CARE MEDICINE SURGERY
DAY CARE IN BLOOD BANK
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
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the treating physician, including the amount of blood to be withdrawn, the frequency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
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
Autologous donations are particularly advantageous for individuals who have
a rare type of blood or antibodies that make it difficult to find compatible
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
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.