Andy Test - Bcsh Guideline On Massive Transfusion
This quiz is to test how well you know the BCSH Guidelines on Massive Transfusion
- 1.
Which of the following are accepted definitions of “massive blood loss”?
- A.
One blood volume within a 24h period
- B.
Transfusion rate of ≥ 6 units within a 24h period
- C.
A haemoglobin level of less than 40g/l
- D.
50% of the blood volume in a 3h period
- E.
Blood loss of ≥ 150ml/min
Correct Answer(s)
A. One blood volume within a 24h period
D. 50% of the blood volume in a 3h period
E. Blood loss of ≥ 150ml/minExplanation
Massive blood loss can be defined as one blood volume within a 24-hour period, 50% of the blood volume in a 3-hour period, or blood loss of ≥ 150ml/min. These definitions indicate a significant amount of blood loss that can have severe consequences on the body's ability to maintain adequate perfusion and oxygenation.Rate this question:
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- 2.
The role of the Hospital Transfusion Committee include:
- A.
Developing an Emergency Blood Management Plan
- B.
Reviewing massive transfusion episodes critically
- C.
Making decisions on when a patient should cease to receive energetic transfusion support
- D.
The development of protocols for management of massive transfusions
- E.
Providing guidance on clinical priorities for use of large volumes of blood components
Correct Answer(s)
A. Developing an Emergency Blood Management Plan
B. Reviewing massive transfusion episodes critically
D. The development of protocols for management of massive transfusions
E. Providing guidance on clinical priorities for use of large volumes of blood componentsExplanation
The correct answer includes the key responsibilities of the Hospital Transfusion Committee. These responsibilities involve developing an Emergency Blood Management Plan, reviewing massive transfusion episodes critically, developing protocols for the management of massive transfusions, and providing guidance on clinical priorities for the use of large volumes of blood components. These tasks highlight the committee's role in ensuring effective and safe blood transfusion practices within the hospital setting.Rate this question:
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- 3.
According to the guideline, when should group O RhD negative blood be used in massive transfusions?
- A.
In pre-menopausal women only
- B.
Never
- C.
Until bleeding in the patient slows sufficiently to make ABO and RhD matching the patient worthwhile
- D.
In an extreme emergency only
- E.
Until the ABO and RhD of the patient is known
Correct Answer(s)
D. In an extreme emergency only
E. Until the ABO and RhD of the patient is knownExplanation
Group O RhD negative blood should be used in massive transfusions in an extreme emergency only, until the ABO and RhD of the patient is known. This means that if there is a situation where there is a severe and life-threatening bleeding and there is no time to determine the patient's blood type and RhD status, group O RhD negative blood can be used temporarily until the patient's blood type and RhD status are determined. Once the patient's blood type and RhD status are known, transfusions can be matched accordingly to minimize potential complications.Rate this question:
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- 4.
Which of the following are therapeutic goals of managing massive blood loss?
- A.
Use of blood component therapy to correct coagulopathy to arrest bleeding
- B.
Treating any traumatic, surgical or obstetric source to arrest bleeding
- C.
To prevent the patient being sensitised and making atypical red cell alloantibodies
- D.
Maintenance of tissue perfusion and oxygenation
- E.
To end an acute sickle crisis in patients suffering from sickle cell disease
Correct Answer(s)
A. Use of blood component therapy to correct coagulopathy to arrest bleeding
B. Treating any traumatic, surgical or obstetric source to arrest bleeding
D. Maintenance of tissue perfusion and oxygenationExplanation
The therapeutic goals of managing massive blood loss include using blood component therapy to correct coagulopathy and arrest bleeding, treating any traumatic, surgical, or obstetric source to arrest bleeding, and maintaining tissue perfusion and oxygenation. These goals aim to address the underlying causes of bleeding, restore normal blood clotting function, and ensure adequate oxygen delivery to tissues. Additionally, preventing the patient from being sensitized and making atypical red cell alloantibodies is not a therapeutic goal specifically related to managing massive blood loss. Ending an acute sickle crisis in patients suffering from sickle cell disease is also not directly related to managing massive blood loss.Rate this question:
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- 5.
Which of the following hazards of transfusion are cited in the guideline as particular problems associated with massive transfusion?
- A.
Acute haemolytic transfusion reaction
- B.
Delayed haemolytic transfusion reaction
- C.
Transfusion-transmitted infections
- D.
Transfusion-related acute lung injury
- E.
Transfusion-associated graft versus host disease
Correct Answer(s)
A. Acute haemolytic transfusion reaction
D. Transfusion-related acute lung injuryExplanation
The guideline cites acute haemolytic transfusion reaction and transfusion-related acute lung injury as particular problems associated with massive transfusion. Acute haemolytic transfusion reaction occurs when there is a mismatch between the donor and recipient blood types, leading to the destruction of red blood cells and potentially life-threatening complications. Transfusion-related acute lung injury is a rare but serious condition characterized by acute respiratory distress following a blood transfusion. Both of these hazards are highlighted in the guideline as significant concerns when performing massive transfusions.Rate this question:
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- 6.
The critical level of fibrinogen (1.0g/l) after which coagulopathy can occur is likely to be reached after about 150% blood volume loss.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because fibrinogen plays a crucial role in blood clotting. When blood loss occurs, the body tries to compensate by increasing the production of fibrinogen to promote clot formation. However, if the fibrinogen level drops below a critical level (1.0g/l), it can lead to coagulopathy, a condition where blood clotting is impaired. Since the statement suggests that this critical level is reached after about 150% blood volume loss, it implies that a significant amount of blood loss is required to reach that point and potentially trigger coagulopathy.Rate this question:
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- 7.
The transfusion trigger for platelets in a patient who is actively bleeding is 50 x 109/l.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
50 x 109/l is the level below which platelets, in an actively bleeding patient, should not fall (to maintain haemostasis) – it is not the transfusion trigger which is 75 x 109/l (100 x 109/l in those patients with multiple high-velocity trauma or CNS injury)Rate this question:
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- 8.
One of the most common metabolic consequences of massive transfusion is hypocalcaemia (reduced calcium levels) which may occur as a result of transfusing large volumes of plasma, especially in the presence of abnormal liver function. This can be corrected by intravenous infusion of gluconate.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Gluconate should not be used to correct hypocalcaemia in these cases as it required metabolism by the liver to release its calcium. Intravenous calcium chloride should be used.Rate this question:
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- 9.
The over-riding first requirement is maintenance of tissue perfusion and oxygenation.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement "The over-riding first requirement is maintenance of tissue perfusion and oxygenation" is true. Tissue perfusion refers to the adequate blood flow to the tissues, ensuring that they receive enough oxygen and nutrients. Oxygenation is the process of oxygen being delivered to the tissues. Both tissue perfusion and oxygenation are crucial for the proper functioning of the body and the survival of cells. Therefore, maintaining tissue perfusion and oxygenation is indeed the primary requirement for the body.Rate this question:
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- 10.
Treatment of coagulation defects (using platelets, cryoprecipitate and FFP) should be done once all the test results are known to avoid making the defects worse
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Treatment of the coagulation defects consists of platelets, FFP and cryoprecipitate given “sooner rather than later” in sufficient dosage, but avoiding circulatory overloadRate this question:
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- 11.
Coagulation factor deficiency (the primary cause of coagulopathy in massive transfusion) is often caused by dilution of the coagulation factors by volume replacement therapies (crystalloids and colloids) and transfusion of red cell products.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because coagulation factor deficiency, which is the primary cause of coagulopathy in massive transfusion, can occur due to dilution of the coagulation factors by volume replacement therapies such as crystalloids and colloids. Additionally, transfusion of red cell products can also contribute to this deficiency. Therefore, both volume replacement therapies and red cell transfusions can lead to coagulation factor deficiency and subsequent coagulopathy in the context of massive transfusion.Rate this question:
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- 12.
Recombinant factor VIIa (licensed for use in haemophiliacs to treat active bleeding or as prophylaxis before surgery) can be used off-licence to reduce blood loss in massive transfusion cases although the evidence for this is only anecdotal.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Recombinant factor VIIa, which is licensed for use in haemophiliacs, can be used off-licence to reduce blood loss in cases of massive transfusion. However, the evidence supporting this use is only anecdotal, meaning that it is based on personal accounts rather than scientific studies. Therefore, the statement that recombinant factor VIIa can be used off-licence to reduce blood loss in massive transfusion cases is true.Rate this question:
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Mar 21, 2023Quiz Edited by
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Aug 14, 2009Quiz Created by
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