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BLOOD DONATION

Laboratory screening of blood

Concept of blood donation Blood is the stream of life.

 

Lifesaving process

PRE-DONATION INTERVIEW DONOR must be assured confidentiality on the given information.

“One glass of your precious blood, and less than one hour of your time can be your gift

Minimum information given to the donor:

to a man, woman or child”

  • 1. Importance of truthfulness in his history.

BLOOD DONORS: Historical Perspectives World War II-- stimulate voluntary blood donation Following War-- American Red Cross and other nonprofit blood services facilitate voluntary blood donation.

WHO DEFINITION OF VOLUNTARY BLOOD DONOR A donor who gives blood by his own initiative ( in community blood letting activities or as a walk-in donor in hospital blood banks). A donor who volunteers to give blood when requested or asked by a colleague, friend or family member. A donor who volunteers to give blood when requested or recruited to do so. A donor who volunteers to give blood when requested or recruited by the Blood Transfusion Services (BTS) or Hospital.

PHILIPPINE SCENARIO:

NATIONAL BLOOD SERVICES ACT OF 1994 ( RA 7719 )

IMPLEMENTING RULES AND REGULATIONS (DOH AO NO. 9 s 1995)

MAY 1998

Closure of all commercial blood banks.

National Voluntary Blood Services Program ( NVBSP)

Reinforce voluntary blood donation.

OBJECTIVES

  • 1. To ensure that all blood centers establish and maintain their own panels or regular voluntary non- remunerated donors.

  • 2. To get at least 4% of the donor age population to voluntarily donate blood regularly at least twice a year.

  • 3. To increase public awareness of the need of safe blood.

General Considerations on Blood Donation:

The voluntary, unpaid donation of blood is a humanitarian act.

What is needed is a strong political commitment which is effectively translated

into substantial investments into a a systematic national effort to professionalize blood donor recruitment.

DONOR SELECTION AND RETENTION Basic principles that shall guide Donor Relations:

Confidentiality Consistency and reliability Constant communication and contact Close relationship Good donor care and other services: safe, professional, pleasant Accessibility and warmth

Blood Donors……. Regular donors are safer than new occasional donors because they are better

informed, are committed to helping others and are regularly screened for transfusion-transmitted infections.

CLASSIFICATION OF DONORS:

I.

VOLUNTARY DONORS (WALK-IN)

II.

MASS BLOOD LETTING PROGRAM (GOVERNMENT, NGO)

III.

REPLACEMENT DONORS.

 

Blood safety starts with quality of blood donors.

Accurate and honest medical and social history must be obtained.

PHASES OF DONOR SCREENING

Donor interview /history taking

Physical examination

  • 2. History of self- deferral when necessary

  • 3. The risk of the donation procedure

  • 4. The test that are going to be done and why

TARGET GROUPS FOR BLOOD DONATION:

 AGE --------- 16 to 65 years old    WEIGHT ---- 50 kgs. (1
AGE --------- 16 to 65 years old
WEIGHT ---- 50 kgs. (1 unit); 40 kgs. (250 ml.)
PULSE RATE – 50-100 beats /min.
BLOOD PRESSURE
90-160 mm Hg systolic and 60-100 mm Hg. diastolic.
HEMOGLOBIN – at least 12.5 g/dl
PERMANENT DONOR DEFERRAL
Cancer
Cardiac disease
Severe lung disease
Viral hepatitis and aids
Use of prohibited drugs
High risk sexual behavior
Sexually transmitted disease
Prolonged bleeding
Unexplained weight loss of more than 5 kg over six months
Chronic alcoholism

TEMPORARY DONOR DEFERRAL

  • A. CONDITIONS:

    • 1. Pregnant ---- 9 mos. And 3-6 months after weaning

    • 2. Acute Febrile illness – 2-3 wks. After febrile episode

    • 3. Previous donation – 250 ml- 6 to 8 wks.; 1 unit 3 months.

    • 4. Major operation – 1 year

    • 5. Skin piercing, tattoo – one year

    • 6. diagnosed with malaria – 3 years

    • 7. Exposure to malaria – one year

    • 8. History of alcohol intake – 12 hours.

    • 9. Chicken pox/measles – 6 months

  • B. Vaccine received:

    • 1. live attenuated vaccine:

      • a. Category 1 : measles, oral polio ,mumps, yellow fever, BCG –2 weeks

      • b. Category 2 : German measles-1 month

      • c. Category 3 : Rabies vaccine – 1 year

  • 2. Killed Vaccine and toxoids

  • Hep. B, DPT,injectable polio vacine, Cholera, Tyhpoid,Influenza

    may donate anytime if without symptoms

    • C. Medications taken:

      • 1. Antibiotics other than anti-TB – may donate anytime

      • 2. Anti-Tb drug – defer until TB is cured

      • 3. Aspirin and Piroxicam – donate anytime except for platelet

     
    • 4. Highly allergenic drugs

    After medications are stopped for at least one day.

    • 5. Contraceptive Pills - may donate anytime.

    • 6. Anti-acne medications

    2 months after cessation of medication.

    PHYSICAL EXAMINATION

    Vital Signs

    Routine P.E.

    LABORATORY TESTING OF BLOOD:

    RPR/VDRL----- SYPHILIS

    HIV

    HEPATITS B

    HEPATITIS C

    MALARIA

    HEMOGLOBIN

    POST DONATION PROCESS:

    Health care after donation including care of the venipuncture site.

    Things to do and not to do after donation.

    COUNSELLING DONORS WITH POSITIVE RESULTS:

    Shall provide counseling to explain why donor has to either postpone or refrain

    from donating blood. Must contact the appropriate health care provider to establish linkage between the health provider and the patient if confirmatory or additional testing and continuing medical care is necessary.

    LABELING “Product code structure and labeling blood components”

    “Standard terminology for blood, cellular therapy and tissue product descriptions”

    AABB, FDA AND ISBT 128

    LABELING Name of the product (e.g. RBC, WBC) Type and amount of anticoagulant Volume of the unit Required storage temp Name and address of collecting facility Expiration date Unique donor identification no. Whether donor a volunteer, autologous or paid Other statements:

    The abo blood group and Rh type are also shown in big bold letters

    STORAGE 500ml bag contains 63 ml of anticoagulant + collected blood

    1-6 ° Centigrade

    CPD; CP2D = 21 DAYS

    CPDA-1=35 DAYS SAGM, AS-5, AS-3 (SAG+Na PO4)=42 d

    WHOLE BLOOD AND BLOOD COMPONENT THERAPY Benefits and reasons for transfusion

    • 1. To restore or maintain the oxygen carrying capacity or hemoglobin

    • 2. To restore or maintain blood volume

    • 3. To replace coagulation factors to maintain hemostasis

    • 4. To restore or maintain leukocyte function (rarely)…

    WHOLE BLOOD Product in which all the red cells and most of plasma from the original unit are

    present. Platelets and WBC present are not active because they require separation and

    special storage. Consists of formed elements (rbc, wbc, plts) making up about 45% of the total volume

    and

    plasma (55% of the total volume)

    .. Indication for whole blood: Volume replacement

    BLOOD COMPONENT Product separated from a single unit of a whole blood.

    FRACTIONATION Process by which blood products are separated from a single unit of whole

    blood.

    ADVANTAGES OF USING BLOOD COMPONENT:

    • 1. There is maximum recovery and utilization of blood products.

    • 2. Service to a wide variety of patient is increased.

    • 3. Transfusion of specific component needed by the patient is made possible.

    • 4. Transfusion of harmful elements is minimized.

    BLOOD COMPONENTS:

    A.

    Oxygen carrying components

    1.

    Packed RBC

    2.

    Leukocyte poor blood

    3.

    Frozen Thawed RBC

    B.

    Platelet Products

    1.

    Platelet rich Plasma

    2.

    Platelet Concentrate

    C.

    Plasma Products:

    1.

    Frozen plasma

    2.

    Cryoprecipitate

    3.

    Cryosupernate

    PLASMA DERIVATIVES:

    A.

    Coagulation Factor Concentrate:

    1.

    Factor VIII conc.

    2.

    Factor IX component conc.

    B.

    Oncotic agents:

    1.

    Albumin

    2.

    Plasma Protein fraction

    PACKED RED BLOOD CELLS 225 ml. in volume when collected from 500 ml. of whole blood.

    200-250 ml. of plasma will be extracted leaving RBC with Hct. of 70-80%.

    Indications for use (PRBC):

    1.

    Increase Oxygen carrying capacity of blood in cases of chronic anemia.

    2.

    In patients with subacute and chronic blood loss where anemia is accompanied by a significant decrease in blood volume.

    3.

    In all forms of anemia.

    4.

    In patients with cardiac disease, and those requiring restricted Na,K and citrate especially in liver and kidney diseases.

    WASHED RED BLOOD CELL contains RBC, no plasma with minimal platelet

    Shelf-life is 24 hours at 1-6 C after wash.

    70-90% of WBC are removed.

    5% loss of RBC due to wash procedure.

    Indications for use

    1.

    For patients with two documented febrile reaction.

    2.

    Patient expected to have multiple transfusions in order to decrease the chance of HLA sensitization.

    3.

    Prevent anaphylactic reaction in IgA deficient patient.

    FROZEN RBC Contains RBC, no plasma, no platelets.

    PLATELET CONCENTRATE Random donor platelets are produced form blood using the light spin to produce

    platelet rich plasma. Indications for use:

    1.

    To correct severe thrombocytopenia.

    2.

    To bleeding patient in surgery or trauma cases with platelet count less than 70,000

    3.

    Bleeding patients with thrombocytopathy

    GRANULOCYTE CONCENTRATE Prepared by apheresis.

    Indications:

    for septic, severely granulocytopenic patient unresponsive to 48 hours of

    antibiotic treatment.

    FRESH FROZEN PLASMA

    Prepared by centrifuging whole blood and extracting 200-260 ml. of the upper

    liquid plasma. Contains 90% water, 6-8%protein, small amount of CHO and lipids.

    Used for bleeding patients with multiple coagulation deficiency problems secondary to liver disease, DIC, or dilutional changes from massive transfusion. Also for factors V and XI deficiencies.

    CRYOPRECIPITATE Contains 80% units of factor VIII, 50% of Von Willebrand factor present in

    original unit, 250 mg. Fibrinogen, 25% factor XIII and some fibronectin activity. Major use for patient with severe Von Willebrands disease, factor XIII deficiency or hypofibrinogenemia and those burn and traumatic shock patients which lacks fibronectin.

    CRYOSUPERNATE Plasma left after separation from fresh blood of cellular component and

    cryoprecipitate. Contains Factor VIII, fibrinogen and normal amount of coagulation factors.

    Used in patients with bleeding other than Hemophilia and Hypofibrinogenemia.

    COMPATIBILITY TESTING

     Prepared by centrifuging whole blood and extracting 200-260 ml. of the upper  liquid plasma.
     Prepared by centrifuging whole blood and extracting 200-260 ml. of the upper  liquid plasma.
     Prepared by centrifuging whole blood and extracting 200-260 ml. of the upper  liquid plasma.
    CROSSMATCHING It is the final check of abo compatibility between donor and patient. It may detect
    CROSSMATCHING
    It is the final check of abo compatibility between donor and patient.
    It may detect the presence of antibody in the patient serum that will react with

    antigens on the donor red blood cells but was not detected in antibody screening because the corresponding antigen was lacking from the screening cells.

    CROSSMATCHING:

    • 1. MAJOR CROSSMATCHING:

     

    patient serum against donor red cells.

    • 2. MINOR CROSSMATCHING:

     

    patient donor red cells against donor serum.

    Phases:

     
    • 1. Saline phase

     
    • 2. Albumin phase--- IgM antibodies

    • 3. Anti-globulin phase– IgG antibodies

    Transfusion Reaction

     

    IMMEDIATE REACTION:

    A.

    IMMUNOLOGIC:

     

    1.

    HEMOLYTIC – preformed antibody

    2.

    FEBRILE NONHEMOLYTIC

     

    Caused by alloantibodies directed vs. Ag present on lymphocytes, granulocytes and platelets.

     

    3.

    ALLERGIC

     

    Reaction between recipient’s Ab and donor plasma protein.

     

    4.

    ANAPHYLACTIC

     

    due to reaction between potent specific anti-IgA Ab and IgA transfused products.

     

    5.

    Transfusion related acute lung injury – leukoagglutinins against recipients leukocytes.

     

    B.

    NONIMMUNOLOGIC:

     

    1.

    Bacterial contamination

    2.

    Circulatory overload- rapid infusion of large volume of blood.

    3.

    Physical or chemical hemolysis

    DELAYED REACTION:

    A.

    IMMUNOLOGIC:

     

    1.

    Delayed hemolytic reaction

    2.

    Graft vs. host disease

    3.

    Post transfusion purpura

     

    B.

    NON-IMMUNOLOGIC:

     

    1.

    Hemosiderosis

    2.

    Disease transmission (HIV ,Malaria, Hepatitis B and C)

    TRANSFUSION REACTION INVESTIGATION:

    Stop the transfusion.

    Clerical check of the compatibility of tag.

    Examination of pre-transfused blood, and EDTA anti-coagulated post-transfused

    blood and the blood bag. Examination of post-transfused urine.

    Determination on the post-transfused specimen for PT, PTT, platelet count, fibrinogen and fibrin split products.

    Measurement of hemoglobin/hematocrit at frequent interval if hemolysis is observed.