in the name of allĀh, the merciful, the mercy … · vii foreword this book is the fulfillment of...
TRANSCRIPT
III
Introduction to
Blood Banking
and
Transfusion Medicine
Dr. Salwa Hindawi Amer H. Asseri
Assistant Professor in Hematology
and Transfusion Medicine
Director of Blood Transfusion Services,
King Abdulaziz University Hospital
Academic Technician,
Faculty of Science, Biochemistry Dept.,
King Abdulaziz University
Scientific Publishing Center
King Abdulaziz University
P.O. Box 80200, Jeddah 21589
Saudi Arabia
http://spc.kau.edu.sa
IV
King Fahd National Library Cataloging-in-Publication Data
Hindawi, Salwa
Introduction to blood banking & transfusion medicine. /
Hindawi, Salwa; Asseri, Amer. - Jeddah, 2011
160 p; 24 cm
ISBN: 978-9960-06-600-4
1- Blood - bank 2- Blood – Transfusion – Safety
measures – Handbooks, manuals, etc.
I - Asseri, Amer (co author) II - Title
615,6507 dc 1432/10320
L.D. no. 1432/10320
ISBN: 978-9960-06-600-4
King Abdulaziz University Press
© King Abdulaziz University 2011A.D. (1432 A.H.)
All rights reserved.
1st Edition: 2011 A.D. (1432 A.H.)
VII
Foreword
This book is the fulfillment of Dr. Salwa I.
Hindawi and Mr. Amer H. Asseri wishes to
put together a comprehensive guide for its
readers as its intention is to shed light on the
subjects concerning blood banking as well as transfusion
medicine. It provides useful information to students as well as
professionals by serving as a guideline in their continuous efforts
to further understand it's relating principles and standard
guidelines. Very useful for students, residents or blood bankers,
where current subjects as quality control and ethical aspects are
approached with precision and clearness. The authors have
exerted every effort to ensure subject matters set forth in this text
book are in accordance with the current recommendations and
practice. Thorough, yet concise, the introduction to blood
banking and transfusion medicine begins with a review of basic
science, plus the history of blood preservation, and continues to
provide students with a working knowledge of modern blood
banking as it focuses on the how and why of transfusion practice,
presenting a perfect "cross match" of theory and practice. Lastly,
I personally congratulate Dr. Salwa Hindawi and Mr. Amer
Asseri and everyone who contributed to this excellent book.
Dr. Adnan Abdularhman Mazroa
Vice President, King Abdulaziz University
IX
Acknowledgments
We would like to thank all who helped us with advice and
encouraged us to finish our book.
Authors
XI
Preface
"Blood is the fluid of life". We would like to introduce this
book with this phrase. We have focused on the science of blood
collection, preparation, testing, storage, reservation, issuing and
transfusion.
What is a blood bank? This question can be answered
immediately as ‘a place where blood is donated and reserved’.
Certainly that is the obvious answer. But the most important
questions are ‘What happens backstage behind the scenes? What
are the rules and regulations regarding blood banks? What are
the correct scientific procedures that must be followed by
workers in blood banks from the moment when the blood is
donated until the minute of administrating blood or its
components to the recipients and thereafter?’
Therefore, we have attempted to answer all these questions,
and many others to convey the information easily to specialists
or those in search of knowledge.
We have been accumulating information relating to blood
banks, transfusion medicine, especially the practical aspects
from a multitude of sources.
The book is divided into three chapters; the first chapter
tackles the definitions and techniques of blood bank, the second
chapter discusses blood donation, the physical condition and
requirements of the donor, types of donors, and healthy and
correct methods of donation. The third chapter deals with how to
administer blood or its components to the patient.
We hope that this book will benefit readers and serve the
medical community.
Authors
XIII
Contents Dedication …………………………………………………….....………..………. V Foreword …………………………………………...……….………………..…... VII
Acknowledgments ……………………….………………….……………………. IX
Preface ………………………………….……………………………………….... XI
Chapter 1: Definition and Blood Bank Techniques………………………….… 1
Definitions…………………………………………………………………………. 3
Blood Bank Techniques…………………...……………………………………..… 3
Patient Identification………………………………..……..…………………..…… 3
Sample Collection…………………………...……..……………………………..... 4
Labeling of Sample………………………….……………………………..………. 4
Blood Banking Reagents……………………….……………………………..…… 5
Testing Procedures (Techniques) Routinely done in Blood Banking……………... 6
Grading Reactions……………………………………………………………….… 9
Blood Grouping and Rh Typing……………………….………………………...… 10
Blood Group system……………………………………………………………..… 10
ABO discrepancies…………………………...………………….........................… 12
Antibody identification…………………………………………………………….. 13
Crossmatch…………………………………………......................……………….. 13
ABO Selection of blood components……..……………………………………….. 13
Transfusion testing Policies ……………………………………………………….. 15
Blood components preparation…………………………………………………….. 17
Preparation steps……………………………………………..…………………….. 19
Leukocyte filtration………………………………………..……...……………….. 29
Methods of filtration……………………………………………………………….. 29
Post-storage…………………………..……………………………………………. 29
Pre-storage...……………………………………………………………………… 30
Blood storage……………………………………………...……………………….. 33
Quality management programme in blood banking……...……………………….. 35
Quality System Essentials & Guidelines for Quality Assurance in Blood
Establishments……………………………………………..……………………….
36
Units Disposal……………………………………………………..……………….. 41
General Safety in the Blood Bank……………………...………………………….. 43
XIV
Chapter 2: Blood Donation Area.…………………………………………..….… 45
Introduction to Blood Donation Area………………..…………………………….. 47
Donor types…………………….………………….……………………………….. 47
A. Autologous Donation………………………..………………………………….. 48
B. Directed Donation………………………...…………………………………….. 50
Donor Selection………………………………………………….………………… 53
General donor requirements…………………….………………...……………….. 53
Donor medical history and questionnaire…………………………………………. 53
Accepted criteria for donor…………………………..……………………………. 57
Physical examination……………...……………………………………………….. 57
Blood examination – Hemoglobin Evaluation…………………………………….. 58
Donation Process………………………………….……………………………….. 59
Collecting blood from donor…………………………………...………………..… 59
Donation steps……………………………………..……………...……………….. 59
Donor care…………………………………………………...…………………….. 74
Donor adverse reaction prevention and treatment………...……………………….. 75
Mild reaction……………………………………………………………………….. 75
Moderate reaction………………………………………………………………….. 76
Severe reaction…………………………………………………….……………….. 76
Hematoma………………………………………………………………………….. 77
Convulsions……………………………………….……………………………….. 77
Cardiac or respiratory difficulties………………………………………………….. 78
Reporting results……………………………………………..…………………….. 80
Procedure notes…………………………………………………………………….. 80
Blood donor testing………………………………………………..……………….. 81
Transmitted diseases……………………………………………………………….. 81
Blood group and Rh typing…………………….…………….…………………….. 82
Aphaeresis………………………………………………………………………….. 84
Tracking Transfusion - Transmittable Disease…………………………………….. 93
Look Back……………………………………..…………………..……………….. 93
Trace Back…………………………………………...………….............................. 93
General Quality control in donation area………...………………..……………….. 94
XV
Chapter 3: Clinical Applications of Blood Transfusion………...……………… 97
Introduction to blood transfusion area…………………...………..…......………… 99
Blood ordering……………………………………………………………………... 99
Request forms……………………………………………………..……………….. 100
Emergency requesting…………………………………………………………...… 101
Patient Sample's collection………………………....………………………..…..… 103
Sample rejection criteria……………………………………………………..…..… 103
Pre-transfusion testing……………………………..……………............................. 103
Delivery of blood……………………………………...………..………………… 104
Administration of blood components…………………………………...……….… 105
Consent form…………………………………………..…………………..…….… 107
Guidelines for blood components……………………….…………………..…...… 108
Irradiation of blood components……………………………………………..…..… 114
Massive Transfusion…………………………………………………………..…… 115
Complications of Blood Transfusion…………………...………………………..… 115
Management of Acute Transfusion Reactions……………………………..…...… 116
Therapeutic Aphaeresis………………………………….....................................… 122
Indication for Therapeutic Aphaeresis……..……………………………..….….… 127
Hemovigilance System …………………………..…………………..…..……...… 131
National blood policy…………………………………..………………..………… 136
References………………………………………….……………………..……...… 139
Appendix .……………………………………..…………………...…………….… 143
XVI
Title of Figure Page
Chapter 1. Figure 1. Diagram for all blood types…………………………………………... 12 Figure 2. RBC Compatibility chart……………………………………………... 13 Figure 3. Plasma compatibility chart……………………………………………. 14 Figure 4. Blood bag after donation……………………………………………… 19
Figure 5. Special centrifuge used for blood bag………………………………… 20
Figure 6. Blood bag after 1st centrifugation…………………………………….. 21
Figure 7. Packed RBCs bag (300-350 ml)……………………………………… 26
Figure 8. Fresh frozen plasma FFP (180-200 ml)………………………………. 26
Figure 9. Platelets (50-75 ml)…………………………………………………… 27
Figure 10. Cryoprecipitate (15-20 ml)………………………………………….. 27
Figure 11. Summary for blood components separation……………………….. 28
Figure 12. Leuko-Filtration procedure………………………………………… 31
Figure 13. Leukoreduction Filtet………………………………………………... 32 Figure 14. Storage Refrigerator………………………………………………… 34 Figure 15. The Document Pyramid……………………………………………… 39 Figure 16. Disposal of Blood Bags, after each unit of blood is separated or
transfused. The empty blood bags disposed of into biohazard container……...… 43
Chapter 2.
Figure 17. Three photos (1, 2, 3) for donor questionnaire and interview….……. 60
Figure 18. This form is example of Blood donor questionnaire forms…………. 61
Figure 19. Photo for Blood Pressure……………………………………………. 62
Figure 20. Two Photos (1, 2) for Hemoglobin meter (HemoCue) and finger
stick tools…………………………………………………………………………
63
Figure 21. Donor sitting on donation chair……………………...………………. 64 Figure 22. Photo showing how to use the tourniquet………………………….... 65
Figure 23. Photo nomber (1) of technician as he chooses the appropriate vein,
photo nomber (2) for vein anatomy, A: Median cubital vein, B: Cephalic vein,
C: Basilic vein…………………………………………………………………....
66
XVII
Figure 24. Two photos (1, 2) showing the sterilization of the venesection area
using iodine, then swab alcohol…………………………………………………..
67
Figure 25. Three photos (1, 2, 3) showing a needle entering a vein………….. 69
Figure 26. Photo of the collection bag and blood monitoring during the
donation…………………………………………………………………………... 69
Figure 27. Blood tubes, from donation bag……………………………………... 70
Figure 28. Three blood tubes……………………………………………………. 70
Figure 29. Two photos (1, 2) for removing the needle from vein………………. 71
Figure 30. Two photos (1, 2) for applying pressure after donation……………... 72
Figure 31. Complete donor pressure on the wound…………………………… 73
Figure 32. Write data on bag……………………………………………………. 73
Figure 33. Delivery of blood bags in special box……………………………….. 74
Figure 34. Donor drinking refreshments………………………………………... 75
Figure 35. Rarely, donors will faint during donation. Gently remove the
tourniquet and needle from the patients arm, apply gauze and pressure to the
skin puncture site, and turn the head of donor down and his feet up……….…..
79
Figure 36. Apply cold compress to the forehead……………………………….. 79
Figure 37. Blood collection monitor, a mechanical tray tilts the bag to prevent
congealing, and displays current volume and flow per minute……………….. 96
Chapter 3.
Figure 38. example for consent form……………………………………………. 107
XVIII
Title of Table Page
Chapter 1. Table 1. Summary of known and unknown sources of both antigens and
antibodies………………………………………………………………………. 6
Table 2. Summarizes the sources of both the antigen and antibody……………. 7 Table 3. Blood grouping in routine testing……………………………………… 11 Table 4. Major ABO Blood Groups…………………………………………….. 11
Table 5. Suggested ABO group selection order for transfusion RBCs…………. 14
Table 6. Plasma compatibility table…………………………………………….. 15
Table 7. Standard temperature for blood storage……………………………….. 33
Chapter 3.
Table 8. Types of Transfusion complications.................................................... 116
Table 9-A. ACE INHIBITORS INCLUDE…………………………………….. 124
Table 9-B. ANTICHOLINESTERASE DRUGS INCLUDE………………….... 124