Overview of the Modern Blood Bank Laboratory and Modern Trends

BLOOD BANK LABORATORY

• A facility that is involved in the collection, storage, processing, and distribution, of human blood and blood products for transfusion.

• Also function as a component of the heavily regulated health-care industry.

Non-profitable

All blood banks are (profitable / nonprofitable)

To save lives, not to earn money.

What is the main goal of blood banks?

American Association of Blood Banks (AABB)

Blood bank laboratory accrediting association

Food and Drug Administration (FDA)

Blood bank laboratory regulating agency

• BLOOD COLLECTION

• BLOOD STORAGE

• DONOR SCREENING

• BLOOD COMPONENT PREPARATION

• BLOOD TYPING AND CROSS-MATCHING

• ANTIBODY SCREENING AND IDENTIFICATION

• APHERESIS

Examples of services that a blood bank provides

• Size

• Resources

• Location

The capabilities of blood banks to offer services rely on their?

• COMPONENT PREPARATION AND STORAGE

• DONOR PROCESSING

• PRODUCT LABELLING

• MAIN LABORATORY

• REFERENCE LABORATORY

Blood bank laboratory is divided into several distinct areas:

• American Red Cross

• Regional Blood Centers

• In-house

Depending on the needs of a hospital, blood components may be acquired from external sources such as ___ or ____, or components may be processed ____

• Blood bank has a collection facility

• Blood bank does not have a collection facility

Component Preparation and Storage also depends on whether:

Blood bank with Collection Facilities

Blood banks that collect their own units of whole blood and use their blood resources more efficiently by separating them into a variety of components.

Blood Bank with no collection facility

These are blood banks that acquire blood components from external sources. They procure and store blood until needed.

Donor processing

What step is this?

The donated blood will be carefully screened and processed to ensure it meets safety and quality standards. These are screened for infectious diseases such as Hepatitis B, Hepatitis C, HIV, etc.

Product labelling

This is a mortal sin.

• Packed RBCs (pRBCs)

• Platelet concentration

• Fresh Frozen Plasma (FFP)

• Frozen Plasma collected within 24 hours (FP24)

• Cryoprecipitate (Cryo)

Blood bank w collection facilities separates variety if components such as:

FOR WHOLE BLOOD

• Room temperature (20-24C) as platelets deteriorate at higher temperatures.

• Cooled to ref temperature (1-10C)

• At what temperature is whole blood → platelets stored?

• At what temperature is frozen plasma stored?

Within 8hrs of collection

Fresh Frozen Plasma must be processed within?

Fresh Frozen Plasma

This can be further processed to cryoprecipitate.

Cryoprecipitate

This is a concentrate of certain proteins used to treat bleeding disorders.

Prepared up to 24hr of collection if stored in room temp (20-24C)

How is Platelet Concentrate prepared?

Apheresis

It is a process where the whole blood is separated into different components.

1. Donor’s blood is removed

2. Anticoagulated

3. Transported directly to apheresis machine

4. Centrifugation

5. Desired component is removed

6. Remaining portion is returned to donor

Explain apheresis

• Plateletpheresis

• Plasmapheresis

• Leukapheresis

• RBC apheresis

Blood products obtained through apheresis:

• Use a prominent vein for collection

• Because the remaining portion is returned to the large vein

• What is the requirement during blood collection?

• Why?

• PHILIPPINE RED CROSS

• REGIONAL BLOOD CENTERS

External sources of blood bank if they dont have any collection facilities.

To ensure a safe and adequate supply of blood for patient’s need

Goal of blood bank

• Plasma

• Platelet

• RBCs

Blood banks are responsible for preparing blood components such as ( __, __, __, ) from whole blood. They are stored under specific conditions until these products are needed for transfusion

• Hepatitis B

• Hepatitis C

• HIV

The blood is screened for infectious diseases such as?

PRODUCT LABELLING

After blood components are prepared and tested, they are labelled with donor’s blood type, expiration date, and other special instructions. it is essential in blood bank.

MAIN LABORATORY

The heart of the laboratory; central area where various laboratory tests related to blood banking are performed, inclusive of compatibility testing.

REFERENCE LABORATORY

Some blood banks do not have this; they are laboratories that performed specialized testing and consultation services (rare blood type testing, unusual antibodies determination, infectious diseases such as HIV and hepatitis)

• Anticoagulant

• Density and size

• This is where blood is placed after collection

• Blood components are separated using centrifuge according to their…?

PROCESS OF PREPARATION:

1. Apheresis

2. Centrifugation, Apheresis, Leukoreduction Filtration

3. Centrifugation, Apheresis, In-line filtration

4. Frozen Plasma, Antihemophilic factor, Cryoprecipitate

5. Heavy Spin-Freezing (-18C)

What is the process of preparation?

1. Granulocytes/ WBC

2. RBC

3. Platelets

4. Cryoprecipitates

5. Fresh Frozen Plasma/FP24

Platelet Concentrates and Cryoprecipitate

These blood components may be received as individual units but are more easily administered if pooled before infusion

pRBCs

Individuals with IgA deficiency must not be transfused with?

AUTOMATED CELL WASHERS

These are used to prepare washed pRBCs

Sterile connecting devices (STCDs)

• These devices produce sterile welds between two pieces of compatible tubing

• this procedure permits sterile connection of a variety of containers and tube diameter

• also called CLOSED SYSTEM

1. pRBCs, WBC

2. FFP/FP24, Cryopercipitate

3. Frozen RBC, Rare blood type [AB-], Rare autologous units

4. PC, Apheresis Platelet

5. PC, Apheresis Platelet

Determine which components are stored in the ff. temperatures:

1. Refrigerators maintained at 1-6C

2. Freezers maintained at -18C or Lower

3. Freezers maintained at -65C or Lower

4. Platelet rotators maintained at 20-24C

5. Platelet agitators maintained at 20-24C

TUBE SEALER

• For sealing blood bag pilot tubing

• For cutting blood bag pilot tubing

PLASMA EXPRESSOR

For packing RBCs, transferring plasma from one blood bag to another, and removing plasma

STERILE CONNECTING DEVICES

For creating sterile welds between two tubes

BLOOD BANK REFRIGERATED CENTRIFUGE

For preparing blood components

BLOOD IRRADIATOR

For preparing leukocyte-poor RBCs (to prevent Graft vs. Host Disease)

Rigorous testing

Before a unit of blood can be placed into the general inventory, ____ must be performed to determine its suitability for transfusion

1. Lavender top (EDTA)

2. Red top (Plain)

Collection tubes

1. used for retyping, hematocrit, and hemoglobin level determination

2. used for blood screening

• ABO and Rh typing

• Hepatitis B surface antigen (HBsAg)

• Anti-HCV

• Antibodies to HIV (Anti-HIV-1)

• Serologic test for syphilis (Syphilis Ag)

• Malaria antibody and antigen

Tests important in blood screening (Philippine Setting)

PRODUCT LABELLING

• Critical step in the transfusion process

• no discrepancies in the ABO and Rh testing

• Absence of detectable Ab in plasma-containing components

• Nonreactive viral marker tests

• non reactive syphilis test

• Sustainability Requirements include:

Reconfirm

However, according to AABB Standards, the blood bank to which this blood is shipped is required to ____ the labeled ABO of each RBC-containing product received

• Anti-A, Anti-B

• Anti-A, Anti-B

• Anti-A, Anti-B

• Anti-A,B

• Anti-A,B, Anti-D

Determine the tests performed.

• A positive

• B positive

• AB positive

• O positive

• O negative

Patient care

The primary mission of the main laboratory

TYPE AND SCREEN

TESTS PERFORMED IN THE MAIN LABORATORY:

• Determines the ABO and Rh type

• Screens unexpected Ab in plasma

• Helps identify compatibility issues before transfusion

TYPE AND CROSSMATCH

TESTS PERFORMED IN THE MAIN LABORATORY:

• Crossmatches the donor’s blood with the patient’s blood

• To avoid adverse transfusion reaction

PRENATAL EVALUATION

TESTS PERFORMED IN THE MAIN LABORATORY:

• Performed to determine the blood type and Rh factor of the pregnant women; to identify any potential risks or HDFN

POSTNATAL EVALUATION

TESTS PERFORMED IN THE MAIN LABORATORY:

• After childbirth (postpartum), the blood type and Rh of the mother is assessed (particularly if theres Rh sensitization); applicable for Rh negative mothers

CORD BLOOD STUDIES

TESTS PERFORMED IN THE MAIN LABORATOR:

• Involved testing the blood collected from the umbilical cord of the newborns to determine the blood type and Rh factor

Proper patient identification

The single most important aspect of patient care in all health-care settings

2

A minimum of __ identifiers is required for patien samples

• Px. Full name (First Name, Middle Name, Last Name)

• Date of birth and/or Medical Record Number

What are the identifiers for patient samples?

• Type and Screen

• Type and Crossmatch

• Prenatal Evaluation

• Postnatal Evaluation

• Cold Blood studies

The tests in routine testing

• Inspect the unit for any abnormal appearance (discoloration or hemolysis)

• Verifies that all required transfusion forms and labels are complete and that they adequately identify the transfusion recipient

The individual in the blood bank who will issue the blood product must do the ff. critical checks

• ABNORMAL APPEARANCE

• INDICATES CONTAMINATION OR HEMOLYSIS

REASONS TO QUARANTINE BLOOD COMPONENTS BEFORE SHIPMENT OR TRANSFUSION:

Plasma of RBC unit is brown, red, murky, or purple

• Indicates bacterial contamination

REASONS TO QUARANTINE BLOOD COMPONENTS BEFORE SHIPMENT OR TRANSFUSION:

Plasma of RBC unit is green

• Not suitable for transfusion; RBCs are damaged

REASONS TO QUARANTINE BLOOD COMPONENTS BEFORE SHIPMENT OR TRANSFUSION:

Zone of hemolysis is above RBC mass

• Contamination or Leakage

REASONS TO QUARANTINE BLOOD COMPONENTS BEFORE SHIPMENT OR TRANSFUSION:

Inadequate sealing of RBC segments in tubing

• Pink to red plasma

REASONS TO QUARANTINE BLOOD COMPONENTS BEFORE SHIPMENT OR TRANSFUSION:

Hemolysis of RBC

• Indicates metabolic disorders

REASONS TO QUARANTINE BLOOD COMPONENTS BEFORE SHIPMENT OR TRANSFUSION:

Grossly lipemic units

• Bacterial contamination or presence of tissue

REASONS TO QUARANTINE BLOOD COMPONENTS BEFORE SHIPMENT OR TRANSFUSION:

Unusual cloudy or turbid appearance of platelet unit

REFERENCE LABORATORY

• the problem-solving section of transfusion service

• their goal is to ensure that any discrepancies detected in routine testing are resolved in an accurate and time-efficient manner

• also serves as a vital source for ensuring the accuracy or reliability or efficiency of transfusion-related testing and services

• ABO discrepancies investigation

• Rh discrepancies investigation

• Unexpected Ab indentification

• Transfusion reaction

Tasks of REFERENCE LABORATORY

• RBC PRESERVATION

• 1-6 C

• The goal of this is to provide viable and functional blood components for patients requiring blood transfusion

• RBC units are stored at ___; storage time may vary depending on the preservative used

• RBC VIABILITY

• More than 75%

• Less than 1%

• A measure of in vivo RBC survival following transfusion

• A critical aspect of blood preservation as it directly impacts the success of transfusion

• The US FDA requires an average 24h post-transfusion RBC survival of ____?

• This is assessed as free hemoglobin of ____ total of hemoglobin to meet viability standards

STORAGE LESION

Associated with loss of RBC viability; due to biochemical changes within the RBC

220-250 mg of iron

How many mg of iron is contained in one RBC unit

RBC STORAGE LESION

• Acid citrate dextrose

• Citrate phosphate dextrose

• Citrate phosphate double dextrose

• Citrate phosphate dextrose adenine

Enumerate the Anticoagulant Preservative Solutions.

ANTICOAGULANT PRESERVATION SOLUTIONS

1. CITRATE (SODIUM CITRATE/CITRIC ACID)

2. MONOBASIC SODIUM PHOSPHATE

3. DEXTROSE

4. ADENINE

CONTENTS OF ANTICOAGULANT PRESERVATIVE SOLUTION:

1. Chelates calcium; prevents clotting

2. Maintains pH during storage; necessary for maintenance of adequate levels of 2,3-DPG

3. Substrate of ATP production (cellular energy)

4. Production of ATP (extends shelf-life from 21-35days)

• Glucose

• Adenine

• Electrolytes (K, Na)

Additive solutions contains what essential nutrients?

• Saline

• Adenine

• Glucose

Additive solutions contains what basic contents?

ADDITIVE SOLUTIONS

• preserving solutions that are added to the RBCs after removal of the plasma with or without platelets

• it is intended to replace the nutrients in the plasma which were removed during packed RBC preparation

• also helps to ease the flow of RBCs during transfusion

• helps maintain the viability and functionality if RBCs during storage

• improves RBC quality for transfusion

• Extends the shelf-life of RBCs to 42 days by adding nutrients

• Allows for the harvesting of more plasma and platelets from the unit

• Produces a pRBC of lower viscosity that is easier to infuse

BENEFIT OF USING ADDITIVE SOLUTIONS:

ADDITIVE SOLUTIONS CURRENTLY APPROVED BY THE FDA

• Adsol

• Nutricel

• Optisol

• SOLX

• AS-1

• AS-3

• AS-5

• AS-7

• ASG + mannitol

• ASG + citrate and phosphate

• ASG + mannitol

• ASG + mannitol

What are their contents?

• Adsol

• Nutricel

• Optisol

• SOLX

• PLATELET PRESERVATION

• PLATELET STORAGE LESION

• Platelets are routinely stored at room temp (20-24C) for 5days with constant agitation

• loss of platelet quality during storage

• Agitation has been shown to facilitate oxygen transfer into the platelet bag and oxygen consumption by the platelets

• Agitation also maintains constant pH inside the platelet bag

WHAT IS THE PURPOSE OF AGITATION?

PERFORMANCE CRITERIA FOR PLATELET CONCENTRATE COLLECTIONS

PLATELET STORAGE LESION

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