Andy Test - Bcsh Guideline On Massive Transfusion

1. 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.

True

False

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.

Explanation

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.

2. 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.

True

False

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.

Explanation

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.

3. The critical level of fibrinogen (1.0g/l) after which coagulopathy can occur is likely to be reached after about 150% blood volume loss.

True

False

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.

Explanation

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.

4. 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

True

False

Treatment of the coagulation defects consists of platelets, FFP and cryoprecipitate given “sooner rather than later” in sufficient dosage, but avoiding circulatory overload

Explanation

Treatment of the coagulation defects consists of platelets, FFP and cryoprecipitate given “sooner rather than later” in sufficient dosage, but avoiding circulatory overload

5. Which of the following are therapeutic goals of managing massive blood loss?

Use of blood component therapy to correct coagulopathy to arrest bleeding

Treating any traumatic, surgical or obstetric source to arrest bleeding

To prevent the patient being sensitised and making atypical red cell alloantibodies

Maintenance of tissue perfusion and oxygenation

To end an acute sickle crisis in patients suffering from sickle cell disease

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.

Explanation

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.

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6. 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.

True

False

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.

Explanation

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.

7. The transfusion trigger for platelets in a patient who is actively bleeding is 50 x 109/l.

True

False

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)

Explanation

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)

8. The role of the Hospital Transfusion Committee include:

Developing an Emergency Blood Management Plan

Reviewing massive transfusion episodes critically

Making decisions on when a patient should cease to receive energetic transfusion support

The development of protocols for management of massive transfusions

Providing guidance on clinical priorities for use of large volumes of blood components

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.

Explanation

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.

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9. Which of the following are accepted definitions of “massive blood loss”?

One blood volume within a 24h period

Transfusion rate of ≥ 6 units within a 24h period

A haemoglobin level of less than 40g/l

50% of the blood volume in a 3h period

Blood loss of ≥ 150ml/min

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.

Explanation

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.

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10. According to the guideline, when should group O RhD negative blood be used in massive transfusions?

In pre-menopausal women only

Never

Until bleeding in the patient slows sufficiently to make ABO and RhD matching the patient worthwhile

In an extreme emergency only

Until the ABO and RhD of the patient is known

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.

Explanation

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.

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11. The over-riding first requirement is maintenance of tissue perfusion and oxygenation.

True

False

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.

Explanation

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.

12. Which of the following hazards of transfusion are cited in the guideline as particular problems associated with massive transfusion?

Acute haemolytic transfusion reaction

Delayed haemolytic transfusion reaction

Transfusion-transmitted infections

Transfusion-related acute lung injury

Transfusion-associated graft versus host disease

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.

Explanation

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.

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