GOVERNING BODIES i.

Protection of Donor (Will it be harmful if blood will be

removed from the donor)
o American Association of Blood Banks (AABB)
ii. Protect Recipient/Patient (Possibility that the donor will
o Food and Drug Administration (FDA)
transmit blood-transmissible diseases)
o College of American Pathologists (CAP)
b) Donor Requirement
o Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
i. Identification Card – For photographic identification
AABB ii. Donor Registration Information – Full name, Date & Time
of Collection, Address, Telephone number, Sex, Age, Date of
o Establish and provide the highest standard of care for patients and donors in all Birth
aspects of transfusion medicine. iii. Consent Form – very important
o Created in 1947 o For legal documentation
o Specific regulations for donor screening and component preparation. o Signed by the donor indicating that he/she allows that
o 2 Publications of AABB: blood will be collected from him/her.
o AABB Standards iv. Donor Samples
o AABB Technical Manual o 2 evacuated tubes (Red & Lavender Stoppered tubes)
FDA for donor testing
o Other tubes used: Tan stoppered (for additional testing)
o Governing body for blood bank inspection.
o Licensing agency in US Allogeneic Blood Donation
o Licensed renewed annually o General appearance: Appears healthy
o Provides regulations and strict compliance with regards to all aspects of o Age: at least 17 years old (16-65 years old)
transfusion medicine o 16 years old – requires a consent form from the guardian
o Blood is regarded as BIOLOGIC and a DRUG o 65 years old – requires a consent form & a consent from the
o DOH Physician
o Licensing agency in the Philippines o In the Philippines – until 60 years old only
TYPES OF BLOOD DONATION o Weight: At least 50 kg/110 lbs
o Hematocrit: ≥38%
1. Allogeneic Blood Donation o Hemoglobin: ≥12.5g/dL
o Most common type o Temperature: not > 37.5ºC/99.5ºF
o Blood is collected from another individual but the same species
Procedures: o Blood Pressure
o Systolic of ≤180mmHg
a) Donor Screening o Diastolic of ≤100mmHg
2 Points to consider: o Pulse: 50-100 bpm
 o Less than 50 bpm is acceptable for athletes or for people who o Needle: 16g
do heavy exercise o Angle: 20º
o Skin Lesions: Donor’s arms. Multiple puncture marks (for indefinite o Storage
deferral) o 1-6ºC; 20-24ºC if used for platelet.
o Contact Dermatitis: Not for deferral
*The phlebotomist must check the condition of the patient and should mix the blood
o DONOR IS <50 kg
bag
o Allowable amount of blood to be drawn
o Amount of anticoagulant needed o Open/Close fist – every 10-12 seconds
o Amount of anticoagulant to be removed o Mixing of Blood – 1-2x per minute/every 30-45 seconds
o Example: 45 kg o Duration of Collection (450 ml) – 7-10 minutes
*Amount of blood to be drawn o Allowable weight of Blood – 425-520g + Weight of blood bag (Blood bag
Donor ′ s Weight and Anticoagulant)
x 450 ml
Ideal Weight
LABELING and CODING of BLOOD BAGS
45 kg
x 450 ml = 𝟒𝟎𝟓 𝐦𝐥
50 kg o ABO Blood Group: Black
*Amount of Anticoagulant needed o Rh (+): Black print on white background
Amount of blood to be drawn o Rh (-): White print on black background
x14
100 o Blood Bags:
Blood Type FDA RED CROSS
405 ml A o Yellow o Blue
x 14 = 𝟓𝟔. 𝟕 𝐦𝐥
100 B o Pink o Yellow
*Amount of Anticoagulant to be removed AB o White o Pink
63 ml − Amount of anticoagulant needed O o None o White
63 ml − 56.7 ml = 𝟔. 𝟑 𝐦𝐥
2. Autologous Donation: Self-donation
BLOOD COLLECTION PROCEDURES Types According to Manner of Collection
o Aseptic Technique: for 30 seconds a) Preoperative Collection
o Iodine compound o Maybe used for orthopedic procedures, vascular surgery, cardiac or
o Chlorhexidine gluconate & Isopropyl Alcohol thoracic surgery and radical prostatectomy.
 If patient is allergic to iodine
o Scrub site: 4 cm/1.5 inches b) Acute Normovolemic Hemodilution: Diluting own blood
o Red Cross: Alcohol, Iodine, Alcohol o While donating, expander/diluent is being infused in the body
o Phlebotomy Proper o Expander/Diluent: Colloid/Crystalloid
o Tourniquet/Blood Pressure Cuffs (40-60mmHg) c) Intraoperative Collection
 o Blood collected during an operation o Interval: At least 2 days
o Collection and infusion of blood happens during operation o Maximum allowable time: 2x a week/24x a year
o Wash blood with saline until the Hematocrit value reaches 50-60% o Platelet Count of Bag: 3.0x1011 with a pH of 6.2
d) Post-operative Collection o Single Donor Platelet: 6-10 random donor platelet concentrate
o Collected blood will be filtered and will be transfused to the patient o Random Donor Platelet: Concentrate from primary blood bag
as whole blood. (Whole Blood)
GENERAL REQUIREMENTS for AUTOLOGOUS DONATION Plasmapheresis
 General condition – No condition predisposing to bacteremia or any o Interval: at least 48 hours before subsequent donation
CVD/Pulmonary condition. o Interval is only followed in cases of emergencies
 Age – No age requirement o Serum/Plasma: test for fetal protein and serum electrophoresis or
 Hemoglobin – At least 11g/dL Quantitative Immunoglobulin in order to ensure that after
 Hematocrit – At least 33% plasmapheresis, the donor will not have any effect to the recipient.
 Last donation – At least 72 hours o Maximum of 2 donations in 1 week
 Prescription/Order from Patients Physician – Should have prescription that
Applications of Plasmapheresis
autologous donation is needed.
 Can be used to increase supply of stored plasma, specifically FFP
3. Directed Donation or for particular ABO Groups
 Same requirement as allogeneic.  Collect Immunoglobulin from Immunoglobulin-rich donors and
 Unit collected is used for a specific patient transfuse it to recipients who are immunocompromised or
 Ethical consideration immunosuppressed.

4. Apheresis (Separator Machine) Leukapheresis

 Greek word “Aphairesis” which means to remove/collect. o WBC’s are collected
 Anticoagulant: ACD o Used for severely neutropenic patients and patients who are
o Plateletpheresis unresponsive to antibacterial treatment
o Plasmapheresis o RBC Sedimenting Agent: Hydroxyethyl starch (HES)
o Leukapheresis o RBC Sedimenting Agent is used in order to increase the yield of
o Erythropheresis leukocyte and to avoid selection of RBC’s
o Therapeutic Cytapheresis/Plasmapheresis – used in patients that has o Corticosteroids: Prednisone or Dexamethasone
increased levels of components of blood (e.g. Polycythemia vera) o Also increases Leukocyte yield
Plateletpheresis/Single Donor Platelet o Administered to donor prior to Leukapheresis
o To increase the number of circulating WBC’s
o Platelet Count of Patient: at least 150x103 /µL
 o Activates marginal pool so that WBC’s will circulate in Adverse Effects of Apheresis
peripheral blood
o Citrate toxicity: ACD
o Decreases departure time from extravascular space (the duration
o Vasovagal reactions and hypovolemia
of time in circulation is long)
o Initially, there is low heart rate but becomes fast due to hypovolemia
o Granulocyte-Colony Stimulating Factor
o Allergic reactions
o Increases the production of granulocytes thereby increasing the no
o Hemolysis
of granulocytes harvested.
o Air embolus
Erythrocytapheresis o Depletion of clotting factors
o Circulatory and respiratory distress
o Maximum of 2 standard RBC Unit for Erythrocytapheresis
o Transfusion-transmitted diseases
o In normal blood donation, only 1 standard RBC Unit will be collected
o Lymphocyte loss
because along with RBC’s are platelets and plasma
o Depletions of protein and immunoglobulins
o Females: 5’5” in height; at least 150 pounds with Hct of 40%
o Males: 5’1” in height; at least 130 pounds with Hct of 40% PRETRANSFUSION COMPATIBILITY TESTING
Therapeutic Cytapheresis/Plasmapheresis o ABO Typing
For both the Donor and Recipient
o Rh Typing
o Bleeding/Blood collection is not meant to donate but is meant to
o Antibody Screen
treat/as a therapeutic management for the condition of the patient
o Crossmatching
o Blood will be removed from the patient to treat his/her condition.
ABO TYPING
2 Forms:
o Forward Typing
i. Cytapheresis: removal of cellular components
o Specimen: 1 drop Patient WB or RCS
 Thrombocytopheresis: abnormally elevated platelet
o Reagent: 2 drops Anti-A1 , Anti-B
counts due to any myeloproliferative disorders because
o Source of Reagent: Lectins
platelets are part of Myeloid series
o Reverse Typing
 Leukopheresis: to treat leukemia
o Specimen: 2 drops Patient serum
ii. Plasmapheresis: removal of plasma components
o Reagent: 1 drop A1 Red cell, B Red cell
 Plasma factors, immune complexes (e.g. SLE – increase
formation of immune complexes due to presence of
 Universal recipient of RBC: AB; Plasma: O
autoantibody, if not removed, will deposit in glomerulus
 Universal donor of RBC: O; Plasma: AB
causing glomerulonephritis), Autoantibody, Alloantibody,
inflammatory mediators, protein-bound toxins, excessive
lipoproteins, platelet aggregating factors, excessive
antibody (causes viscosity in the plasma)
Rh TYPING TRANSFUSION OF BLOOD
o Detect the presence of D Antigen o Positive Identification
o Reagent: Anti-D and BSA o Venous Access
o BSA: Serves as control o Intravenous Infusion
o Result: Agglutination (+)
POSITIVE IDENTIFICATION
o If NEGATIVE  Confirm through Weak D Typing
 Prevent clerical errors
WEAK D TYPING
o Main cause of transfusion reaction deaths and Acute Hemolytic
o Principle: IAT Transfusion Reaction
o Specimen: Negative result from Rh Typing  Patient, patients’ blood specimen prior to transfusion, blood unit
o Reagent: AHG o Needs to have record that identification was performed
 Final check: at the bedside of patient by the nurse (checks blood unit and
ANTIBODY SCREENING
label)
o If positive to Antibody screen, perform Antibody Identification  Patient specimen: collected within 3 days of scheduled transfusion
o Antibody Identification: Performed after transfusion reaction has  Donor’s blood specimen: 1-6ºC for at least 7 days’ post transfusion
occurred in the recipient to identify the specific Antibody causing the
VENOUS ACCESS
reaction.
**Refer to the handout “Antibody Detection and Identification”  Site: Dependent on volume, timing and expected duration
 Infusion of Blood: Use 18-g needle or catheter
CROSSMATCHING
INTRAVENOUS INFUSION
o Major crossmatch is required to be performed; Minor Crossmatch is not
usually performed  Intravenous Solutions: Isotonic Saline or 5% Albumin
o Sample Problem: Six units of pRBC are needed for transfusion. Lab o IV Solution Function: Dilutes blood in order to infuse it smoothly
findings indicates that the recipient has Ab to Fy a and E Ag. Almost 66% o Do not make use of Dextrose (considered to be hypotonic  causes
of the general population is positive to Fy a and 29% is positive to E. How RBC Lysis) and Ringers Solution (contains calcium  initiates
many units of blood should be crossmatched in order to obtain coagulation)
compatible units?  ALL COMPONENTS should be filtered
No of Units Needed by Patient o Clot-screen Filters: removes clot and debris; 70-170µm or 170-
o
(Frequency of Negativity of Ag 1 x Frequency of Negativity of Ag 2) 260µm
6
= 𝟐𝟓 𝐔𝐧𝐢𝐭𝐬 𝐨𝐟 𝐁𝐥𝐨𝐨𝐝 𝐬𝐡𝐨𝐮𝐥𝐝 𝐛𝐞 𝐜𝐫𝐨𝐬𝐬𝐦𝐚𝐭𝐜𝐡𝐞𝐝 VITAL SIGNS
(0.34𝑥0.71)
o Regular monitoring: pulse rate, respiratory rate, BP and Temperature
o Detect signs of transfusion reactions
BLOOD WARMERS SPECIAL CONSIDERATIONS IN TRANSFUSION
o Prevent hypothermia EMERGENCY TRANSFUSION: For patients who are losing 20% of their blood
o Set at 37ºC; not reaching 38ºC (causes complications to patients); if over 42ºC volume
 Blood warmer alarms
o Group O Rh negative red cells
o Never use waterbath or microwave
o Rh (-)  female of child-bearing age
RATE and LENGTH of TRANSFUSION o Rh (+)  male and older female patients
o Slowly for first 10-15 minutes, after 10-15 minutes  can increase rate of MASSIVE TRANSFUSION
transfusion; Slowly to observe if there is transfusion reaction
o Common to vehicular accidents
o 2 ml/minute (infusion rate)
o Usually involves 8-10 units of blood transfused for adults and for infants,
o Red Cell Transfusion: within 2 hours
o Platelet or Plasma Transfusion: within 30-60 minutes slightly higher than 1⁄2 of a unit
o Successful Transfusion  At least 70% of transfused red cells remain in o Complete volume replacement in 24 hours
RECIPIENTS circulation 24 hours’ after o ADVERSE EFFECTS:
o ENTIRE BLOOD TRANSFUSION: within 4 hours o Citrate toxicity and hypocalcemia
o Hypothermia
REISSUING of UNIT o 2,3-DPG depletion
Criteria: o Depletion of coagulation factors and platelets
o Accumulation of biochemical and microaggregates
o Closure must not have been entered in any way
o Once unit is opened, cannot be reissued/stored because it is prone to NEONATAL RBC TRANSFUSION
contamination o For newborn
o Blood must have been kept between 1-10ºC on a continuous basis o Usually in the case of HDFN
o If exposed to room temperature, cannot be reissued o O (-) so that the Ab in the circulation of the mother will not destroy the
o Pilot tube or sealed segment of donor tube must still be attached to the RBC’s
container o Reduce risk of hyperkalemia and maximize 2,3-DPG
o Blood should not be away from blood bank for more than 30 minutes o O (-) or compatible with mother and infant
o Records must be available that verify all inspection criteria o CMV (-) or Leukocyte-reduce (Graft vs Host Disease can occur if not
reduced  Donor cells attacking Recipients cells)
o HbS (-) for hypoxic or acidotic newborns
o 10 ml/kg over 2-3 hours
EXCHANGE TRANSFUSION  Zone III: Severe bilirubin concentration which can predict
preterminated pregnancy
o Small amount of amount will be removed from the baby and will be replaced
o Fetal hydrops: Can be seen in ultrasound of mother
by Donor’s blood
o Selection of Blood:
o Treatment of both anemia and hyperbilirubinemia in HDN
o Group O Rh (-)
o Purpose:
o Compatible with mother’s blood
o Replace Ab-coated RBC’s with compatible donor cells
o Irradiated
o Remove bilirubin and circulating maternal Ab
 Remove bilirubin to prevent the development of Kernicterus TRANSFUSION REACTIONS
o Suppress erythropoiesis
o DON’T PANIC – 1st thing to do
 Not to produce Ag present on RBC’s
o Bedside procedures
o Indications:
o Stop transfusion
o >0.5 mg/dL/hour rise in bilirubin or
o Keep IV Line open: Administer physiologic saline to the patient to dilute
o Rise of 10 mg/dL in the first 24 hours
the blood transfused
o Selection of Blood for Exchange Transfusion:
o Notify patients’ physician and transfusion service (blood bank)
o (-) RBC Ag to maternal Ab
o Perform bedside clerical checks
o ABO group and Rh type compatible with infant’s blood
o Return unit set and attached solution to blood bank
o CMV (-), HbS (-)
o Collect appropriate post-transfusion blood specimen from patient for
o Less than 7 days old (Blood Unit)
evaluation
o Irradiated blood unit
o Document reaction
 Irradiated to reduce the presence of certain components of blood
which will have an effect to the baby INVESTIGATION WORKUP
INTRAUTERINE TRANSFUSION o Clerical checks: check labels
o Visual inspection: check patients’ specimen pre- and post-transfusion
o Intraperitoneal injection of RBC’s into fetal peritoneal cavity
o Pink Plasma: 0.2g/L (20 mg/dL) free Hb
o Intraperitoneal because injected RBC’s will go to the circulation
o Red Plasma: >1g/L (100 mg/dL) free Hb
o Donor RBC’s are directly injected into fetal umbilical vein
o DAT – detects HTR’s
o Repeat every 2-4 weeks until 34-36 weeks’ gestation
o Repeat ABO/Rh Typing
o Purpose:
o Compatibility Testing: Ab Screen and ID
o Maintain Fetal Hb >10 g/dL or until fetal lungs are mature
o Crossmatch
o Indications:
o Bilirubin – 3-6 hours after transfusion
o Amniotic fluid A450 nm: high zone II or III
o Urine (1st voided urine after transfusion) – Free Hb and Urobilinogen
 Amniotic fluid assesses bilirubin concentration.
o Hb and Hct
 Zone II: Indicative of HDFN
TRANSFUSION REACTIONS Anaphylactic and Anaphylactoid Reaction
o Any unfavorable transfusion-related event occurring in the recipient during or o Can be observed upon the administration of 10 ml of blood
after transfusion o Transfusion of IgA (+) blood to an IgA deficient recipient (with Anti-IgA)
o Clinical signs are sudden
Acute Hemolytic Transfusion Reaction
o Prevention – blood component devoid of plasma, Washed components
o Occurs very soon after transfusion or during transfusion
Transfusion-related Acute Lung Injury/Noncardiogenic Pulmonary Edema
o Medical emergency
o Stop immediately and induce diuresis o Ab against WBC’s in donor or patient blood
o Induce diuresis using MANNITOL so that the patient can clear any o S/S: Increasing respiratory distress shortly after transfusion
substance present in the transfused blood that caused the reaction o Prevention: Leukocyte-reduced components
o S/S: Fever with back pain
Transfusion Associated Circulatory Overload/Transfusion Induced
Delayed Hemolytic Transfusion Reaction Hypervolemia
o Anamnestic response in a previously sensitized patient o Physician-caused transfusion reaction (Iatrogenic)
o Sensitization due to previous transfusion, pregnancy or transplant o Treatment: IV diuretics or therapeutic phlebotomy
o Diagnosed 3-5 or 7-10 days after transfusion
Bacterial Contamination/Infection
o S/S: Jaundice and decreasing Hct level
o Implicated Ab: Anti-Jk a , Anti-E, Anti-D, Anti-K, Anti-Fy a , Anti-M o Look for clots, brown/purple color & hemolysis
o Yersinia enterocolitica, Pseudomonas aeruginosa, E. coli
Febrile Non-Hemolytic Transfusion Reaction
o Treatment: IV broad spectrum antibiotics
o Considered to be the most common encountered transfusion reaction o Prevention: visual inspection of blood components
o Can be prevented by the administration of leukocyte-reduce components
Physically-Chemically-Induced Transfusion Reaction
o 1ºC rise in temperature
o Caused by leukocyte Ab in the plasma of patient o Can lead to intravascular hemolysis
o S/S: Fever o Hypertonic or hypotonic solutions
o Heat damage (use of blood warmers)
Urticarial Transfusion Reaction
o Damage during shipping
o Caused by foreign protein in plasma reacting with IgE or IgG (IgG if allergy o Mechanical damage: blood pumps, roller pumps, small-bore needle
becomes chronic)
Transfusion-Associated Graft Vs Host Disease
o Foreign protein can be present on the donor/recipient
o S/S: Hives or pruritus o Donor cells attacking recipient’s cells
o Treatment: Anti-histamine administration/administer washed components o Caused by T cells from donor blood
such as washed RBC’s/Platelets o Patients with immunodeficiency are at risk
 o Prevention: irradiated components o Spherocytosis o Yes o Rare
Post-transfusion Purpura
RHOGAM
o Thrombocytopenia due to anamnestic production of platelet alloantibody
o Increase fragility of capillaries leading to purpura o Prevents formation of Anti-D
o Usually occurs in multiparous women o Neutralizes fetal RBC’s in mother’s circulation
o Antibody involved: Anti-human platelet Antigen-A1 (HPA-1a or Anti-PLAA1 ) o Given:
o Antenatally (before birth)
Iron Overload/Transfusion Hemosiderosis o During early 3rd trimester
o Patients who are chronically dependent on transfusion o At about 28 weeks of gestation
o Aplastic Anemia, Thalassemia, Congenital Hemolytic Anemia o Postpartum within 72 hours after delivery
o Treatment: Iron-chelating agents (desferrioxamine) o After amniocentesis, abortion, ectopic pregnancy of an unsensitized D (-)
o Prevention: Transfusion of NEOCYTES or RETICULOCYTES (longer woman
lifespan) o Fetomaternal Hemorrrhage (FMH) = (%Fetal Cells⁄100)xMaternal Blood Volume
o No weight or blood volume given  use 5000 ml (average maternal blood
HEMOLYTIC DISEASE of the FETUS and NEWBORN volume)
o Erythroblastosis fetalis o If maternal blood volume is not given, use the mother’s weight and multiply it
o Fetal red cells coated with maternal antibodies by 70 kg/ml
o Most common type: ABO HDN o Example: Mother’s weight x 70 kg/ml
o Most severe type: Rh HDN 1 kg x 70 kg/ml = 70 ml (Volume to be neutralized)
o Treatment: early delivery, intrauterine transfusion, exchange transfusion, o Rewrite formula:
phototherapy o FMH = % Fetal cells x 50
o No of Rhogam Vials = FMH/30 or 15
CHARACTERISTICS ABO HDN Rh HDN  No of Rhogam Vials + 1 (For protective purposes)
o Affects first pregnancy o Yes o Rare o Sample Problem
o Disease predicted by o No o Yes o A Kleihauer-Betke acid elution stain for postpartum FHM is reported to
titers be 7.3%. What is the total volume of FMH? How many vials of standard
o Yes (Anti-AB o Yes dose of RhIG should be administered within 72 hours to the mother with
o Antibody IgG
in O mother) this amount of FMH?
o Bilirubin at birth o Normal o Elevated FMH = % Fetal Cells x 50
o Anemia at Birth o No o Yes = 7.3 x 50
o Phototherapy o Yes o Yes = 365 ml
o Exchange Transfusion o Rare o Sometimes No of Rhogam Vials = FMH⁄30
o Intrauterine o None o Sometimes = 365 ml/30
Transfusion = 12.17
 = 12 vials + 1 o Drug alters the membrane of RBC’s so that
= 13 Vials there is a nonspecific adsorption of globulins
(IgG, IgA, IgM and complement)
AUTOIMMUNE HEMOLYTIC ANEMIA
o Presence of Ab that agglutinate, sensitize or lyse one’s own RBC
WAIHA CAIHA
o Four Groups:
o Optimal Reaction o >32ºC o <30 ºC
o Drug-induced hemolysis
Temperature
o WAIHA o IgG o IgM
o Immunoglobulin
o CAIHA Classification
o PCH o Complement o May bind o Binds complement
Drug-induced Hemolysis Activation complement
o Usually o Extravascular/Intravascular
o Patients’ production of Ab to a particular drug or drug complex  Damage o Site of Hemolysis extravascular (cell lysis)
RBC’s (No cell lysis)
o Four Basic Mechanism that causes Drug-induced Hemolytic Anemia o Frequency o 70-75% of cases o 16% of cases (PCH 1-2%)
o Frequently broad o Ii System (for PCH, autoanti-P)
MECHANISM EXAMPLES/CHARACTERISITICS o Specificity
Rh-like
o Example: Quinidine, Phenacetin (QP)
o Immune Complex/Drug- o Drug and antibody forms complexes in the
dependent/ “Innocent serum and attach nonspecifically to RBC’s,
Bystander” attachment induces complement cascade,
leading to intravascular hemolysis
o Example: Penicillin, Erythromycin,
Tetracycline (PET)
o Drug Adsorption/Hapten o Drug binds to any protein, including RBC
Mechanism (DAHM-PET) proteins, which produces a drug-RBC-
hapten complex that stimulates antibody
formation
o Example: Methyldopa (Aldomet),
o Drug- Mefenamic Acid (Ponstel), Levodopa (L-
independent/Autoantibody dopa) (MAMP-L)
Formation o Some drugs induce the production of
autoantibody that recognizes RBC antigens
o Membrane o Example: Cephalosporins
Modification/Nonimmunologic
Protein Adsorption
 PCH CHD
o Children and young o Elderly or middle
o Patient Population
adults aged adults
o Following viral o Idiopathic,
infection Lymphoproliferative
o Pathogenesis
disorder; following M.
pneumoniae infection
o Hemoglobinuria, o Acrocyanosis;
acute attacks upon Autoagglutination of
o Clinical Features exposure to cold blood at room
(symptoms resolve in temperature
hours to days)
o Severity of o Acute and Rapid o Chronic and rarely
Hemolysis severe
o Site of Hemolysis o Intravascular o Extravascular
o IgG (anti-P o IgM (Anti-I/i)
o Autoantibody Class specificity; biphasic monophasic
hemolysin)
o Donath-Landsteiner o Positive o Negative
Test
ROUTINE COMPONENT PREPARATION
 pRBC: Hct *HS: 5000 g for 5 mins at
WHOLE
value <80% 4ºC (performed when pRBC
BLOOD is only needed; no platelet
LS: 3200 g for concentrate)
2-3 mins or
2000 g for HS: 3600 f
3mins for 5 mins

PLATELET- PLATELET
RICH PLASMA o RDP (6-8 hours)
o RDP (6-8 o At least 5.5 x 1010
hours) o pH ≥ 6.2 20-24ºC
o At least 5.5
x 1010
o pH ≥ 6.2
20-24ºC

PLASMA

Plasma FFP 6−8 hours

Frozen248−24 hrs

Slow thawing at 1-6ºC for 14- Forms Cryosupernatant and

HS Cryoprecipitate
16 hours
Cryoprecipitate *Collect Cryoprecipitate
*Completely thawed: slushy *Cryosupernatant can be
plasma frozen again.
DONOR DEFERRAL GUIDELINES
PERMANENT
1-YEAR DEFERRAL 1-MONTH DEFERRAL 2-WEEK DEFERRAL NO DEFERRALS OTHER DEFERRALS
DEFERRAL
o Viral hepatitis after 11th o Mucous membrane o Recipients of live o Recipients of live o Recipients of toxoids o Previous donations –
birthday exposure to blood attenuated for German attenuated or or killed or synthetic defer for 8 weeks; if
o Positive test for o Nonsterile skin or measles (rubella) or bacterial vaccines viral, bacterial or donor has participated
HBsAg needle penetration chicken pox (measles or rubella, rickettsial vaccines in pheresis donation,
o Repeat reactive test for o Sexual contact with an o Donors who have mumps, polio (oral), esp. if donor is defer for at least 48
Anti-HBc on more than individual with a ingested Accutane or typhoid or yellow symptom-free (e.g. hours
one occasion confirmed positive test Proscar – defer for 1 fever, small pox vaccines for anthrax, o Pregnancy – defer for
o Clinical or laboratory for HBsAg month from time of last vaccine) cholera, diphtheria, 6 weeks
evidence of HCV, o Sexual contact with an dose influenza, paratyphoid, o Recipient of blood
HTLV, or HIV individual with viral pertussis, plague, polio transfusion or tissue
infection hepatitis (injection, Salk), transplant – defer for
o Behavioral risk factors o Sexual contact with an Rocky Mountain 12 months
for HIV infection individual with HIV Spotted Fever, tetanus, o Malaria confirmed
according to current infection or at higher typhoid and typhus) diagnosis – defer for 3
FDA guidance risk for HIV infection o A previous history of years after becoming
o History of Babeiosis o Incarceration in a tuberculosis that has asymptomatic
or Chaga’s Disease correctional institution been successfully o Travel to or residence
o Stigma of parenteral for longer than 72 treated and is no longer in an endemic area as
drug use consecutive hours active need not defined by the CDC –
o Injection of o History of syphilis or disqualify a donor defer according to
nonprescription drugs gonorrhea o Recipients of FDA
o Risk of vCJD o If rabies vaccination recombinant type o Male patients who took
according to current has been given growth hormone up Dutasteride or
FDA guidelines following a bite of a AVODART – deferred
o Donors who have taken rabid animal, donor for 6 months since the
Tegison or Etretinate must be deferred for 1 drug is teratogenic
(these drugs are year after the bite o Soriatane carries a
teratogenic) o Recipient of Hepatitis deferral of 3 years
o Donors who have had B immune globulin o Donors who have taken
leukemia or (HBIg) aspirin and aspirin-
lymphoma. containing compounds
– deferred for 3 days
TYPES of DEFERRAL
1. Temporary Deferral
o Prospective donor is unable to donate blood for a limited period of time.
o EXAMPLE:
o Donor has received a blood transfusion; defer for 12 months from the date of transfusion.
o Donor received vaccination for yellow fever; defer for 2 weeks from date of vaccination.

2. Indefinite Deferral
o Prospective donor is unable to donate blood for someone else for an unspecified period of time due to current regulatory requirements.
o Would not be able to donate blood until the current requirement changes.
o May be eligible to donate autologous blood.
o EXAMPLE:
o Donor states they have lived in England for 1 year in 1989; defer indefinitely.

3. Permanent Deferral
o Prospective donor will never be eligible to donate blood for someone else.
o May be eligible to donate autologous blood.
o Some permanent deferrals may result from the testing performed on a previous donation
o EXAMPLE:
o Donor states that he/she has Hepatitis C; defer permanently.