The document provides information about establishing and operating a blood transfusion service. It discusses key aspects like location, facilities, equipment, staffing, donor screening and types, blood collection procedures, storage and transportation of blood and blood products. The document also covers blood grouping systems, components of blood like packed red cells, plasma, platelets etc and their uses in transfusions. Maintaining proper standards and facilities is important for the blood transfusion service to safely and effectively meet transfusion needs.

1. BLOOD BANKING
Dr. Pratima

2. INTRODUCTION
• BTS is a vital component of any health
care delivery system
• The aim of blood transfusion services
should be to provide effective blood and
blood products,which are safe as possible
and adequate to meet patients’ needs
• A Blood Transfusion Service is a complex
organization, requiring careful designing
and management.

3. GENERAL GUIDELINES
LOCATION
• Not exposed to strong sunshine
• Proper natural lighting of rooms &
protection from dust & insects
• Adequate protection against rains,
snow
• Stand by generator

4. GENERAL GUIDELINES
• Equipments & Instruments for diff. sections
• Utilities- Water, Electricity, Fuel
• Consumable supplies
• Lab reagents, bags etc
• Office supplies
• Quality control program followed in BTC
• Lab safety precautions
• Basic financial consideration and budgeting.

5. DONOR AREA
Reception and donor
waiting area
• Spacious
• Well ventilated
• Proper & comfortable
sitting arrangement
• Social worker or tech staff
to answer queries &
alleviate anxiety

6. DONOR AREA
• Medical examination room
• Donor refreshment cum resting room
• AC with proper & comfortable seating
• Drinking water & refreshments
• Observation Room

7. Medical
Examination
Room

8. •Jar with CUSO4
•Sterile lancet &
swabs,spirit
•Capillary tubes
with rubber bulb

9. BLOOD DONATION/COLLECTION ROOM
• AC, proper light, washable floors,
• Should not be visible for people in waiting room
• Comfortable beds
• Sterile equipments
• Refrigerators & resuscitation equipments
• Dust free, quite & pleasant with privacy for
recording history & examination
• Emergency drugs
• Connected to reception on one side and
refreshment room on other

10. DONORS
TYPES OF DONORS:
1. Voluntary Donors
2. Replacement Donors
3. Autologous Donors

11. BLOOD DONORS
VOLUNTARY DONOR is one who donates blood for storage at
a blood blank for transfusion to an unknown recipient.
• A greater percent of better quality blood comes from
voluntary donors.
• These donors are very important because the incidence of
blood transmitted infections is much less in blood drawn
from volunteers.
REPLACEMENT DONOR is a person, often a family member,
donates blood for transfusion to a specific individual.
• The donor is selected by the recipient
• Since there is pressure to donate, they may give blood even
if there is risk behavior

12. BLOOD DONORS
AUTOLOGOUS DONOR is a person who donates
blood to be stored and is transfused back to the
donor at a later stage, usually after surgery.

14. EQUIPMENT IN BLOOD DONATION ROOM
 Blood bag weighing scale
 Heat sealer or tube sealer Artery forceps &
scissors
 Test tubes for typing & serological testing
 Emergency drugs- Adrenaline, corticosteroids,
metachlopromide, IV dextrose, IV Ns etc
 Oxygen cylinders with mask gauges & pressure
regulators
 Cotton, Sterile gauge, antiseptic soln. & adhesive
tapes

15. Shaking Apparatus for proper
mixing of blood
Tube Sealer

16. LABORATORY
 Samples are processed & blood is issued
accordingly
 Grouping, cross matching
 Should be spacious,AC with proper lighting

17. EQUIPMENT USED IN LABORATORY
 Microscope, Centrifuge, Water baths
 Refrigerators
 Incubators
 Graduated pipettes, glass slides, test tubes
 Test tube racks of diff specifications
 Wash bottles, plain & EDTA vials

19. REFRIGERATOR:
• Tested & untested blood stored separately
• Const temp 2-6°c
• Digital dial thermometer, recording
thermograph & alarm device
• Cont power supply

21. PATH OF THE DONOR
Entrance Exit
Waiting room
Donor laboratory
Medical examination
Resting room Blood collection
Donor refreshment room
Waiting
room
Donor records

22. PATH OF THE BLOOD
Blood collection
Preparation of
Blood
components
Refrigeration
&
freezing distribution
Plasma fractionation

23. PATH OF THE BLOOD SAMPLE
Blood
collection
Blood
grouping
Testing for
Transmissible
diseases
Labeling
Discard after
Agreed period

24. DONOR SCREENING
1.Registration,consent of the donor and
demographic information
2.Medical History
3.Limited physical examination
4.Simple laboratory tests

25. DONOR SCREENING
DEMOGRAPHIC INFORMATION:
• It should be complete and correct so that the
donor can be informed of any laboratory testing
abnormality.
1.Donor’s full name
2.Father/Husband’s name
3.Age
4.Gender
5.Residential address
MEDICAL HISTORY :
1.History of any long term illness
2.Medication

26. PHYSICAL EXAMINATION
A qualified practitioner of Medicine or Blood Bank Officer
should carry out the following:
• General Appearance: – should be healthy
• Pulse: - 72 – 90 beats/minute.
• Temperature: - 37 degree C
• Blood Pressure: -
Systolic pressure : 110 – 150mm of Hg
Diastolic pressure: 70 to 100mm of Hg.
• Respiratory, Cardiovascular, Gastro-Intestinal etc, systems
should be normal and no problems could be detected by a
rapid physical examination and / or medical history.

27. DONOR SCREENING
• LABORATORY TESTS:
1.Hemoglobin estimation
2.Blood grouping & Cross matching
4.Screening for unwanted antibodies
5.Screening for transfusion transmissible infections:
HIV 1& 2
Hepatitis B
Hepatitis C
Syphilis
Malaria
Tests must be performed at each donation regardless of no. of
earlier donations

28. TEMPORARY DEFERRAL
• Hb< 12.5gm%
• body weight <45 kgs
• Donated blood in last three months
• Donors on treatment with following drugs:
Insulin, Finasteride,Isotritinoin,Antibiotics
• Diseases:
• Malaria – H/O malaria,treated and free from symptoms
• accepted three months after treatment
• Syphilis – 12 months after rashes disappear and completion
of therapy
• Tuberculosis – defer for 5 years after cessation of symptoms
and treatment
• Females: pregnancy,lactation, miscarriage

29. PERMANENT DEFFERAL
• Malignancy
• Asthma
• AIDS
• Bleeding disorders
• Surgeries like open heart surgery,cancer surgery
• Viral Hepatitis
• Chronic liver disease
• Chronic renal disease
• Leprosy
• Polycythemia Vera

30. COLLECTION OF BLOOD
PROCEDURE OF PHLEBOTOMY:
• Apply tourniquet blood pressure cuff,identify
venipuncture site
• Check for any leak in blood collection bag
• Position bag on weighing machine
• Perform venipuncture
• Blood collection takes 8 – 10 minutes
• Clamp the tubing,remove the needle and shift the
bag immediately to refrigerator

31. DONOR REACTIONS AND
MANAGEMENT
MILD REACTIONS :
• Symptoms: nervousness,pallor,sweating,thready
pulse,nausea,vomiting
• Management:Stop donation
• Immediately raise donor feet by 45 degrees
MODERATE REACTIONS:
• Symptoms: periods of unconsciousness,decreased pulse
rate, continuous fall in blood pressure
• Management: stop donation, admninister25% oxygen,
separate the donor from the general area by using a screen

32. DONOR REACTIONS AND
MANAGEMENT
SEVERE REACTIONS:
• Symptoms:convulsions
• Management:prevent donor from injuring
himself/herself

33. POST DONATION INSTRUCTIONS
• Take more fluids for 24 hrs after blood donation
• Volume wise recovery of blood occurs in 48 hrs,
after blood donation.
• No specific bed rest is required post donation,
general rest is advised.
• Do not lift heavy articles,do vigorous exercise for
24 hrs .
• Do not smoke for ½ an hr after donation.

34. STORAGE AND TRANSPORTATI0N OF
BLOOD
• Temperature range: 2 – 6 degree C.except
platelets –temp range:22 – 24 degree C.
• Refrigerator for storing blood should have a fan
for circulating air to ensure uniform temperature
• System should be there to monitor and record
the temperature continuously
• Temperature recording charts should be changed
regularly
• There should be alarms
• In case where blood has to be transported(
camps)blood should be packed in cold boxes
surrounded by ice packs.

35. STORAGE AND TRANSPORTATI0N OF BLOOD
• ADVANTAGES OF LOWER TEMPERATURE:
• 1.Keeps the rate of glycolysis at lower
limit
• 2.Minimizes the proliferation of bacteria
• 3.Reduces the rate of diffusion of
electrolytes(Na & K) across the cell
membrane.
• Blood should be administered within half
an hour of receiving from the blood bank

36. PRESERVATIVES SOLUTIONS
ACD CPD CP2D CPDA1
Trisodium
citrate(g)
22.0 26.30 26.35 26.35
Ciric acid(g) 8.0 3.27 3.27 3.27
Dextrose(g) 24.5 25.50 51.10 31.90
Monobasic
sodium
phosphate(g)
- 2.22 2.22 2.22
Adenine(g) - - - 0.27
Distilled
water(ml)
1000 1000 1000 1000
Preservativeml/1
00ml blood
15 14 14 14
Initial pH of blood 5.0 5.6 5.6 5.6
Storage time(2-6
C)
21 21 21 35

37. BLOOD GROUP SYSTEMS
• There are around 30 blood group systems
• ABO and Rh systems are the most important
• Others include:
• P
• MNS
• Kell
• Duffy
• Kidd
• Lutheran
• Geribich
• Xg
• Scianna
• Diego
• Cartwright

38. ANTIGEN AND ANTIBODY
Group Antigen Antibody
A A Anti-B
B B Anti-A
AB A and B No
Antibody
O No Antigen Anti-A and
Anti-B and
Anti AB

39. BOMBAY BLOOD GROUP
• It is characterized by the absence of A,B
and H antigens on the red cells.
• The serum contains anti-A,anti-B and anti-
H,which reacts with all O blood groups.
• It lacks the H gene and is homozygous for
its allele h (hh).
• Donor for Bombay blood group person is
another Bombay blood group individual.

40. BLOOD AND ITS COMPONENTS
WHOLE BLOOD :
• Blood collected in an anticoagulant,can be stored and
transfused to a patient in an unmodified state
• During the first 4-6 hrs of collection,blood has 100% of all
its constituents
• ADVANTAGE: has all the components of blood.
• DISADVANTAGE: 1.Side effects due to plasma and
lymphocytes.
• 2.Volume overload
• 3.Allosensitization

41. BLOOD AND ITS COMPONENTS
INDICATIONS:
• 1.Massive hemorrhage,cardiac surgery
• 2.Exchange transfusion
• 3.Anemia
• 4.Exchange for sepsis,toxic substances

42. COMPONENT SEPARATION ROOM
 Units of whole blood are separated into
various components and stored at optimal
conditions
 25 sq m
 Completely secluded, sterile with
restricted entry
 AC, temp 20-25°C
 Well equipped with refrigerators, deep
freezers etc

44. BLOOD AND ITS COMPONENTS
• Packed red cells
• Fresh frozen plasma
• Platelet rich plasma
• Platelet concentrates
• Cryoprecipitate
• Cryo-poor plasma
• Granulocyte concentrate

45. Refrigerated Centrifuge & Cryo Bath

46. BLOOD COMPONENTS
ADVANTAGES:
• 1.Enables selective transfusion of blood
products according to specific needs
• 2.Allows for optimal survival of each of the
component parts
• 3.Maximizes the number of transfusion
recipients
• 4.Enables blood collection agencies to
maximize their financial returns

47. BLOOD COMPONENTS
PACKED RED BLOOD CELLS:
• are a concentrated source of red blood cells that remain in a
small amount of plasma upon removal of supernatant
plasma after centrifugation of the blood transfusion bag
containing whole blood.
• Contains 22-25% of original plasma,100% neutrophils and
lymphocytes,<10% of platelets & clotting factors
INDICATIONS:
• 1.Chronic transfusion dependent anemia
• 2.Acute hemorrhage
• 3.Nutritional anemia if severe
• 4.Before surgery if Hb is < 7gm%.

48. BLOOD COMPONENTS
INDICATIONS OF PLATELET TRANSFUSION:
• 1.Decreased platelet production
• 2. Increased platelet destruction
• 3.Hypersplenism
• 4.Dilutional
• 5. Platelet dysfunction
CONTAINDICATIONS:
• Thrombotic thrombocytopenic purpura (TTP)
• Heparin induced thrombocytopenia (HIT

49. BLOOD COMPONENTS
FRESH FROZRN PLASMA(FFP):
• FFP is plasma obtained from a single donor either
by normal donation or by plasmapheresis and
rapidly frozen within 6-8 hrs to frozen at less than
–30 degree C
• It contains all coagulation factors.
• Fresh frozen plasma contain all coagulation
factors and plasma proteins

50. BLOOD COMPONENTS
• Fresh frozen plasma is stable for 1 year if maintained in a
dedicated freezer at or below –20 degree C.
• FFP contains Factor VII-O.6i.u./ml,IX-0.9i.u.,0.8i.u./ml
• FFP should be administered as soon as possible after
thawing(max.24hrs) at 10 degree C.
INDICATIONS FOR FFP
1.Vitamin K deficiency
2.Liver disease
3.Vitamin K deficiency
4.D I C
5.Correction of warfarin therapy
6.Thrombotic thrombocytopenic purpura

51. CRYOPRECIPITATE
• It is precipitated proteins of plasma,rich in factor VIII
• Maintained in a very small amount of remaining plasma ( 15
to 20ml)
• Cryoprecipitate is stable for 1 year
• One unit of cryoprecipitate is defined as that obtained from
a single FFP bag
• It is a concentrated source of von Willebrand factor,
fibrinogen, factor VIII, factor XIII and fibronectin
• INDICATIONS FOR CP
• Management of von Willebrand disease & Hemophilia A
• Fibrinogen deficiency
• Factor XIII deficiency

52. ADVERSE EFFECTS OF BLOOD TRANSFUSION
REACTION ACUTE(<24
hrs)
DELAYED(Onset
within days or
months)
Immune-
mediated
Hemolytic Hemolytic
Febrile
nonhemol-
ytic
Alloimmun-
ization
Allergic Post-
transfusion
purpura
anaphylactic TR-graft-vs-
host reaction
TR-acute lung
injury
immunomodula
tion

53. ADVERSE EFFECTS OF BLOOD TRANSFUSION
REACTION ACUTE DELAYED
Non-immune
mediated
Bacterial
contamination
TA infections
Circulatory
overload
Hepatitis B &
C
Physical or
chemical
damage to
RBCs
HIV 1 & 2
hyperkalemia Syphilis,
malaria
Iron overload

54. ADVERSE EFFECTS OF BLOOD TRANSFUSION
IMMEDIATE TRANSFUSION REACTIONS:
SIGNS & SYMPTOMS:
• Fever,Rigors,Hypotension,Respiratory distress,
oliguria,shock
• MANAGEMENT
• 1.Stop transfusion
• 2.keep iv line open with a drip of normal saline
• Check the label on blood bag,cross matching report
• Patients physician should be informed
• First voided urine sample should be sent to the lab for
analysis of free hemoglobin
• In bacterial contamination broad spectrum antibiotic
therapy,supportive care, corticosteroids must be given

55. ADVERSE EFFECTS OF BLOOD TRANSFUSION
DELAYED HEMOLYTIC TRANSFUSION REACTIONS:
PRIMARY ALLOIMMUNZATION:mild,due to
incompatibility of Rh,Kell,Duffy,Kidd and other
systems
• Signs & symptoms: mild fever,fall in Hb,DAT may
be positive
PLATELET INCOMPATIBILIY: Thrombocytopenic
purpura
• Due to production of platelet antibodies
• Occurs in patients who are already immunized by
earlier platelet transfusion
• Management:coticosteroids,plasmapheresis

56. TRANSFUSION TRANSMISSIBLE
INFECTIONS(TTI)
• Preventing TTI in developing
countries is difficult as the
resources are limited,even when
strategies and policies are in
place.
• TTI mainly occur because of
inability of tests to detect
diseases in their window periods
of infections,immunologically
variant viruses,non
seroconverting or
immunologically silent carriers
and lab testing errors

57. TRANSFUSION TRANSMISSIBLE
INFECTIONS(TTI)
1.VIRUSES: HIV,Hepatitis
B&C,HTLV,CMV,EBV,Parvovirus
2.BACTERIA: Syphilis,E.coli,staphylococcus
aureus,Yersinia
3.PARASITES :Malarial Pararsite,toxoplasma
gondii,leishmania,babeosis,microfilaria,
4.EMERGING PATHOGENS:TTV,HGV,HHV-
8,West Nile virus

58. Thank you…..