One donation goes a long way. Your single donation may be separated into
four components to help treat several different patients.
Red Cells: anemia, kidney dialysis, surgery
Plasma: burn victims, shock
Platelets: leukemia, cancer, surgery
Cryoprecipitate*: certain types ofhemophilia
*Cryoprecipitate refers to a substance that
settles out when frozen plasma is thawed at refrigerator temperature.
By chance, it was discovered that it is enriched with certain
clotting proteins, mainly antihemophiliac factor [the protein missing
in hemophiliacs] and fibrinogen, the protein that forms fibrin
clots.
The cost has gone up half as fast as other areas of health care. Most of
the cost is for salaries of staff needed for collecting, testing,
processing and shipping blood. Since 1984, the number of screening tests
for infectious agents in blood has increased from two to eight. This has
added significantly to the costs of labor and test materials, and the cost
of computer and quality assurance systems needed to manage the data
generated by these tests.
These are very extensive, and include formal classroom instruction for 1
week, followed by one-on-one training for approximately 2 weeks, and then
one month of preceptorship with a staff nurse. New staff must prove
competency before being signed off to perform independently.
Victims injured by these disasters either die right away, or sustain
injuries that don't require blood transfusions. If the local blood center
is unable to collect and process blood, Red Cross blood centers in other
areas of the country often ship blood in to help with everyday needs of
patients in hospitals.
We are committed to maximal utilization of all donated blood. Some of the
blood that is beyond its shelf-life is used for research or manufacture of
test reagents. The rest is transported by a licensed waste management
company for proper disposal.
This is contained in a
voluminous book published by the U.S. Centers for Disease Control, and
beyond the scope of this document. Prospective donors with questions about
malarial travel may call our Nursing Office at (510) 594-5143 for this
information.
This is something we all have wanted for many years. Our earlier plans were
put on hold a few years ago when the American National Red Cross needed to
consolidate its many different blood computer systems into a single
national system, in order to manage the voluminous data from the increased
number of tests on donated blood and to comply with the increasingly
rigorous demands of regulatory agencies. The first component of this new
state-of-the-art system was implemented in August, 1997. Automated donor
registration is expected to be available in the next version in the
future.
All donated blood is collected in new, sterile, disposable needles and
plastic bags that are used only once and then discarded. Blood donors,
because they are all healthy volunteers and undergo careful screening for
HIV risk behavior before donating blood, have the lowest incidence of HIV
of any population group. Since the first reports of AIDS in the early
1980s, over 150 million blood donations have been made in the USA, without
a single report of a person acquiring HIV/AIDS through donating blood. All
staff collecting blood wear protective gloves and coats. If either item is
punctured or torn, or contaminated with blood, it is replaced immediately.
Our precautions are for the protection of staff, and are in full
compliance with OSHA regulations and recommendations of the U.S. Centers
for Disease Control for healthy blood donors. In clinics and
hospitals, staff are required to change gloves between patients because
they are dealing with sick persons who, in contrast to healthy blood
donors, have a much higher chance of carrying a blood-borne
virus.
Local anesthetic dulls only the skin surface, and is costly. Also, it may
make venipuncture more difficult by obscuring the vein and requiring a
second scrub to sterilize the skin.
Without knowing the specifics of the drive, a number of possibilities may
contribute to bottlenecks during registration. These include: too many
donors arriving at once, new staff undergoing training to do registration,
etc.
We realize this is annoying for many donors. However, Red Cross and other
licensed blood centers must follow regulations of the FDA and other
national organizations. Often questions are changed or new ones are added
in response to concerns about blood safety. The only way we can be sure
each donor answers all current questions is to ask them at each
donation.
Since blood contains iron (which is essential for making new red blood
cells), donating blood more often than every 56 days causes the body to
lose iron faster than it can be made up from iron-containing foods in our
diet. As a result the donor could develop iron deficiency anemia, causing
him/her to feel weak and tired.
This issue was discussed in the correspondence section of the April 11,
1996 issue of the New England Journal of Medicine, as reproduced
below.
To the Editor: The
very small risk of HIV transmission through the transfusion of screened
blood estimated by Lackritz et al, makes the policy of the Food and Drug
Administration (FDA) that effectively prohibits blood donation by gay
men indefensible. In 1983, when the cause of AIDS was not yet understood
and the disease appeared to be linked to homosexuality, the FDA required
blood banks to reject blood donations by men who answered "yes" to the
donor-screening question, "have you ever had sex with another man, even
one time, since 1977?" Incredibly, this policy remains in effect,
unnecessarily disqualifying many potential donors of healthy blood. . .
. The following response was provided: The issue of donor
exclusion raised by Mr. (Name Withheld) was not evaluated in our
original report. Preventing blood donation by those potentially exposed
to infectious diseases has been one of the cornerstones of the
prevention of disease transmission to blood recipients. Questioning
potential blood donors serves to identify those who have medical risks
or have engaged in activities or behavior that is unquestionable
associated with a risk of infection with HIV or another infectious
agent. These policies and others, such as the exclusion of healthy
persons who have traveled to areas with endemic malaria and those who
have had hepatitis infection, disqualify many potential donors of safe
blood but also remove from the donor pool those at increased risk for
transmitting infectious diseases by transfusion. In the United
States, male-male sexual contact remains a leading risk for HIV
infection. Despite the current questioning of donors and use of
exclusion criteria, a study of 19 large U.S. blood centers revealed that
43 percent of all donations discarded because they were HIV-positive
came from men who reported a history of male-male sexual contact. These
data support the need to continue interviewing potential donors about
behavior that presents a risk of HIV transmission.
Eve M. Lackritz, M.D.
Robert S. Janssen, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
Jay S. Epstein, M.D.
Food and Drug Administration
Rockville, MD 20857
There is about a 1 in 20 chance that a donor may faint during or after
blood donations. In many cases this is related to the fall in blood volume
associated with donation. Since blood volume is proportional to body
weight, smaller persons have a greater % of their blood volume removed.
Therefore they are at increased risk of these reactions and should not
donate. Exceptions are made for persons donating for themselves prior to
planned surgery. In this case the volume of blood collected is reduced,
proportional to their weight.
An elaborate system of identification and tagging of units of blood has
been developed to ensure that your blood reaches the intended recipient
when needed. The success of this system underscores the importance of full
and accurate identification of donor and recipient.
Autologous donors are usually older persons on multiple medications and
with medical conditions such as cancer that would make their blood
unsuitable for general use. The few donations that could be salvaged are
insufficient to justify the administrative complexities and cost incurred
by screening these patients in the same manner as volunteer donors. For
these reasons autologous donors undergo an abbreviated medical history
designed only to assess their ability to tolerate the loss of blood. If
their blood is not needed,
it is not available for
general use. To minimize this wastage (and to eliminate risks from
blood donation), patients are encouraged to make autologous donations only
for surgery where there is likely to be sufficient bleeding to require
blood transfusion.
Directed donations such as these, since they undergo the same rigorous
screening and testing as volunteer donations, are available for general use
but must be labeled as coming from a directed donor. Some blood centers,
concerned that such donations are less safe, discourage such "crossover" by
hospitals.
Generally speaking,
husbands may donate blood for their wives provided that their red cells are
compatible in the major ABO and Rh types (or "antigens"). There are many
other antigens (weaker than ABO and Rh) that usually don't have to be
matched because transfusion of blood containing one of these antigens to a
patient lacking this antigen rarely causes production of antibodies
(proteins that react with the antigens). When antibodies do develop they
don't usually appear for several months. By this time the transfused red
cells have disappeared and therefore they escape damage by the
antibody. However, for a woman who plans to become pregnant in
the future, receiving blood from her husband poses a small risk for the
infants of these pregnancies. If, after transfusion the woman develops an
antibody to an antigen on the father's red cells, and a subsequent fetus
inherits the father's red cell antigen, the antibody from the mother may
enter the bloodstream of the fetus causing destruction of the fetal red
cells. This may cause serious anemia in the fetus and excessive jaundice in
the infant after birth (which could cause brain damage). (These conditions
are treated with special blood transfusions, using red cells that lack the
particular offending antigen.) For women who are unable to make an
autologous donation, the decision to select her husband as a donor should
take this risk under consideration.
"STAT": 72 hours; all others: 3-5 days. In general, it is not advisable to
rely on such "directed" donations in a serious emergency, in the event that
testing shows the donor to be incompatible or otherwise unsuitable.
An antibody screen is a test used in blood banking to determine whether or
not a person has antibodies (proteins) that react with red blood cell
antigens (types), other than those for A and B, of donor blood. We are
specifically interested in clinically significant antibodies,
meaning those that might cause a serious ("hemolytic") reaction after
transfusion of blood containing the corresponding antigen. If such
antibodies are present in the patient (usually arising from previous
exposure to the antigen from pregnancy or transfusion), we must search for
blood that lacks the corresponding antigen.
We test for blood type (ABO and Rh) and screen for antibodies to red
cell antigens. We also perform a number of tests for infectious agents:
AIDS/HIV - antibody to HIV-1 and HIV-2, HIV antigen
Other retroviruses - antibody to HTLV-I/II
Various types of hepatitis viruses:
Hepatitis B - hepatitis B surface antigen
and antibody to Hepatitis B core antigen
Hepatitis C - antibody to hepatitis C
We also screen for hepatitis with a test of
liver function called ALT, or alanine aminotransferase
Syphilis
It is important to remember that all of the above tests are
considered screening tests, i.e., they are very sensitive (in
order not to miss blood containing an infectious agent), and they can
provide rapid results on large-volume testing. With any screening test
that is very sensitive, it is inevitable that some persons without the
infection will trigger a "positive" result. For this reason we rely on a
second (more specific, but more complex and costly) test to sort out
these "false-positive" persons from others with a
true-positive result. (The easiest way to think about this
two-step testing procedure is to liken it to the metal detectors at
airports. This equipment must be very sensitive in order to protect
passengers from dangerous items carried on the plane. Most persons who
trigger the buzzers, however, do so because of trivial items such as
watches, keys and jewelry.)
Usually between 17 and 24 hours. The longer period applies when a positive
test is obtained on the initial run, requiring us to repeat the test in
duplicate on a subsequent run.
We did this as part of a national Red Cross plan to ensure that all testing
is of the highest possible caliber, is consistent and standardized across
the country. It saves us money because it avoids duplication and allows for
high volume testing around the clock, which is hard to justify in a smaller
laboratory. With Portland and the other 4 National Testing Laboratories
(NTLs) doing the testing, each individual region does not have to maintain
expensive equipment, and continually meet new regulations and training
requirements. Also, in response to emerging threats to safety of the blood
supply, these labs can rapidly implement new tests immediately upon
licensure.
Donors with confirmed positive tests for infectious agents are informed by
mail. If the result involves something serious like HIV (a very rare
occurrence nowadays) we arrange a personal interview for special
counseling. Doctors are notified only if the donor provides us with written
permission to do so, as occurs with autologous donations.
Hepatitis is an inflammation of the liver usually caused by one or other
hepatitis viruses, such as types A, B and C. Type A is caused by
eating/drinking contaminated food or water, is short-lived, and is usually
not spread by blood. Types B and C are acquired by exposure to the blood of
an infected person (e.g., from sharing needles for illicit drug injection
or tattoos) or through sexual contact. Persons infected with hepatitis B or
C, although usually healthy, may carry the viruses for many years; some are
at risk of later developing serious liver disease. By screening blood
donors for these types of hepatitis through medical history (asking about a
history of jaundice, self-injected drug use, or contact with a person with
hepatitis, etc.) and testing their blood with a battery of very sensitive
tests, we are able to exclude almost all donors whose blood might transmit
hepatitis. A new virus, "hepatitis G", was discovered recently, but is felt
to be a misnomer since most persons harboring the virus show little if any
sign of hepatitis.
This refers to Human T-lymphotropic viruses, types I and II. These are rare
"retroviruses" (like HIV) that are spread like HIV but do not cause AIDS.
Type I occurs predominately in persons from certain parts of the world such
as southeastern Japan, the Caribbean, South America and Africa. Persons
carrying the virus are healthy, and only 3 - 5 percent ever develop signs
of disease, often only after 30 - 40 years. The diseases include a rare
form of leukemia and a neurologic disorder resulting in weakness and
decreased sensation in the legs. Type II is found most commonly in certain
Native-American populations in the southwest, and in persons who have used
self-injected drugs and their sexual partners. Neurologic symptoms may
develop in some of these persons.
Although we understand the desire of many donors to monitor their blood
cholesterol levels, the value of such repeated testing in the donor
population is a subject of controversy among medical authorities. Under the
pressures from hospitals we serve, we must do our best to reduce costs. We
are unable to justify cholesterol screening as an essential part of our
blood collection process. Many blood centers have dropped cholesterol
screening for the same reason. A simple inexpensive home cholesterol test
kit is now available over the counter at many drug stores.
California law requires this to ensure that someone is available to help
donors who might feel weak or faint. This occurs in 2 - 4 percent of
healthy donors, and is most likely to occur in the 15-minute period after
donation.
Since HIV testing began in 1985 we have received no reports of AIDS in
patients receiving blood products from over one-half million donations made
to our center. This points to the effectiveness of the combination of
careful medical history of blood donors and the battery of very sensitive
tests for HIV. The chance of getting hepatitis B or C from screened blood
since 1996 is very low – approximately 1 in 50 - 100,000 per unit of
blood received. It's been stated that "the risk of not getting a blood
transfusion when it's needed is infinitely greater that the risk of
infection from receiving one."
Although gamma globulin (immune globulin) is made from pooled plasma of
many donors, infectious risks are virtually eliminated by use of
manufacturing methods that destroy any viruses that may have escaped the
initial screening of individual donations. The Red Cross preparation
uses plasma derived only from volunteer donors. There have been no
reported cases of HIV infection from intramuscular gamma globulin. A few
cases of hepatitis C have been reported recently from a special
intravenous preparation of gamma globulin (not the intramuscular
type given to travelers). With newer viral inactivation (sterilization)
techniques now in place there have been no further reports of infection to
date (April, 1999).
Research into artificial blood substitutes has been a subject of intense
interest and activity for many years. Although a number of products have
appeared promising as red cell (oxygen-carrying) substitutes (e.g.,
perfluorohydrocarbons and hemoglobin solutions) most have had serious
toxicities. Research in this area is ongoing, however, with promising
initial results from trials of a new virally inactivated hemoglobin
solution. On the other hand, a synthetic (but costly) blood clotting
product made by recombinant technology is now available for treatment of
the common form of hemophilia. Current methods of sterilizing clotting
products made from human plasma have narrowed the safety margin of the
synthetic product. Red Cross has pioneered a new technique of inserting
human genes for therapeutic proteins into animal embryos, and extracting
the human proteins from the milk of the adult animals. This is
promising, but has a way to go before it is proven ready for human
use.
In the US, virtually all whole blood donations come from
volunteer unpaid blood donors. In fact there is a Federal
law requiring labeling of blood that comes from paid donors. The
misunderstanding likely arose from the fact that plasma donors are
often paid (thru commercial blood banks, or "plasma centers"). The American
Red Cross and other non-profit community blood centers do NOT pay donors
for plasma; most of their plasma is made from whole blood collections, and
is sent to hospitals for direct transfusion to patients.
Manufacturers of "derivatives" made from plasma (albumin, clotting factors,
immune globulin, etc.) get some of their plasma from the Red Cross and
other blood collection centers; this comes from supplies that exceed the
amounts needed for direct transfusion to hospital patients. However, since
this is insufficient to meet the needs for manufacture of the above
derivatives, they obtain the rest from commercial blood banks that collect
only plasma. Although there is legitimate concern about the safety of blood
from paid donors, it is felt that the incorporation of viral inactivation
methods into the manufacture of plasma derivatives compensates for this. In
addition they must comply with the same Federal and State regulations for
blood collection and processing as non-profit blood centers.
In normal healthy persons there is a slight drop in blood count (not enough
to be noticed) which returns to normal levels within 3 - 4 weeks. During
this time the donor must be receiving adequate amounts of dietary iron
(needed to make hemoglobin, the protein that carries oxygen and gives blood
its red color).
Since herpes is localized to the mucous lining of the oral or genital area,
and is not associated with virus in the blood, these persons are eligible
to donate blood, provided they meet all other criteria.
Cytomegalovirus (CMV) is a common virus spread by air droplets (from
coughing & sneezing), sexually, and by blood contact. In healthy
persons it may cause minor flu-like symptoms, cough, sore throat and
enlarged glands (resembling infectious mono), or no symptoms at all. It
occurs at all ages, and by adulthood, blood tests show that about 50
percent of healthy adults have had the virus (and are now immune to it).
Some of these persons, while healthy, may still carry and transmit the
virus sexually or by blood donation. In patients with lowered
immunity (small premature infants, patients with immune deficiency that
is hereditary or secondary to diseases like leukemia, cancer or AIDS, or
due to chemotherapy or transplantation) CMV may cause serious disease which
can be fatal. In pregnant women who are not already immune to CMV,
infection with this virus can cause serious disease in the fetus. In order
to protect these patients from getting CMV through blood
transfusion, we give them blood from donors who test negative for CMV.
Healthy persons receiving CMV-positive blood do not generally suffer
any serious consequences of infection.
Yes. A person's blood type results from inheriting a gene
for A, B or O from each parent. Two genes result, and this determines
the blood type of the child. Type O is the name given when someone
lacks an A or B gene. When O is present along with the
gene for A or B, e.g. AO or BO, the A or B is the dominant gene and
determines that person's type, as shown below:
Genes
Blood Type
AA, AO
A
BB, BO
B
AB
AB
OO
O
In your family, the genes of both you and your wife must be AO.
Your son must have inherited the O gene from each of you in order to be
type O.
Yes. The explanation is similar to that for a type O child of
type A parents (see answer to previous question). In this case, the Rh
type depends on a gene called 'D'. The absence of D results in a gene
called 'd'.
Genes
Rh Type
DD, Dd
Positive
dd
Negative
In your family, the genes of both you and your wife must be Dd.
Your son must have inherited the d gene from each of you in order to be
type Rh negative.
