Deck 17: Cellular Therapy

Question 1

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?

Answer 1

C

Question 2

Prior to the recipient receiving the transplant of hematopoietic progenitor cells, the cells must be conditioned with:

A) gamma radiation.
B) high-dose chemotherapy.
C) cytokines.
D) gamma radiation, high-dose chemotherapy, or both.

Answer 2

D

Question 3

Bone marrow transplants and peripheral blood stem cell transplantation (PBSCT) are most commonly used in the treatment of which of the following diseases?

A) Lymphoma
B) Multiple myeloma
C) Neuroblastoma
D) All of the above

Answer 3

D

Question 4

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

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

Question 5

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 6

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 7

The final bacterial culture was positive for hematopoietic progenitor cell batch. What must be done with this batch?

A) The batch must be discarded.
B) Broad spectrum antibiotics can be given to the patient and the batch infused.
C) Have a sensitivity done on the culture and administer the batch, as well as provide antibiotics to which the bacteria are sensitive to the patient.
D) The batch can be irradiated and then transfused.

Question 8

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 9

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

Question 10

Which of the following types of blood should be transfused if necessary prior to a patient receiving a hematopoietic progenitor cell transplant?

A) Leukoreduced
B) CMV-negative
C) Gamma irradiated
D) All of the above

Question 11

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

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

Question 12

ch16
Chapter 16. Adverse Effects of Blood Transfusion

Question 13

When not all of the recipient's hematopoietic progenitor cells are destroyed prior to transplantation, it is called:

A) myeloablative conditioning.
B) nonmyeloablative conditioning.
C) syngeneic conditioning.
D) chimerism.

Question 14

The myeloid line of hematopoietic progenitor cells (HPC) includes all but which of the following?

A) Erythrocytes
B) Monocytes
C) Dendritic cells
D) Basophils

Question 15

An identical twin donating to its twin sibling is an example of what kind of hematopoietic progenitor cell donation?

A) Autologous
B) Syngeneic
C) Allogeneic
D) Philogeneic

Question 16

Which of the following statements is true?

A) Dimethyl sulfoxide is toxic.
B) Dimethyl sulfoxide is the preservative used to prevent damage to hematopoietic progenitor cells during the freezing process.
C) 5% to 10% dimethyl sulfoxide is the final concentration allowed before freezing.
D) All of the above

Question 17

The morbidity and mortality is highest for which adverse reaction to hematopoietic progenitor cell transplantation?

A) CMV
B) HIV
C) TA-GVHD
D) ABO incompatibility

Question 18

Hematopoietic progenitor cell transplantation has been used to treat which of the following diseases?

A) Aplastic anemia
B) Wiskott-Aldricht syndrome
C) Adrenoleukodystrophy
D) Lysosomal disorders
E) All of the above

Question 19

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 20

Which of the following is a cytokine used to stimulate hematopoietic progenitor cell production for harvest by apheresis?

A) Filgrastrim
B) Naproxen
C) Progesterone
D) Erythropoietin

Question 21

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 22

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 23

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 24

What treatment is recommended following a bacterial contamination reaction?

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

Question 25

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 26

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 27

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

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

Question 28

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 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

Which of the following symptoms are consistent with hemosiderosis?

A) Hemoglobinuria, anemia, fever, shock
B) Tachycardia, fever, renal failure, shock
C) Anemia, jaundice, fatigue, muscle weakness
D) Hypotension, bloody diarrhea, renal failure, disseminated intravascular coagulation (DIC)

Question 31

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

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

Question 32

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 33

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 34

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 35

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 36

What is a cause of death in GVHD?

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

Question 37

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 38

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.

Question 39

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 40

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 41

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 42

Persons diagnosed with chronic renal failure and hemosiderosis should be treated with:

A) prednisone.
B) desferrioxamine.
C) neocyte transfusion.
D) washed red blood cells.

Question 43

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

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

Question 44

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 45

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 46

Which of the following can be added to blood prior to or during transfusion?

A) Mild antihistamines
B) Antibiotics
C) Ringer's lactate
D) 0.85% sodium chloride solution (USP grade)

Question 47

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 48

Which of the following is indicative of GVHD?

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

Question 49

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 50

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 51

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 52

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 53

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 54

Which of the following is compromised by iron overload?

A) Heart
B) Liver
C) Endocrine glands
D) All of the above

Question 55

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 56

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 57

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 58

What is meant by the term iatrogenic?

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

Question 59

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 60

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 61

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 62

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 63

What test is indicated for the detection of HLA antibodies?

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

Question 64

A severe manifestation of alloimmunization might include:

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

Question 65

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 66

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 67

When checking out a unit of blood to the floor:

A) the nurse must provide a piece of paper with at least two patient identifiers and preferably, depending on the system, a unique blood bank band number
B) you must visually check and document that the unit is free from hemolysis or possible bacterial contamination
C) you must document who is checking out the blood and transporting it
D) All of the above

Question 68

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 69

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 70

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

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

Question 71

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

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

Question 72

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 73

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 74

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 75

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

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

Question 76

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 77

What type of hemolysis accompanies an anaphylactic reaction?

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

Question 78

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 79

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

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

Question 80

What is the primary mediator of an allergic response?

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