Blood Banking

I was assigned in the blood banking and serology section with my partner Mae on the 9^th day of our clinical duty (June 30, 2008). Our first day in the blood banking section was basically an orientation on the procedures and laboratory tests routinely conducted. We are allowed to perform a certain procedures yet with some limitations.

Basically in this section, we deal with the screening of blood donors. It is in this section where we were able to talk with various people with different personalities. Some approached us timidly, others talk with a “panicking” guestures, a few of them tried to beg to give them prepared blood so as not to find anymore donors.

Our RMTs in this section taught us how to determine a paid donor and a voluntary donor. A paid donor would appear silent and seems not to talk much with the one requesting for blood while a voluntary donor would behave in a very opposite way. Most of the paid donors appears to be so rugged. Though the hospital discourages people to pay for the sake of blood donations, reasons of “emergency” is the one constantly uttered.

All blood donors would go into serious screening processes. After having the blood donor fill-up his personal profile, we review his donation history by checking on the files of blood donors in the hospital. The donor is then extracted with blood using an EDTA tube for the determination of his/her blood type. This procedure would then tell us whether the blood type of the donor and patient is the same to avoid ABO incompatibility transfusion reactions. This procedure employs both the forward typing and the backward typing. The forward typing uses the donors red cells and is made to combine with reagent Anti-sera (Anti A, Anti B and Anti RH) while the backward typing uses the donor’s plasma/serum and is made to react with reagent cells (A cells and B cells). Further, the donor’s haemoglobin and hematocrit were being determined.

After the determination of the blood type, the donor is then subject to a physical examination and interview with a physician or even a post graduate intern. The donor is tested with regards to his height, weight, blood pressure, pulse and physical appearance. The donor is also being asked with sets of question that might determine whether he/she may or may not be able to donate blood. Obviously, if the donor would tell a lie then he/she might pass the interview but his/her recipient would be the one to suffer. It is for this reason alone why paid donors are being discouraged since these type of donors doesn’t care for the patient but instead their focus is on the money they would gain. During our duty in this section we have met three paid donor that was caught telling a lie. The first one was permanently deferred since he took marijuana in the past. When I asked him whether he was able to donate blood, he told me that he was able to donate blood two years ago and his records implies that he is not allowed to donate blood forever. The other two paid donors told a lie with their names and family names. Though, they have presented an ID from an unknown institution, they failed to say their birthday. Because of such act, Kuya George decided that they may be deferred from donating blood.

After the physical examination and interview, the donor is subjected to serologic tests and malarial test. The tests employed are the HBsAg, Syphilis, HIV and HCV. The donor’s blood smear is also tested microscopically with the presence of malarial parasites. The serologic tests uses a rapid test which takes fifteen-minutes and is intended for screening process only.

If the donor passed the three-stage screening process, the donor is then allowed to bleed. The donor’s blood is collected using a triple bag which contains CPD-A as anticoagulant. This type of anti coagulant allows the red blood cells to remain viable for about 42 days. The purpose of having two more satellite bags making it a triple bag together with the main bag is for separation and storage of derived components like the platelets and fresh frozen plasma.

The donors newly collected blood is then subjected with the cross matching and antibody screening procedure. This tests also confirms the blood type of the donor and the patient. The cross matching procedure is done with three phase which are the Immediate spin phase (where IgM are expected to react with this phase), the 37^oC and the AHG phase (where the IgG are expected to react). Any agglutination in any of the phases would mean that the patient and recipient’s blood are incompatible. The antibody screening uses a machine that makes the procedure efficient and fast. The machine’s way to detect presence of antibodies is that if antibodies are coated in the cells then blood agglutinates would disperse at the end portion of the tube whereas absence of antibodies would show that blood agglutinates would settle to the center of the tube after centrifugation.

In the event that all of the test done shows a negative reaction, then blood donated is allowed to be transfused to the patient.

Aside from the routine blood screening, we are also assigned to perform serologic test for Anti-steptolysin-O, rheumatoid factor, serologic tests for syphilis, C-reactive protein and many others. All these tests are rapid in nature and therefore is so easy to perform.

This section taught me how to control my hands for it not to shake upon dispensing reagents and serum for a certain procedures. This section made me appreciate the nature of blood. It is indeed the river-flow of life. Upon writing this narrative report, I can still recall the faces of the people who requests for blood and shares the life-threatening situation of their patients. Some of the patients survived and a few died. This also reminds me to take care of my life since it is not easy to look for good donors.