Eligibility for blood donation (PAHO Occasional Publication) by Pan American Health Org


70583fb59414200-261x361.jpg Author Pan American Health Org
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Year 2009
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Pan American Health Organization ELIGIBILITY FOR BLOOD DONATION PAHO HQ Library Cataloguing–in–Publication Pan American Health Organization Eligibility for Blood Donation: Recommendations for Education and Selection of Prospective Blood Donors Washington, D.C.: PAHO © 2009 ISBN: 978–92–75–12939–5 I. Title 1. 2. 3. 4. 5. 6. 7. BLOOD BANKS – organization & administration BLOOD DONORS BLOOD TRANSFUSION – standards LABORATORY PERSONNEL – education BLOOD SPECIMEN COLLECTION – methods SEROLOGY QUALITY CONTROL NLM WH460 Original Version: English Art Director: Gilles Collette Document layout: Tagino Lobato and Quyen Nguyen Typed and proofread: Sonia James and Soledad Kearns The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Publications Area, Pan American Health Organization, Washington, D.C., U.S.A., which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pa n A m e r i c a n H e a l t h O r g a n i z a t i o n , 2 0 0 9 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions except, the names of proprietary products are distinguished by initial capital letters. Additional information on PAHO publications can be obtained at: http://publications.paho.org Recommendations for Education and Selection of Prospective Blood Donors iii CONTENT INTRODUCTION BACKGROUND.......................................................................1 EDUCATION OF PROSPECTIVE BLOOD DONORS...............5 SELECTION OF BLOOD DONORS ........................................7 AIM OF THE PRESENT DOCUMENT ...................................7 RECOMMENDATIONS THE BASIC REQUIREMENTS Age .........................................................................................11 Body weight ..........................................................................12 Fasting ...................................................................................12 ABO blood group ..................................................................13 FOR FEMALES ONLY Menstrual period...................................................................17 Pregnancy ..............................................................................18 Breastfeeding.........................................................................19 PERSONAL HEALTH CARE ISSUES Dental procedures .................................................................21 Vaccines/Immunizations.......................................................22 Medication.............................................................................23 FOR TRAVELERS Travel......................................................................................26 HOW IS YOUR SKIN? Allergies .................................................................................28 Skin lesions at the venipuncture site ..................................29 RISKY PRACTICES Body piercing ........................................................................31 Tattoos...................................................................................32 Drug use (recreational) .........................................................33 Sexual behaviours .................................................................34 iv ARE YOU WELL? Body temperature/Fever .......................................................37 Blood pressure (arterial)/Hypertension................................37 Pulse.......................................................................................39 MAKING SURE YOUR BLOOD IS GOOD Hemoglobin level/Hematocrit ..............................................41 Pan American Health Organization ELIGIBILITY FOR BLOOD DONATION Blood volume to be collected..............................................42 Interval between donations .................................................43 Polycythemia vera .................................................................44 CHRONIC ILLNESSES Cancer ....................................................................................47 Diabetes .................................................................................48 Epilepsy/Seizures...................................................................49 Heart and blood vessel disease ............................................50 INFECTIOUS CONDITIONS General considerations .........................................................53 Babesiosis ..............................................................................55 Brucellosis..............................................................................55 Common cold........................................................................56 Dengue...................................................................................57 Hepatitis.................................................................................58 Human immunodeficiency virus (HIV) ................................60 Leishmaniasis.........................................................................61 Malaria ...................................................................................62 Syphilis...................................................................................64 Toxoplasmosis .......................................................................65 Transmissible spongiform encephalopathies ......................66 Trypanosoma cruzi/Chagas’ disease ....................................67 HAVE YOU BEEN TREATED AT A HOSPITAL? Major surgery ........................................................................71 Transfusion ............................................................................72 Transplant..............................................................................73 UNDESIRABLE PAST EXPERIENCES History of severe post donation reaction............................75 Incarceration..........................................................................76 CRITERIA IN ALPHABETICAL ORDER .................................78 ACKNOWLEDGEMENTS .......................................................79 ANNEXES • Pan American Health Organization (PAHO) 48th Directing Council - “Improving Blood Availability and Transfusion Safety in the Americas” - Document CD48/11 and Resolution CD48.R7 • International Society of Blood Transfusion (ISBT) “A Code of Ethics for Blood Donation and Transfusion” Recommendations for Education and Selection of Prospective Blood Donors v ACRONYMS AABB ACT AIDS ARC BSE CJD CoE CRS H-Q HBcore HBsAg HBV HCV HIV HTLV ISBT NAT PAHO STD TSE TTI UK VCJD American Association of Blood Banks Artemesin-based Combination Theraphy Adquired Immunodeficiency Syndrome Australian Red Cross Bovine Spongiform Encephalopathy Creutzfeldt–Jakob Disease Council of Europe Caribbean Regional Standards Hema-Quebec Hepatitis B Antigen Core Hepatitis B surface Antigen Hepatitis B Virus Hepatitis C Virus Human Immunodeficiency Virus Human T cell-Lymphotropic Virus International Society for Blood Transfusion Nucleic Acid Testing Pan American Health Organization Sexually Transmitted Disease Transmissible Spongiform Encephalopathy Transfusion-Transmitted Infections United Kingdom Variant Creutzfeldt-Jakob Disease Pan American Health Organization ELIGIBILITY FOR BLOOD DONATION INTRODUCTION Background n the Region of the Americas, efforts have been made to improve the safety and availability of blood for transfusion (1). The work done at the regional level resulted in a significant increase of annual donations and of voluntary blood donations in the Caribbean and Latin American countries during the first years of the 21st century (Figures 1a and 1b), (1, 2). I Blood donation in the Caribbean and Latin America 2000–2005 Figure 1a 9000 8000 7000 6000 5000 Number of annual donations x 1000 4000 3000 2000 1000 0 2000 2001 2002 2003 2004 2005 Figure 1b 3000 2500 2000 Number of annual voluntary donations x 1000 1500 1000 500 1 0 2000 Recommendations for Education and Selection of Prospective Blood Donors 2001 2002 2003 2004 2005 Although the proportion of blood units collected from voluntary donors increased from 15% in 2001 to 34% in 2002, it remained unchanged during the following four years (Figure 1c) (3–5). Figure 1c 40 35 30 25 20 Proportion of voluntary donations (%) 15 10 5 0 2000 2001 2002 2003 2004 2005 The proportion of voluntary blood donations at the national level improved only in a few instances during the 2002 to 2005 period. Tables 1 and 2 summarize the data for the Caribbean and Latin American countries, respectively. Table 1 Proportion (%) of voluntary blood donations in the non–Spanish speaking Caribbean countries Country Anguilla Antigua and Barbuda Aruba Bahamas Barbados Belize Bermuda British Virgin Islands Cayman Islands Curacao Dominica Grenada Guyana Haiti Jamaica Montserrat St. Kitts and Nevis St. Lucia St. Vincent and the Grenadines Suriname Trinidad and Tobago Turks and Caicos Islands 2 2002 Not Reported 6 100 10 Not Reported 6 Not Reported 99.9 98 100 5 30 16 5 10 0 18 69 7 100 17 50 2003 0 6 100 16 Not Reported 9 98 24 99.6 100 Not Reported 39 22 5 12 0 3 79 12 100 Not Reported 32 2004 10 12 100 24 Not Reported 9 Not Reported 21 100 100 4 35 19 5 11 0 6 83 15 100 Not Reported Not Reported 2005 10 Not Reported 100 15 Not Reported 9 Not Reported 0 100 100 5 30 22 15 10 Not Reported 3 82 13 100 13 Not Reported Pan American Health Organization ELIGIBILITY FOR BLOOD DONATION Table 2 Proportion (%) of voluntary blood donations in Latin American countries Country Argentina Bolivia Brazil Chile Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Honduras Mexico Nicaragua Panama Paraguay Peru Uruguay Venezuela 2002 6 24 47 2 41 48 100 17 41 10 4 22 3 56 2 1 6 35 11 2003 8 16 51 6 42 49 100 18 30 10 4 19 4 45 2 6 5 32 4 2004 7 23 46 7 50 57 100 20 29 11 2 16 4 42 2 6 4 26 7 2005 8 28 53 9 58 59 100 20 Not reported 10 1 15 4 44 3 10 5 26 7 Based on the reports of 28 Caribbean and Latin American countries (4), it is estimated that over 1.2 million prospective donors were deferred in 2005. If the donor interview lasted an average of 15 minutes, the staff in the blood services invested 1,200 hrs. each working day in conversations with individuals that were not in condition to donate blood. Furthermore, those donors that were allowed to donate were very likely to carry markers of infections that have the potential to be transmitted through blood transfusion (median proportion of reactive donors was 3.11%, range 0.03% to 11.00%). In addition to the risk for the safety of the blood supply, the 230,000 reactive units that were discarded in 2005 represent US$ 13.4 million in wasted supplies used for blood collection and processing (5). The stagnation in the proportion of voluntary blood donors at the regional level, the overall high rates of donor deferral, and the prevalence of infectious disease markers the national level, clearly indicate that the processes involved in blood donor recruitment and selection need improvement. This is also one of the main conclusions of socio–anthropological studies carried out in 17 countries of the Region of the Americas (6–23). The findings of these surveys were very similar among them and can be summarized in the following manner: The population: • has a positive attitude towards blood donation; • considers that giving blood is useful; • is willing to help to achieve blood sufficiency; • donates blood when it is necessary; • lacks knowledge about blood donation issues; • is interested in learning more about blood donation; • prefers being given opportunities to donate over material incentives; and • requires transparency of the national blood systems. Recommendations for Education and Selection of Prospective Blood Donors 3 The prospective donors demand information on the requirements to become blood donors, the reasons for deferral, the risks and physical consequences of donating blood, the community need of blood, and the places, frequency and procedures for blood donation. The public suggests that workshops and group discussions be used to involve the community and that mobile collections be implemented to avoid blood collection in hospitals. The location, working schedule and the environment of the facilities where blood is currently collected are considered deterrents for blood donation, as are the poor service provided by the staff and the lack of standardized blood collection procedures (6–23). Taking this information into consideration the document IMPROVING BLOOD AVAILABILITY AND TRANSFUSION SAFETY IN THE AMERICAS (5), presented by the Director of the Pan American Health Organization to the Directing Council in 2008, recommended that: a. the coutries make efforts to estimate their annual need for blood and blood components; b. the number of repeat donors be estimated at least as 50% of the national need of red blood cells; c. a national program be put in place to educate and recruit healthy individuals as regular donors and to have them donate at least twice a year; and d. a social network of volunteers be established to help educate the community, to promote voluntary blood donation and to service the donor. The 48th Directing Council of the Pan American Health Organization (PAHO) on 2 October 2008 adopted resolution CD48.R7 (24) which urges the Member States to: a. Proactively implement the Regional Plan of Action for Transfusion Safety 2006–2010 by: i. defining a specific entity within the normative level of their ministries of health as responsible for the planning, oversight, and overall efficient operation of the national blood system; ii. estimating the annual need for blood components and the financial resources to cover those needs; and iii. establishing a network of volunteers to educate the community, to promote voluntary blood donation and to service the donors, with special attention to youth programs. b. Terminate replacement and paid donation by the end of 2010. c. Terminate mandatory patient replacement of transfused blood by the end of 2010. 4 Pan American Health Organization ELIGIBILITY FOR BLOOD DONATION Education of prospective blood donors The approach recommended by PAHO for the education of allogeneic blood donors requires a shift in the way the national health systems currently procure blood in most of the countries of Latin America and the Caribbean. TRADITIONAL APPROACH NEW APPROACH • The patient needs blood • The hospital orders blood donations • Relatives and friends of the patients are required to provide blood • The blood bank collects the blood specifically for a hospital and/or patient • The hospital uses the blood • The country needs blood • The national community educates voluntary blood donors • The health system promotes and encourages blood donation • The blood services cater to blood donors • The country uses the blood The concept that the country needs blood encompasses the estimation of the quantity of blood components that is required to provide appropriate and timely treatment to all the patients, irrespective of their geographic, economic, social and cultural position. It is the hospitals, therefore, that should determine the annual, monthly and weekly requirements of blood components. The blood services should define the number of blood donors to be educated and provide the leadership to the national community – Ministry of Health, Ministry of Education, Ministry of Labour, academic institutions, churches, patient organizations, human rights organizations, social and sports clubs, municipalities – for the education efforts. The blood donor service staff within the national blood services should train community coordinators and volunteers and support their work to educate the donors (25–31). The desired profile of the voluntary blood donor is “An individual who: • has the capacity and the competence to decide to be a blood donor; • knows that she/he is healthy and wants to remain healthy; • is well informed on the measures to maintain her/his health, on how to avoid unhealthy behaviors and risks; • knows what the need, requirements, process and risks of blood donation are; • is positively motivated to donate blood; • decides voluntarily to donate blood; and • donates blood repeatedly.” 5 Recommendations for Education and Selection of Prospective Blood Donors All the appropriate information and the opportunity to ask questions regarding blood donation should be provided to all prospective blood donors, prior to recruitment, in structured presentations for groups of 40–45 individuals. Detailed explanations of the value of blood transfusions, the estimated need of blood components in the community, the specific processes of donor interview and blood donation, its physiological consequences and its potential untoward reactions are necessary during the education phase (32–35). Prospective donors should receive information regarding infections transmitted by blood transfusion (TTI) such as the viruses of the human immunodeficiency (HIV), hepatitis B (HBV), hepatitis C (HCV), human T cell-lymphotropic type I and type II (HTLV I/II), Trypanosoma cruzi and malaria. The information should include means of transmission, incubation and window periods, signs and symptoms, risk behaviors, preventive measures, and the importance of withdrawing from the donation if they believe that either the collection or the transfusion of their blood may pose a risk for them or for the patients, respectively. The International Society for Blood Transfusion (ISBT) adopted a Code of Ethics for blood donation and transfusion that aims to protect blood donors, blood recipients and blood for transfusion as a public good (36). The Code should be provided to prospective donors during the education phase. Blood services must also inform the donor about the tests that will be performed on donated blood, under which circumstances the donor will be informed of test results, and what information will be released to third parties. Donors have the right to be informed in a timely manner of any medically significant abnormalities that may be detected during the interview and the general health asessment (37, 38). PAHO recommends that any clinically significant findings detected during the pre–donation evaluation or during the blood testing should be released. Blood services should refer for appropriate follow–up donors who have indications of clinically significant conditions, including reactive infectious markers. It is vital, however, that test results not be used as a motivational tool for blood donation, as this would encourage donations from people who engage in risky behaviours, thereby increasing the possibility of TTI (39, 40). Prospective blood donors should also be explained about their rights and those of the patients that may receive blood transfusions (41–49). At the end of the education session, prospective donors should be asked to become regular donors. Experiences from the United Kingdom and Paraguay show that 78% of individuals who attend 45–50 minute sessions do become blood donors (50, 51). Specific arrangements for the selection of those who will actually donate blood should be made immediately. 6 ELIGIBILITY FOR BLOOD DONATION Pan American Health Organization Selection of blood donors The aim of donor selection in the blood donation process is to determine whether prospective donors are in good health, and to assure that blood donation will not harm them. Additionally, blood donor selection seeks to prevent any risk of tranfusion– associated untoward reactions in the blood recipient patient, including transmission of infections or the effects of drugs which could be detrimental to them (52–54). To ensure these objectives, and following the education phase, blood services must carry out a confidential pre–donation interview and a general health assessment of all potential blood donors prior to their donation (55). The selection process must start with the prospective blood donor filling a self– administered form to collect his/her demographic, general and contact information, as well as to initially determine if he/she complies with all criteria for blood donation. This step should last approximately five minutes (56). The second step involves a confidential interview with a trained member of the blood services staff who knows that the blood donors have the right to be treated with dignity, fairness and respect. The interviewer should make sure that the prospective donors understand the process of blood donation, the questions in the self–administered form, and that his/her responses are adequate; the level of hemoglobin should then be determined. This step should last approximately 12 minutes (56). If all parameters are acceptable, the prospective donor should be asked to sign the informed consent form (38) and proceed to donate blood. Aim of the present document PAHO considers it essential to provide the National Blood Programs with resources that allow them to develop appropriate programs for blood donor education, recruitment and selection. This document summarizes the rationale for the parameters and conditions that should be taken into consideration in the education and selection of blood donors, in the level of detail that should allow blood service staff, community volunteers and prospective blood donors to understand them. As illustration of how the parameters are applied in various countries, the selection criteria of the American Association of Blood Banks (AABB), Council of Europe (CoE), Héma–Québec (H-Q) (Canada), the Australian Red Cross (ARC), the Caribbean Regional Standards (CRS) and the Estándares de Trabajo para Servicios de Sangre are presented as examples (57–62). In addition, the document includes recommendations made by PAHO to the national health authorities and the national blood programs in order to promote multidisciplinary and coordinated approaches for health promotion, public education, universal and regional human and patient rights —as applicable to blood donors and recipients—, quality assurance and financial efficiency in the issues pertaining to sufficiency, availability, access, quality, safety, and timeliness of blood for transfusion. It is important to keep in mind that these recommendations should be reevaluated when additional information or evidence becomes available. 7 Recommendations for Education and Selection of Prospective Blood Donors 8 References 1. Pan American Health Organization. Progress Report on the Regional Initiative for Blood Safety and Plan of Action for 2006–2010. 46th Directing Council. 57th Session of the Regional Committee, Document CD46/16. Washington, D.C. – U.S.A., 2005. 2. Pan American Health Organization. Transfusion Medicine in the Caribbean and Latin American Countries 2000–2003. Technical Documents. Access to Quality Products. Technology and Health Services Delivery Area. Essential Medicines, Vaccines and Health Technologies. Washington, D.C. – U.S.A., 2005. 3. Pan American Health Organization. National Blood Systems in the Caribbean and Latin American Countries: Basic Indicators of their Status in 2004. Technical Documents. Access to Quality Products. Technology and Health Services Delivery Area. Essential Medicines, Vaccines and Health Technologies. Washington, D. C. – U.S.A., 2006. 4. Pan American Health Organization. Supply of Blood for Transfusion in the Caribbean and Latin American Countries in 2005. Baseline Data for the Regional Plan of Action for Transfusion Safety 2006–2010. Technical Documents. Access to Quality Products. Technology and Health Services Delivery Area. Essential Medicines, Vaccines and Health Technologies. 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Australian Red Cross Blood Service “Giving blood.” Available from: http://www.donateblood/com.au. Consulted 10 May 2008. 9 Recommendations for Education and Selection of Prospective Blood Donors 10 ELIGIBILITY FOR BLOOD DONATION Pan American Health Organization THE BASIC REQUIREMENTS AGE Blood donation is a voluntary procedure that may have untoward effects on the blood donor and, therefore, requires informed consent by the individual. It is necessary to establish a minimum age for blood donation to assure that the donor has both the competence and the capacity to provide informed consent. Likewise, it is necessary to establish a maximum age for blood donation in order to assure that blood collection does not either have a negative long–lasting effect on the health of the donor or increases the potential risk of adverse reactions to blood donation. The American Association of Blood Banks (AABB) and the Australian Red Cross (ARC) have the lower age limit to donate blood at 16 years. The Caribbean Regional Standards (CRS) establish 17 years as the minimum age, while the Council of Europe (CoE) and Hema–Quebec (H–Q) have set it at 18 years. The AABB and CRS do not list an upper age limit. The maximum age to donate blood varies from 65 (CoE) to 81 years (ARC). PAHO Recommendation: Prospective donors should be at least 17 years old. The maximum age to donate blood for the first time and for repeat blood donation should be established based on the health conditions of the local donor population. Individuals of legal age or the guardians of minors willing to become blood donors should provide informed consent before their first donation. Bibliography • Berger K. Informed consent: Information or knowledge? Med Law 2003; 22:743–750. • Badami KG. Adverse reactions to blood donation among adolescents. JAMA 2008; 300: 1760. • Borquez GE, Raineri GB, Bravo ML. The evaluation of decision making capacity in health care and its relationship to informed consent. Rev Med Chi 2004; 132:1243–8. • Eder AF, Hillyer CD, Dy BA, Notari EP, Benjamin RJ. Adverse reactions to allogeneic whole blood donation by 16– and 17– year olds. JAMA 2008; 299:2279–86. • Eder AF, Hillyer CD, Benajmin RJ. Adverse reactions to blood donation among adolescents. JAMA 2008; 1760. • Goldman M, Fournier E, Cameron–Choi, Seed T. Effect of changing the age criteria for blood donors. Vox Sang 2007; 92:368–72. • Kluge EH. Competence, capacity, and informed consent: beyond the cognitive–competence model. Can J Aging 2005; 24:295–304. • Kuchel GA, Avorn J, Reed MJ, Fields D. Cardiovascular responses to phlebotomy and sitting in middle–aged and elderly subjects. Arch Intern Med 1992; 152:366–70. • Mayberry MK, Mayberry Jf. Consent with understanding: a movement towards informed decisions. Clin Med 2002; 2:523–6. • Misje AH, Bosnes V, Heier HE. Recruiting and retaining young people as voluntary blood donors. Vox Sang 2008; 94:119–24. • Mumford SE. Donation without consent? Legal developments in bone marrow transplantation. Br J Haematol 1998; 101:599–602. • Shehata N, Kusano R, Hannach B, Hume H. Reaction rates in allogeneic donors. Transfus Med 2004; 14:327–33. • Symvoulakis CI. Adverse reactions to blood donation among adolescents. JAMA 2008; 300: 1759–60. Recommendations for Education and Selection of Prospective Blood Donors 11 • Tondon R, Pandey P, Chaudhary R. Vasovagal reactions in “at risk” donors: A univariate analysis of effect of age and weight on the grade of donor reactions. Transf Apher Sci 2008; Epub ahead of print. • Wiltbank TB, Giordano GF, Kamel H, Tomasulo P, Custer B. Fait and prefaint reactions in whole–blood donors: an analysis of predonation measurements and their predictive value. Transfusion 2008; 48: 1799–808. • Zou S, Musavi F, Notari EP IV, Fang CT, for the ARCNET Research Group. Changing age distribution of the blood donor population in the United States. Transfusion 2008; 48: 251–7. BODY WEIGHT (SEE BLOOD VOLUME TO BE COLLECTED) The amount of blood that circulates in the human body is proportional to body weight (70 mL per kg). To avoid untoward reactions in donors as a consequence of donating excesive blood volumes it is necessary to establish the minimum body weight for collection of a standard blood unit from an individual. A standard unit of blood usually corresponds to 450+/-50 mL, which should be no more than 12.5% of the total volume of blood circulating in the body. ARC sets the minimum body weight at 45 kg. For AABB, CoE, CRS and H–Q the lower body weight limit is 50 kg. PAHO RECOMMENDATION: Prospective donors should weight at least 50 kg. Individuals with an involuntary weight loss of >10 kg in the six months previous to the donation should be deferred and referred for medical assessment. Bibliography • Lentner C (ed). Blood Volume. Geigy Scientific Tables Volume 3. Medical Education Division, Ciba–Geigy Corporation, New Jersey. 8th Edition, 1984. • Nadler SB, JU Hidalgo, T Bloch. Prediction of blood volume among human adults. Surgery 1962; 51: 224–32. • Newman B. Blood donor suitability and allogeneic whole blood donation. Transfus Med Rev 2001; 15: 234–44. • Newman BH. Vasovagal reactions in high school students: findings relative to race, risk factor synergism, female sex, and non–high school participants. Transfusion 2002; 42: 1557–60. • Newman BH. Vasovagal reaction rates and body weight: findings in high– and low–risk populations. Transfusion 2003;43: 1084–8. • Newman BH, Satz SL, Janowics NM, Siefried BA. Donor reactions in high–school donors: the effects of sex, weight, and collection volume. Transfusion 2006; 46: 284–8. • Tondon R, Pandey P, Chaudhary R. Vasovagal reactions in “at risk” donors: A univariate analysis of effect of age and weight on the grade of donor reactions. Transf Apher Sci 2008; Epub ahead of print. • Trouern–Trend JJ, Cable RG, Badon SJ, Newman BH, Popovsky MA. A case–controlled multicenter study of vasovagal reactions in blood donors: influence of sex, age, donation status, weight, blood pressure, and pulse. Transfusion 1999; 39: 316–20. • Wiltbank TB, Giordano GE, Kamel H, Tomasulo P, Custer B. Faint and prefaint reactions in whole–blood donors: an analysis of predonation measurements and their predictive value. Transfusion 2008; 48: 1799–808. • Yuan S, Gornbein J, Smeltzer B, Ziman AF, Lu Q, Goldfinger D. Risk factors for acute, moderate to severe donor reactions associated with multicomponent apheresis collections. Transfusion 2008; 48:1213–9. • Zervou EK, Zicadis K, Karabini F, Xanthi E, Chrisostomou E, Tzolou A. Vasovagal reactions in blood donors during and immediately after blood donation. Trans Med 2005; 15: 389–94. FASTING 12 It is common for blood services to defer prospective donors because they have ingested foods and liquids before blood donation. This practice was established because hospital–based blood banks usually collected blood during limited early morning hours, using diagnostic laboratory approaches. This practice is unacceptable, may induce a decrease in donor return rates and disrupt blood collection activities. Vomiting is the least common clinical characteristic of adverse reactions to donation. It is desirable that the donors do not donate during a prolonged fast. The ingestion of 475–500 mL of water before the donation reduces the rate of adverse reactions. ELIGIBILITY FOR BLOOD DONATION Pan American Health Organization None of the documents consulted as examples of international, national and institutional criteria includes food ingestion as factor for donor deferral. PAHO Recommendation: Donors should not be asked to fast for the purpose of donating blood. It is highly recommended that, on the day of donation, prospective donors be given 16 oz (473 mL) of drinking water when they first arrive in the blood collection facilities. This practice not only reduces the rate of adverse reactions to donation but also promotes early friendly interaction between blood service staff and blood donors. Bibliography • France CR, Rader A, Carlson B. Donors who react may not come back: analysis of repeat donation as a function of phlebotomist ratings of vasovagal reactions. Transfus Apher Sci 2005; 33: 99–106. • Hanson SA, France CR. Predonation water ingestion attenuated negative reactions to blood donation. Transfusion 2004; 44: 924–8. • Lu CC, Diedrich A, Tung CS, Paranjape SY, Harris PA, Byrne DW, Jordan J, Robertson D. Water ingestion as prophylaxis against syncope. Circulation 2003; 108: 2660–5. • Newman B, Tommolino E, Andreozzi C, Joychan S, Pocedic J, Heringhausen J. The effect of a 473–mL (16–oz) water drink on vasovagal donor reaction rates in high–school students. Transfusion 2007; 47:1524–33. • Zervou EK, Ziciadis K, Karabini F, Xanthi E, Chrisostomou E, Tzolou A. Vasovagal reactions in blood donors during and immediately after blood donation. Trans Med 2005; 15:389–94. ABO BLOOD GROUP Blood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells carry oxygen from the lungs to the tissues, and carbon dioxide from the tissues back to the lungs. White blood cells fight infections and other foreign substances that may enter the body. Platelets play a central rol in coagulation. Plasma, the liquid component of blood, is rich in proteins that help to keep the body healthy and functioning well, carries nutrients to tissues, and transports substances that should be eliminated from the body through excretions. Human beings have different inherited chemical markers in the membranes of their red blood cells. The major markers are called A and B and define the major blood groups. Individuals may have one, the two or none of these markers in all their red blood cells and, therefore, blood groups are called A, B, AB and O, respectively. Persons with group A red blood cells carry anti–B antibodies in their plasma. Persons with group B red blood cells carry anti–A antibodies in their plasma. Persons with AB type blood do not have either anti–A or anti–B. Persons without any of the two erythrocyte markers have anti–A and anti–B antibodies in their plasma. The presence of red blood cell markers and of plasma antibodies determines the major compatibility of blood for transfusion, since antibodies in plasma bind to foreign erythrocytes and induce their destruction. Nevertheless, persons with AB blood can receive red blood cells, but not whole blood, from donors who have A, B or O blood group. Similarly, O red blood cells can be transfused to patients of all four blood groups. It is common for blood services to defer prospective donors based on their ABO blood group. This practice was established because hospital–based blood banks usually collect blood units that are intended to be transfused to patients whose blood group is already known to the service. None of the documents consulted as examples of international, national and institutional criteria includes blood group or type as factor for donor deferral. Recommendations for Education and Selection of Prospective Blood Donors 13 PAHO Recommendation: Prospective donors should not be deferred because of their blood group. Deferring prospective donors based on their ABO blood group may induce a decrease in donor return rates and disrupt blood collection activities. Procedures and mechanisms for defining the local needs of blood components and for monitoring the local blood inventory should be established. This involves good communications with hospitals to anticipate changes in the complexity, reduction or expansion of their health services. A regional blood center approach facilitates blood inventory management. The implementation of national standards for the collection, processing and storage of components will allow the exchange of units among different blood services. Bibliography • Amin M, Fergusson D, Aziz A, Wilson K, Coyle D, Hébert P. The cost of allogeneic red blood cells — a systematic review. Transfus Med 2003;13: 275–85. • Chapman JF, Hyam C, Hick R. Blood inventory management. Vox Sang 2004; 87 (Suppl 2) S143–5. • Custer B, Johnson ES, Sullivan SD, Hazlet TK, Ramsey SD, Hirschler NV, Murphy EL, Busch MP. Quatifying losses to the donated blood supply due to donor deferral and miscollection. Tranfusion 2004; 44:1417–26. • Denesiuk L, Richardson T, Nahirniak S, Clarke G. Implementation of a redistribution system for near–outdate red blood cell units. Arch Pathol Lab Med 2006; 130:1178–83. • Novis DA, Renner S, Friedberg R, Walsh MK, Saladino AJ. Quality indicators of blood utilization. Three College of American Pathologists Q–Probes Studies of 12 288 404 Red Cell Units in 1639 Hospitals. Arch Pathol Lab Med 2002; 126: 150–6. • Participants of the Cost of Blood Consensus Conference, Charleston, S.C. – U.S.A. May 4–5 2003. The Cost of Blood: Multidiscplinary Consensus Conference for a Standard Methodology. Transf Med Rev 2005; 19: 66–78. • Pereira A. Blood inventory management in the type and screen era. Vox Sang 2005; 89:245–50. • Sime SL. Strenghtening the service continuum between transfusion providers and suppliers: enhancing the blood service network. Transfusion 2005; 45: 206S–23S. 14

Author Pan American Health Org Isbn 9789275129395 File size 6MB Year 2009 Pages 79 Language English File format PDF Category Medicine Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare This book summarizes the rationale for the parameters and conditions that should be taken into consideration in the education and selection of blood donors, in order to allow blood service staff, community volunteers and prospective blood donors to understand them.     Download (6MB) Organ Donation and Transplantation Essentials of Mechanical Ventilation, Third Edition Service User and Carer Involvement in Education for Health and Social Care: Promoting Partnership for Health Practical Transfusion Medicine for the Small Animal Practitioner, 2nd Edition Making Sense Of Vascular Ultrasound: A Hands-on Guide Load more posts

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