Blood Component Therapy — MCQs

10 questions

A patient on aspirin for secondary prevention of cardiovascular disease is selected for an elective surgery with low-to-moderate bleeding risk. What should be done regarding aspirin management?

A blood donor is not considered for safe transfusion if he has:

An elderly patient is receiving a blood transfusion for anemia due to myelodysplastic syndrome (MDS). He was diagnosed with MDS two years ago and has required blood transfusions every six weeks for symptomatic anemia over the past six months. His past medical history also includes hypertension, type 2 diabetes, and coronary artery disease. Halfway through the transfusion of the second unit of packed red blood cells, he develops tachypnea, lumbar pain, tachycardia, and nausea. Which of the following is the most likely explanation?

A patient who presented with blunt abdominal injury underwent complete repair of liver and was given transfusion of 12 units of whole blood. Thereafter, it is found that the wound is bleeding. It is treated by

A child presents with recurrent chest infections and abdominal pain. There is a history of 1 blood transfusion in the past. On examination, he had icterus and mild splenomegaly. Electrophoresis shows increased HbA2, HbF, and S spike. What is the likely diagnosis?

Which one of the following drugs is used for fetal therapy of congenital adrenal hyperplasia?

A pregnant woman presents at 28 weeks of gestation with haemoglobin level of 7 gm%; and peripheral smear reveals it to be of microcytic hypochromic type. What would be the correct option of therapy?

Normal reticulocyte count at birth is

HIV RNA by PCR can detect as low as

Q10

Management of typical febrile seizures includes all except:

Blood Component Therapy Indian Medical PG Practice Questions and MCQs

Question 1: A patient on aspirin for secondary prevention of cardiovascular disease is selected for an elective surgery with low-to-moderate bleeding risk. What should be done regarding aspirin management?

A. Stop aspirin for 7 days
B. Infusion of fresh frozen plasma
C. Infusion of platelet concentrate
D. Go ahead with surgery maintaining adequate hemostasis (Correct Answer)

Explanation: ***Go ahead with surgery maintaining adequate hemostasis*** - For patients on **aspirin for secondary prevention** undergoing **low-to-moderate bleeding risk elective surgery**, current guidelines (ACC/AHA, ESC) recommend **continuing aspirin** perioperatively. - The risk of **major adverse cardiovascular events** (MI, stroke, cardiovascular death) from stopping aspirin outweighs the increased bleeding risk in most surgical procedures. - **Adequate hemostasis** can typically be achieved with careful surgical technique, and aspirin-related bleeding is usually manageable. - Examples of low-moderate risk surgeries: most general surgical procedures, orthopedic procedures, dental procedures, cataract surgery. *Stop aspirin for 7 days* - Stopping aspirin **7-10 days** before surgery is recommended only for **high-bleeding-risk procedures** where bleeding would be catastrophic (intracranial neurosurgery, spinal canal surgery, posterior chamber eye surgery, transurethral prostate resection). - This allows time for **platelet function recovery** (platelet lifespan is 7-10 days), as aspirin irreversibly inhibits platelet cyclooxygenase. - However, for **low-to-moderate risk surgeries**, stopping aspirin increases thrombotic risk without sufficient bleeding risk reduction benefit. *Infusion of fresh frozen plasma* - **Fresh frozen plasma (FFP)** contains clotting factors but **no functional platelets**, so it cannot reverse aspirin's antiplatelet effect. - Aspirin inhibits **platelet function**, not coagulation factors, making FFP ineffective for this indication. - FFP is used for **coagulation factor deficiencies**, warfarin reversal, or massive transfusion protocols—not for aspirin-induced platelet dysfunction. *Infusion of platelet concentrate* - **Platelet transfusion** is not routinely recommended prophylactically for aspirin-treated patients undergoing surgery. - It may be considered for **active severe bleeding** during surgery when aspirin is contributing, or in emergency high-risk procedures when aspirin cannot be stopped in advance. - Routine prophylactic platelet transfusion has **transfusion-related risks** (infection, allergic reactions, TRALI) that outweigh benefits in elective surgery.

Question 2: A blood donor is not considered for safe transfusion if he has:

A. Anti-HBc +ve
B. HBsAg +ve and IgM anti-HBc +ve (Correct Answer)
C. Anti-HBsAg +ve
D. Anti-HBsAg and anti-HBc (+)ve

Explanation: ***HBsAg +ve and IgM anti-HBc +ve*** - A positive **HBsAg** indicates current hepatitis B infection, making the donor unsuitable for transfusion due to the risk of transmission [2]. - The presence of **IgM anti-HBc** further confirms a recent or acute infection, enhancing the risk of infectivity [2], [3]. *Anti-HBc +ve* - A positive **anti-HBc** (total) alone can indicate a past resolved infection or chronic infection, but does not always rule out donation, especially if HBsAg is negative and anti-HBs is positive [3]. - In many settings, donors with isolated anti-HBc positive results might be deferred, but it's not as definitive a contraindication as HBsAg positivity. *Anti-HBsAg +ve* - A positive **anti-HBsAg** (HBsAb) indicates immunity to hepatitis B, either due to vaccination or past resolved infection [3]. - Donors with only anti-HBsAg positivity are generally considered safe for transfusion as they are not infectious and may even provide protective antibodies [1]. *Anti-HBsAg and anti-HBc (+)ve* - This profile typically indicates a **resolved hepatitis B infection** with established immunity [3]. - Such individuals are considered safe donors as they are not actively infected and pose no risk of transmitting hepatitis B [1].

Question 3: An elderly patient is receiving a blood transfusion for anemia due to myelodysplastic syndrome (MDS). He was diagnosed with MDS two years ago and has required blood transfusions every six weeks for symptomatic anemia over the past six months. His past medical history also includes hypertension, type 2 diabetes, and coronary artery disease. Halfway through the transfusion of the second unit of packed red blood cells, he develops tachypnea, lumbar pain, tachycardia, and nausea. Which of the following is the most likely explanation?

A. fluid overload
B. hemolysis (Correct Answer)
C. pulmonary embolism
D. anxiety

Explanation: ***hemolysis*** * The sudden onset of **tachypnea**, **lumbar pain**, and **tachycardia** during a blood transfusion is highly suggestive of an acute **hemolytic transfusion reaction**. Lumbar pain is a classic symptom due to **hemoglobinuria** and acute kidney injury [1]. * Patients with a history of frequent transfusions, like this patient with **myelodysplastic syndrome (MDS)**, are at increased risk for developing **alloantibodies** that can cause such reactions [1]. *anxiety* * While anxiety can cause **tachycardia** and **tachypnea**, it typically does not present with **lumbar pain** or **nausea** specifically during a transfusion. * Anxiety is a less specific diagnosis given the constellation of sudden, severe symptoms occurring precisely mid-transfusion. *fluid overload* * **Fluid overload** (TRALI) typically presents with signs of respiratory distress, such as **dyspnea**, **cough**, and **pulmonary edema**, but not typically with severe **lumbar pain**. * While a patient with underlying cardiovascular disease is at risk, the sudden onset of lumbar pain points away from isolated fluid overload. *pulmonary embolism* * **Pulmonary embolism (PE)** can cause tachypnea and tachycardia, but the presence of **lumbar pain** and **nausea** during a transfusion makes it a less likely primary diagnosis. * PE symptoms are generally more acutely focused on respiratory and cardiovascular compromise, often without the systemic symptoms seen here.

Question 4: A patient who presented with blunt abdominal injury underwent complete repair of liver and was given transfusion of 12 units of whole blood. Thereafter, it is found that the wound is bleeding. It is treated by

A. Vitamin-K
B. Platelet concentrates (Correct Answer)
C. Calcium gluconate/calcium chloride
D. Fresh Frozen Plasma

Explanation: ***Platelet concentrates*** - Transfusion of **large volumes of whole blood** can lead to **dilutional coagulopathy**, primarily affecting platelet count and function. - The most effective immediate treatment for bleeding due to dilutional coagulopathy after massive transfusion is the administration of **platelet concentrates** to replenish platelet levels. *Vitamin-K* - **Vitamin-K** is essential for the synthesis of **coagulation factors II, VII, IX, and X** in the liver. - Its administration is typically indicated for patients with **warfarin overdose** or **liver dysfunction**, neither of which is the primary cause of bleeding in this scenario. *Calcium gluconate/calcium chloride* - **Calcium** is an important cofactor in several steps of the coagulation cascade. - While citrate in transfused blood can chelate calcium, significant **symptomatic hypocalcemia** affecting coagulation is less common and usually does not manifest as persistent surgical site bleeding. *Fresh Frozen Plasma* - **Fresh Frozen Plasma (FFP)** provides a broad spectrum of **coagulation factors**, addressing deficiencies in clotting factors. - While FFP can be helpful in massive transfusion protocols, the primary issue after 12 units of whole blood is often **dilutional thrombocytopenia**, making platelet concentrates a more direct and effective initial treatment for sustained bleeding.

Question 5: A child presents with recurrent chest infections and abdominal pain. There is a history of 1 blood transfusion in the past. On examination, he had icterus and mild splenomegaly. Electrophoresis shows increased HbA2, HbF, and S spike. What is the likely diagnosis?

A. HbC disease
B. Sickle cell disease
C. Aplastic anemia
D. Sickle Beta Thalassemia (Correct Answer)

Explanation: ***Sickle Beta Thalassemia*** - The combination of **sickle cell disease manifestations** (recurrent chest infections, abdominal pain, icterus, splenomegaly) with **electrophoresis showing increased HbA2, elevated HbF, and S spike** is diagnostic of **Sickle Beta Thalassemia**. - **Increased HbA2 (>3.5%)** is the key distinguishing feature that differentiates this from pure sickle cell disease. It indicates co-inheritance of a **beta-thalassemia gene** along with the **sickle cell gene**. - Clinical presentation is similar to sickle cell disease with **vaso-occlusive crises**, **acute chest syndrome**, hemolytic anemia, and organomegaly. - The severity depends on the type: S/β⁰-thalassemia (no HbA production) is clinically more severe and similar to SS disease, while S/β⁺-thalassemia (reduced HbA) tends to be milder. *Sickle cell disease* - Pure sickle cell disease (HbSS) presents with similar clinical features: recurrent chest infections, abdominal pain, hemolysis, and splenomegaly. - However, electrophoresis would show **normal or only slightly elevated HbA2 (2-3%)**, not the increased HbA2 mentioned in this case. - The presence of significantly increased HbA2 rules out pure sickle cell disease. *HbC disease* - Patients with HbC disease typically have **mild chronic hemolytic anemia** and **splenomegaly** but usually lack severe vaso-occlusive crises. - Electrophoresis would show primarily **HbC**, not an S spike. - The clinical picture is much milder than described in this case. *Aplastic anemia* - Characterized by **pancytopenia** due to bone marrow failure, leading to fatigue, infections, and bleeding tendency. - Does not involve hemolysis, icterus, or abnormal hemoglobin variants on electrophoresis. - The electrophoresis findings completely exclude this diagnosis.

Question 6: Which one of the following drugs is used for fetal therapy of congenital adrenal hyperplasia?

A. Hydrocortisone
B. Prednisolone
C. Dexamethasone (Correct Answer)
D. Fludrocortisone

Explanation: ***Dexamethasone*** - **Dexamethasone** is used for fetal therapy of congenital adrenal hyperplasia (CAH) to suppress fetal adrenal androgen production, thus preventing virilization in female fetuses [2]. - It is chosen because it is an **active glucocorticoid** that crosses the placenta and is not significantly metabolized by the placenta, directly acting on the fetal adrenal glands. *Hydrocortisone* - **Hydrocortisone** is a glucocorticoid that is largely inactivated (metabolized to cortisone) by the placental enzyme **11̢-hydroxysteroid dehydrogenase type 2**, making it ineffective for fetal therapy. - While it's a common therapeutic for adrenal insufficiency, its placental inactivation limits its utility in directly treating the fetus during pregnancy [1]. *Prednisolone* - **Prednisolone**, like hydrocortisone, is also significantly inactivated by the placental enzyme **11̢-hydroxysteroid dehydrogenase type 2**. - This inactivation prevents sufficient amounts of the active drug from reaching the fetal circulation to suppress adrenal androgen synthesis effectively. *Fludrocortisone* - **Fludrocortisone** is primarily a **mineralocorticoid** used for salt-wasting forms of CAH to replace aldosterone [1]. - It does not effectively suppress adrenal androgen overproduction, which is the main goal of prenatal therapy for preventing virilization.

Question 7: A pregnant woman presents at 28 weeks of gestation with haemoglobin level of 7 gm%; and peripheral smear reveals it to be of microcytic hypochromic type. What would be the correct option of therapy?

A. Blood transfusion
B. Oral iron and folic acid therapy
C. Injectable iron therapy (Correct Answer)
D. Oral iron therapy

Explanation: ***Injectable iron therapy*** - With a hemoglobin of **7 gm%** at **28 weeks of gestation**, the patient has **severe anemia** that requires a rapid increase in hemoglobin. - **Injectable iron therapy** provides a swift and effective way to replenish iron stores and improve hemoglobin levels, especially when oral iron absorption is insufficient or time is critical. *Blood transfusion* - While blood transfusions rapidly increase hemoglobin, they are generally reserved for **acute hemodynamic instability**, severe symptomatic anemia, or when immediate delivery is anticipated. - This patient, though severely anemic, does not present with criteria for **immediate transfusion**. *Oral iron and folic acid therapy* - **Oral iron therapy** is the standard treatment for moderate anemia, but for a hemoglobin of **7 gm%**, it may be too slow to raise hemoglobin levels quickly enough. - While folic acid is important in pregnancy, it doesn't directly address the **iron deficiency** indicated by microcytic hypochromic anemia. *Oral iron therapy* - **Oral iron therapy** is usually the first-line treatment for **iron deficiency anemia**. - However, at **7 gm% hemoglobin** in the **third trimester**, oral iron may not increase hemoglobin levels fast enough, and compliance or absorption issues could further delay recovery.

Question 8: Normal reticulocyte count at birth is

A. 2-6% (Correct Answer)
B. 1-2%
C. 6-10%
D. 30-40%

Explanation: ***2-6%*** - At birth, the normal **reticulocyte count** is elevated primarily due to the physiological stress of **adapting to extrauterine life** and increased erythropoiesis. - This higher range reflects the body's need for a rapid turnover of red blood cells to meet oxygen demands after birth. *1-2%* - This range is considered a **normal reticulocyte count** for **older children and adults**, indicating a steady state of red blood cell production. - It does not account for the **physiological erythropoietic surge** observed in healthy neonates. *6-10%* - While higher than adult levels, a range of **6-10%** in a neonate would still be considered unusually high and might suggest **pathological hemolysis** or significant **blood loss**. - Without other supporting clinical signs, this level is typically higher than the **physiological norm**. *30-40%* - A reticulocyte count of **30-40%** at birth is **extremely elevated** and is highly indicative of a severe underlying condition such as **hemolytic disease of the newborn** or significant **neonatal hemorrhage**. - This level is far beyond the **normal physiological response** and requires urgent investigation.

Question 9: HIV RNA by PCR can detect as low as

A. 50 copies of viral RNA/ml of blood (Correct Answer)
B. 60 copies of viral RNA/ml of blood
C. 40 copies of viral RNA/ml of blood
D. 30 copies of viral RNA/ml of blood

Explanation: ***50 copies of viral RNA/ml of blood*** - **HIV RNA PCR assays** used in clinical practice have a standard detection limit of **50 copies/mL**, which is the widely accepted threshold for defining "undetectable viral load." - This detection limit is used by most major **viral load testing platforms** including Abbott RealTime HIV-1 and Roche COBAS assays. - Achieving viral load **<50 copies/mL** is the goal of antiretroviral therapy (ART) and indicates effective **viral suppression**. - This has been the **standard clinical threshold** used in treatment monitoring and guidelines. *60 copies of viral RNA/ml of blood* - A detection limit of 60 copies/mL is **above the standard threshold** of 50 copies/mL used in clinical practice. - This would be considered less sensitive than conventional **HIV RNA PCR assays**. - Patients with viral loads between 50-60 copies/mL might be misclassified using this threshold. *40 copies of viral RNA/ml of blood* - While some **ultrasensitive assays** can detect down to 20-40 copies/mL, this is not the standard detection limit cited in most medical literature. - The **clinical standard** remains 50 copies/mL for defining undetectable viral load. - Detection at 40 copies/mL represents enhanced sensitivity but is not the commonly referenced threshold. *30 copies of viral RNA/ml of blood* - Some newer generation assays claim detection limits of 20-30 copies/mL, but this is not the **standard clinical threshold**. - The universally accepted detection limit for **HIV viral load testing** is **50 copies/mL**. - While greater sensitivity is theoretically better, 50 copies/mL remains the benchmark for treatment monitoring.

Question 10: Management of typical febrile seizures includes all except:

A. Intermittent diazepam
B. Sponging
C. Paracetamol or ibuprofen
D. Prophylactic phenobarbitone (Correct Answer)

Explanation: ***Prophylactic phenobarbitone*** - **Continuous prophylactic anticonvulsant therapy** with phenobarbitone is **definitively NOT recommended** for typical (simple) febrile seizures - The risks of chronic anticonvulsant use—including **sedation, cognitive impairment, and behavioral problems**—significantly outweigh any potential benefits - Evidence shows prophylactic phenobarbital does **not prevent future epilepsy** and has insufficient benefit in preventing recurrent febrile seizures - This is the **correct answer** as it is explicitly excluded from management guidelines *Intermittent diazepam* - While **not routinely recommended** for typical febrile seizures, intermittent rectal or buccal diazepam may be discussed as a *potential option* for specific situations (frequent recurrences, parental anxiety, prolonged seizures) - It serves as **rescue medication** to abort an ongoing seizure rather than daily prophylaxis - Its role in typical febrile seizure management is controversial and limited, but it may be mentioned in comprehensive management discussions *Sponging* - **Tepid sponging** is a supportive physical cooling measure used in fever management - While it does not prevent febrile seizures, it is part of general **symptomatic care** for fever reduction - Typically used alongside antipyretics to help lower body temperature and improve comfort *Paracetamol or ibuprofen* - **Antipyretics** are standard management for fever control and improving the child's comfort - While they do **not reliably prevent** febrile seizures from occurring, they are essential for **symptomatic fever management** - Recommended as first-line treatment for fever in children with febrile seizures

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