Pathology EMQ template.

Name: Krishna Bakhai        

Theme: Blood transfusion 2

 

OPTION LIST

 

A

G+S, A, RhD neg, K neg

I

 

B

G+S, B, RhD neg, K neg

J

 

C

G+S, B, RhD pos, K neg

K

 

D

G+S, O, RhD neg, K pos

L

 

E

G+S, XM, A, RhD neg, K neg

M

 

F

G+S, XM, B, RhD neg, K neg

N

 

G

G+S, XM, O, RhD neg, K pos

O

 

H

O, RhD neg

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. 23YO F, known blood group A, need a blood transfusion because she is suffering from acute chest syndrome due to a sickle cell crisis.


2. 55YO M, known blood group O, is undergoing surgery to remove gallbladder. The antibody screen reveals that he is K positive.


3. 35YO F, known blood group B, is on a hunger strike, she is moderately anaemic and may require a transfusion if her Hb levels deteriorate.


4. 27YO M, unknown blood group, brought in via ambulance is in a critical hypovolemic state following a RTA, needs an immediate blood transfusion.

 

5. 40YO F, known blood group A, undergoing surgery to remove gallbladder.

 

 

ANSWERS

1. E

2. D

3. B

4. H

5. A

 

Notes:

 

  1. Recipient blood group A makes anti-B. So cannot give donor blood group B or AB.  Female of reproductive age must not be given K-pos or RhD-pos unless previously known to be K-pos or RhD-pos respectively.  Blood group O with RhD neg is a scarce resource that can be used as a 'universal donor' and should be used when no other alternative is available.  This is not a life-threatening emergency so there is time to do a G+S and XM.

 

  1. This procedure rarely requires blood. The G+S units are kept in storage and XM if needed. Anti-Kell antibodies can cause haemolytic transfusion reactions and are relevant in everyone. They are of particular importance in women of childbearing age due to the risk of HDFN.

 

 

  1. Female of reproductive age must not be given K-pos or RhD-pos unless previously known to be K-pos or RhD-pos respectively. The G+S units are kept in storage and XM if definitely needed as that is a complex resource intensive process.

 

  1. Most appropriate answer because in an emergency situation the lifesaving benefits of immediate transfusion outweigh risk of haemolytic transfusion reaction from anti-Kell antibodies if px is K pos or other RBC antibodies. Crossmatching takes ~1hour whereas blood group typing takes a few minutes. Hence, O RhD neg, "O neg" for short, is known as a "universal donor".

 

 

  1. This procedure rarely requires blood. The G+S units are kept in storage and XM if needed. K neg donor is of particular importance in women of childbearing age due to the risk of HDFN. Alternatively blood group O options in the list were K pos so should be excluded.