Computerisation and Automation in Blood Bank

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Computerisation and
Automation in Blood Bank
16.1 COMPUTERISATION
The Mathematical approachof problemsolvingfromobtained/observed datasinthecourseofinvestigation
or research may not be entirely satisfactory in all the set ups. As such an alternative approach to this
could be a system that can store, retrieve and process data through programmable electronic device -
computer. A computercan performcalculationwithconstantreliableaccuracyand at a speedfaster than
human brain. A preprogrammed computer can act like a human expert and is endowed with higher
functional capabilityand speed.This is possiblebecausecomputeruses sophisticatedelectronicdevices
in a highly integratedsystem respectivelyknown as software and hardware.
Ad_vantages of computer
(a) Data processed may be helpful in computerised assisted decision making.
(b) Accuracy and quickness.
(c) Recall and retrievalof data.
(d) Storing.ofdata in miniatureform disk, floppy etc.
(e) Reclassification of data.
(f) Monotonous job like repeated experiment and mathematical calculation etc. can be avoided
and interpretation made easier.
In blood bank and transfusionmedicine,the accuracy, precision, decision making, documentation,
safety and generation of statisticaldata are some of the key functions. The proceduresare tedious and
time consuming,few of them are veryoften boringviz. documentation and labellingetc. Mistakeis thus
not unlikely with an inexperienced operator. Computer can assist in above functions and also in other
technical functiontherebyensuringsafe transfusion with maximumclinicaleffectiveness. Modem blood
bank in most of developed countries are computerised.
The computer can be used in blood bank in different area viz. reception room, technical area, i.e.,
donor complex and laboratory.
460

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Computerisation anc'.., Automation in Blood Bank
461
Office and reception room
General statistical record and generation of statistical data.
Donor complex
(a) Improved procurement of blood.
(b) Donor data.
(c) Automated donor call up.
(d) ,Tracing donor, product and recipient flow.
(e) Record of replacement donation, blood brought from outside or issued against separate credit
card on authority from donor.
Laboratory and cold storage complex
(a) Up-to-date stock of blood (tested, untested, to be discarded, under order for issue-due).
(b) Issue of blood/component according to seniority.
First come, first out from the stock.
(c) Blood component data.
(d) Cross match data for blood issued which can be successfully utilised as guideline for further
issue in multiple transfusion cases.
(e) Rare blood group data and its availability in cold storage.
(t) Performance data laboratory-wise.
(g) Recipient data.
(h) Mandatory (HbsAg, HIV, HeV, VDRL, MP test data.
(i) Quality control.
The computerisation, thus desirable is multiuser facility with updated inventory. This is possible
with online processing capability, processed data are fed into a central command. Central command
placed into blood bank officer's room with extension to reception room. So hardwares required will be
central and interconnections connected to different terminals. These interconnections could be "half
duplex" with.facility for interruption by a break character or it can be a "full duplex" mode, computer
and terminal can send the data simultaneously. Software modules represents the activity in a particular
place/area of blood bank which might have more than one terminal, Software has the facility of easy
manipulation by trained personnel and this also compute, compile and compare the data.
Central command requires a computer trained personnel who is capable of operating the computer
independently. The blood bank officerlblood transfusion officer receives daily feed back from the central
command which helps as management aid on day to day basis or in futuristic planning. Central command
is placed in an isolated airconditioned area within the blood bank campus. This central command is
interconnected through a system of local area network to terminals and subtenninals in different location
as per requirement.
It is important that personnels working in the blood bank viz. doctors, technicians has proper training
and knowledge of computer.

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462
Blood Banking and Transfusion
Computer is a sophisticated programmable electronic device incorporated in a highly integrated
system and is equipped with i/O (input/output) device. A simplifiedflow chart of computeroperation is
appended below.
Centralprocessing unit(Fig. 16.1)is the brainof a computer and consistsofa controlunit,arithmetic
logical unit (ALU) and central memory, each of them has a different function defined below.
'Central
Input
Processing Unit
1. Control unit (c.u.)
2. Arithmetic logical unit (ALU)
3. Central memory (CM)
F'9. 16.i,
The CPU are made of ICS (integrated circuits) and/or semiconductors where the input datas are
processedandoutputted. Thecontrolunit(C.D.)makeschangesin programm~
flowaccordingtocondition
set.. What is then a programme - programmeare set or instructionsto computer for handling the data,
The Arithmetic logical unit is concerned with all arithmetical'operation 'andlogical testing of data.
Central memory main functionis storageand .are made of 'Semi-conductors, it also gives rapid entry
to datas, programmes etc. which can,be divided in two types of access viz..Random Access Memory
(RAM) - alternatememory,
Read only memory (ROM)- Static memory or permanentunless altered intentionally.
E Prom and EA Prom has yielded a definite place in the semiconductor memory (Table 16.1).
Table ·16~1..
I
Prom
(Programmable ROM)
ROM
I
Cdanguage (computer language) is the operationalmedia used by computerfor .all types of work.
This is a type of language understandable by computeror otherwiseknownas 'machine language.In the
beginning of computer era binary numbers were "Used for inputting the tnstructions. Lateron during
process of further evolution, the assembly language. Fortran (Formula translation),'Cobol (common
business oriented language), Algol (Alogrithrnic Ianguage), Basic {Beginners all purpose symbolic
instruction 'code) weredeveloped, these are knownasstructured languagebased on Which languagesfor

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Computerisation and Automation in Blood Bank
463
Rg. 16.2. Bar code showing three
white spaces and four black vertical
bars of different thickness.
Bloodfor
Transfusion
111111111
A
Rh Negative
11I1
123456
Dete of drawal
Date of expiry
HbsAg
VORL
HIV
laboratory use could be developed by a computer specialist.
Already, there are some expert system developed for laboratory
purpose.
Datas are the information within the programme and/or
information collected from outside sources. Files or computer file
are datas stored in devices outside the memory/CPU viz. disks,
tape etc. and data structure are the process oforganising the
information. Both file and data are therefore interrelated.
Input and output device are the channel of communication
between man-machine and device. Different type of I/O devices
designed to support a communication channel according to
requirement are available. Cathode Ray terminal, a television like
device displaying character and graphics are commonly used for
laboratory. Others are card readers, keyboard terminals etc. Bar
code system (Fig. 16.2) has find a place in laboratory of blood
bank and in its management.
The bar code system has been developed in USA where it is
commonly used to label the blood and blood product. CCBBA of
American Blood Commission choosed the CODABAR system
and modified it according to the need of transfusion practice and
it is known as ABC. The CODABAR system consists ofa symbol
of four vertical black bars of different thickness and three
intervening white spaces.
'Fig. 1&.3. Diagrammatic represen-
tation of A label with bar code and
Different combinations of thick and thin bar and spaces
eye readable, numbers.
represents different characters as envisaged under ABC system
of CODABAR. Every country, .where blood banks are computerised, has standardised bar code system
displayed over product information label, The 'combination of numbers, letters and bar codes represents
the donor number, blood group and other relevant information, Laser scanners in i/o device passes a
'beam of light-across the bar code and two label of reflection due to back bar and white spaces, are" made
use 'of, to read the information provided in the bar code. Alternatively, it can be"read with the help of a
'hand held light pen (Fig. 16.3).
Light pen
Hand held bar code readers. To avoid any mistake, an eye readable number/description is also provided
in some of product information label.
In 'similar way, blood products/components can also be labelled and the donor card issued to the
"donor'are also barcoded and printed,
Three important working parameters that requires computerisation for a smooth running or
management of any blood bank are :
1.. "Donor-recipient flow includes processing of samples. and monitoring till safe transfusion,
thereafter record and samples preserved for seven days. Delayed reaction may occur within
seven to ten days.

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464
Blood Banking and Transfusion
2. Storage of whole blood and component produced, its optimum and judicious use.
3. Office record/documentation.
The number one (1) function starts at reception of blood bank where both donors and samples from
recipient are received in different counters.
After preliminary screening, donors are sent to bleeding room, where a fit donor is bled and number
allotted which is bar coded (standardised bar code for that country); label now attached to main bag,
satellite bag, pilot tube, entered into donor card in each instance. Each donor unit is placed in an automatic
grouping machine known as "groupamatic machine" with CODABAR reading facility and printout,
grouping (ABO and Rh) result transferred to computer number-wise, the biolab investigations (HbsAg,
mv, Hey, VDRL, MP) and screening for irregular antibody are all entered numberwise into the keyboard
terminal of the computer. This makes any donor unit subject to further- grading according to results
displayed against each unit/number in the VDU of the computer. Any new donor are grouped and tested
twice so that both the results are in agreement before final codeing is done. In case of old donors, results
are tallied with previous record. -The operator checks the barcoded label and other information in each
instance by hand held light pen. The operator after full satisfaction grades each pack accordingly viz:
"Fit for transfusion purpose", "High risk biohazard", "use in emergency" ('0' group with titre less
than 100) and likewise. "Commercial use", "Further investigation required". Once a satisfactory labelling
of a particular donor unit is done, then only operator proceeds for next donor unit or otherwise the
procedures are' repeated in respect of donor unit which doesnot fulfill all the required criteria.
If any unit is to be utilised for component preparation, same barcode is allotted to the particular
component so that its fitness for transfusion can be counterchecked from the record in the computer. The
name of particular component has to be written over the label viz. plasma, plaetlet, RBC packed etc.
After a particular unit is labelled and all datas in respect of the unit is entered into the computer, the
unit is then transferred for storage in proper environment. In store, all the units are arranged according to
seniority in a raw and the arrangement pattern of any particular group or components are fed into the
computer, so that when needed, the seniority is cared for and the oldest blood goes out first. This is
required to be followed strictly to avoid blood loss due to outdating.
Similarly the documents and records pertaining to blood bank and its activity can also be recorded
and stored in the disks, so that it may be helpful in future viz. automated donor call up, medicolegal
controversy, delayed transfusion reaction etc.
To get a fair idea, let us consider a particular donor unit and follow the chain of events. Say, a donor
unit no. ]234 barcoded, grooped as B negative (in routine working laboratory), cleared offofall mandatory
tests and irregular antibodies (in biological laboratory) declared fit for transfusion is kept stored in walk-
in-coolerlblood bank refrigerator as per seniority arrangement.
All the datas in respect of donor unit no. 1234 has been entered into the computer, sitnultaneously or
at a later date, a sample is received at the counter and on grouping, it has been found that sample
received is B negative. Central command of computer shows on video display, the stock position of B
negative as three unit. The unit' no. 1234 is seniormost amongst all and thus brought out of store for
crossmatching, The demand in requisition form states that one unit ofb(ood is required. On crossmatching
test in the routine working laboratory, the unit number 1234 is found compatible with recipient sample
and thus, issued for transfusion. But since crossmatching is never a full proof method, that ensures a safe
transfusion, it is better to monitor through feedback, till transfusion is over and up to a period till the

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Co.mputerisation and Automation in Blood Bank
465
threatofdelayedtransfusion reactionpersistsa periodof sevendayspost-transfusion. Afterwhichrecords
maybe erased or retained,particularlyin caseslike presentone wherethe blood groupis rarelyavailable
amongstpopulation.The donordata may be kept recordedin disks for automateddonor call up in future.
If the demand would have been a component, viz., B negative packed RBC or B negative plasma,
the procedure or steps would be the same except the following steps :
1. Ask the computer for stock position of 'respective component.
2. Check the grouping in case of packed RBC and plasma and do necessary compatibility tests
with the seniormostloldest unit present in the stock.
3. After issue balance of component adjusted.
4. Post-transfusion follow up.
For officialdocumentation datas in respectof both donor and recipientarepreservedas "B negative"
is considered one of the rare blood group - Automated donor call up, so address of both donor and
recipient are also to be recorded in the disk.
Other officialdocumentation are requiredin connectionwith statisticaldata (monthlyand annually)
so daily figures in respect of issue, receipt and other work statistics are fed into central command.
A conceptualised flow chart of events in a computerised blood bank is given in the diagram
(Fig. 16.4) this is subject to modificationby system designs to fit the local needs.
16.2 AUTOMATION
With the advent of scienceand technology particularlyelectronicsand computronicsthe automationhas
invadedalmostalldisciplineofscienceandmedicineisnoexception.Automation hasbecomeanaccepted
innovation of sciences that has even made its presence felt in our day to day life. Until recently the
laboratoryof bloodbankandtransfusionmedicineprocedurewereheavilydependenton manualmethod.
But the accuracy, speed and handlingof largesamples/specimen in a short time by automaticequipment
. proved advantageous over manual method, further it relieves an operator of monotony and tedium of
manual operation.Automationhas also invadedthe blood bank laboratoryand other allied field but till
today manualmethodsremainsthesheetanchorinthepractice.Andwhenthemachinefails,thealternative
solution in hand is manual procedure. Few of the semiautomatic and automatic equipments being
increasingly used are pipettes, semiautomatic and automatic, single channel or multichannel, blood
group autoanalyser, automated donor call up, Elisa reader, refrigerated centrifuge - semiautomatic,
automatic cell separator, automatic blood collection equipment, automatic cell washer are few of the
examples. Most of the machineshave been describedelsewherein respectivechapters except the blood
group auto-analyser.
The blood group auto-analysercan do the ABO and Rh groupingincludingphenotypeof any blood
samples andinterprettheresultswithinveryshorttime.Thus,it hasbecomean handymachineparticularly
in places where large number of grouping has to be done and result has to beprovided immediately.
Basic work on this machine was done by Matte around 1966and further development on his work
resulted in productionof machineknown as "groupamatic". It has two components :
(a) Electromechanical, and
(b) Electronic

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466
Blood Banking and Transfusion
G
6
7
4
E
F
E1
Subterminal
DD
C,
C2
C
1 2
Fig. 16.4.
~
: Reception(Registration of donor, recipient) office work
Hardwaresof ether not fitted with differentterminalsleads
A1 : Donor counter and terminal
are as follows :
A2 :
Recipient sample counter and terminal
1. Net working that feeds all data regarding donor
..
. .
2. Networking that feeds all data regarding"recipient
~
:
Terml~al
for office work and statistical deta etc.
sample, grouping, crossmatching and issue
8
Bleeding room
3. Networking that feeds office and statistical data
81 : Terminal
4. Networkingthat feeds wholebloodstoredata, pattern
C
: Routine working laboratory
of arrangementgroupwise and senioritywlse.
C1 : Terminal dealing with donor grouping and relevant
5. Networking that feeds whole blood issue data
works
6. Networking that feeds component storage data,
C2 : Terminal dealing with rectplent-prouplnq, cross-
conneet~d
to terminal~
and subterrrnnals
.
"matchingand issueof C~HI
atibleblood or component
7.
N~tworkl~g
that feeds ISSU? of componentdata fitted
.
P
.
with terminal and subterminal.
o
Blo~ogicallaborato.ry
(all m~nda.tory
t~st,
~creenlng
for
Donor unit flow (whole blood and component note
antibody, transfusion reaction Invest.gatlon)
bifurcation before unit Is stored as blood, if unit is
01
"Terminal dealing with mandatory test and screening
meant for componentproduction, it is not storedwith
for antibody of donors blood
whole blood instead taken out for component
E
Store, E1 terminal dealing with storage, E2-terminal
separation)
dealing with issue of blood
Recipient sample flow
F
Component store, F1-storage of componentfitted with
.Bloodor ~?mponent
from store accordingto seniority
subterminals, F2 issueof componentwith subterminals
compatibility tes!
G
Computer central command
== Issue of compatible blood to wards etc.
N.B. Transfusion reaction or safe transfusion report are "obtained from respective ward and in case reaCtion ts reported .
the investigation is carried out in the laboratoryand compatibilitytest, datas regardingdonor and recipientunit'areobtained
from computer tallied with fresh samples obtained from recipient and donor samples from pilot tube. Other investigations
are also carried out as indicated. The transfusion reactions need not be entered into computer and manual record kept.

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Computerisation and Automation in Blood Bank
467
Respectively responsible for agglutination and interpretation and processing of result. The machine
was developed further and facility of barcode reader laser scanner, for identification of samples were
added.
The present day blood group analyser doesnot include electromechanical component that does the
shaking etc. Samples according to serial number are placed in microplate, microplate format described
elsewhere in this book. The steps adopted are as follows:
1. After incubation of antisera, cell mixture for about 30 minutes at RT, the plate 'is centrifuged at
500 rpm for about 40 seconds.
2. Shake the plates again to disperse negative reaction.
3. Now place the plates at an angle of60° to 70° for a period of 60 seconds to 90 seconds and now
put the plate inside automatic reader with printout facility. After a period of 2 to 3 minute, the
results are printedout automatically as per serial arrangement with reliable accuracy and precision.
So these procedure, if adopted in bigger centres, where large number of samples are handled, it
becomes cost effective in terms of man, ·money and material though the initial cost may be
prohibitive or exhorbitant.
Automation though advantageous over manual, cannotbecompletely depended upon machine failure
or breakdown may.occurat any moment thus bringing all the work to standstill. So the manual alternative
must be always ready at hand.
Books recommended for further reading'
1. ClinicalDiagnosisandManagement by LaboratoryMethods, Todd, Sanford, Davidshon; ohnBernardHenry,
second Indian edition, 1989, AITBS, Delhi;
2. Introduction to Transfusion Medicine, Bharuchaand Chauhan.firstedition, 1990, D.K.Publishers, Mumbai.
3. Transfusion Medicine, Technical Manual, Saranand Makroo, First edition, 1991, DGHS,Nirman Bhawan,
New Delhi.
'
4. RecentAdvances in Haematology, Vol. 3, edited by A.~ Holf Brand, 1982, Churchill Livingstone.
Journals and articles
1. Recent Developments in Transfusion Medicine, 1stDr. H.M. Bhatia MemorialOration, BharuchaZarin; S.,
. pp. 2 to 9, Immunohaematology Bulletin, 20, No.1, January-February, 1989.
2. Computerisation of Blood Bank Services of a Large Hospital, J. Pandey, D. Bajpai, S.K. Khurana, V.H.
Talib, pp. 203 to 210, IndianJ. Pathol., Microbiol., 36, 3, 203-210, 1993.