Lec 03Collection and storage of blood

Assist. Prof. Dr. Mudhir S. Shekha

Process of Registration includes

• -verify ID, age and interval of donation

• -donor information sheet

• -medication deferral list

• -donor history questionnaire (DHQ)

3 phases of donor screening• 1. Registration

2. Health history interview3. Physical examination

• Blood should be collected by aseptic methods using sterile blood bags by a single venipuncture.

• The standard operating procedure (SOP) for blood collection should include the details for the preparation of phlebotomysite; labeling; venipuncture, collection of blood and test samples; transport, postdonation care and management of donor reaction.

• All containers and anticoagulants used for storage and preservation of blood and blood components and all reagents used for blood samples should standards

Required donor information includes• full name• permanent address• home or business phone #• date of birth ( at least 16)• date if last donation• written and informed consent• social security #, or ID• photo ID• Race• intended use of donation

• The following information is written on the bag:

• Donor number, Date of collection, Date of expiry, Blood group & Negative for transfusion transmitted infections.

• The preparation of the phlebotomy site is important to prevent bacterial contamination of the blood.

• Blood is collected in 350 ml single blood bag or in a 450 ml, multiple bags, with 14 ml anticoagulant solution per 100 ml blood collections.

• The proper and gentle mixing of the bloodwith the anticoagulant solution should be ensured.

• After collection, the blood bag tubing should be sealed and cut and the needle with any attached tubing disposed as bio-hazard waste.

• The phlebotomy site should be covered with a sterile dressing after blood flow ceases. The donor should be given some light refreshment and kept under observation for 15 to 20 minutes for any signs of adverse reactions.

Donation procedure

1. Donor identification2. Bag labeling3. Vein selection4. Arm prep5. Venipuncture (16 gauge)6. Adverse reaction treatment (if any)7. Post donation care8. Canteen

Donor reactions• Most donors tolerate the

procedure of blood donation well. However, some donors may develop reactions during or after donation of blood.

• These can be mild such as feeling of faintness or dizziness.

• The donor may complain of weakness, profuse sweating and pallor.

• Sometimes these vasovagalattacks are accompanied with loss of consciousness.

• The skin feels cold, pulse rate is increased and the blood pressure may fall.

Donor reactions• Sudden fainting due to

hypotension: The donor’s head should be placed in a low position with the legs raised and fluids/light food may be given.

• Tight clothing must be loosened.

• Blood pressure, pulse and respiration must be monitored closely till the donor recovers.

• Cold compresses may be applied to the donor’s head if required

• Reassurance of the donor with sufficient rest before he leaves is essential.

• A hematoma localized collection of blood under skin caused by needle going through the vein and blood leakage

• Treat by removing needle, apply pressure, raise arm above heart, apply ice for 5min

• Nausea and vomiting may also occur. The donor must be made comfortable and an emesis basin may be provided. The head must be turned to one side to prevent aspiration. Ask the donor to breathe slowly and deeply.

• Muscular spasm or twitching may be seen in some donors.

• Convulsions can be seen in some donors. This is an emergency and the blood bank physician must be informed immediately. Adequate help must be sought while providing necessary assistance so that the donor does not injure himself.

• Sudden cardiac arrest is a very rare reaction. All donor reactions must be recorded. Written instructions must be provided by the blood bank physician for managing these reaction

Q/ Describe the donor reaction that is only seen during apheresis donations

•Citrate toxicity (hypocalcemia and tingling fingers)

Q/How often can you donate whole blood?

• every 56 days (8 weeks)

Q/ How often can you donate double red cells (apheresis)?

• every 112 days (16 weeks)

Q/ State the symptoms and treatment for mild donor reactions

• Symptoms- anxiety, decreased BP, nausea, sweating/pallor, increased pulse/breathing

Treatment- elevate feet, loosen clothing, apply cold clothes

Q/ State the symptoms and treatment for moderate donor reactions

• Symptoms- loss of consciousness, decreased BP, decreased pulse, rapid breathing

Treatment- check vitals frequently, administer oxygen, maintain privacy of donor

Q/ State the symptoms and treatment for severe donor reactions

• Symptoms- convulsions, cerebral ischemia, marked hyperventilation, epilepsy, tingling fingers

Treatment- call for help, remove needle, keep donor from harming themselves, keep airways open

International Society of Blood Transfusion and European HaemovigilanceNetwork Version 2007

Instructions to donors before blood donation

1. Take light refreshment / food before 2 hours of blood donation

2. Women should avoid blood donation during their menstrual bleeding.

3. Person who has consumed alcohol should avoid giving blood for next 24 hours.

4. Person who had recent attack of infection like Jaundice, Typhoid, Malaria, Rubella, etc., should not give blood.

5. Person who had undergone major surgery should avoid blood donation for 6 months.

6. Pregnancy, lactating women should avoid blood donation

Instruction to donors after donation

1. Increase intake of fluids for next 48 hours. No extra/special diet is needed.

2. Do not smoke or drive for next half an hour.

3. Do not drink alcohol for next 24 hours.

4. Do not go for a flight for next 24 hours if the donor is pilot by profession.

5. Avoid strenuous exercise/lifting heavy weights for 24hours.

6. If bleeding occurs from phlebotomy site raise the arm and apply pressure on the venipuncture site.

7. If feeling faint or dizzy lie down with legs slightly raised above the head level. If symptoms still persist consult nearest doctor, blood bank doctor or clinician.

Tests to be performed on donor blood

• The following tests are done on blood collected in pilot tubes:

1. ABO grouping

2. Rh grouping

3. Screening for transfusion transmitted infections: Hepatitis B virus (HBsAg), hepatitis C virus (HCV)

4. Serologic test for HIV , Syphilis

Why blood collection is important

• The demand for donated blood in all countries, however, is consistently high. In USA →40,000 pints of this life-saving blood are used every single day. Blood analysis also is one of the most important diagnostic tools available to clinician within healthcare.

Phlebotomy?• The drawing of blood in a clinical setting for clinical testing .

A balancing act between the comfort of the patient and the quality of the samples

Qualities of a Phlebotomist• Compassion

• Hand–eye coordination

• Ability to multitask.

• Team player

• Dependability

• Honesty

• Integrity

• Flexibility

• Professional

• Appearance

Obtaining the blood

• There are two main methods of obtaining blood from a donor. 1. The most frequent is to simply take the blood from a

vein as whole blood. This blood is typically separated into parts, usually red blood cells and plasma.

2. The other method is to draw blood from the donor, separate it using a centrifuge or a filter, store the desired part, and return the rest to the donor. This process is called apheresis, and it is often done with a machine specifically designed for this purpose. This process is especially common for plasma and platelets.

preparation and collecting blood• The blood is drawn from a large arm vein close

to the skin, usually the median cubital vein on the inside of the elbow. The skin over the blood vessel is cleaned with an antiseptic such as iodine or chlorhexidine to prevent skin bacteria from contaminating the collected blood and also to prevent infections where the needle pierced the donor's skin.

• A large needle (16 to 17 gauge) is used to minimize shearing forces that may physicallydamage red blood cells as they flow through the needle. A tourniquet is sometimes wrapped around the upper arm to increase the pressureof the blood in the arm veins and speed up the process. The donor may also be prompted to hold an object and squeeze it repeatedly to increase the blood flow through the vein.

Whole blood

• The most common method is collecting the blood from the donor's vein into a container. The amount of blood drawn varies from 200 ml to 550 ml depending on the country, but 450–500ml is typical.

• The blood is usually stored in a flexible plastic bag that also contains sodium citrate, phosphate, dextrose, and sometimes adenine. This combination keeps the blood from clotting and preserves it during storage. Other chemicals are sometimes added during processing.

• The plasma from whole blood can be used to make plasma for transfusions or it can also be processed into other medications using a process called fractionation.

• This was a development of the dried plasma used to treat the wounded during World War II and variants on the process are still used to make a variety of other medications

Apheresis• Apheresis is a blood donation method where the blood is

passed through an apparatus that separates out one particular constituent and returns the remainder to the donor. Usually the component returned is the red blood cells, the portion of the blood that takes the longest to replace. Using this method an individual can donate plasma or platelets much more frequently than they can safely donate whole blood. These can be combined, with a donor giving both plasma and platelets in the same donation.

Apheresis• Platelets can also be separated from

whole blood, but they must be pooled from multiple donations. From three to ten units of whole blood are required for a therapeutic dose. Plateletpheresis→Platelet transfusion can be a life-saving procedure in preventing or treating serious complications from bleeding and hemorrhage in patients with low platelet count or platelet dysfunction.

• Plasmapheresis is frequently used to collect source plasma that is used for manufacturing into medications much like the plasma from whole blood. Plasma collected at the same time as plateletpheresis is sometimes called concurrent plasma.

• White blood cell reduction apheresis, a form of therapeutic leukapheresis, is a nonsurgical therapy that reduces the quantity of white blood cells in a patient's circulating blood supply.

Storage of collected blood• The collected blood is usually stored in a

blood bank as separate components, and some of these have short shelf lives. There are no storage solutions to keep platelets for extended periods of time. The longest shelf life used for platelets is seven days.

• Red blood cells (RBC), the most frequently used component, have a shelf life of 35–42 days at refrigerated temperatures. For (relatively rare) long-term storage applications, this can be extended by freezing the blood with a mixture of glycerol, but this process is expensive and requires an extremely cold freezer for storage. Plasma can be stored frozen for an extended period of time and is typically given an expiration date of one year and maintaining a supply is less of a problem.