Recruitment and screening of donors and the collection, processing, and testing of blood

The blood donation and transfusion chain Although much effort has been expended to find suitable replacements for blood components, the best source continues to be blood collected from healthy, human donors. The process of supplying sufficient blood components and derivatives for patient needs is complex and highly regulated. At the same time, it must be dynamic in adapting to the local and regional needs for providing blood products that may have a short shelf life. Other chapters have detailed descriptions of how to prepare and preserve red blood cells (RBCs; Chapter 9), platelets (Chapter 19), granulocytes (Chapter 23), and plasma and plasma derivatives (Chapter 27). This chapter focuses on the donation and collection process, from recruitment of donors to the receipt of products in the hospital inventory. Physician involvement is essential to this process. An overview of the entire blood donation and transfusion chain is seen in Figure 4.1. The role of hemovigilance as the last step of the chain has become increasingly emphasized over the past decade (see Chapter 6). Hemovigilance is “a set of surveillance procedures covering the whole transfusion chain from the collection of blood and its components to the follow-up of its recipients, intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence and recurrence.” The entire process is typically under intense regulatory scrutiny from governmental agencies and industry groups such as AABB (formerly known as the American Association of Blood Banks, see www.aabb.org) and the Plasma Protein Therapeutics Association (www.pptaglobal.org). Details on the regulatory aspects are addressed in Chapter 7. In many countries, there are dual systems for supplying blood for patient transfusion in the hospital, and for collecting source plasma for derivatives. This is due to parallel development of these systems during the latter half of the 20th century. This is reflected in the arrangement of this chapter, with separate sections for collection of transfusable products and source plasma. In this chapter, an introduction to the organization of blood services responsible for managing this complex process will be covered first. Recruitment of blood donors will then be described, followed by a detailed analysis of the donation process from the perspective of the donor and also of the component prepared. Finally, source plasma donation will be addressed. Donor adverse events are considered in Chapter 5.