HEM 3143 Immunohaematology II

Lesson 1: Blood Banking

Blood Bank
A division of a hospital laboratory Blood / blood components are gathered, processed and stored for blood transfusion Proper tests (blood typing, crossmatching etc) are performed reduce the risk of transfusion related events

Two crucial factors for safe blood products

Accurate donor screening and selection Accurate laboratory testing on each unit collected

Selection of a Donor
Broad principles of donor selection: Giving blood does not harm the donor Donated blood loss is restored rapidly and completely The blood must not harm the recipient

Donor Screening
1. Registration of the donor To identify each donor To track the blood / components Particulars of donor full name, I.C. number, age, sex, race, address, contact numbers

 Medical history
To identify the potential risk factor that can harm the health of the donor or the safety of recipient Donors must be assured of a private and confidential interview process for the medical history and the physical examination

Medical History Questions

Have you ever given blood under a different name? In the past 8 weeks, have you given blood, plasma, or platelets? Have you ever been refused as a blood donor or told not to donate blood? Have you ever had cancer, a blood disease or bleeding disorder? Have you ever had yellow jaundice, liver disease or positive test for hepatitis?

 Are you feeling well and healthy today? In the past 3 years, have you had malaria? In the past 1 year, have you been under a doctors care or had a major surgery? In the past 1 year, have you received blood or had an organ or tissue transplant? In the past 1 year, have you had tattoo, skin piercing or accidental needle stick? In the past 1 year, have you had close contact with a person with yellow jaundice or hepatitis?

 In the past 1 year, have you has a positive test for syphilis? In the past 1 year, have you given money or drugs to anyone to have sex with you? For female donors: in the past 6 weeks, have you been pregnant or are you pregnant now? In the past 4 weeks, have you had any shot of vaccinations? In the past 3 days, have you taken aspirin or anything that has aspirin in it?

 Physical examination General appearance of donor Determination of hemoglobin

Males Females Hb: >12.5 g/dl Hb: >12.0 g/dl

Pulse
50-100 beats/min

Blood pressure
Maximum 140/90 mm Hg

Temperature
Maximum 37.5 0C

Donor weight
Minimum 45 Kgs Amount of blood to be drawn (Donor wt. in Kg50) X 450

Venipuncture site
Inspection for scar marks

Criteria for Selection of Blood Donors

Age Lower age limit: 18 Higher age limit: 60 These age limits are set because of: - Age of consent and increased iron needs of the adolescents - Risk of cardiovascular and cerebrovascular disease in old age following removal of large quantity of blood

 Donation interval At least three months Avoid iron depletion in the donor Volume of donation An individual weighing 45kg can safely donate blood up to 350 ml This limit intends to preclude the risk of vasovagal attack

 Pregnancy and lactation Pregnant women and lactating mothers (up to 1 year post-partum) should not donate blood Dentistry A 72-hour deferral period before donation Due to the possibility of bacteremia Blood transfusion A person should not be accepted as blood donor for 6 months after receiving blood transfusion

 Infectious diseases 1. HIV-1 and HIV-2 Exclude donors who give history suggestive of HIV infection (unexplained fever, weight loss, swollen lymph nodes, uncontrolled diarrhea or unusual skin lesions) individuals who have been exposed to the risk of HIV infection (e.g. homosexuals, multiple sexual partners)

 Hepatitis An individual with history of jaundice within last 1 year Positive test for HBsAg or anti-HCV antibodies should not be accepted for blood donation. Malaria In endemic areas, a donor may be accepted after 3 months of asymptomatic period following malarial attack and after full treatment

 Drugs Exclude donors taking aspirin or other non-steroidal inflammatory drugs (which affect platelet function) drugs with teratogenic action patients receiving human pituitary-derived growth hormone are permanently unfit due to the risk of Creutzfeldt-Jakob disease

 Illness Do not accept donors with diabetes mellitus hypertension heart disease renal disease liver disease

lung disease cancer epilepsy bleeding disorder or allergic disease

 Skin piercing Donors with history of Tattooing Electrolysis ear piercing accidental needle stick in health care workers acupuncture during last 12 months should not be accepted.

 Immunization Donors who have received killed viral vaccines are acceptable as blood donors Deferral period: - Attenuated live virus vaccine for measles, mumps, yellow fever, Sabin polio: 2 weeks - German measles: 4 weeks - Rabies: 1 year - Passive immunization with animal sera: 4 weeks - Hepatitis B immune globulin: 1 year

DONOR ARRIVES

Registration & demographic data Temporary Deferral if low Hb

Temporary deferral

Permanent deferral

Hb

OK

Medical history & counseling

Temporary or Permanent deferral

Physical examination

OK to donate

Un Successful Future plan.

Phlebotomy

Successful

Post donation Instruction & refreshments

Collection of Donor Blood

Equipments and materials 1. Blood bag Blood from a donor is collected in a sterile, disposable plastic bag single, double, triple or quadruple bag system capacity to hold 350 ml of blood contain standard amount of anticoagulant preservative solution for specified amount of blood

2. Anticoagulant-preservative solution usually contains citrate phosphate dextrose adenine (CPDA-1) (49 ml for 350 ml) prevents clotting of blood provides nutrients to maintain metabolism and viability of red cells In CPDA-1, blood can be kept stored at 2-6C for maximum of 35 days

 Function of each component of this solution: citrate: anticoagulation by binding of calcium in plasma Phosphate: acts as a buffer to minimize the effects of decreasing pH in blood Dextrose: maintenance of red cell membrane and metabolism Adenine: generation of ATP (energy source)

3. Sphygmomanometer, weighing balance, sealing clips or sealers, artery forceps 4. 70% ethanol, sterile cotton gauze, adhesive tape 5. Emergency drugs and equipment 6. Blood tubes for collection of blood for testing (grouping, crossmatching, screening for infectious disease)

Technique
Label the blood bag with the identification number of the donor Blood is collected from a vein in the antecubital fossa To make the veins prominent and palpable, a sphygmomanometer cuff is applied to the arm and inflated to 60 to 80 mm Hg The area selected for venipuncture is thoroughly cleaned with 70% ethanol and allowed to try

 The blood collection bag is placed on a weighing balance that has been kept about 30 cm below the level of the arm A loose knot is tied in the tubing near the venipuncture needle Venipuncture is performed, and the needle is secured in place with an adhesive tape after ensuring free flow of blood

 The pressure is reduced to 40 to 60 mm Hg The donor is asked to squeeze a rubber ball or a similar object slowly for the duration of donation The blood and the anticoagulant are mixed at short intervals in the blood bag The amount of blood collected should be monitored on the weighing balance

 When the blood bag weighs 400 to 450 g, the required amount of blood has been collected The pressure cuff is completely deflated The tubing is clamped with forceps about 10cm away from the needle The knot made earlier (close to the needle) is tightened or a sealing clip is applied The tubing is cut between the clamp and the knot/sealing clip

 The clamp is removed from the tubing Blood samples (for grouping, cross-matching, infectious disease screening) are collected in appropriate tubes The tubing is reclamped Needle is removed from the vein and pressure is applied over the puncture site with sterile cotton gauze The needle is disposed off in a special sharps container

 Blood remaining in the tubing is nonanticoagulated and is forced back (stripped) into the blood bag Bag is inverted gently several times to mix the blood and the anticoagulant Anticoagulated blood is the allowed to run back into the tubing Time required for blood collection should be between 7 to 10 minutes

 Blood sample tubes should be labeled with the donor identification number After cessation of bleeding, the venipuncture site is covered with sterile gauze and an adhesive tape After a few minutes, the donor is allowed to sit up and taken to the refreshment area

 Donor is given information about need to drink fluids, activities permissible and care of venepuncture site Blood bag is stored in the refrigerator at 2 to 6C At no time during the donation period, donor should be left unattended

 Needle gauge is a number that relates to the diameter of the lumen The needle diameter and the gauge have an inverse relationship The larger the gauge number, the smaller the actual diameter of the needle

 Needle gauge is selected according to the size and condition of the patients vein the type of procedure the equipment used

 Appropriate needles for the collection of most blood specimens for laboratory testing include gauges 20 through 23 However, a 21-gauge needle is considered the standard for most routine phlebotomy situations

Common Venipuncture Needle Gauges with Needle Type and Typical Use
Gauge Needle type 15-17 Special needle attached to collection bag Syringe Typical use Collection of donor units, autologous blood donation and therapeutic phlebotomy Used primarily as a transfer needle rather than for blood collection; safety issues have diminished use

18

Gauge Needle type 20

Typical use

21

Multisample Sometimes used when largesyringe volume tubes are collected or large-volume syringes are used on patients with normalsize veins Multisample Considered the standard syringe venipuncture needle for routine venipuncture on patients with normal veins or syringe blood culture collection

Gauge Needle type 22 Multisample syringe

Typical use Used on older children and adult patients with small veins or syringe draws on difficult veins Veins of infants and children and difficult or hard veins of adults

23

Butterfly

Post Donation Instruction

After donation, please rest in the donation chair for 10 minutes before getting up Eat and drink something before leaving Inform a staff member immediately if you have any unexpected reaction Lightheadedness Perspiration Nervousness Flushing Drink more fluids than usual during the next 4 hours

Donor Reactions
Occurrence of donor reactions is rare One relatively common problem is fainting attack or loss of consciousness due to sudden deprivation of blood supply to the brain It is due to the action of the autonomic nervous system and is induced by anxiety, site of blood or pain

 Its features are sweating slowing of pulse rate pallor coldness of skin sudden hypotension fainting or vomiting

 In such a case, donation should be discontinued Legs should be elevated above the level of the head to augment the venous return and increase blood flow to the brain Oral fluids are given if the donor is conscius If there is prolonged hypotension, intravenous fluids may have to be administered

 A severe vasovagal reaction is a contraindication for future donations If the donor is highly apprehensive, he may hyperventilate which may cause excessive loss of carbon dioxide and respiratory alkalosis Hyperventilation can be corrected by breathing in a paper bag

 Other reactions include formation of a bruise Hematoma infection at venipuncture site Thrombophlebitis puncture of an artery It is necessary to mention occurrence of any adverse reaction on the card issued to the donor

Blood Collection into Blood Bags

350 450 ml (female) 450 550 ml (male) 3 types: Single pack whole blood Double pack packed cells and plasma Triple pack platelet, packed cells and plasma

Blood Collection
Another type of donation is called apheresis, the process of removing one blood component and returning the remaining blood components to the donors circulatory system Apheresis can take 1 to 2 hours to complete and requires special cell-separating machines This process can be used to donate red blood cells, plasma, platelets and granulocytes

 Plateletpheresis is the process of removing only platelets from donor blood One plateletpheresis session provides up to five times more platelets than are present in one platelet component prepared from whole blood

Screening and Testing of Donors Blood

Donors red cells: ABO grouping, Rh typing, routine phenotyping of other antigens, malaria Donors serum: (a) ABO reverse grouping (b) Blood group antibodies screening (c) Transfusion transmitted disease HIV, hepatitis, STDs (syphilis) (d) Special antigen typing and rare blood group typing if necessary

ABO grouping
The presence or absence of the A antigen or B antigen on the surface of red blood cells determines the ABO blood group Based on the ABO blood group system, human blood can be divided into 4 major groups A, B, AB and O

Blood group A B AB O

Antigen on RBC membrane A B A and B Nil

Antibody in the serum Anti-B Anti-A Nil Anti-A and Anti-B

ABO grouping
Most important (clinically significant) blood group system for transfusion practice ABO compatibility between donor and recipient is crucial If ABO antibodies react with antigens in vivo, result in hemolysis possible death

ABO Reverse Grouping

Reverse grouping identifies the antibodies present in a patients serum or plasma by reacting the plasma with a commercial 2% to 5% suspension of group A cells and a commercial 2% to 5% suspension of group B cells and observing for agglutination

Rh Typing
Rh blood group is the second most important human blood group system The major antigen in the Rh system is the D antigen It is important to test for the D antigen in all patients who are to receive transfusions so that the correct type of blood will be given Rh D-negative patients should only be transfused with Rh D-negative blood

Test for Infectious Diseases Performed on Donated Blood

Blood is tested for Syphilis antibodies to hepatitis B and C viruses HIV (HIV-1 and HIV-2) human T-cell lymphotropic virus types I and II (HTLV-I, HTLV-II) Also tested for HIV, hepatitis and West Nile viral antigens

 Any unit that is confirmed positive for any of these tests must be discarded and the donor must be notified and place on a list prohibiting them from giving blood