Blood sampling and blood transfusion are vital parts of the healthcare services globally. Increasing advancement in the field of Transfusion Medicine and Technology has necessitated important measures to ensure quality of blood and its products. In modern medical world, the blood transfusion system has made significant advancement in areas of donor management, storage of blood, cross matching and testing for transmissible diseases.
In order to improve the standards of blood sampling and blood transfusion services, comprehensive standards are adopted ensuring better quality control system on collection, storage, testing and distribution of blood and its components. For quality, safety and efficacy of blood and blood products, well-equipped blood centers with adequate infrastructure and trained medical professionals is an essential requirement. For the best practice of phlebotomy, it is necessary to train clinical staff with updated knowledge and skills of blood collection and sampling.
Policies covering safe blood donation practices, increased and more sensitive testing of donated blood for evidence of transmissible infectious agents, and increased vigilance surrounding the process of blood transfusion have contributed to the improved safety in phlebotomy practices. However, every blood transfusion has potential risk of transmitting transfusion transmitted infections and adverse reactions resulting from alloimmunization against red cell antigen or other cellular blood components. Consequently, protection of recipient from adverse transfusion reactions due to alloimmunization against red cell antigen is one of the challenges related to safe blood transfusion practices.
Transfusion of blood and components
Informed consent and identification of recipient and donor
The recipient and donor both should be informed about their need or requirement for blood donation/transfusion and this procedure, alternatives available, as well as risks involved in blood transfusion. The written consent should be taken in the language the patient understands best, and only after providing all required information as per the facility protocol. For minors and unconscious patients, the next of kin or designated authority should sign the informed consent. Please check the facility protocols prior to starting the procedure.
Immediately before blood transfusion, the phlebotomist/ transfusionist should verify the identification of the patient, the blood unit, blood group and cross matching report and associated records as per the facility protocols. The blood compatibility report should be attached in the patient's record/file.
Administration of blood & blood components
Blood transfusion should be performed under proper medical direction. The phlebotomist/ transfusionist should observe the patient for an appropriate time at the initial stage and during the transfusion to observe any evidence of untoward reaction and to regulate the speed of transfusion. Blood and blood components should be maintained at the optimum temperature before transfusion. Best practice of phlebotomy and blood sampling must be followed as per the facility protocols.
Antibody testing and blood sampling
Antibody testing is also known as serology testing. Antibody serology tests check for the presence or level of specific antibodies in the blood. Antibodies are proteins that immune system makes to fight foreign substances. These substances are often pathogens such as viruses and bacteria. When the body is attacked by an infection, it makes antibodies that are targeted to those pathogens. An antibody serology test can show that the immune system can fight off certain diseases.
The presence of antibodies in the test results can mean that one may have been infected with any virus such as COVID-19 in the past or may have antibodies after being vaccinated. It may also indicate the presence or development of some immunity. The level of immunity and how long immunity lasts are not yet known and continue to be studied. As per Health Canada blood samples need to be collected and tested to track the virus in both the general population and in groups that are at higher risk of being infected, such as health-care workers and the elderly.
Significance of a Positive Test Result
If one has a positive serology test result, it is likely that-
a. One previously had an infection such as Covid 19 and has developed an antibody response to the virus.
b. It may also indicate that antibodies have been developed in response to vaccination.
A positive result does not necessarily mean that one is protected from the infection, though.
A False positive result- There is also a chance that this test can give a positive result that is wrong. Even a very precise antibody test may produce false positive results on occasion.
It is important for a client to talk to the healthcare provider to help understand any questions about the results of their antibody test.
Significance of a Negative Test Result
If one has a Negative serology test result, it is likely that-
· The antibodies to the virus that causing infection were not present in the blood sample.
A False positive result- There is a chance that this test can give a negative result that is wrong. Even a precise antibody test may produce false negative results on occasion. A false negative result could occur if one was tested too early after an infection or vaccination.
It is very important to take precautions while handling the blood specimens in the clinical laboratories that are suspected or confirmed for infection to minimize the risk of infection transmission. It involves safety practices followed by laboratory staff during phlebotomy, blood collection, sample processing, and proper disposal of waste. Timely communication between clinical and laboratory staff is crucial when lab investigations are requested for any suspected or confirmed case of severe infection such as COVID 19. Such specimens should be labeled accordingly, and the laboratory staff should be alerted to ensure proper specimen handling.
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