Transfusion Reactions: Identification and Management

MEDICAL LABORATORY SCIENCE 8. SUMMATIVE EXAM REVIEW QUESTIONS #05 + ANSWERS & RATIONALIZATIONS 1. 2. 3. 4. 5. 6. 7. The k (Cellano) antigen is a high-frequency antigen and is found on most red cells. How often would one expect to find the corresponding antibody? a. Often b. Rarely c. It depends upon the population d. Impossible to determine without consulting regional blood group antigen charts → Note: k (Cellano) is more common than K antigen An individual has been sensitized to the k antigen and has produced anti-k. What is her most probable Kell system genotype? a. KK b. Kk c. kk d. K0K0 → rare genotype → This individual cannot have the k antigen on their cells. K0K0 is rare and no Kell system antigens are detected on the RBCs. Those individuals usually produce antibodies that are reactive with all normal cells. KK is the most probable genotype. An antibody commonly associated with delayed transfusion reactions is: a. Anti-Lua b. Anti-S c. Anti-Jkb d. Anti-M What blood group system antibodies are commonly associated with delayed hemolytic transfusion reactions? a. Rh c b. MNS c. ABO d. Kidd What procedure would help to distinguish between an anti-Fya and anti-Jka in an antibody mixture? a. Lowering the pH of the patient’s serum b. Using a thiol reagent c. Testing at colder temperatures d. Ficin-treated panel cells → Note: Fy vs. Jk ▪ Fy - destroyed by enzymes ▪ Jk - enhanced by enzymes Which of the following antibodies characteristically gives a refractile mixed-field appearance? a. Anti-K b. Anti-Dia c. Anti-Sda d. Anti-s A patient has symptoms indicating a possible hemolytic transfusion reaction. What should be done immediately? a. Stop the transfusion and discard the unit b. Contact the patient's doctor to ask if the transfusion should be stopped c. Stop the transfusion and call the patient's doctor to report the reaction → keep IV line open d. Have patient blood samples sent to the lab to investigate the reaction 9. 10. 11. 12. 13. 14. 15. Fatal transfusion reactions are mostly caused by? a. Serologic errors b. Improper storage of blood c. Clerical errors d. Improper handling of the product Some blood group antibodies characteristically hemolyze appropriate red cells in the presence of: a. Complement b. Anticoagulants c. Preservatives d. Penicillin Pain at infusion site and hypotension are observed with what type of reaction? a. Acute hemolytic transfusion reaction b. Allergic reaction c. Delayed hemolytic transfusion reaction d. Febrile nonhemolytic reaction → Red or dark urine or diffuse oozing may be the only sign in the anesthetized patient. Hypotension, nausea, flushing, fever and chills are symptoms of which of the following transfusion reactions? a. Allergic b. Circulatory overload c. Hemolytic d. Anaphylactic Hemoglobinuria, hypotension and generalized bleeding are symptoms of which of the following transfusion reactions? a. Allergic b. Circulatory overload c. Hemolytic d. Anaphylactic The most serious hemolytic transfusion reactions are due to incompatibility in which of the following blood group systems? a. ABO → severe HTR; intravascular lysis b. Rh → severe HDN c. MN d. Duffy → The severity of symptoms is closely related to the amount and rate of incompatible blood transfused. What would be the result of group A blood given to an O patient? a. Nonimmune transfusion reaction b. Immediate hemolytic transfusion reaction c. Delayed hemolytic transfusion reaction d. Febrile nonhemolytic transfusion reaction A patient has a hemolytic reaction to blood transfused 8 days ago. What is the most likely cause? a. Immediate, nonimmunologic probably due to volume overload b. Delayed immunologic, probably due to an antibody such as anti-Jka c. Delayed nonimmunologic, probably due to iron overload d. Immediate, immunologic, probably due to clerical error, ABO incompatibility 1 16. In a delayed transfusion reaction, the causative antibody is generally too weak to be detected in routine compatibility testing and antibody screening tests, but is typically detectable at what point after transfusion? a. 3 - 6 hours b. 3 - 7 days c. 60 - 90 days d. After 120 days 17. An unexplained fall in hemoglobin and mild jaundice in a patient transfused with Red Blood Cells 1 week previously would most likely indicate: a. Paroxysmal nocturnal hemoglobinuria b. Posttransfusion hepatitis infection c. Presence of HLA antibodies d. Delayed hemolytic transfusion reaction 18. Fever and chills are symptoms of which of the following transfusion reactions? a. Citrate toxicity b. Circulatory overload c. Allergic d. Febrile → use Leukopoor RBC 19. Symptoms of dyspnea, hypoxemia, and pulmonary edema within 6 hours of transfusion is most likely which type of reaction? a. Anaphylactic b. Hemolytic c. Febrile d. TRALI 20. What may be found in the serum of a person who is exhibiting signs of TRALI (Transfusion-Related Acute Lung Injury)? a. Red blood cell alloantibody b. IgA antibody c. Anti-leukocyte antibody d. Allergen 21. Hives and itching are symptoms of which of the following transfusion reactions? a. Febrile b. Allergic → use washed RBC c. Circulatory overload d. Bacterial 22. Which of the following transfusion reactions occurs after infusion of only a few milliliters of blood and gives no history of fever? a. Febrile b. Circulatory overload c. Anaphylactic → afebrile; patient with IgA deficiency w/ anti-IgA; use washed RBC d. Hemolytic 23. Anaphylactic reactions to transfusion are usually caused by: a. Anti-IgA in an IgA-deficient recipient b. Anti-IgG in an IgA-deficient c. IgA deficiency d. IgG deficiency 24. Which of the following transfusion reactions is characterized by high fever, shock, hemoglobinuria, DIC and renal failure? a. Bacterial contamination b. Circulatory overload c. Febrile d. Anaphylactic 25. Coughing, hypoxemia and difficult breathing are symptoms of which of the following transfusion reactions? a. Febrile b. Allergic c. TACO d. Hemolytic 26. Congestive heart failure, severe headache and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion reaction? a. Hemolytic b. Febrile c. Anaphylactic d. TACO 27. Which of the following patient groups is at risk of developing graft-versus-host disease? a. Full-term infants b. Patients with history of febrile transfusion reactions c. Patients with a positive direct antiglobulin test d. Recipients of blood donated by immediate family members → remedy: irradiated blood 28. The most frequent transfusion-associated disease complication of blood transfusions is: a. Cytomegalovirus (CMV) b. Syphilis c. Hepatitis d. HIV-1/2 29. When evaluating a possible delayed hemolytic reaction, what is the best sample to use for bilirubin determination? a. 6 hours posttransfusion → bilirubin peak at 5-7 hrs b. 12 hours posttransfusion c. 24 hours posttransfusion d. 48 hours posttransfusion 30. What is the primary reason that infectious agents can be transmitted following blood transfusion? a. Pathogen reduction technology failure b. Donor in the window period of early infection c. Leukocyte-reduction failure d. Donor history questionnaire not completed 31. What may be done to RBCs before transfusion to a patient with cold agglutinin disease in order to reduce the possibility of a transfusion reaction? a. Irradiate to prevent graft-versus-host-disease (GVHD) b. Wash with 0.9% percent saline c. Warm to 37°C with a blood warmer d. Transport so that temperature is maintained at 20 to 24°C 32. Which of the following is an acceptable time in which a unit of whole blood is collected? a. 33 minutes b. 25 minutes c. 20 minutes d. 13 minutes 2 33. How much anticoagulant would have to be removed from the collection bag given a donor who weighs 90 lb? a. 12 mL b. 15 mL c. 20 mL d. 23 mL → Solution: 34. The minimum hemoglobin concentration in a finger stick from a female blood donor is: a. 12.0 g/dL (120 g/L) b. 12.5 g/dL (125 g/L) → female c. 13.0 g/dL (135 g/L) → male d. 15.0 g/dL (150 g/L) 35. Which of the following donors could be accepted for whole-blood donation? a. A construction worker who was incarcerated for opiate abuse b. A triathlete with a pulse of 45 c. A man who is currently taking finasteride (Propecia) d. A woman in her 14th week of pregnancy 36. How often can a blood donor donate whole blood? a. Every 24 hours b. Once a month c. Every 8 weeks d. Twice a year 37. A donor who has just donated 2 units of Apheresis Red Blood Cells will be deferred from further blood donation for a minimum of how many weeks? a. 8 b. 12 c. 16 d. 24 38. All of the following apply to a double red cell unit apheresis collection EXCEPT: a. The hematocrit must be at least 38% → must be 40% b. The weight for a female is at least 150 lbs c. The height for a male is at least 5 ft 1 in. d. The deferral period following collection is 16 weeks 39. To qualify as a donor for autologous transfusion a patient’s hemoglobin should be at least: a. 8 g/dL b. 11 g/dL c. 13 g/dL d. 15 g/dL 40. Which one of the following constitutes permanent deferral status of a donor? a. A tattoo 5 months previously → 12 months deferral b. Recent close contact with a patient with viral hepatitis → 12 months deferral c. 2 units of blood transfused 4 months previously d. Confirmed positive test for HBsAg 10 years previously 41. Donors who have received HBIG must wait months to donate blood to be sure they were not infected since hepatitis B can be transmitted through transfusion to a patient. a. 2 weeks b. 1 month c. 3 months d. 12 months 42. Which of the following vaccinations carries no deferral period? a. Rubella → 4 weeks deferral b. Varicella zoster → 4 weeks deferral c. Recombinant HPV d. Smallpox → 14-21 day deferral 43. A donor bag is half filled during donation when the blood flow stops. Select the correct course of action. a. Closely observe the bag for at least 3 minutes; if blood flow does not resume, withdraw the needle b. Remove the needle immediately and discontinue the donation c. Check and reposition the needle if necessary; if blood flow does not resume, withdraw the needle d. Withdraw the needle and perform a second venipuncture in the other arm 44. A woman begins to breathe rapidly while donating blood. Choose the correct course of action. a. Continue the donation; rapid breathing is not a reason to discontinue a donation b. Withdraw the needle, raise her feet, and administer ammonia c. Discontinue the donation and provide a paper bag d. Tell her to sit upright and apply a cold compress to her forehead 45. A unit tests positive for syphilis using the rapid plasma reagin test (RPR). The microhemagglutinin assay- Treponema pallidum (MHA-TP) on the same unit is negative. What is the disposition of the unit? a. The unit may be used to prepare components b. The donor must be contacted and questioned further; if the RPR result is most likely a false positive, then the unit may be used c. The unit must be discarded d. Cellular components may be prepared but must be irradiated before issue 46. John Smith donated a unit of whole blood in May. Red blood cells made from the whole blood were transfused to a recipient of a community hospital in June with no apparent complications. The blood supplier notified the medical director of the hospital that the donor reported HIGH-RISK BEHAVIOR with another male in April, although viral tests remain negative and the donor is healthy. What course of action should be taken? a. No action should be taken b. The recipient’s physician should be notified c. The recipient’s physician and the recipient should be notified d. The recipient should be notified 47. Rejuvenation of a unit of Red Blood Cells is a method used to: a. Remove antibody attached to RBCs b. Restore 2,3-DPG and ATP to normal levels c. Inactivate viruses and bacteria d. Filter blood clots and other debris 3 48. A technologist removed 4 units of blood from the blood bank refrigerator and placed them on the counter. A clerk was waiting to take the units for transfusion. As she checked the paperwork, she noticed that one of the units was leaking onto the counter. What should she do? a. Issue the unit if the red cells appear normal b. Reseal the unit c. Discard the unit d. Call the medical director and ask for an opinion 49. What should be done if a noticeable clot is found in an RBC unit? a. Issue the unit; the blood will be filtered b. Issue the unit; note the presence of a clot on the release form c. Filter the unit in the blood bank before issue d. Do not issue the unit 50. Upon inspection, a unit of Apheresis Platelets is noted to have visible clots, but otherwise appears normal. The technologist should: a. Issue without concern b. Filter to remove the clots c. Centrifuge to express off the clots d. Quarantine for Gram stain and culture 4