Donor Selection and Processing

By:Wajnat Tounsi

Donor Types• Allogeneic blood donors: When a donor donate blood for

another person use – Volunteer: for ambiguous recipient – Directed donor: the collected unit is directed toward a specific person – A pheresis donor: donate a specific type of blood component. Either

platelet, plasma, leukocytes, or RBC.

• Autologous blood donors: when a donor donate blood for his/er own use– preoperative– Intraoperative – Postoperative– Acute normovolemic hemodilution

Allogeneic Donor Selection

• Will a donation cause a harm to the donor?!• Would that blood from that donor transmit a

disease to the recipient ?!

Donor Registration• Demographic information's required to ensure

proper donor identification.– Donor’s name: First, middle and last name– Address and phone number– Gender– Date of birth and age: at least 17, no upper age limit– Date of donation– Donor consent: a written signature from the donor

allow for blood bank to take and use the blood. Consent must be obtained before the donation.

Physical Examination

• A short physical examination to ensure the donor safety.1. General appearance: Healthy looking ,and no

sign of cold or other infection.

2. Weight: at least 50Kg (110 lb) • Donation of a unite should not exceed about 10%

of the donor’s blood volume. For donating 525 ml of blood (stander donation), the donor should weight at least 50 Kg.

Physical Examination

• If the donor weight less than 50Kg, the amount of the collected blood should be reduced according to the following equation:

(Donor’s weight (lb) ÷ 110 lb) × 450 ml = allowable amount (ml)

• If the allowable amount is less than (300ml), the regular amount of the anticoagulant (63 ml) should be reduced as well according to the following equation:(Allowable amount ÷ 100) × 14 = Anticoagulant needed (ml)

• A specific amount of the anticoagulant should be removed to reach the desirable amount

63 ml – anticoagulant needed = anticoagulant to remove

Physical Examination

• 3. Temperature: should not exceed 37.5° C (99.5° F). Elevated body temperature is a sign of infection or other diseases that might be transferable through blood transfusion.

Physical Examination

• 4. Pulse: 50-100 beats/min. – should be examined for at least 15 sec.– Increased heart beats caused by anxiety, recent

exercise or fear. Allow the donor to reset for few min and re-evaluate the pulse. If still elevated, defer the donor.

– Pulse lower than 50 can be found in athletes who have high tolerance to exercise.

Physical Examination

• 5. Blood Pressure:o Systolic ≤ 180 mmHg, diastolic ≤ 100 mmHg.

Physical Examination

6. Hematocrit and hemoglobin: 38%, 12.5 g/dl

7. Skin lesions: antecubital area must be checked for sign of drug abuse.

8. Check if donor has been permanently deferred, previously.

Physical Examination

Medical History Questionnaire

• The donor required to answer a questioner with simple yes/no question to give an overview about his/er health status to make sure donation is not harmful to the donor nor has a potential of transmitting a disease to the recipient (Blood Transmitted Diseases)

Donor’s Questionnaire and Interview

Donor Deferral

• Permanent deferral: for one or more reason the donor will NEVER be allowed to donate blood.

• Deferral (Temporary): the donor is not allowed to donate blood for a period of time.

Permanent Deferral

• A confirmed positive test result for Hep. B surface antigen (HBsAg)

• A confirmed positive result for Hep. B core antibody (anti-HBc)

• A confirmed positive test result for Hep. C.• A confirmed positive test result for HIV (I, II).• A positive test result for HTLV.• Donor diagnosed with hemophilia A, B, and von

Willebrand’s disease.

Permanent Deferral

• Leukemia or lymphoma • Drug abusing donor.• Donor who was in UK between 1980-1996, due

to the risk of Creutzfeldt-Jakob Disease (vCJD) • Chagas’ Disease• Growth factor hormone injection from a human

source

• Malaria: donor who have had malaria should be deferred for 3 years post-therapy and remain a symptomatic and anti-malaria drugs free for that period.

3 Years Deferral

One Year Deferral • 12 months deferral if donor:

– was in a close contact with a Hep. Positive patient in the last 12 months– received blood products in the last 12 months.– organ or tissue transplantation in the last 12 months.– tattoo, ear or other skin piercing in the last 12 months.– Had accidental needle stick – received hep. B immunoglobulin (HBIg), given after exposure.– travelled to a malaria endemic area in the last 12 months.– Syphilis or gonorrhea post treatment *** (STD)– was in an intimate contact in the last 12 months with a person who:

was HIV positive, drug abusing, takes money for sex, homosexual – After rabies vaccination post exposure. – Have been in prison in the last 12 months

Other Deferral

• Donor is deferred for 8 weeks (56 days) after a blood transfusion.

• A pheresis donor (WBCs, plasma, platelets) is deferred for 48 hours from the last pheresis donation.

• Pregnant women deferred during pregnancy and 6 weeks postpartum

• Donor with a active TB is temporary deferred until is successfully treated.

• Vaccination:– If killed pathogen, toxoid, or recombinant such as

influenza, and Hep.B vaccines, no deferral needed– 2 weeks deferral for attenuated virus vaccine such

as smallpox, polio (sabin/oral), and measles– 4 weeks deferral for rubella vaccine and chickenpox

• Drugs:– Aspirin: 3 days deferral

Other Deferral

• Donor donate blood for his/er own future use. • There is no risk of blood transmitted disease• There is no risk for RBCs alloimmunization • No risk of blood transfusion reaction• There are four types of autologous donation:– Preoperative– Intraoperative – Postoperative– Immediate preoperative hemodilution

Autologous Donation

1. Preoperative collection: • performed in prior to a scheduled surgery where the patient is

suspected to need a blood transfusion during surgery. • Should be ounce every days, and the last donation should be

minimally 72 hours before surgery.• The patient’s minimal hemoglobin 11g/dl, and hematocrite 33%

2. Intraoperative collection:Blood is collected during surgery by aspiration from the surgical site and then processed and transfused to the patient either during or right after surgery. Collected can be stored for 24 hours at 1-6° C

Autologous Donation Types

3. Postoperative collection:Blood is collected from a drainage tube placed at the site of surgery. Blood collected must be used within 6 hours.

4. Acute normovolemic hemodilution:• Used specifically at surgery where blood lose is expected• The patient infused with crystalloid and colloid (volume

expander)• Collected blood is stored at room temp.• The blood is re-transfused within 8 hours

Autologous Donation Types

Blood Collection(Phlebotomy)

1. The person who is performing should be well trained2. Blood must be drawn in aseptic manner, using a

sterile, closed system, and a single venipuncture3. The Phlebotomy site should be free of any lesions. 4. The site should be disinfected by iodophor solution

for 30 sec. in circular motion, starting from the center and going outward.

5. 5. The unite and all pilot samples should be properly labeled.

o Make donor comfortable.o Select and locate the vein, disinfect, cover the site.o Check the bag and the scaleo Place a clamp between the needle the primary bago Give the donor something to squeeze.o Put the tourniquet o Perform the venipunctureo Secure the needle to the skin with a tape and cover with a

gauzeo Monitor the donor all the time o Periodically mix the blood with the anticoagulant

Blood Collection(Phlebotomy)

o When the primary bag has tripped, advice the donor to stop squeezing and clam the tube.

o A unit contains 405 to 550 ml should weight 429 to 583 g, plus the weight of the bag and the anticoagulants

o 1.06 g/ml is used to convert from (g) to (ml) o Low volume unite contains 300 to 404 ml, which should be

labeled as short volume and not suitable for FFPo The volume-weight for WB is 1.06 g/mlo A unit of WB should weight 430-525 g

Blood Collection(Phlebotomy)

o Collect pilot tubes, that used for donor screening

o Release the tourniquet o Remove the needle, apply pressure at

the site of the puncture until bleeding stops, and then place a bandage

o Label the unit and the tubes properlyo Send the unit and the pilot tubes to

the lab for processing

Blood Collection(Phlebotomy)

• After the donation has been done, advice donor to:– Remain seated for a few min.– Give the donor treats (juice, sandwich)– Increase fluid intake for the next 24 hours– Do not drink alcohol before the next meal– Do not smoke for the next half hour– Leave the bandage for few hours– If bleeding occur, re-apply pressure until it stops– If you feel dizzy, lay down with your feet elevated– Do not perform any hazardous work for few hours

Blood Collection(Phlebotomy)

Donor Reactions

Donor Reactions

• Mild Reactions• Moderate Reactions• Severe Reactions

Mild Reactions

• The most common• Donor show signs of shock• No lose of consciousness

Symptoms:

• Fainting • Feeling warm• Pallor, sweating• Increased in pulse• Hyperventilation• Low blood pressure• Nausea, vomiting • Muscles spasm

Treatment

• Stop donation• Breath in a paper bag• Place a cold compresses on the forehead • Raise the donor feet• Put a cold towel at the donor forehead• Loosen tight clothes, check donor’s airway• Monitor vital signs• Don’t leave the donor unattended

Moderate Reactions

Include one or more of mild reaction symptoms

Lose of consciousness for a period of time Decreased heart rate Hyperventilation Hypotension

Treatment• Same in mild reactions treatment • Check blood pressure and pulse frequently• Administer 95%O2, 5% CO2

• Separate donor from other donors if needed

Severe Reactions

• In addition to other symptoms, sever convulsion also include seizures caused by cerebral ischemia, hyperventilation, or epilepsy.

Treatment – Seek medical attention, remain with the donor– If necessary, gently restrain the donor– Check the donor airway, breathing– If necessary administer 95% O2, 5% CO2 – Keep monitoring the donor until fully recover

Hematomas• Is localized blood collection under skin• Common side effect of donation• Occur when the needle puncture the back side of the

vein• If happened, remove the tourniquet and the needle • Apply pressure venipuncture site, and raise arm for 5-

10 min.• Apply ice for 5 min.

Donor Processing

Donor Processing

• All donor units must be processed and tested before they are ready to be transfused– ABO grouping – Rh typing– Ab screening – Serological Testing:

• Hepatitis B• Hepatitis C• HIV (1,2)• HTLV I/II• Syphilis• others

ABO & Rh Grouping

• ABO testing by two different methods (forward, and reverse)

• Rh typing by using Anti-D (Rh0)– If positive in the immediate spin, the unite should

be labeled– If negative, Du testing should be performed– If Du is positive, the unite should be labeled as Rh

positive

Antibody Screening

• Is required only for female donors who were pregnant, donors who had blood products transfusion

• However, it is a routine procedure performed for all donor units

Serological Testing

Hepatitis BV Surface Antigen (HBsAg) Hepatitis BV core antibody (Anti-HBc):

– Enzyme linked immunosorbent assay (ELISA) is the most used test for secreening

– If negative, no further investigation is necessary– If positive, the test should be repeated in duplicate.

A positive in one of them considered HBsAg positive.– All component must be discarded

Serological Testing

Hepatitis CV antibody (Anti-HCV)• Enzyme immunoassay (EIA) is the screening test

used • Nucleic-acid testing (NAT) screening for HCV RNA

was introduced in 1999• NAT detects viral nucleic acid in blood

Serological Testing

Anti-HIV 1/2 and NAT:– All donors should be screened for presence of HIV-

1/2 antibodies – If the antibody screening is negative, no further

investigation is necessary– If positive, a confirmatory test is needed. – Confirmatory test include: western blot and

Immunofluorescense assay (IFA)– NAT, detect the presence of HIV RNA– NAT reduced the window to 12 days

Serological Testing

Human T-cell lymphotropic virus (HTLV) I/II :

• A virus that cause adult T-cell leukemia• Transmitted through transfusion of infected

lymphocytes• EIA is approved screening test• Positive HTLV I/II cause permanent deferral of

the donor

Serological Testing

• Syphilis:– STD and can also be transmitted through blood

transfusion– No documented cases for blood transmitted

syphilis

• Other serological testing is performed depending of the region and whether there is a specific disease (endemic) that donors should be screened for. For e.g.:

• SARS– Acute case of SARS deferred for 28 days– Traveling to endemic area, deferred for 14 days

• WNV– infected donor deferred for 14 days after recovery or

28 dys from the onset of diagnosis

Serological Testing

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