The procedure for accepting and registering donors.

Reception of donors in blood service institutions is carried out on the basis of a passport (for military personnel – military ID or ID). Donor registration is carried out according to the following primary medical documents:

• event log, performed in case of donor disease with syphilis, hepatitis, AIDS,
• donor registration card,
• active donor medical record,
• reserve donor card,
• donor immunization record,
• donor register.

Active donors are recorded on the basis of “Active donor medical card” in “Diary of registration of active donors”.

Reserve donors are recorded on the basis of “Reserve Donor Cards” in “Reserve Donor Record Diary” based “Active donor medical card” or “Reserve Donor Cards” and directions of medical institutions.

“Donor registration card” filled in for each donor in duplicate, one of which is transferred to the territorial single donor center.

Accounting forms are stored for 5 years, except “Donor registration card”, which must be stored for 75 years. When the donor is removed from the register at “Active donor medical card” and c “Donor registration card” the reason for the donor withdrawal is recorded and the total amount of the withdrawn blood or its components is summed up for the entire donation period.

When collecting blood on-site in organizations, it is allowed to fill out the registration documentation of donors based on the lists, compiled and approved by the medical professional of the relevant organization.

If there is a computer databank of donors, duplication of information on paper is required.

It is advisable to distribute the functions of the medical staff for the reception and registration of donors as follows.

Medical registrar (operator) – fills in accounting documentation based on documents, identification, prepares certificates, issues a standard questionnaire to the primary donor (Application 1). The donor fills out the questionnaire himself or with the help of a medical registrar. The completed application form is then inserted into the donor card. Donors, withdrawn from giving blood or its components for medical reasons, or if it is impossible to carry out the procedure for technical reasons, a certificate of examination is issued.

Laboratory assistant – before blood supply determines the content of hemoglobin, blood type, fills in the accounting documentation.

Hand doctor-transfusiologist – examines donors, fills in the accounting documentation, determines the suitability for donation, determines the amount of blood withdrawn, plasma, blood cells, if necessary, send for additional research and consultations.

Clinical and laboratory examination of donors

When determining indications for donation, the type of donation and the amount of blood or its components taken, the doctor is guided by “List of contraindications for donating blood and its components”, “The intervals between types of donation” (annexes 2 and 3), the results of collecting anamnesis, physical examination and the following regulations:

• standard volume of blood collection – 450 ml 10% , excluding blood, taken for analysis (to 40 ml). Persons weighing less 50 kg are admitted to donation on an individual basis by the decision of the transfusion physician. Their blood donation volume should not exceed 12% circulating blood volume (OCK), which is 6,5 – 7% body weight.
• the maximum volume of one plasma donation should not exceed 650 ml, the maximum volume of plasma donations per year should not exceed 15 l;
• for immunization with antigens of the Rh system, men aged from 18 to 50 years, women – during menopause;
• for immunization with staphylococcal toxoid, men aged 20 – 50 years, women are not allowed to immunize with staphylococcal toxoid.
• the donor's body temperature is measured, which must be at least 36 ° C and no more than 37 ° C.
• the frequency and rhythm of the pulse is determined: fine – rhythmic pulse, from 60 to 80 beats per minute.
• permissible blood pressure indicators: systolic – within 90-170, diastolic – 60-90 mm Hg column.
• the interval between blood donations must be at least 60 days. Number of blood donations per year in men – no more 5, among women – no more 4.

If there are absolute contraindications to donation, the medical documentation reflects the reason for withdrawal from donation (primary donor) or deregistration (second reserve donor, active donor).

If there are temporary contraindications, identifying any visible health problems, if there is a suspicion of contact with an infectious disease, the donor is sent for additional examination.

In the absence of contraindications to donation, the doctor determines the type of donation (blood, plasma, immune plasma, blood cells), volume of donations of blood or its components.

Donor health data, the type of donation and the amount of blood or its components taken are recorded in the relevant medical documentation, issued “Direction to blood supply, plasmapheresis, etc.”, and the donor is sent for donations.

 

Donor blood test

General research:

Before blood supply, the level of hemoglobin in the blood is determined, ABO blood groups.

Further screening of donated blood is carried out according to the following indicators:

• determination of the blood group of the ABO system double (cross) reaction;
• determination of antigen D of the Rhesus system (in his absence – determination of antigens C and E of the Rhesus system; if any of the indicated antigens is detected, this component is made out as Rh-positive; if antigens are absent D, C, E, the component is presented as Rh-negative);
• determination of antigen K in donors of erythrocyte-containing blood components;
• anti-erythrocyte alloantibodies (at least once a year);
• antibodies to HIV-1, HIV-2 and HIV p24 antigen;
• hepatitis B virus surface antigen;
• antibodies to hepatitis C virus;
• antibodies to treponema pallidum.

By decision of regional health authorities, the list of studies can be expanded (determination of alanine aminotransferase activity, brucellosis markers, etc.).

Screening results for markers of blood-borne infections are valid for 10 days from the moment of taking blood for research.

ABO blood group

If the blood group of the donor's ABO system is determined twice on blood samples from different blood supply with two different reagents using a cross-over method of research with standard erythrocytes and the results coincide, then with subsequent blood donations, it is allowed to study the blood group in the laboratory in one series of standard sera or monoclonal antibodies. If differential diagnosis of A1 and A2 antigens is required, anti-A1 reagent is used.

 

Rhesus affiliation

The primary study of the Rh-affiliation of donor blood is carried out in the laboratory by two different methods. To conduct the study, use the express method in test tubes without heating. (anti-D universal reagent), or the method of agglutination in a plane using monoclonal antibodies (reagent coliclone anti-D-super), gel agglutination method, or another approved method.

Anti-D-super reagents, containing antibodies of the immunoglobulin class M, do not detect antigen D variants (eg, DVI). Therefore, all donor blood samples, tested negative with anti-D-super reagent should be additionally tested with anti-D reagent, containing incomplete antibodies (immunoglobulins of class G) gelatinous method, express method in test tubes with 33% polyglucin, agglutination in a gel or antiglobulin test (Coombs reaction). In doubtful cases, an indirect antiglobulin test is performed (AGT). Donors, having a weak antigen D or DVI phenotype, considered Rh positive.

With subsequent blood donations, if the donor's Rh identity is determined twice on blood samples, taken from different blood supply each time with two series of reagents or sera, then studies of Rh-related blood are carried out using one series of reagents.

All D-negative blood samples from donors should be tested for the presence or absence of C and E antigens with sera or monoclonal antibodies of appropriate specificity. The use of polyspecific sera or anti-DCE reagents is allowed, either anti-DC and anti-DE at the same time. Typing of donor blood for antigens C and E is carried out twice during different blood deliveries with different series of sera or reagents. With subsequent blood donations, these studies can be omitted..

 

Antigen K test

Determination of antigen K (K1) Kell erythrocyte antigen systems are carried out using sera or monoclonal anti-K reagents. Typing of donor blood for antigen K is carried out twice during different blood deliveries with different series of sera or monoclonal reagents.

If there is no discrepancy in the typing results, with subsequent blood donations, typing of the K antigen is not necessary.

 

Study of other antigens

When forming a register of typed donors, designed for the selection of blood components for sensitized patients, donors additionally determine antigens of the Rh-Hr system: c(hr’), e(hr”), CW and other antigenic systems: Lea, Fya, if, S.

 

Determination of irregular anti-erythrocyte antibodies

Irregular antibodies are classified as clinically relevant and non-clinically relevant.. Clinically significant antibodies are antibodies, capable of causing in vivo destruction of red blood cells, having the corresponding antigen on the membrane, and with the existence of which the occurrence of hemolytic disease of the newborn is associated, post-transfusion hemolytic complications or shortened survival of transfused red blood cells.

Tests, used for antibody screening, should detect clinically significant antibodies and include: antiglobulin test for 37 оС, or its modification of similar sensitivity (low ionic strength solution, gel test), method using 10% gelatin and microscopic examination of the result.

Erythrocytes of typed donors, intended for the study of antibodies, can be freshly prepared or canned.

Standard red blood cell phenotype: usually a panel, consisting of three samples of group O erythrocytes. for example: one sample of erythrocytes phenotype ccDEEK-, second sample: ССDeeК-, third sample: cсddeeК. Red blood cells and panels must also contain antigens: Fya, Fyb, if, Jkb, S, s, CW, Lea (preferably homozygotes for these genes). For the study of antibodies in donors, it is allowed to use a mixture of three test samples.- erythrocytes of the indicated phenotypes.

Serum of all donors is tested for the presence of antibodies to erythrocyte antigens, regardless of Rh-affiliation. Donors, serum-free antibodies to erythrocyte antigens, repeated studies are carried out once a year, no history of blood transfusions or pregnancies. If irregular antibodies are detected, an antibody screening test is performed at each blood donation..

If irregular anti-erythrocyte antibodies are detected, donor whole blood or plasma should not be used for transfusion (preparation of washed or thawed erythrocytes is allowed), it is advisable to use such plasma for the production of typing sera.

Individual requirements for medical examination of donors

Active donors blood or blood components both sexes present:

• every six months a medical certificate of an outpatient clinic at the place of residence or at the place of attachment indicating the diseases transferred over the past six months;
• once a year data of laboratory and clinical analysis of urine, fluoroscopic (or fluorographic) chest examinations, electrocardiography;
• every three months a certificate of no contact for hepatitis A;
• every six months a certificate of no contact for hepatitis B and C;

Active donor women annually submit a certificate of gynecological status on the day of issuance of the certificate (past illnesses, surgical intervention, childbirth, no pregnancy).

IN plasma donors at the primary, to donations, clinical and laboratory blood tests additionally determine the total protein content in blood serum. With repeated donations of plasma and cells – determination of the level of hemoglobin in the blood. After every five plasmapheresis – serum total protein content, if necessary – content of albumin and immunoglobulins.

IN cell donors (platelets, leukocytes) at the primary, to donations, Clinical and laboratory blood tests additionally perform a clinical blood test with platelet and / or leukocyte count and total protein content in blood serum.

With repeated donations – determination of the level of hemoglobin in the blood, if necessary – counting the number of platelets and / or leukocytes, and after every five cytapheresis – serum total protein and CBC with platelet count.

IN immune plasma donors additionally determine the titer of specific immune antibodies.