Overview of the Blood Banking Process

Overview The Blood Banking industry is responsible for producing, processing, and distributing the nation’s blood supply. Typically, a blood bank is divided into several different departments: A. Donor Development (Recruiting) B. Donor Services C. Component Processing D. Laboratory E. Distribution (Not covered here, varies by Blood Bank) F. Administration (Not covered here, varies by Blood Bank) G. Reference Testing (Not covered here, varies by Blood Bank) A. Donor Development (Recruiting) The Recruiting department is the connection between the blood center and the communities that it serves. 1. They arrange for the creation of donor clubs (funds), and coordinate with the chairmen of these funds to arrange the mobile drives. Donor clubs work together to donate as many units as possible, and the credits accumulated by these donations are used to help people connected with the fund group who require transfusions. The credits give the patients a discount for the units used. They are responsible for media drives, and maintain contact with the local papers, television, and radio stations, to create public service announcements regarding blood donation, or to alert the area in the case of a critical shortage. Larger centers also maintain tele-recruiting offices, where people generate call lists and personally contact past donors in an effort to get them to return. In some centers this may involve making appointments for donors to ensure that they are able to make their donation with as little inconvenience as possible.

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In the end, it is the responsibility of the department to use these sources to ensure a constant flow of donors so that the community has an adequate supply of blood. B. Donor Services The Donor Services department includes the phlebotomy and nursing staff required to make the donation process as safe as possible for both the donors and the recipients. Prior to the actual donation, a potential donor is asked a series of questions that will evaluate not only the potential danger to a recipient, but also to the donor. There are several steps to the donation process: 1. Registration – The potential donor is registered, and any past donation history is evaluated for past deferral information. Any donor with an active deferral is not permitted to donate blood. If, after this evaluation, the potential donor is acceptable, he or she moves on to the screening process. 2. Screening – The potential donor is given access to educational materials about the risks involved in donation, and description of Hepatitis and HIV risk factors. The potential donor is taken to a private booth, and a series of questions which cover the donor’s past health history, lifestyle, and behavior are evaluated. If, at any time, the answers to these questions indicate that the donation

would be harmful to the donor, or that the product would be a risk to a recipient, the donor is deferred (not permitted to donate) for a period of time. The length of the deferral period is the result of evaluation by the FDA, AABB (both regulatory agencies), and may also be extended by the center’s medical director. In addition, the donor is always free to leave at any time if he/she chooses. 3. Exam - When the screening is complete, a donor undergoes a physical evaluation to be sure that he/she is in good health, and that the donation will not cause the donor harm. The donor’s temperature, blood pressure, pulse, and hematocrit or hemoglobin (depending on the facility) is tested. Any deviation from the normal range is another cause for a deferral. 4. Donation - After the donor has passed the evaluation, the actual donation process begins. The identity of the donor is verified, and the donor bag set is prepared. To ensure the safety of both the donor and the unit, the bag set is a sterile sequence of bags, with a clean, unused needle integrally attached. The donor’s arm is cleaned with an iodine swab to prevent bacterial contamination. The needle is placed in the arm vein, and the donation begins. The time of the needle stick is recorded, and the donor is monitored until the correct volume (about 585ml) has flowed into the bag. The donor’s arm is cleaned and bandaged, and offered food and drink and allowed to leave. Test samples are removed from the unit of blood before it is sealed and the needle is removed. The test samples are identified by the same number as the unit in order to maintain a connection between the test results and the unit of blood without compromising the anonymity of the donor. 5. Record keeping – After the phlebotomy, all records pertaining to the donation or deferral is maintained indefinitely. C. Component Preparation A blood donation may be transfused as Whole Blood, or may be separated into several components. A patient may require only one component as a part of their medical treatment, and since the transfusion of the unneeded components may actually cause more harm than good. By separating the whole blood into components, several recipients can receive needed treatment from one donated unit. Blood components include red blood cells, platelets, plasma, and cryoprecipitated antihemophilic factor. A unit of whole blood is separated into components by centrifugation. The units are placed into a centrifuge, and the initial spin (usually 2500 to 3500 rpm) for 2 – 3 minutes packs the red blood cells down into the bottom of the bag, and the plasma and other components are expressed into another bag. The life span of the cells is extended by the addition of a nutrient solution, the bag is sealed and cut, and the packed cells are then refrigerated at 2 – 8 C. With the addition of this solution, the red blood cells will be acceptable for transfusion for up to 42 days. Red blood cells are used to treat chronic anemia caused by kidney failure, internal bleeding, or cancer, or acute blood loss due to trauma. Since the red blood cells have a reduced plasma volume, they are suitable to transfuse to patients who could not tolerate the increase in blood volume that the transfusion of whole blood might cause, for example those with congestive heart failure, or the elderly. The bag containing the plasma may now be centrifuged again, at a higher speed (4000 – 5000 rpm) to separate the platelet component. After approximately 6 minutes, the platelets will form a plug in the bottom of the plasma bag. The plasma, except for 45 – 65 ml is removed, again by expression, into a third bag. The platelet bag is allowed to rest for 1 – 2 hours to give the platelets an opportunity to resuspend into the remaining plasma, then stored at room temperature with gentle agitation for up to 5 days. Platelets are one of the body’s defenses against blood loss due to injury. Also, normal activity during the course of the day causes the blood vessels to leak. Low platelet counts lower the body’s ability to close these leaks. The remaining plasma is placed in a freezer where the temperature is not higher that –18 C. If the plasma is completely frozen within 8 hours from the time of the donor’s phlebotomy, the fresh frozen

plasma is a transfusable product (the plasma proteins have been frozen quickly enough that they have not lost any of their therapeutic value). A unit frozen after this time may still be frozen after the 8-hour period, and be used for the manufacture of reagent proteins such as albumin. If a unit of fresh frozen plasma is partially thawed at refrigerated temperatures, then centrifuged, when the thawed plasma is expressed, the remaining protein plug (which contains the factors used to create blood clots) may be re-frozen. This product is called cryoprecipitated anti-hemolytic factor. Cryoprecipitate is used to treat patients with a genetic disorder known as Hemophilia or Von Willibrand’s disease, where the patient is incapable of building these proteins, and therefore is unable to form blood clots when injured. D. Laboratory Testing Due to the prevalence of blood-borne pathogens, many of which have long incubation periods, laboratory testing of donated units is a necessity. The federal government requires that all units of blood or blood components must be tested for the following: 1. ABO/Rh – All units must be tested for major blood group, and for the Rh antigen D with a method that will detect a weak expression of the D antigen. 2. Atypical antibodies – A screen of donated units must be made to identify any clinically significant antibodies. 3. Syphilis – A screening test for the proteins commonly seen with the presence of the treponema pallidum organism which causes syphilis. 4. Hepatitis B surface antigen – A screening test for the presence of proteins found on the surface of the virus responsible for Hepatitis B. 5. Hepatitis B core antibody – A screening test for antibodies against the proteins found in the core of the virus that causes Hepatitis B. 6. Hepatitis C antibody - A screening test for antibodies against the proteins found in the core of the virus that causes Hepatitis C. 7. HIV 1 and HIV 2 antibodies – Screening tests for antibodies against the HIV type 1 and type 2 viruses. This may either be two separate tests, or a combination test designed to detect both antibodies. 8. HIV 1 p24 Antigen – A screening test designed to detect the protein labeled p24 inside the core of the HIV1 virus. 9. HTLV I/II – A screening test for antibodies against the proteins found in the core of the HTLV virus. 10. In addition, most blood centers test units for the liver enzyme alanine aminotransferase, which is elevated in situations where the liver has been damaged. This may help to detect other forms of hepatitis, such as Hepatitis A, or a chronic use or abuse of alcohol. In the event that one or more of the screening tests are reactive, they are repeated in duplicate to make sure that the reactive result is due to the presence of infectious material, and not due to contamination or tech error. A unit that is reactive at least twice is considered to be repeatedly reactive. Depending on the test, a donor will either be deferred or placed on surveillance and the unit is destroyed. If the repeated testing is non-reactive, the unit is considered non-reactive and the unit is acceptable for use. Before any unit of blood is released for labeling, all donation, preparation, and testing records are evaluated by supervisory personnel. Any unit with questionable or incomplete records is not considered eligible for labeling.

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