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Quiz 02 Ans - Question 1 of 15 1 A 68 year-old woman...

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Question 1 of 15 1. A 68 year-old woman presents with 3 days of black tarry stools, heavy chest pressure, dizziness and evidence of cardiac ischemia on her EKG. Exam is notable for hypotension, tachycardia, mild epigastric tenderness and rectal exam demonstrates heme + black stool. WBC count is 11, hgb 7.9 and platelets 450. Two large bore IVs are placed and hydration with crystalloid is initiated while awaiting 2 typed and crossed units from the blood bank. Assuming there is no acute transfusion reaction or lack of ABO compatibility, the donor red blood cells given to this woman: a. survive for 120 days in the transfused patient b. can elicit an immune response against blood group antigens outside of the ABO system that can eliminate the transfused cells within a couple weeks after the transfusion c. typically are cleared from the circulation within 5 days after the transfusion d. generally have higher levels of 2,3 diphosphoglycerate than that of the red cells of the transfusion recipient e. can undergo hemolysis in a transfusion recipient who has a severe glucose-6-phosphate dehydrogenase (G6PD) deficiency when exposed to an oxidant drug (e.g. sulfamethoxazole). 0 out of 1 B is correct: donor RBC can elicit an immune response against blood group antigens outside of the ABO system that can eliminate the transfused cells within a couple weeks after the transfusion. Typically, transfused RBC have a much shorter half life than new RBC (a is incorrect) but last for up to a few weeks. 2,3 DPG is lower in donor RBCs due to loss during “shelf life.” Normal donor RBC would have sufficient G6PD and therefore less susceptible to oxidant drug compared to a G6PD deficient recipient. Question 2 of 15 2. A 2 day old caucasian newborn boy is noted to have yellow skin and sclera. His parents have no significant past medical history and the pregnancy was uncomplicated. His hemoglobin is found to be 9. Which of the following is most likely true: a. the newborn has anti-red cell antibodies that cross react with maternal red cell antigens b. His mother is Rh(D)-neg and this was her first pregnancy. c. The newborn made warm reactive anti-red cell antibodies against his own cells d. The newborn’s mother is blood group type O and his father is blood group type AB 0 out of 1 D is correct: The newborn’s mother is blood group type O and his father is blood group type AB ; hemolytic disease of the newborn can occur here because group O individuals make predominantly IgG (rather than IgM) anti-A and anti-B isohemagglutinins, which can cross the placenta. Newborns do not make antibodies well so A and C are incorrect. An Rh(D) negative mother is unlikely to have preformed antibodies to Rh(D) if she has not previously been pregnant or transfused (note she had no significant past medical history).
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