Recent Advances in Blood Banking

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Virtual Blood Bank35,36
Virtual blood bank (online blood bank) is the computer-
controlled, electronically linked information management
system that allows online ordering and real-time, remote
delivery of blood for transfusion. It connects the site of testing
to the point of care at a remote site in a real-time fashion with
networked computers thus maintaining the integrity of immuno-
hematology test results. It has taken the advantages of informa-
tion and communication technologies to ensure the accuracy
of patient, specimen and blood component identification and
to enhance personnel traceability and system security. The built-
in logics and process constraints in the design of the virtual
blood bank can guide the selection of appropriate blood and
minimize transfusion risk. The quality of blood inventory is ascer-
tained and monitored, and an audit trail for critical procedures
in the transfusion process is provided by the paperless system.
Thus, the virtual blood bank can help to ensure that the
right patient receives the right amount of the right blood
component at the right time.
Computer crossmatch is considered safer or more efficient
system than the antiglobulin and immediate spin crossmatch,
provided that the ABO and Rh typing has been done twice
and patient has no history of clinically significant antibodies.
Barcode Scanning
Barcode scanning can serve as an adjunct to manual checking
and is prompt to take the operator through each step of patient
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identification. Major problems related to the use of barcoded
identification bracelet are: (A) the availability of equipment
(barcode scanner and printer) at each point of care, (B) the need
to remove the identification bracelet for patient treatment, such
as during surgery.
It is important to note that electronic control of the trans-
fusion process can only help to reduce, but not totally eliminate,
human errors. It should never replace human thinking and
should be treated only as an adjunct to manual checking and
verification. For non-emergency transfusion, group-identical
and electronically crossmatched donor units will be issued for
patients with a negative antibody screen.
The system will prevent the allocation of ABO non-identical
blood and check the concordance of ABO typing results tested
on different specimens and/or at different occasions.
For patients with specific transfusion requirements such as
those with irregular antibodies, only designated donor units
will be issued (the designated donor units may have been
delivered and stored in a remote refrigerator or they will have
to be collected from the central blood bank).
The expiry date of the donor unit is checked before its release,
and some systems can allocate donor unit closest to the end of
its shelf life.
Radio frequency identification device (RFID):37,38 RFID
technology systems utilize radio frequency electromagnetic
fields to obtain data for tracking and identifying medical pro-
ducts and goods. The two main components of RFID are tags
and readers. The tags consist of silicon microchips and antennas
that receive or emit radiofrequency waves.
RFIDs contain identification tags that enable scanning a
device (reader) so contents, location, manufactured date, order
numbers, batch numbers, dosage information and shipping
data can be transmitted to a corresponding data terminal. In
healthcare organizations, tags have been placed on patients,
pharmaceuticals, mobile assets, and blood products. RFID
technology offers several benefits with regard to blood
bank product management, including decreased transfusion
errors, reduction of product loss, and more efficient inventory
management. Barriers to RFID implementation include the cost

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Essentials of Blood Banking and Transfusion Medicine
associated with system implementation and patient privacy issues.
Implementation of an RFID system can be a significant invest-
ment. However, when observing the positive impact that such
systems may have on transfusion safety and inventory manage-
ment, the cost associated with RFID systems can easily be justified.
RFID in blood bank inventory management is vital to ensure
efficient product inventory management and positive patient
outcomes.
Immunocamouflage Technique to Develop Universal RBCs
Scientists have discovered a way to avoid issuing wrong blood
type and can serve as all-purpose red blood cells. To develop
universal red blood cells, the red cells are covered with a multi-
layered polymer shell of polyethylene glycol such that the antigenic
sites are not identified by the body’s immune mechanism.
Smart Blood Bag Management System38
Blood has to be kept at fixed temperature during transportation.
3T (time, temperature and tracking) enhanced system to
provide necessary temperature and to prevent mismatch of
blood a smart blood bag box using sensor network in the blood
bank and RFID sensor tag is placed on the blood bag. This
system can sense the change and also record the time. Also
patient information will be available with unique ID, correct
identification of blood bag, thus, error can be prevented in
transfusion of required specific blood.
Unused Donor Units
Unused donor units can be returned to the remote refrigerator
through the BBLIS. The time when the donor unit leaves the
refrigerator will be recorded, and it will be barred from re-issue
if the donor unit is returned after 30 min. This will safeguard
the integrity of the donor unit and prevent bacterial overgrowth
and other problems associated with inappropriate storage.
The Blood Vending Machine
A latest addition to the virtual blood bank is the blood vending
machine. The machine consists of two components: (A) An intelli-
gent temperature-controlled blood storage and dispensing

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191
refrigerator with computerized controlled electromagnetic door
lock and (B) An attached kiosk that is a purpose-built computer
terminal with identity card reader and barcode scanner for
personnel login and patient identification, process control and
compatibility label printing.
The refrigerator contains a rotating carousel with indivi-
dually electronically controlled and lockable compartments for
undesignated donor units of each ABO group and one compart-
ment for reserved and serologically crossmatched donor units,
which enable physical and electronic control of access,
allocation and dispensing of group-identical electronically
crossmatched or reserved serologically crossmatch-compatible
donor units.
The blood vending machine allows bidirectional informatics
connectivity and ensures that: (A) Only authorized personnel
can gain access, (B) Expiry date of donor unit is checked,
(C) Validity of reserved unit is confirmed, (D) Oldest available
donor unit is dispensed and (E) Inventory and temperature
are monitored continuously by the central blood bank.
The donor unit will be automatically assigned and dispensed
by the refrigerator and labeled at the kiosk. It has further
enhanced the safety, efficacy and security of the virtual blood
bank as it limits access to only the correct donor units, reduces
donor unit expiry and provides an audit trail for the personnel
involved and procedures undertaken. The stock can be
replenished at the convenience of the blood bank staff who
will be alerted when the inventory falls below a pre-set limit.
An obstacle to the wider use of such a blood vending machine
is probably its cost, which is, at present, several times that of
the usual blood storage refrigerator.
Blood transfusion is a high-risk process because of the
complexity of its many procedures (from blood sampling to
laboratory testing and blood administration) and the involve-
ment of multiple staff from different departments.
The virtual blood bank has taken the full advantage of
computer crossmatch, i.e. immediate availability of compatible
blood without the need of prior allocation of donor units to
designated patients, and has allowed the controlled use of

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Essentials of Blood Banking and Transfusion Medicine
group-identical blood, real-time inventory monitoring and
early stock replenishment.
The use of barcode or other identification devices can elimi-
nate human errors in data transcription. Electronic process
control can help ensure compliance with transfusion guidelines
and regulatory requirements.
The advent of information technology has enabled us to
come closer to the goal of zero-risk, zero-time-lag and zero-
wastage transfusion—a goal that was only a dream in the past
but might be reachable in the not-so-distant future.
Recent Advances in Platelet Transfusion
The demand for platelet transfusions continues to grow. Several
complementary approaches may help to meet this demand in
the future. First, platelet bacterial testing is beginning to allow
the extension of platelet storage beyond 5 days.
Studies are also underway aimed at better preserving
viability and function during ex vivo platelet storage: Additive
solutions and other approaches are being developed.
Bacterial Testing34–36
The BacT/ALERT automated blood culture system, can be used
to screen platelet concentrates for bacterial growth.
Platelet products production of CO2 are generally sampled
on day 1 after collection. The samples are cultured for a period
of time, typically 24 hours, and if the cultures fail to produce
abnormal levels of CO2, the product is released into inventory.
Both aerobic and anaerobic cultures may be performed,
although it is known that aerobic organisms cause the vast
majority of septic reactions.
Current generation rapid bacterial tests have a turn around
time of a few hours or less, and use <1 mL of platelet product.
They have a lower sensitivity than culture, however, on the
order of 103–104 CFU/mL.
In principle, rapid bacterial tests could be used for quality
control, as an adjunct to another test, e.g. initial culture, or as a
standalone release test.
Licensing criteria for rapid bacterial tests are being
developed by the FDA.