Creation of a Community Based Blood Bank

Table of Contents

1. Introduction
2. Some Helpful Hints
3. Owner Recruitment
4. Owner and Donor Attributes
5. Basic Equipment Needs for Blood Collection, Processing, and Storage
6. Blood Storage

1. Introduction

The main goal of this book is to provide an easily readable and accessible reference text which we hope will be readily found on the laboratory bench and will be constantly open and used.

2. Some Helpful Hints

Scattered throughout this text are the following symbols to help you focus on what is really important.

• This is a routine feature of the subject being discussed. We've tried to narrow them down.
• This is an important feature. You should remember this.
• Something serious will happen if you do not remember this.

3. Owner Recruitment

Owners can be recruited to enlist their pet(s) into a blood donor program in a variety of ways. This includes:

• Posting notices in the lobby of veterinary clinics
• Advertising in the newspaper
• Advertising at local fairs
• Posting notices at the local human blood center
• By mentioning the need for blood donors to clients
• Advertising to kennel clubs
• Recruiting police dogs

It may be necessary to provide incentives to owners for having their pet(s) in the blood donor program. This may include:

• Discount or free vaccines
• Discount or free flea preventative
• Discount or free heartworm preventative
• Monetary credit for incurred hospital fees
• Discount or free bag of pet food per blood donation
• Free t-shirts for the owners, pet leashes or collars with the practice’s logo may provide for advertisement as well as incentive for the program.

Photographs of the blood donors may be posted in the lobby of the veterinary clinic to provide for advertisement to prospective owners as well as recognition of blood donors currently enrolled in the program.

Good communication between owner and practice is critical to the success of the blood donor program. It is very important to specify to the owner exactly what is expected from the owner and donor.

This information may be provided to the owner by creating a written agreement or a "Frequently Asked Questions" brochure. Some items to be included are:

• Routine blood collection dates and times
• The total volume of the blood donation
• The frequency of the blood donation
• How many times per year the blood donor is expected to donate blood
• If the donor is expected to be available for emergency blood donations
• The owner should be informed that a small area on the donor’s neck will be shaved and used as the venipuncture site.

It is advisable to specify what fees will be paid by the blood collection facility, and what fees will be billed to the client, including provisions for investigation of abnormal physical examination findings or complications from phlebotomy.

4. Owner and Donor Attributes

Owner Attributes

It is important to select owners who are interested in the blood donor program and who understand that their pet’s participation in the program truly saves lives. Conscientious owners will be helpful in monitoring the overall health status of the donor so that neither the blood donor nor the blood supply is compromised in any way.

Donor Attributes

Positive donor attributes can make the entire blood collection process easier for everyone involved. Potential donors should not bite or resist venipuncture or restraint. Blood donors should be of good disposition and good health.

Physical Attributes

Canine Blood Donors

• Canine blood donors should weigh at least 50 pounds so that human blood collection bags (450-ml capacity) may be used. A maximum of 22 mL/kg of blood may be donated every 21 to 28 days; however, one donation every 3 - 4 months may be preferable to the owner.
• For ease of blood collection, donors should possess easily accessible jugular veins; there should be minimal neck folds or thick skin.
• The donor may be male or spayed nulliparous female.
• There should be no history of previous blood transfusions.
• Adherence to the above two criteria will eliminate donors who may have been exposed to foreign blood groups and could have potentially developed antibodies that may interfere with compatibility testing.
• Donors should be between 1 and 8 years of age.
• Vaccination status should be current and the donor should be on heartworm preventative.
• All coagulation factors including von Willebrand Factor levels should be normal.

Feline Blood Donors

• Feline blood donors should be at least 10 pounds in weight. A maximum of 15 mL/kg can be drawn every 4 weeks; however, one donation every 3 - 4 months may be preferable to the owner.
• Although feline blood donors will most likely be sedated for phlebotomy, those with good dispositions should be chosen.
• An easily palatable jugular vein is desirable. A long neck and torso may contribute to ease of phlebotomy by providing a flat, smooth phlebotomy site.
• The donor may be male or spayed nulliparous female.
• There should be no history of previous blood transfusions.
• Adherence to the above two criteria will eliminate donors who may have been exposed to foreign blood groups and could have potentially developed antibodies that may interfere with compatibility testing.
• Donors should be between the ages of 1 and 8 years.
• To minimize exposure to feline infectious diseases, feline blood donors should be strictly indoor cats, with no exposure to outdoor cats.
• All coagulation factor levels should be normal.

Laboratory Evaluation

• In addition to these physical traits, various laboratory tests should be performed to ensure the health status of the donor and to ensure the safety of the blood donor pool.
• For dogs, a complete hemogram and biochemical profile should be performed. Laboratory analysis for brucellosis, Lyme Disease, Rocky Mountain Spotted Fever, dirofilariasis, and Ehrlichiosis are recommended. Additional laboratory testing may be required to evaluate donor health status, including laboratory analysis to evaluate any disease endemic of the geographic locale.
• For cats, a complete hemogram and biochemical profile should be performed. Laboratory analysis for feline leukemia virus, feline immunodeficiency virus, dirofilariasis and hemobartnellosis are recommended. As with dogs, additional laboratory testing may be required to evaluate donor health status including laboratory analysis to evaluate any disease endemic of the geographic locale.
• One additional donor attribute to consider is the donor’s blood type. A brief discussion of canine and feline blood types in regard to donor selection follows.

Canine

• Eleven canine blood groups have been described (Table 1-1). More than one blood group can be present in any given donor. Dog Erythrocyte Antigen (henceforth, "DEA") 1.1,1.2, and 7 are most important when considering canine blood transfusions. DEA 1.1 and 1.2 are highly antigenic and previously sensitized dogs may have hemolytic transfusion reactions when transfused with DEA 1.1 or 1.2 blood. If a transfusion of a random blood type is given, there is a 25% chance that DEA 1.1 or 1.2 positive blood will be given to a 1.1 or 1.2 negative dog. Subsequent transfusions of the same offending blood type would result in major transfusion reaction s in at least 15% of these recipients. DEA 7 is moderately antigenic to DEA 7 negative recipients. This blood group may cause mild to moderate transfusion reactions and can decrease red cell survival when given to previously sensitized DEA 7 negative dogs. Dogs that are DEA 1.1, 1.2, and 7 negative are considered universal donors.
• It is important to understand the significance of these blood types when selecting canine blood donors for a blood donor program. The overall goal of the blood donor program should be considered. If the majority of transfusions are expected to be a once-in-a-lifetime occurrence, the inclusion of all canine blood types may be appropriate. This may assure a large number of donors for the program. If most recipients are expected to need multiple transfusions, it may be appropriate to include only universal donors to the program in order to prohibit development of unexpected antibodies.

• 
  Feline

• Three feline blood groups have been described (Table 1-2). They are A, B, and AB. Blood type A is the most frequent blood group, type B is much less frequent and type AB is extremely rare. Feline blood type frequencies differ in geographic location, as do the frequencies of type A and B in purebreds. It is important to note that cats do not need to be previously sensitized by pregnancy or previous transfusion in order to have serious complications from a first time transfusion. Unlike dogs, cats possess naturally occurring antibodies against the A or B antigen absent from their own red cells. These antibodies can be responsible for transfusion reactions and neonatal isoerythrolysis. With blood type B, 70% of cats have naturally occurring A antibody that causes decreased red cell survival and acute hemolysis when transfused to type A recipients. With type A, 35% of cats have naturally occurring B antibody; but the titer is generally too low to cause significant transfusion reactions. Type AB has no naturally occurring alloantibodies.
• When selecting feline blood donors for a blood donor program, blood type is extremely important. The blood type of the recipient population should be examined, and cats should be accepted to the program accordingly.

Donor Selection

The criteria for selection of blood donors outlined above may be best evaluated at an office visit separate from a scheduled blood donation. This will provide the veterinarian time to evaluate physical exam findings and laboratory test results in view of the overall goals of the blood donor program. Once a donor is accepted into the blood donor program, this process should be repeated annually to maintain donor and product integrity. Donor blood types need not be checked on an annual basis.

Keeping Track of Donors

Once donors are qualified into the blood donor program, it is necessary to maintain information regarding individual donors in an easily accessible format. This may be done by creating a database that contains a variety of donor information including owner name, owner work and home phone numbers, donor medical record number, and last phlebotomy date. By performing this task, donors may be monitored for vaccination status, last annual check-up, and last phlebotomy date. This will be a valuable tool when scheduling donors for phlebotomy.

Scheduling Donors for Phlebotomy

Owners should be contacted to schedule phlebotomy in advance of the desired blood collection date. A consistent day and time (i.e., once every 8 weeks on Monday at 8 a.m.) for routine phlebotomy may be convenient for owners to remember their obligation to the blood donor program. However, if the phlebotomy is scheduled more than one week in advance, a reminder message may be necessary.

When contacted for scheduling donation, owners should be asked about any change in the donor’s health status since the last office visit or donation. A pre-phlebotomy questionnaire is helpful in accomplishing this task. This questionnaire should include any questions that may pertain to any change in health status such as recent weight loss, acute vomiting or diarrhea, or change in behavior. This questionnaire may be completed when contacting owners to schedule phlebotomy. This does not eliminate the need for a physical exam prior to blood donation.

5. Basic Equipment Needs for Blood Collection, Processing, and Storage

Blood Collection Bags

Canine phlebotomies may be performed using human blood collection and storage bags. These are available through manufacturers listed in Appendix 1.

Feline phlebotomies may be performed using a specialized blood collection and storage bag listed in Appendix 1. (Human blood collection and storage bags should NOT be used for cats.) Additionally, whole blood may be collected for immediate transfusion using an anticoagulated syringe; limited processing and storage occurs using this method of blood collection.

For Canine Blood Collection

• A vacuum chamber (Figure 1-1) attached to a vacuum source can provide a light vacuum in which to facilitate blood flow into the blood collection bag.
• A Tube Stripper (Fenwal) is used to strip the blood out of the phlebotomy line (Figure 1-2).
• A Hand Sealer (Fenwal) used in conjunction with metal clips will provide a method for sealing the lines of the blood collection bag. Terumo’s Hand Sealer and Aluminum Sealing Clip performs both functions (Figure 1-3). Electric Heat Sealers (Figure 1-4) are available from both manufacturers.

Figure 1-1. Vacuum chamber.

Figure 1-2. Tube stripper. (Photo used with permission of Baxter Healthcare Corporation).

Figure 1-3. Hand sealer. (Photo used with permission of Baxter Healthcare Corporation).

Figure 1-4. Hematron Seal Rite. (Photo used with permission of Baxter Healthcare Corporation).

For Whole Blood Separation

• In order to separate whole blood into red blood cells and fresh frozen plasma, a refrigerated centrifuge is needed. The necessary temperature range is 1 - 6° centigrade (C). A rotor head with swinging buckets will provide for maximum plasma recovery.
• A Plasma Extractor (Fenwal, Terumo) is needed for removing the appropriate quantity of plasma from the red cells (Figure 1-5).
• A scale for weighing products will be needed (Figure 1-6).

Figure 1-5. Plasma extractor. (Photo used with permission of Baxter Healthcare Corporation).

Figure 1-6. Scale for weighing blood products. (Image supplied by and used with permission of Fisher Scientific).

6. Blood Storage

• A refrigerator is needed to store red cell products. The temperature range should be from 1 - 6°C, with a method to monitor temperature.
• A freezer is needed to store frozen plasma products. These items should be stored at -18° or below. A freezer dedicated to plasma storage is optimal. There should be some type of temperature monitor, be it human or electronic, to ensure that the product is stored at a constant temperature.
• Do not purchase a freezer with a defrost cycle since the defrost cycle may warm the product and cause unexpected degradation.