Blood Banking Overview

Overview of Blood Banking

• Blood banking involves collecting, separating, testing, and storing blood for patients in need
• Medical technologists oversee the blood banking process
• Blood collection from donors is the initial step
• Donated blood undergoes processing, typically through centrifugation
• Whole blood is separated into components such as red blood cells, platelets, and plasma during processing
• White blood cells are usually removed to reduce potential recipient reactions

Blood Banking

• Ensures the safety of donated blood and blood products before use in transfusions or medical procedures
• Transfusions are often needed for trauma patients (e.g., car accidents) or those with low platelet counts
• Blood typing and testing for infectious diseases are crucial in blood banking

General Process of Blood Banking

• Screening: Staff evaluate a donor's health history and conduct a mini physical, including checking blood iron levels
• Only patients who successfully complete the screening may donate
• Donation: A standard donation consists of approximately one pint of blood and several small test tubes
• The bag and test tubes are barcoded and sent to separate facilities for tracking
• Testing and Processing: The test tubes are screened for infectious diseases in a testing laboratory
• The bag undergoes processing at a center, where whole blood is separated into red cells, platelets, and plasma via centrifuges
• Storage: Suitably tested and labeled blood bags can be stored in refrigerators (43°F) for up to 42 days
• Distribution: While hospitals maintain some blood bags, they mostly order from blood centers as needed
• Transfusion: Universal blood is still preferred with reduced usage in elective surgeries, due to effective blood management programs

History of Blood Banking

• 1942: Blood group antigens and blood type incompatibilities caused many early transfusions to be fatal
• 1869: Braxton Hicks suggested sodium phosphate as an anticoagulant
• 1901: Karl Landsteiner discovered ABO blood groups, explaining transfusion reactions, and he later received a Nobel Prize for it
• First Successful vein-to-vein transfusions used multiple syringes and a special cannula
• Preservation solutions were subsequently created to improve the length of time blood could be stored
• 1941: The first blood bank in the US was established

Current Status - The Donation Process

• Step 1: Provide educational materials to prospective donors
• Materials include risks of infectious diseases transmitted by blood, with emphasis on AIDS symptoms
• Step 2: Completion of a Donor Health History Questionnaire
• The questionnaire screens for exposure to diseases transmittable in blood such as Creutzfeldt-Jakob, West Nile virus, malaria, or Chagas disease
• Step 3: Perform An Abbreviated Physical Examination which includes:
• Includes measuring blood pressure, temperature, hemoglobin/hematocrit and physical inspection of the arms

Blood Components

• Plasma:
• Is the yellowish, liquid part of blood
• Composes about 55% of blood
• Contains water, salts, antibodies, enzymes, and other proteins
• Red blood cells (erythrocytes):
• Comprises about 45% of blood
• It contains Hemoglobin, which binds to oxygen
• Lives for about 120 days, and are produced everyday in the bone marrow
• White blood cells (leukocytes):
• They are the cells of the immune system
• Protects from foreign invaders and infectious diseases
• Derived from hematopoietic stem cells in the bone marrow
• Platelets:
• When there is damage to blood vessels, signals send platelets to repair the area of injury

How Blood Flows

• Oxygen then passes through the capillaries of the lungs into the blood during breathing
• Next, oxygen-rich blood flows through the pulmonary veins to the left chamber of the heart. Blood is then sent out of the aorta to the entire body

Other Important Information

• There are 8 blood types: A+, A-, B+, B-, O+, O-, AB+, AB-
• Healthy food choices like dry fruits, green vegetables,beans, whole grains and low-fat dairy is essential to healthy blood

What to know about Blood Donors

• Must meet the age requirement (at least 16 years of age, or in accordance with state law)
• Must be in good health
• Must weigh at least 110 pounds
• Must pass the physical and health history exam given before donation
• Some countries permit people younger than 16 or 17 years to donate blood, with parental consent

Blood Typing Tests

• ABO group
• Rh Typing
• Screening for unexpected red blood cell antibodies

Blood Screening Tests

• Tests year required-
• Syphilis- 1950s
• Hepatitis B Surface Antigen- 1971
• Hepatitis B Core Antibody- 1986
• Hepatitis C Virus Antibody- 1990
• Human Immunodeficiency Virus Antibodies- 1992
• Human T-Cell Lymphotropic Virus Antibody- 1997
• Human Immunodeficiency Virus- 1999
• Hepatitis C Virus (HCV) NAT- 1999
• West Nile Virus NAT- 2004
• Trypanosoma cruzi Antibody- 2007
• Hepatitis B Virus- 2009
• Babesia Microti Antibody- 2012
• Zika Virus NAT- 2016

RBC Biology and Preservation

• Crucial parts for the erythrocyte survival are the structures of the RBC membranes, hemoglobin, and metabolism
• Any impairment will lead to RBCs surviving less than 120 days
• For instance, sickle cell anemia leads to the RBC losing flexibility, which leads to agglutination

RBC Metabolism

• ATP production is primarily anaerobic, to deliver oxygen
• Mature RBCs do not have a nucleus and mitochondria- energy must be produced glucose breakdown
• The main pathway(90% of ATP): Embden-Meyerhof Pathway (Anaerobic glycolytic pathway)
• Three ancillary pathways:
  • Pentose phosphate pathway - Provides 10% of ATP
  • Methemoglobin reductase pathway
  • Luebering-Rapoport shunt - accumulate 2,3-diP-Glycerate metabolite

RBC Preservation

• Preservation must be done to ensure that viable units of blood are on hand for patient transfusions
• The measure of survivability is observed in vivo in RBC survivals
• From the time of donation to transfusion, blood is stored in the liquid state between 1°C to 6°C
• Storage time is determined by preservative solutions used
• The losses of RBC viability have been correlated to various biochemical changes
• Commonly observed RBC characteristics include:
  • Viable Cells (%) Decrease
  • Glucose Decrease
  • ATP Decrease
  • Lactic Acid Increase
  • pH Decrease
  • Oxygen dissociation curve Shift to the left (increase in hemoglobin and oxygen affinity; less oxygen delivered to tissues)
  • Plasma K+ Increase
  • Plasma Hemoglobin Increase

Anticoagulant Preservative Solutions

• Along with the anticoagulant preservative CPD, different chemicals were incorporated to boost glycolysis to maximize ATP levels

Additive Solutions

• Preservative solutions are added to the RBCs, without platelets or the plasma
• This removes most of the nutrients needed to maintain RBCs
• This extends the shelf life of RBCs to 42 days, and allows for more harvesting of plasma and platelets.
• Also creates a lower level viscosity unit for easier transfusions

Platelet Preservation

• Yearly, roughly 2.4 million units of platelets administered transfusions, and 2.2 units were distributed
• Platelets promote and prevent blood coagulation
• The store temperature for Platelets is between 20oC to 24oC while maintaining constant agitation
• Loss of quality occurs while being stored
• Assessments are made immediately before distribution, with special emphasis on platelet swirl (no visible aggregation)

Clinical Use of Platelets

• Use cases include resolving thrombocytopenia or dysfunctional platelets
• Platelets can be created as concentrates from whole blood or through apharesis
• Pathogen inactivation is one of the procedures developed for reducing and deactivating pathogens on platelet components

The Journey of Blood

• The journey of each bag of blood involves many people, many processes, a fleet of vehicles, and some fascinating science, resulting in patients’ lives being saved
• The journey of blood starts once someone decides to donate their blood

Donor Center

• Blood donation session includes a health screening and iron test, which will determine one’s eligibility to donate
• To protect the health of both the blood donor and the patient (blood recipient)
• If eligible, the donor team will start the donation

Blood Donation Process

• Donor's blood will naturally flow into a special bag that contains an anticoagulant to stop it from clotting
• It gently rocks to make sure the anticoagulant mixes through the whole bag
• The blood donation part takes about 5 to 10 minutes
• Aside from the main blood bag, a few sample tubes will also be filled for testing
• All in all, around 470 milliliters of blood will be taken (or just under an average bottle of water)
• The whole blood donation process only takes around an hour

Replenishment

• The body will replenish this volume in 24 to 48 hours
• Blood is made up of several components such as plasma, platelets, and red cells
• The body makes about 2 million new red cells every second, so it only takes a few weeks to build up stores of them again
• The first step to this replenishment is helping yourself to a well-deserved drink and snack

Labelling and Transport

• The blood bag and sample tubes will be labeled with the same unique donation number and barcode to link them together
• The barcode is unique to each donation so it can be traced at every single stage of the process
• The labelled donation will then be packed into insulated containers to protect it and maintain the temperature and quality of the blood
• The transport drivers then collect the blood from that day's session, taking it to the blood processing lab
• Around 5,000 units of blood are donated daily
• While donation goes off to the labs for processing, your donor safety check goes to our donor records, and the samples taken with your donation go to the testing labs.