Unit 4 Review Flashcards
1
Q
What is the purpose of dialysis in uremic patients?
A
Removal of by products of protein metabolism that renders vWF and platelets
2
Q
Which of the following is not an indication for fresh frozen plasma (FFP) transfusion?
A
Factor VIII deficiency
3
Q
The rejection of the transplantation of platelets from one individual to another is termed or defined as:
A
Platelet refractoriness
4
Q
Which of the following may be a serious manifestation of FFP transfusion in congenital factor deficiencies?
A
Pulmonary edema
5
Q
All coagulation factors are produced in the liver except::
A
- vWF
6
Q
What is the advantage of performing a type and screen for patients scheduled for surgery instead of crossmatching units for possible transfusion ?
A
Increases the availability of donor units in the inventory
7
Q
How are RBC aliquots prepared for a neonate transfusion?
A
Blood in transferred from collection bag and withdrawn using a syringe
8
Q
Which of the following is an indication for immunoglobulin administration?
A
Hepatitis A
9
Q
Deglycerolized RBCs can be used interchangeably with washed RBCs because both procedures:
A
- all of the above
- remove WBC
- remove plasma
- have 24-hour outdate
10
Q
Oncology patients usually receive repeated RBC and platelet transfusions because of:
A
- all of the above
- radiation therapy
- tumor infiltration of bone marrow
- chemotherapy
11
Q
Which of the following is not a function of the hospital transfusion committee?
A
FDA certification
12
Q
Liquid plasma is not indicated for factor ______deficiency
A
V
13
Q
Why are fresh blood units (less than 7 days old) preferred for a neonate transfusion?
A
The reduce the risk of Hyperkalemia
14
Q
All of the following are consistent with graft-versus host disease (GVHD) except:
A
Transplantation of “immunologically naive” T lymphocytes
15
Q
The pathological cause of a decreased RBC mass include:
A
*all of the above
- compromised bone marrow production
- decreased RBC survival
- bleeding as a result of trauma
16
Q
Bleeding disorders may be caused by:
A
Dysfunction of platelets
17
Q
Which of the following are not at risk for developing cytomegalovirus (CMV) via CMV- positive blood products?
A
CMV-positive heart transplant recipients
18
Q
Which platelet pheresis product should be irradiated?
A
A directed donation given by a mother to her son
19
Q
Why is whole blood contraindicated for patients with severe chronic anemia?
A
The plasma volume of there patients is increased
20
Q
How is donor platelet survival determined in the recipient?
A
Platelet count increment (1 hour after transfusion)
21
Q
Immunoglobulin prepared from pooled plasma is primarily:
A
IgG
22
Q
A blood component should be transfused within:
A
4 hours
23
Q
Cryoprecipitated AHF can be used in the treatment of:
A
Von Willebrand’s disease (vWD)
24
Q
Why is it recommended that factor VIII concentrates be used in patients with von Willebrand’s disease?
A
Because of the variability in vWF content
25
What would blood component contained in pheresed granulocyte concentrate warrants crossmatching of this product?
RBCs
26
How is the whole blood that is collected from a donor different from whole blood circulating in someone’s blood vessels?
The anticoagulant in donor blood prevents activation of the coagulation system
27
What is the corrected platelet increment for a patient with a body surface area of 2.7 m2, an initial count of 15,000 per uL, and a 1-hour post transfusion platelet count on 80,000 per uL given one apheresed platelet component?
58,500 per uL
28
In addition to non hemolytic febrile transfusion reactions, what other indication exists for washed RBCs?
IgA-deficient patients with anti-IgA
29
How does 25% albumin induce diuresis in liver disease patients?
Albumin solution acts with diuretics and bring extravascular water into vascular space to dilute albumin
30
Which of the following is an indication from plasma transfusion in a patient who has been massively transfused?
PTT greater than 60 seconds
31
In what disease state is acquired antithrombin III deficiency manifested?
DIC
32
Who is at risk for transfusion-associated graft-versus-host disease (TAGVHD)?
*all of the above
- Hodgkin’s lymphoma patients
- Bone marrow transplant recipients
- persons receiving non irradiated directed donations
33
Which class of vWD provides the least amount of vWF?
Type III
34
Which of the following methods provides the purest factor VIII concentrates?
DNA technology
35
What is the expiration on washed on RBCs?
24 hours
36
What is used to anticoagulants the shed blood obtained from intraoperative salvage?
Citrate and heparin
37
Why is it essential that irradiated blood components be used in bone marrow transplant recipients?
Bone marrow recipients are on immunosuppressive therapy
38
Persons making predeposit donations for planned surgery will take iron supplements to replenish iron and stimulate:
Erythropoiesis
39
Platelets prepared from_______ are referred to as random donors platelets
Whole blood units
40
Hemophilia A is clinically apparent when the factor VIII level is less than:
10%
41
Which of the following is not an indication for transfusing platelets?
Massive transfusion, platelet count 250,000/ uL
42
Which type of filter is used in routine blood administration sets to remove gross clots from all blood products?
170 um
43
Which type of autologous transfusion, succesful in liver transplants, involves collecting 1 to 2 units from the patient before surgery, using crystalloid to replace blood volume and reinfusing blood at the end of surgery?
Intraoperative hemodilution
44
Factor VIII is treated by which of the following to ensure sterility for HIV and hepatitis B and C?
* all of the above
- pasteurization
- nanofiltation
- solvent detergent
45
Which of the following should be done when selecting units from a hypoxic neonate?
Hgb S testing
46
Why is RBC transfusion contraindicated in a stable patient with chronic renal failure who has no symptoms except altering climbing three flights of stairs?
The anemia is compensated
47
What is the source of hyperimmune globulins used in the prevention of hepatitis B?
Plasma donors whose sera demonstrate as high titer of hepatitis B antibody
48
Why is the increase in Hb and Hct evident more quickly in RBC transfusion than in whole blood transfusions?
Blood volume adjustment is less when RBCs are transfused
49
Factor IX concentrates Contain which factors (otherwise known as “prothrombin complex”)?
II
VIII
IX
X
50
What is suspected when the Hct has decreased by 4% and the total bilirubin level is increased 5 days after transfusion ?
Delayed hemolytic transfusion reaction
51
The rejection of platelets in multiply transfused patients is called:
Refractoriness
52
Which of the following statements concerning RBCs prepared with additive solution 1 (AS-1) is true?
The Hct is lower than CPDA-1 RBCs
53
What is the immunologic principle of RhIG administration?
Anti-D attaches to Rh-positive cells of the infant in maternal circulation and are subsequently removed by cells of the reticuloendothelial system, preventing sensitization
54
Vitamin K is essential for the carboxylation of which coagulation factors?
II
VIII
IX
X
55
leukoreduction filters are used in the transfusion of RBCs and platelets to prevent:
Febrile nonhemolytic transfusion reactions
56
How would the Hct of a patient with chronic anemia be affected by transfusion of 2 units of whole blood vs transfusion with 3 units of packed RBCs?
The packed RBCs would increase Hct more than the whole blood
57
Which of the following factors are found in therapeutic levels FFP?
*all of the above
- factor VIII
- factor V
- factor XI
58
A patient with severe hemolytic anemia has a pulse of 120 beats per minute and a respiratory rate of 37 breaths per minute. What blood component is indicated for this patient?
RBCs
59
Which of the following Rh-negative patients may be transfused with Rh-positive units when few O-negative units are available is an emergency?
Middle-aged male
60
What is the recommended treatment for mild von Willebrand’s disease?
DDAVP (1-Deamino-8-arginine vasopressin)
61
Neonatal exchange transfusion is performed using which blood preservative?
* both B and C can be safety used
62
A patients with hypofibrinogenemia is receiving cryoprecipitate on an outpatient basis. His plasma volume is 4,000 mL and his physician wants to increase factor I from 40-120 mg/dL. How many bags of cryoprecipitate are needed?
13
63
Why is thrombocytopenia is manifestation of a massive transfusion?
Platelet are diluted by resuscitation fluids and stored blood
64
Which blood product is used in the treatment of DIC?
* all of the above
- plasma
- platelets
- cryoprecipitate
65
All of the following are characteristics of protein C except:
It enhances factors V and VIII
66
Cryoprecipitate is not used to treat which condition?
Hemophilia B
67
A 160 lb man was transfused with 1 unit of whole blood after being rescued from a burning apartment building. His Hct was determined to be 27% before transfusion. what would you expect his Hct to be in 48 hours?
30%
68
What is the only blood component that provides concentration of vWF?
Cryoprecipitated AHF
69
How is Cryoprecipitated AHF used with prosthetic vascular grafts?
Bovine thrombin activates fibrinogen, which acts as a fibrin glue to seal gaps
70
Antithrombin III concentrates are used in the treatment of:
Hereditary antithrombin III deficiency caused by venous thrombosis
71
Which intravenous solution is not recommended for dilution of blood components because of RBC damage?
Dextrose
72
How can GVHD be prevented in transplant recipients?
Irradiation of cellular components
73
Which of the following represents the final clerical check of a transfusion?
The nurse uses the patients armband to compare patient ID with the patient crossmatching report and tags attached to the unit
74
A patient with paroxysmal cold hemoglobinuria (PCH) would require_______ in the event of a blood transfusion
Blood warmer
75
What disease state may require exogenous fibrinogen replacement?
*all of the above
- disseminated intravascular coagulation
- liver failure
- congenital fibrinogen deficiency
76
All blood components should be transfused within What time period to avoid bacterial contamination issues?
4 hours
77
Cryoprecipitate AHF contains how much fibrinogen?
150-250- mg
78
Which f the following criteria warrants a granulocyte concentrate transfusion?
A septic patient unresponsive to antibiotics
79
Each cryoprecipitate unit contains at least how much factor VIII?
80 units
80
What is the most efficient way to remove leukocytes from RBCs units?
Leukoreduction filters
81
What blood component is responsible for most allergic reactions?
Plasma
82
Why is plasma not recommended for the treatment of hemophilia B?
Hypervolemia limits factor IX efficacy
83
What plasma product is used to replace fluid in patients undergoing plasmapheresis procedures?
Albumin
84
What is the best-tolerated form of transplantation in humans?
RBCs
85
What transfusion therapy is indicated for a patient who is found to be refractory to random platelets?
Apheresis platlets from an HLA-compatible donor
86
What Hb level is considered critical and may warrant a RBCs transfusion?
7 g/dL
87
Cryoprecipitated AHF can be used to treat Von Willebrand’s disease by providing _____ vWF after ________ has failed to release adequate amounts of endogenous vWF
Exogenous/DDAVP
88
How is a coagulation factor unit defined?
Activity in 1 mL of pooled plasma
89
Cryoprecipitate AHF contains factor VIII. What other coagulation factor is present?
I
90
Four units of packed RBCs were used in the operating room at 3 pm. Can the remaining 2 units be returned to the blood bank at 5 pm?
Yes, if the 2 units have been kept under the proper storage conditions
91
What component is indicated for patients who have had moderate to severe allergic transfusion reactions and have anti-IgA antibodies because of IgA deficiency?
Washed RBCs
92
Which components provide a concentrated source of fibrinogen?
Cryoprecipitate
93
The most important step in the a safe administration of blood is to:
Accurately identify the donor unit and intended recipient
94
Poor increment in the platelet count 1 hour following platelet transfusion is most commonly caused by:
Splenomegaly
95
Granulocytes for transfusion should:
be ABO- and Rh- compatible with the recipient’s serum
96
In anemia uncomplicated by low plasma proteins or shock, the transfusion of:
Packed RBCs is most desirable
97
For which of the following transfusion candidates would CMV-negative blood be most likely indicated?
Pregnant women
98
Whta are the requirements for a transfusion to be classified as massive in an adult?
10 units within 24 hours
99
In the case of a need for massive transfusion in which a shortage of Rh-negative blood exists, which of these patients must not be switched to administration of Rh-positive blood if at all possible?
35 years old female
100
What does the first transfusion in a massive transfusion protocol consist of?
2 units uncrossmatched group O whole blood
101
Treatment of post-transfusion purpura (PTP) with_______ is not advocated in medical practice
Platelet transfusions
102
A transfusion reaction investigation should include all of the following except:
Neocyte transfusion
103
What should be done in the transfusion process when the patient temperature spike from 37.5-38.5C within 30 minutes of transfusion?
Stop the transfusion and keep the intravenous line open
104
What groups are at risk for graft-versus-host disease (GVHD) as a result of transfusion?
*options B and C
- Fetuses receiving an intrauterine transfusion
- patients receiving a directed donation from a first-degree relative
105
A 41-year old multiparous woman was rushed to the emergency room after being shot in the chest. She received 8 units of packed RBCs and 5 units of platelets. The hb and Hct determinations stabilized after 6 hours in surgery, but the platelet counts remained less than 50,000 per uL. She had received additional units of platelets at 48-hour intervals with liitle efficacy. Her serum was tested for platelet antibodies. She was placed on corticosteroids to control chest wound bleeding. Anti-PL^A1 was identified in the patients serum. This case is representative of what type of transfusion reaction?
Post-transfusion purpura
106
A patient with two or more documented febrile nonhemolytic transfusion reactions (FNHTRs) should receive _______ blood components
Leukopoor
107
Which of the following questions should be asked when investigating a transfusion reaction?
How many mL of RBCs were transfused
108
What measure can be taken to prevent transfusion-associated hypothermia?
Transfusion of product using a blood warmer
109
Which of the following products may lead to sepsis in a patient when contaminated with Escherichia Coli?
* all of the above
- platelets
- Packed RBCs
- normal tissue
110
All of the following are diseases that can mimic a transfusion reaction except:
AML
111
Persons with a documented history of anaphylactic reactions should be transfused with ______ blood products
Washed
112
A postpartum woman was cross matched for 2 units of packed RBCs. The first unit was issued at 3:15 a.m. At 3:45 a.m, the nurse called the blood bank and stated the patient was developing red hives and pruritus (itching). The transfusion was stopped and a post-transfusion specimen was drawn. The unit and identification tags were returned to the blood bank. The DAT on the specimen was negative, and hemolysis was absent. All visual and clerical checks were satisfactory. The pathologist ordered the treatment of diophenydramine (Benadryl) for all subsequent transfusions. What type of transfusion reaction has occurred in this patient?
Urticarial
113
What would be the result of group B given to a group of O patient?
Immediate hemolytic transfusion reaction
114
For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to:
Reverse hypotension and minimize renal damage
115
The plasma level of unconjugated bilirubin is elevated in
Intravascular and extravascular hemolysis
116
Which of the following is an indicator of acute immune hemolytic transfusion reaction?
Increased bilirubin
117
A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except:
Acute immune hemolytic transfusion reaction
118
Which of the following statements is false?
RBC are phagocytized by Marcophages in the spleen and liver intravascular reactions
119
A patient transfused with 2 units of packed cells spiked a fever of 99.5F and complained of chills 3 days after transfusion. The DAT was positive with polyspecific antisera and anti-IgG but negative with anti-C3d. Compatibility testing was performed on the pre- and post- transfusion specimens. The latter was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion. Specimen. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jka. This transfusion reaction is most likely caused by:
Delayed hemolytic transfusion reaction (DHTR) caused by anamnestic response
120
A 35-year old woman was transfused with 1 units of packed RBCs. The nurse monitoring the transfusion noticed hives on the patients arm and increase in body temperature. What is the choice of treatment for this patient?
Antihistamines
121
Why is an FNHTR said to be a “diagnosis of exclusion?’
Fever can be the result of many other underlying maladies
122
Which of the following results when large excesses of free Hb are released into the blood?
Hemoglobinemia
123
What is a cause of death GVHD?
Infection
124
The principle clinical signs of extravascular hemolysis include:
Positive DAT
125
All of the following are symptoms for al allergic reaction except:
Anemia
126
What treatment is recommended following a bacterial contamination reaction?
Broad-spectrum antibiotics
127
In the United States, fatalities associated with transfusion are required to be reported to which organization?
CDC
128
Which of the following is not a finding associated with intravascular hemolytic reaction?
Methemalbumin decreases
129
Which of the following is the most common transfusion reaction reported to blood banks?
Febrile reaction
130
Treatment in the event of an anaphylactic or anaphylactoid reaction should include all of the following except:
Immediately administering PPF
131
Hypothermia as a result of cold fluid replacement can result in all of the following except:
Citrate toxicity
132
Which of the following organisms have been implicated on bacterial contamination reactions?
Yersinia enterocolitica
133
Whta is the team of medical officers who investigate all reported cases of transfusion related fatalities?
CBER
134
What is the physiological mechanism of histamine?
Histamine is released when the allergen-reagin complex attaches to the surface of tissue mast cells, increasing vascular dilation and permeability
135
How can depletion and dilution of coagulation factors be avoided in a massively transfused patient?
Prudent use of platelets and FFP
136
A delayed hemolytic transfusion reaction is most often the result of:
An anamnestic response in a patient who has been previously sensitized by transfusion or pregnancy
137
Who developed the imputability criteria for reporting cases of transfusion fatalities?
NHSN
138
Which of the following in consistent with bacterial contamination reactions?
The organism thrives in cold temperatures
139
What is the most common preventable error occurring among the nursing and medical staff that results in a transfusion-related death?
Improper patient identification
140
A delta check was noted for potassium after a surgical patient was transfused with 2 units of packed RBCs. The pre-transfusion potassium was 3.1 mmol/L and the post-transfusion specimen was 6.2 mmol/L. What could be the reason for this sudden increase?
RBCs spent maximum time in storage
141
Which mechanism may play a role in fever development in an FNHTR?
Release of pyrogens from transfused WBCs
142
How could a potential alloimmunization due to anti-K be prevented?
Matching of donor and recipient RBC phenotype
143
which of these is/are involved in hemovigilance?
* All of these
- collecting information on transfusion complications
- analyzing transfusion complication data
- improving transfusion practices based on transfusion complications data analysis
144
What is the most frequent cause of circulatory overload?
Transfusion of a unit at too fast a rate
145
What is meant by the term iatrogenic?
Physician-caused
146
What is the purpose of performing serial Hb and Hct after a blood transfusion?
To monitor the therapeutic or non therapeutic response
147
Upon investigation of a DHTR, what should be included in the medical history?
* all of the above
- previous transfusion
- pregnancies
- transfusion reactions
148
Which of the following clinical manifestation is not included in the physically or chemically induced transfusion reactions?
Hemosiderosis
149
All of the following are immediate nonhemolytic transfusion reactions, except:
PTP
150
Which of the following indicative of GVHD?
Pancytopenia
151
What is a possible mechanism for noncardiogenic pulmonary edema reactions?
Antileukocyte antibody reacts in donoror patient plasma, initiating complement-mediated pulmonary capillary endothelial injury
152
A patient transfused with 2 units of packed RBCs demonstrated signs of a transfusion reaction just before the second unit was completely infused. Hypotension, fever, and back pain are the immediate symptoms. Blood work reveals a 3% drop on Hct and prolonged PT. What therapy is given to correct the PT?
FFP
153
Which of the following is not a symptom of noncardiogenic pulmonary edema?
Hypervolemia
154
Which of the following may be factor in a nonimmune transfusion reaction?
Circulatory overload
155
Which of the following urinalysis results represents hemolysis?
Reagent strip is positive for blood in absence of intact RBCs (microscopic)
156
Physical or chemical damage of the transfused RBCs can result in:
Intravascular hemolysis
157
An O-positive patient transfused with A-positive RBCs would experience which of the following clinical manifestations?
Acute hemolysis
158
What is the primary mediator of an allergic response?
Histamine
159
The presence of intactRBCs in microscopic urinalysis examination indicates
Bleeding
160
Immediate transfusion reaction procedures consist of all of the following expect:
Serum haptoglobin
161
What symptom would not usually be found in a bacterial contamination reaction?
Tachycardia
162
What test is indicated for the detection of HLA antibodies?
Lymphocyte panels
163
What may be found in the serum of a person who is exhibiting signs of a noncardiogenic pulmonary edema reaction?
Antileukocyte antibody
164
Which of the following describe the etiology of GVHD?
T lymphocytes from donor blood react with major and minor histocompatibility antigens in the patient
165
A severe manifestation of alloimmunization might include:
Platelet refractoriness
166
Which patients are not as risk for circulatory overload?
Patients with iron-deficiency anemia
167
What type of hemolysis accompanies ananaphylactic reaction?
*non of the above
- acute
- intravascular
- extravascular
168
Which of the following therapies is not advocated in circulatory overload?
Whole blood units
169
Which of the following should be collected immediately from a patent exhibiting signs of a septic reaction to blood products?
Blood cultures
170
Changes that occur to RBCs upon storage include an increase in
Calcium
171
Which of the following indicates a hemolytic process?
Pre-transfusion plasma is yellow; post-transfusion plasma is red
172
What is a common finding in a DHTR?
Jaundice
173
Persons with PTP exhibit thrombocytopenia with platelet counts al low as 10,000 per uL. What other complications might be present?
Hematuria
174
Which of the following is not characteristic of an anaphylactic reaction?
Electrophoresis levels of IgA
175
What type of hemolysis is implicated in a DHTR caused by primary alloimmunization?
Extravascular
176
Which of the following best describes a transfusion reaction?
Any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components
177
In a DHTR, patient antibody attaches to the specific foreign donor RBC antigen, causing sensitization of RBCs, which are removed by the:
Reticuloendothelial system (RES)
178
Which of the following is characterized by a rapid onset of thrombocytopenia due to anamnestic production of platelet antibody?
PTP
179
What is the length of time required for production of antibody in a DHTR caused by an anamnestic immune response?
3-7 days
180
All of the following signs are consistent with circulatory overload except:
Fever
181
The most important initial step in evaluating a suspected hemolytic transfusion reaction is to:
Reconfirm the patient’s identity and reexamine all pre-transfusion testing
182
How is a febrile nonhemolytic transfusion reaction FNHTR best defined?
A 1C temperature rise associated with transfusion that has no medical explanation other than blood component transfusion
183
Besides Hb, what other protein can cause a pink discoloration of serum or plasma in association with muscle trauma?
Myoglobin
184
Alloimmunization may result from which of the following?
Prior exposure to donor blood components
185
A patient undergoing transfusion of packed RBCs became hypotensive and cyanosis 30 minutes into the transfusion. The nurse also noted a 0.8C increase in temperature. The transfusion was stopped and post-blood specimens were sent down to the laboratory for a transfusion reaction investigation. The donor serum was tested against screening cells (3-vials) and was reactive at AHG in all vials. A panel was performed, and anti-Bg^a was identified. What special blood component should this patient now receive?
* none of the above
- leukopoor
- washed
- deglycerolized
186
Circulatory overload is cause by which of the following?
*all of these
- excessive transfused fluid
- rapid rate of infusion
- decreased
187
Alloimmunization is categorized as what type of transfusion reaction?
Delayed nonhemolytic
188
Which of the following should be collected 5-7 hours after transfusion for unconjugated bilirubin determination?
Clotted blood specimen
189
What is the pathophysiological cause surrounding anaphylactic and anaphylactoid reactions?
A patient who is deficient in IgA antibodies via sensitization from transfusion or pregnancy
190
The specific cell product used for treating sepsis is the:
Granulocyte
191
Photophoresis is effective against what malignant disorder?
Cutaneous T-cell lymphoma
192
Plasma exchange when ________ is considered the pathological substance
IgM
193
What is an example of a continuous flow centrifugation (CFC) instrument?
COBE spectra
194
What effect does aspirin have on platelets?
Prevents platelet aggregation
195
Which of the following incorporates membrane filtration technology with intermittent flow centrifugation (IFC) apheresis?
Fenwal Autopheresis-C
196
What is the definition of apheresis?
Separation or removal of a blood component from whole blood
197
Which cell type is densest in WBC layer when anticoagulated blood is centrifuged?
Granulocyte
198
When a sample of whole blood is spun distinct layers from. What cell line or lines make up the Buffy coat?
WBC and platelets
199
A child undergoing apheresis may require CFC to minimize:
Extracorporeal volume
200
A normal healthy donor undergoes a procedure to obtain platelets that will be transfused to a patient is representative of:
Component apheresis collection
201
In what circumstances is a plasmapheresis donor rejected from donation?
Serum protein = 5.0 g/dL
202
What other technique is available for neonates with sepsis when apheresis is unavailable?
A Buffy coat prepared from a whole blood unit less than 12 hours old
203
Which of the following is in indication for therapeutic apheresis?
*options B and C
- a pathogenic substance exists in the blood that contributes to a disease process
- a substance can be more effectively removed by apheresis than by the body’s own hemostatic mechanisms
204
Which of the following factors influenced the need for apheresis technology?
The blood component needs of patients chemotherapy
205
Which of the following terms is defines as the removal of WBCs with the return RBCs, plasma and platelets?
Leukapheresis
206
All of the following statements are consistent with photopheresis expect:
The patient is given an oral dose of piroxicam, which binds too the RNA of all nucleated cells
207
Which of the following statements best describes the apheresis concept?
Blood is removed from an individual, anticoagulated, and separated, the desired component is retained, and the remaining portions are returned to the donor/patient
208
What is the physiological cause of citrate toxicity in cytapheresis procedures?
The anticoagulant in plasma contain citrate, which binds calcium, lowering the body’s ionized calcium
209
Fresh frozen plasma (FFP) is not the optimal product for replacement fluids for a therapeutic plasma exchange procdure. For which patient is FFP the optimal product of choice?
*all of the above
- patient with a liver disease
- patient with thrombotic thrombocytopenic purpura (TTP)
- patient scheduled to undergo an invasive procedure
210
What possible risk exists when hydroxyethyl starch (HES) concentration has exceeded the renal threshold and excretion is retarded?
Blockage of the reticuloendothelial system
211
All of the following statements are consistent with CFC except:
Reinfusion to the patient completes one cycle
212
Currently, the immunoaffinity column has FDA licensure for treating what disease state?
Idiopathic thrombocytopenia purpura (ITP)
213
What is a disadvantage of choosing fresh frozen plasma for fluid replacement in persons undergoing therpeautic plasmapheresis?
*all of the above
- citrate toxicity
- ABO incompatibility
- disease transmission
214
The platelet count of the plateletpheresis donor must be _______ prior to the procedure
>150 x 10^9 per L
215
A donor’s estimated total blood volume was determined to be 4,500 mL before a plasmapheresis procedure. The extracorporeal blood volume should not exceed:
675 mL
216
In plateletpheresis, which blood component is returned to the donor?
*A and C
- RBCs
- WBCs
217
Antiplatelet medication have differing deferral time periods. Which of the following does not match?
Feldene - 7 days
218
______ testing is performed on platelet apheresis products to make sure that HIV, WNV, and hepatitis C are not present
Nucleic acid
219
Plasmapheresis is synonymous with what term?
Plasma exchange
220
Erythrocytapheresis is successful in which of the following conditions?
Malaria
221
The removal of RBCs in a hemapheresis procedure is called:
Erytrhocytapheresis
222
What is the primary anticoagulant used in pheresis procedures?
Citrate
223
What variables are necessary to calculate the donor’s total blood volume?
*all of these above
- height
- weight
- sex
224
Fatalities that result from therapeutic apheresis have primarily been caused by:
Cardiac arrest and arrhythmia
225
Leukopheresis may be indicated when the WBC count exceeds ________
100,000 per uL
226
Which apheresis method carries the additional RBCs to the wrong individual and yielding the smallest volume of selected blood component?
Manual apheresis
227
Which immunoadsorbent has an affinity for IgG classes 1, 2, and 4 and their immune complexes?
Staphylococcal protein A
228
What can be done to prevent the development of HLA alloimmunization and platelet refractoriness?
Reduce the number of leukocytes in the platelet product
229
Which of the following is not an indication for plasmapheresis?
To decrease iron deposition in tissues in chronically transfused patients
230
All of the following constitute variables of apheresis procedures except:
Blood type
231
What is therapeutic plasmapheresis?
The removal of large volumes of patient plasma
232
The hematopoietic progenitor cells that eventually repopulate the bone marrow and also circulate in the blood are called:
Peripheral blood stem cells (PBSC)
233
A person participating in a serial apheresis program would not:
Lose more than 25 mL of RBCs per week
234
How is HES used in apheresis procedures?
As a sedimenting agent to separate WBCs from RBCs
235
While undergoing plasmapheresis, the donor experienced numbness around his mouth, which is indicative of citrate toxicity. How can this be treated?
Administrating exogenous calcium
236
The concentrate obtained from plateletpheresis via a closed system is stored for 5 days at room temperature. What must the pH be at the end of storage?
>=6.0
237
When is isolation of PBSCs via apheresis equipment indicated?
*all of the above
- the bone marrow contains malignant cells
- the bone marrow has been irradiated
- the patient cannot tolerate general anesthesia
238
The method is which of specfic ligand is an insoluble matrix in a column and plasma is perfused over the column with select removal of pathogenic substance and return of patient’s plasma is known as:
Immunoadsorption
239
Which of the following conditions could necessitate a plasmapheresis procedure?
Barbiturate poisoning
240
During a plasmapheresis procedure, the RBCs must be returned within how many hours of phlebotomy?
2 hours
241
Citrate used as an antigcoagulant is apheresis procedures is removed from the body by:
Being metabolized in the liver
242
What effect do steroids have on leukeapheresis?
Increase the vascular pool of granulocytes
243
Which patient are at the most risk for platelet refractoriness where they become alloimmunuized to HLA antigens on platelets?
Leukemia patients
244
One unit of apheresed platelets should increase the platelet count_________.
20,000-60,000 per uL
245
Compatibility testing is required for granulocyte concentration if the RBC contamination is greater than:
5 mL
246
What does the Hct need to be (regardless of gender) for a double RBC collection?
40%
247
The removal of bile acids from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures?
Charcoal
248
The removal of endotoxin from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures?
Polymyxin B
249
The removal of granulocytic cells from patient plasma can be assisted through the use of which adsorbent during plasmapheresis produces?
Cellulose acetate
250
What is the purpose of washing the ells after the initial cell-serum incubation in the Amos-modified antibody screen procedure?
To remove aggregated immunoglobulin in the serum
251
How is induction of tolerance achieved in kidney transplantation?
Blood transfusions before transplant
252
How are the heavy chains of MHC classes I and II molecules transported into the cell membrane?
Heavy chains are inserted through the membrane via hydrophobic residues
253
Which of the following is a phenomenon to which an antiserum directed against one HLA determinant reacts with other HLA antigenic determinants?
Cross reactivity
254
HLA-DR typing requires a ________ suspension
B-lymphocytes
255
HLA testing is useful in what other area of study?q
*all of the above
- paternity testing
- disease correlation
- anthropology
256
All of the following disease have been associated with a significant HLA correlation except:
Fanconi’s anemia
257
What is the linkage disequilibrium in reference to the HLA antigens?
Occurrence of HLA genes more frequently in the same haplotype than would be expected by chance alone
258
Why is histocompatilibilty testing negated in both lung and heart transplants?
The cold ischemic time is too short
259
What is the most important step for increasing the number of bone marrow transplants performed?
Expand the donor pool to include both related and unrelated individuals
260
What is meant by the term public as applied to HLA antibodies?
Binding to epitopes shared by more than one HLA gene product
261
What is the definition of total ischemic time in heart transplantation?
The amount of time there is not blood flow through the organ
262
The MHC class I region encodes for all of the following genes except:
HLA-DR
263
Which of the following is an example of linkage disequilibrium?
The actual occurrence of haplotype HLA-A1 and HLA-B8 is 8%; the expected occurence based on gene frequencies is 2%
264
What does HLA stand for?
Human leukocyte antigen
265
Why are monoclonal antibodies able to detect a broad range of epitopes?
They are derived through xenoimmunization
266
How is complement detected in HLA testing?
Uptake of trypan blue dye
267
The majority of HLA alloantibodies are_______ immunoglobulins
IgG
268
How is histocompatibility testing different from RBC testing?
*none of the above
269
The surface marker, or antigen, detected in histocompatibility testing of single individual is referred to as HLA:
Phenotype
270
Which of the following is acceptable for cytotoxicity techniques?
ACD
271
What is the main purpose of crossmatching before transplantation?
To identify antibody in the serum of the potential recipient to antigens present on donor tissues
272
Recipient lymphocytotoxic HLA-antibody to donor antigens is associated with:
*both A and B
- accelerated graft rejection
- platelet refractoriness
273
When the entire set of A, B, C, DR, DQ, and DP antigens are located on one chromosome, it is called a:
Haplotype
274
The genetic region that contains surface antigens or receptors responsible for the recognition and elimination of foreign tissues is referred to as:
MHC
275
How many targets are required for HLA antibody screening?
30
276
How might platelet survival be improved in a pateint receiving platelets despite a near perfect HLA match between recipient and donor?
Remove leukocytes from the donor unit
277
In HLA testing, what is the purpose of mineral out contained in the testing well?
To prevent evaporation of antiseri during incubation
278
A platelet recipient whose HLA phenotype includes A3, B7; A11, B42 is transfused from a A1, B7; A3, B13 donor. Given the following CREG (cross-reactive groups), what would you expect the outcome on this transfusion to be? A1-CREG: A1, 36, 3, 9 (23,24), 10(25, 26, 34, 66), 11, 19 (29, 30, 31, 32, 33) 28 B7-CREG: B7, 42, 22(54, 55, 56), 27, 40 (60,61) 13, 41, 47, 48
The recipient would benefit from this transfusion because A3 and A11 and B13 and B42 are cross-reactive
279
Kidney transplants are used to treat which disease?
End-stage renal disease
280
Which MHC region encodes for complement proteins?
Class III
281
Between which two loci are recombination (crossing over) most likely to occur?
HLA-A and HLA-DP
282
What does the “R” signify in the HLA-DR locus?
Subregion of D
283
MCH class II molecules expressed on all of the following except:
Platelets
284
A common technique used for HLA class II typing that involves amplification of specific DNA sequences for hybridization is called:
PCR
285
Testing for the HLA-S antigens (DR, DP, DQ) _______ typing cells of each phenotype are set up in an MLR as _______ against the test cells
Homozygous/stimulators
286
What is the most important pre transplant test preformed on the recipient in a heart transplantation?
HLA-antibody screen
287
How are monoclonal HLA antibodies (MoAbs) produced?
The fusion of HLA antibody, producing B cells with plasmacytoma lines
288
Why are T cells unacceptable for cytotoxicity testing using fluorescent labeling?
T cells lack immunoglobin on their surface
289
What kidney transplant strategy is satisfied through matching of the donor and recipient antigens?
Reduction of graft “foreignness”
290
A double lung transplant is indicated in which of the following disorders?
Cystic fibrosis
291
A patient who have been presensitized to foreign HLA antigens all demonstrate ________ if the donor tissue expresses the same antigens
Graft rejection
292
The primary indication for pancreas transplantation is:
Diabetes
293
The HLA-A locus antigens A2, A23, A24, and A28 make up the:
A2-CREG
294
Which of the following specificities designates the HLA-C gene?
Cw
295
Which of the following is not a rule for HLA nomenclature?
The allele group is designated by the fourth numeric field
296
What is placed between the gene name and the numerical identifier for the allele to differentiate between the gene nomenclature and HLA serologic reactivity?
Asterisk
297
Which of the these is NOT the purpose for the virtual crossmatch?
Eliminations the serologic testing process
298
Which of these is not a concern in the virtual crossmatch?
The type of organ that is being transplanted
299
True or False? Patient who have been presenstized to HLA antigens have a much higher graft survival rate in liver transplantation than nonsensitized patients
false
300
True or False? The majority of cross-reactive alloantibodies detect HLA specificities of allelic molecules coded by the same locus
True
301
How do internal assessments differ from compliance inspections?
Internal assessments are more fregquent than compliance inspections
302
Why might a laboratory adopt an individualized quality control plan (IQCP)?
* to do all of these
- to customize its QC program to its specific needs
- to demonstrate where costs can be saved
- to eliminate the need to perform daily quality control
303
Employee training takes places:
After hiring and after implementing new procedures
304
What is a function of the quality committee or quality council?
To set priorities for quality improvements
305
What is the main purpose of linking current good manufacturing practices (CGMPs) to process control?
To build quality into the manufacturing process from the beginning to the end
306
A physician complains that she has not received a test from the blood bank. The remedial action is to:
Prepare a copy of the report for the physician
307
When a new shipment of reagents is received, what measure is taken to determine equivalency?
Lot-to-lot testing of new and old lot numbers of reagent
308
Which of the following is not regarded as an instrument?
Cuvette
309
Which of the following might lead to unacceptable quality control results?
* all of the above
- a technician who has not worked in the area for several months
- a deteriorated “anti-A”
- an uncalibrated serofuge
310
Which of the following is an example of an external customer?
A blood donor
311
Blood collected in a red-top tube and a lavender tube was sent through a tube system to the STAT laboratory. The blood specimens were not labeled with any type of patents identification. The medical technologist called the emergency room (ER) to notify them of the problem. The ER nurse stated she wanted the tube sent back to the ER and that she would label them. The stat laboratory technologist related the laboratory’s policy on unlabeled specimens, saying that they would be discarded. At that point the disgruntled nurse said she would write up a(n) ______ for the laboratory’s refusal to analyze blood on an emergency patient
Incident report
312
Which of statement concerning compliance programs is false?
Programs are designed to evaluate effectiveness of blood bank laboratories
313
A standard operating procedure (SOP) is:
A set of directions for how to perform a particular task
314
What phase is synonymous with “quality management?”
Organization-wide quality assurance
315
All of the following are transfusion service quality assurance indicators used to monitor patient care except:
Number of therapeutic unit drawn
316
Which of the following statements concerning equipment is true?
Frequency of testing is determined by manufacturer recommendations
317
Which continuous improvement cycle component ensures the finished product has met required specifications?
Assess
318
As part of postemployment departmental training, a medical technologist was given 10 known blood samples to analyze for ABO specificity. This is referred to as:
A competence assessment
319
Process improvement teams address all of the following issues except:
Filing a grievance
320
Calibrating equipment prior to use is considered which function of quality?
Quality control
321
Daily testing the reactivity of blood typing reagents is considered which function of quality?
Quality control
322
Which of the following is not part of an individualized quality control plan (IQCP)?
New instrument validation
323
Which of these need NOT be evaluated during a risk assessment?
Patient opinion survey
324
Which of these should be evaluated during a risk assessment?
*all of these
- airflow/ventilation
- competency of testing personnel
- equipment functioning
325
Quality assessment monitors include reviews of all of these EXCEPT:
Vendor selection process
326
Which of the following provides a framework for applying quality principles and practices in the blood bank?
Quality management system
327
A quality framework in the blood bank ensures all of the following except:
Blood bank operations are customized to individual staff preferences
328
Which of the following relationships is NOT considered a quality essential of an organization?
Blood bank personnel links to their families
329
Which of the following is not internal customer for the transfusion service?
Patient receiving blood products
330
Laboratory safety training must include which of these for blood bank personnel?
* all of these
- chemical hygiene
- emergency preparedness
- radiation safety
331
Competency assessment for blood bank personnel includes all of these except:
Cross-training into other areas of the laboratory
332
Which of these records may be reviews during competency assessment for blood bank personnel?
* all of the above
- quality control records
- proficiency testing results
- maintenance records
333
What is a flowchart?
A tool that displays all the elements involved in a process
334
What is the purpose of a flowchart?
*all of the above
- facilitates understanding of resources when planning a new process
- reveal problems in current process
- shows how process inputs are converted into outputs
335
Which of these does NOT describe a flowchart?
Is useless in obtaining better control of a process
336
Testing all activities in a new process to ensure that the process will work in the live environment is a function of:
Validation studies
337
The use of different colored sea for blood bank reagents is an example of:
Process control
338
Which of these is part of process control?
* all of these
- performing routine QC of test methods and reagents
- performing proficiency testing and personnel competency checks
- using a manual or automated action to prevent the occurrence of errors
339
An outcomes of performing procedures and testing is called a:
Result
340
Copies of regulations and accreditation requirements are example of:
Documents
341
Examples of document include:
* all of these
- written policies, procedures and instructions
- process flowcharts and forms
- manufactures package inserts and operator manuals
342
Examples of forms include:
* all of these
- instrument printouts
- manual or electronic worksheets
- tags, stickers or labels
343
An error has occurred during a test procedure, which was found to be caused by the technologist using a copy of the procedure that was being used at the time of her training. What should be put in place to ensure this type of mistake is not made again
Document control process
344
A good document control process does all of these except:
Eliminates the need to document all changes or corrections to procedures
345
Which of the following statements is true?
Remedial action does not uncover the real cause of the nonconformance
346
An action taken to identify and eliminate the cause of a nonconformance is what type of action?
Corrective
347
An action taken to reduce or eliminate the potential for a nonconformance is what type of action?
Preventive
348
The process of define, measure, analyze, improve, and control (DMAIC) is known as which
Six sigma
349
A Pareto chart is used at what stage of the DMAIC process?
Define
350
Using a SIPOC diagram occurs at what stage of the DMAIC process?
Define
351
Understanding the cause and effect relationships occurs at what stage of DMAIC process?
Analyze
352
Using the DOE tool occurs at what stage of the DMAIC process?
Improve
353
Ensuring that the implemented changes are sustained occurs at what stage of the DMAIC Process
Control
354
The cost of good quality (COGQ) does not include which of these?
Nonconformance costs
355
Conformance cost may include:
* all of these
- preventive maintenance
- quality management activities
- validation activities
356
The cost incurred for calibration materials and reagents is an example of what type of cost?
Internal evaluation costs
357
The cost incurred for proficiency testing periodic licensure or accreditation inspections is what type of cost?
External evaluation costs
358
Which of these costs is a cost of poor quality (COPQ)?
Nonconformance costs
359
The cost incurred when disregarding donated blood units is an example of what type of cost?
Internal failure cost
360
The cost incurred with customer product recalls is an example of what type of cost?
External failure costs
361
Both the blood bank and the entire medical laboratory use which of the following?
* all of these
- Quality management systems
- continuous improvement systems
- essentials quality indicators
362
Many transfusion-transmitted acquired immunodeficiency syndrome (TTAIDS) lawsuits have been dismissed because of:
Inability to prove negligence
363
What is the meaning of tort reform?
Protection of specificity practices from punitive or excessive awards by state legislatures
364
What kind of cases stimulated state legislatures to enact protection for blood banks through so-called blood shield statutes?
TTH
365
What body of government is authorized to pass laws?
* all of the above
- U.S congress
- U.S. Supreme Court
- State courts
366
What are physician selected as the “respondent superior” in negligent cases?
Physician give the order to transfuse
367
A blood bank technologist working in an army medical enter discovers that a colleague from boot camp who donated blood in HIV- positive. While at a nightclub on base, the technologist discloses this information to his sergeant. Within 24 hours commander confronts the donor with this rumor. By law the donor can file suit against the donor center for______
Loss of privacy
368
Which of the following situations is grounds for plaintiff claim under invasion of privacy?
* all of the above
- public disclosure of embarrassing facts
- placement of plaintiff in a “false light” in public
- intrusions on plaintiffs seclusions
369
What is the rationale surrounding the Doctrine of Charitable immunity?
Courts provide immunity from excess liability for nonprofit organizations
370
Liability for negligence includes all of the following except:
Failure to meet the duty was indirectly responsible for harm suffered by injured party
371
What was the reason for the negligence verdict in the district Belle Bonfils Memorial Blood Bank vs Denver district court (1988)?
Lack of standard protocol for implementing new HIV testing on available components
372
How does the doctrine of informed consent protect the donor?
By requiring that information be provided to the donor in a manner that he or she can understand and ask questions about, if so desired
373
What would be the effect of redefining blood banking outside the realm of medical practice in litigation cases?
Expert medical testimony would not be needed to establish standard of care
374
How is battery conceptualized in transfusion medicine?
A donor chain never to have agreed to be stuck by a needle
375
In regard to donor histories, the federal government has put an emphasis on______ in the hope of acquiring more descriptive information from persons who may be infected with HIV
Face-to-face oral questions
376
What would be the plaintiffs claims for a case involving a donor or defendant who intentionally donated HIV-positive blood for transfusion purposes/
Wrongful death
377
All of the following are emerging concerns of transfusion medicine except:
Antibody testing procedures
378
Blood banks are federally regulated by which of the following?
FDA
379
In transfusion services, who is liable for the actions of employees as determined by federal law?
Physician
380
In the case of Kazuhiro v. Georgetown University hospital (1987), what were the circumastances surrounding the courts decision to rule in favor of the defendant?
Parents did not object to transfusion at the same time of infusion
381
The _______ is an example of a voluntary standard, as related to transfusion medicine
AABB standard
382
Who determines the professional standard of care in negligence lawsuits?
Expert witnesses
383
Plaintiffs have prevailed in TTAIDS multimillion-dollar medical malpractice suits against physicians for which of the following arguments?
The patient did not need a transfusion based on clinical data
384
Which of the following best describes strict liability/
Manufacturers are legally liable for all harm that occurs through use of a product
385
Which of the following species of organisms are known to infect RBCs in storage?
*all of the above
- escherichia Coli
- enterobacter species
- yersinia species
386
What is the legal basis for lawsuits filed as a result of a transfusion?
Civil actions for tort and tort liability
387
All of the following injuries from component collection may be grounds for a civil suit except:
A hematoma
388
Civil cases involving TTAIDS in the 1980s, when plaintiffs argued infected patients were insufficiently warned of the hazards of transfusion, were unsuccessful in their litigation efforts because:
Scientific knowledge was limited, as stated by experts
389
Lawsuits against blood collection agencies for improper donor screening can be ruled in favor of the plaintiff if which of the following occurs?
*all of the above
- facilities cannot show that they had implemented written procedures
- facilities cannot show that they and had properly trained employees
- facilities cannot document that employees followed procedures for proper documentation of each screen
390
How must a standard operating procedure (SOP) be written in order to stand up against legal scrutiny?
* all of these
- SOPs must be consistent with quality principles
- SOPs must comply with recognized authorities, regulations, and statutes.
- SOPs must include a method of measuring and recording how persons actually follow those procedures
391
In the absence of federal law, what justification can provide precedence for future decisions.
State
392
Donor who were protected in the past from subpoena in cases of transfusion-transmitted diseases now may be questioned by the court. How might the donor identify be handled?
* any of these
- completely protected
- partially protected
- must be appear in open court
393
When checking out a unit for blood to the floor:
* all of the above
- the nurse must provide a piece of paper with at least two patient identifiers and preferably, depending on the system, a unique blood bank band number
You must visually check and document that the unit is free from hemolysis or possible bacterial contamination
You must document who is checking out the blood and transporting it.
394
What phrase is synonymous with “quality management?”
Organization-wide quality assurance
395
SHORT ANSWER: Describe the difference between compliance and quality control
Compliance programs are designed to evaluate how effectively a facility meets certain requirements established by governing agencies at a single point in time every 1-2 years b detecting errors, deficiencies, & deviations from standard protocol
Quality control is an aspect of quality management that aids in monitoring performance (unbiasedly accurate & precise) & identifying problem areas; used at least at the beginning of every shift alongside testing; helps determine reactivity of blood-typing reagents, calibrating centrifuges, etc.
396
A 45-year old female bone marrow transplant patient with non-Hodgkin’s lymphoma required transfusion on a regular basis due to chronic anemia. During her current transfusion, the patient developed a 1.8 C increase in temperature with rigors. The transfusion was stopped by the nurse and a transfusion reaction workup was initiated
The transfusion service performed the workup and found no clerical errors and testing was performed on pre and post samples with no discrepancies. The DAT test result was associated with sepsis (TAS) reaction based on the patients presentations
Based on this information, answers the following questions
1. What laboratory workup is performed to diagnose TAS?
2. What symptoms usually present with transfusion-associated sepsis?
1. A gram stain, aerobic culture and anaerobic culture
2. Symptoms may include hypotension, fever, tachycardia, confusion, difficulty breathing, oliguria, etc.
397
Why are physicians selected as the “respondent superior” in negligent cases?
Physicians give the order to transfuse
398
What kind of cases stimulate state legislature to enact protection for blood banks through so-called blood shield statutes?
TTH
399
Which of the following is the correct order of steps in a post-transfusion workup?
- Obtain a post-transfuson specimen and look for hemolysis
- check the ID of patient and donor unit
- perform a DAT
- perform ABO/Rh-grouping
- repeat pretransfusion crossmatch
400
What hemoglobin level is considered critical and may warrant a RBC transfusion?
7 g/dL`
401
SHORT ANSWER: Describe 2 ways that blood bank professionals avoid litigation
- doctrine of informed consent & donor rights
- following ordinary & professional standards of Care by maintaining patient/donor confidentiality
402
MHC class II molecules are expressed on all of the following except:
Platelets
403
The major HLA antibodies are
IgG
404
Which of the following is used to determine if reagents and equipment are functioning prior to testing?
Quality control
405
SHORT ANSWER: Describe how to prepare cytoprecipitate
FFP is thawed slowly at 1-6 C
406
A transfusion reaction investigation should include all of the following except
Washed RBCs
407
In what circumstances is a plasmapheresis donor rejected from donation?
Serum protein = 5.0 g/dL
408
Which of the following is an indicator of acute immune hemolytic transfusion reaction?
Increased Hb
