EXPERIMENT #12: BLOOD DONATION PROCESS

1. Describe importance of screening potential blood donors prior to blood collection.

Screening Donated Blood
Blood donors are asked a set of standard questions just before they donate blood to assist in determining
if they are in good health and free of any diseases that could be transmitted by blood transfusion. If the
donor’s answers indicate they are not well or are at risk for having a disease transmissible by blood
transfusion, they are not allowed to donate blood.
If the donor is eligible to donate, the donated blood is tested for blood type (ABO group) and Rh type
(positive or negative). This is to make sure that patients receive blood that matches their blood type.
Before transfusion, the blood is also tested for certain proteins (antibodies) that may cause problems in a
person receiving a blood transfusion.

All blood is tested for evidence of certain infectious disease pathogens, such as hepatitis B and C viruses
and human immunodeficiency virus (HIV). The tests used to screen donated blood are listed below:
o Infectious Disease Pathogen
o Laboratory Tests Used
o Bacterial Contamination
o Bacterial culture
o Hepatitis B virus (HBV)
o Hepatitis B surface antigen (HBsAg) detection
o Hepatitis B core antibody (anti-HBc) detection
o Hepatitis C virus (HCV)
o Hepatitis C virus antibody (anti-HCV) detection
o Nucleic acid amplification testing (NAT) for HCV
o Human Immunodeficiency virus Types 1 and 2 (HIV)
o HIV-1 and HIV-2 antibody (anti-HIV-1 and anti-HIV-2) detection
o Nucleic acid amplification testing (NAT) for HIV-1
o Human T-Lymphotropic Virus Types I and II (HTLV)
o HTLV-I and HTLV-II antibody (anti-HTLV-I and anti-HTLV-II) detection
o Treponema pallidum (syphilis)
o Anti-treponemal antibody detection
o West Nile virus (WNV)
o Nucleic acid amplification testing (NAT) for WNV

Transfusion Transmitted Diseases

o Hepatitis B
Hepatitis B virus (HBV) is transmitted through parenteral and sexual exposure. The incubation time is a
mean of 90 days with a range of 30 to 180 days.

Donor blood is routinely tested for HBsAg and HBcAb. There is no routine testing for hepatitis A,
because it is rarely transmitted by blood products.

Recipients of blood products can also be infected with hepatitis delta, which is a defective RNA virus that
needs a HBV superinfection to replicate.

Persons who have received a hepatitis B vaccination (recommended for all health care workers with
patient contact) will have hepatitis B surface antibody present, but not HBsAg or HBcAb

Risk of transmission (RT) = 1 in 200,000 to 500,000

o Hepatitis C

The route of transmission is parenteral, with sexual transmission lower than previously throught. The
mean incubation time is 6 to 8 weeks.

Blood Bank testing for HCV started in 1990. At present, only testing for hepatitis C antibody is available.

Risk of transmission (RT) = 1 in 1,000,000 to 2,000,000

o Human Immunodeficiency Virus (HIV)

In 1982 the first cases of AIDS obtained from blood or blood components were reported, but the etiology
of the infections was not known at that time.

By 1983 changes occurred in the donor cirteria to exclude those at high risk for transmission of HIV.

The first testing of blood products for HIV started in 1985 and is a test to detect the presence of antibody
directed against HIV. Testing for HIV p24 antigen was mandated in 1996.

Risk of transmission = 1 in 1,000,000 to to 2,000,000

Human T-lymphocytotrophic Virus (HTLV-I/II).

HTLV-1 is a retrovirus that is endemic in Japan and the Caribbean. Implicated as causing adult T-cell
leukemia/lymphoma and a neurological disorder similar to multiple sclerosis.

Blood is routinely screened for antibodies to HTLV-I.

Risk of transmission = 1 in 2,000,000 t0 3,000,000 (but only 1-3% of seropositive individuals will
develop disease).
 o Cytomegalovirus (CMV)

The prevalence of CMV antibody ranges from 50 to 80% of the population. Blood contaminated with
CMV can cause problems in neonates or immunocompromised patients.

Potential problems in selected patient populations can be prevented by transfusing CMV negative blood
or frozen, deglycerolized RBC's.

Donor blood is not routinely tested for CMV.

o Malaria

Malaria is rarely transmitted by RBC products, although the number of transfusion associated cases of
malaria is at an all-time high.

Donors traveling to high risk malaria areas are excluded from donating blood for six months. In areas of
high prevalence, an antibody test to detect Plasmodium falciparium and Plasmodium vivax can be
employed.

o Bacterial Contamination

Bacterial contamination of blood can occur during collection. Bacteria can grow during storage at room
temperature and during refrigeration (psychrophilic organisms). Platelet products carry the greatest risk (1
in 3000 units may have bacteria), because they are stored at room temperature. Transfusing a
contaminated unit may uncommonly result in severe sepsis (1 in 100,000), septic shock and death.

Others

Additional diseases which are rarely transmitted by blood products include:

o Lyme disease

o Dengue fever

o Babesiosis

o Creutzfeldt-Jakob disease

Potential donors may be screened by questionnaire regarding travel to endemic areas or contact with
persons at risk. Antibody tests available for all but babesiosis and CJD are available, preferentially
applied in regions of high prevalence.

REFERENCE: http://library.med.utah.edu/WebPath/TUTORIAL/BLDBANK/BBTEST.html
 http://www.cdc.gov/bloodsafety/basics.html
RESEARCHER: HINSON, Kristine

2. Describe the law in the Philippines that has provisions about voluntary blood donation.
REPUBLIC ACT NO. 7719

AN ACT PROMOTING VOLUNTARY BLOOD DONATION, PROVIDING FOR AN ADEQUATE

SUPPLY OF SAFE BLOOD, REGULATING BLOOD BANKS, AND PROVIDING PENALTIES FOR
VIOLATION THEREOF

Republic Act No. 7719, also known as the National Blood Services Act of 1994, promotes
voluntary blood donation to provide sufficient supply of safe blood and to regulate blood banks. This act
aims to inculcate public awareness that blood donation is a humanitarian act. In tripartite cooperation with
the Department of Health and the Philippine Blood Coordination Council, the Philippine Red Cross
(PRC) is one of the key organizations tasked to provide safe blood to the country through its active role in
advocacy, promotion of voluntary blood donation, donor retention and care and the operation of a
network of 74 Blood Service Facilities all over the country.

The National Voluntary Blood Services Program (NVBSP) of the Department of Health is targeting
the youth as volunteers in its blood donation program this year. In accordance with RA No. 7719, it aims
to create public consciousness on the importance of blood donation in saving the lives of millions of
Filipinos.
Blood Collection

In line with mandate of the Philippine Red Cross, the organization shall provide blood assistance to
both rich and less fortunate clients. Safe and quality blood carries costs that most indigent patient cannot
afford. And though blood itself is free, collecting and processing of one (1) unit of safe and quality whole
blood costs P 1,500.00. The PRC operates a Blood Samaritan Program. This means that in cases when the
hospital could not meet the blood requirements of a patient due to the inability of the patient to pay,
patients will be assisted by this Red Cross project.

PRC Blood Samaritan Project is aimed mainly at assisting indigent patients needing blood transfusion.
The Philippine Red Cross seeks kind-hearted agencies that are willing to give financial donations to
support the health care needs, specifically the blood requirements of charity patients. Likewise,
individuals can donate money to cover the payment of blood processing fees of legitimate indigent
patients.

Blood Testing

To ensure that the blood we collect is safe for transfusion, we perform blood tests for Malaria,
Syphilis, Hepatitis B & C, Human Immunodeficiency Virus (HIV) and Blood Typing (both ABO and Rh
typing). All blood units found reactive or positive in any of the abovementioned transfusion-transmitted
infections are quarantined and retested. Blood units found reactive twice are labeled "not for transfusion-
for confirmatory testing," quarantined and then sent within 48 hours to appropriate center for
confirmatory testing.

Blood Component Processing

Some of the PRC Blood Centers have facilities that separate blood into components using special
equipment called refrigerated centrifuge. Thus, when you donate blood, you help save 3 lives.

REFERENCES:
http://www.gov.ph/1994/05/05/republic-act-no-7719/
http://www.doh.gov.ph/blood-donation-program
RESEARCHER:
LOMEREZ, Rassel, S.
3. Enumerate factors to be considered during blood collection from the donor? Such as the
equipment, site of collection, donor care, etc.
Collection of Blood
 Materials used are sterile and single use.
 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
 Use 16-17 gauge needle to collect blood from a single venipuncture within 15 minutes
 Collect 450 +/- 45 mLs of blood
Donor Reactions
 Syncope (fainting)
 Remove needle immediately
 Hyperventilation
 Have donor rebreathe into paper bag.
 Nausea/vomiting
 Twitching/muscle spasms
 Hematoma
 Convulsions – rare, get immediate assistance
 Cardiac difficulties
Post-Phlebotomy Care
 Donor applies pressure for 5 minutes
 Check and bandage site
 Have donor sit up for few minutes
 Have donor report to refreshment area for additional 15 minutes of monitoring
Testing Donor Blood
 CANNOT rely on previous testing
 Records must be kept for 5 years

REFERENCE:
https://www.google.com.ph/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0ahUKEwijwML854zQAhXEpJQKHamGA-
sQFggyMAQ&url=http%3A%2F%2Fwww2.austin.cc.tx.us%2Fkotrla
%2FBBDonorBloodCollection.ppt&usg=AFQjCNHvnh2BffjY11mswJ369-
0vImNMhg&bvm=bv.137901846,bs.2,d.dGc
RESEARCHER: RUBY PAGKANLUNGAN

4. Enumerate and briefly describe the different types of blood donation.

 WHOLE BLOOD DONATIONS
The most common type of blood donation is whole blood where one unit of blood is taken from a donor.
The donation is called “whole blood” because the blood is taken in its entirety, for separation into its
component parts later in the lab. This donation process takes about one hour from the time the donor
comes in to the time the donor is ready to leave. The donation itself takes only 10 to 15 minutes. Whole
blood donations can be performed every 56 days.
 AUTOMATED DONATIONS
 PLATELETS
Platelets help the blood clot, and are used primarily in cancer patients, heart surgery, and massive
bleeding such as trauma. Because certain medications interfere with platelet function, platelet donors
must not be taking aspirin or other medications that affect platelets.

 RED BLOOD CELLS

Automated donation can allow one or two units of red blood cells to be collected at one sitting. To qualify
for double red cell donation, donors must meet special criteria including higher hemoglobin/hematocrit.
Double red cell donation can only be done once every 112 days or more. Double red cell donation is ideal
for donors who want to minimize their trips to the blood center and who are blood type O.

 PLASMA
Plasma is the liquid part of the blood. It is transfused to replace clotting factors in trauma patients and
other large volume transfusions, liver disease and burn victims. Automated donation allows collection of
a larger amount of plasma from one donor at one sitting than whole blood donation. This is particularly
good for donors of type AB, which is the universal donor for plasma. Plasma can be donated every 4
weeks or more.

 GRANULOCYTES
Granulocytes are only collected upon a physician’s request for a specific patient need. The donor and
patient blood types must match, and the granulocyte cannot be stored but must be transfused immediately.
Therefore, interested donors will be called and scheduled for a granulocyte donation when the need arises.
Donors must also get a red cell settling medication called hydroxyethyl starch, or HES to help the red
blood cells separate from the white blood cells.
Granulocytes are life-saving for patients with poor bone marrow function after cancer treatment or
transplantation or patients with certain blood disorders that cause poor white blood cell function. A course
of daily transfusion for at least 3 to 5 days is generally needed for treatment of bacterial infection in these
patients.
  SOURCE PLASMA
Source plasma is a special type of plasma donation by automated collection which will be made into
blood derivatives which are used to treat many diseases. Depending on the size and blood count of the
donor, 400 to 800 ml of plasma will be retained, and the blood cells returned to the donor. Donation is
limited to once every 4 weeks or longer to protect the protein-making ability of the body. The donation
will take about 20 minutes for screening and about 40 minutes for the actual donation, although times
may vary somewhat depending on the individual.

 SPECIAL DONATIONS
 AUTOLOGOUS DONATIONS
Donation of your own blood (usually red blood cells) prior to planned (non-emergency) surgery is
available with the request of your physician. Donations must be made within a specific time frame (no
less than 5 days and no more than 30 days prior to surgery). Donations must be scheduled in advance at
donor center sites.
 DIRECTED DONATIONS
Directed donation is a friend or family member that is approved to donate for a specific patient. If the
blood type is compatible, the unit will be reserved for that patient. Directed donations require the
approval of the patient’s physician and the patient must approve the names of the directed donors.
 THERAPEUTIC DONATION
Some individuals require withdrawal of blood for treatment of a medical condition. It is for persons with
hereditary hemochromatosis or high blood counts due to testosterone therapy. The individual can qualify
for blood withdrawal at no charge and possible use of the units for patient transfusion, if the donor has no
disqualifying health history.

REFERENCE: Retrieved from Carter Blood Care (2016). Types of donations.

http://www.carterbloodcare.org/blood-facts/types-of-donations/
RESEARCHER: RUBY GRAIL NABUS

5. Describe and discuss the significance of performing component preparation.

1. Whole Blood (WB)
a. Clinical indications for use of WB are extremely limited.
b. Used for massive transfusion to correct acute hypovolemia such as in trauma and shock.
c. Rarely used today, platelets non-functional, labile coagulation factors gone.
d. Must be ABO identical due to ABO antibodies present in plasma.

2. Red Blood Cells (RBCs)

a. Used to treat symptomatic anemia and routine blood loss during surgery
b. Hematocrit is approximately 80% for non-additive (CPD), 60% for additive (ADSOL). c. Allow WB to
sediment or centrifuge WB, remove supernatant plasma.

3. Red Blood Cells Leukocyte Reduced

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

4. Washed Red Blood Cells (W-RBCs)

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

e. Expires 24 hours after unit is entered.

5. Frozen Red Blood Cells; Deglycerolized Red Blood Cells (D-RBC)

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

e. Deglycerolization of donor unit, removal of glycerol.

1) Thaw unit at 37C, thawed RBCs will have high concentration of glycerol.
2) A solution of glycerol of lesser concentration of the original glycerol is added.
3) This causes glycerol to come out of the red blood cells slowly to prevent hemolysis of the RBCs.
4) After a period of equilibration the unit is spun, the solution is removed and a solution with a lower
glycerol concentration is added.
5) This procedure is repeated until all glycerol is removed, more steps are required for the high glycerol
stored units.
6) The unit is then washed
6. Rejuvenated Red Blood Cells
a. 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.
b. Rejuvenated RBCs regain normal characteristics of oxygen transport and delivery and improved post
transfusion survival.
c. Expiration is 24 hours or, if frozen, 10 years.

7. Platelets (PLTS)
a. Used to prevent spontaneous bleeding or stop established bleeding in thrombocytopenic
patients.
b. Prepared from a single unit of whole blood.
c. Due to storage at RT it is the most likely component to be contaminated with bacteria. d.
Therapeutic dose for adults is 6 to 10 units.
e. Some patients become "refractory" to platelet therapy.
f. Expiration is 5 days as a single unit, 4 hours if pooled.
g. Store at 20-24 C (RT) with constant agitation.
h. D negative patients should be transfused with D negative platelets due to the presence of a
small number of RBCs.

8. Apheresis Platelet Concentrate

a. Used to decrease donor exposure, to obtain HLA matched platelets for patients who are
refractory to RD-PC or prevent platelet refractoriness from occurring.
b. Prepared by hemapheresis.
c. One pheresed unit is equivalent to 5-6 RD-PC.
d. Store at 20-24 C (RT) with agitation for 5 days. NOTE: FDA considering extension to 7 days
if bacterial contamination identification is used.
e. D negative patients should be transfused with D negative platelets due to the presence of a
small number of RBCs

9. Granulocytes
a. Primary use is for patients with neutropenia who have gram negative infections documented
by culture, but are unresponsive to antibiotics.
b. Therapeutic efficacy and indications for granulocyte transfusions are not well defined. c.
Better antimicrobial agents and use of granulocyte and macrophage colony stimulating factors
best for adults, best success with this component has been with babies d. Daily transfusions are
necessary.
d. Prepared by hemapheresis.
e. Expiration time is 24 hours but best to infuse ASAP.
f. Store at 20-24 C.

REFERENCE: Retrieved from http://www.austincc.edu/mlt/bb/bblect2componentsSp11.pdf on

November 2, 2016
RESEARCHER: AIRA VALDEZ