walking donor

[newBB]

i am looking for information about walking donor . is new for us . i like to know what is AABB rule in this . i need to know the regulation and guildlines to recrute walking donors. please share your expreince dealing with walking donors

[khalidm3]

20 years back, I was working in a small (200 bed hospital), having few deliveries. Our Paediatrician was not accepting old red cells for neonates. At that time we established a walking Donor program approved by Lab Director (A us trained physician) and the Paediatrician.

We were testing some of the regular volunteer donors and had a list of them on call. At arise of need we were calling them and drawing from them just required amount of blood and blood samples. We were transfusing the blood to patient and testing their blood samples later with regular batch. I am not sure about FDA/AABB regulation

[Malcolm Needs ☆]

It would be interesting to find out how much you would be stung for by the lawyers if one of these walking donors passed on a blood borne virus that could have been caught by proper testing.

A substantial amount I'll be bound, if not an actual jail sentence.

[EDibble]

;)That was going to be my response as well Malcolm.

[Bill]

It would be nice to here from some of our military laboratorians who have served in Iraq and/or Afghanistan. It is my understanding that they use walking donors more often than not AND yet are able to maintain the quality of AABB & FDA requirements. Let's hear from some of those HEROES (from both sides of the pond).

[khalidm3]

I shall explain little more my 20 years old experience. At that time we were testing our donors for HBsAg, HIV antibodies, Malaria and VDRL only. We were testing our on call donor for these markers each two months and at the time of donation. We were calling these donors rarely, when need was arising and taking from them little amount of blood. The practice was discontinued when we draw 50 ml blood from a donor twice in less than 2 months period and we had an objection from ministry of Health inspector that there must be 8 weeks of gap between donations even the amount is 50 ml. He did not object on the testing policy. The facility was not observing AABB/CAP. Just local MOH instructions were followed.

[jcdayaz]

It would be interesting to find out how much you would be stung for by the lawyers if one of these walking donors passed on a blood borne virus that could have been caught by proper testing.

A substantial amount I'll be bound, if not an actual jail sentence.

I concur totally and completely!

[tbostock]

It would be nice to here from some of our military laboratorians who have served in Iraq and/or Afghanistan. It is my understanding that they use walking donors more often than not AND yet are able to maintain the quality of AABB & FDA requirements. Let's hear from some of those HEROES (from both sides of the pond).

Here's a good overview of how they do it:

http://www.af.mil/news/story.asp?id=123088559

[newBB]

It would be interesting to find out how much you would be stung for by the lawyers if one of these walking donors passed on a blood borne virus that could have been caught by proper testing.

A substantial amount I'll be bound, if not an actual jail sentence.

i agree with you totally . just sometime in holiday or vacation is hard to find donors. i am thiking if we can get doctors or nuses for walking donors . we will test them but want to save the time. to send out to virology lab and waite a day for release. i heard we can do that with plalatelts pharises donor to test one time valid for a month .but why we cannot do same wiht PRBC donors ?

[Malcolm Needs ☆]

i agree with you totally . just sometime in holiday or vacation is hard to find donors. i am thiking if we can get doctors or nuses for walking donors . we will test them but want to save the time. to send out to virology lab and waite a day for release. i heard we can do that with plalatelts pharises donor to test one time valid for a month .but why we cannot do same wiht PRBC donors ?

I'm not saying you can't; I just see it as a huge risk.

Think, just for a moment, how many patients these doctors and nurses will be seeing in a month, many of whom will have infections that these individuals could catch at any moment.

[khalidm3]

Might be adopted, but must be used only in life threatening conditions upon discretion of treating physician and approved by blood bank medical director.

[heathervaught]

AABB Standard 5.8.4.1 states, "If, due to urgent need, blood or components are distributed or issued before completion of these tests, a notation that testing is not completed shall appear conspicuously on an attached label or tie tag. Required tests shall be completed and results reported ... as soon as possible."

[Deb]

What you are describing here is called a "Dedicated Donor" (Testing 1x per 30 days). My understanding is that their is a catch: all of the products collected must be dedicated to the same patient....

[heathervaught]

No - 5.8.4.2 talks about dedicated cytapheresis donors (i.e. granulocyte donors). 5.8.4.1 makes statements about allogeneic donors.

[csjuarez]

i am looking for information about walking donor . is new for us . i like to know what is AABB rule in this . i need to know the regulation and guildlines to recrute walking donors. please share your expreince dealing with walking donors

I served for 2 months this summer with Mercy Ships (www.mercyships.org) on board the hospital ship Africa Mercy in Lome, Togo (W. Africa) and will be returning to the Africa Mercy in January 2011. We have a unique way of dealing with the the transfusion needs of our surgical patients -- our crew members serve as a "walking blood bank" and we do not store any processed units. Donors are drawn and the still warm whole blood unit taken to the OR suite or patient ward for transfusion! To do this we prescreen the donors which makes them available for 21 days (I'd like to change this to 30 days) and use that sample for crossmatching as well. In our case, the viral testing is done before the donor is drawn for actual transfusion, but not with FDA approved methods -- we are working in a third world country.

I think it would be difficult to impossible to have a "walking donor" policy (other than as mentioned by Heather or that initiated by the Armed Forces for critical emergencies) and meet AABB/CAP/FDA requirements. I certainly wouldn't recommend it and would encourage you to plan to meet possible emergency needs by having an adequate inventory and working with your blood supplier for meeting unforseen emergency needs.

[cmelloh]

We have a list of walking donors who can be called the day they are needed to donate. But we do not cut corners with testing. Their blood/platelet products go through the same rigorous testing that "Joe the Plumber" has. You just can take chances.

[MJDrew]

I would concur with that assessment! And given the article in the May 2012 issue of Transfusion, detailing a fatal case of transfusion-associated graft vs. host disease in a type A combat casualty in Afghanistan being given the magical potion of type O "fresh, whole blood", I would think this practice would be forever wiped out everywhere. Tranfusion-transmitted infection isn't the only potential risk that could result from this sort of magical thinking that, somehow, the blood is better when it's still warm. :disbelief An episode like this is totally unforgivable in this day and age, when we know that TA-GVHD can happen even in patients not usually thought of as immunocompromised. Trauma causes profound suppression of the immune system!!! READ MY LIPS!!

Perhaps some of our military friends will enlighten us on whether this resuscitation policy will continue. MJD :cool:

[Bill]

As a father of a soldier who was killed in Afghanistan, I have seen the "walking blood bank" work! My son was in the high mountains over 2 hrs away from any facility and 3 hrs from nearest hospital by helicopter. He transfused soldiers with blood from his squad on more than one occasion. It would indeed be very interesting how many of our brave men and women have been saved vs killed by the "walking blood bank."

[tbostock]

Bill, so very sorry to hear about your loss. And so proud of your son and the ultimate sacrifice he made for our freedom. I agree that being out in the field is a different story than stateside in a hospital. The rules need to be a little looser to save lives.

[Smarty pants]

Back when I worked in the donor room, we would periodically collect a granulocyte (we had a list of frequent platelet donors we called from... they had to have donated platelets in the past month to be eligible).

We did the exact protocol you're describing for your walking donors. Tested AFTER transfusion

There was an additional informed consent that was required (in addition to the standard risk of transfusion), so the perscribing MD and patient were both aware that we had done all we could to verbally screen the donor, but that in this urgent case, the blood product was being transfused untested.

We never had one come up positive for anything after the fact.

I think it would somewhat cover you in a court of law ...