I. Blood Collection An overview of the process involved in collecting donor blood.

I. Blood CollectionI. Blood Collection

An overview of the process involved in An overview of the process involved in collecting donor bloodcollecting donor blood

Donor ScreeningDonor Screening

Starts with the donor and first impressions Starts with the donor and first impressions are criticalare critical

Clean, well lit donation facility from Clean, well lit donation facility from waiting room to collection areawaiting room to collection area

Pleasant, professional staff who can ask Pleasant, professional staff who can ask the appropriate questions, observe and the appropriate questions, observe and interpret the responses, and ensure that interpret the responses, and ensure that the collection process is as pleasant as the collection process is as pleasant as possiblepossible

Blood Bank versus Blood Blood Bank versus Blood CenterCenter

Confusion exists and terms are sometimes Confusion exists and terms are sometimes used inappropriatelyused inappropriately

Blood bank in a hospital is also known as the Blood bank in a hospital is also known as the transfusion service, performs compatibility transfusion service, performs compatibility testing and prepares components for testing and prepares components for transfusiontransfusion

Blood Center is the donation center, screens Blood Center is the donation center, screens donors, draws donors, performs testing on the donors, draws donors, performs testing on the donor blood, and delivers appropriate donor blood, and delivers appropriate components to the hospital blood bankcomponents to the hospital blood bank

Standards, Regulations, Governing Standards, Regulations, Governing BodiesBodies

Strict guidelines exist and inspections are Strict guidelines exist and inspections are performed in both blood centers and blood banks performed in both blood centers and blood banks to ensure the safety of the donors and patientsto ensure the safety of the donors and patients

Some or all of the following agencies may be Some or all of the following agencies may be involved:involved: AABB – American Association of Blood BanksAABB – American Association of Blood Banks FDA – Food and Drug AdministrationFDA – Food and Drug Administration CAP – College of the American PathologistsCAP – College of the American Pathologists JCAHO - Joint Commission on the Accreditation of JCAHO - Joint Commission on the Accreditation of

Hospital OrganizationsHospital Organizations NCCLS – National Committee for Clinical Laboratory NCCLS – National Committee for Clinical Laboratory

StandardsStandards

Donor ScreeningDonor Screening

Medical History based on a standardized Medical History based on a standardized questionnaire obtains critical information questionnaire obtains critical information about the donor’s health and risk factors about the donor’s health and risk factors which may make it unsafe for donationwhich may make it unsafe for donation

Physical Exam which includes blood Physical Exam which includes blood pressure, temperature, pulse and screen pressure, temperature, pulse and screen for anemia are performed to ensure donor for anemia are performed to ensure donor is healthy enough to donate.is healthy enough to donate.

Two goals of screeningTwo goals of screening Protect the health of the potential donorProtect the health of the potential donor Protect the health of the potential recipientProtect the health of the potential recipient

Donor RegistrationDonor Registration

Donor signs inDonor signs in Written materials are given to the donor which Written materials are given to the donor which

explains high risk activities which may make the explains high risk activities which may make the donor ineligibledonor ineligible

Donor must be informed and give consent that Donor must be informed and give consent that blood will be used for others unless they are in a blood will be used for others unless they are in a special donor categoryspecial donor category

First time donors must provide proof of First time donors must provide proof of identification such as SS#, DL#, DOB, address and identification such as SS#, DL#, DOB, address and any other unique information.any other unique information.

Repeat donors may be required to show DL or Repeat donors may be required to show DL or some other photo IDsome other photo ID

Frequency of donationFrequency of donation

Whole blood or red blood cells 8 Whole blood or red blood cells 8 weeksweeks

Plateletpheresis – up to 24 Plateletpheresis – up to 24 times/yeartimes/year

Plasmapheresis– once every 4 weeks, Plasmapheresis– once every 4 weeks, can be done twice a weekcan be done twice a week

GranulocytesGranulocytes

Medical HistoryMedical History

A thorough history is obtained each timeA thorough history is obtained each time Standardized universal questionnaire is Standardized universal questionnaire is

usedused Questions are asked that are very intimate Questions are asked that are very intimate

in nature but are critical in assessing HIV in nature but are critical in assessing HIV or HBV risksor HBV risks

Medications the donor taking are present Medications the donor taking are present in plasma, may cause deferralin plasma, may cause deferral

Infections the donor has may be passed to Infections the donor has may be passed to recipient, may be cause for deferralrecipient, may be cause for deferral

12 Month Deferral12 Month Deferral

Any intimate sexual relations with HIV Any intimate sexual relations with HIV positive, HBV positive, hemophiliacs, drug positive, HBV positive, hemophiliacs, drug users or individuals receiving drugs/money users or individuals receiving drugs/money for sex.for sex.

Recipient of blood, components or blood Recipient of blood, components or blood products such as coagulation factorsproducts such as coagulation factors

Sexually transmitted disease-if acquired Sexually transmitted disease-if acquired indicates safe sex not practiced and donor indicates safe sex not practiced and donor at risk for HIV and HBVat risk for HIV and HBV

Travel to malarial endemic countryTravel to malarial endemic country

Temporary DeferralsTemporary Deferrals

Certain immunizations Certain immunizations 2 weeks -MMR, yellow fever, oral polio, typhoid 2 weeks -MMR, yellow fever, oral polio, typhoid 4 weeks -Rubella, Chicken Pox 4 weeks -Rubella, Chicken Pox 2 months – small pox2 months – small pox

Pregnancy – 6 weeks upon conclusionPregnancy – 6 weeks upon conclusion Certain medicationsCertain medications

Proscar/Propecia, Accutain – 1 monthProscar/Propecia, Accutain – 1 month Avodart – 6 monthsAvodart – 6 months Soriatane – 3 yearsSoriatane – 3 years Tegison - permanentTegison - permanent

Permanent DeferralsPermanent Deferrals

HIV, HBV, or HCV positiveHIV, HBV, or HCV positive Protozoan diseases such as Chagas disease or Protozoan diseases such as Chagas disease or

BabesiosisBabesiosis Received human pituitary growth hormoneReceived human pituitary growth hormone Donated only unit of blood in which a recipient Donated only unit of blood in which a recipient

contracted HIV or HBVcontracted HIV or HBV Was the only common donor in 2 cases of post-Was the only common donor in 2 cases of post-

transfusion HIV or HBV in recipienttransfusion HIV or HBV in recipient Lived in a country where Creutzfeld-Jacob disease is Lived in a country where Creutzfeld-Jacob disease is

prevalentprevalent Most cancers except minor skin cancer and Most cancers except minor skin cancer and

carcinoma in-situ of the cervixcarcinoma in-situ of the cervix Severe heart disease, liver diseaseSevere heart disease, liver disease

Helpful HintHelpful Hint

Permanent deferralPermanent deferral – any member of high – any member of high risk group such as: HIV/HBV/HCV pos, risk group such as: HIV/HBV/HCV pos, drugs/sex for money, cancer, serious illness drugs/sex for money, cancer, serious illness or disease, CJD, Chagas disease, Babesiosis or disease, CJD, Chagas disease, Babesiosis

12 month deferral12 month deferral – sex with any high risk – sex with any high risk group, any blood exposure, recipient of group, any blood exposure, recipient of blood/blood products, STD, jail/prison, rabies blood/blood products, STD, jail/prison, rabies vaccine after exposure, HBIG, malariavaccine after exposure, HBIG, malaria

Have to Have to memorizememorize: medications and : medications and vaccinationsvaccinations

Self-ExclusionSelf-Exclusion

Two stickersTwo stickers ““Yes, use my blood”Yes, use my blood” ““No, do not use my blood”No, do not use my blood”

After interview the donor will place the After interview the donor will place the appropriate bar coded label on the donation appropriate bar coded label on the donation recordrecord

If “no” selected the unit is collected, fully tested, If “no” selected the unit is collected, fully tested, but not used for transfusionbut not used for transfusion

Allows donors who know they are at risk to “save Allows donors who know they are at risk to “save face” if pressured to donate by friends and familyface” if pressured to donate by friends and family

Donor CategoriesDonor Categories

““AllogeneicAllogeneic”, “homologous” and “random donor” ”, “homologous” and “random donor” terms used for blood donated by individuals for terms used for blood donated by individuals for anyone’s useanyone’s use

Autologous Autologous – donate blood for your own use only– donate blood for your own use only Recipient Specific DirectedRecipient Specific Directed donation – donor donation – donor

called in because blood/blood product is needed called in because blood/blood product is needed for a specific patientfor a specific patient

Directed DonorDirected Donor – patient selects their own donors – patient selects their own donors Therapeutic bleedingTherapeutic bleeding – blood removed for medical – blood removed for medical

purposes such as in polycythemia vera. NOT purposes such as in polycythemia vera. NOT used for transfusion.used for transfusion.

Auto/Directed Blood LabelsAuto/Directed Blood Labels

Donor CategoriesDonor Categories

Safest is autologous, blood is your Safest is autologous, blood is your own, no risk of disease acquisitionown, no risk of disease acquisition

Most dangerous is Directed Donor, Most dangerous is Directed Donor, you select a donor who may, you select a donor who may, unknown to you, be in a high risk unknown to you, be in a high risk category but feels obligated to follow category but feels obligated to follow through and donatethrough and donate

Blood CollectionBlood Collection

Collection of BloodCollection of Blood

Materials used are Materials used are sterile and single usesterile and single use.. Most important step is preparing the site Most important step is preparing the site

to a state of almost to a state of almost surgical cleanlinesssurgical cleanliness.. Bacteria on skin, if present, may grow well Bacteria on skin, if present, may grow well

in stored donor blood and cause a fatal in stored donor blood and cause a fatal sepsis in recipientsepsis in recipient

Use 16-17 gauge needle to collect blood Use 16-17 gauge needle to collect blood from a single venipuncture within 15 from a single venipuncture within 15 minutesminutes

Collect Collect 450 +/- 45 mLs450 +/- 45 mLs of blood of blood

Donor ReactionsDonor Reactions

Syncope (fainting)Syncope (fainting) Remove needle immediatelyRemove needle immediately

HyperventilationHyperventilation Have donor rebreathe into paper bag.Have donor rebreathe into paper bag.

Nausea/vomitingNausea/vomiting Twitching/muscle spasmsTwitching/muscle spasms HematomaHematoma Convulsions – rare, get immediate assistanceConvulsions – rare, get immediate assistance Cardiac difficultiesCardiac difficulties

Post-Phlebotomy CarePost-Phlebotomy Care

Donor applies pressure for 5 minutesDonor applies pressure for 5 minutes Check and bandage siteCheck and bandage site Have donor sit up for few minutesHave donor sit up for few minutes Have donor report to refreshment Have donor report to refreshment

area for additional 15 minutes of area for additional 15 minutes of monitoringmonitoring

Post-Phlebotomy Post-Phlebotomy InstructionsInstructions

Eat/drink before leavingEat/drink before leaving Wait until staff releases youWait until staff releases you Drink more fluids next 4 hoursDrink more fluids next 4 hours No alcohol until after eatingNo alcohol until after eating Refrain from smoking for 1 hourRefrain from smoking for 1 hour If bleeding continues apply pressure and raise If bleeding continues apply pressure and raise

armarm Faint or dizzy sit with head between kneesFaint or dizzy sit with head between knees Abnormal symptoms persist contact blood center.Abnormal symptoms persist contact blood center. Remove bandageRemove bandage

Testing Donor BloodTesting Donor Blood

CANNOT rely on previous testingCANNOT rely on previous testing Records must be kept for 5 yearsRecords must be kept for 5 years

Serological TestingSerological Testing

ABO/D typingABO/D typing Antibody Screen – if positive, ID Antibody Screen – if positive, ID

antibody, cannot make plasma antibody, cannot make plasma productsproducts

Antibodies to other blood group Antibodies to other blood group antigens which are present in the antigens which are present in the donor may react with recipient red donor may react with recipient red cells resulting in a reaction.cells resulting in a reaction.

Disease TestingDisease Testing

Disease testing Disease testing include: include: HBsAG HBsAG HBcHBc HCVHCV HIV 1&2HIV 1&2 HTLV I/IIHTLV I/II RPRRPR NAT for HIV-1, HCV NAT for HIV-1, HCV

& WNV& WNV

Results of TestingResults of Testing

Tests for disease markers must be Tests for disease markers must be negative or within normal limits.negative or within normal limits.

Donor blood which falls outside these Donor blood which falls outside these parameters must be quarrantined.parameters must be quarrantined.

Repeat testing, if still abnormal must Repeat testing, if still abnormal must dispose.dispose.

Transfusion Service TestingTransfusion Service Testing

The only repeat testing required is:The only repeat testing required is: ABO on red cell productsABO on red cell products D typing (IS) on D negative red cell productsD typing (IS) on D negative red cell products

Plasma products (FFP, CRYO, PLTS) do not require Plasma products (FFP, CRYO, PLTS) do not require any testing.any testing.

Donor samples must be stored at 1-6C for at least Donor samples must be stored at 1-6C for at least 7 days after transfusion7 days after transfusion ADSOL unit transfused today must save sprig for one ADSOL unit transfused today must save sprig for one

weekweek Many facilities will pull a sprig from each donor during Many facilities will pull a sprig from each donor during

processing and save all sprigs for 49 days, regardless of processing and save all sprigs for 49 days, regardless of expiration of unitexpiration of unit

SummarySummary

Blood collection starts with screening of the donor to:Blood collection starts with screening of the donor to: Ensure they are healthy enough to donateEnsure they are healthy enough to donate Ensure they do not have transmissible diseasesEnsure they do not have transmissible diseases

Many organizations set standards and monitor all aspects of Many organizations set standards and monitor all aspects of blood collection and administration.blood collection and administration.

Collection of blood must be done in such a manner as to Collection of blood must be done in such a manner as to ensure sterility of the component.ensure sterility of the component.

Testing of donor blood includes serological testing for Testing of donor blood includes serological testing for ABO/D typing, antibody screening, and testing for markers ABO/D typing, antibody screening, and testing for markers indicating infection.indicating infection.

The blood supply is NOT safe, only careful screening and The blood supply is NOT safe, only careful screening and testing can prevent, as much as possible, disease testing can prevent, as much as possible, disease transmission.transmission.