Module No.

Laboratory Diagnosis

TRANSFUSION MEDICINE Part 1

3.1

Dr. Tungol

Sept. 10, 2015

Outline
I.

II.

Community based blood

donations

Transfusion Medicine
A. Philippine Laws
B. NVBSP
C. Classification of Blood service facilities
Donor Selection
A. Types of Blood Donors
B. General Requirements
C. Eligibility of Donor
D. Blood Center Model (Making components, Apheresis)

Blood Center for Centralized

Testing & Component Processing

Blood Products to Hospitals

LEGEND
Lecture Powerpoint, Audio, Textbook

Blood Service Fees (Cost

Recovery)

TRANSFUSION MEDICINE

Philhealth Reimbursement

A Multidisciplinary specialty encompassing all aspects of

blood donation, blood component preparation, blood cell
serology, and blood transfusion therapy.

I. Philippine Laws Regulating Blood Services

Donor Selection

Donor Screening
Objectives:
1. The blood product will benefit the recipient
2. The blood product will not harm the recipient
3. The safety and health of the blood donor is
protected

Voluntary Donor
Paid Donor
Replacement Donor
Direct Donor
Dedicated donors
Autologous
Apherisis Donor

1. R.A 7719 and A.O 9s 1995

The National Blood Services Act of 1994

An
act
promoting
VOLUNTARY
BLOOD
DONATION, providing for an adequate supply of
blood, regulating blood banks, and providing
penalties for violations thereof.
Bureau of Research and Laboratories

2. A.O 2005-0002

Rules and Regulations for the establishment of Philippine

National Blood Services
o
National Council for Blood Services
o
Philippine National Blood Services

Types of Blood Donor

Ultimate Goal in Donor Selection

3. A.O 2008-0008

Rules and Regulations Governing the Regulation of Blood

Service Facility

To select HEALTHY persons who are part of the low risk

exposure/behaviour segment of the population who would
donate blood VOLUNTARILY without expecting monetary or
other substantial material compensation.

1.
2.
3.
4.

Persons in good physical condition

Free of disease transmissible by blood transfusion
Has not been exposed to transmissible diseases
Has not engaged in behavior, having a high risk of contracting
such transmissible diseases.

1.
2.
3.

Male/Female
In good health
Age:
16 - <18 years WRITTEN PARENTAL
CONSENT
18 65 years old ELIGIBLE
>60 70 EVALUATION by BLOOD BANK
PHYSICIAN

4.

Weight:

4. Department Memorandum No. 2008-0109

Centralized testing of blood units collected from mobile blood

donation activities of Metro Manila lead blood service facilities

The National Voluntary Blood Services Program (NVBSP)

Aims to achieve:
1. Development of fully voluntary blood donation
system
2. Strengthening of a nationally coordinated network
of BSP to increase efficiency by centralized testing
and processing of blood
3. Implementation of a quality management system
including Good Manufacturing Process (GMP) and
Management Information Systems (MIS).
4. Attainment of maximum utilization of blood through
rational use of blood products and component
therapy/
5. Development of a sound, viable, sustainable
management and funding for the nationally
coordinated blood network.

Classification of Blood Service Facilites

Blood Center Model

General Blood Donor Requirements

Persons Eligible to Donate BLOOD

50kg (110lbs) and above collect 450mL

45 50kg (100 110lbs) collect 250 300mL

5.

Body Temperature
<37.5 C (Axillary Temp)

6.

Pulse Rate :
60 100 bpm
No irregularity in rhythm

b. Institutional Character:
Hospital Based
Non Hospital based (Government or PRC owned)

7.

Blood Pressure:
90 -160 mmHg (systolic)
60 -100 mmHg (diastolic)

c. Service Capability:
Blood Station (BS) -smallest
Blood Collecting Unit (BCU)
Blood Bank (BB)
Blood Center (BC)

8.

Hemoglobin Concentration
Atleast 125g/L (12.5g/gL)

9.

Hematocrit
Atleast 38%

Based on the following:

a. Ownership:
Government
Private

Napilot | Paulino

Checked by: Del Rosario

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Transfusion Medicine Pt.2

10. Interval between donations --- 3 Months (Yung conventional

na whole blood donation; iba ang interval pag apheresis)

Module 3, Lecture 3.1

WINDOW PERIOD
o
The period between infection by HIV and the
development of detectable antibodies.

How to get an honest reply:

o
Allow for enough privacy
o
Reassure donors of strict confidentiality
o
Use simple language: verify if they understood what
you are saying
o
Allow sufficient time for discussion

Other Things to Consider:

Donor Appearance (Because you dont want paid donors to

donate; and you need good quality blood for your patients.
Kailangan maging subjective sa blood bank)
Skin at potential venipuncture
sites (Consider the size of the
vein too, because most blood
bags have gauge16/ gauge18
needles; kung maliit ang vein,
di din makukuhanan yung
donor)
Alcohol and drug use
Medications
taken
(Some
medications
are
not
allowedteratogenic drugs, accutane (wait for 1 month), etc.)
Vaccinations (Some vaccinations may interfere with serologic
testing, some vaccines may develop complications. Donors
must wait for a certain no. of days before donating)
Postpartum and breastfeeding women (Pregnant women are
not allowed to donate generally; only allowed after a certain
amount of time post partum)
Hazardous occupations or hobbies (Again, you want to get
good quality blood for your patients)
Travel, residence (Especially those who live/visited Palawan,
or other places which are endemic for some diseases)

Steps in Selecting a Donor

1. Pre-donation counseling
2. Medical history and Personal Data:
Donor History Questioning (DHQ)
3. Health Check
4. Decision:
-ACCEPT as FIT TO DONATE
-DEFER donation, temporary or permanent

Donors rights and responsibilities

Blood donation process
Potential donation-related complications
Tests performed on donated blood
Procedure in the event of a positive result
Donor confidentiality
Importance of regular donation
Donation intervals
TTIs and how they can be avoided
High risk behavior
Window period of infection
Importance of maintaining a healthy lifestyle
Alternate testing sites for those at risk or for those who wants
to be tested.
Means of self-deferral
o
Self Exclusion

The decision by the potential donor not to

give blood.
** have engaged in risk behavior.
o
PEER GROUP PRESSURE

Confidential Unit Exclusion

Removal and disposal of a unit
of blood after donation at the
request of the donor
May be included in the consent
Never assume that the donors
know what risk behavior
means.
Types of Risk Behavior:
o
Multiple sex partners
o
Commercial sex (prostitution)
o
Have engaged in MSM even once
o
Have had Syphilis, Gonorrhea, or other STI in past
12 months
o
Injecting drug use
o
Skin scarification (tattooing, blood rituals)
o
Have been imprisoned in the last 12 months
o
Having sexual relations with anyone engaging in
any of the above risk behaviors.
(Practice good observation skills when conversing with a
potential donor)
Napilot | Paulino

Persistent Cough
Unexplained weight loss
Night sweat/fever
STD/VD
HIV/ AIDS
Malaria (fever)
Hepatitis / jaundice
Lung disease
Tuberculosis
Asthma
Thyroid disorder
Cancer
Recent history of medication
Recent injections
Recent operations
Recent acupuncture, scarification
Recent blood transfusion history
Recent contact with infectious disease
Recent travel to areas endemic for certain disease, e.g.
Malaria, Mad Cow Disease

Potential Risks to the Safety of the Donor

Pre-donation Counseling

Potential risks to the health of recipient

Low/high blood pressure

Excessive nose bleeds
Epilepsy
Rheumatic fever
Circulation problems
Diabetes
Anemia
Ulcers
Kidney disease
Pregnancy
Breast feeding

Blood Center Model

**(Refer to the colorful diagram on pg 1)
Community Based Blood Donations (all blood units collected) tapos
pupunta Blood Center (for centralized testing component processing)
tapos mapupunta na sya for Blood products or Blood Service Fees
(for cost recovery)
Kasama sa Blood Service Fees:
- Advocacy on VBD
- Rational Blood Use
- Blood Stocks Inventory
- Transfusion Reaction Work-up
- Hemovigilance (Post Transfusion Surveillance)

Importance of written / documented medical history

1.It provides information needed to decide whether to:
- accept the donor
- defer the donor temporarily
- exclude the donor permanently
2. it provides a permanent record of the donors health status
Post Donation Instructions
- Applying pressure for 2 5 minutes on the venipuncture site
- Drink more than the usual amount of fluids
- Avoid lifting weight or strenuous activities for 24 hours
- Lie down with the legs elevated if the donor feels dizzy or lightheaded
***The donor is encouraged to become a regular donor
Post Donation Counseling
- A highly confidential, individualized, face to face counseling provided
by a trained and skilled counselor

Checked by: Del Rosario

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Transfusion Medicine Pt.2

- Done ASAP after receipt of confirmatory test result (for HIV

RITM)
- Intended to help the donor cope with the psychological impact of
a confirmed positive result
- Giving the donor enough time to grasp the information
- Giving the donor enough time and opportunity to ask questions
- Helping the donor cope with the emotional and practical impact of a
confirmed positive result
- Offering options for continued care for infected donors and their
families and/ or sexual contacts through referral to appropriate health
facilities
Making Components
Donation of 450 ml blood in 60 ml anticoagulant yields:
- 160 ml red cells in total of 280 ml including added nutrient
- About 250 ml frozen plasma
- 70 ml of platelets
- Cryoprecipitate (fibrinogen, factor VIII, won Willebrand factor) in 15 ml

Module 3, Lecture 3.1

Types:
- Plateletpharesis
- Leukapheresis
- Erythrocytapheresis
- Plasmapheresis
- Stem Cell collection

Plateletpheresis
- Most commonly requested procedure
- Can produce 6 8 units from a single donor
- Pre Apheresis platelet count should not beg at least 200,000 x 109/ L
- No aspirin, within the last 48 hours, nor clopidogrel, ticlopidine intake
within the last 14 days
Interval bet donations for repeat platelet aphresis donors:
- At least 2 days between donations but not
- 2x a week and not more than 24x a year
BLOOD SERVICE FACILITIES

The ABO Blood System

Blood Type
Red Blood
Cell
Surface
Proteins
(phenotype)
Plasma
Antibodies
(phenotype)

Type A (AA,
AO)
A
Agglutinogens
only

Type B (BB,
BO)
B
Agglutinogens
only

Type AB
(AB)
A and B

Type O
(OO)
None

b agglutinins
only

b agglutinins
only

None

a and b

Blood Bank Refrigerators

- Uniform 4C Temperature Recovery
- Forced Air Circulation System
- Audio/Visual Alarm
- Temp. Display

Apheresis

Whole blood in; then a specific

component is chosen using
centrifugal mechanism:
- Plasma
- Platelet rich plasma
- Leukocytes
- Erythrocytes
The selected component is
then removed out and the
remaining blood components
will be brought back to the
donor.

Napilot | Paulino

Checked by: Del Rosario

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