Blood Transfusion MCQ

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BLOOD TRANSFUSION BLOOD TRANSFUSION

1.

1. MC MC blood blood transfusion transfusion reaction reaction is:is: (All India 2008)(All India 2008) a.

a. Febrile Febrile non-hemolytic non-hemolytic transfusion transfusion reactionreaction b.

b. HemolysisHemolysis c.

c. TransmTransmission ission of of infectionsinfections d.

d. Electrolyte Electrolyte imbalanceimbalance 2.

2. All All of of the the following following infections infections may may be be transmied transmied via via bloodblood transfusion, except:

transfusion, except: (AIIMS May 2009, All India 2002)(AIIMS May 2009, All India 2002) a.

a. Parvo Parvo B-19 B-19 b. b. Hepatitis Hepatitis GG c.

c. Dengue Dengue virus virus d. d. CytomegalovirusCytomegalovirus 3.

3. Which of Which of the following the following is the least is the least likely complication likely complication aeraer massive blood transfusion?

massive blood transfusion? (AIIMS May 2009)(AIIMS May 2009) a.

a. Hyperkalemia Hyperkalemia b. b. Citrate Citrate toxicitytoxicity c.

c. Hypothermia Hypothermia d. d. Metabolic Metabolic acidosisacidosis 4.

4. Fresh hold blood Fresh hold blood transfusion is done transfusion is done with in how with in how much timemuch time of collection?

of collection? (DNB 2006)(DNB 2006) a.

a. Immediately Immediately b. b. 1 1 hourshours c.

c. 4 4 hours hours d. d. 24 24 hourshours 5. Which

5. Which of of the the following following investigations investigations should should be be donedone immediately to best conrm a non matched blood transfusion immediately to best conrm a non matched blood transfusion reaction?

reaction? (All India 2010)(All India 2010) a.

a. Indirect Indirect Coomb’Coomb’s s testtest b.

b. Direct Coomb’Direct Coomb’s tests test c.

c. Antibody Antibody in in patient’patient’s s serumserum d.

d. Antibody Antibody in in donor donor serumserum 6.

6. Blood Blood components components products products are:are: (PGI Dec 2005)(PGI Dec 2005) a.

a. Whole Whole blood blood b. b. PlateletsPlatelets c.

c. Fresh Fresh frozen frozen plasma plasma d. d. Leukocyte Leukocyte reduced reduced RBCRBC e.

e. All All of of the the aboveabove 7.

7. A A man man is is rushed rushed to to casualty, casualty, nearly nearly dying dying aer aer a a massivemassive blood loss in an accident. There is not much time to match blood loss in an accident. There is not much time to match blood groups, so the physician decides to order for one of the blood groups, so the physician decides to order for one of the following blood groups. Which one of the following blood following blood groups. Which one of the following blood groups should the physician decide:

groups should the physician decide: (AIIMS June 2004)(AIIMS June 2004) a.

a. O O negative negative b. b. O O positivepositive c.

c. AB AB positive positive d. d. AB AB negativenegative 8.

8. One One unit unit of of fresh fresh blood blood arises arises the the Hb% Hb% concentration concentration by:by: a.

a. 0.1 0.1 gm% gm% b. b. 1 1 gm%gm% (All India 2003)(All India 2003) c.

c. 2 2 gm% gm% d. d. 2.2 2.2 gm%gm% 9.

9. Which Which of of the the following following statements statements about acute about acute hemolytichemolytic blood transfusion reaction is true?

blood transfusion reaction is true? (PGI June 2004)(PGI June 2004) a.

a. Complement Complement mediated mediated hemolysis hemolysis is is seenseen b.

b. Type III hType III hypersensitivity is responsible for most casesypersensitivity is responsible for most cases c.

c. Rarely Rarely life life threateningthreatening d.

d. Renal Renal blood ow blood ow is alwis always ays maintainedmaintained e.

e. No No need need for for stopping stopping transfusiontransfusion 10.

10. TrTrue about ue about blood trablood transfusions:nsfusions: (PGI June 98)(PGI June 98) a.

a. Antigen Antigen ‘D” ‘D” determines determines Rh Rh positivitypositivity b.

b. Febrile reaction is due to HLA anFebrile reaction is due to HLA antigenstigens c.

c. Anti-d Anti-d is is naturally naturally occurring occurring antibodyantibody d.

d. Cryoprecipitate Cryoprecipitate contains contains all all coagulation coagulation factorsfactors

11. Which

11. Which of the following is beer indicator of need for of the following is beer indicator of need for transfusion?

transfusion? (AIIMS 80, UPSC 87)(AIIMS 80, UPSC 87) a.

a. Urine Urine output output b. b. HematocritHematocrit c.

c. Colour Colour of of skin skin d. d. Clinical Clinical examinationexamination 12.

12. Massive Massive blood blood transfusion transfusion is is dened dened as:as: (PGI 95)(PGI 95) a.

a. 350 350 ml ml in in 5 5 min min b. b. 500 500 ml ml in in 5 5 minmin c.

c. 1 1 litre litre in in 5 5 min min d. d. Whole Whole blood blood volumevolume 13.

13. How How long long can can blood blood stored stored with with CPDA?CPDA? (JIPMER 2003)(JIPMER 2003) a.

a. 12 12 days days b. b. 21 21 daysdays c.

c. 28 28 days days d. d. 48 48 daysdays 14.

14. Massive Massive transfusion transfusion in in previous previous healthy healthy adult adult male male cancan cause hemorrhage due to:

cause hemorrhage due to: (PGI 98)(PGI 98) a.

a. IncreasIncreased ed t-PAt-PA b.

b. Dilutional thrombocytopeniaDilutional thrombocytopenia c.

c. Vitamin Vitamin K K deciencydeciency d.

d. Decreased Decreased brinogenbrinogen 15.

15. Arterial blood gas Arterial blood gas analysis in a boanalysis in a bole containing heparinle containing heparin causes a decrease in value of:

causes a decrease in value of: a.

a. pCO2 pCO2 b. b. HCOHCO₃₃ c.

c. pH pH d. d. All All of of the the aboveabove 16.

16. Massive blood Massive blood transfusion transfusion is dened is dened as:as: a.

a. Whole Whole blood blood volume volume in in 24 24 hourshours(Recent Questions 2013)(Recent Questions 2013) b.

b. Half blood volume in Half blood volume in 24 hours24 hours c.

c. 40% 40% blood blood volume volume in in 24 24 hourshours d.

d. 60% 60% blood blood volume volume in in 24 24 hourshours

BLOOD TRANSFUSION COMPLICATIONS BLOOD TRANSFUSION COMPLICATIONS

17.

17. AerAer blood transfusion the febrile non-hemolytic transfu- blood transfusion the febrile non-hemolytic transfu-sion reaction (FNHTR) occurs due to?

sion reaction (FNHTR) occurs due to? a. Alloimmunization

a. Alloimmunization b.

b. Antibodies against donor leukocytes and HLA Antibodies against donor leukocytes and HLA AgAg c.

c. Allergic Allergic reactionreaction d. Anaphylaxis d. Anaphylaxis 18.

18. Blood grouping Blood grouping and cross-matching and cross-matching is must priis must prior to ior to infusionnfusion of:

of: (MHPGMCET 2007)(MHPGMCET 2007)

a.

a. Gelatin Gelatin b. b. DextranDextran c.

c. Albumin Albumin d. d. FFPFFP 19.

19. Blood Blood grouping grouping and and cross cross matching matching is is must must prior prior to to infusioninfusion of:

of: (MHPGMCET 2008)(MHPGMCET 2008)

a.

a. Gelatin Gelatin b. b. AlbuminAlbumin c.

c. Dextran Dextran d. d. HemacealHemaceal 20.

20. Collection Collection of of blood blood for for cross cross matching matching and and grouping grouping is is donedone before administration of which plasma expander?

before administration of which plasma expander? a.

a. Hydroxyl Hydroxyl ethyl ethyl starch starch b. b. DextranDextran(MHSSMCET 2007)(MHSSMCET 2007) c.

c. Mannitol Mannitol d. d. HemaceleHemacele 21.

21. Mismatched Mismatched blood blood transfusion transfusion in in anesthetic anesthetic patient patient presentspresents is:

is: a.

a. Hyperthermia Hyperthermia and and hypertensionhypertension (PGI June 2000)(PGI June 2000) b.

b. Hypotension and bleeding from site of wHypotension and bleeding from site of woundound c.

c. Bradycardia Bradycardia and and hypertensionhypertension d.

d. TaTachycardia chycardia and and hypertensionhypertension

MULTIPLE CHOICE QUESTIONS

CHAPTER 49

Blood Transfusion

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22.

22. AlAll of the following are major complications of massivel of the following are major complications of massive transfusion except:

transfusion except: (All India 2006)(All India 2006) a.

a. Hypokalemia Hypokalemia b. b. HypothermiaHypothermia c.

c. Hypomagnesaemia Hypomagnesaemia d. d. HypocalcaemiaHypocalcaemia 23.

23. Massive Massive transfusions transfusions results results in:in: (PGI 88)(PGI 88) a.

a. DIC DIC b. b. HypothermiaHypothermia c.

c. Hypercalcemia Hypercalcemia d. d. ThrombocytopeniaThrombocytopenia RED BLOOD CELLS

RED BLOOD CELLS 24.

24. The The maximum maximum life life of of a a transfused transfused RBC RBC is:is:

(JIPMER 80, DNB 89) (JIPMER 80, DNB 89) a.

a. One One hour hour b. b. One One dayday c.

c. 15 15 days days d. d. 50 50 daysdays E.

E. 100 100 daysdays PLATELETS PLATELETS

25.

25. Platelets Platelets can can be be stored stored at:at: (AIIMS Nov 2005)(AIIMS Nov 2005) a.

a. 20-24°C 20-24°C for for 5 5 days days b. b. 20-24°C 20-24°C for for 8 8 daysdays c.

c. 4-8°C 4-8°C for for 5 5 days days d. d. 4-8°C 4-8°C for for 8 8 daysdays 26.

26. Blood Blood platelets platelets in in stored stored blood blood do do not not remain remain functionalfunctional aer:

aer: (PGI 88, 81, AIIMS 86)(PGI 88, 81, AIIMS 86) a.

a. 24 24 hours hours b. b. 48 48 hourshours c.

c. 72 72 hours hours d. d. 96 96 hourshours PLASMA

PLASMA 27.

27. Indication Indication of of fresh fresh frozen frozen plasma plasma is/are:is/are: (PGI Nov 2011)(PGI Nov 2011) a. Hypovolemia

a. Hypovolemia b.

b. Nutritional supplementNutritional supplement c.

c. Coagulation Coagulation factor factor deciencydeciency d.

d. WaWarfarin rfarin toxicitytoxicity e. Hypoalbuminemia e. Hypoalbuminemia 28. True a

28. True about FFP bout FFP (Fresh frozen (Fresh frozen plasma) plasma) is the is the followingfollowing except:

except: (MHPGMCET 2009)(MHPGMCET 2009) a.

a. Good Good source source of of all all coagulation coagulation factorsfactors b.

b. Prepared from single unit of bloodPrepared from single unit of blood

c.

c. Coagulation Coagulation factor factor levels levels are are equal equal to to PlasmaPlasma d.

d. None None of of the the aboveabove 29.

29. Stored Stored plasma plasma is is decient decient in:in: (PGI 79, DNB 90)(PGI 79, DNB 90) a.

a. Factors Factors 7 7 and and 8 8 b. b. Factors Factors 2 2 and and 55 c.

c. Factors Factors 5 5 and and 8 8 d. d. Factors Factors 7 7 and and 99 30.

30. With reference to frWith reference to fresh frozen plasma (FFP), which one esh frozen plasma (FFP), which one ofof the following statement is not correct?

the following statement is not correct? (UPSC 2008)(UPSC 2008) a.

a. It It is is used used as as volume volume expanderexpander b.

b. It is stored at – 40°C to – 50°CIt is stored at – 40°C to – 50°C c.

c. It It is is a a source source of of coagulation coagulation factorsfactors d.

d. It is It is given in given in a dose a dose of 12-15 of 12-15 ml/kg body ml/kg body weightweight 31.

31. In In cholecystectomycholecystectomy, , fresh fresh frozen frozen plasma plasma should should be be given:given: a.

a. Just Just before before operationoperation (UPPG 2008)(UPPG 2008) b.

b. At the time of operationAt the time of operation c.

c. 6 6 hours hours before before operationoperation d.

d. 12 12 hours hours aer aer operationoperation 32.

32. Half Half life life of of factor factor VIII VIII is:is: (PGI 88)(PGI 88) a.

a. 4 4 hours hours b. b. 8 8 hourshours c.

c. 34 34 hours hours d. d. 48 48 hourshours 33.

33. Rosenthal’s Rosenthal’s syndrome syndrome is is seen seen in in deciency deciency of of factor:factor: a. a. II II b. b. VV (AIIMS 81, DNB 91)(AIIMS 81, DNB 91) c. c. IX IX d. d. XIXI CRYOPRECIPITATE CRYOPRECIPITATE 34. Cryoprecipitate

34. Cryoprecipitate contains:contains: (MCI March 2009)(MCI March 2009) a.

a. Factor Factor II II b. b. Factor Factor VV c.

c. Factor Factor VIII VIII d. d. Factor Factor IXIX 35.

35. Cryoprecipitate Cryoprecipitate is is a a rich rich source source of:of: (PGI 79, AIIMS 85)(PGI 79, AIIMS 85) a.

a. Thromboplastin Thromboplastin b. b. Factor Factor VIIIVIII c.

c. Factor Factor X X d. d. Factor Factor VIIVII 36.

36. Which oWhich one of ne of the follthe following owing blood fractiblood fractions is ons is stored astored att -40°C?

-40°C? (UPSC 2006)(UPSC 2006)

a.

a. Cryoprecipitate Cryoprecipitate b. b. Human Human albuminalbumin c.

c. Platelet Platelet concentrate concentrate d. d. Packed Packed red red cellscells 37.

37. Cryoprecipitate Cryoprecipitate contains contains all all except:except: (AIIMS Nov 2007)(AIIMS Nov 2007) a.

a. Factor Factor VIII VIII b. b. Factor Factor IXIX c.

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Blood Transfusion

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EXPLANATIONS

BLOOD TRANSFUSION BLOOD TRANSFUSION 1. Ans.

1. Ans. a. a. Febrile Febrile non-hemolytic non-hemolytic transfusion transfusion reactionreaction(Ref: Harrison 18/e p954-956)(Ref: Harrison 18/e p954-956) Febrile

Febrile non-hemolytic non-hemolytic transfusion transfusion reaction reaction is is the the most most common common complication complication associated associated with with the the transfusion transfusion of of cellular cellular bloodblood components.

components.

Complications of Blood Transfusion Complications of Blood Transfusion

R

Reeaaccttiioonnss InInffeeccttiioonnss OOtthheer r CCoommpplliiccaattiioonnss •

• Febrile Febrile non-hemolytic non-hemolytic transfusiontransfusion reaction (

reaction (FNHTRFNHTR):):MCMCQQ

• Allergic • Allergic •

• Delayed hemolyticDelayed hemolyticQQ

• Transfusion-related acute lung • Transfusion-related acute lung

injury (

injury (TRALITRALI))QQ

•

• Acute hemolyticAcute hemolyticQQ

•

• Fatal Fatal hemolytichemolytic • Anaphylactic • Anaphylactic

• Hepatitis

• HepatitisBB and andCCQQ

• Hepatitis • HepatitisGGQQ

•

• HIV-1 and -2HIV-1 and -2QQ

•

• HTLV-I and -IIHTLV-I and -IIQQ

•

• MalariaMalariaQQ

•

• West Nile virusWest Nile virusQQ

• • Parvovirus B-19Parvovirus B-19QQ • • HHV-8HHV-8QQ • • CMVCMVQQ • • RBC RBC allosensitizationallosensitizationQQ •

• HLA HLA allosensitizationallosensitizationQQ

•

• Graft-versus-hoGraft-versus-host st diseasedisease

2.

2. Ans. Ans. c. Dengue c. Dengue virusvirus 3.

3. Ans. Ans. d. d. Metabolic Metabolic acidosisacidosis(Ref: Harrison 18/e p954-956)(Ref: Harrison 18/e p954-956)

•

• Massive transfusionMassive transfusion can lead to can lead tocoagulopathycoagulopathyandandmetabolic complicationsmetabolic complicationsQQ..

Metabolic Complications of

Metabolic Complications of Massive TransfusionMassive Transfusion

General Electrolyte

•

• Fluid overloadFluid overloadQQ

•

• HypothermiaHypothermiaQQ

•

• Impaired oxygen delivery capacity of HbImpaired oxygen delivery capacity of HbQQ

(decreased 2, 3-DPG) (decreased 2, 3-DPG) • • HyperkalemiaHyperkalemiaQQ • • HypocalcemiaHypocalcemiaQQ • • HypomagnesemiaHypomagnesemiaQQ •

• Metabolic alkalosisMetabolic alkalosisQQ

•

• Metabolic acidosis (rare)Metabolic acidosis (rare)QQ

4.

4. Ans. Ans. d. d. 24 24 hourshours 5.

5. Ans. Ans. b. Db. Direct irect Coomb’s Coomb’s testtest(Ref: Harrison 18/e p954)(Ref: Harrison 18/e p954)

•

• Direct Coomb’s testDirect Coomb’s test oror direct antiglobulin testdirect antiglobulin test on post-transfusion blood sample from patient should be done to on post-transfusion blood sample from patient should be done to detectdetect

antibodies directed against

antibodies directed againstthethe transfused RBCs transfused RBCsQQ_._.

6.

6. Ans. e. Ans. e. All of All of the abovethe above(Ref: Harrison 18/e p952-954)(Ref: Harrison 18/e p952-954)

Characteristics of Selected Blood Components Characteristics of Selected Blood Components C

Coommppoonneenntt VVoolluumme e ((mmLL)) CCoonntteenntt CClliinniiccaal l RReessppoonnssee W

Whhoolle e BBlloooodd 44550 0 mml l ± ± 4455 • • No No elements elements removedremoved • Contains

• Contains RBCs, WBCs, plasmaRBCs, WBCs, plasma and and platelets

platelets ( (WBCsWBCsandandplateletsplatelets may be may be non-functional

non-functionalQQ₎₎

•

• Not Not for for routine routine useuse • Used for

• Used for acute massive bleeding,acute massive bleeding, open heart surgery

open heart surgery and neonatal total and neonatal total exchange

exchange P

Paacckkeed d RRBBCCss 118800––220000 •• RBCsRBCs with variablewith variable leukocyteleukocyte contentcontent and

andsmallsmallamount ofamount ofplasmaplasma

• Increase

• Increase HbHb 1 gm/dL1 gm/dL and and hematocrithematocrit 3%

3%QQ

P

Pllaatteelleettss 5500––7700 • • 5.5 5.5 x x 10101010_/_/R_RD_D_u_un_ni_it_t _•_• _I_In_nc_cr_re_ea_as_se_e_p_pl_la_at_te_el_le_et_t_c_co_ou_un_nt_t_{5000–10,000/µL}_{5000–10,000/µL}QQ

F

FFFPP 220000––225500 •• Plasma proteinsPlasma proteins::Coagulation factors,Coagulation factors, proteins

proteins C and S, antithrombin C and S, antithrombinQQ

• Increases

• Increases coagulation factors aboutcoagulation factors about 2%

2% C

Crryyoopprreecciippiittaattee 1100––1155 • • Cold-insoluble Cold-insoluble plasma plasma proteins,proteins, brinogen, factor VIII, vWF

brinogen, factor VIII, vWFQQ

•

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7.

7. Ans. Ans. a. a. O O negativenegative(Ref: Harrison 18/e p951; Bailey 26/e (Ref: Harrison 18/e p951; Bailey 26/e p21-22, 25/e p21-22)p21-22, 25/e p21-22)

Selection of Blood for Emergency Transfusion Selection of Blood for Emergency Transfusion

P

Paattiieenntt’’s s BBllooood d ggrroouup p iis s kknnoowwnn PPaattiieenntt’’s s BBllooood d ggrroouup p ccaannnnoot t bbe e ddeetteerrmmiinneedd • Unmatched

• Unmatched blood groupblood group of theof the same group same group should be used

should be used

• Group

• Group ‘O’ RBCs ‘O’ RBCsare chosenare chosen •

• Such unmaSuch unmatched blood tched blood should beshould be Rh negativeRh negative,, when used in

when used inwomen of child bearing agewomen of child bearing age, in whom, in whom sensitization to Rh antigen would be

sensitization to Rh antigen would be undesirableundesirable •

• Rh positive Rh positive blood can blood can be used be used if Rh if Rh negative blood negative blood isis not available in older females and males

not available in older females and males

8.

8. Ans. Ans. b. b. 1 1 gm%gm% 9.

9. Ans. Ans. a. Complea. Complement mement mediated hemdiated hemolysis is olysis is seenseen(Ref: Harrison 18/e p954)(Ref: Harrison 18/e p954)

•

• Acute hemolytic transfusion reactionsAcute hemolytic transfusion reactions following blood transfusion are following blood transfusion aretype II hypersensitivity reactionstype II hypersensitivity reactions caused most oen by caused most oen by

the

thecomplement mediated hemolysiscomplement mediated hemolysisQQ_._.

•

• These reactions are oenThese reactions are oenlife-threateninglife-threatening and complications include and complications includeoliguriaoliguria and andacute renal failureacute renal failure ( (decreased renal blood owdecreased renal blood ow))QQ..

10.

10. Ans. Ans. a. a. Antigen Antigen ‘D” ‘D” determines determines Rh Rh positivity; positivity; b. b. Febrile Febrile reaction reaction is is due due to to HLA HLA antigensantigens (Ref: Harrison 18/e p954)(Ref: Harrison 18/e p954)

•

• Rh positiveRh positive or ornegative statusnegative status depends on the depends on thepresence or absence of antigen Dpresence or absence of antigen D (Rh D) (Rh D)on RBCson RBCsQQ.. •

• Febrile (non-hemolytic) reactionsFebrile (non-hemolytic) reactions are caused by are caused byantibodies directed against donor leucocytesantibodies directed against donor leucocytes and andHLA antigenHLA antigen may maymediatemediate

these reactions these reactionsQQ_._.

11.

11. Ans. Ans. b. b. HematocritHematocrit 12.

12. Ans. Ans. d. d. Whole Whole blood blood volumevolume 13. Ans.

13. Ans. c. c. 28 28 daysdays(Ref: Sabiston 19/e p588)(Ref: Sabiston 19/e p588)

Whole Blood Whole Blood A Annttiiccooaagguullaannt t uusseedd MMaaxxiimmuum m ssttoorraaggee A ACCDD//CCPPDD//CCPP22DD 2211ddaayyssQQ CPDA-1 CPDA-1

(citrate phosphate dextrose adenine) (citrate phosphate dextrose adenine)

35 days 35 daysQQ

14. Ans.

14. Ans. b. b. Dilutional Dilutional thrombocytopeniathrombocytopenia 15.

15. Ans. d. Ans. d. All All of of the the aboveabove(Ref: Clinical Laboratory Medicine 6/e p396)(Ref: Clinical Laboratory Medicine 6/e p396)

Heparin Excess in Blood gas Syringe Heparin Excess in Blood gas Syringe

E

Effffeecctts s dduue e tto o DDiilluuttiioon n oof f SaSammppllee EEffffeecctts s dduue e to to AAcciiddiic c NNaattuurre e oof f HHeeppaarriinn •

• Decreased PaCODecreased PaCO₂₂QQ

•

• Decreased HCODecreased HCO₃₃QQ

•

• Decreased pHDecreased pHQQ

16.

16. Ans. Ans. a. a. i.e., i.e., Whole Whole blood blood volume volume in in 24 24 hourshours

According to Sabiston Massive Blood Transfusion is dened as According to Sabiston Massive Blood Transfusion is dened as

-•

• Transfusion greater than patient’s total blood volume in 24 hoursTransfusion greater than patient’s total blood volume in 24 hours •

• Or as acute administration of more than 10 units of blood over a few hours.Or as acute administration of more than 10 units of blood over a few hours.

According to Schwartz “

According to Schwartz “ Massive transfusion is a si Massive transfusion is a single transfusion of 250ngle transfusion of 2500 ml or 5000 ml t0 ml or 5000 ml transfused over a period of 24 ransfused over a period of 24 hours”hours”

BLOOD TRANSFUSION COMPLICATIONS BLOOD TRANSFUSION COMPLICATIONS

17.

17. Ans. b. Ans. b. Antibodies Antibodies against against donor donor leukocytes leukocytes and and HLA HLA AgAg 18.

18. Ans. Ans. b. b. DextranDextran 19.

19. Ans. Ans. c. c. DextranDextran 20. Ans.

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D DEXTRANEXTRAN •

• It is aIt is apolysaccharide polymerpolysaccharide polymer of varying molecular weight producing an of varying molecular weight producing anosmotic pressureosmotic pressure similar to the plasma similar to the plasma •

• Disadvantages:Disadvantages:

−

− It induces rouleaux of RBCsIt induces rouleaux of RBCs and this and thisinterferes with blood groupinginterferes with blood grouping and andcross matchingcross matchingQQ_{procedures, hence need for a blood}_{procedures, hence need for a blood}

sample beforehand. sample beforehand. −

− ItItinterferes with platelet functioninterferes with platelet function , hence it is recommended that , hence it is recommended thattotal volumetotal volume of dextran of dextranshould not exceed 1000 mL.should not exceed 1000 mL.

•

• LMW dextranLMW dextran ((short actingshort acting)) prevents sludgingprevents sludging of RBCsof RBCs in vesselsin vessels and and renal shut down in severerenal shut down in severe

hypotension

hypotension and it is and it isless likely to induce rouleaux formationless likely to induce rouleaux formation than HMW dextran (long acting). than HMW dextran (long acting). 21.

21. Ans. b. Ans. b. Hypotension Hypotension and and bleeding bleeding from from site site of of woundwound (Ref: Schwartz 10/e (Ref: Schwartz 10/e p119,122,171p119,122,171-172, 9/e p83)-172, 9/e p83)

•

• Schwartz says “InSchwartz says “In patients who are anesthetizedpatients who are anesthetized and have an and have an open woundopen wound , , the the two two dominant dominant signs signs (of(of mismatched bloodmismatched blood

transfusion

transfusion) are) arediuse bleedingdiuse bleeding and andhypotensionhypotension.”.”

•

• MC symptom of hemolytic transfusionMC symptom of hemolytic transfusion reactions reactionsinin a aconscious patientconscious patient: Sensation of: Sensation ofheatheat and andpain along the veinpain along the vein into which into which

the blood is being transfused the blood is being transfusedQQ_._.

•

• MC signMC sign of ofhemolytic transfusionhemolytic transfusion reactions reactionsininaaconscious patientconscious patient::OliguriaOliguriaQQ>>hemoglobinuria.hemoglobinuria.

22.

22. Ans. a. Ans. a. HypokalemiaHypokalemia 23.

23. Ans. Ans. a. DIC; a. DIC; b. Hypob. Hypothermia; d. thermia; d. ThrombocytopeniaThrombocytopenia RED BLOOD CELLS

RED BLOOD CELLS 24.

24. Ans. Ans. d. d. 50 50 daysdays(Ref: Schwartz 10/e p1914-1915, 9/e p78; Bailey 26/e p21, (Ref: Schwartz 10/e p1914-1915, 9/e p78; Bailey 26/e p21, 25/e p21)25/e p21) R

REDED B BLOODLOOD C CELLSELLS

•

• RBCsRBCs are arestored at 1-6stored at 1-600CCQQ;;Mean lifeMean life of oftransfused RBCstransfused RBCs is is35 days35 daysQQ..

A Annttiiccooaagguullaannt t uusseedd MMaaxxiimmuum m ssttoorraaggee A ACCDD//CCPPDD//CCPP22DD 2211ddaayyssQQ C CPPDDAA--11 3355ddaayyssQQ PLATELETS PLATELETS 25.

25. Ans. Ans. a. a. 20-2420-2400_{C for 5 days}_{C for 5 days}

(Ref: Harrison 18/e p953; Sabiston 19/e

(Ref: Harrison 18/e p953; Sabiston 19/e p588; Schwartz 10/e p85, 9/e p588; Schwartz 10/e p85, 9/e p79; Bailey 26/e p21, 25/e p21)p79; Bailey 26/e p21, 25/e p21) P

PLATELETLATELET C CONCENTRATESONCENTRATES

•

• VolumeVolume::50 ml50 mlQQ •

• Platelets are thePlatelets are theonly blood productsonly blood products which are which arestored at room temperature, 20-24stored at room temperature, 20-2400CCQQ((survival is 4-5 dayssurvival is 4-5 days))QQ.. •

• 1 unit of platelet1 unit of platelet increases the count by increases the count by5000-100005000-10000QQ.. •

• TheThethreshold for prophylactic platelet transfusionthreshold for prophylactic platelet transfusion is is10,000/ 10,000/ µµLLQQ.. •

• For invasive proceduresFor invasive procedures , ,50,000/ 50,000/ µµLL platelets is the usual target level. platelets is the usual target level. •

• Platelet count should bePlatelet count should be1,00,000/ 1,00,000/ µµLL before accepting the patient before accepting the patientfor surgeryfor surgery.. •

• Transfused plateletsTransfused platelets generally generallysurvive for 2-7 dayssurvive for 2-7 days following transfusion. following transfusion. •

• ABO compatibilityABO compatibility is desirable but is desirable butnot necessarynot necessary.. •

• Blood platelets in stored bloodBlood platelets in stored blood are arenon-functional aer 24 hoursnon-functional aer 24 hoursQQ..

26.

26. Ans. Ans. a. a. 24 24 hourshours PLASMA

PLASMA 27.

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F

FRESHRESH--FROZENFROZEN P PLASMALASMA (FFP) (FFP)

•

• FFPFFPis produced from theis produced from the separation of plasma separation of plasmafromfrom donated blood donated bloodQQ.. •

• StoredStoredatat -18 -1800CCand has aand has a shelf life shelf lifeofof1 year1 yearQQ.. •

• Each unitEach unitcontainscontains400 mg of brinogen400 mg of brinogenandand1 unit activity of each1 unit activity of eachof theof the cloing factors cloing factorsQQ.. •

• Most labile cloing factorsMost labile cloing factors((VVandand VIII VIII) may be) may be diminished diminishedQQproportional to shelf life.proportional to shelf life. •

• FFP contains stable coagulation factorsFFP contains stable coagulation factors and andplasma proteinsplasma proteins::brinogen, antithrombin, albumin, proteins C and Sbrinogen, antithrombin, albumin, proteins C and SQQ..

Indications for FFP Indications for FFP •

• Correction of coagulopathies:Correction of coagulopathies: ₋

₋ Rapid reversal of warfarinRapid reversal of warfarinQQ

₋

₋ Supplying Supplying decient decient plasma plasma proteinsproteinsQQ

• Treatment of

• Treatment of thrombotic thrombocytopenicthrombotic thrombocytopenic purpura

purpuraQQ

•

• Patients who arePatients who areIgA-decientIgA-decient and andrequire plasma supportrequire plasma support should receive should receiveFFP from IgA-decient donors to prevent anaphylaxis.FFP from IgA-decient donors to prevent anaphylaxis. •

• FFP should not beFFP should not beroutinelyroutinely used to expand blood volume used to expand blood volumeQQ.. •

• FFPFFP: An: Anacellular componentacellular component and anddoes not transmit intracellular infectionsdoes not transmit intracellular infections , e.g., CMV , e.g., CMV..

28.

28. Ans. Ans. a. Good a. Good source of source of all coagulaall coagulation factorstion factors 29.

29. Ans. Ans. c. Fac. Factors 5 ctors 5 and and 88 30.

30. Ans. a. Ans. a. It It is is used used as as volume volume expanderexpander 31. Ans. a.

31. Ans. a. Just Just before before operationoperation The

The question question is is incomplete. incomplete. It It should should be be ““A A cirrhotic cirrhotic patient patient with with abnormal abnormal coagulation coagulation needs needs cholecystectomycholecystectomy, , FFP FFP should should be be given:”given:” F

FRESHRESH F FROZENROZEN P PLASMALASMA

•

• TransfusionTransfusions s withwithFFPFFP are given to are given toreplenish cloing factorsreplenish cloing factorsQQ.. •

• TheTheeectivenesseectiveness of the of thetransfusiontransfusion in maintaining hemostasis is in maintaining hemostasis isdependent ondependent on the thequantityquantityof each factor delivered and itsof each factor delivered and its

half-life half-life..

•

• TheThehalf-lifehalf-life on the on themost stable cloing factormost stable cloing factor , factor , factorVIIVII , is , is4 to 6 hours4 to 6 hoursQQ.. •

• A reasonable transfusion scheme would be toA reasonable transfusion scheme would be togive FFP on callgive FFP on call to the to theoperating roomoperating room.. •

• This way theThis way the transfusiontransfusionisis complete prior complete prior to theto the incision incision , , withwith circulating factorscirculating factors toto covercover the the operativeoperative and and immediateimmediate

postoperative period postoperative periodQQ_._.

32. Ans.

32. Ans. b. b. 8 8 hourshours

•

• TheThehalf lifehalf lifeofoffactor VIIIfactor VIIIisis88--1212hourshours..

33.

33. Ans. d. Ans. d. XIXI(Ref: (Ref: htp://en.wikipedihtp://en.wikipedia.org/wiki/Haemophia.org/wiki/Haemophilia_C)lia_C)

•

• Hemophilia C (Rosenthal syndrome):Hemophilia C (Rosenthal syndrome):Due toDue tofactor XI deciencyfactor XI deciencyQQ

CRYOPRECIPITATE CRYOPRECIPITATE

34. Ans.

34. Ans. c. c. Factor Factor VIIIVIII(Ref: Harrison 18/e p953; Sabiston 19/e (Ref: Harrison 18/e p953; Sabiston 19/e p588; Schwartz 10/e p73-75,1599, 9/e p82; Bailey 26/e p21, p588; Schwartz 10/e p73-75,1599, 9/e p82; Bailey 26/e p21, 25/e p21)25/e p21) C

CRYOPRECIPITATERYOPRECIPITATE

•

• CryoprecipitateCryoprecipitate is a source of is a source ofbrinogenbrinogenQQ, factor VIII, factor VIIIQQ and andvon Willebrand factor (vWF)von Willebrand factor (vWF)QQ.. •

• It isIt isideal for supplying brinogenideal for supplying brinogen to the to the volume-sensitive patient.volume-sensitive patient. •

• Stored at ≤-18Stored at ≤-1800CC •

• 1 unit1 unit of cryoprecipitate contains of cryoprecipitate contains80-145 units of Factor VIII80-145 units of Factor VIII and and250 mg of brinogen250 mg of brinogenQQ.. •

• Cryoprecipitate isCryoprecipitate ispooled from many donorspooled from many donors , , so so there there areare maximum chances of disease transmissionmaximum chances of disease transmission among all among all

blood products blood productsQQ_._.

•

• Cryoprecipitate may alsoCryoprecipitate may alsosupply vWFsupply vWF to patients with to patients withdysfunctionaldysfunctional((type IItype II) or) orabsentabsent ( (type IIItype III))von Willebrand diseasevon Willebrand disease..

35.

35. Ans. Ans. b. b. Factor Factor VIII VIII 36. 36. Ans. Ans. a. a. CryoprecipitateCryoprecipitate 37. Ans.

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