This article provides an extensive overview of blood transfusions, covering the different types and their applications, as well as the critical aspects of blood donation and donor management.

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Blood usage

Blood or the components of blood are used to treat patients with different medical conditions:

• Anaemia
• Cancer 
• Blood disorders
• Pre, Post and During surgery

Blood can be whole blood or blood components

1. Whole blood transfusion: Whole blood transfusion is a medical procedure that involves transfusing a patient with a combination of red blood cells, white blood cells, platelets, and plasma:

• Red blood cells: Carry oxygen
• White blood cells: Part of the blood's composition
• Platelets: Helps with haemostasis can be used in thrombocytopenia due to dengue and blood loss
• Plasma: A protective yellow liquid

Here are some advantages of whole blood transfusions:

1. Balanced components.
2. Whole blood has a 1:1:1 ratio of components, which is the ideal ratio for massive transfusions.
3. Reduced exposure.
4. Whole blood transfusions can reduce exposure for the patient, which is especially important for patients undergoing transplants, oncology treatments, or pediatric care.
5. Less volume and blood factor dilution.
6. Whole blood transfusions result in less volume and blood factor dilution for the patient.
7. One blood access point.
8. Whole blood transfusions can be administered through one blood access point, which can be useful for patients who are severely injured.
9. After a blood transfusion, you should expect to have a bruise around the needle site that should go away in a few days. You should contact your health care provider if you experience chest or back pain, or shortness of breath in the days following the transfusion.

2. Blood components

Blood is made up of several components and can be used to treat many different conditions, components can be:

• Packed red blood cells
• Platelets
• Plasma

Blood is usually separated into its components or parts, so a patient can be given the needed component.

This makes the most of every blood donation, as the components in one unit of blood (or one donation) can be used to treat different patients for different diseases.

3. Blood transfusions

In a blood transfusion, a patient receives donated blood or its components. A line is inserted into a vein to administer blood transfusions.

1. In England, anaemia, cancer, and blood disorders are among the illnesses that are treated with about two-thirds of blood donations.
2. Almost one-third is utilised in surgery and emergencies, including childbirth.

Hospitals use it differently depending on their specific expertise.

To ensure that precious blood donations are used properly, we collaborate closely with hospitals.

Increased efficiency has reduced hospital blood demand, but new donors are constantly required to ensure there is enough blood to treat patients.

4. Blood transfusions for vitality

For patients undergoing surgery or with underlying medical issues, blood can be essential. However, blood transfusions can also help those whose condition has no known cure. "These essential transfusions improve patients' quality of life and provide them with the energy and capacity to cherish this last, valuable moment with their loved ones."

5. Blood not used for transfusion

Sometimes, blood may not be suitable for transfusion. This blood can still benefit patients in areas like the development of treatment and therapies.

Blood can be a valuable resource for training, research, and test development.

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Donor registration

1. Even if they are later rejected for donation, all potential donors who fulfil the general requirements for blood donation, such as being of legal age and in good health, should register when they attend a blood donation session.

Essential donor registration information includes:

• Individual's full name
• Date of birth
• Gender
• Contact details

2. When someone first registers, they should be given a unique donor number.
3. Every time a donation is made, it should be assigned a unique identification number, either alphanumeric or numeric.
4. This ought to be affixed to the blood sample tubes, donor questionnaire, primary blood collection bag, and related satellite bags.
5. The donor questionnaire, which should be filled out each time a donation is made, donor information, and educational materials should be given to potential donors during the donor registration process.

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Pre-donation information

Pre-donation information is an important step in blood donor selection. Through donor education and public awareness initiatives, the donor selection process starts even before donors arrive to donate blood. Pre-donation information should be given verbally or in print, graphic, audio-visual, or online materials during the donation session. These materials should be delivered straightforwardly and understandably and in the proper languages.

Pre-donation information provides an opportunity for prospective donors to know about health conditions or high-risk behaviour that would make them unsuitable to donate blood. This information helps the donors in deciding whether to self-defer; it may also assist in donor return if they understand the reason why they should not donate blood on this occasion.

Pre-donation information has the following objectives:

1. Educate donors on the requirements for selecting donors, the donation procedure, and the tests that will be run on their blood.
2. Urge potential donors to disclose to the BTS any health issues or TTI-related concerns that might compromise their eligibility to donate blood.
3. Encourage individuals to self-defer from blood donation if they recognise that they are not suitable to donate blood due to general health or medical conditions or risk for TTI.

Pre-donation information should cover:

1. Nature and use of blood and its components; the need for voluntary non-remunerated blood donors; and the importance of preserving healthy lifestyles.
2. The blood donation process includes the donor questionnaire, donor medical history, health and risk assessment, venepuncture, blood collection as whole blood or apheresis, post-donation care, and screening tests done on donated blood.
3. Justification for the pre-donation health examination and donor questionnaire, the significance of donor compliance in the donor selection process, and the rights, obligations, and responsibilities of the donor.
4. The donor has the option to change their mind about donating blood before continuing, to withdraw or self-defer at any point during or after the donation process, and to do so without being unduly questioned or embarrassed.
5. Transfusion-transmissible illnesses, such as syphilis, HIV, HBV, and HCV; how they are spread; their natural history and prevention; the kinds of screening tests that are carried out; the window period of infection; and other testing locations for people who want to find out whether they are infected.
6. Potential repercussions for donors and the blood they donate in the event of abnormal TTI test findings; the process for informing donors of abnormal test results and providing post-donation counselling, confidentiality assurance, and, if required, referral for additional testing, care, and treatment.
7. The possibility of adverse donor reactions.

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Completion of donor questionnaire

1. A donor questionnaire should be filled out by each potential blood donor in order to gather data regarding the donor selection standards outlined in the national guidelines. Donors are typically given the donor questionnaire to complete at the time of registration, prior to the donor assessment and interview.
2. An alternative is to send the donor questionnaire to their home so they can fill it out prior to making a gift. This has the benefit of saving time during a blood donation session and giving donors time to consider the responses. Donors might, however, misinterpret some of the enquiries and self-defer for the incorrect reasons.
3. Another option is to use a computer-based questionnaire to administer the donor survey.
4. puter-based questionnaire. A wide literature is developing around computerised questionnaires and computer-assisted self-interviews (CASI). By promoting self-disclosure and self-deferral, CASI has been demonstrated to elicit more information on risk conduct than conventional face-to-face interviews. It may also lower the percentage of donors having a history of high-risk behaviour.
5. Although it has been noted that frequent donors may be less careful when filling out the questionnaire, special attention must be paid to first-time donors since they are unfamiliar with it and its purpose and may take longer to finish.
6. It is essential that donors are aware of the importance of the questionnaire, the significance of the questions and the need to provide accurate information. The information provided by the donor can then be further elaborated on during the interview.

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Donor interview and pre-donation counselling

In order to evaluate the donor's overall health, medical history, and potential TTI concerns, the donor and a donor selection staff member should have a private, one-on-one conversation to go over the completed donor questionnaire before the donation.

Additionally, it offers a chance to verify that the donor has comprehended the questions and has provided accurate responses. Many people do not understand medical terms and may be so eager to give blood that they do not recognise the significance of their answers for their own health. Therefore, everyone who is having trouble understanding the questions should be helped.

Assurance of the confidentiality of the donor's medical history is essential. If donors understand why it is in their interests to give accurate and complete information about their health, it will reassure them that their welfare is important to the BTS & may motivate them to become regular donors. It is important to evaluate the donor's capacity to give informed permission and comprehend the blood donation procedure.

Whenever possible, a donor selection staff member should expound on the medical history, especially for new donors.

An initial question such as:

1. “When did you last see a health care professional?” may avoid multiple questions and lead to further information about the donor's medical history.
2. Similarly, relevant travel information may be elicited by a simple question such as “When did you last travel to another region or country?”

Pre-donation counselling is an essential component of the donor interview. It enables donor selection staff to:

1. Verify that the donor has comprehended every question and provided accurate answers.
2. Answer the donor's questions and reassure them if they are anxious.
3. Explain reasons for any deferral and advise about further medical care, if needed.
4. Ensure that the donor can give informed consent to donate and recognise that his/her signature is an affirmation that responses provided to the questionnaire are accurate.

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Assessing donor suitability

Donors should be in good health at the time of donation and free of illnesses transmitted by blood. The BTS should provide unambiguous guidance for staff involved in donor selection.

All blood donors, whether they are first-time or repeat donors, should be subject to rigorous donor selection, whether they donate whole blood or through apheresis.

Long wait times should be avoided and the procedure should be designed to maximise the time of both staff and donors while making blood donation as convenient as feasible for them.

The key elements of blood donor selection are as follows:

1. The health and safety of both the donor and the recipient must be ensured.
2. Only individuals in good health should be accepted as donors of whole blood and blood components.
3. Blood donors should be selected using periodically reviewed selection criteria, with no discrimination based on gender, ethnicity, nationality, or religion.
4. Before blood is collected on the day of donation, a potential donor's health and medical history should be assessed.
5. The BTS should get the donor's informed consent to donate blood by giving them the necessary information and a straightforward donor questionnaire for risk and health evaluation.
6. Employees should receive the necessary training and qualifications to pick donors.
7. Donor confidentiality should be guaranteed, and good communication should be built between the donor and the BTS personnel.
8. Counselling and referrals for additional management are part of the BTS's duty of care to all deferred donors.

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Donor health and risk assessment

1. The evaluation of donor health and TTI concerns necessitates privacy, a sympathetic, nonjudgmental approach, and a promise of anonymity. The reason for enquiries designed to elicit any health or TTI hazards should be discussed, and the donor should be given the option to self-defer.
2. The assessment of donor suitability and deferral, where appropriate, aims to exclude donations from people at risk of TTI, particularly those who have recently acquired infections that cannot or may not be detected by routine screening tests, or who have infections for which no effective blood screening tests exist.
3. A more in-depth discussion may be required, especially with new donors who are unfamiliar with the "window period" or the signs and symptoms of an infection. Individuals who come to the BTS for HIV testing put the blood supply at risk.
4. The donor assessment not only allows for a review of the donor's medical history and medications, but it also provides an opportunity for a basic health check to determine whether the donor is in overall good health. Any symptoms of debility, malnutrition, pallor, jaundice, cyanosis, dyspnoea, or intoxication from alcohol or narcotics should also be observed during the donor's appearance and inspection).
5. Physical examination, weighing and/or measurement of vital signs (pulse, blood pressure) are part of the basic health check and are carried out at this stage. The venepuncture site should be inspected to ensure that the donor's veins are accessible and appropriate for uncomplicated venepuncture.

A preliminary health examination allows for an assessment of any physical limitations that may impede the donation process, such as:

• Mobility: Donors should have easy access to the donor bed or couch.
• Sight or hearing impairment: assistance should be provided by a staff member

Issues that require special attention during donor health and risk assessment include:

1. The primary culture and context of the environment for donation; in certain cases, a donor may just be overwhelmed by the medical setting and processes.
2. The donor is given enough privacy and promise of anonymity to feel comfortable answering probing and sensitive questions.
3. Identifying and resolving linguistic obstacles or misunderstandings of questions in the donor questionnaire.
4. Ensure effective communication by utilising straightforward, jargon-free language and explaining any medical words.

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Informed consent

To obtain informed consent, the BTS should provide the following minimum information to the potential donor:

1. The donation process and potential adverse donor reactions.
2. The tests that will be performed (TTI and others) on the samples taken from the donated blood and the reasons for these tests.
3. Confidentiality of all personal information, including test results.

The donor should sign and offer informed consent for the voluntary donation of blood or blood components. Informed consent indicates that the donor understands the questionnaire, submits accurate responses, and is willing to donate blood.

It also indicates that the donor understands the blood donation process, the possibility of adverse reactions to blood donation, the risks of infection transmission through donated blood, and the implications of any abnormalities detected during the donation process and blood screening, and has given consent for post-donation notification and counselling if a positive viral infection marker or any other abnormality is discovered.

The donor's understanding of the questionnaire and its implications is of particular importance in countries where donors may be held legally liable if they give incorrect information.

In nations where young persons under the legal age of majority may give blood, a parent or guardian's written agreement must be sought before donation, as required by national law.

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Donor deferral

Donors who do not match the selection criteria should be postponed, either temporarily or permanently. All deferred donors should be treated with dignity and care in a confidential setting, with a clear explanation of the reason for deferral and the opportunity to ask questions.

They should be notified whether the deferral is intended to protect their own or the recipient's health. It is the BTS's obligation to ensure that donors who are postponed due to medical issues are referred for additional investigations and care, as needed.

Studies have indicated that postponement has a detrimental impact on future donor return, particularly among first-time donors and those who deferred for more than a year. Donors who have been temporarily deferred should be informed of their next donation opportunity and encouraged to return.

Donors are less likely to donate blood again if they are provided confusing or unsatisfactory information regarding the cause for deferral. Many temporarily postponed donors may not spontaneously return to donate blood and may need to be reminded once the deferral period has expired. Counselling postponed blood donors may improve donors' compliance in seeking follow-up medical care.

A process for donor counselling and referral should be in place if additional investigations, treatment, or care are required.

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Donor records

1. The donor should always sign the record of their general health, medical history, and TTI risk assessment as part of the donor form as correct. The questionnaire is kept with the donor's records and serves as proof of informed permission.
2. Records of all blood donation activities should be kept, preferably in an electronic database that can generate reports.
   In addition to donor identification, assessment, and selection, records should include donor deferrals, adverse reactions, unexpected events, and unsuccessful donations.
3. Donor records should be kept secret, easily accessible, and traceable from the donor to the patient receiving the transfusion, and vice versa.
4. Records should be kept for the duration specified by local or national legislation or recommendations.
   Donor records should be examined on a regular basis, and donor data (e.g., male: female ratio, donor deferrals, adverse donor events and reactions) should be evaluated to assess the success of donor selection and take corrective action as needed.
5. During the donor selection process, key records such as dates, timings, and signatures must be maintained and retained.

• Donor registration information
• Completed donor questionnaires and informed consent
• Outcomes of donor interview and assessment
• Donor deferral records
• Unique donation number for each donation
• Donor counselling and follow-up records
• Adverse donor events and reactions
• Donor deferral registry

8. Data on donor deferrals should be gathered and evaluated regularly so that the BTS can examine the principal causes of deferral, particularly those that result in the highest number of deferrals and pose a significant risk to patients.
9. These differ per country, thus there is a need to acquire local facts on which to make applicable decisions. The most common causes of donor deferral are particularly interesting because they indicate whether donor information and education need to be enhanced or donor selection criteria should be reconsidered.
10. A deferral database will also show whether employees are appropriately interpreting the selection parameters and where additional education and training should be focused.
11. Donor deferral data also allow for the verification of donors' previous deferral status and the making of choices regarding the re-entry of temporarily deferred donors.
12. A donor deferral registry (DDR) is a secret list of donors who tested positive for a transfusion-transmissible infection and were permanently postponed. A DDR is used to track the incidence and prevalence of such illnesses in the donor population and may also help identify areas for improvement in the donor selection process.

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Confidential unit exclusion (CUE)

The mechanism of confidential unit exclusion (CUE) allows donors to notify the BTS immediately after donation or later if they believe their blood is unsafe for transfusion; this may be especially valuable if donors were persuaded or coerced into donating. Where CUE is used, donors should be provided information on how to contact the BTS and convey that their blood should not be used for transfusions.

The CUE system is intended to improve the safety of donor selection and blood screening processes and has proven beneficial in some cases.

However, there is some evidence that it may have a limited effect on preventing illness transmission through window-period contributions, potentially leading to the disposal of safe donations. According to one study, its use may have detrimental implications since it reduces staff's perceived responsibility in eliciting a history of high-risk behaviour.

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Adverse donor reactions and post-donation care

1. Donors should be treated in such a way that they receive high-quality care and are confident that the BTS values their health and well-being. Nonetheless, there are known adverse effects that can occur after blood donation; they can usually be reduced or prevented with proper donor selection and care, as well as suitably trained staff. Donors who experience an unfavourable reaction are less inclined to donate again.
2. The most common donor reactions are vasovagal episodes and soft tissue damage, such as bruising and haematomas at the venepuncture site.
   The majority of these are minimal, and donors normally recover quickly; however, these reactions might be concerning for donors, thus reassurance should be provided.
3. In rare situations, a reaction may motivate the donor to provide essential medical information. A minority of adverse responses may necessitate medical attention outside of the BTS and result in persistent symptoms or disability.
4. Staff should be educated in recognising and managing adverse donor reactions, including administering first aid.
5. The incidence of bruising should be observed so that additional venepuncture training can be provided to workers as needed. A method for reporting and investigating adverse donor events and reactions should be implemented as part of the dDrr haemovigilance system.
6. Donors should be given oral and written guidance on how to handle bruising and delayed vasovagal episodes, as well as information on how to contact the BTS if further assistance is required.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr. Deepti Pruthvi is a Professor Department of Pathology at SS Institute of medical sciences and Research Centre, Karnataka.