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Transfusion essay October 2009

Page history last edited by James Davies 8 years, 10 months ago

Discuss the measures that can be used to reduce the risk of transmitting viruses to patients via red cells, platelets and fresh frozen plasma

 

1. Donor Selection

Motivation – altruistic ie. no financial gain

Rules dictating who can donate blood are complex and are constantly being updated by the NBS - (please correct these if you think they are out of date)

Permanent exclusions

  • People who are carriers of infectious diseases such as
    • HIV +
    • Hep B carrier
    • Hep C carrier
  • High risk behaviour 
    • MSM
    • Money or drugs for sex
    • IVDU includes body building drugs
  • Risk of CJD
    • Previous recipient of a blood transfusion
    • Human pituatry hormones
    • Family history
  • People who have diseases of unknown or viral aetiology
    • UC, Crohns, malignancy

Temporary exclusions 

  • 12 month exclusion if had sex in the last year with
    • A partner who has high risk behaviour (as above)
    • + anyone who has received clotting factor concentrates or who has been sexually active in areas where HIV is common
  • 6 month exclusion if
    • Travel to malaria endemic country
  • Infectious disease or contact or finished antibiotics within the last 7 days
  • Vaccination
  • Piercing, tattoo, acupuncture outside the NHS
  • Complicated dental work
  • Serious illness or major surjery
  • Pregnancy or delivered within last 9 months

 

2. Venepuncture

  • Checks of donor identity
  • Check for integrity of blood pack
  • Labelling of pack and samples
  • Arm cleansing / Diversion pouch
  • Closed bag technique
  • Mixing of packs to prevent clotting

 

3. Storage / processing

  • Storage and transport conditions – cold chain 4 C for red cells
  • Microbiology - environmental testing
  • Platelet storage 5 days
    • Moves to increase to 7 days, with micro testing
  • Leukodepletion - will reduce risk of CMV transmission 

 

4. Microbiology

Mandatory tests

  • Syphilis (Ab)
  • HBV (Nucleic acid testing (NAT) HBsAg) 
  • HIV(NAT and Ab and Ag testing) 
  • HCV (Ab and NAT) 
  • HTLVI and II (Ab and NAT)

Discretionary tests

  • CMV (test 30%)

 

5. Transfusion

  • Mecahnisms in place to withdraw products if necessary
  • Appropriate transfusion
  • Traceability and ‘look back’ procedures

 

 

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