No shortcuts to evolution : A holistic laboratory approach to blood safety. Dr. Neelam Marwaha , M.D., F.A.M.S, F.I.S.H.T.M . Professor& Head Department of Transfusion Medicine, PGIMER, Chandigarh.
No shortcuts to evolution:
A holisticlaboratoryapproach to bloodsafety
Dr. NeelamMarwaha, M.D., F.A.M.S, F.I.S.H.T.M.
Department of Transfusion Medicine,
Comprehensive quality system covering the entire transfusion process, from donor recruitment to the follow-up of recipients of transfusion
Change in the Blood Banking Scenario
Single donor apheresis
Specialised products ( Leucodepleted ,irradiated,washed,pooled)
Adequate staff / no pendency of work / no undue delays
Equipment Management Program
Red Cell Serology
ABO grouping and Rh typing
Weak D or Du testing
Antibody detection and identification
Direct antiglobulin test
Haemagglutination inhibition test
Effects of alloantibodies
Work Area: Shifting of grouping lab
Sample collection:3 clotted pilot tubes to 1 ACD and 1 clotted
Centrifugation:Essential step now
Barcode labelling: Essential additional step
Reagents:More stringent inventory management
Training: Test runs, interpretation, troubleshooting,
Staff change: Two senior technicians
Duty hours:To balance workload and throughput
Results:Change in format of documentation
Reagents e.ggrouping antisera
Department of Transfusion Medicine, PGIMER, Chandigarh Quality Control Report of Anti A monoclonal antisera
Signed by: 123
Signature of HOD
Safety from Transfusion Transmissible Infections
Quality of the specimen used for testing
Quality of kits used for testing
Calibration and validation of equipment used
Use of SOPs for testing
Type of Controls used while testing
Interpretation of results
Validation of results
Record keeping- kits,results
Training of staff-induction, refresher
Look for trends, shifts and random errors
HIV Ab Negative
HCV Ab Negative
Sources: (1) Busch et al. Transfusion. 2005;45(2):254-264.
(2) Kleinman and Busch. J Clin Virol. 2006;36:S23-S29.
(3) Data on file at Chiron, Novartis Vaccines and Diagnostics, Inc.
Platelet PGD test Blood bag with diversion pouch
Blood Component Preparation and Special Processing
Planning a component lab
Type of hospital and bed strength
(+ 50 m2)
or quadruple bags
Strict guidelines for selection of blood donor
Adequate disinfection of venipuncture site
Single non-traumatic venepuncture
Blood and anticoagulant mixing
Volume of blood collected
Total time of collection
No aspirin in 48 hrs. -Platelets
Storage conditions for blood prior to component preparation-
(cold chain:4/ 20-240 C)
Time restrictions for processing (6 hours)
Validated equipment and program
1. Time, speed, temperature
2. Monitor QC results in components prepared in
Proper storage temp.
Labeling and releasing product from quarantine for issue
Separate storage: positive for TTI, their disposal and record of discarded units
G, M, L
: High occurrence
G: Granulocytes M : Monocytes L : Lymphocytes B : Lymphocytes-B
Transfusion Reaction (WBC-associated)
The job is not done until the paperwork is complete
Do what is documented; document what you do
It is a legal requirement
Who performed the test?
When was it done?
What method was used?
What were the results?
Who approved the results?
“Challenges are what make life interesting;Overcoming them is what makes life meaningful”Joshua J. Marine