Blood Donors, Blood Collection

Dr. Soheila ZareifarDepartment of Hematology/Oncology

January 2016

Donation must be accomplished in such a way that the safety of both the donor and the potential recipient is assured

DefinitionDefinition Autologous Autologous

Derived from organisms of the self; Derived from organisms of the self; same individual; "autologous blood same individual; "autologous blood donation" donation"

HeterologousHeterologous Derived from organisms of a different Derived from organisms of a different

but related species; "a heterologous but related species; "a heterologous blood donation”blood donation”

DefinitionDefinition ApheresisApheresis

Greek work meaning “take out”Greek work meaning “take out” The process of removal of whole blood from a donor The process of removal of whole blood from a donor

or patient, separating out specific portions, and or patient, separating out specific portions, and returning the other portions to the donor/patientreturning the other portions to the donor/patient

– Can be done forCan be done for Harvesting specific components for transfusion Harvesting specific components for transfusion

(plasma, platelet, red cells)(plasma, platelet, red cells) Removal of specific pathologic substancesRemoval of specific pathologic substances

CytapheresisCytapheresis To harvest specific cellular components such as To harvest specific cellular components such as

platelets, granulocytes or red cells.platelets, granulocytes or red cells. PlasmapheresisPlasmapheresis

To harvest plasma only and return back the cellular To harvest plasma only and return back the cellular components to the donor/patientcomponents to the donor/patient

Type of blood donation Whole blood donationWhole blood donation

Apheresis donationApheresis donation

Autologous blood donationAutologous blood donation

Blood donation sites Walk in donationsWalk in donations

Blood donors coming to the blood bank Blood donors coming to the blood bank for donationsfor donations

Usually regular blood donorsUsually regular blood donors

Mobile blood donationsMobile blood donations Major part of blood donationsMajor part of blood donations Blood donations out side the campus forBlood donations out side the campus for

Targeted population groupTargeted population group Untargeted population groupUntargeted population group

Standard of practice for donor screening First time donorsFirst time donors

Longer screening process to fully Longer screening process to fully explain all parts of the donation processexplain all parts of the donation process

Expected to have more quiresExpected to have more quires Regular donorsRegular donors

Shorter screening processShorter screening process Autologous blood donorsAutologous blood donors

Planning for donation according to the Planning for donation according to the time and need of bloodtime and need of blood

Donor selection Two crucial factors for safe blood

products

Accurate donor screening or selection

Accurate laboratory testing on each unit collected

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

Why does one donate? Volunteer donation Donation to replace products used Donation to cover family and friends Donation for payment

The last category, paid donors are not used in today’s blood banks

– Motivation such as time off, T-shirts, coffee cups and pens are not considered direct payment for donation.

Purpose of donor screening First

Healthy enough to donate Second

Recipient is protected Laboratory staff is protected

Outcome of donor screening Acceptance

Temporary deferral Permanent deferral

Donor screening Registration of the donor Medical history Physical examination

Upon successful completion of these the donor proceeds to phlebotomy

Donors must be assured of a private and confidential interview process for the medical history and the physical examination.

Registration & demographic data

DONOR ARRIVES

HbTemporary

Deferral if lowHb

OK Medical history &counseling

Permanentdeferral

Temporarydeferral

OK to donatePhysicalexamination

Phlebotomy SuccessfulPost donationInstruction &refreshments

Temporary or Permanent

deferral

Un SuccessfulFuture plan.

Demographic data Donors full name as in

identification card and ID card number Permanent address with telephone

number Gender Age

18-55 years Date of birth

Demographic data Donors occupation

Date of last donation if any Whole blood should be 3 months Apheresis 2 weeks Autologous depends on the requirement

Weight Should be >45 Kg

Medical historyMedical history Medical history should be taken by Medical history should be taken by

trained health care professionaltrained health care professional

It must be assured that the It must be assured that the confidentiality of the donor should be confidentiality of the donor should be maintainedmaintained

Direct questions or leading questions Direct questions or leading questions are allowed in the intervieware allowed in the interview

Medical history questions:

Have you every given blood under a different Have you every given blood under a different name?name?

In the past 8 weeks, have you given blood, In the past 8 weeks, have you given blood, plasma, or platelets?plasma, or platelets?

Have you ever been refused as a blood donor or Have you ever been refused as a blood donor or told not to donate blood?told not to donate blood?

Have you ever had cancer, a blood disease or Have you ever had cancer, a blood disease or bleeding disorder?bleeding disorder?

Have you ever had jaundice, liver disease or Have you ever had jaundice, liver disease or positive test for hepatitis?positive test for hepatitis?

Have you ever given growth hormone?Have you ever given growth hormone?

Medical history questions

Are you feeling well and healthy today?Are you feeling well and healthy today? In the past 3 years, have you had malaria?In the past 3 years, have you had malaria? In the past 1 year, have you been under a In the past 1 year, have you been under a

doctor’s care or had a major surgery?doctor’s care or had a major surgery? In the past 1 year, have you received blood or In the past 1 year, have you received blood or

had an organ or tissue transplant?had an organ or tissue transplant? In the past 1 year, have you had tattoo, skin In the past 1 year, have you had tattoo, skin

piercing or accidental needle stick?piercing or accidental needle stick? In the past 1 year, have you had close contact In the past 1 year, have you had close contact

with a person with yellow jaundice or hepatitis?with a person with yellow jaundice or hepatitis?

Medical history questions:

In the past 1 year, have you has a positive test In the past 1 year, have you has a positive test for syphilis?for syphilis?

In the past 1 year, history of high risk sexual In the past 1 year, history of high risk sexual contactcontact

For female donors: in the past 6 weeks, have For female donors: in the past 6 weeks, have you been pregnant or are you pregnant now?you been pregnant or are you pregnant now?

In the past 4 weeks, have you had any shot of In the past 4 weeks, have you had any shot of vaccinations?vaccinations?

In the past 3 days, have you taken aspirin or In the past 3 days, have you taken aspirin or anything that has aspirin in it?anything that has aspirin in it?

Medical history questions:

Male and female donors: history of Male and female donors: history of contact with homosexual malecontact with homosexual male

Have you ever taken clotting factor for Have you ever taken clotting factor for bleeding disorder?bleeding disorder?

Have you had a positive test for AIDS?Have you had a positive test for AIDS? Are you giving blood to be tested for Are you giving blood to be tested for

AIDS?AIDS? Have you had any symptoms of AIDS or Have you had any symptoms of AIDS or

weight loss?weight loss?

Have you read and under stood all Have you read and under stood all the donor information presented to the donor information presented to you, and have all your questions you, and have all your questions been answered?been answered?

Signature____________________Signature____________________date________________________date________________________

Physical examination

General appearance of donorGeneral appearance of donor Determination of hemoglobinDetermination of hemoglobin

Males Males Hb: >12.5 g/dlHb: >12.5 g/dl FemalesFemales Hb: >12.0 g/dl Hb: >12.0 g/dl

PulsePulse 50-100 beats/min50-100 beats/min

Blood pressureBlood pressure Maximum 140/90 mm HgMaximum 140/90 mm Hg

Physical examination TemperatureTemperature

Maximum 37.5 Maximum 37.5 00CC Donor weightDonor weight

Minimum 45 KgsMinimum 45 Kgs Amount of blood to be drawnAmount of blood to be drawn

(Donor wt. in Kg÷50) X 450(Donor wt. in Kg÷50) X 450 Venipuncture siteVenipuncture site

Inspection for scar marksInspection for scar marks

PhlebotomyPhlebotomy Preparation for the venipuncturePreparation for the venipuncture

Reidentification of the donor to avoid errorsReidentification of the donor to avoid errors Selection of the arm and veinSelection of the arm and vein Skin preparation, scrubbing of the areaSkin preparation, scrubbing of the area Local anesthesiaLocal anesthesia

VenipunctureVenipuncture Mixing of the blood bag during the Mixing of the blood bag during the

procedureprocedure Samples for the screening testsSamples for the screening tests End of procedureEnd of procedure

Preparation of Preparation of ComponentsComponents Collect unit within 15 minutes to prevent Collect unit within 15 minutes to prevent

activation of coagulation systemactivation of coagulation system Draw into closed system – primary bag with Draw into closed system – primary bag with

satellite bags with hermetic seal between.satellite bags with hermetic seal between. If hermetic seal broken transfuse within 24 hours If hermetic seal broken transfuse within 24 hours

if stored at 1-4C, 4 hours if stored at 20-24Cif stored at 1-4C, 4 hours if stored at 20-24C

Preparation of Preparation of ComponentsComponents Centrifuge – light spin, platelets suspendedCentrifuge – light spin, platelets suspended Remove platelet rich plasma (PRP)Remove platelet rich plasma (PRP) Centrifuge PRP heavy spinCentrifuge PRP heavy spin Remove platelet poor plasmaRemove platelet poor plasma Freeze plasma solid within 8 hoursFreeze plasma solid within 8 hours Thaw plasma at 1-4C – precipitate formsThaw plasma at 1-4C – precipitate forms Centrifuge, express plasma leaving Centrifuge, express plasma leaving

cryoprecipitate. Store both at -18Ccryoprecipitate. Store both at -18C RBCs – CPD – 21 days, ADSOL – 42 days – 1-RBCs – CPD – 21 days, ADSOL – 42 days – 1-

6C6C

Anticoagulants Preservative Solutions Anticoagulants prevent blood Anticoagulants prevent blood

clottingclotting Preservatives provide nutrients for Preservatives provide nutrients for

cellscells HeparinHeparin

– Rarely if ever used anymoreRarely if ever used anymore– Anticoagulant ONLYAnticoagulant ONLY– Transfuse within 48 hours, preferably 8Transfuse within 48 hours, preferably 8

AnticoagulantsAnticoagulantsCPDCPD CPD-A1CPD-A1

Storage Storage timetime

21 days21 days 35 days35 days

TemperaturTemperaturee

1-6 C1-6 C 1-6 C1-6 CSlows glycolytic activitySlows glycolytic activity

AdenineAdenine NoneNone Substrate for ATP Substrate for ATP synthesissynthesis

VolumeVolume 450 +/- 10%450 +/- 10%DextroseDextrose Supports ATP generation by glycolytic Supports ATP generation by glycolytic

pathwaypathwayCitrateCitrate Prevents coagulation by binding Prevents coagulation by binding

calciumcalcium

Additive Solution (AS)Additive Solution (AS) Primary bag with satellite bags attached.Primary bag with satellite bags attached. One bag has additive solution (AS)One bag has additive solution (AS) Unit drawn into CPD anticoagulantUnit drawn into CPD anticoagulant

Additive SolutionAdditive Solution Remove platelet rich plasma within 72 Remove platelet rich plasma within 72

hourshours Add additive solution to RBCs, ADSOL, Add additive solution to RBCs, ADSOL,

which consists of:which consists of:– SalineSaline– AdenineAdenine– GlucoseGlucose– MannitolMannitol

Extends storage to 42 daysExtends storage to 42 days Final hematocrit approximately 66%Final hematocrit approximately 66%

Changes Occur During Changes Occur During StorageStorage Shelf life = expiration dateShelf life = expiration date

– At end of expiration must have 75% At end of expiration must have 75% recoveryrecovery

– At least 75% of transfused cells At least 75% of transfused cells remain in circulation 24 hours remain in circulation 24 hours AFTERAFTER transfusiontransfusion

Storage Storage Significant for infants and massive Significant for infants and massive

transfusion.transfusion. Summary of biochemical changesSummary of biochemical changes

– pH decreasespH decreases– 2,3 DPG decreases2,3 DPG decreases– ATP decreasesATP decreases– Potassium increasesPotassium increases– Sodium decreasesSodium decreases– Plasma hemoglobin increasesPlasma hemoglobin increases

Preparation of Preparation of ComponentsComponents Summary – One unit of whole Summary – One unit of whole

blood can produce:blood can produce:– Packed RBCsPacked RBCs– Fresh frozen plasma (FFP)Fresh frozen plasma (FFP)– Cryoprecipitate (CRYO)Cryoprecipitate (CRYO)– Single donor plasma (SDP) – cyro Single donor plasma (SDP) – cyro

removedremoved– Platelets Platelets

StorageStorage Biochemical changes which occur at 1-6CBiochemical changes which occur at 1-6C Affects oxygen dissociation curve, Affects oxygen dissociation curve,

increased affinity of hemoglobin for oxygen.increased affinity of hemoglobin for oxygen.– Low 2,3-DPG, increased OLow 2,3-DPG, increased O22 affinity, less O affinity, less O22

released.released.– pH drops causes 2,3-DPG levels to fallpH drops causes 2,3-DPG levels to fall– Once transfused RBCs regenerate ATP and 2,3-Once transfused RBCs regenerate ATP and 2,3-

DPGDPG Few functional platelets presentFew functional platelets present Viable (living) RBCs decreaseViable (living) RBCs decrease

Plasma hemoglobin

Plasma K+

Viable cells

pH

ATP

2,3-DPG

Plasma Na+

Helps release oxygen from hemoglobin (once transfused, ATP & 2,3-DPG return to normal)

K+Na+

Post donation Post donation instructionsinstructions After donation, please rest in the donation After donation, please rest in the donation

chair for 10 minutes before getting upchair for 10 minutes before getting up Eat and drink something before leavingEat and drink something before leaving Inform a staff member immediately if you Inform a staff member immediately if you

have any unexpected reactionhave any unexpected reaction LightheadednessLightheadedness PerspirationPerspiration NervousnessNervousness FlushingFlushing

Drink more fluids than usual during the Drink more fluids than usual during the next 4 hoursnext 4 hours

Post donation Post donation instructionsinstructions If there is bleeding from the site where the If there is bleeding from the site where the

needle was placed raise your arm and needle was placed raise your arm and apply pressureapply pressure

If you feel dizzy or faint, lie down or sit If you feel dizzy or faint, lie down or sit down, placing your head lower than your down, placing your head lower than your kneesknees

If either bleeding or faintness persists, If either bleeding or faintness persists, return to blood bankreturn to blood bank

If you become ill in the next 3 to 4 days, If you become ill in the next 3 to 4 days, contact the department with information contact the department with information on our illnesson our illness

THANK YOU FOR YOUR DONATION.THANK YOU FOR YOUR DONATION.WE HOPE TO SEE YOU AGAIN SOON!WE HOPE TO SEE YOU AGAIN SOON!

Post donation care of blood donorPost donation care of blood donor

Donor care is provided my trained Donor care is provided my trained nurse under the supervision of nurse under the supervision of doctordoctor

Occasionally donors experience Occasionally donors experience adverse reactionadverse reaction

Record of donor adverse reaction Record of donor adverse reaction should be kept for future decisionsshould be kept for future decisions

Donor reactionsDonor reactions

Vasovagal reactionVasovagal reaction Sudden fainting due to hypotensionSudden fainting due to hypotension Neurophysiological responseNeurophysiological response

Apprehension, first time donor, femaleApprehension, first time donor, female Emotional stressEmotional stress Sight of bloodSight of blood

PreventionPrevention Donor screeningDonor screening Psychological support through positive Psychological support through positive

donor-staff relationship and reassurancedonor-staff relationship and reassurance Physical comfort like temperature and Physical comfort like temperature and

surrounding environmentsurrounding environment

Donor reactionsDonor reactions

HyperventilationHyperventilation Increased inspiration and expiration either Increased inspiration and expiration either

rate or depthrate or depth Results in excessive loss of COResults in excessive loss of CO22 Severe cases can result into hypocalcaemia Severe cases can result into hypocalcaemia

tetany or syncopetetany or syncope Usually associated with anxietyUsually associated with anxiety Prevention and treatmentPrevention and treatment

Reassure the donorReassure the donor Ask the donor to cough to interrupt the Ask the donor to cough to interrupt the

pattern of breathingpattern of breathing Instruct the donor to rebreathe expelled air Instruct the donor to rebreathe expelled air

into a small paper baginto a small paper bag

Donor reactionDonor reaction

HematomasHematomas A mass of blood (usually clotted) that is A mass of blood (usually clotted) that is

confined to a local region and usually confined to a local region and usually results from the rupture of a blood vesselresults from the rupture of a blood vessel

Prevention is by effective collection Prevention is by effective collection techniquetechnique

Resolves spontaneously or by apply ice Resolves spontaneously or by apply ice packpack

Autologous donationAutologous donation

A Donation by the intended recipient A Donation by the intended recipient of his or her own blood or of his or her own blood or component for a possible component for a possible subsequent transfusionsubsequent transfusion

ClassificationClassification Preoperative or predepositPreoperative or predeposit Perioperative hemodilutionPerioperative hemodilution Intraoperative salvageIntraoperative salvage Postoperative salvagePostoperative salvage

Criteria for predepositCriteria for predeposit

Donation can be made at weekly interval (1-5units)Donation can be made at weekly interval (1-5units) HbHb

>11.0 g/dl>11.0 g/dl HCTHCT

>33%>33% Last donation should be 72 hours before surgeryLast donation should be 72 hours before surgery Cross match is required before each transfusionCross match is required before each transfusion Blood not required during or after the patient Blood not required during or after the patient

surgery normally is discardedsurgery normally is discarded Screening test are performed as per normal Screening test are performed as per normal

donationdonation Label should clearly state “For Autologous Use Label should clearly state “For Autologous Use

Only”Only”

criteriacriteria Preferably regular donorPreferably regular donor Weight Weight

>55 Kgs>55 Kgs Good venous accessGood venous access Prior investigations requiredPrior investigations required

CBCCBC VDRLVDRL Hbs AgHbs Ag Anti HIVAnti HIV Anti HCVAnti HCV Serum lipid profileSerum lipid profile

Blood Component General Blood Component General InformationInformation Storage temperatures:Storage temperatures:

– RBCs 1-6CRBCs 1-6C– Platelets, Cryo (thawed) and Platelets, Cryo (thawed) and

granulocytes 20-24C (room granulocytes 20-24C (room temperature)temperature)

– Any frozen plasma product ≤ -18CAny frozen plasma product ≤ -18C– Any liquid plasma product EXCEPT Any liquid plasma product EXCEPT

Cryo 1-6CCryo 1-6C

Blood ComponentsBlood Components CellularCellular

– Red blood cell productsRed blood cell products– PlateletsPlatelets– GranulocytesGranulocytes

PlasmaPlasma– FFPFFP– CryoprecipitateCryoprecipitate

Products With Red Products With Red CellsCells

Whole BloodWhole Blood Clinical indications for use of WB are extremely

limited. Used for massive transfusion to correct acute

hypovolemia such as in trauma and shock, exchange transfusion.

RARELY used today, platelets non-functional, labile coagulation factors gone.

Must be ABO identical.

Changes in Stored Changes in Stored BloodBlood

Red Blood Cells (RBC)Red Blood Cells (RBC) Used to treat symptomatic anemia and

routine blood loss during surgery Hematocrit is approximately 80% for non-

additive (CPD), 60% for additive (ADSOL).

RBCs Leukocyte ReducedRBCs Leukocyte Reduced Leukocytes can induce adverse affects during

transfusion, primarily febrile, non-hemolytic reactions. Reactions to cytokines produced by leukocytes in

transfused units. Other explanations to reactions include: immunization

of recipient to transfused HLA or granulocyte antigens, micro aggregates and fragmentation of granulocytes.

Historically, indicated only for patients who had 2 or more febrile transfusion reactions, now a commonly ordered, popular component.

“CMV” safe blood, since CMV lives in WBCs. Most blood centers now leukoreduce blood

immediately after collection. Bed side filters are available to leukoreduce products

during transfusion.

Leukocyte ReductionLeukocyte Reduction

Washed Red Blood Cells (W-RBCs) Washing removes plasma proteins, platelets, WBCs

and micro aggregates which may cause febrile or urticarial reactions.

Patient requiring this product is the IgA deficient patient with anti-IgA antibodies.

Prepared by using a machine which washes the cells 3 times with saline to remove and WBCs.

Two types of labels:– Washed RBCs - do not need to QC for WBCs.– Leukocyte Poor WRBCs, QC must be done to

guarantee removal of 85% of WBCs. No longer considered effective method for leukoreduction.

Expires 24 hours after unit is entered.

Cell Washer Prepares Cell Washer Prepares Washed CellsWashed Cells

Frozen BloodFrozen Blood

Frozen RBCs; Deglycerolized RBCs Blood is frozen to preserve: rare types, for

autologous transfusion, stock piling blood for military mobilization and/or civilian natural disasters.

Blood is drawn into an anticoagulant preservative.– Plasma is removed and glycerol is added.– After equilibration unit is centrifuged to remove excess

glycerol and frozen. Expiration

– If frozen, 10 years.– After deglycerolization, 24 hours.

Storage temperature– high glycerol -65 C.– low glycerol -120 C, liquid nitrogen.

Frozen RBCs; Deglycerolized RBCs Thaw unit at 37C, thawed RBCs will have high

concentration of glycerol. A solution of glycerol of lesser concentration of

the original glycerol is added. This causes glycerol to come out of the red blood

cells slowly to prevent hemolysis of the RBCs. After a period of equilibration the unit is spun,

the solution is removed and a solution with a lower glycerol concentration is added.

This procedure is repeated until all glycerol is removed, more steps are required for the high glycerol stored units.

The unit is then washed.

Rejuvenated Red Blood Cells A special solution is added to expired RBCs

up to 3 days after expiration to restore 2,3-DPG and ATP levels to prestorage values.

Rejuvenated RBCs regain normal characteristics of oxygen transport and delivery and improved post transfusion survival.

Expiration is 24 hours or, if frozen, 10 years