Question 1

Which of the following criteria warrants a granulocyte concentrate transfusion?

Accepted Answer

Granulocyte concentrate transfusion is indicated for septic patients who are unresponsive to antibiotics. A neutrophil count >1000/µL and bone marrow hyperplasia alone are not criteria for granulocyte concentrate transfusion.

Question 2

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

Accepted Answer

Leukoreduction filters are the most efficient and widely used method for removing leukocytes from red blood cell units. They can remove up to 99.9% of leukocytes, without affecting the red blood cells or other cellular components. Centrifugation and washing can also remove leukocytes, but are less efficient and may have negative impacts on the quality and function of the red blood cells. Deglycerolizing is a process used to remove glycerol from frozen red blood cell units before transfusion and does not have any impact on leukocytes.

Question 3

Why is thrombocytopenia a manifestation of a massive transfusion?

Accepted Answer

Thrombocytopenia is a common manifestation of massive transfusion due to dilution of platelets in resuscitation fluids and stored blood. This results in a decreased platelet count leading to an increased risk of bleeding.

Question 4

All of the following are characteristics of protein C except:

Accepted Answer

Protein C, when activated, actually inactivates factors V and VIII, thereby playing a crucial role in anticoagulation and preventing excessive clot formation, not enhancing them.

Question 5

Antithrombin III concentrates are used in the treatment of:

Accepted Answer

Antithrombin III concentrates are primarily used to treat hereditary antithrombin III deficiency, which can lead to venous thrombosis.

Question 6

Neonatal exchange transfusion is performed using which blood preservative?

Accepted Answer

Both Citrate-phosphate-dextrose (CPD) and Citrate-phosphate-dextrose adenine (CPDA-1) are suitable preservatives for blood used in neonatal exchange transfusions. CPD acts as an anticoagulant and preserves the blood, while CPDA-1 also contains adenine, which further extends the shelf life of the stored blood by supporting the red blood cells' energy needs.

Question 7

Which blood product is used in the treatment of DIC?

Accepted Answer

All of the above blood products can be used in the treatment of DIC as they address different aspects of the condition. Plasma can replenish clotting factors and inhibitors, platelets can help with clot formation, and cryoprecipitate can provide fibrinogen and other clotting factors. Therefore, using multiple blood products can be beneficial in appropriately treating DIC.

Question 8

Each cryoprecipitate unit contains at least how much factor VIII?

Accepted Answer

The answer of Each cryoprecipitate unit contains at least how...

Question 9

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?

Accepted Answer

One unit of cryoprecipitate contains approximately 150 mg of fibrinogen. To increase the factor I level from 40 mg/dL to 120 mg/dL in 4,000 mL of plasma, a total of 240 grams of fibrinogen is needed (80 mg/dL x 4,000 mL = 320,000 mg or 320 g). Therefore, approximately 1,600 mL (240 g ÷ 150 mg per unit = 1,600 mL) of cryoprecipitate is needed. Since each bag of cryoprecipitate is typically 50 mL, a total of approximately 32 bags (1,600 mL ÷ 50 mL per bag = 32) of cryoprecipitate are needed. Since the patient is receiving cryoprecipitate on an outpatient basis, it may be more practical to administer the cryoprecipitate in several smaller doses rather than all at once. Therefore, the closest answer choice is 13 (since 13 bags of cryoprecipitate would provide approximately 650 mL, which could be given in smaller doses).

Question 10

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

Accepted Answer

PCH involves the destruction of red blood cells upon exposure to cold temperatures. Using a blood warmer during transfusion helps prevent the cold-induced hemolysis characteristic of this condition.

Question 11

Cryoprecipitate is not used to treat which condition?

Accepted Answer

Cryoprecipitate is used to treat conditions associated with low levels of fibrinogen, factor VIII, factor XIII, von Willebrand factor, and fibronectin. Hemophilia B, however, is caused by a deficiency of factor IX, which is not present in cryoprecipitate.

Question 12

What disease state may require exogenous fibrinogen replacement?

Accepted Answer

- Disseminated intravascular coagulation (DIC) is a condition where clotting proteins and platelets are used up rapidly, leading to bleeding. Fibrinogen replacement is used to correct clotting abnormalities.
- Liver failure can cause a decrease in production of clotting factors, including fibrinogen, and replacement may be necessary.
- Congenital fibrinogen deficiency is a rare genetic disorder that results in a lack or dysfunction of fibrinogen, requiring exogenous replacement.

Question 13

Cryoprecipitate AHF contains how much fibrinogen?

Accepted Answer

Cryoprecipitate AHF typically contains 150 to 250 mg of fibrinogen per unit.

Question 14

How is cryoprecipitated AHF used with prosthetic vascular grafts?

Accepted Answer

Cryoprecipitated AHF is rich in fibrinogen, which, when activated by bovine thrombin, forms a fibrin glue. This glue is used to seal gaps in prosthetic vascular grafts, enhancing their integration and reducing the risk of leaks.

Question 15

How can GVHD be prevented in transplant recipients?

Accepted Answer

The answer of How can GVHD be prevented in transplant...

Question 16

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?

Accepted Answer

A single unit of whole blood transfusion typically raises the hematocrit by about 3% in a 70 kg (approximately 154 pounds) adult. Given the man's weight is close to 70 kg and his initial hematocrit was 27%, an increase to approximately 30% is expected.

Question 17

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

Accepted Answer

The final clerical check of a transfusion involves the nurse using the patient's armband to compare patient identification with the patient crossmatch report and tags attached to the unit. This step ensures that the correct blood product is being given to the correct patient. Although the other options involve important checks, they do not represent the final clerical check of the transfusion.

Question 18

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

Accepted Answer

Dextrose solutions are not recommended for dilution of blood components because they can cause red blood cell damage due to osmotic changes.

Question 19

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

Accepted Answer

Cryoprecipitated AHF (Antihemophilic Factor) is rich in von Willebrand factor (vWF), fibrinogen, factor VIII, factor XIII, and fibronectin, making it the only blood component among the options listed that provides high concentrations of vWF.

Question 20

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

Accepted Answer

Blood components should be transfused within 4 hours to minimize the risk of bacterial contamination and ensure patient safety.

Quiz 15: Transfusion Therapy