Blood Bank Conclusion, Open Discussion, and Recommendations

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Blood BankConclusion, Open Discussion, and
Recommendations
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Safe Blood Donation

• Voluntary blood donation.
• Unpaid blood donation.
• Absence of profit.

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Donor Categories

• Allergenic, homologous and random donor
  terms used for blood donated by individuals for
  anyones use
• Autologous donate blood for your own use only
• Recipient Specific Directed donation donor
  called in because blood/blood product is needed
  for a specific patient
• Directed Donor patient selects their own donors
• Therapeutic bleeding blood removed for medical
  purposes such as in polycythemia vera. NOT used
  for transfusion.

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Donor Categories

• Safest is autologous, blood is your own, no risk
  of disease acquisition
• Most dangerous is Directed Donor, you select a
  donor who may, unknown to you, be in a high risk
  category but feels obligated to follow through
  and donate

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Blood donation reactions and complications

• Mild Reactions- ( Anxiety, Increase respiration,
  Rapid Pulls, Pallor and mild Sweating.
• Moderate Reactions- Loss of Consciousness
  (faint), Slow Pulls (Difficult to feel ).
• Sever Reactions- Faint, Convulsion,----

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How To Manage Donation Reaction Mild)

• 1- Discontinue Donation.
• 2- Raise Legs and Lower Head.
• 3- Loose or Remove tight.
• 4- Keep the donor Cool.
• 5- After recover offer him a cool drink.
• 6- Record the reaction at the BB recording.
• Ensure that he is full recovered before leaving.

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How To Manage Donation Reaction (Moderate)

• As before in addition to-
• 1- Remove him to another room for privacy
• 2- Chick the pulls, the appearance.
• 3- release him when full recovered.

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How To Manage Donation Reaction (Sever)

• As before in addition to-
• 1- Turn the donor to a lateral position to
  maintain a clear airway.
• 2- Gently restrain the donor to prevent any
  injury.
• 3- Ensure that he is full recovered before
  leaving.
• 4- Advise him not to donate blood again and
  contact a doctor.

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Post-Phlebotomy Care

• Donor applies pressure for 5 minutes
• Check and bandage site
• Have donor sit up for few minutes
• Have donor report to refreshment area for
  additional 15 minutes of monitoring

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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 1 hour
• If bleeding continues apply pressure and raise
  arm
• Faint or dizzy sit with head between knees
• Abnormal symptoms persist contact blood center.
• Remove bandage

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Blood Collection

• Post-donation observe donor, give post-donation
  
• instructions (remain sitting 10 minutes, drink
  more fluids than normal the next 4 hours,
  caffeine until
• you eat, dont smoke for 30 minutes, if you feel
• dizzy lie down, if venipuncture starts to bleed
  apply pressure for 5-10 minutes, remove bandage
  after a
• few hours, call your physician if symptoms
  persist,
• resume normal activities

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Question

• A 35 year-old nurse received their first
  hepatitis B vaccination as part of the hospitals
  safety program requirement. He is eligible to
  donate blood
• A. Today.
• B. In 24 hours.
• C. In 48 hours.
• D. In 6 months.
• E. In 12 months.

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Question

• A contact person to HBV, or HCV patient is not
  eligible to donate blood for -
• A- Two months
• B- 6 months
• C- Four month

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Question

• During Your Councilling, a blood donor
• before collecting his blood , he prevails that
  
• he is a diabetic patient. Would you accept or
• differed him?

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Specimen Considerations Recipient Specimen
must be clearly and accurately identified
Labeled with patients first and last name,
hospital ID, date specimen drawn, who drew the
specimen. Information on request for
crossmatch must exactly match information on
patient ID. Never rely on door tag, bed tag,
patient chart for ID
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Blood Typing (Reverse method)

• There are 2 components to blood typing
• Test unknown cells with known antibodies
• Test unknown serum/plasma with known RBcs
• The patterns are compared and the blood
• group is determined.

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Slide Blood Typing - continued

• The slide is divided into halves.
• On one side a drop of anti-A is added, this will
  attach to and cause clumping of RBcs possessing
  the A antigen.
• On the other side a drop of anti-B is added which
  will cause clumping of RBcs with the B antigen.
• A drop of RBcs is added to each side and mixed
  well with the reagent.
• The slide is tilted back and forth for one minute
  and observed for agglutination (clumping) of the
  RBcs

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Slide Blood Typing

• Very rudimentary method for determining blood
  groups.
• CANNOT be used for transfusion purposes as false
  positives and negatives do occur.
• A false positive is when agglutination occurs
  not because the antigen is present, but cells may
  already be clumpled.
• A false negative is one in which the cells are
  not clumped because there are too many cells or
  not enough reagent.

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ABO Compatibility
Best to give ABO group specific blood
Should not give ABO non-specific whole blood In
Packed Red Cells small amount of antibodies
remaining in plasma are diluted by patients
system are inconsequential Recipient blood is
forward and reverse typed. Donor ABO group must
be confirmed after ABO label is attached.
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Cross-Reaction

• If donor and recipient blood types not
  compatible
• Plasma antibody meets its specific surface
  antigen and blood will agglutinate and hemolyze

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Cross-Reaction
Figure 196b
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Blood Storage

• Blood Donated is stored in low temp ( 1-6C)
• To slow or stop al biochemical activities, and
• keep blood cells active, and avoid
• contamination.

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Blood Transfusion Request

• It should provide the following information's-
• . Date of Request.
• .Patients full name, date of birth, sex, hospital
  No, word, address, blood group if known.
• .provisional diagnosis.
• . Presence of antibodies.
• . History of previous transfusion, and reaction
  if happened.
• . No of previous pregnancies (female)
• . No and type of units of blood and blood
  products required.
• . Reason of transfusion.
• Signature of doctor requesting the blood.
• .
• .
• .
• .

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Blood transfusion reaction

1. Stop transfusion immediately
2. Continue IV infusion with normal saline
3. Notify physician of clients signs and symptoms
4. Provide care for client as indicated
5. Complete reaction form according to institution
   protocol.
6. Obtain urine specimen from client and send for
   free hemoglobin.

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Ordering blood
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Urgent Release of Blood
Requesting physician must document that
the clinical situation was urgent to require
release of uncross matched blood. Usually
give O neg unless ABO type/Rh of recipient has
been determined (can't use previous records).
Units must be labeled to make it clear
that testing was incomplete
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Personnel

• Does the facility have qualified personnel with
  appropriate education, training and
  experience-competent performance of assigned
  duties
• Effective job description

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Personnel
Well defined program
Regular scheduled competency evaluation of
staff To ensure that their skills are
maintained
Orientation of new employees
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DOCUMENTATION

• If you have not documented it,You have NOT done
  it.

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Records Management

• Proper documentation of all samples processed
• All forms required in trace back or look back
  process
• Transfusion requests kept for 1 month
• Transfusion reaction forms indefinitely
• Records( employee signature,ID,initials) 5 years
  or as per national guidelines
• Non transfusion serological tests results for 5
  years

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Records Management

• Quality controls records (reagents/serological
  test controls/external proficiency testing) 5
  years
• Quality assurance 5 years
• Antibody identification reports indefinitely
• Method revision sheet indefinitely
• Donor segments/serum/plasma,clotted and or EDTA
  sample for 7 days post-transfusion
• Computer QA records 3 years
• Patient data files indefinitely
• Policy for Product Recall/Retrival/Lookback-Trac
  eback

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Documentation Hierarchy- representing the level
of documentation in a blood bank
Level IPolicies What to do
Policies
Level IIProcesses How it happens
Processes
Level IIIProcedures How to do it
Procedures (SOPs)
Forms/Records/Supporting documents/Data/QC
Records/Templates
Level IV
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Documentation

• Are the records of incidents, errors, and
  accidents maintained ?

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Types of Clerical Errors

• Venipuncture of the wrong patient
• failure to identify patient correctly
• wrong name placed on sample
• blood taken to the wrong patient
• failure to properly identify the patient prior to
  transfusion

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ERRORS ARE USEFUL INFORMATION

• WE LEARN MORE FROM OUR FAILURES THAN WE MAY FROM
  SUCCESS

Give me a fruitful error anytime, full of seeds,
bursting with its own corrections. You can keep
your sterile truth for yourself VILFRED PARETO

• CAN IMPROVE OUR PROCESS WHEN STUDIED
• BENIGN ERROR MAY PREDICT DISASTERS OR BAD OUTCOMES

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Basic Blood Components

• Red Blood Cells
• Platelets
• Fresh Frozen Plasma (FFP)
• Cryoprecipitate Anti-hemophilic Factor
• Granulocytes

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BLOOD COMPONNET AND SEPARATION
Blood components are packed Red Blood Cells,
Platelets, Rich Plasma, Platelet concentrate,
Fresh Plasma, Fresh Frozen Plasma, Frozen Plasma,
Cryoprecipitate, and Cryosupernant. Double,
Triple and Quadruple blood bags are used for
producing and separating components in closed
system.
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PACKED RED BLOOD CELLS
fresh frozen plasma
cryoprecipitate
Whole blood
PLATELETS
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Terms to know

• Whole blood blood collected before separation
  into components
• Components parts of whole blood that are
  separated
• Closed system a sterile system of blood
  collection
• Open system when the collection is exposed to
  air, decreasing expiration date

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Collection basics

• Blood is collected in a primary bag that
• contains anticoagulant-preservatives
• Satellite bags may also be attached,
• depending on what components are needed
• Anticoagulant-preservatives minimize biochemical
  changes and increase shelf life

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WHY BLOOD COMPONENTS ?

• TO CORRECT SPECIFIC DEFICIENCY
• STORAGE CONSIDERATIONS

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Red Blood Cells

• RBCs
• 1-6 C (stored) 1-10 C (shipped)
• 21, 35, or 42 days depending on preservative or
  additive
• Hematocrit should be 80
• One unit increases hematocrit 3
• Once the unit is opened it has a 24 hour
  expiration date!

24 hours
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Leukocyte Reduction Filters (maintains closed
system)
http//www.pall.com/39378_39479.asp
Final unit must have less than 5 x 106 WBCs
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Preparation of platelet concentrate
Plasma
RBCs
PRP
Platelet concentrate
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How platelets are processed

• Requires 2 spins
• Soft separates RBCs and WBCs from plasma and
  platelets
• Heavy
• platelets in platelet rich plasma (PRP) will be
  forced to the bottom of a satellite bag
• 40-60 mL of plasma is expelled into another
  satellite bag, while the remaining bag contains
  platelet concentrate

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Platelets

• Important in maintaining hemostasis
• Help stop bleeding and form a platelet plug
  (primary hemostasis)
• People who need platelets
• Cancer patients
• Bone marrow recipients
• Postoperative bleeding

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BLOOD BANK REFRIGERATORS

• Uniform 40C Temperature Recovery
• Forced Air Circulation system
• Audio/ Visual Alarm
• Temp. Display

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What is Apheresis
The process of apheresis involves removal of
whole blood from a patient or donor. Within an
instrument that is essentially designed as a
centrifuge, the components of whole blood are
separated. One of the separated portions is then
withdrawn and the remaining components are
retransfused into the patient or donor
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Plasma (plasmapheresis) Platelets
(plateletpheresis) Leukocytes (leukapheresis)
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Whatever the local system for the collection,
screening and processing of blood, clinicians
must be familiar with it and understand any
limitations that it may impose on the safety or
availability of blood.
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Getting the right blood to the right patient at
the right time
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• Blood products
• Key points
• 1 Safe blood products, used correctly, can be
  life-saving, However, even where quality
  standards are very high, transfusion carries some
  risks. If standards are poor or inconsistent,
  transfusion may be extremely risky.
• No blood or blood product should be administered
  unless all nationally required tests have been
  carried out.
• 3 Each unit should be tested and labeled to show
  its ABO and Rh D group.
• 4 whole blood can be transfused to replace red
  cells in acute bleeding when there is also a need
  to correct hypo volaemia.

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5. The preparation of blood components allows a
single blood donation to provide treatment for
two or three patients and also avoids the
transfusion of elements of the whole blood that
the patient may not require. Blood components can
also be collected by apheresis. 6. Plasma can
transmit most of the infections present in whole
blood and there are very few indications for its
transfusion. 7. Plasma derivatives are made by a
pharmaceutical manufacturing process from large
volumes of plasma comprising many individual
blood donation. Plasma used in the process should
be individually tested prior to pooling to
minimize the risks of transmitting infection. 8.
Factors VIII and IX and immunoglobulins are also
made by recombinant DNA technology and are often
favoured because there should be no risk of
transmitting infectious agents to the patient.
However, the costs are high and there have been
some reported cases of complications.
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• Clinical transfusion procedures
• Key points
• Every hospital should have standard operating
  procedures for each stage of the clinical
  transfusion process. All staff should be trained
  to follow them.
• Clear communication and cooperation between
  clinical and blood bank staff are essential in
  ensuring the safety of blood issued for
  transfusion.
• The blood bank should not issue blood for
  transfusion unless a blood sample label and blood
  request form have been correctly completed. The
  blood request form should include the reason for
  transfusion so that the most suitable product can
  be selected for compatibility testing.
• Blood products should be kept within the correct
  storage conditions during transportation and in
  the clinical area before transfusion, in order to
  prevent loss of function or bacterial
  contamination.

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• 5. The transfusion of an incompatible blood
  component is the most
  common cause of acute transfusion reaction,
  which may be fatal.
• The safe administration of blood depends on
• Accurate, unique identification of the patient.
• Correct labeling of the blood sample for
  pre-transfusion testing.
• A final identity check of the patient and the
  blood unit to ensure the administration of the
  right blood to the right patient.
• 6. For each unit of blood transfused, the patient
  should be monitored by a trained member of staff
  before, during and on completion of the
  transfusion.

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Monitor and record daily blood stock and prevent
shortages of specific group. The daily blood and
blood component stock is monitored and checked by
head of the sections, in case of specific group
shortage the following actions is taken 1. 
Phone call the donors with needed specific group.
2.  Phone call the institute and establishments
that held blood campaign 3.  Communicate central
blood bank society. 4.  Call blood collection
centers in other government hospitals. 5. 
Demand patient family to replace needed  blood.
6.  On top emergencies call the TV. and other
media for public announcement.
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Do not ever leave the donor during or after
donation process until he or she leave the
donation hall.
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