Blood Transfusion MCQ

CHAPTER 49

Blood Transfusion

MULTIPLE CHOICE QUESTIONS BLOOD TRANSFUSION

1. MC blood transfusion reaction is: (All India 2008) a. Febrile non-hemolytic transfusion reaction  b. Hemolysis c. Transm Transmission ission of infections d. Electrolyte imbalance 2. All of the following infections may be transmied via blood transfusion, except: (AIIMS May 2009, All India 2002) a. Parvo B-19 b. Hepatitis G c. Dengue virus d. Cytomegalovirus 3. Which of the following is the least likely complication aer massive blood transfusion? (AIIMS May 2009) a. Hyperkalemia b. Citrate toxicity c. Hypothermia d. Metabolic acidosis

4. Fresh hold blood transfusion is done with in how much time (DNB 2006) of collection? a. Immediately b. 1 hours c. 4 hours d. 24 hours 5. Which of the following investigations should be done immediately to best conrm a non matched blood transfusion (All India 2010) reaction? a. Indirect Coomb’ Coomb’ss test  b. Direct Coomb’s Coomb’s test c. Antibody in patient’ patient’ss serum d. Antibody in donor serum 6. Blood components products are: (PGI Dec 2005) a. Whole blood b. Platelets c. Fresh frozen plasma d. Leukocyte reduced RBC e. All of the above 7. A man is rushed to casualty, nearly dying aer a massive blood loss in an accident. There is not much time to match blood groups, so the physician decides to order for one of the following blood groups. Which one of the following blood groups should the physician decide: (AIIMS June 2004) a. O negative b. O positive c. AB positive d. AB negative

8. One unit of fresh blood arises the Hb% concentration by: a. 0.1 gm% b. 1 gm% (All India 2003) c. 2 gm% d. 2.2 gm% 9. Which of the following statements about acute hemolytic blood transfusion reaction is true? (PGI June 2004) a. Complement mediated hemolysis is seen  b. Type III hypersensitivity hypersensitivity is responsible for most cases c. Rarely life threatening d. Renal blood ow is always always maintained e. No need for stopping transfusion 10. Tr True ue about blood transfusions: transfusions: (PGI June 98) a. Antigen ‘D” determines Rh positivity  b. Febrile reaction is due to HLA antigens antigens c. Anti-d is naturally occurring antibody d. Cryoprecipitate contains all coagulation factors

11. Which  of the following is beer indicator of need for transfusion? (AIIMS 80, UPSC 87) a. Urine output b. Hematocrit c. Colour of skin d. Clinical examination (PGI 95) 12. Massive blood transfusion is dened as: a. 350 ml in 5 min b. 500 ml in 5 min c. 1 litre in 5 min d. Whole blood volume 13. How long can blood stored with CPDA? (JIPMER 2003) a. 12 days b. 21 days c. 28 days d. 48 days 14. Massive transfusion in previous healthy adult male can cause hemorrhage due to: (PGI 98) a. Increas Increased ed t-PA  b. Dilutional thrombocytopenia c. Vitamin K deciency d. Decreased brinogen 15. Arterial blood gas analysis in a bole bole containing heparin causes a decrease in value of: a. pCO2 b. HCO 3 c. pH d. All of the above 16. Massive blood transfusion is dened as: a. Whole blood volume in 24 hours (Recent Questions 2013)  b. Half blood volume in 24 hours c. 40% blood volume in 24 hours d. 60% blood volume in 24 hours BLOOD TRANSFUSION COMPLICATIONS

17. Aer  blood transfusion the febrile non-hemolytic transfusion reaction (FNHTR) occurs due to? a. Alloimmunization  b. Antibodies against donor leukocytes and HLA Ag c. Allergic reaction d. Anaphylaxis 18. Blood grouping and cross-matching is must prior prior to infusion infusion of: (MHPGMCET 2007) a. Gelatin b. Dextran c. Albumin d. FFP 19. Blood grouping and cross matching is must prior to infusion of: (MHPGMCET 2008) a. Gelatin b. Albumin c. Dextran d. Hemaceal 20. Collection of blood for cross matching and grouping is done before administration of which plasma expander? a. Hydroxyl ethyl starch b. Dextran (MHSSMCET 2007) c. Mannitol d. Hemacele 21. Mismatched blood transfusion in anesthetic patient presents is: a. Hyperthermia and hypertension (PGI June 2000)  b. Hypotension and bleeding from site of wound wound c. Bradycardia and hypertension d. Ta Tachycardia chycardia and hypertension

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22. All of the following are major complications of massive transfusion except: (All India 2006) a. Hypokalemia b. Hypothermia c. Hypomagnesaemia d. Hypocalcaemia 23. Massive transfusions results in: a. DIC b. c. Hypercalcemia d.

(PGI 88) Hypothermia Thrombocytopenia

RED BLOOD CELLS

24. The maximum life of a transfused RBC is: (JIPMER 80, DNB 89) a. One hour b. One day c. 15 days d. 50 days E. 100 days PLATELETS

25. Platelets can be stored at: a. 20-24°C for 5 days c. 4-8°C for 5 days

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b. d.

(AIIMS Nov 2005) 20-24°C for 8 days 4-8°C for 8 days

26. Blood platelets in stored blood do not remain functional aer: (PGI 88, 81, AIIMS 86) a. 24 hours b. 48 hours c. 72 hours d. 96 hours PLASMA

27. Indication of fresh frozen plasma is/are: a. Hypovolemia  b. Nutritional supplement c. Coagulation factor deciency d. Wa Warfarin rfarin toxicity e. Hypoalbuminemia

(PGI Nov 2011)

28. True about about FFP (Fresh frozen plasma) is the following except: (MHPGMCET 2009) a. Good source of all coagulation factors  b. Prepared from single unit of blood

c. Coagulation factor levels are equal to Plasma d. None of the above 29. Stored plasma is decient in: (PGI 79, DNB 90) a. Factors 7 and 8 b. Factors 2 and 5 c. Factors 5 and 8 d. Factors 7 and 9 30. With reference to fresh fresh frozen plasma (FFP), which one of (UPSC 2008) the following statement is not correct? a. It is used as volume expander  b. It is stored at – 40°C to – 50°C c. It is a source of coagulation factors d. It is given in a dose of 12-15 ml/kg body weight 31. In cholecystectomy cholecystectomy,, fresh frozen plasma should be given: a. Just before operation (UPPG 2008)  b. At the time of operation c. 6 hours before operation d. 12 hours aer operation

32. Half life of factor VIII is: (PGI 88) a. 4 hours b. 8 hours c. 34 hours d. 48 hours 33. Rosenthal’s syndrome is seen in deciency of factor: a. II b. V (AIIMS 81, DNB 91) c. IX d. XI CRYOPRECIPITATE

34. Cryoprecipitate contains: a. Factor II c. Factor VIII

b. d.

(MCI March 2009) Factor V Factor IX

35. Cryoprecipitate is a rich source of: (PGI 79, AIIMS 85) a. Thromboplastin b. Factor VIII c. Factor X d. Factor VII 36. Which one one of the following following blood fractions fractions is stored at at (UPSC 2006) -40°C? a. Cryoprecipitate b. Human albumin c. Platelet concentrate d. Packed red cells 37. Cryoprecipitate contains all except: (AIIMS Nov 2007) a. Factor VIII b. Factor IX c. Fibrinogen d. VWF

Blood Transfusion

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EXPLANATIONS BLOOD TRANSFUSION

1. Ans. a. Febrile non-hemolytic transfusion reaction (Ref: Harrison 18/e p954-956) Febrile non-hemolytic transfusion reaction is the most common complication associated with the transfusion of cellular blood components. Complications of Blood Transfusion

Reactions • • • • • • •

Infections

Febrile non-hemolytic transfusion reaction (FNHTR (FNHTR): ): MCQ Allergic Delayed hemolyticQ Transfusion-related acute lung injury (TRALI (TRALI))Q Acute hemolyticQ Fatal hemolytic Anaphylactic

• • • • • • • • •

Other Complications

Hepatitis B and CQ Hepatitis GQ HIV-1 and -2Q HTLV-I and -II Q MalariaQ West Nile virusQ Parvovirus B-19Q HHV-8Q CMVQ

RBC allosensitizationQ HLA allosensitizationQ Graft-versus-host Graft-versus-ho st disease

• • •

2. Ans. c. Dengue virus

3. Ans. d. Metabolic acidosis (Ref: Harrison 18/e p954-956) •

Massive transfusion can lead to coagulopathy and metabolic complicationsQ. Metabolic Complications of Massive Transfusion

General • • •

Electrolyte

Q

Fluid overload HypothermiaQ Impaired oxygen delivery capacity of Hb Q (decreased 2, 3-DPG)

• • • • •

Q

Hyperkalemia HypocalcemiaQ HypomagnesemiaQ Metabolic alkalosisQ Metabolic acidosis (rare)Q

4. Ans. d. 24 hours 5. Ans. b. Direct Direct Coomb’s test (Ref: Harrison 18/e p954) •

Direct Coomb’s test or direct antiglobulin test  test  on post-transfusion blood sample from patient should be done to detect antibodies directed against the  transfused RBCsQ. the transfused

6. Ans. e. All of the above (Ref: Harrison 18/e p952-954) Characteristics of Selected Blood Components Component

Volume (mL)

Content

Clinical Response

Whole Blood

450 ml ± 45

• •

No elements removed • Contains RBCs, WBCs, plasma  plasma  and • platelets ( platelets  (WBCs WBCs and platelets platelets may  may be non-functionalQ)

Not for routine use Used for acute massive bleeding, open heart surgery  surgery  and neonatal total exchange

Packed RBCs

180–200

•

RBCs with variable leukocyte content • and small amount of plasma

Increase Hb 1 gm/dL  gm/dL  and hematocrit 3%Q

Platelets

50–70

•

5.5 x 1010/RD unit

•

Increase platelet count 5000–10,000/µLQ

F FP

200–250

•

Plasma proteins: proteins: Coagulation factors, • proteins C proteins  C and S, antithrombin Q

Increases coagulation factors about 2%

Cryoprecipitate

10–15

•

Cold-insoluble plasma proteins, • brinogen, factor VIII, vWF Q

Topical brin glue, also also 80  80 IU factor VIII Q

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7. Ans. a. O negative (Ref: Harrison 18/e p951; Bailey 26/e p21-22, 25/e p21-22) Selection of Blood for Emergency Transfusion

Patient’s Blood group is known

Patient’s Blood group cannot be determined

• Unmatched blood group of the  the  same group should be used

• •

•

Group ‘O’ Group  ‘O’ RBCs are chosen Such unmatched unmatched blood should be Rh negative, negative, when used in women of child bearing age, age, in whom sensitization to Rh antigen would be undesirable Rh positive blood can be used if Rh negative blood is not available in older females and males

8. Ans. b. 1 gm% 9. Ans. a. Complement Complement mediated mediated hemolysis hemolysis is seen (Ref: Harrison 18/e p954) •

•

Acute hemolytic transfusion reactions following reactions following blood transfusion are type II hypersensitivity reactions  caused most oen by the complement mediated hemolysisQ. These reactions are oen life-threatening life-threatening and  and complications include oliguria oliguria and  and acute renal failure ( failure  (decreased renal blood ow)Q.

10. Ans. a. Antigen ‘D” determines Rh positivity; b. Febrile reaction is due to HLA antigens (Ref: Harrison 18/e p954)

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• •

D  (Rh D) on RBCsQ. Rh positive  or negative status depends on the presence or absence of antigen D (Rh Febrile (non-hemolytic) reactions are reactions are caused by antibodies directed against donor leucocytes and leucocytes and HLA antigen may mediate these reactionsQ.

11. Ans. b. Hematocrit 12. Ans. d. Whole blood volume

13. Ans. c. 28 days (Ref: Sabiston 19/e p588) Whole Blood Anticoagulant used

Maximum storage

ACD/CPD/CP2D

21 daysQ

CPDA-1

35 daysQ

(citrate phosphate dextrose adenine)

14. Ans. b. Dilutional thrombocytopenia 15. Ans. d. All of the above (Ref: Clinical Laboratory Medicine 6/e p396) Heparin Excess in Blood gas Syringe

Effects due to Dilution of Sample •

Decreased PaCO 2

•

Decreased HCO 3Q

Q

Effects due to Acidic Nature of Heparin •

Decreased pH Q

16. Ans. a. i.e., Whole blood volume in 24 hours According to Sabiston - Massive Blood Transfusion is dened as Transfusion greater than patient’s total blood volume in 24 hours Or as acute administration of more than 10 units of blood over a few hours. According to Schwartz “ Massive transfusion is a single single transfusion of 2500 2500 ml or 5000 ml transfused transfused over a period of 24 hours” • •

BLOOD TRANSFUSION COMPLICATIONS

17. Ans. b. Antibodies against donor leukocytes and HLA Ag

18. Ans. b. Dextran 19. Ans. c. Dextran 20. Ans. b. Dextran (Ref: en.wikipedia.org/wiki/Dextran) en.wikipedia.org/wiki/Dextran)

Blood Transfusion

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DEXTRAN • •

polymer of varying molecular weight producing an osmotic pressure similar pressure similar to the plasma It is a polysaccharide polymer of Disadvantages: RBCs and this interferes with blood grouping and grouping and cross matchingQ procedures, hence need for a blood − It induces rouleaux of RBCs and sample beforehand. − It interferes with platelet function , hence it is recommended that total volume  of dextran should not exceed 1000 mL. •

acting) prevents sludging of RBCs in vessels  and renal shut down in severe LMW dextran (short acting) hypotension and hypotension  and it is less likely to induce rouleaux formation than formation than HMW dextran (long acting).

21. Ans. b. Hypotension and bleeding from site of wound wound (Ref:  (Ref: Schwartz 10/e p119,122,171 p119,122,171-172, -172, 9/e p83) •

•

•

Schwartz says “In patients who are anesthetized  anesthetized   and have an open wound , the two dominant signs (of mismatched blood transfusion)) are diuse bleeding and hypotension transfusion hypotension.” .” MC symptom of hemolytic transfusion reactions transfusion  reactions in in a  a conscious patient: patient: Sensation of heat heat and  and pain along the vein  into which the blood is being transfusedQ. MC sign of sign of hemolytic transfusion reactions transfusion reactions in a conscious patient: patient: OliguriaQ >hemoglobinuria.

22. Ans. a. Hypokalemia 23. Ans. a. DIC; b. Hypothermia; Hypothermia; d. Thrombocytopenia RED BLOOD CELLS

24. Ans. d. 50 days (Ref: Schwartz 10/e p1914-1915, 9/e p78; Bailey 26/e p21, 25/e p21) RED BLOOD CELLS •

RBCs are stored at 1-60CQ; Mean life of RBCs are life of transfused RBCs is RBCs is 35 daysQ. Anticoagulant used

Maximum storage

ACD/CPD/CP2D

21 daysQ

CPDA-1

35 daysQ

PLATELETS

25. Ans. a. 20-240 C for 5 days (Ref: Harrison 18/e p953; Sabiston 19/e p588; Schwartz 10/e p85, 9/e p79; Bailey 26/e p21, 25/e p21) PLATELET CONCENTRATES

•

Volume: 50 mlQ Volume: Platelets are the only blood products which products which are stored at room temperature, 20-24 0 CQ (survival is 4-5 days )Q.

•

1 unit of platelet increases platelet  increases the count by 5000-10000Q.

•

• • •

transfusion is 10,000/ µLQ. The threshold for prophylactic platelet transfusion is For invasive procedures , 50,000/ µL platelets is the usual target level. surgery. Platelet count should be 1,00,000/ µL before accepting the patient for surgery.

•

Transfused platelets generally platelets generally survive for 2-7 days following transfusion.

•

ABO compatibility is compatibility is desirable but not necessary. necessary. •

Blood platelets in stored blood are blood are non-functional aer 24 hoursQ.

26. Ans. a. 24 hours PLASMA

27. Ans. c. Coagulation factor deciency; d. Warfarin Warfarin toxicity (Ref: Harrison 18/e p953; Sabiston 19/e p588)

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Surgery Essence FRESH-FROZEN  PLASMA (FFP) • • •

FFP is produced from the separation  donated bloodQ. the separation of plasma from from donated 0 Q Stored at at -18  -18 C and has a shelf a shelf life of 1 year . Each unit contains 400 mg of brinogen and 1 unit activity of each of the cloing factors Q. •

•

 VIII)) may be diminished Most labile cloing factors (V and and VIII be diminishedQ proportional to shelf life.

FFP contains stable coagulation factors and factors and plasma proteins: proteins: brinogen, antithrombin, albumin, proteins C and S Q. Indications for FFP •

•

Correction of coagulopathies: ₋ Rapid reversal of warfarin Q ₋ Supplying decient plasma proteinsQ

•

Treatment purpuraQ

of

thrombotic

thrombocytopenic

support should receive FFP from IgA-decient donors to prevent anaphylaxis. Patients who are IgA-decient and require plasma support should • •

FFP should not be routinely used to expand blood volume Q. FFP:: An acellular component and FFP component and does not transmit intracellular infections , e.g., CMV. CMV.

28. Ans. a. Good source of all coagulation coagulation factors 29. Ans. c. Factors Factors 5 and 8 30. Ans. a. It is used as volume expander

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31. Ans. a. Just before operation The question is incomplete. It should be “A cirrhotic patient with abnormal coagulation needs cholecystectomy cholecystectomy,, FFP should be given:” FRESH FROZEN PLASMA • •

• • •

Transfusions with FFP Transfusions FFP are  are given to replenish cloing factors Q. transfusion in on  the quantity of each factor delivered and its The eectiveness of the transfusion  in maintaining hemostasis is dependent on  half-life.. half-life half-life on The half-life  on the most stable cloing factor , factor VII , is 4 to 6 hoursQ. A reasonable transfusion scheme would be to give FFP on call  to the operating room. room. This way the transfusion is is   complete prior to the  the  incision , with circulating factors to cover  the operative  and immediate postoperative periodQ.

32. Ans. b. 8 hours •

hours.. The half life of factor VIII is 8-12 hours

33. Ans. d. XI (Ref: htp://en.wikipedi htp://en.wikipedia.org/wiki/Haemophi a.org/wiki/Haemophilia_C) lia_C) •

Hemophilia C (Rosenthal syndrome): Due to factor XI deciencyQ

CRYOPRECIPITATE

34. Ans. c. Factor VIII (Ref: Harrison 18/e p953; Sabiston 19/e p588; Schwartz 10/e p73-75,1599, 9/e p82; Bailey 26/e p21, 25/e p21) CRYOPRECIPITATE

•

Cryoprecipitate is a source of brinogenQ, factor VIIIQ and von Willebrand factor (vWF) Q. Cryoprecipitate is It is ideal for supplying brinogen  to the volume-sensitive patient.

•

Stored at ≤-180C

•

• •

•

1 unit of unit of cryoprecipitate contains 80-145 units of Factor VIII and VIII and 250 mg of brinogenQ. transmission  among all Cryoprecipitate is pooled from many donors , so there are maximum chances of disease transmission   blood productsQ.

II) or absent absent ( type III) III) von Willebrand disease . Cryoprecipitate may also supply vWF to patients with dysfunctional (type II)  (type

35. Ans. b. Factor VIII 37. Ans. b. Factor IX

36. Ans. a. Cryoprecipitate