Unit 2 Objectives

What is the purpose of a donor interview?

• Ensuring the donors health will not be compromised by donating 

• Ensuring the recipients health will not be compromised by donating

What is the weight needed to donate blood?

• < 110 lbs (50 kg)

What is the temperature needed to donate blood?

• < 99.5 F

• < 37.5 C

What BP is needed to donate blood?

• systolic: 90-180

• diastolic: 50-100

What pulse rate is needed to donate blood?

• 50-100 bpm

What hemoglobin is needed to donate blood?

• female: < 12.5 g/dL

• male: <13.0 g/dL

What hemoglobin is needed to donate blood?

• female: 38%

• male: 39%

what is used for a donor interview?

• Universal donor history questionare (UDHQ)

What questions are used to ensure the donor is protected?

• current illness

• pregnancy

• medication

• recent surgeries

• weight/ overall health

What questions are asked to protect the recipient?

• HIV risk behaviors

• drug use

• travel to malaria areas

• past infections

• blood transfusion history

• tattoos or piercings

What is a temporary deferral?

• Deferred based on current regulations and technology for an unforeseeable period of time 

What is a permanent deferral?

• Can no longer reenter donor pool and forever deferred

what events would result in a permanent deferral?

• positive HIV test

• Xenotransplantation

• Cadaveric dura mater graft

• some cancers

What is the deferral time for pregnancy?

• 6 weeks postpartum

What is the deferral time for anticoagulant medication (heparin, warfarin)?

• 7 days

What is the deferral time for acne medication?

• 1 month

What is the deferral time for PEP and Hep B immune globulin?

• 3 months

What is the deferral time for prophylactic medication?

• 2 years

What is the deferral time for traveling to a malaria-endemic area?

• 3 months

What is the deferral time for being a resident of a malaria endemic area?

• 3 years

what is the deferral time for the smallpox vaccine?

• 8 weeks

What is the deferral time for the German measles and Varicella vaccine?

• 4 weeks

What is the deferral time for a live bacteria MMR vaccine?

• 2 weeks

What is the deferral time for an unlicensed tattoo or body piercing?

• 3 months

What is the deferral time for being in juvenile detention for over 72 hours?

• 1 year

What is the deferral time for a person who is HIV positive?

• permanent

What is the deferral time for someone who received a dura mater graft/xenotransplant?

• permanent

What is the deferral time for a whole blood donation?

• 8 weeks (56 days)

What is the deferral time for a double red blood cell donation?

• 16 weeks (112 days)

what is the deferral time for donating plasma?

• 4 weeks

What is the deferral time for donating platelets?

• 2-7 days

  • many donor centers are every 14 days to align closer to 24 donations per year

What information is given during the donor screening history?

• donor identification

• name

• adress

• phone number

• DOB

• gener

• race

• verify last donation

What is an indefinite deferral?

• based on current regulations and technology for an unforeseeable period of time

• if regulations change than person may be able to donate in the future

What is the deferral time for Anti-platelet medications?

• 2-14 days depending on medication

  • aspirin is OKAY if donating whole blood, plasma, or RBC by apheresis

What is the deferral time for anticoagyulants

• most are 2 days

• warfarin/ heparin: 7 days

What acne medications have a 1 month deferral?

• actuate

• amnesteem

• absorica

• clavarvis

• myosrisan

• sotret

• zenatane

If someone receives an injectable medication for HIV but isnt HIV positive but is at high risk, what is there deferral time?

• 2 years

What live attenuated vaccines have a 2 week deferral?

• MMR

• polio

• typhoid

• yellow fever

What scenarios warrant a 3 month deferral?

• PEP

• sexual contact with new partner

• sexual contact with someone + for HIV

• someone who received payment or drugs for sex

• use of needles to abuse drugs or sexual contact with anyone who uses needles

• accidental needle stick or contact with another individuals blood

• history assessment of blood transfusions

If someone comes into donate blood but has a cold or isnt feeling well, what is the proper action?

• temporary deferral till they feel better

What needle is used for blood donations?

• 16 gauge needle with needle guard

What is the purpose of a diversion pouch?

• approx. 20 ml of blood is diverted containing skin plug and bacteria in skin layers

• those ares used to fill testing tubes that will screen the blood for disease

Describe the process of whole blood collection

1. properly identify the donor

2. prepare venipuncture site

3. draw donor with 16 gauge needle

   1. bag fills with 450 - 500 ml of blood

4. constantly mix blood and anticoagulants using scale

5. remove needle and seal off bag

6. give donor post collection instructions

How is the venipuncture site prepared when donating blood?

1. Scrub for a min and 30 sec with FDA approved cleanser

2. Scrub 1.5 inches in all directions

3. Leave untouched for 30 seconds 

4. Cover with sterile gauze

5. Phlebotomist may NOT retouch site

What is the preferred vein order for donating blood?

1. median cuboidal

2. cephalic

3. basilic

What adverse donor reactions can occur?

• vasovagal

  • weakness, sweating,dizziness, pallor, nausea and vomiting

• syncope

• twitching

• hematoma

• convulsions

• cardiac difficulties

What are the steps in responding to adverse donor reactions

• remove needle and tourniquet

• appropriate treatment

• continue observation

• canteen area

• information for donor to contact appropriate individuals if future system

• document adverse reaction

What are the postdonation care instructions?

• drink 12 oz fluid and eat before you leave

• remain at least 15 min, do NOT leave till released

• wait 30 min (prefer: 2-4 hrs) before smoking

• leave bandage on for 4 hours

• avoid strenuous activity

• drink extra fluids for 24 hrs

• avoid alcohol till you’ve eaten

Define autologous donation.

• collection and reinfsuion of shed blood

  • donor and recipient are the same person

what are the autologous donation requiremnents?

• hgb must be > 11 g/dL

• must have procedures in place to make sure patient receives autlogus units before any other units

• pre transfusion testing: minimum of ABO/Rh

• if not transfused, it is discarded or frozen

What are the benefits of an autologous donation?

• peace of mind

• nor transmission of disease

• no alloimmunization

• phlebotomy process stimulates erythropoiesis

• reduced possibility of transfusion reactions

• compatible blood for person with multiple alloantibodies

What are the requirements needed for an autologous donation?

• prescription from physician

• need review by blood bank medical director

• patient consent

• if patient weighs less than 110 lbs, then low volume collection can be taken

What are the donor criteria for autologous donations?

• no age limit

• no weight limit

• Hgb: >11 g/dL OR Hct: > 34%

• can donate every 3 days

What blood processing is done to autologous donations?

• ABO/Rh testing

What tests must be done to autologous donations if transfusion is done outside of collection facility?

• HBsAG

• Anti-HCV

• HCV NAT

• Anti-HIV 1 and 2

• HIV NAT

• STS

What are the steps in an autologous blood recovery?

• medical device collects shed blood from operative field

• usually washed, filtered, concentrated, then rein-fused

• does not remove bacteria

What is offered along with an autologous donation?

• warm IV fluids

• reducing patient BP

• use of topical hemostasis agents

• use of modern cauterization methods

How are the donor history and physical exam requirements different in autologous vs homologous/alogenic blood donors?

• allogenic donors

  • strick eligibility criteria

• Autologous

  • less strick requirements

Justify the need for information required on the donor unit label

• ensures correct blood type is given

• prevents transfusion errors

• allows tracking of units

• enables recall if problem occurs

• ensures regulatory compliance

describe intraopperatice blood salvage also known as cell saver, a type of autologous transfusion method.

• autotransfusion device that suction, filters, washes, and concentrates blood lost during surgery, returning it to the patient

• Blood is aspirated from the surgical field, mixed with anticoagulant, centrifuged to separate red blood cells from waste (fat, plasma, tissue debris), washed with saline, and packed into an IV bag for reinfusion

what is an acute normovolemic hemodilution?

• surgical blood conservation technique where a patient’s blood is collected immediately before or after anesthesia induction and replaced with volume-expanding fluids (crystalloids/colloids)

• reduces the red blood cell count lost during surgery, and the autologous blood is reinfused afterward

What are the requirements for an acute norovolumic hemodilution?

• patient HCT must be high enough to tolerate

• surgery will cause significant blood loss

• blood collection at start of surgery must be large enough volume to make a significant impact when reinfused

What is a directed donation?

• donor requests specific individuals to be allowed to donate blood specifically for them

What is an aphaeresis collection?

• whole blood is removed from donor

• components are separated via centrifugal force

• one or more components retained while others are returned to donor

• may be used as donor collection or therapy

What factor is important in apheresis?

• different densities of blood components

  • RBC heaviest/most dense

  • platelets/ WBC form middle layer

  • plasma is lightest

what is platletpheresis?

• collection of a single donor platelet product

what is leukapheresis?

• granulocyte collection

What is plasma pheresis?

• collection of plasma

What is double red cell collection known as?

• erythrocytapheresis

What is the need for irradiating directed blood donations?

• preventing Transfusion-Associated Graft-versus-Host Disease (TA-GVHD).

  • Irradiation destroys donor lymphocytes that could attack the recipient’s tissues

How are the requirements for a double red cell donation different compared to a regular donation?

• females

  • height: 5’5

  • weight: 150 lbs

• males

  • height: 5’1

  • weight: 130 lbs

What are the minimum hemoglobin and hematocrit requirements for a double RBC aphaeresis blood donation?

Male

• Hgb: 13.3 g/dL

• Hct: 40%

Female

• Hbg: 13.3 g/dL

• Hct: 40%

What is therapeutic phlebotomy?

• removal of blood from a patient for medical reasons

• requires a physicians order

What conditions could benefit from therapeutic phlebotomy?

• polycythemia

• hemochromatosis

• testosterone therapy

• certain porphyria

• treating conditions with iron overload in RBC

What is an allogenic blood donation?

• voluntary donation of blood for the general public

If a donor is positive in donor blood testing, what should happen?

• unit is discarded or used for research

• donor is notified and deferred as required

• alorgithms are used to confirm patients positive result’s

what are the donor frequency of donations for allogenic donors?

• every 8 weeks (56 days)

what are the donor frequency of donations for autogenic donors?

• more frequent if medically approved before surgery

what are the donor frequency of donations for apheresis donors?

• platelets: up to twice weekly

• double RBC: every 16 weeks

What is the reason for different donation frequencies?

• Red blood cells take weeks to regenerate

• Platelets regenerate in a few days

• Plasma proteins regenerate quickly

What are the organizations regulating blood banks?

• FDA (Food and Drug Administration)

• AABB

• CAP (College of American Pathologists)

• Joint Commission

• American Red Cross

What is the FDAs job in blood bank regulation?

• governing regulatory agency

• Responsible for:

  • Blood safety regulations

  • Licensing blood centers

  • Enforcing compliance

What is the AABB’s job in blood bank regulation?

• developing standards

• provide accreditation

• sets the highest industry standards for blood banking and transfusion medicine.

What is CAPs job in blood bank regulation?

• provides laboratory inspection and accreditation

• Accredits hospital transfusion services and laboratories, ensuring compliance with laboratory standards through on-site inspections and proficiency testing.

What is the Joint Commissions job in blood bank regulation?

• evaluates healthcare organization quality

• Evaluates the laboratory and transfusion service within the context of the entire hospital’s safety and quality protocols

What is the American Red Crosses role in blood banking regulation?

• A major blood collection and processing entity responsible for a significant portion of the nation’s blood supply

What are the two categories of testing required for allogenic and directed donor blood?

• serologic testing

• infectious disease screening

What are the different serologic test needed for allogenic and directed blood donations?

• ABO typing

• Rh(D) typing

• RBC antibody screen

What does ABO typing determine?

• blood group (A,B,AB, or O)

• done using two tests

  • forward type

  • reverse type

What is the forward type test in ABO typing?

• tests for antigens on donors RBC

• these are mixed with anti-A and anti-B reagents

• clumping (agglutination) indicates antigen is present

  • ex:

    • clumps with anti-A → type A

    • clumps with anti-B → type B

    • clumps with both→ AB

    • clumps with none → O

What is the reverse type test in ABO typing?

• tests for antibodies in donors plasma

• plasma is mixed with known A and B cells

• ^ex:

  • clumps with B cells → anti-B present → type A

  • clumps with A cells → anti-A present → type B

What is Rh typing?

• determines if the Rh(D) antigen is present on RBC

  • Rh(D) positive → D antigen present

  • Rh(D) negative → D antigen absent

What is required if you have a negative Rh(D) test?

• weak D test

  • D antigen can be present but very weak so it may not react during Rh testing

What are the possible results of a Weak D test?

• Weak D pos → label as Rh positive

• Weak D negative → label as Rh(D) negative

What happens if the RBC antibody screen is negative?

• blood is good to go/safe to use

What happens if RBC antibody screen is positive?

• you can use the RBC

  • platelets and plasma must be discarded

What are the required infectious disease ANTIBODY testings for allogenic and directed donations?

• Anti-HTLV I and II

• Anti HIV 1 and 2

• Anti- HCV (Hepatitis C viris)

• Anti-HBc (Hepatitis B)

• antibodies to Trypanosoma cruzi on current or at least 1 periods donations

What methods are used for collecting antibody infection diseases tests?

• ELSA

• ChLIA

• CMIA

What are the required infectious disease ANTIGEN testings for allogenic and directed donations?

• HsBAG: Hepatitis B surface antigen

• NATs

  • HBV DNA

  • HCV RNA

  • HIV-1 RNA

  • WNV RNA

  • Babes DNA/RNA in states where required by FDA

• serologic test for treponema pallidum (Syphilis)

What methods are used to perform syphilis tests?

• STS

• PRP

• microhemagluttination assays

• antibodies against Treponema pallidum