Deck 18: Apheresis

Question 1

What is the definition of apheresis?

A) The process of freezing RBCs in liquid nitrogen
B) Separation or removal of a blood component from whole blood
C) The addition of EPO to red blood cells to increase 2,3 DPG levels
D) The extraction of plasma from a whole blood unit

Answer 1

B

Question 2

What other technique is available for neonates with sepsis when apheresis is unavailable?

A) A buffy coat prepared from plasma less than 12 hours old
B) A buffy coat prepared from red blood cells less than 12 hours old
C) A buffy coat prepared from a whole blood unit less than 12 hours old
D) A buffy coat prepared from platelets less than 12 hours old

Answer 2

C

Question 3

The specific cell product used for treating sepsis is the:

A) lymphocyte.
B) granulocyte.
C) monocyte.
D) plasmacyte.

Answer 3

B

Question 4

Photopheresis is effective against what malignant disorder?

A) Hairy cell leukemia
B) Cutaneous T-cell lymphoma
C) Hodgkin's lymphoma
D) Acute lymphocytic leukemia

Question 5

Plasma exchange is most effective when is considered the pathological substance.

A) IgG
B) IgM
C) IgA
D) IgE

Question 6

Which of the following is an indication for therapeutic apheresis?

A) Collection of neocytes to reduce the number of transfusions in patient with thalassemia major
B) A pathogenic substance exists in the blood that contributes to a disease process.
C) A substance can be more effectively removed by apheresis than by the body's own homeostatic mechanisms.
D) Options B and C

Question 7

When a sample of whole blood is spun, distinct layers form. What cell line or lines make up the buffy coat?

A) White blood cells only
B) White blood cells and platelets
C) Red blood cells
D) Cellular fragments

Question 8

Which of the following incorporates membrane filtration technology with intermittent flow centrifugation (IFC) apheresis?

A) Haemonetics V50
B) COBE Spectra
C) Fenwal Autopheresis-C
D) Haemonetics V30

Question 9

A normal healthy donor undergoes a procedure to obtain platelets that will be transfused to a patient is representative of:

A) therapeutic apheresis collection.
B) component apheresis collection.
C) whole blood donation.
D) None of the above.

Question 10

What is an example of a continuous flow centrifugation (CFC) instrument?

A) Haemonetics V50
B) COBE Spectra
C) Fenwal Autopheresis-C
D) Haemonetics V30

Question 11

Which cell type is densest in the white blood cell layer when anticoagulated blood is centrifuged?

A) Granulocyte
B) Monocyte
C) Lymphocyte
D) Platelets

Question 12

All of the following statements are consistent with photopheresis except:

A) the patient is given an oral dose of psoralen, which binds to the DNA of all nucleated cells.
B) collected white blood cells are exposed to ultraviolet light, which activates psoralen, preventing replication.
C) the patient is given an oral dose of piroxicam, which binds to the RNA of all nucleated cells.
D) treated cells are returned to the patient, inducing an immune response against the abnormal lymphocyte clone.

Question 13

Which of the following statements best describes the apheresis concept?

A) Blood is removed from an individual and separated, the desired component is retained, and the remaining portions are returned to the donor/patient.
B) Blood is removed from an individual, the desired component is retained, anticoagulated, and separated, and the remaining portion is returned to the donor/patient.
C) Blood is removed from an individual, anticoagulated, and separated, the desired component is retained, and the remaining portions are returned to the donor/patient.
D) None of the above

Question 14

A child undergoing apheresis may require CFC to minimize:

A) extracorporeal volume.
B) extravascular volume.
C) intracorporeal volume.
D) extramedullary volume.

Question 15

What effect does aspirin have on platelets?

A) Prevents release of ATP
B) Prevents platelet adhesion
C) Prevents platelet aggregation
D) Inhibits antigen expression

Question 16

Fresh frozen plasma (FFP) is not the optimal product for replacement fluids for a therapeutic plasma exchange procedure. For which patient is FFP the optimal product of choice?

A) Patient with liver disease
B) Patient with thrombotic thrombocytopenic purpura (TTP)
C) Patient scheduled to undergo an invasive procedure
D) All of the above

Question 17

Which of the following terms is defined as the removal of white blood cells with the return of red blood cells, plasma, and platelets?

A) Leukapheresis
B) Erythrocytapheresis
C) Plasmapheresis
D) Plateletpheresis

Question 18

What is the physiological cause of citrate toxicity in cytapheresis procedures?

A) The extracorporeal blood volume leaks citrate into the reinfusion site of the donor.
B) The anticoagulant in plasma contains citrate, which binds calcium, lowering the body's ionized calcium.
C) The anticoagulant in plasma contains citrate, which binds chloride, lowering the anion gap.
D) None of the above.

Question 19

In what circumstance is a plasmapheresis donor rejected from donation?

A) Blood pressure = 140/95
B) Temperature = 99.5°F
C) Serum protein = 5.0 g/dL
D) Hematocrit = 40%

Question 20

Which of the following factors influenced the need for apheresis technology?

A) Marked increase in the number of exchange transfusions
B) Amputee patients
C) The blood component needs of patients on chemotherapy
D) AIDS epidemic

Question 21

All of the following statements are consistent with CFC except:

A) blood is drawn from one phlebotomy site and returned through another.
B) reinfusion to the patient completes one cycle.
C) the process of phlebotomy, separation, and reinfusion is uninterrupted.
D) separation of components is achieved through centrifugation.

Question 22

Currently, the immunoaffinity column has FDA licensure for treating what disease state?

A) Hemolytic uremic syndrome
B) TTP
C) AIDS
D) Idiopathic thrombocytopenic purpura (ITP)

Question 23

The removal of red blood cells in a hemapheresis procedure is called:

A) thrombocytapheresis.
B) plasmapheresis.
C) erythrocytapheresis.
D) leukapheresis.

Question 24

Which immunoadsorbent has an affinity for IgG classes 1, 2, and 4 and their immune complexes?

A) Charcoal
B) Staphylococcal protein A
C) DNA
D) A antigen

Question 25

Plasmapheresis is synonymous with what term?

A) Plasma exchange
B) Antibody exchange
C) Plasma dilution
D) Antibody dilution

Question 26

Leukopheresis may be indicated when the white blood cell count exceeds .

A) 50,000 per µL
B) 100,000 per µL
C) 75,000 per µL
D) 25,000 per µL

Question 27

A donor's estimated total blood volume was determined to be 4,500 mL before a plasmapheresis procedure. The extracorporeal blood volume should not exceed:

A) 675 mL.
B) 335 mL.
C) 187 mL.
D) 50 mL.

Question 28

Which of the following is not an indication for plasmapheresis?

A) To decrease iron deposition in tissues in chronically transfused patients
B) To collect rare red blood cell antibodies
C) To increase the inventory of AB plasma
D) To manufacture Rh-immune globulin

Question 29

Which apheresis method carries the additional risk of returning red blood cells to the wrong individual and yielding the smallest volume of selected blood component?

A) IFC
B) Manual apheresis
C) CFC
D) Membrane filtration

Question 30

In plateletpheresis, which blood component is returned to the donor?

A) Red blood cells
B) Platelets
C) White blood cells
D) Options A and C

Question 31

What possible risk exists when hydroxyethyl starch (HES) concentration has exceeded the renal threshold and excretion is retarded?

A) Blockage of the reticuloendothelial system
B) Blockage of the spleen
C) Citrate toxicity
D) Infiltration of the liver by activated macrophages

Question 32

The platelet count of the plateletpheresis donor must be prior to the procedure.

A) >100 $\times$ 10⁹ per L
B) >50 $\times$ 10⁹ per L
C) >150 $\times$ 10⁹ per L
D) >20 $\times$ 10⁹ per L

Question 33

Fatalities that result from therapeutic apheresis have primarily been caused by:

A) cardiac arrest and arrhythmia.
B) stroke.
C) seizure.
D) renal failure.

Question 34

testing is performed on platelet apheresis products to make sure that HIV, WNV, and hepatitis C are not present.

A) Serological
B) Nucleic acid
C) Electrophoretic
D) Rapid

Question 35

What can be done to prevent the development of HLA alloimmunization and platelet refractoriness?

A) Test the donor for the presence of platelet antibodies.
B) Issue only cytomegalovirus-negative platelets.
C) Irradiate the platelet concentrate.
D) Reduce the number of leukocytes in the platelet product.

Question 36

Antiplatelet medications have differing deferral time periods. Which of the following does not match?

A) Aspirin-48 hours
B) Plavix-14 days
C) Feldene-7 days
D) Ticlid-14 days

Question 37

What is a disadvantage of choosing fresh frozen plasma for fluid replacement in persons undergoing therapeutic plasmapheresis?

A) Citrate toxicity
B) Disease transmission
C) ABO incompatibility
D) All of the above

Question 38

What is the primary anticoagulant used in pheresis procedures?

A) CPDA-1
B) Heparin
C) Citrate
D) EDTA

Question 39

What variables are necessary to calculate the donor's total blood volume?

A) Height
B) Weight
C) Sex
D) All of the above

Question 40

Erythrocytapheresis is successful in which of the following conditions?

A) Leukemia
B) Colon/rectal cancer
C) Malaria
D) Waldenstrom's macroglobulinemia

Question 41

While undergoing plasmapheresis, the donor experienced numbness around his mouth, which is indicative of citrate toxicity. How can this be treated?

A) Administering exogenous sodium
B) Administering exogenous potassium
C) Administering exogenous calcium
D) Decreasing the extracorporeal volume

Question 42

Which of the following conditions would necessitate a plasmapheresis procedure?

A) Sickle-cell anemia
B) Barbiturate poisoning
C) CML
D) Polycythemia vera

Question 43

The concentrate obtained from plateletpheresis via a closed system is stored for 5 days at room temperature. What must the pH be at the end of storage?

A) >=5.0
B) >=6.0
C) >=4.0
D) >=8.0

Question 44

All of the following constitute variables of apheresis procedures except:

A) centrifuge speed.
B) anticoagulant.
C) length of blood dwell time in centrifuge.
D) blood type.

Question 45

The removal of granulocytic cells from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures?

A) Cellulose acetate
B) Charcoal
C) Polymyxin B
D) Any of these.

Question 46

Which patients are at the most risk for platelet refractoriness where they become alloimmunized to HLA antigens on platelets?

A) Patients with liver disease
B) Cardiac patients
C) Leukemic patients
D) Kidney transplant patients

Question 47

During a plasmapheresis procedure, the red blood cells must be returned within how many hours of phlebotomy?

A) 2 hours
B) 4 hours
C) 6 hours
D) 8 hours

Question 48

What does the hematocrit need to be (regardless of gender) for a double red blood cell collection?

A) 25%
B) 45%
C) 40%
D) 35%

Question 49

The removal of bile acids from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures?

A) Cellulose acetate
B) Charcoal
C) Polymyxin B
D) Any of these.

Question 50

How is HES used in apheresis procedures?

A) As a chelation agent to bind calcium
B) As a sedimenting agent to separate white blood cells from red blood cells
C) As a primer to keep infusion lines open
D) As a hemolysin to lyse red blood cells

Question 51

Citrate used as an anticoagulant in apheresis procedures is removed from the body by:

A) the kidneys.
B) being metabolized in the liver.
C) sweating.
D) none of the above.

Question 52

One unit of apheresed platelets should increase the platelet count .

A) 5,000 to 10,000 per µL
B) 20,000 to 60,000 per µL
C) 80,000 to 100,000 per µL
D) 15,000 to 30,000 per µL

Question 53

The hematopoietic progenitor cells that eventually repopulate the bone marrow and also circulate in the blood are called:

A) peripheral blood stem cells (PBSC).
B) hematopoietic stem cells (HSC).
C) myeloid stem cells (MSC).
D) lymphoid stem cells.

Question 54

When is isolation of PBSCs via apheresis equipment indicated?

A) The bone marrow contains malignant cells
B) The bone marrow has been irradiated
C) The patient cannot tolerate general anesthesia
D) All of the above

Question 55

The removal of endotoxin from patient plasma can be assisted through the use of which adsorbent during plasmapheresis procedures?

A) Cellulose acetate
B) Charcoal
C) Polymyxin B
D) Any of these.

Question 56

What effect do steroids have on leukapheresis?

A) Decrease the vascular pool of granulocytes
B) Increase the vascular pool of granulocytes
C) Help to separate red blood cells from white blood cells, using specific gravity properties
D) Neutralize the effect of toxic granulation in neutrophils

Question 57

What is therapeutic plasmapheresis?

A) The removal of large volumes of patient plasma
B) The removal of minute volumes of patient plasma
C) The removal of plasma containing anti-D
D) The removal of plasma containing immunoglobulin

Question 58

A person participating in a serial apheresis program would not:

A) donate more frequently than every 4 weeks.
B) lose more than 25 mL of red blood cells per week.
C) be monitored for weight loss.
D) donate every 72 hours.

Question 59

The method in which a specific ligand is bound to an insoluble matrix in a column and plasma is perfused over the column with select removal of pathogenic substance and return of patient's plasma is known as:

A) immunoinhibition.
B) plasma exchange.
C) immunoadsorption.
D) elution.

Question 60

Compatibility testing is required for granulocyte concentration if the red blood cell contamination is greater than:

A) 20 mL.
B) 10 mL.
C) 5 mL.
D) 15 mL.