Transfusion Health Article

Blood donation

Each year in the United States, about 14,000,000 pints of blood are donated. Blood collection is strictly regulated by the Food and Drug Administration (FDA). The FDA has rules for the collection, processing, storage, and transportation of blood and blood products. In addition, the American Red Cross, the American Association of Blood Banks, and most states have specific rules for the collection and processing of blood. The main purpose of regulation is to ensure the quality of blood and to prevent the transmission of infectious diseases through donated blood. Before blood and blood products are used, they are extensively tested for such infectious agents as hepatitis and AIDS.

DONORS. Blood donors are questioned about their general health, their lifestyle, and any medical conditions that might disqualify them as donors. These conditions include hepatitis, AIDS, cancer, heart disease, asthma, malaria, bleeding disorders, and high blood pressure. Screening prevents blood donation by people who could transmit diseases or by people whose medical condition would place them at risk if they donated blood. Some geographical areas or communities have a high rate of hepatitis or AIDS. Blood collection in most of these areas has been discontinued.

The blood pressure, temperature, and pulse of donors are taken to ensure that they are physically able to donate blood. One pint (450 ml) of blood is usually donated, although it is possible to donate smaller volumes. The average man has 10-12 pints and the average woman 8-9 pints of blood. Within hours after donating, most people have replaced the fluid lost with the donated blood, bringing their blood volume back to normal. Replacing donated blood cells and platelets can take several weeks. People with low blood pressure or anemia and pregnant women should not donate blood or should limit the amount of blood they donate. Generally, people are allowed to donate blood only once every two months. This delay ensures the health of the donor and discourages people from selling their blood. The practice of paying donors for blood has essentially stopped. Donors who sell blood tend to have a high risk for the transmission of infectious agents.

BLOOD COLLECTION. Blood is collected from the donor by inserting a large needle into a vein in the arm. Usually, one of the larger veins near the inside of the elbow is used. A tourniquet is placed on the upper arm to increase the pressure in the arm veins and make them swell and become more accessible. Once a suitable vein is identified, the area where the needle will be inserted is sterilized by washing with soap solution or an iodine-containing antiseptic. Sometimes both are used. The donor lies on a bed or cot during the procedure, which takes about ten minutes. Generally, an 18-gauge needle is used. This needle can easily fit into the veins and yet is large enough that the blood flows easily. Blood will sometimes clot in a smaller needle and stop flowing. Blood is collected in sterile plastic bags that hold one pint (450 ml). The bags contain an anticoagulant to prevent clotting and preservatives to keep the blood cells alive. Properly handled and refrigerated, whole blood can last for 42 days.

AUTOLOGOUS TRANSFUSION. Autologous transfusion is a procedure in which patients donate blood for their own use. Patients who are to undergo surgical procedures for which a blood transfusion might be required may elect to donate a store of blood for the purpose ahead of time. The blood is stored at the hospital for the exclusive use of the patient. This procedure assures that the blood type is an exact match. It also assures that no infection will be transmitted through the blood transfusion.

DIRECTED DONATION. Directed donors are family or friends of the patient who needs a transfusion. Some people think that family and friends provide a safer source of blood than the general blood supply. Studies do not show that directed donor blood is any safer. Blood that is not used for the identified patient becomes part of the general blood supply.

APHERESIS. Apheresis is a special procedure in which only the necessary components of a donor's blood are collected. The remaining components are returned to the donor. A special blood-processing instrument is used in apheresis. It separates the blood into components, saves the desired component, and pumps all the other components back into the donor. Because donors give only part of their blood, they can donate more frequently. For example, people can give almost ten times as many platelets by apheresis as they could give by donating whole blood.

BLOOD PROCESSING. A sample of the donator's blood is collected at the time of donation and tested for infectious diseases. Blood is not used until the results from these tests confirm that it is safe.

BLOOD TYPING. The donated blood is typed. There are major and minor blood types, also called blood groups. The major types are classified by the ABO system. This system groups blood by two substances, called antigen A and antigen B, in the red blood cells. The four ABO blood types are A, B, AB, and O. Type A blood has the A antigen, type B has the B antigen, type AB has both, and type O has neither. These four types of blood are further sorted by the Rh factor. The Rh, or rhesus factor, is also an antigen in the red blood cells. A person who has the Rh factor is Rh positive; a person who does not have the factor is Rh negative. If a person has red blood cells with both the B and the Rh antigens, that person is said to have a B positive (B+) blood type. Blood types determine what blood a patient can receive. Generally, patients are limited to receiving only blood of the exact same ABO and Rh type as their own. For example, a person with B+ blood can only receive blood or blood cells from another person with B+ blood. An exception is blood type O. O is called the universal donor, because people of all blood types can accept it.

Blood can be typed by several other minor antigens, such as Kell, Duffy, and Lewis. These minor antigens can become important when a patient has received many transfusions. These patients tend to build up an immune response to the minor blood groups that do not match their own. Upon receiving a transfusion with a mismatched minor blood group, they may have an adverse reaction. A third group of antigens to which a patient can react are residues from the donor's plasma that have attached to the RBCs. To eliminate this problem, the RBCs are rinsed to remove plasma residues. These rinsed cells are called washed RBCs.