Transfusion Reactions

Question 1

1. 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

Answer 1

b

Question 2

2. 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

Answer 2

d

Question 3

3. 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

Answer 3

b

Question 4

4. 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

Answer 4

c

Question 5

5. 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

Answer 5

c

Question 6

6. 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

Answer 6

b

Question 7

7. 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

Answer 7

c

Question 8

8. 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

Answer 8

d

Question 9

9. 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

Answer 9

c

Question 10

10. 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

Answer 10

d

Question 11

11. 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

Answer 11

b

Question 12

12. 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

Answer 12

a

Question 13

13. 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

Answer 13

a