Blood administration and patient blood management

6 ASCP MLS practice questions on Blood administration and patient blood management, part of Blood Banking. The first 6 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   Which intravenous solution may be given through the same line as red cells?

   1. A5% dextrose in water
   2. BLactated Ringer's solution
   3. C0.45% sodium chloride
   4. D0.9% sodium chloride

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   Answer: D · 0.9% sodium chloride

   Normal saline is isotonic and does not damage red cells or cause clotting in the line. Lactated Ringer's contains calcium, which can overcome the citrate and let the blood clot. Dextrose solutions and hypotonic saline can make red cells swell and hemolyze. Other solutions may be used only if they are FDA-approved for use with blood.

   • A: 5% dextrose can cause red cell clumping and hemolysis.
   • B: The calcium in lactated Ringer's can clot citrated blood in the line.
   • C: Hypotonic saline makes red cells swell and lyse.

2. Question 2 · Hard

   At the bedside, the patient's wristband name matches the unit's transfusion tag, but the medical record number differs by one digit. What should be done?

   1. ACorrect the record number on the tag by hand
   2. BAsk the patient to state their name, then transfuse
   3. CTransfuse, because the patient's name matches
   4. DHold the unit and resolve it with the blood bank

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   Answer: D · Hold the unit and resolve it with the blood bank

   Two independent identifiers on the patient and the unit must match exactly before any transfusion starts. A mismatch may mean the unit was crossmatched for another patient, which can lead to ABO-incompatible transfusion. The unit is held and the blood bank investigates and corrects the problem. Misidentification at sample collection or at the bedside is the leading cause of ABO-incompatible transfusions.

   • A: Labels must not be altered at the bedside.
   • B: Asking the name does not resolve a mismatched record number.
   • C: A matching name alone is not enough; two identifiers must match.

3. Question 3 · Medium

   Why are blood warmers used during massive transfusion?

   1. ARapid cold infusions cause hypothermia and bleeding
   2. BWarming prevents febrile nonhemolytic reactions
   3. CWarming kills any bacteria present in the units
   4. DWarming restores the 2,3-DPG lost from stored red cells

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   Answer: A · Rapid cold infusions cause hypothermia and bleeding

   Rapid infusion of refrigerated blood lowers body temperature, which slows clotting enzymes, impairs platelets and can cause cardiac arrhythmias. Approved blood warmers have a temperature monitor and alarm. Units must never be warmed in a microwave or hot water bath, which can hemolyze them. Warmers are also used for patients with cold agglutinins.

   • B: Febrile reactions are caused by cytokines or antibodies, not by temperature.
   • C: Warming to body temperature does not sterilize a unit.
   • D: 2,3-DPG is rebuilt in the patient over days, not by warming.

4. Question 4 · Hard

   A stable adult inpatient without heart disease or bleeding has a hemoglobin of 7.6 g/dL (76 g/L) from iron deficiency. Which approach best fits patient blood management?

   1. ATransfuse until the hemoglobin is back to normal
   2. BTransfuse 2 units to reach a hemoglobin of 10 g/dL
   3. CTransfuse 1 unit, because the hemoglobin is under 8 g/dL
   4. DNo transfusion; treat the iron deficiency and recheck

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   Answer: D · No transfusion; treat the iron deficiency and recheck

   AABB guidelines support a restrictive threshold of about 7 g/dL (70 g/L) for most stable hospitalized adults, with 7.5 to 8 g/dL for cardiac or orthopedic surgery and existing cardiovascular disease. This patient is above 7 g/dL and stable, so the cause is treated instead, here with iron. When transfusion is needed, one unit is given and the patient reassessed. Patient blood management also limits blood draws and uses cell salvage and antifibrinolytics in surgery.

   • A: Transfusing to a normal hemoglobin exposes the patient to risk without benefit.
   • B: Two units to a target of 10 g/dL is a liberal strategy without benefit here.
   • C: A threshold of 8 g/dL is for selected patients, such as those with heart disease.

5. Question 5 · Hard

   A 28-year-old man with a pelvic fracture is in hemorrhagic shock. The massive transfusion protocol issues red cells, plasma and platelets in a 1:1:1 ratio and adds fibrinogen replacement when fibrinogen falls below 150 mg/dL (1.5 g/L). After 10 units of red cells, 10 units of plasma and 2 apheresis platelet units he is still bleeding. Results: hemoglobin 8.4 g/dL (84 g/L), platelets 96 x 10^3/µL, INR 1.5, fibrinogen 92 mg/dL (0.92 g/L), ionized calcium 1.16 mmol/L (reference 1.12-1.32 mmol/L), temperature 36.4 °C. What should be added to the next cooler?

   1. AFour extra units of thawed plasma
   2. BCryoprecipitate, about 10 units
   3. CTwo extra apheresis platelet units
   4. DIntravenous vitamin K, 10 mg

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   Answer: B · Cryoprecipitate, about 10 units

   Fibrinogen is the first clotting factor to fall to critical levels in major bleeding, and at 92 mg/dL it is below the protocol's trigger. Cryoprecipitate replaces it efficiently: about 1 unit per 10 kg of body weight raises fibrinogen by roughly 50 mg/dL, while plasma would need a very large volume for the same rise. The platelet count, ionized calcium and temperature are acceptable, and the INR of 1.5 is being treated by the ongoing 1:1 plasma. Vitamin K acts over hours and corrects only vitamin K deficiency or warfarin effect. Adding components according to repeated laboratory or viscoelastic results is a core patient blood management strategy in massive transfusion.

   • A: Plasma has too little fibrinogen per unit to correct 92 mg/dL quickly.
   • C: A platelet count of 96 x 10^3/µL is acceptable in this bleeding patient.
   • D: Vitamin K acts slowly and treats warfarin effect or deficiency, not dilution.

6. Question 6 · Medium

   In an emergency, before the patient's ABO group is known, which red cells should be issued?

   1. AGroup AB red cells
   2. BGroup A red cells
   3. CGroup B red cells
   4. DGroup O red cells

   Answer and explanation in LearnFree account