Lecture 8 - Blood Donors, Blood Collection & Storage PDF

# LECTURE 8 : BLOOD DONORS, BLOOD COLLECTION & STORAGE ## Course: Blood transfusion & transplantation (373413-3) ## Objectives By the end of this lecture student should be able to: - Identify the anticoagulants and additives used in blood bank. - Discuss the changes associated with blood storage...

# LECTURE 8 : BLOOD DONORS, BLOOD COLLECTION & STORAGE ## Course: Blood transfusion & transplantation (373413-3) ## Objectives By the end of this lecture student should be able to: - Identify the anticoagulants and additives used in blood bank. - Discuss the changes associated with blood storage. - Be familiar with temperature suitable to store blood. - List of criteria used for the selection of blood donors - List of instruments/materials used for the collection of donors blood - Pre and post donation care - Screening tests done - Common anticoagulants - Advantages and disadvantages - Changes that occur on blood during storage. - Ethical issues related to donation - Concept of mobile blood bank and public relation in donor recruitment program ## Screening test for donors blood prior to transfusion - Blood donors are asked a set of standard questions prior to donating blood to assist in determining if they are in good health and free of any diseases that could be transmitted by blood transfusion such as: - Infection screening - Syphilis - HIV - Hepatitis B virus (HBV) - Hepatitis C virus (HCV) - Malarial parasite - Further tests; - West Nile virus (WNV) - Zika Virus (ZIKV) - Grouping and reverse grouping - Cross matching ## Blood Storage - The development of blood banks in the early to mid 20th century following the discovery that blood collected in anticoagulant solution can be stored for several days when refrigerated. - Blood components may be prepared using either a manual or automated procedure. ### 1. The Manual Method - Centrifugation of a unit of whole blood at low speed to obtain; - RBCs and platelet-rich plasma (PRP). - The PRP centrifugation at high speed to obtain; - the platelets and plasma. - Alternatively, whole blood can be centrifuged at high speed to obtain; - three layers consisting of RBCs, plasma and a buffy coat containing platelets and leukocytes. ### 2. The Automated Method - The second method of component preparation is an automated procedure that involves the use of apheresis machines that separate whole blood into its components. - Transfer the desired components into containers and return the remaining components to the donor. - Some apheresis machines have built-in leukocyte-reduction mechanisms. ## Cont. Blood Storage - Series of changes occur in vitro that alters the physiological properties. - To ensure that blood retains its in vivo environment involves: - Anticoagulants - Preservative - Characteristics of plastic bag - Storage temperature - Shipping and transport conditions ## Anticoagulation and Preservatives For Blood Products 1. To ensure the viability and stability of the products 2. To inhibit growth of microorganisms 3. To prevent clotting of the product ## Red Cell Anticoagulants and Preservation - **Citrate** - Calcium-chelating agent - Prevents coagulation by interfering with calcium-dependent steps in the coagulation cascade. - **Citrate-dextrose** - The dextrose provide nutrient for red cells - Support the generation of ATP by glycolysis thus enhancing red cell viability and extending shelf life - **Acid-citrate-dextrose** - Contains citric acid, sodium citrate, and dextrose - Shelf life of 21 days and now no longer use this for red cells as other solutions are available with extended shelf life of red cells - Acid PH does not help in maintaining 2,3-DPG levels - Used in apheresis procedure ## Cont. Red Cell Anticoagulants and Preservation - **Citrate-phosphate-dextrose (CPD)** - Alkaline pH helps in maintaining 2,3-DPG - Shelf life is extended to 28 days - CPD is not now commonly used - **Citrate-phosphate-dextrose-adenine (CPDA-1)** - Addition of adenine is associated with improved synthesis of ATP, allowing longer shelf life (35 days) - **Other solutions** - Adsol or AS-1 - Nutricel or AS-3 - Optiso or AS-5 - **Saline-adenine-glucose-mannitol (SAGM)** - After taking blood donation in CPD and separating red cells from plasma and platelets SAGM is added to the packed red cells - The resulting red cells have flow characteristics equivalent to plasma reduced blood and a storage life of 35-42 days - Other advantage is by removing maximum amount of plasma from blood for the manufacture of factor VIII and albumin ## Storage changes in blood - In vivo, red cells are carried and protected by the plasma, which helps: - Regulated temperature - Controlled pH - Adequate glucose supply - Removal of metabolic waste - In a protected environment life span is 110-120 days. - Lowering of temperature and preservatives do help in reducing the changes but changes do occur and known as "storage lesion”. ## Cont. Storage changes in blood - **PH** - Glycolysis is slowed at temperature of 1 to 6°C - Glycolysis results in the production of lactate and decrease in pH - Day 0 (CPD) pH = 7.20 - Day 21 (CPD) pH = 6.84 - **ATP** - ATP is closely associated with red cell viability - Loss results in rigidity and decrease deformability - ATP is also needed for Na+/K+-ATPase pump - ATP levels on day 35 of storage is 45% in CPDA-1 - **2,3-DPG Levels** - Decrease in pH of stored blood results in low 2,3-DPG levels - With low levels, there will be left shift of oxygen dissociation curve and increase affinity of oxygen. - **Na+ and K+ levels** - Na+/K+ leak through the red cells - Cells lose K and gain Na - **Plasma Hemoglobin** - Hemolysis results in raised plasma hemoglobin - Hemolysis results in raised plasma hemoglobin ## General requirements for Storage of Blood Products - Separate areas should be reserved for untested, tested, and quarantined products - Continual monitoring of temperature - Audible alarm signals - Emergency procedure power failure and power back-up ## Appropriate storage temperatures | Type | Temperature | |------------------------------------|-------------| | Whole Blood and packed RBC | 1 to 6°C | | Fresh Frozen Plasma (FFP) | ≤ -18°C | | Platelets | 20 to 24°C | | Cryoprecipitate | ≤ -18°C | ## Ethical issues related to blood donation - Is blood donation ethically justified - Muslim prospective - Blood a dead element - Is blood donation from a female allowed to male - Other concerns - Jews prospective - Whether autologous is the only choice? - Other religions ## Ethical issues of screening - What information should be given to donor? - How to ask personal questions? - Attitude during the interview - Data security - High risk group donors - Screening test results - Information to the spouse - Information to the employer ## Ethical issues raised after transfusion of tainted blood - Information to the recipients - Treatment of the recipients - Recalling of all blood products ## Blood mobiles & Public relations in donor recruitment - Mobile blood bank - Major contributor in blood stocks - Counseling of the first time donors - Good communication skills and public relations - Helps in recruiting new donor and for first time donor to become regular blood donors - Functions, parties in appreciation of regular blood donors and for departments helping in collecting maximum number of units