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Plasmapheresis is a procedure in which one-pint or less of whole blood is removed from a donor into a separation device in order to separate it into plasma and red blood cells. The plasma is then pooled into a separate collection container. Under aseptic procedure, the remaining cells are returned to the donor. The procedure is repeated until the desired collection weight is achieved. The collection weight is of the plasma is determined by body weight and measured in grams.
The Code of Federal Regulations requires that the suitability of a donor for source plasma be determined by a qualified, licensed physician or by persons under the physicians supervision who are specifically trained in determining donor suitability. To donate, one must have a normal temperature, blood pressure within normal limits, and pulse rate within normal limits. The donor’s hematocrit value must be 38 percent to 54 percent. Their total protein reading must be within 6.0 to 9.0.
The first-time donor undergoes a lengthy screening process. The donor must have a photo ID with a physical description and a piece of mail they have received in the last thirty days to verify residency requirements (within 120 miles of donation center). This mail must be a telephone bill, light bill, etc. No junk mail can be accepted. Whether or not the donor has donated elsewhere, area centers are contacted to determine if the donor has been previously rejected or deferred. The donor is also verified through the National Donor Deferral Registry (NDDR). This nation-wide system lists donors who have tested positive for tested diseases and who have been permanently deferred.
The donor is required to pass a quiz about the facts of HIV and AIDS. They are also questioned as to whether they have participated in high-risk behavior. High-risk behavior includes IV drug use, homosexual sex, and sex with prostitutes. Any person who answers yes to these questions is permanently deferred. In addition, they are asked of any body piercing, tattoos, or if they have spent more than 72 hours in jail in the past twelve months. Any person who answers yes is deferred for twelve months. Any person who has received blood transfusions or blood products is also deferred for twelve months.
Donors are given a physical on their first donation and annually. This includes a urinalysis to determine whether glucose or proteins are present in the urine. The vital signs must me within normal limits. The hematocrit and total protein must be within acceptable ranges. There are several steps in which high risk activity is determined. Many of the questions are repeated throughout the phase by the different screening personnel. The donor may answer negative to the first screener, but in a change of setting may answer affirmative to the second screener. This process is used to ensure donor suitability and help ensure product safety.
The physical examination includes checking the pupils for proper response to light. Ears are checked for infection. Lymph nodes are checked for swelling. The donor’s mouth is checked for abnormalities and needle marks. Under the tongue is an area carefully scrutinized because this is an area especially preferred by drug users for injection.
The lung sounds are checked to determine if there is wheezing or congestion. The heart is osculated to determine no murmurs are present. The abdomen is palpated for masses. The donor is also checked for an enlarged liver (possible hepatitis). The kidneys are "bumped" to check for pain or sensitivity associated with a possible kidney infection.
The reflexes are checked to determine any possible neuro deficit. The extremities are checked for any tremors or shaking. The lower legs are checked for edema or swelling which could indicate heart problems. The backs of the thighs are checked for needle marks and red or purple spots. The spots could be Kaposis Sarcoma, which is a sign of HIV. The donor is also required to remove their shoes and socks. The foot is checked for needle marks with special attention to areas between the toes. This is another area IV drug users like to shoot up in.
There are lab tests performed every donation. These include Hepatitis (Hepatitis B surface Antigen-HbsAg, and the Antibody to Hepatitis C-antiHCV). Tests for HIV include HIV1, HIV2Combs Test, and HIVP24 for antibody to Human Immunodeficiency Virus. Tests for Hepatitis B antibodies are often done. A serologic test for syphilis and a serum protein electrophoresis (this measures the five major proteins in the body) are done on the first donation and every four months thereafter.
If a test shows positive, the unit of plasma must be destroyed. The donor is counciled on whatever test showed positive and referred to their personal physician or local health department. The donor is reminded that all tests can have false positives (this means that the individual’s blood contains or reacts to antibodies of whatever virus, even though that is not the case). Regardless of a false positive, the donor is permanently deferred and entered into the NDDR.
If active (regular) donor tests positive for anything tested for, a look back is required. Records of every donation must be kept for a minimum of ten years. The information of the positive test result is sent to whatever institution received the donor’s plasma. This allows for product recall, notification, etc. This is as added safety feature.
While rare, there are possible side effects of donating plasma. These include infection of the phlebotomy sight. There is the possibility of nausea and vomiting, convulsions, light-headedness and/ or fainting. Although rare, some individuals may experience allergic reactions such as flushing, hives, abdominal cramps, difficulty breathing, chest pain, and /or bronchospasm which could be life threatening.
Plasma helps burn victims, trauma victims, and even hemophiliacs. Plasma is used for transfusions and to make many other products. Some is used to make medicines, laboratory controls, and vaccines. Rabies series is made from plasma from donors who receive injections of the modified rabies virus. Plasma is also used in products including cosmetics. Whatever it is used for, plasma donors are invaluable.
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