Unit 1 Part 1 Blood Collection

Terry Kotrla, MS, MT(ASCP)

MLAB 2431 Immunohematology
Introductory Comments

An overview of the process involved in collecting donor blood

Donor Screening
 All blood comes from VOLUNTEER donors.
 Screening performed to ensure donor is healthy.
 Starts with the donor and first impressions are critical
 Clean, well lit donation facility from waiting room to
collection area
 Pleasant, professional staff who can ask the appropriate
questions, observe and interpret the responses, and
ensure that the collection process is as pleasant as
possible
Blood Bank versus Blood Center
 Confusion exists and terms are sometimes used
inappropriately
 Blood bank in a hospital is also known as the transfusion
service, performs compatibility testing and prepares
components for transfusion
 Blood Center is the donation center, screens donors,
draws donors, performs testing on the donor blood, and
delivers appropriate components to the hospital blood
bank
Standards, Regulations, Governing Bodies
 Strict guidelines exist and inspections are performed in both blood
centers and blood banks to ensure the safety of the donors and
patients
 Some or all of the following agencies may be involved:
 FDA – Food and Drug Administration – CBER and CFR
 AABB
 CAP – College of the American Pathologists
 Joint Commission – inspects hospitals, lab included
 CLSI – Clinical Laboratory Standards Institute
Donor Screening
 Two goals or purposes for screening
 Protect the health of the potential donor
 Protect the health of the potential recipient
 Four outcomes
 Acceptance
 Temporary deferral
 Indefinite deferral
 Permanent deferral
 Three components of screening
 Registration
 Health history interview
 Limited physical examination.
Donor Registration
 Donor signs in
 Written materials are given to the donor which explains high risk
activities which may make the donor ineligible
 Donor must be informed and give consent that blood will be used
for others unless they are in a special donor category
 First time donors must provide proof of identification such as
SS#, DL#, DOB, address and any other unique information.
 Repeat donors may be required to show DL or some other photo
ID.
Donor Registration
 Additional useful information
 Name of patient or group to credit
 Race
 Unique donor characteristics
 Donor must be provided with
 HIV high risk activities
 Warnings about donor reactions
 Tests that will be performed and notification
 Post phlebotomy care instructions
Medical History
 Frequency of donation
 Whole blood or red blood cells 8 weeks
 Two unit red cell unit 16 weeks
 Plateletpheresis – up to 24 times/year
 Plasmapheresis– once every 4 weeks, can be done twice a week
Medical History
 A thorough history is obtained each time
 Standardized universal questionnaire is used
 Questions are asked that are very intimate in nature but
are critical in assessing HIV or HBV risks
 Has donor ever been deferred, if “yes”, why.
 Medications the donor is taking are present in plasma,
may cause deferral
 Infections the donor has may be passed to recipient, may
be cause for deferral
Permanent Deferrals
 Males who had sex with males OR engaged in sex for drugs or money since
1977.
 Used IV drugs even ONCE in lifetime.
 Taking clotting factors.
 Hepatitis after age 11.
 Cancer deferrals vary, some accept after period of being disease free others
do not accept.
 Lived in a country where Creutzfeld-Jacob disease is prevalent or family
member with CJD.
 Protozoan diseases such as Chagas disease or Babesiosis
 Received human pituitary growth hormone.
 Positive test for: HBsAg, Hepatitis C, HTLV I/II or HIV.
 Donated only unit of blood in which a recipient contracted HIV or HBV
 Was the only common donor in 2 cases of post-transfusion HIV or HBV in
recipient
12 Month Deferral
 Recipient of blood, components or blood products such as
coagulation factors
 Sexually transmitted disease-if acquired indicates safe sex
not practiced and donor at risk for HIV and HBV
 Received HBIG.
 Accupuncture, tattoo, ear piercing
 Needle stick
 Rabies vaccine
 Any intimate sexual relations with HIV or HBV positive,
hemophiliacs, drug users or individuals receiving
drugs/money for sex.
Temporary Deferrals
 Certain immunizations
 2 weeks -MMR, yellow fever, oral polio, typhoid
 4 weeks -Rubella, Chicken Pox
 2 months – small pox
 Pregnancy – 6 weeks upon conclusion
 Certain medications
 Proscar/Propecia, Accutane – 1 month
 Avodart – 6 months
 Soriatane – 3 years
 Tegison – permanent
 Feldene – no platelet donation for 2 days.
 Plavix and Ticlid – no platelet donation for 14 days
 Malaria 3 years
 West Nile virus 28 days
Helpful Hint
 Permanent deferral – any member of high risk group
such as: HIV/HBV/HCV pos, drugs/sex for money,
cancer, serious illness or disease, CJD, Chagas disease,
Babesiosis
 12 month deferral – sex with any high risk group, any
blood exposure, recipient of blood/blood products,
STD, jail/prison, rabies vaccine after exposure, HBIG,
malaria
 Have to memorize: medications and vaccinations
Physical Examination
 Evaluate general appearance
 Weight – 110 1bs national, 123 lbs. Austin – eff. Jan 2010
 Temperature 37.5 C OR 99.5F
 Blood pressure
 Systolic </= to 180 mm Hg
 Diastolic </= 100 mm Hg
 Hemoglobin and Hematocrit
 Allogenic 12.5 g/dL or 38%
 Autologous 11.0 g/dL or 33%
Self-Exclusion
 Rescinded by FDA in 1992 but some blood centers may still use.
 Two stickers
 “Yes, use my blood”
 “No, do not use my blood”
 After interview the donor will place the appropriate bar coded
label on the donation record
 If “no” selected the unit is collected, fully tested, but not used for
transfusion
 Allows donors who know they are at risk to “save face” if pressured
to donate by friends and family
Donor Categories
 “Allogeneic”, “homologous” and “random donor” terms used for
blood donated by individuals for anyone’s use
 Autologous – donate blood for your own use only
 Recipient Specific Directed donation – donor called in because
blood/blood product is needed for a specific patient
 Directed Donor – patient selects their own donors
 Therapeutic bleeding – blood removed for medical purposes such
as in polycythemia vera. NOT used for transfusion.
Auto/Directed Blood Labels
Donor Categories
 Apheresis – removal of 1 component, return the rest
 Leukapheresis
 Plateletpheresis
 Plasmapheresis
 Stem cells
 Bone marrow
 Apheresis
Donor Categories
 Safest is autologous, blood is your own, no risk of disease
acquisition
 Most dangerous is Directed Donor, you select a donor who
may, unknown to you, be in a high risk category but feels
obligated to follow through and donate
References
 http://www.fda.gov/cber/dhq/dhq.htm
 AABB Technical Manual 17th edition.