BLOOD DONATIONConcept of blood donation Blood is the stream of life. Lifesaving process

One glass of your precious blood, and less than one hour of your time can be your gift to a man, woman or child BLOOD DONORS: Historical Perspectives World War II-- stimulate voluntary blood donation Following War-- American Red Cross and other nonprofit blood services facilitate voluntary blood donation.

WHO DEFINITION OF VOLUNTARY BLOOD DONOR A donor who gives blood by his own initiative ( in community blood letting activities or as a walk-in donor in hospital blood banks). A donor who volunteers to give blood when requested or asked by a colleague, friend or family member. A donor who volunteers to give blood when requested or recruited to do so. A donor who volunteers to give blood when requested or recruited by the Blood Transfusion Services (BTS) or Hospital.

PHILIPPINE SCENARIO: NATIONAL BLOOD SERVICES ACT OF 1994 ( RA 7719 ) IMPLEMENTING RULES AND REGULATIONS (DOH AO NO. 9 s 1995) MAY 1998 Closure of all commercial blood banks. National Voluntary Blood Services Program ( NVBSP) Reinforce voluntary blood donation.

OBJECTIVES1. To ensure that all blood centers establish and maintain their own panels or regular voluntary non- remunerated donors.2. To get at least 4% of the donor age population to voluntarily donate blood regularly at least twice a year.3. To increase public awareness of the need of safe blood.

General Considerations on Blood Donation: The voluntary, unpaid donation of blood is a humanitarian act. What is needed is a strong political commitment which is effectively translated into substantial investments into a a systematic national effort to professionalize blood donor recruitment. DONOR SELECTION AND RETENTIONBasic principles that shall guide Donor Relations: Confidentiality Consistency and reliability Constant communication and contact Close relationship Good donor care and other services: safe, professional, pleasant Accessibility and warmthBlood Donors. Regular donors are safer than new occasional donors because they are better informed, are committed to helping others and are regularly screened for transfusion-transmitted infections.

CLASSIFICATION OF DONORS:I. VOLUNTARY DONORS (WALK-IN)II. MASS BLOOD LETTING PROGRAM (GOVERNMENT, NGO)III. REPLACEMENT DONORS.

Blood safety starts with quality of blood donors. Accurate and honest medical and social history must be obtained.

PHASES OF DONOR SCREENING Donor interview /history taking Physical examination Laboratory screening of blood

PRE-DONATION INTERVIEW DONOR must be assured confidentiality on the given information. Minimum information given to the donor:1. Importance of truthfulness in his history.2. History of self- deferral when necessary3. The risk of the donation procedure4. The test that are going to be done and why

TARGET GROUPS FOR BLOOD DONATION: AGE --------- 16 to 65 years old WEIGHT ---- 50 kgs. (1 unit); 40 kgs. (250 ml.) PULSE RATE 50-100 beats /min. BLOOD PRESSURE 90-160 mm Hg systolic and 60-100 mm Hg. diastolic. HEMOGLOBIN at least 12.5 g/dl

PERMANENT DONOR DEFERRAL Cancer Cardiac disease Severe lung disease Viral hepatitis and aids Use of prohibited drugs High risk sexual behavior Sexually transmitted disease Prolonged bleeding Unexplained weight loss of more than 5 kg over six months Chronic alcoholism

TEMPORARY DONOR DEFERRALA. CONDITIONS:1. Pregnant ---- 9 mos. And 3-6 months after weaning2. Acute Febrile illness 2-3 wks. After febrile episode3. Previous donation 250 ml- 6 to 8 wks.; 1 unit 3 months.4. Major operation 1 year5. Skin piercing, tattoo one year6. diagnosed with malaria 3 years7. Exposure to malaria one year8. History of alcohol intake 12 hours.9. Chicken pox/measles 6 months B. Vaccine received:1. live attenuated vaccine:a. Category 1 : measles, oral polio ,mumps, yellow fever, BCG 2 weeksb. Category 2 : German measles-1 monthc. Category 3 : Rabies vaccine 1 year2. Killed Vaccine and toxoids Hep. B, DPT,injectable polio vacine, Cholera, Tyhpoid,Influenza may donate anytime if without symptomsC. Medications taken:1. Antibiotics other than anti-TB may donate anytime2. Anti-Tb drug defer until TB is cured3. Aspirin and Piroxicam donate anytime except for platelet 4. Highly allergenic drugs After medications are stopped for at least one day.5. Contraceptive Pills - may donate anytime.6. Anti-acne medications 2 months after cessation of medication.

PHYSICAL EXAMINATION Vital Signs Routine P.E.

LABORATORY TESTING OF BLOOD: RPR/VDRL----- SYPHILIS HIV HEPATITS B HEPATITIS C MALARIA HEMOGLOBIN

POST DONATION PROCESS: Health care after donation including care of the venipuncture site. Things to do and not to do after donation.

COUNSELLING DONORS WITH POSITIVE RESULTS: Shall provide counseling to explain why donor has to either postpone or refrain from donating blood. Must contact the appropriate health care provider to establish linkage between the health provider and the patient if confirmatory or additional testing and continuing medical care is necessary.

LABELING Product code structure and labeling blood components Standard terminology for blood, cellular therapy and tissue product descriptions AABB, FDA AND ISBT 128

LABELING Name of the product (e.g. RBC, WBC) Type and amount of anticoagulant Volume of the unit Required storage temp Name and address of collecting facility Expiration date Unique donor identification no. Whether donor a volunteer, autologous or paid Other statements: The abo blood group and Rh type are also shown in big bold letters

STORAGE 500ml bag contains 63 ml of anticoagulant + collected blood 1-6 Centigrade CPD; CP2D = 21 DAYS CPDA-1=35 DAYS SAGM, AS-5, AS-3 (SAG+Na PO4)=42 d

WHOLE BLOOD AND BLOOD COMPONENT THERAPYBenefits and reasons for transfusion1. To restore or maintain the oxygen carrying capacity or hemoglobin2. To restore or maintain blood volume3. To replace coagulation factors to maintain hemostasis4. To restore or maintain leukocyte function (rarely)

WHOLE BLOOD Product in which all the red cells and most of plasma from the original unit are present. Platelets and WBC present are not active because they require separation and special storage. Consists of formed elements (rbc, wbc, plts) making up about 45% of the total volume ..and plasma (55% of the total volume) Indication for whole blood: Volume replacement

BLOOD COMPONENT Product separated from a single unit of a whole blood.

FRACTIONATION Process by which blood products are separated from a single unit of whole blood.

ADVANTAGES OF USING BLOOD COMPONENT:1. There is maximum recovery and utilization of blood products.2. Service to a wide variety of patient is increased.3. Transfusion of specific component needed by the patient is made possible.4. Transfusion of harmful elements is minimized.

BLOOD COMPONENTS:A. Oxygen carrying components1. Packed RBC2. Leukocyte poor blood3. Frozen Thawed RBCB. Platelet Products1. Platelet rich Plasma2. Platelet Concentrate C. Plasma Products:1. Frozen plasma2. Cryoprecipitate3. Cryosupernate

PLASMA DERIVATIVES:A. Coagulation Factor Concentrate:1. Factor VIII conc.2. Factor IX component conc.B. Oncotic agents:1. Albumin2. Plasma Protein fraction

PACKED RED BLOOD CELLS 225 ml. in volume when collected from 500 ml. of whole blood. 200-250 ml. of plasma will be extracted leaving RBC with Hct. of 70-80%. Indications for use (PRBC):1. Increase Oxygen carrying capacity of blood in cases of chronic anemia.2. In patients with subacute and chronic blood loss where anemia is accompanied by a significant decrease in blood volume.3. In all forms of anemia.4. In patients with cardiac disease, and those requiring restricted Na,K and citrate especially in liver and kidney diseases.

WASHED RED BLOOD CELL contains RBC, no plasma with minimal platelet 70-90% of WBC are removed. 5% loss of RBC due to wash procedure. Shelf-life is 24 hours at 1-6 C after wash. Indications for use1. For patients with two documented febrile reaction.2. Patient expected to have multiple transfusions in order to decrease the chance of HLA sensitization.3. Prevent anaphylactic reaction in IgA deficient patient.

FROZEN RBC Contains RBC, no plasma, no platelets.

PLATELET CONCENTRATE Random donor platelets are produced form blood using the light spin to produce platelet rich plasma. Indications for use:1. To correct severe thrombocytopenia.2. To bleeding patient in surgery or trauma cases with platelet count less than 70,0003. Bleeding patients with thrombocytopathy

GRANULOCYTE CONCENTRATE Prepared by apheresis. Indications: for septic, severely granulocytopenic patient unresponsive to 48 hours of antibiotic treatment.

FRESH FROZEN PLASMA Prepared by centrifuging whole blood and extracting 200-260 ml. of the upper liquid plasma. Contains 90% water, 6-8%protein, small amount of CHO and lipids. Used for bleeding patients with multiple coagulation deficiency problems secondary to liver disease, DIC, or dilutional changes from massive transfusion. Also for factors V and XI deficiencies.

CRYOPRECIPITATE Contains 80% units of factor VIII, 50% of Von Willebrand factor present in original unit, 250 mg. Fibrinogen, 25% factor XIII and some fibronectin activity. Major use for patient with severe Von Willebrands disease, factor XIII deficiency or hypofibrinogenemia and those burn and traumatic shock patients which lacks fibronectin.

CRYOSUPERNATE Plasma left after separation from fresh blood of cellular component and cryoprecipitate. Contains Factor VIII, fibrinogen and normal amount of coagulation factors. Used in patients with bleeding other than Hemophilia and Hypofibrinogenemia.

COMPATIBILITY TESTING

CROSSMATCHING It is the final check of abo compatibility between donor and patient. It may detect the presence of antibody in the patient serum that will react with antigens on the donor red blood cells but was not detected in antibody screening because the corresponding antigen was lacking from the screening cells.

CROSSMATCHING:1. MAJOR CROSSMATCHING: patient serum against donor red cells.2. MINOR CROSSMATCHING: patient donor red cells against donor serum. Phases:1. Saline phase2. Albumin phase--- IgM antibodies3. Anti-globulin phase IgG antibodies Transfusion Reaction IMMEDIATE REACTION:A. IMMUNOLOGIC:1. HEMOLYTIC preformed antibody 2. FEBRILE NONHEMOLYTIC Caused by alloantibodies directed vs. Ag present on lymphocytes, granulocytes and platelets.3. ALLERGIC Reaction between recipients Ab and donor plasma protein.4. ANAPHYLACTIC due to reaction between potent specific anti-IgA Ab and IgA transfused products.5. Transfusion related acute lung injury leukoagglutinins against recipients leukocytes.B. NONIMMUNOLOGIC:1. Bacterial contamination 2. Circulatory overload- rapid infusion of large volume of blood.3. Physical or chemical hemolysis

DELAYED REACTION:A. IMMUNOLOGIC:1. Delayed hemolytic reaction2. Graft vs. host disease3. Post transfusion purpuraB. NON-IMMUNOLOGIC:1. Hemosiderosis2. Disease transmission (HIV ,Malaria, Hepatitis B and C)

TRANSFUSION REACTION INVESTIGATION: Stop the transfusion. Clerical check of the compatibility of tag. Examination of pre-transfused blood, and EDTA anti-coagulated post-transfused blood and the blood bag. Examination of post-transfused urine. Determination on the post-transfused specimen for PT, PTT, platelet count, fibrinogen and fibrin split products. Measurement of hemoglobin/hematocrit at frequent interval if hemolysis is observed.

Compiled: Rem Alfelor Page 1 of 1