Blood Donors, Blood Collection & Storage Dr. Tariq M. Roshan Department of Hematology Dated 12/7/2004

List of criteria used for the selection of blood donors List of instruments/materials used for the collection of donors blood Definition Plasmapheresis Cytopheresis Autologous donation Heterologous donation Steps in preparation of a donor prior to venisection and collection of blood Pre and post donation care Screening tests done Common anticoagulants Advantages and disadvantages Changes that occur on blood during storage Ethical issues related to donation Concept of mobile blood bank and public relation in donor recruitment program

Screening test for donors blood prior to transfusion Infection screening VDRL HbsAg Anti HIV Anti HCV Malarial parasite Grouping and reverse grouping Cross matching

Storage of blood Series of changes occur in vitro that alters the physiological properties To ensure that blood retains its in vivo environment involves Anticoagulants Preservative Characteristics of plastic bag Storage temperature Shipping and transport conditions

Anticoagulation and preservatives for blood products To ensure the viability and stability of the products To inhibit growth of microorganisms To prevent clotting of the product

Red cell anticoagulants and preservation Citrate Calcium-chelating agent Prevents coagulation by interfering with calcium-dependent steps in the coagulation cascade Citrate-dextrose The dextrose provide nutrient for red cells Support the generation of ATP by glycolysis thus enhancing red cell viability and extending shelf life Acid-citrate-dextrose Contains citric acid, sodium citrate, and dextrose Shelf life of 21 days and now no longer use for red cells as other solution are available with extended shelf life of red cells Acid pH does not help in maintaining 2,3-DPG levels Used in apheresis procedure

Red cell anticoagulants and preservation Citrate-phosphate-dextrose (CPD) Alkaline pH helps in maintaining 2,3-DPG Shelf life is extended to 28 days CPD is not now commonly used Citrate-phosphate-dextrose-adenine (CPDA-1) Addition of adenine is associated with improved synthesis of ATP, allowing longer shelf life (35 days) Other solutions Adsol or AS-1 Nutricel or AS-3 Optiso or AS-5

Red cell anticoagulants and preservation Saline-adenine-glucose-mannitol (SAGM) After taking blood donation in CPD and separating red cells from plasma and platelets SAGM is added to the packed red cells The resulting red cells have flow characteristics equivalent to plasma reduced blood and a storage life of 35-42 days Other advantage is by removing maximum amount of plasma from blood for the manufacture of factor VIII and albumin

Storage changes in blood In vivo, red cells are carried and protected by the plasma, which helps Regulated temperature Controlled pH Adequate glucose supply Removal of metabolic waste In protected environment life span is 110-120 days Lowering of temperature and preservatives do help in reducing the changes but changes do occur and known as “storage lesion”

Storage changes in blood pH Glycolysis is slowed at temperature of 1 to 60C Glycolysis results in the production of lactate and decrease in pH Day 0 (CPD) pH = 7.20 Day 21 (CPD) pH = 6.84 ATP ATP is closely associated with red cell viability Loss results in rigidity and decrease deformability ATP is also needed for Na+/K+-ATPase pump ATP levels on day 35 of storage is 45% in CPDA-1

Storage changes in blood 2,3-DPG levels Decrease in pH of stored blood results in low 2,3-DPG levels With low levels there will be left shift of oxygen dissociation curve and increase affinity of oxygen After transfusion the levels return to normal values within 24 hours Na+ and K+ levels Na+/K+ leak through the red cells Cells lose potassium and gain sodium Plasma Hemoglobin Hemolysis results in raised plasma Hb

General requirements for Storage of Blood Products Separate areas should be reserved for untested, tested, and quarantined products Continual monitoring of temperature Audible alarm signals Emergency procedure power failure and power back-up

Appropriate storage temperatures WB and packed RBC 1 to 60C FFP ≤ -180C Platelets 20 to 240C Cryoprecipitate ≤ -180C

Ethical issues related to blood donation Is blood donation ethically justified Muslim prospective Blood a dead element Is blood donation from a female allowed to male Other concerns Jews prospective Whether autologous is the only choice? Other religions

Ethical issues of screening What information should be given to donor? How to ask personal questions? Attitude during the interview Data security

Ethical issues of screening High risk group donors Screening test results Information to the spouse Information to the employer

Ethical issues raised after transfusion of tainted blood Information to the recipients Treatment of the recipients Recalling of all blood products

Blood mobiles & Public relations in donor recruitment Mobile blood bank Major contributor in blood stocks Counseling of the first time donors Good communication skills and public relations Helps in recruiting new donor and for first time donor to become regular blood donors Functions, parties in appreciation of regular blood donors and for departments helping in collecting maximum number of units

Thank you