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In: Leonard G, Licata M.
Practical Self-Assessment for Transfusion Medicine Professionals
Bethesda, MD: AABB Press, 2012
14
Therapeutic Apheresis
QUESTIONS
Question 1: Which of the following fluids is an appropriate replacement fluid?
A. Normal (0.9%) saline.
B. Cryoprecipitate.
C. Lactated Ringer’s solution.
D. Albumin and saline combined.
E. Human plasma.
________________________________ ________________________________
夝
Question 2: In which setting would plasma be a better choice as a replacement fluid
than albumin or saline?
A. Thrombotic thrombocytopenic purpura.
B. Posttranfusion purpura.
C. Myasthenia gravis.
D. Hyperviscosity.
E. Polycythemia vera.
________________________________ ________________________________
夝
Question 3: Which of the following drugs can cause profound hypotension during
apheresis?
A. Statins.
B. Beta-blockers.
C. Antihistamines.
D. ACE inhibitors.
E. Angiotensin II receptor blocker.
178 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
________________________________ _______________________________
夝
Question 4: What is the maximum permissible extracorporeal blood volume?
A. 5%
B. 15%
C. 25%
D. 50%
E. 75%
________________________________ _______________________________
夝
Question 5: Risks associated with apheresis can be divided into three major catego-
ries: Line-related, procedure-related, and __________-related.
A. Anticoagulant.
B. Machine.
C. Patient.
D. Medication.
E. None of the above.
________________________________ _______________________________
夝
Question 6: Which of the following is the rationale for combining plasma exchange
with immunosuppressive therapy in conditions such as Goodpasture syndrome?
A. Avoid rebound antibody production.
B. Keep serum levels of complement low.
C. Minimize host response to donor replacement plasma.
D. Clear antibody complexes through the kidney.
E. None of the above.
________________________________ _______________________________
夝
Question 7: What is the predominantly intravascular pathological immunoglobulin
in Waldenstrom macroglobulinemia?
A. IgA
B. IgD
C. IgG
D. IgM
E. IgF
THERAPEUTIC APHERESIS 179
________________________________ ________________________________
夝
Question 8: What was the fatality rate of thrombotic thrombocytopenic purpura
before the advent of plasma exchange?
A. <5%
B. 10%
C. 20%
D. 50%
E. 90%
________________________________ ________________________________
夝
Question 9: In the case of TTP, what is the role of plasma exchange?
A. Provides unusually large vWF multimers.
B. Replaces ADAMTS13, a protease that cleaves large vWF multimers and is defi-
cient in TTP patients.
C. Prevents formation of inhibitory autoanti-ADAMTS13.
D. Removes senescent platelets.
E. Removal of ammonia, which is responsible for the neurologic changes.
________________________________ ________________________________
夝
Question 10: In which of the following diseases is therapeutic leukapheresis most
commonly employed?
A. Acute myelogenous leukemia.
B. Chronic myelogenous leukemia.
C. B-cell acute lymphocytic leukemia.
D. Chronic lymphocytic leukemia.
E. T-cell acute lymphocytic leukemia.
________________________________ ________________________________
夝
ANSWERS
Question 1: Which of the following fluids is an appropriate replacement fluid?
A. Normal (0.9%) saline.
B. Cryoprecipitate.
180 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
C. Lactated Ringer’s solution.
D. Albumin and saline combined.
E. Human plasma.
D. In all cases the fluid must be FDA-approved for use with blood components.
Saline rapidly equilibrates between intra- and extravascular spaces, requiring
approximately three times the volume to be replaced. The best choice is 50/50 mix
of 5% albumin and normal saline. Cryo-reduced plasma has been used, but not typ-
ically the precipitate. Plasma carries the risks of exposure to infectious agents.
________________________________ _______________________________
夝
Question 2: In which setting would plasma be a better choice as a replacement fluid
than albumin or saline?
A. Thrombotic thrombocytopenic purpura.
B. Posttranfusion purpura.
C. Myasthenia gravis.
D. Hyperviscosity.
E. Polycythemia vera.
A. TTP treatment with plasma exchange presumably restores the deficient
ADAMTS13.
________________________________ _______________________________
夝
Question 3: Which of the following drugs can cause profound hypotension during
apheresis?
A. Statins.
B. Beta-blockers.
C. Antihistamines.
D. ACE inhibitors.
E. Angiotensin II receptor blocker.
D. In addition to inhibiting conversion of angiotensin I to angiotensin II, ACE inhibi-
tors also interfere with the breakdown of bradykinin. This can result in profound
hypotension. ACE inhibitors should be withheld for at least 24 hours prior to apher-
esis procedures. Angiotensin II receptor blocker does not have that effect.
________________________________ _______________________________
夝
Question 4: What is the maximum permissible extracorporeal blood volume?