Blood Transfusion Mcq 6e1b43

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. Transmission of infections d. Electrolyte imbalance



2. All of the following infections may be transmitted 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 after 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 of collection? (DNB 2006) a. Immediately b. 1 hours c. 4 hours d. 24 hours



5. Which of the following investigations should be done immediately to best confirm a non matched blood transfusion reaction? (All India 2010) a. Indirect Coomb’s test b. Direct Coomb’s test c. Antibody in patient’s 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 after 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 is responsible for most cases c. Rarely life threatening d. Renal blood flow is always maintained e. No need for stopping transfusion 10. True about blood transfusions: (PGI June 98) a. Antigen ‘D” determines Rh positivity b. Febrile reaction is due to HLA antigens c. Anti-d is naturally occurring antibody d. Cryoprecipitate contains all coagulation factors

11. Which of the following is better indicator of need for transfusion? (AIIMS 80, UPSC 87) a. Urine output b. Hematocrit c. Colour of skin d. Clinical examination 12. Massive blood transfusion is defined as: (PGI 95) 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 DA? (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. Increased t-PA b. Dilutional thrombocytopenia c. Vitamin K deficiency d. Decreased fibrinogen 15. Arterial blood gas analysis in a bottle containing heparin causes a decrease in value of: a. pCO2 b. HCO3 c. pH d. All of the above

16. Massive blood transfusion is defined 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. After 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 to 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 istration 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 c. Bradycardia and hypertension d. Tachycardia and hypertension

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1002  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: (PGI 88) a. DIC b. Hypothermia c. Hypercalcemia d. Thrombocytopenia

c. Coagulation factor levels are equal to Plasma d. None of the above

29. Stored plasma is deficient 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 frozen plasma (FFP), which one of the following statement is not correct? (UPSC 2008) 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, 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 after operation



32. Half life of factor VIII is: a. 4 hours c. 34 hours



33. Rosenthal’s syndrome is seen in deficiency of factor: a. II b. V (AIIMS 81, DNB 91) c. IX d. XI

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

Section 10: Others



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

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

26. Blood platelets in stored blood do not remain functional after: (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 deficiency d. Warfarin toxicity e. Hypoalbuminemia

(PGI Nov 2011)

28. True 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

b. 8 hours d. 48 hours

(PGI 88)

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

(MCI March 2009) b. Factor V d. 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 of the following blood fractions is stored at -40°C? (UPSC 2006) 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  1003

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 • • • • • • • • •

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

• RBC allosensitizationQ • HLA allosensitizationQ • Graft-versus-host 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

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



4. Ans. d. 24 hours



5. Ans. b. Direct Coomb’s test (Ref: Harrison 18/e p954)

• • • • •

Hyperkalemia HypocalcemiaQ HypomagnesemiaQ Metabolic alkalosisQ Metabolic acidosis (rare)Q Q

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



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

Volume (mL) 450 ml ± 45

Content Clinical Response • No elements removed • Not for routine use • Contains RBCs, WBCs, plasma and • Used for acute massive bleeding, platelets (WBCs and platelets may be open heart surgery and neonatal total non-functionalQ) exchange

Packed RBCs

180–200

Platelets FFP

50–70 200–250

Cryoprecipitate

10–15

• RBCs with variable leukocyte content and small amount of plasma • 5.5 x 1010/RD unit • Plasma proteins: Coagulation factors, proteins C and S, antithrombinQ • Cold-insoluble plasma proteins, fibrinogen, factor VIII, vWFQ http://vip.persianss.ir/

• Increase Hb 1 gm/dL and hematocrit 3%Q • Increase platelet count 5000–10,000/µLQ • Increases coagulation factors about 2% • Topical fibrin glue, also 80 IU factor VIIIQ

Section 10: Others

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

Other Complications 

Q

1004  Surgery Essence

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 same group should be used

• Group ‘O’ RBCs are chosen • Such unmatched blood should be Rh negative, when used in women of child bearing 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 mediated hemolysis is seen (Ref: Harrison 18/e p954) • Acute hemolytic transfusion reactions following blood transfusion are type II hypersensitivity reactions caused most often by the complement mediated hemolysisQ. • These reactions are often life-threatening and complications include oliguria and acute renal failure (decreased renal blood flow)Q.

Section 10: Others



10. Ans. a. Antigen ‘D” determines Rh positivity; b. Febrile reaction is due to HLA antigens (Ref: Harrison 18/e p954) • Rh positive or negative status depends on the presence or absence of antigen D (Rh D) on RBCsQ. • Febrile (non-hemolytic) reactions are caused by antibodies directed against donor 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/D/2D

21 daysQ

DA-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 PaCO2Q

Effects due to Acidic Nature of Heparin • Decreased pHQ

• Decreased HCO3Q



16. Ans. a. i.e., Whole blood volume in 24 hours According to Sabiston - Massive Blood Transfusion is defined as • Transfusion greater than patient’s total blood volume in 24 hours • Or as acute istration of more than 10 units of blood over a few hours. According to Schwartz “Massive transfusion is a single transfusion of 2500 ml or 5000 ml 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) http://vip.persianss.ir/

Blood Transfusion  1005 Dextran • It is a polysaccharide polymer of varying molecular weight producing an osmotic pressure similar to the plasma • Disadvantages: −− It induces rouleaux of RBCs and this interferes with blood grouping and cross matchingQ procedures, hence need for a blood sample beforehand. −− It interferes with platelet function, hence it is recommended that total volume of dextran should not exceed 1000 mL. • LMW dextran (short acting) prevents sludging of RBCs in vessels and renal shut down in severe hypotension and it is less likely to induce rouleaux formation than HMW dextran (long acting).

21. Ans. b. Hypotension and bleeding from site of wound (Ref: Schwartz 10/e p119,122,171-172, 9/e p83) • Schwartz says “In patients who are anesthetized and have an open wound, the two dominant signs (of mismatched blood transfusion) are diffuse bleeding and hypotension.” • MC symptom of hemolytic transfusion reactions in a conscious patient: Sensation of heat and pain along the vein into which the blood is being transfusedQ. • MC sign of hemolytic transfusion reactions in a conscious patient: OliguriaQ >hemoglobinuria.



22. Ans. a. Hypokalemia



23. Ans. a. DIC; b. Hypothermia; d. Thrombocytopenia



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 transfused RBCs is 35 daysQ. Anticoagulant used

Maximum storage

ACD/D/2D

21 daysQ

DA-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 ml • Platelets are the only blood products which are stored at room temperature, 20-240 CQ (survival is 4-5 days)Q. Q

• 1 unit of platelet increases the count by 5000-10000Q. • The threshold for prophylactic platelet transfusion is 10,000/µLQ. • For invasive procedures, 50,000/µL platelets is the usual target level. • Platelet count should be 1,00,000/µL before accepting the patient for surgery. • Transfused platelets generally survive for 2-7 days following transfusion. • ABO compatibility is desirable but not necessary. • Blood platelets in stored blood are non-functional after 24 hoursQ.



26. Ans. a. 24 hours

PLASMA

27. Ans. c. Coagulation factor deficiency; d. Warfarin toxicity (Ref: Harrison 18/e p953; Sabiston 19/e p588) http://vip.persianss.ir/

Section 10: Others

RED BLOOD CELLS

1006  Surgery Essence Fresh-frozen Plasma (FFP) • FFP is produced from the separation of plasma from donated bloodQ. • Stored at -180C and has a shelf life of 1 yearQ. • Each unit contains 400 mg of fibrinogen and 1 unit activity of each of the clotting factorsQ. • Most labile clotting factors (V and VIII) may be diminishedQ proportional to shelf life. • FFP contains stable coagulation factors and plasma proteins: fibrinogen, antithrombin, albumin, proteins C and SQ. Indications for FFP • Correction of coagulopathies: ₋₋ Rapid reversal of warfarinQ ₋₋ Supplying deficient plasma proteinsQ

• Treatment purpuraQ

of

thrombotic

thrombocytopenic

• Patients who are IgA-deficient and require plasma should receive FFP from IgA-deficient donors to prevent anaphylaxis.

Section 10: Others

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

28. Ans. a. Good source of all coagulation factors



29. Ans. c. Factors 5 and 8



30. Ans. a. It is used as volume expander



31. Ans. a. Just before operation



The question is incomplete. It should be “A cirrhotic patient with abnormal coagulation needs cholecystectomy, FFP should be given:”

Fresh Frozen Plasma • Transfusions with FFP are given to replenish clotting factorsQ. • The effectiveness of the transfusion in maintaining hemostasis is dependent on the quantity of each factor delivered and its half-life. • The half-life on the most stable clotting factor, factor VII, is 4 to 6 hoursQ. • A reasonable transfusion scheme would be to give FFP on call to the operating room. • This way the transfusion is complete prior to the incision, with circulating factors to cover the operative and immediate postoperative periodQ.

32. Ans. b. 8 hours • The half life of factor VIII is 8-12 hours. 



33. Ans. d. XI (Ref: http://en.wikipedia.org/wiki/Haemophilia_C) • Hemophilia C (Rosenthal syndrome): Due to factor XI deficiencyQ

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 fibrinogenQ, factor VIIIQ and von Willebrand factor (vWF)Q. • It is ideal for supplying fibrinogen to the volume-sensitive patient. • Stored at ≤-180C • 1 unit of cryoprecipitate contains 80-145 units of Factor VIII and 250 mg of fibrinogenQ. • Cryoprecipitate is pooled from many donors, so there are maximum chances of disease transmission among all blood productsQ. • Cryoprecipitate may also supply vWF to patients with dysfunctional (type II) or absent (type III) von Willebrand disease.

35. Ans. b. Factor VIII



37. Ans. b. Factor IX

36. Ans. a. Cryoprecipitate

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