Under Indian law, every unit of donated blood must be tested for:

HIV, HBV, HCV, syphilis and malaria

HIV, HBV, dengue, syphilis and malaria

HIV, HBV, HCV, HTLV and syphilis

What most often causes transfusion-related acute lung injury (TRALI)?

Donor anti-HLA or anti-HNA antibodies

Circulatory overload from fast infusion

Bacterial endotoxin in the unit

Blood banking: transfusion reactions, TTI and apheresis

18 Kerala PSC Lab Technician Gr II practice questions on Blood banking: transfusion reactions, TTI and apheresis, part of Pathology. The first 18 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
An apheresis donor gives only platelets, and the rest of the blood is returned to him. This procedure is called:
1. ALeucapheresis
2. BPlasmapheresis
3. CErythrocytapheresis
4. DPlateletpheresis
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Answer: D · Plateletpheresis
In apheresis, blood passes through a cell separator that spins it, collects one component and returns the rest to the donor. Plateletpheresis collects a therapeutic dose of platelets from one donor (single-donor platelets), so the patient is exposed to fewer donors than with pooled random-donor platelets. Citrate is used as the anticoagulant in the circuit. Plasmapheresis collects plasma, and leucapheresis collects white cells.
- A: Leucapheresis collects white cells.
- B: Plasmapheresis collects plasma, not platelets.
- C: Erythrocytapheresis collects or removes red cells.
Question 2 · Easy
Under Indian law, every unit of donated blood must be tested for:
1. AHIV, HBV, HCV, CMV and malaria
2. BHIV, HBV, HCV, syphilis and malaria
3. CHIV, HBV, dengue, syphilis and malaria
4. DHIV, HBV, HCV, HTLV and syphilis
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Answer: B · HIV, HBV, HCV, syphilis and malaria
The Drugs and Cosmetics Rules make five tests mandatory on every unit: HIV-1 and HIV-2 antibodies, hepatitis B surface antigen, hepatitis C antibodies, syphilis serology and malarial parasites. Units reactive in any test are discarded as biohazardous waste. Many blood centres also add nucleic acid testing (NAT) to shorten the window period. CMV and HTLV testing are not mandatory in India.
- A: CMV is not a mandatory test in India; syphilis is.
- C: Dengue is not a mandatory donor test; HCV is.
- D: HTLV is not mandatory in India; malaria is.
Question 3 · Hard
A 10-year-old with thalassaemia major gets fever and chills during each red cell transfusion. His plasma is not pink, the DAT is negative and bag cultures are sterile. Which red cell product should he receive next?
1. ALeucoreduced red cells
2. BFresh whole blood
3. CGroup O red cells
4. DIrradiated red cells
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Answer: A · Leucoreduced red cells
Repeated fever and chills with no hemolysis and sterile cultures point to febrile non-hemolytic reactions. These are caused by cytokines from donor white cells or by the patient's antibodies to donor leucocytes, which are common in multiply transfused patients. Leucoreduction, ideally before storage, removes most white cells and prevents most such reactions; it also reduces HLA alloimmunisation. Irradiation prevents transfusion-associated graft-versus-host disease, not febrile reactions.
- B: Fresh whole blood is full of leucocytes and would not help.
- C: Changing the ABO group does not remove the leucocytes that cause the fever.
- D: Irradiation prevents TA-GVHD; it does not remove leucocytes.
Question 4 · Medium
In which transfusion reaction may the same unit be restarted slowly once the symptoms settle with an antihistamine?
1. AFebrile non-hemolytic reaction
2. BAnaphylactic reaction
3. CAcute hemolytic reaction
4. DMild urticarial reaction
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Answer: D · Mild urticarial reaction
A mild allergic reaction with only local hives and itching is caused by recipient antibodies, usually IgE, to donor plasma proteins. The transfusion is paused and an antihistamine given, and if the hives settle with no other symptoms the same unit may be restarted slowly. This is the only reaction type in which the unit may be resumed. In every other reaction, including fever, the transfusion is stopped and the unit and post-transfusion samples are sent to the blood bank for investigation.
- A: In a febrile reaction the transfusion is stopped, because hemolysis or sepsis cannot be excluded at once.
- B: Anaphylaxis needs the transfusion stopped and emergency treatment.
- C: An acute hemolytic reaction is an emergency; the unit is never restarted.
Question 5 · Medium
What most often causes transfusion-related acute lung injury (TRALI)?
1. ACirculatory overload from fast infusion
2. BRecipient anti-IgA antibodies
3. CBacterial endotoxin in the unit
4. DDonor anti-HLA or anti-HNA antibodies
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Answer: D · Donor anti-HLA or anti-HNA antibodies
In TRALI, antibodies in donor plasma bind the recipient's neutrophils, which collect and become activated in the lung capillaries. Fluid leaks into the lungs, causing breathlessness, hypoxia and bilateral infiltrates within 6 hours, without fluid overload. The antibodies are commonest in women who have had several pregnancies. Using plasma mainly from male donors has reduced TRALI.
- A: Circulatory overload (TACO) causes pulmonary oedema from excess volume, not TRALI.
- B: Recipient anti-IgA causes anaphylaxis, not lung injury.
- C: Endotoxin causes septic reactions with fever and shock.
Question 6 · Easy
The most common cause of an acute haemolytic transfusion reaction is:
1. AA Kell antibody in the recipient
2. BClerical error in identification
3. COverheating the unit before use
4. DBacterial contamination of the unit
Answer and explanation in LearnFree account
Question 7 · Hard
Fifteen minutes into a platelet transfusion from a 4-day-old unit stored at 22°C, a patient develops rigors, temperature 40°C and BP 80/50 mmHg. Urine is clear and the DAT is negative. The most likely cause is:
1. ABacterial contamination of the unit
2. BAnaphylaxis from anti-IgA
3. CFebrile non-haemolytic reaction
4. DABO haemolytic reaction
Answer and explanation in LearnFree account
Question 8 · Medium
A 30-year-old woman with thrombotic thrombocytopenic purpura is started on plasma exchange. The replacement fluid of choice is:
1. ANormal saline
2. B5% albumin
3. CPlatelet concentrate
4. DFresh frozen plasma
Answer and explanation in LearnFree account
Question 9 · Easy
Which parasitic infection must every donated unit be screened for in India?
1. ALeishmaniasis
2. BMalaria
3. CToxoplasmosis
4. DFilariasis
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Question 10 · Hard
A 60 kg patient with hematocrit 40% is to have a one-volume plasma exchange. Taking blood volume as 70 mL/kg, what plasma volume is exchanged?
1. AAbout 2,520 mL
2. BAbout 3,000 mL
3. CAbout 1,680 mL
4. DAbout 4,200 mL
Answer and explanation in LearnFree account
Question 11 · Easy
An 80-year-old with heart failure becomes breathless with raised BP after two units given quickly. The likely reaction is:
1. ATRALI
2. BFebrile non-hemolytic reaction
3. CCirculatory overload (TACO)
4. DAnaphylaxis
Answer and explanation in LearnFree account
Question 12 · Easy
Which marker is tested in donor blood to screen for hepatitis B?
1. AAnti-HBe
2. BHBeAg
3. CAnti-HBs
4. DHBsAg
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Question 13 · Medium
A patient develops chills and back pain ten minutes into a transfusion. The first action is to:
1. ASlow the drip and give paracetamol
2. BGive an antihistamine and continue
3. CStop it and keep the line open with saline
4. DFinish the unit, then send samples
Answer and explanation in LearnFree account
Question 14 · Medium
Exchange of one plasma volume in therapeutic plasmapheresis removes about what share of a plasma substance?
1. A90%
2. B50%
3. C100%
4. D63%
Answer and explanation in LearnFree account
Question 15 · Medium
Pink plasma and fever follow a transfusion. Which test on a fresh EDTA sample proves that antibody has coated red cells inside the patient?
1. AOsmotic fragility test
2. BDirect antiglobulin test
3. CAntibody titration
4. DIndirect antiglobulin test
Answer and explanation in LearnFree account
Question 16 · Medium
A patient with Waldenström macroglobulinemia has blurred vision and bleeding gums from hyperviscosity. Which procedure gives the quickest relief?
1. ALeukapheresis
2. BPlateletpheresis
3. CPlasmapheresis
4. DRed cell exchange
Answer and explanation in LearnFree account
Question 17 · Easy
Within minutes of starting plasma, a patient with IgA deficiency develops wheeze and hypotension. The likely cause is:
1. ADonor leucocyte cytokines
2. BAnti-A antibodies
3. CAnti-IgA antibodies
4. DBacterial contamination
Answer and explanation in LearnFree account
Question 18 · Hard
A group O patient is given a unit labelled group A. Within minutes he has fever, back pain and hypotension. His post-transfusion plasma is pink and the DAT is positive. The diagnosis is:
1. ADelayed hemolytic reaction
2. BFebrile non-hemolytic reaction
3. CSeptic transfusion reaction
4. DABO-incompatible acute hemolytic reaction
Answer and explanation in LearnFree account

Blood banking: transfusion reactions, TTI and apheresis

An apheresis donor gives only platelets, and the rest of the blood is returned to him. This procedure is called:

Under Indian law, every unit of donated blood must be tested for:

A 10-year-old with thalassaemia major gets fever and chills during each red cell transfusion. His plasma is not pink, the DAT is negative and bag cultures are sterile. Which red cell product should he receive next?

In which transfusion reaction may the same unit be restarted slowly once the symptoms settle with an antihistamine?

What most often causes transfusion-related acute lung injury (TRALI)?

The most common cause of an acute haemolytic transfusion reaction is:

Fifteen minutes into a platelet transfusion from a 4-day-old unit stored at 22°C, a patient develops rigors, temperature 40°C and BP 80/50 mmHg. Urine is clear and the DAT is negative. The most likely cause is:

A 30-year-old woman with thrombotic thrombocytopenic purpura is started on plasma exchange. The replacement fluid of choice is:

Which parasitic infection must every donated unit be screened for in India?

A 60 kg patient with hematocrit 40% is to have a one-volume plasma exchange. Taking blood volume as 70 mL/kg, what plasma volume is exchanged?

An 80-year-old with heart failure becomes breathless with raised BP after two units given quickly. The likely reaction is:

Which marker is tested in donor blood to screen for hepatitis B?

A patient develops chills and back pain ten minutes into a transfusion. The first action is to:

Exchange of one plasma volume in therapeutic plasmapheresis removes about what share of a plasma substance?

Pink plasma and fever follow a transfusion. Which test on a fresh EDTA sample proves that antibody has coated red cells inside the patient?

A patient with Waldenström macroglobulinemia has blurred vision and bleeding gums from hyperviscosity. Which procedure gives the quickest relief?

Within minutes of starting plasma, a patient with IgA deficiency develops wheeze and hypotension. The likely cause is:

A group O patient is given a unit labelled group A. Within minutes he has fever, back pain and hypotension. His post-transfusion plasma is pink and the DAT is positive. The diagnosis is: