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Pretransfusion Testing
The immunohematologic testing needed for proper patient blood typing, component selection and compatibility testing. Which ensure patient safety and transfusion efficacy.
Blood transfusion services
By
Dr. Reham Talaat Blood bank specialist and
quality officer in MRBTC
Blood Donation
Blood Donation
A person has 5 - 6 liters of blood in their
body A person can donate blood every 90days (3
months) Body recovers the Blood very quickly:
Blood plasma volume: within 24 - 48 hours
Red Blood Cells : in about 3 weeks
Platelets & White Blood Cells: within minutes
Procedure for
Voluntary Blood Donation
Pre-Donation: Donor registration
Medical history
Physical examination
Blood Donation:
Blood donation procedure
Post donation
Rest, advice
Donor Screening
Registration ( national ID is must) Required information
Name Date and time of donation Address Telephone Gender Age (date of birth)
Donors must also be given education material about blood donation
Medical Questionnaire
Why ask questions?
Asking questions helps determine the overall suitability of the donor; from this, the donor will be:
Accepted
Temporarily deferred
Permanently deferred
Donor selection criteria
Donor selection criteria
Have you donated blood in the last 8
weeks?
The time interval between allogeneic whole blood donation is 8 weeks at least (better 3 month)
A donor must wait 48 hours after donating platelets, plasma
before donating whole blood
Physical Examination
General Appearance
Weight
Temperature
Pulse
Blood Pressure
Hemoglobin
Skin Lesions
Physical Exam:
- General Appearance: The donor should appear alert
- Weight: A minimum weight
limit of (50 kg) is used to avoid hypovolemia
- Temperature Less than or equal to 37.5°C
Physical Exam (cont’d)
Pulse Between 50-100 bpm (count for at least 15 sec)
Blood Pressure Systolic ≤180 mm Hg (110- 180 )
Diastolic ≤100 mm Hg ( 70-100)
Physical Exam: Hemoglobin
Hemoglobin can quickly be obtained from a finger stick.
Hemoglobin should be
≥13 g/dL for male ≥12 g/dL for female
In summary
99.5°F
37.5°C 180
100 12.5 g/dL
38%
110 lbs
(50 kg )
50-100
bpm
Blood Donation Procedure
Remember!
The Donor Must ….
have had good rest / sleep
have had light meal
be mentally prepared
Whole Blood Collection
Whole blood is collected in clear plastic bags that contain different mixtures of anticoagulants
CLOSED SYSTEM (remains sterile)
Post Donation Advice
Drink lots of fluids for at least the next 4 hours )
Avoid smoking for one hour Avoid exercises & games for a day If you feel dizzy, lie down & put your feet
up. You will be alright in 10-20 mins. Remove band-aid after 4 hours. If it bleeds, apply pressure & reapply
band-aid. If bruised and painful, apply cold-pack for
5 mins each. It will take a few days to get reabsorbed.
Blood Products / Components
& their uses
Blood collected is screened for TTIs (infections) & IF SAFE, is separated into components & stored for issue to patients
Benefits to Donor of blood donation
Health benefits:
- Lowers cholesterol - Lowers lipid levels - Decreases incidence of
heart attacks, strokes
Blood
Formed elements 45% of blood volume
Erythrocytes (red blood cells) 99% of cells
Carry oxygen
Leukocytes (white blood cells) Protect against infection
and cancer
Platelets (cell fragments) Blood clotting
Plasma 55% of blood volume
Water (90%)
Electrolytes
Plasma proteins
Albumin
Fibrinogen
Globulins
Substances transported by blood Nutrients
Waste products
Respiratory gases
Whole Blood
Consists of RBCs, WBCs, platelets and plasma (with anticoagulant)
1 unit increases Hgb 1 g/dL and Hct 3%
When is it used?
Patients who are actively bleeding and lost >25% of blood volume
Exchange transfusion
WHOLE BLOOD
- The term whole should be no longer used and is needed only in emergency .
- The storage defects of whole blood make it unsuitable for such replacement
The term used now is :
BLOOD COMPONENTS
Components are:
Those therapeutic constitutes
of blood that can be prepared by centrifugation .
Centrifuged blood
Buffy Coat
(WBCs & Platelets)
Red Blood Cells
Plasma/serum
Storage temp.
Plasma (freezer )
RBCs (refrigerator)
Platelets (agitator)
-18℃ or below
+2℃ to + 6℃
+22℃ to + 24℃
With continuous shaking
Types of Bags:
There are many types of blood bags to help in maintaining closed system throughout the separation procedures :
Single.
Double.
Triple.
Quadruple
Pedi bags.
Transfer bags with different capacities.
Red Blood Cells
Volume: 280 + 50 ml
Storage period: 21, 35, or 42 days depending on preservative or additive
Outcome Indicators: One unit increases hematocrit 3% and Hgb on average 1g/dL
Unit should be transfused within 4 hours
Once the unit is “opened” it has a 24 hour expiration date!
RBCs
Conditions include:
Oncology patients (chemo/radiation)
Trauma victims
Cardiac, orthopedic, and other surgery
End-stage renal disease
Premature infants
Sickle cell disease ( Hgb A)
Platelets
Volume: SDP = 200-300 ml
RP = 50-60 ml
Storage Temperature
20-24°C for 5 days (constant agitation)
Each therapeutic unit should contain at least 5.5 x 1010 platelets
Outcome Indicators :Each unit should elevate the platelet count by 5000 µL in a 70 Kg. person
Platelets
Important in maintaining hemostasis
Help stop bleeding and form a platelet plug (primary hemostasis)
People who need platelets:
Cancer patients
Bone marrow recipients
Postoperative bleeding
Preparation of platelet concentrate
RBCs PRP
Plasma
Platelet
concentrate
Fresh Frozen Plasma (FFP)
Prepared within 6 hours of whole blood.
Volume: 150 – 250 ml .
Storage period :Frozen at -18°C for one year thawed at bed side.
Indication :
- Multiple coagulation factors deficiency
- Massive transfusion
- liver dis.
- vit.K deficiency & DIC.
Fresh Frozen Plasma
FFP is thawed before transfusion
30-37°C waterbath for 30-45 minutes
Stored 1-6°C and transfused within 24 hours
Needs to be ABO compatible
Contains
V , VIII , XI
Von willbrand and fibrinogen , firbronectin
400 mgm fibrinogen /ml
Outcome Indicators
Prevention and/or cessation of bleeding
Frozen Plasma
* Plasma separated and frozen at –18 C between 8 and 24 hours,of collection.
* It contains all the stable proteins found in FFP plus minimal Factor VIII .
Indication: Bleeding associated with stable clotting factor deficiencies.
Cryoprecipitate
Volume: 20 – 30ml .
Storage period :Frozen at -18°C for one year
Contains: von Willebrand’s factor (plt. adhesion)
Fibrinogen 150 mg in each unit
Factor VIII About 80 IU in each unit
Fibrinonectin
FFP
Frozen
within 8
hours
Thawed
FFP
Cryoprecipitate
(VIII, vW)
Plasma cryoprecipitate, reduced
(TTP, FII, V, Vii, IX, X, XI)
Thaw at 30-37°C
Store at RT 4 hrs
Refrozen with 24 hrs of
separation
Store at ≤18°C 1 yr
5 day expiration at 1-6°C
Cryoprecipitate
Cryoprecipitate
Indication:
Factor VIII deficiency (Hemophilia A) von Willebrand’s Disease
Congenital or acquired fibrinogen defects Advanced liver disease Bleeding DIC Renal failure ( VWF ) Fibrinogen defects
Outcome Indicators
Cessation of bleeding
Fibrinogen level >100 mg/dL
Blood grouping and cross matching .
Screening of collected blood for infectious diseases .
In Egypt every blood donation is checked for:
- Hepatitis B surface antigen
- Hepatitis C virus antibody
- HIV 1+2
- Treponema pallidum antibody(syphilis)
Lab. Samples should be collected at the time of donation
Pretransfusion testing
ABO grouping /Rh typing /
Antibody screening / Antibody ID
ABO typing: direct agglutination by
IgM antibodies
Cells v Serum Serum v Cells
Forward and reverse grouping must agree !
Indirect antiglobulin test – gel
Collection of blood only from voluntary donors at low risk .
Screening of all donated blood for TT infections (HIV-HBV-HCV-SYPHILIS)
Avoid unnecessary transfusions.
This helps in decreasing the risk of transfusion transmitted infections
Strategy for blood safety
Under complete aseptic conditions.
Arm preparation:-
- should be done with care and ideally with vigorous scrubbing.
- The contact time of alcohol is 30 seconds.
- The application of alcohol must be in a spiral way, once at a time , or one way direction.
*Blood collection:
Never recap needles, recap using one hand technique.
Sharps , broken glass ware, lancets should be disposed in sharp box.
Any waste material contaminated with biological material must be packed safely in red bags.
Contaminated blood bags and expired blood bags to be disposed according to hospitals rules.
Dangerous waste disposal
Hygienic Practices
Protective clothing
(white coats and rubber gloves)
Regular change
Appropriate usage
Cover cuts and abrasions
No eating, drinking or smoking in work areas
Handwashing before and after handling donations, specimens, components.
Safe Disposal of Hazardous Waste
(1)
Types of waste
Non-hazardous: e.g. paper
Biohazardous: e.g. containing human material
Hazardous: e.g chemicals, sharp metal or glass, radioactive material
Proper separation of waste
Hazardous/non-hazardous
Sharps/non-sharps
Liquid/solid
Safe Disposal of Hazardous Waste
(2)
Appropriate disposal
Pre-treatment: e.g. autoclaving, disinfection, inactivation, neutralization
Incineration
Landfill
Using chlorine 1%
Procedures must be in place for the safe and effective disposal of waste