Blood Transfusion Safety 2026 Clinical Practice Guidelines

1. Which is the most important first step before starting a blood transfusion? A. Check patient temperature B. Verify patient identity and blood compatibility at bedside C. Start infusion immediately D. Give pre-medication routinely Correct Answer: B. Verify patient identity and blood compatibility at bedside Rationale: Bedside verification prevents fatal ABO incompatibility errors, the most serious transfusion complication. 2. Which blood group is considered the universal donor for red blood cells? A. AB B. A C. B D. O negative Correct Answer: D. O negative Rationale: O negative red cells lack A, B, and Rh antigens, reducing risk of immune reaction. 3. Which blood transfusion reaction is most life-threatening? A. Mild allergic reaction B. Febrile reaction C. Acute hemolytic reaction D. Iron overload Correct Answer: C. Acute hemolytic reaction Rationale: ABO incompatibility can lead to intravascular hemolysis, shock, and death. 4. What is the priority action if a transfusion reaction is suspected? A. Slow the infusion B. Continue transfusion and observe C. Stop transfusion immediately D. Give antihistamine and continue Correct Answer: C. Stop transfusion immediately Rationale: Prevents further exposure to incompatible blood and limits severity of reaction. 5. What should be done with IV access after stopping a transfusion reaction? A. Remove IV catheter immediately B. Flush with normal saline using new tubing C. Infuse dextrose solution D. Clamp and leave unused Correct Answer: B. Flush with normal saline using new tubing Rationale: Maintains IV access for emergency medications without infusing blood product. 6. Which solution is compatible with blood transfusion administration sets? A. 0.9% sodium chloride B. Dextrose 5% in water C. Lactated Ringer’s D. Hypotonic saline Correct Answer: A. 0.9% sodium chloride Rationale: Normal saline is isotonic and does not cause RBC hemolysis. 7. Which vital sign change is an early sign of transfusion reaction? A. Bradycardia only B. Fever and chills C. Increased appetite D. Improved oxygen saturation Correct Answer: B. Fever and chills Rationale: Fever and rigors are common early indicators of reaction. 8. When is the highest risk period for transfusion reactions? A. First 15 minutes B. After 6 hours C. After 24 hours D. End of transfusion only Correct Answer: A. First 15 minutes Rationale: Most acute reactions occur shortly after initiation of transfusion. 9. Which monitoring frequency is appropriate during blood transfusion? A. Only at the end B. Before, during, and after transfusion C. Every 24 hours D. Only if symptoms occur Correct Answer: B. Before, during, and after transfusion Rationale: Continuous monitoring allows early detection of complications. 10. Which symptom suggests acute hemolytic transfusion reaction? A. Back pain and hypotension B. Increased energy C. Improved breathing D. Mild itching only Correct Answer: A. Back pain and hypotension Rationale: Hemolysis triggers systemic inflammatory and shock response. 11. Which finding suggests allergic transfusion reaction? A. Urticaria and itching B. Hematuria C. Hypertension D. Bradycardia only Correct Answer: A. Urticaria and itching Rationale: Mild allergic reactions commonly present with skin symptoms. 12. Which severe complication involves lung injury after transfusion? A. TRALI B. TACO C. DIC D. Hypoglycemia Correct Answer: A. TRALI Rationale: Transfusion-related acute lung injury causes non-cardiogenic pulmonary edema. 13. Which complication is caused by fluid overload? A. TRALI B. TACO C. Hemolysis D. Sepsis Correct Answer: B. TACO Rationale: Transfusion-associated circulatory overload results from excess volume. 14. Which patient is at highest risk for TACO? A. Heart failure patient B. Healthy athlete C. Teenager with flu D. Patient with acne Correct Answer: A. Heart failure patient Rationale: Reduced cardiac function increases risk of fluid overload. 15. Which intervention helps prevent TACO? A. Slow infusion rate B. Rapid infusion C. No monitoring D. High-volume transfusion Correct Answer: A. Slow infusion rate Rationale: Reduces risk of circulatory overload. 16. Which blood type can receive type O negative blood? A. Only O negative B. Any blood type C. Only AB negative D. Only A positive Correct Answer: B. Any blood type Rationale: O negative RBCs lack A, B, and Rh antigens. 17. Which test confirms blood compatibility before transfusion? A. Crossmatch testing B. Urinalysis C. ECG D. Liver enzymes Correct Answer: A. Crossmatch testing Rationale: Ensures donor and recipient blood compatibility. 18. Which is a common cause of transfusion reactions? A. Clerical or identification errors B. High protein diet C. Exercise D. Hydration Correct Answer: A. Clerical or identification errors Rationale: Most severe reactions result from wrong patient/blood mismatch. 19. What should be sent to the blood bank during a reaction? A. Blood unit and tubing B. Only IV bag C. No samples D. Food tray Correct Answer: A. Blood unit and tubing Rationale: Used for investigation of reaction cause. 20. Which intervention is appropriate after transfusion reaction stabilization? A. Delay further transfusion until cause identified B. Restart same unit immediately C. Increase transfusion rate D. Ignore event Correct Answer: A. Delay further transfusion until cause identified Rationale: Prevents recurrence of life-threatening reaction.