The Donor and Blood Collection by bxl82158

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									                                                                      Objectives:

The Donor and Blood                                  List Blood Bank Donor requirements

     Collection
  Krystal E. Pearce MHS, MT (ASCP), CLS (NCA)
                                                     Discuss lab test performed on donor units
 Louisiana State University Health Sciences Center
        School of Allied Health Professions
                  Shreveport, La.
                                                     Discuss autologous donation requirements




                                                                    Donor Selection
                                                     Registration

                                                     – Date and time of donation
    Donor Selection                                    Donor s
                                                     – Donor’s name

                                                     – Address and phone number (work and home)

                                                     – Sex




                                                                                                  1
            Donor Selection                           Physical Findings

  Age-
– Age-at least 17
                                                    apperance-
                                            General apperance-appear in good health
  Consent-
– Consent-informed
                                                 lesions- p       y            ;            g
                                            Skin lesions-especially in AC areas; look for signs
           deferrals
– Previous d f    l                         of IV drug use
– Other information
                                            Hemoblobin/hematocrit-> 12.5 g/dL or > 38%
                                            Hemoblobin/hematocrit-       g/dL
                                            hct




           Physical Findings                          Physical Findings
            (oral)-             37.5°
Temperature (oral)-upper limits 37.5°C or
99.5°
99.5°F
                                            Hemoblobin/
                                            Hemoblobin/
Pulse-50-
Pulse-50-100 and regular                    hematocrit-> 12.5
                                            hematocrit-
                                            g/dL or > 38% hct
                                            g/dL
BP-systolic no higher than 180 mm
BP-
mercury; diastolic no higher than 100 mm
mercury




           Physical findings                            Medical History
                                            Last donation

Weight-110 pounds
Weight-
                                            Have they ever been
                                            deferred as a donor?




                                                                                                  2
             Medical History                Medical History
Preganancy or
miscarriage-
miscarriage-defer 6            Heart, lung, or liver
weeks following                diseases or history of
conclusion of                  cancer or abormal
pregnancy                      bleeding tendencies

Major surgery or
      illness-
major illness-defer 6
months




             Medical History                Medical History
Drugs and                      Vaccinations and immunizations (if symptom
medications-defer or
medications-                            afebrile)
                               free and afebrile)
reject if on any of the                   (Rubeola),
                               – Measles (Rubeola), mumps, yellow fever, oral polio
following:                       vaccine-
                                 vaccine-2 weeks
                               – German measles (Rubella) and Varicella zoster
                                           pox)-
                                 (chicken pox)-4 weeks
– Ingestion within 3
  days of asprin or                                                           animal-
                               – Rabies vaccine if given after bite of rabid animal-
  asprin containing              1year
  medications-
  medications-ok if not        – No deferral for vaccines against hepatitis A, or B,
  sole source ol plts for        tetnas, diptheria, pertussis,
                                 tetnas, diptheria, pertussis, polio (injection) or
  a patient                      infulenza
                                                                (HBIG)-
                               – Hepatitis B Immune Globulin (HBIG)-defer 12 months




             Medical History                Medical History
      diseases-
Viral diseases-                Viral deferment
indefinite deferral            – Present or past clinical or laboratory evidence of
– History of viral               infection with hepatitis C virus, HTLV or HIV
  hepatitis after 11th
         y
  birthday or have had a
  confirmed positive            Donated th only unit of bl d or component
                               –D    t d the l        it f blood            t
  tesd for HBsAg of who         transfused to a patient who developed clinical or
  have had a repeatedly                                  transfusion-
                                laboratory evidence of transfusion-associated
  reactive test for anti-
                    anti-       hepatitis or infection with HIV or HTLV and had no
  HBc on more than 1            other probable cause of infection.
  occasion




                                                                                        3
               Medical History                                             Medical History
12 month deferral                                          – Sexual contact with an
                                                             individual with HIV antibody
– Mucous membrane                                            or at high risk for HIV
  exposure to blood                                          infection
– Nonsterile skin                                          – Incarcerated in correctional
                                                             institution for more than 72
  penetration with                                           consecutive hours
  instruments or                                           – Donors who have received
  equipment                                                  blood, blood components, or
                                                             derivatives or other human
  contaminated with                                          tissues known to be sources of
  blood or body fluids                                       blood-
                                                             blood-borne pathogens
– Close contact with an                                    – History or treatment of
                                                             syphilis or gonorrhea or a
  individual with viral                                      reactive screening test for
  hepatitis (sexual or                                       syphilis-defer for 12 months
                                                             syphilis-
  hosehold contact)                                          after completion of therapy




               Medical History                                             Medical History
                                                           Malaria (plasma products are
                                                           exempted from these
                                                           restrictions)
Tattoos                                                    – Travelers from a
                                                             nonendemic area to an
                                                             area considered endemic
                                                                 malaria-
                                                             for malaria-defer 1 yr after
                                                             return if symptom free
                                                             irrespective of receipt of
                                                             antimalarial prophylaxis




               Medical History                                             Medical History
AIDS                                                       Creutzfeldt-
                                                           Creutzfeldt-Jakob Disease

– Donors given education material informing them of        – Donor who have received tissue or tissue derivatives
  signs and symptoms of AIDS                                                                  Creutzfeldt-
                                                             known to be a possible source of Creutzfeldt-Jakob
                                                             agent (Dura matter, pituitary growth hormone of
– Donor screening must include questions intended to         h        i i )
                                                             human origin)
  identify person at high risk for HIV (defer if answers
  suggestive of high risk)                                 – Donors who have a family history




                                                                                                                    4
           Medical History                                          Medical History
Protozoan disease                                   At-
                                                    At-risk behavior

                                                    – Stigmata of parenteral
                           Chagas’ disease-
– History of babesiosis or Chagas’ disease-                use-
                                                      drug use-permanently
  permanent deferral                                  exclude
                                                    – Stigmata of alcohol
                                                      habituation-
                                                      habituation-exclude




           Medical History
                                                           Special donor categories
West Nile Virus
– Donor deferral for patients suspected of being                        Autologous
  exposed to WNV
                                                                         Directed
– A potential donor diagnosed with WNV
  infection should be deferred until 14 days                             Apheresis
  after the condition is resolved and at least 28
  days from the onset of febrile illness or
  diagnosis of WNV, which ever date is later.




              Autologous                                             Autologous
                                                    Volume must comply with
                                                    established weight
                                                    provisions

                                                        g
                                                    No age limits

                                                    Hemoglobin should be at
                                                             g/dL
                                                    least 11 g/dL or
                                                    hematocrit 33%




                                                                                      5
                   Autologous                                                          Directed
Donation intervals determined by blood bank physician
        donor-        physcian;
and the donor-patient physcian; not drawn within 72 hrs
of surgery                                                      Patient recieves blood
                                                                from donors of their
                                                                choice i.e. family
Perop.
     p
Perop. Donation should not be undertaken if
patient/donor has or is being treated for bacteremia            members, friends,
                                                                members friends
                                                                church members in
Unit must be segregated and used soley for autologous
                                                                the belief that there is
transfusion (unless exceptional circumstances exist)            lower HIV risk




                      Directed                                                       Apheresis
Studies indicate that                                           Method in which whole blood
                                                                is withdrawn, a desired
directed donations                                              component separated and
                                                                retained, and the remainder of
are not any safer than                                          blood returned to the donor.
random donor                                                    Same donor requirements as
                                                                for whole blood plus
donations                                                       consideration of:
Unit should be
                                                                – Reactions or allergies to
irradiated to prevent                                                Hydroxyetheyl starch
graft-vs-host disease
graft-vs-                                                            (HES)
if donor is a blood                                                  Steroids
                                                                     heparin
relative




                     Apheresis
– Defer females with menses, pts with a history of bleeding
  problems, or thrombocytopenia
                                                                Work up includes:
                                                                – Identical testing as would be performed for whole
– Allergies to beef or pork (source of heparin)                   blood if intended for transfusion
                                                                          protien-
                                                                – Serum protien-at least 6.0
– Medical condition aggravated by steroids (hypertension, TB,   – Plt count (more than 150,000/uL)
  diabetes)
                                                                – White cell count and differential
– Weight must be at least 110                                           electrophoresis-
                                                                Protien electrophoresis-every 4 months is
                                                                regular, biweekly plasma donor
           taken-
– Medicine taken-esp. aspirin

– Interval between procedures at least 48 hours                             phlebotomy-
                                                                Therapeutic phlebotomy-done for medical
                                                                indications
                               xs/yr
– No more than 2xs/month or 24 xs/yr

– At least 8 weeks after whole blood donation




                                                                                                                      6
            Donor Reactions                                                 Donor Reactions
                                                                 General
                                                                 – Remove tourniquet and needle immediately in
                                                                   moderate or severe reactions
                                                                                       alone
                                                                 – Do not leave donor alone, but give him
                                                                   privacy if possible
                                                                 – Most reactions are vasovagal, caused by
                                                                   emotional stress such as the sight of blood,
                                                                   excitement, fear or apprehension
                                                                 – Always record reaction on donor’s record




            Donor Reactions                                                 Donor Reactions
Mild reactions                                                   – Treatment
– Signs and symptoms                                                 Rebreath into a paper
                                                                            hyperventilating-
                                                                     bag if hyperventilating-
                                                                     increases CO2 level; do
     Nervousness, anxiety                                            not give oxygen

     C
     Complaints of being
          l i t fb i                                                 Loosen clothing
     warm
                                                                     Apply cold compress
     Pallor and sweating
                                                                     Talk to donor to
     Increased pulse                                                 decrease anxiety and to
                                                                     distract
     Increased respirations
          hyperventilation-
     with hyperventilation-
     decreased CO2 level




            Donor Reactions                                                 Donor Reactions
Moderate reactions                                               – Treatment
– Signs and symptoms                                                 As with mild reactions
                                                                     except give oxygen if
     Peroids of unconsciousness (fainting)                           donor is not
     Decreaded pulse                                                 hyperventilating
     Rapid, shallow respirations                                     Use spirits of amonia
     Decreased BP                                                    for fainting
     Nausea with vomiting                                            Raise feet and lower
                                                                     head
– Treatment                                                          Instruct donor to
     As with mild reactions except give oxygen if donor is not       breathe slowly and
     hyperventilating                                                deeply
     Use spirits of amonia for fainting                              If vomiting, provide a
     Raise feet and lower head                                       suitable receptacle
     Instruct donor to breathe slowly and deeply
     If vomiting, provide a suitable receptacle




                                                                                                                  7
            Donor Reactions                                      Donor Reactions
Severe reactions:                                     Hematomas-
                                                      Hematomas-occurs if
– Convulsions due to cerebral ischemia caused         needle not properly
  by carbon dioxide depletion                         seated and blood
     Prevent donor injury and summon medical help     leaks around needle
     immediately;
     i    di t l                                      into surrounding
     CAN LEAD TO CARDIAC ARREST                       tissues or if needle
     rare                                             punctures back wall
– Cardiac difficulties                                of vein
     Summon help
     If in cardiac arrest, perform CPR




            Donor Reactions                           Test Performed on Donor Units
– Immediately remove needle and tourniquet

                                 5-
– Apply firm direct pressure for 5-10 min

– When bleeding has stopped, apply a bandage

– Apply cold compress or ice packs if stiff or sore

– Remind donor they will have a bruise




Test performed on donor units                                                 Tests
Serological tests                                      – Antibody Detection
                                                         Test
                                                           Can use pooled group O
– ABO and RH                                               screening cells
                                                           Method to detect
     Standard protocol                                     clinically significant
                                                           antibodies
     Test for Du on all
     negative units                                        Required on all donors




                                                                                      8
                                 Tests Performed on autologous
Test performed on donor units
                                              units
Other tests
– HBsAg                         ABO/RH
  Anti-
– Anti-HBc
  Anti-     a d
– Anti-HCV and NAT
– Anti-HIV ½ and NAT
  Anti-                         If transfused outside of collecting facility
– WNV RNA                                HBsAg, anti-HBc, anti-       anti-
                                test for HBsAg, anti-HBc, anti-HCV, anti-
  Anti-
– Anti-HTLV I/II                HIV-1/2, HIV 1 Ag, anti-HTLV I/II and
                                HIV-                 anti-
– Serologic test for syphilis   serologic test for syphilis
– WNV RNA




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