Pretransfusion Testing

The immunohematologic testing needed for proper patient blood typing, component selection and compatibility testing. Which ensure patient safety and transfusion efficacy.

Blood transfusion services

By

Dr. Reham Talaat Blood bank specialist and

quality officer in MRBTC

Blood Donation

Blood Donation

A person has 5 - 6 liters of blood in their

body A person can donate blood every 90days (3

months) Body recovers the Blood very quickly:

Blood plasma volume: within 24 - 48 hours

Red Blood Cells : in about 3 weeks

Platelets & White Blood Cells: within minutes

Procedure for

Voluntary Blood Donation

Pre-Donation: Donor registration

Medical history

Physical examination

Blood Donation:

Blood donation procedure

Post donation

Rest, advice

Donor Screening

Registration ( national ID is must) Required information

Name Date and time of donation Address Telephone Gender Age (date of birth)

Donors must also be given education material about blood donation

Medical Questionnaire

Why ask questions?

Asking questions helps determine the overall suitability of the donor; from this, the donor will be:

Accepted

Temporarily deferred

Permanently deferred

Donor selection criteria

Donor selection criteria

Have you donated blood in the last 8

weeks?

The time interval between allogeneic whole blood donation is 8 weeks at least (better 3 month)

A donor must wait 48 hours after donating platelets, plasma

before donating whole blood

Physical Examination

General Appearance

Weight

Temperature

Pulse

Blood Pressure

Hemoglobin

Skin Lesions

Physical Exam:

- General Appearance: The donor should appear alert

- Weight: A minimum weight

limit of (50 kg) is used to avoid hypovolemia

- Temperature Less than or equal to 37.5°C

Physical Exam (cont’d)

Pulse Between 50-100 bpm (count for at least 15 sec)

Blood Pressure Systolic ≤180 mm Hg (110- 180 )

Diastolic ≤100 mm Hg ( 70-100)

Physical Exam: Hemoglobin

Hemoglobin can quickly be obtained from a finger stick.

Hemoglobin should be

≥13 g/dL for male ≥12 g/dL for female

In summary

99.5°F

37.5°C 180

100 12.5 g/dL

38%

110 lbs

(50 kg )

50-100

bpm

Blood Donation Procedure

Remember!

The Donor Must ….

have had good rest / sleep

have had light meal

be mentally prepared

Whole Blood Collection

Whole blood is collected in clear plastic bags that contain different mixtures of anticoagulants

CLOSED SYSTEM (remains sterile)

Post Donation Advice

Drink lots of fluids for at least the next 4 hours )

Avoid smoking for one hour Avoid exercises & games for a day If you feel dizzy, lie down & put your feet

up. You will be alright in 10-20 mins. Remove band-aid after 4 hours. If it bleeds, apply pressure & reapply

band-aid. If bruised and painful, apply cold-pack for

5 mins each. It will take a few days to get reabsorbed.

Blood Products / Components

& their uses

Blood collected is screened for TTIs (infections) & IF SAFE, is separated into components & stored for issue to patients

Benefits to Donor of blood donation

Health benefits:

- Lowers cholesterol - Lowers lipid levels - Decreases incidence of

heart attacks, strokes

Blood

Formed elements 45% of blood volume

Erythrocytes (red blood cells) 99% of cells

Carry oxygen

Leukocytes (white blood cells) Protect against infection

and cancer

Platelets (cell fragments) Blood clotting

Plasma 55% of blood volume

Water (90%)

Electrolytes

Plasma proteins

Albumin

Fibrinogen

Globulins

Substances transported by blood Nutrients

Waste products

Respiratory gases

Whole Blood

Consists of RBCs, WBCs, platelets and plasma (with anticoagulant)

1 unit increases Hgb 1 g/dL and Hct 3%

When is it used?

Patients who are actively bleeding and lost >25% of blood volume

Exchange transfusion

WHOLE BLOOD

- The term whole should be no longer used and is needed only in emergency .

- The storage defects of whole blood make it unsuitable for such replacement

The term used now is :

BLOOD COMPONENTS

Components are:

Those therapeutic constitutes

of blood that can be prepared by centrifugation .

Centrifuged blood

Buffy Coat

(WBCs & Platelets)

Red Blood Cells

Plasma/serum

Storage temp.

Plasma (freezer )

RBCs (refrigerator)

Platelets (agitator)

-18℃ or below

+2℃ to + 6℃

+22℃ to + 24℃

With continuous shaking

Types of Bags:

There are many types of blood bags to help in maintaining closed system throughout the separation procedures :

Single.

Double.

Triple.

Quadruple

Pedi bags.

Transfer bags with different capacities.

Red Blood Cells

Volume: 280 + 50 ml

Storage period: 21, 35, or 42 days depending on preservative or additive

Outcome Indicators: One unit increases hematocrit 3% and Hgb on average 1g/dL

Unit should be transfused within 4 hours

Once the unit is “opened” it has a 24 hour expiration date!

RBCs

Conditions include:

Oncology patients (chemo/radiation)

Trauma victims

Cardiac, orthopedic, and other surgery

End-stage renal disease

Premature infants

Sickle cell disease ( Hgb A)

Platelets

Volume: SDP = 200-300 ml

RP = 50-60 ml

Storage Temperature

20-24°C for 5 days (constant agitation)

Each therapeutic unit should contain at least 5.5 x 1010 platelets

Outcome Indicators :Each unit should elevate the platelet count by 5000 µL in a 70 Kg. person

Platelets

Important in maintaining hemostasis

Help stop bleeding and form a platelet plug (primary hemostasis)

People who need platelets:

Cancer patients

Bone marrow recipients

Postoperative bleeding

Preparation of platelet concentrate

RBCs PRP

Plasma

Platelet

concentrate

Fresh Frozen Plasma (FFP)

Prepared within 6 hours of whole blood.

Volume: 150 – 250 ml .

Storage period :Frozen at -18°C for one year thawed at bed side.

Indication :

- Multiple coagulation factors deficiency

- Massive transfusion

- liver dis.

- vit.K deficiency & DIC.

Fresh Frozen Plasma

FFP is thawed before transfusion

30-37°C waterbath for 30-45 minutes

Stored 1-6°C and transfused within 24 hours

Needs to be ABO compatible

Contains

V , VIII , XI

Von willbrand and fibrinogen , firbronectin

400 mgm fibrinogen /ml

Outcome Indicators

Prevention and/or cessation of bleeding

Frozen Plasma

* Plasma separated and frozen at –18 C between 8 and 24 hours,of collection.

* It contains all the stable proteins found in FFP plus minimal Factor VIII .

Indication: Bleeding associated with stable clotting factor deficiencies.

Cryoprecipitate

Volume: 20 – 30ml .

Storage period :Frozen at -18°C for one year

Contains: von Willebrand’s factor (plt. adhesion)

Fibrinogen 150 mg in each unit

Factor VIII About 80 IU in each unit

Fibrinonectin

FFP

Frozen

within 8

hours

Thawed

FFP

Cryoprecipitate

(VIII, vW)

Plasma cryoprecipitate, reduced

(TTP, FII, V, Vii, IX, X, XI)

Thaw at 30-37°C

Store at RT 4 hrs

Refrozen with 24 hrs of

separation

Store at ≤18°C 1 yr

5 day expiration at 1-6°C

Cryoprecipitate

Cryoprecipitate

Indication:

Factor VIII deficiency (Hemophilia A) von Willebrand’s Disease

Congenital or acquired fibrinogen defects Advanced liver disease Bleeding DIC Renal failure ( VWF ) Fibrinogen defects

Outcome Indicators

Cessation of bleeding

Fibrinogen level >100 mg/dL

Blood grouping and cross matching .

Screening of collected blood for infectious diseases .

In Egypt every blood donation is checked for:

- Hepatitis B surface antigen

- Hepatitis C virus antibody

- HIV 1+2

- Treponema pallidum antibody(syphilis)

Lab. Samples should be collected at the time of donation

Pretransfusion testing

ABO grouping /Rh typing /

Antibody screening / Antibody ID

ABO typing: direct agglutination by

IgM antibodies

Cells v Serum Serum v Cells

Forward and reverse grouping must agree !

Indirect antiglobulin test – gel

Collection of blood only from voluntary donors at low risk .

Screening of all donated blood for TT infections (HIV-HBV-HCV-SYPHILIS)

Avoid unnecessary transfusions.

This helps in decreasing the risk of transfusion transmitted infections

Strategy for blood safety

Under complete aseptic conditions.

Arm preparation:-

- should be done with care and ideally with vigorous scrubbing.

- The contact time of alcohol is 30 seconds.

- The application of alcohol must be in a spiral way, once at a time , or one way direction.

*Blood collection:

Never recap needles, recap using one hand technique.

Sharps , broken glass ware, lancets should be disposed in sharp box.

Any waste material contaminated with biological material must be packed safely in red bags.

Contaminated blood bags and expired blood bags to be disposed according to hospitals rules.

Dangerous waste disposal

Hygienic Practices

Protective clothing

(white coats and rubber gloves)

Regular change

Appropriate usage

Cover cuts and abrasions

No eating, drinking or smoking in work areas

Handwashing before and after handling donations, specimens, components.

Safe Disposal of Hazardous Waste

(1)

Types of waste

Non-hazardous: e.g. paper

Biohazardous: e.g. containing human material

Hazardous: e.g chemicals, sharp metal or glass, radioactive material

Proper separation of waste

Hazardous/non-hazardous

Sharps/non-sharps

Liquid/solid

Safe Disposal of Hazardous Waste

(2)

Appropriate disposal

Pre-treatment: e.g. autoclaving, disinfection, inactivation, neutralization

Incineration

Landfill

Using chlorine 1%

Procedures must be in place for the safe and effective disposal of waste