I

IN THE NAME OF ALLĀH, THE MERCIFUL,

THE MERCY-GIVING

II

III

Introduction to

Blood Banking

and

Transfusion Medicine

Dr. Salwa Hindawi Amer H. Asseri

Assistant Professor in Hematology

and Transfusion Medicine

Director of Blood Transfusion Services,

King Abdulaziz University Hospital

Academic Technician,

Faculty of Science, Biochemistry Dept.,

King Abdulaziz University

Scientific Publishing Center

King Abdulaziz University

P.O. Box 80200, Jeddah 21589

Saudi Arabia

http://spc.kau.edu.sa

IV

King Fahd National Library Cataloging-in-Publication Data

Hindawi, Salwa

Introduction to blood banking & transfusion medicine. /

Hindawi, Salwa; Asseri, Amer. - Jeddah, 2011

160 p; 24 cm

ISBN: 978-9960-06-600-4

1- Blood - bank 2- Blood – Transfusion – Safety

measures – Handbooks, manuals, etc.

I - Asseri, Amer (co author) II - Title

615,6507 dc 1432/10320

L.D. no. 1432/10320

ISBN: 978-9960-06-600-4

King Abdulaziz University Press

© King Abdulaziz University 2011A.D. (1432 A.H.)

All rights reserved.

1st Edition: 2011 A.D. (1432 A.H.)

V

Dedication

To our families for their support and inspiring us to do the best.

Authors

VI

VII

Foreword

This book is the fulfillment of Dr. Salwa I.

Hindawi and Mr. Amer H. Asseri wishes to

put together a comprehensive guide for its

readers as its intention is to shed light on the

subjects concerning blood banking as well as transfusion

medicine. It provides useful information to students as well as

professionals by serving as a guideline in their continuous efforts

to further understand it's relating principles and standard

guidelines. Very useful for students, residents or blood bankers,

where current subjects as quality control and ethical aspects are

approached with precision and clearness. The authors have

exerted every effort to ensure subject matters set forth in this text

book are in accordance with the current recommendations and

practice. Thorough, yet concise, the introduction to blood

banking and transfusion medicine begins with a review of basic

science, plus the history of blood preservation, and continues to

provide students with a working knowledge of modern blood

banking as it focuses on the how and why of transfusion practice,

presenting a perfect "cross match" of theory and practice. Lastly,

I personally congratulate Dr. Salwa Hindawi and Mr. Amer

Asseri and everyone who contributed to this excellent book.

Dr. Adnan Abdularhman Mazroa

Vice President, King Abdulaziz University

VIII

IX

Acknowledgments

We would like to thank all who helped us with advice and

encouraged us to finish our book.

Authors

X

XI

Preface

"Blood is the fluid of life". We would like to introduce this

book with this phrase. We have focused on the science of blood

collection, preparation, testing, storage, reservation, issuing and

transfusion.

What is a blood bank? This question can be answered

immediately as ‘a place where blood is donated and reserved’.

Certainly that is the obvious answer. But the most important

questions are ‘What happens backstage behind the scenes? What

are the rules and regulations regarding blood banks? What are

the correct scientific procedures that must be followed by

workers in blood banks from the moment when the blood is

donated until the minute of administrating blood or its

components to the recipients and thereafter?’

Therefore, we have attempted to answer all these questions,

and many others to convey the information easily to specialists

or those in search of knowledge.

We have been accumulating information relating to blood

banks, transfusion medicine, especially the practical aspects

from a multitude of sources.

The book is divided into three chapters; the first chapter

tackles the definitions and techniques of blood bank, the second

chapter discusses blood donation, the physical condition and

requirements of the donor, types of donors, and healthy and

correct methods of donation. The third chapter deals with how to

administer blood or its components to the patient.

We hope that this book will benefit readers and serve the

medical community.

Authors

XII

XIII

Contents Dedication …………………………………………………….....………..………. V Foreword …………………………………………...……….………………..…... VII

Acknowledgments ……………………….………………….……………………. IX

Preface ………………………………….……………………………………….... XI

Chapter 1: Definition and Blood Bank Techniques………………………….… 1

Definitions…………………………………………………………………………. 3

Blood Bank Techniques…………………...……………………………………..… 3

Patient Identification………………………………..……..…………………..…… 3

Sample Collection…………………………...……..……………………………..... 4

Labeling of Sample………………………….……………………………..………. 4

Blood Banking Reagents……………………….……………………………..…… 5

Testing Procedures (Techniques) Routinely done in Blood Banking……………... 6

Grading Reactions……………………………………………………………….… 9

Blood Grouping and Rh Typing……………………….………………………...… 10

Blood Group system……………………………………………………………..… 10

ABO discrepancies…………………………...………………….........................… 12

Antibody identification…………………………………………………………….. 13

Crossmatch…………………………………………......................……………….. 13

ABO Selection of blood components……..……………………………………….. 13

Transfusion testing Policies ……………………………………………………….. 15

Blood components preparation…………………………………………………….. 17

Preparation steps……………………………………………..…………………….. 19

Leukocyte filtration………………………………………..……...……………….. 29

Methods of filtration……………………………………………………………….. 29

Post-storage…………………………..……………………………………………. 29

Pre-storage...……………………………………………………………………… 30

Blood storage……………………………………………...……………………….. 33

Quality management programme in blood banking……...……………………….. 35

Quality System Essentials & Guidelines for Quality Assurance in Blood

Establishments……………………………………………..……………………….

36

Units Disposal……………………………………………………..……………….. 41

General Safety in the Blood Bank……………………...………………………….. 43

XIV

Chapter 2: Blood Donation Area.…………………………………………..….… 45

Introduction to Blood Donation Area………………..…………………………….. 47

Donor types…………………….………………….……………………………….. 47

A. Autologous Donation………………………..………………………………….. 48

B. Directed Donation………………………...…………………………………….. 50

Donor Selection………………………………………………….………………… 53

General donor requirements…………………….………………...……………….. 53

Donor medical history and questionnaire…………………………………………. 53

Accepted criteria for donor…………………………..……………………………. 57

Physical examination……………...……………………………………………….. 57

Blood examination – Hemoglobin Evaluation…………………………………….. 58

Donation Process………………………………….……………………………….. 59

Collecting blood from donor…………………………………...………………..… 59

Donation steps……………………………………..……………...……………….. 59

Donor care…………………………………………………...…………………….. 74

Donor adverse reaction prevention and treatment………...……………………….. 75

Mild reaction……………………………………………………………………….. 75

Moderate reaction………………………………………………………………….. 76

Severe reaction…………………………………………………….……………….. 76

Hematoma………………………………………………………………………….. 77

Convulsions……………………………………….……………………………….. 77

Cardiac or respiratory difficulties………………………………………………….. 78

Reporting results……………………………………………..…………………….. 80

Procedure notes…………………………………………………………………….. 80

Blood donor testing………………………………………………..……………….. 81

Transmitted diseases……………………………………………………………….. 81

Blood group and Rh typing…………………….…………….…………………….. 82

Aphaeresis………………………………………………………………………….. 84

Tracking Transfusion - Transmittable Disease…………………………………….. 93

Look Back……………………………………..…………………..……………….. 93

Trace Back…………………………………………...………….............................. 93

General Quality control in donation area………...………………..……………….. 94

XV

Chapter 3: Clinical Applications of Blood Transfusion………...……………… 97

Introduction to blood transfusion area…………………...………..…......………… 99

Blood ordering……………………………………………………………………... 99

Request forms……………………………………………………..……………….. 100

Emergency requesting…………………………………………………………...… 101

Patient Sample's collection………………………....………………………..…..… 103

Sample rejection criteria……………………………………………………..…..… 103

Pre-transfusion testing……………………………..……………............................. 103

Delivery of blood……………………………………...………..………………… 104

Administration of blood components…………………………………...……….… 105

Consent form…………………………………………..…………………..…….… 107

Guidelines for blood components……………………….…………………..…...… 108

Irradiation of blood components……………………………………………..…..… 114

Massive Transfusion…………………………………………………………..…… 115

Complications of Blood Transfusion…………………...………………………..… 115

Management of Acute Transfusion Reactions……………………………..…...… 116

Therapeutic Aphaeresis………………………………….....................................… 122

Indication for Therapeutic Aphaeresis……..……………………………..….….… 127

Hemovigilance System …………………………..…………………..…..……...… 131

National blood policy…………………………………..………………..………… 136

References………………………………………….……………………..……...… 139

Appendix .……………………………………..…………………...…………….… 143

XVI

Title of Figure Page

Chapter 1. Figure 1. Diagram for all blood types…………………………………………... 12 Figure 2. RBC Compatibility chart……………………………………………... 13 Figure 3. Plasma compatibility chart……………………………………………. 14 Figure 4. Blood bag after donation……………………………………………… 19

Figure 5. Special centrifuge used for blood bag………………………………… 20

Figure 6. Blood bag after 1st centrifugation…………………………………….. 21

Figure 7. Packed RBCs bag (300-350 ml)……………………………………… 26

Figure 8. Fresh frozen plasma FFP (180-200 ml)………………………………. 26

Figure 9. Platelets (50-75 ml)…………………………………………………… 27

Figure 10. Cryoprecipitate (15-20 ml)………………………………………….. 27

Figure 11. Summary for blood components separation……………………….. 28

Figure 12. Leuko-Filtration procedure………………………………………… 31

Figure 13. Leukoreduction Filtet………………………………………………... 32 Figure 14. Storage Refrigerator………………………………………………… 34 Figure 15. The Document Pyramid……………………………………………… 39 Figure 16. Disposal of Blood Bags, after each unit of blood is separated or

transfused. The empty blood bags disposed of into biohazard container……...… 43

Chapter 2.

Figure 17. Three photos (1, 2, 3) for donor questionnaire and interview….……. 60

Figure 18. This form is example of Blood donor questionnaire forms…………. 61

Figure 19. Photo for Blood Pressure……………………………………………. 62

Figure 20. Two Photos (1, 2) for Hemoglobin meter (HemoCue) and finger

stick tools…………………………………………………………………………

63

Figure 21. Donor sitting on donation chair……………………...………………. 64 Figure 22. Photo showing how to use the tourniquet………………………….... 65

Figure 23. Photo nomber (1) of technician as he chooses the appropriate vein,

photo nomber (2) for vein anatomy, A: Median cubital vein, B: Cephalic vein,

C: Basilic vein…………………………………………………………………....

66

XVII

Figure 24. Two photos (1, 2) showing the sterilization of the venesection area

using iodine, then swab alcohol…………………………………………………..

67

Figure 25. Three photos (1, 2, 3) showing a needle entering a vein………….. 69

Figure 26. Photo of the collection bag and blood monitoring during the

donation…………………………………………………………………………... 69

Figure 27. Blood tubes, from donation bag……………………………………... 70

Figure 28. Three blood tubes……………………………………………………. 70

Figure 29. Two photos (1, 2) for removing the needle from vein………………. 71

Figure 30. Two photos (1, 2) for applying pressure after donation……………... 72

Figure 31. Complete donor pressure on the wound…………………………… 73

Figure 32. Write data on bag……………………………………………………. 73

Figure 33. Delivery of blood bags in special box……………………………….. 74

Figure 34. Donor drinking refreshments………………………………………... 75

Figure 35. Rarely, donors will faint during donation. Gently remove the

tourniquet and needle from the patients arm, apply gauze and pressure to the

skin puncture site, and turn the head of donor down and his feet up……….…..

79

Figure 36. Apply cold compress to the forehead……………………………….. 79

Figure 37. Blood collection monitor, a mechanical tray tilts the bag to prevent

congealing, and displays current volume and flow per minute……………….. 96

Chapter 3.

Figure 38. example for consent form……………………………………………. 107

XVIII

Title of Table Page

Chapter 1. Table 1. Summary of known and unknown sources of both antigens and

antibodies………………………………………………………………………. 6

Table 2. Summarizes the sources of both the antigen and antibody……………. 7 Table 3. Blood grouping in routine testing……………………………………… 11 Table 4. Major ABO Blood Groups…………………………………………….. 11

Table 5. Suggested ABO group selection order for transfusion RBCs…………. 14

Table 6. Plasma compatibility table…………………………………………….. 15

Table 7. Standard temperature for blood storage……………………………….. 33

Chapter 3.

Table 8. Types of Transfusion complications.................................................... 116

Table 9-A. ACE INHIBITORS INCLUDE…………………………………….. 124

Table 9-B. ANTICHOLINESTERASE DRUGS INCLUDE………………….... 124