CRNI Blood Component Transfusion 2 — Questions and Answers

Question 1: What is the maximum infusion time allowed for one unit of packed red blood cells?

2 hours
4 hours (Correct answer)
6 hours
8 hours

Correct answer: 4 hours

Packed red blood cells must be infused within 4 hours of removal from controlled storage to minimize bacterial proliferation risk.

According to AABB standards and INS guidelines, packed red blood cells must be infused within 4 hours of being removed from monitored blood bank storage (1-6 degrees C). Beyond 4 hours at room temperature, the risk of bacterial proliferation increases significantly, potentially causing septic transfusion reactions. If the unit cannot be started within 30 minutes of issue, it should be returned to the blood bank. The infusion typically starts slowly (2 mL/min for the first 15 minutes) to monitor for reactions, then increases to complete within the 4-hour window.

Question 2: Which type of blood component requires irradiation before transfusion to immunocompromised patients?

Fresh frozen plasma
Cryoprecipitate
Granulocyte concentrates (Correct answer)
Albumin

Correct answer: Granulocyte concentrates

Granulocyte concentrates and other cellular blood products require irradiation to prevent transfusion-associated graft-versus-host disease in immunocompromised patients.

Granulocyte concentrates contain large numbers of viable donor lymphocytes that can engraft in immunocompromised recipients, causing transfusion-associated graft-versus-host disease (TA-GVHD), which is nearly always fatal. Irradiation (25 Gy) inactivates donor lymphocytes while preserving granulocyte function. Other cellular products (RBCs, platelets) are also irradiated for at-risk patients, but granulocytes are the highest risk product. FFP, cryoprecipitate, and albumin do not contain viable lymphocytes and do not require irradiation.

Question 3: During a platelet transfusion, the patient develops rigors and a temperature increase of 1.5 degrees C. What is the MOST likely cause?

ABO incompatibility
Febrile non-hemolytic transfusion reaction (Correct answer)
Bacterial contamination
Transfusion-related acute lung injury

Correct answer: Febrile non-hemolytic transfusion reaction

Febrile non-hemolytic transfusion reactions are the most common reaction with platelet transfusions, characterized by fever and rigors without hemolysis.

Febrile non-hemolytic transfusion reactions (FNHTRs) are the most common adverse event with platelet transfusions, occurring in 1-3% of transfusions. They result from recipient antibodies against donor leukocyte antigens or cytokines accumulated during storage. Symptoms include fever (1 degree C or more rise), rigors, and chills, typically occurring during or shortly after transfusion. While FNHTRs are benign, the transfusion should be stopped and the reaction evaluated to rule out more serious causes such as bacterial contamination or hemolytic reaction. Leukoreduction of blood products significantly reduces FNHTR incidence.

Question 4: What is the correct blood sample labeling requirement for pre-transfusion testing?

Pre-printed labels applied at the patient's bedside
Labels with patient name and room number
Labels with patient name, MRN, date, time, and collector's initials applied at the bedside (Correct answer)
Any label matching the transfusion order

Correct answer: Labels with patient name, MRN, date, time, and collector's initials applied at the bedside

Pre-transfusion specimens must be labeled at the bedside with complete patient identifiers, date, time, and phlebotomist identification to prevent specimen misidentification.

Proper blood bank specimen labeling is critical for transfusion safety. Labels must be applied at the patient's bedside (never pre-labeled) and include: patient's full legal name, unique identifier (MRN), date and time of collection, and the phlebotomist's identification. This is a regulatory requirement from AABB, CAP, and The Joint Commission. Mislabeled specimens are the leading cause of ABO-incompatible transfusions, which can be fatal. Many facilities require two independent patient identifications before collection. Any discrepancy requires recollection.

Question 5: Which IV solution is compatible for co-infusion with blood components?

Lactated Ringer's solution
5% Dextrose in water
0.9% Normal saline (Correct answer)
5% Dextrose in 0.45% saline

Correct answer: 0.9% Normal saline

Only 0.9% normal saline is compatible with blood component administration. Other solutions can cause hemolysis or clotting.

Normal saline (0.9% NaCl) is the only IV solution approved for use with blood components. Lactated Ringer's contains calcium, which can chelate the citrate anticoagulant in blood products and cause clotting in the tubing. Dextrose solutions (D5W, D5NS) cause osmotic swelling and hemolysis of red blood cells. No medications should be added to or co-infused through the same line as blood products. If the patient requires another IV solution, it should be infused through a separate IV site.

Question 6: A patient with a history of allergic transfusion reactions is ordered packed RBCs. What premedication is typically administered?

Epinephrine 0.3 mg IM
Diphenhydramine 25-50 mg IV (Correct answer)
Methylprednisolone 125 mg IV
Acetaminophen 650 mg PO only

Correct answer: Diphenhydramine 25-50 mg IV

Diphenhydramine is the standard premedication for patients with a history of allergic transfusion reactions, given 30 minutes before transfusion to prevent urticaria and itching.

For patients with a documented history of allergic transfusion reactions, diphenhydramine 25-50 mg IV or PO is the standard premedication, administered 30 minutes before the transfusion. It blocks histamine receptors and reduces the incidence of urticaria, pruritus, and mild allergic symptoms. Acetaminophen may be added for fever prevention but alone is insufficient for allergic prophylaxis. Corticosteroids are reserved for patients with recurrent or severe reactions despite antihistamines. Epinephrine is an emergency treatment for anaphylaxis, not a premedication.

CRNI Blood Component Transfusion 2

What is the maximum infusion time allowed for one unit of packed red blood cells?