Donor Blood Processing & Autologous Donation

• Most common tests for donor blood processing

  • ABO
  • Rh
  • Antibody Screen
• ABO testing

  • Both forward and reverse blood typing are done
  • FBT: Anti-A, Anti-B, Anti-A,B typing sera
  • RBT: A1, B cells
• Rh testing

  • Tested with Anti-D typing serum for rapid testing
  • (-) initial test → do weak D test
• Antibody Screen


  • Optional in autologous donation
  • AABB requires donors with history of pregnancy or transfusion
  • Generally uses pooled cell reagent
• Screening for blood transfusion transmittable infections (TTIs)

  • Syphilis
  • Hepatitis B
  • Hepatitis C
  • HIV
  • HTLV 1 and 2
  • CMV
  • Malaria
• Syphilis screening

  • Rapid tests: Nontreponemal, Treponemal
  • FTA-ABS is serological confirmatory test
  • If (+), donor's blood must not be used for transfusion
• Hepatitis B screening


  3 nonreactive screening tests = can be used for transfusion
• Hepatitis C screening

  • Confirmatory tests: Recombinant Immunoblot Assay (RIBA), HCV RNA
  • Screening test: Chemiluminescent assay (ChLIA)
• HIV screening

  • Screening tests: EIA, ChLIA, NAT (Minipool-NAT)
  • Confirmatory test: Western Blot, IFA
• HTLV 1 and 2 screening

  Screening tests: EIA, ChLIA
• CMV and Malaria testing

  • Can be for testing or for malaria
  • Malaria rapid test kit: Malariaquick for detection of Plasmodium spp.
• Autologous donor


  • One who is donating blood for his or her own future use
  • With special label, usually in GREEN color
• Advantages of autologous donation

  • No risk of disease transmission
  • No risk of alloimmunization to red cells, platelets, WBC or plasma proteins
  • No risk of transfusion reactions
  • Phlebotomy process stimulates the bone marrow to increase cell production
  • Decreases the need for allogeneic blood and may increase supply for allogeneic blood supply
• Disadvantages of autologous donation

  • There is still a risk of disease transmission
  • Costly
  • Special labeling process
  • Risk for circulatory overload
  • Misidentification
• Criteria for autologous donation

  • No age limit
  • No strict weight requirements
  • Hemoglobin/hematocrit should not be less than 11 g/dL and 33%
  • Donations should not be more frequent than every 3 days and the final donation must be completed at least 3 days prior to the scheduled surgical procedure
• Contraindications of autologous donation

  • Conditions of presenting risk of bacteremia
  • Unstable angina
  • Recent myocardial infarction and cerebrovascular accident
  • Significant disease with ongoing symptoms but who have not been evaluated by the physicians
  • Untreated aortic stenosis
• Types of autologous donations/transfusions

  • Predeposit donation
  • Intraoperative autologous transfusion
  • Immediate preoperative hemodilution
  • Post-operative salvage
• Predeposit donation

  • Preoperative
  • Refers to the blood that is drawn some time before the anticipated transfusion and stored, usually liquid but occasionally frozen
  • Approval is needed from the patient and physician
  • Last blood donation should occur later than 72 hours
• Intraoperative autologous transfusion

  • Occurs when blood is collected during the surgical procedure
  • Usually reinfused immediately
  • Usually requires 50–60% hematocrit
• Immediate preoperative hemodilution

  • Acute normovolemic hemodilution
  • Takes place in the operating room when 1–3 units of whole blood are collected
  • Patient's volume is replaced with colloid or crystalloid (1:1 colloids, 3:1 crystalloid)
  • Blood is reinfused during the surgical procedure
• Post-operative salvage

  • An autologous donation in which drainage tube is placed in the surgical site and postoperative bleeding is salvaged, cleaned, and reinfused
  • Recommended reinfused blood: > 1400 mL
  • Risks: febrile nonhemolytic transfusion reaction, fibrin degradation
• A single blood donation can provide transfusion therapy to multiple patients in the form of RBCs, platelets, fresh-frozen plasma, and cryoprecipitate
• A single blood donation can save 3 lives
• Other products such as derivatives of plasma (e.g. immune serum globulin) also benefit patients with various diseases or conditions
• Component manufacturing centrifuge


  • Large floor units or large tabletop units that can spin a maximum of 6–12 units of whole blood at once
  • Blood bags for centrifugation must always be balanced
  • Has programmable speed (RPM) and time settings

  
• Hard spin


  1. Preparation of PPP

  2. Longer time; faster speed
• Soft spin


  1. Preparation of PRP

  2. Shorter time; slower speed
• AABB - Recommended Centrifuge Conditions

  • RBCs + Plasma: 5000 x g → 5 mins
  • RBCs + PRP: 2000 x g → 3 mins
  • Harvesting Platelets or Cryoprecipitate from Plasma: 5000 x g → 7 mins
• Plasma expressors


  • Mechanical devices that apply pressure to the blood bag, which allows blood components to flow from one bag to another by way of the integrated tubing system

  
• Tubing sealers


  • Tubing that connects blood bags is usually made of polyvinyl chloride (PVC) to protect the component of the blood bag's exterior
• Sterile connection devices (SCDs)


  • Allow two separate blood bags to be connected via their PVC tubing without breaching the integrity of either container
• Storage devices


  • Should be carefully selected and validated to ensure that they are capable of maintaining the FDA-regulated storage temperatures
  • Temperatures must be continuously monitored and recorded at least every 4 hours (everyday)
  • The device should alert the user if an unacceptable temperature condition occurs
• Quadruple bag


  • Mother bag: where the donor's blood initially flows (whole blood)
  • Satellite bags: where the expressed components are placed

  
• Preparation protocol


  1. Weigh each blood bag

  2. Counterbalance blood bags with similar weight

  3. Centrifuge

  4. Carefully remove the blood units from the centrifuge

  5. Expression of the blood unit

  
• Blood components


  • Oxygen-carrying products: red cell concentrates, leukocyte-poor RBC, frozen-thawed RBCs
  • Platelet products: PRP, platelet concentrates
  • Plasma products: fresh frozen plasma (FFP), cryoprecipitate antihemophilic factorOxygen-carrying
  • Plasma derivatives: normal serum albumin (NSA), immune serum globulin, Factor VIII & IX concentrates, plasma protein fraction (PPF), Rhogam
• Whole blood (WB)


  Collected from the donor, given for emergency transfusion or rapid dispensing, indicated when BOTH oxygen-carrying capacity and volume expansion are required

  
• Whole blood shelf life

  • CPD: 21 days
  • ACD: 21 days
  • CP2D: 21 days
  • CPD-A1 (most common), CPD-A2: 35 days
  • CPD-AS-1 (adsol), AS-3 (nutricel), AS-5 (optisol): 42 days
  • Heparin: 2 days

  
• Packed red blood cells (pRBC)

  Restore oxygen-carrying capacity, preferred when ONLY oxygen-carrying capacity is required, requested for those who do not need volume expansion
• Leukoreduced red blood cells

  • Febrile Nonhemolytic Transfusion Reaction (FNHTR): recurrent episodes of fever every after transfusion, not a severe case
  • To decrease alloimmunization to WBC or HLA antigens or CMV transmission
  • Residual leukocytes: 5 x 10^6
• Rejuvenated red blood cells


  REJUVESOL is applied after 3 days from the expiration date, contains PIPA (phosphate, inosine, pyruvate, adenine), regenerates ATP and 2,3-DPG