Blood Collection
An overview of the process involved in collecting donor blood
Donor Screening
* 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:
o AABB – American Association of Blood Banks
o FDA – Food and Drug Administration
o CAP – College of the American Pathologists
o JCAHO - Joint Commission on the Accreditation of Hospital Organizations
o NCCLS – National Committee for Clinical Laboratory Standards
Donor Screening
* Medical History based on a standardized questionnaire obtains critical information about the donor’s health and risk factors which may make it unsafe for donation
* Physical Exam which includes blood pressure, temperature, pulse and screen for anemia are performed to ensure donor is healthy enough to donate.
* Two goals of screening
o Protect the health of the potential donor
o Protect the health of the potential recipient
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
Frequency of donation
* Whole blood or red blood cells 8 weeks
* Plateletpheresis – up to 24 times/year
* Plasmapheresis– once every 4 weeks, can be done twice a week
* Granulocytes
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
* Medications the donor taking are present in plasma, may cause deferral
* Infections the donor has may be passed to recipient, may be cause for deferral
12 Month Deferral
* Any intimate sexual relations with HIV positive, HBV positive, hemophiliacs, drug users or individuals receiving drugs/money for sex.
* 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
* Travel to malarial endemic country
Temporary Deferrals
* Certain immunizations
o 2 weeks -MMR, yellow fever, oral polio, typhoid
o 4 weeks -Rubella, Chicken Pox
o 2 months – small pox
* Pregnancy – 6 weeks upon conclusion
* Certain medications
o Proscar/Propecia, Accutain – 1 month
o Avodart – 6 months
o Soriatane – 3 years
o Tegison - permanent
Permanent Deferrals
* HIV, HBV, or HCV positive
* Protozoan diseases such as Chagas disease or Babesiosis
* Received human pituitary growth hormone
* 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
* Lived in a country where Creutzfeld-Jacob disease is prevalent
* Most cancers except minor skin cancer and carcinoma in-situ of the cervix
* Severe heart disease, liver disease
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
Self-Exclusion
* Two stickers
o “Yes, use my blood”
o “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
* 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
Blood Collection
* Materials used are sterile and single use.
* Most important step is preparing the site to a state of almost surgical cleanliness.
* Bacteria on skin, if present, may grow well in stored donor blood and cause a fatal sepsis in recipient
* Use 16-17 gauge needle to collect blood from a single venipuncture within 15 minutes
* Collect 450 +/- 45 mLs of blood
Donor Reactions
* Syncope (fainting)
o Remove needle immediately
* Hyperventilation
o Have donor rebreathe into paper bag.
* Nausea/vomiting
* Twitching/muscle spasms
* Hematoma
* Convulsions – rare, get immediate assistance
* Cardiac difficulties
Post-Phlebotomy Care
* Donor applies pressure for 5 minutes
* Check and bandage site
* Have donor sit up for few minutes
* Have donor report to refreshment area for additional 15 minutes of monitoring
Post-Phlebotomy Instructions
* Eat/drink before leaving
* Wait until staff releases you
* Drink more fluids next 4 hours
* No alcohol until after eating
* Refrain from smoking for 1 hour
* If bleeding continues apply pressure and raise arm
* Faint or dizzy sit with head between knees
* Abnormal symptoms persist contact blood center.
* Remove bandage
Testing Donor Blood
* CANNOT rely on previous testing
* Records must be kept for 5 years
Serological Testing
* ABO/D typing
* Antibody Screen – if positive, ID antibody, cannot make plasma products
* Antibodies to other blood group antigens which are present in the donor may react with recipient red cells resulting in a reaction.
Disease Testing
* Disease testing include:
o HBsAG
o HBc
o HCV
o HIV 1&2
o HTLV I/II
o RPR
o NAT for HIV-1, HCV & WNV
Results of Testing
* Tests for disease markers must be negative or within normal limits.
* Donor blood which falls outside these parameters must be quarrantined.
* Repeat testing, if still abnormal must dispose.
Transfusion Service Testing
* The only repeat testing required is:
o ABO on red cell products
o D typing (IS) on D negative red cell products
* Plasma products (FFP, CRYO, PLTS) do not require any testing.
* Donor samples must be stored at 1-6C for at least 7 days after transfusion
o ADSOL unit transfused today must save sprig for one week
o Many facilities will pull a sprig from each donor during processing and save all sprigs for 49 days, regardless of expiration of unit
Summary
* Blood collection starts with screening of the donor to:
o Ensure they are healthy enough to donate
o Ensure they do not have transmissible diseases
* Many organizations set standards and monitor all aspects of blood collection and administration.
* Collection of blood must be done in such a manner as to ensure sterility of the component.
* Testing of donor blood includes serological testing for ABO/D typing, antibody screening, and testing for markers indicating infection.
* The blood supply is NOT safe, only careful screening and testing can prevent, as much as possible, disease transmission.
Blood Collection
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