Deck 15: Transfusion Therapy

Question 1

How are RBC aliquots prepared for a neonate transfusion?

A) Blood is withdrawn from collection bag using a syringe and diluted 1:2 with saline.
B) Blood is withdrawn from collection bag using a syringe and diluted 1:2 with glycerol.
C) Blood is transferred from collection bag to satellite bag and withdrawn using a syringe.
D) None of the above

Answer 1

C

Question 2

What is the advantage of performing a type and screen for patients scheduled for surgery instead of crossmatching units for possible transfusion?

A) Increases the amount of crossmatch performed
B) Increases the availability of donor units in the inventory
C) Contributes to outdating of blood products
D) Decreases the number of panel studies done on positive antibody screens

Answer 2

B

Question 3

Bleeding disorders may be caused by:

A) dysfunction of lymphocytes.
B) dysfunction of neutrophils.
C) dysfunction of platelets.
D) dysfunction of erythrocytes.

Answer 3

C

Question 4

Which plateletpheresis product should be irradiated?

A) Autologous unit collected prior to surgery
B) Random stock unit going to a patient with disseminated intravascular coagulation (DIC)
C) A directed donation given by a mother to her son
D) A directed donation given by an unrelated family friend

Question 5

What is the purpose of dialysis in uremic patients?

A) Release of functional von Willebrand factor (vWF) from endothelial cells
B) Removal of by-products of protein metabolism that renders vWF and platelets nonfunctional
C) Release of platelets from the bone marrow
D) All of the above

Question 6

Which of the following is an indication for immunoglobulin administration?

A) Cytomegalovirus
B) Hepatitis A
C) Infectious mononucleosis
D) Congenital hypergammaglobulinemia

Question 7

Deglycerolized red blood cells can be used interchangeably with washed red blood cells, because both procedures:

A) remove white blood cells.
B) remove plasma.
C) have 24-hour outdate.
D) all of the above.

Question 8

All of the following are consistent with graft-versus-host disease (GVHD) except:

A) transplantation of immunocompetent T lymphocytes.
B) HLA incompatibility between graft and recipient.
C) transplantation of "immunologically naive" T lymphocytes.
D) an immunocompromised recipient.

Question 9

Why is whole blood contraindicated for patients with severe chronic anemia?

A) These patients have a reduced number of red blood cells.
B) The plasma volume of these patients is decreased.
C) The plasma volume of these patients is increased.
D) These patients have an increased number of red blood cells.

Question 10

Oncology patients usually receive repeated red blood cell and platelet transfusions because of:

A) radiation therapy.
B) tumor infiltration of bone marrow.
C) chemotherapy.
D) all of the above.

Question 11

Which of the following may be a serious manifestation of FFP transfusion in congenital factor deficiencies?

A) Tachycardia
B) Pleurisy
C) Hypogammaglobulinemia
D) Pulmonary edema

Question 12

Why are fresh blood units (less than 7 days old) preferred for a neonate transfusion?

A) They reduce the risk of hyperkalemia.
B) They minimize 2,3 DPG levels.
C) They reduce the risk of hypokalemia.
D) They reduce the risk of hypernatremia.

Question 13

Liquid plasma is not indicated for factor_____ deficiency.

A) XI
B) V
C) II
D) X

Question 14

How is donor platelet survival determined in the recipient?

A) Platelet count increment (1 hour after transfusion)
B) Radiolabeled metals
C) Antiplatelet antibody detection
D) None of the above

Question 15

Which of the following is not an indication for fresh frozen plasma (FFP) transfusion?

A) Disseminated intravascular coagulation (DIC)
B) Vitamin K deficiency
C) Factor VIII deficiency
D) Massive transfusion

Question 16

The rejection of the transplantation of platelets from one individual to another is termed or defined as:

A) a hemolytic transfusion reaction.
B) platelet refractoriness.
C) graft versus host disease.
D) none of the above.

Question 17

All coagulation factors are produced in the liver except:

A) antihemophilic factor (AHF).
B) factor I.
C) vWF.
D) factor VII.

Question 18

Which of the following are not at risk for developing cytomegalovirus (CMV) via CMV-positive blood products?

A) CMV-positive heart transplant recipients
B) CMV-negative pregnant women
C) CMV-negative bone marrow transplant recipients
D) CMV-negative premature infants

Question 19

The pathological cause of a decreased red blood cell mass include(s):

A) compromised bone marrow production.
B) decreased red blood cell survival.
C) bleeding as a result of trauma.
D) all of the above.

Question 20

Which of the following is not a function of the hospital transfusion committee?

A) FDA certification
B) Reviewing transfusion reactions
C) Submitting reports of committee recommendations to medical staff
D) Ensuring proper procedures are upheld by hospital personnel

Question 21

Hemophilia A is clinically apparent when the factor VIII level is less than:

A) 20%
B) 10%
C) 50%
D) 60%

Question 22

Which of the following methods provides the purest factor VIII concentrates?

A) Anion exchange chromatography
B) Monoclonal antibody purification
C) DNA technology
D) Pasteurization

Question 23

What is used to anticoagulate the shed blood obtained from intraoperative salvage?

A) EDTA
B) Citrate
C) Heparin
D) Citrate and heparin

Question 24

Which of the following is an indication for plasma transfusion in a patient who has been massively transfused?

A) PT = 12 seconds
B) PTT greater than 60 seconds
C) Fibrinogen = 120 mg/dL
D) Platelets = 25,000/µL

Question 25

Why is it recommended that factor VIII concentrates be used in patients with von Willebrand's disease?

A) Because of the variability in vWF content.
B) Because of factor VIII's short half-life.
C) Factor VIII concentrates are reserved for hemophiliacs.
D) All of the above.

Question 26

How is the whole blood that is collected from a donor different from whole blood circulating in someone's blood vessels?

A) The anticoagulant in donor blood prevents activation of the coagulation system.
B) The citrate mixed with donor blood serves as substrate for red blood cell metabolism.
C) The pH of whole blood is higher in collected units than in blood vessels.
D) Immunogenicity is diminished in collected units.

Question 27

What whole blood component contained in pheresed granulocyte concentrate warrants crossmatching of this product?

A) White blood cells
B) Red blood cells
C) Platelets
D) Plasma

Question 28

How does 25% albumin induce diuresis in liver disease patients?

A) Albumin inactivates antidiuretic hormone in diabetics.
B) Albumin solution acts with diuretic drugs to concentrate plasma driving water into extravascular spaces.
C) Albumin solution acts with diuretics and brings extravascular water into vascular space to dilute albumin.
D) None of the above

Question 29

What is the expiration on washed red blood cells?

A) 35 days
B) 24 hours
C) 42 days
D) 6 hours

Question 30

What is the corrected platelet increment for a patient with a body surface area of 2.7 m², an initial count of 15,000 per µL, and a 1-hour post-transfusion platelet count of 80,000 per µL given one apheresed platelet component?

A) 53,182 per µL
B) 58,500 per µL
C) 31,900 per µL
D) 5,000 per µL

Question 31

In addition to nonhemolytic febrile transfusion reactions, what other indication exists for washed red blood cells?

A) IgM-deficient patients with anti-IgM
B) IgE-deficient patients with anti-IgE
C) IgA-deficient patients with anti-IgA
D) IgG-deficient patients with anti-IgG

Question 32

Why is it essential that irradiated blood components be used in bone marrow transplant recipients?

A) Irradiation counteracts the effects of neutrophil toxicity.
B) Bone marrow recipients demonstrate hyperimmunity to lymphocytes.
C) Bone marrow recipients are on immunosuppressive therapy.
D) None of the above

Question 33

Who is at risk for transfusion-associated graft-versus-host disease (TAGVHD)?

A) Hodgkin's lymphoma patients
B) Bone marrow transplant recipients
C) Persons receiving nonirradiated directed donations
D) All of the above

Question 34

A blood component should be transfused within:

A) 1 hour.
B) 2 hours.
C) 3 hours.
D) 4 hours.

Question 35

Platelets prepared from_____ are referred to as random donor platelets.

A) recovered plasma
B) pheresis products
C) whole blood units
D) red blood cells

Question 36

Immunoglobulin prepared from pooled plasma is primarily:

A) IgG
B) IgM
C) IgA
D) IgE

Question 37

Which class of vWD provides the least amount of vWF?

A) Type I
B) Type IIB
C) Type III
D) Type IIA

Question 38

In what disease state is acquired antithrombin III deficiency manifested?

A) DIC
B) von Willebrand's disease
C) Liver disease
D) Lupus erythematosus

Question 39

Persons making pre-deposit donations for planned surgery will take iron supplements to replenish iron and stimulate:

A) myelopoiesis.
B) erythropoiesis.
C) thrombopoiesis.
D) lymphopoiesis.

Question 40

Cryoprecipitated AHF can be used in the treatment of:

A) Bernard-Soulier syndrome.
B) von Willebrand's disease (vWD).
C) antithrombin III deficiency.
D) hemolytic uremic syndrome.

Question 41

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

A) Pasteurization
B) Nanofiltration
C) Solvent detergent
D) All of the above

Question 42

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

A) Acute hemolytic transfusion reaction
B) Volume overload
C) Delayed hemolytic transfusion reaction
D) Urticarial reaction

Question 43

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

A) VIII concentrate
B) Fresh frozen plasma
C) Cryoprecipitate
D) DDAVP (1-Deamino-8-arginine vasopressin)

Question 44

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

A) I, V, VII, IX
B) II, V, VII, IX
C) II, VII, IX, X
D) V, VII, IX, XII

Question 45

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?

A) Plasma
B) Whole blood
C) Red blood cells
D) Platelets

Question 46

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?

A) Intraoperative hemodilution
B) Pre-deposit donation
C) Intraoperative salvage
D) Postoperative salvage

Question 47

What is the immunologic principle of RhIG administration?

A) Anti-D attaches to Rh-positive cells of mother and are subsequently removed by cells of the reticuloendothelial system, preventing sensitization.
B) 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.
C) Anti-D attaches to Rh-negative cells of the infant in maternal circulation and are subsequently removed by cells of the reticuloendothelial system, preventing sensitization.
D) None of the above

Question 48

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

A) Irradiation
B) Cytomegalovirus testing
C) Hgb S testing
D) Epstein-Barr virus testing

Question 49

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

A) Leukopoor
B) 170 µm
C) 100 µm
D) 50 µm

Question 50

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?

A) Patient's hematocrit would be equally affected.
B) The packed RBCs would increase the hematocrit more than the whole blood.
C) The whole blood would increase the hematocrit more than the packed RBCs.
D) The hematocrit would not change at all with the whole blood because of the plasma in the unit.

Question 51

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

A) Factor VIII
B) Factor V
C) Factor XI
D) All of the above

Question 52

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

A) Recombinant hepatitis B purified protein
B) Plasma donors whose sera are devoid of hepatitis B antibody
C) Plasma donors whose sera demonstrate a high titer of hepatitis B antibody
D) None of the above

Question 53

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

A) I, VII, IX, X
B) I, V, IX, X
C) II, VII, IX, X
D) II, VII, XI, XII

Question 54

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

A) Pregnant woman
B) Middle-aged male
C) 25-year-old female
D) Neonate

Question 55

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?

A) The anemia is compensated.
B) The anemia is a "nutritional anemia."
C) Whole blood is recommended because the plasma volume is decreased in these patients.
D) None of the above

Question 56

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

A) nonfebrile hemolytic transfusion reactions.
B) febrile hemolytic transfusion reactions.
C) febrile nonhemolytic transfusion reactions.
D) nonfebrile nonhemolytic transfusion reactions.

Question 57

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

A) The shelf-life is 35 days.
B) The AS-1 unit contains more plasma than the CPDA-1 red blood cells.
C) Red blood cell mass is lower than that of CPDA-1 red blood cells.
D) The hematocrit is lower than CPDA-1 red blood cells.

Question 58

The rejection of platelets in multiply transfused patients is called:

A) platelet satellitism.
B) stimulation.
C) refractoriness.
D) urticaria.

Question 59

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

A) Thrombocytopenia with bleeding or invasive procedure
B) Disseminated intravascular coagulation
C) Chemotherapy for malignancy
D) Massive transfusion, platelet count 250,000/µL

Question 60

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

A) Blood volume adjustment is less when red blood cells are transfused.
B) Blood volume adjustment is greater when red blood cells are transfused.
C) Whole blood takes longer to mix.
D) Whole blood is usually transfused through a porous filter.

Question 61

Which of the following criteria warrants a granulocyte concentrate transfusion?

A) A neutrophil count greater than 1,000 per µL
B) A septic patient unresponsive to antibiotics
C) Bone marrow hyperplasia
D) None of the above

Question 62

What is the most efficient way to remove leukocytes from red blood cell units?

A) Leukoreduction filters
B) Centrifugation
C) Deglycerolizing
D) Washing

Question 63

Why is thrombocytopenia a manifestation of a massive transfusion?

A) Platelets are diluted by resuscitation fluids and stored blood.
B) Platelets are refractory to infused blood.
C) Platelets are sequestered in the spleen due to abnormal hemodynamics.
D) None of the above

Question 64

All of the following are characteristics of protein C except:

A) it has a vitamin K dependent factor.
B) it has a serine protease inhibitor.
C) it enhances factors V and VIII.
D) it produces a hypercoagulable state.

Question 65

Antithrombin III concentrates are used in the treatment of:

A) dysfibrinogenemia.
B) acquired antithrombin III deficiency caused by DIC.
C) hereditary antithrombin III deficiency caused by venous thrombosis.
D) All of the above

Question 66

Neonatal exchange transfusion is performed using which blood preservative?

A) AS-1
B) Citrate-phosphate-dextrose (CPD)
C) Citrate-phosphate-dextrose adenine (CPDA-1)
D) Both B and C can be safely used

Question 67

Which blood product is used in the treatment of DIC?

A) Plasma
B) Platelets
C) Cryoprecipitate
D) All of the above

Question 68

Each cryoprecipitate unit contains at least how much factor VIII?

A) 80 units
B) 50 units
C) 30 units
D) 100 units

Question 69

A patient with hypofibrinogenemia is receiving cryoprecipitate on an outpatient basis. His plasma volume is 4,000 mL, and his physician wants to increase factor I from 40 mg/dL to 120 mg/dL. How many bags of cryoprecipitate are needed?

A) 8
B) 13
C) 15
D) 21

Question 70

A patient with paroxysmal cold hemoglobinuria (PCH) would require _____ in the event of a blood transfusion.

A) irradiation
B) cytomegalovirus-negative units
C) a blood warmer
D) Hgb S-negative units

Question 71

Cryoprecipitate is not used to treat which condition?

A) Hemophilia A
B) von Willebrand's disease
C) Hemophilia B
D) Hypofibrinogenemia

Question 72

What disease state may require exogenous fibrinogen replacement?

A) Disseminated intravascular coagulation
B) Liver failure
C) Congenital fibrinogen deficiency
D) All of the above

Question 73

Cryoprecipitate AHF contains how much fibrinogen?

A) 500 to 750 mg
B) 50 to 100 mg
C) 150 to 250 mg
D) 250 to 400 mg

Question 74

How is cryoprecipitated AHF used with prosthetic vascular grafts?

A) Bovine thrombin activates factor XIII, which acts as a fibrin solvent to prime grafts.
B) Bovine thrombin activates factor VIII, which acts as a fibrin glue to seal gaps.
C) Bovine thrombin activates fibrinogen, which acts as a fibrin glue to seal gaps.
D) None of the above

Question 75

How can GVHD be prevented in transplant recipients?

A) Filtering of cellular components
B) Irradiation of cellular components
C) Deglycerolizing of cellular components
D) None of the above

Question 76

A 160-pound man was transfused with 1 unit of whole blood after being rescued from a burning apartment building. His hematocrit was determined to be 27% before transfusion. What would you expect his hematocrit to be in 48 hours?

A) 28%
B) 30%
C) 40%
D) 45%

Question 77

Which of the following represents the final clerical check of a transfusion?

A) The phlebotomist asks the patient to state his name and Social Security number and compares that information with the patient requisition.
B) The medical technologist compares the specimen label with computer information.
C) The nurse uses the patient's armband to compare patient identification with the patient crossmatch report and tags attached to the unit.
D) Two individuals verify affixing of proper labels to selected blood products.

Question 78

Which intravenous solution is not recommended for dilution of blood components because of red blood cell damage?

A) 0.9% saline
B) Dextrose
C) 5% albumin
D) Plasma

Question 79

What is the only blood component that provides high concentrations of vWF?

A) FFP
B) Whole blood
C) Platelets
D) Cryoprecipitated AHF

Question 80

All blood components should be transfused within what time period to avoid bacterial contamination issues?

A) 4 hours
B) 6 hours
C) 8 hours
D) 24 hours