1. Blood Donors, Blood Collection & Storage Dr. Tariq M. Roshan Department of Hematology Dated 11/7/2004

2. 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

3. Donation must be accomplished in such a way that the safety of both the donor and the potential recipient is assured

4. DEFINITIONS Autologous Autologous derived from organisms of the self; same individual; "autologous blood donation" derived from organisms of the self; same individual; "autologous blood donation" Heterologous Heterologous derived from organisms of a different but related species; "a heterologous blood donation” derived from organisms of a different but related species; "a heterologous blood donation”

5. DEFINITIONS Apheresis Apheresis Greek work meaning “take out” Greek work meaning “take out” The process of removal of whole blood from a donor or patient, separating out specific portions, and returning the other portions to the donor/patient The process of removal of whole blood from a donor or patient, separating out specific portions, and returning the other portions to the donor/patient –Can be done for Harvesting specific components for transfusion (plasma, platelet, red cells) Harvesting specific components for transfusion (plasma, platelet, red cells) Removal of specific pathologic substances Removal of specific pathologic substances Cytapheresis Cytapheresis To harvest specific cellular components such as platelets, granulocytes or red cells. To harvest specific cellular components such as platelets, granulocytes or red cells. Plasmapheresis Plasmapheresis To harvest plasma only and return back the cellular components to the donor/patient To harvest plasma only and return back the cellular components to the donor/patient

6. TYPE OF BLOOD DONATION WHOLE BLOOD DONATION WHOLE BLOOD DONATION APHERESIS DONATION APHERESIS DONATION AUTOLOGOUS BLOOD DONATION AUTOLOGOUS BLOOD DONATION

7. BLOOD DONATION SITES WALK IN DONATIONS WALK IN DONATIONS Blood donors coming to the blood bank for donations Blood donors coming to the blood bank for donations Usually regular blood donors Usually regular blood donors MOBILE BLOOD DONATIONS MOBILE BLOOD DONATIONS Major part of blood donations Major part of blood donations Blood donations out side the campus for Blood donations out side the campus for Targeted population group Targeted population group Untargeted population group Untargeted population group

8. STANDARD OF PRACTICE FOR DONOR SCREENING FIRST TIME DONORS FIRST TIME DONORS Longer screening process to fully explain all parts of the donation process Longer screening process to fully explain all parts of the donation process Expected to have more quires Expected to have more quires REGULAR DONORS REGULAR DONORS Shorter screening process Shorter screening process AUTOLOGOUS BLOOD DONORS AUTOLOGOUS BLOOD DONORS Planning for donation according to the time and need of blood Planning for donation according to the time and need of blood

9. DONOR SECLECTION Two crucial factors for safe blood products Accurate donor screening or selection Accurate laboratory testing on each unit collected

10. BROAD PRINCIPLES OF DONOR SELECTION Giving blood does not harm the donor Donated blood loss is restored rapidly and completely The blood must not harm the recipient

11. WHY DOES ONE DONATE? Volunteer donation Donation to replace products used Donation to cover family and friends Donation for payment The last category, paid donors are not used in today’s blood banks – –Motivation such as time off, T-shirts, coffee cups and pens are not considered direct payment for donation.

12. PURPOSE OF DONOR SCREENING FIRST Healthy enough to donate SECOND Recipient is protected Laboratory staff is protected OUTCOMES OF DONOR SCREENING Acceptance Temporary deferral Permanent deferral

13. DONOR SCREENING Registration of the donor Medical history Physical examination Upon successful completion of these the donor proceeds to phlebotomy Donors must be assured of a private and confidential interview process for the medical history and the physical examination.

14. Registration & demographic data DONOR ARRIVES Hb Temporary Deferral if low Hb OK Medical history & counseling Permanent deferral Temporary deferral OK to donate Physical examination PhlebotomySuccessful Post donation Instruction & refreshments Temporary or Permanent deferral Un Successful Future plan.

15. DEMOGRAPHIC DATA Donors full name as in identification card and ID card number Permanent address with telephone number Gender Age 18-55 years Date of birth

16. DEMOGRAPHIC DATA Donors occupation Date of last donation if any Whole blood should be 3 months Apheresis 2 weeks Autologous depends on the requirement Weight Should be >45 Kgs

17. MEDICAL HISTORY Medical history should be taken by trained health care professional Medical history should be taken by trained health care professional It must be assured that the confidentiality of the donor should be maintained It must be assured that the confidentiality of the donor should be maintained Direct questions or leading questions are allowed in the interview Direct questions or leading questions are allowed in the interview

18. MEDICAL HISTORY QUESTIONS Have you every given blood under a different name? Have you every given blood under a different name? In the past 8 weeks, have you given blood, plasma, or platelets? In the past 8 weeks, have you given blood, plasma, or platelets? Have you ever been refused as a blood donor or told not to donate blood? Have you ever been refused as a blood donor or told not to donate blood? Have you ever had cancer, a blood disease or bleeding disorder? Have you ever had cancer, a blood disease or bleeding disorder? Have you ever had yellow jaundice, liver disease or positive test for hepatitis? Have you ever had yellow jaundice, liver disease or positive test for hepatitis? Have you ever given growth hormone? Have you ever given growth hormone?

19. MEDICAL HISTORY QUESTIONS Are you feeling well and healthy today? Are you feeling well and healthy today? In the past 3 years, have you had malaria? In the past 3 years, have you had malaria? In the past 1 year, have you been under a doctor’s care or had a major surgery? In the past 1 year, have you been under a doctor’s care or had a major surgery? In the past 1 year, have you received blood or had an organ or tissue transplant? In the past 1 year, have you received blood or had an organ or tissue transplant? In the past 1 year, have you had tattoo, skin piercing or accidental needle stick? In the past 1 year, have you had tattoo, skin piercing or accidental needle stick? In the past 1 year, have you had close contact with a person with yellow jaundice or hepatitis? In the past 1 year, have you had close contact with a person with yellow jaundice or hepatitis?

20. MEDICAL HISTORY QUESTIONS In the past 1 year, have you has a positive test for syphilis? In the past 1 year, have you has a positive test for syphilis? In the past 1 year, have you given money or drugs to anyone to have sex with you? In the past 1 year, have you given money or drugs to anyone to have sex with you? For female donors: in the past 6 weeks, have you been pregnant or are you pregnant now? For female donors: in the past 6 weeks, have you been pregnant or are you pregnant now? In the past 4 weeks, have you had any shot of vaccinations? In the past 4 weeks, have you had any shot of vaccinations? In the past 3 days, have you taken aspirin or anything that has aspirin in it? In the past 3 days, have you taken aspirin or anything that has aspirin in it?

21. MEDICAL HISTORY QUESTIONS Male donors: have you had sex with another male even once? Male donors: have you had sex with another male even once? Female donors: have you had sex with a male who has had sex, even on time with another man? Female donors: have you had sex with a male who has had sex, even on time with another man? Have you ever taken clotting factor for bleeding disorder? Have you ever taken clotting factor for bleeding disorder? Have you had a positive test for AIDS? Have you had a positive test for AIDS? Are you giving blood to be tested for AIDS? Are you giving blood to be tested for AIDS? Have you had any symptoms of AIDS or weight loss? Have you had any symptoms of AIDS or weight loss?

22. Have you read and under stood all the donor information presented to you, and have all your questions been answered? UNDERTAKING………………………………SIGNATURE____________________DATED________________________

23. PHYSICAL EXAMINATION General appearance of donor General appearance of donor Determination of hemoglobin Determination of hemoglobin Males Hb: >12.5 g/dl Males Hb: >12.5 g/dl Females Hb: >12.0 g/dl Females Hb: >12.0 g/dl Pulse Pulse 50-100 beats/min 50-100 beats/min Blood pressure Blood pressure Maximum 140/90 mm Hg Maximum 140/90 mm Hg

24. PHYSICAL EXAMINATION Temperature Temperature Maximum 37.5 0 C Maximum 37.5 0 C Donor weight Donor weight Minimum 45 Kgs Minimum 45 Kgs Amount of blood to be drawn Amount of blood to be drawn (Donor wt. in Kg÷50) X 450 (Donor wt. in Kg÷50) X 450 Venipuncture site Venipuncture site Inspection for scar marks Inspection for scar marks

25. PHELEBOTOMY Preparation for the venipuncture Preparation for the venipuncture Reidentification of the donor to avoid errors Reidentification of the donor to avoid errors Selection of the arm and vein Selection of the arm and vein Skin preparation, scrubbing of the area Skin preparation, scrubbing of the area Local anesthesia Local anesthesia Venipuncture Venipuncture Mixing of the blood bad during the procedure Mixing of the blood bad during the procedure Samples for the screening tests Samples for the screening tests End of procedure End of procedure

26. POST DONATION INSTRUCTIONS After donation, please rest in the donation chair for 10 minutes before getting up After donation, please rest in the donation chair for 10 minutes before getting up Eat and drink something before leaving Eat and drink something before leaving Inform a staff member immediately if you have any unexpected reaction Inform a staff member immediately if you have any unexpected reaction Lightheadedness Lightheadedness Perspiration Perspiration Nervousness Nervousness Flushing Flushing Drink more fluids than usual during the next 4 hours Drink more fluids than usual during the next 4 hours

27. POST DONATION INSTRUCTIONS If there is bleeding from the site where the needle was placed raise your arm and apply pressure If there is bleeding from the site where the needle was placed raise your arm and apply pressure If you feel dizzy or faint, lie down or sit down, placing your head lower than your knees If you feel dizzy or faint, lie down or sit down, placing your head lower than your knees If either bleeding or faintness persists, return to blood bank If either bleeding or faintness persists, return to blood bank If you become ill in the next 3 to 4 days, contact the department with information on our illness If you become ill in the next 3 to 4 days, contact the department with information on our illness THANK YOU FOR YOUR DONATION. WE HOPE TO SEE YOU AGAIN SOON!

28. POST DONATION CARE OF BLOOD DONOR Donor care is provided my trained nurse under the supervision of doctor Donor care is provided my trained nurse under the supervision of doctor Occasionally donors experience adverse reaction Occasionally donors experience adverse reaction Record of donor adverse reaction should be kept for future decisions Record of donor adverse reaction should be kept for future decisions

29. DONOR REACTIONS Vasovagal reaction Vasovagal reaction Sudden fainting due to hypotension Sudden fainting due to hypotension Neurophysiological response Neurophysiological response Apprehension, first time donor, female Apprehension, first time donor, female Emotional stress Emotional stress Sight of blood Sight of blood Prevention Prevention Donor screening Donor screening Psychological support through positive donor-staff relationship and reassurance Psychological support through positive donor-staff relationship and reassurance Physical comfort like temperature and surrounding environment Physical comfort like temperature and surrounding environment

30. DONOR REACTIONS Hyperventilation Hyperventilation Increased inspiration and expiration either rate or depth Increased inspiration and expiration either rate or depth Results in excessive loss of CO 2 Results in excessive loss of CO 2 Severe cases can result into hypocalcaemia tetany or syncope Severe cases can result into hypocalcaemia tetany or syncope Usually associated with anxiety Usually associated with anxiety Prevention and treatment Prevention and treatment Reassure the donor Reassure the donor Ask the donor to cough to interrupt the pattern of breathing Ask the donor to cough to interrupt the pattern of breathing Instruct the donor to rebreathe expelled air into a small paper bag Instruct the donor to rebreathe expelled air into a small paper bag

31. DONOR REACTIONS Hematomas Hematomas A mass of blood (usually clotted) that is confined to a local region and usually results from the rupture of a blood vessel A mass of blood (usually clotted) that is confined to a local region and usually results from the rupture of a blood vessel Prevention is by effective collection technique Prevention is by effective collection technique Resolves spontaneously or by apply ice pack Resolves spontaneously or by apply ice pack

32. AUTOLOGOUS DONATION A Donation by the intended recipient of his or her own blood or component for a possible subsequent transfusion A Donation by the intended recipient of his or her own blood or component for a possible subsequent transfusion Classification Classification Preoperative or predeposit Preoperative or predeposit Perioperative hemodilution Perioperative hemodilution Intraoperative salvage Intraoperative salvage Postoperative salvage Postoperative salvage

33. CRITERIA FO PREDEPOSIT Donation can be made at weekly interval (1-5units) Donation can be made at weekly interval (1-5units) Hb Hb >11.0 g/dl >11.0 g/dl HCT HCT >33% >33% Last donation should be 72 hours before surgery Last donation should be 72 hours before surgery Cross match is required before each transfusion Cross match is required before each transfusion Blood not required during or after the patient surgery normally is discarded Blood not required during or after the patient surgery normally is discarded Screening test are performed as per normal donation Screening test are performed as per normal donation Label should clearly state “For Autologous Use Only” Label should clearly state “For Autologous Use Only”

34. CRITERIA FOR APERESIS PLATELET DONATION Preferably regular donor Preferably regular donor Weight Weight >55 Kgs >55 Kgs Good venous access Good venous access Prior investigations required Prior investigations required FBC FBC VDRL VDRL HbsAg HbsAg Anti HIV Anti HIV Anti HCV Anti HCV Serum lipid profile Serum lipid profile

35. End of part 1.