Blood component, sample collection, storage, preservation

Blood components: sample collection, labeling, preservation, storage, documentation, record keeping, retention of records, quality control system.

1. BLOOD COMPONENTS Preservation, Storage and Dccumentation By: Nityanand Upadhyay Associate Professor Department of MLT Integral University, Lucknow

2. SAMPLE COLLECTION PRESEVATION STORAGE LABELING TRANSPORT RECORD KEEPING DOCUMENTATION QUALITY CONTROL LESSION PLAN

3. 1. Venipunture site: i . Inspection of the area situated in front of the elbow ( Antecubital area ). ii. Both are should be checked. iii. Locate and select suitable vein to be punctured. SAMPLE COLLECTION

4. 2. Use of Tourniquet: i . A sphygmomanometer placed on the upper arm. ii. Inflated to 50 mm Hg. iii. It is important to make sure not to impair arterial flow.

5. 3. Phlebotomy: i . Prepare an Area of about 1.5 inches in all direction. ii. Scrub vigorously with soap solution for 30 second ( clean away fat, oils, dirt , skin cells). iii. Apply 10 percent acetone in 70 percent isopropylalcohol (1+9 part) allow to dry.

6. iv. Apply Tincture of Iodine (3 percent iodine in 70 percent ethyl alcohol) and allow to dry. v. Remove the iodine with 10 percent acetone in 70 percent isopropylalcohol . vi. Perform Venipunture .

7. 4. Instructions: a. Do not repalpate the vein after venipunture . b. Blood collected in double or triple bags containing suitable Anticoagulant. c. The flow of blood should be rapid and without intrupted . d. Blood bag should be inverted several time during Phlebotomy.(Satisfactory mixing of anticoagulant with blood).

8. e. The collection should be completed within 8-10 mins . f. Total Quantity are: 350ml bag: 350ml± 10% of blood. 450ml bag: 450ml± 10% of blood. g. Collected blood store in an air condition room.

9. 1. ACD & CPD preserve the unit for 21 days at 2-6ºC. 2. CPDA-1 (anticoagulant/preservative for 35 days). C = Citrate → to prevent clotting P = Phosphate → to maintain pH D = Dextrose → ATP generation A = Adenine-1→ substrate from which RBC produce PRESEVATION Anticoagulant ratio is 1.4 ml:10ml blood (63ml / 450ml)

10. Additive Solution: (SAGM) → Saline-Adenine-Glucose- Manitol Purpose of additive solution, to improve RBCs storage viability till 42 days @ 2-6ºC Note: Added only to PRBC,s

11. 1. PRBC : 2-6 C 35 days , 42 days with additive solution “SAGM” 2. FFP : - 18 C for 1year, at -80 C for >1 Years. 3. CPP : -30 C , 5-7 days according to bag in use. STORAGE

12. 4. Granulocytes: -20 C to -24 C 5. Platelets: 2 C to 24 C 3-5 days (with gentle agitation). 6. CRYO: -30 C for 1 Year

13. LABELING

14. Whole blood/PRBC/FFP/Cryoprecipitate, must be transported in Blood transport box which contains ice packs inside the box, Platelets do not use freezing. TRANSPORT

15. 1. A record keeping system must be in place to trace significant steps in processing of Donor blood and Recipient sample . 2. Documentation and Record form one of the important quality system essentials in any blood bank/blood transfusion service. RECORD KEEPING

16. 3. The record keeping system may be Manual, Computerized or a Combination of both . 4 . Abbreviations and symbols must be properly defend. 5. Documentation and Records involve every aspect of blood banking i.e. i . Donor recruitment II. Donor selection

17. III. Donor recall. IV. Blood collection. V. Blood components processing. VI. Storage. VII. Transportation of blood and blood components.

18. VIII. Screening of blood for TTI'S. IX. Adverse reactions to blood transfusion (Blood Transfusion Reaction). X. Issue of and transfusion of blood and blood component to the patient. XI. Stock XII. Disposal Record. => Ensurance of Confidentiality and Security of the all information.

19. 1.Record of blood donors: . Blood donor consent for donation Donor's name and father/husband name. . Donation - voluntary or replacement. . Date of birth (age), gender and weight. . Address (office & residence) and telephone number History of illness.  

20. 2. Record of blood donation: . Date of blood donation. . Donation number (Identification number) 3. Physical examination record : . Pulse , temperature, and blood pressure. . Hemoglobin ABO and Rh (D) group. . Results of HBsAg , anti-HCV, anti-HIV 1&2.

21. . VDRL/RPR and malaria tests. . Disposal: issued for transfusion or discarded. “ Minimum record keeping requirements Source: Drugs and Cosmetic Act 1940”

22. 4. Record of blood component preparation: . Name of component. . Donation number. . ABO and Rh (D) group. . Date of preparation. . Result of tests of markers of transmissible infections.

23. 5. Disposal : . Issued for transfusion or discarded. 6. R ecipient requisition form: . Patient's name with father/husband's name. . Admission/Registration number. . Age and Sex. . Hospital name - room/bed number. . Name of clinician attending the patient.

24. . Diagnosis and reasons of transfusion. . Number of units of blood/component required. . Date and time of requirement. . Requirement is routine or emergency. “ Minimum record keeping requirements Source: Drugs and Cosmetic Act 1940.”

25. 7. Compatibility Test Record on the Requisition Form : . Recipient's ABO and Rh (D) group. . Antibody screening in patient's blood. . Donor's unit donation number ABO and Rh (D) of donor‘ unit. . Cross-matching for IgM & IgG .

26. Result of compatibility : . Compatible or not compatible. . Initial of technician performing the test. 8. Blood / component issue record: . Serial number & Date. . Patient's name, Age & Sex. . Admission number & room / ward number. . ABO&Rh (D) Donor's unit.

27. . Donation number . . Date of Collection & Date of Expiry . Name of Components. . Compatibility for IgM & IgG . . Cross-matched by. . Issued by & time of issue. “Minimum record keeping requirements Source: Drugs and Cosmetic Act 1940.”

28. 9. Record of blood transfusion reactions: . Reported transfusion reaction cases should be investigated. . Record should be kept. 10. Records of Infectious markers tests: . Anti-HIV 1& 2Test HBsAg . . Test Anti-HCV test. . VDRL/RPR Malaria. . These all records to be retained for five years.

29. 1. Unique unit identification: 10 years. 2. Medical director approval for exceptions to donation: 5 years. 3. Donors placed on indefinite deferral: Indefinite 4. Investigation of transfusion-transmitted disease: 10 years. RECORD RETENTION TIME

30. 5. Donor's ABO & Rh type: 5 years. 6. Donor testing for unexplained antibodies:10 years. 7. HCV or HIV look back: 10 years. 8. Recipient's ABO & Rh type : 5 years.

31. 9. Patient's transfusion medical record (unit, date, vital signs ): 10 years. 10. Suspected transfusion complication: 5 years. 11. Archival of obsolete documents: 5 years. 12. Orders for tissue: 10 years.

32. “Testing of random components to ensure they achieve reliably certain specific standards • It includes analysis of test results and detection of irregularities to identify deficiencies in production of Blood & Blood Components.” QUALITY CONTROL OF BLOOD COMPONENTS:

33. Indian standards • Drugs and Cosmetics Act 1940, Rules), Govt of India • Transfusion Medicine Technical Manual DGHS, Ministry of Health And Family Welfare, Govt of India

34. • Blood Bank Standards of NACO, Ministry of Health and Family Welfare, Govt of India. • NABH Accreditation Standards for Blood Banks.

35. 1. REFRIGERATED CENTRIFUGE: • Buckets & centrifuge bowls – clean with - warm water and mild detergent - 1% Na hypochlorite after each spill/breakage • Calibrated upon receipt, repairs or if low platelet yields. • Preventive Maintenance - calibration of speed with a tachometer (twice a year) - QC OF EQUIPMENTS

36. 2. CRYOPRECIPITATE BATH/WATER BATH: • Temperature - checked and recorded daily. • Change water once a week or if leakage • Recalibration of temperature controller if - temp. probe/ circuit board replaced - diff. in digital display & certified thermometer.

37. 3. Platelet Agitator: • No. of strokes – 60-70/min • Periodic cleaning & lubrication. 4. Components storage: . Daily temp check of REFRIGERATORS, FREEZERS & PLATELET INCUBATOR. • Visual and audio alarms – check regularly

38. • Monitoring device - THERMOGRAPH (continuous temperature recorder) • Temperature check - different locations in large equipment • Actual temperature checked with Hg thermometer in glycerol • Alarm test - sensor dipped in a beaker with tap water / ice slush.

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