Donor Screening

 Medical History based on a standardized

questionnaire obtains critical information about the
donor’s health and risk factors which may make it
unsafe for donation
 Physical Exam which includes blood pressure,
temperature, pulse and screen for anemia are
performed to ensure donor is healthy enough to
donate.
 Two goals of screening
 Protect the health of the potential donor
 Protect the health of the potential recipient
 The following information should be Known
for each donor:
 Donor’s name
 Donor’s address and phone number
 Additional identification e.g. license number
 Gender ( if female ask about pregnancy)
 Date of birth and age
 Date of last donation
 Donor ’s consent
 Donor occupation (pilots, fire fighter ,heavy
machinery operator)
 Time of last meal: fasting not more than 4h
 Age: 17-70 years (not 60 or above at first donation)

 General appearance: Good

 Weight : above 50 kg (110 Ib)

 Temperature: Not >37.5o C

 Pulse: 50-100; if more than 100 deferral , less than 50 is

accepted in athletes

 Blood pressure: Systolic ≤180mmHg, Diastolic ≤ 100 mmHg

 Hb: > 13.5 g/dL/ or 41% PCV for men, 12.5 g/dL or 38% PCV for
women (both ≥12.5)
Exclusion of
 women because of high iron requirements
 Any donor returning to such as police
officers, firefighters, pilots, bus, or train drivers, heavy machine
operator, mining, etc. needs to be informed and cautioned
concerning safe return to their full range of job activities.

1. cardiovascular disease, including hypertension
2. Significant respiratory disorders
3. Epilepsy and other CNS disorders
4. Gastrointestinal disorders with impaired absorption
5. Insulin-dependent diabetes
6. Chronic renal disease
7. Ongoing medical investigations or clinical trials.
 Donor selection

 Donor deferral/exclusion: part of the

 Microbiological-serological- testing of donations

 Immunohaematological testing of donations

 Stringent arm cleansing

 Diversion of the first 20–30 mL of blood collected

 Leucodepletion of cellular products

  Hepatitis/Unexplained Jaundice
 Age,  AIDS
 General appearance ,  Creutzfeldt-Jakob Disease (CJD)
 Malaria
 Weight  Other infectious diseases
 Temperature  Immunization/Vaccination
 Cancer
 Pulse  Pregnancy & Surgery
 Blood pressure  Medications
 Organ/Tissue Transplants
 Hb  Skin Disease and Rash
 Minor red cell abnormalities
 Other conditions
 (defer indefinitely)
1. History of viral hepatitis after the age of 11 Years
2. A confirmed positive test result for Hepatitis B surface antigen
(HBsAg) (Currently has or previously exposed)
3. More than one reactive test result for hepatitis B core antibody
(anti-HBc)
4. Has present or past evidence (either clinical or laboratory) of
hepatitis C infection
5. Presents with an elevated alanine aminotransferase (ALT) level,
more than twice the highest acceptable level on any one
occasion or above the acceptable high level on two occasions
6. Defer 12 months for:
• Hepatitis in family or close contact.
• Hepatitis Immunoglobulin
 Donors had a positive test for AIDS (HIV) or AIDS antibody
or antigen, should be permanently deferred

 Those at risk of HIV through lifestyle (sexual practices,

piercing, tattooing, abuse of self-injected drugs) should not
donate blood permanently deferred

 defer 12 months if health care worker exposed to blood of

patients with HIV infection by a needle stick or open wound
 Defer 3 years after last symptom
 Defer 3 years to visitors (stayed 1 year), immigrants or
refugees from endemic area of malaria (unless antibody test
available)
 Defer 12 months for travel into areas with a risk of malaria
 Chagas’ disease: deferral of those with travel history places them at risk
of Chagas' disease (unless antibody test available)
 Leishmaniasis: Deferral period is 12 months after departure from Iraq
 Syphilis: Best to reject such donors, but if accepted the blood should not be
issued before at least 3 days of storage in refrigerator.The spirochetes do not
survive refrigeration.
 Gonorrhea: Best to reject such donors, but if accepted defer if treated in
last 12 months
 Influenza: Defer temporarily for active cold or flu symptoms on day of
donation
 Infectious mononucleosis: Accept after recovery
 defer 3 weeks for exposure to the following (unless immunized or had
the disease): Red Measles, German Measles , Chicken Pox, Mumps or
meningitis
 Defer 4 weeks for most vaccines e.g. German Measles
(Rubella), MMR (Measles, Mumps and Rubella), Chicken Pox
vaccine , Oral Polio, Small Pox , Yellow Fever vaccine

 Hepatitis B vaccination- donor is not deferred unless it has been

given for specific exposure, in such cases the donor is deferred for
at least 6 months after last exposure.
 Defer 12 months for donors who have received rabies vaccine.

 Accept hepatitis A vaccine and most other immunizations/

vaccinations, e.g. flu, tetanus, providing donor is symptom-free
and fever-free
 usually deferred as the general condition is usually
bad and we should defer any case with
 leukemia or lymphoma
 Receiving chemotherapy or irradiation

 Abnormal bleeding tendencies

 Unexplained weight loss
 Epilepsy, convulsions, seizures
 Defer permanently for donor who has had filariasis,
bilharzias, yaws ,Q fever or SARS.
 Defer indefinitely for Pituitary-Derived Human Growth
Hormone
 Defer 8 weeks for injections of radioactive material
 Donor administrate regular drugs based on the underlying
illness, e.g. cardiovascular, diabetes, malignancy, anemia or
bleeding problems.
 Defer indefinitely for donors taking teratogenic drugs or
drugs that accumulate in the tissues
 Defer for 2 days from last dose of antibiotics , antifungal or
antiviral, donors must have completed his treatment and free
from illness. Generally OK if taken for chronic conditions like
acne and penicillin-free
 Aspirin :Acceptable for whole blood donations. Platelet
donors must wait three days after last dose.
 Defer
 Accept autologous transplants.

 Permanent defer e.g. Crohn's disease, autoimmune

diseases,…

 Phlebotomy site must be free of rash/skin disease

 Accept diabetics on Oral medication

 Insulin dependent diabetics are eligible for whole blood
donation only as long as blood sugar is well controlled and
have NEVER taken Bovine insulin
 Defer while pregnant
 Defer 6 weeks after uncomplicated third trimester
or term delivery or caesarean section
 Defer 12 months if delivery required a blood
transfusion

 If received a blood transfusion : Eligible 12 months

after transfusion
 If no blood transfusion : Generally accepted after
released from physician’s care, healed wound, fell
well, and resumed full activity
 Minor red cell abnormalities, such as Thalassaemia trait
and hereditary spherocytosis, are acceptable, providing that
there is no anemia.
 Red cells containing HbS have a limited survival under
reduced oxygen tension and so should not be transfused to
newborn , patients with hypoxia or sickle cell disease. Red
cells with HbS obstruct leucodepletion filters and it is
therefore advisable to defer such people
 Blood from donors with G6PD deficiency survives normally,
unless the recipient is given oxidant drugs.
 The blood bags for
collection of blood should
be:
 Sterile
 Pyrogen free
 Disposable
 With a closed system of
collection.
 Multiple interconnected
plastic bags should be used for
blood component preparation
(closed system).
 Venting – exposure to open
air- of any container should be
done under laminar airflow
and used within 24 hours.
 multiple inter-connected
closed containers should be
used for pediatric use to avoid
venting.
 450 ± 45 ml of blood mixed with 63 mL of citrate–
phosphate-dextrose-adenine (CPD-A) anticoagulant.

donor weight in Kg
 Amount of blood taking =
50
× 450

 E.g. a donor weight as 40 Kg either reject or calculate as

follow: 40/50 X450=360 ml and use a special bag
contains less amount of CPD-A
 Allowable amount x 14
 Amount of anticoagulant needed =
100
=Anticoagulant needed (mL).

 Amount of anticoagulant to remove = 63-anticoagulant

(mL) = Anticoagulant to remove (mL).
 Whole blood: (8weeks) three donations per year
maximum.
 2 units of RBC by apheresis: 16 wks (4 months)
 Infrequent plasma pheresis: 4 wks
 Plasma, Platelets or leucopheresis: more than
2 days
 (which may be repetitive): this is the most
common adverse effect (2-5%). Common in young
people and in those donating for the first time. The
donor does not lose consciousness
occurring after a donor has left the
clinic
2. Nervousness, weakness, sweating, dizziness, anxiety,
pallor, nausea, vomiting.
3. Convulsions or seizures. prevent donor from falling
from the donor chair or injuring himself
4. Cardiac and/or Respiratory Problems. Begin
cardiopulmonary resuscitation (CPR)
Treatment of fainting

1. Rest in a horizontal position and elevation of the

legs is usually sufficient.
2. Delayed faints are potentially hazardous and a
contraindication to further donation. For this
reason, those donors who are drivers, machine
operators, pilots and so on should not return to
work on the day of donation.
Treatment

1. Stop the donation; remove the tourniquet and

needle from the donor's arm.
2. Have the donor breathe into a paper bag,
3. Loosen any tight clothing
4. DO NOT LEAVE THE DONOR
 Sympathetic approach by blood collection staff,
enforcement of an adequate rest period can help to avert
this problem.
 Talk to the donor to reduce his or her stress.
 follow the previous general measures till seeking medical
advice.
 Close observation for early detection of vasovagal attacks
 occurs when venous
access has been difficult
Treatment
1. Remove the tourniquet and the needle.

2. Apply pressure to the venipuncture site

and raise the arm for 5 to 10 minutes.
3. Make sure the bleeding has completely
stopped, then apply a bandage.
4. If the arm is stiff or sore, a cold (ice)
pack can be used over the dressing.
 The rate of blood donation under such
circumstances is usually very rapid
Treatment
 Elevation of the limb and firm pressure over the site for
10-15 min combined with prolonged rest if a whole
donation has been taken, as.

: resulting in pain,
parathesiae and numbness
Treatment
 Symptoms generally resolve in a few days, but very rarely
may take several months of recovery.
 It should be avoided by

 Pay attention to skin cleansing and aseptic techniques.

 All blood collection packs are manufactured as integral sets,

 each needle is sterile, to be used only once.

 No pack should be reused (even on the same donor) if the

initial venipuncture attempt fails.

Treatment

 Local antibiotics and may be systemic if fever develops

 Hepatitis B 2- to 6-month incubation period; carrier state transmission
Hepatitis C Majority of cases asymptomatic; carrier state transmission
HIV1 & 2 Both causes AIDS, HIV-2, mainly occurs in West Africa
HTLV1 HTLV-1causes adult T cell leukemia and tropical spastic
Viruses paraparesis
HTLV2 Not clear
CMV Immuno-suppressed individuals can get fatal pneumonitis or
disseminated CMV infection
EBV Latent infection in WBCs
Bacterial Syphilis organism died at 4 °C but in platelets transfusion it survive

Malaria remain viable at 4 °C

Parasites
Chagas’ disease cause problems for the blood transfusion in Latin America
Prions vCJD the human form of bovine spongiform encephalopathy
 HIV : (combined HIV Ag & anti-HIV1 and anti-HIV2)by ELISA.
Positive results should be confirmed due to probability of false
positive results (also p24 antigen)
 Confirmation tests for HIV include the Western blot (Wb) and
the immunofluorescence assay (IFA).
 HBV : HBs Ag by sensitive ELISA (may be also HBc
antibodies usually develops before symptoms of disease are
apparent)
 HCV: Anti-HCV by ELISA plus NAT
 HTLV: Anti-HTLVI&II by ELISA
 Malaria: Antibody screening of potentially exposed donors
 Chagas' disease: Antibody screening of potentially exposed
donors
 Syphilis: antibody test to syphilis
 is determined routinely on each occasion.
(forward and reverse blood grouping).
 Typing for other Rh antigens (C, E, c and e) and K is now routinely
performed.
 Ideally, girls and women of childbearing age should be matched for c
and K, as anti-c and anti-K are after anti-D the major causes of
severe HDN.
 All donations are also screened for the presence of atypical red cell
by testing against group O red cells.
 If significant abs have been detected the donor unit should be used
for transfusion as RBCs.
A "directed" donation occurs when the
potential recipient of blood or blood
products designates certain persons to
donate specifically for his or her use.
Therapeutic bleeding
(phlebotomy):

blood removed for

medical purposes such as in
polycythemia vera (NOT used
for transfusion).
An autologous donor is one who is donating
blood for his or her own future use
Advantages
 Autologous blood is the safest transfusion possible.
 There is no risk of disease transmission.
 There is no alloimmunization to RBCs, platelets, WBCs, or
plasma proteins; or transfusion reactions.
 The phlebotomy process stimulates the bone marrow to
increase cell production.
 It decreases the need for allogeneic blood, frequently
decreases the total amount of blood needed.
 Increase the supply of allogeneic blood if the unused
autologous units are "crossed over" into the general
inventory ….?
1- Predeposit donation :
 Blood is drawn sometime before the anticipated transfusion and
stored, usually liquid but occasionally frozen, in the blood bank.
 It is usually performed in elective operations.

1. Age: no age limits exits

2. Weight: no strict weight exits. if <50kg, volume will be taken
according to the formula of weight.
3. Hb not < 11g/dl and Hct not< 33%
4. Frequency: every 3days and must to be stopped at least 3
days before operation with iron supplementation.
5. Medical history: The donor will be the recipient so no cause
for deferral
2- Intra-operative autologous transfusion :
 Blood is collected during a surgical procedure and usually re-
infused immediately
3- Preoperative hemodilution.
 Once the patient is in the operating room, 1 to 3 units of WB
are collected and the volume is replaced with colloid or
crystalloid, or both.
 The patient's hemoglobin level is reduced by about 1 to 3 g/dl.
 The blood remains in the operating room and is used for
transfusion during the surgical procedure.
3- Postoperative "salvage,“
 a drainage tube is placed in the surgical site and
postoperative bleeding is salvaged, cleaned, and re-infused.
 Table 1. Autologous Blood Donation

Advantages: Disadvantages:

1. Prevents transfusion-transmitted 1. Does not affect risk of bacterial

disease. Contamination.

2. Prevents red cell alloimmunization. 2. Increased incidence of adverse

3. Supplements the blood supply. reactions to donation

4. Provides compatible blood for 3. Is more costly than allogenic blood.

patients with alloantibodies.
4. Results in wastage of blood not
5. Prevents some adverse transfusion transfused.
reaction.
5. Can subject patients to perioperative
6. Provides reassurance to patients anaemia.
concerned about blood risks.
 The process of apheresis involves removal of
whole blood from a patient or donor. Within an
instrument that is designed as a centrifuge, the
components of whole blood are separated.
One of the separated portions is then
withdrawn and the remaining components are
re-transfused into the patient or donor.
Principle of apheresis: Conical centrifugal separation chamber

Anticoagulants is continuously pumped through the process to

Ensures extracorporeal blood remains in fluid state, we may use
1- Anticoagulation-citrate-dextrose solution (ACD-A)
2- Heparin
3- Combination of ACD-A and Heparin
1. Plasmapheresis: removal of the liquid portion of
blood to remove harmful substances( auto antibodies
, Ag/Ab complex, excess or abnormal proteins or
lipids, drugs and toxins bounded to albumin).
 Examples of these diseases include:
 Waldenstrom's macroglobulinemia:
 Hyperviscosity Syndromes
 Paraproteinemia
 Cryoglobulinemia
 Goodpasture's syndrome & Myasthenia gravis
 The plasma is replaced with a replacement solution:
 The best choice is 5% Albumin dilute with saline
 FFP, but it carry the danger of citrate toxicity
2. Plateletpheresis: removal of platelets in
people with symptoms from extreme elevations
in platelet count such as Essential
Thrombocythemia

3. Leukapheresis: removal of malignant white

blood cells in people with leukemia and very
high white blood cell counts causing symptoms.
To provide specific blood components for therapy.
Examples include:
1. Plateletpheresis: for supplying HLA matched platelets
to patients who have become HLA sensitized and
require platelets from a single donor with matched HLA.
2. Plasmapheresis: the plasma can be removed to supply
blood components such as clotting factors. Donors can
give plasma once/month or more.
3. Stem Cell Harvesting: to use in transplantation
procedures.
4. Leukopheresis: the granulocytes can be harvested from a
donor to help fight infection in neonates.

 Hydroxy ethyl starch(HES) sedimentation was evaluated

as a method of RBCs reduction of granulocyte
components, that would result in safe transfusion of RBC-
incompatible WBC units.

 Corticosteroids used to mobilize the WBCs from BM to PB.

 Growth factors (GM-CSF) used to increase production of

WBC.
1. Hypocalcemia due to citrate toxicity.
2. Hypotension and vasovagal attack
3. Bleeding or thrombocytopenia, or both.
4. Fluid retention problems.
5. More extracorporeal removal of fluids from the donor .
6. Allergic reaction to hydroxyethyl starch (HES) which
use to sediment WBC and cause RBC to be aggregate
 The donor selection requirements for apheresis donor are
generally the same as those for a whole blood (WB) donor.
 Past history of complication due to previous apheresis donation
should be evaluated carefully and may lead to deferral from
apheresis donation
e.g.
1. Possible adverse reactions to hydroxyethyl starch (HES),
steroids, or heparin.
2. A history of bleeding problems or thrombocytopenia, or both. It is
best to defer female donors from heparin procedures during
menses.
3. history of fluid retention problems. This may be a significant
problem if using HES or steroids or both in the apheresis
procedure.
4. Deferral of any patient with An underlying medical condition
that may be aggravated by steroids e.g. hypertension,
tuberculosis, and diabetes mellitus.
5. The donor weight: No more than 15 percent of the donor's total
blood volume can be extra-corporeal. The size of the bowl used
in the procedure (225 ml or 375 ml) and therefore will change the
donor's weight requirements. The small bowl requires 110 Ib
(50kg); the large about 150 Ib (68 kg).
6. Medications: Use of any medication that might increase the
donor's risk or decrease the effectiveness of the product. E.g.
aspirin (or aspirin-containing substances): The donor should stop
aspirin ingestion for 3 to 5 days before platelet pheresis or
leukopheresis.
 Depending on which pheresis procedure is being performed, the
following additional laboratory tests must be performed before
each donation:
1. Hemoglobin and hematocrit must be normal
2. Serum protein must be normal
3. Platelet count (not less than 50,000/ml)for plateletpheresis
4. White blood cell (WBC) count and differential (for
Leukapheresis)
5. Partial thromboplastin time (PTT) must to be normal, if using
heparin
1. Hemoglobin and hematocrit

2. Platelet count

3. White blood cell count

4. Protein electrophoresis should be done every 4

months if the donor is biweekly plasma donor or
give 12L plasma /year
The End