Transcript I. Blood Collection - Austin Community College

I. Blood Collection
An overview of the process involved in collecting
donor blood
Donor Screening
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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
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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
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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:
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FDA – Food and Drug Administration – CBER and CFR
AABB – American Association of Blood Banks
CAP – College of the American Pathologists
Joint Commission – inspects hospitals, lab included
CLSI – Clinical Laboratory Standards Institute
Donor Screening
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Two goals of screening
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Four outcomes
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Protect the health of the potential donor
Protect the health of the potential recipient
Acceptance
Temporary deferral
Indefinite deferral
Permanent deferral
Two components of screening
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Health history interview
Limited physical examination.
Donor Registration
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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
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Additional useful information
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Name of patient or group to credit
Race
Unique donor characteristics
Donor must be provided with
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HIV high risk activities
Warnings about donor reactions
Tests that will be performed and notification
Post phlebotomy care instructions
Medical History
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Frequency of donation
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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
Medical History
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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 taking are present in
plasma, may cause deferral
Infections the donor has may be passed to
recipient, may be cause for deferral
Permanent Deferrals
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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 PRIOR to age 11.
Most cancers except minor skin cancer and carcinoma
in-situ of the cervix.
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 posttransfusion HIV or HBV in recipient
12 Month Deferral
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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
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Certain immunizations
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Pregnancy – 6 weeks upon conclusion
Certain medications
Proscar/Propecia, Accutain – 1 month
 Avodart – 6 months
 Soriatane – 3 years
 Tegison – permanent
Malaria 3 years
West Nile virus 28 days
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2 weeks -MMR, yellow fever, oral polio, typhoid
4 weeks -Rubella, Chicken Pox
2 months – small pox
Helpful Hint
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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
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Evaluate general appearance
Weight – 123 lbs. – NEW JAN 2010
Temperature 37.5 C OR 99.5F
Blood pressure
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Systolic </= to 180 mm Hg
Diastolic </= 100 mm Hg
Hemoglobin and Hematocrit
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Allogenic 12.5 g/dL or 38%
Autologous 11.0 g/dL or 33%
Self-Exclusion
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Two stickers
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“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
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“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
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Apheresis – removal of 1 component,
return the rest
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Leukapheresis
Plateletpheresis
Plasmapheresis
Stem cells
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Bone marrow
Apheresis
Donor Categories
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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
Collection of Blood
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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
Collecting Unit
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Gloves should be worn.
Single venipuncture
Mix blood bag frequently
Monitor volume of blood drawn
Collection should be within 15 minutes
Donor Reactions
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Syncope (fainting)
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Hyperventilation
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Remove needle immediately
Have donor rebreathe into paper bag.
Nausea/vomiting
Twitching/muscle spasms
Hematoma
Convulsions – rare, get immediate assistance
Cardiac difficulties
Record ANY donor reactions
Post-Phlebotomy Care
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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
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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
THANK DONOR
Testing Donor Blood
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CANNOT rely on previous testing
Records must be kept for 5 years OR 6 months
after product expires.
Serological Testing
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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
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Disease testing
include:
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HBsAG
HBc
HCV
HIV 1&2
HTLV I/II
RPR
NAT for HIV-1, HCV &
WNV
Results of Testing
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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.
Optional tests – CMV testing, special
antigen typing or sickle cell testing
Labeling Donor Units
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Component name
Unique donor number
ABO group, D type (not required for plasma)
Interpretation of tests
Type and volume of anticoagulant.
Storage temperature
Expiration date
Name/address of collecting facility
Reference to Circular of Information http://www.aabb.org/Content/About_Blood/Circulars_of_Informatio
n/
Donor classification
Results of testing
Essential instructions
Pooled component information
Transfusion Service Testing
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The only repeat testing required is:
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ABO on red cell products
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
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ADSOL unit transfused today must save sprig for one week
Many facilities will pull a sprig from each donor during
processing and save all sprigs for 49 days, regardless of
expiration of unit
Summary
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Blood collection starts with screening of the donor to:
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Ensure they are healthy enough to donate
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.