Blood Transfusion
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1002 Surgery Essence
22. All of the following are major complications of massive c. Coagulation factor levels are equal to Plasma
transfusion except: (All India 2006) d. None of the above
a. Hypokalemia b. Hypothermia 29. Stored plasma is deficient in: (PGI 79, DNB 90)
c. Hypomagnesaemia d. Hypocalcaemia a. Factors 7 and 8 b. Factors 2 and 5
23. Massive transfusions results in: (PGI 88) c. Factors 5 and 8 d. Factors 7 and 9
a. DIC b. Hypothermia 30. With reference to fresh frozen plasma (FFP), which one of
c. Hypercalcemia d. Thrombocytopenia the following statement is not correct? (UPSC 2008)
a. It is used as volume expander
b. It is stored at 40C to 50C
RED BLOOD CELLS c. It is a source of coagulation factors
24. The maximum life of a transfused RBC is: d. It is given in a dose of 12-15 ml/kg body weight
(JIPMER 80, DNB 89) 31. In cholecystectomy, fresh frozen plasma should be given:
a. One hour b. One day a. Just before operation (UPPG 2008)
c. 15 days d. 50 days b. At the time of operation
E. 100 days c. 6 hours before operation
d. 12 hours after operation
32. Half life of factor VIII is: (PGI 88)
PLATELETS a. 4 hours b. 8 hours
25. Platelets can be stored at: (AIIMS Nov 2005) c. 34 hours d. 48 hours
a. 20-24C for 5 days b. 20-24C for 8 days 33. Rosenthals syndrome is seen in deficiency of factor:
c. 4-8C for 5 days d. 4-8C for 8 days a. II b. V (AIIMS 81, DNB 91)
26. Blood platelets in stored blood do not remain functional c. IX d. XI
after: (PGI 88, 81, AIIMS 86)
Section 10: Others
27. Indication of fresh frozen plasma is/are: (PGI Nov 2011) 35. Cryoprecipitate is a rich source of: (PGI 79, AIIMS 85)
a. Hypovolemia a. Thromboplastin b. Factor VIII
b. Nutritional supplement c. Factor X d. Factor VII
c. Coagulation factor deficiency 36. Which one of the following blood fractions is stored at
d. Warfarin toxicity -40C? (UPSC 2006)
e. Hypoalbuminemia a. Cryoprecipitate b. Human albumin
28. True about FFP (Fresh frozen plasma) is the following c. Platelet concentrate d. Packed red cells
except: (MHPGMCET 2009) 37. Cryoprecipitate contains all except: (AIIMS Nov 2007)
a. Good source of all coagulation factors a. Factor VIII b. Factor IX
b. Prepared from single unit of blood c. Fibrinogen d. VWF
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Blood Transfusion 1003
EXPLANATIONS
BLOOD TRANSFUSION
1. Ans. a. Febrile non-hemolytic transfusion reaction (Ref: Harrison 18/e p954-956)
Febrile non-hemolytic transfusion reaction is the most common complication associated with the transfusion of cellular blood
components.
General Electrolyte
Fluid overload Q
Hyperkalemia Q
HypothermiaQ HypocalcemiaQ
Impaired oxygen delivery capacity of HbQ HypomagnesemiaQ
(decreased 2, 3-DPG) Metabolic alkalosisQ
Metabolic acidosis (rare)Q
4. Ans. d. 24 hours
5. Ans. b. Direct Coombs test (Ref: Harrison 18/e p954)
Direct Coombs test or direct antiglobulin test on post-transfusion blood sample from patient should be done to detect
antibodies directed against the transfused RBCsQ.
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7. Ans. a. O negative (Ref: Harrison 18/e p951; Bailey 26/e p21-22, 25/e p21-22)
Unmatched blood group of the same group Group O RBCs are chosen
should be used Such unmatched blood should be Rh negative,
when used in women of child bearing age, in whom
sensitization to Rh antigen would be undesirable
Rh positive blood can be used if Rh negative blood is
not available in older females and males
8. Ans. b. 1 gm%
9. Ans. a. Complement mediated hemolysis is seen (Ref: Harrison 18/e p954)
Acute hemolytic transfusion reactions following blood transfusion are type II hypersensitivity reactions caused most often by
the complement mediated hemolysisQ.
These reactions are often life-threatening and complications include oliguria and acute renal failure (decreased renal blood flow)Q.
10. Ans. a. Antigen D determines Rh positivity; b. Febrile reaction is due to HLA antigens (Ref: Harrison 18/e p954)
Rh positive or negative status depends on the presence or absence of antigen D (Rh D) on RBCsQ.
Section 10: Others
Febrile (non-hemolytic) reactions are caused by antibodies directed against donor leucocytes and HLA antigen may mediate
these reactionsQ.
11. Ans. b. Hematocrit
12. Ans. d. Whole blood volume
13. Ans. c. 28 days (Ref: Sabiston 19/e p588)
Whole Blood
Anticoagulant used Maximum storage
ACD/CPD/CP2D 21 daysQ
CPDA-1 35 daysQ
(citrate phosphate dextrose adenine)
14. Ans. b. Dilutional thrombocytopenia
15. Ans. d. All of the above (Ref: Clinical Laboratory Medicine 6/e p396)
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Blood Transfusion 1005
Dextran
It is a polysaccharide polymer of varying molecular weight producing an osmotic pressure similar to the plasma
Disadvantages:
It induces rouleaux of RBCs and this interferes with blood grouping and cross matchingQ procedures, hence need for a blood
sample beforehand.
It interferes with platelet function, hence it is recommended that total volume of dextran should not exceed 1000 mL.
LMW dextran (short acting) prevents sludging of RBCs in vessels and renal shut down in severe
hypotension and it is less likely to induce rouleaux formation than HMW dextran (long acting).
21. Ans. b. Hypotension and bleeding from site of wound (Ref: Schwartz 10/e p119,122,171-172, 9/e p83)
Schwartz says In patients who are anesthetized and have an open wound, the two dominant signs (of mismatched blood
transfusion) are diffuse bleeding and hypotension.
MC symptom of hemolytic transfusion reactions in a conscious patient: Sensation of heat and pain along the vein into which
the blood is being transfusedQ.
MC sign of hemolytic transfusion reactions in a conscious patient: OliguriaQ >hemoglobinuria.
PLATELETS
25. Ans. a. 20-240 C for 5 days
(Ref: Harrison 18/e p953; Sabiston 19/e p588; Schwartz 10/e p85, 9/e p79; Bailey 26/e p21, 25/e p21)
Platelet Concentrates
Volume: 50 ml Q
Platelets are the only blood products which are stored at room temperature, 20-240 CQ (survival is 4-5 days)Q.
1 unit of platelet increases the count by 5000-10000Q.
PLASMA
27. Ans. c. Coagulation factor deficiency; d. Warfarin toxicity (Ref: Harrison 18/e p953; Sabiston 19/e p588)
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Most labile clotting factors (V and VIII) may be diminishedQ proportional to shelf life.
FFP contains stable coagulation factors and plasma proteins: fibrinogen, antithrombin, albumin, proteins C and SQ.
The question is incomplete. It should be A cirrhotic patient with abnormalcoagulation needs cholecystectomy, FFP should be given:
The half-life on the most stable clotting factor, factor VII, is 4 to 6 hoursQ.
A reasonable transfusion scheme would be to give FFP on call to the operating room.
This way the transfusion is complete prior to the incision, with circulating factors to cover the operative and immediate
postoperative periodQ.
CRYOPRECIPITATE
34. Ans. c. Factor VIII (Ref: Harrison 18/e p953; Sabiston 19/e p588; Schwartz 10/e p73-75,1599, 9/e p82; Bailey 26/e p21, 25/e p21)
Cryoprecipitate
Cryoprecipitate is a source of fibrinogenQ, factor VIIIQ and von Willebrand factor (vWF)Q.
It is ideal for supplying fibrinogen to the volume-sensitive patient.
Stored at -180C
1 unit of cryoprecipitate contains 80-145 units of Factor VIII and 250 mg of fibrinogenQ.
Cryoprecipitate is pooled from many donors, so there are maximum chances of disease transmission among all
blood productsQ.
Cryoprecipitate may also supply vWF to patients with dysfunctional (type II) or absent (type III) von Willebrand disease.
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