Pretransfusion Testing

Transcription

1 Pretransfusion Testing Blood transfusion services The immunohematologic testing needed for By proper patient blood typing, component Dr. selection Reham and Talaat compatibility testing. Which Blood ensure bank patient specialist safety and and transfusion quality efficacy. officer in MRBTC

2 Blood Donation

3 Blood Donation A person has 5-6 liters of blood in their body A person can donate blood every 90days (3 months) Body recovers the Blood very quickly: Blood plasma volume: within hours Red Blood Cells : in about 3 weeks Platelets & White Blood Cells: within minutes

4 Procedure for Voluntary Blood Donation Pre-Donation: Donor registration Medical history Physical examination Blood Donation: Blood donation procedure Post donation Rest, advice

5 Donor Screening Registration ( national ID is must) Required information Name Date and time of donation Address Telephone Gender Age (date of birth) Donors must also be given education material about blood donation

6 Medical Questionnaire Why ask questions? Asking questions helps determine the overall suitability of the donor; from this, the donor will be: Accepted Temporarily deferred Permanently deferred

7 Donor selection criteria

8 Donor selection criteria

9 Have you donated blood in the last 8 weeks? The time interval between allogeneic whole blood donation is 8 weeks at least (better 3 month) A donor must wait 48 hours after donating platelets, plasma before donating whole blood

10 Physical Examination General Appearance Weight Temperature Pulse Blood Pressure Hemoglobin Skin Lesions

11 Physical Exam: - General Appearance: The donor should appear alert - Weight: A minimum weight limit of (50 kg) is used to avoid hypovolemia - Temperature Less than or equal to 37.5 C

12 Physical Exam (cont d) Pulse Between bpm (count for at least 15 sec) Blood Pressure Systolic 180 mm Hg ( ) Diastolic 100 mm Hg ( )

13 Physical Exam: Hemoglobin Hemoglobin can quickly be obtained from a finger stick. Hemoglobin should be 13 g/dl for male 12 g/dl for female

14 In summary bpm 99.5 F 37.5 C 12.5 g/dl 38% 110 lbs (50 kg )

15 Blood Donation Procedure Remember! The Donor Must. have had good rest / sleep have had light meal be mentally prepared

16 Whole Blood Collection Whole blood is collected in clear plastic bags that contain different mixtures of anticoagulants CLOSED SYSTEM (remains sterile)

17 Post Donation Advice Drink lots of fluids for at least the next 4 hours ) Avoid smoking for one hour Avoid exercises & games for a day If you feel dizzy, lie down & put your feet up. You will be alright in mins. Remove band-aid after 4 hours. If it bleeds, apply pressure & reapply band-aid. If bruised and painful, apply cold-pack for 5 mins each. It will take a few days to get reabsorbed.

18 Blood Products / Components & their uses Blood collected is screened for TTIs (infections) & IF SAFE, is separated into components & stored for issue to patients

19 Benefits to Donor of blood donation Health benefits: - Lowers cholesterol - Lowers lipid levels - Decreases incidence of heart attacks, strokes

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21 Blood Formed elements 45% of blood volume Erythrocytes (red blood cells) 99% of cells Carry oxygen Leukocytes (white blood cells) Protect against infection and cancer Platelets (cell fragments) Blood clotting Plasma 55% of blood volume Water (90%) Electrolytes Plasma proteins Albumin Fibrinogen Globulins Substances transported by blood Nutrients Waste products Respiratory gases

22 Whole Blood Consists of RBCs, WBCs, platelets and plasma (with anticoagulant) 1 unit increases Hgb 1 g/dl and Hct 3% When is it used? Patients who are actively bleeding and lost >25% of blood volume Exchange transfusion

23 WHOLE BLOOD - The term whole should be no longer used and is needed only in emergency. - The storage defects of whole blood make it unsuitable for such replacement The term used now is : BLOOD COMPONENTS

24 Components are: Those therapeutic constitutes of blood that can be prepared by centrifugation.

25 Centrifuged blood Plasma/serum Buffy Coat (WBCs & Platelets) Red Blood Cells

26 Storage temp. Plasma (freezer ) -18 or below RBCs (refrigerator) +2 to + 6 Platelets (agitator) +22 to + 24 With continuous shaking

27 Types of Bags: There are many types of blood bags to help in maintaining closed system throughout the separation procedures : Single. Double. Triple. Quadruple Pedi bags. Transfer bags with different capacities.

28 Red Blood Cells Volume: ml Storage period: 21, 35, or 42 days depending on preservative or additive Outcome Indicators: One unit increases hematocrit 3% and Hgb on average 1g/dL Unit should be transfused within 4 hours Once the unit is opened it has a 24 hour expiration date!

29 RBCs Conditions include: Oncology patients (chemo/radiation) Trauma victims Cardiac, orthopedic, and other surgery End-stage renal disease Premature infants Sickle cell disease ( Hgb A)

30 Platelets Volume: SDP = ml RP = ml Storage Temperature C for 5 days (constant agitation) Each therapeutic unit should contain at least 5.5 x platelets Outcome Indicators :Each unit should elevate the platelet count by 5000 µl in a 70 Kg. person

31 Platelets Important in maintaining hemostasis Help stop bleeding and form a platelet plug (primary hemostasis) People who need platelets: Cancer patients Bone marrow recipients Postoperative bleeding

32 Preparation of platelet concentrate Plasma RBCs PRP Platelet concentrate

33 Fresh Frozen Plasma (FFP) Prepared within 6 hours of whole blood. Volume: ml. Storage period :Frozen at -18 C for one year thawed at bed side. Indication : - Multiple coagulation factors deficiency - Massive transfusion - liver dis. - vit.k deficiency & DIC.

34 Fresh Frozen Plasma FFP is thawed before transfusion C waterbath for minutes Stored 1-6 C and transfused within 24 hours Needs to be ABO compatible Contains V, VIII, XI Von willbrand and fibrinogen, firbronectin 400 mgm fibrinogen /ml Outcome Indicators Prevention and/or cessation of bleeding

35 Frozen Plasma * Plasma separated and frozen at 18 C between 8 and 24 hours,of collection. * It contains all the stable proteins found in FFP plus minimal Factor VIII. Indication: Bleeding associated with stable clotting factor deficiencies.

36 Cryoprecipitate Volume: 20 30ml. Storage period :Frozen at -18 C for one year Contains: von Willebrand s factor (plt. adhesion) Fibrinogen 150 mg in each unit Factor VIII About 80 IU in each unit Fibrinonectin

37 Cryoprecipitate Cryoprecipitate (VIII, vw) FFP Thaw at C Store at RT 4 hrs Frozen within 8 hours Thawed FFP Plasma cryoprecipitate, reduced (TTP, FII, V, Vii, IX, X, XI) Refrozen with 24 hrs of separation Store at 18 C 1 yr 5 day expiration at 1-6 C

38 Cryoprecipitate Indication: Factor VIII deficiency (Hemophilia A) von Willebrand s Disease Congenital or acquired fibrinogen defects Advanced liver disease Bleeding DIC Renal failure ( VWF ) Fibrinogen defects Outcome Indicators Cessation of bleeding Fibrinogen level >100 mg/dl

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40 Pretransfusion testing Blood grouping and cross matching. Screening of collected blood for infectious diseases. In Egypt every blood donation is checked for: - Hepatitis B surface antigen - Hepatitis C virus antibody - HIV Treponema pallidum antibody(syphilis) Lab. Samples should be collected at the time of donation

41 ABO grouping /Rh typing / Antibody screening / Antibody ID

42 ABO typing: direct agglutination by IgM antibodies Cells v Serum Serum v Cells Forward and reverse grouping must agree!

43 Indirect antiglobulin test gel

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45 Strategy for blood safety Collection of blood only from voluntary donors at low risk. Screening of all donated blood for TT infections (HIV-HBV-HCV-SYPHILIS) Avoid unnecessary transfusions. This helps in decreasing the risk of transfusion transmitted infections

46 *Blood collection: Under complete aseptic conditions. Arm preparation:- - should be done with care and ideally with vigorous scrubbing. - The contact time of alcohol is 30 seconds. - The application of alcohol must be in a spiral way, once at a time, or one way direction.

47 Dangerous waste disposal Never recap needles, recap using one hand technique. Sharps, broken glass ware, lancets should be disposed in sharp box. Any waste material contaminated with biological material must be packed safely in red bags. Contaminated blood bags and expired blood bags to be disposed according to hospitals rules.

48 Hygienic Practices Protective clothing (white coats and rubber gloves) Regular change Appropriate usage Cover cuts and abrasions No eating, drinking or smoking in work areas Handwashing before and after handling donations, specimens, components.

49 Safe Disposal of Hazardous Waste (1) Types of waste Non-hazardous: e.g. paper Biohazardous: e.g. containing human material Hazardous: e.g chemicals, sharp metal or glass, radioactive material Proper separation of waste Hazardous/non-hazardous Sharps/non-sharps Liquid/solid

50 Safe Disposal of Hazardous Waste (2) Appropriate disposal Pre-treatment: e.g. autoclaving, disinfection, inactivation, neutralization Incineration Landfill Using chlorine 1% Procedures must be in place for the safe and effective disposal of waste

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