Blood Transfusion, Coagulation and Massive Transfusion Protocols MCQs

Anaesthesia · 18 free questions with answers & explanations.

1. A trauma patient requires massive transfusion protocol (MTP) activation. Which product ratio has been demonstrated to best improve survival in major haemorrhage based on PROPPR trial data?
2. A patient with haemophilia A (Factor VIII < 1%) presents for emergency appendicectomy. Preoperative factor replacement target to achieve adequate haemostasis for major surgery is:
3. Viscoelastic haemostatic assay (TEG/ROTEM) is used perioperatively. A patient has prolonged R-time/CT (clotting time) with normal alpha angle and MA. What does this pattern indicate and what is the appropriate treatment?
4. Tranexamic acid (TXA) is administered in a trauma patient with suspected major haemorrhage. According to the CRASH-2 trial, the optimal timing of administration is:
5. A patient is receiving heparin infusion post-cardiac surgery and develops heparin-induced thrombocytopaenia (HIT) with thrombosis on day 5. The platelet count has fallen from 280 to 60 × 10⁹/L. What is the MOST appropriate next step?
6. A 32-year-old trauma patient receives 12 units of packed red blood cells, 10 units of fresh frozen plasma, and 10 units of platelets over 4 hours (massive transfusion). Which metabolic complication is MOST likely to occur specifically from the stored blood itself?
7. A hospital activates a massive transfusion protocol (MTP) for an exsanguinating trauma patient. The evidence-based target ratio for red blood cells : fresh frozen plasma : platelets in damage-control resuscitation is:
8. Viscoelastic testing (TEG/ROTEM) is increasingly used in perioperative coagulation management. A ROTEM result shows prolonged CFT (clot formation time), reduced alpha-angle, and low MCF (maximum clot firmness) with a normal CT (clotting time). What does this pattern indicate?
9. Tranexamic acid (TXA) is administered for a patient with major haemorrhage. Its mechanism of action is:
10. A patient undergoing emergency aortic surgery has received 12 units of packed red blood cells in 30 minutes. A massive transfusion protocol (MTP) is activated. What is the current recommended ratio of blood components in damage control resuscitation?
11. A postoperative patient develops oozing from IV sites and surgical drains. Thromboelastography (TEG) shows prolonged clot initiation time (R-time) with normal MA and LY30. This pattern indicates:
12. Tranexamic acid (TXA) is administered to a trauma patient. What is its mechanism of action and critical time window for administration?
13. A patient with haemophilia A (factor VIII deficiency) requires emergency appendicectomy. Pre-surgical factor VIII level is 2%. What target factor VIII level should be achieved before surgery, and what is the treatment of choice?
14. Which of the following is the MOST accurate statement regarding cell salvage (intraoperative autotransfusion) during surgery?
15. A 35-year-old woman with a known diagnosis of haemophilia A (factor VIII deficiency, level 3%) requires urgent appendicectomy. Which is the MOST appropriate perioperative coagulation management?
16. A trauma patient receives a massive transfusion (>10 units of packed red cells in 24 h). Viscoelastic testing (TEG) shows clot formation time (K time) prolonged and maximum amplitude (MA) severely reduced. Which product addresses the primary abnormality indicated?
17. During massive transfusion, the recommended ratio of FFP:platelets:packed RBCs in the empirical damage-control resuscitation (DCR) approach is approximately:
18. A patient develops acute transfusion-related acute lung injury (TRALI) 2 hours after receiving 2 units of FFP. Which pathophysiological mechanism best explains this reaction?