BLOOD DONATION

Concept of blood donation

Blood is the stream of life.

Lifesaving process
One glass of your precious blood, and less than one hour of your time can be your gift
to a man, woman or child
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

Compiled: Rem Alfelor

Laboratory screening of blood

PRE-DONATION INTERVIEW

DONOR must be assured confidentiality on the given information.

Minimum information given to the donor:

1.
Importance of truthfulness in his history.
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 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.

C.

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
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:

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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.

Compiled: Rem Alfelor

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

70-90% of WBC are removed.

5% loss of RBC due to wash procedure.

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

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

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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

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 recipients 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.

Compiled: Rem Alfelor

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Measurement of hemoglobin/hematocrit at frequent interval if hemolysis is

observed.

Compiled: Rem Alfelor

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