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Home , Blood donation, Plateletpheresis

11/13/2020

An Overview of DONATIONS Donation Requirements, OF THE PAST Restrictions, and Recent AM I Policy Changes Human-to-human ELIGIBLE transfusions were TO restricted to DONATE Objectives: collection and BLOOD? 1. Differentiate categories. 2. Explain the procedures that are performed as immediate transfusion part of the blood donation process in accordance with AABB standards. 3. Discuss donation deferral types, including the most recent deferral policy changes.

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DONATION TODAY DONOR CATEGORIES

• The blood supply today is safer than it has ever been • The process of selecting blood donors aims to determine that the Allogeneic donor is in good general health and free of transmissible infectious disease Autologous • A person's suitability to donate blood depends on two general considerations: Directed ✓the donation will not be injurious to the donor ✓the donated blood will not be unnecessarily hazardous to the recipient Therapeutic

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ALLOGENEIC DONATION AUTOLOGOUS DONATION

• Also termed homologous donation • Donor gives blood for own use • When a donor gives blood for • Donor and recipient are the same storage at a • May not be placed in regular • Donor and recipient are not the inventory if not used by donor same • For surgical use: orthopedic, • Recipient is unknown vascular, cardiothoracic

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DIRECTED DONATION THERAPEUTIC PHLEBOTOMY

• Blood donation requested to be • Units of blood are removed from patient for medical used for a particular patient indications and then discarded • No safer than blood from ➢Myeloproliferative Disorders general public ➢Hemochromatosis • Same criteria/testing as ➢ (PV) allogeneic donation ➢Porphyrias • May be placed in regular ➢Sickle cell inventory if not used 7 8

THE BLOOD DONATION PROCESS 1. Donor must provide identification 2. Demographic info is obtained Registration → Educational materials → Donor history → 3. Age requirements are defined by Abbreviated physical exam → Donation DONOR state laws REGISTRATION ➢Age 16 with parental consent ➢Age 17 without parental consent 4. Date of the last donation 5. Donor Deferral Registry (DDR)

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• Developed by AABB 1. Infectious diseases • Recognized by FDA 2. HIV/AIDS • Most recent version accepted by 3. Importance of honesty DONOR FDA 5/5/2020 EDUCATIONAL 4. Lab tests on donated blood HISTORY • Full length used for any donor MATERIALS 5. Notification of abnormal and/or QUESTIONNAIRE • Abbreviated version used for positive lab results (state law) (DHQ) frequent donors 6. Medication deferral list • Many facilities use computerized 7. vCJD at-risk countries self-interview • Consent form included here

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• Prospective donors should Age State law or ≥ 16 feel well and must meet all Weight 110 lb (50 kg) requirements: WHAT’S Temperature ≤ 99.5°F (37.5°C) ➢General appearance INCLUDED IN ABBREVIATED ➢Temperature THE ≤ 180/100 mmHg PHYSICAL ➢Weight ABBREVIATED EXAMINATION 50-100 bpm ➢Skin inspection PHYSICAL Regular rhythm ➢ or EXAM? < 50 bpm if athlete ➢Blood Pressure Hemoglobin ≥ 12.5 g/dL ➢Pulse Hematocrit ≥ 38%

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DONOR WEIGHT EFFECTS OF BLOOD LOSS

• Weight must be at least 110 pounds 10% loss - no effect ➢Defer if recent unexplained weight loss 20% loss - postural signs 30% loss - hypotension at rest • Cannot draw more than 10% of donor’s blood volume 40% loss – , shock • Standard donation is ~450 ± 45 ml 50% loss - lethal; if not corrected • Standard amount of anticoagulant is ~63 ml

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• Normal adult blood volume = 70 mL/kg WHAT IF I AM UNDERWEIGHT? WHAT IS • Average adult blood volume ≈ 5 Liters MY BLOOD VOLUME? Autologous or rare blood types when donor is < 110 pounds: Calculate blood volume: 150 lb patient Donor’s weight X 450 = Volume of blood to collect 150 lbs x 0.454 = 68.1 kg 110 68.1 kg x 70 mL/kg = 4767 mL 4767 mL / 1000 = 4.7 L = 5 L 63 - Donor’s weight X 63 = Volume of anticoagulant 110 to remove 17 18

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HEMOGLOBIN & HEMATOCRIT HGB AND HCT REQUIREMENTS Carries O2 on RBC % of RBC in

Hgb Hct Hemoglobin Hematocrit Normal: Normal: 14-18 g/dL 40-54% • Allogenic donation • Allogenic donation (male) (male) ≥ 12.5 g/dL ≥ 38%

12-15 g/dL 35-45% • Autologous donation • Autologous donation (female) (female) ≥ 11.0 g/dL ≥ 33% • Double RBC donation • Double RBC donation Donation: Donation: ≥ 12.5 g/dL ≥ 38% ≥ 13.3 g/dL ≥ 40% 19 20

WHAT ARE DEFERRALS? DEFERRAL TIMES • Donor is not eligible to donate at this time • Donor was deferred at a previous Temporary: donor cannot give for limited registration date period of time • Donor Deferral Registry (DDR) Ex: 2-week deferral after Yellow Fever vaccine ➢Checked at registration if a patient Ex: 3-month deferral after has any previous deferral Ex: Incomplete antibiotic regimen ➢Always checked before distributing a blood unit Ex: Hgb/Hct below minimum requirement

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DEFERRAL TIMES DEFERRAL TIMES

Permanent: donor will NEVER be eligible to give Indefinite: donor cannot give for unspecified Ex: Positive for HIV period of time Ex: Positive for HCV or HBV Subject to current regulations/requirements Ex: Certain medications (Tegison, human growth Ex: Some European travel hormone) Ex: Domicile in some countries Ex: Some cancers Ex: Some military service

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MEDICATION DEFERRALS MEDICATION DEFERRALS

• Aspirin or medications containing aspirin • Antibiotics ➢Irreversibly inactivates function ➢Indicates recent or present infection ➢Defer 48 hours for platelet donation ➢Defer until finished per SOP ➢No deferral for whole blood (WB) • Psoriasis treatments • Blood Thinners ➢Cause birth defects ➢Defer 14 days for platelet donation ➢Soriatane = defer 3 years ➢No deferral for WB ➢Tegison = defer permanent

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MEDICATION DEFERRALS VACCINE DEFERRALS • Human growth hormone, bovine insulin ➢Potential transmission of prion • 8 weeks: smallpox diseases • 4 weeks: Rubella, Varicella Zoster LIVE ➢Permanent or indefinite deferral • 2 weeks: Rubeola, mumps, oral polio (Sabin), Yellow VAX • HBIG ( Immunoglobulin) fever, oral typhoid fever ➢Indicates exposure to HBV ➢Defer 1 year • No deferral: flu, HAV, HBV, anthrax, cholera, DTaP, Rocky Mtn Spotted fever, rabies, injection polio (Salk)

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PERSONAL HEALTH DEFERRALS DONATION INTERVAL DEFERRALS

• Pregnancy Plasma or • Major Whole Double Platelet • Major illness Blood RBC ➢Cancer ➢Heart and/or lung problems 16 8 weeks 2 days ➢ conditions weeks • Received a blood transfusion • Received an organ transplant 29 30

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BLOOD EXPOSURE DEFERRALS MISC DEFERRALS • Contact with someone else’s blood • Transplant • Blood or body fluid contact • Tattoos ➢Occupational Needle Stick • Ear or body piercing • Mucous membrane exposure • Treated for CT/NG or ➢Open wound, non-intact skin; eyes, mouth • Juvenile detention centers, or prison for >72 hours

• 12-month deferral (old version) • 12-month deferral (old version) • 3-month deferral (new version) • 3-month deferral (new version) 31 32

SEXUAL CONTACT DEFERRALS TRAVEL DEFERRALS TRAVEL OUTSIDE OF OR THE USA • HIV/AIDS • Donors may have an ↑ risk of exposure to: • Prostitution • Injection drug user ➢ • Male who had sex with another male (MSM) ➢Creutzfeldt-Jakob Disease • Female who has had sex with MSM ➢Leishmania ➢Chagas • 12-month deferral (old version) • 3-month deferral (new version) ➢ • exposure – 12-month deferral ➢Zika

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MALARIA DEFERRAL Creutzfeldt-Jakob Disease (CJD) Variant Creutzfeldt-Jakob disease (vCJD) Travel from a non-endemic area to endemic area • Caused by prions (proteinaceous infectious particles) • 12-month deferral (old version) • Rapid degeneration of the cerebral cortex • 3-month deferral (new version) • Transmissible spongiform encephalopathies (TSEs) Domicile in endemic area • Mad Cow Disease • Defer 3 years

➢After departure ➢Remained symptom free

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VARIANT CJD CLASSIC CJD • First described in 1996 in the • Recognized since early 1920s • Strong scientific evidence that prion responsible for BSE or Mad Cow Disease is the same prion responsible for vCJD in • Mainly occurs in persons over 50 years of age humans • 85% of cases occur sporadically • Consumption of cattle products contaminated with BSE or from blood transfusions received from people contaminated • 5 – 15% of cases are hereditary (family history permanent) with BSE • Per CDC, 1979 – 2017 average annual rate in U.S. was 3.5 cases • Not the same disease as classic CJD per million • Permanent/indefinite deferral • Permanent/indefinite deferral

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LEISHMANIA DEFERRAL CHAGAS DEFERRAL • Intracellular protozoan parasite • Transmitted by sandfly What is ? • Operation Desert Storm • Trypanosoma cruzi • Operation Iraqi Freedom • Trasnmitted by bite from Reduviid bug, transfusion, • Defer 12 months breastfeeding, and ingestion of contaminated food/drink • Usually lifelong infection • Permanent deferral

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BABESIA DEFERRAL HEPATITIS AND HIV DEFERRALS What is Babesia ? • Tick-borne parasite Hep A • Blacklegged tick and deer tick • If recovered, ok to donate • May survive in RBC 3 weeks or more Hep B or Hep C • March 2018 = FDA licensed NAT test • Indefinite deferral

• 2-year deferral (from positive test) HIV/AIDS • Permanent deferral 41 42

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WHAT DO THE BAGS LOOK LIKE? OK, I’M ELIGIBLE. NOW WHAT?

• Donor properly identified • Collection bags labeled • Sample tubes labeled • Evaluate the site • Aseptic technique • 16-gauge needle • Most whole blood donations completed within 5 to 10 minutes

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WHAT’S WITH HOW IS MY ALL THAT BLOOD TUBING? DONATION • Segments produced TESTED? • 13 or more • For crossmatching and • ABO/Rh type investigation of • screens transfusion reactions • Retained by donor • FDA-licensed tests for center and transfusion infectious disease facility

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FDA-LICENSED TESTS FOR INFECTIOUS DISEASE

• Anti-HIV • HIV-1RNA • West Nile RNA • Anti- AUTOMATED COLLECTIONS • Anti-HTLV • Treponemal antigen (syphilis) • Anti-Hepatitis B core antigen • Ab to syphilis • Hepatitis B surface antigen • Ab to Trypanosoma cruzi APHERESIS • Hepatitis B DNA • Ab to • Hepatitis C RNA • Babesia DNA

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WHAT IS APHERESIS? APHERESIS

• Whole blood is withdrawn • Desired component is separated out • Remainder of blood is returned • Uses the same collection set/line (closed system) • Saline to replace volume loss • Same donor requirements as WB donation plus considerations

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ERYTHROCYTAPHERESIS

• Donation every 16 weeks • Regardless of gender • Single unit donation every 2 days • Double RBC apheresis donation ➢Hemoglobin ≥ 13.3 g/dL • One apheresis unit is equivalent to 2 WB-derived plasma units • Height and weight ➢Hematocrit ≥ 40% • Can be frozen and used for plasma transfusion ➢Females 5’5” and at least 150 lbs • May be used to make are immunoglobulin products ➢Males 5’1” and at least 130 lbs ➢Ex: HBIG, Rhogam (RHIg)

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PLATELETPHERESIS

• Single unit donation every 2 days • Single unit donation every 2 days • 1 unit of apheresis = 1 adult dose • Produces higher yield than WB-derived donation • 1 unit of apheresis platelets is equivalent to 6-8 WB-derived • Donor given G-CSF to increase granulocyte yield platelets units • Must contain minimum of 1 x 1010 granulocytes • Donor platelet count must be ≥ 150,000/ul • RBC and plts remain in units • Must contain minimum of 3 x 1011 platelets

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GEAUX DONATE!!!

• Our nation is experiencing CRITICAL shortages • URGENT need for RBCs and platelets

https://donor.lifeshare.org/donor/schedules/zip https://www.tbcdonors.org/donor/schedules/geo https://www.redcrossblood.org/give.html/find-drive

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CEU CERTIFICATE PIN# 0685

KRISTIN BUTLER, MPH, MLS (ASCP) CM LSU HEALTH SHREVEPORT 318-813-2919 [email protected]

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