Question 1

Factor VIII is treated by which of the following to ensure sterility for HIV and hepatitis B and C?

Accepted Answer

Factor VIII is typically treated by all three methods (pasteurization, nanofiltration, and solvent detergent) in order to ensure the removal or inactivation of HIV and hepatitis B and C. Each method works in a slightly different way to achieve a high level of sterility.

Question 2

What is suspected when the hematocrit has decreased by 4% and the total bilirubin level is increased 5 days after transfusion?

Accepted Answer

A decrease in hematocrit and an increase in total bilirubin level suggest hemolysis. However, the timing of the symptoms (5 days after transfusion) points towards a delayed hemolytic transfusion reaction rather than an acute hemolytic reaction.

Question 3

What is the recommended treatment for mild von Willebrand's disease?

Accepted Answer

DDAVP (1-Deamino-8-arginine vasopressin) is the recommended treatment for mild von Willebrand's disease. It stimulates the release of von Willebrand factor and factor VIII from endothelial cells, increasing their levels in the blood and improving clotting function. VIII concentrate, fresh frozen plasma, and cryoprecipitate are also options, but DDAVP is the preferred treatment for mild cases.

Question 4

Factor IX concentrates contain which factors (otherwise known as "prothrombin complex")?

Accepted Answer

Factor IX concentrates contain factors II, VII, IX, and X, which are collectively known as "prothrombin complex." A and B are incorrect because they do not include factor X, which is essential for effective clotting. D is incorrect because it includes factor XII, which is not part of the prothrombin complex.

Question 5

A patient with severe hemolytic anemia had a pulse of 120 beats per minute and a respiratory rate of 37 breaths per minute. What blood component is indicated for this patient?

Accepted Answer

Severe hemolytic anemia indicates a significant loss of red blood cells. The increased heart rate (tachycardia) and respiratory rate (tachypnea) are compensatory mechanisms to deliver more oxygen to the tissues. Therefore, the best choice for this patient would be red blood cells to increase oxygen-carrying capacity and reduce compensatory mechanisms. Plasma, whole blood, or platelets would not address the underlying cause of the hemolytic anemia.

Question 6

Which type of autologous transfusion, successful in liver transplants, involves collecting 1 to 2 units from the patient before surgery, using crystalloid to replace blood volume and reinfusing blood at the end of surgery?

Accepted Answer

Intraoperative hemodilution involves collecting blood from the patient just before or during surgery, replacing the volume with crystalloid or colloid solutions to maintain blood pressure and volume, and then reinfusing the patient's own blood towards the end of the surgery. This method is particularly useful in surgeries like liver transplants where significant blood loss can occur, allowing for the patient to receive their own blood, thus minimizing the risks associated with blood transfusions.

Question 7

What is the immunologic principle of RhIG administration?

Accepted Answer

Anti-D attaches to Rh-positive cells of the infant in maternal circulation and are subsequently removed by cells of the reticuloendothelial system, preventing sensitization. This process prevents the mother's immune system from recognizing and creating antibodies against Rh-positive cells, which could affect future pregnancies.

Question 8

Which of the following should be done when selecting units for a hypoxic neonate?

Accepted Answer

Hgb S testing should be done to identify units without sickle cell trait or disease, as these can cause additional complications in a hypoxic neonate. Irradiation is typically done for immunocompromised patients or those at risk for transfusion-associated graft-versus-host disease. Cytomegalovirus and Epstein-Barr virus testing are also not necessary for unit selection in a hypoxic neonate.

Question 9

Which type of filter is used in routine blood administration sets to remove gross clots from all blood products?

Accepted Answer

A 170 µm filter is used in routine blood administration sets to remove gross clots from all blood products. This choice is correct as it is specific to the question and is the only correct answer. Leukopoor filters are used to remove white blood cells from blood products, and 100 µm and 50 µm filters are not commonly used in blood administration sets.

Question 10

How would the hematocrit of a patient with chronic anemia be affected by transfusion of 2 units of whole blood versus transfusion with 3 units of packed RBCs?

Accepted Answer

Packed RBCs have a higher concentration of red blood cells compared to whole blood, which contains other components such as plasma and platelets. Therefore, transfusion with 3 units of packed RBCs would increase the hematocrit more than transfusion with 2 units of whole blood.

Question 11

Which of the following factors are found in therapeutic levels in fresh frozen plasma?

Accepted Answer

Fresh frozen plasma contains all of the factors listed (VIII, V, and XI) in therapeutic levels.

Question 12

What is the source of hyperimmune globulins used in the prevention of hepatitis B?

Accepted Answer

Hyperimmune globulins used in the prevention of hepatitis B are derived from plasma donors whose sera demonstrate a high titer of hepatitis B antibody. These donors are specially selected because they have a high level of immunity against hepatitis B, which means that their plasma can be used to manufacture hyperimmune globulins that are very effective at preventing the disease.

Question 13

Vitamin K is essential for the carboxylation of which coagulation factors?

Accepted Answer

Vitamin K is essential for the carboxylation of clotting factors II, VII, IX, and X, making them active in the coagulation cascade. Choice A is incorrect as factor V does not require vitamin K for carboxylation. Choice B is incorrect as factor V does not require vitamin K for carboxylation, and factor V is not involved in the coagulation cascade. Choice D is incorrect as factor XI and XII do not require vitamin K for carboxylation, and are part of the intrinsic pathway of the coagulation cascade, not the common pathway that involves factors II, VII, IX, and X.

Question 14

Which of the following Rh-negative patients may be transfused with Rh-positive units when few O-negative units are available in an emergency?

Accepted Answer

In emergencies, when O-negative blood is scarce, Rh-positive units can be safely transfused to Rh-negative individuals if they are not at risk of future sensitization issues related to pregnancy. Middle-aged males, being beyond childbearing concerns and not at risk for fetal Rh incompatibility, are the safest choice for this practice. Pregnant women, females of childbearing potential, and neonates are at higher risk of complications from Rh incompatibility, making them less suitable for receiving Rh-positive blood if they are Rh-negative.

Question 15

Why is red blood cell transfusion contraindicated in a stable patient with chronic renal failure who has no symptoms except after climbing three flights of stairs?

Accepted Answer

The anemia in this patient is likely chronic and compensated, meaning that the body has adjusted to the low hemoglobin levels and the patient is asymptomatic except with significant exertion. Red blood cell transfusion is not necessary in this stable patient, and may actually increase the risk of adverse effects such as fluid overload or transfusion reactions. Whole blood transfusion is also not recommended as it carries additional risks and may not be necessary in this patient. Nutritional anemia (due to deficiencies in iron, vitamin B12, or folate) is a possible cause of anemia in chronic renal failure, but it is unlikely to be the sole cause in this patient with stable symptoms.

Question 16

Leukoreduction filters are used in the transfusion of red blood cells and platelets to prevent:

Accepted Answer

Leukoreduction filters are used to remove white blood cells (leukocytes) from blood products. This process helps to prevent febrile nonhemolytic transfusion reactions, which are often caused by the recipient's immune response to donor leukocytes.

Question 17

Which of the following statements concerning red blood cells prepared with additive solution 1 (AS-1) is true?

Accepted Answer

The answer of Which of the following statements concerning red...

Question 18

The rejection of platelets in multiply transfused patients is called:

Accepted Answer

The rejection of platelets in multiply transfused patients is called refractoriness. Platelet satellitism is a phenomenon that occurs when platelets surround neutrophils in vitro but do not cause any clinical issues. Stimulation refers to the process of enhancing platelet activity. Urticaria is an allergic reaction that can occur in response to a transfusion.

Question 19

Which of the following is not an indication for transfusing platelets?

Accepted Answer

Platelet transfusion is not indicated in patients with platelet count above 50,000/µL unless they have active bleeding or are undergoing invasive procedures. In cases of massive transfusion, platelets may be given along with other blood products, but a platelet count of 250,000/µL does not indicate a need for platelet transfusion. Thrombocytopenia with bleeding or invasive procedure, disseminated intravascular coagulation, and chemotherapy for malignancy are all indications for platelet transfusion.

Question 20

Why is the increase in hemoglobin and hematocrit evident more quickly in red blood cell transfusions than in whole blood transfusions?

Accepted Answer

Blood volume adjustment is less when only red blood cells are transfused, leading to a more rapid increase in hemoglobin and hematocrit levels compared to whole blood transfusions, which include plasma and can dilute the concentration of hemoglobin and hematocrit in the recipient's blood.

Quiz 15: Transfusion Therapy