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Blood bank
A blood bank is a center where blood gathered as a result of blood donation is stored and preserved
for later use in blood transfusion. The term "blood bank" typically refers to a division of a hospital
where the storage of blood product occurs and where proper testing is performed (to reduce the risk
of transfusion related adverse events). However, it sometimes refers to a collection center, and indeed
some hospitals also perform collection.

For blood donation agencies in various countries, see List of blood donation agencies and List of
blood donation agencies in the United States.

Contents
Types of blood transfused
History
First World War
Expansion
Medical advances
Collection and processing
Storage and management
RBC storage lesion
Platelet storage lesion
Alternative inventory and release practices
Long-term storage
See also
References
Further reading
External links

Types of blood transfused

Whole blood or blood with RBC, is transfused to patients with anaemia/iron deficiency. It also helps
to improve the oxygen saturation in blood. It can be stored at 1.0 °C-6.0 °C for 35–45 days. Platelet
transfusion, is transfused to those who suffer from low platelet count. This can be stored at room
temperature for 5–7 days. The donation of Plasma is called (plasmapheresis).Plasma transfusion is
indicated to patients with liver failure, severe infections or serious burns. Fresh frozen plasma can be
stored at a very low temperature of -25 °C for up to 12 months.

History
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Further extending the shelf life of stored blood up to 42 days was

an anticoagulant preservative, CPDA-1, introduced in 1979, which
increased the blood supply and facilitated resource-sharing
among blood banks.[13][14]

Collection and processing

In the U.S., certain standards
are set for the collection and
processing of each blood
product. "Whole blood" (WB)
is the proper name for one
defined product, specifically
unseparated venous blood
with an approved
Charles R. Drew oversaw the preservative added. Most
production of blood plasma for
blood for transfusion is
shipping to Britain during WW2.
collected as whole blood.
Autologous donations are Blood donation at the Royal
sometimes transfused without further modification, however Melbourne Hospital during the
1940s.
whole blood is typically separated (via centrifugation) into its
components, with red blood cells (RBC) in solution being the
most commonly used product. Units of WB and RBC are both
kept refrigerated at 33.8 to 42.8 °F (1.0 to 6.0 °C), with maximum permitted storage periods (shelf
lives) of 35 and 42 days respectively. RBC units can also be frozen when buffered with glycerol, but
this is an expensive and time-consuming process, and is rarely done. Frozen red cells are given an
expiration date of up to ten years and are stored at −85 °F (−65 °C).

The less-dense blood plasma is made into a variety of frozen components, and is labeled differently
based on when it was frozen and what the intended use of the product is. If the plasma is frozen
promptly and is intended for transfusion, it is typically labeled as fresh frozen plasma. If it is intended
to be made into other products, it is typically labeled as recovered plasma or plasma for fractionation.
Cryoprecipitate can be made from other plasma components. These components must be stored at
0 °F (−18 °C) or colder, but are typically stored at −22 °F (−30 °C). The layer between the red cells
and the plasma is referred to as the buffy coat and is sometimes removed to make platelets for
transfusion. Platelets are typically pooled before transfusion and have a shelf life of 5 to 7 days, or 3
days once the facility that collected them has completed their tests. Platelets are stored at room
temperature (72 °F or 22 °C) and must be rocked/agitated. Since they are stored at room temperature
in nutritive solutions, they are at relatively high risk for growing bacteria.

Some blood banks also collect products by apheresis. The most common component collected is
plasma via plasmapheresis, but red blood cells and platelets can be collected by similar methods.
These products generally have the same shelf life and storage conditions as their conventionally-
produced counterparts.

Donors are sometimes paid; in the U.S. and Europe, most blood for transfusion is collected from
volunteers while plasma for other purposes may be from paid donors.
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Most collection facilities as well as hospital blood banks also

perform testing to determine the blood type of patients and to
identify compatible blood products, along with a battery of tests
(e.g. disease) and treatments (e.g. leukocyte filtration) to ensure
or enhance quality. The increasingly recognized problem of
inadequate efficacy of transfusion[15] is also raising the profile of
RBC viability and quality. Notably, U.S. hospitals spend more on
dealing with the consequences of transfusion-related
US Food and Drug Administration
complications than on the combined costs of buying,
scientist prepares blood donation
testing/treating, and transfusing their blood.[16] samples for testing

Storage and management

Routine blood storage is 42 days or 6 weeks for stored packed red
blood cells (also called "StRBC" or "pRBC"), by far the most
commonly transfused blood product, and involves refrigeration
but usually not freezing. There has been increasing controversy
about whether a given product unit's age is a factor in transfusion
efficacy, specifically on whether "older" blood directly or
indirectly increases risks of complications.[17][18] Studies have not
been consistent on answering this question,[19] with some
Whole blood is often separated,
showing that older blood is indeed less effective but with others
using a centrifuge, into components
showing no such difference; nevertheless, as storage time remains for storage and transportation
the only available way to estimate quality status or loss, a first-in-
first-out inventory management approach is standard
presently.[20] It is also important to consider that there is large variability in storage results for
different donors, which combined with limited available quality testing, poses challenges to clinicians
and regulators seeking reliable indicators of quality for blood products and storage systems.[21]

Transfusions of platelets are comparatively far less numerous, but they present unique
storage/management issues. Platelets may only be stored for 7 days,[22] due largely to their greater
potential for contamination, which is in turn due largely to a higher storage temperature.

RBC storage lesion

Insufficient transfusion efficacy can result from red blood cell (RBC) blood product units damaged by
so-called storage lesion—a set of biochemical and biomechanical changes which occur during storage.
With red cells, this can decrease viability and ability for tissue oxygenation.[23] Although some of the
biochemical changes are reversible after the blood is transfused,[24] the biomechanical changes are
less so,[25] and rejuvenation products are not yet able to adequately reverse this phenomenon.[26]

Current regulatory measures are in place to minimize RBC storage lesion—including a maximum shelf
life (currently 42 days), a maximum auto-hemolysis threshold (currently 1% in the US), and a
minimum level of post-transfusion RBC survival in vivo (currently 75% after 24 hours).[27] However,
all of these criteria are applied in a universal manner that does not account for differences among
units of product;[21] for example, testing for the post-transfusion RBC survival in vivo is done on a
sample of healthy volunteers, and then compliance is presumed for all RBC units based on universal
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(GMP) processing standards. RBC survival does not guarantee efficacy, but it is a necessary
prerequisite for cell function, and hence serves as a regulatory proxy. Opinions vary as to the best way
to determine transfusion efficacy in a patient in vivo.[28] In general, there are not yet any in vitro tests
to assess quality deterioration or preservation for specific units of RBC blood product prior to their
transfusion, though there is exploration of potentially relevant tests based on RBC membrane
properties such as erythrocyte deformability[29] and erythrocyte fragility (mechanical).[30]

Many physicians have adopted a so-called "restrictive protocol"—whereby transfusion is held to a

minimum—due in part to the noted uncertainties surrounding storage lesion, in addition to the very
high direct and indirect costs of transfusions,[16] along with the increasing view that many
transfusions are inappropriate or use too many RBC units.[31][32]

Platelet storage lesion

Platelet storage lesion is a very different phenomenon from RBC storage lesion, due largely to the
different functions of the products and purposes of the respective transfusions, along with different
processing issues and inventory management considerations.[33]

Alternative inventory and release practices

Although as noted the primary inventory-management approach is first in, first out (FIFO) to
minimize product expiration, there are some deviations from this policy—both in current practice as
well as under research. For example, exchange transfusion of RBC in neonates calls for use of blood
product that is five days old or less, to "ensure" optimal cell function.[34] Also, some hospital blood
banks will attempt to accommodate physicians' requests to provide low-aged RBC product for certain
kinds of patients (e.g. cardiac surgery).[35]

More recently, novel approaches are being explored to complement or replace FIFO. One is to balance
the desire to reduce average product age (at transfusion) with the need to maintain sufficient
availability of non-outdated product, leading to a strategic blend of FIFO with last in, first out
(LIFO).[36]

Long-term storage
"Long-term" storage for all blood products is relatively uncommon, compared to routine/short-term
storage. Cryopreservation of red blood cells is done to store rare units for up to ten years.[37] The cells
are incubated in a glycerol solution which acts as a cryoprotectant ("antifreeze") within the cells. The
units are then placed in special sterile containers in a freezer at very low temperatures. The exact
temperature depends on the glycerol concentration.

See also
Medical technologist
Phlebotomist

References
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