FRCPath Haem Part 1 EMQs-Transfusion 51 and 52

Theme: Haemorrhage

Options

A. Immediate issue O D negative red cells

B. Immediate issue O D positive red cells

C. Take crossmatch sample before first emergency unit

D. Tranexamic acid (TXA) should not be used in GI Bleed

E. Second dose TXA 1 g if bleeding persists after 30 min

F. Early fibrinogen monitoring and replacement

G. Intraoperative cell salvage (ICS)

H. ABO-incompatible platelets (low titre)

I. Anti-D immunoglobulin 1500 IU

J. Switch rapidly to group-specific blood

K. Platelet target >75 × 10⁹/L

L. Hb target 80 g/L

M. PT ratio target <1.5

N. Avoid delay waiting for age-specific components

O. Use leucodepletion filter for salvaged blood

Questions

Scenario 1

A 28-year-old woman presents with severe postpartum haemorrhage following emergency Caesarean section. Estimated blood loss is 1800 mL and ongoing. She is hypotensive and tachycardic. Blood group is unknown. Immediate emergency blood is required while the laboratory is preparing compatibility testing. She has not yet had a blood sample sent.

What is the SINGLE most important immediate laboratory-related action?

Scenario 2

A 34-year-old D negative woman undergoes Caesarean section complicated by placenta accreta and major haemorrhage. Cell salvage is used intraoperatively. The baby is confirmed O D positive. Salvaged blood is reinfused successfully.

Which additional treatment is essential?

Scenario 3

A 40-year-old trauma patient arrives after a road traffic collision with pelvic fractures and major haemorrhage. Blood group is unknown. Massive transfusion protocol is activated. The emergency department asks whether TXA should be given.

What is the most appropriate management?

Scenario 4

A 31-year-old woman develops severe postpartum haemorrhage after vaginal delivery due to uterine atony. TXA was given immediately on diagnosis. After 40 minutes, bleeding continues despite uterotonics and blood component support.

What is the next most appropriate action regarding antifibrinolytic therapy?

Scenario 5

A 5-year-old child weighing 18 kg undergoes emergency surgery for splenic rupture following trauma. Significant haemorrhage is ongoing. Paediatric red cells are temporarily unavailable.

What is the most appropriate immediate transfusion strategy?

Scenario 6

A 9-year-old child with major haemorrhage has received multiple transfusions. Laboratory results show:

Hb 82 g/L, Fibrinogen 1.2 g/L, Platelets 90 × 10⁹/L, PT ratio 1.4

Which abnormality should be corrected most urgently?

Scenario 7

A woman aged 42 years presents with antepartum haemorrhage at 35 weeks gestation due to placental abruption. Blood loss is significant. Initial fibrinogen is 2.1 g/L.

Why is this fibrinogen result particularly concerning?

Scenario 8

A major trauma patient has already received 4 units of emergency O negative blood. Crossmatch sample taken on arrival confirms the patient is group A RhD positive.

What should happen next?

Scenario 9

A patient with catastrophic GI bleeding is receiving major haemorrhage support. A junior doctor asks whether TXA should routinely be administered because it is beneficial in all major bleeds.

What is the best response?

Scenario 10

A 7-year-old child with major haemorrhage remains haemodynamically unstable. Laboratory values show:

Hb 68 g/L, Platelets 62 × 10⁹/L, Fibrinogen 1.8 g/L, PT ratio 1.3

Which therapeutic target is currently NOT achieved and requires urgent correction?