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Safe Blood for Transfusion

You are here : Home/ Blood Bank Zone/ Transfusion Safety and Optimal Utilization of Blood/ 2. Safe Blood for Transfusion

2. Safe Blood for Transfusion

The infections transmitted through blood transfusion can be
a) exogenous
b) endogenous

Exogenous infections are those which are introduced into a blood unit from an external source.

Prevention of exogenous infection

* Close disposable blood collection system
* Careful collection of blood under aseptic conditions
* Storage of blood at correct temperature

To safeguard against exogenous infections, it is essential to use closed system plastic disposable blood collection bags in which blood is collected under all aseptic precautions and the blood units are stored at the correct temperature.

Endogenous infections are those transmitted from donors blood to the recipient.

Prevention of endogenous infection

* Screening of donated blood units for HIV-1+2, HBV, HCV, CMV, Syphilis, etc.
* Use of highly sensitive and specific appropriate assay systems
* Use of simple and rapid test if inadequate blood stock

Endogenous microbiological agents transmitted by blood transfusion have certain characteristics and the hallmark is persistence of infection i.e.

* Long incubation period
* Carrier or latent state
* Asymptomatic subclinical infection
* Viability in stored blood

These characteristics enable viruses such as HBV, CMV & I-IIV to be transmitted by blood transfusion. It is therefore, essential to screen for the transfusion transmitted diseases to prevent the transmission of endogenous infections In India, it is mandatory to screen all blood units for HBsAg, HIV-1 + HIV-2 and syphilis.

Quality Assurance Scheme to Ensure Safety of Blood

* Stringent and critical donor selection
* Proper documentation of all donations
* Validation of sensitivity and specificity of all new batch of test kits
* Strict adherence to recommended procedures
* Use of appropriate test and internal positive & negative controls
* Implementation of external quality assurance scheme (EQAS)
* Safe disposal of infected blood units.

Procedures to be carried out before all transfusion to minimize the risk of bacterial contamination

* Check that the bag is intact (no tear or holes).
* Ensure the btood is stored at correct temperature with minimal time at room temperature (except platelets).
* Do not warm units of blood before transfusion.
* Look at the pack that had been standing undistributed to see if there is any evidence of haemolysis (purple mass of red cell or brown red plasma) which may be indicative of bacterial contamination.
* Check clearly defined interface between the cell and the plasma.

Summary

Donor selection, screening of blood units for markers of infections and vital inactivation of blood products are three lines of defence to achieve transufion safety.

Effective quality assurance system, proper documentation and record maintenance, constitution of hospital transfusions committee to look into optimal use of blood and blood ordering strategies, clinical audit for review of blood usage are other important aspects for safety of blood transfusion.

Active interaction between blood transfusion service & clinicians will further ensure safety.

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