Transfusion essays

March 2011

This question is in three parts:

a) Discuss the pathophysiology of haemolytic disease of the newborn caused by anti-D.

b) Critically evaluate the tests available for investigation of a woman who is 29 weeks pregnant and who has had abdominal trauma following a fall. Her “group & screen” test states A negative with anti-D detected. 

c) Discuss the laboratory investgation and clinical management of a woman in her 2nd pregnancy who is found to have anti-D of 20.9 IU/ml in her plasma for the first time at 36 weeks gestation


October 2010

You are a newly appointed Consultant Haematologist at a hospital and you are informed of a recent incident in which a group O patient received 50 ml of group A blood in error, before it was stopped due to a reaction in the patient.  Explain what you would do to investigate this incident and prevent a recurrence?


March 2010

A 60-year-old female patient was prescribed 1 unit of apheresis platelets and 4 units of fresh frozen plasma (FFP). The platelets and first 3 units of FFP were transfused without incident over a period of an hour and a half.  Ten minutes after starting the 4th unit of FFP she became acutely short of breath and hypotensive with a temperature of 38°C. Discuss the differential diagnosis, laboratory investigation and management of this adverse reaction


October 2009

Discuss the measures that can be used to reduce the risk of transmitting viruses to patients via red cells, platelets and fresh frozen plasma


March 2009

Discuss the management of massive blood loss in a hospital setting


September 2008

Explain the pathogenesis of  neonatal alloimmune thrombocytopenia (NATP), and critically evaluate treatment options for a woman with  anti-HPA1a, who is now in the early stages of her second pregnancy. Her first child suffered an inutero intracranial haemorrhage


March 2008

A pandemic flu outbreak has led to a reduction of 50% in available blood stocks. Design an emergency blood management plan for your hospital to be activated in this situation


September 2007

Prepare a guideline for your hospital on the indications for the use of FFP and Cryoprecipitate


March 2007

Prepare a patient information leaflet about blood transfusion, intended for adult patients scheduled for elective surgery attending a pre-admission clinic approximately 1 month prior to the date of admission. 


September 2006

Discuss current antenatal prophylaxis for haemolytic disease of the newborn. Critically evaluate methods for the quantitation of feto-maternal haemorrhage. Discuss the management of HDN due to Rh-incompatibility.


March 2006

Discuss the reasons for the need to reduce the use of blood. Critically evaluate the strategies that may be used to achieve this and identify those strategies that you believe will be effective.

September 2005 

The Blood Safety and Quality Regulation (No 50) 2005 transposes two EU Directives (2002/98/EC and 2004/33/EC) into UK law, and comes into force from 8 November 2005. Describe the requirements on hospital blood banks contained in the Regulation(s) and / or the EU Directives. What are the necessary components of a quality system in a hospital blood bank?


Discuss the key elements involved in pretransfusion testing in the hospital blood bank. What are the requirements to implement electronic cross-matching and what are the potential benefits and risks of this approach?


Evaluate the risk of transmission of variant Creutzfeldt Jakob disease by blood components and plasma products and discuss strategies which have or could be used to manage that risk.


What steps could a hospital take to minimise patients’ exposure to donor blood components?


Describe the principles by which the safety of blood components (red cells, platelets and fresh frozen plasma) is achieved by a blood transfusion service. Illustrate your answer with a list of the specific measures which are currently employed. What other measures are available that might affect blood component safety and what impact might these have if introduced within a national transfusion service?


Discuss the patho-physiology of transfusion related lung injury (TRALI). Describe how you would diagnose and manage this condition and discuss the strategies for preventing TRALI.  



In the UK nearly 30% of serious hazards of transfusion are due to hospital laboratory errors. Discuss how these may be prevented.


Discuss the factors which should be taken into account when infants in a neonatal unit are transfused with blood components.


Describe the clinical features and underlying immunological basis of:

(ii) immediate haemolytic transfusion reactions

(iii) delayed haemolytic transfusion reactions.


Discuss the potential benefits and disadvantages of pre-storage leucodepletion of all blood products. How would you manage a patient whose temperature rises to 39C following the administration of 50ml of leucodepleted red cells?