7 - DONOR SELECTION, COLLECTION, TESTING, STORAGE AND INFUSION OF BLOOD

DONOR SCREENING

Carried out by an adequately trained physician and/or qualified staff under the supervision of a qualified physician to determine the suitability of the blood donor

Between 16-65 years old (parental consent is required for ages under 18)

Age of potential blood donor

At least 50 kg (for 500 ml blood unit)

At least 45 kg (for 250 ml blood unit)

Weight of of potential blood donor

50-100 beats/min (regular rhythm)

Pulse rate of potential blood donor

90-160 mm Hg (systolic)

60-100 mm Hg (diastolic)

Blood Pressure of potential blood donor

125 g/L (12.5 g/dl)

Hemoglobin of potential blood donor

37 volume percent

Hematocrit of potential blood donor

copper sulfate method (sp. gr. 1.053)

the determination of either hemoglobin or hematocrit is acceptable, however, more blood bankers prefer hemoglobin determination using a what method with a SG of?

• drop

• directly

• sinks ; floats

• sink ; 15 seconds

Principle of CuSO4 method for hemoglobin determination:

• A _____ of blood is dropped into a solution of CuSO4 which has a given specific gravity.

• The density of a drop is ________ proportional to the amount of hemoglobin in that drop.

• lf the drop is denser than the specific gravity of the CuS04, the drop ______ to the bottom; if not, it _____ on top.

• The drop of blood must ______ in CuSO4 solution for ______________.

spectrophotometric methods

Hemoglobin levels may also be determined using what methods?

• Previous donation

• Pregnant women

• Major operation

  • dental surgery

  • blood transfusion include administration of Igs

• Acute febrile illness

• Malaria (diagnosed or treated)

• Past exposure to a close household contact with hepatitis

• Past exposure to unhygienic skin piercing, tattooing, earholing, needle puncture, etc.

• Recent alcohol intake (positive for alcoholic breath)

• Skin lesions at venipuncture site

TEMPORARY DEFERMENT OF BLOOD DONATIONS

6-8 weeks interval from previous donation of 200 mL

12 weeks or longer interval from previous donation of 450 mL

Duration for previous donation

9 months after childbirth

3 months after weaving (whichever is longer)

Duration for pregnant women

12 months after operation or transfusion

Duration for Major operation including:

a. dental surgery

b. Blood transfusion include administration of immunoglobulins

2-3 weeks after febrile episode or until fully recovered

Duration for Acute febrile illness

3 years after cessation of signs and symptoms of malaria or treatment of malaria

Duration for Malaria (diagnosed or treated)

1 Year after exposure

Duration for Past exposure to a close household contact with hepatitis

1 year after the incident

Duration for Past exposure to unhygienic skin piercing, tattooing, earholing, needle puncture, etc.

12 hours after the last alcohol intake

Duration for Recent alcohol intake (positive for alcoholic breath)

After skins have completely healed

Duration for Skin lesions at venipuncture site (indefinite)

2 weeks after vaccination

Duration for Live attenuated vaccine:

Category 1 - measles (rubeola), oral polio, mumps, and yellow fever vaccines, BCG

1 month after vaccination

Duration for Live attenuated vaccine:

Category 2 - German measles (rubella) vaccine

1 year after vaccination

Duration for Live attenuated vaccine:

Category 3 - rabies vaccine

May donate anytime if without vaccine associated symptoms like fever

Duration for Killed vaccines and toxoids (DPT and DT), polio injectagble HBV, cholera, typhoid and paratyphoid typhus, influenza vaccines)

5 days after the last dose

Duration for Antibiotics other than anti-TB drugs

Until TB is completely cured

Duration for Anti-TB drugs

5 days after completion of treatment

Duration for Anti-fungal drugs

1 day after the last dose (but blood is labeled not for the preparation of platelets)

Duration for Allergenic drugs such as penicillin and aspirin

While on treatment

Duration for Oral corticosteroids

2 months after treatment

Duration for Anti-acne drugs

PERSONS WHO ARE NOT ALLOWED TO DONATE BLOOD

Persons with the followina conditions shall not be allowed to donate blood at anytimeo

• Cancers

• Cardiac diseases like arrhythmias, congestive heart failure

• Severe lung diseases like complicated asthma with bronchiectasis or atelectasis

• Viral hepatitis and jaundice of unknown origin and other severe liver diseases like cirrhosis

• Use of prohibited drugs (past or present)

• High-risk sexual behavior or continuing exposure to persons with hepatitis, HIV/AIDS and other sexually transmitted diseases (STD) including inmates of mental institutions and prisons

• High risk occupations (e.g. prostitution)

• Sexually transmitted diseases (STD) past or present

• Prolonged bleeding

• Unexplained weight loss of more than 5 kg over six months

• Chronic alcoholism

• Autoimmune diseases like SLE, etc.

>11 g/dl

Hb criteria for autologous donors

no limit

age critera for autologous donors

no minimum requirement

weight requirement for autologous donors

11 g/dl

bacteremia

Note for AUTOLOGOUS DONORS: less than _______ and _____________ preclude a patient from donating blood for autologous transfusion

3 days

72 hours

For autologous transfusion, a blood may be drawn from patient every ________ but not within _______ of surgery

quality blood for transfusion

It starts with the collection of blood from properly selected and screened healthy voluntary blood donors.

Venipuncture

• Must be done using aseptic technique under closed system

• Do not leave the donor unattended at any time during phlebotomy procedure

Volume of Anticoagulant per Unit of Blood

A 63 ml of anticoagulant is required for a 450 ml blood volume and 31.5 ml of anticoagulant for a 200 ml blood volume

300 ml

If less than ______ is to be drawn, the amount of anticoagulant in the bag must be reduced accordingly

Allowable amount / 100 × 14 = anticoagulant needed (mL)

Formula for amount of anticoagulant needed

63 mL - anticoagulant (mL) = anticoagulant to remocve (mL)

Formula for amount of anticoagulant to remove from the bag

• Acid-citrate-dextrose (ACD)

• Heparin

• Citrate-Phosphate-Dextrose (CPD)

• Citrate-Phosphate-Dextrose-Adenine (CPDA)

• CPD plus AS-1 or AS-2, consisting of saline, dextrose, mannitol, adenine

• Citrate-Phosphate-Double dextrose (CP2D) plus AS, consisting of saline, dextrose, adenine

Anticoagulants and additive solutions considered acceptable by FDA

Additive solutions (AS)

These are added to the RBC after the plasma has been removed

Post Donation Donor's Care

Donors should be offered a drink (at least one glass of fluid) and is observed for 10-15 minutes to ascertain complete stoppage of bleeding a the puncture site

Post Donation Donor's Care

Donors are instructed to drink liberally and avoid strenuous exercise for several hours.

Mild reactions

• They are the most frequently encountered type of reaction

• Donor exhibits sign of shock but does not lose consciousness

Moderate reactions

Signs and symptoms similar in mild reactions but the donor now loses his consciousness

Severe reactions

Signs and symptoms plus the fact that the donor undergoes convulsions or seizures characterize them

Light headedness

Weakness

Tingling sensation

Palpitation

Fainting

Cause:

• Anxiety

• Hypoglycemia

Convulsion

Cause:

Anxiety of underlying disease

Light headedness

Weakness

Tingling sensation

Palpitation

Management:

a. Reassuring colversation

b. Elevate donor's feet at a 45 angle for a few minutes then lower to 20 angle to increase venous return

c. Apply cold, wet towels to neck and forehead

d. Have donor breath into paper bag

e. Provide juice even before donation

Last resort: discontinue donation

Fainting

Management:

• Discontinue donation, if necessary, administer glucose solution

• Position donor in a place protected from a possible fall

Convulsion

Management:

• Discontinue donation

• Maintain airway

• Restrain gently to prevent injury

• Reassure after recovering consciousness

• Inform about possible involuntary loss of control of urine or stool

Cardiopulmonary emergency

Cause:

Underlying heart dx

Cardiopulmonary emergency

Management:

• Ventilation

• Cardiopulmonary resuscitation (if necessary)

• Transfer donor to Emergency Medical Facility

Hematoma

Cause:

• Very fragile veins

• Unskilled Phlebotomist

• Uncooperative donor

Hematoma

Management:

• Discontinue if large

• Apply pressure to site for at least 5 minutes

• Apply cold packs

• Reassure donor

Jet-like bleeding with bright red blood

Cause:

Inadvertent puncture of artery when deep vein is attempted

Jet-like bleeding with bright red blood

• Discontinue immediately

• Apply firm pressure at the puncture site for at least 10 minutes

• Apply dressing on site

• Follow-up donor for additional care if necessary

Shooting pain followed by numbness and tingling in the forearm

Cause:

Inadvertent puncture of median nerve or cutaneous branches (rare accident)

Shooting pain followed by numbness and tingling in the forearm

• Reassurance

• Apply support to arm

DONOR BLOOD UNIT PROCESSING

A ll donor units are processed before being released to compatibility testing and transfusion

1. ABO grouping

2. Rh typing (and Du typing)

3. Antibody screening

The tests done on the donor blood unit (3)

Antbody screening

Required only on those with previous pregnancy and transfusion

Antibody screening

This is done by incubation of serum with panel of red cells at 37 deg C in:

• Saline

• LISS

• Albumin

• PEG

• AHG

• Syphilis

• HBsAg

• Anti-HCV antibody

• Hepatitis Surrogate testing (anti-HBc)

• Anti-HIV ½ antibody

• HIV (HIV-1 p24 antigen)

• Human T-cell lymphotropic Virus Type 1 antibody

• Malaria

Serologic tests for donor blood unit processing

1. Syphillis

2. HBsAg

3. Anti-HCV

4. Anti-HIV

5. Malaria

5 Serologic tests in Philippines

• immediately ; 1-6 deg C

• 24 hours

• 6 hours

SUBMISSION OF WHOLE BLOOD TO BLOOD BANK/CENTER:

• The unit of blood shall be stored __________ after collection and validation in a blood bank refrigerator or cold box at ________

• The blood should be submitted to the Blood Bank/Center within ______ after collection

• Whole blood submitted within ______ after blood collection can be used for platelet preparation

Whole blood

It is an unprocessed blood containing all cellular and plasma components of donor blood

Whole blood

It is collected using single or multiple bags

Whole blood

lts volume is 450 ml (in 63 ml anticoagulant solution) or 200 ml (in 31.5 ml anticoagulant solution)

0.35 to 0.45

The erythrocyte volume factor (EVF) of whole blood

21 days

Whole blood is stored at 1-6 deg C for how many days if CPD?

35 days

Whole blood is stored at 1-6 deg C for how many days if CPDA?

42 days

Whole blood is stored at 1-6 deg C for how many days if CPDA2 or SAG-M?

Whole blood

lt may also contain 7 parts of blood to 1 part anticoagulant. If platelets are to be harvested, blood units are stored at 20-24 deg C and processed within 6 hours after blood collection

PRBC

It consists of cellular products remaining after removal of plasma by sedimentation or centrifugation of whole blood.

PRBC

It contains RBC, platelets and leukocytes that are potential immunizing agents

PRBC

It is collected using double blood bags

PRBC

The volume is 350 ml

PRBC

It has a hematocrit value of 55-70%

PRBC

It is stored at 1-6°C same as whole blood if it is prepared under closed system (lf under open system, storage is up to 24 hours only)

red cells

platelets

plasma proteins

During storage of whole blood, metabolism continues in the ______ and _______ while some _____________ lose their biological activity

• Reduction ; acidic

• Rise

• Reduction ; reduce

• Loss

• Decrease ; VIll ; V

• Reduction ; 70% ; VIl and IX

• Platelets and leukocytes

The biochemical and metabolic effects of storage are:

• ________ in the pH (blood becomes more ______) due to rise in hydrogen ion content

• ________ in plasma potassium concentration (extracellular K+)

• Progressive ________ in the red cell content of 2,3 diphosphoglycerate (2,3 DPG), which may ________ the release of oxygen at tissue level until 2,3 DPG is restored

• ________ platelet function in whole blood within 48 hours of donation

• The levels of Factor V and VIll ________. Factor ___ drops to 50% by 24 hours after collection; Factor ___ reaches 50% by 10-14 days

• Gradual _________ of RBC viability related to the duration of storage. Red cells stored for 5 weeks in CPDA have a mean recovery of ____ (the minimum acceptable level). Coagulation factors ___ and ___ are relatively stable in storage

• _________ and __________ become non-functional within hours of collection

Correct identification of the patient

It is probably the most crucial activity in the blood transfusion process.

1. At the time of the specimen collection

2. At the initiation of the blood transfusion

The patient must be properly identified (2)

1. Starting the IV

2. Diluting the RBC

3. Filters

4. Blood warmer

5. Speed of infusion

Conditions affecting infusion (5)

Normal saline solution (NSS)

It is employed to start an IV prior to instituting a blood transfusion

Five percent dextrose in water (D5W)

When starting the IV, this should not be used because it is hypotonic and may cause RBC aggregation and hemolysis

Ringer's lactate solution

When starting the IV, this should not be used because it may cause clotting due to its calcium content

Packed RBC

It may be diluted to decrease the viscosity and allow increased rates of infusion by:

• NSS

• ABO compatible plasma (seldom)

• 5% albumin

Filters

Blood components and derivatives are transfused through these to remove fibrin clots and other particulate debris

First generation filters

• Pore size of 170 um

• Used to remove fibrin clots

Second generation microaggregate filters

• Pore size between 20 to 40 um

• Used to remove microaggregate such as platelets, degenerating WBC, cell fragments, nuclei, fibrin

Third generation leuko reduction filters

Used to remove 99.69% of WBC from RBC and platelet products, leaving less than 5 × 10^6 WBC in their respective components

37°C

The blood warmer should maintain a temperature of about?

Blood warmer

It is recommended for:

• Patients receiving many units of blood in a short period of time

• In massive transfusion

• In exchange transfusion

• In transfusion of premature infants

• In patients with strong cold agglutinins

• 1 mL

• 240 mL

• 1 or 2 hours ; 4 hours

• 30 minutes ; 15 minutes

Speed of infusion:

• In most administration sets - 15 drops equals ____

• At a rate of 60 drops per minute, _____ of blood can be transfused in one hour

• Under normal conditions, for an average adult without cardiopulmonary dysfunction, one unit of blood should be infused within _______. If the blood is to be transfused slowly: the transfusion should be completed within _______

• Most transfusion reactions develop within _________ of transfusion. Patient's vital signs should be taken or recorded shortly before the transfusion to serve as a baseline, then every _________ after the beginning of transfusion and again at the end of transfusion

Whole blood or Red cells

• The administration should start within 30 minutes of removing the pack from the storage temperature of +20 deg C to +60 deg C

• It should be completed within 4 hours of starting the transfusion