Question 1

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

Accepted Answer

Increased bilirubin is an indicator of acute immune hemolytic transfusion reaction because it is a byproduct of the breakdown of red blood cells, which occurs during such reactions.

Question 2

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

Accepted Answer

While the other three options are essential in the treatment of an anaphylactic or anaphylactoid reaction, administering PPF (prothrombin complex concentrate) is not typically indicated. Epinephrine is the primary treatment for anaphylaxis and should be given immediately. Stopping the transfusion and keeping the IV line open with normal saline are also necessary steps to take.

Question 3

What treatment is recommended following a bacterial contamination reaction?

Accepted Answer

The recommended treatment for bacterial contamination is broad-spectrum antibiotics. Antibiotics can be used to kill or inhibit the growth of bacteria, helping to prevent further spread of the infection. Plasma protein fraction (PPF) is a blood product that is used to treat certain medical conditions, but it is not an appropriate treatment for bacterial contamination. Aspirin and epinephrine are medications that are used to treat pain and allergic reactions, respectively, and are not appropriate treatments for bacterial contamination.

Question 4

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

Accepted Answer

Febrile reactions are the most common transfusion reactions reported to blood banks, accounting for up to 50% of all transfusion reactions. These reactions are generally mild, presenting with fever, chills, and rigors, and are thought to be caused by antibodies in the recipient's plasma reacting with leukocytes in the donated blood. Anaphylactic reactions, intravascular hemolytic reactions, and extravascular hemolytic reactions are much less common but have more severe consequences.

Question 5

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

Accepted Answer

A negative direct antiglobulin test (DAT) indicates absence of immunoglobulins or complement bound to the patient’s red blood cells. Acute immune hemolytic transfusion reactions are associated with a positive DAT, as it is caused by recipient antibodies reacting with donor antigens. Nonimmune transfusion reactions are associated with a negative DAT. Acute nonimmune hemolytic transfusion reactions are caused by transfusion of ABO-incompatible blood and are characterized by intravascular hemolysis, fever, chills, and flank pain. Febrile nonhemolytic transfusion reactions are caused by donor leukocytes in the blood, leading to fever, chills, and headache. Transfusion-associated sepsis is caused by bacterial contamination of the transfused blood and is characterized by fever, hypotension, and shock.

Question 6

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

Accepted Answer

The answer of Persons with a documented history of anaphylactic...

Question 7

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

Accepted Answer

The primary treatment goal for a patient who has suffered an acute hemolytic transfusion reaction should be to reverse hypotension and minimize renal damage. This is because these reactions can lead to life-threatening complications, such as acute kidney injury and shock. Diminishing chills and fever and making the patient comfortable should be addressed, but it is not the primary goal. Preventing alloimmunization and preventing hemoglobinemia are also important but are not the primary goal in the acute phase of treating this type of transfusion reaction.

Question 8

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

Accepted Answer

Methemalbumin levels actually increase in intravascular hemolytic reactions due to the formation of heme-albumin complexes. Choices B, C, and D are all findings associated with intravascular hemolytic reactions.

Question 9

Which of the following symptoms are consistent with hemosiderosis?

Accepted Answer

Anemia, jaundice, fatigue, and muscle weakness are all consistent with hemosiderosis, which is a condition caused by the deposition of iron in tissues such as the liver, spleen, and bone marrow. Hemoglobinuria (A) is more consistent with hemolytic anemia, while tachycardia, fever, and renal failure (B) may indicate sepsis or a more severe underlying condition. Hypotension, bloody diarrhea, renal failure, and DIC (D) are all associated with a condition called hemolytic uremic syndrome, which is caused by a type of E. coli infection.

Question 10

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

Accepted Answer

Anemia is not a symptom of an allergic reaction. The other choices, pruritus (itching), local erythema (redness), and hives (urticaria) are all common symptoms of an allergic reaction.

Question 11

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

Accepted Answer

Group O individuals have both anti-A and anti-B antibodies. If a group O patient receives group B blood, the anti-B antibodies in the patient's plasma will attack the B antigens on the transfused red cells, leading to an immediate hemolytic transfusion reaction.

Question 12

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

Accepted Answer

FNHTR is considered a "diagnosis of exclusion" because fever can be caused by many other underlying conditions, and it is necessary to rule out other possible causes before making a definitive diagnosis of a FNHTR.

Question 13

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?

Accepted Answer

The patient is experiencing an allergic reaction to the transfused blood. The appropriate treatment in this case would be antihistamines. Leukopoor blood products are not necessary unless the patient has a known history of febrile non-hemolytic transfusion reactions. Premedication with aspirin is not appropriate as it can increase the risk of bleeding in transfusion recipients.

Question 14

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

Accepted Answer

The answer of All of the following are diseases that...

Question 15

What is a cause of death in GVHD?

Accepted Answer

The most common cause of death in GVHD is infection, as the immune system is weakened and the patient is more susceptible to infections. Anemia, cardiac arrest, and renal failure can also occur, but are less common as direct causes of death in GVHD.

Question 16

The plasma level of unconjugated bilirubin is elevated in:

Accepted Answer

In both intravascular and extravascular hemolysis, the breakdown of red blood cells leads to an increase in the production of bilirubin, a byproduct of hemoglobin breakdown. This can result in elevated levels of unconjugated bilirubin in the plasma.

Question 17

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:

Accepted Answer

CThe patient's symptoms and laboratory findings suggest a delayed hemolytic transfusion reaction (DHTR). The positive direct antiglobulin test (DAT) with anti-IgG and the detection of a new antibody (anti-Jk^a) in the post-transfusion specimen that was not present in the pre-transfusion specimen indicate an immune response to transfused red cells. The incompatibility with one of the transfused units and the absence of symptoms immediately after transfusion support a delayed reaction. This can be caused by an anamnestic response (B), where the patient had been previously sensitized to the antigen and produced antibodies upon re-exposure, or by primary alloimmunization (C), where the patient is exposed to the antigen for the first time and develops antibodies.

Question 18

Which of the following statements is false?

Accepted Answer

Intravascular transfusion reactions typically involve the destruction of red blood cells within the blood vessels, often mediated by antibodies such as IgM that activate the complement system, leading to cell lysis. The phagocytosis of red blood cells by macrophages primarily occurs in extravascular reactions, not intravascular ones, where the destruction of red blood cells happens within the circulation.

Question 19

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

Accepted Answer

The answer of Which of the following results when large...

Question 20

The principle clinical signs of extravascular hemolysis include:

Accepted Answer

The answer of The principle clinical signs of extravascular hemolysis...

Quiz 17: Cellular Therapy