Question 1

Which of the following should be collected 5 to 7 hours after transfusion for unconjugated bilirubin determination?

Accepted Answer

A)  EDTA blood specimen 
B)  Clotted blood specimen 
C)  Post-transfusion urine specimen 
D)  Heparinized blood specimen 
A)  EDTA blood specimen 
B)  Clotted blood specimen 
C)  Post-transfusion urine specimen 
D)  Heparinized blood specimen B

Question 2

Which of these is/are involved in hemovigilance?

Accepted Answer

A)  Collecting information on transfusion complications. 
B)  Analyzing transfusion complication data. 
C)  Improving transfusion practices based on transfusion complications data analysis. 
D)  All of these. 
A)  Collecting information on transfusion complications. 
B)  Analyzing transfusion complication data. 
C)  Improving transfusion practices based on transfusion complications data analysis. 
D)  All of these. D

Question 3

Physical or chemical damage of the transfused red blood cells can result in:

Accepted Answer

A)  intravascular hemolysis. 
B)  extravascular hemolysis. 
C)  sepsis. 
D)  pulmonary edema. 
A)  intravascular hemolysis. 
B)  extravascular hemolysis. 
C)  sepsis. 
D)  pulmonary edema. A

Question 4

Treatment of post-transfusion purpura (PTP) with is not advocated in medical practice.

Accepted Answer

A)  plasmapheresis 
B)  prednisone 
C)  platelet transfusions 
D)  exchange transfusions 
A)  plasmapheresis 
B)  prednisone 
C)  platelet transfusions 
D)  exchange transfusions

Question 5

Who developed the imputability criteria for reporting cases of transfusion fatalities?

Accepted Answer

A)  AMA 
B)  CBER 
C)  FDA 
D)  NHSN 
A)  AMA 
B)  CBER 
C)  FDA 
D)  NHSN

Question 6

Which patients are not at risk for circulatory overload?

Accepted Answer

A)  Patients with iron-deficiency anemia 
B)  Pediatric patients 
C)  Geriatric patients 
D)  Persons homozygous for hemoglobin S 
A)  Patients with iron-deficiency anemia 
B)  Pediatric patients 
C)  Geriatric patients 
D)  Persons homozygous for hemoglobin S

Question 7

A severe manifestation of alloimmunization might include:

Accepted Answer

A)  renal failure. 
B)  rising hemoglobin and hematocrit. 
C)  platelet refractoriness. 
D)  cyanosis. 
A)  renal failure. 
B)  rising hemoglobin and hematocrit. 
C)  platelet refractoriness. 
D)  cyanosis.

Question 8

What treatment is recommended following a bacterial contamination reaction?

Accepted Answer

A)  Plasma protein fraction (PPF) 
B)  Broad-spectrum antibiotics 
C)  Aspirin 
D)  Epinephrine 
A)  Plasma protein fraction (PPF) 
B)  Broad-spectrum antibiotics 
C)  Aspirin 
D)  Epinephrine

Question 9

Which of the following is characterized by a rapid onset of thrombocytopenia due to anamnestic production of platelet antibody?

Accepted Answer

A)  GVHD 
B)  Alloimmunization 
C)  PTP 
D)  Iron overload 
A)  GVHD 
B)  Alloimmunization 
C)  PTP 
D)  Iron overload

Question 10

A 41-year-old multiparous woman was rushed to the emergency room after being shot in the chest. She received 8 units of packed red blood cells and 5 units of platelets. The hemoglobin and hematocrit determinations stabilized after 6 hours in surgery, but the platelet counts remained less than 50,000 per µL. She had received additional units of platelets at 48-hour intervals with little efficacy. Her serum was tested for platelet antibodies. She was placed on corticosteroids to control chest wound bleeding. Anti-PLA1 was identified in the patient's serum. This case is representative of what type of transfusion reaction?

Accepted Answer

A)  Post-transfusion purpura 
B)  Circulatory overload 
C)  Graft-versus-host disease 
D)  Alloimmunization 
A)  Post-transfusion purpura 
B)  Circulatory overload 
C)  Graft-versus-host disease 
D)  Alloimmunization

Question 11

What is the purpose of performing serial hemoglobin and hematocrit after a blood transfusion?

Accepted Answer

A)  To detect the presence of hemoglobinemia 
B)  To monitor platelet refractoriness 
C)  To monitor the therapeutic or nontherapeutic response 
D)  To monitor the efficacy of clotting factors 
A)  To detect the presence of hemoglobinemia 
B)  To monitor platelet refractoriness 
C)  To monitor the therapeutic or nontherapeutic response 
D)  To monitor the efficacy of clotting factors

Question 12

Which of the following questions should be asked when investigating a transfusion reaction?

Accepted Answer

A)  How many milliliters of red blood cells were transfused? 
B)  What time of day was the donor unit collected? 
C)  What methodology was used for serologic testing? 
D)  What was the donor unit hematocrit? 
A)  How many milliliters of red blood cells were transfused? 
B)  What time of day was the donor unit collected? 
C)  What methodology was used for serologic testing? 
D)  What was the donor unit hematocrit?

Question 13

The presence of intact red blood cells in microscopic urinalysis examination indicates:

Accepted Answer

A)  bleeding. 
B)  hemolysis. 
C)  hemosiderinuria. 
D)  bilirubinemia. 
A)  bleeding. 
B)  hemolysis. 
C)  hemosiderinuria. 
D)  bilirubinemia.

Question 14

What is the length of time required for production of antibody in a DHTR caused by an anamnestic immune response?

Accepted Answer

A)  7 to 14 days 
B)  5 to 10 days 
C)  1 to 2 hours 
D)  3 to 7 days 
A)  7 to 14 days 
B)  5 to 10 days 
C)  1 to 2 hours 
D)  3 to 7 days

Question 15

Upon investigation of a DHTR, what should be included in the medical history?

Accepted Answer

A)  Previous transfusion 
B)  Pregnancies 
C)  Transfusion reactions 
D)  All of the above 
A)  Previous transfusion 
B)  Pregnancies 
C)  Transfusion reactions 
D)  All of the above

Question 16

What is a possible mechanism for noncardiogenic pulmonary edema reactions?

Accepted Answer

A)  Antileukocyte antibody reacts with leukocytes and activates the reticuloendothelial system 
B)  Histamine is released from mast cells, increasing vascular dilation and fluidity to tissues 
C)  Antileukocyte antibody reacts in donor or patient plasma, initiating complement-mediated pulmonary capillary endothelial injury 
D)  None of the above 
A)  Antileukocyte antibody reacts with leukocytes and activates the reticuloendothelial system 
B)  Histamine is released from mast cells, increasing vascular dilation and fluidity to tissues 
C)  Antileukocyte antibody reacts in donor or patient plasma, initiating complement-mediated pulmonary capillary endothelial injury 
D)  None of the above

Question 17

The most important initial step in evaluating a suspected hemolytic transfusion reaction is to:

Accepted Answer

A)  perform a CBC and urinalysis. 
B)  perform a DAT. 
C)  recheck the compatibility testing, using a pre- and post-sample. 
D)  reconfirm the patient's identity and reexamine all pre-transfusion testing. 
A)  perform a CBC and urinalysis. 
B)  perform a DAT. 
C)  recheck the compatibility testing, using a pre- and post-sample. 
D)  reconfirm the patient's identity and reexamine all pre-transfusion testing.

Question 18

A patient transfused with 2 units of packed cells spiked a fever of 99.5°F and complained of chills 3 days after transfusion. The DAT was positive with polyspecific antisera and anti-IgG but negative with anti-C3d. Compatibility testing was performed on the pre- and post-transfusion specimens. The latter was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion specimens. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jka. This transfusion reaction is most likely caused by:

Accepted Answer

A)  an anaphylactic response. 
B)  delayed hemolytic transfusion reaction (DHTR) caused by anamnestic response. 
C)  DHTR caused by primary alloimmunization. 
D)  post-transfusion purpura. 
A)  an anaphylactic response. 
B)  delayed hemolytic transfusion reaction (DHTR) caused by anamnestic response. 
C)  DHTR caused by primary alloimmunization. 
D)  post-transfusion purpura.

Question 19

What type of hemolysis is implicated in a DHTR caused by primary alloimmunization?

Accepted Answer

A)  Extravascular 
B)  Intravascular 
C)  Nonimmune 
D)  None of the above 
A)  Extravascular 
B)  Intravascular 
C)  Nonimmune 
D)  None of the above

Question 20

Besides hemoglobin, what other protein can cause a pink discoloration of serum or plasma in association with muscle trauma?

Accepted Answer

A)  Myosin 
B)  Albumin 
C)  Haptoglobin 
D)  Myoglobin 
A)  Myosin 
B)  Albumin 
C)  Haptoglobin 
D)  Myoglobin

Exam 17: Adverse Effects of Blood Transfusion

Which of the following should be collected 5 to 7 hours after transfusion for unconjugated bilirubin determination?

Which of these is/are involved in hemovigilance?

Physical or chemical damage of the transfused red blood cells can result in:

Treatment of post-transfusion purpura (PTP) with is not advocated in medical practice.

Who developed the imputability criteria for reporting cases of transfusion fatalities?

Which patients are not at risk for circulatory overload?

A severe manifestation of alloimmunization might include:

What treatment is recommended following a bacterial contamination reaction?

Which of the following is characterized by a rapid onset of thrombocytopenia due to anamnestic production of platelet antibody?

What is the purpose of performing serial hemoglobin and hematocrit after a blood transfusion?

Which of the following questions should be asked when investigating a transfusion reaction?

The presence of intact red blood cells in microscopic urinalysis examination indicates:

What is the length of time required for production of antibody in a DHTR caused by an anamnestic immune response?

Upon investigation of a DHTR, what should be included in the medical history?

What is a possible mechanism for noncardiogenic pulmonary edema reactions?

The most important initial step in evaluating a suspected hemolytic transfusion reaction is to:

What type of hemolysis is implicated in a DHTR caused by primary alloimmunization?

Besides hemoglobin, what other protein can cause a pink discoloration of serum or plasma in association with muscle trauma?

Red Blood Cells and Platelet Preservation: Historical Perspectives and Current Trends

Basic Genetics

Fundamentals of Immunology

Concepts in Molecular Biology

The Antiglobulin Test

The Abo Blood Group System

The Rh Blood Group System

Blood Group Terminology and Common Blood Groups

Uncommon Blood Groups

Detection and Identification of Antibodies

Pre-Transfusion Testing

Blood Bank Technologies and Automation

Donor Selection

Transfusion-Transmitted Diseases

Component Preparation

Transfusion Therapy

Apheresis

Cellular Therapy in the Transplant Setting

Hemolytic Disease of the Fetus and Newborn

Autoimmune Hemolytic Anemias

Tissue Banking As Part of the Transfusion Service

The Hla System

Relationship Testing

Quality Management

Patient Blood Management

Transfusion Safety and Federal Regulatory Requirements

Laboratory Information Systems in the Blood Bank

Medicolegal and Ethical Aspects of Providing Blood Collection and Transfusion Services

Filters