Transfusion Therapy

Chapter 15.
Transfusion Therapy
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. What is the purpose of dialysis in uremic patients?

a. Release of functional von Willebrand factor (vWF) from endothelial cells
b. Removal of by-products of protein metabolism that renders vWF and platelets
nonfunctional
c. Release of platelets from the bone marrow
d. All of the above
____ 2. Which of the following is not an indication for fresh frozen plasma (FFP) transfusion?
a. Disseminated intravascular coagulation (DIC)
b. Vitamin K deficiency
c. Factor VIII deficiency
d. Massive transfusion
____ 3. The rejection of the transplantation of platelets from one individual to another is termed or defined as:
a. a hemolytic transfusion reaction. c. graft versus host disease.
b. platelet refractoriness. d. none of the above.
____ 4. Which of the following may be a serious manifestation of FFP transfusion in congenital factor deficiencies?
a. Tachycardia c. Hypogammaglobulinemia
b. Pleurisy d. Pulmonary edema
____ 5. All coagulation factors are produced in the liver except:

a. antihemophilic factor (AHF). c. vWF.
b. factor I. d. factor VII.
____ 6. 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 amount of crossmatch performed
b. Increases the availability of donor units in the inventory
c. Contributes to outdating of blood products
d. Decreases the number of panel studies done on positive antibody screens
____ 7. How are RBC aliquots prepared for a neonate transfusion?

a. Blood is withdrawn from collection bag using a syringe and diluted 1:2 with saline.
b. Blood is withdrawn from collection bag using a syringe and diluted 1:2 with glycerol.
c. Blood is transferred from collection bag to satellite bag and withdrawn using a syringe.
d. None of the above
____ 8. Which of the following is an indication for immunoglobulin administration?

a. Cytomegalovirus
b. Hepatitis A
c. Infectious mononucleosis
d. Congenital hypergammaglobulinemia
____ 9. Deglycerolized red blood cells can be used interchangeably with washed red blood cells, because both
procedures:
a. remove white blood cells. c. have 24-hour outdate.
b. remove plasma. d. all of the above.
____ 10. Oncology patients usually receive repeated red blood cell and platelet transfusions because of:
a. radiation therapy. c. chemotherapy.
b. tumor infiltration of bone marrow. d. all of the above.
____ 11. Which of the following is not a function of the hospital transfusion committee?
a. FDA certification
b. Reviewing transfusion reactions
c. Submitting reports of committee recommendations to medical staff
d. Ensuring proper procedures are upheld by hospital personnel
____ 12. Liquid plasma is not indicated for factor ___________ deficiency.
a. XI c. II
b. V d. X
____ 13. Why are fresh blood units (less than 7 days old) preferred for a neonate transfusion?
a. They reduce the risk of hyperkalemia.
b. They minimize 2,3 DPG levels.
c. They reduce the risk of hypokalemia.
d. They reduce the risk of hypernatremia.
____ 14. All of the following are consistent with graft-versus-host disease (GVHD) except:
a. transplantation of immunocompetent T lymphocytes.
b. HLA incompatibility between graft and recipient.
c. transplantation of "immunologically naive" T lymphocytes.
d. an immunocompromised recipient.
____ 15. The pathological cause of a decreased red blood cell mass include(s):
a. compromised bone marrow production.
b. decreased red blood cell survival.
c. bleeding as a result of trauma.
d. all of the above.
____ 16. Bleeding disorders may be caused by:

a. dysfunction of lymphocytes. c. dysfunction of platelets.
b. dysfunction of neutrophils. d. dysfunction of erythrocytes.
____ 17. Which of the following are not at risk for developing cytomegalovirus (CMV) via CMV-positive blood
products?
a. CMV-positive heart transplant recipients
b. CMV-negative pregnant women
c. CMV-negative bone marrow transplant recipients
d. CMV-negative premature infants
____ 18. Which plateletpheresis product should be irradiated?

a. Autologous unit collected prior to surgery
b. Random stock unit going to a patient with disseminated intravascular coagulation (DIC)
c. A directed donation given by a mother to her son
d. A directed donation given by an unrelated family friend
____ 19. Why is whole blood contraindicated for patients with severe chronic anemia?
a. These patients have a reduced number of red blood cells.
b. The plasma volume of these patients is decreased.
c. The plasma volume of these patients is increased.
d. These patients have an increased number of red blood cells.
____ 20. How is donor platelet survival determined in the recipient?

a. Platelet count increment (1 hour after transfusion)
b. Radiolabeled metals
c. Antiplatelet antibody detection
____ 21. Immunoglobulin prepared from pooled plasma is primarily:

a. IgG c. IgA
b. IgM d. IgE
____ 22. A blood component should be transfused within:

a. 1 hour. c. 3 hours.
b. 2 hours. d. 4 hours.
____ 23. Cryoprecipitated AHF can be used in the treatment of:

a. Bernard-Soulier syndrome.
b. von Willebrand's disease (vWD).
c. antithrombin III deficiency.
d. hemolytic uremic syndrome.
____ 24. 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.
b. Because of factor VIIIs short half-life.
c. Factor VIII concentrates are reserved for hemophiliacs.
d. All of the above.
____ 25. What whole blood component contained in pheresed granulocyte concentrate warrants crossmatching of this
product?
a. White blood cells c. Platelets
b. Red blood cells d. Plasma
____ 26. How is the whole blood that is collected from a donor different from whole blood circulating in someone's
blood vessels?
a. The anticoagulant in donor blood prevents activation of the coagulation system.
b. The citrate mixed with donor blood serves as substrate for red blood cell metabolism.
c. The pH of whole blood is higher in collected units than in blood vessels.
d. Immunogenicity is diminished in collected units.
____ 27. What is the corrected platelet increment for a patient with a body surface area of 2.7 m 2, an initial count of
15,000 per L, and a 1-hour post-transfusion platelet count of 80,000 per L given one apheresed platelet
component?
a. 53,182 per L c. 31,900 per L
b. 58,500 per L d. 5,000 per L
____ 28. In addition to nonhemolytic febrile transfusion reactions, what other indication exists for washed red blood
cells?
a. IgM-deficient patients with anti-IgM
b. IgE-deficient patients with anti-IgE
c. IgA-deficient patients with anti-IgA
d. IgG-deficient patients with anti-IgG
____ 29. How does 25% albumin induce diuresis in liver disease patients?
a. Albumin inactivates antidiuretic hormone in diabetics.
b. Albumin solution acts with diuretic drugs to concentrate plasma driving water into
extravascular spaces.
c. Albumin solution acts with diuretics and brings extravascular water into vascular space to
dilute albumin.
____ 30. Which of the following is an indication for plasma transfusion in a patient who has been massively
transfused?
a. PT = 12 seconds c. Fibrinogen = 120 mg/dL
b. PTT greater than 60 seconds d. Platelets = 25,000/L
____ 31. In what disease state is acquired antithrombin III deficiency manifested?
a. DIC c. Liver disease
b. von Willebrand's disease d. Lupus erythematosus
____ 32. Who is at risk for transfusion-associated graft-versus-host disease (TAGVHD)?

a. Hodgkin's lymphoma patients
b. Bone marrow transplant recipients
c. Persons receiving nonirradiated directed donations
d. All of the above
____ 33. Which class of vWD provides the least amount of vWF?
a. Type I c. Type III
b. Type IIB d. Type IIA
____ 34. Which of the following methods provides the purest factor VIII concentrates?
a. Anion exchange chromatography c. DNA technology
b. Monoclonal antibody purification d. Pasteurization
____ 35. What is the expiration on washed red blood cells?

a. 35 days c. 42 days
b. 24 hours d. 6 hours
____ 36. What is used to anticoagulate the shed blood obtained from intraoperative salvage?
a. EDTA c. Heparin
b. Citrate d. Citrate and heparin
____ 37. Why is it essential that irradiated blood components be used in bone marrow transplant recipients?
a. Irradiation counteracts the effects of neutrophil toxicity.
b. Bone marrow recipients demonstrate hyperimmunity to lymphocytes.
c. Bone marrow recipients are on immunosuppressive therapy.
____ 38. Persons making pre-deposit donations for planned surgery will take iron supplements to replenish iron and
stimulate:
a. myelopoiesis. c. thrombopoiesis.
b. erythropoiesis. d. lymphopoiesis.
____ 39. Platelets prepared from ______ are referred to as random donor platelets.
a. recovered plasma c. whole blood units
b. pheresis products d. red blood cells
____ 40. Hemophilia A is clinically apparent when the factor VIII level is less than:
a. 20% c. 50%
b. 10% d. 60%
____ 41. Which of the following is not an indication for transfusing platelets?
a. Thrombocytopenia with bleeding or invasive procedure
b. Disseminated intravascular coagulation
c. Chemotherapy for malignancy
d. Massive transfusion, platelet count 250,000/L
____ 42. Which type of filter is used in routine blood administration sets to remove gross clots from all blood
products?
a. Leukopoor c. 100 m
b. 170 m d. 50 m
____ 43. Which type of autologous transfusion, successful 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?
a. Intraoperative hemodilution c. Intraoperative salvage
b. Pre-deposit donation d. Postoperative salvage
____ 44. Factor VIII is treated by which of the following to ensure sterility for HIV and hepatitis B and C?
a. Pasteurization c. Solvent detergent
b. Nanofiltration d. All of the above
____ 45. Which of the following should be done when selecting units for a hypoxic neonate?
a. Irradiation c. Hgb S testing
b. Cytomegalovirus testing d. Epstein-Barr virus testing
____ 46. Why is red blood cell transfusion contraindicated in a stable patient with chronic renal failure who has no
symptoms except after climbing three flights of stairs?
a. The anemia is compensated.
b. The anemia is a "nutritional anemia."
c. Whole blood is recommended because the plasma volume is decreased in these patients.
____ 47. What is the source of hyperimmune globulins used in the prevention of hepatitis B?
a. Recombinant hepatitis B purified protein
b. Plasma donors whose sera are devoid of hepatitis B antibody
c. Plasma donors whose sera demonstrate a high titer of hepatitis B antibody
____ 48. Why is the increase in hemoglobin and hematocrit evident more quickly in red blood cell transfusions than in
whole blood transfusions?
a. Blood volume adjustment is less when red blood cells are transfused.
b. Blood volume adjustment is greater when red blood cells are transfused.
c. Whole blood takes longer to mix.
d. Whole blood is usually transfused through a porous filter.
____ 49. Factor IX concentrates contain which factors (otherwise known as "prothrombin complex")?
a. I, V, VII, IX c. II, VII, IX, X
b. II, V, VII, IX d. V, VII, IX, XII
____ 50. What is suspected when the hematocrit has decreased by 4% and the total bilirubin level is increased 5 days
after transfusion?
a. Acute hemolytic transfusion reaction
b. Volume overload
c. Delayed hemolytic transfusion reaction
d. Urticarial reaction
____ 51. The rejection of platelets in multiply transfused patients is called:

a. platelet satellitism. c. refractoriness.
b. stimulation. d. urticaria.
____ 52. Which of the following statements concerning red blood cells prepared with additive solution 1 (AS-1) is
true?
a. The shelf-life is 35 days.
b. The AS-1 unit contains more plasma than the CPDA-1 red blood cells.
c. Red blood cell mass is lower than that of CPDA-1 red blood cells.
d. The hematocrit is lower than CPDA-1 red blood cells.
____ 53. What is the immunologic principle of RhIG administration?

a. Anti-D attaches to Rh-positive cells of mother and are subsequently removed by cells of
the reticuloendothelial system, preventing sensitization.
b. 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.
c. Anti-D attaches to Rh-negative 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?
a. I, VII, IX, X c. II, VII, IX, X
b. I, V, IX, X d. II, VII, XI, XII
____ 55. Leukoreduction filters are used in the transfusion of red blood cells and platelets to prevent:
a. nonfebrile hemolytic transfusion reactions.
b. febrile hemolytic transfusion reactions.
c. febrile nonhemolytic transfusion reactions.
d. nonfebrile nonhemolytic transfusion reactions.
____ 56. How would the hematocrit of a patient with chronic anemia be affected by transfusion of 2 units of whole
blood versus transfusion with 3 units of packed RBCs?
a. Patient's hematocrit would be equally affected.
b. The packed RBCs would increase the hematocrit more than the whole blood.
c. The whole blood would increase the hematocrit more than the packed RBCs.
d. The hematocrit would not change at all with the whole blood because of the plasma in the
unit.
____ 57. Which of the following factors are found in therapeutic levels in fresh frozen plasma?
a. Factor VIII c. Factor XI
b. Factor V d. All of the above
____ 58. A patient with severe hemolytic anemia had a pulse of 120 beats per minute and a respiratory rate of 37
breaths per minute. What blood component is indicated for this patient?
a. Plasma c. Red blood cells
b. Whole blood d. Platelets
____ 59. Which of the following Rh-negative patients may be transfused with Rh-positive units when few O-negative
units are available in an emergency?
a. Pregnant woman c. 25-year-old female
b. Middle-aged male d. Neonate
____ 60. What is the recommended treatment for mild von Willebrand's disease?
a. VIII concentrate
b. Fresh frozen plasma
c. Cryoprecipitate
d. DDAVP (1-Deamino-8-arginine vasopressin)
____ 61. Neonatal exchange transfusion is performed using which blood preservative?
a. AS-1
b. Citrate-phosphate-dextrose (CPD)
c. Citrate-phosphate-dextrose adenine (CPDA-1)
d. Both B and C can be safely used
____ 62. A patient 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 mg/dL to 120 mg/dL. How many bags of
cryoprecipitate are needed?
a. 8 c. 15
b. 13 d. 21
____ 63. Why is thrombocytopenia a manifestation of a massive transfusion?

a. Platelets are diluted by resuscitation fluids and stored blood.
b. Platelets are refractory to infused blood.
c. Platelets are sequestered in the spleen due to abnormal hemodynamics.
____ 64. Which blood product is used in the treatment of DIC?

a. Plasma c. Cryoprecipitate
b. Platelets d. All of the above
____ 65. All of the following are characteristics of protein C except:

a. it has a vitamin K dependent factor.
b. it has a serine protease inhibitor.
c. it enhances factors V and VIII.
d. it produces a hypercoagulable state.
____ 66. Cryoprecipitate is not used to treat which condition?

a. Hemophilia A c. Hemophilia B
b. von Willebrand's disease d. Hypofibrinogenemia
____ 67. A 160-pound man was transfused with 1 unit of whole blood after being rescued from a burning apartment
building. His hematocrit was determined to be 27% before transfusion. What would you expect his hematocrit
to be in 48 hours?
a. 28% c. 40%
b. 30% d. 45%
____ 68. What is the only blood component that provides high concentrations of vWF?
a. FFP c. Platelets
b. Whole blood d. Cryoprecipitated AHF
____ 69. How is cryoprecipitated AHF used with prosthetic vascular grafts?
a. Bovine thrombin activates factor XIII, which acts as a fibrin solvent to prime grafts.
b. Bovine thrombin activates factor VIII, which acts as a fibrin glue to seal gaps.
c. Bovine thrombin activates fibrinogen, which acts as a fibrin glue to seal gaps.
____ 70. Antithrombin III concentrates are used in the treatment of:
a. dysfibrinogenemia.
b. acquired antithrombin III deficiency caused by DIC.
c. hereditary antithrombin III deficiency caused by venous thrombosis.
d. All of the above
____ 71. Which intravenous solution is not recommended for dilution of blood components because of red blood cell
damage?
a. 0.9% saline c. 5% albumin
b. Dextrose d. Plasma
____ 72. How can GVHD be prevented in transplant recipients?

a. Filtering of cellular components
b. Irradiation of cellular components
c. Deglycerolizing of cellular components
____ 73. Which of the following represents the final clerical check of a transfusion?
a. The phlebotomist asks the patient to state his name and Social Security number and
compares that information with the patient requisition.
b. The medical technologist compares the specimen label with computer information.
c. The nurse uses the patients armband to compare patient identification with the patient
crossmatch report and tags attached to the unit.
d. Two individuals verify affixing of proper labels to selected blood products.
____ 74. A patient with paroxysmal cold hemoglobinuria (PCH) would require_________ in the event of a blood
transfusion.
a. irradiation c. a blood warmer
b. cytomegalovirus-negative units d. Hgb S-negative units
____ 75. What disease state may require exogenous fibrinogen replacement?
a. Disseminated intravascular coagulation
b. Liver failure
c. Congenital fibrinogen deficiency
d. All of the above
____ 76. All blood components should be transfused within what time period to avoid bacterial contamination issues?
a. 4 hours c. 8 hours
b. 6 hours d. 24 hours
____ 77. Cryoprecipitate AHF contains how much fibrinogen?

a. 500 to 750 mg c. 150 to 250 mg
b. 50 to 100 mg d. 250 to 400 mg
____ 78. Which of the following criteria warrants a granulocyte concentrate transfusion?
a. A neutrophil count greater than 1,000 per L
b. A septic patient unresponsive to antibiotics
c. Bone marrow hyperplasia
____ 79. Each cryoprecipitate unit contains at least how much factor VIII?
a. 80 units c. 30 units
b. 50 units d. 100 units
____ 80. What is the most efficient way to remove leukocytes from red blood cell units?
a. Leukoreduction filters c. Deglycerolizing
b. Centrifugation d. Washing
____ 81. What blood component is responsible for most allergic reactions?
a. Platelets c. Red blood cells
b. Plasma d. White blood cells
____ 82. Why is plasma not recommended for the treatment of hemophilia B?
a. Hypervolemia limits factor IX efficacy.
b. Hypovolemia limits factor IX efficacy.
c. Plasma is devoid of factor IX.
____ 83. What plasma product is used to replace fluid in patients undergoing plasmapheresis procedures?
a. Albumin c. Immune globulin
b. Plasma protein fraction d. Cryoprecipitate
____ 84. What is the best-tolerated form of transplantation in humans?

a. Red blood cells c. Bone marrow
b. Platelets d. Liver
____ 85. What transfusion therapy is indicated for a patient who is found to be refractory to random platelets?
a. Irradiated random donor platelets
b. Random platelets from other donors
c. Apheresis platelets from an HLA-compatible donor
d. Neutralization of antiplatelet antibodies by type-specific platelets
____ 86. What hemoglobin level is considered critical and may warrant a red blood cell transfusion?
a. 10 g/dL c. 12 g/dL
b. 7 g/dL d. 9 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.
a. exogenous/DDAVP
b. endogenous/DDAVP
c. exogenous/factor VIII concentrates
d. endogenous/factor VIII concentrates
____ 88. How is a coagulation factor unit defined?

a. Activity in 1 mL of pooled plasma c. Activity in 100 units/mL
b. 100% activity in 1 unit/L d. All of the above
____ 89. Cryoprecipitate AHF contains factor VIII. What other coagulation factor is present?
a. I c. VII
b. V d. XII
____ 90. Four units of packed RBCs were used in the operating room at 3 p.m. Can the remaining 2 units be returned
to the blood bank at 5 p.m.?
a. Yes, if the 2 units have been kept under the proper storage conditions
b. Yes, but only if the units are to be used for the same patient
c. No, units may have been out of blood bank for more than 4 hours
d. No, units have been out of the blood bank for longer than 30 minutes
____ 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?
a. Whole blood c. Washed RBCs
b. Packed RBCs d. Granulocyte preparations
____ 92. Which component(s) provide(s) a concentrated source of fibrinogen?

a. Fresh or frozen RBCs and FFP c. Cryoprecipitate
b. FFP and cryoprecipitate d. Random donor platelets and plasma
____ 93. The most important step in the safe administration of blood is to:
a. perform compatibility testing accurately.
b. get an accurate patient history.
c. exclude disqualified donors.
d. 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:
a. splenomegaly.
b. alloimmunization to HLA antigens.
c. disseminated intravascular coagulation.
d. defective platelets.
____ 95. Granulocytes for transfusion should:

a. be administered through a microaggregate filter.
b. be ABO- and Rh-compatible with the recipient's serum.
c. be infused within 72 hours of collection.
d. never be transfused to patients with a history of febrile transfusion reaction.
____ 96. In anemia uncomplicated by low plasma proteins or shock, the transfusion of:
a. whole blood is most desirable.
b. plasma is desirable.
c. packed red blood cells is most desirable.
d. fresh frozen plasma is most desirable.
____ 97. For which of the following transfusion candidates would CMV-negative blood be most likely indicated?
a. Renal dialysis patients c. Transplant candidates
b. Pregnant women d. CMV seropositive patients
Chapter 15. Transfusion Therapy
Answer Section
MULTIPLE CHOICE
1. ANS: B PTS: 1 KEY: Taxonomy Level: 3

2. ANS: C PTS: 1 KEY: Taxonomy Level: 2
4. ANS: D PTS: 1 KEY: Taxonomy Level: 2
11. ANS: A PTS: 1 KEY: Taxonomy Level: 2

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Chapter 15.

____ 1. What is the purpose of dialysis in uremic patients?

____ 5. All coagulation factors are produced in the liver except:

____ 7. How are RBC aliquots prepared for a neonate transfusion?

____ 8. Which of the following is an indication for immunoglobulin administration?

____ 16. Bleeding disorders may be caused by:

____ 18. Which plateletpheresis product should be irradiated?

____ 20. How is donor platelet survival determined in the recipient?

____ 21. Immunoglobulin prepared from pooled plasma is primarily:

____ 22. A blood component should be transfused within:

____ 23. Cryoprecipitated AHF can be used in the treatment of:

____ 32. Who is at risk for transfusion-associated graft-versus-host disease (TAGVHD)?

____ 35. What is the expiration on washed red blood cells?

____ 51. The rejection of platelets in multiply transfused patients is called:

____ 53. What is the immunologic principle of RhIG administration?

____ 63. Why is thrombocytopenia a manifestation of a massive transfusion?

____ 64. Which blood product is used in the treatment of DIC?

____ 65. All of the following are characteristics of protein C except:

____ 66. Cryoprecipitate is not used to treat which condition?

____ 72. How can GVHD be prevented in transplant recipients?

____ 77. Cryoprecipitate AHF contains how much fibrinogen?

____ 84. What is the best-tolerated form of transplantation in humans?

____ 88. How is a coagulation factor unit defined?

____ 92. Which component(s) provide(s) a concentrated source of fibrinogen?

____ 95. Granulocytes for transfusion should:

1. ANS: B PTS: 1 KEY: Taxonomy Level: 3

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