Safe

Blood
and
Blood
Products

Module 1 Safe Blood

Donation
Safe
Blood
and
Blood
Products

Module 1 Safe Blood

Donation
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Contents

1 INTRODUCTION TO MODULE 1 1
1.1 The Distance Learning Materials 2
1.2 Before You Begin This Module 3
1.3 Module 1: Safe Blood Donation 4
1.4 Module Objectives 6
1.5 Planning Your Study 8

2 IDENTIFYING LOW-RISK DONORS 11

2.1 Types of Blood Donor 12
2.2 Identifying Unsuitable Donors 17
2.3 Regular Voluntary Non-remunerated Donors 23
2.4 Donor Self-exclusion and Self-deferral 24

3 ESTIMATING BLOOD REQUIREMENTS 28

3.1 Your Locality 29
3.2 Methods of Estimating Blood Requirements 30
3.3 Selecting a Method to Estimate Blood Requirements 32

4 DONOR EDUCATION, MOTIVATION AND RECRUITMENT 35

4.1 Educating Potential Blood Donors 36
4.2 Resources 38
4.3 Communication Methods 41
4.4 Monitoring and Evaluation 48

5 ORGANIZING DONOR CLINIC SESSIONS 52

5.1 Fixed and Mobile Donor Clinics 53
5.2 Planning a Mobile Donor Session 54
5.3 Donor Call-up 56
5.4 Staff and Equipment 59
5.5 Temporary Storage of Collected Blood 61
5.6 Monitoring Mobile Donor Sessions 65
6 BLOOD DONOR SELECTION 69
6.1 Predonation Counselling 70
6.2 The Medical History 72
6.3 The Health Check 77
6.4 Donor Deferral 79
6.5 Monitoring Donor Selection 80

7 THE CARE OF BLOOD DONORS 85

7.1 A Professional and Pleasant Reception 86
7.2 Confidentiality 89
7.3 Venepuncture 91
7.4 Adverse Donor Reactions 92
7.5 Postdonation Care 93
7.6 Postdonation Notification and Counselling 94

8 BLOOD DONOR RECORDS 97

8.1 Essential Donor Records 98
8.2 Using Donor Records 104
8.3 Other Uses of Donor Records 107

9 DONOR RETENTION AND RECALL 111

9.1 Essentials of Donor Retention and Recall 112
9.2 Blood Donor Records 112
9.3 Postdonation Follow-up 114
9.4 Public Relations 116

10 ACTION PLAN 119

10.1 Reviewing Your Progress 120
10.2 Making Your Action Plan 121
10.3 Implementing Your Action Plan 121

Activity Checklists and Answers 125

Answers to Self-Assessment Questions 150

Glossary 154

Appendices 157
Preface

Safe Blood and Blood Products

Safe Blood and Blood Products is a series of interactive learning
materials developed by the World Health Organization (WHO). The
materials have been designed for use in distance learning programmes
in blood safety, although they can also be used for independent study or
as resource materials in conventional training courses and in-service
training programmes.
The learning materials have been produced for staff with responsibility
for donor recruitment and retention, and for the collection, testing and
issue of blood for transfusion. They comprise the following modules:
■ Introductory Module: Guidelines and Principles for Safe Blood
Transfusion Practice
■ Module 1: Safe Blood Donation
■ Module 2: Screening for HIV and Other Infectious Agents
■ Module 3: Blood Group Serology.
The English edition was first published in 1993. French, Spanish,
Russian, Chinese and Portuguese editions have since been produced
and the materials have also been translated into a number of national
languages.
This second, updated edition of the materials has been developed to
reflect changes in transfusion medicine and laboratory technology since
the publication of the first edition.

Distance learning in blood safety

Since the publication of Safe Blood and Blood Products, WHO has held
a series of regional and sub-regional workshops for senior blood
transfusion service personnel from over 100 countries on establishing
national distance learning programmes in blood safety. Programmes
have since been established in every region of the world, using the WHO
learning materials.
Part of the follow-up to the workshops has been the production of
Establishing a Distance Learning Programme in Blood Safety: A Guide for
Programme Coordinators. This provides a practical guide to the planning,
implementation and evaluation of a distance learning programme in
blood safety.
Other WHO learning materials
The Clinical Use of Blood consists of an open learning module and pocket
handbook which provide comprehensive guidance on transfusion and
alternatives to transfusion in the areas of general medicine, obstetrics,
paediatrics and neonatology, surgery and anaesthesia, trauma and
acute surgery, and burns. They are designed to promote a reduction in
unnecessary transfusions through the wider use of plasma substitutes
and more effective prevention and treatment of the conditions that may
make transfusion necessary.
WHO has also published recommendations on Developing a National
Policy and Guidelines on the Clinical Use of Blood which encourage the
use of the learning materials in education and training programmes to
promote effective clinical decisions on transfusion.
Additional learning materials in the Safe Blood and Blood Products series
that are available or in development by the WHO Department of Blood
Safety and Clinical Technology (WHO/BCT) include:
■ Costing Blood Transfusion Services

■ The Blood Cold Chain

■ Blood Collection
■ Blood Components Production.
More detailed information on these materials and other documents and
publications related to blood transfusion is available from WHO/BCT,
which also issues regular reports on evaluations of the operational
characteristics of many commercially available screening assays for
transfusion-transmissible infections.

Information can be obtained from the BCT section of the WHO website
at http://www.who.int/bct or by contacting WHO/BCT at WHO
Headquarters or WHO Regional Offices.

Dr Jean C. Emmanuel
Director, Blood Safety and Clinical Technology
World Health Organization
INTRODUCTION TO MODULE 1

1
Introduction to Module 1

The purpose of this section is to introduce you to Module 1: Safe Blood

Donation which focuses on ways of ensuring safe and adequate supplies
of blood.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Explain the purpose of Module 1.
2 Identify a personal “supporter” who can assist you
throughout your work on this module.
3 Assess your current knowledge, skills and experience in
relation to the objectives of this module.
4 Make a realistic Study Plan for your work on this module.

1
 SECTION 1

1.1 THE DISTANCE LEARNING MATERIALS

Module 1: Safe Blood Donation is part of the series of distance learning
materials, Safe Blood and Blood Products, developed by the World
Health Organization Blood Transfusion Safety team (WHO/BTS). These
materials have been designed to provide access to training for staff
working in blood transfusion services, hospital blood banks and public
health laboratories who have limited opportunities to attend conventional
training courses.
The other modules in this series are:
„ Introductory Module: Guidelines and Principles for Safe
Blood Transfusion Practice
„ Module 2: Screening for HIV and Other Infectious Agents
„ Module 3: Blood Group Serology.
You should already be familiar with the use of these distance learning
materials from your work on the Introductory Module. If you have not yet
read it, it is essential to do so before studying this module so that you
understand how the programme is organized. In particular, make sure
that you read Section 1 which explains the role of your trainer and
supporter and how to use the learning materials, especially Section 1.2
on pages 5– 8 which describes the following features of the modules:
„ module objectives
„ sections
„ learning objectives
„ activities
„ action list and action plan
„ summary
„ self-assessment
„ progress check
„ glossary
„ appendices
„ offprints.

Using Module 1
You should find this module useful if you are a nurse–phlebotomist or a
blood donor recruitment organizer working in a blood transfusion service,
hospital blood bank or the national Red Cross or Red Crescent Society.
You should also find it helpful if you are a member of the laboratory
technical staff and are involved in any aspects of donor recruitment,
donor screening and the collection of blood.
You may also find Module 1 of interest if you are a member of the medical
or laboratory technical staff, such as a hospital medical superintendent
or a senior technologist, and are responsible for training or supervising
staff who are involved in any aspects of donor recruitment and blood
collection. In this case, the module will offer basic refresher and updating

2
INTRODUCTION TO MODULE 1

material for your own use as well as a comprehensive resource that you
can integrate into your own training programmes.
Some sections of this module may be more relevant to your own work
than others. This will depend on where you work and what your job is. For
example, you may work in a blood transfusion service that provides blood
and blood products to all hospitals within easy reach and acts as a
reference centre for those hospitals. If you mainly work in the laboratory,
blood collection may be only a small part of your job. You are unlikely to
be responsible for planning a donor education, motivation and recruitment
campaign, as described in Section 4, or for screening donors, which is
covered in Section 6.
Alternatively, you may work in a small hospital blood bank which provides
blood only for patients in your own hospital. Although some hospital
blood banks obtain blood from the national or regional transfusion
service, others recruit their own donors and collect blood from them. In
this case, you may be responsible for all aspects of donor recruitment,
selection and bleeding in your locality.
The way in which this module will be most useful to you, therefore,
depends on how much of your time you spend working with donors. You
may decide to work through every section and attempt all the activities;
alternatively, you may decide to complete only the sections that relate
directly to your work and simply to read the remainder. Your trainer should
highlight these areas when you plan your work on this module.
Module 1 may contain some material which is new to you. Take as much
time as you need to read through each section and mark anything that
you find difficult. Then go back to those parts and reread them until you
feel sure that you are able to understand them. If you still find them
complicated or are unable to complete some of the activities, seek help
from your trainer, your supporter or another senior colleague. Don’t be
afraid to ask for assistance – what you are learning is extremely
important and will directly benefit the centre in which you work.

1.2 BEFORE YOU BEGIN THIS MODULE

You should already have completed the Introductory Module and may
also have worked through other modules in this series of distance
learning materials. During this period, you should have been in regular
contact with your trainer. You should already have had an opportunity to
discuss the work you will be undertaking on Module 1, but if this has not
yet been possible, contact your trainer before you begin this module.
When you started working through the Introductory Module, you were
asked to identify someone who would act as your personal “supporter”.
You should have been able to find someone who was willing to meet with
you regularly to discuss your progress and provide assistance and
support, particularly when you were developing and implementing your
Action Plan. You now need to choose a supporter for your work on this
module – perhaps the same person or another senior colleague who has
experience in donor recruitment and blood collection.

3
 SECTION 1

ACTIVITY 1

Think about the people with whom you work, particularly your
supervisor and other senior colleagues, who could support you while
you are working through Module 1. Identify one person whom you
think would be willing to spend some time talking to you periodically
about your work on this module and helping you with any problems
that you might face. Remember that it is important to choose
someone who is prepared to discuss your ideas about ways of
improving the service and to assist you in planning and implementing
any changes that you identify as being needed as a result of your
work on this module.
Check that the person you have identified is prepared to help you. If
you have chosen a different supporter from the person you selected
for your work on the Introductory Module, explain how the learning
programme operates and what the role of the supporter involves.
Show this module to your supporter so that he or she becomes
familiar with its content and approach. When you are preparing your
Study Plan, arrange regular meetings to discuss your progress.
If you have any difficulty in finding a suitable supporter in your
workplace, talk to your trainer who will help to find someone to
support you.

Even though your supporter will be your main source of assistance, you
will also find it helpful to discuss your work on this module with other
colleagues, particularly those who are involved in donor recruitment and
blood collection. In addition, you may find it useful to talk to people
outside your own workplace, such as health education officers and staff
from the Red Cross or Red Crescent Society and the national AIDS control
programme. Blood donors themselves are an important source of
information and ideas about how to develop effective strategies for
recruiting and retaining voluntary non-remunerated donors so make use
of all available opportunities to talk to them about ways in which your
service might be improved.

1.3 MODULE 1: SAFE BLOOD DONATION

With the rapid increase in the number of people with transfusion-
transmissible infections, and in particular the human immunodeficiency
virus (HIV), an essential part of the global strategy to ensure supplies of
safe blood is to select healthy donors with a low risk of transfusion-
transmissible infections. Whatever your job, your role in this process is
extremely important. This module is therefore designed to help you to
develop the knowledge and skills needed to ensure that blood donation
is safe, both for donors themselves and for the recipients of their blood.
In particular, it focuses on ways of:
„ reducing the proportion of unsafe blood that is collected
„ building up a panel of voluntary non-remunerated donors

4
INTRODUCTION TO MODULE 1

who are willing to give blood regularly, since these are the
foundation of a safe blood supply.
Section 1: Introduction to Module 1 outlines the contents of the module
and contains activities that are designed to help you to prepare for your
work on it.
Section 2: Identifying Low-risk Donors examines the advantages and
disadvantages of different types of blood donor and emphasizes the
importance of voluntary non-remunerated donors for a safe and adequate
blood supply. It also looks at risk behaviour and the transmission of HIV
infection and explores ways of identifying sources of safe blood.
Section 3: Estimating Blood Requirements introduces three simple
methods of calculating the amount of blood required to meet the needs
of your locality.
Section 4: Donor Education, Motivation and Recruitment explores ways
of improving the safety and adequacy of the blood supply by developing
an appropriate education, motivation and recruitment campaign to
attract voluntary non-remunerated donors.
Section 5: Organizing Donor Clinic Sessions deals with planning and
organizing fixed and mobile donor clinics and with evaluating the
effectiveness of blood donor sessions.
Section 6: Blood Donor Selection focuses on procedures for screening
donors in order to ensure their own safety as well as the safety of the
recipients of their blood, including predonation counselling, the medical
history, the health check and donor deferral.
Section 7: The Care of Blood Donors looks at ways of ensuring that all
donors receive a high standard of care before, during and after donating
blood and that the experience of donation is safe, efficient and pleasant
for them.
Section 8: Blood Donor Records considers the various types of donor
record and their uses and asks you to explore ways of improving the
effectiveness of record-keeping in your centre.
Section 9: Donor Retention and Recall focuses on ways of encouraging
voluntary non-remunerated donors to give blood regularly.
Section 10: Action Plan is the final section in which you are asked to
review all the ideas you have included in your Action List and to prepare
an Action Plan as a basis for improving working practices in your blood
collection centre. You will find the Action List for Module 1 on page 122.
The sections in this module follow a logical sequence in the establishment
of an effective blood collection programme. However, depending on the
stage of development of your own programme, you may prefer to study
them in a different order and to focus initially on the sections that relate
most directly to your current work. For example, if your blood bank still
depends on family or family replacement donors rather than on voluntary
non-remunerated donors, you may decide to leave Sections 4 and 9 on
donor recruitment and retention until you have completed the other
sections.

5
 SECTION 1

Before starting work on this module, therefore, you should identify any
sections which cover tasks that are not undertaken in your centre or that
you do not currently perform. Discuss them with your trainer before you
draw up your Study Plan and decide on the most appropriate sequence
for your study of this module.

1.4 MODULE OBJECTIVES

There are eight overall objectives for this module which specify what you
should be able to do as a result of reading the text, answering the self-
assessment questions, completing the activities and preparing your
individual Action Plan.
When you have finished working through this module, you should be able
to achieve the following objectives:
Section 2
Identify low-risk donor populations and explain the importance
of encouraging potentially unsafe donors to self-exclude.
Section 3
Estimate the number of donors needed to meet the blood
requirements of your locality.
Section 4
Develop an effective education, motivation and recruitment
campaign to increase the number of voluntary non-remunerated
blood donors.
Section 5
Plan and organize fixed and mobile donor clinic sessions.
Section 6
Develop and maintain effective donor selection procedures.
Section 7
Provide a high standard of care for donors before, during and
after donation.
Section 8
Maintain an efficient donor record-keeping system.
Section 9
Develop an effective system for retaining regular voluntary non-
remunerated donors.

ACTIVITY 2

Before you begin work on Section 2, you will find it helpful to assess
your current level of knowledge, skill and experience in relation to the
module objectives and to decide what you want to achieve by working
through the module. Look carefully at the objectives and, for each
one, decide whether you have:
1 A high level of knowledge, skill and experience.
2 A reasonably good level of knowledge, skill and experience.

6
 INTRODUCTION TO MODULE 1

Rating
Module objectives (1–4) Comments

Section 2
Identify low-risk donor populations and explain
the importance of encouraging potentially unsafe
donors to self-exclude.
Section 3
Estimate the number of donors needed to meet
the blood requirements of your locality.
Section 4
Develop an effective education, motivation and
recruitment campaign to increase the number of
voluntary non-remunerated blood donors.
Section 5
Plan and organize fixed and mobile donor clinic
sessions.
Section 6
Develop and maintain effective donor selection
procedures.
Section 7
Provide a high standard of care for donors
before, during and after donation.
Section 8
Maintain an efficient donor record-keeping
system.
Section 9
Develop an effective system for retaining regular
voluntary non-remunerated donors.

3 Some knowledge, skill and experience.

4 Little or no knowledge, skill or experience.
The objectives are repeated in the table above. Note down your rating
(1, 2, 3 or 4) for each objective and add any comments you wish to
make. Note any objectives that relate to areas of work that you do not
currently undertake.

You have now identified the areas which will be mostly revision for you
and the areas to which you need to pay particular attention. The module
objectives are designed to help you to assess your own progress. When
you reach the end of the module, you will be asked to look back at them
to check whether you feel that you have achieved them. The most
important question to ask yourself then is whether you feel that you can
do your job better as a result of your work on this module. If you feel that
you would like to improve your knowledge, understanding and skills

7
 SECTION 1

further, think carefully about the topics you would like to learn more
about. Then talk to your supporter, supervisor or trainer about how you
can achieve this.

1.5 PLANNING YOUR STUDY

Since you should already have completed the Introductory Module, you
should be able to make a reasonable estimate of the amount of time that
you will need to spend on Module 1. The activities are likely to be time-
consuming, but remember that you will be able to complete most of them
during the course of your normal work.

ACTIVITY 3

Look quickly at the other sections in this module to get an idea of the
content, level and approach and to assess how much of the material
is likely to be new to you. Also look at some of the activities to
assess the kind of work that will be involved.
Try to estimate how much time you will need to study each section,
including answering the self-assessment questions and completing
the activities. Remember that you will also need to allocate time to
meet with your supporter and trainer and to prepare your Action Plan.
Then talk to your supervisor about the amount of time you could be
allocated each week, or each month, for your work on Module 1.
Now fill in the Study Plan on page 9. Copy the ratings of your
knowledge, skills and experience from Activity 2 as they are an
indication of how much time you will need to spend on each section.
Then add the dates by which you plan to complete each section,
taking into account your current knowledge, skills and experience in
relation to each module objective and the time you are likely to have
available for study. When you have arranged dates for meetings or
other contact with your trainer and supporter, add these to your Study
Plan.

SUMMARY
1 Module 1 emphasizes the recruitment of regular, voluntary
non-remunerated blood donors as the foundation of a
safe and adequate supply of blood.
2 You should identify a personal supporter to provide
ongoing support while you work through this module.
3 Before starting work on Module 1, you should review your
knowledge, skills and experience in relation to the module
objectives.
4 A realistic Study Plan will help you to organize your work
on this module.

8
 INTRODUCTION TO MODULE 1

STUDY PLAN

Meeting dates
Rating Planned completion
Section (1 to 4) dates with trainer with supporter

Section 2
Identifying Low-risk Donors

Section 3
Estimating Blood
Requirements

Section 4
Donor Education,
Motivation and
Recruitment

Section 5
Organizing Donor Clinic
Sessions

Section 6
Blood Donor Selection

Section 7
The Care of Blood
Donors

Section 8
Blood Donor Records

Section 9
Donor Retention and
Recall

Section 10
Action Plan

Notes

9
 SECTION 1

PROGRESS CHECK

Before moving on to Section 2, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 1. These were to:
1 Explain the purpose of Module 1.
2 Identify a personal “supporter” who can assist you
throughout your work on this module.
3 Assess your current knowledge, skills and experience in
relation to the objectives of this module.
4 Make a realistic Study Plan for your work on this module.
If you feel confident that you have understood everything, turn
to Section 2. If you feel that you need more information about
Module 1 or the learning programme as a whole, contact your
trainer to discuss anything you are unsure about or talk to your
supporter.

10
IDENTIFYING LOW-RISK DONORS

2
Identifying Low-risk Donors

The purpose of this section is to compare the advantages and

disadvantages of different types of blood donor and to illustrate the
importance of regular, voluntary, non-remunerated blood donors for a
safe and adequate blood supply. In this section, you will look particularly
at risk behaviour and the importance of encouraging self-exclusion and
self-deferral by unsuitable donors.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Estimate the proportion of different types of blood donor
attending your donor clinics.
2 Identify the most common forms of risk behaviour in your
locality.
3 Assess the prevalence of HIV among donors in different
age groups in your locality.
4 Estimate the proportion of regular donors attending your
donor clinics.
5 Review the approaches used in your centre to encourage
self-exclusion, self-deferral or confidential unit exclusion
by donors who are unsuitable to donate blood.

11
 SECTION 2

2.1 TYPES OF BLOOD DONOR

There are basically three types of blood donor. These are:
1 Family or family ‘replacement’ donors
2 Paid commercial or professional donors
3 Voluntary, non-remunerated (unpaid) donors

Family or family replacement donors

family or family
replacement donor: Replacement donation is a common practice in many countries. In this
A donor who gives blood system, the blood needed by a patient is supplied by one or more donors
when it is required by a from within the patient’s own family or community. In most cases, the
member of the donor’s patient’s family is requested to donate blood but, in some countries, it
family or community.
is compulsory for every patient to provide a specified number of donors
directed donation: on admission to hospital. Donors are not paid by the blood transfusion
A donation that is given service or hospital blood bank, although they may sometimes be given
specifically for transfusion
to a named patient.
money or another form of payment by the patient’s relatives.
There are two basic forms of this system. The first is where the family
donates the same quantity of blood as that given to their relative. This
blood is added to the general pool in the blood bank and is then used as
required. The donor is not told the identity of the recipient of the blood.
directed donation
A second variation is known as ‘directed donation’, where a donor
specifically requests that their blood is given to a named patient,
perhaps because of fears about the safety of blood from unknown
donors. However, directed donations are strongly discouraged by WHO.
In Minimum Targets for Blood Transfusion Services (WHO, 1989) it is
clearly stated that:

If family or “replacement” donors are used their donations

should be to the transfusion service and not “directed” to
named recipients. Care must be taken to ensure that this is
not a hidden (remunerated) system.

Advantages
Family or family replacement donation can be useful because it helps to
meet a need for blood where voluntary non-remunerated donors are not
available. In addition, once replacement donors recognize that their
blood has helped to save the life of their relative, they may be willing to
become regular, voluntary donors so that other patients will also benefit
in the future. Ways of establishing a panel of voluntary non-remunerated
donors are covered in detail in later sections.

Disadvantages
Unfortunately, there are also disadvantages to the system of replacement
donation.
1 Patients or their relatives are expected to find replacement
donors. This puts additional responsibility and stress on
them at a time when they are already under strain
because of the patient’s illness.

12
 IDENTIFYING LOW-RISK DONORS

2 There is pressure on members of the family unit to give

transfusion-
transmissible infection: blood, even when they may be unsuitable to do so, either
An infection that is capable because of their health status or because of the risk of
of being transmitted by transfusion-transmissible infection
infection.
blood transfusion.
3 The blood given to patients will not necessarily be replaced
in type or quantity. Where a transfusion is required for an
adult, it is likely that several units of blood will be needed.
A donation from one or two family members may not be
sufficient to replace the blood used. As a result, the blood
needs of the community may not be met adequately.
4 Relatives who cannot find suitable donors within the
family unit – or who are unwilling to give blood – may seek
donors who are prepared to give their blood for payment.
We shall discuss the disadvantages of paid donors
shortly.

Research undertaken in a number of countries has shown that blood

from family or family replacement donors is found to be unsuitable more
often than blood from unpaid voluntary donors. This is to be expected
because people who give blood under pressure or for payment by the
patient’s family are less likely to reveal any reasons why they may be
unsuitable as donors. As a result, they present a potentially greater risk
to the safety of the blood supply.

Where family or family replacement donors are used, therefore, it is

essential to ensure that appropriate screening and selection procedures
are always maintained, including:

1 Screening all donors before donation, in order to ensure

that they meet the normal criteria set for low-risk donors
(see Section 6).
2 Informing donors that their blood will be placed in the
blood bank and will not necessarily be given to their
relative or any other named patient.
3 Ensuring that the handling of family or family replacement
donors is under the control of donor clinic or blood bank
staff, not hospital or ward staff.

commercial or
Commercial or professional donors
professional donor: Commercial or professional donors receive money or other rewards
A donor who gives blood (which can be exchanged for money) for the blood that they donate. They
in return for money or often give blood regularly and may even have a contract with a blood bank
other form of payment.
to supply blood for an agreed fee. Alternatively, they may sell their blood
to more than one blood bank or approach patients’ families and try to sell
their services as replacement donors.
Commercial or professional donors are usually motivated by what they
will receive for their blood rather than by a wish to help other people. It
may be possible, however, to persuade them to become voluntary non-
remunerated donors, although it is always essential to ensure that they
meet the national criteria for low-risk donors through careful screening.

13
 SECTION 2

Disadvantages
There are major disadvantages to paying donors for their blood.
1 Paying donors to give blood undermines the voluntary non-
remunerated donation system which is the foundation of
a safe blood supply.
2 Many commercial donors come from the poorer sectors of
society where the need for money drives them to sell their
blood. They may be in poor health, undernourished or at
risk of transfusion-transmissible infections which would
endanger the lives of the recipients of their blood.
3 Commercial donors may donate their blood more frequently
than is recommended. This may have harmful effects on
their own health, with the result that they may supply
substandard units of blood which could either present a
risk to the recipients or provide little or no benefit.
4 If donors are paid, it is usually necessary to charge
patients for the blood they receive. Poor families may not
be able to afford to pay for blood when they need it.

Voluntary non-remunerated donors

voluntary non-
remunerated donor: A Voluntary non-remunerated donors are people who give blood, plasma or
donor who gives blood, other blood components of their own free will and receive no money or
plasma or other blood other form of payment for it which could be considered a substitute for
components freely and
money, such as time off work except that reasonably needed for the
voluntarily without
receiving payment in the donation and travel. Their primary motivation is to help unknown
form of money or a recipients and not to obtain any personal benefit.
substitute for money.
The following items are not normally considered as payments or substitutes
for money:
„ small tokens of recognition or appreciation, such as
badges or certificates, that have no commercial value
„ reimbursement of the direct costs of travel that was
specifically undertaken in order to donate blood
„ light refreshment immediately before, during or after a
donation.

Advantages
Voluntary non-remunerated blood donors have the following very important
advantages over other types of donor.
1 Voluntary non-remunerated donors are not under pressure
to give blood and are therefore more likely to meet the
national criteria for low-risk donors.
2 They are more likely to be willing to donate blood regularly,
which is important in maintaining adequate supplies of
blood.
3 Regular donors are more likely to be free from transfusion-
transmissible infections because they have been educated

14
IDENTIFYING LOW-RISK DONORS

about the importance of safe blood and are screened

each time they attend to give blood.
4 They are more likely to respond to an appeal for blood
donors during an emergency because they have already
expressed a commitment to voluntary blood donation.
World Health Assembly Resolution 28.72 of 1975 urged Member States
to:

Promote the development of national blood services based

on the voluntary non-remunerated donation of blood.

This means that the target for every country should be to ensure that all
blood donors are voluntary and non-remunerated. How far is your country
from achieving this target? In the next activity, you will look at the
proportion of different types of donor in your own locality.

ACTIVITY 4

Study the records of blood donors attending your blood transfusion

centre or hospital blood bank over the past six months. In the table
below, write down the number of each type of donor for this period.
Then calculate the percentage of each type of donor, as follows:

Number of replacement donors

x 100 = % of replacement donors
Total number of donors
Calculate the percentage of commercial donors and voluntary non-
remunerated donors in the same way.
If you are unable to obtain this information, try to estimate the
percentage of each type of donor from your own experience.

Type of donor No. % of total

Family or family replacement

Commercial/professional

Voluntary non-remunerated

Total

Find out from your Ministry of Health what the national policy is on
recruiting family or family replacement donors and commercial
donors. Also try to find out the proportions of different types of donor
in your country as a whole.

15
 SECTION 2

How safe do you think your blood supply is likely to be? Remember that
the higher the proportion of family or family replacement donors or
commercial donors, the greater the risk to the safety and adequacy of the
blood supply.
There are two basic approaches to identifying safer donors which should
always be used together:
„ avoiding unsuitable donors, particularly individuals at risk
of contracting any transfusion-transmissible infection
„ recruiting regular, voluntary non-remunerated donors.
In blood transfusion practice, the term low-risk donors is commonly used
low-risk donor: The term
commonly used in blood to describe donors who have a low risk of contracting an infection that
transfusion practice to could be transmitted by blood transfusion. Remember, however, that
describe a donor who is at careful screening of both donors and their blood is always essential, even
low risk for transfusion- with regular, voluntary non-remunerated donors.
transmissible infections.
Before examining these two approaches in detail, it is necessary to
therapeutic phlebotomy:
The collection of blood
mention two other types of blood collection – therapeutic phlebotomy
from patients in order to and preoperative donation – although these cannot strictly be called
improve their own health. donations since their purpose is not to add to the national supply of
blood.
autologous transfusion:
The transfusion of any
blood component that was
donated by the intended Therapeutic phlebotomy
recipient. Therapeutic phlebotomy is the collection of blood from patients in order
alloimmunization: The to improve their own health, usually because of a blood disorder leading
immune response in which to an abnormally high red cell count (haemoglobin level). Patients with
an antibody is produced such disorders do not qualify as being medically fit to be blood donors,
when a body meets a even though their high haemoglobin level may be their only clinical
foreign antigen. problem. Blood from these patients is therefore not normally used for
transfusion.

Autologous transfusion
The term autologous transfusion describes the transfusion of any blood
component that was donated by the intended recipient.
Recipients who serve as their own donors receive the safest possible
transfusion since the risks of transfusion-transmitted infection and
alloimmunization are eliminated.
Autologous transfusion also provides benefits to a blood transfusion
service or hospital blood bank because it ensures that blood is available
for patients even where the supply of compatible blood is otherwise
limited. Where units are not used for autologous transfusion, they can
be added to the homologous supply, provided that the donor–patient
meets the standard criteria for blood donors.
Wherever there are national guidelines on autologous transfusion, they
should always be followed. If you are unaware of any guidelines in your
country, contact the national blood transfusion service or the Ministry of
Health to find out whether any are available.

16
 IDENTIFYING LOW-RISK DONORS

2.2 IDENTIFYING UNSUITABLE DONORS

It is essential to be aware of the reasons why certain individuals may be
unsuitable as blood donors because their blood may present a risk to the
patients who receive it. These factors may include:
1 Poor health and nutritional status of donors
Blood donation by people who are suffering from nutritional
deficiency or other health problems poses a threat to their
own health, as well as to that of the recipients of their
blood. They may not meet minimum clinical criteria such
as weight or haemoglobin level and may also be more
likely to faint during or after the bleed. Where there is a
high level of poor nutrition or other conditions leading to
poor health in a given population, there will also be a high
proportion of unsuitable donors. It may not be cost-
effective to attempt to recruit donors from such
populations.
2 Non-voluntary donation
The ideal source of blood for a transfusion service is
voluntary non-remunerated donors. Blood donation in
institutions such as the army, the police and prisons is
unlikely to be purely voluntary since donors may have
been ordered to give blood. In the case of prisons, in
particular, the possibility of receiving postdonation
comforts may be an important incentive that detracts
from true voluntary blood donation ethics. Individuals
from such institutions may, however, be accepted as
donors in a normal voluntary donor clinic provided that
they fulfil the national criteria set for safe blood donation.
Donors from prisons and other institutions may have
infectious disease higher levels of infectious disease markers in their
markers: The detectable communities. Careful donor screening and selection is
signs of infection appearing therefore particularly important in these populations.
in the bloodstream during,
or following, infection. In addition, the aim of a blood transfusion service should
always be to recruit voluntary donors who give blood
regularly. Personnel in institutions may not always be
available because of their duties; for example, army or
police personnel may be transferred to other areas.
3 Blood donor risk behaviour
Certain social behaviour may expose donors to the risk of
acquiring infections, such as HIV, which can then be
transmitted to the recipients of their blood. Risk behaviour
is particularly important because of the growing incidence
of HIV and AIDS and we shall therefore consider it in
detail.

Transmission of HIV infection

The transmission of HIV infection is covered more fully in Section 3 of
Module 2: Screening for HIV and Other Infectious Agents. In brief,
however, there are only three main routes of transmission of HIV
infection:

17
 SECTION 2

1 Unprotected penetrative sexual contact with an infected

person, either between men or between men and women.
2 Inoculation of infected blood through:
„ blood transfusion or the infusion of blood products
„ needlestick injuries
„ the reuse of contaminated needles, syringes or knives:
for example, in injecting drug use, body-piercing,
scarification, tattooing or blood rituals.
3 Transmission of infection from an infected mother to her
child through:
„ infection of the developing fetus during pregnancy
„ infection of the infant at birth through cervical
secretions containing the virus
„ breastfeeding.

risk behaviour: Risk behaviour

Behaviour that exposes a Potential donors often do not realize how their own behaviour can
person to the risk of increase their risk of contracting HIV or other transfusion-transmissible
acquiring transfusion- infections, so it is essential to educate them about the dangers, both to
transmissible infections.
themselves and to anyone receiving their blood. The more sexual
partners that a donor has, for example, the higher the risk that they will
acquire a sexually-transmitted infection. Injecting drug use is a direct
route of acquiring bloodborne infections, such as HIV, and is a major form
of risk behaviour in some communities.
The most common types of risk behaviour include:
„ having more than one sexual partner
„ prostitution (commercial sex)
„ homosexuality (men having sex with other men): in some
countries, however, men who have sex with other men
may not consider themselves to be homosexual if they are
the active partner rather than the passive partner.
„ bisexuality (men having sex with both men and women)
„ injecting drug use
„ skin scarification, tattooing and blood rituals
„ being the sexual partner of anyone engaging in any form
of risk behaviour.
Each country should define the criteria for identifying the lifestyles and
behaviours that expose potential donors to the risk of acquiring transfusion-
transmissible infections. This is important for two reasons:
1 To inform potential donors about the behaviour that would
make them unsuitable to donate blood because of the
risk of acquiring transfusion-transmissible infections and
transmitting them to the recipients of their blood.

18
IDENTIFYING LOW-RISK DONORS

2 To assist donor clinic staff and health educators to

develop strategies for identifying and deferring potential
donors who may be at risk of transmitting transfusion-
transmissible infections through their blood.
If you do not have copies of any national or local guidelines, contact your
national blood transfusion service or national AIDS control programme
for information since it is essential to know the criteria set in your country
for defining risk behaviour.

ACTIVITY 5

Think about the types of risk behaviour that are common in your
locality. Using the table below, tick the relevant boxes to identify the
kinds of risk behaviour that:
„ are common
„ sometimes occur, perhaps amongst particular groups of people
or in particular areas
„ are rare.

Sometimes
Risk behaviour Common Rare
occurs
More than one sexual partner

Prostitution

Homosexuality (men having sex

with men)

Bisexuality (men having sex with

both men and women)

Injecting drug use

Skin scarification/tattooing/
blood rituals

Sexual partner of above

Then find out whether there is a similar pattern of risk behaviour in

the rest of your country.
In order to complete this activity, you may need to consult your
records and talk to your colleagues or perhaps to contact your local
health education officer. You may also need to consult the Ministry of
Health since your area may not be typical of your country as a whole.

19
 SECTION 2

If you live in a city, for example, injecting drug use may be more
common than in rural areas.

You have now identified the most common forms of risk behaviour in your
locality. This information will be important in helping you to identify
donors who are at high risk for transfusion-transmissible infections and
will indicate the issues that should always be covered thoroughly in the
screening of donors (we shall focus on donor selection in Section 6).
Information about risk factors should also be included in all donor
education activities and in predonation counselling to discourage anyone
who engages in any form of risk behaviour from donating blood.

Effects of risk behaviour on blood safety

It is very important to defer donors or to encourage them to self-exclude
or self-defer – that is, to decide not to give blood – if they have engaged
in any risk behaviour. This is because it is impossible to know whether
they have recently acquired a transfusion-transmissible infection which
laboratory tests may not yet be able to detect. We shall return to the issue
of self-exclusion and self-deferral later in this section.
Look at Figure 1, below, which shows that there is a period of time
between infection by HIV and the development of antibodies. This is often
window period: The window period
referred to as the “window period”. It is not possible to identify whether
period between infection a person has been infected until the antibodies can be detected. Unlike
by HIV and the tests for hepatitis B, routine HIV tests are based on the presence of
development of detectable
antibodies.
detectable HIV antibody levels (anti-HIV), not antigen. (This is discussed
in more detail in Section 3 of Module 2.)
The presence of detectable antibodies and therefore the exact duration
of the “window period” varies with each individual. Some research
papers report that antibodies are present as early as 14 days or more
after infection while others indicate that they may not be present until 28
days or more after infection. This means that even if laboratory tests
indicate that a donor is not infected by HIV, there is still a risk that the
donor has recently contracted the virus and that it will be transmitted to
the recipient of the blood. The risk to patients increases if donors are not
properly informed about the “window period” and wrongly assume that
their blood is safe because they have no clinical signs or symptoms of
disease.

Window
HIV antibody level

period Anti-HIV

Time
Point
of
Figure 1: The “window period” infection

20
 IDENTIFYING LOW-RISK DONORS

Tests are now available that can detect the HIV antigen during the HIV
antibody “window period”. These tests are generally too expensive for
use in most countries but, even if they were inexpensive and relatively
accessible, they would not solve the problem of the “window period”
completely. There will always be a time span between the contraction of
an infection and the development of serologically detectable factors
(antigen or antibody) of the infection.

Seroprevalence
epidemiology: The study Studies of the epidemiology of HIV show the following general trends in
of the occurrence, seroprevalence which relate to sexual activity:
distribution and spread of
infection and disease in 1 HIV seroprevalence is lower in people under the age of 20.
the population.
2 HIV seroprevalence is higher in the 20–45 year age group.
seroprevalence: The
proportion of a specific 3 HIV seroprevalence is also lower in people above 45 years
population that are
of age.
infected with the
infectious agent at any
In theory, therefore, people in the age groups below 20 and above 45
particular time.
years are safer than those in the 20–45 year age group and should be
the main target groups for donor recruitment. In practice, blood is not
normally taken from people below 18 years of age or above the age of
65. Remember, however, that people aged below 20 or more than 45 are
not necessarily safe and that people between 20 and 45 years of age are
not necessarily at risk. Even if particular age groups are targetted,
therefore, it is essential to follow all normal donor screening and
selection procedures, whatever the age of a donor.
It is vitally important for every centre that collects blood to try to identify
safe donor groups by:
1 Assessing the seroprevalence of transfusion-transmissible
infections among existing and past donors from different
communities, work environments, and age and sex groups.
2 Assessing the epidemiological data for transfusion-
transmissible infections produced by the Ministry of
Health in order to identify relatively safe communities,
work environments, age and sex groups from which to
draw blood.

ACTIVITY 6

Look at the table on page 22. In the top row, write the names of
three different places where your service has collected blood during
the last year. Choose places where a relatively large volume was
collected.
Look at the records on the donor sessions that were held in these
places during the last year. Then, for each location, find out:
„ the total number of donors in each age group: under 20,
between 20 and 45 years and over 45

21
 SECTION 2

LOCATION 1 LOCATION 2 LOCATION 3

Under 20 20–45 Over 45 Under 20 20–45 Over 45 Under 20 20–45 Over 45

Total number of donors

Number of HIV positive

donors

Percentage of HIV
positive donors

„ the total number of donors in each age group who were

found to be HIV-positive by laboratory screening tests.
Calculate the percentage of HIV-positive donors in each age group at
each location, as follows:
Number of HIV-positive donors
x 100 = % of HIV-positive donors
Total number of donors
Which age groups in your locality have the highest HIV sero-
prevalence? What are your conclusions about the results?
Try to obtain some epidemiological data on transfusion-transmissible
infections in your country from your Ministry of Health. Compare these
data with the percentages you have just calculated and note down
your observations.
What do the Ministry of Health data add to your own thoughts on
identifying safer donor groups? Can you suggest any further data that
your service should routinely collect and use to identify potentially
safe sources of blood? If so, note your ideas down on your Action
List.

If you divide your results for Activity 6 further into new and regular donors
for each age range, you may notice that the seroprevalence of HIV is
higher in new donors in the 20– 45 year age group than among regular
donors. You may wish to try out this calculation. The reason for this may
be that new donors often do not fully understand why some people are
unsuitable to give blood or that they are donating under pressure,
perhaps because they are family donors. On the other hand, they may
donate blood to find out whether they are HIV-positive, particularly if there
is no free and confidential HIV testing centre in the community.
Some countries have now introduced a policy under which donated blood
from new adult donors is not transfused, even if it tests negative for all

22
 IDENTIFYING LOW-RISK DONORS

transfusion-transmissible infections. Can you think why? There are two

reasons for this.

incidence: The proportion The first reason is that the incidence of HIV is likely to be at least 10 times
of a specific population higher among new donors than regular donors. There is therefore a higher
becoming newly infected risk of a new, or once-only, donor being in the “window period” than a
by an infectious agent regular blood donor.
within a certain period of
time. The second reason is that there may be a higher HIV seroprevalence
among new donors than regular donors. There is therefore a higher risk
that donated blood from a new donor may be in the “window period” and
so may be potentially infectious, but undetectable by laboratory tests.
For both of these reasons, it is important to build up a panel of regular,
voluntary non-remunerated blood donors.

2.3 REGULAR, VOLUNTARY NON-REMUNERATED DONORS

You have already considered the advantages of voluntary non-remunerated
blood donors over other types of donor. Voluntary non-remunerated blood
donors who give blood regularly are considered to be donors at the lowest
risk of all because their blood is tested frequently and they are less likely
to attend the donor clinic if they know that they have engaged in any risk
behaviour. Since they donate blood regularly, they help to ensure that
there is normally an adequate supply of blood, but they can also usually
be relied on to donate blood in emergencies.
Blood transfusion services and hospital blood banks should therefore
regular donor: A donor always encourage donors to become regular donors
donors. It is internationally
who has given blood at accepted that men can donate blood every three months and that women
least three times and who
can donate every four months, without any ill-effects on their own health.
continues to donate blood
at least once a year. Individuals who have given blood at least three times and who continue
to donate at least twice a year (or whenever called on to do so) can be
regarded as regular donors. Some centres use stricter criteria to define
regular donors. They may, for example, require donors to give blood at
least two or three times a year before they can be considered regular
donors.

ACTIVITY 7

Study the records of blood donors attending your donor clinic over the
past year. From these records, find out the number of regular donors
who gave blood during this period: that is, the number of donors
whose records show that they had donated three times previously and
at least once during the last year. Then work out the percentage of
regular donors, as follows:
Number of regular donors
x 100 = % of regular donors
Total number of donors
If you do not have this information, try to estimate the percentage of
regular donors.

23
 SECTION 2

Do you think that sufficient numbers of regular donors attend your

donor clinic to ensure a safe and adequate supply of blood?

Use the information that you have collected for Activities 4 and 7 as your
baseline to measure future progress in developing a panel of regular,
voluntary non-remunerated donors. We shall consider ways of recruiting
and retaining regular voluntary non-remunerated donors in Sections 4
and 9.

2.4 DONOR SELF-EXCLUSION AND SELF-DEFERRAL

self-exclusion: The
decision by a potential Encouraging donor self-exclusion and self-deferral is a very important
donor not to give blood
because they have
part of recruiting donors whose blood is likely to be safe. Self-exclusion
engaged in risk behaviour means that potential donors make the decision not to give blood
or because of the state of because they recognize that their blood may be unsafe for the recipient
their own health. as a result of risk behaviour or because of the state of their own health.
self-deferral: The Self-deferral means that they wait until the condition that makes them
decision by a potential unsuitable has resolved.
donor to wait until a
condition that makes Every transfusion service has a responsibility to educate existing donors
them unsuitable has and the general public, who are potential donors, about the importance
resolved. of avoiding risk behaviour. It is also essential to train donor clinic staff
to counsel donors about risk behaviour and to encourage them to self-
exclude if they have engaged in any behaviour that may have exposed
them to the risk of transfusion-transmissible infection.
Let us look in more detail at why it is very important to give clear
explanations about risk behaviour to all existing and potential donors.
1 They may not understand what behaviour exposes them
to possible infection. As a result, they may not realize the
risks to their own health or that their blood could be
dangerous for the patient who receives it.
2 They may not know that, if they engage in risk behaviour,
they may transmit an infection to the recipient of their
blood – even if they have no clinical evidence of infection.
3 They may come to donate blood because of pressure from
other people, such as their family, friends or colleagues,
even when they think that their blood may not be safe. For
this reason, potential donors should be informed of the
importance of circumventing or overcoming this pressure
without telling anyone why they do not wish to give blood.
Potential donors are often reluctant to ask questions in public about why
certain people should not give blood, so information about self-exclusion
and self-deferral should be included in every talk and discussion and in
all educational materials, as well as in predonation counselling. The
information given should include:
„ how people can contract infections that can be transmitted
through blood

24
 IDENTIFYING LOW-RISK DONORS

„ how to recognize the clinical symptoms of HIV/AIDS

„ the significance of the ‘window period’ and why people
who are at risk of contracting transfusion-transmissible
infections should not give blood
„ why people who already have a transfusion-transmissible
infection should not give blood
„ why people with other sexually transmitted diseases
should not give blood
„ why there is no risk to blood donors of infection by HIV or
any other infectious disease through giving blood.
Blood transfusion staff must give uniform and consistent advice in order
to avoid confusion among potential donors. Cooperation between different
health agencies, including health educators and AIDS educators, will
help to ensure that everyone is given the same message.
If you do not have any leaflets or posters available to educate donors
about self-exclusion and self-deferral, try to find out whether any exist in
your country. Materials of this kind may already have been produced by
the national blood transfusion service, the national Red Cross or Red
Crescent Society, the health education unit in the Ministry of Health or
the national AIDS control programme. They should be able to supply you
with copies that you can distribute to donors.
If no suitable educational materials are available in your country, you may
be able to encourage one of these organizations to produce a leaflet or
poster giving the relevant information. If this is not possible, talk to your
senior colleagues about how you could develop some material for local
use. Look at an example of a simple information leaflet for donors,
Important Information about AIDS for Those Who Wish to Give Blood,
produced by a blood transfusion service in Africa. You will find this in
Appendix 1 on page 159 of the module. We shall consider the use of
educational materials in Section 4 and will return to the subject of self-
exclusion and self-deferral in Section 6.

Confidential unit exclusion

Some donors may be unwilling to self-exclude or self-defer, even if they
know that their blood might be unsafe, because they do not want other
people to know why they are reluctant to give blood. For example, if you
are visiting a local factory to collect blood, some people may donate
because their friends or their supervisors expect them to do so. They may
be worried that, if they refuse, others may suspect that they are HIV-
positive and will be hostile towards them. This is known as ‘peer group
pressure’.

confidential unit Because of this, it is important to give all donors the opportunity to tell
exclusion: The removal clinic staff in confidence to remove and dispose of the blood they have
and disposal of a unit of donated. This is called confidential unit exclusion
exclusion. Each service should
blood after donation at have a policy on this which should be followed by all staff. Strict
the request of the confidentiality must always be maintained when donors ask for unit
donor.
exclusion.

25
 SECTION 2

ACTIVITY 8

What approaches are used in your centre to encourage self-exclusion,

self-deferral and confidential unit exclusion, where appropriate?
Can you suggest any ways in which you could further encourage
unsuitable donors not to give blood? If so, note your ideas on your
Action List.

SUMMARY
1 Regular, voluntary, non-remunerated donors are safer
than family or family replacement donors and commercial
or professional donors.
2 People who give blood under pressure or for payment are
less likely to reveal their unsuitability as donors. They are
therefore a risk to the safety of the blood supply.
3 Potential donors may be unsuitable to give blood because:
„ they are in poor health
„ they are not giving blood voluntarily
„ their behaviour exposes them to the risk of transfusion-
transmissible infections.
4 It is not possible to detect HIV antibodies during the
“window period”.
5 HIV seroprevalence is generally higher in new donors than
among regular donors.
6 Every blood transfusion service and hospital blood bank
should be aware of national criteria for identifying low-risk
donor groups and, therefore, potentially safe donors.
They should concentrate on finding donors from among
these groups by:
„ avoiding unsuitable donors
„ recruiting regular, voluntary non-remunerated donors.
7 Potential donors who have engaged in risk behaviour or
who are in poor health should be encouraged to self-
exclude or self-defer. Donor clinic staff should always
provide opportunities for donors to ask for confidential
unit exclusion. In such cases, strict confidentiality must
always be maintained.

SELF-ASSESSMENT

1 What are the disadvantages of using paid commercial or

professional donors?

26
IDENTIFYING LOW-RISK DONORS

2 Identify at least three types of behaviour that pose a risk to

the safety of the blood supply.
3 In which age group is HIV seroprevalence generally higher?

PROGRESS CHECK

Before moving on to Section 3, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 2. These were to:
1 Estimate the proportion of different types of blood donor
attending your donor clinics.
2 Identify the most common forms of risk behaviour in your
locality.
3 Assess the prevalence of HIV amongst donors in different
age groups in your locality.
4 Estimate the proportion of regular donors attending your
donor clinics.
5 Review the approaches used in your centre to encourage
self-exclusion, self-deferral or confidential unit exclusion
by donors who are unsuitable to donate blood.
If you feel confident that you have understood everything in
this section, turn to Section 3.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

27
 SECTION 3

3
Estimating Blood
Requirements

The purpose of this section is to help you to make reasonably accurate

estimates of the amount of blood required for use by your blood
transfusion service or hospital blood bank. It is important to know how
much is likely to be needed so that you can plan blood collection
systematically in order to avoid either an excess or a shortage of blood.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Identify the main features of the geographical area served
by your blood transfusion service or hospital blood bank,
including the sites at which blood is collected and the
hospitals to which it is distributed.
2 Review the system used in your blood bank to estimate
the blood requirements of your locality.

28
ESTIMATING BLOOD REQUIREMENTS

3.1 YOUR LOCALITY

An efficient blood collection programme needs careful planning and you
need a variety of information in order to calculate blood requirements,
recruit adequate numbers of donors and collect blood in a cost-effective
way. This includes a good knowledge of:
„ the geographical area served by your blood transfusion
service or hospital blood bank
„ the population of this area
„ the main population centres and the communication and
transportation systems
„ the locations at which blood is collected (including fixed
clinics and places where mobile donor clinics are held,
such as schools, colleges, factories, offices and community
centres)
„ the hospitals and health centres to which blood is
distributed
„ previous blood usage
„ the number of acute hospital beds in your locality.
A good knowledge of the geographical area served by your centre is
important since this will affect the way in which you work.

ACTIVITY 9

Obtain a recent map of your locality which shows towns, villages,

roads and railway lines and any major geographical features such as
rivers, lakes and forests. If you have difficulty finding one, try to draw
a simple map using your knowledge of the area.
Mark your blood transfusion centre or hospital on the map and then
mark the boundary of the area that your service covers.
Using a different coloured pen or pencil, mark the sites from which
your centre has collected blood in the past three years, including
places in which mobile donor clinic sessions have been held, such as
schools, colleges, factories, offices and rural communities. Also
identify any areas of relatively high population density from which
blood is not collected.
With a third coloured pen or pencil, mark the hospitals and health
centres to which your service has supplied blood or blood products in
the last three years.

You should now have a map that shows the collection and distribution
points of your service, the main centres of population and the road
networks. Keep this map for use in Activity 10 and later activities.

29
 SECTION 3

3.2 METHODS OF ESTIMATING BLOOD REQUIREMENTS

In any blood transfusion service, it is important that the volume of blood
collected balances the volume that needs to be issued. Not only are
regular, voluntary non-remunerated blood donors the lowest-risk donors,
they also help to ensure that an adequate supply of blood is always
available. Using regular donors makes it possible to plan blood collection
in a systematic way and to avoid the blood bank becoming either short
of blood or overstocked.
How many units of blood will you need each week, each month and each
year? This will obviously depend on the size of your transfusion service
or blood bank, the size of the population it serves and the number of
hospitals it supplies.
There are several methods of estimating the number of units of blood –
and therefore the number of donors – needed to meet the blood
requirements of a particular geographical area or hospital. None of them
can be completely accurate, but they are an important basis for planning
donor recruitment activities. However, before you look at three methods
of estimating blood requirements, complete Activity 10 to find out the
number of acute hospital beds in your locality.

ACTIVITY 10

Look back at the map you produced for Activity 9.

Find out the number of acute hospital beds at each site to which your
blood bank supplies blood. Do not include beds used for the
treatment of infectious disease, chronic sickness, mental illness and
convalescence. Make sure that the information is up to date since
the number of acute beds may change according to the staff and
other resources available.
Add together the number of acute hospital beds at each site to obtain
the total number of acute beds in your locality.

Method 1
The first method for calculating the volume of blood required is to assess
the number of units of blood used in a specified period of time in a defined
geographical area or population, or for a specific number of acute
hospital beds. An analysis of blood usage on a weekly, monthly and
annual basis gives an approximate indication of whether the demand for
blood is constant, increasing or decreasing. It also indicates where there
tends to be a greater or reduced demand at certain times of the year.
This information should be available from the senior laboratory staff
member responsible for the issue of blood from the blood bank. Section
6 in Module 3 focuses in more detail on how to calculate blood
requirements on the basis of previous blood usage. If you are responsible
for managing stocks of blood and plasma, look at that section now.

30
ESTIMATING BLOOD REQUIREMENTS

Other factors may also need to be taken into account when analysing
blood demand, including changes at a hospital, such as in the number
of beds, the number of doctors or additional work being undertaken in
new clinical areas. A shortage of medical staff, for example, may mean
that a district hospital has to transfer all acute cases to the nearest
hospital with adequate facilities. Other changes, such as the opening of
a new hospital in a neighbouring district or region, may also affect the
amount of blood required.
Social, political or economic changes necessitating the movement of
people to another area may also have a direct effect on hospital
admissions and blood usage. War, drought, earthquakes, floods and the
expansion or loss of employment are examples of common causes of
population migration. Can you think of any changes that have affected
blood requirements in your area recently?

Method 2
A second method of estimating the number of units of blood needed to
meet blood requirements can be used in countries with modern hospital
services that are adequate to meet the needs of the population. In 1971,
the World Health Organization suggested that 6.7 units of blood would
be required each year per acute hospital bed.
Example
Using the figure of 6.7 units of blood used per acute hospital
bed each year, the number of units of blood needed for a
hospital with 50 acute beds can be calculated as follows:
50 x 6.7 = 335 units per year or approximately 7 units per
week
In most countries, the policy is to bleed donors three or four times each
year. This would mean that a minimum of 112 voluntary donors would be
needed to meet the annual blood requirements of a 50-bed hospital if
every donor attends three times. If the average number of donations from
each donor is less than three a year, however, far more donors would be
required.

Method 3
The third method can be used to estimate the number of units of blood
needed to meet a country’s blood requirements over a period of one year.
A figure of 2% of the country’s population is used to give the approximate
number of units required. The same method can be used to calculate the
blood requirements of individual regions or districts within the country.
Example
Using this method, 2% of the population of a country with 10
million people is 200 000 people. This is the approximate
number of units of blood needed each year.
If each donor gives blood at least three times a year, a minimum of
67 000 donors will be required to meet the country’s needs. In practice,
however, the number of donors needed would depend on how regularly
and frequently each donor gives blood.

31
 SECTION 3

3.3 SELECTING A METHOD TO ESTIMATE BLOOD

REQUIREMENTS
Method 1 may be the most practical approach to use in estimating blood
requirements because it relies on actual figures rather than theoretical
calculations. However, although it is usually the most accurate method,
it can sometimes give a misleading result. This is because it is based on
previous blood usage rather than previous blood requirements. Since
there may not always have been sufficient supplies of blood available in
comparison with the amount required, the estimate obtained by this
method may be too low.
It is therefore sensible to use one of the other methods as well to confirm
the blood requirements of the defined area. However, in order to identify
the number of donors needed to provide the required number of units,
it is also necessary to take the following factors into account.
1 It is impossible to predict how many of the donors called
to attend a donor session will do so, even when the
majority of them are registered voluntary donors who give
blood regularly. Some transfusion services estimate that
only around 50% will actually attend to donate blood. On
this basis, a panel of regular donors should be at least
twice as large as the total number of donors required.
2 Some donors who attend to give blood will be deferred on
a temporary or permanent basis. The number of actual
donations will therefore be smaller than the number of
donors who attend.
3 After collection, some blood will be discarded following
laboratory testing because it is unsuitable (for example,
because it tests positive for infectious agents).
The assessment of blood requirements on a weekly, monthly and annual
basis will therefore need to be adjusted accordingly. Can you think of any
other factors that should be taken into account in your calculations of the
number of donors that are needed?
Remember that it is also important to take into account the possibility
of large-scale disasters or other emergencies that may require the supply
of large quantities of blood. It is usually difficult to predict crises of this
kind, but every blood bank has a responsibility to ensure that a clear plan
for obtaining blood urgently is included in the local or national ‘disaster
plan’. Every centre should try to keep reasonable stocks of blood to take
care of the initial impact of such emergencies, although this may not be
practical in smaller blood banks.

ACTIVITY 11

How adequate was the supply of blood in your blood bank during the
last year? Note down your answers to the following questions:
1 What were the blood requirements of the hospital(s) your
blood bank served in the last year?

32
ESTIMATING BLOOD REQUIREMENTS

2 How many units of blood were collected over the same

period?
3 Was your blood bank able to supply all the blood needed by
the hospitals and health centres that it serves?
You will have to check your records to find these figures. If you have
any difficulty in obtaining this information, note down on your Action
List what information you need to obtain and discuss it with your
supervisor.
What method is used in your centre for estimating the number of
units of blood that need to be collected each year? Comment on how
accurate you think it is.
Using one of the three methods described above, estimate the total
blood requirements for the current year. Compare your estimate with
the figure calculated by your centre. Then check your result by using a
second method. Do the answers differ by a large amount? If so, write
down why you think this is the case.
If you feel that there is a need to improve the way in which your
centre estimates its blood requirements, note your recommendations
down on your Action List and discuss them with your supervisor.

SUMMARY
1 Every blood transfusion service or hospital blood bank
should estimate the number of units of blood it is likely to
need on a weekly, monthly and annual basis and plan
ways of collecting sufficient blood to meet these
requirements.
2 Establishing a panel of regular, voluntary non-remunerated
donors makes it possible to plan blood collection in a
systematic way and to avoid the blood bank becoming
either short of blood or overstocked.
3 There are three basic methods for estimating blood
requirements:
„ assessing past blood usage over a specified period of
time in a defined geographical area or population, or
for a specific number of acute hospital beds
„ multiplying the number of acute hospital beds by 6.7
to calculate the approximate number of units of blood
required each year
„ calculating the number of people who constitute 2% of
the population of a country or other defined
geographical area in order to estimate the number of
units of blood required each year.

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 SECTION 3

SELF-ASSESSMENT

4 Using Method 2, work out how many units of blood are likely
to be required each year for a hospital with 130 acute
hospital beds.
5 What additional factors need to be taken into account when
calculating the number of donors needed to provide the
required number of units of blood?

PROGRESS CHECK

Before moving on to Section 4, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 3. These were to:
1 Identify the main features of the geographical area served
by your blood transfusion service or hospital blood bank,
including the sites at which blood is collected and the
hospitals to which it is distributed.
2 Review the system used in your blood bank to estimate
the blood requirements of your locality.
If you feel confident that you have understood everything in
this section, turn to Section 4.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

4
Donor Education, Motivation
and Recruitment

The purpose of this section is to help you to develop an effective donor

education, motivation and recruitment programme in order to build up a
panel of regular, voluntary non-remunerated donors.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Assess the information that people need before deciding
to become blood donors.
2 Identify the resources needed to develop an effective
donor education, motivation and recruitment campaign.
3 Make effective use of appropriate communication methods
to educate the public and motivate them to become
voluntary non-remunerated donors.
4 Assess the efficiency and effectiveness of your centre’s
donor education, motivation and recruitment activities.

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 SECTION 4

4.1 EDUCATING POTENTIAL BLOOD DONORS

As we have already seen, voluntary non-remunerated blood donors are
considered safer than family or family replacement donors and, in
particular, commercial or professional donors. Similarly, regular donors
are safer than new or occasional donors because they should be well-
informed, are committed to helping others and are regularly screened for
transfusion-transmissible infections. Establishing a panel of regular,
voluntary non-remunerated blood donors is therefore the most effective
way of ensuring adequate supplies of safe blood on a continuing basis.
The practice of blood donation is relatively new in many countries,
however, and people are often reluctant to give blood. Some do not
realize how their blood could be used to save lives, while others are
frightened of harming their own health. Many are unwilling to donate
blood if they will not be paid for it or unless it is to be given to a member
of their own family. Perhaps the most important reason is that most
people have probably never been asked to donate blood. None of these
people are likely to become voluntary non-remunerated donors unless
they receive accurate information about why blood is needed and are
given positive encouragement to donate blood.
Education is therefore an essential part of a donor recruitment strategy.
Before people can be motivated to donate blood for the benefit of others,
they must understand how they, as individuals, can play an important
part in contributing to the health of the nation. There are three basic goals
for a donor education, motivation and recruitment campaign.
1 To promote changes in the public’s knowledge, attitudes
and beliefs so that they understand why blood donation
is a vital, life-saving service to the community.
2 To promote changes in people’s behaviour so that they
become willing to donate blood on a regular, voluntary
basis, without payment.
3 To ensure that potential donors understand the importance
of safe blood so that they do not donate blood if they are
in poor health or at risk for transfusion-transmissible
infections.

Information needs
In order to achieve these goals, it is important to start by identifying the
information that people might need to encourage them to become
donors.
Consider the following questions that are commonly asked:
„ What is the purpose of blood in our bodies?
„ Why do some people need emergency blood transfusions?
„ What is my blood going to be used for?
„ Are there any artificial alternatives to blood that can be
given to patients?
„ Who should or should not give blood? Why?

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

„ What will happen if I give blood? Will it hurt?

„ Will giving blood affect my health? Could I lose my
strength? Could I catch AIDS as a result of giving blood?
„ What tests are made on blood? Why are they necessary?
„ Why do patients sometimes have to pay for blood, even
if donors are not paid?
„ Why shouldn’t I be paid for giving blood?

ACTIVITY 12

Over the next few days, talk to at least 10 people whom you hope
might become blood donors. Try to talk to a variety of people, such as
senior school students, factory workers, community leaders and
people from rural areas.
Make a list of all the questions that they ask you about blood
donation. What are the most common questions?
You may find it helpful to discuss your findings with your colleagues
to see whether they can identify any other questions that people
often ask before deciding whether to become blood donors.

This activity should show you any serious gaps in knowledge that must
be filled before people can be motivated to give blood. You will probably
find that people with limited education have less knowledge and that
even better educated people have varying levels of knowledge and
understanding.
The information you collect in this activity should help you to identify the
subjects that are poorly understood and therefore need to be emphasized
in a donor education programme. It should also demonstrate that
different people need different information. It is important to be aware
of these differences when planning educational talks and materials so
that they can be presented in an appropriate way.
If the concept of voluntary non-remunerated blood donation is not widely
accepted in your country, it may be worth organizing a small study on why
people do not readily give blood. For example, cultural or religious beliefs
may influence people’s attitudes towards blood donation and it is
important to address these when planning a donor education and
communication strategy. Your centre will probably not be able to
undertake a study itself, but it may be possible to obtain external
assistance. University or college departments of social sciences or
health education, for example, may be looking for suitable research
projects for lecturers or students to undertake as part of their academic
programme. It may also be possible to get assistance from staff or
students involved in marketing, communications or journalism courses
in planning the best approaches to the public, particularly where people
think they ought to be paid for their blood.

37
 SECTION 4

4.2 RESOURCES
An investment in human and material resources for an effective donor
education, motivation and recruitment campaign will produce the following
long-term benefits for the service.
1 An adequate supply of blood, because of an increase in
the number of voluntary non-remunerated donors who
give blood regularly.
2 Safer blood, because regular, voluntary non-remunerated
donors are well motivated, receive continuing education
about risk behaviour and are regularly screened.
Since resources are usually limited, every education, motivation and
recruitment campaign needs careful planning, as well as regular monitoring
and evaluation of its effectiveness, to ensure that the resources
available are being used in the most efficient and appropriate way. These
resources include:
„ staff and volunteers
„ educational materials
„ finance.

Staff and volunteers

A national or regional blood transfusion service may have a designated
blood donor promotions officer or donor recruitment organizer who is
responsible for organizing the donor education, motivation and recruitment
programme. Other donor clinic staff, particularly nurses, will also play an
important role.
In smaller centres and many hospital blood banks, there may not be
anyone with full-time responsibility for donor education, motivation and
recruitment. These functions may, therefore, have to be undertaken by
donor clinic staff or senior laboratory technical staff who are able to
devote only a small amount of time to them.
The responsibility for coordinating the education campaign should
preferably be given to a member of staff who is, or has been, a blood
donor and who has the following skills:
„ an understanding of how to assess people’s needs for
information and plan an appropriate response
„ an ability to communicate effectively with people from all
walks of life
„ a good knowledge of health issues related to blood
transfusion
„ enthusiasm and the initiative to use all possible
opportunities for promoting the message
„ fluency in the local language
„ patience, tact and empathy.

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

It is also important to draw on external sources of support such as other

health workers, particularly health education officers who are used to
planning and implementing education programmes.
In many countries, the national Red Cross or Red Crescent Society and
other non-governmental organizations play a major role in the recruitment
of voluntary blood donors and sometimes also in the collection of blood.
They can offer a great deal of practical support at both national and local
level. However, the head of the blood transfusion service or blood bank
should ensure that all staff involved are appropriately trained so that
there is no inconsistency in the information given to donors.
It is also important to promote the participation of individual volunteer
motivators, such as community leaders, teachers, social workers,
journalists and other influential people in the community. They should be
encouraged to use their particular skills, experience, position and
contacts to reach potential donors. For example, a head teacher may be
willing to incorporate education about blood donation into the school
curriculum or the leader of a community or religious group might organize
a talk for members. Some communities and workplaces organize blood
donation committees to run education campaigns to encourage new
donors to come forward. These approaches can be particularly useful in
long-term donor recruitment strategies. One of the most effective ways
of attracting new donors is to involve existing donors in educational
activities. People who take pride in being regular, voluntary non-
remunerated donors act as ambassadors for the service and so every
opportunity should be taken to encourage them to recruit more low-risk
donors.
We have suggested a number of ways in which it is possible to draw on
support from other organizations and from members of the community.
However, even if much of the education campaign is delegated to other
individuals or community support groups, including voluntary blood donor
organizations, blood donation committees, the overall responsibility for
the education of the public still remains with the transfusion service. In
hospital blood banks, the responsibility lies with senior laboratory staff
or the hospital superintendent. They must ensure that the information
given is consistent and accurate by providing appropriate training and
educational materials for everyone involved in donor recruitment.

ACTIVITY 13

Who is responsible for organizing donor education, motivation and

recruitment in your centre? Which other staff are also involved?
List any other organizations or individuals, including volunteers, who
take part in donor recruitment, such as the Red Cross or Red
Crescent Society, health education officers or community workers.
What training is given to staff and volunteer donor promoters and
educators at your centre? Find out whether they feel they need any
further training. Can you suggest ways in which their training could be
improved? Note your recommendations on your Action List.

39
 SECTION 4

Educational materials
Educational materials are an important part of a donor recruitment
campaign. Materials such as leaflets and posters may have been
produced by the national blood transfusion service, the national Red
Cross or Red Crescent Society or the health education unit in the Ministry
of Health.
If no suitable materials are available, however, it may be necessary to
adapt existing ones or to prepare your own. We shall look at this in more
detail in Section 4.3. Always remember, however, that any educational
materials you produce may need to be approved by the relevant national
authorities.

ACTIVITY 14

What educational materials and equipment do you have for use in

donor education, motivation and recruitment? For example:
„ leaflets
„ posters
„ films and videos
„ blackboards
„ flip charts
„ overhead projector/slide projector.
Find out whether any materials have been produced by other
organizations which might be suitable for use in your educational
campaign. Try to obtain copies since you will be asked to review the
materials available in your country when you reach Activity 17.

Finance
Even if assistance is available from volunteers who give their services
free, a donor education, motivation and recruitment campaign requires
the allocation of funds to cover:
„ staff costs
„ the cost of the preparation and distribution of educational
materials
„ the costs of holding meetings to educate the public,
including transport and refreshments.
It is therefore important to try to find additional sources of funding from
the community to supplement your service’s own resources. Charitable
organizations such as the Rotary Club or Lions Club, or religious
organizations may be willing to undertake fund-raising activities. Industrial
or commercial companies may agree to support a programme because
it will provide good publicity. Companies supplying blood banks with

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

equipment or consumables may also be willing to donate funding to

assist in the expansion of the education programme. However, it is
essential to follow local policy about accepting sponsorship from
commercial companies in case it is seen to compromise the integrity of
the service.

ACTIVITY 15

How much did the education and recruitment of donors cost your
centre during the last financial year? If you do not know, ask your
supervisor or another senior member of staff for this information.
What financial support for the donor education, motivation and
recruitment campaign did you receive from the community, including
local businesses, during the last financial year?
Can you suggest any ways of increasing the level of financial support
provided by the community? Note your recommendations on your
Action List.

4.3 COMMUNICATION METHODS

As you probably found in Activity 12, different audiences require different
information about blood donation. It is important to identify the various
sections of the community, their socioeconomic and cultural
characteristics, their level of education and their access to other sources
of information. This is necessary in order to choose appropriate
communication methods in your efforts to promote positive attitudes
towards blood donation. For example, the approach that is suitable when
trying to motivate senior school or university students to become blood
donors would not be suitable when working with adults in rural agricultural
communities where there may be a relatively low level of literacy.
Whenever you are planning an educational activity, therefore, you first
need to find out the answers to the following questions:
„ What information is already available?
„ Who do we want to educate?
„ What do we want them to know and understand?
„ How do we want them to respond?
„ What should we tell them?
„ Who can help us?
„ How do we measure whether our communication has
been effective?
You can then plan how to present the information so that it is appropriate
for the people it is designed to reach. For example, the local language and
cultures must be respected if an audience at a talk is to be receptive and
motivated. You will therefore need to decide on the following issues:

41
 SECTION 4

„ Should the information be presented in oral or written

form?
„ How will it be communicated? In a leaflet, poster,
newspaper, through a public talk, on the radio or television?
„ What language should be used?
„ Who will prepare it?
„ How will it be pretested?
„ How much will it cost?
„ When should it be done?
Figure 2 shows some of the differences between presenting information
orally (such as when giving a talk) and through written materials.
As you can see, each approach has particular strengths and weaknesses
and, in practice, the two approaches can sometimes be combined. When
giving a talk, for example, you can use posters or flip charts to illustrate

Oral presentation Written materials

The effectiveness of a talk does not The effectiveness of the materials is

depend on the literacy level of the dependent on the literacy level of the
audience. audience.

The speaker can adjust the style and Different materials can be produced to
level of the talk to suit the particular suit different literacy levels.
audience.

Immediate feedback on the message Readers cannot ask questions about

is possible through questions and anything they do not understand and no
discussion. immediate feedback is possible.

The effectiveness of a talk partly Once the materials have been written
depends on the skill of the speaker and produced, it is expensive to change
in speaking clearly in a logical them.
sequence.

The audience may be influenced more The effectiveness of the materials

by the appearance, confidence or sense depends on the skill of the writer.
of humour of the speaker than by the
content.

Talks can usually reach only a relatively Written materials can reach a large
small number of people. number of people.

The audience may not remember Readers can look at the materials
everything that has been said if there whenever they want and refer back to
Figure 2: Features of oral are no written materials for them to them if they have forgotten anything.
presentations and written take away and read later. They can then pass them on to other
people.
materials

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

points that you want to make or leave some leaflets for the audience to
read afterwards to reinforce what you have said.
Let us now look briefly at some of the channels of communication that
can be used for educating and motivating the public about the need for
blood donation.

Predonation information and education talks

Potential donors will rarely come to you. In most cases, you will have to
go to them to begin the process of educating and motivating them to
donate blood and to become regular donors. Predonation talks to
individuals or groups are an effective method of communication. Unlike
educational materials, which often depend for their effectiveness on the
reader’s literacy level, they provide an opportunity for people to ask
questions and for you to check whether they have understood what you
are saying.
One of the most important functions of public talks is to educate
potential donors about any reasons why they should not give blood,
particularly because of poor health or risk behaviour which may expose
them to transfusion-transmissible infections such as HIV, hepatitis B or
syphilis. This serves the purpose of educating people about how to avoid
infection, encourages unsafe donors to self-exclude and reinforces
public confidence in the safety of the blood supply.
Educational talks and discussions can be held in a variety of places, such
as:
„ educational institutions, such as universities, colleges
and high schools
„ workplaces, such as government offices, factories and
plantations
„ community centres
„ at meetings of religious organizations, women’s groups,
voluntary community groups
„ at donor clinics, as part of the donor screening process.
You can probably think of many additional places where talks can be
given. For example, you could set up a blood donor recruitment stand
near the entrance at a large public gathering, such as a sporting or
musical event, and give leaflets to people as they come in. You could
then talk informally to those who are interested in more information
about becoming blood donors.
Educational talks should be carefully planned beforehand so that they
are concise, informative and stimulating and the audience do not lose
interest. Whenever you see other people giving talks, observe what
makes them a good or poor speaker and learn from this. If you are
inexperienced in giving talks, you may be able to get help from your local
health education officer who can teach you how to increase your
confidence and improve your performance. You may find the following
guidelines helpful.

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 SECTION 4

1 Identify a suitable place to give an educational talk and make

appropriate arrangements to publicize the event well in
advance.
2 Assess the likely knowledge and attitudes of the audience
and the kind of information that you think they will need. You
should already have gathered a great deal of useful information
on this from your work on Activity 12.
3 Plan your talk. You will probably find it helpful to write down
what you want to say or at least to make brief notes about
the key points. Include all the information that you think this
particular audience will want and put it into a logical order.
Remember to emphasize the need for safe blood donors and
why certain donor behaviour presents a risk to donors
themselves as well as to the recipients of their blood.
4 If you are nervous about giving the talk, practise it in privacy
until you feel more confident.
5 Obtain any visual aids that you could use to illustrate your
talk.
6 Ask a local community leader or another public figure,
preferably one who is a blood donor, to join you in speaking
to people about the importance of blood donation and about
his or her experiences as a donor. Blood donors are often
effective recruiters of other donors so ask if there are any
donors in the audience who would also be willing to share
their experiences.
7 Encourage feedback and questions and distribute any
educational materials that you have been able to obtain.
8 After the talk, spend a few minutes assessing how well it was
received and identify any ways in which you could improve
your technique in the future.

ACTIVITY 16

Do you give public talks? If so, how many public talks do you and your
colleagues give each month? From looking at records and the map
that you developed in Activity 9, can you identify any additional places
where you could give a talk?
Use the guidelines above to help you prepare for your next talk and,
most importantly, assess its effectiveness. How do you think you
could improve your performance as a public speaker? For example,
would you benefit from training in this area? Note your ideas down on
your Action List.

Most people who speak well in public have had to learn how to give talks.
If you find it difficult, always remember the importance of planning and
practising your talk and then evaluating it so that you constantly learn
from your own experience.

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

Educational materials
Written educational materials such as leaflets and posters are a vital part
of a public education programme, but they are expensive and time-
consuming to produce and should preferably be developed by people who
have experience in this area. Wherever possible, always use materials
that are already available, unless they are unsuitable for some of the
audiences that you want to reach.
Even if you do not know of any suitable materials, it is worth spending
time investigating whether any exist. As we have already suggested, the
national blood transfusion service, the health education unit in the
Ministry of Heath or the Red Cross or Red Crescent Society may have
produced some. If none are available, you may be able to persuade one
of these organizations to develop some.
You may decide, however, that you need to adapt some existing
materials, perhaps by translating them into the language spoken in your
area, or to produce some simple materials yourself, such as posters
advertising a mobile donor clinic session. Always try to find someone who
can help you to do this, such as the local health education officer. This
is essential if you don’t have any experience in developing materials.
An important part of the planning process is to think carefully about how
your materials will be distributed and used. There is no point in producing
thousands of copies of a poster if it will be displayed only in a small
number of places. Printing can be very expensive so it is essential to find
a cost-effective means of reproduction and to find out in advance how
much it will cost and whether sufficient money is available. Remember
that any educational materials you produce may need to be approved by
the relevant national authorities.
When preparing leaflets, the information should be presented clearly in
a logical sequence and in simple language with attractive illustrations,
if possible. You have already looked at an example of a simple leaflet for
donors about AIDS in Appendix 1. Now look at another example, Think
You Can’t Afford to Give Blood?, which was adapted by the Fiji Red Cross
Society from a leaflet produced by the Australian Red Cross Society
Blood Transfusion Service. You will find this in Appendix 2.
Leaflets should always be pretested, even if only with a small number of
people. Choose a few people who know very little about blood donation
and ask them whether the leaflet is clear and contains all the information
they would need before deciding whether to give blood. Any changes
required can then be made before the leaflet is finalized and distributed
more widely. Wherever possible, a simple follow-up study should be
carried out through interviews or discussion to check how effective
the material is in conveying the desired message.
Posters are very useful because they are likely to be seen by a large
number of people, particularly if they are displayed in popular public
places or large offices, factories or colleges. They can be used to remind
the public of the need for blood donors as well as to advertise the date,
location and time of a public talk or blood collection session.
As with leaflets and other educational materials, it is preferable to use
existing posters rather than to make your own. Unless you are very

45
 SECTION 4

experienced in communications, it is wise to leave it to the professionals.

If you do decide to make a poster, make it as simple as possible since
most people will not read detailed information in small print. It should,
of course, be attractive and eye-catching with the important information
appearing in large print.

ACTIVITY 17

How effective are the educational materials that you use? Talk to
some people who have seen them (both potential donors and
colleagues) and find out whether they think they are:
„ relevant and informative
„ interesting
„ easy to understand.
Ask them to rate each publication according to the following scale:
1 Very poor
2 Poor
3 Fair
4 Good
5 Excellent
Work out the average score in each category for each publication and
write it on the table below. Then add up the total score for each
publication. A total score of between 10 and 15 means that the
publication is likely to be reasonably effective in giving people the
information they need in order to decide whether to donate blood. A
score of between 3 and 9 probably means that the material is
unlikely to be successful in encouraging people to become donors.
Do you think that these materials serve their purpose of informing
and motivating the public or are other materials needed?
If you feel that it is necessary to develop some new materials or to
adapt existing ones, discuss this with your supervisor. On your Action

Publication 1 2 3 4 5

Relevant and informative

Interesting

Easy to understand

Total score

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

List, note down your suggestions on how this might be achieved.

Remember that it is difficult to develop new materials and it is usually
best to adapt existing materials. Identify any local sources of
assistance, such as the health education officer.

Press
Both the local and national press are important means of keeping the
public informed about the daily need for voluntary blood donors and
about where and when they can donate their blood. Newspapers are
always looking for good stories and may be especially interested in
writing about donors who have given a particularly large number of
donations or about patients whose lives have been saved by blood
transfusions. You could also ask your local newspaper to show appreciation
of the valuable contribution that donors make to the community by
publishing regular reports about the village, college, industry or office
with the highest donation record.
If you do not have access to the press, you may be able to make some
useful suggestions to national organizations such as the national blood
transfusion service about how they can make more effective use of the
media.

Radio and television

Radio and television provide an excellent opportunity for donor recruitment
organizers to reach a large number of people with relatively little effort.
In most countries, radio and television companies give high priority to
public service broadcasting and are generally pleased to assist, particularly
if there is an interesting story to report.
Occasional talks can be given on the radio or television to inform the
general public of the daily need for blood and the importance of voluntary
blood donors in helping to provide an effective hospital service – and in
securing their own safety if ever they urgently need a blood transfusion
themselves. Talks can be supported by brief radio and television spots
to remind the public about the need for blood donors and where they can
go to donate.
It is particularly important to use the radio or television to broadcast
urgent appeals for new and regular donors to donate their blood when
blood stocks are low, such as during public holidays or when an
unexpectedly high volume of blood is required after a large-scale
disaster.

Cinemas
Like television, the cinema provides a large captive audience, particularly
of young people. National blood transfusion services may be able to
obtain funding or sponsorship to make a short advertisement or film on
the need for voluntary blood donation which gives information to
potential donors on how and where to register.

47
 SECTION 4

ACTIVITY 18

Which of the communication methods described in this section does

your centre use to educate and motivate people to give blood? Which
methods are most effective? Do they achieve their objectives?
Think carefully about the following questions:
„ How could the effectiveness of these methods be improved?
„ What additional methods could you use to reach more
potential donors?
„ What assistance and support could you get from other
organizations and individual volunteers?
„ What training would people need?
„ What resources would be required?
Discuss your ideas with your colleagues and note down your
recommendations on your Action List.

Once an effective campaign has been established, it may generate its

own momentum as the community becomes more aware of the importance
of blood donation as a valuable humanitarian service and more donors
talk about their own experiences.
The communication methods that you can use to educate and motivate
potential donors will obviously depend on the nature of your job. If you
work in a small hospital blood bank, blood donor recruitment will be only
a part of your work. Obviously you will not be able to plan the same kind
of educational campaign as a donor recruitment organizer in a national
blood transfusion service. The important issue, however, is to plan how
to make the most effective use of whatever resources are available to
you.

4.4 MONITORING AND EVALUATION

It is essential to evaluate the effectiveness of any donor education,
motivation and recruitment activities in order to ensure that the most
efficient and cost-effective communication strategies are being used. To
do this, it is first necessary to set some targets against which you can
measure your success.
Records should be kept of all educational activities so that the
effectiveness of different aspects of the education and recruitment
campaign can be monitored. It is obviously also important to keep
detailed records of all donors so that people who have agreed to donate
blood when required can be contacted easily. It is difficult to operate a
well-organized and regular supply of blood without a panel of regular
donors. We shall look at record-keeping in detail in later sections,
particularly in Section 8.
In simple terms, donor recruitment can be considered successful if an
adequate supply of safe blood is always available. Some of the main

48
DONOR EDUCATION, MOTIVATION AND RECRUITMENT

indicators of the effectiveness of a donor education, motivation and

recruitment campaign are:
1 An increase in the number of communities involved in
giving blood.
2 An increase in the total number of voluntary non-
remunerated donors.
3 An increase in the number of donors who return to give
blood a second or subsequent time.
4 An increase in the average number of donations per
person per year (within acceptable limits of safety to the
donor).
5 A decrease in the number of donors who have to be
permanently excluded because of transfusion-
transmissible infections.

ACTIVITY 19

Look at the main indicators of the effectiveness of a donor education,

motivation and recruitment campaign in the table below. For each
indicator, look at your centre’s records to assess the current
situation and fill in the appropriate box with the number at the
present time.
Then set some dates on which you will return to the table and review
the situation (for example, every six months) to see whether there
has been an improvement. Note these dates on your Action List and,
on these dates, check whether there have been any significant
changes.

Number at review
Number at
Indicators present 1 2 3

1 An increase in the number of

communities involved in giving
blood

2 An increase in the total number

of voluntary non-remunerated
donors

3 An increase in the number of

donors who return to give blood
a second or subsequent time

4 An increase in the average

number of donations per person
per year

5 A decrease in the number of

donors who have to be
permanently excluded because
of transfusion-transmissible
infections

49
 SECTION 4

Developing an effective donor education, motivation and recruitment

campaign takes time, particularly where there is a replacement donor
system and people are not familiar with the concept of voluntary non-
remunerated blood donation. An essential part of assessing the
effectiveness of donor education, motivation and recruitment activities
is therefore to identify any reasons why people may be deterred from
becoming donors. A number of factors are likely to be involved, including:
1 Inadequate communication about the importance of a
continuing supply of blood for the health of the community
and nation.
2 Fear of the donation process by people who might otherwise
be willing to become donors.
3 Lack of support from community leaders, community
organizations and influential people.
4 A poor image of the transfusion service or blood bank.
5 Unpleasant experiences of blood donation by previous
donors.
When you review your findings from Activity 19 in a few months’ time,
therefore, it will be important to assess the significance of these and
other factors and to decide whether it is necessary to amend the donor
education, motivation and recruitment strategy that has been developed.
In Section 9, we shall focus on donor retention and recall as a further
means of encouraging regular donation in order to maintain an adequate
supply of safe blood.

SUMMARY
1 An awareness of the kind of information people need
before deciding to donate blood is an important basis for
donor education, motivation and recruitment activities.
2 Education about the need for safe blood is an essential
part of a donor recruitment campaign.
3 Careful planning and adequate resources are needed for
the development of an effective education, motivation
and recruitment campaign.
4 Community organizations and individual volunteers can
play an important role in recruiting potential blood donors,
particularly well-informed donors who have had positive
experiences of blood donation.
5 A variety of communication methods can be used to
educate the public about blood donation. These include:
„ educational talks
„ educational materials, including leaflets and posters
„ the press
„ radio and television
„ cinema.

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DONOR EDUCATION, MOTIVATION AND RECRUITMENT

6 The effectiveness of the donor education, motivation and

recruitment campaign should be monitored and evaluated
on a regular basis.

SELF-ASSESSMENT

6 List three goals for a donor education, motivation and

recruitment campaign.
7 What are the two long-term benefits to the blood transfusion
service of an effective community education, motivation and
recruitment campaign?
8 Why is it important to monitor and evaluate donor education,
motivation and recruitment activities?

PROGRESS CHECK

Before moving on to Section 5, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 4. These were to:
1 Assess the information that people need before deciding
to become blood donors.
2 Identify the resources needed to develop an effective
donor education, motivation and recruitment campaign.
3 Make effective use of appropriate communication methods
to educate the public and motivate them to become
voluntary non-remunerated blood donors.
4 Assess the efficiency and effectiveness of your centre’s
donor education, motivation and recruitment activities.
If you feel confident that you have understood everything in
this section, turn to Section 5.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

51
 SECTION 5

5
Organizing Donor Clinic
Sessions

The purpose of this section is to assist you in planning and organizing

donor clinic sessions, particularly mobile donor clinics, and evaluating
their effectiveness.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Identify suitable sites for mobile donor clinic sessions.
2 Plan and prepare for a mobile session to ensure that it
operates efficiently.
3 Develop efficient procedures for calling up donors to fixed
and mobile donor clinic sessions.
4 Ensure the safe, efficient preparation and use of blood
collection packs.
5 Monitor and evaluate donor clinic sessions in order to
improve their efficiency.

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ORGANIZING DONOR CLINIC SESSIONS

5.1 FIXED AND MOBILE DONOR CLINICS

Blood donor sessions can be organized and held:
1 In a blood transfusion centre, a hospital blood bank or a
permanent location near the centre of the community
where registered donors are called to attend. These types
of blood collection session are usually referred to as fixed
or static blood donor clinics.
2 At mobile blood donor clinics. This involves organizing a
blood collection team that travels to schools, colleges,
workplaces or community centres in large or remote
communities where it is not convenient for people to
attend fixed blood donor clinics.
Although these two kinds of clinic differ in some ways, it is most
important that wherever donors go to give blood, they experience the
same high level of courtesy, efficiency and care.
The responsibility for organizing both fixed and mobile blood donor clinics
normally lies with the blood donor recruitment officer. In small hospital
blood banks or regional blood transfusion services where there is no
donor recruitment officer, a senior nurse or senior laboratory technician
generally organizes blood collection sessions.
The bleeding and care of donors is usually the responsibility of the senior
nurse in charge of the clinic.
A fixed donor clinic should attract a large number of donors if it is well
sited and is close to the centre of town or in a community centre. Donors
can come whenever it suits them and there is generally little peer group
pressure placed on them to donate. It is normally easier to develop a
panel of regular voluntary donors for a fixed clinic than for mobile clinics.
If your fixed clinic attracts fewer donors than mobile sessions, however,
it is important to identify the reasons for this so that you can find ways
of improving the recruitment and retention of donors at the centre.

ACTIVITY 20

Look at your records to identify all the locations where mobile clinics
have been held during the last year. If the information is available,
note down how many units of blood were collected at each session.
Then list the various locations in order of their effectiveness in terms
of the amount of blood collected. If you have no records of this, use
your experience to assess the effectiveness of each location.
Which locations appear to be the most successful? Do any mobile
sessions result in a larger number of donations than at your fixed
clinic? Why do you think there is a larger number of donations in
some locations than in others? Note any particular factors you can
think of that may have affected the amount of blood collected, such
as how easy it is for donors to reach the venue, the weather
conditions and special events, such as religious festivals.

53
 SECTION 5

Many hospital blood banks, especially those that use replacement

donors, collect blood in or near the blood bank laboratory. However, there
are several important reasons why blood should not be taken inside the
laboratory.
1 It is important to try to provide donors with a pleasant
experience in order to encourage them to give blood on a
regular, voluntary, non-remunerated basis. This requires
a safe and hygienic environment that cannot be provided
in a laboratory containing equipment, chemicals and
pathological material.
2 Privacy is essential during predonation counselling and
while the donor’s medical history is being taken. This is
unlikely to be possible in a laboratory.
3 Donors sometimes faint during or after giving blood and
this could be very dangerous if it happens in the laboratory.
4 Donors require light refreshment after giving blood, but
food and drink should not be allowed inside the laboratory.
Even in small hospitals where space is very limited, it should be possible
to find a small room where blood can be collected safely. If donors are
currently being bled in the laboratory in your hospital, it is important to
discuss the problem with your supervisor or hospital administrator and
to seek another place that can be used for collecting blood. You may like
to note your suggestions on your Action List.

5.2 PLANNING A MOBILE DONOR SESSION

Mobile blood donor sessions enable the service to reach those donors
who cannot come to a fixed clinic because the transfusion centre or blood
bank is too far away. The size of a regular donor panel can be
considerably increased through the use of mobile sessions.
Organizing a mobile clinic is more complicated than organizing a fixed
clinic and the donor recruitment officer, or whoever else is responsible
for this, must carefully plan every aspect of it in advance.
From your own experience, you know the kinds of resources that you need
for a mobile session and those that you have available. A common
problem in setting up a mobile clinic is finding the finance for a suitable
vehicle and other items of equipment. However, it is often possible to
obtain assistance from the Red Cross or Red Crescent Society, charitable
organizations such as the Rotary Club or from religious and community
groups. Organizations of this kind may consider this to be a worthwhile
use of their funds in contributing to community health.

Selecting a venue
One of the most important tasks in planning mobile donor sessions is to
select suitable venues that will be cost-effective because they are likely
to result in good blood collection figures. It is the responsibility of the
organizer to estimate how many people are likely to donate in each place
and to assess how far it is worth travelling, taking into account the time
and costs that will be involved. An estimate of the number of donors who

54
 ORGANIZING DONOR CLINIC SESSIONS

will attend will also help you to plan the allocation of donor clinic staff and
the equipment and materials that must be taken.
It is therefore useful to keep a record of the locations where mobile
sessions can be held, either on a routine basis or in an emergency, and
to record information on the number of donations collected on each visit.
This enables the suitability of the venue to be monitored so that the most
cost-effective locations can be selected in the future. The record should
also contain details of the people to be contacted and the special
features of the venue, such as the facilities available and the preferred
days and times for visits. Perhaps the simplest way of recording this
information is to use individual cards for each venue and to file them in
alphabetical order. An example is shown in Figure 3 below.

VENUES AVAILABLE FOR MOBILE SESSIONS

Name of venue:

Address of venue:

Telephone no. (if known):

Contact/responsible officer at venue:

Record of sessions held

Special features

Date of No. of Type of venue Preferred

visit donations (e.g. factory, Facilities (e.g. day/time of Other
received school) on site) visit remarks

Figure 3: Example of record of

venues available for mobile
sessions

ACTIVITY 21

Look back at the list you made in Activity 20 of the locations in which
mobile sessions have been held during the last year and at the
number of units of blood collected in each place. Identify the
locations to which it is worth returning in the future for further mobile
sessions because you could reasonably expect to collect an
adequate number of units of blood.
If you don't already keep a record of suitable locations for mobile
clinics, such as in the example in Figure 3, record the relevant
information for each of these locations.

55
 SECTION 5

Mobile sessions are usually held in schools, colleges, village halls,

community centres, offices, factories and similar venues. Wherever
possible, the donor recruitment organizer should inspect the venue to
ensure that there is a supply of clean water, toilet facilities and good light
in order to maintain standards of hygiene, health and safety. People are
often reluctant to become blood donors because they are frightened of
contracting an infection by giving blood. It is therefore important to make
sure that the environment is clean and tidy so that, as soon as they enter,
donors feel confident about the professionalism of the clinic staff and the
safety of the environment and the procedures.
The organizer should also plan the layout for the blood collection session
to ensure that donor screening can be undertaken in privacy and that
there is sufficient space for the actual bleeding and for donors to recover
after donating blood.
Appendix 3 contains further guidance on selecting a venue for a mobile
session.

ACTIVITY 22

Look back at the map you produced in Activity 9. Identify an area that
is not close to a fixed clinic and where no mobile clinics have been
held before. Choose a location where you would expect to find a high
proportion of low-risk donors and that has a reasonably high
population density, such as a large village, a college or a factory.
Try to identify a site in this area that would be suitable for holding a
mobile clinic, taking into account the number of potential donors, how
easy it is to reach the venue and the facilities that might be available.
Find out who is in charge of this venue and contact them to ask
whether they would be willing to host a mobile donor clinic and to
arrange a convenient date. Try to arrange an informal visit to the site
so that you can make an initial assessment of its suitability and meet
the person in charge. Keep a record of your comments.

5.3 DONOR CALL-UP

Where a panel of regular voluntary donors has been established and
there is an efficient donor records system, it should be easy to identify
donors who are due to give another donation and who therefore need to
be contacted and asked to attend the clinic. However, it is important to
avoid either an excess or a shortage of particular blood groups. The
person responsible for recalling donors therefore also needs to find out
from the medical director of the service or from the person in charge of
the blood bank how many units of blood are required for each blood
group, Estimating the number of units needed for each blood group is
covered in Section 6 of Module 3. It is not possible to predict the blood
groups of new donors, but the groups of existing donors are already
known. This is a further reason why regular donors are preferable

56
ORGANIZING DONOR CLINIC SESSIONS

because it is possible to identify and recall those with the required blood
groups to ensure that there is always the correct proportion of different
blood groups in stock. We shall return to the subject of donor records in
Section 8 and to donor retention and recall in Section 9.
Where there are insufficient voluntary donors available, it may be
possible to contact replacement donors and persuade them to donate
blood again. They may be willing to become regular voluntary donors
because they realize that their blood has already saved the life of their
relatives and they recognize the importance of stocks of blood always
being available. Another approach is to introduce a policy where a relative
of a regular donor does not have to find a replacement donor if they are
admitted to hospital. Remember, however, that it is important to avoid
putting pressure on families to provide donors as this may lead to them
paying others to donate blood.

Calling donors to fixed clinics

When the number of donors required has been decided, they need to be
invited to attend a donor session. Wherever possible, they should be
contacted individually by letter or telephone, preferably giving them
several days’ notice.
It is best to ask donors to attend at different times to avoid them all
arriving together. This would put pressure on donor clinic staff and could
cause delays, which might discourage donors from attending again. The
senior nurse in charge of the clinic needs to be informed of the number
of donors who have been called so that she can be prepared for them.

Calling donors to mobile clinics

When organizing a mobile clinic, it is essential to inform local people well
in advance that a blood collection session will be held in their area. It is
costly and time-consuming to organize mobile sessions and so every
available opportunity must be taken to make it worthwhile. If only a few
people know it is going to take place, it will be difficult to collect the
required number of units of blood.
It is important to attract as many regular donors as possible, although
it may be more difficult and costly to inform regular donors on an
individual basis about mobile clinic sessions than about a fixed donor
clinic. However, the majority of people attending a mobile session are
likely to be new donors who decide to donate their blood on hearing that
a mobile blood collection session is being held in their area. While it is
obviously important to publicize the session in advance, information
about the venue, date and time of the session may not be sufficient to
attract the required number of new donors. It is usually necessary to give
a talk or distribute some educational materials to create awareness of
the need for low-risk blood donors. If it is not possible for the donor
recruitment organizer to do this, perhaps because of a shortage of
transport or because the distance to be travelled is too great, it is
important to seek the assistance of other health workers or volunteers.
If the mobile team plans to visit a village or community centre, it is
essential to contact community leaders in advance and to ask them to

57
 SECTION 5

tell people when the donor session will take place. Ask them to put up
posters in prominent places so that as many people as possible will know
the date, time and location of the mobile clinic. Always try to obtain the
assistance of existing donors and other volunteers in encouraging their
family, friends, colleagues and other members of the public to give blood.
Depending on the resources available, it may be possible to use the local
press, radio or television to inform people when a mobile session will be
held in their area. Using a loudhailer can be effective in informing the
community about the session.
If the mobile clinic is to visit a school, college, factory or a similar
location, the principal or manager should be contacted well in advance
in order to agree a suitable time and date for the donor session and for
any predonation talks or other educational activities that may be
organized. It will also allow sufficient time for information to be circulated
about the session to all existing and potential donors. If the initial contact
is made by telephone, always send a follow-up letter to confirm the
arrangements and ensure that there is no confusion.

ACTIVITY 23

What approaches are used in your centre to inform potential donors

and regular donors that a mobile session will be held in their area?
Fill in the table below by ticking the methods that you use. Which
methods do you find most effective?
Can you think of any ways of improving the system for publicizing
mobile donor clinic sessions? Note them down on your Action List.
The next time you organize a mobile session, try to use an additional
method that you have never used before and evaluate its
effectiveness.

Method Often Sometimes Never

Letter

Telephone

Word of mouth

Posters

Newspapers

Radio

Television

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 ORGANIZING DONOR CLINIC SESSIONS

After each mobile session, it is important to send a letter thanking the

person in charge of the venue for their support. This will assist in building
and maintaining a good relationship for future visits.

5.4 STAFF AND EQUIPMENT

The staff and equipment required to operate a mobile blood donor
session will be similar to those for a fixed clinic, but obviously depends
partly on the number of donors who are expected to attend, as well as
on the resources available.

Donor clinic staff

The number of staff required will probably be similar to that in a fixed
clinic, apart from a driver, although the rate at which donors arrive will to
some extent determine the staffing pattern. If you have two hours
available and you are expecting around 100 donors, you will obviously
need more staff than if you are expecting 50 donors to attend the clinic
over a period of eight hours. If the number of donors attending is likely
to be low, the number of nurses or trained phlebotomists could be
reduced.
The suggestions for staffing levels given in Figure 4 are for a session in
which donor clinic staff expect to collect 50–60 units of blood in a period
of four hours. They are simply guidelines, however, and you must use
your own experience to decide how closely they match your own
requirements.

Staff requirements for a mobile donor clinic

„ 1 doctor or experienced senior nurse in charge
„ 1 donor screening nurse
„ 2 donor bleeding nurses or staff trained in phlebotomy
„ 1 clerk/receptionist
Figure 4: Suggested staff
requirements for a mobile „ 1 driver/clerk
donor clinic

Laboratory technical staff should undertake donor screening or phlebotomy

only where nurses are not available and if they have been adequately
trained for these roles.
Donor assistants or volunteers may be used, under supervision, to carry
out simple tasks such as preparing refreshments for donors.

ACTIVITY 24

The next time you go on a mobile session, select three donors and
record the total time that each person spends in the clinic. Note
down:

59
 SECTION 5

„ whether there are significant differences in the time each

person spends at the session
„ whether each donor is attended to promptly or has to wait
for long periods
„ the stages at which donors have to wait and the reasons for
any delays
„ whether donor clinic staff are able to spend sufficient time
with each donor.
Note down any ways in which you think the organization of the
session could have been improved. For example, were there sufficient
staff? Was the venue suitable? Was there sufficient publicity to
attract the anticipated number of donors? Note down your findings
and recommendations on your Action List.

Equipment and materials

The most expensive item required for a mobile session is the vehicle.
This needs to be large enough to carry staff and all the equipment
needed, such as fold-up donor bleeding beds and equipment for keeping
blood cold.
Apart from the vehicle, all the equipment and materials required will be
the same as for a fixed donor clinic although some equipment, such as
tables, chairs and perhaps even beds, may be available in the place
where the mobile clinic is to be held. It is important to use local resources
to your full advantage and to check what equipment is available in order
to avoid transporting any unnecessary items. The quantities of the
remaining equipment and materials required will depend on the number
of staff and the number of donors who are expected to attend. Figure 5
suggests the equipment and materials that are required for a mobile
clinic.
It is helpful to compile a checklist of all the equipment and materials
required for mobile clinics. This can then be used before departing for
each session to check that everything required is in the mobile clinic
vehicle. It can also be used on return from the session to check that
nothing is missing.

ACTIVITY 25

Do you use a checklist of equipment and materials required for

mobile sessions? If so, compare it with the list in Figure 5 and make
any additions or amendments that you feel are necessary.
If checklists are not yet used in your centre, draw up a checklist
containing all the items of equipment and materials that are needed
for mobile clinics and use it to check each item before departure and
on return from each mobile session.

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 ORGANIZING DONOR CLINIC SESSIONS

Equipment and materials required for a mobile donor clinic

„ A medium or large vehicle, ideally specially designed to carry staff and
equipment
„ Collapsible tables for the clerk/receptionist
„ Donor information and education materials
„ Screens to ensure privacy during donor selection
„ Fold-up donor bleeding beds
„ Chairs for staff and donors
„ Donor enrolment and record forms
„ Donor medical history forms/questionnaires
„ Soap and hand towels
„ Sphygmomanometers
„ Stethoscopes
„ Cotton wool swabs
„ Antiseptic solution
„ Capillaries and copper sulfate solution (CuSO4) for male and female
donors, or other means of checking the haemoglobin level, such as the
WHO Haemoglobin Colour Scale or a battery-operated haemoglobinometer
„ Box of lancets
„ Donor weighing scales
„ Height measure
„ Tourniquets
„ Donation reference number sets, one for each donor
„ Blood collection tubes
„ Blood bag pilot tube sealer and clips
„ Blood collection bags
„ Plasters or strips of sticky tape for holding the needle in position
„ Small spring balances or scales for weighing the blood collected
„ Tube strippers
„ Forceps and scissors
„ Container for the safe disposal of lancets and needles
„ Blood mixers
„ Disinfectant solution, such as hypochlorite solution, for cleaning spilt
blood and cleaning equipment and furniture after the session
„ Facilities for providing refreshments for donors
„ Small battery-operated refrigerator or insulated cold boxes and ice-packs
Figure 5: Suggested for filled blood bags
equipment and materials „ Refreshments for donors
required for a mobile „ First-aid kit.
donor clinic

5.5 TEMPORARY STORAGE OF COLLECTED BLOOD

An important part of organizing a blood donor session is making suitable
arrangements for the preparation, temporary storage and transportation
of the blood to the blood bank. Section 5 of the Introductory Module
describes the blood cold chain, which is a system for storing and

61
 SECTION 5

transporting blood and and blood products in as safe a way as possible

to maintain its functions. If you have not already done so, read this
section now. Remember that there are two equally important parts in an
efficient blood cold chain:
„ people to organize and manage the storage and
transportation of the blood
„ equipment to store and transport the blood.
The cold chain should begin as soon as blood is collected. Donor clinic
staff are responsible for ensuring that blood reaches the blood bank in
a suitable condition by following the procedures that are designed to:
„ maintain the viability and functions of the constituents of
the blood
„ prevent physical changes that may be detrimental to the
constituents of the blood
„ minimize bacterial contamination of the blood.

Plastic blood collection bags

The preservative solution in the blood bag contains anticoagulants to
prevent the donor’s blood from clotting. It also contains nutrients for the
blood cells. Blood bags should be stored at +2°C to +6°C in order to
maintain the delicate biochemical balance required by the blood cells to
sustain their viability and functions. This temperature range minimizes
the growth of any bacterial contamination that may have entered the unit
of blood during venepuncture.

Handling sample containers and blood bags

Sample containers and blood bags should be kept as cool as possible.
Excessive heat or freezing may affect the preservative solutions which,
in turn, affect the viability of the red cells. If glass or plastic sample
containers are too hot or are frozen immediately before filling them with
haemolysis: The blood, haemolysis of the red cells may occur, which will affect the blood
breaking down of the red grouping and serology tests.
cell membrane which
liberates the contents: During collection, the blood should be mixed with the anticoagulant-
haem and globin. preservative solution contained in the blood bag. Mixing should be
frequent during the first minute of bleeding, with further mixing after
approximately every 100 ml until the bag is full.
The amount of blood collected should be closely monitored by using a
spring balance or blood donation scales. The total volume to be collected
will depend on the type of pack used and on the procedures agreed
locally. When you have collected the appropriate amount and filled the
pilot tubes and sample containers, strip the tubing. This will mix the
blood in the tubing with the blood in the pack so that it is all adequately
anticoagulated. Dispose of the needle safely in a container for sharps.
Recapping needles is dangerous and often leads to needlestick injuries
to staff. If, before the venesection, you make a loose knot in the tubing
to which the needle is attached, you can then tie it off at the end of the
bag when the bleed is completed.
At this stage, always check that the donor records, the identification of
the unit and the sample tubes match.

62
 ORGANIZING DONOR CLINIC SESSIONS

The blood packs should then immediately be put in a refrigerator or a

precooled blood transport box. Sturdy, well-insulated cold boxes can
maintain a temperature of +2°C to +6°C if they contain sufficient ice-
packs; dry ice or supercooled ice should not be used. The ice should
never be allowed to come into direct contact with the blood bags or
sample containers since this may cause haemolysis of the red cells.
If possible, put a maximum/minimum thermometer inside the cold box
so that the maximum and minimum temperatures reached inside the box
can be recorded when the blood reaches the blood bank. The thermometer
should not touch the ice-packs. If the temperature is outside the range
of +2°C to +6°C, a decision will have to be taken about whether to discard
or keep the blood. If there is no thermometer, the temperature has
probably remained within this range if there is unmelted ice remaining in
the box. See Section 5 of the Introductory Module for further details on
the storage and transportation of blood.

ACTIVITY 26

What types of blood pack are used in your blood collection

programme: single, double, triple, a combination of types or other
types? If you use different types, which are the best? Why?
Note your answers to the following questions on the table below.
„ What type of preservative solution (e.g. CPDA) is used?
„ What volume of preservative solution is used?
„ What volume of blood do you collect in each type of collection
pack?
„ What is the weight of an empty pack in grams?
„ What is the weight of the pack when the allowed volume of blood
is collected?
„ At what temperature should the pack be stored when empty?

Weight of blood Recommended

Type of Volume of Volume of Weight of an pack when allowed storage
Type of preservative preservative blood empty blood volume of blood is temperature for
blood pack solution solution collected pack in grams collected empty blood packs

Single

Double

Triple

Glass bottles

Other types

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 SECTION 5

Are the packs always used in accordance with the instructions

provided by the manufacturers? If you can suggest any improvements
to the way the packs are used, note them on your Action List.

Glass collection bottles

Some blood banks and transfusion services still use glass blood
collection bottles rather than plastic blood collection bags that are
recommended by WHO in Guidelines for the Organization of a Blood
Transfusion Service (1992). The ability to reuse glass bottles has cost-
saving advantages over disposable plastic blood collection packs, which
are more expensive. However, these must be balanced against the
problems that may be encountered with the use of glass bottles and the
need to ensure that sufficient stocks of appropriately prepared bottles
are always available.
There are a number of disadvantages to the use of glass bottles. They
are relatively heavy and bulky to store compared with plastic bags which
are very light and take up less room in storage, both when empty and
when full.
The reuse of glass bottles involves the initial cleaning and sterilization
of the bottles, the preparation and sterilization of the anticoagulant
solution and its addition to the bottles, and the sealing of the prepared
bottles ready for use. In addition, the blood collection sets also need to
be cleaned, prepared and sterilized before reuse. It is clear that to use
glass bottles successfully, a dedicated production area is required. This
is unlikely to be available in an ordinary district hospital which should
obtain prepared glass collection bottles and collection sets from a
central production unit where high standards can be maintained.

Potential problems in the use of glass bottles

Air embolism
Air embolism is probably the most important problem that may be
encountered when collecting blood into glass bottles. An air embolism
can occur in the donor if the flow of blood into the collection bottle stops
because the air vent has become blocked and the pressure builds up
inside the bottle. When the pressure cuff is released, the pressure in the
bottle becomes greater than that in the vein and air is forced back along
the collection tube and into the donor’s arm.
There is no risk of embolism when using plastic blood bags because
there is no air in the bag that could cause an embolism. The bag expands
as the blood is collected and there is no pressure build-up inside it.

Infection risk
The collection set needs to be physically connected to the collection
bottle. This creates an open system with the potential for contamination
of the donated blood when the needle is inserted into the cap of the
collection bottle.

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ORGANIZING DONOR CLINIC SESSIONS

The collection line and needle form an integral part of a plastic blood pack
so the venepuncture itself is the only point at which the system is open.
The risk of contamination is therefore greatly reduced.
Blood collected into glass bottles can undergo only limited processing
and this also involves an open system with an increased risk of infection.
Since plastic blood bags can be obtained in a number of different
formats, the processing potential is much higher and a closed system is
maintained at all times throughout processing.

5.6 MONITORING MOBILE DONOR SESSIONS

Wherever possible, the person responsible for organizing a mobile donor
clinic should be present during the entire session to ensure that
everything goes according to plan. They should also:
„ encourage and reassure any donors who have any doubts
or anxieties about giving blood
„ attend to any donor problems
„ ensure that good public relations are fostered by all staff
„ thank local contacts for their support.
Each clinic session should be monitored in a systematic way so that any
action required to improve the service can be identified. Using a donor
session analysis form like that shown in Figure 6 on page 66 makes it
easier to monitor:
„ the effectiveness of the donor education, motivation and
recruitment campaign, including the number of new and
repeat donors out of the potential donor population and
the number who were accepted
„ the trends in the donor population, such as whether the
number of new and repeat donors is increasing
„ the cost-effectiveness of each venue used for mobile
donor clinic sessions and whether it is worth returning to
particular sites in the future, considering the suitability of
the venue, the number of donors bled and the number of
exclusions and deferrals
„ the workload of the donor clinic staff, including whether
there were too few or too many staff
„ the performance of the donor clinic team and how efficiently
they coped with the workload
„ the adequacy of the equipment and materials available,
including whether any additional materials were required
or there was an excess of consumables
„ the relationship between the mobile team and the person
responsible for the venue at which the session took place.
If you do not have computerized system, you would need to use large
printed forms or a large ledger to record the information in Figure 6.
Information on the number of donations received and any comments on
the venue can then be transferred to the record of venues available for

65
66
DONOR SESSION ANALYSIS FORM

Repeat donors New donors

bled bled Total bled Total deferred Venue suitability Time

Temp. Perm.

Date of % of % of % of % of
previous Potential total total total total Very Start– Staff: prof./
Date visit Venue population No. bled No. bled No. popul. No. defer. Poor Good good finish support Comments Signature
SECTION
5

Figure 6: Example of a donor session analysis form

 ORGANIZING DONOR CLINIC SESSIONS

Key to Figure 6
Date Date on which the mobile session was held
Date of previous visit Date on which the last session was held at this venue
Venue Name of the place where the mobile session was held
Potential population Estimate of the total number of persons eligible to give blood
Repeat donors bled Number of donors who had given blood before and the percentage of repeat donors
among the total number of donors bled
New donors bled Number of new donors and the percentage of new donors among the total number of
donors bled
Total bled Total number of new and repeat donors bled and the estimated percentage of the
potential donor population
Total deferred Number of donors not bled after screening
Temporary Number of donors deferred temporarily
Permanent Number of donors permanently excluded and the percentage of permanent exclusions
among the total number of donors deferred
Venue suitability Assessment of the suitability of the venue for future mobile sessions: e.g. hygiene/
cleanliness, cooperation of owners of venue, facilities for confidential donor screening,
number of donors bled, number of donors permanently excluded
Time: start–finish Times when the bleeding session started and finished
Staff Adequacy of the number of staff for the session
Professional Number of professional staff at the session: doctors, nurses
Support Number of support staff at the session: clerk/receptionist, driver, volunteer donor
assistants
Comments Any additional observations and comments from donors, staff, owners of the venue,
etc.
Signature Signature of member of staff completing the form after the session

mobile sessions, shown in Figure 3 on page 55. You will then have a
simple record of the value of each venue which can be used in planning
future mobile sessions.

ACTIVITY 27

Does your centre use a donor session analysis form like that shown
in Figure 6 to evaluate the effectiveness of mobile sessions? If so,
does it include all the points included in the example? If you think
your form could be improved, note down your ideas on your Action
List.
If records of this kind are not kept in your centre, use Figure 6 to
evaluate the performance of the next mobile session that you attend.
Then design a form that will help you to record the outcomes of each
donor session, adapting Figure 6 to your own situation.

SUMMARY
1 Mobile donor clinics enable the service to reach donors
who cannot easily attend a fixed clinic.
2 Mobile donor sessions can considerably increase the
number of regular voluntary non-remunerated donors.

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 SECTION 5

3 Advance planning is essential for mobile clinics, particularly

in:
„ selecting a suitable venue
„ publicizing the donor session
„ calling up donors
„ planning staff requirements
„ organizing equipment and materials.
4 Plastic blood collection bags should be used wherever
possible. If glass bottles are used, they should be
obtained ready to use from a central supply unit where all
the necessary production facilities are available.
5 Donor sessions should be evaluated systematically in
order to ensure that they are efficient and cost-effective.

SELF-ASSESSMENT

9 Why should donors never be bled in the laboratory?

10 What are the two essential parts of the blood cold chain?
11 Name two potential problems in using glass blood collection
bottles.

PROGRESS CHECK

Before moving on to Section 6, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 5. These were to:
1 Identify suitable sites for mobile donor clinic sessions.
2 Plan and prepare for a mobile session to ensure that it
operates efficiently.
3 Develop efficient procedures for calling up donors to fixed
and mobile donor clinic sessions.
4 Ensure the safe, efficient preparation and use of blood
collection packs.
5 Monitor and evaluate donor clinic sessions in order to
improve their efficiency.
If you feel confident that you have understood everything in
this section, turn to Section 6.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

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BLOOD DONOR SELECTION

6
Blood Donor Selection

The purpose of this section is to help you to review and improve the
effectiveness of the donor selection procedures used in your centre.
Every blood transfusion service or hospital blood bank has a responsibility
to ensure that blood donation does not harm either the donor or the
recipient of the blood. The purpose of donor selection is to identify any
factors that might make an individual unsuitable as a donor, either
temporarily or permanently. This section focuses on the three main parts
of the donor selection process:
„ predonation counselling
„ the medical history
„ the health check.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Develop appropriate procedures for providing predonation
counselling for donors.
2 Accurately record donors’ medical histories.
3 Carry out a basic health check of donors, within the limits
of your training.
4 Recognize when temporary deferral or permanent exclusion
is necessary and explain the reasons for deferral to
donors who are unsuitable to give blood.
5 Undertake simple monitoring of the donor selection
procedures used in your blood transfusion service or
hospital blood bank.

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 SECTION 6

6.1 PREDONATION COUNSELLING

The process of donor selection should begin even before donors come
to give blood through an effective education programme that informs
potential donors about health conditions or risk behaviour that would
make them unsuitable to donate blood. However, donors may still be
unaware of these factors, particularly if they are family or family
replacement donors or commercial donors. Predonation counselling is
therefore an essential part of donor selection because it enables donor
clinic staff to:
„ make a preliminary assessment of the donor’s state of
health
„ provide information about risk factors
„ assess the donor’s understanding of risk factors
„ offer the donor an opportunity to self-exclude or self-defer
„ explain the procedures involved in blood donation and the
reasons why they are undertaken, including the medical
history, the basic health check, the venepuncture itself,
postdonation care and the laboratory tests that are
performed on all donors’ blood
„ answer the donor’s questions and provide reassurance in
cases of anxiety
„ obtain the donor’s informed consent to donation and to
the procedures that will be followed.
Donors often assume that because they feel healthy, they are healthy.
This is not always the case. It is therefore vital to ensure that all donors
understand why they should provide accurate and complete information
about their health and any medication they may be using. They need to
understand that if they do not give this information, they risk endangering
their own health as well as that of the patients receiving their blood. In
order to do this, donors need simple information on the physiology of
blood, the causes of anaemia and the need for blood in different clinical
situations. They must also be informed about diseases that could be
transmitted by blood transfusion such as HIV, hepatitis viruses, syphilis,
malaria and Chagas disease, and their signs and symptoms.
If donors understand why it is to their own benefit to give honest, accurate
and complete information about their health, it will reassure them that
their welfare is as important to the service as that of the recipients of
their blood. If they do not believe that donor clinic staff are concerned
about their health, they are less likely to become regular donors.
It is particularly important to explain to donors about the laboratory tests
that will be performed on their blood and the reasons for them. They
should also be told the meaning of a negative or positive result for an
infectious disease and, if it is negative, how they can stay safe. This step
is important because it prepares donors psychologically for a possible
positive result. At the end of the predonation counselling, each donor
must give informed consent to blood donation, clearly acknowledging the
actions the blood centre may take following testing of the blood.

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BLOOD DONOR SELECTION

Risk behaviour
One of the most important parts of predonation counselling is to explain
what risk behaviour is and why it is necessary to assess whether the
donor is at risk for any transfusion-transmissible infections. It is
particularly important to encourage self-exclusion by people such as sex
workers, homosexual or bisexual men, injecting drug users, those who
have unprotected sexual contact with anyone other than a regular
partner, and the sexual contacts of any of these people.
Never assume that donors know what risk behaviour means. Sometimes
a simple leaflet, such as the example given in Appendix 1, is sufficient
to enable donors to understand why they may be at risk and the danger
that this poses to anyone receiving their blood. However, an in-depth
discussion is often needed, particularly with new donors. They may not
understand the terms ‘homosexuality’, ‘prostitution’ or ‘injecting drug
use’ or why having more than one sexual partner is risky. They may not
know about the ‘window period’ for HIV or the signs and symptoms of
infection. Always use simple language and check that they understand
what you are saying.
In Activity 5 in Section 2, you identified the kinds of risk behaviour that
are common or that sometimes occur in your community. It is important
to ask donors whether they have ever engaged in any of these forms of
risk behaviour or have been the sexual partner of someone who has. They
may find it embarrassing, but you must try to get an honest reply. Always
allow sufficient time for discussion and ensure that it takes place in
privacy. Reassure donors that strict confidentiality will be maintained.

ACTIVITY 28

Write down the questions that you would ask donors to help them
assess whether they have engaged in any risk behaviour and decide
whether they should self-exclude.
Then ask other donor clinic staff whether there are any additional
questions that they normally ask. If there are, note them down.

Discussion about risk behaviour provides an important opportunity to

counsel donors about reducing the risk of contracting HIV and other
infectious diseases. It also gives the opportunity to educate them about
why signs of infection may not be evident in themselves or other people.

ACTIVITY 29

Draw up a checklist of all the issues and questions that need to be

covered routinely during the predonation counselling of donors. Show
this to other members of the donor clinic staff and add any further
points that they suggest.
During the next few weeks, use this checklist as a basis for any
predonation counselling that you undertake and assess its

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 SECTION 6

effectiveness. Amend it, where necessary, and ask other staff also to
use it in their predonation counselling.

6.2 THE MEDICAL HISTORY

If a donor appears to be healthy and there is no indication that they have
engaged in any risk behaviour, the next step in the selection procedure
is to take the medical history. Sometimes donor clinic staff simply ask
donors about their health without writing down the information that they
receive. However, recording a donor’s medical history at the time of
donation is important for several reasons.
1 It provides information needed to decide whether to:
„ accept the donor
„ defer the donor temporarily
„ exclude the donor permanently.
2 It provides a permanent record of the donor’s health
status. If the donor returns to give blood again in the
future, the initial medical history provides baseline
information that enables comparisons of their health
status to be made. Changes in weight or blood pressure,
for example, are significant markers in making a decision
about whether to defer the donor or to proceed with
collecting blood.
3 It enables staff to check on any previous deferrals and
whether they were intended to be temporary (for example,
because the donor had recently been vaccinated or was
breastfeeding).
4 It enables staff to prevent donation if a donor presents
when they have previously been excluded (for example,
because of their medical history or because of risk
behaviour).
5 It enables studies to be carried out on the reasons for
temporary or permanent donor deferral. This enables the
service to monitor the effectiveness of its education
about self-exclusion and self-deferral.
6 It can be used to protect the service if a donor sustains
an unexpected injury or ill-effects for which the service
may be blamed. For this reason, the record of the donor’s
medical history should always be signed by the donor as
being correct.

The medical history questionnaire

The simplest way of taking a medical history is to fill in a standard medical
history questionnaire for the donor each time they come to give blood.
You will find an example of a medical history questionnaire in Appendix
4. Look at this now.

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BLOOD DONOR SELECTION

Using a standard questionnaire to record information about a donor’s

medical history has four advantages:
1 It helps to ensure that the same information is collected
systematically about each donor.
2 It should prevent donor clinic staff from forgetting to ask
important questions.
3 It reminds donor clinic staff to look for clinical signs of ill-
health while they are listening to what the donor is saying.
4 It makes it easier for donor clinic staff to decide whether
to accept, temporarily defer or permanently exclude the
donor because all the relevant information is presented in
a standard format.
The medical history should be signed by both the donor and the person
taking it, and the date added.
You have seen why it is important to take a written medical history.
However, the medical history is of little value – and can be misleading –
unless it is taken accurately. This means that, wherever possible, it
should be taken by a doctor or a nurse rather than by other staff who have
not been trained in recognizing the signs and symptoms of disease. This
is particularly important when dealing with new donors. Doctors and
nurses are trained to recognize clinical signs of ill-health and to know
whether they should temporarily or permanently defer a donor or proceed
to the next stage of the donor selection procedure. They are also used
to asking questions that other people might find embarrassing.
Donors should not simply be given a medical history questionnaire and
be asked to complete it by themselves. Most people do not understand
medical terms and may be so eager to give blood that they do not
recognize the significance of their answers for their own health. It is
therefore important to explain these terms in simple words so that all
donors can understand them and identify whether they have any of these
conditions. Always check that the donor has understood the questions.
The medical history should be taken in a place where it is possible to
ensure privacy since donors may not disclose important information if
they are worried that other people may overhear what they are saying.
Strict confidentiality must always be maintained about any information
obtained. We shall look at the subject of confidentiality in more detail in
Section 7.
We have emphasized that taking a medical history is a vital step in
ensuring that blood donation does not harm:
„ the donor
„ the recipient of the donated blood.
Look at the medical history questionnaire in Appendix 4 again. You will
see that it contains a number of questions about specific health
conditions. The donor should always be asked these questions before
donating blood. Some of these questions are designed to protect the
health of the donor. The others are designed to protect the health of the
recipient. Can you recognize the difference between them?

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 SECTION 6

ACTIVITY 30

Study the example of a medical history questionnaire in Appendix 4.

Identify the conditions listed that are concerned with the safety of the
blood donor.
Then identify the conditions listed that are concerned with the safety
of the recipient of donated blood.

Don’t worry if you find this activity difficult at this stage. You will find the
answers on the next three pages.

The safety of the donor

Table 1 below shows some of the conditions that would make it
potentially unsafe for the health of the donor if they give blood.

Table 1: Potential risks to the safety of the donor

„ Low/high blood pressure

„ Heart disease
„ Dizziness
„ Excessive nose bleeds
„ Epilepsy
„ Rheumatic fever
„ Circulation problems
„ Anaemia
„ Diabetes
„ Ulcers
„ Kidney disease
„ Pregnancy
„ Breastfeeding
„ Menstrual problems (excessive menstrual bleeding)
„ Recent operation which may have incurred blood loss

ACTIVITY 31

For each of the conditions listed in Table 1, list the possible

consequences for a donor who fails to acknowledge the condition.
Check your answers by talking to a doctor or nurse in the transfusion
service or hospital where you work.
Do you understand why the conditions listed in Table 1 would make it
potentially unsafe for a donor to give blood? Ask for a full explanation
of anything that you do not understand or did not know before.

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BLOOD DONOR SELECTION

The safety of the recipient

Table 2 shows some of the signs and symptoms in the donor that could
make the donated blood potentially harmful to the health of the recipient.

Table 2: Potential risks to the health of the recipient

„ Swollen glands
„ Persistent cough
„ Unexplained weight loss
„ Shingles
„ Night sweats/fever
„ Brucellosis
„ Skin rashes
„ Sleeping sickness (trypanosomiasis)
„ Sexually transmitted diseases (STD/VD)
„ HIV/AIDS
„ Prolonged diarrhoea
„ Malaria (fever)
„ Hepatitis/jaundice
„ Lung disease
„ Tuberculosis
„ Asthma
„ Thyroid disorder
„ Cancer
„ Recent history of medication
„ Recent injections
„ Recent vaccinations
„ Recent operations
„ Recent acupuncture
„ Recent scarification
„ Recent blood transfusion history
„ Recent contact with infectious disease

ACTIVITY 32

For each of the conditions listed in Table 2, list the possible

consequences for the recipient of the donated blood if the donor fails
to acknowledge the condition. Check your answers by talking to a
doctor or nurse in the transfusion service or hospital where you work.
Do you understand why the conditions listed in Table 2 would make it
potentially unsafe for the recipient if the donor gives blood? Ask for a
full explanation of anything that you do not understand or did not
know before.

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 SECTION 6

Remember the risks of the “window period” that we discussed in Section

2. It is very important to relate indications of risk behaviour to any
symptoms mentioned by a donor. For example, someone reporting
recent treatment for a sexually transmitted disease may actually be in
the “window period” for HIV. Similarly, a donor who has recently been in
a malaria endemic zone may be harbouring parasites.

ACTIVITY 33

Using Table 1 and Table 2 as a guide, identify the health conditions

that are found in your country and that fit in the following two broad
categories:
„ health factors of importance to the safety of the donor
„ health factors of importance to the safety of the recipient.
List them in their order of prevalence: that is, start with the most
common, then the next most common and continue until you have
listed the rarest.

You may be wondering ‘But where can I find this information?’ The
Ministry of Health is the most important source of health information and
you may be able to find out the answers from local Ministry of Health
officials, particularly those dealing with epidemiology. If you have any
difficulty, ask one of your senior colleagues for help. Although it may take
you some time to get the answers, this is an important activity because
it will highlight the conditions that everyone involved in donor selection
must particularly look out for.
Training and experience in donor selection will increase your effectiveness
in screening donors. However, it is essential to understand the importance
of the medical history since you should now think about whether you can
improve the donor medical history records that are kept in your centre.

ACTIVITY 34

In your centre, are records kept of donors’ responses to questions

about their medical history? If they are, compare your system with the
example of a donor medical history questionnaire in Appendix 4.
Can you suggest any ways in which the records in your centre could
be improved? If you are not responsible for keeping these records
yourself, discuss your ideas with the appropriate donor clinic staff.
Note down your recommendations on your Action List.
If records of donors’ medical histories are not kept in your centre,
talk to your colleagues and supervisor about whether a system could
be introduced. Note down your recommendations on your Action List.

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BLOOD DONOR SELECTION

If you and your colleagues agree that medical history records need to be
amended or introduced, it is important to ask a medical officer to review
them carefully before they are used.
Remember that any donor clinic staff who complete medical history
questionnaires or similar records must understand everything included
in them. They must also ensure that all donors, particularly new donors,
understand all the questions they are asked.

6.3 THE HEALTH CHECK

So far in this section, we have focused on collecting information from
donors themselves about any health conditions or other factors that
might either endanger their own health if they give blood or adversely
affect the health of the recipients. As you have already seen, this should
include:
„ questioning donors to assess the likelihood of risk
behaviour and counselling them to self-exclude, where
appropriate
„ interviewing donors to assess their health status, using
a medical history questionnaire or a similar record
„ identifying any drugs or medicines being used by donors
and assessing their significance for the safety of blood
donation.
As with all medical procedures, however, it is unwise for donor clinic staff
to rely solely on what donors tell them because they may not realize that
they have a particular health problem. It is important also to give each
donor a health check before they donate blood in order to make a
complete assessment of their health status.
The following assessments need to be made as part of the health check
each time a donor comes to give blood:
„ blood pressure
„ pulse rate
„ weight
„ haemoglobin estimation
„ weight and height parameters
„ physical assessment of the donor for such symptoms as
skin rashes and swollen glands, or needle marks that
might indicate injecting drug use
„ the time of the donor’s last meal. Not having had a meal
in the last 12–24 hours may lead to a fainting attack.
An example of a simple format for recording the results of the health
check on the donor’s personal record card is shown in Figure 7 on page
78.
The health check should be carried out only by staff trained in the clinical
diagnosis of disease. Laboratory technical staff are not trained in

77
 SECTION 6

Blood pressure/ Haemoglobin (by

Date pulse Weight copper sulfate)

Donor height:

Comments:

Figure 7: Recording the basic

health check

recognizing the signs and symptoms of disease and should not normally
carry out the screening procedure unless they are adequately trained and
supervised. They may, for example, carry out some of the simple
assessments, such as measuring the donor’s weight, height and
haemoglobin level, if they have received suitable training. Two examples
of standard operating procedures are given in Appendix 5 which provide
clear and detailed instructions on:
„ the procedure for haemoglobin screening using the copper
sulfate method
„ the procedure for dealing with donors who fail the copper
sulfate test.
If you are responsible for carrying out haemoglobin screening using the
copper sufate test, read Appendix 5 carefully to ensure that you follow
the correct procedure.
In 2001, a new method of screening haemoglobin levels was introduced.
Appendix 6 describes the WHO Haemoglobin Colour Scale, which is a
simple and inexpensive clinical device that provides a reliable method for
screening for the presence and severity of anaemia.
The physical assessment should ideally be made by a trained nurse or
medical officer.

ACTIVITY 35

In your centre, who is responsible for undertaking the various

assessments in the basic health check of donors? What training have
they received?
Talk to your colleagues and identify any areas in relation to the
screening of donors in which donor clinic staff feel they need more
training. Add these to your Action List and discuss them with your
supervisor or a senior medical or nursing colleague.

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BLOOD DONOR SELECTION

Even the most experienced staff find it helpful to use guidelines on the
medical assessment of blood donors. An example of some guidelines is
given in Appendix 7. Are any similar guidelines used in your blood
transfusion centre or hospital blood bank?

ACTIVITY 36

Read the Guide to Medical Assessment of Blood Donors in Appendix

7 and compare it with any guidelines that are currently used in your
centre. If you think that your guidelines need to be amended, note
down your recommendations on your Action List and discuss them
with your colleagues and senior medical staff.
If guidelines of this kind are not yet used in your centre, show
Appendix 6 to other donor clinic staff who are responsible for
screening donors and ask them whether they would find it useful as
an aid in donor selection. Discuss with them any ways in which the
guide might need to be adjusted before it could be used in your local
situation. For example, it might need to be amended to take into
account such factors as the average height and weight of the donor
population or normal haemoglobin levels for adult males and
females. Note down your recommendations on your Action List.

It is important for your centre to seek guidance from your local health
authority or from the Ministry of Health in producing or adapting any
guidelines for the medical assessment of donors. When they are
completed, ensure that they are reviewed thoroughly and approved by a
medical officer.
Each part of the donor selection process must be undertaken
systematically and should never be rushed, even if other donors are
waiting to give blood. An adequate number of appropriately trained staff
is therefore necessary to ensure that sufficient time can be given to each
donor. You may already have suggested in your response to Activity 24
that the number of trained staff available for blood collection in your
centre is insufficient. If so, make a further note on your Action List to
discuss with your supervisor any changes that may be required in order
to ensure that donor selection is safe for everyone.

6.4 DONOR DEFERRAL

In this section, we have emphasized the importance of the medical
history and the health check in identifying donors who should be excluded
or deferred. Ideally, potential donors who are unsuitable will decide to
self-exclude as a result of predonation information and counselling.
However, it will always be necessary to defer some potential donors.
Some may need to be deferred on a temporary basis only, but others may
have to be asked not to come to blood donor sessions again. Always
follow local or national guidelines when deferring donors.

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 SECTION 6

When donors are deferred, whether on a temporary or permanent basis,

they may become very anxious. There are six steps that should be
followed when it is not possible to accept a donor.
1 Explain to them in a clear and sympathetic way why they
are unsuitable to donate blood. They need to be told
whether it is because:
„ giving blood may endanger their own health
„ the blood might be dangerous to the recipient, either
because of the donor’s medical condition or because
of the possible risk of infectious agents in the blood.
2 Reassure them. They may be frightened that their health
is worse than it really is.
3 Explain whether the deferral is temporary or permanent.
If it is temporary, tell them when it will be safe to donate
blood and encourage them to return then.
4 Give them information about where they can go for further
advice and support, if needed.
5 Where appropriate, refer them to an expert, such as a
doctor or a counsellor, for follow-up.
6 Wherever possible, follow them up yourself to ensure that
they are given an opportunity for further discussion about
anything that they are concerned about.

6.5 MONITORING DONOR SELECTION

Always remember that poor donor selection can endanger the health of
both the donors themselves as well as the patients who receive their
blood. For this reason, the effectiveness of donor selection should be
continually monitored and evaluated to ensure that it is working as
expected and is achieving its objective of ensuring safe and adequate
supplies of blood. This is an essential part of your programme’s quality
system.
It is difficult to measure the effectiveness of donor selection, however,
if there is no systematic plan setting out the programme’s objectives and
targets and how they will be achieved. The targets set for a donor
selection programme are usually closely linked with the targets for a
donor education, motivation and recruitment campaign, as follows.
1 An increase in the number of voluntary non-remunerated
donors.
2 An increase in the number of voluntary non-remunerated
donors who are willing to give blood regularly.
3 A reduction in the number of donors who have to be
deferred temporarily.
4 A reduction in the number of donors who have to be
permanently excluded.
5 A reduction in the number of donations that have to be
rejected because they test positive for a transfusion-

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BLOOD DONOR SELECTION

transmissible infection, such as HIV. A reduction in the

seroprevalence of infection in repeat donations is a
particularly important indicator of the effectiveness of the
donor education programme.
6 A balance between the amount of blood required and the
amount of suitable blood that is collected.
As we have seen in earlier parts of this module, in order to achieve these
targets, it is important to undertake the following activities:
1 Estimate the amount of blood that is likely to be required
each week, month and year.
2 Develop an effective donor education, motivation and
recruitment campaign to encourage more people to become
regular, voluntaryp non-remunerated donors.
3 Create public awareness about the importance of safe
blood and promote self-exclusion or self-deferral by people
who might be unsuitable as donors.
4 Plan donor clinic sessions so that donors have sufficient
time for questions and discussion.
5 Ensure that there is an adequate number of donor clinic
staff to carry out each stage of the donor selection process
thoroughly.
6 Provide appropriate training for all donor clinic staff to
ensure that donor selection procedures are carried out
efficiently.
7 Provide predonation counselling for all donors and
encourage self-exclusion or self-deferral, where appropriate.
8 Develop a medical history questionnaire, or similar record,
and ensure that donor clinic staff use it systematically.
9 Undertake a health check of all donors.
10 Ensure that privacy and confidentiality are maintained at
all stages of the donor selection process.

ACTIVITY 37

What targets have been set for the donor selection programme in
your centre? How do you plan to achieve them?
If there is no plan, discuss with colleagues the objectives and targets
that you think are realistic for the next year in your donor selection
programme. Note down your recommendations on your Action List.
Keep a record of these so that you can measure the effectiveness of
your donor selection programme against them in the future.

A useful way of recording information about donor selection is to

complete a donor screening report at the end of every donor session. An
example is shown in Figure 8 on page 82, with an explanation of each
column on page 83. If this is used in conjunction with the donor session

81
82
DONOR SCREENING REPORT

Number deferred

Permanent Temporary
SECTION
6

Self- Signature of
Venue Date Seen Passed Age Unfit Risk exclusion Age Unfit Weight staff in charge

Figure 8: Donor screening report

 BLOOD DONOR SELECTION

Key to Figure 8
Venue Name of the place where the donor clinic is held: e.g. college, factory, community hall, etc.
Date Date of the clinic session
Seen Number of donors attending the donor clinic
Passed Total number of donors accepted for donation
No. deferred Total number of donors deferred after counselling and health check
Permanent Number of donors permanently excluded
Age Number of donors excluded because they are over the age limit acceptable for donation
Unfit Number of donors excluded on the grounds of health, such as heart disease
Risk Number of donors excluded following counselling and health check because of identification of
possible risk factors for transfusion-transmissible infections
Self-exclusion Number of donors self-excluding after recognizing that their behaviour poses a risk to recipients
of their blood
Temporary Number of donors deferred temporarily
Age Number of donors deferred because they are below the age acceptable for donation
Unfit Number of donors deferred on the grounds of health, such as pregnancy
Weight Number of donors deferred because they do not meet the minimum weight accepted
Signature Signature of member of staff in charge of the donor session

analysis form shown in Figure 6 on page 66, it should provide an accurate

record of the clinic’s progress in achieving its targets.

ACTIVITY 38

Is some form of donor screening record kept in your centre? Does it

contain sufficient information to enable the effectiveness of the donor
selection programme to be monitored? If you can suggest any ways in
which it might be improved, note them down on your Action List.
If no record of this kind is currently kept in your centre, talk to your
supervisor about introducing one to assist you in monitoring your
donor selection programme. Note down your ideas on what it should
contain on your Action List.

The issues we have dealt with in this section are the foundations of a safe
and efficient transfusion service. Always remember that, without the
donor, there can be no blood transfusion and therefore the donor’s
welfare must receive the highest attention if the public is to be persuaded
to give blood. In Section 7, we shall consider further ways of ensuring that
blood donation is a positive experience for donors.

SUMMARY
1 During predonation counselling, donors should be given
information about the blood donation process and the
procedures to identify their suitability as donors. Donors
should be encouraged to self-exclude or self-defer if they
think they may be unsuitable.
2 A written record should be kept of the donor’s medical
history at each donation, using a standard form,
questionnaire or similar record.

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 SECTION 6

3 The basic health check of donors should always be

undertaken by qualified or suitably trained staff.
4 When donors are deferred, either temporarily or
permanently, they should be given reassurance and an
explanation for their deferral and, where appropriate,
should be referred to other sources of advice and support.
5 Privacy and confidentiality should be maintained at all
stages of the donor selection process.
6 Targets should be set for the donor selection programme,
together with a plan for achieving them, in order to enable
it to be monitored effectively.

SELF-ASSESSMENT

12 What are the three main parts of the donor selection

process?
13 What are the advantages of using a medical history
questionnaire?

PROGRESS CHECK

Before moving on to Section 7, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 6. These were to:
1 Develop appropriate procedures for providing predonation
counselling for donors.
2 Accurately record donors’ medical histories.
3 Carry out a basic health check of donors, within the limits
of your training.
4 Recognize when temporary deferral or permanent exclusion
is necessary and explain the reasons for deferral to
donors who are unsuitable to give blood.
5 Undertake simple monitoring of the donor selection
procedures used in your blood transfusion service or
hospital blood bank.
If you feel confident that you have understood everything in
this section, turn to Section 7.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

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THE CARE OF BLOOD DONORS

7
The Care of Blood Donors

The purpose of this section is to help you to ensure that all donors who
come to give blood receive a high standard of care and that their
experience of donation is safe, efficient and pleasant.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Develop appropriate procedures to ensure that high
standards of care are provided for all donors before,
during and after donation,
2 Maintain confidentiality of information about donors.
3 Identify appropriate sources of expertise in counselling.

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 SECTION 7

7.1 A PROFESSIONAL AND PLEASANT RECEPTION

The most important people at a blood donor session are the blood donors
themselves. Without their blood, the service could not continue to
operate. The conditions surrounding blood donation should therefore be
as safe, pleasant and convenient as possible for donors. If they are not,
a bad image of the service will be created. As word spreads, it will be more
difficult to attract new voluntary non-remunerated donors and to retain
existing donors.
It is essential that all staff involved in blood donor sessions are well
trained in carrying out their particular tasks. Each blood transfusion
service or blood bank should prepare its own guidelines or standard
operating procedures (SOPs) covering all activities in the donor area.
Section 4 in the Introductory Module discusses how to prepare SOPs and
you have already seen examples of SOPs for haemoglobin estimation,
using the copper sulfate method, in Appendix 5.
Staff should always be smart and clean in appearance and maintain a
high standard of personal hygiene. They should have a pleasant manner
and be capable of conversing freely with donors, particularly at the time
of bleeding. Everyone involved in interviewing or counselling should
develop a friendly and tactful approach that encourages donors to be
honest and accurate in their answers to questions about their medical
history so that an accurate assessment of their suitability can be made.
The health check must always be handled professionally so that donors
feel that they are in good hands.
It takes much time, effort and money to recruit voluntary blood donors
successfully, but donors can be easily lost to the service by an act of
carelessness or a lack of professionalism on the part of donor clinic staff
before, during or after donation. Let us consider some common examples
of unprofessional behaviour that may make the experience of blood
donation unpleasant for donors.

Professional issues
„ unhygienic or unsafe environment
„ crowded room, with inadequate or uncomfortable seating
in the waiting area
„ long waiting times or unnecessary delays during the
donation process
„ lack of privacy during predonation counselling and other
discussions
„ inadequate explanation of the procedures involved in
blood donation
„ failure to discuss any adverse findings from the donor’s
physical screening
„ failure to explain the reasons for temporary or permanent
deferral and their significance for the donor
„ inadequate period of rest for donors after they have given
blood

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THE CARE OF BLOOD DONORS

„ failure to provide refreshments for donors while they are

resting after donating blood.

Staff attitudes and behaviour

„ failure to welcome each donor on arrival at the clinic
„ unprofessional image: for example, dirty or untidy clothing
„ apparent lack of confidence, knowledge or skill among
staff
„ unfriendly or impolite behaviour
„ lack of interest in the individual donor: for example, no
acknowledgement of previous donations or not wanting to
know the donor’s full name
„ failure to reassure donors and put them at ease during
predonation counselling, the medical assessment, the
health check and the bleeding
„ insensitivity to donors’ feelings, particularly those of fear
or embarrassment
„ indiscreet comments about donors, such as about the
results of the current or previous health check, particularly
when a donor is being excluded or deferred
„ unwillingness to talk to donors while bleeding them
„ chatting to other staff and ignoring donors
„ impression of being bored
„ failure to thank donors or to show other signs of
appreciation.

ACTIVITY 39

During the next month, carefully observe the fixed and mobile donor
clinics that you are involved in. List any factors that you think might
contribute to an unpleasant experience for donors.
On each occasion, talk to some donors while they are resting after
giving blood to find out what they think about the service provided
and how they think it could be improved.
Also talk to other donor clinic staff about what improvements they
think could be made. Note down your ideas on your Action List.

New and repeat donors

New donors generally have different expectations of the service from
those of repeat donors, particularly those who donate regularly. When
donors have never given blood before, they are usually nervous about
what will happen, both during screening and while they are being bled,
and need much more reassurance than repeat donors.

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 SECTION 7

Repeat donors may still be nervous about being bled, and therefore also
need reassurance, but they know what is going to happen to them. They
should also be more aware of risk factors and should not need such
detailed re-screening.
Look at Figure 9 below, which suggests some differences in the
characteristics of new and repeat donors and how they should be
handled. It is important that all donor clinic staff understand these
differences. You can probably add others that you have noticed from your
own experience.

New donors Repeat donors

A potentially higher risk of transfusion- A lower risk of transfusion-

transmissible infection because they transmissible infection because they
have never been screened before. have been screened at least once.

Their motivation to become a donor is Their motivation is already known from

unknown: it may be to help others, but discussions at previous donations.
may be to find out whether they are They may be used to motivate others
HIV positive. to give blood.

It is easier to deal with if they are It is more difficult to deal with if they
seropositive because their blood has are seropositive because their last
never been used. donation may have been given when
they were in the ‘window period’.
They need more reassurance about They need less reassurance because
procedures, particularly about what to they are familiar with the procedures.
expect when being bled and about
confidentiality.

Detailed predonation counselling is Less predonation counselling is

required. required.

More time is needed to complete Less time is required to complete

records and other procedures. records and other procedures.

Postdonation follow-up may be required Postdonation counselling may not be

if donor is seronegative to encourage required if donor is seronegative.
safe behaviour. Where the donor has been deferred for
any reason, careful counselling is
required.

Greater appreciation needs to be shown Appreciation by the service is no

to encourage them to return. longer the main motivating factor. But
it still needs to be shown to encourage
Figure 9: Characteristics of
continued donations.
new and repeat donors

ACTIVITY 40

During the next few donor sessions that you are involved in, observe
carefully how donor clinic staff deal with new and repeat donors.
Does your centre have a policy on the way that new and repeat
donors are treated? Are there differences in the way that staff behave
towards new and repeat donors, particularly regular donors?
Can you suggest any ways in which the treatment of new or repeat
donors could be improved? Note your ideas down on your Action List.

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THE CARE OF BLOOD DONORS

Remember that the way in which donors are treated will have a direct
effect on their willingness to give blood again and therefore on the
achievement of a safe and adequate supply of blood. If a new donor’s
first experience of being a blood donor is a bad one, they will probably
never come back again and may deter other potential donors. Even a
regular voluntary donor who has an unpleasant experience may be
unwilling to return. Every member of the donor clinic staff has a personal
responsibility to ensure that this does not happen.

7.2 CONFIDENTIALITY
Confidentiality is a vital part of a professional service. The information
provided by the donor is personal and is given solely to assist the service
in ensuring the safety of the blood supply. It should never be disclosed
to another person without that donor’s specific consent. If confidentiality
is not maintained, the trust between the donor and the service will be
broken.
Confidentiality is always necessary in relation to the following areas:
1 During donor screening and blood collection
It is important to ensure that the donor clinic, whether
fixed or mobile, is organized so that nobody else can hear
what is being said in personal interviews between donors
and clinic staff. Every member of staff has a professional
responsibility not to talk about individual donors to other
people. This applies equally whether they have been
accepted or deferred.
2 Donor records
Donor records contain information about the donor,
including their personal details, their medical history, the
results of the laboratory tests on their blood and whether
they have been deferred. It is essential to keep records in
a safe place where only authorized staff have access to
them. Each blood centre has a professional responsibility
to ensure the confidentiality of all donor records.
3 Consent
Information about a donor should never be disclosed to
other people, such as their family, colleagues or employers,
without the written consent of that donor.
4 Published information
Care should be taken when circulating or publishing
information about your centre’s work: for example,
statistics on the seroprevalence of infection in relation to
a particular donor clinic site may result in that place
becoming the subject of public ridicule or fear.

ACTIVITY 41
What do you think the effects of a breach of confidentiality might be
on your centre’s ability to maintain safe and adequate supplies of
blood?

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 SECTION 7

Think back to any situations you have experienced in which

confidentiality was broken. What happened as a result?

Some of the most common effects of not maintaining confidentiality are:

1 Donors are less likely to be truthful about their health
status or risk behaviour during predonation counselling if
they think that it may become public knowledge. This
results in an increased risk to blood safety.
2 Low-risk donors may be unwilling to give blood again
because they do not trust the service.
3 They may also discourage their family, friends, colleagues
and other potential donors from giving blood.
4 Word may spread more widely about breaches of
confidentiality, resulting in poor donor turnout and serious
long-term effects on donor recruitment and retention.
5 A breach of confidentiality about a donor who has been
deferred, perhaps about their risk behaviour or the results
of screening tests on their blood, may lead to victimization
by other people in the community.
6 A donor may take legal action against the centre if
personal information is disclosed without his or her
specific consent.
You may have identified additional harmful effects.
On the other hand, there are major benefits if the service maintains strict
confidentiality.

ACTIVITY 42
Can you suggest some of the long-term benefits of maintaining
confidentiality in relation to donors?

Some of the important benefits of maintaining confidentiality are:

1 Donors will be more likely to trust the service enough to
respond honestly to questions about risk behaviour or
their health status, resulting in a lower risk to blood
safety.
2 Donors will be more likely to return to give blood in the
future, which will help to ensure adequate supplies of
blood.
3 This will also lead to greater blood safety because regular
donors are safer donors.
4 Donors will be more likely to recruit other people to
become donors.

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THE CARE OF BLOOD DONORS

5 Donor recruitment and retention will be more successful

because the public will have confidence in the service.
Again, you may be able to think of additional benefits of maintaining
confidentiality and thus increasing donors’ trust in the service.
What steps can be taken to ensure confidentiality?
1 In fixed and mobile sessions, the layout should be
organized so that donors and staff are unable to hear what
is being said by other donors.
2 No member of staff should reveal personal information
about a donor to other people without the donor’s written
consent.
3 Staff who collect blood from donors should not test the
blood from those donors or handle the serology results.
4 Donors’ names should not appear on blood collection
bags or samples. Instead, only numbers, alphanumeric
codes or other identification codes should be used.
Where it is necessary to inform a donor of the results of
laboratory tests, only an authorized senior member of
staff should be allowed to match the numbers on the
blood bags or samples to the donor’s name.
5 Donor clinic staff or laboratory staff should not inform
donors about the results of tests on their blood, particularly
if they test seropositive for transfusion-transmissible
infections. This should be undertaken by a medical
officer, a counsellor or another authorized member of
staff who has been trained in counselling.

ACTIVITY 43

What steps are currently taken in your centre to ensure donor

confidentiality? Do you think they are adequate? You may find it
helpful to talk to some donors and to other donor clinic staff about
whether they think arrangements to ensure confidentiality could be
improved, perhaps by further staff training or reorganizing the layout
of the clinic to provide more privacy. Note your recommendations
down on your Action List.

7.3 VENEPUNCTURE
Many transfusion services that have assessed donor anxieties have
identified fear of ‘the needle’ and adverse reactions as major causes of
an unwillingness to give blood or fainting during donation. In fact, some
people are frightened of the very sight of a needle, even in a photograph.
Obviously anyone who performs a venepuncture must be skilled. If their
technique is poor, the donor will suffer discomfort and may be unwilling

91
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to give blood again. Donors may also discourage other potential donors
by telling them about their own unpleasant experience. Every transfusion
service or hospital blood bank should always ensure that clinic staff who
perform venepunctures are adequately trained and that their performance
is monitored. Appendix 8 provides guidance on how to perform a
venepuncture.

ACTIVITY 44

Read Appendix 8: Venepuncture. If you perform venepunctures, how

confident are you about your ability to carry them out competently
without causing discomfort to donors? Do you feel that you need
further training in performing a venepuncture?
If you feel that you or other members of staff need more training,
note this down on your Action List and discuss it with your supervisor.

Sometimes poor venepuncture is not the fault of the staff performing it.
It may be caused by a blunt needle in a poorly-designed blood pack or
poor veins, for example. When blood packs are evaluated for suitability
by your centre, therefore, it is important to assess the performance of the
needle before an order is placed.

7.4 ADVERSE DONOR REACTIONS

Donors give their time and blood for the benefit of others and so it is
important to show appreciation for this through appropriate care during
and after donation.
Most donors tolerate giving blood very well, but occasionally adverse
reactions may occur. The most common problems include:
„ problems with blood flow
„ haematoma
„ accidental puncture of the artery
„ mild reactions
„ moderate reactions, such as fainting
„ severe reactions, such as convulsions (uncommon)
„ hyperventilation
„ accidents.
All donor clinic staff should be trained to recognize and treat these
reactions. This training should include first aid. Information on how to
recognize and deal with adverse donor reactions is given in Appendix 9.

ACTIVITY 45

Read Appendix 9: Adverse Donor Reactions. Do you feel confident

about your ability to recognize and deal with adverse donor reactions?

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THE CARE OF BLOOD DONORS

What training is provided to donor clinic staff in this area? Do you

think that you need any further training?
If you feel that you or other members of staff need more training in
dealing with adverse donor reactions, talk to your supervisor or
supporter about making arrangements for an experienced doctor or
senior nurse to provide appropriate training. Note this down on your
Action List.

7.5 POSTDONATION CARE

Having completed the donation, a donor must be allowed to rest for a
minimum of 20 minutes so that the body can adjust to the loss of blood.
During this time, some liquid refreshment should be provided to replace
lost body fluid, together with a light snack, if possible. A donor who feels
faint or dizzy should be helped to lie down, with the legs raised to improve
the blood supply to the head. Before leaving the clinic, the donor should
be seen by a trained member of staff to ensure that they are feeling fit
and have been cared for in an appropriate way.
It is important to ensure that donor clinic staff always give information
to donors about how to look after themselves following donation by telling
them that:
1 They should drink more fluids than usual during the four
hours before and after donating blood.
2 They should keep the dressing on the venepuncture site
for about 12 hours.
3 They should not consume excessive alcohol before the
next meal.
4 If the venepuncture site bleeds, they should raise their
arm and apply pressure until the bleeding stops. If it
continues, they should contact the blood bank, a doctor
or a nurse.
5 If they experience faintness or dizziness and the symptoms
persist, they should contact the blood bank, a doctor or
a nurse.
6 They should avoid strenuous exercise for 24 hours.
Any observations made about the venepuncture or adverse reactions
should be recorded on the donor’s record card so that particular care can
be taken at the next donation.
Always thank donors for giving blood before they leave. If your centre
operates an appointments system, make an appointment for the next
donation if the donor is willing to give blood regularly. This is normally
three months later for men or four months later for women. Where donors
have attended a mobile session, they should be informed about when the
next mobile clinic will be held in their area and encouraged to attend it.

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7.6 POSTDONATION NOTIFICATION AND COUNSELLING

Despite predonation information and counselling and careful donor
screening, laboratory tests may reveal adverse results indicating the
presence of a transfusion-transmissible infection such as HIV, hepatitis
B or C, or syphilis in a donor’s blood. In such cases, the donor must not
be bled again. The donor’s individual record card should be marked
‘permanently excluded’ so that they can be prevented from donating
blood if they attend the donor clinic in the future. In order to maintain
confidentiality, however, the specific reason for the exclusion should not
be recorded on the donor’s card.
In many countries, donors are notified if laboratory tests reveal that they
are unsuitable as donors. However, each transfusion service should
have a clear policy to follow in such situations which is compatible with
established health practices and is culturally acceptable. Maintaining
strict confidentiality about HIV-positive donors must be part of the agreed
policy in every blood centre.
Postdonation counselling of HIV-positive donors is important in order to
prepare them for changes in their health condition and to help them to
come to terms with the disease. They may need help in deciding what to
tell their family, friends and colleagues and in planning a different
lifestyle. They will also need to be informed about the dangers of
transmitting the infection to other people and how to avoid this.
Some blood transfusion services are able to provide counselling for HIV-
positive donors by employing a trained counsellor specifically for this
purpose or by providing training in counselling skills for selected staff.
This is more likely to be possible in countries with a low prevalence of HIV
and AIDS.
In most countries, however, it is not feasible for transfusion services to
provide counselling and it is more appropriate for HIV-positive donors to
be counselled by trained counsellors in specialist institutions or
organizations with adequate facilities. It is important that close, strong
relationships are established between the transfusion service and
organizations of this kind. Confidentiality must, of course, be maintained
and information should not be given to another organization about an HIV-
positive donor without that donor’s consent.
Some transfusion services provide counselling for new donors who test
negative for infectious diseases in order to reinforce safe behaviour.
Postdonation counselling of HIV-negative new donors is very useful in
AIDS prevention and provides an opportunity to demonstrate that the
service cares about their well-being and appreciates their willingness to
donate blood. In most countries, however, there is no policy to provide
routine postdonation counselling and it would generally not be feasible
because of limited staff resources.

ACTIVITY 46

Is any counselling or other follow-up provided by your service for

donors who test positive for HIV or any other infectious agents? Have
staff been trained in counselling techniques?

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THE CARE OF BLOOD DONORS

Which other organizations in your country or area provide counselling

and other follow-up for HIV-positive donors? How do you think you
could strengthen your service’s relationship with them? Find out
whether they or any other organizations could provide training in
counselling skills.
If you do not know of any other organizations providing training in
counselling, discuss with your supporter the best way of finding out
this information, perhaps from the Ministry of Health. Note down any
action you wish to take on your Action List.

If you would like more information on the counselling of donors, try to

obtain a copy of Guidelines for Counselling about HIV Infection and
Disease, published by WHO in 1990 (WHO AIDS Series No. 8). You
should be able to obtain one from the World Health Representative in
your country.

SUMMARY
1 Guidelines or standard operating procedures on all aspects
of the care of donors should be prepared by each blood
transfusion service or blood bank. These will help to
maintain the consistently high standards expected by the
blood donor public.
2 Donors must be cared for efficiently throughout the
donation process. Every donor has the right to expect a
professional and pleasant reception and high standards
of care.
3 New and repeat donors have different expectations and
needs. Donor clinic staff should be aware of these and
respond accordingly.
4 Confidentiality is an essential part of donor care and is a
prerequisite for blood safety and effective donor
recruitment and retention.
5 Venepuncture should be performed only by staff who have
been adequately trained for this task.
6 Donor clinic staff should be trained to recognize and deal
with adverse donor reactions.
7 Appropriate care should be provided for all donors following
donation, including informing them about their own
postdonation care.
8 Postdonation counselling should be available to all donors
who require it. Close links should be established with
other organizations that can provide appropriate
counselling.

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 SECTION 7

SELF-ASSESSMENT

14 Name four areas in which confidentiality is always necessary.

15 Identify three problems sometimes experienced by donors
during or after giving blood.

PROGRESS CHECK

Before moving on to Section 8, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 7. These were to:
1 Develop appropriate procedures to ensure that high
standards of care are provided for all donors before,
during and after donation.
2 Maintain confidentiality of information about donors.
3 Identify appropriate sources of expertise in counselling.
If you feel confident that you have understood everything in
this section, turn to Section 8.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

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BLOOD DONOR RECORDS

8
Blood Donor Records

The purpose of this section is to help you to establish an efficient system

of record-keeping that will enable you to maintain confidentiality and
develop a panel of regular, voluntary non-remunerated donors.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Maintain an efficient record-keeping system to assist in
the development of a panel of regular, voluntary non-
remunerated blood donors.
2 Identify information from records that can be used for
reporting purposes.

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 SECTION 8

8.1 ESSENTIAL DONOR RECORDS

We have already briefly considered some of the records that are
essential for an efficient donor clinic. In this section, we shall look in
more detail at:
1 Personal donor enrolment card/medical history/health
check.
2 Donor’s record of donations.
3 Donor clinic register.
4 Record of venues available for mobile sessions.
5 Donor session analysis form.
6 Donor screening report.
7 Regular donor panel register.
8 Register of donors with less common blood types.
9 Temporary donor deferral record.

Personal donor enrolment record

A personal donor enrolment record has four main components:
„ personal details
„ informed consent
„ donor’s medical history
„ record of the basic health check.
Where possible, all the relevant information should be recorded on one
card. For simplicity, however, we shall look at each section separately.

Personal details
An example of the first part of the donor enrolment record, showing the
donor’s personal details, is shown in Figure 10.
Let us examine this part of the donor enrolment record in detail in order
to see why this information is important.
Surname and first names
The surname or family name of the donor is obviously essential, but it is
also important to include the donor’s first and other names as well in
order to distinguish between people with the same surnames or family
names. Every society has large numbers of people with the same names,
such as Singh, Lee or Smith.
Identity number
In some countries, every person has a national identity number. In such
cases, it may be helpful to record this.
Sex
It is important to record the sex of the donor because of the biological
differences between men and women, including desirable weight/height
parameters, haemoglobin levels and blood volume, etc.

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 BLOOD DONOR RECORDS

PERSONAL DETAILS

Surname First names

Sex Date of birth Occupation

Home address

Telephone number

Work address

Figure 10: Example of a

donor enrolment card – Telephone number
personal details

Date of birth
The date of birth should always be recorded rather than the donor’s age
because, of course, the donor’s age will change each year.
Occupation
The occupation of most donors is not significant. However, donors who
have certain kinds of jobs, such as sportsmen or pilots, should not be
bled immediately before working. The donor’s occupation should therefore
be recorded.
Address
Wherever possible, both the home and work addresses of the donor
should be recorded, together with a telephone number where they can be
contacted. This enables the service to contact the donor to request
attendance at a clinic, whether on a routine or emergency basis, or to
follow them up after donation, if necessary.
Race
Although not included in the example given in Figure 10, it may be
important to record the donor’s race, particularly in countries where there
are several different ethnic groups. The service may, for example, wish
to take advantage of the differences in certain blood group frequencies
when looking for a blood donor for a patient with an unusual antibody.

Informed consent
The second part of a donor enrolment record is the donor’s consent. An
example of this part of the record is shown in Figure 11 on page 100.
Where the donor is registered with a doctor, the doctor’s name and
address should be recorded in case of emergency or if information needs
to be given through the doctor to the donor.
When this part of the donor enrolment form has been signed by the donor,
it confirms that the donor clinic staff have fully explained the procedures
involved in blood donation, including the clinical screening procedures,

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 SECTION 8

Informed consent

The donation procedures and the tests carried out on my blood have been
explained to me and I consent to this. I understand that I may be rejected as
a blood donor if the results of any of these tests are positive.

Doctor

Address

Signed (donor)

Date

Signed (witness)
Figure 11: Example of a donor
enrolment card – Date
donor consent

the necessary laboratory tests and what the service will do if the donor
has to be deferred temporarily or permanently.
The statement should be witnessed and signed by a member of the donor
clinic staff.

Medical history
In Section 6, we looked at how to record the donor’s medical history. Look
again at the example of a medical history questionnaire in Appendix 4.
This provides important baseline information that is needed for future
use in the clinical evaluation of the donor and should be kept with the
donor’s enrolment card.

Basic health check

In Section 6, we stressed the need for baseline information about the
donor’s health, including blood pressure, weight, height and haemoglobin
levels. An example of a simple record of the basic health check is shown
in Figure 7 on page 78. Look at this again now.
This information should be recorded at every donation so that the clinical
significance of any changes can be assessed.

Donor’s record of donations

The donor enrolment record contains basic information that provides a
permanent record of the donor’s personal details and health check.
When a printed donor enrolment card is used rather than a computerized
record, there may be room to record only a few donations. When the card
is full, therefore, it is usual to create an additional card to record the
donations by the donor. The record of donations card normally contains
the donor’s personal details on one side, with space on the other side
for recording donations. Record of donations cards are usually filed
under the dates on which donors are due to give blood again, in
alphabetical order. This makes it easier to know when donors need to be
recalled. An example of a donor’s record of donations card is shown in
Figure 12.

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 BLOOD DONOR RECORDS

SIDE 1

RECORD OF DONATIONS

Name of donor:

Contact addresses:

Home:

Workplace:

Blood group:

I am aware of the tests done on my blood and hereby certify that, to the best of my knowledge, I have not
engaged in risk behaviour as defined by the blood bank.

Signature of donor:

SIDE 2

Signature of donor
Date Volume to statement Signature of staff
Donation no. Hb test BP record of bleed collected on Side 1 collecting blood

Figure 12: Example of a donor’s record of donations

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 SECTION 8

ACTIVITY 47

Compare the records that your service keeps with the various parts of
a personal donor enrolment card and record of donations, as shown
in Figures 7, 10, 11 and 12 and in Appendix 4. Are there any
important differences?
Is there any additional information that you now feel should be
included in your donor records? If there is, discuss this with your
colleagues and supervisor and note down any recommendations on
your Action List.

Donor clinic register

The donor clinic register is used to record further information about
donors and about the blood they have donated. This serves as another
permanent record of the donation, the venue of the blood collection
session and the laboratory results. An example is given in Figure 13.
A blood collection pack should be identified by a number, an alpha-
numeric symbol or another code and not by the name of the donor. This
is because the anonymity of the donor to the patient must always be
maintained.

ACTIVITY 48

Compare the donor clinic register kept in your centre with the
example shown in Figure 13.
Is there any additional information that you feel should be included in
your records? If there is, discuss this with your colleagues and
supervisor and note down your recommendations on the Action List.

Record of venues available for mobile sessions

As we saw in Section 5, it is useful to keep a record of venues used for
mobile sessions, which contains details of people to be contacted, the
special features of the venue and the number of donations collected on
previous visits. The simplest way of recording this information is to use
individual cards for each venue and to file them in alphabetical order.
Look back at the example shown in Figure 3 on page 55.

Donor session analysis form

In Section 5, you looked at an example of a donor session analysis form
that provides a record of the number of new and repeat donors attending
donor clinic sessions, including the number that are accepted and the
number that are deferred, either temporarily or permanently. It also
includes sections for evaluating the suitability of the venue and the
number of staff available. This serves a purpose in helping to monitor the
effectiveness of the donor education, motivation and recruitment

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 BLOOD DONOR RECORDS

DONOR CLINIC REGISTER

Date: Clinic staff:

Venue:

Previous Checked
Previous results results
Donation Sex Pack donations
Name of donor number (M/F) Race type (total) Group Rh Group Rh Comments

Signature:

Key to Figure 13
Date Date of session
Clinic staff Names of all staff attending the clinic, including the head of the team
Venue Location of the donor session
Name of donor Name of donor, including initials
Donation number A number or alphanumeric code allocated to the particular donation, which should not be used
again for at least one year
Sex Male or female
Race To be included where there are different ethnic groups in the donor population
Pack type Blood pack used: e.g. single, dry, double, triple, quadruple
Previous donations
(total) Number of donations previously given by this particular donor
Previous results ABO and Rh results from previous tests
Checked results ABO and Rh results from tests on this donation
Comments Any additional comments by donor clinic staff
Signature Signature of person completing the donor clinic register

Figure 13: Example of a donor clinic register

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 SECTION 8

campaign, the cost-effectiveness of particular venues for donor clinics

and the workload and efficiency of donor clinic staff. Look back at the
example of a donor session analysis form in Figure 6 on page 66.

Donor screening report

As we saw in Section 6, a donor screening report that is used in
conjunction with the donor session analysis form can be useful in
monitoring the effectiveness of the donor selection programme. An
example of a donor screening report was shown in Figure 8. Turn back
to page 82 and look at it again.

Confidentiality
As we saw in Section 7, confidentiality of all donor records must always
be maintained. Sections 2 and 4 of the Introductory Module outline ways
of keeping records confidential. Look back at these sections now.

8.2 USING DONOR RECORDS

Accurate donor records benefit both the donors and the recipients of their
blood and also contribute to the efficient operation of the blood collection
programme. They are particularly important in developing a panel of
regular, voluntary non-remunerated donors.

Developing a panel of regular donors

The personal donor enrolment record and record of donations can be
used to do much more than simply record the donations made. They
show the date of the donor’s last donation and therefore indicate when
they should be recalled. Donors who have given blood more than three
times and donate regularly, at least once a year, are regarded as regular
donors.
Throughout this module we have stressed the importance of building a
panel of regular donors because:
1 They are screened regularly and understand the importance
of health and risk behaviour factors.
2 They have experience in giving blood and therefore can be
dealt with more quickly in the clinic.
3 They are dependable and are usually willing to give blood
in an emergency, as well as on a regular basis.
4 They provide the basic source of safe blood.
These donors are very valuable to the service and so it is important to
compile a register of regular donors. A simple example of a regular donor
panel register is shown in Figure 14. Note that a separate record should
be kept for each blood group so that it will be easy to identify appropriate
donors when particular blood groups are required.
It is important to try to ensure that the regular donor panel includes
donors with different blood groups in approximately the same proportions
as those of the blood groups in your total population.

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 BLOOD DONOR RECORDS

REGULAR DONOR PANEL REGISTER Blood group:

Telephone Registration Date of Date

Donor Contact addresses nos. no. registration removed

Key to Figure 14
Blood group A separate record is required for each blood group
Donor Full name of donor
Contact addresses Work and home addresses
Telephone nos. Work and home telephone numbers
Registration no. Donor’s registration number, given after three regular donations
Date of registration Date when donor’s registration number was allocated
Date removed Date when donor was removed from the register: e.g. because of ill-health, death, lapsed
or irregular attendance

Figure 14: Example of a Criteria for donors admitted as regular donors

regular donor panel register
A donor who meets the following criteria can be registered as a regular
donor:
1 Has agreed to donate blood regularly: that is, at least
twice a year and up to four times a year for men and three
times a year for women.
2 Has donated blood in the last year, when called upon to
do so.
3 Has not posed any problems during blood donation, such
as fainting or having poor veins.
4 Is in a generally healthy state.
5 Can be easily contacted by the blood bank and can reach
the blood bank without difficulty.

Using the regular donor panel register

The regular donor panel register can only be created from the records of
donations. The register provides the blood bank with a list of regular,

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 SECTION 8

dependable donors in each blood group. When donors with particular

blood groups are needed, this list can be used in conjunction with the
donors’ record of donations cards to ensure that only donors who are due
to give blood again are called.

ACTIVITY 49

Is a regular donor panel register kept in your centre? If it is, compare

it with the example shown in Figure 14. Can you suggest any
additions or improvements that could be made to your register? If so,
discuss your recommendations with your colleagues and supervisor
and note them down on your Action List.
If a regular donor panel register is not kept in your centre, talk to your
colleagues and supervisor about introducing one to assist in recalling
donors. Note down on your Action List your recommendations on what
it should contain.

Developing a panel of donors with less common blood types

It is important to maintain a record of donors with less common blood
types so that if the need arises for a particular blood group, a suitable
donor can be contacted quickly and easily. Rare blood types vary in
different populations and each blood transfusion centre needs to identify
which blood groups fall into this category. In some populations, for
example, these may include O Rh negative, B Rh negative and AB Rh
negative. Only people with less common blood types who are willing to
be regular donors should be included on the rare donor panel.
The record of donations cards of donors with less common blood types
should be filed under the specific blood type, in alphabetical order.
Alternatively, the information can be recorded as shown in Figure 15
below.

BLOOD TYPE

Name of donor

Contact addresses

Telephone numbers

Figure 15: Example of a

register of donors with less Date of last donation
common blood types

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BLOOD DONOR RECORDS

ACTIVITY 50

Find out from the national blood transfusion service about the
proportions of different blood groups in the population in your country.
Examine your donor records and work out the proportions of different
blood groups among the donations collected in your centre. How does
this compare with the proportion of different blood groups in the
population as a whole?
Classify each blood group amongst the donations received over the
last six months according to whether there has been:
„ an excess
„ an adequate number
„ a shortage.
Turn back to Activity 11 on pages 32–33 and decide whether the
information you have now collected affects your estimates of blood
requirements. How do you think you could increase the number of
regular donors with less common blood types? Note down your
recommendations on your Action List.
Does your system for recording donors with less common blood types
enable you to identify and contact them easily? If you can suggest
any improvements to your system, note them down on your Action
List.
If you do not keep a record of donors with less common blood types,
develop a simple system and discuss it with your colleagues and
supervisor. Note down your ideas on your Action List.

Record of temporary donor deferrals

It may also be useful to keep a record of donors temporarily deferred by
each donor clinic team, filed under the dates when they can be accepted
again. This will help the clinic to contact the donors when it is safe for
them to give blood again.

8.3 OTHER USES OF DONOR RECORDS

Keeping accurate donor records brings additional benefits to a blood
transfusion service, particularly in relation to:
„ donor incentives and rewards
„ statistics
„ the recipients of donated blood.

Donor incentives and awards

The record of donations is important in assessing which donors are due
to receive incentives or awards given as a token of recognition and

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 SECTION 8

appreciation by the transfusion service for the number of donations that

they have given. Without accurate donor records, it is not possible to
identify how many donations a particular donor has given and when an
award should be made. As we shall see in Section 9, although incentives
and awards should have no commercial value, they are usually appreciated
by donors because they provide evidence of their humanitarian contribution
to the health of the community. Donation awards to institutions such as
colleges and factories that regularly host blood donation sessions
should also be considered.

Statistics
Statistics provide a vital source of information for the service. They are
the most accurate means of evaluating the effectiveness of donor
education, recruitment and selection policies and in establishing a
regular donor panel. The following statistics are particularly useful:
1 The number of donors who donate blood only once
compared with the number of repeat and regular donors.
This information can then be further broken down to show
the cost-effectiveness of clinic sessions in different
locations, different kinds of venue, different parts of the
country and so on.
2 An analysis of laboratory results. From this information,
transfusion-transmissible infections can be analysed in
relation to the venues used for blood collection, the age
groups and sex of donors, and so on. It should then be
possible to identify the safest sources of donors.
3 The cost-effectiveness of arranging bleeds in different
venues. It may not be worth continuing to go to venues
where there is a high incidence of transfusion-transmissible
infections or there is a particularly high proportion of the
most common blood groups of which there are always
adequate stocks in the blood bank.
4 An analysis of clinic consumables used, such as blood
bags or donor refreshments, and the adequacy of staffing
levels in relation to the number of donors.
5 The epidemiology of transfusion-transmissible infections
in the donor population. The transfusion service can play
a vital role in contributing to the health information
system of the country.
Statistical information is vital for the effective functioning of any
organization. If it is to be useful, however, it must be accurate and easily
accessible. It is important to think carefully about which statistics are
worth collecting and how to design information-gathering systems that
are easy to use.

Recipients of donated blood

Donor records are very important in relation to the recipients of donated
blood, for the following reasons:

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BLOOD DONOR RECORDS

1 If a patient with an unusual blood group antibody requires

a transfusion of blood urgently and no supplies are in
stock, accurate donor records will assist in identifying a
donor whose blood lacks the corresponding antigen and
is therefore compatible. The donor can then be contacted
and asked to give blood on an emergency basis.
2 A donor may be in the ‘window period’ at the time of
donation and test seropositive at the next donation. It is
essential to be able to contact the doctor of the patient
who received the blood from the earlier donation so that
the necessary follow-up can be made.
3 If a patient claims to have been infected as a result of a
blood transfusion, any donor whose blood has been used
can be contacted and recalled for retesting in order to
identify the source of infection.

ACTIVITY 51

Study the donor records kept in your centre. Make a list of the kinds
of information that you could extract from these records if you were
asked to prepare an annual report on your service’s donor clinics.
Compare this list with the areas of information that we have
considered in this section. Are there any areas in which you would not
be able to provide accurate information? Are there any areas in which
you feel you need more information to help you plan how to organize
blood collection in the future?
If so, make a note of what these areas are and think carefully about
how you could improve the record-keeping system in your centre.
Discuss your ideas with your supervisor and note your
recommendations on your Action List.

SUMMARY
1 Accurate records of individual donors are required in order
to develop a panel of regular, voluntary non-remunerated
blood donors and donors with less common blood types.
2 The confidentiality of donor records must be maintained
at all times.
3 Donor records are essential for monitoring the
effectiveness of the blood collection programme, enabling
regular donors to be identified and rewarded, providing
statistical information and safeguarding the recipients of
donated blood.

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 SECTION 8

SELF-ASSESSMENT

16 List three kinds of records that are important in maintaining

a safe and adequate supply of blood.
17 Why is it important to keep a register of donors with less
common blood types?

PROGRESS CHECK

Before moving on to Section 9, spend a few minutes thinking

about whether you have achieved the learning objectives for
Section 8. These were to:
1 Maintain an efficient record-keeping system to assist in
the development of a panel of regular, voluntary non-
remunerated blood donors.
2 Identify information from records which can be used for
reporting purposes.
If you feel confident that you have understood everything in
this section, turn to Section 9.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

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DONOR RETENTION AND RECALL

9
Donor Retention and Recall

The purpose of this section is to help you to develop an effective system

of donor retention and recall in order to maintain a panel of voluntary non-
remunerated donors who give blood regularly.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Use donor records to maintain an effective system of
donor follow-up and recall.
2 Develop an appropriate public relations programme to
improve donor retention.

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 SECTION 9

9.1 ESSENTIALS OF DONOR RETENTION AND RECALL

We have repeatedly emphasized the importance of building up a panel
of low-risk blood donors in order to ensure an adequate supply of safe
blood. As you have seen, donors should ideally be:
„ voluntary
„ non-remunerated
„ willing to donate blood regularly.
In Section 4, you explored ways of increasing the number of voluntary
non-remunerated donors. How can you increase the number who give
blood regularly? As you have probably recognized, almost everything that
we have considered in this module contributes to the retention of low-risk
donors, as follows.
1 Identifying low-risk donor populations, encouraging
replacement donors to become regular, voluntary non-
remunerated donors and promoting the self-exclusion or
self-deferral of unsuitable donors (see Section 2).
2 Developing an effective donor education, motivation and
recruitment campaign to encourage people to give blood
regularly for the benefit of the community (see Section 4).
3 Ensuring the efficient organization of blood collection
sessions in fixed and mobile donor clinics (see Section 5).
4 Maintaining a professional and efficient approach to
donor screening and selection to ensure the safety of
donors and the recipients of donated blood (see Section
6).
5 Providing high standards of care for donors to encourage
them to donate on a regular basis (see Section 7).
6 Maintaining strict confidentiality at all times so that
donors trust the service and the people who work in it (see
Section 7).
7 Providing appropriate follow-up of donors, showing
appreciation of their special contribution to health care in
the community (see Section 7).
8 Maintaining accurate and comprehensive donor records
to enable the service to follow-up and recall donors (see
Sections 8 and 9).
9 Following-up lapsed donors to find out why they have not
returned and taking any action necessary to encourage
them to return (see Section 9).

9.2 BLOOD DONOR RECORDS

If donor recall and retention are to be effective, there is a need for
meticulous donor record-keeping. Blood donor records were discussed
in detail in Section 8 so here we shall simply consider the specific
information you require if you are to recall a donor for future donations.

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DONOR RETENTION AND RECALL

The most important records are the donor enrolment card and record of
donations. For the purposes of donor retention and recall, the important
parts of them are:
„ personal details, including the donor’s name, work and
home addresses and, if possible, telephone numbers, so
that they can be contacted for follow-up or recall
„ records of the donor’s medical history
„ records of the assessments made during the health
checks at previous donations.
The last two items are important because they will indicate whether a
donor should be followed up, recalled to give future donations or
requested not to donate again.
Probably the simplest way of recording – and retrieving – information
about donors is to use a card system in which individual donor cards are
filed under the dates when they are due to donate blood again, in
alphabetical order. It should then be easy to locate the records of all the
donors who are due to attend on the same day and to contact them with
details of the date and time of the donor session. In cases of emergency,
when blood stocks are low or there is an unexpected need for additional
blood, the donors who are due to return shortly can be contacted and
asked to attend. If the cards of donors with less common blood types are
filed under their blood group or in a register, it should also be possible
to identify them easily when the need arises for that group.
When developing a donor record system, remember that the number of
donors will increase if your centre’s donor education, motivation and
recruitment activities are successful. The record system should therefore
be designed to accommodate an increase in the size of the donor panel.
As with all records, it is essential that donor records should be accurate
and kept up to date. It is the responsibility of the senior nurse or donor
recruitment organizer to ensure that this is done. Remember that blood
donor records are strictly confidential and that no unauthorized person
should have access to them.
In Section 5, we considered how to recall donors for fixed and mobile
blood collection sessions. While it is always preferable to contact donors
individually, the date, location and time of a donor clinic should be
publicly advertised.

ACTIVITY 52

What type of donor recall system is used in your centre? How easy is
it to identify and contact donors who are due to donate blood again?
Talk to other donor clinic staff about any ways in which this system
could be improved. Note down your recommendations on your Action
List.

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 SECTION 9

9.3 POSTDONATION FOLLOW-UP

Section 7 considered how to care for donors in a way that will encourage
them to return regularly. Always remember the importance of:
1 A professional and pleasant reception for the donor.
2 An awareness of the donor’s needs for reassurance.
3 The maintenance of confidentiality.
4 Appropriate predonation and postdonation counselling
and, if necessary, follow-up.
5 Skilled venepuncture.
6 Appropriate postdonation care.
7 Appreciation of the donor’s willingness to give blood.
All aspects of donor care play an important part in donor retention.
Unpaid voluntary blood donors will only return if they receive a favourable
impression of the service and feel needed, important and appreciated.
The follow-up of blood donors is also an important aspect of donor care.
While some donors may need to be informed about their health status,
it is rarely possible to routinely follow up all donors on an individual basis.
Nevertheless, where it is appropriate and feasible, sensitive follow-up
will help to demonstrate the service’s appreciation of its donors.

Medical follow-up
The medical follow-up of donors may be necessary if they are deferred on
medical grounds or because laboratory tests show that they are carrying
a transfusion-transmissible infection.

Medical grounds
There are many reasons why donors may be temporarily or permanently
deferred on medical grounds; for example, they may be on medication
such as antibiotics or suffer from anaemia or heart disease. If the
deferral is temporary, it is important to indicate when they may return to
give blood and, if possible, to make an appointment for them to return
after an appropriate period of time. Appendix 7, Guide to Medical
Assessment of Blood Donors, indicates the length of time for which
donors suffering from various conditions should be deferred.
Wherever possible, the donor recruitment organizer or donor clinic staff
should try to find time to follow up these donors and ensure that they have
understood any advice given and are receiving proper medical attention,
if required. If they have been deferred temporarily, they should be
contacted when they are eligible to donate blood again in order to remind
them to attend the donor clinic where their health condition will be
reassessed.

Transfusion-transmissible infections
As we saw in Section 7.6, it may be necessary to follow up a donor if the
laboratory tests on the donated blood show evidence of markers for a
transfusion-transmissible infection, such as HIV or hepatitis B.

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In the case of HIV infection, it is essential to develop a policy on how to

inform donors that they are HIV-positive and to ensure that all staff follow
the policy. Wherever possible, the donor should be told the results on a
face-to-face basis. The person responsible for this should be well trained
in counselling skills and should always refer the donor to other sources
of advice and support, such as a counselling service or their own doctor.
It is more difficult to maintain confidentiality if a donor is informed of the
results by post because other people may see the letter. A donor who is
illiterate, for example, would have to ask someone else to read the letter.
It is also difficult to check whether the donor has clearly understood the
information because there will be no feedback and there is less
opportunity to provide advice on referral.

Lapsed donors
Inevitably, some donors will not return to give more blood. Since they
have been sufficiently motivated in the past to donate blood, it is
important to know why they have failed to attend again. In some cases,
there may be a simple reason; for example:
„ they may have been temporarily deferred and have forgotten
that they are due to donate blood: they therefore need to
be contacted to remind them that they are now eligible to
donate blood again
„ they may not have known about mobile blood donor
sessions held in their area and may simply need information
about when and where they will be held in the future.
lapsed donor: A voluntary Some donors will have to be classified as lapsed donors – donors who,
non-remunerated donor after making one or more donations, do not return despite being
who, after making one or
requested to do so. Donors may lapse for a variety of reasons, some of
more donations does not
return to give blood, which may be beyond the control of the transfusion service or blood bank.
despite being requested to However, it is important to know why they have not returned so that
do so. appropriate action can be taken, if necessary; for example:
n they may have decided not to return because they recognize
that they are at risk of transmitting an infectious agent
n they may have moved to another area or have become ill:
their records therefore need to be brought up to date
n they may have had an unpleasant experience the last time
they donated blood: they may be willing to return if they
are reassured that action has been taken to ensure that
this will not happen again
n they may have heard inaccurate rumours that it is possible
to become infected with HIV by giving blood: the education
campaign would therefore need to focus even more
strongly on giving the public accurate information about
the safety of blood donation.
Information of this kind is essential if the service is to monitor the
performance of its donor clinic and promotions staff. It is clearly wasteful
of time and resources to continue recalling donors who are unwilling to
give blood again, and so a simple and practical system is needed to

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identify lapsed donors and to follow them up to find out why they have
dropped out. All contacts with donors should therefore be recorded so
that it is possible to classify those who have truly lapsed.

ACTIVITY 53

What action is taken in your service to follow up lapsed donors? What

are the most common reasons why donors do not continue to give
blood?
Talk to your colleagues about any ways in which the system for
following up donors could be improved. Also discuss whether there
are any actions that could be taken to reduce the number of lapsed
donors. Add your recommendations to your Action List.

9.4 PUBLIC RELATIONS

Public relations activities are an important form of follow-up which help
to strengthen the bond between the service and donors by reinforcing
donors’ awareness of how important they are and how their continuing
support is needed. Ideally, individual written notes of appreciation would
be sent to every donor following donation. Most services do not have the
time or money to do this, but there are a number of public relations
activities that you could undertake to maintain donors' motivation and
encourage them to become regular donors.
1 Inform donors of their blood group. Most donors want to
know this and it can also be a useful recruitment exercise
because their family and friends may also want to find out
what their own blood group is.
2 Provide donors with a record of their donations. At the
time of the first donation, give the donor a small record
card or booklet that shows the donor’s name, address
and ABO and RhD type. At each subsequent donation, a
further record can be added.
3 Provide small tokens of appreciation for achieving certain
numbers of donations. Donors usually enjoy receiving
them, particularly if they are given with as much publicity
as possible. Such tokens should be inexpensive and of no
commercial value, but something that donors will value.
Some services, for example, give badges or certificates
or, if they consent, include donors’ names in public
notices of thanks.
The decision about what awards to give will depend on
their availability, the costs involved and the extent to
which they would be appreciated by donors. Many centres
give small awards after the following donations:

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DONOR RETENTION AND RECALL

„ 3rd donation
„ 5th donation
„ 10th donation
„ 25th donation
„ 50th donation
„ 75th donation
„ 100th donation
„ 100+ donation
Notice that the awards tend to be given more frequently
up to the tenth donation. This is because it is more
difficult to motivate new donors to continue than those
who have been donors for many years. Remember,
though, that awards must never have any commercial
value as this might undermine the concept of voluntary
non-remunerated blood donation.
4 Use the press, radio and television to promote the blood
collection programme and express appreciation of donors
who have given blood, while reminding them of the need
for regular donations.
5 Arrange for donors to visit the service so that they can see
how the blood is tested, processed and stored. Ensure
that there is time for discussion so that they can ask
questions and express any concerns they may have about
blood donation or transfusion.
6 Encourage donors to recruit other donors, using every
opportunity to provide them with up-to-date information so
that they can keep abreast of changes. Make sure that
supplies of leaflets on such subjects as HIV infection and
AIDS are available for donors to read while they are
waiting to donate blood or are resting afterwards.
Encourage them to take the literature away with them and
to show it to other people.

ACTIVITY 54

What public relations activities does your centre use to follow up

donors in order to show your appreciation and motivate them to
continue giving blood?
Think about any additional activities that it might be possible for your
service to introduce, such as inexpensive tokens for regular donors
as a mark of appreciation.
Note down your ideas on your Action List and discuss them with your
colleagues and supervisor.

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 SECTION 9

SUMMARY
1 Effective systems for donor retention and recall are
essential in building up a panel of regular, voluntary non-
remunerated blood donors.
2 A system for postdonation follow-up and care needs to be
established to encourage donors to remain on the regular
donor panel.
3 Efforts should be made to contact lapsed donors to
identify whether they have been discouraged by any
deficiencies in the service.
4 Public relations activities are an important means of
showing appreciation of donors and motivating them to
give blood regularly.

SELF-ASSESSMENT

18 What are the three parts of a donor’s records that are

required in order to recall the donor?

PROGRESS CHECK
Before moving on to Section 10, spend a few minutes thinking
about whether you have achieved the learning objectives for
Section 9. These were to:
1 Use donor records to maintain an effective system of
donor follow-up and recall.
2 Develop an appropriate public relations programme to
improve donor retention.
If you feel confident that you have understood everything in
this section, turn to Section 10.
If you feel that you need to spend more time on this section,
go back to the parts that are most unfamiliar or that you find
difficult. You may find it helpful to talk to other people, such
as your supporter or other senior colleagues, about anything
you are still not sure about.

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ACTION PLAN

10
Action Plan

This final section focuses on the Action List you have been building up
as you have worked through this module. You have probably identified a
number of improvements that you think could be made in your blood
collection programme and it is now time to identify priorities and begin
putting your ideas into action.

LEARNING OBJECTIVES

When you have completed this section, you should be able to:
1 Reassess your knowledge and skills in relation to the
module objectives now that you have completed Module
1.
2 Review your Action List, identifying improvements that
you can implement and those that will require action by
others.
3 Prepare and implement a realistic Action Plan to introduce
changes that will improve the quality of your blood
collection programme.

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 SECTION 9

10.1 REVIEWING YOUR PROGRESS

Before you start making your Action Plan, think carefully about the
module objectives and the progress you have made since you started
working through this module.

ACTIVITY 55

Complete the table below. You will notice that it is the same as the
one you filled in for Activity 2. Use it to review the knowledge you
have gained and the skills you have developed as a result of your
work on this module. Have you changed your rating in relation to each
module objective?
You should have made some identifiable progress in each area
covered by this module. If there is anything you still do not feel
confident about, however, re-read the appropriate section and then
discuss any remaining problems with your supporter or trainer before
continuing with your Action Plan.

Rating
Module objective (1–4) Comments

Section 2
Identify low-risk donor populations and explain the
importance of encouraging potentially unsafe
donors to self-exclude.
Section 3
Estimate the number of donors needed to meet the
blood requirements of your locality.
Section 4
Develop an effective education, motivation and
recruitment campaign to increase the number of
voluntary non-remunerated donors.
Section 5
Plan and organize fixed and mobile donor clinic
sessions.
Section 6
Develop and maintain effective donor selection
procedures.
Section 7
Provide a high standard of care for donors
before, during and after donation.
Section 8
Maintain an efficient donor record-keeping system.
Section 9
Develop an effective system for retaining regular
voluntary non-remunerated donors.

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ACTION PLAN

10.2 MAKING YOUR ACTION PLAN

The Action Plan provides you with an opportunity to make practical
improvements in your own workplace, within any financial, resource or
staffing constraints that exist. As you worked through this module, you
have been noting down your ideas on the Action List on page 122. You
should have listed the number of the activity in Column 1 and noted your
ideas for improvement in Column 2. You should also have discussed your
ideas with your supporter.
You may have tried out some of your ideas already, but some may require
more time and effort and so it is important to identify priorities. You may
not be in a position to put all your ideas into action yourself and it may
be necessary to convince other members of staff to take the actions that
you have identified as being both necessary and feasible.

ACTIVITY 56

Look carefully at all the suggestions for improvements that you have
written down on your Action List. Mark those where you have not yet
been able to take any action. Then divide them into two categories:
1 Actions that you can take.
take Choose those that you think are
most important and put them in order of priority. Note them
down in Column 1 of the Action Plan on page 123. In Column 2,
briefly summarize the action that you plan to take. In Column 3,
note down the results that you would expect after taking this
action.
2 Actions that others could take
take. Note them down in Column 1 of
the Action Plan on page 123. In Column 2, write down the name
of the person who would be responsible for making the changes
that you are recommending and, in Column 3, summarize the
results that you would expect.
Then show your plan to your supervisor and supporter and discuss it
with them. Your ideas for improvement may need to be modified as a
result of these discussions. Other senior staff may also need to be
consulted before your Action Plan can be agreed. You should also
discuss it with your trainer at this stage.
When you have reached agreement about the actions you are going to
take, set a date by which you hope to complete each of them and
note this in Column 4. Also use Column 4 to set a date by which you
expect the completion of any actions taken by others.
Your Action Plan is now ready.

10.3 IMPLEMENTING YOUR ACTION PLAN

You should now begin to implement your Action Plan along the lines
agreed with your supervisor and supporter. It will probably take you

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ACTION LIST

Activity number Ideas for improvement

122
 ACTION PLAN

Planned Actual
completion completion
Ideas for improvement Planned action Expected results date date Actual results
ACTION
PLAN

123
 SECTION 9

several weeks or months to put your all plans into action and you may
need more time than you expected. In fact, you will probably start the next
module in the programme before you are able to complete everything.
You may also find that some of your ideas for improvement are more
difficult to put into action than you expected and you may need to revise
some of your plans if they are too ambitious or are not working as well
as you hoped. However, if you have thought carefully about how you could
apply what you have learned from this module and have discussed your
ideas with the appropriate people, you should be able to put most of them
into practice. You may even find that there are some unexpected
benefits. If you have any problems during this time, talk to your supporter
or supervisor and ask them for any assistance you need. You should also
give them regular reports on your progress.

ACTIVITY 57

Once you have completed each action you included in your Action
Plan, note down the date in Column 5 and the final results in Column
6. Then review the implementation of your Action Plan by comparing
the actual results with the results that you expected. Also compare
the planned completion dates with the actual completion dates.
Discuss the outcomes with your supporter and supervisor.
Identify any further actions required to ensure the implementation of
the improvements you have identified as being necessary.
Over the next few months, monitor the effectiveness of any changes
you have been able to introduce and be prepared to make any further
changes or take any follow-up action needed to ensure that they
continue to lead to improved quality in your programme.

As you work through the remainder of the learning programme, you will
be asked to complete an Action List and Action Plan for each module.
This approach can be applied to almost any situation and you may decide
to use it in other areas of your work to improve the quality of the service
that you provide.

PROGRESS CHECK
Now that you have completed this module, spend some time
thinking about whether you have achieved the learning
objectives for this section. These were to:
1 Reassess your knowledge and skills in relation to the
module objectives now that you have completed Module
1.
2 Review your Action List, identifying improvements that
you can implement and those that will require action by
others.
3 Prepare and implement a realistic Action Plan to introduce
changes that will improve the quality of your blood
collection programme.

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ACTIVITY CHECKLISTS AND ANSWERS

Activity Checklists and

Answers

SECTION 1

Activity 1

Purpose
To identify a personal ‘supporter’ for your work on Module 1.

Checklist
You should have:
„ Identified senior colleagues in your workplace who can
provide assistance to you as you work through this
module
„ Selected one particular person, ideally your supervisor, to
be your supporter and checked that he or she is willing to
assist you
„ Explained how the learning programme operates and
what the role of the supporter involves
„ Agreed how frequently you will meet to discuss your work
on this module
„ Showed Module 1 to your supporter
„ Informed your trainer about who your supporter is
„ Asked your trainer for assistance if you had any difficulty
in finding a supporter in your workplace.

Activity 2

Purpose
To assess your knowledge, skills and experience in relation to the
module objectives before you start work on Module 1.

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 ACTIVITY CHECKLISTS AND ANSWERS

Checklist
You should have:
„ Looked carefully at the module objectives and, for each
one, assessed your current knowledge, skills and
experience, using the rating 1, 2, 3 or 4
„ Completed the table on page 8
„ Added any further comments you wish to make, such as
any module objectives that relate to areas of work that you
do not undertake.

Activity 3

Purpose
To make a realistic Study Plan for your work on Module 1.

Checklist
You should have:
„ Quickly looked at other sections of the module to get an
idea of its content, level and approach and assessed how
much of the material is likely to be new to you
„ Estimated how much time you will need to study each
section, including completing the activities and answering
the self-assessment questions
„ Discussed with your supervisor how much time can be
allocated for study on a regular basis
„ Completed the Study Plan on page 9, adding the dates by
which you plan to complete each section and the dates of
meetings with your trainer and supporter.

SECTION 2

Activity 4

Purpose
To review the types of blood donor recruited by your transfusion centre
or blood bank.

Checklist
You should have:
„ Studied the records in your transfusion centre or blood
bank to identify the number of family or family replacement
donors, commercial donors and voluntary non-remunerated
donors who attended in the past six months
„ Noted the number of each type of donor on the table on
page 15

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ACTIVITY CHECKLISTS AND ANSWERS

„ Calculated or estimated the percentage of each type of

donor in relation to the total number of donors and added
this to the table
„ Found out the national policy on recruiting family or family
replacement donors and commercial donors
„ Found out the proportion of different types of donor in your
country as a whole.

Activity 5

Purpose
To identify the most common forms of risk behaviour in your locality and
country.

Checklist
You should have:
„ Identified the forms of risk behaviour in your locality that:
— are common
— sometimes occur
— are rare
„ Completed the table on page 19
„ Consulted colleagues, records, your local health education
officer or Ministry of Health to identify the patterns of risk
behaviour in the rest of your country and compared them
with your local situation.

Activity 6

Purpose
To identify the HIV seroprevalence among different age groups in your
donor population.

Checklist
You should have:
„ Selected three places in which blood has been collected
in the last year
„ For each location:
— found out the total number of donors in each age
group: under 20, 20–45 and over 45
— found out the total number of donors in each age
group who were found to be HIV-positive by laboratory
tests on their blood
— calculated the percentage of HIV-positive donors in
each age group at each location

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Identified the age groups that have the highest HIV

seroprevalence in your locality
„ Obtained epidemiological data on transfusion-
transmissible infections in your country from the Ministry
of Health
„ Compared these data with your data on your own locality
„ Noted your observations and conclusions about identifying
safer donor groups in your locality
„ Suggested any further data that your service should
routinely collect in order to identify potentially safe sources
of blood and noted your ideas on your Action List.

Activity 7

Purpose
To identify the proportion of regular donors contributing to your blood
collection programme.

Checklist
You should have:
„ Found out the number of regular donors who gave blood
during the past year
„ Calculated or estimated the percentage of regular donors
in relation to the total number of donors
„ Commented on whether sufficient numbers of regular
donors attend your donor clinic to ensure a safe and
adequate supply of blood.

Activity 8

Purpose
To review the procedures used in your centre to encourage self-
exclusion, self-deferral and confidential unit exclusion.

Checklist
You should have:
„ Noted down the procedures used in your centre to
encourage self-exclusion, self-deferral and confidential
unit exclusion, where appropriate
„ Suggested any ways in which unsuitable donors could be
further encouraged not to give blood, and noted your
ideas on your Action List.

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ACTIVITY CHECKLISTS AND ANSWERS

SECTION 3

Activity 9

Purpose
To identify the main geographical features of the area served by your
blood transfusion service or blood bank, including the blood collection
and distribution points.

Checklist
You should have:
„ Obtained or drawn a map of your locality and marked on
it:
— your transfusion centre or hospital and the boundary
of the area that it serves
— the sites from which blood has been collected in the
past three years
— areas of relatively high population density from which
blood has not been collected
— the hospitals and health centres to which blood has
been supplied in the past three years.

Activity 10

Purpose
To identify the total number of acute hospital beds in your locality.

Checklist
You should have:
„ Noted down the number of acute hospital beds at each
site to which blood is supplied by your blood bank
„ Noted down the total number of acute hospital beds in
your locality.

Activity 11

Purpose
To review the procedures used in your blood bank to estimate blood
requirements.

Checklist
You should have:
„ Found out the blood requirements of the hospitals served
by your blood bank during the past year

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Found out how many units of blood were collected during

the past year
„ Noted whether your blood bank was able to supply all the
blood required during the past year
„ Noted on your Action List any information that you found
difficult to obtain and discussed it with your supervisor
„ Noted the method used in your centre to estimate blood
requirements and commented on how accurate it is
„ Selected a method to estimate total blood requirements
for the current year and compared it with the figure
calculated by your centre
„ Used a second method to check your result and commented
on any differences in the answers
„ Noted down on your Action List your recommendations on
any ways of improving the method used to calculate your
centre’s blood requirements, and discussed them with
your supervisor.

SECTION 4

Activity 12

Purpose
To assess the information that people need before deciding to become
blood donors.

Checklist
You should have:
„ Talked to at least 10 people who are potential blood
donors
„ Made a list of all the questions that these people asked
about blood donation
„ Identified the questions that were most commonly asked
„ Added to the list any additional questions suggested by
your colleagues.

Activity 13

Purpose
To review staff and volunteer involvement in your donor education,
motivation and recruitment programme and to identify any training
needs.

Checklist
You should have:

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ACTIVITY CHECKLISTS AND ANSWERS

„ Noted who is responsible for organizing your donor

education, motivation and recruitment programme
„ Noted the other staff involved in donor education,
motivation and recruitment
„ Listed all other organizations and individuals, including
volunteers, who take part in donor education, motivation
and recruitment
„ Noted the training provided for staff and volunteers
„ Identified any further training required and noted down on
your Action List any ways in which training could be
improved.

Activity 14

Purpose
To identify the educational materials and equipment available for use in
your donor education, motivation and recruitment programme.

Checklist
You should have:
„ Listed all the materials and equipment available
„ Identified any suitable materials produced by other
organizations
„ Obtained copies of suitable educational materials.

Activity 15

Purpose
To consider ways of increasing financial support for your donor education,
motivation and recruitment programme.

Checklist
You should have:
„ Found out the cost of your donor education, motivation
and recruitment programme in the past financial year
„ Identified sources of financial support from the community
during the past year
„ Suggested ways of increasing the level of financial support
from the community and noted your ideas on your Action
List.

Activity 16

Purpose
To increase your effectiveness in public speaking.

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 ACTIVITY CHECKLISTS AND ANSWERS

Checklist
You should have:
„ Noted the number of public talks that you and your
colleagues give each month
„ Identified any additional places that would be suitable for
giving a talk
„ Used the guidelines on page 44 to prepare for your next
talk and to assess its effectiveness
„ Identified any ways in which you could improve your
performance as a public speaker and noted down your
ideas on your Action List.

Activity 17

Purpose
To review the effectiveness of the educational materials used in your
donor education, motivation and recruitment programme.

Checklist
You should have:
„ Shown the educational materials used in your programme
to colleagues and potential donors and asked them to
rate each publication on a scale of 1–5 according to
whether they are:
„ relevant and informative
„ interesting
„ easy to understand
„ Calculated the average score in each category for each
publication
„ Written these average scores in the table on page 46 and
calculated the total score for each publication
„ Assessed how effective each publication is likely to be in
informing and motivating the public to become blood
donors
„ Talked to your supervisor or supporter if you feel there is
a need to develop new materials or adapt existing materials
and, on your Action List, noted down your ideas on how
this might be achieved
„ Identified any local sources of assistance in developing
materials.

Activity 18

Purpose
To review the communication methods used in your donor education,
motivation and recruitment programme.

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ACTIVITY CHECKLISTS AND ANSWERS

Checklist
You should have:
„ Noted all the communication methods used by your
centre and assessed their effectiveness
„ Suggested ways of increasing the effectiveness of these
communication methods
„ Identified any additional methods that could be used to
reach more potential donors
„ Identified the assistance and support that you may be
able to obtain from other organizations and individual
volunteers
„ Identified any further training needs in relation to
communication methods
„ Identified the resources that would be required to expand
the range of communication methods used
„ Discussed your ideas with your colleagues and noted
down your recommendations on your Action List.

ACTIVITY 19

Purpose
To assess the effectiveness of your donor education, motivation and
recruitment programme.

Checklist
You should have:
„ Used your records to identify the current situation in
relation to:
— the number of communities involved in giving blood
— the total number of voluntary non-remunerated donors
— the number of donors who return to give blood a
second or subsequent time
— the average number of donations per person per year
— the number of donors who have to be permanently
excluded because of evidence of transfusion-
transmissible infections
„ Recorded the number in the column ‘Number at present’
„ Set dates on which you will review the situation and noted
them on your Action List
„ On the planned dates, identified whether there have been
any significant changes in relation to these indicators.

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 ACTIVITY CHECKLISTS AND ANSWERS

SECTION 5

Activity 20

Purpose
To identify factors that may affect the success of a donor clinic session.

Checklist
You should have:
„ Listed all the locations where mobile donor clinics have
been held in the past year and noted the number of units
of blood collected at each session
„ Identified the sites that appear to have been the most
successful in terms of the amount of blood collected
„ Noted any mobile donor sessions that resulted in a larger
number of donations than at your fixed clinic
„ Suggested any reasons for variations in the amount of
blood collected at different locations
„ Identified any particular factors that may have influenced
the amount of blood collected at different locations or at
different sessions at the same location.

Activity 21

Purpose
To assess the most effective locations for mobile donor clinics.

Checklist
You should have:
„ Reviewed the list you made in Activity 20 and identified
the locations to which it is worth returning in the future for
further mobile sessions
„ Developed a record of suitable venues available for
mobile sessions.

Activity 22

Purpose
To select a suitable new location for a mobile donor session.

Checklist
You should have:
„ Used the map you produced in Activity 9 to identify a
suitable location for holding a mobile donor clinic which is:

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ACTIVITY CHECKLISTS AND ANSWERS

— not close to a fixed clinic and has not been used for a
mobile clinic before
— likely to have a high proportion of low-risk donors
— in an area of reasonably high population density
— relatively easy for both the mobile team and sufficient
numbers of potential donors to reach
— likely to have suitable facilities
„ Contacted the person in charge of the venue to find out
whether they would be willing to host a mobile clinic and
to arrange a convenient date
„ If possible, made an informal visit to assess the suitability
of the venue and recorded the outcomes of this visit.

Activity 23

Purpose
To review the procedures used to publicize mobile donor clinic sessions.

Checklist
You should have:
„ Used the table on page 58 to note down the methods
used in your centre to inform potential donors and regular
donors about mobile donor sessions in their area
„ Noted the methods that you find to be most effective
„ Suggested ways of improving the system for publicizing
mobile sessions and noted them down on your Action List
„ Used an additional method to publicize the next mobile
session and evaluated its effectiveness.

Activity 24

Purpose
To review the effectiveness of the organization of a mobile donor session
and, in particular, the adequacy of the number of staff available.

Checklist
You should have:
„ Selected three donors attending a mobile session and
recorded the amount of time that each person spent in the
clinic
„ Noted whether there were significant differences in the
time that each of these three donors spent at the session
„ Noted whether donors were attended to promptly or had
to wait, and identified the reasons for any delays at
various stages of the donation process

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Observed the amount of time that staff spent with donors

„ Noted any ways in which the organization of the session
could have been improved in relation to:
— the number of staff present
— the suitability of the venue
— the publicity about the session
„ Noted your findings and recommendations on your Action
List.

Activity 25

Purpose
To develop an efficient system for monitoring the use of equipment and
materials required for mobile donor clinics.

Checklist
You should have:
„ Compared the list on page 61 with any checklist of
equipment and materials used in your centre and made
any additions or amendments, where needed
„ Developed a checklist of equipment and materials, if one
is not yet used in your centre, and used it to check each
item before departure and on return from each mobile
session.

Activity 26

Purpose
To ensure the correct use of blood collection packs in your donor clinics.

Checklist
You should have:
„ Noted the types of blood collection pack used in your
donor clinics and commented on why you find some types
more suitable than others
„ Completed the table on page 63 for each type of blood
pack used in your centre
„ Noted any differences between your procedures for using
different types of blood packs and the manufacturers’
instructions
„ Identified any improvements required in the use of blood
packs and noted down your recommendations on your
Action List.

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ACTIVITY CHECKLISTS AND ANSWERS

Activity 27

Purpose
To monitor the effectiveness of mobile donor clinic sessions.

Checklist
You should have:
„ Compared the example of a donor session analysis form
in Figure 6 on page 66 with any similar record used in your
own centre
„ Identified any ways in which your own record might be
improved and noted down your ideas on your Action List
„ Used Figure 6 to evaluate the performance of the next
mobile session that you attended, if records of this kind
are not yet kept in your centre
„ Designed a donor session analysis form, adapting Figure
6 to your own situation.

SECTION 6

Activity 28

Purpose
To review the questions used in your donor clinic to promote self-
exclusion, where appropriate.

Checklist
You should have:
„ Listed the questions that you ask donors to help them
assess whether they have engaged in any risk behaviour
and should therefore self-exclude
„ Added any further questions that other donor clinic staff
normally ask donors.

Activity 29

Purpose
To develop a systematic approach to predonation counselling.

Checklist
You should have:
„ Developed a checklist of issues and questions that need
to be covered routinely in predonation counselling
„ Added any further suggestions from other donor clinic
staff to the checklist

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Used the checklist as a basis for predonation counselling

and reviewed its effectiveness, amending it where
appropriate
„ Asked other donor clinic staff to use the checklist in
predonation counselling.

Activity 30

Purpose
To identify medical conditions that may affect the safety of a donor or the
recipient of donated blood.

Checklist
You should have:
„ Studied the example of a medical history questionnaire in
Appendix 4
„ Identified the conditions in Appendix 4 that are concerned
with the safety of the donor
„ Identified the conditions in Appendix 4 that are concerned
with the safety of the recipient.

Activity 31

Purpose
To understand the potential consequences for a donor who fails to
acknowledge specific medical conditions.

Checklist
You should have:
„ Listed the possible consequences for a donor who fails to
acknowledge each of the conditions in Table 1
„ Checked your answers with a doctor or nurse
„ Asked for a full explanation of anything you did not
understand or did not know before.

ACTIVITY 32

Purpose
To understand the potential consequences for the recipient of donated
blood if a donor fails to acknowledge specific medical conditions.

Checklist
You should have:
„ Listed the possible consequences for the recipient of
blood from a donor who fails to acknowledge each of the
conditions in Table 2

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ACTIVITY CHECKLISTS AND ANSWERS

„ Checked your answers with a doctor or nurse

„ Asked for a full explanation of anything you did not
understand or did not know before.

Activity 33

Purpose
To identify the health conditions in your country that are of importance
to the safety of donors or the recipients of donated blood.

Checklist
You should have:
„ Identified the health conditions in your country that are of
importance for the safety of the donor and listed them in
order of their prevalence
„ Identified the health conditions found in your country that
are of importance for the safety of the recipients of
donated blood and listed them in order of their prevalence.

Activity 34

Purpose
To review the system used in your centre for recording donors’ medical
histories.

Checklist
You should have:
„ Compared the records kept of donors’ responses to
questions about their medical history with the
questionnaire in Appendix 4
„ Suggested any ways in which your records of donors’
medical histories might be improved, discussed them
with other donor clinic staff and noted down your
recommendations on your Action List
„ Talked to your colleagues and supervisor about introducing
a system for recording donors’ medical histories, if none
exists at present, and noted down your recommendations
on your Action List.

Activity 35

Purpose
To review the training provided for donor clinic staff responsible for
undertaking the health check of donors.

Checklist
You should have:

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Identified the members of staff who undertake the various

assessments in the health check of donors
„ Noted the training they have received
„ Talked to your colleagues about any further training
needed to enable them to undertake donor screening
safely and efficiently
„ Noted your recommendations on training needs on your
Action List and discussed them with your supervisor or a
senior medical or nursing colleague.

Activity 36

Purpose
To develop guidelines on the medical assessment of donors.

Checklist
You should have:
„ Read the Guide to Medical Assessment of Donors in
Appendix 6 and compared it with any guidelines used in
your donor clinic
„ Identified any amendments that you think should be made
to your guidelines, noted your recommendations on your
Action List and discussed them with your colleagues and
senior medical staff
„ Asked other donor clinic staff whether they would find the
Guide to Medical Assessment of Donors a useful aid to
donor selection, if no guidelines are currently used in your
centre
„ Talked to colleagues to identify any areas of the guide that
might need amendment before it could be used in your
own donor selection programme and noted your
recommendations on your Action List
„ Consulted your local health authority or the Ministry of
Health and ensured that any guidelines that are produced
or adapted are reviewed and approved by a medical officer
before use.

Activity 37

Purpose
To develop appropriate targets and a plan for your donor selection
programme.

Checklist
You should have:

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ACTIVITY CHECKLISTS AND ANSWERS

„ Identified the targets set for your donor selection

programme and the plan that has been made to achieve
them
„ If there is no plan, discussed possible objectives and
targets for next year with your colleagues and noted down
your recommendations on your Action List
„ Kept a record of them to enable you to measure future
progress in developing an effective donor selection
programme.

Activity 38

Purpose
To review the system used to monitor the effectiveness of your donor
selection programme.

Checklist
You should have:
„ Reviewed any donor screening record currently used in
your centre
„ Identified any ways in which it might be improved to
enable the effectiveness of the donor selection programme
to be monitored and noted your recommendations on your
Action List
„ Talked to your supervisor about introducing a donor
screening record, if none is kept at present
„ Noted on your Action List your ideas on what a donor
screening record should contain.

SECTION 7

Activity 39

Purpose
To ensure that blood donation is, as far as possible, a pleasant
experience for donors attending your donor clinics.

Checklist
You should have:
„ Observed your fixed and mobile donor clinics over a period
of a month to identify any factors that may contribute to
an unpleasant experience for donors
„ Talked to donors to find out any ways in which they think
the service could be improved

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Talked to other donor clinic staff about any improvements

that they think could be made
„ Noted down your recommendations on your Action List.

Activity 40

Purpose
To ensure that new and repeat donors are treated appropriately.

Checklist
You should have:
„ Observed whether there are any differences in the way
that donor clinic staff treat new and repeat donors
„ Found out whether your centre has a policy on the way that
new and repeat donors should be treated
„ Suggested any ways in which the treatment of new and
repeat donors could be improved and noted down your
recommendations on your Action List.

Activity 41

Purpose
To identify the potential consequences of a breach of confidentiality.

Checklist
You should have:
„ Identified any possible effects of a breach of confidentiality
on your centre’s ability to maintain safe and adequate
supplies of blood
„ Noted the consequences of any situations in which you
know that a breach of confidentiality occurred.

Activity 42

Purpose
To identify the benefits of maintaining confidentiality.

Checklist
You should have:
„ Identified the long-term benefits of maintaining
confidentiality in relation to donors.

Activity 43

Purpose
To review the procedures used in your centre to maintain confidentiality.

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ACTIVITY CHECKLISTS AND ANSWERS

Checklist
You should have:
„ Noted all the steps currently taken in your centre to
maintain confidentiality and commented on whether they
are adequate
„ Asked donor clinic staff and donors for their suggestions
on how arrangements to ensure confidentiality could be
improved
„ Noted down your recommendations on your Action List.

Activity 44

Purpose
To review the training provided for staff who perform venepunctures.

Checklist
You should have:
„ Read Appendix 7: Venepuncture
„ Identified any further training that you need in order to
perform a venepuncture competently
„ Identified any further training that other donor clinic staff
need in order to perform a venepuncture competently
„ Noted down your recommendations on your Action List
and discussed them with your supervisor.

Activity 45

Purpose
To review the training provided for donor clinic staff in dealing with
adverse donor reactions.

Checklist
You should have:
„ Read Appendix 8: Adverse Donor Reactions
„ Noted the training that is provided for donor clinic staff in
dealing with adverse donor reactions
„ Identified any further training that you need in order to
recognize and deal with adverse donor reactions
„ Identified any further training that other donor clinic staff
need in order to recognize and deal with adverse donor
reactions
„ Noted down your recommendations on your Action List
and talked to your supervisor or supporter about making
arrangements for an experienced doctor or senior nurse
to provide appropriate training, where necessary.

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 ACTIVITY CHECKLISTS AND ANSWERS

Activity 46

Purpose
To identify and strengthen relationships with organizations providing
counselling and follow-up services for HIV-positive donors.

Checklist
You should have:
„ Noted any counselling or follow-up provided by your
service for donors who test positive for HIV or any other
infectious diseases
„ Identified any training provided for staff in counselling
techniques
„ Identified any other organizations providing counselling or
follow-up for HIV positive donors
„ Suggested practical ways to strengthen relationships
with these organizations
„ Identified any organizations that could provide training in
counselling techniques
„ Noted down your recommendations for further action on
your Action List.

SECTION 8

Activity 47

Purpose
To develop an efficient donor record-keeping system in your centre.

Checklist
You should have:
„ Compared your donor records with the parts of the donor
enrolment card and record of donations shown in Figures
7, 10, 11, 12 and in Appendix 4
„ Noted any important differences between them
„ Identified any additional information that you think should
be included in your donor records and discussed this with
your colleagues and supervisor
„ Noted down your recommendations on your Action List.

Activity 48

Purpose
To develop a suitable donor clinic register.

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ACTIVITY CHECKLISTS AND ANSWERS

Checklist
You should have:
„ Compared your donor clinic register with the example
shown in Figure 13
„ Identified any additional information that you think should
be included in your donor clinic register
„ Discussed this with your colleagues and supervisor
„ Noted down your recommendations on your Action List.

Activity 49

Purpose
To maintain an accurate register of regular donors.

Checklist
You should have:
„ Compared the example of a regular donor panel register
shown in Figure 14 with your system for recording regular
donors
„ Identified any additions or improvements that could be
made to your regular donor panel register
„ Discussed them with your colleagues and supervisor and
noted them on your Action List
„ Talked to your colleagues and supervisor about introducing
a regular donor panel register, if one is not currently kept
in your centre
„ Noted down on your Action List your recommendations on
what it should contain.

Activity 50

Purpose
To maintain a register of donors with less common blood types.

Checklist
You should have:
„ Found out the proportions of different blood groups in your
country’s population
„ Worked out the proportions of different blood groups
among the donations collected in your centre and compared
this with the proportion nationally
„ Classified each blood group of the donations from the
past six months according to whether there has been an
excess, an adequate number or a shortage

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Noted any changes that need to be made to the estimate

of blood requirements that you made in Activity 11
„ Suggested ways of increasing donations from donors with
less common blood types and noted down your
recommendations on your Action List
„ Reviewed your system for recording donors with less
common blood types and noted your suggestions for
improving the system on your Action List
„ Developed a simple system for recording donors with less
common blood types, if no record is kept at present,
discussed your ideas with your colleagues and supervisor
and noted your recommendations on your Action List.

Activity 51

Purpose
To review the effectiveness of your centre’s record-keeping system.

Checklist
You should have:
„ Listed the kinds of information that you can currently
extract from your records for reporting purposes
„ Compared this with the records discussed in Section 8
and identified any areas in which accurate information is
not available or is insufficient to assist in future planning
for the blood collection programme
„ Talked to your supervisor about ways of improving your
record-keeping system and noted your recommendations
on your Action List.

SECTION 9

Activity 52

Purpose
To review the effectiveness of your centre’s system for recalling donors.

Checklist
You should have:
„ Noted down the system used in your centre to recall
donors and commented on how easy it is to identify and
contact donors who are due to donate blood again
„ Talked to other donor clinic staff about ways in which this
system could be improved
„ Noted down your recommendations on your Action List.

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ACTIVITY CHECKLISTS AND ANSWERS

Activity 53

Purpose
To reduce the number of lapsed donors.

Checklist
You should have:
„ Noted down the action taken by your centre to follow up
lapsed donors
„ Listed the most common reasons why donors do not
continue to give blood
„ Talked to your colleagues about ways of improving the
follow-up system and reducing the number of lapsed
donors.
„ Noted down your recommendations on your Action List.

Activity 54

Purpose
To strengthen your centre’s public relations activities in order to retain
regular donors.

Checklist
You should have:
„ Noted down any public relation activities currently
undertaken by your centre to show your appreciation of
donors and motivate them to continue to give blood
„ Identified any additional activities that could be introduced
in order to demonstrate appreciation of regular donors
„ Noted down your ideas on your Action List and discussed
them with your colleagues and supervisor.

SECTION 10

Activity 55

Purpose
To assess the progress you have made through your work on Module 1.

Checklist
You should have:
„ Assessed your knowledge, skills and experience in relation
to each of the module objectives now that you have
reached the end of the module

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 ACTIVITY CHECKLISTS AND ANSWERS

„ Completed the table on page 120

„ Identified any areas in which you still do not feel fully
confident about your knowledge or skills
„ Reread the appropriate sections of the module and
discussed any remaining problems with your supporter or
trainer before continuing with your Action Plan.

Activity 56

Purpose
To plan how to implement the improvements that you have identified as
being necessary to ensure quality in your blood collection programme.

Checklist
You should have:
„ Looked at all the suggestions for improvements that you
have included on your Action List and marked those where
you have not yet been able to take any action
„ Divided them into two categories:
„ Actions that you can take
„ Actions that others could take
„ Identified priorities for action
„ Filled in your Action Plan, as follows:
„ Column 1: the improvements you have identified as
being necessary
„ Column 2: the action you plan to take or the name of
the person who would be responsible for taking action
„ Column 3: the results you would expect as a result of
implementing your planned actions
„ Discussed your plan with your supervisor, supporter,
trainer and any other appropriate senior staff
„ Modified your plan, where necessary
„ Filled in Column 4 with the dates by which you hope each
planned action will be completed.

Activity 57

Purpose
To review the implementation of your Action Plan and identify any follow-
up action required.

Checklist
You should have:

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ACTIVITY CHECKLISTS AND ANSWERS

„ Filled in Column 5 with the dates on which you completed

each planned action and compared them with the planned
completion dates
„ Summarized the results of your planned action in Column
6 and compared them with the results you had expected
„ Discussed the outcomes with your supporter
„ Discussed the outcomes with your supervisor
„ Identified any further actions required to ensure the
implementation of the improvements you identified as
being necessary
„ Monitored the effectiveness of the changes you have
been able to introduce
„ Identified any further changes or follow-up action required.

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 ANSWERS TO SELF-ASSESSMENT QUESTIONS

Answers to Self-assessment
Questions

SECTION 2

1 The disadvantages of using paid commercial or

professional donors are that:
„ paying donors undermines the voluntary non-
remunerated donation system which is the foundation
of a safe blood supply
„ commercial donors may be unhealthy, undernourished
or at risk of transfusion-transmissible infections which
endanger the lives of recipients of their blood
„ they may donate blood more frequently than
recommended and supply substandard units of blood
which are a risk to the recipient or give little or no
benefit
„ where donors are paid, it is usually necessary to
charge patients for the blood they receive, which poor
families may not be able to afford.

2 Behaviour that poses a risk to the safety of the blood

supply includes:
„ having more than one sexual partner
„ prostitution
„ homosexuality
„ bisexuality
„ injecting drug use
„ skin scarification, tattooing and blood rituals
„ being the sexual partner of anyone engaging in any
form of risk behaviour.

3 HIV seroprevalence is generally higher in the 20–45 year

age group.

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ANSWERS TO SELF-ASSESSMENT QUESTIONS

SECTION 3

4 A hospital with 130 acute beds is likely to need 871 units

of blood each year, or approximately 17 each week.
5 When calculating the number of donors needed to provide
the required number of units of blood, it is important to
take into account the following factors:
„ the number of donors who attend a donor session is
generally much lower than the number requested to
attend
„ the number of donations collected will be smaller than
the number of donors who attend because some
donors will be deferred, either temporarily or
permanently
„ some blood will be discarded after laboratory testing
because it is unsuitable for issue
„ unexpected emergencies may arise in which large
quantities of blood are required.

SECTION 4

6 The goals for a donor education, motivation and recruitment

campaign should be to:
„ promote changes in the public’s knowledge, attitudes
and beliefs so that they understand the importance of
blood donation
„ promote changes in people’s behaviour so that they
become willing to donate blood on a regular voluntary
basis
„ ensure that potential donors understand the
importance of safe blood so that they do not donate
blood if they are in poor health or at risk for transfusion-
transmissible infections.
7 The two long-term benefits of an effective donor education,
motivation and recruitment campaign are:
„ an adequate supply of blood because of an increase
in the number of regular, voluntary non-remunerated
donors
„ safer blood, because regular, voluntary non-
remunerated donors are well motivated, receive
continuing education about risk behaviour and are
regularly screened.
8 It is important to monitor and evaluate donor education,
motivation and recruitment activities in order to ensure
that the most efficient and cost-effective communication
strategies are being used.

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 ANSWERS TO SELF-ASSESSMENT QUESTIONS

SECTION 5

9 Donors should never be bled in the laboratory because:

„ bleeding should take place in a safe and hygienic
environment where the experience of blood donation
is as pleasant as possible for donors
„ privacy is essential during donor screening and this is
unlikely to be possible in a laboratory
„ it could be very dangerous if a donor faints in the
laboratory
„ donors require refreshment after giving blood but food
and drink are not allowed inside the laboratory.
10 The two essential parts of the cold chain are:
„ people to organize and manage the storage and
transportation of blood
„ equipment to store and transport blood.
11 Two potential problems in the use of glass blood collection
bottles are:
„ air embolism
„ risk of infection.

SECTION 6

12 The three main parts of the donor selection process are:

„ predonation counselling
„ the medical history
„ the health check.
13 The advantages of using a standard medical history
questionnaire are that:
„ the same information is collected systematically about
each donor
„ donor clinic staff do not forget to ask important
questions
„ it reminds donor staff to observe for clinical signs of
ill-health
„ all the relevant information needed to make a decision
on whether to accept or defer the donor is presented
in a standard format.

SECTION 7

14 Confidentiality is always necessary in the following areas:

„ during donor selection and blood collection

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ANSWERS TO SELF-ASSESSMENT QUESTIONS

„ donor records
„ consent
„ published information.
15 Problems sometimes experienced by donors during or
after giving blood include:
„ problems with blood flow
„ haematoma
„ accidental puncture of the artery
„ mild reactions
„ moderate reactions, such as fainting
„ severe reactions, such as convulsions
„ hyperventilation
„ accidents.

SECTION 8

16 Records that are required to maintain a safe and adequate

supply of blood include:
„ donor’s personal enrolment record/medical history/
health check
„ donor’s record of donations
„ donor clinic register
„ record of venues available for mobile sessions
„ donor session analysis form
„ donor screening report
„ regular donor panel register
„ register of donors with less common blood types
„ temporary donor deferral record.
17 It is important to keep a register of donors with less
common blood types so that, if the need arises for a
particular blood group, a suitable donor can be contacted
quickly and easily.

SECTION 9

18 The three parts of a donor’s records that are required in

order to recall the donor are:
„ the donor’s personal details, including name, work and
home addresses and, if possible, telephone numbers
„ the donor’s medical history
„ the assessments made during the health check at
previous donations.

153
 GLOSSARY

Glossary

Air embolism
Obstruction of a blood vessel caused by air entering the circulatory
system.

Alloimmunization
The immune response in which an antibody is produced when a body
meets a foreign antigen.

Autologous transfusion
The transfusion of any blood component that was donated by the
intended recipient.

Commercial or professional donor

A donor who gives blood in return for money or other form of payment.

Confidential unit exclusion

The removal and disposal of a unit of blood after donation at the request
of the donor.

Directed donation
A donation that is given specifically for transfusion to a named patient.

Epidemiology
The study of the occurrence, distribution and spread of infection and
disease in the population.

Family or family replacement donor

A donor who gives blood when it is required by a member of the donor’s
family or community.

Haemolysis
The breaking down of the red cell membrane, which liberates the
contents: haem and globin.

Incidence
The proportion of a specific population becoming newly infected by an
infectious agent within a certain period of time.

154
GLOSSARY

Infectious disease markers

The detectable signs of infection appearing in the bloodstream during or
following infection.

Lapsed donor
A voluntary non-remunerated donor who, after making one or more
donations, does not return to give blood, despite being requested to do
so.

Low-risk donor
The term commonly used in blood transfusion practice to describe a
donor who is at low risk for transfusion-transmissible infections.

Regular donor
A donor who has given blood at least three times and who donates blood
at least once a year.

Risk behaviour
Behaviour that exposes a person to the risk of acquiring transfusion-
transmissible infections.

Self-deferral
The decision by a potential donor to wait until a condition that makes
them unsuitable has resolved.

Self-exclusion
The decision by a potential donor not to give blood because they have
engaged in risk behaviour or because of the state of their own health.

Seroprevalence
The proportion of a specific population infected with the infectious agent
at any particular time.

Therapeutic phlebotomy
The collection of blood from patients in order to improve their own health.

Transfusion-transmissible infection
An infection that is capable of being transmitted by blood transfusion.

Voluntary non-remunerated donor

A donor who gives blood, plasma or other blood components freely and
voluntarily, without receiving payment in the form of money or a
substitute for money.

Window period
The period between infection by HIV and the development of detectable
antibodies.

155
Appendices
 APPENDIX 1

IMPORTANT INFORMATION ABOUT AIDS

for those who wish to give blood
WHAT IS AIDS? transfusion service as a place to find
out whether they are infected. This
AIDS is a disease that destroys the
could be very dangerous to the patient
body’s ability to protect itself against
who receives their blood.
infections and other illnesses. It is
caused by HIV, a virus that lives in
blood and other body fluids. You can WHO SHOULD GIVE BLOOD?
therefore get HIV infection if blood
containing the virus enters your Please remember blood is required in
bloodstream. You can also get HIV order to save lives. Only healthy
infection by having sex with someone people who are not at risk from HIV
who has HIV. This is particularly true and other transmissible infections
if you have had a sexual contact that should donate blood. If all the people
has resulted in your contracting a in this category give blood regularly,
sexually- transmitted disease (STD). our country will have sufficient
More information about HIV and AIDS supplies of blood which will greatly
and how to protect yourself from assist in saving lives.
getting the disease can be obtained from
your doctor or your nearest health WHO SHOULD NOT GIVE BLOOD?
clinic.
Blood should not be given by people
who have had a sexually transmitted
IS THERE ANY RISK OF CATCHING disease or who are at risk of contracting
HIV FROM BLOOD DONATION? HIV, including those with many
There is absolutely no risk to blood sexual partners, homosexuals,
donors giving blood at any blood donor prostitutes and injecting drug users.
clinic. All the materials used for It should also not be given by anybody
collecting blood are sterile and are used who has had sexual contact with
only once, so HIV or any other disease anyone in these categories.
cannot be caught from giving blood.

WHAT TESTS ARE DONE ON

DONATED BLOOD TO ENSURE THAT Blood transfusion services have
IT IS SAFE FOR TRANSFUSION? a very high respect for people
who give their blood to save a
The laboratory does tests for HIV,
life. We are confident that
syphilis (an STD) and hepatitis B. The
nobody would knowingly donate
tests are the same as those used
blood if they thought that they
anywhere in the world. However, these
could possibly transmit HIV and
tests may not show the early stages of
cause the recipient of the blood
infection. So people who may have
to develop AIDS.
been exposed to HIV infection must
not donate blood. If the results of a test Blood is required daily. Give
are positive, a donor is informed only if blood and save a life with your
he or she requests this. People who safe blood. Your support is
think that they may have been infected appreciated.
by HIV must not use the blood

An example of a donor information leaflet from a blood transfusion service in Africa

159
160
“You wouldn’t want “You wouldn’t want my
my blood because I’m blood. I’ve had hepatitis.”
common old ‘O’ group.”
Think you Every type of blood is important. Because groupe O is
1 We do a test for hepatitis on each donation, and even if
5
the most common type, it is also the most needed. Often we find the presence of hepatitis in your blood it often
group O is particularly valuable because in certain cases can be valuable helping to make vaccine against
it can be used when other groups are not available. All hepatitis.
APPENDIX 2

blood types are required – remember the rarest type is

can’t afford the type that’s not available when you need it.

“I haven’t enough
to give blood to spare.”
“I’m too old.” 6
blood? The average adult has about 8 pints of blood, and
doctors agree that healthy people can give blood quite
regularly. A donation is less than a pint (450 ml) and
Age requirement for donors: 16-65 years, and if you’re
2
in good health you can keep on donating right up until
donors may give this safely four times a year. Your body
keeps on discarding and replenishing blood all the time
Fiji Red Cross Society your 65th birthday. whether you donate or not, so this amount is quickly
22 Gorrie Street replaced.
Suva, Fiji
Phone: 314133
“Oh, but I’m anaemic.” “No-one has ever
asked me to
3 donate.”
People may be anaemic, and it’s the Blood Bank’s job
to ensure blood is not taken from these people. So
7
Consider yourself invited. Your blood is the most
precious gift you can give. It can mean life itself for a
there’s a simple test performed at each donation: a sick child, an accident victim or for someone facing
small drop of blood is taken from the donor’s finger surgery.
and in about 15 seconds we’ll be able to determine your
haemoglobin (iron) level.

“It’s too inconvenient

An example of a donor motivation leaflet from the Fiji Red Cross Society
and I’m too busy.”
“I’m scared about
giving blood.” 8
The Blood Bank tries to make it as convenient as
possible to donate. The Mobile Unit visits many offices,
Everyone feels a bit like that for the first time, but really factories and schools. Even the busiest people make
4
there’s nothing to it. In fact, there are hundreds of time to give blood. When you stop to think of all the
donors who have given 40 to 70 donations. You don’t good your blood can do, we believe you might decide
READ ON — there are about 20 have to be a superman or superwoman to give blood: it you are not too busy after all to spare less than four
commom excuses for not giving blood. really is a simple procedure. hours each year.
 “You wouldn’t want “But it will the consequent sale of blood to patients has resulted
in enormous health risks. In Fiji every unit of blood
my blood because make me provided by the Blood Bank is given voluntarily by a
of recent illnesses.” weak.” donor. The donor is not paid, nor is the recipient charged
for the blood concerned. Blood is FREE.
9
Certainly you should not donate while you have an acute
ilness or for some time after major surgery. Please let
13
The volume of blood is replaced quite quickly. In fact,
by the time you leave the Blood Bank your body has
us know if you have been ill recently. We never take commenced replacing the blood you have given. After
blood from people who may not be well enough to just a few hours the total volume will be back to normal
“There’s too
donate. A medical history is taken to make sure it is and in the meantime you should experience no dis- much alcohol
safe for you to donate. comfort and you are able to go about your normal duties. in my blood.”
17
So long as there’s a drop of blood in the alcohol, the
“I intend to, Blood Bank can use your donations... but being sober
does help!
“I’m not heavy but I never get
enough.” around to it.”
“If you give
14
Come today there’s no need for an appointment. You
once, you have
will feel really good having made up your mind to come.
10
If you weigh 55 kg or more you will have enough blood Call at the Blood Bank, CWM Hospital, Suva between to keep giving.”
to donate. 8am-4.30pm any working day. For further details, phone
313444 extension 468.
18
Giving blood will not cause you to produce blood at a
greater rate. You will not be forced to give blood
regularly, because a blood donation is no different from
a bleeding nose, a menstrual period, or a cut finger in
“I’ve done my bit. its effect on blood production.
“I hate needles.” I gave donations
many years ago.”
15 “But I play
11 Thank you for giving blood at the time. We’ll still have
sport.”
To ensure that the blood giving process is not painful, your records and we want you to know that you really
local anaesthetic is applied to the skin. You then feel are needed now. There are just so many good uses for
no pain giving your blood and there is no need to watch
the procedure.
your donations. Each year as medical science and surgery
advance, more blood is used and each year more donors
19
So you’re healthy and that’s one ver good reason for
making a donation. Your donation of blood will not affect
must be found to meet the spiralling demand for blood.
your sporting performance and it will certainly help
someone else who needs your donation to stay alive.

“I gave
“I’ll only overseas and “I might catch
give in an was paid for it.” AIDS by giving
emergency.”
16 blood.”
Here blood donations are regarded as unique gifts and
12
Emergencies happen every minute of the day. For each a priceless natural resource. In other places blood has
20
Blood donors cannot catch AIDS or any other infection
APPENDIX 2

patient requiring a blood transfusion it is an emergency: become a marketable commodity and experience in by giving blood. All the equipment used for collecting
the patient could die if the blood is not available. these places indicates that the payment of donors and blood is sterile and is used only once.

161
 APPENDIX 3

Essentials for the Mobile Donor Clinic

PREMISES 5 Storage of equipment, reagents

and disposables.
The premises used for mobile donor sessions
may often be the only local venue available, but 6 Access to an adequate electrical
they must be of sufficient size, suitable supply for any onboard refrigerator
construction and in an appropriate location to in the sessional vehicle, and for all
allow proper operation. They must be clean and electrical equipment used during
maintained in accordance with accepted rules of the session.
hygiene.
HEALTH AND SAFETY
The designated person in charge of the blood
collection team should always be provided with a Health and safety factors should be taken into
written plan of action appropriate to each venue. account when selecting venues for mobile donor
This can be used as a checklist on arrival to make clinic sessions. In particular, the following points
sure that conditions are acceptable. If the venue should be kept in mind.
is being shared, care must be taken to avoid
disturbing any other activities. 1 The venue should be as close as
possible to the centre of population
being served. It should be possible
SPACE REQUIREMENTS for the sessional vehicle to park
close to the access doors in order
The space required will obviously depend on the
to facilitate the unloading of
number of staff and donors and the rate at which
equipment. The ground to be
donors arrive. The following activities should be
covered by staff carrying equipment
kept in mind when accepting a venue.
into the building should be even
1 Registration of donors and all other and well lit. If possible, the space
necessary information processing. to be used should not require the
Wherever possible, there should carrying of equipment up or down
be easy access to a telephone, stairs. A similar safe approach to
preferably within the venue. the building should be ensured for
donors, with car-parking space
2 Predonation counselling, the available where possible. Notices
medical history and the health should be displayed directing
check to determine donors’ fitness donors to the appropriate entrance
to donate blood. Facilities should to the building and to the room
be available for confidential being used.
discussions between donors and
donor clinic staff. 2 The furniture and equipment should
be arranged within the available
3 Withdrawal of blood from donors space to minimize crowding (with
without risk of contamination or the increased possibility of
errors. mistakes or accidents), enabling
privacy and adequate supervision
4 The social and medical care of
to be maintained and ensuring a
donors, including those who suffer
smooth and logical work-flow.
adverse reactions. Sufficient
seating should be provided for 3 Fire exits should be unobstructed
donors and staff, with allowance and operational. All donor session
made for possible queues during staff must be aware of the location
busy periods. of fire exits and fire extinguishers.

162
 APPENDIX 3
4 There should be adequate lighting should be made to ensure that
for all the required activities. equipment used in this area does
Wherever possible, there should not pose a safety hazard.
be provision for the use of
emergency lighting in the event of 7 Toilet facilities for male and female
a power cut. donors and staff should be
available. Separate washing
5 It may not be possible for the facilities are desirable for staff
mobile team to control the involved in ‘clean’ procedures.
temperature, but every effort should
be made to ensure that the space 8 Adequate facilities should be
does not become too hot, too cold available for the safe disposal of
or stuffy. If possible, subsidiary waste at mobile sessions. Sharps
cooling fans or heating should be and solid waste should be collected
carried on sessional vehicles, and in suitable containers for return to
used as necessary. the blood transfusion centre or
blood bank and for subsequent
6 Facilities for providing refreshments safe disposal.
for donors and staff should be
separate from other activities, 9 The premises should be free from
wherever possible. Every effort vermin.

163
 APPENDIX 4

Example of medical history questionnaire

I fully understand that any incorrect statement or concealment may be to the detriment of my health or the health of
the patient who receives the blood donated by me.

DO YOU SUFFER OR HAVE YOU SUFFERED FROM:

† Lung disease † Tuberculosis † Rheumatic fever

† Persistent cough † Heart disease † Circulation problems
† Anaemia † Nose bleeds (excessive) † STD/VD
† Low/high blood pressure † Dizziness † HIV/AIDS
† Diabetes † Ulcers † Prolonged diarrhoea
† Unexplained weight loss † Kidney disease † Thyroid disorder
† Swollen glands † Epilepsy † Cancer
† Shingles † Skin rashes † Malaria
† Night sweats/fever † Sleeping sickness † Hepatitis/jaundice
† Brucellosis † Asthma

ARE YOU TAKING OR HAVE YOU TAKEN ANY MEDICINES:

† Aspirin † Antibiotics † Steroids

† Injections † Vaccinations

HAVE YOU HAD ANY OPERATIONS?

† Minor † Major

HAVE YOU HAD ANY?

† Acupuncture † Scarifications † Blood transfusion

HAVE YOU BEEN IN CONTACT WITH ANY INFECTIOUS DISEASE?

FEMALES ONLY:

ARE YOU PREGNANT OR HAVE YOU BEEN PREGNANT WITHIN THE LAST 6 MONTHS?

ARE YOU BREASTFEEDING?

DO YOU HAVE ANY MENSTRUAL PROBLEMS (EXCESSIVE MENSTRUAL BLEEDING)?

DONOR’S SIGNATURE D ATE

SISTER’S SIGNATURE D ATE

A CCEPT /D EFER /R EJECT

164
 APPENDIX 5

Examples of Standard Operating

Procedures
STANDARD OPERATING PROCEDURE SOP/BTS/CLN/001/01
Donor haemoglobin screening using the copper sulfate method

This SOP replaces Quality Manager Date effective

New Copy no

1 PURPOSE
To define the procedure for the haemoglobin screening of blood donors using the copper sulfate
method on blood obtained from a fingerprick.

2 RESPONSIBILITIES
All BTS teams and clinic staff
All trained and authorized BTS teams and clinic staff can use this SOP.

Head of Collection
Head of Collection must resolve any:
„ problems with the process
„ difficulties using the SOP.

3 RESTRICTIONS
This SOP must not be used by unauthorized teams or clinic staff or by any non-teams or clinic staff.
Only venous blood obtained from a fingerprick is to be used for donor haemoglobin screening.

4 DEFINITIONS
Copper sulfate solution – female
Copper sulfate solution prepared with a specific gravity of 1.053 to screen a haemoglobin level of
12.5 g/dl or above.
Copper sulfate solution – male
Copper sulfate solution prepared with a specific gravity of 1.055 to screen a haemoglobin level of
13.5 g/dl or above.

5 ITEMS REQUIRED
Prepared copper sulfate solutions
Sterile plain capillary tubes
Sterile disposable lancets or automated fingerprick device with disposable lancets
Finger cleansing solution (0.5% hibitane in 70% alcohol)
Sterile cotton wool swabs OR disposable sterile antiseptic skin wipes
Documents:
Dealing with donors who fail the copper sulfate screening test (SOP/BTS/CLN/002/01).

Uncontrolled document unless printed on “Controlled Paper”

Author: John Smith df: SOPHbScr.rtf Date: 01/06/01 Page: 1 of 2

165
 APPENDIX 5

STANDARD OPERATING PROCEDURE SOP/BTS/CLN/001/01

6 PROCEDURE
Prior to any procedure the donor must be fully aware of what is going to happen to them.
6.1 Explain briefly to the donor what is going to happen and why.

6.2 Performing the fingerprick

6.2a Select the finger on which to perform the fingerprick: usually the first or second finger.
6.2b Clean the skin with the area with the cleansing solution or disposable skin wipe and allow
to dry.
6.2c Using either a lancet or an automated device, perform the fingerprick.
6.2d Wipe away the first drop of blood.
6.2e Collect the next drop of blood in the capillary tube as it forms by placing one end in the
drop of blood. Collect about 2 cm of blood in the capillary.
6.2 f Keep the capillary horizontal and place a finger over the top end.
6.2g Place a small sterile cotton wool swab on the puncture site and ask the donor to hold this
in place for a few minutes.

6.3 Performing the copper sulfate test

6.3a Uncap the appropriate bottle of copper sulfate solution: male or female.
6.3b Hold the capillary tube about 1 cm above the surface of the liquid, remove the finger from
the top of the tube and allow one drop to form and fall into the copper sulfate solution.
Do not force the drop to form or shake the tube to release the drop.
6.3c Watch the drop of blood in the copper sulfate solution and note whether it sinks to the
bottom or floats.
6.3d If the drop of blood falls through the solution within 15 seconds, the donor has passed
the copper sulfate screen.
6.3e If the drop hesitates before falling, does not sink at all or rises in the solution, repeat the
screen. If the same result is obtained, the donor has failed the copper sulfate
haemoglobin test and needs further investigation: SOP/BTS/CLN/002/01 (Dealing with
donors who fail the copper sulfate screening test).
6.3f Record the test result on the donor record card.
6.3g If the donor has failed the copper sulfate, test explain to the donor what is to happen next
(SOP/BTS/CLN/002/01).

Uncontrolled document unless printed on “Controlled Paper”

Author: John Smith df: SOPHbScr.rtf Date: 01/06/01 Page: 2 of 2

166
 APPENDIX 5

STANDARD OPERATING PROCEDURE SOP/BTS/CLN/002/01

Dealing with donors who fail the copper sulfate test

This SOP replaces Quality Manager Date effective

New Copy no

1 PURPOSE
To define the procedure for dealing with blood donors who fail the copper sulfate screening test

2 RESPONSIBILITIES
All BTS teams and clinic staff
All trained and authorized BTS teams and clinic staff can use this SOP.

Head of Collection
Head of Collection must resolve any:
„ problems with the process
„ difficulties using the SOP.

3 RESTRICTIONS
This SOP must not be used by unauthorised Teams or Clinic staff or by any non-teams or clinic staff.
This SOP is to be applied only to those donors who fail the copper sulfate screening test.

4 DEFINITIONS
Failed copper sulfate test
The drop of blood does not cleanly and rapidly sink in copper sulfate solution of the appropriate
specific gravity for that donor.

5 ITEMS REQUIRED
5 ml syringe and needle
EDTA sample tube
Sphygmomanometer or tourniquet
Skin cleansing solution
Sterile cotton wool swabs
Documentation:
Failed haemoglobin report (FRM/BTS/CLN/002)
Selecting a vein for venepuncture (SOP/BTS/CLN/003/01)
Cleansing of skin prior to venepuncture (SOP/BTS/CLN/004/01)
Venepuncture using the “bevel up” technique (SOP/BTS/CLN/005/01).

6 PROCEDURE
In order to identify and treat anaemic donors, and to identify failures of the copper sulphate test itself,
the haemoglobin level of donors who fail the copper sulfate test is measured. Depending on the
result, a full blood count is carried out using a properly collected venous sample.

Uncontrolled document unless printed on “Controlled Paper”

Author: John Smith df: SOPFailHb.rtf Date: 01/06/01 Page: 1 of 2

167
 APPENDIX 5

STANDARD OPERATING PROCEDURE SOP/BTS/CLN/002/01

6.1 Label an EDTA sample tube with the donor’s name, identification number and the date bled.
6.2 Apply the sphygmomanometer cuff to the upper arm and inflate to a pressure of 50 mm OR apply
a tourniquet to restrict the veins in the upper arm.
6.3 Select a vein for venepuncture (SOP/BTS/CLN/003/01).
6.4 Prepare the skin for venepuncture (SOP/BTS/CLN/004/01).
6.5 Aseptically attach the needle to the syringe and perform the venepuncture using ‘bevel up’
technique (SOP/BTS/CLN/005/01).
6.6 Draw 4–5 ml of blood into the syringe.
6.7 Remove the needle and introduce the blood from the syringe into the EDTA tube. Mix the blood
by gentle, repeated inversion. NB: Repeat the inversion at least 10 times to ensure that the
anticoagulant has dissolved fully. Do not shake the tube.
6.8 Complete a “Failed haemoglobin report” (FRM/BTS/CLN/002) for each donor and package it
together with the matching sample.
6.9 Send the sample and paperwork to the donation testing laboratory at the BTS for haematological
investigation.

Uncontrolled document unless printed on “Controlled Paper”

Author: John Smith df: SOPFailHb.rtf Date: 01/06/01 Page: 2 of 2

168
 APPENDIX 6

WHO Haemoglobin Colour Scale

The Haemoglobin Colour Scale is a simple, reliable

and inexpensive clinical device developed by the 14 Too light
World Health Organization to screen for the
presence and severity of anaemia. It enables an 12 Too light
accurate estimation of haemoglobin levels in
10 Correct
blood to be made through a comparison of the
colour of a drop of blood with predetermined
8 Too dark
shades of red.
Unlike earlier methods, the Haemoglobin Colour 6 Too dark
Scale has been developed using computerized
spectrometric analysis to identify colours that can 4 Too dark
accurately match shades of haemoglobin at
different concentrations when used with special
absorbent test-strip papers. 4 If the blood stain matches one of the
shades of red exactly, record the
The Scale comprises a small card containing a haemoglobin value. If the colour lies
standardized set of shades of red representing a between two shades, record the mid-
range of haemoglobin values (4 g/dl, 6 g/dl, value. If in doubt between two shades,
8 g/dl, 10 g/dl, 12 g/dl and 14 g/dl respectively). record the lower value.
5 Discard the test-strip after use.
How does it work?
The device is simple to use, but must be carried Validation
out according to the instructions and using the The Haemoglobin Colour Scale is accurate to
test-strips provided. within 1 g/dl when used according to the
1 Place a drop of blood on the test-strip instructions and using the test-strips supplied in
provided. the kit. Extensive testing and field trials have been
carried out on the performance of the Scale and
2 Wait about 30 seconds. have confirmed its reliability when used correctly.
3 Compare the blood stain with the Using a photometric method as a reference, the
shades of red in the Scale to find the Scale was shown to be more reliable than copper
best colour match: sulfate, the tests giving 2.4% and 5.4% false
„ Keep the test-strip close to the readings respectively.
back of the Scale
„ Avoid direct sunlight Availability
„ Avoid marked shade The Starter Kit with approved test-strips for 1000
„ Avoid shadow. tests costs about US$20. This works out at about
2¢ per test – less than a copper sulfate test. The
cost per test falls with each purchase of refills.
the Haem
oglobin 14
Using Scale
Colour
Haemoglobin equivalent g/dl

test-strips.

Information on suppliers of the WHO Haemoglobin

approved
Use only
1
to one
end of
of blood h to cover
a
an 12
2 Add a drop – just enougr Scale.
test-strip in the Colou
aperture
then readthe blood
minute
Wait one y by comp
aring find the 10
3 Scale to

Colour Scale is available from:

immediatel the Colour
stain with r match: to the back
best colou test-strip close
the
■ Keep Colour Scale
of the
direct sunlig
ht
■ Avoid marked shade w or any other
8
■ Avoid your own shado
■ Avoid w
shado
value .
oglobin
4 Record
the haem 6
use.
trip after
the test-s
5 Discard

4
World Health Organization
Blood Safety and Clinical Technology
CH-1211 Geneva 27, Switzerland
Fax: +41 22 791 4836.
E-mail: [email protected]

169
 APPENDIX 7

Guide to medical assessment of blood

donors
Only people who have a negative medical history This interval may be reduced at the discretion of
and appear to be healthy and free of disease may the medical director, but is never less than 10
be accepted as donors. Persons with features weeks in cases of O Rhesus positive and O Rhesus
indicative of ill-health or previous disease may only negative.
be accepted at the discretion of a medical officer
of the blood transfusion service. Similarly, persons Haemoglobin (copper sulfate)
identified with patterns of risk behaviour should
Using copper sulfate method:
not donate blood.
„ Females: 12.5 g/dl
1 QUANTITATIVE SELECTION CRITERIA „ Males: 13.5 g/dl.

Age
Blood pressure
Any healthy adult between 18 and 60 years of age,
„ Minimum: 90/50
both included, may become a blood donor. Donors
who have donated blood regularly prior to the age „ Diastolic under 30 years: 90 mmHg
of 60 may continue to donate up to 65 years. „ Diastolic over 30 years: <100 mmHg.
Donors over 65 years may only donate with their
doctor’s consent. New donors over 60 years may
only donate with their doctor’s consent. Food
First-time donors should have something to eat
Some countries may consider reducing the age of before donating blood, preferably within the
first donation to 16, provided that donors conform previous four hours. Well-established donors who
to the physical and haematological criteria required have frequently donated on an empty stomach can
for those aged 18 years and that appropriate be accepted. All other donors can be provided with
consent is obtained. tea, coffee, orange juice or a cola drink and
biscuits prior to or after donating.
Weight
Minimum weight: 50 kg or 110 lb. Hazardous occupations
If possible, people in hazardous occupations should
The volume of blood to be donated should not
donate when off duty or when they have finished
exceed 13% of the circulating blood volume.
work for the day: e.g. pilots, workers on scaffolding,
Donors who weigh more than 50 kg and who
firemen, train drivers, etc.
comply with the weight/height requirements can
safely donate 450 ml of blood. Donors who do not
comply with the weight/height requirements but Sporting activities
weigh between 45 and 50 kg can donate 350 ml Donating blood does not have any physically harmful
into suitable blood bags of blood as this does not effects on the donor, but may reduce the person’s
exceed 13% of their circulating blood volume. maximum athletic performance. Regular short-
distance runners should not run on the day of
Unexplained loss of weight of a significant degree
donation.
excludes the donor. Overweight can be a cause of
deferral due to inaccessible veins in the ante- Long-distance runners and persons preparing for a
cubital fossa. marathon or other significant races should not
donate at all during the period of intensive training.
Frequency of donations
Donors who undertake ordinary diving for pleasure
„ Females: every 4 months
are acceptable, but deep-sea divers and saturation
„ Males: every 3 months. divers should be deferred. Mountaineers should

170
 APPENDIX 7
not donate on the day of climbing and should not and women according to height and frames is
climb for one week after donation. based on typical figures for European populations.
Contact your Ministry of Health to obtain suitable
The following table of desirable weights for men figures for your country.

EXAMPLES OF IDEAL WEIGHT/HEIGHT PARAMETERS (EUROPEAN DONOR POPULATIONS)

Desirable weights for men, according to height and frame, ages 25 years and over

MEN WEIGHT IN POUNDS AND KILOGRAMS (in indoor clothing)

Height in shoes Small frame Medium frame Large frame

Feet Metres Pounds Kilograms Pounds Kilograms Pounds Kilograms

5' 2" 1.575 112–120 51–55 118–129 54–59 126–141 57–64

5' 3" 1.600 115–123 52–56 121–133 55–60 129–144 59–65
5' 4" 1.626 118–126 54–57 124–136 56–62 132–148 60–67
5' 5" 1.651 121–129 55–59 127–139 58–63 135–152 61–69
5' 6" 1.676 124–133 56–60 130–143 59–65 138–156 63–71
5' 7" 1.702 128–137 58–62 134–147 61–67 142–161 65–73
5' 8" 1.727 132–141 60–64 138–152 63–69 147–166 67–75
5' 9" 1.753 136–145 62–66 142–156 65–71 151–170 69–77
5' 10" 1.778 140–150 64–68 146–160 66–73 155–174 70–79
5' 11" 1.803 144–154 65–70 150–165 68–75 159–179 72–81
6' 0" 1.829 148–158 67–72 154–170 70–77 164–184 75–84
6' 1" 1.854 152–162 69–74 158–173 72–80 168–189 76–86
6' 2" 1.860 156–167 71–76 162–180 74–82 173–194 79–88
6' 3" 1.905 160–171 73–78 167–185 76–84 178–199 81–90
6' 4" 1.930 164–175 75–80 172–190 78–86 182–204 83–93

Desirable weights for women, according to height and frame, ages 25 years and over

WOMEN WEIGHT IN POUNDS AND KILOGRAMS (in indoor clothing)

Height in shoes Small frame Medium frame Large frame

Feet Metres Pounds Kilograms Pounds Kilograms Pounds Kilograms

4' 10" 1.473 92–98 42–45 96–107 44–49 104–119 47–54

4' 11" 1.499 94–101 43–46 98–110 45–50 106–122 48–55
5' 0" 1.523 96–104 44–47 101–113 46–51 109–124 50–56
5' 1" 1.549 99–107 45–49 104–116 47–53 112–128 51–58
5' 2" 1.575 102–110 46–50 107–119 49–54 115–131 52–60
5' 3" 1.600 105–113 48–51 110–122 50–55 118–134 54–61
5' 4" 1.626 108–116 49–53 113–126 51–57 121–138 55–63
5' 5" 1.651 111–119 50–54 116–130 53–59 125–142 57–65
5' 6" 1.676 114–123 52–56 120–135 55–61 129–146 59–66
5' 7" 1.702 118–127 54–58 124–139 56–63 133–150 60–68
5' 8" 1.727 122–131 55–60 128–142 58–65 137–154 62–70
5' 9" 1.753 126–135 57–61 132–147 60–67 141–158 64–72
5' 10" 1.778 130–140 59–64 136–151 62–69 145–163 66–74
5' 11" 1.803 134–144 61–65 140–155 64–70 149–168 68–76
6' 0" 1.829 138–148 63–67 144–159 65–72 153–174 70–79

171
 APPENDIX 7
MEDICAL HISTORY SELECTION CRITERIA (GUIDELINE EXAMPLES ONLY)

Condition Acceptability
Abortion Acceptable after 6 months
Acne Acceptable if lesions are not active or infected
Isotretinoin: defer until 1 month after last dose
Retin A cream: defer for 6 months
Etretinate: permanently defer
Acupuncture Unregistered doctor: defer for 6 months
Registered doctor: defer for 3 months
Body-piercing, tattoos, scarification: defer for 6 months
AIDS/HIV 1 No person in a risk group should donate blood: i.e.
„ male homosexuals or bisexuals
„ injecting drug users
„ prostitutes
„ any sexual contact with the above
„ any person who is HIV positive
„ any person with a history of hepatitis B or C
„ any person with a history of syphilis

2 Every donor is assessed or asked questions about the signs and symptoms
of AIDS/HIV infection and any disease related to it:
„ swollen glands
„ night sweats/fever
„ prolonged diarrhoea
„ shingles
„ persistent cough
„ skin rashes/lesions
„ unexplained weight loss

Alcoholism Acceptable when sober. Unfit when intoxicated (for assessment after interview/history)
Allergies Severe allergy: permanently unfit
Seasonal allergy: may be bled during symptom-free period
Defer if on steroids or desensitization injections
Anaemia Only iron deficiency anaemia is acceptable after treatment
All other causes: permanently unfit
Anaesthesia See Surgery
Angina pectoris Permanently unfit
Arthritis Acceptable unless acute or refer to Medical Officer
Asthma Acceptable between attacks if not on a course of steroid therapy. If on drugs, refer to
Medical Officer
Biopsy Acceptable if benign and healed
Blood diseases Permanently unfit, except for iron deficiency anaemia
Blood transfusion Acceptable 1 year after treatment if no other contraindications
(including human plasma-
derived medicinal products)
Boils Acceptable after 3 weeks
Brain injury Permanent brain injury: permanently unfit
Bronchitis (acute) Acceptable 1 month after recovery
Brucellosis (undulant fever) Acceptable 1 year after recovery as serum donor only

172
 APPENDIX 7

Medical history selection criteria (guideline examples only)

Condition Acceptability
Burns (minor) Acceptable, if no sepsis

Cancer Acceptable after 5 years if no recurrence, with letter from doctor

Cerebrovascular disease Permanently unfit

Chagas disease Local criteria to be defined

Chest pains/shortness Defer until fit, with letter from doctor

of breath on exertion

Chickenpox Acceptable after recovery, minimum 3 weeks; as serum donor for plasma fractionation,
3 weeks – 3 months after attack

Chickenpox contact Acceptable if donor has previously suffered from chickenpox; otherwise, defer for 3
weeks

Cholecystitis Acceptable after recovery

Colitis (ulcerative) Permanently unfit

Common cold Defer if donor has a temperature

Concussion Acceptable 3 months after recovery or refer to Medical Officer

Convulsions as adult Permanently unfit

Coronary artery disease Permanently unfit

Cystitis Acceptable 3 weeks after recovery

Dengue fever Acceptable 1 month after recovery or contact

Dermatitis (eczema, Acceptable when quiescent, if venepuncture site clear, not on systemic treatment
psoriasis) and no indication of HIV/AIDS

Diabetes Diet-controlled: acceptable with letter from doctor

Insulin and oral drugs controlled: permanently unfit

Diphtheria Acceptable 3 months after recovery

Diverticulitis Acceptable

Dysentery (amoebic) Acceptable 1 month after recovery

Dysentery (bacillary) Acceptable 1 month after recovery

Embolism Permanently unfit

Emphysema Permanently unfit, unless with letter from own doctor

Encephalitis Acceptable 6 months after recovery

Epilepsy Permanently unfit

Fainting Permanently unfit after 3 consecutive faints

Fracture „ Minor fractures: acceptable after 3 months e.g. crack fracture, closed reduction of
ankle/wrist
„ Major fractures/multiple fractures, fractures of major bones, e.g. femur/pelvis:
acceptable after 6 months

Gall stones Acceptable after recovery

Gastroenteritis Acceptable after 1 month

German measles Acceptable 3 weeks after recovery

Glandular fever Acceptable 6 months after recovery

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 APPENDIX 7

Medical history selection criteria (guideline examples only)

Condition Acceptability
Glaucoma Acceptable after treatment

Gonorrhoea Unfit; acceptable 1 year after treatment if complete cure and no risk activities for 3 years

Gout Acceptable if quiescent and not on systemic treatment

Haematuria Acceptable after recovery, depending on the cause

Haemochromatosis Unfit, but may be accepted by medical officer for therapeutic bleeding on written authority
from own doctor

Haemorrhoids Acceptable if asymptomatic

Haemorrhoid injection: acceptable after 1 month

Hay fever Acceptable during symptom-free period

Head injury Acceptable 3 months after recovery

Heart disease Permanently unfit

Hepatitis A contact Acceptable after 6 months

(household)

Hepatitis B infection Unacceptable

Hepatitis C infection Unacceptable

Herpes (cold sores) Unacceptable until all lesions have healed; acceptable when donor has completed
treatment and completely healed, provided no history of other sexually-transmitted
disease

HIV See AIDS/HIV

Hypertension Defer or refer to own doctor

Hyperthyroidism Unacceptable

Hypotension Acceptable minimum 90/50 mmHg; if lower, defer

Hypothyroidism Unfit

Infectious mononucleosis Acceptable 6 months after recovery

Influenza Acceptable after recovery

Injecting drug use Unacceptable

Malaria National policies to be followed in malaria-free parts of the world.

In non-endemic areas, all donors should be questioned as to whether they have visited
a malaria area within the previous 0 – 21 days.
i) If they have, defer until 3 weeks after their return if they did not take any prophylaxis
ii) If they have, and did contract malaria, defer for 6 months after they have received
a full course of the recommended treatment and have been clinically symptom-free
of malaria
Local criteria to be followed in endemic areas

Measles Acceptable after recovery, minimum 3 weeks

Measles contact Acceptable if donor has previously suffered from measles; otherwise defer for 3 weeks

Menière disease Acceptable, if symptom-free

Meningitis Acceptable 6 months after recovery

Menstruation Acceptable

Migraine Acceptable

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 APPENDIX 7

Medical history selection criteria (guideline examples only)

Condition Acceptability
Multiple sclerosis Permanently unfit
(disseminated)
Mumps Acceptable after recovery, minimum 3 weeks
Mumps contact Acceptable if donor has previously suffered from mumps; otherwise, defer for 3 weeks
Nephritis (acute) Acceptable 6 months after recovery (includes kidney stones)
Nephritis (chronic) Permanently unfit
Osteomyelitis Acceptable 6 months after recovery
Pancreatitis Acceptable 6 months after recovery
Peptic ulcer Acceptable if no haemorrhage for 6 months, provided only on diet or antacids
Peritonitis Acceptable 6 months after recovery
Phlebitis Acceptable 6 months after recovery
Pneumonia Acceptable 6 months after recovery, but check underlying disease; unacceptable if
possibility of malignancy
Pneumothorax Acceptable 6 months after recovery
Poliomyelitis Acceptable 6 months after recovery
Polycythemia vera Acceptable for therapeutic bleeding only on written authority from own doctor
Porphyria To bring a letter from own doctor
Pregnancy (breastfeeding) Acceptable 6 months after delivery or 1 year if breastfeeding
Psychiatric disorder Unfit or refer to Medical Officer
Pyelitis Acceptable 3 months after recovery
Raynaud disease Permanently unfit
Renal colic Acceptable when symptom-free
Respiratory infection Acceptable 3 weeks after recovery
(upper)
Rheumatic fever Acceptable only after consultation with Medical Officer
Rheumatism Acceptable
Rubella Acceptable after recovery, minimum 3 weeks
Rubella contact Acceptable after 3 weeks
Sarcoidosis Permanently unfit
Scabies Acceptable when symptom-free
Scarlet fever Acceptable after 3 weeks
Schistosomiasis Acceptable 1 month after treatment
Septicaemia Acceptable 6 months after recovery
Shingles Unacceptable
Skin disease Acceptable when quiescent, venepuncture site clear, not on systemic treatment and no
relation with HIV/AIDS
Sleeping sickness Acceptable after 3 weeks after recovery

Snake bite Acceptable after recovery, minimum 6 months

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 APPENDIX 7

Medical history selection criteria (guideline examples only)

Condition Acceptability
Stab injuries Acceptable after 6 months

Surgery Exclude the following:

„ Any cardiac surgery
„ Total gastrectomy
„ Splenectomy, except post-trauma
„ Nephrectomy, except post-trauma

Defer for 3 months after the following minor surgery:

„ appendicectomy
„ closed reduction of small fractures e.g. ankle/wrist
„ haemorrhoidectomy
„ hernia repair
„ lumpectomy (breast)
„ stripping of varicose veins
„ tonsillectomy

Defer 6 months after the following major surgery:

„ circumcision in adults (tribal customary)
„ cholecystectomy
„ craniotomy/neurosurgical procedures, provided no neurological sequelae
„ hysterectomy
„ laminectomy/spinal fusion
„ laparotomy – vagotomy pyloroplasty
„ major trauma due to road traffic accidents
„ thyroidectomy
„ any surgery requiring blood transfusion

Minor procedures:
These will depend on nature of procedure and should be left to the discretion of the
clinic sister
„ general anaesthetic: defer 1 week
„ dental operations under local anaesthetic: 72 hours
„ dental operations under general anaesthetic: 1 month

Syphilis Unacceptable

Tetanus Acceptable 6 months after recovery

Thrombophlebitis Acceptable 6 months after recovery

Thyrotoxicosis Permanently unfit

Tick bite fever Acceptable 2 months after recovery

Tonsillitis Acceptable after recovery

Toxoplasmosis Acceptable after recovery

Trypanosomiasis Acceptable after 3 months

Tuberculosis Acceptable 5 years after recovery, provided no relation with HIV/AIDS

Typhoid Acceptable 6 months after recovery

Typhoid contact Acceptable after 1 month

Typhus Acceptable 6 months after recovery

Underweight Unfit

Undulant fever Acceptable after one year as a serum donor

176
 APPENDIX 8

Venepuncture

PREPARATION of blood. The most obvious visible vein is not

necessarily the most suitable one, as superficial
Blood should be drawn from a large, firm vein in an veins are often too narrow.
area that is free from skin lesions.
Procedure Procedure
1 Inspect both of the donor’s arms to 1 Greet the donor and, during the
select the better one. process of selecting a vein, ask
2 Ask the donor to remove any tight- the following questions to identify
fitting sleeved clothing, if possible, any potential problems:
or to roll up loose sleeves. „ Have you donated blood
before?
APPLYING THE SPHYGMOMANOMETER
„ Are you keeping well? Are you
Procedure attending the doctor or on any
1 Gently apply the deflated medication?
sphygmomanometer cuff around „ Have you had any problems
the donor’s upper arm, approxi- when donating blood in the
mately 6 cm above the elbow. The past?
rubber tubing and hand bulb should
2 Inflate the sphygmomanometer cuff
be at the top.
to 80/100 mmHg.
The anaeroid gauge should register
3 Ask the donor to clench and release
0 before inflation.
his or her hand several times and
2 Inflate the ad the blood then to make and maintain a
pressureand record it on the clenched fist.
donor’s card.
4 Examine and palpate the turgid
3 Talk to the donor while waiting for veins in the antecubital fossa and
a medical officer, nurse or other select the vein.
trained member of staff to come
5 Check the donor’s record card
and perform the venepuncture.
where relevant information from
previous donations should have
SELECTING A VEIN been recorded: e.g. “Felt faint after
donation”.
The area should be free from skin lesions or
evidence of infection. Veins in the antecubital
fossa should be used and no more than one PREPARING THE SKIN
venepuncture should be performed on each arm.
Once blood is outside the body, it can serve as an
Selection of an adequate vein ensures a “clean” ideal medium for bacterial growth. Blood cannot
venepuncture, rapid withdrawal and donor comfort. be sterilized without destroying many of its
Always give an adequate explanation of the components. It is therefore important to prevent
procedure to maintain the donor’s trust and contamination at the time of blood withdrawal.
respect. Skin preparation before phlebotomy deserves the
attention usually devoted to a minor surgical
The vein selected should have sufficient diameter, procedure.
be turgid and have adequate tissue support for
the retention of the venepuncture needle There are distinct groups of microorganisms
throughout the entire procedure for the withdrawal present in the skin causing contamination: normal

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 APPENDIX 8
flora and ‘hidden’ bacteria which are harboured in subcutaneously at the intended
main follicles and sebaceous glands. site of skin puncture approximately
1 cm below and to the side of the
The skin can never be made free of ‘hidden’ intended vein entry.
bacteria and therefore cannot be made sterile. It
can only be made surgically clean. 4 Remove the needle guard.
5 Place your free hand well below the
There is no way to prepare a completely aseptic
prepared area in order to pull the
site for venepuncture, but surgical cleanliness
skin taut over the puncture site.
can be achieved to provide maximum assurance
of a sterile unit of blood. 6 Holding the needle at a 45° angle,
aim it carefully through the local
anaesthetic ‘bump’ and puncture
Procedure
the skin with a quick thrust.
1 Starting at the intended site of
venepuncture, clean the ante- 7 Lower the angle of the needle
cubital fossa, using an enlarging 10–15° and, with a steady thrust,
concentric circular pattern. The area advance the needle to pierce the
should be 10 cm x 10 cm. Prepared vessel wall.
swabs containing 70% isopropanol 8 Remove the occluding forceps and,
alcohol are commonly used. (See depending on the local anatomical
Section 7 of the Introductory layout of the venous system,
Module on the preparation of basic advance the needle 1–2 cm inside
solutions and the Appendix for a the lumen of the vein. Blood should
standard operating procedure for now flow freely into the pack.
the preparation of an antiseptic
9 Reduce the sphygmomanometer
solution for donor arm cleansing.)
pressure to 40–50 mmHg.
2 Allow this to dry on the prepared
10 Secure the needle with two pieces
arm. If possible, do not touch the
of tape.
site of venepuncture following skin
preparation, unless your fingers 11 Cover the venepuncture site with a
are surgically clean. sterile gauze swab.
12 Ask the donor if the arm feels
VENEPUNCTURE comfortable. Also ask the donor
not to twist or turn the arm and to
The venepuncture requires a smooth, clean entry make a fist and release it every 10
with the needle. Swiftly pierce the skin, with the seconds in order to encourage a
needle held at an angle of approximately 45°. For better flow.
the second thrust, lower the needle until it is
almost parallel to the skin before carefully entering 13 If the session is not too busy,
the vein. remain to talk to the donor. Before
leaving the donor, always check
that there is a donor assistant
Procedure looking after him or her.
1 Check that the sphygmomanometer
pressure is still at 80 mmHg or
above and that the cubital vein is FILLING THE BLOOD PACK
engorged. The volume of blood to be collected will depend on
2 Clamp the donor tubing just by the the weight of the donor and the type and size of the
needle guard, using a pair of artery blood pack used. National or local guidelines
forceps. should always be followed.
3 A local anaesthetic injection of The filling of the blood container should be
1% lidocaine (0.3 ml) may be given monitored, using a spring balance or blood donor

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 APPENDIX 8
scales. A filled unit must not be obtained at the 2 When the appropriate amount has
expense of donor comfort or safety. been collected, clamp the tubing
with two sets of artery forceps and
Note: Before using a spring balance or scales, it
Note cut between the forceps. Tie off or
is important to ensure that the actual weight of a seal the tubing to the blood bag and
full blood pack is known and marked on the strip the tubing to mix the blood
balance or scale. This can easily be done by filling with the anticoagulant in the pack.
an unused pack with water to the volume required.
3 Release the forceps attached to
Take note of its weight and mark it on the scales
the needle tubing to allow blood to
or balance so that when that weight is reached
flow into the pilot tubes and sample
when collecting blood, the donation can be
containers. Ask the donor to relax
stopped.
his or her fist.
4 Gently remove the needle and apply
Procedure
a sterile swab and pressure to the
1 Mix the blood with the venepuncture site. Dispose of the
anticoagulant. In the absence of needle safely in a puncture-proof
an automatic shaker or rocking container that is kept specially for
device, take special care to the disposal of ‘sharps’.
thoroughly agitate the blood with 5 Check that the donation numbers
the anticoagulant in the primary or codes on the blood pack match
bag by gently lift-tilting the bag those on the sample tubes and the
during the first minute and then at donor’s card.
least three times while the bag is
filling. Do not knead or squeeze 6 Ensure that the venepuncture site
the blood bag. Proper mixing will is not bleeding and apply a dressing.
prevent clot formation and keep 7 Thank the donor and escort him or
red cell injury to a minimum. her to the resting area.

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 APPENDIX 9

Adverse donor reactions

PROBLEMS WITH BLOOD FLOW 2 Remove the swab and check that
there is no haematoma present.
Occasionally, venepuncture is unsuccessful or
the vein may develop spasm after venepuncture 3 If there are no other apparent
so that blood flow is not maintained. problems, proceed with adjusting
the needle.
If this happens:
4 Avoid excessive manipulation of
1 Do not try to probe around in the the needle or squeezing the donor
vein, as this can result in a tubing as small clots may form
haematoma and discomfort for the which will then be released into the
donor. circulation.
2 Remove the needle and discard A failure to re-establish a blood flow will result in
the pack as it will be contaminated. a partial collection. This should be marked on the
3 Never resite the needle in the same donor’s record card and the donor should be given
arm. an explanation and apology. If the collection is too
slow, the donation should be discontinued. This
4 Reassure the donor, giving a full should be recorded on the donor’s record card.
explanation for the unsuccessful
venepuncture in order to retain
their confidence, and apologize. HAEMATOMA
If the donor consents, a further venepuncture on Haematoma can be prevented by good
the other arm may be attempted, provided that a venepuncture technique and application of
suitable vein is located. No more than a total of adequate pressure following donation.
450 ml of blood should be withdrawn from both
sides. If a haematoma is noted:

If there is a failure to maintain a blood flow during 1 Stop the donation.

the collection, the person who has performed the 2 Apply firm pressure until the vene-
venepuncture should be informed immediately. puncture site stops oozing blood.
Slowing of the flow rate may be due to: 3 Apply an anti-inflammatory cream
in a circular motion over the area
„ reduced cuff pressure: check that
and cover it with a small plaster or
cuff pressure has been maintained
swab dressing. Then apply a
„ occlusion of the lumen of the needle pressure bandage.
by the vein wall: rotating the needle
4 Reassure the donor, explaining
may help
what has happened and the reason
„ positioning of the lumen of the for the bruise, and then apologize.
needle on a valve within the vein:
try to re-establish the flow by 5 Ask the donor to keep the dressing
withdrawing the needle gently or on for 24 hours and the bandage
even by slight rotation of the needle. for 2–4 hours. If they feel that it is
too tight and stopping their
Before doing any of these things: circulation, it should be loosened.
1 Explain that there is a problem with 6 Tell the donor that they can use
the blood flow and ask whether the their arm normally, but should not
donor is experiencing any lift any heavy objects. Also tell
discomfort. them that they can take painkillers

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 APPENDIX 9
for moderate discomfort, but that if ‘uneasiness’ to obvious shock-like symptoms,
the area becomes unduly painful fainting or even generalized convulsions. These
they should contact the transfusion reactions can occur at any time – during the donor
centre or their own doctor. selection process, during donation, in the resting
or refreshment area or even hours following a
7 Record details of the haematoma
donation.
on the donor’s record card.
There is a psychological element to most reactions,
so a friendly, cheerful atmosphere at the session
ACCIDENTAL PUNCTURE OF THE ARTERY
can often reduce donor anxiety and perhaps
This is an uncommon complication of blood prevent any adverse reactions. Donor reactions
donation, but you should be able to recognize it do sometimes occur, however, and can be
immediately by a very fast flow of bright red blood. categorized as follows:

If accidental puncture of the artery occurs: Mild: vasovagal symptoms without loss of
consciousness.
1 Discontinue the donation
immediately and apply hard Moderate: a progression of symptoms associated
pressure to the puncture site with a mild donor reaction, resulting in
immediately after the withdrawal unconsciousness.
of the needle. Raise the limb above
heart level.
Severe: any of the above, accompanied by
convulsions (uncommon).
2 Maintain pressure for a minimum
of 15 minutes.
Mild donor reactions
3 When the bleeding has stopped,
apply a pressure bandage and tell The signs of mild donor reactions include:
the donor to keep this on for
„ anxiety
4–6 hours.
„ increased respiration
4 Reassure the donor, giving a full
explanation of what has happened, „ rapid pulse
and apologize. „ pallor and mild sweating
5 Record the appropriate information „ dizziness/continuous yawning
on the donor’s record card. „ nausea/vomiting.
6 Do not allow the donor to leave When mild donor reactions occur:
until they are feeling well and after
the most senior member of the 1 Discontinue the donation.
donor clinic staff has discharged 2 Raise both of the donor’s legs and
them. lower the head to improve the blood
7 If you suspect that tissue bleeding supply.
may still be continuing, refer the 3 Loosen or remove tight clothing.
donor to the nearest hospital or
health centre. If the donor lives 4 Keep the donor cool by opening
near the donor clinic, ask them to windows or switching on a fan.
come back for assessment the 5 Have a suitable receptacle
following day. available at the bedside in case
the donor vomits.
MILD, MODERATE OR SEVERE REACTIONS 6 Allow a sufficient rest period.

Most people can tolerate the withdrawal of 450 ml 7 Offer a cool drink.
of blood without any ill-effects. Others experience 8 Once the donor has recovered,
reactions ranging in severity from a feeling of assist them from the bed to the

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 APPENDIX 9
refreshment area where another 9 If there is no other room available,
cool drink should be given. put screens around the donor.
9 Reassure and talk to the donor 10 Ensure that someone remains with
throughout all these stages. Explain the donor.
that this type of reaction is common
11 Reassure and talk to the donor
and does not mean that they are
throughout all these stages. It may
now physically ‘unwell’.
be necessary to advise the donor
10 Record the reaction on the donor’s not to donate in future.
record card.
12 Record the reaction on the donor’s
11 Advise the donor that, if symptoms record card.
persist, they should report to the
blood bank or consult a doctor or 13 Ensure that the donor rests for
nurse. some time and is fully recovered
before leaving.
12 Ensure that the donor is fully
recovered before leaving the 14 Advise the donor that if symptoms
session and has been seen by a persist, they should contact their
trained member of staff. doctor or the nearest hospital.
15 Ensure that the donor is discharged
Moderate donor reactions by a senior member of staff.
The signs of moderate donor reactions include: 16 Where feasible, arrange transport
„ loss of consciousness (fainting) home for the donor.
„ repeated periods of unconscious-
ness
Severe donor reactions
„ a slow pulse, which may be difficult A faint may be accompanied by convulsions.
to feel because of poor volume Convulsions may be preceded by all the signs and
„ shallow respiration. symptoms of a vasovagal attack or they may occur
without warning. Convulsions vary in severity from
When moderate donor reactions occur: loss of consciousness accompanied by a slight
1 Discontinue the donation. twitching of extremities to a grand mal type seizure
with incontinence of urine or faeces. A medical
2 Raise both of the donor’s legs and
officer or trained nurse must be called immediately.
lower the head.
3 Ensure that the donor is examined Faints are common, but convulsions are very
by a medical officer or senior nurse. uncommon. If the correct procedure for donor
screening has been carried out through the medical
4 Loosen or remove tight clothing. history and health check, convulsions should not
5 Keep the donor cool by opening occur. Most convulsions stop within a few minutes,
windows or switching on a fan. but they are often very upsetting for other donors,
so staff not actively involved in looking after a
6 Have a suitable receptacle convulsing donor should distract and reassure
available at the bedside in case other donors.
the donor vomits.
7 Check the pulse rate regularly. The When generalized convulsions occur:
appearance of the donor and the 1 Turn the donor to a lateral position
pulse rate are a good guide to the to maintain a clear airway.
donor’s condition.
2 Gently restrain the donor to prevent
8 If possible, remove the donor to any injury.
another room for privacy and to
prevent other donors from seeing 3 Put screens around the donor to
what is happening. maintain privacy.

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 APPENDIX 9
4 Check the pulse rate frequently. turn, this leads to muscle spasms. Talking to the
5 Ensure that the donor is examined donor to reassure them and relieve anxiety should
by a medical officer or senior nurse. prevent hyperventilation. If hyperventilation
occurs:
6 Loosen tight clothing.
1 Instruct the donor to breathe quietly
7 Keep the donor cool by opening and slowly, but not deeply.
windows or switching on a fan.
2 If this fails to relieve muscle
8 If a convulsion lasts longer than
spasms, instruct the donor to
five minutes, this is a medical
rebreathe expired air into a paper
emergency and a medical officer
bag.
must be in attendance. Diazepam
may be given intravenously under 3 Explain what is happening and
the direction of the medical officer. reassure the donor.
Intramuscular diazepam is
ineffective in these circumstances. ACCIDENTS
9 Reassure the donor and explain
There may be a risk of injury to the head or body
what has happened.
if a donor faints and falls.
10 Tactfully advise the donor not to
donate blood again. When head injuries or other injuries requiring
medical attention occur:
11 Record the incident:
1 Always ensure that the donor is
„ on the donor’s record card
examined by a medical officer or
„ in the clinic incident book. senior nurse.
12 Recheck the donor’s medical 2 If there is any doubt about the
history and record of the donor’s condition, arrange for their
predonation health check to identify transfer to hospital with a doctor or
whether there were any indications qualified nurse as escort.
that a convulsion might occur.
3 Record the incident:
13 Advise the donor that they should
contact their doctor or the nearest „ on the donor’s record card
hospital. „ on an accident form (this
14 Ensure that the donor rests for should also be filled in if a
some time and is fully recovered member of staff is involved in
before leaving the session. an accident)

15 Ensure that the donor is discharged „ in the clinic incident book.

by a medical officer or a very senior If the injury is of a minor nature:
member of staff.
1 Ensure that the donor rests for
16 Inform the donor’s own doctor some time and is fully recovered
about the incident. before leaving, unless transfer to
17 Arrange transport home for the hospital has been arranged.
donor when fully recovered and 2 Ensure that the donor is discharged
ensure that they are escorted or by a senior member of staff who
arrange for their transfer to hospital. should decide whether the donor’s
own doctor should be informed.
HYPERVENTILATION
3 Advise the donor that if they feel
Hyperventilation is a rapid overbreathing that unwell, they should contact their
lowers the carbon dioxide content of blood. In doctor or the nearest hospital.

183