CRNI Blood Component Transfusion 5 — Questions and Answers
Question 1: A patient develops back pain, hemoglobinuria, and hypotension shortly after beginning a red cell transfusion. Which action takes highest priority?
- Administer diphenhydramine and slow the infusion
- Stop the transfusion and maintain IV access with normal saline (Correct answer)
- Obtain a blood culture and continue the transfusion at a slower rate
- Administer furosemide to promote urinary output
Correct answer: Stop the transfusion and maintain IV access with normal saline
These signs indicate an acute hemolytic transfusion reaction; the transfusion must be stopped immediately and IV access maintained with normal saline while notifying the blood bank and physician.
Question 2: Which of the following cryoprecipitate indications is considered most appropriate?
- Reversal of warfarin anticoagulation
- Replacement of factor VIII in hemophilia A when recombinant factor is unavailable (Correct answer)
- Treatment of thrombocytopenia
- Correction of protein C deficiency
Correct answer: Replacement of factor VIII in hemophilia A when recombinant factor is unavailable
Cryoprecipitate is rich in factor VIII, fibrinogen, vWF, and factor XIII, making it appropriate for hemophilia A when recombinant or plasma-derived factor VIII is unavailable.
Question 3: Transfusion-related acute lung injury (TRALI) is most commonly associated with transfusion of which blood product?
- Packed red blood cells
- Platelets
- Fresh frozen plasma from multiparous female donors (Correct answer)
- Cryoprecipitate
Correct answer: Fresh frozen plasma from multiparous female donors
TRALI is most associated with plasma-containing products from multiparous donors who have developed HLA or HNA antibodies that react with recipient leukocytes.
Question 4: A patient with a platelet count of 48,000/µL is scheduled for a lumbar puncture. The physician orders prophylactic platelet transfusion. What is the generally accepted threshold for this procedure?
- < 100,000/µL
- < 50,000/µL (Correct answer)
- < 20,000/µL
- < 10,000/µL
Correct answer: < 50,000/µL
A platelet count of at least 50,000/µL is the generally accepted threshold before invasive procedures such as lumbar puncture to minimize bleeding risk.
Question 5: During blood component administration, which solution is the ONLY acceptable co-infusion with blood products through the same IV line?
- 5% Dextrose in water (D5W)
- Lactated Ringer's solution
- 0.9% Normal saline (Correct answer)
- Albumin 5%
Correct answer: 0.9% Normal saline
Only 0.9% normal saline is compatible with blood products; dextrose causes red cell hemolysis and calcium-containing solutions like LR can cause clotting.
Question 6: A nurse notes that a unit of packed red blood cells has visible clumping and a dark, discolored appearance. What is the correct action?
- Warm the unit to dissolve the clumping and administer
- Administer slowly and monitor closely for reaction
- Return the unit to the blood bank and do not administer (Correct answer)
- Filter the unit through a leukoreduction filter before administration
Correct answer: Return the unit to the blood bank and do not administer
Visual abnormalities such as clumping or abnormal discoloration indicate potential bacterial contamination or hemolysis; the unit must be returned to the blood bank and not administered.
Question 7: A patient with chronic renal failure requires a blood transfusion. Which pre-transfusion concern is most critical related to stored PRBCs?
- Risk of hypocalcemia from citrate
- Risk of hyperkalemia from lysed red cells in older blood (Correct answer)
- Risk of hypothermia from cold blood
- Risk of air embolism from the blood bag
Correct answer: Risk of hyperkalemia from lysed red cells in older blood
Stored PRBCs release potassium as red cells lyse over storage time, posing a significant hyperkalemia risk to patients with renal failure who cannot excrete excess potassium.
CRNI Blood Component Transfusion 5
A patient develops back pain, hemoglobinuria, and hypotension shortly after beginning a red cell transfusion.
Which action takes highest priority?