Module 1: The Journey of Blood: Donation to Distribution Transfusion Training Workshop KKM 2012

The journey

Donors Voluntary, non-remunerated We advocate self-deferral

Donate At blood collection centers/blood drives Donate whole blood or Donate platelet only / plasma only

Transportation The donated blood is quickly transported to the blood bank Whole blood is kept at RT before processing The cold chain is maintained throughout Blood is labeled as UNSCREENED and quarantined until virology results are obtained

Testing Screening for infectious diseases:  HBV, HCV, HIV, Syphilis  Newly emerging viruses ?  Bacteria, parasites, fungi ? If all the tests are negative the blood is labeled SCREENED If either one of the tests are positive, the blood is pulled out of stock and discarded The blood donor will be called back for counseling and further testing

Different Components

Blood Components Prepared from whole blood donation Blood components derived from plasma  Fresh Frozen Plasma (FFP)  Cryoprecipitate  Cryosupernatant  Plasma-derived fractionated products

Fresh Whole Blood Efficacy based on the minimal time from donation to administration “Freshness” is different among collection centers Fresh WB is defined as <7 days old It has a haematocrit level of 30 – 40% Storage: 2 – 6°C (4±2°C)

Fresh Whole Blood Constituents  Coagulation factors: all present, but rapid reduction in FV, FVIII (labile factors)  Platelets: as WB is cold-stored, platelets do not circulate; do not arrest bleeding  Storage lesions Most indications for WB are now well managed with blood component therapy

Packed Red Cells Prepared by removing most of the plasma from the unit It has a haematocrit level of 55 – 65% Storage: 2 – 6°C (4±2°C) Shelf life: 42 days (max)

Packed Red Cells Red cells are the preferred product for patients with symptomatic anaemia Restore/ improve oxygen-carrying capacity 2,3-diphosphoglycerate (DPG) necessary to allow oxygen release to tissues

Fresh Frozen Plasma (FFP) Storage at -20°C Prepared within 6 hrs of WB collection ABO compatible and crossmatching not required Contents : all coagulation factors, no platelet Use: to replace all coagulation factor deficiencies Thawed in 37°C water bath in the BB Administer within 30 min after thawing (activity of labile FV, FVIII is rapidly lost) Increase factor levels 20 – 30% per dose of 10 – 15 ml/kg BW

Cryoprecipitate Prepared from FFP – 10 – 20 ml Dosage: 1 unit/10 kg ABO compatible and crossmatching not required Contents: Fibrinogen, FVIII, FXIII and vWF Indications:  Correction of fibrinogen deficiency (DIC)  Correction of factor XIII deficiency

Liver Plasma / Cryosupernatant Contents : plasma- stable clotting factors, no platelet Storage temperature : frozen -20 o C or colder Indications:  Plasma exchange eg. in TTP  Should not be used for blood volume expansion or protein replacement

Platelets  Random  Apheresis Kept at RT 22 – 24°C and constantly agitated

Distribution: blood components will be supplied to hospitals Based on:  Average daily usage: to avoid expiry / wastage  Patient load  Special circumstances: patient with massive bleeding, natural disaster

What happens in the blood transfusion unit?

Pre-transfusion Compatibility Testing  Positive recipient identification:  blood request form and  blood samples  Clerical check: manual or computerized  Every patient, every time

Process Blood Sample

Serological Tests 1. Blood grouping  ABO testing  Rh testing 2. Rh negative: additional testing is performed

Serological Testing 3. Antibody screening  to detect presence of clinically significant unexpected alloantibodies  all positive screening must be investigated regardless of whether transfusion is needed 4. Antibody identification  laborious, time-consuming

Pre-transfusion Compatibility Testing  Cross-match testing:  Serologic cross- match  Immediate spin/RT  LISS 37°C  AHG  Estimated minutes

Pre-transfusion Compatibility Testing Selection and issuance of suitable blood/ blood components  ABO and Rh type  Rare blood: liaise with hospital BB, PDN  Specifications: filtered blood, irradiated blood, exchange transfusion

Pre-transfusion Compatibility Testing Group, screen and hold (GSH) 1. Positive recipient i/d 2. ABO, Rh grouping 3. Rh negative 4. Antibody screen 5. Antibody identification Group and cross-match (GXM)  Conversion of GSH (steps 1 – 5) 6. Serologic cross-match  Immediate spin/RT  LISS 37  AHG 7. Blood issued

The end