Laboratory 2 Donor Physical Examination

Skills: 20 points
Objectives
1.
a.
b.
c.
d.
e.
f.
2.
3.
4.
5.
6.
7.
8.

For each of the following state the acceptable values for blood donation using appropriate units:
Frequency of donation
Pulse
Temperature (Celsius and Fahrenheit)
Weight
Hemoglobin, for both autologous and allogeneic donations
Hematocrit, for both autologous and allogeneic donations
Describe the appearance of an acceptable blood collection site.
Describe the appearance of a site that is unacceptable for blood collection.
State the principle of the copper sulfate screening procedure for hemoglobin.
State the purpose for obtaining informed consent from the blood donor.
List 3 adverse affects of blood donation.
List the advice which must be given to donors concerning post-phlebotomy activities.
Given results of a blood donors physical exam evaluate the results and determine whether or not the
donor is eligible to donate and defend your decision.

Discussion
Alimitedphysicalexaminationalongwitharatherdetailedmedicalhistorymustbedoneonthedayofand
priortoeachblooddonationtodeterminewhethergivingbloodwillinanywayharmthedonororiftransfusion
ofthedonorunitwillinanywayharmtherecipient.Inthepreviouslaboratoryexercisethepotentialdonorwas
interviewedanddeferralsweremadeforavarietyofreasons,mostofwhichweremadetoprotectthepotential
recipientofblood.Intoday'sexercisealimitedphysicalexaminationwillbeperformedonthepotentialdonor
toensurethatthedonationofaunitofbloodwillinnowayaffectthedonorscurrenthealthstatus.

Principle
Thehealthstatusofthepotentialdonorisevaluatedbasedonthefollowingparameters:
FrequencyofDonation
Wholebloodorredbloodcells8weeks
Twounitredcellunit16weeks
Plateletpheresisupto24times/year
Plasmapheresisonceevery4weeks,canbedonetwiceaweek
Weightdonormustweighatleast110lbs.Donorsarenotactuallyweighed,justaskediftheyweighatleast
110lbs.Donorswhoweighlessmaybedrawn,butthevolumeofblooddrawnmustbecalculatedandthe
amountofanticoagulantinthebloodbagmustbereducedaccordingly.Thisisrarelydoneexceptinvery
unusualcircumstances.
Temperaturemustnotexceed99.5F or 37.5 C
Pulseshouldbebetween50100beatsperminutewithnopathologicirregularity.Lowerratesare
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acceptablefromprospectivedonorswhohavehighexercisetolerance.Highpulseratesand/orirregularitiesin
thepulsebeatmayindicateanundiagnoseddiseasecondition.Thedonorshouldbedeferredandinstructedto
seetheirphysician.
Bloodpressuresystolicnohigherthan180mmHganddiastolicnohigherthan100mmHg.Patientswith
highbloodpressureareatanincreasedriskofhavingheartattacksorstrokes.Theyshouldbeadvisedtosee
theirphysicianassoonaspossible.Highbloodpressureisverytreatableandmaypreventfuturehealth
problemsoncecontrolled.
HemoglobinHemoglobinmustbe12.5g/dLorgreaterforallogeneicdonationsor11.0g/dLforautologous
donations.Hemoglobinisthesubstanceinredbloodcellswhichcarriesoxygentothetissues.Alow
concentrationofhemoglobinindicatesanemiainthepotentialdonor.Manyfemaledonorswilloftenhavetobe
deferredduetoslightlylowhemoglobin.Womenlosebloodeachmonthduetomenstruation.Iftheirdietis
notadequatetoreplacethelostiron(whichisamajorcomponent)theymaybecomeslightlyanemic.Thisis
quicklyremediedwithacorrectionindietorironsupplements.Ifthehemoglobinisverylowthisisindicative
ofsomeunderlyingconditionwhichshouldbeevaluatedbytheirphysicianassoonaspossible.The
hemoglobinconcentrationisdeterminedbyaddingthebloodtoaspecialsolutionandgettingareadingfroman
instrument.ThisprocedurehasbeencoveredindetailintheHematologycourse.
Amorecommonmethodusedtodeterminehemoglobinconcentrationinthedonorcenters,especiallythe
mobileunits,isthecoppersulfatehemoglobindetermination.This is a qualitative screening test based on
specific gravity. Thedensityofthedropofbloodisdirectlyproportionaltotheamountofhemoglobinit
contains.The principle of the test is that when the drop of donor's blood dropped into copper sulfate solution
becomes encased in a sac of copper proteinate, which prevents any change in the specific gravity for about 15
seconds. If the hemoglobin is equal to or more than 12.5 gm/dL the drop will sink within 15 seconds and the
donor is accepted. Iftheblooddropsinkstothemiddleandremainsorstartstorisetothetopthedonoris
deferred.
Thisisnotaquantitativetestandwillonlyshowthatthehemoglobinisequalto,below,oraboveacceptable
limits.Testresultsthatindicatesatisfactoryhemoglobinlevelsareusuallyaccurate,butsomeresultsthat
indicatelowhemoglobinlevelsarefalse.Repeatingthetestbyasecondmethodwillhelpresolvethisproblem.
Thespecificgravityofthecoppersulfatesolutionis1.053,mustbekepttightlycappedtopreventevaporation
whichwillaffectthespecificgravity,mustbechangeddailyorafter25tests.
Hematocritwholebloodismadeupofplasmaandredbloodcells.Thehematocritvalueisthepercentageof
redbloodcellspresentinthewholeblood.Lowhematocritvaluesareindicativeofanemiainthepotential
donor(asoutlinedabove).Theprocedureinvolvesfillingcapillarytubeswithdonorbloodandspinningthem
downinamicrohematocritcentrifuge.Thetubesarethenplacedonadevicetodeterminethepercentageofred
bloodcells.Thehematocritmustbe38%ormoreforallogeneicdonationsor33%ormoreforautologous
donations.Potentialdonorswithlowvaluesaredeferredandshouldbereferredtotheirphysicianifthe
hematocritisverylow.
Venipuncturesitetheskinatthesiteofvenipuncturemustbefreeoflesions.Checkbotharmsforsignsof
IVdrugabusewhichwouldbeindicatedbytrackmarks.
Afterthedonorhasbeenevaluatedandpassesboththemedicalhistoryandphysicalexaminationtheunitof
bloodmaybedrawn.
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Writteninformedconsentmustbeobtainedfromthedonor.Theconsentshouldincludeastatement
informingthedonorabouttheinfectiousdiseasesforwhichthebloodwillbetested,astatementofwhatwill
happenifthebloodisfoundpositiveinalaboratorytest,thattheyunderstandtherisksofblooddonationand
theirquestionshavebeenanswered,astatementthatthedonorisvoluntarilydonatingtheirbloodforusebythe
bloodcenterandthatthedonorhasprovidedatrueandaccuratemedicalhistory..
AdverseReactionsDonorsmustalsobeinformedofthepossibleadversereactionswhichmayoccurduring
orshortlyafterthedonationprocess.Thisinformationisveryhelpfultodonorroompersonnelinthatthedonor
mayrecognizeearlyonthatareactionistakingplaceandbetreatedsooner.Refertoyourtextbookandlecture
guideforthelistofadversereactionstodonation.
PostPhlebotomyActivityDonorsmustalsobeinformedaboutpostphlebotomyactivityandcaresuchas
drinkingmorefluidsinthenext4hours,refrainfromsmokingforonehalfhour,whattodoifdizzinessoccurs,
howtotakecareofthephlebotomysite,whatactivitiestorefrainfromandtoeatahealthymealfollowing
donation.Withadequatefluidintake,completebloodvolumerestorationshouldtakelessthan12hours.

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Instructions
Reagents/Supplies
1.
a.
b.
c.
d.
e.
f.
2.
3.
4.

Fingerstickprocedureandsupplies
Microhematocrittubes
Clay
Lancet
Alcoholswab
Biowipe(towipeofffirstdropofblood)
Microhematocritcentrifuge
Coppersulfatesolution(ifavailable)
Thermometer
Bloodpressurecuffandstethoscope(ifnotavailableinstructorwillsupplybloodpressurevalues)
Procedure:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

TurnonHemoPointmeter.Performcalibrationifrequired.Referto
http://www.austincc.edu/mlt/phb/phb_unit9labs.htmlforproperuse.
Properlyperformcapillarypunctureprocedure.
Properlyfilltwomicrohematocrittubesapproximatelytwothirdsfullofblood.
Allowonedropofbloodfromoneofthemicrohematocrittubestofallintothecoppersulfatesolution.
Timeitfor15seconds.Ifitsinks,hemoglobinofdonorisacceptable.Ifitremainssuspendedorfloats
tothetop,hemoglobinisunacceptableanddonormustbedeferredunlesshematocritprovestobeinan
acceptablerange.
Afterperformanceofthecoppersulfateprocedureplaceclayinoneendofeachmicrohematocrittubein
theendOPPOSITEoftheredringandspininmicrohematocritcentrifugefor5minutes.
Whilemicrohematocrittubesarespinningtakedonorstemperatureandpulse.NOTE:Neverperforma
capillarypunctureonadonorwhileglassthermometerisintheirmouth.Recordresults.
Takedonorsbloodpressure(ifequipmentnotavailablegetvaluesfrominstructor).
Aftermicrohematocrittubesarereadyreadandrecordtheresults.
Atthebottomofthesheetmakeyourdeterminationastowhetherornotthedonoriseligibletodonate
blood.Iftheanswerisnoteligibleexplainwhy.
BASE YOUR EVALUATION OF ACCEPTABILITY ONLY ON THE PHYSICAL EXAM RESULTS.

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Name_________________________________

Date_________________________________

Laboratory2:DonorPhysicalExamination
RecordingResults
Recordresultsusingproperunitsasnecessary.
1. Weightgreaterthan110lbs.?(circleone)

YES

NO

2. Hemoglobin_________________________________
3. Coppersulfatemethodresult(circleone)
a. dropsank
b. remainedsuspended
c. floatedtotop
4. Temperature
5. Pulse

_________________

________________________

6. Bloodpressure________________________________
7. Appearanceofskinatvenipuncturesite(circleone)
a. freeoflesionsandtrackmarks
b. boils,openwoundsorsevereskininfectionspresent
c. IVdrugtrackspresent
8. Hematocrit_________________________________
9. Generalappearanceofdonor(circleone)
a.
b.
c.
d.

appearsexcessivelynervous
appearsdrunkorunderinfluenceofdrugs
appearsill
appearsreadytodonate

10. CONCLUSIONSASTODONORELIGIBILITY:
a. Accept________
b. Rejectdueto____________________________

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Name_________________________________

Date_________________________________

Laboratory2:DonorPhysicalExamination
StudyQuestions
Points:20

Grade___________/20

Usethelabexercise,lectureguideand/ortextbooktoanswerthefollowingquestions
Foreachofthefollowingparameterslistthevalueswhichareconsideredacceptableforanallogeneicblood
donor.Answersmustcontainproperunitstoreceivecredit.
1. List the frequency of donation for each of the following (2 total):
a. Wholebloodorredbloodcells
b. Twounitredcellunit
c. Plateletpheresis
d. Plasmapheresis
2. Weight (0.5 point)
3. Temperature
a. Fahrenheit(0.5point)
b. Centigrade(0.5point)
4.

Pulse(0.5point)

5. Blood pressure
a. Systolic (0.5point)
b. Diastolic (0.5point)
6. Hemoglobin
a. allogeneic (0.5point)
b. autologous (0.5point)
7. Hematocrit
a. allogeneic (0.5point)
b. autologous (0.5point)

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8. Answer each of the following as it relates to the copper sulfate screening procedure for hemoglobin.
a. Specific gravity of copper sulfate solution used (0.5point)b. Number of times copper sulfate solution can be used (0.5point)

c. Principle of the copper sulfate test (2 points)

d. Describe 2 observations that indicate an unacceptable copper sulfate test (1 point)

1.
2.
9. Describewhatshouldbelookedforatthesitechosenforperformanceofthephlebotomy.(2point)
a.
b.
10. State2itemswhichmustbeexplainedtothedonorpriortoobtainingwritteninformedconsent.(2point)
a.
b.
11. Listtwopossibleadverseaffectsofblooddonation.(2points)
a.
b.
12. List three instructions to be given to the donor about post-phlebotomy activity. (3 points)
a.
b.
c.

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