The Central Blood Bank-Kingdom of Bahrain(CBB) with its team of highly trained professional staff offers its congenial and caring services to an increasing number of conscientious blood donors who know that this is the most precious gift that can be given by one human being to a fellow human.

A large number of blood-donation camps averaging 70 per year are organised each year with the cooperation of numerous socially responsible organisations and societies.Consequently about eleven thousand units are processed yearly – and the number is rising. Other health-care centres, Governmental and private, frequently use blood products and laboratory services of SMC, as this is the apex blood bank in the country as well as the largest. Hemapheresis is also a treatment modality that is offered by the blood bank and is finding increasing use in clinical medicine. Each donation, or unit, is tested whether the donor has given blood once or multiple times. Since CBB only accepts donations from unpaid volunteer donors, most blood is acceptable to transfuse. More than 97% of the blood collected by CBB passes all the tests. The CBB follows the International Standard and Regulation of the American Association of Blood Banks (AABB) and the International Society of Blood Transfusion (ISBT). These agencies set the standards for testing performed at CBB. If a donation is found unsuitable for transfusion to another person, CBB destroys the donated blood. Section also notify donors who have unsuitable test results. Donors with positive test results for blood-borne infections must not give blood again. Unsuitable units are not necessarily infectious. Because screening tests are so sensitive, some blood may react to tests, but be found negative when confirmatory tests are performed. These are called "false-positive" results. For the safety of the patient, CBB will not transfuse any unsuitable donations. "False-positive" units, as well as confirmed positive units, are discarded.

Donors results are confidential. Kingdom of Bahrain laws require CBB to report the names of donors found positive for specific tests to the Department of Public Health. This information is treated confidentially; however, it may be used for contact tracing by public health authorities. This information also provides statistical data for determining infection rates in the donor population.

Donor Information

Central Blood Bank provides Salmaniya Medical Complex and other Governmental and Private Hospitals patients with the vast majority of their transfusion needs. Most of our donors are volunteers blood donors who have been giving blood at our Center for years. Due to the generous support of these dedicated donors, we never needed to import blood from outside sources. All blood donors are important, but if you are type O or AB, you are special because type O negative red blood cells and type AB plasma can be transfused to any patient. Your donations are VITAL - please donate as often as you can, every 90 days for red blood cells. Having blood immediately available when it is needed may help save many lives.

Facts About Blood and Your Blood Donation

• The average adult has 10 to 12 pints of blood in their body;
• Your one donation can save up to 3 lives;
• No valid substitute for blood - so when you need it, the only possible way to get it is from other human beings;
• Any day, these facts could mean the difference between life and death;
• You cannot get AIDS or any other disease by giving blood;
• You can give whole blood every 90 days, single platelets every 48 hours;

Autologous Donations: may be made by patients for their own use at a future time. Because autologous blood is the safest type of transfusion to receive, we also provide this collection service for patients scheduled for elective surgery. Autologous donations, however, must be scheduled in advance and require physician approval.

Directed Donation: may be donated by specified persons, generally family members or friends, for use by a specific individual. Directed donors must meet the same screening requirements as routine transfusion donors. Directed donations have not been shown to be safer, and may potentially be less safe, than donations from random volunteer donors who have donated many times in the past.

What to expect when you donate:

1. Registration: Confidential information is gathered which will positively identify you and each of your donations.
   
   
2. Interview: A medical history is taken in a private booth. You will be asked some very personal questions. Please do not be offended. We are required to ask them.
   
   
3. Mini-Physical: Current pulse, blood pressure, and hemoglobin levels are determined.
   
   NOTE: Information from the interview and the physical is designed to make sure donating will not adversely affect you or any recipient of your blood. Some health conditions or medications may require a temporary deferral from donating.
   
   
4. Phlebotomy: You will be seated in a reclining donor chair. A tourniquet will be applied to your arm and a suitable vein located. The site will be cleaned with an antiseptic scrub containing iodine. (Please tell us if you are allergic to iodine as we have alternate methods.) A collection needle will be gently inserted into your vein and the blood collected in a sterile attached bag for 5 to 15 minutes. When the donation is completed, you will be asked to hold a gauze over the site while keeping your arm elevated. Finally a pressure bandage will be applied to the site and you may rest and enjoy some refreshments.
   
   

What Blood Tests Are Done:

1. ABO and Rh blood type along with tests for unexpected blood group antibodies.
   
   
2. Tests for antibodies, which may indicate past or present exposure to:
   
   
   • HIV, associated with AIDS
     
     
   • HBsAg (hepatitis B)
     
     
   • Anti HBc (hepatitis B core antibody)
     
     
   • HCV (hepatitis C)
     
     
   • Syphilis
     
     
   
   Donors with positive tests will be notified and placed on the deferral roster. In some cases, further testing is required to confirm the results obtained. Therefore, notification may take several weeks.
   
   

Care After Donating

1. Relax and enjoy the refreshments provided. You normally have 10 to 12 pints of blood in your body and have just donated about one. It will only take a few minutes before your body adjusts to the change. The fluid volume will be replaced in a few days, but the red cells will take several weeks. Remember, we have not taken enough to hurt you.
   
   
2. If you smoke, do not do so for at least 30 minutes. Doing so before then may make you lightheaded.
   
   
3. Be careful of alcoholic beverages. If you do drink any, the effect will be intensified because of your donation.
   
   
4. Drink plenty of non-alcoholic beverages. The more you drink, the faster the fluid volume of your blood will be replaced. We recommend 1/2 to 1 extra gallon in the next 24 hours.
   
   
5. Do not remove the bandage over the site for at least 4 hours. This gives it time to heal. If you notice bleeding before then, please raise your arm up and apply a new bandage just as was done after your donation.
   
   
6. Avoid strenuous activity for the rest of the day. Do not push, pull, or lift any objects greater than 25 pounds.
   
   

Important Information

1. You cannot get any disease from donating blood. The needles and bags we use are sterile, have never been used before, and will never be used again.
   
   
2. No one can obtain your test results without written authorization from you.
   
   
3. The Central Blood Bank staff will notify you of your results if indicated. You also permit us to notify the Public Health Directorate (Communicable Disease Section) of your identity if the test for hepatitis B (HBsAg), Hepatitis C, or HIV is confirmed positive.
   
   
4. The majority of donors do not experience any unpleasant effects from donating. Rarely, however, reactions do occur. If you have any unexpected reactions before, during, or after the phlebotomy, please tell us. Risks and/or complications associated with donating include the following conditions most of which are quite rare:
   
   
   • Rapid pulse rate
     
     
   • Dizziness or light headache
     
     
   • Itching at the site from an allergy to iodine
     
     
   • Bruising (hematomas), pain or nerve damage at the site
     
     
   • Nausea and/or vomiting
     
     
   • Convulsions
     
     
5. Remember, if you are newly infected, you can pass a disease but still test negative. So in order to protect others, donating just to obtain infectious disease results is prohibited. If you want to obtain infectious disease testing, please arrange that through your Health Center physician:
   
   

   Basic Requirements

   • Be in generally good health and feeling well.
     
     
   • Be at least 18 years of age; upper age 60.
     
     
   • Weigh at least 110 pounds (50kg).
     
     
   • Pulse: 80 to 100 beats/min and regular.
     
     
   • Temperature: Should not exceed 99.5 (37.5c)
     
     
   • Skin: the venipuncture site should be free of any lesion or scar of needle pricks indicative of addiction to narcotics or frequent Blood donation (as in the case of professional Blood donors).
     
     

Donation Frequency (may vary)

• You will be deferred permanently from donation if you have ever tested positive for HIV.
  
  
• You have ever injected yourself with drugs or other substances not prescribed by a physician.
  
  
• You have hemophilia or another Blood clotting disorder and received clotting factor concentrate.
  
  
• You have been held in a correctional facility (including jails, prisons and/or detention centers) for more than 72 hours in the last 12 months.
  
  

Relevance Of Some Medical Conditions In Relation To Blood Donations

• Accident & Injury: can donate if otherwise healthy.
  
  
• AIDS: cannot donate.
  
  
• Allergies: can donate if there is no infection present and there is no treatment ongoing.
  
  
• Anemia: defer donation until no symptoms exist.
  
  
• Arthritis: can donate if mild and not on medication.
  
  
• Asthma: those with severe asthma requiring regular treatment cannot donate; others can donate if there are no symptoms evident.
  
  
• Babesiosis: cannot donate.
  
  
• Blood disorders or bleeding tendencies: cannot donate.
  
  
• Blood Pressure: acceptable range is (systolic less than 200 mm Hg, and diastolic not more than 100). Please see medication section below for medication restrictions.
  
  
• Brain or spinal surgery that required a transplant of brain covering (dura mater): cannot donate.
  
  
• Bronchitis: defer donation until four weeks or after recovery.
  
  
• CJD: When a Blood relative has been diagnosed with Creutzfeldt-Jakob Disease (CJD), or there is an increased family risk of CJD; cannot donate.
  
  
• Cancer: Basal cell, squamous cell skin cancers and keratosis; cannot donate until removed and healed. Melanoma; cannot donate. Malignant tumors; can donate five years after removal of early stage contained solid tumor, no chemotherapy, and in remission
• Chicken Pox: defer donation until four weeks after recovery.
  
  
• Chlamydia: like all other venereal diseases; a minimum of a one year deferral is required.
  
  
• Colds, fever, flu, sore throat: cannot donate until symptoms (sore throat, cough, respiratory infection, headache) are completely gone.
  
  
• Cold Sore, Fever Blister, Canker Sore: can donate.
  
  
• Colitis: cannot donate.
  
  
• Colostomy: cannot donate.
  
  
• Dementia: cannot donate.
  
  
• Dermatitis: can donate if mild; defer donation if severe.
  
  
• Diabetes: can donate if treatment is by diet control, oral hypoglycemic medication and glucose level is controlled. If in insulin please see the Blood Bank physician.
  
  
• Diarrhea: defer donation until three weeks after recovery.
  
  
• Eczema: can donate if mild. Defer donation if severe.
  
  
• Emphysema: cannot donate.
  
  
• Filariasis: cannot donate.
  
  
• Food Poisoning: defer donation for one week after full recovery.
  
  
• Gastroenteritis: defer donation for one week after full recovery.
  
  
• Gall Stone: can donate if not on medication.
  
  
• Gonorrhea/Syphilis: defer donation for one year after complete recovery.
  
  
• Heart attack: can donate if greater than one year since, and no symptoms present, the attending Blood Bank physician must carefully evaluate.
  
  
• Heart surgery, Coronary artery bypass surgery (CABG) or angioplasty: can donate one year after surgery, if no history of heart attack, and the donor is on no medication for the heart (aspirin is okay).
  
  
• Hemochromatosis: cannot donate.
  
  
• Hepatitis: Hepatitis or undiagnosed jaundice after age ten; can not donate. Positive hepatitis test: cannot donate. Can donate if the history of hepatitis is pertaining to mononucleosis or CMV infection.
  
  
• Herpes (genital): can donate four weeks after lesions completely clear.
  
  
• Leprosy: cannot donate.
  
  
• Malaria; had Malaria in last three years: defer donation for three years after full recovery.
  
  
• Pregnancy and Miscarriage: can donate after six weeks of full term normal delivery. Can donate six weeks after termination in third trimester. First or second trimester miscarriage can donate after stable.
  
  
• Sickle Cell Trait: can donate.
  
  
• Seizures in the last five Years: cannot donate.
  
  
• Spondylosis: can donate if feeling well and not under any treatment at all.
  
  
• Strokes: cannot donate.
  
  
• Surgery (all): can donate after healed and released from physician care.
  
  
• Syphilis: see Gonorrhea.
  
  
• Thyroid: for Hypothyroid, can donate if feeling well and euthyroid on thyroxine for six months. For Hyperthyroid: cannot donate until euthyroid for six months.
  
  
• Tuberculosis: cannot donate until two years after complete cure.
  
  
• Viral Infection: can donate after cure and off treatment.
  
  
• Worms: can donate after complete cure.
  
  

Medication Guidelines

• Acetaminophen (e.g. Tylenol): may be taken in normal moderate doses before any Blood donation.
  
  
• Accutane (Isotretinoin, eg. for acne): four-week deferral.
  
  
• Allergy medication: can donate.
  
  
• Antibiotics: 72-hour deferral after infection is healed.
  
  
• Anti-inflammatory drugs (Advil, Ibuprofen, Motrin and Naprosyn): may not be taken within 24 hours before a platelet donation (some other rules may apply) .
  
  
• Aspirin-containing products or Feldene and Lodine XL: may not donate within 36 hours before platelet donation.
  
  
• Birth control pills: can donate.
  
  
• Blood pressure medication: can donate if not beta-blocker medication.
  
  
• Depression medication: can donate.
  
  
• Diabetic medication - Injected bovine (beef) insulin; cannot donate.
  
  
• Diet pills: can donate.
  
  
• Diuretics: can donate.
  
  
• Female hormone pills: can donate.
  
  
• Any human pituitary-derived hormone (i.e. growth hormone): cannot donate.
  
  
• Soriatane (Acitretin): three-year deferral.
  
  
• Tegison (used to treat a severe skin disorder): cannot donate if ever taken.
  
  
• Thyroid medication: can not donate.
  
  

Immunization Exclusions

• Polio, mumps, smallpox: two-week or more deferral.
  
  
• Rubella or Rubeola (types of measles): four week deferral.
  
  
• Tetanus, diphtheria, flu, Hepatitis B: cannot donate until any reaction is over.
  
  

Other Possible Restrictions

• Acupuncture: one-year deferral.
  
  
• Alcohol: defer donation if consumed in last 12 hours.
  
  
• Body piercing: one-year deferral.
  
  
• Cocaine: taking through the nose (snorting); one-year deferral minimum, local Blood authority will prevail.
  
  
• Dental work - Cleaning and fillings: one-day deferral; Root canal: three-day deferral after work is complete.
  
  
• Ear piercing: can donate if the piercing was performed in a doctor’s office (with written verification) otherwise, one-year deferral.
  
  
• Electrolysis: defer donation for one year.
  
  
• Hepatitis exposure: one-year deferral.
  
  
• Menstruation: defer donation until bleeding stops.
  
  
• Rape: one-year deferral.
  
  
• Smoker: can donate.
  
  
• Tattoo in the last 12 months: one-year deferral.
  
  
• Transfusion: defer donation by one year if undergone transfusion with Blood products. Can donate if undergone autologous transfusion only.
  
  

Directed Donations

Directed Donations are units collected from family members and friends whom the patient has specified. It is the patient’s responsibility to select the donors. However, directed donors must meet the same criteria as donors for the general blood supply.

All directed donors must meet the same basic health criteria as regular donors. Contact the Central Blood Bank. Our staff will make an appointment for your donors and explain all the details of directed donations.

Is Directed blood safer than the general blood supply? No. There is no scientific evidence that blood for directed donations is safer than the general blood supply. Occasionally, however, patients, their families and friends feel more comfortable if blood transfusions come from family members or friends.

Are there special concerns for directed donations? Yes. The patient must have a minimum of a week to plan for their directed donors. The donor and patient need to be to know their blood type. In order to protect the donor’s privacy, information regarding names of donors or individual units of blood will not be available.

Central Blood Bank, will deliver the blood to the hospital location where you are admitted and will make every effort to see that your blood is available when you have your surgery. There are circumstances, however, that could prevent your donations from being available for use. These circumstances include a positive test result for certain infectious diseases in the blood, not enough time required for processing the blood, the breakage of the plastic bag in which the blood is collected, a power or mechanical failure of the refrigerators used to store the blood, etc.

What happens if I need more blood than I donated prior to surgery? If more blood is needed than you will be given blood from our Central Blood Bank stock. All blood comes from healthy volunteer donors who are thoroughly screened prior to donation. Each donation is tested before it is released to the general blood supply.

What happens if my surgery is postponed? Your red cells may be stored up to 42 days from the day it is donated.

What happens if I do not need all of the blood that has been donated for me? Once your doctor had determined that you would no longer need any additional blood, the remaining units will be released to the general community supply, unless otherwise directed by your doctor.

How soon before my surgery should the directed donations be made? Donations can be made up to 42 days before the scheduled surgery. However, donations must be made at least one week before the scheduled surgery. This allows time for Central Blood Bank. To do all testing and screening procedures in time for your use.

Designated Donor Program

In the event that you need to undergo surgery, which will utilize a few units of blood and choose not to utilize the hospital’s volunteer blood supply, our Designated Donor Program may be an option for you. This program makes it possible for a patient to receive blood from donors they have chosen.

Designated donations have not been proven to be any safer than the general blood supply. The only possible benefit is to the patient’s peace of mind.

The program may be of use to patients who:

• Will use a limited amount of blood.
  
  
• Will use the blood within a specified amount of time.
  
  
• May feel better emotionally about receiving blood from family members
  
  

Designated donations are not suggested for patients who:

• Will need on-going transfusion over a long period of time.
  
  
• Will need blood in unknown or large amounts (cancer, leukemia, transplants).
  
  

What are the guidelines for setting up a program?

If the designated program is chosen, it becomes the responsibility of the patient or their medical proxy to:

• Authorize or set up a Designated Donor Program. To set up the program, it is preferred that the patient comes to the donor center. This way, all the forms can be filled out, the program explained and the consent documents reviewed.
  
  
• Choose the donors and inform them of donation guidelines.
  
  
• Distribute the signed consent forms.
  
  
• Inform donors in what time frame they should donate.
  
  

Cnsent forms may be photocopied prior to the signature, but all donors must have a consent form signed with the patient/medical proxy's original ink signature when they come to donate.

Unfortunately, no exceptions can be made for faxed or photocopied signatures.

Donors must meet the general blood requirement criteria.

Whole blood designated donations

No appointment is necessary for whole blood donations. Designated red blood cells are reserved for the patient for 30 days from the date of donation. The platelet and plasma portions of the donor's blood are released to the general blood supply. To allow time for processing, blood donations should be made between 2 weeks - 48 hours prior to the surgery or scheduled transfusion.

Plateletpheresis designated donations

Plateletpheresis donations are made by appointment only. Plateletpheresis products are reserved for the patient for a minimum of 3 days. To allow time for processing, platelets should be donated at least 24 hours before they will be needed.

Red Cell Compatibility Chart

Autologous Donation

Autologous blood is drawn from an individual prior to surgery and given back to the same individual when and if a need for transfusion arises.

This is safest possible blood transfusion, as there will be almost no risk of any adverse reaction or infectious disease; and your blood will be available when needed. This will help conserve our community blood supply so that there will be enough blood available for both emergencies and for those who cannot donate for themselves.

A physician's prescription is needed for autologous donations. Bring your prescription to the Central Blood Bank. Appointments are not required, but are recommended. Your donation must not occur within 72 hours of your scheduled surgery. At the time of donation, your blood is specially labeled with tags. It is tracked through the processing, testing and delivery cycle to make sure you, and only you, will receive it. If you do not use the blood you donated for yourself during your surgery, it will be discarded.

Setting up an autologous donation program

Physician will decide that autologous blood donation is in your best interest, then your physician will then fill out the "Autologous BloodOrder Form" and submit it to the Blood Transfusion Service.

You should not try to donate for yourself more frequently than once a week. Ideally, you should allow yourself from 7 to 10 days to recover between donations and 7 to 10 days to recover before surgery.

If this will be your first time making a blood donation, please consider bringing a companion in case of unforeseen difficulties.

The day of your donation

You should eat a good meal within 3 hours of donating.

When you arrive at the Donor Center:

1. You must present your CPR Card.
   
   
2. You will be asked to fill out a Donor Health Questionnaire
   
   
3. You will then register and a technician will do a quick fingerstick to make sure you are not too anemic (low blood count) to donate.
   
   
4. The blood bank physician or a nurse who will review your health history will interview you in private. The nurse will also be able to answer any questions or concerns you have regarding autologous donations. If you have a disease of the heart or lungs, you should tell the nurse at the time of the interview. You will be asked to sign consent for the donation.
   
   
5. A unit of blood (approximately 500 ml) withdrawn from an arm vein. The actual blood draw takes about 10 minutes. Only disposable, sterile needles are used.
   
   
6. After your blood is drawn, you will be asked to relax in the donor lounge and have some juice and cookies to help your body replace the lost volume.
   
   The entire process will take between 45 minutes to an hour.
   
   

What are the benefits and risks?

Autologous blood donation is most useful for surgical procedures where blood is commonly used and for patients for whom blood donation is safe. Surgeon will be able to tell how likely it is that you might be transfused during a specific procedure.

Many surgical procedures do not usually require blood transfusions and so autologous blood donation is not necessary.

Although many people can donate blood safely for themselves, blood donation may put patients with heart and lung disease or anemia at risk for complications. Patients with these medical problems may experience chest pain (angina) or shortness of breath, or increased anemia as a result of donating blood.

Special considerations before coming in to donate

If you have a cold, have taken antibiotics within the last 48 hours (except for prophylactic use) or have had dental work within the last 48 hours, you will not be able to donate and should reschedule your appointment

Blood donation may worsen some seizure disorders or heart conditions. You may not donate if you've had seizures.

You should inform the nurse at the time of the interview if you have experienced any of these problems.

The handling of your donation

Your unit of blood will be tested the same way as a volunteer blood donation.

If a medically important result is obtained from any one of these tests, both you and your physician will be notified.

Blood will be stored for you for up to 42 days as whole blood in liquid form. Any blood stored for you will be discarded shortly after you are discharged from the hospital.

If surgery or procedure is delayed inform the Blood Transfusion Service at 289455. It is your responsibility to communicate changes in your plans to us.

Rarely, accidents occur and units of blood, or the sample tubes for testing, break open, leak or become contaminated. If such an accident should occur, it may not be possible to test or save your unit and it would then not be available for use. You would be notified if such an event did occur.

If you need more blood than you have donated for yourself, banked blood from volunteer donors will be available if you and your physician decide that a transfusion is necessary.

Possible complications of giving blood.

Only a small number of donors experience any unpleasant effects from donation. During the donation, some donors feel light-headed or nauseous and a few even faint, especially if they haven't eaten recently.

After the donation, donors occasionally report one of the following: pain in the arm, bruising, nerve damage, local infection (finger or arm), skin allergic reaction to iodine (used to wash arm), light-headedness, fainting, or rapid heart beat.

All of these problems are uncommon.

Even people who can't donate blood for others may be able to give blood for themselves.

Donation Guidelines

• You must have a medical order from your doctor prior to the first donation.
  
  
• You must plan ahead (3-6 weeks) so there will be enough time to donate the needed number of units.
  
  
• You may give a unit of blood as often as once a week.
  
  
• Donations should be discontinued at least a week before surgery. You cannot be an autologous donor if you are anemic. Your doctor will probably recommend that you take an oral iron supplement throughout the donation period.
  
  

Apheresis Donor Program

Patients of Bone marrow transplants, cancer, leukemia and other fatal blood disorders during treatment are susceptible to infection and bleeding because malignant and healthy cells are destroyed. Transfusion of platelets is needed to control these complications. Apheresis blood donor can aid in this process.

Special automated devices called apheresis (a-fur-ee-sis) machines can separate blood into its components. Unlike a whole blood donation, during an apheresis donation, a needed component, or a combination of components (such as platelets or plasma), can be collected and saved while the remaining unneeded components are returned to the donor. Donor blood remains inside sterile, disposable plastic software at all times and is not exposed to any tubing or equipment that has been in contact with another donor's blood. All apheresis donors must meet all regular donor criteria. Apheresis procedures usually last between 45 to 90 minutes.

If you are suitable to give a pint of whole blood, you are usually fit to be an apheresis donor. However, the following additional guidelines have been established:

1. You should have given whole blood at least once before being considered for apheresis; to be sure that you tolerate the blood donation well and that all the tests we do on your blood are normal.
   
   
2. You should not take aspirin or an aspirin-containing drug within the 36 hours preceding a platelet donation.
   
   
3. Your blood cell count must be high enough so we may collect the best possible product for the patient and your own cell count will not drop too low after the procedure. (We will do a test to count your cells during each procedure.)
   
   
4. Individuals with a history of hypertension are carefully evaluated. Individuals with diabetes or epilepsy are evaluated on a case-by-case basis.
   
   
5. If you have given whole blood, you must wait 48 hours after that donation before you may undergo an apheresis procedure. However, you may make an appointment in advance with the Central Blood Bank-SMC.
   
   
6. You should have very good veins in at least one arm.
   
   

Platelet transfusions are needed each year by thousands of patients like Heart Surgery Patient 6 units, Burn Patient 20 units, Organ Transplant Patient 30 units, Bone Marrow Transplant Patient 120 units.

Testing Donor for infectious disease

The Central Blood Bank and is committed t ensuring a safe blood supply for everyone who may need transfusions. An important step in ensuring safety is the screening of donated blood for infectious diseases.. The following tests are performed on each unit of blood:

Hepatitis B Surface Antigen (HBsAg)

Antibodies to the Hepatitis B Core (Anti-HBc)

The anti-HBc test detects an antibody to the hepatitis B virus that is produced during and after infection. If an individual has a positive anti-HBc test, but the HBsAg test is negative, it may mean that the person once had hepatitis B, but has recovered from the infection. Of the individuals with a positive test for anti-HBc, many have not been exposed to the hepatitis B virus. This kind of test result is called a false positive, and although the individual may be permanently deferred from donating blood, it is unlikely that the person’s health will be negatively affected.

Antibodies to the Hepatitis C Virus (Anti-HCV)

Antibodies to the Human Immunodeficiency Virus, Types 1 and 2 (Anti-HIV-1, -2)

This test is designed to detect antibodies directed against antigens of the HIV-1 or HIV-2 viruses. Both of these viruses can cause acquired immunodeficiency syndrome, or AIDS. A new kind of testing called nucleic acid amplification testing or NAT is believed to identify HIV infection even sooner and it may make the latter test unnecessary.

VDRL

This test is done to detect evidence of infection with the spirochete that causes syphilis.

Confirmatory Testing

All of the above tests are referred to as screening tests, and are designed to detect as many infections as possible. Because these tests are so sensitive, some donors may have a false positive result, even if the donor were never exposed to the particular infection. In order to sort out true infections from false positive test results, may be followed up with more specific tests called confirmatory tests .

If the test result from a donated unit of blood is abnormal for any of these disease markers, the unit is discarded and the donor is notified. The donor’s name is then added to a donor deferral list and is prohibited from donating blood indefinitely.

Common blood products

Whole blood

Blood and Blood component products, like any other use of intrusive medicine, should be used only in critical conditions. All around the world, most countries have stopped giving whole Blood to the patients for the following reasons:

• whole Blood may be a carrier of transfusion-transmitted diseases.
  
  
• Keeping in mind the frequency of serious shortages of quality Blood, it is considered imprudent to use whole Blood.
  
  
• Most patients require only one particular component of whole Blood. Better patient management is achieved by giving only the desired and/or essential component.
  
  
• Utilizing normal Blood storage techniques, Blood products have a greater shelf life than whole Blood.
  
  
• Blood filtration and other techniques help to make Blood safer; and, Blood products can often be infused regardless of ABO Blood group.
  
  

The product of one unit of donated Blood plus ACD (anticoagulant/ preservative). whole Blood contains one unit of plasma and cells. Whole Blood can be stored, normally and conventionally, for 5 weeks. Factors V and VIII are labile and are significantly decreased after 7 days.

If "fresh" (less than 24 hours since drawn) whole Blood is still utilized in resuscitation of a patient who has been loosing a lot of Blood. Whole Blood is not used for "routine" Blood transfusion when red cells (RBC) will suffice. Since one unit of donated Blood can be broken down into one unit RBC, one-unit platelets, and one unit fresh frozen plasma (FFP), and more, the use of whole Blood is considered to be a waste of resources.

Following here is a set of common products made from donated Blood:

Red blood cell components

• Red Blood Cells (RBC).
• Washed Red Blood Cells.
• Leukoreduced Red Blood Cells.
• Pediatric/Divided RBCs Units.

Platelets

Fresh frozen plasma

Cryoprecipitate

CMV negative, irradiated and leukoreduced preparations

• CMV Negative Blood and Components.
• Irradiated Blood and Components.
• Leukoreduced Blood and Components.

RBC

Description - One unit of red Blood cells (RBC) contains approximately 180ml (range 150 to 210 ml) of red cells, 100ml of ö(Adsol) and approximately 30ml (range 10 to 50 ml) of plasma. As an average, the total volume of a RBC unit is 310 ml (range 270 to 350 ml).

A unit of RBC is prepared from a whole Blood collection using a closed sterile system. Blood is drawn into a bag containing the anticoagulant CPD. Most of the platelet rich plasma is separated with a centrifuge and separated into an attached container. 100 ml of an additive nutritive solution (Adsol) is added to RBC. Adsol® is a crystalloid solution containing sodium, dextrose, adenine and mannitol. The Adsol supports red cell survival and extends the shelf life of the unit to 42 days. The added fluid volume of the Adsol also reduces the unit's hematocrit to ~57% (range 50 to 65%), thereby improving the flow characteristics of the component. Adsol^® is also known as AS-5.

All RBC transfusions must be ABO/Rh compatible with the recipient. Packed red Blood cells do not provide viable platelets or neutrophils, nor do they provide clinically significant amounts of coagulation factors. RBC must be stored between 1°C to 6°C.

Indication - Red Blood cells are indicated for patients with symptomatic anemia that is not treatable with specific therapy such as iron, vitamin B12 or with folic acid.

Therapeutic Effect - In a 155-pound adult, one unit of RBCs can be expected to increase the hematocrit by approximately 3% or the hemoglobin by 1 gm/dl.

Washed Red Blood Cells

Description - Washed red Blood cells are red Blood cells washed with normal saline to remove most of the plasma. Washed red Blood cells should not be considered leukoreduced. Because the bag must be entered to introduce the saline, washed red cells must be given within 24 hours of their preparation.

Indication - Washed red cells can be considered for patients who have had repeated hypersensitivity reactions to Blood or components despite prophylactic administration of antihistamines. It should be kept in mind, however, that the red cell washing procedure might not reduce the proteins enough to prevent hypersensitivity reactions (e.g. hypersensitivity to IgA). Controversial indicators for washed red Blood cells include complement mediated immune hemolysis and paroxysmal nocturnal hemoglobinuria.

Therapeutic Effect - A unit of washed red Blood cells will raise the hematocrit less than will a unit of red Blood cells because of an approximate 20% loss of red cells from the unit during the washing process.

Leukoreduced Red Blood Cells

Description - Leukoreduced red Blood cell units contain leukocytes in a specifically reduced amount. We use filtration to make leukoreduced red Blood cell units.

Indication - The most common indication for leukoreduced red Blood cells is for patients who have experienced two or more non-hemolytic febrile transfusion reactions. Leukoreduced red cells are usually effective in preventing non-hemolytic febrile transfusion reactions for most patients.

Leukoreduced red Blood cells are also effective in prevention of CMV transmission or HLA alloimmunization.

Therapeutic Effect - Leukoreduced red Blood cells will have a slightly lower therapeutic effect than red cells that have not been leukoreduced. Depending on the filter used, there is a 10 to 15% loss of red cells with leukoreduction by filtration.

Pediatric/Divided RBC Units

Description - Pediatric/Divided red Blood cell units are prepared by separating packed red blood cell unit into multiple bags. This processing minimizes wasting Blood when only small volume transfusion is required. In addition, it may reduce the recipient's donor exposure because four units for transfusion are available from one unit of donated Blood. Divided red cell units are issued when they are less than six days old. This helps ensure adequate amounts of 2,3 DPG for optimal delivery of oxygen to the tissues and relatively low plasma potassium levels when stored a shorter period of time. All divided units are irradiated. They may or may not be serologically negative for CMV.

Indication - Divided red Blood cell units are indicated for infants who require small amounts of red cells.

Therapeutic Effect - A divided red Blood cell unit will increase the hematocrit/hemoglobin the same as a standard red Blood cell unit when corrected for the weight of the child and the volume infused.

Platelets

Description - Platelet products also contain plasma (coagulation factors), some red cells and some white cells (leukocytes). Platelet products are usually cloudy and yellowish in color but may occasionally have a pink tone because of the presence of residual red cells. Platelets are stored at 22 C° (room temperature) and require continuous gentle agitation. They can be stored at the Blood Bank for up to five days. When received for transfusion, both pooled and apheresis platelets will expire in less than four hours.

A Whole Blood Platelet Concentrate is prepared from whole Blood by an initial soft centrifugation to separate the red cells from the platelet rich plasma. A second harder centrifugation is used to concentrate the platelets that are then resuspended in 50-60 ml of residual plasma. Each unit contains a specific ratio/quantity of platelets. To provide an adequate dose of platelets for an adult, four to six platelet concentrates of the same Blood type are issued for transfusion. Pooled platelets are generally issued ABO type compatible, but other types may be substituted. One should avoid, if possible, giving type A platelets to an O recipient. If the O recipient happens to have a high titer of anti-A, the post transfusion platelet increment will be reduced. Platelets products contain an insufficient number of red cells to cause an incompatibility reaction. There are sufficient numbers of red cells, however, for an Rh negative person to be sensitized (develop Rh antibodies) if they receive Rh positive Blood. There is very little risk of the patient having an incompatibility reaction because the plasma in a pooled unit is combined from different donors thereby reducing the possibility that isoagglutinins (anti-A and/or anti-B) would be present in high titer. Due to the smaller blood volumes of infants and small children, ABO compatible or reduced volume ABO incompatible platelets must be given.

Apheresis Platelets are obtained from one donor with the use of an apheresis machine. Blood is drawn from a donor’s arm into a self-contained, single use Blood tubing/collection set which has been inserted into the apheresis machine. Blood does not come into contact with the apheresis machine itself. Anticoagulant is added to the Blood as it is drawn from the donor. The platelets are separated from the red cells, leukocytes and most of the plasma by centrifugation. The red cells, leukocytes and plasma are returned to the donor, and the platelets are retained in a collection bag for later transfusion to a patient. The procedure takes approximately 60 to 90 minutes.

The majority of apheresis platelets collected contains less than a specific amount of leukocytes and are labeled as leukocyte reduced.

One apheresis collection of platelets generally contains 200 to 400 ml of plasma. Because of the possibility of a high titer of ABO antibodies in the donor plasma, the unit is volume reduced in cases of minor ABO incompatibility. Apheresis platelet concentrates can be collected from unselected community donors. This yields a product known as a Random Apheresis Platelet (RAP). Alternately the platelets may be drawn from a family or community donor who has been specifically matched to the patient on the basis of HLA (Human Lymphocyte Antigen) typing. This yields a product known as a Matched Apheresis Platelet (MAP).

Random Apheresis Platelets are available in two doses: Standard and Large. The standard dose contains a smaller average count of platelets (approximately equivalent to four units of pooled platelets). The standard dose is generally ordered for smaller patients, for those in whom a high platelet count is not required, and for patients who respond well to transfusion. The large dose contains, as the name would indicate, a greater average number of platelets, approximately equivalent to six units of pooled platelets. The large dose is generally ordered for larger and heavier patients, for those in whom a high platelet count is desired, and for those who do not respond well to transfusion.

As many platelets as possible are collected from HLA matched apheresis donors, therefore it is not necessary to specify dose when ordering these platelets.

Indications - Platelet transfusions are indicated for patients with bleeding due to either thrombocytopenia, platelet dysfunction or some combination of the two conditions. The point at which bleeding may occur varies depending on the patient’s condition. The majority of patients with normal platelet function will not experience bleeding until the platelet count drops below a certain point. In patients with abnormal platelet function, usually caused by drugs (e.g. aspirin or semi-synthetic penicillin), uremia or elevated split products of fibrinogen/fibrin, bleeding may occur with higher platelet counts. In patients undergoing surgery, bleeding may occur with relatively low platelet counts.

In addition to evaluating platelet count and patient condition, bleeding time may also be used in determining the need for platelet transfusions. A bleeding time twice the upper normal limit may be an indication for a platelet transfusion in a bleeding patient. HLA Matched platelets are indicated for patients who are refractory (demonstrate a poor post-transfusion platelets increment) to random donor platelets due to alloimmunization.

Patients with auto-immune thrombocytopenic purpura (ITP) should not receive platelet transfusions unless bleeding is significant or life threatening. Platelet transfusions given to patients with ITP will be rapidly removed from circulation by the patient’s anti-platelet antibodies and thus will be, at most, only of transient benefit.

Therapeutic Effect - Each unit of platelets prepared from donated whole Blood contains a certain number of platelets and can be expected to increase the platelet count of a 70 Kg patient by a known approximate amount by one hour after transfusion. Since the usual dose for adults with platelet related bleeding is a pool of four to six units of platelet concentrates from whole Blood or one standard sized unit of apheresis platelets, an increase in the platelet count by one hour after transfusion is expected.

Effect of Platelet Product and Patient Weight on Platelet Increment*

*Data is given as one-hour post transfusion platelet increment

Patients demonstrating two consecutive platelet count increases of less than a known standard range at one hour after transfusion of four to six units of pooled platelets (or one unit of apheresis platelets) are considered refractory. Failure to achieve hemostasis or the expected increment in the platelet count may signify a refractory state. A refractory state to platelets may be caused by fever, sepsis, DIC, or splenomegaly or an immune response to the platelets also referred to as platelet alloimmunization. In patients with alloimmunization, HLA matched platelets may be necessary to control bleeding due to thrombocytopenia.

Fresh Frozen Plasma (FFP)

Description - Fresh frozen plasma (FFP) is the plasma removed from a unit of whole Blood and frozen at or below –20 C° within eight hours of collection. FFP contains all coagulation factors in normal amounts and is free of red cells, leukocytes and platelets. It is not a concentrate of clotting factors. One unit is approximately 225 ml and must be ABO compatible with the recipient’s red cells, Rh need not be considered.

Indications - FFP is indicated for patients with documented coagulation factor deficiencies who are actively bleeding or who are about to undergo an invasive procedure. Causes of such deficiencies include congenital deficiency, liver disease, anticoagulation with warfarin or massive transfusion with red cells and crystalloid/colloid solutions. Factor deficiencies severe enough to be clinically significant are usually associated with prolongation of the coagulation screening tests (prothrombin time, partial thromboplastin time) at least 1.5 times the control value or an INR of 1.6. FFP is also indicated in treatment of thrombotic thrombocytopenic purpura (TTP), usually in conjunction with plasma exchange. FFP should not be used for volume expansion or nutritional support. Immune globulin preparations are available for the provision of immune proteins instead of FFP. Reversal of warfarin anticoagulation should be accomplished with Vitamin K rather than FFP if two to three days can be allowed for clotting factors to return to hemostatic levels. Massively bleeding patients may be given FFP along with red Blood cells to prevent dilution of clotting proteins.

Therapeutic Effect - One ml of FFP per Kg of patient weight will raise most clotting factors by approximately 1%. FFP should be used as soon as possible after it is thawed and always within 24 hours after thawing. The amount of FFP needed depends on the patient’s clotting factor levels, levels needed to achieve a therapeutic effect, whether or not the patient is bleeding and the patient’s Blood volume. Clotting factor activity should be estimated by specific coagulation factor assays, or in emergencies, at least by coagulation screening tests.

Cryoprecipitate (CRYO)

Description - Cryoprecipitate (Cryo) is a low purity concentrate of three hemostatic proteins prepared from donated whole Blood. A single bag of Cryo contains an average of 100 units of factor VIII and von Willebrand factor and 150 to 250 mg of fibrinogen with some factor XIII and fibronectin. No compatibility testing is required and ABO-Rh type is not relevant. However, due to their small Blood volumes, children less than one year of age should be given ABO compatible Cryo in case trace amounts of anti-A or anti-B are present. When Cryo is ordered, units are thawed, suspended in sterile normal saline (20ml/bag) and pooled. Once pooled, Cryo should not be chilled or refrigerated, as the protein will re-precipitate. The volume of a dose of Cryo depends upon the number of units pooled. For young children who cannot tolerate a large volume or to increase the fibrinogen concentration for fibrin glue preparation, Cryo can be suspended in 10 ml of saline per bag (reduced-volume Cryo). Cryoprecipitate is the only fibrinogen concentrate available for intravenous use.

Indication - Cryoprecipitate is indicated for bleeding or imminent invasive procedures for patients with significant hypofibrinogenemia (<100 mg/dl). Commercial Clotting Factor Concentrates made with viral inactivation methods are preferred over Cryo for hemophilia A and von Willebrand treatment.

The use of cryoprecipitate for the preparation of fibrin glue is increasing as applications in neurosurgery, orthopedic and ENT surgeries are expanding. Autologous units can be collected ahead of time and processed into Cryo to be used for fibrin glue.

Therapeutic Effect - When used for fibrinogen replacement, ten bags should provide enough fibrinogen to raise the fibrinogen 60 to 70 mg/dl in a 70 KG adult. Fibrinogen levels and the patient’s clinical response can monitor therapeutic effect.

Note: Cryoprecipitate transfusions may be prepared from a designated donor for some young or mildly affected patients with hemophilia A or von Willebrand disease to limit potential viral exposure through transfusions. These single donor Cryo products may have higher concentrations of factor VIII and von Willebrand factor than regular donor Cryo because of DDAVP used to stimulate the apheresis donor prior to collection. Multiple bags of high potency Cryo are then prepared from one collection.

A single unit (bag) of Cryo is usually adequate for the preparation of fibrin glue unless more than 10 ml is needed.

CMV Negative Blood Components

Description - CMV is a herpes virus that resides in the white Blood cells of persons who have been infected with the virus. There is a high prevalence of CMV positive persons worldwide. Most persons that are CMV positive have no history of illness.

CMV transmission to susceptible patients is effectively prevented by use of either CMV seronegative, a donor determined to be negative for antibody to CMV, or Leukoreduced, containing less than a certain range of leukocytes.

Cryoprecipitate and Fresh Frozen Plasma are cell free and have not been implicated in CMV transmission.

Indications - CMV negative Blood products are indicated for patients in the following categories, regardless of CMV status of the mother

• Premature infants;
  
  
• Infants under four weeks of age; and,
  
  
• Patients requiring intrauterine transfusion.
  
  CMV negative Blood products are indicated for CMV negative patients in the following categories:
  
  
  • Bone marrow or organ transplant recipients (if the marrow or the organ donor is also CMV negative);
    
    
  • Potential candidates for transplant;
    
    
  • AIDS or HIV infected patients;
    
    
  • Patients who have congenital immune deficiency;
    
    
  • Patients undergoing splenectomy; and,
    
    
  • Pregnant women.
    
    
  If CMV status is pending in these patients, CMV negative components are indicated. CMV negative components are not considered necessary for patients receiving chemotherapy.
  
  

Therapeutic Effect - In patients with compromised immune systems, a CMV infection could result in a serious complication. CMV negative or leukoreduced Blood products reduce this hazard.

Irradiated Blood Products

Description - Irradiated Blood products are exposed to approximately 2500 rads of Gamma radiation to destroy the lymphocyte’s ability to divide. Transfusion-associated graft-versus-host disease (TA-GVHD) has not been reported from transfusion of cryoprecipitate or fresh frozen plasma (FFP), thus these components do not require irradiation. Fresh plasma (not frozen) for transfusion should be irradiated if the patient is at risk for TA-GVHD.

Indications - The following indications for irradiation apply to patients with the listed diagnoses.

Absolute Indication:

• Bone marrow transplant (BMT) recipients (allogeneic, autologous);
  
  
• BMT or stem cell donors if allogeneic transfusion must be given prior to completing the harvest;
  
  
• Cellular (T-cell) Immune Deficiency (congenital or acquired);
  
  
• Intrauterine transfusion;
  
  
• Transfusions from family members (any degree);
  
  
• Directed donors (when not identified as family members versus friends);
  
  
• HLA-matched platelet transfusions.
  
  

Appropriate Indication:

• Hematologic malignancies (leukemias);
  
  
• Hodgkin’s Disease;
  
  
• Non-Hodgkin’s Lymphoma;
  
  
• Neonatal exchange transfusion;
  
  
• Premature infants; and,
  
  
• Certain solid tumors (neuroblastoma, glioblastoma).
  
  

Irradiation not considered as indicated:

• AIDS;
  
  
• Most solid tumors;
  
  
• Non-myeloablative chemotherapy recipients;
  
  
• Routine immunosuppressive drugs (such as prednisone);
  
  
• Solid organ transplant recipients;
  
  
• Aplastic anemia (except if BMT); and,
  
  
• Humoral immunodeficiency.
  
  

Therapeutic Effect - Irradiation destroys the ability of transfused lymphocytes to respond to host foreign antigens thereby preventing graft vs. host disease in susceptible recipients. Patients with functional immune systems will destroy foreign lymphocytes, making irradiation of Blood and Blood components unnecessary.

Leukoreduced Blood Components

Description - Cellular Blood components that contain less than a known and accepted range of leukocytes (white Blood cells) are considered leukocyte reduced. The leukocyte content of Blood components can be reduced by filtration. With platelet preparations, filtration results in the loss of 10 to 30% of the platelets. Single donor platelets prepared with the most modern apheresis machines will already contain a miniscule amount of leukocytes (LRS platelets), can be labeled as leukocyte reduced, and do not require filtration. Cryoprecipitate and fresh frozen plasma do not contain intact or viable leukocytes making leukoreduction unnecessary.

Indications - Leukoreduced Blood and components are indicated:

• For patients who have experienced two or more non-hemolytic febrile transfusion reactions;
  
  
• As a method of preventing transfusion transmitted CMV; and,
  
  
• As a method of preventing platelet alloimmunization in some case
  
  

Summary

* Note 1 - these are not "packed" red cells. Packed red cells have a Hct of 70-80%.
** Note 2 - these times do not consider cryo-freezing technologies.

Therapeutic aphaeresis service

Therapeutic Apheresis is the removal of abnormal or pathological substances from a patient’s blood using an automated blood cell separator machine. A replacement fluid such as fresh frozen plasma, human serum albumin or normal saline is often required.

We’re on call

Apheresis Team at the Central Blood Bank-SMC brings the mobile Therapeutic Apheresis Services directly to the patient’s facility, providing the latest continuous-flow apheresis technology operated by skilled therapeutic apheresis nurse-specialists.

This procedure requires advanced scheduling with the Central Blood Bank consultant or the Senior Medical Technologist and a special request form must be filled by the patient’s physician. If the Therapeutic Apheresis request is approved by the Central Blood Bank Consultant/Hematologist, the patient’s physician will be notified and it’s the responsibility of the patient’s physician to prepare the patient for the procedure, which requires a central (double lumen) line to be inserted and also arrange for the replacement fluid if other than Fresh Frozen Plasma (FFP).

Therapeutic Apheresis timing is from 8:00 am – 1:00 pm (sat-wed).

Therapeutic apheresis has become an effective treatment option and a first-line adjunct to initial therapies for many blood disorders.

Different Types And Uses of Therapeutic Apheresis

Benefits

Our service has been carefully designed to provide the following benefits:

• Shorter run times:
  Enhances patient comfort
  
  
• Low extracorporeal volumes:
  Improves patient safety by reducing potential reactions - especially good for pediatric patients
  
  
• Consistent fluid balance and precise component separation through computerized calibration:
  Effective for all patients, regardless of age and weight
  
  
• No need to transfer patients:
  Our mobile service comes to the patient’s site eliminating the need to transfer patients elsewhere for therapeutic apheresis services
  
  
• Unlimited access to our physicians:
  Our physicians are recognized transfusion medicine specialists and are available to support the course of treatment and answer questions regarding patient management
  
  
• Shorter hospital stays:
  Patients realize shorter hospital stays and lower morbidity with early use
  
  Therapeutic apheresis has become the standard primary therapy and a first-line adjunct to initial therapies for many hematologic, oncologic, autoimmune, metabolic, neurologic and renal disorders.
  
  

  Hematology / Oncology

  • Thrombotic thrombocytopenic purpura (TTP)
    
    
  • Hemolysis, elevated liver enzyme values and low platelet counts (HELLP syndrome)
    
    
  • Hemolytic uremic syndrome (HUS)
    
    
  • Idiopathic thrombocytopenic purpura (ITP)
    
    
  • Post-transfusion purpura (PTP)
    
    
  • Platelet alloimmunization
    
    
  • Hyperviscosity in Waldenstrom’s macroglobulinemia and multiple myeloma
    
    
  • Cold agglutinin disease
    
    
  • Inhibitors of coagulation
    
    
  • Leukostasis syndrome in leukemia
    
    
  • Complications of essential thrombocythemia
    
    
  • Sickle cell anemia
    
    
  • Paraneoplastic syndromes
    
    

  Neurology

  • Guillain-Barré syndrome
    
    
  • Chronic inflammatory demyelinating polyneuropathy (CIDP)
    
    
  • Myasthenia gravis
    
    

  Autoimmune Disorders

  • Goodpasture’s syndrome
    
    
  • Vasculitis
    
    
  • Cryoglobulinemia
    
    
  • Rapidly progressive glomerulonephritis
    
    

  Autoimmune Disorders

  • Good pasture’s syndrome
    
    
  • Vasculitis
    
    
  • Cryoglobulinemia
    
    
  • Rapidly progressive glomerulonephritis
    
    

  Immunoheamatology Laboratory

  A Medical Technologist/Technician is available at all times.
  An Attending Pathologist is on call at all times.
  Specimens are available for crossmatch for three days after collection.
  

  Specimen Requirements

  The Blood Bank maintains strict standards for specimen collection to ensure safe blood transfusion. Specimens will be rejected if they are not properly labeled. Please call the Blood Bank with any questions you may have about labeling specimens. Patients should be wearing a hospital armband that contains: Patient's first and last names Patient CPR Number
  
  All specimens must be labeled from the patient's armband. All specimens are required to have the following written on the label already on the purple top:
  
  
  • Patient's first and last names
    
    
  • Patients CPR Number
    
    
  • Date of collection
    
    
  • Time of collection
    
    

  Available Tests

  • ABO Group
    
    
  • Anti-A or anti-B Titration
    
    
  • Red Cell Antigen Typing
    
    
  • Direct Antiglobulin Test
    
    
  • Indirect Antiglobulin Test (Antibody Screen)
    
    
  • Antibody Identification
    
    
  • Prenatal Antibody Identification
    
    
  • Prenatal Profile
    
    
  • Suspected Delayed Hemolytic Transfusion Reaction
    
    
  • Cold Auto agglutinins Titer
    
    
  • Type and Screen
    
    
  • Crossmatch
    
    

  Test Results

  • Test results are generally charted within 24 hours.
    
    
  • Call the blood bank if results are not in the chart.
    
    
  • Turnaround time on STAT specimens is 1 hour providing there are no problems.
    
    
  • Turnaround time on Routine specimens is 8 hours providing there are no problems.
    
    

  ABO Group

  Determined by the presence or absence of A and B blood group antigens on red blood cells as well as the presence or absence of the expected reciprocal ABO blood group antibodies in the serum.
  
  Sample Required: 2 ml EDTA
  Analytic Time: 24 hours if weekday; 48 hours if weekend
  Days Test is Set Up: Saturday through Wednesday
  
  

  Anti-A or anti-B Titration

  Semi quantitative method for determining anti-A or anti-B concentration. Serial two-fold dilutions of serum are tested against A or B cells, respectively. Result is expressed as the reciprocal of the highest serum dilution at which (1+) agglutination is still present. This test is generally used to monitor therapeutic reduction of anti-A or anti-B in recipients of ABO mismatched bone marrow or liver transplants. Target hemagglutinin levels are generally in the range of less than 16 to 8.
  
  Sample required: 7 ml purple top
  Normal Test Values: Interpretation depends on clinical setting
  Analytic Time: 24 hours if weekday; 48 hours if weekend
  Days Test is Set Up: Saturday through Wednesday
  

  Red Cell Antigen Typing

  Antigen typing is performed using licensed commercial antisera to detect the presence or absence of individual blood group antigens (other than A, B or D).
  
  Rh (D antigen typing) – Most typically done when a patient’s ABO and Rh type is needed. Unless the patient has known antibodies to other Rh antigens, the D type alone is sufficient for pre-transfusion testing.
  
  Single antigen phenotype – When confirming or excluding HDN, it is often useful to order a single antigen typing to determine if a father carries the antigen corresponding to a maternal antibody. Single antigen phenotyping can also be ordered in other scenarios where the red cell antigen to be typed is known.
  
  Rh phenotype – The Rh phenotype consists of typing for D, C, c, E, and e, if indicated. This is often useful for prenatal patients as the Rh system is the system most often involved in HDN.
  
  Extended phenotype – Any patient that produces an unexpected antibody to one or more red cell antigens (such as K, k, Fya, Fyb, Jka, Jkb, S, s) will need an extended phenotype of all the common antigens to confirm or exclude antibody specificity. Patients who may require long-term transfusion therapy (i.e. sickle cell anemia or WAIHA) often have extended phenotypes done to help identify the safest product for transfusion. When an antibody workup is done, an extended phenotype is part of the identification process.
  
  Sample required: 7 ml purple top
  Normal Test Values: Not applicable
  Analytic Time: 24 hours if weekday; 48 hours if weekend
  Days Test is Set Up: Saturday through Wednesday
  

  Direct Antiglobulin Test

  Detects the presence of red blood cell-bound IgG and/or complement by agglutination using an antiglobulin (Coombs) reagent. Positive results can occur in patients with autoimmune hemolytic anemia, drug-induced immune hemolysis (e.g., alpha-methyldopa, procainamide), hemolytic transfusion reactions, or hemolytic disease of the newborn. Positive results can also occur due to non-specific IgG absorption (e.g., hypergamma-globulinemia), and occasionally in otherwise healthy individuals. Extended evaluation may include elution and absorption studies.
  
  Sample Required: 7 ml purple top
  Normal Test Values: Negative
  Analytic Time: 24 hours if weekday; 48 hours if weekend
  Days Test is Set Up: Saturday through Wednesday
  

  Indirect Antiglobulin Test (Antibody Screen)

  This test detects the presence of unexpected antibody (allo- or auto-) against red blood cell antigens. Patient serum is tested against a three-cell panel that contains 18 common red cell antigens. Antibodies are detected by either direct agglutination or cell lysis at 37°C or antiglobulin (Coombs) reagent (IgG) in the presence of low ionic strength saline. The majority of clinically significant red blood cell alloantibodies are detected by this technique. If positive, an extended cell panel (antibody identification) will be performed to determine red blood cell antigen specificity.
  
  Sample required: 7 ml purple top
  Normal Test Values: Negative. If positive, antibody identification will be performed
  Analytic Time: 24 hours if weekday; 48 hours if weekend
  Days Test is Set Up: Saturday through Wednesday
  

  Clinically Significant Red Cell Antibodies

  Group IClinically significant antibodies.	Group IIBenign antibodies.	Group IIIClinically insignificant if not reactive at 37°C; possibly significant when reacting at 37°C.	Group IVAntibodies that are sometimes clinically significant.
  ABO	Chido/Rodgers(Cha/Rga)	Lewis(Lea/Leb)	Yta
  Rh (D, C, c, E, e)	Xga	M, N	Vel
  Kell (K, k)	Bg	P1	Ge
  Kidd (Jka, Jkb)	Csa	A1	Hy
  S, s	Kna		Sda
  	McCa, Yka
  	JMH

  Postnatal Profile (Mother or Baby)

  Rh type of mother and infant are determined (including weak D test). If mother is Rh negative and infant is Rh positive. This test is recommended as routine testing for uncomplicated pregnancies (Rh positive or Rh negative). If hemolytic disease of the newborn (HDN) is suspected.
  
  Sample required:For mother: 7 ml purple top. For baby: prefer 7 ml purple top or 1-2 microtainers peripheral (prefer EDTA).
  Normal Test Values:See individual tests
  Analytic Time:24 hours if weekday; 48 hours if weekend
  Days Test is Set Up:Saturday through Wednesday
  

  Antibody Identification

  Red blood cell antibody specificity is determined by reacting patient serum with extended panel of reagent red blood cells of known phenotype. The clinical significance of some of the more commonly encountered red cell alloantibodies are summarized in the clinically significant Red cell Antibodies table. Clinically significant alloantibodies (e.g., Rh, Kell, Duffy, Kidd) may be present in patients with hemolytic transfusion reactions or hemolytic disease of the newborn (see DAT table). Autoantibodies usually react with all panel cells (i.e., "panagglutinins"), and are present in the sera of ~80% of patients with warm (IgG) autoimmune hemolytic anemia. Red cell alloantibodies may require several techniques for final identification; the presence of an autoantibody may require a series of absorptions and elutions to determine the presence of underlying alloantibodies.
  
  Sample required:7 ml purple top -x- match bottle
  Normal Test Values:Not applicable
  Analytic Time:48 hours
  Days Test is Set Up:Saturday through Wednesday
  

  Prenatal Antibody Identification

  This profile can be ordered for any pregnant patient who has not had an antibody screen performed during the current pregnancy or has been found to have a positive antibody screen (LISS-IAT). If the LISS antibody screen test is reactive, antibody identification will be performed until all common exclusions are completed. Depending on the complexity of the case and number of antibodies identified, further testing may be required. These tests could include ABO and D typing, complete phenotyping, antibody titration (one per specificity unless all antibodies are in Rh system), alloabsorption or adsorption for specificity separation, and plasma/substance inhibitions. If a titer is performed, the remaining sample will be frozen for use as a parallel control to be tested with future samples.
  
  Sample required:7 ml purple top -x- match bottle
  Normal Test Values:Antibody screen test negative. Further testing will follow if this is positive.
  Analytic Time:24 hours if on a weekday, 72 hours if on a weekend
  Days Test is Set Up:Saturday through Wednesday
  

  Prenatal Profile

  Includes ABO, Rh, and antibody screen (indirect antiglobulin test) to detect previous alloimmunization to clinically significant red blood cell antigens. Recommended at initial prenatal evaluation and at 26-28 weeks gestation (for first pregnancies and/or Rh negative women only). All Rh negative women in whom there is no evidence of active Rh immunization should receive a standard dose of Rh immune globulin (RhIg) at 28 weeks gestation as prophylactic therapy. Patients who are weak D positive should be considered Rh positive, and are generally not candidates for RhIg prophylaxis.
  
  Sample required:7 ml purple top
  Normal Test Values:See individual tests
  Analytic Time:24 hours if weekday; 48 hours if weekend
  Days Test is Set Up:Saturday through Wednesday
  

  Suspected Delayed Hemolytic Transfusion Reaction

  This profile is used to investigate samples from patients that have been recently transfused and have clinical or serological indications that are suggestive of a delayed hemolytic transfusion reaction. Most testing will be performed on post transfusion samples but some testing may be performed on pretransfusion sample if available. The battery of testing performed may include direct antiglobulin testing, ABO and D typing, RBC separation and complete phenotyping, antibody screening and identification if needed, and antibody elution with identification if needed.
  
  Sample required: 7 ml purple top Normal Test Values: DAT negative; antibody screen test negative; Follow up testing will be performed if either of the preceding is positive. Analytic Time: 24 to 48 hours Days Test is Set Up: Saturday through Wednesday

  Cold Autoagglutinins Titer

  Cold agglutinin syndrome (also called cold hemagglutinin disease CHD) is the hemolytic anemia most commonly associated with cold reactive autoantibodies and account for approximately 16-32% of all cases of immune hemolysis. It occurs as an acute or chronic condition. The acute form is often secondary to lymphoprolifeerative disorders (eg.lymphoma) or mycoplasma pneumoniae infection. The chronic form, which causes mild or moderate hemolysis, is often Seen in elderly patients, sometimes associated with lymphoma, chronic lymphcytic leukemia, or waldenstrom’s macroglobulinemia, Raynaud’s phenomenon and hemoglobinuria may occur in cold weather.
  
  Sample required: 7 ml purple top
  Normal Test Values: Titer less than 1/64 at 4 Centigrade
  Analytic Time: 24 to 48 hours
  Days Test is Set Up: Tuesday’s only before 8:30 A.M
  

  Type and Screen

  Type and Screen is a policy in which crossmatched blood is not labeled and reserved for patients undergoing surgical procedures that rarely require transfusion. Instead, the patient’s blood sample is tested for ABO, Rh, and unexpected antibodies, and then stored in the blood bank for immediate crossmatching should this prove necessary .If transfusion becomes necessary, ABO, and Rh compatible blood can be safely released, for patients with no clinically significant antibodies, after immediate –spin crossmatch.
  
  Sample required: 7 ml purple top
  Normal Test Values: Negative.
  Analytic Time: 2-4 hours.
  Days Test is Set Up: Daily around the clock.
  

  Crossmatch

  Unless there is urgent need for blood, the recipient’s serum or plasma must be crossmatched with the donor’s red cell before transfusion of any red cells component. The major significance of the crossmatch is as final check on ABO compatibility between donor and recipient, and also to ensure that the recipient has no clinically significant antibodies against the donor’s cells. For infants less than 6 months of age mother sample is required for crossmatching.
  
  Sample required: 7 ml purple top
  Normal Test Values: Compatible.
  Analytic Time: 2-4 hours.
  Days Test is Set Up: Daily around the clock.
  

  Blood Drives (Campaigns)

  The central Blood Bank has a mobile unit, which can service your company, ministry, and place of worship or civic organization.
  
  To schedule a mobile drive for your company, please contact us at 17284454 or 17284455. Our staff will be happy to help educate your staff, supply marketing materials, and make your drive a fun and friendly experience. So if you have a minimum of 30 donors or more, we can organize a Donor Blood Drive to your premises.
  
  

  Organize a Blood Drive

  What you need to know before planning a Blood Drive. Please read this first!
  
  How many donors do I need to have a blood drive?
  60 to 70 or more committed donors depending on the size of your group. A full-day blood drive (up to six hours) can be held with as few as 50 donors.
  
  What is a "committed" donor?
  Someone who has signed up on the donor commitment sheet stating that they will donate at your blood drive. Our experience shows that prospective donors who sign up in advance will be more committed to giving at your blood drive. Their phone number will help to schedule them once a date is set.
  
  When can I schedule a date for our drive?
  When you have a commitment of at least 60 donors, contact the Donor Section at the Central Blood Bank to schedule a date. Blood Drives are usually scheduled about two months in advance, but we may have an earlier opening in our schedule.
  
  Why do I have to get advance commitments from donors before I schedule a date?
  Through our experience, we have learned that an advance commitment from donors usually ensures that they will participate. Advance commitments help you, your donors and your community Blood Bank.
  
  Where should I host the Blood Drive?
  For blood drives of 50 or more we recommend you host the drive inside your location. An inside blood drive requires a minimum of 25' x 30' of space (or larger if you expect more than 65 donors). For smaller inside blood drives (20 to 30 donors) you will need a room 20' x 20'. At your site you will also need to provide tables and chairs. The Blood Center will provide all other equipment.
  
  How do I get people to sign up?
  Don't be shy; ask them. The main reason people don't donate blood is that they have not been asked. Another option is to form a committee and have each person recruit a certain number of donors. Tell potential donors that each donation can save as many as three lives. Also, if this drive takes place at work, make sure that you have the support from upper management so that your donors may give on company time.
  
  How long does it take to donate?
  About 30 minutes from walking in the door to walking out. The collection of one unit of blood takes only about 7-10 minutes.
  
  Who can donate?
  Almost anyone in good health (no colds or flu) who weighs more than 110 pounds (55 KG), is 18 years or older may donate. For health-related questions call us at 17284454 or 17284455. Some medications, medial conditions or risk factors may be a basis for deferral. We encourage all donors to eat and drink plenty of fluids before donating.
  
  

  Location

  Blood transfusion center / central blood bank is located at level 2 in new block.
  Tel.No 17284454 – 17284455 (fax) 17284467
  
  

  Staff

  Morning Shift (Saturday to Thursday on regular working days)	Consultant
  	Resident
  	Senior Medical Technologist
  	3 Medical Technologists
  	5 Laboratory Technicians
  	3 Nurses (2 on deputation)
  	Medical Secretary
  	Lab Aide
  On Public Holidays	2 Lab Technicians
  Afternoon Shift	1 Medical Technologist
  	2-3 Lab Technicians
  Night Shift	2 Lab Technicians

  Timing

  Round the clock in 3 shifts.hifts.
  
  

  Blood donation timing	Saturday to Thursday 7:30am to 12:30pm
  Sunday, Monday and Wednesday	4:00pm to 7:00pm.