BLOOD COLLECTION PROCESS.pptx

Blood banks use various processes to try to prevent infections that can be transmitted by infected blood donation. One important measure to prevent infection is to recruit donors from populations that are known to have low rates of infection for blood borne diseases, such as voluntary, unpaid donors and people with no history of intravenous drug use.The process for collecting blood from donors is similar to that used for blood sampling; however, a few additional measures are required for collection of donated blood. These measures are primarily to to minimize exogenous contamination of a donated blood unit or its derived components, particularly contamination from the skin flora of the donor's arm. Because of the volume or blood collected and the length of storage, pathogens can multiply during storage. Safe collection ensures that the blood products are safe for therapeutic use throughout their shelf life.
Skin flora is a common source of contaminants; it is therefore important to use an effective antiseptic on the donor's arm before blood donation. Transfusion with blood components that are contaminated with exogenous bacteria or other agents can cause fatal complications ., the recommended option for skin antisepsis for blood donation is the one-step application of a combination of 2% chlorhexidine gluconate and 70% isopropyl alcohol for 30 seconds, followed by 30 seconds drying time .
Blood donations should be collected only by trained and qualified blood transfusion services personnel. Equipment:

All equipment used for collection of blood donations should be regularly calibrated, maintained and serviced, as required. Such equipment includes blood pressure monitors, scales, donor couches or chairs, blood collection monitors or mixers, blood bag tube sealers, blood transportation boxes and blood bank refrigerators.Equipment:

All equipment used for collection of blood donations should be regularly calibrated, maintained and serviced, as required. Such equipment includes blood pressure monitors, scales, donor couches or chairs, blood collection monitors or mixers, blood bag tube sealers, blood transportation boxes and blood bank refrigerators.
–Furniture and equipment in the area of blood donation and processing should be made of cleanable surfaces (e.g. vinyl rather than fabric). Containers used to transport supplies and specimens should also be cleanable by disinfectants such as sodium hypochlorite bleach solutions. Fabric or textile carriers should be machine washable.WHO has developed a set of basic requirements for blood transfusion services, which cover the steps to take before donation . Blood donation should be voluntary; it should not involve duress, coercion or remuneration. Also, potential blood donors should be selected carefully, according to the national criteria for donor selection.Step 2. Select the vein
Select a large, firm vein, preferably in the antecubital fossa, from an area free from skin lesions or scars.
Apply a tourni

1. BLOOD COLLECTION PROCESS PRESENTED BY – DR PRAGYA BHARDWAJ MODERATED BY – DR AAKRITI BAIJJAL

2. CONTENTS

3. MOST IMPORTANT AND ESSENTIAL FUNCTION OF BLOOD TRANSFUSION SERVICE .

4. REGISTRATION C onfirm donor’s identity and link him to existing records. Photographic identification – driver’s license, passport, school identification card. Previous deferral if any.

5. The registration must include the following information:- Name (first, last, MI) Date and time of last donation Age( >/= 18) Gender Address Telephone Informed consent

6. Additional information :- Any other name used during previous donation. Race : for matching specific phenotypes In case of directed donations- Name and other identifiers of recipient. Order from recipient’s physician. If donor is blood relative then cellular component must be irradiated. Unique characteristics- to make optimum use donation. Blood from donors who are seronegative for CMV/ who are O RH negative is often designated for neonatal patients. Donors with clinically significant antibodies- their blood can be processed in components that contain only minimal amount of plasma.

7. DONOR SELECTION Based on two important things : Medical history Preliminary medical examination

8. MEDICAL HISTORY Give pre donation information before taking maedical history. If the donor appears healthy Medical history questionnaire is filled by donor or the clinical staff( interviewer) Evaluated by medical officer.

9. ADVANTAGES OF STANDARD MEDICAL QUESTIONNAIRE Helps to collect same information systematically from each donor. Clinical staff does not forget to ask important questions Helps to make quick assessment whether to accept, temporary defer or permanently reject the donor.

10. MEDICAL QUESTIONNAIRE

11. PHYSICAL EXAMINATION It is important to make preliminary health check of donors before donation and solely depend upon the medical history told by the donor. The following parameters are checked General appearance The donor should be in good health . Age Between 18-65 years Weight 45-55kg : 350 ml blood >/=55 kg: 450 ml blood Blood pressure Systolic : 100-140 mm Hg Diastolic : 60-90 mm Hg

12. PHYSICAL EXAMINATION Pulse 60-100 bpm and regular Temperature Oral temperature not more than 37.5 degree celsius Physical assessment Check for skin rashes and swollen glands Check for needle prick marks at venepuncture sites Haemoglobin estimation 12.5 g/dl – 17 g/dl

13. Based on the medical history and examination, the donors should be : Accepted Temporarily deferred Rejected

14. COLLECTION OF BLOOD The area should be- To make donors comfortable and relaxed CONVENIENT WELL VENTILATED (PREFERABLYAIR CONDIONED) ORDERLY & CLEAN WELL LIT PLEASENT

15. Accessible & open at hours convenient for donors Staff should be friendly, understanding, professional & well trained Minimum risk of contamination or exposure Adequate space for private and accurate examination of donors Done by qualified physician or under his/her supervision an assistant trained in the procedure.

16. MATERIALS AND METHOD

17. MATERIALS BLOOD COLLECTION BAGS: 350 ML & 450ML( Single, double, triple, triple ADSOL/ SAG-M, quadruple ADSOL/ SAGM with or without integral filter) anticoagulant in primary bag – CPD or CPDA-1

18. SPHYGMOMANOMETER STETHOSCOPE VACUTAINER TUBES FOR SAMPLE COLLECTION TEST TUBE RACKS COTTON WOOL SWABS SCALE FOR WEIGHING THE BLOOD COLLECTED IN BAGS BLOOD MIXER TUBE SEALER, ROLLER, & CUTTER (DIELECTRIC SEALER)

19. ARTERY FORCEPS AND SCISSORS NEEDLE DESTROYER/ SHARP CONTAINER ANTISEPTIC SOLUTION BAND-AIDS SYRINGES & NEEDLES ( DISPOSABLE) EMERGENCY DRUGS ( FIRST AID KIT) LABELS

20. BEFORE STARTING THE PROCEDURE IDENTIFICATION: The blood collection bags & pilot tubes should be identified by a specific donor registration number, so it can be traced back to the donor and also to the recipient. R eview the donor records and ensure that the donor name and the identification number match.

21. LABELING: The phlebotomist should ask the donor to spell his/her name. At this time, he must attach all labels to blood bags, donor record and pilot tubes. The date of collection and expiry should be written on the label of the bag. INSPECTION: Inspect the blood bags for any leakage, defects and discoloration.

22. ARM PREPARATION

23. PRECAUTIONS TO BE TAKEN WHILE COLLECTING BLOOD FOR BLOOD COMPONENTS. The blood is collected in blood bags with integral filter containing suitable anticoagulant. Venepuncture should be clean with minimum trauma to tissue to prevent initiation of blood clotting . The flow of blood - rapid and uninterupted . The collection should be completed in less than 15 min . The blood bags should be constantly but gently agitated so that blood and anti coagulant are mixed thoroughly. The ratio of blood to anticoagulant should be correct ie . 350 ml should contain 350 ml +/-10% of blood 450 ml bag should contain 450 ml +/- 10% of blood .

24. STORAGE For preparation of FFP , Frozen plasma and cryoprecipitate , the blood should be stored at 4-10 degree celcius till processed . For platelet rich plasma, platelet concentrate and buffy coat , the blood should be stored in an air conditioned room at 22-24 degree celcius till processed.

25. POST DONATION CARE AND ADVICE Drink more fluids in the next 4 hrs. If there is bleeding from venepuncture site, raise the arm and apply pressure until the bleeding stops. If bleeding continues, donor should contact the blood bank. If the donor feels dizzy, he should be made to lie down with both legs raised( if symptoms persist, donor should contact blood bank). Remove band aid after 10-12 hrs. Donor should avoid strenuous exercise for the next 24 hrs post donation. Avoid smoking for half an hour after donation. Don’t consume exessive alcohol before the next meal. TAKE NOTE OF ANY ADVERSE REACTION IN THE DONOR RECORD SO THAT DUE CARE CAN BE TAKEN AT THE NEXT DONATION.

26. ADVERSE DONOR REACTIONS Rare but can occur either during donation or after donation. The clinical staff should be well trained to recognise and treat them without delay . Common problems encountered in donation – Difficulty in blood flow. Vasovagal syndrome with or without loss of consciousness . Hyperventilation Convulsions Accidental puncture of artery

27. DIFFICULTY WITH BLOOD FLOW It may be due to Spasm of the vein Reduced cuff pressure Occlusion of the lumen of the needle by vein wall or by the valve within the vein. MANAGEMENT Give reassurance to the donor and check the cuff pressure. Do little positioning of the needle. Avoid excess manipulation as this can result in hematoma. If it does not help, remove the needle and discard the bag. If donor agrees , further venepuncture on the other arm may be attempted provided a suitable vein is found.

28. HEMATOMA It is a localised collection of blood under the skin , resulting in bluish discoloration Caused by needle going through the vein with leakage of blood into the tissue . MANAGEMENT Stop the donation and give reassurance to the donor. Place a sterile guaze over hematoma and apply firm pressure until blood stops oozing. Apply anti inflammatory cream and pressure bandage for 24 hrs. Suggest NSAID in case there is pain.

29. VASOVAGAL SYNDROME( REACTIONS) MILD CASES - MODERATE CASES Sweating - Loss of consciousness Anxiety - Nausea and vomiting Rapid thready pulse Pallor and dizziness Cold skin with fall in BP.

30. MANAGEMENT Stop donation Raise the legs of donor and lower the head Loosen tight clothing Ensure adequate airway Provide suitable receptacle if donor vomits, turn his/ her head on one side to avoid aspiration of vomitus . Move the donor to another room to prevent other donors from apprehention .

31. HYPERVENTILATION Hyperventilation results in lowering of CO2 This may lead to twitching or tingling sensations. MANAGEMENT Ask the donor to breathe quickly and slowly. If this fails to relieve the spasm ,ask the donor to breathe into a paper bag ,it will bring prompt relief.

32. CONVULSIONS Associated with vasovagal syncope or reduced blood flow to the brain. MANAGEMENT- Prevent the donor from injuring himself. Keep a tongue depressor between the teeth to prevent the donor from biting his tongue. Ensure adequate airway. Put screens around to maintain privacy. Check the pulse frequently. Loosen tight clothing. Doesn’t stop after 5 minutes, call medical specialist. After recovery, give reassurance to the donor and advise him not donate blood in future.

33. ACCIDENTAL PUNCTURE OF ARTERY Very rare. There is fast flow of bright red blood. MANAGEMENT:- Stop donation immediately. Apply hard pressure to puncture site for min. 15-20 minutes. Raise the limbs above the heart level. Give reassurance to the donor and record the finding in donor card. Allow the donor to leave only when senior member of clinical team is satisfied about his well being.

34. DUTIES OF A BLOOD BANK Not the primary duty of blood bank or BTS to confirm the diagnosis of the TTI screened for. Sero - reactive blood units should be discarded complying with biomedical waste management rules 2016. Sero - reactive donors shall be recalled & offered post donation counselling . They are then referred for further counselling , confirmation & management to appropriate facility. Results shall not be disclosed over the telephone.

35. A standard referral format should be used. Blood bank shall maintain all records of recall and referral. Signatures are to be taken on consent form so as to avoid litigations in the future if screening test results are found to be false positive during confirmatory tests. If the initial sero - reactive donor does not return to blood bank after 3 consecutive weekly attempts, the list of HIV sero - reactive blood donors should be shared with the linked ICTC under shared confidentiality under guidance from state AIDS control society.

36. REFERRAL MECHANISM OF HIV SERO- REACTIVE BLOOD DONORS TO ICTC: Testing strategy used in blood bank “Strategy 1” The blood unit is subjected to a high sensitivity test for HIV reactivity. If non reactive - free for HIV. HIV positive blood donors referred to ICTC for counseling and confirmation. Maintain confidentiality

37. REFERRAL MECHANISM OF OTHER TTI SERO-REACTIVE BLOOD DONORS Blood donors, found sero -reactive for HBV, HCV, Syphilis, Malaria are referred to clinicians for assessment and retesting. Blood Bank shall fill referral form as per standard format. Maintain Confidentiality.

38. SINCE BLOOD CENTRES AND TRANSFUSION SERVICES DEPENDS ON VOLUNTEER DONORS TO MEET THE NEEDS OF PATIENTS THEY SERVE , IT IS ESSENTIAL THAT THE WHOLE BLOOD DONATION PROCESS SHOULD BE PLEASANT, SAFE AND AS CONVENIENT AS POSSIBLE TO ENCOURAGE THEIR CONTINOUS PARTICIPATION .

39. BIBLIOGRAPHY

40. THANK- YOU