Donor Selection

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Donor Selection

• Renee Newman Wilkins, Ph.D., MLS(ASCP)CM
• CLS 325/435
• School of Health Related Professions
• University of Mississippi Medical Center

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Blood History

• 1818 the first human-to-human transfusion takes
  place.unfortunately patient dies
• 1901 Karl Landsteiner discovers blood groups
• 1907 checking for incompatibilities
  (crossmatching) is performed and leads to less
  transfusion reactions (N128)
• 1916 a citrate-glucose solution is developed to
  prolong the life of stored blood (weeks)

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Blood History

• 1917 the first blood depot is formed with Group
  O blood for casualties in World War I
• 1922-1937 more blood donor and transfusion
  services are established and the term blood
  bank is coined
• 1939-1940 Rh system discovered
• World War II begins.

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History

• 1940 Plasma of Britain campaign begins after a
  shortage of plasma in WWII plasma separation
  methods are first used
• 1941 the American Red Cross organizes a
  civilian blood donor service for WWII

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History

• 1947 small blood banks across the country join
  together to form the American Association of
  Blood Banks
• 1948 first plastic bag developed for blood
  collection

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History

• 1960s Factor VIII concentrate developed for
  hemophiliacs
• 1971 Blood banking becomes regulated by the FDA
• 1980s dozens of blood recipients develop what
  is now called AIDS
• 1980s to present more sensitive tests have
  been developed to screen donors (hepatitis and
  HIV)

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Did you know?

• Over 4.5 million patients need blood transfusions
  each year
• 43,000 pints of donated blood are used each day
  in the U.S. and Canada
• Someone needs blood every two seconds
• About 37 of the U.S. population can donate
  blood, but only 3-5 actually donate!

2005 Nationwide Blood Collection and
Utilization Survey Report, Department of Health
Human Services
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Regulatory Agencies

• Food and Drug Administration (FDA) regulates
  the blood banking industry
• American Association of Blood Banks (AABB)
  professional organization that provides standards
  for blood centers and transfusion services
• The College of American Pathologists (CAP)
  inspects and accredits labs by using a
  checklist accreditation occurs every 2 years
• Joint Commission on Accreditation of Healthcare
  Organizations (JCAHO) inspects entire hospitals
  every other year focuses on healthcare delivery
• National Committee for Clinical Laboratory
  Standards (NCCLS) develops standards for
  clinical lab testing (i.e., format for correctly
  writing laboratory procedure)

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Blood Donation

• Parts of the donation process
• Donor screening
• Physical exam and medical history
• Blood collection
• Phlebotomy, adverse reactions, blood labeling
• Special donors
• Directed donation, autologous donation,
  hemapheresis, and therapeutic phlebotomy

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Blood Donation

• Most blood donations are allogeneic
• Allogeneic donations are used for the general
  population
• Donors are not paid for donations nor are they
  required to donate
• As a result, this maximizes blood safety
• Donor centers must keep a record on each donor
  for at least 10 years

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Donor Screening

• Registration
• AABB Standards require that the donor be linked
  to the donor records (photo ID)
• Required information
• Name (first, last, MI)
• Date and time of donation
• Address
• Telephone
• Gender
• Age (date of birth) allogeneic donors must be
  at least 17 years of age

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Donor Screening

• Donors must also be given education material
  about blood donation
• Refer to handout titled Blood Donor Educational
  Material

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Medical Questionnaire

• Derived from FDA regulations and AABB
• Why ask questions?
• Asking questions helps determine the overall
  suitability of the donor from this, the donor
  will be
• Accepted
• Temporarily deferred
• Permanently deferred

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Medical Questionnaire

• Please refer to the attached Full-Length Donor
  History Questionnaire by AABB
• The first few questions refer to general patient
  health
• Questions 2 3 ask about antibiotics and
  infection
• Antibiotics given after a dental procedure cause
  a temporary deferral until the infection is
  cleared
• Tetracyclines and other antibiotics for acne are
  acceptable

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Are you or have you ever taken any medications on
the Medication Deferral List?
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Other drugs

• Aspirin, piroxicam, Plavix if taken within 3
  days (some say 48 hours), you cannot donate
  platelets by apheresis however, whole blood
  donations are acceptable. Remember aspirin
  effects platelet function (inhibits
  cyclooxygenase) Plavix blocks ADP receptors on
  platelets)
• Chemotherapy wait 4 weeks from last dose
• Human Growth hormone permanent deferral
• Heparin or Coumadin wait at least 5 days after
  discontinuing therapy (or until clotting is
  regulated)

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Have you donated blood in the last 8 weeks?

• The time interval between allogeneic whole blood
  donation is 8 weeks
• A donor must wait 48 hours after donating
  platelets, plasma) before donating whole blood

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Immunizations Vaccinations

• Acceptible donations if the vaccine was synthetic
  or contained killed bacteria, virus, rickettsia
  and they are symptom-free
• 2-week deferral
• Live attenuated or bacterial vaccine
• Measles, mumps, polio, typhoid, or yellow fever
• 4-week deferral
• Live attenuated vaccine for German measles or
  chicken pox
• Rabies vaccine
• 12-month deferral ONLY if they have been bitten
• Smallpox vaccine
• Deferral until after the vaccination scab falls
  off, or 21 days, whichever is longer. Donor
  could be infectious.

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Blood exposure and sexual activity

• Questions regarding blood exposure and sexual
  activity are presented next
• Permanent deferrals refer to individuals with
  infections, exposure risk, or certain lab results
• 12 month deferrals refer to exposures or possible
  exposures to infectious agents

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Permanent deferral

• Permanent deferral if the donor has had
• Diagnosis of HIV/AIDS
• Viral hepatitis after age 11
• Positive HbsAg or HCV
• Male-to-male sex since 1977
• History of babesiosis or Chagasdisease
• IV drug use
• Creutzfeldt-Jakob disease (prion)

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12-month deferral

• 12-month deferral if donor has had
• Blood transfusion
• Transplant
• Needle stick and/or tattoo
• Mucous membrane blood exposure
• Sexual contact or living with person with viral
  hepatitis or sexual contact with person with HIV
• Incarceration for more than 72 consecutive hours
• Treatment for STD, including gonorrhea or
  syphilis (only 3 cases documented)

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Travel-Related Questions

• These questions ask if the donor has traveled
  outside of the U.S. or Canada in the last 3
  years, and then more specifically from 1980 to
  the present
• These questions refer to the possibility of
  acquiring an infectious agent that may be passed
  to the recipient in a transfusion

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Malaria

• A vector-borne disease caused by protozoan
  parasites (genus Plasmodium)
• Occurs in numerous regions of the world

Anopheles mosquito
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Malaria
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Malaria

• 3 year deferral if the donor becomes asymptomatic
  after infection
• 3 year deferral after the immigrant/citizen
  departs from the endemic area
• 12-month deferral if a person travels to an
  endemic area and shows no symptoms on return

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HIV (travel-related)

• Permanent deferral if a person was born or lived
  in OR has had sexual contact with anyone who was
  born or lived in
• Cameroon
• Central African Republic
• Chad
• Congo
• Equatorial Guinea
• Gabon
• Niger
• Nigeria

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Creutzfeldt-Jakob Disease (or variant)

• CJD or vCJD
• Rare neurologic disorder caused by a prion
• Causes progressive dementia and spongiform
  alterations in brain
• May be transmitted by corneal transplants, human
  dura mater grafts, pituitary-derived human growth
  hormone
• vCJD may be transmitted to humans from cattle
  with mad cow disease

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vCJD (variant form)

• Permanent deferral if donor lived in UK for more
  than 3 months between 1980-1996
• Permanent deferral if donor spent a cumulative of
  more than 5 years in Europe since 1980

http//www.pbs.org/newshour/bb/health/mad_cow.html
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Leishmania

• Transmitted by the sandfly
• A protozoan parasite that infects WBCs
• Limited to those who lived and traveled to Iraq
  (includes military)
• 12 month deferral from departure date

Photo courtesy of CDC
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Babesiosis

• Babesia parasites are transmitted by ticks and
  reproduce in the red blood cells
• Occurs in New England states
• Permanent deferral

Photo courtesy of CDC
32
Chagas Disease

• Parasitic infection caused by Trypanasoma cruzi
• Most infections are life-long
• Occurs in South America, but is a growing concern
  for U.S. blood donation centers because of the
  influx of hispanics from Latin American countries
• Tests are being developed
• Permanent Deferral

Photo courtesy of NIH
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Endemic Areas of Chagas Disease
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West Nile Virus

• Spread by the bite of a female Culex mosquito
• 80 of people infected with WNV remain without
  symptoms
• 20 develop mild symptoms, including fever,
  headache, eye pain, body aches, gastrointestinal
  complaints, and occasionally a generalized rash
  or swollen lymph nodes
• Tests include an FDA-approved WNV IgM capture
  ELISA and nucleic acid amplification test (NAT)

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West Nile Virus

• Deferrals according to AABB
• A potential donor who has been diagnosed with WNV
  infection (including diagnoses based on symptoms
  and laboratory results) will be deferred for 120
  days (4 months)
• A donor whose blood or components potentially
  were associated with a transfusion-related WNV
  transmission will be deferred for 120 days from
  the date of the implicated donation

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Sudden Acute Respiratory Syndrome (SARS)

• Respiratory illness reported in Asia, North
  America, Europe, and Canada
• Person-to-person contact
• 14 day deferral after a person who travels to or
  through endemic area returns to U.S.
• 28 day deferral after being treated for SARS
• Peoples Republic of China, Hanoi, Vietnam,
  Singapore, and Toronto, Canada

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Physical Examination

• General Appearance (donations are now accepted
  from those 16 yrs old)
• Weight
• Temperature
• Pulse
• Blood Pressure
• Hemoglobin
• Skin Lesions

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Physical Exam General Appearance

• The donor should not show
• Intoxication
• Drug-induced mental impairment
• Signs of infection
• Skin lesions on arms
  (IV drug use)
• Should appear alert

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Physical Exam Weight

• Hypovolemia is a decrease in intravascular blood
  volume
• A minimum weight limit of 110 lbs. is used to
  avoid hypovolemia
• This means the maximum amount of blood that can
  be removed is 10.5 mL/kg of donor weight (donor
  unit including tubes for testing)
• Each bag can hold 450 or 500 mL of blood
• Adjustments can be made if patient is small

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Physical Exam (contd)

• Temperature
• Less than or equal to 37.5C or 99.5F
• Donor should not drink coffee or hot beverages
  before donating
• Pulse
• Between 50-100 bpm (count for at least 15 sec)
• Blood Pressure
• Systolic 180 mm Hg
• Diastolic 100 mm Hg

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Physical Exam Hemoglobin

• Hemoglobin can quickly be obtained from a finger
  stick
• Hemoglobin should be high enough to support
  405-550 mL of blood
• Hemoglobin should be 12.5 g/dL
• Hematocrit should be 38

3 times rule ? 12.5 g/dL X 3 37.5 or 38
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Hemoglobin Testing

• Copper sulfate method or point-of-care
  instruments using a spectrophotometric method
• Copper sulfate method
• Solution of CuSO4 has a specific gravity of 1.054
• The SG of blood correlates with the hemoglobin
• A small blood sample is dropped in the solution
  to see if it floats or sinks
• Difficult to dispose of, so may test may
  eventually be replaced

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In summary.
99.5F 37.5C
180 100
50-100 bpm
12.5 g/dL 38
?
110 lbs
?
?
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Informed consent

• Before donation, a donor must provide informed
  consent
• If for any reason a donor doesnt think their
  blood is safe to donate, they may affix a
  barcoded sticker to the unit indicated it should
  not be used
• It is all kept confidential.

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Confidential Unit Exclusion (CUE)
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Types of donations

• Allogeneic Donors for the general population
• Autologous Donors donoation for his or her own
  use
• Directed Donors directed toward a specific
  patient
• Pheresis Donation separated into several
  components

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Autologous Donation

• Safest possible transfusion
• Candidates include
• Those with rare blood types (Bombay)
• Elective surgery (donate in advance)
• Normal criteria waived except if the patient has
  bacteremia
• No age or weight limit
• Pregnant women can donate
• No minimum hemoglobin required
• Can donate as often as 3 days apart but NOT
  within 3 days of surgery

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Directed Donation

• Directed donors must meet exact criteria as a
  random blood donor
• Directed donations have become popular because of
  the fear of AIDS
• Directed donations may cause graft-vs-host
  disease and must be irradiated if it is from a
  blood relative
• A directed donor may also be reluctant to admit
  they may not be eligible to donate because of an
  undisclosed condition

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Apheresis

• Apheresis involves the removal of whole blood,
  separating specific components, and returning the
  unused portion back to the donor
• Plateletpheresis (no more than 2x per week)
• Plasmapheresis (tested for protein and Ig 2x wk)
• Leukopheresis (uses components to stimulate
  granulocytes hydroxyethyl starch, steroids,
  G-CSF)
• Double RBC pheresis (2 units every 16 weeks)

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Whole Blood Collection

• Blood is collected in a primary plastic bag that
  may have satellite bags connected with a long
  tube with a 16 or 17 gauge needle
• Everything is connected and is considered a
  CLOSED SYSTEM (remains sterile)

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Remains in a closed system! (except when needle
is removed from arm)
Tubes for testing
Bag OBlood
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Blood Collection

• Whole blood is collected in clear plastic bags
  that contain different mixtures of
  anticoagulants
• Citrate chelate calcium, preventing coagulation
• Phosphate prevents pH from dropping
• Dextrose provides nutrients to RBCs during
  storage
• Adenine amino acid that maintains ATP

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Anticoagulants

• Anticoagulants
• CPD
• Citrate, Phosphate, and Dextrose
• 21 day shelf life (at 1-6C)
• CP2D
• Citrate, Phosphate, and 2Xdextrose
• 21 day shelf life (at 1-6C)
• CPDA-1
• Adenine added
• 35 day shelf life

• 63 mL in 450 mL bag
• 70 mL in 500 mL bag

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Additive Solutions (AS)

• Additional solutions may be added after the
  primary bag is filled
• Red cell preservation systems contain a primary
  bag with anticoagulant and usually 2 satellite
  bags (1 empty 1 with AS)

http//www.health.gov.mt/nbts/bldprocatpro.htm
After
Before
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Additive Solutions

• Additive Solutions prolong red cell survival for
  42 days
• AS is added to primary bag after plasma is
  removed (100mL in 450-mL bag 110mL in 500-mL
  bag)
• Final hematocrit should be between 55-65
• All contain varying concentrations of substances
  like dextrose, adenine, sodium chloride and
  others
• AS-1 (Adsol)
• AS-3 (Nutricel)
• AS-5 (Optisol)

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Collection

• The arm is cleansed with iodine for at least 30
  seconds
• Use circular motion (inside to outside)
• Cover a 3 inch diameter
• Cover with gauze until ready to draw
• Can use chlorhexidrine gluconate and isopropyl
  alcohol if donor is sensitive to iodine

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Appropriate amount of blood

• If a donor meets the 110 lb weight, then the
  amount of blood drawn should be
• 405-495 mL (in a 450 mL bag) includes tubes
• 450-550 mL (in a 500 mL bag)
• How is this monitored? Using a scale
• 405- 550 mL should weigh 429-583 g (includes
  container and anticoagulant)

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Low volume units

• Calculations are used when the donor weighs less
  than 110 lbs (autologous) or are children
• The amount of blood to be drawn is calculated
• The amount of anticoagulant needed for the bag is
  calculated

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Amount of blood to be drawn
Donors weight (lb) X 450 mL Allowable amount
(mL) 110 lb
The amount of anticoagulant must also be
adjustedrefer to textbook for more detail of the
calculations
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Example

• A donor weighs 70 lbs
• (70/110) X 450 mL bag 286.4 mL should be drawn
  from donor
• 14 mL of anticoagulant is needed for every 100 mL
  of blood (14100 ratio)
• 286.4 mL X (14/100) 40.1 mL anticoagulant
• Each 450 mL bag contains 63 mL of anticoag
• 63 mL 40.1 mL 22.9 mL of anticoagulant should
  be removed from the primary bag
• To convert mL to grams, multiply by 1.06
• 286.4 mL X 1.06 304 grams of blood

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Preparation of Segments
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Donor Reactions

• Hematoma subcutaneous collection of blood
• Arterial Puncture needle passes through vein
  into artery
• Needle pulsates
• Blood is bright red
• Bag fills in 4-5 minutes
• Nerve Injury sharp, shooting pain
• Fainting pulse and BP fall
• Hyperventilation due to anxiety
• Nausea/Vomiting autonomic and CNS pathways
• Cardiac Problems rare due to cardiovascular
  disease

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