1. Blood Donors, Blood Collection Dr. Soheila Zareifar Department of Hematology/Oncology January 2016

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

3. Definition 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”

4. Definition 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

5. Type of blood donation Whole blood donation Whole blood donation Apheresis donation Apheresis donation Autologous blood donation Autologous blood donation

6. 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

7. 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

8. Donor selection Two crucial factors for safe blood products Accurate donor screening or selection Accurate laboratory testing on each unit collected

9. 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

10. 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.

11. Purpose of donor screening First Healthy enough to donate Second Recipient is protected Laboratory staff is protected Outcome of donor screening Acceptance Temporary deferral Permanent deferral

12. 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.

13. 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.

14. 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

15. 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 Kg

16. 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

17. 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 jaundice, liver disease or positive test for hepatitis? Have you ever had jaundice, liver disease or positive test for hepatitis? Have you ever given growth hormone? Have you ever given growth hormone?

18. 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?

19. 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, history of high risk sexual contact In the past 1 year, history of high risk sexual contact 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?

20. Medical history questions: Male and female donors: history of contact with homosexual male Male and female donors: history of contact with homosexual male 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?

21. Have you read and under stood all the donor information presented to you, and have all your questions been answered? Signature____________________date________________________

22. 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

23. 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

24. Phlebotomy 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 bag during the procedure Mixing of the blood bag during the procedure Samples for the screening tests Samples for the screening tests End of procedure End of procedure

25. Preparation of Components Collect unit within 15 minutes to prevent activation of coagulation system Collect unit within 15 minutes to prevent activation of coagulation system Draw into closed system – primary bag with satellite bags with hermetic seal between. Draw into closed system – primary bag with satellite bags with hermetic seal between. If hermetic seal broken transfuse within 24 hours if stored at 1-4C, 4 hours if stored at 20-24C If hermetic seal broken transfuse within 24 hours if stored at 1-4C, 4 hours if stored at 20-24C

31. Preparation of Components Centrifuge – light spin, platelets suspended Centrifuge – light spin, platelets suspended Remove platelet rich plasma (PRP) Remove platelet rich plasma (PRP) Centrifuge PRP heavy spin Centrifuge PRP heavy spin Remove platelet poor plasma Remove platelet poor plasma Freeze plasma solid within 8 hours Freeze plasma solid within 8 hours Thaw plasma at 1-4C – precipitate forms Thaw plasma at 1-4C – precipitate forms Centrifuge, express plasma leaving cryoprecipitate. Store both at -18C Centrifuge, express plasma leaving cryoprecipitate. Store both at -18C RBCs – CPD – 21 days, ADSOL – 42 days – 1-6C RBCs – CPD – 21 days, ADSOL – 42 days – 1-6C

32. Anticoagulants Preservative Solutions Anticoagulants prevent blood clotting Anticoagulants prevent blood clotting Preservatives provide nutrients for cells Preservatives provide nutrients for cells Heparin Heparin –Rarely if ever used anymore –Anticoagulant ONLY –Transfuse within 48 hours, preferably 8

33. Anticoagulants CPDCPD-A1 Storage time 21 days 35 days Temperature 1-6 C Slows glycolytic activity AdenineNone Substrate for ATP synthesis Volume 450 +/- 10% Dextrose Supports ATP generation by glycolytic pathway Citrate Prevents coagulation by binding calcium

34. Additive Solution (AS) Primary bag with satellite bags attached. Primary bag with satellite bags attached. One bag has additive solution (AS) One bag has additive solution (AS) Unit drawn into CPD anticoagulant Unit drawn into CPD anticoagulant

35. Additive Solution Remove platelet rich plasma within 72 hours Remove platelet rich plasma within 72 hours Add additive solution to RBCs, ADSOL, which consists of: Add additive solution to RBCs, ADSOL, which consists of: –Saline –Adenine –Glucose –Mannitol Extends storage to 42 days Extends storage to 42 days Final hematocrit approximately 66% Final hematocrit approximately 66%

36. Changes Occur During Storage Shelf life = expiration date Shelf life = expiration date –At end of expiration must have 75% recovery –At least 75% of transfused cells remain in circulation 24 hours AFTER transfusion

37. Storage Significant for infants and massive transfusion. Significant for infants and massive transfusion. Summary of biochemical changes Summary of biochemical changes –pH decreases –2,3 DPG decreases –ATP decreases –Potassium increases –Sodium decreases –Plasma hemoglobin increases

38. Preparation of Components Summary – One unit of whole blood can produce: Summary – One unit of whole blood can produce: –Packed RBCs –Fresh frozen plasma (FFP) –Cryoprecipitate (CRYO) –Single donor plasma (SDP) – cyro removed –Platelets

39. Storage Biochemical changes which occur at 1-6C Biochemical changes which occur at 1-6C Affects oxygen dissociation curve, increased affinity of hemoglobin for oxygen. Affects oxygen dissociation curve, increased affinity of hemoglobin for oxygen. –Low 2,3-DPG, increased O 2 affinity, less O 2 released. –pH drops causes 2,3-DPG levels to fall –Once transfused RBCs regenerate ATP and 2,3-DPG Few functional platelets present Few functional platelets present Viable (living) RBCs decrease Viable (living) RBCs decrease

40. Plasma hemoglobin Plasma K + Viable cells pH ATP 2,3-DPG Plasma Na + Helps release oxygen from hemoglobin (once transfused, ATP & 2,3- DPG return to normal) K+K+ Na +

41. 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

42. 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!

43. 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

44. 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

45. 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

46. Donor reaction 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

47. 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

48. Criteria for 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”

49. criteria Preferably regular donor Preferably regular donor Weight Weight >55 Kgs >55 Kgs Good venous access Good venous access Prior investigations required Prior investigations required CBC CBC VDRL VDRL Hbs Ag Hbs Ag Anti HIV Anti HIV Anti HCV Anti HCV Serum lipid profile Serum lipid profile

50. Blood Component General Information Storage temperatures: Storage temperatures: –RBCs 1-6C –Platelets, Cryo (thawed) and granulocytes 20-24C (room temperature) –Any frozen plasma product ≤ -18C –Any liquid plasma product EXCEPT Cryo 1-6C

51. Blood Components Cellular Cellular –Red blood cell products –Platelets –Granulocytes Plasma Plasma –FFP –Cryoprecipitate

52. Products With Red Cells

53. Whole Blood Clinical indications for use of WB are extremely limited. Used for massive transfusion to correct acute hypovolemia such as in trauma and shock, exchange transfusion. RARELY used today, platelets non-functional, labile coagulation factors gone. Must be ABO identical.

54. Changes in Stored Blood

55. Red Blood Cells (RBC) Used to treat symptomatic anemia and routine blood loss during surgery Hematocrit is approximately 80% for non- additive (CPD), 60% for additive (ADSOL).

56. RBCs Leukocyte Reduced Leukocytes can induce adverse affects during transfusion, primarily febrile, non-hemolytic reactions. Reactions to cytokines produced by leukocytes in transfused units. Other explanations to reactions include: immunization of recipient to transfused HLA or granulocyte antigens, micro aggregates and fragmentation of granulocytes. Historically, indicated only for patients who had 2 or more febrile transfusion reactions, now a commonly ordered, popular component. “CMV” safe blood, since CMV lives in WBCs. Most blood centers now leukoreduce blood immediately after collection. Bed side filters are available to leukoreduce products during transfusion.

57. Leukocyte Reduction

58. Washed Red Blood Cells (W- RBCs) Washing removes plasma proteins, platelets, WBCs and micro aggregates which may cause febrile or urticarial reactions. Patient requiring this product is the IgA deficient patient with anti-IgA antibodies. Prepared by using a machine which washes the cells 3 times with saline to remove and WBCs. Two types of labels: – –Washed RBCs - do not need to QC for WBCs. – –Leukocyte Poor WRBCs, QC must be done to guarantee removal of 85% of WBCs. No longer considered effective method for leukoreduction. Expires 24 hours after unit is entered.

59. Cell Washer Prepares Washed Cells

60. Frozen Blood

61. Frozen RBCs; Deglycerolized RBCs Blood is frozen to preserve: rare types, for autologous transfusion, stock piling blood for military mobilization and/or civilian natural disasters. Blood is drawn into an anticoagulant preservative. – –Plasma is removed and glycerol is added. – –After equilibration unit is centrifuged to remove excess glycerol and frozen. Expiration – –If frozen, 10 years. – –After deglycerolization, 24 hours. Storage temperature – –high glycerol -65 C. – –low glycerol -120 C, liquid nitrogen.

62. Frozen RBCs; Deglycerolized RBCs Thaw unit at 37C, thawed RBCs will have high concentration of glycerol. A solution of glycerol of lesser concentration of the original glycerol is added. This causes glycerol to come out of the red blood cells slowly to prevent hemolysis of the RBCs. After a period of equilibration the unit is spun, the solution is removed and a solution with a lower glycerol concentration is added. This procedure is repeated until all glycerol is removed, more steps are required for the high glycerol stored units. The unit is then washed.

63. Rejuvenated Red Blood Cells A special solution is added to expired RBCs up to 3 days after expiration to restore 2,3- DPG and ATP levels to prestorage values. Rejuvenated RBCs regain normal characteristics of oxygen transport and delivery and improved post transfusion survival. Expiration is 24 hours or, if frozen, 10 years