A 30-year-old woman with iron deficiency anemia has hemoglobin 7.2 g/dL (72 g/L). She is breathless only on stairs and otherwise stable. The best management is:

Iron replacement, oral or intravenous

Transfusion of 2 red cell units

Transfusion until hemoglobin reaches 10 g/dL

A patient on warfarin has an INR of 3.5, no bleeding, and elective surgery planned in 4 days. What is the best approach?

Stop warfarin; give oral vitamin K if needed

Give prothrombin complex concentrate now

Give cryoprecipitate before surgery

Transfuse 4 units of plasma now

A patient with heparin-induced thrombocytopenia has a platelet count of 35 × 10^9/L and no bleeding. Should platelets be given?

No; avoid platelets unless there is serious bleeding

Yes; give platelets with continued heparin

Yes; keep the count above 50 × 10^9/L

Yes; give platelets daily until heparin is stopped

Indications for transfusion

9 ASCP MLS practice questions on Indications for transfusion, part of Blood Banking. The first 9 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 30-year-old woman with iron deficiency anemia has hemoglobin 7.2 g/dL (72 g/L). She is breathless only on stairs and otherwise stable. The best management is:
1. AIron replacement, oral or intravenous
2. BTransfusion of 2 red cell units
3. CA plasma transfusion
4. DTransfusion until hemoglobin reaches 10 g/dL
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Answer: A · Iron replacement, oral or intravenous
She is stable and has a correctable cause of anemia, so iron replacement is the right treatment. Intravenous iron raises hemoglobin faster when oral iron is poorly tolerated or too slow. Transfusion is kept for severe symptoms, instability or active bleeding. This approach is part of patient blood management.
- B: Transfusion is not needed in a stable patient with a treatable cause.
- C: Plasma does not treat anemia.
- D: Aiming for 10 g/dL by transfusion exposes her to needless risk.
Question 2 · Medium
In a stable adult with chemotherapy-induced thrombocytopenia and no bleeding, prophylactic platelets are usually given when the count falls below:
1. A50 × 10^9/L
2. B10 × 10^9/L
3. C100 × 10^9/L
4. D150 × 10^9/L
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Answer: B · 10 × 10^9/L
AABB recommends prophylactic platelet transfusion at or below 10 × 10^9/L for hospitalized adults with low platelets from marrow failure or chemotherapy. Trials showed higher thresholds add exposure without fewer serious bleeds. Higher counts are targeted for procedures or active bleeding. A single apheresis unit is the standard dose.
- A: 50 × 10^9/L is used for most invasive procedures, not routine prophylaxis.
- C: 100 × 10^9/L is used for neurosurgery or eye surgery.
- D: 150 × 10^9/L is the lower limit of normal, not a transfusion threshold.
Question 3 · Medium
A patient on warfarin has an INR of 3.5, no bleeding, and elective surgery planned in 4 days. What is the best approach?
1. AGive prothrombin complex concentrate now
2. BStop warfarin; give oral vitamin K if needed
3. CGive cryoprecipitate before surgery
4. DTransfuse 4 units of plasma now
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Answer: B · Stop warfarin; give oral vitamin K if needed
With no bleeding and days to spare, stopping warfarin, with oral vitamin K if the INR is still high, lets the liver make new clotting factors. Plasma and prothrombin complex concentrate are kept for bleeding or urgent surgery. Plasma also carries risks such as circulatory overload and TRALI. The INR is rechecked before surgery.
- A: PCC is reserved for urgent reversal in bleeding or emergency surgery.
- C: Cryoprecipitate does not replace the vitamin K-dependent factors.
- D: Plasma is not needed when there is time for vitamin K to work.
Question 4 · Hard
A patient with heparin-induced thrombocytopenia has a platelet count of 35 × 10^9/L and no bleeding. Should platelets be given?
1. ANo; avoid platelets unless there is serious bleeding
2. BYes; give platelets with continued heparin
3. CYes; keep the count above 50 × 10^9/L
4. DYes; give platelets daily until heparin is stopped
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Answer: A · No; avoid platelets unless there is serious bleeding
Heparin-induced thrombocytopenia is a clotting disorder, not mainly a bleeding one, and platelet transfusion may add to thrombosis. Heparin is stopped and a non-heparin anticoagulant is started. Platelets are reserved for serious bleeding or a high-risk procedure. The same caution applies in thrombotic thrombocytopenic purpura.
- B: Heparin must be stopped in HIT.
- C: There is no bleeding, so raising the count to 50 × 10^9/L only adds risk.
- D: Routine daily platelets are not used in HIT.
Question 5 · Easy
For most hemodynamically stable hospitalized adults, AABB recommends red cell transfusion when the hemoglobin falls below:
1. A10 g/dL (100 g/L)
2. B5 g/dL (50 g/L)
3. C7 g/dL (70 g/L)
4. D9 g/dL (90 g/L)
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Answer: C · 7 g/dL (70 g/L)
AABB's 2023 guideline recommends a restrictive threshold of 7 g/dL for most stable inpatients, including those in intensive care. Thresholds of 7.5 g/dL for cardiac surgery and 8 g/dL for orthopedic surgery are used, as is 8 g/dL for patients with existing cardiovascular disease. Restrictive strategies cut blood use without worse outcomes. Symptoms and active bleeding still guide decisions for each patient.
- A: 10 g/dL is the old liberal threshold that trials showed gives no added benefit.
- B: 5 g/dL is too low as a general threshold and risks harm from anemia.
- D: 9 g/dL is higher than the recommended threshold for stable patients.
Question 6 · Hard
A patient with cirrhosis needs a paracentesis. The INR is 1.7 and there is no bleeding. What is the best plan?
1. AProceed without plasma
2. BGive cryoprecipitate to correct the INR
3. CGive plasma until the INR is 1.0
4. DGive 2 units of plasma before the procedure
Answer and explanation in LearnFree account
Question 7 · Hard
A patient needs urgent neurosurgery. The platelet count is 70 × 10^9/L and platelet function is normal. Which is appropriate?
1. APlatelets to reach at least 100 × 10^9/L
2. BTransfuse only if the count falls below 10 × 10^9/L
3. CGive plasma instead of platelets
4. DNo platelets; 50 × 10^9/L is enough for any surgery
Answer and explanation in LearnFree account
Question 8 · Medium
A 72-year-old with coronary artery disease is stable after hip fracture surgery, with hemoglobin 7.6 g/dL (76 g/L) and no chest pain. Under AABB 2023 guidance, red cells are:
1. AIndicated; the threshold for him is 8 g/dL (80 g/L)
2. BNot indicated until the hemoglobin is below 7 g/dL
3. CIndicated, aiming for a hemoglobin of 12 g/dL
4. DNot indicated until the hemoglobin is below 6 g/dL
Answer and explanation in LearnFree account
Question 9 · Hard
A 7-year-old boy with beta thalassemia major comes for his transfusion, which he receives every 3 weeks. He feels well, attends school and plays football, and his echocardiogram is normal. Today's results: hemoglobin 8.9 g/dL (89 g/L), ferritin 1,450 ng/mL (1,450 µg/L) on iron chelation, antibody screen negative. A resident notes that the hemoglobin is above the restrictive threshold of 7 g/dL (70 g/L) used for hospitalized adults and asks whether this transfusion can be skipped. What is the best response?
1. ASkip it; transfuse only when Hb is below 7 g/dL
2. BSkip it; transfuse only if he has symptoms
3. CTransfuse; keep pretransfusion Hb at 9.5-10.5 g/dL
4. DSkip it until ferritin is below 1,000 ng/mL
Answer and explanation in LearnFree account

Indications for transfusion

A 30-year-old woman with iron deficiency anemia has hemoglobin 7.2 g/dL (72 g/L). She is breathless only on stairs and otherwise stable. The best management is:

In a stable adult with chemotherapy-induced thrombocytopenia and no bleeding, prophylactic platelets are usually given when the count falls below:

A patient on warfarin has an INR of 3.5, no bleeding, and elective surgery planned in 4 days. What is the best approach?

A patient with heparin-induced thrombocytopenia has a platelet count of 35 × 10^9/L and no bleeding. Should platelets be given?

For most hemodynamically stable hospitalized adults, AABB recommends red cell transfusion when the hemoglobin falls below:

A patient with cirrhosis needs a paracentesis. The INR is 1.7 and there is no bleeding. What is the best plan?

A patient needs urgent neurosurgery. The platelet count is 70 × 10^9/L and platelet function is normal. Which is appropriate?

A 72-year-old with coronary artery disease is stable after hip fracture surgery, with hemoglobin 7.6 g/dL (76 g/L) and no chest pain. Under AABB 2023 guidance, red cells are: