BLOOD BANKING A blood bank is a cache or bank of blood or blood components, gathered as a result of blood donation, stored and

preserved for later use in blood transfusion. The term "blood bank" typically refers to a division of a hospital laboratory where the storage of blood product occurs and where proper testing is performed to reduce the risk of transfusion related events. It is important for a blood bank to pass all the eligibility guidelines as mandated by the National Health Service (NHS) in Britain and the Food and Drug Administration (FDA) in the United States. The safety and reliability should also be a consideration too. This includes compatibility testing for transfusion and may include blood donation processing, depending on the capabilities of the facility. Most hospital blood banks also perform testing to determine the blood type of patients and to identify compatible blood products for blood transfusions, along with a battery of tests (e.g. disease) and treatments (e.g. leukocyte filtration) to ensure and enhance quality. Some such procedures can be done "upstream" by the collecting agency, or a contracted laboratory. The increasingly recognized problem of inadequate efficacy of transfusion and post-transfusion complications raises the importance of quality testing and screening; U.S. hospitals spend more on dealing with the consequences of transfusion-related complications than on the combined costs of buying, testing/treating, and transfusing their blood. Donors are sometimes paid; in the U.S. and Europe, most blood for transfusion is collected from volunteers while plasma for manufacturing is from paid donors. In the U.S., certain standards are set for the collection and processing of each blood product. "Whole blood" (WB) is the proper name for one defined product, specifically unseparated venous blood with an approved preservative added. Most blood for transfusion is collected as whole blood. Autologous donations are sometimes transfused without further modification, however whole blood is typically separated (via centrifugation) into its components, with red blood cells (RBC) in solution being a commonly used product. Units of WB and RBC are both kept refrigerated at 33.8-42.8 F (1-6 C), with maximum permitted storage periods (shelf lives) of 35 and 42 days respectively. Red Blood Cell units can also be frozen when buffered with glycerol, but this is an expensive and time consuming process, and is rarely done. Frozen red cells are given an expiration date of up to 10 years and are stored at -85F (-65C).[citation needed] The less-dense blood plasma is made into a variety of frozen components, and is labeled differently based on when it was frozen and what the intended use of the product is. If the plasma is frozen promptly and is intended for transfusion, it is typically labeled as fresh frozen plasma. If it is intended to be made into other products, it is typically labeled as recovered plasma or plasma for fractionation. Cryoprecipitate can be made from other plasma components. These components must be stored at -0F (-17.7C) or colder, but are typically stored at -22F (-30C). The layer between the red cells and the plasma is referred to as the buffy coat and is sometimes removed to make platelets for transfusion. Platelets are typically pooled before transfusion and have a shelf life of five days, or three days once the transfusion centre that collected them has completed their tests. Platelets are stored at room temperature (72F=22.2C) and must be rocked. Since they are stored at room temperature in nutritive solutions, they are at high risk for growing bacteria. Some blood banks also collect products by apheresis. The most common component collected is plasma via plasmapheresis, but red blood cells and platelets can be collected by similar methods. These

products have the same shelf life and storage conditions as their manually produced counterparts. An ongoing study allows platelets collected by apheresis to be kept for seven days, but only with specific microbiological testing. The lack of a preservative solution makes a longer shelf life of little use. Routine blood storage is 42 days or 6 weeks for stored packed red blood cells or pRBC (the most common blood product), and involves refrigeration but usually not freezing. There has been increasing controversy about whether the age of blood is a factor in transfusion efficacy, specifically on whether older blood directly or indirectly increases risks of complications. Studies have not been consistent on answering this question, with some showing that older blood is indeed less effective but with others showing no such difference; nevertheless, as storage time remains the only available way to estimate quality status or loss, a first-in-first-out inventory management approach is standard presently. Insufficient transfusion efficacy can result from blood product units damaged by so-called storage lesion - a set of biochemical and biomechanical changes which occur during storage. With red cells, this can decrease viability and ability for tissue oxygenation. (Note that upon transfusion, cells have exhibited some degree of ability to reverse their storage lesion, albeit not entirely - and often too slowly to benefit urgent-care patients.) Without a clinically feasible and reliable means to directly measure this phenomenon (during storage), many physicians have adopted a so-called "restrictive protocol" whereby transfusions are simply being held to a minimum, as delayed recovery times and extended hospitals stays is viewed as the "lesser evil" compared to the harm and thus resulting cost of transfusing blood product of unknown quality. Long-term storage is relatively uncommon, compared to short-term storage. Cryopreservation of red blood cells is done to store rare units for up to 10 years. The cells are incubated in a glycerol solution which acts as a cryoprotectant ("antifreeze") within the cells. The units are then placed in special sterile containers in a freezer at very cold temperatures. The exact temperature depends on the glycerol concentration.

HISTORY An early development leading to the establishment of blood banks occurred in 1915, when Richard Lewison of Mount Sinai Hospital in New York City initiated the use of sodium citrate as an anticoagulant. This discovery transformed the blood transfusion procedure from direct (vein-to-vein) to indirect. In the same year, Richard Weil demonstrated the feasibility of refrigerated storage of anticoagulated blood. The introduction of a citrate-glucose solution by Francis Peyton Rous and JR Turner two years later permitted storage of blood in containers for several days, thus opening the way for the first "blood depot" established in Britain during World War I.

Blood donation at the Royal Melbourne Hospital during the 1940s. In Russia Sergei Yudin pioneered the transfusion of cadaveric blood and performed this successfully for the first time on March 23, 1930. Also in 1930 Yudin organized the world's first blood bank at the Nikolay Sklifosovskiy Institute, which set an example for the establishment of further blood banks in different regions of the Soviet Union and in other countries. By the mid-1930s the Soviet Union had set up a system of at least sixty five large blood centers and more than 500 subsidiary ones, all storing "canned" blood and shipping it to all corners of the country. News of the Soviet experience traveled to the United States, where in 1937 Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago, established the first hospital blood bank in the United States.[8] In creating a hospital laboratory that preserved and stored donor blood, Fantus originated the term "blood bank." Within a few years, hospital and community blood banks were established across the United States. Willem Johan Kolff organised the first blood bank in Europe (in 1940). In 1939 Charles R. Drew researched in the field of blood transfusions, developing improved techniques for blood storage, and applied his expert knowledge in developing large-scale blood banks early in World War II. Oswald Hope Robertson, a medical researcher and U.S. Army officer who established the depots, is often regarded as the creator of the first blood bank. The University of Louisville is also credited for the Blood Bank. An important breakthrough came in 1939-40 when Karl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson discovered the Rh blood group system, which was found to be the cause of the majority of transfusion reactions up to that time. Three years later, the introduction by J.F. Loutit and Patrick L. Mollison of acid-citrate-dextrose (ACD) solution, which reduces the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer term storage. Carl Walter and W.P. Murphy, Jr., introduced the plastic bag for blood collection in 1950. Replacing breakable glass bottles with durable plastic bags allowed for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of Whole Blood. An anticoagulant preservative, CPDA-1 was introduced in 1979. It decreased wastage from expiration and facilitated resource sharing among blood banks. Newer solutions containadenine.

PROCESS OF DONATING BLOOD Donating blood is a safe, simple, and rewarding experience that usually only takes 45-60 minutes. Before You Donate To donate blood, find a blood bank near you using AABBs blood bank locator. Then, call the blood bank to make an appointment. When making the appointment, ask the following questions:

What are your general donor requirements? (Most places require you to weigh a minimum of 110 pounds, be at least 16 years old and be generally healthy). What kind of identification is required? (First-time donors are usually asked to present two forms of identificationthe type of identification needed varies by facility).

If you have any particular health concerns or have traveled outside of the country, its also a good idea to inform the blood bank at the time you are making your appointment.

When You Arrive at the Blood Donation Center

When you sign in, you will be asked to complete a donor registration form, which includes your name, address, phone number, and various other types of demographic information. You will also be asked to show your donor card or the type of identification required by the particular blood bank you visit.

Pre-Donation Screening

During pre-donation screening, a blood bank employee will ask you some questions about your health, lifestyle, and disease risk factors. All of this information is confidential. Next, an employee will perform a short health exam, taking your pulse, temperature and blood pressure. A drop of blood from your finger will also be tested to ensure that your blood iron level is sufficient for you to donate. All medical equipment used for this test, as well as during the donation process, is sterile, used only once and then disposed.

Blood Donation

Once the pre-donation screening is finished, you will proceed to a donor bed where your arm will be cleaned with an antiseptic, and a professional will use a blood donation kit to draw blood from a vein in your arm. If you are allergic to iodine, be sure to tell the phlebotomist at this point. During the donation process, you will donate one unit of blood; this takes about six to ten minutes.

Post-Donation

Following your donation, you will receive refreshments in the canteen area, where you can stay until you feel strong enough to leave. After donating, it is recommended that you increase your fluid intake for the next 24 to 48 hours; avoid strenuous physical exertion, heavy lifting or pulling with the donation arm for about five hours; and eat well balanced meals for the next 24 hours. After donating, smoking and alcohol consumption is not recommended Although donors seldom experience discomfort after donating, if you feel light-headed, lie down until the feeling passes. If some bleeding occurs after removal of the bandage, apply pressure to the site and raise your arm for three to five minutes. If bruising or bleeding appears under the skin, apply a cold pack periodically to the bruised area during the first 24 hours, then warm, moist heat intermittently. If you have any questions concerning your donation or experience any unexpectedd problems, please call the you donated blood.

Who can donate blood?

Blood donors are volunteers who provide a greatly needed service. About 4 million patients receive blood transfusions each year, and approximately 40,000 units of red blood cells are needed every day. Although 14 million blood units are donated a year, more volunteers are needed to keep the blood supply at an adequate volume. Donors must meet certain criteria to ensure their safety and the safety of the recipients. Rules of eligibility have been established by the U.S. Food and Drug Administration (FDA), although some donor centers may have additional requirements. Donors must:

be at least 17 years of age (although some states permit younger people to donate if they have parental consent) be in good health weigh at least 110 pounds (Some facilities will allow people who weigh less to donate, but they must then adjust the amount of blood collected and the amount of anticoagulant in the collection bags.) pass a physical and health history examination prior to donation.

The physical includes measurement of blood pressure, pulse, and temperature as well as a test for anemia, which requires just a few drops of blood from your finger. To protect the health of both the donor and the recipient, the health history questionnaire asks about potential exposure to transfusion-transmissible diseases, such as viruses like HIV, hepatitis B and C, and HTLV I and II as well as parasites that cause malaria, babesiosis, and Chagas' disease. Certain people are not permitted to donate blood for health concerns. This includes:

Anyone who has ever used illegal intravenous (IV) drugs Men who have had sexual contact with other men since 1977 Hemophiliacs Anyone with a positive test for HIV Men and women who have ever taken money, drugs, or other payment for sex since 1977 Anyone who has had hepatitis since his or her eleventh birthday Anyone who has had babesiosis or Chagas' disease Anyone with Crueutzfeldt-Jakob disease (CJD) or who has an immediate family member with CJD Because of CJD, anyone who has spent time in the United Kingdom between 1980-1996 that adds up to 3 months or more; anyone who, from 1980 to the present, spent time in Europe that adds up to 5 years or more; and anyone who received a blood transfusion in the UK between 1980 and the present. Some travel or health problems may require a temporary deferral.

There also may be some restrictions if you are taking certain medications at the time of donation. You may be ineligible to donate or deferred for a period of time. For example, the FDA has specified that

individuals on Tegison (etretinate), human growth hormone, or bovine insulin from the United Kingdom must be deferred indefinitely. Those taking Proscar (finasteride), Propecia (finasteride), or Accutane (isotretinoin) will be deferred from donating for 4 weeks following last dose. Use of hepatitis B immune globulin results in a 12-month deferral and Soriatane (acitretin) is a 3-year deferral. In addition, if you are taking an antibiotic or any other medication for an infection, you will be evaluated and deferred temporarily. There also are varying deferral periods if you have been vaccinated recently. For a more complete list, review "Medications" in the American Red Cross's blood donation eligibility criteria. Donors have a personal responsibility to help ensure the safety of the blood supply. You should express any concerns or questions you may have about past illnesses you had or may have been exposed to before donating. Who knows? Maybe someone close to you will be the recipient of your blood donation. Where can blood be donated? Blood can be donated at community blood centers, hospital-based donor centers, or mobile sites temporarily set up in public areas like colleges, workplaces, and churches. There are hundreds of institutions involved in blood banking throughout the U.S. For more information on where you can go to donate, visit AABB's online Locator. What is donated and how often? Usually one unit (about a pint) of blood is collected into a blood bag from a vein in the inner part of the elbow joint using a new, sterile needle. Your body replenishes the fluid lost during donation in 24 hours, but it may take up to 2 months to replace the lost red blood cells. Therefore, whole blood can be donated only once every 8 weeks. Two units of red blood cells can be donated at a time, using a process called red cell apheresis, every 16 weeks. Platelets can also be donated by apheresis, usually every 4 weeks. What are the components of blood? Blood is made up of several components. These components can be separated in the laboratory so that they can be transfused into multiple patients, each with different needs, since rarely will a person need all of the components within whole blood. These components include: Red blood cells main cellular element in the blood; carry oxygen to the body tissues; used in the treatment of anemia resulting from, for example, kidney failure, gastrointestinal bleeding, or blood loss during trauma or surgery

Platelets cellular elements needed for blood to clot; used in the treatment of leukemia and other types of cancer and conditions in which patients have a shortage of platelets (e.g., thrombocytopenia) or abnormal platelet function to control bleeding Plasma straw-colored fluid part of blood in which the red and white blood cells and platelets are suspended; helps to maintain blood pressure and the fluid-electrolyte and acid-base balances of the body and transport wastes; used to help control bleeding when no coagulation factor-specific concentrate is available Cryoprecipitate antihemophilic factors (AHF) part of the plasma that contains clotting factors to

help control bleeding in people with hemophilia and von Willebrand's disease; only used in most places in the U.S. when viral-inactivated concentrates containing Factor VIII and von Willebrand factor are unavailable or, at times, during surgery as a hemostatic preparation (fibrin sealant) White blood cells cellular elements that fight infection and function in the immune process, including allergic reactions; one type, called granulocytes, can be transfused to fight infections that are unresponsive to antibiotic therapy, although the effectiveness of this form of treatment is still being investigated

Separation of these components is performed by first treating the blood to prevent clotting and then letting the blood stand. Red blood cells settle to the bottom, while plasma migrates to the top. Using a centrifuge to spin out these components can speed up the process. The plasma is then removed and placed in a sterile bag. It can be used to prepare platelets, plasma, and cryoprecipitate antihemophilic factors, again with the help of a centrifuge to separate out the platelets. Plasma may be pooled with that from other donors and processed further (fractionated) to provide purified plasma proteins, such as albumin, immunoglobulin, and clotting factor concentrates. For more information, see the detailed list of Blood and Components. What is autologous blood donation? Another type of blood donation is autologous donation. This refers to transfusions in which the blood donor and the transfusion recipient are the same. People may elect to do this before a surgical procedure in which the likelihood of needing a transfusion is high. Although there are still risks with this process, autologous donation minimizes many of them because it is the person's own blood that is being returned to his or her body. A person can donate their blood up until 72 hours prior to their surgery. Iron supplements or erythropoietin also may be prescribed to help increase the person's red blood cell count. Any blood that remains unused during the surgery is usually discarded. However, the blood can be transfused into another patient if it has been fully tested and is compatible with the recipient. According to the National Blood Collection and Utilization Survey and AABB, autologous blood accounted for 2.1% of all donated blood in 2006. The use of this type of donation varies by location, and not all physicians recommend it. There has been some concern about low hematocrit levels following surgery in patients who donate autologous units. The decision should be made together by the patient and his or her doctor. Other options may be preferred, such as intra-operative blood salvage, in which any blood lost during the surgery can be collected and returned to the patient.