Blood Donors and Products Lecture 11 PDF

Canadian Blood Services: Blood Donors Products CBS References: Circular of Information for RBCs, Platelets and Plasma components: https://www.blood.ca/en/hospital-services/products/component-types/circular -information Clinical Guide t...

Canadian Blood Services: Blood Donors Products CBS References: Circular of Information for RBCs, Platelets and Plasma components: https://www.blood.ca/en/hospital-services/products/component-types/circular -information Clinical Guide to Transfusion (Ch. 2 and 6) https://professionaleducation.blood.ca/en/transfusion/clinical-guide-transfusi on Visual Assessment Guide https://professionaleducation.blood.ca/sites/default/files/VAG_en.pdf Donor Eligibity Guide and Donor Questionaire https://www.blood.ca/en/blood/am-i-eligible-donate-blood/abcs-eligibility https://www.blood.ca/en/blood/donating-blood/donor-questionnair  References: Canadian Blood Services Circular of Information for RBCs, Platelets and Plasma components: https://www.blood.ca/en/hospital-services/products/component-t ypes/circular-information Clinical Guide to Transfusion (Ch. 2 and 6) https://professionaleducation.blood.ca/en/transfusion/clinical-gui de-transfusion Visual Assessment Guide https://professionaleducation.blood.ca/sites/default/files/VAG_en. pdf Donor Eligibity Guide and Donor Questionaire https://www.blood.ca/en/blood/am-i-eligible-donate-blood/abcs-el igibility https://www.blood.ca/en/blood/donating-blood/donor-questionnai  Tainted Blood Scandal and Krever Inquiry Throughout the 1980s, over 2,000 recipients of blood products in Canada contracted HIV, and another 30,000 were infected with hepatitis. https://youtu.be/QPIbwnWmkmk The Krever Inquiry published a report in 1997, implicating both the Canadian government and the Canadian Red Cross Society. As a result, new Health Canada regulation was introduced, and two new organizations replaced the Canadian Red Cross Society for maintaining Canada’s blood system: Héma-Québec (Quebec) Canadian Blood Services, serving all provinces and territories outside of Quebec  Donation Frequency All CBS donors are volunteer donors CBS accepts Whole Blood and Apheresis donations Whole Blood: Frequency: up to every 56 days (7x/year) for males, 84 days (4x/year) for females Collection: 10-15 minute phlebotomy collecting approx. 480 ml of blood Apheresis: RBCs returned to the donor during a longer donation process, obtaining large volumes of plasma or platelet-rich plasma Apheresis platelet frequency: up to every  Donor Eligibility Criteria Donors are questioned about medical conditions and behaviours to determine if their blood donation would pose an increased risk to their own health or the health of the recipient. For more information refer to: https://www.blood.ca/en/blood/am-i-eligible-donate-blood/abcs-eligibility General Health Three month deferral for tattoos, piercings and Feeling well on day of donation, no currently for men who have sex with men diagnosis of transmissible viral disease, (MSM) bacterial infection, or certain MSM restriction to be removed in 2022 pending autoimmune conditions Health Canada approval Age Permanent deferral for taking money or drugs for sex since 1977 or having used intravenous At least 17 years of age (18 for Quebec) street drugs Height and weight Geographic deferrals based on travel risk of All donors: at least 110 lbs malaria or Zika (temporary) or having lived in Under 23 : Height (4’10”) and an area with vCJD outbreaks (permanent) additional weight restrictions Ineligible for platelet donation if recently taken Hemoglobin: a medication that inhibits platelet function (ex: Aspirin within 72 hours). Whole blood/plasma Females: least 125 g/L still acceptable. Males: at least 130 g/L  Mandatory Donation Testing The donor’s skin is disinfected using a swab stick containing 2% chlorhexidine gluconate and 70% isopropyl alcohol. The first few milliliters of blood from a donation are routed into a diversion pouch. This reduces the contamination of the collection pack and provides blood that can be used for testing. All ABO/Rh, donationsandareother testedantigens for: RBC antibody screen to detect the presence of atypical antibodies in Transmissible Disease Testing for All the plasma Donations: Infectious disease screening and Human immunodeficiency virus (HIV) 1 and 2 confirmatory testing uses a Hepatitis B virus (HBV) combination of: Hepatitis C virus (HCV) Serological testing on individual Human T-cell lymphotrophic virus (HTLV) I and II specimens: detects antigens or West Nile Virus (WNV) from June-November corresponding antibodies and/or Syphilis (Treponema pallidum)  Additional Testing Trypanosoma cruzi (Chagas disease) If donor, mother or maternal grandmother resided in Central/South America Out-of-Season West Nile Virus (WNV) If travel risk has occurred in the prior eight weeks Cytomegalovirus (CMV) CMV is a commonly encountered leukocyte- associated virus. Testing is performed on a small subset of donors to provide a small inventory of CMV- units. CMV- units are required for fetal intrauterine transfusion (IUT) only. As all cellular products are leukoreduced (“CMV safe”), and therefore CMV risk in all other recipients is extremely low. IgA Deficiency Some recipients are IgA deficient and experience severe anaphylactic reactions to donor IgA antibodies.  Product-Specific Testing The warmer storage conditions of platelets leave them more prone to bacterial growth Therefore, platelet products undergo bacterial detection testing 36 hours after collection, since. This time allows bacteria, if present, to proliferate to a detectable level. Aerobic and anaerobic culture bottles are inoculated and incubated for up to seven days. Platelets can be issued as “negative-to-date” as early as 6 hours after inoculation. A positive bacterial culture may require a retrieval of a platelet component that is already in hospital inventory. Some plasma donations will be pooled together and undergo further manufacturing into fractionated plasma protein products. These include albumin, coagulation factor concentrates and intravenous immune globulin [IVIG]. These donations undergo testing for Parvovirus B19. Parvovirus B19 is the causative agent of a condition called fifth disease.  Product Labelling Guidelines All manufactured blood components released for issue to hospital customers have a standard format label applied to the bag. This is often referred to as the ‘end label’. Labelling of blood and blood components by blood operators in Canada aligns with the International Society of Blood Transfusion (ISBT) 128 Standard Hospitals scan or enter this barcoded information to accept a component into their own inventory  Blood Products: Whole Whole Blood blood collections consist of about 480 mL of donor whole blood collected in 70mL of CPD (Citrate, Phosphate, Dextrose) anticoagulant. Sodium citrate - Binds calcium and prevents initiation of coagulation Citric acid - Creates an acidic environment to slow down glycolysis that occurs through cell metabolism Monobasic sodium phosphate - Buffer to maintain pH Dextrose - Provides a source of sugar for cell metabolism Whole blood is generally NOT directly transfused but separated into components. Canadian Blood Services uses two different types of whole blood collection methods, using two different collection packs: Buffy Coat (B1) method, used in the production of red blood cell, plasma and platelet products from a whole blood donation Whole blood filtration (B2) methods, production of red blood cell and plasma products (no platelet products) Both methods involve cooling, centrifugation, extraction and leukoreduction – filtering out most white blood cells. WBCs can cause febrile transfusion reactions, promote immune response against donor cells and may harbor infectious agents like CMV, so we want them removed before transfusion!  From a single whole blood donation, the B1 method produces an RBC unit (packed red blood cells), a plasma unit, and a buffy coat. The buffy coat is not transfused directly, it goes on to be pooled.  Buffy coats from four different donors of the same ABO group will be pooled together into the plasma from one of the donors using a sterile docking device. The resulting pooled buffy coats are leukoreduced by filtration into a  Using the B2 method, no separate buffy coat is created, so pooled platelets cannot be produced. All whole blood processing done in Newfoundland is B2, so any pooled platelets in inventory were imported from other provinces. The plasma unit created in a B2 method gets frozen and can be used as: Frozen Plasma (FP), to be transfused directly to a patient Recovered Plasma (RP), to be exported for further manufacturing First Stage Cryo, where it is later thawed and separated into Cryoprecipitate  Red Blood B2 collection methods Cells RBC units, or packed red blood cells, are produced in both B1 and Volume is around 290 mL, containing approximately 55g of Hgb with a Hct of 0.67 RBCs treat anemia, with a single unit increasing a non-bleeding patient’s hemoglobin concentration by approximately 10 g/L Packed cells are mixed with saline-adenine-glucose-mannitol (SAGM) additive solution to prevent storage lesion. This helps maintain ATP and 2,3-DPG during metabolism in stored red blood cells. This will help maintain the oxygen carrying capacity and reduce leakage of intracellular potassium. This gives red blood cells a shelf life of 42 days from collection. If irradiated for additional WBC reduction, shelf life reduced to 14 days from irradiation. These units experience accelerated hemolysis and should only be requested as needed and RBCs may also be frozen, using transfused ASAP. glycerol as a cryoprotectant, for up to 10 years stored below -65°C. Must be stored at 1-6°C in temperature-controlled storage with This is normally done only for units an alarm system, air-circulating fan and continuous monitoring from donors of a rare phenotype. device Before transfusion, frozen RBCs For transit times of 24 hours or less, a transport system are thawed, washed to validated to maintain an environmental temperature of 1–10°C deglycerolize, and must then be is allowable. transfused within 24 hours. If removed, cannot be returned to inventory unless it passes visual inspection and was outside temperature-controlled  Visual Assessment of Blood Components Plasma Hemolysis (degrees red) up to 0.8% at expiry is Discolourati acceptable. Units exhibiting gross hemolysis must on NOT be transfused. Other acceptable discolorations are: Icterus (yellow-brown), Oral contraceptives (green) Vitamin A/carrots (orange) Lipemia (increased opacity - “milkshake”) Bacterial contamination of RBCs may be identified by excessive and unusual air bubbles and a dark purple or black colour. This is NOT acceptable for transfusion. Particulate WPM (White Particulate Matter) is a lipid-rich Matter noncellular material that may dissipate with changing temperature. WPM is acceptable for transfusion. Particulates that do not dissipate with gentle manipulation are NOT acceptable for transfusion, and include: Clots and/or fibrin strands  Platelets Platelet components have a typical volume of just over 300 mL and typically contain over 300 x 109 platelets. Pooled Platelets are pooled from the buffy coats of 4 different B1 whole blood donors using CPD anticoagulant. Apheresis platelets are from a single plateletpheresis donor using ACD-A anticoagulant. Large volume donors can provide two apheresis platelet products from a single donation. Stored at 20–24°C under continuous agitation. May be stored in a platelet incubator/agitator under continuous monitoring or in an agitator at ambient room temperature continuous monitoring or manually recorded every 4 hours. Platelets are stored in gas-permeable containers, as CO2 from metabolic captivity causes pH to drop. Shelf life is seven days after collection. Expiry is reduced to 4 hours after breaching, unless aliquots are prepared using a sterile connection device Platelet transfusion is indicated in the treatment of patients with bleeding due to severely decreased or dysfunctional platelets, or prophylactically to patients with conditions causing rapidly falling platelet counts. Platelet transfusions are not recommended for patients with rapid platelet destruction Each dose of platelets should increase the patient’s platelet count at 1 hour by at least 15-25 x 109/L. Patients that do not respond expectedly to a platelet transfusion are considered “refractory.” Indications are similar for both Pooled Platelets and Apheresis Platelets. Plasma – AFFP, FP/AFP, CSP and SD Coagulation factors V and VIII, known as liable factors, are not stable for prolonged periods under refrigeration. Therefore, plasma products are stored frozen at -18˚C or lower under continuous monitoring for a maximum of 12 months (FP, AFFP and CSP). Cannot remain outside the temperature-controlled environment for more than 30 minutes. Prior to transfusion, plasma is typically thawed by the hospital in a water bath using an overwrap to avoid bacterial contamination, or in a specially designed microwave. It cannot be refrozen if thawed, but may be refrigerated at 1-6°C for up to 24 hours (AFFP) or 120 hours (FP or CSP). Aphresis Fresh Frozen Plasma is collected by plasmapheresis and frozen within 8 hours of collection. It contains sodium citrate as an anticoagulant and has all clotting factors. Frozen Plasma (FP) is produced from CPD whole blood donations and frozen within 24 hours of collection. Contains all factors, but slightly reduced amounts of liable factors (V and VIII). Apheresis Frozen Plasma (AFP) using ACD-A anticoagulant is an equivalent product collected concurrently from plateletpheresis donors. In practice, AFFP and FP/AFP are largely interchangeable. An AFFP is approximately twice the volume of an FP (about 500 mL vs 290 mL) Cryosupernatant Plasma (CSP) is prepared from thawed FP, separated from cryoprecipitate and refrozen. Contains all factors but has reduced levels of liable factors, fibrinogen and vWF. Solvent Detergent plasma (SD) is plasma pooled from many donors, treated with processing steps (solvent detergent, immune neutralization, sterile filtration) to remove or inactivate pathogens, cells, allergens and antibodies. This product has a 4 year shelf life. Only indicated for certain conditions like TTP or HUS, in patients who have experienced an allergic reaction to other frozen plasma products or have pre-existing lung conditions  Apheresis Cryosup Solvent Frozen Fresh ernatant Deterge Condition/Clinical Circumstance Plasma Frozen Plasma nt (SD) CPD (FP) Plasma CPD Plasma (FFPA) (CSP) Reversal of warfarin therapy when prothrombin X X X complex concentrates and/or vitamin K is contra- indicated or unavailable Correction of microvascular bleeding when X X laboratory testing demonstrates coagulopathy Liver disease X X Massive transfusion X X Exchange transfusion in neonates X X TTP or adult HUS plasma exchange therapy X X X Patients with selected coagulation factor deficiency X X or rare plasma protein deficiencies when specific alternative therapy is not available Patients who meet the qualifying criteria for SD X plasma (see previous) Cryoprecipitate Prepared by taking previously frozen “1st stage” plasma and slowly thawing it. The thawed “2nd stage” plasma is centrifuged to separate the insoluble cryoprecipitate from the plasma. The Cryosupernatant Plasma (CSP) is removed and the insoluble cryoprecipitate is refrozen and labelled as Cryoprecipitate (Cryo). Also stored at -18°C or below for up to a year, but can only be out of temperature-controlled storage for 10 minutes as opposed to 30. Each 10 mL bag of cryoprecipitate contains an average of 285 mg of fibrinogen. Used for fibrinogen replacement in certain conditions such as acquired hypofibrinogenemia or fibrinogenolysis. Multiple cryo are usually thawed and pooled together in normal saline by the hospital. They must be stored at room temperature after thawing and transfused within 4 hours. Other Transfusions Directed Donations collected by Canadian Blood Services from a parent or legal guardian and designated to be transfused to their minor child. Directed donations have declined steadily. Directed donations pose an increased risk to patients at additional cost with very little identifiable benefit over a random blood donor. Autologous Donations involve a preoperative patient donating blood in the weeks prior to surgery to be self-transfused. Autologous donations have also declined. They may be necessary in corner cases of patients with exceptionally rare blood group compatibility or serious psychiatric risk of allogenic blood, but autologous donation contributes to pre- operative anemia and is often counter-productive. Canadian Blood Services now operates a stem cell registry in searching for compatible blood stem cell (cord blood) and bone marrow donors