Blood banking:- part 3 – Blood Donation Procedure, Blood Components and Their Indications

Procedure to collect blood from the donor.

Donor assurance:

1. Make the donor comfortable and assure him about safety.
2. Give some time to the donor to acclimatize with the atmosphere.
3. Now apply the blood pressure cuff above the elbow and give a pressure of 20 to 40 mmHg.

Cleaning the site:

1. Now clean the site of venipuncture thoroughly.
   1. Can use chlorhexidine, or 1% tincture iodine, or 1% PVP iodine.

Collection of the blood (Procedure for the collection of blood bag):

1. Keep the blood pack below the level of the donor.
   1. Can keep the pack in the balance.
2. Now increase the blood pressure to 60 to 80 mmHg till the vein is prominent. Ask him to clench their fist.
3. Insert the needle into the vein; as blood comes out, remove the bead, which prevents the blood from entering the pack.
4. Now reduce the pressure in the cuff.
5. Carefully and slowly mix the blood with the anticoagulants.
6. When blood donation is complete, reduce the pressure to 0 in the cuff.
7. Clamp the blood pack (bag).
8. Take out the needle and apply the pressure on the venipuncture site.
   

   Blood collection procedure

Precaution after the collection of blood (Post blood donation precautions):

1. Please don’t allow the donor to sit immediately; ask him to lie down for at least 5 to 10 minutes.
   1. Sometimes the donor gets headaches, nausea, and dizziness.
   2. Donor blood pressure may become low.
2. Label the pack and make at least 4 to 5 tubing segments for further testing.
3. Allow the blood to cool down before refrigeration is done. This period should not exceed more than one hour.
   

   Blood bank refrigerator (Thermo Scientific)

Before the donated blood is released, the following tests are done:

1. The following tests are done on the donor blood and the serum.
   1. The donor’s blood grouping ABO is verified.
      1. Verify the Rh typing. Rh-negative blood is reconfirmed.
   2. Reverse blood ABO grouping is done on the donor serum.
      1. Antibody screening is done by the enzyme and antiglobulin method.
   3. Perform the VDRL, HBS, HCV, and HIV.
2. After doing all these tests, you can now release the blood pack for donation to the patient.
   

   Before releasing the Blood bag

Blood components most common in use are:

1. Whole blood.
2. Fresh frozen plasma.
3. Packed red blood cells.
4. Frozen red blood cells.
5. Human serum albumin.
6. Human immune serum globulin.
7. Antihemophilic factor concentrate (cryoprecipitate).
8. Factor IX concentrate.
9. Platelets concentrate or platelets-rich plasma.
10. White blood cell poor blood (where the white cells are removed).
    

    Donor blood products

Blood donation:

1. Donors can donate the blood at intervals of 8 weeks.
2. Healthy individuals can donate blood every 5 to 7 days for a limited period of time around 1 to 2 months.
   1. In the above donor, an iron supplement is needed.

Autotransfusion (autologous transfusion):

This is the collection of blood and subsequent transfusion of the patient’s own blood.

Can donate blood every 5 to 7 days before elective surgery.

Advantages:  This will prevent all problems of the transfusion reaction, transfusion-related infections, and also avoid religious beliefs.

Packed red blood cells:

Packed RBCs consist of refrigerated stored RBCs without three-fourth plasma. The majority of plasma is removed.

Advantages: This will avoid overloading and pulmonary edema.

1. 1. This is especially useful in patients with anemia where plasma is not needed.
   2. It is used in pure RBCs deficiency.
   3. In case if antibodies are present in the plasma of the donor.
   4. This also prevents other problems of the stored blood like raised levels of potassium or ammonium level.

Washed red blood cells:

1. These are the packed red blood cells that were washed several times with saline, followed by centrifugation.

How to make Fresh Frozen Plasma:

1. Fresh frozen plasma is prepared from the fresh whole blood within 6 hours after collection.
2. Fresh frozen plasma is separated from the RBCs after centrifugation at 4 °C temperature and immediately is frozen.
3. Before giving to the patients, it needs to be thaw at 37 °C for at least 20 minutes or until the thawing is complete.
4. Don’t delay after thawing to transfuse into the patient because factors V and VIII deteriorate in a short time.
5. The thawing process may be accelerated by an agitator machine and a specially designed microwave.
6. Used for: Fresh frozen plasma is the choice treatment for coagulation factor deficiency such as factor VIII (Hemophilia A), von Willebrand’s disease, or fibrinogen.

How to make Cryoprecipitate:

1. Cryoprecipitate is prepared from fresh frozen plasma; it is the material that does not become totally liquid when fresh frozen plasma is slowly thawed and the major part has liquefied.
2. Advantage: The major advantage over fresh frozen plasma is the reduced volume of fluid that is transfused.
   1. Each unit contains around 150 mg of fibrinogen.
   2. Cryoprecipitate is good to treat von Willebrand’s disease and Hemophilia A.
3. Contents: Cryoprecipitate contains 50% of the factor around 50% factor VIII and von Willebrand factor activity.
   1. Fibrinogen and factor XIII is around 20% to 40%.

Albumin:

5% albumin can be used instead of plasma to restore colloid oncotic pressure.

In a normal person, 500 ml of blood contains 11 grams of albumin. 70% of the albumin is synthesized in the liver.

Indications: To restore the colloid oncotic pressure.

1. This is used in hypovolemic shock due to massive acute blood loss or extensive burns.
2. It is not given in hypoalbuminemia due to chronic liver disease or loss through kidneys or gastrointestinal tract.

Platelets:

1. Platelets are supplied in units that contain platelets equivalent to one point of blood roughly 5.5 x 10^10_.
2. Can get multiple units from a single donor by means of platelet apheresis.
3. Platelets are store at room temperature.
4. A single unit of the platelets will raise the platelet count to 7,000 to 11,000/cmm.
5. Platelets should be transfused as soon as possible after collection to get the maximum functions of the platelets.
6. Indications: Platelet transfusion may be prophylactic or therapeutic.
   1. Therapeutic transfusion is done when it is severe thrombocytopenia <50,000/cmm and there is severe acute bleeding.
   2. When there is thrombocytopenia, but no bleeding then can give prophylactically platelets transfusion.
   3. Bleeding time may be the guide for the platelets transfusion.
   4. It is not indicated in idiopathic thrombocytopenia (ITP) unless the patient is actively bleeding.
   5. No use of platelets transfusion, in case of drug-induced thrombocytopenia unless the drug is stopped.

Blood components and their indications:

Components	Composition	Indications
Packed RBCs	Only RBCs without plasma	For the treatment of anemia Hemolytic disease of the newborn
Fresh frozen plasma	Plasma separated and frozen in 8 hours of collection.	Used to control bleeding in coagulation factors deficiency
Cryoprecipitate	Prepared by thawing fresh frozen plasma at 1 to 6 °C; The precipitates are collected and again refrozen. Cryoprecipitate <25 mL contains fibrinogen 150 mg and 80 units of factor VIII.	Used in deficiency of fibrinogen, Or deficiency of factor XIII, and in DIC.
Platelets concentrate	Platelets are separated from a single unit of blood. Suspended in 40 to 60 mL of plasma Stored at 20 to 24 °C	Indicated in thrombocytopenia  due to any cause Prevents bleeding in low platelets count
Granulocytes collected by apheresis	Granulocytes are collected by apheresis.	In neutropenia Infection It is more effective in infants than adults.
Platelets collected by apheresis	platelets collected by apheresis and volume is 200 to 300 mL	Used as platelets concentrate