Blood Donation and Registry
Blood Donation and Registry
Blood donation refers to the process of collecting, testing, preparing, and storing blood and blood components. Donors are most commonly unpaid volunteers, but they may also be paid by commercial enterprises. Blood registry refers to the collection and sharing of data about donated blood and ineligible donors.
The purpose of the blood collection and distribution system is to help ensure an adequate supply of blood for accident victims, people needing surgery, and people suffering from certain diseases, as well as for medical research.
Sometimes, donors give blood specifically to benefit a particular person. People preparing for elective surgery may donate their own blood to be held and then returned to them during surgery. This is known as autologous blood donation. Directed donor blood has been donated by someone known to the intended recipient, such as a family member or friend.
Each year, more than four million Americans receive blood transfusions involving more than 26 million units of blood (one unit equals 450 milliliters, or about one pint), or an average of about 32,000 units per day. All of that blood must be collected, tested, prepared, stored, and delivered to the appropriate sites. Roughly eight million people in the United States donate blood each year; about half of the total amount needed is provided by the 36 regional blood centers of the American Red Cross.
Whole blood and the various blood components have many uses. Red blood cells, which carry oxygen, are used to treat anemia. Platelets, which play a role in controlling bleeding, are commonly used in the treatment of leukemia and other cancers. Fresh frozen plasma is also used to control bleeding in people deficient in certain clotting factors. Cryoprecipitated AHF, made from fresh frozen plasma, contains a few specific clotting factors.
To ensure the safety of the blood supply, a multitiered process of donor screening and deferral is employed. This involves donor education, taking a detailed health history of each prospective donor, and giving potential donors a simple physical examination (which includes taking a few drops of blood to test for anemia). At any point in the process, a potential donor may be "deferred," or judged ineligible to donate blood. This deferral may be temporary or permanent, depending on the reason. Potential donors are also encouraged to "self-defer," or voluntarily decline to donate, rather than put future blood recipients at risk.
All donated blood is extensively tested before being used. The first step is determining the blood type, which indicates who can receive the blood. Receiving the wrong type of blood can cause death. Blood is also screened for any antibodies that could cause complications for recipients. In addition, blood is tested to screen out donors infected with the following diseases: Hepatitis B surface antigen ADD, hepatitis B core antibody, hepatitis C virus antibody, HIV-1 and HIV-2 antibody, HIV p24 antigen, HTLV-I and HTLV-II antibodies, and syphilis. Nucleic Acid Amplification testing is also performed, and other tests may be done if a doctor requests them.
In order to detect the greatest possible number of infections, these screening tests are extremely sensitive. For this reason, however, donors sometimes receive false positive test results. In these cases, more specific confirmatory tests are performed, to help rule out false positive results. Blood found to be abnormal is discarded, and all items coming into direct contact with donors are used only once and then discarded. Donors of infected blood are entered into the Donor Deferral Register, a confidential national data base used to prevent deferred people from donating blood.
In general, blood donors must be at least 17 years old (some states allow younger people to donate blood with their parents' consent), must weigh at least 110 pounds (50 kg), and must be in good health.
Many factors can temporarily or permanently disqualify potential donors. Most of them have to do with having engaged in behaviors that put them at risk of infection or having spent time in certain specified areas. Among these factors are having had a tattoo, having had sex with people in high-risk groups, having had certain diseases, and having been raped.
Apheresis — Extraction of a specific component from donated blood, with the remainder returned to the donor.
Autologous donation — Blood donated for the donor's own use.
Granulocytes — White blood cells.
Plasma — The liquid part of blood.
Platelets — Tiny, disklike elements of plasma that promote clotting.
There are eight different blood types in all—four ABO groups, each of which may be either Rh positive or Rh negative. These types, and their approximate distribution in the U.S. population, are as follows: O+ (38%), O− (7%), A+ (34%), A− (6%), B+ (9%), B− (2%), AB+ (3%), AB− (1%). In an emergency, anyone can safely receive type O red blood cells, and people with this blood type are known as "universal donors." People with type AB blood, known as "universal recipients," can receive any type of red blood cells and can give plasma to all blood types.
Blood donations can be made in community blood centers, at hospitals or in bloodmobiles, which visit schools, churches and workplaces. The actual process of donating whole blood takes about 20 minutes. A sterile needle is inserted into a vein in the donor's arm. The blood flows through plastic tubing into a blood bag. Donors may be asked to clench their fist to encourage blood to flow. Usually, one unit of blood is collected. Afterward, donors are escorted to an observation area, given light refreshments, and allowed to rest.
Plasma, the liquid portion of the blood in which red blood cells, platelets and other elements are suspended, is also collected, often by commercial enterprises that sell it to companies manufacturing clotting factors and other blood products. This is done using a process known as apheresis, in which whole blood is collected, the desired blood component is removed, and the remainder is returned to the donor. Collecting plasma generally takes one to two hours. Apheresis may also be used to collect other blood components, such as platelets and granulocytes.
Once whole blood has been collected, it is sent to a lab for testing and processing. Most donated blood is separated into its constituent components, such as red blood cells, platelets, and cryoprecipitate. This enables more than one person to benefit from the same unit of donated blood.
Different blood components vary in how long they can be stored. Red blood cells can be refrigerated for up to 42 days or frozen for as much as 10 years. Platelets, stored at room temperature, may be kept for up to five days. Fresh frozen plasma and cryoprecipitated AHF can be kept for as much as one year.
It generally takes about 24 hours for the donor's body to replenish the lost fluid. Replacing the lost red blood cells, however, may take as much as two months. Whole blood donors must wait a minimum of eight weeks before donating again. Some states place further limits on the frequency and/or total number of times an individual may donate blood within a 12-month period.
Thanks to the use of a multi-tiered screening system and advances in the effectiveness of screening tests, the transmission of infectious diseases via transfusion has been significantly diminished. Nonetheless, there is still a minuscule risk that blood recipients could contract HIV, Hepatitis C or other infections via transfusion. Other diseases that could conceivably be contracted in this way, or that are of particular concern to blood-collection agencies, include babesiosis, Chagas disease, HTLV-I and -II, Creutzfeldt-Jakob disease, cytomegalovirus, Lyme disease, malaria, and new variant Creutzfeldt-Jakob disease.
Autologous blood donors run a tiny risk of having the wrong blood returned to them due to clerical error. There is also a faint possibility of bacterial contamination of the autologous blood.
For most donors, the process is quick and painless and they leave feeling fine. They may also find satisfaction in knowing that they have contributed to the nation's blood supply and may even have helped save lives.
Most blood donors suffer no significant aftereffects. Occasionally, however, donors feel faint or dizzy, nauseous, and/or have pain, redness, or a bruise where the blood was taken. More serious complications, which rarely occur, include fainting, muscle spasms, and nerve damage.
McKenna, C. "Blood Minded" Nursing Times April 6, 2000: 27-28.
Wagner, H. "Umbilical Cord Blood Banking: Insurance Against Future Diseases?" USA Today Magazine (March 2000) : 59-61.
American Association of Blood Banks. 8101 Glenbrook Road, Bethesda, MD 20814-2749. (301) 907-6977. http://www.aabb.org.
American Red Cross. 430 17th Street NW, Washington, D.C. 20006. http://www.redcross.org.
National Blood Data Resource Center. (301) 215-6506. http://www.nbdrc.org.