In order to protect the donor as well as the recipient, each blood
donor must be screened prior to each blood donation by medical history and
limited physical examination on the day of donation. This is to insure that no
harm will come to the donor by giving blood and that the transfused unit will
not in any way harm the recipient. Whenever a decision is made regarding
acceptance or rejection of a blood donor, there two goals should be kept in
mind, i.e, safety of donor and safety of patient.
Registration
The following information must be recorded initially or updated on
a Donor Record (either single or multiple donation cards) which is kept on the
file in the Blood Bank.
1.
Date
2.
Name: Last, First and Middle Initial
3.
Address: Residence and/or Business
4.
Telephone: Residence and/or Business
5.
Sex
The following information is not required but
may be useful
1.
Additional identification such as Social
Security or Driver’s License number.
2.
Time of last meal. Fasting is not recommended
and if donor has not eaten within past 4–6 hours, he may be sent to the
refreshment area for a slight snack.
3.
Name of intended recipient or donor group.
a.
Full name of patient and hospital or donor
group is essential to assure proper credit.
b.
A record of rejected donors may be useful to
the patient or to others concerned with donor recruitment.
4.
Hazardous occupation (or hobby)
If the job duties (or hobbies)
include possible hazard to self or responsibility for the safety of others, the
consequence of temporary incapacity due to fainting or other delayed reaction
should be considered. Donors should be accepted only if adequate time lapses
before returning to such activities.
Examples: Operators of cranes, heavy equipment,
power machinery, buses,
taxi
cabs or trains (12 hours). Workers on jobs requiring climbing
Ladders
and scaffolding (12 hours), scuba or sky divers (12 hours),
Flight
crews (72 hours)
Basic qualification
1.
Age
Between 21st and 66th
birthday and between 17th and 21st birthday depending on
local law (age of minority) and consent of a guardian
2.
Body weight
110 lbs. or more for 450 (+/– 45)
ml of blood collected in 63 ml of CPD anticoagulant plus up to 30 ml for
additional tubes.
3.
Temperature
Less than 37.5oC (99.5oF)
4.
Pulse
Between 50 – 100 beats per minute
(regular)
5.
Blood pressure
Systolic between 90 – 180 mmHg
Diastolic between 50 – 100 mmHg
6.
Minimum Hemoglobin
13.5 g / dl (male)
12.5 g / dl (female)
Minimum
hematocrit
41%
(male)
38%
(female)
Specific
gravity
More
than 1.055 (male)
More
than 1.053 (female)
7.
Skin lesion
The skin at the site of
venipuncture shall be free from lesions including stigmata of drug injection.
Examine both arms.
Mild skin disorders such as acne,
psoriasis, rash of poison ivy are not cause for deferment unless in antecubital
area. Donors with boils or other severe skin infections should be deferred.
8.
General appearance
If the donor looks ill or appears
to be in the influence of drugs or alcohol or is excessively nervous, it is
best to defer temporarily.
Deferment
1.
Permanent
a.
History of viral hepatitis
b.
History of jaundice of unknown cause
c.
The only donor implicated in post–transfusion
hepatitis
d.
Malignant tumor
e.
Leukemia
f.
Convulsion
g.
After infancy
h.
Fainting spells
i.
Abnormal bleeding tendency
j.
Positive HBsAg test
k.
Serious cardiopulmonary disease
2.
Temporary
a.
Conditions requiring rest or medication
(cold, flu)
b.
Diabetes
c.
Tuberculosis
d.
Syphilis
e.
Infections and diseases involving heart,
lungs, kidneys, stomach or liver
3.
For 3 years
After prior residence in areas
endemic for malaria or after cessation of anti– malaria prophylaxis or therapy
provided the donors have been asymptomatic.
4.
For 1 year
a.
Severe illness
b.
Therapeutic rabies vaccines
5.
For 6 months
a.
Close contact with viral hepatitis
b.
Skin allgrafts, ear piercing, tattoo
c.
Injection of blood or components
d.
One of the donors implicated in post
transfusion hepatitis
e.
Major surgery
f.
Travel to areas endemic for malaria without
symptoms or suppressive medication
g.
Inmates of penal colony or mental institution
until six months after release
6.
For 2 months
a.
German measles (rubella) vaccines
b.
Previous blood donation (interval of blood
donation)
7.
For 6 weeks
a.
After termination of pregnancy
8.
For 2 weeks
a.
Smallpox
b.
Measle
c.
Mumps
d.
Yellow fever vaccines
e.
Oral polio vaccines
9.
For 72 hours
a.
Dental or minor surgery
b.
Hyposensitization injection for allergy
c.
Symptomatic bronchial asthma
10. For 48 hours
a.
Plasmapheresis
b.
Aspirin consumption by donor who is the only
source of platelet for a patient.
Techniques of blood collection
Before a technologist start phlebotomy, he must be sure that all
the things needed are ready, including those that a donor may need if some reaction
occurs
1.
Technologist must wash hands thoroughly using
surgical soaps.
2.
Materials used should be sterile. Disposable
materials are preferred whenever possible.
3.
The donor blood bag, sample tube and donor
record should be properly identified and labeled before drawing blood.
4.
Select the venipuncture site. The
venipuncture site should be free of skin lesions of an infectious nature. Arms
should be inspected for needle marks, a sign of drug addiction.
5.
Thoroughly clean the proposed site of
venipuncture with a disinfectant having a rapid bactericidal action. Start from
the center to the outer portion. Do not go back to the area which has already
been cleaned.
a.
Scrub vigorously with surgical soap for at
least 30 seconds with gauze or 60 seconds with cotton balls to clean away fat,
oils, dirt, etc.
b.
To remove soap, apply 10% acetone in 70%
alcohol and allow to dry.
c.
Apply tincture of iodine (3% in 70% alcohol).
Allow to dry.
d.
Remove iodine with 10% acetone in 70%
alcohol. Allow to dry. Iodophor compounds may also be used instead of iodine.
Iodophor compounds are preferred because they leave less odor and stain than
does tincture of iodine. They also do not cause skin reactions and removal of
iodine by additional washing is not required.
e.
Cover site with dry sterile gauze unless
ready to do venipuncture.
6.
Inspect bag for any defects. Solution must be
clear.
7.
Position bag carefully
a.
If balance system is used, be sure counter–balance
is adjusted for the amount to be drawn. Unless metal clips and hand sealer are
used, make a very loose overhand knot in tubing. Hang the bag and route tubing
through the pinch clamp.
b.
If balance system is not used, position bag
low enough to allow gravity collection. It may be hung upside down so blood
flow through the anticoagulant.
c.
If using a vacuum–assist device, certain
modifications are necessary and the manufacturer’s instruction should be
followed.
8.
Reapply tourniquet
9.
Uncover sterile needle and do venipuncture
immediately. If desired, tape the tubing to hold needle in place and cover site
with sterile gauze.
10. Release
hemostat or the temporary closure to allow blood to flow into the bag.
11. Observe the
donor for any reaction.
12. Instruct the
donor to open and close his hand during donation.
13. Mix blood
and anticoagulant every 30 seconds. Donation should be complete within 7
minutes.
14. Seal the
tubing 4 to 5 inches from the needle by making a white knot using a metal clip.
15. Grasp tubing
on the donor side of the seal and press to remove blood for a distance of no
more than an inch. Clamp with hemostat.
16. Cut tubing
between seal and hemostat. To fill processing tubes for laboratory tests, other
than compatibility testing, remove stopper from tubes, release hemostat and
allow blood to flow directly from vein.
17. Remove
tourniquet, remove needle. Apply sterilize gauze at the site and have the donor
apply firm pressure while holding arm straight above the head.
18. Discard
needle. Starting at seal, strip donor tubing as completely as possible into the
bag. It is important to work quickly before initiation of coagulation.
19. Invert bag
several times to mix thoroughly.
20. Tubing must
be left attached to the bag and sealed into sterile segment.
21. Recheck
identification before storing blood.
After care of donor
1.
Bandage phlebotomy site after bleeding stops.
2.
Allow the donor to remain reclining for 10
minutes. Then have him seated for 10 –20 minutes.
3.
Instruct him as to possible post phlebotomy
symptoms.
4.
Thank him and encourage him to donate again.
Some reactions which may occur
1.
Weakness or dizziness
2.
Sweating, pale or clammy skin
3.
Fainting
4.
Vomiting
5.
Severe reactions such as convulsion and
cardiac arrest
Instructions to blood donor before they are
allowed to go home
1.
Do not smoke for half an hour.
2.
Eat and drink something before leaving the
donor room.
3.
Drink more liquids than usual for the next
day.
4.
Avoid alcoholic drink until after meal.
5.
Lie down if feeling faint or dizzy.
6.
Resume normal activities in half an hour, if
no reaction are felt; but should not perform
7.
Remove bandage after one day.
Processing requirement for donor blood
1.
ABO group
2.
Rh type
3.
Detection of antibodies
4.
Test for syphilis
5.
Test for HBsAg
6.
Test for AIDS (HIV antigen)
7.
Test for hemolysis
8.
A donor’s previous record of ABO grouping and
Rh type shall not serve for identification of units of blood subsequently given
by the same donor; new determinations shall be made for each collection.
9.
Processed samples shall be stored at 1–6oC
for at least 7 days after transfusion.
Code of ethics for blood donation and transfusion
The code of ethics for blood donation and transfusion of the International Society of Blood Transfusion was adapted by the General Assembly in
Montreal, Canada in August 1980 and was approved by International Group
of Red Cross Blood Transfusion Experts in Vienna in May 1981 as well as
by the International Federation of Blood Donor Organization (FIODS)
in Madrid in June 1981.
This was also adopted by the International
Conference of the Red Cross in Manila in November 1981.
A.
The Donor
1.
Blood donation shall, in all circumstances,
be voluntary: no pressure of any king must be brought to bear upon the donor.
2.
The donor should be advised of the risks
connected with the procedure; the donor’s health and safety must be constantly
concern.
3.
Financial profit must never be a motive
either for the donor or for those responsible for collecting the donation. Voluntary
non–remunerated donors should always be encouraged.
4.
Anonymity between donor and recipient must be
respected except in special cases.
5.
Blood donation must not entail discrimination
of any kind, either of race, nationality or religion.
6.
Blood must be collected under the
responsibility of a physician.
7.
The frequency of donations and the total
volume of the blood collected according to sex and weight of the individual as
well as the upper and lower age limits for blood donation should be defined by
regulations.
8.
Suitable testing of each donor and blood
donation must be performed in an attempt to detect any abnormalities
a.
That would make the donation dangerous for
the donor.
b.
That would be likely to be harmful to the
recipient.
9.
Donation by plasmapheresis should be the
subject of special regulations that would specify
a.
The nature of additional tests to be carried
out on the donor.
b.
The maximum volume of plasma to be taken
during one session.
c.
The maximum volume of plasma to be taken in
one year.
d.
The minimum time interval between two
consecutive sessions.
10.
Donation of leukocytes or platelets by
cytopheresis should be the subject of special regulations that specify:
a.
The information to be given to the donor
about any drugs injected and about the risk connected to the procedure
b.
The nature of any individual tests to be
carried out on a donor.
c.
The number of sessions within a given frame.
11.
Deliberate immunization of donors by any
foreign antigen with the aim of obtaining products with a specific diagnostic
or therapeutic activity should be the subject of special regulations that would
specify:
a.
The information to be given to the donor
about the substance injected and the risk involved.
b.
The nature of any additional tests which have
to be carried out on the donor.
·
The purpose of the special regulation in
items 9,10 and 11 is to safe guard the donor. After being told about the nature
of the operation and the risk involved, a statement of informed consent mu be
signed by the donor. For donors immunized against red cell antigens, a special
card should indicate the antibodies and specific details as to the appropriate
blood to be used in case the donors need to be transfused.
12.
The
donor must be protected by adequate insurance against the risk inherent in the
donation of blood, plasma or cells as well as the risk of immunization.
B.
The Recipient
13.
The objective of transfusion is to ensure the
recipient the most efficient therapy compatible with maximum safety.
14.
Before any transfusion of blood or blood
products, a written request signed by a physician or issued under his
responsibility must be made, which specified the identity of the recipient and
the nature and quantity of substances to be administered.
15.
Except for the emergency use of type O blood
or red blood cells, every red cell transfusion necessitates preliminary blood
grouping tests on the recipients and compatibility tests between the donor and
recipient.
16.
Before administration, one must verify that
blood and blood products are correctly identified and the expiry date has not
been passed, the recipient’s identity must be verified.
17.
The actual transmission must be given under
the responsibility of physician.
18.
In case a reaction during or after the
injection of blood or blood products, appropriate investigations may be
required to ascertain the origin of the reaction and to prevent its recurrence.
A reaction may require the interruption of the transfusion.
19.
Blood and blood products must not be given
unless there is a genuine therapeutic need. There must be no financial
motivation on the part of either the prescriber or the establishment where the
patient is treated.
20.
Whatever their financial resources, all
patients must be able to benefit from administration of human blood or blood
products
21.
As far as possible, the patient should
receive only that particular component (cells, plasma, or plasma derivatives)
that is needed. To transfuse whole blood into a patient who requires only part
of it, may deprive other patient of necessary components and may carry some
additional risks to the recipient.
22.
Owing to the human origin of blood and to the
limited quantities available, it is important to safeguard the interest of both
recipients and donor by avoiding abuse or waste.
23.
The optimal use of blood and blood products
requires regular contact between the physician who prescribe and those who work
in blood transfusion centers.
C.
The Controls
24.
Appropriate controls should be required by
the Health Authorities to verify that the blood transfusion practices meet
internationally accepted standards and that the guidelines or regulations
issued in accordance with this code are effectively respected.
25.
The following should be regularly checked:
a.
The proficiency of the staff
b.
The adequacy of the equipment and premises
c.
The quality of methods and reagents, source
materials and finished products
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