Blood Banking and Transfusion for NEET PG Pathology: NBTC Donor Criteria, Cross-Match, Blood Products, Transfusion Reactions

Start Here

🎯 Exam priority: High. Expect: the minimum Hb and weight to donate in India, donation interval for men and women, deferral periods, the mandatory screening tests, the blood group in an emergency, the commonest and the deadliest transfusion reactions, TRALI vs TACO, and irradiated blood.

CBME mapping: PA 21.1–21.6. Indian rules: NBTC Guidelines for Blood Donor Selection and Referral (2017).

The Indian Blood Donor (NBTC 2017)

Indian donor criteria, blood products and transfusion reactions. Drawn by TrackNation.

• Voluntary, non-remunerated donors only; replacement donation is to be phased out.

• Eligibility: age 18–65 (first-time donors not over 60); weight ≥ 45 kg for 350 mL, > 55 kg for 450 mL; Hb ≥ 12.5 g/dL (thalassaemia trait accepted if Hb is adequate); BP 100–140/60–90; pulse 60–100, regular; afebrile.

• Interval: 90 days for men, 120 days for women.

• Every unit is tested for hepatitis B, hepatitis C, HIV, syphilis and malaria; HIV-reactive donors are referred to ICTC.

Before the Transfusion

• Compatibility testing: type the recipient's red cells for A, B and Rh(D); screen the plasma for red-cell antibodies; and cross-match the recipient's plasma against the donor's cells.

• Emergency: if the group is unknown, give group O red cells (no A or B antigens); use Rh-negative for girls and women of child-bearing age to prevent alloimmunisation.

• Bedside check of wristband, unit label and compatibility report — mislabelled samples and wrong-patient transfusions cause most acute haemolytic reactions.

• Products: packed red cells (1–6 °C, up to 42 days) to raise Hb; FFP (−18 °C, up to 1 year) supplies all clotting factors without platelets; cryoprecipitate is the fibrinogen source; leukoreduced cells (≥ 99.99% of white cells removed) after febrile reactions; irradiated products prevent transfusion GVHD. Rh immune globulin prevents maternal anti-D.

• Autologous donation: 3–4 units collected 2–3 weeks before elective surgery with iron; now reserved for rare blood types or multiple alloantibodies.

Transfusion Reactions

• Commonest: febrile non-haemolytic reactions.

• Acute haemolytic reaction: recipient antibodies (usually ABO) destroy donor cells; haemolysis is intravascular with haemoglobinuria, often within the first hour, with chills, fever and severe lumbar pain. MSD calls it the commonest cause of transfusion death (TRALI second), but the same chapter notes that TACO is now the commonest cause of transfusion deaths reported to the US FDA. Older exam keys expect "acute haemolytic".

• Anaphylaxis: rare, especially in IgA-deficient recipients.

• TRALI: donor anti-HLA or anti-granulocyte antibodies activate the recipient's neutrophils in the lungs; the chest X-ray shows non-cardiogenic pulmonary oedema, and diuretics are avoided. TACO: volume overload in people with heart or kidney disease and in older adults.

• Transfusion GVHD: donor lymphocytes attack an immunocompromised host (for example stem-cell transplant recipients, neonates) or a recipient of blood from a first-degree relative — prevented by irradiation.

Traps the Examiner Sets

• India: Hb 12.5, weight 45 kg, 90/120-day interval, age 18–65.

• Five mandatory tests: HBV, HCV, HIV, syphilis, malaria.

• Commonest reaction = febrile. Classic "deadliest" key = acute haemolytic (ABO, clerical error); TACO now tops US FDA death reports.

• Irradiation prevents GVHD; leukoreduction prevents febrile reactions.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 India donates at 18, 45 and 12.5 — age, weight, haemoglobin

• 🧠 Men 3 months, women 4 — donation interval

• 🧠 Five tests: B, C, HIV, Syphilis, Malaria — mandatory screening

• 🧠 O for Orphan blood in emergencies, negative for women — emergency transfusion

• 🧠 IRradiate to stop GVHD; filter to stop Fever — irradiation vs leukoreduction

• 🧠 TRALI = donor antibodies; TACO = too much volume — lung reactions

Rapid-Revision Cards

• NBTC donor basics

  18–65 y, ≥ 45 kg, Hb ≥ 12.5 g/dL.

• First-time donor age

  Not over 60.

• Volume by weight

  350 mL ≥ 45 kg; 450 mL > 55 kg.

• Donation interval

  Men 90 days; women 120 days.

• Mandatory screening

  HBV, HCV, HIV, syphilis, malaria.

• Post-delivery / abortion

  12 months / 6 months.

• Tattoo, transfusion

  12 months.

• Malaria / typhoid / TB

  3 m / 12 m / 2 y.

• Hepatitis B or C

  Permanent deferral.

• Vaccines

  Killed 14 d; live 28 d; anti-rabies after bite 1 y.

• Cross-match

  Recipient plasma vs donor cells.

• Emergency blood

  Group O; Rh-negative for women of child-bearing age.

• Packed RBCs

  1–6 °C, 42 days.

• FFP

  All factors, no platelets; −18 °C, 1 year.

• Cryoprecipitate

  Fibrinogen.

• Commonest reaction

  Febrile non-haemolytic.

• Deadliest reaction (classic key)

  Acute haemolytic (ABO, labelling error); TRALI second. TACO now leads US FDA death reports.

• Anaphylaxis

  IgA deficiency.

• TRALI

  Donor anti-HLA/granulocyte antibodies.

• GVHD prevention

  Irradiation.

• Febrile prevention

  Leukoreduction.

Sources

Facts in this article were checked against these documents.

• Guidelines for Blood Donor Selection and Blood Donor Referral — National Blood Transfusion Council / NACO, MoHFW, 2017 (link)

• MSD Manual Professional: Blood Collection; Blood Products; Technique of Transfusion; Complications of Transfusion — Merck & Co. (MSD Manuals), reviewed 2026 (link)

• Competency Based Undergraduate Curriculum, Pathology (PA 21) — National Medical Commission, 2024

Test Yourself: Practice Questions

Twenty-four questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. Under India's NBTC guidelines, the minimum haemoglobin to donate blood is

• (a) 14 g/dL

• (b) 10 g/dL

• (c) 11 g/dL

• (d) 12.5 g/dL

Q2. A 48-kg healthy man wants to donate. NBTC allows collection of

• (a) 450 mL

• (b) no donation below 60 kg

• (c) 350 mL (≥ 45 kg); 450 mL needs > 55 kg

• (d) 500 mL

Q3. A regular woman donor last gave whole blood 3 months ago. NBTC says she may donate after

• (a) 1 year

• (b) 120 days (4 months)

• (c) 90 days

• (d) 30 days

Q4. A 62-year-old wants to donate blood for the first time. Under NBTC he is

• (a) eligible only for plasma

• (b) not eligible: first-time donors must not be over 60

• (c) eligible

• (d) eligible after an ECG

Q5. Every donated unit in India must be screened for

• (a) dengue and typhoid

• (b) hepatitis B, hepatitis C, HIV, syphilis and malaria

• (c) HIV only

• (d) HIV and hepatitis B only

Q6. A woman who delivered 8 months ago wants to donate. NBTC advises

• (a) accept now

• (b) defer until 12 months after delivery

• (c) permanent deferral

• (d) defer 6 weeks

Q7. A man got a tattoo 5 months ago. Under NBTC he is

• (a) deferred for 12 months

• (b) accepted

• (c) deferred for 1 month

• (d) permanently deferred

Q8. A donor recovered from malaria 2 months ago. NBTC advises

• (a) defer 2 years

• (b) accept now

• (c) defer for 3 months after full recovery

• (d) permanent deferral

Q9. A donor with known hepatitis B is

• (a) accepted for plasma only

• (b) permanently deferred

• (c) deferred 12 months

• (d) accepted if asymptomatic

Q10. After a live attenuated vaccine, NBTC defers blood donation for

• (a) 1 year

• (b) 28 days

• (c) no deferral

• (d) 14 days

Q11. A person with insulin-treated diabetes wants to donate. NBTC says

• (a) permanently defer

• (b) defer 4 weeks

• (c) accept if HbA1c is normal

• (d) accept

Q12. Before a routine transfusion, the cross-match tests

• (a) donor plasma against recipient cells

• (b) the recipient's plasma against the donor's red cells

• (c) only the ABO group

• (d) only the Rh group

Q13. A bleeding trauma patient of unknown blood group, a 25-year-old woman, needs blood before grouping. Give

• (a) no blood until cross-matched

• (b) group O Rh-negative packed red cells

• (c) group AB Rh-positive whole blood

• (d) group A Rh-negative

Q14. The commonest complication of blood transfusion is

• (a) acute haemolytic reaction

• (b) TRALI

• (c) GVHD

• (d) febrile non-haemolytic reaction

Q15. Within the first hour of a transfusion, a patient develops chills, fever and severe lumbar pain, and the urine turns dark. Usual cause and mechanism:

• (a) bacterial contamination always

• (b) volume overload

• (c) IgA deficiency

• (d) ABO-incompatible blood from a labelling error; intravascular haemolysis

Q16. MSD lists four serious transfusion complications with very high mortality. Which of these is NOT one of them?

• (a) transfusion-associated GVHD

• (b) acute haemolytic reaction

• (c) localised urticaria

• (d) TRALI

Q17. A patient develops anaphylaxis during a blood transfusion. A predisposing condition is

• (a) IgA deficiency

• (b) thalassaemia trait

• (c) G6PD deficiency

• (d) iron deficiency

Q18. Acute breathing difficulty develops during a transfusion; the chest X-ray shows non-cardiogenic pulmonary oedema. The mechanism is

• (a) volume overload (TACO)

• (b) donor anti-HLA or anti-granulocyte antibodies (TRALI)

• (c) ABO incompatibility

• (d) bacterial sepsis

Q19. To prevent transfusion-associated GVHD in a stem-cell transplant recipient, blood products should be

• (a) leukoreduced only

• (b) irradiated

• (c) warmed

• (d) washed only

Q20. A patient who had a febrile non-haemolytic reaction to a previous transfusion should now receive

• (a) leukoreduced red cells

• (b) FFP

• (c) irradiated red cells only

• (d) whole blood

Q21. Packed red cells are stored at

• (a) −18 °C for a year

• (b) room temperature for 5 days

• (c) 1–6 °C for up to 42 days

• (d) 37 °C for 24 hours

Q22. A bleeding patient with very low fibrinogen should receive

• (a) albumin

• (b) platelets only

• (c) cryoprecipitate

• (d) packed red cells only

Q23. Fresh frozen plasma contains

• (a) platelets and factor VIII only

• (b) red cells

• (c) all clotting factors but no platelets

• (d) only fibrinogen

Q24. For planned elective surgery, autologous donation means

• (a) using a relative's blood

• (b) giving FFP

• (c) collecting 3–4 of the patient's own units 2–3 weeks before, with iron

• (d) transfusing O-negative blood

Active Recall

From memory: give the NBTC donor criteria, interval and key deferrals; the five mandatory screening tests; the steps of compatibility testing and the emergency blood choice; the main blood products and their storage; and the cause and prevention of each transfusion reaction.