Whole Blood REQUIRED  PATIENT  Information


Welcome to the JIVAN JYOT Blood Bank


Patient information: Blood donation and transfusion


INTRODUCTION — Blood is essential for transporting oxygen, nutrients, and other substances to tissues throughout the body. Donated blood can be lifesaving for individuals who have lost blood because of accidents or surgery, as well as for people who have become severely anemic or have dangerously low platelet counts because of certain medical conditions and/or treatments.

Screening measures help to ensure that blood donation is safe for the donor and that transfusion is safe for the recipient. These measures are very effective, and complications of blood donation and transfusion are rare.

For people who are considering donating blood, a local blood bank can describe the criteria for being a blood donor. The web sites at the end of this topic also include information about eligibility criteria (see "Where to get more information" below). People who have a preexisting medical condition may wish to consult their own healthcare provider.

SCREENING MEASURES TO PROTECT THE DONOR — Several screening measures are used to ensure that blood donation is safe for the donor and is unlikely to have any negative health effects.

Medical history interview — All blood donors are asked questions about their medical history to help determine if they can safely donate blood without experiencing any negative health effects [1] . During the donation, one unit of blood (approximately 450 mL or 15 fluid ounces) is removed.

Medical evaluation — Donors undergo brief medical testing before donation to check for any obvious signs of illness or conditions that would disqualify them from blood donation.

Time interval until next donation — Donors are eligible to donate another unit of blood 56 days after their previous donation (five times per year). However, the frequency of donation depends upon how rapidly each individual's body replenishes the donated blood and blood components. Some donors, especially women who have menstrual periods, will not be able to donate every 56 days because their iron stores are not sufficient to replenish the lost red blood cells.

APHERESIS DONATION — A technology called apheresis has made it possible to collect specific components of blood during the donation procedure. Apheresis is used to selectively collect red blood cells, platelets (blood components that play an important role in clotting), and granulocytes (a type of infection-fighting white blood cell).

SCREENING MEASURES TO PROTECT THE RECIPIENT — Screening of blood donors helps to ensure that the donated blood is safe for transfusion into a recipient. A variety of different measures are used for this screening.

Screening for infections

Human immunodeficiency virus (HIV) — The human immunodeficiency virus (HIV) is the virus that causes AIDS. A variety of measures are used to screen donors for potential or actual HIV infection:

Donors are told about the risk factors for HIV and the potential for transmitting HIV through donated blood. Donors are also told that early in HIV infection, an individual may be infected and capable of transmitting HIV despite a negative HIV test. Donors are also given information about obtaining HIV testing at another location.

Donors are told that all donated units of blood are tested for the presence of HIV and that if the results are positive, the donor will be notified, and his/her name will be placed in a donor deferral registry (a list of individuals who are not permitted to donate blood).

Donors are told not to donate if they have symptoms of HIV infection or AIDS. These symptoms include persistent fever, night sweats, unexplained weight loss, persistent cough or shortness of breath, persistent diarrhea, swollen lymph nodes for more than one month, whitish lesions in the mouth, or bluish-purple spots on the skin or in the mouth. (See "Patient information: Symptoms of HIV infection").

Donors are also asked questions about behaviors that are known to increase the risk for HIV infection.

Finally, donors must sign an informed consent form stating that they understand that they should not donate blood if they are at risk for HIV infection.

Donors will be permanently disqualified from donating if they answer "yes" to any of the following questions:

Donors are also asked questions about their behaviors during the previous 12 months. Donors answering "yes" to any part of the following question will be temporarily disqualified from donating blood. This disqualification is removed 12 months after the last potential exposure:

Have you had sex in the past 12 months with:

Donors will also be asked the following questions pertaining to the past 12 months:

Donors will be asked if they have spent at least 72 hours in a prison in the past 12 months. Individuals answering "yes" may not be permitted to donate blood for at least 12 months from the last day of imprisonment.

Donors will also be asked if they were born in Cameroon or the surrounding West African countries, if they have received a blood transfusion or medical treatment in these countries, and if they have had sexual contact with anyone who was born in or lived in these countries since 1977.

Hepatitis — Hepatitis is an infection that causes inflammation of the liver. Blood donors are routinely screened to determine if they have or have been exposed to hepatitis.

West Nile virus infection — Initial blood donor screening for the presence of non-specific complaints (eg, fever) may help to identify donors at risk of transmitting West Nile Virus (WNV) infection. However, because most WNV-infected donors do not have symptoms, blood banks in the United States perform laboratory testing for WNV as part of their routine screening procedure. (See "Patient information: West Nile virus infection").

Parasitic diseases — Blood donors are routinely asked questions about possible exposure to several parasitic diseases that can be transmitted by blood transfusion.

To date, there have been no reported cases of transfusion-related transmission of CJD and only three reports of probable transmission of vCJD in the UK. Despite this theoretical (CJD) or extremely small (vCJD) risk, donors who meet one or more of the following criteria are not allowed to donate:

Bacterial infection — Bacteria can get into donated blood if a donor has a bacterial infection, if bacteria on the skin gets into the blood, or if there is an skin infection near the location where the blood is drawn. To reduce the likelihood of bacterial contamination of blood, the skin around the site is carefully examined and cleaned before the needle is inserted.

Donors who have a fever, who do not feel well, or who are taking oral antibiotics (except for acne) are not permitted to donate blood. These restrictions also apply to individuals who are banking blood for their own use (autologous transfusion).

Other medical conditions — In order to protect the recipient against non-infectious complications, the donor is evaluated for the presence of certain medical conditions before blood donation.

Donors who have had cancer of a solid organ (such as the lung or liver) are permitted to donate only if they have been symptom-free and cancer-free for a prolonged period of time, usually five years.

Donors who have had blood cancers (such as leukemia or lymphoma) are permanently disqualified from donating.

Donors who have had a superficial cancer that has been completely removed by surgery (such as basal cell cancer of the skin or early cervical cancer) can donate blood.

Medications — Most medications taken by donors do not pose a risk to recipients. However, five drugs are known to cause birth defects and are considered during donor screening:

Donors who have taken isotretinoin and finasteride are asked to wait one month after last taking the drug before donating blood, donors who have taken dutasteride are asked to wait six months, and donors who have taken acitretin are asked to wait three years after last taking the drug. Individuals who have taken etretinate are permanently disqualified from donating blood.

Laboratory testing of donated blood — After a unit of blood has been donated, the blood is tested in a laboratory for infectious diseases that can be transmitted by blood transfusion. These include tests for HIV, hepatitis B, hepatitis C, human T-lymphotropic virus (HTLV), and West Nile virus. In addition, when platelets are collected by apheresis or made from a unit of whole blood, most blood banks test the platelets for the presence of bacteria.

Confidential unit exclusion (CUE) — The confidential unit exclusion (CUE) process allows someone who has donated blood to confidentially indicate that his or her blood should not be given to others. This process protects individuals who feel pressured to donate at the workplace or during community blood drives. Donors are asked to make this indication after the interview, but before donation, usually by placing computerized bar code stickers on donation forms. This procedure is used by some, but not all, US blood banks.

Registry of deferred donors — A registry of deferred donors contains names of individuals who have been disqualified from blood donation in the past. Some donors in the registry have infectious diseases such as hepatitis B and HIV infection; individuals with these diseases may have positive test results at one time but negative test results at a later time. Other donors in the registry have provided information in the past that disqualified them from blood donation. A donor's name is usually checked against this registry before or after donation.

Telephone callbacks — After donating blood, donors can call the donation center to report any factors that may affect the use of their blood or to report symptoms of infections in the first days after donating (such as symptoms of upper respiratory tract infection or gastrointestinal illness). Such reports will be evaluated and the unit of blood given by the donor may be removed from inventory and destroyed.

RISK OF INFECTION FROM A TRANSFUSION — Safety measures, such as improved screening tests, have dramatically reduced the risk of acquiring a viral infection from a blood transfusion. Recent estimates suggest the following risks of developing certain infections after receiving a unit of blood:

AUTOLOGOUS BLOOD DONATION — Autologous blood donation is when a person donates blood several days to six weeks ahead of a surgery, when blood might be needed. Autologous blood donation reduces the risk of most but not all infectious complications of blood transfusion.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:

Patient information: Symptoms of HIV infection
Patient information: West Nile virus infection

Professional Level Information:

Laboratory testing of donated blood
Procedures used for blood donor screening: Protection of potential blood donors and recipients
Blood donor medical history
Controversial areas in preoperative autologous blood donation
Directed (designated) blood donation programs
Preoperative autologous blood donation
Indications for red cell transfusion in the adult
Massive blood transfusion
Transfusion of plasma components
Use of red blood cells for transfusion
Compatibility testing
General principles of home blood transfusion
Immunologic blood transfusion reactions
Intraoperative and postoperative blood salvage
Leukoreduction to prevent complications of blood transfusion

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.