What increment of platelets/uL (platelets/L), in the typical 70 kg human, is expected to results from each single unit of Platelets transfused to a non-HLA-sensitized recipient?
a. 3,000-5,000
b. 5,000-10,000
c. 20,000-25,000
d. 25,000-30,000
c
Symptoms of hemolytic transfusion reactions are fever, chills, flushing, chest and back pain, hypotension, nausea, dyspnea, shock, renal failure, and DIC. Circulatory overload, allergic and anaphylactic reactions are not characterized by fever.
certain groups of immunocompromised patients at particular risk of TA-GvHD:
---pts with Hematologic malignancies
---transplant recipients
---patients with congenital or T-cell immunodeficiency, eg, Wiskott-Aldrich
---recipients of granulocyte concentrates
---patients receiving nucleoside analogs:
(flucytosine, Ribavarin,tenofovir, abacavir,Fludarabine,etc)
--- treatment with purine analogue
drugs:
-Allopurinol
-Nelarabine a purine analog used for T-cell acute lymphoblastic leukemia
-pentostatin(Hairy cell Leukemia),
-cladribine (2-chlorodeoxyadenosine)
-Thioguanine
-Fludarabine
-Mercaptopurine
--- patients with Hodgkin lymphoma
---recipients of donations from related donors
----HSCT pts
---fetuses and neonates who have received an intrauterine transfusion.
---infants with prematurity, low birth weight, or HDFN
(Source: Practical Clinical Pathology, 2nd Ed, Mais, p104)
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The majority of HLA antibodies are _____ Immunoglobulins:
IgG
Which of the following questions should be asked when investigating a transfusion reaction
How may mL of RBCs were transfused
Which of the following is NOT a finding associated with intravascular hemolytic reaction?
Methemalbumin decrease
Which of the following incorporates membrane filtration with intermittent flow centrifugation ( IFC)?
Fenwal Autopheresis-C
All of the following are diseases that can mimic a transfusion reaction except
AML
For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal is:
Reverse hypotension and minimize renal failure
Between which two loci are recombination (crossing over) most likely to occur?
Cardiac arrest and arrythmia
What type of hemolysis accompanies an anaphalytic reaction?
None of the above
How is histocompatibility testing different from RBC testing?
None of the above
Upon investigation of DHTR, what should be included in the medical history?
All of the above
Hypothemia as a result of cold fluid replacement can result in all of the following except:
Citrate toxicity
A person participating in a serial apheresis program would not:
Lose more than 25mL of RBCs per week
All of the following signs are consistent with circulatory overload except:
Fever
What may be found in the serum of a person who is exhibiting signs of a noncardiogenic pulmonsry edema reaction?
Antileukocyte antibody
Which of the following conditions would necessitate a plasmapheresis procedure?
Barbiturate poisoning
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
A delayed hemolytic transfusion reaction is most often a result of
An anamnestic response in a patient who has been previously sensitized by transfusion or pregnancy
Immediate transfusion reaction procedure consist of all of the following except:
Serum haptoglobin
How can depletion and dilution of coagulation factors be avoided in a massively transfused patient?
Prudent use of platelets and fresh frozen plasma (FFP)
How is complement detected in HLA testing?
Uptake of trypan blue dye
What is meant by the term public as applied to HLA antibodies?
Binding epitopes shared by more than one HLA gene product
Which of the following should be collected 5 to 7 hours after transfusion for unconjugated bilirubin determinants?
Clotted blood specimen
In plateletpheresis, which of the following components is returned to donor?
A and C
The removal of endotoxin from patient can be assisted through the use of which adsorbent during plasmapheresis procedure?
Polymyxin B
A double-lung transplant is indicated in which of the following disorders?
Cystic fibrosis
Treatment in the event of an anaphylactic or anaphylactoid reaction include all of the following except:
Immediately administering PPF
In the US fatalities associated with transfusion are required to be reported to which organization?
CDC
What effect does aspirin have on platelets?
prevents platelet aggregation
The genetic region that contains surface antigens or receptors responsible for the recognition and elimination of foreign tissues is referred to as:
Major histocompatibility Complex
What is meant by iatrogenic?
Physician caused
Which of the following organisms have been implicated in bacterial contamination reactions?
Yersinia enterocolitica
MHC class II molecules are expressed on all of the following except:
Platelets
Fresh Frozen Plasma is not the optimal product for replacement fluid for a therapeutic plasma exchange. For which patient is FFP the optimal product of choice?
All of the above
Recipient lymphocytotoxic HLA antibody to donor antigens is associated with
Both A and B
Which of the following is an indicator of acute immune hemolytic transfusion reaction?
Increased bilirubin
The MHC class I region encodes all of the following except:
HLA-DR
Which apheresis method carries the additional risk of returning RBCs to the wrong individual and yielding smallest volume of selected component?
Manual apheresis
Which of the following results when large excesses of free hemoglobin are released into the blood?
Hemoglobinemia
Which of the following is indicative of GVHD?
pancytopenia
Currently, the immunoaffinity column has FDA licensure for treating what disease state?
Idiopathic thrombocytopenic purpura
The specific cell product used for treating sepsis is the:
Granulocyte
Which of the following specificities designates the HLA-C gene?
Cw
Which of the following is an example of linkage disequilibrium?
The actual occurrence of haplotype HLA-A1 and HLA-BB 8%, the expected occurrence based on gene frequencies is 2%
How is HES used in apheresis procedure?
As a sediment agent to separate WBCs from RBCs
What treatment is recommended following bacterial contamination reaction?
Broad spectrum antibiotics
Which patients are not at risk for a circulatory overload?
Iron deficiency anemia
HLA testing is useful in what other area of study?
All of the above
Alloimmunization may result from which of the following?
Prior exposure to donor blood components
What symptom would not usually be found in a bacterial contamination reaction?
Tachycardia
What groups are at risk for graft vs host disease as result of transfusion?
B and C
What is the length of time required for production of antibody in a DHTR by an anamnestic immune response?
3 to 7 days
The hematopoiectic progenitor cells that eventually repopulate the bone marrow and also circulate the blood are called:
PBSC
A normal healthy donor undergoes a procedure to obtain platelets that will be transfused to a patient is representative of:
Component apheresis
Physical or chemical damage of the transfused RBCs can result in:
Intravascular hemolysis
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
A transfusion reaction investigation should include all of the following except:
Neocyte transfusions
During a plasmapheresis, RBCs should be returned within how many hours ?
2 hours
The platelet count of the plateletpheresis donor must be ______ prior to procedure.
>150x10^9 per L
How might a platelet survival be improved despite a near perfect HLA match
Remove leukocytes from donor unit
Which of the following is the most common transfusion reactions reported to blood banks?
Febrile
One unit of apheresed platelets should increase the platelet count
20,000 to 60,000 mL
Circulatory overload is caused by which of the following:
All of the above
What does R signify in the HLA-DR locus?
Subregion of D
Why is histocompatibility testing negated in both lung and heart transplant?
Ischemic time is too short
Which of the following is acceptable for cytotoxicity techniques?
ACD
What is the purpose of washing cells after initial incubation in the AMOS modified antibody screen procedure?
To remove any aggregated immunoglobulin in the serum
What effect does steroids have on leukapheresis?
Increase vascular pool of granulocytes
Changes that occur to RBCs upon storage include an increase in:
Calcium
Erythrocytapheresis is successful in which of the following conditions?
Malaria
Which pf these costs is a cost of poor quality (COPQ)?
Nonconformance costs
Liability for negligence includes all of the following except:
Failure to meet the duty was indirect responsible for harm suffered
When a new shipment of reagent is received, what measure is taken?
Lot-to-lot testing of new and old lot numbers of reagents
A quality framework in the blood bank ensure all of the following except
BB operations are customized to individual staff preferences
Quality assessment monitors include reviews of all of these except
Vendor selection process
Which of these should be evaluated during risk management assessment?
All of the above
Which of these records may be reviewed during competency assessment for BB personnel?
All of the above
Calibrating equipment prior to use in considered which function of quality?
QC
The use of different colored sera for blood bank reagents is an example of
Process control
Which of the following organisms is known to infect RBCs in storage
All of the above
What is the rationale surrounding the Doctrine of Charitable immunity?
Courts provide immunity from excess liability for nonprofit organizations
All of the following are transfusion service quality assurance indicators used to monitor patient care except:
Number of therapeutic units drawn
Competency assessment for BB personnel includes all of these except
Cross-training into other areas of the lab
What is the meaning of tort reform?
Protection of specialty practices from punitive or excessive rewards by state legislatures
All of the following are consistent with photopheresis except
The patient is given an oral dose of piroxicam which binds to RNA of all nucleated cells
What is the definition of ischemic time in heart transplantation?
The amount of time there is not blood flow through the organ
Photopheresis is effective against what malignant disorder?
Cutaneous T cell lymphoma
The removal of bile acids from patients plasma can be assisted through the use of which adsorbent
Charcoal
In HLA testing what is the purpose of using mineral oil?
To prevent evaporation of antisera during incubation
What is placed between the gene name and the numerical identifier for the allele to differentiate between the gene nomenclature of HLA serological reactivity?
Asterisk
Antiplatelet medications have differing deferral periods, which does not match?
Feldenea 7 days
What is the purpose of performing serial hemoglobin and hematocrit after blood transfusion?
To monitor the therapeutic and nontherapeutic response
How many targets are required for HLA antibody screening?
30
A severe manifestation of alloimmunization might include
Platelet refractoriness
The surface marker or antigen detected in histocompatibility testing of a single individual is referred to as HLA:
Phenotyping
Which of the following is not an indication for plasmapheresis
To decrease iron deposition in tissues in chronically transfused patients
Which of the following is not a symptom of noncardiogenic pulmonary edema?
Hypervolemia
What risks exists when HES has exceeded its renal threshold and execretion is retarded
Blockage of reticuloendothelial system
_____________ ______ testing is performed on plateletpheresis products to make sure HIV, WNV, HEPC are not present
Nucleic acid
What type of hemolysis is implicated in a DHTR by primary alloimmunization
Extravascular
Which of the following is characterized by a rapid onset of thrombocytopenia due to anamnestic productions of platelet antibody?
PTP
What is the physiological cause of citrate cytotoxicity in cytapheresis procedure?
The anticoagulant in plasma contains citrate, which binds calcium, lowering body's ionized calcium
When the entire set of A, B, C, DR, DQ, and DP antigens are located on one chromosome, it is called:
Haplotype
Which patients are at the most risk of platelet refractoriness where they become alloimmunized to HLA antigens on platelets
Leukemic patients
Belle Bonifils Memorial case
Lack of standard protocol for implementing new HIV testing on available components
The cost incurred for calibration materials and reagents are what type of costs?
Internal evaluation costs
Which of the following statements are true?
Remedial action does not uncover the real cause of nonconformance
The cost incurred when discarding donated blood units is an example of what type of cost?
Internal failure costs
TTAIDS case
Scientific knowledge was limited
The cost incurred for calibration materials and reagents are what type of costs?
Internal evaluation costs
Ensuring that the implemented changes are sustained occurs at what stage of the DMAIC process?
Control
How is battery conceptualized in transfusion medicine?
A donor claims never to have agreed to be stuck by a needle
All of the following are emerging concerns of transfusion medicine except
Antibody testing procedure
A pareto chart is used at what stage of DMAIC process?
Define
What is the function of a quality committee or quality council?
To set priorities for quality improvements
To process define measure analyze improve and control is know as which process?
Six sigma
Process improvement teams address all of the following except
Filing a grievance
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