Free ASCP MLS Blood Banking Exam Mock Test – Part 62: Donor Screening and Blood Collection

• a) Hepatitis B immune globulin 2 months ago → Deferral (usually 12-month deferral after hepatitis B immune globulin).

• b) HIV prevention drugs 6 months ago → If referring to PrEP (pre-exposure prophylaxis) or PEP (post-exposure prophylaxis), current FDA guidelines (as of recent changes) may have a 3-month deferral from last dose; 6 months ago would be acceptable in some systems, but earlier rules had longer deferrals. However, newer FDA guidance (2020) removed deferral for PrEP/PEP, but some centers may still ask; but compared to others, this might be acceptable depending on interpretation.

• c) Blood transfusion 2 months ago → Deferral (wait 12 months after transfusion in the US).

• d) Travel to a malaria-endemic country 1 month ago → Deferral (3-month deferral after travel).

A recent vaccination typically results in a temporary deferral (the length depends on the type of vaccine) to avoid the risk of transmitting the live agent or because the donor might experience side effects that could be mistaken for a transfusion-related infection.

The other options are causes for permanent deferral:

• b) HIV infection

• c) Positive hepatitis B surface antigen

• d) Heart disease (depending on the severity and history, but significant heart disease is usually a permanent deferral)

A potential donor’s oral temperature must not exceed 37.5°C (99.5°F). An elevated temperature can be a sign of an underlying infection, which could pose a risk to both the donor’s well-being and the safety of the blood supply.

Donor deferral is the practice of determining that a potential donor is not eligible to give blood, either for a temporary period (e.g., due to recent travel, illness, or low hemoglobin) or permanently (e.g., due to certain medical conditions or risk factors for transfusion-transmitted diseases). The purpose is to protect both the donor’s health and the safety of the blood supply.

During blood collection, one of the main sources of bacterial contamination in platelet products is skin bacteria entering the collection bag at the start of donation.

To minimize this risk:

• The first 20–30 mL of blood collected is diverted into a diversion pouch.

• This diverts the initial flow of blood (which may contain skin contaminants) away from the main collection bag, greatly reducing bacterial contamination risk.

Other options:

• (a) Use of 18-gauge needle → helps ensure proper blood flow, but does not specifically prevent bacterial contamination.

• (c) Green soap scrub → inadequate; antisepsis requires povidone-iodine or chlorhexidine, not soap alone.

• (d) UV irradiation → sometimes used after collection for pathogen reduction, but not during collection.

 The pre-donation physical is a brief assessment to ensure the donor is in good health for the procedure. It includes:

• Temperature: To check for signs of infection.

• Pulse: To assess heart rate and rhythm.

• Blood pressure: To screen for hypotension or hypertension.

• Hemoglobin (or hematocrit): To ensure the donor is not anemic.

According to AABB Standards, the minimum hemoglobin (Hb) level for an autologous blood donor is 11.0 g/dL (hematocrit ≥ 33%).

This is lower than the requirement for allogeneic donors, where the minimum Hb is 12.5 g/dL (hematocrit ≥ 38%), because the blood will be returned to the same individual, not transfused to others.

When preparing leukocyte-reduced red blood cells (RBCs), the method used must retain at least 85% of the original red blood cells in the unit.

• This ensures that the therapeutic efficacy of the RBC transfusion is maintained after leukoreduction.

• Methods that reduce WBCs too aggressively and remove more than 15% of RBCs would not meet AABB quality standards.

 For allogeneic donations, FDA-required infectious disease testing using Nucleic Acid Testing (NAT) must be performed for HIV-1, HCV, and HBV (Hepatitis B Virus). NAT is used to directly detect the genetic material of the virus, shortening the “window period” before detection.

The other options are not routinely tested for with NAT:

• b) HTLV I/II: Screened using an antibody test, not NAT.

• c) Syphilis: Screened using a serological test (e.g., RPR).

• d) Cytomegalovirus (CMV): Not a required test for all donations. When performed, it is an antibody (serological) test to identify CMV-negative units.

• Whole blood collected in CPDA-1 can be safely stored at 1–6 °C for up to 35 days.

• The adenine in CPDA-1 helps maintain red cell ATP and viability throughout this period.

• Other anticoagulants have different storage limits:

  • CPD – 21 days

  • CP2D – 21 days

  • Additive solutions with AS-1, AS-3, AS-5 – up to 42 days

• Autologous donation is when a person donates blood for their own future transfusion, typically before a planned surgery.

• Benefits include:

  • Eliminating risk of transfusion-transmitted infections

  • Avoiding alloimmunization

• It is distinct from directed donations, which are for a specific other recipient, and from standard or platelet-only donations.

AABB Standards require that methods for preparing Leukocyte Reduced Red Blood Cells must be proven to retain at least 85% of the original red cells and reduce the leukocyte count to less than 5 × 10⁶ per unit. However, for a single unit, this correlates to a residual leukocyte count of less than 8.3 × 10⁵ per unit, which is the value typically listed as the quality control threshold for a single unit.

• b) <5.0 × 10⁶ is the standard for the total dose of whole blood-derived platelets.

• c) <5.5 × 10¹⁰ and d) <3.0 × 10¹¹ are not relevant to leukocyte reduction standards.

• Blood pressure limits for blood donation are set to ensure donor safety:

  • Systolic: 90–180 mmHg

  • Diastolic: 50–100 mmHg

• Donors below 90/50 mmHg may be at risk of hypotensive reactions.

• Donors above 180/100 mmHg may be at risk of cardiovascular complications.

• Exact 120/80 mmHg is ideal but not required; a safe range is acceptable.

• The standard interval between whole blood donations is 8 weeks (56 days).

• This allows the donor’s red blood cell mass and iron stores to recover sufficiently before the next donation.

• Shorter intervals (4–6 weeks) may be used in special cases or for platelet donations, but not for standard whole blood.

CPDA-1 is the most common anticoagulant-preservative solution used in collection bags for whole blood that will be processed into components like Red Blood Cells. It contains:

• Citrate: Anticoagulant (chelates calcium).

• Phosphate: Buffers pH.

• Dextrose: Nutrient for red cells.

• Adenine: Extends RBC shelf life to 35 days.

• a) Heparin: Used in some medical procedures but not for routine blood bank storage.

• b) EDTA: Used in small sample tubes for lab testing, not for blood collection for transfusion.

• d) Sodium citrate: Used in apheresis collections and plasma samples, but CPDA-1 is the standard for whole blood bags.

• Donors who have received a live attenuated vaccine (e.g., MMR, varicella, yellow fever) are temporarily deferred for 4 weeks.

• This precaution ensures:

  • Safety of the recipient, as live virus could theoretically be transmitted

  • Accurate donor screening, since mild post-vaccination symptoms may mimic infection

• Inactivated vaccines generally do not require deferral.

Pathogen reduction technology (PRT) is designed to inactivate a broad range of pathogens, including bacteria. Therefore, for platelet components that have undergone approved PRT, AABB Standards allow for the discontinuation of routine bacterial testing (culture-based testing).

The other options are still required:

• a) Hepatitis B virus NAT and c) West Nile virus NAT: PRT does not eliminate the requirement for mandatory infectious disease testing for HBV, HIV, HCV, etc., or for seasonal/residual NAT testing like WNV.

• d) ABO and Rh testing: This is always required for proper labeling and transfusion compatibility.

• HBsAg (Hepatitis B surface Antigen) positive → indicates current or chronic hepatitis B infection → permanent deferral.

• a) Tattoo 5 months previously → deferral is usually 3–12 months depending on whether it was done in a regulated facility (in many places now, if done in a licensed state-regulated facility, no deferral; if not, 12-month deferral). Not permanent.

• b) Recent close contact with a patient with viral hepatitis → temporary deferral (usually 12 months after last contact).

• c) 2 units of blood transfused 4 months previously → temporary deferral (12 months after transfusion).

According to AABB Standards, at least 75% of apheresis granulocyte units tested must contain a minimum of 1.0 × 10¹⁰ granulocytes. This is the quality control threshold to ensure the component is therapeutically effective.

This is the standard post-donation advice. Drinking fluids helps restore the plasma volume lost during donation. Avoiding strenuous activity for a few hours prevents dizziness or fainting and allows the body to recover.

• b) Taking antibiotics is unnecessary.

• c) Sleep is not specifically required.

• d) A cold compress is not standard; pressure is applied to the site to stop bleeding.

While c) 18 years is the minimum age in some countries (and the most common answer for a single choice), the AABB Standard in the U.S. allows 16-year-olds to donate with parental consent, and 17-year-olds are eligible. Many other countries also set the minimum at 16 or 17.

Since the question specifies “in most countries,” the most inclusive and accurate single answer from the options provided is 16–17 years, as this range covers the majority of minimum age requirements internationally

A 16-gauge needle is the standard for whole blood donation. It provides a large enough bore to allow for the rapid, smooth flow of blood (completing the donation in 5-10 minutes) while minimizing hemolysis (red cell damage) that can occur with smaller, higher-gauge needles.

• a) 14-gauge is larger than typically needed.

• c) 18-gauge and d) 20-gauge are smaller and would slow the collection, increasing the risk of clotting in the line.

The primary screening test for HIV in blood donors is an ELISA (Enzyme-Linked Immunosorbent Assay) or a similar immunoassay (like Chemiluminescent Immunoassay). These tests are highly sensitive for detecting HIV antibodies and antigens.

• a) Western blot: This is a confirmatory test, not the primary screening test.

• c) PCR only: Nucleic Acid Testing (NAT, which uses PCR) is used to directly detect the virus and shorten the window period, but it is used in conjunction with, not instead of, the initial immunoassay.

• d) Coombs test: This is for detecting antibodies coating red blood cells, not for HIV.

 Federal regulations (FDA) require all donor blood to be tested for syphilis (using a serological test), as well as for Hepatitis B, Hepatitis C, HIV, HTLV, and ABO/Rh.

The other tests are not universally required:

• a) Complete Rh phenotyping: Only ABO and Rh(D) typing are required.

• b) Anti-CMV testing: This is not a routine required test; CMV testing is only performed on specific units designated as “CMV negative.”

• c) Direct antiglobulin test (DAT): This is not a mandatory donor screening test. It is sometimes used to resolve serological problems but is not required for every donation.

Green soap is not an appropriate disinfectant for preparing the venipuncture site in blood donation. It is not effective in killing skin flora, which are the main source of bacterial contamination in platelet components.

Effective strategies to reduce bacterial contamination include:

• (b) Diverting the first 10–40 mL of blood → removes skin plugs and bacteria from the initial flow.

• (c) Performing culture-based bacterial detection on platelets → identifies contaminated units before transfusion.

• (d) Pathogen reduction technology (e.g., INTERCEPT™ or Mirasol™) → inactivates bacteria, viruses, and parasites.

Before blood donation, the venipuncture site must be thoroughly cleaned to minimize the risk of bacterial contamination of the blood unit.

Standard procedure:

• The site is disinfected using a two-step scrub technique:

  1. Scrub with 70% isopropyl alcohol to remove surface dirt and oils.

  2. Apply povidone-iodine (10%) in a concentric circular motion, allowing it to dry completely before venipuncture.

This combination provides broad-spectrum antiseptic action against bacteria, viruses, and fungi.

Other options:

• (a) Hypochlorite → used for disinfecting equipment or surfaces, not skin.

• (b) Green soap → used for general cleaning, not sufficient for asepsis in blood collection.

• (c) 10% acetone → harsh and not an antiseptic.

The primary reason is the window period—the time after a donor is infected but before a screening test can detect the infection (because markers like viral antigens or nucleic acids are still below detectable levels, or antibodies have not yet formed). During this window, an infected unit can test negative and be released for transfusion.

The other options, while potential failures, are not the primary reason:

• a) Pathogen reduction technology failure: Not all components undergo PRT; it’s not a universal primary cause.

• c) Leukocyte-reduction failure: This is for reducing white cell-related complications, not primarily for preventing most infectious transmissions.

• d) Donor history questionnaire not completed: This is a procedural error, but the core challenge is the biological window period.

Plasma from blood donations is screened for syphilis using non-treponemal tests like the Rapid Plasma Reagin (RPR) or Venereal Disease Research Laboratory (VDRL) test. These are serological tests that detect antibodies to substances released by damaged host cells, which are often present during a syphilis infection.

• b) ELISA is used for other infectious agents like HIV and Hepatitis.

• c) Coombs test is for detecting red blood cell antibodies.

• d) Western blot is a confirmatory test, not the primary screening method for syphilis in blood banks.

The minimum hemoglobin level for whole blood donation is 12.5 g/dL for both females and males, according to AABB standards. This is a change from the previous standard which was 12.5 g/dL for females and 13.0 g/dL for males.

The other options are incorrect:

• a) 10.0 g/dL and b) 11.0 g/dL are too low and would not be acceptable for donor safety.

• d) 13.5 g/dL is above the minimum requirement.

According to AABB and FDA requirements, all allogeneic blood donations must be tested for specific infectious disease markers to ensure transfusion safety.

Option analysis:

• (a)  Includes four key required agents.

• (b) Includes CMV and T. cruzi — CMV is not routinely tested for all donations.

• (c) Includes P. falciparum and Babesia — only regionally tested, not for all.

• (d) Dengue testing is not required for donor screening.

Red Blood Cells (including leukocyte-reduced units) must be stored at 1-6°C. However, during transport, a slightly wider temperature range of 1-10°C is permitted to account for potential temperature fluctuations while ensuring the unit remains within a safe, refrigerated range to maintain viability and prevent bacterial growth.

• a) 1-6°C is the strict storage temperature, not the allowable transport range.

• c) 18-20°C and d) 20-24°C are temperature ranges associated with platelet transport and storage, not Red Blood Cells.

• Directed donations are blood donations made specifically for a designated recipient, usually a family member or friend.

• They are not intended for the general blood supply.

• Directed donations can be whole blood or apheresis products.

• Donations for research or general supply are not considered directed donations.

• During blood donation, the collection bag is positioned below the donor’s arm to:

  • Use gravity to help blood flow from the vein into the bag

  • Maintain a steady flow rate without excessive suction

• This positioning does not affect sterility, oxygen saturation, or hemolysis directly.

Fainting (syncope) during or after blood donation is most commonly a vasovagal reaction. This is a reflex where the body overreacts to the stress of the procedure (e.g., fear, pain, sight of blood), leading to a sudden drop in heart rate and blood pressure, reducing blood flow to the brain and causing fainting. It is the most frequent type of donor reaction.

• Donors must have a platelet count of at least 150,000/µL before being accepted for plateletpheresis.

• This ensures that after donating, the donor’s platelet count remains at a safe level (usually above 100,000/µL post-donation).

In CPDA-1, adenine is the component that helps preserve red blood cell ATP (adenosine triphosphate) levels. ATP is the primary energy source for red cells, and maintaining adequate ATP levels is crucial for cell viability and membrane integrity during storage. Adenine is incorporated into ATP, extending the shelf life of Red Blood Cells to 35 days.

• a) Citrate is the anticoagulant.

• b) Dextrose provides energy for glycolysis.

• c) Phosphate acts as a buffer.

• b) –20°C is the correct storage temperature for Fresh Frozen Plasma (FFP). It must be stored at -18°C or colder to preserve labile coagulation factors.

The other options are incorrect:

• a) 4°C is the storage temperature for Red Blood Cells.

• c) –40°C is colder than required; while acceptable, -18°C to -20°C is the standard.

• d) 37°C is body temperature and is not a storage temperature for any blood component.

• Trypanosoma cruzi causes Chagas disease; a positive test leads to permanent deferral in most blood donor guidelines.

• Babesia infection (a) often leads to temporary, not always indefinite, deferral (though some centers defer indefinitely if confirmed).

• Residence in an endemic malaria region (b) typically leads to a 3-year deferral after leaving the area, not indefinite.

• Chicken pox vaccination (d) is not a cause for long-term deferral.

For a unit labeled “Leukocytes Reduced,” the FDA and AABB standards require that the label include the residual leukocyte count (e.g., <5 x 10^6) or a statement that it meets the standard for leukocyte reduction. This is a critical quality control step to ensure the component meets the specific criteria for being “leukocytes reduced.”

While the other options (b, c, d) are required on the label of any blood collection unit, they are not unique to the “Leukocytes Reduced” label. The known leukocyte count is the specific requirement for this particular component.

When a unit of Red Blood Cells (RBCs) is split into aliquots using a sterile connecting device (closed system), sterility is maintained. In a closed system, each aliquot retains the original unit’s expiration date.

• If a non-sterile (open) system were used, the aliquots would have a much shorter shelf life (typically 24 hours at 1–6 °C).

• Since this is a closed system, all 5 aliquots will still expire in 35 days, just like the original unit.

Platelets are very sensitive to temperature. When stored on a rotator outside a controlled storage unit (like on an open bench top), the ambient air temperature should be monitored and recorded at least every 4 hours to ensure the platelets remain within the safe storage range (20–24 °C with gentle agitation). This helps prevent loss of platelet function or bacterial growth.

• Proper donor identification and labeling is essential for traceability and safety. Labels on blood units must include:

  • Unique donor identification number

  • Collection date

  • Volume collected

  • Often also blood type (ABO/Rh) and component type

• Donor age, ABO alone, or technician name alone are insufficient for proper identification.

• After blood donation, the donor should be observed for at least 15 minutes to monitor for immediate adverse reactions, such as:

  • Vasovagal syncope

  • Dizziness or fainting

  • Bleeding or hematoma at the needle site

• This observation period helps ensure donor safety before they leave the donation area.

Donors who give two units of Apheresis Red Blood Cells (Double RBC donation) lose approximately twice the amount of red cells compared to a whole blood donation.

Incorrect options:

• (a) 8 weeks → for whole blood donation only.

• (b) 12 weeks → not standard for any donation type.

• (d) 24 weeks → longer than necessary.

To preserve labile coagulation factors (especially Factor V and Factor VIII), Fresh Frozen Plasma (FFP) must be frozen solid at -18°C or colder within 8 hours of the whole blood collection.

• a) Red Blood Cells: Typically prepared within 8 hours, but the critical time limit is for FFP and plasma-based components.

• c) Red Blood Cells, Frozen: This process involves adding a cryoprotectant and can be done later, after the RBC unit has been stored.

• d) Cryoprecipitated AHF: This is prepared from FFP, so it is indirectly subject to the 8-hour rule for the initial plasma freezing.

Screening for Hepatitis B in blood donors primarily includes:

• HBsAg (Hepatitis B surface Antigen): Indicates current infection.

• Anti-HBc (Antibody to Hepatitis B core antigen): Indicates past or ongoing infection.

The other options are incorrect:

• a) Anti-HCV is for Hepatitis C screening.

• c) Anti-HBs only shows immunity (from vaccination or past infection) but is not the primary screening test.

• d) ALT levels are no longer routinely used for donor screening.

The standard blood donation volume (450 mL ± 10%) is calculated so that it does not exceed 10.5 mL per kg of donor body weight. A minimum weight of 50 kg (approximately 110 lbs) ensures that the donation volume is within a safe limit for the donor.

Visible clots in a platelet unit are unusual and can be a sign of bacterial contamination. Bacteria can release pro-coagulant substances that activate the clotting cascade within the bag. Therefore, the unit must be quarantined and not transfused. It should be sent for further investigation, such as a Gram stain and culture, to rule out contamination.

• a) Issue without concern: This is incorrect and dangerous, as it could lead to a septic transfusion reaction.

• b) Filter to remove the clots: A standard blood filter will not remove bacteria, and the underlying cause of the clotting (potential contamination) remains.

• c) Centrifuge to express off the clots: This is not a standard procedure and would not address the potential for bacterial contamination.

A standard whole blood donation collects 450 mL ± 10% of blood, plus an additional 10–15 mL for pilot samples, making the total volume approximately 450–500 mL. This volume is standardized to mix correctly with the 63 mL of anticoagulant-preservative solution in the collection bag (like CPDA-1), ensuring proper ratios for component storage and viability.

• a) Trypanosoma cruzi (Chagas disease): Donor questioning is used, but there is also an FDA-licensed blood donor screening test. It does not rely solely on questioning.

• b) Plasmodium falciparum (a cause of malaria): There is no FDA-licensed blood test to screen donors for malaria. Prevention of transfusion-transmitted malaria relies entirely on donor questioning about travel and residence history in malaria-endemic areas and previous history of malaria.

• c) HCV (Hepatitis C Virus): Relies primarily on highly sensitive and specific laboratory tests (nucleic acid testing and serology), not on donor questioning.

• d) CMV (Cytomegalovirus): There is no routine donor questioning for CMV. Instead, it is managed by providing CMV-seronegative or leukoreduced blood products to at-risk patients. Laboratory testing is available to determine a donor’s CMV status.

This donor meets all criteria. There is no upper age limit for donation if the donor is otherwise healthy. The minimum hemoglobin for a male donor is 13.0 g/dL, which he exceeds.

The other donors are deferred:

• a) 62-year-old female with a blood pressure of 210/80: This is severely hypertensive (systolic > 180 is a deferral criterion).

• b) 18-year-old female who weighs 100 lb: This is below the minimum weight requirement of 110 lbs (50 kg) for allogeneic donation.

• c) 40-year-old male with a pulse of 115: A pulse rate must be between 50-100 bpm (with some exceptions for well-conditioned athletes below 50). A rate of 115 is too high and requires deferral.

The common cold virus (rhinovirus, etc.) is not tested for in donor screening. It is not considered a serious transfusion-transmitted infection, and testing is not feasible or necessary.

Routine screening includes:

• a) Syphilis

• c) West Nile virus (via NAT in endemic areas/seasons)

• b) Malaria is not routinely tested for all donors, but donors are deferred based on travel history to endemic regions; however, it is not part of the standard universal test panel like syphilis or WNV. For this question, the clear non-routine agent is the common cold virus.

The actual blood draw (from needle insertion to completion) typically takes 5 to 10 minutes. This is the standard, safe timeframe to collect a full unit (450 mL) without compromising the quality of the blood or causing donor discomfort.

• A time significantly less than 5 minutes could indicate a rapid flow, potentially causing hemolysis.

• A time longer than 10 minutes might suggest a poor flow, which can lead to clotting in the tubing or bag.

 Donors with confirmed positive tests for major transfusion-transmissible infections like Hepatitis B (surface antigen) and HIV are permanently deferred to protect the safety of the blood supply.

• a) Have mild anemia: This is a temporary deferral until the condition is corrected.

• c) Recently donated platelets: Apheresis platelet donors have a shorter waiting period (a few days to weeks), not a permanent deferral.

• d) Traveled abroad: This often results in a temporary deferral based on malaria risk in the visited region.

According to AABB, WHO, and most national blood donation standards, the minimum hemoglobin concentration required for blood donation is:

• Males: ≥ 12.5 g/dL

• Females: ≥ 12.5 g/dL

This ensures that the donor has sufficient red cell mass to safely tolerate blood loss without becoming anemic after donation.

Incorrect options:

• (a) 12.0 g/dL → too low; donor may risk anemia.

• (c) 13.0 g/dL and (d) 13.5 g/dL → above required threshold; unnecessarily restrictive.

AABB Standards require that when a platelet unit is reported as positive by a culture-based bacterial detection method, the blood bank or transfusion service must immediately take action to prevent transfusion. If the unit has already been issued (sent to the floor or released for a patient), it must be retrieved and quarantined. This is the most urgent and critical step to ensure patient safety.

The other actions are important but secondary:

• a) Set up another culture to confirm positivity: This may be done for quality control, but the initial positive result triggers immediate action to block transfusion.

• b) Determine sensitivity to antibiotics and d) Identify the organism: These are follow-up procedures that aid in patient management if a transfusion has already occurred, but they do not take precedence over preventing the transfusion in the first place.

The primary goal of donor screening (via the health history questionnaire and physical exam) is to protect both the donor (by ensuring they are healthy enough to donate blood without harm) and the recipient (by identifying risks that could transmit disease or cause a transfusion reaction).

• a) Increasing donation frequency is an operational goal, not the primary purpose of screening.

• c) Identifying rare blood groups is a beneficial outcome, but not the main goal of screening.

• d) Detecting Rh antibodies is part of laboratory testing, not the core purpose of donor screening.

The initial blood drawn (usually the first 10-40 mL) is diverted into a pouch or tubes separate from the main collection bag. This blood is more likely to contain skin cells and bacteria from the venipuncture site. Using this portion for laboratory testing (like infectious disease screening and blood typing) helps prevent contamination of the main transfusion unit.

For RBCs issued in a validated transport cooler, the key to re-entry into inventory is verifying that the temperature was maintained at 1-10°C throughout the transport period. Since 40 minutes is well within the typical hold time of a validated cooler (often 4-12 hours), the units can be returned to inventory only if the temperature is verified to be acceptable (e.g., by checking a temperature monitor or the units themselves feel cold). The 40-minute time frame alone is not sufficient; temperature validation is the critical step.

• a) Discard the units: This is unnecessary if temperature was maintained.

• c) Continue to store in cooler: The cooler is for transport, not storage; units must be returned to the blood bank refrigerator.

• d) Put units back into inventory as only 40 minutes has elapsed: Time is a factor, but the definitive criterion is temperature maintenance, not just elapsed time.

Autologous donations collected and used within the same facility (not stored long-term) are generally exempt from infectious disease testing requirements by FDA regulations, provided the blood is for autologous use only and clearly labeled as such.

The other options are still required:

• a) ABO and Rh typing – needed for proper labeling and in case emergent crossmatch is necessary.

• b) A physician’s order – required for collection and transfusion.

• d) Evaluation for risk of bacteremia – part of donor screening to ensure patient safety.