The easy-to-use format presents comprehensive disease information ranging from causes, signs and symptoms, and diagnosis through treatment and special considerations. Helpful tips, charts, anatomic drawings, and other illustrations supplement the text. This edition includes expanded information on obesity treatments and differential diagnosis algorithms for difficult-to-diagnose problems.
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Buy with confidence, excellent customer service!. However, currently, the questionnaire is the only means of excluding donors with a risk of Creutzfeldt—Jakob disease CJD , variant CJD, Ebola virus, malaria, Zika virus, babesiosis or leishmaniasis.
Testing is not performed for these agents. Selective testing is performed for Chagas disease, on donors identified as being at risk based on the questionnaire.
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Selective testing is also performed for West Nile Virus WNV during the winter months on donors identified as being at risk based on the questionnaire. Donors are also asked about travel outside of Canada, the continental US and Europe, and deferred for three weeks after their return to reduce the risk of transmission of Zika virus.
In addition, individuals taking teratogenic medications are identified and excluded from donation. Depending on the magnitude of the risk, donors may be deferred temporarily or indefinitely. For example, currently, people who have taken illegal drugs by injection are indefinitely deferred, while travellers to a region where malaria is considered endemic are deferred from donation of cellular blood components for one year.
For younger donors, more stringent height and weight criteria may apply. It is estimated that less than four in eligible Canadians donate blood each year. The average donor donates slightly less than twice a year.
Over one-third of deferrals are due to inadequate hemoglobin levels. Based on studies of iron deficiency in blood donors, Canadian Blood Services recently revised its whole blood donor eligibility criteria. The minimum hemoglobin level was increased to g per litre for male donors; the minimum level remained at g per litre for female donors. For more information, see our publication The importance of iron for whole blood donors: a Canadian perspective. In addition, a screening test for hemoglobin level is done on a capillary blood sample. Both arms are examined for signs of injection intravenous drug use.
An alternative disinfection protocol is used for donors allergic to chlorhexidine. For more information read our publication Alternative methods of blood donor skin disinfection. Phlebotomy is performed using a sterile single-use kit that contains an anticoagulant nutritive solution. The time for phlebotomy varies from 10 to 15 minutes. Approximately ml of blood are collected per donation. The first few millilitres of blood are directed to a diversion pouch before filling the main collection bag. The diversion pouch has been shown to decrease the contamination of the collection bag with bacterial skin flora.
The blood in the diversion pouch is used for the serological and infectious disease testing performed on each unit of blood collected. The process for screening apheresis donations is very similar to the one for whole blood donation. Several additional criteria are present to ensure the safety of the donor and the quality of the blood product.
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Plateletpheresis donors must have a platelet count of x 10 9 per litre prior to undergoing each procedure. Plateletpheresis may be performed every 14 days for a maximum of 24 donations in a calendar year. Depending on donor characteristics, such as initial platelet count and blood volume, each plateletpheresis donation may yield single or multiple platelet units, or both platelet and plasma products.
Donors may make weekly plasmapheresis donations. Multiple screening tests are performed on each donation to detect the presence of transfusion-transmissible infectious agents. The screening tests performed may detect antigens, antibodies or nucleic acids of the infectious agents. Table 1 provides the screening and confirmatory tests performed at Canadian Blood Services. Antibody and antigen tests are done on individual donor samples while nucleic acid testing NAT is primarily done on pools of six samples.
Apart from detecting both lineages of WNV, the WNV assay will also react with other viruses in the Japanese encephalitis virus serocomplex including Japanese encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, and Kunjin virus. Testing for WNV is performed based on potential risk. However, during the winter months, from December 1 st to May 31 st , WNV testing is performed only on donors who are identified as being at-risk on the donor questionnaire because of travel outside of Canada in the eight weeks prior to their current donation.
Testing for antibodies to Trypanosoma cruzi Chagas disease is performed on donors identified as being at-risk on the donor questionnaire.
Donors are designated as at-risk if they, their mother or their maternal grandmother was born in Mexico, Central America or South America or if the donor has resided in these at-risk countries for a significant period of time. Testing for antibodies to cytomegalovirus CMV is performed on a small subset of donations to provide CMV-negative products only for fetuses receiving intrauterine transfusions.
For more information, see our publication Use of cytomegalovirus CMV seronegative blood products.
Table 1: Transfusion-transmissible disease testing at Canadian Blood Services. Donors who have initially reactive results on antigen or antibody testing have repeat testing performed twice on the same sample. If one of these two repeats is reactive, the donation is discarded, and additional testing is performed to determine the true status of the donor for donor notification and counselling.
For some markers, donors may return and be re-tested at least six months post-donation, and resume donation if test results are negative donor re-entry. Depending on the viral marker, inventory retrieval of blood products from previous donations and notification of the hospitals that received blood products from previous donations Iookback process may be performed.
For more information on this process see chapter 1 of this Guide. For WNV the reactive pool is resolved to the individual reactive specimen. Donors reactive on the multiplex screen test are indefinitely deferred, whereas donors reactive on the WNV screen test are deferred for 56 days. Because platelets are stored at room temperature for up to seven days, they are the blood product most likely to support bacterial growth. Confirmatory typing is done for first-time donors found to be Rh negative, and donors are tested for the presence of Rh D and weak D antigens. The Kell phenotype appears on the end label if the donor is antigen negative.
Testing is also performed for unexpected red blood cell antibodies. The methods used may be less sensitive than those required in pre-transfusion antibody detection. In recipient testing, a low level of antibody may be of clinical importance, since an anamnestic response may occur.
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In donor testing, only a small amount of passive antibody transfusion will occur and is generally clinically insignificant for red cell transfusion. Plasma and platelets are not produced from donations with red blood cell alloantibodies. This has led to a substantial inventory of red blood cell units end-labeled as negative for those antigens.
The number of donors tested depends on the antigen.