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4: Blood Technologies 4 Blood Technologies; 82 83 86 86 . 87 . 88 . 89 . 90 Page . 81 . 84 . ‘,. 90 4 Blood Technologies; PART 1: TECHNOLOGIES FOR BLOOD COLLECTION AND PROCESSING Introduction ing potentially fatal hemolytic transfusion re- actions. Modern blood bank technology began less than 100 years ago, when several technological ob- In 1945, a new test was described (Coombs) stacles were overcome. First, it was necessary to which made possible the recognition of previously arrest the blood clotting mechanisms which nor- undetectable antigens and led to the identification mally convert liquid blood into a gel in a matter of more than 400 new red blood cell types over of minutes. Second, physicians needed tools by the subsequent 30 years (284). However, prob- which blood could be collected from one individ- ably fewer than 30 of these types are of clinical ual and infused into another with minimum risk concern in routine transfusion practice (220). to donor and recipient. Third, there was a lack As the demand for blood increased, the larger of understanding of the immune system and the blood banks began to consider adaptations of clin- potential for incompatibility between donor red ical chemistry analyzers which could perform blood cells and red blood cell antibodies produced multiple tests on a single blood sample to remove by recipients. some of the tedium and manual labor from mass The coagulation problem was solved by the ad- blood-typing. These systems have evolved into dition of citrate into freshly collected blood (344); computerized testing devices which deliver sam- citrate compounds are still the basis for stored ples, interpret results, and flag any spurious find- blood anticoagulants today. Preservatives such ings for further investigation. as glucose were soon added to extend the shelf In the beginning, donor blood collection and life of stored red cells from several days to sev- testing were conducted in the same setting as eral weeks. blood transfusion; each hospital would screen Devices used in collecting, storing, and ad- donors on the basis of specific patient needs, and ministering blood have ranged from quill and tub- donors were often a patient’s family and friends. ing contraptions to syringes (used currently for World War II resulted in the creation of donor newborn exchange transfusions), to reusable centers across the United States to collect large vacuum glass bottles, still the standard in parts amounts of plasma for use in treating combat of the world today. In the United States, glass bot- casualties, and intensive research into improving tles have been replaced by flexible plastic con- the storage life and function of red blood cells. tainers with attached satellite bags to hold sepa- When the war ended, community blood centers rate blood components. began to appear under the auspices of American Red Cross chapters, community service clubs, and Landsteiner’s description of ABO blood groups local medical societies. These centers acted as stag- in the early 1900s and other researchers’ elucida- ing areas from which mobile operations could be tion of antigen/antibody relationships led to sim- sent for blood collections, after which the blood ple laboratory tests for compatibility between was returned to the center for processing and donors and recipients, but 15 percent of transfu- subsequent distribution to hospitals. sion recipients remained at risk until the Rhesus or Rh blood types were discovered (331,342). Blood collection and processing in a commu- From that time to the present, determination of nity blood center can function as an assembly- the donor and recipient ABO and Rh blood types line operation because of the need for repeating has been the most important procedure in prevent- the same battery of tests on a number of donor 79 80 ● Blood Policy and Technology samples, ranging from 200 per day in medium- Figure 9 shows an example of this labeling for- size centers to over 1,000 per day in large centers. mat. The labeling scheme has been endorsed by On the other hand, transfusion services repeat the FDA (182) and appears on 60 to 70 percent of entire workflow upon receipt of physician orders products distributed by U.S. blood banks. How- which, except in cases of standing orders for elec- ever, not all blood centers who label their prod- tive surgeries, are unpredictable and often urgent. ucts with bar codes have the equipment to make Therefore, batch or assembly-line processing is use of the machine-readable information, and few not as feasible, except for verification of donors’ transfusion services have the capability. Never- blood types and elective surgery workups. theless, eye-readable uniformity and simplicity are universally appreciated aspects of the commonality Blood is inherently variable, with each collected label, given a history of multiple color-coded la- unit representing a unique “lot. ” Because it is im- bel schemes and superfluous information on possible to test each unit for effectiveness before earlier blood product label formats. The uniform transfusion, the use of scientifically proven pro- label has allowed developers of automated testing tocols and regular checks on representative prod- systems and management information systems to ucts are important. design equipment and software around a single The use of computers for donor resources and machine-readable format for use in the United inventory management at the community blood States and several countries in Europe and the Far center, and standard policies for surgical blood East. needs at the transfusion service have improved As yet untapped, but applicable, technologies blood utilization, decreased outdating, reduced include: recruiting by computerized telecommuni- charges to the patient, and improved management cations linkages, donor and physician education of donor resources. Computer management of via cable health networks, and robotics labora- discrete functions has been accomplished at many tories to perform certain repetitive tasks (209). U.S. blood centers, but often lack coordination The feasibility of these alternatives is unproven, among donor recruitment, collection, laboratory, but studies are under way. inventory, and financial management depart- ments. One comprehensive information system has been designed as a joint venture between two Blood Collection community blood centers (Blood Center of South- Technologies involved with collection of blood eastern Wisconsin and the South Florida Blood from donors address three basic functions: 1) ac- Service) and Arthur Andersen & Co. The goals curate identification of donors, 2) determination of all such systems are to minimize manual docu- of donor suitability, and 3) collection of blood. mentation and subjective analysis, and provide useful statistics for operational management and Donor identification is accomplished in most planning. blood banks by the use of a cardboard or plastic A number of automated data management sys- card embossed with name, address, permanent identification number, and blood type. Most tems throughout the world utilize uniform bar blood banks also have rosters of “special” donors coding technology for the identification of donor against which the donor’s identification is com- units and samples for production and inventory pared. “Special” donors include individuals whose management. This uniformity, which has the blood is extraordinarily rare (for special needs), advantage of standardized machine-readable as well as simplified eye-readable features, is the re- as well as those whose blood is unacceptable for transfusion due to laboratory findings on previ- sult of a special task force of the American Blood ous donations. Commission, whose efforts were funded by the National Heart, Lung, and Blood Institute and en- Donor suitability is determined by an assess- dorsed by the International Society for Blood ment of current health status (temperature, blood Transfusion. pressure, screening test for anemia, etc. ) and an Ch. 4—Blood Technologies . 81 Figure 9.— Uniform Labeling Format for Blood Products Form 7203 (1/81) EXPIRES F 01255 I I II II I II \\ \ \ \ 9 Unit Number EXPIRES I \ -------- 1 hlrmd / LOT NO CODE SOURCE: E Rosslter, “Technologies for Blood Collection, ” 1984 interview covering past and present illnesses, im- (598). There are also concerns among blood bank munizations, hospital procedures, or other con- physicians about the adequacy of current donor ditions (including travel outside the United States, criteria when used for frequent, long-term donors lifestyle, and exposure to other individuals) which (562). could make donating blood unsafe for the donor or transfusion unsafe for the recipient. While some Pre-donation cell counts or hemoglobin meas- of the donor acceptability criteria are straightfor- urements generally assure that donating will not ward, most are subject to varying degrees of inter- be unduly risky for the donor and that an ade- pretation at the time of screening, In the absence quate number or volume of the desired compo- of factual information to support all the decisions nent can be collected. Findings of diminished that affect donor suitability, intuition is often used platelet effectiveness in individuals taking aspirin 82 . Blood Policy and Technology has led to deferral of such donors in platelet- donor who subsequently has a traumatic veni- apheresis programs (565). (See ch. 2, pt. 3, for puncture in the collecting process, only red blood a discussion of the risks to donors. ) cells and plasma
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