During massive transfusion, a bleeding patient has these results: platelets 92 × 10^9/L; PT 17 s (reference 11 to 14 s); APTT 40 s (reference 25 to 35 s); fibrinogen 0.9 g/L (90 mg/dL) (reference 2.0 to 4.0 g/L). The component that best corrects the main defect is:

Prothrombin complex concentrate

Two uncrossmatched group O D-negative units were issued for a bleeding patient. Testing of the pretransfusion sample then shows anti-K, and one transfused unit was K-positive. What should the blood bank do?

Notify the physician and medical director, and give K-negative units

Take no action, as emergency release waives compatibility rules

Continue with K-positive units, as the patient is already exposed

Stop all transfusion until an anti-K titer is available

During a large trauma response, group O D-negative red cells are running low. Which patient should be switched to group O D-positive red cells first?

A D-negative woman 30 weeks pregnant

When red cells are issued before pretransfusion testing is complete, AABB standards require which record?

A signed statement from the requesting physician

Signed consent from the patient or family

A second sample confirming the ABO group

Written approval from the medical director

Massive transfusion and emergency release

9 DOH Abu Dhabi (HAAD) lab licensing practice questions on Massive transfusion and emergency release, 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
During massive transfusion, a bleeding patient has these results: platelets 92 × 10^9/L; PT 17 s (reference 11 to 14 s); APTT 40 s (reference 25 to 35 s); fibrinogen 0.9 g/L (90 mg/dL) (reference 2.0 to 4.0 g/L). The component that best corrects the main defect is:
1. AProthrombin complex concentrate
2. BPlasma
3. CPlatelets
4. DCryoprecipitate
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Answer: D · Cryoprecipitate
Fibrinogen is the first clotting factor to fall to critical levels in massive bleeding, through loss, dilution and consumption. A level of 0.9 g/L is well below the usual replacement trigger of about 1.5 g/L in major hemorrhage, while the platelet count is adequate and the PT and APTT are only mildly prolonged. Cryoprecipitate, or fibrinogen concentrate, delivers fibrinogen in a small volume. Raising fibrinogen with plasma alone would need very large volumes.
- A: Prothrombin complex concentrate supplies factors II, VII, IX and X, not fibrinogen.
- B: Plasma helps the PT and APTT but raises fibrinogen slowly and needs large volumes.
- C: A platelet count of 92 × 10^9/L is adequate for most bleeding patients.
Question 2 · Hard
Two uncrossmatched group O D-negative units were issued for a bleeding patient. Testing of the pretransfusion sample then shows anti-K, and one transfused unit was K-positive. What should the blood bank do?
1. ATake no action, as emergency release waives compatibility rules
2. BContinue with K-positive units, as the patient is already exposed
3. CStop all transfusion until an anti-K titer is available
4. DNotify the physician and medical director, and give K-negative units
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Answer: D · Notify the physician and medical director, and give K-negative units
Testing continues after emergency release, and AABB requires any incompatibility to be reported promptly to the patient's physician and the transfusion service medical director. The patient is watched for a hemolytic transfusion reaction, with a DAT and hemolysis markers. All further red cells should be K-negative and crossmatch-compatible; about 91% of donors are K-negative, so they are easy to find. Stopping needed transfusion would put the bleeding patient at greater risk.
- A: Testing must still be completed, and incompatibilities reported, after emergency release.
- B: More K-positive units would add to hemolysis and are easily avoided.
- C: A bleeding patient should not be denied blood while waiting for a titer.
Question 3 · Medium
For adult trauma patients with massive bleeding, many protocols aim to give plasma, platelets and red cells in a unit ratio close to:
1. A1:1:4
2. B1:1:1
3. C4:1:1
4. D1:2:6
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Answer: B · 1:1:1
Early, balanced replacement aims to give back whole-blood-like proportions and limit trauma-induced coagulopathy. The PROPPR trial compared plasma:platelet:red cell ratios of 1:1:1 and 1:1:2 and found fewer early deaths from bleeding with 1:1:1. In this count, one apheresis or pooled platelet dose counts as about six units. Protocols send preset packs, such as 6 red cells and 6 plasma with one platelet dose, and switch to laboratory-guided therapy once results are available.
- A: 1:1:4 gives far too little plasma and platelets for the red cells.
- C: 4:1:1 gives far more plasma than red cells and does not restore oxygen delivery.
- D: 1:2:6 is a red-cell-heavy ratio that leads to dilutional coagulopathy.
Question 4 · Hard
During a large trauma response, group O D-negative red cells are running low. Which patient should be switched to group O D-positive red cells first?
1. AA 68-year-old D-negative man
2. BA D-negative woman 30 weeks pregnant
3. CA 9-year-old D-negative girl
4. DA 24-year-old D-negative woman
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Answer: A · A 68-year-old D-negative man
The main harm of giving D-positive cells to a D-negative patient is anti-D formation, which matters most for girls and women who may become pregnant, because anti-D can cause severe HDFN. Older men, and women past childbearing age, can safely be switched to D-positive red cells when D-negative stock is short. Not every patient forms anti-D after D-positive red cells, but the risk to a future pregnancy is avoided wherever possible. D-negative units are kept for patients of childbearing potential.
- B: A pregnant woman's fetus could be harmed by anti-D in this or a later pregnancy.
- C: A girl has her childbearing years ahead and should keep D-negative units.
- D: A young woman may become pregnant, so anti-D could harm a future baby.
Question 5 · Easy
When red cells are issued before pretransfusion testing is complete, AABB standards require which record?
1. ASigned consent from the patient or family
2. BA signed statement from the requesting physician
3. CA second sample confirming the ABO group
4. DWritten approval from the medical director
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Answer: B · A signed statement from the requesting physician
In an emergency, the physician decides that waiting for testing is more dangerous than giving untested blood. AABB requires a signed statement from the requesting physician that the situation was urgent enough, and it may be signed after the blood is issued. The units are labeled to show that testing was not complete, and testing is finished as soon as possible. Group O red cells are issued if the patient's ABO group is not yet known.
- A: Consent rules for emergencies vary, but AABB specifically requires the physician's statement.
- C: Waiting for a second sample would delay emergency blood; group O cells are given instead.
- D: The medical director is told of any problems, but the requesting physician signs the statement.
Question 6 · Easy
When a bleeding patient's ABO group is not yet known, the plasma issued as universal plasma is:
1. AGroup A
2. BGroup B
3. CGroup O
4. DGroup AB
Answer and explanation in LearnFree account
Question 7 · Medium
A trauma patient has received 4 group O red cell units and 4 group AB plasma units. The pretransfusion sample now types as group A, D-positive, with a negative antibody screen, and group O and AB stocks are low. Which components should follow?
1. AGroup O red cells and group AB plasma
2. BGroup AB red cells and group A plasma
3. CGroup A red cells and group O plasma
4. DGroup A red cells and group A plasma
Answer and explanation in LearnFree account
Question 8 · Medium
Why should a sample for ABO grouping and antibody screen be drawn before the first uncrossmatched red cells are given?
1. ALater samples contain donor cells and diluted plasma
2. BGroup O donor cells change the patient's ABO group
3. CUncrossmatched units cannot be issued without it
4. DRed cell additive solutions destroy antibodies
Answer and explanation in LearnFree account
Question 9 · Hard
A 32-year-old man with a crush injury arrives at an Abu Dhabi trauma centre. His first sample, drawn before any transfusion, types group A, D-positive (A1 lectin positive), antibody screen negative. Under the massive transfusion protocol he receives 6 units of low-titer group O, D-positive whole blood (anti-A and anti-B titers below 200) in 2 hours, and bleeding continues. The protocol requires a check before switching to group A red cells. Current sample: anti-A 3+ mixed field, anti-B 0; A1 cells 1+, B cells 4+; immediate-spin crossmatch with two group A red cell units 1+. What should the blood bank conclude and do?
1. AAnti-A1 in an A2 man; give A2 red cells
2. BWeak reaction only; switch to group A cells
3. CPassive anti-A; keep issuing group O red cells
4. DHe is group O; the first sample was wrong
Answer and explanation in LearnFree account

Massive transfusion and emergency release

During massive transfusion, a bleeding patient has these results: platelets 92 × 10^9/L; PT 17 s (reference 11 to 14 s); APTT 40 s (reference 25 to 35 s); fibrinogen 0.9 g/L (90 mg/dL) (reference 2.0 to 4.0 g/L). The component that best corrects the main defect is:

Two uncrossmatched group O D-negative units were issued for a bleeding patient. Testing of the pretransfusion sample then shows anti-K, and one transfused unit was K-positive. What should the blood bank do?

For adult trauma patients with massive bleeding, many protocols aim to give plasma, platelets and red cells in a unit ratio close to:

During a large trauma response, group O D-negative red cells are running low. Which patient should be switched to group O D-positive red cells first?

When red cells are issued before pretransfusion testing is complete, AABB standards require which record?

When a bleeding patient's ABO group is not yet known, the plasma issued as universal plasma is:

A trauma patient has received 4 group O red cell units and 4 group AB plasma units. The pretransfusion sample now types as group A, D-positive, with a negative antibody screen, and group O and AB stocks are low. Which components should follow?

Why should a sample for ABO grouping and antibody screen be drawn before the first uncrossmatched red cells are given?