CRNI Blood Component Transfusion 4 — Questions and Answers
Question 1: A patient with IgA deficiency requires a transfusion. Which blood product modification is most appropriate to prevent anaphylactic reaction?
- Irradiated blood
- Washed red blood cells (Correct answer)
- Leukoreduced blood
- CMV-negative blood
Correct answer: Washed red blood cells
Washed red blood cells remove plasma proteins including IgA, preventing anaphylaxis in IgA-deficient patients who have anti-IgA antibodies.
Question 2: During a platelet transfusion, the patient develops rigors, fever of 38.9°C (102°F), and hypotension. What is the most likely cause?
- Allergic reaction
- Transfusion-associated circulatory overload (TACO)
- Septic transfusion reaction (Correct answer)
- Febrile non-hemolytic transfusion reaction
Correct answer: Septic transfusion reaction
Hypotension combined with high fever and rigors during platelet transfusion is a hallmark of septic transfusion reaction, as platelets are stored at room temperature and are prone to bacterial contamination.
Question 3: A nurse is preparing to administer FFP. The FFP has been thawed for 26 hours. What action should the nurse take?
- Administer it immediately before it expires
- Return it to the blood bank for re-freezing
- Discard it and request a new unit (Correct answer)
- Use it only if the patient is bleeding actively
Correct answer: Discard it and request a new unit
Thawed FFP must be transfused within 24 hours; after 26 hours it should be discarded as labile coagulation factors V and VIII significantly degrade.
Question 4: Which of the following is the correct maximum infusion time for a single unit of packed red blood cells (PRBCs) to minimize risk of bacterial proliferation?
- 2 hours
- 3 hours
- 4 hours (Correct answer)
- 6 hours
Correct answer: 4 hours
Each unit of PRBCs must be infused within 4 hours of being removed from temperature-controlled storage to prevent bacterial proliferation.
Question 5: A patient receives a massive transfusion (>10 units PRBCs in 24 hours). Which electrolyte imbalance is most commonly anticipated?
- Hypernatremia
- Hypomagnesemia
- Hypocalcemia (Correct answer)
- Hyperkalemia only
Correct answer: Hypocalcemia
Citrate used as a preservative in banked blood chelates calcium, causing hypocalcemia during massive transfusion, especially when the liver cannot metabolize citrate fast enough.
Question 6: A post-bone marrow transplant patient needs a transfusion. Which blood product modification is essential to prevent transfusion-associated graft-versus-host disease (TA-GvHD)?
- Washed blood products
- CMV-negative blood products
- Irradiated blood products (Correct answer)
- Leukoreduced blood products
Correct answer: Irradiated blood products
Irradiation inactivates donor T-lymphocytes, preventing them from engrafting and attacking the immunocompromised recipient's tissues (TA-GvHD).
Question 7: A patient's type and screen shows blood type B negative. Which blood type is universally acceptable for emergency red cell transfusion when B negative is unavailable?
- O negative (Correct answer)
- AB negative
- B positive
- O positive
Correct answer: O negative
O negative is the universal donor for red blood cells because it lacks A, B, and Rh(D) antigens, making it compatible with any recipient in emergencies.
CRNI Blood Component Transfusion 4
A patient with IgA deficiency requires a transfusion.
Which blood product modification is most appropriate to prevent anaphylactic reaction?