CLS 3311
Advanced Clinical
Immunohematology
Donor Physical and Interview
Donor Processing
• Donor Physical
– Basic physical and testing processes including
Hematocrit, Blood pressure, Pulse, Temperature,
and Weight.
• Donor Interview
– Series of questions and guidelines to be reviewed
by the donor and Blood Bank personnel.
Purpose of the Donor
Interview and Physical
• Protect the Donor
– Those aspects of the interview that are in place
to protect the donor.
• Protect the Recipient
– Those aspects of the interview that are in place
to protect the recipient.
• As you progress through this lecture
consider each item as to whether we
are protecting the donor, the
recipient or both.
Donor Registration
• Date and time of donation
• Name: Last, first (middle initial if
available)
• Address: Residence and/or business
• Telephone: Residence and/or business
• Gender
• Age and/or date of birth
• Donors must be at least 17 years of age
• Exceptions: Autologous collections, various
laws, no upper age limit (discretion of blood
bank physician)
Donor Registration
• Record of previous deferrals
– Has the donor ever been rejected as a donor? Why?
• Additional Identification
– SS #, Drivers license, etc.
• Race
• Time of last meal
• Occupation
• Directed donation, Replacement credit,
Donor group
Donor Registration
Donor Consent
• Informed consent: Procedure must be
explained in terms that the donor can
understand and there must be an opportunity for
the donor to ask questions.
– Including risks for donor and recipient, testing on
donation, etc.
Donor Physical Examination
• General Appearance
– Does the donor look ill? Appears to be under
the influence of drugs or alcohol? Excessively
nervous? It is best to defer the donor.
• Weight: 50 Kg (110 lbs) or more may
donate 525 mls, total.
– <110 lbs? May draw as little as 300 ml without
reducing the amount of anticoagulant. Need to
be labeled ‘low volume unit’ and not be used
for platelets.
If it is necessary to draw less than 300 mls, the
amount of anticoagulant in the collection bag
must be reduced proportionately.
Calculations for Drawing Donors Weighing
Less Than 50 Kg (110 lb)
A. Volume to draw = (Donor’s weight in kg/50) x 450 ml
B. Amount of anticoagulant needed = (A/100) x 14
C. Amount of anticoagulant to remove from the
collection bag = 63 ml - B
Donor Physical Examination
• Temperature: Not to exceed 37.5oC (99.5 F)
• Pulse: Between 50 - 100 beats per minute (bpm)
– Show no irregularities
– Athletes <50 bpm? Should be noted and accepted.
• Blood Pressure: No higher than 180 mmHg for
the Systolic and no higher than 100 mmHg for
the Diastolic
Donor Physical Examination
• Hemoglobin or Packed cell volume (Hct)
– Minimal acceptable value: Hgb = 12.5 g/dl,
Hematocrit = 38%, Copper Sulfate = 1.053 specific
gravity
• Skin Lesions: Skin at the site of the
venipuncture must be free of lesions. Both arms
must be examined for signs of repeated
parenteral entry, especially multiple needle
puncture marks…
Donor Interview
Medical History: Purpose
• To obtain a profile of the prospective donor’s
health status to determine his or her suitability
for donating blood. Harmening
• Questions are designed to establish whether
the donation will be harmful to the donor or
the recipient.
Donor Interview
• Handout: AABB Technical Manual, Page
103. Appendix 4-1. Uniform Donor History
Questionnaire (May 1998)
– At your facility there should be a current
AABB Technical Manual. If there is not let
me know and I will fax this to you.
– You need to review the questions and how they
apply to the donor and recipient. Why is the
question asked? Who is being protected? Is
there a deferral time? If so, how long?
Donor Interview
• Permanent Deferral: Go back through the
questionnaire and list those parameters that
will result in the permanent deferral of the
donor.
• Temporary Deferral: Go back through the
questionnaire and list those parameters that
will result in the temporary deferral of a donor
and the length of the deferral.
Donor Phlebotomy
• Medical Director: Qualified licensed
physician oversees all functions in the donor
center.
• Materials and instruments: Blood bags
(FDA approved), hemostats, sterile gauze,
tourniquet, iodine swabs, tubes, etc.
Donor Phlebotomy
• Approach: Need to be confident and at ease
with the donor. Being organized helps, too.
Help the donor be comfortable.
• Organize Equipment: Blood bag and tubing,
tubes for tests (purple top, red tops, etc.),
cleansing swabs (2 iodine cleansers), blood
pressure cuff (tourniquet), something to
squeeze during collection, sterile gauze,
bandage or wrap, paper work, hemostats.
Donor Phlebotomy
Procedure
1. Locate Vein: Apply BP cuff and pump to 40mmHg
and find the vein to access. Identify location - cannot
touch site after cleansing. Deflate BP cuff.
2. Cleanse site: With first swab vigorously scrub area to
loosen dirt, etc. With second swab make concentric
circles from center of area out. This removes loosened
debris. Allow to dry. Cover with sterile gauze.
3. Organize equipment: Bag, tubing, collection tubes,
gauze, bandage, etc. Attach bag to mechanism that will
end collection when volume is adequate.
Donor Phlebotomy
• Perform phlebotomy: Pump BP cuff to greater than
40 mmHg for stick only. Remove cap from needle and
flip several times to remove anticoagulant from needle
tip. DO NOT PALPATE SITE - IT IS STERILE.
Anchor vein and insert needle clean and quick - very
sharp, very big needle - blood will show in tubing when
in the vein. Tape needle hub to arm so as to maintain
flow and secure needle. Tape tubing to lower arm to
avoid tangles. Reduce BP cuff pressure to 40 mmHg for
remainder of collection.
• Mix blood periodically as it flows into blood bag
throughout collection to insure anticoagulant activity.
Donor Phlebotomy
• Full Unit: Before needle removal need to collect tubes
for testing directly from donor. Most blood bag sets
have a mechanism to accommodate this.
• Hemostat tubing to stop flow. Withdraw needle,
dispose and apply pressure to site with sterile gauze.
Make a pressure bandage to be worn for 1-2 hours.
Observe donor.
• Insure Donor well being. Cookies and Juice!!
• Seal tubing and Strip remaining blood from tubing
into bag to enable exposure to anticoagulant. Mix and
allow anticoagulated blood to flow back into tubing.
Segment the tubing using a heat sealer.
Donor Phlebotomy
• Store blood in appropriate temperature for
platelets, etc. (Room Temp)
• Organize and record donor collection begin and
finish time. Make note of any abnormalities. i.e.
donor reactions, short draw, long collection time, etc.
• Post phlebotomy instructions: Drink more fluids
than usual in next 4 hours. Avoid alcohol and
tobacco. Dizzy? Lie down or put head between
knees. Symptoms persist? Call Blood Bank or see
physician. Certain jobs beware of possible dizziness
immediately following donation. (construction,
machinery, etc.)
Donor Reactions
• Mild Reactions
– Nervousness, anxiety, feeling warm, pallor, sweating, etc.
Does NOT lose consciousness.
– Stop donation!!! Do NOT leave donor!!
• Moderate Reactions
– Previous symptoms PLUS donor loses consciousness.
• Severe Reactions
– Add convulsions to previous listed symptoms
• Harmening Page 231 to 233
• Training is NECESSARY for personnel in donor
room to respond properly to each situation. CPR
knowledge is REQUIRED.
Donor Testing
Required Testing:
• ABO, Rh (Weak D), IAT
• Transmissible disease testing:
– HIV 1/2
– Hepatitis B and C
– HTLV I/II
– Syphilis (RPR)
Transmissible Disease Testing
Viral Marker Testing
• HIV 1/2, Hepatitis B and C, and HTLV I/II
• Enzyme linked immunosorbant assay
(ELISA or EIA). Screen test only. Test
for presence of viral antibodies and/or
antigens. Non reactive initial screening tests
are considered negative.
Reactive tests on initial screening need
to be repeated in duplicate.
Transmissible Disease Testing
• Reactivity on one or both of the repeated
tests constitutes a positive result and is
considered repeatedly reactive.
• Confirmatory Tests
– HIV: Western Blot, HIV neutralization
– HCV: Recombinant Immunoblot assay (RIBA)
– HBV: Neutralization or Repeatedly reactive HBcAb
– HTLV: Repeat test with another manufacturers EIA kit
Transmissible Disease Testing
Look Back
• Donations with repeatedly reactive screening test
results (HBsAg, anti-HBc, anti-HCV, HIV) cannot
be transfused
• In date units from preceding collections need to be
quarantined or destroyed until confirmation.
• Must be able to track ANY donor from collection to
transfusion.
Reentry Protocol
• Process to accommodate the reentry of a donor back
into the donor pool after false positive testing.