Guidelines For Blood Transfusion Service

2nd Edition
Department of Medical Services

Ministry of Health and Sports
Myanmar
2018 (2nd Printing)

Guidelines for
Blood Transfusion
Service
2nd Edition
2018
2nd Time Printing

FOREWORD
This book includes two parts, one as a guideline for administrative tasks to be
undertaken in transfusion services and the other as a technical manual for handling and usage
of blood components. The first part of this guideline is systematic approaches towards efficient
functioning of the transfusion service, where clerical and statistical priorities turn out first. The
second portion, on the other hand, is a set of instructions to which all levels of professional
health staffs involved in the transfusion service; pathologists, clinicians, medical officers, house
officers, nurses and medical technologists; should take a careful notice of.
The patient should be, and by all means, is the center of medical practice. Transfusion
of blood and blood components has nowadays become an integral portion of clinical
management. Thus, the pros and cons of the era become the focus of attention. Whether one
should make decisions and take relevant responsibility to use transfusion services as a part of
clinical routine has become a true burden upon our shoulders. Often specialist consultation is
desirable, but where this is not one of the options, the clinician is vested the power of ultimate
authority. Thus, transfusions are undertaken, and thence, problems concerning that part of the
practice arise. This manual, as a special guideline, attempts to answer most questions which
arise from this quarter of the realm, and tries to provide effective solutions towards safe and
successful usage of the transfusion service.
Cooperation at all levels of health organization is the key to success in contemplating

the guidance laid down in this manual. Not only the clinicians but also the pathologists in
charge of the transfusion services, the administrators who take care of everyday needs of the
hospital, the junior medical officers and interns, the nurses, the medical technologists and
medical laboratory technicians are all responsible for the overall success of Blood Transfusion
Service including both patient safety and donor safety. It is hoped that this manual, in other
words, a hand book of transfusion services, shall pave way towards safe and successful use of
transfusion therapy at all levels of professional health care in this country.
Department of Medical Services

Ministry of Health and Sports
Myanmar
[i]
[ii]
Abbreviation
SOP - Standard Operating Procedure

WI - Work Instruction
WB - Whole Blood
PC - Pack Red Cell
FB - Fresh Blood
PRP - Platelet Rich Plasma
Plt Con - Platelet Concentrate
FFP - Fresh Frozen Plasma
Cryo - Cryoprecipitate
SDP - Single Donor Platelet
BTS - Blood Transfusion Service
PO - Per Oral
IV - Intravenous
IM - Intramuscular
BP - Blood Pressure
NS - Normal Saline
PT - Prothrombin Time
APTT - Activated Partial Thromboplastin Time
C&S - Culture and Sensitivity
HR - Heart Rate
T - Temperature
RR - Respiratory Rate
ARDS - Acute Respiratory Distress Syndrome
DIC - Disseminated Intravascular Coagulation
TRALI - Transfusion Related Acute Lung Injury
FNHTR - Febrile Non-Hemolytic Transfusion Reaction
GVHD - Graft Versus Host Disease
Ab - Antibody
HLA - Human Leucocyte Antigen
AHG - Anti-Human Globulin
PPP - Platelet Poor Plasma
[iii]
Contents
Foreword ……………………………………………….……………………………………………………………………………………..i
Abbreviation……………………………………………………….…………………………………………………….…………………..iii
Part I Guidelines and SOP for Administrative Tasks and Routine Procedures of Blood
Transfusion Services
Chapter (1) The Blood Transfusion Service…………………………………………………………………………………….3
Chapter (2) Pre – donation…………………………………………………………………………………………………………….5

2.1 Candidate Selection..…………………………………………………………………………………………………………5
2.1.1. Candidacy…………………………………………………………………………………………………………….5
2.1.2. Selection သွေးလှူရှင်စိစစ်ရွေးချယ်ခင
ြ ်း………………………………………………………………….5
2.2 Registration of Blood Donors……………………………………………………………………………………………11
Chapter (3) Donation…………………………………………………………………………………………………………………….18

3.1 Procedure for Collection of Blood…………………………………………………………………………………….18
3.2 Instruction for Care of the Donor during and Immediately after Donation……………………….24
Chapter (4) Post-Donation…………………………………………………………………………………………………………….26

4.1 Labeling of Collected Blood Packs…………………………………………………………………………………….26
4.2 Blood Group Serology Testing…………………………………………………………………………………..……..26
Work Instruction for ABO Grouping…………………….…………………………………………………………..27
Work Instruction for Rh (D) Grouping……………………………………………………………………………..30
Work Instruction for Compatibility Testing……………………………………………………………………..32
4.3. Infection Screening…………………………………………………………………………………………………………..36
4.4 Preparation and Systematic Storage of Blood and Blood Components……………………………37
1. Preparation of Red Cell Component…………………………………………………………………………….38
2. Preparation of Fresh Frozen Plasma (FFP) …………………………………………………………………..38
3. Preparation of platelets from Whole Blood………………………………………………………………….39
4. Preparation of Cryoprecipitate……………………………………………………………………………………..40
Chapter (5) Waste disposal…………………………………………………………………………………………………………..41
Chapter (6) Monitoring and Evaluation………………………………………………………………………………………...41

လစဉ်ပေးပို့ရမည့် အချက်အလက်များ…………………………………………….…………………………………...42
Form (5) …………………………………………………………………………………………………….……………..………43
Chapter (7) The needs for organized setup in transfusion service…………..……………………………………48

Part II Guidelines for Handling and Usage of Blood Components
Introduction…………………………………………………………………………………………………………………………………51
Principles of Clinical Transfusion Practice……………………………………………………………………………………51
Section (A) Component Therapy…………………………………………………………………………………………………52

1. Red Cell Components………………………………………………………………………………………………………………52
1.1 Types of Red Cell Components………………………………………………………………………………….52
1.1.1. Whole Blood………………………………………………………………………………………….52
1.1.2. Red Cells Suspended in Optimal Additive Solutions………………………………53
1.1.3. Red Cell Packs for Pediatric Use…………………………………………………………….53
1.1.4. Leukocyte Poor Red Cells…………………………………………………………………………54
1.1.5. Washed Red Cells………………………………………………………………………………….54
1.1.6. Frozen-Thawed-Deglycerolized-Red Cells………………………………………………54
1.2. General Guidelines for preparation of Red Cell Components……………………………………54
1.3. Indication for Red Cell Transfusion…………………………………………………………………………..55
1.3.1. Red Cell Transfusion In Active Bleeding……………………………………………………56
1.3.2 Red Cell Transfusion in Peri-Operative Setting…………………………………………..57
1.3.3. Red Cell Transfusion In Anaemia………………………………………………………………58
2. Platelet Concentrates……………………………………………………………………………………………………………..61
2.1 Types…………………………………………………………………………………………………………………………61
2.1.1 Random Donor Platelets……………………………………………………………………………61
2.1.2 Single Donor Platelets……………………………………………………………………………….61
2.2 General Consideration for Platelet Transfusion………………………………………………………..62
3. Granulocytes…………………………………………………………………………………………………………………………..64
4. CMV- sero negative Blood Component…………………………………………………………………………………..64
5. Irradiated Blood Components…………………………………………………………………………………………………65
6. Fresh Frozen Plasma…………………………………………………………………………….…………………………………66
7. Cryoprecipitate……………………………………………………………………………………………………………………….69
8. Factor Concentrate…………………………………………………………………………………………………………………70
Section (B) Transfusion Practice ………………………………………………………………………………………………..73

1. Ensuring Compatibility (Pretransfusion practice) ………………………………………………………………….73
1.1 Taking Blood Samples from Patient for Compatibility Test…………………………………73
1.2 Laboratory Tests………………………………………………………………………………………………..73
1.3 Transfusing infants……………………………………………………………………………………………74
1.4 Final identity check prior to transfusion…………………………………………………………………74
2. Administration of blood transfusion………………………………………………………………………………………74
2.1 Key Principles of Safe Blood Administration……………………………………………………………..74
2.1.1. Patient Identification……………………………………………………………………………….75
2.1.2. Documentation……………………………………………………………………………………….75
2.1.3. Communication………………………………………………………………………………………75
3. Administration of Blood Components…………………………………………………………………………………..75
3.1. Patient Information and Consent……………………………………………………………………………76
3.2. Prescription and Request……………………………………………………………………………………….76
3.3. Pre-transfusion blood sample collect-ion (Pre-transfusion Testing) ………………………76
3.4. Collection and Delivery of Blood Compo-nent to the Clinical Area…………………………77
3.5. Administering Blood………………………………………………………………………………………………77
3.6. Monitoring during transfusion………………………………………………………………………………78
3.7 Completion of Transfusion episode and Record Keeping………………………………………..78
DON'T FOR BLOOD TRANSFUSION……………………………………………………………………….……….78
3.8. Adverse Reactions to Transfusion………………………………………………………………………….79
Figure: An approach to diagnosing the type of likely transfusion related adverse event………….80
Figure: An approach to diagnosing the type of likely transfusion related adverse event………….81
Categories and management of acute and delayed adverse reactions to transfusion……………...82
References………………………………………………………………………………………………………………………………87
Consent Form (Myanmar) ……………………………………………………………………………………………………..88
Blood Request Form………………………………………………………………………………………………………………89
Blood Issue Form………………………………………………………………………………………………………………….. 90
Points to Remember………………………………………………………………………………………………………………91
Lists of Experts …………………………………………………………………………………………………………..………….92
Part I
Guidelines and SOP for
Administrative Tasks and Routine Procedures of
Blood Transfusion Services

Guidelines and SOP for Administrative Tasks and Routine Procedures of Blood Transfusion Service | 2
Chapter (1)
The Blood Transfusion Service
Blood Transfusion is a procedure whereby blood or its specific components, whether

they are red cells, white cells, plasma or clotting factors, are infused into the vascular system
for the replacement of loss from the body. Blood is lost from body due to physiology,
disease or clinical procedures such as surgical operations. Not all diseases bleed, and not all
bleed need replacement. But whether there is requirement for it is a matter of prime
importance, and this part of the management is to be taken care of by the attending
clinicians plus a consultant specialist with proper knowledge in transfusion medicine.
The blood transfusion service, or in simple terms, the blood bank, is a place where
blood is collected, stored, processed, and issued whenever there is need for it. Pathologists,
medical technologists, medical laboratory technicians, the general staffs and other trained
personnel as necessary formed the core work force of the blood bank. Virtually, all clinical
departments are potential customers to the blood banks. The blood is a renewable resource
produced by the human species. By theory, all resources have limitation. It is the art of
logistics, which dictates where, when, how and why these scarce resources should be
allocated. It is known as “management”. The blood transfusion service manages the
distribution and use of blood and blood components according to requirements.
The need for transfusion is decided by the clinician and evaluated whenever
necessary by the transfusion specialist. The primary function of the blood bank is to first
select eligible donors, and then to collect blood by standard procedures as required. Then,
the blood is tested for serologic grouping, screened for infections and afterwards, processed
into specific components. These blood and blood components are stored at optimal
conditions for future use. Emergency requirements are met with by such strategies as
keeping an archive of legible donors or encouraging mass donations whenever possible.
Wastage is kept to a minimum and the quality of the service is regularly evaluated by
specially designed programs. In this way, the functioning of the blood transfusion service is
aligned with overall capacity of the hospital or hospitals within its schedule.
The blood bank is run by officers who are trained in the field of transfusion medicine.
In this country, it is headed by a pathologist. Under the pathologist are junior medical
officers, medical technologists, medical laboratory technician and other levels of clerical staff.
The pathologist has a responsibility to liaise administrative, technical and public
relations/sectors of the service to ensure its standard and efficiency of work. Other members
of the transfusion service contribute to fulfill this overall purpose of the transfusion service.
With proper documentation and logical reason, the blood transfusion service accepts
requisitions from various departments of the hospital and fulfills their needs using all
resources available. With an efficient blood transfusion service functioning, many problems
including shortages and transfusion-associated infections can be minimized. Therefore, it is
very important that blood transfusion services be provided with all that is necessary,
manpower, finance, and technology. And to have it properly and efficiently functioning, all
levels of procedures must be done by sets of strict and systematic methods, and also must
be evaluated routinely according to service policies. Mistakes cannot be allowed. Harm to
patients is not tolerated by anyone. Thus, all members of service should work by strict ethical
and technical rules.
One other important part of the transfusion service is the social service. Social
counsel is required when there are problems such as identified infectious disease of the
donor or communication problems. A medical social officer is appointed to the National
Blood Center for this purpose down to the township blood bank. When this is not possible,
the medical officers are to take over this duty. Also, the clerical staff and the nursing staff
should be properly trained for public relations since those in direct contact with the
customers will have to lace most of the problems.
In conclusion, a maximally effective transfusion service is a very important integral
component of a functioning hospital, and therefore the quality of the service should be kept
to its best by all efforts as necessary. Technologists, technicians and clerical staffs alike are as
responsible as their superiors, the medical officers, for safety and wellbeing of the patients.
Thus, all things must be done according to strict sets of instructions and standardized
procedures. By reducing all possible chances of error and by adjusting the capacity of the
service in accordance with the situation, the blood transfusion services will be always
dependable and trustworthy partners of the clinical authorities.
Chapter (2)
Pre - donation
The primary function of the blood bank begins when blood is collected from a
chosen donor at an appropriate time. However, since standardized procedures are to be
followed, things must be done stepwise in the following manner.
2.1 Candidate Selection

2.1.1. Candidacy
Virtually all living humans are potential candidates for blood donation. However, it is
practically not possible to extract blood from every human being since it would be
inappropriate and unethical to just let blood be transfused and turn a blind eye to its
potential hazards. Patients must be protected from harm in the process. Thus, lists of
potential candidates presented to the transfusion service must be carefully filtered down
through in order to achieve a clean healthy blood pool fit for transfusion. The following
routine must be exactly followed to achieve that goal.
2.1.2. Selection သ ွေးလှူရှငစ

် စ
ိ စ်သ ွေးချယ်ခခင်ွေး
ည် ယ်ချက်
သ ွေးလှူရှငန
် င
ှ ်သ ွေး င်ွေးခံရမည် လူနာတက
ို ို အနတရာယ် မဖြစ်သစရန်။
Procedure
A selection of donors from a compiled list of candidates must be assessed to approve
fitness for donation. This is a job of the medical officers. The process, like in clinical practice,
will include the following components.
(1) History
(2) Physical examination
(3) Laboratory investigations
Collection of blood will be described in detail in chapter (3). Stages prior to it will be
discussed here.
(1) History
Taking a background medial history is important since it would be the first filter sieve
prior to actual donation. This must be carried out by medical officers using specific
guidelines. Certain rules shall apply.
Background medical history

A. Conditions leading to permanent deferral
• Malignant disease (? CIN, rodent ulcer)
• Diabetes in requirement of insulin therapy
• Injectable drug abuse
• Cardiovascular diseases (coronary heart disease, severe arrhythmias, when there is
history of CVA, arterial thrombosis, recurrent venous thrombosis)
• Infections especially carriers of HIV, HBV, HCV and Leishmaniasis
• Known cases of primary polycythemia
B. Conditions leading to temporary deferral (suspension)

• Endoscopy with biopsy, acupuncture, tattooing or body piercing (an interval of 12
months from the time of the procedure must pass before coming for donation)
• Epilepsy (3 years off treatment and without an attack)
• In case of fever (>38° C) and flulike illnesses, until after 2 weeks following
cessation of symptoms
• In case of kidney disease, AGN, until 5 years after complete recovery
• Medication (depends on underlying disease, drugs with teratogenic effect)
• In case of osteomyelitis, until 2 years after cure
• In case of rheumatic fever until 2 years after attack, without chronic heart disease
• Until 6 months after major surgery, and one week after minor surgery without any
complications
• Until 12 months after transfusion of blood & blood products
C. Immunization
• Vaccines with live attenuated bacteria/viruses (BCG, Yellow fever, Rubella,
Measles, Poliomyelitis (oral vaccine), Mumps, Live attenuated Typhoid fever
vaccine, LA cholera vaccine), until 4 weeks after immunization
• Vaccines with killed bacteria (Cholera, Typhoid); accept for donation if the donor
is healthy
• Vaccines with inactivated virus (Poliomyelitis (injection), Influenza); accept for
donation if the donor is healthy
• Toxoids (DPT) ; accept for donation if the donor is healthy
• Others; in case of Hepatitis A vaccine, accept for donation if the donor is healthy
and without exposure; in case of Hepatitis B vaccine, accept for donation if the
donor is healthy and the vaccine is made of recombinant technology, but an
interval of 12 months is required if the vaccine is plasma-derived
D. Conditions requiring individual assessment

• Permanent deferral if documented history of anaphylaxis
• Permanent deferral if there is autoimmune disease
• Thalassemia trait can be accepted if heterozygote carrier and if he or she is in
good health, and Hb % within accepted values
• Symptomatic bronchitis should not be accepted
• Accept common cold if the donor feels well at the day of donation
• Mild hypertension with diastolic pressure < 100 mmHg can be accepted
• For infectious disease (other than HIV, HBV & HCV), wait until 2 weeks after
cessation of symptoms
E. Infections
• In case of jaundice and hepatitis, if HBs Ag and HCV Ab tested negative, the
donor should be accepted. However, Hepatitis B vaccine can give false positive
results for HBs Ag.
• Presence of anti-HBs Ab is not a factor for deferral
• Close household contacts with hepatitis B patients take one year to develop
immunity.
• Reported cases of post-transfusion hepatitis should be investigated by a look-
back study
• Sexual partners of HBV positive patients should be deferred unless they are
immunized. For previous partners, must wait 12 months.
F. Malaria
• The individual can be accepted if symptom-free period of 3 years has passed after
returning from endemic area without Antibody testing
• All persons who have visited endemic areas without a febrile episode can be
accepted 6 months after returning
• All persons who have visited endemic areas with febrile episodes can be accepted
6 months after returning when Antibody results are negative
• If approved antibody test is not available, the individuals who are from endemic
areas may be accepted as a blood donor if a symptom-free period of a minimum
of 3 years has passed
• An individual with history of malaria must be deferred until he or she has become
asymptomatic, after which he or she should donate only plasma for the first 3
years. He or she should donate red cells only after tests become negative.
• If the individual gives a history suggestive of malaria or if he or she has been to
an endemic area within the past 6 months, ICT malaria test is advisable.
G. Drugs
Accept donors with history of taking;
• Tetracycline and other antibiotics for treatment of acne
• Topical steroid preparations for skin lesions (if not at venipuncture site)
• Blood pressure medication, if free from CVS symptoms
• Over-the-counter bronchodilators and decongestants
• Oral hypoglycemic agents in well-controlled diabetes without any vascular
complications - accept
• Tranquilizers if non-antipsychotic
• Hypnotics at bed time
• Alcohol (not currently under influence)
• Mild analgesics, Vitamins, Replacement hormones, Weight-reducing pills
Standardized and revised set of questionnaires which are required to be filled out by
the candidates is now available in all blood transfusion services of Myanmar. It encompasses
all health data to be assessed as described above.
(2) Physical examination
Before going through the process, particulars of the potential donors must be
checked out. Small leaflets of donor registration form are used in NBC. Age is to be filled out
in the form, and the rest is assessed by medial officers.
Donor details
A. Age
• A minimum of 18 years, maximum 60 years.
• Between 18 and 17, consent of parents or guardian must be taken.
• If over 60 years of age, fitness for donation will be decided by the physician.
B. Body weight
Individuals are weighed before going through selection process. Minimum limits of
weights required for donation are as follows.
• For male donors, minimum limit is 110 lb
• For female donors, minimum limit is 100 lb
C. Blood pressure
This is assessed by medical officers. Variations between 180/100 mmHg and 100/60
mmHg can be accepted.
D. Hazardous occupations
For those of the profession described below, a time interval of at least 12 hours must
be taken before returning to work.
• Aircraft piloting
• Bus/Train driving
• Crane/Bulldozer operation
• Climbing heights (ladders, scaffoldings)
• Gliding
• Diving esp. deep-sea dive
E. Special considerations
Pregnancy, lactation and bleeding phase of menstruation shall be factors for deferral.
That part of the questionnaire that concerns these details are for women only.
F. Physical status of the candidate
The following are to be searched for and filtered out by the medical officer in
performing physical examination.
• Plethora
• Debilitation
• Emaciated appearance
• Pallor
• Jaundice
• Cyanotic color
• Mental instability
• Intoxication (alcohol, drugs etc.)
(3) Laboratory investigation

A. Haemoglobin concentration
Haemogloblin status of the potential donor is to be assessed.
• Minimum limit for male donors will be 12 gm/dL
• Minimum limit for female donors will be 11.5 gm/dL
2.2 Registration of Blood Donors
(က) သ ွေးလှူဘဏ် ို သ ွေးလှူဒါန်ွေးရန် လာသရာက် ူမ ာွေးအာွေးလံိုွေး၏ ကယ
ို ်သရွေးအခ က်အလက်
မ ာွေးနင
ှ က
် န်ွေးမာ သရွေးဆိုငရ
် ာအခ က်အလက်မ ာွေးကို မှတ်တမ်ွေးတင်နင
ို ရ
် န်
(ခ) သ ွေး င်ွေးကို မှု၏ အနတရာယ် ကင်ွေးမကင်ွေးကို ဆန်ွေးစစ်နင
ို ရ
် န်အတက်လိုအပ်သ ာ အခ က်အလက်
မ ာွေး ပါဝင်သစရန် (ဥပမာ၊ အကကမ်သရ၊ သစတနာသ ွေးလှူရှင/် အစာွေးထွေးို သ ွေးလှူရှင)် (အလတ်လဒ
ှူ ါန်ွေး
ူ/လိုအပ်ခ က်အရလှူဒါန်ွေး ူ)
(ဂ) သ ွေးလှူရှငမ
် ာွေး၏ ပိုွေးစစ်သဆွေးမှုအသဖခအသနမ ာွေးကို မှတတ
် မ်ွေးတင်ရန်နင
ှ ် သ ွေးစစ်သဆွေး
မှုနင
ှ ပ
် တ် က် ည် အခ က်အလက်မ ာွေးကို လံိုဖခံြုံစာ ထန်ွေး မ်ွေး ထာွေးရန်
(ဃ) သ ွေး င်ွေးကို ခ ည်သ ွေးယူနစ်မ ာွေးကို မည် ည်အသ ကာင်ွေးကစစအလိုငှာ အ ံိုွေးဖပြုံ ည်၊
သ ွေးအိုပ်စို တည်မတည်ကို စမ်ွေး ပ်စစ်သဆွေးမှုဖပြုံလိုပ်ပပွေး/မပပွေး၊ ထိုတ်ယူ ူ၊ ထိုတ်ယူ ာွေး
ည်အခ န် စ ည်တိုကို ရှနင
ို ရ
် န်
(င) အ ံိုွေးမဖပြုံဖြစ် ည်သ ွေးယူနစ်မ ာွေး၏ စနပ
် စ်မအ
ှု သဖခအသနမ ာွေးကို ရှနင
ို ရ
် န်
အ ွေးခ ြု မညမ
် ှတတ
် မ်ွေးစနစ်မျ ွေး
၁။ သ ွေးလှူရှငမ
် ှတ်တမ်ွေး (Donor Register) မှတ်ပံိုတင် (၁)
၂။ ပိုွေးစစ်သဆွေးမှုမှတ်တမ်ွေး (Testing Register) မှတ်ပံိုတင် (၂)
၃။ သ ွေးထတ
ို ်သပွေးမှုမှတ်တမ်ွေး (Issue Register) မှတ်ပံိုတင် (၃)
၄။ သ ွေးစနပ
် စ်မှုမတ
ှ ်တမ်ွေး (Damage Register)
သ ွေးလှူဘဏ်၏ အသဖခအသနသပေါ်မူတည်၍ မှတ်တမ်ွေးတင်မှုအဆငဆ

် ငက
် ို သနာက်ဆက်တ SOP
အတိုငွေး် က င် ံိုွေးနင
ို ် ည်။
(က) Computerized Software ထာွေးရှသ ာသ ွေးလှူဘဏ်မ ာွေးတင် အ ံိုွေးဖပြုံရမည် SOP

(ခ) Computerized Software မထာွေးရှသ ာသ ွေးလှူဘဏ်မ ာွေးတင် အ ံိုွေးဖပြုံရမည် SOP
သ ွေးလှူရှငမ
် ှတ် တင်ခခင်ွေးလ ် သ င် အစီအစဉ် (SOP)
အကျြုွေးဝင်မညသ
် န
် ှတ်ပံိုတင် ည်သနရာ။
သ ွေးလှူဘဏ်တင် သ ွေးလှူရှငမ
် ှတ်ပတ
ံို င်ဖခင်ွေး စနစ်တက ရှသစရန်။ (ကန်ဖပြူတာဖြင် မှတတ
် မ်ွေးတင်
ဖခင်ွေး၊ ိုမဟိုတ် ွေးဖခာွေးစာရင်ွေး င်ွေးမှတတ

် မ်ွေးတင်ဖခင်ွေး)
တ ဝန်ရှိ မ
ူ ျ ွေး
် ှတ်ပံိုတင်ဖခင်ွေးနင
ှ ်သ ွေးထတ
ို ်ယူဖခင်ွေးတိုကို သဆာင်ရက်မည် ဓါတ်ခဝန်ထမ်ွေးမ ာွေး
လ ်သ င်နည်ွေးအ င် င်
(၁) သ ွေးလှူရှင၏
် ကယ
ို ်သရွေးအခ က်အလက်မ ာွေးကို ပံိုစံ (၁) တင် ဖြည်စက်ပပွေး ထပ
ို စ
ံို ံ၏
သနာက်သက ာတင် လူနာအမည်နင

ှ ် သဆွေးကို သဆာင်တိုကို မှတ်တမ်ွေးတင်ရမည်။
(၂) သ ွေးလှူရှငမ
် ှတ်ပံိုတင် စာအိုပ်တင် သ ွေးလှူရှင၏
် အဆိုပါ ကိုယ်သရွေးအခ က်အလက်မ ာွေးကို တစ်ခ န်
တည်ွေးတင် မှတ်တမ်ွေးသရွေး င်ွေးရမည်။
(၃) သ ွေးလှူရှငထ
် မ
ံ ှသ ွေး (၅) မလလတာ ထိုတယ
် ူရမည်။
(က) သဟမိုဂလိုဘင် စစ်သဆွေးရန် (Sarli Method)
(ခ) သ ွေးအိုပ်စိုခဖခာွေးရန် (ABO နှင် ရနင

ို ပ
် ါက Rh (D) ခွဲခခ ြားရန်)
(၄) သဟမိုဂလိုဘင်စံခ န်ကိုအမ ြုံွေး ာွေးမ ာွေးအတက် ၁၂ဂရမ် %နှင် အမ ြုံွေး မွေးမ ာွေးအတက် ၁၁.၅ ဂရမ် %
သတ်မှတ်ထ ြားသည်။
(၅) အကယ်၍ သဟမိုဂလိုဘင် မဖပညမ

် ပါက
ှ
(က) သဟမိုဂလိုဘင် အသဖြကို ပံစ

ို ံ (၁) နှင် မှတပ
် ံိုတင်စာအိုပ်တတ
ို င် သရွေး င်ွေးရမည်
(ခ) သ ွေးလှူရှငက
် ို သဟမိုဂလဘ
ို င် မဖပညမ
် သ ွေးသ ကာင်ွေး အ သပွေး၍ သ ွေးလှူရန် မ ငသ
် ွေး
သ ကာင်ွေး၊ လှူဒါန်ွေးလ င် အနတရာယ်ရှနင

ို သ
် ကာင်ွေး ပညာသပွေးသဆွေးသနွေး ရမည်။
(၆) သဟမိုဂလိုဘင် ဖပည်မပါက

ှ
(က) သ ွေးလှူရှငအ
် ာွေး သမွေးခန်ွေးလာစာရက်သပွေး၍ ကိုယ်တိုငသ
် ခ ာစာ ြတ်ရှုပပွေး သဖြဆိုသစရမည်။
(ဓါတ်ခဝန်ထမ်ွေးက ဖြည် င်ွေးသပွေးဖခင်ွေးမဖပြုံရ)
(ခ) သမွေးခန်ွေးမ ာွေးသဖြဆိုပပွေးပါက တာဝန်က ဓါတ်ခဝန်ထမ်ွေးက စစစ်ပပွေး သ ွေးလှူရှင် မှတ်ပံိုတင်
စာအိုပ် (၂) နှင် သ ွေးလှူရှငမ

် ှတပ
် ံိုတင် သဆာြ်ဝလ် တင် မှတ်တမ်ွေး တင်ရမည်။
(ဂ) ယခင်သ ွေးလှူဒါန်ွေးြူွေးပါက သ ွေးလှူရှငအ
် မှတ်စဉ် ဖြင် သ ွေးလှူရှင် သဆာြ်ဝလ်တင် အမည်၊
ယခင်သ ွေးလှူခ ည်ရက်စ၊ သ ွေးအိုပ်စိုတက

ို ို ဖပန်လည် တိုက်ဆိုင် စစ်သဆွေး ရမည်။
(ဃ) အကယ်၍ ပိုွေးစစ်သဆွေးမှုတင် ပငစန်ွေး ည်အခ က်ရှခသ ာ် (သရာဂါပိုွေးတစ်ခိုခို စစ်သဆွေး
သတွေ့ ရှ ထာွေးခသ ာ်)
• HIVသတွေ့ ရှထာွေးပါက အဖခာွေးစစ်သဆွေးနည်ွေးမ ာွေးဖြငထ

် ပ်မံစစ်သဆွေးနင
ို ရ
် န် သ ွေး
သြာက်ယူဖခင်ွေး၊ အသဖြရရှ ည်အခါပိုွေးသတွေ့ ရှသ ကာင်ွေးသ ခ ာပါက နှစ် မ်
သဆွေးသနွေး ပညာသပွေး ဌာန ို လသဖပာင်ွေးသပွေးဖခင်ွေးမ ာွေး ဖပြုံလိုပ်ရမည်။
• အ ည်ွေးသရာင်အ ာွေးဝါ ဘ နှင် စ ပိုွေးမ ာွေးသတွေ့ ရှထာွေးပါက စစ်သဆွေးသတွေ့ ရှ ည်
အသဖြကို အ မသပွေး သ ွေးပ သ ွေးလှူဒါန်ွေးရန် မ ငသ

် ကာင်ွေးသဖပာ ကာွေးပပွေး က န်ွေးမာ
သရွေး ထခိုက်သစနင
ို ် ည် အဖပြုံအမူအသနအထင
ို မ
် ာွေးကို သရှာင်ရှာွေးဆင်ဖခင်သစနင
ို ရ
် န်
ပညာသပွေး သဆွေးသနွေးရမည်။
• ကာလ ာွေးသရာဂါပိုွေးစစ်သဆွေးသတွေ့ ရှပါက ခိုခအ

ံ ာွေးက ဆင်ွေးမှု ကူွေးစက်သရာဂါနှင်
ကာလ ာွေးသရာဂါ တိုက်ြ က်သရွေးဌာန ို လသဖပာင်ွေးသပွေးရမည်။
• သရာဂါပိုွေးကင်ွေးရှငွေး် ပါကလိုပ်ထွေးံို လိုပ်နည်ွေးမ ာွေးအတိုငွေး် အဆငဆ

် ငဆ
် က်လက်လိုပ်
သဆာင် ၍ သ ွေး လှူရှင် သဆာြ်ဝလ်တင် ထပ်မံစာရင်ွေး င်ွေးမှတ်တမ်ွေးတင်ရမည်။
(၇) သ ွေးလှူရှင၏
် သ ွေးနမူနာမ ာွေးကို သအာက်သြာ်ဖပပါ သရာဂါပိုွေးသလွေးမ ြုံွေး ရှ မရှ စစ်သဆွေး ရမည်။
(က) HIV သရာဂါပိုွေး
(ခ ) ကာလ ာွေးသရာဂါပိုွေး
(ဂ ) အ ည်ွေးသရာင်အ ာွေးဝါ ဘ ဗိုငွေး် ရပ်စပ

် ိုွေး
(ဃ) အ ည်ွေးသရာင်အ ာွေးဝါ စ ဗိုငွေး် ရပ်စပ

် ိုွေး
(၈) သရာဂါပိုွေးတစ်ခိုခို စစ်သဆွေးသတွေ့ ရှခပါက ပိုွေးစစ်မတ

ှ ်တမ်ွေးစာအိုပ်၊ သ ွေးလှူရှငမ
် ှတပ
် ံိုတင် စာအိုပ်နင
ှ ်
သ ွေးလှူရှင် Software တိုတင် တပပြုံငန

် က်သရွေး င်ွေးမှတ်တမ်ွေးတင်ရမည်။
• HIV ပိုွေးနင
ှ ် ကာလ ာွေးသရာဂါပိုွေး သတွေ့ ရှပါက ခိုခံအာွေးက ဆင်ွေးမှုကူွေးစက်သရာဂါနှင်
ကာလ ာွေး သရာဂါ တိုက်ြ က်သရွေးဌာန ို လသဖပာင်ွေးသပွေးရမည်။
• အ ာွေးသရာင်အ ာွေးဝါ ဘ နှင် စ ပိုွေးမ ာွေး သတွေ့ ရှပါက က်ဆိုငရ

် ာသဒ တင်ွေး က င် ံိုွေး
ည် နည်ွေး စနစ်မ ာွေး အတိုငွေး် လိုက်နာသဆာင်ရက်ရမည်။
(၉) သရာဂါပိုွေးစစ်သဆွေးရာတင် ပိုွေးကင်ွေးရှငွေး် ခလျှင် အသဖြမ ာွေးကို ပိုွေးစစ်မှတ်တမ်ွေးစာအိုပ်၊ သ ွေးလှူ ရှင်
မှတ်တမ်ွေးစာအိုပ်နင
ှ ် Software တတ
ို င် တပပြုံငန
် က်တည်ွေး သရွေး င်ွေးရမည်။
(၁၀) သ ွေးလှူရှငမ
် ှတ်တမ်ွေးတင် (မှတ်ပတ
ံို င် - ၁ ) မ ာွေးကို သ ွေးလှူဘဏ်တင် သနစဉ်ြိုငတ
် ဖြင် ထန်ွေး မ်ွေး
ထာွေး ရမည်။
(၁၁) သရာဂါပိုွေးကင်ွေးရှငွေး် ၍ သ ွေးလှူဒါန်ွေးခငရ

် ခပါက သ ွေးလှူရှငအ
် မှတ်စဉ် သရာဂါပိုွေးစစ်သဆွေးမှု အမှတစ
် ဉ်
သ ွေးလှူဒါန်ွေးခ ည်ရက်စ၊ သ ွေး က်တမ်ွေးကိုနဆ

် ံိုွေး ည်ရက်စ၊ သ ွေးအိုပ်စို အမ ြုံွေးအစာွေးတိုကို
သ ွေးအတ်သပေါ်တင် သရွေးမှတ်ရမည်။ သတာင်ွေးခံလာ၍ သ ွေးထတ

ို ်သပွေး ည်အခါ အဆိုပါ က်တမ်ွေး
ကိုနရ
် က်အစဉ်အတိုငွေး် ထိုတ်သပွေးရမည်။
(၁၂) လူနာထံမှ လိုအပ်ခ က်အရ သ ွေးသတာင်ွေးခံ ည်အခါ လူနာ၏သ ွေးအိုပ်စအ

ို မ ြုံွေးအစာွေးကို
ခဖခာွေးစစ်သဆွေးဖခင်ွေး၊ လူနာ၏သ ွေးအိုပ်စိုနင

ှ ် အမ ြုံွေးအစာွေးတူည ည်သ ွေးဖြင် တညမ
် တည်
စစ်သဆွေးဖခင်ွေးတိုကို ဖပြုံလိုပ်ရ မည်။ သ ွေးထတ

ို ်သပွေးလိုက်သ ာအခါ သ ွေးထတ
ို ်ယူဖခင်ွေး
မှတ်တမ်ွေးစာအိုပ် (၃)တင် မှတ်တမ်ွေး သရွေး င်ွေးရမည်။
(၁၃) လူနာမ ာွေးထမ

ံ ှ ထိုတ်ယူထာွေး ည် သ ွေးနမူနာမ ာွေးအာွေးလံိုွေးကို ၁% hypochlorite ဖြင် ပိုွေး တ်ပပွေးမှ
စနပ
် စ်ရမည်။
(၁၄) သရာဂါပိုွေးသတွေ့ ရှ ည် သ ွေးနမူနာမ ာွေး၊ သ ွေးအတ်မ ာွေးကို တ်မတ

ှ ်ဖပဌာန်ွေးထာွေး ည် ပိုွေး တ်နည်ွေး
အတိုငွေး် အဆငဆ
် ငပ
် ိုွေး တ်ပပွေးမှ မွေးရှု ွေ့ြ က်ဆွေးရမည်။
် ှတ် တင် (၁)
Lab
Donor သ ွေးလှူရှင် က ာွေး / မှတ်ပံိုတင် သ ွေး အကကမ်
သနစ စဉ် ID သမွေး ကကရာဇ် အဘအမည် V/R လပ်စာ Deferral
ID အမည် မ အမှတ် အိုပ်စို သရ
No
မှတ်ခ က် ။ ။ အမှတ်စဉ် ည် တစ် လစအတက် ဖြစ် ည်။
Lab ID ည် တစ် နှစ် စအတက် ဖြစ် ည်။
Donor ID တစ် ခို ည် သ ွေးလှူရှင် တစ် ဦွေးအတက် ပံိုသ ဖြစ် င် ည်။
ိ ွေးစစ်သ ွေးမှုမှတ် တင် (၂)
HIV Ab HBsAg HCV Ab Syphilis

No. of
သနစ စဉ် Age Sex V/R Lab ID No. Test Name Test Name Test Name Test Name Remark
Donation Exp Date R/NR Exp Date R/NR Exp Date R/NR Exp Date R/NR
Lot No. Lot No. Lot No. Lot No.
သ ွေးထတ်သ ွေးခခင်ွေးမှတ် တင် (၃)
သဆွေးရို ံ
Lab ID လူနာ အ သဆွေးကို သ ွေး သ ွေးတည် ထိုတသ
် ပွေး ည်
သနစ စဉ် မှတပ
် ံိုတင် Diagnosis ထုတပ
် ြားသူ ထုတယ
် သ
ူ ူ
No အမည် က် သဆာင် အိုပ်စို မတည် အခ န်
အမှတ်
ပံိုစံ (၁) နှင ် ပံိုစံ (၂) တ၏

ို ဖခာွေးနာွေးခ က် ည် Donor Deferral အပရအတက် ဖြစ် ည်။ (သ ွေး သ
ို လှာင်သ ာသ ွေးလှူဘဏ် မဟိုတ်ပါက)
ပံိုစံ (၂) နှင ် ပံိုစံ (၃) တို၏ ဖခာွေးနာွေးခ က် ည် Positive Donor အသရအတက် ဖြစ် ည်။ (သ ွေး သ
ို လှာင်သ ာသ ွေးလှူဘဏ်မဟိုတ်ပါက)
Chapter (3)
Donation
3.1 Procedure for Collection of Blood

After the selected donors have passed all preliminary examinations and registration
stage, blood is collected using standardized bags with strict procedures and sterile
precaution. It is to be carried out by trained personnel (technicians or nursing staff), or in
certain instances, by medical officers.
သ ွေးလှူဒါန်ွေးခခင်ွေး
က န်ွေးမာသရွေးစစ်သဆွေးမှုအဆငက
် ို သအာင်ဖမင်ပပွေးဖြစ်သ ာ သ ွေးလှူရှငမ
် ာွေးထမ
ံ ှ သ ွေးထတ
ို ် ယူနင
ို ပ် ပ
ဖြစ်ပါ ည်။ သ ွေးထတ

ို ်ယူမှုကို ကျွမ်ွေးက င် ူ ဝန်ထမ်ွေးမ ာွေး (ဥပမာ သဆွေးဘက်ဆိုငရ
် ာ နည်ွေးပညာ ည်၊
ူနာဖပြုံ .. စ ည်) က သ ွေးလှူဒါန်ွေးမှုအတက် ဖပင်ဆင်ထာွေးရှသ ာသနရာတင် ဖပြုံလိုပ်သပွေး မည်ဖြစ်ပါ ည်။
သ ွေးလှူရှင် မ ာွေးအတက် သ ွေးအတ်မ ာွေးကို က်ဆိုငရ

် ာ ဝန်ထမ်ွေး မ ာွေးက စနစ်တက အမှတစ
် ဉ်သရွေးထွေးို ၍
မှတ်တမ်ွေးတင် ဖြည် င်ွေးပပွေး ထိုတ်သပွေး မည်ဖြစ် ည်။
(က) သ ွေးလှူရှငအ
် ာွေး လံိုဖခံြုံမှုရှသစရန်
(ခ) သ ွေးလှူရှငမ
် ာွေး ထပ်မံလှူဒါန်ွေးလိုစတ် ဖြစ်သပေါ်သစရန်
လိက်န မညအ
် ချက်မျ ွေး
(က) သ ွေးလှူဒါန်ွေးမည်သနရာ ည် အလင်ွေးသရာင်၊ သလဝင်သလထက်၊ နရ
် ှငွေး် မှုအာွေးသကာင်ွေး ရမည်။
(ခ) သ ွေးသြာက်မည် ူ ည် ကျွမ်ွေးက င် ူဖြစ်ရမည်။
(ဂ) သ ွေးသြာက်ယူမည်သနရာ(လက်သမာင်ွေးသ ွေးဖပန်သ ကာ)ကို နရ

် ှငွေး် သအာင်သဆာင်ရက်ရာတင် သတ်
မှတ် ညန် ကာွေး ထာွေး ည်အတိုငွေး် သဆာင်ရက်ရမည်။ (SOP For Blood Collection)
(ဃ) သ ွေးသြာက်ပပွေးပါက ဖြစ်သပေါ်တတ် ည် အနတရာယ်မ ာွေးကို သိရှိန ြားလည်ြားပ ြား ကာကယ်သစာင်
သရှာက်မှု သပွေးနင
ို ် ရမည်။ (Instruction For Donor Reaction)
(င) သ ွေးသြာက်ရာတင်အ ံိုွေးဖပြုံသ ာပိုကမ

် ာွေး၊အပ် မ ာွေးကို အ ံိုွေးဖပြုံပပွေးလျှငပ် ပွေးခ င်ွေး 1% Hypochlorite
Solution ါရှိသည်Container ထ ို ခ က်ခ င်ွေးထည်ရမည်။
(စ) သြာက်ယူရရှထာွေး ည် သ ွေးအတ်မ ာွေးကို စနစ်တက label တင်သရွေးမှတ်ပပွေး 4°C Storage အတင်ွေး
ခ က်ခ င်ွေး မ်ွေးဆည်ွေးရမည်။ ိုသလှာင်ရန်သနရာမရှပါက ၃၀ မနစ်ထက် မသက ာ် သစဘ အ ံိုွေး
ဖပြုံမည် သနရာ ို ထိုတ်သပွေးရမည်။
(ဆ) သ ွေးအတ်သပေါ်တင် ပအ က် ါတိုကို ပရြားမှတ်ပ ြားရမည်
• သ ွေးလှူရှင၏
် ID (Donor ID)
• ပိုွေးစစ်သဆွေးမှု ID (Testing ID)
• သ ွေးအိုပ်စို (ABO, Rh(D))
• သ ွေးသြာက်ယူ ည်သန (Collection Date)
• က်တမ်ွေးကိုနဆ
် ံိုွေး ည်သန (Expiratory Date)
• သ ွေးပစစည်ွေးအမ ြုံွေးအစာွေး (Type of Component)
(ဇ) သ ွေး ိုသလှာင်နင

ို ် ည်သ ွေးဘဏ်မ ာွေးတင်ပိုွေးစစ်သဆွေးပပွေးမှ သြာက်ယူဖခင်ွေးမဟိုတ်ပါက ပိုွေးမစစ်သဆွေး
ရသ ွေး ည် သ ွေးအတ်မ ာွေးကို ွေး နခ

် ထာွေးရမည်။
(ဈ) ပိုွေးစစ်သဆွေးပပွေးအ ံိုွေးဖပြုံနင

ို မ
် ည် သ ွေးအတ်မ ာွေးကို သရခသ တတာရှပါက က်ဆိုငရ
် ာ သ ွေးအိုပ်စို
အလိုက် ိုသလှာင်ထာွေးပပွေး က်တမ်ွေးကိုနဆ

် ံိုွေးရက် အသစာဆံိုွေးဖြစ်သ ာ သ ွေးအတ်မ ာွေးကို
အဦွေးထာွေး၍ ထိုတ်သပွေး ည်စနစ် (First-Expired-First-Issue System) ဖြင် ထိုတ်သပွေးရမည်။
(ည) သ ွေးပစစည်ွေးမ ာွေးကိုခထိုတ်နင

ို သ
် ာ နည်ွေးပညာ/စက်ပစစည်ွေး ရှ ည်သ ွေးဘဏ်မ ာွေးတင် သြာက်ယူပပွေး
သ ွေးမ ာွေးကို ၆ နာရထက်မသက ာ်သစဘ က်ဆိုငရ

် ာသ ွေးပစစည်ွေး (Blood Component) မ ာွေး
အဖြစ် ို ခထိုတ်ဖပင်ဆင်ရမည်။
သ ွေးသ က်ယူ န် နည်ွေးစနစ် (SOP)
(၁) သ ွေးသြာက်ယူရာမှ ဗက်တွေးရွေးယာွေးသရာဂါပိုွေးမ ာွေး ကူွေးစက်ဝင်သရာက်မှု မရှသစသရွေးအတက်
သ ွေးသြာက်ယူမည်သနရာတစ်ဝက
ို ်ကို ရာနှုနွေး် ဖပည်ပိုွေး နစ
် င် ည်နည်ွေးစနစ် (aseptic method) ဖြင်
ဂရိုတစိုက် နရ
် ှငွေး် သစရန်
(၂) တစ်သနရာတည်ွေး၊ တစ်ကကမ်တည်ွေး သြာက်ယဖူ ခင်ွေးအာွေးဖြင် သ ွေးလှူရှငအ

် ြို စတ်သက နပ် ြယ်ဖြစ်သစ
ရန်နင
ှ ်သ ွေးလှူဒါန်ွေးရာတင် လိုပ်ငန်ွေးအရည်အသ ွေးနင
ှ ် စတ်ခ ရမှုအတိုငွေး် အတာတို စံခ န်မဖြစ်သစရန်
အကျြုွေးဝင်မညသ
် န
သ ွေးလှူခန်ွေး
လ ်သ င် မညဝ
် န်ထမ်ွေးမျ ွေး
လိုပ်ငန်ွေးကျွမ်ွေးက င်မှုရှ ူ သဆွေးဘက်ဆိုငရ
် ာ ဓာတ်ခဝန်ထမ်ွေးမ ာွေးနင
ှ ် ူနာဖပြုံမ ာွေး
လိအ ် ည် စစညွေး် မျ ွေး

၁။ Kidney tray/ sterilizing tray ၉။ သ ွေးပိုက်ပတ်ကရယာ (electronic
၂။ အရက်ဖပန် tube sealer)
၃။ အိုငအ
် ိုဒင်ွေးသဆွေးရည် ၁၀။ ကတ်သ ကွေး
၄။ ဂမ်ွေး၊ ပတ်တွေး၊ ပိုွေး နစ

် င်ပပွေးဂမ်ွေးလံိုွေးမ ာွေး ၁၁။ သ ွေးအတ်မ ာွေး
၅။ သ ွေးသ ကာြမ်ွေးညှပ် (artery forceps) ၁၂။ Pilot bottle နှင် tube မ ာွေး
၆။ လက်ပတ်ကကြုံွေး (tourniquet) ၁၃။ ပလာစတာ
၇။ သရာ်ဘာလက်အတ်မ ာွေး ၁၄။ သ ွေးအတ်အသလွေးခ န် ည် ကရယာ
၈။ သရှွေးဦွေး ူနာဖပြုံသဆွေးသ တတာ ၁၅။ သရခသ တတာ
၁၆။ သ ွေးလှူရှငထ
် င
ို ရ
် န်/ လှရန် ခံ/ို ခိုတင်မ ာွေး
နည်ွေးစနစ်
(၁) သ ွေးလှူရှငက
် တ်ဖပာွေး၊ ကိုယ်သရွေးမှတ်တမ်ွေးစာရက်ငယ် (ပံိုစံ - ၁)၊ သ ွေးအတ်၊ Pilot bottle ၂လံိုွေးနင
ှ ်
Pilot tube ၁ သခ ာင်ွေးတို ထည်ထာွေးသ ာ ဖခင်ွေးငယ်တစ်ခိုကို ယူသဆာင်လာ ည် သ ွေးလှူရှငက

် ို
သနွေးသထွေးစာ ကကြုံဆိုပပွေး သ ွေးလှူခန်ွေးထ ို သခေါ်သဆာင်လာရမည်။
(၂) သ ွေးလှူရှငက
် ို ခိုတင်သပေါ်တင် သခါင်ွေးအံိုွေးဖြင် က်သတာင် က် ာ လှသနသစရမည်။ အဝတ် အစာွေး
တင်ွေးက ပ်သနပါက သလျှာထာွေးရမည်။
(၃) သ ွေးလှူရှငအ
် မည်ကို သ ခ ာစာသမွေးဖမန်ွေးပပွေး သရာဂါပိုွေးစစ်သဆွေးမှုအမှတ်စဉ်နှင် သ ွေးအတ်
ပိုက်သပေါ် ရှ နံပါတ်မ ာွေးကို ပံိုစံ (၁) စာရက်ငယ်သနာက်သက ာတင် သရွေးမှတ်ရမည်။ သရာဂါပိုွေး
စစ်သဆွေးမှုအမှတ်စဉ်၊ သ ွေးလှူရှငအ
် မှတ်စဉ်နှငသ
် ွေးအိုပ်စိုတိုကို သ ွေးအတ်သပေါ် ရှနံပါတ် မ ာွေးနင
ှ ်
တိုက်ဆိုငစ
် စ်သဆွေးရမည်။
(၄) သ ွေးသြာက်ယူ ည် သနရာတစ်ဝက

ို ်ကို နရ
် ှငွေး် မှုဖပြုံလပ
ို ်ရန် သအာက်ပါနည်ွေးစနစ်အတိုငွေး်
သဆာင်ရက်ရမည်။
• သ ွေးသြာက်ယူမည် သ ွေးသ ကာသနရာ သရွေးခ ယ်ပပွေးသနာက် ၎င်ွေးအသပေါ်နင

ှ ် အနွေး တစ်ဝိုက် ရှ
အသရဖပာွေးကို အိုငအ
် ိုဒင်ွေးနင
ှ ် အရက်ဖပန်တိုဖြင် အစဉ်အတိုငွေး် ိုတ်လမ်ွေးပါ။
• ိုတ် ည်အခါ သြာက်ယူမည်သ ွေးဖပန်သ ကာ အသပေါ်တည်တည်မှ အစဖပြုံ၍ သဘွေးပတ် လည် ို
စက်ဝိုငွေး် ပံိုအတင်ွေးမှ အဖပင် ို ရစ်ပတ်၍ ိုတ်ပါ။
• အိုငအ
် ိုဒင်ွေး ိုတ် ည်အခါ သနရာလပ်မက န်သအာင် ိုတပ
် ါ။ အနည်ွေးဆံိုွေးစကကန ် ၃၀၊ ိုမဟိုတ်
အဖမြုံပ် ထက် ည်အထ ိုတ်ပါ။
• နရ
် ှငွေး် ပပွေး ာွေးသ ာသ ွေးသြာက်မည်သနရာကို လံိုွေးဝ မထမကိုငပ
် ါနှင။် ထမကိုငမ
် ခ ပါက အထက်
သြာ်ဖပပါ နည်ွေးစနစ်အတိုငွေး် အစမှတြန် ဖပန်လည် နရ

် ှငွေး် ပါ။
• နရ
် ှငွေး် ရာတင် အ ံိုွေးဖပြုံ ည် ဂမ်ွေးလံိုွေးမ ာွေးကို သ ခ ာစာ ကည်ရှုစစ်သဆွေးပပွေး ညစ်သပ သနပါက
အ စ်လ၍ အစမှတစ်ြန် ဖပန်လည် နရ

် ှငွေး် ပါ။
• အ ံိုွေးဖပြုံပပွေးဂမ်ွေးလံိုွေးမ ာွေးကိုစနစ်တက စနပ

် စ်ပါ။ ထသနာက်
ို နရ
် ှငွေး် ပပွေးသနရာ တစ်ဝက
ို ်ကို အသဖခာက်
ခံပါ။ ဂမ်ွေးအသဖခာက်နင
ှ ် ိုတ်မပစ်ရ။
(၅) သ ွေးသြာက်ယူရာတင် သအာက်ပါအတိုငွေး် အဆငဆ

် ငသ
် ဆာင်ရက်ရမည်။
• သရှွေးဦွေးစာ သ ွေးအတ်ပိုက်ကို တစ်ပတ်လျှြုံကင်ွေးထွေးို ပပွေး ဆတင်ွေးမပစ်သ ွေးဘ သလ ာသလ ာခ ထာွေးပါ။
• သ ွေးအတ်အသလွေးခ န် ည်ကရယာ ရှပါက သ ွေးအတ်ကို ၎င်ွေးတင် ခ တ်ဆပါ။
• သ ွေးလှူရှင၏
် လက်သမာင်ွေးကို လက်ပတ်ကကြုံွေးဖြငပ
် တ်ပါ။ သ ွေးဖပန်သ ကာသပေါ် ည်အထ တင်ွေးပါ။
• သ ွေးသြာက်ရန်အတက် ဦွေးစာပထမ အ ်၏ထိ ် သ ါက်ဝဘက်ခခမ် ွေးကိ အသ ေါ်ဘက် ထ ွေး၍
အသရဖပာွေးမ က်နာှ ဖပင်နင

ှ ် မ ဉ်ွေးပပြုံငအ
် သနအထာွေးတင် ၁၅ ဒဂရခန ် ခာထာွေးပါ။
• အပ်ကို သ ွေးဖပန်သ ကာထ ို ၁ စင်တမတာမှ ၁.၅ စင်တမတာထ တစ်ခ က်တည်ွေး ဝင်သအာင်
ထွေးို င်ွေးပါ။ သ ွေးအလယ်တကူ လိုက်လာပါသစ။ ထသနာက်

ို ပက
ို ်နင
ှ အ
် ပ် တိုကို လက်သမာင်ွေးတင်
ပလာစတာနှင် တယ်ကပ်ထာွေးပါ။
• သ ွေးစွေးဆင်ွေးမှု ဖမန်ဆန်လယ်ကူသစရန်အတက် သ ွေးလှူရှငက
် ို လက် ွေးဆိုပ်လက
ို ် ဖြနလ
် က
ို ်
မှနမ
် ှနလ
် ိုပ်သပွေးသနရန် ညန် ကာွေးပါ။
• သ ွေးသြာက်ယူရာတင် ပထမတစ်ခ က်တည်ွေးဖြင် သအာင်ဖမင်မမ

ှု ရပါက ၎င်ွေးလက် တစ်ြက် တည်ွေးမှ
ဒိုတယအကကမ်၊ တတယအကကမ် ထပ်မထွေးို ပါနှင။် သ ွေးလှူရှငက

် ို ခငသ
် တာင်ွေးပပွေးမှ ာ ဒိုတယ
အကကမ် ထပ်သြာက်ပါ။ (သ ွေးအတ် စ်လရမည်)
• သ ွေးအတ်ထ ို သ ွေးဝင်လာလျှင် သ ွေးအတ်ထတင် သ ွေးမခသစရန် ထည်ထာွေး ည်
anticoagulant နှင် သရာသနှာ မသစရန် သ ွေးအတ်ကို ဖြည်ွေးညင်ွေးစာ လှုပ်ခါသပွေး ပါ။
• တ်မှတ်သ ွေးပမာဏဖပည် ာွေး ည်အခါ သရှွေးဦွေးစာသ ွေးအတ်ကိုတစ်ပတ်လျှြုံ ကင်ွေး ထွေးို ထာွေး ည်
သနရာမှ ဆတင်ွေး၍ပတ်ပပွေး ၎င်ွေးအထံွေးို အသပေါ်နာွေးမှ ကတ်သ ကွေးဖြင် ဖြတ်ပါ။
• ထသနာက်
ို ဖြတ်လိုက် ည် ပိုက်စန်ွေးမှ က လာ ည်သ ွေးကို pilot bottle နှင် tube မ ာွေး ထ ို
ခံယူထည် င်ွေးပါ။ သ ွေးလှူရှငလ

် က်သမာင်ွေးသ ွေးဖပန်သ ကာထမှ သ ွေးမ ာွေး ည် ပိုလင်ွေး မ ာွေးထ ို
တိုက်ရို က်က လာမည်ဖြစ် ည်။
ို လက်ပတ်ကိုဖြည်ပပွေး အပ်ထွေးို ထာွေး ည်သနရာ အသပေါ်တည်တည်မှ အ ာ အယာ
ဂမ်ွေးဖြငြ
် ၍ အပ်ကို သ ွေးဖပန်သ ကာထမှ ဖြည်ွေးညင်ွေးစာ ဆထိုတ်ပါ။
ို ပိုက်နင
ှ အ
် ပ်တိုကို ၁% hypochlorite သဆွေးရည်ထည်ထာွေး ည် ပံိုွေးထ ို ထည်ပါ။
(၆) သ ွေးလှူဒါန်ွေးပပွေးသနာက် သ ွေးလှူရှငတ

် င် မူွေးသဝဖခင်ွေး၊ တလစ်ဖခင်ွေး၊ သအာအန်ဖခင်ွေးစ ည်
သဘွေးအနတရာယ်မ ာွေး ဖြစ်သပေါ်တတ်ပါ ည်။ ထသ

ို ကာင်၎င်ွေးတိုကို ကာကယ်ရန်နင
ှ ် ဖြစ်သပေါ် လာပါက
သစာငသရှ
် ာက်ဖပြုံစို ကို မှုသပွေးနင
ို ရ
် န် သအာက်ပါအတိုငွေး် သဆာင်ရက်ရ ပါမည်။
• သ ွေးလှူပပွေးသနာက် ဖြစ်သပေါ်တတ် ည် သဘွေးအနတရာယ်မ ာွေး မဖြစ်သပေါ်သစရန်အတက် သ ွေးလှူရှငက

် ို
ပိုက်ဖြြုံတ်ပပွေးလျှငပ် ပွေးခ င်ွေး မထပါသစနှင။် အနည်ွေးဆံိုွေး ၅ မနစ်မှ ၁၀ မနစ် ဆက်လက်လှသနပါသစ။
ို စာွေးသ ာက်ခန်ွေး ( ွေးဖခာွေးမရှပါက သ ွေးလှူ ည်သနရာမှာပင်) သနာက်ထပ် ၁၀ မနစ်
အတင်ွေး မူွေးသဝဖခင်ွေး၊ သအာအန်ဖခင်ွေး၊ တလစ်ဖခင်ွေး စ ည်တို ဖြစ်မဖြစ် တဖပြုံသစာင် ကည်သပွေး
ပါ။ အကယ်၍ တစံိုတရာဖြစ်သပေါ် ခလျှင် ဆရာဝန်ကို အဖမန်ဆံိုွေးအသ ကာင်ွေး ကာွေးပါ။
• သ ွေးသြာက်ယူ ည်သနရာကို သ ွေးလှူခန်ွေးမှမထက်ခာမှ သ ခ ာစာ ကည်ရှုစစ်သဆွေး ပပွေးမှ သ ွေးတတ်
ာွေးပါက ပလာစတာကပ်သပွေးပါ။
• အကယ်၍ သ ွေးမတတ်ခလျှင် ပိုွေး နစ

် င် ည် ဂမ်ွေးလံိုွေးဖြင် အ ာအယာ သ ွေးတတ် ည်အထ
ြထာွေးသပွေးပါ။
• အသရဖပာွေးသအာက်၌ သ ွေးယစ
ို မ်ဖခင်ွေး (haematoma) ဖြစ်သပေါ်ပါက ၎င်ွေးသနရာ တစ်ဝိုကတ
် င်
အသရာင်သဖပာင်ွေးလမှု ဖြစ်သပေါ်လာမည်အသ ကာင်ွေး သ ွေးလှူရှငက

် ို ရှငွေး် ဖပ၍ သရခဖြင် အ ာ အယာ
ြကပ်သပွေးဖခင်ွေးမှတပါွေး တဖခာွေး မည် ည်သ ွေးကိမှ ဆရာဝန်ညန် ကာွေးခ က်မရှပ မမ သဘာဖြင်
လိမ်ွေးခခင်ွေး၊ ထည်ခခင်ွေး စ ည်မခ ြုလ ် န် ညန် ကာွေးသပွေးပါ။
• ပသြားလှူဒါန်ြားပ ြားပန က် အရည်မ ြားမ ြားဝင်ပအ င်ပသ က်ပ ြားရန် ပသြားလှူရှငအ

် ြား ညွှန ် ကက ြား ါ။
ထိပ
ု နအဖို ခန်အ ြားစိုက်ထတ
ု ်ရမည် အလု ်မ ိ ြား၊ င် န်ြားနမ်ြားနယ်ပစမည် အလု ်မ ိ ြား၊ အ ြားကစ ြား
စသည် မခ လု ်ရန် ညွှနက် က ြား ါ။
(၇) မှတ်တမ်ွေးမှတ်ရာတင် ဖပြုံစိုထန်ွေး မ်ွေးဖခင်ွေးကို သအာက်ပါအတင

ို ွေး် လိုပ်သဆာင်သပွေးရမည်။
• သ ွေးသြာက်ယူမှု မသအာင်ဖမင် ည်အကကမ်အတက် အ ံိုွေးဖပြုံ ည်သ ွေးအတ်ကို ဆံိုွေးရှုံွေး သ ွေး
အတ်အဖြစ် ကန်ပ ြူတာမှတ်တမ်ွေး၊ ိုမဟိုတ် သ ွေးစနပ

် စ်မှုမတ
ှ ်တမ်ွေး (damage register) တင်
ထည် င်ွေးရမည်။
• သ ွေးလှူရှငတ
် င် တစ်စံိုတစ်ရာသ ာအနတရာယ် (မူွေးသဝဖခင်ွေး၊ တလစ်ဖခင်ွေး စ ည်) ဖြစ်သပေါ် ခလျှင်
သ ွေးလှူရှငက
် တ်ဖပာွေးတင် မှတတ
် မ်ွေးတင်ပါ။
• အ ံိုွေးဖပြုံ ည်ပစစည်ွေးစာရင်ွေး၊ သဆွေးဝါွေးမ ာွေး၏ က်တမ်ွေးကိုနရ

် က်စစ ည်မ ာွေးကို မှတတ
် မ်ွေးဖပြုံ
ထာွေးပါ။
• သ ွေးလှူဒါန်ွေးပပွေးသနာက် သ ွေးလှူရှငအ
် ာွေး သ ွေးလှူဒါန်ွေးမှုဆိုငရ
် ာ က န်ွေးမာသရွေးပညာသပွေး လက်ကမ်ွေး
စာသစာင်ငယ်ကို သပွေးပါ။
3.2 Instruction for Care of the Donor during and Immediately after
Donation
GENERAL
(a) Remove the tourniquet and withdraw the needle from the arm if signs of adverse
reaction occur during the phlebotomy.
(b) If possible, remove any donor who experiences an adverse reaction to an area where
he or she can be attended in privacy.
(c) Apply the measures suggested below and, if they do not lead to rapid recovery call
the blood bank medical physician officer designated for such purpose.
FAINTING
(a) Apply cold compresses to the donor's forehead or the back of the neck.
(b) Administer aromatic spirits of ammonia by inhalation if donor does not respond to
initial measures. Test the ammonia on yourself before passing it under the donor’s
nose, as it may be too strong or too weak. Strong ammonia may injure the nasal
membrane; weak ammonia is not effective. The donor should respond by coughing,
which elevates the blood pressure.
(c) Place the donor on his/her back with legs raise above level of the head.
(d) Loosen tight clothing.
(e) Be sure the donor has an adequate airway.
(f) Monitor blood pressure, pulse, and respiration periodically until the donor recovers.
NAUSEA AND VOMITING

(a) Make the donor as comfortable as possible.
(b) Instruct the donor who is nauseated to breathe slowly and deeply.
(c) Apply cold compresses to the donor's forehead and, /or back of neck
(d) Turn donor's head to the side.
(e) Provide a suitable receptacle if the donor vomits and have cleansing tissues or a
damp towel ready. Be sure the donor's head if turned to the side because of the
danger of aspiration.
(f) After vomiting has ended, give the donor some water to rinse out his/her mouth.
TWITCHING OR MUSCULAR SPASMS
Extremely nervous donors may hyperventilate, causing faint muscular twitching or
tetanic spasm of their hands or face. Donor room personnel should watch closely for these
symptoms during and immediately after the phlebotomy.
(a) Divert the donor's attention by engaging in conversation, to interrupt the hyper-
ventilation pattern.
(b) Have the donor breathe into a paper bag if he or she is symptomatic. Do not give
oxygen.
HAEMATOMA DURING OR AFTER PHLEBOTOMY
(a) Remove the tourniquet and the needle from the donor's arm.
(b) Place three or four sterile gauze squares over the venipuncture site and apply firm
digital pressure for 7 - 10 minutes with the donor's arm held above the heart level.
An alternative is to apply a tight bandage, which should be removed after 7 - l0
minutes to allow inspection.
(c) Apply ice to the area for 5 minutes, if desired.
(d) Should an arterial puncture be suspected, immediately withdraw needle and apply
firm pressure for 10 minutes. Apply pressure dressing afterwards. Check for the
presence of a radial pulse. If pulse is not palpable or is weak, call a blood bank
medical physician officer.
CONVULSION
(a) Call for help immediately. Prevent the donor from injuring him/herself. During severe
seizures, some people exhibit great muscular power and are difficult to restrain. If
possible, hold the donor on the chair or bed; if not possible place the donor on the
floor.
Try to prevent injury to the donor and to yourself.
(b) Be sure the donor has an adequate airway. Jaws should be separated by a padded
device after convulsion has passed.
The nature and
(c) Notify the blood bank physician
treatment of all reaction
SERIOUS CARDIAC DIFFICULTIES
should be recorded on
(a) Call for medical aid and/or an emergency care unit
the donor record or
immediately
special incident report
(b) If the donor is in cardiac arrest, begin CPR
form.
immediately and continue it until help arrives.
Chapter (4)
Post-Donation
4.1 Labeling of Collected Blood Packs

On the blood bag have already been noted donor ID, Test ID, Blood Group, Dates of
collection, Expiry and Type of component.
4.2 Blood Group Serology Testing
(၁) ခတင် (၂၀ဝ) နှငအ

် ထက် သ ွေးရမျ ွေးရှိ သ ွေးဘဏ် မျ ွေးတင် သ ွေးအ ်စစစ်သ ွေးမှု
ABO အိုပ်စိုအတက် Cell and Serum Grouping နှစ်မ ိ ြားစလုြား ဖပြုံလိုပ်ရမည်။ ယင်ွေး ို ဖပြုံလိုပ်ရာ
တင် Cell Grouping အတက် Polyclonal Antiserum အသုြားခ ါက Anti-A, Anti-B တိုအဖပင် O သ ွေး
လှူ ရှငမ
် ှ ထိုတ်ယူထာွေး ည် Anti-AB ကိုပါ အ ံိုွေးဖပြုံရမည်။ Monoclonal Antiserum အ ံိုွေး ဖပြုံ ပါက
Anti-A, Anti-B နှစ်မ ြုံွေး ာအ ံိုွေးဖပြုံနင

ို ် ည်။ (Please refer to work instruction for ABO Grouping)
၎င်ွေးအဖပင် Rh (D) Typing ကိုလည်ွေး ဖပြုံလပ

ို ်ရမည်။ (Please refer to work instruction for Rh(D)
typing)
(၂) ခတင် (၂၀ဝ) သအ က်သ ွေးရမျ ွေးရှိ သ ွေးဘဏ် မျ ွေးတင် သ ွေးအ ်စစစ်သ ွေးမှု
ABO အု ်စုအတက် Cell Grouping သ ခ လု ်နင
ို သ
် ည်။ Rh (D) Typing ကို သ ွေးလှူရှင် တိုငွေး်
တင် ဖပြုံလိုပ်ရမည်။
(၃) သ ွေး င်ွေးက မှုခယူမညလ

် ူန မျ ွေးအတက် သ ွေးတညမ
် တညစ
် စ်သ ွေးမှု
သ ွေး င်ွေးကို မှုခံယူမည်လူနာမ ာွေးအတက် သ ွေးတည်မတည်စစ်သဆွေးမှု ကို ခိုတင် (၂၀ဝ) သအာက်
သဆွေးရို ံမ ာွေးတင် Tile ဖြငဖ် ပြုံလပ

ို ်နင
ို ် ည်။ ခိုတင် ၂၀ဝ နှငအ
် ထက်သဆွေးရို ံမ ာွေးတင်မူ သ ွေး င်ွေးကို မှု
အကကမ်ကကမ်ခံယူရန် လိုအပ် ည် လူနာမ ာွေးအတက် 37°C AHG method ဖြင် ဖပြုံလိုပ်ရမည်။ (Please
refer to work instruction for Compatibility/ Work Sheet for Compatibility)
Work Instruction for ABO Grouping
(Tube Method)
1. Purpose
To identify ABO group of recipient and donor.
2. Scope
This procedure is applied to National Blood Center Yangon.
3. Responsibility
Medical Technologists
Technicians Grade I and Grade II
4. References
WHO Blood Group Serology
5. Materials Required
5.1 Equipment
▪ Refrigerator 2-6 °C ▪ Microscope
▪ Centrifuge
5.2 Specimen
▪ Clotted and citrated blood samples of donors (2 ml)
▪ Clotted and citrated blood samples of patients (2 ml)
▪ Test red cell suspension
5.3 Reagents
▪ Anti A, Anti B, Anti AB antisera
▪ 2-5 % known A cell, B cell, O cell suspension
▪ 0.9 % Normal Saline
▪ Distilled water
5.4 Glass wares

▪ Khan Tube ▪ Glass slides
▪ Pasteur Pipettes
▪
5.5 Miscellaneous
▪ Racks ▪ Beakers
▪ Disposable box
6. Precaution
▪ Use only non-hemolyzed blood samples
▪ Check agglutination and also hemolysis of the result
▪ Check correct labeling
7. Procedure
Principle: Based on agglutination reaction of antigen present on red cells and
the presence of antibody directed towards the antigen.
Cell Grouping (Forward Grouping)

(1) Prepare the racks and Khan Tubes
(2) Label the tubes with test number and anti A, anti B and anti AB
(3) 3 tubes for one person
(4) Add 2 drops of antisera (anti A, anti B, anti AB) to labeled tubes
(5) Prepare 2-5 % cell suspension (refer to WI)
(6) Add 1 drop of 2-5 % cell suspension (tested cell) to each tube
(7) Mix gently and centrifuge at 3000 rpm/ 15 sec.
(8) Re-suspend the red cell button and examine for agglutination and record.
Result and Interpretation

Cell grouping
Test No Anti A Anti B Anti AB Group
1 4+ - 4+ A
2 - 4+ 4+ B
3 4+ 4+ 4+ AB
4 - - - O
Agglutination reactions are graded from 1+ to 4+

4+ - one big clump in the center
3+ - one big clump with some small clumps
2+ - two or more clumps of equal sizes
1+ - small clumps scattered in the test area
+/- - doubtful for agglutinations
All negative results must be examined under microscope.
Serum Grouping (Reverse Grouping)
(1) Prepare the racks and Khan tubes
(2) Label the tubes with test number and A cell, B cell and O cells (3 tubes for one
person)
(3) Add 2 drops of tested serum to all tubes
(4) Prepare 2-5% known A cell, B cell, O cell suspension (refer to WI)
(5) Add 1 drop of 2-5 % known A cell, B cell, O cell suspension to labeled tubes
(6) Mix gently and centrifuge at 3000 rpm for 15 sec.
(7) Gently re-suspend the red cell button and examine for agglutination and also
hemolysis.
Result and Interpretation

Serum Grouping (Reverse Grouping)
Test No A cell B cell O cell Group
1 - 4+ - A
2 4+ - - B
3 4+ 4+ - O
4 - - - AB
There is any discrepancy report the both test (cell and serum) for sample from segment. If
there is discrepancy, inform to Pathologist.
8. Documentation and Record

▪ Enter the results of donor grouping in the donor grouping register and computer.
▪ Enter the results of patients grouping in the patient grouping register and blood
requisition form.
Work Instruction for Rh (D) Grouping
(Tube Method)
1. Purpose
To identify Rh group of the donor and recipient
2. Scope
This procedure is applied to National Blood Center, Yangon
3. Responsibility
Medical Technologists
Technicians grade I and II
4. References
WHO BLOOD GROUP SEROLOGY GUIDELINE
5.1 Equipment
▪ Refrigerator 2-6 °C ▪ Microscope
▪ Centrifuge ▪ Water bath 37°C and dry bath
5.2 Specimen
▪ Clotted and citrated blood sample of donor
▪ Clotted and citrated blood sample of recipient
5.3 Reagent
▪ Anti D (diluted and neat) ▪ Distilled water
▪ 0.9% Normal saline ▪ AHG (polyclonal)
5.4 Glass wares

▪ Khan tubes ▪ Glass slides
▪ Pasteur pipettes
5.5 Miscellaneous
▪ Racks ▪ Beakers
▪ Disposable box
6. Precaution
▪ Use non-hemolyzed blood samples ▪ Calibration of centrifuge
▪ Check agglutination 3+ - 4+ ▪ Check water bath at 37°
▪ Check correct labeling
7. Procedure
(1) Prepare the racks and Khan tubes
(2) Label the tubes with test number and anti D
(3) Prepare diluted Anti D (10% Bovine Albumin) (Refer to WI)
(4) Prepare 2-5% cell suspension of donor/recipient blood sample (Refer to WI)
(5) Add 2 drops of diluted anti D to labeled tubes
(6) Add 1 drop of 2-5% cell suspension (tested cell)
(7) Mix gently and centrifuge at 3000 rpm for 15 sec.
(8) Gently resuspend the cell button and examine agglutination 3+ - 4+.
(9) Macroscopically
(10) Record the result
8. Result and Interpretation

(1) Agglutination (3+ - 4+) of red cell with diluted anti D is D positive result
(2) A smooth suspension of red cells after resuspension (no agglutination) is negative
result.
(3) Negative result samples must be tested for real D negative and weak D.
D Negative / Weak D
▪ Incubate the agglutination negative tube in 37°C for 30-60 min
▪ Wash the cell for 3 times with normal saline
▪ Centrifuge 3000 rpm for 1 min
▪ Add 2 drops of AHG
▪ Mix well and centrifuge at 3000 rpm for 15 sec
▪ Read agglutination macroscopically and microscopically
Result and interpretation

▪ Agglutination (3+ - 4+) of red cell after AHG is weak D
▪ No agglutination is real D negative result
9. Documentation and Record

▪ Enter the results in donor’s record as D Positive
▪ D Negative or weak D together with ABO grouping
Work Instruction for Compatibility Testing
(Tube Method)
1. Purpose
▪ To obtain safe blood supply for the patients
2. Scope
▪ This procedure in applied for compatibility testing of all patients requiring transfusion
in National Blood Center, Yangon
3. Responsibility
▪ Medical Technologists
▪ Technicians Grade I and II
4. References
▪ WHO BLOOD GROUP SEROLOGY
5.1 Equipment
▪ Refrigerator to store samples and reagents at 2-8°C
▪ Centrifuge
▪ Microscope
▪ Water / dry bath 37°C
5.2 Blood Samples

▪ Clotted blood sample of donors
▪ Clotted and citrated blood samples of patients
5.3 Reagents
▪ 0.9% saline solution
▪ AHG Anti-human Globulin Reagents (Poly Specific)
▪ Distilled water
5.4 Glass ware

▪ Khan’s Tubes ▪ Glass Slides
▪ Pipettes
5.5 Miscellaneous
▪ Rubber teats ▪ Beakers
▪ Disposal box ▪ Test tubes racks
6. Precaution
▪ Hemolyzed blood samples
▪ Inadequate blood samples
▪ Out of specification of samples
7. Procedure
Principle: the major cross match is used to detect unexpected blood group antibodies
in patient’s serum against antigens on donor cells. Positive reaction in any test indicates
incompatibility.
Cross-match
▪ Prepare the Khan’s tubes and racks
▪ Labeling
o the patients’ serial numbers
o Donors D1, D2, D3 .. etc by test ID according
▪ For auto agglutination test: add 2 drops of patient’s serum and 1 drop of 2-5%
patient cell suspension
▪ For major Cross-Match: (For WB/FB/PC) Add 2 drops of patient’s serum and 1 drop of
2-5% donor cell suspension.
▪ For minor Cross-Match: (PRP/Plt Conc/FFP/Cryo) Add 2 drops of donor serum and 1
drop of 1-5% patient’s cell suspension.
▪ Mix and centrifuge (3000 rpm for 15 sec)
▪ Read agglutination and hemolysis by macroscopically and microscopically and
record.
▪ Incubate at 37°C for 30 mins
▪ Mix and centrifuge (3000 rpm x 15 secs)
▪ Read agglutination by macroscopically and microscopically and record
▪ Wash 3 times with 0.9% normal saline solution at 3000 rpm for 1 min
▪ Add 2 drops of AHG
▪ Mix and centrifuge at 3000 rpm for 15 secs
▪ Read agglutination by microscopically and microscopically and record
▪ If no agglutination, add 1 drop of Coomb’s control cell.
▪ Mix and centrifuge at 3000 rpm for 15 sec.
▪ Read agglutination by macroscopically and microscopically and record
8. Interpretation
• Absence of agglutination in all tests indicates compatibility
• Agglutination in any test indicates incompatibility
Limitation
• Will not detect errors in Rh typing
• Will not detect some weakly reactive antibodies
9. Documentation
• Enters results cross-match register book
• Must be signed by performed technicians and counter signed by checked persons
10. Annex
• Compatibility report form
Daily Work Sheet for Cross Matching
Sheet No. _____________
Date. _____________
Patient Donor Compatible by

Blood
Sr No Remark
Test Donor Component
Name Age Hospital Ward R/N ABO Rh ABO Rh IS 37°C AHG
ID ID
Key Positive = +
Negative = 0
Test Done by _________________________
4.3. INFECTION SCREENING
(က) သ ွေးမှတစ်ဆင် ကူွေးစက်နင

ို ် ည် သရာဂါမ ာွေး သ ွေး င်ွေးကို ခံမည် လူနာ ို မကူွေးစက် နင
ို သ
် စရန်
(က) လူနာမ ာွေး ို သပွေး င်ွေးမည် သ ွေးအာွေးလံိုွေးကို Syphilis, HIV, HCV စစ်သဆွေးမှုမ ာွေး ဖပြုံလိုပ်ရမည်။
အခါအာွေးသလ ာ်စာထိုတ်ဖပန်သ ာစစ်သဆွေးမှုမ ာွေးကိုလည်ွေး လိုက်နာသဆာင်ရက်ရမည်။
(ခ) စစ်သဆွေးရာတင် WHO ကဖပဌာန်ွေးထာွေး ည် sensitivity 100% ရှသ ာ Test-Kit မ ာွေးကို ာ
အ ံိုွေးဖပြုံရမည်။
(ဂ) Test Kitကိုထတ

ို ်လိုပ်သ ာ ကိုမပဏ၏ ညန် ကာွေးခ က်အတိုငွေး် တတက က လိုက်နာအ ံိုွေးဖပြုံ ရမည်။
(ဃ) ပိုွေးစစ်သဆွေးသတွေ့ ရှသ ာ သ ွေးလှူရှငမ

် ာွေးအာွေး က်ဆိုငရ
် ာသဒ တင်ွေးအသဖခအသနကိုလိုက်၍ လအ
ို ပ်
သ ာ သဆွေးသနွေးပညာသပွေးမှုရရှရန် စစဉ်သပွေးရမည်။
4.4 PREPARATION AND SYSTEMATIC STORAGE OF BLOOD AND
BLOOD COMPONENTS
(က) သ ွေးအတင်ွေးပါဝင် ည် အစတ်အပိုငွေး် မ ာွေးကို သရာဂါအလိုက် လိုအပ် လို သပွေး င်ွေး နင

ို ရ
် န်အတက်
က်ဆိုငရ
် ာပစစည်ွေးမ ာွေးအဖြစ် ို ခထိုတ်ဖပင်ဆင်ဖခင်ွေးဖြစ် ည်။ (ဥပမာ - Red Cell, Plasma,
Platelet, Factor concentrate etc.)
(ခ) သ ွေးပစစည်ွေးမ ာွေးကို ၎င်ွေးတိုနှင် ငသ

် လ ာ်မည်ပတ်ဝန်ွေးက င်အသဖခအသနမ ာွေးတင် ခထိုတ် ဖပင်ဆင်ဖခင်ွေး
အာွေးဖြင် က်ဆိုငရ
် ာဇဝကမမဂိုဏ် တတမ ာွေး မသပ ာက်ပ က်သစဘ ထသရာက်စာ အ ံိုွေးခ နင
ို ရ
် န်
(ဂ) သ ွေးလှူရှငတ
် စ်ဦွေး လှူဒါန်ွေးသ ာသ ွေးမှ သ ွေးပစစည်ွေး (၃) မ ြုံွေးခန ် ခထိုတ်ဖပင်ဆင်နင
ို ် ဖြင် မလအ
ို ပ်
ဘသ ွေးလှူရှင် အမ ာွေးအဖပာွေး ရှာသြရမှု မရှသစရန်
လိအ ် ချက်မျ ွေး

(က) သ ွေးပစစည်ွေးမ ာွေးအာွေးလံိုွေးအတက်သ ွေးလှူရှငစ
် စစ်သရွေးခ ယ်ပံို ကဖပာွေးဖခာွေးနာွေးမှုမရှသပ။ မည် ည်သ ွေး
ပစစည်ွေးကိုထတ
ို ်ယူလို ည်ဖြစ်သစ၊ စစစ်သရွေးခ ယ်ပံိုမှာအတူတူပင်ဖြစ် ည်။ ိုရာတင် သအာက်သြာ်
ဖပပါခခင်ွေးခ က်မ ာွေးကို ရှလိုက်နာက င် ံိုွေးရမည်။
(ခ) Plasma or FFP ထိုတ်ယူလိုပါက သ ွေးလှူရှင် ည် အမ ြုံွေး ာွေးဖြစ်ရမည်အဖပင် ပထမဆံိုွေး အကကမ်
လှူဒါန်ွေးဖခင်ွေး မဖြစ်သစရ။
(ဂ) SDP ထိုတ်ယူလပ

ို ါက ပထမဆံိုွေးအကကမ်လှူဒါန်ွေးဖခင်ွေး မဖြစ်သစရ။ သ ွေးသြာက်ယူမည် သနရာတင်
သ ွေးဖပန်သ ကာမ ာွေး ကကွေးမာွေးထင်ရှာွေးသပေါ်လင်ရမည်။ အကိုက်အခသပ ာက်သဆွေး တစ်မ ြုံွေးမ ြုံွေး ၇၂ နာရ
အတင်ွေး ံိုွေးစထာွေးဖခင်ွေး မရှသစရ။
(ဃ) Plasma နှင် Platelet ထိုတ်ယူလိုပါက သ ွေးသြာက်ယူရာတင် ပိုက်ထ၌ သ ွေးစွေးဆင်ွေးမှု ည်
ရပ်တန် ာွေးဖခင်ွေး၊ သနှာငသ

် နှွေး ကန ် ကာဖခင်ွေးမ ာွေး မဖြစ်သပေါ်သစရ။
(င) လိုအပ် ည်ပစစည်ွေးမ ာွေးနင

ှ ် ခထိုတပ
် ံိုနင
ှ လ
် ိုအပ်သ ာကရယာမ ာွေးကို ပူွေးတပါသနာက် ဆက်တ (ခ)
တင်သြာ်ဖပထာွေး ည်။
Preparation of Blood Components
1. Preparation of Red Cell Component
Process Equipment Required
• Collect Blood • Multiple /Double Bags
• Blood Collection Monitor
• Centrifuge at heavy spin at 5°C • Refrigerated Centrifuge
• Remove plasma • Plasma Expresser
• Clamp the tubing between primary and satellite • Tube Sealer
bags
• Cut the linking between the bags
• Weigh the bag containing plasma and that • Blood Weighing Scale
containing RBCs
• Check to ensure the donor number in the primary
bag and satellite bags are the same
• Store RBCs in the refrigerator at 2-6°C • Refrigerator
2. Preparation of Fresh Frozen Plasma (FFP)

• Collect Blood • Multiple bag
• Centrifuge blood at heavy spin (1-6°C)(to be done • Refrigerated centrifuge
within 6 hours of collection)
• Express plasma • Plasma expresser
• Seal the tubing between primary and satellite bags at • Tube sealer
two places
• Weigh plasma bag • Blood weighing scale
• Check to ensure that the donor number in the
primary bag and satellite bags are the same
• Store plasma at -18°C lower within 6 hours of • Deep freezer
collection
3. Preparation of platelets from Whole Blood
• Collect Blood • Triple Bag
• Keep it at 20-24°C (room temperature) for about 1 •

hour
• Separate platelet rich plasma from RBC by • Refrigerated centrifuge

centrifuging at 20°C light spin
• Express supernatant PRP into to second bag (platelet • Plasma expresser

storage bag)
• Seal the tube at tube points between the primary • Tube sealer
bag and Y connector and cut between the seals
• Store RBC at • Centrifuge PRP at 20°C using a • Refrigerated centrifuge

1-6°C heavy spin
• Express supernatant platelet poor plasma into the • Plasma expresser

second transfer bag and seal the tubing, minimum of • Tube sealer
70ml of plasma should be left in the bag along with
platelets.
Platelet poor Store platelets at 20-24°C gently • Platelet agitator with

plasma stored as agitating it (shelf life – 72 hours) incubator
FFP
4. Preparation of Cryoprecipitate

Collect blood in multiple bag Triple bag
Centrifuge blood at heavy spin (1-6°C) (to be done within Refrigerated centrifuge
6 hours of collection)
Express supernatant plasma into the second bag Plasma expresser
Seal the tube at tube points between the primary bag and Tube sealer
Y connector and cut between the seals
Freeze plasma rapidly at -65°C or lower (FFP for Deep freezer
cryoprecipitate preparation may be stored at -18°C or
lower for up to 12 months)
Thaw FFP at 1-6°C by placing the bag in refrigerator until it Refrigerator
has a slushy consistency. Centrifuge at 1-6°C using heavy Refrigerated centrifuge
spin
Hang the bag in an inverted position allowing the
supernatant plasma to flow rapidly into the transfer bag.
This leaves the cryoprecipitate adhering to the sides of the
primary bag. 10-15 ml of supernatant plasma may be left
in the bag to resuspend the cryo after thawing.
Seal the tube Tube sealer
Refreeze immediately Deep freezer
Place the thawing plasma in a plasma expresser Plasma expresser
Express plasma
Seal the bag when 90% of the cryoprecipitate poor plasma
has been removed
The cryoprecipitate paste adhering to the sides of the bag Deep freezer
or to the ice (from the semi frozen plasma) is refrozen
immediately
Store cryoprecipitate at -18°C or lower Deep freezer
Chapter (5)
Waste disposal
(က) အလိုပ်လိုပ် မ
ူ ာွေးနင
ှ ် ပတ်ဝန်ွေးက င်ကို မထခိုကသ
် စရန်
(က) စနပ
် စ်ပစစည်ွေးမ ာွေးအာွေးလံိုွေး မမဌာနမှ မထိုတယ
် ူ ာွေးမ အာွေးလံိုွေး ပိုွေး တ်ပပွေးဖြစ်သစရမည်။
(ခ) စန်ပစ်ပစစည်ွေးအမ ြုံွေးအစာွေးအလိုက် အ ံိုွေးဖပြုံရမည် ပိုွေး တ်မှုနည်ွေးစနစ်ကို အမ ြုံွေး ာွေး က န်ွေးမာသရွေး
ဓါတ်ခဌာနမှ ထိုတ်ဖပန်ထာွေးသ ာ ညန် ကာွေးခ က်မ ာွေးအတိုငွေး် လိုက်နာလိုပ် သဆာင်ရမည်။
မှတခ
် ျက်။ ။ ဓါတ်ခခန်ွေးမှအ ံိုွေးဖပြုံပပွေးပစစည်ွေးမ ာွေး (eg. tips, tube, glass slide, etc..) မ ာွေး နှင်
သ ွေးနမူနာအာွေးလံိုွေးကို မစနပ
် စ်/မသဆွေးသ ကာမ 1% Hypochlorite Solution နှင် နာရဝက်
ခနစ
် မ်ပပွေးမှ စနပ
် စ်/သဆွေးသ ကာရပါမည်။ (1% Hypochlorite Solution ကို Blanching powder
28gm နှင် သရ ၁ လတာသြ ာ်ဖခင်ွေးဖြင် ရရှနင

ို ပ
် ါ ည်)။ (ဟင်ွေးခတ်ဇန်ွေး ( Zebra ဇန်ွေး) ၅ ဇန်ွေးခန)်
Chapter (6)
Monitoring and Evaluation
လ ် ငန်ွေးစစ်သ ွေး ွေး ် မှုနင
ှ ် ခ ြုခ င်သ င် က်မှု
(က) တစ်နင
ို င
် လ
ံ ံိုွေးတင် သ ွေး င်ွေးကို မှု လိုပ်ငန်ွေးမ ာွေး သနရာသဒ ၊ အသဖခအသနမ ာွေးအလိုက် ကဖပာွေးမှုရှ
သ ာ်လည်ွေး တတ်နင
ို ် မျှ ပူွေးသပါင်ွေးသဆာင်ရက်ရန်
(က) က်ဆိုငရ
် ာ တိုငွေး် /ဖပည်နယ် သဒ အ ွေး ွေးရှ သ ွေးလှူဘဏ်တာဝန်ခံမ ာွေးမှ မမတိုသဒ တင်ွေးရှ
သ ွေး င်ွေးကို မှု လိုပ်ငန်ွေးမ ာွေး၏ စာရင်ွေးဇယာွေးမ ာွေးကို လစဉ် စိုသဆာင်ွေးဖပြုံစိုသပွေးရန် (ပံိုစံ ၄)
(ခ) ရရှထာွေး ည် အခ က်အလက်မ ာွေးကို အမ ြုံွေး ာွေးသ ွေးဌာန ို စိုစည်ွေးတင်ဖပရန်
(ဂ) သပွေးပိုရမည်အခ က်အလက်မ ာွေးနင

ှ ် အခါအာွေးသလ ာ်စာ စစ်သဆွေးရမည် အခ က်အလက်မ ာွေး တူညသစ
ရန် ပူွေးတပါ ပံိုစံမ ာွေးကို အ ံိုွေးဖပြုံရမည်။
လစဉ်သ ွေး ိ မည် အချက်အလက်မျ ွေး
Blood Collection Volunteer Replacement Total

A
B
O
AB
Other ____________________
Other ____________________
Sub Total
Volunteer Replacement
TTI Total
New Rep Total New Rep Total
Donor
HIV Positive
HBsAg Positive
HCV Positive
VD Positive
Defer Male Female Total

Hemoglobin
Blood Pressure
Low Body Weight
Risk Behavior
Other
Total
Blood Components
Total Blood Whole Other
Pack Cell FFP Cryo Platelet
Donation Blood (Specify)
Form (5)
Check List for Monitoring and Supervision
National Blood Center
Date: _____/_____/______
Name of Supervisor/Visitor: __________________
1. Name of Hospital - _____________________________________________

a) No. of Bed: - _____________________________________________
b) Past history of supervisory visit: □None; □1st Time (____); □2nd Time (____); □3rd Time
(_____________)
c) Address : ____________________________________________________________; Phone No:
_____________________
d) Responsible person (Contact Person): _________________________________________
2. Training Experience
a) By NBC in _______________________________________________________________________
b) By NHL for refresher training in ________________________________________________
3. Staffs for Blood Transfusion Services

Shift 1 Shift 2 Shift 3
: ~ : : ~ : : ~
:
a) Pathologist
b) Medical Officer
c) Med Tech
d) Grade I Lab Tech
e) Grade 2 Lab Tech
f) Nurse
g) Lab Assistant
h) Lab Clerk
i)
1) Blood Transfusion Committee: □Have ; □ No ;

(Comment)______________________________________________________________________
2) Specific Building for Blood Bank: □Have ; □ No ;
(Comment)_____________________________________________________________________
3) Enough Blood Bottle/Unit: □Have ; □ No ;

(Comment)_____________________________________________________________________
4) Medicine (FBC, FeSo4): □Have ; □ No ;

(Comment)_____________________________________________________________________
5) ACD Bottles/Blood Bags □Have ; □ No ;

(Comment)_____________________________________________________________________
6) Donor Sets □Have ; □ No ;

(Comment)_____________________________________________________________________
7) Stock Register □Have ; □ No ;

(Comment)_____________________________________________________________________
4. Refrigeration:
Equipment Br Year Monito Mainten Auto Temp Cleani
an Purch ring ance Temp Alarm ng
d ased Record Record Logger
Blood □Yes □Yes □Yes □Yes
Storage □No □No □No □No
Refrigerator □Broken □Broke
1 n
2 n
3 n
Freezer 1 □Yes □Yes □Yes □Yes
□No □No □No □No
□Broken □Broke
n
Freezer 2 □Yes □Yes □Yes □Yes
□No □No □No □No
□Broken □Broke
n
Obtained all copies of record? □Yes □No _____________________
Are blood units touching the wall of fridge? □Yes □No _______________________
Checked if blood temperature indicator is properly functioning? □Yes □No

Is staff reading the proper temperature indicator? □Yes □No ________________
5. Room Temperature Control:

Room Monitoring Door Remarks
Record Control
Collection Room □Yes □No □Yes

□No
Blood Store Room □Yes □No □Yes
□No
Test Lab □Yes □No □Yes
□No
Agitator Room □Yes □No □Yes
□No
Obtained all copies of record? □Yes □No ___________________________

6. Appropriate Use of Register Books:
a) Donor Register Book: □Yes; □No (Comment) ___________________________
b) Testing Result Book □Yes; □No (Comment) ___________________________
c) Blood Issue Register □Yes; □No (Comment) ___________________________
7. Send Monthly Blood Report for _______________: □Yes; □No

8. Appropriate Donor Deferral
a) By Questionnaire □Yes; □No

(Comment) __________________________________________________________________________________
By By Physical Check up and Hb Estimation □Yes; □No (Comment)

______________________________________________________________________________________________
b) By Interview Conducted by Trained Staff □Yes; □No (Comment)

______________________________________________________________________________________________
9. 100% Blood Screening Tests
1) HIV □Yes; □No (Comment) _______________________________________________________

2) HBV □Yes; □No (Comment) _______________________________________________________
3) HCV □Yes; □No (Comment) _______________________________________________________
4) VDRL □Yes; □No (Comment) _______________________________________________________
5) Malaria □Yes; □No (Comment) _______________________________________________________
10. TTIs Prevalence
1. Year: ________ 2. Year: _______ 3. Year: ________
Annual Test No. Annual Test No. Annual Test No.
__________ __________ ____________
HIV ______ ( %) HIV ______ ( %) HIV ______ ( %)
HBV ______ ( %) HBV ______ ( %) HBV ______ ( %)
HCV ______ ( %) HCV ______ ( %) HCV ______ ( %)
VDRL ______ ( %) VDRL ______ ( %) VDRL ______ ( %)
PMCT______ ( %) PMCT______ ( %) PMCT______ ( %)
11. Source of Blood Donors

New Repeat
Total
Donor Donor
NBC
Voluntary Donor
Replacement from Donor
Organization
Replacement from Relatives
Other hospital ( )
Total
12. Safer Donor Recruitment Activities
1) Blood Donor Organization: □Yes; □No

Supported by TMO, NGO
2) Recruitment from Safer Donor Groups □Yes; □No

3) IEC Material Use □Yes; □No
4) Education for or Blood Donors/Public □Yes; □No
13. Register for Blood Transfusion Reaction : □Have; □No
14. Discarded Blood Units:
Q’ty Remarks
Reactive
Expired
Damaged
Total
15. Use of BMS (Blood Management System)
Yes/No Remarks
Checking Eligibility by □Yes □No
BMS?
Entering all donation data? □Yes □No If not, number of data entered:
Entering all test data? □Yes □No If not, number of data entered:
Entering all issued units? □Yes □No
Entering all discarded □Yes □No
units?
16. Reactive Units Removal Process

Yes/No Remarks
Double Signing Off Process? □Yes □No
Using Multiple Identifiers? □Yes □No
Using barcode for confirmation? □Yes □No
Internal audit done periodically? □Yes □No
17. Pest Control :
18. Other Concerns:
Chapter (7)
The needs for organized setup in transfusion service
ပပွေးဖပည်စံိုသ ာသ ွေး င်ွေးကို မှုလပ

ို ်ငန်ွေးဖြစ်လာသစရန်အတက် သအာက်ပါအြွေ့/ လူပိုဂြုံ္ လ်မ ာွေး
ြွေ့စည်ွေးပါ ဝင်ရန် လိုအပ် ည်။
၁။ က်ဆိုငရ
် ာသဆွေးရို ံမ ာွေးတင်အမ ြုံွေး ာွေးသ ွေးလိုပ်ငန်ွေးစဉ်အရ သ ွေးဘဏ်ကကွေး ကပ်သရွေး သကာ်မတမ ာွေး
ြွေ့စည်ွေးနင
ို ရ
် မည်။ ယင်ွေး ို ြွေ့စည်ွေးဖခင်ွေး၏ ရည်ရယ်ခ က်မ ာွေးမှာ
(က) လိုပ်ငန်ွေးကကွေး ကပ်မှု ဖပြုံလိုပ်ရန်
(ခ) လိုပ်ငန်ွေးလိုအပ်ခ က်မ ာွေး ရှာသြ ံိုွေး ပ်မှုအတက် စမံရန်
(ဂ) သ ွေးလှူရှင် ရှာသြစိုသဆာင်ွေးမှု ဖပြုံလိုပ်ရန်
(ဃ) Volume replacement therapy ဖပြုံလိုပ်နင
ို ရ
် န်
(င) သ ွေး င်ွေးကို မှုလိုပ်ငန်ွေးမ ာွေး၏ အရည်အသ ွေးဖမင်မာွေးသစရန်အတက် လိုအပ်သ ာ
သငသ ကွေး အရင်ွေးအနှွေး လံိုသလာက်စာရှသစရန်
၂။ သ ွေးဘဏ်ကကွေး ကပ်သရွေးသကာ်မတတင်သအာက်သြာ်ဖပပါပိုဂ္ြုံလ်မ ာွေးကိုထည် င်ွေး င် ည်။

(က) သဆွေးရို ံအိုပ်ခ ြုံပ်သရွေးအရာရှမ ာွေး/ တာဝန်ခံ ဥကကဌ
(ခ) သဒ ဆိုငရ
် ာအာဏာပိုငမ
် ာွေး
(ဂ) သစတနာဝန်ထမ်ွေးပါဝင် ူမ ာွေး/ သစတနာလူမှုသရွေးအြွေ့ မှပိုဂြုံ္ လမ
် ာွေး
(ဃ) ကို သရွေးတင် တာဝန်ယူ ည် သဆွေးပညာရှငမ
် ာွေး
(င) သ ွေးဘဏ်လိုပ်ငန်ွေး ကျွမ်ွေးက င် ူ သဆွေးပညာရှငမ
် ာွေး/ တာဝန်ခံ
(စ) ူနာဖပြုံမ ာွေး
(ဆ) သဆွေးဝါွေးကျွမ်ွေးက င်ပညာရှငမ
် ာွေး
(ဇ) သ ွေးဘဏ်တာဝန်ခံ/ သရာဂါသဗဒဆရာဝန် အတင်ွေးသ ွေးမှူွေး
၃။ သ ွေး င်ွေးကို မှုလိုပ်ငန်ွေးအတက် သရာဂါသဗဒပညာရှငန

် င
ှ ် ၎င်ွေး၏ လက်သအာက်ရှ ဓါတ်ခကျွမ်ွေးက င်
ပညာရှငမ
် ာွေး ခနထ
် ာွေးယံို ာမက သအာက်သြာ်ဖပပါပိုဂြုံ္ လ်မ ာွေး ပါဝင် ည် အြွေ့တစ်ြွေ့ကိုလည်ွေး အမ ြုံွေး ာွေး
သ ွေးလိုပ်ငန်ွေးစဉ်နှငအ
် ည ွေးဖခာွေးြွေ့စည်ွေးသစရမည်။
(က) လက်သထာက်ဆရာဝန်(အပမတမ်ွေးတာဝန်ခ ထာွေး ူ/ အလှည်က တာဝန်ခ ထာွေး ူ/
ပမြုံွေ့နယ် က န်ွေးမာသရွေးအရာရှ/ ပမြုံွေ့နယ်ဆရာဝန်)
(ခ) ူနာဖပြုံ
(ဂ) ရံိုွေးဝန်ထမ်ွေး
(ဃ) သဆွေးလူမှုွေ့ဆက်ဆံသရွေးအရာရှ(အခ န်ပိုငွေး် / အခ န်ဖပည်)
Part II
Guidelines for Handling and Usage of
Blood Components
Guidelines for Handling and Usage of Blood Components| 50
Introduction
Blood transfusion can be a life-saving intervention. However, like all treatments, it may
result in acute or delayed complications and carries the risk of transfusion-transmissible
infection, including HIV, Hepatitis viruses, syphilis and malaria.
The safety and effectiveness of transfusion depend on two key factors:
1. A supply of blood and blood products those are safe, accessible at reasonable cost
and adequate to meet national needs.
2. The appropriate clinical use of blood and blood products.
Principles of Clinical Transfusion Practice
1. Transfusion is only one part of the patient’s management.

2. Prescribing should be based on national guidelines on the clinical use of blood, taking
individual patient needs into account.
3. Blood loss should be minimized to reduce the patient’s need for transfusion.
4. The patient with acute blood loss should receive effective resuscitation (intravenous
replacement fluids, oxygen, etc.) while the need of transfusion is being assessed.
5. The patient’s hemoglobin value, although important, should not be the sole deciding
factor in starting transfusion. This decision should be supported by the need to relieve
clinical signs and symptoms and prevent significant morbidity or mortality.
6. The clinician should be aware of the risks of transfusion-transmissible infections in the
blood products that are available for the individual patient.
7. Transfusion should be prescribed only when the benefits to the patients are likely to
outweigh the risks.
8. The clinician should record the reason for transfusion clearly.
9. A trained person should monitor the transfused patient and respond immediately if any
adverse effects occur.

Section (A)
Component Therapy
This section shall provide technical guidelines and knowledge about blood and blood
components, their use, handling and hazards particularly directed towards those medical
officers who will be assigned to Blood Transfusion Services (BTS) throughout the country,
and those technicians who will be responsible for preparing, storing and issuing of blood
and blood components for clinical use. This guideline is to be helpful rather than restrictive.
The concept of blood component therapy refers to the transfusion of a special
constituent of blood according to patients need, as opposed to the routine transfusion of
whole blood. This not only conserves blood sources, but provides the optimal method of
transfusion for patients who require large amount of a specific blood component.
Processing whole blood into components marks it possible to develop optimal storage
condition for maximal functional recovery over a prolonged period of time. One donation
unit can benefit several patients. After all, there are few indications for transfusion whole
blood.
1. Red Cell Components
Red cell components are essentially red cells in blood prepared by a variety of methods
for various purposes. There are five kinds.
1.1 Types of Red Cell Components

1) Whole blood
2) Red cell suspended in optimal additive solution
3) Red cell packs for pediatric use
4) Leukocyte-poor red cell
5) Washed red cell
6) Frozen-thawed deglycerolized red cell
1.1.1. Whole Blood

Donation collected into single pack are not processed into components (300 ml whole
blood plus 42 ml CPDA-1; HCT 0.35-0.45). It contains all the cellular and plasma constituents

of blood, subject to changes on storage. In practice, stored blood contains no functioning
platelet or granulocyte and is defective in haemostatic properties.
Indications
Primarily used to treat patients who are actively bleeding with loss >25% of the blood
volume.
Contraindications
Whole blood should not be used to raise the haematocrit in chronic anemia. These
patients have normal or elevated plasma volume and are susceptible to volume overload.
Red cell concentrate should be used for such purposes.
There are insufficient scientific data to support the use of fresh whole blood (within
24 hours of collection) rather than stored blood products . Blood that has not
undergone full microbiological testing must be considered unsafe for transfusion.
1.1.2. Red Cells Suspended in Optimal Additive Solutions

Most donations are collected into Quadri-packs where plasma and platelets are
separated. The remaining red cell concentrate (220-300 ml) is then suspended in 100 ml
additive solution (combinations of saline, adenine, dextrose and/or mannitol). Final volume
365 (+ or -) 45 ml; HCT 0.55 (+ or -) 0.04.
Additive solution enables -
▪ Maximum harvesting of plasma;
▪ Longer shelf-life (42 days);
▪ Lower viscosity to facilitate administration.
However, it is not suitable for –
▪ Neonates and infants;
▪ Open heart surgery;
▪ Anemic patients with hypoproteinaemia, eg. Burns.
1.1.3. Red Cell Packs for Pediatric Use

Red cell packs for pediatric use to avoid wastage and limit donor exposure. Multiple
packs of small volume for pediatric use can be prepared.
Fresh blood (< 72 hours old) is needed for neonatal use, especially for exchange
transfusion. Red cells up to one week old are suitable for such purposes.

1.1.4. Leukocyte Poor Red Cells
Leukocyte depletion can be achieved by many methods with varying degrees of success.
Centrifugation in a closed quadruple-bag system can remove about 80% of the leucocytes.
The red cell concentrate is then suspended in 100 ml of adenine additive solution, with HCT
of 0.6.
By using leucocytes filter either pre-storage or pre-transfusion can remove 99.9% of
white cells.
Indications
Severe and recurrent (at least 2 episodes) febrile non-hemolytic transfusion reactions.
Prevention of HLA alloimmunization in patients requiring repeated transfusion or if bone
marrow transplantation is envisaged, eg. Patients suffering from severe aplastic anemia.
As an alternative to using CMV negative blood in susceptible hosts.
1.1.5. Washed Red Cells

Saline washed in an open system. Use within 12 hours of preparation.
Indications
Plasma depletion, for IgA deficient recipients who may develop anaphylaxis to transfused
plasma proteins. PNH, not essential but advocated.
1.1.6. Frozen-Thawed-Deglycerolized-Red Cells

The freezing of red cells with special cryoprotectants permits red cell storage for up to 10
years. Reconstitution for use requires special cell washing equipment which is time
consuming and expensive.
Indication
Useful for storing red cells of rare phenotypes.
1.2. General Guidelines for preparation of Red Cell Components
Source
Non-remunerated donation from healthy donors.
Storage
Between 2 to 6 °C in approved blood refrigerator equipped with a temperature chart and
alarm. It should never be left in domestic type refrigerators.

Shelf-life
Depending on the type of anticoagulant used.
Whole Blood CPDA-1 35 days
Red Cell preparation Adenine additive 42 days
Compatibility
Must be ABO compatible. Donor units and recipient will be typed for ABO & Rh(D)
status. Unless in life-saving emergency endorsed by medical staff, major cross-match
between recipient’s serum and donor’s red cells must be performed to rule out
compatibility. Antibody screening is desirable; it is more sensitive than the major cross-
match.
RhD-ve individuals should ideally receive RhD-ve blood. However, due to shortage of
supply, available D-ve blood will be issued according to priority:
1. D-ve individuals with anti-D.
2. D-ve females prior to menopause.
3. D-ve parous women with no detectable anti-D. (Depending on the sensitivity of the
screening test, they may still be immunized with very low levels of anti-D
undetectable by laboratory test).
4. Other D-ve individuals.
Dose
One unit of Red Cell increases Hb by 1 g/dl or Hct by 3% in 70kg adult.
Administration
Through a blood giving set, at a rate determined by the clinical condition, but each unit
should be complete within 4 hours. Change blood filter after 12 hours to avoid possible
bacterial contamination and growth.
1.3. Indication for Red Cell Transfusion

Red cell (RC/RBC) transfusion increases oxygen-carrying capacity by increasing the
hemoglobin (Hb) concentration and circulating red cells mass.
Red Cell Transfusion is indicated in –
(a) Bleeding (Acute blood loss – Trauma or gastero-intestinal Bleeding)
(b) Perioperative Setting (c) Anaemia

1.3.1. In Active Bleeding
• Maintenance of normovolemia is the single most important strategy for ensuring
adequate tissue perfusion.
• Source of bleeding should be identified early and appropriate action should be taken
immediately, including endoscopic or surgical control of bleeding.
• Up to 40% of the blood volume in a bleeding healthy young adult can be replaced with
crystalloid without the need for red cell transfusion.
Recommendations for Red Cell Transfusion in Bleeding
A blood volume loss Red Cell Transfusion in Bleeding

15%
Transfusion is not required.
(750 ml in adults)
RC transfusion is usually not necessary unless the patient
has pre-existing anaemia, reduced cardiorespiratory reserve
15–30%
or if blood loss continues. (Transfuse crystalloids or colloids
(800–1500 ml )
first)
RC transfusion is probably necessary.

30–40%
(requires rapid volume replacement with crystalloids or
(1500–2000 ml)
colloids)
> 40%
Rapid volume replacement including red cells is indicated.
(> 2000 ml)
• In patients with haemorrhage and haemodynamic instability, estimation of blood loss

may be difficult and Hb is a poor indicator of the need for transfusion. When
normovolaemia has been achieved/maintained, frequent measurement of Hb should
be used to guide the use of red cell transfusion
• For a single transfusion episode in adult patients with a potentially reversible cause of
anaemia e.g. after surgery, consider transfusing one unit only with a further Hb
estimation before further units are given.

1.3.2 Red Cell Transfusion in Peri-Operative Setting
(I) PREOPERATIVE EVALUATION

Where possible, preoperative evaluation should be done well in advance to correct or
plan for the management of risk factors associated with transfusions.
Preoperative evaluation should include:
• Review of previous medical records
• Interview of the patient or family
• Physical examination of the patient
• Review of laboratory test results including haemoglobin and coagulation profiles
The aim is to identify risk factors:
• Organ ischemia (e.g. cardiorespiratory disease), which may influence the ultimate
transfusion trigger for red blood cells (e.g. haemoglobin level)
• Coagulopathy (e.g. use of warfarin, clopidogrel, asprin), which may influence
transfusion of non-red blood cell components
• History of congenital or acquired blood disorders e.g. haemophilia, ITP, liver cirrhosis
• The use of vitamins or herbal supplements that may affect coagulation.
(II) PREOPERATIVE PATIENT PREPARATION

Preoperative patient preparation includes optimization of haemostatic function (including
discontinuation of antiplatelet drugs and management of patients on oral anti-coagulation) to
prevent perioperative bleeding.
If a patient admitted for elective surgery or an invasive procedure is found to have
thrombocytopenia or an abnormal coagulation screen, the procedure should be postponed
until the cause of the abnormality is identified.
Preoperative preparation should include:
❖ Discontinuation or modification of antiplatelet and anticoagulation therapies
• Aspirin and clopidogrel should be discontinued at least 7 days prior to planned-

surgery unless there is a strong contraindication for stopping it.
• Vitamin K or another warfarin antagonist should be used for reversal of warfarin to
potentially avoid transfusion of fresh frozen plasma (FFP).
• The effects of warfarin may last for several days depending on patient response and
the administration of reversal agents (e.g. vitamin K, prothrombin complex
concentrate, recombinant activated Factor VII, or FFP). The risk of thrombosis versus

the risk of increased bleeding should be considered when altering anticoagulation
status.
❖ Administration of prophylactic pharmacologic agents
• Administering of prophylactic pharmacologic agents prophylactically should be

considered to promote coagulation and minimize blood loss (e.g. tranexamic acid).
• Prevention or reduction of allogeneic transfusion requirements:
o Specific attention should be paid to the detection, investigation and appropriate
treatment of anaemia in advance of major elective surgery.
o Correction of haemoglobin before surgery with measure other than red cell
transfusion (e.g. iron replacement or erythropoietin) should be considered where
appropriate.
o Erythropoietin may be administered in anaemic patients to reduce the need for
allogeneic blood in selected patient populations (e.g. chronic renal insufficiency,
anaemia of chronic disease, refusal of transfusion).
o Pre-operative transfusion is rarely required when Hb > 10g/dl and no differences
have been found between patients who received transfusions to maintain their
Hb > 10g/ dl and those who received transfusions only when symptomatic or if
Hb fell below 8 g/dl.
o Where suitable and indicated, autologous blood donation should be considered.
• Liaise with Blood Bank to ensure that blood and blood components are available for
patients when significant blood loss or transfusion is expected.
• The management of perioperative bleeding would otherwise follow the guidelines as
for acute blood loss. In the event of unexpected, considerable, blood loss, this may be
treated as major blood loss.
1.3.3. In Anaemia
❖ The cause of anaemia should be established
❖ Red cell transfusions should not be given where effective alternatives exist unless the
anaemia is life threatening

❖ Decision to transfuse red cell should be based not only on Hb concentration, but also on
other factors like underlying cause, amount and rate of blood loss, presence of
coagulopathies, the risk of further bleeding, severity and chronicity of the anaemia, the
patient's clinical condition and ability to compensate, body temperature, and other risk
factors or co-morbidities, etc.

Recommendations for Red Cell Transfusion in Anaemia
Hb level at which RC transfusion is

Clinical Conditions
indicated
Stable non- bleeding patients Hb < 7 g/dL
Hb < 7 g/dL - at least as effective

Critical Care
and possibly superior to transfusion
at Hb <10g/dL.
Patients with cardiovascular disease Hb < 8 g/dL or for symptoms

Patients with severe sepsis, traumatic brain injury
Hb < 9 g/dL
and/or acute cerebral ischemia
Patients with co-morbidities and risk factors Hb 7-10 g/dL
(age>65years, cardio/ respiratory diseases, etc.) Depend on clinical assessment
Radiotherapy
Hb < 10 g/dL
(In patients receiving radiotherapy for cervical and
possibly other tumors.)
• Hb > 10 g/dL: RBC transfusion is not indicated

• Hb between 7-10 g/dL: Transfusion should be guided by clinical signs and symptoms,
coexisting medical problems, other important risk factors as well as clinical assessment.
• Chronic Anaemia: In asymptomatic patients with chronic anaemia or anaemia
treatable by specific therapy, (eg. treatment of iron deficiency or autoimmune
hemolytic anaemia) the cause of anaemia should be investigated and treated first. Red
cell transfusion is not usually required even if Hb is < 7g/dL unless the anaemia is life
threatening.
• Symptomatic: Transfuse to maintain haemoglobin just above the lowest level that is not
associated with symptoms.
• Haemoglobinopathy: Haemoglobinopathy patients frequently require individualized Hb
thresholds for trans-fusion depending on their age and the precise indication; discussion
with a haematologist is advised.
• Erythropoietin should be considered when it is indicated, e.g. chronic renal failure,
anaemia of chronic illness, haematologic malignancies.
• Its safety and efficacy profile has been established including its role in reducing exposure
to allogeneic blood and its attendant risks.

• However, reports of anti-erythropoietin antibodies have been described with
subcutaneous administration of erythropoietin and although rare, are important as they
can cause red cell aplasia.
• Hemodynamically stable patients with acute coronary syndrome: No strong
recommendation existed (cannot recommend)
• Elective surgery: Most patients will not require transfusion support if their Hb is normal
before surgery.
• Bleeding in elderly patients, or those with underlying anemia or other comorbid
factors: may need to be transfused following a blood loss of < 30% (<1500ml).
• Active upper gastrointestinal bleeding: Transfusion at Hb < 7 g/dL has better outcome
compared to transfusion at Hb <9 g/dL.

2. Platelet Concentrates
2.1 Types
1) Random donor platelets
2) Single Donor Platelets
2.1.1 Random Donor Platelets
Source
Prepared from individual unit of fresh whole blood by centrifugation.
Description
Each pack contains not less than 55x 10 9 platelets in 50-60 ml of plasma with variable
amounts of red cells (usually < 1.2 x 109/unit) and leucocytes (<0.12 109/unit).
2.1.2 Single Donor Platelets
Source
By aphaeresis.
Description
The platelet content, volume of plasma and leucocyte contamination varies widely
depending on procedure. Usually contain 150-500 x 109 platelets (equivalent to 3-8
single donations) in 150-300 ml plasma.
Indications
Usually HLA-matched (compatible) with recipient for management of platelet
refractoriness due to HLA allo-immunization.
Precautions
Use of “random” unmatched single-donor platelets for patients unresponsive to routine
random-donor platelets without knowing the presence of HLA antibody or for those who
have not been HLA typed is not an appropriate use of the product.
Storage
At 20-24 degree Celsius, with constant gentle agitation.
Shelf-life: 5 days.

2.2 General Consideration for Platelet Transfusion
Thrombocytopenia does not always correlate with abnormal bleeding. Hence the
decision for platelet transfusion should not be used based on platelet count alone but take
into consideration of clinical situation of the patient and other risk factors for bleeding.
These include fever or sepsis, presence of other coagulopathies, coexistent medical
conditions including liver disease and renal failure and the rapidity of fall of the platelet
count.
Platelet transfusion should be given as close to the procedure as possible for the best
haemostatic effect.
Platelet count should not be used as the only indicator for transfusion and bleeding time is
not a good indicator for risk of bleeding.
The cause of thrombocytopenia should always be established before considering platelet
transfusion unless there is life threatening bleeding.
If platelet transfusion is administered in certain conditions such as heparin-induced
thrombocytopenia, thrombotic thrombocytopenic purpura or haemolytic uraemic syndrome,
there can be possible exacerbation of the clinical situation. In these conditions, platelet
transfusion should only be given after risks associated with transfusion have been considered
and only when benefits outweigh the risks.
There is no difference in the efficacy, post-transfusion yield, haemostatic efficacy and
frequency of transfusion reactions between aphaeresis platelet and random donor platelet if
the same quantity of platelets is given.
The major risk of platelet transfusion is bacterial contamination (1:10,000). There is also
the risk of human leucocytes antigen (HLA) alloimmunization with platelet transfusion.
Indications
Prophylactic and therapeutic, against significant thrombo-cytopenia or
thrombocytopathy.
Platelet transfusion is advisable when:

• Platelet count <20 x 109/L and not ITP, TTP or HUS.
• Platelet count <50 x 109/L and active bleeding or scheduled for invasive procedure (e.g.
liver biopsy, lumbar puncture, epidural anesthesia, etc.) within 8 hours.
• Platelet count <70 x 109/L and patient scheduled for surgery with >2 units of anticipated
blood loss within 8 hours.

• Platelet count <100 x 109/L perioperatively and surgery in a critical area (e.g. brain, eye).
Severe platelet dysfunction with active bleeding or scheduled for invasive procedure.
Unexpected bleeding or petechiae in a patient with bleeding time > 15 min not due to
uremia or concurrent anti-platelet drugs.
Less Well-Defined Indications:

• Massive blood transfusion. Clinically significantly dilutional thrombocytopenia only
occurs with transfusion > 1.5 times the blood volume of the recipient. The platelet count
should be maintained above 50 x 109/L
• Cardiopulmonary bypass (CP) surgery. Mild thrombocytopenia and functional defects
are expected to occur after CP bypass. There is no ground for giving prophylactic
platelet transfusion. It should be reserved for patients with bleeding not due to surgically
correctable causes.
• Disseminated intravascular coagulation (DIC). Not indicated in chronic DIC in the
absence of bleeding.
In acute DIC where thrombocytopenia is suspected to contribute to bleeding, give
supportive platelet transfusion in addition to coagulation factor replacement.
Not Indicated
• ITP - Platelet transfusion is usually ineffective. However, with major bleeding, massive and
frequent platelet transfusion may be lifesaving.
• Post-transfusion purpura - Platelet transfusion is ineffective even if they are prepared from
donors negative for the target platelet alloantigen.
• Thrombotic thrombocytopenic purpura (TTP) - There are reports of rapid
deterioration and death associated with platelet transfusion in patients with TTP.
• Provided adequate external pressure is applied to the puncture site, bone marrow biopsy
may be performed in patients with severe thrombocytopenia without platelet support.
• Uremia - Consider dialysis, correcting the haematocrit to > 0.30, and DDAVP in uremic
from platelet dysfunction.
• Angioplasty.
Compatibility
• ABO compatibility is preferred but not essential.
• Cross-matching is not required.

• The donor plasma should preferably be ABO compatible with the recipient’s red cells if they
are not group-specific.
• RhD-ve patients should ideally receive RhD-ve platelets; the red cells present may cause
immunization.
• If Rh+ve platelets were given to Rh-ve females who have not reached menopause should
receive anti-D immunoglobulin, 250 IU (50µg) for every 5-6 units.
Dose
5-6 units of platelet transfusion should raise the platelet count by 20-40 x 109/L in a 60-
70 kg adult. (Less if there is splenomegaly, DIC, fever, septicaemia, alloantibodies, or is
receiving chemotherapy). For paediatric patients, give 1 unit/ 10 kg body weight.
Administration
Transfusion as soon as possible and not longer than 6 hours after issue from the hospital blood
bank. Do not refrigerate. Transfusion should normally be completed within 30 minutes.
Administer through a standard blood transfusion set or a special platelet transfusion set, (not
an IV set).
3. Granulocytes
Usually not indicated because of severe reaction and doubtful effectiveness. Use of GCSF
may be indicated in cases with severe neutropenia.
4. CMV- sero negative Blood Component

Theoretically indicated in following conditions:
o Low-birth-weight neonates (<1500g) born to seronegative mothers (or if status is
unknown)
o Seronegative recipients of seronegative donor bone marrow (allogenic BMT)
o Seronegative recipients of seronegative solid-organ transplant
However, in this part of the world, CMV seronegative blood is very rare, since CMV
antibodies are positive in > 90% of the population.

5. Irradiated Blood Components
The prime purpose of irradiation is to prevent transfusion-associated graft-vs-host
disease (TA-GVHD).
Indication
• Severe suppression of cellular immunity
▪ Bone marrow transplantation recipients
▪ Congenital immunodeficiency syndrome (However- AIDS patients do not appear to
be risk for TA-GVHD)
• May be indicated in
▪ Fetus requiring intrauterine transfusion
▪ Hodgkin’ Disease
▪ Transfusion from first degree relatives
• Cellular blood components implicated in TA-GVHD
▪ Whole blood/Red cells components
▪ Platelets
▪ Leucocytes
(Fresh frozen plasma, clotting factor concentrate and frozen deglycerolized red cells
have not been implicated in TA-GVHD)
Dosage
Usually 15-25 Gy of gamma irradiation
Effect of irradiation and shelf-life

• Irradiation at the usual dosage causes minimal damage to platelets, granulocytes, and
red cells. This, however, does not significantly affect their in vivo function after
transfusion.
• There is currently no official guideline regarding shelf-life after irradiation.
• Platelets and granulocytes should be transfused as soon as possible.
• Red cells recovery is acceptable up to 28 days post-irradiation.
• Neonates and patients with renal impairment should receive freshly irradiated blood to
avoid the potential risk of hyperkalaemia.

6. Fresh Frozen Plasma
Source
Primarily separated from single unit of blood donated within 8 hours and rapidly frozen
at or below -30 °C.
Description
200-250 ml in volume. It contains normal plasma level of all clotting factors, albumin and
immunoglobulin. Factor VIII level should be greater than or equal 0.7 IU/ml.
Storage
May be stored for up to 1 year at or below -18 °C, lower temperature is preferable.
Indication
It should only be used to treat bleeding episodes or prepare patients for surgery in
certain defined situation.
General consideration
• Routine and timely tests for coagulopathy such as the prothrombin time (PT) or
international normalized ratio (INR), activated partial thromboplastin time (APTT), platelet
count and fibrinogen level as well as haemoglobin, haematocrit should be obtained to
guide decision on plasma transfusion. These results should be integrated with a
thorough assessment of patient’s clinical condition and the presence of risk of bleeding.
• Abnormal prothrombin time (PT)/international normalized ratio (INR) or activated partial
thromboplastin time (APTT) result should not be the sole reason for plasma transfusion
as they do not correlate well with bleeding risk and only a small proportion of patients
with abnormal results will experience bleeding manifestations.
• All attempts must be made to identify the underlying cause of a coagulopathy and
manage this appropriately together with efforts to correct such abnormality with plasma
transfusion if necessary
• A comprehensive personal and family history of bleeding is the best preoperative screen
for bleeding in surgical patients. In the event that preoperative prothrombin time (PT)
and partial thromboplastin time (PTT) tests are performed and found to be abnormal, its
significance should be carefully considered and if necessary, further discussed with a
haematologist.

Definite Indications
• Specific factor deficiencies where treatment with factor concentrate or cryoprecipitate is
not appropriate.
(i.e. factor II, V, VII, X, XI and mild IX)
• Correction of warfarin overdose in patients who bleed, and when factor concentrate is
unavailable. Intravenous vitamin K should be concurrently given for sustained reversal of
warfarin level.
• Supportive therapy in acute DIC.
• Plasma exchange for Thrombotic Thrombocytopenic purpura (TTP) and haemolytic
ureamic syndrome (HUS). Cryosupernatant may also be considered as an alternative.
• Hereditary angioneurotic oedema (C1 esterase inhibitor deficiency)
• Pseudo cholinesterase deficiency
Conditional use
• Clinical coagulopathy (supported by laboratory evidence) associated with
o Massive transfusion (> 10 units of blood in 24 hours) Massive blood transfusion,
especially with evidence of micro vascular bleeding and associated with significant
(>1.5 x midpoint of normal range) abnormalities in prothrombin time (PT) and
activated partial thromboplastin time (APTT). When PT and APTT cannot be obtained
in a timely fashion, it is reasonable to give fresh frozen plasma after replacement of
one volume while waiting for result.
o Advanced liver disease, bleeding due to coagulopathy associated with chronic liver
diseases.
• Cardiopulmonary bypass
o In the presence of post-operative or micro vascular bleeding not due to surgically
correctable cause, initial consideration should be with platelet concentrates.
• FFP should only be used to correct proven coagulation abnormalities other than residual
heparin effects.
No justification
• Hypovolaemia
• “Formula replacement”
(The practice to give FFP after a predetermined amount of blood transfusion (i.e. 1 unit of
FFP following every 4-6 units of blood) is unwarranted.)
• Chronic DIC associated with haemorrhages.

• Plasma exchange procedure, except for replacement of coagulation factors after multiple
large volume plasma exchanges and thrombotic thrombocytopenic purpura (TTP) and
haemolytic ureamic syndrome (HUS).
• Reversal of warfarin effect in the absence of bleeding. Oral or intravenous vitamin K
should be the therapy of choice in this instance.
• Nutritional support.
• Treatment of immunodeficient states.
Compatibility
• Cross match is not required
• must be ABO compatible to recipient’s red cells
• whenever possible D-ve FFP to D-ve females prior to menopause
• If D+ve FFP is administered, anti-D immunoglobulin for prophylaxis (50 IU per unit of FFP
transfused) may be considered.
• Although small amount of red cell stroma may be present in fresh frozen plasma (FFP), it
is less immunogenic than intact red cells. Sensitization following RhD positive to RhD
negative patients is unlikely. FFP of any Rh type may be given regardless of Rh status of
the patient.
Blood group compatibility for Plasma infusion
Recipient’s blood group Donor’s blood group

O O, A, B, AB
A A, AB
B B, AB
AB AB
Dose
• depend on the clinical situation
• the initial dose for factor replacement for an adult should be 12-15 ml/kg (approx. 2-4
units)
• for TTP, at least 3L/day are generally given
Administration
• Thaw at 30-37°C in a water bath with constant agitation (Never under hot water taps).

• All precipitate must be resuspended for maximum benefit.
• Since water bath may be contaminated with bacteria, it is recommended to protect the
plasma units with plastic overwraps.
• After thawing, infuse as soon as possible.
• If delay is unavoidable, store at 1-6°C for no more than 6 hours after thawing.
• Infuse through a standard blood giving set at a rate not greater than 10ml/min, within
not more than 30 min.
7. Cryoprecipitate
Source
Precipitate obtained from fresh frozen plasma by controll-ed gradual thawing at 4-8°C.
Resuspended in 10-20 ml of plasma and refrozen until use.
Description
Each pack contain approximately 150-250 mg of fibrinogen, 60-100 IU Factor VIII, 40-
70% of the Factor VIII: vWF and 20-40% of factor XIII and fibronectin present in starting
plasma.
Storage & shelf-life

Stable for up to 2 years at or below -30°C.
Indications
• As an alternatives to Factor VIII concentrate in the treatment of von-Willebrand’s disease
and haemophilia A where DDAVP and Factor concentrate are inappropriate or
unavailable.
• Significant hypofibrinogenemia (< 100 mg/dL)
• Factor XIII deficiency
• Uraemic bleeding with prolonged bleeding time, if DDAVP not appropriate.
Compatibility
• Use ABO compatible product however possible but no cross-matching is required.
Dose
• Calculate the dose of Factor VIII for haemophilia A and von Willebrand’s disease by the
following formula.

Dose (IU) = Body Wt. (Kg) x Desired increment/2
• The number of packs of cryo needed is calculated by dividing the number of units of
Factor VIII needed by 80.
• (1U/5kg/day in divided doses for Factor VIII)
• (1U/7-10kg/day in divided doses for Fibrinogen)
Administration
• Use plastic overwrap to protect the units from contamination
• Thaw at 30-37°C in a water bath with manual agitation, thawing occurs rapidly (about 10
min).
• Rinse each pack with small volume of sterile saline to maximize recovery of factor VIII.
• Must be administered immediately through a standard blood giving set at a rate not
exceeding 10ml/min.
• If thawed cryo is not used immediately, store at room temperature for no more than 6
hours.
8. Factor Concentrate
Source
Fractionate from pool plasma or synthesized by recombinant technology.
Replacement therapy in Haemophilia

• Treatment depends on the location and severity of bleeding
• Bleeding or surgery in critical areas i.e: brain, posterior pharynx, or closed compartments
– usually required more aggressive treatment than muscular or joint bleeding
• Bleeding episodes should be treated as quickly possible, before visible objective findings
appear because the longer the bleeding the more difficult to treat and more factor
replacement is required.

Acute management of haemorrhages
• Desired trough level of factor VIIIC or IX (% of normal) in various clinical circumstances.
Indication Haemophilia A Haemophilia B
Mild Bleeding 20 – 30% 15 – 20%

• Early haemarthrosis (Single dose may (Single dose may be
• Mild haematoma be adequate if adequate if given early
• Epistaxis given early)
• Haematuria
Definite/threatening haemorrhag 50% 40%

• Haemarthrosis or haematomas with pain &
swelling
• Head trauma without neurological deficit
• Severe trauma without evidence of bleeding
• Gastrointestinal bleeding
• Suspected intra-abdominal bleeding
Life-threatening 80-100% 60-70%

• Intracranial haemorrhage (keep < 80% because
• Major trauma with bleeding of thrombo-genicity)
• Major surgery
• Compartment syndrome
Maintenance therapy (Depend on the clinical situation)

• Single dose for early subjective haemarthrosis or muscle bruising.
• 2-4 days for dental extraction& established haemarthrosis.
• Management of a bad haemarthrosis requires replace-ment therapy, adequate rest with
splinting, and 2-3 months period of prophylactic replacement to prevent re-bleed.
• Severe haemorrhages into the ilio-psoas causing fixed flexion deformity of hip and
neurological deficits usually require prolonged treatment (> 1 month) before there is
noticeable improvement. Maintain high FVIII: C level as for major surgery.
• Pseudo tumors are very difficult to manage.

Surgery
• Before any operation, one must exclude presence of factor inhibitor and confirm that the
expected degree of FVIII:C rise is attained.
▪ For minor surgery
o Dental extraction – raise approximately 30-40% immediately preoperatively.
▪ For major surgery
o Factor level 80-100% at the time of operation is optimal.
o Postoperatively – maintain between 40-100% for 5-12 days.
Calculation of factor VIII & IX dosage

• Dose (IU of FVIII) = Body Wt (Kg) x Desired increment / 2
• Initial half-life of infused VIII: C is 3-6 hour
• During equilibration with extravascular space, the half-life is 8-12 hours
• VIII: C should be given 8-12 Hly
• Dose (IU of F IX) = Body Wt (Kg) x Desired increment
• The half-life of FIX is approximately 12 hrs – maintenance dose at Q18-24HL

Section (B)
Transfusion Practice
1. Ensuring Compatibility (Pretransfusion practice)

• Most fatal hemolytic transfusion reaction arise from clerical errors
• Essential to have SOPs for compatibility testing, with positive identification of patients
and blood sample
1.1 Taking Blood Samples from Patient for Compatibility Test

• Identify patient (wrist-bands are advisable).
• Obtain required samples.
• Sample tube must be clearly labeled including name of patient, age, Registration No.,
Ward.
• Do not pre-label a number of tubes for several patients prior to venipuncture.
• Send together with a properly completed request form including reason for request
(Haemoglobin level for request of red cells, platelet count for platelet preparation, PT for
cryo & FFP) to hospital blood bank.
• Signature of doctor who take responsibility of that request.
A history of recent transfusion should be taken, and obtain samples close to the
date of transfusion.
Pregnant or transfused within preceding 3 Obtain sample within 72 hours of scheduled

months transfusion
Obtain sample within 24 hours of the
Transfuse within 10 days
scheduled transfusion
1.2 Laboratory Tests

• Blood grouping: ABO & Rh (D) status.
• Antibody screening: Currently performed by a few hospital laboratories.
It has the advantages of -
(a) More sensitivity
(b) Early detection of alloantibodies
• Cross-matching: Only major cross-matching performed.

1.3 Transfusing infants
If infant < 4 months:
• Both infant & maternal samples should be ABO & Rh grouped.
• Maternal serum should be screened for alloantibodies.
• Infant’s red cells should be tested for direct AHG tests.
• If both of above are negative, blood that matches ABO & Rh for the infant is issued.
• Cross-matching is optional.
If infant is suffering from haemolytic disease of newborn; or if alloantibodies are
detected in the maternal serum:
• Use maternal serum for compatibility testing
• Issue blood that matches with that of the mother; this may dictate use of blood group O
1.4 Final identity check prior to transfusion

Before issue, check:
• Patient’s Identity
• Patient’s blood group
• Type of component used
• Date & time of issue
2. Administration of blood transfusion

The systems and processes involved in the transfusion pathway are very complex.
Transfusion (from unrelated donor to a recipient) is:
▪ a form of allogenic transplant, and
▪ inevitably carries a risk
2.1 Key Principles of Safe Blood Administration

Three key principles which must be strictly followed at every stage of blood
administration process include:
1) Patient identification
2) Documentation
3) Communication

2.1.1. Patient Identification
Positive patient identification – ESSENTIAL AT ALL STAGES of BLOOD TRANSFUSION
PROCESS:
• Blood sampling
• Collection of blood from storage and delivery to wards
• Administration to the patient
[Positive means the patient MUST be asked to state their full name and date of birth and/or
age, and father’s name]
For patients who are unable to identify themselves; e.g. pediatric, unconscious or
confused patients or where there is language barrier, verification of patient's identification
should be obtained from a parent or care giver (if present). This information must match
exactly the information on the patient’s identification in patient’s medical notes. If there are
discrepancies in patient’s identification; the information must be verified, and the
discrepancies must be investigated and corrected before proceeding to the next stage of the
transfusion process. They must never be assumed to be clerical errors.
2.1.2. Documentation
Full and complete documentation is required at every stage of the blood transfusion
process.
2.1.3. Communication
Clear and unambiguous communication between all staffs involved in the transfusion
process, including all clinical and laboratory staff and any other support staff, is essential.
3. Administration of Blood Components

KEY ACTION POINTS
Positive patient identification at all stages of blood transfusion process is essential.
1) Patient Information and consent
2) Prescription and requests for transfusion
3) Pre-transfusion blood sample collection
4) Collection and delivery of blood components to the clinical area
5) Administering blood
6) Monitoring during transfusion
7) Completion of transfusion episode and Record keeping

3.1. Patient Information and Consent
• Proposed blood transfusion if there is no any alternatives, (clinical indication for
transfusion).
• Relevant pre-transfusion indices (e.g. full blood count, coagulation screen).
• If the date of decision for transfusion is different from the date of actual transfusion, all
the dates need to be recorded accordingly.
• The blood component to be transfused and their number of units.
• Benefits and hazards (including possible transfusion reaction) of blood transfusion.
• Pre-transfusion documentation in patient medical note
• Consent to proceed.
3.2. Prescription and Request

Complete blood request form - Clearly and accurately (see Example of form)
• Patient’s identification - Name (In Myanmar)
o Date of Birth/Age, Gender
o Registration No.
o Hospital/Ward (± Bed Number)
• Current diagnosis
• Reason for request (clinical/ lab data)
• Blood component (Type, Volume, Number of unit required)
• Requested date of transfusion
• Signed by Doctor (Name, Ward, Hospital)
3.3. Pre-transfusion blood sample collect-ion (Pre-transfusion Testing)

• Positive patient identification by the house physician or nursing staff who took the
sample
• should be checked again by medical officer who signed for requisition form
• Sample tubes must be clearly labeled at the patient’s side by the individual who took
the sample
• Sample tubes should not be pre-labeled
• Label: Patient’s name, Age, Gender, Hospital RN, Ward, Hospital, Date, blood group if
known

3.4. Collection and Delivery of Blood Compo-nent to the Clinical Area
• Ensure the patient is ready to start & has patent venous access
• Date and time of collection and staff identification detail must be recorded
• Should be delivered to the clinical area without delay with transfusion carrier box.
3.5. Administering Blood

• Positive patient identification at bedside
• All patient information must match the details on the patient medical note, blood
request form and the blood component label
• Undertaken by 2 people, at least one doctor or nurse
• Blood administration set should be used for all blood component transfusion
Blood Component Check

▪ Date of donation ,Expiry date
▪ Component donation number, blood group
▪ Type of component
▪ Time of issue
▪ Inspect blood component pack (e.g. sign of leakage, damaged packing)
▪ Inspect blood component (e.g. unusual color, turbidity, blood clot)
Time schedule for transfusion after issue
Blood Started Start

Complete
Component at (after issue)
2 - 6°C
Whole blood Within 30 minutes Within 4 hrs
(Never freeze)
2 - 6°C Within 2 - 3 hrs
Packed red cells Within 30 minutes
(Never freeze)
Platelet Never refrigerate As soon as possible Within 30 - 45 minutes
FFP
(Never freeze) As soon as possible Within 30 minutes
(after thawing)
Cryoprecipitate Never refrigerate As soon as possible Push

3.6. Monitoring during transfusion
• Observation for every unit transfused
• Never leave the transfused patient unmonitored
• Minimum monitoring:
o Close observation of pulse rate (>20% of pre-transfusion HR), BP(>20% of systolic BP),
T°(>1.5°C), respiratory rate before and first 5 -15 minutes after the start of each unit
o Periodical visual observation towards the end of transfusion
• Done by Doctor or Nurse on duty
• If transfusion reaction is suspicious, stop transfusion, monitor and record the vital signs,
give appropriate and necessary immediate action, and inform to FA / consultant.
3.7 Completion of Transfusion episode and Record Keeping

• If a further blood component is prescribed, repeat the administration/ identification
check with each unit.
• If no further units prescribed, remove the blood administration set.
• Don't continue other IV infusion with the current used blood set.
• Record keeping:
o Date and Time of starting transfusion and end of transfusion.
o Blood group, type, number of blood component transfused.
o Pre and post transfusion vital signs.
o Any transfusion reaction and action.
o Signed by Doctor or Nurse on duty.
DON'T FOR BLOOD TRANSFUSION

▪ Don't use blood from immediate relatives if possible. (risk of transfusion associated
GVHD)
▪ Don't warm blood pack in a bowl of hot water or under the tap water.
▪ Don't add any medication to the blood bag.
▪ Don't leave the transfused patient unmonitored.
▪ Don't store platelets in a refrigerator.
▪ Don’t transfuse whole blood or Packed red cells over >4hrs.
▪ Don't use the IV infusion drip set for any blood component transfusion.
▪ Don't forget to return unused blood units to blood bank for safe disposal.
▪ Don't give IV Calcium injection unless massive blood transfusion is given.

3.8. Adverse Reactions to Transfusion
An adverse reaction to transfusion is defined as an undesirable response or effect in a

patient temporally associated with the administration of blood or blood component. It may
be the result of an incident or of interaction between a recipient and infused blood, a
biologically active product.
Each blood or blood component transfused carries a risk of an acute or delayed effect
and for this reason; physicians prescribing the transfusion should carefully select patients
who will benefit from transfusion therapy according to established criteria. The indication for
transfusion should be documented in the medical record.
The aim of this guideline is to provide the hospital doctor, with the necessary tools to
recognize transfusion reactions and to concentrate on their immediate management. When
an adverse transfusion reaction occurs, medical and nursing personnel must be prepared to
recognize both acute (immediate) and delayed reactions, and be ready to provide the
immediate management. Because the signs and symptoms of different types of adverse
reactions overlap and their severity can vary considerably, all transfusions must be carefully
monitored and stopped as soon as symptoms of a reaction appear. Early recognition is the
key to minimizing serious complications.
Adverse reactions to transfusion can be categorized into acute (immediate) and delayed.
Acute (immediate) reaction usually presents within minutes to hours but usually within 24
hours of the transfusion. Acute reactions can be further divided into subgroups of presenting
signs and symptoms: fever and chills, hives or urticaria, dyspnea and hypotension.
Allergic reactions and febrile non haemolytic transfusion reactions are common but less
serious whereas acute haemolytic reactions, bacterial contamination, Transfusion Related
Acute Lung Injury and anaphylactic reactions are less common but life threatening.
Acute haemolytic reaction is commonly due to misidentification of the patient and
therefore positive identification of the patient at the bedside when taking blood for cross
match and before commencing transfusion is the most important step in the prevention of
this complication.
Delayed transfusion reactions usually manifest days or weeks after the completion of
blood transfusion. Recognition of signs and symptoms and correlation with an earlier
transfusion can aid in the correct management of the patient and in some cases even reduce
the potential complications.

Figure: An approach to diagnosing the type of likely transfusion related adverse event
Fever/Chills
Acute Hemolytic Bacterial Contamination

Febrile Non Haemolytic
Reaction Transfusion Reaction
Hives/Urticaria
With respiratory symptoms

No other symptoms and or hypotension
Anaphylatoid or Anaphylactic
Allergic Reaction (Mild)
(Severe)

Figure: An approach to diagnosing the type of likely transfusion related adverse event
(Continuation)
Dyspnea
Tachycardia
Hypertension
Transfusion Associated
Hypotension
Circulatory Overload (TACO)
CXR shows Rash/

infiltrates Urticaria
TRALI Anaphylaxis
Anaphylactoid
Hypotension
Acute Hemolytic Reaction Bacterial Contamination
TRALI Anaphylactoid
Anaphylaxic (Severe)

Categories and management of acute and delayed adverse reactions to transfusion
Grade D, Level 3
Diagnostic
Type Incidence/Aetiology Diagnostic Criteria/Presentation Management
testing
Acute – within 24 hours of transfusion
Allergic Reaction • Interaction of an • Mobilliform rash with or N/A • Diphynhydramine
(Mild)/ Urticarial allergen with without pruritis • Transfusion can be restarted if the symptoms and
preformed • Urticaria (hives) signs have subsided provided the incomplete unit
antibodies • Flushing can be completed within 4 hours of issuance
• Localized angioedema • Monitor closely for other signs and symptoms
Anaphylactoid • Antibody to donor • Mucocutaneous symptoms Rule out • Maintain airway; provide oxygen and ventilator
Anaphylaxis (Severe) plasma protein • Hypotension haemolysis support
(IgA, Haptoglobin, • Respiratory signs and • Treat hypotension with fluids, dopamine if
C4) symptoms may be laryngeal unresponsive
(tightness in throat, • Initiate transfusion reaction workup
dysphagia, dysphonia, • Do not initiate another transfusion without blood
hoarseness, stridor) or bank consultation
pulmonary (dyspnea, cough, • Premedicate with diphendydramine and or steroids
wheezing, bronchospasm, • Use of washed red cells (and platelets) in severe
hypoxemia) anaphylaxis

Diagnostic
Type Incidence/Aetiology Diagnostic testing Management
Criteria/Presentation
Hemolytic Reaction • results in • Chills/rigors • Clerical Check • Maintain airway; provide oxygen and
antigen/antibody • Fever • Check for Haemolysis ventilatory support
response with • Back/flank pain o Direct Coombs test • Hydration to maintain urinary output
activation of • Hypotension o Visual inspection • Diuretics to promote renal perfusion
complement and • Hemoglobinuria o Repeat patient ABO, pre- • Cardiovascular support with pressor agents if
subsequent • Oliguria / anuria and post-sample needed
intravascular • Disseminated o Further tests to detect • Treatment of disseminated intravascular
haemolysis intravascular haemolysis (LDH, Bilirubin, coagulation
coagulation etc.) • Initiate transfusion reaction workup; inform
• Pain or oozing at Blood Bank
IV site
Febrile Non • Cytokines • Fever (≥38C or a • Rule out haemolysis • Initiate transfusion reaction workup; inform
Hemolytic • Antibody to change of ≥1C • Rule out Bacterial Blood Bank
Transfusion donor white cells from pre- contamination • Leucoreduced components
Reaction transfusion value) • Premedication with antipyretics
• Chills / Rigors
• Headache
• Vomiting

Type Incidence/Aetiology Diagnostic Criteria/Presentation Diagnostic testing Management
• Anti- human • Acute respiratory distress within • Rule out haemolysis • Maintain airway; provide oxygen
Transfusion leucocyte antigen six hours of transfusion • Rule out cardiogenic and ventilatory support
Associated (HLA) and anti-HNA • Bilateral pulmonary infiltrates • Oedema • Treat Hypotension
Acute antibodies in donor on chest X-ray • Human leucocyte antigen • Supportive care
Lung Injury (occasionally in • Hypoxemia (02 sat ≤ 90% on (HLA) antibody screen • Initiate transfusion reaction
(TRALI) recipients) room air or PaO2 ≤ 300 mm Hg) • Chest X-ray workup; inform Blood Bank
• No evidence of circulatory
overload
• Hypotension (some cases
hypertension)
• Fever
• Transient Leucopenia

Diagnostic
Type Incidence/Aetiology Diagnostic testing Management
Criteria/Presentation
• Transfusion • Sepsis is the result of • Fever, often ≥ 2C rise • Rule out haemolysis • Maintain airway; provide oxygen and
Associated Sepsis transfusion of from baseline • Gram stain ventilatory support
(Bacterial contaminated blood • Chills / Rigors • Component culture • Hydration to maintain urinary output
Contamination) components • Hypotension • Blood culture on • Diuretics to promote renal perfusion
• The bacteria usually • Shock patient • Broad Spectrum Antibiotics
originate from the blood • Renal failure • Cardiovascular support with pressor
donor either from • Unexplained bleeding agents if needed
venipuncture (e.g. from muco-cutaneous • Treatment of disseminated
Staphylococcus, or infusion sites intravascular coagulation
Streptococcus) or • Initiate transfusion reaction workup;
unsuspected bacteremia inform Blood Bank
(e.g. Yersinia) but may
also result from donor
unit processing

Type Incidence/Aetiology Diagnostic Criteria/Presentation Diagnostic testing Management
Delayed – more than 24 hours from transfusion
Delayed Haemolytic • Anamnestic immune • Decrease in haemoglobin • Antibody screen and • Initiate Delayed transfusion
Transfusion Reaction response to red cell • Fever Identification reaction workup; inform Blood
antigens • Jaundice (Mild) • Direct Coombs test Bank
• Patient may be asymptomatic • Elution • Transfuse AHG crossmatch
• Test for haemolysis compatible blood; antigen
negative if indicated
Graft Versus Host • Donor lymphocytes • Fever • Skin biopsy • Immunosupressive agents
Disease (GVHD) engraft in recipient • Gastrointestinal symptoms • Human leucocyte • Irradiation of blood components
and mount attack on • Rash antigen (HLA) typing for patients at risk
host tissues • Hepatitis • Molecular Analysis
• Pancytopenia for Chimerism

References
▪ Handbook of Transfusion Medicine, United Kingdom Blood Services, 5th Edition (2013)
▪ American Association of Blood Bank (AABB) – Technical Manual, 13th Edition
▪ HAS-MOH Clinical Practice Guidelines 1/2011 – Clinical Blood Transfusion (2011)
▪ Handbook on The Clinical Use of Blood, World Health Organization (2001)
▪ Handbook of Transfusion Medicine, Hong Kong Red Cross Blood Transfusion Service
(1993)
▪ Guide to the preparation use and quality assurance of blood components, Council of
Europe Publishing, 7th Edition (2001)

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vlemtrnf ……………………………………………………………………… aoG;tkyfpk ……………………………………………………

taqmif ……………………………………………………………………… aq;&krH Swfykw
H iftrSwf …………………………………
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vufrwS f ……………………………… vufrw S f ………………………………

trnf ……………………………… trnf ………………………………
(vlemESihf awmfpyfykH) &mxl; ………………………………
taqmif ………………………………
aeYpJG ………………………………

Example of
BLOOD REQUEST FORM
HOSPITAL : ………………………………………. Date of Request: …………………………………

PATIENT’S PARTICULARS
Name (IN MYANMAR): …………………………… Father’s Name: ……………………………………………
Hospital Registration No: ……………………….. Date of Birth or Age: …………………; Sex: M / F
Ward: …………………………………………………….. Hospital ……………………………………….………………
Blood Group (If Known): …………………………
HISTORY
Diagnosis: Previous transfusion: Yes/No ……………………
……………………………………………………………….
Reason for Transfusion: Any reaction: Yes/No ……………………
……………………………………………………………….
Full Blood Count: Antibiotics: Yes/No ……………………
……………………………………………………………….
Relevant Medical History: Previous Pregnancy: Yes/No ……………………
……………………………………………………………….
REQUEST
Date required: Whole Blood: …………………… Units
……………………………………………………………….
Time required: Red Cells: …………………… Units
……………………………………………………………….
Deliver to: Platelet: ……………………. Units
………………………………………………………………. Other: …………………… Units
Signature: ………………………………………………….
Name of Doctor: ………………………………………………….
Designation: ………………………………………………….
Ward/Hospital: ………………………………………………….
Date/Time: ………………………………………………….
BLOOD ISSUE FORM
Issued ________________________ Unit of Cryo/FFP/OP/PRP/PPP

FB/WB/PC/Plt Con: /Buffy Coat
Patient's Name_________________ Age/Sex ___________________________
Hospital _______________________ Reg No ___________________________
Ward No. _______________________ Bed No. ___________________________
Date of indent _______________________ Indent No. ___________________________
Patient's Blood Group________________ Rh ___________________________
Group
Sr.No Donor ID Test ID Issue Date & Time
ABO Rh
Major/Minor cross matching between patient's & donor's blood show no agglutination
by Immediate Spin, 37C & AHG.
Issuing Officer
National Blood Centre
Yangon
Guidelines for Handling and Usage of Blood Components|| 90

POINTS TO REMEMBER
1. No blood is transfused without being checked by two persons, in respect to

correctness of the blood issued for the recipient.
2. Blood from the wards should be kept in the ward refrigerator without delay, if
transfusion is not immediately required. (Not in freezer) (Maximum allowed - 30
minutes)
3. If the blood kept at room temperature for more than 30 minutes, it must be
"Dangerous" and returned to National Blood Centre with full data.
4. In case of transfusion reaction, a report must be made to the Pathologist, National
Blood Centre, with a prescribed form accompanied by the unit of blood transfused
(In the giving set) and a post transfusion clot sample (5 cc) from vein different
from transfused one.

This manual is prepared by the Following Experts on (26.2.2010)
1. Dr. Ne Win
Director
National Health Laboratory
2. Dr. Daw Nu Nu Tha
Medical Superintendent
Yangon General Hospital
3. Dr. U Zaw Win
North Okkalapa General Hospital
4. Professor U Rai Mra
Professor / Head Of Department
Department Of Clinical Haematology
5. Professor Daw Khin Thandar Aye
North Okkalapa General Hospital
6. Professor U Tun Lwin Nyein
Magway Hospital
7. Professor Daw Aye Aye Myint
Department Of Pathology
University Of Medicine (1), Yangon
8. Professor Daw Aye Aye Than
9. Dr. Daw Hla Kyin

New Yangon General Hospital
10. Dr. U Aung Win
Central Women's Hospital
11. Dr. U Aung Kyi Win
Yangon Children's Hospital
12. Dr. Tin Tin Sein
East Yangon General Hospital
13. Dr. Khin Soe Soe Kyu
West Yangon General Hospital
14. Dr. Aung Lwin
Waibargi Specialist Hospital
15. Dr. Phyu Phyu
Tingangyun Sanpya Hospital
16. Dr. Kyaw Kyaw
Insein General Hospital
17. Dr. Win Thein
DDCP
18. Dr. Thida Aung
Associate Professor / Head-in-charge
19. Dr. Daw Aye Aye Gyi
Associate Professor
20. Dr. Htay Htay Tin

Associate Professor / Consultant Pathologist
21. Dr. Khin Swe Mar
Consultant Pathologist
22. Dr. Htay Hla
23. Dr. Tun Lin
Junior Consultant Pathologist
New Yangon General Hospital
24. Dr. Swe Sett
25. Dr. Su Le Htay
26. Dr. Aye Aye Win
Thingangyun Sanpya Hospital
27. Dr. Khwar Nyo Zin
Consultant Microbiologist
28. Dr. Nan Ei Khin
Medical Officer
29. Dr. Tun Aung Cho
Medical Officer
30. Daw Soe Soe Win
Computer Operator
31. Dr. Thida Moe - JICA

And approved by following Experts on (28.2.2011)
1. Dr. Ne Win
Director
2. Professor Rai Mra
Professor / Head of Department
Department of Clinical Haematology
3. Professor Nyunt Thein
Department Of Medicine
4. Professor Saw Win
Department of Pediatric
5. Professor Than Than Aye
Department Of Medicine
6. Professor Win Win Mya
Department of Obstetrics and Gynecology
7. Professor Mya Thidar
Department Of Obstetrics and Gynecology
8. Professor Aye Aye Myint
9. Professor Aye Aye Myint

10. Professor Tun Lwin Nyein
Department of Clinical Haematology
11. Professor Tin Latt
Department of Surgery
12. Dr. Khin Tin
13. Dr. U Aung Kyi Win
14. Dr. Thida Aung
Associate Professor / Head-in-charge
15. Dr. Daw Aye Aye Gyi
Associate Professor
16. Dr. Htay Htay Tin
Associate Professor / Consultant Pathologist
17. Dr. Khin Shwe Mar
18. Dr. Htay Hla

19. Dr. Win Thein
DDCP
20. Dr. Kyaw Swar Lwin
Assistant Medical Superintendent
21. Dr Aye Aye Khine
Paediatrician
Yangon Children’s Hospital

Representatives from International Society of Blood Transfusion (13th March 2015)
SrNo Name Designation
1 Dr. Peter Flanagan Immediate Post President, ISBT

National Medical Director
New Zealand Blood Service
2 Dr. Jean Claude FABER Member, WHO Expert Panel in Blood

Transfusion
Immediate Post-President, IHN President, ALH
(Luxembourg Hemophilia Association), CEO, LCT
(Luxconsul Transfusion)
3 Dr. Diana Teo Vice Presidnet, ISBT.

Senior Director, Blood Service Group
Health Science Authority
Chairman, Professional Board, Singapore
4 Dr. Thynn Thynn Yee Consultant Haematologist

National Center for Global Health and Medicine,
Tokyo, Japan
5 Prof: Sato Paediatric Oncologist

National Center for Global Health and Medicine,
Tokyo, Japan
6 Dr. Shotaro Hagiwara Chair of Haematology, National Center for

Global Health and Medicine, Tokyo, Japan
7 Dr. Ikuma Nozaki JICA-MIDC Project

Representatives from Myanmar National Society of Blood Transfusion
SrNo Name Designation
1 Prof: Rai Mra President, Myanmar Medical Association (MMA)
2 Prof: Htun Lwin Professor and Head, Department of Haematology, YGH

Nyein
3 Dr. Thida Aung Director, National Blood Center
4 Prof: Aye Aye Gyi Professor and Head, Department of Haematology, NOGH
5 Prof: Zaw Than Htun Professor, Department of Medicine, UM (1)
6 Prof: Kyi Kyi San Professor and Head, Department of Anaesthesiology and
ICU, YGH
7 Dr. Myat Mon Professor and Head, Department of Pathology, UM (1)
8 Dr. Tin Tin Cho Associate Professor, Department of Obstetrics and

Gynecology, UM (2)
9 Dr. Aye Aye Khaing Associate Professor, Department of Haemato-oncology,

YCH
10 Dr. Khin Phyu Pyar Senior Head, Clinical Research Unit
11 Dr. Tin Moe Mya Senior Head, Principal Diseases Research unit, DSMRC


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Guidelines For Blood Transfusion Service

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2nd Edition

Department of Medical Services

2018 (2nd Printing)

2nd Time Printing

Cooperation at all levels of health organization is the key to success in contemplating

Department of Medical Services

SOP - Standard Operating Procedure

Chapter (1) The Blood Transfusion Service…………………………………………………………………………………….3

Chapter (2) Pre – donation…………………………………………………………………………………………………………….5

Chapter (3) Donation…………………………………………………………………………………………………………………….18

Chapter (4) Post-Donation…………………………………………………………………………………………………………….26

Chapter (5) Waste disposal…………………………………………………………………………………………………………..41

Chapter (6) Monitoring and Evaluation………………………………………………………………………………………...41

Chapter (7) The needs for organized setup in transfusion service…………..……………………………………48

Section (A) Component Therapy…………………………………………………………………………………………………52

Section (B) Transfusion Practice ………………………………………………………………………………………………..73

Guidelines and SOP for

Administrative Tasks and Routine Procedures of

Blood Transfusion Services

The Blood Transfusion Service

Blood Transfusion is a procedure whereby blood or its specific components, whether

2.1 Candidate Selection

2.1.2. Selection သ ွေးလှူရှငစ

Background medical history

B. Conditions leading to temporary deferral (suspension)

D. Conditions requiring individual assessment

(3) Laboratory investigation

သ ွေးလှူဘဏ်၏ အသဖခအသနသပေါ်မူတည်၍ မှတ်တမ်ွေးတင်မှုအဆငဆ

(က) Computerized Software ထာွေးရှသ ာသ ွေးလှူဘဏ်မ ာွေးတင် အ ံိုွေးဖပြုံရမည် SOP

ဖခင်ွေး၊ ိုမဟိုတ် ွေးဖခာွေးစာရင်ွေး င်ွေးမှတတ

သနာက်သက ာတင် လူနာအမည်နင

တည်ွေးတင် မှတ်တမ်ွေးသရွေး င်ွေးရမည်။

(က) သဟမိုဂလိုဘင် စစ်သဆွေးရန် (Sarli Method)

(ခ) သ ွေးအိုပ်စိုခဖခာွေးရန် (ABO နှင် ရနင

(၅) အကယ်၍ သဟမိုဂလိုဘင် မဖပညမ

(က) သဟမိုဂလိုဘင် အသဖြကို ပံစ

သ ကာင်ွေး၊ လှူဒါန်ွေးလ င် အနတရာယ်ရှနင

(၆) သဟမိုဂလိုဘင် ဖပည်မပါက

(ဓါတ်ခဝန်ထမ်ွေးက ဖြည် င်ွေးသပွေးဖခင်ွေးမဖပြုံရ)

(ခ) သမွေးခန်ွေးမ ာွေးသဖြဆိုပပွေးပါက တာဝန်က ဓါတ်ခဝန်ထမ်ွေးက စစစ်ပပွေး သ ွေးလှူရှင် မှတ်ပံိုတင်

စာအိုပ် (၂) နှင် သ ွေးလှူရှငမ

ယခင်သ ွေးလှူခ ည်ရက်စ၊ သ ွေးအိုပ်စိုတက

(ဃ) အကယ်၍ ပိုွေးစစ်သဆွေးမှုတင် ပငစန်ွေး ည်အခ က်ရှခသ ာ် (သရာဂါပိုွေးတစ်ခိုခို စစ်သဆွေး

သတွေ့ ရှ ထာွေးခသ ာ်)

• HIVသတွေ့ ရှထာွေးပါက အဖခာွေးစစ်သဆွေးနည်ွေးမ ာွေးဖြငထ

သြာက်ယူဖခင်ွေး၊ အသဖြရရှ ည်အခါပိုွေးသတွေ့ ရှသ ကာင်ွေးသ ခ ာပါက နှစ် မ်

သဆွေးသနွေး ပညာသပွေး ဌာန ို လသဖပာင်ွေးသပွေးဖခင်ွေးမ ာွေး ဖပြုံလိုပ်ရမည်။

• အ ည်ွေးသရာင်အ ာွေးဝါ ဘ နှင် စ ပိုွေးမ ာွေးသတွေ့ ရှထာွေးပါက စစ်သဆွေးသတွေ့ ရှ ည်

အသဖြကို အ မသပွေး သ ွေးပ သ ွေးလှူဒါန်ွေးရန် မ ငသ

• ကာလ ာွေးသရာဂါပိုွေးစစ်သဆွေးသတွေ့ ရှပါက ခိုခအ

ကာလ ာွေးသရာဂါ တိုက်ြ က်သရွေးဌာန ို လသဖပာင်ွေးသပွေးရမည်။

• သရာဂါပိုွေးကင်ွေးရှငွေး် ပါကလိုပ်ထွေးံို လိုပ်နည်ွေးမ ာွေးအတိုငွေး် အဆငဆ

သဆာင် ၍ သ ွေး လှူရှင် သဆာြ်ဝလ်တင် ထပ်မံစာရင်ွေး င်ွေးမှတ်တမ်ွေးတင်ရမည်။

(က) HIV သရာဂါပိုွေး

(ဂ ) အ ည်ွေးသရာင်အ ာွေးဝါ ဘ ဗိုငွေး် ရပ်စပ

(ဃ) အ ည်ွေးသရာင်အ ာွေးဝါ စ ဗိုငွေး် ရပ်စပ

(၈) သရာဂါပိုွေးတစ်ခိုခို စစ်သဆွေးသတွေ့ ရှခပါက ပိုွေးစစ်မတ

သ ွေးလှူရှင် Software တိုတင် တပပြုံငန