UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA,

Mary Christelle G. Donor Selection and Blood Collection BLOOD DONATION PROCEDURE 1. BEFORE BLOOD DONATION: REGISTRATION

Blood collection facilities must confirm donor identity and link the donor to existing donor records. Photographic identification using valid I.D. (e.g. drivers license or school identification card) is required. The following is a list of information used by the collection facility in the registration process and is kept on record by use of a single donation record form: Date/Time of Donation Name of Donor (Surname, First Name, Middle Name) Age Sex Status Birth date Contact Number Complete Address Occupation Office Address Name of Patient (Recipient) Ward/Hospital Relation Type of Donor Blood Type*

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. Donors record must be retained by the blood collection facility as mandated by FDA and AABB. There must be a system to ensure the confidentiality of the donor is not compromised and that the donor records are not altered. Policies on record keeping and storage must be implemented and the blood bank staff should be well trained on these policies. *Donors blood type is done after the medical test.

2.

CLASSIFICATION OF DONORS

Blood donors may be categorized into three: a. VOLUNTARY, NON-RENUMERATED BLOOD DONORS i. They give blood on their own free will and receive no money of any form of payment ii. The reasons for promoting regular voluntary non-renumerated blood donor are: 1. Lower incidence and prevalence of transfusion transmissible infection

2. Absence of risks of anemia on the part of donors through depletion of their own iron stores 3. Donors are more willing to donate blood regularly

4. Donors have expressed a commitment to donate blood during emergency b. FAMILY or REPLACEMENT BLOOD DONORS i. Theyre required to give blood when a member of the patients family or community requires it. c. PROFESSIONAL or PAID or COMMERCIAL BLOOD DONORS i. They are donors who give blood for money or other form of payment. ii. The disadvantages of paid or professional blodd donation:

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. 1. 2. 3. High incidence and prevalence of transfusion transmissible infection Often donors are undernourished and in poor health Donor Screening

d. PRE-DEPOSIT i. They are donors who donate blood to gain security on the availability of blood in case of emergency

e. MBD: MUMBAI BLOOD DONORS i. They are donors who have Rh negative blood

Donor screening is carried out by an adequately trained physician and/or qualified staff under the supervision of a qualified physician to determine the sustainability of the blood donor.

3.

DONORS CONSENT

Figure 6.1. National Childrens Hospital Interview Sheet of Blood Bank (2011) Donors Consent

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G.

According to the Modern Blood Banking and Transfusion Practices, Donors should be given educational materials informing them of the risks of the procedure, signs and symptoms associated with the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), and the opportunity to decline from the donation process. If they believe their blood is not safe or they are not comfortable with the procedure. (Harmening, 2005)

4. PHYSICAL TEST - POTENTIAL BLOOD DONOR A potential blood donor must have the following characteristics are the time of donation:

Table 3.1. Criteria for Potential Donors 1. 2. 3. 4. 5. 6. 7. CRITERIA General Appearance Age Body Weight Pulse Rate Blood Pressure Temperature Skin CHARACTERISTICS No presence of excessive anxiety, drug or alcohol influence or nervousness Between 16-65 years old (parental consents is required under 18 y/o) At least 50 kg (500 ml blood unit) At least 45 kg (250 ml blood unit) 50 100 beats/minute (regular rhythm) Systolic: 90-160 mm Hg Diastolic: 60-100 mm Hg 37 degrees Celsius 98.6 degrees Fahrenheit Deferral : Evidence skin lesions (puncture marks) Observed donors facial expression, visual & hearing ability, and physiology of the nose, mouth & tongue, etc. Look for symmetry, size, shape,

8. HEENT (Head, Ears, Eyes, Nose, Throat)

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. masses, involuntary movements, presence of lesions & allergies, and form of disability or complications. Permanent deferral if severe heart and lung disease is present 125g/L (12.5 g/dL) Male: 40 - 49 Female: 35 -49

9. 10. 11.

Heart & Lungs Hemoglobin Hematocrit

Figure 3.1. National Childrens Hospital Interview Sheet of Blood Bank Section (2011) Physical Exam

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G.

5. MEDICAL TEST Obtaining an accurate medical history of the donor is essential to ensure the benefit to the recipient. The medical history questions have been developed and revised as necessary.

Figure 4.1. A donor that is temporarily deferred.

i.

Temporary Deferment of Blood Donor

Table 4.1. Conditions of donor that may be reasons for their deferment 1. 2. CONDITION Previous Donation Pregnant Women DURATION Three (3) months or longer interval from previous donation of 450 ml 9 months after childbirth 3 months after weaning (whichever is longer)

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. 3. Major Operation including: a. Dental Surgery b. Blood transfusion include administration of immunoglobulins 4. Acute Febrile Illness 5. Malaria (diagnosed or treated) 6. Past exposure to a close household contact with hepatitis 7. Past exposure to unhygienic skin, piercing, tattooing, ear holding, needle puncture, etc. 8. Recent alcohol intake (positive for alcoholic breath) 9. Skin lesions at venipuncture site 10. Menstruation (for females only) ii. 12 months after operation or transfusion

2-3 weeks after febrile episode or until full recovery 3 years after cessation of signs and symptoms of malaria or treatment of malaria 1 year after exposure 1 year after exposure

12 hours after the last alcohol intake After skin have completely healed 1 week before menstruation

Deferment of Blood Donation Following Vaccination (Table 4.2.) TREATMENT 1. Live attenuated vaccines Category 1: Measles (rubeola), Oral polio, Mumps. Yellow fever vaccines, BCG Category 2: German measles (rubella) vaccine Category 3: Rabies vaccines 2. Killed vaccines and toxoids (DPT and DT, polio injectable, HBV, Cholera, Typhoid and paratyphoid typhus and influenza vaccines DURATION 2 weeks after vaccination

1 month after vaccination 1 month after vaccination May donate any time if without vaccine associate symptoms like fever

iii.

Deferment Due to Medications taken By the Donor (Table 4.3.) MEDICATION DURATION

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. 1. Antibiotics other than anti-TB drugs 2. Anti-TB drugs 3. Anti-Fungal drugs 5 days after the last dose Until TB is completely cured 5 days after completion of treatment 1 day after the last dose (but blood is labeled NOT FOR THE PREPARATION OF PLATELETS) While on treatment 2 months after treatment

4. Allergic drugs such and penicillin and aspirin, isotretinoin, etretinat 5. 6. iv. Oral Corticosteroids Anti-Acne drugs

Permanent Deferment of Blood Donor Persons with the following conditions shall not be allowed to donate blood at any time. 1. 2. Cancers Cardiac diseases like arrhythmias, congestive heart failure

3. Severe lung diseases like complicated asthma with bronchiectasis or atelectasis 4. Viral hepatitis and jaundice of unknown origin and other severe liver disease like cirrhosis 5. Use of prohibited drugs (past or present)

6. High-risk sexual behavior or continuing exposure to persons with hepatitis, HIV/AIDS and other sexually transmitted diseases (STD) 7. 8. 9. 10. 11. High risk occupations (e.g. prostitution) Sexually transmitted diseases (STD) (past or present) Prolonged bleeding Unexplained weight loss of more than 5 kg over six months Chronic alcoholism

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. 12. Autoimmune diseases like SLE, etc.

6. SEROLOGICAL TESTS Serological tests involved in the interaction between the paratope of antibody and epitope of antigen. The forces of attraction include electrostatic forces, Van der Waals forces, hydrogen bonding and hydrophobic bonding. Factors affecting forces of attraction are the physiologic pH and salt concentration that promotes optimal union of antibody and antigen, and temperature (higher temperature, up to 50-55 degrees Celsius, increases the rate of reaction.

Serologic tests may be categorized as follow: (a) to detect unknown antibody in serum using a known commercial antigen as reagent; and (b) to detect unknown antigen in the specimen using known commercial antiserum as reagent. Figure 5.1. Diagram showing the antibody-antigen interaction of the unknown antibody

The general procedure for serologic tests, such as HEPATITIS B and MALARIA, is placing the serum on the sample well, then the diluent. Incubation period may vary depending on the manufacturer. The test is interpreted in the result window. Presence of line on the control area indicates the test kits validity. A positive result is seen when a line is present on its test band area. Negative result is the absence of line on the test band. Figure 5.2. Diagram showing a sample test kit of its result window and interpretation

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G.

Malarial Smear

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. Laboratory Diagnosis 1. Thick and Thin Smear (Gold Standard) a. Stained with Giemsa or Wright Stain b. Blood smears should be prepared every 6-8 hours Note: A properly prepared thin film is thick at one end and thin at the other. The thin, feathered end of the film should be centrally located on the slide with free margins on both sides; the feathered edge should be only one layer thick. Streaks in the blood film indicate dirt on the slides; holes indicate the presence of grease on the slide. Qualitative Reporting: + : 1-10 parasite /100 thick Field ++ : 11-100 parasite/ 100 thick Field +++ : 1-10 parasite/ thick field ++++ : 10 parasites/ thick Field Figure 5.4. Thin & Thick Smear 2. QBC: Quantitative Buffy coat a. - uses capillary tube with Acridine Orange b. - (+) bright green & yellow under fluorescent microscope Quantitative Reporting: # of Malarial parasite/ L = # of parasite count/ 200 WBC * 8000 3. RDT: Rapid Diagnostic Test Figure 5.3. Plasmodium falciparum Presence of single ring in the red cell (Parasitology Laboratory, UST, 2010)

a. uses the principle of immunochromatography i. HRP II detection- Parachek P.f., Para HIT fecal Test ii. LDH Detection- to differentiate falcifarum from non falcifarum, DIAMED Optimal IT a. uses in vitro continuous culture in human Erythrocytes b. RPMI 1640 (Rosewell Park Memorial Institute) a. IHA (Immunohepatoagglutanation) b. IFAT

4. Culture Method

5. Serological Test

Table 5.2. Differentiation of different agents of Malaria (Pallidium spp.)

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G.

Point of Difference Type of Malaria Length of sexual Cycle Length of Asexual Cycle Size of Infected RBC Type or RBC infected # of merozoites in Schizont Ring Form # of Chromatin Dots Accol/appliqu/Mar ginal Form Multiple Infection of Same RBC Gametocyte Asexual Stage in the Peripheral Smear Malarial Stipplings

P. falcifarum Malignant Tertian Subtertian 9-10 days 36-48 hours Normal Young and old 8-36 (1232) Single/ Multiple Single/ double Present Common sticky RBC Crescent/ Banana Shape Not all Stages Mauers Dots/ Cuneiform dots

P. malariae Quartan 15-20 days 72 hours Normal Old /senescent 6-12 (Rosette Formation/frui t pie/Flowery daisy head) Single Singles Not present Rarely Round/ oval All Stages Ziemann dots

P. vivax Benign Tertian 8-9 days 48 hours Enlarged Young 12-24 (8-12) Single Single/dense Not Present Rarely Round/ Oval All Stages Schuffners dots

P. ovale Benign or ovale Tertian 14 days 48 hours Normal to slightly Enlarged Young Usually 8 (6-12) Single Single Not Present Rarely Round / Oval All Stages James Dots

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G.

6. DURING BLOOD DONATION

a. Identify the donor through his/her identification card. b. Let the donor lie on the bleeding bed c. Apply the tourniquet to palpitate the suitable vein for bleeding, then release. d. Cleanse the site for bleeding using alcohol, iodine then alcohol. Dry the site. e. Prepare your blood bag. Clip the blood bag cord to prevent the anticoagulant to spill. Check the needle. If any problems are encountered, change your blood bag. f. Everything is set; apply the tourniquet and let the donor squeeze the stress ball once. When the palpable vein is in sight, insert the needle then release the clip to let the blood flow. Let the donor squeeze the stress ball every 3 5 seconds for continuous flow. Mix the blood bag continuously and label it (date & time of collection, donors blood type & donors number). Always check for signs of blood flow. g. Fill up the blood bag up to 450cc. Then, clip again the blood bag. Ask the donor to halt squeezing the stress ball and relax. h. Remove the needle in an upright position then cover it.

UNIVERSITY OF SANTO TOMAS Faculty of Pharmacy Department of Medical Technology National Childrens Hospital Blood Bank Section AQUITANIA, Mary Christelle G. i. Place pressure on the puncture site to stop the bleeding. Let him/her rest for 10 15 minutes.

7. AFTER BLOOD DONATION Drink plenty of fluids over the next 24-48 hours to replenish any fluids you lost during donation. Avoid strenuous physical activity or heavy lifting for about five hours after donation. If you feel light headed, lie down, preferably with feet elevated, until the feeling passes. In rare cases when bleeding occurs after removing the bandage, apply pressure to the site and raise your arm for 3-5 minutes. If bleeding or bruising occurs under the skin, apply a cold pack to the area periodically during the first 24 hours. Enjoy the good feeling that comes with knowing that you may have saved as many as three lives.