OVERVIEW OF THE MODERN BLOOD BANK
LABORATORY AND CURRENT TRENDS
ORGANIZATION
• What is a Blood Bank Laboratory?
o A blood bank laboratory is defined
as a facility involved in the
collection, storage, processing, and
distribution of human blood and
blood products for transfusion.
o NOTE: All blood banks are non-
profitable.
• The blood bank laboratory also functions as a
component of the heavily regulated health-
care industry.
o Food and Drug Administration
(FDA)
▪ Is the regulating agency
o American Association of Blood
Banks (AABB)
▪ The accrediting organization
• The extent of services that a blood bank
offers may vary, depending on the location
and the set-up of the laboratory itself.
• Examples of services that a blood bank
provides:
o Blood Collection
o Blood Storage
o Donor Screening
o Blood Component Preparation
o Blood Typing and Cross-Matching
o Antibody Screening and
Identification
o Apheresis
BLOOD BANK AREAS AND FUNCTIONS
Component Preparation and Storage
• Depending on the needs of a hospital, blood
components may be acquired from external
sources such as the American Red Cross or
other regional blood centers, or components
may be processed in-house.
• It also depends on whether;
o A blood bank has a collection facility
o A blood bank does not have a
collection facility
Blood Banks w/ Collection Facilities
• Blood banks that collect their own units of
whole blood can use their blood resources
more efficiently by separating them into a
variety of components, including;
o Packed RBCs (pRBC)
o Platelet Concentrate (PC)
o Fresh Frozen Plasma (FFP)
o Frozen Plasma Prepared w/in 24
hours of collection (FP24)
o Cryoprecipitate (Cryo)
• After blood collection;
o Whole blood is allowed to cool to
room temperature (20°C to 24°C) if
platelets are to be prepared.
o OR it can be cooled to 1°C to 10°C
(ref temp) if the unit is to be
processed for frozen plasma.
• For fresh frozen plasma (FFP): must be
prepared w/in 8 hours of collection.
o FFP can further be processed to
cryoprecipitate.
• For FP24: can be prepared up to 24 hours
after collection.
• For platelet concentrate (PC): can be
prepared up to 24 hours of collection if
stored at room temperature (20-24 °C)
• Blood components may also be obtained
through apheresis;
o A donor’s blood is removed,
anticoagulated, and transported
directly to an apheresis machine.
• The blood is separated into specific
components by centrifugation within the
machine, and the desired component(s) is
removed.
• The remaining portion of the blood is
returned to the donor.
• Blood products obtained through Apheresis:
o Plateletpheresis
o Plasmapheresis
o Leukapheresis
o RBC apheresis
Components Made from Whole Blood and • Sterile connecting devices (STCDs)
Processes of Component Preparation o These devices produce sterile welds
between two pieces of compatible
tubing.
o This procedure permits sterile
connection of a variety of containers
and tube diameters.

• Some applications of STCDs:

Blood Banks w/o Collection Facilities

• Blood banks that depend on an outside
source for their blood supplies usually
receive their products in component form.
• Blood components such as platelet
concentrates, and cryoprecipitate may be
received as individual units but are more
easily administered if pooled before
infusion.
• However, situations do arise in which
products must be modified: COMMON BLOOD BANK EQUIPMENT
o E.g. a patient with IgA Deficiency
should not be transfused with
pRBCs; RBCs must be washed first
before transfusing.
o Automated Cell Washers are used
to prepare washed pRBCs

Donor Processing Area
• Before a unit of blood can be placed into the
general inventory, testing must be
performed to determine its suitability for
transfusion.
• Usually, two (2) separate tubes are collected
for testing purposes:
o Lavender Top (EDTA)
o Red Top (Plain)
Product Labeling
• Labeling of blood products may occur only
after a careful review of all test results shows
the unit to be suitable for transfusion.
• Suitability requirements include:
o No discrepancies in the ABO and Rh
testing
o Absence of detectable antibodies in
plasma- containing components
o Nonreactive viral marker tests
o Nonreactive syphilis test
• When the established criteria are met, the
RBCs and any other components are labeled
with the appropriate ABO, Rh, and expiration
date, and the products are stored at their
proper temperatures.
• Units received from outside sources would
have undergone the required testing and
been deemed suitable for transfusion by the
shipping facility.
• However, according to AABB Standards, the
blood bank to which this blood is shipped is
required to reconfirm the labeled ABO of
each RBC containing product received.
Main Laboratory
• Patient care is the primary mission of the
main laboratory.
• Here the testing is performed that
determines the compatibility between a
patient requiring transfusion and the unit of
blood to be transfused.
• Some tests performed in the main laboratory
may include:
 o Type and screen • Unusual cloudy or turbid appearance of
o Type and crossmatch platelet unit
o Prenatal evaluation
o Postpartum evaluation
o Cord blood studies

Main Laboratory – Sample Collection and

Acceptance
• Proper patient identification is the single
most important aspect of patient care in all
health-care settings.
• A minimum of two identifiers is required for
patient samples used for blood bank testing.
o PATIENT’S FULL NAME (First Name,
Middle Name, Last Name)
o DATE OF BIRTH and/or MEDICAL
RECORD NUMBER
Main Laboratory – Routine Testing
• Once a patient sample has been judged
acceptable, the testing requested by the
patient’s physician can be performed.
• These tests may include:
o Type and screen
o Type and crossmatch
o Prenatal evaluation
o Postpartum evaluation
o Cord blood studies
Issue of Blood Products
• After all, pretransfusion testing has been
completed, blood components may be
released for transfusion to the designated
recipient.
• The individual in the blood bank who will
issue the blood product inspects the unit for
any abnormal appearance and verifies that
all required transfusion forms and labels are
complete and that they adequately identify
the transfusion recipient.
RBC PRESERVATION AND CURRENT TRENDS
RBC Preservation
• The goal of blood preservation is to provide
viable and functional blood components for
patients requiring blood transfusion.
• RBC Viability : a measure of in vivo RBC
survival following transfusion.
• The U.S. Food and Drug Administration (FDA)
requires an average 24-hour post-
transfusion RBC survival of more than 75%.
• This is assessed as free hemoglobin less than
1% of total hemoglobin
• RBC units are stored at 1-6C°; storage time
may vary depending on the preservative
used.
• Storage Lesion: associated with loss of RBC
viability; due to biochemical changes within
the RBC.
• NOTE: Approximately 220 to 250 mg of iron
are contained in one RBC unit.
Storage Lesion of RBCs

Reasons to Quarantine Blood Components

Before Shipment or Transfusion
• Plasma of RBC unit is brown, red, murky, or
purple
• Plasma of RBC unit is green
• Zone of hemolysis is above RBC mass
• Inadequate sealing of RBC segments in
tubing
• Hemolysis of RBCs
• Grossly lipemic units
 Anticoagulant Preservative Solutions with a volume of approximately 300 to
400mL.
• The additive solution is contained in a
satellite bag and is added to the RBCs after
most of the plasma has been expressed.

Platelet Preservation
• What is the purpose of agitation?
o Agitation has been shown to facilitate
oxygen transfer into the platelet bag
Contents of Anticoagulant Preservative
and oxygen consumption by the
Solutions
platelets
o Agitation also maintains constant pH
inside the platelet bag.

Additive Solutions (AS) Performance Criteria for Platelet Concentrate

• Additive solutions (AS) are preserving Collections
solutions that are added to the RBCs after
removal of the plasma with or without
platelets.
• It is intended to replace the nutrients in the
plasma which were removed during packed
RBC preparation. It also helps to ease the
flow of RBCs during transfusion.
• Additive Solutions (AS) currently approved
by the FDA:
o Adsol
o Nutricel
o Optisol
o SOLX
• Additive solutions reduce hematocrits from
around 65% to 80% to around 55% to 65%
Platelet Storage Lesion