Gift of Life - Blood Donation

Insights Background

Stages & Phases

Services

Advices to Donors

Criterias of a Donor

Summary

Suggestions

Acknowledgement I take this opportunity to express my profound gratitude and deep regards to my parents for their exemplary guidance, monitoring and constant encouragement throughout the course of the my study. The blessing, help and guidance given by them time to time shall carry me a long way in the journey of life on which I am about to embark.

I also take this opportunity to express a deep sense of gratitude to my lecturer Miss Saw Seow Hoon, for her cordial support, valuable information and guidance, which helped me in completing this task through various stages.

I am obliged to staff members of Pusat Darah Negara Malaysia, for the valuable information provided by them in their respective fields. I am grateful for their cooperation during the period of my assignment.

Lastly, I thank almighty, my siblings and friends for their constant encouragement without which this assigment would not be possible.

Arvind Devar a/l Ramachendrin 13ADB00584 Bsc. Biomedical Science (Hons)

Study Excursion to Pusat Darah Negara (PDN)

Date: 24th February 2014 Time: 11am-8pm Location: Jalan Tun R azak Kuala Lumpur

PDN Insights

Background

The National Blood Bank or better known as Pusat Darah Negara (PDN) located at Jalan Tun Razak, Kuala Lumpur is a government organization responsible for planning and developing blood transfusion services at regional and national levels in Malaysia. PDN provides expert services in the areas of Procurement and blood donation, Transfusion Medicine, Haematology and etc.

In the National Capital Region, PDN is responsible for collecting, processing and supplying of blood and blood products for the use of patients in both government and private hospitals around the Federal Territory of Kuala Lumpur and Putrajaya. PDN is also responsible for processing and conducting blood screening tests for the entire state of Selangor, Negri Sembilan and West Pahang. Inorder to improve the services and to ensure PDN members receiving adequate training and continuous learning , PDN had organized and provided trainings nationally and internationally through courses, seminars, workshops and conferences . PDN has been recognized and accredited by NATA (National Association of Testing Authorities), and by Australia for ISO / IEC 17025. Moreover, it is engaged in providing trainings to employees in both the district and state hospitals, to trainee medical lab technologist (MLT), Medical Officers and etc.

Historical Perspective

The Blood Bank Services in Malaysia were initiated by a group of volunteer women of the British Red Cross in 1955. Initially the service was only open on Wednesdays from 5.00 pm to 5.30 pm at the Kuala Lumpur General Hospital building. For this initiative, a total of 25 to 44 donors were collected every month. The Donors at that time consisted mainly of police, military and government personnel.Soon, after 15 years of the start of the service, 5,830 units of blood and not less than 13,860 successful compatibility testing were conducted. Due to growing services, The Blood Bank moved to another building within The Hospital Kuala Lumpur compound in 1971 .

The building was then known as the “National Blood Services Center “ and was inaugurated on April 1972 by the Director General of Health. It was then placed under the Ministry of Health Malaysia, headed by a Director. Starting from 1975, the Center played an important role in standardizing the rules, methodology and blood bank equipment across country. In 2002, the current National Blood Centre building was built in Jalan Tun Razak and was inaugurated by Yg Bhg Datuk Sri Hasmah Mohd Ali. The Centre has to date upkept SAFE , CLEAN and QUALITY blood collection, processing and storage services

vision The National Blood Bank is ready to serve the community in providing safe and adequate blood transfusion as well as a being a reference centre of excellence in the field of Transfusion Medicine.

PDN Insights

mission The National Blood Bank strives to provide quality service through teamwork, ethical, professional attitude imbued with respect, knowledge and innovative solutions as well as a network of cooperation between other institutions within and outside the country to carry out research and sharing knowledge for the well-being of patients, donors, and individuals in the health line and society in general.

objectives The National Blood Bank is entitled to create and maintain a safe blood donor group. To verify whether the blood components are safe , adequate and appropriate in practices, in the storage and screening according to international standards. In addition, to establish and maintain cooperative relations through training, research and development in line with the requirements of the latest technologies and practices in the medical field to date.

Aim of the study excursion 1. To be aware of the various haematological services offered by the National Blood Bank of Malaysia.

2. To broaden our knowledge on the procedures and techniques of Blood Collection, processing and Transfusion beyond the classroom setting.

3. To understand the various criteria’s for a person to be fit for blood and aphaeresis donation.

4. To understand the various stages of screening and testing prior to blood collection and aphaeresis.

5. To correlate the various haematological disorders and treatments from a theoretical basis to a non-lecture setting.

6. To reinforce, complement and extend learning opportunities beyond the classroom.

Why did we go on an excursion ?

We were offered the chance to visit the National Blood Bank to enhance and broaden our knowledge and understanding on the various activities conducted by the centre which comprises of blood collection, processing and transfusion. Furthermore, the trip was to reinforce, complement and extend learning opportunities beyond the classroom setting.

The field trip was also beneficial as it could play a major role in planning and organizing our upcoming Industrial Training, where we could co-opt to practice in Haematological Departments around the country. Not surprisingly this field trip could also shape our interest to continue our future career in haematological related areas.

11 .00

Departed from UTAR Perak

Campus 14.30

Reached Jalan Tun Razak Kuala

Lumpur 14.35

Had our Lunch in Balai Seni Visual

Negara Canteen 15.00

Arrived at Pusat Darah Negara

(PDN)

- Briefing by one of the staff

- Visited the Different Phases of

Blood Collection and Processing

- End Briefing

16.30

Blood Donation by some of my

Colleagues 17.30

Departed from Kuala Lumpur

19.30

Arrived in UTAR Kampar

Time Schedule

You don’t have to have a medical degree to save a life. Just a fair degree of humanity. Give Blood.

Save Life.�

Insights of Blood Transfusion

As early as 1950, the importance of blood transf usion as a life-saing procedure was recognized in Malaysia.

The type of organization of transfusion services may differ considerably from country to country. It may be an independent organization completely divorced from hospital services, its functions being mainly collection, processing, special despatch of blood and research activities which are carried out by very largecentres run by specialist haematologists while the actual hospital transfusion services and haematology services together are looked after by other specialist haematologists.

laysia and 32 hospitals in EastMalaysia, 13 of which may be designated as having regional blood banks.

The National Blood Services Centre is itself part of the General Hospital Kuala Lumpur.Some of the aims of the Ministry of Health are listed below

In Malaysia almost all the blood banks are attached to government hospitals i.e. the organization is fundamentally hospital based and hospital controlled. There are 60 hospitals in Peninsular Ma-

-Greater centralization of donor recruitment was to be brought about to prevent unnecessary competition for donors, particularly in the main cities.

-To achieve a target of 10% of adult urban or 2% of the general population in donorrecruitment in all states in Malaysia. Under this system mobile and group donations were to be increased.

be replaced in about 24 hours..

Besides, whole blood donation, PDN also accepts aphaeresis donation which is termed as the donation of plasma or platelets or both, it is a highly controlled process where donors were carefully selected and should have donated whole blood a couple of times prior to aphaeresis donation this is to prevent erroneous donors from donating.

Services

The services offered by the Malaysian Blood Bank includes collecting blood, separation of blood components, storage and distribution of blood components. PDN generally collects whole blood which comprises of erythrocytes, leukocytes, thrombocytes and plasma. Basically, blood is needed for patients undergoing surgery, met with an accident, leukaemic, cancer , thalassemia, heart disease patients, children with bleeding complication, haemophiliacs and others. The Blood volume donated is usually 450ml or less than 1 pint of blood. The amount of blood donated depends on the body size of a donor.The time for the process of blood donation ranges from 15-20 minutes however donors were advised to be in place for approximately 1 hour.

Prior to donation, donors were advised to have a moderate breakfast. Erythrocytes that were donated takes a time for about 4-8 weeks while plasma will

-To encourage, foster and support effortsto form a totally voluntary non-remunerative blood donation system;

stages/phases At the Registration counter, staffs will collect donor’s information inorder to process the donor application. They will determine the donor’s Hemoglobin concentration, perform cross matching to check for the donor’s blood group and weigh him/her to determine his/her weight.

Registration Interview Session Blood Donation

Once completed the registration session together with the screenings, donor’s enter into the next phase where they are interviewed by doctors in a one to one fashion. This is done to examine the mental state of the donor, whether they’re prepared to donate blood.

Soon, after both the stages, donors enter into the final stage where they donate blood. The process normally takes around 15 to 20 minutes. At the end of the session donors were given a slight refreshment to replace the electrolytes and energy lost during the donation process.

The stages above are done for a normal complete blood donor, however, for an aphaeresis donor are carefully selected and are usually donors who have donated complete blood a couple of times. This is to ensure that donors are fit for the donation and to prevent erroneous donation.

Criterias of a Donor A blood donor should be Healthy and fit particularly on the day of donation. They should be aged between 18-60 years.

However, for those who are 17 years old, they must obtain a written consent from one of their parents or guardians, and for those aged 61-65 years, must receive a written approval from a doctor regarding their health condition. The Weight of a donor should exceed 45 kg and they should have had atleast 5 hours sleep prior to the day of donation. Importantly, they should not have taken any medications or antibiotics within 7 days from the day of donation. Donors were advised to have a moderate meal prior to their donation. In addition, those who were willing to donate should not have engaged in any of the following activities.

-In a relationship with those of the same sex ( homosexual ) -In relationship with both sexes ( bisexual) -In relationship with commercial sex workers / prostitutes -Sharing needles or injecting drugs between partners However for female donors , they should not be conceived and breast-feeding. Finally, those who have lived in the United Kingdom ( England , Northern Ireland , Scotland , Wales , the Isle of Man or the Channel Islands ) or the Republic of Ireland from the year 1980 to 1996 for a period of 6 months or more were not allowed to donate. This is due to the outbreak of the Mad Cow Disease during the period.

The Collected Blood undergoes a series of process where they were initially separated into four different components according to its densities namely the plasma, erythrocytes, thrombocytes and leukocytes under a Giant centrifuge. Once centrifuged the components were separated manually from the mother blood bag into a new bag.

Storage The separated components were then stored in a cold chamber under different temperatures.

Plasma

CSL

Others

Blood Processing and storage

Post Blood Collection

Centrifugation

Stored plasma were later packaged and sent to the Commonwealth Serum Lab (CSL) in Australia for the process of separation into plasma proteins and factors. The packaged plasma should be stored at a temperature below 30oC till it reaches the destination.

FFP Plasma were also distributed to Hospitals in the form of Fresh Frozen Plasma (FFP). It has a lifespan of over 3 years and are generally stored at 30-40oC.

Erythrocytes were stored at a temperature of 2-6oC for a day and were distributed to government hospitals on the next day at 7am.

However, for private hospitals and clinics, upon request they were sold at a rate of MYR 20/bag. On the other hand, aphaeresis bags, were sold to private hospitals at a rate ranging between MYR 580-700

Advices to Donors

Once finish donating blood, donors were advised to pay attention to the following: -Press the needle into the container while resting for at least 10 minutes in bed before getting up .

- Consume snacks and drinks provided by the staffs before leaving the centre.

-Take a tablet of iron and folic acid supplement once a day after meal. This will help you to rebuild your red blood cells that you have to donated.

-Be careful while driving or while working with machineries.

Within 24 hours of the donation : -Try not to engage in any sport activities or strenuous exercise or lifting heavy items -Avoid alcoholic beverages.

-Eat and drink more water -If you experience any adverse reactions or reactions such as dizziness or about to faint. Lay yourself for a few minutes with both feet raised above head level .

-If you feel ill / uncomfortable , or if there is any sign of bruising , swelling or pain, immediately contact the centre. Blood Bank Medical Centre numbers 03-2693 3888 / 03-2695 5564 .

Many people pray for mountains to be moved when all they need is to climb. Donate Blood for your near and dear one.�

Summary The excursion trip has provided me with a memorable journey through the blood donation and transfusion related services offered by the Malaysian Blood Bank. The trip has reinforced and extended my learning opportunities beyond the classroom and enhanced my understanding and knowledge on the various WH- questions that I used to question myself related to blood and organ donation. I was never a fan of such activities from my childhood days ; however the excursion trip has broadened my mind on the necessity of blood donation. It has also provided me with the opportunity to build my understanding on the various theoretical concepts and ideas learnt during the lecture classes by experiencing it in a natural setting. Throughout, the excursion trip I have learnt that blood donation is not a simple task as we hear. But, there are many stages involved for instance a donor is required to undergo registration, donor interview and etc inorder for his request to be processed. Besides that, the trip has broadened my knowledge on the process of blood separation, its lifespan and storage temperatures of each of the blood components. Is it possible to put the experience into a longer frame? Of course, yes! I am looking forward to continue this experience in the future and I am proud to say that am planning to apply to the Director of the Malaysian Blood Bank to be given a chance to undergo my Industrial training at the end of this year in any of their centres throughout the country. I hope this initial step which am about to take will enable me to explore the activities being conducted in their centres, in depth and at a broader perspective. I would like to end this report by saying

“The Gift of Blood Is The Gift of Life�.

Suggestions

Suggestions to improve blood transfusion in our country would be primarily setting up a National Blood Authority for crucial, clinical and appropriate decision making dealing with blood collection and transfusion practices. The challenges are many; however, the authorites should demand a critical mass of expertise at the highest level to manage the services. Furthermore, a truly coordinated and integrated national blood transfusion service should be established to achieve the national aim of targeting 5% of the citizens to donate blood by 2020 compared to the current 2% rate. In order to cope up with the target, the building capacity should be maximized. The current building is assumed to have a staff capacity of 200, however there are 450 staffs working in the building.

The building should be renovated to accommodate another 20,000 collection together with the original 160,000 collections aimed by the PDN before the year 2020.

Modification of routine practices can minimize the need to transfuse red cells, such as checking and correcting anaemia before planned surgery, use of erythropoietin to improve haemoglobinization and aprotinin to reduce surgical bleeding. These recommendations outline clinical circumstances in which blood transfusion may be the appropriate therapy. They are not intended as an indication for the use of blood or blood products. The decision to transfuse varies from patient to patient and should be based on sound clinical judgement.

FAQ’s

Who is a Healthy Donor?

Any person within the age group of 18 - 60 years with a body weight as minimum 45 kgs, and having hemoglobin content as minimum 12.5 gm%.

How long does the donation take?

The procedure is done by skilled, specially trained technicians and takes three to eight minutes. However, from start to finish (filling form, post donation rest etc) the entire process should take upwards of 35 minutes.

How long can blood be stored?

Whole blood can be stored up to 35 days, when kept in CPDA anti coagulant solution and refrigerated at 2 - 4 deg C. But the demand is so great that blood hardly ever remains in storage for so long and is used much before expiry.

Can we separate blood into its components?

Yes! Now with technical advancements, we can make components of blood and store them. For example, plasma can be separated from whole blood and stored up to one year in frozen state at -80 deg C temperature or below. This is called Fresh Frozen Plasma. Similarly there are other components like Platelet Rich Plasma; Platelet Concentrate (can be stored as a life saving measure upto 5 days now at 22- 24 degrees C in a platelet incubator and agitator); Cryoprecipitate (which is very useful in treating bleeding disorders due to the deficiency of factor VIII and IX); Factor VIII and IX; Albumin, Globulin and many others. In most progressive blood banks more than 85 % of the blood collected is converted into components and stored. This is because many patients do not require whole blood. For example, a patient whose hemoglobin is low and is therefore anemic, may just require Packed Cells i.e. only red cells; a patient with burns may need more of plasma than cells; a patient with hemophilia may require only Factor VIII. Now with the advent of Cell-separators we can directly draw a particular component from the donor, while rest of the blood constituents go back to the donor.

What blood type is needed the most?

All blood types are needed for blood donation. We often have requests for the following: *All donation types - Whole Blood and Platelets *AB donors - Plasma *O, A and B donors - Red Cells

In which situations do patenits need blood transfusion?

There are many situations in which patients need blood to stay alive: A patient needs blood after a major accident in which there is loss of blood. No major surgery is performed without blood as there is bound to be blood loss. On an average, for every open heart surgery about 6 units of blood is required. In miscarriage or childbirth, cases the patient may need large amount of blood to be transfused for saving her life and also the child’s.For patients with blood diseases like severe Anaemias especially Aplastic Anaemias, Leucaemias (blood cancer), Haemophilia (bleeding disorder), Thalassemia etc. repeated blood transfusions are the only solution. In many other situations like poisoning, drug reactions, shock, burns, blood transfusion is the only way to save precious human life.

References

1.

Anonymous. 2014. [online] Available at: http://hsajb.moh.gov.my/ versibaru/uploads/bloodbank/garispanduan2.pdf [Accessed: 16 Mar 2014].

2.

Lopez, C. 2014. Blood Transfusion Services in Malaysia. [online] Available at: http://www.mjpath.org.my/past_issue/MJP1983/t he%20blood%20transfusion%20services%20in%20malaysia.pdf [Accessed: 16 Mar 2014].

3.

Malaysiablooddonors.org. 2014. Malaysia Blood Donors, Donate Blood,Mobile Blood Donation, Blood Bank kuala lumpur, Malaysia [online] Available at: http://www.malaysiablooddonors.org/ [Accessed: 16 Mar 2014].

4.

Pdn.gov.my. 2014. pusat darah negara. [online] Available at: http://www.pdn.gov.my/ [Accessed: 16 Mar 2014].

5.

Wales, N. 2014. Give Blood – Do Something Amazing. [online] Available at: http://www.blood.co.uk/index.aspx [Accessed: 16 Mar 2014].