Enforcing Good Manufacturing Process Through A Dedicated Blood Bank Software

Blood components are a drug and like medications must be consistently produced and follow Good Manufacturing Practices GMP.  The following system that I set up for HMC Doha Qatar blood collection and processing is an example of the impact of Medinfo donor software on enhancing our safety and GMP compliance.  In earlier posts, I provided the Medinfo flowcharts for these processes.

This is an outline of the processes I built in conjunction with the Medinfo software engineers:

1. Registration:
   1. Read the barcode on the specified picture ID (usually a Qatar Residency/Citizen card).
      1. Retrieve the prospective donor’s demographics in English and Arabic from the Ministry of Interior.
      2. Check the donor deferral database (Qatar has only one), defer if contraindicated according to the rules built into Medinfo.
   2. Choose the type of donation (apheresis or whole blood;  volunteer, directed, or autologous).
   3. Print a consent form and ISBT specimen labels for the donation.
2. Pre-Collection Screening:
   1. Perform the donor questionnaire on-line in English or Arabic:  this has contingent fields and could exceed 60 questions depending on the answers provided.
   2. Proceed to donor physical exam (vital signs and arm check).
3. Collection:
   1. Collect the whole blood or apheresis component and specimen tubes:  determine if the collection meets the volume requirement and time limit.
   2. Send the specimens for donor marker and donor immunohematology testing.
   3. Send the raw components for processing.
4. Donor Marker Testing:
   1. Perform NAT, EIA, and LIA marker testing according to algorithms defined in Medinfo.
   2. Perform follow-up reflex marker testing according to Medinfo criteria.
5. Component Processing:
   1. Process the raw whole blood in the Reveos machine into PRBCs, leukodepleted plasma, and buffy coat platelets.
   2. Filter/leukodeplete the RBCs.
   3. If marker test results pass:
      1. Pool the buffy coat platelets according to the platelet yield index for a yield of 2.4E11/dose.
      2. Add platelet additive solution PAS and pathogen inactivate (Mirasol).
      3. Pathogen inactivate the whole-blood-derived plasma.
      4. Divide the apheresis plasma into 200-250 ml aliquots and pathogen inactivate.
   4. Divide the apheresis platelets to provide a yield of 2.4E11 in each dose, then pathogen-inactivate (PAS had been added at the time of the apheresis collection).
6. Donor Immunohematology Testing:
   1. Perform ABO/D testing and antibody screen (identification if positive):
   2. If antibody screening positive, discard the component.
      1. If ABO discrepancy, send for manual review and approval, otherwise discard.
7. Labelling, Storage, and Transfer:
   1. If all criteria were met, attach the final ISBT label (this can only be printed based on the acceptance of each component).
   2. Place the components into storage (37C, 1-6C, or <= minus 18C).
   3. Distribute to the hospital blood banks using Inter-Depot Transfer function.

I emphasize that only if all criteria across all areas pass is the final ISBT label printed.  Medinfo is not a label printing program.  It enforces the rules ruthlessly.  My technical staff tell me that it is merciless—as it should be for patient safety.

Attachments:  None—please refer to earlier posts regarding collection, processing, donor testing, and inter-depot transfer.

28/6/20