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Blood transfusion: Guidelines by MoHFW

M3 India Newsdesk Jun 14, 2022

This article elucidates the guidelines for blood donation put forth by the Government of India, MoHFW with approval from the National Aids Control Organisation (NACO) and the Nation Blood Transfusion Council (NBTC).

Key takeaways

  1. Blood donation should be voluntary and a sole act of benevolence.
  2. Donors should be in the age groups of 18-65 yrs with minimum haemoglobin of 12.5.
  3. Testing for TTIs for all donated blood samples.
  4. Donor counselling and criteria for blood transfusion.

The primary responsibility of a blood transfusion service is to provide a safe, sufficient and timely supply of blood and blood components to those in need. The act of blood donation should be safe and cause no harm to the donor. All necessary steps should be taken to ensure that the products derived from donated blood are efficacious for the recipient, with minimal risk of any infection that could be transmitted through transfusion.

Donor engagement at the blood bank

  1. Blood should be accepted only from voluntary, non-remunerated, low risk, safe and healthy donors.
  2. Efforts should be directed towards encouraging and retaining adequate numbers of healthy repeat donors.
  3. Donors should be appropriately recognised and thanked for their contribution.
  4. The minimum criteria for blood donation are:
  • Age between 18-65 years
  • Weight at least 45 Kg
  • Hemoglobin of at least 12.5 grams

Donor selection and counselling

1. Pre-donation information

  1. Nature and use of blood and its components and the importance of maintaining healthy lifestyles.
  2. Eligibility for blood donation rationale for the donor questionnaire and pre-donation health assessment.
  3. Options for the donor to withdraw or self-defer at any time before, during or after donation.
  4. Blood donation process and potential adverse donor reactions.
  5. Testing for common TTI (Transfusion Transmissible Infections), modes of transmission and window period.
  6. Basic information on tests performed on the donated blood.
  7. Possible consequences for donors and donated blood in the case of abnormal TTI test results.

2. Pre-donation counselling

  1. Understanding of Donor Questionnaire.
  2. Reiterate understanding of TTI testing and the disclosure of results.
  3. Clarify any misunderstanding about donor selection, blood donation and blood screening.
  4. Explain self-deferral and permanent deferral.
  5. Familiarise donors with the process of blood donation.
  6. Obtain the donor's Informed consent.

3. Donor consent components

Explain to the donor that:

  1. Blood donation is a voluntary act and no inducement or remuneration has been offered.
  2. Donation of blood/ components is a medical procedure and that by donating voluntarily. The donor accepts the risk associated with this procedure.
  3. The donated blood and plasma recovered from the blood may be sent for plasma fractionation for the preparation of plasma-derived medicines, which may be used for the larger patient populations and not just this blood bank.
  4. The blood will be tested for Hepatitis B, Hepatitis C, Malarial parasite, HIV/AIDS and Syphilis diseases in addition to any other screening tests required to ensure blood safety.
  5. The donor would like to be informed about any abnormal test results done on his/her donated blood.

4. Post-donation interaction

       1. Brief instructions on self-care:

  • Intake plenty of fluids
  • No heavy work
  • No smoking or driving immediately post-donation
  • Remove bandage after 6 hours

       2. Contact the blood bank in case of discomfort following donation.

       3. Information about what to do in case of specific adverse donor reactions.

       4. Message on healthy lifestyle and regular blood donation.

       5. Donor feedback:

  • Issuance of donor card, donor certificate or a memento

  • Reiteration for recalling blood donors for abnormal test results

Blood donor selection criteria

1. Wellbeing

  • Good health
  • Mentally alert
  • Physically fit

2. Age- The age group should be 18-65 years.

3. Whole blood volume- 350 ml- for 45 kg, 450ml- for more than 55 kg.

4. Donation interval- For whole blood donation, once in three months (90 days) for males and four months (120 days) for females.

5. Blood pressure- 100-140mm Hg systolic and 60-90 mm Hg diastolic with or without medications.

6. Pulse- The pulse rate should be 60-100 beats per minute.

7. Temperature- The body temperature of the donor should be afebrile - 98.4°F.

8. Haemoglobin-Should be more than or equal to 12.5g/dL.

9. For female patients, defer donation in the following cases:

  • Menstruation
  • Lactation
  • Within 12 months of delivery in case of pregnant women
  • Within 6 months of abortion

10. Conditions which require deferring from donation until symptoms subside- General malaise, headache, cold, flu, and sore throat.

11. Conditions which require 6 months of deferring from donation

  • Minor surgery
  • Tooth extraction or other dental surgery

12. Conditions which require 12 months of deferring from donation

  • Major surgery
  • Received blood transfusion
  • Typhoid
  • GI endoscopy

13. Conditions that require permanent deferring from donation

  • Asthmatic patients
  • Open heart surgery
  • Myocardial infarction
  • Coronary artery disease
  • Convulsion and epilepsy
  • Uncontrolled diabetes
  • Hypertension
  • Endocrine disorder
  • Hepatitis
  • Jaundice
  • STDs such as Syphilis and Gonorrhea

Algorithm for patients referred to ICTC

  1. All initial sero-reactive donors referred to ICTC (Integrated Counselling and Testing Center) from Blood Bank shall be offered HIV pre-test counselling and a consent form for HIV test.
  2. ICTC shall perform the first test (A1). In case the first test is positive, ICTC shall perform the remaining two tests and give a positive result after three sequential reactive tests.
  3. In case the first test is negative, ICTC shall report the result as HIV inconclusive and recall the donor for re-testing after two weeks after thorough counselling for risk perception.
  4. All blood donors found to be positive for HIV shall be counselled and deferred from donating in addition to referral for Pre-ART during post-test counselling.
  5. In addition, the message for all People Living with HIV/AIDS (PLHA) to permanently defer themselves/ spouses/ partners from donating blood shall be incorporated into the information for all PLHA during post-test counselling.

Testing strategy for other TTI at blood banks

Blood is subjected to high sensitivity testing for:

  • Hepatitis B
  • Hepatitis C
  • Malaria
  • Syphilis

If non-reactive, the specimen is to be considered free of infection and can be moved further for donation.

Benefits of blood donation for the donor

  1. Free health checkup.
  2. Screening of infectious diseases. An early diagnosis can help speed up recovery.
  3. Sense of emotional wellbeing in the act of benevolence.
  4. Some studies have suggested that regular blood donations decrease the risk of heart attacks and hypertension

Click here to see references


Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.

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