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

2. The journey

3. Donors Voluntary, non-remunerated We advocate self-deferral

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

5. 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

6. 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

7. Different Components

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

9. 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)

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. What happens in the blood transfusion unit?

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

20. Process Blood Sample

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

22. 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

23. Pre-transfusion Compatibility Testing  Cross-match testing:  Serologic cross- match  Immediate spin/RT  LISS 37°C  AHG  Estimated 20- 25minutes

24. 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

25. 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

26. The end