Technical Manual of Blood Components Preparation Bibekananda Mukherjee
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1Transfusion Medicine Step by Step Technical Manual of Blood Components Preparation A unit of whole blood can save four lives2
3Transfusion Medicine Step by Step Technical Manual of Blood Components Preparation A unit of whole blood can save four lives
Bibekananda Mukherjee BSc DMLT WHO Fellow Senior Technologist Department of Transfusion Medicine Bokaro General Hospital, Bokaro Steel Plant Steel Authority of India Limited Bokaro Steel city, Jharkhand, India Forewords K Ghosh Utpal Chaudhuri Sudipta Sekhar Das
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Step by Step Technical Manual of Blood Components Preparation
First Edition: 2016
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5Dedicated to
my respected father Late Nonigopal Mukherjee respected mother Late Shankari Mukherjee and beloved brother Late Ramkrishna Mukherjee (1968–2005) whose inspirations have encouraged me for this work
It gives me immense pleasure and a sense of pride to see that our WHO trainee Bibekananda Mukherjee has written a small but very useful handbook detailing how blood components may be prepared in a blood bank. The book is well-illustrated, compact, full of figures for easy comprehension and can be easily carried in a small bag. In India, increasingly more and more medical colleges are coming up with curriculam of “MD” program in transfusion medicine. Similarly, trainee technicians for blood banks and transfusion medicine setups need to know in their fingertips how blood components can be produced and how its quality can be maintained. Mukherjee's book will fill up a long felt gap in this area. It will be useful to doctors and technicians alike, if they are in the field of transfusion medicine. I wish all the success for this book.
Director National Institute of Immunohaematology (ICMR) 13th Floor, New Multistoreyed Bldg, KEM Hospital Campus, Parel Mumbai, Maharashtra8
It is a great pleasure for me to write a foreword for the book Step by Step Technical Manual of Blood Components Preparation written by Bibekananda Mukherjee. The book is compact and well-illustrated. The pictorial demonstrations will help the students understand the procedures with ease. It will help not only the medical technologists working in blood banks but also to the postgraduate students of MD transfusion medicine. There was hardly any book in this subject that can help students and trainees in their day-to-day work. The book would help to fill up their this lacuna.
I wish all the success for this book.
Utpal Chaudhuri
Director, IHTM10
It gives me immense pleasure to mention the effort of Bibekananda Mukherjee who besides his busy working schedule managed to prepare this Step by Step Technical Manual of Blood components Preparation. Mukherjee has very well enumerated his technical skill and experiences in this manual. Hope this technical manual would enable the blood bank professionals and other blood users to update their knowledge of blood component preparation methodology and use of blood and blood components in clinical practice.
With regards
Sudipta Sekhar Das12
The extent to which human blood is used therapeutically demands that the quality and safety of whole blood components be ensured in order and primarily to prevent the transmission of diseases. Since 20 years of my technical association with blood bank of Bokaro General Hospital, I feel that care should be taken throughout the whole blood transfusion chain, starting from the collection, testing, component preparation, processing, and storage and also for safe distribution.
In our country today, the use of blood components remains an essential-step in therapy, and as a matter of fact, majority of blood bank and blood laboratories prepare blood components after receiving the whole blood. With over five years of practical experience in preparation of blood components in my blood bank, I feel that several technical tips are essential for qualitative preparation of blood components. Moreover, during my recent WHO fellowship training, I have acquired several technical know-how, which I feel to communicate to those who are engaged in such vital activities.
Writing of this technical manual is an attempt to help those young persons who are sincerely engaged in such profession. I have tried my best effort to present my practical knowledge regarding blood component preparation. The book covers all areas of the subject, i.e. selection of donors, safe handling of equipments, calibration, preparation of components, component storage, component thawing, issue of component, transfusion doses, quality control, 14etc. Many important informations are presented clearly for quality product, which are normally overlooked or escaped by an author. This manual meets the ready references for safe and qualitative preparation of blood components.
Bibekananda Mukherjee
I wish to thank all those working in department of Transfusion Medicine who have helped in the preparation of this technical manual and expressed their ideas regarding this book.
I am very much indebted to (Prof) Dr Kanjaksha Ghosh, Director NIIH (ICMR), Mumbai, who has motivated me for giving special attention for blood bank methodology and blood component preparation during my fellowship. I express my thanks because he spent his valuable time to read this manual and exporessed his fillings regarding the manual.
I am indebted to (Prof) Dr Utpal Chaudhuri, Director IHTM, Medical College Kolkata, West Bengal, India for his valuable recommendation regarding my book.
I am specially indebted to Dr Sudipta Sekhar Das, MD, PDCC (Transfusion Medicine SGPGIMS, Lucknow), Head of the Department of Transfusion Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India for giving me proper guidance to complete this work.
I express my gratitude to honorable Doctors, viz Dr Prasun Bhattacharya, MD (Transfusion Medicine), Assistant Professor and Head, Department of Immunohematology and Blood Transfusion, Medical College Kolkata; Dr B Bhattacharjee (Deputy Director, Tech) SBTC,WB and Ex-HOD (Transfusion Medicine), RG Kar Medical College; Dr Sidda Raju, Head, Department of Pathology, JIPMER Medical College, Puduchery; Dr Madhusudan Mandal, Head (Transfusion Medicine), National Medical College, Kolkata; Dr Dilip Panda, Head (Transfusion Medicine), NRS Medical College, Kolkata; Dr Subhasis Chakrabarty, Central Blood bank, (Institute of Immunohematology and Transfusion Medicine) Kolkata, Dr Tapan Kr Ghosh, 16Head, Department of Pathology, BS Medical College and Hospital, Bankura (WB) and Dr Alok Kumar Mandal, Head, (Transfusion Medicine), BS Medical College and Hospital, Bankura (WB), and (Prof) Dr Malay Ghosh (WB), Director RBTC, RG Kar Medical College Kolkata (WB).
Dr Tushar Kanti Gupta, MO (Transfusion Medicine), AMRI Hospital Kolkata, Dr Akhil Kr Mandal, Ex-Director, Institute of Transfusion Medicine and Immunohaematology, Central Blood Bank, Kolkata, Dr Devashish R Desai, MO, Life Care Medical Complex, Kolkata, and Dr Prosanto Chowdhury, Member of Thalassemia International Federation, who have spent their valuable time to read this manual and expressed their feelings regarding the manual.
I am also indebted to Dr YP Bhattacharya and Dr GN Sahoo (DMS, BGH/BSL), Dr AK Singh, Director, I/C (BGH, BSL), Shri Biswarup Mukhopadhyay, GM, (HRD/BSL), Dr Mrs Manju Roy, Ex-HOD (BGH, Pathology), Dr Upendra Mohanty Ex-JD, Dr RN Pradhan JD, Dr KN Thakur JD, Dr TM Singh JD, Dr SK Sinha JD, Dr Prasanta Kumar Sarkar JD, Dr NK Das JD, Dr Subrato Dey JD, Dr Shrawan Kumar I/C (Transfusion Medicine), Dr Prakash Pandey, Dr Md Isha, Dr M Rajak, Dr Aninda Mandal, Dr Aniruddha Bandopadhyay, for their proper guidance and moral support.
I am indebted to Dr Trinath Pachal (BGH, BSL) Dr Mrs K Vasantha, Dr Ajit C Gorakshakar, Dr Mrs Swati Kulkarni (NIIH, ICMR Mumbai), Dr RK Verma and Mr Sanjay Chaudhary (Jamshedpur Blood Bank), Dr Arshad Hassan Siddiqie, Blood Bank Officer (Jammu and Kashmir, Health Department), Dr Sagar Chatterjee (Ortho Dign), Mr Sabyasachi Hazra, Mr Arunangshu Saha, and Production Unit (Kolkata branch) of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India and Mr Dhruba Mandal (IBTMI, Kolkata) for their valuable contribution in writing the manual.17
I also want to acknowledge my elder brother respected Shri Swapan Kumar Mukhopadhyay, Mrs Jharna Mukherjee (Baudi), Mrs Mithu Banerjee (Didi), Mrs Reena Sarkar (Baudi), Dr Mrs Anju Parira, Shri Sushanta Chakraborty (Brother-in-law), Shri Rajarshi Mukherjee (Nephew), Shri Indranil Chakrabarty (nephew), Mr Sujit Kr Pal, Mr Subal Dutta, Mr Subhas Chandra Dey (Jamshedpur Blood bank), Mr Avijit Pal (RSP, Hospital), Mr Pradeep Kr Ghosal and Mr Samarendra Kundu (Friend), Mr Avishek Kumar, Mr Animesh Mukherjee, Mr Jayanta Roy Chaudhary Mr Tapan Mohanta (Friend), Mr Angsuman Banerjee (Nephew), Miss Meghna Chatterjee (Cousin), Mrs Uma Unnikrishnan who always encourage and boost up me for good work.
Lastly, I express my thanks to my wife Mrs Anjali Mukherjee, daughter Miss Deep Shikha Mukherjee (Diya) and my best friend Mr Ghanshyam Sharma for helping and cooperating me for this book.18
19Abbreviations ACCL :
Adenine saline glucose mannitol
Antihemophilic factor
BV :
Blood volume
Cryopoor plasma
Ethylenediaminetetraacetic acid
Fresh frozen plasma
PC :
Packed cell (PRBC)
PL :
Platelet concentrate
Platelet-poor plasma
Packed red blood cell
Platelet-rich plasma
Red blood cell
Relative centrifugal force
Rotation per minute
RT :
Room temperature
Saline, adenine, glucose, mannitol
UV :
White blood cell
Blood bank number
C :
Vol :
21History of Blood Banking/Blood Transfusion Service (BTS)
Presently, we transfuse blood with the hope to cure someone. Modern humanity is very much successful in transfusion medicine. This success was not reached in a day or in years. The history behind this success was succeeded by many reported failures, but our physical, emotional, spiritual and our intelligence had overcome all this difficulties. With our best efforts, we archived a successful procedure for an efficient, safe, and uncomplicated transfusion technique.
In 1492, to save life of a Pope Innocent VIII, an attempt of blood treatment was made; he had to drink 3 healthy boy's blood. The result was—Both were died.
Before Harvey's description of circulation in 1628 a technique for artery to artery administration of blood was proposed by Libavious in 1615.
The first successful blood transfusion was made by Blundell approx 150 years ago.
A rational explanation for incompatibility and hemolytic transfusion reaction was given by Landsteiner. He also discovered ABO group in 1900 and Rh system in 1940.
Blood Storage
The concept of blood banking or blood storage was put in practice after discovery of sodium citrate—with donor lying next to the patient in 1917. An effort was made to improve banking of blood and to extend lifespan of blood (RBC) from 21 days (ACD) to 28 days (CPD) to 35 days (CPDA-1) to 42 days (SAGM solution—Saline, adenine, glucose, mannitol).22
The complication of blood transfusion is transmission of syphilis, after that Australia antigen hepatitis B and HIV in 1980. For blood transfusion service a mandatory screening is required for 5 diseases, (HBV, HCV, HIV, malaria, and syphilis).
Present Situation
Nowadays, blood transfusion faces the interesting challenges. In developed countries, how blood service should be organized through high technology, with addition of AIDS which provoked a great heightened emphasis of safety.
In many instances, the problems like lack of component therapy, level of shortage and unsolved safety problems are perpetuated by financial limitations, endemic infections, and political instability.
Blood is needed for its lifesaving properties and cannot justify its provision with basic safety precaution is the fact, but there could not be a single solution to these problems.
During 1990s and onwards, future technical advances are taking place, including computerization, recombinant DNA techniques as well as improvement of cell separation and test for transfusion transmissible infections and plasma apheresis.
Early Attempts
The first attempt for blood transfusion was experimented to Pope Innocent VIII who was in coma. The blood of three boys was infused through the mouth, and both were died.
More sophisticated research in blood transfusion began in 17th century with Harvey's experiment with circulation 23of blood. The experiment was successful in transfusion between animals but, on human, continues poor results.
On June 15, 1667 Dr Jean Baptiste Denys, an eminent physician of king Louis XIV of France was administrator of the first fully documented human blood transfusion. He transfused the blood of a sheep into a 15-year-old boy and a laborer; both were survived. Then he withstoods the allergic reaction. The second attempt of transfusion was on a Swedish, Baron Bonde. He received two transfusions, and in second, he died. After that Denys performed some transfusion with calf's blood on Antoine Mauroy. After the third transfusion he also died. According to Mauroy's death, it was later determined that the arsenic poison was responsible for Mauroy's death. Finally, this procedure was banned in 1670 that continued for next 150 years.
In 1674, Antonie van Leeuwenhoek discovered the platelets.
First recorded successful blood transfusion occurred in England in 1665.
Richard Lower, a physician, kept a dog alive by transfusion of blood from other dogs.
Clotting was the principal obstacle for transfusion of blood. In 1869, Braxton Hicks recommended sodium phosphate as a nontoxic anticoagulant, and this was first example of blood preservation research.
Karl Landsteiner in 1901 discovered the ABO blood groups. He explained the serious reactions that occur in humans as a result of incompatible transfusion, and he won the Nobel prize.
An unprecedented blood transfusion was achieved in 1914. Huston reported the use of sodium citrate and glucose as diluents and anticoagulant solution for transfusion.
In 1915 minimum sodium citrate was used by Richard Lewishon to prevent clotting of blood, and this discovery 24opened the process of collection of blood from donors and to be stored for later transfusion to patient.
Rous and Turner introduced citrate-dextrose solution in 1916. Transfusion became more practical and safer for the patient from that time.
Early in 1932, the first blood bank was established in Leningrad Hospital, Russia to combat blood loss in World War II.
Dr Charles Drew was the pioneer to describe the techniques in blood transfusion and establishment of blood bank. Dr Drew was the first Director of first American red cross blood bank.
The Rh blood group system was discovered by Karl Landsteiner.
Edwin Cohn developed fractionation—plasma, albumin, protein.
P. Beeson published description of transfusion transmitted hepatitis.
Coombs, MouranT, and Race described the use of antihuman globulin.
Development of plastic bag for blood collection
Antihemophilic factor was discovered and use of component was understood.
Plasmapheresis introduced.
Cryoprecipitate was first used.
HBsAg antigen testing introduced for safe blood transfusion.
First AIDS case reported.
Screening of HIV in donated blood started.
Hepatitis C testing became mandatory for blood transfusion.