Pathology - Anaemias : Management Flashcards
which antibodies would be present in a person in blood group A?
a. A
b. anti A
c. anti B
d. B
c.anti B
which antibodies would be present in a person in blood group B?
a. A
b. anti A
c. anti B
d. B
b.anti A
which antibodies would be present in a person in blood group AB?
a. A and B
b. anti A and anti B
c. none
d. B
c.none
presence of which antigen determines the positive or negative aspect of a patients blood group?
a. RhD
b. RhC
c. RhE
d. Rhd
a.RhD
positive blood group refers to?
a. presence of RhD antibody
b. lack of RhD antigen
c. presence of RhD antigen
c.presence of RhD antigen
which antibody is only present in an antibody -ve patient patient pregnant with and antibody positive foetus or an antibody negative patient ransfused with antibody positive blood?
a. anti A
b. anti B
c. anti C
d. Anti D
d.Anti D
what is the first choice red cells, platelets and FFP for a patient with blood group O?
a. A
b. AB
c. none
d. O
d.O
what is the first choice red cells, platelets and FFP for a patient with blood group A?
a. A
b. AB
c. none
d. O
a. A
what is the first choice red cells, platelets and FFP for a patient with blood group B?
a. A
b. AB
c. none
d. B
d.B
what is the first choice red cells, platelets and FFP for a patient with blood group AB?
a. A
b. AB
c. none
d. O
b.AB
which blood group is known as the universal donor as they have no antigens on their red cells?
a. AB
b. O
c. O -ve
d. O +ve
c.O -ve
which blood group is known as the universal recipient as they have no antibodies to A or B in their blood?
a. O -ve
b. A
c. AB-ve
d. AB+ve
d.AB+ve
which of donors would not be increased risk for donating blood?
a. anaemic
b. low weight
c. elderly
d. young
d.young
which of these factors does not increase risk to the blood recipient?
a. unwell donor
b. high risk activity donor
c. donor underweight
c. donor underweight
what is plasma screened for?
a. antigens
b. antibodies
b.antibodies
what is blood screened for?
a. ABO group and RhD
b. genes and ABO group
c. drugs /alcohol and ABO group
a.ABO group and RhD
what does the pre transfusion group and screen of the patients blood identify`?
a.ABO and RhD
bABO and alloantibodies in plasma
c.ABO RhD and alloantibodies in plasma
c.ABO RhD and alloantibodies in plasma
what happens in a crossmatch?
a. patients plasma and donor red cells mixed
b. patient red cells and donor plasma mixed
a.patients plasma and donor red cells mixed
what are the 4Rs of safe transfusion
right blood
right patient
right time
right place
what is the cause of an acute haemolytic transfusion reaction`?
a. acute or worsening pulmonary oedema within 6 hours of transfusion
b. acute pulmonary oedema within 6 hours of transfusion (usually within 2 hours)
c. transfusion of ABO incompatible red cells which react with patients anti A/B antibodies
c. transfusion of ABO incompatible red cells which react with patients anti A/B antibodies
transfusion of an incompatible unit of which substance leads to an acute haemolytic trasfusion reaction?
a. FFP
b. red cells
c. plasma
b.red cells
what happens after tranfusion of incompatible red cells (acute haemolytic transfusion reaction)?
a. rapid destruction of transfused red cells in circulation and release of inflammatory cytokines
b. rapid destruction of patients red cells in circulation and release of inflammatory cytokines
c.acute or worsening pulmonary oedema
within 6 hours of transfusion
a.rapid destruction of transfused red cells in circulation and release of inflammatory cytokines
intravascular haemolysis
following an acute haemolytic transfusion reactionpatient develops shock, acute renal failure and which other symptom?
a. rash
b. disseminated intravascular coagulation
c. positive fluid balance
d. cough productive of pink sputum
b.disseminated intravascular coagulation
heart failure, low albumin, pre existing fluid overload, elderly patients , low weight are all predisposing factors for which transfusion reaction?
a. AHTR
b. TRALI
c. TACO
c.TACO
patient given transfusion 4 hrs later they experiencing tachycardia, hypertension, acute resp distress, positive fluid balance. They are referred for an xray which shows pulmonary oedema and an enlarged heart. which reactin most likley?
a. AHTR
b. TACO
c. TRALI
b.TACO
Patient shows tachycardia, acute resp distress and x ray shows pulmonary oedema and enlarged heart. What is the correct management?
a. stop transfusion, diuretics, oxygen
b. stop transfusion, high flow oxygen, supportive care
a.stop transfusion, diuretics, oxygen
patient shows acute resp distress, a cough productive of pink sputum, hypotension and fever 2 hours post transfusion. the patient is referred for an x ray which shows; bilateral nodular shadowing and a normal heart size. which reaction is most likely?
a. AHTR
b. TACO
c. TRALI
c.TRALI
patient shows acute resp distress, a cough productive of pink sputum, hypotension and fever 2 hours post transfusion. the patient is referred for an x ray which shows; bilateral nodular shadowing and a normal heart size. which management pathway is most suitable ?
a. stop transfusion , high flow oxygen, supportive care
b. stop transfusion, diuretics, oxygen
a.stop transfusion , high flow oxygen, supportive care
what is the pathophysiology of TRALI?
a. rapid destruction of transfused red cells in circulation and release of inflammatory cytokines
b. rapid destruction of patients red cells in circulation and release of inflammatory cytokines
c.acute or worsening pulmonary oedema
within 6 hours of transfusion
d.antibodies in the donor blood react with the patients white blood cells or pulmonary endothelium, inflammatory cells sequestered into lungs, leakage of plasma to alveolar spaces
d.antibodies in the donor blood react with the patients white blood cells or pulmonary endothelium, inflammatory cells sequestered into lungs, leakage of plasma to alveolar spaces
In TRALI which white blood cells in the patients blood react with the antibodies of the donor oedema?
a. neutrophils and monocytes
b. neutrophils and macrocytes
c. monocytes and lymphocytes
d. leucocytes and erythrocytes
a.neutrophils and monocytes
which transfusion reaction would lead to an x ray showing bilateral nodular shadowing and normal heart size?
a. TACO
b. TRALI
c. AHTR
b.TRALI
which transfusion reaction would lead to an x ray showing pulmonary oedema and enlarged heart?
a. TACO
b. TRALI
c. AHTR
a. TACO
which reaction is more common in patients over 70?
a. TACO
b. TRALI
a.TACO
what happens to oxygen saturation in bith TACO and TRALI?
a. increase
b. no change
c. decrease
c.decrease
what in which type of transfusion reaction does hypertension occur?
a. TRALI
b. TACO
b.TACO
what in which type of transfusion reaction does hypotension occur?
a. TRALI
b. TACO
b.TRALI
which transfusion reaction is JVP elevated?
a. TRALI
b. TACO
b.TACO
which transfusion reaction will cause an abnormal ECG?
a. TRALI
b. TACO
b.TACO
in which transfusion reaction does fluid challenge improve the patient condition?
a. TRALI
b. TACO
a.TRALI
which component of blood is stored at 22 degrees and is therefore more susceptible to bacteria?
a. plasma
b. red cells
c. platelets
c.platelets
how is risk of bacterial infection via transfusion reduced?
a. group and screen
b. crossmatch
c. visual inspection prior to transfusion
c.visual inspection prior to transfusion
patient shows signs of fever , rigors, hypotension and shock following platelet transfusion. what is most likely?
a. TRALI
b. TACO
c. bacterial infection
c.bacterial infection
what is the correct management for transfusion associated bacterial infection?
a. stop transfusion , high flow oxygen, supportive care
b. stop transfusion, diuretics, oxygen
c. stop transfusion, ABC, blood cultures, broad spectrum antibiotics
c.stop transfusion, ABC, blood cultures, broad spectrum antibiotics
why is there still a small remaining risk of viral infection despite screening of donor blood?
a. computers inaccurate
b. window period before detectable antibody present
c. window period before detectable antigen present
b. window period before detectable antibody present
who must serious reactions and events regarding transfusion?
a. SHOT
b. MHRA
c. SABRE
b.MHRA
patient 55 yrs with no cardiovascular disease. Hb 80g/l
would transfusion be considered?
a. yes
b. no
b.no
transfusion considered when Hb<70g/l
patient 75 yrs with no cardiovascular disease. Hb 75g/l
would transfusion be considered?
a. yes
b. no
a.yes
in patients over 65 with no cvd Hb under 80g/l to consider transfusion
patient 45 yrs with cardiovascular disease. Hb 85 g/l
would transfusion be considered?
a. yes
b. no
a.yes
patients with cvd , transfusion considered when Hb<90 g/l
patient with symptoms including dyspnoea, hypotension, syncope etc due to anaemia. bloods taken. Hb 110g/l
would transfusion be considered?
a. yes
b. no
b.no
patients with symptoms have a threshold for transfusion of Hb <100g\l
In which of these scenarios does restrictive red cell transfusion thresholds apply?
a. patient with major haemorrage
b. patient with acute coronary syndrome
c. patient with need for regular blood transfusions due to chronic anaemia
d. patient with hypotension
d.patient with hypotension
what is the correct threshold for transfusion when using a restrictive threshold?
a. 80 g/l
b. 90 g/l
c. 70 g/l
d. 60 g/l
c.70 g/l
what is the Hb concentration target for after transfusion?
a. 60-90 g/l
b. 70-90 g/l
c. 80-100 g/l
b.70-90 g/l
what is the Hb concentration target for after transfusion for patients with acute coronary syndrome ?
a. 60-90 g/l
b. 70-90 g/l
c. 80-100 g/l
c.80-100 g/l
what is the correct threshold for transfusion when using a restrictive threshold in patients with acute coronary syndrome?
a. 80 g/l
b. 90 g/l
c. 70 g/l
d. 60 g/l
a.80 g/l
in what case should a non bleeding patient with anaemia be transfused?
no suitable alternative treatment
benefits outweigh risk
first line of treatment for iron defficiency anaemia?
a. transfusion
b. IM B12 replacement
c. IV iron
d. oral iron
d. oral iron
what may some patients experience when taking oral iron which could cause them to take IV iron instead?
a. GI side effects
b. GU side effects
c. nausea
d. fever
a.GI side effects
dietary insufficiency, malabsorption and chronic blood loss can cause which type of anaemia?
a. B12/folate defficiency
b. iron deficiency
c. haemolytic
b. iron deficiency
what is the first line of treatment for folate deficiency anaemia?
a. transfusion
b. oral folic acid replacement
c. IV iron
d. oral iron
b. oral folic acid replacement
chronic inflam. disease, GI surgery, malabsorption, liver disease, and alcohol misuse are causes of which type of anaemia
a. B12/folate deficiency
b. iron deficiency
c. haemolytic
a.B12/folate deficiency
what should be done 6 weeks prior to elective surgery to reduce chances of requiring a transfusion?
a. cross match
b. group and screen
c. full blood count
c.full blood count
what are the 3 pillars of patient blood management
optimise red cell mass
minimise blood loss
optimise tolerance of anaemia
loss of 50% of total blood vol in less than 3 hrs , loss of more than than 1 blood vol in 24 hrs (>5l) and what bleeding in excess of ….. are all thresholds for major major haemorrhage
a. 300ml/min
b. 100ml/min
c. 150 ml/min
d. 200 ml/min
c.150 ml/min
which group is it especially important to recieve RhD negative cells?
a. men over 50
b. women over 50
c. women below 50
d. men below 50
c. women below 50
what is required when making decision whether or not to transfuse a jehovas witness patient?
advance decision document
hospital trust checklist
alert wristband
frank and confidential discussion
