Transfusion reactions

Question 1

Which of the following reactions to a blood transfusion is most common?

1 - bacterial contamination
2 - delayed haemolytic reaction
3 - non-haemolytic febrile transfusion reaction
4 - transfusion associated circulatory overload (TACO)
5 - Anaphylaxis

Answer 1

3 - non-haemolytic febrile transfusion reaction

Question 2

Non-haemolytic febrile transfusion reaction is the most common reaction following a blood transfusion. Which of the following typically does NOT occur during this type of reaction?

1 - fever
2 - jaundice
3 - shivering
4 - headache

Answer 2

2 - jaundice

Patient is typically hot but is generally well

Question 3

Non-haemolytic febrile transfusion reaction is the most common reaction following a blood transfusion. How long following the initiation of the blood transfusion does this reaction typically take to occur?

1 - immediately
2 - 0-15 minutes
3 - 30-60 minutes
4 - 4-8 days

Answer 3

3 - 30-60 minutes

Question 4

Non-haemolytic febrile transfusion reaction is the most common reaction following a blood transfusion. Which of the following should NOT be performed in this patient?

1 - immediately stop the transfusion
2 - slow the transfusion
3 - give paracetamol
4 - ABCDE assessment

Answer 4

1 - immediately stop the transfusion

This may be performed, but typically slowing the transfusion is enough

Question 5

An acute haemolytic reaction, also referred to as ABO incompatibility is when a patient is given the wrong blood and anti A or B antibodies activate the complement pathway, triggering the release of pro-inflammatory cytokines. How long does this typically take to occur?

1 - 0-5 minutes
2 - 15-30 minutes
3 - 30-60 minutes
4 - 24-48 hours

Answer 5

1 - 0-5 minutes

Typically within a few minutes

Question 6

An acute haemolytic reaction, also referred to as ABO incompatibility is when a patient is given the wrong blood and anti A or B antibodies activate the complement pathway, triggering the release of pro-inflammatory cytokines. Which of the following is NOT an acute/early presenting symptoms?

1 - hypertension
2 - fever
3 - anxiety
4 - erythroderma

Answer 6

1 - hypertension

Typically causes hypotension and the patient is sick and unwell, similar to sepsis

Question 7

An acute haemolytic reaction, also referred to as ABO incompatibility is when a patient is given the wrong blood and anti A or B antibodies activate the complement pathway, triggering the release of pro-inflammatory cytokines. Which of the following is NOT a late presenting symptoms?

1 - hypotension
2 - systemic haemorrhage
3 - hypothermia
4 - DIC

Answer 7

3 - hypothermia

Patient is sick and unwell, similar to sepsis

Question 8

An acute haemolytic reaction, also referred to as ABO incompatibility is when a patient is given the wrong blood and anti A or B antibodies activate the complement pathway, triggering the release of pro-inflammatory cytokines. Which of the following is part of the management for this type of reaction?

1 - stop the transfusion immediately
2 - ABCDE assessment
3 - fluid resuscitation
4 - check blood products and confirm diagnosis
5 - all of the above

Answer 8

5 - all of the above

When checking the diagnosis, need to do:

• check the identity of patient and confirm it matches name on blood products
• send blood for direct Coombs test
• repeat typing and cross-matching

Question 9

Bacterial contamination is the most common form of blood product contamination. Which of the following is NOT an acute/early presenting symptoms?

1 - hypertension
2 - fever
3 - anxiety
4 - erythroderma

Answer 9

1 - hypertension

Typically causes hypotension and the patient is sick and unwell, similar to sepsis

Question 10

Bacterial contamination is the most common form of blood product contamination. Which of the following is part of the management for this type of reaction?

1 - stop the transfusion immediately
2 - ABCDE assessment
3 - treat as sepsis
4 - check blood products and confirm diagnosis
5 - all of the above

Answer 10

5 - all of the above

Question 11

A delayed transfusion reactions are those that occur after the transfusion has been administered. When do these typically occur?

1 - 24-48 hours
2 - 24 hours to 8 days
3 - 12 hours to 8 weeks
4 - 72 hours to 4 weeks

Answer 11

2 - 24 hours to 8 days

Typically occur after 24h, but can occur weeks after transfusion

Question 12

A delayed transfusion reactions are those that occur after 24 hours to 8 days of the transfusion being administered. These can be due to all of the following, EXCEPT which one?

1 - Delayed haemolytic transfusion reaction (DHTR)
2 - Febrile non-haemolytic transfusion reaction (FNHTR)
3 - Post-transfusion purpura (PTP)
4 - Transfusion-associated circulatory overload (TACO)
5 - Graft versus host disease (GvHD)

Answer 12

4 - Transfusion-associated circulatory overload (TACO)

Question 13

A delayed transfusion reactions are those that occur after 24 hours to 8 days of the transfusion being administered. Which of the following are is NOT a presentation of patients with this type of reaction?

1 - anaemia
2 - sepsis
3 - jaundice
4 - haemoglobinuria

Answer 13

2 - sepsis

Haemoglobinuria
- high concentrations of haemoglobin present in urine

Question 14

A delayed transfusion reactions are those that occur after 24 hours to 8 days of the transfusion being administered. Which of the following is NOT a management option for this type of reaction?

1 - monitor renal function
2 - ABCDE assessment and monitoring
3 - investigation to confirm diagnosis
4 - all of the above

Answer 14

4 - all of the above

Specific treatment is not normally required

Question 15

A transfusion-related acute lung injury (TRALI) is a non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood. Patients typically present with all of the following, EXCEPT which one?

1 - dysponea
2 - cough
3 - hyper inflated chest X-ray
4 - acute respiratory distress syndrome

Answer 15

3 - hyper inflated chest X-ray

Typically causes a white out

Question 16

A transfusion-related acute lung injury (TRALI) is a non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood. How long does it typically take for a TRALI reaction to typically occur?

1 - 0-15 minutes
2 - 30-60 minutes
3 - 2-6 hours
4 - 6-12 hours

Answer 16

3 - 2-6 hours

Generally less than 2 hours

Question 17

A transfusion-related acute lung injury (TRALI) is a non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood. Which of the following is NOT a management option for this type of reaction?

1 - slow transfusion
2 - ABCDE assessment
3 - ICU involvement
4 - supportive care

Answer 17

1 - slow transfusion

Stop transfusion immediately if ongoing

Question 18

A transfusion-associated circulatory overload (TACO) is when the patient t is given an excessive rate of transfusion in poor heart function of pre-existing heart failure patients. Patients typically present with all of the following, EXCEPT which one?

1 - dysponea
2 - hypoxaemia
3 - bradycardia
4 - increased JVP
5 - ling base crepitations

Answer 18

3 - bradycardia

Causes tachycardia as heart aims to maintain output with excessive load

Question 19

A transfusion-associated circulatory overload (TACO) is when the patient t is given an excessive rate of transfusion in poor heart function of pre-existing heart failure patients. Which of the following is NOT a management option for this type of reaction?

1 - slow transfusion
2 - ABCDE assessment
3 - furosemide
4 - oxygen

Answer 19

1 - slow transfusion

Stop transfusion immediately if ongoing

Question 20

An anaphylactic reaction occurs when the recipient is allergic to protein components present in the donor transfusion. How do patients typically react?

1 - itchy rash with angioedema
2 - dyspnoea
3 - vomiting
4 - lightheadedness
5 - hypotension.
6 - all of the above

Answer 20

6 - all of the above

Anaphylaxis typically develops over minutes to hours and can quickly become life-threatening.

Question 21

An anaphylactic reaction occurs when the recipient is allergic to protein components present in the donor transfusion. All of the following are used in the management of anaphylaxis, EXCEPT which one?

1 - stop transfusion
2 - lie patient in supine position and raise legs
3 - give IM adrenaline
4 - give oxygen and monitor patient
5 - give salbutamol
6 - IV fluid bolus if unresponsive and further IM adrenaline after 5 minutes

Answer 21

5 - give salbutamol

Question 22

A minor allergic reaction can occur following a blood transfusion and is thought to be due to foreign plasma proteins. Does the transfusion always need to be stopped?

Answer 22

• No

Can slow or stop transfusion, depending on the severity.

Question 23

A minor allergic reaction can occur following a blood transfusion and is thought to be due to foreign plasma proteins. These patients are typically monitored and present with urticaria. Which of the following medications are they typically given?

1 - Chlorphenamine
2 - Chloramphenicol
3 - Chlorpromazine
4 - any of the above

Answer 23

1 - Chlorphenamine