Before I became a donor technician, I had to complete CPR training and get my certification in cases of emergency wherein I might need to revive a patient before the emergency medical team arrived at the scene. More importantly, I needed to know the FDA blood donor regulations like the back of my hand. This is because I had to interview the donors and ask the tough questions like the intimacies of their lifestyle, drug addictions or medications they had and have been taking, and any other medical concerns that may have a direct effect on the blood they are set to donate. I know that the job sounds like a piece of cake, but the truth of the matter is that it took a lot of hard work and perseverance on my part before I became a phlebotomist. After I completed my training, I was lucky enough to have been given a chance to practice my newly gained knowledge. Through this paper, I will be discussing the various processes that a blood donor undergoes including the different blood donor types and related terminologies.
It was my privilege to work as a Donor phlebotomist at the Staten Island University hospital from the year 1999 to 2004. It was my duty to attend to people who come into the hospital to donate blood. It was my responsibility to assist the blood platelet donor by giving them a standard donor form to fill out. After the proper forms are filled out, I entered the data into the computerized DDR system that is used nationwide to determine the viability of accepting the donors blood. If a donor is denied or deferred, his donor status may be listed as temporary or permanent depending upon the FDA protocol covering his case.
In the event that the potential donor passes the first step in the screening process, that is the interview part based upon the form he filled out, he will go on to the next step which is the mini physical check up that includes a vital signs monitoring and a complete blood count (CBC). It is of the utmost importance that the patient be relaxed and confident during this process. Even though this is not yet the actual blood donation part, I must extract blood for testing from the client. I do this by having him sit in a comfortable recliner and while soft music plays in the background, I explain what exactly I will be doing to the donor. The blood extraction is done by placing a tourniquet on the donor’s arm in order to help me in finding a vein area. I have to sterilize this area before I can collect any blood from the donor.
It is as this point that I have to classify what type of blood donation I will be doing. You see, there are 3 types of blood donation. These blood donation types are (1) autologus, (2) Random, (3) and directed.
An Autologus donor is somebody who stocks up on his own blood prior to undergoing major surgery. The amount of blood requested by physicians to be kept in stock from such a donor varies from 2-3 units of blood depending upon whether the surgery is for a hip or knee replacement patient, or if the patient is replacing both the knee and hip. Since the donor will be donating blood to himself, the FDA has less stringent rules regarding blood collection. Even if the patient is afflicted with a serious illness such as HIV or Hepatitis, the recipient will be allowed to receive his own blood should a transfusion become necessary. The exception to this rule though is if the patient/donor has a pre existing cardiac condition. In such cases, I have to request for clearance from the attending physician prior to drawing blood. If the physician declines the blood drawing, the patients relative may be called upon to donate blood or in some cases, we get blood from the blood bank. Any blood that is not used after the operation is automatically autoclaved and discarded for sanitation purposes. The FDA has set the patient hemoglobin count to a low 11% with a hematocrit count of 33%. All because the blood is expected to be returned to the same patient it was originally drawn from.
On the other hand, Random donors are people who donate blood to hospitals through blood drives. Since majority of our blood supply comes from random donors, these people pass through the most stringent testing and screening procedures. The random blood donations are typically used by blood transfusion patients A random donor can only donate blood every 56 days because his body needs time to recover and replenish their RBC count prior to donating again. The FDA requirement for their blood criteria is stricter. These donors are required to have a 38% HCT count with a 12.5% Hgb count.
Last, but not the least, we have the Directed Donors blood. These are friends and relatives of patients who are asked to donate blood to patient but have compatibility problem with the patient. In such cases, the incompatible blood will be donated to our blood bank and in exchange, our blood bank will give their patient a compatible blood cell pack. These donors must follow the same criteria as the random donors.
Now, aside from the patients who undergo major operation procedures at the hospital, we also have Therapeutic patients who sometimes have a need for blood transfusions as well. These patients are usually diagnosed to be suffering from Hemochromatosis or Poly CethmiaVera. These terms are used to describe imbalances in a patients Hgb or Hct counts. Such patients are sent me people like me in the laboratory with a prescription from the doctor indicating the problem and how to correct it. The standard procedure for such cases is to give them a mini physical exam and the take a unit of blood that is to be discarded. The blood extraction and discarding is done repeated over a number of days or until the doctor is convinced that is finally well with the patients blood count.
My job as a phlebotomist is not limited to only drawing blood and assisting with paperwork. I also process and test the collected blood prior to its use in any transfusion or surgery. Due to the blood shortage in the blood banks, all healthy people are being encouraged to donate blood in order to close the gap between need and availability a little. In order to do this job accurately, I use any of the 3 standards in processing blood and platelets. These standards are the Trima, Heamonetics, and Manual System. These systems each have a specific use and I will be discussing each specific scenario in detail below.
The Trima System is a computerized system used specifically for platelet pherosis. The computer requires me to enter the basic data of the patient as well a few advanced yet important information that the physician needs to know. I must input the donors height, weight, sex, Hct and Plt count. Using this information, the system will then determine the platelet number that the donor can donate. Not everybody is welcome to donate platelets though. If the donor does not meet the criteria for height, weight, vital signs, or his Hct is low or borderline, he will be declined by the system. On the other hand, approved donors are prepared and hooked up to the system in order for the phlebotomist to collect 4 blood samples in order to screen for diseases of abnormalities. If the blood clears the testing stage, I then proceed to collect the actual blood donation. In this case, only the platelets are necessary for collecting so after the platelets are segregated, the blood is returned to the donor using an anticoagulant in order to prevent blood clotting once the blood is reintroduced to the original system. Any side effects from the anticoagulant is countered with calcium and milk supplements. Trima System donors can donate once a week of 25 times a year because only their platelets are taken for donation.
Now, the Haemonetic system is quite similar to the Trima system except that the Haemonetic system is used specifically for double RBC pheresis. This means that 2 units of Red Blood Cells (RBC) are extracted into 2 bags of 180 ml each. After extraction, the blood is then returned to the donor using 500 ml of saline with a coagulant. The side effects are dealt with using the same method as with the Trima system. Such donors can give every 112 days.
As for the manual system, 4 blood sample tubes totaling 500 ml are collected and tested for various illnesses. This is a totally different system from the first 2 as this process requires the separation of RBC from the plasma. This is done by placing the blood on a centrifuge refrigerator and spun consistently for 5 minutes at 5000 revolutions per minute. At the end of the cycle, the pack cells fall to the bottom of the bag, separated and then frozen immediately. This is what is then called Fresh Frozen Plasma. Such pack cells are stored at 4.2 degrees Celsius with a life span of 42 days Such kinds of blood donation and collecting is usually reserved for sever burn or cancer patients. Frozen Fresh Plasma is good for 1 year. While platelet donations are only good for 5 days.
I would like to present you with a chart that accurately details the current need for blood in our blood banks and hospitals in order to entice people to participate in the civic activity of blood donation.
As you can see, the job of a phlebotomist is not easy. In fact, it requires a lifetime commitment to excellence and service. My job sometimes spells the difference between who will survive and who will not survive. It is not an easy job because of all the screening and testing that is required. It is a job that requires precision and accuracy at every step of the way.