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…please consider donating blood and/or platelets at your local Red Cross or donor center.

Having spent around thirty years as a hematologist-oncologist in a busy community practice, I can attest that a) the need is constant and b) there is no substitute, at least in the near future.

In each workday of those thirty years, I prescribed on average the transfusion of at least two units of blood. Many days, it was more…on on-call days when I was also covering urgent needs for another two or more oncologists’ patients, it could easily be ten units. In years past (before more sophisticated data and techniques [e.g. erythropoietin, EPO] allowed minimization of transfusions), it was sometimes much more.

Usually, this was for patients whose marrow had failed – temporarily (high dose chemotherapy) or permanently (various marrow diseases). A healthy marrow manufactures, very roughly, a pint of blood each week…so someone whose marrow has failed entirely, and permanently, could be expected to need two pints every two weeks.

Only around a third of the adult population is medically eligible to donate. Of that third, only around 10% do. That makes 3-4% of the healthy adult population carrying all of the freight for the hematology, trauma, uncontrolled GI bleeders of the world.

I donated my fifty-ninth unit of blood this morning. (Actually, that’s only since modern record-keeping started, around 1990. Add the dozen or so years before that, and it’s probably in the seventies)

It’s not hard. Granted, I know a few tricks to game the system (times they’re least crowded, completing paperwork before I show up, being blessed with veins like garden hoses especially for an old guy), but less than an hour elapsed from the time I parked my car to the time I left today.

I’m not a huge Red Cross fan (for one thing, they’re a fan of robocalls soliciting donations…on Sunday night…when I already have an appointment scheduled) - but it’s the arrogance of a monopoly, and there is no other choice. And, as I said, there is no substitute.

–sutton
whose reward is to eat whatever I want for the rest of the day. Mushroom cheeseburger and fries for lunch…mmmm

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I have applied numerous times to donate blood, but rarely have they drawn it. There is generally a survey which asks which countries I’ve visited over the past year or two and invariably I’ve visited one with malaria concerns. Generally I am unceremoniously chucked out (leaving the rest of the people on line wondering what strange malady I might have to have been rejected).

Jeff

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Hepatitis?

The Captain

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Well, the endemic malaria travel exclusion is based on the life cycle of the malaria pathogen (various species of Plasmodium). Each of the little monsters live in a red cell for a period, using the hemoglobin therein as a food source (red cells are a Ziploc baggie of hemoglobin, that being the complex red-colored molecule responsible for shuttling oxygen from the lungs to everywhere else).

So receiving a transfusion from a not-yet symptomatic (or at least undiagnosed) donor infected with malaria is a really good way to instantly contract the disease. And post-donation serologic tests are far from perfect for malaria.

Other exclusions, since you ask: personal history of most cancers (risk of transfusing CTCs, circulating tumor cells); exposure to other infectious diseases (same rationale as malaria); transplants of dura and the like (prions, iirc); use of any of a long list of medications e.g. blood thinners or potential liver toxins. (Bear in mind that recipients are always frail and often profoundly immunosuppressed)

Gay men still have a blanket exclusion, I think, which was appropriate thirty years or more ago while HIV was being sorted out. Now? Uh, no (Did I mention I’m not a huge Red Cross fan?).

Self-reported risky personal behavior (on a confidential questionnaire) will exclude donated blood: being incarcerated for >72 hours in the last ?year?; IVDA; cash transactions of a certain personal nature.

Finally, exclusions can be made wrt donor safety: being too small or light to safely, suddenly part with a pint of blood; having a borderline red cell level (tested on-site immediately prior to donation); significant heart or lung disease; poorly controlled hypertension (also tested on-site)

You did ask… :slight_smile:

-sutton
happy to drone on at length re hemoglobin. Or platelets, for that matter.
Miraculous things…

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i have the opposite issue. I don’t dare tell the Red Cross I have O-, as they would want every drop. Was talking about that with a nurse at the clinic one day. She has O- too, and the Red Cross is constantly after her to give them more.

Steve

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When I fill out the questionnaire for my local donation center they seem concerned about visits to countries with Mad Cow outbreaks. Although google tells me that restriction was lifted recently.

I hadn’t been able to donate for decades because I was taking Propecia, but during the pandemic’s blood shortage I decided it was more important to donate blood than have thick hair. At my age no one cares about how my hair my looks anymore anyway.

BY THE WAY, while you’re thinking about donating blood, please also think about joining the bone marrow registry. BeTheMatch.org.

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For the last few years, I donate every 8 weeks to the day. My doctor told me that it is a healthy practice.

However, before patting ourselves on the back too vigorously, we should realize that blood and blood products are a large export business from the USA. I’ve read that 2% of our total exports are blood and blood products. And business means profits.

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Well, “blood products” maybe. But not the red cells or platelets used in transfusion, which is what the Red Cross takes as donations.

I’ll back up a step.

Whole blood – the stuff that comes out of your arm – is a complex mishmash of stuff that can be divided into three categories: cells, salt water, and proteins.

The cells are, broadly speaking, three things: a) red cells (around 4 million per cc., around a quarter-teaspoon); b) several types of white cells (around 10,000 per cc) and c) platelets (much smaller than the other two, and around 200,000 per cc, with wide variation**) (Platelets are also not really cells, for you see…shut up, sutton, you’re losing your audience)

Red cells can last a few months under refrigeration; platelets, maybe ten days or so. They are not sold, except as regards set handling and processing and administration fees. No profit to the Red Cross.

No one wants the salt water part. Nor the white cells*

The protein fraction of whole blood, however, can be valuable. It’s called plasma.

As far as the whole blood you donate at the Red Cross – there’s not a lot of plasma in a single pint of whole blood – but if you instead go down the street to a different building and are there hooked up to a dedicated plasma-extraction machine (which take no substantial number of red cells from the body), then a healthy donor can donate much more.

Four things about plasma:

  1. You can fractionate it into a number of useful things: various types of blood-clotting factors, and various types of immunological proteins (antibodies), each of which are very useful in certain, widely varying diagnoses, and
  2. You can freeze it away for later, allowing its use at a location far distant in space and time from where it was collected, and
  3. With current technology, you can (virtually) sterilize it, pretty much doing away with the infectious risk (something you can’t do with the cells, as they can’t withstand the treatment)***, and
  4. you can pool plasma from many donors in order to get a therapeutically relevant dose of the protein(s) in question…sometimes with some platelets included (the so-called “platelet-rich plasma”, PRP, a currently popular therapy with some pain management physicians)

This plasma all comes from the “Plasma Donation Centers” you see scattered in marginal areas of town and near college campuses, not from the Red Cross. Paying for plasma is legal, and common. When you read of an impecunious college student who “sold his/her blood to make ends meet” - that’s what they’re talking about.

Conversely, no red cells for transfusion are sold in this country. A simple reason: the infectious risk to the recipient is much higher from paid donors than it is with blood from volunteer donors.

– sutton

“no one wants the white cells”: almost always true, and true enough for the purposes of this discussion

**there is up to a three-fold variation in platelet levels in normal people. Not too much else in healthy adult humans – height, number of kidneys, shoe size – routinely varies by 250-300%. The reason is really cool, and…shut up, sutton, you’re losing your audience

***“infectious risk”: currently almost but not quite zero for pooled plasma products, a very impressive technological development…and tragically not true in the 1980s. At that time, there were no recombinant human coagulation factors for use in hemophiliacs, so pooled human factors were used - with some university hemophilia specialists seeing the majority of their practice – largely children and teenagers – dying of fulminant AIDS over only a few years. (The drug companies behaved heroically…kidding! No, they did what they do: Contaminated haemophilia blood products - Wikipedia )

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The point is that “we” donate blood freely, generally freely, though sometimes they give a $10 gift card or a T-shirt, and then those companies process and sell the blood products. It’s kind of like solar power, where the main input used to produce the product is essentially free.

Around here, they usually send two blood buses to each blood drive, one for whole blood and the other for plasma. Whole blood donation is pretty quick, maybe 15-30 minutes max, but plasma donation takes longer. So while the whole blood bus, with 4 “beds”, can handle roughly 8-10 pints per hour, the plasma bus can only handle 2-3 plasma donations per hour.

And I know a little bit about plasma. On Thursday afternoon, I am receiving a transfusion of 2 units of plasma in preparation for shoulder surgery early Friday morning.

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Um.

Are you sure that the “plasma bus” isn’t the “platelet bus”?

The American Red Cross (ARC) aggressively solicits volunteer platelet donors, as the need for platelets is at least as acute as that for red cells – marrow transplant and acute leukemia patients rely on them for survival, and despite best technology donated platelets outdate almost as fast as the bananas we buy at the store.

And, the technology (“pheresis”) to remove platelets and plasma is the same. Same machine, in fact, for “plasmapheresis” (for profit) and “platelet pheresis” (volunteer). And, they each take about the same amount of time (lots, or at least a lot more than red cell donation).

At the Red Cross donation center I use, there is at least one platelet pheresis machine going in the back while 2-3 of us are donating red cells. (I don’t donate platelets because of my ibuprofen habit).

For the ARC to actually collect plasma would be a reputation-damaging departure from decades-long practice and common sense, afaik.

If you’re sure they’re collecting plasma from volunteer donors, I’d like to know: where?

–sutton
and yes, the ARC does pass out free (cheap) T shirts and $10 Amazon gift cards from time to time. (The one time I tried to redeem my Azon $10, the link didn’t work…have to admit, I didn’t try very hard)

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Hmmm, I’ll have to look closely next time they come. It’s not the Red Cross, it’s some other organization, their website is oneblood.org

I think you are correct. While they do pints, double red blood cells, platelets, and plasma, it seems that the plasma isn’t available in every bus.