A 27-year-old primigravida has sudden onset of cramping pelvic pain with vaginal bleeding at 36 weeks gestation. Emergent delivery of a liveborn male infant is performed, but she is noted to have a Hct of 18% following delivery, and an order for 2 units of packed red blood cells is given. As the first unit is nearly finished transfusing, she becomes febrile and hypotensive. Urine output ceases. A red top and lavender top tube are drawn, and the serum above the clot in the red top tube is pink. Which of the following findings is most likely in this situation?
A The transfused unit contained antibodies directed against her granulocytes
B Congestive heart failure resulted from fluid overload
C The type and screen specimens were mislabelled
D The transfused unit was found to be contaminated with hepatitis C virus
E T-lymphocytes in the transfused unit attacked her tissues
NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU
A laboratory study is conducted with subjects who received blood product therapy. It is observed that some of these subjects developed transfusion-associated graft-versus-host disease (TAGVHD). Methods are analyzed for prevention of TAGVHD. Which of the following methods is most likely to be successful in reducing the risk for TAGHVD?
A Use of frozen, deglycerolized RBC's to remove most WBC's
B Screening of blood donors for a history of GVHD
C Use of blood products that have been filtered to remove WBC's
D Gamma irradiation of blood products to eliminate lymphocyte proliferation
E Adding cytoxan to tranfused units
A 30 year-old G2 P1 woman presents to the emergency room with third trimester vaginal bleeding and the sudden onset of marked pelvic pain. She is quickly admitted to labor and delivery, where severe fetal distress is discovered and ultrasound reveals placental abruption. An emergent cesarean section is performed, and packed red blood cells are given, after which her hematocrit is 25%. A few minutes after the male infant is delivered, her vaginal bleeding increases notably. Laboratory findings now reveal a PT 150 of seconds, PTT 150 seconds, platelet count 15,000/microliter, Hct 25%, fibrinogen 30 mg/dL, and D-Dimer 1:256. Which of the following therapies should this patient now receive?
A Cryoprecipitate and platelets
B O negative whole blood
C Packed RBCs and fresh frozen plasma
D Plasmapheresis
E Single donor platelets
A 29-year-old primigravida has not had any prenatal care and shows up at the emergency room in labor with marked vaginal bleeding. An ultrasound scan shows placental abruption. Her hematocrit is now at 14% and she has orthostatic hypotension. In this situation, which blood product may be released for immediate transfusion without routine compatibility testing?
A Frozen, deglycerolized RBC's
B Group O, Rh negative packed RBC's
C RBC's lacking high incidence antigens
D Irradiated blood
E Group AB, Rh negative whole blood
A 40-year-old man has the sudden onset of severe hematemesis. On physical examination he has a temperature of 37.1 C, pulse 106/minute, respiratory rate 20/minute, and blood pressure 80/40 mm Hg. Laboratory studies show Hgb 8.2 g/dL, Hct 24.5%, MCV 98 fL, platelet count 75,000/microliter, and WBC count 4500/microliter. His prothrombin time is 30 seconds and partial thromboplastin time 63 seconds. Which of the following is the best blood product in this situation?
A Whole blood
B Cryoprecipitate
C Packed red blood cells
D Granulocytes
E Fresh frozen plasma (FFP)
A 2-day-old term infant was transferred from a local hospital to the NBICU at University Hospital in respiratory distress. On arrival, the neonate is noted to have ecchymoses over the extremities and trunk. Laboratory test findings include prothrombin time >100 seconds, partial thromboplastin time >100 seconds, D-dimer of 0, Hgb 11.1 g/dL, Hct 34.3%, WBC count 8800/microliter, and platelet count 144,000/microliter. The fibrinogen level at the local hospital was measured as 0, but when repeated using a test for direct determination of fibrinogen, the value is 200 mg/dL. Which of the following therapies is indicated for this infant?
A Protamine sulfate
B Fresh frozen plasma
C Ciprofloxacin
D "Six pack" of platelets
E Whole blood
A 26-year-old man comes to the donor center as a volunteer donor for a directed donation to his mother-in-law, who is undergoing a left hip prosthesis surgery. She is blood type O positive and CMV negative. Her preoperative Hct is 36.8%. Which of the following conditions will exclude using this young man's blood for use by this patient?
A His blood is CMV positive
B Her Hct is higher than 24%
C She could get transfusion associated graft versus host disease
D His blood type is A positive
E He travelled to Wisconsin last year
A 40-year-old woman with severe thrombocytopenia is given a "six-pack" (6 unit) platelet transfusion and a CBC drawn one hour later reveals an increase in the platelet count by 50,000/microliter. Another CBC drawn 24 hours later reveals that her platelet count has dropped by only 5,000/microliter. Three weeks later, the patient receives another six-pack platelet transfusion and this time the post-transfusion platelet count rises by 42,000/microliter, and 24 hours later the count has dropped by 35,000/microliter. Her hematocrit has remained stable between 30 and 35% over this time. Which of the following conditions best explains these findings?
A Febrile transfusion reaction
B Disseminated intravascular coagulation
C Alloimmunization
D Myelodysplastic syndrome
E Gastrointestinal hemorrhage
A laboratory study is conducted to determine the optimal usage of platelets for transfusion. The blood bank inventory along with the transfusion records and medical records of subjects who were recipients of platelet transfusion are reviewed. Which of the following conclusions is most likely to be made from this study?
A Frozen storage of platelets helps increase the units available
B Platelet units carry no risk for transmission of HIV infection
C Platelet transfusions are rarely successful in patients with autoimmune thrombocytopenia
D Pooled donor platelets are preferred over single-donor platelets
E Platelet transfusion is not indicated above a level of 10,000/microliter
A 56-year-old man is brought to the emergency department with delirium. Vital signs on admission show T 39.3 C, P 100/minute, RR 22/minute, and BP 85/40 mm Hg. On physical examination he has ecchymoses on his skin. He requires increasing pressor support to maintain his blood pressure. Laboratory studies show Hgb 9.2 g/dL, Hct 28.3%, MCV 92 fL, platelet count 54,000/microliter, and WBC count 7,800/microliter. His D-dimer test is 24 micrograms/mL. Schistocytes are seen on his peripheral blood smear. Escherichia coli is cultured from blood and sputum. Which of the following blood products should be used to treat his condition?
A Pooled platelets
B Packed red blood cells
C Fresh frozen plasma
E Cryoprecipitate
A laboratory study is conducted to determine the optimal usage of blood products. The transfusion records and medical records of subjects receiving packed RBCs are reviewed. It is observed that some patients benefit from transfusion of cryopreserved units. However, cryopreservation increases the cost of blood product usage. In which of the following situations is use of regular units most likely to be as safe as use of cryopreserved units for transfusion?
A Reduction in CMV transmission to neonates
B Prevention of transfusion-associated infection
C Transfusion to sensitized IgA-deficient patients
D Patients with antibodies to high-incidence red cell antigens
E Patients with multiple alloantibodies difficult to crossmatch
A retrospective laboratory study is conducted to determine the optimal usage of blood products with subjects who received transfusion therapy. It is observed that the use of whole blood for some patients reduces the availability of blood products for other patients. There is one subset of subjects receiving blood products who benefit from use of whole blood. In which of the following situations is transfusion of whole blood most likely to be useful?
A Severe anemia and congestive heart failure
B Postpartum disseminated intravascular coagulation (DIC)
C Hemophilia B with active bleeding into joints
D Transsection of the aorta and >20% blood loss
E Blood group AB negative
A 55-year-old man has a history of peptic ulcer disease. He is admitted following an episode of hematemesis in which he remembers vomiting "about a quart" (1 liter) of dark red bloody emesis into the bathroom sink. He is found to have orthostatic hypotension. His Hgb is 6.8 g/dL, Hct 19.8%, MCV 76 fL, platelet count 98,000/uL, and WBC count 10,100/uL. His prothrombin time is 12.1 seconds and partial thromboplastin time 26.8 seconds. Which of the following blood products is most appropriate for this man?
A Irradiated RBC's
D Packed RBC's
E Platelet 6-pack
A clinical study is performed to determine potential complications of blood product therapy. The transfusion records and medical records of subjects who received blood product therapy are analyzed. It is observed that one subset of subjects developed a sudden drop in blood pressure following transfusion, though they remained afebrile. Which of the following conditions is most likely to be found in this subset of subjects?
A Staphylococcus aureus septicemia
B Blood group AB negative
C Graft-versus-host disease
D Penicillin allergy
E IgA deficiency
A laboratory study is conducted to determine the optimal usage of blood products. Blood bank inventories and transfusion records are reviewed. Blood products not used by their expiration date must be discarded. It is observed that the shorter the shelf life of the blood product, the more likely outdating occurs. Which of the following blood products is most likely to outdate the quickest?
A Granulocytes
B Whole blood
D Platelets
E Fresh frozen plasma
A retrospective clinical study is performed to determine the potential complications from transfusion of autologous blood products. The records of patients who received autologous blood products are reviewed. Which of the following complications is most likely to be seen in these patients?
A Febrile reactions
B Viral infections
C Circulatory overload
D Graft-versus-host disease
E Alloimmunization
A laboratory study is conducted to determine whether cryoprecipitate or fresh frozen plasma (FFP) is of greater use in treating different coagulopathies. A deficiency involving which of the following coagulation factors is most likely to be found to require FFP therapy?
A Fibrinogen
B Prothrombin
C vonWillebrand factor
D Factor VIII procoagulant activity
E Factor XIII
A 24-year-old G2 P1 woman gives birth at 35 weeks gestation to twin male infants. Both infants are noted to have marked hydrops along with generalized icterus. The infants' peripheral blood smears demonstrate numerous nucleated RBC's, and the spun hematocrit is only 20%. Which of the following mechanisms is most likely to produce these infants' disease?
A Twin-twin transfusion syndrome
B Naturally occurring maternal antibodies
C Fetal autoantibody production
D Prior maternal alloimunization
E Congenital HIV infection
A 68-year-old woman undergoes a left total hip replacement. She requires 2 units of PRBCs during the procedure. Following surgery, she is stable, with a Hct of 30%. A week later she develops a urinary tract infection from an indwelling catheter, which is complicated by acute pyelonephritis. A day later her blood pressure is 85/45 mm Hg. Her peripheral blood smear shows schistocytes. She receives 5 units of FFP. As the 5th unit is being transfused, she develop sudden severe dyspnea and begins coughing up large quantities of frothy sputum. A chest radiograph shows bilateral pulmonary edema. She is most likely to have developed a transfusion reaction to which of the following components of blood?
A Albumin
B Fibrinogen
C Granulocytes
E Red blood cells
A 25-year-old healthy man man goes to the donor center. He fills out the questionnaire and is interviewed by the technician. Which of the following findings during that screening process will exclude him as a blood donor:
A He travelled to Japan since his last donation
B He took a couple of aspirin tablets for a headache a month ago
C He has a past history of infectious mononucleosis
D His blood is found to be type AB negative
E He had sexual intercourse with another man last year
A 22-year-old primigravida delivers a term girl infant following an uncomplicated pregnancy. However, she has marked blood loss during the delivery and receives 2 units of PRBCs. An hour following transfusion, her Hct is 28%, but she suddenly develops marked pruritis. Physical examination reveals blotchy urticaria of her skin. Vital signs record T 37.1 C, P 83/minute, RR 17/minute, and BP 110/75 mm Hg. The donors of the two units are contacted and interviewed. Which of the following behaviours by one of the donors is most likely to have caused her transfusion reaction?
A Having sexual intercourse with a prostitute
B Eating seafood
C Smoking cigarettes
D Drinking wine
E Swimming in a river in an urban area
A retrospective clinical study is performed to determine the risks associated with transfusion of blood products. The medical records of subjects who received transfusion therapy are reviewed. It is observed that some subjects died from transfusion therapy. Which of the following complications of blood product transfusion is most likely to be found to have the greatest risk for death?
A Circulatory overload
B Allergic reaction
C Febrile reaction
D ABO incompatibility
E Acute lung injury
A 16-year-old boy has had easy bruising, petechiae, and gum bleeding for the past 2 months. On physical examination his vital signs include T 37 C, P 77/minute, RR 17/minute, and BP 110/75 mm Hg. His neurologic status is normal. Laboratory studies show his Hgb is 12.7 g/dL, Hct 38%, platelet count 22,000/microliter, and WBC count 5789/microliter. His prothrombin time is 12.8 seconds, partial thromboplastin time 28 seconds, and D-dimer 0. A bone marrow biopsy is performed and microscopic examination shows increased megakaryocytes. A test for anti-platelet antibodies (glycoprotein IIb/IIIa) is positive. Which of the following is the most appropriate therapy for this patient?
A Packed RBC's
C Cryoprecipitate
E No blood products
A 31-year-old woman has had increasing numbers of pinpoint hemorrhages on her skin for the past month. On physical examination she is afebrile and normotensive. She has petechiae of skin and mucosal surfaces. Laboratory studies shown her platelet count is 10,000/microliter. She receives 10 units of platelets. Following the transfusion, the platelet count is only 2,000/microliter. Which of the following is the most probable cause for this finding?
A Splenomegaly
B Anti-HLA antibodies
C Septicemia
D Hemorrhage
E Single donor source
A 26-year-old woman has had menorrhagia since menarche. On physical examination she has no abnormal findings. Laboratory studies show Hgb 11.3 g/dL, Hct 33.6%, MCV 73 fL, platelet count 231,700/microliter, and WBC count 5690/microliter. Her prothrombin time is 13 seconds and partial thromboplastin time 27 seconds. Her bleeding time is 12 minutes. Which of the following blood products is most likely to be useful in treating bleeding complications in this woman?
A Fresh frozen plasma
D Factor VIII concentrate
E Platelets
A clinical study is performed to determine the optimal usage of blood products. It is observed that few patients develop graft versus host disease following transfusion, but most do not. Prevention of graft versus host disease requires irradiation of the units prior to use and increases the cost for blood product therapy. For patients with which of the following conditions is use of regular units of PRBCs as likely to be as safe as use of irradiated units?
A Bone marrow transplantation
B Hodgkin lymphoma
C DiGeorge anomaly
D Breast carcinoma
E Acute lymphocytic leukemia
A clinical study is performed to determine the usefulness of washing RBCs prior to transfusion. It is observed that one type of complication occurs less frequently when washed RBCs are transfused. Which of the following complications of transfusion therapy is most likely occur less frequently with use of washed RBCs?
A Allergic transfusion reaction
B HLA alloimmunization
D Febrile transfusion reaction
E Transmission of cytomegalovirus
A 15-year-old girl is diagnosed with acute lymphocytic leukemia. She is being considered for bone marrow transplantation. However, she may then require transfusion of multiple blood products. Use of which of the following products or procedures is most likely to prevent HLA alloimmunization from blood product therapy in this girl?
A Washed RBC's
B Gamma irradiation
C Leukodepletion filters
D Corticosteroid therapy
E Avoidance of blood products
A directed blood donation is a poor idea for many reasons. Which of the following outcomes is the best that can be expected from a directed donation:
A A family member with hepatitis can be identified
B The risk for GVHD is diminished
C Family members can learn more about their risks for HIV infection
D A family member encouraged to donate may become a regular donor
E Directed donations are safer than those from the general donor pool
A 23-year-old primigravida delivers a term girl infant following an uncomplicated pregnancy. However, the placenta subsequently cannot be completely delivered, and she develops marked vaginal bleeding. A day later she has schistocytes noted on her peripheral blood smear. Which of the following therapies is most useful for her eventual recovery and not for her emergent situation?
A Platelets
B Fresh frozen plasma (FFP)
C Packed RBC's
D Vitamin K
A laboratory study is conducted with subjects who received pooled donor platelets. The transfusion and medical records for these subjects are reviewed. It is observed that some subjects benefitted from this therapy while others did not. For which of the following conditions is a post-transfusion rise in platelet count of >50,000/microliter most likely to occur?
A Leukemia with splenomegaly
B Thrombotic thrombocytopenic purpura
D vonWillebrand disease
E Idiopathic thrombocytopenic purpura
A 40-year-old man has a history of mild upper respiratory tract infections and mild diarrhea. He has had increasing fatigue for the past 3 months. On physical examination he has orthostatic hypotension. Laboratory studies show Hgb 6.8 g/dL, Hct 20.3%, MCV 85 fL, platelet count 162,000/microliter, and WBC count 4810/microliter. His serum total protein is 7.5 g/dL, albumin 3.9 g/dL, IgG 1123 mg/dL, IgM 208 mg/dL, and IgA not detected. Which of the following transfusion reactions is most likely to occur if he receives PRBCs?
A Anaphylactic transfusion reaction
B Hemolytic transfusion reaction
E Allergic transfusion reaction
A laboratory study is performed to determine what screening procedures need to be performed to help prevent transfusion acquired infections. Labortory testing is performed on potential donors. It is observed that antibodies to one infectious agent are found in 60 to 100% of the adult population in the U.S. It is determined that no routine donor blood screening will be performed for this agent. Which of the following organisms is most likely to fit this criterion?
A Hepatitis A virus
B HTLV-1
C Cytomegalovirus
D Malaria
E Hepatitis C virus
While driving to his next clinic visit, a 52-year-old man is involved in a vehicular accident in which his car is struck broadside at an intersection. Though the air bag inflates, the car rolls over, and the impact against the door results in a large laceration to his lower leg. After transport to a local hospital, he is found to have a Hct of 16%. Coagulation studies reveal a prothrombin time of 16 seconds and partial thromboplastin time of 26 seconds. His platelet count is 69,000/microliter. Transfusion with which of the following blood products is most likely to be of benefit to this man?
A Platelet packs
D Cryoprecipitate
A clinical study is performed with subjects who are healthy blood donors. These donors answered the questionnaire, and no risks excluding donation were identified. Serologic testing for multiple infectious agents is carried out on blood samples from these donors. It is observed that there is no value in screening donated blood for one infectious agent, because review of transfusion records reveals that no recipients became ill from infection following transfusion. As a result, which of the following infectious agents will not routinely tested for on blood collected for transfusion?
A Human immunodeficiency virus type 1
B Hepatitis A virus
C Human T lymphocytotrophic virus
D Treponema pallidum
E Hepatitis C
A retrospective clinical study is performed to determine the risks associated with transfusion of blood products. The medical records of subjects who received transfusion therapy are reviewed. It is observed that a subset of subjects with one complication had a death rate near 100%. Which of the following complications from receiving blood products is most likely to have this death rate?
A Cytomegalovirus infection
B Allergic transfusion reaction
C Hepatitis B infection
D Transfusion associated graft versus host disease
E Febrile transfusion reaction
An 18-year-old man is admitted to the hospital following a motorcycle accident in which his popliteal artery is lacerated. He is taken to surgery and his condition is stablized. Following surgery his vital signs include temperature 37.2 C, pulse 95/minute, respirations 22/minute, and blood pressure 115/80 mm Hg lying and 80/55 sitting. His Hct is 22% He receives 2 units of packed RBCs and following transfusion his CBC shows Hgb 9.4 g/dL, Hct 28.3%, MCV 99 fL, platelet count 197,000/uL, and WBC count 8100/uL. Two hours later, the trauma unit nurse records vital signs with temperature 38.9 C, pulse 100/minute, respirations 24/minute, and blood pressure 110/75 mm Hg. His urine output remains unchanged. Which of the following is the most likely interpretation for these findings?
A He is developing disseminated intravascular coagulopathy
B He received someone else's units of blood by mistake
C A transfusion reaction to transfused WBC's has occurred
D An additonal 2 units of PRBCs needs to be transfused
E He has evidence for an acute HIV infection
A 41-year-old woman has had headaches with blurred vision for 3 days. Over the past day she has developed increasing mental confusion. On admission to the hospital, she has vital signs showing temperature 37.9 C, pulse 104/minute, respirations 25/minute, and blood pressure 70/40 mmHg. She has petechial hemorrhages noted over her arms and trunk on physical examination, along with a stool sample positive for occult blood. Her CBC shows Hgb 9.1 g/dL, Hct 27.2%, MCV 92 fL, RDW 19%, platelet count 8900/microliter, and WBC count 8950/microliter. Her peripheral blood smear shows schistocytes. A serum electrolyte panel shows sodium 147 mmol/L, potassium 5.0 mmol/L, chloride 105 mmol/L, CO2 26 mmol/L, creatinine 2.9 mg/dL, urea nitrogen 32 mg/dL, and glucose 80 mg/dL. Which of the following therapies should she receive emergently?
A 6 pack of platelets
B 2 units of packed RBCs
C Exploratory laparotomy
E Dopamine
A 19-year-old woman is a passenger involved in a motorcycle accident in which she incurs deep lacerations to her extremities. In hospital she has an initial hematocrit of 20%. She begins to receive the first of 3 units of PRBCs. Within an hour her blood pressure drops precipitously. A peripheral blood smear reveals schistocytes. Her prothrombin time and partial thromboplastin time are prolonged. Her urine output drops, and what urine is produced is red-brown. Which of the following complications of blood product therapy has most likely occurred?
A retrospective clinical study is performed to determine rates of transfusion associated infection for the period from 1980 to 2000. The subjects are adult patients who survived for at least 5 years following transfusion. It is observed that after 1991 the rate of infection for one particular infectious disease dropped significantly. Which of the following infections is this most likely to be?
F HIV-1
G Group A streptococcus
FIRST QUESTION - - INDEX OF QUESTIONS - - EXAM MENU