Deck 12: Adverse Complications of Transfusions

Question 1

Ten days after the transfusion of 2 units, a patient had a 2 g/dL drop in hemoglobin and was slightly jaundiced. No evidence of bleeding was found. What tests would be helpful in determining whether the patient is experiencing a delayed hemolytic transfusion reaction?

A) Culture the donor unit.
B) Compare pretransfusion and posttransfusion ABO and D typing.
C) Perform hepatitis B surface antigen test.
D) Perform an antibody screen on the posttransfusion sample.

Answer 1

D
A delayed transfusion reaction is due to alloantibodies that have developed from the red cells recently transfused or from antibodies made against prior red cell exposure.

Question 2

Match the transfusion reaction with the description that best fits.
a.Prevented by leukoreduced components
b.Prevented by irradiation of components
c.Symptoms include hives and itching
d.Associated with ABO incompatibilities
e.Caused by donor white cell antibodies
f.Alloantibodies to red cell antigens
g.Can be prevented by transfusion slowly
Febrile, nonhemolytic

Answer 2

A

Question 3

Match the transfusion reaction with the description that best fits.
a.Prevented by leukoreduced components
b.Prevented by irradiation of components
c.Symptoms include hives and itching
d.Associated with ABO incompatibilities
e.Caused by donor white cell antibodies
f.Alloantibodies to red cell antigens
g.Can be prevented by transfusion slowly
Urticarial

Answer 3

C

Question 4

A patient is observed to have a rise in temperature and chills during a transfusion. The transfusion is stopped, and a posttransfusion blood sample is carefully drawn. On receipt of this postreaction sample, the transfusion service should immediately:

A) observe the color of serum and perform an antibody screen.
B) observe the color of serum and perform a direct antiglobulin test.
C) perform an antibody screen and a direct antiglobulin test.
D) perform an antibody screen and a crossmatch.

Question 5

The clinical sequelae of a hemolytic transfusion reaction may include all of the following except:

A) disseminated intravascular coagulation.
B) renal failure.
C) shock.
D) graft-versus-host disease.

Question 6

Which blood product is recommended for transfusions to individuals with a history of febrile nonhemolytic transfusion reactions?

A) Leukocyte-reduced red blood cells
B) Packed red blood cells
C) Frozen red blood cells
D) Whole blood

Question 7

Which of the following blood group systems has been implicated in transfusion reactions on the first exposure to incompatible red blood cells?

A) Rh
B) Kell
C) Kidd
D) ABO

Question 8

In what circumstance would a direct antiglobulin test be negative in the presence of a hemolytic process?

A) Bacterial contamination of the unit
B) Medications that were administered with the unit
C) Red blood cell unit transfused quickly through a leukopoor filter
D) All of the above

Question 9

A 44-year-old woman has a hemoglobin level of 6.1 g/dL. White blood cell and platelet counts are within normal levels. The patient is group O D-negative with a negative antibody screen. Crossmatches are compatible. However, 15 minutes after the first transfusion is started, she experiences erythema and hives. What type of transfusion reaction is occurring?

A) Urticarial
B) Febrile nonhemolytic
C) Delayed hemolytic
D) Acute hemolytic

Question 10

An anaphylactic transfusion reaction is caused by __________ antibodies.

A) IgA
B) IgG
C) IgE
D) All of the above

Question 11

A hemolytic reaction to red blood cells can be caused by which of the following nonimmune mechanisms?

A) Incompatible intravenous solutions mixed with the unit
B) Improper storage of the unit
C) Bacterial contamination of the unit
D) All of the above

Question 12

Which of the following is necessary to prevent an anaphylactic reaction due to a known IgA antibody in a patient?

A) All red blood cell units should be irradiated.
B) Red blood cell units should be washed.
C) All blood components should be leukoreduced.
D) Patient should be given antihistamine before transfusion.

Question 13

Which of the following transfusion reactions has the highest incidence?

A) Hemolytic reactions due to ABO incompatibility
B) Urticarial
C) Graft-versus-host disease
D) Transfusion-related acute lung injury

Question 14

Administration of whole blood to a patient with cardiac insufficiency could result in which of the following transfusion reactions?

A) Delayed hemolytic reaction
B) Transfusion-related acute lung injury
C) Circulatory overload
D) Febrile nonhemolytic reaction

Question 15

Posttransfusion purpura is caused by:

A) red cell antibodies.
B) white cell antibodies.
C) platelet antibodies.
D) bacterial contamination.

Question 16

What component is indicated for patients who receive directed donations from immediate family members to prevent graft-versus-host transfusion reactions?

A) Irradiated red blood cells
B) Packed red blood cells
C) Washed red blood cells
D) Cytomegalovirus-negative red blood cells

Question 17

A patient was identified as having cardiac insufficiency that needed a red blood cell transfusion. How should the transfusion be administered?

A) The red blood cell unit should be transfused slowly over a 4-hour period.
B) The unit should be transfused as whole blood.
C) Diuretics should be administered with the unit.
D) Transfusion should be avoided.

Question 18

Long-term red blood cell transfusion can result in which of the following conditions?

A) Citrate toxicity
B) Hemosiderosis
C) Graft-versus-host disease
D) Transfusion-related acute lung injury

Question 19

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

A) posttransfusion patient temperature.
B) human leukocyte antigen type.
C) reidentification of the patient and transfused component.
D) collection of a blood sample.

Question 20

What organ of the recipient's body is involved in a transfusion-related acute lung injury transfusion reaction?

A) Heart
B) Lung
C) Liver
D) Brain

Question 21

Match the transfusion reaction with the description that best fits.
a.Prevented by leukoreduced components
b.Prevented by irradiation of components
c.Symptoms include hives and itching
d.Associated with ABO incompatibilities
e.Caused by donor white cell antibodies
f.Alloantibodies to red cell antigens
g.Can be prevented by transfusion slowly
Transfusion-related acute lung injury

Question 22

Match the transfusion reaction with the description that best fits.
a.Prevented by leukoreduced components
b.Prevented by irradiation of components
c.Symptoms include hives and itching
d.Associated with ABO incompatibilities
e.Caused by donor white cell antibodies
f.Alloantibodies to red cell antigens
g.Can be prevented by transfusion slowly
Delayed hemolytic

Question 23

Match the transfusion reaction with the description that best fits.
a.Prevented by leukoreduced components
b.Prevented by irradiation of components
c.Symptoms include hives and itching
d.Associated with ABO incompatibilities
e.Caused by donor white cell antibodies
f.Alloantibodies to red cell antigens
g.Can be prevented by transfusion slowly
Acute hemolytic

Question 24

Match the transfusion reaction with the description that best fits.
a.Prevented by leukoreduced components
b.Prevented by irradiation of components
c.Symptoms include hives and itching
d.Associated with ABO incompatibilities
e.Caused by donor white cell antibodies
f.Alloantibodies to red cell antigens
g.Can be prevented by transfusion slowly
Graft-versus-host disease

Question 25

Match the transfusion reaction with the description that best fits.
a.Prevented by leukoreduced components
b.Prevented by irradiation of components
c.Symptoms include hives and itching
d.Associated with ABO incompatibilities
e.Caused by donor white cell antibodies
f.Alloantibodies to red cell antigens
g.Can be prevented by transfusion slowly
Circulatory overload