Unit 1 Part 1 Blood Collection Terry Kotrla, MS, MT(ASCP) MLAB 2431 Immunohematology

Introductory Comments An overview of the process involved in collecting donor blood

Donor Screening All blood comes from VOLUNTEER donors. Screening performed to ensure donor is healthy. 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 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 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: FDA – Food and Drug Administration – CBER and CFR AABB CAP – College of the American Pathologists Joint Commission – inspects hospitals, lab included CLSI – Clinical Laboratory Standards Institute

Donor Screening Two goals or purposes for screening Four outcomes Protect the health of the potential donor Protect the health of the potential recipient Four outcomes Acceptance Temporary deferral Indefinite deferral Permanent deferral Three components of screening Registration Health history interview Limited physical examination.

Donor Registration 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 Additional useful information Name of patient or group to credit Race Unique donor characteristics Donor must be provided with HIV high risk activities Warnings about donor reactions Tests that will be performed and notification Post phlebotomy care instructions

Medical History Frequency of donation Whole blood or red blood cells 8 weeks Two unit red cell unit 16 weeks Plateletpheresis – up to 24 times/year Plasmapheresis– once every 4 weeks, can be done twice a week

Medical History 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 is taking are present in plasma, may cause deferral Infections the donor has may be passed to recipient, may be cause for deferral

Permanent Deferrals 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 after age 11. Cancer deferrals vary, some accept after period of being disease free others do not accept. 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 post-transfusion HIV or HBV in recipient

12 Month Deferral 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 Certain immunizations 2 weeks -MMR, yellow fever, oral polio, typhoid 4 weeks -Rubella, Chicken Pox 2 months – small pox Pregnancy – 6 weeks upon conclusion Certain medications Proscar/Propecia, Accutane – 1 month Avodart – 6 months Soriatane – 3 years Tegison – permanent Feldene – no platelet donation for 2 days. Plavix and Ticlid – no platelet donation for 14 days Malaria 3 years West Nile virus 28 days

Helpful Hint 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 Evaluate general appearance Weight – 110 1bs national, 123 lbs. Austin – eff. Jan 2010 Temperature 37.5 C OR 99.5F Blood pressure Systolic </= to 180 mm Hg Diastolic </= 100 mm Hg Hemoglobin and Hematocrit Allogenic 12.5 g/dL or 38% Autologous 11.0 g/dL or 33%

Self-Exclusion Rescinded by FDA in 1992 but some blood centers may still use. Two stickers “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 “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 Apheresis – removal of 1 component, return the rest Leukapheresis Plateletpheresis Plasmapheresis Stem cells Bone marrow Apheresis

Donor Categories 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

References http://www.fda.gov/cber/dhq/dhq.htm AABB Technical Manual 17th edition.