Pathology EMQ template.

Name: Danielle Banfield     

Theme: Blood transfusions/reactions

 

OPTION LIST

 

A

Bacterial infection

I

Transfusion associated GVHD

B

Anaphylaxis

J

Air embolism

C

TRACO

K

 

D

Delayed haemolytic TR

L

 

E

Febrile non haemolytic TR

M

 

F

TRALI

N

 

G

Massive transfusion

O

 

H

Iron overload

P

 

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 59 year old female patient is given a blood transfusion after a TAH. Two days later she is noted to have slightly yellow sclera. Blood tests reveal: Bilirubin 35, ALT 15, Alk Phos 82, Hb 8.7. The blood film shows a raised reticulocyte and urinalysis shows haemoglobinuria. The next day her renal function is shown to be deteriorating. A cross match is repeated and identifies a previously undetected red cell Ab.

 

 

2. A 23 year old unconcious female patient is brought into A&E following an RTA. She has suffered massive blood loss and is given an urgent transfusion. Shortly after the transfusion is started she becomes hypotensive and tachycardic, showing signs of respiratory distress and stridor. The patient is stabilised and moved to ITU. The family arrive and inform you that the patient is known to have a “problem with her immune system” but had a transfusion in the past with no significant reaction.

 

 

3. A 63 year old man on warfarin is brought into A&E with a laceration to the right forearm sustained whilst gardening. He is bleeding profusely and the decision is made to give him FFP to aid haemostasis. He has had one previous blood transfusion age 40. A few minutes into the infusion he becomes acutely short of breath and his oxygen saturations drop to 87% on room air. He is given oxygen but continues to deteriorate, requiring ventilation and transfer to ITU.

 

 

4. An 85 year old lady is receiving a blood transfusion for severe iron deficiency anaemia. The nurse carrying out her 15 minute observations notices the patient is pyrexial, with a temperature of 38.2 (orally measured). All other observations are stable and the patient feels well. After discussion with the doctors it is decided to continue the transfusion at a slower rate. 

 

 

5. A 15 year old boy visits his GP complaining of polyuria and polydipsia. He is known to have beta thalassaemia for which he has received regular blood transfusions since he was a child. Urinalysis shows glucose ++ and a fasting blood glucose is 13.5. The GP notes he has a tanned appearance. 

 

 

 

ANSWERS

1. D

2. B

3. F

4. E

5. H