HaemBase

I have dated when I wrote questions, to help you gauge if particular answers may be obsolete.

question 1 (Written 2020)

A woman with sickle cell anaemia is found to have an Anti-U alloantibody during her pregnancy booking bloods. She does not currently require blood. Later in the pregnancy she is found to have placenta praevia.

a. How will you manage this patient’s pregnancy?

b. What options do you have to source blood for this patient, and what would be your preferred choice? 

c. Could you use a relative as a directed donor?

d. What are the risks to the baby and how will you manage these?

question 2 (Written 2020)

Mr Grissom is a 45 year old man admitted electively for allogeneic stem cell transplant in first remission from acute myeloid leukaemia diagnosed four months earlier. Mr Grissom is blood group O Rh D negative and is receiving stem cells from a blood group A Rh D positive donor.

a. Define major & minor ABO incompatibility

b. State two potential risks following allogeneic stem cell transplant that may be attributable to major ABO incompatibility between the recipient and donor.

c. At day +10 Mr Grissom is anaemic with haemoglobin 70g/l, platelets 20x10e9/l and neutrophils 0.02x10e9/l. You prescribe one unit of packed red cells for transfusion. What ABO and Rh D blood group should the donor red cell unit be?

Six months later Mr Grissom is admitted to hospital following an upper GI bleed. He is symptomatically anaemic with haemoglobin 65g/l, platelets 210x10e9/l and neutrophils 2.7x10e9/l. The result of his transfusion investigations are given in the table.

d. You prescribe one unit of packed red cells for transfusion. What ABO and Rh D blood group should the donor red cell unit be?

question 3 (Written 2021)

A five year old child presents to the emergency department with a three day history of progressive lethargy, fever, back pain and jaundice. She is drwosy, tachycardic and hypotensive. She is usually fit and well but her parents report a recent viral upper respiratory tract infection three weeks previously which appeared to have made a full recovery from.

Haemoglobin 47g/l, platelets 180x10e9/l, white cell count 10x10e9/l, Bilirubin 60umol/l

Blood group O Rh D positive

Blood film - red cell spherocytosis with marked polychromasia and frequent nucleated red cells seen

Direct antiglobulin test - results shown in Figure A

a. List your differential diagnosis for this patient

b. With reference to Figure B, state the most likely full Rh type of this child, expressed in both the Fisher-Race and the Weiner nomenclature

c. State the specification of the red cell units you would prefer to issue in this case

d. Describe the principle of the Donath-Landsteiner test