Blood donation

Safe blood saves lives. Every day thousands of people would die if others did not donate their blood. By donating blood, you are giving a patient something money cannot buy and science cannot create.

A single blood donation can equal three gifts of life, as nearly every blood donation is separated into red blood cells, plasma and platelets.

The majority of transfusions are given to:

• Women who haemorrhage as a complication of pregnancy;
• Children with severe anaemia;
• Accident victims; and
• Surgical and cancer patients.

By donating blood you make a difference.

Why is there such a demand for donor blood?
The huge number of traffic accidents over the holidays creates a high demand for donor blood. Right? Wrong. the interesting thing is that traffic accidents have little impact on the demand for donor blood.

While there is only a slight increase in demand for donor blood over holidays, there is also a corresponding decrease in elective surgery during these times. So the demand for donated blood remains pretty steady all-year round. Blood usage in South Africa is more or less at a plateau, but slight increases are visible as the population increases.

These facts transpired in and interview with Dr Arthur Bird, medical director of the Western Province Blood Transfusion Service.

Shortages in donor blood do not occur – as is the general perception - due to an increase in demand, but as and when regular donors skip or delay a donation over a long weekend or when on holiday. Two factors are at play to create shortages in donor blood, namely the smaller number of regular donors and the fact that platelets (one of the components of blood) can be stored for only five days.

Blood banks in South Africa run into shortages as soon as a percentage of regular donors go on holiday at the same time without donating blood, or if regular donors don’t (or can’t) donate blood over a long weekend.

Who needs blood?
Eight out of every ten people will need donated blood at some time in their lives. Without blood donated by other people, many of them would have died. Still, many people don't give the blood transfusion service a second thought until they are the ones needing the blood.

Blood gets used for different medical procedures. These are as follows:

• 28 percent for patients with chronic diseases that are not surgically treated and for blood cancers, such as leukaemia and bone marrow cancer
• 26 percent for women who haemorrhage during or after childbirth and for premature babies
• 26 percent for patients undergoing surgery such as hip and knee replacements, heart surgery and gastrointestinal surgery. Many operations would be impossible without donated blood.
• 10 percent for sick children
• 6 percent for research and
• 4 percent for people injured in accidents

“Just in the Western Cape, we need up to 130 000 donated units per year,” according to Dr Bird.

The donated blood is divided into three different components: red cell concentrate, plasma and platelets, all of which get used for different things. Red cell concentrate is mostly used when patients suffer severe haemorrhage as a result of surgery, for childbirth complications, trauma or cancer. Fresh frozen plasma is used to control bleeding and platelet concentrate is used for leukaemia and cancer patients and patients with bone marrow deficiency. Donating one unit of blood could mean helping three different people.

The red cell concentrate can be kept for five to six weeks, the frozen plasma for a year, but the platelets can only be stored at room temperature for about five days, and it is here where problems arise over long weekends like the Easter weekend.

While blood banks keep a three to five day reserve of donated blood, problems can arise when there are several public holidays in a row. On the Monday after Easter, the services often run an emergency donation clinic to make sure they don't run out of reserves.

Who can donate blood?
Anyone who is over 17, weighs at least 50 kilograms and who has not donated blood in the preceding 56 days, who is healthy, not anaemic, not on certain types of medication, or whose social behaviour does not place them at an increased risk of transmitting the HI-virus or a hepatitis virus. People who have recently travelled to malaria areas are usually also excluded.

Before you can donate blood, you will be asked about your lifestyle, personal details and medical history. These questions are asked to make sure that it is medically safe for you to donate blood and that the person who receives your blood, will not be harmed in any way. A finger prick test is done to determine your haemoglobin levels and your blood pressure and pulse rate will also be checked. If everything is in order, you will donate about 480 ml of blood, which will take between six and 10 minutes. The average person contains about 5 litres of blood, which is continuously replaced. Donating blood is thus not usually a problem. It is not possible to contract any disease by giving blood.

What about artificial blood?
Much has been written about the development of artificial blood and there have been advances in this field, especially in producing the active oxygen-carrying chemical in the blood, but clinical trials have not yet been completed. But there are problems, which include possible toxicity, and the very high cost of producing artificial blood, explained Dr Bird.

The safety of donor blood
The WPBTS utilises the latest international technology to test donor blood. Nucleic Acid Testing (NAT) uses DNA technology which effectively narrows the detection period of HIV infection to between 5-11 days. This technology is being used by the blood transfusion services nationally and is currently the largest application of single-donor testing in the world. This ensures that South African transfusion services are in line with the highest standards of international blood transfusion practices.

Dr Bird agrees that there is “an outside chance” that infected blood could slip through. But new screening tests and rigorous quality assurance procedures, has reduced this 'window period' to between 5 and 11 days. Given the fact that the general population is estimated to have an HIV-infection rate of between ten and twenty percent, depending on the region, the fact that fewer than one in a thousand potential donors are HIV-positive, says a lot for the screening procedures, he says.

But there is still a risk. However, weighed up against the dangers of not transfusing when blood is required, this risk turns out to be minimal.

If you still have doubts about the safety of donated blood, you can pre-donate your own blood, which many people do, especially before they undergo orthopaedic surgery. By doing this, a very minimal risk turns into no risk at all. This should be done not less than three to seven days before surgery. If you need more than one unit, allow four to seven days in between each donation.

The donation process
Donating blood is a safe and simple procedure that takes about 30 minutes. All needles are new, sterile, used only once and incinerated after use.

But many people are still uncertain as to exactly what happens when you donate blood.

This is how the actual donation process works: like this:

• You will complete a donor questionnaire that includes your personal details;
• You will answer questions regarding your health and social behaviour;
• You will undergo a one-on-one interview with a staff member following the questions you answered on the donor questionnaire;
• Your iron (haemoglobin) level will be checked and your blood pressure and pulse rate will be taken;
• During the donation process you will donate one unit of blood (480ml), which your body will quickly replace; and
• You will receive refreshments to aid in replacing lost fluid.

After donating, eat well and increase your fluid intake for the next four to six hours. Do not smoke for at least 30 minutes. Also avoid strenuous physical exertion and lifting heavy objects with the arm used for making the donation for at least two hours afterwards.

Where you can donate blood
You've decided you want to donate blood, but you don't know where to go. The South African National Blood Service can be contacted at www.sanbs.org.za or by phoning the toll free number 0800 11 9031 for a list of locations in your area.

Can I donate blood to myself?  
While the risk of receiving contaminated blood in South African hospitals is minimal, some people prefer to self-donate blood – or have friends and family give blood - before elective surgery. What are the advantages, and how does one go about it?

Belinda had serious bowel problems. She was bleeding, and the doctors wanted to go in, to find out what was wrong. But they knew the operation was going to require a transfusion, and Belinda was refusing to have one – stressed and frightened as she was, she had become convinced that the hospital’s blood wasn’t safe.

Friends and family rallied around, a compatible donor was identified, and a direct donation took place.

Was Belinda right? Is there, in fact, a question mark over the safety of blood in South Africa – is it safer to get blood from yourself, or from someone you know personally?

Not necessarily, says Dr Bird,  ;Volunteer donors are screened no less carefully than direct donors are.

In fact, he says, blood from a close family member carries its own risks. There is a rare, but preventable, disease called Graft versus Host disease. The risk may be as high as one in 400 when you receive blood from a close relative. It develops when the white blood cells from a blood-related donor interfere with the recipient's immune system, skin and liver, leading to severe infection and in some cases to death.

“To prevent this disease it is necessary to irradiate the blood before it is transfused to the patient. This is done in all cases of direct donation.

That’s not a risk, of course, when you self-donate blood in anticipation of a transfusion. It’s called autologous donation, and it may be appropriate, says Dr Bird, before you undergo certain elective surgeries, which may result in moderate to major blood loss.

People who choose to donate their own blood, do so before elective surgery, most often orthopaedic operations, plastic surgery or urological procedures. The Western Province Blood Transfusion Service deals with 350 – 400 cases annually, he says.

By receiving your own blood you run no risk of contracting any infection carried by a volunteer donor. Your blood is always the right 'type' for you and therefore there is no risk of incompatible reactions.

Who can donate their own blood?
Most of the health requirements of normal donors apply here. Donors have to be healthy, aged 12 and 70 years, and preferably weigh over 50kg. Their haemoglobin level must be 11g/dL or more, and their blood pressure and pulse rate within normal limits. Even pregnant women can donate their own blood, provided there are no pregnancy complications.

Who cannot?
Those people advised against autologous donation include people with:

• cardiac disease, or a history of aneurysms or strokes;
• severe respiratory disorders such as asthma and emphysema. In the case of asthma, this is not a rigid regulation – people with well-controlled asthma can donate. The fear exists that severe asthmatics can become anxious when they have to donate blood, thereby bringing on an asthmatic attack;
• uncontrolled insulin-dependent diabetes. Blood donation may result in hypoglycaemia in certain people who have Type 1 diabetes. Anxiety, brought about by having to donate blood, could also lead to fluctuations in blood glucose levels;
• epilepsy. Once again this is not a completely hard-and-fast rule and it depends on the severity of the condition. The important thing is that the condition must be mentioned to the blood transfusion service, who will then make the decision on whether to go ahead;
• some blood cancers, such as leukaemia, lymphoma and multiple myeloma as well as bleeding disorders or other major blood diseases. A patient who has gone into remission from one of the cancers mentioned above, may be considered for self- donation;
• dental work within three days of the donation. There’s a high possibility of bacterial infections following dental work, especially root canal treatment and tooth extractions;
• current bacterial or viral infections.

When and how should you donate blood for yourself?
Self-donation should be planned well in advance of surgery. Your doctor will determine how many units are likely to be needed. A unit of blood can be donated at intervals of four to seven days. Therefore, if you need four units, you should start the donation process at least four weeks before the surgery. The last donation should not be less than three to seven days before the surgery, thus allowing you to recover from the temporary loss of blood volume and proteins.

Discuss this with your doctor well in advance of surgery to allow enough time for self-donation or direct donation. You and your doctor will have to complete forms, which are available from your nearest branch of the South African National Blood Service. Further arrangements for testing and donation can be made at the branch.

What are the costs?
There are additional blood tests and administration, so it costs more to donate your own blood than it does to receive donor blood. Even if you end up not needing the blood, you will still be charged for the procedure.

Where can you have this done?
Only the South African National Blood Service or the Western Province Blood Transfusion Service may handle blood donations. It cannot be done by your doctor or by another institution.

What happens if you don't use the blood yourself?
Your blood does not get pooled with other blood donations. Usually, this blood gets discarded, as self-donations are not seen as truly voluntary donations, says Dr Bird. Only in rare cases, where the self-donor is also a regular blood donor (who has donated blood in the previous 12 months), could the blood be crossed over to the general pool, but this does not happen often. The fact that this blood often gets discarded, also adds to the price of the whole procedure.

What if friends or family want to donate blood for you?
As long as blood groups are compatible, donations by friends or family, called direct donation, can be done. It takes at least two working days for all the testing and processing to be completed satisfactorily, though, so this is suitable only for elective surgery procedures, and not in the case of medical emergencies.

The same health criteria apply to family and friends as to volunteer donors.

People who may be excluded are those who have:

• a history of hepatitis;
• recently visited a malaria area;
• had diarrhoea or who have vomited in the last 30 days;
• had dental work within the last three days;
• have current minor infections;
• have a history of sexually transmitted infections;
• have had a recent change of sexual partner;
• have any serious medical condition.

Again the costs are slightly higher, for the same reasons.

*Not her real name.

Six top excuses for not donating blood
Here are the top six excuses people give for not being a blood donor.

• I am afraid of the needle. This is quite understandable, but after you make that first donation, you will wonder why you ever hesitated.
• Other people are giving enough blood. Unfortunately, less than one percent of the population give blood, which means that the majority of South Africans do not donate and there is always a need to recruit donors.
• My blood isn’t the right type. Regular donations of all blood types are needed.
• I had an illness. Discuss this with the trained clinic staff who will give you the right advice.
• I don’t have enough blood to spare.; The average adult body contains approximately five litres of blood and a donation is only 480ml.
• It will hurt and I will faint. A slight pinch on the inside of your arm is all that you will feel and if you have had something substantial to eat in the four hours prior to donating, you should be fine.

Top 10 blood facts
You hardly ever see your blood, yet it is the very thing that keeps you going. Here are some interesting facts on blood:

• The average adult man has about five to six litres of blood in his body, while the average woman has about four.
• Your blood makes up about 7% of your total body weight.
• About 95% of the body’s blood cells are made in bone marrow.
• There are approximately 1 billion red blood cells in two to three drops of blood.
• There are three types of blood cells: Red blood cells, white blood cells and platelets, all of which float around in plasma. The blood that you donate can be separated into these constituent parts.
• Your body usually replaces the volume of the blood you donate within 24 hours. Restoring red blood cell levels to normal can take up to two months though.
• Whole blood has a shelf-life of 35 days. Red blood cells last 42 days, platelets only five days and plasma up to one year.
• The most common blood type is O positive, while AB negative is the rarest. People with AB blood can receive any kind of blood from a donor, while O negative blood can be given to anyone.
• Scientists recently managed to change type A and B blood into type O. If this process can one day be done on a large scale, it would go a long way to alleviating the persistent shortage of blood.
• If you are healthy, you will be eligible to donate blood up to 330 times in your life.