Establishment and management of emergency blood donor panels
Introduction
1. The Emergency Donor Panels (EDP) consists of a group of volunteer blood donors
who are pre-screened in accordance with Blood Transfusion Services in the United
Kingdom (UK)1
and are available to donate whole blood or platelets in emergency
situations.
2. This policy replaces SGPL 10/06 dated 18 Apr 06 and provides improved clarity for Commanders.
Aim
3. The aim of this leaflet is to issue policy guidance for the establishment, management
and activation of an EDP, including platelet apheresis, on land and at sea.
Scope
4. The technical aspects are outside the scope of this policy and are covered by
associated Standard Operating Procedures (SOPs) controlled by Blood Supply Team
(BST) with copies held at Permanent Joint Headquarters (PJHQ).
Background
5. The Surgeon General (SG) fully endorses the use of EDPs in the extenuating
circumstances that could be encountered on operations or with extended lines of supply
and personnel involved in the process have his full backing. The responsibility of Defence
Medical Services (DMS) personnel to the safety and management of their patients and
donors2 remains the paramount concern.
6. The establishment and management of an EDP is under the guidance of Medical and
General Supply (M&GS), BST. BST staff would normally establish the EDP in the UK,
before any deployment; however, this may be arranged overseas by any Blood Donation,
Storage and Supply (BDSS) trained staff if directed by medical command.
Medical planning for the EDP
7. Medical planners should consider transfusion support and EDP for an overseas
Exercise or Operation, when:
a. There is a risk of significant injury requiring blood.
b. The risk assessment has deemed that blood supply from the UK or from a
coalition partner is required.
c. Local surgical support is to be used and/or evacuation may be delayed.
d. Local blood supply is considered insufficient or unsafe3
e. Re-supply of ‘Blood Service’ blood is not available in a timely manner.
8. BST should be contacted as early as possible of the requirement for an EDP in order
to advise and plan the donor selection process and this should be undertaken at least one
month before any proposed deployment to allow for the blood samples to be screened and
results provided.
Potential donor screening and selection
9. Potential donor screening uses a standard donor questionnaire which includes donor
consent for disease screening. It is the responsibility of BDSS trained staff to ensure that
potential donors clearly understand the nature of the donation process and the associated
risks involved. The potential donors must also understand the health check and other
medical information presented to them. Potential donors are asked about confidential and
sensitive aspects of their medical history and lifestyle. Potential donors should be
consented in facilities which offer privacy and are assured of the confidentiality of any
information they provide. The potential donor also consents for a Medical Officer to be
informed if they are judged to be unsuitable for blood donation. Therefore the unit’s
Medical Centre should be notified of the plan to establish the EDP.
10. The criteria for the selection of potential donors are based on the National Health
Service Blood and Transplant (NHSBT) Donor Selection Guidelines4. In addition, military
donors must be vaccinated and have confirmed immunity against Hepatitis B.
Testing of potential donor blood samples
11. Blood samples must be tested in a Medicines and Healthcare Products Regulatory
Agency (MHRA) accredited laboratory (compliant with BSQR 2005, EC Directive
2002/98/EC)5 or US equivalent. The costs are assigned to M&GS as part of the Service
Level Agreement (SLA) with the NHSBT.
12. The current testing regime is in accordance with Blood Safety and Quality
Regulations 20056
together with additional testing as indicated by prevailing risk
assessments. At the time of publication, the testing schedule includes:
a. ABO and Rh D grouping including Rh Variant.
b. High Titre Haemolysins for Group O donors.
c. Red cell alloantibody screening.
d. HIV I and II.
e. HBV (HBsAg).
f. NAT Testing for HIV, HCV, HBV.
g. HTLV I and II.
h. Syphilis (TPHA).
i. Full blood count for apheresis donors7.
j. Other tests indicated by the donor questionnaire eg Malaria Antibody Testing, T
Cruzei.
Potential donor testing results
13. The results of the donor testing will be made available to the medical centre via BST.
BST will provide a compatibility matrix for small groups where requested based on the
donor testing.
14. It is the Unit’s responsibility to confirm that the blood group of the donor is the same
as that held on Unit medical records and the identification discs. All inconsistencies
should be referred back to BST and the donor withdrawn from the EDP until the blood
group has been confirmed.
15. If a potential donor is considered to be unsuitable, following donor screening, then
advice and/or confirmatory results will be forwarded to OC BST. OC BST will liaise with
NHS Blood and Transplant, the Lead BMS (if applicable) and an appropriate UK or
deployed Medical Officer regarding interpretation and clinical advice8. The Medical Officer
is responsible for informing the donor of the results and arranging further management if
required. The timing of which will be dependent on the context.
EDP Expiry
16. The EDP has an expiry date of 7 months from the date of the initial sample.
Locations and operations with an ongoing requirement for an EDP are required to
rescreen their panel members, in location, and return samples to BST for retesting.
Selected personnel on the EDP are to be used only if they are well and continue to satisfy
the Donor Selection Guidelines at the time of donation.
Training
17. Units requiring an EDP for whole blood only should have BDSS9 trained personnel to
establish the donor panel and to conduct a donor session, store, issue and account for any
blood donated. Acceptable alternative arrangements include the use of local staff to
collect blood with prior agreement and authorisation from BST; however a record must be
kept of donation and subsequent transfusion.
18. Units requiring an EDP for Platelet Apheresis, such as Very High Readiness (VHR)
and Primary Casualty Receiving Facility (PCRF), must have both BDSS trained personnel
and Apheresis trained personnel with the appropriate knowledge, skills and experience10.
Activation of the Emergency Donor Panel
19. It is the responsibility of the most senior Medical Commander to activate an EDP in
accordance with the clinical and command risk assessment. The rationale for this decision
is to be documented in the recipient’s clinical notes.
20. The use of Fresh Whole Blood may be indicated to support the following:
a. Treatment of anaemia which is life threatening or is compromising aeromedical
evacuation; the aim is to raise the patient’s haemoglobin concentration to improve
oxygen carrying capacity.
b. Partial correction of coagulopathies associated with active, life threatening
haemorrhage where component therapy is not available.
c. Treatment of massive haemorrhage unresponsive to conventional haemorrhage
control measures and component therapy. Fresh Whole blood may be used to
supplement blood components.
21. The use of locally collected platelets may be indicated to support:
a. The treatment of thrombocytopenia or abnormal platelet function leading to
insufficient haemostasis
b. Platelet provision for the Massive Transfusion Protocol11.
ABO Blood Group Compatibility
22. The safe use of whole blood is determined principally by the ABO blood group.
Blood may be given on the basis of blood group alone where BMS support is not available.
In the absence of BMS support, or an agreed compatibility matrix, group A blood may be
used for group A donors and group O for all others.
Group O whole blood with low anti-A/B titres should be used where the blood group of the
recipient is unknown or there is uncertainty12.
Rhesus D (RhD) Compatibility
23. The use of RhD incompatible blood may lead to the subsequent development of red
cell antibodies. Such antibodies may complicate further transfusion and cause haemolytic
disease of the newborn. RhD negative blood can be used for all patients however the use
of RhD negative blood should be prioritised for RhD negative females under the age of 50.
Post Donation Activity
24. Post donor care. Recognised complications include fainting and haematoma due to
venepuncture. All available evidence indicates that military performance is not impaired by
donation13. All donors should receive advice about immediate post donor activities, and
the requirement to notify any adverse events of illness within a 14 day period after
donation.
25. Records. All procedures and the associated records related to the conduct of a field
collection are to be completed in a timely manner. The disposal of all donations,
transfused and discarded, must be recorded and returned to BST. The use of EDP blood
must also be recorded in the clinical notes.
26. Samples. Samples collected at the time of donation may be tested using Point of
Care Testing, if available. All samples must be returned to the UK for confirmatory testing
within 5 days of sampling. Samples that cannot be tested within in this timeline should be
separated and the plasma frozen until transport is available14. BST should be notified that
the panel has been activated and the Estimated Time of Arrival (ETA) for samples.
27. Storage. Whole Blood and platelets that are not immediately required are to be
placed into appropriate blood storage facilities.
28. Exclusion of donors. After whole blood donation, donors are required to be
excluded from further whole blood donation for up to 12 weeks to permit natural recovery
of iron stores. However, in extremis this can be safely shortened if the donor’s
haemoglobin levels are satisfactory (>12.5g/dl for females and >13.5g/dl for males).
Regulatory Framework
29. The MHRA acknowledges the difficulties of applying the regulations to deployments
and overseas locations, particularly in relation to the use of EDPs on operations overseas.
Potential areas of non-compliance, such as EDPs, should not give rise to any legal
issues15.
30. M&GS BST is responsible for producing and maintaining SOPs for the running of the
EDP in line with current best practice and on advice from SO2 Responsible Person
(Blood)16 and DCA Transfusion17 or civilian equivalent in Transfusion Medicine.
31. SO2 Responsible Person (Blood) is responsible for the specification and assurance
of the regulatory framework and for preparing the BST for regulatory inspection.
Authorisation
32. This policy is released for publication by Head of Medical Strategy and Policy on
behalf of the SG. Unless cancelled or otherwise revised, this leaflet will routinely be
reviewed after five years. HQ SG will make policy leaflets publicly available in accordance
with the Freedom of Information Act. This policy leaflet is releasable to the Internet. An
Equality Analysis has been undertaken in the production of this policy and no impact is
anticipated in terms of the Equality Act 2010.
Point of contact
33. The general point of contact is SO2 Medical Policy at HQ SG, via email to
mailto:SGACDSStratPol-MedPolSO2@mod.uk or by telephone on 01543 434669.
Specific or technical queries should be addressed to OC M & GS BST on 0121 414 7911.
1. http://www.transfusionguidelines.org.uk/red-book Guidelines for blood transfusion services in the UK 8th Edition
2. The individual establishing an EDP has a duty of care to those individuals acting as potential donors. This extends to handling
individual potential donor’s data in a timely, secure and confidential manner; and to their clinical care both during and after the time of
donation.
3. BST can provide advice on a suitability of host nation blood safety.
4. http://www.transfusionguidelines.org.uk/red-book/chapter-3-care-and-selection-of-whole-blood-and-component-donors-includingdonors-of-pre-deposit-autologous-blood.
5. Screening is usually undertaken at NHSBT Filton. 6
Blood Safety and Quality Regulations http://www.legislation.gov.uk/uksi/2005/50/contents/made accessed 13 Aug 14.
7. Haemoglobin assessment is undertaken at the point of donation by trained personnel.
8. A volunteer may be found to be unsuitable for a variety of reasons. A common scenario is that the individual reacts as positive in a
screening test but is found to be negative for the disease on confirmatory testing. However, some individuals may be found to have
Blood Borne viruses which may have an impact on their future employment.
9. Blood donation storage and supply course – via JMC Schedule of courses.
10. 2014DIN07-004 Instructions for the learn blood transfusion and apheresis courses.
11. JSP 999. Clinical Guidelines for Operations. Massive Transfusion Protocol.
12. Strandenes G, Berséus O, Cap AP, Hervig T, Reade M, Prat N, Sailliol A, Gonzales R, Simon CD, Ness P, Doughty HA, Spinella PC
and Kristoffersen EK (2014). Low Titer Group O Whole Blood in Emergency Situations. Shock 41 (Suppl 1), 70-75.
13. Strandenes G, Skogrand H, Spinella PC, Hervig T & Rein E B(2013). Donor performance of combat readiness skills of Special
Forces soldiers are maintained immediately after whole blood donation. Transfusion, 53, (3) 526-530.
14. Samples must be packed and transported in IATA 650 packaging.