summary of blood bank requirements infrastructure in inda from public health perspective

1. BLOOD BANK
DR. NAINSHREE BHUNJIYA

2. A blood bank is a center where blood gathered as a result
of blood donation is stored and preserved for later use in
blood transfusion. The term "blood bank" typically refers to
a division of a hospital where the storage of blood product
occurs and where proper testing is performed.
All blood banks should be licensed by State Drug
Controller and approved by Drugs Controller General-
(India) and should be regulated by Drugs and Cosmetics
Act.
Blood Blanks are attached with hospitals which should
atleast be First Referral Unit
A medical officer designated for this purpose will be
responsible for overall working of the storage center.

3. REQUIREMENTS FOR A BLOOD
BANK
(i) Space:10 square metres, well lighted, clean and preferably air-
conditioned.
(ii) One doctor and technician :trained in the operation of blood storage
centres and other basic procedures like storage, grouping, cross- matching
and release of blood
(iii) Electricity: 24 hours supply is essential. Provision of backup Generator is
required.
(iv) Reagents: All the reagents should come from the Mother Blood Bank.
(v) Equipment Each FRU should have the following:
◦ Blood Bank Refrigerators - storage capacity of 50 units of Blood.
◦ Deep Freezers for freezing ice packs required for transportation.
◦ Insulated Carrier boxes with ice packs for maintaining the cold chain during
transportation of blood bags.
◦ Microscope and centrifuge
Disinfectants Bleach & Hypochlorite Solution As required.

4. SUGGESTED QUANTITIES OF WHOLE
BLOOD UNITS TO BE AVAILABLE AT A
BLOOD STORAGE UNITS
5 units each of A, B, O (Positive)
2 units of AB (Positive)
1 units each of A, B & O (Negative)
 This can be modified according to the actual requirement.
First In and First Out (FIFO) policy, whereby blood closer to
expiry date is used first,

5. Blood should be accepted only from voluntary, non-
remunerated, low risk, safe and healthy donors.
Pre-donation counselling by trained staff should be made
available maintaining privacy and confidentiality. Consent
should be obtained in writing from the donors after explaining
the procedure, potential adverse reactions.
Demographic details such as name and address of donor, date
and time of donor selection and donation should be registered
donor’s health and has not suffered or is not suffering from any
serious illness e.g. malignant disease, epilepsy, bronchial
asthma, diabetes, excessive menstrual bleeding, cardio-vascular
conditions, renal disease, allergic diseases, abnormal bleeding
tendency.

7. Whole blood is collected from donors into a collection pack in
which multiple bags are connected, allowing blood and
components to be transferred between bags aseptically
during manufacturing.
The collection packs include two different configurations.
 Buffy coat collection set: red blood cell, plasma and platelet products;
 Whole blood filtration set : red blood cell and plasma products.
One unit of red blood cells usually increases the hemoglobin
concentration by approximately 10 g/l in an average size, non-
bleeding adult.
1 unit of platelet concentrate/10 kg body weight e.g. for 60
kg man 6 units of random donor platelets concentrate.

8. DONATION INTERVAL: interval between two blood donations
should be at least 12 weeks.
ANTICOAGULANT SOLUTIONS
◦ Citrate-Phosphate-Dextrose (CPD) Solution. 14 ml solution is required
for 100 ml of blood.
◦ Citrate-Phosphate-Dextrose-Adenine (CPDA-1) solution. 14 ml solution
is required for 100 ml of blood.
◦ 100 ml SAG-M/ADSOL or any approved additive solution containing
saline adenine and glucose (or with mannitol) is added to packed cells
after separation of plasma for storage.

9. CRITERIA FOR SELECTION OF
DONORS
The prospective donor should appear to be in good health
Donors should be between the age of 18 and 65 years
The haemoglobin should be not less than 12.0 gm/dl or the haematocrit should
be not less than 36%.
Blood collection from donors weighing 45-55 Kg should be 350 ml blood and
from those weighing 55 Kg and above should be 450 ml.
The systolic blood pressure should be between 100 and 160 mm of Hg and the
diastolic pressure should be between 60-90 mm of Hg
Temperature should not exceed 37.50 C/ 99.5o F
Pulse should be between 60 to 100 beats per minute and regular.
The skin at the venipuncture site should be free of any skin lesion or scar
indicative of addiction to narcotics or infection as well as marks of repeat
venepuncture.

10. Donor’s should not be accepted
Pregnancy- 12 months after full
term delivery and also during
lactation
abortions - 6 months
malaria -3 months.
jaundice -1 year.
 Yellow fever/measles/polio - 2
weeks
Hepatitis B Immunoglobulin - 1
year
measles/mumps/chickenpox -8
weeks. Hepatitis B vaccination -7
days
HIV, HBsAg / HCV antibody positive
should be permanently deferred.
 Donors having intimate contact with
HIV, HBsAg / HCV antibody positive
individual should be deferred for 1
year.
Ingestion of Aspirin or any related
medicine within three days prior to
donation should preclude use of donor
as a source of platelet preparation.
Rabies vaccination - 1 year. Those
bitten by any animal should be
deferred for one year.

11. Testing of Donated Blood
ABO group should be determined.
The Rh(D) type should be determined
A donor's previous record of ABO and Rh(D) type should not serve as
identification of units of blood subsequently given by the same donor
Serum or plasma from donors should be tested for unexpected antibody/ies
with pooled O Rh (D) positive cells or preferably screening cell panel using
albumin/enzyme/indirect AHG test which can identify clinically significant
antibodies. Blood in which such antibody/ies are found, should be used as
packed cells only.

12. LABORATORY TESTS FOR INFECTIOUS
DISEASES
Test for Syphilis Each donation of whole blood should be subjected to a
serological test for syphilis by VDRL / RPR Method / TPHA.
Test for Viral Hepatitis A test for hepatitis B (HBsAg) and hepatitis C (anti-HCV)
by ELISA/Rapid test which is a validated method should be done on each unit of
blood. Any technology with similar or higher sensitivity may be used additionally
to improve blood safety.
Screening for HIV Antibodies All blood units collected should be tested for HIV
1&2 antibodies using ELISA/Rapid which is a validated method. Any alternative
technology with similar or higher sensitivity may be used.
Test for Malaria All blood units should be tested for malarial parasites using a
validated and sensitive antigen test.

13. Color Scheme: The following color code is used to differentiate the ABO group
label
◦ Blood group O - Blue
◦ Blood group A - Yellow
◦ Blood group B - Pink
◦ Blood group AB – White
INSTRUCTIONS FOR TRANSFUSION
◦ Do not use if there is any visible evidence of deterioration.
◦ Keep at 4°C +2° C before use.
◦ Shake gently before use.
◦ Do not add any other medication to the blood/blood component.
◦ Check blood group on label and that of the recipient before administration.
◦ Use a fresh, clean, sterile and pyrogen free disposable transfusion set with filter to
transfuse blood.
◦ Do not dispense without a prescription.

14. Platelets should be separated from whole blood within 8 hours of
collection by centrifugation at 220 C + 20 C using either platelet rich
plasma (PRP) or buffy coat (BC) method
Platelets should be suspended in approximately 50 ml of plasma and
stored at 220 C + 20 C . The pH at storage temperature should not be
lower than 6.0 at the end of storage period.
Fresh Frozen Plasma Fresh plasma should be separated from the whole
blood not later than 6 - 8 hours of collection and frozen solid at –300 C
or lower as early as possible. Prior to infusion the frozen plasma should
be thawed rapidly at 30-370 C in a water bath with shaker. Once thawed
it should be used within 6 hours.

15. SL
No.
Blood Component Storage
Temperature
Expiry
1 Whole blood coagulant citrate-phosphate-dextrose
solution . (CPD)
4° C±2°C 21 days
2 Whole blood in citrate-phosphate dextrose with
adenine (CPDA-1)
4° C±2°C 35 days
3 Whole blood in heparin solution 4° C±2°C 24 hours
4 Red blood cells which is prepared by an open system 4° C±2°C 24 hours
5 Red cell concentrate SAGM, ADSOL 4° C±2°C 42 days
6 glycerolized (low or high) frozen red cells -80° to -196° C. 10 years
7 Washed red blood cells and deglycerolized red blood
cells
4° C±2°C 24 hours
8 platelet concentrate (with continuous gentle flat bed
agitation)
22 °C ±20° C 3 to 5 days
9 Fresh frozen plasma and cryoprecipitate -30 C° or below 12 months
Expiry date of any component should be calculated by considering the day of collection as day
zero.

16. WASTE DISPOSAL
Blood bags are disposed in yellow dustbins .These should then be sent
for Autoclaving
Needles discarded in a puncture proof container of a non-chlorinated
plastic. These should then be sent for deep burial or incineration.
Spills on the table tops/sinksThe spill should be covered with papers or
plain cloth and soak with 1% hypochlorite solution for at least 30
minutes and later swabbed.

17. Covid 19 related updates
National Blood Transfusion Council has issued 2nd guidelines in view of covid
19 pandemic on 25th of June 2020. Major highlights of which are:
 there is no precedent evidence of transfusion related transmission of
respiratory virus.
Donated blood will not be tested for covid 19 by RTPCR before transfusion.
 Exclusion of: Confirmed cases, Cases with contact history and travel history
should be deferred from donation for 28 days.
 outdoor and indoor blood donation activities may be continued by
following social distancing. Hand hygiene, cough etiquette, and infection
control protocol.
Post donation the donor is supposed to report to the blood bank if he is
suffering from post donation illness suspicious of covid or is a Confirmed
cases, or is a close contact of Covid confirmed Case.
In such cases the blood is to be recalled and discarded. If it has
already been transfused then the concerned doctor is to be informed