CLS 3311 Advanced Clinical Immunohematology

1. CLS 3311 Advanced Clinical Immunohematology Donor Physical and Interview

2. Donor Processing • Donor Physical • Basic physical and testing processes including Hematocrit, Blood pressure, Pulse, Temperature, and Weight. • Donor Interview • Series of questions and guidelines to be reviewed by the donor and Blood Bank personnel.

3. Purpose of the Donor Interview and Physical • Protect the Donor • Those aspects of the interview that are in place to protect the donor. • Protect the Recipient • Those aspects of the interview that are in place to protect the recipient. • As you progress through this lecture consider each item as to whether we are protecting the donor, the recipient or both.

4. Donor Registration • Date and time of donation • Name: Last, first (middle initial if available) • Address: Residence and/or business • Telephone: Residence and/or business • Gender • Age and/or date of birth • Donors must be at least 17 years of age • Exceptions: Autologous collections, various laws, no upper age limit (discretion of blood bank physician)

5. Donor Registration • Record of previous deferrals • Has the donor ever been rejected as a donor? Why? • Additional Identification • SS #, Drivers license, etc. • Race • Time of last meal • Occupation • Directed donation, Replacement credit, Donor group

6. Donor Registration Donor Consent • Informed consent: Procedure must be explained in terms that the donor can understand and there must be an opportunity for the donor to ask questions. • Including risks for donor and recipient, testing on donation, etc.

7. Donor Physical Examination • General Appearance • Does the donor look ill? Appears to be under the influence of drugs or alcohol? Excessively nervous? It is best to defer the donor. • Weight: 50 Kg (110 lbs) or more may donate 525 mls, total. • <110 lbs? May draw as little as 300 ml without reducing the amount of anticoagulant. Need to be labeled ‘low volume unit’ and not be used for platelets.

8. If it is necessary to draw less than 300 mls, the amount of anticoagulant in the collection bag must be reduced proportionately.

9. Donor Physical Examination • Temperature: Not to exceed 37.5oC (99.5 F) • Pulse: Between 50 - 100 beats per minute (bpm) • Show no irregularities • Athletes <50 bpm? Should be noted and accepted. • Blood Pressure: No higher than 180 mmHg for the Systolic and no higher than 100 mmHg for the Diastolic

10. Donor Physical Examination • Hemoglobin or Packed cell volume (Hct) • Minimal acceptable value: Hgb = 12.5 g/dl, Hematocrit = 38%, Copper Sulfate = 1.053 specific gravity • Skin Lesions: Skin at the site of the venipuncture must be free of lesions. Both arms must be examined for signs of repeated parenteral entry, especially multiple needle puncture marks…

11. Donor Interview Medical History: Purpose • To obtain a profile of the prospective donor’s health status to determine his or her suitability for donating blood. Harmening • Questions are designed to establish whether the donation will be harmful to the donor or the recipient.

12. Donor Interview • Handout: AABB Technical Manual, Page 103. Appendix 4-1. Uniform Donor History Questionnaire (May 1998) • At your facility there should be a current AABB Technical Manual. If there is not let me know and I will fax this to you. • You need to review the questions and how they apply to the donor and recipient. Why is the question asked? Who is being protected? Is there a deferral time? If so, how long?

13. Donor Interview • Permanent Deferral: Go back through the questionnaire and list those parameters that will result in the permanent deferral of the donor. • Temporary Deferral: Go back through the questionnaire and list those parameters that will result in the temporary deferral of a donor and the length of the deferral.

14. Donor Phlebotomy • Medical Director: Qualified licensed physician oversees all functions in the donor center. • Materials and instruments: Blood bags (FDA approved), hemostats, sterile gauze, tourniquet, iodine swabs, tubes, etc.

15. Donor Phlebotomy • Approach: Need to be confident and at ease with the donor. Being organized helps, too. Help the donor be comfortable. • Organize Equipment: Blood bag and tubing, tubes for tests (purple top, red tops, etc.), cleansing swabs (2 iodine cleansers), blood pressure cuff (tourniquet), something to squeeze during collection, sterile gauze, bandage or wrap, paper work, hemostats.

17. Donor Phlebotomy Procedure • Locate Vein: Apply BP cuff and pump to 40mmHg and find the vein to access. Identify location - cannot touch site after cleansing. Deflate BP cuff. • Cleanse site: With first swab vigorously scrub area to loosen dirt, etc. With second swab make concentric circles from center of area out. This removes loosened debris. Allow to dry. Cover with sterile gauze. • Organize equipment: Bag, tubing, collection tubes, gauze, bandage, etc. Attach bag to mechanism that will end collection when volume is adequate.

18. Donor Phlebotomy • Perform phlebotomy: Pump BP cuff to greater than 40 mmHg for stick only. Remove cap from needle and flip several times to remove anticoagulant from needle tip. DO NOT PALPATE SITE - IT IS STERILE. Anchor vein and insert needle clean and quick - very sharp, very big needle - blood will show in tubing when in the vein. Tape needle hub to arm so as to maintain flow and secure needle. Tape tubing to lower arm to avoid tangles. Reduce BP cuff pressure to 40 mmHg for remainder of collection. • Mix blood periodically as it flows into blood bag throughout collection to insure anticoagulant activity.

19. Donor Phlebotomy • Full Unit: Before needle removal need to collect tubes for testing directly from donor. Most blood bag sets have a mechanism to accommodate this. • Hemostat tubing to stop flow. Withdraw needle, dispose and apply pressure to site with sterile gauze. Make a pressure bandage to be worn for 1-2 hours. Observe donor. • Insure Donor well being. Cookies and Juice!! • Seal tubing and Strip remaining blood from tubing into bag to enable exposure to anticoagulant. Mix and allow anticoagulated blood to flow back into tubing. Segment the tubing using a heat sealer.

20. Donor Phlebotomy • Store blood in appropriate temperature for platelets, etc. (Room Temp) • Organize and record donor collection begin and finish time. Make note of any abnormalities. i.e. donor reactions, short draw, long collection time, etc. • Post phlebotomy instructions: Drink more fluids than usual in next 4 hours. Avoid alcohol and tobacco. Dizzy? Lie down or put head between knees. Symptoms persist? Call Blood Bank or see physician. Certain jobs beware of possible dizziness immediately following donation. (construction, machinery, etc.)

21. Donor Reactions • Mild Reactions • Nervousness, anxiety, feeling warm, pallor, sweating, etc. Does NOT lose consciousness. • Stop donation!!! Do NOT leave donor!! • Moderate Reactions • Previous symptoms PLUS donor loses consciousness. • Severe Reactions • Add convulsions to previous listed symptoms • Harmening Page 231 to 233 • Training is NECESSARY for personnel in donor room to respond properly to each situation. CPR knowledge is REQUIRED.

22. Donor Testing Required Testing: • ABO, Rh (Weak D), IAT • Transmissible disease testing: • HIV 1/2 • Hepatitis B and C • HTLV I/II • Syphilis (RPR)

23. Transmissible Disease Testing Viral Marker Testing • HIV 1/2, Hepatitis B and C, and HTLV I/II • Enzyme linked immunosorbant assay (ELISA or EIA).Screen test only. Test for presence of viral antibodies and/or antigens. Non reactive initial screening tests are considered negative. Reactive tests on initial screening needto be repeated in duplicate.

24. Transmissible Disease Testing • Reactivity on one or both of the repeated tests constitutes a positive result and is considered repeatedly reactive. • Confirmatory Tests • HIV: Western Blot, HIV neutralization • HCV: Recombinant Immunoblot assay (RIBA) • HBV: Neutralization or Repeatedly reactive HBcAb • HTLV: Repeat test with another manufacturers EIA kit

27. Transmissible Disease Testing Look Back • Donations with repeatedly reactive screening test results (HBsAg, anti-HBc, anti-HCV, HIV) cannot be transfused • In date units from preceding collections need to be quarantined or destroyed until confirmation. • Must be able to track ANY donor from collection to transfusion. Reentry Protocol • Process to accommodate the reentry of a donor back into the donor pool after false positive testing.