Blood Donation

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IMPORTANCE OF BLOOD DONATION2
Following are some of the facts of blood transfusion:
• Every two seconds someone needs blood and it may be you.
• One out of ten patients in a hospital requires blood.
• According to WHO data in the South East Asian Region
(SEAR) countries, the annual requirement is 15 million units,
but collected is only 9.3 million units.2 In India, every year
our nation requires about 9–9.5 million units of blood, out
of which only about 60% of blood is available.
• More than 1 million new patients are diagnosed with cancer
each year. Many of them will need blood, sometimes daily,
during their chemotherapy treatment.
• Blood cannot be manufactured. It has to come only from
generous donors.
• Blood donation is the greatest donation. You are saving life,
not one, but three to four lives.
• The average adult has 5 liters of blood in his body.
• You are donating less than 500 mL of blood.
• About 8 mL per kg body weight blood can be given.
• Donating blood is a safe process. A sterile needle is used to
each donor and blood donation takes less than 10–12 minutes.
• The donated red blood cells/whole blood is used within
35 days with CPDA1.
• Donated platelets are used within 5 days.
• Plasma and cryoprecipitate are stored in frozen state and
can be used up to one year.
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Essentials of Blood Banking and Transfusion Medicine
AIMS OF BLOOD DONATION
The main aim of blood donation is to save the patients by blood
transfusion in the following occasions:
• In emergency cases such as bleeding during accidents.
• Bleeding in disorders like haemophilia and other bleeding
disorders.
• In cases of severe anaemias.
• In pregnant patients with bleeding before, during or after
delivery.
• During major surgeries such as heart surgeries, etc.
Quantity of blood to be donated
The amount of blood to be drawn is determined by the
following formula:
Amount of blood to be drawn = Donor's weight in kg
50
 × 450
Amount of blood to be drawn = Donor's weight in lbs
110
 × 450
You are donating 350 mL/450 mL (one unit) of blood and it
is collected in appropriate anticoagulant (CPD-A1) to prevent
coagulation. This represents 10–13% of blood volume which
can be well sustained by our body.
For 100 mL of blood 14 mL of anticoagulant/preservative is
added. The amount of anticoagulant needed for the specific
volume to be drawn is calculated as follows:
Anticoagulant to be used
Amount of anticoagulant = Amount of blood drawn
100
 × 14
Healthy bone marrow makes a constant supply of red cells,
white blood cells and platelets. The body will replenish the
elements given during a blood donation—some in a matter of
hours and others in a matter of weeks.
Interval for Donation of Blood and Blood Components
The blood donated by donor will be again regenerated by his
body. The plasma volume and platelets are replaced within

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Blood Donation
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48 hours, granulocytes and other elements of plasma (proteins
etc.) within 7 days, red blood cells in 56 days and iron lost is
replaced in 8 weeks. Hence he can donate whole blood every
12 weeks (3 months). Plasmapheresis can be done at an interval
of 48 hours. Donor can undergo platelet apheresis at an interval
of 48 hours, twice in a week and 24 times in a year.
Voluntary donor is healthy and the blood donated is again
regenerated in body. One unit of blood can save not one patient
but three–four patients as it is separated into components like
packed red blood cells, plasma, platelets, granulocytes and
cryoprecipitate.
Blood donation is superior of all donations. The healthy and
repeat donors are great asset of the blood bank which is doing
human service to the mankind.
BLOOD DONATION
At the time blood donation Questionnaire for donors is
provided and purpose of this is:
• To find out, if the donor is having any transmissible diseases.
Transfusion transmitted diseases (TTDs) are deferrals, some
are permanent and some temporary.
Thus, screening of blood for infectious diseases is essential.
• The aim of blood transfusion is to do good to the patient.
Testing at Blood Bank for Transfusion Transmissible Infections
(TTIs)
As per the rules of Indian Government (Drug Control Act) and
National Aids Prevention and Control (NACO) policy, testing
of every unit of blood is mandatory and blood collected is
screened using highest quality of screening tests for TTIs/TTDs.
The donor is asked for any signs and symptoms of AIDS
and high risk activities, foreign travel, donation risks, tests done
on their blood and window periods of infections are evaluated.
Donors must document accurate information, and should
understand the donation process and blood testing, and that
blood donation is voluntary with informed decision.
Do not donate blood to be tested for a HIV/AIDS, hepatitis
or any other infectious disease.

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Essentials of Blood Banking and Transfusion Medicine
Counseling for Reactive Donors
If a blood sample tests positive for any TTI, then:
• Only the donor is informed, counseled and encouraged for
further testing.
• A pre- and post-counseling of the donors is done by the
doctors at the center.
• Donors who are HIV sero-reactive are referred to voluntary
counseling and testing center (VCTC) or integrated counsel-
ing and testing center (ICTC) for post-donation counseling.
• For TTI other than HIV, the donor is informed about the
positive status and is advised accordingly.
HIV Positive Patients
When the donor is found to be positive for HIV, following
instructions have to be followed.
• Consult a clinician experienced in treating HIV/AIDS.
• Protect sex partner(s) from HIV by following safe-sex guide-
lines.
• Inform sex partner(s) who may also be infected.
• Do not share needles/blades/sharps contaminated with blood.
• Get psychological support from a counselor and/or join a
support group for people with HIV.
Note: For more information refer to topic on TTDs.
Types of Blood Donors
There are different types of blood donors:
• Voluntary donors
• Replacement donors
• Autologous donors
Voluntary donor is one who donates blood for storage at a
blood blank for transfusion to an unknown recipient.
• A greater percentage of better quality of blood comes from
voluntary donors.
• These donors are very important because the incidence of
blood transmitted infections is much less in blood drawn
from these volunteers.

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Replacement donor is a person, often a family member,
donates blood for transfusion to a specific individual.
• The donor is selected by the recipient.
• Since there is pressure to donate, they may give blood even
if there is risk behavior.
Autologous donor is a person who donates blood to be
stored and is transfused back to himself/herself at a later stage,
usually during and/or after surgery. For details, please refer
to Chapters on “Autologous blood transfusion” and “Blood
substitutes”.
Directed donation: When a person, often a family member,
donates blood for transfusion to a specific individual, is called
directed donation. This is only possible when the donor’s blood
type and other factors match the person needing the
transfusion. Directed donations are relatively rare.
Directed Donation Procedure
A directed donation is a donation made for a specific recipient.
Through directed donations, recipients can receive blood from
family members and friends. Some recipients may feel more
comfortable selecting their own donors. Directed donations
may not be appropriate for emergency procedures since it takes
time to fully test and process each unit of blood. If a physician
recommends and/or a patient prefers to receive directed
donations, blood bank can make every effort to collect, test,
process, and distribute the blood units to the hospital for
surgery.
It is the patient/recipient’s responsibility, or they may select
a representative to schedule directed donation appointments
and ensure that these recruited donors keep their appointments.
Directed donations are made by appointment only. Before
donating, directed donors and recipients must follow a protocol.
1. Patients must obtain a prescription from their physician. It
must include the patient’s name, type and screen for directed
donation, type and amount of blood product(s), date
required, and hospital where the blood product(s) should
be sent.

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Essentials of Blood Banking and Transfusion Medicine
2. Donors can call the blood bank to schedule the directed
donation. Patient’s blood type should be known. If the
patient does not know his or her blood type, a typing will be
ordered by a physician, which can be performed at the blood
bank or at its affiliated laboratory.
3. Patients need to recruit family members and friends for the
required number of blood products needed. It is important
to recruit extra donors since some of the selected donors may
not have a compatible blood type, or may be not eligible to
donate.
All directed donors must meet the same strict regulatory
requirements for the general blood supply. Directed donors
must also meet the same criteria as general blood donors
regarding prior health history and should not have high-risk
activities. Directed donors will be deferred from giving blood
based upon the standard regulatory requirements for blood
donation.
If directed donations meet all the safety requirements and
for some reason (such as a change in the date of surgery) when
blood cannot be used for the intended patients, these units of
blood may be used for other patients.
Advantages and Disadvantages
There are no medical advantages to directed donation blood.
It may seem safer to families for their infant/patient to receive
blood from someone that they know. However, prevalence rate
of infectious diseases is not necessarily lower in directed donors
when compared with voluntary donors.
Donation from a husband to his wife during child bearing
age is discouraged, to avoid likely pre-sensitisation.
Directed donations have risk of graft-versus-host disease
(GvHD), which is sometimes seen in donations from blood
relatives.
Delay
A directed donation must be co-ordinated by the patient and
the donor of their specific choice, blood needs to be collected
at the blood bank and further blood bank requires about

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5–7 days to process the donated blood. Whereas blood pre-
viously received from voluntary donors is available to the
patient right away.
Cost
Directed donations are costlier than the usual blood given by
voluntary blood donations.
The American Red Cross has given permission for directed
blood donation.
CRITERIA FOR DONOR SELECTION
Age: 18–65 years.
Minimum body weight: 45 kg.
A person can donate 8 mL/kg body weight (up to 450 mL every
three months).
Haemoglobin (Hb): 12.5 gm% or above or Hct equal to more
than 38%. Hb can be estimated by spectrophotometric or other
methods. The haemoglobin is estimated by specific gravity
method is mentioned here. Known specific gravity of blood
that corresponds to the minimum acceptable haemoglobin level,
necessary for safe blood donation is necessary. To know this, a
drop of donor’s red cells is dropped into the solution of copper
sulphate. The copper sulphate used to determine the donor
acceptability has a specific gravity of 1.054 which is equal to
the weight of a red cells with Hb of 12.5 gm/dL. If the donor’s
haemoglobin is at acceptable minimum level, the specific
gravity of donor’s red cells is the same as the specific gravity
Fig. 2.1: Haemoglobin estimation by copper sulphate method

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Essentials of Blood Banking and Transfusion Medicine
of copper sulphate. The drop of blood in the solution should
stay in the centre for approximately for 15 seconds and then
slowly sink to the bottom. If the Hb level is greater than the
required level, the drop falls in the solution before 15 seconds.
It the Hb level lower than required level, the drop of blood
does not fall during the required 15 seconds. A decision on the
donor’s acceptability, can be made on the Hb content which
can be easily made on this simple procedure.
Preparation of copper sulphate solution of specific gravity
1.054:
1. Dissolve 159.63 gm of pure dried crystals of copper sulphate
(CuSO4.5H2O) and make the volume to 1000 mL at 25°C.
This is stock solution. The specific gravity of this is 1.100.
2. Prepare working solution with specific gravity of 1.054 by
adding 52 mL of stock solution and 48 mL of distilled water.
This solution is stored at room temperature in tightly capped
containers.
Donor Screening
Involves registration, consent of the donor, demographic
information, medical history, limited physical examination and
simple laboratory tests.
Demographic information: It should be complete and correct
so that the donor can be informed of any laboratory testing
abnormality.
1. Donor’s full name
2. Father’s/Husband’s name
3. Age
4. Gender
5. Phone number
6. Residential address
Medical history:
1. History of any long-term illness.
2. Any medication if patient is taking.
3. Allergy to any substance/medication, etc.

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Physical examination: A qualified practitioner of medicine or
Blood Bank Officer will examine for the following:
• General appearance: A donor should be healthy.
• Pulse: 60–100 beats/minute.
• Temperature: 37°C.
• Blood pressure:
– Systolic pressure: 100–140 mm of Hg
– Diastolic pressure: 60–90 mm of Hg.
• Respiratory, cardiovascular, gastrointestinal, etc. systems
should be normal and no problems should be detected by a
rapid physical examination.
Informed consent: If the donor has successfully passed the
history, physical examination, prior to donation, informed
consent is required.
Laboratory tests: Following are the tests done on the unit of
blood donated.
1. Haemoglobin estimation
2. Blood grouping and crossmatching
3. Screening for unwanted antibodies
4. Screening for transfusion transmissible infections: Indian
Government regulatory authorities for blood bank
recommends following 5 tests to be mandatory. These are
mentioned below.
– HIV 1 and 2
– Hepatitis B
– Hepatitis C
– Syphilis
– Malaria
Tests must be performed at each donation regardless of
number of earlier donations.
Blood is not collected on the following occasions and
depending upon the conditions they can be temporary deferral
or permanent deferral.
Temporary deferrals are deferred temporarily on the
following occasions: Hb <12.5 gm %, body weight <45 kg and
if blood donated within last 3 months.

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Essentials of Blood Banking and Transfusion Medicine
As an occupational hazard aircrews, drivers of long-distance
heavy-duty vehicles and construction workers on high
buildings are advised not to give blood within 12 hours of going
on duty.
Respiratory infection
Cold, flu, cough, sore throat or
Defer until all symptoms subside
acute sinusitis
and temperature normal
Chronic sinusitis
No deferral unless using antibiotics
Asthmatic attack
1 week after last attack if chest is
clear
Asthmatics on steroids
Defer
Pregnancy and abortion
Pregnancy or recently delivered
Defer for 6 months after delivery
Abortion
Defer for 6 months after abortion
Breast feeding
12 months after delivery
Women during menstrual cycle
Defer during menstrual cycle
Surgical procedures
Major surgery
12 months after recovery
Minor surgery
3 months after recovery
Open heart surgery including
Permanently defer
by-pass surgery
Cancer surgery
Permanently defer
Localized skin cancer that was
Defer for 6 months after removal
removed
Tooth extraction or dental
Defer for 3 days
manipulation
Dental surgery under anesthesia
Defer for 1 month
Alcohol beverages
Defer if taken within 24 hr
Heart disease
Has any active symptom (chest
Permanently defer
pain, shortness of breath,
swelling of feet)
Restricted activity
Permanently defer
Cardiac medication (digitalis,
Permanently defer
nitroglycerine)
Cardiovascular disease
Myocardial infarction
Permanently defer
Coronary artery disease
Permanently defer
Angina pectoris
Permanently defer
Rheumatic heart disease with
Permanently defer
residual damage

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Seizures
Convulsion and epilepsy
Permanently defer
Endocrinal disorders
Permanently defer
Infectious disease
Donors should be free from infectious diseases known to be trans-
missible by blood, so far as can be determined by usual examination
and history.
Viral hepatitis
Has had hepatitis (jaundice other Permanently defer
than hepatitis A, positive test for
hepatitis B (HBsAg), hepatitis C
(HCV))
Exposure to possibility of hepatitis Defer for 12 months
by tattoos, acupuncture or body
piercing
Worked in renal dialysis
Defer for 12 months
Received transfusion of blood
Defer for 12 months
and its component
Close contact with individual
Defer for 12 months
suffering with hepatitis
Jaundice
Has ever had jaundice associated with
Rh disease
No deferral
Gall stone
No deferral
Infectious mononucleosis
Accept after 6 months
(If no hepatitis)
HIV infection/AIDS
High risk group for HIV infection Permanently defer
HIV positive person
Permanently defer
Donor having symptoms of AIDS Permanently defer
IV drug abusers
Permanently defer
Malaria
History of malaria in endemic area Accepted 3 years after treatment
but duly treated and free from any
symptoms
Travel to endemic area
Defer for 1 year
Syphilis
Genital sores or generalized skin
Defer for 12 months after rashes dis-
rashes
appear and completion of therapy
Gonorrhea
12 months deferral after completion
of therapy

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Essentials of Blood Banking and Transfusion Medicine
Tuberculosis
Defer for 5 years after successful
completion of treatment
Fever
Had prolonged or rheumatic fever Defer till fully recovered and off
medication
Kidney disease
Acute infection of kidney
Defer for 6 months after cessation
or acute infection of bladder
Chronic kidney disease/failure
Permanently defer
Digestive system
Stomach ulcer with symptoms or
Permanently defer
with recurrent bleeding
Chronic liver disease/failure
Permanently defer
Medication
If donor is taking some medicine it may not be in his/her own
interest to donate blood and may also affect the patient/
recipient who would receive the blood.
Medicines
Accepted/Deferred
Oral contraceptive
Accepted
Analgesics
Accepted
Vitamins
Accepted
Mild sedative and tranquillizers
Accepted
Salicylates (Aspirin) taken in last
Not accepted if blood to be
three days
used for preparing platelets
Isotretinoin (Accutane) used for acne
Defer for 1 month after the last
dose
Finasteride (i.e. Proscar) used to treat
Defer for 1 month after the last
benign prostatic hyperplasia
dose
Oral anti-diabetic drugs with no
Acceptable
vascular complication
Diabetics on insulin
Defer while taking the drug
Antibiotics (oral)
Defer for 3 days and till symp-
tom free
Antibiotics (injection)
Defer for 4 days and till symp-
tom free/after the last injection
Cortisone
Defer for 7 days after the last dose
Medicine to treat hypercholesterolemia Accepted

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Donors taking following medicines are permanently rejected:
Anti-arrhythmics
Immunosuppressive drugs
Anticonvulsions
Pituitary growth hormones of
human origin
Anticoagulants
Sedatives or tranquillisers in
high dose
Antithyroid drugs
Vasodilators
Cytotoxic drugs
Etretinate to treat psoriasis. It
is teratogenic.
Digitalis
Drugs for Parkinson’s disease
Dilantin
Vaccination and Deferral
No deferral
Two weeks
Four weeks
One year
deferral
deferral
deferral
Tetanus
Smallpox
Anti-tetanus serum Anti-rabies vaccination
Typhoid
Polio
Anti-venom serum
Hepatitis B immuno-
globulin (HBIG)
Cholera
Measles
Anti-gas gangrene
Gammaglobulin
serum
Diphtheria
Mumps
Rubella
Yellow fever
Other conditions requiring permanent deferral are:
No person shall donate blood and no blood bank shall draw
blood from person, suffering from any of the disease mentioned
below, namely:
• Cancer
• Abnormal bleeding tendencies
• Unexpected weight loss
• Polycythemia vera
• Leprosy
• Schizophrenia
• Severe allergic disorders

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Essentials of Blood Banking and Transfusion Medicine
Instructions to the Donor
The donor is instructed to have breakfast and then asked to
donate blood. He has to feel well and be relaxed.
He is advised for the following, as post-donation instructions:
• Take more fluids for 24 hr after blood donation.
• Volume wise recovery of blood occurs in 48 hr after blood
donation.
• No specific bed rest is required during post-donation period,
general rest is advised.
• Donor is advised not to lift heavy articles or do vigorous
exercises for 24 hr
• He is advised not to smoke for ½ an hr after donation.
Rarely there can be donor reactions and these needs to be
managed
The reactions can categorized as follows:
Mild reactions:
• Symptoms: Nervousness, pallor, sweating, thready pulse,
nausea, vomiting.
• Management: Stop donation.
Immediately raise donor’s feet by 45 degrees.
Moderate reactions:
• Symptoms: Increased period of unconsciousness, decreased
pulse rate, continuous fall in blood pressure.
• Management: Stop donation, administer oxygen and
separate the donor from the general area by using a screen.
Severe reactions:
• Symptoms: Convulsions.
• Management: Prevent donor from injuring himself/herself.
Emergency Drugs
The following emergency drugs must be available at the
donation site:
Glucose powder
Tablets
• Paracetamol
• Diclofenac sodium

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Injections
• Dexamethasone
• Diclofenac sodium
• Chlorpheniramine maleate
• Calcium gluconate
• Adrenaline
• IV fluids
Important Days
14th June: World Blood Donor’s Day.
1st October: National Blood Donation Day.
Blood is donated on the birthday celebrations of important
national and local leaders.