Professional Documents
Culture Documents
Courtesy of:
LEON SU, MD
CHIEF MEDICAL OFFICER, UNITED BLOOD SERVICES OF ARIZONA ASSISTANT PROFESSOR OF LABORATORY MEDICINE AND PATHOLOGY, MAYO CLINIC COLLEGE OF MEDICINE CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF PATHOLOGY, THE UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE - PHOENIX
OBJECTIVES
Overview of blood donation process
TYPES OF DONATION
Community Blood Center (For transfusion in patients at hospitals) Whole Blood
Produces
Packed red blood cells Fresh frozen plasma Random platelet
Apheresis
May produce
1-3 Apheresis platelets Fresh frozen plasma One or two units of red cells
Plasma Center Plasmapheresis Plasma used for medications that are derived from human plasma
CURRENT ESTIMATES
Of the 177 million age eligible
Approximately 66 million expected loss due to deferrals (22% reduction in eligible donors) leaving 111 million eligible donors New estimates show only 38% of population eligible to donate
WHY DO WE DEFER?
Do No Harm Protect the recipient Protect the health of our donors Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things-to help, or at least to do no harm.
Hippocrates (circa 400BC) Epidemics, Bk.I, Sect. XI
Donor Screening
Abbreviated Physical Exam
Other Testing
DONOR QUESTIONNAIRE
Screening by questionnaire - important step in protecting the safety of the blood supply Series of questions designed to minimize the adverse consequences to the blood donor and patient Identify elements of the donors medical history and behavior or events that put a donor at risk for transmitting disease or their own personal health at risk
MSM DEFERRALS
Current indefinite deferral in US: men who have had sex with men since 1977
Controversial
Professional medical community (AMA, AABB and ABC) all favor change to current deferrals FDA position prevents change at the moment UK moved to one year deferral from last sexual contact starting Nov 7, 2011
31%
N = 42,959
TEMP
BLOOD PRESSURE
37.5 C (99.5 F)
90 to 180 mm Hg systolic 50 to 100 mm Hg diastolic 50-100 bpm 12.5 g/dl 38%
37.5 C (99.5 F)
180 mm Hg systolic 100 mm Hg diastolic 50-100 bpm 12.5 g/dl 38%
PULSE HGB/HCT
1907 Crossmatching
1987 Implementation of hepatitis B core antibody (anti-HBc) and the alanine aminotransferase test (ALT).
CMV
Bacterial Detection West Nile Virus Chagas
HIV
HIV 1/2 Antibody Enzyme immunoassay Confirmed by Western Blot/ Immunofluorescence Assay (IFA) Negative confirmatory unlicensed HIV-2 western blot Multiplex NAT HIV-1/HCV Discriminatory NAT HIV
HIV AB
Modified from Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases, 6th ed.
-CONTINUED-
CDC sequenced the HIV DNA from donor and recipient and confirmed 99% identical
Donor revealed in a follow up by Missouri State Health that he was married but engaged in sex with both men and women outside the marriage, often anonymously and while he was drunk, including shortly before his June donation.
Hepatitis B
1:300,000 1:357,000
Hepatitis C
~ 1:1,149,000
HIV
~ 1:1,467,000
Zou S, Stramer SL, Dodd RY. Donor testing and risk: current prevalence, incidence, and residual risk of transfusion-transmissible agents in US allogeneic donations. Transfus Med Rev 2011;Aug 24 Epub.