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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5565_Библиотеки_им_академика_М_И_Перельмана.pdf
56 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
patient identification. Because mislabeled specimens are associated with a very sig-
nificant risk of patient misidentification (much more than twofold) the specimen
should not be returned to the submitting individual for relabeling, but rather should
be discarded by the transfusion service with the requirement for another draw of a
properly labeled specimen.
________________________________ _______________________________
夝
Question 2: For pretransfusion compatibility testing, which of the following is NOT
required for the proper identification of a sample?
A. First and last name of patient.
B. Unique identifying number.
C. Date of draw.
D. A method to identify the drawer.
E. A method to identify the facility.
E. This may be desirable, but it is not required.
________________________________ _______________________________
夝
Question 3: Which statement about blood product filters is NOT true?
A. All blood components must be transfused through a filter capable of removing
clots, fibrin strands, and other potentially harmful particles.
B. Leukocyte reduction filters have a pore size that is small enough to remove par-
ticulate matter greater than 170 microns.
C. Leukocyte reduction filters are designed so that their performance is not
affected by the position of, or the pressure within the filter.
D. Leukocyte reduction filters are designed to be used once and then discarded.
E. Leukocyte reduction filters should not be flushed following infusion.
C. They must be used vertically and be gravity-fed only. In addition, they should not
be flushed as they are intended for single use.
________________________________ _______________________________
夝
Question 4: Which statement about blood component transfusions is true?
A. A 21-gauge needle is the minimum size required for most patient populations.
B. The only IV fluid that should be used to transfuse RBCs is normal saline,
although some other fluids, such as 5% albumin, may be used.
C. Lactated Ringer’s solution contains citrate, which promotes clotting, and there-
fore should not be used to transfuse RBCs.
ADMINISTRATION OF BLOOD COMPONENTS 57
D. Medications can be infused safely through the same line that is being used to
transfuse RBCs.
E. Because cold blood can cause arrhythmias and even cardiac arrest, the blood
warmers must be used even for routine infusions.
B. Standard needle size is 18-gauge. Lactated Ringer’s contains calcium, which
neutralizes the anticoagulant activity of the citrate that is present in the RBC units.
Blood warmers may be indicated in the operating room or trauma settings when
large volumes of blood are being transfused, but there’s no need to warm blood for
routine transfusions.
________________________________ ________________________________
夝
Question 5: Regarding blood component transfusion, which statement is true?
A. Patients should be premedicated to prevent fever and allergic reactions.
B. A full set of vital signs should be obtained immediately before transfusion, after
15 minutes, and then hourly until completion of the transfusion.
C. The last 15 minutes of a transfusion is the best time to closely monitor the
recipient because that is when most major hemolytic reactions become appar-
ent.
D. Washing all blood components can help minimize the risk of transfusion reac-
tions.
E. A full set of vital signs should be obtained exactly 24 hours following the com-
pletion of transfusion.
B. Premedication may be desirable for patient comfort but is not required and may
in fact mask a potential reaction. Close monitoring for signs and symptoms of a reac-
tion during the infusion is strongly encouraged. Some blood components such as
plasma cannot be washed. Washing platelets can result in decreased function.
________________________________ ________________________________
夝
Question 6: In the event of a possible transfusion reaction, which of the following
should take place?
A. The transfusion should be stopped and reported to the transfusion service.
B. The transfused unit, all associated tubing, and a sample of venous blood should
be taken to the transfusion service.
C. The transfusion service should do a clerical check.
D. The transfusion service should visually inspect and perform a DAT on the
recipient’s pre- and posttransfusion venous blood samples.
E. All of the above.
58 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
E. All of the above should be done and also the transfusion service should order a
STAT Gram stain if the recipient had a significant fever or change in temperature
during the transfusion.
________________________________ _______________________________
夝
Question 7: Transfusions for neonates (less than 4 months old) differ from transfu-
sions in children and adults in several ways. Which statement is true regarding the
recommendations for neonatal transfusions?
A. Transfusion-associated graft-vs-host disease can be fatal, so platelets and RBCs
should be leukocyte-reduced.
B. CMV transmission can cause serious illness, so platelets and RBCs should be
CMV-reduced.
C. Potassium and anti-A or anti-B often cause severe illness, so platelets and RBCs
should be washed.
D. The RBC transfusion “threshold” is lower for newborns with cardiac or pulmo-
nary disease compared to adults.
E. Reference ranges for PT and PTT are lower in neonates.
B. Along with the profoundly immunocompromised, neonates are most susceptible
to symptomatic CMV infection and the poor outcomes associated with infection.
________________________________ _______________________________
夝
SUGGESTED READING
AABB, American Red Cross, America’s Blood Centers, and Armed Services Blood
Program. Circular of information for the use of human blood and blood compo-
nents. Bethesda, MD: AABB, 2008.
Lee DA, Slagle TA, Jackson TM, Evans CS. Reducing donor exposures in low birth
weight infants by the use of older, unwashed packed red blood cells. J Pediatr 1995;
126:280-6.
Liu EA, Mannino FL, Lane TA. Prospective, randomized trial of the safety and effi-
cacy of a limited donor exposure transfusion program for premature neonates. J
Pediatr 1994;125:92-6.
Ryden SE, Oberman HA. Compatibility of common intravenous solutions with CPD
blood. Transfusion 1975;15:250-5.
Carson TH, ed. Standards for blood banks and transfusion services. 27th ed.
Bethesda, MD: AABB, 2011.
Strauss RG. Data-driven blood banking practices for neonatal RBC transfusions.
Transfusion 2000;40:1528-40.
ADMINISTRATION OF BLOOD COMPONENTS 59
Strauss RG, Burmeister LF, Johnson K, et al. AS-1 red cells for neonatal transfusions:
A randomized trial assessing donor exposure and safety. Transfusion 1996;36:873-
8.
Strautz RL, Nelson JM, Meyer EA, Shulman IA. Compatibility of ADSOL-stored red
cells with intravenous solutions. Am J Emerg Med 1989;7:162-4.
In: Leonard G, Licata M.
Practical Self-Assessment for Transfusion Medicine Professionals
Bethesda, MD: AABB Press, 2012
7
Adverse Effects of Transfusion
QUESTIONS
Question 1: Which of the following is a sign or symptom of a transfusion reaction?
A. Fever.
B. Rash.
C. Respiratory distress/dyspnea.
D. Shock.
E. All of the above.
________________________________ ________________________________
夝
Question 2: Which statement is true about the events that occur during a transfusion
reaction workup?
A. The posttransfusion venous sample should be in an EDTA-containing (purple
top) tube to prevent a false-negative DAT result.
B. If the posttransfusion urine is dipstick-positive for blood in the absence of intact
red cells seen microscopically, then this is highly suggestive of a hemolytic
transfusion reaction.
C. The suspected unit should be returned to the blood bank without any tubing.
D. If a hemolytic transfusion reaction is suspected, the unit should undergo ABO
typing, antibody screening, and repeat crossmatch using the recipient’s pre-
transfusion red cells.
E. In addition to DAT, the posttransfusion venous sample should be examined for
evidence of autoantibodies.
________________________________ ________________________________
夝
Question 3: Which statement about acute hemolytic transfusion reactions is NOT
true?
A. By definition, the reaction must occur within 4 hours of the transfusion.
62 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
B. The reaction is caused by preformed antibodies and complement.
C. Red cells undergo intravascular hemolysis.
D. Signs/symptoms include fever, flank pain or infusion site pain, and hyperten-
sion.
E. Signs/symptoms include red urine, red plasma, rash, chest tightness.
________________________________ _______________________________
夝
Question 4: Which of the following statements about delayed hemolytic transfusion
reactions is not true?
A. The reaction typically occurs 15 to 30 days after the transfusion.
B. The reaction is caused by preformed antibodies and complement.
C. Red cells undergo extravascular hemolysis.
D. Recipients are often asymptomatic; it is usually discovered when the recipient
has an unexplained drop in hematocrit or increase in bilirubin.
E. The DAT is always positive at the time of workup.
________________________________ _______________________________
夝
Question 5: Which of the following is NOT a sign/symptom of a febrile nonhemo-
lytic transfusion reaction (FNHTR)?
A. Hypotension.
B. Fever (temp above 38 C) or temperature increase of more than 1 C.
C. Shaking chills (rigors).
D. Hypertension.
E. Tachycardia and/or palpitations.
________________________________ _______________________________
夝
Question 6: Which statement about FNHTRs is true?
A. FNHTRs are only rarely caused by preformed recipient antibodies directed
against leukocytes or platelets.
B. Unlike some anaphylactoid and urticarial reactions, mast cells are usually
involved in the pathogenesis of FNHTRs.
C. FNHTRs may be caused by cytokines released during storage of cellular blood
components, particularly platelets.
D. Studies have shown that leukocyte reduction eliminates the risk of FNHTRs.
E. FNHTRs tend to recur during subsequent transfusions.
ADVERSE EFFECTS OF TRANSFUSION 63
________________________________ ________________________________
夝
Question 7: Which statement regarding anaphylactoid/anaphylactic transfusion
reactions is true?
A. Both anaphylactoid/anaphylactic reactions are IgE-mediated.
B. Anaphylactic reactions may occur even the first time a plasma-containing com-
ponent is transfused to an IgA-deficient recipient.
C. Both anaphylactoid and anaphylactic transfusion reactions require prior “sensi-
tization” for the immune response to occur.
D. Anaphylactic transfusion reactions can occur if the donor had been taking anti-
biotics before the transfusion.
E. Anaphylactoid and anaphylactic transfusion reactions cannot be treated the
same way.
________________________________ ________________________________
夝
Question 8: Which statement about transfusion-related acute lung injury (TRALI) is
true?
A. TRALI is believed to be caused by either lipid activators of neutrophils or anti-
bodies directed against neutrophil or HLA antigens.
B. No laboratory tests are available to help support the diagnosis of TRALI.
C. The clinical picture is similar to ARDS with acute onset of dyspnea and hypox-
emia, but ARDS has a better prognosis.
D. A TRALI diagnosis may include transfusion-associated circulatory overload
(TACO).
E. Pooled plasma derivatives (ie, albumin, IVIG, RhIG, etc) are associated with
TRALI.
________________________________ ________________________________
夝
Question 9: Which statement about transfusion-associated graft-vs-host disease (TA-
GVHD) is true?
A. The fatality rate is the same as that for transplant-related GVHD.
B. Patients receiving blood components from close relatives are not at increased
risk of TA-GVHD.
C. Leukocyte reduction reliably prevents TA-GVHD.
D. Irradiation shortens the lifespan of RBC units to 14 days from the date of irradi-
ation.
E. Signs/symptoms of TA-GVHD include diffuse rash, severe diarrhea, abnormal
liver function tests, and pancytopenia.
64 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
________________________________ _______________________________
夝
Question 10: Which statement about bacterial contamination of blood components
is true?
A. RBC units are more likely to be contaminated with gram-positive organisms.
B. Platelets are more likely to be contaminated with gram-negative organisms.
C. RBC-associated sepsis occurs more frequently than platelet-associated sepsis.
D. There is a much lower risk of sepsis with autologous transfusions compared to
allogeneic transfusions.
E. In the event of a possible septic transfusion reaction, Gram’s stain and culture
of the unit should always be performed, along with recipient blood culture(s).
________________________________ _______________________________
夝
Question 11: About a week after receiving a RBC (or platelet) transfusion, the recip-
ient notices several rashes on his body. His test results reveal only a decreased plate-
let count and no other abnormalities. What is the most likely explanation?
A. The recipient has been previously sensitized and is exhibiting an anaphylactic
or anaphylactoid reaction.
B. The recipient has been previously sensitized and is exhibiting an anamnestic
response to a high-frequency platelet antigen.
C. The recipient’s own platelets are protected from this destructive process.
D. The recipient has a disease process that cannot be treated.
E. If the recipient requires another RBC transfusion in the future, washing the unit
will be of no value in preventing recurrence.
________________________________ _______________________________
夝
Question 12: Which of the following statements about viral hepatitis infections is
true?
A. Hepatitis A may be transmitted by blood components, and may cause chronic
hepatitis.
B. Hepatitis before the age of 11 excludes a person from donating blood.
C. About one-third of patients with hepatitis B virus infection are asymptomatic
and without long-term sequelae.
D. Donors are screened for HBV infection by testing for HBsAg and/or anti-HBc.
E. HBV is not effectively inactivated by solvent/detergent (SD) treatment.
________________________________ _______________________________
夝
Question 13: Which of the following statements about hepatitis C infections is true?
ADVERSE EFFECTS OF TRANSFUSION 65
A. HCV is less likely to lead to chronic hepatitis and hepatocellular carcinoma
than HBV.
B. HCV is the second most common reason for liver transplantation in the United
States today.
C. The only effective way to detect HCV infection is by either detecting the viral
DNA in the serum or by detecting HCV antigens in the serum.
D. There is no effective method currently available to immunize against HCV.
E. A combination of interleukin-2 and riboflavin may be effective therapy for
chronic HCV patients.
________________________________ ________________________________
夝
Question 14: Which of the following statements about HIV infection is NOT true?
A. The HIV p24 antigen can be detected as early as 16 days following infection.
B. HIV can be detected by reverse transcriptase PCR as early as 10 days following
infection.
C. HIV antibody takes at least 3 weeks to reach detectable levels following infec-
tion.
D. With current testing regimens, the risk of being infected with HIV due to a
transfusion is about 1:100,000.
E. Among the donor population, less than 20% of people who screen positive for
HIV on enzyme immunoassay end up confirming positive on Western blot.
________________________________ ________________________________
夝
Question 15: Which of the following statements about HTLV-I is true?
A. It is the etiologic agent of adult T-cell leukemia/lymphoma.
B. It is the etiologic agent of filariasis.
C. It is transmitted by sexual contact only.
D. Influenza immunization within the preceding months can cause false-negative
test results.
E. Donors are screened for this virus using Western blot or recombinant immuno-
precipitation assay (RIPA).
________________________________ ________________________________
夝
Question 16: Which of the following statements about CMV is true?
A. CMV is thought to be transmitted as intact, infectious virion particles.
B. A CMV-reduced-risk unit is almost as effective as a CMV-seronegative unit in
preventing infection. Both significantly reduce risk of transmission
66 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
C. Newborns, HIV-positive patients, and transplant recipients frequently develop
CMV infections, but they are most often asymptomatic.
D. The primary CMV-related concern for marrow transplant recipients is CMV
encephalitis.
E. HIV-infected patients are particularly at risk for CMV pneumonitis.
________________________________ _______________________________
夝
Question 17: Which statement about Creutzfeldt-Jakob disease is NOT true?
A. There has never been a report of blood-borne transmission of classic CJD.
B. Variant CJD occurs in younger patients and tends to have a faster clinical
course leading to death than classic CJD.
C. The prion protein has never been isolated in lymphoid tissue in either classic or
variant CJD; therefore, it is not possible for these diseases to be transmitted by
blood.
D. Histologically, CJD is characterized by spongiform degeneration with neuronal
loss in the absence of inflammation.
E. The causative agent in CJD is an abnormally folded protein, called a prion.
________________________________ _______________________________
夝
ANSWERS
Question 1: Which of the following is a sign or symptom of a transfusion reaction?
A. Fever.
B. Rash.
C. Respiratory distress/dyspnea.
D. Shock.
E. All of the above.
E. Any of the above signs or symptoms (among others) can be associated with a
transfusion reaction.
Steps to take when a transfusion reaction is suspected
Stop the transfusion.
Report reaction to blood bank.
Fill out hospital transfusion reaction report form.
Return bag and infusion set (minus needle) to the blood bank.
Send a posttransfusion venous blood sample to the blood bank.
Send first urine sample.