7. Blood donations

Learning Objectives

1. Whole Blood Donation Collection:
      - Explain the process.

2. Types of Blood Donations:
      a. Allogenic
      b. Autologous
      c. Directed
      d. Designated

3. Blood Donation Components:
      a. Anticoagulants
      b. Additives
      c. Component preparation

4. Blood Products:
      - Discuss products available for therapeutic use:
        - Packed red cells
        - Frozen plasma
        - Platelets
        - Cryoprecipitate

5. Storage and Transport:
      - Explain standard methods that maintain quality and integrity of blood products.

6. Expiry Dates:
      - Identify and adhere to guidelines for all blood products.

7. Routine Tests on Blood Donations:
      - List tests routinely performed.

8. Canadian Blood Organizations:
      - Identify organizations responsible for collection and distribution.

9. Donor Criteria Limits:
      a. Age
      b. Weight
      c. Hemoglobin levels
      d. Hematocrit levels

10. Deferrals:
        - Describe various deferral categories affecting donation ability.

11. Donation Procedure:
        - Describe the procedure for whole blood donation including:
          - Arm preparation
          - Blood collection
          - Post-phlebotomy care instructions

Blood Donation Overview

• Canadian Blood Services website: www.blood.ca
  

Key References

1. Blood

2. Hospitals

3. Clinical Guide to Transfusion

4. Circular of Information

5. Visual Guide
   

• Importance of staying updated on donor eligibility changes through regular website visits.

Canadian Blood Services (CBS)

Overview

• Established: 1998

• Role: Manages blood, plasma, and stem cell donations for provinces (except Quebec).

• Operates as a non-profit organization, focusing on blood safety, research, and donation programs.

Héma-Québec

• Founded: 1998

• Role: Independent organization handling blood collection and distribution in Quebec.

• Operates separately from CBS but follows similar protocols.

Responsibilities of CBS

• Collection, testing, distribution of blood & plasma

• Maintain national inventory and manage stem cell registry

• Oversee organ & tissue donation

• Support transfusion research & innovation

Blood Donation Process at CBS

1. Recruitment:
      - Outreach through call centers, GiveBlood app, website, or phone.

2. Donation Locations:
      - Permanent centers or mobile clinics.

3. Screening Process:
      - Online health questionnaire + in-person review and hemoglobin check.

4. Collection Time:
      - Whole Blood: 10-15 minutes
      - Plasma/Platelets: Up to 90 minutes

5. Testing of Donor Blood:
      - Disease screening performed.

6. Component Processing:
      - Whole blood separated into components.

7. Distribution:
      - Sent to hospitals as needed.

Why Donate Blood?

• Impact on Lives:
  

Blood Volume Needed in Various Conditions

1. Cancer treatment: Up to 8 units/week

2. Coronary artery bypass: 1 to 5 units

3. Auto accidents/gunshot wounds: Up to 50 units

4. Liver transplant: Up to 100 units

5. Other organ transplants: Up to 10 units

6. Brain surgery: 2 to 5 units

7. Fractured hip/joint replacement: 4 to 10 units

Blood Safety

• Classification: Blood is classified as a biopharmaceutical. Safety is paramount.

Safety Measures Include:

1. Donor Screening

2. Sterilization

3. Testing

4. Production

5. Storage

6. Monitoring

Donor Criteria

• Mandatory selection process for every donation to protect:
  

Eligibility Requirements

• Age: Minimum 17 years old

• Health: Must be in good health and pass eligibility requirements.

• Determination: Final eligibility determined by CBS staff, regularly reviewed for changes.

Specific Criteria

Age & Weight

• Age: At least 17 years

• Weight: Minimum 110 lbs (50 kg)

Donation Frequency

• Whole Blood (Males): Every 56 days

• Whole Blood (Females): Every 84 days

• Plasma: Every 6 to 14 days

• Platelets (by apheresis): Every 14 days

Hemoglobin and Health Checks

• Hemoglobin Testing:
     - Checked prior to donation.
     - Minimum requirements (effective March 5, 2017):
       - Women: Minimum of 125 g/L
       - Men: Minimum of 130 g/L

• Donors with low hemoglobin should not return until the cause is addressed.

Pre-Donation Questionnaire

• Before Donation:
     - Have a meal, drink fluids, and consume salty snacks while avoiding fatty foods.

Donor Deferrals

Types of Deferrals

1. Temporary Deferrals

2. Indefinite Deferrals

3. Permanent Deferrals

Temporary Deferral Criteria

• Medications: Requires confirmation from CBS.

• Tattoo/Piercing: 3-month deferral.

• Acupuncture: If done with single-use needles, no deferral; otherwise, 3-month deferral.

• Blood Transfusion: 6-month wait post transfusion.

• COVID-19: 10 days from symptom onset after testing positive.

• Dental Work: Varies based on procedure (1 day to 3 months) based on risk of infection.

• Pregnancy: Temporarily deferred until 6 months post-delivery.

• Breastfeeding: Ineligible for the first 6 months.

• Malarial Risk:
      - Less than 6 months of risk: eligible to donate after 3 months of leaving.
      - More than 6 months of risk: eligible after 3 years.

Indefinite and Permanent Deferrals

1. Indefinite Deferrals:
      - Due to serious health problems or high-risk activities. Examples: IV drug use, CJD risk history.

2. Permanent Deferrals:
      - Individuals not allowed to donate under any circumstances. Examples include Hepatitis C positive, HIV positive.

Medical Treatments and Medications

• Periods of deferral apply to recipients of certain vaccinations, blood transfusions, organ transplants, or infections that could be bloodborne.
  

Sexual Activity

• Men who have sex with men and commercial sex workers have a three-month deferral after their most recent contact.

False Positive Test Results

1. Re-entry Program:
      - Available with a 6-month waiting period after a false positive.

2. Donors must provide documentation and go through testing.

3. Repeat false positives may lead to indefinite ineligibility.

Diseases Impacting Blood Donation

Chagas Disease

• Description: Caused by the parasite Trypanosoma cruzi, transmitted by triatomine bugs.
  

Transmission Methods

1. Insect bites (kissing bugs).

2. Consumption of contaminated food.

3. Congenital transmission.

4. Blood transfusion and organ transplantation risk.

5. Laboratory exposure.

Disease Phases

1. Acute Phase: Lasts weeks/months; majority asymptomatic.

2. Chronic Phase: Appears 10-20 years post-infection with potential severe complications affecting heart/intestines.

Babesiosis Disease

• A malaria-like illness caused by a tick-transmitted protozoal parasite. Symptoms include fever, fatigue, hemolytic anemia.

Types of Blood Donations

Classifications Based on Recipient and Relationship

1. Allogenic: Unknown donor/recipient relationship.

2. Autologous: Self-donated blood.

3. Directed: Donated to a specific minor.

4. Designated: Selected for specific medical reasons.

Specifics of Each Type

Allogenic Donations:

• Collected within 15 minutes.

• Used in the general supply for transfusion.

Autologous Donations:

• Donor's blood collected in advance for personal use; up to four donations allowed in four weeks.

Directed Donations:

• From a guardian to a minor; does not guarantee safety.

Designated Donations:

• Allogeneic donations for patients with specific needs, such as rare blood types.

Blood Donation Collection Process

Main Types

1. Whole Blood

2. Apheresis Units
      - Platelets
      - Plasma

Whole Blood Collection

• Volume: Approximately 480 mL per donation.

• Requires proper anticoagulant ratios (CPD) to prevent clotting.

• Continuous rocking of the collection bag is essential during collection.

Blood Storage Lesions

• Overview: Storage can affect red blood cell viability and function.

• Decreased elements include:
     - Red Cell Stability
     - Plasma pH
     - RBC ATP levels
     - 2,3-DPG levels

Anticoagulant Function

• Citrate in CPD: Prevents clotting by chelating calcium.

• Phosphate: Buffers pH and stabilizes red cells.

• Dextrose: Provides nutrients for survival.

Red Cell Additives

• Components of SAGM:
     - Sodium Chloride, Adenine, Glucose, Mannitol to improve shelf life and viability.

Post-Donation Care

1. Monitoring: Donors observed after donation for safety.

2. Recovery: Snacks and hydration recommended.

3. Post-Donation Instructions: Avoid heavy lifting for 24 hours.

Potential Donor Reactions

Common Reactions

1. Light-headedness

2. Dizziness

3. Fatigue

4. Nausea

Severe Reactions

• Loss of consciousness and seizures; treatment includes monitoring and potentially medical intervention.

Whole Blood Donation Insights

• Each donation is screened for
     - Blood group (ABO, Rh)
     - Unexpected antibodies and diseases (HIV, Hepatitis, Syphilis, etc.)
     - Bacterial cultures for platelets to ensure safety.

Whole Blood Processing

• Two methods: Buffy coat method (B1) and Whole blood filtration (B2).

• Each method effectively separates components while ensuring a sterile environment for collection.

Blood Product Transportation Guidelines

• Monitoring Temperature: Importance of maintaining proper storage conditions during transport.

• Inventory Management: Regular checking to fulfill hospital requirements.

Product Receipt Process

• At the hospital, confirm temperature and visual inspection for acceptance into inventory.

Transportation Guidelines

• Red Blood Cells: Stored 1-6°C, shelf life of 42 days.

• Platelets: 20-24°C, shelf life of 7 days.

• Plasma: -18°C or lower, frozen shelf life of 1 year.

• Cryoprecipitate: Stored similarly with specific thawing procedures.

Redistribution of Blood Products

• Collaboration between CBS and hospitals to prevent waste.

• Expired blood products can be transferred to hospitals in greater need.