Shortages of Lifesaving Blood Chronic
Nearly 20,000 Americans receive organ transplants each year, and their dramatic stories are regularly featured on television and in newspapers and magazines. Little attention is paid, however, to another form of human tissue donation: blood transfusion.
Every year, about 4.5 million American men, women and children receive transfusions of blood or blood components that are required to save their lives or maintain their health. Blood is a living tissue no less vital for survival than your lungs, heart, liver or kidneys. Whole blood contains erythrocytes, or “red” cells, that carry oxygen throughout the body; leukocytes, or “white” cells, that fight infection; and platelets that are required for normal blood clotting. Even the liquid portion of blood, the plasma, is essential, transporting nutrients and helping maintain blood pressure.
Under normal conditions, the body can manufacture enough new blood to replace the individual components that are lost due to aging and to replenish the plasma. But the replacement process is relatively slow, and--under some conditions--your body may not be able to keep up with the need. For example, when a lot of blood has been lost rapidly because of an injury or operation, a transfusion of whole blood may be lifesaving. In other situations, transfusions of specific blood elements may be needed: Someone receiving anti-cancer drugs may require a transfusion of white blood cells; a person with a blood clotting disorder may require only platelets. None of these needs can be met unless blood is readily available--and that is not always the case.
Although about 14 million units of blood are donated by Americans every year (a unit is about a pint), there are serious shortages of blood in many parts of the country. These shortages occur, in part, because blood can be stored only for limited periods of time (red blood cells can be stored for 42 days, platelets for five).
The problem is complicated further by the fact that all blood is not the same. There are four major blood types (A, B, AB and O), and most people receiving a transfusion require a specific one. The only way to ensure that every blood type is always available when it is needed is to increase the inventory of blood in blood banks. To accomplish that goal, more people must donate blood more often. Currently, fewer than 5% of those eligible to donate blood actually do so.
Anyone in good health can donate blood provided they meet several basic requirements. The American Red Cross, for example, requires that donors be at least 17 years old and weigh at least 110 pounds. Donors cannot have anemia (a deficiency of red blood cells), so a small amount of blood is taken from the fingertip to check the blood cell count prior to the actual donation. Donors must also be free of infectious diseases that could be transmitted through blood transfusions and must demonstrate that they are unlikely to carry them.
All potential donors are asked directly if they have ever had certain types of infections (including HIV and hepatitis) and are questioned very specifically about lifestyle issues that could put them at risk. Questions about sexual behavior and intravenous drug use, for example, are used to evaluate a donor’s risk for HIV; questions about travel and immigration are used to evaluate a donor’s risk for malaria. Although this type of donor screening is thought to be extremely effective (eliminating about 90% of unsuitable donors), all donated blood also undergoes extensive testing. Eleven tests for infectious diseases are routinely performed, including tests for HIV, syphilis, and hepatitis B and C, and any potentially infectious blood that is identified is discarded.
One possible solution to the blood supply problem would be an artificial blood substitute. Although researchers are working hard to develop one, it is unlikely that an acceptable substitute will become available for quite some time. Until then, the only way to assure your own safety, as well as that of your family and friends, is to donate blood regularly.
*
Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached at ourhealth@dhs.co.la.ca.us. Their column appears the second and fourth Mondays of the month.
