Transfusion medicine

Blood donation

Donor collection


Editorial Board Member: Kyle Annen, D.O.
Deputy Editor-in-Chief: Patricia Tsang, M.D., M.B.A.
Evelyn M. Potochny, D.O.
Melissa R. George, D.O.

Last author update: 12 September 2022
Last staff update: 12 September 2022

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PubMed Search: Blood donor collection

Evelyn M. Potochny, D.O.
Melissa R. George, D.O.
Page views in 2022: 124
Page views in 2023 to date: 23
Cite this page: Potochny EM, George MR. Donor collection. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/transfusionmeddonorcollection.html. Accessed February 8th, 2023.
Definition / general
  • Therapeutic blood products may be collected as whole blood and processed into components or collected by apheresis for the targeted component(s)
Essential features
  • Donor collection is the process by which whole blood or individual components are collected from an eligible blood donor via phlebotomy or by apheresis, respectively
  • Whole blood collection may proceed to postcollection manufacture of individual components through centrifugation, the addition of preservatives / storage solutions and appropriate labeling
  • Apheresis collection targets a specific component from the outset and can be labeled with minimal postcollection manufacturing
Terminology
  • Donor collection
  • Whole blood collection
  • Apheresis collection
  • Donor history questionnaire (DHQ)
Symptoms
  • Complications to apheresis or whole blood components; see Donor reactions
Blood donor screening
  • Donor screened to identify whether blood donation will be safe for the individual and to ensure safety of the blood product for transfusion recipients
  • Screening includes self assessment of donor following review of educational material at time of donation
  • Donor given health questionnaire (DHQ) assessing current health status, travel history, behavioral risks, exposure risks, medications, pregnancy status
  • Interview by screener with potential donor conducted to clarify responses to the DHQ
  • If deemed eligible to donate that day, a mini physical exam is conducted that includes:
    • Assessment of vital signs
    • Point of care hemoglobin
    • Visual inspection of phlebotomy site
  • At time of collection, blood sample taken for infectious disease testing and blood typing (see Blood donor testing)
  • Reference: Simon: Rossi's Principles of Transfusion Medicine, 5th Edition, 2016
Whole blood collection
  • Roughly 45 - 60 minute process for above screening, collection and observance for postdonation adverse events
  • Performed at fixed donor site or mobile unit
  • Aseptic technique used prior to venipuncture, per establishment's protocol
  • Donor is either seated upright, semirecumbent in chair or lying on cot or table
  • Following venipuncture, blood specimen collected for ABO / Rh typing and infectious disease testing
  • Whole blood collection of approximately 500 mL (or ~10% of the donor's blood volume) takes on average < 10 minutes
    • Collections exceeding 15 - 20 minutes may not be eligible for processing into plasma containing products (Cohn: AABB Technical Manual, 20th Edition, 2020)
    • Collections taking only a few minutes to complete indicate possible arterial puncture
      • May be associated with pulsating needle, bright red blood entering collection bag
    • Cutoff times for collection established by medical director via standard operating procedures (SOPs)
  • Following collection, the collection bag is clamped, needle removed and donor is instructed to elevate arm slightly or hold direct pressure over venipuncture site with gauze
  • Donor is encouraged to slowly sit up and eventually walk to canteen area for food / drink
  • Staff uses this time to observe donor for any reactions (see Donor reactions)
  • U.S. donors must wait 56 days prior to attempting subsequent donations (whole blood or apheresis)
    • This can allow iron levels to improve
    • Roughly 238 - 265 mg iron removed with each donation
    • May also avoid subsequent deferral due to low hemoglobin
    • May mitigate fatigue or other symptoms of iron deficiency
  • U.K. donors can donate every 12 weeks and 16 weeks for males and females, respectively (Transfusion 2016;56:2005)
  • In Germany and France, whole blood donations may occur every 8 and 12 weeks for males and females, respectively
  • In the interval study conducted in Europe, more frequent donations were associated with increased frequency of certain symptoms (such as fatigue and dizziness) but did not have major effects on quality of life or physical and mental performance (Lancet 2017;390:2360)
  • Iron supplementation has been shown to increase iron levels and avoid iron deficiency (Transfusion 2016;56:2005)
  • Following collection, the whole blood collection undergoes component processing
  • Blood products made from a given donation are linked to unique donor identification number (DIN)
    • DIN is a federally required label to allow hospitals / blood banks to trace origin of donation
    • 13 digit code unique to collection facility and individual donor
    • Needed in event of transfusion transmissible infection or other biological product deviation investigation
  • Whole blood may be separated into up to 4 different components, potentially:
    • Red blood cells
    • Plasma
    • Platelets
    • Cryoprecipitate
  • Whole blood in primary bag is centrifuged to separate red cells, which sediment to the bottom of the bag due to their high density relative to the other components
    • Platelet rich plasma (typically straw colored) settles on layer above (U.S. method of processing / centrifugation settings)
    • Thin white-gray layer of white blood cells may be visible at the interface between the red cells and plasma; granulocytes cannot be donated from whole blood processing but by apheresis
    • Plasma expressor (automated or manual) expresses off the plasma into a separate bag / container
    • If platelets will be made from whole blood collection, a second spin in the centrifuge is performed to better separate the platelets from the plasma
      • Platelets can later be leukocyte reduced (leukoreduced)
      • Platelets combined from several donors to constitute one transfusable unit
    • AABB Standards requires < 8.3 x 105 residual lymphocytes for whole blood derived platelets to be considered leukoreduced
  • Following separation from the plasma, the red cells may be hung on equipment and attached to a leukoreduction filter
    • Leukoreduction decreases the amount of residual lymphocytes from the red cells
    • Per AABB Standards < 5 x 106 for red blood cells to be considered leukoreduced
  • Reference: AABB: Standards for Blood Banks and Transfusion Services, 32nd Edition, 2021
Apheresis collection
  • Collection via automated apheresis, of which several FDA approved platforms exist
  • Includes collection of platelets, red blood cells, plasma, granulocytes
  • Similar requirements for whole blood donors
  • Donors must be monitored for red cell loss, which cannot exceed 200 mL in 56 days
  • Plasma and platelet donors must be monitored for plasma loss as well
  • Collections centers must maintain ongoing records documenting the above for those donating more frequently than every 56 days and still meeting standard eligibility criteria
  • Plateletpheresis:
    • Collection from single donor for a platelet unit
    • Per AABB Standards, 90% of sampled apheresis platelet units must have a minimum of 3 x 1011 platelets
    • If a unit is below that threshold, the unit must be labeled with the platelet count (AABB: Standards for Blood Banks and Transfusion Services, 32nd Edition, 2021)
    • May collect single units, double units and triple units, depending on the technology, donor weight and platelet count
    • Collections may be for conventionally manufactured platelets or for pathogen reduced platelets (Cerus: How INTERCEPT Works [Accessed 27 May 2022])
    • May process into platelet additive solution, limiting the residual plasma content to 33% of the original collection
    • Donors may donate as frequently as every 2 days, not to exceed more than 2 days in a rolling week and cannot exceed more than 24 times in a rolling year
    • Unless a directed donor or donor is a good match for a recipient with platelet refractoriness secondary to HLA or HPA antibodies, routine donors are likely to donate much less frequently
    • Platelet counts may be monitored per blood center policy
    • Platelet counts only required prior to donation for triple unit platelet collections
    • Platelets may be collected concurrently with plasma (AABB: Standards for Blood Banks and Transfusion Services, 32nd Edition, 2021)
  • Plasmapheresis:
    • Infrequent donors (donate no more frequently than once a month) require same collection criteria as whole blood donors
    • Cannot exceed more than 800 mL of plasma, dependent upon donor weight (McCullough: Transfusion Medicine, 5th Edition, 2021)
    • Frequent donors (> monthly collections) require serum protein monitoring, which is used for source plasma donations
    • Source (recovered) plasma is not transfused therapeutically at hospitals or infusion centers but manufactured into derivatives that are concentrates of specific plasma proteins (e.g., factor VIII concentrate) (AABB: Standards for Blood Banks and Transfusion Services, 32nd Edition, 2021)
      • Generally, source plasma is plasma from women who have been identified as having HLA antibodies from prior pregnancy (TRALI risk, see Transfusion related acute lung injury) or because the donor is on a medication that cannot be transfused or from donors with certain disorders that do not impact the red cells. (e.g., von Willebrand disease)
  • Red cells:
    • Double red cells donation refers to equivalent of 2 units of packed red blood cells but from single apheresis donor
    • May collect equivalent of single red cell unit along with platelets or plasma by automated means
  • Granulocytes:
    • Leukocytapheresis (Transfusion 2018;58:598, Simon: Rossi's Principles of Transfusion Medicine, 5th Edition, 2016):
      • Donors called upon for specific patients with:
        • Severely low absolute neutrophil count
        • Life threatening bacterial or fungal infection unresponsive to antimicrobial therapy
      • Unique among cellular collections in that donor is stimulated with a corticosteroid (dexamethasone or hydrocortisone) or granulocyte colony stimulating factor (G-CSF) or both
      • Apheresis collection occurs the next day
      • Collected granulocyte product has higher hematocrit (~7.5%) compared with mononuclear cell collection (MNC) for hematopoietic progenitor cell (HPC) transplant
      • Hydroxyethyl starch (HES) may be used as a sedimenting agent to aid separation of cellular layers
      • Safety concerns regarding use of HES as a volume expander for treating hypovolemia
    • Buffy coat preparation method (Vox Sang 2017:112:173):
      • Used in Canada and some European countries
      • Platelet concentrates produced from room temperature whole blood stored overnight, saline is added, then product is centrifuged to further separate out granulocytes
      • 5 donor samples processed, purified and pooled
      • Potentially better Candida albicans killing capacity
      • Less risk to donors, no steroid, G-CSF or HES exposure
Blood donor testing
Donor deferral
Board review style question #1
A 35 year old male blood donor takes 22 minutes to collect during a whole blood donation. Which of the following would be most likely, assuming the blood establishment has a conservative protocol regarding the whole blood collection time limit?

  1. His collection may be manufactured into all components: red cells, platelets and plasma
  2. His collection may be manufactured into plasma only
  3. His collection may be manufactured into platelets only
  4. His collection may be manufactured into red cells only
  5. His whole blood collection must be discarded
Board review style answer #1
D. His collection may be manufactured into red cells only. Whole blood collections exceeding 10 minutes may not be eligible for processing into plasma containing products, per blood center protocol, which affects both plasma and platelets (which are suspended in plasma).

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Reference: Donor collection
Board review style question #2
A 50 year old woman attempts to donate whole blood. Her last whole blood donation was 40 days ago. Which of the following is she eligible to donate today?

  1. Double red cells by apheresis
  2. Plasma by plasmapheresis
  3. Platelets by plateletpheresis
  4. She is ineligible for any whole blood or apheresis donation today
  5. Whole blood donation
Board review style answer #2
D. Due to the red cell loss, she is ineligible for any whole blood or apheresis donation until 56 days from the date of her last whole blood donation.

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Reference: Donor collection
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