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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5565_Библиотеки_им_академика_М_И_Перельмана.pdf
PLASMA DERIVATIVES AND RECOMBINANT PLASMA PROTEINS 161
to both the intravascular and extravascular spaces. Only 50% of administered Factor
IX is in the intravascular space, so one should double the dose.
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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.
C. Factor IX complex concentrate.
D. Anti-inhibitor coagulant complex.
E. Recombinant von Willebrand factor.
E. Von Willebrand factor is not an acceptable treatment in this case. All the other
products are acceptable. If there is a low-activity inhibitor, purified recombinant fac-
tors may be in sufficient quantity to “overwhelm” the inhibitor. Porcine factor is use-
ful if the inhibitor does not cross-react with it. If there is high-activity inhibitor, then
AICC or Factor IX complex are preferred.
________________________________
_____________________________
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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.
D. Humate-P is Factor VIII concentrate containing significant amounts of high-
molecular-weight vWF. Unlike other non-recombinant Factor VIII preparations
Humate-P is FDA-approved for the treatment of vWD. It is used in the treatment of
type IIb vWD where desmopressin (DDAVP) is contraindicated or other types of
vWD where desmopressin is ineffective.
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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).
162 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
D. Recombinant Factor V.
E. Factor VIIa.
D. Depending on the intensity of bleeding and the titer of factor inhibitors different
treatment modalities are preferred. In a patient with a low titer of inhibitor, Cryopre-
cipitated AHF is recommended as first-line therapy. However, with higher titers of
inhibitor (greater than 10 Bethesda Units), Cryoprecipitate AHF is not recommended
and the other products (with the exception of Factor V) mentioned in the question
choices have been used.
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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.
B. Factor IIa, also known as thrombin, is inhibited by antithrombin. There are sev-
eral commercially available antithrombin products that vary in their dosing. In addi-
tion to thrombin, antithrombin also inhibits Factors IXa, Xa, XIa, and XIIa. These
products should not be confused with argatroban, which is a direct thrombin inhibi-
tor and does not require antithrombin for activity.
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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.
C. Fondaparinux works through potentiating antithrombin inhibition of Factor Xa. It
is used as prophylaxis against venous thromboembolism in patients undergoing
large joint replacement or abdominal surgery with increased risk of thromboembolic
complications.
PLASMA DERIVATIVES AND RECOMBINANT PLASMA PROTEINS 163
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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.
C. A severe hypotensive reaction is possible due to the presence of complement-
activating aggregates of immunoglobulins. In addition, because immune globulin
preparations contain IgA and that IgA-deficient patients can develop IgA antibodies,
which have been associated with anaphylactic hypersensitivity reactions.
________________________________ ________________________________
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.
D. In addition to prophylactic use for HAV, IMIG is also used for prophylaxis against
measles (rubeola), rubella, varicella zoster, and in decreasing the clinical severity of
HAV and measles. Hyperimmune globulin has been used as post-exposure prophy-
laxis against rabies, hepatitis B, and tetanus, among others. These preparations are
made from donors with high titers of the specific immune globulin.
________________________________ ________________________________
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.
164 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
B. IVIG is effective in the treatment of Guillain-Barré syndrome, as is therapeutic
apheresis. However, combining the two modalities does not seem to provide any
additional benefit.
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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.
C. Passive immunity is provided by immune globulin derived from patients with
high-titer antibodies against a particular agent. Examples include rabies Ig, cytomeg-
alovirus Ig, and varicella zoster virus Ig.
________________________________ _______________________________
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.
D. For idiopathic thrombocytopenic purpura (ITP) the IV formulation is preferred.
For the prevention of anti-D formation both IV and IM preparations are effective.
________________________________ _______________________________
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.
B. Within 72 hours of delivery is the preferred interval. However, it should and can
still be administered up to 4 weeks postpartum (with decreased efficacy).
PLASMA DERIVATIVES AND RECOMBINANT PLASMA PROTEINS 165
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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.
C. A mini-dose (1/6 full dose) of IV RhIG can be used to suppress an immune
response against 4.0 mL of Rh-positive whole blood (2.5 mL red cells). At 12 weeks,
the fetal red cell blood volume does not exceed 2.5 mL.
________________________________ ________________________________
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.
A. Immediately before use, fibrinogen is mixed with aprotinin (an inhibitor of fibri-
nolysis) and prothrombin is mixed with CaCl
2
to stimulate conversion to thrombin.
The two solutions are mixed to make fibrin, which acts as a topical sealant.
________________________________ ________________________________
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.
B. All of the other choices are intrinsically incorrect. GM-CSF typically invokes
more toxic side effects than G-CSF, presumably due to the stimulation of the mono-
166 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
cyte/macrophage lineage. There is no evidence that GM-CSF promotes leukemia
development.
________________________________ ________________________________
夝
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