Donor Selection

Eligible donor

The donor is qualified to donate

Suitable donation

The donation is suitable for safe transfusion

Allogenic donation

Donation for use by the general population

Directed donation

Donation reserved for use by a specific patient

Autologous donation

Donation reserved for self for later use

Apheresis donation

Donation of a specific component of blood

List the four steps of the blood donation process in order

1. Registration

2. Education Materials

3. Health History Interview

4. Physical Exam

Registration

1st step of the blood donation process. It involves documenting that the donor fully identifies themself. This process assures that sufficient time has passed since last donation, that no prior deferrals are in place, and to contact with any test result they may need notification about.

Educational Materials

2nd step of the blood donation process. Essentially an informed consent process. Also educates the donor about diseases that can be transmitted via blood. Must be available for non-English speakers, illiterate individuals, or individuals with physical disabilities.

Health history interview

3rd step of the blood donation process. A questionnaire designed to identify if the donor is elegible to donate and if donation is safe. The Donor History Questionnaire (DHQ) is developed by the AABB with approval from the FDA. Medical directors are allowed to add questions. Frequent donors can use an abbreviated form to expedite the donation process.

Physical Exam

4th step of the blood donation process. Looks at general appearance, H&H, temperature, blood pressure, pulse, and weight.

State the required demographic information to be collected and stored in a donor’s record.

• Full name

• Permanent address (postal address for the next 8 weeks)

• DOB (must be at least 16 and that may require parental consent. Varies by state, 17 in FL, 16 w/ parental consent)

• Gender

• Date of last donation

• Unique ID number (SSN or Driver’s license)

• Positive ID (photo ID, which means two forms of ID)

• Race

• Intended use of donation

Indefinite deferral

Cannot donate until regulatory statute is changed.

Permanent deferral

Will never be elegible to donate.

Temporary deferral

Inelegible to donate blood for a specific period, but may be elegible again later.

If the donor is experiencing weakness, nausea, dizziness, pallor, nausea, and vomiting

Remove needle and cuff; elevate legs above the head; apply cold compress to forehead.

If donor has a syncope (faints/passes out)

Apply a cold compress on the back of the neck.

If the donor is experiencing twitching or muscle spasms

Have the donor cough

If the donor forms a hematoma

Apply pressure for 7-10 minutes; then apply ice for 5 minutes.

If a donor is convulsing

Call for help; prevent donor from falling; and ensure airway is ok.

If a donor is having cardiac difficulties

Begin CPR and call for emergency help.

After the donation, the donor should be told the following:

• Contact the blood center with any concerns

• Avoid smoking for 30 minutes

• Avoid drinking alcohol until you eat

• If dizzy or faint, lie down or sit with your knees between your head.

• Drink more fluids over the next 4 hours.

• Caution folks who work in physically demanding fields to be careful and vigilant of their safety.

• Remove the bandage only after a few hours.

• Inform the blood center if any symptoms persist.

• Remind them they can donate blood again in 8 weeks.

Apheresis

Removal of one component by centrifugation with the rest returned to the donor.

Leukapheresis

Use of certain drugs that aid in harvesting granulocytes, requires the patient’s consent.

Plateletpheresis

Can only donate every 48 hours and no more than twice per week or more than 24 times in a rolling 12 month period. Must have a PLT count greater than 150,000/μL if last donation is within 4 weeks. No aspirin within the last 36 hours.

Plasmapheresis

Frequent donations require total protein and IgG levels.

Hemapheresis (Red Cell Apheresis)

Two units of PRBCs are removed. Donors must be larger to handle that loss.

• Males must be at least 130 lbs and 5’ 1”.

• Females must be at least 150 lbs and 5’ 5” tall.

• Both must have HCT > 40%

Donor deferral doubles from 8 weeks to 16 weeks (because two units are being collected).

List the 5 layers used for screening the blood supply

Layer I: Population screening

• Looks at population as a whole and helps determine who we want to recruit.

Layer II: Individual screening

• Educational materials, DHQ, and physical exam

Layer III: Lab testing

• Checking for blood types, perform unexpected antibodies, and infectious illnesses in donations.

Layer IV: Confidential Unit Exclusion

Layer V: Donor Record Checks

ABO and Rh types

ABO forward and reverse typing (w/ discrepancies clarified)

D-typing and Weak-D performed on all immediate spin negatives.

Clinically significant RBC antibodies

Antibody screen

Viral Hepatitis

HBsAg and anti-HBc

Anti-HCV

NAT for HCV and HBV(individually or pooled)

HIV-1 and HIV-2

Anti-HIV-1, Anti-HIV-2 and HIV-1 RNA.

HTLV-1 and HTLV-2

Anti-HTLV-1 and Anti-HTLV-2

Syphilis

Non treponemal test or Anti-treponemal antibodies.

WNV (West Nile Virus)

WNV RNA

Chagas Disease

IgG antibody to T.cruzi (only one time test/donor)

List the steps involved in testing for infectious disease in donated blood

• Screening tests

• Confirmation

• True positive

Screening Tests

Typically immunoassays. They are highly sensitive but may lack specificity. Can be tested in pools for NAT.

Confirmation tests

Repeats any positive screening tests and tests individual units if pooled NAT is positive. These tests are more specific tests than the screening tests.

True positive

Notify the donor, health department, and other required groups. Initiate a look-back process.

Look-back process

Process where previous blood components from a donor who has later tested positive for an infectious disease (like HIV, HCV, or Chagas) are traced and investigated to identify recipients who may have received those components.

This process helps alert recipients to potential infection and offer them testing and counseling.

Steps in the look-back process

1. Quarantine units from prior collections still on the shelves.

2. Notify facilities that received these units so they can also quarantine.

3. Further testing on donor, if needed.

4. Destruction or relabeling of potentially infectious prior collections.

5. Have a policy to notify recipients and their physicians so follow-up can be performed.