Editing Blood transfusion (section)

== Procedure ==

[[File:Blausen 0087 Blood Transfusion.png|thumb|Illustration depicting intravenous blood transfusion]]
Before a blood transfusion is given, there are many steps taken to ensure quality of the blood products, compatibility, and safety to the recipient. In 2012, a national blood policy was in place in 70% of countries and 69% of countries had specific legislation that covers the safety and quality of blood transfusion.<ref>{{cite web |url=https://www.who.int/mediacentre/factsheets/fs279/en/ |title=Blood safety and availability |publisher=[[World Health Organization]] |date=June 2014 |access-date=22 August 2014 |archive-date=29 June 2008 |archive-url=https://web.archive.org/web/20080629085919/http://www.who.int/mediacentre/factsheets/fs279/en/ |url-status=live }}</ref>

=== Blood donation ===
{{Main|Blood donation}}

The source of blood to be transfused can either be the potential recipient ([[Autotransfusion|autologous]] transfusion), or someone else ([[allogeneic]] or homologous transfusion). The latter is much more common than the former. Using another's blood must first start with donation of blood. Blood is most commonly donated as [[whole blood]] obtained intravenously and mixed with an [[anticoagulant]]. In first-world countries, donations are usually anonymous to the recipient, but products in a [[blood bank]] are always individually traceable through the whole cycle of donation, testing, separation into components, storage, and administration to the recipient.<ref>{{cite journal |vauthors=Distler P, Ashford P |title=Twenty-five years later: has ISBT 128 fulfilled its promise? |journal=Transfusion |volume=59 |issue=12 |pages=3776–82 |date=December 2019 |pmid=31565803 |pmc=6916302 |doi=10.1111/trf.15519 }}</ref> This enables management and investigation of any suspected transfusion related disease transmission or [[transfusion reaction]]. Developing countries rely heavily on replacement and remunerated donors rather than voluntary nonremunerated donors due to concerns regarding donation- and transfusion-transmitted infection as well as local and cultural beliefs.<ref name="a321">{{cite journal | last1=Gress | first1=Kyle L. | last2=Charipova | first2=Karina | last3=Urits | first3=Ivan | last4=Viswanath | first4=Omar | last5=Kaye | first5=Alan D. | title=Supply, Demand, and Quality: A Three-Pronged Approach to Blood Product Management in Developing Countries | journal=Journal of Patient-Centered Research and Reviews | volume=8 | issue=2 | date=2021 | pmid=33898644 | pmc=8060046 | pages=121–6| doi=10.17294/2330-0698.1799 }}</ref>

It is unclear whether applying alcohol swab alone or alcohol swab followed by antiseptic is able to reduce contamination of donor's blood.<ref>{{cite journal | vauthors = Webster J, Bell-Syer SE, Foxlee R | title = Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 2 | pages = CD007948 | date = February 2015 | pmid = 25674776 | pmc = 7185566 | doi = 10.1002/14651858.CD007948.pub3 | collaboration = Cochrane Wounds Group }}</ref>

Studies show that the main motivators to blood donation tend to be prosocial (e.g., altruism, selflessness, charity), while the main deterrents include fear, distrust,<ref>{{Cite journal |last1=Edwards |first1=Patrick W. |last2=Zeichner |first2=Amos |date=January 1985 |title=Blood donor development: Effects of personality, motivational and situational variables |journal=Personality and Individual Differences |volume=6 |issue=6 |pages=743–751 |doi=10.1016/0191-8869(85)90085-6 |issn=0191-8869}}</ref><ref name=":43">{{Cite journal |last1=Muthivhi |first1=Tshilidzi |last2=Olmsted |first2=M. |last3=Park |first3=H. |last4=Sha |first4=Mandy |date=August 2015 |title=Motivators and deterrents to blood donation among Black South Africans: a qualitative analysis of focus group data |journal=Transfusion Medicine |volume=25 |issue=4 |pages=249–258 |doi=10.1111/tme.12218 |pmc=4583344 |pmid=26104809}}</ref> or perceived racial discrimination in historic contexts.<ref name=":43" />

=== Processing and testing ===
[[File:FreshFrozenPlasma.JPG|thumb|alt=photograph of a bag containing one unit of fresh frozen plasma|A bag containing one unit of fresh frozen plasma]]

Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Collected blood is then separated into blood components by centrifugation: [[red blood cell]]s, [[blood plasma|plasma]], and [[platelet]]s.  Plasma can be further processed to manufacture [[human serum albumin|albumin]] [[protein]], clotting factor concentrates, [[cryoprecipitate]], [[fibrinogen]] concentrate, and [[immunoglobulin]]s ([[antibody|antibodies]]). Red cells, plasma and platelets can also be donated individually via a more complex process called [[apheresis]].
* [[File:Vidro para transfusão de sangue, Centro de Memórias do Curso de Enfermagem da UFES (2).jpg|thumb|Glass used in an antiquated method of blood transfusion]]The [[World Health Organization]] (WHO) recommends that all donated blood be tested for transfusion-transmissible infections. These include [[HIV]], [[hepatitis B]], [[hepatitis C]], ''[[Treponema pallidum]]'' ([[syphilis]]) and, where relevant, other infections that pose a risk to the safety of the blood supply, such as ''[[Trypanosoma cruzi]]'' ([[Chagas disease]]) and ''[[Plasmodium]]'' species ([[malaria]]).<ref>{{cite book|title=Screening donated blood for transfusion-transmissible infections: recommendations|date=2009|publisher=World Health Organization|isbn=978-92-4-154788-8|url=http://apps.who.int/iris/bitstream/10665/44202/1/9789241547888_eng.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://apps.who.int/iris/bitstream/10665/44202/1/9789241547888_eng.pdf |archive-date=2022-10-09 |url-status=live}}</ref> According to the WHO, 10 countries are not able to screen all donated blood for one or more of: [[HIV]], hepatitis B, hepatitis C, or syphilis.<ref name=":0">{{cite web|title=Blood safety and availability Fact sheet 279|url=https://www.who.int/mediacentre/factsheets/fs279/en/|publisher=World Health Organization|access-date=21 January 2016|archive-date=29 June 2008|archive-url=https://web.archive.org/web/20080629085919/http://www.who.int/mediacentre/factsheets/fs279/en/|url-status=live}}</ref> One of the main reasons for this is because testing kits are not always available.<ref name=":0" /> However the prevalence of transfusion-transmitted infections is much higher in low income countries compared to middle and high income countries.<ref name=":0" />
* All donated blood should also be tested for the [[ABO blood group system]] and [[Rh blood group system]] to ensure that the patient is receiving compatible blood.<ref>{{cite web|title=Testing of donated blood|url=https://www.who.int/bloodsafety/donation_testing/en/|archive-url=https://web.archive.org/web/20110318122653/http://www.who.int/bloodsafety/donation_testing/en/|url-status=dead|archive-date=March 18, 2011|website=World Health Organization|access-date=21 January 2016}}</ref>
* In addition, in some countries platelet products are also tested for bacterial infections due to its higher inclination for contamination due to storage at room temperature.<ref>{{cite web|title=Bacterial Detection Testing by Blood and Blood Collection Establishments and Transfusion Services to Enhance the Safety and Availability of Platelets for Transfusion|url=https://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm426310.htm|archive-url=https://web.archive.org/web/20150306105828/http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm426310.htm|url-status=dead|archive-date=March 6, 2015|website=FDA U.S. Food and Drug Administration|access-date=21 January 2016}}</ref><ref>{{cite journal | vauthors = Benjamin RJ, McDonald CP | title = The international experience of bacterial screen testing of platelet components with an automated microbial detection system: a need for consensus testing and reporting guidelines | journal = Transfusion Medicine Reviews | volume = 28 | issue = 2 | pages = 61–71 | date = April 2014 | pmid = 24636779 | doi = 10.1016/j.tmrv.2014.01.001 | author3 = ISBT Transfusion Transmitted Infectious Disease Bacterial Workgroup }}</ref>
*Donors may be tested for [[cytomegalovirus]] (CMV) because of the risk of transmission to certain immunocompromised recipients, such as those with stem cell transplant or T cell diseases. However, testing is not universally mandated, because leukoreduced blood is generally considered safe from CMV transmission; also, most donors (and recipients) are seropositive for CMV, and are not actively viremic. CMV seropositive donors are still eligible to donate.<ref>{{cite journal | vauthors = Ziemann M, Hennig H | title = Prevention of Transfusion-Transmitted Cytomegalovirus Infections: Which is the Optimal Strategy? | journal = Transfusion Medicine and Hemotherapy | volume = 41 | issue = 1 | pages = 40–44 | date = February 2014 | pmid = 24659946 | pmc = 3949610 | doi = 10.1159/000357102 }}</ref>
* Leukocyte reduction is the removal of white blood cells by filtration. Leukoreduced blood products are less likely to cause HLA [[alloimmunization]] (development of antibodies against specific blood types), [[febrile non-hemolytic transfusion reaction]], [[cytomegalovirus infection]], and [[platelet-transfusion refractoriness]].<ref name=":3">{{cite journal | vauthors = Bassuni WY, Blajchman MA, Al-Moshary MA | title = Why implement universal leukoreduction? | journal = Hematology/Oncology and Stem Cell Therapy | volume = 1 | issue = 2 | pages = 106–123 | year = 2008 | pmid = 20063539 | doi = 10.1016/s1658-3876(08)50042-2 | doi-access = free }}</ref>
* Pathogen reduction treatment that involves, for example, the addition of [[riboflavin]] with subsequent exposure to [[UV light]] has been shown to be effective in inactivating pathogens (viruses, bacteria, parasites and white blood cells) in blood products.<ref>{{cite journal | vauthors = Hardwick CC, Herivel TR, Hernandez SC, Ruane PH, Goodrich RP | title = Separation, identification and quantification of riboflavin and its photoproducts in blood products using high-performance liquid chromatography with fluorescence detection: a method to support pathogen reduction technology | journal = Photochemistry and Photobiology | volume = 80 | issue = 3 | pages = 609–615 | year = 2004 | pmid = 15382964 | doi = 10.1562/0031-8655(2004)080<0609:TNSIAQ>2.0.CO;2 | s2cid = 198154059 }}</ref><ref>{{cite journal | title = A randomized controlled clinical trial evaluating the performance and safety of platelets treated with MIRASOL pathogen reduction technology | journal = Transfusion | volume = 50 | issue = 11 | pages = 2362–75 | date = November 2010 | pmid = 20492615 | doi = 10.1111/j.1537-2995.2010.02694.x | s2cid = 28186229 | first23 = J. | first22 = R.P. | first20 = P. | first26 = B. | first25 = R.J. | first19 = Gines | first18 = Paolo | first12 = D. | first13 = R. | first24 = C. | first16 = T. | first17 = J. | first14 = J.-D. | first15 = L. }}</ref><ref>{{cite journal | vauthors = Goodrich RP, Edrich RA, Li J, Seghatchian J | title = The Mirasol PRT system for pathogen reduction of platelets and plasma: an overview of current status and future trends | journal = Transfusion and Apheresis Science | volume = 35 | issue = 1 | pages = 5–17 | date = August 2006 | pmid = 16935562 | doi = 10.1016/j.transci.2006.01.007 }}</ref> By inactivating white blood cells in donated blood products, [[Pathogen Reduction Using Riboflavin and UV Light|riboflavin and UV light treatment]] can also replace gamma-irradiation as a method to prevent [[graft-versus-host disease]] ([[TA-GvHD]]).<ref>{{cite journal | vauthors = Fast LD, DiLeone G, Cardarelli G, Li J, Goodrich R | title = Mirasol PRT treatment of donor white blood cells prevents the development of xenogeneic graft-versus-host disease in Rag2-/-gamma c-/- double knockout mice | journal = Transfusion | volume = 46 | issue = 9 | pages = 1553–60 | date = September 2006 | pmid = 16965583 | doi = 10.1111/j.1537-2995.2006.00939.x | s2cid = 13065820 }}</ref><ref>{{cite journal | vauthors = Fast LD, DiLeone G, Marschner S | title = Inactivation of human white blood cells in platelet products after pathogen reduction technology treatment in comparison to gamma irradiation | journal = Transfusion | volume = 51 | issue = 7 | pages = 1397–1404 | date = July 2011 | pmid = 21155832 | doi = 10.1111/j.1537-2995.2010.02984.x | s2cid = 34154946 }}</ref><ref>{{cite journal | vauthors = Reddy HL, Dayan AD, Cavagnaro J, Gad S, Li J, Goodrich RP | title = Toxicity testing of a novel riboflavin-based technology for pathogen reduction and white blood cell inactivation | journal = Transfusion Medicine Reviews | volume = 22 | issue = 2 | pages = 133–153 | date = April 2008 | pmid = 18353253 | doi = 10.1016/j.tmrv.2007.12.003 }}</ref>

=== Compatibility testing ===
[[File:Blausen 0086 Blood Bag.png|thumb|Illustration of labeled blood bag]]
{{Main|Blood compatibility testing}}
Before a recipient receives a transfusion, compatibility testing between donor and recipient blood must be done. The first step before a transfusion is given is to type and screen the recipient's blood. Typing of recipient's blood determines the ABO and Rh status. The sample is then screened for any alloantibodies that may react with donor blood.<ref name=uutah>{{Cite web|url=https://webpath.med.utah.edu/TUTORIAL/BLDBANK/BBPROC.html|archiveurl=https://web.archive.org/web/20090303204956/http://library.med.utah.edu/WebPath/TUTORIAL/BLDBANK/BBPROC.html|url-status=dead|title=Blood Donation and Processing|archivedate=March 3, 2009|website=webpath.med.utah.edu}}</ref> It takes about 45 minutes to complete (depending on the method used). The blood bank scientist also checks for special requirements of the patient (e.g. need for washed, irradiated or CMV negative blood) and the history of the patient to see if they have previously identified antibodies and any other serological anomalies.

[[File:Serology interpretation of antibody panel for blood group antigens.jpg|thumb|300px|Interpretation of antibody panel to detect patient antibodies towards the most relevant [[human blood group systems]] {{further|Blood compatibility testing}}]]
A positive screen warrants an antibody panel/investigation to determine if it is clinically significant. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for antigens that correspond to commonly encountered and clinically significant alloantibodies. Donor cells may have homozygous (e.g. K+k+), heterozygous (K+k-) expression or no expression of various antigens (K−k−). The phenotypes of all the donor cells being tested are shown in a chart. The patient's serum is tested against the various donor cells using an indirect [[Coombs test]]. Based on the reactions of the patient's serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (i.e. cause transfusion reactions, HDN, etc.). Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen-negative red blood cells to prevent future transfusion reactions.<ref>{{Cite book | vauthors = Harmening D |title=Modern Blood Banking and Transfusion Practices |location=Philadelphia |publisher=F. A. Davis |edition=4th |year=1999 |isbn=978-0-8036-0419-3 |url-access=registration |url=https://archive.org/details/isbn_9780803604193 }}</ref>

If there is no antibody present, an immediate spin [[cross-matching|crossmatch]] may be performed where the recipient serum and donor rbc are incubated. In the immediate spin method, two drops of patient serum are tested against a drop of 3–5% suspension of donor cells in a test tube and spun in a serofuge. Agglutination or hemolysis (i.e., positive Coombs test) in the test tube is a positive reaction.  If the crossmatch is positive, then further investigation is needed.  Patients with no history of red cell antibodies may qualify for computer-assisted crossmatch, which does not involve combining patient serum with donor cells.

If an antibody is suspected, potential donor units must first be screened for the corresponding antigen by phenotyping them. Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read.

In urgent cases where crossmatching cannot be completed, and the risk of dropping hemoglobin outweighs the risk of transfusing uncrossmatched blood, O-negative blood is used, followed by crossmatch as soon as possible. O-negative is also used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies.

====Compatibility of ABO and Rh system for Red Cell (Erythrocyte) Transfusion====
This chart shows possible matches in blood transfusion between donor and receiver using ABO and Rh system. The symbol [[File:Blood drop plain.svg|25px]] indicates compatibility.
{| class="wikitable" style="text-align: center"
!colspan=2 rowspan=2|
! colspan="8" |Donor
|-
!O−!!O+!!B−!!B+!!A−!!A+!!AB−!!AB+
|-
! rowspan="8" |Recipient
!AB+
|[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]
|-
!AB−
|[[File:Blood drop plain.svg|25px]]||||[[File:Blood drop plain.svg|25px]]||||[[File:Blood drop plain.svg|25px]]||||[[File:Blood drop plain.svg|25px]]||
|-
!A+
|[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||||||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||||
|-
!A−
|[[File:Blood drop plain.svg|25px]]||||||||[[File:Blood drop plain.svg|25px]]||||||
|-
!B+
|[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||||||||
|-
!B−
|[[File:Blood drop plain.svg|25px]]||||[[File:Blood drop plain.svg|25px]]||||||||||
|-
!O+
|[[File:Blood drop plain.svg|25px]]||[[File:Blood drop plain.svg|25px]]||||||||||||
|-
!O−
|[[File:Blood drop plain.svg|25px]]||||||||||||||
|}
[[File:Agglutinatie rode bloedcellen libtheora.ogg|thumb|Agglutination (clumping) of red blood cells due to an incorrect transfusion]]