BLOOD DONATION LAB

Donor Selection

• its purpose is to to assess the suitability of an individual to be a blood

  donor so that blood donation is safe for the donor and the blood products derived from this donation are safe for the recipients.

1. Will a donation of approximately 450 mL of whole blood be harmful to the donor?

2. Could blood drawn from this donor at this time potentially transmit a disease to the recipient?

• questions that are answered when you assess the medical history information and physical examination

1. Registration

2. Health History Interview

3. Physical Exam

• three phases of donor screening

Registration

• this process includes documenting information that fully identifies the

  donor on an individual donation registration record.

True

T or F

Registration should also include prescreening for donor eligibility status.

Donor Deferral Registry (DDR) or Deferred Donor Directory (DDD)

• list of donors who have been deferred from donating blood on a previous donation or donation attempt.

at least 16 yo (<18 needs parental consent)

• minimum age requirement for donating blood

16-60 yo

• range of age acceptance for new donors

16-70 yo

• range of age acceptance for regular donors

8 weeks (2 months)

• time elapsed between whole blood donations

12 weeks (3 months)

• time elapsed between whole blood donations according to DOH-NVBSP

16 weeks (4 months)

• time elapsed after two-unit red cell collection

4 weeks (1 month)

• time elapsed after infrequent plasmapheresis

>2 days

• time elapsed after plasmapheresis, plateletpheresis, or leukapheresis

Allogenic Donation

• donation for use by the general patient population.

Directed Donation

• donation reserved for use by a specific patient.

Autologous donation

• donation by a donor reserved for the donor’s later use.

Apheresis donation

• donation of a specific component of the blood

• parts of the whole blood that are not retained are returned to the

  donor.

AABB Standards

• mandates that informed consent of allogeneic, autologous, and apheresis donors be obtained before donation.

Health History

• used to protect both the donor during the donation process and the patient receiving the blood.

• questions are asked in an environment that provides confidentiality and encourages the donor to answer truthfully.

True

T or F

Self-administered interview formats have been shown to yield more information regarding HIV high-risk behavior.

1. questions intended to protect the donor

2. questions intended to protect the recipient

• two categories of the questions during health history interview

1. Cold

2. Influenza

3. headache

4. Nausea

5. pregnant

• conditions for protection of the donor

• conditions that could get a donor to be temporarily deferred

1. exposure to bloodborne diseases

2. medications, vaccinations, high-risk activities

3. viral markers

• conditions related for questions that protects the recipient

1. Temporary Deferral

2. Indefinite Deferral

3. Permanent Deferral

• types of deferral

Temporary Deferral

• Prospective donor is unable to donate blood for a limited period of time.

1. Malaria

2. History of residence (lived longer than 5 consecutive years) in countries considered malaria-endemic

3. Acitretin (Soriatane) therapy

• 3 years temporary deferral

1. Mucous membrane exposure to blood

2. Nonsterile skin or needle penetration

3. Sexual contact with an individual with viral hepatitis/HIV/Hepa B surface antigen

4. Incarceration in a correctional institution for longer than 72 consecutive

   hours

5. History of syphilis or gonorrhea

6. Military personnel with history of travel to Iraq in 2003 (Leishmaniasis)- for 1 year from departure

7. Transfusion of blood, components, human tissue, plasma-derived clotting

   factor concentrates

8. Human diploid cell–rabies vaccine after animal bite

9. History of travel to a malaria-endemic area

10. Receipt of Hepatitis B immune globulin

11. Receipt of tetanus immunoglobulin

12. Receipt of unlicensed vaccines

• 12 month (1 year) deferral

West Nile Virus (WNV)

• 120 days deferral

Dutasteride (Avodart, Jalyn) therapy

• 6 months deferral

1. Pregnancy

2. Gamma Globulin for contact with Hepatitis A

• 6 weeks deferral

1. Receipt of German measles (rubella) vaccine

2. Receipt of Varicella-zoster (chickenpox) vaccine

3. Isotretinoin (Accutane, Amnesteem, Claravis, Sotret) therapy

• 4 weeks (1 month) deferral

1. Measles (rubeola) vaccine

2. Mumps vaccine

3. Polio (oral) vaccine

4. Typhoid (oral) vaccine

5. Yellow fever vaccine

6. Clopidogrel (Plavix), Ticlopidine (Ticlid) therapy (for platelet donors)

• 2 weeks (14 days) deferral

Warfarin (Coumadin) therapy

• 1 week deferral

1. Aspirin therapy

2. Piroxicam (Feldene) therapy

• 2 days deferral

✓ Viral hepatitis after 11th birthday

✓ Repeat reactive test for anti-HBc on more than one occasion

✓ Clinical or laboratory evidence of HCV, HTLV, or HIV infection

✓ Previous donation associated with hepatitis, HIV, or HTLV transmission

✓ Behavioral risk factors for HIV infection according to current FDA guidance

✓ History of Babesiosis or Chagas’ disease

✓ Stigma of parenteral drug use

✓ Injection of nonprescription drugs

✓ Risk of vCJD according to current FDA guidelines

• Receipt of bovine insulin

• Family history of CJD

• Dura mater transplant

• Receipt of human pituitary-derived growth hormone

✓ History of a bleeding disorder / blood disorder such as:

• Hemophilia, von Willebrand disease, sickle cell anemia, thalassemia,

  Kaposi’s sarcoma, polycythemia, or a history of receiving clotting factor

  concentrates

✓ History of cancer, leukemia, or lymphoma

• Exceptions include basal or squamous cell cancer, carcinoma in situ of the

  cervix, and papillary thyroid carcinoma that has been surgically removed.

• indefinite deferral

Indefinite Deferral

• Prospective donor is unable to donate blood for someone else for an unspecified period of time due to current regulatory requirements.

Indefinite Deferral

• this donor would not be able to donate blood for as long as these requirements are in force or until the current requirement changes

• These donors may be eligible to donate autologous blood.

Permanent Deferral

• prospective donor will never be eligible to donate blood for someone else

• These donors may be eligible to donate autologous blood.

1. HBsAg, HIV or Hepatitis C

2. Xenotransplantation

3. Receipt of a dura mater (or brain covering) graft

4. Etretinate (Tegison) therapy

• permanent deferral

✓ Anthrax

✓ Cholera

✓ DPT

✓ Influenza (live, attenuated)

✓ Polio (Salk)

✓ Rocky mountain spotted fever

✓ Typhoid (injection)

• vaccinations with no deferral (toxoids, synthetic, killed)

1. Hypnotics used at bedtime

2. Blood pressure medications

3. Bronchodilators

4. Decongestants

5. Oral contraceptives

6. Replacement hormones

7. Weight-reduction drugs

8. Mild analgesics

9. Vitamins

10. Tetracyclines and other antibiotics taken for acne

• medications commonly accepted for blood donation

Copper Sulfate

• what is used to estimate hemoglobin

Spectrophotometric Methods

• method that determined hemoglobin when using copper sulfate

12.5 g/dL (125 g/L)

38%

• minimum hemoglobin and hematocrit level for whole blood donation

125 - 175 g/L

• range of hemoglobin level for female donors according to DOH-NVBSP

135 - 185 g/L

• range of hemoglobin level for male donors according to DOH-NVBSP

<37.5 C (99.5 F)

• body temp

< 160/100 mm Hg

• blood pressure according to DOH-NVBSP

True

T or F

The medical director establishes the normal range of blood pressure for each facility and the appropriate deferral when the donor does not meet the requirement.

50-100 bpm

• pulse rate according to FDA for PLASMA DONORS

None

• pulse rate for whole blood donors according to AABB standards or FDA

60-100 bpm

• pulse rate according to DOH-NVBSP

>50 kg (>110 lbs)

• weight of donor

10.5 mL of blood/kg

• max volume of blood to be collected for whole blood collection, inclusive of pilot tubes testing

Confidential Unit Exclusion (CUE)

• Donors must be given a confidential way to indicate that their blood should not be used for transfusion.

Barcode Label System

• can be used where the donor is given a card with two barcode labels.

CUE

• Pressure from family, friends, or coworkers may cause someone to donate when he or she realizes they should not.

  • provides a confidential way to indicate this when more open ways may not be acceptable to the donor.

False (not always)

T or F

The person taking the donor’s health history should be the phlebotomist.

Antecubital Area

• where is blood ususally drawn from the donor

vasovagal reaction

• most common type of donor reaction which can cause fainting

1. Remove needle and tourniquet

2. Elevate legs above head

3. Apply cold compresses to forehead and back of neck

• treatment when the donor experiences weakness, sweating, dizziness, pallor, nausea, and vomiting

Cold compress on back of the neck

• treatment for syncope

Have donor cough

• treatment for when a donor twitches or have muscle spasms

1. Apply pressure for 7-10 minutes

2. Apply ice to area for

3. 5 minutes

• treatment for hematoma

1. Call for help

2. Prevent donor from falling from the donor chair or injuring himself or herself

3. Ensure donor’s airway is adequate

• treatment for convulsions

1. Begin cardiopulmonary resuscitation

2. Call for emergency help

• treatment for cardiac difficulties

1. Contact the donor center if there are any concerns regarding the safety of the blood or if you believe the blood should not be transfused.

2. Avoid smoking for 30 minutes; avoid alcohol until something has been eaten.

3. Drink more fluids than usual in the next 4 hours.

4. If dizziness or fainting occurs, lie down or sit with the head between the knees.

5. Caution donors who work at certain occupations who will be returning to work immediately (involving heights, construction, or machine operators).

6. Remove the bandage after a few hours.

7. Inform the blood center if any symptoms persist.

8. Post-donation fluid replacement begins in the donor room.

9. Donors should not be released until checked by a staff member.

• post-donation instructions and care

ABO group

Rh type

Weak D when needed

Antibody screening

• what should the blood be tested for

Antibody identification

• what should the blood undergo if positive for antibody screening

✓ Syphilis

✓ Hepatitis B

✓ Hepatitis C

✓ Human T cell lymphotropic virus (HTLV)

✓ HIV

✓ West Nile virus

• Infectious disease testing currently required by the FDA on units intended for allogeneic use includes tests for ____________

• ABO/Rh

• Antibody screen

• HBsAg

• Anti-HBc

• Anti-HCV and NAT

• Anti-HIV 1/2 and NAT

• WNV RNA

• Anti-HTLV I/II

• Serologic test for syphilis

• Blood donor serologic screening tests

Donor Lookback

• performed whenever a repeat donor tests positive for an infectious disease when the donor was previously negative.

• the blood center checks which patient(s) received the blood products from the donor’s previous donation and whether the patient(s) contracted the disease for which the donor now tests positive.

• Summary Table of Required Infectious Disease Testing using FDA-Licensed Tests (US)

1. Autologous Donations

2. Recipient-Specific “Designated” or “Directed” Blood Donations

3. Directed/Designated Donations

4. Apheresis/Hemapheresis

5. Therapeutic Phlebotomy/Therapeutic Donation/Therapeutic Apheresis

• special blood collection

Autologous Donations

• one who donates blood for his or her own use; thus, such a donor is referred to as the donor-patient.

Autologous Donations

• used to treat surgical blood loss in very specific situations

  where there is a reasonable opportunity to avoid homologous transfusions or when

  compatible allogeneic blood is not available.

1. Rare Blood Types

2. Multiple Antibodies difficult to find

• autologous blood is beneficial for them

False (less stringent)

True

T or F

Medical history and physical exam requirements for autologous donation are more stringent than those for allogeneic donations.

There is no minimum or maximum age requirement in autologous donation

✓ A prescription or order from the patient’s physician.

✓Hgb conc: 11 g/dL or HCT: 33%.

✓ Collection at least 72 hours before the anticipated surgery or transfusion.

✓ Deferral for conditions presenting a risk of bacteremia.

✓ Use only for the donor-patient if labeled “autologous use only.”

• criteria for autologous donations specified by the FDA, AABB

1. Prevent Transfusion-transmitted diseases

2. Prevent of alloimmunization

3. Supplement blood supply

4. Prevent febrile and allergic reactions

5. Reassurance of patient

• advantage of autologous blood

1. bacterial contamination

2. circulatory overload

3. cytokine-mediated reactions

4. misidentification of the product or patient

• possible risks in autologous donation

1. Inventory Control

2. Preoperative Anemia

3. Increased Cost

4. High Wastage

5. Inc Incidence of Adverse Reactions to donation

• disadvantage of autologous donation

Autologous Donation

• there is a high percentage of wasted units (30% to 50%) because patients end up not requiring any or all of the units donated

1. Unstable angina

2. Recent myocardial infarction or cerebrovascular accident

3. Significant cardiac or pulmonary disease with ongoing symptoms but without an evaluation by the treating physician

4. untreated aortic stenosis

• Contraindications to autologous blood donation should be defined by the blood center and may include medical conditions associated with the greatest risk from blood donation, such as _________

True

T or F

The AABB Standards does not permit “crossing over” of unused autologous units into the general inventory, except in exceptional circumstances.

The decision must be approved by the medical director on a case-by-case basis.

1. Preoperative collection

2. Acute normovolemic/ isovolemic hemodilution

3. Intraoperative collection

4. Postoperative collection

• methods for obtaining autologous blood

Preoperative collection

• Occurs during the 5 to 6 weeks immediately preceding a scheduled,

  elective surgical procedure unless the red blood cells and plasma are

  scheduled to be frozen

  • The last blood collection should occur no later than 72 hours (3 days)

    before the scheduled surgery to allow for volume replacement.

Acute normovolemic/ isovolemic hemodilution

• Results in the collection of whole blood with the concurrent infusion of

  crystalloid or colloid solutions, thus maintaining a normal blood volume

  but decreasing the patient’s hematocrit.

Acute normovolemic/ isovolemic hemodilution

• Performed in surgery immediately prior to beginning the surgical

  procedure and is managed by anesthesiology.

• The blood is collected in standard blood bags containing anticoagulant

  or preservative and is stored in the room at room temperature.

Intraoperative collection

• Involves collecting shed blood from the surgical site; processing the

  blood through an instrument that washes it with saline to remove tissue

  debris, free hemoglobin, and plasma that may contain activated

  coagulation factors

Intraoperative collection

• Residual RBCs are concentrated to a hematocrit of 50% to 60%; and then reinfusing those cells immediately.

• Has been used in cardiothoracic, major orthopedic, and cardiac surgeries, in addition to vascular surgeries, such as liver transplantation

Intraoperative collection

• The advantage of using intraoperative autologous blood collection is

  that it may be used in cases where preoperative donation is not possible

  due to the urgency of the surgery, or when the patient cannot be

  scheduled for multiple preoperative donations

• The blood may be stored at room temperature for up to 6 hours or at

  1°C to 6°C for up to 24 hours as long as the latter temperature has begun

  within 4 hours from the end of collection.

Postoperative collection

• Postoperative blood salvage is collected from a drainage tube placed

  at the surgical site.

• It is reinfused, with or without processing, via a microaggregate filter to

  screen out any debris.

Postoperative collection

• Blood is characterized as being dilute, partially hemolyzed, and defibrinated.

• Recommendation is that no more than 1,400 mL should be reinfused

• Blood must be reinfused within 6 hours of collection or it is to be

  discarded

RECIPIENT-SPECIFIC “DESIGNATED” OR “DIRECTED” BLOOD DONATIONS

• EXCEPTIONAL MEDICAL NEED

• Frequent donation by a specific donor for a specific patient with a medical need requires that the donor center have a procedure that typically calls for both a request from the patient’s physician and approval by the donor center’s physician.

• The donor must meet all allogeneic donor selection requirements, with the exception of donation frequency, provided that they are examined and certified by a physician.

1. Multiple antibodies or with antibodies to high incidence antigens who requires units from donors whose red cells are negative for the corresponding antigens

2. An infant with neonatal alloimmune thrombocytopenia who requires antigen-negative platelets from his or her mother.

• conditions for RECIPIENT-SPECIFIC “DESIGNATED” OR “DIRECTED” BLOOD DONATIONS

DIRECTED/ DESIGNATED DONATIONS

• A type of practice when a person seeks to receive blood from a named donor or a donor wishes to donate blood to be transfused to a named recipient.

• Directed donors must meet the same criteria as voluntary donors, and their blood can be used for other patients if not needed by the individual for whom the donations were initially intended.

DIRECTED/ DESIGNATED DONATIONS

• There is a rare possibility of graft-versus-host

  disease if a donor is a close relative and the

  patient is immunocompromised (e.g., an infant, a

  cancer patient, or a transplant patient). In this

  case, an irradiated blood product is indicated.

DIRECTED/ DESIGNATED DONATIONS

• Physicians may request cytomegalovirus (CMV)- negative blood components for patients who are immunocompromised and known to be CMV-negative. Leukoreduction reduces exposure to CMV because the virus is found within the WBCs. Seronegative, leuko- reduced blood products carry the least risk for infection with CMV.