Blood Bank

Conclusion, Open Discussion, and

Recommendations
 Safe Blood Donation

• Voluntary blood donation.

• Unpaid blood donation.

• Absence of profit.
 Donor Categories
• “Allergenic”, “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.
 Donor Categories
• 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 donation reactions and
complications
• Mild Reactions:- ( Anxiety, Increase
respiration, Rapid Pulls, Pallor and mild
Sweating.
• Moderate Reactions:- Loss of
Consciousness (faint), Slow Pulls
(Difficult to feel ).
• Sever Reactions:- Faint, Convulsion,----
 How To Manage Donation
Reaction Mild)
1- Discontinue Donation.
2- Raise Legs and Lower Head.
3- Loose or Remove tight.
4- Keep the donor Cool.
5- After recover offer him a cool drink.
6- Record the reaction at the BB recording.
Ensure that he is full recovered before leaving.
 How To Manage Donation
Reaction (Moderate)
• As before in addition to:-
• 1- Remove him to another room for privacy
• 2- Chick the pulls, the appearance.
• 3- release him when full recovered.
 How To Manage Donation
Reaction (Sever)
• As before in addition to:-
• 1- Turn the donor to a lateral position to maintain
a clear airway.
• 2- Gently restrain the donor to prevent any injury.
• 3- Ensure that he is full recovered before leaving.
• 4- Advise him not to donate blood again and
contact a doctor.
 Post-Phlebotomy Care
• 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
• 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
 Blood Collection

• Post-donation: observe donor, give post-donation

• instructions (remain sitting 10 minutes, drink more
fluids than normal the next 4 hours, caffeine until
• you eat, don’t smoke for 30 minutes, if you feel
• dizzy lie down, if venipuncture starts to bleed apply
pressure for 5-10 minutes, remove bandage after a
• few hours, call your physician if symptoms persist,
• resume normal activities
 Question
• A 35 year-old nurse received their first
hepatitis B vaccination as part of the hospital’s
safety program requirement. He is eligible to
donate blood:
– A. Today.
– B. In 24 hours.
– C. In 48 hours.
– D. In 6 months.
– E. In 12 months.
 Question
• A contact person to HBV, or HCV patient is
not eligible to donate blood for :-
•
• A- Two months
• B- 6 months
• C- Four month
 Question
• During Your Councilling, a blood donor
before collecting his blood , he prevails that
he is a diabetic patient. Would you accept or
differed him?
Specimen Considerations – Recipient
Specimen must be clearly and accurately
identified

Labeled with patient’s first and last name,

hospital ID, date specimen drawn, who drew the
specimen.

Information on request for crossmatch must

exactly match information on patient ID.
Never rely on door tag, bed tag, patient chart
for ID
 Blood Typing (Reverse method)
• There are 2 components to blood typing:

– Test unknown cells with known antibodies

– Test unknown serum/plasma with known RBc’s

• The patterns are compared and the blood

• group is determined.
 Slide Blood Typing - continued
• The slide is divided into halves.
• On one side a drop of anti-A is added, this will attach to
and cause clumping of RBcs possessing the A antigen.
• On the other side a drop of anti-B is added which will
cause clumping of RBcs with the B antigen.
• A drop of RBcs is added to each side and mixed well
with the reagent.
• The slide is tilted back and forth for one minute and
observed for agglutination (clumping) of the RBcs
 Slide Blood Typing
• Very rudimentary method for determining blood
groups.
• CANNOT be used for transfusion purposes as
false positives and negatives do occur.
• A “false positive” is when agglutination occurs not
because the antigen is present, but cells may
already be clumpled.
• A “false negative” is one in which the cells are not
clumped because there are too many cells or not
enough reagent.
 ABO Compatibility

Best to give ABO group specific blood

Should not give ABO non-specific whole
blood

In Packed Red Cells small amount of

antibodies remaining in plasma are diluted by
patient’s system are inconsequential
Recipient blood is forward and reverse typed.
Donor ABO group must be confirmed after
ABO label is attached.
 Cross-Reaction
• If donor and recipient blood types not
compatible:
– Plasma antibody meets its specific surface
antigen and blood will agglutinate and
hemolyze
Cross-Reaction

Figure 19–6b
 Blood Storage
• Blood Donated is stored in low temp ( 1-6C)
• To slow or stop al biochemical activities, and
• keep blood cells active, and avoid
• contamination.
 Blood Transfusion Request
• It should provide the following information's:-
• . Date of Request.
• .Patients full name, date of birth, sex, hospital No, word,
address, blood group if known.
• .provisional diagnosis.
• . Presence of antibodies.
• . History of previous transfusion, and reaction if happened.
• . No of previous pregnancies (female)
• . No and type of units of blood and blood products required.
• . Reason of transfusion.
• Signature of doctor requesting the blood.
• .
• .
• .
• .
 Blood transfusion reaction
1. Stop transfusion immediately
2. Continue IV infusion with normal saline
3. Notify physician of client’s signs and
symptoms
4. Provide care for client as indicated
5. Complete reaction form according to
institution protocol.
6. Obtain urine specimen from client and
send for free hemoglobin.
 Ordering blood

Assess patient’s
need for transfusion

Emergency Possible need for blood

Definite need for blood
Blood needed e.g. obstetrics,
e.g. elective surgery
within 1 hour or less elective surgery

Urgently request ABO and Request ABO and RhD

RhD compatible units. Request group,
Blood bank may
Compatible units to be
antibody screen and hold
select group O available at stated time
 Urgent Release of Blood

Requesting physician must document that the

clinical situation was urgent to require release
of uncross matched blood.

Usually give O neg unless ABO type/Rh of

recipient has been determined (can't use
previous records).

Units must be labeled to make it clear that

testing was incomplete
 Personnel

1. Does the facility have qualified

personnel with appropriate education,
training and experience-competent
performance of assigned duties

2. Effective job description

 Personnel

Well defined program

Regular scheduled
Orientation of new employees competency
evaluation of staff:
To ensure that
their skills are
maintained
 DOCUMENTATION

If you have not

documented it,You have
NOT done it.
 Records Management
• Proper documentation of all samples
processed

• All forms required in trace back or look

back process

• Transfusion requests kept for 1 month

• Transfusion reaction forms indefinitely

• Records( employee signature,ID,initials) 5

years or as per national guidelines

• Non transfusion serological tests results for

5 years
 Records Management
• Quality controls records
(reagents/serological test controls/external
proficiency testing) 5 years
• Quality assurance 5 years
• Antibody identification reports indefinitely
• Method revision sheet indefinitely
• Donor segments/serum/plasma,clotted and
or EDTA sample for 7 days post-transfusion
• Computer QA records 3 years
• Patient data files indefinitely
Policy for Product
Recall/Retrival/Lookback-Traceback
Documentation Hierarchy- representing the
level of documentation in a blood bank
Level I:Policies
“What to do”
Policies
Level II:Processes
Processes “How it happens”

Level III:Procedures
Procedures “How to do it”
(SOPs)

Forms/Records/Supporting
documents/Data/QC Level IV
Records/Templates
 Documentation

Are the records of incidents,

errors, and accidents

maintained ?
 Types of Clerical Errors

• Venipuncture of the wrong patient

• failure to identify patient correctly
• wrong name placed on sample
• blood taken to the wrong patient
• failure to properly identify the patient prior
to transfusion
 ERRORS ARE USEFUL INFORMATION

 WE LEARN MORE FROM OUR FAILURES THAN

WE MAY FROM SUCCESS
“Give me a fruitful error anytime, full of
seeds, bursting with its own corrections.
You can keep your sterile truth for
yourself”
VILFRED PARETO
 CAN IMPROVE OUR PROCESS WHEN STUDIED
 BENIGN ERROR MAY PREDICT DISASTERS OR
BAD OUTCOMES
 Basic Blood Components
• Red Blood Cells

• Platelets

• Fresh Frozen Plasma (FFP)

• Cryoprecipitate Anti-hemophilic Factor

• Granulocytes
 BLOOD COMPONNET AND SEPARATION

Blood components are packed Red Blood Cells,

Platelets, Rich Plasma, Platelet concentrate, Fresh
Plasma, Fresh Frozen Plasma, Frozen Plasma,
Cryoprecipitate, and Cryosupernant.

Double, Triple and Quadruple blood bags are used for

producing and separating components in closed
system.
 PACKED RED BLOOD
CELLS

cryoprecipitate Whole blood fresh frozen plasma

PLATELETS
 Terms to know:
• Whole blood: blood collected before
separation into components
• Components: parts of whole blood that are
separated
• Closed system: a sterile system of blood
collection
• Open system: when the collection is
exposed to air, decreasing expiration date
 Collection basics
• Blood is collected in a primary bag that
• contains anticoagulant-preservatives
• Satellite bags may also be attached,
• depending on what components are needed
• Anticoagulant-preservatives minimize
biochemical changes and increase shelf life
 WHY BLOOD COMPONENTS ?

•TO CORRECT SPECIFIC DEFICIENCY

•STORAGE CONSIDERATIONS
 Red Blood Cells
RBCs •
1-6° C (stored); 1-10° C (shipped) –
21, 35, or 42 days depending on preservative or –
additive
Hematocrit should be ≤80% –
One unit increases hematocrit 3% –
Once the unit is “opened” it has a 24 hour – 24
expiration date! hours
 Leukocyte
Reduction Filters
(maintains closed system)

http://www.pall.com/39378_39479.asp

Final unit must have less

than 5 x 106 WBCs
 Preparation of platelet
concentrate

Plasma

RBCs PRP

Platelet
concentrate
How platelets are processed
• Requires 2 spins:
– Soft – separates RBCs and WBCs from
plasma and platelets
– Heavy
• platelets in platelet rich plasma (PRP) will be
forced to the bottom of a satellite bag
• 40-60 mL of plasma is expelled into another
satellite bag, while the remaining bag contains
platelet concentrate
 Platelets
• Important in maintaining hemostasis
• Help stop bleeding and form a platelet plug (primary
hemostasis)
• People who need platelets:
– Cancer patients
– Bone marrow recipients
– Postoperative bleeding
BLOOD BANK REFRIGERATORS

• Uniform 40C Temperature Recovery

• Forced Air Circulation system

• Audio/ Visual Alarm

• Temp. Display
 What is Apheresis

The process of apheresis involves removal of

whole blood from a patient or donor. Within
an instrument that is essentially designed as
a centrifuge, the components of whole blood
are separated. One of the separated portions
is then withdrawn and the remaining
components are retransfused into the patient
or donor
Plasma (plasmapheresis)

Platelets (plateletpheresis)

Leukocytes (leukapheresis)
Whatever the local system for the collection,

screening and processing of blood,

clinicians must be familiar with it and

understand any limitations that it may

impose on the safety or availability of blood.

Getting the right blood
to the right patient
at the right time
 Blood products
Key points
1 Safe blood products, used correctly, can be life-saving, However,
even where quality standards are very high, transfusion carries
some risks. If standards are poor or inconsistent, transfusion may
be extremely risky.

2 No blood or blood product should be administered unless all

nationally required tests have been carried out.

3 Each unit should be tested and labeled to show its ABO and Rh D
group.

4 whole blood can be transfused to replace red cells in acute

bleeding when there is also a need to correct hypo volaemia.
5. The preparation of blood components allows a single blood donation to
provide treatment for two or three patients and also avoids the transfusion
of elements of the whole blood that the patient may not require. Blood
components can also be collected by apheresis.

6. Plasma can transmit most of the infections present in whole blood and
there are very few indications for its transfusion.

7. Plasma derivatives are made by a pharmaceutical manufacturing

process from large volumes of plasma comprising many individual blood
donation. Plasma used in the process should be individually tested prior to
pooling to minimize the risks of transmitting infection.

8. Factors VIII and IX and immunoglobulins are also made by

recombinant DNA technology and are often favoured because there
should be no risk of transmitting infectious agents to the patient.
However, the costs are high and there have been some reported cases of
complications.
 Clinical transfusion procedures
Key points

1. Every hospital should have standard operating procedures for each

stage of the clinical transfusion process. All staff should be trained to
follow them.
2. Clear communication and cooperation between clinical and blood bank
staff are essential in ensuring the safety of blood issued for transfusion.
3. The blood bank should not issue blood for transfusion unless a blood
sample label and blood request form have been correctly completed. The
blood request form should include the reason for transfusion so that the
most suitable product can be selected for compatibility testing.
4. Blood products should be kept within the correct storage conditions
during transportation and in the clinical area before transfusion, in order
to prevent loss of function or bacterial contamination.
5. The transfusion of an incompatible blood component is the most
common cause of acute transfusion reaction, which may be fatal.

The safe administration of blood depends on:

 Accurate, unique identification of the patient.

Correct labeling of the blood sample for pre-transfusion testing.

A final identity check of the patient and the blood unit to ensure the
administration of the right blood to the right patient.

6. For each unit of blood transfused, the patient should be

monitored by a trained member of staff before, during and on
completion of the transfusion.
 Monitor and record daily blood stock and prevent

shortages of specific group.

The daily blood and blood component stock is monitored and checked by

head of the sections, in case of specific group shortage the following actions

is taken:

1. Phone call the donors with needed specific group.

2. Phone call the institute and establishments that held blood campaign

3. Communicate central blood bank society.

4. Call blood collection centers in other government hospitals.

5. Demand patient family to replace needed blood.

6. On top emergencies call the TV. and other media for public

announcement.
 Do not ever leave the donor
during or after donation process
until

he or she leave the donation hall.

 ‫‪RECOMMENDATION‬‬

‫‪ -1‬تفعيل جمعيات بنوك الدم ‪.‬‬

‫‪ -2‬اإلعداد لبنك دم مركزي ‪.‬‬
‫‪ -3‬تفعيل المؤسسات االهلية ونشر ثقافة التبرع الطوعي بالدم ‪.‬‬
‫‪ -4‬إعداد إل ‪ SOP‬الخاص ببنك الدم ‪.‬‬
‫‪ -5‬االهتمام بتدريب الكادر ‪.‬‬
‫‪ -6‬توفير جميع االمكانيات الالزمة ألقسام بنوك الدم في المستشقيات ‪.‬‬
‫‪ -7‬تبادل الخبرات بين المستشفيات ‪.‬‬
‫‪ -8‬ابتعاث الكادر الذي يعمل على االرض لالطالع على كل ماهو جديد في بنوك‬
‫الدم في الدول المجاورة ‪.‬‬
‫‪ -9‬االهتمام بالتوثيق وانشاء قاعدة بيانات بأسماء المتبرعين وخصوصا ذوي‬
‫الفصائل النادرة ‪.‬‬