

Question 15

Persons with a documented history of anaphylactic reactions should be transfused with blood products.

A) IgE-deficient
B) leukodepleted
C) washed
D) irradiated

Question 16

What should be done in the transfusion process when the patient temperature spikes from 37.5°C to 38.5°C within 30 minutes of transfusion?

A) Continue the transfusion.
B) Stop the transfusion and keep the intravenous line open.
C) Treat with diphenhydramine (Benadryl).
D) Affix a leukocyte filter to transfusion line.

Question 17

A patient with two or more documented febrile nonhemolytic transfusion reactions (FNHTRs) should receive blood components.

A) irradiated
B) leukopoor
C) cytomegalovirus-negative
D) hemoglobin S-negative

Question 18

A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except:

A) Acute nonimmune hemolytic transfusion reaction
B) Febrile nonhemolytic transfusion reaction
C) Acute immune hemolytic transfusion reaction
D) Transfusion-associated sepsis

Question 19

Which of the following is an indicator of acute immune hemolytic transfusion reaction?

A) Increased haptoglobin
B) Increased hemoglobin
C) Decreased LDH
D) Increased bilirubin

Question 20

What measure can be taken to prevent transfusion-associated hypothermia?

A) Prudent use of platelet concentrates
B) Close monitoring of patient vital signs
C) Transfusion of product using a blood warmer
D) Premedication with calcium gluconate

Question 21

A delta check was noted for potassium after a surgical patient was transfused with 2 units of packed red blood cells. The pre-transfusion potassium was 3.1 mmol/L and the post-transfusion specimen was 6.2 mmol/L. What could be the reason for this sudden increase?

A) Coagulation factors were diluted out of patient plasma.
B) Red blood cells were washed prior to infusion.
C) Red blood cells spent maximum time in storage.
D) None of the above

Question 22

A delayed hemolytic transfusion reaction is most often the result of:

A) bacterial-contaminated red blood cells.
B) a unit of packed cells infected with hepatitis B virus.
C) an anamnestic response in a patient who has been previously sensitized by transfusion or pregnancy.
D) hemosiderosis in a massively transfused patient.

Question 23

What is the physiologic mechanism of histamine?

A) Histamine is released when the allergen-reagin complex attaches to the surface of basophils, increasing vascular dilation and permeability
B) Histamine is released when the allergen-reagin complex attaches to the surface of tissue mast cells, increasing vascular dilation and permeability
C) Histamine is released when the allergen-reagin complex attaches to the surface of eosinophils, increasing vascular dilation and permeability
D) Histamine is released when the allergen-reagin complex attaches to the surface of tissue mast cells, decreasing vascular dilation and permeability

Question 24

Hypothermia as a result of cold fluid replacement can result in all of the following except:

A) hemolysis.
B) abnormal electrocardiogram.
C) coagulopathy.
D) citrate toxicity.

Question 25

How can depletion and dilution of coagulation factors be avoided in a massively transfused patient?

A) Prudent use of colloid replacement solutions
B) Prudent use of platelets and fresh frozen plasma (FFP)
C) Whole blood infusions
D) None of the above

Question 26

Which of the following is consistent with bacterial contamination reactions?

A) The organism is a fastidious anaerobe.
B) The organism thrives in warm temperatures.
C) The organism thrives in cold temperatures.
D) The organism exhibits motility.

Question 27

What treatment is recommended following a bacterial contamination reaction?

A) Plasma protein fraction (PPF)
B) Broad-spectrum antibiotics
C) Aspirin
D) Epinephrine

Question 28

Which mechanism may play a role in fever development in an FNHTR?

A) Release of pyrogens from transfused white blood cells
B) The production of interleukin-6 by the complement system
C) Synthesis of prostaglandins (PGE±) in hypothalamic cells by interleukin-6
D) None of the above

Question 29

Which of the following is not a finding associated with intravascular hemolytic reaction?

A) Methemalbumin decreases
B) Haptoglobin decreases
C) Increased free hemoglobin in the plasma
D) Increased free hemoglobin in the urine

Question 30

The principle clinical signs of extravascular hemolysis include:

A) bilirubinemia mostly of the direct type.
B) hemoglobinuria.
C) positive DAT.
D) bilirubinemia and positive DAT.

Question 31

Which of the following is the most common transfusion reaction reported to blood banks?

A) Anaphylactic reaction
B) Febrile reaction
C) Intravascular hemolytic reaction
D) Extravascular hemolytic reaction

Question 32

Who developed the imputability criteria for reporting cases of transfusion fatalities?

A) AMA
B) CBER
C) FDA
D) NHSN

Question 33

All of the following are symptoms of an allergic reaction except:

A) pruritus.
B) local erythema.
C) anemia.
D) hives.

Question 34

Treatment in the event of an anaphylactic or anaphylactoid reaction should include all of the following except:

A) stopping the transfusion.
B) immediately administering PPF.
C) keeping the intravenous line open with normal saline.
D) immediately administering epinephrine.

Question 35

Which of the following results when large excesses of free hemoglobin are released into the blood?

A) Hemosiderinuria
B) Hematuria
C) Hemoglobinuria
D) Hemoglobinemia

Question 36

What is a cause of death in GVHD?

A) Anemia
B) Infection
C) Cardiac arrest
D) Renal failure

Question 37

What is the team of medical officers who investigate all reported cases of transfusion related fatalities?

A) AMA
B) CBER
C) FDA
D) NHSN

Question 38

What is the most common preventable error occurring among the nursing and medical staff that results in a transfusion-related death?

A) Alloantibody misidentified
B) Improper patient identification
C) Specimen mislabeled
D) Incorrect crossmatch procedure

Question 39

Which of the following organisms have been implicated in bacterial contamination reactions?

A) Corynebacterium flavescens
B) Yersinia enterocolitica
C) Enterobacter aerogenes
D) Clostridium perfringens

Question 40

In the United States, fatalities associated with transfusion are required to be reported to which organization?

A) AMA
B) CDC
C) FDA
D) NHSN

Question 41

How could a potential alloimmunizaton due to anti-K be prevented?

A) Matching of donor and recipient red blood cell phenotype
B) Use of third-generation bedside leukocyte filters
C) Use of washed red blood cells
D) Use of apheresed platelets

Question 42

Immediate transfusion reaction procedures consist of all of the following except:

A) clerical check.
B) DAT.
C) serum haptoglobin.
D) visual check.

Question 43

Which of these is/are involved in hemovigilance?

A) Collecting information on transfusion complications.
B) Analyzing transfusion complication data.
C) Improving transfusion practices based on transfusion complications data analysis.
D) All of these.

Question 44

Which of the following clinical manifestations is not included in the physically or chemically induced transfusion reactions?

A) Citrate toxicity
B) Hyperkalemia
C) Hemosiderosis
D) Factor VIII depletion

Question 45

What is meant by the term iatrogenic?

A) Generic treatment
B) Underlying disease
C) Physician-caused
D) Hospital-contracted

Question 46

An O-positive patient transfused with A-positive red blood cells would experience which of the following clinical manifestations?

A) Acute hemolysis
B) Delayed hemolytic transfusion reaction
C) Anaphylaxis
D) External hemolysis

Question 47

Physical or chemical damage of the transfused red blood cells can result in:

A) intravascular hemolysis.
B) extravascular hemolysis.
C) sepsis.
D) pulmonary edema.

Question 48

Which of the following may be a factor in a nonimmune transfusion reaction?

A) Post-transfusion purpura
B) Circulatory overload
C) Allergic reaction
D) Immediate hemolytic transfusion reaction

Question 49

Which of the following urinalysis results represents hemolysis?

A) Reagent strip is negative for blood in presence of intact red blood cells (RBCs) (microscopic)
B) Reagent strip is positive for blood in presence of intact RBCs (microscopic)
C) Reagent strip is positive for blood in absence of intact RBCs (microscopic)
D) Reagent strip is negative for blood and positive for urobilinogen

Question 50

The presence of intact red blood cells in microscopic urinalysis examination indicates:

A) bleeding.
B) hemolysis.
C) hemosiderinuria.
D) bilirubinemia.

Question 51

What is a possible mechanism for noncardiogenic pulmonary edema reactions?

A) Antileukocyte antibody reacts with leukocytes and activates the reticuloendothelial system
B) Histamine is released from mast cells, increasing vascular dilation and fluidity to tissues
C) Antileukocyte antibody reacts in donor or patient plasma, initiating complement-mediated pulmonary capillary endothelial injury
D) None of the above

Question 52

Which of the following is indicative of GVHD?

A) Thrombocytopenia
B) Anemia
C) Pancytopenia
D) Hematuria

Question 53

What symptom would not usually be found in a bacterial contamination reaction?

A) Tachycardia
B) Hypotension
C) Hemoglobinuria
D) Fever

Question 54

All of the following are immediate nonhemolytic transfusion reactions, except:

A) being febrile.
B) PTP.
C) anaphylaxis.
D) an allergic response.

Question 55

Which of the following is not a symptom of noncardiogenic pulmonary edema?

A) Hypervolemia
B) Fever
C) Hypotension
D) Coughing

Question 56

A patient transfused with 2 units of packed red blood cells demonstrated signs of a transfusion reaction just before the second unit was completely infused. Hypotension, fever, and back pain are the immediate symptoms. Blood work reveals a 3% drop in hematocrit and prolonged PT. What therapy is given to correct the PT?

A) FFP
B) Dopamine
C) Platelet concentrates
D) Mannitol

Question 57

What is the most frequent cause of circulatory overload?

A) Transfusion of a unit at too slow a rate
B) Massive transfusion of blood components
C) Transfusion of a unit at too fast a rate
D) Transfusion of a partially deglycerolized unit

Question 58

What is the purpose of performing serial hemoglobin and hematocrit after a blood transfusion?

A) To detect the presence of hemoglobinemia
B) To monitor platelet refractoriness
C) To monitor the therapeutic or nontherapeutic response
D) To monitor the efficacy of clotting factors

Question 59

What is the primary mediator of an allergic response?

A) Melatonin
B) Lysozyme
C) Histamine
D) Pyrimidine

Question 60

Upon investigation of a DHTR, what should be included in the medical history?

A) Previous transfusion
B) Pregnancies
C) Transfusion reactions
D) All of the above

Question 61

All of the following signs are consistent with circulatory overload except:

A) orthopnea.
B) fever.
C) dyspnea.
D) tachycardia.

Question 62

What test is indicated for the detection of HLA antibodies?

A) Direct Coombs'
B) Antibody screen
C) Lymphocyte panels
D) Cold antibody panel

Question 63

A severe manifestation of alloimmunization might include:

A) renal failure.
B) rising hemoglobin and hematocrit.
C) platelet refractoriness.
D) cyanosis.

Question 64

What is the length of time required for production of antibody in a DHTR caused by an anamnestic immune response?

A) 7 to 14 days
B) 5 to 10 days
C) 1 to 2 hours
D) 3 to 7 days

Question 65

Which of the following describes the etiology of GVHD?

A) Anti-PL^A1 attaches to platelet surface, permitting extravascular destruction by RES
B) B lymphocytes from donor blood react with major and minor histocompatibility antigens in the patient
C) T lymphocytes from donor blood react with major and minor histocompatibility antigens in the patient
D) Alloantibody in patient serum reacts with donor red blood cells

Question 66

Which of the following best describes a transfusion reaction?

A) An urticarial response to blood products occurring 1 to 2 hours after infusion
B) A physiologic response to a blood product transfused 5 to 10 days before host symptoms
C) Any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components
D) None of the above

Question 67

In a DHTR, patient antibody attaches to the specific foreign donor red blood cell antigen, causing sensitization of red blood cells, which are removed by the:

A) complement system.
B) kidneys.
C) reticuloendothelial system (RES).
D) MHC complex.

Question 68

What type of hemolysis accompanies an anaphylactic reaction?

A) Intravascular
B) Extravascular
C) Acute
D) None of the above

Question 69

Which of the following is characterized by a rapid onset of thrombocytopenia due to anamnestic production of platelet antibody?

A) GVHD
B) Alloimmunization
C) PTP
D) Iron overload

Question 70

Which of the following therapies is not advocated in circulatory overload?

A) Whole blood units
B) Transfusing at too fast a rate
C) Therapeutic phlebotomy
D) Washed red blood cells

Question 71

Which of the following indicates a hemolytic process?

A) Pre-transfusion plasma is yellow; post-transfusion plasma is red.
B) Pre-transfusion plasma is yellow; post-transfusion plasma is yellow.
C) Pre-transfusion plasma is red; post-transfusion plasma is yellow.
D) None of the above.

Question 72

The most important initial step in evaluating a suspected hemolytic transfusion reaction is to:

A) perform a CBC and urinalysis.
B) perform a DAT.
C) recheck the compatibility testing, using a pre- and post-sample.
D) reconfirm the patient's identity and reexamine all pre-transfusion testing.

Question 73

What may be found in the serum of a person who is exhibiting signs of a noncardiogenic pulmonary edema reaction?

A) Red blood cell alloantibody
B) IgA antibody
C) Antileukocyte antibody
D) Allergen

Question 74

Which of the following should be collected immediately from a patient exhibiting signs of a septic reaction to blood products?

A) DAT
B) Complete blood count (CBC)
C) Urine sample
D) Blood cultures

Question 75

Which patients are not at risk for circulatory overload?

A) Patients with iron-deficiency anemia
B) Pediatric patients
C) Geriatric patients
D) Persons homozygous for hemoglobin S

Question 76

Changes that occur to RBCs upon storage include an increase in

A) ATP.
B) calcium.
C) glucose.
D) all of these.

Question 77

Persons with PTP exhibit thrombocytopenia with platelet counts as low as 10,000 per µL. What other complications might be present?

A) Hematuria
B) Hypotension
C) Fever
D) DIC

Question 78

What is a common finding in a DHTR?

A) DIC
B) Jaundice
C) Renal failure
D) Hypotension

Question 79

What type of hemolysis is implicated in a DHTR caused by primary alloimmunization?

A) Extravascular
B) Intravascular
C) Nonimmune
D) None of the above

Question 80

Which of the following is not characteristic of an anaphylactic reaction?

A) Hypotension
B) Abdominal cramps
C) Electrophoretic levels of IgA
D) Loss of consciousness