CLT Treatment Protocols & Procedures 2 — Questions and Answers
Question 1: A patient on warfarin therapy has an INR of 5.8 with no active bleeding. What is the most appropriate initial management?
- Administer IV vitamin K immediately
- Hold warfarin and monitor closely (Correct answer)
- Administer fresh frozen plasma
- Continue warfarin at the same dose
Correct answer: Hold warfarin and monitor closely
For supratherapeutic INR without bleeding, holding warfarin and monitoring is the first-line approach before considering vitamin K.
Question 2: Which blood component is the MOST appropriate for a patient with isolated factor VIII deficiency (hemophilia A)?
- Fresh frozen plasma
- Cryoprecipitate (Correct answer)
- Platelets
- Packed red blood cells
Correct answer: Cryoprecipitate
Cryoprecipitate is rich in factor VIII, fibrinogen, von Willebrand factor, and factor XIII, making it preferred for hemophilia A treatment.
Question 3: A patient requires a blood transfusion but has a known history of febrile non-hemolytic transfusion reactions. What modification to the transfusion should be made?
- Use irradiated blood products
- Use leukoreduced blood products (Correct answer)
- Use washed red blood cells
- Use CMV-negative blood products
Correct answer: Use leukoreduced blood products
Leukoreduction removes white blood cells that cause febrile non-hemolytic reactions by releasing cytokines during storage.
Question 4: In disseminated intravascular coagulation (DIC), which laboratory finding combination is most characteristic?
- Prolonged PT/PTT, elevated fibrinogen, low D-dimer
- Prolonged PT/PTT, low fibrinogen, elevated D-dimer (Correct answer)
- Normal PT/PTT, low platelets, elevated fibrinogen
- Short PT/PTT, elevated platelets, low D-dimer
Correct answer: Prolonged PT/PTT, low fibrinogen, elevated D-dimer
DIC is characterized by consumption of clotting factors (prolonged PT/PTT), fibrinogen depletion, low platelets, and elevated D-dimer from fibrin degradation.
Question 5: Which electrolyte imbalance is most commonly associated with massive blood transfusion and requires monitoring?
- Hypernatremia
- Hypercalcemia
- Hypocalcemia (Correct answer)
- Hypermagnesemia
Correct answer: Hypocalcemia
Citrate in stored blood products chelates calcium, causing hypocalcemia during massive transfusion, especially when the liver cannot metabolize citrate fast enough.
Question 6: A patient with type O-negative blood receives an incompatible crossmatch transfusion. Which finding would FIRST indicate an acute hemolytic transfusion reaction?
- Fever and chills (Correct answer)
- Pink or red urine
- Back pain and flank pain
- Drop in blood pressure
Correct answer: Fever and chills
Fever and chills are typically the earliest signs of an acute hemolytic transfusion reaction, prompting immediate investigation.
Question 7: For therapeutic phlebotomy in hereditary hemochromatosis, what is the standard volume removed per session in most protocols?
- 100 mL
- 250 mL
- 450–500 mL (Correct answer)
- 750 mL
Correct answer: 450–500 mL
Standard therapeutic phlebotomy removes approximately 450–500 mL (equivalent to one unit of blood) per session to reduce iron stores.
CLT Treatment Protocols & Procedures 2
A patient on warfarin therapy has an INR of 5.8 with no active bleeding.
What is the most appropriate initial management?