BLOOD BANKING

AND QUALITY
ASSURANCE IN
THE BLOOD
BANK
 Introduction
• Blood transfusion is a multi-step
process with risk of error in each
process from:
• selecting donors
• collecting and processing donations
• testing of donor and patient samples
• issue of compatible blood
• transfusing the patient
 Introduction
• Primary goal of transfusion medicine is
to promote high standard of quality in
all aspects of patient care and related
services
• To achieve this,
– there is the need for quality control and
quality assurance units
– Professional and accrediting organisations.
Eg AABB, GABMLS
 Quality assurance (QA)
• Falls under the broad term Quality
Management
• Deals with the maintenance of a system to
ensure that the performance in a laboratory
is of the required quality.

• In a blood transfusion centre, it means that

a management system should exist to look
into provision of a safe unit of blood and,
• If any errors are identified, these should be
corrected
 Quality Assurance
Programme
• It is concerned with sampling, specifications
and testing as well as with organization,
documentation and release procedures that
ensure that the necessary and relevant steps
have been taken to ensure satisfactory
quality.
 Quality
• In blood transfusion service, the primary goal
of quality is transfusion of safe unit of blood.
• The objective is to ensure :
availability of a sufficient supply of
high quality blood
blood components for transfusion with

maximum efficacy
minimum risk to both donors and
recipients.
 Quality process involves
• Quality control and competency
• Internal and external audits
• Personnel and organization
• Premises, equipment and materials
• Documentation
• Blood processing
• Complaints and component recall
• Investigation of errors and accidents
• Quality control is the system of testing to assure
the materials and processes meet their intended
specifications.

• Competency /proficiency testing is an aspect of

quality assurance that monitors the ability to
perform laboratory procedures within established
limits of accuracy through the analysis of unknown
specimens distributed by an external source

• Personnel and Organisation: There should be

adequate number of qualified and trained personnel.
Presence of organization chart showing the
hierarchical structure of the blood transfusion
• Laboratory premises: The blood transfusion
centre/Lab should be suitably located,
designed and constructed to suit the
operations to be carried out. The area should
be well demarcated to provide separate areas
for :
Donor selection
Blood collection
Blood processing
Storage
Laboratory facilities
Auxiliary facilities
• Staff training: There should be regular
training of staff both internally and
externally through the organisation of
in service trainings, workshops, seminars
and conferences

• Staff should be made aware of , taught

any new procedures and their
competency assessed periodically
• Manufactured equipment: Should be designed
and maintained to suit its intended purpose
and should not present any hazard to donors,
components or operators. Periodic
maintenance and calibration should be carried
and documented according to established
procedures.

• Documentation- Adequate documentation

prevent errors which may result from
communication. It include:-all manufactures
steps, data affecting the quality of the
component to be checked, from the donor to
the recipient of the blood component and
• Complaint and component recall: Any
complaint about a component of blood should
immediately be investigated and in serious
complaints blood withdrawn.
• There should be a tracking system to enable
effective investigation and blood withdrawal

• Error investigation and incident reporting:

Procedure for adequate investigation into all
forms of errors should be in place corrective
actions should be well documented. Report
should be made to the right authorities for
immediate action
 Blood processing
• To ensure safety of both donor and
recipient,
Donor selection
Blood collection
Component preparation
Storage , issue and transportation
Should be carefully considered.
Quality Assurance in blood
processing
• Donor selection :
Donor demographics
Medical History
physical health/examination
Possible risk of exposure
travel history*
Life style
Should be considered
 QA in Blood collection and
processing
• Blood collected aseptically in a closed system
• Screen for important blood borne
transmissible infections
• ABO and Rh group checked and expiratory
date of blood boldly written
• Immediate storage of blood in the blood
fridge at the right temperature (1-6 deg.C)
• Separation of blood should be done aseptically
and within 6 hours of blood collection
 Blood Donation
• Three types of blood donation
-Voluntary, unpaid donation
-Paid donation
-Family replacement
 Blood Donation
Donor ( pre-donation procedures)
• Questionnaire filled out
• Important donor demographics are:
Name
Sex
Age
• Weight (averagely 45kg)
• Heamoglobin level estimation (12.5 g/dl)
• Medical History: Does the donor have any chronic
illness, Fit at the time of screening and donation, is the
donor on any medication, has he received repeated
transfusion
• Life style: Homosexual, multiple sexual partners,
• Travel history: donors who have lived in a
malaria endemic areas may not be eligible
• Donor screening for transmission transmitted
infections (varies from country to country)
HIV I& II
Hepatitis B surface Ag/ Hep C antibodies
HTLV I & II
Syphilis
• Donor ABO and Rh Group (confirmed after
donation)
• All done to identify potential health problems
for the donor and possible transmission of
infection to the recipient
Blood donation process
 Anticoagulants in blood bag
• ACD -Acid Citrate Dextrose (21 days)
• CPD –citrate Phosphate Dextrose (28 days)
• CPDA-Citrate Phosphate Dextrose Adenine (35
days)
• SAGM- Saline Adenine Glucose Mannitol

• prevents coagulation of blood and adjusts pH,

supports ATP production and helps to maintain
ATP level in red cells.

• Volume of anticoagulant = 63 ml
 Donation process
• Blood should be taken aseptically
• The whole process of taking the blood should
not exceed 30 minutes

• After donation, the donor should be studied

for sometime to ensure he is stable before
leaving the donation centre

• There should be continuous monitoring of the

donor for days to months to ensure complete
 Post donation
• Blood should be grouped, screened for
antibodies and labelled
• Screen for transmission transmissible
infection
-HIV I& II
-Hepatitis B surface Ag/ Hep C antibodies
-HTLV I & II
-Syphilis
• Blood should be separated into the various
components
 Components of blood
• Blood collected in an anticoagulant can be stored
and transfused to a patient in an unmodified
state. This is known as ‘whole blood’ transfusion

• For more effective use, whole blood may also be

separated to
• Pack red cells
• Platelet concentrate
• Plasma: Fresh frozen plasma
cryoprecipitate
cryosupernatant
• http://www.who.int/entity/bloodsafety/testin
g_processing/components/en/Component_1.j
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