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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5565_Библиотеки_им_академика_М_И_Перельмана.pdf
TRANSFUSION EMERGENCIES 141
________________________________ ________________________________
夝
Question 8: During the workup of a patient who received blood on an emergent
basis, when is additional compatibility testing unnecessary?
A. In the case of massive transfusion.
B. Patient with known antibody.
C. Parentologous transfusion.
D. Patient with hepatitis C.
E. Patients with splenomegaly.
________________________________ ________________________________
夝
Question 9: If an A-negative patient requires blood and no A-negative units are
available, which is the best second choice?
A. O-negative.
B. A-positive.
C. O-positive.
D. AB-positive.
E. Bombay phenotype.
________________________________ ________________________________
夝
Question 10: Which of the following steps is NOT recommended in the transfusion
of incompatible blood?
A. Waiver signed by treating physician.
B. Premedication with acetaminophen.
C. Premedication with corticosteroids.
D. Slow infusion of the first 50 mL.
E. Reporting to the FDA.
________________________________ ________________________________
夝
Question 11: In most cases the transfusion of Rh-negative blood is the safest choice
in emergent situations. Known Rh-positive patients should receive Rh-positive blood
if they have which antibody?
A. Anti-D.
B. Anti-E.
C. Anti-c.
D. Anti-C.
E. Anti-G.
142 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
________________________________ _______________________________
夝
Question 12: Neonatal alloimmune thrombocytopenia poses a threat to newborns
due to the significant risk of intracranial hemorrhage. What is the best source of
platelets for these infants?
A. Washed platelets from whole blood.
B. Washed maternal platelets.
C. Washed paternal platelets.
D. Washed random-donor apheresis platelets.
E. Any parentologous donation.
________________________________ _______________________________
夝
Question 13: In which thrombocytopenic setting should platelet transfusion gener-
ally be avoided?
A. Idiopathic thrombocytopenic purpura.
B. Thrombotic thrombocytopenic purpura.
C. HIV-associated thrombocytopenia.
D. Heparin-induced thrombocytopenia.
E. May-Hegglin anomaly.
________________________________ _______________________________
夝
Question 14: Which of the following is an indication for urgent plasma transfusion?
A. Emergency reversal of warfarin.
B. Emergency reversal of heparin.
C. Emergent treatment of patients with thrombin inhibitors.
D. Emergent treatment of patients with factor deficiencies.
E. Emergent treatment of idiopathic thrombocytopenia purpura.
________________________________ _______________________________
夝
ANSWERS
Question 1: Acute blood loss is classified according to percentage of total blood
loss. Which of the following is a symptom of >40% total blood loss?
A. Tachycardia >100 bpm.
B. Tachypnea.
TRANSFUSION EMERGENCIES 143
C. Markedly decreased (or absent) urinary output.
D. Cool/clammy skin.
E. Mild anxiety.
C. Anuria is a late symptom of blood loss and usually doesn’t develop until the
patient experiences Class IV hemorrhage (>40%). The other symptoms can occur
with significantly less blood loss.
________________________________ ________________________________
夝
Question 2: In acute hemorrhage, which has the highest priority?
A. Transfusion of red cells.
B. Transfusion of fresh whole blood.
C. Volume replacement with crystalloids.
D. Volume replacement with plasma.
E. Coagulation factor replacement.
C. Volume replacement with crystalloids should be given the highest priority. Loss
of volume is not well tolerated. Although red cells are needed for transport of oxy-
gen to tissues, they rely on adequate intravascular volume to circulate and deliver
oxygen. For that reason it is more important to reconstitute volume before attempt-
ing to reconstitute red cells.
________________________________ ________________________________
夝
Question 3: What is a good rule of thumb for volume of crystalloid needed to
restore intravascular volume?
A. 1 volume crystalloid to 1 volume blood loss.
B. 1 volume crystalloid to 3 volumes blood loss.
C. 3 volumes crystalloid to 1 volume blood loss.
D. 10 volumes crystalloid to 1 volume blood loss.
E. 1/2 volume crystalloid to 1 volume blood loss.
C. The crystalloids rapidly distribute between intravascular and extravascular spaces
and therefore a greater volume of crystalloid than red cells is often needed.
________________________________ ________________________________
夝
Question 4: What component of lactated Ringer’s solution makes it incompatible to
run in the same line as blood components?
A. Lactate.
B. Potassium.
144 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
C. Calcium.
D. Ammonia.
E. Citrate.
C. The calcium in lactated Ringer’s solution can overwhelm the chelating capacity
of citrate as an anticoagulant and may lead to clotting during transfusion.
________________________________ _______________________________
夝
Question 5: If uncrossmatched blood is issued for emergency release what is the
most important reason that the incomplete portions of the compatibility testing be
performed?
A. Antibody determination.
B. Antigen determination.
C. Rh determination.
D. ABO determination.
E. Accurate record keeping for inspection purposes.
A. If unexpected antibodies are found, then the donor units should be tested for anti-
gens to the corresponding antibodies to predict the extent of a potential hemolytic
reaction.
________________________________ _______________________________
夝
Question 6: What antibody is of most concern when giving non-matched O-nega-
tive RBC units?
A. Anti-c.
B. Anti-A.
C. Anti-D.
D. Anti-E.
E. Anti-M.
A. The vast majority of Rh-negative red cells will bear the c antigen; therefore, pre-
formed circulating anti-c poses the highest risk.
________________________________ _______________________________
夝
Question 7: Approximately what percentage of Rh-negative recipients will generate
an anti-D after receiving more than 200 mL of Rh-positive RBCs?
A. 5%
B. 25%
TRANSFUSION EMERGENCIES 145
C. 50%
D. 85%
E. 100%
D. Most sources report an approximately 85% seroconversion rate. For this reason,
all females of child-bearing potential should be assumed to be Rh-negative until Rh-
typed (for the prevention of hemolytic disease of the fetus and newborn).
________________________________ ________________________________
夝
Question 8: During the workup of a patient who received blood on an emergent
basis, when is additional compatibility testing unnecessary?
A. In the case of massive transfusion.
B. Patient with known antibody.
C. Parentologous transfusion.
D. Patient with hepatitis C.
E. Patients with splenomegaly.
A. With massive transfusion, hemorrhage is ongoing and the patient’s serum is
diluted with crystalloids and transfused blood components. This leads to almost
complete replacement of the recipient's circulating blood, making compatibility
testing with the recipient's original specimen unnecessary. As previously mentioned,
the most straightforward definition of massive transfusion is replacement of a
patient’s total blood volume or more within 24 hours.
________________________________ ________________________________
夝
Question 9: If an A-negative patient requires blood and no A-negative units are
available, which is the best second choice?
A. O-negative.
B. A-positive.
C. O-positive.
D. AB-positive.
E. Bombay phenotype.
A. It is better to give O-negative blood and prevent the almost certain development
of anti-D that would occur with the administration of A-positive blood.
146 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
________________________________ _______________________________
夝
Question 10: Which of the following steps is NOT recommended in the transfusion
of incompatible blood?
A. Waiver signed by treating physician.
B. Premedication with acetaminophen.
C. Premedication with corticosteroids.
D. Slow infusion of the first 50 mL.
E. Reporting to the FDA.
E. The first four choices are all correct. Incompatible blood transfusion is not
required as part of FDA error reporting, although a fatal outcome is.
________________________________ _______________________________
夝
Question 11: In most cases the transfusion of Rh-negative blood is the safest choice
in emergent situations. Known Rh-positive patients should receive Rh-positive blood
if they have which antibody?
A. Anti-D.
B. Anti-E.
C. Anti-c.
D. Anti-C.
E. Anti-G.
C. Most Rh-negative RBCs are c-positive. The c-negative phenotype occurs in a
slightly higher percentage of Rh-positive than Rh-negative RBCs.
________________________________ _______________________________
夝
Question 12: Neonatal alloimmune thrombocytopenia poses a threat to newborns
due to the significant risk of intracranial hemorrhage. What is the best source of
platelets for these infants?
A. Washed platelets from whole blood.
B. Washed maternal platelets.
C. Washed paternal platelets.
D. Washed random-donor apheresis platelets.
E. Any parentologous donation.
B. Washed maternal platelets are the best source, the collection means (apheresis or
from whole blood) is not as important. The reason is that maternal platelets will gen-
erally be compatible with the platelet alloantibody.
TRANSFUSION EMERGENCIES 147
________________________________ ________________________________
夝
Question 13: In which thrombocytopenic setting should platelet transfusion gener-
ally be avoided?
A. Idiopathic thrombocytopenic purpura.
B. Thrombotic thrombocytopenic purpura.
C. HIV-associated thrombocytopenia.
D. Heparin-induced thrombocytopenia.
E. May-Hegglin anomaly.
B. Platelet transfusion should be avoided in patients presenting with TTP. Transfused
platelets may lead to increased platelet microthrombi, which can cause multiple
organ damage. However, in the case of patients with TTP and a life-threatening
hemorrhage, there may be a role for platelet transfusion.
________________________________ ________________________________
夝
Question 14: Which of the following is an indication for urgent plasma transfusion?
A. Emergency reversal of warfarin.
B. Emergency reversal of heparin.
C. Emergent treatment of patients with thrombin inhibitors.
D. Emergent treatment of patients with factor deficiencies.
E. Emergent treatment of idiopathic thrombocytopenia purpura.
A. In addition to thrombotic thrombocytopenic purpura, the emergent reversal of
warfarin is considered one of the major indications for urgent plasma transfusion. If
type-specific plasma is not available, AB plasma should be given. The use of other
agents, such as prothrombin complex concentrate or Factor VIIa in an acutely life-
threatening hemorrhage has shown some efficacy, but the widespread use/benefit is
controversial. Protamine, rather than plasma, is used to reverse heparin. Use of
plasma in patients on heparin may actually promote heparin activity by providing
substrate.
________________________________ ________________________________
夝
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