National Blood Service is responsible for the collection and distribution of blood and blood components. It has responsibility for ensuring the security and adequacy of blood supply to meet the needs of the health care system lies with government. A blood transfusion is a hazardous procedure and it should only be given when the clinical benefits of patient exceed the potential risks. Procedures must be followed to ensure that the correct blood is given and that any adverse reactions are dealt with promptly and efficiently. There are risks associated with receiving a blood transfusion .There is a risk that a given blood transfusion will transmit a viral infection to its recipient.The purpose of this policy is to establish safe and consistent practice in the administration of blood. This policy refers to all health care staff who is involved at every stage of collection, preparation and administration of a blood and blood components transfusion. The policy is to ensure the principles of safe and secure handling of the blood carried out by health care staff. Policies and procedures shall include all aspects of the transfusion including donor selection, collection , storage , assessment, consent, labelling, , storage emergency and safety procedures, equipment and supplies.
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Minimising the risk for transfusion transmitted infections relies on selection of safe donors, including microbiological screening, and avoidance of unnecessary transfusions. Precautions should take in order to prevent any transfusion transmitted infection. Because of the precautions taken in drawing and handling donated blood, this risk becomes reduced. All blood donors must provide health and medical history, including infections, medicines, and other problems. All blood donations are tested for several viruses such as HIV , hepatitis B, hepatitis C. If any of these things are found, the blood is destroyed. Because blood can be infected with bacteria or viruses and certain blood components are tested for contamination with bacteria as well. Ways to prevent the spread of transfusion transmitted infections are selection of right donors by providing questionnaires, microbial testing , compatibility testing ,leukocyte depletion, pathogen reduction and autologous transfusion. If any signs of transfusion reaction appear, it stops immediately. Blood sample is tested to check whether infections are caused by transfusion reaction. Donated blood is put into ABO and Rh groups may reduce the risk of transfusion reaction. Microbial testing is used to screen signs of antibody reaction. This reduces the risk of antibodies against different infectious agents and implies that there is window period. The window period refers to time of period from infection until antibodies against infection agents can be detected in the blood. Blood samples from all donors are taken at the time of each donation for laboratory tests.Compatibility testing is used to determine the type of blood group and screen for alloantibody. Once the type and screen has been completed, potential donor units will be selected based on compatibility with the patient's blood group. Cross matching is performed prior to a blood transfusion to determine if the donor's blood is compatible with the blood of recipient. Some infectious agents reside within leukocytes. Leukocyte depletion is associated by filtration of blood products. The white blood cells are removed from the blood by filtration. Their transmission can be interrupted if the blood product is depleted of leukocytes.This will reduce the risk for transmission of leukocyte in viruses. Pathogen reduction means that viruses are unable to infect. The desirable inactivation method would interfere with the function of blood product. The solvent-detergent method is used to damage membranes of lipid-enveloped viruses . The method is effective in destroying HIV, Epstein-Barr virus (EBV), HBV, and HCV. Methylene blue is a dye that combines with cellular elements. Once it is exposed to light, the dye becomes active and destroys the wall that attached to it. The method extensively inactivates viruses. Amotosalen is a synthetic psoralen and once exposure to ultraviolet light , it form cross-links in nucleic acid chains and prevent the multiplication of pathogen. This method inactivates almost screened agents such as HIV, enveloped and nonenveloped virus, bacteria, and protozoa. Riboflavin (vitamin B2) is used to inactivate pathogens in platelets and plasma . Riboflavin binds to DNA and RNA to make cross-links when photo activated. It effectively inactivates HIV and WNV, as well as some bacteria and protozoa.
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The transfusion of blood must be prescribed by medical staff. Only one patient blood is taken at any one time and patient should give their consent for the blood to taken. The appropriate transfusion of combination of various components depend on the clinical needs of patient. Whole blood donations are collected into various closed bag that allow blood components to be transferred aseptically between bags. The patient should be bled and labelling procedure must be completed before proceeding on to the next patient. This will reduce problems with mislabelling. Accurate patient identification is essential for safe transfusion practice. Patient is identified and before blood is taken, patient's identification wristband must be placed .The complete and accurate labelling of the sample in the presence of the patient at the time of collection is essential to patient identification .So All blood and blood components must be labelled according to regulatory specifications.Greater care must be taken when labelling specimens with pre-printed labels to ensure that the correct patient's label has been attached to the sample tube. All specimens for transfusion testing shall be labelled in that patient's presence with patient name , surname , date of birth ,the date and time of collection , date of phleobotomy, blood group and reason for transfusion. The following details should check on the patients identification wristband match those on the blood transfusion request form. The checking units of blood to be transfused and patients identity must be checked against blood unit details. The blood bag and the blood supply slip should then be checked to match the patient identification number, ABO compatibility, unique donation number and the expiry date of the blood provided. The information on the identification band must be compared to the information on the requisition prior to drawing blood for compatibility testing. Compatibility testing is required and consists of the following tests to determine if the patient's plasma or serum is compatible with the donor's red cells
The criteria for selecting blood donors apply to donors of whole blood and of components collected by apheresis. Persons in good health will be accepted as donors of blood .A donor's medical history must be evaluated on the day of donation. The combination of assessing each donor clinically and testing them for markers of infection is essential to increase donor and recipient safety. Each donor must undergo JPAC Donor Selection Guidelines to identify their eligibility for donation. Therefore each donor needs to answer series of standard questions relating to their general health, lifestyle, past medical history and medication. Donor age should be between t 17 and 65 years but regular donors may be allowed to donate beyond their 65 yrs . The minimum interval is 12 weeks between donations of whole blood. Normally, no more than three donations should be collected from any donor during any 12-month period. The donation of 450 mL_10% is given to ensure the final red cell component meets specification. No more than 13% of the estimated blood volume should be taken during any one donation. In general 470-475 mL of blood excludes samples and is collected into the main pack.
The proper storage of blood components is critical to safe transfusion. Storage of blood products outside of the transfusion service is in satellite storage refrigerators and requires an extra monitoring system for transfusion services. Processes must be in place to ensure satellite storage equipment is monitored, cleaned and calibrated at specified interval. A visual inspection of each product received and they should take place with great care comparison of the product with the packing slip . Blood components should be unpacked and stored as soon as possible after arriving at the hospital and must be taken within 24 hours after issue from the blood supplier . The receiving process must ensure that components are not outside the temperature-controlled environment longer than 30 minutes. All components containing RBC must be stored at 1- 6°C. Shelf life depends upon the anticoagulant and additive used. Units must not be out of the controlled environment of the blood storage refrigerator longer than 30 minutes. This standard and the shelf life are established to ensure the efficacy of the component and to reduce bacterial contamination of the component. Platelet components must be stored at 20-24°C under continuous agitation. Their shelf-life is five days from the date of collection. All frozen components must be stored in a controlled, monitored freezer.
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Maintaining proper storage temperature during transportation is essential. The allowable temperature limit is up to 10 °C during transportation for refrigerated blood components . Records must keep for maintaining the chain of traceability. So it is possible to trace all blood components from their source to final disposition. Validated shipping containers are critical to this process. They are necessary to ensure blood components remain within environmental specifications at all times. In some cases, temperature monitoring devices used in shipping containers in each shipment of blood and blood products to meet with environmental specifications. The visual inspection of each product in the shipping must be performed and documented . Record of issue transfer must be included with all transported blood components. For platelet components must be continuously agitated and so it can be used. that transportation of these components cannot take longer than 24 hours from the time the product leaves the blood supplier. Standard Operating Procedures (SOPs) must identify the training requirements for handling and transportation of components.. Transportation between facilities should not exceed 24 hrs.