Allogeneic Blood Donation

Allogeneic blood donation refers to blood donated from an individual which, once tested and found suitable for transfusion is placed in the general blood supply for the purpose of transfusion to another individual unknown to the donor. This is a voluntary donation usually for the national supply. Historically this type of donated blood was referred to as homologous blood.

Further Reading

1. Kleinman S, Chan P, Robillard. Risks associated with transfusion of cellular blood components in Canada. Transfusion Medicine Reviews 2003; 17: 120-162. [Medline]
2. Thomson RA, Bethel J, Lo AY, Ownby HE, Nass CC, Williams AE. Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study. Transfusion 1998 Apr;38(4):359-67. [ Medline ]

Apheresis Blood Donation

Apheresis is an automated process in which donor blood is collected, the red cells and plasma or platelets are separated, and then the red cells are returned to the donor.

Each year, CBS collects approximately

• 45,000 units of plasma
• 20,000 units of platelets

Donating by apheresis provides large quantities of plasma and/or platelets and, because donors are not giving red cells, they can donate more frequently. Besides apheresis, this process may also be called plateletpheresis when platelets are collected or plasmapheresis when plasma is collected.

Instruments to harvest the plasma or cellular products include the COBE Spectra Cell Separator, COBE Trima Automated Blood Component Collection Cell Separator®, Haemonetics PCS® and MCS®+, and others.

Further reading on apheresis donation

Apheresis Components

• Fresh Frozen Plasma, Apheresis
• Platelets, Apheresis, Leukocytes Reduced

Fresh Frozen Plasma, Apheresis

Some donors donate plasma by plasmapheresis. The donor's blood is processed through an apheresis machine that extracts only the plasma and returns the rest of the blood to the donor. Plasma may be transfused into a patient or further processed into other products.

For additional information on Fresh Frozen Plasma, Apheresis, see the Circular of Information for the Use of Human Blood and Blood Components (Section E.1).

Platelets Apheresis, Leukocytes Reduced

Platelets can be donated by plateletpheresis in which only the platelets are collected and the rest of the blood is returned to the donor. Leukocyte reduction is achieved by an automated process using a chamber in which centrifugal force separates leukocytes from platelets.

For additional information on Platelets Apheresis, LR, see the Circular of Information for the Use of Human Blood and Blood Components (Section D.1).

Autologous Blood Donation

Autologous blood donations are a means for patients to donate their blood many weeks pre-operatively for transfusion to themselves during or post surgery.

Autologous donations are indicated when the likelihood of transfusion during or after a surgical procedure is high and the patient is healthy enough to donate. As many as four autologous donations can be made in four weeks, up to three days before the scheduled surgery.

Autologous programs may be hospital-based or collected at a CBS site.

Further reading on autologous and high risk autologous programs.

Prior to donation, the patients must be evaluated by their physicians or surgeons to ensure it is safe for them to donate. Certain medical conditions disqualify individuals from autologous donation. To donate blood at CBS, the donor must meet some allogeneic donor eligibility requirements. The blood drawn is subject to the standard CBS screening tests before being designated suitable for transfusion.

If the autologous donation is not used by the patient-donor, the blood is discarded and therefore not used for other patients.

The types of autologous donation-transfusion programs described above occur via predeposit of blood. Other types of autologous donation-transfusion exist such as:

• perioperative normovolemic hemodilution (withdrawal of blood immediately before surgery, with volume replacement by crystalloid solutions and subsequent re-infusion of removed blood)
• intraoperative blood salvage
• postoperative blood salvage

These take place in hospitals and are collectively known as perioperative autologous transfusions.

Designated Blood Donation

Designated blood donations are allogeneic donations selected for medical reasons for transfusion to a specific recipient. The donor and recipient are unknown to each other. An example would be a donor with a rare blood type (e.g., lacks a high frequency antigen) whose donation is designated for a patient with an antibody to the high frequency antigen.

An example would be a donor with a rare blood type (e.g., lacks a high frequency antigen) whose donation is designated for a patient with an antibody to the high frequency antigen.

Dedicated Blood Donation

Dedicated blood donations involve an allogeneic donor who has been "matched" with a patient who has more specific requirements. A dedicated donor may donate numerous units for the specific recipient. Typically in Canada this will be a platelet donor who has been HLA-matched to a patient who receives regular transfusions. The donor may or may not know the intended recipient depending on the situation.

Directed Blood Donation

A directed donation is a blood donation from a parent or guardian to a minor child who requires transfusion. While there is no evidence that these donations are safer than those from regular anonymous allogeneic donors, CBS offers this service in order to decrease the psychological stress for parents/guardians whose children require a transfusion.

This type of donation must be authorized by the medical director of the hospital transfusion service in consultation with the patient's physician and the local Canadian Blood Services medical director. Pre-screening is required to ensure blood group compatibility.

Blood transfusion from related donors has been shown to increase the risk of transfusion-associated graft-versus-host disease (TA-GVHD).

This complication is common when the donor is homozygous for an HLA haplotype found in the recipient. To reduce the risk of TA-GVHD, all donations from blood relatives must be irradiated before transfusion.

MAK PROGESA Labels

MAK PROGESA labels are different than labels previously used by Canadian Blood Services. See graphical representation of the MAK Progesa label.

Main Changes to Component Labels (effective March 24, 2003):

1. The PROGESA label is applied at the time of manufacture after all testing is completed. The "Suitable for Issue" sticker is no longer used
2. A donation label (bottom right of bag) is applied at the time of collection. The ABO is not on this label (or on the labels at the back of the bag)
3. Deletion of ABO blood group colour coding-all labels are black and white
4. ABO and Rh barcode labels are combined
5. Most component information is printed on the label (e.g., anti-CMV negative)
6. The ABO and Rh are bar code readable on all plasma products
7. The expiry date is included on the component label (just below the collection date) and is bar codable
8. The Source Code (Collection site) is a four-digit (0510) code instead of a three-digit code (510)
9. The seven-digit Unit ID number is separated from the Source Code (CBS Collection site) on the PROGESA label
10. To alleviate the duplicate unit number problems in the computerized sites, the seven digit number has been expanded to eleven digits by use of an optional four-digit number (last two digits of collection site and last two digits of year of collection) on the top middle of the PROGESA label
    - Computerized transfusion services have the option to have bar code scanners concatenate this to a unique eleven-digit serial number and avoid current problems with duplicate unit numbers in their systems
    - Non-computerized transfusion services should use the seven-digit Unit ID number and four-digit site code on all documentation.

Preparation of Red Blood Cells

Canadian Blood Services produces three types of Red Blood Cells (RBC):

• AS-3 RBCs, LR (Leukocytes reduced)
• CP2D RBCs, LR (Leukocytes reduced)
• CPDA-1 RBCs, LR (Leukocytes reduced)

Following the implementation of the Buffy Coat Production Method (BCPM), a fourth red blood cell product will also be available:

• SAGM RBCs, LR (Leukocytes reduced)

Preparation of AS-3 RBC

Below is a description of how AS-3 RBCs are prepared from a whole blood collection. Leukofiltration is not shown, but is done prior to centrifugation in Step 1.

Step 1		The whole blood donation is centrifuged to separate red cells from plasma.
Step 2		Approximately 190-260 mL of donor plasma is expressed into the first satellite bag (the maximum amount of plasma is removed) The plasma can be used to prepare Fresh Frozen Plasma (FFP), Frozen Plasma (FP) or cryoprecipitate and cryosupernatant plasma. Alternatively, the plasma may be shipped as recovered plasma for further manufacture.
Step 3		The AS-3 (Nutricel ™) is added to the RBC
Step 4		The AS-3 RBC LR unit is sealed and stored at 1-6oC for 42 days.

Preparation of CP2D or CPDA-1 RBC

Step 1		The whole blood donation is centrifuged to separate red cells from plasma.
Step 2		Approximately 190-260 mL of donor plasma is expressed into the satellite bag. The plasma can be used to prepare FFP, FP or cryoprecipitate and cryosupernatant plasma. The plasma may also be shipped as recovered plasma for further manufacture.
Step 3		The RBC unit is sealed and stored at 1-6°C. CP2D RBCs have a shelf life of 21 days. CPDA-1 RBCs may be stored for 35 days from

Additional information on RBCs may be found in the Circular of Information for the Use of Human Blood and Blood Components - 2004.

Preparation of SAGM RBC

When RBCs are prepared by the BCPM, the whole blood donation is centrifuged using a “hard spin” to separate red cells from plasma  (the buffy coat layer containing the platelets appears as a thick white layer above the red cells). Using the component separator (Compomat G4) RBCs and plasma are extracted from the buffy coat (from the bottom and top of the primary bag respectively). See preparation of random donor platelets for additional information.

Below is a simplified explanation of how SAGM Red Blood Cells (LR) is prepared from a whole blood collection using the wholed blood filtration method.  Leukofiltration is not shown.

Step 1		The whole blood donation is centrifuged to separate red cells from plasma. Segments are prepared and secured to the blood pack.
Step 2		The plasma is separated from the red blood cells using the Compomat G4 (a semi-automated instrument for extracting the plasma).  The SAGM additive is then added to the red cells.
Step 3		The SAGM RBC unit is gently mixed until homogenous and stored at 1-6° C for a maximum of 42 days.

Additional information on SAGM RBCs (LR), may be found in the Circular of Information for the Use of Human Blood and Blood Components - 2005.

Preparation of Plasma Products

Canadian Blood Services manufactures the following plasma products:

• CP2D Fresh Frozen Plasma, LR (Leukocytes reduced)
• CPDA-1 Fresh Frozen Plasma, LR (Leukocytes reduced)
• Fresh Frozen Plasma Apheresis
• Frozen Plasma, LR (Leukocytes reduced)

Following the implementation of the Buffy Coat Production Method (BCPM), another plasma product will also be available:

• CPD Frozen Plasma

For information about cryosupertant plasma, see Preparation of Cryoprecipitate and Cryosupernatant Plasma.

Preparation of CP2D or CPDA-1 Fresh Frozen Plasma (FFP) and Frozen Plasma (FP)

Fresh Frozen Plasma is plasma that is frozen within 8 hours of collection. It may be prepared from a whole blood donation (by separating the red cells and plasma collected) or from an apheresis collection.

Frozen Plasma is plasma that is frozen within 24 hours of collection. All Frozen Plasma prepared by Canadian Blood Services comes from whole blood donations.

Below is a simplified explanation of how these products are prepared from a whole blood collection. Leukofiltration is not shown. Note that Fresh Frozen Plasma can also be prepared when manufacturing platelets.

Step 1		The whole blood donation is centrifuged to separate red cells from plasma.
Step 2		Approximately 190-260 mL of donor plasma is expressed into the first satellite bag. The RBC unit is sealed and stored at 1 – 6oC for its shelf-life. The plasma can be stored as FP or FFP that can be further processed to cryoprecipitate and cryosupernatant plasma using the attached satellite container.
Step 3		Plasma is stored frozen by the manufacturer at temperatures less than minus 20oC for up to 12 months. Non-manufacturers(hospitals and transfusion facilities) are referred to the Canadian Standards Association CAN/CSA-Z902-04, which state that: FFP and FP be stored at -18°C or colder for up to 12 months, and thawed FFP and FP be stored at 1-6°C for up to 24 hours.

Additional information on plasma components may be found in the Circular of Information for the Use of Human Blood and Blood Components - 2004

Preparation of CPD Frozen Plasma

With the implementation of the Buffy Coat Production Method, Frozen Plasma will be prepared from whole blood collected in CPD anticoagulant. Using this production method:

• Plasma will be frozen within 24 hours of collection.
• Frozen plasma from whole blood donations will not be identified as being leukoreduceded, although some will be. Units that are not intended for platelet (buffy coat) production will be leukoreduced as a consequence of whole blood filtration, while those units that are intended for platelet (buffy coat) production will have had the buffy coat removed.

Below is a simplified explanation of how FP from a whole blood collection is prepared. Leukofiltration is not shown.  

Step 1	Whole blood collected into CPD is centrifuged to separate red cells from plasma.
Step 2	Following centrifugation the whole blood is loaded onto the component separator (Compomat G4). The plasma is extracted and frozen within 24 hrs. of collection
Step 3	Plasma is stored frozen by the manufacturer at - 20oC or colder for up to 12 months.   Non-manufacturers (hospitals and transfusion facilities) are referred to the Canadian Standards Association CAN/CSA-Z902-04, which states: Frozen plasma be stored at -18°C or colder for up to12 months, and thawed FP be stored at 1-6°C for up to 24 hours.

 

Preparation of Platelets

Canadian Blood Services produces two platelet components:

• CP2D Platelets, LR (Leukocytes Reduced)
• Platelets, Apheresis, LR (Leukocytes Reduced)

Following the implementation of the Buffy Coat Production Method (BCPM), another platelet product will be available:

• CPD Platelets, Pooled, LR (Leukocytes reduced)

Preparation of CP2D Platelets

CP2D Platelets are prepared from a single unit of whole blood collected in CP2D. This product is also known as random donor platelets.

If platelet preparation is intended, the donor unit must be bled into a specific multiple bag system designed for this purpose. Below is a simple schematic of how random donor platelets are prepared.

The whole blood donation is centrifuged at room temperature to separate red cells from plasma.

Centrifugation at room temperature (20-24° C) is required to prevent the platelets from aggregating. A “light spin” is used to keep the platelets suspended in plasma.
 
Approximately 190-260 mL of donor plasma is expressed through a filter into the first satellite bag to produce platelet-rich plasma (PRP).

The RBC unit and additive pack are separated from the PRP and sent for preparation of AS-3 RBC LR. Following filtration, the RBC unit is sealed and stored at 1-6° C for 42 days.

The PRP is centrifuged at room temperature using a “hard spin” to concentrate the platelets.

All but approximately 50 mL of plasma is expressed into the second satellite bag.

The supernatant (platelet poor) plasma is stored at temperatures of less than -20° C as Fresh Frozen Plasma, LR for up to 12 months. The plasma may also be shipped as recovered plasma for further manufacture.

The platelet units rest at room temperature for one to two hours to recover from the preparation manipulations. The platelet units are then stored on a platelet agitator in a room temperature incubator.

Additional information on Platelets, LR may be found in the Circular of Information for the Use of Human Blood and Blood Components -2004

 

Preparation of Platelet Apheresis

Platelet Apheresis, LR are collected from single donors using automated apheresis techniques, which include steps to separate leukocytes. Platelet Apheresis, LR are supplied in one 400mL container.

Additional information on Platelet Apheresis, LR, may be found in the Circular of Information for the Use of Human Blood and Blood Components - 2004 and 2005

Preparation of CPD Platelets

Below is a simple schematic of how CPD Platelets Pooled, LR are prepared from a whole blood collection using the buffy coat production method. Not shown is the procedure for leukofiltration.

Step 1		The whole blood donation is centrifuged using a “hard spin” to separate red cells from plasma. The buffy coat layer containing the platelets appears as a thick white layer above the red cells.
Step 2		Using the component separator (Compomat G4) RBCs and plasma are extracted from the buffy coat (from the bottom and top of the primary bag respectively). Red cells and plasma are forwarded for further processing.
Step 3		The buffy coats are allowed to rest for a minimum of two hours. Four buffy coats with the same ABO group and plasma from one of the same four buffy coats are grouped together for pooling.
Step 4		The buffy coats and plasma are sterile docked together in the “train” method. The platelet storage container with filter is sterile docked to the last buffy coat in the train.
Step 5		The buffy coats and plasma are pooled together using the “train” method.
Step 6		Pooled buffy coats are centrifuged using a “soft spin” to separate platelet rich plasma from the plasma containing the majority of the white blood cells.
Step 7 (picture unavailable)		Platelets (platelet rich plasma) are extracted and filtered using the Compomat G4
Step 8		CPD Platelets, Pooled, LR is similar in physical size to an apheresis platelet concentrate The platelets are placed on a platelet agitator for storage. Sampling for potential bacterial contamination is obtained at this time

Additional information on CPD Platelets, Pooled, LR may be found in the Circular of Information for the Use of Human Blood and Blood Components - 2005 

Preparation of Cryoprecipitate and Cryosupernatant Plasma

Canadian Blood Services produces two products from Fresh Frozen Plasma, LR

• Cryosupernatant, LR (Leukocytes reduced), which is also known as CSP, LR
• Cryopreciptate, LR (Leukocytes reduced), which is also known as Cryo, LR

Following the implementation of the Buffy Coat Production Method (BCPM), these components produced from CPD Frozen Plasma will also be available:

• CPD Cryosupernatant Plasma
• Cryoprecipitate

Preparation of CSP, LR and Cryo, LR

Cryoprecipitate is so named because it precipitates when frozen plasma is thawed at low temperatures. Below is a simple description of how Cryoprecipitate, LR and Cryosupernatant, LR is prepared from CP2D whole blood. Leukofiltration is not shown.

Step 1		The whole blood donation is centrifuged to separate red cells from plasma.
Step 2		Approximately 190-260 mL of donor plasma is expressed into the satellite bag. The RBC unit is sealed and stored at 1-6o C for varying shelf lives. Not shown is the AS-3 container should the RBC be made into an AS-3 RBC.
Step 3		Donor plasma is rapidly frozen within eight hours of collection to preserve Factor VIII.
Step 4		Donor plasma is thawed slowly at 1-6°C to the slush stage. Plasma is then centrifuged to separate the cryoprecipitated portion (i.e., cryoprecipitate) from the liquid portion (cryosupernatant plasma).
Step 5		All but ~10 mL of plasma is expressed into the final satellite bag. The three mL of Cryo remains in a plasma volume of about 5-15 mL. Plasma separated from the Cry is know as Cryosupernatant Plasma and can be < href="/resources/books/vein-vein/pretransfusion/storage-blood-componants">stored frozen for u to 12 month t temperatures less than minus 20OC. (While at Canadian Blood Services) Cryo i href="/resources/books/vein-vein/pretransfusion/storage-blood-componants">stored frozen for u to 12 month t 20OC or colder (whil store at CBS).   Preparat on of CPD Cryosupernatant Plasma and CPD Cryoprecipitate CPD Cryos pernatant Plasma is th newly froze roduc obtained following th production of CPD Cryo using the Buffy Coat Production Method (BCPM). Below is simple schematic of how CPD Cryoprecipitate and CPD Cyrosupernan Plasma is prepared fro CPD Whole Blood.

Buffy Coat Component Production Method

A project update from Susan Shimla, Buffy Coat Project Manager, January 2009:
The Buffy Coat production method has been successfully implemented at eleven sites, Edmonton, British Columbia & Yukon, Central Ontario, Hamilton, Calgary, Halifax, New Brunswick, Newfoundland, Ottawa, London and Winnipeg.

The last scheduled implementation occurred on November 28, 2008. All CBS sites, with the exception of Saskatchewan have converted to the new production method.

In the short term Saskatchewan will continue to produce an ongoing national supply of platelets made by the Platelet Rich Plasma method to provide a low volume platelet dose. A longer term solution, the splitting of apheresis platelets, will be investigated but is not expected to be implemented prior to March 2010.

The Buffy Coat project will officially end just prior to the end of the fiscal year with the transition of functions back into operations.

Canadian Blood Services is introducing a new method to produce platelets from whole blood collections called the Buffy Coat Component Production method. This method offers significant benefits for hospitals: a pooled, bacterially tested, ready-to-transfuse platelet concentrated with a higher yield of platelets, greater availability and a five-day shelf life.

This page summarizes the resources available on TransfusionMedicine.ca that will help you better understand this new production method. We welcome your questions and resource suggestions; please use the feedback button.

For a brief summary of changes and components, visit:

• Changes Affecting Hospitals and Patients Following the Implementation of Buffy Coat Production Method
• Amendments 1 and 2 from the 2005 Circular of Information, which lists additional information for red blood cell products manufactured by the Buffy Coat Production method.

For more general information about component preparation, visit our Component Preparation section, which has been updated to include the new products available and their storage conditions:

• Component Preparation
• Preparation of Red Blood Cells
• Preparation of Plasma Products
• Preparation of Platelets
• Preparation of Cryoprecipitate and Cryosupernatant Plasma
• Storage of Blood Components

Training Resources for Nurses and Paramedicals

For nurses and other paramedical personnel in Canadian Hospitals where the method is being introduced, we offer the following training resources:

• Blood Bag Spiking Procedures. A six-minute video showing the spiking technique for the new blood and blood product bags used in buffy coat production. Produced and hosted by the B.C. Blood Coordinating Office.
• Spiking Procedure for Use with Baxter and Macopharma Blood Bags. A presentation by Susan Shimla, Project Director, that shows the spiking technique for specific vendor blood infusion administration sets. December 2005.
• Procedure for Spiking New Buffy Coat Blood Bags. A letter sized poster with troubleshooting tips. Suitable for printing. Updated Dec 2007.
• Introducing ...... Buffy Coat Production Method. Buffy Coat Syllabus Poster. Includes benefits. August 2006.
• Buffy Coat Coming Soon to Newfoundland and Labrador Hospitals An overview article, "Do the Twist," suitable for local hospital or regional publications or newsletters. June 2008.
• Buffy Coat Project: Compatibility of transfusion sets with component bags used by the CBS. A summary of a two part study performed by the CBS designed to assess the compatibility of commonly used transfusion sets with various component bags currently used. January 2006. Important Note: Effective January 2007 all MacoPharma component bags used by CBS are of the modified port design.
• CBS Buffy Coat Blood Bag Evaluation: Technical Report. Results and recommendations from the study by the Provincial Blood Coordinating Office, B.C., investigating the introduction of new blood bags to B.C. hospitals. October 2006. Important Note: Effective january 2007 all MacoPharma component bags used by CBS are of the modified port design.
• Buffy Coat Project: Compatibility of transfer sets with component bags used by the CBS. A summary of a study performed by the CBS to assess the compatibility of commonly used transfer sets with various component bags. February 2007.
• Buffy Coat Readiness Checklist. Is your hospital ready for Buffy Coat? A sample checklist to ensure readiness for Buffy Coat products.

ABO and Rh Typing

ABO and Rh (D) typing is performed on every blood donation. Large numbers of donor tests can be processed using automated equipment.

ABO typing of donors is done using a forward red cell group (including anti-A,B) and a reverse serum group. Rh typing for the D antigen is performed, including a test for weak D on donors who initially type as Rh negative. Weak D donors are classified as Rh positive.

Antibody Screen

Antibody screening is performed on all blood donations. The purpose is to detect clinically significant red cell antibodies, i.e., those that could destroy recipient red cells. Unlike the possible anamnestic response in patients, there is no danger of an increase in antibody level during storage. Therefore, the methods used for antibody detection in donors are not as sensitive as those used for pretransfusion testing of recipients.

Canadian Blood Services routinely issues packed red blood cells from donors with red cell antibodies to all hospital customers. Each unit is labeled (on the lower left quadrant of the label) to indicate the presence of antibodies in the donor plasma.

Plasma and Platelets from donors with red cell antibodies are NOT issued for transfusion.
 

Tests for Transmissible Diseases

Many processes are used to prevent disease transmission via donated blood. These include the following screening procedures:

• blood donor eligibility standards
• pre-donation information pamphlet
• pre-donation questionnaire (record of donation)
• pre-donation interview
• pre-donation blood pressure & temperature
• confidential unit exclusion
• verification of records of previous donations
• laboratory screening tests

Also see donor criteria.

Laboratory Screening Tests

CBS uses laboratory tests to screen every donation for transmissible diseases. PRISMTM, Abbott's high-volume immunoassay analyzer, is used for transmissible disease testing.

See detailed TD tests on the blood.ca site and Further Reading for additional information.

Reactive results

Any samples that are reactive with the screening tests are subject to more specific supplemental assays or confirmatory tests and the blood is not used for transfusion. Donors are contacted by letter if a test is reactive, regardless of the confirmatory result. With the donor's consent the information is forwarded to their physician for appropriate follow-up, if necessary. Test results are kept confidential.

CBS conducts lookback studies on donors with confirmed positive tests for HCV and HIV.

Donors may be temporarily, indefinitely, or permanently excluded from donating blood, either because of their health history or because of test results. Where required by provincial law, positive results are reported, in confidence, to the public health authorities who investigate appropriately.

Also see information on false positives on the bloodservices.ca site

Further Reading - Transmissible Diseases

Transmissible disease screening

1. Busch MP. HIV, HBV and HCV: new developments related to transfusion safety. Vox Sang 2000;78 Suppl 2:253-6.
2. Canadian Blood Services. Safety is Paramount: NAT.
3. CBER, FDA (USA). Draft guidance for industry use of nucleic acid tests on pooled and individual samples from donors of whole blood and blood components for transfusion to adequately and appropriately reduce the risk of transmission of HIV-1 and HCV. (Draft posted: 2002-03-11; for comment only)
4. Dodd RY, Stramer SL. Indeterminate results in blood donor testing: what you don't know can hurt you. Transfus Med Rev 2000 Apr.;14(2):151-60.
5. Fischer G, Hoots WK, Abrams C. Viral reduction techniques: types and purpose. Transfus Med Rev 2001 Apr.;15(2 Suppl 1):27-39. [ Medline ]
6. Holland PV. Old and new tests: where will it end? Vox Sang 2000;78 Suppl 2:67-70.
7. Hoots WK, Abrams C, Tankersleydagger D. The impact of Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease on plasma safety. Transfus Med Rev. 2001 Apr.;15(2 Suppl 1):45-59. [ Medline ]
8. Kleinman S. Hepatitis G virus biology, epidemiology, and clinical manifestations: Implications for blood safety. Transfus Med Rev. 2001 Jul.;15(3):201-12. [ Medline ]
9. Morgenthaler JJ. Securing viral safety for plasma derivatives. Transfus Med Rev 2001 Jul.;15(3):224-33. [ Medline ]
10. Orton S. Syphilis and blood donors: what we know, what we do not know, and what we need to know. Transfus Med Rev 2001 Oct.;15(4):282-91. [ Medline ]
11. Orton SL, Dodd RY, Williams AE; ARCNET Epidemiology Group. Absence of risk factors for false-positive test results in blood donors with a reactive test result in an automated treponemal test (PK-TP) for syphilis. [ Full text ] [ Medline ]
12. Roth WK, Buhr S, Drosten C, Seifried E. NAT and viral safety in blood transfusion. Vox Sang 2000;78 Suppl 2:257-9.

Transmissible diseases - lookbacks

1. Goldman M, Long A. Hepatitis C lookback in Canada. Vox Sang 2000;78 Suppl 2:249-52. [ Medline ]
2. Goldman M, Spurll G. Hepatitis C lookback. Curr Opin Hematol 2000 Nov.;7(6):392-6. [ Medline ]
3. Stramer SL, ed. Blood Safety in the New Millennium. Bethesda, MD: American Association of Blood Banks, 2001.

 

Detailed Tests for Transmissible Diseases

Every donation is tested as follows:

• Hepatitis B and C
• Hepatitis B surface antigen (HBsAg)
  The hepatitis B surface antigen (HBsAg) test screens for hepatitis B virus (HBV) by identifying the presence of the viral coat protein (antigen) on the envelope of HBV.
• Hepatitis B core antibody (anti-HBc)
  The anti-HBc test screens for hepatitis B virus by detecting specific antibodies to the Hepatitis B core antigen.
• Hepatitis C virus antibody (anti-HCV)
  The anti-HCV test screens for hepatitis C virus (HCV) detecting specific antibodies to the HCV antigen.

See additional information on hepatitis on the Canadian Blood Services Web site.

HCV Nucleic Acid Testing (NAT)

Nucleic Acid Testing uses a Polymerase Chain Reaction (PCR) to amplify the nucleic acids of HCV, allowing direct detection of small amounts of virus. NAT for HIV and HCV is done on pools of 24 samples but may also be done on individual samples to improve sensitivity.

See NAT-Safety is Paramount on the Canadian Blood Services Web site.

Human Immunodeficiency Virus (HIV)

anti-HIV-l and anti-HIV-2

The anti-HIV-1/2 test screens for antibodies to the human immunodeficiency virus (HIV) types 1 and 2. Both HIV-1 and HIV-2 cause acquired immune deficiency syndrome (AIDS) but HIV-2 is uncommon in North America.

HIV Nucleic Acid Testing (NAT)

Nucleic Acid Testing uses PCR to amplify the nucleic acids of HIV, allowing direct detection of small amounts of virus.

See information on HIV and AIDS on the Canadian Blood Services Web site.

West Nile Virus (WNV)

The TaqScreenTM West Nile Virus system (Roche Diagnostics) is a nucleic acid test (NAT) that uses PCR to amplify the nucleic acids (RNA) of WNV, allowing direct detection of small amounts of virus.

West Nile virus testing is usually performed on pools of six samples but may also be done on individual samples to improve sensitivity.

See information on West Nile Virus on the Canadian Blood Services Web site.

Syphilis

Serologic Test for Syphilis (passive hemagglutination test for the qualitative detection of specific Treponema pallidum antibodies).

See information on syphilis on the Canadian Blood Services Web site.

HTLV-I and HTLV-II

anti-HTLV-I, anti-HTLV-II

The anti-HTLV-I/II test screens for an antibody to human T-cell lymphotropic virus (HTLV) types I and II.

See information on HTLV on the Canadian Blood Services Web site.

Chagas Disease

Chagas disease antibody testing is performed on selected donors who are at-risk of infection with the protozoan parasite Trypanosoma cruzi, the cause of Chagas disease (American Trypanosomiasis).
Canadian Blood Services implemented additional screening questions for donors regarding risk factors for Chagas disease. Any donor who answers ‘yes’ to a Chagas risk question has their blood tested for the presence of T. Cruzi antibodies.

See information on Chagas on the Canadian Blood Services Web site.

Testing Platform

Hepatitis B testing (HBsAg and anti-HBc), Hepatitis C antibody testing, anti-HIV 1/2 testing, anti-HTLV I/II and Chagas testing are done on the Abbott PRISM^TM analyzer which utilizes chemiluminescent technology.

Cytomegalovirus (CMV) Tested Components

Recognized methods of reducing CMV transmission by cellular blood components include testing donor units for CMV antibodies and prestorage leukoreduction. A recent Canadian consensus conference (Jan. 2000), "determined that since leukoreduction alone provides excellent protection from CMV, there was unanimous agreement that the administration of leukoreduced blood components that are clinically required should not be delayed if seronegative blood components are not available.

(See Blajchman article in Further Reading)

Indications

Some categories of patients may be at significant clinical risk when exposed to CMV infection. Included in these categories are neonates weighing below 1250 grams, organ and bone marrow transplant recipients and other immuno-compromised patients. Since CMV is a cell-associated virus, frozen plasma and cryoprecipitate do not transmit CMV infection.

CSA Standard Z902-04, Blood and Blood Components

Criteria have been developed for candidacy for CMV reduced risk blood components. As well, hospital transfusion services must have written policies indicating which patients are eligible for anti-CMV negative blood components and a process for identifying and providing these products.

Prevalence & Other Therapies

As the CMV antibody positive status of the donor population may be 50 per cent or higher, it may be difficult for Canadian Blood Services to provide blood products negative for the CMV antibody, for all high risk patients. CMV-seronegative pregnant women, fetuses receiving intrauterine transfusions, and CMV-seronegative allogeneic stem cell transplantation recipients are at highest risk for CMV related morbidity. In addition to the use of leukoreduced CMV seronegative cellular components, other strategies to reduce CMV related morbidity in allogeneic stem cell transplantation include the use of special immunoglobulin preparations and frequent testing to detect early CMV infection.

Additional Resources:

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Blajchman MA, Golman M, Freedman JJ, Sher G. Proceedings of a Consensus Conference: Prevention of Post-transfusion CMV in the Era of Universal Leukoreduction. Transfusion Medicine Reviews Vol 15 No 1 Jan 2001 pp 1-20.
2. Laupacis A, Brown J, Costello B, et al. Prevention of posttransfusion CMV in the era of universal WBC reduction: a consensus statement. Transfusion Vol 41 April 2001 pp 560-69.
3. Popovsky MA, Benson K, Glassman AB, et al. Transfusion practices in human immunodeficiency virus-infected patients. Transfusion. 1995;35:612-616.
4. Preiksaitis J. The cytomegalovirus-"safe" blood product: is leukoreduction equivalent to antibody screening? Transfus Med Rev. 2000 Apr;14(2):112-36.
5. Triulzi Darrell J. Transfusion Support in Solid-Organ Transplantation. Institute for Transfusion Medicine. Transfusion Medicine Update. April 2001.

Bacterial Detection

Bacterial contamination of blood products may lead to severe, even fatal transfusion reactions. Because they are stored at room temperature, platelets constitute a favourable growth environment for a wide range of bacteria. These bacteria may be present in an asymptomatic, bacteremic blood donor, or more commonly may be part of normal donor skin flora. Methods to decrease bacterial contamination currently include questioning all donors about fever and infections, careful skin disinfection, and diversion of the initial aliquot of donor blood away from the main collection bag. In addition, the donor’s temperature is measured prior to each donation.

There is no ideal method to detect the very low numbers of bacteria that may be present shortly after blood collection. No methods are required or licensed by Health Canada at the present time as a release test for blood components. Canadian Blood Services is performing aerobic automated blood cultures, using the BacT/ALERT system on apheresis platelets. Such cultures will also be performed on buffy coat platelets, when this method of production is introduced.

Platelet Donor Selection Registry

Canadian Blood Services has a registry of HLA and HPA typed platelet apheresis donors. This registry, known as PDS (Platelet Donor Selection) is a computerized model developed by CBS for the selection of HLA/HPA compatible donors for alloimmunized patients. It allows the user to perform searches at both local and national levels (with the exception of Héma-Québec). The system supports two groups of patients: refractory patients with haematological malignancies and infants with Neonatal Alloimmune Thrombocytopenia (NAIT).

Donors enrolled in the platelet apheresis program are DNA typed for HLA and HPA-1. At the present time PDS lists over 13000 donors. Of these, approximately 49% are typed for HPA-1. Currently there are 129 HPA-1a negative platelet apheresis donors in the registry. A small number of donors are also typed for HPA-2 to-6 and -15 to support infants affected by NAIT due to antibodies other than anti-HPA-1a. Three centres collect HPA-1a negative platelets weekly, which allow us to maintain a small inventory available nationally.

Other Tests

The following tests are not routinely done on all donations but are occasionally performed to meet the needs of patients with special needs.

Screen for CMV

screen for antibodies to cytomegalovirus (anti-CMV) using
the CMV Particle Agglutination assay (CMV-PA)

Antigen phenotyping

Canadian Blood Services occasionally tests for red cell antigens beyond ABO and
Rh(D).

Screen for IgA Deficiency

Canadian Blood Services screens donors for the presence of IgA in order to increase the number of IgA deficient donors whose IgA deficient products are required by patients with anti-IgA.

General and Whole Blood Donation: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Blajchman MA, Goldman M, Freedman JJ, Sher GD. Proceedings of a consensus conference: prevention of post-transfusion CMV in the era of universal leukoreduction. Transfus Med Rev. 2001 Jan; 15(1):1-20.
2. Goodnough LT. Universal leukoreduction of cellular blood components in 2001? No. Am J Clin Pathol 2001; 115(5):674-7.
3. Sweeney JD. Universal leukoreduction of cellular blood components in 2001? Yes. Am J Clin Pathol 2001; 115(5):666-73.

Apheresis blood donation: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Bolan CD, Greer SE, Cecco SA, Oblitas JM, Rehak NN, Leitman SF. Comprehensive analysis of citrate effects during plateletpheresis in normal donors. Transfusion 2001 Sep;41(9):1165-71. [ Full text ] [ Medline ]
2. Bonomo P, Garozzo G, Bennardello F. The selection of donors in multicomponent collection management. Transfus Apheresis Sci. 2004 Feb; 30(1): 55-9. [Medline]
3. Cable RG, Edwards RL. The use of platelet concentrates versus plateletpheresis - the donor perspective. Transfusion 2001 Jun;41(6):727-9. (Also see Lazarus et al. below) [ Full text ] [ Medline ]
4. Goodnough LT, Ali S, Despotis G, Dynis M, DiPersio JF. Economic impact of donor platelet count and platelet yield in apheresis products: relevance for emerging issues in platelet transfusion therapy. Vox Sang 1999;76(1):43-9. [ Medline ]
5. Kiprov DD, Golden P, Rohe R, Smith S, Hofmann J, Hunnicutt J. Adverse reactions associated with mobile therapeutic apheresis: analysis of 17,940 procedures. J Clin Apheresis 2001;16(3):130-3. [ Medline ]
6. Lazarus EF, Browning J, Norman J, Oblitas J, Leitman SF. Sustained decreases in platelet count associated with multiple, regular plateletpheresis donations. Transfusion 2001 Jun;41(6):756-61. [ Full text ] [ Medline ]
7. Strauss RG. Mechanisms of adverse effects during hemapheresis. J Clin Apheresis 1996;11(3):160-4. [ Medline ]
8. Tran-Mi B, Storch H, Seidel K, Schulzki T, Haubelt H, Anders C, Nagel D, Siegler Ke, Vogt A, Seiler D, Hellstern P. The impact of different intensities of regular donor plasmapheresis on humoral and cellular immunity, red cell and iron metabolism, and cardiovascular risk markers. Vox Sang. 2004 Apr; 86(3): 189-97. [Medline]
9. Vrielink H, van der Meer PF. Collection of white blood cell-reduced plasma by apheresis. Transfusion. 2004 Jun; 44(6): 917-23. [Medline]

Allogeneic Blood Donation: Further Reading

Allogeneic blood donation refers to blood donated from an individual which, once tested and found suitable for transfusion is placed in the general blood supply for the purpose of transfusion to another individual unknown to the donor. This is a voluntary donation usually for the national supply. Historically this type of donated blood was referred to as homologous blood.

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Kleinman S, Chan P, Robillard. Risks associated with transfusion of cellular blood components in Canada. Transfusion Medicine Reviews 2003; 17: 120-162. [Medline]
2. Thomson RA, Bethel J, Lo AY, Ownby HE, Nass CC, Williams AE. Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study. Transfusion 1998 Apr;38(4):359-67. [ Medline ]

Autologous Blood Donation: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Goldman M, Savard R, Long A, Gélinas S, Germain M. Declining value of preoperative autologous donation. Transfusion 2002; 42:819-23. [Medline]
2. Blum LN, Allen JR, Genel M, Howe JP 3rd. Crossover use of donated blood for autologous transfusion: report of the Council on Scientific Affairs, American Medical Association. Transfusion 1998 Sep.; 38(9):891-5. [ Medline ]
3. Feagan BG, Wong CJ, Johnston WC, Arellano R, Colterjohn N, Karkouti K, et al. Transfusion practices for elective orthopedic surgery. CMAJ 2002 Feb. 5; 166(3):310-4.
4. Goldman M, Remy-Prince S, Trepanier A, Decary F. Autologous donation error rates in Canada. Transfusion 1997 May; 37(5):523-7. [ Medline ]
5. Kanter MH, van Maanen D, Anders KH, Castro F, Win Mya W, Clark K. A study of an educational intervention to decrease inappropriate preoperative autologous blood donation: its effectiveness and the effect on subsequent transfusion rates in elective hysterectomy. Transfusion 1999 Aug.; 39(8):801-7. [ Medline ]
6. Letts M, Perng R, Luke B, Jarvis J, Lawton L, Hoey S. An analysis of a preoperative pediatric autologous blood donation program (pdf file). Can J Surg 2000 Apr.; 43(2):125-9.
7. Moltzan C, Proulx N, Bormanis J, Lander N, Degroot H, Rock G. Perceptions and motivations of Canadian autologous blood donors. Transfus Med 2001 Jun.; 11(3):177-82. [ Medline ]
8. Perkins J, Kaminer L, Kruskall M, Cannon M, Uhl L, Dzik W, et al. Should the FDA mandate that autologous units drawn and transfused within a single institution be tested for markers of infectious disease? Transfusion. 2000 Jun.; 40(6):752-4. [ Full text ] [ Medline ]
9. Popovsky MA, Whitaker B, Arnold NL. Severe outcomes of allogeneic and autologous blood donation: frequency and characterization. Transfusion 1995 Sep.; 35(9):734-7. [ Medline]
10. Vanderlinde ES, Heal JM, and Blumberg N. Autologous transfusion. Br Med J 2002; 324:772-5.
11. Yomtovian R. Practical aspects of preoperative autologous transfusion. Am J Clin Pathol 1997 Apr.; 107(4 Suppl 1):S28-35. [ Medline ]

Hospital based high risk programs

Cormack JG. Autologous blood donation in high risk patients. Department of Anaesthesia, W.C. MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta. http://www.anesthesia.org/winterlude/wl98/Cormack.htm

Directed Donations: Further Reading

Note: Canadian Blood Services offer no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Breacher ME, Borchers G, Rosen NR, Lord M. Directed donations: an underutilized blood donor resource. Lab Med 1988; 19: 103-105.
2. Cordell RR, Yalon Va, Cigahn-Haskell C, McDonough BP, Perkins HA. Experience with 11,916 designated donors. Transfusion 1986; 26: 484-486.[ Medline].
3. Goldfinger D. Directed blood donations: Pro 1989; 29: 70-74. Transfusion 1989; 29: 70-74.
4. Goldfinger D. The community blood supply and the patient’s choice. The case for directed donations. Hastings Center Report 1987; 17: 7-8.
5. Goldman M, Demers H, Long A, Charest L. Directed donations in the province of Quebec. CSTM Bulletin. 1998: 10; (3) 78-83.
6. Grindon AJ. Infectious disease markers in directed donors in the Atlanta region. Transfusion 1991; 31: 872-873.
7. Myhre BA, Figueroa PI. Infectious disease markers in various groups of donors. Ann Clin Lab Sci 1995; 25: 39-43.[Medline]
8. Page PL. Controversies in transfusion medicine. Directed blood donations: Con. Transfusion 1989; 29: 65-70.
9. Petz L, Kanter MH, Pink J, Wylie B. Infectious disease markers in autologous and Directed donations. Transfusion Medicine 1995; 5: 159-163.
10. Salonen K. Directed blood donation: a matter of public trust. Health Law in Canada. 1996; 17: 10-19.[Medline]
11. Shah VP, Molstad SL, Segall CL, Strand CL. A hospital donor room’s three year experience with directed donations (abstract). Transfusion 1986; 26: 599.
12. Starkey JM, MacPherson JL, Bolgiano DC, Simon ER, Zuck TF, Sayers MH. Markers for Transfusion-transmitted disease in different groups of blood donors. Journal of the American Medical Association 1989; 262: 3452-3454.
13. Umlas J. Transfusion-related acquired immunodeficiency syndrome and directed donations: would the national blood supply be safer with directed donations. Human Pathology 1986; 17: 108-110.
14. Wales PW, Lau W, Kim PC. Directed blood donation in pediatric general surgery: Is It worth it? J Pediatr Surg 2001 May; 36 (5): 722-5. [Medline]
15. Williams AE, Kleinman S, Gilcher RO, Jackson CM, Murphy EL, Shreiber GB et al. The prevalence of infectious disease markers in directed vs. homologous donations. (Abstract) Transfusion 1992; 32: 45S.

Criteria for temporary deferral: Further Reading

Prospective blood and/or bone marrow donors may be unable to donate for reasons that could either compromise their own health or the safety of the blood supply or marrow product.

Common reasons why people may be temporarily deferred are listed below. Read More>>

Transmissible disease screening: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Busch MP. HIV, HBV and HCV: new developments related to transfusion safety. Vox Sang 2000;78 Suppl 2:253-6.
2. Canadian Blood Services. Safety is Paramount: NAT.
3. CBER, FDA (USA). Draft guidance for industry use of nucleic acid tests on pooled and individual samples from donors of whole blood and blood components for transfusion to adequately and appropriately reduce the risk of transmission of HIV-1 and HCV. (Draft posted: 2002-03-11; for comment only)
4. Dodd RY, Stramer SL. Indeterminate results in blood donor testing: what you don't know can hurt you. Transfus Med Rev 2000 Apr.;14(2):151-60.
5. Fischer G, Hoots WK, Abrams C. Viral reduction techniques: types and purpose. Transfus Med Rev 2001 Apr.;15(2 Suppl 1):27-39. [ Medline ]
6. Holland PV. Old and new tests: where will it end? Vox Sang 2000;78 Suppl 2:67-70.
7. Hoots WK, Abrams C, Tankersleydagger D. The impact of Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease on plasma safety. Transfus Med Rev. 2001 Apr.;15(2 Suppl 1):45-59. [ Medline ]
8. Kleinman S. Hepatitis G virus biology, epidemiology, and clinical manifestations: Implications for blood safety. Transfus Med Rev. 2001 Jul.;15(3):201-12. [ Medline ]
9. Morgenthaler JJ. Securing viral safety for plasma derivatives. Transfus Med Rev 2001 Jul.;15(3):224-33. [ Medline ]
10. Orton S. Syphilis and blood donors: what we know, what we do not know, and what we need to know. Transfus Med Rev 2001 Oct.;15(4):282-91. [ Medline ]
11. Orton SL, Dodd RY, Williams AE; ARCNET Epidemiology Group. Absence of risk factors for false-positive test results in blood donors with a reactive test result in an automated treponemal test (PK-TP) for syphilis. [ Full text ] [ Medline ]
12. Roth WK, Buhr S, Drosten C, Seifried E. NAT and viral safety in blood transfusion. Vox Sang 2000;78 Suppl 2:257-9.

Transmissible diseases - lookbacks

1. Goldman M, Long A. Hepatitis C lookback in Canada. Vox Sang 2000;78 Suppl 2:249-52. [ Medline ]
2. Goldman M, Spurll G. Hepatitis C lookback. Curr Opin Hematol 2000 Nov.;7(6):392-6. [ Medline ]
3. Stramer SL, ed. Blood Safety in the New Millennium. Bethesda, MD: American Association of Blood Banks, 2001.

Component Preparation: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. AuBuchon JP, Herschel L, Roger J, Murphy S. Preliminary validation of a new standard of efficacy for stored platelets. Transfusion. 2004 Jan; 44(1): 36-41. [Medline]
2. Brecher ME, ed. Technical manual, 14th ed. Bethesda, MD: AABB Press; 2002.
3. DeSantis D., Donor selection and component preparation. In: Harmening D ed. Modern blood banking and transfusion practices. 4th ed. Philadelphia, PA: FA Davis;1999.
4. International Forum. The official requirements for platelet concentrates. (pdf file) Vox Sang 1998;75(4):308-17.
5. Petrides, M. Blood Component Preparation in: Petrides M, Stack G. Practical Guide to Transfusion Medicine. Bethesda MD: AABB Press; 2002: 1-18.