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This is a MCQ quiz on transfusion of red cells and FFP. We suggest reviewing the Transfusion therapy, Complications of transfusion, Packed cell transfusion and Clotting factor replacement pages of the manual before taking this quiz.
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Question 1 of 15
1. Question
Which one of the following blood products ideally requires ABO and Rh blood group matching
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Question 2 of 15
2. Question
The weakest risk factor for antibodies to red blood cell transfusion of the following is
Correct
The prevalence of clinically significant antibodies is 2% in ED patients, 1.7% in trauma patients, 5% in haematology/oncology patients and 7.5% in the group aged 40-49 years. It increases with age and is more common in women of post child bearing age. RBC transfusion is by far the most important independent risk factor for non-RhD immunisation. The incidence of these events ranges between 1%–6% in single transfused and up to 30% in polytransfused patients (eg, sickle cell disease, thalassaemia and myelodysplasia). Risk is about 1•0% at 5 units, 2•4% at 10 units, 3•4% at 20 units and 6•5% at 40 units of red-blood-cells transfused.
Incorrect
The prevalence of clinically significant antibodies is 2% in ED patients, 1.7% in trauma patients, 5% in haematology/oncology patients and 7.5% in the group aged 40-49 years. It increases with age and is more common in women of post child bearing age. RBC transfusion is by far the most important independent risk factor for non-RhD immunisation. The incidence of these events ranges between 1%–6% in single transfused and up to 30% in polytransfused patients (eg, sickle cell disease, thalassaemia and myelodysplasia). Risk is about 1•0% at 5 units, 2•4% at 10 units, 3•4% at 20 units and 6•5% at 40 units of red-blood-cells transfused.
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Question 3 of 15
3. Question
The maximum initial infusion rate of packed red blood cells recommended by the ARCBS for the treatment of chronic anaemia should ideally be no faster than:
Correct
The slow rate is to reduce the risk of a severe reaction to the blood product. As little as 10mL of incompatible blood can cause a severe reaction. Transfusing at too slow a rate may result in clotting of the line and increases the risk from bacterial contamination.
Incorrect
The slow rate is to reduce the risk of a severe reaction to the blood product. As little as 10mL of incompatible blood can cause a severe reaction. Transfusing at too slow a rate may result in clotting of the line and increases the risk from bacterial contamination.
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Question 4 of 15
4. Question
IV fluids compatible with red blood cell transfusion include all of the following except:
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Question 5 of 15
5. Question
The least common blood group in Australia is
Correct
The frequency of blood types in Australia is approximately: O 46% ,A 39%, B 11% and AB 3.5%.
Incorrect
The frequency of blood types in Australia is approximately: O 46% ,A 39%, B 11% and AB 3.5%.
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Question 6 of 15
6. Question
The percentage of people who have a Rh+ve blood type in Australia is approximately
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Question 7 of 15
7. Question
The increased probability of incompatibility of transfusion of one unit of blood matched only for ABO blood group compared to one with a full cross match is approximately
Correct
The estimated compatibility of a unit of blood is as follows: ABO matched 99.4%, ABO & Rh 99.8%, ABO, Rh & Ab 99.94%, XMatched 99.95%; Autologous 100%. The increase in risk of transfusion reaction between group specific and cross matched blood is small, hence delaying transfusion for group specific blood is usually inappropriate in significant haemorrhage. (link)
Incorrect
The estimated compatibility of a unit of blood is as follows: ABO matched 99.4%, ABO & Rh 99.8%, ABO, Rh & Ab 99.94%, XMatched 99.95%; Autologous 100%. The increase in risk of transfusion reaction between group specific and cross matched blood is small, hence delaying transfusion for group specific blood is usually inappropriate in significant haemorrhage. (link)
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Question 8 of 15
8. Question
The increased probability of incompatibility of transfusion of one unit of blood matched for ABO blood and Rh groups compared to one with a full cross match is approximately
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Question 9 of 15
9. Question
Risk factors for citrate toxicity following red blood transfusion include all of the following except
Correct
The hepatic metabolism of citrate is normally rapid, but is impaired by hypotension, hypothermia and liver disease. An infusion rate of > 100mL/min is usually required to produce citrate toxicity in patients without these risk factors. Citrate contributes to metabolic acidosis and can decrease ionised calcium (cofactor in coagulation cascade), although the significance of this is debated as hypocalcaemia severe enough to impair coagulation is incompatible with life. Citrate toxicity can also cause a metallic taste or perioral paraesthesia. (link)
Incorrect
The hepatic metabolism of citrate is normally rapid, but is impaired by hypotension, hypothermia and liver disease. An infusion rate of > 100mL/min is usually required to produce citrate toxicity in patients without these risk factors. Citrate contributes to metabolic acidosis and can decrease ionised calcium (cofactor in coagulation cascade), although the significance of this is debated as hypocalcaemia severe enough to impair coagulation is incompatible with life. Citrate toxicity can also cause a metallic taste or perioral paraesthesia. (link)
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Question 10 of 15
10. Question
The effects of transfused blood that can potentially be reversed by warming stored blood prior to administration include all of the following except:
Correct
Cooled blood shifts the haemoglobin oxygen dissociation curve to the left, hence cool red cells have a higher affinity for O2 and release it less. Cool red cells also have impaired red cell deformability. Potassium moves out of the red cell when cooled, but is taken back up as the blood is warmed. Bacterial infection rates are increased by blood warming, due to higher replication rates of organisms at higher temperatures (the reason RBCs are cooled in the first place and platelets only have a 5 day shelf life). (link)
Incorrect
Cooled blood shifts the haemoglobin oxygen dissociation curve to the left, hence cool red cells have a higher affinity for O2 and release it less. Cool red cells also have impaired red cell deformability. Potassium moves out of the red cell when cooled, but is taken back up as the blood is warmed. Bacterial infection rates are increased by blood warming, due to higher replication rates of organisms at higher temperatures (the reason RBCs are cooled in the first place and platelets only have a 5 day shelf life). (link)
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Question 11 of 15
11. Question
Which one of the following is the least useful in distinguishing a non haemolytic febrile transfusion reaction from a haemolytic transfusion reaction
Correct
A febrile non haemolytic reaction is seen frequently multiparous women or in multiply transfused patients and is due to recipient antibodies to donor white cells. It is dose related and often occurs towards the end of the transfusion (30 – 120 min after starting transfusion) and can occur 1-2 hours after the transfusion has finished. The temperature rise is usually ≤ 1C above baseline.
A haemolytic reaction usually occurs at the start of the transfusion and is characterised by pain at the injection site as well as headache, chest or back pain +/- hypotension or other evidence of haemolysis. A mild haemolytic reaction can also cause a temperature rise of ≤ 1C above baseline, so is the least useful of the features listed. (link)Incorrect
A febrile non haemolytic reaction is seen frequently multiparous women or in multiply transfused patients and is due to recipient antibodies to donor white cells. It is dose related and often occurs towards the end of the transfusion (30 – 120 min after starting transfusion) and can occur 1-2 hours after the transfusion has finished. The temperature rise is usually ≤ 1C above baseline.
A haemolytic reaction usually occurs at the start of the transfusion and is characterised by pain at the injection site as well as headache, chest or back pain +/- hypotension or other evidence of haemolysis. A mild haemolytic reaction can also cause a temperature rise of ≤ 1C above baseline, so is the least useful of the features listed. (link) -
Question 12 of 15
12. Question
The average volume of one unit of adult RBCs in Australia is approximately
Correct
Whilst the ARCBS only specifies that a unit of RBCs is > 220mL, the average unit is probably closer to 250mL than 350mL. There is a strange absence of relevant information about this. (link)
Incorrect
Whilst the ARCBS only specifies that a unit of RBCs is > 220mL, the average unit is probably closer to 250mL than 350mL. There is a strange absence of relevant information about this. (link)
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Question 13 of 15
13. Question
The maximum recommended time to transfuse one unit of red blood cells is
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Question 14 of 15
14. Question
The maximum time a unit of FFP should be transfused over is
Correct
FFP should usually be administered at 10 mL/min (i.e. within 30 min), but not over longer than 1 hour for stable patients. It should be given as rapidly as possible in the presence of severe bleeding. (link)
Incorrect
FFP should usually be administered at 10 mL/min (i.e. within 30 min), but not over longer than 1 hour for stable patients. It should be given as rapidly as possible in the presence of severe bleeding. (link)
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Question 15 of 15
15. Question
Each unit of FFP will increase clotting factors in a 70kg adult by approximately
Correct
A change in clotting factor concentrations of at least 10% is considered clinically significant. Usually there is an ample oversupply of clotting factors in the blood for normal functioning. (link)
Incorrect
A change in clotting factor concentrations of at least 10% is considered clinically significant. Usually there is an ample oversupply of clotting factors in the blood for normal functioning. (link)