Donor Selection and Processing By: Wajnat Tounsi

Donor Types Allogeneic blood donors: When a donor donate blood for another person use – Volunteer: for ambiguous recipient – Directed donor: the collected unit is directed toward a specific person – A pheresis donor: donate a specific type of blood component. Either platelet, plasma, leukocytes, or RBC. Autologous blood donors: when a donor donate blood for his/er own use – preoperative – Intraoperative – Postoperative – Acute normovolemic hemodilution

Allogeneic Donor Selection Will a donation cause a harm to the donor?! Would that blood from that donor transmit a disease to the recipient ?!

Donor Registration Demographic information's required to ensure proper donor identification. – Donor’s name: First, middle and last name – Address and phone number – Gender – Date of birth and age: at least 17, no upper age limit – Date of donation – Donor consent: a written signature from the donor allow for blood bank to take and use the blood. Consent must be obtained before the donation.

Physical Examination A short physical examination to ensure the donor safety. 1.General appearance: Healthy looking,and no sign of cold or other infection.

2. Weight: at least 50Kg (110 lb) Donation of a unite should not exceed about 10% of the donor’s blood volume. For donating 525 ml of blood (stander donation), the donor should weight at least 50 Kg. Physical Examination

If the donor weight less than 50Kg, the amount of the collected blood should be reduced according to the following equation: (Donor’s weight (lb) ÷ 110 lb) × 450 ml = allowable amount (ml) If the allowable amount is less than (300ml), the regular amount of the anticoagulant (63 ml) should be reduced as well according to the following equation: (Allowable amount ÷ 100) × 14 = Anticoagulant needed (ml) A specific amount of the anticoagulant should be removed to reach the desirable amount 63 ml – anticoagulant needed = anticoagulant to remove Physical Examination

3. Temperature: should not exceed 37.5° C (99.5° F). Elevated body temperature is a sign of infection or other diseases that might be transferable through blood transfusion. Physical Examination

4. Pulse: beats/min. – should be examined for at least 15 sec. – Increased heart beats caused by anxiety, recent exercise or fear. Allow the donor to reset for few min and re-evaluate the pulse. If still elevated, defer the donor. – Pulse lower than 50 can be found in athletes who have high tolerance to exercise. Physical Examination

5. Blood Pressure: o Systolic ≤ 180 mmHg, diastolic ≤ 100 mmHg. Physical Examination

6. Hematocrit and hemoglobin: 38%, 12.5 g/dl 7. Skin lesions: antecubital area must be checked for sign of drug abuse. 8. Check if donor has been permanently deferred, previously. Physical Examination

Medical History Questionnaire The donor required to answer a questioner with simple yes/no question to give an overview about his/er health status to make sure donation is not harmful to the donor nor has a potential of transmitting a disease to the recipient (Blood Transmitted Diseases)

Donor’s Questionnaire and Interview

Donor Deferral Permanent deferral: for one or more reason the donor will NEVER be allowed to donate blood. Deferral (Temporary): the donor is not allowed to donate blood for a period of time.

Permanent Deferral A confirmed positive test result for Hep. B surface antigen (HBsAg) A confirmed positive result for Hep. B core antibody (anti-HBc) A confirmed positive test result for Hep. C. A confirmed positive test result for HIV (I, II). A positive test result for HTLV. Donor diagnosed with hemophilia A, B, and von Willebrand’s disease.

Permanent Deferral Leukemia or lymphoma Drug abusing donor. Donor who was in UK between , due to the risk of Creutzfeldt-Jakob Disease (vCJD) Chagas’ Disease Growth factor hormone injection from a human source

Malaria: donor who have had malaria should be deferred for 3 years post-therapy and remain a symptomatic and anti-malaria drugs free for that period. 3 Years Deferral

One Year Deferral 12 months deferral if donor: – was in a close contact with a Hep. Positive patient in the last 12 months – received blood products in the last 12 months. – organ or tissue transplantation in the last 12 months. – tattoo, ear or other skin piercing in the last 12 months. – Had accidental needle stick – received hep. B immunoglobulin (HBIg), given after exposure. – travelled to a malaria endemic area in the last 12 months. – Syphilis or gonorrhea post treatment *** (STD) – was in an intimate contact in the last 12 months with a person who: was HIV positive, drug abusing, takes money for sex, homosexual – After rabies vaccination post exposure. – Have been in prison in the last 12 months

Other Deferral Donor is deferred for 8 weeks (56 days) after a blood transfusion. A pheresis donor (WBCs, plasma, platelets) is deferred for 48 hours from the last pheresis donation. Pregnant women deferred during pregnancy and 6 weeks postpartum Donor with a active TB is temporary deferred until is successfully treated.

Vaccination: – If killed pathogen, toxoid, or recombinant such as influenza, and Hep.B vaccines, no deferral needed – 2 weeks deferral for attenuated virus vaccine such as smallpox, polio (sabin/oral), and measles – 4 weeks deferral for rubella vaccine and chickenpox Drugs: – Aspirin: 3 days deferral Other Deferral

Donor donate blood for his/er own future use. There is no risk of blood transmitted disease There is no risk for RBCs alloimmunization No risk of blood transfusion reaction There are four types of autologous donation: – Preoperative – Intraoperative – Postoperative – Immediate preoperative hemodilution Autologous Donation

1. Preoperative collection: performed in prior to a scheduled surgery where the patient is suspected to need a blood transfusion during surgery. Should be ounce every days, and the last donation should be minimally 72 hours before surgery. The patient’s minimal hemoglobin 11g/dl, and hematocrite 33% 2. Intraoperative collection: Blood is collected during surgery by aspiration from the surgical site and then processed and transfused to the patient either during or right after surgery. Collected can be stored for 24 hours at 1-6° C Autologous Donation Types

3. Postoperative collection: Blood is collected from a drainage tube placed at the site of surgery. Blood collected must be used within 6 hours. 4. Acute normovolemic hemodilution: Used specifically at surgery where blood lose is expected The patient infused with crystalloid and colloid (volume expander) Collected blood is stored at room temp. The blood is re-transfused within 8 hours Autologous Donation Types

Blood Collection (Phlebotomy) 1.The person who is performing should be well trained 2.Blood must be drawn in aseptic manner, using a sterile, closed system, and a single venipuncture 3.The Phlebotomy site should be free of any lesions. 4.The site should be disinfected by iodophor solution for 30 sec. in circular motion, starting from the center and going outward The unite and all pilot samples should be properly labeled.

o Make donor comfortable. o Select and locate the vein, disinfect, cover the site. o Check the bag and the scale o Place a clamp between the needle the primary bag o Give the donor something to squeeze. o Put the tourniquet o Perform the venipuncture o Secure the needle to the skin with a tape and cover with a gauze o Monitor the donor all the time o Periodically mix the blood with the anticoagulant Blood Collection (Phlebotomy)

o When the primary bag has tripped, advice the donor to stop squeezing and clam the tube. o A unit contains 405 to 550 ml should weight 429 to 583 g, plus the weight of the bag and the anticoagulants o 1.06 g/ml is used to convert from (g) to (ml) o Low volume unite contains 300 to 404 ml, which should be labeled as short volume and not suitable for FFP o The volume-weight for WB is 1.06 g/ml o A unit of WB should weight g Blood Collection (Phlebotomy)

o Collect pilot tubes, that used for donor screening o Release the tourniquet o Remove the needle, apply pressure at the site of the puncture until bleeding stops, and then place a bandage o Label the unit and the tubes properly o Send the unit and the pilot tubes to the lab for processing Blood Collection (Phlebotomy)

After the donation has been done, advice donor to: – Remain seated for a few min. – Give the donor treats (juice, sandwich) – Increase fluid intake for the next 24 hours – Do not drink alcohol before the next meal – Do not smoke for the next half hour – Leave the bandage for few hours – If bleeding occur, re-apply pressure until it stops – If you feel dizzy, lay down with your feet elevated – Do not perform any hazardous work for few hours Blood Collection (Phlebotomy)

Donor Reactions

Mild Reactions Moderate Reactions Severe Reactions

Mild Reactions The most common Donor show signs of shock No lose of consciousness

Symptoms: Fainting Feeling warm Pallor, sweating Increased in pulse Hyperventilation Low blood pressure Nausea, vomiting Muscles spasm

Treatment Stop donation Breath in a paper bag Place a cold compresses on the forehead Raise the donor feet Put a cold towel at the donor forehead Loosen tight clothes, check donor’s airway Monitor vital signs Don’t leave the donor unattended

Moderate Reactions  Include one or more of mild reaction symptoms  Lose of consciousness for a period of time  Decreased heart rate  Hyperventilation  Hypotension

Treatment Same in mild reactions treatment Check blood pressure and pulse frequently Administer 95%O 2, 5% CO 2 Separate donor from other donors if needed

Severe Reactions In addition to other symptoms, sever convulsion also include seizures caused by cerebral ischemia, hyperventilation, or epilepsy.

Treatment – Seek medical attention, remain with the donor – If necessary, gently restrain the donor – Check the donor airway, breathing – If necessary administer 95% O 2, 5% CO 2 – Keep monitoring the donor until fully recover

Hematomas Is localized blood collection under skin Common side effect of donation Occur when the needle puncture the back side of the vein If happened, remove the tourniquet and the needle Apply pressure venipuncture site, and raise arm for min. Apply ice for 5 min.

Donor Processing

All donor units must be processed and tested before they are ready to be transfused – ABO grouping – Rh typing – Ab screening – Serological Testing: Hepatitis B Hepatitis C HIV (1,2) HTLV I/II Syphilis others

ABO & Rh Grouping ABO testing by two different methods (forward, and reverse) Rh typing by using Anti-D (Rh 0 ) – If positive in the immediate spin, the unite should be labeled – If negative, Du testing should be performed – If Du is positive, the unite should be labeled as Rh positive

Antibody Screening Is required only for female donors who were pregnant, donors who had blood products transfusion However, it is a routine procedure performed for all donor units

Serological Testing  Hepatitis BV Surface Antigen (HBsAg)  Hepatitis BV core antibody (Anti-HBc): – Enzyme linked immunosorbent assay (ELISA) is the most used test for secreening – If negative, no further investigation is necessary – If positive, the test should be repeated in duplicate. A positive in one of them considered HBsAg positive. – All component must be discarded

Serological Testing  Hepatitis CV antibody (Anti-HCV) Enzyme immunoassay (EIA) is the screening test used Nucleic-acid testing (NAT) screening for HCV RNA was introduced in 1999 NAT detects viral nucleic acid in blood

Serological Testing  Anti-HIV 1/2 and NAT: – All donors should be screened for presence of HIV-1/2 antibodies – If the antibody screening is negative, no further investigation is necessary – If positive, a confirmatory test is needed. – Confirmatory test include: western blot and Immunofluorescense assay (IFA) – NAT, detect the presence of HIV RNA – NAT reduced the window to 12 days

Serological Testing  Human T-cell lymphotropic virus (HTLV) I/II : A virus that cause adult T-cell leukemia Transmitted through transfusion of infected lymphocytes EIA is approved screening test Positive HTLV I/II cause permanent deferral of the donor

Serological Testing Syphilis: – STD and can also be transmitted through blood transfusion – No documented cases for blood transmitted syphilis

Other serological testing is performed depending of the region and whether there is a specific disease (endemic) that donors should be screened for. For e.g.: SARS – Acute case of SARS deferred for 28 days – Traveling to endemic area, deferred for 14 days WNV – infected donor deferred for 14 days after recovery or 28 dys from the onset of diagnosis Serological Testing

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