Immunohematology-Transfusion Reactions Flashcards
1
Q
- A patient had a transfusion reaction to packed red
blood cells. The medical laboratory scientist began
the laboratory investigation of the transfusion
reaction by assembling pre- and post-transfusion
specimens and all paperwork and computer
printouts.
What should he do next?
A. Perform a DAT on the post-transfusion sample
B. Check for a clerical error(s)
C. Repeat ABO and Rh typing of patient and
donor unit
D. Perform an antibody screen on the posttransfusion sample
A
B. Check for a clerical error(s)
2
Q
- What is the pathophysiological cause surrounding
anaphylactic and anaphylactoid reactions?
A. Antibody in patient serum is detected 3–7 days
after transfusion, and is attached to donor red
blood cells
B. Donor plasma has reagins (IgE or IgA) that
combine with allergens in patient plasma
C. Patient is deficient in IgE and develops IgE
antibodies via sensitization from transfusion or
pregnancy
D. Patient is deficient in IgA and develops IgA
antibodies via sensitization from transfusion or
pregnancy
A
D. Patient is deficient in IgA and develops IgA
antibodies via sensitization from transfusion or
pregnancy
3
Q
- A patient has a hemolytic reaction to blood
transfused 8 days ago. What is the most likely
cause?
A. Immediate, nonimmunologic probably due to
volume overload
B. Delayed immunologic, probably due to an
antibody such as anti-Jka
C. Delayed nonimmunologic, probably due to iron
overload
D. Immediate, immunologic, probably due to
clerical error, ABO incompatibility
A
B. Delayed immunologic, probably due to an
antibody such as anti-Jka
4
Q
- What may be found in the serum of a person who
is exhibiting signs of TRALI (transfusion-related
acute lung injury)?
A. Red blood cell alloantibody
B. IgA antibody
C. Antileukocyte antibody
D. Allergen
A
C. Antileukocyte antibody
5
Q
- Which type of transfusion reaction occurs in about
1% of all transfusions, results in a temperature
rise of 1°C or higher, is associated with blood
component transfusion, and is not related to the
patient’s medical condition?
A. Immediate hemolytic
B. Delayed hemolytic
C. Febrile nonhemolytic reaction
D. Transfusion-related acute lung injury
A
C. Febrile nonhemolytic reaction
6
Q
- What would be the result of group A blood given
to an O patient?
A. Nonimmune transfusion reaction
B. Immediate hemolytic transfusion reaction
C. Delayed hemolytic transfusion reaction
D. Febrile nonhemolytic transfusion reaction
A
B. Immediate hemolytic transfusion reaction
7
Q
- Patient DB received 2 units of group A-positive
red cells 2 days ago. Two days later, he developed a
fever and appeared jaundiced. His blood type was
A positive. A transfusion reaction workup was
ordered. There were no clerical errors detected.
A post-transfusion specimen was collected and a
DAT performed. The DAT was positive with
monospecific anti-IgG. The plasma was also
hemolyzed. An antibody screen and panel studies
revealed the presence of anti-Jkb (postspecimen).
The antibody screen on the pretransfusion
specimen was negative. Which of the following
explain the positive DAT?
A. The donor cells had a positive DAT
B. The donor cells were polyagglutinable
C. The donor cells were likely positive for the Jkb
antigen
D. The recipient cells were likely positive for the Jkb
antigen
A
C. The donor cells were likely positive for the Jkb
antigen
8
Q
- All of the following are part of the preliminary
evaluation of a transfusion reaction, except:
A. Check pre- and post-transfusion samples for
color of serum
B. Perform ABO and Rh recheck
C. DAT on the post-transfusion sample
D. Panel on pre- and post-transfusion samples
A
D. Panel on pre- and post-transfusion samples
9
Q
- A 68-year-old female diagnosed with neutropenia
and inflammation of the left hand was typed as A
positive, and received 1 packed red blood cell unit.
The antibody screen was negative and crossmatch
was compatible. During the transfusion, her pulse
was 94, and blood pressure rose from 114/59 to
132/64. Her temperature rose from 37.1°C
pretransfusion to 37.8°C 60 minutes after starting
transfusion, then to 38.1°C upon completion. A
post-transfusion specimen yielded plasma that was
neither hemolyzed nor icteric, and a negative DAT.
Post-transfusion urinalysis gave a 1+ blood and
protein with 10 RBCs/hpf microscopically. The
clerical check was acceptable. What type of reaction
most likely occurred as a result of transfusion?
A. Allergic
B. Circulatory overload
C. Febrile nonhemolytic
D. Delayed hemolytic
A
C. Febrile nonhemolytic
10
Q
- A 92-year-old male diagnosed with anemia
and episodes of frequent falling was typed as
B negative and transfused 1 unit of packed red
blood cells, also B negative. He was not recently
transfused, and the antibody screen was negative.
During the transfusion, his temperature rose from
36.2°C to 36.4°C, his pulse rose from 96 to 124,
respirations from 18 to 20, and BP from 127/81
to 174/83. He was transfused with 205 mL before
a reaction was called by the transfusionist. The
postspecimen DAT was negative and clerical
check acceptable. Urinalysis yielded 1+ blood
with 5 RBCs microscopically. Other symptoms
included tachycardia and flushing. What reaction
had most likely taken place?
A. Febrile nonhemolytic
B. Acute hemolytic
C. Anaphylactic
D. Volume overload
A
D. Volume overload
11
Q
- A 76-year-old female diagnosed with urosepsis was
transfused 2 units of packed red blood cells. Her
type was AB positive with a negative antibody
screen. The units transfused were AB positive.
Upon receiving the second unit, the patient
became hypoxic with tachypnea. The clerical check
was acceptable and DAT negative. She received
269 mL from the second unit before a reaction was
called. Her temperature fell from 38°C to 36.4°C,
her pulse increased from 72 to 90, and respirations
rose from 35 to 41. Her BP was 110/70. The
patient expired approximately 12 hours from the
time the reaction was called. What type of reaction
was most likely present?
A. Febrile
B. Symptoms not related to transfusion
C. Allergic
D. TRALI
A
B. Symptoms not related to transfusion
12
Q
- A 52-year-old male received 2 units of packed red
blood cells as an outpatient in the IV therapy unit.
He had a 20-year history of head trauma and was
quadriplegic. He had recurrent pneumonia and
hematuria due to removal of a Foley catheter.
His blood type was A positive with a previously
identified anti-Fya. There was an ABO discrepancy
in that the A1 cells were positive. The technologist
attributed the reaction to the Fya antigen being
present on the A1 cells. The patient also had a cold
autoantibody. Two units of A-positive packed
cells were crossmatched that were Fya negative,
and were compatible. One unit was transfused at
11:30 a.m. without incident. The second unit was
transfused at 2:16 p.m., and stopped at 3:55 p.m.
due to reddish brown–tinged urine discovered in
his collection bag. A post-transfusion specimen
yielded a positive DAT, and plasma that was
grossly hemolyzed. A prewarm crossmatch was
incompatible in both the pre- and postspecimen.
Anti-E and c were present in the postspecimen.
What reaction was most likely present?
A. Acute hemolytic
B. Febrile
C. Allergic
D. TRALI
A
A. Acute hemolytic
13
Q
- An 82-year-old male was admitted for renal
failure. His type was B positive, and his antibody
screen was negative. Two units of red cells were
ordered. The first unit was transfused at 1:00 p.m.
without incident. The second was started at
4:15 p.m. and stopped at 5:12 p.m., after the
nurse observed the patient had expired. Vital signs
were taken at 4:30 p.m. with no abnormalities.
A transfusion reaction was called and the blood
unit, tubing, and paperwork sent to the blood
bank. There were no clinical manifestations
noted on the paperwork and no post-transfusion
specimen was sent to the blood bank. What type
of reaction most likely occurred?
A. Symptoms not related to transfusion
B. Acute hemolytic reaction
C. Anaphylactic reaction
D. Volume overload
A
A. Symptoms not related to transfusion
