[LO 187] MAY 2019 Sub. Code: 2097
M.D. DEGREE EXAMINATION
BRANCH XXI IMMUNOHAEMATOLOGY AND BLOOD TRANSFUSION
PAPER I BASIC APPLIED ASPECTS RELATED TO
IMMUNOHAEMATOLOGY AND BLOOD TRANSFUSION
Q.P. Code: 202097
Time: Three Hours Maximum: 100 Marks
I. Essay Questions: x 15 30)
1. Pathophysiology of acute blood loss.
2. Process of setting up an in house 3-cell panel for antibody screening in your
blood bank.
II. Short notes: (10 x 5 50)
1. Functional differences between Naive and memory B cells.
2. Heparin analogues and implication for a blood bank.
3. Drugs that interfere with compatibility testing.
4. Cryopreservation of blood cells.
5. Enzyme linked immunosorbent assay in the blood bank.
6. Platelet crossmatch.
7. Pathogen inactivation system for platelets.
8. National plasma policy.
9. List the essential records for a blood bank and discuss the principles of
document control.
10. Solution to avoid blood transfusion in a patient who professes to being a
Jehovah's witness.

III. Reasoning Out: x 5 20)
1. A 50 year old male patient, smoker was admitted with community acquired
pneumonia. He was moved to ICU for ventilator support. On day 2 he
continued to be febrile and peripheral blood showed moderate leucocytosis
and left shift with thrombocytopenia. Haemoglobin remained at 10g/dL.
What is the likely reasons for new onset thrombocytopenia?
What additional tests would you like to do to confirm and what are the
expected results?
What blood products will you recommend?
2. See the Oxygen dissociation curve below: Oxygen transport increases with
increasing haemoglobin until viscosity effects reduce flow and transport.
Transfusing normal red blood cells to patients with sickle cell disease
increases the viscosity. As the haemoglobin increases there is an initial
increase in oxygen transport, but as viscosity effects take hold, transport
decreases.
How would you manage transfusion in patient with sickle cell crisis?
How do we perform adult manual red cell exchange in a sickle cell patient?

3. Informed consent for transfusion means a conversation has occurred
between the patient and the doctor. The significant risks benefits and
alternatives to transfusion must be discussed. Blood products must be
prescribed by doctor and every transfusion must be documented.
List 5 items that must be included in the medical order for blood transfusion?
4. Twenty days after receiving an autologous transplant for non-Hodgkin's
lymphoma, a 46-year old male has a platelet count of 13,000/cumm. He
requires drainage of pleural effusion; hospital transfusion guideline
mandates that the platelet count should be at least 50,000 /cumm before the
procedure. He is transfused a unit of pooled, ABO-matched platelets; an
hour after the transfusion, the platelet count is 21,000/cumm.
What may be the reasons for the modest platelet increment in this case?
Assuming a body surface area of 2.0 m^2 and an average content of
5.5*10^10 platelets per donor in a pool of platelets, what is the 1-h
corrected count increment
In a hypothetical alloimmunized patient who continues to bleed, and no
matched platelets are available, what other strategies may be attempted?

[LO 187]