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 transmied 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 aer 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 conrm 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 aer 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 beer 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 dened 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 deciency d. Decreased brinogen 15. Arterial blood gas analysis in a bole bole 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 dened 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. Aer 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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Surgery Essence
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 aer: (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 deciency 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 decient 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 aer 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 deciency 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
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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
Q
Hepatitis B and C 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 oen by the complement mediated hemolysisQ. These reactions are oen 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 2Q Decreased HCO 3
Effects due to Acidic Nature of Heparin •
Decreased pH Q
Q
16. Ans. a. i.e., Whole blood volume in 24 hours According to Sabiston - Massive Blood Transfusion is dened 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) http://vip.persianss.ir/
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 diuse 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 aer 24 hoursQ.
26. Ans. a. 24 hours PLASMA
27. Ans. c. Coagulation factor deciency; d. Warfarin Warfarin toxicity (Ref: Harrison 18/e p953; Sabiston 19/e p588) http://vip.persianss.ir/
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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 cloing factors Q. •
•
VIII)) may be diminished Most labile cloing 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 decient plasma proteinsQ
•
Treatment purpuraQ
of
thrombotic
thrombocytopenic
support should receive FFP from IgA-decient donors to prevent anaphylaxis. Patients who are IgA-decient 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 cloing factors Q. transfusion in on the quantity of each factor delivered and its The eectiveness of the transfusion in maintaining hemostasis is dependent on half-life.. half-life half-life on The half-life on the most stable cloing 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 deciencyQ
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
36. Ans. a. Cryoprecipitate
37. Ans. b. Factor IX
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