Module 1: The Journey of Blood: Donation to Distribution

Transfusion Training WorkshopKKM 2012

The journey

Donors

Voluntary, non-remunerated

We advocate self-deferral

Donate

At blood collection centers/blood drives

Donate whole bloodor

Donate platelet only / plasma only

Transportation

The donated blood is quickly transported to the blood bank

Whole blood is kept at RT before processing

The cold chain is maintained throughout

Blood is labeled as UNSCREENED and quarantined until virology results are obtained

Testing Screening for infectious diseases:

HBV, HCV, HIV, Syphilis Newly emerging viruses ? Bacteria, parasites, fungi ?

If all the tests are negative the blood is labeled SCREENED

If either one of the tests are positive, the blood is pulled out of stock and discarded

The blood donor will be called back for counseling and further testing

Different Components

Blood Components

Prepared from whole blood donation

Blood components derived from plasma Fresh Frozen Plasma (FFP) Cryoprecipitate Cryosupernatant Plasma-derived fractionated products

Fresh Whole Blood

Efficacy based on the minimal time from donation to administration

“Freshness” is different among collection centers

Fresh WB is defined as <7 days old

It has a haematocrit level of 30 – 40%

Storage: 2 – 6°C (4±2°C)

Fresh Whole Blood

Constituents Coagulation factors: all present, but rapid

reduction in FV, FVIII (labile factors) Platelets: as WB is cold-stored, platelets do

not circulate; do not arrest bleeding Storage lesions

Most indications for WB are now well managed with blood component therapy

Packed Red Cells

Prepared by removing most of the plasma from the unit

It has a haematocrit level of 55 – 65%

Storage: 2 – 6°C (4±2°C)

Shelf life: 42 days (max)

Packed Red Cells

Red cells are the preferred product for patients with symptomatic anaemia

Restore/ improve oxygen-carrying capacity

2,3-diphosphoglycerate (DPG) necessary to allow oxygen release to tissues

Fresh Frozen Plasma (FFP)

Storage at -20°C

Prepared within 6 hrs of WB collection

ABO compatible and crossmatching not required

Contents : all coagulation factors, no platelet

Use: to replace all coagulation factor deficiencies

Thawed in 37°C water bath in the BB

Administer within 30 min after thawing (activity of labile FV, FVIII is rapidly lost)

Increase factor levels 20 – 30% per dose of 10 – 15 ml/kg BW

Cryoprecipitate

Prepared from FFP – 10 – 20 ml

Dosage: 1 unit/10 kg

ABO compatible and crossmatching not required

Contents: Fibrinogen, FVIII, FXIII and vWF

Indications: Correction of fibrinogen

deficiency (DIC) Correction of factor XIII

deficiency

Liver Plasma / Cryosupernatant

Contents : plasma- stable clotting factors, no platelet

Storage temperature : frozen -20oC or colder

Indications: Plasma exchange

eg. in TTP Should not be used

for blood volume expansion or protein replacement

Platelets

Platelets Random Apheresis

Kept at RT 22 – 24°C and constantly agitated

Distribution: blood components will be supplied to hospitalsBased on:

Average daily usage: to avoid expiry / wastage Patient load Special circumstances: patient with massive bleeding, natural disaster

What happens in the blood transfusion unit?

Pre-transfusion Compatibility Testing Positive recipient

identification: blood request form and blood samples

Clerical check: manual or computerized

Every patient, every time

Process Blood Sample

Serological Tests

1. Blood grouping

ABO testing Rh testing

2. Rh negative: additional testing is performed

Serological Testing

3. Antibody screening to detect presence of

clinically significant unexpected alloantibodies

all positive screening must be investigated regardless of whether transfusion is needed

4. Antibody identification laborious, time-consuming

Pre-transfusion Compatibility TestingCross-match testing:

Serologic cross-match

Immediate spin/RT LISS 37°C AHG

Estimated 20-25minutes

Pre-transfusion Compatibility Testing Selection and issuance of suitable

blood/ blood components ABO and Rh type Rare blood: liaise with hospital BB, PDN Specifications: filtered blood, irradiated

blood, exchange transfusion

Pre-transfusion Compatibility Testing Group, screen and

hold (GSH)1. Positive recipient i/d

2. ABO, Rh grouping

3. Rh negative

4. Antibody screen

5. Antibody identification

Group and cross-match (GXM)

Conversion of GSH (steps 1 – 5)

6. Serologic cross-match Immediate spin/RT LISS 37 AHG

7. Blood issued

The end