1. Terry Kotrla, MS, MT(ASCP)BB MLAB 2431 Immunohematology Unit 1 Part 2 Blood Collection

2. Blood Collection

3. Collection of Blood Collection performed by well trained personnel. Materials used are FDA approved sterile and single use. Donor identification critical Identify donor record with donor Attach numbered labels Label processing tubes Final recheck before leaving donor

4. Preparing Site Inspect BOTH arms for signs of IV drug abuse. Select large firm vein in area free of scarring or skin lesions. Vein selection priority same as for routine phlebotomy. Most important step is preparing the site to a state of almost surgical cleanliness. Bacteria on skin, if present, may grow well in stored donor blood and cause a fatal sepsis in recipient

5. Blood Collection Gloves are optional, OSHA provides specific exemption for drawing volunteer donors. Gloves should be worn: By personnel in training Collecting autologous units If employee has cuts, scratches or breaks in skin. Use 16-17 gauge needle to collect blood from a single venipuncture within 10 minutes. First 30 to 45 mLs of blood diverted to pouch to collect skin plug. Mix blood bag frequently or use shaker. Collect 450 or 500 mLs +/- 10% of blood

6. Blood Collection System

7. Donor Reactions Syncope (fainting) Remove needle immediately Hyperventilation Have donor rebreathe into paper bag. Nausea/vomiting Twitching/muscle spasms Hematoma Upper extremity deep vein thrombosis Convulsions – rare, get immediate assistance Cardiac difficulties – get emergency care Record ANY donor reactions

8. Post-Phlebotomy Care Donor applies pressure for 5 minutes with arm elevated. Check and bandage site Have donor sit up for few minutes Have donor report to refreshment area for additional 15 minutes of monitoring

9. Post-Phlebotomy Instructions Eat/drink before leaving Wait until staff releases you Drink more fluids next 4 hours No alcohol until after eating Refrain from smoking for 30 minutes. If bleeding continues apply pressure and raise arm Faint or dizzy sit with head between knees Abnormal symptoms persist contact blood center. Cautions about returning to work. Let them know when to remove bandage

10. Post-Phlebotomy Instructions In canteen provide donor refreshments and watch for signs of a reaction. Provide phone number for donor to call if: bleeding recurs feels donated unit should not be used has any type of reaction. experiences signs or symptoms of infection. THANK DONOR

11. Processing Donor Blood All reagents used for testing must meet or exceed appropriate FDA regulations. CANNOT rely on previous testing Results recorded immediately. Record system to track unit to final disposition. Records must be retrievable. Records must be kept for 5 years OR 6 months after product expires.

12. General Considerations Numbers on blood bag, processing tubes and donor records should be rechecked prior to processing. ABO group and D type, including weak D Donor with history of transfusion or pregnancy should be tested for unexpected antibodies.

13. Serological Testing ABO/D typing Antibody Screen – if positive, ID antibody, cannot make plasma products Antibodies to other blood group antigens which are present in the donor may react with recipient red cells resulting in a reaction.

14. Infectious Disease Testing Methods ELISA to detect antigens or antibodies Chemiluminescent to detect antigens or antibodies Detection of syphilis antibodies by RPR Nucleic Acid Test (NAT) detects viral nucleic acids, much more sensitive, reduces window period HIV from 22 to 12 days HCV from 70 to 10-14 days Antigen, antibody and NAT testing will allow positive results through out disease process.

15. Disease Testing Disease testing include: Dectection of bacteria HBsAG Anti-HBc Anti-HCV Anti-HIV 1&2 Anti-HTLV I/II RPR Chagas disease antibodies NAT for HIV-1, HCV WNV

16. Results of Testing Tests for disease markers must be negative or within normal limits. Donor blood which falls outside these parameters must be quarrantined. Repeat testing, if still abnormal must dispose.

17. Optional Tests CMV testing CMV devastating to premature infants and immunocompromised Removing leukocytes greatly reduces risk. Some physicians still request CMV negative for select patients Special antigen typing Patients may develop antibodies against other RBC antigens. Test donors to find antigen negative Sickle cell testing Exchange transfusion Sickle trait may sickle in neonates

18. Labeling Donor Units Component name Unique donor number ABO group, D type (not required for plasma) Interpretation of tests Type and volume of anticoagulant. Storage temperature Expiration date Name/address of collecting facility Reference to Circular of Information - http://www.aabb.org/Content/About_Blood/Circulars_of_Information/ http://www.aabb.org/Content/About_Blood/Circulars_of_Information/ Donor classification Results of testing Essential instructions Pooled component information

19. Transfusion Service Testing The only repeat testing required is: ABO on red cell products D typing (IS) on D negative red cell products Plasma products (FFP, CRYO, PLTS) do not require any testing. Donor samples must be stored at 1-6C for at least 7 days after transfusion ADSOL unit transfused today must save sprig for 7 days post-transfusion. Many facilities will pull a sprig from each donor during processing and save all sprigs for 49 days, regardless of expiration of unit

20. Red Cell Unit With Sprigs

21. Summary Blood collection starts with screening of the donor to: Ensure they are healthy enough to donate Ensure they do not have transmissible diseases Many organizations involved in setting standards and monitoring all aspects of blood collection and administration. Collection of blood must be done in such a manner as to ensure sterility of the component. Testing of donor blood includes serological testing for ABO/D typing, antibody screening and testing for infectious disease markers. The blood supply is NOT safe, only careful screening and testing can prevent, as much as possible, disease transmission.

22. References AABB Technical Manual 16 th edition http://www.fda.gov/cber/dhq/dhq.htm