BB lab

• TRANSFUSION MEDICINE- The practice of blood transfusion and blood conservation, complementary activities that ensure the best balance between safety and convenience during emergency care or surgery.
• NTERNATIONAL GOVERNING AGENCIES

  • U.S. Food and Drug Administration (FDA)
  • Association for the Advancement of Blood and Biotherapies (AABB)
  • College of American Pathologists (CAP) Philippine Blood
• U.S. Food and Drug Administration (FDA)

  • Regulating agency.
  • Center for Biologics Evaluation and Research (CBER) - 1988
  • Regulates the collection of blood (also its components)
  • Manufacture of pharmaceuticals derivatives (1 blood unit can save 3 lives)
  • Develops and enforces quality standards
  • Inspects blood establishment REMEMBER: Blood is a biological drug
• Association for the Advancement of Blood and Biotherapies (AABB)

  • International association of blood centers, transfusion and transplantation services, and individuals involved in transfusion medicine.
  • Standards from donor to patient
  • Provide voluntary inspection and accreditation program for its member institution
• College of American Pathologists (CAP) Philippine Blood

  • Provides a voluntary inspection and accreditation program for its member institutions (same sila ni AABB)
  • Since most transfusion services are part of the clinical laboratory departments in a hospital, they are included in a CAP inspection.
• PHILIPPINES GOVERNING AGENCIES

  The Tripartite Summit

  • Department of Health- NVBSP
  • Philippine National Red Cross (PNRC)
  • Philippine Blood Coordinating Council (PBCC)
  • COMMON GOAL: To provide or to make sure a voluntary blood donation and make sure all services/practices could make sure the safety of the donors, patients, blood, and its components.
• PBCC

  • Education – about voluntary blood donation (both private and public)
• NVBSP

  • Develop fully voluntary system
  • Promote nationally coordinated network of all the blood services facilities here in the Philippines
  • Implements quality management system including good practices, good manufacturing practices
  • Attain maximum utilization of blood
• PNRC

  • To deliver safe and adequate blood supply (to the most vulnerable)
  • Promote voluntary non renumerated blood donation to attain adequacy of the blood
• GOVERNING LAWS IN THE PHILIPPINES

  • Department Order #339-K S. 1988- Creation of the committee on National Blood Services Program (NBSP)
  • DOH A.O 188-A S. 1992- Promulgation of National Blood Services Program (NBSP)
  • R.A. 7719- National Blood services Act of 1994, Aims to promote a voluntary blood donation
• FIVE PROCESSES OF DONOR SELECTION (R2PCP)

  1. Recruitment
  2. Registration/Screening
  3. Physical Examination
  4. Collection
  5. Post Donation Care
• • 60% eligible to donate
  • 450ml of blood/ bag
  • 16 Gauge
  • M: max. of 6 Whole Blood units/yr
  • F: max. of 4 Whole Blood units/yr
  • Age: DOH: 18yrs old – 65yrs old o Harmening: at least 17yrs old (with parental consent) (>66 yrs old can donate if there’s medical certificate)
• Deferral period for whole blood:

  • Philippines: after 3 months
  • International: after 2 months or 8 weeks
• Pheresis

  • hindi lahat kukunin ▪ 2 units of pheresis deferral period is (after) 16 weeks

  Infrequent apheresis

  • deferral period 4 weeks/1 month
  • Leukapheresis; plasma; platelet deferral period 2 days
  • According to FDA in terms platelet pheresis, donate not more than 24x per year
• TYPES OF DONORS

  • Allogeneic
  • Directed
  • Autologous
  • Apheresis
• Allogeneic

  • For general population
  • Donating blood to same species but different individual
• Directed

  • “Tagged amounts” (specific patient; ex. Your family)
  • You will reserved a certain blood unit for another individual
• Autologous

  • Safest type of donation
  • Self-donation
  • For your own future use
  • Common for scheduled surgery (3 days before the surgery)
  • Rare phenotypes (such as Bombay, Rh-)
  • Preserved via Glycerolization then RBC freezing (preserved up to 10 years) Permanent deferred = × allogeneic but autologous
• Apheresis

  • Separation of blood components
• • Cough and cold = deferred for 48 hours
  • Multiple puncture mark: according to Harmening = indefinite deferral; DOH = Permanently deferred.
  • Rash or poison ivy: not a cause for deferral
  • For female prospective donor: ask if pregnant (temporary deferred; should be 6 weeks after delivery) or not. (or last menstruations).
  • 1st/2nd term of abortion or miscarriage = not deferral
  • Alcohol intoxication = 24 hours deferred
• At least 50kgs (110lbs)

  
• • Normal temperature: ≤ 37.5 degC (99.5 degF)
  • Deferred: 38-40 degC
  • DOH: Systole = 90-160 mm/Hg Diastole = 60-100 mm/Hg
  • 50 or 60-100 bpm = must be on a regular rhythm
  • Abnormal or irregular pulse rate: for further evaluation
  • Athletes: have slower pulse rate (50bpm) = not deferred
• LIMITED PHYSICAL EXAMINATION (Get Well Tito Boy PH)

  • General Appearance
  • Weight
  • Temperature
  • Blood Pressure
  • Pulse Rate
  • Hemoglobin and Hematocrit
• Hemoglobin and Hematocrit

  • Most common cause of deferral (low hemoglobin results)
  • Normal hemoglobin count: 12.5g/dL
  • Tested using gravimetric method or POCT Machines
• Gravimetric Method

  • Copper Sulfate Method: mostly used for mass blood donation (MBD)
  • Not reliable (kasi tantsa tantsa lang)
  • Has specific gravity of 1.053/1.054 (equivalent for specific gravity of blood which has the normal hemoglobin levels)
  • If blood sink to the copper sulfate = accepted!
  • If nag float = deferred
• Point of Care Testing

  -HemoCue Machines- Uses capillary blood

  -Automated CBC Analyzers
• Allogeneic

  • Hemoglobin: 12.5 g/dL
  • Hematocrit: 38%
• Autologous

  • Hemoglobin: 11 g/dL
  • Hematocrit: 33%
• TYPES OF DEFERRAL

  1. Temporary Deferral: - Not be able to donate for a specific period of time
  2. Indefinite Deferral: - Hindi alam kung kailan pwede magdonate ulit kasi baka ang reason ng deferral is dahil sa standards ng FDA and wala pa binibigay na go signal on when you can donate
  3. Permanent Deferral: - Not be able to donate blood forever. - Can still be able to donate for autologous
• History of viral hepatitis

  • In the Philippines, if may hepatitis permanent deferral na
  • Surface antigen/HBS Ag (+) = indefinite deferral
  • Reactive for Anti-HBC = deferral
  • Past/present evidence of HCV = “deferred tlaga”
  • Post transfusion hepatitis = Permanent or indefinite deferral
• Past/present abuse of self injected drugs- Permanent deferral

  Hemophilia = permanent deferral

  Leukemia, lymphoma= Permanent deferral


  Clotting factor deficiencies = permanent deferral

  Cancer- Permanent deferral

  • No deferral- carcinoma in situ of cervix, first basal/squamous cell carcinoma, if the person surgically removed capillary thyroid carcinoma
• HEPATITIS

  • Permanent = (+) HBS AG – meaning the person is suffering from acute or active hepatitis.
  • Temporary = The donor has been diagnosed w/ viral hepatitis before 11 y/o
  • Indefinite = Donor reacted positively for anti HBC and positive in HBV NAT
  • 12-month deferral = Sexual contact or living with a person w/ acute or chronic HBV, Those with other hepa virus (fecal oral = Hepa A & hepa B)
• DEFERRAL PERIODS FOR POTENTIAL TRANSFUSION-TRANSMITTED INFECTIONS (HCLCBMA)

  • HEPATITIS
  • CREUTZFELDT-JAKOB DISEASE
  • LEISHMANIASIS
  • CHAGA’S DISEASE
  • BABESIOSIS
  • MALARIA
  • ACTIVE TB
• CREUTZFELDT-JAKOB DISEASE

  • Known as Mad cow disease caused by a prion
  • Endemic in UK, France, and Europe •
  • Indefinite o Blood relative of someone diagnosed with CJD or Vcjd o Received bovine insulin since 1980
  • Permanent deferral is indicated for: Diagnosed Creutzfeldt-Jakob Disease (CJD) or Variant Creutzfeldt-Jakob Disease (vCJD), Donor had received a pituitary growth hormone from Human Derived Growth Hormone, Duramater transplant (brain)
• LEISHMANIASIS

  • Bloodborne diseases
  • Causative agent: Phlebotomus spp./sandflies
  • Endemic in Africa, South and Central America, other parts of Middle Coast and Asia
  • Travel to Iraq: deferred 1 yr after departure
• CHAGA’S DISEASE

  • Causative agent: Trypanosoma cruzi
  • Vector: Kissing bug or reduviid bugs
  • Endemic in South and Central America, and Mexico
  • Also known as American trypanosomiasis
  • History of Chaga’s disease: Indefinite to Permanent deferral
  • In the Philippines – Permanent deferral: If the person is a Latin-American immigrant and they are planning to donate here in the Philippines
• BABESIOSIS

  • Causative agent: Babesia microti
  • Vector: Ixodes tick or deer ticks
  • Endemic in US
  • History of Babesiosis: Indefinite to Permanent deferral
• MALARIA

  • Causative agent: Plasmodium spp
  • Endemic in Philippines (Palawan, Samar, Cagayan, Negros) and Africa
  • Temporary deferral: History of malaria: deferred 3 yrs after treatment
  • Lived in endemic country: deferred 3 yrs from departure
  • Travel to endemic area: deferred 1 yr from departure
  • Malaria (without the specifics): deferred 3 yrs after treatment
• ACTIVE TB

  • Harmening: o Deferred for 2 yrs
  • DOH: 6-12 months deferral to 2 neg exam results o Recovered TB → Blood Test (-) → Blood Test (-) → 6-12 months
• Previous donation associated with Hepatitis, HIV, or HTLV transmission