7 COMPONENTS

Question 1

(1) A male patient with cancer was admitted to the hospital with acute abdominal pain and a hemoglobin level of 6 g/dL. Small bowel resection was indicated, but the attending physician wanted to raise the patient’s hemoglobin level to 12 g/dL before surgery. How many units of RBCs would most likely be required to accomplish this?

A. 2
B. 3
C. 6
D. 8

Answer 1

C. 6

One unit of RBCs will raise the hemoglobin level by approximately 1.0 to 1.5 g/dL, and the hematocrit by 3% to 4%. Results vary, depending on the age of the blood and the patient’s blood volume and hydration status. Six units will raise the hemoglobin level to at least 12 g/dL.

Question 2

(2) Which of the following is not a viable method for removing leukocytes from RBCs?

A. Prestorage filtration
B. Bedside filtration
C. Poststorage filtration
D. Buffy coat removal

Answer 2

D. Buffy coat removal

Removal of the buffy coat, which contains both platelets and white blood cells (WBCs), is not an approved method for leukocyte reduction of RBCs. The other methods can be employed to achieve a leukocyte reduction of less than 5 × 106.

Question 3

(3) Four units of packed RBCs were brought to the nurses’ station at 10:20 a.m. Two units were transfused immediately, and 1 unit was transfused at 10:40 a.m. The remaining unit was returned to the blood bank at 11:00 a.m. The units were not refrigerated after leaving the blood bank. What problem(s) is (are) present in this situation?

A. The only problem is with the returned unit; the 30-minute limit has expired and the unit cannot be used
B. The unit should not have been transfused at 10:40 a.m. because the time limit had expired; this unit and the remaining unit should have been returned to the blood bank
C. The returned unit may be held for this patient for 48 hours but cannot be used for another patient
D. No problems; all actions were performed within the allowable time limits

Answer 3

A. The only problem is with the returned unit; the 30-minute limit has expired and the unit cannot be used

There is a 30-minute time limit for a unit of RBCs that is not kept under proper storage conditions (1°C–6°C).

Question 4

(4) A unit of whole blood is collected at 10:00 a.m. and stored at 20°C to 24°C. What is the last hour at which platelet concentrates may be made from this unit?

A. 4:00 p.m.
B. 6:00 p.m.
C. 7:00 p.m.
D. 8:00 p.m.

Answer 4

B. 6:00 p.m.

Platelet preparation from whole blood must be done within 8 hours of collection.

Question 5

(5) Which of the following is acceptable according to the AABB standards?

A. Rejuvenated RBCs may be made within 3 days of outdate and transfused or frozen within 24 hours of rejuvenation
B. Frozen RBCs must be prepared within 30 minutes of collection and may be used within 10 years
C. Irradiated RBCs must be treated within 8 hours of collection and transfused within 6 hours
D. Leukocyte-reduced RBCs must be prepared within 6 hours of collection and transfused within 6 hours of preparation

Answer 5

A. Rejuvenated RBCs may be made within 3 days of outdate and transfused or frozen within 24 hours of rejuvenation

Rejuvenated RBCs may be prepared within 3 days of the outdate of the unit and washed and transfused or frozen within 24 hours. A unit of RBCs may be frozen within 6 days of collection. An RBC unit can be irradiated any time prior to the expiration date; once irradiated, the unit must be transfused within 28 days of irradiation or the original outdate, whichever comes first. Leukocyte-reduced RBCs should be prepared within 6 hours of collection, but must be given within 24 hours, if prepared using an open system. Leukocyte-reduced RBCs prepared using a closed system may be kept until the original date of expiration.

Question 6

(6) Which of the following is true regarding apheresis platelets?

A. The minimum platelet count must be 3.0 × 10^11, pH must be 6.0 or greater
B. The minimum platelet count must be 3.0 × 10^10, pH must be 6.2 or less
C. The minimum platelet count must be 3.0 × 10^11, pH must be 6.2 or greater
D. The minimum platelet count must be 5.5 × 10^10, pH must be 6.0 or less

Answer 6

C. The minimum platelet count must be 3.0 × 10^11, pH must be 6.2 or greater

Single-donor platelets prepared by apheresis must contain a minimum of 3.0 × 10^11 platelets, and pH must be 6.2 or higher throughout the shelf life of the product.

Question 7

(7) What is the component of choice for a patient with chronic granulomatous disease (CGD)?

A. Fresh frozen plasma (FFP)
B. Granulocytes
C. Cryoprecipitate
D. RBCs

Answer 7

B. Granulocytes

Patients with CGD cannot fight bacterial infections because of dysfunctional phagocytic enzymes; granulocyte concentrates are the product of choice for these patients.

Question 8

(8) What method can be employed to detect bacteria in random donor platelets?

A. pH
B. Glucose
C. Pan-genera detection (PGD) assay
D. Gram stain

Answer 8

C. Pan-genera detection (PGD) assay

The FDA has mandated that pH and glucose can no longer be used as a screening test for platelets. The Verax PGD assay has been FDA approved for both single-donor platelets and random-donor platelets for bacteria screening.

Question 9

(9) All of the following statements regarding FFP are true, except:

A. FFP must be prepared within 24 hours of collection
B. After thawing, FFP must be transfused within 24 hours
C. Storage temperature for FFP with a 1-year shelf life is –18°C or less
D. When thawed, FFP must be stored between 1°C to 6°C

Answer 9

A. FFP must be prepared within 24 hours of collection

FFP must be prepared within 8 hours after collection or according to FDA cleared operator manual/inserts.

Question 10

(10) What may be done to RBCs before transfusion to a patient with cold agglutinin disease to reduce the possibility of a transfusion reaction?

A. Irradiate to prevent graft-versus-host-disease (GVHD)
B. Wash with 0.9% saline
C. Warm to 37°C with a blood warmer
D. Transport so that temperature is maintained at 20°C to 24°C

Answer 10

C. Warm to 37°C with a blood warmer

A patient having cold agglutinins might have a reaction to a cold blood product. The product should be warmed to 37°C before transfusion.

Question 11

(11) A unit of packed RBCs is split using the open system. One of the half units is used. What may be done with the second half unit?

A. Must be issued within 24 hours
B. Must be issued within 48 hours
C. Must be irradiated
D. Must retain the original expiration date

Answer 11

A. Must be issued within 24 hours

The other half unit must be issued within 24 hours, if an open system is used to split the unit.

Question 12

(12) 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

Answer 12

D. Do not issue the unit

A unit having a noticeable clot should not be issued for transfusion to a patient. The clot may be an indication of contamination or bacterial growth.

Question 13

(13) Cryoprecipitate may be used to treat all of the following, except:

A. von Willebrand disease
B. Hypofibrinogenemia
C. Idiopathic thrombocytopenic purpura (ITP)
D. Factor XIII deficiency

Answer 13

C. Idiopathic thrombocytopenic purpura (ITP)

Cryoprecipitate may be used to treat von Willebrand disease, hypofibrinogenemia, and factor XIII deficiency, but is not indicated in ITP. IVIG is the product of choice for ITP.

Question 14

(14) SITUATION: A transplant patient may receive only type A or AB platelets. Only type O apheresis platelets are available. What devices may be used to deplete the incompatible plasma and replace with sterile saline?

A. Cytospin/irradiator
B. Water bath/centrifuge
C. Centrifuge/sterile connecting device
D. Cell washer/heat sealer

Answer 14

C. Centrifuge/sterile connecting device

In the event of an ABO-mismatched stem cell transplant, special attention must be paid to the choice of transfused blood products. Type A or AB platelets may be given to a transplant in which the donor is type A and the recipient is type O; once the stem cells engraft, platelets/plasma must be compatible with type A cells. If only type O single-donor platelets are available, the product can be spun down using a centrifuge and plasma can be removed. Then, a sterile connecting device can be used to aseptically transfer sterile isotonic saline to the platelet product, replacing the incompatible plasma.

Question 15

(15) What component(s) is (are) indicated for patients who have anti-IgA antibodies?

A. Whole blood
B. Packed RBCs
C. Washed or deglycerolized RBCs
D. Granulocytes

Answer 15

C. Washed or deglycerolized RBCs

Patients with anti-IgA antibodies should not receive components containing plasma. Washed or deglycerolized RBCs can be issued.

Question 16

(16) What is the expiration date for pooled cryoprecipitate (pooled before freezing)?

A. 12 months from latest date of collection of product in pool
B. 12 months from earliest date of collection of product in pool
C. 4 hours
D. 6 hours

Answer 16

B. 12 months from earliest date of collection of product in pool

Expiration of pooled cryoprecipitate must take into account that there may be units that makeup the pool with differing collection dates where the earliest date is used to determine the expiration date.

Question 17

(17) All of the following are true regarding washed RBCs, except:

A. RBCs are washed with 1 to 2 L of normal saline
B. Volume is 180 mL
C. Shelf life is extended
D. Leukocytes are removed

Answer 17

C. Shelf life is extended

Washed RBCs renders the system “open” and shortens the expiration time to 24 hours.

Question 18

(18) What is a special condition for the storage of platelets?

A. Room temperature, 20°C to 24°C
B. No other components may be stored with platelets
C. Platelets must be stored upright in separate containers
D. Platelets require constant agitation at 20°C to 24°C

Answer 18

D. Platelets require constant agitation at 20°C to 24°C

Platelets require constant agitation and are stored at temperatures between 20°C and 24°C. Cold-stored platelets (single donor [apheresis] platelets stored at 1-6°C for up to 3 days) may be used for actively bleeding patients, but are not approved for treating thrombocytopenia.

Question 19

(19) Transfusion of an irradiated product is indicated in all of the following conditions except:

A. Exchange transfusion
B. Bone marrow transplantation
C. Severe combined immunodeficiency syndrome (SCIDS)
D. Warm autoimmune hemolytic anemia

Answer 19

D. Warm autoimmune hemolytic anemia

WAIHA would not require irradiation unless the patient had an underlying immunosuppressive disorder.

Question 20

(20) What percentage of RBCs must be retained in leukocyte-reduced RBCs?

A. 75%
B. 80%
C. 85%
D. 100%

Answer 20

C. 85%

An RBC unit that has been leukocyte reduced must retain 85% of original RBCs.

Question 21

(21) Which of the following is true regarding granulocyte concentrates?

A. The product must contain a maximum of 1.0 × 10^10 granulocytes
B. pH must be 6.0
C. The product must be crossmatched
D. The product must be irradiated

Answer 21

C. The product must be crossmatched

Granulocyte concentrates contain a large amount of RBCs (greater than 2 mL) that must be crossmatched with the recipient’s serum.

Question 22

(22) What course of action should be taken if an MLS inadvertently irradiates a unit of RBCs twice?

A. Issue the unit
B. Discard the unit
C. Change the expiration date; then issue the unit
D. Note on the irradiation sticker that the unit was irradiated twice, and then issue the unit

Answer 22

B. Discard the unit

If an MLS mistakenly irradiates a unit of RBCs more than once, the unit must be discarded because of subsequent potassium accumulation. This does not apply to platelets.

Question 23

(23) What components(s) may be shipped together with FFP?

A. Frozen RBCs and cryoprecipitate
B. Platelets
C. Packed RBCs and granulocytes
D. Double RBC units

Answer 23

A. Frozen RBCs and cryoprecipitate

FFP requires dry ice for shipment. Frozen RBCs and cryoprecipitate also require dry ice.

Question 24

(24) A blood supplier ships 3 units of pooled cryoprecipitate. Each pool consists of 5 units of cryoprecipitate. If one unit is thawed at 5:00 p.m., when must it be dispensed from the blood bank?

A. Before 9:00 p.m.
B. Before 11:00 p.m.
C. Before 12:00 a.m.
D. Before 5:00 p.m. the next day

Answer 24

A. Before 9:00 p.m.

A thawed unit of pooled cryoprecipitate must be dispensed within 4 hours unless a sterile connecting device was used, which would extend expiration to 6 hours.

Question 25

(25) How does irradiation prevent transfusion-associated graft-versus-host disease (TA-GVHD)?

A. Gamma rays and x-rays destroy the lymphocytes’ ability to divide
B. X-rays cause lysis of the lymphocytes
C. Gamma rays enhance lymphocyte reactivity
D. Ultraviolet radiation induces apoptosis of lymphocytes

Answer 25

A. Gamma rays and x-rays destroy the lymphocytes’ ability to divide

Gamma rays or x-rays have the ability to prohibit a lymphocyte’s ability to divide, preventing TA-GVHD.

Question 26

(26) Which component has the longest expiration date?

A. Cryoprecipitate
B. FFP
C. Frozen RBCs
D. Platelet concentrates

Answer 26

C. Frozen RBCs

Frozen RBCs may be kept for up to 10 years, or longer if the transfusion service or blood center has a policy for extension beyond 10 years. FFP and cryoprecipitate stored at –18°C or lower expire in 1 year. If FFP is kept at
65°C or lower, the expiration time is 7 years. Platelet concentrates expire from 24 hours to 5 days, depending on the collection system used.

Question 27

(27) All of the following are advantages of using single-donor platelets as opposed to random donor platelets, except:

A. Less preparation time
B. Less antigen exposure for patients
C. May be HLA matched
D. No pooling is required

Answer 27

A. Less preparation time

Single-donor platelets require more preparation time compared with random-donor platelets because they are prepared by apheresis, which may require 1 to 3 hours, depending on the instrumentation used. Pooling random donor platelets in equivalent amounts may require only a few minutes.

Question 28

(28) What is the expiration of cryoprecipitate once pooled without the use of a sterile connecting device?

A. 4 hours
B. 6 hours
C. 8 hours
D. 24 hours

Answer 28

A. 4 hours

When individual cryoprecipitate units are pooled in an open system, the expiration time is 4 hours; if cryoprecipitate is pooled using a sterile connecting device, the expiration time is 6 hours.

Question 29

(29) What is the number of WBCs permitted in a unit of leukocyte-reduced RBCs?

A. Less than 5 × 10^10
B. Less than 5 × 10^6
C. Less than 8.3 × 10^5
D. Less than 8.3 × 10^6

Answer 29

B. Less than 5 × 10^6

RBCs that have been leukocyte reduced must have fewer than 5 × 10^6 WBCs per unit.

Question 30

(30) SITUATION: A patient with cancer recently developed a severe infection. The patient’s hemoglobin level is 8 g/dL as a result of chemotherapy with a drug known to cause bone marrow depression and immunodeficiency. Which blood products are indicated for this patient?

A. Liquid plasma and cryoprecipitate
B. Crossmatched platelets and washed RBCs
C. Factor IX concentrates and FFP
D. Irradiated RBCs, platelets, and granulocytes

Answer 30

D. Irradiated RBCs, platelets, and granulocytes

The patient with cancer may be immunocompromised because of the medication used but needs to receive RBCs for anemia; therefore, irradiated RBCs are indicated. Platelets may be needed to control bleeding, and granulocytes may be indicated for short-term control of severe infection.