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CHAPTER 13 DONOR SCREENING

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Governing Agencies
- U.S. Food and Drug Administration
- AABB- American Association of Blood Banks
- College of American Pathologist
DONOR SCREENING
- Medical history
- Physical examination
1. Will a donation of approximately 450ml of whole blood
at this time be harmful to the donor?
2. Could blood drawn from this donor at this time
potentially transmit a disease to the recipient?
- Serologic testing

Registration
- Outlined in the AABB Standards
- Must confirm donor identity and link the donor to existing
donor records
- Photographic identification
Drivers license
Passport
School ID
- To prevent ineligible donor: Every donor must be checked
against a permanent record
- List of information in the registration process:

Name (first, last, MI)
Date and time of donation
Address
Telephone
Gender
Age or date of birth
o Minimum age
o For allogenic donation:
Between 16-17 years old
Depend on individual state requirements
No upper age limit
o For autologous donation:
No age restriction
Each blood donor-patient must be evaluated
by the blood bank medical director

Consent to donate
Donors should be informed of the procedure and
its potential risks
Must also be given educational materials
informing the signs and symptoms associated
with HIV infection and AIDS
Statement documenting that the donor have
given consent to the donation.
Typically done at the end of the donor history
questionnaire

Additional information
The name of the patient for whom the blood is
intended (directed donation)
Race of the donor - for unique phenotypes
CMV status


Medical History Questionnaire
- Obtains accurate medical history of the donor
- Ensure protection of the donor and the benefit to the
recipient
- A standardized medical history questionnaire was
developed by representatives from:
AABB
FDA
Blood and plasma industry
- Questionnaire was designed to be:
Self-administered
o Must be reviewed before completing the
screening process and prior to blood collection
Can be administered by trained donor historian
- Interviewer should be familiar with the questions
- Interview should be conducted in a secluded area of blood
center or donor site
- Questions are designed to a simple yes or no but
elaborated if indicated
- Currently approved version of the Donor History
Questionnaire (DHQ) can be downloaded from the FDA
website.

Medical History Questions
1. Are you feeling healthy and well today?
- Donor should be in good health without obvious signs
or symptoms of colds, flu, or other illness.

2. Are you currently taking an antibiotic or taking any
other medication for an infection?
- Antibiotics for infection
- Prophylaxis after dental surgery
- Deferred temporarily until treatment completed

3. Are you now taking or have you ever taken any
medications on the Medication Deferral List?
- Developed along with DHQ



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4. Have you read the educational materials?


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5. In the past 48 hours, have you taken aspirin or
anything with aspirin in it?
- Piroxicam, aspirin
- May not be suitable donor for platelet apheresis
- Inhibit platelet function
- No restriction for whole blood donation

6. In the past 6 weeks, have you been pregnant or are
you pregnant now?
- Female donors: 6-week deferral
- 1
st
-trimester or 2
nd
trimester or miscarriage is not a cause
for deferral
- Pregnant woman received a transfusion: 12 month
deferral

7. In the past 8 weeks, have you donated blood, platelets
or plasma? In the past 16 weeks, have you donated a
double unit of red cells using an apheresis machine?
- Time interval for allogeneic whole blood donations: 8
weeks or 56 days
- Apheresis donation (platelets, leukocytes, granulocytes):
at least 48 hours
- Infrequent plasma apheresis: 4-week deferral
- Double red cell unit apheresis: 16 weeks

8. In the past 8 weeks, have you had any vaccinations or
other shots? Have you had contact with someone who
had a smallpox vaccination?
- Live attenuated or bacterial vaccine (measles/rubeola,
mumps, oral polio, typhoid, yellow fever): 2-week deferral
- Live attenuated vaccine for German measles/rubella or
chickenpox: 4-week deferral
- Toxoids or killed or synthetic viral, bacterial, or rickettsial
vaccines with no deferral if symptom-free and afebrile:
Diphtheria
Hepatitis A
Hepatitis B
Influenza
Lyme disease
Pneumococcal polysaccharide
Polio injection (Salk)
Anthrax
Cholera
Pertussis
Plague
Paratyphoid
Rabies
Rocky Mountain spotted fever
Tetanus
Typhoid injection
- Smallpox vaccination: deferred for 14-21 days or until
the scab has fallen off
- Close contact (defined by FDA): exposure to vaccination
site or bandages, clothing, towes, or bedding that have
been in contact with the vaccination site
- Vaccinia virus infection symptoms (new rash or skin
sores since the time of contact) from the vaccine

9. In the past 12 months, have you had a blood
transfusion; a transplant such as organ, tissue, or
bone marrow; or a graft such as bone or skin?
- 12-month deferral

10. In the past 12 months, have you come in contact with
someone elses blood or had an accidental needle-
stick injury? Had a tattoo? Had ear or body piercing?
- 12-month deferral
- Exposure of blood in contact with an open wound, any
broken skin, or mucous membranes (nose, mouth, eyes)
- Skin-penetrating injuries from instruments, equipment,
needles that are non-sterile and contaminated with blood
or body fluids
- Includes tattoos, permanent makeup, ear and body
piercing

11. In the past 12 months, have you had a sexual contact with
anyone who has HIV/AIDS or has had a positive test for
HIV/AIDS?
- 12-month deferral

12. In the past12 months, have you had sexual contact with a
prostitute or anyone else who takes money or drugs or
other payment for sex?
- 12-month deferral

13. In the past 12months, have you had sex with anyone who
has ever used a needle to take drugs or steroids or
anything not prescribed by their doctor? In the past 12
months, have you ever had sex with anyone who has
hemophilia or has used clotting factor concentrates?
- Sex with any person who is past or present IV drug user:
12-month deferral
- Sex with persons with hemophilia or related blood
disorder who has received factor concentrates: 12-month
deferral

14. Female donors: have you had sexual contact with a male
who has ever had sexual contact with another male?
- 12-month deferral
- No deferral if only close contact (living in the same house,
kissing, shaking hands, working with)

15. In the past 12months, have you had sexual contact with a
person who has hepatitis? Have you lived with a person
who has hepatitis?
- Sexual contact or close contact with person who has acute
or chronic hepatitis B (HBsAg or HBV positive) or who has
symptomatic hepatitis C: 12-month deferral

16. In the past 12 months, have you been treated for syphilis
or gonorrhea?
- 12-month deferral after completion of therapy
- Treponema pallidum
- May live for 1 to 5 days in cold storage
- Fresh unit RBCs may transmit infection
- Thrives very well at room temperature

17. Have you been in juvenile detention, lockup, or prison for
more than 72 hours?
- 12-month deferral

18. In the past 3 years, have you been outside of the United
States or Canada?
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a. Malaria
- 1-year deferral no signs and symptoms of malarial
infection
- Immigrants resided in the endemic area for at least 5
consecutive years: 3-year deferral

b. CJD and vCJD
- Indefinitely deferred
- Transmissible spongiform encephalopathies or prion
diseases
- Affect sheep, cows, and humans
- CJD
Results in progressive dementia and spongiform
alterations in the brain
Rapidly fatal
May be transmitted by:
o Corneal transplants
o Human dura mater grafts
o Pituitary-derived human growth hormone
o Neurosurgical instruments

c. Leishmaniasis
- 12-month deferral
- Intracellular protozoan parasites (Leishmania spp)
- Endemic tropical and subtropical areas in the Middle East,
Mediterranean coast, Africa, Cantral and South America,
and Asia

19. From 1980 through 1996:
a. Did you spend time that adds up to 3 months or more
in the United Kingdom?
- Indefinitely deferred

b. Were you a member of the U.S. military, a civilian
military employee, or a dependent of a member of the
U.S. military?
- Indefinitely deferred
- Spent 6 months or more at U.S. military base in Europe
(United Kingdom, Belgium, Netherlands, Germany) from
1980-1990
- Who were at a base in Spain, Portugal, Turkey, Italy, or
Greece from 1980-1996

20. From 1980 to the present, did you:
a. Spend time that adds up to 5 years or more in
Europe?
- Indefinitely deferred as donors of whole blood, blood
components, or source of leukocytes
- Not deferred as donor source of plasma

b. Receive a blood transfusion in the United Kingdom or
France?
- Received transfusion of blood, platelets, plasma,
cryoprecipitate, or granulocytes
- Indefinitely deferred

21. From 1977 to the present, have you:
a. Received money drugs, or other payment for sex?
- Permanently deferred

b. Male Donors: Have you had sexual contact with
another male, even once?
- Permanently deferred

22. Have you ever:
a. Had a positive test for HIV/AODS virus?
- Indefinitely deferred

b. Used needles to take drugs, steroids, or anything not
prescribed by your doctor?
- Indefinitely deferred

c. Used clotting factor concentrates?
- 12-month deferral

d. Had hepatitis?
- Indefinitely deferred

e. Had malaria?
- 3-year deferral after being asymptomatic

f. Had Chagas disease? Had babesiosis?
- Indefinitely deferred
- Chagas disease
American trypanosomiasis
Caused by protozoan parasite Trypanosoma cruzi
Hematophagous bug (Vector)- Reduviidae
Mucous membranes or breaks in skin are
contaminated with the feces of infected
hematophagous bug
Endemic in Central and South America and Mexico
Maybe transmitted congenitally by breastfeeding,
organ transplant, or blood transfusion
- Babesiosis
Babesia microti utilizes the vector Ixodes scapularis
Penetrates erythrocytes where throphozoite
multiplies; upon lysis of RBC, merozoites are released
into the blood and infect other RBCs
Transfusion-associated infection carries an incubation
period of 2 to 8 weeks
Symptoms:
o Malaise
o Fatigue
o Anorexia
o Arthralgias
o Nausea
o Vomiting
o Abdominal pain
o Fever reaching 40C

g. Received a dura mater (or brain covering) graft?
- Indefinitely deferred

h. Had any type of cancer, including leukemia?
- Indefinitely deferred
- History of cancer, leukemia, or lymphoma
- Exceptions:
Basal or squamous cell cancer
Carcinoma in situ of the cervix
Papillary thyroid carcinoma

i. Had any problems with your heart or lungs?
- Deferral
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- History of cardiovascular, coronary, or rheumatic heart
disease
- Active pulmonary tuberculosis or other pulmonary disease

j. Had a bleeding condition or a blood disease?
- History of bleeding problem following surgery, invasive
dental procedures, cuts, or abrasions must be further
evaluated by the blood bank director.
- Indefinitely deferred
Hemophilia
von Willebrand disease
Sickle cell anemia
Thalassemia
Kaposis sarcoma
Polycythemia
History of receiving clotting factor concentrates

k. Been in Africa?
- Indefinitely deferred

l. Had sexual contact with anyone who was born in or
lived in Africa?
- Indefinitely deferred
- African Countries at Increased Risk of HIV-1 Group O
Benin
Cameroon
Central African Republic
Chad
Congo
Equatorial Guinea
Gabon
Kenya
Niger
Nigeria
Senegal
Togo
Zambia

m. Have any of you relatives had Creutzfeldt-Jakob
disease?
- Permanently deferred

The Physical Examination
1. General appearance
- Should observe for presence of:
Excessive anxiety
Drug or alcohol influence
Nervousness

2. Weight
- Standard: Maximum of 10.5 mL of blood/kg of donor
weight
- Weigh <100 pounds:
Amount of blood collected must be proportionately
reduced as well as anticoagulant
- Formulas used to calculate the adjusted volume of blood
to be collected and anticoagulant to be used:
- Volume to collect =
(Donors weight in kg/50) x 450 mL

- Reduced volume of anticoagulant=
Volume to collect/450 x 63 mL

- Amount of solution to be removed=
63 mL above calculated volume

3. Temperature
- Standard: Must be less than or equal to 37.5C or
99.5F
- Donors are asked not to drink coffee while waiting, as this
may affect their temperature.
- Oral temperatures that are lower than normal are not
cause for deferral.

4. Pulse
- Should be between 50 and 100 bpm
- Athletic donors will have a pulse less than 50 bpm, which
is not cause for deferral
- Should be counted for at least 15 seconds
- Any irregularities should be evaluated by blood bank
physician

5. Blood pressure
- Systolic blood pressure:
Should be less than or equal to 180 mmHg
- Diastolic blood pressure:
Should be less than or equal to 100 mmHg
- Blood pressure above these should be evaluated by a
blood bank physician.

6. Hemoglobin and Hematocrit
- For allogeneic donation:
Hemoglobin: Should be greater than or equal to
12.5 g/dL
Hematocrit: Should be greater than or equal to 38%
- For analogous donation:
Hemoglobin: Should be greater than or equal to 11
g/dL
Hematocrit: Should be greater than or equal to 33%
- Methods used for measuring Hgb:
Copper sulfate
Point-of-care instruments using
spectrophotometer
- Methods used for measuring Hct or Packed Cell Volume:
Manually by centrifugation
Blood is usually acquired via finger stick

7. Skin lesions
- Donors arms should be inspected for skin lesions prior to
donation.
- Evidence of skin lesions (e.g., multiple puncture marks) is
cause for indefinite deferral.
- Skin disorders that are not cause for deferral:
Poison ivy and other rashes
Should not be present in the venipuncture site
May need to be evaluated by a blood bank physician
Review of Permanent Deferral File
- Allogeneic whole blood donation: 8 weeks or 56 days
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- Apheresis donation (platelets, leukocytes, granulocytes):
At least 48 hours
Types of Deferral
1. Temporary deferral
12 months deferral:
- Blood transfusion during pregnancy
- Blood transfusion
- Organ transfusion
- Tissue and bone marrow transplant
- Accidental needle-stick injury
- Tattoo
- Permanent make up
- Ear or body piercing
- Sexual contact with:
Someone who has HIV/AIDS
Prostitute
Anyone who takes money or drugs or other payment
for sex
Past or present IV drug user
Person with hemophilia who has received factor
concentrates
- Women who have had sex with men who have had sex
with another man, even once since 1977
- Sexual contact or close contact with Acute/ Chronic
Hepatitis B (HBsAg/HBV)
- Hepatitis C
- Syphilis
- Gonorrhea
- Prisoner for more than 72 hours

2. Indefinite deferral
- Prospective donor is unable to donate blood for someone
else for an unspecified period of time due to current
regulatory requirements
- May be eligible to donate autologous blood
- Cancer, except:
Basal or squamous cell carcinoma
Carcinoma in the site of cervix
Papillary thyroid carcinoma
- Leukemia
- Lymphoma
- HBsAg (+)
- HBc (+)
- Hepatitis after 11
th
birthday
- Blood diseases:
- Hemophilia
- vW disease
- Sickle cell anemia
- Kaposis sarcoma
- Polycythemia vera
- Babesiosis and Chagas disease

3. Permanent deferral
- Prospective donor will never be eligible to donate blood for
someone else
- AIDS (+)
- HIV (+)
- Tegison
- Etretinate
- HBsAg (+) HBc (+)
Informed Consent
- AABB Standards: informed consent of allogeneic,
autologous, and apheresis donors be obtained before
donation
- Donor must be informed of the risks of the procedure and
of tests
- Donor must be able to ask questions concerning element
of collection or testing process.
- If the donor is a minor or is unable to comprehend the
informed consent protocol, applicable state law provisions
will intercede.
Autologous Donors
- The one who donates blood for his or her own use
- Such a donor is referred to as the donor patient
- Most autologous blood is used to treat surgical blood loss:
To avoid homologous transfusions or
When compatible allogeneic blood is not available
- Potential advantage of using autologous blood over
allogeneic blood includes decreased risk of:
Disease transmission
Transfusion reactions
Alloimmunization
- However, there is still a risk of:
Bacterial contamination
Circulatory overload
Cytokine-mediated reaction
Misidentification of the product or patient
- Greatest advantage to patients:
With very rare blood types
With multiple antibodies where compatible units in the
general blood supply may be difficult or impossible to
find
- Disadvantages:
Higher cost due to:
o Added administrative processes
o Special labeling requirements to ensure that units
get transfused to the proper patient
There is a high wasted units (30% to 50%)
Patients end up not requiring any or all of the units
donated
AABB Standards do not permit crossing over of
unused autologous units to general inventory, except
in exceptional circumstances.
- Various methods and techniques for obtaining autologous
blood:
Preoperative collection
Acute normovolemic hemodilution
Intraoperative collection
Postoperative collection
Preoperative Collection
- Occurs during the 5 to 6 weeks immediately preceding a
scheduled, elective surgical procedure unless the red
blood cells and plasma are scheduled to be frozen
- Procedures that typically might use preoperative
autologous blood include:
Orthopedic procedures
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Vascular surgery
Cardiac or thoracic surgery
Radical prostatectomy
- Some women do participate in autologous blood collection
during pregnancy for unseen complications
Blood is seldom needed except when the mother has:
o Multiple antibodies to high-frequency antigens
o Risk for placenta previa
o Intrapartum hemorrhage
- Decision to use preoperative autologous blood requires:
Order from the patients physician
Approval from the blood bank medical director
- MSBOS Maximal Surgical Blood Order Schedule
Provide guidance for surgical procedures to estimate
the number of units need for transfusion
Last blood collection should occur no later than 72
hours (3days) before the scheduled surgery to allow
volume replacement.
- Medical history and physical exam requirements are less
stringent than those for allogeneic donations
- There is no minimum or maximum age requirement
- Donor must be able to tolerate the procedure
- For young donors, most centers limit the age to children
whose veins can accommodate the phlebotomy needle
and who can understand the procedure.
- Minimum hemoglobin/ hematocrit: 11 g/dL and 33%
- Blood pressure and pulse are same with allogeneic unless
otherwise defined by the blood bank director.
- Donors temperature should not be elevated or indicate
any sign of possible infection
- Medical history questions to ensure safety of the donor:
Cardiac history
Bleeding disorders
Major illness
Previous donor reactions
Fainting problems
- There should be question to rule out bacteremia. Includes:
Information on current medications
Antibiotics
Fever
Recent minor procedures
Dental procedures
Gastrointestinal problems
Diarrhea
- Standard of autologous donor units: 450 or 500 mL 10%
- Weigh less than 50 kg (110 lb): total amount of blood
collected must be reduced proportionately
Amount of blood to be collected is determined 300 to
450 mL: unit must be labeled as low volume
No requirement to reduce the volume of
anticoagulant-preservative solution
Plasma is not suitable for transfusion
- Unit less than 300 mL: anticoagulant-preservative
solution must be adjusted
Approval by the blood bank director is required
- Testing requirements for autologous donor units are
somewhat less stringent than with allogeneic.
Collecting facility must determine the ABO and Rh of
the blood
Antibody screening is optional
- If the collecting facility and transfusion are the same: Viral
marker testing is not required
- If they are different, the collecting facility must test for:
HBsAg
Anti-HBc
Anti-HCV
HCV RNA
Anti-HIV-1/2
HIV-1 RNA
Anti-HTLV-I/II
WNV RNA
STS
- On at least the first unit collected from the donor in every
30-day period
- If positive (any markers): patients physician and
transfusion facility must be notified of the result
- Transfusing facility must confirm the ABO and Rh of the
unit, but a crossmatch is optional.
- Immediate spin crossmatch would be a good safety
check that the selected unit is identified properly.
- Units collected must be labeled correctly. The label should
include:
Patients name
Medical record number or ID number
Expiration date of the unit
Name of the facility where the donor-patient will be
transfused
Label must also clearly state For Autologous Use
Only
- Autologous units generally have a distinct green label
and tag. Done to both ensure:
The unit is linked correctly with the donor-patient
To make the blood bank technologists aware that
certain patients have autologous units on the shelf
that must be transfused for allogeneic units
- Oldest units should be transfused first
- Blood banks should have a system in place to ensure
autologous units must be selected first.

Acute Normovolemic Hemodilution (ANH)
- Results in the collection of whole blood with the
concurrent infusion of crystalloid or colloid solutions
- Maintaining normal volume but decreasing the patients
hematocrit
- Ratio of replacement:
For crystalloids= 3:1
For colloids= 1:1
- The number of units collected depends on the patients
ability to tolerate the decrease in hemoglobin/hematocrit.
- Limited hemodilution will reduce the hematocrit to 28%
- Severe dilution will reach 21% or less
- It is recommended that the patient start with a hemoglobin
of at least 12 g/dL
- Performed in surgery immediately prior to beginning the
surgical procedure and is managed by anesthesiology
- Blood is collected in standard blood bags containing
anticoagulant or preservative and is stored in the room
at RT.
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- Blood is normally reinfused to the patient during or
immediately following the surgery, but within 8 hours of
collection
Maintains the viability of both platelets and
coagulation factors
In the reverse order of collection
The last unit carries the highest hematocrit level
- Blood generally does not leave the operating room, the
units generally are not tested, labeled, or tracked, and
blood bank is generally not involved
- If the blood is not transfused during surgery, it can be
stored up to 24 hours in a monitored blood bank
refrigerator if refrigerated within the first 8 hours
- If the units leave the OR and are stored, they must be
appropriately tested and labeled as with predeposit
autologous units

Intraoperative Collection
- Involves collecting shed blood from surgical site
- Process blood through an instrument that washes it with
saline
- To remove tissue debris, free hemoglobin, and plasma
that may contain activated coagulation factors
- Concentrating the residual red cells to a hematocrit of 50%
to 60%
- Reinfusing those cells immediately
- This process is repeated continually during the surgical
procedure
- This type of collection has been used in:
Cardiothoracic
Major orthopedic
Cardiac surgeries
Vascular surgeries
Liver transplantation
- Advantages:
May be used in cases where preoperative donation is
not possible due to the:
Urgency of the surgery
Patient cannot be scheduled for multiple preoperative
donations
The risk of misidentifying the patient and the blood
product is minimized
No labeling, testing, and storing costs
- Disadvantages:
High cost of the instrumentation involved and training
of the personnel to run the instrument
Frequent amount of blood collected is not sufficient
for the patients total needs, and allogeneic blood may
still be given
- Labeled with:
Patients full name
Medical record number
Date and time of collection
With For Autologous Use Only
- Blood may be stored :
At room temperature for up to 6 hours
At 1C to 6C for up to 24 hours, as long as within 4
hours from the end of the collection

Postoperative Blood Salvage
- Collected from a drainage tube placed at the surgical site
- Reinfused with or without processing
- Via a microaggregate filter to screen out any debris
- Characterized as:
Dilute
Partially hemolyzed
Defibrinated
- Recommended that no more than 1, 400 mL be reinfused
- Procedures that have used postoperative blood collection:
Orthopedic (e.g., arthroplasty)
Cardiac surgeries
- Blood must be reinfused within 6 hours of collection or it is
to be discarded
- Advantage:
Very low cost
Can be used in conjunction with other autologous
blood collection procedures
No risk of blood being transfused with other person
- Disadvantage:
Does not yield a large volume of blood
Do not produce enough blood for patients needs
Significant risk of producing transfusion reactions, due
to presence of:
o Activated coagulation factors
o Fibrin degradation products
o Cytokines
- Blood bank is frequently not responsible for managing
ANH, intraoperative recovery and postoperative blood
salvage
- AABB and CAP have recommendations and guidelines.
This includes:
Assisting with the development of procedures
Maintaining the equipment
Monitoring quality control
Training personnel
Assessing competency

Directed Donation
- Unit collected is directed toward a specific patient
- Tag for the directed unit is a distinct color (e.g., yellow,
salmon)
- Unit must be irradiated if the donor is blood relative:
To prevent graft versus host disease
Viable T cells from the donor enter the patients
circulation do not mount an attack against patients
cells and tissues

Apheresis Donation
- For collecting specific blood component while returning the
remaining whole blood components back to the patient.
- Use an automated cell separator device whose centrifugal
force separates blood into components based on
difference in density
- Can be used to collect:
Platelets
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Plasma
White cells(leukocytes)
Red cells
Stem cells
- Designed to collect large volumes of the intended
component
- The only effective method for collecting leukocytes and
stem cells
- Regulated by FDA, AABB and ASFA

Plateletpheresis

- More than 75% of platelet transfusion are platelet-derived
platelets
- A pheresis platelet unit is equivalent to six to eight random
donor platelets
- Advantage:
Reduces the recipients donor exposure
Makes routine leukoreduction of the product practical
Allows compatibility matching of the donor and patient
possible
May donate more often
- Interval between donations is at least 2 days
- Aspirin, Feldene, or aspirin-containing medications: 48
hour-deferral
- PLavix (clopidogrel) or Ticlid (ticlopidine): 14-day deferral
- If the donor has donated whole, or if 100 mL or more of
red cells were not able to be returned to the donor: 8-
week deferral
- Platelet count is not required on the first donation, it is
required if the interval between donations is less than 4
weeks. In that case: Must be above 150, 000/ uL
- Total amount of plasma that can be removed along
platelets: 500 mL (600 mL for donors weighing more than
175 lb)
- Each platelet unit contain at least 3 x 10
11
platelets
- Donor reactions:
Reaction to the citrate or anticoagulant used
Vasovagal and hypovolemic reactions rare
- Testing requirements:
ABO group
Rh type
Antibody screen
Infectious disease markers
- If the donor is donating repeating for a specific patient:
Repeat testing every 30 days
Platelet count is determined and recorded, but not
recorded on product label
- if the product contains more than 2 mL of red cells, a pilot
smaple must be attached
- FDA guidelines: record of regular platelet pheresis donors
be reviewed by physician at least every 4 months

Plasmapheresis
- Plasma first product to be collected by apheresis
- Primarily used as a method for collecting source plasma
- Also used to collect transfusable fresh frozen plasma
- Classified as either: infrequent/occasional or serial
- Infrequent donor
Undergoes no more than one procedure in a 4-week
period
- Serial donors
May donate more frequently than 4 weeks but no
more than every 48 hours and no more than two
donations in a 7-day period
- Red cell loss must not exceed 25 mL/week or 200 mL in
an 8-week period
- If the donors red cells cannot be returned: 8-week
deferral
- At 4-month intervals, the donor must be tested for:
Total serum/plasma protein levels
Quantitative immunoglobulin levels
Protein electrophoresis
- Performed manually
- There should be separate forms of identifications. May
use:
Full names
Signatures
Unique numbers
Pictures

Leukopheresis
- Apheresis is the only effective method for collecting
leukocytes or, more specifically, granulocytes
- Typical therapeutic dose: at least 1 x 10 11 granulocytes
each day for 2 consecutive days
- Drugs or sedimenting agents is given to collect large
volume of leukocytes:
Hydroxyethyl starch (HES)
o Common sedimenting agent
o Enhances separation of the white cells from red
cells during centrifugation
o Increases the amount of leukocytes collected
o Decreases the amount of red cell contamination
o Disadvantage:
HES is a colloid
It expands the donors blood volume
Remains in the circulation for extended
periods of time
Corticosteroids such as prednisone or
dexamethasone
o Given prior to the collection procedure
o Pulls the granulocytes from the marginal pool into
the general circulation
o Increase the supply of cells available for
collection
Recombinant hematopoietic growth factors
o Advantage:
Can produce four to eight times the volumes
of cells in each collection
Quite well tolerated by the donor
- Testing requirements:
ABO group
Rh type
HLA type of the leukocytes
- If the amount of contaminating red cells exceeds 2 mL, the
product should be crossmatched with the recipient, and a
pilot tube sample must accompany the product
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Double RBC Pheresis
- Collected in 1990s
- Can be used to collect either allogeneic or autologous
units
- Hemoglobin level must be determined by a quantitative
method, copper sulfate method is not acceptable
- Saline infusion
Minimizes volume depletion
Male donors must weigh at least 130 lbs and be at
least 51 tall
Female donors must weigh at least 150 lbs and be at
least 55 tall
Hematocrit level must be a minimum of 40%
- Donors participating in double red cell pheresis: 16-week
deferral
- Procedure is discontinued prior to completion and the total
red cell loss is less than 200 mL: 8-week deferral
- If the red cell loss is greater than 200 mL but less than 300
mL: 8-week deferral
- If the total red cell loss is greater than 300 mL: 16-week
deferral
WHOLE BLOOD COLLECTION
I. Donor Identification
- Numeric or alpha numeric system
- Avoid duplicate numbers, voided numbers, or other
mistakes in labeling system
- Issues must be investigated and kept on record
- Attach all labels to blood bags, donor record and pilot
tubes
II. Aseptic Technique
- most blood centers use an iodine compound such as PVP-
iodine or polymer iodine complex
- area is scrubbed at least 4 cm for at least of 30 seconds
- donors who are allergic or sensitive to iodine compounds
may use chlorhexidine gluconate and isopropyl alcohol
- all methods must be approved by the FDA






III. Collection Procedures

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DONOR REACTIONS

Mild Reactions

a. Syncope or fainting
- Signs and symptoms:
Sweating
Dizziness
Pallor
Convulsions
Instructions apply for a donor who has fainted:
1. Remove the tourniquet and withdraw needle
2. Place cold compresses on the donors forehead
3. Raise the donors legs above the level of the head
4. Loosen tight clothing and secure airway
5. Monitor vital signs

b. Twitching and muscle spasm
- For donors who are extremely nervous

c. Hyperventilation
- Conversing the donor
- Having the donor breath into a paper bag
- It is not advised to give oxygen to donors

d. Nausea or vomiting
Instructions apply for a donor who started to feel
nauseated or vomits:
1. Instruct the donor to breath slowly
2. Apply cold compress to the forehead
3. Turn the donors head one side and provide an
appropriate receptacle
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4. The donors may be given water after vomiting has
ceased
Moderate Reactions
- Decreased pulse rate
- May hyperventilate
- May exhibit a fall in systolic pressure to 60 mmHg
Instructions:
1. Check the vital signs frequently
2. Administer 95% oxygen and 5% carbon dioxide

Severe Reactions
- Convulsions, can be caused by:
Cerebral ischemia. Associated with:
o Vasovagal syncope
o Reduced blood flow to the brain
o Shock symptoms

Marked hyperventilation
o Marked depletion of carbon dioxide

Epilepsy
Instructions:
1. Call for help immediately; notify blood bank physician.
2. Try and restrain the donor to prevent injury to self or
others
3. Ensure an adequate airway

- In the event of cardiac or respiratory difficulties, should
perform CPR until medical help arrives

Hematomas
- Bluish discoloration of the skin after collection of blood
- Caused by needle going through the vein, with
subsequent leakage of blood into the tissue
Instructions:
1. Remove the tourniquet and needle from the donors
arm
2. Apply pressure with sterile gauze pads for 7 to 10
minutes, with the donors raising his or her arm above
the heart
3. Apply ice to the area for 5 minutes




DONOR RECORDS


DONOR PROCESSING
ABO/Rh
- For ABO group:
Include both forward and reverse grouping
Donors RBCs are tested with anti-A and anti-B
reagents
Donors serum or plasma is tested with reagent A1
cells and B cells
- For Rh type:
Determined by testing with anti-D reagent at the
immediate spin phase
If the initial test is negative, a test for weak-D is
performed
Involves a 37C incubation and an antihuman
globulin (AHG) phase
If both immediate spin and weak-D test results are
negative, label the donor as Rh-negative





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SUMMARY CHART
An allogeneic blood donor should weigh at least 110
lb (50kg).
The pulse rate of a potential blood donor should be
between 50 and 100 beats per minute.
The hemoglobin/hematocrit level of an allogeneic
blood donor should be at least 12.5/38%.
A donor must be permanently deferred if she or he
had a confirmed positive test for HBsAg after the 11
th

birthday.
The deferral period for persons who have been
treated for malaria is 3 years following therapy.
Persons who have had a blood transfusion are
deferred for 12 months owing to risk of exposure to
hepatitis, HIV, or other viral diseases.
A platelet apheresis donor should not have taken
aspirin for 3 days before donation because it
decreases platelet function.
The interval between whole blood donations is 8
weeks or 56 days.
A person with a history of hemophilia A or B, von
Willebrand disease, or severe thrombocytopenia
must be permanently deferred from donating blood.
Attenuated live viral vaccines such as smallpox,
measles, mumps, yellow fever, and influenza (live
virus) carry a 2-week deferral.
A blood donor who has a positive serologic test for
syphilis must be deferred for 12 months.
Donors who have tested positive for the HIV antibody
must be indefinitely deferred.
Predeposit autologous donation refers to blood for
the donor-patient that is drawn before an anticipated
transfusion (e.g., surgery) and stored until use.
An autologous donor must have hemoglobin of at
least 11 g/dL and a hematocrit of at least 33%.
Intraoperative autologous transfusion occurs when
blood is collected during a surgical procedure and is
usually reinfused immediately.
Acute normovolemic hemodilution takes place in
the operating room when 1 to 3 units of whole blood
are collected and the patients volume is replaced
with colloid or crystalloid. The blood is reinfused
during surgical procedure.
Postoperative salvage is an autologous donation in
which a drainage tube is placed in the surgical site
and postoperative bleeding is salvaged, cleaned, and
reinfused.
All whole blood units should be stored at 1C to 6C;
those units destined for platelet production should be
stored at 20C to 24C until platelets have been
removed.
Donor units must be tested for the following viral
markers: STS. Anti-HIV-1/2, HIV-antigen, anti-HTLV
I/II, HBsAg, anti-HBc, and anti-HCV.
RBCs must be prepared by a method that separates
the RBCs from the plasma and results in a hematocrit
level of less than or equal to 80%.
Irradiated RBCs must be given a radiation dose of at
least 25 Gy to the midplane of the canister, after
which the expiration date of the product changes to
28 days from the time of irradiation or maintains the
original outdate, whichever comes first.
Leukocyte-reduced RBCs are products in which the
absolute leukocyte count is less than 5 x10
6
.
Random-donor platelets must contain at least 5.5
x10
10
platelets; single donor platelets must contain at
least 3 x10
11
platelets; each carries a shelf-life of 5
days.
FFR must be prepared within 8 hours of collection
for CPD, CPDA-1, and CP2D; it is stored at -18C for
12 months.
Cryoprecipitate is prepared from FFP and contains
at least 80 units of antihemophilic factor and 150
to 250 mg of fibrinogen; this product is indicated for
hemophilia A, factor XIII deficiency, and
hypofibrinogenemia.
RhIg is a solution of concentrated anti-Rho(D), which
is manufactured from pooled hyperimmunized donor
plasma. It is used to prevent Rh-negative mother after
an abortion, miscarriage, amniocentesis, or delivery of
an Rh-positive or Rh-unknown infant.
One unit of random-donor platelets typically
increases the platelet count in a 70-kg adult by 5,000
to 10,000/uL; 1 unit of apheresis platelets should
increase the platelet count in a 70-kg adult by 30,000
to 60,000/uL.

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REVIEW QUESTIONS
1. Which of the following information is not required for
whole blood donors?
a. Name
b. Address
c. Occupation
d. Sex
e. Date of birth
2. Which of the following would be cause for deferral?
a. Temperature of 99.2F
b. Pulse of 90 beats per minute
c. Blood pressure of 110/70 mmHg
d. Hematocrit level of 37%
e. None of the above
3. Which of the following would be cause for permanent
deferral?
a. History of hepatitis after 11
th
birthday
b. Positive hepatitis C test result
c. Positive HTLV-I antibody
d. Positive anti-HBc test result
e. All of the above
4. Immunization for rubella would result in a temporary
deferral for:
a. 4 weeks
b. 8 weeks
c. 6 months
d. 1 year
e. No deferral required
5. Which of the following donors is acceptable?
a. Donor who had a first-trimester therapeutic
abortion 4 weeks ago
b. Donor whose husband is hemophiliac who
regularly received cryoprecipitate before 1989
c. Donor who was treated for gonorrhea 6 months
ago
d. Donor who had a needlestick injury 10 months
ago
6. Which of the following tests is not required as part of
the donor processing procedure for allogeneic
donation?
a. ABO
b. Rh
c. STS
d. Anti-HTLV I
e. Anti-CMV
7. Which of the following lists the correct shelf-life for the
component?
a. Deglycerolized RBCs - 24 hours
b. RBCs (CPD) - 35 days
c. Platelet concentrate - 7 days
d. FFP 5 years
e. RBCs (CPDA-1) 21 days




8. Each unit of cryoprecipitate prepared from whole
blood should contain approximately how many units
of AHF activity?
a. 40 IU
b. 80 IU
c. 120 IU
d. 160 IU
e. 180 IU
9. Platelet concentrates prepared by apheresis should
contain how many platelets?
a. 5.5 x10
10

b. 6 x 10
10

c. 3 x 10
11

d. 5.5 x 10
11

e. 6 x 10
11

10. The required storage temperature for frozen RBCs
using the high-glycerol method is:
a. 4C
b. -20C
c. -18C
d. -120C
e. -65C
11. How does irradiation affect the shelf-life of the red
blood cells?
a. Irradiation has no effect on the shelf-life.
b. The expiration date is 28 days from the date of
irradiation or the original outdate, whichever is
later.
c. The expiration date is 28 days from the date of
irradiation or the original outdate, whichever is
sooner.
d. The expiration date is 25 days from the date of
irradiation or the original outdate, whichever is
later.
e. The expiration date is 25 days from the date of
irradiation or the original outdate, whichever is
sooner.
12. Once thawed, FFP must be transfused within:
a. 4 hours
b. 6 hours
c. 8 hours
d. 12 hours
e. 24 hours
13. Quality control for RBCs requires a maximum
hematocrit level of:
a. 75%
b. 80%
c. 85%
d. 90%
e. 95%
14. AHF concentrates are used to treat:
a. Thrombocytopenia
b. Hemophilia A
c. Hemophilia B
d. Von Willebrand disease
e. Factor XIII deficiency


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15. Prothrombin complex concentrates are used to treat
which of the following?
a. Factor IX deficiency
b. Factor VIII deficiency
c. Factor XII deficiency
d. Factor XIII deficiency
e. Factor V deficiency
16. How is the antibody screen test different for donors
than for patients?
a. In donors, a 2-cell screen is used.
b. In donors, a 3-cell screen is used.
c. In donors, a pooled cell is used.
d. There is no difference in testing.
17. RBCs that have been leukoreduced must contain less
than _____ and retain at least _____ of original
RBCs.
a. 8 x 10
6
/85%
b. 8 x 10
6
/90%
c. 5 x 10
6
/85%
d. 5 x 10
6
/90%
18. Random-donor platelets that have been leukoreduced
must contain less than _____ leukocytes.
a. 8.3 x 10
5

b. 8 x 10
6

c. 5 x 10
6

d. 3 x 10
11

19. A single unit of FFP or PF24 should contain _____
mL of plasma.
a. 100-150
b. 200-400
c. 150-250
d. 50-150
20. Cryoprecipitate that has been pooled must be
transfused within _______ hours.
a. 24
b. 26
c. 4
d. 8