CCRN Hematology and Immunology 3 — Questions and Answers
Question 1: Which blood product is the treatment of choice to rapidly reverse warfarin in a patient with life-threatening bleeding?
- Prothrombin complex concentrate (PCC) (Correct answer)
- Platelets
- Cryoprecipitate
- Packed red blood cells
Correct answer: Prothrombin complex concentrate (PCC)
PCC provides concentrated vitamin K-dependent factors and reverses warfarin faster than fresh frozen plasma for life-threatening bleeding.
Question 2: Cryoprecipitate is most specifically indicated to replace which component?
- Fibrinogen (Correct answer)
- Red blood cells
- Immunoglobulins
- Albumin
Correct answer: Fibrinogen
Cryoprecipitate is rich in fibrinogen, factor VIII, von Willebrand factor, and factor XIII, and is used primarily for low fibrinogen.
Question 3: A patient develops dyspnea, hypoxemia, and bilateral infiltrates within 6 hours of transfusion. Which reaction is most likely?
- Transfusion-related acute lung injury (TRALI) (Correct answer)
- Acute hemolytic reaction
- Bacterial contamination
- Allergic reaction
Correct answer: Transfusion-related acute lung injury (TRALI)
TRALI presents with acute non-cardiogenic pulmonary edema within 6 hours of transfusion and is a leading cause of transfusion-related death.
Question 4: Which assessment finding distinguishes TACO (circulatory overload) from TRALI?
- Hypertension and elevated BNP with jugular venous distention (Correct answer)
- Normal blood pressure and normal BNP
- Fever and hypotension with rash
- Hemoglobinuria and flank pain
Correct answer: Hypertension and elevated BNP with jugular venous distention
TACO is volume overload, so it presents with hypertension, elevated BNP, and JVD, unlike TRALI which has normal filling pressures.
Question 5: A patient with hemophilia A is bleeding. Which factor must be replaced?
- Factor VIII (Correct answer)
- Factor IX
- Factor VII
- Factor XIII
Correct answer: Factor VIII
Hemophilia A is a deficiency of factor VIII, which must be replaced to control bleeding.
Question 6: Which type of hypersensitivity reaction is anaphylaxis?
- Type I (IgE-mediated) (Correct answer)
- Type II (cytotoxic)
- Type III (immune complex)
- Type IV (delayed cell-mediated)
Correct answer: Type I (IgE-mediated)
Anaphylaxis is a Type I IgE-mediated immediate hypersensitivity reaction causing mast cell degranulation.
Question 7: What is the most appropriate first-line medication for a patient in anaphylactic shock?
- Intramuscular epinephrine (Correct answer)
- Intravenous diphenhydramine
- Oral corticosteroids
- Nebulized albuterol
Correct answer: Intramuscular epinephrine
Epinephrine is the first-line treatment for anaphylaxis because it reverses bronchoconstriction, vasodilation, and capillary leak.
CCRN Hematology and Immunology 3
Which blood product is the treatment of choice to rapidly reverse warfarin in a patient with life-threatening bleeding?