BCA Fluid Management & Blood Transfusion 2

Question 1

What is the most common cause of acute hemolytic transfusion reactions resulting in significant morbidity and mortality?

Accepted Answer

ABO incompatibility due to clerical or patient identification errors

Answer

Rh (D) incompatibility

Answer

Allergic reaction to donor plasma proteins

Answer

Bacterial contamination of the blood product

Question 2

Which hemodynamic parameter is most reliable for guiding goal-directed fluid therapy in mechanically ventilated patients?

Accepted Answer

Stroke volume variation (SVV) or pulse pressure variation (PPV) > 13%

Answer

Central venous pressure (CVP) > 8 mmHg

Answer

Pulmonary artery wedge pressure (PAWP)

Answer

Urine output > 0.5 mL/kg/hr

Question 3

The formula for Maximum Allowable Blood Loss (MABL) before red blood cell transfusion is required is:

Accepted Answer

MABL = EBV × (Starting Hct − Minimum Acceptable Hct) / Starting Hct

Answer

MABL = Body weight × 70 mL/kg × Hematocrit

Answer

MABL = (Target Hct − Current Hct) × EBV / 0.6

Answer

MABL = Measured losses + Insensible losses + Urine output

Question 4

Current evidence-based massive transfusion protocols for hemorrhagic trauma recommend which blood product ratio?

Accepted Answer

1:1:1 ratio of FFP:Platelets:pRBC

Answer

2:1:1 ratio of pRBC:FFP:Platelets

Answer

4:2:1 ratio of pRBC:FFP:Platelets

Answer

pRBC alone until hemorrhage is surgically controlled

Question 5

Hypocalcemia during massive blood transfusion is primarily caused by which mechanism?

Accepted Answer

Citrate preservative in blood products chelates ionized calcium, reducing its bioavailability

Answer

Red blood cells consume calcium for cellular metabolism during storage

Answer

Dilutional effect from large volumes of calcium-free crystalloid co-administered

Answer

Hypothermia causes ionized calcium to shift intracellularly

Question 6

Fresh Frozen Plasma (FFP) transfusion is most appropriately indicated for which clinical scenario?

Accepted Answer

Correction of coagulopathy from multiple factor deficiencies (e.g., liver disease, DIC) or when specific factor concentrates are unavailable

Answer

Volume replacement in active hemorrhagic shock when crystalloids are unavailable

Answer

Prophylactic correction of a mildly elevated INR (1.5-2.0) before elective central line placement

Answer

Reversal of systemic heparin anticoagulation after cardiopulmonary bypass

Question 7

How is Transfusion-Associated Circulatory Overload (TACO) best differentiated from Transfusion-Related Acute Lung Injury (TRALI)?

Accepted Answer

TACO responds to diuretic therapy with improvement; TRALI does not improve with diuretics

Answer

TACO typically occurs more than 6 hours after transfusion; TRALI occurs within 6 hours

Answer

TACO is associated with hypoxia; TRALI typically has normal oxygen saturation

Answer

TACO causes fever and rigors; TRALI is an afebrile reaction