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

ABO-incompatible transfusions, most commonly caused by clerical or patient identification errors (wrong blood in tube, mislabeled samples), trigger complement-mediated intravascular hemolysis that can lead to DIC, acute renal failure, and death.

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

Dynamic indices like SVV and PPV (>13% predicts fluid responsiveness) are superior to static preload measures like CVP or PAWP because they reflect the interaction between heart-lung during mechanical ventilation to predict volume responsiveness.

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 = EBV × (Starting Hct − Minimum Acceptable Hct) / Starting Hct, where EBV (estimated blood volume) is typically 70 mL/kg for adults; this determines how much blood can be lost before the hemoglobin reaches the transfusion trigger.

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

The PROPPR trial demonstrated that a 1:1:1 ratio of plasma:platelets:pRBC resulted in better 24-hour hemostasis and trend toward improved 30-day survival compared to 1:1:2, supporting balanced resuscitation that mimics whole blood.

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

Citrate (sodium citrate) is used as an anticoagulant preservative in blood products; during massive transfusion, the liver cannot metabolize citrate fast enough, leading to accumulation and chelation of ionized calcium, causing hypocalcemia and myocardial depression.

(BCA) Board of Certification in Anesthesiology Practice Test

(BCA) Board of Certification in Anesthesiology Practice Test

BCA Fluid Management & Blood Transfusion 2