Quiz on Blood & Component Transfusion

Prepared by Dr. Pradeep Bhatia

Dr. S. N. Medical College, Jodhpur

(Posted 16th February, 2007)

Question 1. For acute blood loss during surgery, select the wrong statement: Maintenance of normovolemia is the most important strategy Vital signs of blood loss may be masked by anaesthetic agents Haemoglobin estimation alone is an imprecise measurement due to fluid resuscitation Blood volume loss of 15-30% should be treated with RBC transfusion	Question 2. Regarding perioperative blood transfusion, select the wrong statement: At hemoglobin >10 g/dL, transfusion is rarely indicated For critically ill patients and/or those with cardiopulmonary problems, RBCs may be transfused for Hb of 10 g/dL or lower Patients with asymptomatic anemia and Hb <7 g/dL always need to be transfused irrespective of the perioperative anaesthesia risk and severity of blood loss In severe Thalassemia or other congenital anaemia, maintain Hb at 9-11g/dl
Question 3. The potential metabolic problems from massive blood transfusion are all except: Hyperkalemia Citrate Toxicity Hypomagnesemia Increased 2,3-DPG levels	Question 4. Select the wrong statement regarding massive transfusion: It is defined as the acute replacement of more than one blood volume within several hours Coagulation defects can develop from dilution of coagulation factors and platelets Platelets & FFP should be routinely administered during massive transfusion Calcium is indicated only when there is low measured ionized calcium and evidence of cardiovascular compromise not attributable to other causes
Question 5. FFP is stored at: Room Temperature 18 degree C 0 degree C -18 degree C or Less	Question 6. Each Unit of FFP (200-250 ml) will raise plasma clotting factors by: 3-5% 5-10% 10-20% 20-25%
Question 7. For FFP transfusion, select the correct statement: Cross-matching should always be done Cross-matching is not required but ABO-compatible plasma must be selected ABO compatible plasma is not required All the above statements are wrong	Question 8. FFP transfusion is indicated in all except: Microvascular bleeding due to coagulopathies To reverse the effect of Warfarin prior to surgery As volume expander during massive haemorrhage In plasmapheresis for TTP
Question 9. Select the wrong statement: One unit of platelets generally increases the platelet count by approximately 5-10 x 10⁹/L in the average adult Surgical and obstetrical patients with microvascular bleeding usually require platelet transfusion if count is <50 x 10⁹/L Operative procedures ordinarily associated with insignificant blood loss may be undertaken in patients with platelet counts <50 x 10⁹/L Prophylactic administration of platelets is recommended in patients with chronic thrombocytopenia caused by increased platelet destruction	Question 10. Cryoprecipitate is used for the treatment of all except: Sole replacement therapy for DIC Congenital or acquired fibrinogen deficiency Von Willebrand's disease (deficient or abnormal molecule) unresponsive to desmopressin Uremic bleeding diathesis

References & Bibliography

Questions and Answers About Transfusion Practices, Committee on Transfusion Medicine of the American Society of Anesthesiologists. http://www.asahq.org/publicationsAndServices/transfusion.pdf
Donald L. Kelley: Update on Plasma and Cryoprecipitate Transfusion. The Institute For Transfusion Medicine http://www.itxm.org/tmu2004/issue2004-1.htm
Guidelines for transfusion of Red Blood Cells - Adults, New York State Council on Human Blood and Transfusion Services http://www.wadsworth.org/labcert/blood_tissue/txrbcadultsfinal1104.pdf