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DAY CARE MEDICINE SURGERY

DAY CARE IN BLOOD BANK
Maya Parihar-Malhotra

Nowadays, day-care facilities in medicine are becoming popular as they are a very convenient option, saving time and money, for patients.

In the blood bank, where the main focus is on the blood donor, the entire process of a donor donating whole blood or undergoing an Aphaeresis procedure is short, involving a couple of hours, at the most.
However, Day care patient Services enables healthcare providers (here blood bank) to avoid costly patient hospitalization for transfusion administration offering blood component transfusions (red cell, platelets and clotting factors) on an outpatient basis.

The services include:
1) Blood transfusion: to transfusion dependent patients - e.g. Thalassaemic children.
2) Therapeutic Phlebotomy procedures.
3) Autologous blood donations - Pre-operative deposit.
4) Therapeutic Aphaeresis procedures.
5) Counselling cell.

1) Many patients are dependent on blood transfusions for survival. In our setup, most common being: Thalassaemic children. In Greek, Thalassaemia, means “globin chain which is deficient". The thalassaemias are a diverse group of genetic blood diseases, characterized by absent or decreased production of normal haemoglobin. These results in a microcytic anaemia of varying degree that begins in early childhood and lasts throughout life. Lifelong red blood cell transfusions are the main supportive treatment offered for all major forms of thalassaemia. Today, most patients with a major form of thalassaemia receive red blood cell transfusions every two to three weeks, amounting to as much as 52 pints of blood a year. If these transfusions are given to patients at a day care facility, it enables these patients to lead a better quality of life.

2) Therapeutic phlebotomy is simply the process of collecting and disposing of blood as a medical treatment. Therapeutic phlebotomy is used to eliminate or control a dangerous condition in the blood, which must be corrected quickly or is not responding to more conventional treatments. A written request from the treating physician, including the amount of blood to be withdrawn, the frequency of donation, and the desired haemoglobin level, is required. A health history and mini-physical are done, and consent for phlebotomy is given.

The blood is drawn from the patient and disposed of and the patient may be re-infused with healthy blood if indicated. This blood is not taken into the routine blood bank stock. Therapeutic phlebotomy is indicated in the treatment of hemochromatosis, polycythaemia and porphyrias.

3) Autologous donations - Autologous is a word meaning “self directed.” Autologous blood units are those that are collected from a patient prior to elective medical procedures and surgeries. The requirements in patients are less stringent than for blood donors. e.g., the age and weight restrictions are relaxed for patients.
Whole blood autologous donations include: a) Pre-operative deposit, b) Immediate Pre-operative red cell dilution, c) Intra-operative red cell dilution, and d) Post operative cell salvage. Autologous collections can also be made of other blood components.

Pre-operative deposit is applicable in blood bank. The blood units are stored for transfusion to the patient when needed. They are available only for the patient from whom they were collected. If not used these blood units are discarded and not transferred to the routine blood bank stock. Donating to oneself prior to elective surgery for example, can eliminate many risks. These risks include, but are not limited to: Infectious disease transmission, Allo-immunization to red blood cell, platelet and leucocyte antigens, haemolytic, febrile or graft-vs.-host reactions.
Autologous donations are particularly advantageous for individuals who have a rare type of blood or antibodies that make it difficult to find compatible blood.

4) Some patients need to have medically indicated Therapeutic Aphaeresis (the process whereby, selected components of a patient’s blood are removed or replaced) in order to treat a disease. These procedures include cellular depletion, plasma exchange and red cell exchange.

Cellular Depletion - Removes harmful cells from a patient’s blood. Conditions / complications treated with cellular depletion therapies are: Acute or chronic leukaemia, thrombocytosis and leucostasis (pulmonary or cerebral).

Therapeutic Plasma exchange (aphaeresis) is the removal of plasma (containing abnormal antibodies) from the blood and the replacement of the plasma with protein and salt solutions. A special machine is used to remove a small amount of blood at a time. The aphaeresis procedure (= blood components separation) consists of extracting plasma: - small volumes (600 ml max: plasmaphaeresis still used for plasma donation) or -large volumes (2 to 5 litres - plasma exchange, with volume balanced by replacement fluids used for treatment). The number of treatments needed depends upon the condition of the patient and the protocol, which the physician has determined is best for the patient. E.g. Myasthenia Gravis, Guillain-Barré syndrome, Cryoglobulinaemias, Macroglobulinaemias and Thrombotic thrombocytopenic purpura.
Red Cell Exchange -Through therapeutic erythrocytaphaeresis, defective red blood cells can be removed and substituted with healthy ones, alleviating complications associated with sickle cell anaemia and other conditions.

5) Counselling Cell - For blood donors, infectious diseases, thalassaemia detection and marriage counselling and Organ donation programme.

As far as the law goes, the blood bank requirements have to be met with regards to space, equipment and qualified personnel. These day care facilities can be conducted in separate pre-allotted premises, the area of which should depend on the number of patients catered to. They require the co-ordination of the blood bank staff with a haematologist, paediatrician, nurse and qualified counsellor.




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