Terry Kotrla, MS, MT(ASCP)BBMLAB 2431 Immunohematology

Unit 1 Part 2 Blood Collection

Blood Collection

Collection of BloodCollection performed by well trained

personnel.Materials used are FDA approved sterile

and single use.Donor identification critical

Identify donor record with donorAttach numbered labelsLabel processing tubesFinal recheck before leaving donor

Preparing SiteInspect BOTH arms for signs of IV drug abuse.Select large firm vein in area free of scarring or

skin lesions.Vein selection priority same as for routine

phlebotomy.Most important step is preparing the site to a

state of almost surgical cleanliness.Bacteria on skin, if present, may grow well in

stored donor blood and cause a fatal sepsis in recipient

Blood CollectionGloves are optional, OSHA provides specific

exemption for drawing volunteer donors.Gloves should be worn:

By personnel in trainingCollecting autologous unitsIf employee has cuts, scratches or breaks in skin.

Use 16-17 gauge needle to collect blood from a single venipuncture within 10 minutes.

First 30 to 45 mLs of blood diverted to pouch to collect skin plug.

Mix blood bag frequently or use shaker.Collect 450 or 500 mLs +/- 10% of blood

Blood Collection System

Donor ReactionsSyncope (fainting)

Remove needle immediatelyHyperventilation

Have donor rebreathe into paper bag.Nausea/vomitingTwitching/muscle spasmsHematomaUpper extremity deep vein thrombosisConvulsions – rare, get immediate

assistanceCardiac difficulties – get emergency careRecord ANY donor reactions

Post-Phlebotomy CareDonor applies pressure for 5 minutes with

arm elevated.Check and bandage siteHave donor sit up for few minutesHave donor report to refreshment area for

additional 15 minutes of monitoring

Post-Phlebotomy InstructionsEat/drink before leavingWait until staff releases youDrink more fluids next 4 hoursNo alcohol until after eatingRefrain from smoking for 30 minutes.If bleeding continues apply pressure and raise

armFaint or dizzy sit with head between kneesAbnormal symptoms persist contact blood

center.Cautions about returning to work.Let them know when to remove bandage

Post-Phlebotomy InstructionsIn canteen provide donor refreshments and

watch for signs of a reaction.Provide phone number for donor to call if:

bleeding recursfeels donated unit should not be usedhas any type of reaction.experiences signs or symptoms of infection.

THANK DONOR

Processing Donor BloodAll reagents used for testing must meet or

exceed appropriate FDA regulations.CANNOT rely on previous testingResults recorded immediately.Record system to track unit to final

disposition.Records must be retrievable.Records must be kept for 5 years OR 6 months

after product expires.

General ConsiderationsNumbers on blood bag, processing

tubes and donor records should be rechecked prior to processing.

ABO group and D type, including weak DDonor with history of transfusion or

pregnancy should be tested for unexpected antibodies.

Serological TestingABO/D typingAntibody Screen – if positive, ID antibody,

cannot make plasma productsAntibodies to other blood group antigens

which are present in the donor may react with recipient red cells resulting in a reaction.

Infectious Disease Testing MethodsELISA to detect antigens or antibodiesChemiluminescent to detect antigens or

antibodiesDetection of syphilis antibodies by RPRNucleic Acid Test (NAT) detects viral nucleic

acids, much more sensitive, reduces window periodHIV from 22 to 12 daysHCV from 70 to 10-14 days

Antigen, antibody and NAT testing will allow positive results through out disease process.

Disease Testing

Disease testing include: Dectection of bacteriaHBsAG Anti-HBcAnti-HCVAnti-HIV 1&2Anti-HTLV I/IIRPRChagas disease

antibodiesNAT for

HIV-1, HCV WNV

Results of TestingTests for disease markers must be negative

or within normal limits.Donor blood which falls outside these

parameters must be quarrantined.Repeat testing, if still abnormal must

dispose.

Optional TestsCMV testing

CMV devastating to premature infants and immunocompromised

Removing leukocytes greatly reduces risk.Some physicians still request CMV negative for

select patientsSpecial antigen typing

Patients may develop antibodies against other RBC antigens.

Test donors to find antigen negativeSickle cell testing

Exchange transfusionSickle trait may sickle in neonates

Labeling Donor Units Component name Unique donor number ABO group, D type (not required for plasma) Interpretation of tests Type and volume of anticoagulant. Storage temperature Expiration date Name/address of collecting facility Reference to Circular of Information -

http://www.aabb.org/Content/About_Blood/Circulars_of_Information/

Donor classification Results of testing Essential instructions Pooled component information

Transfusion Service TestingThe only repeat testing required is:

ABO on red cell productsD typing (IS) on D negative red cell products

Plasma products (FFP, CRYO, PLTS) do not require any testing.

Donor samples must be stored at 1-6C for at least 7 days after transfusionADSOL unit transfused today must save sprig for 7

days post-transfusion.Many facilities will pull a sprig from each donor during

processing and save all sprigs for 49 days, regardless of expiration of unit

Red Cell Unit With Sprigs

Summary Blood collection starts with screening of the donor to:

Ensure they are healthy enough to donateEnsure they do not have transmissible diseases

Many organizations involved in setting standards and monitoring all aspects of blood collection and administration.

Collection of blood must be done in such a manner as to ensure sterility of the component.

Testing of donor blood includes serological testing for ABO/D typing, antibody screening and testing for infectious disease markers.

The blood supply is NOT safe, only careful screening and testing can prevent, as much as possible, disease transmission.

ReferencesAABB Technical Manual 16th editionhttp://www.fda.gov/cber/dhq/dhq.htm