(M) Pretransfusion testing and Transfusion practices

Question 1

A series of testing procedures and processes with the ULTIMATE objective of ensuring the best possible outcome of a blood transfusion.

Answer 1

Pretransfusion testing

Question 2

Purpose of pretransfusion testing - T or F

To select blood components that will have 100% survival when transfused and will not cause harm to the patient

Answer 2

F (acceptable survival)

REMEMBER!
blood transfusion is not 100% safe

Question 3

If pretransfusion testing is performed properly, it will be
able to: (2)

Answer 3

a) Establish ABO - Rh compatibility
b) Detect most clinically significant unexpected antibodies.

Question 4

Familiarize!

Steps in pretransfusion testing

Answer 4

1. request for transfusion
2. Identification of transfusion recipient and blood specimen collected
3. Testing of tranfusion recipient’s blood specimen
4. Donor RBC unit testing
5. Donor red cell unit selection
6. compatibility testing / crossmatching
7. Labelling of blood or blood components with the recipient’s identifying information and issue

Question 5

What are the tests done in testing of transfusion recipient’s blood specimen:

Answer 5

➔ Blood specimen acceptability
➔ ABO group and Rh type
➔ Antibody detection testing
➔ Antibody identification
➔ Comparison of current and previous test results

Question 6

fill in the blanks

1. _____ of transfusion errors come from the preanalytical
   phase of testing
2. The patient should have at least ___ identifiers
   3-5. A major cause of transfusion-associated fatalities is due
   to_________ esulting in incorrect ____
   groupings and transfusion of _____ incompatible blood

Answer 6

1. 40%
2. 2
3. Clerical error
4. ABO
5. ABO

Question 7

T or F

1. We may rely on patient’s charts and records for patient identification.
2. Labelling of samples must be done at the bedside of the recipient
3. If there is any doubt about the identity of th patient sample integrity, simply ask the phlebotomist for any clarifications.
4. When extracting blood from a patient with IV, the first 5mL of blood withdrawn should be discarded.
5. Before drawing blood from a patient with IV line, it must first be disconnected or stopped for 5 to 10 minutes

Answer 7

1. F
2. T
3. F (new sample must be obtained)
4. F (10mL)
5. T

Question 8

1. What are the samples used for testing?
2. How much blood is needed?

Answer 8

1. Serum / plasma or RBCs either clotted or anticoagulated
   samples (2 - 5% concentration)
2. 10mL

Question 9

If the sample of patient is still hemolyzed after several blood
draws which may be due to autoimmune hemolytic anemia,
or ongoing hemolysis, just accept the hemolyzed sample
and make sure to ________________

Answer 9

compare the degree of hemolysis

Question 10

results of a patient with an autommine hemolytic disease:

a. positive
b. negative

1. the degree of hemolysis is the same from before,
   during, and after testing
2. increasing intensity in the hemolysis of the
   sample

Answer 10

1. b
2. a

Question 11

What may be reagent may be added to quickly induce clotting and ensures the yield of good quality serum for testing

Answer 11

1 drop of thrombin
reagent

50 Units/L in every 1 mL of plasma

or

dry thrombin that will adhere
to the end of an applicator stick

Question 12

What are the tools that you may use to detach the segment attached to the blood bag?

Answer 12

• segment puncture device
• scissors
• lancets

Question 13

Samples for donor testing must be collected (before /at the same time/ after)
as the full donor unit.

Answer 13

at the same time

Question 14

• a unique serial number that comes with each blood bag
• must be checked toroughly

Answer 14

Donor unit identification number

Question 15

What are the five transfusion transmissible infections?

Answer 15

1. Hepa B
2. Hepa C
3. HIV
4. Malaria
5. Syphilis

Question 16

1. all recipient samples for pre transfusion testing should not be older than how many hours / days?
2. In the Philippines, the DOH recommends a ___ hour limit to ensure the detection of all clinically significant antibodies

3-4. After testing, according to AABB the sample used must be stored for at at least ______ after each transfusion. Carefully label and refridgerate at ________.

Answer 16

1. 3 days or 72 hours
2. 42 hour limit
3. 7 days
4. 1-6C

Question 17

a. forward typing
b. reverse typing
c. both
d. neither

1. ABO Rh typing of recipient’s blood
2. ABO Rh typing of donor’s blood

Answer 17

1. C
2. A

Question 18

Steps in serologic testing

Answer 18

1. ABO Rh of recipient’s blood
2. antibody detection tests
   - Ab screening
   - Ab identification
   - crossmatching

Question 19

Comparison and Review of Recipients Current and
Previous Records:

Check if the patient has previously identified an ________
and it is just falling below detectable level.

Answer 19

antibody

Question 20

1. Any discrepancies in blood typing results should be resolved before blood is given.
2. If you have not identified yet what is the blood type of the patient, you cannot withhold the unit if it is an emergency and
   the patient is in need of blood, the doctor may opt to give O red cells.

a. first stament is true
b. second statement is true
c. both statements are true
d. neither of the statements are true

Answer 20

c

Question 21

1. If problems in D typing arise, the patient should be
   given Rh-negative blood until the problem has been
   resolved.
2. if you cannot
   determine if the
   patient is Rh
   positive or negative
   and you do not
   have the capability
   to perform weak D,
   then the patient
   should be given
   Rh positve blood

a. first stament is true
b. second statement is true
c. both statements are true
d. neither of the statements are true

Answer 21

a

Question 22

What are the criteria for clinically significant antibodies?

Answer 22

o Reacts at 37°C and AHG test
o Implicated with HDN; Cause HTR, or decreased
survival of transfused RBC

Question 23

Selection of RBC components

1. what is the first choice?
2. Rh-negative patients should always receive Rh-(positive / negative)
   blood
3. Rh-positive blood may only be given to Rh-negative if the
   patient (has / lacks) pre-formed anti-D given that : patient is male or beyond menopause

Answer 23

1. ABO- Type specific
2. Rh negative
3. lacks

Question 24

mandatory and routinely done for donors

a. ABO reverse typing
b. Rh-D
c. both
d. neither

Answer 24

b.

(ABO forward lang ang routine)

Question 25

1. Rh negative blood can be given to Rh-positive patients and is routinely done 2. Rh-positive blood can be given to male and menopausal patients a. first stament is true b. second statement is true c. both statements are true d. neither of the statements are true

Answer 25

b Rh negative can be given to Rh-positive patients BUT IT IS NOT ROUTINELY DONE because Rh negative blood is rare Rh positive blood can be given to male and menopausal patients because there's no risk for HDFN since they cannot / will not get pregnant

Question 26

1. What is the ABO requirement for Whole Blood transfusion when an ABO-identical donor is not available? a) Must be compatible with the recipient’s plasma b) Must be identical to the recipient c) Any ABO group is acceptable d) Must be compatible with the recipient’s red cells

Answer 26

b

Question 27

For Red Blood Cells transfusion, the donor’s blood must be compatible with the recipient’s: a) Red cells b) Plasma c) Whole blood type d) Antibodies

Answer 27

b

Question 28

What is the ABO requirement for Granulocytes Pheresis? a) Must be identical to the recipient b) Must be compatible with the recipient’s plasma c) Any ABO group is acceptable d) Must be type specific

Answer 28

b

Question 29

Fresh Frozen Plasma (FFP) must be compatible with the recipient’s: a) Red cells b) Plasma c) Whole blood type d) Platelets

Answer 29

a

Question 30

What is the recommended approach for selecting Platelets Pheresis components? a) Only type-specific platelets should be used b) Any ABO group is acceptable, but compatibility with the recipient’s red cells is preferred c) Only O blood group platelets should be used d) Platelets should be identical to the recipient’s blood type

Answer 30

b

Question 31

Why is reverse typing recommended when selecting Platelets Pheresis? a) To confirm the blood type of plasma components b) To match the donor's red cells with the recipient’s plasma c) To check for the presence of antigens d) To ensure that the donor and recipient have the same blood type

Answer 31

a

Question 32

what is the maximum amount of red blood cells incorporated in a Platelets Pheresis unit? a) 50 ml b) 10 ml c) 5 ml d) 1 ml

Answer 32

c

Question 33

Why is non-type specific Platelets Pheresis acceptable in some cases? a) Because platelets do not carry antigens b) Because the unit contains minimal red cells (maximum of 5 ml) c) Because plasma compatibility is not necessary d) Because platelet transfusions are universal

Answer 33

b

Question 34

What is the ABO requirement for Cryoprecipitated AHF transfusion? a) Must be ABO identical to the recipient b) Must be compatible with the recipient’s plasma c) Any ABO group is acceptable since it doesn’t have red cells d) Must be compatible with the recipient’s red cells

Answer 34

c

Question 35

What is the most important compatibility requirement for Whole Blood transfusion? a) Any ABO group can be used b) Must be identical to the recipient c) Must be compatible with the recipient’s plasma d) Must be compatible with the recipient’s red cells

Answer 35

c

Question 36

What are the 2 main functions of compatibility testing a. Initial check of ABO compatibility b. Detect the presence of antibody present in the donor directed against recipient RBC c. both d. neither

Answer 36

d. neither FINAL check of ABO compatibility Detect the presence of an antibody present in the recipient directed agains an antigen on the donor RBC

Question 37

That is the limitation of crossmatching?

Answer 37

there is no test that can guarantee the fate of a unit of blood

Question 38

Compatibility testing a. major crossmatch b. minor crossmatch c. both d. neither

Answer 38

a

Question 39

preferred by most blood blanks as it has three phases of testing a. antiglobulin crossmatch b. spectrum compatibility testing c. both d. neither

Answer 39

c

Question 40

Only performed if the type and screen of the patient and donor are negative

Answer 40

abbreviated crossmatch

Question 41

* Matches donor and patient ABO Rh and antibody profile on database * Requires two (2) patient data on file: o Maybe 1 recent and 1 old file or o Testing patient’s submitted sample twice done by 2 different technologists.

Answer 41

Computer crossmatch

Question 42

What are the advantages of computer crossmatch

Answer 42

* reduced costs (since you don't need to use reagents) * reduced handling of biological materials

Question 43

Computer crossmatch Elimination of false reactions associated with the ___________ crossmatch

Answer 43

Immediate spin

Question 44

What a good RMT does in the event that there is no current file on the patient: a. collect a current specimen and perform ABO / Rh typing once and antibody screen tests and log it into the system. b. Test the current sample twice c. both d. neither

Answer 44

b. 2 patient data is required, so if there’s no previous file you should test the sample twice

Question 45

If there are two computer files for the patient: a. determine any ABO / Rh discrepancies b. check for positive antibody screening or history of clinically significant antibodies c. both d. neither

Answer 45

c

Question 46

PRETRANSFUSION FOR SPECIAL CASES : INTRAUTERINE TRANSFUSION blood and Rh type used if the blood group is unknown

Answer 46

O negative

Question 47

PRETRANSFUSION FOR SPECIAL CASES : INTRAUTERINE TRANSFUSION blood type that will be provided if there's no fetomaternal ABO or Rh incompatibility

Answer 47

type specific blood

Question 48

PRETRANSFUSION FOR SPECIAL CASES : INTRAUTERINE TRANSFUSION sample used: a. serum / plasma from mother b. red cells from mother c. both d. neither

Answer 48

a a) Serum or plasma from the mother b) Sample from fetus (through amniocentesis, chorionic villus, or umbilical cord sampling)

Question 49

In intrauterine transfusion, blood is usually injected from the _________ and is done with the guide of a __________

Answer 49

In intrauterine transfusion, blood is usually injected from the **umbilical cord** and is done with the guide of a **sonography** (ultrasound guided)

Question 50

PRETRANSFUSION FOR SPECIAL CASES : Neonatal Transfusion T or F 1. Blood transfused should be compatible with the infant's blood if they are 6 months old 2. Both forward and reverse typing may be done with the baby's sample 3. ABO Rh type specific blood may be given as long as there is no indication of HDN due to ABO incompatibility 4. If there is circulating maternal Anti-A or Anti-B, transfuse with Type O blood after crossmatching

Answer 50

1. T (if less than 4 months, blood should be compatible with maternal blood) 2. F (forward only) 3. T 4. F (NO CROSSMATCHING REQUIRED)

Question 51

PRETRANSFUSION FOR SPECIAL CASES : Neonatal Transfusion samples used for crossmatching a. maternal red cells b. infant's red cells c. both d. neither

Answer 51

d. neither (maternal's serum or infant's serum)

Question 52

PRETRANSFUSION FOR SPECIAL CASES : Neonatal Transfusion Frequency of testing: ○ Crossmatching done ____ per admission ○ Repeat testing if transfused with ____ antibody screening OR transfused with ____ incompatible blood (non-type specific blood)

Answer 52

Frequency of testing: ○ Crossmatching done **ONCE** per admission ○ Repeat testing if transfused with **POSITIVE** antibody screening OR transfused with **ABO-Rh** incompatible blood (non-type specific blood)

Question 53

# COMPATIBILITY TESTS Infant's serum is used especially in these 2 cases:

Answer 53

1. no maternal specimen available 2. mother has clinically insignificant antibodies

Question 54

What routine compatibility tests are performed for infants once per admission? a) ABO, Rh, and hemoglobin levels b) ABO, Rh, and antibody screen c) ABO, Rh, and platelet count d) ABO, Rh, and white blood cell count

Answer 54

b) ABO, Rh, and antibody screen

Question 55

When should the infant’s serum be used instead of maternal serum for antibody screening? a) When no maternal specimen is available b) When the mother has clinically insignificant antibodies c) Both a and b d) Never, only maternal serum should be used

Answer 55

c) Both a and b

Question 56

Why must an indirect antiglobulin test (IAT) using infant serum and A₁ or B cells be performed? a) To check for minor blood infections b) To confirm the presence of Rh factor c) If non-group O cells will be transfused d) To determine platelet compatibility

Answer 56

c) If non-group O cells will be transfused

Question 57

When should compatibility tests be repeated every three days? a) When ABO- or Rh-incompatible units are transfused b) When antibody screening shows unexpected antibodies c) Both a and b d) No need to repeat tests once done

Answer 57

c) Both a and b

Question 58

Massive transfusion Is an infusion of ____ of whole blood within 24 hours of a blood volume exceeding the recipient’s total blood volume OR transfusion of ____ RBCs units within 1 hour

Answer 58

Is an infusion of **8 to 10 units **of whole blood within 24 hours of a blood volume exceeding the recipient’s total blood volume OR transfusion of **4 to 5** RBCs units within 1 hour

Question 59

T or F 1. RBCs transfusion and other componenta are equally important 2. RBCs and IV solutions may replace clotting factors or platelets, taknig into consideration dilutional coagulopathy 3. massively bleeding patients are provided with 4 units of type specific negative RBCs, 4 AB FFP, and 1 AB platelet. 4. Crossmatching is not necessary in massive transfusions.

Answer 59

1. T 2. F ( Giving RBCs and IV solutions **will not replace clotting factors or platelets**. Must take into consideration dilutional coagulopathy” ) 3. F (4 units group **O negative RBC**s, 4 AB FFP and 1 AB platelet can be combined.) 4. T

Question 60

# Massive transfusion a common transfusion reaction in which pulmonary edema develops primarily due to volume excess or circulatory overload.

Answer 60

Iatrogenic, Transfusion-associated circulatory overload (TACO)

Question 61

Familiarize the possible causes of Massive transfusion

Answer 61

* Unexpected surgical or medical emergencies * Planned circumstances in cardiac or vascular surgery * Exchange transfusion in an infant or adult

Question 62

# Massive transfusion Test required a. ABO b. Crossmatching c. both d. neither

Answer 62

a

Question 63

# TRANSFUSION AFTER NON-GROUP SPECIFIC TRANSFUSION How do you switch from the nontype specific blood to the actual blood type of the patient? ASAP: a. ABO b. Rh negative c. Rh positive d. A and C e. B and C

Answer 63

d. switch to ABO type specific and Rh positive as soon as possible If patient is Rh negative, continue to provide them with Rh negative blood

Question 64

# LABELING AND RELEASE OF BLOOD 1. ____ process in pretransfusion compatibility testing before releasing the unit of blood equally important with other processes. 2. A ____ must exist to confirm that all of the following are in aggreement : Identifying information, request, records, blood or components 3. Every ____ in transfusion should be observed 4. Jot down time the transfusion ____, if the transfusion was stopped before transfusing the whole unit and indicate it in the ____ with the reason of doing so. 5. All discrepancies must be resolved before _____.

Answer 64

1. **Last** process in pretransfusion compatibility testing before releasing the unit of blood equally important with other processes. 2. A **process** must exist to confirm that all of the following are in agreement: 3. Every **15** minutes in transfusion should also be observed and recorded. 4. Jot down time the transfusion **ended**, if the transfusion was stopped before transfusing the whole unit and indicate it in the **BTR form** with the reason of doing so. 5. All discrepancies must be resolved before **issue**

Question 65

# Prior to issuing the blood, blood bank personel must: 1. Check the ____ of the blood to avoid issuing an outdated component 2. Inspect the unit for abnormal appearance. For red cells, check for ____ or ____ on top which is a sign of bacterial contamination, or ____ plasma which is also a sign of bacterial contamination. 3. Check also the bag for ____ because these may pose risk for contamination. o Remember that your blood bag is ____ so it should be intact.

Answer 65

1. Check the **expiration date** of the blood to avoid issuing an outdated component 2. Inspect the unit for abnormal appearance. For red cells, check for **clot** or **hemolysis** on top which is a sign of bacterial contamination, or **greenish** plasma which is also a sign of bacterial contamination. 3. Check also the bag for **leaks or nicks** because these may pose risk for contamination. o Remember that your blood bag is **semi-permeable** so it should be intact.

Question 66

# How do you document the release of blood? 1. Write the ____ of the individual issuing the blood 2. ____ of issue 3. Name of the blood ____ or destination

Answer 66

1. Write the **name** of the individual issuing the blood 2. **date and time** of issue 3. Name of the blood **recipient** or destination

Question 67

A TRANSFUSION TAG OR LABEL MUST BE ATTACHED TO BLOOD CONTAINER INDICATING: (3)

Answer 67

1. Recipient's two independent identifiers 2. Donor unit number 3. Interpretation of compatibility testing

Question 68

# Release of blood in urgent situations 1. In cases of deperate need for blood, the medical technologist must weigh the hazard of transfusing uncrossmatched blood agains risk of waiting for you to complete the procedure. 2. If blood is released before crossmatch is completed, it must contain a statement, usually a form, signed by a physician indicating the reason why the testing procedure was waived. 3. A form or waiver signed by the physician absolves the transfusion service from responsibility to issue properly labeled donor blood of an ABO compatible group Which of these statements is / are false? a. 1 only b. 2 only c. 3 only d. 1 and 2 e. 1 and 3

Answer 68

e. 1 and 3 1. Desperate need for blood, the **physician** must weigh the hazard of transfusing uncrossmatched blood against risk of waiting for you to complete the crossmatch procedure. 3. A form or waiver signed by the physician **does not absolve** transfusion service from responsibility to issue properly labeled donor blood of an ABO compatible group.

Question 69

# Release of blood in urgent situations 1. Once you have released the non specific blood, you may stop with the prior compatibility testing. 2. ABO / Rh typing is mandatory as you cannot rely on previous records in case there was a clerical error 3. Indicate in incospicuous fashion that blood is incrossmatched or write "Crossmatching: waived" in the transfusion tag Which of the following statements is / are true? a. 1 only b. 2 only c. 3 only d. 1 and 2 e. 1 and 3

Answer 69

b. 2 only 1. Even if the nonspecific blood has been released, you must proceed with crossmatching in case there is an incompatibility 3. Indicate in **cospicuous** fashion that blood is incrossmatched or write "Crossmatching: waived" in the transfusion tag

Question 70

READ!! SUMMARY: PROCEDURES PRIOR TO ISSUANCE OF BLOOD FOR TRANSFUSION

Answer 70

1. Positive ID of recipient and recipient’s blood sample. 2. ABO Rh typing of recipient’s blood 3. Antibody detection tests using the recipient's serum or plasma. 4. Comparison and review of recipient’s previous records. 5. Tests on donor blood (w/ separate discussion) 6. Selection of components of ABO RH type appropriate for the recipient based on the AABB guidelines. 7. Performance of serological or computer crossmatch as necessary or as allowed in the institution. 8. Labeling of components with recipient’s identifying information before you release the unit.

Question 71

# FINAL STEP FOR THE ISSUANCE OF BLOOD 1. Final identification of the recipient prior to transfusion tests with the ____. They must identify the patient and donor unit and certify that identifying forms, tags, and labels are in agreement. 2. The blood bag, label, and the transfusion tag should be checked very well against the blood ____ we released, the result of the ____, and the patient’s ID. 3. Transfusion is an ____ that carries potential benefits and risks to the recipient.

Answer 71

1. Final identification of the recipient prior to transfusion tests with the **transfusionist**. They must identify the patient and donor unit and certify that identifying forms, tags, and labels are in agreement. 2. The blood bag, label, and the transfusion tag should be checked very well against the **blood transfusion records (BTR)** we released, the result of the **crossmatching**, and the patient’s ID. 3. Transfusion is an **IRREVERSIBLE EVENT** that carries potential benefits and risks to the recipient.