Blood Bank Management
Blood Bank Management
Blood Bank Management
Transfusion of blood and blood components is an established standard way of treating patients
who are deficient in one or more blood constituents and is therefore an essential part of health
care. A blood transfusion service is a complex organization requiring careful design and
management. Essential functions of a blood transfusion service are donor recruitment, blood
collection, testing of donor blood, component preparation and supply of these components to the
patients.
The organization of a blood transfusion service should receive utmost attention and care for
smooth functioning of various components of the service. The goal of blood transfusion service is
to provide effective blood and blood components which are as safe as possible and adequate to
meet the patientsƞ needs.
As a blood transfusion service deals with different functions related to donors and patients, it is
imperative to keep in mind the safety of both donors and recipients. The blood transfusion service
has to be planned and organized in such a way that it fulfils its ideal aims and objectives i.e.
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1. Donor Complex
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2. Blood storage
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3. Component preparation
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4. Serology laboratory
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5. Laboratory for transfusion transmitted disease
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6. Issue counter
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Blood transfusion centres are graded into 3 categories for space requirements.
3-7 ÿOB / Hosp Bed. 1000- 8-15 ÿOB / Hosp 16 ÿOB or more per Hosp.
6000 ÿOB consumed per Bed. 6000-15000 Bed. over 15000 ÿOB
year ÿOB consumed per consumed per year
year
ÿ%$ÿ%'%%Ñ 100-800 Bed, Hosp., District 400-1000 Bed 800-1000 Bed Hosp., Apex
Hospit., Health Service Hosp., Medical institutes. Metropolitan Medical
Hosp., Corporation Hosp., College Specizlised Colleges Hosp., All super-
No Super-specialities., non Hosp., Teaching specialities Teaching Hosp.,
teaching Hospital and Blood bank.
1. xeception room 25 25 40
5. Kitchen/Pantry 5 5 10
6. Apheresis room 40
4. Issue counter 18 20 20
5. Emergency laboratory 20
4. Stores 20 25 35
8. Library/Conference room 30
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Decision on the staffing pattern of a blood transfusion service must take into account the specific
function of the centre, It will also be influenced by the availability of qualified trained personnel.
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1. Jr. Doctors/
2 4 4
xesidents
2. Nurses 2 3 4
3. Social Worker 1 2 3
4. Attendants 1 2 3
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1. Nurse - 1* 3
2. Attendant - 1* 1
2. Tech. Assistant 2 4 8
4. Laboratory Asst. 1 2 4
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1. ClerlclTypist 1 1 1
2. Store Keeper 1 1 1
3. Cleaner/ Sweeper 1 1 2
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1. Professor - - 1
2. Associate
- 1 1
Professor/xeader
3. Assistant
1 2 1
Professor/Lecturer
4. Senior xesidents 1 2 3
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The blood transfusion centre should be equipped with the machines and instrument appropriate to
its functions. The quality and quantity of equipment required depends on the number of blood
units collected and procurred, the techniques used, the infrastructure of the centre and the size of
the hospital.
To ensure the smooth functioning of a transfusion centre, a comprehensive plan for the
procurement of basic equipment is essential. Each hospital has its own rules and regulations for
procurement of expensive equipment which should be followed. In order to avoid ambiguity,
specifications of a required equipment should be clearly and precisely defined considering the
space, operation and maintenance of the equipment. National AIDS Control Organization (NACO)
has drawn up specifications for all blood bank equipment and assistance can be taken from NACO.
All instruments must be properly maintained and regularly checked for their functioning.. The staff
must be familiar with the use of all the equipment.
xegular quality monitoring checks on the equipment must be done and recorded. (xefer Section
Seven-Quality Assurance in Blood Transfusion Service).
ÿninterrupted power supply should be maintained for all the equipment with efficient back-up
system.
Intrinsic safety of the equipment and safety of its operation are essential. Greatest number of
accidents involving equipment are caused by improper use of the equipment and a failure to install
it correctly or unsatisfactory maintenance.
Only centrifuges with lids that latch firmly should be used. If spoilage occurs due to breakage or
loosening of cap, it must be immediately cleaned with disinfectants.
xefrigerators and freezers should be defrosted periodically and the interiors should be cleaned
with detergent and disinfectant. Water bath, test-tube racks, incubator, etc. should be regularly
cleaned once a month.
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While planning a laboratory, sufficient electrical outlets above or at the back of benches are
essential. Two or more outlets may be needed for each technician. In addition, enough electrical
outlets should be there in each laboratory for easy installation and operation of the equipment.
All essential equipment required for blood storage, storage of kits, reagent and blood or serum
samples must have back-up emergency electrical generators. It is preferrable to have a full back-
up emergency electric supply for essential services such as the blood transfusion service.
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All the reagents and kits used in the blood transfusion service must be checked for reactivity,
specificity and validity. The oldest reagents should be used first (First in, first out) and there
should be a system to check when stocks are low.
A regular supply of reagents and kits should be ensured. The antisera must be carefully stored and
grossly checked on each day of use for any contamination.
Glassware used in blood transfusion laboratory must be cleaned thoroughly. Cell-serum mixture
must not be allowed to dry on the glass.
Immediately after completion of any technical procedure, dirty tubes and slides should be placed
in a suitable disinfectant. Buckets kept under the work benches containing disinfectants are
convenient for this purpose.
Disinfectants recommended for general laboratory use are sodium hypochlorite (ig/dI) and
aldehydes such as glutaraldehyde (2%) or formaldehyde (5%). After soaking in the disinfectant for
24 hours, glassware is placed in hot detergent solution and washed in hot water. Glassware is then
dried in hot air oven in an inverted position. It is absolutely essential that no traces of the
detergent should remain on the glassware.
Dirty glassware can give rise to erroneous results and/or may cause haemolysis of red cells.
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Documentation provides the ability to trace prospectively and retrospectively all steps in all
procedures, dating from collection of the blood to monitoring techniques, component preparation,
laboratory testing, issue and transfusion of blood.
An effective record system helps to judge the performance of the blood transfusion service, traces
any donated unit of blood from its source to the final fate and also helps in legal or investigational
purposes. Various aspects which need proper documentation are :
1. . Donor records inlcuding details of donor information, rare donor panels, donor deferraLs
and adverse donor reactions.
2. xecord of results and interpretation of all laboratory tests.
3. Patientƞs record (for all patients and specifically important in patients with multiple
transfusions, previous transfusion reactions, presence of unexpected antibodies or cross-
match problems).
xecord and documents also help to identify possible sources of error in any technique.
The results of manually performed tests should be recorded carefully in a clean and easily
understandable way i.e. as the laboratory worksheet. Laboratory worksheets should be preserved
as permanent record of the test performed and the readings obtained.
xecords of the reagents and kits used for a particular test with their batch no., lot no. and expiry
dates should be maintained so that in case of any problem, it is easier to find the source of error.
All records must include the date and signature of the laboratory staff performing the test.
xecords should be retained for at least 5 years and kept confidential.
Computers are being widely employed in maintaining the records. With the growing demand for
improving the efficiency, accuracy and effectiveness it has become imperative to introduce
computers in the blood transfusion service.
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Ongoing training and continuing education fo the staff are crucial elements of efficient blood
transfusion service. As there have been significant advances in the field of transfusion medicine
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blood components, advances in immunology, blood group serology, coagulation, microbiology and
clinical application of blood transfusion, there is a strong need or regular educational programmes
for different categories of staff working in the blood transfusion centre.
The teaching programme should be based on the basic functions of the service and give necessary
theoretical and practical technical skills to ensure upgraded knowledge and ability to perform all
the procedures with skill and talent.
It is extremely important to have teaching sessions for the hospital staff and clinicians to help in
appropriate utilization of blood and promotion of autologous blood transfusion programme.
Continuing education of medical residents and senior staff is required to achieve rational, optimal
and safe utilization of blood. In addition, the possibilities of active research makes the service
more attractive for well- qualified doctors and scientists.
The medical and paramedical staff should be encouraged to participate in seminars, workshops and
conferences to update their knowledge, widen their vision and interest in the subject.
A training programme for transfusion centre staff should also include methods for improving the
organization of donor recruitment and donor appeals. The laboratory technical staff should be
trained in all practical aspects of blood group serology, immunology and quality control measures.
The staff working in the blood transfusion sErvice should be rotated in different laboratories to
prevent monotony and boredom and avoid any mishaps which may occur due to lack of interest by
the laboratory staff. Newly recruited staff should have an initial orientation to the workspace.
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xepresentative from clinical departments that use large quantities of blood i.e. surgery,
anaesthesiology, gynaecology & obstetrics, cardiothoracic surgery, etc.
xepresentatives of blood transfusion service, hospital administration and nursing staff.
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ÿ
Blood Bank Management
Introduction and Functions
Need For Blood Bank
Blood Bank Premises Design
Basic Equipments and xeagents
Donor xecruitment and Motivations
Donor Blood Collection
Laboratory Techniques
Documentation and xecord Maintenance
Continuing Education in Blood Transfusion
Guidelines for clinical use of blood
Consummables and equipment for bloodbank
Blood Zone
About blood
About Blood Transfusion
Autologous Blood Transfusion
Effects of blood transfusion
Blood facts
Blood Diseases and Disorders
Eligibility test
Why many people don't donate blood
Blood Components
Human immune system
Blood Donor xequirements
Blood Products
Blood Substitutes
Blood types
Apheresis
Q&A - Blood
Foods to increase your blood
Food to increase immunity
xh Factor
What are Blood Groups
Health calendar
Glossary
The director and other staff members of blood transfusion centre should actively interact
with the clinicians and formulate guidelines for effective and optimal use of blood and
blood components.
Blood and blood components should be requested for only if other modes of therapy have
proved ineffective and if the benefit of transfusion outweights the risk associated with it.
Following broad guidelines should be followed.
<!--[endif]-->ÿse of red cell and platelet concentrate, fresh frozen plasma and
cryoprecipitate as indicated.
As far as possible transfusion of whole blood should be avoided and efforts should be made
to initiate blood component therapy. If the transfusion service does not have the facility
for preparing blood components, all efforts of the technical experts and hospital
administrators should be directed to initiate blood component preparation in thç blood
transfusion service.
As far as possible, fresh blood transfusion with < 3 days old red cells and single unit
transfusion should not be used.
Transfusion trigger may be lowered to <7gIdl haemoglobin value specially if the fall in I-lb
had not been rapid.
Programme for autologous blood transfusion should be initiated, promoted and sustained.
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Disposable lancets.
Disinfectants and dressings.
Material and supplies for the determination of haemoglobin concentration and haemotocrit
(Copper suphate at the basic level).
Blood collection containers preferrably plastic, including disposable needles.
Multiple blood bags for component preparation where feasible.
Test tubes for sample collection.
Transfusion administration sets with needles.
Labels for blood containers, samples and records.
Supplies for donor refreshment.
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Donor beds.
Balances for controlling the blood collection procedure, blood collection monitor and
shaker.
Domestic scales for weighing donors.
Suitable vehicles for blood collection and distribution, and Blood Transport Containers.
Miscellaneous equipment and surgical items, eg., scissors, forceps, sphygmomanometers,
tourniquets,
stethoscopes, thermometers.
Necessary refreshments.
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Disposable lancets.
Disinfectants and dressings.
Material and supplies for the determination of haemoglobin concentration and haemotocrit
(Copper suphate at the basic level).
Blood collection containers preferrably plastic, including disposable needles.
Multiple blood bags for component preparation where feasible.
Test tubes for sample collection.
Transfusion administration sets with needles.
Labels for blood containers, samples and records.
Supplies for donor refreshment.
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/
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Donor beds.
Balances for controlling the blood collection procedure, blood collection monitor and
shaker.
Domestic scales for weighing donors.
Suitable vehicles for blood collection and distribution, and Blood Transport Containers.
Miscellaneous equipment and surgical items, eg., scissors, forceps, sphygmomanometers,
tourniquets,
stethoscopes, thermometers.
Necessary refreshments.
Vou are here : Home/ Blood Bank Zone/ Donor selection and Blood collection/ 1. Introduction
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Collection of blood is the most important function of a blood transfusion centre. If the procedure
of donor selection and blood colection is carried out meticulously, it will assure a safe and
adequate blood supply. To obatain safe blood and blood components it is important to ensure that
the donors are healthy and free from transfusion transmissible infections. Therefore, the practice
of recruiting voluntary, non-paid donors should be followed.
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The aim of the subsection is to acquaint the medical officers with different types of blood donors
and the need to build up a panel of regular, voluntary non-paid donors. Also to make them aware
of the criteria for selection of safe donors and the conditions for permanent and temporary
rejection of donors.
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2. xeplacement donors
3. Voluntary donors
Paid Commercial donors or professional blood donors (blood sellers) receive monetary returns for
donation of blood. These donors are usually not healthy, are often anaemic and at risk of
transfusion- transmissible infections.
xeplacement donors usually are the family members or friends of a patient and donate blood for
their relative in need. This type of donation help to maintain blood stock when voluntary donations
are not available. However, pressure from the family may force an individual to donate blood even
when he or she is not suitable as a donor. Voluntary donors are individuals who are self-motivated
and onate blood with the prime aim of hleping an unknown patient. They receive no payment for it
and do not have any desire for personal benefits. These donors more often meet the criteria fo
safe donors. They are more likely to be free from transfusion-transmissible infections and hence
assure a safe blood supply. They can be motivated to become regular donors.
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Many people are reluctant to donate blood due to lack of information, Education of the community
at large may help change the attitudes and beliefs about blood donation and encourage people to
donate blood. Educational leaflets, films and posters may be used for this purpose.
Educational talks can be arranged for small groups. This has the advantage that people can ask
questions and clarify their apprehensions. Emphasis should be laid during the talk on conditions
when blood should not be donated particularly regarding high risk behaviour. The ensures the
potential donors that their safety is as important to the transfusion centre as that of the recipient.
The objective of a blood transfusion centre should be to retain individuals who donate blood once,
as regular donors. Individuals who donate blood at least twice a year or whenever called upon to
do so can be regarded as regular donors. They are considered to be safe donors as their blood is
regularly tested at the time of each donation. They can be relied upon in emergencies to donate
blood. Each transfusion centre must develop ways to recruit donors and retain them. Newer and
more efficient methods may be developed according to the needs of the hospital.
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Common forms of risk behaviour which disqualify a potential donor from blood donation are
* Heterosexual / Homosexual promiscuity
* Sexually transmitted diseases
* Intravenous drug abuse
* Chronic alcoholism
Individuals practising such behaviour may be at risk of blood borne infections which can
transmitted during transfusion.
It is the responsibility of the transfusion centre to educate all donors about what constitutes risk
behaviour. A leaflet which enlists the various high risk activities permanently disqualifying a
potential donor may be provided to donors. If the donor discovers that his blood may be unsafe
for transfusion, a confidential means of self-exclusion should be developed by the transfusion
centre.
Self-deferral means that donors make the decision not to donate blood as they understand their
blood may be unsafe for the recipient. This may be due to their high risk behaviour or poor health.
Some donors may be under family or peer pressure to donate blood and may be afraid to self
defer. They man inform the transfusion centre later of their risk category. It is also important that
strict confidentiality must always be maintained under such circumstances and the donor assured
of it. Self- deferral ensures blood safety as recently acquired transfusion transmissible infections
may not be detected even by most sensitive laboratory tests.
In Indian situation total voluntary blood donation, self-deferral and other strategies appear as
distant goals. The level of education in the predominant donor population i.e. replacement donors
may not be very high, however donor education does play a significant role in deferring donors
with high risk and assuring safety of blood.
Voluntary donors usually are college students who are young and enthusiastic but very few of
them actually become regular donors.
All efforts must be made to motivate voluntary donors to become regular donors. Donor
Identification/xegistration
It should be possible to trace every unit of blood donated by the donor. The following information
pertaining to each donor must be recorded.
1. Date of donation
2. Name, age (date of birth) and sex of donor
3. Fatherƞs/Husbandƞs name
4. Address and telephone no - office -residence
5. Blood group, if known
6. Type of donor voluntary, replacement, professional or autologous.
7. Date of last donation
8. Donor adverse reaction, if any, during last donation
X. Previous rejection from donation and its reason
10. Consent in writing
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Stringent and critical donor selection is a very important approach for the ultimate objective of
blood safety. xecruitment of healthy blood donors is important both for the safety of donor and
the recipient.
The suitability of a donor for blood donation is determined by medical history, physical
examination and few preliminary laboratory tests. These guidelines ensure that the donor is in
good health and protects the recipient from any ill effects of disease transmission.
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A brief medical history should be recorded for all prospective donors. The donor must be explained
the need to give accurate information about his health status and any medication or drugs that he
may be taking. Donor must be assured that donfidentiality will be maintained under all
circumstances. A medical officer/trained nurse should take the history.
It is preferable to record the medical history on the day of donation. Each time a donor comes to
donate blood, a standard history questionnaire should be filled. This ensures a systematic
collection of the information. It also provides a permanent record of the health status of the
donor. In donors who donate blood regularly it provides base line data regarding their health.
All donors must be treated courteously and any doubts/apprehensions must be cleared. This will
encourage them to become regular donors. Careful donor selection plays a major role in
determining donor and recipient safety.
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A certain set of standard tests are performed in the laboratory once blood is
donated, including, but not limited to, the following:
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- carry oxygen to the tissues in the body and are
commonly used in the treatment of anemia.
- help the blood to clot and are used in the treatment of
leukemia and other forms of cancer.
i - help to fight infection, and aid in the immune
process.
- the watery, liquid part of the blood in which the red blood cells,
white blood cells, and platelets are suspended. Plasma is needed to carry
the many parts of the blood through the bloodstream. Plasma serves
many functions, including the following:
p helps to maintain blood pressure
p provides proteins for blood clotting
p balances the levels of sodium and potassium
- a portion of the plasma that contains clotting
factors that help to control bleeding.
Phlebotomy is the act of drawing or removing blood from the circulatory system through
a cut (incision) or puncture in order to obtain a sample for analysis and diagnosis.
Phlebotomy is also done as part of the patient's treatment for certain blood disorders.
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Patient identification
Filling out the requisition
Equipment
Apply tourniquet and palpate for vein
Sterilize the site
Insert needle
Drawing the specimen
Drawing the specimen
xeleasing the tourniquet
Applying pressure over the vein
Applying bandage
Disposing needle into sharps
Labeling the specimens
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