Blood Donation and Transfusion Guidelines

Canadian Blood Services: Blood Donor Products

• Canadian Blood Services (CBS) provides RBCs, platelets, and plasma components.
• Refer to the following resources for information:
  • Circular of Information: https://www.blood.ca/en/hospital-services/products/component-types/circular-information
  • Clinical Guide to Transfusion (Chapters 2 & 6): https://professionaleducation.blood.ca/en/transfusion/clinical-guide-transfusion
  • Visual Assessment Guide: https://professionaleducation.blood.ca/sites/default/files/VAG_en.pdf
  • Donor Eligibility Guide and Donor Questionnaire: https://www.blood.ca/en/blood/am-i-eligible-donate-blood/abcs-eligibility, https://www.blood.ca/en/blood/donating-blood/donor-questionnaire

Tainted Blood Scandal and Krever Inquiry

• In the 1980s, over 2,000 Canada blood recipients contracted HIV. Another 30,000 were infected with hepatitis.
• Review the Krever Inquiry Report: https://youtu.be/QPIbwnWmkmk
• The Krever Inquiry (1997) implicated both the Canadian government and the Canadian Red Cross Society.
• New Health Canada regulations and organizations (Héma-Québec and Canadian Blood Services) replaced the Canadian Red Cross Society to oversee Canada's blood system.

Donation Frequency

• CBS donors are volunteers.
• CBS accepts whole blood and apheresis donations.
• Whole Blood:
  • Frequency: up to every 56 days (for males) and 84 days (for females).
  • Collection: 10-15 minutes, approximately 480 mL of blood.
• Apheresis:
  • Frequency: up to every 14 days.
  • Process: returning RBCs to the donor while obtaining large volumes of plasma or platelet-rich plasma.

Donor Eligibility Criteria

• Donors are screened for medical conditions and behaviors that might pose a risk to themselves or recipients.
• Refer to the eligibility guide for precise details: https://www.blood.ca/en/blood/am-i-eligible-donate-blood/abcs-eligibility
• General Health:
  • Feeling well on the day of donation. No transmissible viral diseases, bacterial infections, or certain autoimmune conditions.
• Age: Minimum 17 years old (18 in Quebec).
• Height and Weight: Minimum weight requirements specified for different age groups.
• Hemoglobin levels: Defined minimums for females and males.
• Deferrals: Three-month deferral for tattoos, piercings, and men who have sex with men; permanent deferral for various reasons (e.g., intravenous drug use).
• Travel Restrictions: Geographic deferrals based on risk of malaria or Zika, or residence in areas with vCJD outbreaks.

Mandatory Donation Testing

• Skin disinfection with 2% chlorhexidine gluconate and 70% isopropyl alcohol.
• Initial blood samples are diverted to test for various transmissible diseases, including HIV, HBV, HCV, HTLV-I and II, WNV, and Syphilis.
• Infectious disease screening and confirmatory testing using a combination of serological tests to detect antigens or corresponding antibodies.

Additional Testing

• Testing for various diseases such as Trypanosoma cruzi (Chagas disease), Cytomegalovirus (CMV), and West Nile Virus (WNV).
• Testing on a subset of donors to maintain an inventory.
• Conditions affecting fetal intrauterine transfusion are considered.

Product-Specific Testing

• Platelet products are tested for bacteria 36 hours after collection.
• Aerobic and anaerobic culture is performed.
• Platelets can be issued as "negative-to-date" as early as 6 hours after inoculation.
• Certain plasma donations are pooled and further processed. (e.g., albumin, coagulation factors, immunoglobulins, and Parvovirus B19)

Product Labelling Guidelines

• All blood components have standard labels.
• Information is barcoded for hospital inventory management.
• ISBT 128 standard is followed in Canada.

Whole Blood Products

• Whole blood donations are collected in anticoagulants (CPD).
• Sodium citrate prevents coagulation.
• Citric acid slows down glycolysis.
• Monobasic sodium phosphate maintains pH.
• Dextrose is a source of sugar for cell metabolism.
• Two collection methods (Buffy Coat and Whole Blood Filtration) separate whole blood into components (e.g., red blood cells, plasma, platelets).
• Leukoreduction removes white blood cells to prevent potential immune reactions.

Buffy Coat (B1) Method

• Separation of whole blood into red blood cells (RBC) unit, plasma unit, and buffy coat.
• Buffy coat is combined from multiple donors for pooling, and leukoreduction takes place.

Whole Blood Filtration (B2) Method

• Direct production of plasma and RBC units without separating a buffy coat.
• Pooled platelets cannot be produced.
• Plasma can be further processed. (e.g., frozen plasma, cryosupernatant plasma, cryoprecipitate.)

Red Blood Cells

• RBC units are stored at 1-6°C.
• Shelf life is 42 days; with irradiation, it reduces down to 14 days.
• RBCs may be frozen with glycerol. This extends storage to 10 years at -65°C.
• Thawing and washing must occur before transfusion.

Platelets

• Typical platelet volume: over 300 mL; with over 300 x 10⁹ platelets.
• Pooled platelets are from buffy coats of four whole blood donors (using CPD).
• Apheresis platelets are from single apheresis donors (using ACD-A).
• Platelet storage: 20-24°C under continuous agitation.
• 7 days shelf life; 4 hours after breaching.

Plasma - AFFP, FP/AFP, CSP and SD

• Coagulation factors (V and VIII) are not stable for long periods under refrigeration and are stored frozen at –18°C.
• Thawed plasma may be refrigerated at 1-6°C for up to 24 hours.
• Fresh frozen plasma collection is collected by apheresis in 8 hours; or whole blood within 24 hours.
• Different classifications for plasma (e.g., frozen plasma FP, apheresis fresh frozen plasma AFFP, cryosupernatant plasma CSP, solvent detergent plasma SD).
• Usage and indications are separated based on the different plasma classifications.

Cryoprecipitate

• Cryoprecipitate is extracted from frozen plasma.
• It is stored at -18 °C.
• Shelf life is one year.
• Used for fibrinogen replacement in various conditions.
• It contains 285 mg of fibrinogen per 10 mL bag.
• Cryo must be processed in a specific way (room temperature).

Other Transfusions

• Directed donations are collected by relatives.
• Autologous transfusions are for patients donating blood before surgery later for their use.
• Stem cell and bone marrow donors may be involved.

Test your knowledge of the essential guidelines and conditions regarding blood donation and transfusion practices. This quiz covers topics such as donor eligibility, platelet component shelf life, and contamination protocols. Perfect for healthcare professionals and students in blood banking and transfusion medicine.