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Practical Self-Assessment for
Transfusion Medicine Professionals
Other related publications available from the AABB:
Practical Guide to Transfusion Medicine, 2nd edition
By Marian Petrides, MD; Gary Stack, MD, PhD;
Laura Cooling, MD, MS; and Lanne Maes, MD
Transfusion Medicine Interactive: A Case Study Approach CD-ROM
By Marian Petrides, MD; Roby Rogers, MD; and Nora Ratcliffe, MD
Transfusion Medicine: Self-Assessment and Review, 2nd edition
By Douglas P. Blackall, MD; Priscilla I. Figueroa, MD; and
Jeffrey L. Winters, MD
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Practical Self-Assessment for
Transfusion Medicine Professionals
George Leonard, MD, PhD
MAJ, MC, USA
Madigan Army Medical Center
Tacoma, WA
Michael Licata, MD
LTC, MC, USA
Landstuhl Regional Medical Center
Landstuhl, Germany
AABB Press
Bethesda, Maryland
2012
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represent an endorsement of such products by the AABB Press nor does it necessarily indicate a
preference for those products over other similar competitive products.
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of relationships with commercial firms. A copy of the policy is located at http://www.aabb.org.
The authors have disclosed no conflicts of interest.
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banking occur, changes may be recommended to the AABB Standards for Blood Banks and Transfusion
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Thus, it is essential that the most recent edition of the Standards be consulted as a reference in regard to
current acceptable practices. Second, the views expressed in this publication represent the opinions of
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AABB
8101 Glenbrook Road
Bethesda, Maryland 20814-2749
ISBN NO. 978-1-56395-832-8
Printed in the United States
Library of Congress Cataloging-in-Publication Data
Leonard, George, MD.
Practical self-assessment for transfusion medicine professionals / George Leonard, Michael Licata.
p. ; cm.
ISBN 978-1-56395-832-8
I. Licata, Michael, MD. II. AABB. III. Title.
[DNLM: 1. Blood Transfusion—Examination Questions. 2. Blood Physiological Phenomena—Examination Ques-
tions. WB 18.2]
615.3’9
—dc23
2012020204
AABB Press
Editorial Board
Miguel Lozano, MD, PhD
Richard J. Davey, MD
Susan T. Johnson, MSTM, MT(ASCP)SBB
Marisa B. Marques, MD
Sally V. Rudmann, PhD, MT(ASCP)SBB
John W. Semple, PhD
Yanyun Wu, MD, PhD
Table of Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1. Blood Component Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
2. Blood Component Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
3. Pretransfusion Compatibility Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
4. Carbohydrate Blood Group Antigens and Collections . . . . . . . . . . . . . . . . . .31
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
5. Polypeptide Blood Group Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
6. Administration of Blood Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
viii PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
7. Adverse Effects of Transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
8. Indications for Transfusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
9. Autologous Blood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
10. Erythropoietin, Blood Substitutes, and Enzymatically Converted
Red Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
11. Special Transfusion Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
12. Transfusion Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
13. Plasma Derivatives and Recombinant Plasma Proteins. . . . . . . . . . . . . . . . .151
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
14. Therapeutic Apheresis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
15. Managing a Hospital Transfusion Service. . . . . . . . . . . . . . . . . . . . . . . . . . .187
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
Preface
The AABB Press book Practical Guide to Transfusion Medicine was received by
pathology staff, residents, and technologists with open arms from the moment it was
released. Prior to the publication of Practical Guide, students relied primarily on the
AABB Technical Manual as their standard reference text. However, for some, delv-
ing into the Technical Manual proved to be overwhelming. In contrast, the accessi-
ble style and high-yield content of Practical Guide was particularly attractive to
residents who would be faced with on-call transfusion issues, clinical transfusion
service rotations, and eventually the clinical pathology board exam.
As the authors of that volume explained, it was a book they wished was available
during their early careers. Those of us lucky enough to benefit from the book have
prospered. However, there has been no clear way to evaluate a student’s progress in
learning the material. From the need for evaluation the seeds of Practical Self-Assess-
ment for Transfusion Medicine Professionals were planted.
The questions in the present volume were written by residents who, like so many of
our colleagues, struggled through transfusion medicine rotations and ultimately took
and passed the clinical pathology board exam. Both authors became interested in
blood banking and subsequently became medical directors of transfusion services at
their respective hospitals.
It is the authors’ intent that these question-and-answer pairs are used in the same
manner in which they were conceived—to evaluate retention of the material cov-
ered in Practical Guide. We will be very pleased if this resource incites in readers an
interest in the dynamic world of transfusion medicine.
George Leonard, MD, PhD
Michael Licata, MD
About the Authors
George Leonard, MD, PhD, is an Assistant Professor of Pathology at the Uniformed
Services University of Health Sciences, Bethesda, MD, and the Chief of Anatomic
Pathology at Madigan Healthcare System in Tacoma, WA. He earned his undergrad-
uate BS from the University of Cincinnati in Biology with certification in Business
Spanish then received his PhD in Biochemistry from Case Western Reserve Univer-
sity with laboratory research at the Cleveland Clinic. Following graduate school he
pursued post-doctoral research at Oregon Health and Sciences University where he
also earned his MD degree. After residency in Anatomic and Clinical Pathology in
the National Capital Consortium he became Medical Director of Transfusion Ser-
vices at Walter Reed Army Medical Center and Staff Pathologist at Walter Reed
Army Medical Center and the National Naval Medical Center. He completed a fel-
lowship in Molecular Genetic Pathology at Oregon Health and Sciences University
and has been practicing academic medicine since. Dr. Leonard is board-certified in
Anatomic and Clinical Pathology as well as Molecular Genetic Pathology.
Dr. Leonard has an interest in education and has published several books geared
toward preparing residents for the clinical pathology and molecular genetic pathol-
ogy board exams. He has lectured at the Osler Institute Pathology Review Course
and is currently the chairman of the Reference Textbook Committee for the Ameri-
can Society of Clinical Pathology.
Michael Licata, MD, is the Chief of Clinical Pathology at Landstuhl Regional Medi-
cal Center in Landstuhl, Germany, and Laboratory Director for four military hospi-
tals in Italy and Belgium. He received his Bachelor’s Degree in Biology and
Chemistry from the University of Delaware, his Masters Degree in Biochemistry
from the University of Texas at Austin, and his Medical Degree from the Uniformed
Services University of the Health Sciences. He completed his residency in Anatomi-
cal and Clinical Pathology at the Walter Reed Army Medical Center in Washington,
DC. After completion of residency, he served as the Chief of Pathology for the
DeWitt Army Healthcare Network in Fort Belvoir, VA.
Dr. Licata is a fellow of the College of American Pathologists and has served as a
Team Leader for CAP inspections in the United States and Europe. He has been
involved in BK virus research in renal transplant patients and is currently involved in
studying fungal infections in military amputees.
In: Leonard G, Licata M.
Practical Self-Assessment for Transfusion Medicine Professionals
Bethesda, MD: AABB Press, 2012
1
Blood Component Preparation
QUESTIONS
Question 1: Testing for which of the following infectious disease markers is NOT
currently required during the screening of donor blood units?
A. Anti-HIV-1 and -2; HIV-1 NAT.
B. Anti-HBc; HBsAg.
C. Anti-HCV and HCV NAT.
D. Anti-CMV.
E. Anti-HTLV-I and -II.
________________________________ ________________________________
夝
Question 2: Screening tests are not available for all transfusion-transmissible agents.
For some agents, the donor history should be consulted to determine if a blood
donor should be excluded. Which of the following diseases is NOT regularly
included in donor history questioning?
A. Malaria.
B. Filariasis.
C. Babesiosis.
D. Chagas’ disease.
E. Variant CJD.
________________________________ ______________________ __________
夝
Question 3: What is the maximum amount of the donor’s estimated blood volume
that can be withdrawn?
A. 5%
B. 10%
C. 15%