Blood Donation and Transfusion

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Every year, 4.5 million American lives are saved with blood transfusions, while an estimated 38,000 units-5,000 gallons-of donated blood are used each day in the U.S. Yet even though about 40,000 Americans donate blood each day, that's barely enough to keep the health care system running. The fact is, the country's blood supply runs on perilously thin margins. Just a few years ago, blood shortages occurred in late summer and around the Christmas holidays; these days, they often occur throughout the year because supply has not kept up with demand.

Shortages occur for numerous reasons, including generational differences and behaviors associated with giving blood and an increased need for blood transfusions. Blood banks work hard to make it as easy and convenient as possible to donate blood. Still, there are numerous restrictions on who can donate blood, with about 40 percent of the American population unable to donate.

Donating blood is relatively simple and entirely safe, however, taking just an hour and requiring little preparation. There is little to no risk of any adverse reaction when donating blood, and you can donate whole blood every 56 days; blood platelets every 48 hours, up to 24 times a year.

Women are critical to the country's blood supply, since their role as caregivers sends a message that donating blood is the right thing to do. However, they are also more likely than men to be temporarily restricted from donating because of low hematocrit, or red blood cell, levels if they are still menstruating.

The blood supply today is extremely safe, with the risk of catching a blood-borne disease via a transfusion miniscule. Research is underway to make the blood supply even safer via blood sterilization. Transfusions carry other risks, including the risk of receiving the wrong blood type and of contracting a rare lung condition that can be deadly.

During a transfusion, any one of several blood products may be transfused, including blood platelets, which help blood clot; red cells, which carry oxygen; and plasma, the watery fluid that transports cells and replaces blood volume.

There are four types of blood-O, A, B, and AB-and each type can be positive or negative, referred to as the Rh factor. In an emergency, anyone can receive type O blood, regardless of his or her own blood type.

Throughout your life, you will undergo numerous blood tests. The most common blood test, called a complete blood count, or CBC, measures the number of white and red blood cells, your hemoglobin and hematocrit values, and your platelet count. Another slew of blood tests, referred to as a comprehensive metabolic panel, provide important information about your kidneys, liver, blood sugar and blood proteins.

Current research in the field of blood transfusion is focusing on longer storage time for blood components and artificial blood products that, becaue they're artificial, don't require significant donations. However, some artificial blood products are developed with some donated blood products.

The Need for Blood

Every year, 4.5 million American lives are saved with blood transfusions, while an estimated 38,000 units-5,000 gallons-of donated blood are used each day in the U.S. Yet even though about 40,000 Americans donate blood each day, that's barely enough to keep the health care system running. The fact is, the country's blood supply runs on perilously thin margins. Just a few years ago, blood shortages occurred in late summer and around the Christmas holidays; these days, they often occur throughout the year because supply has not kept up with demand.

In a 1999 report from the National Blood Data Resources Center, an independent not-for-profit corporation, conceived and founded by the American Association of Blood Banks, nine percent of the nation's hospitals reported at least one day in which they had to cancel or postpone elective surgery because of a lack of red cell units. Half of those hospitals had to do this at least two days. Additionally, one-fourth of the hospitals could not meet their non-surgical blood requests at least one day, and for those experiencing such shortages, half were not able to meet it on at least five days. Since then, experts say, the situation has worsened.

It wouldn't take much to improve the situation. Just a five percent increase in the number of people who donate-about 40 more people in each state every day-would be enough to pull the nation's blood supply from the brink of disaster, experts say.

A major reason for the blood shortage is that even though 60 percent of the country's population is eligible to donate blood, only about five percent does. There are three main reasons for the shrinking numbers, say experts:

1. Changing demographics.

   Since blood transfusions became commonplace in the 1950s, blood centers have depended on the World War II generation for donations. This generation is now aging and fewer, and Baby Boomers and the generations that follow simply don't donate as much. Experts aren't sure why, but suspect it may be related to differences in lifestyle, the level of altruism, and the fact that the blood community may not be effectively appealing to these generations.

2. Increasing need for blood.

   As surgeries become more complex and cancer treatments more aggressive, and as people live longer, this country uses about five percent more blood every year.

3. Increasing blood donor rejection rate.

   Beginning with the AIDS epidemic in the early 1980s, the blood supply has gotten much safer. But that's required turning away more and more potential donors. Today, increasingly sophisticated and sensitive tests, coupled with significantly more questions on application forms designed to weed out donors who may transmit blood-borne diseases, means there are fewer people who are able to donate blood even if they want to. For instance, people who have spent three or more months in the United Kingdom between 1980 and 1996 cannot donate blood for fear they could introduce the human version of mad-cow disease, variant Creutzfeldt-Jakob Disease (vCJD), into the blood supply.

There are other reasons for the shortage as well. For one, blood products are perishable. Red blood cells have a shelf life of 42 days, platelets just five days, so blood donations are needed every day, 365 days a year.

Then there are people's perceptions about blood donation. For instance, a study evaluating why people don't donate blood and other organs found that a persistent mistrust of doctors and hospitals as well as religious misconceptions played a major role. Minorities were particularly likely to avoid donation for these reasons. The study, which involved 20-minute phone interviews with 339 Baltimore, MD residents, found that African-American and Caucasian women were less willing to donate blood than Caucasian men (36 percent compared to 86 percent), while just 41 percent of African-American women surveyed said they would donate blood.

But the greatest barrier that prevents people from donating is a lack of convenience and a lack of knowledge of the importance of donating, experts say. And it is important. Every pint of donated blood saves three lives, and someone needs blood every three seconds.

Making Donation Convenient

A survey conducted by the American Red Cross found donors want to donate at or near a hospital, and generally don't want to travel more than 10 miles to donate. That's one reason why the American Red Cross, along with other blood banks, do all they can to bring opportunities to donate to the donors, through work-site and community blood drives.

Although the U.S. Food and Drug Administration (FDA) sets most blood donation guidelines, some additional criteria are set by the blood donation centers. So the information below should be taken as a guide only. Check with your blood center about its specific rules. To find the closest blood center near you, just call either the American Red Cross or the America's Blood Centers hotlines, or visit their Web sites to set an appointment.

Donor eligibility rules are intended to protect the health and safety of the donor as well as the patient who will receive the transfusion. If you have any kind of medical condition, you should check with your health care professional about your ability to donate blood.

To be eligible to donate blood, you must be in good health and at least 17 years old (although some states permit younger people, with parental consent, to donate). Few have any upper age limit. Generally, donors must weight at least 110 pounds and all must pass a physical and health history examination given prior to donation. "Healthy" means you feel well and can perform normal activities. If you have a chronic condition such as diabetes or high blood pressure, "healthy" also means your condition is controlled with treatment.

Temporary Deferral

This includes those who:

• Have had a heart attack in the last six to 12 months.

• Have had malaria in the last three years.

• Have visited areas where malaria is found in the last year.

• Have received blood, plasma or other types of blood components in the last year. You must wait 12 months after receiving a blood transfusion from another person in the United States before donating blood. And you may not donate if you received a transfusion since 1980 in the United Kingdom (England, Wales, Scotland, Northern Ireland, Channel Islands, Isle of Man), Gibraltar or Falkland Islands. This requirement is related to concerns about variant Creutzfeldt-Jakob disease (vCJD), or "mad cow" disease.

• Have been tattooed in the last year (you must wait 12 months after a tattoo).

• Have had cardiac surgery in the last year or have not completely recuperated from the surgery and are taking cardiovascular medicine.

• Have been exposed to someone with hepatitis within the last year.

• Are not feeling well the day of the blood donation.

• Have taken antibiotics within the last 24 to 72 hours.

• Are pregnant or have had an abortion in the last six weeks. Wait six weeks after giving birth before donating blood.

• Have had oral surgery or treatment for an abscess or infection of the mouth. In this instance, you should wait three days before attempting to donate blood.

• Have had immunizations for German measles (rubella), MMR (measles, mumps and rubella), or chicken pox. In those instances, wait four weeks before donating. If you've been immunized against red measles (rubeola), mumps, polio or yellow fever, wait two weeks. Wait seven days after immunization for Hepatitis B (unless you were given the immunization for exposure to hepatitis B. Then wait 12 months). There are also various waiting periods after receiving smallpox vaccine, depending on your reaction to the vaccine.

• Have traveled in an area where malaria is found (wait 12 months). Wait three years after moving to the United States after living in a country where malaria is found.

• Have been treated for syphilis or gonorrhea. Wait 12 months before donating.

• Have been raped in the past 12 months.

Certain drugs also carry certain waiting periods. The Red Cross lists the following waiting times after you have taken your last dose:

• Accutane (isotretinoin), Proscar (finasteride), and Propecia (finasteride): Wait four weeks.

• Arava (leflunomide): Wait three months.

• Avodart (dutasteride): Wait six months.

• Aspirin: No waiting period for donating blood. However, you must wait 36 hours after taking aspirin or any medication containing aspirin before donating platelets by apheresis.

• Coumadin, heparin or other prescription blood thinner: Wait five days after discontinuing.

• Human pituitary-derived growth hormone: You are not eligible to donate blood.

• Lupron (leuprolide acetate) used for condition other than cancer: Wait four months from last dose

• Plavix (clopidogrel): Wait 36 hours before donating platelets by apheresis

• Soriatane (acitretin): Wait three years before donating.

• Tegison (etretinate): You are not eligible to donate blood.

Overall, you must wait at least eight weeks between whole blood (standard) donations, at least three days between platelet apheresis donations, and at least 16 weeks between double red cell (automated) donations.

Permanent Deferrals

If you meet any of the following criteria you will be permanently deferred, which means you cannot donate blood.

• You have ever tested positive for hepatitis B or hepatitis C.

• You have had hepatitis (inflammation of the liver) caused by a virus, or unexplained jaundice (yellow discoloration of the skin) since age 11.

• You have received chemotherapy, hormonal therapy or immunotherapy for the treatment of cancer. If you only received radiation and surgery for the cancer and it has been five years since your last treatment with no recurrence, you may donate. Some low-risk cancers, including squamous or basal cell cancers of the skin, do not require a five-year waiting period. However, if you had leukemia or lymphoma, including Hodgkin's disease, you are not eligible to donate.

• You are at high risk of contracting the HIV virus/AIDS or are already infected with the virus.

• You have sickle cell disease.

• You have spent any cumulative period of three or more months in the United Kingdom from 1980 through 1996.

• You have received an injection of bovine (beef) insulin made from cattle from the United Kingdom since 1980. This requirement is related to concerns about variant Creutzfeldt-Jakob disease, or 'mad cow' disease.

• You have a generalized autoimmune disease, including systemic lupus erythematosus and multiple sclerosis.

• You have a clotting disorder, such as von Willebrand's disease or hemophilia. You should also not donate if you are taking any "blood thinner" medication such as Coumadin or heparin.

• You have ever received a corneal (eye) transplant, a dura mater (brain covering) transplant or human pituitary growth hormone. This requirement is related to concerns about variant Creutzfeldt-Jacob disease. You are also not eligible to donate if you have a close family member who has had the disease, or if you are in a family that has been told they have a genetic risk for the disease.

Women and Blood Donation

One reason women donate blood less often than men may have to do with the fact that women who are still menstruating are more likely to have lower hematocrit, or red blood cell, levels than men. Having adequate iron stores is important for donation since iron is needed to make hemoglobin, the red pigment that carries oxygen inside red cells. Without adequate iron, you will not be able to make up for blood loss through menstruation or through donation. The U.S. Food and Drug Administration (FDA) requires that all donors have a blood hemoglobin level of at least 12.5 g/dL. So about eight out of every 100 people who turn up to donate blood-nearly all of them women-wind up being turned away, or "deferred," because of low hematocrit, or red blood cell, levels. Overall, about 30 percent of women who try to donate blood are deferred, or told to return at a later time.

That doesn't mean women can't eventually donate. They just need to get their iron levels up either through diet or supplements. Don't try to do this on your own, however. If you learn that your iron levels are low when you try to donate blood, see a health care professional. You may need prescription iron supplements to return your levels to normal.

One blood donation organization, America's Blood Centers, is testing a program in which women with low hemoglobin levels receive a supply of supplemental iron to take at home. When they finish the last pill, they're eligible to donate again. The hope is that this will not only improve a woman's hemoglobin level, but also increase the number of women who donate after deferral. Unfortunately, few people who are deferred ever return to donate.

If You Are Deferred

If you are temporarily deferred, or turned away, at a blood donation center, ask the staff at the blood center what you need to do to be able to donate. In some instances, you may just need to wait a few weeks. In others, you may need some medical attention. Don't take the deferral as a personal affront or insult. It definitely is not personal. And the blood centers really need your donation. So mark your calendar for the date when you can return to try again.

If you are permanently deferred, you cannot donate blood. But you can still help. Ask your blood center about volunteer opportunities, or offer to organize a community or workplace blood drive.

How to Donate

First, check the list of exceptions for donation to see if you are eligible to donate. If you have any questions, call your health care professional or your local blood donation center. To find the closest blood center near you, just call either the American Red Cross or the America's Blood Centers hotlines, or visit their Web sites to set an appointment.

On the day of your appointment, follow these recommendations:

• Eat heartily and drink fluids (non-caffeinated, nonalcoholic) before you donate.

• Don't exercise immediately before you donate blood.

• Arrive on time. Most of the people staffing blood centers are volunteers. It's not fair to waste their time, and they try hard not to waste yours.

• Bring a picture ID. You'll be asked to prove your identity.

• Relax during the donation, which only takes about 10 to 15 minutes.

What to Expect

When you arrive, you'll register and answer a series of questions concerning your medical history. Then a medical staffer will conduct a health examination and measure your pulse, blood pressure, temperature and red cell level. You may feel a little pain when the needle goes in. Some people don't feel any pain. It might help to look away while the needle is inserted. You'll lie down for about 10 to15 minutes while a pint, or unit, of blood is collected.

Donating blood is strictly a volunteer activity-there is no payment. There are plasma centers in some cities, however, where you can receive compensation for donating plasma, the fluid that transports blood cells.