Whole Blood Collection

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Whole Blood Collection

• SLML014E
• 012008

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Donor Categories

• Allogeneic donors
• Autologous donors
• Directed donors
• Designated donors
• Hemapheresis
• Platelet Apheresis
• Plasma Pheresis

ELO A
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DONOR CATEGORIES

• Allogeneic
• Unpaid
• Voluntary donors
• Blood can be transfused to the general population

ELO A
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DONOR CATEGORIES

• Autologous
• For donors own use
• Procedure done prior to operation
• Directed donors
• Recipients choose their donors

ELO A
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DONOR CATEGORIES

• Designated donors
• Blood or blood components from a specific donor
• Used for a specific patient
• Used patients have multiple antibodies and need
  antigen compatible blood or blood products

ELO A
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DONOR CATEGORIES

• Hemapheresis
• Removal of whole blood and it is separated into
  components
• One or more components retained
• Unused components are returned
• Two types
• Platelet Apheresis
• Plasma Pheresis

ELO A
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DONOR CATEGORIES

• Hemapheresis
• Platelet Apheresis
• Removal of donors platelets
• Return of their cellular and plasma components
• Plasma Pheresis
• Removal of patients plasma and return of the
  remaining cellular components
• Crystalloid given back as replacement fluid
• Used to treat TTP

ELO A
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Donor Registration

• DD Form 572
• Record of Donation
• Valid photo ID required
• Information obtained must fully identify link
  to previous records

ELO B
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Donor Registration

• DD Form 572 Required information
• Date and time of donation
• Donor Family Member Prefix and SSN
• Name/Grade/Rank
• Date of Birth
• Donor Category

ELO B
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Donor Registration

• DD Form 572 (cont)
• Address
• Phone Number
• Organization/Station
• Gender
• Age 17 or older

ELO B
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Donor Registration

• DD Form 572 (cont)
• Check Deferral Registry for previous deferrals
• Document that it was checked
• Ideally, identify currently deferred persons
  before a unit of blood is drawn
• However, MUST identify deferrals before unit is
  released for manufacturing

ELO B
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Donor Registration

• Other useful information
• Race Phenotype Specific
• Unique characteristics
• Seroneative for CMV
• Group O, Rh negative
• Date of last donation - must wait 56 days between
  donations

ELO B
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Information Given to Donor

• Education materials on signs and symptoms of
  HIV/AIDS
• High-risk activities for HIV transmission
• Information about all the tests to be performed
  on the blood
• Risks of the donation procedure and post
  phlebotomy care

ELO C
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AIDS

• Symptoms of AIDS
• Unexplained weight lose, gt10 lbs
• Night sweats
• Blue/purple spots (Kaposis sarcoma)
• White spots in the mouth
• Temp. gt100.5ºF more than 10 days
• Persistent cough and/or diarrhea

ELO D
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CHECK ON LEARNING

• Which donor category chooses their donor for
  transfusion?
• Directed donor

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CHECK ON LEARNING

• Describe platelet apheresis and which donor
  category does it fall under?
• Removal of donors platelets and return of their
  cellular and plasma components
• Hemapheresis

17
CHECK ON LEARNING

• What is the minimum age of a donor?
• 17 and older, unless written permission is given
  from a parent or legal guardian

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CHECK ON LEARNING

• Name four symptoms of AIDS?
• Unexplained weight loss gt10 lbs and night sweats
• Kaposis sarcoma
• Swollen lymph nodes gt1 month
• Temp gt100.5 for gt10 days
• Persistent cough, shortness of breath and
  diarrhea
• Persistent white spots or unusual blemishes in
  the mouth

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Allogeneic Donor Selection

• Based on medical history and a limited physical
  exam
• Serves two purposes
• Donating blood wont harm donor
• Blood wont be harmful to the recipient (patient)

• Screening is done in private

ELO E
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Donor Medical History

• Use most recent DOD approved uniform donor
  history questionnaire (DD572 Blood Donor Card)
• Written and Verbal screening questions are
  intended to identify risk factors for exposure to
  transfusion-transmissible diseases (TTDs)
• Tests not available for all pathogens

ELO F
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Donor Medical History

• Standardized DOD Lists for
• Medications
• Medical Conditions
• Vaccinations
• Foreign Countries
• Defer if unacceptable (the length of time is
  directed in the list)

ELO F
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Donor Medical History

• Document any medication use
• Certain meds. affect platelet function
• Aspirin/ASA and Feldene
• If taken within last 72 hours
• Defer if platelet apheresis donor

• Identify random donor platelet units so that it
  is not the sole source of platelet used for
  transfusion (i.e. used to transfuse infants)

ELO F
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DONOR PHYSICAL EXAM

• Weight
• No more than 15 of the donors blood volume may
  be removed at one time
• This includes samples drawn for testing

ELO G
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DONOR PHYSICAL EXAM

• Weight
• 110 lbs may donate a max of 525 mLs (450 45
  mL whole blood plus 30 mLs for testing)
• For 500 mL blood bags (used for the frozen blood
  program), the donor must weigh 121.5 lbs to
  allow for 450-550 mLs of whole blood plus 30 mL
  of pilot tubes

ELO G
25
Donor Physical Examination

• Temperature must be less than or equal to
  37.5C (99.5F)
• General appearance acceptable

ELO G
26
Donor Physical Examination

• Pulse between 50-100 bpm
• can be lower if donor is athletic

• Blood Pressure Maximum Levels
• Systolic 180 mmHg
• Diastolic 100 mmHg
• If normal while taking medication, accept donor

ELO G
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Donor Physical Examination

• Arm Inspection
• Suitable vein
• Skin lesions
• Possible drug use
• Days Between Donation
• Must be at least 56 days
• The Hemoglobin or Hematocrit must be measured

ELO G
28
HEMOGLOBIN TESTING
Copper Sulfate is the primary method used for
allogeneic donor Hgb testing. If the blood drop
falls within 15 seconds the specific gravity of
the donors blood is higher than the copper
sulfate which corresponds to a acceptable Hgb
level.
ELO G
29
HEMOGLOBIN TESTING
The HemoCue is an alternate method used for
hemoglobin testing for allogeneic donors. It is
also used for autologous donors as well.
ELO G
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HEMATOCRIT TESTING

• The Hematocrit is measured as an alternative to
  Hemoglobin testing
• Or used to verify borderline low hemoglobin
  levels (donor may be acceptable)

ELO G
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Donor Physical Examination

• Minimal Acceptable HH Levels

ELO G
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Donor Physical Examination

• Written Consent signs the donor card
• Allows blood bank to collect and use blood for
  transfusion
• Part of donor record
• Must be completed prior to collection of blood

ELO G
33
CHECK ON LEARNING

• What are the two purposes of the interview in
  allogeneic donor selection?
• Determine whether giving blood will harm the
  donor or if the blood will be harmful to the
  recipient

34
CHECK ON LEARNING

• Can a person that ingested aspirin within the
  last 72 hours donate?
• Yes, but their blood is not made into the sole
  source of platelet products

35
CHECK ON LEARNING

• What is the specific gravity of the copper
  sulfate and acceptable Hgb levels for allogeneic
  and autologous donors?
• 1.053 specific gravity and 12.5 g/dl Hgb
  (allogeneic) and 1.049 specific gravity and 11.0
  g/dl (autologous)

36
CHECK ON LEARNING

• How much must a donor weigh if a 500 mL blood bag
  is used for whole blood collection?
• 121.5 lbs

37
COLLECTION OF BLOOD
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PHLEBOTOMISTSS DUTIES

• Trained professionals
• Use aseptic methods
• Use New container for every donor venipuncture
  (even if have to redraw because missed stick)

ELO H
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PHLEBOTOMISTSS DUTIES

• Blood bags
• Must be an FDA approved sterile pyrogen free bag
  with sufficient anticoagulant
• The amount and type of anticoagulant must be
  labeled on the bag (63 mL for 450 mL bag)

ELO H
41
IDENTIFICATION OF WHOLE BLOOD UNITS
ELO H

• Check integrally attached tubing and needle

Donor Labels
Pilot Tubes
Component bag
Component bag
Collection bag with anticoagulant
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PHLEBOTOMISTS DUTIES

• ID of whole blood units
• ID is critical in each step
• Use numeric or alphanumeric system used that
  identifies and relates to
• The source donor, the donor record, the specimens
  for testing, the collection bag, and components
  prepared from the unit
• ISBT labels are now used throughout the world so
  that all blood products are labeled the same

ELO H
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PHLEBOTOMISTS DUTIES

• ID of whole blood units
• Use extreme caution to avoid mix-up or
  duplication
• NEVER remove or obscure identification from a
  blood product once it has been assigned

ELO H
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PHLEBOTOMISTS DUTIES

• Before collection
• Confirm the donors identity
• Ensure testing tubes have same donor numbers as
  whole blood collection bag and donor card
• The above things are done BEFORE sticking the
  donor

ELO H
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PREPARING THE VENIPUNCTURE SITE

• Select the vein
• Draw from large vein
• Area should be free of lesions
• Inflate BP cuff to 40-60 mmHg to make vein more
  prominent
• Once vein selected release BP cuff

ELO I
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PREPARING THE VENIPUNCTURE SITE

• Select the vein
• Draw from large vein
• Area should be free of lesions
• Inflate BP cuff to 40-60 mmHg to make vein more
  prominent
• Once vein selected release BP cuff

ELO I
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PREPARING THE VENIPUNCTURE SITE

• Prepare the site
• Vigorously Scrub venipuncture area at least 4 cm
  (1.5 inches) in all directions from the intended
  site of venipuncture (3 inch diameter) for
  minimum of 30 seconds with a 0.7 aqueous scrub
  solution of iodophor compound

ELO I
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PREPARING THE VENIPUNCTURE SITE

• Prepare the site
• Apply iodine swab solution
• Start at the intended site of venipuncture and
  move outward in a concentric spiral,
• Do not go over the same area more than once

ELO I
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PREPARING THE VENIPUNCTURE SITE

• Prepare the site
• Let the area stand for 30 seconds
• Cover the area with dry, sterile gauze until the
  time of venipuncture
• Do not repalpate the vein

ELO I
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PREPARING THE VENIPUNCTURE SITE

• Prepare the site
• If donor is allergic to shellfish or iodine use
  ChloraPrep swabs containing 2 chlorhexidine and
  70 isopropyl alcohol
• Do not use Green soap

ELO I
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Hang bag below the donor on a scale
• Clamp the tubing with a hemostat
• Reapply B.P. cuff
• Remove needle cover

ELO J
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Pull the donors skin taut over the site
• Perform venipuncture with bevel up

ELO J
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Release the hemostats from the tubing and allow
  the blood to flow into the bag

• Instruct donor to squeeze fist every 10-12 seconds

ELO J
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Secure the needle with tape and cover with
  sterile gauze
• During collection mix the blood with
  anticoagulant to prevent clots from forming in
  the bag

ELO J
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AUTOMATED BLOOD MIXER
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Clamp off tubing with hemostat when appropriate
  amount is collected (trip scale goes off)

ELO J
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Fill pilot tubes and deflate B.P. cuff
• Record the start and stop times for performing
  the procedure (must be 15 minutes to make
  platelets)

ELO J
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Remove the needle and instruct donor to elevate
  his/her arm without bending the elbow

• Apply firm pressure to the site
• Detach needle from the tubing and dispose of
  properly

ELO J
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PHLEBOTOMY COLLECTION OF PILOT TESTING SAMPLES

• Bandage puncture site
• Strip the whole blood in the integral tube line
  back into the whole blood bag (three times)
• Recheck all identification numbers on the unit,
  tubes, and donor card
• Send unit, tubes and donor card to initial
  processing area

ELO J
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Check On Learning

• How is the venipuncture site prepared for
  donation?

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ANSWER

• Vigorously scrub the area at least 4 cm in all
  directions from the intended site of venipuncture
  (3 inch diameter) for a minimum of 30 seconds
  with a 0.7 aqueous scrub solution of iodophor
  compound

63
CHECK ON LEARNING

• How are mix-ups avoiding in the identification of
  whole blood units?
• Check ID numbers at each step
• Ensure numbers match the source, record,
  specimens, collection bag, and components

64
CHECK ON LEARNING

• Is it acceptable to use Green Soap to prepare a
  phlebotomy site?
• NO

65
CARE OF THE DONOR AFTER PHLEBOTOMY

• Have donor remain reclining for observation
• Allow the donor to sit up slowly
• Give donor post phlebotomy care instructions
• Thank the donor for their donation

ELO J
66
CARE OF THE DONOR AFTER PHLEBOTOMY

• Note any adverse reactions and corrective actions
  taken on donor card
• A staff member is stationed in the refreshment
  area for continued monitoring of donors ( 10 min)

• Juice and cookies help increase the donors fluid
  and glucose levels

ELO J
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ADVERSE DONOR REACTIONS

• Blood Bank physician must provide written
  instructions for handling donor reactions
• Adverse reactions occur occasionally
• Personnel must be trained to recognize and
  provide initial treatment to include CPR

ELO K
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ADVERSE DONOR REACTIONS

• General Instructions
• For moderate or severe reactions, remove the
  tourniquet and withdraw the needle
• If possible move the donor to a private area

ELO K
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ADVERSE DONOR REACTIONS

• General Instructions
• Apply the specific measure for the reaction type
• If they do not lead to rapid recovery, call the
  blood bank physician
• Record nature and treatment of the reaction on
  the donor record or adverse event form

ELO K
70
ADVERSE DONOR REACTIONS

• Class interaction activity
• Identify the signs/symptoms of each donor
  category
• Identify the treatment for each category

ELO K
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ADVERSE DONOR REACTIONS

• Slight reaction
• Most common type
• Signs/Symptoms?
• Treatment?

ELO K
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ADVERSE DONOR REACTIONS

• Moderate reaction
• Hematoma
• Treatment?

ELO K
73
ADVERSE DONOR REACTIONS

• Moderate reaction
• Fainting/Syncope
• Vasovagal means what?
• Prevention?
• Treatment?

ELO K
74
ADVERSE DONOR REACTIONS

• Moderate reaction
• Nausea with vomiting
• Treatment?

ELO K
75
ADVERSE DONOR REACTIONS

• Moderate reaction
• Twitching or spasms
• Signs/Symptoms?
• Treatment?
• Hemapheresis and Citrate Toxicity how to treat?

ELO K
76
ADVERSE DONOR REACTIONS

• Severe reaction
• Convulsions
• Signs/Symptoms?
• Treatment?

ELO K
77
ADVERSE DONOR REACTIONS

• Severe reaction
• Cardiac Arrest
• Treatment?

ELO K
78
CHECK ON LEARNING

• What are the different categories of donor
  reactions?
• Slight
• Moderate
• Severe

79
INITIAL UNIT PROCESSING

• Unit, blood testing samples, and donor card must
  be rechecked to ensure all label numbers match
• Strip the integral donor tubing two more times to
  ensure well mixed with anticoagulated blood from
  primary bag

ELO L
80
INITIAL UNIT PROCESSING

• Heat seal integral tubing at marked points (X)
  to create segments that can be used by
  transfusion service for compatibility testing

ELO L
81
INITIAL UNIT PROCESSING

• Weigh Units of blood
• Acceptable bag weight
• Weight of empty blood bag with anticoagulant and
  satellite bags plus volume of blood converted
  into grams
• Determine
• Maximum acceptable gram limit
• Minimum acceptable gram limit

ELO L
82
INITIAL UNIT PROCESSING

• Ratio of Blood to Anticoagulant is critical to
  prevent clots in units
• Destroy (Record Destruction)
• Underfills below acceptable weight
• Overfills above acceptable weight
• Donor testing will still be completed and
  notification of any abnormal results

ELO L
83
INITIAL UNIT PROCESSING

• Place blood in temporary storage container having
  sufficient refrigeration capacity to cool the
  blood continuously toward a1 - 6C range, unless
  platelets are to be prepared

• Transport blood and tubes to Component Processing
  Lab

ELO L
84
CHECK ON LEARNING

• What is performed on the blood during initial
  processing?
• Check Labels
• Strip 2 more times
• Weigh blood destroy under and overfills
• Transport blood samples to Component Lab

85
DONOR UNIT TESTING

• AABB and FDA requires all donor units be fully
  tested prior to label and release for transfusion
• Reagents used must meet or exceed FDA regulations

ELO M
86
DONOR UNIT TESTING

• Carefully document each step
• Meticulous records must be kept for every
  component tested
• There must be a mechanism for the removal of
  reactive units from the inventory

ELO M
87
DONOR UNIT TESTING

• ABO
• Perform front and back type using appropriate
  reagents
• Reverse and forward group must agree
• Compare ABO to previous donations
• Resolve discrepancies

ELO M
88
DONOR UNIT TESTING

• Rh
• Units found to be D negative at initial spin must
  be tested for weak D
• Weak D cells may suffer accelerated destruction
  if introduced into the circulation of a recipient
  whose serum already contains anti-D

ELO M
89
DONOR UNIT TESTING

• Rh Labeling of blood
• Weak D is positive, label the blood as Rh
  Positive
• Weak D negative, label the blood as Rh Negative

ELO M
90
DONOR UNIT TESTING

• Antibody Screen
• Must demonstrate clinically significant
  antibodies (37C and AHG phases)
• Whole blood that screens positive must be labeled
  with the antibody identified

ELO M
91
DONOR UNIT TESTING

• Infectious disease testing
• Done to protect the recipient
• Samples that are initially reactive must be
  repeat tested in duplicate
• Destroy repeatedly reactive units and send to
  reference lab for confirmation testing

ELO M
92
DONOR UNIT TESTING

• Infectious disease testing
• Screening tests can be false negative due to
  donors in early incubation phase of the infection
  may not have produced antibodies yet (window
  period)

ELO M
93
DONOR UNIT TESTING

• Required Infectious disease testing
• Hepatitis B Surface Antigen
• Hepatitis B Core Antibody
• Hepatitis C Virus Antibody
• Long window period
• Seroconversion can take 6 -12 months

ELO M
94
DONOR UNIT TESTING

• Required Infectious disease testing
• Human T-cell Lymphotropic Virus types 1 and 2
  Antibody
• Human Immunodieficiency Virus types 1 and 2
  Antibody
• Serologic test for syphilis

ELO M
95
DONOR UNIT TESTING

• Required Infectious disease testing
• Nucleic Acid Amplification Test direct RNA test
  for HIV, HCV, WNV, and soon HBV

ELO M
96
CHECK ON LEARNING

• In what phases do clinically significant
  antibodies normally react?
• 37ºC and AHG

97
CHECK ON LEARNING

• Donor blood that tests Weak D positive is labeled
  as what?
• Rh Positive

98
AUTOLOGOUS BLOOD DONATIONS

• Donation of any blood component that was donated
  for the intended recipient for their own surgery
• Recipient receives the safest blood possible
  since the risks of transfusion transmitted
  infection or alloimmunization are eliminated

ELO N
99
AUTOLOGOUS BLOOD DONATIONS

• Advantages
• Prevents transfusion transmitted disease and red
  cell alloimmunization
• Does not take away form allogeneic blood supply
• Provides compatible blood for patients with
  alloantibodies
• Provides reassurance to patients concerned about
  blood risks

ELO N
100
AUTOLOGOUS BLOOD DONATIONS

• Disadvantages
• Does not change the risk of bacterial
  contamination or ABO incompatibility
• More costly than allogeneic collection
• Wastage of blood when not transfused
• Subjects patients to perioperative anemia

ELO N
101
AUTOLOGOUS BLOOD DONATIONS

• Physician Responsibility
• Patients who do not meet the criteria for
  acceptable autologous donation may request
  special permission to enter the program
• The Blood Bank physician is ultimately
  responsible for accepting a donor

ELO N
102
CRITERIA FOR AUTOLOGOUS DONATION

• No minimum weight requirements
• If donor weighs lt 110 lbs. the 63mL anticoagulant
  must be readjusted for lower blood collection
  volume
• 300-405 ML of whole blood may be drawn
• Cannot make platelets or plasma
• Label Cells as Low Volume Unit

ELO O
103
CRITERIA FOR AUTOLOGOUS DONATION

• No age limits
• B.P. can be waived by Medical Director
• Temperature same as allogeneic
• Hgb 11.0 g/L or 33 HCT (can be waived in
  extreme circumstances)

ELO O
104
CRITERIA FOR AUTOLOGOUS DONATION

• Frequency of donation
• No more than every 3 days
• Last phlebotomy should be at least 72 hours
  before an operation

ELO O
105
CRITERIA FOR AUTOLOGOUS DONATION

• Iron supplements
• Each donation depletes the body of 200mg of iron
• Iron supplements may be necessary to replenish
  iron reserves for frequent autologous donors

ELO O
106
AUTOLOGOUS DONOR BLOOD TESTING

• Minimum testing requirements
• ABO/Rh
• Antibody screen
• If blood is to be shipped outside the collecting
  facility for transfusion, perform all the same
  serological tests as with allogeneic donors

ELO P
107
AUTOLOGOUS DONOR BLOOD TESTING

• Receiving facility must accept, in writing,
  autologous units that test positive for HBc,
  HTLV-I/II and syphilis
• Destroy units that tests positive for HIV, HCV,
  HBsAg and defer donor form further autologous
  donations

ELO P
108
LABELING AND STORAGE OF AUTOLOGOUS BLOOD

• Each unit is assigned a unique identification
  number
• FOR AUTOLOGOUS USE ONLY sticker
• Donor FMP/SSN
• ABO/Rh
• Collection location (hospital) and date
• Patient ID

ELO Q
109
LABELING AND STORAGE OF AUTOLOGOUS BLOOD
ELO Q
110
TRANSFUSING AUTOLOGOUS BLOOD

• Must ID intended recipient as the donor
• Treat recipients in the same manner as allogeneic
  recipients
• Test ABO/Rh, Antibody screen, crossmatch
• If transfusing facility did not draw the unit,
  they must reconfirm ABO/Rh
• Records of transfusion and adverse reactions must
  be maintained

ELO R
111
CHECK ON LEARNING

• If a potential autologous donor has a temperature
  of 99.7F can the medical director or blood bank
  physician waive this criteria?
• NO

112
CHECK ON LEARNING

• What are the minimum test requirements for
  autologous units?
• ABO/Rh
• Antibody screen

113
CHECK ON LEARNING

• How does autologous blood labeling differ from
  allogeneic?
• FOR AUTOLOGOUS USE ONLY label

114
DIRECTED DONATIONS

• Allows patient to choose their donor
• Same history and screening criteria as allogeneic
  donors
• Donor must be serologically compatible

ELO S
115
DIRECTED DONATIONS

• Patients and their physicians will not be
  informed which donors are ineligible and why
  (privacy considerations)
• Normally not allowed by DoD because donors may
  feel compelled to help family member and might
  lie about risk factors

ELO S
116
DIRECTED DONATIONS

• Ineligible Directed Donors
• Husband to Wife of Childbearing Age
• Father to Infant Diagnosed with HDFN

ELO S
117
PLATELET APHERESIS

• Done with automated cell separation devices
• Involves removal of blood from a donor,
  processing blood into separate cellular elements,
  collecting the platelet product, and returning
  the unharvested portion (blood and plasma)

ELO T
118
PLATELET APHERESIS

• Same standards as allogeneic Except
• Plt count must be 150,000/uL
• Donation period once every 2 days per 7 day
  period, not to exceed 24 donations per year
• 72 hour deferral after ingesting of aspirin
  medications

ELO T
119
THERAPEUTIC PHLEBOTOMY

• Removal of patients own red cells as treatment
  of a medical condition
• Polycythemia
• Hemochromacytosis

ELO U
120
THERAPEUTIC PHLEBOTOMY

• Polycythemia
• Patients HCT above 50
• Phlebotomy reduces blood viscosity which
  facilitates organ perfusion and decreases the
  probability of thrombosis or stroke

ELO U
121
THERAPEUTIC PHLEBOTOMY

• Hemochromacytosis
• Phlebotomy reduces Hgb with patients with iron
  overload to prevent iron-associated organ damage

ELO U
122
THERAPEUTIC PHLEBOTOMY

• Physician must prescribe the phlebotomy
• Whole blood is removed to the desired Hgb or HCT
  level

ELO U
123
CHECK ON LEARNING

• What is the acceptable criteria for a directed
  donor ?
• Same as allogeneic and be serologically compatible

124
CHECK ON LEARNING

• What is the minimum platelet count for a Platelet
  Pheresis donor?
• 150,000/uL

125
CHECK ON LEARNING

• Why a therapeutic phlebotomies performed?
• Medical reasons

126
DEFFERAL CRITERIA

• Review DoD Criteria Lists
• Drugs and Medications
• Medical Conditions
• Vaccinations
• Countries Traveled
• Know the requirements for the items identified
  with an

ELO V
127

• QUESTIONS??