Donor selection and blood collection

donor selection and blood collection

1. DONOR SELECTION AND BLOOD COLLECTION Presented By: Dr Kriti Chaturvedi

2. Blood Transfusion Services (BTS) AIM Provide safe, adequate, effective and timely supply of blood and blood components Ensure safety of donor and recipient.

3. Donor Recruitment Strategies    Pure voluntary based donations Social persuasion based donations Remunerated based donations

4. Pure Voluntary Based Donors A voluntary donor donates the blood on his/her own free will Does not expect any monetary benefit

5. Social persuasion based donations Blood donated with persuasion and pressure of: friends and colleagues heads of religious organizations political leaders Replacement donors: Donate blood for specific patients

6. Remunerated Based Donations       These donations are done by blood sellers (paid professional donors) . Due to frequent donations their blood is mostly of poor quality and may carry infection.

7.       Donor Selection and Counseling STEPS: Pre-donation information Pre-donation counseling Donor Questionnaire and Health check up Counseling during blood donation Post-donation counseling

8. Pre-donation information: Blood donation process Use of blood and its components Eligibility for blood donation Pre-donation health assessment Options for the donor to withdraw or self-defer at any time. Potential adverse donor reactions Common Transfusion transmitted infection (TTI), modes of transmission. Basic information on tests performed on donated blood

9. Medium: IEC material (Information education and communication) like leaflets, posters etc. One-on-one group Integrated with the activities undertaken for donor recruitment

10. Pre-donation Counseling Understanding of Donor Questionnaire Understanding of TTI testing. Explain self-deferral Explain temporary and permanent deferral Familiarize donor to process of blood donation Obtain donor’s Informed consent

11. Donor Questionnaire and Health Check-up Includes: Demographic details of the donor Relevant history Informed consent of the donor Limited physical examination and blood test. Questionnaire -prepared in English and Local languages For illiterate donors -assistance provided by staff. Informed regarding testing of blood Opportunity to ask questions and refuse consent . Basic health check up: History taking Limited physical examination Hb test

12. Counseling during donation Reduce donor anxiety and minimizing the risk of any adverse donor reactions such as fainting Foster donor trust and confidence for donor retention Thanking the donor for his valuable contribution

13. Post-donation counseling: 1.Instructions on self-care o Drink plenty of fluids o Avoid heavy work o Avoid smoking or driving immediately post donation 2 Advice regarding care of the venipuncture site 3.Information about specific adverse donor reactions 4.Message on regular blood donation 5.Donor feedback 6.Issuance of donor card, donor certificate or a memento

14. Donor’s Demographic Information Donor’s full name Father/husband’s name Date of birth/age Gender Residential and official addresses with phone numbers Donor can be informed about abnormal test results or may be called for future donations.

15. Occupational history Air crews drivers of long distance vehicles construction workers on high buildings Advised not to give blood within 12 hours of going on duty. Health-care workers Police, military personnel Work with animals Carry an increased risk of exposure to blood-borne infections. Questioned about exposure risk . Deferral  period of 6–12 months , based on the incubation period.

16. Medical history Present health status Time since last meal Medicine intake H/O alcohol intake H/O recent vaccination or immunization H/O epileptic fits ,convulsions or mental disorders. H/O jaundice or hepatitis H/O HBV and HCV

17. Medical history H/O contact with a person suffering from jaundice (hepatitis) during the past 6 months H/O HIV positive test results H/O unsafe exposure with an individual at increased risk for AIDS H/O weight loss in last 6 months

18. Donor interval Whole blood Once in 3 months-males Once in 4 months-females Min 28 days after apheresis (in case of reinfusion of RBC’S) Apheresis 48 hrs interval between platelet and plasma apheresis . </=2 times a week </=24 times in a year After Bone marrow harvest 12 months After peripheral stem cell harvest 6 months

19. Donor’s Physical Examination General appearance : should be in good health Age : 18-65 years, first time donors should not be over 60 years of age Weight : (8-9ml/kg BW) 350 ml- 45 kg 450ml- more than 55 kg , Apheresis — 50 kg Blood pressure : Systolic : 100 -140, diastolic: 60-90 (with or without medications.)

20. Donor’s Physical Examination Pulse: 60 to 100 bpm and regular Temperature: Afebrile;37 C Donor skin : venipuncture site should be free of any lesion or scar of needle pricks (addiction to narcotics or frequent blood donation as in the case of blood sellers.) Systemic examination : Clinically heart, lungs and abdomen should be normal. Liver and spleen should not be palpable.

21. Laboratory Tests Hemoglobin : Measured by: Specific gravity method using copper sulphate solution Sahlis method. Cyanmethaemoglobin method using spectrophotometer or photoelectric colorimeter. Hemo -cue method. Haemoglobin : >or =12.5g/ dL Thalassemia trait may be accepted, provided haemoglobin and reticulocyte counts are normal.

22. LABORATORY TESTS ABO and RH(D) Blood Grouping: Donor is screened for ABO and RH(D) group by slide/tile or tube method. Hb and ABO and Rh group is recorded on the donor form.

23. Temporary Deferral Criterias Physiological Status for Women: 1) Pregnancy / Recent delivery 12 months after delivery 2)Abortion 6 months 3)Breast-feeding Period of lactation 4)Menstruation Period of menstruation SURGICAL PROCEDURES 1) Major surgery 12 months after recovery. 2) Minor surgery 6 months after recovery. 3) Received Blood Transfusion 12 months 4) Tooth extraction 6 months

24. Endocrine disorders DIABETES: Oral hypoglycaemic medication Defer if altered/dosage adjusted in last 4 weeks THYROID: Under investigation for Thyroid Disease or thyroid status not known Defer Temporary Deferral Criterias Minor non-specific symptoms Defer until all symptoms subside

25. Temporary Deferral Criterias Liver Diseases and Hepatitis infection 1) Known hepatitis A or E 12 months 2) Spouse/ partner/ close contact of individual suffering with hepatitis 12 months 3) At risk for hepatitis by tattoos, acupuncture or body piercing, invasive cosmetic procedure by self/spouse. 12 months

26. Temporary Deferral Criterias Other Infectious diseases 1) Measles , Mumps, chickenpox 2 weeks following full recovery 2)Malaria 3 months following full recovery 3)Typhoid 12 months following full recovery 4) Tuberculosis 2 years following confirmation of cure

27. Temporary Deferral Criterias Other Infectious diseases 4 ) Dengue/ Chikungunya 6 months following full recovery Visit to endemic area: 4 weeks following return , if no febrile illness is noted 5) Zika Virus/ West Nile Virus 4 months following full recovery Visit to endemic/outbreak zone: 4 months

28. Temporary Deferral Criterias Kidney Disease 1 ) Acute infection of kidney 6 months after complete recovery and last dose of medication 2 ) Acute infection of bladder (cystitis) 2 weeks after complete recovery and last dose of medication

29. Temporary Deferral Criterias Digestive system 1) D iarrhoea in preceding week (particularly if associated with fever) 2 weeks after complete recovery and last dose of medication 2) GI endoscopy: 12 months

30. Temporary Deferral Criterias Vaccination and inoculation (A) Non live vaccines and Toxoid : 14 days Typhoid Cholera Papillomavirus Influenza Meningococcal Pertussis Pneumococcal Polio injectable Diphtheria Tetanus Plague

31. Temporary Deferral Criterias Vaccination and inoculation (B) Live attenuated vaccines 28 days Polio oral Measles, rubella , Mumps Yellow fever Japanese encephalitis Influenza Hepatitis A (C) Anti-tetanus serum Anti-venom serum Anti-diphtheria serum 28 days (D) Anti-rabies vaccination , Hepatitis B , Immunoglobulins 1 year

32. Temporary Deferral Criterias Medications Aspirin/Other NSAIDs 3 days Acitretin , Isotretinoin 28 days Dutasteride 6 months Finasteride 28 days Antibiotics 14 days after last dose Ketaconazole 7 days Antihelminthic drugs 7 days Ticlopidine , clopidrogel 2 weeks Radioactive contrast material 8 weeks

33. Permanent Deferral Criterias Cardio-Vascular Diseases (Heart Disease) Has any active symptom (Chest Pain, Shortness of breath, swelling of feet) Myocardial infarction Cardiac medication (digitalis, nitro- glycerine ) Hypertensive heart disease Coronary artery disease Angina pectoris Rheumatic heart disease with residual damage Central Nervous System/ Psychiatric Diseases Convulsions and Epilepsy Schizophrenia

34. Permanent Deferral Criterias HIV Infection/AIDS Known HIV positive person or spouse/ partner of PLHA (person living with HIV AIDS) At risk for HIV infection Persons having symptoms suggestive of AIDS - lymphadenopathy prolonged &repeated fever prolonged & repeated diarrhoea irrespective of HIV risk or status

35. Permanent Deferral Criterias Autoimmune disorders Systemic lupus erythematosis scleroderma dermatomyositis ankylosing spondylitis severe rheumatoid arthritis Other diseases Polycythaemia Vera Bleeding disorders and unexplained bleeding tendency Malignancy Severe allergic disorders Haemoglobinopathies and red cell - enzyme deficiencies with known history of haemolysis

36. Permanent Deferral Criterias Surgical procedures Open heart surgery Including By-pass surgery Cancer surgery Endocrine Insulin and/or complications of Diabetes with multi organ involvement Thyrotoxicosis due to Graves’ Disease Hyper/Hypo Thyroid History of malignant thyroid tumours

37. Permanent Deferral Criterias Liver Diseases and Hepatitis infection Known Hepatitis B, C Unknown Hepatitis Chronic Liver disease/ Liver Failure Other infectious diseases Leishmaniasis Leprosy

38. Permanent Deferral Criterias Kidney Disease Chronic infection of kidney Chronic kidney disease Renal failure Digestive system Stomach ulcer with symptoms or with recurrent bleeding

39. Permanent Deferral Criterias Organ, Stem Cell and Tissue Transplantation Medication Anti-arrhythmic Anti- convulsant Anti-thyroid Cytotoxic drugs Cardiac failure drugs (digitalis)

40. BLOOD COLLECTION

41. Donation Premises : Attractive Well lighted Clean Well-equipped

42. Out-door blood collection: Advance visit Personnel -trained to recognize unsafe conditions and understand infection control policies and procedures. Hand washing Carpeted or difficult-to-clean surfaces can be protected with a clean suitable overlay Portable screens to protect and maintain safe work areas. Refreshment area- separate from area of blood collection Blood-contaminated waste- packaged and returned to a central location for disposal

43. Equipment and Materials Blood Containers: Polyvinyl chloride (PVC) plastic bags- closed system single, double or triple bags for collection of 350 ml or 450 ml blood. anticoagulant solutions: citrate-phosphate-dextrose (CPD) or citrate-phosphate-dextrose-adenine (CPDA-1) volume :49 ml for 350 ml or 63 ml for 450 ml of blood (14 ml CPD or CPDA-1 for 100 ml blood). Sphygmomanometer Donor couch

44. Equipment and material: Automatic mixing of blood and weighing of blood bag machine Plastic clips, di -electric tube sealer or aluminium clips Sterile cotton swabs and band-aids/bandages Methylated spirit, tincture of iodine, providone -iodine solution (1 %) & alcohol

45. Emergency Drugs Intravenous crystalloid normal saline (sodium chloride 0.9%) Inj Rantac Inj Metaclopromide Inj Pheniramine Inj Dopamine Inj Hydrocortisone Inj Adrenaline Inj Atropine Inj. Furosemide Inj. Calcium gluconate Oxygen cylinder with regulator and mask

46. METHOD OF PHLEBOTOMY: Wash hands with soap and water and wear sterile gloves. Inspect the bag for leakage or any other defect. The anticoagulant solution must be clear. Check the donor name, donation number on the form bag and pilot tube. Place the bag on a balance which is below the level of the arm.

47. METHOD OF PHLEBOTOMY: Choose the site of venipuncture in the anticubital area of the arm (area that is free of any skin lesion/needle marks.) Apply blood pressure cuff, inflate to 50-60 mm of Hg Select a prominent and firm vein (Asking the donor to close the fist helps in bringing the vein into prominence. ) Release the blood pressure cuff

48. METHOD OF PHLEBOTOMY: Clean 4-5 cm area on proposed site of venipuncture ,starting at the site of venipuncture and moving outwards in a concentric spiral way with methylated spirit/alcohol. Apply 10% providone -iodine solution ( betadine ) or tincture of iodine in the same way ,allow it to dry. Clean with methylated spirit or alcohol ,allow the solution to dry. The cleaned area is should not be touched.

49. . METHOD OF PHLEBOTOMY: Inflate blood pressure cuff to maintain pressure 50-60 mm of Hg. Ask the donor to close the fist. Uncover the sterile needle and perform venipuncture immediately Ask the donor to open and close hand or to squeeze a rubber ball.

50. METHOD OF PHLEBOTOMY: The donor should be under constant observation throughout the phlebotomy and should never be left unattended. Mix the blood and anticoagulant gently and periodically during collection of blood. Mixing can be done by hand or blood collection monitor -Scale/Mixer. The flow of blood should be uninterrupted and constant

51. METHOD OF PHLEBOTOMY: Monitor the volume of blood being drawn Once donation is complete clamp the tubing of the bag with plastic clip Deflate the cuff or release the tourniquet. Place the sterile swab at the venipuncture site Apply light pressure and withdraw the needle. Remove blood pressure cuff or tourniquet

52. METHOD OF PHLEBOTOMY: Ask the donor to put the fingers of the other hand on the swab at the venipuncture site and to raise the arm. Take the bag to the processing table. Loosen the plastic clip and apply light pressure on the bag to transfer 5-6 ml of blood in the pilot tube. Seal the tube with di -electric tube sealer and separate the needle.

53. METHOD OF PHLEBOTOMY: Strip blood bag tubing, starting at seal, pushing blood into bag. Do it quickly, to avoid allowing the blood to clot in the tubing. Invert bag several times to mix blood thoroughly; then allow tubing to refill with anticoagulated blood from the bag. Repeat the process a second time. Seal the tubing attached to the bag with di-electrictube sealer.

54. METHOD OF PHLEBOTOMY: Keep the blood bag at 2-6°C in the refrigerator immediately after collection. If platelets are to be harvested, blood bag should be kept at 20-24°C until platelets are separated. Platelets should be separated within 6-8 hours after the collection. The donor should remain on the bleeding couch for 8-10 minutes under the observation of the staff.

55. METHOD OF PHLEBOTOMY: Check the arm and apply band-aid after bleeding stops. Then the donor is allowed to sit up and go for refreshment. Light refreshment are given to donors The donor should be given donation card

56. ADVERSE DONOR REACTION Personnel in the phlebotomy area must be trained to respond quickly to adverse donor reactions. In general, if adverse reactions occur: Remove/deflate the tourniquet and withdraw the needle from the donor’s vein . Put the sterile swab at the venipuncture site and apply pressure with thumb. Call for assistance from other personnel. Remove the donor to an area where he/she can be attended to in privacy.

57. ADVERSE DONOR REACTION Syncope (fainting or vasovagal syndrome): Sweating Weakness Dizziness Pallor Loss of consciousness Cold skin Low blood pressure Thready pulse

58. ADVERSE DONOR REACTION Management Place the donor on his/her back and raise the legs above the level of the donor’s head. Loosen tight clothings . Ensure adequate air-way. Administer inhalation of aromatic spirit of ammonia. Apply cold compresses to donor’s head. Check the blood pressure, pulse and respiration until donor recover.

59. ADVERSE DONOR REACTION Tetany (Twitching or Muscular spasm) Anxiety and deep breathing causes loss of excess of carbon dioxide, which may cause tetany ; characterized by twitching or muscular spasm due to hyperventilation. Management : Breathing into a paper bag. Don’t give oxygen.

60. ADVERSE DONOR REACTION Nausea and vomiting. Management: Make the donor comfortable. Ask the donor to breath slowly and deeply. Turn the donor’s head to a side to avoid aspiration of vomits.

61. ADVERSE DONOR REACTION Hematoma Management Deflate the blood pressure cuff, ask the donor to open the fist and withdraw the needle from the vein. Place 3 or 4 sterile gauze pieces or cotton swabs over the haematoma Apply digital pressure for 7-10 min with the donors arm held above the heart level. Apply ice to the area for 5 min.

62. ADVERSE DONOR REACTION Convulsions Prevent the donor from injuring himself/herself Place tongue blade between the teeth to prevent him/her from biting the tongue Ensure adequate air way Cardiac problems Very rare If cardiac arrest occurs, begin CPR till medical aid arrives

63. THANKYOU