NNP Hematology and Hyperbilirubinemia 2

Question 1

A neonate is being evaluated for exchange transfusion. Which of the following is an absolute indication for emergency exchange transfusion?

Accepted Answer

Signs of acute bilirubin encephalopathy (ABE) with rapidly rising TSB

Answer

TSB at phototherapy threshold on the Bhutani nomogram

Answer

TSB 2 mg/dL above the phototherapy line in a term infant

Answer

Positive direct Coombs test with TSB of 10 mg/dL at 48 hours

Question 2

What volume of blood is used for a double-volume exchange transfusion in a neonate?

Accepted Answer

160 mL/kg

Answer

40 mL/kg

Answer

80 mL/kg

Answer

200 mL/kg

Question 3

Which type of blood product is MOST appropriate for exchange transfusion in a neonate with Rh hemolytic disease?

Accepted Answer

O-negative irradiated CMV-negative red blood cells reconstituted with AB plasma

Answer

Type-specific irradiated packed red blood cells reconstituted with fresh frozen plasma

Answer

Leukoreduced type-specific whole blood less than 7 days old

Answer

O-positive washed packed red blood cells

Question 4

A neonate receiving intensive phototherapy has a TSB that rises by 1 mg/dL in 6 hours despite treatment. What is the MOST appropriate next action?

Accepted Answer

Begin intravenous immunoglobulin (IVIG) therapy

Answer

Add a second phototherapy unit and reassess in 4–6 hours

Answer

Discontinue phototherapy and perform exchange transfusion immediately

Answer

Increase the neonate's fluid intake by 10% and continue phototherapy

Question 5

Which complication is MOST commonly associated with exchange transfusion in neonates?

Accepted Answer

Thrombocytopenia and metabolic acidosis

Answer

Hypercalcemia

Answer

Hypermagnesemia

Answer

Polycythemia

Question 6

A 28-week preterm neonate has a bilirubin level of 8 mg/dL on day 3. Which factor MOST lowers the threshold for phototherapy in this infant compared to a term neonate?

Accepted Answer

Increased risk of bilirubin neurotoxicity at lower TSB levels due to prematurity and low albumin

Answer

Immature hepatic glucuronidation only

Answer

Higher hematocrit leading to more bilirubin production

Answer

Greater skin surface area per kilogram

Question 7

Which condition is associated with elevated DIRECT (conjugated) bilirubin in a neonate and requires further workup for cholestasis?

Accepted Answer

Biliary atresia

Answer

Rh hemolytic disease

Answer

Physiologic jaundice

Answer

ABO incompatibility