MLPAO Transfusion Medicine Case-Based Practice Flashcards

A blood bank receives two patient specimens with the same name but different dates of birth. How should this discrepancy be handled?

Answer: Do not process either specimen for transfusion until the patient identity discrepancy is resolved and a new properly identified specimen is collected

Any discrepancy in patient identification is a critical safety issue. Neither specimen should be processed until the identity confusion is resolved. A new specimen must be collected with proper bedside identification. Wrong patient identification is the leading cause of fatal ABO-incompatible transfusions. Never make assumptions about patient identity.

A D-negative woman delivers a D-positive baby and the Kleihauer-Betke test shows 1.5% fetal cells. How many vials of RhIg (300 µg) should be administered?

Answer: 3 vials

Calculation: 1.5% fetal cells × 5000 mL (estimated maternal blood volume) = 75 mL fetal whole blood. Convert to mL of fetal red cells: 75 × 0.5 (hematocrit) = 37.5 mL RBCs. Each 300 µg vial covers 30 mL of fetal red cells. 37.5/30 = 1.25, round up to 2, then add 1 safety vial = 3 vials. (Some institutions use the formula: divide mL fetal bleed by 30, round up, add 1.)

A patient has a positive DAT and the serum reacts with all panel cells. The autocontrol is also positive. How should the blood bank proceed?

Answer: Perform autoabsorption to remove autoantibody, test the absorbed serum for underlying alloantibodies, and provide antigen-matched blood if alloantibodies are found

When autoantibody masks potential alloantibodies, autoabsorption is performed (patient cells adsorb autoantibody from serum). The absorbed serum is tested for alloantibodies. If the patient was recently transfused, allogeneic adsorption (using selected reagent cells) is used instead, as the patient's circulating cells include transfused cells. Antigen-matched blood is provided based on patient phenotype.

What is the correct storage temperature for platelets and what is their shelf life?

Answer: 20-24°C with continuous gentle agitation for 5-7 days

Platelets are stored at 20-24°C with continuous gentle agitation to maintain gas exchange and prevent clumping. The shelf life is 5 days (or 7 days with pathogen reduction technology). The short shelf life and room temperature storage make platelets susceptible to bacterial contamination, which is monitored by bacterial detection systems.

A physician orders 'type-specific blood' for a patient in moderate hemorrhage. What does the blood bank provide?

Answer: ABO/Rh-type-specific blood with an abbreviated crossmatch (immediate spin) before full testing is complete

Type-specific blood means ABO and Rh-compatible blood based on the patient's confirmed blood type, issued with an abbreviated (immediate-spin) crossmatch or before the antibody screen is complete. This provides blood faster than a full crossmatch while still ensuring ABO compatibility. The full type and screen/crossmatch is completed as soon as possible.

A transfusion sample is received in the blood bank with a label that has the patient's name but no second identifier. What should be done?

Answer: Reject the specimen and request a new properly labeled specimen collected with bedside identification

A specimen missing a required identifier (two independent identifiers are mandatory) must be rejected. A new specimen must be collected at the bedside with proper patient identification. No exceptions should be made, as mislabeled specimens are the most common cause of fatal transfusion errors. This policy must be enforced consistently.