I. Blood Collection
An overview of the process involved in collecting
donor blood
Donor Screening
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Starts with the donor and first impressions are
critical
Clean, well lit donation facility from waiting room
to collection area
Pleasant, professional staff who can ask the
appropriate questions, observe and interpret the
responses, and ensure that the collection
process is as pleasant as possible
Blood Bank versus Blood Center
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Confusion exists and terms are sometimes used
inappropriately
Blood bank in a hospital is also known as the
transfusion service, performs compatibility
testing and prepares components for transfusion
Blood Center is the donation center, screens
donors, draws donors, performs testing on the
donor blood, and delivers appropriate
components to the hospital blood bank
Standards, Regulations, Governing Bodies
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Strict guidelines exist and inspections are performed in
both blood centers and blood banks to ensure the safety
of the donors and patients
Some or all of the following agencies may be involved:
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AABB – American Association of Blood Banks
FDA – Food and Drug Administration
CAP – College of the American Pathologists
JCAHO - Joint Commission on the Accreditation of Hospital
Organizations
NCCLS – National Committee for Clinical Laboratory Standards
Donor Screening
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Medical History based on a standardized
questionnaire obtains critical information about
the donor’s health and risk factors which may
make it unsafe for donation
Physical Exam which includes blood pressure,
temperature, pulse and screen for anemia are
performed to ensure donor is healthy enough to
donate.
Two goals of screening
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Protect the health of the potential donor
Protect the health of the potential recipient
Donor Registration
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Donor signs in
Written materials are given to the donor which explains
high risk activities which may make the donor ineligible
Donor must be informed and give consent that blood will
be used for others unless they are in a special donor
category
First time donors must provide proof of identification
such as SS#, DL#, DOB, address and any other unique
information.
Repeat donors may be required to show DL or some
other photo ID
Frequency of donation
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Whole blood or red blood cells 8 weeks
Plateletpheresis – up to 24 times/year
Plasmapheresis– once every 4 weeks, can
be done twice a week
Granulocytes
Medical History
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A thorough history is obtained each time
Standardized universal questionnaire is used
Questions are asked that are very intimate in
nature but are critical in assessing HIV or HBV
risks
Medications the donor taking are present in
plasma, may cause deferral
Infections the donor has may be passed to
recipient, may be cause for deferral
12 Month Deferral
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Any intimate sexual relations with HIV positive,
HBV positive, hemophiliacs, drug users or
individuals receiving drugs/money for sex.
Recipient of blood, components or blood
products such as coagulation factors
Sexually transmitted disease-if acquired
indicates safe sex not practiced and donor at risk
for HIV and HBV
Travel to malarial endemic country
Temporary Deferrals
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Certain immunizations
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2 weeks -MMR, yellow fever, oral polio, typhoid
4 weeks -Rubella, Chicken Pox
2 months – small pox
Pregnancy – 6 weeks upon conclusion
Certain medications
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Proscar/Propecia, Accutain – 1 month
Avodart – 6 months
Soriatane – 3 years
Tegison - permanent
Permanent Deferrals
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HIV, HBV, or HCV positive
Protozoan diseases such as Chagas disease or Babesiosis
Received human pituitary growth hormone
Donated only unit of blood in which a recipient
contracted HIV or HBV
Was the only common donor in 2 cases of posttransfusion HIV or HBV in recipient
Lived in a country where Creutzfeld-Jacob disease is
prevalent
Most cancers except minor skin cancer and carcinoma insitu of the cervix
Severe heart disease, liver disease
Helpful Hint
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Permanent deferral – any member of high risk
group such as: HIV/HBV/HCV pos, drugs/sex for
money, cancer, serious illness or disease, CJD,
Chagas disease, Babesiosis
12 month deferral – sex with any high risk
group, any blood exposure, recipient of
blood/blood products, STD, jail/prison, rabies
vaccine after exposure, HBIG, malaria
Have to memorize: medications and
vaccinations
Self-Exclusion
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Two stickers
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“Yes, use my blood”
“No, do not use my blood”
After interview the donor will place the appropriate bar
coded label on the donation record
If “no” selected the unit is collected, fully tested, but not
used for transfusion
Allows donors who know they are at risk to “save face” if
pressured to donate by friends and family
Donor Categories
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“Allogeneic”, “homologous” and “random donor” terms
used for blood donated by individuals for anyone’s use
Autologous – donate blood for your own use only
Recipient Specific Directed donation – donor called in
because blood/blood product is needed for a specific
patient
Directed Donor – patient selects their own donors
Therapeutic bleeding – blood removed for medical
purposes such as in polycythemia vera. NOT used for
transfusion.
Auto/Directed Blood Labels
Donor Categories
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Safest is autologous, blood is your own,
no risk of disease acquisition
Most dangerous is Directed Donor, you
select a donor who may, unknown to you,
be in a high risk category but feels
obligated to follow through and donate
Blood Collection
Collection of Blood
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Materials used are sterile and single use.
Most important step is preparing the site to a
state of almost surgical cleanliness.
Bacteria on skin, if present, may grow well in
stored donor blood and cause a fatal sepsis in
recipient
Use 16-17 gauge needle to collect blood from a
single venipuncture within 15 minutes
Collect 450 +/- 45 mLs of blood
Donor Reactions
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Syncope (fainting)
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Hyperventilation
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Remove needle immediately
Have donor rebreathe into paper bag.
Nausea/vomiting
Twitching/muscle spasms
Hematoma
Convulsions – rare, get immediate assistance
Cardiac difficulties
Post-Phlebotomy Care
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Donor applies pressure for 5 minutes
Check and bandage site
Have donor sit up for few minutes
Have donor report to refreshment area for
additional 15 minutes of monitoring
Post-Phlebotomy Instructions
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Eat/drink before leaving
Wait until staff releases you
Drink more fluids next 4 hours
No alcohol until after eating
Refrain from smoking for 1 hour
If bleeding continues apply pressure and raise arm
Faint or dizzy sit with head between knees
Abnormal symptoms persist contact blood center.
Remove bandage
Testing Donor Blood
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CANNOT rely on previous testing
Records must be kept for 5 years
Serological Testing
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ABO/D typing
Antibody Screen – if positive, ID antibody,
cannot make plasma products
Antibodies to other blood group antigens
which are present in the donor may react
with recipient red cells resulting in a
reaction.
Disease Testing
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Disease testing
include:
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HBsAG
HBc
HCV
HIV 1&2
HTLV I/II
RPR
NAT for HIV-1, HCV &
WNV
Results of Testing
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Tests for disease markers must be
negative or within normal limits.
Donor blood which falls outside these
parameters must be quarrantined.
Repeat testing, if still abnormal must
dispose.
Transfusion Service Testing
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The only repeat testing required is:
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ABO on red cell products
D typing (IS) on D negative red cell products
Plasma products (FFP, CRYO, PLTS) do not require any
testing.
Donor samples must be stored at 1-6C for at least 7
days after transfusion
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ADSOL unit transfused today must save sprig for one week
Many facilities will pull a sprig from each donor during
processing and save all sprigs for 49 days, regardless of
expiration of unit
Summary
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Blood collection starts with screening of the donor to:
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Ensure they are healthy enough to donate
Ensure they do not have transmissible diseases
Many organizations set standards and monitor all aspects of blood
collection and administration.
Collection of blood must be done in such a manner as to ensure
sterility of the component.
Testing of donor blood includes serological testing for ABO/D typing,
antibody screening, and testing for markers indicating infection.
The blood supply is NOT safe, only careful screening and testing can
prevent, as much as possible, disease transmission.