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ADVERSE EFFECTS OF TRANSFUSION 77
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ADVERSE EFFECTS OF TRANSFUSION 79
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Alter HJ, Nakatsuji Y, Melpolder J, et al. The incidence of transfusion associated
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747-54.
Seifried C, Weber M, Bialleck H, et al. High prevalence of GBV-C/HGV among rela-
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80 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
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new strategy for estimating risks of transfusion-transmitted viral infections based on
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Busch MP, Kleinman SH. Nucleic acid amplification testing of blood donors for
transfusion-transmitted disease. Report of the Interorganizational Task Force on
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1 Western blot tests in non-infected blood donors. Transfusion 1996;35:45-52.
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ADVERSE EFFECTS OF TRANSFUSION 81
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82 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
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In: Leonard G, Licata M.
Practical Self-Assessment for Transfusion Medicine Professionals
Bethesda, MD: AABB Press, 2012
8
Indications for Transfusion
QUESTIONS
Question 1: Which of the following is a valid indication for RBC transfusion?
A. To increase colloid osmotic pressure.
B. To prevent anemia.
C. To improve wound healing.
D. To increase oxygen-carrying capacity in a hypoxic patient.
E. To enhance a patient’s sense of well-being.
________________________________ ________________________________
夝
Question 2: Published experimental data support which of the following state-
ments?
A. Otherwise healthy patients who are hypovolemic due to acute hemorrhage
should receive RBC transfusion.
B. Cardiac output decreases dramatically when hemoglobin levels fall below 7 g/
dL in healthy patients.
C. Most patients benefit from a more liberal RBC transfusion threshold, such as
hemoglobin ~ 10 g/dL.
D. A platelet count of 50,000/L is a more reasonable transfusion threshold than
20,000/L in afebrile, non-bleeding patients who do not have an underlying
coagulopathy.
E. A platelet count of 5000 to 10,000/L is a safe transfusion threshold for acute
leukemic patients.
________________________________ ________________________________
夝
Question 3: Which statement about the transfusion of factor concentrates or FFP is
true?
86 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
A. Prophylactic FFP transfusions for patients scheduled for invasive procedures
are generally indicated when the PT or PTT are 15 times their mid-normal val-
ues or greater.
B. If the PT and PTT are prolonged, FFP should be given the night before surgery.
C. Pooled factor concentrates have a lower risk of viral transmission compared to
FFP.
D. FFP should be used to reverse the effects of warfarin. Vitamin K should be the
second choice when FFP is not effective.
E. The initial dose of FFP should be approximately 1.0 mL/kg. PT and/or PTT
should be measured 15 minutes after infusion.
________________________________ _______________________________
夝
Question 4: Which of the following is NOT considered to be an indication for FFP?
A. Patient with petechial bleeding, but a normal PT/PTT.
B. Massive transfusion.
C. Warfarin reversal when vitamin K fails.
D. Replacement of coagulation factors during therapeutic plasma exchange.
E. Bleeding patient with a documented factor deficiency and no available factor
concentrate.
________________________________ _______________________________
夝
Question 5: Which of the following statements about Cryoprecipitated AHF is true?
A. It is ineffective in a patient who is also hypofibrinogenemic (fibrinogen <80-
100 mg/dL).
B. Each unit of Cryoprecipitated AHF contains 15 to 25 mg of fibrinogen in
approximately 10 mL of plasma.
C. Cryoprecipitate can be used to treat patients with all types of vWF disease.
D. One unit of Cryoprecipitated AHF contains twice as much fibrinogen as one
unit of FFP.
E. In a patient in whom volume overload is a likely concern, it is better to give
FFP than Cryoprecipitated AHF to replace fibrinogen levels.
________________________________ _______________________________
夝
Question 6: Which of the following outcomes is effectively accomplished by leuko-
cyte reduction of blood components?
A. Decreases the incidence of febrile nonhemolytic transfusion reactions.
B. Helps prevent transfusion-associated graft-vs-host disease.
C. Decreases the incidence of transfusion-associated acute lung injury.
INDICATIONS FOR TRANSFUSION 87
D. Eliminates the risk of CMV transmission.
E. Reverses the effects of platelet refractoriness.
________________________________ ________________________________
夝
Question 7: When is the best time to perform leukocyte reduction?
A. At the bedside, just before the transfusion.
B. At the bedside, during the transfusion.
C. In the blood bank, just before issuing the unit.
D. In the blood donor center, before storage.
E. It makes no difference when it occurs; the incidence of adverse effects will be
the same regardless.
________________________________ ________________________________
夝
Question 8: Which of the following statements about transfusion-associated graft-
vs-host disease (TA-GVHD) is true?
A. The GVHD that may occur in marrow transplant recipients is much more fatal
than TA-GVHD.
B. TA-GVHD is caused by engraftment of viable donor lymphocytes.
C. Recipients who receive non-HLA-matched blood components are at increased
risk compared to those receiving HLA-matched blood components.
D. Elderly patients are at increased risk for TA-GVHD compared to the general
population.
E. Leukocyte-reduced blood components are an acceptable substitute for irradi-
ated products.
________________________________ ________________________________
夝
ANSWERS
Question 1: Which of the following is a valid indication for RBC transfusion?
A. To increase colloid osmotic pressure.
B. To prevent anemia.
C. To improve wound healing.
D. To increase oxygen-carrying capacity in a hypoxic patient.
E. To enhance a patient’s sense of well-being.
D. The choices other than D are not scientifically validated indications for transfusion.