CRNI Blood Transfusion 4 — Questions and Answers
Question 1: A patient receiving packed red blood cells develops flank pain, hypotension, and hemoglobinuria 30 minutes into the transfusion. Which reaction is most likely occurring?
- Febrile non-hemolytic reaction
- Acute hemolytic transfusion reaction (Correct answer)
- Transfusion-related acute lung injury
- Allergic reaction
Correct answer: Acute hemolytic transfusion reaction
Acute hemolytic transfusion reaction (AHTR) classically presents with flank pain, hypotension, and hemoglobinuria due to ABO incompatibility causing rapid intravascular hemolysis.
Question 2: What is the maximum allowable hang time for a unit of packed red blood cells once it leaves the blood bank?
- 2 hours
- 4 hours (Correct answer)
- 6 hours
- 8 hours
Correct answer: 4 hours
PRBCs must be infused within 4 hours of leaving the blood bank to prevent bacterial proliferation and product deterioration.
Question 3: A nurse is preparing to administer fresh frozen plasma (FFP). Which of the following is the correct administration filter to use?
- Leukocyte-reduction filter
- Standard 170-260 micron blood filter (Correct answer)
- 0.22 micron inline filter
- No filter is required for FFP
Correct answer: Standard 170-260 micron blood filter
All blood products, including FFP, must be administered through a standard 170-260 micron filter to remove clots and cellular debris.
Question 4: Which blood product is MOST appropriate for a patient with thrombocytopenic purpura who is actively bleeding with a platelet count of 8,000/mcL?
- Fresh frozen plasma
- Cryoprecipitate
- Platelet concentrate (Correct answer)
- Packed red blood cells
Correct answer: Platelet concentrate
Platelet concentrate is indicated for active bleeding with severe thrombocytopenia (platelet count below 10,000/mcL).
Question 5: Transfusion-associated circulatory overload (TACO) is best distinguished from TRALI by which clinical feature?
- Fever greater than 38°C
- Response to diuretics and elevated BNP (Correct answer)
- Bilateral pulmonary infiltrates on chest X-ray
- Onset within 6 hours of transfusion
Correct answer: Response to diuretics and elevated BNP
TACO improves with diuretics and is associated with elevated BNP/NT-proBNP, reflecting volume overload rather than the inflammatory mechanism of TRALI.
Question 6: A patient with a history of IgA deficiency requires a blood transfusion. Which precaution is MOST critical for this patient?
- Premedicate with acetaminophen only
- Use irradiated blood products
- Use IgA-deficient or washed blood products (Correct answer)
- Administer blood over 6 hours
Correct answer: Use IgA-deficient or washed blood products
Patients with IgA deficiency can develop anti-IgA antibodies and are at high risk for severe anaphylactic reactions; IgA-deficient or washed products are required.
Question 7: Which solution is SAFE to co-infuse in the same IV line as packed red blood cells?
- Lactated Ringer's solution
- Dextrose 5% in water (D5W)
- Normal saline (0.9% NaCl) (Correct answer)
- Total parenteral nutrition (TPN)
Correct answer: Normal saline (0.9% NaCl)
Only 0.9% normal saline is compatible for co-infusion with PRBCs; dextrose solutions cause hemolysis and lactated Ringer's contains calcium that can cause clotting.
CRNI Blood Transfusion 4
A patient receiving packed red blood cells develops flank pain, hypotension, and hemoglobinuria 30 minutes into the transfusion.
Which reaction is most likely occurring?