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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5565_Библиотеки_им_академика_М_И_Перельмана.pdf
In: Leonard G, Licata M.
Practical Self-Assessment for Transfusion Medicine Professionals
Bethesda, MD: AABB Press, 2012
13
Plasma Derivatives and Recombinant
Plasma Proteins
QUESTIONS
Question 1: Plasma derivatives are typically obtained from plasma pooled from
large amounts. What is the approximate amount of plasma that is pooled?
A. Liters.
B. Tens of liters.
C. Hundreds of liters.
D. Thousands of liters.
E. Gazillions of liters.
________________________________ ________________________________
夝
Question 2: Which of the following is NOT a plasma derivative?
A. Albumin.
B. Factor IX concentrate.
C. Antithrombin.
D. Rh Immune Globulin.
E. Autologous platelet gel.
________________________________ ________________________________
夝
Question 3: Of the plasma derivatives purified from plasma concentrates, which is
the least stable?
A. Factor V.
B. Factor VII.
C. Factor VIII.
152 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
D. Immunoglobulin.
E. Factor II.
________________________________ _______________________________
夝
Question 4: Cryoprecipitation is used to prepare concentrates of factors. Which of
the following factors will preferentially precipitate in the cold?
A. Factor VII.
B. Factor II.
C. Factor IX.
D. von Willebrand Factor.
E. Factor X.
________________________________ _______________________________
夝
Question 5: Despite the current solvent/detergent-based virucidal techniques,
which virus continues to pose a significant risk of transmission through pooled
plasma?
A. HIV.
B. HCV.
C. vCJD.
D. Parvovirus B19.
E. HBV.
_____________________________ _____________________________
夝
Question 6: In which situation(s) is albumin NOT useful?
A. Shock.
B. Severe burns.
C. Acute hypoproteinemia.
D. Neonatal hyperbilirubinemia.
E. Severe anemia.
________________________________ _______________________________
夝
Question 7: Concentration of factor concentrates can be categorized. How is con-
centration measured?
A. Micrograms of factor per milligram of total protein.
B. International units of factor per milligram of total protein.
C. 1 − (total protein milligrams − milligrams of factor).
PLASMA DERIVATIVES AND RECOMBINANT PLASMA PROTEINS 153
D. 1/(total protein milligrams − milligrams of factor).
E. Milligrams of factor/volume.
________________________________ ________________________________
夝
Question 8: What is the recommended Factor VIII level for patients about to
undergo major surgery?
A. 1-10%
B. 20-30%
C. 50%
D. 50-100%
E. >100%
________________________________ ________________________________
夝
Question 9: Approximately how many IUs of Factor VIII are needed to achieve 50%
normal factor level in a 70-kg patient with pretreatment level of 10%? (Assume esti-
mated plasma volume to be 40 mL/kg.)
A. 100 IU.
B. 1000 IU.
C. 5000 IU.
D. 7500 IU.
E. 10,000 IU.
________________________________ ________________________________
夝
Question 10: What is the difference between Factor IX complex concentrate and
high-purity Factor IX?
A. The presence of albumin.
B. The presence of immunoglobulins and Factor VIII.
C. The presence of Factors II, VII, and X.
D. The presence of vWF and Factor VIII.
E. None of the above.
________________________________ ________________________________
夝
Question 11: Which of the following is NOT an acceptable treatment for bleeding
hemophiliacs with factor inhibitors?
A. Recombinant Factor VIIa.
B. Porcine Factor VIII.
154 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
C. Factor IX complex concentrate.
D. Anti-inhibitor coagulant complex.
E. Recombinant von Willebrand factor.
_____________________________ _____________________________
夝
Question 12: What is Humate-P?
A. Recombinant Factor IX.
B. Recombinant Factor VIII.
C. Recombinant vWF.
D. Factor VIII concentrate.
E. Factor VIII/IX concentrate.
________________________________ _______________________________
夝
Question 13: Which of the following has NOT proven efficacy in the treatment of
bleeding hemophilic patients with Factor VIII or IX inhibitors?
A. Porcine Factor VIII.
B. Cryoprecipitated AHF.
C. Anti-Inhibitor Coagulant Complex (AICC).
D. Recombinant Factor V.
E. Factor VIIa.
________________________________ _______________________________
夝
Question 14: Which of the following factors is inhibited by antithrombin?
A. Factor VIII.
B. Factor IIa.
C. Factor VIIa.
D. Factor V.
E. Factor XIIIa.
________________________________ _______________________________
夝
Question 15: What factor does fondaparinux directly inhibit?
A. Activated Factor VIIIa.
B. Activated Factor IXa.
C. Activated Factor Xa.
D. Activated Factor Xia.
E. Activated Factor XIIa.
PLASMA DERIVATIVES AND RECOMBINANT PLASMA PROTEINS 155
________________________________ ________________________________
夝
Question 16: Why shouldn’t intramuscular formulations of immune globulins be
administered intravenously?
A. The concentration is too high.
B. The concentration is too low.
C. They contain complement-activating aggregates of immunoglobulins.
D. There is a unique slow-dispersal compound present in the intramuscular for-
mulation that is toxic if administered in the bloodstream.
E. They are inactivated by muscle glycophorase.
________________________________ ________________________________
夝
Question 17: For which of the following viruses is prophylactic intramuscular
immune globulin used?
A. Hepatitis B.
B. Cytomegalovirus.
C. Poliomyelitis.
D. Hepatitis A.
E. Mumps.
________________________________ ________________________________
夝
Question 18: Which of the following has been shown to be as effective as plasma
exchange in shortening the recovery time in patients with Guillain-Barré syndrome?
A. IMIG (immune globulin for intramuscular use).
B. IVIG (immune globulin for intravenous use).
C. RhIG.
D. Albumin.
E. Watchful waiting.
________________________________ ________________________________
夝
Question 19: How do hyperimmune globulins induce post-exposure protection?
A. Induce anamnestic responses.
B. Provide active immunity.
C. Provide passive immunity.
D. Increase protein concentration.
E. Stimulate the cell-mediated immune response.
156 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
________________________________ _______________________________
夝
Question 20: Rh Immune Globulin is available in both IM and IV forms. For which
of the following applications is the IM form used?
A. Treatment of childhood acute ITP.
B. Treatment of chronic ITP.
C. Treatment of HIV-related ITP.
D. Suppression of Rh alloimmunization.
E. Treatment of heparin-induced thrombocytopenia.
________________________________ _______________________________
夝
Question 21: What is the preferred administrative schedule for IV RhIG in an Rh-
negative pregnant patient?
A. 18 weeks’ gestation and within 24 hours of delivery of an Rh-positive infant.
B. 26 to 28 weeks’ gestation and within 72 hours of delivery of an Rh-positive infant.
C. 26 to 28 weeks’ gestation and within 2 weeks of delivery of an Rh-positive infant.
D. 26 to 28 weeks’ gestation and within 2 weeks of delivery of an Rh-negative infant.
E. After 28 weeks’ gestation only.
________________________________ _______________________________
夝
Question 22: What is the approximate cutoff point for gestational age when a mini-
dose of IV RhIG can be administered in a patient who has had an abortion?
A. 1st week.
B. 5th week.
C. 12th week.
D. 28th week.
E. After 28 weeks only.
________________________________ _______________________________
夝
Question 23: Fibrin sealant is a mixture of which two factors?
A. Fibrinogen and thrombin.
B. Fibrin and Factor VII.
C. Thrombin and prothrombin.
D. Factor IX and fibrinogen.
E. Protein C and protein S.
PLASMA DERIVATIVES AND RECOMBINANT PLASMA PROTEINS 157
________________________________ ________________________________
夝
Question 24: Both G-CSF and GM-CSF can be used to stimulate the proliferation of
granulocyte precursors. What is the benefit of using G-CSF over GM-CSF?
A. G-CSF will also stimulate the monocyte, erythroid, and megakaryocytic lin-
eages.
B. G-CSF is less toxic than GM-CSF.
C. G-CSF is produced from human cells, whereas GM-CSF is not.
D. G-CSF is made from recombinant technology, GM-CSF is made from purifica-
tion of human sera.
E. GM-CSF promotes the development of leukemia.
________________________________ ________________________________
夝
ANSWERS
Question 1: Plasma derivatives are typically obtained from plasma pooled from
large amounts. What is the approximate amount of plasma that is pooled?
A. Liters.
B. Tens of liters.
C. Hundreds of liters.
D. Thousands of liters.
E. Gazillions of liters.
D. Thousands of liters are pooled to make highly purified protein preparations. For
this reason it is important to minimize their use because they present a significant
exposure to patients.
________________________________ ________________________________
夝
Question 2: Which of the following is NOT a plasma derivative?
A. Albumin.
B. Factor IX concentrate.
C. Antithrombin.
D. Rh Immune Globulin.
E. Autologous platelet gel.
E. The first four products are plasma derivatives. Platelet gel is prepared from plate-
let-rich plasma, thrombin, and calcium or other activator.
158 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
________________________________ _______________________________
夝
Question 3: Of the plasma derivatives purified from plasma concentrates, which is
the least stable?
A. Factor V.
B. Factor VII.
C. Factor VIII.
D. Immunoglobulin.
E. Factor II.
C. The least stable prepared factor is Factor VIII. For that reason it is typically pre-
pared from the rapidly frozen plasma of paid plasmapheresis donors. Factor V is also
one of the more labile coagulation factors in plasma, but not as much as Factor VIII.
________________________________ _______________________________
夝
Question 4: Cryoprecipitation is used to prepare concentrates of factors. Which of
the following factors will preferentially precipitate in the cold?
A. Factor VII.
B. Factor II.
C. Factor IX.
D. von Willebrand Factor.
E. Factor X.
D. Factor VIII and von Willebrand factor preferentially precipitate in the cold. The
other factors remain in the supernatant and can be subsequently purified by extrac-
tion techniques.
________________________________ _______________________________
夝
Question 5: Despite the current solvent/detergent-based virucidal techniques,
which virus continues to pose a significant risk of transmission through pooled
plasma?
A. HIV.
B. HCV.
C. vCJD.
D. Parvovirus B19.
E. HBV.
D. Techniques employed now can inactivate most viruses. Solvent-detergent treat-
ment destroys enveloped viruses and neither Hepatitis A nor parvovirus have enve-
PLASMA DERIVATIVES AND RECOMBINANT PLASMA PROTEINS 159
lopes. There have been also been outbreaks of HCV and HBV, but they are much
less common. The agent of vCJD is a prion, not a virus.
________________________________
_____________________________
夝
Question 6: In which situation(s) is albumin NOT useful?
A. Shock.
B. Severe burns.
C. Acute hypoproteinemia.
D. Neonatal hyperbilirubinemia.
E. Severe anemia.
E. The first four conditions presented have been treated with albumin. However,
studies have shown that crystalloid rather than colloid is the preferred resuscitation
fluid in shock patients. Albumin is contraindicated in patients with severe anemia or
cardiac failure in the presence of normal or increased intravascular volume.
________________________________ ________________________________
夝
Question 7: Concentration of factor concentrates can be categorized. How is con-
centration measured?
A. Micrograms of factor per milligram of total protein.
B. International units of factor per milligram of total protein.
C. 1 − (total protein milligrams − milligrams of factor).
D. 1/(total protein milligrams − milligrams of factor).
E. Milligrams of factor/volume.
B. The concentration (sometimes referred to as purity) of a factor is the activity of
that factor per total amount of protein. Purity is categorized as low, intermediate,
high, and very high. “Ultrapure” refers to synthetic recombinant factor preparations.
________________________________ ________________________________
夝
Question 8: What is the recommended Factor VIII level for patients about to
undergo major surgery?
A. 1-10%
B. 20-30%
C. 50%
D. 50-100%
E. >100%
160 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
D. For minor bleeding the recommended levels are 20-50%; however, in the case of
major surgery with a more than significant chance of bleeding, it is recommended
that a patient has 50-100% factor levels.
________________________________ _______________________________
夝
Question 9: Approximately how many IUs of Factor VIII are needed to achieve 50%
normal factor level in a 70-kg patient with pretreatment level of 10%? (Assume esti-
mated plasma volume to be 40 mL/kg.)
A. 100 IU.
B. 1000 IU.
C. 5000 IU.
D. 7500 IU.
E. 10,000 IU.
B. There is 1 IU of each coagulation factor in 1 mL of plasma (assuming 100%
recovery).
For a 70-kg person the estimated plasma volume would be 2800 mL @ the 40 mL/kg
provided. Multiply the result by the amount of factor needed (0.50 − 0.10) gives
1120 IU needed.
Calculating estimated plasma volume (EPV):
• EPV = (1 − Hct) × Estimated blood volume (EBV).
• The EBV is 70 mL/kg for an average adult male. The EBV is different for
infants (90 mL/kg), children (80 mL/kg), and adult women (65 mL/kg).
________________________________ _______________________________
夝
Question 10: What is the difference between Factor IX complex concentrate and
high-purity Factor IX?
A. The presence of albumin.
B. The presence of immunoglobulins and Factor VIII.
C. The presence of Factors II, VII, and X.
D. The presence of vWF and Factor VIII.
E. None of the above.
C. The differences are not just esoteric. Due to the presence of other vitamin-K-
dependent factors in Factor IX complex, it has been used to rapidly reverse warfarin,
promote hemostasis in hemophilia A and B patients with factor inhibitors, and in the
treatment of patients with congenital Factor VII deficiency. Although the dosage of
Factor IX follows the same calculations as the other factors, Factor IX is distributed